H 5644

HOUSE . . . . . . . . No. 5644
  The Commonwealth of Massachusetts
  ________________________________________
  HOUSE OF REPRESENTATIVES, August 10, 2026.
    The committee on Health Care Financing, to whom was referred the
Bill relative to supported decision-making agreements for certain adults
(House, No. 4852), reports recommending that the same ought to pass
with an amendment substituting therefor the accompanying bill (House,
No. 5644) [Cost: Greater than $100,000.00].
  For the committee,
  JOHN J. LAWN, JR.
  FILED ON: 7/31/2026
HOUSE . . . . . . . . . . . . . . . No. 5644
  The Commonwealth of Massachusetts
  _______________
  In the One Hundred and Ninety-Fourth General Court
  (2025-2026)
  _______________
     An Act relative to supported decision-making agreements for certain adults.
  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, as appearing in the 2024 Official Edition,
2 is hereby amended by inserting after section 16F the following section:-
3Section 16F½. The executive office of health and human services shall establish a
4 training program on supported decision-making. The training program shall include instruction
5 by state agencies including, but not limited to, the department of developmental services, the
6 department of mental health and the executive office of elder affairs. The training program shall
7 be provided to any supporter or decision-maker pursuant to section 5-601 of chapter 190B and
8 shall include instruction on the rights and obligations contained in section 5-602 of chapter 190B
9 and dispute resolution. The executive office of health and human services shall consult with the
10 executive office of elder affairs, the department of developmental services, the department of
11 mental health, the department of public health, the Disability Law Center, the Massachusetts
12 Health and Hospital Association, the Massachusetts Medical Society, the Massachusetts Bankers
13 Association and adults who receive supported decision-making assistance and supporters who
14 assist in decision-making pursuant to a supported-decision making agreement in the development
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15 of the training. The training shall be in a format accessible to the individuals receiving the
16 training.
17SECTION 2. Section 2 of chapter 71B of the General Laws, as appearing in the 2024
18 Official Edition, is hereby amended by inserting, in line 86, after the words “et sec.” the
19 following sentence :- The department shall post a sample for a decision-maker to request the
20 release of educational records on the department’s website.
21SECTION 3. Section 3 of said chapter 71B of the General Laws, as so appearing, is
22 hereby amended by inserting, in line 301 after the word “program.” the following paragraph:-
23At the first individualized education program meeting held after a student attains 16 years
24 of age, the individualized education program team shall provide the student and the student's
25 parent, guardian or other authorized representative with information regarding alternatives to
26 guardianship, including supported decision-making agreements. Such information shall include
27 publicly available online resources maintained by the Massachusetts Office on Disability, in
28 consultation with the Office of Adult Guardianship and Conservatorship Oversight, The Arc of
29 Massachusetts, the Center for Public Representation, Massachusetts Advocates Standing Strong,
30 Massachusetts Association for Mental Health, the Massachusetts Developmental Disabilities
31 Council and other state agencies and organizations serving individuals with disabilities,
32 regarding supported decision-making, guardianship, conservatorship and other less restrictive
33 alternatives.
34SECTION 4. Section 5-303 of said chapter 190B, as appearing in the 2024 Official
35 Edition, is hereby amended by inserting, in line 50, after the words “why limited guardianship”,
36 the following words:- or a supported decision-making agreement.
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37SECTION 5. Subsection (b) of section 5-303 of said chapter 190B, as so appearing, is
38 hereby amended, by inserting after paragraph (9) the following paragraph:-
39(9½) a copy of any supported decision-making agreement executed by the person alleged
40 to be incapacitated, if available:-
41SECTION 6. Said section 5-303 of said chapter 190B is hereby further amended by
42 inserting after subsection (c) the following subsection:-
43(c) In determining whether the appointment of a guardian is necessary, the court may
44 consider the existence of a valid supported decision-making agreement executed pursuant to
45 section 5-602, together with any other less restrictive alternatives available to meet the
46 respondent's demonstrated needs.
