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An Act relative to promoting comprehensive transparency in the pharmaceutical industry | S732 | SD1754 | 193 | {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-18T16:13:20.143'} | [{'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-18T16:13:20.1433333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S732/DocumentHistoryActions | Bill | By Mr. Cronin, a petition (accompanied by bill, Senate, No. 732) of John J. Cronin for legislation to promote comprehensive transparency in the pharmaceutical industry. Health Care Financing. | SECTION 1. Section 1 of chapter 6D, as appearing in the 2016 Official Edition, is hereby amended by inserting after the definition of “Disproportionate share hospital” the following definition:-
“Early notice”, advanced notification by a pharmaceutical manufacturing company of a new drug, device or other development coming to market.
SECTION 2. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by inserting after the definition of “Performance penalty” the following 3 definitions:-
“Pharmaceutical manufacturing company”, any entity engaged in the production, preparation, propagation, compounding, conversion or processing of prescription drugs, either directly or indirectly, by extraction from substances of natural origin, or independently by means of chemical synthesis or by a combination of extraction and chemical synthesis, or any entity engaged in the packaging, repackaging, labeling, relabeling or distribution of prescription drugs; provided however, that “pharmaceutical manufacturing company” shall not include a wholesale drug distributor licensed pursuant to section 36A of chapter 112 or a retail pharmacist registered pursuant to section 38 of said chapter 112.
“Pharmacy benefit manager”, any person, business or entity, however organized, that administers, either directly or through its subsidiaries, pharmacy benefit services for prescription drugs and devices on behalf of health benefit plan sponsors, including, but not limited to, self-insured employers, insurance companies and labor unions.
“Pharmacy benefit services” shall include, but not be limited to: formulary administration; drug benefit design; pharmacy network contracting; pharmacy claims processing; mail and specialty drug pharmacy services; and cost containment, clinical, safety, adherence programs for pharmacy services. For the purposes of the chapter, a health benefit plan that does not contract with a pharmacy benefit manager shall be a pharmacy benefit manager.
SECTION 3. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by inserting after the definition of “Physician” the following definition:-
“Pipeline drugs”, which are defined as those drugs that contain a new molecular entity (“NME”) for which the sponsor has submitted a new drug application or biologics license application (“BLA”).
SECTION 4. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by inserting after the definition of “State Institution” the following definition:-
“Sponsor”, any person who submits an NDA (including a 505(b)(2) application), ANDA, BLA or an amendment or supplement to an NDA, ANDA, or BLA to obtain FDA approval of a new drug or FDA licensure of a biological product application and any person who owns an approved NDA (including a 505(b)(2) application), ANDA, or BLA.
SECTION 5. Section 4 of said chapter 6D, as so appearing, is hereby amended by striking out, in lines 6 and 7, the word “manufacturers” and inserting in place thereof the following words:- manufacturing companies, pharmacy benefit managers.
SECTION 6. Section 6 of said chapter 6D, as so appearing, is hereby amended by adding the following paragraph:-
To the extent that the analysis of spending trends with respect to pharmaceutical or biopharmaceutical products increases the expenses of the commission, such expenses shall be fully assessed to pharmaceutical manufacturing companies and pharmacy benefit managers. Any fees assessed by the commission under this section, when paid by every pharmaceutical manufacturing company and pharmacy benefit manager, shall not exceed the commission’s reasonable regulatory costs to analyze such spending trends, and in no event shall exceed $2000 annually as assessed against each such pharmaceutical manufacturing company and pharmacy benefit manager. A pharmacy benefit manager that is a surcharge payor subject to the preceding paragraph and administers its own prescription drug, prescription device or pharmacist services or prescription drug and device and pharmacist services portion shall not be subject to additional assessment under this paragraph.
SECTION 7. Section 8 of said chapter 6D, as so appearing, is hereby amended by inserting after the word “organization” , in lines 6 and 7, the following words:- , pharmacy benefit manager, pharmaceutical manufacturing company.
SECTION 8. Said section 8 of said chapter 6D, as so appearing, is hereby further amended by inserting after the word “organizations”, in line 14, the following words:- , pharmacy benefit managers, pharmaceutical manufacturing companies.
SECTION 9. Said section 8 of said chapter 6D, as so appearing, is hereby further amended by striking out, in lines 32 and 33 , the words “and (xi) any witness identified by the attorney general or the center” and inserting in place thereof the following words:- (xi) 2 pharmacy benefit managers; (xii) 3 pharmaceutical manufacturing companies, 1 of which shall be representative of a publicly traded company that manufactures specialty drugs, 1 of which shall be representative of and doing business in generic drug manufacturing and 1 of which shall have been in existence for fewer than 10 years; and (xiii) any witness identified by the attorney general or the center.
SECTION 10. Said section 8 of said chapter 6D, as so appearing, is hereby further amended by striking out, in line 48, the first time it appears, the word “and”.
SECTION 11. Said section 8 of said chapter 6D, as so appearing, is hereby further amended by inserting after the word “commission”, in line 59, the first time it appears, the following words:- ; and (iii) in the case of pharmacy benefit managers and pharmaceutical manufacturing companies, testimony that is suitable for public release and that is not likely to compromise the financial, competitive or proprietary nature of any information and data concerning factors underlying prescription drug costs and price increases; the impact of aggregate manufacturer rebates, discounts and other price concessions on net pricing; and any other matters as determined by the commission. No pharmaceutical manufacturing company identified as a witness under this section, or any testimony by any such company, shall be subject to the provisions of section 17 of chapter 12C.
SECTION 12. Subsection (g) of said section 8 of said chapter 6D, as so appearing, is hereby amended by striking out the second sentence and inserting in place thereof the following sentence:-
The report shall be based on the commission's analysis of information provided at the hearings by witnesses, providers, provider organizations, insurers, pharmaceutical manufacturing companies and pharmacy benefit managers, registration data collected pursuant to section 11, data collected or analyzed by the center pursuant to sections 8, 9, 10, 10A and 10B of chapter 12C and any other available information that the commission considers necessary to fulfill its duties in this section, as defined in regulations promulgated by the commission.
SECTION 13. Section 8A of chapter 6D is hereby deleted and replaced in its entirety with the following new section:-
Section 8A. (a) As used in this section, the following word shall, unless the context clearly requires otherwise, have the following meaning:
“Manufacturer”, an entity that manufactures a pharmaceutical drug covered by MassHealth.
“Rare disease”, any disease that affects fewer than 200,000 people in the United States, which has status as an "orphan" disease for research purposes, or is known to be substantially under diagnosed and unrecognized as a result of lack of adequate diagnostic and research information.
“Wholesale acquisition cost”, the cost of a prescription drug as defined in 42 U.S.C. §1395w-3a(c)(6)(B).
(b) The commission may require a manufacturer specified in subsection (c) to disclose to the commission within a reasonable time the following information relating to the manufacturer’s pricing of that drug, as applicable, on a standard reporting form developed by the commission with the input of the manufacturers:
(1) A schedule of the drug’s wholesale acquisition cost increases over the previous five calendar years if the drug was manufactured by the company;
(2) A written description suitable for public release of the specific financial and nonfinancial factors used to make the decision to increase the wholesale acquisition cost of the drug over the previous five calendar years including, but not limited to, an explanation of how these factors explain the increase in the wholesale acquisition cost;
(3) The manufacturer’s aggregate, company-level research and development and other relevant capital expenditures, including facility construction, for the most recent year for which final audited data are available;
(4) If the drug was acquired by the manufacturer within the previous 5 years, all of the following information:
(A) The wholesale acquisition cost at the time of acquisition and in the calendar year prior to acquisition.
(B) The name of the company from which the drug was acquired, the date acquired, and the purchase price.
(C) The year the drug was introduced to market and the wholesale acquisition cost at the time of introduction.
(5) The patent expiration date of the drug if it is under patent.
(6) If the drug is a multiple source drug, an innovator multiple source drug, a noninnovator multiple source drug, or a single source drug, as defined in subparagraph (A) of paragraph (7) of subdivision (k) of Section 1396r–8 of Title 42 of the United States Code.
(7) A description of the change or improvement in the drug, if any, that necessitates the price increase.
(8) Volume of sales of the drug in the US for the previous year.
(9) If the drug was approved during the preceding 5 calendar years, and the wholesale acquisition cost of the drug exceeded a current average annual gross cost per utilizer for public and private health care payers in Massachusetts of greater than $50,000 during the immediately preceding calendar year, all of the following information:
(A) A description of the marketing and pricing plans used in the launch of the drug in the US and internationally.
(B) The estimated volume of patients that are prescribed the drug.
(C) If the drug was granted breakthrough therapy designation or priority review by the Federal Food and Drug Administration prior to final approval.
(D) The date and price of acquisition if the drug was not developed by the manufacturer.
(10) Any other information that the manufacturer wishes to provide to the commission.
The manufacturer may limit the information reported pursuant to this section to that which is otherwise in the public domain or publicly available. Based on the records furnished, as well as any records relied upon by the executive office of health and human services in connection with the procedures under section 12A of chapter 118E and any other publicly available records, the commission may identify a proposed supplemental rebate, in consultation with the executive office, for a prescribed drug specified in subsection (c); provided that the proposed supplemental rebate may be based on a proposed value of the drug; and provided further, that the commission shall consider any proposed supplemental rebate framework or other information provided to the commission under subsection (g) of section 12A of chapter 118E.
(c) A manufacturer of the following prescribed drugs shall comply with the requirements set forth in this section: a drug for which the executive office was unable to successfully conclude supplemental rebate negotiations with the manufacturer under subsections (b) and (c) of section 12A of chapter 118E, and for which the commission has received notice from the executive office under subsection (g) of said section 12A of said chapter 118E.
(d) Records disclosed by a manufacturer under this section shall: (i) be accompanied by an attestation that all information provided is true and correct; (ii) not be public records under section 7 of chapter 4 or chapter 66; and (iii) remain confidential; provided, however, that the commission may produce reports summarizing any findings; provided that any such report shall not be in a form that identifies specific prices charged for or rebate amounts associated with drugs by a manufacturer, or in a manner that is likely to compromise the financial, competitive or proprietary nature of any information.
(e) If, after review of any records furnished to the commission under subsection (b), the commission determines that the manufacturer’s pricing of the drug is potentially unreasonable or excessive in relation to the commission’s proposed value under subsection (b), the commission shall, with 30 days’ advance notice to the manufacturer, request that the manufacturer provide, at the manufacturer’s discretion, further information related to the pricing of the prescribed drug and the manufacturer’s justification for the pricing. In addition to the manufacturer, the commission may identify other relevant parties including but not limited to patients, providers, provider organizations, external experts and payers who may provide information to the commission.
(f) Any information, analyses or reports regarding a particular drug reviewed or used in identifying the supplemental rebate or assessing the proposed value of the drug shall be provided to the manufacturer for review and input. The commission shall consider any clarifications or data provided by the manufacturer with respect to its drug. The commission may not base its determination on the supplemental rebate, the proposed value or the reasonableness of the drug pricing, solely on the analysis or research of an outside third party.
(g) If the commission relies upon a third party to provide cost-effectiveness analysis or research related to the proposed value, such analysis or research shall also provide, but not be limited in scope to, (i) a description of the methodologies and models used in its analysis; (ii) any assumptions and potential limitations of research findings in the context of the results; and (iii) outcomes for affected subpopulations that utilize the drug.
(h) (1) In connection with the identification of a proposed supplemental rebate or a proposed value for a drug that is approved for the treatment of a rare disease or that is otherwise identified as first-in-class, including without limitation any consultation with a third party to provide cost effectiveness analysis or research related to the proposed value for such a drug, the commission shall ensure that opportunities exist, at a time the commission determines appropriate, for consultations with stakeholders on the following topics:
(A) the disease treated by such drug;
(B) the severity of disease treated by such drug;
(C) the unmet medical need associated with the disease treated by such drug;
(D) the impact of particular coverage, cost-sharing, tiering, utilization management, prior authorization, medication therapy management, or other Medicaid policies on access to such drug;
(E) an assessment of the benefits and risks of such drug for patients;
(F) the impact of particular coverage, cost-sharing, tiering, utilization management, prior authorization, medication therapy management, or other policies on patients’ adherence to the treatment regimen prescribed or otherwise recommended by their physicians;
(G) Whether beneficiaries who need treatment from or a consultation with a rare disease specialist or a specialist in the disease being treated by the first-in-class drug have adequate access and, if not, what factors are causing the limited access; and
(H) the demographics and the clinical description of patient populations.
(2) The commission shall develop and maintain a list of external experts who, because of their special expertise, are qualified to provide advice on rare disease issues and topics described in subsection (h)(1) of this section. The commission may, when appropriate to address a specific question, consult such external experts when making a determination on a proposed supplemental rebate or proposed value of a drug approved for the treatment of a rare disease or that is designated first-in-class, when consultation is necessary because the commission lacks the specific scientific, medical, or technical expertise necessary for the performance of its responsibilities and the necessary expertise can be provided by the external experts.
(3) For purposes of this section, external experts are individuals who possess scientific or medical training that the commission lacks with respect to one or more rare diseases or the disease treated by the first-in-class therapy under review.
(i) Not later than 60 days after receiving information from the manufacturer, as required under subsection (b) or (e), the commission shall issue a determination on whether the manufacturer’s pricing of a drug subject to the supplemental rebate negotiation that resulted in the provision of notice under section 12A of chapter 118E is unreasonable or excessive in relation to the commission’s proposed value of the drug.
(j) If the manufacturer fails to timely comply with the commission’s request for records under subsections (b) or otherwise knowingly obstructs the commission’s ability to issue its determination under subsection (i), including, but not limited to, providing incomplete, false or misleading information, the commission may impose appropriate sanctions against the manufacturer, including reasonable monetary penalties not to exceed $500,000, in each instance. The commission shall seek to promote compliance with this section and shall only impose a civil penalty on the manufacturer as a last resort.
(k) The commission shall adopt any written policies, procedures or regulations the commission determines necessary to implement this section.
SECTION 14. Section 9 of said chapter 6D, as so appearing, is hereby amended by inserting after the word “organization”, in line 72, the following words:- , pharmacy benefit manager, pharmaceutical manufacturing company.
SECTION 15. Said chapter 6D is hereby further amended by adding the following section:-
Section 20. (a) In the course of its duties the commission may contract with a third-party entity, such as an accounting firm, to conduct an annual study of pharmaceutical or biopharmaceutical companies with pipeline drugs, generic drugs or biosimilar drugs that may have a significant impact on state health care expenditures.
(b) For purposes of this section, early notice as described in subsections (c) and (d) shall be provided in the timeframes set forth in subsection (e) for the following:
(1) Pipeline drugs, which are defined as those drugs that contain a new molecular entity (“NME”) for which the sponsor has submitted a new drug application or biologics license application (“BLA”);
(2) All abbreviated new drug applications for generic drugs; and
(3) All biosimilar biologics license applications,
(c) In connection with the annual study, if requested, the applicant for a pipeline brand, biosimilar or generic drug shall provide notice to the contracted third-party entity with a brief description of the following for each drug, using data fields consistent with those employed by the United States National Institutes of Health in clinicaltrials.gov, if applicable:
(1) The primary disease, health condition or therapeutic area being studied and the indication;
(2) The routes of administration being studied;
(3) Clinical trial comparators, if applicable; and
(4) Estimated year of market entry or applicable FDA user fee action date, per the discretion of the manufacturer.
(d) As part of such submission, manufacturers shall also report the receipt of any of the following designations from the FDA for each pipeline drug:
(1) Orphan Drug;
(2) Fast Track;
(3) Breakthrough Therapy;
(4) Accelerated Approval; or
(5) Priority Review for New Molecular Entities (“NMEs”).
(e) The data submissions required by this section shall be submitted to the contracted third-party entity no later than 60 days after receipt of the FDA user fee action date
(1) Notwithstanding the foregoing, for drugs in development that receive any of the FDA designations listed in subsection (d) for NMEs, such submissions shall be provided as soon as practical upon receipt of the relevant designation.
(f) Notwithstanding any provision of law to the contrary, information provided to the contacted third-party entity or to the Secretary pursuant to this section, any analysis of such information, and any resulting study or studies shall be considered to be a trade secret and confidential commercial information, and shall not be a public record pursuant to clause Twenty-sixth of section 7 of chapter 4 or chapter 66, and shall not be subject to public inspection, and shall not be released in a manner that would allow for the identification of an individual drug, therapeutic class of drugs, or manufacturer, or in a manner that is likely to compromise the financial, competitive, or proprietary nature of the information. Information disclosed pursuant to this section and any analyses of such information shall be used only by the contracted third-party entity or by the Secretary, and shall be used only for development of the study described in (a).
SECTION 16. Section 11N of chapter 12 of the General Laws, as so appearing, is hereby amended by striking out subsection (a) and inserting in place thereof the following subsection:-
(a) The attorney general shall monitor trends in the health care market including, but not limited to, trends in provider organization size and composition, consolidation in the provider market, payer contracting trends, patient access and quality issues in the health care market and prescription drug cost and price trends. The attorney general may obtain the following information from a private health care payer, public health care payer, pharmacy benefit manager, provider or provider organization, as any of those terms may be defined in section 1 of chapter 6D: (i) any information that is required to be submitted pursuant to sections 8, 9, 10 and 10B of chapter 12C; (ii) filings, applications and supporting documentation related to any cost and market impact review pursuant to section 13 of said chapter 6D; (iii) filings, applications and supporting documentation related to a determination of need application filed pursuant to section 25C of chapter 111; and (iv) filings, applications and supporting documentation submitted to the federal Centers for Medicare and Medicaid Services or the Office of the Inspector General for any demonstration project. Pursuant to section 8 of said chapter 6D and section 17 of said chapter 12C, and subject to the limitations in said sections, the attorney general may require that any provider, provider organization, pharmacy benefit manager, private health care payer or public health care payer produce documents, answer interrogatories and provide testimony under oath related to health care costs and cost trends, the factors that contribute to cost growth within the commonwealth's health care system and the relationship between provider costs and payer premium rates.
SECTION 17. Section 1 of chapter 12C of the General Laws, as so appearing, is hereby amended by inserting after the definition of “Patient-centered medical home” the following 3 definitions:-
“Pharmaceutical manufacturing company”, any entity engaged in the production, preparation, propagation, compounding, conversion or processing of prescription drugs, either directly or indirectly, by extraction from substances of natural origin, or independently by means of chemical synthesis or by a combination of extraction and chemical synthesis, or any entity engaged in the packaging, repackaging, labeling, relabeling or distribution of prescription drugs; provided however, that “pharmaceutical manufacturing company” shall not include a wholesale drug distributor licensed pursuant to section 36A of chapter 112 or a retail pharmacist registered pursuant to section 38 of said chapter 112.
“Pharmacy benefit manager”, any person, business, or entity, however organized, that administers, either directly or through its subsidiaries, pharmacy benefit services for prescription drugs and devices on behalf of health benefit plan sponsors, including, but not limited to, self-insured employers, insurance companies and labor unions;
“Pharmacy benefit services” shall include, but not be limited to, formulary administration; drug benefit design; pharmacy network contracting; pharmacy claims processing; mail and specialty drug pharmacy services; and cost containment, clinical, safety, and adherence programs for pharmacy services. For the purposes of this section, a health benefit plan that does not contract with a pharmacy benefit manager shall be a pharmacy benefit manager, unless specifically exempted.
SECTION 18. Said section 1 of said chapter said 12C, as so appearing, is hereby further amended by adding the following definition:-
“Wholesale acquisition cost”, the cost of a prescription drug as defined in 42 U.S.C. §1395w-3a(c)(6)(B).
SECTION 19. Section 3 of said chapter 12C, as so appearing, is hereby amended by inserting after the word “organizations”, in lines 13 and 14, the following words:- , pharmaceutical manufacturing companies, pharmacy benefit managers.
SECTION 20. Said section 3 of said chapter 12C, as so appearing, is hereby further amended by striking out, in line 24, the words “and payer” and inserting in place thereof the following words:- , payer, pharmaceutical manufacturing company and pharmacy benefit manager.
SECTION 21. Section 5 of said chapter 12C, as so appearing, is hereby amended by inserting after the word “organizations”, in line 11, the following words:- , pharmaceutical manufacturing companies, pharmacy benefit managers.
SECTION 22. Said section 5 of said chapter 12C, as so appearing, is hereby further amended by inserting after the word “providers”, in line 15, the following words:- , affected pharmaceutical manufacturing companies, affected pharmacy benefit managers.
SECTION 23. Section 7 of said chapter 12C, as so appearing, is hereby further amended by adding the following paragraph:-
To the extent that the analysis and reporting activities pursuant to sections 10A or 10B increases the expenses of the center, the estimated increase in the center’s expenses shall be fully assessed to pharmaceutical manufacturing companies and pharmacy benefit managers. Any fees assessed by the center under this section, when paid by every pharmaceutical manufacturing company and pharmacy benefit manager, shall not exceed the center’s actual and reasonably regulatory costs to implement and enforce sections 10A or 10B, and in no event shall exceed $2000 annually as assessed against each such pharmaceutical manufacturing company and pharmacy benefit manager.
SECTION 24. Said chapter 12C is hereby further amended by inserting after section 10 the following 2 sections:-
Section 10A. (a) On or before March 1, 2026, and annually thereafter, the center shall prepare a list of not more than ten outpatient prescription drugs that the center determines account for a significant share of state health care spending, considering the net cost of such drugs in the immediately preceding calendar year. The list shall include outpatient prescription drugs from different therapeutic classes and no more than three generic outpatient prescription drugs. The center shall not list any outpatient prescription drug pursuant to this subsection unless the wholesale acquisition cost of the prescription drug, less all rebates paid to the commonwealth for such drug during the immediately preceding calendar year, increased by not less than 25 per cent during the immediately preceding calendar year.
(b) The pharmaceutical manufacturing company that manufacturers a prescription drug included on a list prepared by the center pursuant to subsection (a) shall provide to the center the following:
(i) a written, narrative description, suitable for public release, of factors that caused the increase in the wholesale acquisition cost of the listed prescription drug; and
(ii) aggregate, company-level research and development costs and such other capital expenditures that the center deems relevant for the most recent year for which final audited data is available.
(c) The quality and types of information and data that a pharmaceutical manufacturing company submits to the center pursuant to this section shall be consistent with the quality and types of information and data that the pharmaceutical manufacturing company includes in: (i) such pharmaceutical manufacturing company’s annual consolidated report on Securities and Exchange Commission Form 10-K or (ii) any other public disclosure.
(d) The center shall consult with pharmaceutical manufacturing companies to establish a single, standardized form for reporting information and data pursuant to this section. The form shall minimize the administrative burden and cost imposed on the center and pharmaceutical manufacturing companies.
(e) The center shall compile an annual report based on the information that the center receives pursuant to subsection (b). The center shall post such report and the information described in this subsection on the center's website on or before October 1 of each year.
(f) Except as otherwise provided in this section, information and data submitted to the center pursuant to this section shall not be a public record and shall be exempt from disclosure pursuant to clause Twenty-sixth of section 7 of chapter 4 or section 10 of chapter 66. No such information and data shall be disclosed in a manner that may compromise the financial, competitive or proprietary nature of such information and data, or that would have enable a third party to identify an individual drug, therapeutic class of drugs or pharmaceutical manufacturing company the prices charged for any particular drug or therapeutic class of drugs, or the value of any rebate or discount provided for any particular drug or class of drugs.
Section 10B. The center shall promulgate regulations necessary to ensure the uniform analysis of information regarding pharmacy benefit managers that enables the center to analyze: (1) year-over-year wholesale acquisition cost changes; (2) year-over-year trends in formulary, maximum allowable costs list and cost-sharing design, including the establishment and management of specialty product lists; (3) aggregate information regarding discounts, utilizations limits, rebates, manufacturer administrative fees and other financial incentives or concessions related to pharmaceutical products or formulary programs; (4) information regarding the aggregate amount of payments made to pharmacies owned or controlled by the pharmacy benefit managers and the aggregate amount of payments made to pharmacies that are not owned or controlled by the pharmacy benefit managers; (5) pharmacy benefit manager practices related to spread pricing, administrative fees, clawbacks and formulary placement; and (6) additional information deemed reasonable and necessary by the center as set forth in the center’s regulations.
(b) Not later than March 1 of each year, each pharmacy benefit manager shall file a report with the center. The report must state for the immediately preceding calendar year:
(1) the aggregated rebates, fees, price protection payments, and any other payments collected from pharmaceutical drug manufacturers; and
(2) the aggregated dollar amount of rebates, fees, price protection payments, and any other payments collected from pharmaceutical drug manufacturers that were:
(A) passed to:
(i) health plan issuers; or
(ii) enrollees at the point of sale of a prescription drug; or
(B) retained as revenue by the pharmacy benefit manager.
(b) A report submitted by a pharmacy benefit manager may not disclose the identity of a specific health plan or enrollee, the price charged for a specific prescription drug or class of prescription drugs, or the amount of any rebate or fee provided for a specific prescription drug or class of prescription drugs.
(c) Not later than June 1 of each year, the center shall publish the aggregated data from all reports for that year required by this section in an appropriate location on the center’s website. The combined aggregated data from the reports must be published in a manner that does not disclose or tend to disclose proprietary or confidential information of any pharmacy benefit manager, and any such information shall not be a public record and shall be exempt from disclosure pursuant to clause Twenty-sixth of section 7 of chapter 4 or section 10 of chapter 66.
SECTION 25. Section 11 of said chapter 12C, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:-
The center shall ensure the timely reporting of information required pursuant to sections 8, 9, 10, 10A, and 10B.
SECTION 26. Said section 11 of said chapter 12C, as so appearing, is hereby further amended by striking out, in line 11, the figure “$1,000” and inserting in place thereof the following figure:- $5,000.
SECTION 27. Said section 11 of said chapter 12C, as so appearing, is hereby further amended by striking out, in line 16, the figure “$50,000” and inserting in place thereof the following figure:- $200,000.
SECTION 28. Section 12 of said chapter 12C, as so appearing, is hereby amended by striking out, in line 2, the words “9, and 10” and inserting in place thereof the following words:- 9, 10, 10A and 10B.
SECTION 29. Subsection (a) of section 16 of said chapter 12C, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:- The center shall publish an annual report based on the information submitted pursuant to sections 8, 9, 10, 10A and 10B concerning health care provider, provider organization, pharmaceutical manufacturing company, pharmacy benefit manager and private and public health care payer costs and cost and price trends, pursuant to section 13 of chapter 6D relative to market impact reviews and pursuant to section 15 relative to quality data.
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An Act expanding affordable coverage through ConnectorCare | S733 | SD1950 | 193 | {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-19T20:49:02.443'} | [{'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-19T20:49:02.4433333'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-01-27T12:58:06.2533333'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-27T12:58:06.2533333'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-30T12:56:51.83'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-07T16:18:19.27'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-20T11:32:25.0233333'}, {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-02-23T08:37:13.9833333'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-03-13T10:11:33.8'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-03-24T10:06:27.1'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-12T09:36:42.1366667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S733/DocumentHistoryActions | Bill | By Mr. Cronin, a petition (accompanied by bill, Senate, No. 733) of John J. Cronin, Susannah M. Whipps, Joanne M. Comerford, Jack Patrick Lewis and other members of the General Court for legislation to expand affordable coverage through ConnectorCare. Health Care Financing. | SECTION 1. (a) Notwithstanding clause (b) of section 3 of chapter 176Q of the General Laws or any other general or special law to the contrary, the commonwealth health insurance connector authority established in section 2 of said chapter 176Q shall implement a 5-year pilot program to extend eligibility for premium assistance payments or point-of-service cost-sharing subsidies for applicants at or below 500 percent of the federal poverty guidelines.
(b) Applicants participating in the pilot program that are between 300 and 500 percent of the federal poverty guidelines shall have access to a plan that meets at least 90 per cent actuarial value; provided, that the affordability standard for the pilot program shall be consistent with current practices pursuant to said section 3 of said chapter 176Q.
(c) Notwithstanding the second paragraph of section 2OOO of chapter 29 of the General Laws or any other general or special law to the contrary, amounts necessary to support the 5-year pilot program established in subsection (a) shall be expended from the Commonwealth Care Trust Fund established in said section 2OOO of said chapter 29.
(d) The commonwealth health insurance connector authority, in consultation with the center for health information and analysis, shall evaluate the pilot program to assess the public health, health equity, utilization and financial impacts on residents of reducing out-of-pocket costs and premium costs. The center shall collect quantitative and qualitative data at the start of the pilot program and at the end of each year of the pilot program to assess the impact on pilot program participants. Data points to be collected shall include, but not be limited to: (i) rates of unmet medical need due to cost; (ii) disparities in rates of unmet medical need due to cost; (iii) difficulties accessing care at a doctor’s office or clinic; (iv) racial and ethnic disparities in difficulties accessing care at a doctor’s office or clinic; (v) insurance coverage rates, including rates of continuous insurance coverage; (vi) racial and ethnic disparities in insurance coverage rates; (vii) visits to a doctor’s office; and (viii) racial and ethnic disparities in visits to a doctor’s office. The connector authority shall file reports of its evaluation with the clerks of the house of representatives and the senate, the house and senate committees on ways and means, the joint committee on public health and the joint committee on health care financing not later than December 1, 2026 and December 1, 2029.
SECTION 2. Section 1 shall take effect on Jan 1, 2024.
SECTION 3. Section 1 shall be repealed on Dec 31, 2028.
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An Act updating high-cost hospital and Health Policy Commission system accountability | S734 | SD1953 | 193 | {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-19T20:47:35.137'} | [{'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-19T20:47:35.1366667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-02-20T11:32:06.82'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S734/DocumentHistoryActions | Bill | By Mr. Cronin, a petition (accompanied by bill, Senate, No. 734) of John J. Cronin and Joanne M. Comerford for legislation to update high-cost hospital and Health Policy Commission system accountability. Health Care Financing. | SECTION 1. Section 10 of chapter 6D of the General Laws as so appearing in the 2020 Official Edition, is hereby amended by striking clause (6) of subsection (f) and inserting in place thereof the following 2 clauses:-
(6) The payer mix of the population served by the entity and the demographics of the population served including but not limited to the underlying risk of the population.
(7) any other factors the commission considers relevant.
SECTION 2. Subsection (q) of said section 10 of said chapter 6D of the General Laws, as so appearing in the 2020 Official Edition, is hereby amended by striking the figure “$500,000” and inserting in place thereof the following words:-
A sum commensurate with the amount that the spending for the entity’s members or patients exceeded the benchmark as established under section 9A in the relevant year or years.
SECTION 3. Section 18 of chapter 12C of the General Laws, as so appearing in the 2020 Official Edition, is hereby amended by striking the words “health status adjusted”.
SECTION 4. Chapter 12C of the General Laws, is hereby further amended by inserting after section 18 the following section:-
Section 18A. The center shall additionally perform analysis of data it receives under this chapter to identify hospitals whose contribution to spending growth is considered excessive and who threaten the ability of the state to meet the health care cost growth benchmark established by the health policy commission under section 10 of chapter 6D. The center shall additionally perform analysis to identify hospitals whose relative prices are in the top quartile and whose relative price values within a payer’s network have increased. The center shall confidentially provide a list of said hospitals identified under this section to the health policy commission such that the authority may pursue further action under section 10 of chapter 6D.
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An Act providing affordable care through out-of-pocket assistance | S735 | SD1954 | 193 | {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-19T20:52:13.767'} | [{'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-19T20:52:13.7666667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-02-28T10:42:59.2'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-12T09:36:27.3966667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S735/DocumentHistoryActions | Bill | By Mr. Cronin, a petition (accompanied by bill, Senate, No. 735) of John J. Cronin and Joanne M. Comerford for legislation to provide affordable care through out-of-pocket assistance. Health Care Financing. | SECTION 1. (a) Notwithstanding any other general or special law to the contrary, the Secretary of Health and Human Services, in consultation with the commonwealth health insurance connector authority established in section 2 of chapter 176Q shall implement a cost-sharing assistance program for applicants at or below 500 percent of the federal poverty guidelines enrolled in employer-sponsored insurance plans.
(b) Applicants shall be deemed eligible for the cost-sharing assistance program established under subsection (a) of section 1 if they meet the following criteria: (1) have income under 500 percent of the federal poverty level; and (2) are enrolled in an employer sponsored health insurance plan that meets the criteria for minimum value and affordable coverage under U.S. Code section 36B(c)(2)(C).
(c) The cost-sharing assistance program established under subsection (a) shall provide supplemental insurance coverage to eligible applicants that covers the differences in cost-sharing, including co-pays, co-insurance, and deductibles, between the employer plan in which the applicant is enrolled, and a plan equivalent to plans sold through the connector that are eligible for premium assistance payments or cost sharing subsidies under section 3 of Chapter 176Q.
(d) The commonwealth health insurance connector authority, in consultation with the center for health information and analysis, shall evaluate the cost assistance program to assess the public health, health equity, utilization and financial impacts on residents of reducing out-of-pocket costs. The center shall collect quantitative and qualitative data at the start of the program and at the end of each year of the program to assess the impact on program participants. Data points to be collected shall include, but not be limited to: (i) rates of unmet medical need due to cost; (ii) disparities in rates of unmet medical need due to cost; (iii) difficulties accessing care at a doctor’s office or clinic; (iv) racial and ethnic disparities in difficulties accessing care at a doctor’s office or clinic; (vii) visits to a doctor’s office; and (viii) racial and ethnic disparities in visits to a doctor’s office. The connector authority shall file a report of its evaluation with the clerks of the house of representatives and the senate, the house and senate committees on ways and means, the joint committee on public health and the joint committee on health care financing not later than December 1, 2029.
SECTION 2. Section 1 shall take effect on Jan 1, 2026.
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An Act relative to the closing of hospital essential services | S736 | SD379 | 193 | {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-13T17:27:12.683'} | [{'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-13T17:27:12.6833333'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-01-25T11:45:54.84'}, {'Id': 'AJS1', 'Name': 'Adam Scanlon', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJS1', 'ResponseDate': '2023-01-25T11:45:54.84'}, {'Id': 'JCV0', 'Name': 'John C. Velis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JCV0', 'ResponseDate': '2023-01-25T11:42:30.7666667'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-01-25T15:09:29.17'}, {'Id': 'E_U1', 'Name': 'Erika Uyterhoeven', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/E_U1', 'ResponseDate': '2023-01-26T11:30:53.2933333'}, {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-01-26T11:30:53.2933333'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-26T11:30:53.2933333'}, {'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-01-26T11:30:53.2933333'}, {'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-02-07T16:35:11.6866667'}, {'Id': 'MRP0', 'Name': 'Marc R. Pacheco', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MRP0', 'ResponseDate': '2023-02-07T16:35:11.6866667'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-07T16:35:11.6866667'}, {'Id': 'MFR0', 'Name': 'Michael F. Rush', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MFR0', 'ResponseDate': '2023-02-07T16:35:11.6866667'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-07T16:35:11.6866667'}, {'Id': 'PMP0', 'Name': 'Pavel M. Payano', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMP0', 'ResponseDate': '2023-02-07T16:35:11.6866667'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-22T13:52:37.6033333'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-02-22T13:52:37.6033333'}, {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-02-22T13:52:37.6033333'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-03-07T16:12:40.35'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-03-14T11:40:08.7466667'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-03-14T14:27:05.2966667'}, {'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-04-14T17:45:03.07'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-04-14T17:45:03.07'}, {'Id': 'M_C3', 'Name': 'Manny Cruz', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/M_C3', 'ResponseDate': '2023-04-24T16:05:04.7733333'}, {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-06-15T14:00:33.5966667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S736/DocumentHistoryActions | Bill | By Mr. Cyr, a petition (accompanied by bill, Senate, No. 736) of Julian Cyr, John C. Velis, Michael D. Brady, Adam Scanlon and other members of the General Court for legislation relative to the closing of hospital essential services. Health Care Financing. | SECTION 1. Chapter 111 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking subsection (4) of section 51G and inserting in place thereof the following section:
(4) (a) A hospital shall notify the department of a proposed closure at least one calendar year in advance of the date of the proposed closure or discontinuance of an essential health service.
(b) At least 30 days prior to notifying the department of the proposed closure or discontinuance of an essential health service, the hospital shall inform either electronically or in writing the Department and the following parties of its intent to submit notice to close a service: (a) The hospital’s patient and family council; (b) Each staff member of the hospital; (c) Every labor organization that represents the hospital’s workforce during the period of the essential services closure; (d) The members of the General Court who represent the city or town in which the hospital is located; and; (e) A representative of the local officials of the city or town in which the hospital is located. The department shall define essential services according to 105 CMR 130.
(c) At least 30 days prior to notifying the department of the proposed closure of an essential health service, a detailed account of any community engagement and planning which has occurred prior to such filing, and such other information as the Commissioner may require shall be presented to the department. With respect to the proposed closure of an essential health service, the hospital shall also send a copy of the notice that it submits to the Department to the Health Policy Commission, Office of the Attorney General, Center for Health Information and Analysis, and Executive Office of Labor and Workforce Development as well as each of the health care coalitions and community groups identified by the hospital in its notice to the department.
(d) The hospital proposing the discontinuance shall provide, with their initial notice to the department, evidence of support or non-opposition to the proposed change from each municipality to which it provides the service as a health care resource, as determined pursuant to section 16T of chapter 6A of the General Laws, or, if a statement of non-opposition cannot be obtained, evidence of having given notice and allowed an opportunity for comment from said municipalities. Any information given without meeting the requirements of this paragraph shall not constitute notice to the department for the purpose of establishing the earliest date on which the hospital may close or discontinue an essential health service.
(e) The department shall, in the event that a hospital proposes to discontinue an essential health service or services, determine whether any such discontinued services are necessary for preserving access and health status in the hospital’s service area, require the hospital to submit a plan for assuring access to such necessary services following the hospital’s closure of the service, and assure continuing access to such services in the event that the department determines that their closure will significantly reduce access to necessary services. This plan shall include the creation of a community oversight committee comprised of a representative from each municipality to which the hospital provides the service as a health care resource as well as non-managerial employees, including registered nurses and ancillary staff, from the hospital, and a representative from a local interfaith organization to ensure that any plan approved by the department is followed. The community oversight group shall inform the department in the event the plan is not executed and followed by the hospital. If the hospital's plan for assuring continued access to a necessary service relies upon the availability of similar services at another hospital or health facility with which it does not share common ownership, the department shall require the hospital to submit with said plan a statement from each other hospital or health facility listed in the plan, affirming their capacity to provide continued access as described in the plan. The department shall conduct a public hearing prior to a determination on the closure of said essential services or of the hospital. No original license shall be granted to establish or maintain an acute-care hospital, as defined by section 25B, unless the applicant submits a plan, to be approved by the department, for the provision of community benefits, including the identification and provision of essential health services. In approving the plan, the department may take into account the applicants existing commitment to primary and preventive health care services and community contributions as well as the primary and preventive health care services and community contributions of the predecessor hospital. The department may waive this requirement, in whole or in part, at the request of the applicant which has provided or at the time the application is filed, is providing, substantial primary and preventive health care services and community contributions in its service area.
(f) If a hospital executes a plan to discontinue an essential health service, said plan not having been approved by the department pursuant to this section, the Attorney General shall seek an injunction to require that the essential health service be maintained for the duration of the notice period outlined in paragraph (a) of this section. Additionally, that hospital shall not be eligible to have an application approved pursuant to section 25C for a period of three years from the date the service is discontinued, or until the essential health service is restored, or until such time as the department is satisfied that a plan is in place that, at the time of the discontinuance, would have met the requirements of paragraph (c).
(g) To preserve access to essential services, hospitals shall not close any beds, units or facilities for the duration of any declared state of emergency pertaining to health care.
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An Act to ensure effective health care as a right | S737 | SD388 | 193 | {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-13T17:55:28.747'} | [{'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-13T17:55:28.7466667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S737/DocumentHistoryActions | Bill | By Mr. Cyr, a petition (accompanied by bill, Senate, No. 737) of Julian Cyr for legislation to ensure effective health care cost control. Health Care Financing. | SECTION 1. (a) Notwithstanding any general or special law to the contrary, the following terms shall have the following meanings unless the context clearly requires otherwise:-
“Single payer benchmark”, the estimated total costs of providing health care to all residents of the commonwealth under a single payer health care system in a given year.
“Single payer health care”, a system that provides publicly financed, universal access to health care for the population through a unified public health care plan.
(b) The center for health information and analysis shall recommend a methodology to develop a single payer benchmark. The single payer health care system considered under the single payer benchmark shall offer continuous, comprehensive and affordable coverage for all residents of the commonwealth regardless of income, assets, health status or availability of other health coverage. The benchmark may consider the costs of a single-payer health care system at different actuarial values, levels of cost-sharing and levels of provider reimbursement; provided however that the benchmark shall include all actuarial values, levels of cost-sharing and levels of provider reimbursement considered by the center. In developing the methodology, the center shall monitor, review and evaluate reports related to single payer health care and the performance of single payer health care systems in other states and countries.
(c) The center for health information and analysis, in conjunction with the health policy commission and the division of insurance, shall provide an annual report detailing a comparison of the actual health care expenditures in the commonwealth for 2024, 2025 and 2026 with the single payer benchmark for 2024, 2025 and 2026, respectively, indicating whether the commonwealth would have saved money while expanding access to care under a single payer health care system. The first report shall be filed by not later than July 1, 2026 to the clerks of the senate and house of representatives, the joint committee on health care financing and the senate and house committees on ways and means.
(d) If a report under subsection (c) determines that the single payer benchmark outperformed the actual total health care expenditures in the commonwealth in 2024, 2025 and 2026 the health policy commission shall submit a proposed single payer health care implementation plan to the clerks of the senate and house of representatives, the joint committee on health care financing and the senate and house committees on ways and means within 1 year of the date that the report is filed. The plan may include proposed legislation to implement a single payer health care system that offers continuous, comprehensive and affordable coverage for all residents regardless of income, assets, health status or availability of other health coverage. When developing the implementation plan, the commission shall hold not less than 3 public hearings and seek stakeholder input from across the commonwealth.”.
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An Act relative to the nursing home quality jobs initiative | S738 | SD400 | 193 | {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-13T18:33:32.34'} | [{'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-13T18:33:32.34'}, {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-02-07T16:35:33.0533333'}, {'Id': 'MJM2', 'Name': 'Mathew J. Muratore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJM2', 'ResponseDate': '2023-02-28T12:49:08.8333333'}, {'Id': 'AJP1', 'Name': 'Angelo J. Puppolo, Jr.', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJP1', 'ResponseDate': '2023-03-07T16:12:16.8966667'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-21T09:49:47.4333333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S738/DocumentHistoryActions | Bill | By Mr. Cyr, a petition (accompanied by bill, Senate, No. 738) of Julian Cyr, Paul W. Mark, Mathew J. Muratore and Angelo J. Puppolo, Jr. for legislation relative to the nursing home quality jobs initiative. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws, as appearing in the 2020 official edition is hereby amended by inserting at the end thereof the following new section:-
Section 80. For the purpose of ensuring a living wage for nursing facility direct care staff, MassHealth shall enact regulations regarding standard payments from MassHealth to nursing facilities that establish a living wage for direct care staff of licensed nursing homes, including, but not limited to, certified nurse aides, and housekeeping, laundry, dietary, plant operations, activities, behavioral, security and clerical staff. Such regulations shall ensure that such standard payments shall reimburse nursing facilities for the costs of paying a living wage, associated payroll benefits and related employee costs. Provided further that MassHealth shall, subject to appropriation, adjust such payments for all direct care staff with an inflation adjustment consistent with the annual unadjusted Skilled Nursing Facility Market Basket Update, as established by the Centers for Medicare & Medicaid Services in 42 C.F.R. § 413.337. For the purposes of this adjustment, direct care staff shall include the staff recognized in the MassHealth Direct Care Cost-Quotient calculation. MassHealth shall adopt all additional regulations and procedures necessary to carry out this section, provided, that such regulations shall include permissible use standards mandating that facilities shall expend these supplemental payments exclusively on direct care staff expenses, which shall be further defined in such regulations but that shall not include spending on temporary nursing staff, management staff or nursing facility administrators. Such additional regulations and procedures shall include: (i) mandated facility interim reporting to the executive office of health and human services on the ways in which the facility expects to spend; and (ii) mandated facility final reporting on the expenditure of payments received under this section, including audits and provisions that reconcile such expenditure reporting with the Direct Care Cost-Quotient calculation. MassHealth shall submit to the house and senate committees on ways and means a report containing an analysis of funds expended under this program.
SECTION 2. Chapter 23 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 9U the following 2 sections:-
Section 9V. The Executive Office of Labor and Workforce Development, through the Commonwealth Corporation, shall establish a grant program for nursing facility supervisory and leadership training. The program shall include, but not be limited to, covering the cost of nursing facility employee participation in evidence-based supervisory training for the express purpose of building supervisory skill and competency in improving staff satisfaction, retaining staff and reducing turnover.
Section 9W. The Executive Office of Labor and Workforce Development shall, subject to appropriation, establish a Certified Nursing Assistant to Licensed Practical Nurse Career Ladder grant program to be administered by the Massachusetts Commonwealth Corporation, in consultation with, but not limited to, the Massachusetts Senior Care Association, Social Finance and practical nursing training providers for the express purpose of establishing a career advancement pathway to enable certified nursing assistants to enroll in licensed practical nursing programs at local community colleges, technical high schools or other accredited programs. The Commonwealth Corporation shall establish criteria for awarding regional collaborative grants that shall fund the full cost of tuition, fees and curriculum materials, as well as paying staff wages to attend classes to secure their practical nursing certificate and may include stipends for childcare, transportation, English as a second language classes and other costs the Corporation deems necessary to ensure the success of the program; and provided further that these grants can be expended over a three-year period.
SECTION 3. Chapter 111 of the General Laws, as so appearing, is hereby amended by inserting after section 4O the following section:-
Section 4P. The Executive Office of Labor and Workforce Development shall, subject to appropriation, establish a Resident Care Assistant to Certified Nursing Assistant career ladder grant program to be administered by the Massachusetts Commonwealth Corporation. The grant shall fund the full costs of certified nursing assistant training and competency testing, as well paying staff wages to attend certified nursing assistant training, and may include stipends for childcare, transportation, and English as a second language classes provided that: (i) the tuition is for an approved certified nursing assistant training program; and (ii) individuals have begun employment as a resident care assistant in a licensed nursing facility and complete the approved certified nursing assistant training program within 90 days of employment as a resident care assistant; and (iii) individuals take the required nurse aid certification exam within 30 days of completing the approved nurse aide training program.
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An Act relative to stabilizing the commonwealth’s nursing facilities | S739 | SD433 | 193 | {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-15T21:35:22.827'} | [{'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-15T21:35:22.8266667'}, {'Id': 'AJS1', 'Name': 'Adam Scanlon', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJS1', 'ResponseDate': '2023-01-18T20:01:17.5266667'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-02-07T16:31:30.4333333'}, {'Id': 'MJM2', 'Name': 'Mathew J. Muratore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJM2', 'ResponseDate': '2023-02-28T12:49:01.1766667'}, {'Id': 'AJP1', 'Name': 'Angelo J. Puppolo, Jr.', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJP1', 'ResponseDate': '2023-03-07T16:12:00.8966667'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-21T09:49:24.48'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S739/DocumentHistoryActions | Bill | By Mr. Cyr, a petition (accompanied by bill, Senate, No. 739) of Julian Cyr, Adam Scanlon, Vanna Howard, Mathew J. Muratore and others for legislation relative to stabilizing the commonwealth’s nursing facilities. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws, as appearing in the 2020 official edition is hereby amended by inserting at the end thereof the following new sections:-
Section 80. In setting Medicaid rates for nursing homes licensed pursuant to section seventy-one of chapter 111 of the general laws, the executive office of health and human services shall annually adjust such payments with an inflation adjustment consistent with the annual unadjusted Skilled Nursing Facility Market Basket Update, as established by the Centers for Medicare & Medicaid Services in 42 C.F.R. § 413.337.
Section 81. For the purpose of recognizing current labor and resident care costs in setting Medicaid rates for nursing homes licensed pursuant to section seventy-one of the chapter 111 of the general laws, the executive office of health and human services shall use as base year costs for rate determination purposes the reported costs of the calendar year not more than 2 years prior to the current rate year.
Section 82. Nursing homes licensed pursuant to section seventy-one of chapter 111 of the general laws must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required at 42 CFR 483.70(e). For the purpose of setting Medicaid rates for nursing homes licensed pursuant to section seventy-one of chapter 111 of the general laws, the executive office of health and human services shall recognize its full share of the actual nursing costs of meeting this requirement.
Section 83. In setting Medicaid rates for nursing homes licensed pursuant to section seventy-one of chapter 111 of the general laws, the executive office of health and human services shall utilize a single form by the division and the federal Department of Health and Human Services to: (i) collect resident care information including, but not limited to, case-mix information to be used for resident reimbursement; and (ii) set the nursing component of the Medicaid skilled nursing facility rate. In transitioning to a new single acuity payment method for the nursing component, MassHealth shall ensure that facilities will receive a nursing rate per diem that is no less than the per nursing per diem amount under the dual acuity system.
Section 84. In setting the capital rate component of the Medicaid rate for nursing homes licensed pursuant to section seventy-one of chapter 111 of the general laws, the executive office of health and human services shall recognize costs necessary to enable facilities to invest in building repairs, maintenance, updates and durable medical equipment to ensure nursing facility resident safety, comfort and quality of life. Reimbursement for new and updated construction projects shall be based on valid economic indicators that accurately reflect current building and maintenance costs.
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An Act relative to Children’s Advocacy Centers and the Massachusetts Children’s Alliance | S74 | SD382 | 193 | {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-13T17:34:59.393'} | [{'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-13T17:34:59.3933333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S74/DocumentHistoryActions | Bill | By Mr. Cyr, a petition (accompanied by bill, Senate, No. 74) of Julian Cyr for legislation relative to Children’s Advocacy Centers and the Massachusetts Children’s Alliance. Children, Families and Persons with Disabilities. | The General Laws are hereby amended by inserting after chapter 220 the following chapter:-
CHAPTER 220A
MASSACHUSETTS CHILDREN’S ALLIANCE
Section 1. As used in this chapter the following words shall, unless the context clearly requires otherwise, have the following meanings:-
"Accreditation", the process in which certification of competency, authority, or credibility is presented by national or state level standards to ensure effective, efficient and consistent delivery of services by a children’s advocacy center.
“Alliance”, Massachusetts Children’s Alliance.
