SENATE DOCKET, NO. 1524        FILED ON: 1/17/2019

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 686

The Commonwealth of Massachusetts

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PRESENTED BY:

Cindy F. Friedman

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act to protect medically fragile kids.

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PETITION OF:

SENATE DOCKET, NO. 1524        FILED ON: 1/17/2019

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 686

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-First General Court
(2019-2020)

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An Act to protect medically fragile kids.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Chapter 12C of the General Laws is hereby amended by adding the following section:-

Section 24. The center, in conjunction with MassHealth, shall prepare a biennial report related to patients requiring continuous skilled nursing care, as defined in 101 CMR 350.02 and 130 CMR 403.402. The report shall include, but not be limited to: (i) the number of pediatric patients and the number of adult patients requiring continuous skilled nursing care; (ii) the average, median and total number of continuous skilled nursing hours authorized by MassHealth per day, week, month and year for pediatric patients and for adult patients; (iii) the average, median and total number of authorized continuous skilled nursing hours actually delivered per day, week, month and year for pediatric patients and for adult patients; (iv) the proportion of utilization to authorization of service hours in comparison to patient acuity for pediatric patients and for adult patients; (v) the number of nurses providing continuous skilled nursing care to more than 1 patient at a time and the proportion of utilization to authorization of said patients; (vi) the number of nurses who contract with MassHealth to provide continuous skilled nursing care and the number of nurses who provide continuous skilled nursing care through a home health agency that contracts with MassHealth and whether the total number of nurses providing such care is sufficient to fill all authorized continuous skilled nursing hours; (vii) the training, experience and education level of the nurses who contract with MassHealth to provide continuous skilled nursing care; and (viii) an evaluation of the adequacy of the reimbursement rates for continuous skilled nursing, as defined in 101 CMR 350.04(2), and a comparison of those rates between the rate paid to nurses who contract directly with MassHealth to provide continuous skilled nursing care, the portion of the reimbursement rate paid directly as wages to nurses providing continuous skilled nursing care through a home health agency that contracts with MassHealth, and the median wage rate paid to all nurses in the commonwealth.

Not later than January 1 of each even-numbered year, the report shall be filed with the secretary of health and human services, the clerks of the senate and the house of representatives, the joint committee on health care financing, the joint committee on public health and the senate and house committees on ways and means. The center shall make the report publicly available on its website.

SECTION 2. Chapter 118E of the General Laws is hereby amended by adding the following section:-

Section 78. (a) Notwithstanding any general or special law to the contrary, and subject to appropriation, the executive office of health and human services shall increase the budget for continuous skilled nursing care, as defined in 101 CMR 350.02 and 130 CMR 403.402, by an amount that ensures:

(1) At least 55 percent of continuous skilled nursing hours authorized by MassHealth are filled on or before July 1, 2021;

(2) At least 65 percent of continuous skilled nursing hours authorized by MassHealth are filled on or before July 1, 2022;

(3) At least 75 percent of continuous skilled nursing hours authorized by MassHealth are filled on or before July 1, 2023; and

(4) At least 85 percent of continuous skilled nursing hours authorized by MassHealth are filled on or before July 1, 2024, and shall remain at 85 percent or above thereafter.

(b) The executive office of health and human services may require any portion of the budget increases provided for in this section to be used exclusively to increase the wage payment rate of nurses providing continuous skilled nursing care.

(c) To satisfy the requirements in subsection (a), the executive office of health and human services shall require MassHealth to submit an annual report no later than January 1 that:

(1) demonstrates that MassHealth has not changed its authorization criteria for continuous skilled nursing services in a way that is more restrictive and results in a reduction in the amount of authorized hours that would have been authorized previously; and

(2) includes the following information from the immediately preceding calendar year: (i) the number of filled and unfilled continuous skilled nursing hours authorized by MassHealth; (ii) the number of appeals received by MassHealth for the denial or modification of continuous skilled nursing hours and the number of patients that filed an appeal; (iii) the number of patients that received a reduction in the amount of authorized continuous skilled nursing hours; and (iv) the number of authorized continuous skilled nursing hours reduced from the immediately preceding calendar year, if any.

(d) The executive office of health and human services, in conjunction with MassHealth and after consultation with the Massachusetts Pediatric Nursing Care Campaign, shall adopt regulations to implement this section.

(e) Nothing in this section shall be construed to prohibit filling 85 percent of the continuous skilled nursing hours authorized by MassHealth prior to July 1, 2024.

SECTION 3. Notwithstanding any general or special law to the contrary, the office of Medicaid shall review the wage payment rates established by home health agencies that provide continuous skilled nursing care, as defined in 101 CMR 350.02 and 130 CMR 403.402, for the providers of those services. The office shall provide: (i) an aggregated overview of the wage payment rates paid by home health agencies to staff or contracted nurses providing continuous skilled nursing care, including any increases in said wage rates resulting from increases in Medicaid rates paid to home health agencies for continuous skilled nursing care in state fiscal years 2017 and 2018; (ii) an aggregated breakdown of said wage rates as applied to the acuity level of patients receiving continuous skilled nursing care; (iii) an aggregated breakdown of said wage rates as applied to the licensure level of the providers of continuous skilled nursing care; (iv) recommendations on criteria to be included in any future reporting by home health agencies receiving an increase of continuous skilled nursing care rates provided by the office. The office shall provide this report not later than March 1, 2020 to the clerks of the senate and house of representatives, the joint committee on health care financing and the senate and house committees on ways and means. Home health agencies providing continuous skilled nursing care shall provide all information and documentation requested by the office of Medicaid to compile the required report under this section.

SECTION 4. The first report required pursuant to section 24 of chapter 12C of the General Laws shall be filed on January 1, 2021.