The Baker-Polito Administration has begun implementing its second round of comprehensive nursing home reforms to keep older adults safe, improve the standards of care and infection control, and respond to the ongoing COVID-19 pandemic. As part of the Accountability and Supports Package 2.0 announced in September, the first phase includes $82 million in restructured Medicaid rates and immediate steps to eliminate 3 and 4 bed rooms in nursing homes. In addition, the state released updated surveillance testing guidance for nursing homes and rest homes and announced new funding for assisted living residences (ALRs) to support surveillance testing.
The Administration also announced strengthened flu vaccine requirements for staff at nursing homes, rest homes, ALRs, adult day health programs, and dialysis units to protect vulnerable residents and providers.
Over 55,500 older adults live in 700 nursing homes, rest homes, and ALRs in Massachusetts. The Administration has taken significant action to support these residents throughout the COVID-19 emergency, and the actions announced today reinforce the state’s commitment to improving care for these residents both during the pandemic and long-term.
Nursing Facility Accountability and Supports Package 2.0
The Executive Office of Health and Human Services (EOHHS) is implementing the first phase of several significant reforms announced as part of the Accountability and Supports Package 2.0 in September. This package of reforms holds long term care facilities to higher standards of care and infection control, provides up to $140 million in additional funding to nursing homes, and restructures Medicaid rates to be consistent with the recommendations of the Nursing Facility Taskforce.
This first phase of reforms includes:
Requiring nursing homes to take immediate steps to reduce or eliminate rooms with more than two residents to improve infection control standards and resident quality of life, the first step in eliminating 3 and 4 bed rooms in nursing homes
$82 million in restructured Medicaid rates, which incentivize high-quality, high-occupancy, and care for high-acuity special populations, including residents with substance use disorder and/or several mental health diagnoses, while ensuring stability for high-Medicaid facilities
Strengthened criteria for nursing homes that establish isolation spaces for COVID-19 positive residents being discharged from hospitals, limiting isolation spaces to facilities that have a high DPH quality score, meet specific staffing and PPE requirements and have no deficiencies on DPH infection control surveys
The reforms build off of the strong steps Commonwealth has taken since the start of the COVID-19 public health emergency to support nursing home residents and staff. With this package, the Commonwealth has committed over $400 million in new funding directly to nursing homes, on top of over $180 million in federal funding. In addition, the state has provided direct staffing supports, provided over 2.8 million pieces of personal protective equipment (PPE), provided testing via mobile testing units and reimbursement for surveillance testing, and enhanced facility accountability through regular infection control surveys and other audits.
Long-Term Care Surveillance Testing
The Administration has updated long-term care staff surveillance testing guidance to align with federal guidance. Surveillance testing is a critical way for facilities to mitigate the spread of COVID-19 and better protect high-risk residents. The updated guidance ensures all staff are tested at least once each month, with additional testing in facilities with new COVID cases or in high-positivity areas.
While nursing homes and rest homes are required to adhere to the surveillance testing guidance, ALRs are recommended to do so. To further support ALRs in performing adequate surveillance testing, the state will fund up to two rounds of testing for all staff per 30 days when there is a new staff case in an ALR. Nursing homes and rest homes have been reimbursed for staff surveillance testing since the policy was released in June.
Flu Vaccine Requirements
To protect long-term care residents and other vulnerable populations from a potentially deadly flu season, and preserve health care resources needed to respond to the COVID-19 emergency throughout the fall and winter, the Department of Public Health (DPH) has revised the flu vaccination requirements for staff at nursing homes, rest homes, ALRs, adult day health programs, and out-of-hospital dialysis units. The DPH order eliminates the option for staff to opt-out of getting a flu vaccine, with exemptions only for medical or religious reasons. Immunization is the most effective method for preventing infection of the flu, and staff at long-term care facilities and other health care providers serving vulnerable populations play an important role in stopping its spread. The order applicable to nursing homes, rest homes, adult day health programs and dialysis can be read here, and the order applicable to ALRs can be read here. For more information on protecting yourself and your family by getting the flu vaccine, visit: https://www.mass.gov/flu-facts