47SECTION 7. Subsection (c)(3) of section 5-404 of said chapter 190B, as so appearing, is
48 hereby amended, by inserting after the word “conservatorship” in the first instance, the following
49 words:- “or a supported decision-making agreement”.
50SECTION 8. Subsection (b) of section 5-404 of said chapter 190B, as so appearing, is
51 hereby amended, by inserting after paragraph (8) the following paragraph:-
52(8½) a copy of any supported decision-making agreement executed by the person alleged
53 to be incapacitated, if available:
54SECTION 9. Chapter 190B, as so appearing, is hereby amended by inserting after
55 section 5-507 the following sections:-
56Section 5-601. Definitions:
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57As used in this section, the following words shall have the following meaning unless the
58 context clearly requires otherwise:
59“Adult”, an individual 18 years of age or older.
60“Coercion”, the use of force or threats to persuade someone to do something.
61“Decision-maker”, an adult who seeks to execute, or has executed, a supported decision-
62 making agreement with 1 or more supporters under this chapter.
63“Executed”, a supported decision-making agreement that is signed by both the decision
64 maker and all supporters in accordance with requirements set forth in this chapter.
65“Supported decision-making”, the process of supporting and accommodating the
66 decision-maker, without impeding the self-determination of the decision-maker, in making life
67 decisions, including, but not limited to: (i) decisions related to where the decision-maker wants
68 to live; (ii) the services, supports, financial decisions and medical care the decision-maker wants
69 to receive; (iii) whom the decision-maker wants to live with; and (iv) where the decision-maker
70 wants to work.
71“Supported decision-making agreement”, a voluntary, written agreement, written in plain
72 language that is accessible and understood by the decision-maker and entered into by the
73 decision-maker with one or more supporters pursuant to section 5-602 used to support decision-
74 making.
75“Supporter”, an adult who meets the requirements of section 5-602 and has executed a
76 supported decision-making agreement with a decision-maker.
77Section 5-602
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78(a) A decision-maker may voluntarily enter into a supported decision-making agreement
79 with 1 or more supporters.
80(b) The decision-maker may amend or terminate a supported decision-making agreement
81 at any time pursuant to section 5-602(3)(e).
82(1) Any person, eighteen years of age or older, may be a supporter.
83(2) A person shall not serve as a supporter in a supported decision-making agreement
84 when:
85(i) The decision-maker previously made, or makes, an allegation of elder abuse against
86 the supporter.
87(ii) The decision-maker has obtained or obtains a Protection from Abuse Order issued
88 under chapter 209A against the supporter or a harassment prevention order against the supporter
89 issued under chapter 258E of the General Laws.
90(iii) The supporter is the subject of a civil or criminal order prohibiting contact with the
91 decision-maker;
92(iv) The supporter has been removed as the conservator of the decision-maker, based
93 upon a finding that they did not act in the protected person’s best interest; or
94(v) The supporter is found criminally, civilly, or administratively liable for abuse,
95 neglect, mistreatment, coercion, or fraud.
96(3)(a) Except as limited by a supported decision-making agreement, a supporter shall do
97 all the following:
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98(i) Respect the values, beliefs, and preferences of the decision-maker.
99(ii) Act honestly, diligently, and in good faith.
100(iii) Act within the scope identified by the decision-maker.
101(iv) Support and implement the direction, will, and preferences of the decision-maker.
102(v) Maintain confidentiality of any information obtained by a supporter, unless the
103 decision-maker specifically authorizes its disclosure.
104(vi) Exercise only the authority granted to the supporter in the supported decision-making
105 agreement.