"Children's Advocacy Center", a child-focused, trauma-informed, facility-based program in which a multidisciplinary team with representatives from law enforcement, child protection, prosecution, mental health, forensic interviewing, medical, and victim advocacy disciplines collaborate to offer the best response to child victims of maltreatment. Children advocacy centers assist in the response to allegations of child sexual abuse, severe physical abuse and exploitation of children. The multidisciplinary team collaborates to interview children, meet with a child's non-offending parents, guardians, caregivers, and family members, and to coordinate a streamlined, victim-focused response including investigation and provision of necessary services to ensure children can heal. A children’s advocacy center response facilitates efficient collection and sharing of information, improves timely evidence gathering, enhances communication among agencies involved, and broadens the knowledge base from which protective and investigative decisions are made. Children’s advocacy centers may be private nonprofit organizations or based within hospitals, district attorney’s offices, or other governmental entities.
“Center,” Children’s Advocacy Center.
"Forensic interview", an interview of a child victim of maltreatment by a forensic interviewer who meets or exceeds national training standards. Forensic interviews are conducted in an unbiased, developmentally appropriate, culturally sensitive, and fact-finding manner to obtain accurate information and support the best outcome for children. Whenever practical, members of the multidisciplinary team involved in the response shall observe the interview, which shall be electronically recorded.
"Massachusetts Children’s Alliance", the statewide membership organization that serves as a funding source to ensure children’s advocacy centers have the necessary fiscal resources to properly and effectively respond to child victims. The alliance engages member children’s advocacy centers in an accreditation process which meets or exceeds standards set by the national children’s alliance, by collecting and sharing of data, and by providing training, leadership, and technical assistance to existing and emerging children’s advocacy centers in the commonwealth. The alliance ensures through contractual relationship that children’s advocacy centers meet or exceed national standards for operating and these standards shall include:
1. multidisciplinary teams that include representation from law enforcement, prosecutors, child protective services, the medical and mental health fields, and victim advocacy;
2. services that are cultural sensitivity and able to meet the needs of the diverse population of the commonwealth;
3. forensic interviews that are neutral, fact-finding, and avoid duplicative interviewing;
4. victim support and advocacy for children and caregivers, including appropriate counseling, legal, and medical services or referrals;
5. access to medical evaluations;
6. access to mental health services;
7. a formal case review process;
8. a case tracking, monitoring, and outcomes process;
9. organizational capacity;
10. a child-focused setting that is comfortable, safe, and private; and
11. any additional necessary standards.
"Multidisciplinary team”, a group of professionals working collaboratively under a written protocol, who represent various disciplines to assure the most effective and coordinated response to child maltreatment for every child. A children’s advocacy center’s multidisciplinary team shall include professionals involved in the coordination, assessment, investigation, and prosecution of child abuse cases, including the children advocacy center’s staff, participating law enforcement agencies, the district attorney, and the department of children and families. A multidisciplinary team shall include professionals involved in the delivery of services, including medical and mental health services, to victims of child maltreatment and their non-offending family members.
"National Children's Alliance", the national, professional membership organization that provides standards for accreditation of children’s advocacy centers and is dedicated to helping local communities respond to allegations of child abuse in an effective and efficient manner.
Section 2. There is hereby created a body politic and corporate to be known as the Massachusetts Children’s Alliance for the purpose of providing leadership, innovative programming, training, technical assistance, data collection, and capacity building to meet local, state, and national requirements for children’s advocacy centers. The alliance may contract with state and federal entities to ensure that children’s advocacy centers are equipped to meet the needs of child victims of abuse. The alliance may receive and disburse any funds, grants, and services in furtherance of its functions.
Section 3. Children’s advocacy centers shall provide a formal, integrated, culturally competent and multidisciplinary response to child maltreatment for the benefit of children and their non-offending family members. The centers shall expedite a streamlined process by means of a prompt, coordinated, child focused, fact finding forensic multidisciplinary team interview and assessment which obtains the information required by involved agencies and ensures children are not further traumatized by the systems intended to aid. Moreover, this collaborative process shall ensure that professionals have the necessary information to provide services in the best interest of the child. The centers shall offer comprehensive services to address the mental health and medical needs of children. The centers shall continuously work towards the improvement of prevention strategies and intervention responses.
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An Act to ensure equitable health coverage for children | S740 | SD778 | 193 | {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-11T14:24:40.843'} | [{'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-11T14:24:40.8433333'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-01-23T14:30:38.87'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-27T13:48:38.14'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-01-30T10:39:59.9766667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-30T10:38:35'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-08T10:22:14.12'}, {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-02-09T12:25:35.6166667'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-02-09T12:23:52.24'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-02-10T09:04:19.8433333'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-02-14T14:16:07.25'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-02-21T11:13:07.7533333'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-17T10:54:32.9266667'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-02-21T11:11:40.39'}, {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-02-23T15:08:50.95'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-03-14T21:17:32.8233333'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-03-15T09:58:49.93'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-21T12:44:37.6766667'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-05-01T12:49:35.0966667'}, {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-06-28T14:36:26.76'}, {'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-08-09T11:33:58.6466667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S740/DocumentHistoryActions | Bill | By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 740) of Sal N. DiDomenico, Rebecca L. Rausch, Joanne M. Comerford, Jack Patrick Lewis and other members of the General Court for legislation to ensure equitable health coverage for children. Health Care Financing. | Chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding after Section 16D the following section:-
"Section 16E. (1) Notwithstanding any other law, there is hereby established a program of comprehensive health coverage for children and young adults under the age of 21 who are residents of the Commonwealth, as defined under section 8 of this chapter, who are not otherwise eligible for comprehensive benefits under Title XIX or XXI of the Social Security Act or under the demonstration pursuant to Section 9A of this chapter solely due to their immigration status. Children and young adults shall be eligible to receive comprehensive MassHealth benefits equivalent to the benefits available to individuals of like age and income under categorical and financial eligibility requirements established by the executive office pursuant to said Title XIX and Title XXI.
(2) The executive office of health and human services shall maximize federal financial participation for the benefits provided under this section, however, benefits under this section shall not be conditioned on the availability of federal financial participation."
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An Act to reduce racial and ethnic health disparities through commercial rate equity for safety net hospitals | S741 | SD1615 | 193 | {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-17T22:01:29.54'} | [{'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-17T22:01:29.54'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-01-23T14:28:32.6366667'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-03-14T21:06:12.2366667'}, {'Id': 'PMP0', 'Name': 'Pavel M. Payano', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMP0', 'ResponseDate': '2023-08-31T16:25:47.26'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S741/DocumentHistoryActions | Bill | By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 741) of Sal N. DiDomenico and Rebecca L. Rausch for legislation to reduce racial and ethnic health disparities through commercial rate equity for safety net hospitals. Health Care Financing. | SECTION 1. Chapter 176J of the General Laws, as appearing in the 2020 Official Edition, is hereby amended in section 6 in subsection (c), as so appearing, by adding at the end thereof the following:-
"The subscriber contracts, rates and evidence of coverage for health benefit plans shall be subject to the disapproval of the commissioner of insurance. To promote health equity and access through commercial rate equity for high Medicaid safety net acute hospitals that predominantly serve communities that experience health disparities as a result of race, ethnicity, socioeconomic status or other status, for all commercial insured health benefit plan rates effective for rate years on and after January 1, 2023, the carrier's health benefit plan rates filed with the division of insurance are considered presumptively disapproved if the carrier's network provider reimbursement rates, inclusive of rates and targets within re-based alternative payment contracts, do not reimburse high Medicaid acute hospitals, defined as acute care hospitals with a fiscal year 2020 Medicaid payer mix at or above 25 per cent calculated using data published by the center for health information and analysis in April 2022 in its databook titled Massachusetts Hospital Profiles, at or greater than the carrier’s statewide average commercial relative price calculated separately for acute hospital inpatient and outpatient services in accordance with requirements established by the division of insurance, based on the most recent relative price analysis by the center for health information and analysis. Carriers shall annually certify and provide hospital-specific evidence to the division of insurance that each high Medicaid acute hospital’s rates meet a minimum threshold of the carrier’s statewide average commercial relative price individually calculated for inpatient and outpatient services."
SECTION 2. Chapter 176A of the General Laws is hereby amended in section 6, as so appearing, by adding the following after the word “discriminatory”:-
"The subscriber contracts, rates and evidence of coverage for health benefit plans shall be subject to the disapproval of the commissioner of insurance. To promote health equity and access through commercial rate equity for high Medicaid safety net acute hospitals that predominantly serve communities that experience health disparities as a result of race, ethnicity, socioeconomic status or other status, for all commercial insured health benefit plan rates effective for rate years on and after January 1, 2023, the carrier's health benefit plan rates filed with the division of insurance are considered presumptively disapproved if the carrier's network provider reimbursement rates, inclusive of rates and targets within alternative payment contracts, do not reimburse high Medicaid acute hospitals, defined as acute care hospitals with a fiscal year 2020 Medicaid payer mix at or above 25 per cent calculated using data published by the center for health information and analysis in April 2022 in its databook titled Massachusetts Hospital Profiles, at or greater than the carrier’s statewide average commercial relative price calculated separately for acute hospital inpatient and outpatient services in accordance with requirements established by the division of insurance, based on the most recent relative price analysis by the center for health information and analysis. Carriers shall annually certify and provide hospital-specific evidence to the division of insurance that each high Medicaid acute hospital’s rates meet a minimum threshold of the carrier’s statewide average commercial relative price individually calculated for inpatient and outpatient services."
SECTION 3. Chapter 176B of the General Laws is hereby amended in section 4, as so appearing, by inserting the following after the word “discriminatory”:-
"The subscriber contracts, rates and evidence of coverage for health benefit plans shall be subject to the disapproval of the commissioner of insurance. To promote health equity and access through commercial rate equity for high Medicaid safety net acute hospitals that predominantly serve communities that experience health disparities as a result of race, ethnicity, socioeconomic status or other status, for all commercial insured health benefit plan rates effective for rate years on and after January 1, 2023, the carrier's health benefit plan rates filed with the division of insurance are considered presumptively disapproved if the carrier's network provider reimbursement rates, inclusive of rates and targets within alternative payment contracts, do not reimburse high Medicaid acute hospitals, defined as acute care hospitals with a fiscal year 2020 Medicaid payer mix at or above 25 per cent calculated using data published by the center for health information and analysis in April 2022 in its databook titled Massachusetts Hospital Profiles, at or greater than the carrier’s statewide average commercial relative price calculated separately for acute hospital inpatient and outpatient services in accordance with requirements established by the division of insurance, based on the most recent relative price analysis by the center for health information and analysis. Carriers shall annually certify and provide hospital-specific evidence to the division of insurance that each high Medicaid acute hospital’s rates meet a minimum threshold of the carrier’s statewide average commercial relative price individually calculated for inpatient and outpatient services."
SECTION 4. Chapter 176G of the General Laws, as appearing in the 2020 Official Edition, is hereby amended in section 16, as so appearing, by inserting the following after the word “reasonable”:-
"To promote health equity and access through commercial rate equity for high Medicaid safety net acute hospitals that predominantly serve communities that experience health disparities as a result of race, ethnicity, socioeconomic status or other status, for all commercial insured health benefit plan rates effective for rate years on and after January 1, 2023, the carrier's health benefit plan rates filed with the division of insurance are considered presumptively disapproved if the carrier's network provider reimbursement rates, inclusive of rates and targets within alternative payment contracts, do not reimburse high Medicaid acute hospitals, defined as acute care hospitals with a fiscal year 2020 Medicaid payer mix at or above 25 per cent calculated using data published by the center for health information and analysis in April 2022 in its databook titled Massachusetts Hospital Profiles, at or greater than the carrier’s statewide average commercial relative price calculated separately for acute hospital inpatient and outpatient services in accordance with requirements established by the division of insurance, based on the most recent relative price analysis by the center for health information and analysis. Carriers shall annually certify and provide hospital-specific evidence to the division of insurance that each high Medicaid acute hospital’s rates meet a minimum threshold of the carrier’s statewide average commercial relative price individually calculated for inpatient and outpatient services."
SECTION 5. Chapter 175 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following new section:-
"Section 229. Approval of Contracts
The subscriber contracts, rates and evidence of coverage for health benefit plans shall be subject to the disapproval of the commissioner of insurance. No such contracts shall be approved if the benefits provided therein are unreasonable in relation to the rate charged, or if the rates are excessive, inadequate, or unfairly discriminatory.
To promote health equity and access through commercial rate equity for high Medicaid safety net acute hospitals that predominantly serve communities that experience health disparities as a result of race, ethnicity, socioeconomic status or other status, for all commercial insured health benefit plan rates effective for rate years on and after January 1, 2023, the carrier's health benefit plan rates filed with the division of insurance are considered presumptively disapproved if the carrier's network provider reimbursement rates, inclusive of rates and targets within alternative payment contracts, do not reimburse high Medicaid acute hospitals, defined as acute care hospitals with a fiscal year 2020 Medicaid payer mix at or above 25 per cent calculated using data published by the center for health information and analysis in April 2022 in its databook titled Massachusetts Hospital Profiles, at or greater than the carrier’s statewide average commercial relative price calculated separately for acute hospital inpatient and outpatient services in accordance with requirements established by the division of insurance, based on the most recent relative price analysis by the center for health information and analysis. Carriers shall annually certify and provide hospital-specific evidence to the division of insurance that each high Medicaid acute hospital’s rates meet a minimum threshold of the carrier’s statewide average commercial relative price individually calculated for inpatient and outpatient services. SECTION 6. The rules or regulations necessary to carry out this act shall be adopted not later than May 1, 2023 or not later than 90 days after the effective date of this act, whichever is sooner."
SECTION 7. Sections 1, 2, 3, 4, 5 to 6, inclusive, shall take effect immediately upon the effective date of this act.
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An Act to ensure access and continuity of care to specialist and hospital services for dually eligible individuals | S742 | SD1641 | 193 | {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-11T14:31:32.143'} | [{'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-11T14:31:32.1433333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S742/DocumentHistoryActions | Bill | By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 742) of Sal N. DiDomenico for legislation to ensure access and continuity of care to specialist and hospital services for dually eligible individuals. Health Care Financing. | SECTION 1. Section 9d of Chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following new paragraph:-
"(r) To ensure access to specialist and hospital care for dually eligible individuals residing in the Commonwealth, any dually eligible individual shall be permitted to receive health care services from any specialist or hospital provider in the commonwealth that participates in and is enrolled in Medicare or MassHealth, irrespective of any health plan or provider network limitation and subject to all others terms and conditions of the member’s benefit plan. In such situations where an existing contractual relationship between the health plan and the hospital or specialist provider does not exist, the provider shall be reimbursed by the One Care or SCO plan at the Medicare or MassHealth fee-for-service amount for the service rendered, as applicable, unless the plan and provider already have a contract agreement in place for the covered service, or mutually agree to a different reimbursement amount for the service.
(1) To ensure continued access to primary, specialist, and hospital care for our most vulnerable members MassHealth shall require any One Care or SCO plan and provider that has terminated a contract that includes the provision of health care services to One Care or SCO members, to allow impacted members to continue to receive services from their primary care, specialist provider, or any inpatient or outpatient hospital subject to the termination, under the terms of the pre-existing contract, for twelve months following the expiration of any continuity of care requirements that may follow the contractual termination. During this period, plans shall be required to maintain all contractual terms and conditions that were in effect with the provider prior to the notice of termination being sent by either party, including but not limited to reimbursement, unless mutually agreed upon by the plan and the provider. Plans and providers shall be prohibited from using this provision to avoid using good faith efforts to negotiate contractual arrangements."
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An Act to ensure uniform and transparent reporting of medical debt data | S743 | SD1586 | 193 | {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-01-18T16:51:14.02'} | [{'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-01-18T16:51:14.02'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-11T11:13:42.7533333'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-02-13T12:30:58.01'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-08-01T17:03:21.1933333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S743/DocumentHistoryActions | Bill | By Ms. Edwards, a petition (accompanied by bill, Senate, No. 743) of Lydia Edwards, James B. Eldridge and Patrick M. O'Connor for legislation to ensure uniform and transparent reporting of medical debt data. Health Care Financing. | SECTION 1. Chapter 12C of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting in 1 the following new definitions:-
“Medical debt”, any debt owed for goods or services provided by a medical facility, a provider of health care or a provider of emergency medical services including the financing or an extension of credit by a third party for the sole purpose of purchasing goods or services provided by a medical facility, a provider of health care or a provider of emergency medical services.
“Significant medical debt”, any medical debt owed by an individual exceeding $200.
SECTION 2. Chapter 12C of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 24 the following new section:-
“SECTION 25. Uniform medical debt reporting system.
(a) The center shall coordinate with the public health council, the boards of registration for providers, the commission board, and the state finance and governance board to develop a uniform and interoperable electronic system of public reporting for providers as a prerequisite condition for advancing overdue medical bills to a debt collection agency.
(b) The uniform medical debt reporting system shall include information designed to advise on policy relating to medical debt. The uniform medical debt reporting system shall also ensure a comprehensive and transparent analysis of demographic data as it relates to medical debt including, but not limited to, rates of medical debt carried in the following demographics: (1) race; (2) sex, gender identity, and sexual orientation; (2) disability status; (3) criminal record; (4) health status; (5) family and individual income level; (6) education; (7) nation of origin; (8) region of residence in the commonwealth; (8) individual and family health insurance status; (8) veteran status; (9) age group; (10) chronic condition status; (11) education level; (12) primary language; and (13) times between procedures and reporting of debt to a collection agency.
(c) The purpose of the uniform medical debt reporting system is to reduce the adverse effects of medical debt and to protect patients in matters related to medical creditors, medical debt buyers, and medical debt collectors with respect to such debt. As such, the center shall collect and analyze data on all aspects related to the purposes of this section including, but not limited to, trends of medical debt assignment and collection per provider; rates of medical debt qualifying as “significant” as defined in chapter 12C, section 1; the relative concentration of individual and family debt per person as compared to the total amount of medical debt in the commonwealth; any risks associated with masking medical debt data; the impact of medical debt data on public health and welfare; and dating relating to the rate at which those carrying medical debts successfully settle such debt.
(d) The center may centralize the uniform medical debt reporting system or create a central portal for public access to the medical debt data and information. The uniform medical debt reporting system shall be accessible to other state agencies and authorities including, but not limited to, the commission, the secretary for the executive office of health and human services, the department of public health, and the state finance and governance board.
(e) The center shall promptly make available to the secretary of the executive office of health and human services all data pursuant to paragraph (a) of this section prior to a provider sending such debt information to a collection agency.”
(f) The center shall coordinate with the commission, through its oversight and control of the Healthcare Payment Reform Fund pursuant to chapter 6D, section 7, to receive reimbursement funds for the purposes of executing the uniform medical debt reporting system as established in this section.
SECTION 3. Section 52 of chapter 93 of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by inserting after clause (6) the following clause:-
(7) Information concerning medical debt arising from the receipt of health care services.
SECTION 4. Said section 52 of said chapter 93 of the General Laws, as so appearing is further amended by striking subsection (b) and inserting in place thereof the following subsection:-
(b) Except for subsection (7), the provisions of subsection (a) are not applicable in the case of any consumer credit report to be used in connection with (1) a credit transaction involving, or which may reasonably be expected to involve, a principal amount of fifty thousand dollars or more; or -
(2) the underwriting of life insurance involving, or which may reasonably be expected to involve, a face amount of fifty thousand dollars or more.
SECTION 5. Chapter 93, section 52 of the General Laws, as appearing in the 2020 Official Edition, hereby amended by inserting after subsection (a)(6) the following new subsection:-
(7) Medical debt which has:
(a) not yet been reported to the secretary of the executive office of health and human services pursuant to chapter 12C, section 25, subsection c; (b) already been fully paid or settled; or
(c) existed for less than one year from the date of first acquisition.
SECTION 6. Chapter 6D, section 7 of the General Laws, as appearing in the 2020 Official Edition, hereby amended by inserting after subsection (d)(v) and before subsection (d)(vi), which shall now be amended as subsection (d)(vii), the following new subsection:-
(vi) to reimburse the center for health information analysis on all funds expended for the purposes of executing the uniform medical debt reporting system established in chapter 12C, section 25.
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An Act establishing medicare for all in Massachusetts | S744 | SD2182 | 193 | {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-01-20T12:14:49.99'} | [{'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-01-20T12:14:49.99'}, {'Id': 'L_S1', 'Name': 'Lindsay N. Sabadosa', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L_S1', 'ResponseDate': '2023-01-20T14:13:39.8166667'}, {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-02-23T15:33:06.5066667'}, {'Id': 'DCG1', 'Name': 'Denise C. Garlick', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DCG1', 'ResponseDate': '2023-01-20T14:13:39.8166667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-23T12:24:19.0266667'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-26T09:41:56.2366667'}, {'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-01-27T09:47:53.8166667'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-01-31T11:26:09.8033333'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-02-02T10:28:18.38'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-02-03T08:18:56.42'}, {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-02-07T16:37:57.4533333'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-02-09T14:26:14.9566667'}, {'Id': 'CSC0', 'Name': 'Cynthia Stone Creem', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CSC0', 'ResponseDate': '2023-02-14T16:01:03.1066667'}, {'Id': 'M_C1', 'Name': 'Mike Connolly', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/M_C1', 'ResponseDate': '2023-02-16T09:49:16.67'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-02-16T17:51:40.1533333'}, {'Id': 'PAD1', 'Name': 'Patricia A. Duffy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PAD1', 'ResponseDate': '2023-03-02T09:37:18.9266667'}, {'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-03-03T10:30:16.1266667'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-03-30T16:08:43.3033333'}, {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-04-28T12:50:59.0333333'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-05-05T11:22:47.0533333'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-05-18T11:03:19.6066667'}, {'Id': 'RAM1', 'Name': 'Rita A. Mendes', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RAM1', 'ResponseDate': '2023-05-30T16:06:26.22'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-06-15T17:18:54.6866667'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-08-03T10:12:17.5466667'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-08-03T15:12:07.2133333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S744/DocumentHistoryActions | Bill | By Mr. Eldridge, a petition (accompanied by bill, Senate, No. 744) of James B. Eldridge, Lindsay N. Sabadosa, Adam Gomez, Denise C. Garlick and other members of the General Court for legislation to establish medicare for all in Massachusetts. Health Care Financing. | SECTION 1. The General Laws are hereby amended by inserting after chapter 175M the following chapter:-
CHAPTER 175N.
MASSACHUSETTS HEALTH CARE TRUST
Section 1. Definitions
The following words and phrases shall have the following meanings, except where the context clearly requires otherwise:
“Board”, the Board of Trustees of the Massachusetts Health Care Trust.
“Executive Director”, the Executive Director of the Massachusetts Health Care Trust.
“Health care”, care provided to a specific individual by a licensed health care professional to promote physical and mental health, to treat illness and injury, and to prevent illness and injury.
“Health care facility”, any facility or institution, whether public or private, proprietary or nonprofit, that is organized, maintained, and operated for health maintenance or for the prevention, diagnosis, care, and treatment of human illness, physical or mental, for one or more persons.
“Health care practitioner”, any professional person, medical group, independent practice association, organization, health care facility, or other person or institution licensed or authorized by law to provide professional health care services to an individual in the Commonwealth.
“Professional advisory committee”, a committee of advisors appointed by the director of the Administrative, Planning, Information, Technology, or any Regional division of the Massachusetts Health Care Trust.
“Resident”, a person who lives in Massachusetts as evidenced by an intent to continue to live in Massachusetts and to return to Massachusetts if temporarily absent, coupled with an act or acts consistent with that intent. The Trust shall adopt standards and procedures for determining whether a person is a resident. Such rules shall include: (1) a provision requiring that the person seeking resident status has the burden of proof in such determination; (2) a provision that a residence established for the purpose of seeking health care shall not by itself establish that a person is a resident of the Commonwealth; and (3) a provision that, for the purposes of this chapter, the terms “domicile” and “dwelling place” are not limited to any particular structure or interest in real property and specifically include homeless individuals, individuals incarcerated in Massachusetts, and undocumented individuals.
“Secretary”, the Secretary of the Executive Office of Health and Human Services.
“Trust”, the Massachusetts Health Care Trust.
“Trust Fund”, the Massachusetts Health Care Trust Fund.
Section 2. Policy and Goals
It is hereby declared to be the policy of the Commonwealth to provide equitable access to quality, affordable health care services for all its residents as a right, responsive to the needs of the Commonwealth and its residents, without co-insurance, co-payments, deductibles, or any other form of patient cost sharing, and be accountable to its citizens though the Trust. The Trust shall be responsible for the collection and disbursement of funds required to provide health care services for every resident of the Commonwealth.
It is hereby declared that the Trust shall guarantee health care access to all residents of the Commonwealth without regard to financial or employment status, ethnicity, race, religion, gender, gender identity, sexual orientation, previous health problems, or geographic location.
It is hereby declared that the Trust shall provide access to health care services that is continuous, without the current need for repeated re-enrollments or changes when employers choose new plans and residents change jobs. Coverage under the Health Care Trust shall be comprehensive and affordable for individuals and families. It shall have no co-insurance, co-payments, deductibles, or any other form of patient cost sharing.
It is hereby declared that providing access to health care services for all Massachusetts residents through a single payer health care financing system is essential for achieving and sustaining universal equitable access, affordability, cost control, and high quality medical care.
It is hereby further declared that in pursuit of universal access to quality, affordable care, the Commonwealth supports the following goals:
(a) to guarantee every resident of the Commonwealth access to high quality health care by: (i) providing reimbursement for all medically appropriate health care services offered by the eligible practitioner or facility of each resident’s choice; and (ii) funding capital investments for adequate health care facilities and resources statewide.
(b) to ensure that all residents have access to dental care, behavioral health, eyeglasses, hearing aids, home health care, nursing home care, and other important health care needs.
(c) to eliminate co-insurance, co-payments, deductibles, and any other form of patient cost sharing;
(d) to control costs as a key component of a sustainable health care system that will reduce health care costs for residents, municipalities, counties, businesses, health care facilities, and the Commonwealth.
(e) to save money by replacing the current mixture of public and private health insurance plans with a uniform and comprehensive health care plan available to every Massachusetts resident;
(f) to reduce administrative cost and inefficiencies and use savings to: (i) expand covered health care services; (ii) contain health care cost increases; (iii) create practitioner incentives to innovate and compete by improving health care service quality and delivery to patients; and (iv) expand preventive health care programs and the delivery of primary care.
(g) to fund, approve, and coordinate capital improvements in excess of a threshold to be determined annually by the Executive Director to qualified health care facilities in order to: (i) avoid unnecessary duplication of health care facilities and resources; and (ii) encourage expansion or location of health care practitioners and health care facilities in underserved communities;
(h) to assure the continued excellence of professional training and research at health care facilities in the Commonwealth;
(i) to achieve measurable improvement in health care outcomes;
(j) to prevent disease and disability and maintain or improve health and functionality;
(k) to ensure that all residents of the Commonwealth receive care appropriate to their special needs as well as care that is culturally and linguistically competent;
(l) to increase satisfaction with the health care system among health care practitioners, patients, and the employers and employees of the Commonwealth;
(m) to implement policies that strengthen and improve culturally and linguistically sensitive care;
(n) to develop an integrated population-based health care database to support health care planning; and
(o) to fund training and retraining programs for professional and non-professional workers in the health care sector displaced as a direct result of implementation of this chapter.
Section 3. Establishment of the Massachusetts Health Care Trust
(a) There shall be within the Executive Office of Health and Human Services, but not under its control or any political subdivision thereof in the Commonwealth, a division known as the Massachusetts Health Care Trust. The Trust shall be responsible for the collection and disbursement of funds required to provide health care services for every resident of the Commonwealth. The Trust is hereby constituted a public instrumentality of the Commonwealth and the exercise by the Trust of the powers conferred by this chapter shall be deemed and held the performance of an essential governmental function.
(b) The provisions of chapter 268A shall apply to all Trustees, officers, and employees of the Trust, except that the Trust may purchase from, contract with, or otherwise deal with any organization in which any Trustee is interested or involved, provided, however, that such interest or involvement is disclosed in advance to the Trustees and recorded in the minutes of the proceedings of the Trust, and provided, further, that a Trustee having such interest or involvement may not participate in any decision relating to such organization.
(c) Neither the Trust nor any of its officers, Trustees, employees, consultants, or advisors shall be subject to the provisions of section 3B of chapter 7, sections 9A, 45, 46, and 52 of chapter 30, chapter 30B, or chapter 31, provided, however, that in purchasing goods and services, the Trust shall at all times follow generally accepted good business practices.
(d) All officers and employees of the Trust having access to its cash or negotiable securities shall give bond to the Trust at its expense, in such amount and with such surety as the Board of Trustees shall prescribe. The persons required to give bond may be included in one or more blanket or scheduled bonds.
(e) Trustees, officers, and advisors who are not regular, compensated employees of the Trust shall not be liable to the Commonwealth, to the Trust, or to any other person as a result of their activities, whether ministerial or discretionary, as such Trustees, officers, or advisors except for willful dishonesty or intentional violations of law. The Board of the Trust may purchase liability insurance for Trustees, officers, advisors, and employees and may indemnify said persons against the claims of others.
Section 4: Powers of the Trust
(a) The Trust shall have the following powers:
(1) to make, amend, and repeal by-laws, rules, and regulations for the management of its affairs;
(2) to adopt an official seal;
(3) to sue and be sued in its own name;
(4) to make contracts and execute all instruments necessary or convenient for the carrying on of the purposes of this chapter;
(5) to acquire, own, hold, dispose of, and encumber personal, real or intellectual property of any nature or any interest therein;
(6) to enter into agreements or transactions with any federal, state, or municipal agency or other public institution or with any private individual, partnership, firm, corporation, association, or other entity;
(7) to appear on its own behalf before boards, commissions, departments, or other agencies of federal, state, or municipal government;
(8) to appoint officers and to engage and employ employees, including legal counsel, consultants, agents, and advisors, and prescribe their duties and fix their compensations;
(9) to establish advisory boards;
(10) to procure insurance against any losses in connection with its property in such amounts, and from such insurers, as may be necessary or desirable;
(11) to invest any funds held in reserves or sinking funds, or any funds not required for immediate disbursement, in such investments as may be lawful for fiduciaries in the Commonwealth pursuant to sections 38 and 38 A of chapter 29;
(12) to accept, hold, use, apply, and dispose of any and all donations, grants, bequests, and devises, conditional or otherwise, of money, property, services, or other things of value which may be received from the United States or any agency thereof, any governmental agency, any institution, person, firm, or corporation, public or private; such donations, grants, bequests, and devises to be held, used, applied, or disposed for any or all of the purposes specified in this chapter and in accordance with the terms and conditions of any such grant. A receipt of each such donation or grant shall be detailed in the annual report of the Trust; such annual report shall include the identity of the donor, lender, the nature of the transaction and any condition attaching thereto;
(13) to do any and all other things necessary and convenient to carry out the purposes of this chapter.
Section 5. Board of Trustees: Composition, Powers, and Duties
(a) The Trust shall be governed by a Board of Trustees with 29 members including:
(1) the Secretary of Health and Human Services; the Secretary of Administration and Finance, and the Commissioner of Public Health;
(2) eight Trustees appointed by the Governor, three of whom shall be nominated by organizations of health care professionals who deliver direct patient care, one of whom shall be nominated by a statewide organization of health care facilities, one of whom shall be nominated by an organization representing non-health care employers, one of whom shall be nominated by a disability rights organization, one of whom shall be nominated by an organization advocating for mental health care, and one of whom shall be a health care economist;
(3) ten Trustees appointed by the Attorney General, two of whom shall be nominated by a statewide labor organization, two of whom shall be nominated by statewide organizations who have a record of advocating for universal single payer health care in Massachusetts, one of whom shall be nominated by an organization representing Massachusetts senior citizens, one of whom shall be nominated by a statewide organization defending the rights of children, one of whom shall be nominated by an organization providing legal services to low-income clients, one of whom shall be an epidemiologist, one of whom shall be an expert in racial disparities in health care nominated by a statewide public health organization, and one of whom shall be an expert in women’s health care nominated by a statewide public health organization;
(4) and eight Trustees elected by the citizens of the Commonwealth pursuant to subsection (b).
(5) Before appointing members to the Board of Trustees, the Governor and the Attorney General shall conduct a public awareness process, encourage representation from different racial, ethnic, and gender populations, and take nominations from all interested organizations.
(b) Each of the eight citizen-elected Trustees must: (1) reside in a different Governor’s Council district than the other seven elected Trustees; (2) be ineligible for any Trustee positions appointed by the Governor or the Attorney General; (3) run in accordance with Fair Campaign Financing Rules; and (4) serve staggered four-year terms; provided, however, that two of the first eight elected Trustees shall be elected for two years, three for three years, and three for four years. Each elected Trustee shall be eligible for reelection to a second term only.
(c) Each appointed Trustee shall serve a term of five years; provided, however, that initially six appointed Trustees shall serve three-year terms, six appointed Trustees shall serve four-year terms, and six appointed Trustees shall serve five-year terms. The initial appointed Trustees shall be assigned to a three-, four-, or five- year term by lot. Any person appointed to fill a vacancy on the Board shall serve for the unexpired term of the predecessor Trustee. Any appointed Trustee shall be eligible for reappointment to a second term only. Any appointed Trustee may be removed from the Trustee’s appointment by the Governor or Attorney General, respectively, for just cause.
(d) The Board shall elect a chair from among its members every two years. A majority of the Trustees shall constitute a quorum and the affirmative vote of a majority of the Trustees present and eligible to vote at a meeting shall be necessary for any action to be taken by the Board. The Board of Trustees shall meet at least ten times annually and shall have final authority over the activities of the Trust.
(e) The Trustees shall be reimbursed for actual and necessary expenses and loss of income incurred for each full day serving in the performance of their duties to the extent that reimbursement of those expenses is not otherwise provided or payable by another public agency or agencies. For purposes of this section, “full day of attending a meeting” shall mean presence at, and participation in, not less than 75 percent of the total meeting time of the Board during any particular 24-hour period.
(f) No member of the Board of Trustees shall make, participate in making, or in any way attempt to use his or her official position to influence a governmental decision in which the Trustee knows or has reason to know that the Trustee, or a family member, business partner, or colleague, has a financial interest.
(g) The Board is responsible for ensuring universal access to high quality, affordable health care for every resident of the Commonwealth and shall specifically address the following:
(1) establish policy on medical issues, population-based public health issues, research priorities, scope of services, expanding access to care, and evaluation of the performance of the system;
(2) evaluate proposals from the Executive Director and others for innovative approaches to health promotion, disease and injury prevention, health education and research, and health care delivery; and
(3) establish standards and criteria by which requests by health facilities for capital improvements shall be evaluated.
Section 6. Executive Director; Purpose and Duties
(a) The Board of Trustees shall hire an Executive Director who shall be the executive and administrative head of the Trust and shall be responsible for administering and enforcing the provisions of law relative to the Trust.
(b) The Executive Director may, as she or he deems necessary or suitable for the effective administration and proper performance of the duties of the Trust and subject to the approval of the Board of Trustees, do the following: (1) adopt, amend, alter, repeal, and enforce, all such reasonable rules, regulations, and orders as may be necessary; and (2) appoint and remove employees and consultants: provided, however, that, subject to the availability of funds in the Trust, at least one employee shall be hired to serve as director of each of the divisions created in Sections 7 through 11, inclusive, of this chapter.
(c) The Executive Director shall: (1) establish an enrollment system that will ensure that all eligible Massachusetts residents are formally enrolled; (2) use the purchasing power of the state to negotiate price discounts for prescription drugs and all needed durable and nondurable medical equipment and supplies; (3) negotiate or establish terms and conditions for the provision of high quality health care services and rates of reimbursement for such services on behalf of the residents of the Commonwealth; (4) develop prospective and retrospective payment systems for covered services to provide prompt and fair payment to eligible practitioners and facilities; (5) oversee preparation of annual operating and capital budgets for the statewide delivery of health care services; (6) oversee preparation of annual benefits reviews to determine the adequacy of covered services; and (7) prepare an annual report to be submitted to the Governor, the President of the Senate, and Speaker of the House of Representatives and to be easily accessible to every Massachusetts resident.
(d) The Executive Director of the Trust may utilize and shall coordinate with the offices, staff, and resources of any agencies of the executive branch including, but not limited to, the Executive Office of Health and Human Services and all line agencies under its jurisdiction, the Center for Health Information and Analysis, the Department of Revenue, the Division of Insurance, the Group Insurance Commission, the Department of Employment and Training, the Industrial Accidents Board, the Health and Educational Finance Authority, and all other executive agencies.
Section 7. Regional Division: Director, Offices, Purposes, and Duties
(a) There shall be a regional division within the Trust which shall be under the supervision and control of a director. The powers and duties given the director in this chapter and in any other general or special law shall be exercised and discharged subject to the control and supervision of the Executive Director of the Trust. The director of the regional division shall be appointed by the Executive Director of the Trust, with the approval of the Board of Trustees, and may, with like approval, be removed. The director shall establish a professional advisory committee to provide expert advice: provided, however, that such committee shall have at least 25% representation from the general public.
(b) The Trust shall have a reasonable number of regional offices located throughout the state. The number and location of these offices shall be proposed to the Executive Director and Board of Trustees by the director of the regional division after consultation with the directors of the planning, administration, quality assurance, and information technology divisions and consideration of convenience and equity. The adequacy and appropriateness of the number and location of regional offices shall be reviewed by the Board at least once every 3 years.
(c) The regional division shall establish a statewide education program that ensures that all residents understand how the Trust affects their health care costs, including, but not limited to, information about the following: (1) tax increases; (2) elimination of premiums, co-payments, deductibles, and any other form of patient cost sharing; (3) state-issued health care cards; and (4) choosing practitioners. Each regional office shall be professionally staffed to perform local outreach and informational functions and to respond to questions, complaints, and suggestions.
(d) Each regional office shall hold public hearings annually to determine unmet health care needs and for other relevant reasons. Regional office staff shall immediately refer evidence of unmet needs or of poor quality care to the director of the regional division who will plan and implement remedies in consultation with the directors of the administrative, planning, quality assurance, and information technology divisions.
Section 8. Administrative Division: Director, Purpose, and Duties
(a) There shall be an administrative division within the Trust which shall be under the supervision and control of a director. The powers and duties given the director in this chapter and in any other general or special law shall be exercised and discharged subject to the direction, control, and supervision of the Executive Director of the Trust. The director of the administrative division shall be appointed by the Executive Director of the Trust, with the approval of the Board of Trustees, and may, with like approval, be removed. The director may, at the director’s discretion, establish a professional advisory committee to provide expert advice: provided, however, that such committee shall have at least 25% representation from the general public.
(b) The administrative division shall have day-to-day responsibility for: (1) making prompt payments to practitioners and facilities for covered services; (2) collecting reimbursement from private and public third party payers and individuals for services not covered by this chapter or covered services rendered to non-eligible patients; (3) developing information management systems needed for practitioner payment, rebate collection, and utilization review; (4) investing Trust Fund assets consistent with state law and Section 18 of this chapter; (5) developing operational budgets for the Trust; and (6) assisting the planning division to develop capital budgets for the Trust.
Section 9. Planning Division: Director, Purpose, and Duties
(a) There shall be a planning division within the Trust which shall be under the supervision and control of a director. The powers and duties given the director in this chapter and in any other general or special law shall be exercised and discharged subject to the direction, control, and supervision of the Executive Director of the Trust. The director of the planning division shall be appointed by the Executive Director of the Trust, with the approval of the Board of Trustees, and may, with like approval, be removed. The director may, at the director’s discretion, establish a professional advisory committee to provide expert advice: provided, however, that such committee shall have at least 25% representation from the general public.
(b) The planning division shall have responsibility for coordinating health care resources and capital expenditures to ensure all eligible participants reasonable access to covered services. The responsibilities shall include but are not limited to:
(1) An annual review of the adequacy of health care resources throughout the Commonwealth and recommendations for changes. Specific areas to be evaluated include but are not limited to the resources needed for underserved populations and geographic areas, for recruitment of primary care physicians, dentists, and other specialists needed to provide quality health care, for culturally and linguistically competent care, and for emergency and trauma care. The director shall develop short term and long term plans to meet health care needs; and
(2) An annual review of capital health care needs, including but not limited to recommendations for a budget for all health care facilities, evaluating all capital expenses in excess of a threshold amount to be determined annually by the Executive Director, and collaborating with local and statewide government and health care institutions to coordinate capital health planning and investment. The director shall develop short term and long term plans to meet capital expenditure needs.
(c) In making its review, the planning division shall consult with the regional offices of the Trust and shall hold public hearings throughout the state on proposed recommendations. The division shall submit to the Board of Trustees its final annual review and recommendations by October 1. Subject to Board approval, the Trust shall adopt the recommendations.
Section 10. Information Technology Division: Director, Purpose, and Duties
(a) There shall be an information technology division within the Trust which shall be under the supervision and control of a director. The powers and duties given the director in this chapter and in any other general or special law shall be exercised and discharged subject to the direction, control, and supervision of the Executive Director of the Trust. The director of the information technology division shall be appointed by the Executive Director of the Trust, with the approval of the Board of Trustees, and may, with like approval, be removed. The director may, at the director’s discretion, establish a professional advisory committee to provide expert advice: provided, however, that such committee shall have at least 25% representation from the general public.
(b) The responsibilities of the information technology division shall include but are not limited to: (1) developing an information technology system that is compatible with all medical and dental facilities in Massachusetts; (2) maintaining a confidential electronic medical records system and prescription system in accordance with laws and regulations to maintain accurate patient records and to simplify the billing process, thereby reducing medical errors and bureaucracy; and (3) developing a tracking system to monitor quality of care, establish a patient database, and promote preventive care guidelines and medical alerts to avoid errors.
(c) Notwithstanding that all billing shall be performed electronically, patients shall have the option of keeping any portion of their medical records separate from their electronic medical record. The information technology director shall work closely with the directors of the regional, administrative, planning, and quality assurance divisions. The information technology division shall make an annual report to the Board of Trustees by October 1. Subject to Board approval, the Trust shall adopt the recommendations.
Section 11. Quality Assurance Division: Director, Purpose, and Duties
(a) There shall be a quality assurance division within the Trust which shall be under the supervision and control of a director. The powers and duties given the director in this chapter and in any other general or special law shall be exercised and discharged subject to the direction, control, and supervision of the Executive Director of the Trust. The director of the quality assurance division shall be appointed by the Executive Director of the Trust, with the approval of the Board of Trustees, and may, with like approval, be removed. The director may, at the director’s discretion, establish a professional advisory committee to provide expert advice: provided, however, that such committee shall have at least 25% representation from the general public.
(b) The quality assurance division shall support the establishment of a universal, best quality of standard of care with respect to: (1) appropriate hospital staffing levels for quality care; (2) evidence-based best clinical practices developed from analysis of outcomes of medical interventions; appropriate medical technology; (3) design and scope of work in the health workplace; and development of clinical practices that lead toward elimination of medical errors; (4) timely access to needed medical and dental care; (5) development of medical homes that provide efficient patient-centered integrated care; and (6) compassionate end-of-life care that provides comfort and relief of pain in an appropriate setting evidence-based best clinical practices.
(c) The director shall conduct a comprehensive annual review of the quality of health care services and outcomes throughout the Commonwealth and submit such recommendations to the Board of Trustees as may be required to maintain and improve the quality of health care service delivery and the overall health of Massachusetts residents. In making its reviews, the quality assurance division shall consult with the regional, administrative, and planning divisions and hold public hearings throughout the state on quality of care issues. The division shall submit to the Board of Trustees its final annual review and recommendations on how to ensure the highest quality health care service delivery by October 1. Subject to Board approval, the Trust shall adopt the recommendations.
Section 12. Eligible Participants
(a) The following persons shall be eligible participants in the Massachusetts Health Care Trust:
(1) all Massachusetts residents, as defined in Section 1;
(2) all non-residents who:
(i) work 20 hours or more per week in Massachusetts;
(ii) pay all applicable Massachusetts personal income and payroll taxes; and
(iii) pay any additional premiums established by the Trust to cover non-residents.
(3) All non-resident patients requiring emergency treatment for illness or injury: provided, however, that the Trust shall recoup expenses for such patients wherever possible.
(b) Payment for emergency care of Massachusetts residents obtained out of state shall be at prevailing local rates. Payment for non-emergency care of Massachusetts residents obtained out of state shall be according to rates and conditions established by the Executive Director. The Executive Director may require that a resident be transported back to Massachusetts when prolonged treatment of an emergency condition is necessary if transportation is safe for the patient in light of the patient’s medical condition.
(c) Visitors to Massachusetts shall be billed for all services received under the system. The Executive Director of the Trust may establish intergovernmental arrangements with other states and countries to provide reciprocal coverage for temporary visitors.
Section 13. Eligible Health Care Practitioners and Facilities
(a) Eligible health care practitioners and facilities shall include an agency, facility, corporation, individual, or other entity directly rendering any covered benefit to an eligible patient: provided, however, that the practitioner or facility:
(1) is licensed to operate or practice in the Commonwealth;
(2) does not accept payment from other sources for services provided for by the Trust;
(3) furnishes a signed agreement that:
(i) all health care services will be provided without discrimination on the basis of factors including, but not limited to age, sex, race, national origin, sexual orientation, gender identity, income status, preexisting condition, or citizenship status;
(ii) the practitioner or facility will comply with all state and federal laws regarding the confidentiality of patient records and information;
(iii) no balance billing or out-of-pocket charges will be made for covered services unless otherwise provided in this chapter; and
(iv) the practitioner or facility will furnish such information as may be reasonably required by the Trust for making payment, verifying reimbursement and rebate information, utilization review analyses, statistical and fiscal studies of operations, and compliance with state and federal law;
(4) meets state and federal quality guidelines including guidance for safe staffing, quality of care, and efficient use of funds for direct patient care; and
(5) meets whatever additional requirements that may be established by the Trust.
Section 14. Budgeting and Payments to Eligible Health Care Practitioners and Facilities
(a) To carry out this Act there are established on an annual basis:
(1) an operating budget;
(2) a capital expenditures budget; and
(3) reimbursement levels for practitioners consistent with rates set by the Trust that ensure that: (i) the total costs of all services offered by or through the practitioner are reasonable; and (ii) the aggregate rates of the practitioner are related reasonably to the aggregate costs of the health care practitioner.
(b) The operating budget shall be used for:
(1) payment for services rendered by physicians and other clinicians;
(2) global budgets for institutional practitioners;
(3) capitation payments for capitated groups; and
(4) administration of the Trust.
(c) Payments for operating expenses shall not be used to finance capital expenditures; payment of exorbitant salaries; or for activities to assist, promote, deter, or discourage union organizing. Any prospective payments made in excess of actual costs for covered services shall be returned to the Trust. Prospective payment rates and schedules shall be adjusted annually to incorporate retrospective adjustments. Except as provided in Section 15 of this chapter, reimbursement for covered services by the Trust shall constitute full payment for the services rendered.
(d) The Trust shall provide for retrospective adjustment of payments to eligible health care facilities and practitioners to:
(1) assure that payments to such practitioners and facilities reflect the difference between actual and projected use and expenditures for covered services; and
(2) protect health care practitioners and facilities who serve a disproportionate share of eligible participants whose expected use of covered health care services and expected health care expenditures for such services are greater than the average use and expenditure rates for eligible participants statewide.
(e) The capital expenditures budget shall be used for funds needed for:
(1) the construction or renovation of health facilities; and
(2) major equipment purchases.
(f) Payment provided under this section shall be used only to pay for the capital costs of eligible health care practitioners or facilities, including reasonable expenditures, as determined through budget negotiations with the Trust, for the replacement and purchase of equipment.
(g) The Trust shall provide funding for payment of debt service on outstanding bonds as of the effective date of this Act and shall be the sole source of future funding, whether directly or indirectly, through the payment of debt service, for capital expenditures by health care practitioners and facilities covered by the Trust in excess of a threshold amount to be determined annually by the Executive Director.
Section 15. Covered Benefits
(a) The Trust shall pay for all professional services provided by eligible practitioners and facilities to eligible participants needed to:
(1) provide high quality, appropriate, and medically necessary health care services;
(2) encourage reductions in health risks and increase use of preventive and primary care services; and
(3) integrate physical health, mental and behavioral health, and substance abuse services.
(b) Covered benefits shall include all high quality health care determined to be medically necessary or appropriate by the Trust, including, but not limited to, the following:
(1) prevention, diagnosis, and treatment of illness and injury, including laboratory, diagnostic imaging, inpatient, ambulatory, and emergency medical care, blood and blood products, dialysis, mental health services, palliative care, dental care, acupuncture, physical therapy, chiropractic, and podiatric services;
(2) promotion and maintenance of individual health through appropriate screening, counseling, and health education;
(3) the rehabilitation of sick and disabled persons, including physical, psychological, and other specialized therapies;
(4) mental health services, including supportive residences, occupational therapy, and ongoing outpatient services;
(5) behavioral health services, including supportive residences, occupational therapy, and ongoing outpatient services;
(6) substance misuse services, including supportive residences and ongoing outpatient service;
(7) prenatal, perinatal and maternity care, family planning, fertility, and reproductive health care, including abortion;
(8) long-term services and supports including home health care and personal support care;
(9) long term care in institutional and community-based settings;
(10) hospice care;
(11) language interpretation and such other medical or remedial services as the Trust shall determine;
(12) emergency and other medically necessary transportation;
(13) the full scale of dental services, other than cosmetic dentistry;
(14) basic vision care and correction, including glasses, other than laser vision correction for cosmetic purposes;
(15) hearing evaluation and treatment including hearing aids;
(16) prescription drugs;
(17) durable and non-durable medical equipment, supplies, and appliances, including complex rehabilitation technology products and services as medically necessary, individually-configured manual and power wheelchair systems, adaptive seating systems, alternative positioning systems, and other mobility devices that require evaluation, fitting, configuration, adjustment, or programming; and
(18) all new emerging technologies irrespective of where the parent company is located, such as telemedicine and telehealth practitioners.
(19) infection by the virus that causes COVID-19 and any long-term effects, known as post-COVID conditions (PCC) or Long COVID.
(c) No deductibles, co-payments, co-insurance, or other cost sharing shall be imposed with respect to covered benefits. Patients shall have free choice of participating physicians and other clinicians, hospitals, inpatient care facilities, and other practitioners and facilities.
Section 16. Wraparound Coverage for Federal Health Programs
(a) Prior to obtaining any federal program's waivers to receive federal funds through the Health Care Trust, the Trust shall seek to ensure that participants eligible for federal program coverage receive access to care and coverage equal to that of all other Massachusetts participants. It shall do so by (1) paying for all services enumerated under Section 15 not covered by the relevant federal plans; (2) paying for all such services during any federally mandated gaps in participants’ coverage; and (3) paying for any deductibles, co-payments, co-insurance, or other cost sharing incurred by such participants.
