Amendment ID: S2202-110

Amendment 110

Post Acute Care Referral Consultation Program

Messrs. Timilty and Cyr and Ms. Gobi move to amend the bill by striking Section 114 in its entirety, and replaced with the following new language:

SECTION 114. Section 9 of chapter 118E is hereby further amended by adding, after the

words “pre-admission counseling program” in the fourth paragraph, the following new

paragraph:

The executive office of health and human services, in collaboration with the executive

office of elder affairs, the office of Medicaid and the department of public health, shall develop a

post-acute care referral consultation program, subject to appropriation, of regional consultation

teams to ensure education and outreach to hospital, skilled nursing facility, primary care

providers, and consumers on the pre-admission counseling required under this section. A

referral for an evidence-based Care Transitions Intervention that includes a home visit by a

trained coach shall be included in this post-acute care program. The program shall (i) through

outreach and educations in the community, assist providers, consumers and their families in

determining appropriate post-acute care settings and (ii) share best practices among providers;

and (iii) the Care Transitions Intervention shall be provided to consumers to reduce hospital readmissions.

The program shall also provide outreach and education to ensure that acute care

hospitals are offering to patients access to thepre-admission counseling required under this

section. The executive office of health and human services shall notify all acute care hospitals at

least once annually of the requirements of section 9 of chapter 118E, that consumers seeking

admission to a long term care facility paid for by MassHealth be offered pre-admission

counseling for long term care services.

A regional consultation team shall include regional representation from: (i) aging service access

points members of Mass Home Care , including Care Transition Intervention staff (ii) senior care

organization members of the MassHealth Senior Care Options program; (iii) Program of All7

inclusive Care for the Elderly plans; (iv) One Care plans (v) the Massachusetts council on aging;

(vi) the Massachusetts Healthy Aging Collaborative; (vii) skilled nursing facilities; (viii)

independent living centers; (ix) and other entities or individuals deemed appropriate by the

executive office of health and human services. A regional consultation team shall be based

within an aging service access point.

The executive office of health and human services shall submit an initial report to the joint

committee on health care financing, the joint committee on elder affairs and the senate and house

committees on ways and means not later than March 15, 2018, that details: (i) the anticipated

structure for the program; (ii) estimated cost estimates for the implementation and maintenance

of the program; (iii) a breakdown of the state investment and anticipated alternate funding

sources; and (iv) a timeline for program implementation. Beginning in 2019, the executive

office of health and human services shall submit an annual report not later than March 15 to the

joint committee on health care financing, the joint committee on elder affairs and the senate and

house committees on ways and means that shall include, but not be limited to: (i) education and

outreach efforts on preadmission counseling; (ii) the number of providers accessing the program;

(iii) the estimated cost estimates for the implementation and maintenance of the program; and

(iv) a breakdown of referrals based on the site of post-acute care.