The Determination of Need (DoN) Program of the Massachusetts Department of Public Health (Department) recently signaled its intention to end a decades-long moratorium on new nursing home beds in the Commonwealth with the release of proposed DoN guidelines for approval of new long-term care beds.

Background. The DoN Program has for many years maintained a moratorium on accepting applications for new nursing home beds in Massachusetts. The DoN Program imposed the moratorium because it calculated that Massachusetts had more licensed nursing home beds than were necessary to meet the projected needs of the state’s population. However, many of the nursing home beds that the Program included in its calculations were no longer in service. During the moratorium, a nursing home operator that closed a facility could ask the Department to maintain the facility’s beds on file with the Department as licensed, but out of service. The Department kept a list of licensed out-of-service beds and the DoN Program included those beds in its calculation of nursing home beds available to meet the public need. Nursing home operators could purchase out-of-service beds from prior operators and relocate the beds to build new nursing facilities or expand existing facilities.

The DoN Program did away with the licensed out-of-service beds category in December 2018, which reduced the number of licensed nursing home beds in the state. The DoN Program will take applications for new nursing home beds after formally adopting the proposed guidelines.

The Proposed Guidelines. An application for new long-term care beds will be accepted if the application meets all four of the following criteria:

  1. Proposes to improve access to long-term care in a defined geographic area and address at least one of the following:
    1. Treat substance abuse and mental health disorders, including the ability to provide medication-assisted treatment and psychiatric medications/treatments;
    2. Provide safe and innovative models for individuals with dementia;
    3. Reduce the risk of homelessness by improving housing stability; or
    4. Address unmet cultural or linguistic needs of a population.
  2. Reserves at least 65% of bed capacity for (i) MassHealth residents (paid directly or through a contractor), or (ii) residents whose payments are provided directly or indirectly by another agency of the Commonwealth.
  3. Applicant is a current licensee with a mean performance rating of all facilities under its management or ownership among the top quartile of performers as measured by the Commonwealth’s Nursing Home Compare Performance Tool, or the CMS Nursing Home Compare Rating System. Level IV facilities must have had deficiency-free surveys over the past two years in key measures of care (e.g., nursing services, dietary services and social services).
  4. Proposes to address at least one of the following Health Care Priorities:
    1. Social environment
    2. Built environment
    3. Housing
    4. Violence and trauma
    5. Employment, or
    6. Education

The DoN Program will evaluate accepted applications using the Determination of Need Factors set forth in 105 CMR 100.210.

Public Comment. The public is invited to submit comments on the proposed guidelines through the end of business on Monday, June 17, 2019. Comments should be submitted to [email protected].