H 5627

HOUSE . . . . . . . . . . . . . . No. 5627
  The Commonwealth of Massachusetts
  _______________
  The committee of conference on the disagreeing votes of the two branches with reference
to the Senate amendment (striking out all after the enacting clause and inserting in place thereof
the text contained in Senate document numbered 3183) of the House Bill to improve
Massachusetts home care (House, No. 4706, amended), reports recommending passage of the
accompanying bill (House, No. 5627). July 30, 2026.
  Thomas M. Stanley  William N. Brownsberger
  Frank A. Moran  Patricia D. Jehlen
  David F. DeCoste  Ryan C. Fattman
  FILED ON: 7/30/2026
HOUSE . . . . . . . . . . . . . . . No. 5627
  The Commonwealth of Massachusetts
  _______________
  In the One Hundred and Ninety-Fourth General Court
  (2025-2026)
  _______________
     An Act to improve Massachusetts home care.
  Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
     of the same, as follows:
1SECTION 1. Chapter 6A of the General Laws is hereby amended by inserting after
2 section 16GG the following 4 sections:-
3Section 16HH. For the purposes of this section and sections 16II to 16KK, inclusive, the
4 following words shall, unless the context clearly requires otherwise, have the following
5 meanings:
6“Abusive treatment”, physical, verbal or mental abuse, including, but not limited to,
7 bullying, either directed at or committed by individual home care consumers, surrogates, family
8 members, home care workers, other caregivers and any other individuals present in the home
9 care consumers’ household when the home care worker is providing home care services.
10“Executive office”, the executive office of health and human services.
11“Home care agency”, any business, including a sole proprietorship, nonprofit
12 organization or other entity that: (i) provides home care services to consumers in the consumers’
  1 of 18
13 residences for compensation; (ii) represents itself as a home care agency by name, advertising or
14 communications to the public, or uses the terms “home care agency” or “home care” in the
15 entity’s name; or (iii) procures, offers, refers, provides or attempts to provide home care services
16 by matching individuals seeking home care services to entities that provide home care services;
17 provided, however, that “home care agency” shall not include: (A) an entity operated by either
18 the federal government or the commonwealth that provides home care services; (B) an entity that
19 limits its business to the provision of house cleaning services; (C) an entity designated as an
20 aging services access point pursuant to section 4B of chapter 19A; (D) a hospice program
21 licensed under section 57D of chapter 111; or (E) a home health agency as defined in section
22 51K of chapter 111.
23“Home care consumer”, an individual receiving home care services or any legal
24 representative of such individual.
25“Home care services”, supportive services provided to an individual in their residence to
26 enable such individual to remain in their residence safely and comfortably, including, but not
27 limited to, assistance with eating, toileting, dressing, bathing, transferring, ambulation and other
28 activities of daily living, housekeeping, personal laundry and companionship; provided,
29 however, that “home care services” shall not include: (i) hospice services provided by an entity
30 subject to licensure under section 57D of chapter 111; (ii) home health services provided by an
31 entity subject to licensure under section 51K of chapter 111; (iii) services provided by a personal
32 care attendant in the commonwealth’s personal care attendant program as defined in 130 CMR
33 422.000; or (iv) services provided under the MassHealth adult foster care program as defined in
34 130 CMR 408.402.
  2 of 18
35“Home care worker”, an individual employed by a home care agency who provides home
36 care services to a consumer in the consumer’s residence.
37“PCA quality home care workforce council”, the council established in section 71 of
38 chapter 118E.
39“Personal care attendant”, as defined in section 70 of chapter 118E.
40“Surrogates”, as defined in section 70 of chapter 118E.
41"Violent act", any act involving: (i) an assault or other infliction or threat of infliction of
42 death or bodily harm; or (ii) damage to, or destruction of, real or personal property committed by
43 individual home care consumers, surrogates, family members, home care workers, other
44 caregivers and any other individuals present in the home care consumers’ household when the
45 home care worker is providing home care services.
46Section 16II. (a) No person or entity shall establish, maintain, operate or hold itself out as
47 a home care agency, provide home care services or use the words “home care” to describe its
48 services without a home care agency license issued pursuant to subsection (b); provided,
49 however, that home care agency licensure shall be required for home care agencies that directly
50 employ home care workers and home care agencies that contract with entities that employ home
51 care workers.
