2025-08-04 Spotlight: Chapter 197 Final Reports

MGL Chapter 197 of 2024 (also known as the Long Term Care Act) established a number of commissions and task forces. The final reports from several of them have recently been released which are listed below along with commentary by DignityMA participants.

Long Term Care Task Force Final Report (pdf)

Massachusetts General Law Chapter 197 of the Acts of 2024
Summary

Download the MGL Chapter 70 Summary

Massachusetts General Law Chapter 197 of the Acts of 2024, titled “An Act to improve quality and oversight of long-term care,” is a comprehensive law signed by Governor Healey on September 6, 2024, . It focuses on enhancing the quality and oversight of long-term care services in the Commonwealth.

Key provisions of the Act include:

• Establishing Task Forces: It created several task forces to examine different aspects of long-term care, including the Viability and Sustainability of Long-Term Care Facilities Task Force (mandated to report by July 31, 2025) and the Rest Home Task Force (which reported on April 1, 2025).
• Improving Nursing Home Oversight: The Act requires annual inspections of nursing homes, increased financial penalties for violations, and enhanced transparency regarding ownership and management. It also mandates that long-term care facilities develop and submit outbreak response plans.
• MassHealth Estate Recovery Reform: A significant component of the law limits MassHealth estate recovery to the minimum required by federal law, protecting the estates of many individuals with disabilities and seniors who receive long-term care services.
• Expanding Assisted Living Services: The Act codifies the ability of Assisted Living Residences to provide basic health services, such as injections and wound care, by qualified staff once certified to do so.
• Support for the Long-Term Care Workforce: It establishes a fund to recruit and retain long-term care workers, offering grants for CNA and LPN training and leadership development.
• Addressing Discharge Delays and Transitions: The Act includes provisions aimed at mitigating hospital discharge delays, such as requiring faster prior authorization for post-acute care and mandating a uniform prior authorization form. It also directs studies on the feasibility of professional guardians for indigent persons and the cost-effectiveness of changes to Medicaid long-term care eligibility.
• Anti-discrimination Protections: The Act requires staff training on the rights and care of LGBTQ+ older adults and individuals living with HIV, and prohibits discrimination based on sexual orientation, gender identity, or HIV status.
• Small House Nursing Homes: The law mandates the Department of Public Health to create regulations for “small house nursing homes,” a model designed to be more homelike and for no more than 14 residents.

In essence, Chapter 197 is a comprehensive measure to improve the quality, oversight, and accessibility of long-term care in Massachusetts, while also addressing issues related to affordability and resident rights.

Massachusetts Transitions from Acute Care to Post-Acute Care (TACPAC) Task Force Selected excerpts

Task Force: Purpose and Scope

The Transitions from Acute Care to Post-Acute Care (TACPAC) Task Force was established under Section 25 of Chapter 197 of the Acts of 2024 to study and propose recommendations to address acute care hospital throughput challenges and the impact of persistent delays in discharging patients from acute to post-acute care settings. The work of the Task Force focused on identifying system barriers, advancing innovative solutions, and promoting timely, appropriate care transitions.

Specifically, the Task Force was responsible for examining:

1. hospital discharge planning and case management practices;
2. ipayer administrative barriers to discharge;
3. legal and regulatory barriers to discharge;
4. efforts to increase public awareness of health care proxies and the importance of designating a health care agent;
5. post-acute care capacity constraints and additional opportunities to provide financial incentives to increase capacity;
6. administrative day rates and the cost to hospitals of discharge delays;
7. enhanced hospital case management practices and reimbursement for wraparound services;
8. the adequacy of post-acute care facility insurance networks and the establishment of an out-of-network rate for post-acute care facilities;
9. expanding MassHealth Limited coverage to include post-acute and long-term care services;
10. the effectiveness of interagency coordination to resolve complex case discharges;
11. the adequacy of reimbursement rates of MassHealth and commercial carriers for nonemergency medical transportation;
12. opportunities to expand coverage and reimbursement for services delivered by mobile integrated health programs certified by the department of public health and by participating providers in the federal Centers for Medicare and Medicaid Services acute hospital care at home program;
13. alternative transportation options for patients being discharged and transferred to post- acute care facilities or home health agencies; and
14. the adequacy of state resources and infrastructure to place complex case discharges in appropriate post-acute care settings, including, but not limited to, patients with dementia diagnoses, geriatric patients with psychiatric diagnoses, patients with behavioral health diagnoses, patients with substance use disorder diagnoses, justice-involved patients and patients who have been unable to find an appropriate placement for post-acute care for 6 months or longer.