106(b) Except as limited by a supported decision-making agreement, a supporter may, with
107 the consent of the decision-maker, provide to the decision-maker decision-making assistance
108 regarding the decision-maker’s affairs, including, but not limited to: (i) communicating decisions
109 and understanding information about, options for, the responsibilities of and the consequences of
110 decisions; (ii) accessing, obtaining and understanding information that is relevant to decisions,
111 necessary for the decision-maker to manage their affairs, including, but not limited to, medical
112 records, including protected health information under the Health Insurance Portability and
113 Accountability Act of 1996 (Pub. L. 104-191); psychological records; financial records to the
114 extent provided in Subsection (c); educational records under the Family Education Rights and
115 Privacy Act of 1974 (20 U.S.C. s. 1232g), or information protected by 42 U.S.C.A. s. 290dd-2, 4
116 C.F.R. Part 2; as well as other educational records including Individualized Education Programs,
117 transcripts, a transition plan, a student summary of performance and any other materials as
118 requested; (iii) ascertaining the wishes and decisions of the decision-maker, assisting in
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119 communicating those wishes and decisions to other persons and assisting to ensure the decision-
120 maker’s wishes and decisions are implemented; and (iv) accompanying the decision-maker and
121 participating in discussions with other persons when the decision-maker is making decisions or
122 attempting to obtain information needed to make decisions.
123(c) A limited power of attorney is required for one or more supporters to access financial
124 records, including bank records of the decision-maker without the decision-maker. A supporter
125 may accompany a decision-maker and participate in discussions with banking personnel when
126 the decision-maker is making decisions or attempting to obtain banking related information
127 needed to make decisions.
128(d) Unless the supporter has a valid legal authorization to do so and the action is within
129 the scope of their authority, a supporter shall not do either of the following: (i) make decisions
130 for, or on behalf of, the decision-maker, or (ii) sign documents on behalf of the decision-maker.
131(e) A supporter shall not participate in any life decision in which they have a conflict of
132 interest. This includes, but is not limited to, any decision in which the supporter, his or her
133 immediate family or partner, a business organization in which he or she is serving as officer,
134 director, trustee, partner or employee has a financial interest or other direct and substantial
135 interest in the outcome.
136(f) A supporter shall only be authorized to assist the decision-maker in accessing,
137 collecting or obtaining information that is relevant to a decision authorized under the supported
138 decision-making agreement and to which the decision-maker agrees that the supporter should
139 have access pursuant to a written authorization in accordance with the applicable federal or state
140 privacy laws. The decision-maker may withdraw the authorization at any time in whatever
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141 manner is authorized by applicable state or federal law. A supporter shall keep confidential any
142 information obtained in the process of assisting the decision-maker.
143(g) A decision-maker may bring a civil action for damages and equitable relief, including
144 injunctive relief, resulting from a violation of this section or a regulation promulgated under this
145 section in any court of competent jurisdiction.
146(1) The existence of a supported decision-making agreement shall not preclude a
147 decision-maker from seeking personal information without the assistance of a supporter.
148(2) To be valid, a supported decision-making agreement shall be signed and dated by the
149 decision-maker and each applicable supporter in the presence of a notary public. The decision-
150 maker may use reasonable modifications, such as assistive technology or physical assistance, to
151 sign the agreement.
152(3) Evidence of undue influence or coercion in the creation or signing of a supported
153 decision-making agreement shall render the supported decision-making agreement invalid.