52(b)(1) The executive office shall issue for a term of 3 years, and may renew for like
53 terms, a home care agency license to any person or entity that the executive office deems
54 responsible and suitable to establish or maintain a home care agency and which meets the
  3 of 18
55 requirements of the rules and regulations promulgated pursuant to subsection (e). A license
56 issued under this subsection shall not be transferable or assignable.
57(2) The executive office may suspend, revoke or refuse to renew for cause a home care
58 agency license in accordance with regulations promulgated by the executive office pursuant to
59 subsection (e); provided, however, that the office shall provide home care agencies an
60 opportunity for appeal of such suspension, revocation or refusal of renewal.
61(3) License application and renewal fees shall be established pursuant to section 3B of
62 chapter 7.
63(c) If the executive office determines a licensee has failed or refused to comply with
64 requirements established under this section or the regulations promulgated thereunder, the
65 executive office may: (i) deny an application for licensure; (ii) modify, suspend or revoke a
66 license; or (iii) issue a fine of not more than $500 for each day of such failure or refusal to
67 comply.
68(d) The executive office, in collaboration with the executive office of aging and
69 independence and the department of public health, may conduct surveys and investigations to
70 monitor and enforce compliance with this section.
71(e)(1) The executive office shall, in consultation with the executive office of aging and
72 independence, the department of public health and the home care oversight advisory council
73 established in section 16KK, promulgate rules and regulations for the licensing and conduct of a
74 home care agency.
  4 of 18
75(2) The executive office shall ensure that home care agency licensure, reporting and
76 oversight requirements align with and avoid the duplication of licensure, reporting and oversight
77 requirements across the long-term care services and support system, including home health
78 agency licensure and provider monitoring conducted by aging services access points.
79(3) The regulations shall include, but shall not be limited to:
80(i) background checks for all home care workers which shall include, but shall not be
81 limited to: (A) Massachusetts criminal background checks; (B) state or county criminal history
82 checks for each location outside of the commonwealth in which the home care worker is known
83 to have lived or worked during the previous 5 years; (C) a review of the United States Office of
84 Inspector General List of Excluded Individuals/Entities; (D) a review of the nurse aide registry;
85 (E) if applicable, a review of professional certifications or other credentials; and (F) for all home
86 care workers who will transport home care consumers, verification of licensure, auto insurance
87 and driving records for not less than the previous 5 years;
88(ii) minimum standards for consumer-specific service plans and contracts that home care
89 agencies shall develop with home care consumers; provided, however, that the plans shall
90 include: (A) a detailed description of services, including services the home care agency is
91 subcontracting to another agency or provider; (B) a written unit rate and total cost of services,
92 inclusive of any additional fees or deposits; and (C) home care agency contact information for
93 consumer questions;
94(iii) minimum coverage requirements for workers’ compensation insurance and liability
95 insurance for the home care agency;
  5 of 18
96(iv) maintenance of a payroll process that follows all state and federal labor and wage
97 laws for the home care agency;
98(v) annual and ongoing training and competency requirements for home care workers and
99 home care agency staff that interact with home care consumers; provided, however, that
100 minimum training and competency requirements shall include: (A) confidentiality and privacy
101 rights of home care consumers; (B) infection control and communicable diseases; (C) handling
102 of emergencies, including safety and falls prevention; (D) observing, reporting and documenting
103 changes in home care consumer needs and environment; (E) identifying and reporting suspected
104 abuse, neglect or misappropriation of property; (F) understanding Alzheimer’s disease and
105 dementia, including person-centered care, activities of daily living, safety and dementia-related
106 behaviors and communication; and (G) employee rights and remedies under the
107 commonwealth’s wage and hour laws; provided further, that the trainings shall be culturally and
108 linguistically competent for the trainee;
109(vi) policies and procedures to ensure home care workers have safe working conditions,
110 adequate safety training and a process for submitting complaints;
111(vii) development and maintenance of an emergency preparedness plan;
112(viii) quality metrics and standards for services provided to home care consumers,
113 including reporting mechanisms for tracking performance of home care agencies;
114(ix) annual reporting by home care agencies on quality and any significant changes
115 related to home care agency finances;
  6 of 18
116(x) requirements and written processes for the timely reporting of home care consumer
117 complaints; and
118(xi) requirements for home care agencies to provide adequate equipment and supplies for
119 home care workers.
