HOUSE DOCKET, NO. 3451        FILED ON: 1/20/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1166

The Commonwealth of Massachusetts

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PRESENTED BY:

Ruth B. Balser

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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 address the overuse of temporary nursing service agencies at Massachusetts skilled nursing facilities.

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PETITION OF:

HOUSE DOCKET, NO. 3451        FILED ON: 1/20/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1166

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-Third General Court
(2023-2024)

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An Act to address the overuse of temporary nursing service agencies at Massachusetts skilled nursing facilities.

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. (a) Notwithstanding any special or general law to the contrary, the department of public health is directed to amend the state regulations governing the reporting by and rates paid by health-care providers to temporary nursing agencies registered with the department (101 CMR 345).

(b) Such amendment shall include reductions in the maximum prices set forth in 101 CMR 345.03(2) that an agency may charge for registered nurse, licensed practical nurse, or certified nurse aide services provided to a skilled nursing facility. In setting such reduced maximum rates, the department shall establish hourly rate caps through a process that establishes and considers a weighted average wage for regular skilled nursing facility employees, plus a factor to incorporate payroll taxes, for each applicable employee classification, shift, and region. The department shall establish such weighted average service rates annually utilizing information provided by facilities.  In no case shall the established maximum prices of temporary nursing agencies be permitted to exceed one hundred and fifty percent of the established average wages for regular employees at each applicable classification.  

(c) Such amendment shall require reporting any individual or business entity with an ownership interest of 5 percent or more of a temporary nursing agency is also the holder of an operating license issued to establish or maintain a Massachusetts skilled nursing facility. Further, a temporary nursing agency so owned by any such individual or entity shall be prohibited from procuring or providing temporary employment at a skilled nursing facility so owned by the same individual or entity.

(d) The process for establishing the amendments as outlined in the subsections above shall also include an examination and analysis of the Temporary Nursing Service Cost Report and Reporting Requirements established in 101 CMR 345.05.  As it so determines in such analysis, the department may amend the Reporting Requirements regulatory provision to strengthen the transparency of, increase the mandated disclosures required in or to otherwise strengthen the state accountability standards now included in the mandated Temporary Nursing Service Cost Report. Such analysis shall include and such amendments to the regulatory reporting requirements may include improved standards for temporary nursing agency reporting on compensation, benefits and worker supports for temporary nursing agency workers; licensing, training, and continuing education requirements for assigned workers; reporting on the operations, cost trends and financial performance of temporary nursing agencies; processes utilized to assure prompt arrival of assigned workers; procedures for reporting on, the investigation of and the resolution of complaints about the performance of temporary nursing agency workers; and procedures for the notice of and for resolving actual or suspected abuse, theft, tampering or other diversion of controlled substances by temporary nursing agency staff workers. Such amendments may also include the establishment of or increases to corresponding registration and reporting fees.

(e) The process for determining maximum rates as outlined in subsection (b) above shall also include an examination and analysis of Travel Nurse Factor established in 101 CMR 345(e).  The department may amend the Travel Nurse Factor provision to reduce the established percentage amount above which an agency’s price for travel nurses’ services provided to a nursing facility may exceed the base rate limits established in 101 CMR 345.03.

(f) Prior to and during the process of making the regulatory amendments outlined in the subsections above, the department shall consult with the Massachusetts Senior Care Association, Inc. and 1199 SEIU United Healthcare Workers East.

(g) The department of public health shall complete the processes above and file for Emergency Adoption of such amended regulations no later than 180 days after passage of this Act.

SECTION 2. (a) Notwithstanding any special or general law to the contrary, the executive office of health and human services is directed to amend the state standard payment regulations establishing Quality Adjustment Payments (101 CMR 206.06).

(b) Such amendment shall require each nursing facility to report to EOHHS on the amount and percentage of the facility’s federally reported nursing care hours per patient day that was provided by temporary nursing agency staff.

(c) Such amendment shall include establish a new Quality Adjustment Payment subsection and a Nursing Care Staffing Levels Achievement rate adjustment that implements such new rate adjustment and that is based upon a facility’s compliance with the Massachusetts hours per resident day standard.  For purposes of determining such a rate adjustment, a facility’s reported nursing care hours per resident day standard shall be adjusted downward to reduce the facility’s credit for reported hours of care provided by temporary nursing agency staff by a percentage to be determined by EOHHS but that shall adjust credited hours downward by least twenty-five percent. 

(d) Prior to and in making the regulatory amendments as outlined in the subsections above, the executive office of health and human services shall consult with the Massachusetts Senior Care Association, Inc. and 1199 SEIU United Healthcare Workers East.

(e) The executive office of health and human services shall complete the process above and file for Emergency Adoption of such amended regulations no later than 180 days after passage of this Act.

SECTION 3. (a) Notwithstanding any special or general law to the contrary, the department of public health is directed to amend the Massachusetts long term care facility operating regulations provisions relative to Staff Qualifications and Training (105 CMR 150.024) and Educational Programs (105 CMR 150.7(I)). 

(b) Such amendments shall require that any temporary nursing agency staff that works in a skilled nursing facility is compliant with all applicable requirements and qualifications, as determined by the department, that are required of nursing care staff regularly employed in their position.  Such amendments shall require temporary nursing agency staff working for more than one hundred hours in a facility participate in any job orientation and other continuing in-service educational programs appropriate to the care provided in the facility by regularly employed nursing personnel.

(c) Prior to and in making the regulatory amendments as outlined in the subsections above, the executive office of health and human services shall consult with the Massachusetts Senior Care Association, Inc. and 1199 SEIU United Healthcare Workers East.

(d) The department of public health shall complete the process above and file for Emergency Adoption of such amended regulations no later than 180 days after passage of this Act.