154(4) A supported decision-making agreement shall be personalized by the decision-maker
155 to reflect the decision-maker’s personal circumstances. A supported decision-making agreement
156 shall:
157(i) be in writing in plain language that is accessible and understood by the decision-
158 maker;
159(ii) identify the decision-maker and all supporters;
160(iii) describe the types of decisions with which each supporter shall assist the decision-
161 maker. If the decision-maker wants assistance to access their medical records, the agreement
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162 must specifically reference that the supporter shall have access to protected health information
163 under the Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191). If the
164 decision-maker wants assistance to access their education records, the agreement must
165 specifically reference that the supporter shall have access to protected education records under
166 the Family Education Rights and Privacy Act of 1974 (20 U.S.C. s. 1232g) or information
167 protected by 42 U.S.C. a. s. 290dd-2, 4 C.F.R. Part2; as well as other education records including
168 Individualized Education Programs, transcripts, a transition plan, a student summary of
169 performance and any other materials;
170(iv) indicate that all supporters agree to assist the decision-maker in making such
171 decisions, to respect the decision maker's decisions and to assist the decision-maker in
172 communicating such decisions;
173(v) state that supporters shall not make decisions for the decision-maker;
174(vi) indicate that the decision-maker may amend or terminate the supported decision-
175 making agreement at any time and for any reason subject to the requirements of section 5-
176 602(3)(e);
177(vii) list contact information for the disabled persons protection commission, the elder
178 abuse hotline and all programs providing services to the decision-maker; and
179(viii) include a statement from each supporter that they understand and accept their roles,
180 responsibilities and limitations as outlined in section 5-602(3)(a).
181(5) A person who receives the original or a copy of a supported decision-making
182 agreement shall rely on the agreement and recognize a decision, request or communication made
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183 with the decision-making assistance of a supporter as the decision, request or communication of
184 the decision-maker. A written confirmation from the decision-maker may be required affirming
185 that the supported decision-making agreement presented is current.
186(6) A person or entity that, in good faith, acts in reliance on a decision made pursuant to a
187 supported decision-making agreement shall not be subject to civil or criminal liability or to
188 professional discipline.
189(7)(a) The supported decision-making agreement shall remain in effect until it is
190 terminated or expires.
191(b) A supportive decision-making agreement shall be terminated as follows:
192(i) On any termination date set forth in the agreement but no more than a term of three
193 years, unless extended by agreement, in writing, of the decision-maker and supporters, pursuant
194 to section 5-602 with terms of execution.
195(ii) A supporter may terminate participation in a supported decision-making agreement at
196 any time, by written notice to the decision-maker and any other supporters to the agreement;
197 provided, however, that if the agreement has more than 1 supporter, the agreement shall remain
198 valid as to the remaining supporters.
199(iii) A decision-maker may terminate a supported decision-making agreement at any time
200 by written notice to all supporters to the agreement.
201(iv) Notice of the suspension of a supporter pursuant to section 5-602 shall be given in
202 writing and delivered in hand to said person or his or her attorney or sent by registered mail to
203 said person at his or her residence or his place of business. Such notice so given, delivered or
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204 sent shall automatically suspend the authority of such person to perform the duties of his or her
205 office or employment until he or she is notified in like manner that his or her suspension is
206 removed.
207(v) The death or incapacitation of the decision-maker.
208(vi) If the decision-maker becomes subject to a guardianship or conservatorship order or
209 decree, the probate and family court may limit the scope of the supported decision-making
210 agreement to the extent necessary to remain consistent with the authority granted under such
211 order or decree.
212(8)(a) The disabled persons protection commission, an elder protective services agency,
213 the department of developmental services, the department of mental health or any person
214 interested in the decision-maker's welfare may petition the probate and family court to revoke or
215 suspend the role of the supporter within one or more supported decision-making agreements on
216 the grounds of abuse, neglect, exploitation or failure of the supporter to follow their roles and
217 responsibilities resulting in serious physical, emotional, or financial harm to the decision-maker,
218 or on the grounds that the supporter is not qualified pursuant to section 5-602(2)(b). The court
219 shall provide notice to the decision-maker, the supporter who is the subject of the petition, any
220 other supporters identified in the supported decision-making agreement whose interests may be
221 affected by the petition and any other interested persons as determined by the court, and shall
222 provide the decision-maker and the supporter who is the subject of the petition an opportunity to
223 be heard. The court shall revoke or suspend the role of the supporter within the supported
224 decision-making agreement, in whole or in part, if the court makes a finding under any grounds
225 set forth in this paragraph. The court shall not order a supported decision-making agreement to
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226 remain in effect over the objection of the decision-maker. If the decision-maker is indigent, the
227 court shall appoint counsel for the decision-maker upon the filing of any petition under this
228 paragraph.