120(f) The executive office shall:
121(i) review and process licensure applications, including a suitability review that ensures
122 the applicant shall meet the obligations and conditions of licensure, including, but not limited to:
123(A) a review of the state debarment list maintained by the operational services division
124 and federal Office of Inspector General List of Excluded Individuals/Entities;
125(B) a competency review where all individuals with not less than a 5 per cent ownership
126 stake in the home care agency shall submit the individuals’ names, contact information,
127 companies where they have not less than a 5 per cent ownership interest, any civil or criminal
128 findings against said individual and a completed background check; and
129(C) a review to ensure that applicants have the financial capacity to provide ongoing
130 home care services while maintaining compliance with labor and employment laws;
131(ii) establish a process for a change of ownership that includes advanced notice to home
132 care consumers and home care workers and a review by the executive office to determine if the
133 new owner can meet the obligations and conditions of licensure, including a suitability review;
134(iii) work with other state agencies to investigate and resolve complaints against the
135 licensee; and
  7 of 18
136(iv) publicly post a list of licensed home care agencies on the executive office’s website.
137Section 16JJ. (a) The executive office, in consultation with the home care worker and
138 consumer abuse stakeholder advisory committee established in subsection (b), MassHealth, the
139 executive office of aging and independence, the department of public health and the PCA quality
140 home care workforce council, shall adopt minimum standards and procedures for addressing
141 abusive treatment of home care workers, personal care attendants and home care consumers in
142 the commonwealth. The standards and procedures shall: (i) address abusive treatment, including
143 the connection between abusive behavior by home care consumers and disruptive behavioral
144 disorders; (ii) recommend appropriate training and support for home care workers, personal care
145 attendants and home care consumers; (iii) ensure a safe and healthy work environment for home
146 care workers and personal care attendants; (iv) recognize the privacy rights of home care
147 consumers; and (v) recognize the responsibilities of the consumer-employers of personal care
148 attendants.
149(b) There shall be a home care worker and consumer abuse stakeholder advisory
150 committee within the executive office. The advisory committee shall advise the executive office
151 on addressing abusive treatment of home care workers, personal care attendants and home care
152 consumers and shall periodically conduct studies and issue reports containing its findings and
153 recommendations.
154(c) The advisory committee shall consist of the following members: the secretary of
155 aging and independence or a designee, who shall serve as chair; the assistant secretary for
156 MassHealth or a designee; the commissioner of public health or a designee; the chairs and
157 ranking minority members of the joint committee on aging and independence or their designees;
  8 of 18
158 and 10 persons to be appointed by the governor, 1 of whom shall be a personal care attendant, 1
159 of whom shall be a home care worker, 1 of whom shall be a consumer of personal care attendant
160 services who shall be a member of the PCA quality home care workforce council, 1 of whom
161 shall be a home care consumer, 1 of whom shall be a representative of the statewide independent
162 living council, 1 of whom shall be a representative of the Disability Law Center, Inc., 1 of whom
163 shall be a representative of Massachusetts Aging Access Association, Inc., 1 of whom shall be a
164 representative of the Home Care Aide Council, 1 of whom shall be a representative of the Home
165 Care Alliance of Massachusetts, Inc. and 1 of whom shall be a representative of the Local 1199
166 Service Employees International Union. The members of the advisory committee shall serve
167 without compensation.