Section 17. Establishment of the Health Care Trust Fund
(a) In order to support the Trust effectively, there is hereby established the health care trust fund, hereinafter the Trust Fund, which shall be administered and expended by the Executive Director of the Trust subject to the approval of the Board. The Trust Fund shall consist of all revenue sources defined in Section 19, and all property and securities acquired by and through the use of monies deposited to the Trust Fund, and all interest thereon less payments therefrom to meet liabilities incurred by the Trust in the exercise of its powers and the performance of its duties.
(b) All claims for health care services rendered shall be made to the Trust Fund and all payments made for health care services shall be disbursed from the Trust Fund.
Section 18. Purpose of the Trust Fund
(a) Amounts credited to the Trust Fund shall be used for the following purposes:
(1) to pay eligible health care practitioners and health care facilities for covered services rendered to eligible individuals;
(2) to fund capital expenditures for eligible health care practitioners and health care facilities for approved capital investments in excess of a threshold amount to be determined annually by the Executive Director;
(3) to pay for preventive care, education, outreach, and public health risk reduction initiatives, not to exceed 5% of Trust income in any fiscal year;
(4) to supplement other sources of financing for education and training of the health care workforce, not to exceed 2% of Trust income in any fiscal year;
(5) to supplement other sources of financing for medical research and innovation, not to exceed 1% of Trust income in any fiscal year;
(6) to supplement other sources of financing for training and retraining programs for workers displaced as a result of administrative streamlining gained by moving from a multi-payer to a single payer health care system, not to exceed 2% of Trust income in any fiscal year: provided, however, that eligible workers must have enrolled by June 20 of the third year following full implementation of this chapter;
(7) to fund a reserve account to finance anticipated long-term cost increases due to demographic changes, inflation, or other foreseeable trends that would increase Trust Fund liabilities, and for budgetary shortfall, epidemics, and other extraordinary events, not to exceed 1% of Trust income in any fiscal year: provided, however, that the Trust reserve account shall at no time constitute more than 5% of total Trust assets;
(8) to pay the administrative costs of the Trust which, within two years of full implementation of this chapter shall not exceed 5% of Trust income in any fiscal year.
(b) Unexpended Trust assets shall not be deemed to be “surplus” funds as defined by chapter twenty-nine of the general laws.
Section 19. Funding Sources
(a) The Trust shall be the repository for all health care funds and related administrative funds. A fairly apportioned, dedicated health care tax on employers, workers, and residents will replace spending on insurance premiums and out-of-pocket spending for services covered by the Trust. The Trust shall enable the state to pass lower health care costs on to residents and employers through savings from administrative simplification, negotiating prices, discounts on pharmaceuticals and medical supplies, and through early detection and intervention by universally available primary and preventive care. Additionally, collateral sources of revenue – such as from the federal government, non-residents receiving care in the state, or from personal liability – shall be recovered by the Trust. The Trust shall be funded by dedicated revenue streams and its budget shall not affect other public health programs run by the state. Lastly, the Trust shall enact provisions ensuring a smooth transition to a universal health care system for employers and residents.
(b) The following dedicated health care taxes will replace spending on insurance premiums and out-of-pocket spending for services covered by the Trust. Prior to each state fiscal year of operation, the Trust will prepare for the Legislature a projected budget for the coming fiscal year, with recommendations for rising or declining revenue needs.
(1) An employer payroll tax of 7.5 percent will be assessed on employee W-2 wages, exempting the first $20,000 of payroll per establishment, replacing previous spending by employers on health premiums. An additional employer payroll tax of 0.5 per cent will be assessed on establishments with 100 or more employees;
(2) An employee payroll tax of 2.5 percent will be assessed, exempting the first $20,000 of income, replacing previous spending by employees on health premiums and out-of-pocket expenses; all W-2 wages will be combined for each taxpayer and one $20,000 exemption will be allowed;
(3) A 10 percent payroll tax on the self-employed, including general partnership income and other income subject to self-employment tax for Federal purposes, will be assessed, exempting the first $20,000 of payroll per self-employed taxpayer; income from all sources subject to tax in this section shall be combined and allowed one $20,000 exemption per taxpayer; and
(4) For the purposes of sections (2) and (3) above, each taxpayer will combine all income reported on from IRS Form W-2s and self-employment income and be allowed one $20,000 exemption. The exemption will apply first to W-2 income and then to self-employment income.
(5) A 10 percent tax on taxable unearned income and all other income not specifically excluded will be assessed on such income above $20,000. Exclusions not taxed: Social Security, Supplemental Security Income (SSI), Social Security Disability Income (SSDI), unemployment benefits, workers compensation benefits, sick pay, paid family and medical leave, capital gains resulting from the sale of owner-occupied two- or three-family rental property, and defined contribution and defined benefit pension payments. Capital gains from the portion attributed to a primary residence in excess of the exclusion allowed by Massachusetts law will be subject to the tax. The $20,000 exemption for this section shall be applied to each individual taxpayer.
(c) An employer, private or public, may agree to pay all or part of an employee’s payroll tax obligation. Such payment shall not be considered income to the employee for Massachusetts income tax purposes.
(d) Default, underpayment, or late payment of any tax or other obligation imposed by the Trust shall result in the remedies and penalties provided by law, except as provided in this section.
(e) Eligibility for benefits shall not be impaired by any default, underpayment, or late payment of any tax or other obligation imposed by the Trust.
(f) It is the intent of this act to establish a single public payer for all health care in the Commonwealth. Towards this end, public spending on health insurance shall be consolidated into the Trust to the greatest extent possible. Until such time as the role of all other payers for health care has been terminated, health care costs shall be collected from collateral sources whenever medical services provided to an individual are, or may be, covered services under a policy of insurance, health care service plan, or other collateral source available to that individual, or for which the individual has a right of action for compensation to the extent permitted by law.
(g) The Legislature shall be empowered to transfer funds from the General Fund sufficient to meet the Trust’s projected expenses beyond projected income from dedicated tax revenues. This lump transfer shall replace current General Fund spending on health benefits for state employees, services for patients at public in-patient facilities, and all means- or needs-tested health benefit programs.
(h) The Trust shall receive all monies paid to the Commonwealth by the federal government for health care services covered by the Trust. The Trust shall seek to maximize all sources of federal financial support for health care services in Massachusetts. Accordingly, the Executive Director shall seek all necessary waivers, exemptions, agreements, or legislation, if needed, so that all current federal payments for health care shall, consistent with the federal law, be paid directly to the Trust Fund. In obtaining the waivers, exemptions, agreements, or legislation, the Executive Director shall seek from the federal government a contribution for health care services in Massachusetts that shall not decrease in relation to the contribution to other states as a result of the waivers, exemptions, agreements, or legislation.
(i) As used in this section, “collateral source” includes all of the following:
(1) insurance policies written by insurers, including the medical components of automobile, homeowners, workers’ compensation, and other forms of insurance;
(2) health care service plans and pension plans;
(3) employee benefit contracts;
(4) government benefit programs;
(5) a judgment for damages for personal injury;
(6) any third party who is or may be liable to an individual for health care services or costs;
(j) As used in this section, “collateral sources” does not include either of the following:
(1) a contract or plan that is subject to federal preemption; and
(2) any governmental unit, agency, or service, to the extent that subrogation is prohibited by law.
(k) An entity described as a collateral source is not excluded from the obligations imposed by this section by virtue of a contract or relationship with a governmental unit, agency, or service.
(l) Whenever an individual receives health care services under the system Trust and the individual is entitled to coverage, reimbursement, indemnity, or other compensation from a collateral source, the individual shall notify the health care practitioner or facility and provide information identifying the collateral source other than federal sources, the nature and extent of coverage or entitlement, and other relevant information. The health care practitioner or facility shall forward this information to the Executive Director. The individual entitled to coverage, reimbursement, indemnity, or other compensation from a collateral source shall provide additional information as requested by the Executive Director.
(m) The Trust shall seek reimbursement from the collateral source for services provided to the individual, and may institute appropriate action, including suit, to recover the costs to the Trust. Upon demand, the collateral source shall pay to the Trust Fund the sums it would have paid or expended on behalf of the individuals for the health care services provided by the Trust.
(n) If a collateral source is exempt from subrogation or the obligation to reimburse the Trust as provided in this section, the Executive Director may require that an individual who is entitled to medical services from the collateral source first seek those services from that source before seeking those services from the Trust.
(o) To the extent permitted by federal law, contractual retiree health benefits provided by employers shall be subject to the same subrogation as other contracts, allowing the Trust to recover the cost of services provided to individuals covered by the retiree benefits, unless and until arrangements are made to transfer the revenues of the benefits directly to the Trust.
(p) The Trust shall retain:
(1) all charitable donations, gifts, grants, or bequests made to it from whatever source consistent with state and federal law;
(2) payments from third party payers for covered services rendered by eligible practitioners to non-eligible patients but paid for by the Trust; and
(3) income from the investment of Trust assets, consistent with state and federal law.
(q) Any employer who has a contract with an insurer, health services corporation, or health maintenance organization to provide health care services or benefits for its employees, which is in effect on the effective date of this section, shall be entitled to an income tax credit against premiums otherwise due in an amount equal to the Trust Fund tax due pursuant to this section.
(r) Any insurer, self-insured employers, union health and welfare fund, health services corporation, or health maintenance organization which provides health care services or benefits under a contract with an employer or group of employers, which is in effect on the effective date of this act, shall pay to the Trust Fund an amount equal to the Health Care Trust employer payroll tax based on the number of employees of each employer.
(s) Six months prior to the establishment of the Health Care Trust, all laws and regulations requiring health insurance carriers to maintain cash reserves for purposes of commercial stability (such as under Chapter 176G, Section 25 of the General Laws) shall be repealed. In their place, the Executive Director of the Trust shall assess an annual health care stabilization fee upon the same carriers, amounting to the same sum previously required to be held in reserves, which shall be credited to the Health Care Trust Fund.
Section 20. Insurance Reforms
Insurers regulated by the division of insurance are prohibited from charging premiums to eligible participants for coverage of services already covered by the Trust. The commissioner of insurance shall adopt, amend, alter, repeal, and enforce all such reasonable rules and regulations and orders as may be necessary to implement this section.
Section 21. Health Care Trust Regulatory Authority
The Trust shall adopt and promulgate regulations to implement the provisions of this chapter. The initial regulations may be adopted as emergency regulations but those emergency regulations shall be in effect only from the effective date of this chapter until the conclusion of the transition period.
Section 22. Implementation of the Health Care Trust
Not later than sixty days after enactment of this legislation, the Governor and Attorney General shall make the initial appointments to the Board of the Massachusetts Health Care Trust and coordinate with the Secretary of the Commonwealth to set the date for public elections of the eight Trustees elected by the citizens of the Commonwealth within four months of the appointments. The first meeting of the Board shall take place within 30 days of the election of the Trustees.
The Board shall immediately begin the process of hiring an Executive Director of the Trust, review enabling legislation, educating itself regarding general purposes, economics, and authority of the Trust. The Board shall develop a budget for the first year of transition and initiate the process of obtaining federal waivers and agreements concerning payments from Medicare, Medicaid, and other public programs. The Board shall also set a general timeframe for establishing the Trust with a launch date no less than one year and no more than 18 months after the first meeting of the Board.
In the first phase of transition, the Executive Director shall begin hiring staff, establishing the administrative and information technology infrastructure for the Trust, and negotiating reimbursement rates for health care services, pharmaceuticals, and medical equipment. Health care practitioners shall develop plans for transitioning to the Trust.
In the second phase of transition, the infrastructure of the Trust shall be established, including Regional Offices to provide public education about the new system; training of health care practitioners staff on systems for processing bills to the Trust; and introduction of accounting regulations to employers for payment of payroll taxes. Private insurers shall pay the annual health care stabilization fee. Residents of the Commonwealth shall receive health care identification cards with an explanation of benefits and contact information for their Regional office.
Funding for the establishment of the Trust during the transition period shall be provided by the Legislature, supplemented by the reserve funds of private insurers.
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An Act relative to fiduciary responsibility | S745 | SD1582 | 193 | {'Id': 'RCF0', 'Name': 'Ryan C. Fattman', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RCF0', 'ResponseDate': '2023-01-13T12:49:33.337'} | [{'Id': 'RCF0', 'Name': 'Ryan C. Fattman', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RCF0', 'ResponseDate': '2023-01-13T12:49:33.3366667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S745/DocumentHistoryActions | Bill | By Mr. Fattman, a petition (accompanied by bill, Senate, No. 745) of Ryan C. Fattman for legislation relative to fiduciary responsibility. Health Care Financing. | Chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following section:-
Section 80. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:
"Asset transfer disqualification'', a transfer of assets for less than fair market value by a Medicaid applicant or recipient as set forth in 42 U.S.C. 1396p(c)(1)(A) and 42 U.S.C. 1396p(c)(1)(B).
"Costs of care'', all costs of health care and lodging and all related costs, including transportation, medical and personal care and any other costs, charges and expenses incurred by the facility in rendering care to the resident.
"Department'', the department of public health.
"Fiduciary'', a person to whom power or property has been formally entrusted for the benefit of another such as an attorney-in-fact, legal guardian, trustee, or representative payee.
"Long-term care facility'', a facility licensed by the department of public health pursuant to section 71 of chapter 111 of the General Laws.
“Patient liability amount'', the amount of income that a resident is liable to contribute toward the cost of his or her nursing facility care.
"Period of asset transfer disqualification'', the period of ineligibility for Medicaid required under 42 U.S.C. 1396p(c)(1)(E).
"Person'', persons both natural and otherwise, including, without limitation, any corporation, partnership, limited liability company, trust or other entity.
"Resident", any person who inhabits or inhabited a long-term care facility for any period of time.
(b) Except as provided in subsection (c), when an asset transfer made on or after the effective date of this section results in a final determination of a Medicaid asset transfer disqualification, the person who received the assets from a resident which resulted in the Medicaid asset transfer disqualification shall be liable under this section to the long-term care facility for all costs of care up to the amount transferred to the person. The person shall be liable at the facility's Medicaid rate for services for the period of asset transfer disqualification.
(c) It shall be an affirmative defense in any action instituted under subsection (b), that the transfer of the asset which resulted in a final determination of a Medicaid asset transfer disqualification was not a disqualifying transfer under 42 U.S.C. 1396p. The court's decision regarding such affirmative defense shall be made independently of the determination made by the department. If that affirmative defense is proven, the person shall not be liable under subsection (b).
(d) The facility shall send a written notice of its intent to file the action to any person whom it intends to name as a defendant in the action at least 45 days before filing an action pursuant to this section.
(e) Any fiduciary or person who has received authority over the income of a resident such as a person who has been given or otherwise obtained authority over a resident's bank account, has been named as or has rights as a joint account holder, or otherwise has obtained or received any control over a resident's bank account or any other income of a resident, shall be liable under this section to the long-term care facility to the extent that any such person or fiduciary refuses to pay the patient liability amount due under Medicaid, provided that the person or fiduciary is in receipt of written notice from the department of the patient liability amount at the time such income is received by the fiduciary or person, and provided further that the liability of the person or fiduciary shall be for amounts going forward from the receipt of the notice. The facility shall send a written notice of its intent to file the action to any person or fiduciary that it intends to name as a defendant in the action at least 30 days before filing an action pursuant to this subsection.
(f) No judgment obtained in any proceeding under this section shall be acted upon through execution, levy, or otherwise during the pendency of any actually completed and filed application for Medicaid. Attachments and trustee process to secure any judgment or potential judgment shall be permitted subject to the discretion of the court to protect facilities from non-payment or from the failure of the resident, or that resident's fiduciary, to cooperate in obtaining Medicaid.
(g) Nothing contained in this section shall prohibit or otherwise diminish any other causes of action possessed by any such long-term care facility. The death of the resident shall not nullify or otherwise affect the liability of the person or persons charged with the cost of care rendered or the patient liability amount as referenced in this section.
(g) A fiduciary under this section shall not be personally liable for the acts or omissions of the fiduciary's predecessor, if any, solely by reason of his or her role as successor fiduciary.
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An Act relative to the operating budgets of health care oversight agencies | S746 | SD1291 | 193 | {'Id': 'BRF0', 'Name': 'Barry R. Finegold', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BRF0', 'ResponseDate': '2023-01-18T19:39:23.123'} | [{'Id': 'BRF0', 'Name': 'Barry R. Finegold', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BRF0', 'ResponseDate': '2023-01-18T19:39:23.1233333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S746/DocumentHistoryActions | Bill | By Mr. Finegold, a petition (accompanied by bill, Senate, No. 746) of Barry R. Finegold for legislation relative to the operating budgets of health care oversight agencies. Health Care Financing. | SECTION 1. Section 6 of chapter 6D of the General Laws is hereby amended by inserting at the end thereof the following paragraph:-
The assessed amount for hospitals and ambulatory surgical centers, and surcharge payors, shall not increase from the previous year at a rate greater than the health care cost growth benchmark approved by the commission pursuant to section 9 of this chapter for the same year.
SECTION 2. Section 7 of chapter 12C of the General Laws is hereby amended by inserting at the end thereof the following paragraph:-
The assessed amount for hospitals and ambulatory surgical centers, and surcharge payors, shall not increase from the previous year at a rate greater than the health care cost growth benchmark approved by the health policy commission pursuant to section 9 of chapter 6D for the same year.
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An Act relative to the nurse licensure compact in Massachusetts | S747 | SD2113 | 193 | {'Id': 'BRF0', 'Name': 'Barry R. Finegold', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BRF0', 'ResponseDate': '2023-01-20T12:46:25.357'} | [{'Id': 'BRF0', 'Name': 'Barry R. Finegold', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BRF0', 'ResponseDate': '2023-01-20T12:46:25.3566667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S747/DocumentHistoryActions | Bill | By Mr. Finegold, a petition (accompanied by bill, Senate, No. 747) of Barry R. Finegold for legislation relative to participation in the national nurse licensure compact agreement. Health Care Financing. | SECTION 1. Subsection (c) of section 14 of chapter 13 of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by inserting, in line 4, after the words “twelve,”, the following words:- and chapter 112A.
SECTION 2. Section 79 of chapter 112 of the General Laws, as so appearing, is hereby amended by adding the following two sentences:-
The board may assess a licensed nurse a penalty of not more than $2,000 for each violation of regulations promulgated pursuant to this section and for each violation of any general law that governs the practice of nursing. The board, through regulation, shall ensure that any fine levied is commensurate with the severity of the violation.
SECTION 3. The General Laws, as so appearing, are hereby amended by inserting after chapter 112 the following chapter:-
Chapter 112A. Nurse Licensure Compact
Section 1.
As used in this chapter, the following words shall have the following meanings:
“Adverse action”, any administrative, civil, equitable or criminal action permitted by a state’s laws which is imposed by a licensing board or other authority against a nurse, including actions against an individual’s license or multistate licensure privilege such as revocation, suspension, probation, monitoring of the licensee, limitation on the licensee’s practice or any other encumbrance on licensure affecting a nurse’s authorization to practice, including issuance of a cease and desist action.
“Alternative program”, a non-disciplinary monitoring program approved by a licensing board.
“Compact” or “Nurse Licensure Compact”, the legally binding agreement between party states as adopted by the National Council of State Boards of Nursing Nurse Licensure Compact in its Final Version dated May 4, 2015, and entered into by the commonwealth in accordance with this chapter.
“Coordinated licensure information system”, an integrated process for collecting, storing and sharing information on nurse licensure and enforcement activities related to nurse licensure laws that is administered by a nonprofit organization composed of and controlled by licensing boards.
“Current significant investigative information”, (i) investigative information that a licensing board, after a preliminary inquiry that includes notification and an opportunity for the nurse to respond, if required by state law, has reason to believe is not groundless and, if proved true, would indicate more than a minor infraction or (ii) investigative information that indicates that the nurse represents an immediate threat to public health and safety regardless of whether the nurse has been notified and had an opportunity to respond.
“Encumbrance”, a revocation or suspension of, or any limitation on, the full and unrestricted practice of nursing imposed by a licensing board.
“Home state”, the party state which is the nurse’s primary state of residence.
“Interstate commission”, the Interstate Commission of Nurse Licensure Compact Administrators as established in section 6 of this chapter.
“Licensing board”, a party state’s regulatory body responsible for issuing nurse licenses.
“Multistate license”, a license to practice as a registered nurse or a licensed practical or vocational nurse issued by a home state licensing board that authorizes the licensed nurse to practice in all party states under a multistate licensure privilege.
“Multistate licensure privilege”, a legal authorization associated with a multistate license permitting the practice of nursing as either a registered nurse or as a licensed practical or vocational nurse in a remote state.
“Nurse”, registered nurse or a licensed practical or vocational nurse, as those terms are defined by each party state’s practice laws.
“Party state”, the commonwealth and any other state that has adopted this compact.
“Remote state”, a party state other than the home state.
“Single-state license”, a nurse license issued by a party state that authorizes practice only within the issuing state and does not include a multistate licensure privilege to practice in any other party state.
“State”, a state, territory or possession of the United States and the District of Columbia.
“State practice laws”, a party state’s laws, rules and regulations that govern the practice of nursing, define the scope of nursing practice and establish the methods and grounds for imposing discipline. “State practice laws” do not include requirements necessary to obtain and retain a license, except for qualifications or requirements of the home state.
Section 2.
(a) A multistate license to practice as a nurse issued by a home state to a resident in that state will be recognized by each party state as authorizing a nurse to practice as a registered nurse or as a licensed practical or vocational nurse, under a multistate licensure privilege, in each party state.
(b) A state must implement procedures for considering the criminal history records of applicants for initial multistate license or licensure by endorsement. Such procedures shall include the submission of fingerprints or other biometric-based information by applicants for the purpose of obtaining an applicant’s criminal history record information from the Federal Bureau of Investigation and the agency responsible for retaining that state’s criminal records.
(c) Each party state shall require the following for an applicant to obtain or retain a multistate license in the home state:
(1) Meets the home state’s qualifications for licensure or renewal of licensure, as well as, all other applicable state laws;
(2) (i) Has graduated or is eligible to graduate from a licensing board-approved registered nurse or practical or vocational nurse pre-licensure education program; or (ii) has graduated from a foreign registered nurse or practical or vocational nurse pre-licensure education program that (A) has been approved by the authorized accrediting body in the applicable country and (B) has been verified by an independent credentials review agency to be comparable to a licensing board-approved pre-licensure education program;
(3) Has, if a graduate of a foreign pre-licensure education program not taught in English or if English is not the individual’s native language, successfully passed an English proficiency examination that includes the components of reading, speaking, writing and listening;
(4) Has successfully passed an NCLEX-RN® or NCLEX-PN® Examination or recognized predecessor, as applicable;
(5) Is eligible for or holds an active, unencumbered license;
(6) Has submitted, in connection with an application for initial licensure or licensure by endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history record information from the Federal Bureau of Investigation and the agency responsible for retaining that state’s criminal records;
(7) Has not been convicted or found guilty, or entered into an agreed disposition, of a felony offense under applicable state or federal criminal law;
(8) Has not been convicted or found guilty, or entered into an agreed disposition, of a misdemeanor offense related to the practice of nursing as determined on a case-by-case basis;
(9) Is not currently enrolled in an alternative program;
(10) Is subject to self-disclosure requirements regarding current participation in an alternative program; and
(11) Has a valid United States Social Security number.
(d) All party states shall be authorized, in accordance with existing state due process law, to take adverse action against a nurse’s multistate licensure privilege such as revocation, suspension, probation or any other action that affects a nurse’s authorization to practice under a multistate licensure privilege, including cease and desist actions. If a party state takes such action, it shall promptly notify the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the home state of any such actions by remote states.
(e) A nurse practicing in a party state must comply with the state practice laws of the state in which the client is located at the time service is provided. The practice of nursing is not limited to patient care, but shall include all nursing practice as defined by the state practice laws of the party state in which the client is located. The practice of nursing in a party state under a multistate licensure privilege will subject a nurse to the jurisdiction of the licensing board, the courts and the laws of the party state in which the client is located at the time service is provided.
(f) Individuals not residing in a party state shall continue to be able to apply for a party state’s single-state license as provided under the laws of each party state. However, the single-state license granted to these individuals will not be recognized as granting the privilege to practice nursing in any other party state. Nothing in this compact shall affect the requirements established by a party state for the issuance of a single-state license.
(g) Any nurse holding a home state multistate license, on the effective date of this compact, may retain and renew the multistate license issued by the nurse’s then-current home state, provided that:
(1) A nurse, who changes primary state of residence after this compact’s effective date, must meet all applicable requirements under section 2 to obtain a multistate license from a new home state.
(2) A nurse who fails to satisfy the multistate licensure requirements in section 2 due to a disqualifying event occurring after this compact’s effective date shall be ineligible to retain or renew a multistate license, and the nurse’s multistate license shall be revoked or deactivated in accordance with applicable rules adopted by the interstate commission.
Section 3.
(a) Upon application for a multistate license, the licensing board in the issuing party state shall ascertain, through the coordinated licensure information system, whether the applicant has ever held, or is the holder of, a license issued by any other state, whether there are any encumbrances on any license or multistate licensure privilege held by the applicant, whether any adverse action has been taken against any license or multistate licensure privilege held by the applicant and whether the applicant is currently participating in an alternative program.
(b) A nurse may hold a multistate license, issued by the home state, in only one party state at a time.
(c) If a nurse changes primary state of residence by moving between two party states, the nurse must apply for licensure in the new home state, and the multistate license issued by the prior home state will be deactivated in accordance with applicable rules adopted by the interstate commission.
(1) The nurse may apply for licensure in advance of a change in primary state of residence.
(2) A multistate license shall not be issued by the new home state until the nurse provides satisfactory evidence of a change in primary state of residence to the new home state and satisfies all applicable requirements to obtain a multistate license from the new home state.
(d) If a nurse changes primary state of residence by moving from a party state to a non-party state, the multistate license issued by the prior home state will convert to a single-state license, valid only in the former home state.
Section 4.
(a) In addition to the other powers conferred by state law, a licensing board shall have the authority to:
(1) Take adverse action against a nurse’s multistate licensure privilege to practice within that party state.
(i) Only the home state shall have the power to take adverse action against a nurse’s license issued by the home state.
(ii) For purposes of taking adverse action, the home state licensing board shall give the same priority and effect to reported conduct received from a remote state as it would if such conduct had occurred within the home state. In so doing, the home state shall apply its own state laws to determine appropriate action.
(2) Issue cease and desist orders or impose an encumbrance on a nurse’s authority to practice within that party state.
(3) Complete any pending investigations of a nurse who changes primary state of residence during the course of such investigations. The licensing board shall also have the authority to take appropriate action(s) and shall promptly report the conclusions of such investigations to the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the new home state of any such actions.
(4) Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses, as well as, the production of evidence. Subpoenas issued by a licensing board in a party state for the attendance and testimony of witnesses or the production of evidence from another party state shall be enforced in the latter state by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage and other fees required by the service statutes of the state in which the witnesses or evidence are located.
(5) Obtain and submit, for each nurse licensure applicant, fingerprint or other biometric-based information to the Federal Bureau of Investigation for criminal background checks, receive the results of the Federal Bureau of Investigation record search on criminal background checks and use the results in making licensure decisions.
(6) If otherwise permitted by state law, recover from the affected nurse the costs of investigations and disposition of cases resulting from any adverse action taken against that nurse.
(7) Take adverse action based on the factual findings of the remote state, provided that the licensing board follows its own procedures for taking such adverse action.
(b) If adverse action is taken by the home state against a nurse’s multistate license, the nurse’s multistate licensure privilege to practice in all other party states shall be deactivated until all encumbrances have been removed from the multistate license. All home state disciplinary orders that impose adverse action against a nurse’s multistate license shall include a statement that the nurse’s multistate licensure privilege is deactivated in all party states during the pendency of the order.
(c) Nothing in this compact shall override a party state’s decision that participation in an alternative program may be used in lieu of adverse action. The home state licensing board shall deactivate the multistate licensure privilege under the multistate license of any nurse for the duration of the nurse’s participation in an alternative program.
Section 5.
(a) All party states shall participate in a coordinated licensure information system of all licensed registered nurses and licensed practical or vocational nurses. This system will include information on the licensure and disciplinary history of each nurse, as submitted by party states, to assist in the coordination of nurse licensure and enforcement efforts.
(b) The interstate commission, in consultation with the administrator of the coordinated licensure information system, shall formulate necessary and proper procedures for the identification, collection and exchange of information under this compact.
(c) All licensing boards shall promptly report to the coordinated licensure information system any adverse action, any current significant investigative information, denials of applications with the reasons for such denials and nurse participation in alternative programs known to the licensing board regardless of whether such participation is deemed nonpublic or confidential under state law.
(d) Current significant investigative information and participation in nonpublic or confidential alternative programs shall be transmitted through the coordinated licensure information system only to party state licensing boards.
(e) Notwithstanding any other provision of law, all party state licensing boards contributing information to the coordinated licensure information system may designate information that may not be shared with non-party states or disclosed to other entities or individuals without the express permission of the contributing state.
(f) Any personally identifiable information obtained from the coordinated licensure information system by a party state licensing board shall not be shared with non-party states or disclosed to other entities or individuals except to the extent permitted by the laws of the party state contributing the information.
(g) Any information contributed to the coordinated licensure information system that is subsequently required to be expunged by the laws of the party state contributing that information shall also be expunged from the coordinated licensure information system.
(h) The compact administrator of each party state shall furnish a uniform data set to the compact administrator of each other party state, which shall include, at a minimum:
(1) Identifying information;
(2) Licensure data;
(3) Information related to alternative program participation; and
(4) Other information that may facilitate the administration of this compact, as determined by interstate commission rules.
(i) The compact administrator of a party state shall provide all investigative documents and information requested by another party state.
Section 6.
(a) The party states hereby create and establish a joint public entity known as the Interstate Commission of Nurse Licensure Compact Administrators.
(1) The interstate commission is an instrumentality of the party states.
(2) Venue is proper, and judicial proceedings by or against the interstate commission shall be brought solely and exclusively, in a court of competent jurisdiction where the principal office of the interstate commission is located. The interstate commission may waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings.
(3) Nothing in this compact shall be construed to be a waiver of sovereign immunity.
(b) Membership, Voting and Meetings
(1) Each party state shall have and be limited to one administrator. The head of the state licensing board or designee shall be the administrator of this compact for each party state. Any administrator may be removed or suspended from office as provided by the law of the state from which the administrator is appointed. Any vacancy occurring in the interstate commission shall be filled in accordance with the laws of the party state in which the vacancy exists.
(2) Each administrator shall be entitled to 1 vote with regard to the promulgation of rules and creation of bylaws and shall otherwise have an opportunity to participate in the business and affairs of the interstate commission. An administrator shall vote in person or by such other means as provided in the bylaws. The bylaws may provide for an administrator’s participation in meetings by telephone or other means of communication.
(3) The interstate commission shall meet at least once during each calendar year. Additional meetings shall be held as set forth in the bylaws or rules of the interstate commission.
(4) All meetings shall be open to the public, and public notice of meetings shall be given in the same manner as required under the rulemaking provisions in section 7.
(5) The interstate commission may convene in a closed, nonpublic meeting if the interstate commission must discuss:
(i) Noncompliance of a party state with its obligations under this compact;
(ii) The employment, compensation, discipline or other personnel matters, practices or procedures related to specific employees or other matters related to the interstate commission’s internal personnel practices and procedures;
(iii) Current, threatened or reasonably anticipated litigation;
(iv) Negotiation of contracts for the purchase or sale of goods, services or real estate;
(v) Accusing any person of a crime or formally censuring any person;
(vi) Disclosure of trade secrets or commercial or financial information that is privileged or confidential;
(vii) Disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy;
(viii) Disclosure of investigatory records compiled for law enforcement purposes;
(ix) Disclosure of information related to any reports prepared by or on behalf of the interstate commission for the purpose of investigation of compliance with this compact; or
(x) Matters specifically exempted from disclosure by federal or state statute.
(6) If a meeting, or portion of a meeting, is closed pursuant to this provision, the interstate commission’s legal counsel or designee shall certify that the meeting may be closed and shall reference each relevant exempting provision. The interstate commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, and the reasons therefor, including a description of the views expressed. All documents considered in connection with an action shall be identified in such minutes. All minutes and documents of a closed meeting shall remain under seal, subject to release by a majority vote of the interstate commission or order of a court of competent jurisdiction.
(c) The interstate commission shall, by a majority vote of the administrators, prescribe bylaws or rules to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise the powers of this compact, including but not limited to:
(1) Establishing the fiscal year of the interstate commission;
(2) Providing reasonable standards and procedures:
(i) For the establishment and meetings of other committees; and
(ii) Governing any general or specific delegation of any authority or function of the interstate commission;
(3) Providing reasonable procedures for calling and conducting meetings of the interstate commission, ensuring reasonable advance notice of all meetings and providing an opportunity for attendance of such meetings by interested parties, with enumerated exceptions designed to protect the public’s interest, the privacy of individuals, and proprietary information, including trade secrets. The interstate commission may meet in closed session only after a majority of the administrators vote to close a meeting in whole or in part. As soon as practicable, the interstate commission must make public a copy of the vote to close the meeting revealing the vote of each administrator, with no proxy votes allowed;
(4) Establishing the titles, duties and authority and reasonable procedures for the election of the officers of the interstate commission;
(5) Providing reasonable standards and procedures for the establishment of the personnel policies and programs of the interstate commission. Notwithstanding any civil service or other similar laws of any party state, the bylaws shall exclusively govern the personnel policies and programs of the interstate commission; and
(6) Providing a mechanism for winding up the operations of the interstate commission and the equitable disposition of any surplus funds that may exist after the termination of this compact after the payment or reserving of all of its debts and obligations;
(d) The interstate commission shall publish its bylaws and rules, and any amendments thereto, in a convenient form on the website of the interstate commission.
(e) The interstate commission shall maintain its financial records in accordance with the bylaws.
(f) The interstate commission shall meet and take such actions as are consistent with the provisions of this compact and the bylaws.
(g) The interstate commission shall have the following powers:
(1) To promulgate uniform rules to facilitate and coordinate implementation and administration of this compact. The rules shall have the force and effect of law and shall be binding in all party states;
(2) To bring and prosecute legal proceedings or actions in the name of the interstate commission, provided that the standing of any licensing board to sue or be sued under applicable law shall not be affected;
(3) To purchase and maintain insurance and bonds;
(4) To borrow, accept or contract for services of personnel, including, but not limited to, employees of a party state or nonprofit organizations;
(5) To cooperate with other organizations that administer state compacts related to the regulation of nursing, including but not limited to sharing administrative or staff expenses, office space or other resources;
(6) To hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of this compact, and to establish the interstate commission’s personnel policies and programs relating to conflicts of interest, qualifications of personnel and other related personnel matters;
(7) To accept any and all appropriate donations, grants and gifts of money, equipment, supplies, materials and services and to receive, utilize and dispose of the same; provided that at all times the interstate commission shall avoid any appearance of impropriety or conflict of interest;
(8) To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold, improve or use, any property, whether real, personal or mixed; provided that at all times the interstate commission shall avoid any appearance of impropriety;
(9) To sell, convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of any property, whether real, personal or mixed;
(10) To establish a budget and make expenditures;
(11) To borrow money;
(12) To appoint committees, including advisory committees comprised of administrators, state nursing regulators, state legislators or their representatives, and consumer representatives, and other such interested persons;
(13) To provide and receive information from, and to cooperate with, law enforcement agencies;
(14) To adopt and use an official seal; and
(15) To perform such other functions as may be necessary or appropriate to achieve the purposes of this compact consistent with the state regulation of nurse licensure and practice.
(h) Financing of the interstate commission
(1) The interstate commission shall pay, or provide for the payment of, the reasonable expenses of its establishment, organization and ongoing activities.
(2) The interstate commission may also levy on and collect an annual assessment from each party state to cover the cost of its operations, activities and staff in its annual budget as approved each year. The aggregate annual assessment amount, if any, shall be allocated based upon a formula to be determined by the interstate commission, which shall promulgate a rule that is binding upon all party states.
(3) The interstate commission shall not incur obligations of any kind prior to securing the funds adequate to meet the same; nor shall the interstate commission pledge the credit of any of the party states, except by, and with the authority of, such party state.
(4) The interstate commission shall keep accurate accounts of all receipts and disbursements. The receipts and disbursements of the interstate commission shall be subject to the audit and accounting procedures established under its bylaws. However, all receipts and disbursements of funds handled by the interstate commission shall be audited yearly by a certified or licensed public accountant, and the report of the audit shall be included in and become part of the annual report of the interstate commission.
(i) Qualified Immunity, Defense and Indemnification
(1) The administrators, officers, executive director, employees and representatives of the interstate commission shall be immune from suit and liability, either personally or in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error or omission that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred, within the scope of interstate commission employment, duties or responsibilities; provided that nothing in this paragraph shall be construed to protect any such person from suit or liability for any damage, loss, injury or liability caused by the intentional, willful or wanton misconduct of that person.
(2) The interstate commission shall defend any administrator, officer, executive director, employee or representative of the interstate commission in any civil action seeking to impose liability arising out of any actual or alleged act, error or omission that occurred within the scope of interstate commission employment, duties or responsibilities, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of interstate commission employment, duties or responsibilities; provided, however, that nothing herein shall be construed to prohibit that person from retaining his or her own counsel; and provided, further, that the actual or alleged act, error or omission did not result from that person’s intentional, willful or wanton misconduct.
(3) The interstate commission shall indemnify and hold harmless any administrator, officer, executive director, employee or representative of the interstate commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error or omission that occurred within the scope of interstate commission employment, duties or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of interstate commission employment, duties or responsibilities, provided that the actual or alleged act, error or omission did not result from the intentional, willful or wanton misconduct of that person.
Section 7.
(a) The interstate commission shall exercise its rulemaking powers pursuant to the criteria set forth in this section and the rules adopted thereunder. Rules and amendments shall become binding as of the date specified in each rule or amendment and shall have the same force and effect as provisions of this compact.
(b) Rules or amendments to the rules shall be adopted at a regular or special meeting of the interstate commission.
(c) Prior to promulgation and adoption of a final rule or rules by the interstate commission, and at least 60 days in advance of the meeting at which the rule will be considered and voted upon, the interstate commission shall file a notice of proposed rulemaking:
(1) On the website of the interstate commission; and
(2) On the website of each licensing board or the publication in which each state would otherwise publish proposed rules.
(d) The notice of proposed rulemaking shall include:
(1) The proposed time, date and location of the meeting in which the rule will be considered and voted upon;
(2) The text of the proposed rule or amendment, and the reason for the proposed rule;
(3) A request for comments on the proposed rule from any interested person; and
(4) The manner in which interested persons may submit notice to the interstate commission of their intention to attend the public hearing and any written comments.
(e) Prior to adoption of a proposed rule, the interstate commission shall allow persons to submit written data, facts, opinions and arguments, which shall be made available to the public.
(f) The interstate commission shall grant an opportunity for a public hearing before it adopts a rule or amendment.
(g) The interstate commission shall publish the place, time and date of the scheduled public hearing.
(1) Hearings shall be conducted in a manner providing each person who wishes to comment a fair and reasonable opportunity to comment orally or in writing. All hearings will be recorded, and a copy will be made available upon request.
(2) Nothing in this section shall be construed as requiring a separate hearing on each rule. Rules may be grouped for the convenience of the interstate commission at hearings required by this section.
(h) If no one appears at the public hearing, the interstate commission may proceed with promulgation of the proposed rule.
(i) Following the scheduled hearing date, or by the close of business on the scheduled hearing date if the hearing was not held, the interstate commission shall consider all written and oral comments received.
(j) The interstate commission shall, by majority vote of all administrators, take final action on the proposed rule and shall determine the effective date of the rule, if any, based on the rulemaking record and the full text of the rule.
(k) Upon determination that an emergency exists, the interstate commission may consider and adopt an emergency rule without prior notice, opportunity for comment or hearing, provided that the usual rulemaking procedures provided in this compact and in this section shall be retroactively applied to the rule as soon as reasonably possible, in no event later than 90 days after the effective date of the rule. For the purposes of this provision, an emergency rule is one that must be adopted immediately in order to:
(1) Meet an imminent threat to public health, safety or welfare;
(2) Prevent a loss of interstate commission or party state funds; or
(3) Meet a deadline for the promulgation of an administrative rule that is required by federal law or rule.
(l) The interstate commission may direct revisions to a previously adopted rule or amendment for purposes of correcting typographical errors, errors in format, errors in consistency or grammatical errors. Public notice of any revisions shall be posted on the website of the interstate commission. The revision shall be subject to challenge by any person for a period of thirty (30) days after posting. The revision may be challenged only on grounds that the revision results in a material change to a rule. A challenge shall be made in writing, and delivered to the interstate commission, prior to the end of the notice period. If no challenge is made, the revision will take effect without further action. If the revision is challenged, the revision may not take effect without the approval of the interstate commission.
Section 8.
(a) Oversight
(1) Each party state shall enforce this compact and take all actions necessary and appropriate to effectuate this compact’s purposes and intent.
(2) The interstate commission shall be entitled to receive service of process in any proceeding that may affect the powers, responsibilities or actions of the interstate commission, and shall have standing to intervene in such a proceeding for all purposes. Failure to provide service of process in such proceeding to the interstate commission shall render a judgment or order void as to the interstate commission, this compact or promulgated rules.
(b) Default, Technical Assistance and Termination
(1) If the interstate commission determines that a party state has defaulted in the performance of its obligations or responsibilities under this compact or the promulgated rules, the interstate commission shall:
(i) Provide written notice to the defaulting state and other party states of the nature of the default, the proposed means of curing the default or any other action to be taken by the interstate commission; and
(ii) Provide remedial training and specific technical assistance regarding the default.
(2) If a state in default fails to cure the default, the defaulting state’s membership in this compact may be terminated upon an affirmative vote of a majority of the administrators, and all rights, privileges and benefits conferred by this compact may be terminated on the effective date of termination. A cure of the default does not relieve the offending state of obligations or liabilities incurred during the period of default.
(3) Termination of membership in this compact shall be imposed only after all other means of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be given by the interstate commission to the governor of the defaulting state and to the executive officer of the defaulting state’s licensing board and each of the party states.
(4) A state whose membership in this compact has been terminated is responsible for all assessments, obligations and liabilities incurred through the effective date of termination, including obligations that extend beyond the effective date of termination.
(5) The interstate commission shall not bear any costs related to a state that is found to be in default or whose membership in this compact has been terminated unless agreed upon in writing between the interstate commission and the defaulting state.
(6) The defaulting state may appeal the action of the interstate commission by petitioning the U.S. District Court for the District of Columbia or the federal district in which the interstate commission has its principal offices. The prevailing party shall be awarded all costs of such litigation, including reasonable attorneys’ fees.
(c) Dispute Resolution
(1) Upon request by a party state, the interstate commission shall attempt to resolve disputes related to the Compact that arise among party states and between party and non-party states.
(2) The interstate commission shall promulgate a rule providing for both mediation and binding dispute resolution for disputes, as appropriate.
(3) In the event the interstate commission cannot resolve disputes among party states arising under this compact:
(i) The party states may submit the issues in dispute to an arbitration panel, which will be comprised of individuals appointed by the compact administrator in each of the affected party states and an individual mutually agreed upon by the compact administrators of all the party states involved in the dispute.
(ii) The decision of a majority of the arbitrators shall be final and binding.
(d) Enforcement
(1) The interstate commission, in the reasonable exercise of its discretion, shall enforce the provisions and rules of this compact.
(2) By majority vote, the interstate commission may initiate legal action in the U.S. District Court for the District of Columbia or the federal district in which the interstate commission has its principal offices against a party state that is in default to enforce compliance with the provisions of this compact and its promulgated rules and bylaws. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorneys’ fees.
(3) The remedies herein shall not be the exclusive remedies of the interstate commission. The interstate commission may pursue any other remedies available under federal or state law.
Section 9.
(a) This compact shall become effective and binding on the earlier of the date of legislative enactment of this compact into law by no less than twenty-six (26) states or December 31, 2018. All party states to this compact, that also were parties to the prior Nurse Licensure Compact, superseded by this compact, (“prior compact”), shall be deemed to have withdrawn from said prior compact within 6 months after the effective date of this compact.
(b) Each party state to this compact shall continue to recognize a nurse’s multistate licensure privilege to practice in that party state issued under the prior compact until such party state has withdrawn from the prior compact.
(c) Any party state may withdraw from this compact by enacting a statute repealing the same. A party state’s withdrawal shall not take effect until 6 months after enactment of the repealing statute.
(d) A party state’s withdrawal or termination shall not affect the continuing requirement of the withdrawing or terminated state’s licensing board to report adverse actions and significant investigations occurring prior to the effective date of such withdrawal or termination.
(e) Nothing contained in this compact shall be construed to invalidate or prevent any nurse licensure agreement or other cooperative arrangement between a party state and a non-party state that is made in accordance with the other provisions of this compact.
(f) This compact may be amended by the party states. No amendment to this compact shall become effective and binding upon the party states unless and until it is enacted into the laws of all party states.
(g) Representatives of non-party states to this compact shall be invited to participate in the activities of the interstate commission, on a nonvoting basis, prior to the adoption of this compact by all states.
Section 10.
This compact shall be liberally construed so as to effectuate the purposes thereof. The provisions of this compact shall be severable, and if any phrase, clause, sentence or provision of this compact is declared to be contrary to the constitution of any party state or of the United States, or if the applicability thereof to any government, agency, person or circumstance is held invalid, the validity of the remainder of this compact and the applicability thereof to any government, agency, person or circumstance shall not be affected thereby. If this compact shall be held to be contrary to the constitution of any party state, this compact shall remain in full force and effect as to the remaining party states and in full force and effect as to the party state affected as to all severable matters.
Section 11. The executive director of the board of registration in nursing, or the board executive director’s designee, shall be the administrator of the Nurse Licensure Compact for the commonwealth.
Section 12. The board of registration in nursing shall adopt regulations in the same manner as all other with states legally joining in the compact and may adopt additional regulations as necessary to implement the provisions of this chapter.
Section 13. The board of registration in nursing may recover from a nurse the costs of investigation and disposition of cases resulting in any adverse disciplinary action taken against that nurse’s license or privilege to practice. Funds collected pursuant to this section shall be deposited in the Quality in Health Professions Trust Fund established pursuant to section 35X of chapter 10.
Section 14. The board of registration in nursing may take disciplinary action against the practice privilege of a registered nurse or of a licensed practical or vocational nurse practicing in the commonwealth under a license issued by party state. The board’s disciplinary action may be based on disciplinary action against the nurse’s license taken by the nurse’s home state.
Section 15. In reporting information to the coordinated licensure information system under section 8 of this chapter related to the Nurse Licensure Compact, the board of registration in nursing may disclose personally identifiable information about the nurse, including social security number.
Section 16. Nothing in this chapter, nor the entrance of the commonwealth into the Nurse Licensure Compact shall be construed to supersede existing labor laws.
Section 17. The commonwealth, its officers and employees, and the board of registration in nursing and its agents who act in accordance with the provisions of this chapter shall not be liable on account of any act or omission in good faith while engaged in the performance of their duties under this chapter. Good faith shall not include willful misconduct, gross negligence, or recklessness.
Section 18. As part of the licensure and background check process for a multistate license and to determine the suitability of an applicant for multistate licensure, the board of registration in nursing, prior to issuing any multistate license, shall conduct a fingerprint-based check of the state and national criminal history databases, as authorized by 28 CFR 20.33 and Public Law 92-544.
Fingerprints shall be submitted to the identification section of the department of state police for a state criminal history check and forwarded to the Federal Bureau of Investigation for a national criminal history check, according to the policies and procedures established by the state identification section and by the department of criminal justice information services. Fingerprint submissions may be retained by the Federal Bureau of Investigation, the state identification section and the department of criminal justice information services for requests submitted by the board of registration in nursing as authorized under this section to ensure the continued suitability of these individuals for licensure. The department of criminal justice information services may disseminate the results of the state and national criminal background checks to the executive director of the board of registration in nursing and authorized staff of the board.
All applicants shall pay a fee to be established by the secretary of administration and finance, in consultation with the secretary of public safety, to offset the costs of operating and administering a fingerprint-based criminal background check system. The secretary of administration and finance, in consultation with the secretary of public safety, may increase the fee accordingly if the Federal Bureau of Investigation increases its fingerprint background check service fee. Any fees collected from fingerprinting activity under this chapter shall be deposited into the Fingerprint-Based Background Check Trust Fund, established in section 2HHHH of chapter 29.
The board of registration in nursing may receive all criminal offender record information and the results of checks of state and national criminal history databases under said Public Law 92-544. When the board of registration in nursing obtains the results of checks of state and national criminal history databases, it shall treat the information according to sections 167 to 178, inclusive, of chapter 6 and the regulations thereunder regarding criminal offender record information.
Notwithstanding subsections 9 and 9 1/2 of section 4 of chapter 151B, if the board of registration in nursing receives criminal record information from the state or national fingerprint-based criminal background checks that includes no disposition or is otherwise incomplete, the agency head may request that an applicant for licensure provide additional information regarding the results of the criminal background checks to assist the agency head in determining the applicant’s suitability for licensure.
SECTION 4. Notwithstanding any general or special law to the contrary, the secretary of administration and finance, following a public hearing, shall increase the fee for obtaining or renewing a license, certificate, registration, permit or authority issued by a board within the department of public health, excluding the board of registration in medicine, as necessary to implement the provisions of chapter 112A of the General Laws. The amount of the increase in fees shall be deposited in the Quality in Health Professions Trust Fund established in section 35X of chapter 10.
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An Act to protect medically fragile children | S748 | SD1126 | 193 | {'Id': 'CFF0', 'Name': 'Cindy F. Friedman', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CFF0', 'ResponseDate': '2023-01-15T13:11:03.807'} | [{'Id': 'CFF0', 'Name': 'Cindy F. Friedman', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CFF0', 'ResponseDate': '2023-01-15T13:11:03.8066667'}, {'Id': 'S_G1', 'Name': 'Sean Garballey', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/S_G1', 'ResponseDate': '2023-01-24T15:42:57.45'}, {'Id': 'RMH1', 'Name': 'Richard M. Haggerty', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RMH1', 'ResponseDate': '2023-01-30T11:19:48.3933333'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-31T16:52:34.7566667'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-03-02T16:24:12.5366667'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-03-06T09:18:22.3433333'}, {'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-03-06T09:17:19.2566667'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-30T15:24:50.94'}, {'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-04-12T15:01:02.84'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-06-11T17:51:16.8766667'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-06T09:59:23.89'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S748/DocumentHistoryActions | Bill | By Ms. Friedman, a petition (accompanied by bill, Senate, No. 748) of Cindy F. Friedman, Sean Garballey, Richard M. Haggerty, Joanne M. Comerford and other members of the General Court for legislation to protect medically fragile children. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws is hereby amended by adding the following section:-
Section 80. (a) Notwithstanding any general or special law to the contrary, and subject to appropriation, the executive office of health and human services shall increase the budget for continuous skilled nursing care, as defined in 101 CMR 361 and 130 CMR 403.402, by an amount that ensures:
(1) At least 75 percent of continuous skilled nursing hours authorized by MassHealth are filled on or before July 1, 2023;
(2) At least 80 percent of continuous skilled nursing hours authorized by MassHealth are filled on or before July 1, 2024; and
(3) At least 85 percent of continuous skilled nursing hours authorized by MassHealth are filled on or before July 1, 2025, and shall remain at 85 percent or above thereafter.
