Massachusetts Nursing Homes Medicaid Ratemaking Initiative (2020)

Massachusetts Nursing Homes Medicaid Ratemaking Initiative
Election date November 3, 2020
Topic Healthcare
Status Not on the ballot
Type State statute	Origin Citizens
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The Massachusetts Nursing Homes Medicaid Ratemaking Initiative was not on the ballot in Massachusetts as an initiated state statute on November 3, 2020.

The ballot measure would have amended state law to change the formula that state healthcare programs, such as MassHealth (Medicaid), which is used to determine payments to nursing homes and rest homes.

As of 2019, state healthcare programs are required to set rates for payments based on the reported costs of general health supplies, care and rehabilitative services, and accommodations of the calendar year not more than 4 years prior to the current rate year.

The ballot measure would have required state healthcare programs to set rates for payments based on 100 percent of the allowable cost to providers of caring for patients who are beneficiaries of MassHealth and 100 percent of additional allowable costs, fees, and assessments associated with the implementation of state or federal laws, regulations, or mandates, to the extent that the U.S. Centers for Medicare and Medicaid Services allows.

Text of measure

Ballot summary

The final ballot summary for the measure would have been as follows. Click [show] to expand the summary.

Initiative 19-11 ballot summary

“ This proposed law would change how reimbursement rates for nursing homes and rest homes paid by the state are established by the state Executive Office of Health and Human Services. The proposed law would require the Executive Office to use historical costs from a “base year” not more than two years before the current year in calculating a provider’s reimbursement rates. The proposed law would eliminate the Executive Office’s ability to make adjustments for reasonableness, remove the current restriction against providers using costs from years other than the chosen base year to appeal the reimbursement rates established by the Executive Office, and set the occupancy standard for nursing homes used in calculating a nursing home’s reimbursement rate as the statewide average from the base year. The proposed law would require that the rates set for each provider be sufficient to pay all allowable costs of caring for beneficiaries of the state’s MassHealth program and all allowable costs of implementation of any state or federal law, regulation, or other governmental mandate to the extent permissible by the United States Department of Health and Human Services Centers for Medicare and Medicaid Services. Any additional costs incurred by a provider as a result of the ratesetting process established by the proposed law would also be included in that provider’s rate. The proposed law would require the Executive Office, in compliance with the methods and standards described above, to determine and certify rates for general health supplies, care, rehabilitative services, and accommodations incurred in the ordinary course of running a facility. The proposed law would require that the Executive Office apply the regulations governing the calculation of nursing home rates in effect on January 25, 2019, to the extent that those regulations are consistent with the proposed law, when establishing rates for the covered facilities. The proposed law could be amended only by a two-thirds roll-call vote of the Legislature. ”

Full text

The full text of the measure is available here.

Support

Massachusetts Senior Coalition led the campaign in support of the initiative.

Arguments

• Thomas Lavallee, chairman of Massachusetts Senior Care, said, "Massachusetts nursing facilities are in the midst of a historic financial and workforce crisis. This crisis impacts all nursing facilities — not for profit, for-profit, family-owned — and is directly attributable to a MassHealth payment system that has not kept pace with the cost of nursing facility care over the last decade."

Opposition

If you are aware of any opponents or opposing arguments, please send an email with a link to editor@ballotpedia.org.

Path to the ballot

See also: Laws governing the initiative process in Massachusetts

Process in Massachusetts

In Massachusetts, the number of signatures required to qualify an indirect initiated state statute for the ballot is equal to 3.5 percent of the votes cast for governor in the most recent gubernatorial election. No more than one-quarter of the verified signatures on any petition can come from a single county. The process for initiated state statutes in Massachusetts is indirect, which means the legislature has a chance to approve initiatives with successful petitions directly without the measure going to the voters. A first round of signatures equal to 3 percent of the votes cast for governor is required to put an initiative before the legislature. A second round of signatures equal to 0.5 percent of the votes cast for governor in the last election is required to put the measure on the ballot if the legislature rejects or declines to act on a proposed initiated statute. Signatures for initiated statutes in Massachusetts are collected in two circulation periods. The first period runs from the third Wednesday in September to two weeks prior to the first Wednesday in December, a period of nine weeks. If the proposed law is not adopted by the first Wednesday of May, petitioners then have until the first Wednesday of July (eight weeks) to request additional petition forms and submit the second round of signatures.

The requirements to get an initiated state statute certified for the 2020 ballot:

• Signatures required (first round): 80,239 signatures
• Signatures required (second round): 13,374 signatures
• Deadline (first round): The deadline to submit the first round of signatures to the secretary of state was December 4, 2019. Signatures needed to be submitted to local registrars by November 20, 2019.
• Deadline (second round): The deadline to submit the second round of signatures was July 1, 2020.

If enough signatures are submitted in the first round, the legislature must act on a successful petition by the first Wednesday of May. The measure only goes on the ballot if the legislature does not pass it and if the second round of signatures is successfully collected.

Details about this initiative

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• The ballot initiative was filed with the office of Attorney General Maura Healey (D) on August 7, 2019.
• The initiative was cleared to circulate on September 4, 2019.
• The sponsors of the initiative reported submitting over 130,000 signatures on November 20, 2019, to local registrar for verification.
• The sponsors of the initiative reported submitting 101,999 locally certified signatures on December 3. Secretary of the Commonwealth William F. Galvin verified that more than 80,239 signatures were valid. The legislature has until May 5, 2020, to pass the ballot measure, or petitioners may gather a second round of signatures to place it on the 2020 ballot.
• On April 26, 2020, the campaigns supporting Massachusetts "Right to Repair" Initiative, Massachusetts Ranked-Choice Voting Initiative, Massachusetts Nursing Homes Medicaid Ratemaking Initiative, and Massachusetts Beer and Wine in Food Stores Initiative filed a suit jointly against Massachusetts Secretary of State William Galvin seeking permission to gather the 13,347 signatures needed by July 1 electronically. Petitioners argued, "Without immediate relief from this Court, Petitioners and all other ballot proponents similarly situated will face an unduly burdensome Catch-22: either risk their health and the health of voters to satisfy unjustifiable and unachievable ballot restrictions and participate in democracy or protect their health and give up their fundamental right to access the ballot."
  • On April 29, 2020, all four campaigns and Secretary Galvin agreed to a resolution that allows the campaigns to gather the second round of 13,347 signatures by distributing the petitions online to be electronically signed or printed and mailed back to the respective campaign.
• Since the General Court failed to act on the initiative by May 5, 2020, an additional 13,347 signatures were required by July 1, 2020.
• Massachusetts Senior Coalition did not submit enough signatures for the second round of collection by the July 1 deadline. The Coalition said, "Our thoughts over the past month have been focused on our loved ones and the thousands of dedicated individuals that provide care to them around the clock while at risk to their own personal safety. There is no doubt that this outcome was affected by the unique and difficult circumstances under which we were forced to collect signatures."

To learn more about how the coronavirus pandemic impacted ballot measure campaigns, see the following: Changes to ballot measure campaigns, procedures, and policies in response to the coronavirus (COVID-19) pandemic, 2020-2022

See also

2020 measures

• 2020 ballot measures
• Healthcare on the ballot

Massachusetts

• Massachusetts ballot measures
• Massachusetts ballot measure laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
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