The Task Force was chaired by Executive Office of Health and Human Services Assistant Secretary Joanne Marqusee, acting as the designee of the Secretary of Health and Human Services, and was comprised of a diverse panel of public health professionals, experts in health care administration and finance, and legal and law enforcement professionals (see full list in Appendix B). 

The Task Force met nine times from January through July 2025 and was required to submit its recommendations to the Clerks of the House of Representatives and Senate, the Joint Committee on Ways and Means, and the Joint Committee on Health Care Financing not later than July 31, 2025.

All meetings were subject to the Open Meeting Law and minutes were taken and approved for each meeting. All materials considered by the Task Force as well as minutes of the Task Force’s meetings were posted on a publicly-available webpage.

Bridging the Gaps: Recommendations for Consideration

The Task Force developed a package of recommendations based on its deliberations, as well as the presentations and resources shared with the group. While efforts were made to reach broad consensus amongst the Task Force’s membership, on one of the proposed recommendations below, the group was unable to reach full agreement, and the varying opinions are noted.

As noted in several of the recommendations, there are legislative proposals in the 194^th Massachusetts General Court that include provisions consistent with the recommendation(s). Appendix C includes the references to those legislative proposals. While the Task Force is not necessarily advocating for a specific legislative proposal, we wanted to share where our recommendations overlapped with provisions in legislative proposals that are being considered.

Additionally, it is important to note that the work of the Task Force was conducted prior to the passage of federal legislation signed into law on July 4, 2025, which includes certain provisions that may significantly impact access and barriers to healthcare, e.g., introducing penalties for insuring individuals with documentation issues, retroactively reducing coverage from 90 days to 60 days, etc. These federal changes are likely to exacerbate the problem of patients being delayed in transitioning from acute to post-acute care settings.

A Path Forward: Strategic Alignment and Accountability

Massachusetts has launched a range of promising efforts to improve hospital throughput and transitions to post-acute care. Building on this momentum will require a trained, skilled workforce and deliberate alignment across agencies, providers, and payers to ensure these efforts translate into sustained, system-level change.

To move forward effectively, state partners can:

• Scale what works. Time-limited pilots and embedded staffing models are already showing value. Promising innovations should be assessed for long-term sustainability and opportunities to support statewide adoption.
• Strengthen infrastructure for coordination. Durable tools, workflows, and data systems that support real-time discharge planning, referral management, and transport readiness an help streamline transitions and reduce delays across the continuum.
• Clarify roles and accountability. Shared expectations, standard operating procedures, and clear lines of responsibility—across hospitals, post-acute providers, transportation brokers, and community-based organizations—can reduce fragmentation and improve outcomes.
• Ensure ongoing performance monitoring. Implementation of recent reforms, including those under Chapter 197 of 2024, should be closely monitored to ensure intended outcomes and to identify opportunities for course correction.
• Advance equity. Populations with complex needs, including those with behavioral health conditions, disabilities, or limited insurance coverage—continue to face disproportionate discharge delays. Targeted strategies must ensure equitable access to timely, appropriate care transitions.

The Viability and Sustainability of Long-term Care Facilities Task Force
Summary prepared by Dignity Alliance Massachusetts

The PowerPoint containing the final report will be posted on the Dignity Alliance MA website. (Search “Chapter 197”)

Download the Sustainability and Viability of Long-Term Care Report (pdf)

The final report of the Task Force on the Viability and Sustainability of Long-Term Care Facilities, submitted on July 31, 2025, addressed the challenges facing the long-term care sector in Massachusetts. The task force, established by Governor Healey, focused on ensuring the long-term care system, particularly rest homes, can meet the needs of the Commonwealth’s aging population. The report highlighted key issues such as workforce shortages, financial instability, and the need for regulatory reform. It also emphasized the importance of community-based care and the need to balance institutional and non-institutional settings. 

Executive Summary:

The long-term care facility (LTCF) sector in the Commonwealth of Massachusetts is currently operating under significant duress, facing profound challenges that threaten its fundamental viability and long-term sustainability. An analysis of the Massachusetts Executive Office of Health and Human Services (EOHHS) report reveals a sector at a critical juncture, where current operational models are fundamentally unsustainable. This precarious state is primarily driven by a severe structural financial deficit, largely attributable to inadequate Medicaid reimbursement rates, compounded by a deepening and persistent workforce crisis. Further pressures stem from aging infrastructure requiring substantial capital investment and the cumulative burden of extensive regulatory compliance.