(b) The executive office of health and human services may require any portion of the budget increases provided for in this section to be used exclusively to increase the wage payment rate of nurses providing continuous skilled nursing care.
(c) To satisfy the requirements in subsection (a), the executive office of health and human services shall require MassHealth to submit an annual report no later than January 1 that:
(1) demonstrates that MassHealth has not changed its authorization criteria for continuous skilled nursing services in a way that is more restrictive and results in a reduction in the amount of authorized hours that would have been authorized previously; and
(2) includes the following information from the immediately preceding calendar year: (i) the number of filled and unfilled continuous skilled nursing hours authorized by MassHealth; (ii) the number of appeals received by MassHealth for the denial or modification of continuous skilled nursing hours and the number of patients that filed an appeal; (iii) the number of patients that received a reduction in the amount of authorized continuous skilled nursing hours; and (iv) the number of authorized continuous skilled nursing hours reduced from the immediately preceding calendar year, if any.
(d) The executive office of health and human services, in collaboration with MassHealth and after consultation with the Massachusetts Pediatric Nursing Care Campaign, shall promulgate regulations to implement this section.
(e) Nothing in this section shall be construed to prohibit filling 85 percent of the continuous skilled nursing hours authorized by MassHealth prior to July 1, 2025.
SECTION 2. Notwithstanding any general or special law to the contrary, the office of Medicaid shall review the wage payment rates established by home health agencies that provide continuous skilled nursing care, as defined in 101 CMR 361.00 and 130 CMR 403.402, for the providers of those services. The office shall provide: (i) an aggregated overview of the wage payment rates paid by home health agencies to staff or contracted nurses providing continuous skilled nursing care, including any increases in said wage rates resulting from increases in Medicaid rates paid to home health agencies for continuous skilled nursing care in state fiscal years 2020, 2021 and 2022; (ii) an aggregated breakdown of said wage rates as applied to the acuity level of patients receiving continuous skilled nursing care; (iii) an aggregated breakdown of said wage rates as applied to the licensure level of the providers of continuous skilled nursing care; and (iv) recommendations on criteria to be included in any future reporting by home health agencies receiving an increase of continuous skilled nursing care rates provided by the office. The office shall provide this report not later than March 1, 2025 to the clerks of the senate and house of representatives, the joint committee on health care financing and the senate and house committees on ways and means. Home health agencies providing continuous skilled nursing care shall provide all information and documentation requested by the office of Medicaid to compile the required report under this section.
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An Act relative to pharmaceutical access, costs and transparency | S749 | SD2232 | 193 | {'Id': 'CFF0', 'Name': 'Cindy F. Friedman', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CFF0', 'ResponseDate': '2023-01-20T13:25:52.1'} | [{'Id': 'CFF0', 'Name': 'Cindy F. Friedman', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CFF0', 'ResponseDate': '2023-01-20T13:25:52.1'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-01-24T09:48:55.3633333'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-01-27T09:40:46.8033333'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-27T12:18:23.6166667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-30T11:19:27.6066667'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-31T12:34:59.2033333'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-02-08T11:45:48.2766667'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-16T13:50:34.5933333'}, {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-02-23T09:45:40.82'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-03-02T16:24:20.9266667'}, {'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-03-06T09:17:38.0666667'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-16T14:43:02.6266667'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-03-27T14:15:10.2033333'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-04-03T09:10:09'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-04-10T16:48:47.0533333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S749/DocumentHistoryActions | Bill | By Ms. Friedman, a petition (accompanied by bill, Senate, No. 749) of Cindy F. Friedman, Rebecca L. Rausch, Susannah M. Whipps, Joanne M. Comerford and other members of the General Court for legislation relative to pharmaceutical access, costs and transparency. Health Care Financing. | SECTION 1. Chapter 6A of the General Laws is hereby amended by adding the following section:-
Section 16DD. (a) The following terms shall have the following meanings, unless the context clearly requires otherwise:
“Brand name drug”, a drug that is: (i) produced or distributed pursuant to an original new drug application approved under 21 U.S.C. 355(c) except for: (a) any drug approved through an application submitted under section 505(b)(2) of the federal Food, Drug, and Cosmetic Act that is pharmaceutically equivalent, as that term is defined by the United States Food and Drug Administration, to a drug approved under 21 U.S.C. 355(c); (b) an abbreviated new drug application that was approved by the United States Secretary of Health and Human Services under section 505(c) of the federal Food, Drug, and Cosmetic Act, 21 U.S.C. 355(c), before the 2 of 53 date of the enactment of the federal Drug Price Competition and Patent Term Restoration Act of 1984, Public Law 98-417, 98 Stat. 1585; or (c) an authorized generic drug as defined by 42 C.F.R. 447.502; (ii) produced or distributed pursuant to a biologics license application approved under 42 U.S.C. 262(a)(2)(C); or (iii) identified by the health benefit plan as a brand name drug based on available data resources such as Medi-Span.
“Generic drug”, a retail drug that is: (i) marketed or distributed pursuant to an abbreviated new drug application approved under 21 U.S.C. 355(j); (ii) an authorized generic drug as defined by 42 C.F.R. 447.502; (iii) a drug that entered the market before January 1, 1962 and was not originally marketed under a new drug application; or (iv) identified by the health benefit plan as a generic drug based on available data resources such as Medi-Span.
(b) Notwithstanding any general or special law to the contrary, there shall be a drug access program, administered by the executive office of health and human services, for the purpose of enhancing access to targeted high-value medications used to treat certain chronic conditions. To implement the drug access program, the secretary of health and human services, in consultation with the department of public health, the division of insurance, the health policy commission, and the center for health information and analysis, shall identify one generic drug and one brand name drug used to treat each of the following chronic conditions: (i) diabetes; (ii) asthma; and (iii) heart conditions, including, but not limited to, hypertension and coronary artery disease. In determining the one generic drug and one brand name drug used to treat each chronic condition, the secretary shall consider whether the drug is:
(1) of clear benefit and strongly supported by clinical evidence to be cost-effective;
(2) likely to reduce hospitalizations or emergency department visits, or reduce future exacerbations of illness progression, or improve quality of life;
(3) relatively low cost when compared to the cost of an acute illness or incident prevented or delayed by the use of the service, treatment or drug;
(4) at low risk for overutilization, abuse, addiction, diversion or fraud; and
(5) widely utilized as a treatment for the chronic condition.
(c) The secretary of health and human services shall identify insulin as the drug used to treat diabetes under the drug access program.
(d) Every two years, the secretary of health and human services, in consultation with the health policy commission, the center for health information and analysis and the division of insurance, shall evaluate the impact of the drug access program established in this section on drug treatment adherence, incidence of related acute events, premiums and cost-sharing, overall health, long-term health costs, and any other issues that the secretary may deem relevant. The secretary may collaborate with an independent research organization to conduct such evaluation. The secretary shall file a report of its findings with the clerks of the house of representatives and senate, the chairs of the joint committee on public health, the chairs of the joint committee on health care financing and the chairs of house and senate committees on ways and means.
(e) The secretary, in consultation with the division of insurance, shall promulgate rules and regulations necessary to implement this section.
SECTION 2. Section 1 of chapter 6D of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the definition of “Alternative payment methodologies or methods” the following 2 definitions:-
“Biosimilar”, a drug that is produced or distributed pursuant to a biologics license application approved under 42 U.S.C. 262(k)(3).
“Brand name drug”, a drug that is: (i) produced or distributed pursuant to an original new drug application approved under 21 U.S.C. 355(c) except for: (a) any drug approved through an application submitted under section 505(b)(2) of the federal Food, Drug, and Cosmetic Act that is pharmaceutically equivalent, as that term is defined by the United States Food and Drug Administration, to a drug approved under 21 U.S.C. 355(c); (b) an abbreviated new drug application that was approved by the United States Secretary of Health and Human Services under section 505(c) of the federal Food, Drug, and Cosmetic Act, 21 U.S.C. 355(c), before the date of the enactment of the federal Drug Price Competition and Patent Term Restoration Act of 1984, Public Law 98-417, 98 Stat. 1585; or (c) an authorized generic drug as defined by 42 C.F.R. 447.502; (ii) produced or distributed pursuant to a biologics license application approved under 42 U.S.C. 262(a)(2)(C); or (iii) identified by the health benefit plan as a brand name drug based on available data resources such as Medi-Span.
SECTION 3. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by inserting after the definition of “Disproportionate share hospital” the following definition:-
“Early notice”, advanced notification by a pharmaceutical manufacturing company of a: (i) new drug, device or other development coming to market; or (ii) a price increase, as described in subsection (b) of section 15A.
SECTION 4. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by inserting after the definition of “Fiscal year” the following definition:-
“Generic drug”, a retail drug that is: (i) marketed or distributed pursuant to an abbreviated new drug application approved under 21 U.S.C. 355(j); (ii) an authorized generic drug as defined by 42 C.F.R. 447.502; (iii) a drug that entered the market before January 1, 1962 and was not originally marketed under a new drug application; or (iv) identified by the health benefit plan as a generic drug based on available data resources such as Medi-Span.
SECTION 5. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by striking out, in line 189, the words “not include excludes ERISA plans” and inserting in place thereof the following words:- include self-insured plans to the extent allowed under the federal Employee Retirement Income Security Act of 1974.
SECTION 6. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by inserting after the definition of “Performance penalty” the following 2 definitions:-
“Pharmaceutical manufacturing company”, an entity engaged in the: (i) production, preparation, propagation, compounding, conversion or processing of prescription drugs, directly or indirectly, by extraction from substances of natural origin, independently by means of chemical synthesis or by a combination of extraction and chemical synthesis; or (ii) packaging, repackaging, labeling, relabeling or distribution of prescription drugs; provided, however, that “pharmaceutical manufacturing company” shall not include a wholesale drug distributor licensed under section 36B of chapter 112 or a retail pharmacist registered under section 39 of said chapter 112.
“Pharmacy benefit manager”, a person, business or other entity, however organized, that directly or through a subsidiary provides pharmacy benefit management services for prescription drugs and devices on behalf of a health benefit plan sponsor, including, but not limited to, a self-insurance plan, labor union or other third-party payer; provided, however, that pharmacy benefit management services shall include, but not be limited to: (i) the processing and payment of claims for prescription drugs; (ii) the performance of drug utilization review; (iii) the processing of drug prior authorization requests; (iv) pharmacy contracting; (v) the adjudication of appeals or grievances related to prescription drug coverage contracts; (vi) formulary administration; (vii) drug benefit design; (viii) mail and specialty drug pharmacy services; (ix) cost containment; (x) clinical, safety and adherence programs for pharmacy services; and (xi) managing the cost of covered prescription drugs; provided further, that “pharmacy benefit manager” shall include a health benefit plan that does not contract with a pharmacy benefit manager and manages its own prescription drug benefits unless specifically exempted by the commission.
SECTION 7. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by inserting after the definition of “Physician” the following definition:-
“Pipeline drug”, a prescription drug product containing a new molecular entity for which the sponsor has submitted a new drug application or biologics license application and received an action date from the United States Food and Drug Administration.
SECTION 8. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by adding the following definition:-
“Wholesale acquisition cost”, shall have the same meaning as defined in 42 U.S.C. 1395w-3a(c)(6)(B).
SECTION 9. Said chapter 6D is hereby further amended by striking out section 2A, as so appearing, and inserting in place thereof the following section:-
Section 2A. The commission shall keep confidential all nonpublic clinical, financial, strategic or operational documents or information provided or reported to the commission in connection with any care delivery, quality improvement process, performance improvement plan, early notification or access and affordability improvement plan activities authorized under sections 7, 10, 14, 15, 15A, 20 or 21 of this chapter or under section 2GGGG of chapter 29 and shall not disclose the information or documents to any person without the consent of the payer, provider or pharmaceutical manufacturing company providing or reporting the information or documents under said sections 7, 10, 14, 15, 15A, 20 or 21 of this chapter or under said section 2GGGG of said chapter 29, except in summary form in evaluative reports of such activities or when the commission believes that such disclosure should be made in the public interest after taking into account any privacy, trade secret or anticompetitive considerations. The confidential information and documents shall not be public records and shall be exempt from disclosure under clause Twenty-sixth of section 7 of chapter 4 or under chapter 66.
SECTION 10. Section 4 of said chapter 6D, as so appearing, is hereby amended by striking out, in lines 7 and 8, the word “manufacturers” and inserting in place thereof the following words:- manufacturing companies, pharmacy benefit managers,.
SECTION 11. Section 6 of said chapter 6D, as so appearing, is hereby amended by inserting after the word “center”, in line 1, the following words:- , pharmaceutical and biopharmaceutical manufacturing company, pharmacy benefit manager.
SECTION 12. Said section 6 of said chapter 6D, as so appearing, is hereby further amended by striking out, in lines 5 and 36, the figure “33” and inserting in place thereof, in each instance, the following figure:- 25.
SECTION 13. Said section 6 of said chapter 6D, as so appearing, is hereby further amended by adding the following paragraph:-
The assessed amount for pharmaceutical and biopharmaceutical manufacturing companies and pharmacy benefit managers shall be not less than 25 per cent of the amount appropriated by the general court for the expenses of the commission minus amounts collected from: (i) filing fees; (ii) fees and charges generated by the commission's publication or dissemination of reports and information; and (iii) federal matching revenues received for these expenses or received retroactively for expenses of predecessor agencies. Pharmaceutical and biopharmaceutical manufacturing companies and pharmacy benefit managers shall, in a manner and distribution determined by the commission, pay to the commonwealth an amount of the estimated expenses of the commission attributable to the commission’s activities under sections 8, 9, 15A, 20 and 21. A pharmacy benefit manager that is a surcharge payor subject to the preceding paragraph and manages its own prescription drug benefits shall not be subject to additional assessment under this paragraph
SECTION 14. Section 8 of said chapter 6D, as so appearing, is hereby amended by inserting after the word “organization”, in lines 6 and 7, the following words:- , pharmacy benefit manager, pharmaceutical manufacturing company.
SECTION 15. Said section 8 of said chapter 6D, as so appearing, is hereby further amended by inserting after the word “organizations”, in line 14, the following words:- , pharmacy benefit managers, pharmaceutical manufacturing companies.
SECTION 16. Said section 8 of said chapter 6D, as so appearing, is hereby further amended by striking out, in line 32, the words “and (xi)” and inserting in place thereof the following words:- (xi) not less than 3 representatives of the pharmaceutical industry; (xii) at least 1 representative of the pharmacy benefit management industry; and (xiii).
SECTION 17. Said section 8 of said chapter 6D, as so appearing, is hereby further amended by striking out, in line 48, the first time it appears, the word “and”.
SECTION 18. Said section 8 of said chapter 6D, as so appearing, is hereby further amended by inserting after the word “commission”, in line 59, the first time it appears, the following words:- ; and (iii) in the case of pharmacy benefit managers and pharmaceutical manufacturing companies, testimony concerning factors underlying prescription drug costs and price increases including, but not limited to, the initial prices of drugs coming to market and subsequent price increases, changes in industry profit levels, marketing expenses, reverse payment patent settlements, the impact of manufacturer rebates, discounts and other price concessions on net pricing, the availability of alternative drugs or treatments and any other matters as determined by the commission.
SECTION 19. Subsection (g) of said section 8 of said chapter 6D, as so appearing, is hereby amended by striking out the second sentence and inserting in place thereof the following 2 sentences:-
The report shall be based on the commission’s analysis of information provided at the hearings by witnesses, providers, provider organizations, payers, pharmaceutical manufacturing companies and pharmacy benefit managers, registration data collected under section 11, data collected or analyzed by the center under sections 8, 9, 10 and 10A of chapter 12C and any other available information that the commission considers necessary to fulfill its duties under this section as defined in regulations promulgated by the commission. To the extent practicable, the report shall not contain any data that is likely to compromise the financial, competitive or proprietary nature of the information.
SECTION 20. Section 9 of said chapter 6D, as so appearing, is hereby amended by inserting after the word “organization”, in line 72, the following words:- , pharmacy benefit manager, pharmaceutical manufacturing company.
SECTION 21. Said chapter 6D is hereby further amended by inserting after section 15 the following section:-
Section 15A. (a) A pharmaceutical manufacturing company shall provide early notice to the commission in a manner described in this section for a: (i) pipeline drug; (ii) generic drug; or (iii) biosimilar drug. The commission shall provide non-confidential information received under this section to the office of Medicaid, the division of insurance and the group insurance commission.
Early notice under this subsection shall be submitted to the commission in writing not later than 30 days after receipt of the United States Food and Drug Administration approval date.
For each pipeline drug, early notice shall include a brief description of the: (i) primary disease, health condition or therapeutic area being studied and the indication; (ii) route of administration being studied; (iii) clinical trial comparators; and (iv) estimated date of market entry. To the extent possible, information shall be collected using data fields consistent with those used by the federal National Institutes of Health for clinical trials.
For each pipeline drug, early notice shall include whether the drug has been designated by the United States Food and Drug Administration: (i) as an orphan drug; (ii) for fast track; (iii) as a breakthrough therapy; (iv) for accelerated approval; or (v) for priority review for a new molecular entity; provided, however, that notwithstanding clause (v), submissions for drugs in development that are designated as new molecular entities by the United States Food and Drug Administration shall be provided as soon as practical upon receipt of the relevant designations. For each generic drug, early notice shall include a copy of the drug label approved by the United States Food and Drug Administration.
(b) A pharmaceutical manufacturing company shall provide early notice to the commission if it plans to increase the wholesale acquisition cost of a: (i) brand-name drug by more than 15 per cent per wholesale acquisition cost unit during any 12-month period; or (ii) generic drug with a significant price increase as determined by the commission during any 12-month period. The commission shall provide non-confidential information received under this section to the office of Medicaid, the division of insurance and the group insurance commission.
Early notice under this subsection shall be submitted to the commission in writing not less than 60 days before the planned effective date of the increase.
A pharmaceutical manufacturing company required to notify the commission of a price increase under this subsection shall, not less than 30 days before the planned effective date of the increase, report to the commission any information regarding the price increase that is relevant to the commission including, but not limited to: (i) drug identification information; (ii) drug sales volume information; (iii) wholesale price and related information for the drug; (iv) net price and related information for the drug; (v) drug acquisition information, if applicable; (vi) revenue from the sale of the drug; and (vii) manufacturer costs.
(c) The commission shall conduct an annual study of pharmaceutical manufacturing companies subject to the requirements in subsections (a) and (b). The commission may contract with a third-party entity to implement this section.
(d) Notwithstanding any general or special law to the contrary, information provided under this section shall be protected as confidential and shall not be a public record under clause Twenty-sixth of section 7 of chapter 4 or under chapter 66.
(e) If a pharmaceutical manufacturing company fails to timely comply with the requirements under subsection (a) or subsection (b), or otherwise knowingly obstructs the commission’s ability to receive early notice under this section, including, but not limited to, providing incomplete, false or misleading information, the commission may impose appropriate sanctions against the manufacturer, including reasonable monetary penalties not to exceed $500,000, in each instance. The commission shall seek to promote compliance with this section and shall only impose a civil penalty on the manufacturer as a last resort. Amounts collected under this section shall be deposited into the Prescription Drug Cost Assistance Trust Fund established in section 2RRRRR of chapter 29.
SECTION 22. Said chapter 6D is hereby further amended by adding the following 2 sections:-
Section 20. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:
“Eligible drug”, (i) a brand name drug or biologic, not including a biosimilar, that has a launch wholesale acquisition cost of $50,000 or more for a 1-year supply or full course of treatment; (ii) a biosimilar drug that has a launch wholesale acquisition cost that is not at least 15 per cent lower than the referenced brand biologic at the time the biosimilar is launched; (iii) a public health essential drug, as defined in subsection (f) of section 13 of chapter 17, with a significant price increase over a defined period of time as determined by the commission by regulation or with a wholesale acquisition cost of $25,000 or more for a 1-year supply or full course of treatment; or (iv) other prescription drug products that may have a direct and significant impact and create affordability challenges for the state’s health care system and patients, as determined by the commission; provided, however, that the commission shall promulgate regulations to establish the type of prescription drug products classified under clause (iv) prior to classification of any such prescription drug product under said clause (iv).
“Manufacturer”, a pharmaceutical manufacturer of an eligible drug.
“Public health essential drug”, shall have the same meaning as defined in subsection (f) of section 13 of chapter 17.
(b) The commission shall review the impact of eligible drug costs on patient access; provided, however, that the commission may prioritize the review of eligible drugs based on potential impact to consumers.
In order to conduct a review of eligible drugs, the commission may require a manufacturer to disclose to the commission within a reasonable time period information relating to the manufacturer’s pricing of an eligible drug. The disclosed information shall be on a standard reporting form developed by the commission with the input of the manufacturers and shall include, but not be limited to:
(i) a schedule of the drug’s wholesale acquisition cost increases over the previous 5 calendar years;
(ii) the manufacturer’s aggregate, company-level research and development and other relevant capital expenditures, including facility construction, for the most recent year for which final audited data are available;
(iii) a narrative description, absent proprietary information and written in plain language, of factors that contributed to reported changes in wholesale acquisition cost during the previous 5 calendar years; and
(iv) any other information that the manufacturer wishes to provide to the commission or that the commission requests.
(c) Based on the records furnished under subsection (b) and available information from the center for health information and analysis or an outside third party, the commission shall identify a proposed value for the eligible drug. The commission may request additional relevant information that it deems necessary.
Any information, analyses or reports regarding an eligible drug review shall be provided to the manufacturer. The commission shall consider any clarifications or data provided by the manufacturer with respect to the eligible drug. The commission shall not base its determination on the proposed value of the eligible drug solely on the analysis or research of an outside third party and shall not employ a measure or metric that assigns a reduced value to the life extension provided by a treatment based on a pre-existing disability or chronic health condition of the individuals whom the treatment would benefit. If the commission relies upon a third party to provide cost-effectiveness analysis or research related to the proposed value of the eligible drug, such analysis or research shall also include, but not be limited to: (i) a description of the methodologies and models used in its analysis; (ii) any assumptions and potential limitations of research findings in the context of the results; and (iii) outcomes for affected subpopulations that utilize the drug, including, but not limited to, potential impacts on individuals of marginalized racial or ethnic groups, and on individuals with specific disabilities or health conditions who regularly utilize the eligible drug.
(d) If, after review of an eligible drug and after receiving information from the manufacturer under subsection (b) or subsection (e), the commission determines that the manufacturer’s pricing of the eligible drug does not substantially exceed the proposed value of the drug, the commission shall notify the manufacturer, in writing, of its determination and shall evaluate other ways to mitigate the eligible drug’s cost in order to improve patient access to the eligible drug. The commission may engage with the manufacturer and other relevant stakeholders, including, but not limited to, patients, patient advocacy organizations, consumer advocacy organizations, providers, provider organizations and payers, to explore options for mitigating the cost of the eligible drug. Upon the conclusion of a stakeholder engagement process under this subsection, the commission shall issue recommendations on ways to reduce the cost of the eligible drug for the purpose of improving patient access to the eligible drug. Recommendations may include, but shall not be limited to: (i) an alternative payment plan or methodology; (ii) a bulk purchasing program; (iii) co-pay, deductible, coinsurance or other cost-sharing restrictions; and (iv) a reinsurance program to subsidize the cost of the eligible drug. The recommendations shall be publicly posted on the commission’s website and provided to the clerks of the house of representatives and senate, the joint committee on health care financing and the house and senate committees on ways and means.
(e) If, after review of an eligible drug, the commission determines that the manufacturer’s pricing of the eligible drug substantially exceeds the proposed value of the drug, the commission shall request that the manufacturer provide further information related to the pricing of the eligible drug and the manufacturer’s reasons for the pricing not later than 30 days after receiving the request.
(f) Not later than 60 days after receiving information from the manufacturer under subsection (b) or subsection (e), the commission shall confidentially issue a determination on whether the manufacturer’s pricing of an eligible drug substantially exceeds the commission’s proposed value of the drug. If the commission determines that the manufacturer’s pricing of an eligible drug substantially exceeds the proposed value of the drug, the commission shall confidentially notify the manufacturer, in writing, of its determination and request the manufacturer to enter into an access and affordability improvement plan under section 21.
(g) Records disclosed by a manufacturer under this section shall: (i) be accompanied by an attestation that all information provided is true and correct; (ii) not be public records under clause Twenty-sixth of section 7 of chapter 4 or under chapter 66; and (iii) remain confidential; provided, however, that the commission may produce reports summarizing any findings; provided further, that any such report shall not be in a form that identifies specific prices charged for or rebate amounts associated with drugs by a manufacturer or in a manner that is likely to compromise the financial, competitive or proprietary nature of the information.
Any request for further information made by the commission under subsection (e) or any determination issued or written notification made by the commission under subsection (f) shall not be public records under said clause Twenty-sixth of said section 7 of said chapter 4 or under said chapter 66.
(h) The commission’s proposed value of an eligible and the commission’s underlying analysis of the eligible drug is not intended to be used to determine whether any individual patient meets prior authorization or utilization management criteria for the eligible drug. The proposed value and underlying analysis shall not be the sole factor in determining whether a drug is included in a formulary or whether the drug is subject to step therapy.
(i) If the manufacturer fails to timely comply with the commission’s request for records under subsection (b) or subsection (e), or otherwise knowingly obstructs the commission’s ability to issue its determination under subsection (f), including, but not limited to, by providing incomplete, false or misleading information, the commission may impose appropriate sanctions against the manufacturer, including reasonable monetary penalties not to exceed $500,000, in each instance. The commission shall seek to promote compliance with this section and shall only impose a civil penalty on the manufacturer as a last resort. Penalties collected under this subsection shall be deposited into the Prescription Drug Cost Assistance Trust Fund established in section 2RRRRR of chapter 29.
(j) The commission shall adopt any written policies, procedures or regulations that the commission determines are necessary to implement this section.
Section 21. (a) The commission shall establish procedures to assist manufacturers in filing and implementing an access and affordability improvement plan.
Upon providing written notice provided under subsection (f) of section 20, the commission shall request that a manufacturer whose pricing of an eligible drug substantially exceeds the commission’s proposed value of the drug file an access and affordability improvement plan with the commission. Not later than 45 days after receipt of a notice under said subsection (f) of said section 20, a manufacturer shall: (i) file an access and affordability improvement plan; or (ii) provide written notice declining the commission’s request.
(b) An access and affordability improvement plan shall: (i) be generated by the manufacturer; (ii) identify the reasons for the manufacturer’s drug price; and (iii) include, but not be limited to, specific strategies, adjustments and action steps the manufacturer proposes to implement to address the cost of the eligible drug in order to improve the accessibility and affordability of the eligible drug for patients and the state’s health system. The proposed access and affordability improvement plan shall include specific identifiable and measurable expected outcomes and a timetable for implementation. The timetable for an access and affordability improvement plan shall not exceed 18 months.
(c) The commission shall approve any access and affordability improvement plan that it determines: (i) is reasonably likely to address the cost of an eligible drug in order to substantially improve the accessibility and affordability of the eligible drug for patients and the state’s health system; and (ii) has a reasonable expectation for successful implementation.
(d) If the commission determines that the proposed access and affordability improvement plan is unacceptable or incomplete, the commission may provide consultation on the criteria that have not been met and may allow an additional time period of not more than 30 calendar days for resubmission; provided, however, that all aspects of the access plan shall be proposed by the manufacturer and the commission shall not require specific elements for approval.
(e) Upon approval of the proposed access and affordability improvement plan, the commission shall notify the manufacturer to begin immediate implementation of the access and affordability improvement plan. Public notice shall be provided by the commission on its website, identifying that the manufacturer is implementing an access and affordability improvement plan; provided, however, that upon the successful completion of the access and affordability improvement plan, the identity of the manufacturer shall be removed from the commission's website. All manufacturers implementing an approved access improvement plan shall be subject to additional reporting requirements and compliance monitoring as determined by the commission. The commission shall provide assistance to the manufacturer in the successful implementation of the access and affordability improvement plan.
(f) All manufacturers shall work in good faith to implement the access and affordability improvement plan. At any point during the implementation of the access and affordability improvement plan, the manufacturer may file amendments to the access improvement plan, subject to approval of the commission.
(g) At the conclusion of the timetable established in the access and affordability improvement plan, the manufacturer shall report to the commission regarding the outcome of the access and affordability improvement plan. If the commission determines that the access and affordability improvement plan was unsuccessful, the commission shall: (i) extend the implementation timetable of the existing access and affordability improvement plan; (ii) approve amendments to the access and affordability improvement plan as proposed by the manufacturer; (iii) require the manufacturer to submit a new access and affordability improvement plan; or (iv) waive or delay the requirement to file any additional access and affordability improvement plans.
(h) The commission shall submit a recommendation for proposed legislation to the joint committee on health care financing if the commission determines that further legislative authority is needed to assist manufacturers with the implementation of access and affordability improvement plans or to otherwise ensure compliance with this section.
(i) An access and affordability improvement plan under this section shall remain confidential in accordance with section 2A.
(j) The commission may assess a civil penalty to a manufacturer of not more than $500,000, in each instance, if the commission determines that the manufacturer: (i) willfully neglected to file an access and affordability improvement plan with the commission under subsection (a); (ii) failed to file an acceptable access and affordability improvement plan in good faith with the commission; (iii) failed to implement the access and affordability improvement plan in good faith; or (iv) knowingly failed to provide information required by this section to the commission or knowingly falsified the information. The commission shall seek to promote compliance with this section and shall only impose a civil penalty as a last resort. Penalties collected under this subsection shall be deposited into the Prescription Drug Cost Assistance Trust Fund established in section 2RRRRR of chapter 29.
(k) If a manufacturer declines to enter into an access and affordability improvement plan under this section, the commission may publicly post the proposed value of the eligible drug, hold a public hearing on the proposed value of the eligible drug and solicit public comment. The manufacturer shall appear and testify at the public hearing held on the eligible drug’s proposed value. Upon the conclusion of a public hearing under this subsection, the commission shall issue recommendations on ways to reduce the cost of an eligible drug for the purpose of improving patient access to the eligible drug. The recommendations shall be publicly posted on the commission’s website and provided to the clerks of the house of representatives and senate, the joint committee on health care financing and the house and senate committees on ways and means.
If a manufacturer is deemed to not be acting in good faith to develop an acceptable or complete access and affordability improvement plan, the commission may publicly post the proposed value of the eligible drug, hold a public hearing on the proposed value of the eligible drug and solicit public comment. The manufacturer shall appear and testify at any hearing held on the eligible drug’s proposed value. Upon the conclusion of a public hearing under this subsection, the commission shall issue recommendations on ways to reduce the cost of an eligible drug for the purpose of improving patient access to the eligible drug. The recommendations shall be publicly posted on the commission’s website and provided to the clerks of the house of representatives and senate, the joint committee on health care financing and the house and senate committees on ways and means.
Before making a determination that the manufacturer is not acting in good faith, the commission shall send a written notice to the manufacturer that the commission shall deem the manufacturer to not be acting in good faith if the manufacturer does not submit an acceptable access and affordability improvement plan within 30 days of receipt of notice; provided, however, that the commission shall not send a notice under this paragraph within 120 calendar days from the date that the commission issued its request that the manufacturer enter into the access and affordability improvement plan.
(l) The commission shall promulgate regulations necessary to implement this section.
SECTION 23. Section 1 of chapter 12C of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the definition of “Ambulatory surgical center services” the following 3 definitions:-
“Average manufacturer price”, the average price paid to a manufacturer for a drug in the commonwealth by a: (i) wholesaler for drugs distributed to pharmacies; and (ii) pharmacy that purchases drugs directly from the manufacturer.
“Biosimilar”, a drug that is produced or distributed pursuant to a biologics license application approved under 42 U.S.C. 262(k)(3).
“Brand name drug”, a drug that is: (i) produced or distributed pursuant to an original new drug application approved under 21 U.S.C. 355(c) except for: (a) any drug approved through an application submitted under section 505(b)(2) of the federal Food, Drug, and Cosmetic Act that is pharmaceutically equivalent, as that term is defined by the United States Food and Drug Administration, to a drug approved under 21 U.S.C. 355(c); (b) an abbreviated new drug application that was approved by the United States Secretary of Health and Human Services under section 505(c) of the federal Food, Drug, and Cosmetic Act, 21 U.S.C. 355(c), before the date of the enactment of the federal Drug Price Competition and Patent Term Restoration Act of 1984, Public Law 98-417, 98 Stat. 1585; or (c) an authorized generic as defined by 42 C.F.R. 447.502; (ii) produced or distributed pursuant to a biologics license application approved under 42 U.S.C. 262(a)(2)(C); or (iii) identified by the health benefit plan as a brand name drug based on available data resources such as Medi-Span.
SECTION 24. Said section 1 of said chapter 12C, as so appearing, is hereby further amended by inserting after the definition of “General health supplies, care or rehabilitative services and accommodations” the following definition:-
“Generic drug”, a retail drug that is: (i) marketed or distributed pursuant to an abbreviated new drug application approved under 21 U.S.C. 355(j); (ii) an authorized generic as defined by 42 C.F.R. 447.502; (iii) a drug that entered the market before January 1, 1962 that was not originally marketed under a new drug application; or (iv) identified by the health benefit plan as a generic drug based on available data resources such as Medi-Span.
SECTION 25. Said section 1 of said chapter 12C, as so appearing, is hereby further amended by inserting after the definition of “Patient-centered medical home” the following 2 definitions:-
“Pharmaceutical manufacturing company”, an entity engaged in the: (i) production, preparation, propagation, compounding, conversion or processing of prescription drugs, directly or indirectly, by extraction from substances of natural origin, independently by means of chemical synthesis or by a combination of extraction and chemical synthesis; or (ii) packaging, repackaging, labeling, relabeling or distribution of prescription drugs; provided, however, that “pharmaceutical manufacturing company” shall not include a wholesale drug distributor licensed under section 36B of chapter 112 or a retail pharmacist registered under section 39 of said chapter 112.
“Pharmacy benefit manager”, a person, business or other entity, however organized, that, directly or through a subsidiary, provides pharmacy benefit management services for prescription drugs and devices on behalf of a health benefit plan sponsor, including, but not limited to, a self-insurance plan, labor union or other third-party payer; provided, however, that pharmacy benefit management services shall include, but not be limited to: (i) the processing and payment of claims for prescription drugs; (ii) the performance of drug utilization review; (iii) the processing of drug prior authorization requests; (iv) pharmacy contracting; (v) the adjudication of appeals or grievances related to prescription drug coverage contracts; (vi) formulary administration; (vii) drug benefit design; (viii) mail and specialty drug pharmacy services; (ix) cost containment; (x) clinical, safety and adherence programs for pharmacy services; and (xi) managing the cost of covered prescription drugs; provided further, that “pharmacy benefit manager” shall include a health benefit plan that does not contract with a pharmacy benefit manager and manages its own prescription drug benefits unless specifically exempted by the commission.
SECTION 26. Said section 1 of said chapter 12C, as so appearing, is hereby further amended by adding the following definition:-
“Wholesale acquisition cost”, shall have the same meaning as defined in 42 U.S.C. 1395w-3a(c)(6)(B).
SECTION 27. Section 3 of said chapter 12C, as so appearing, is hereby amended by inserting after the word “organizations”, in lines 13 and 14, the following words:- , pharmaceutical manufacturing companies, pharmacy benefit managers.
SECTION 28. Said section 3 of said chapter 12C, as so appearing, is hereby further amended by striking out, in line 24, the words “and payer” and inserting in place thereof the following words:- , payer, pharmaceutical manufacturing company and pharmacy benefit manager.
SECTION 29. Section 5 of said chapter 12C, as so appearing, is hereby amended by striking out, in lines 11 and 12, the words “and public health care payers” and inserting in place thereof the following words:- , public health care payers, pharmaceutical manufacturing companies and pharmacy benefit managers.
SECTION 30. Said section 5 of said chapter 12C, as so appearing, is hereby further amended by striking out, in line 15, the words “and affected payers” and inserting in place thereof the following words:- affected payers, affected pharmaceutical manufacturing companies and affected pharmacy benefit managers.
SECTION 31. The first paragraph of section 7 of said chapter 12C, as so appearing, is hereby amended by adding the following sentence:- Each pharmaceutical and biopharmaceutical manufacturing company and pharmacy benefit manager shall pay to the commonwealth an amount for the estimated expenses of the center and for the other purposes described in this chapter.
SECTION 32. Said section 7 of said chapter 12C, as so appearing, is hereby further amended by striking out, in lines 8 and 42, the figure “33” and inserting in place thereof, in each instance, the following figure:- 25.
SECTION 33. Said section 7 of said chapter 12C, as so appearing, is hereby further amended by adding the following paragraph:-
The assessed amount for pharmaceutical and biopharmaceutical manufacturing companies and pharmacy benefit managers shall be not less than 25 per cent of the amount appropriated by the general court for the expenses of the center minus amounts collected from: (i) filing fees; (ii) fees and charges generated by the commission's publication or dissemination of reports and information; and (iii) federal matching revenues received for these expenses or received retroactively for expenses of predecessor agencies. Pharmaceutical and biopharmaceutical manufacturing companies and pharmacy benefit managers shall, in a manner and distribution determined by the center, pay to the commonwealth an amount of the estimated expenses of the center attributable to the center’s activities under sections 3, 10A, 12 and 16. The assessed amount shall be based on business conducted in the commonwealth by the pharmaceutical and biopharmaceutical manufacturing company and pharmacy benefit manager. A pharmacy benefit manager that is also a surcharge payor subject to the preceding paragraph and manages its own prescription drug benefits shall not be subject to additional assessment under this paragraph.
SECTION 34. Said chapter 12C is hereby further amended by inserting after section 10 the following section:-
Section 10A. (a) The center shall promulgate the regulations necessary to ensure the uniform reporting of information from pharmaceutical manufacturing companies to enable the center to analyze: (i) year-over-year changes in wholesale acquisition cost and average manufacturer price for prescription drug products; (ii) year-over-year trends in net expenditures; (iii) net expenditures on subsets of biosimilar, brand name and generic drugs identified by the center; (iv) trends in estimated aggregate drug rebates, discounts or other remuneration paid or provided by a pharmaceutical manufacturing company to a pharmacy benefit manager, wholesaler, distributor, health carrier client, health plan sponsor or pharmacy in connection with utilization of the pharmaceutical drug products offered by the pharmaceutical manufacturing company; (v) discounts provided by a pharmaceutical manufacturing company to a consumer in connection with utilization of the pharmaceutical drug products offered by the pharmaceutical manufacturing company, including any discount, rebate, product voucher, coupon or other reduction in a consumer’s out-of-pocket expenses including co-payments and deductibles under section 3 of chapter 175H; (vi) research and development costs as a percentage of revenue; (vii) annual marketing and advertising costs, identifying costs for direct-to-consumer advertising; (viii) annual profits over the most recent 5-year period; (ix) disparities between prices charged to purchasers in the commonwealth and purchasers outside of the United States; and (x) any other information deemed necessary by the center.
The center shall require the submission of available data and other information from pharmaceutical manufacturing companies including, but not limited to: (i) wholesale acquisition costs and average manufacturer prices for prescription drug products as identified by the center; (ii) true net typical prices charged to pharmacy benefits managers by payor type for prescription drug products identified by the center, net of any rebate or other payments from the manufacturer to the pharmacy benefits manager and from the pharmacy benefits manager to the manufacturer; (iii) aggregate, company-level research and development costs to the extent attributable to a specific product and other relevant capital expenditures for the most recent year for which final audited data is available for prescription drug products as identified by the center; (iv) annual marketing and advertising expenditures; and (v) a description, absent proprietary information and written in plain language, of factors that contributed to reported changes in wholesale acquisition costs, net prices and average manufacturer prices for prescription drug products as identified by the center.
(b) The center shall promulgate the regulations necessary to ensure the uniform reporting of information from pharmacy benefit managers to enable the center to analyze: (i) trends in estimated aggregate drug rebates and other drug price reductions, if any, provided by a pharmacy benefit manager to a health carrier client or health plan sponsor or passed through from a pharmacy benefit manager to a health carrier client or health plan sponsor in connection with utilization of drugs in the commonwealth offered through the pharmacy benefit manager and a measure of lives covered by each health carrier client or health plan sponsor in the commonwealth; (ii) pharmacy benefit manager practices with regard to drug rebates and other drug price reductions, if any, provided by a pharmacy benefit manager to a health carrier client or health plan sponsor or to consumers in the commonwealth or passed through from a pharmacy benefit manager to a health carrier client or health plan sponsor or to consumers in the commonwealth; and (iii) any other information deemed necessary by the center.
The center shall require the submission of available data and other information from pharmacy benefit managers including, but not limited to: (i) true net typical prices charged by pharmacy benefits managers for prescription drug products identified by the center, net of any rebate or other payments from the manufacturer to the pharmacy benefits manager and from the pharmacy benefits manager to the manufacturer; (ii) the amount of all rebates that the pharmacy benefit manager received from all pharmaceutical manufacturing companies for all health carrier clients in the aggregate and for each health carrier client or health plan sponsor individually, attributable to patient utilization in the commonwealth; (iii) the administrative fees that the pharmacy benefit manager received from all health carrier clients or health plan sponsors in the aggregate and for each health carrier client or health plans sponsors individually; (iv) the aggregate amount of all retained rebates that the pharmacy benefit manager received from all pharmaceutical manufacturing companies and did not pass through to each pharmacy benefit manager’s health carrier client or health plan sponsor individually; (v) the aggregate amount of rebates a pharmacy benefit manager: (A) retains based on its contractual arrangement with each health plan client or health plan sponsor individually; and (B) passes through to each health care client individually; (vi) the percentage of contracts that a pharmacy benefit manager holds where the pharmacy benefit manager: (A) retains all rebates; (B) passes all rebates through to the client; and (C) shares rebates with the client; and (vii) other information as determined by the center, including, but not limited to, pharmacy benefit manager practices related to spread pricing, administrative fees, claw backs and formulary placement.
(c) Except as specifically provided otherwise by the center or under this chapter, data collected by the center pursuant to this section from pharmaceutical manufacturing companies and pharmacy benefit managers shall not be a public record under clause Twenty-sixth of section 7 of chapter 4 or under chapter 66.
SECTION 35. Said chapter 12C is hereby further amended by striking out section 11, as so appearing, and inserting in place thereof the following section:-
Section 11. The center shall ensure the timely reporting of information required under sections 8, 9, 10 and 10A. The center shall notify private health care payers, providers, provider organizations, pharmacy benefit managers, pharmaceutical manufacturing companies and their parent organization and other affiliates of any applicable reporting deadlines. The center shall notify, in writing, a private health care payer, provider, provider organization, pharmacy benefit manager or pharmaceutical manufacturing company, and their parent organization and other affiliates, that has failed to meet a reporting deadline of such failure and that failure to respond within 2 weeks of the receipt of the notice may result in penalties. The center may assess a penalty against a private health care payer, provider, provider organization, pharmacy benefit manager or pharmaceutical manufacturing company, and their parent organization and other affiliates, that fails, without just cause, to provide the requested information, including subsets of the requested information, within 2 weeks following receipt of the written notice required under this section, of not more than $2,000 per week for each week of delay after the 2-week period following receipt of the notice. Amounts collected under this section shall be deposited in the Healthcare Payment Reform Fund established in section 100 of chapter 194 of the acts of 2011. SECTION 36. Section 12 of said chapter 12C, as so appearing, is hereby amended by striking out, in line 2, the words “and 10” and inserting in place thereof the following words:- , 10 and 10A.
SECTION 37. Subsection (a) of section 16 of said chapter 12C, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:- The center shall publish an annual report based on the information submitted under: (i) sections 8, 9, 10 and 10A concerning health care provider, provider organization, private and public health care payer, pharmaceutical manufacturing company and pharmacy benefit manager costs and cost and price trends; (ii) section 13 of chapter 6D relative to market power reviews; and (iii) section 15 of said chapter 6D relative to quality data.
SECTION 38. Said section 16 of said chapter 12C, as so appearing, is hereby further amended by striking out, in line 18, the words “in the aggregate”.
SECTION 39. Said section 16 of said chapter 12C, as so appearing, is hereby further amended by inserting after the second paragraph the following paragraph:-
As part of its annual report, the center shall report on prescription drug utilization and spending for pharmaceutical drugs provided in an outpatient setting or sold in a retail setting for private and public health care payers, including, but not limited to, information sufficient to show (i) highest utilization drugs; (ii) drugs with the greatest increases in utilization; (iii) drugs that are most impactful on plan spending, net of rebates; and (iv) drugs with the highest year-over-year price increases, net of rebates.
SECTION 40. Section 13 of chapter 17 of the General Laws, as so appearing, is hereby amended by adding the following subsection:-
(f) As used in this subsection, the following words shall have the following meanings unless the context clearly requires otherwise:
“Public health essential drug”, a prescription drug, biologic or biosimilar approved by the United States Food and Drug Administration that: (i) appears on the Model List of Essential Medicines most recently adopted by the World Health Organization; or (ii) is deemed an essential medicine by the commission due to its efficacy in treating a life-threatening health condition or a chronic health condition that substantially impairs an individual’s ability to engage in activities of daily living or because limited access to a certain population would pose a public health challenge.
The commission shall identify and publish a list of public health essential prescription drugs. The list shall be updated not less than annually and be made publicly available on the department’s website; provided, however, that the commission may provide an interim listing of a public health essential drug prior to an annual update. The commission shall notify and forward a copy of the list to the health policy commission established under chapter 6D.
SECTION 41. Chapter 29 of the General Laws is hereby amending by inserting after section 2QQQQQ the following section:-
2RRRRR. (a) There shall be a Prescription Drug Cost Assistance Trust Fund. The secretary of health and human services shall administer the fund and shall make expenditures from the fund, without further appropriation, to provide financial assistance to state residents for the cost of prescription drugs through the prescription drug costs assistance program established under section 244 of chapter 111. For the purpose of this section “prescription drug” shall include the prescription drug and any drug delivery device needed to administer the drug that is not included as part of the underlying drug prescription.
The fund shall consist of: (i) revenue generated from the penalty established under chapter 63E; (ii) revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; and (iii) funds from public or private sources, including, but not limited to, gifts, grants, donations, rebates and settlements received by the commonwealth that are specifically designated to be credited to the fund. An amount equal to the total receipts deposited each quarter from the penalty on drug manufacturers for excessive price increases established under chapter 63E shall be transferred from the General Fund to the Prescription Drug Costs Assistance Trust Fund before the end of each fiscal year. Money remaining in the fund at the close of a fiscal year shall not revert to the General Fund and shall be available for expenditure in the following fiscal year.
(b) Annually, not later than March 1, the secretary shall report on the activities detailing the funds expenditures from the previous calendar year. The report shall include: (i) the number of individuals who received financial assistance from the fund; (ii) the breakdown of fund recipients by race, gender, age range, geographic region and income level; (iii) a list of all prescription drugs that were covered by money from the fund; and (iv) the total cost savings received by all fund recipients and the cost savings broken down by race, gender, age range and income level. The report shall be submitted to the clerks of the senate and house of representatives, senate and house committees on ways and means and the joint committee on health care financing.
(c) The secretary shall promulgate regulations or issue other guidance for the expenditure of the funds under this section.
SECTION 42. Section 17G of chapter 32A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following sentence:-
Coverage for insulin under this section shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply, regardless of the amount or type of insulin needed to fill an insured’s prescription; provided, however, that nothing in this section shall prevent the commission and its contracted health benefit plans from reducing the co-payment for insulin for a 30-day supply below the amount specified in this section.
SECTION 43. Said chapter 32A, as so appearing, is hereby further amended by inserting after section 17R the following section:-
Section 17S. Any carrier offering a policy, contract or certificate of health insurance under this chapter shall provide coverage for the brand name drugs and generic drugs identified by the drug access program established in section 16DD in chapter 6A. Coverage for identified generic drugs shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible. Coverage for identified brand name drugs shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply.
Notwithstanding this section or any other general or special law to the contrary, coverage for insulin shall be provided under section 17G of this chapter.
SECTION 44. The General Laws are hereby amended by inserting after chapter 63D the following chapter:-
Chapter 63E. PENALTY ON DRUG MANUFACTURERS FOR EXCESSIVE PRICE INCREASES
Section 1. As used in this chapter, the following words shall, unless the context clearly requires otherwise, have the following meanings:
“Commissioner”, the commissioner of revenue.
“Core consumer price index”, the consumer price index for all urban consumers (CPI-U): U.S. city average, for all Items less food and energy, as reported by the U.S. Bureau of Labor Statistics.
“Drug”, any medication, as identified by a National Drug Code, approved for sale by the U.S. Food and Drug Administration.
“Excessive price,” the price of a drug that exceeds the sum of the reference price of that drug plus the three -year average of the core consumer price index, as measured on January 1 of the current calendar year.
“Excessive price increase”, the amount by which the price of a drug exceeds the sum of the reference price of that drug plus the three-year average of the core consumer price index, as measured on January 1 of the current calendar year.
“Person”, any natural person or legal entity.
“Price”, the wholesale acquisition cost of a drug, per unit, as reported to the First Data Bank or other appropriate price compendium designated by the commissioner.
“Reference date”, January 1 of the calendar year prior to the current calendar year.
“Reference price”, the price of a drug on the reference date, or in the case of any drug first commercially marketed in the United States after the reference date, the price of the drug on the date when first marketed in the United States.
“Related party”, an entity is a related party with respect to a person if that entity (i) belongs to the same affiliated group as that person under section 1504 of the Internal Revenue Code provided that the term 50 per cent shall be substituted for the term 80 per cent each time it appears in said section 1504, (ii) has a relationship with that person that is specified in subsections (b) and (c) of section 267 of the Internal Revenue Code, or (iii) is otherwise under common ownership and control with regard to that person; provided, that all references to the Internal Revenue Code in this definition refer to the Internal Revenue Code as amended and in effect for the taxable year.
“Unit”, the lowest dispensable amount of a drug.
