MASSACHUSETTS
In 2002, Massachusetts continued to expand community services for people with disabilities who were on waiting lists in compliance with the settlement of Boulet et al. vs. Cellucci et al. in December 2000. Under the terms of the agreement, the state was to provide residential services to an additional 300 people during FY 2001, using already appropriated funds. During the next five years (FY 2002 to FY 2006), the state said it would seek enough funding to extend community services to almost 2,000 additional people at the rate of 375 to 400 per year. The legislature approved $36.5 million in new funding for FY 2003 to continue implementation of this program.
Planning and Reports
Planning work also continued in 2002 on ways to build on the work of an Olmstead advisory group and a steering committee of agency officials from key human services agencies. The steering committee designated an interagency leadership team to draft a plan with the advisory group. On July 31, 2002, the interagency leadership team (representatives of the executive offices of Health and Human Services, Elder Affairs, and Administration and Finance) issued a report, Enhancing Community-Based Services: Phase One of the Massachusetts Plan.
The plan included 62 activities to be implemented in FY 2003. Highlights of phase one activities included the following.
- Continuing to target individuals for community placement when such placements were desired and available;
- Educating residents of institutions about the array of available community-based services and their eligibility for such services, and documenting their preferences;
- Requiring all state agencies that offer long-term care to prescreen Medicaid eligible beneficiaries who are seeking nursing home care for the possibility of community care; and
- Improving the availability of accessible and affordable housing.
Work Force
The legislature appropriated $50 million in 2002 to fund a rate add-on for wages and benefits and related employee costs of direct care staff of nursing homes. The state will require each nursing home to document that the funds are spent only on direct care staff by increasing their wages, hours or benefits or by increasing the facility's staff-to-patient ratio. The funds also may be used to improve a facility's recruitment and retention of nursing staff.
End of Life
The legislature also approved a bill that affects hospice care by updating the statutory definition of "hospice program" to reflect the goal of hospice care to meet the physical, emotional and spiritual needs of both the terminally ill patient and his or her family. The legislation also prohibited unlicensed programs from using the words "hospice" or "hospice program" for marketing or other purposes. Finally, the legislation allows licensed hospices to directly operate general inpatient units under their hospice licenses so that a hospice can continue to provide care when its patients have acute episodes instead of having to admit such patients to a hospital or skilled nursing facility.
Nursing Homes
The state enacted a nursing home user fee to be levied on an estimated 8,000 private-pay nursing home residents, which was expected to generate about $145 million. State officials said the state planned to use $130 million from the tax for its share of increased Medicaid reimbursements to nursing homes, with an equal amount coming from federal matching payments. The tax would be $9.60 per day or $3,504 per year per person for October, November and December 2002.
However, incoming Governor Mitt Romney said he wanted to use those funds for other medical expenses for three months. Moreover, the governor proposed cutting $14 million from nursing home rates starting in March 2003 and announced plans to cut an addition $2 million paid to nursing homes to hold beds for those who need temporary hospitalization. State officials said there were 4,231 empty nursing home beds as of February 2003.
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