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Bill

H 788

An Act to ensure senior care organization quality and accountability

194th Legislature (2025-2026) Introduced by Dave Robertson

The bill sets a minimum reimbursement floor for capitated MassHealth SOC contracts, guaranteeing payments to nursing homes at least Medicaid FFS rates plus room/board and add-ons.

Accompanied a study order, see H5310 (under House Rule 27)
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Bill Summary · H 788

Summary of Bill H.788 (An Act to ensure senior care organization quality and accountability)

Overview

H.788 proposes a targeted update to Massachusetts law governing MassHealth Senior Care Options (SOC) contracts with nursing homes. The bill adds a new requirement to ensure that, when SOC programs contract with nursing homes on a capitated basis, payments to the nursing homes for MassHealth members are no less than the Medicaid fee-for-service (FFS) rates established in 101 CMR 206 (Standard Payments to Nursing Facilities), including room and board and all rate add-ons. The aim is to improve access to essential services and facilitate hospital-to-nursing-facility transitions.

Key Provisions

  • Location in law: Adds a new subsection (7) to Section 9D of Chapter 118E, as appearing in the 2020 official edition.
  • Requirement: For contracts between MassHealth SOC programs and nursing homes (licensed under Chapter 111, Section 71) to provide and coordinate services on a capitated basis, the MassHealth agency must reimburse at least the Medicaid FFS payment rates established in 101 CMR 206.
  • Scope of payments: The required reimbursement must cover care and services for MassHealth members, and must include room and board plus all rate add-ons specified in 101 CMR 206.
  • Purpose stated: To ensure access to critical services and support hospital-to-nursing-facility transitions.

Who Is Affected

  • MassHealth agency and its SOC programs that contract with nursing homes on a capitated basis.
  • Licensed nursing homes (Chapter 111, Section 71) participating in SOC arrangements.
  • MassHealth members residing in or transitioning to nursing facilities and receiving SOC services.

Financial and Operational Implications

  • Policy impact: Establishes a minimum funding floor for capitated SOC contracts, aligning capitation payments with FFS Medicaid rates to ensure adequate reimbursement.
  • Budgetary considerations: Potential increase in payments to nursing homes under SOC contracts; may require adjustments to SOC capitation rates and contract terms.
  • Administrative considerations: Implementation would rely on 101 CMR 206 for rate add-ons and room/board components; likely need contract amendments and ongoing rate compliance monitoring by MassHealth.

Legislative History and Status

  • Introduced: February 27, 2025
  • Initial referral: House Committee on Elder Affairs (February 27, 2025)
  • Related actions: Senate concurrence noted; similar matter previously filed as House Bill 646 in 2023-2024.
  • Current status: Referred to the Committee on Aging and Independence (order from both branches). Hearing scheduled: June 24, 2025, 10:00 AM–1:00 PM, in Committee Room B-1 (House action listed on May 19, 2025; 06/27/2025 reference indicates continued committee consideration).

Next Steps

  • Public hearing and committee deliberations on June 24, 2025, and subsequent committee action in the Aging and Independence committee.
  • If advanced, potential amendments and eventual floor consideration in both chambers.

This bill would create a clear, minimum reimbursement standard for SOC-funded nursing home care, with the stated goals of safeguarding access to essential services and improving hospital discharge transitions for MassHealth members.

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

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