Section 2. (a) Any person who manufactures and sells drugs, directly or through another person, for distribution in the commonwealth and who establishes an excessive price for any such drug directly or in cooperation with a related party, shall pay a per unit penalty on all units of the drug ultimately dispensed or administered in the commonwealth. The penalty for each unit shall be 80 per cent of the excessive price increase for each unit.
(b) A person who establishes an excessive price for a drug as described in subsection (a) shall file a return as provided in section 4 declaring all units of excessively priced drug sold for distribution in the commonwealth during each calendar quarter. In the event that a person filing such a return pays a penalty with regard to one or more units of drug that are ultimately dispensed or administered outside of the commonwealth, the person may claim a credit for such penalty amounts on the return for the tax period during which such units are ultimately dispensed or administered.
Section 3. The penalty under section 2 shall apply for any calendar quarter only to a person who maintains a place of business in the commonwealth or whose total sales of all products, directly or through another person, for distribution in the commonwealth were more than $100,000 in the calendar year beginning with the reference date. The penalty shall not apply more than once to any unit of drug sold.
Section 4. Any person subject to the penalty under section 2 shall file a return with the commissioner and shall pay the penalty by the fifteenth day of the third month following the end of each calendar quarter, subject to such reasonable extensions of time for filing as the commissioner may allow. The return shall set out the person’s total sales subject to penalty in the immediately preceding calendar quarter and shall provide such other information as the commissioner may require.
Section 5. The penalty imposed under this chapter shall be in addition to, and not a substitute for or credit against, any other penalty, tax or excise imposed under the General Laws.
Section 6. The commissioner may disclose information contained in returns filed under this chapter to the department of public health, the executive office of health and human services, or other appropriate agency for purposes of verifying that a filer’s sales subject to penalty are properly declared and that all reporting is otherwise correct. Return information so disclosed shall remain confidential and shall not be public record.
Section 7. To the extent that a person subject to penalty under section 2 fails to pay amounts due under this chapter, a related party of such person that directly or indirectly distributes in the commonwealth any drug whose sales are subject to this chapter shall be jointly and severally liable for the penalty due.
Section 8. The commissioner may promulgate regulations for the implementation of this chapter.
SECTION 45. Chapter 111 of the General Laws is hereby amended by adding the following section:-
Section 244. (a) The department shall establish and administer a prescription drug cost assistance program, which shall be funded by the Prescription Drug Cost Assistance Trust Fund established in section 2RRRRR of chapter 29. The program shall provide financial assistance for prescription drugs used to treat: (1) chronic respiratory conditions, including, but not limited to, chronic obstructive pulmonary disease and asthma; (2) chronic heart conditions, including, but not limited to, heart failure, coronary artery disease, hypertension and high blood pressure; (3) diabetes; and (4) any other chronic condition identified by the department that disproportionally impacts people of color or is a risk factor for increased COVID-19 complications; provided, that for paragraphs (1) and (3), “prescription drug” shall include the prescription drug and any drug delivery device needed to administer the drug that is not included as part of the underlying drug prescription. Such financial assistance shall cover the full cost of any co-payment, co-insurance or deductible for the prescription drug for an individual who is eligible for the program.
(b) An individual shall be eligible for the program if the individual: (1) is a resident of Massachusetts; (2) has a current prescription from a health care provider for a drug that is used to treat a chronic condition listed in subsection (a); (3) has a family income equal to or less than 500 per cent of the federal poverty level; and (4) is not enrolled in MassHealth.
(c) The department shall create an application process, which shall be available electronically and in hard copy form, to determine whether an individual meets the program eligibility requirements under subsection (b). Upon receipt of such application, the department shall determine an applicant’s eligibility and notify the applicant of the department’s determination within 10 business days. If necessary for its determination, the department may request additional information from the applicant; provided, that the department shall notify the applicant within 5 business days of receipt of the original application as to what specific additional information is being requested. If additional information is being requested, the department shall, within 3 business days of receipt of the additional information, determine whether the applicant is eligible for the program and notify the applicant of the department’s determination.
If the department determines that an applicant is not eligible for the program, the department shall notify the applicant and shall include in the department’s notification the specific reasons why the applicant is not eligible. The applicant may appeal this determination to the department within 30 days of receiving such notification.
If the department determines that an applicant is eligible for the program, the department shall provide the applicant with a prescription drug cost assistance program identification card, which shall clearly indicate that the department has determined that the applicant is eligible for the program; provided, that the program identification card shall include, at a minimum: (1) the applicant’s full name, and (2) the full name of the prescription drug that the applicant is eligible to receive under the program without having to pay a co-payment, co-insurance or deductible. An applicant’s program identification card shall be valid for 12 months and shall be renewable upon a redetermination of program eligibility.
(d) An individual with a valid program identification card issued under subsection (c) may present such card at any pharmacy in the commonwealth and, upon presentation of such card, the pharmacy shall fill the individual’s prescription and provide the prescribed drug to the individual without requiring the individual to pay a co-payment, co-insurance or deductible; provided, that the pharmacy shall be reimbursed for its costs by the Prescription Drug Cost Assistance Trust Fund established in section 2RRRRR of chapter 29, in a manner determined by the department, in an amount equal to what the pharmacy would have received had the individual been required to pay a co-payment, co-insurance or deductible.
(e) The department, in collaboration with the division of insurance and board of registration in pharmacy, shall develop and implement a plan to educate consumers, pharmacists, providers, hospitals and insurers regarding eligibility for and enrollment in the program under this section. The plan shall include, but not be limited to, appropriate staff training, notices provided to consumers at the pharmacy, and a designated website with information for consumers, pharmacists and other health care professionals. The plan shall be developed in consultation with groups representing consumers, pharmacists, providers, hospitals and insurers.
(f) The department shall compile a report detailing information about the program from the previous calendar year. The report shall include: (1) the number of applications received, approved, denied and appealed; (2) the total number of applicants approved, and the number of applicants approved broken down by race, gender, age range and income level; (3) a list of all prescription drugs that qualify for the program under subsection (b) and a list of prescription drugs that applicants actually received financial assistance for; and (4) the total cost savings received by all approved applicants, and the cost savings broken down by race, gender, age range and income level. The report shall be submitted annually, by March 1, to the clerks of the senate and house of representatives, the chairs of the joint committee on ways and means and the chairs of the joint committee on health care financing.
(g) The department shall promulgate regulations or issue other guidance for the implementation and enforcement of this section.
SECTION 46. Section 10C of chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following sentence:-
Coverage for insulin under this section shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply, regardless of the amount or type of insulin needed to fill an insured’s prescription; provided, however, that nothing in this section shall prevent the division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract with the division, a Medicaid managed care organization or a primary care clinician plan, from reducing the co-payments for insulin for a 30-day supply below the amount specified in this section.
SECTION 47. Said chapter 118E, as so appearing, is hereby amended by inserting after section 10N the following section:-
Section 10O. Any carrier offering a policy, contract or certificate of health insurance under this chapter shall provide coverage for the brand name drugs and generic drugs identified by the drug access program established in section 16DD in chapter 6A. Coverage for identified generic drugs shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible. Coverage for identified brand name drugs shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply.
Notwithstanding this section or any other general or special law to the contrary, coverage for insulin shall be provided under section 10C of this chapter.
SECTION 48. Section 47N of chapter 175 of the General Laws, as so appearing, is hereby amended by adding the following paragraph:-
Coverage for insulin under this section shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply, regardless of the amount or type of insulin needed to fill an insured’s insulin prescription; provided, however, that nothing in this section shall prevent an individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance or a group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth, from reducing the co-payment for insulin for a 30-day supply below the amount specified in this section.
SECTION 49. Said chapter 175, as so appearing, is hereby further amended by inserting after section 47PP the following new section:-
Section 47QQ. Any carrier offering a policy, contract or certificate of health insurance under this chapter shall provide coverage for the brand name drugs and generic drugs identified by the drug access program established in section 16DD in chapter 6A. Coverage for identified generic drugs shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible. Coverage for identified brand name drugs shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply.
Notwithstanding this section or any other general or special law to the contrary, coverage for insulin shall be provided under section 47N of this chapter.
SECTION 50. Section 226 of said chapter 175, as so appearing, is hereby amended by striking out subsection (a) and inserting in place thereof the following subsection:-
(a) For the purposes of this section, the term “pharmacy benefit manager” shall mean a person, business or other entity, however organized, that directly or through a subsidiary provides pharmacy benefit management services for prescription drugs and devices on behalf of a health benefit plan sponsor, including, but not limited to, a self-insurance plan, labor union or other third-party payer; provided, however, that pharmacy benefit management services shall include, but not be limited to: (i) the processing and payment of claims for prescription drugs; (ii) the performance of drug utilization review; (iii) the processing of drug prior authorization requests; (iv) pharmacy contracting; (v) the adjudication of appeals or grievances related to prescription drug coverage contracts; (vi) formulary administration; (vii) drug benefit design; (viii) mail and specialty drug pharmacy services; (ix) cost containment; (x) clinical, safety and adherence programs for pharmacy services; and (xi) managing the cost of covered prescription drugs; provided further, that “pharmacy benefit manager” shall include a health benefit plan that does not contract with a pharmacy benefit manager and manages its own prescription drug benefits unless specifically exempted.
SECTION 51. Section 8P of chapter 176A of the General Laws, as so appearing, is hereby amended by adding the following paragraph:-
Coverage for insulin under this section shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply, regardless of the amount or type of insulin needed to fill an insured’s insulin prescription; provided, however, that nothing in this section shall prevent a contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within or without the commonwealth, from reducing the co-payment for insulin for a 30-day supply below the amount specified in this section.
SECTION 52. Said chapter 176A, as so appearing, is hereby further amended by inserting after section 8QQ the following new section:-
Section 8RR. Any carrier offering a policy, contract or certificate of health insurance under this chapter shall provide coverage for the brand name drugs and generic drugs identified by the drug access program established in section 16DD in chapter 6A. Coverage for identified generic drugs shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible. Coverage for identified brand name drugs shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply.
Notwithstanding this section or any other general or special law to the contrary, coverage for insulin shall be provided under section 8P of this chapter.
SECTION 53. Section 4S of chapter 176B of the General Laws, as so appearing, is hereby amended by adding the following sentence:-
Coverage for insulin under this section shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply, regardless of the amount or type of insulin needed to fill an insured’s insulin prescription; provided, however, that nothing in this section shall prevents a subscription certificate under an individual or group medical service agreement that is issued or renewed within or without the commonwealth, from reducing the co-payment for insulin for a 30-day supply below the amount specified in this section.
SECTION 54. Said chapter 176B, as so appearing, is hereby further amended by inserting after section 4QQ the following new section:-
Section 4RR. Any carrier offering a policy, contract or certificate of health insurance under this chapter shall provide coverage for the brand name drugs and generic drugs identified by the drug access program established in section 16DD in chapter 6A. Coverage for identified generic drugs shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible. Coverage for identified brand name drugs shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply.
Notwithstanding this section or any other general or special law to the contrary, coverage for insulin shall be provided under section 4S of this chapter.
SECTION 55. Section 4H of chapter 176G of the General Laws, as so appearing, is hereby amended by adding the following paragraph:-
Coverage for insulin under this section shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply, regardless of the amount or type of insulin needed to fill an insured’s insulin prescription; provided, however, that nothing in this section shall prevent any individual or group health maintenance contract that is issued or renewed within or without the commonwealth, from reducing the co-payment for insulin for a 30-day supply below the amount specified in this section.
SECTION 56. Said chapter 176G, as so appearing, is hereby further amended by inserting after section 4GG the following new section:-
Section 4HH. Any carrier offering a policy, contract or certificate of health insurance under this chapter shall provide coverage for the brand name drugs and generic drugs identified by the drug access program established in section 16DD in chapter 6A. Coverage for identified generic drugs shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible. Coverage for identified brand name drugs shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply.
Notwithstanding this section or any other general or special law to the contrary, coverage for insulin shall be provided under section 4H of this chapter.
SECTION 57. Section 2 of chapter 176O of the General Laws, as so appearing, is hereby amended by adding the following subsection:-
(i) Every 3 years, a carrier that contracts with a pharmacy benefit manager shall coordinate an audit of the operations of the pharmacy benefit manager to ensure compliance with this chapter and to examine the pricing and rebates applicable to prescription drugs that are provided to the carrier’s covered persons.
SECTION 58. Said chapter 176O, as so appearing, is hereby further amended by inserting after section 22 the following section:-
Section 22A. Notwithstanding any other general or special law to the contrary, each carrier shall require that a pharmacy benefit manager receive a license from the division under chapter 176X as a condition of contracting with that carrier.
SECTION 59. Said chapter 176O as so appearing, is hereby further amended by adding the following section:-
Section 30. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:
“Cost-sharing”, an amount owed by an individual under the terms of the individual’s health benefit plan.
“Pharmacy retail price”, the amount an individual would pay for a prescription medication at a pharmacy if the individual purchased that prescription medication at that pharmacy without using a health benefit plan or any other prescription medication benefit or discount.
(b) At the point of sale, a pharmacy shall charge an individual the: (i) appropriate cost-sharing amount; or (ii) pharmacy retail price, whichever is the lowest; provided, however, that a carrier, or an entity that manages or administers benefits for a carrier, shall not require an individual to make a payment for a prescription drug at the point of sale in an amount that exceeds the lesser of the: (a) individual’s cost share; or (b) pharmacy retail price.
(c) A contract shall not: (i) prohibit a pharmacist from complying with this section; or (ii) impose a penalty on the pharmacist or pharmacy for complying with this section.
SECTION 60. The General Laws are hereby amended by inserting after chapter 176W the following chapter:-
Chapter 176X. LICENSING AND REGULATION OF PHARMACY BENEFIT MANAGERS.
Section 1. As used in this chapter, the following words shall have the following meanings unless the context clearly requires otherwise:
“Carrier”, an insurer licensed or otherwise authorized to transact accident or health insurance under chapter 175, a nonprofit hospital service corporation organized under chapter 176A, a non-profit medical service corporation organized under chapter 176B, a health maintenance organization organized under chapter 176G and an organization entering into a preferred provider arrangement under chapter 176I; provided, however, that the term “carrier” shall not include an employer purchasing coverage or acting on behalf of its employees or the employees of any subsidiary or affiliated corporation of the employer; provided further, that unless otherwise provided, the term “carrier” shall not include any entity to the extent it offers a policy, certificate or contract that provides coverage solely for dental care services or vision care services.
“Center”, the center for health information and analysis established in chapter 12C.
“Commissioner”, the commissioner of insurance.
“Division”, the division of insurance.
“Health benefit plan”, a contract, certificate or agreement entered into, offered or issued by a carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services; provided, however, that the commissioner may by regulation define other health coverage as a “health benefit plan” for the purposes of this chapter.
“Pharmacy”, a physical or electronic facility under the direction or supervision of a registered pharmacist that is authorized to dispense prescription drugs and has entered into a network contract with a pharmacy benefit manager or a carrier.
“Pharmacy benefit manager”, a person, business or other entity, however organized, that directly or through a subsidiary provides pharmacy benefit management services for prescription drugs and devices on behalf of a health benefit plan sponsor, including, but not limited to, a self-insurance plan, labor union or other third-party payer; provided, however, that pharmacy benefit management services shall include, but not be limited to: (i) the processing and payment of claims for prescription drugs; (ii) the performance of drug utilization review; (iii) the processing of drug prior authorization requests; (iv) pharmacy contracting; (v) the adjudication of appeals or grievances related to prescription drug coverage contracts; (vi) formulary administration; (vii) drug benefit design; (viii) mail and specialty drug pharmacy services; (ix) cost containment; (x) clinical, safety and adherence programs for pharmacy services; and (xi) managing the cost of covered prescription drugs; provided further, that “pharmacy benefit manager” shall not include a health benefit plan unless otherwise specified by the division.
Section 2. (a) A person, business or other entity shall not establish or operate as a pharmacy benefit manager without obtaining a license from the division pursuant to this section. The division shall issue a pharmacy benefit manager license to a person, business or other entity that demonstrates to the division that it has the necessary organization, background expertise and financial integrity to maintain such a license. A pharmacy benefit manager license shall be valid for a period of 3 years and shall be renewable for additional 3-year periods. Initial application and renewal fees for the license shall be established pursuant to section 3B of chapter 7.
(b) A license granted pursuant to this section and any rights or interests therein shall not be transferable.
(c) A person, business or other entity licensed as a pharmacy benefit manager shall submit data and reporting information to the center according to the standards and methods specified by the center pursuant to section 10A of chapter 12C.
(d) The division may issue or renew a license pursuant to this section, subject to restrictions in order to protect the interests of consumers. Such restrictions may include: (i) limiting the type of services that a license holder may provide; (ii) limiting the activities in which the license holder may be engaged; or (iii) addressing conflicts of interest between pharmacy benefit managers and health plan sponsors.
(e) The division shall develop an application for licensure of pharmacy benefit managers that shall include, but not be limited to: (i) the name of the applicant or pharmacy benefit manager; (ii) the address and contact telephone number for the applicant or pharmacy benefit manager; (iii) the name and address of the agent of the applicant or pharmacy benefit manager for service of process in the commonwealth; (iv) the name and address of any person with management or control over the applicant or pharmacy benefit manager; and (v) any audited financial statements specific to the applicant or pharmacy benefit manager. An applicant or pharmacy benefit manager shall report to the division any material change to the information contained in its application, certified by an officer of the pharmacy benefit manager, within 30 days of such a change.
(f) The division may suspend, revoke, refuse to issue or renew or place on probation a pharmacy benefit manager license for cause, which shall include, but not be limited to: (i) the applicant or pharmacy benefit manager engaging in fraudulent activity that is found by a court of law to be a violation of state or federal law; (ii) the division receiving consumer complaints that justify an action under this chapter to protect the health, safety and interests of consumers; (iii) the applicant or pharmacy benefit manager failing to pay an application or renewal fee for a license; (iv) the applicant or pharmacy benefit manager failing to comply with reporting requirements of the center under section 10A of chapter 12C; or (v) the applicant pharmacy benefit manager’s failing to comply with a requirement of this chapter.
The division shall provide written notice to the applicant or pharmacy benefit manager and advise in writing of the reason for any suspension, revocation, refusal to issue or renew or placement on probation of a pharmacy benefit manager license under this chapter. A copy of the notice shall be forwarded to the center. The applicant or pharmacy benefit manager may make written demand upon the division within 30 days of receipt of such notification for a hearing before the division to determine the reasonableness of the division’s action. The hearing shall be held pursuant to chapter 30A.
The division shall not suspend or cancel a license unless the division has first afforded the pharmacy benefit manager an opportunity for a hearing pursuant to said chapter 30A.
(g) If a person, business or other entity performs the functions of a pharmacy benefit manager in violation of this chapter, the person, business or other entity shall be subject to a fine of $5,000 per day for each day that the person, business or other entity is found to be in violation. Penalties collected under this subsection shall be deposited into the Prescription Drug Cost Assistance Trust Fund established in section 2RRRRR of chapter 29.
(h) A pharmacy benefit manager licensed under this section shall notify a health carrier client in writing of any activity, policy, practice contract or arrangement of the pharmacy benefit manager that directly or indirectly presents any conflict of interest with the pharmacy benefit manager’s relationship with or obligation to the health carrier client.
(i) The division shall adopt any written policies, procedures or regulations that the division determines are necessary to implement this section.
Section 3. (a) The commissioner may make an examination of the affairs of a pharmacy benefit manager when the commissioner deems prudent but not less frequently than once every 3 years. The focus of the examination shall be to ensure that a pharmacy benefit manager is able to meet its responsibilities under contracts with carriers licensed under chapters 175, 176A, 176B, or 176G. The examination shall be conducted according to the procedures set forth in paragraph (6) of section 4 of chapter 175.
(b) The commissioner, a deputy or an examiner may conduct an on-site examination of each pharmacy benefit manager in the commonwealth to thoroughly inspect and examine its affairs.
(c) The charge for each such examination shall be determined annually according to the procedures set forth in paragraph (6) of section 4 of chapter 175.
(d) Not later than 60 days following completion of the examination, the examiner in charge shall file with the commissioner a verified written report of examination under oath. Upon receipt of the verified report, the commissioner shall transmit the report to the pharmacy benefit manager examined with a notice that shall afford the pharmacy benefit manager examined a reasonable opportunity of not more than 30 days to make a written submission or rebuttal with respect to any matters contained in the examination report. Within 30 days of the end of the period allowed for the receipt of written submissions or rebuttals, the commissioner shall consider and review the reports together with any written submissions or rebuttals and any relevant portions of the examiner’s work papers and enter an order:
(i) adopting the examination report as filed with modifications or corrections and, if the examination report reveals that the pharmacy benefit manager is operating in violation of this section or any regulation or prior order of the commissioner, the commissioner may order the pharmacy benefit manager to take any action the commissioner considered necessary and appropriate to cure such violation;
(ii) rejecting the examination report with directions to examiners to reopen the examination for the purposes of obtaining additional data, documentation or information and re-filing pursuant to the above provisions; or
(iii) calling for an investigatory hearing with not less than 20 days’ notice to the pharmacy benefit manager for purposes of obtaining additional documentation, data, information and testimony.
(e) Notwithstanding any general or special law to the contrary, including clause Twenty-sixth of section 7 of chapter 4 and chapter 66, the records of any such audit, examination or other inspection and the information contained in the records, reports or books of any pharmacy benefit manager examined pursuant to this section shall be confidential and open only to the inspection of the commissioner, or the examiners and assistants. Access to such confidential material may be granted by the commissioner to law enforcement officials of the commonwealth or any other state or agency of the federal government at any time if the agency or office receiving the information agrees in writing to keep such material confidential. Nothing in this subsection shall be construed to prohibit the required production of such records, and information contained in the reports of such company or organization before any court of the commonwealth or any master or auditor appointed by any such court, in any criminal or civil proceeding, affecting such pharmacy benefit manager, its officers, partners, directors or employees. The final report of any such audit, examination or any other inspection by or on behalf of the division of insurance shall be a public record.
SECTION 61. Notwithstanding any general or special law to the contrary, the health policy commission, in consultation with the center for health information and analysis, the executive office of health and human services and the division of insurance, shall produce interim and final reports on the use of insulin in the commonwealth and the effects of capping copayments and eliminating deductible and co-insurance requirements for insulin for individuals with diabetes on health care access and system cost.
The interim and final report shall include, but not be limited to: (i) rates of insulin utilization; (ii) an analysis of the use of insulin, broken down by patient demographics, geographic region and insulin delivery device; (iii) annual plan costs and member premiums; (iv) the average price of insulin; (v) the average insulin price net of rebates or discounts received by or accrued directly or indirectly by health insurance carriers; (vi) average and total out-of-pocket expenditures on insulin delivery devices and glucose monitoring tests that are not included as part of an insulin prescription; (vii) an analysis of the impact of capping co-payments and eliminating deductible and co-insurance requirements for insulin on patient access to and cost of care by patient demographics and geographic region; (viii) additional funding sources for the Prescription Drug Cost Assistance Trust Fund established in section 2RRRRR of chapter 29 of the General Laws; and (ix) any barriers to accessing insulin for individuals with diabetes and policy recommendations for resolving such barriers. The interim report, including any recommendations for expanding access to insulin for individuals with diabetes, shall be filed with the clerks of the house of representatives and senate, the joint committee on public health, the joint committee on health care financing and the house and senate committees on ways and means not later than 18 months after the effective date of this act. The final report, including any recommendations for expanding access to insulin for individuals with diabetes, shall be filed with the clerks of the house of representatives and senate, the joint committee on public health, the joint committee on health care financing and the house and senate committees on ways and means not later than 3 years after the effective date of this act.
SECTION 62. (a) Notwithstanding any general or special law to the contrary, the commonwealth health insurance connector authority, in consultation with the division of insurance, shall report on the impact of pharmaceutical pricing on health care costs and outcomes for ConnectorCare and non-group and small group plans offered through the connector and its members.
The report shall include, but not be limited to: (i) information on the differential between medication list price and price net of rebates for plans offered and the impact of those differentials on member premiums; (ii) the relationship between medication list price and member cost-sharing requirements; (iii) the impact of medication price changes over time on premium and out-of-pocket costs in plans authorized under section 3 of chapter 176J of the General Laws offered through the commonwealth health insurance connector authority; (iv) trends in changes in medication list price and price net of rebates by health plan; (v) an analysis of the impact of member out-of-pocket costs on medication utilization and member experience; and (vi) an analysis of the impact of medication list price and price net of rebates on member formulary access to medications. Data collected under this subsection shall be protected as confidential and shall not be a public record under clause Twenty-sixth of section 7 of chapter 4 or under chapter 66 of the General Laws.
The report shall be submitted to the joint committee on health care financing and the house and senate committees on ways and means not later than July 1, 2025.
(b) In fiscal year 2024, the amount required to be paid pursuant to the last paragraph of section 6 of chapter 6D of the General Laws shall be increased by $500,000; provided, however, that said $500,000 shall be provided to the commonwealth health insurance connector authority not later than October 14, 2023 for data collection and analysis costs associated with the report required by this section.
SECTION 63. Notwithstanding any general or special law to the contrary, there shall be a special commission to examine the feasibility of: (i) establishing a system for the bulk purchasing and distribution of pharmaceutical products with a significant public health benefit and the potential for significant health care cost savings for consumers through overall increased purchase capacity; and (ii) making bulk purchase pricing information available to purchasers in other states.
The commission shall consist of: the commissioner of public health or a designee, who shall serve as chair; the executive director of the group insurance commission or a designee; the chief of pharmacy of the state office for pharmacy services; the MassHealth director of pharmacy; the secretary of technology services and security; and 9 members to be appointed by the commissioner of public health, 2 of whom shall be health care economists, 1 of whom shall be an expert in health law and policy innovation, 1 of whom shall be an academic with relevant expertise in the field, 1 of whom shall be a representative from a community health center, 1 of whom shall be the chief executive officer of a hospital licensed in the commonwealth, 1 of whom shall be a representative of the Massachusetts Association of Health Plans, Inc., 1 of whom shall be a representative of Blue Cross Blue Shield of Massachusetts, Inc. and 1 of whom shall be a member of the public with experience with health care and consumer protection.
The commission shall hold not less than 3 public hearings in different geographic areas of the commonwealth, accept input from the public and solicit expert testimony from individuals representing health insurance carriers, pharmaceutical companies, independent and chain pharmacies, hospitals, municipalities, health care practitioners, health care technology professionals, community health centers, substance abuse disorder providers, public health educational institutions and other experts identified by the commission.
The commission shall consider: (i) the process by which the commonwealth could make bulk purchases of pharmaceutical products with a significant public health benefit and the potential for significant health care cost savings to consumers; (ii) the process by which both governmental and nongovernmental entities may participate in a collaborative to purchase pharmaceutical products with a significant public health benefit and the potential for significant health care cost savings; (iii) the feasibility of developing an electronic information interchange system to exchange bulk purchase price information with partnering states; (iv) potential sources of funding available to implement bulk purchases; (v) potential cost savings of bulk purchases to the commonwealth or other participating nongovernmental entities; (vi) the feasibility of partnering with the federal government and or other states in the New England region; and (vii) any other factors that the commission deems relevant.
The commission shall file a report of its analysis, along with any recommended legislation, if any, to the clerks of the senate and house of representatives, the house and senate committees on ways and means, the joint committee on health care financing, the joint committee on public health, the joint committee on elder affairs and the joint committee on mental health, substance abuse and recovery not later than September 1, 2024.
SECTION 64. (a) As used in this section, the following words shall have the following meanings, unless the context clearly requires otherwise:
“Chain pharmacist”, a pharmacist employed by a retail drug organization operating not less than 10 retail drug stores within the commonwealth under section 39 of chapter 112 of the General Laws.
“Independent pharmacist”, a pharmacist actively engaged in the business of retail pharmacy and employed in an organization of not more than 9 registered retail drugstores in the commonwealth under said section 39 of said chapter 112 that employs not more than a total of 20 full-time pharmacists.
(b) There shall be a task force to: (i) review the drug supply chain including, but not limited to: (A) plan and pharmacy benefit manager reimbursements to pharmacies; (B) wholesaler or pharmacy service administrative organization prices to pharmacies; and (C) drug manufacturer prices to pharmacies; (ii) review ways to recognize the unique challenges of small and independent pharmacies; (iii) identify methods to increase pricing transparency throughout the supply chain; (iv) make recommendations on the use of multiple maximum allowable costs lists and their frequency of use for mail order products; (v) review the utilization of maximum allowable costs lists or similar reimbursement structures established by a pharmacy benefit manager or payer; (vi) review the availability of drugs to independent and chain pharmacies on the maximum allowable cost list or any similar reimbursement structures established by a pharmacy benefit manager or payer; (vii) review the pharmacy acquisition cost from national or regional wholesalers that serve pharmacies compared to the reimbursement amount provided through a maximum allowable cost list or any similar reimbursement structures established by a pharmacy benefit manager or payer and the conditions under which an adjustment to a reimbursement is appropriate; (viii) review the timing of pharmacy purchases of products and the relative risk of list price changes related to the timing of dispensing the products; (ix) assess ways to increase transparency for chain and independent pharmacists to understand the methodology used by a pharmacy benefit manager or payer to develop a maximum allowable cost list or any similar reimbursement structure established by the pharmacy benefit manager or payer; (x) assess the prevalence and appropriateness of pharmacy benefit managers requiring, or using financial incentives or penalties to incentivize, customer use of pharmacies with whom the pharmacy benefit manager has an ownership or financial interest; (xi) examine the impact of the merger or consolidation of pharmacy benefit managers and health carrier clients on drug costs; (xii) review current appeals processes for a chain or independent pharmacist to request an adjustment on a reimbursement subject to a maximum allowable cost list or any similar reimbursement structure established by a pharmacy benefit manager or payer; and (xiii) evaluate the effect of differences between pharmacy benefit manager payments to pharmacies and charges made to health carrier clients on drug price.
(c) The task force shall consist of: the commissioner of insurance or a designee, who shall serve as chair; and 6 members to be appointed by the commissioner, 2 of whom shall be independent pharmacists employed in the independent pharmacy setting or representatives of independent pharmacies, 2 of whom shall be chain pharmacists employed in the chain pharmacy setting or representatives of chain pharmacies and 2 of whom shall be representatives of a pharmacy benefit managers or payers who manage their own pharmacy benefit services. If more than 1 independent pharmacist is appointed, each appointee shall represent a distinct practice setting. If more than 1 chain pharmacist is appointed, each appointee shall represent a distinct practice setting. A pharmacy benefit manager or payer appointed to the task force shall not be co-owned or have any ownership relationship with any other payer, pharmacy benefit manager or chain pharmacist also appointed to the task force.
(d) The commissioner shall file the task force’s findings with the clerks of the house of representatives and the senate, the joint committee on health care financing and the house and senate committees on ways and means not later than December 1, 2024.
SECTION 65. The health policy commission shall consult with relevant stakeholders, including, but not limited to, consumers, consumer advocacy organizations, organizations representing people with disabilities and chronic health conditions, providers, provider organizations, payers, pharmaceutical manufacturers, pharmacy benefit managers and health care economists and other academics, to assist in the development and periodic review of regulations to implement section 20 of chapter 6D of the General Laws, including, but not limited to: (i) establishing the criteria and processes for identifying the proposed value of an eligible drug as defined in said section 20 of said chapter 6D; and (ii) determining the appropriate price increase for a public health essential drug as described within the definition of eligible drug in said section 20 of said chapter 6D.
The commission shall hold its first public outreach not more than 45 days after the effective date of this act and shall, to the extent possible, ensure fair representation and input from a diverse array of stakeholders.
SECTION 66. Notwithstanding subsection (b) of section 15A of chapter 6D of the General Laws, for the purposes of providing early notice under said section 15A of said chapter 6D, the health policy commission shall determine a significant price increase for a generic drug to be defined as a generic drug priced at $100 or more per wholesale acquisition cost unit that increases in cost by 100 per cent or more during any 12-month period.
SECTION 67. Section 66 is hereby repealed.
SECTION 68. The drug access program, established in section 16DD of chapter 6A of the General Laws, shall take effect not later than 1 year after the effective date of this act.
SECTION 69. To implement chapter 63E of the General Laws, as inserted by section 44, the commissioner of revenue shall promulgate regulations or other guidance regarding the reporting and payment of the penalty as soon as practicable after the effective date of this act.
SECTION 70. Chapter 63E of the General Laws, as inserted by section 44, shall apply to sales commencing on or after the effective date of this act.
SECTION 71. Sections 22 and 40 shall take effect on July 1, 2024.
SECTION 72. Sections 42, 46, 48, 51, 53 and 55 shall take effect January 1, 2024.
SECTION 73. Section 58 shall take effect on July 1, 2024.
SECTION 74. Section 60 shall take effect on March 30, 2024.
SECTION 75. Section 67 shall take effect on January 1, 2025.
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An Act to lift kids out of deep poverty | S75 | SD501 | 193 | {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-13T12:08:40.357'} | [{'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-13T12:08:40.3566667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-23T14:31:11.1233333'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-01-23T14:31:03.5133333'}, {'Id': 'MDB0', 'Name': 'Michael D. 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Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-01-27T13:51:30.55'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-01-27T13:51:45.55'}, {'Id': 'RKK0', 'Name': 'Robyn K. 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Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-04-18T12:28:15.2666667'}, {'Id': 'EDJ0', 'Name': 'Edward J. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/EDJ0', 'ResponseDate': '2023-05-01T12:51:41.3666667'}, {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-05-01T12:49:49.1366667'}, {'Id': 'M_C1', 'Name': 'Mike Connolly', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/M_C1', 'ResponseDate': '2023-06-28T14:36:54.8033333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S75/DocumentHistoryActions | Bill | By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 75) of Sal N. DiDomenico, Rebecca L. Rausch, Jack Patrick Lewis, Mark C. Montigny and other members of the General Court for legislation to lift kids out of deep poverty. Children, Families and Persons with Disabilities. | SECTION 1. Section 2 of chapter 118 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking the fourth paragraph and inserting in place thereof the following new paragraph:- "Notwithstanding any general or special law to the contrary, the payment standards for monthly benefits for the program not including the rental allowance shall be increased effective July first of each year beginning with July 1, 2023 by 25 percent above the payment standard in effect in the previous fiscal year until the payment standard for the household size equals 50 percent of the federal poverty level for the household size; provided further, that once the payment standard for the household size equals 50 percent of the federal poverty level for the household size, the payment standard shall be increased effective July first of each year in order that the payment standard shall be no less than 50% of the poverty level for the household size as determined by the federal Department of Health and Human Services; provided further, that the need standard and the payment amounts shall be further increased by the amount of a clothing allowance in the month for which it is paid and by the rental allowance for households incurring a rent or mortgage expense and not residing in public or subsidized housing."
SECTION 2. Section 1 of chapter 117A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the first paragraph the following new paragraph:- "Notwithstanding any general or special law to the contrary, the payment standards for monthly benefits for the program shall be increased effective July first of each year beginning with July 1, 2023 by 25 percent above the payment standard in effect in the previous fiscal year until the payment standard for the household size equals 50 percent of the federal poverty level for the household size; provided further, that once the payment standard for the household size equals 50 percent of the federal poverty level for the household size, the payment standard shall be increased effective July first of each year in order that the payment standard shall be no less than 50% of the poverty level for the household size as determined by the federal Department of Health and Human Services".
| null | [] | [] | [] | [] |
An Act relative to primary care for you | S750 | SD2233 | 193 | {'Id': 'CFF0', 'Name': 'Cindy F. Friedman', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CFF0', 'ResponseDate': '2023-01-20T14:18:28.353'} | [{'Id': 'CFF0', 'Name': 'Cindy F. Friedman', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CFF0', 'ResponseDate': '2023-01-20T14:18:28.3533333'}, {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-04-13T15:21:00.0866667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S750/DocumentHistoryActions | Bill | By Ms. Friedman, a petition (accompanied by bill, Senate, No. 750) of Cindy F. Friedman for legislation relative to primary care for you. Health Care Financing. | SECTION 1. Section 1 of chapter 6D of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the definition of “After-hours care” the following definitions:-
“Aggregate primary care baseline expenditures”, the sum of all primary care expenditures, as defined by the center, in the commonwealth in the calendar year preceding the year in which the aggregate primary care expenditure target applies.
“Aggregate primary care expenditure target”, the targeted sum, set by the commission in section 9A, of all primary care expenditures, as defined by the center, in the commonwealth in the calendar year in which the aggregate primary care expenditure target applies.
SECTION 2. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by inserting after the definition of “Physician” the following definitions:-
“Primary care baseline expenditures”, the sum of all primary care expenditures, as defined by the center, by or attributed to an individual health care entity in the calendar year preceding the year in which the primary care expenditure target applies.
“Primary care expenditure target”, the targeted sum, set by the commission in section 9A, of all primary care expenditures, as defined by the center, by or attributed to an individual health care entity in the calendar year in which the entity’s primary care expenditure target applies.
SECTION 3. Section 8 of said chapter 6D, as so appearing, is hereby amended by striking out subsection (a) and inserting in place thereof the following subsection:-
(a) Not later than October 1 of every year, the commission shall hold public hearings based on the report submitted by the center under section 16 of chapter 12C comparing the growth in total health care expenditures to the health care cost growth benchmark for the previous calendar year and comparing the growth in actual aggregate primary care expenditures for the previous calendar year to the aggregate primary care expenditure target. The hearings shall examine health care provider, provider organization and private and public health care payer costs, prices and cost trends, with particular attention to factors that contribute to cost growth within the commonwealth’s health care system and challenge the ability of the commonwealth’s health care system to meet the benchmark established under section 9 or the aggregate primary care expenditure target established under section 9A.
SECTION 4. Said section 8 of said chapter 6D, as so appearing, is hereby further amended by striking out, in line 94, the word “and” and inserting in place thereof the following words:- , including primary care expenditures, and.
SECTION 5. Said chapter 6D is hereby further amended by inserting after section 9 the following sections:-
Section 9A. (a) The commission- shall establish an aggregate primary care expenditure target for the commonwealth, which the commission shall prominently publish on its website.
(b) The commission shall establish the aggregate primary care expenditure target and the primary care expenditure target as follows:
(1) For the calendar year 2026, the aggregate primary care expenditure target and the primary care expenditure target shall be equal to 8 per cent of total health care expenditures in the commonwealth;
(2) For the calendar year 2027, the aggregate primary care expenditure target and the primary care expenditure target shall be equal to 10 per cent of total health care expenditures in the commonwealth;
(3) For the calendar year 2028, the aggregate primary care expenditure target and the primary care expenditure target shall be equal to 12 per cent of total health care expenditures in the commonwealth; and
(4) For calendar years 2029 and beyond, if the commission determines that an adjustment in the aggregate primary care expenditure target and the primary care expenditure target is reasonably warranted, the commission may recommend modification to such targets, provided, that such targets shall not be lower than 12 per cent of total health care expenditures in the commonwealth or higher than 15 per cent of total health care expenditures in the commonwealth.
(c) Prior to establishing the aggregate primary care expenditure target and the primary care expenditure target, the commission shall hold a public hearing. The public hearing shall be based on the report submitted by the center under section 16 of chapter 12C, comparing the actual aggregate expenditures on primary care services to the aggregate primary care expenditure target, any other data submitted by the center and such other pertinent information or data as may be available to the commission. The hearings shall examine the performance of health care entities in meeting the primary care expenditure target and the commonwealth’s health care system in meeting the aggregate primary care expenditure target. The commission shall provide public notice of the hearing at least 45 days prior to the date of the hearing, including notice to the joint committee on health care financing. The joint committee on health care financing may participate in the hearing. The commission shall identify as witnesses for the public hearing a representative sample of providers, provider organizations, payers and such other interested parties as the commission may determine. Any other interested parties may testify at the hearing.
(d) Any recommendation of the commission to modify the aggregate primary care expenditure target and the primary care expenditure target under paragraph (4) of subsection (b) shall be approved by a two thirds vote of the board.
Section 9B. (a) As used in this section, the following words shall have the following meanings, unless the context clearly requires otherwise:
“Primary care provider”, a health care professional qualified to provide general medical care for common health care problems, who supervises, coordinates, prescribes or otherwise provides or proposes health care services, initiates referrals for specialist care and maintains continuity of care within the scope of practice; provided, that a “primary care provider” shall include a provider organization that provides primary care services in the commonwealth.
“Primary care service”, a service provided by a primary care provider.
(b) There shall be within the commission a primary care board, which shall consist of 19 members: the executive director of the commission or a designee, who shall serve as chair; the secretary of the executive office of health and human services or a designee; the senate chair of the joint committee on health care financing or a designee; the house chair of the joint committee on health care financing or a designee; 2 members to be appointed by the governor, 1 of whom shall be a primary care patient in the commonwealth and 1 of whom shall be the parent of a pediatric primary care patient in the commonwealth; the commissioner of insurance or a designee; 1 member from the Massachusetts Primary Care Alliance for Patients; 1 member from the Massachusetts Academy of Family Physicians; 1 member from the Massachusetts Chapter of the American Academy of Pediatrics; 1 member from the Massachusetts Chapter of the American College of Physicians; 1 member from the Massachusetts League of Community Health Centers; 1 member from Health Care For All Massachusetts; 1 member from the Massachusetts Medical Society; 1 member from the Association for Behavioral Healthcare; 1 member from the Massachusetts Association of Physician Assistants; 1 member from the Massachusetts Coalition of Nurse Practitioners; 1 member from the Massachusetts Association of Health Plans; and 1 member from Blue Cross Blue Shield of Massachusetts.
All appointments shall serve a term of 3 years, but a person appointed to fill a vacancy shall serve only for the unexpired term. An appointed member of the board shall be eligible for reappointment. The members shall be appointed not later than 60 days after a vacancy.
(c) The board shall develop and recommend a primary care prospective payment model, to be implemented by the commission, that allows a primary care provider in the commonwealth to opt in to receiving a monthly lump sum payment for all primary care services delivered. Any recommendation of the board to establish a primary care prospective payment model shall be approved by a two thirds vote of the commission’s board established in section 2; provided, that the recommended payment model shall comply with the requirements of this section.
(d) The primary care prospective payment model shall include a baseline monthly per patient payment, which shall be based on the historical monthly primary care spending per patient at the primary care provider or provider organization level, the historical monthly primary care spending per patient statewide, the primary care expenditure data published in the center’s annual report under section 16 of chapter 12C, and any other factors deemed relevant by the board. The baseline monthly per patient payment shall be adjusted based on:
(1) a primary care provider’s adoption of the primary care transformers established in subsection (e);
(2) the quality of patient care delivered by a primary care provider, as described in subsection (f); and
(3) the clinical and social risk of the primary care provider’s patient panel, as described in subsection (g).
(e) The primary care prospective payment model shall include a list of primary care transformers, created by the board, that, if adopted by a primary care provider, shall increase a primary care provider’s baseline monthly per patient payment, as determined by the board. A primary care transformer shall be an evidence-informed or evidence-based primary care service that improves primary care quality, increases primary care access, enhances a patient’s primary care experience, or promotes health equity in primary care. A primary care transformer shall include, but not be limited to: (i) employing community health workers or health coaches as part of the primary care team; (ii) investing in social determinants of health; (iii) collaborating with primary care-based clinical pharmacists; (iv) integrating behavioral health care with primary care; (v) offering substance use disorder treatment, including medication-assisted treatment, telehealth services, including telehealth consultations with specialists, medical interpreter services, home care, patient advisory groups, and group visits; (vi) using clinician optimization programs to reduce documentation burden, including, but not limited to, medical scribes and ambient voice technology; (vii) investing in care management, including employing social workers to help manage the care for patients with complicated health needs; (viii) establishing systems to facilitate end of life care planning and palliative care; (ix) developing systems to evaluate patient population health to help determine which preventative medicine interventions require patient outreach; (x) offering walk-in or same-day care appointments or extended hours of availability; and (xi) any other primary care service deemed relevant by the board.
The board shall assign a value to each primary care transformer based on the strength of evidence that the transformer will: (i) improve patient health; (ii) enhance patient experience; (iii) improve clinician experience, including reducing administrative burden; (iv) decrease total medical expense; and (iv) promote health equity. Assigned values may account for the total time and expense required to implement the transformer by a primary care provider. When assigning a value to each primary care transformer, the board shall consider the primary care sub-capitation and tiering system established in the MassHealth section 1115 demonstration waiver. The board shall review the primary care transformers, at least every 3 years, to determine the appropriateness of each transformer, its value, and whether additional transformers are necessary.
A primary care provider shall only be granted credit for a primary care transformer if the primary care provider attests to meeting the transformer’s requirements.
(f) The board shall consider a primary care provider’s performance on patient care quality measures when establishing the baseline monthly per patient payment under subsection (d). Patient care quality measures shall include, but not be limited to, established measures related to: (i) care continuity, comprehensiveness, and coordination; (ii) patient access to primary care; and (iii) patient experience. Each quality measure shall be patient-centered, appropriate for a primary care setting, and supported by peer-reviewed, evidence-based research that the measure is actionable and that its use will lead to improvements in patient health. The board shall establish not more than 10 quality measures and shall require a primary care provider to only adopt 5 of the quality measures, which shall include at least 2 measures of patient experience and 1 person-centered primary care measure.
(g) The board shall consider the clinical and social complexity of a primary care provider’s patient panel when establishing the baseline monthly per patient payment under subsection (d). Measures of the clinical and social complexity of a patient panel shall include, but not be limited to, measures that promote health equity and measures such as MassHealth’s Neighborhood Stress Score. The board shall, to the extent possible, use measures of the clinical and social complexity of a patient panel in a manner that minimizes opportunities to artificially increase the clinical and social complexity of a patient panel.
(h) The board may establish a primary care provider tiering structure based on the type and number of primary care transformers adopted by a primary care provider. This tiering structure may be used by the board to determine the baseline monthly per patient payment. When establishing the tiering structure, the board shall consider the primary care sub-capitation and tiering system established in the MassHealth section 1115 demonstration waiver.
(i) The primary care prospective payment model shall include a voluntary opt-in process that allows a primary care provider in the commonwealth to opt in to the payment model.
(j) The primary care prospective payment model shall require at least 95 per cent of primary care payments made under the model to go directly to primary care providers for the delivery of primary care services in the commonwealth.
(k) Health insurance coverage for a patient’s primary care services delivered by a primary care provider participating in the primary care prospective payment model shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible.
(l) Any carrier that provides health insurance coverage to a patient receiving primary care services from a primary care provider participating in the primary care prospective payment model shall comply with the requirements of said payment model, as described in this section.
(m) Payments made to primary care providers under the primary care prospective payment model shall be included in the medical loss ratio calculated under section 6 of chapter 176J.
(n) Payments made to primary care providers under the primary care prospective payment model shall be primary care expenditures for a primary care provider and a carrier for purposes of complying with the primary care expenditure target established in section 9A.
(o) A Federally qualified community health center may receive a prospective monthly payment for primary care services delivered to their commercially-insured patients, as determined by the board. The payment shall be no less than what the federally qualified community health center would receive through the Prospective Payment System rate.
(p) The board shall establish an attestation, public reporting, and audit process for primary care providers that opt in to the primary care prospective payment model to ensure compliance with this section. A primary care provider that does not comply with the requirements of this section may be prohibited from participating in the primary care prospective payment model until such noncompliance is rectified.
(q) The board shall review and revise the primary care prospective payment model as necessary. Annually, the board shall submit a report summarizing it activities to the chair of the commission’s board, the clerks of the house of representatives and senate, the chairs of the house and senate committees on ways and means, and the chairs of the joint committee on health care financing.
(r) The commission shall promulgate rules and regulations necessary to implement this section.
SECTION 6. Said chapter 6D, as so appearing, is hereby further amended by inserting after section 10 the following section:-
Section 10A. (a) For the purposes of this section, “health care entity” shall mean any entity identified by the center under section 18 of chapter 12C.
(b) The commission shall provide notice to all health care entities that have been identified by the center under section 18 of chapter 12C for failure to meet the primary care expenditure target. Such notice shall state that the center may analyze the performance of individual health care entities in meeting the primary care expenditure target and, beginning in calendar year 2025, the commission may require certain actions, as established in this section, from health care entities so identified.
(c) In addition to the notice provided under subsection (b), the commission may require any health care entity that is identified by the center under section 18 of chapter 12C for failure to meet the primary care expenditure target to file and implement a performance improvement plan. The commission shall provide written notice to such health care entity that they are required to file a performance improvement plan. Within 45 days of receipt of such written notice, the health care entity shall either:
(1) file a performance improvement plan with the commission; or
(2) file an application with the commission to waive or extend the requirement to file a performance improvement plan.
(d) The health care entity may file any documentation or supporting evidence with the commission to support the health care entity’s application to waive or extend the requirement to file a performance improvement plan. The commission shall require the health care entity to submit any other relevant information it deems necessary in considering the waiver or extension application; provided, however, that such information shall be made public at the discretion of the commission.
(e) The commission may waive or delay the requirement for a health care entity to file a performance improvement plan in response to a waiver or extension request filed under subsection (c) in light of all information received from the health care entity, based on a consideration of the following factors: (1) the primary care baseline expenditures, costs, price and utilization trends of the health care entity over time, and any demonstrated improvement to increase the proportion of primary care expenditures; (2) any ongoing strategies or investments that the health care entity is implementing to invest in or expand access to primary care services; (3) whether the factors that led to the inability of the health care entity to meet the primary care expenditure target can reasonably be considered to be unanticipated and outside of the control of the entity; provided, that such factors may include, but shall not be limited to, market dynamics, technological changes and other drivers of non-primary care spending such as pharmaceutical and medical devices expenses; (4) the overall financial condition of the health care entity; and (5) any other factors the commission considers relevant.
(f) If the commission declines to waive or extend the requirement for the health care entity to file a performance improvement plan, the commission shall provide written notice to the health care entity that its application for a waiver or extension was denied and the health care entity shall file a performance improvement plan.
(g) The commission shall provide the department of public health any notice requiring a health care entity to file and implement a performance improvement plan pursuant to this section. In the event a health care entity required to file a performance improvement plan under this section submits an application for a notice of determination of need under section 25C or 51 of chapter 111, the notice of the commission requiring the health care entity to file and implement a performance improvement plan pursuant to this section shall be considered part of the written record pursuant to said section 25C of chapter 111.
(h) A health care entity shall file a performance improvement plan: (1) within 45 days of receipt of a notice under subsection (c); (2) if the health care entity has requested a waiver or extension, within 45 days of receipt of a notice that such waiver or extension has been denied; or (3) if the health care entity is granted an extension, on the date given on such extension. The performance improvement plan shall identify specific strategies, adjustments and action steps the entity proposes to implement to increase the proportion of primary care expenditures. The proposed performance improvement plan shall include specific identifiable and measurable expected outcomes and a timetable for implementation.
