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SD 734

An Act relative to funding for nursing home staffing

194th Legislature (2025-2026) Introduced by Mike Brady

Inflation-adjusted MA Medicaid rates for nursing homes via CMS market basket; require adequate, competent nursing staff to meet resident needs; fully fund actual nursing costs.

House concurred
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Bill Summary · SD 734

Summary: An Act relative to funding for nursing home staffing (Senate Docket No. 734)

Purpose and intent

This bill aims to reform how Massachusetts funds nursing home staffing under Medicaid. It would:
- Ensure Medicaid rates for nursing homes are adjusted annually for inflation, using a CMS-established market basket update.
- Require nursing homes to maintain sufficient nursing staff with appropriate competencies to protect resident safety and promote well-being, with funding to reflect the actual costs of meeting those staffing requirements.

Key provisions

1) Inflation-adjusted Medicaid rates for nursing homes
- When setting Medicaid rates for nursing homes licensed under section 71 of chapter 111, the Executive Office of Health and Human Services (EOHHS) must annually adjust payments using an inflation adjustment aligned with the annual unadjusted Skilled Nursing Facility Market Basket Update as established by the Centers for Medicare & Medicaid Services (CMS) in 42 C.F.R. § 413.337.

2) Staffing adequacy and competencies
- Nursing homes must have sufficient nursing staff with the necessary competencies and skills to provide nursing and related services, ensuring resident safety and striving for the highest practicable physical, mental, and psychosocial well-being.
- This determination must reflect resident assessments, individual care plans, and the facility’s resident population’s number, acuity, and diagnoses, in accordance with the facility assessment required by 42 C.F.R. § 483.70(e).

3) Recognition of actual nursing costs in rate setting
- For the purpose of setting Medicaid rates, EOHHS must recognize its full share of the actual nursing costs incurred to meet the staffing requirement described above.

Affected parties and scope

  • Primary beneficiaries: Residents of nursing homes licensed under section 71 of chapter 111 (Massachusetts nursing facilities), through improved staffing and funding adequacy.
  • Implementing agencies: Executive Office of Health and Human Services (EOHHS) and other departments involved in Medicaid rate setting under Chapter 118E.
  • Indirect beneficiaries: Nursing home operators and staff, given changes to rate calculations and staffing requirements.
  • Legal/regulatory references: Chapter 118E; 42 C.F.R. § 413.337 (SNF Market Basket Update); 42 C.F.R. § 483.70(e) (facility assessment).

Procedural history and status

  • Introduction: February 27, 2025.
  • Senate action: Senate Docket No. 734, Senate No. 839, introduced by Sen. Michael D. Brady.
  • Committee actions: Referred to the Senate Committee on Health Care Financing (2025-02-27); subsequently, the House concurred (2025-02-27).
  • Current status: House concurrence noted; bill status listed as “House concurred.”

Practical considerations

  • Fiscal impact: The inflation-adjusted rate approach and full recognition of actual nursing costs are likely to increase Medicaid expenditures for nursing home care, depending on the magnitude of the Market Basket Update and actual staffing costs.
  • Compliance and data needs: Facilities may need to enhance data collection on staffing levels, competencies, and resident acuity to satisfy assessments and care-planning requirements.
  • Oversight: Clear methodologies for determining “full share of actual nursing costs” will be important to ensure consistent application across facilities.

Overall, the bill seeks to align Medicaid nursing home funding with inflation and real staffing costs while codifying staffing adequacy standards to support resident safety and well-being.

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

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