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Bill

SD 3895

MassHealth 2025 Continuous Skilled Nursing Report

194th Legislature (2025-2026)

Requires a comprehensive, data-driven report detailing CSN wage payment rates, how Medicaid rates translate to nurse pay, and related fiscal impacts to inform policy and future rat

Placed on file
0
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Bill Summary · SD 3895

Purpose of the Bill

  • SD 3895 from the 194th Massachusetts Legislature requires a detailed report from MassHealth (the Executive Office of Health and Human Services in Massachusetts) on wage payment rates for continuous skilled nursing (CSN) care provided by home health agencies to MassHealth members.
  • The reporting obligation stems from line item 4000-0300 of the FY2025 budget and references existing CSN wage regulations (101 CMR 350.04, 101 CMR 361, 101 CMR 453).

Key Provisions and Changes

  • Required Report Content (aggregate and breakdown data):
    • (I) Aggregated overview of wage payment rates paid by home health agencies to staff or contracted nurses delivering CSN, including any increases tied to increases in Medicaid CSN rates.
    • (II) Aggregated overview of the portion of the Medicaid reimbursement rate that is paid directly as wages and benefits to CSN nurses via MassHealth-contracted agencies.
    • (III) Aggregated wage-rate breakdown by patient acuity level.
    • (IV) Aggregated wage-rate breakdown by provider licensure level.
    • (V) State costs for wage rates promulgated in state fiscal years 2020–2024, by regulation, department, and program.
    • (VI) Fiscal impact analysis comparing increases in state funding versus prior-year actual costs for wage rates (SFY2020–SFY2024), by regulation, department, and program.
    • (VII) Recommendations on information to include in future CSN rate reporting by home health agencies receiving rate increases.
  • Data and Compliance:
    • The report must assemble information from MassHealth claims data and agency surveys.
    • Agencies providing CSN services must supply all requested information and documentation to enable the compilation of the report.
  • Population and provider context:
    • As of January 2025, CSN serves about 1,010 MassHealth members.
    • ~55 MassHealth-enrolled CSN agencies and ~375 MassHealth-enrolled independent nurse providers support CSN services.
    • CSN is defined as skilled nursing care provided by a licensed nurse requiring more than two continuous hours of service per day.
    • In January 2022, MassHealth created a separate CSN provider type to distinguish CSN services from intermittent (home health) nursing services.

Who Is Affected

  • MassHealth members eligible for CSN services (approximately 1,010 as of January 2025).
  • MassHealth-funded CSN agencies (about 55) and independent nurse providers (approximately 375) who deliver CSN.
  • State agencies and departments involved in MassHealth financing and wage rate regulation (EOHHS and MassHealth, with oversight by the Joint Committee on Health Care Financing and the House and Senate Ways and Means).

Timeline and Procedural Aspects

  • Background trigger: Line item 4000-0300 in the FY2025 budget (Chapter 140 of the Acts of 2024) requires the CSN wage-rate review and reporting.
  • Due date for reporting: Not later than March 7, 2025.
  • Report recipients: Executive Office of Health and Human Services, the Office of Administration and Finance, the Joint Committee on Health Care Financing, and the House and Senate Committees on Ways and Means.
  • Report contents: The executive office, in consultation with MassHealth, must prepare and submit the comprehensive CSN wage-rate report, including data, analysis, and recommendations.
  • Current status: The FY2025 funding and reporting requirements have led to a completed or to-be-submitted report (as of the provided letter dated May 5, 2026). The action history notes the bill was “Placed on file” on May 7, 2026.

Potential Impacts

  • Transparency: Increases transparency around how CSN wage rates are set and how Medicaid rates translate into nurse wages and benefits.
  • Workforce insight: Provides detailed, provider-type, acuity, and licensure breakdowns that could inform policy decisions, wage policy adjustments, and future rate setting.
  • Budget relevance: Enables comparison of state funding with actual expenditures, aiding fiscal planning for SFY 2020–2024 and informing potential rate changes or caps.
  • Administrative burden: Requires CSN agencies to gather and share data; may impose reporting requirements on providers.

Summary

SD 3895 mandates a comprehensive, data-driven report on CSN wage payment rates and related fiscal impacts, with inputs from MassHealth claims data and provider surveys. The report covers wage structures, proportion of reimbursements paid as wages and benefits, acuity- and licensure-based wage variations, historical state costs and fiscal impacts from 2020–2024, and recommendations for future reporting. The goal is to clarify how CSN rates translate into nurse compensation, understand cost implications, and guide future policy and rate-setting decisions.

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

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