(i) The commission shall approve any performance improvement plan that it determines is reasonably likely to address the underlying cause of the entity’s inability to meet the primary care expenditure target and has a reasonable expectation for successful implementation.
(j) If the board determines that the performance improvement plan is unacceptable or incomplete, the commission may provide consultation on the criteria that have not been met and may allow an additional time period, up to 30 calendar days, for resubmission.
(k) Upon approval of the proposed performance improvement plan, the commission shall notify the health care entity to begin immediate implementation of the performance improvement plan. Public notice shall be provided by the commission on its website, identifying that the health care entity is implementing a performance improvement plan. All health care entities implementing an approved performance improvement plan shall be subject to additional reporting requirements and compliance monitoring, as determined by the commission. The commission shall provide assistance to the health care entity in the successful implementation of the performance improvement plan.
(l) All health care entities shall, in good faith, work to implement the performance improvement plan. At any point during the implementation of the performance improvement plan the health care entity may file amendments to the performance improvement plan, subject to approval of the commission.
(m) At the conclusion of the timetable established in the performance improvement plan, the health care entity shall report to the commission regarding the outcome of the performance improvement plan. If the performance improvement plan was found to be unsuccessful, the commission shall either: (1) extend the implementation timetable of the existing performance improvement plan; (2) approve amendments to the performance improvement plan as proposed by the health care entity; (3) require the health care entity to submit a new performance improvement plan under subsection (c); or (4) waive or delay the requirement to file any additional performance improvement plans.
(n) Upon the successful completion of the performance improvement plan, the identity of the health care entity shall be removed from the commission’s website.
(o) The commission may submit a recommendation for proposed legislation to the joint committee on health care financing if the commission determines that further legislative authority is needed to achieve the health care quality and spending sustainability objectives of section 9A, assist health care entities with the implementation of performance improvement plans or otherwise ensure compliance with the provisions of this section.
(p) If the commission determines that a health care entity has: (1) willfully neglected to file a performance improvement plan with the commission by the time required in subsection (h); (2) failed to file an acceptable performance improvement plan in good faith with the commission; (3) failed to implement the performance improvement plan in good faith; or (4) knowingly failed to provide information required by this section to the commission or that knowingly falsifies the same, the commission may assess a civil penalty to the health care entity of not more than $500,000. The commission shall seek to promote compliance with this section and shall only impose a civil penalty as a last resort.
(q) The commission shall promulgate regulations necessary to implement this section.
(r) Nothing in this section shall be construed as affecting or limiting the applicability of the health care cost growth benchmark established under section 9, and the obligations of a health care entity thereto.
SECTION 7. Section 16 of chapter 12C of the General Laws, as so appearing in the 2020 Official Edition, is hereby amended by striking out subsection (a) and inserting in place thereof the following subsection:-
(a) The center shall publish an annual report based on the information submitted under this chapter concerning health care provider, provider organization and private and public health care payer costs and cost trends, section 13 of chapter 6D relative to market power reviews and section 15 relative to quality data. The center shall compare the costs and cost trends with the health care cost growth benchmark established by the health policy commission under section 9 of chapter 6D, analyzed by regions of the commonwealth, and shall compare the costs, cost trends, and expenditures with the aggregate primary care expenditure target established under section 9A of chapter 6D, and shall detail: (1) baseline information about cost, price, quality, utilization and market power in the commonwealth's health care system; (2) cost growth trends for care provided within and outside of accountable care organizations and patient-centered medical homes; (3) cost growth trends by provider sector, including but not limited to, hospitals, hospital systems, non-acute providers, pharmaceuticals, medical devices and durable medical equipment; provided, however, that any detailed cost growth trend in the pharmaceutical sector shall consider the effect of drug rebates and other price concessions in the aggregate without disclosure of any product or manufacturer-specific rebate or price concession information, and without limiting or otherwise affecting the confidential or proprietary nature of any rebate or price concession agreement; (4) factors that contribute to cost growth within the commonwealth's health care system and to the relationship between provider costs and payer premium rates; (5) primary care expenditure trends as compared to the aggregate primary care baseline expenditures, as defined in section 1 said chapter 6D; (6) the proportion of health care expenditures reimbursed under fee-for-service and alternative payment methodologies; (7) the impact of health care payment and delivery reform efforts on health care costs including, but not limited to, the development of limited and tiered networks, increased price transparency, increased utilization of electronic medical records and other health technology; (8) the impact of any assessments including, but not limited to, the health system benefit surcharge collected under section 68 of chapter 118E, on health insurance premiums; (9) trends in utilization of unnecessary or duplicative services, with particular emphasis on imaging and other high-cost services; (10) the prevalence and trends in adoption of alternative payment methodologies and impact of alternative payment methodologies on overall health care spending, insurance premiums and provider rates; (11) the development and status of provider organizations in the commonwealth including, but not limited to, acquisitions, mergers, consolidations and any evidence of excess consolidation or anti-competitive behavior by provider organizations; (12) the impact of health care payment and delivery reform on the quality of care delivered in the commonwealth; and (13) costs, cost trends, price, quality, utilization and patient outcomes related to primary care services.
SECTION 8. Said section 16 of said chapter 12C, as so appearing, is hereby further amended by adding the following subsections:-
(d) The center shall publish the aggregate primary care baseline expenditures in its annual report.
(e) The center, in consultation with the commission, shall determine the primary care baseline expenditures for individual health care entities and shall report to each health care entity its respective baseline expenditures annually, by October 1.
SECTION 9. Said chapter 12C, as so appearing, is hereby further amended by striking out section 18 and inserting in place thereof the following section:-
Section 18. The center shall perform ongoing analysis of data it receives under this chapter to identify any payers, providers or provider organizations: (i) whose increase in health status adjusted total medical expense is considered excessive and who threaten the ability of the state to meet the health care cost growth benchmark established by the health care finance and policy commission under section 10 of chapter 6D; or (ii) whose expenditures fail to meet the primary care expenditure target under section 9A of chapter 6D. The center shall confidentially provide a list of the payers, providers and provider organizations to the health policy commission such that the commission may pursue further action under sections 10 and 10A of chapter 6D.
SECTION 10. Chapter 29 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 2OOOOO the following section:-
Section 2PPPPP. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:
“Carrier”, an insurer licensed or otherwise authorized to transact accident or health insurance under chapter 175; a nonprofit hospital service corporation organized under chapter 176A; a nonprofit medical service corporation organized under chapter 176B; a health maintenance organization organized under chapter 176G; and an organization entering into a preferred provider arrangement under chapter 176I; provided, that this shall not include an employer purchasing coverage or acting on behalf of its employees or the employees of 1 or more subsidiaries or affiliated corporations of the employer; provided that, unless otherwise noted, the term ''carrier'' shall not include any entity to the extent it offers a policy, certificate or contract that provides coverage solely for dental care services or visions care services.
“Provider”, any person, corporation, partnership, governmental unit, state institution or any other entity qualified under the laws of the commonwealth to perform or provide health care services.
“Provider organization”, any corporation, partnership, business trust, association or organized group of persons, which is in the business of health care delivery or management, whether incorporated or not that represents 1 or more health care providers in contracting with carriers for the payments of heath care services; provided, that ''provider organization'' shall include, but not be limited to, physician organizations, physician-hospital organizations, independent practice associations, provider networks, accountable care organizations and any other organization that contracts with carriers for payment for health care services.
(b) There is hereby established and set up on the books of the commonwealth a separate fund to be known as the primary care trust fund for the purpose of providing the prospective monthly payments to primary care providers participating in the primary care prospective payment model established in section 9B of chapter 6D. The fund shall be administered by the health policy commission. There shall be credited to the fund: (i) an annual assessment on carriers, providers, provider organizations, and for profit non-traditional healthcare corporations and entities that provide, as part of a larger business model, primary care services in the commonwealth, including, but not limited to, retailers, pharmacy benefits manager, and private equity firms, in an amount and manner determined by the commission; (ii) revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; and (iii) interest earned on such revenues. Amounts credited to the fund shall not be subject to further appropriation and any money remaining in the fund at the end of a fiscal year shall not revert to the General Fund.
Funds may be used for scientific evaluation of the primary care prospective payment model established under section 9B of chapter 6D.
(c) Not later than the first day of each month, the commission shall ensure that the primary care trust fund transfers the necessary amount to cover the payments to primary care provers required by the primary care prospective payment model established in section 9B of chapter 6D.
(d) Annually, not later than October 1, the commission shall report to the clerks of the house of representatives and senate, the chairs of the joint committee on health care financing, and the chairs of the house and senate committees on ways and means on the fund’s activity. The report shall include, but not be limited to: (i) the source and amount of funds received; (ii) total expenditures; and (iii) anticipated revenue and expenditure projections for the next calendar year.
SECTION 11. The regulations required by subsection (r) of section 9B of chapter 6D of the General Laws shall be promulgated not later than January 1, 2025.
SECTION 12. Subsection (e) of section 16 of chapter 12C of the General Laws shall take effect October 1, 2025.
SECTION 13. The primary care board, established in section 9B of chapter 6D of the General Laws, shall convene its first meeting not later than March 1, 2025, and shall develop and recommend the implementation of a primary care prospective payment model to the health policy commission, established in said chapter 6D, not later than January 1, 2026.
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An Act relative to medical records requests | S751 | SD785 | 193 | {'Id': 'AMG0', 'Name': 'Anne M. Gobi', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AMG0', 'ResponseDate': '2023-01-18T12:46:01.62'} | [{'Id': 'AMG0', 'Name': 'Anne M. Gobi', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AMG0', 'ResponseDate': '2023-01-18T12:46:01.62'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-30T14:13:32.28'}, {'Id': 'DFD1', 'Name': 'David F. DeCoste', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DFD1', 'ResponseDate': '2023-04-06T11:20:39.8366667'}, {'Id': 'CRF1', 'Name': 'Christopher Richard Flanagan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CRF1', 'ResponseDate': '2023-04-26T11:30:43.3466667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S751/DocumentHistoryActions | Bill | By Ms. Gobi, a petition (accompanied by bill, Senate, No. 751) of Anne M. Gobi for legislation relative to medical records requests. Health Care Financing. | Chapter 118I of the General Laws, as so appearing in the 2020 Official Edition, is hereby amended by adding the following new section:-
(x) Upon request, a provider shall supply to a patient or a patient's authorized representative within 15 business days of receiving a written request for medical records complete and current information possessed by that provider concerning any diagnosis, treatment, and prognosis of the patient in terms and language the patient can reasonably be expected to understand.
(y) Except as provided in section (x), upon a patient's written request, a provider, at a reasonable cost to the patient, shall promptly furnish to the patient or the patient's authorized representative within 15 business days of receiving a written request for medical records:
(1) copies of the patient's health record, including but not limited to laboratory reports, x-rays, prescriptions, and other technical information used in assessing the patient's health conditions; or
(2) the pertinent portion of the record relating to a condition specified by the patient. With the consent of the patient, the provider may instead furnish only a summary of the record. The provider may exclude from the health record written speculations about the patient's health condition, except that all information necessary for the patient's informed consent must be provided.
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Resolve to establish a special commission to evaluate the rate structure for rest homes or residential care homes | S752 | SD1816 | 193 | {'Id': 'AMG0', 'Name': 'Anne M. Gobi', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AMG0', 'ResponseDate': '2023-01-20T09:06:47.383'} | [{'Id': 'AMG0', 'Name': 'Anne M. Gobi', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AMG0', 'ResponseDate': '2023-01-20T09:06:47.3833333'}, {'Id': 'MJM2', 'Name': 'Mathew J. Muratore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJM2', 'ResponseDate': '2023-01-30T15:44:34.2166667'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-02-07T15:57:19.65'}, {'Id': 'MFR0', 'Name': 'Michael F. Rush', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MFR0', 'ResponseDate': '2023-03-06T16:28:56.8233333'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-17T09:35:45.42'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S752/DocumentHistoryActions | Resolve | By Ms. Gobi, a petition (accompanied by resolve, Senate, No. 752) of Anne M. Gobi, Mathew J. Muratore, Patrick M. O'Connor and Michael F. Rush that provisions be made for an investigation and study by a special commission to evaluate the rate structure for rest homes or residential care homes. Health Care Financing. | Resolved, there is hereby established a special commission to evaluate the rate structure for rest homes or residential care homes. Said study shall include, but not be limited to, an examination of the following: (1) a review of the current rate structure and its relation to the actual cost of care (2) an inventory of the current licensed rest home facilities, number of licensed rest home beds, and the location and service area of said facilities (3) a review of the rest homes closures since 2015 and identification of any similar causes or trends that led to closure (4) a review of the recommendations and any actions taken from the nursing facilities task force report per chapter 41 of the acts of 2019 (5) a review of the licensing, regulatory, and reporting structure for licensed rest homes (6) a determination of the eligibility and feasibility of rest home expenses being eligible for federal reimbursement.
Said commission shall consist of the two members appointed by the speaker of the house, one of which will serve as co-chair, two members appointed by the president of the senate, one of which will serve as co-chair, one member appointed by the minority leader in the house, one member appointed by the minority leader in the senate, the secretary of health and human services or a designee, the secretary of elder affairs or a designee, the commissioner of MassHealth, the commissioner of the department of mental health, the commissioner of the department of public health, the commissioner of the department of transitional assistance, a representative from the Massachusetts association of residential care homes, a representative of leading age Massachusetts, a representative of Massachusetts senior action, and two persons to be appointed by the governor, one of whom shall have direct caregiver experience, and one of whom shall have experience in health care administration and finance.
Said commission shall file a report on the results of its study, together with recommendations and any legislation necessary to carry its recommendations into effect with the clerks of the house of representatives and the senate, and the house and senate committees on ways and means, no later than April 1, 2025.
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An Act relative to preventing discrimination against persons with disabilities in the provision of health care | S753 | SD308 | 193 | {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-01-13T09:50:37.99'} | [{'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-01-13T09:50:37.99'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-04-04T12:02:54.1266667'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-04-26T10:39:31.1'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S753/DocumentHistoryActions | Bill | By Mr. Gomez, a petition (accompanied by bill, Senate, No. 753) of Adam Gomez for legislation to prevent discrimination against persons with disabilities in the provision of health care. Health Care Financing. | SECTION 1. Section 1 of chapter 151B of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking out, in line 138, the word “handicap” and inserting in place thereof the following word:- disability.
SECTION 2. Section 4 of said chapter 151B, as so appearing, is hereby amended by adding the following subsection:-
20. (a) As used in this subsection, the following words shall have the following meaning unless the context clearly requires others:
“Disability”, shall have the same meaning as defined in section 1 of chapter 151B.
“Short-term survival”, an individual’s assessed probability of surviving an acute illness from which they are presently suffering and being successfully discharged from a hospital or other inpatient medical facility.
(b) It shall be an unlawful practice:
(i) For any public or private entity or agency of the commonwealth, to approve or implement a plan for the distribution of scarce healthcare resources during a crisis, including, but not limited to, crisis standards of care implemented during a public health emergency, that deny an individual lifesaving treatment or place an individual at reduced priority for lifesaving treatment if such a determination is based on: (A) a presumption that an individual has a reduced quality of life due to a disability or chronic health condition; (B) a presumption that an individual’s life is less worth saving due to a disability or chronic health condition; or (C) any measure, metric, or third party analysis which has the effect of setting a value for the life of an individual or individuals with a specific disability or medical diagnosis that is less than the value given to the life of an individual or individuals without a disability; provided however that this subsection shall not prohibit such a plan from considering an individual’s prospects for short-term survival in determining whether they are prioritized for care.
(ii) For any public or private entity or agency of the commonwealth, to withhold any medical treatment to an individual based on: (A) a presumption that an individual has a reduced quality of life due to a disability or chronic health condition; (B) a presumption that an individual’s life is less worth saving due to a disability or chronic health condition; or (C) any measure, metric, or third party analysis which has the effect of setting a value for the life of an individual or individuals with a specific disability or medical diagnosis that is less than the value given to the life of an individual or individuals without a disability.
(iii) For any public or private entity or agency of the commonwealth, when determining whether a healthcare treatment should be available within a formulary, or determining the value of a healthcare treatment, to employ a measure or metric which assigns a reduced value to the life extension provided by a treatment based on a pre-existing disability or chronic health condition of the individuals whom the treatment would benefit.
(iv) For a hospital or other entity engaged in the provision of healthcare to: (A) condition the provision of treatment on an individual having an order to not resuscitate, advance directive or any instruction relating to the administration, withholding or withdrawing of life-sustaining procedures or artificially administered nutrition and hydration; (B) communicate to any individual or person acting on behalf of the individual, before or after admission to the hospital, that treatment is conditioned on the individual having an order to not resuscitate, an advance directive or any instruction relating to the administration, withholding or withdrawing of life-sustaining procedures or artificially administered nutrition and hydration; (C) suggest to any individual, or person acting on behalf of the individual, who contacts the hospital regarding treatment for the individual that admission or treatment is conditioned on the individual having an order to not resuscitate, an advance directive or any instruction relating to the administration, withholding or withdrawing of life-sustaining procedures or artificially administered nutrition and hydration; or (D) discriminate in any other way against an individual based on whether the individual has an order to not resuscitate, an advance directive or any instruction relating to the administration, withholding or withdrawing of life-sustaining procedures or artificially administered nutrition and hydration.
(c) This subsection shall not prohibit a hospital from providing written materials and information about advance directives to an individual or prohibit a licensed health care professional from engaging in a discussion with an individual about the written materials and information, so long as the professional does not disproportionately advise an individual to sign an advanced directive based on the race, ethnicity, gender, sexuality, or disability status of said individual.
(d) Nothing in this subsection shall prevent healthcare practitioners, hospitals or other healthcare entities from providing a medically appropriate course of treatment to an individual that they believe will extend that individual’s life, improve their symptoms or alleviate pain and suffering.
(e) The secretary of health and human services shall promulgate regulations to implement this subsection.
SECTION 3. The secretary of health and human services shall promulgate regulations for the implementation of subsection 20 of section 4 of chapter 151B not later than 60 days after the effective date of this act.
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An Act to ensure access to the full range of treatment options for people with obesity | S754 | SD743 | 193 | {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-01-18T10:37:34.723'} | [{'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-01-18T10:37:34.7233333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S754/DocumentHistoryActions | Bill | By Mr. Gomez, a petition (accompanied by bill, Senate, No. 754) of Adam Gomez for legislation to ensure access to the full range of treatment options for people with obesity. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 10N, the following section:-
SECTION 10O. Notwithstanding any general or special rule to the contrary, the division shall require comprehensive coverage for treatment of obesity. The term “comprehensive coverage for treatment of obesity” includes coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication. The term ‘FDA-approved anti-obesity medication’ refers to any medication approved by the US Food and Drug Administration with an indication for chronic weight management in patients with obesity.
a) Coverage criteria for FDA-approved anti-obesity medications provided under this section shall not be more restrictive than the FDA-approved indications for those treatments.
b) Coverage under this section shall be neither different nor separate from coverage for any other illness, condition, or disorder for purposes of determining deductibles, lifetime dollar limits, copayment and coinsurance factors, and benefit year maximum for deductibles and copayment and coinsurance factors.
c) Nothing shall preclude the undertaking of utilization management to determine the medical necessity for treatment of obesity under this section, provided that all such appropriateness and medical necessity determinations are made in the same manner as those determinations are made for the treatment of any other illness, condition, or disorder covered by such policy, contract, or plan.
d) The division shall provide notice to its members regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to members and shall be transmitted to members within calendar year when annual information is made available to members, or in any other mailing or communication to members.
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An Act clarifying rate setting processes for home health and home care services
| S755 | SD854 | 193 | {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-01-11T14:43:28.313'} | [{'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-01-11T14:43:28.3133333'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-01-26T16:52:30.5866667'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-01-31T12:30:52.12'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-02-02T16:04:30.4033333'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-02-08T15:23:30.1733333'}, {'Id': 'AMG0', 'Name': 'Anne M. Gobi', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AMG0', 'ResponseDate': '2023-02-09T11:39:02.2966667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-02-09T14:10:39.1033333'}, {'Id': 'MJM2', 'Name': 'Mathew J. Muratore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJM2', 'ResponseDate': '2023-02-10T11:35:26.0366667'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-10T12:20:12.7866667'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-02-14T09:14:51.8133333'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-15T14:54:24.5933333'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-02-23T13:33:38.1466667'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-03-01T16:56:33.84'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-03-22T13:25:06.1766667'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-04-13T13:37:06.1233333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S755/DocumentHistoryActions | Bill | By Ms. Jehlen, a petition (accompanied by bill, Senate, No. 755) of Patricia D. Jehlen, Carmine Lawrence Gentile, Vanna Howard, Susannah M. Whipps and other members of the General Court for legislation to clarify rate setting processes for home health and home care services. Health Care Financing. | SECTION 1: Section 13D of Chapter 118E of the general laws is amended after the second paragraph by inserting the following new paragraph:
Such rates for home health agencies, as defined under section 51K of chapter 111, shall be established at least biennially. In setting such rates, the executive office shall use as base year costs for rate determination purposes the reported costs of the calendar year not more than 4 years prior to the current rate year, adjusted for reasonableness and to incorporate any new regulatory costs imposed since said base year costs. In establishing rates of payment to home health agencies, the executive office shall consider all costs which must be incurred by efficiently and economically operated providers. The rates shall also include an allowance for reasonable administrative expenses and a reasonable profit factor, as determined by the executive office. Such cost analysis shall include, but not be limited to, the following: costs of similar services provided in other care settings; use of national or regional indices to measure increases or decreases in reasonable costs incurred since the base year costs; the revision of existing historical cost bases, where applicable, to reflect changing norms or models of efficient service delivery; and other means to encourage the cost-efficient delivery of services. In determining the methodology for setting rates, the Secretary shall consult with stakeholders impacted by the rates. The Secretary shall, concurrent with the completion of setting such rates, provide a report to the house and senate committees on ways and means detailing how the rates issued under this paragraph were analyzed and revised; provided further, that the report shall compare the inflationary considerations made in the adopted rate with the most recent “Home Health Agency Market Basket” index posted by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services; provided further, that if the adopted rate does not rely on the “Home Health Agency Market Basket” index for the purpose of determining inflationary adjustments, then the report will simulate what the rate would have been if such index was a factor in rate development.
SECTION 2: Section 4 of Chapter 19A is hereby amended by adding after Section 4D the following new section:
Section 4E: In establishing rates of payment pursuant to the second paragraph of section 13C of chapter 118E of the M.G.L., the executive office shall consider changes to the state minimum wage or changes to employer payroll tax obligations as governmental mandates that affect the costs of providing homemaker and personal care homemaker services to elderly clients under this section.
The executive office shall also consider and analyze rates of payment and wages associated with providing similar services in both the public and private settings. In calculating operating costs, the executive office shall consider costs of; health insurance, employee benefits and training, payroll taxes, technology costs, administrative allocation and staff salaries using the latest available national or regional indices and benchmarked to the latest available Bureau of Labor Statistics median wage data. Nothing in this section shall be construed as limiting consideration of other governmental mandates or operating costs that affect the cost of providing services pursuant to section 4 of chapter 19A of the General Laws. In determining the methodology for setting rates, the Secretary shall consult with stakeholders impacted by the rates.
The Secretary of Elder Affairs shall, concurrent with the promulgation of the final rates of payment for services under section 4 of chapter 19A, issue a report to the House and Senate committees on ways and means detailing how the rates promulgated were analyzed and determined in compliance with the provisions set forth in the second paragraph of section 13C of chapter 118E of the General Laws. The report shall detail the department’s analysis of changes in the costs of providing homemaker and personal care homemaker services since the immediately preceding rate determination; provided further, that the report shall compare the inflationary considerations made in the adopted rate with the most recent “Home Health Agency Market Basket” index posted by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services; provided further, that if the adopted rate does not rely on the “Home Health Agency Market Basket” index for the purpose of determining inflationary adjustments, then the report will simulate what the rate would have been if such index was a factor in rate development.
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An Act preserving special needs trusts for disabled seniors | S756 | SD1832 | 193 | {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-01-11T11:54:37.933'} | [{'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-01-11T11:54:37.9333333'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-02-02T16:06:13.55'}, {'Id': 'BWM1', 'Name': 'Brian W. Murray', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BWM1', 'ResponseDate': '2023-02-03T15:10:02.89'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-02-07T15:32:30.8866667'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-02-14T09:15:34.3733333'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-15T14:53:39.1366667'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-03-02T15:15:24.57'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-03-08T12:53:14.49'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-04-05T13:48:38.4466667'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-06T12:39:27.7766667'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-07-20T13:05:03.2066667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S756/DocumentHistoryActions | Bill | By Ms. Jehlen, a petition (accompanied by bill, Senate, No. 756) of Patricia D. Jehlen, Susannah M. Whipps, Brian W. Murray, Patrick M. O'Connor and other members of the General Court for legislation to preserve special needs trusts for disabled seniors. Health Care Financing. | Section 28 of chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following paragraph:-
The division shall consider a transfer of assets by an individual age 65 or older or a transfer made for the sole benefit of an individual age 65 or older into a trust pursuant to 42 U.S.C. 1396p(d)(4)(C), established for the sole benefit of said individual, to be a disposal of resources for fair market value, to the extent that such resources shall be available, under any circumstances, to be used by the trustee to provide goods and services to the individual, or to reimburse such costs, at fair market value.
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An Act promoting workforce development and provider retention at community health centers | S757 | SD1165 | 193 | {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-01-11T14:59:28.583'} | [{'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-01-11T14:59:28.5833333'}, {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-27T15:53:34.51'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-30T13:17:51.7'}, {'Id': 'RME1', 'Name': 'Rodney M. Elliott', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RME1', 'ResponseDate': '2023-01-30T13:15:40.3966667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-30T15:58:56.65'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-02T13:13:48.9766667'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-02-02T15:24:57.3866667'}, {'Id': 'JKH1', 'Name': 'James K. Hawkins', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JKH1', 'ResponseDate': '2023-02-07T20:30:42.6233333'}, {'Id': 'PMP0', 'Name': 'Pavel M. Payano', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMP0', 'ResponseDate': '2023-02-15T11:36:25.08'}, {'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-02-17T17:00:26.3766667'}, {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-02-22T15:25:29.49'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-02-24T14:32:19.7533333'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-03-06T17:11:41.9566667'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-03-24T16:18:06.5366667'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-04-27T13:40:20.6033333'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-05-22T07:32:24.2366667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S757/DocumentHistoryActions | Bill | By Mr. Keenan, a petition (accompanied by bill, Senate, No. 757) of John F. Keenan, John J. Cronin, Rodney M. Elliott, Joanne M. Comerford and other members of the General Court for legislation to promote workforce development and provider retention at community health centers. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following new section:-
Section 80. The division shall establish a community health center nurse practitioner residency program for the purposes of recruiting and retaining nurse practitioners at community health centers in order to increase access to high-quality community-based primary, preventative and integrated care.
These programs shall:
(i) Provide a 24-month post-graduate residency program, administered by community health centers, defined as community health centers receiving a grant under 42 USC 254b, for certified nurse practitioners who have graduated from an accredited school of nursing within the past three years;
(ii) Provide nurse practitioners in the program with patient panels under the supervision and mentorship of a physician or other advanced practice registered nurse at a community health center; and
(iii) Require nurse practitioners that participate in the 24-month residency program enter into a contract with the community health center for at least eighteen months of employment.
Nothing in this section shall be interpreted to conflict with, replace, or supersede any licensure requirements or standards for the advanced nursing practice established pursuant to chapters 94C or 112.
SECTION 2. The division shall make expenditures of no less than $2,500,000 annually to this program and shall seek federal Medicaid reimbursement for this program as graduate medical education.
SECTION 3. The division shall promulgate regulations to implement said program, including program details and grant guidelines as necessary, no later than six months after the passage of this act.
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An Act providing access to patient protection services for MassHealth consumers | S758 | SD1781 | 193 | {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-01-18T09:46:40.337'} | [{'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-01-18T09:46:40.3366667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S758/DocumentHistoryActions | Bill | By Mr. Keenan, a petition (accompanied by bill, Senate, No. 758) of John F. Keenan for legislation to provide access to patient protection services for MassHealth consumers. Health Care Financing. | SECTION 1. Section 47 of Chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding after the third paragraph the following new paragraph:-
Notwithstanding the provision of any general or special law to the contrary, every person covered by the division of medical assistance, its contracted health plans, health maintenance organizations, behavioral health management firms, and third-party administrators under contract to a medicaid managed care organization or primary care clinician plan shall have access to the standards and procedures established under sections 12, 13, and 14 of chapter 176O. Such standards shall be administered and enforced by the office of patient protection established by section 16 of chapter 6D. The executive office of health and human services and the division of medical assistance shall request waivers from any federal laws or regulations that impede the effective implementation of this act.
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An Act requiring equitable access to behavioral health services for MassHealth consumers | S759 | SD1932 | 193 | {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-01-12T17:21:54.033'} | [{'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-01-12T17:21:54.0333333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S759/DocumentHistoryActions | Bill | By Mr. Keenan, a petition (accompanied by bill, Senate, No. 759) of John F. Keenan for legislation to provide equitable access to behavorial health for MassHealth consumers. Health Care Financing. | SECTION 1. Section 12 of chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the ninth paragraph the following paragraphs:-
The division shall certify and ensure that all contracted accountable care organizations, contracted health insurers, health plans, health maintenance organizations, and behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan provide equal access to behavioral health services, benefits and medications of comparable quality in providing medical assistance to recipients.
The division shall obtain the approval of the secretary of the executive office of health and human services for all behavioral health services, benefits, and medications, including, but not limited to, policies, protocols, standards, contract specifications, utilization review and utilization management criteria and outcome measurements, used by all contracted accountable care organizations, contracted insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan.
Notwithstanding the provision of any general or special law to the contrary, all contracted accountable care organizations, contracted health insurers, health plans, health maintenance organizations and behavioral health management firms and third-party administrators under contract to a Medicaid managed care clinician plan shall submit its method of determining reimbursement levels to all network inpatient mental health and substance use providers and how such methodology is sufficient to meet the costs of providing inpatient care. Such method shall include, but not be limited to, the range of payment amounts including the median payment levels and how such payments are regularly updated. A report including this information shall be submitted to the division and the house and senate committees on ways and means; the committee on health care financing, and the committee on mental health, substance use and recovery no later than 90 days after the effective date of this act.
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An Act establishing basic needs assistance for Massachusetts immigrant residents | S76 | SD507 | 193 | {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-11T12:57:25.923'} | [{'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-11T12:57:25.9233333'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-25T16:21:24.13'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-01-27T13:51:59.1466667'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-31T13:28:28.8566667'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-06T10:49:49.29'}, {'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-02-08T10:22:21.9633333'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-21T11:12:04.6833333'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-02-21T11:11:51.4166667'}, {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-02-23T15:09:39.8533333'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-02-28T10:59:28.9633333'}, {'Id': 'C_G1', 'Name': 'Carlos González', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/C_G1', 'ResponseDate': '2023-03-01T12:07:05.7133333'}, {'Id': 'AJP1', 'Name': 'Angelo J. Puppolo, Jr.', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJP1', 'ResponseDate': '2023-03-01T16:30:49.4133333'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-03-15T10:00:00.1133333'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-04-06T11:14:02.1533333'}, {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-04-10T11:53:41.0666667'}, {'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-05-22T17:58:45.1933333'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-06-28T14:36:44.63'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-12T16:42:09.1233333'}, {'Id': 'EDJ0', 'Name': 'Edward J. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/EDJ0', 'ResponseDate': '2023-07-12T16:41:34.7866667'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-07-13T16:26:44.98'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S76/DocumentHistoryActions | Bill | By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 76) of Sal N. DiDomenico, Joanne M. Comerford, Michael D. Brady, Jason M. Lewis and other members of the General Court for legislation to establish basic needs assistance for Massachusetts immigrant residents. Children, Families and Persons with Disabilities. | SECTION 1. Chapter 18 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 39 the following new section:-
Section 40: The department of transitional assistance shall, subject to appropriation, provide the following basic needs benefits to persons residing in the Commonwealth who are lawfully admitted for permanent residence or are otherwise permanently residing in the United States under color of law: a) cash assistance and related benefits to children, pregnant women and caretaker adults who meet the eligibility requirements of Chapter 118 of the General Laws except for the program requirements related to immigration status or citizenship, and b) nutritional assistance benefits to persons who meet the eligibility requirements of the Supplemental Nutrition Assistance Program except for the program requirements related to immigration status or citizenship. The basic needs benefits authorized under this section shall be provided at the same level and subject to the same requirements as benefits provided under Chapter 118 or the Supplemental Nutrition Assistance Program, with the exception of the immigration status or citizenship requirements of those programs.
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An Act relative to behavioral health clinic rates | S760 | SD2229 | 193 | {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-01-06T19:50:05.723'} | [{'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-01-06T19:50:05.74'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-02T11:55:59.8533333'}, {'Id': 'EDJ0', 'Name': 'Edward J. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/EDJ0', 'ResponseDate': '2023-03-28T15:39:56.29'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-04-04T14:03:17.83'}, {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-04-12T13:55:34.3233333'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-09-15T13:11:47.6133333'}, {'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-10-03T14:06:55.5066667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-10-04T11:17:34.2266667'}, {'Id': 'JJO1', 'Name': "James J. O'Day", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJO1', 'ResponseDate': '2023-10-17T07:42:34.34'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-10-17T11:08:30.1966667'}, {'Id': 'AJS1', 'Name': 'Adam Scanlon', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJS1', 'ResponseDate': '2023-10-17T12:20:29.3666667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-10-17T14:49:13'}, {'Id': 'MMD1', 'Name': 'Michelle M. DuBois', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MMD1', 'ResponseDate': '2023-10-17T15:51:54.8766667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S760/DocumentHistoryActions | Bill | By Mr. Keenan, a petition (accompanied by bill, Senate, No. 760) of John F. Keenan and Michael O. Moore for legislation relative to behavioral health clinic rates. Health Care Financing. | SECTION 1. Chapter 118E of the general laws, as appearing in the 2020 official edition, is hereby amended by inserting after 13D the following section:-
Section 13D ½.
(a) For the purposes of this section, the following words shall have the following meanings:
“Behavioral health clinic”, a clinic licensed by the department of public health pursuant to section 3 and sections 51 through 56 of chapter 111 of the general laws, as appearing in the 2020 official edition, and regulated pursuant to title 130 of the code of Massachusetts regulations 429.000.
“Behavioral health services”, evaluation, diagnosis, treatment, care coordination, management, or peer support of patients with mental health, developmental or substance use disorder.
“Independent practitioner”, an individual who is licensed by the board to practice independent clinical social work and who meets the qualifications set forth in section 131 of chapter 112 of the general laws, as appearing in the 2020 official edition, for an independent clinical social worker and is regulated pursuant to title 130 of the code of Massachusetts regulations 462.000.
“Minimum payment rates”, rates of payment for services below which managed care entities may not enter into provider agreements.
(b) The division shall increase minimum payment rates for behavioral health services by 5% per procedure code for rates of payment effective as of January 1, 2023.
(c) Pursuant to sections 13C and 13D, and notwithstanding applicable state and federal laws, the division shall ensure that each rate of payment or component payment in a bundled rate for behavioral health services delivered in behavioral health clinics are no less than 20% above comparable behavioral health services delivered by independent practitioners.
(d) The division shall review behavioral health service rates biennially. This review shall include, but not be limited to the following: (i) adoption of an inflationary adjustment factor no less than the total Medicare Economic Index percentage for the past two calendar years; (ii) where possible, comparison of the wage estimate for each classification of staff position to the 75th percentile wage estate for that position as determined by the most current United States Bureau of Labor Statistics for the commonwealth; and (iii) consideration of the reasonable cost to providers of any existing or new governmental mandate that has been enacted, promulgated or imposed by any governmental unit or federal governmental authority.
SECTION 2. Said chapter 118E is hereby amended by inserting after section 13K the following new section:-
Section 13L.
(a) For the purposes of this section, the following words shall have the following meanings:
“Behavioral health clinic”, a clinic licensed by the department of public health pursuant to section 3 and sections 51 through 56 of chapter 111 of the general laws, as appearing in the 2020 official edition, and that is regulated pursuant to title 130 of the code of Massachusetts regulations 429.000.
“Behavioral health services”, evaluation, diagnosis, treatment, care coordination, management or peer support of patients with mental health, developmental or substance use disorder.
“Independent practitioner”, an individual who is licensed by the board to practice independent clinical social work and who meets the qualifications set forth in section 131 of chapter 112 of the general laws, as appearing in the 2020 official edition, and who is regulated pursuant to title 130 of the code of Massachusetts regulations 462.000.
“Managed care entity”, all contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan, and accountable care organizations.
“Minimum payment rates”, rates of payment for services below which managed care entities may not enter into provider agreements.
(b) Notwithstanding applicable state and federal laws, the division shall direct its managed care entities to increase minimum payment rates for behavioral health services by 5% per procedure code for rates of payment effective as of January 1, 2023.
(c) The division shall direct managed care entities to ensure that each rate of payment or component payment in a bundled rate for behavioral health services delivered in behavioral health clinics is no less than 20% above comparable behavioral health services delivered by independent practitioners.
(d) The division shall review rates of payment by managed care entities for behavioral health services biennially. This review shall include, but not be limited to the following: (i) adoption of an inflationary adjustment factor no less than the total Medicare Economic Index percentage for the past two calendar years; (ii) where possible, comparison of the wage estimate for each classification of staff position to the 75th percentile wage estate for that position as determined by the most current United States Bureau of Labor Statistics for the commonwealth; and (iii) consideration of the reasonable cost to providers of any existing or new governmental mandate that has been enacted, promulgated or imposed by any governmental unit or federal governmental authority.
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An Act relative to hospital closures and health planning | S761 | SD2355 | 193 | {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-01-19T16:47:07.83'} | [{'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-01-19T16:47:07.83'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S761/DocumentHistoryActions | Bill | By Mr. Keenan, a petition (accompanied by bill, Senate, No. 761) of John F. Keenan for legislation relative to hospital closures and health planning. Health Care Financing. | SECTION 1. Section 16T of chapter 6A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking subsection (a) and inserting in place thereof the following:-
(a) There shall be a health planning council within the executive office of health and human services whose purpose shall be to develop and periodically update a state health plan as described in this section. The council shall consist of the secretary of health and human services, or a designee, who shall serve as chair; the commissioner of public health or a designee; the director of the office of Medicaid or a designee; the commissioner of mental health or a designee; the secretary of elder affairs or a designee; the executive director of the center for health information and analysis or a designee; the executive director of the health policy commission or a designee; 3 members appointed by the governor, 1 of whom shall be a health economist; 1 of whom shall have experience in health policy and planning; and 1 of whom shall have experience in health care market planning and service line analysis.
The council shall assemble an advisory committee of not more than 13 members who shall reflect a broad distribution of diverse perspectives on the health care system, including health care providers and provider organizations, community health centers, academic institutions, health care workforce development expertise, third-party payers, both public and private, consumer representatives and labor organizations representing health care workers. The advisory committee shall review drafts and provide recommendations to the council for the development, and each periodic update, of the plan.
The council chair shall establish processes to ensure public access to the most current version of the state health plan, and to allow interested persons to submit testimony toward the development and updating of the plan, which shall include public hearings in geographically diverse areas, and a website to allow members of the public to submit comments electronically and review comments submitted by others.
The state health plan shall identify needs of the commonwealth in health care services, providers, programs and facilities; the resources available to meet those needs; and the priorities for addressing those needs. To assess and report on such needs, the council shall establish not fewer than fifteen health planning regions to reflect variance in the service needs and resource capacities across the different geographies of the commonwealth. The assessments, findings and recommendations of the council shall be presented according to said planning regions, taking into consideration each region’s chronic disease data, health outcomes data, population characteristics, transportation resources and travel considerations of each region.
SECTION 2. Said section 16T is hereby further amended in subsection (b), by inserting after the words “primary care resources” in lines 54-55 the following:-
; community-based health care resources;
SECTION 3. Said section 16T is hereby further amended in subsection (b), by striking the first sentence of the third paragraph, in lines 63 through 68, and inserting in place thereof the following:-
The plan shall also make recommendations for the appropriate supply and distribution of resources, programs, capacities, technologies and services identified in the second paragraph of this subsection on a statewide and regional basis, based on an assessment of regional needs and resource capacity for the subsequent 5 years and options for implementing such recommendations, to include the identification of shortages and excesses in each region and recommended statutory or regulatory mechanisms to incentivize a rebalancing of said shortage and excess resources.
SECTION 4. Said section 16T is hereby further amended in subsection (c), by inserting after the word “need” in line 83 the following:-
pursuant to section 25C of chapter 111, and for making assessments and determinations on the impact of service discontinuations and closures pursuant to section 51G of chapter 111
SECTION 5. Said section 16T is hereby further amended by inserting at the end thereof the following new subsection:-
(g) The secretary of human services shall work in conjunction with the agencies and organizations having membership on the council, as defined in the first paragraph of subsection (a), to establish agreements and mechanisms for appropriate sharing of data between agencies as required for the council to fulfill its responsibilities, provided that no such agreement or mechanism shall conflict with state and federal laws and rules for medical privacy.
SECTION 6. Section 13 of chapter 6D of the General Laws is hereby amended by inserting at the end thereof the following new subsection:-
(l) Notice from the department of public health of a proposed hospital closure or discontinuation of an essential health service pursuant to section 51G of chapter 111 shall constitute a material change notice by the relevant provider or provider organization, and the commission shall conduct a review of the impact of the material change pursuant to this section; provided, however, that no report shall be referred to the attorney general under subsection (f). The commission shall report the findings of a review conducted pursuant to this subsection, including any preliminary findings, to the commissioner of public health. The executive director of the commission and the commissioner of public health shall enter into a mutual agreement to share documentation provided by the hospital relative to the proposed closure or discontinuation in order to reduce duplicative reporting requirements by the hospital.
SECTION 7. Section 8 of chapter 12C of the General Laws is hereby amended in subsection (c) by striking the last sentence of the second paragraph, in lines 55 through 60, and inserting in place thereof the following:-
The center shall also identify hospitals that the center considers to be in financial distress, including, but not limited to, any hospitals at risk of closing or discontinuing essential health services, as defined by the department of public health under section 51G of chapter 111, and shall report a list of such at-risk hospitals, which shall not be subject to disclosure under chapter 66, to the secretary of health and human services, the commissioner of public health and the executive director of the health policy commission no less frequently than once every 120 days.
SECTION 8. Section 8 of chapter 12C of the General Laws, as so appearing, is hereby further amended in subsection (c) by inserting after the word “subsection.” in line 63 the following:-
Compliance with said reporting requirements shall also be considered a condition of licensure pursuant to section 51 of chapter 111.
SECTION 9. Section 11 of chapter 12C of the General Laws, as so appearing, is hereby amended by striking the section in its entirety and inserting in place thereof the following:-
Section 11. The center shall ensure the timely reporting of information required under sections 8, 9 and 10. The center shall notify public and private healthcare payers, including third-party administrators, providers and provider organizations of any applicable reporting deadlines and shall promulgate regulations to establish administrative sanctions against private health care payers, third-party administrators, providers and provider organizations, including, but not limited to, administrative fines, for any violations of sections 8, 9 and 10. Amounts collected under this section shall be deposited in the healthcare payment reform fund, established under section 100 of chapter 194 of the acts of 2011.
The center or its designated representative may petition the superior court seeking injunctive relief to enforce the provisions of sections 8, 9 and 10. If the superior court upon summary hearing determines that an entity subject to the requirements of this chapter has, without justifiable cause, refused to furnish information required by sections 8, 9 and 10 or any regulation promulgated by the center thereunder, it shall issue an order directing the payer, third-party administrator, provider or provider organization to furnish the information within 5 business days; provided, that any failure to obey any such order may be penalized by the court as contempt thereof.
The center may refer delinquent entities to the executive office of health and human services and the department of public health, with recommendations that the executive office of health and human services or the department of public health impose any penalty authorized under chapters 111 and 118E of the General Laws or other applicable regulations.
SECTION 10. Section 51 of chapter 111 is hereby amended by inserting after the second paragraph the following new paragraph:-
Each hospital licensee shall comply with the uniform reporting requirements to the center for health information and analysis as established pursuant to chapter 12C.
SECTION 11. Section 51G of chapter 111 is hereby amended by inserting after the word “laws” in line 9 the following:-
and a demonstrated plan for financial sustainability
SECTION 12. Section 51G of said chapter 111, as so appearing, is hereby further amended by striking subsection (4) and inserting in place thereof the following subsection:-
(4) (a) Any hospital shall give notice to the department 90 days prior to the discontinuance of any essential health service provided therein. The department shall by regulation define “essential health service” for the purposes of this section and may establish distinct definitions for each health planning region as defined pursuant to section 16T of chapter 6A. The hospital proposing the discontinuance shall provide, with initial notice to the department, (i) evidence of having given notice to municipal officials from each municipality to which it provides the service as a health care resource as determined pursuant to section 16T of chapter 6A of the General Laws and of having allowed reasonable opportunity for comment by a stated deadline; and (ii) evidence of a plan to give public notice, including a plan allowing for a reasonable opportunity for public comment, within 10 days of submission of initial notice to the department. Any information given without meeting the requirements of this paragraph shall not constitute notice to the department for the purpose of establishing the earliest date on which the hospital discontinued the essential health service. The department shall forward any notice received under this section to the secretary of labor and workforce development and to the health policy commission.
(b) Any hospital shall give notice to the department 120 days prior the closure of the hospital. The hospital undergoing the closure shall provide, with initial notice to the department: (i) evidence of having given notice to municipal officials from each municipality to which it provides the service as a health care resource, as determined pursuant to section 16T of chapter 6A of the General Laws, and of having allowed reasonable opportunity for comment; (ii) notice to primary service area stakeholders including, but not limited to: (a) the hospital’s patient and family council; (b) all staff members of the hospital; (c) any labor organization that is currently representing any members of the hospital’s workforce; and (d) any members of the General Court who represent the city or town in the hospital’s primary service area; and (iii) evidence of a plan to give public notice, including a plan allowing for a reasonable opportunity for comment from the public and primary service area stakeholders pursuant to (ii) within 10 days of submission of their initial notice to the department. Any information given without meeting the requirements of this paragraph shall not constitute notice to the department for the purpose of establishing the earliest date on which the hospital may close. The department shall forward any notice received under this section to the secretary of labor and workforce development and to the health policy commission.
(c) The department shall, in the event that a hospital intends to close or proposes to discontinue an essential health service or services, determine whether any closed or discontinued services are necessary for preserving access and health status in the hospital’s service area, require hospitals to submit a plan for ensuring access to such necessary services following the hospital’s closure or discontinuation of the service and ensure continuing access to such services in the event that the department determines that closure will significantly reduce access to necessary services. If the hospital’s plan for ensuring continued access to a necessary service relies upon the availability of similar services at another hospital or health facility with which it does not share common ownership, the department shall require the hospital to submit with said plan a statement from each other hospital or health facility listed in the plan affirming capacity to provide continued access as described in the plan. The department shall conduct a public hearing prior to a determination on the closure of said essential services or of the hospital.
(d) The department, in conducting any assessment and prior to making any determination pursuant to paragraph (c), shall refer to the state health plan and regional considerations established pursuant to section 16T of chapter 6A, and shall also request and consider information presented by the health policy commission pursuant to section 13 of chapter 6D.
(e) If a hospital closes or discontinues an essential health service without a plan approved by the department pursuant to paragraphs (a) and (b) of this section, that hospital shall not be eligible to have an application approved pursuant to section 25C of chapter 111 for a period of two years from the date the service is discontinued, until the essential health service is restored or until such time as the department is satisfied that a plan is in place that, at the time of the discontinuance, would have met the requirements of paragraph (b). If the closed hospital or the hospital discontinuing the essential health service is part of a network of hospitals under common ownership, the same restrictions shall apply against each hospital owned, managed or controlled by the hospital network. The commissioner may waive a restriction established pursuant to this subsection if the application of such restriction causes an imminent hazard to the public health.
(f) If a hospital executes a plan to close or to discontinue an essential health service, said plan not having been approved by the department pursuant to paragraphs (a) and (b) of this section, that hospital shall not be eligible to receive funding under sections 2PPP or 2GGGG of chapter 29, or under section 2G of Chapter 111, for a period of two years from the date the service is discontinued, until the essential health service is restored or until such time as the department is satisfied that a plan is in place that, at the time of the discontinuance, would have met the requirements of paragraph (b). If the closed hospital or the hospital discontinuing the essential health service is part of a network of hospitals under common ownership, the same restrictions shall apply against each hospital owned, managed or controlled by the hospital network. The commissioner may waive a restriction established pursuant to this subsection if the application of such restriction causes an imminent hazard to the public health.
(g) No original license shall be granted to establish or maintain an acute-care hospital, as defined by section 25B of chapter 111, unless the applicant submits a plan, to be approved by the department, for the provision of community benefits, including the identification and provision of essential health services. In approving the plan, the department may take into account the applicant’s existing commitment to primary and preventive health care services and community contributions as well as the primary and preventive health care services and community contributions of the predecessor hospital. The department may waive this requirement, in whole or in part, at the request of the applicant.
SECTION 13. Section 51G of said chapter 111 is hereby amended by inserting after subsection (6) the following subsection:-
(7) A demonstrated plan for financial sustainability shall include:
(a) a needs assessment that identifies the current state of contracting, current and projected resources for coordination and delivery of care, areas for additional education and assessments of technology and analytic resources;
(b) an implementation plan listing activities aimed at supporting and improving the delivery of health care services delivered by the licensee, including any clinical affiliations as defined in section 1 of chapter 12C of the General Laws, and how well those activities are supported by their current resources;
(c) a financial plan that includes an evidence-based budget, contains proof of sources of revenue to cover expenses and is based on a hospital’s past financial performance, or in the case of a new hospital, comparable to a hospital of similar size, providing same or similar services, in a similar geographic type, and with a similar anticipated case mix based on epidemiological surveillance data; and
(d) any other documentation that the department sees fit to evaluate the sustainability of essential health services at said hospital.
SECTION 14. Section 56 of chapter 111 is hereby amended by inserting after the second sentence the following new sentence:-
Whoever, being licensed under section 51, discontinues an essential health service or closes a hospital under said license and in violation of section 51G shall, for a first offense, be punished by a fine of not more than $150,000 and for a subsequent offense by a fine of not more than $300,000 or by imprisonment for not more than two years or both. Any licensee under section 51 that closes a hospital under said license and in violation of section 51G shall be punished by a fine of not more than $500,000, by imprisonment for not more than two years or both; provided, that if a closed hospital is part of a network of hospitals under common ownership the penalties herein described shall be levied against the authority, entity or corporation having control of the hospital network.