The Commonwealth faces a paradox: a rapidly aging population is driving a projected increase in demand for long-term care services, yet the existing supply infrastructure is struggling to maintain operations, let alone expand or modernize. This situation suggests that without significant, systemic reforms, a substantial portion of the sector faces potential closure, which would leave a burgeoning senior population without access to necessary care. The confluence of persistent financial losses, a deepening workforce crisis, and significant capital needs indicates that the current system is not merely experiencing temporary difficulties but is structurally unsound. This report underscores the urgent need for strategic intervention to safeguard access to quality long-term care for Massachusetts residents.

Key Findings and Recommendations: Workforce Crisis:

The task force acknowledged the critical shortage of qualified staff in long-term care facilities, impacting both the quality of care and the ability to meet the growing demand. 

Financial Sustainability:

The report addressed the financial challenges faced by many long-term care facilities, including low Medicaid reimbursement rates and the rising costs of care. 

 Regulatory Framework:

The task force examined the existing regulatory structure for rest homes, recognizing the need for clearer licensing requirements and enhanced oversight to ensure quality and safety. 

Community-Based Care:

The report emphasized the growing preference for aging in the community and the need to support home and community-based services alongside institutional care. 

Discharge Planning:

The task force addressed the issue of discharge delays from acute care hospitals, highlighting the need for better coordination between facilities and payers to ensure timely and appropriate placement. 

Specific Recommendations: Workforce Development:

The task force recommended strategies to attract and retain qualified staff, including increased wages, benefits, and training opportunities.

 Financing Reform:

The report called for a review of Medicaid reimbursement rates and explored potential public-private partnerships to support long-term care facilities. 

Regulatory Modernization:

The task force recommended updates to regulations governing rest homes, including enhanced staffing requirements and quality reporting. 

Community Integration:

The report emphasized the need to strengthen community-based services and ensure individuals have access to the appropriate level of care based on their needs. 

Data Collection and Transparency:

The task force called for improved data collection and public reporting on ownership, costs, and quality metrics for long-term care facilities. 
Next Steps: The report was submitted to the Massachusetts Legislature for review and potential action. 

The recommendations will likely inform future legislation and policy decisions related to long-term care in the state. 

Further action will be needed to implement the recommendations and ensure the long-term viability and sustainability of the long-term care system in Massachusetts. 

Conclusion:

The Massachusetts Executive Office of Health and Human Services report on the viability and sustainability of long-term care facilities paints a stark picture of a sector at a critical crossroads. The analysis underscores profound financial and operational challenges, primarily driven by inadequate Medicaid reimbursement and a deepening workforce crisis, exacerbated by aging infrastructure and regulatory burdens. These issues, intensified by the lingering effects of the COVID-19 pandemic, threaten the fundamental ability of LTCFs to provide essential services to the Commonwealth’s most vulnerable residents.

The long-term care sector’s struggles represent a societal challenge that transcends individual facility operations, impacting public health, economic stability, and the social fabric of the Commonwealth. When a critical service like long-term care is failing, it is not just a business failure; it impacts families, hospitals (who cannot discharge patients), and the state’s ability to care for its most vulnerable citizens. This broad impact elevates the issue from a sectoral problem to a fundamental public policy challenge.

The confluence of demographic trends, indicating a rapidly aging population and increasing demand for long-term care, and the current state of decline within the sector creates a narrow window of opportunity for intervention. Delaying comprehensive reforms will only exacerbate the crisis, leading to higher costs, reduced access, and a significant decline in quality of care in the future. The problems are not static; they are worsening, and the aging population is a demographic certainty. This means the gap between demand and sustainable supply is widening. The longer action is delayed, the more expensive and difficult it will be to rectify the situation, potentially leading to irreversible damage to the care infrastructure.

Ensuring the future viability and sustainability of long-term care facilities in Massachusetts requires urgent, comprehensive, and collaborative action. Implementing the recommended reforms, which span funding models, workforce development, regulatory streamlining, and innovation, is essential to safeguard access to quality long-term care for all Massachusetts residents and to build a resilient system capable of meeting the demands of an aging population.

