December 19, 2016
Commissioner Monica Bharel, MD, MPH
Massachusetts Department of Public Health
250 Washington Street
Boston, MA 02108
Re: Long Term Care Regulations
Dear Commissioner Bharel:
I am writing to voice my strong opposition to the Department’s proposal to eliminate grandfather clauses relative to 105 CMR 151.000, which pertain to construction standards in long term facilities across the Commonwealth. I am concerned that by removing these grandfather protections for facilities dating back to 1968 or prior, many of these facilities will be forced to undertake very costly renovations. This would very likely represent a tremendous unfunded mandate, which apparently contradicts the compromise reached through the Americans with Disabilities Act of 1990 relative to older buildings that are not presently commencing major renovations.
Many of these nursing care facilities, which disproportionately take Medicaid patients who cannot otherwise afford private pay arrangements but whom are nevertheless provided high-quality 24/7 care as a last resort, already operate on razor thin financial margins. Given the State’s very poor Medicaid reimbursement rate for nursing care residents, these facilities can ill afford to consolidate beds, undertake massive new construction projects and still maintain mortgage payments. The immediate results of implementation of these regulatory changes would be massive staffing layoffs, the dislocation of patients due to new construction codes conflicting with the finite space of older facilities, outright closures, and mortgage defaults. This scenario would significantly worsen an already fragile economic landscape for many nursing care facilities in my district. These nursing care facilities currently operate under strong supervision from the state, and there are no indications that these older facilities are sacrificing quality care for their residents within the older building configurations. Therefore, what exactly is the impetus for these regulatory changes?
Rather than expunging outdated, cost prohibitive, duplicated and confusing regulations from the books, which we will all continue to support, these regulatory changes will have the complete opposite effect and will adversely impact hundreds, if not thousands, of nursing care residents. Therefore, I urge you to reverse course on these untimely, unfunded and economically unwise changes.
In closing, I wish to thank you in advance for your due diligence and careful review of all matters submitted to your purview.
Very truly yours,
John V. Fernandes
State Representative
10th Worcester District
JVF:krw