Bill
SD 2260
MassHealth SCO contracts must pay nursing homes at least the current Medicaid FFS rate (including room, board, and add-ons) to ensure care access and hospital-to-facility transitio
Status and routing
- Bill Number: Senate Docket No. 2260; Senate No. 467
- Title: An Act ensuring senior care organization quality and accountability
- Introduced: March 10, 2025
- Current status: House concurred (the House approved the Senate-passed version)
- Legislative actions: Referred to the Committee on Elder Affairs on 2025-03-10; House concurred on the same day
Background and purpose
- This bill adds a new requirement to MassHealth’s contracting framework for senior care options programs (SCO) when those programs contract with nursing homes on a capitated basis. The goal is to ensure nursing homes receive adequate reimbursement to support quality care, access to critical services, and smooth transitions from hospital to nursing facility care.
Key provision (what the bill would change)
- New paragraph (7) added to Subsection (e) of section 9D of chapter 118E (Massachusetts General Laws).
- Scope: Applies to nursing homes licensed under section 71 of chapter 111 when MassHealth senior care options program contracts with them on a capitated basis to provide and coordinate services.
- Reimbursement floor: MassHealth SCO contracts must reimburse the nursing home for care and services provided to a MassHealth member at an amount not less than the current Medicaid fee-for-service (FFS) payment rate established under 101 CMR 206.
- Inclusions: Reimbursement must include room and board and all rate add-ons specified by 101 CMR 206.
- Purpose of this floor: To ensure access to critical services and facilitate transitions from hospitals to nursing facilities.
Who is affected
- MassHealth and its Senior Care Options programs (SCO)
- Nursing homes licensed under chapter 111, section 71
- MassHealth members receiving SCO services who are placed in nursing facilities
Implications and impact
- Financial: Establishes a minimum payment floor that could increase or stabilize payments to nursing homes under capitated SCO contracts, potentially affecting MassHealth budgeting and contract negotiations.
- Care quality and access: Aims to safeguard access to critical services (as defined by Medicaid rules) and support timely hospital-to-nursing facility transitions.
- Administrative: May require adjustments to SCO contract templates, rate-setting processes, and regulatory guidance to reflect the new floor and inclusions (room and board and add-ons).
Implementation timeline
- The text provided does not specify a separate effective date. If enacted, the effective date and any related regulatory rules would be determined in subsequent implementing actions and Department guidance.
Notes
- This is a new proposal linked to prior similar legislation (Senate No. 369 of 2023-2024) and builds on the existing framework of MassHealth SCO contracts and 101 CMR 206 rate rules.
Compiled from official sources — confirm details with the bill’s official record.
Sign in to ask a question.