Retirement Communities

Read the final report and comments as well as meeting notes

Download the Special Commissionon Continuing Care Retirement Communities Report (pdf)

Overview:

• The CCRC Commission was established in Section 29 of Chapter 197 of the Acts of 2024, An Act to Improve Quality and Oversight in Long-Term Care.
• The Commission was co-chaired by Representative Thomas M. Stanley and Senator Patricia D. Jehlen, Chairs of the Joint Committee on Aging and Independence. Commissioners included industry professionals and administrators, lawmakers, advocates, and CCRC residents. 
• The Commission met 8 times between April and July 2025, including a public hearing on 6/16/25. All meetings were held virtually on Zoom. 
• The Commission was required to submit recommendations to the Clerks of the Senate and House of Representatives, the Joint Committee on Aging and Independence, and Senate and House Committees on Ways and Means by August 1st, 2025.

Summary of Public Hearings

• More than a dozen residents testified in support of resident representation on their individual CCRC’s board.  
• Multiple constituents testified in support of changes to the entrance fee refund, expressing interest in there being a hard deadline when CCRCs need to return the money by. 
• Commission received testimony in support of a new, clear definition of a CCRC, and/or that CCRCs become certified through AGE so consumers have a strong understanding of what the facility does and doesn’t offer. 
• Multiple residents testified that they were satisfied with their care at their CCRC and enjoyed the peace of mind they have living there.
• Commission received testimony from employees and administrators of CCRCs who enjoy working in the industry and feel that it is an important and needed part of the continuum of care. 
• Commission received testimony in support of endorsing S478, An Act relative to disclosing continuing care retirement community entrance fees. 

Commission Charge:

The commission was charged to study and report on:

• Continuing care retirement communities, their care contracts, and
  their impact on consumers
• The financial viability of CCRCs
• The payment and return of entrance fees at CCRCs
• Statutory and regulatory oversight of CCRCs, including any activities by state agencies to enforce those regulatory requirements 
• Advertising practices communicated to potential residents and families about CCRCs
• Regulatory procedures for the closure or change of ownership of CCRCs

The Commission was also required to:

Submit a report with recommendations, including legislation or regulations necessary to carry out such recommendations, to the Clerks of the House of Representatives and the Senate, the Joint Committee on Aging and Independence and the Senate and House Committees on Ways and Means no later than August 1st, 2025.

Recommendations:

• The CCRC Commission endorses and recommends passage of S478 to increase transparency for consumers around the entrance fee refund.
• S478, An Act relative to disclosing continuing care retirement community entrance fees, would require CCRCs to give prospective residents a separate document that clearly states:
• The amount of the entrance fee to be refunded to the resident under the provider’s contract
• The terms, conditions and explanation of the process by which the provider will make such refund to the resident after the resident leaves the facility or passes away

The CCRC Commission recommends that AGE’s consumer guide be updated:

• Recommend for AGE to collaborate with LeadingAge MA, MLCRA, Massachusetts Senior Care Association, Massachusetts Assisted Living Association, and AARP on updating the consumer guide.
• Require AGE to update the consumer guide annually.
• Require that the consumer guide include a list of known CCRCs in the Commonwealth.
• Require that CCRCs give prospective residents access to the consumer guide.

The CCRC Commission recommends further discussion on other recommendations considered, such as:  

• A mandate that each CCRC board include not less than one resident member with voting rights. 
• The resident board member would be chosen by the residents of each CCRC.
• That CCRC boards hold an open meeting each year.
• The open meeting will be an opportunity for residents and family members to have their opinions and concerns heard by their respective CCRC’s board.  
• Changes to how CCRCs refund their entrance fees, including:
• A sequential model, meaning that residents/families would receive their refund in the order of when they left the unit.
• An interest model, meaning that the CCRC would pay interest to the resident or their family each month until the unit is re-occupied.
• A blanket 1-year deadline, meaning that the CCRC would be required to issue the refund within 1 year of the resident leaving the unit. 
• Changes to how CCRCs refund their entrance fees, including:
• A sequential model, meaning that residents/families would receive their refund in the order of when they left the unit.
• An interest model, meaning that the CCRC would pay interest to the resident or their family each month until the unit is re-occupied.

A blanket 1-year deadline, meaning that the CCRC would be required to issue the refund within 1 year of the resident leaving the unit.

Dissents to the final report offered by CCRC Commission members

Dissent by John J. Ford, JD, Northeast Justice Center

I join in the dissenting views expressed by Christine Griffin and Dave VanArsdale from the final Report of the Commission.

Please include this message and the attached letters as addenda to the Report. 