229Annually, as of June 30, the trial court shall report the number of petitions filed under this
230 subsection, the disposition of each petition, and the basis upon which each petition was granted
231 or denied, provided that no personally identifying information shall be included in the report.. A
232 report of the court’s findings shall be submitted to the clerks of the senate and house of
233 representatives, the joint committee on committee on children, families and persons with
234 disabilities and the senate house committees on ways and means.
235(b)(i) If a person who receives a copy of a supported decision-making agreement or is
236 aware of the existence of a supported decision-making agreement has cause to believe that the
237 decision maker is being abused, neglected or exploited by a supporter, the person may report the
238 alleged abuse, neglect or exploitation to the disabled persons protection commission pursuant to
239 chapter 19C or the elder abuse prevention hotline pursuant to chapter 19A.
240(ii) If a mandated reporter pursuant to subsection (a) of section 15 of said chapter 19A or
241 said chapter 19C has reasonable cause to believe that the decision-maker has been abused,
242 neglected or exploited by a supporter, the mandated reporter shall make a report to the disabled
243 persons protection commission or an elder protective services agency, as applicable.
244(iii) Execution of a supported decision-making agreement shall not be a condition of
245 participation in any activity, service or program.
246(iv) Nothing in this section shall be interpreted to limit or restrict the right of an
247 individual to execute a health care proxy pursuant to chapter 201D or a power of attorney.
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248SECTION 10. There shall be established pursuant to section 2A of chapter 4 of the
249 General Laws a special legislative commission, known as the Authorization Documents
250 Commission, to study, examine and make recommendations regarding: (i) the expansion of the
251 authorized state registry for health care authorizations to tally the number of individuals with a
252 supported decision-making agreement and that enables providers to verify that the supported
253 decision-making agreement presented by a decision-maker or a supporter is current; or (2) the
254 creation of one or more new online registries for authorizations for educational, financial, and
255 other information, including supported decision-making agreements and power of attorney
256 authorizations, and that enables providers to verify that the authorization, including supported
257 decision making agreements, presented is current.
258(a) The commission shall consist of: the chairs of the joint committee on children,
259 families and persons with disabilities, who shall serve as co-chairs; 1 member to be appointed by
260 the senate president; 1 member to be appointed by the speaker of the house of representatives; 1
261 member to be appointed by the minority leader of the senate; 1 member to be appointed by the
262 minority leader of the house of representatives; the secretary of health and human services or a
263 designee; the secretary of the executive office of technology services and security or a designee;
264 the commissioner of public health or a designee; the commissioner of the division of insurance
265 or designee; the commissioner of the division of banks or designee; the chief justice of the trial
266 court or a designee; the chief justice of probate and family court or a designee; 1 member
267 representing the Massachusetts Health and Hospital Association; 1 member representing the
268 Massachusetts Bankers Association; 1 member representing The Arc of Massachusetts; 1
269 member representing the Disability Law Center; and 1 individual who has lived experience
270 utilizing supported decision-making.
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271(b) State agencies shall make available to the commission any documents, data or
272 materials in a timely manner when reasonably requested by the commission.
273(c) The commission shall submit a report of its findings and recommendations to the
274 clerks of the senate and house of representatives, the joint committee on committee on children,
275 families and persons with disabilities and the senate and house committees on ways and means
276 not later than June 1, 2027.
277SECTION 11. A supported decision-making agreement executed before July 31, 2026,
278 shall be valid until July 31, 2027. Thereafter, only supported decision-making agreements that
279 conform to the requirements of section 5-602 of chapter 190B of the General Laws shall be
280 valid.
281SECTION 12. Section 3 shall take effect 6 months after the effective date of this Act.
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