168(d) The advisory committee shall advise the executive office on addressing abusive
169 treatment of home care workers, personal care attendants and home care consumers and shall
170 periodically conduct studies and issue reports containing its findings and recommendations,
171 which shall include, but shall not be limited to best practices and recommendations on:
172(i) reporting abusive treatment and post-incident debriefing of abusive treatment,
173 including best practices for standards and procedures for reporting abuse to the home care
174 workers’ employers or appropriate state entities, including, in the case of personal care
175 attendants, the PCA quality home care workforce council or MassHealth, without retaliation and
176 while retaining the right to report any criminal activity to law enforcement; provided, however,
177 that the standards shall include, but not be limited to, best practices for a debriefing process for
178 affected home care workers and home care consumers following abusive treatment and violent
179 acts;
  9 of 18
180(ii) tracking and retaining records of abusive treatment, including best practices for
181 standards and procedures for the executive office to track and monitor reports of both home care
182 worker abuse and reports of home care consumer abuse or neglect;
183(iii) informing home care workers and personal care attendants of potentially unsafe
184 working environments, including best practices for standards and procedures requiring
185 employers of home care workers or other appropriate state entities, including, in the case of
186 personal care attendants, the PCA quality home care workforce council or MassHealth, to
187 regularly inform home care workers of patterns of abusive treatment by home care consumers
188 that may indicate a potentially unsafe working environment; provided, however, that the
189 standards and procedures shall balance respect for home care consumer privacy with the need to
190 protect home care worker safety and ensure continuity of care;
191(iv) employee training, including best practices for standards and procedures for home
192 care consumer orientations and home care worker trainings on recognizing, preventing and
193 addressing abuse including: (A) abusive treatment in the home care setting; (B) escalation cycles
194 and effective de-escalation techniques; and (C) culturally competent and peer-to-peer trainings
195 and strategies to prevent physical harm with hands-on practice or role play; and
196(v) employer internal policies, including best practices for standards and procedures to:
197 (A) prevent abusive treatment among employees; (B) offer resources to employees for coping
198 with the effects of violence; and (C) develop labor-management workplace safety committees.
199(e) The advisory committee shall submit a report containing findings and
200 recommendations, including drafts of proposed legislation or regulatory changes to carry out its
201 recommendations, with the secretary of the executive office, the clerks of the house of
  10 of 18
202 representatives and the senate, the senate and house committees on ways and means, the joint
203 committee on aging and independence and the joint committee on public health.
204Section 16KK. (a) There shall be a home care oversight advisory council within the
205 executive office. The advisory council shall consist of the following members: the commissioner
206 of public health or their designee, who shall serve as chair; the secretary of aging and
207 independence or their designee; the assistant secretary for MassHealth or their designee; the
208 chairs and ranking minority members of the joint committee on aging and independence or their
209 designees; and 4 persons to be appointed by the governor, 1 of whom shall be a representative of
210 the Home Care Aide Council, 1 of whom shall be a representative of the Home Care Alliance of
211 Massachusetts, Inc., 1 of whom shall be a representative of Massachusetts Aging Access
212 Association, Inc. and 1 of whom shall be a representative of Local 1199 Service Employees
213 International Union.
214(b) The advisory council shall advise the executive office on the oversight of licensed
215 home care agencies and shall assist in the development and implementation of regulations
216 promulgated by the executive office pursuant to subsection (e) of section 16II. The advisory
217 council shall advise the executive office on:
218(i) the process of implementing home care agency licensure requirements in the
219 commonwealth pursuant to section 16II;
220(ii) existing licensure, reporting and oversight requirements across the long-term care
221 services and support systems and other relevant state agencies, including the provider monitoring
222 conducted by the aging services access points, to avoid duplication and conflicting requirements;
  11 of 18
223(iii) developments and trends in other states relative to the licensure of home care
224 agencies;
225(iv) processes to ensure that the home care agency licensure process shall align with and
226 avoid duplication of licensure for home health agencies and with state oversight process already
227 in place through the aging services access points, the home care worker registry established in
228 section 4D of chapter 19A and the nurse aide registry established in section 72J of chapter 111;
229(v) the development of a process for the commonwealth to conduct a statewide home care
230 market analysis and issue a report on current available home care services in all regions; and
231(vi) any additional subjects that the advisory council and the executive office deem
232 necessary and appropriate.
233SECTION 2. Section 4 of chapter 151B of the General Laws, as appearing in the 2024
234 Official Edition, is hereby amended by adding the following subsection:-
23520. It shall be unlawful discrimination for any individual consumer of services provided
236 by a personal care attendant, as defined in section 70 of chapter 118E, to engage in conduct
237 described in subsections 1 to 3, inclusive, subsections 4 to 5, inclusive, subsections 9A, 11A; 16,
238 16A and 19.
239SECTION 3. (a) There shall be a special legislative commission, pursuant to section 2A
240 of chapter 4 of the General Laws, to conduct a comprehensive study on family caregiving policy
241 in the commonwealth, including: (i) an evaluation of all state-funded efforts in caregiving
242 research, clinical care, institutional and home-based and community-based services and supports;
  12 of 18
243 and (ii) an investigation into the potential fiscal, access and quality impacts of allowing spouses
244 to serve as paid caregivers in the MassHealth program.