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An Act to protect MassHealth applicants facing undue hardship | S762 | SD658 | 193 | {'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-01-17T16:19:44.407'} | [{'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-01-17T16:19:44.4066667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S762/DocumentHistoryActions | Bill | By Ms. Kennedy, a petition (accompanied by bill, Senate, No. 762) of Robyn K. Kennedy for legislation to establish criteria for Masshealth hardship waivers. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after section 28 the following section:—
Section 28A.
(a) A nursing facility resident may claim undue hardship in order to eliminate the period of ineligibility. In accordance with P.L. 109-171 amending Section 1917(c)(2)(D) of the Social Security Act, the division shall establish procedures for determining whether undue hardship exists as a result of the imposition of a period of ineligibility, which shall include written notice to said individual that an undue hardship exception exists, a timely process for determining whether an undue hardship waiver shall be granted and an opportunity to appeal an adverse determination. An individual may request an undue hardship waiver within 90 days after the date of the final decision to impose a period of ineligibility, including judicial appeals.
(b) There shall be a rebuttable presumption that an institutionalized individual is eligible for an undue hardship waiver if the individual provides documentation that all of the following criteria are met:
1) the individual has insufficient available resources, excluding the community spouse resource allowance, to provide medical care, food, shelter, clothing and other necessities of life such that the individual would be at risk of serious deprivation or harm;
2) the individual has made reasonable attempts to retrieve the transferred resources or receives adequate compensation;
3) there is no available less costly alternative to institutional care that would meet the individual's care needs; and
4) the period of ineligibility will not be a mere inconvenience to the applicant but rather will create a situation that would subject the applicant to risk of serious deprivation.
(c) A nursing facility need not express an intent to discharge the individual for nonpayment in order for a hardship waiver to be granted.
(d) The division shall promulgate regulations incorporating these criteria for consideration of an undue hardship waiver request.
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An Act to promote an enhanced care worker minimum wage | S763 | SD1285 | 193 | {'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-01-19T13:16:27.95'} | [{'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-01-19T13:16:27.95'}, {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-25T15:52:07.4766667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-26T11:30:08.29'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-01-26T13:42:35.2333333'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-01-27T16:12:08.3633333'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-01-27T16:12:08.3633333'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-01-27T16:12:08.3633333'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-02T09:55:02.3066667'}, {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-02-06T13:11:29.4133333'}, {'Id': 'JKH1', 'Name': 'James K. Hawkins', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JKH1', 'ResponseDate': '2023-02-08T16:38:46.0533333'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-02-08T16:38:46.0533333'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-02-10T14:24:52.8366667'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-13T16:13:05.27'}, {'Id': 'RAM1', 'Name': 'Rita A. Mendes', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RAM1', 'ResponseDate': '2023-04-11T12:17:52.9966667'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-05-12T09:21:46.9566667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-05-19T14:57:48.0866667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S763/DocumentHistoryActions | Bill | By Ms. Kennedy, a petition (accompanied by bill, Senate, No. 763) of Robyn K. Kennedy, John J. Cronin, Jack Patrick Lewis, Rebecca L. Rausch and other members of the General Court for legislation to promote an enhanced care worker minimum wage. Health Care Financing. | SECTION 1. Section 13C of Chapter 118E of the general laws is amended after the second paragraph by inserting the following new paragraphs:
In establishing such rates of payment pursuant to the second paragraph of this section and in implementing rate regulations, the secretary of the executive office shall require that the minimum wage paid to employees of social service program providers receiving such payments shall be no less than 140 percent of the statewide minimum wage. When establishing rates of payment for social service programs, the secretary of the executive office shall adjust such rates of payment to ensure that the rates fully account for the cost to providers of paying such enhanced minimum wage.
Prior to establishing such rates of payment pursuant to the second paragraph of this section and prior to the issuance of proposed regulations, the secretary of the executive office shall hold hearings that are open to the public. Such public hearings shall solicit input from social service program providers, social service program workers, labor organizations representing social service program workers, and other community stakeholders. Concurrent with such public hearings and prior to establishing such rates of payment, the executive office shall investigate and analyze the wage rates and working conditions for employees of social service program providers. In conducting such public hearings and investigations, the executive office may issue subpoenas to compel the attendance of witnesses and the production of books, papers, and records.
SECTION 2. Section 4 of Chapter 19A is hereby amended by adding after Section 4D the following new section:
SECTION 4E: In establishing rates of payment for homemaker and personal care homemaker services pursuant to the second paragraph of section 13C of chapter 118E of the M.G.L. and in implementing rate regulations, the executive office shall require by that the minimum wage paid to employees of home care agencies providing such services shall be no less than 140 percent of the statewide minimum wage. When establishing rates of payment for homemaker and personal care homemaker services pursuant, the executive office shall adjust such rates to ensure that the rates fully account for the cost to providers of paying such enhanced minimum wage. Nothing in this section shall be construed as limiting consideration of other governmental mandates or operating costs that affect the cost of providing services pursuant to section 4 of chapter 19A of the General Laws.
Prior to establishing such rates of payment and prior to the issuance of proposed regulations, the executive office shall hold hearings that are open to the public. Such public hearings shall solicit input from homemaker and personal care homemaker service providers, homemakers, personal care homemakers, labor organizations representing such workers, and other community stakeholders. Concurrent with such public hearings and prior to establishing such rates of payment, the executive office shall investigate and analyze the wage rates and working conditions for homemakers and personal care homemakers. In conducting such public hearings and investigations, the executive office may issue subpoenas to compel the attendance of witnesses and the production of books, papers, and records.
SECTION 3. Section 13D of Chapter 118E of the general laws is amended after the second paragraph by inserting the following new paragraphs:
In establishing such rates for nursing homes and rest homes and in implementing rate regulations, the executive office shall require that the minimum wage paid to employees of nursing homes and rest homes receiving such payments shall be no less than 140 percent of the statewide minimum wage. When establishing rates of payment for nursing homes and rest homes, the executive office shall adjust such rates to ensure that the rates fully account for the cost to providers of paying such enhanced minimum wage.
Prior to establishing such rates for nursing homes and rest homes and prior to the issuance of proposed regulations, the executive office shall hold hearings that are open to the public. Such public hearings shall solicit input from nursing home and rest home operators, nursing home and rest home workers, labor organizations representing nursing home and rest home workers, and other community stakeholders. Concurrent with such public hearings and prior to establishing such rates of payment, the executive office shall investigate and analyze the wage rates and working conditions for employees of nursing homes and rest homes. In conducting such public hearings and investigations, the executive office may issue subpoenas to compel the attendance of witnesses and the production of books, papers, and records.
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An Act to establish the family caregiver tax credit | S764 | SD936 | 193 | {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-11T13:36:51.093'} | [{'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-11T13:36:51.0933333'}, {'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-02-06T09:54:25.99'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-02-06T09:54:25.99'}, {'Id': 'AJP1', 'Name': 'Angelo J. Puppolo, Jr.', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJP1', 'ResponseDate': '2023-02-06T09:54:25.99'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-02-07T10:23:37.4333333'}, {'Id': 'BMA1', 'Name': 'Brian M. Ashe', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BMA1', 'ResponseDate': '2023-02-13T09:58:23.58'}, {'Id': 'SSH1', 'Name': 'Steven S. Howitt', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SSH1', 'ResponseDate': '2023-02-13T14:23:38.2266667'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-14T14:16:24.8933333'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-02-15T10:15:01.3866667'}, {'Id': 'AMG0', 'Name': 'Anne M. Gobi', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AMG0', 'ResponseDate': '2023-02-21T16:36:10.7366667'}, {'Id': 'PMP0', 'Name': 'Pavel M. Payano', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMP0', 'ResponseDate': '2023-02-23T10:44:16.73'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-03-13T16:05:59.76'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-03-13T16:05:59.76'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-03-13T16:05:59.76'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-03-14T09:48:53.1466667'}, {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-03-20T13:34:53.0733333'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-03-27T16:38:02.3733333'}, {'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-04-10T14:43:44.5'}, {'Id': 'EDJ0', 'Name': 'Edward J. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/EDJ0', 'ResponseDate': '2023-05-03T11:09:37.8466667'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-06-07T11:32:19.3633333'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-06-07T11:32:19.3633333'}, {'Id': 'D_R1', 'Name': 'David Allen Robertson', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/D_R1', 'ResponseDate': '2023-06-07T11:32:19.3633333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S764/DocumentHistoryActions | Bill | By Mr. Lewis, a petition (accompanied by bill, Senate, No. 764) of Jason M. Lewis, Mark C. Montigny, Jack Patrick Lewis, Angelo J. Puppolo, Jr. and other members of the General Court for legislation to establish the family caregiver tax credit. Health Care Financing. | SECTION 1. Section 6 of Chapter 62 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after subsection (t) the following new subsection:-
(u)(1) As used in this subsection, the following words shall have the following meanings unless the context clearly requires otherwise:
"Activities of daily living", everyday functions and activities, which individuals usually do without help, including, but not limited to, bathing, continence, dressing, eating, toileting and transferring.
"Eligible family member", an individual who (1) is at least 18 years of age during a taxable year, (2) requires assistance with at least one activity of daily living and (3) qualifies as a dependent, spouse, parent or other relation by blood or marriage, including an in-law, grandparent, grandchild, step-parent, aunt, uncle, niece or nephew of the family caregiver.
“Evaluation year”, the year in which an evaluation of the tax credit is to be complete. The evaluation year shall be every 5 years after the effective date of this subsection.
"Family caregiver", an individual who is a resident taxpayer for the taxable year and had eligible expenditures, as described in paragraph (3) of this subsection, with respect to 1 or more eligible family members during the taxable year. In the case of a joint return, the term includes the individual and the individual's spouse. The family caregiver claiming the credit must have a Massachusetts adjusted gross income of less than $75,000 for an individual and $150,000 for a couple and incur uncompensated expenses directly related to the care of an eligible family member.
(2) A taxpayer who is a family caregiver is eligible to receive for a taxable year is equal to a refundable credit against the taxes imposed by this chapter. The credit shall be equal to 100 per cent of the eligible expenditures incurred by the taxpayer during the taxable year, with a maximum allowable credit of $1,500.
(3) Expenditures eligible to be claimed for the tax credit include the costs associated with:
(i) the improvement or alteration to the family caregiver's primary residence to permit the eligible family member to remain mobile, safe, and independent;
(ii) the purchase or lease of equipment that is necessary to assist an eligible family member in carrying out one or more activities of daily living; and
(iii) other goods, services or supports that assist the family caregiver in providing care to an eligible family member, such as expenditures related to hiring a home care aide or personal care attendant, respite care, adult day health, transportation, legal and financial services and assistive technology.
(4) No taxpayer shall be entitled to claim a tax credit under this subsection for the same eligible expenditures claimed by another taxpayer. The total amount of tax credits claimed by family caregivers shall not exceed $1,500 for the same eligible family member. If two or more family caregivers claim tax credits for the same eligible family member, the total of which exceeds $1,500, the total amount of the credit allowed shall be allocated in amounts proportionate to each eligible taxpayer’s share of the total amount of the eligible expenditures for the eligible family member.
(5) A taxpayer may not claim a tax credit under this section for expenses incurred in carrying out general household maintenance activities, including painting, plumbing, electrical repairs or exterior maintenance, and such expenses must be directly related to assisting the family caregiver in providing care to an eligible family member.
(6) The commissioner of the department of revenue shall promulgate rules and regulations relative to the administration and enforcement of this subsection.
(7) The commissioner shall annually, not later than September 1, file a report with the house and senate committees on ways and means, the chairs of the joint committee on revenue and the chairs of the joint committee on elder affairs identifying, by community, the total amount of tax credits claimed and the total number of tax filers who received the tax credit for the preceding fiscal year.
(8) On or before May 31 of the year before the evaluation year, there shall be established a committee entitled the Caregiver Tax Credit Evaluation Committee to conduct a review of the tax credit.
The committee shall be comprised of 7 members: 2 of whom shall be appointed by the secretary of the executive office of health and human services; 2 of whom shall be appointed by the secretary of the executive office of elder affairs; 1 of whom shall be appointed by the secretary of the executive office for administration and finance; 1 of whom shall be appointed by the president of the senate; and 1 of whom shall be appointed by the speaker of the house of representatives.
The committee shall: (1) examine the purpose for which the tax credit was established; (2) determine whether the original intent of the tax credit is still appropriate; (3) examine whether the tax credit is meeting its objectives; (4) examine whether the purposes of the tax credit could be more efficiently and effectively carried out through alternative methods; and (5) calculate the costs of providing the tax credit, including the administrative cost and lost revenues to the commonwealth.
The committee shall file a report of its findings with the senate and house clerks and with the governor, which shall include a recommendation as to whether the tax credit should be continued, with or without changes, or be terminated. The report shall be accompanied by any legislation that is needed to accomplish the recommendations of the report. The report shall be filed no later than December 31 of the evaluation year.
SECTION 2. This act shall apply to taxable years beginning on or after January 1 next following the date of enactment.
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An Act to promote graduate medical education | S765 | SD947 | 193 | {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-11T14:47:51.777'} | [{'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-11T14:47:51.7766667'}, {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-30T11:16:48.33'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-30T13:32:27.2466667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-31T12:18:35.7133333'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-02-02T12:05:16.8533333'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-02T14:28:50.8966667'}, {'Id': 'JKH1', 'Name': 'James K. Hawkins', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JKH1', 'ResponseDate': '2023-02-08T12:36:58.7066667'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-02-10T11:06:38.0166667'}, {'Id': 'PMP0', 'Name': 'Pavel M. Payano', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMP0', 'ResponseDate': '2023-02-15T16:02:28.92'}, {'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-02-21T09:34:54.9266667'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-02-28T11:12:17.6466667'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-05-03T11:09:14.9533333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S765/DocumentHistoryActions | Bill | By Mr. Lewis, a petition (accompanied by bill, Senate, No. 765) of Jason M. Lewis, John J. Cronin, Joanne M. Comerford, Jack Patrick Lewis and other members of the General Court for legislation to require MassHealth to make Graduate Medical Education payments. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws is amended by adding at the end thereof, the following new section:
Section 78. MassHealth shall make Graduate Medical Education payments for primary care, behavioral health, and other physician shortage professions residency training. Eligible recipients shall include community health centers and hospitals licensed in the Commonwealth.
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An Act establishing a public health option | S766 | SD958 | 193 | {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-11T14:52:27.383'} | [{'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-11T14:52:27.3833333'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-01-23T12:13:03.07'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S766/DocumentHistoryActions | Bill | By Mr. Lewis, a petition (accompanied by bill, Senate, No. 766) of Jason M. Lewis and Rebecca L. Rausch for legislation to establish a public health option. Health Care Financing. | SECTION 1. The General Laws are hereby amended by inserting after chapter 176Q the following new chapter:-
CHAPTER 176S. PUBLIC HEALTH INSURANCE OPTION
Section 1. As used in this chapter, the following words shall, unless the context clearly requires otherwise, have the following meanings:—
“Commonwealth Connector Board”, the board of the commonwealth health insurance connector, established by subsection (b) of section 2 of chapter 176Q.
“Commonwealth Connector”, the commonwealth health insurance connector authority, established by subsection
(a) of section 2 of chapter 176Q.
“Connector seal of approval”, the approval given by the board of the connector to indicate that a health benefit plan meets certain standards regarding quality and value, as established by section 10 of Chapter 176Q.
“Carrier”, an insurer licensed or otherwise authorized to transact accident and health insurance under chapter 175; a nonprofit hospital service corporation organized under chapter 176A; a nonprofit medical service corporation organized under chapter 176B; a health maintenance organization organized under chapter 176G.
“Health benefit plan”, any individual, general, blanket or group policy of health, accident and sickness insurance issued by an insurer licensed under chapter 175; a group hospital service plan issued by a non-profit hospital service corporation under chapter 176A; a group medical service plan issued by a non-profit medical service corporation under chapter 176B; a group health maintenance contract issued by a health maintenance organization under chapter 176G; a coverage for young adults health insurance plan under section 10 of chapter 176J. The words “health benefit plan” shall not include accident only, credit-only, limited scope vision or dental benefits if offered separately, hospital indemnity insurance policies if offered as independent, non-coordinated benefits which for the purposes of this chapter shall mean policies issued under chapter 175 which provide a benefit not to exceed $500 per day, as adjusted on an annual basis by the amount of increase in the average weekly wages in the commonwealth as defined in section 1 of chapter 152, to be paid to an insured or a dependent, including the spouse of an insured, on the basis of a hospitalization of the insured or a dependent, disability income insurance, coverage issued as a supplement to liability insurance, specified disease insurance that is purchased as a supplement and not as a substitute for a health plan and meets any requirements the commissioner by regulation may set, insurance arising out of a workers’ compensation law or similar law, automobile medical payment insurance, insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in a liability insurance policy or equivalent self-insurance, long-term care if offered separately, coverage supplemental to the coverage provided under 10 U.S.C. section 55 if offered as a separate insurance policy, or any policy subject to chapter 176K or any similar policies issued on a group basis, Medicare Advantage plans or Medicare Prescription drug plans. A health plan issued, renewed or delivered within or without the commonwealth to an individual who is enrolled in a qualifying student health insurance program under section 18 of chapter 15A shall not be considered a health plan for the purposes of this chapter and shall be governed by said chapter 15A. The commissioner of insurance may by regulation define other health coverage as a health benefit plan for the purposes of this chapter.
“Eligible individuals”, an individual who is a resident of the commonwealth; provided however, that the individual is not offered subsidized health insurance by an employer with more than 50 employees.
“Eligible small groups”, groups, any sole proprietorship, labor union, educational, professional, civic, trade, church, not-for-profit or social organization or firms, corporations, partnerships or associations actively engaged in business that on at least 50 per cent of its working days during the preceding year employed at least one but not more than 50 employees.
“Eligible large groups”, groups, any labor union, educational, professional, civic, trade, church, not-for-profit or social organization or firms, corporations, partnerships or associations actively engaged in business that on at least 50 per cent of its working days during the preceding year employed at least 51 employees.
"Public Option", the public health benefits plan offered through the Commonwealth Connector, established by section 2.
"Trust Fund", the Public Health Insurance Trust Fund, established by section 7.
Section 2. The Commonwealth Connector Authority shall provide for the offering a public health benefits plan - the public health insurance option - to eligible individuals and groups, to ensure choice, competition, and stability of affordable, high quality coverage throughout Massachusetts. The public option shall:-
(a) be made available exclusively through the Commonwealth Connector, alongside health benefit plans receiving the Connector seal of approval;
(b) meet all the requirements established for health benefit plans to receive the Commonwealth Connector seal of approval;
(c) meet the Connector's standards for minimum creditable coverage; and
(d) comply with subsections (b), (c), and (d) of section 5 of chapter 176Q.
Section 3. The public option shall be made available to eligible individuals and eligible small groups through the Connector no later than January 1, 2025. In addition the public option shall be made available to eligible large groups no later than July 1, 2025.
Section 4. The executive director of the commonwealth connector may contract with managed care organizations or other such health benefits administrators to administer aspects of plans offered under the public health insurance option. Notwithstanding any general or special law to the contrary, the executive director shall collaborate with the secretary of health and human services and the commissioner of insurance to ensure that only Medicaid managed care organizations, that have contracted with the commonwealth as of January 1, 2024, to deliver such managed care services, are so contracted with to administer aspects of the public option. The executive director may accept applications from non-Medicaid managed care organizations for the provision of such services after January 1, 2025.
Section 5. A report on the activities, receipts, expenditures, and enrollments of the public option shall be included in the Commonwealth Connector's annual reports and shall be subject to the prescription and oversight of the Commonwealth Connector Board and state auditor as per section 14 and section 15 of chapter 176Q.
Section 6. The Commonwealth Connector shall establish premium rates for the public health insurance option at a level sufficient to fully finance the costs of:-
(a) health benefits provided by the public option; and
(b) administrative costs related to operating the public option.
Section 7. The Connector Board shall establish payment rates for the Public Health Insurance Option for services and providers based on parts A and B of Medicare. The Commonwealth Connector Board may determine the extent to which adjustments to base Medicare payment rates shall be made in order to fairly reimburse providers and medical goods and device makers, as well as to maintain a a strong provider network.
Section 8. Health care providers (including physicians and hospitals) participating in Medicare are participating providers in the public option unless they opt out through a process to be established by the Commonwealth Connector. This opt-out process must ensure that:
(a) no provider shall be subject to a penalty for not participating in the public health insurance option;
(b) the connector shall include information on how providers participating in Medicare who chose to opt out of participating in the public health insurance option may opt back in; and
(c) there shall be an annual enrollment period in which providers may decide whether to participate in the public health insurance option.
Section 9. The Commonwealth Connector may adopt regulations to implement this chapter.
SECTION 2. Chapter 26 of the General Laws is hereby amended by inserting after section 8J the following new section:-
Section 8K. (a) The commissioner of insurance is hereby authorized to make an assessment against all health plans, health insurers, and health maintenance organizations in the Commonwealth, as well as the public health insurance option established by section 2 of chapter 176R of the General Laws (which shall be referred to herein as "risk-adjusted health plans") , if the actuarial risk of the enrollees of such plans or coverage for a year is less than the average actuarial risk of all enrollees in all risk-adjusted health plans for such year. Self-insured group health plans (which are subject to the provisions of the Employee Retirement Income Security Act of 1974), shall be exempted from such risk adjustment.
(b) Using the criteria and methods developed under subsection (c), the commissioner of insurance shall provide a payment to risk-adjusted health plans (with respect to health insurance coverage) if the actuarial risk of the enrollees of such plans or coverage for a year is greater than the average actuarial risk of all enrollees in all risk-adjusted health plans for such year that are not self-insured group health plans (which are subject to the provisions of the Employee Retirement Income Security Act of 1974).
(c) The commissioner shall establish criteria and methods to be used in carrying out the risk adjustment activities under this section. In calculating the actuarial risk of risk-adjusted health plans, the commissioner may utilize data including but not limited to enrollee demographics, inpatient and outpatient diagnoses (in similar fashion as such data are used under parts C and D of title XVIII of the Social Security Act), and such other information as the commissioner determines may be necessary such as the actual medical costs of enrollees during the previous year. Upon request, such risk-adjusted health plans shall make information available to the division of insurance for the purposes of risk adjustment under this section. Such information shall be limited to the minimum amount of personal information necessary, shall be confidential, and shall not constitute a public record.
(d) Section 123 of chapter 58 of the Session Laws of 2006 is hereby amended by striking out the last two sentences of the section, beginning with “The director shall collaborate with the secretary…”
SECTION 3. Chapter 29 of the General Laws is hereby amended by inserting after section 2XXX the following new section:-
Section 2FFFF. There is hereby established and set up on the books of the commonwealth a separate fund to be known as the Public Health Insurance Option Trust Fund, in this section called the trust fund. Amounts credited to the trust fund shall be expended without further appropriation for operation of the public health insurance option. Not later than January 1, the comptroller shall report an update of revenues for the current fiscal year. The comptroller shall file this report with the secretary of administration and finance, the office of Medicaid, the joint committee on health care financing, and the house and senate committees on ways and means.
SECTION 4. Subsection (a) of section 5 of Chapter 176Q of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting, after the words "underwritten by a carrier," the following words:- , as well as the public health insurance option,
SECTION 5. Section 1 of Chapter 176Q of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting, after the definition of "Eligible Small Groups", the following definition:-
"Eligible large groups", groups, any labor union, educational, professional, civic, trade, church, not-for-profit or social organization or firms, corporations, partnerships or associations actively engaged in business that on at least 50 per cent of its working days during the preceding year employed at least 51 employees.’
SECTION 6. Section 4(a) of Chapter 176Q of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting prior to the words “groups as defined,” the following words:- eligible small and large
SECTION 7. Section 4(b) of Chapter 176Q of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking out the phrase “or small group” and inserting in its place the following words:- , small group, or large group
SECTION 8. Effective no later than July 1, 2024, the board of the Commonwealth Connector shall, consistent with the Board’s powers and duties as enumerated in section 3 of chapter 176J, extend its seal of approval to large group plans and offer such plans, alongside a public health insurance option for large groups, through the Connector.
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An Act to define modest meals and refreshments in prescriber education settings | S767 | SD964 | 193 | {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-11T15:05:07.41'} | [{'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-11T15:05:07.41'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S767/DocumentHistoryActions | Bill | By Mr. Lewis, a petition (accompanied by bill, Senate, No. 767) of Jason M. Lewis for legislation to define modest meals and refreshments in prescriber education settings. Health Care Financing. | SECTION 1. Section 1 of Chapter 111N of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting before the definition of “Person” the following definition:-
“Modest Meals and Refreshments,” food and/or drinks provided by or paid for by a pharmaceutical or medical device manufacturing company or agent to a health care practitioner, the cost of which does not exceed the allowance defined by the United States General Services Administration for the Massachusetts per diem localities. The allowable amounts for modest meals and refreshments shall be updated on an annual basis in accordance with the United States General Services Administration meal allowance rates.
SECTION 2. Section 2 of Chapter 111N of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking out, in line 84, the words “; provided that the department shall define modest meals and refreshments through regulation”.
Section 3. The sixth paragraph of section 2 of Chapter 111N of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting, in line 84, after the words “in section 2A.”, the following sentences:-
For the purposes of this section, presentations that occur in a manner conducive to informational communication shall prohibit the provision of and pharmaceutical or medical device manufacturing company payment for any form of alcoholic beverage. Meals and refreshments shall be provided within the context of the informational presentation, and shall not occur prior to or following the educational presentation. Presentations shall not occur in locations that are otherwise recreational in nature, including, but not limited to, resorts, sporting clubs, casinos or other vacation destinations.
SECTION 3. Section 2A of Chapter 111N of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting, after clause (3), the following items:
(4) total amount spent on meals for such presentation;
(5) total amount spent on the venue for such presentation;
(6) a description of the content of such presentation;
(7) total number of prescriber attendees at such presentation;
(8) names of attendees present at such presentation;
(9) names and credentials of presenters at such presentation; and
(10) total amount spent on other items of economic value provided at such presentation.
SECTION 4. Subsection (1) of section 6 of Chapter 111N of the General Laws, as appearing in the 2016 Official Edition, is hereby amended by adding the following sentence:-
The department of public health shall collect receipts for all required reporting expenditures pursuant to this section and section 2A of this chapter.
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An Act providing Medicaid coverage for tobacco cessation programs | S768 | SD971 | 193 | {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-11T15:08:50.587'} | [{'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-11T15:08:50.5866667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-26T09:58:35.55'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-30T11:16:42.4333333'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-02T12:05:03.1566667'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-02-03T09:25:42.5966667'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-02-10T11:07:26.1733333'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-03-03T08:58:37.5833333'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-03-06T08:53:40.9166667'}, {'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-03-06T08:53:40.9166667'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-08-03T15:11:07.6533333'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-08-03T15:11:07.6533333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S768/DocumentHistoryActions | Bill | By Mr. Lewis, a petition (accompanied by bill, Senate, No. 768) of Jason M. Lewis, Joanne M. Comerford, Jack Patrick Lewis, Michael O. Moore and other members of the General Court for legislation to provide Medicaid coverage for tobacco cessation. Health Care Financing. | Chapter 118E of the General Laws is hereby amended by inserting at the end of section 10M the following:-
“provided further that “tobacco use cessation counseling” shall include individual, group and phone counseling by a physician, dentist, behavioral health counselor, mental health counselor, certified tobacco use cessation counselor, or other qualified clinician."
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An Act to update Medicaid resource limits for seniors | S769 | SD974 | 193 | {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-17T16:42:44.83'} | [{'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-17T16:42:44.83'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-02-02T14:28:44.22'}, {'Id': 'S_G2', 'Name': 'Steven Ultrino', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/S_G2', 'ResponseDate': '2023-02-03T09:26:48.3866667'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-06T12:51:20.86'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S769/DocumentHistoryActions | Bill | By Mr. Lewis, a petition (accompanied by bill, Senate, No. 769) of Jason M. Lewis, Sal N. DiDomenico and Steven Ultrino for legislation to update Medicaid resource limits for seniors. Health Care Financing. | SECTION 1. Section 25 of chapter 118E of the General Laws is hereby amended by striking out subsection (1) in its entirety and replacing it with the following new subsection:-
(1) Monthly income in an amount not exceeding the level equivalent of 138% of the federal poverty level, as updated annually;
SECTION 2. Section 25 of chapter 118E of the General Laws is hereby amended by inserting after subsection (5) the following:
(6) the cash surrender value of any life insurance owned by the applicant or member or his or her spouse without regard to the face value of the policy or policies;
(7) resources in the amount of $10,000 per individual and $20,000 per couple.
The division shall submit a state plan amendment to implement this section no later than 30 days after the effective date of this section and subsequently promulgate all regulations necessary to implement said income and resource exemptions.
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An Act relative to a loan repayment program for human services workers | S77 | SD512 | 193 | {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-11T14:51:40.833'} | [{'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-11T14:51:40.8333333'}, {'Id': 'HEK1', 'Name': 'Hannah Kane', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/HEK1', 'ResponseDate': '2023-01-25T15:05:44.9266667'}, {'Id': 'AJP1', 'Name': 'Angelo J. Puppolo, Jr.', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJP1', 'ResponseDate': '2023-01-27T13:51:19.4733333'}, {'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-01-27T13:52:01.3466667'}, {'Id': 'MJM2', 'Name': 'Mathew J. Muratore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJM2', 'ResponseDate': '2023-01-27T13:50:53.3766667'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-01-27T13:49:19.8133333'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-01-27T13:46:44.0333333'}, {'Id': 'BWM1', 'Name': 'Brian W. Murray', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BWM1', 'ResponseDate': '2023-01-27T13:46:27.0933333'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-31T12:27:21.84'}, {'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-02-01T12:50:10.5133333'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-02-02T12:18:50.2233333'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-02-07T11:39:38.8733333'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-07T11:38:03.8533333'}, {'Id': 'AMG0', 'Name': 'Anne M. Gobi', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AMG0', 'ResponseDate': '2023-02-08T10:23:44.8333333'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-02-08T10:21:55.8866667'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-21T11:12:35.15'}, {'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-03-01T16:31:44.21'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-03-02T13:38:08.6866667'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-03-02T13:37:54.6966667'}, {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-03-14T21:05:56.3733333'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-03-15T09:59:06.58'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-21T12:46:36.4933333'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-03-22T15:40:02.9933333'}, {'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-04-06T11:14:15.8766667'}, {'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-04-18T12:28:01.1733333'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-08-09T11:34:49.63'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S77/DocumentHistoryActions | Bill | By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 77) of Sal N. DiDomenico, Hannah Kane, Brian W. Murray, Susannah M. Whipps and other members of the General Court for legislation relative to a loan repayment program for human services workers. Children, Families and Persons with Disabilities. | Chapter 6A of the General Laws, as so appearing in the 2020 Official Edition, is hereby amended by inserting after section 16Z the following new section:-
Section 16AA. (a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:
“human service provider,” a community-based human services organization with a human services program funded by the executive office of health and human services, the executive office of elder affairs, the department of housing and community development or the department of early education and care.
“human services worker,” an employee of a human service provider who provides treatment, support or services to clients or their families.
“qualified education loan,” any indebtedness, including interest on such indebtedness, incurred to pay tuition or other direct expenses incurred in the connection with the pursuit of a certificate, undergraduate or graduate degree by an applicant. It shall not include loans made by any person related to the applicant.
(b) There shall be a student loan repayment program for human service workers to encourage individuals to enter the field and maintain employment at human service programs. The executive office of health and human services shall administer the program in accordance with guidelines promulgated by the department of higher education.
(c) To be eligible for the program, a participant must be working a minimum of 35 hours per week as a human services worker. Further, individuals must have maintained 12 consecutive months of employment as a human service worker at a minimum of 35 hours per week to be eligible for this program. This program will help defray costs from previously incurred student loans for graduates holding a certificate or undergraduate/graduate degrees.
(d) Priority for funding should be given to applicants who have an individual salary less than 50 percent of the median income; who are bilingual; who are living and/or working in a vaccine equity initiative community; or who have worked in the direct care field for three or more years.
(e) Applicants will be eligible for up to $6,000 if they have an associate degree, up to $20,000 if they have a bachelor’s degree and up to $30,000 if they have a master’s degree.
(f) Other eligibility criteria may created to determine how applicants to the program should be prioritized and how much funding each would be able to apply for.
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An Act regarding Medicare savings programs eligibility | S770 | SD975 | 193 | {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-17T16:41:20.377'} | [{'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-17T16:41:20.3766667'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-02-02T14:28:57.4566667'}, {'Id': 'S_G2', 'Name': 'Steven Ultrino', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/S_G2', 'ResponseDate': '2023-02-03T09:26:40.3566667'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-03-03T08:59:14.9733333'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-03-13T16:12:30.83'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-03-29T10:40:20.0166667'}, {'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-04-13T10:29:58.9'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S770/DocumentHistoryActions | Bill | By Mr. Lewis, a petition (accompanied by bill, Senate, No. 770) of Jason M. Lewis, Sal N. DiDomenico, Steven Ultrino and Patricia D. Jehlen for legislation relative to Medicare savings programs eligibility. Health Care Financing. | SECTION 1. Section 25A of Chapter 118E of the General Laws is hereby amended by replacing Section 25A with the following section:-
SECTION 25A. The division shall disregard income in an amount equivalent to one-hundred-sixty-five percent (165%) of the federal poverty level, as adjusted annually, in determining eligibility for the Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual programs, described in 42 U.S.C. §1396(a)(10)(E) and also known as the Medicare Savings or Medicare Buy-In Programs in the year in which the state plan amendment is approved;
The division shall not apply an asset test in determining eligibility for said Medicare Savings Programs;
The division shall implement a waiting list in any year in which the number of qualified applicants for the Qualified Individual Program exceeds the annual block grant amount for said program;
The division shall submit a state plan amendment to implement this section no later than 30 days after the effective date of this section and subsequently promulgate all regulations necessary to implement said income and asset disregards.
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An Act providing transparency for patients receiving care at hospital-based facilities | S771 | SD979 | 193 | {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-18T17:25:16.927'} | [{'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-18T17:25:16.9266667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S771/DocumentHistoryActions | Bill | By Mr. Lewis, a petition (accompanied by bill, Senate, No. 771) of Jason M. Lewis for legislation relative to transparency for patients receiving care at hospital-based facilities. Health Care Financing. | SECTION 1. Chapter 111 of the General Laws is hereby amended by inserting the following section:-
Section 228A. (a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:
“Facility fee”, a fee charged or billed for outpatient hospital services provided in a hospital-based facility that is intended to cover the cost of the hospital operational expenses, which is separate and distinct from a professional fee.
“Hospital-based facility”, a provider of health care services, including but not limited to a department of a provider, a remote location of a hospital, or a satellite facility that meets the requirements of 42 C.F.R. § 413.65.
(a) Prior to the delivery of non-emergency services, a hospital-based facility that charges or bills a facility fee for services shall inform the patient that: 1) it is licensed as part of the hospital and the patient may receive a separate charge that is in addition to and separate from the professional fee charged by the provider; 2) the patient may incur financial liability that is greater than the patient would incur if the professional medical services were not provided by a hospital-based facility; and 3) information on how the patient can obtain financial liability for the known services through the hospital or the patient’s insurance carrier, along with information that the actual liability may change depending on the actual services provided. This information shall be provided in written form before the delivery of services.
(b) If a hospital or health system designates a location as a hospital-based facility, the facility shall clearly identify the facility as being hospital-based, including by stating the name of the hospital or health system in the facility’s signage, marketing materials, Internet web sites and stationery and by posting notices in designated locations accessible to and visible by patients in a manner proscribed by the commissioner.
(c) The commissioner may promulgate regulations that are necessary to implement this section.
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An Act to continue enhanced Medicaid hospital payments | S772 | SD981 | 193 | {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-18T17:27:44.34'} | [{'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-18T17:27:44.34'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S772/DocumentHistoryActions | Bill | By Mr. Lewis, a petition (accompanied by bill, Senate, No. 772) of Jason M. Lewis for legislation relative to the calculation of reimbursement rates to disproportionate share hospitals. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws is hereby amended by inserting the following new section:-
Section XX (a) The executive office shall direct monthly payments to eligible hospitals in the form of enhanced Medicaid payments, supplemental payments or other appropriate mechanism. Each payment made to an eligible hospital shall equal 5 per cent of the eligible hospital’s average monthly Medicaid payments, as determined by the executive office, for inpatient and outpatient acute hospital services for the preceding year or the most recent year for which data is available; provided, however, that such enhanced Medicaid payments shall not be used in subsequent years by the secretary to calculate an eligible hospital’s average monthly payment; and provided further, that such payments shall not offset existing Medicaid payments for which an eligible hospital may be qualified to receive.
(b) The executive office may require as a condition of receiving payment any such reasonable condition of payment that the secretary determines necessary to ensure the availability, to the extent possible, of federal financial participation for the payments, and the executive office may incur expenses and the comptroller may certify amounts for payment in anticipation of expected receipt of federal financial participation for the payments.
(c) The executive office may promulgate regulations as necessary to carry out this section.
(d) For the purposes of this section “eligible hospital” shall mean a non-profit or municipal acute care hospital licensed under section 51 of chapter 111 that: (i) has a statewide relative price less than 0.90, as calculated by the center for health information and analysis pursuant to section 10 of chapter 12C according to data from the most recent available year; (ii) has a public payer mix equal to or greater than 60 per cent, as calculated by the center for health information and analysis according to data from the most recent available year; and (iii) is not owned, financially consolidated or corporately affiliated with a provider organization, as defined by section 1 of chapter 6D, that: (A) owns or controls 2 or more acute care hospitals licensed under section 51 of chapter 111; and (B) the total net assets of all affiliated acute care hospitals within the provider organization is greater than $600,000,000, as calculated by the center for health information and analysis according to data from the most recent available year.
(e) For the purposes of subsection (d), a hospital’s mere clinical affiliation with a provider organization, absent ownership, financial consolidation or corporate affiliation, shall not disqualify an eligible hospital from payments authorized under this section.
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An Act relative to premium impact statements | S773 | SD248 | 193 | {'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-01-11T13:19:40.703'} | [{'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-01-11T13:19:40.7033333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S773/DocumentHistoryActions | Bill | By Ms. Lovely, a petition (accompanied by bill, Senate, No. 773) of Joan B. Lovely for legislation relative to premium impact statements. Health Care Financing. | SECTION 1. Prior to the adoption, amendment, or repeal of any healthcare or health insurance related regulation, an agency must file with the secretary of state’s office a public notice of the proposed action and include a premium impact statement. In the statement, the agency must consider the impact the proposed action will or will not have on health insurance premium rates in Massachusetts. The agency must afford the public an opportunity to present data, views, or arguments related to the impact statement, and prior to adopting the proposed regulation, the agency must file an amended premium impact statement with the secretary of state’s office.
SECTION 2. Any joint committee, house committee or senate committee may report favorably any bill or petition relative to health care or health insurance so long as that bill or petition shall have first received a premium impact statement conducted by the center for health information and analysis. Any joint committee, house committee or senate committee shall refer all healthcare and health insurance related bills or petitions to an accompanied study order pending a final report by the center for health information and analysis pursuant to this section.
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An Act relative to the continuous skilled nursing program | S774 | SD249 | 193 | {'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-01-11T13:20:08.843'} | [{'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-01-11T13:20:08.8433333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S774/DocumentHistoryActions | Bill | By Ms. Lovely, a petition (accompanied by bill, Senate, No. 774) of Joan B. Lovely for legislation relative to the continuous skilled nursing program. Health Care Financing. | MassHealth, through its home health care agency program, shall perform a rate review for every child and adult in the Commonwealth who is eligible for or receives care under the continuous skilled nursing program, with a medically complex health condition or special health needs requiring specialized care in all settings. Said rate review shall be submitted as a report to the house and senate committees on ways and means no later than December 31 of 2025 and every two years thereafter. Said report shall take into consideration the ability of a provider to compete for the median of nurses in the Commonwealth and shall include, but may not be limited to: the raw data relative to the number of patients who have received eighty percent or less of the continuous skilled nursing hours for which they have been deemed eligible; and a plan by which MassHealth intends to reduce the number of unfilled continuous skills nursing hours.
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An Act relative to family members serving as caregivers | S775 | SD1170 | 193 | {'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-01-19T08:43:34.49'} | [{'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-01-19T08:43:34.49'}, {'Id': 'S_G1', 'Name': 'Sean Garballey', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/S_G1', 'ResponseDate': '2023-01-26T14:50:29.6433333'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-26T14:49:33.3766667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-26T14:49:23.9233333'}, {'Id': 'KWP1', 'Name': 'Kelly W. Pease', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/KWP1', 'ResponseDate': '2023-01-26T14:49:18.6233333'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-01-26T14:49:14.0766667'}, {'Id': 'MJM2', 'Name': 'Mathew J. Muratore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJM2', 'ResponseDate': '2023-01-26T14:48:59.25'}, {'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-01-26T14:48:49.74'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-01-27T13:04:10.7433333'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-01-27T13:03:59.5033333'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-30T10:57:59.7366667'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-01-30T10:57:40.44'}, {'Id': 'AJP1', 'Name': 'Angelo J. Puppolo, Jr.', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJP1', 'ResponseDate': '2023-02-08T11:54:21.7966667'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-08T11:54:21.7966667'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-02-08T11:54:21.7966667'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-02-08T11:54:21.7966667'}, {'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-02-08T11:54:21.7966667'}, {'Id': 'JCV0', 'Name': 'John C. Velis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JCV0', 'ResponseDate': '2023-02-08T11:54:21.7966667'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-08T11:54:21.7966667'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-02-08T11:53:32.4'}, {'Id': 'SSH1', 'Name': 'Steven S. Howitt', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SSH1', 'ResponseDate': '2023-02-21T14:20:53.6533333'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-21T14:19:51.7066667'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-02-21T10:51:43.0433333'}, {'Id': 'AMG0', 'Name': 'Anne M. Gobi', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AMG0', 'ResponseDate': '2023-02-21T14:17:50.1466667'}, {'Id': 'BHJ1', 'Name': 'Bradley H. Jones, Jr.', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BHJ1', 'ResponseDate': '2023-03-09T13:50:22.93'}, {'Id': 'DAS1', 'Name': 'Danillo A. Sena', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DAS1', 'ResponseDate': '2023-03-09T13:50:22.93'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-03-23T09:30:34.9966667'}, {'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-04-03T11:51:48.7766667'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-05-09T13:55:12.8266667'}, {'Id': 'FEP1', 'Name': 'Francisco E. Paulino', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/FEP1', 'ResponseDate': '2023-06-06T11:10:25.13'}, {'Id': 'DTV1', 'Name': 'David T. Vieira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DTV1', 'ResponseDate': '2023-10-04T09:53:50.65'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S775/DocumentHistoryActions | Bill | By Ms. Lovely, a petition (accompanied by bill, Senate, No. 775) of Joan B. Lovely, Robyn K. Kennedy, Mathew J. Muratore, Michael D. Brady and other members of the General Court for legislation relative to family members serving as caregivers. Health Care Financing. | Section 12 of chapter 118E of the general laws is hereby amended by inserting, after paragraph 4, the following paragraph:-
Notwithstanding the provisions of any general or special law to the contrary, any program of home and community based services funded pursuant to the provisions of this chapter, in which family members are permitted to serve as caregivers paid by MassHealth, shall include legally liable family members, including but not limited to biological, adoptive, foster or step parents, legal guardians, powers of attorney, healthcare powers of attorney, and adult children of care recipient, within the definition of family member; provided further, the executive office of health and human services shall file a state plan amendment or waiver application, as may be required, to allow legally liable family members to serve as caregivers paid by MassHealth.
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An Act limiting out of pocket expenses | S776 | SD1858 | 193 | {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-01-19T13:51:14.31'} | [{'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-01-19T13:51:14.31'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-10T15:40:34.61'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S776/DocumentHistoryActions | Bill | By Mr. Mark, a petition (accompanied by bill, Senate, No. 776) of Paul W. Mark for legislation to limit out of pocket expenses. Health Care Financing. | SECTION 1. Section 6 of chapter 32A of the General Laws is hereby amended by inserting after the fourth sentence thereof the following new sentence: -
For active and retired employees, their dependents and the survivors of deceased employees, including municipal subscribers, the maximum amount of deductibles and copayments for covered services during an enrollment year in a plan shall not exceed $2,500 for individual coverage and $5,000 for family coverage.
SECTION 2. Subsection (b) Section 22 of Chapter 32B is hereby amended by striking the first paragraph and inserting the following new paragraph:-
(b) An appropriate public authority may increase the dollar amounts for copayments, deductibles, tiered provider network copayments and other cost-sharing plan design features; provided that, for subscribers enrolled in a non-Medicare plan, such features do not exceed plan design features offered by the commission pursuant to section 4 or 4A of chapter 32A in a non-Medicare plan with the largest subscriber enrollment and, for subscribers enrolled in a Medicare plan under section 18A, such features do not exceed plan design features offered by the commission pursuant to section 4 or 4A of chapter 32A in a Medicare plan with the largest subscriber enrollment; provided that for active and retired employees, their dependents and the survivors of deceased employees the maximum amount of health insurance deductibles and copayments for covered services during an enrollment year in a plan shall not exceed those offered by the commission; provided, however, that the public authority need only satisfy the requirements of subsection (a) of section 21 the first time changes are implemented pursuant to this section; and provided, further that the public authority meet its obligations under subsections (b) to (h), inclusive, of section 21 each time an increase to a plan design feature is proposed.
SECTION 3. Section 9 of Chapter 32A is hereby amended by inserting the following new paragraph at the end thereof:-
Any and all excess premium payments made by the Commonwealth and or its employees and retirees shall remain in the trust fund, to be utilized for the purposes of paying the out of pocket expenses in excess of the limitations established in Section 6 up to the combined medical and pharmaceutical maximums established pursuant to the Patient Protection and Affordable Care Act , 42 U.S.C. §18001 et seq. (2010) or improving insurance benefits for its employees and retirees. Premium payments pursuant to this section shall include sums appropriated by the General Court or paid by the insured for self-insured products offered by the group insurance commission.
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An Act relative to hospital billing and licensure | S777 | SD1870 | 193 | {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-01-19T14:55:30.35'} | [{'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-01-19T14:55:30.35'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S777/DocumentHistoryActions | Bill | By Mr. Mark, a petition (accompanied by bill, Senate, No. 777) of Paul W. Mark for legislation relative to hospital billing and licensure. Health Care Financing. | SECTION 1. Chapter 111 of the General Laws is hereby amended by inserting the following new section:
Section XX Hospital Billing and Licensure.
As used in this section, the following terms shall have the following meanings:
“Health Care Entity“, an acute care hospital as defined in section 25B of chapter 111 of the Massachusetts General Laws and physician practice.
“Facility of Primary Licensure”, the single physical structure and location where the majority of the hospital’s licensed beds or where most of the physician practices are located.
(b) Every health care entity that provides any services at a location other than its Facility of Primary Licensure is prohibited from operating a Secondary Facility pursuant to the original license of the Facility of Primary Licensure and is hereby required to obtain from the department a new license for that location if the facility constitutes a Secondary Facility. A facility constitutes a Secondary Facility if:
The facility is physically located a distance greater than 500 yards, or
The facility requires or maintains separate heating, cooling, electric, sewer systems from the Facility of Primary Licensure.
(c) The licensed Secondary Facility shall obtain from the federal Centers for Medicare and Medicaid Services a separate National Provider Identification Number.
(d) Every health care facility, ambulatory surgical center, or outpatient facility shall bill all public and private payors for services using the National Provider Identification Number assigned to the specific facility and physical locations where the services were provided.
(e) No public or private payor shall be required to pay a claim billed by a health care facility, ambulatory surgical center, or outpatient facility not billed in accordance with this section.
(f) Subject to any agreement between the parties, a Secondary facility shall bill a carrier for services at a rate negotiated by the parties separately from the rates for the Facility of Primary Licensure or in the absence of an agreement, 110% of Medicare.
(g) Notwithstanding the provisions of this chapter, the department shall not grant a license to any Secondary Facility unless there is a determination by the department that there is a need for such a facility pursuant to section 25C. Secondary Facilities in operation as of the effective date of this section shall be exempt from the department’s determination of need requirements for purposes of obtaining licensure as a Secondary Facility.
(h) The department, along with the office of the attorney general, shall have the authority to enforce the requirements of this section.
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An Act to bring down the cost of prescription drugs | S778 | SD1916 | 193 | {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-01-19T16:09:30.047'} | [{'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-01-19T16:09:30.0466667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S778/DocumentHistoryActions | Bill | By Mr. Mark, a petition (accompanied by bill, Senate, No. 778) of Paul W. Mark for legislation to bring down the cost of prescription drugs. Health Care Financing. | Notwithstanding any general or special law to the contrary, the health policy commission shall conduct a study examining the feasibility of establishing a program for the commonwealth to direct the manufacture of generic or biosimilar prescription drugs.
The study shall analyze whether the creation of a state-directed prescription drug manufacturing program would have the intended result of increasing competition, lowering prices, and addressing shortages in the market for prescription drugs; reducing the cost of prescription drugs for public and private purchasers, taxpayers, and consumers; and increasing patient access to affordable drugs. The study shall examine the factors that most greatly contribute to drug costs in the commonwealth, the ways in which the cost of generic prescription drugs factors into MassHealth spending and healthcare costs across the Massachusetts healthcare system, and whether establishing a state-directed prescription drug manufacturing program related to generic or biosimilar drugs would be reasonable and effective at reducing drug prices and the cost of healthcare to patients and payors in Massachusetts including, but not limited to: (i) factors that contribute towards the increase of prescription drug prices for older, off-patent, or generic drugs; (ii) identifying generic prescription drugs that comprise the greatest proportion or a disproportionate amount of generic prescription drug spending; (iii) identifying generic prescription drugs that comprise the greatest proportion or a disproportionate amount of generic prescription drug price increases; (iv) the competitive landscape of generic and biosimilar drug manufacturing and its effects on prescription drugs prices in Massachusetts; (v) the degree of competition in regards to the generic prescription drugs that comprise the greatest degree or a disproportionate amount of spending; and (vi) the potential impact on prescription drug costs and healthcare costs by establishing a state-run program to direct the manufacture generic or biosimilar prescription drugs.