As a result of the Commission’s definition of “consensus”, any proposed recommendation to the Legislature required unanimous support so that any one Commissioner, e.g., a CCRC industry representative, could object to the proposal and that recommendation was eliminated from our final Report.

That resulted in the elimination of virtually all proposed recommendations made by CCRC residents and their advocates and resulted in a Report that fails to address the issues discussed at length and basically advocates for the status quo – no legislative action is needed.  

The only specific recommendation was support for the enactment of the so-called “CCRC disclosure form bill”, S 478, and the issues unaddressed by this Commission will or may be addressed in the process of amending and enacting that bill into law. 

As of now, any such disclosure form would have to  make AT LEAST the following disclosures to prospective CCRC residents: 

THE CCRC MAY USE YOUR ENTRANCE FEE FOR ANY PURPOSE. INCLUDING BUT NOT LIMITED TO, OPERATING EXPENSES, DEBT REDUCTION, COSTS OF IMPROVEMENTS OR EXPANSION, AND, IF THE CCR IS A FOR PROFIT CCRC, THE PAYMENT OF DIVIDENDS TOANY OWNERS OR SHAREHOLDERS.

IF YOUR ENTRANCE FEE OR A PORTION OF IT IS REFUNDABLE WHEN YOU CEASE TO OCCUPY THE UNIT, THERE IS NO TIME LIMIT OR DEADLINE WITHN WHICH YOUR ENTRANCE FEE WILL BE REFUNDED.

RESIDENTS OF THIS CCRC HAVE NO RIGHT TO BE REPRESENTED BY ONE OF THEIR OWN ON THE GOVERNING BOARD OF THE CCRC.

THERE IS NO STATE AGENCY WITH AUTHORITY TO REGULATE OR MONITOR THE CCRC FOR FINANCIAL HEALTH OR VIABILITY NOR ANY RELEVANT STANDARDS BY WHICH TO EVALUATE SUCH CONDITIONS.   

Unfortunately, the Commission has given no guidance to what is needed to protect the consumer rights of CCRC residents. 

David L. VanArsdale, resident, Edgewood Retirement Community, North Andover, MA 

I wish to present a dissenting report from those recommendations expressed in the final report of the Special Legislative Commission to Investigate Continuing Care Retirement Communities in Massachusetts.

I have served as a Resident Member of the Commission from the beginning of the process and would express great appreciation for the leadership from Senator Patricia Jehlen and Representative Thomas Stanley.  I also wish to express a strong word of thanks from Julianna Fernandez and Jennifer L’Heureux for their competent work on behalf of the Commission. 

The first parts of the final report summarizing the Charges and then the Findings was summarized in a very professional manner. 

The first recommendation “to pass S. 478, the Disclosure Bill, to Increase Transparency for Consumers” around the questions of the entrance fee refund is an absolutely necessary “next step” for legislation for future CCRC Consumers.  I affirm Recommendation #1. 

The second recommendation to update the Consumer Guide for CCRC’s produced by AGE is also absolutely necessary for future CCRC Consumers.  I affirm Recommendation #2. 

But I wish to express strongly my opposition the Recommendation #3:  that each CCRC’s Board hold one open meeting each year.  First, this was never part of the Commission’s discussions and it seems most inappropriate to include this is the recommendations.  Second, there is absolutely no reason to restrict a CCRC’s Board from an open session, except as it may involve an issue warranted by the rules of Executive Session.

Further, I wish to register my dissent concerning the recommendation that representation by a resident on the Board of a CCRC needs further discussion. 

There should always be a resident chosen by the residents on the Board of Directors of all CCRC’s.  The need for one or more residents to be elected as voting members of the Board of Directors is clearly supporter by the CCRC residents on the Commission.  The residents are “paying the bills” and committing much of their life savings to live in the CCRC, they have earned the right to have a voice on the Board.  Why is this questioned?  Is there a defensive fear that a resident may raise difficult questions for management or reveal actual events or issues affecting everyday living in a CCRC?  This is a structure of professional leadership and the input from residents needs to be decisive and truthful for future stability. 

Finally, I wish to offer my dissent that further discussion is needed to resolve the issues of the terms of the admission fee refund.  There needs to be a standard timetable and procedure for when a resident chooses to depart and move on from a CCRC.  There needs to be another standard for the return of the refundable admission fee to the estate of a CCRC resident upon death. 

I wish to thank the Commission members and the time they have given to address specific issues affecting the management and residents of the Continuing Care Retirement Communities in Massachusetts.