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HD 6129

A communication from the Executive Office of Health and Human Services (see item 4000-0300 of Section 2 of Chapter 140 of the Acts of 2024) submitting the Office of Medicaid continuous skilled nursing report for fiscal year 2025

194th Legislature (2025-2026)

The bill provides a detailed annual accounting of MassHealth CSN wage rates, their relation to Medicaid reimbursements, and fiscal impacts, with improved future reporting timing.

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Bill Summary · HD 6129

Overview

HD 6129 (Massachusetts, 194th Session) pertains to a communication from the Executive Office of Health and Human Services (EOHHS) submitting the Office of Medicaid continuous skilled nursing (CSN) report for fiscal year 2025. The bill documents wage rates and related data for CSN services, as well as state cost impacts and recommendations for future reporting when CSN rate increases occur.

Main purpose and intent

  • To present a comprehensive annual report on how MassHealth CSN rate increases are reflected in nurse wages and benefits paid by home health agencies that contract CSN services.
  • To detail wage rate structures, acuity-based and licensure-based breakdowns, and the share of Medicaid reimbursement that goes to wages and benefits for CSN nurses.
  • To summarize historical and current state costs (SFYs 2020–2024) and the fiscal impact of wage rate changes.
  • To set expectations for future reporting requirements and timing, including recommendations to synchronize reporting timelines with agency capabilities.

Key provisions and changes

  • Wage rate reporting (Section I):

    • Aggregated overview of wage payment rates paid by home health agencies to staff or contracted nurses providing continuous skilled nursing care.
    • Includes analysis of wage rate changes resulting from Medicaid rate increases for CSN.
    • Provides acuity-based and licensure-based breakdowns of wage rates.
    • Data points include RN (Registered Nurse) and LPN (Licensed Practical Nurse) wages, across different shifts and visit types (weekday, night, weekend, holidays, overtime), with specific example figures for pre- and post-August 1, 2024 rate increases.

  • Post-rate increase wage data (August 1, 2024 – December 31, 2024):

    • Similar wage breakdowns with updated “weighted average” gross hourly wages by service level (single patient visit, two publicly aided patients, three publicly aided patients, high acuity visit) for RN and LPN, across shift times and categories.

  • Medicaid reimbursement share (Section II):

    • Aggregated overview of the proportion of the MassHealth reimbursement rate paid directly as wages and benefits to CSN nurses.
    • Median wage percentages shown by service category and time period (weekday, night, holiday, overtime) for RN and LPN.
    • Note: Direct benefits share not available for this reporting period; prior legislative report estimated ~69.71% direct wages/benefits for CSN nurses.

  • State cost data (Section V):

    • State costs for wage rates promulgated in SFYs 2020–2024, by provider type:
    • Home Health Agency (CSN spend only)
    • CSN Agency
    • Independent Nurse
    • Totals for each SFY with a note on enrollment changes and timing (CSN agency requirement in SFY2024–2025; one-year claims adjustment window).
    • Blended FMAP for CSN in FFY 2020–2024: 51.02%.

  • Fiscal impact analysis (Section VI):

    • Year-over-year fiscal impact comparisons of wage-rate increases:
    • SFY2020 vs SFY2021
    • SFY2021 vs SFY2022
    • SFY2022 vs SFY2023
    • SFY2023 vs SFY2024
    • Highlights shifts from Home Health Agency CSN spend to CSN Agency spend due to provider enrollment changes and regulatory requirements.

  • Reporting recommendations (Section VII):

    • Recommends future information be submitted with an April (or later) due date to improve data quality and alignment with MassHealth capabilities.
    • Calls for agencies to provide all requested information and documentation to support the required report.

Who or what would be affected

  • MassHealth (Massachusetts Medicaid) CSN providers:
    • Home health agencies providing CSN services
    • CSN agencies (designated provider type)
    • Independent CSN nurses
  • Beneficiaries receiving CSN services and their acuity levels may indirectly be affected via wage-rate-driven changes in service capacity, staffing consistency, and potentially continuity of care.

Procedural and timeline aspects

  • August 1, 2024: MassHealth implemented CSN rate increases (~$30 million investment) with agencies reporting salary data before and after this date.
  • Reporting period covered:
    • January 1, 2024 – July 31, 2024 (pre-increase wages)
    • August 1, 2024 – December 31, 2024 (post-increase wages)
  • Data limitations noted:
    • Some acuity or rate components (e.g., benefits share) may not be available for the current period.
    • SFY2024 CSN payments may be updated in future reporting due to a one-year claims adjustment window for CSN agencies.
  • Recommendation on submission timing:
    • Preferred submission date: April or later for future reports to improve data quality and allow adequate aggregation.

Summary takeaways

  • The bill consolidates a detailed accounting of CSN wage rates, how those wages align with Medicaid reimbursements, and how rate increases affect provider compensation.
  • It tracks fiscal impacts across SFYs, highlighting shifts in provider enrollment type (home health agencies vs. CSN agencies) and the resulting budget implications.
  • It emphasizes improved data quality and timing for future reporting, advocating April-or-later deadlines.

Compiled from official sources — confirm details with the bill’s official record.

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