245(b) The special legislative commission shall consist of: the chairs of the joint committee
246 on aging and independence, who shall serve as co-chairs; 1 member of the senate to be appointed
247 by the senate president; 1 member of the house of representatives to be appointed by the speaker;
248 1 member of the senate appointed by the minority leader of the senate; 1 member of the house of
249 representatives appointed by the minority leader of the house of representatives; the secretary of
250 aging and independence or a designee; the secretary of health and human services, or a designee;
251 the commissioner of public health or a designee; the commissioner of the department of mental
252 health, or a designee; the commissioner of the department of developmental services, or a
253 designee; the assistant secretary for MassHealth or a designee; the secretary of labor and
254 workforce development or a designee; and 13 persons to be appointed by the governor in a
255 manner that promotes geographic and demographic diversity, 1 of whom shall be a family
256 caregiver advocate, 1 of whom shall be a family caregiver, 1 of whom shall be a health care
257 provider, 2 of whom shall be representatives of state-based academic institutions, 1 of whom
258 shall be a gerontologist, 1 of whom shall be a representative from the Association for Behavioral
259 Healthcare, Inc., 1 of whom shall be a representative from the Massachusetts chapter of the
260 American Association of Retired Persons, 1 of whom shall be a representative from the
261 Massachusetts Council for Adult Foster Care, Inc., 1 of whom shall be a representative from
262 Massachusetts Aging Access Association, Inc., 1 of whom shall be a representative from the
263 Association of Developmental Disabilities Providers, Inc., 1 of whom shall be a representative
264 from the Seven Hills Foundation, Inc., and 1 of whom shall be a representative from ARC
265 Massachusetts, Inc.
  13 of 18
266(c)(1) The study shall include, but not be limited to, an analysis of: (i) the anticipated
267 costs of allowing spouses to serve as paid caregivers in the MassHealth program; (ii) the
268 potential savings from supporting home-based care in lieu of institutional care; (iii) the
269 anticipated impact of allowing spouses to serve as paid caregivers in the MassHealth program to
270 access to care, quality of care and quality of life; (iv) the policies of other states regarding
271 spousal caregivers and the costs, savings, access, quality of care and quality of life impacts
272 associated with such policies; and (v) any federal approvals, statutory changes and regulatory
273 changes necessary for the commonwealth to allow spouses to serve as paid caregivers in the
274 MassHealth program.
275(2) The special legislative commission shall consult with the health policy commission
276 established under section 2 of chapter 6D of the General Laws. Notwithstanding any general or
277 special law to the contrary, the special legislative commission and the health policy commission
278 may request from the division of medical assistance, the center for health information and
279 analysis and the executive office of aging and independence any information necessary to
280 conduct the study required under this section, and each such agency shall provide the requested
281 information.
282(d) The special commission shall submit a report of its findings and recommendations to
283 the clerks of the senate and house of representatives, the senate and house committees on ways
284 and means, the joint committee on health care financing and the joint committee on aging and
285 independence by not later than July 1, 2027.
286SECTION 4. (a) There shall be a special commission to study and report on the creation
287 of a statewide long-term services and supports benefit program, which shall research, analyze
  14 of 18
288 and report on issues including, but not limited to: (i) incorporating a long-term services and
289 supports benefit program into existing state benefit plans; (ii) criteria for participation; (iii)
290 mandatory enrollment; (iv) providing individuals with functional or cognitive limitations with
291 nonmedical services and supports to help individuals remain in their communities; (v) offsetting
292 the cost of chronic and disabling conditions; (vi) expanding the options for individuals in need of
293 long-term services and supports, including, but not limited to, insurance options for the costs
294 associated with functional or cognitive disability; (vii) aligning with the MassHealth programs
295 and other publicly funded resources, including, but not limited to, the home care program under
296 section 4 of chapter 19A of the General Laws; and (viii) the demands on the long-term care
297 workforce and how such workforce can be prepared to meet future needs.
