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The nursing home sector is facing a host of challenges. A new Mass. bill aims to help ease them.

One of the hallways at Blaire House nursing home in Tewksbury, on Dec. 6, 2022.Jim Davis/Globe Staff

Massachusetts legislators are eyeing reforms to the long-term care industry, with a bill that would increase oversight and help ease access issues.

Long-term care, which includes nursing homes and skilled nursing facilities, is a critical component of the health care system, and staffing challenges have led to a shortage of beds for patients needing to be discharged from a hospital. Hospitals have subsequently faced a capacity crisis, as patients have stayed in hospital beds longer.

Beyond the staffing issues, long-term care facilities have faced financial challenges, which were exacerbated by the pandemic. Legislators voiced a desire to help while also establishing greater accountability.


“Addressing persistent challenges within this important sector will not only improve the quality of care that residents receive, it will increase capacity and help acute care hospitals more efficiently discharge patients to the appropriate post-acute care settings,” House Speaker Ron Mariano said in a statement.

Bill H.4178, which House lawmakers passed on Wednesday, features a number of steps to ease bottlenecks from hospitals to post-acute care locations.

The measure would create a two-year pilot program, which would require insurance carriers including MassHealth to process administrative approvals, known as prior authorization requests, by the next business day or waive the approval altogether if a patient can be admitted into a facility over the weekend.

The bill also establishes a Long-Term Care Workforce and Capital Fund, which will receive half of all civil penalties secured by the attorney general against nursing facilities for abuse or neglect.

Proceeds from the fund will be used toward workforce training programs for a variety of jobs and no-interest or forgivable capital loan programs to nursing facilities to offset certain capital costs and to fund other capital improvements.

A task force would also be created to make further recommendations on remedying the challenges in the interplay between hospitals and post-acute care facilities, and MassHealth, the state Medicaid program, would be required to study changes to the way it assesses the eligibility patients have for long-term care.


Currently, MassHealth patients have to go through a rigorous eligibility process, which delays access to long-term care.

Lawmakers also sought to address workforce challenges facing long-term care facilities by authorizing direct care workers, including certified nurse assistants, to obtain a certification to administer non-narcotic medications to long-term care facility residents under the supervision of a licensed nurse or physician.

Because the bill raises money through fines, it also creates new mechanisms to fine people who don’t comply with the rules.

The bill would increase penalties by 400 percent for abuse and neglect, which can be sought by the attorney general. If no bodily injury results, the fine would be $25,000. If bodily injury results, the fine would go to $50,000. In instances of sexual assault or serious bodily injury, the fine increase to $100,000. Deaths would be penalized with a $250,000 fine.

The fines the Department of Public Health could levy for operating a long-term facility without a license would also double.

The DPH would be given additional tools to monitor and take punitive action against facilities, such as limiting, restricting, suspending, or revoking a license for cause and appointing temporary managers.

DPH’s review of nursing homes would also be strengthened to include a more comprehensive review of the background and legal record of applicants, including any entity with at least 5 percent ownership interest in a nursing facility.


State regulators and lawmakers will also have greater transparency of the sector, expanding facility financial reporting to detail the complicated ownership arrangements of nursing homes.

The bill is a variation of one filed last session, but includes more provisions targeted at the throughput crisis hospitals are facing. The legislation will now go to the Senate for consideration.

“We believe this historic and sweeping reform legislation continues to build upon the Legislature’s longstanding commitment to the individuals who live and work in the Commonwealth’s nursing facilities and will have a profound impact on nursing facility care by requiring even greater transparency and accountability,” said Tara Gregorio, president of the Massachusetts Senior Care Association.

Jessica Bartlett can be reached at Follow her @ByJessBartlett.