298(b) The commission shall consist of: the secretary of health and human services or
299 a designee, who shall serve as chair; the secretary of aging and independence or a designee; the
300 commissioner of insurance or a designee; the assistant secretary for MassHealth or a designee;
301 the chairs and ranking minority members of the joint committee on aging and independence or
302 their designees; the chairs and ranking minority members of the joint committee on financial
303 services or their designees; and 19 persons to be appointed by the governor, 1 of whom shall be a
304 representative of the Home Care Aide Council, 1 of whom shall be a representative of the Home
305 Care Alliance of Massachusetts, Inc., 1 of whom shall be a representative of Massachusetts
306 Aging Access Association, Inc., 1 of whom shall be a representative of the Massachusetts Senior
307 Care Association, Inc., 1 of whom shall be a representative of LeadingAge Massachusetts, Inc., 1
308 of whom shall be a representative of the Massachusetts Assisted Living Association, Inc., 1 of
309 whom shall be a representative of AARP Massachusetts, 1 of whom shall be a representative of
310 Local 1199 Service Employees International Union, 1 of whom shall be a representative of
  15 of 18
311 MassPACE, Inc., 1 of whom shall be a representative of the Massachusetts Academy of Elder
312 Law Attorneys, 1 of whom shall be a representative of Massachusetts Senior Action Council,
313 Inc., 1 of whom shall be a representative of Blue Cross Blue Shield of Massachusetts
314 Foundation, Inc., 1 of whom shall be a representative of the National Association of Insurance
315 and Financial Advisors of Massachusetts, Inc., 1 of whom shall be a representative of the
316 Massachusetts chapter of the Alzheimer’s Association, 1 of whom shall be a representative of
317 Life Insurance Association of Massachusetts, Inc., 1 of whom shall be a representative of the
318 Massachusetts Business Roundtable, Inc., 1 of whom shall be an actuary with experience in
319 long-term care insurance, 1 of whom shall be an expert on long-term care and aging policy and 1
320 of whom shall be an intergenerational advocate.
321(c) Prior to issuing the report required under this section, the commission shall review
322 the independent study for actuarial modeling of public, private and public-private hybrid long-
323 term care services and supports financing options to help individuals prepare for, access and
324 afford such services authorized in item 4000-0300 of chapter 28 of the acts of 2023. The
325 commission shall identify state resources to support any recommendations that would result in
326 increased costs to the commonwealth.
327(d) The commission shall submit a report containing its findings and
328 recommendations, including any proposed legislation, with the clerks of the senate and house of
329 representatives, the senate and house committees on ways and means, the joint committee on
330 aging and independence, the joint committee on health care financing and the joint committee on
331 financial services not later than 2 years after the effective date of this act.
  16 of 18
332SECTION 5. The executive office of health and human services shall promulgate
333 regulations for the temporary licensure of home care agencies and shall issue temporary licenses
334 for home care agencies within 180 days of the effective date of this act; provided, that the
335 executive office shall issue a temporary license to an applicant upon verification that the
336 applicant is currently contracted with an aging services access point or MassHealth. The
337 temporary licenses shall be valid until the date established by the executive office pursuant to
338 section 7 by which entities providing home care services shall be licensed as home care agencies.
339SECTION 6. The executive office of health and human services shall, in consultation
340 with the executive office of aging and independence, the department of public health and the
341 home care oversight advisory council established in section 16KK of chapter 6A of the General
342 Laws, inserted by section 1, adopt rules and promulgate regulations pursuant to subsection (e) of
343 section 16II of said chapter 6A, inserted by section 1, for the licensing and conduct of home care
344 agencies within 1 year of the effective date of this act.
345SECTION 7. The executive office of health and human services shall establish a date not
346 later than 1 year after adopting rules and promulgating regulations pursuant to this act by which
347 entities providing home care services shall be licensed as home care agencies.
348SECTION 8. The home care worker and consumer abuse stakeholder advisory committee
349 established in subsection (b) of section 16JJ of chapter 6A of the General Laws shall meet not
350 less than monthly in the first 6 months after the effective date of this act and shall file a report
351 containing its initial findings and recommendations not later than 6 months after the effective
352 date of this act.
  17 of 18
353SECTION 9. Members of the home care oversight advisory council established in section
354 16KK of chapter 6A of the General Laws shall be named and the council shall commence its
355 work within 60 days of the effective date of this act.
  18 of 18