The commission shall submit a report of its findings and recommendations to the governor, speaker of the house, senate president, clerks of the house and senate, chairs of the joint committee on ways and means and chairs of the joint committee on health care finance no later than 1 year after the passage of this act. Recommendations of the report shall include, but not be limited to: (i) a cost-benefit analysis of establishing a state-run program to direct the manufacture generic prescription drugs; (ii) whether such a program would be sensible for the commonwealth to establish; (iii) a plan for the establishment of such a program if believed to be effective; (iv) the generic or biosimilar prescription drugs that would be most beneficial to manufacture; and (v) any legislative recommendations.
| Whereas, The deferred operation of this act would tend to defeat its purpose, which is to determine the feasibility of state-directed manufacture of certain prescription drugs, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public health.
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An Act increasing access to MassHealth dental providers
| S779 | SD1995 | 193 | {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-01-19T15:13:18.053'} | [{'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-01-19T15:13:18.0533333'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-02-13T20:41:06.42'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-02-13T20:41:06.42'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-02-13T20:41:06.42'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-16T12:22:12.47'}, {'Id': 'J_B1', 'Name': 'John Barrett, III', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/J_B1', 'ResponseDate': '2023-02-21T15:10:16.8233333'}, {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-02-22T08:40:09.0766667'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-03-07T11:04:48.1333333'}, {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-03-08T15:22:41.5566667'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-03-10T10:21:10.89'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-17T13:04:35.52'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-03-23T10:56:37.2966667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S779/DocumentHistoryActions | Bill | By Mr. Mark, a petition (accompanied by bill, Senate, No. 779) of Paul W. Mark, Susannah M. Whipps, Joanne M. Comerford, Vanna Howard and other members of the General Court for legislation to increase access to MassHealth dental providers. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws is hereby amended by inserting after Section 82 the following section:-
SECTION 83. (a) Notwithstanding any general or special law to the contrary, and subject to appropriation, the secretary of health and human services shall provide MassHealth supplemental payments to eligible MassHealth-participating dental providers who render covered dental services to an additional ten or greater MassHealth beneficiaries in a given year compared to the number of beneficiaries they provided services to in the prior year.
(b) The supplemental payment established in section (a) shall initially be set at $31 for the first year and shall be distributed to eligible dental providers as a rate add-on for each patient encounter in which a MassHealth-covered dental service are administered to an actively enrolled MassHealth beneficiary. The payment rate shall be subject to re-evaluation by the secretary of health and human services under Section 13C and 13D of this chapter.
(c) The supplemental payment established in section (a) will be available to providers located in twenty specific municipalities that are designated by the secretary of health and human services as having a high number or proportion of MassHealth enrollees and low rates of utilization of dental services.
(d) To be eligible for supplemental payments dental providers must meet each of the following criteria:
(1) Be a dentist or public health dental hygienists licensed in the state of Massachusetts.
(2) Be enrolled with MassHealth as an approved billing provider.
(3) Provide dental services to a minimum of ten additional MassHealth beneficiaries than the number of beneficiaries the dental provider provided services to in the previous year.
(4) Provide dental services at a location in eligible municipalities, as determined by the secretary of health and human services under section (c).
(e) MassHealth shall promulgate regulations to implement this section. These regulations shall define provider-eligible municipalities using available data on past year MassHealth enrollment and utilization.
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An Act updating the juvenile justice policy and data board | S78 | SD2015 | 193 | {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-19T20:55:16.663'} | [{'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-19T20:55:16.6633333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S78/DocumentHistoryActions | Bill | By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 78) of Sal N. DiDomenico for legislation to update the juvenile justice policy and data board. Children, Families and Persons with Disabilities. | Subsection (b) of Section 89 of Chapter 119 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking out the following words:- “The board shall consist of 21 members,” and replacing it thereof with the following:- “The board shall consist of 22 members,”
Said subsection (b) of said Section 89 of said Chapter 119 is further amended by inserting after the words "Massachusetts juvenile justice advisory committee or a designee” the following:- "; 1 of whom shall be the executive director of the Commission on Lesbian, Gay, Bisexual, Transgender, and Queer Youth or a designee".
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An Act to address the overuse of temporary nursing service agencies at Massachusetts skilled nursing facilities | S780 | SD1042 | 193 | {'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-01-18T18:36:50.707'} | [{'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-01-18T18:36:50.7066667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-02-08T13:41:10.4066667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-02-08T13:41:10.4066667'}, {'Id': 'JKH1', 'Name': 'James K. Hawkins', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JKH1', 'ResponseDate': '2023-02-08T13:41:10.4066667'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-02-08T13:41:10.4066667'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-02-21T15:18:04.4766667'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-21T15:13:14.49'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-03-15T13:23:34.7633333'}, {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-03-15T13:21:30.33'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-04-12T08:45:05.0433333'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-05-15T16:53:30.7433333'}, {'Id': 'RAM1', 'Name': 'Rita A. Mendes', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RAM1', 'ResponseDate': '2023-05-19T12:55:00.32'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S780/DocumentHistoryActions | Bill | By Ms. Miranda, a petition (accompanied by bill, Senate, No. 780) of Liz Miranda, Joanne M. Comerford, Jack Patrick Lewis, James K. Hawkins and other members of the General Court for legislation to address the overuse of temporary nursing service agencies at Massachusetts skilled nursing facilities. Health Care Financing. | SECTION 1. (a) Notwithstanding any special or general law to the contrary, the department of public health is directed to amend the state regulations governing the reporting by and rates paid by health-care providers to temporary nursing agencies registered with the department (101 CMR 345).
(b) Such amendment shall include reductions in the maximum prices set forth in 101 CMR 345.03(2) that an agency may charge for registered nurse, licensed practical nurse, or certified nurse aide services provided to a skilled nursing facility. In setting such reduced maximum rates, the department shall establish hourly rate caps through a process that establishes and considers a weighted average wage for regular skilled nursing facility employees, plus a factor to incorporate payroll taxes, for each applicable employee classification, shift, and region. The department shall establish such weighted average service rates annually utilizing information provided by facilities. In no case shall the established maximum prices of temporary nursing agencies be permitted to exceed one hundred and fifty percent of the established average wages for regular employees at each applicable classification.
(c) Such amendment shall require reporting any individual or business entity with an ownership interest of 5 percent or more of a temporary nursing agency is also the holder of an operating license issued to establish or maintain a Massachusetts skilled nursing facility. Further, a temporary nursing agency so owned by any such individual or entity shall be prohibited from procuring or providing temporary employment at a skilled nursing facility so owned by the same individual or entity.
(d) The process for establishing the amendments as outlined in the subsections above shall also include an examination and analysis of the Temporary Nursing Service Cost Report and Reporting Requirements established in 101 CMR 345.05. As it so determines in such analysis, the department may amend the Reporting Requirements regulatory provision to strengthen the transparency of, increase the mandated disclosures required in or to otherwise strengthen the state accountability standards now included in the mandated Temporary Nursing Service Cost Report. Such analysis shall include and such amendments to the regulatory reporting requirements may include improved standards for temporary nursing agency reporting on compensation, benefits and worker supports for temporary nursing agency workers; licensing, training, and continuing education requirements for assigned workers; reporting on the operations, cost trends and financial performance of temporary nursing agencies; processes utilized to assure prompt arrival of assigned workers; procedures for reporting on, the investigation of and the resolution of complaints about the performance of temporary nursing agency workers; and procedures for the notice of and for resolving actual or suspected abuse, theft, tampering or other diversion of controlled substances by temporary nursing agency staff workers. Such amendments may also include the establishment of or increases to corresponding registration and reporting fees.
(e) The process for determining maximum rates as outlined in subsection (b) above shall also include an examination and analysis of Travel Nurse Factor established in 101 CMR 345(e). The department may amend the Travel Nurse Factor provision to reduce the established percentage amount above which an agency’s price for travel nurses’ services provided to a nursing facility may exceed the base rate limits established in 101 CMR 345.03.
(f) Prior to and during the process of making the regulatory amendments outlined in the subsections above, the department shall consult with the Massachusetts Senior Care Association, Inc. and 1199 SEIU United Healthcare Workers East.
(g) The department of public health shall complete the processes above and file for Emergency Adoption of such amended regulations no later than 180 days after passage of this Act.
SECTION 2. (a) Notwithstanding any special or general law to the contrary, the executive office of health and human services is directed to amend the state standard payment regulations establishing Quality Adjustment Payments (101 CMR 206.06).
(b) Such amendment shall require each nursing facility to report to EOHHS on the amount and percentage of the facility’s federally reported nursing care hours per patient day that was provided by temporary nursing agency staff.
(c) Such amendment shall include establish a new Quality Adjustment Payment subsection and a Nursing Care Staffing Levels Achievement rate adjustment that implements such new rate adjustment and that is based upon a facility’s compliance with the Massachusetts hours per resident day standard. For purposes of determining such a rate adjustment, a facility’s reported nursing care hours per resident day standard shall be adjusted downward to reduce the facility’s credit for reported hours of care provided by temporary nursing agency staff by a percentage to be determined by EOHHS but that shall adjust credited hours downward by least twenty-five percent.
(d) Prior to and in making the regulatory amendments as outlined in the subsections above, the executive office of health and human services shall consult with the Massachusetts Senior Care Association, Inc. and 1199 SEIU United Healthcare Workers East.
(e) The executive office of health and human services shall complete the process above and file for Emergency Adoption of such amended regulations no later than 180 days after passage of this Act.
SECTION 3. (a) Notwithstanding any special or general law to the contrary, the department of public health is directed to amend the Massachusetts long term care facility operating regulations provisions relative to Staff Qualifications and Training (105 CMR 150.024) and Educational Programs (105 CMR 150.7(I)).
(b) Such amendments shall require that any temporary nursing agency staff that works in a skilled nursing facility is compliant with all applicable requirements and qualifications, as determined by the department, that are required of nursing care staff regularly employed in their position. Such amendments shall require temporary nursing agency staff working for more than one hundred hours in a facility participate in any job orientation and other continuing in-service educational programs appropriate to the care provided in the facility by regularly employed nursing personnel.
(c) Prior to and in making the regulatory amendments as outlined in the subsections above, the executive office of health and human services shall consult with the Massachusetts Senior Care Association, Inc. and 1199 SEIU United Healthcare Workers East.
(d) The department of public health shall complete the process above and file for Emergency Adoption of such amended regulations no later than 180 days after
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An Act relative to the primary care workforce development and loan repayment grant program at community health centers | S781 | SD1075 | 193 | {'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-01-18T20:23:10.437'} | [{'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-01-18T20:23:10.4366667'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-08T13:39:33.9666667'}, {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-02-08T13:39:33.9666667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-02-08T13:39:33.9666667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-02-08T13:39:33.9666667'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-02-08T13:39:33.9666667'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-02-08T13:39:33.9666667'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-02-07T13:08:33.3233333'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-02-07T13:08:03.53'}, {'Id': 'JKH1', 'Name': 'James K. Hawkins', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JKH1', 'ResponseDate': '2023-02-08T13:39:33.9666667'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-02-13T11:53:19.3066667'}, {'Id': 'PMP0', 'Name': 'Pavel M. Payano', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMP0', 'ResponseDate': '2023-02-21T15:16:28.5566667'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-21T15:16:28.5566667'}, {'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-02-21T15:16:28.5566667'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-03-28T11:36:06.57'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-04-27T11:41:34.92'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-05-15T16:53:14.2366667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S781/DocumentHistoryActions | Bill | By Ms. Miranda, a petition (accompanied by bill, Senate, No. 781) of Liz Miranda, Rebecca L. Rausch, Sal N. DiDomenico, Thomas M. Stanley and other members of the General Court for legislation relative to the primary care workforce development and loan repayment grant program at community health centers. Health Care Financing. | SECTION 1. Chapter 6A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following after Section 16CC
Section 16DD (a) There shall be established a primary care workforce development and loan forgiveness grant program at community health centers for the purpose of enhancing recruitment and retention of primary care physicians, other clinicians, bachelor’s degree-level mental health and primary care professionals including, but not limited to, community health workers, recovery coaches and family partners, as well as all other non-clinician staff at community health centers throughout the Commonwealth. Priority shall be given to clinicians and bachelor’s degree-level mental health and primary care professionals. The grant program shall be administered by the Executive Office of Health and Human Services, provided, that the office may contract with an organization to administer the grant program. This program shall ensure the continuation of state-level loan repayment for clinicians at community health centers including but not limited to those programs established by Chapter 102 of the acts of 2021, reserve 1599-2026.
(b) the program shall prioritize the recruitment and retention of a culturally, ethnically and linguistically diverse workforce; provided further, that to be eligible for loan repayment assistance under this item, an individual shall: (a) work in a community health center (i) have outstanding educational debt; (ii) not participate in any other loan repayment program; and (iii) be required to enter into a contract with the commonwealth for not less than 4 years; provided further, that the amounts of assistance per individual shall be pro-rated for individuals working on a part-time basis; provided further, that the executive office shall promulgate regulations for the administration and enforcement of the loan repayment assistance program under this item which shall include penalties and repayment procedures if a participating individual fails to comply with the program requirements;
(c) The program shall be funded through expenditures from the Behavioral Health and Community-Based Primary Care Reserve established in section 2a of chapter 102 of the Acts of 2021.
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An Act relative to Medicaid coverage for doula services | S782 | SD1638 | 193 | {'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-01-19T14:13:26.987'} | [{'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-01-19T14:13:26.9866667'}, {'Id': 'L_S1', 'Name': 'Lindsay N. Sabadosa', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L_S1', 'ResponseDate': '2023-01-19T17:04:54.2666667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-02-08T13:41:00.58'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-02-08T13:41:00.58'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-02-08T13:41:00.58'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-08T13:41:00.58'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-02-07T13:08:53.0466667'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-02-13T11:53:03.5733333'}, {'Id': 'AJP1', 'Name': 'Angelo J. Puppolo, Jr.', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJP1', 'ResponseDate': '2023-02-21T15:16:39.73'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-02-21T15:16:39.73'}, {'Id': 'DRC1', 'Name': 'Daniel R. Carey', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DRC1', 'ResponseDate': '2023-03-02T10:06:07.0033333'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-03-02T13:57:02.27'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-03-06T14:22:12.13'}, {'Id': 'M_C1', 'Name': 'Mike Connolly', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/M_C1', 'ResponseDate': '2023-06-27T17:03:02.7366667'}, {'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-07-26T17:01:12.7966667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S782/DocumentHistoryActions | Bill | By Ms. Miranda, a petition (accompanied by bill, Senate, No. 782) of Liz Miranda, Lindsay N. Sabadosa, Jacob R. Oliveira, Jack Patrick Lewis and other members of the General Court for legislation relative to Medicaid coverage for doula services. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws is hereby amended by inserting after section 10N the following section:-
Section 10-O: Medicaid Coverage for Doula Services.
(A) For purposes of this section, the term “doula services” shall have the following meaning:
“Doula Services” are physical, emotional, and informational support, but not medical care, provided by trained doulas to individuals and families during and after pregnancy, labor, childbirth, miscarriage, stillbirth or pregnancy loss. Doula services include but are not limited to:
(1) continuous labor support;
(2) prenatal, postpartum, and bereavement home or in-person visits throughout the perinatal period, lasting until 1 year after birth, pregnancy loss, stillbirth, or miscarriage;
(3) accompanying pregnant individuals to health care and social services appointments;
(4) providing support to individuals for loss of pregnancy or infant from conception
through one year postpartum;
(5) connecting individuals to community-based and state- and federally-funded resources, including those which address social determinants of health;
(6) making oneself available (being on-call) around the time of birth or loss as well as providing support for any concerns of pregnant individuals throughout pregnancy and until one year after birth, pregnancy loss, stillbirth, or miscarriage.
(7) providing support for other individuals providing care for a birthing parent, including a birthing parent’s partner and family members.
(B) Coverage of Doula Services:
(1) The Division shall provide coverage of doula services to pregnant individuals and postpartum individuals up to 12 months following the end of the pregnancy who are eligible for medical assistance under this chapter and/or through Title XIX or Title XXI of the Social Security Act. The Division shall provide the same coverage of doula services to pregnant and postpartum individuals who are not otherwise eligible for medical assistance under this chapter or Titles XIX or XXI of the Social Security Act solely because of their immigration status.
(2) The Division must cover continuous support through labor and childbirth, and at least up to six doula visits across the prenatal and one year postpartum period, including at least two postpartum visits, without the need for prior authorization. The Division must also establish a procedure to cover additional doula visits as needed.
(C) Creation of Doula Advisory Committee: There is hereby created a Doula Advisory Committee.
(1) The committee shall consist of 10-12 members to be appointed by the commissioner of public health, or designee.
(a) All but 2 of the members must be practicing doulas from the community; the remaining 2 members must be individuals from the community who have experienced pregnancy as a MassHealth member and are not practicing doulas.
(b) Among the members described in (a) above:
(i) at least 1 member must be a person who identifies as belonging to the LGBTQIA+ community;
(iii) at least 1 member must be a person who has experienced a severe maternal morbidity, a perinatal mental health or mood disorder, or a near-death experience while pregnant or in maternity care;
(iv) at least 1 member must be a person who identifies as a person with disabilities or disabled person;
(c) The members of the committee shall represent a diverse range of experience levels- from doulas new to the practice to more experienced doulas.
(d) The members of the committee shall be from areas within the Commonwealth where maternal and infant outcomes are worse than the state average, as evidenced by the MA Department of Public Health’s most current perinatal data available at the time the member is appointed.
(e) The members of the committee shall represent an equitable geographic distribution from across the Commonwealth.
(2) The committee must be convened within six months of passage of this law.
(3) Of the initial appointments to the Doula Advisory Committee, half shall be appointed to a term of 2 years and half shall be appointed to a term of 18 months. Thereafter, all terms shall be 2 years. The commissioner of public health, or designee, shall fill vacancies as soon as practicable.
(4) At least once every 8 weeks, the Division must meet with the Doula Advisory Committee to consult about at least the following:
(a) the scope of doula services covered by MassHealth;
(b) doula competencies required for reimbursement by MassHealth, and standards of proof or demonstration of those competencies;
(c) the recruitment of a diverse workforce of doulas to provide services to MassHealth members;
(d) the development of comprehensive and high quality continuing education and training that is free or low cost to doulas committed to providing services to MassHealth members, as well as the development of mentorship and career growth opportunities for doulas providing services to MassHealth members;
(e) the performance of any third party administrators of MassHealth’s doula coverage program, and standards and processes around billing for and prompt reimbursement of doula services;
(f) establishing grievance procedures for doulas, MassHealth members, and health care providers about MassHealth’s coverage of doula services and/or the provision of doula services to MassHealth members;
(g) outreach to the public and stakeholders about how to access doula care for MassHealth members, and about the availability of and advantages of doula care;
(h) the evaluation and collection of data on the provision of, outcomes of, access to, and satisfaction with doula care services provided to MassHealth members;
(i) maintaining a reimbursement rate for doula services that incentivizes and supports a diverse workforce representative of the communities served, and establishing a recurring timeframe to review that rate in light of inflation and changing costs of living in the commonwealth;
(j) how to ensure that MassHealth’s doula reimbursement program is directed towards the goal of reducing inequities in maternal and birth outcomes among racial, ethnic, and cultural populations who reside in all areas within the commonwealth, as evidenced by the most current perinatal data supplied by the department of public health.
(5) Each year, the Doula Advisory Committee must, by a majority vote of a quorum of its members, select an individual to serve as its chairperson for a one year term. The Doula Advisory Committee may replace the chairperson in the same manner mid-term.
(6) The Doula Advisory Committee may, by a majority vote of a quorum of its members, reduce the frequency of meetings with MassHealth to less than once every 8 weeks.
(7) The division and the Department of Public Health shall seek resources to offer reasonable compensation to members of the Doula Advisory Committee for fulfilling their duties, and must reimburse members for actual and necessary expenses incurred while fulfilling their duties.
(8) The division, in partnership with the Doula Advisory Committee, shall conduct at least 1 public hearing or forum each year until three years after passage of this law. The purposes of these hearings or forums shall be to gather feedback from the public and to inform the public about MassHealth’s coverage of doula care.
SECTION 2. Chapter 29 of the Massachusetts General Laws is hereby amended by inserting after section 2QQQQQ the following section:-
Section 2RRRRR. (a) There shall be established and set up on the books of the commonwealth a separate fund known as the Doula Workforce Development Trust Fund, hereinafter called the fund. The fund shall be administered by the department of career services which shall contract with the Commonwealth Corporation to administer the fund. The fund shall be credited with: (i) revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; (ii) interest earned on such revenues; and (iii) funds from public and private sources; and other gifts, grants and donations for the growth, training and continuous support of the doula workforce. Amounts credited to the fund shall not be subject to further appropriation and any money remaining in the fund at the end of a fiscal year shall not revert to the General Fund.
(b) The Commonwealth Corporation shall make expenditures from the fund for the purposes of:
(i) the development and expansion of comprehensive doula training available across the commonwealth. including the development of doula training focused on meeting the needs of MassHealth members;
(ii) ensuring that doulas committed to serving MassHealth members have access to high quality doula training at no- or low-cost to them;
(iii) the recruitment and retention of doulas from communities with high concentrations of MassHealth members, as well as areas within the commonwealth where maternal and infant outcomes are worse than the state average, as evidenced by the MA Department of Public Health’s perinatal data.
(iv) expanding doula mentoring opportunities across the state, which provide new doulas the opportunity to attend births and incentivize experienced practicing doulas to take on mentees.
(v) leveraging funds to secure future federal funding to support doula workforce development in the commonwealth.
(c) The director of career services shall annually, not later than December 31, report to the secretary of administration and finance, the house and senate committees on ways and means and the joint committee on labor and workforce development on the efforts undertaken in support of section (b) above; the number of doulas recruited and trained as a result of activities taken in support of (b) above, including but not limited to sex, gender identity, race, and ethnicity of such doulas; the amount of grants and identities of grantees awarded in support of section (b) above; and the availability of doula training at no- or low-cost to doulas committed to serving MassHealth members.
SECTION 3. Chapter 111 of the General Laws is hereby amended by inserting in section 70E after “Every patient or resident of a facility shall have the right:”:
(p) to have their birth doula’s continuous presence during labor and delivery. Facilities shall not place an undue burden on a patient’s doula’s access to clinical labor and delivery settings, and shall not arbitrarily exclude a patient’s doula from such settings.
| null | [] | [] | [] | [] |
An Act to promote transparency and prevent price gouging of pharmaceutical drug prices | S783 | SD2130 | 193 | {'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-01-13T12:15:03.647'} | [{'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-01-13T12:15:03.6466667'}, {'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-01-30T10:37:44.66'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S783/DocumentHistoryActions | Bill | By Mr. Montigny, a petition (accompanied by bill, Senate, No. 783) of Mark C. Montigny and Michael J. Barrett for legislation to promote transparency and prevent price gouging of pharmaceutical drug prices. Health Care Financing. | SECTION 1. Section 1 of chapter 6D of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the definition of “Performance penalty” the following 2 definitions:-
“Pharmaceutical manufacturing company”, an entity engaged in the production, preparation, propagation, conversion or processing of prescription drugs, directly or indirectly, by extraction from substances of natural origin or independently by means of chemical synthesis or by a combination of extraction and chemical synthesis or an entity engaged in the packaging, repackaging, labeling, relabeling or distribution of prescription drugs; provided, however, that ''Pharmaceutical manufacturing company'' shall not include a wholesale drug distributor licensed under section 36B of chapter 112 or a retail pharmacist registered under section 39 of said chapter 112.
“Pharmacy benefit manager”, a person or entity that administers: (i) a prescription drug, prescription device or pharmacist services; or (ii) a prescription drug and device and pharmacist services portion of a health benefit plan on behalf of a plan sponsor including, but not limited to, self-insured employers, insurance companies and labor unions; provided, however, that “Pharmacy benefit manager” shall include a health benefit plan that does not contract with a pharmacy benefit manager and administers its own: (a) prescription drug, prescription device or pharmacist services; or (b) prescription drug and device and pharmacist services portion, unless specifically exempted by the center.
SECTION 2. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by inserting after the definition of “Physician” the following definition:-
“Pipeline drugs”, prescription drug products containing a new molecular entity for which the sponsor has submitted a new drug application or biologics license application and received an action date from the federal Food and Drug Administration.
SECTION 3. Section 6 of said chapter 6D, as so appearing, is hereby amended by adding the following paragraph:-
If the analysis of spending trends with respect to the pharmaceutical or biopharmaceutical products increases the expenses of the commission, the estimated increases in the commission’s expenses shall be assessed fully to pharmaceutical manufacturing companies and pharmacy benefit managers in the same manner as the assessment under section 68 of chapter 118E. A pharmacy benefit manager that is a surcharge payor subject to the preceding paragraph and administers its own prescription drug, prescription device or pharmacist services or prescription drug and device and pharmacist services portion shall not be subject to additional assessment under this paragraph.
SECTION 4. Section 8 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 32, the words “ and (xi) ” and inserting in place thereof the following words:- (xi) not less than 3 representatives of the pharmaceutical industry; (xii) at least 1 pharmacy benefit manager; and (xiii).
SECTION 5. Said section 8 of said chapter 6D of the General Laws, as so appearing, is hereby amended by inserting after the word “commission”, in line 59, the first time it appears, the following words:- ; and (iii) in the case of pharmacy benefit managers and pharmaceutical manufacturing companies, testimony concerning factors underlying prescription drug costs and price increases, the impact of manufacturer rebates, discounts and other price concessions on net pricing, the availability of alternative drugs or treatments and any other matters as determined by the commission.
SECTION 6. Said chapter 6D is hereby further amended by inserting after section 15 the following section:-
Section 15A. (a) The commission shall conduct an annual study of pharmaceutical manufacturing companies with pipeline drugs, generic drugs or biosimilar drug products that may have a significant impact on statewide health care expenditures; provided, however, that the commission may issue interim studies if it deems it necessary. The commission may contract with a third-party entity to implement this section that has familiarity with the development and approval of pharmaceuticals or biologics or studies and compares the clinical effectiveness and value of prescription drugs.
(b) A pharmaceutical manufacturing company shall, provide early notice to the commission for: (i) a pipeline drug; (ii) an abbreviated new drug application for generic drugs, upon submission to the federal Food and Drug Administration; or (iii) a biosimilar biologics license application upon the receipt of an action date from the federal Food and Drug Administration. The commission shall make early notice information available to the office of Medicaid or another agency in addition to acute hospitals, ambulatory surgical centers and surcharge payors, as deemed appropriate.
Early notice shall be submitted to the commission not later than 60 days after receipt of the federal Food and Drug Administration action date or after the submission of an abbreviated new drug application to the federal Food and Drug Administration action.
For each prescription drug product, early notice shall include a brief description of the: (i) primary disease, health condition or therapeutic area being studied and the indication; (ii) route of administration being studied; (iii) clinical trial comparators; and (iv) estimated year of market entry. To the extent possible, information shall be collected using data fields consistent with those used by the federal National Institutes of Health for clinical trials.
For each pipeline drug, early notice shall include whether the drug has been designated by the federal Food and Drug Administration: (i) orphan drug; (ii) fast track; (iii) breakthrough therapy; (iv) for accelerated approval; or (v) priority review for a new molecular entity.
Notwithstanding the foregoing, submissions for drugs in development that receive such a designation by the federal Food and Drug Administration for new molecular entities shall be provided as soon as practical upon receipt of the relevant designation.
(c) The commission shall assess pharmaceutical manufacturing companies for the implementation of this section in a similar manner to the annual registration fees and other assessments related to the annual marketing disclosure reports required under section 2A of chapter 111N.
(d) Notwithstanding any general or special law to the contrary, information provided under this section shall be protected as confidential and shall not be a public record under clause Twenty-sixth of section 7 of chapter 4 or under chapter 66.
SECTION 7. Said chapter 6D is hereby further amended by adding the following 2 sections:-
Section 20. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:
“Eligible drug”, a (i) brand name drug or biologic, not including a biosimilar, that has a launch wholesale acquisition cost of $50,000 or more for a 1-year supply or full course of treatment; (ii) biosimilar drug that has a launch wholesale acquisition cost that is not at least 15 per cent lower than the referenced brand biologic at the time the biosimilar is launched; or (iii) public health essential drug, as defined in section 239 of chapter 111, with a significant price increase over a defined period of time as determined by the commission by regulation or with a wholesale acquisition cost of $25,000 or more for a 1-year supply or full course of treatment.
“Manufacturer”, a pharmaceutical manufacturer of an eligible drug.
“Public health essential drug”, shall have the same meaning as defined in section 239 of chapter 111.
(b) The commission shall review the impact of eligible drug costs on patient access; provided, however, that the commission may prioritize the review of eligible drugs based on potential impact to consumers.
In order to conduct a review of eligible drugs, the commission may require a manufacturer to disclose to the commission within a reasonable time period information relating to the manufacturer’s pricing of an eligible drug. The disclosed information shall be on a standard reporting form developed by the commission with the input of the manufacturers and shall include, but not be limited to:
(i) a schedule of the drug’s wholesale acquisition cost increases over the previous 5 calendar years;
(ii) the manufacturer’s aggregate, company-level research and development and other relevant capital expenditures, including facility construction, for the most recent year for which final audited data are available;
(iii) a written, narrative description, suitable for public release, of factors that contributed to reported changes in wholesale acquisition cost during the previous 5 calendar years; and
(iv) any other information that the manufacturer wishes to provide to the commission or that the commission requests.
(c) Based on the records furnished under subsection (b) and available information from the center for health information and analysis or an outside third party, the commission shall identify a proposed value for the eligible drug. The commission may request additional relevant information that it deems necessary.
Any information, analyses or reports regarding an eligible drug review shall be provided to the manufacturer. The commission shall consider any clarifications or data provided by the manufacturer with respect to the eligible drug. The commission shall not base its determination on the proposed value of the eligible drug solely on the analysis or research of an outside third party.
(d) If, after review of an eligible drug and after receiving information from the manufacturer under subsections (b) or (e), the commission determines that the manufacturer’s pricing of the eligible drug does not substantially exceed the proposed value of the drug, the commission shall notify the manufacturer, in writing, of its determination and shall evaluate other ways to mitigate the eligible drug’s cost in order to improve patient access to the eligible drug. The commission may engage with the manufacturer and other relevant stakeholders, including, but not limited to, patients, patient advocacy organizations, providers, provider organizations and payers, to explore options for mitigating the cost of the eligible drug. Upon the conclusion of a stakeholder engagement process under this subsection, the commission shall issue recommendations on ways to reduce the cost of the eligible drug for the purpose of improving patient access to the eligible drug. Recommendations may include, but not be limited to: (i) an alternative payment plan or methodology; (ii) a bulk purchasing program; (iii) co-pay, deductible, coinsurance or other cost-sharing restrictions; and (iv) a reinsurance program to subsidize the cost of the eligible drug. The recommendations shall be publicly posted on the commission’s website and provided to the clerks of the house of representatives and senate, the joint committee on health care financing and the house and senate committees on ways and means.
(e) If, after review of an eligible drug, the commission determines that the manufacturer’s pricing of the eligible drug substantially exceeds the proposed value of the drug, the commission shall request that the manufacturer provide further information related to the pricing of the eligible drug and the manufacturer’s reasons for the pricing not later than 30 days after receiving the request.
(f) Not later than 60 days after receiving information from the manufacturer under subsections (b) or (e), the commission shall confidentially issue a determination on whether the manufacturer’s pricing of an eligible drug substantially exceeds the commission’s proposed value of the drug. If the commission determines that the manufacturer’s pricing of an eligible drug substantially exceeds the proposed value of the drug, the commission shall confidentially notify the manufacturer, in writing, of its determination and require the manufacturer to enter into an access improvement plan under section 21.
(g) Records disclosed by a manufacturer under this section shall: (i) be accompanied by an attestation that all information provided is true and correct; (ii) not be public records under clause Twenty-sixth of section 7 of chapter 4 or chapter 66; and (iii) remain confidential; provided, however, that the commission may produce reports summarizing any findings; provided further, that any such report shall not be in a form that identifies specific prices charged for or rebate amounts associated with drugs by a manufacturer or in a manner that is likely to compromise the financial, competitive or proprietary nature of the information.
Any request for further information made by the commission under subsection (e) or any determination issued or written notification made by the commission under subsection (f) shall not be public records under said clause Twenty-sixth of said section 7 of said chapter 4 or said chapter 66.
(h) If the manufacturer fails to timely comply with the commission’s request for records under subsections (b) or (e), or otherwise knowingly obstructs the commission’s ability to issue its determination under subsection (f), including, but not limited to, by providing incomplete, false or misleading information, the commission may impose appropriate sanctions against the manufacturer, including reasonable monetary penalties not to exceed $1,000,000, in each instance. The commission shall seek to promote compliance with this section and shall only impose a civil penalty on the manufacturer as a last resort.
(i) The commission shall adopt any written policies, procedures or regulations that the commission determines are necessary to implement this section.
Section 21. (a) The commission shall establish procedures to assist manufacturers in filing and implementing an access improvement plan.
Upon providing written notice provided under subsection (f) of section 20, the commission shall require that a manufacturer whose pricing of an eligible drug substantially exceeds the commission’s proposed value of the drug file an access improvement plan with the commission. Not later than 45 days after receipt of a notice under subsection (g) of section 20, a manufacturer shall: (i) file an access improvement plan; or (ii) provide written notice declining the commission’s request.
(b) An access improvement plan shall: (i) be generated by the manufacturer; (ii) identify the reasons for the manufacturer’s drug price; and (iii) include, but not be limited to, specific strategies, adjustments and action steps the manufacturer proposes to implement to address the cost of the eligible drug in order to improve patient access to the eligible drug. The proposed access improvement plan shall include specific identifiable and measurable expected outcomes and a timetable for implementation. The timetable for an access improvement plan shall not exceed 18 months.
(c) The commission shall approve any access improvement plan that it determines: (i) is reasonably likely to address the cost of an eligible drug in order to substantially improve patient access to the eligible drug; and (ii) has a reasonable expectation for successful implementation.
(d) If the commission determines that the access improvement plan is unacceptable or incomplete, the commission may provide consultation on the criteria that have not been met and may allow an additional time period of not more than 30 calendar days for resubmission; provided, however, that all aspects of the access improvement plan shall be proposed by the manufacturer and the commission shall not require specific elements for approval.
(e) Upon approval of the proposed access improvement plan, the commission shall notify the manufacturer to begin immediate implementation of the access improvement plan. All manufacturers implementing an approved access improvement plan shall be subject to additional reporting requirements and compliance monitoring as determined by the commission. The commission shall provide assistance to the manufacturer in the successful implementation of the access improvement plan.
(f) All manufacturers shall work in good faith to implement the access improvement plan. At any point during the implementation of the access improvement plan the manufacturer may file amendments to the access improvement plan, subject to approval of the commission.
(g) At the conclusion of the timetable established in the access improvement plan, the manufacturer shall report to the commission regarding the outcome of the access improvement plan. If the commission determines that the access improvement plan was unsuccessful, the commission shall: (i) extend the implementation timetable of the existing access improvement plan; (ii) approve amendments to the access improvement plan as proposed by the manufacturer; (iii) require the manufacturer to submit a new access improvement plan; or (iv) waive or delay the requirement to file any additional access improvement plans.
(h) The commission may submit a recommendation for proposed legislation to the joint committee on health care financing if the commission determines that further legislative authority is needed to assist manufacturers with the implementation of access improvement plans or otherwise ensure compliance with this section.
(i) An access improvement plan under this section shall remain confidential in accordance with section 2A.
(j) The commission shall assess a civil penalty to a manufacturer of not more than $1,000,000, in each instance, if the commission determines that the manufacturer: (i) willfully neglected to file an access improvement plan with the commission under subsection (a); (ii) failed to file an acceptable access improvement plan in good faith with the commission; (iii) failed to implement the access improvement plan in good faith; or (iv) knowingly failed to provide information required by this section to the commission or knowingly falsified the information,. The commission shall seek to promote compliance with this section and shall only impose a civil penalty as a last resort.
(k) If a manufacturer fails to enter into an access improvement plan under this section, the commission may publicly post the proposed value of the eligible drug, hold a public hearing on the proposed value of the eligible drug and solicit public comment. The manufacturer shall appear and testify at any hearing held on the eligible drug’s proposed value. Upon the conclusion of a public hearing under this subsection, the commission shall issue recommendations on ways to reduce the cost of an eligible drug for the purpose of improving patient access to the eligible drug. The recommendations shall be publicly posted on the commission’s website and provided to the clerks of the house of representatives and senate, the joint committee on health care financing and the house and senate committees on ways and means.
(l) Amounts collected under this section shall be deposited in to the Prevention and Wellness Trust Fund established in section 2G of chapter 111.
(m) The commission shall promulgate regulations necessary to implement this section.
SECTION 8. Chapter 12 of the General Laws, as so appearing, is hereby amended by striking out section 11N and inserting in place thereof the following section:-
Section 11N. (a) The attorney general shall monitor trends in the health care market including, but not limited to, trends in provider organization size and composition, consolidation in the provider market, payer contracting trends, patient access and quality issues in the health care market and prescription drug cost trends. The attorney general may obtain the following information from a private health care payer, public health care payer, pharmaceutical manufacturing company, pharmacy benefit manager, provider or provider organization as any of those terms may be defined in section 1 of chapter 6D: (i) any information that is required to be submitted under sections 8, 9 10 and 10A of chapter 12C; (ii) filings, applications and supporting documentation related to any cost and market impact review under section 13 of said chapter 6D; (iii) filings, applications and supporting documentation related to a determination of need application filed under section 25C of chapter 111; and (iv) filings, applications and supporting documentation submitted to the federal Centers for Medicare and Medicaid Services or the Office of the Inspector General for any demonstration project. Under section 17 of said chapter 12C and section 8 of said chapter 6D and subject to the limitations stated in those sections, the attorney general may require that any provider, provider organization, pharmaceutical manufacturing company, pharmacy benefit manager, private health care payer or public health care payer produce documents, answer interrogatories and provide testimony under oath related to health care costs and cost trends, pharmaceutical costs, pharmaceutical cost trends, the factors that contribute to cost growth within the commonwealth's health care system and the relationship between provider costs and payer premium rates and the relationship between pharmaceutical drug costs and payer premium rates.
(b) The attorney general may investigate a pharmaceutical manufacturing company or pharmacy benefit manager referred to the attorney general by the center for health information and analysis under section 11 of chapter 12C to determine whether the pharmaceutical manufacturing company or pharmacy benefit manager engaged in unfair methods of competition or anticompetitive behavior in violation of chapter 93A or any other law and, if appropriate, take action under said chapter 93A or any other law to protect consumers in the health care market.
(c) The attorney general may intervene or otherwise participate in efforts by the commonwealth to obtain exemptions or waivers from certain federal laws regarding provider market conduct, including, from the federal Office of the Inspector General, a waiver or expansion of the safe harbors' provided for under 42 U.S.C. § 1320a-7b and obtaining from the federal Office of the Inspector General a waiver of or exemption from 42 U.S.C. § 1395nn subsections (a) to (e), inclusive.
(d) Nothing in this section shall limit the authority of the attorney general to protect consumers in the health care market under any other law.
SECTION 9. Chapter 12C of the General Laws, as so appearing, is hereby amended by inserting after section 10 the following section:-
Section 10A. (a) The center shall promulgate regulations necessary to ensure the uniform analysis of information regarding pharmaceutical manufacturing companies and pharmacy benefit managers and that enable the center to analyze: (i) year-over-year wholesale acquisition cost changes; (ii) year-over-year trends in net expenditures; (iii) net expenditures on subsets of brand and generic pharmaceuticals identified by the center; (iv) research and development costs as a percentage of revenue, costs paid with public funds and costs paid by third parties, to the extent such costs are attributable to a specific product or set of products; (v) annual marketing and advertising costs, identifying costs for direct-to-consumer advertising; (vi) annual profits over the most recent 5-year period; (vii) information regarding trends of estimated aggregate drug rebates and other price reductions paid by a pharmaceutical manufacturing company in connection with utilization of all pharmaceutical drug products offered by the pharmaceutical manufacturing company; (viii) information regarding trends of estimated aggregate drug rebates and other price reductions paid by a pharmacy benefit manager in connection with utilization of all drugs offered through the pharmacy benefit manager; (ix) information regarding pharmacy benefit manager practices in passing drug rebates or other price reductions received by the pharmacy benefit manager to a private or public health care payer or to the consumer; (x) information regarding discount or free product vouchers that a retail pharmacy provides to a consumer in connection with a pharmacy service, item or prescription transfer offer or to any discount, rebate, product voucher or other reduction in an individual's out-of-pocket expenses, including co-payments and deductibles under section 3 of chapter 175H; (xi) cost disparities between prices charged to purchasers in the commonwealth and purchasers outside of the United States and (xii) any other information deemed necessary by the center.
(b) The center shall require the submission of available data and other information from pharmaceutical manufacturing companies and pharmacy benefit managers including, but not limited to: (i) changes in wholesale acquisition costs for prescription drug products as identified by the center; (ii) aggregate, company-level and product-specific research and development to the extent attributable to a specific product or products and other relevant capital expenditures for the most recent year for which final audited data are available for prescription drug products as identified by the center; (iii) the price paid by the manufacturer to acquire the prescription drug product if not developed by the manufacturer; (iv) the 5-year history of any increases in the wholesale acquisition costs; (v) annual marketing and advertising expenditures apportioned by activities directed to consumers and prescribers for prescription drug products as identified by the center; and (vi) a description, suitable for public release, of factors that contributed to reported changes in wholesale acquisition costs for prescription drug products as identified by the center.
SECTION 10. Section 11 of said chapter 12C is hereby amended by striking out in its entirety and inserting in place thereof the following:-
Section 11. The center shall ensure the timely reporting of information required under sections 8, 9, 10 and 10A. The center shall notify payers, providers, provider organizations, pharmacy benefit managers and pharmaceutical manufacturing companies of any applicable reporting deadlines. The center shall notify, in writing, a private health care payer, provider, provider organization, pharmacy benefit manager or pharmaceutical manufacturing company that it has failed to meet a reporting deadline and that failure to respond within 2 weeks of the receipt of the notice shall result in penalties. The center shall assess a penalty against a private health care payer, provider, provider organization, pharmacy benefit manager or pharmaceutical manufacturing company that fails, without just cause, to provide the requested information within 2 weeks following receipt of the written notice required under this paragraph of up to $20,000 per week for each week of delay after the 2-week period following receipt of the written notice; provided, however, that the maximum annual penalty against a private health care payer, provider, provider organization, pharmacy benefit manager or pharmaceutical manufacturing company under this section shall be $1,000,000. Amounts collected under this section shall be deposited in the Healthcare Payment Reform Fund established in section 100 of chapter 194 of the acts of 2011.
The center shall notify the attorney general of any pharmaceutical manufacturing company or pharmacy benefit manager that fails to comply with this section for further action pursuant to section 11N of chapter 12 or any other law.
For the purposes of this section, the center may promulgate regulations to define “just cause”.
SECTION 11. Said chapter 12C is hereby further amended by striking out section 17, as so appearing, and inserting thereof the following section:-
Section 17. The attorney general may review and analyze any information submitted to the center under sections 8, 9, 10, 10A and the health policy commission under section 8 of chapter 6D. The attorney general may require that any provider, provider organization, pharmaceutical manufacturing company, pharmacy benefit manager or payer produce documents, answer interrogatories and provide testimony under oath related to health care costs and cost trends, pharmaceutical cost trends, factors that contribute to cost growth within the commonwealth's health care system and the relationship between provider costs and payer premium rates. The attorney general shall keep confidential all nonpublic information and documents obtained under this section and shall not disclose the information or documents to any person without the consent of the provider, pharmaceutical manufacturing company, pharmacy benefit manager or payer that produced the information or documents except in a public hearing under said section 8 of said chapter 6D, a rate hearing before the division of insurance or in a case brought by the attorney general, if the attorney general believes that such disclosure will promote the health care cost containment goals of the commonwealth and that the disclosure shall be made in the public interest after taking into account any privacy, trade secret or anticompetitive considerations. The confidential information and documents shall not be public records and shall be exempt from disclosure under clause Twenty-sixth of section 7 of chapter 4 or section 10 of chapter 66.
SECTION 12. Chapter 111 of the General Laws is hereby amended by adding the following section:-
Section 239. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:
“Public health essential drug”, a prescription drug, biologic or biosimilar approved by the federal Food and Drug Administration that: (i) appears on the Model List of Essential Medicines most recently adopted by the World Health Organization; or (ii) is deemed an essential medicine by the commissioner due to its efficacy in treating a life-threatening health condition or a chronic health condition that substantially impairs an individual's ability to engage in activities of daily living or because limited access to a certain population would pose a public health challenge.
(b) The department shall identify and publish a list of public health essential prescription drugs. The list shall be updated not less than annually and be made publicly available on the department’s website; provided, however, that the department may provide an interim listing of a public health essential drug prior to an annual update. The department shall also notify and forward a copy of the list to the health policy commission established under chapter 6D.
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An Act relative to coverage for chronic illness | S784 | SD2146 | 193 | {'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-01-13T11:41:30.15'} | [{'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-01-13T11:41:30.15'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S784/DocumentHistoryActions | Bill | By Mr. Montigny, a petition (accompanied by bill, Senate, No. 784) of Mark C. Montigny for legislation relative to coverage for chronic illness. Health Care Financing. | SECTION 1. Chapter 176J of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 14 the following new section:-
Section 14A. No carrier shall charge a co-payment or deductible for any prescriptions or devices that are prescribed by a physician and are necessary for the treatment or maintenance of a chronic disease, illness or condition. The department of public health shall adopt regulations further defining a chronic disease, illness or condition for purposes of this section.
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An Act to ensure timely health care cost reporting | S785 | SD2147 | 193 | {'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-01-12T16:10:32.74'} | [{'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-01-12T16:10:32.74'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S785/DocumentHistoryActions | Bill | By Mr. Montigny, a petition (accompanied by bill, Senate, No. 785) of Mark C. Montigny for legislation to ensure timely health care cost reporting. Health Care Financing. | SECTION 1. Section 11 of chapter 12C of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking out the fourth and fifth sentences and inserting in place thereof the following sentences:-
"The center shall assess a penalty against a private payer, provider or provider organization that fails, without just cause, to provide the requested information within 2 weeks following receipt of the written notice required under this paragraph, of up to $5,000 per week for each week of delay after the 2 week period following the private payer's, provider's or provider organization's receipt of the written notice; provided, however, that the maximum annual penalty against a private payer, provider or provider organization under this section shall be $200,000. An amount collected under this section shall be deposited in the Healthcare Payment Reform Fund established by section 100 of chapter 194 of the acts of 2011.
The center may promulgate regulations to define “just cause” for the purposes of this section.".
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An Act relative to transfer of assets by MassHealth members | S786 | SD2148 | 193 | {'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-01-12T16:09:04.2'} | [{'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-01-12T16:09:04.2'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S786/DocumentHistoryActions | Bill | By Mr. Montigny, a petition (accompanied by bill, Senate, No. 786) of Mark C. Montigny for legislation relative to transfer of assets by MassHealth members. Health Care Financing. | SECTION 1: Section 28 of chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting at the end thereof, the following section:
The division shall not impose a period of ineligibility against an individual who demonstrates that a transfer of assets by said individual or his spouse was intended exclusively for a purpose other than qualifying for MassHealth or was intended to be a transfer for fair market value. The division shall consider specific factors in determining whether the individual has met his burden in establishing such intent including but not limited to the following:
1) The individual provides documentation demonstrating a regular pattern of small transfers for at least three years consistent with the transfer in question;
2) The individual or his spouse made the transfer to a religious institution, charity or other non-profit entity in an amount consistent with prior charitable giving ;
3) at the time of the transfer the individual and his spouse had resources at or below the allowable limit for MassHealth eligibility for long term care;
4) the transfer was intended to alleviate a relative’s financial crisis, prevent a relative’s mortgage foreclosure or pay for a relative’s medical care; or
5) at the time of the resource transfer, the individual’s medical record did not indicate a significant likelihood that the individual would require nursing home services in the near future.
If the individual establishes any of the above factors, then the burden of proving that the individual intended the transfer of assets to qualify the individual for MassHealth shifts to the division.
The division shall promulgate regulations implementing this section.
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An Act to alleviate skyrocketing consumer health care costs | S787 | SD2159 | 193 | {'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-01-11T16:16:25.483'} | [{'Id': 'MCM0', 'Name': 'Mark C. Montigny', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MCM0', 'ResponseDate': '2023-01-11T16:16:25.4833333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S787/DocumentHistoryActions | Bill | By Mr. Montigny, a petition (accompanied by bill, Senate, No. 787) of Mark C. Montigny for legislation to alleviate skyrocketing consumer health care costs. Health Care Financing. | Section 10 of chapter 6D of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by striking subsection (q) and inserting in place thereof the following:-
“(q) If the commission determines that a health care entity has: (i) willfully neglected to file a performance improvement plan with the commission within 45 days as required under subsection (d); (ii) failed to file an acceptable performance improvement plan in good faith with the commission; (iii) failed to implement the performance improvement plan in good faith; or (iv) knowingly failed to provide information required by this section to the commission or that knowingly falsifies the same, the commission shall assess a civil penalty to the health care entity of $500,000 per day.”.
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An Act to prohibit inappropriate use of the health care cost growth benchmark | S788 | SD1490 | 193 | {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-01-19T15:31:44.347'} | [{'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-01-19T15:31:44.3466667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S788/DocumentHistoryActions | Bill | By Mr. Moore, a petition (accompanied by bill, Senate, No. 788) of Michael O. Moore for legislation to prohibit inappropriate use of the health care cost growth benchmark. Health Care Financing. | Section 9A of chapter 176O of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after clause (e), in line 32, the following clause:-
(f) limits the ability of the health care provider to negotiate a rate increase with a carrier that exceeds the health care cost growth benchmark as established in Chapter 6D of section 9 of the general laws.
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An Act relative to hospital price transparency | S789 | SD1495 | 193 | {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-01-19T15:28:58.453'} | [{'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-01-19T15:28:58.4533333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S789/DocumentHistoryActions | Bill | By Mr. Moore, a petition (accompanied by bill, Senate, No. 789) of Michael O. Moore for legislation relative to hospital price transparency. Health Care Financing. | Chapter 111 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting, after section 51k, the following section:-
Section 51L. Hospital Price Transparency
(a) Every hospital shall make available to the public on its website a machine-readable file containing a list of all standard charges for all items and services provided by the hospital in accordance with 45 C.F.R. § 180.50, as amended. As used in this section, “hospital,” “items and services,” “machine-readable,” and “standard charge” have the same meaning as set forth in 45 C.F.R § 180.20.
(b) Every hospital shall, upon request of a patient scheduled to receive an elective procedure, test or service to be performed by the hospital, or upon request of such patients’ legally authorized representative, made no less than 3 days in advance of the date on which such elective procedure, test or service is scheduled to be performed, furnish the patient with an estimate of the payment amount for which the participant will be responsible for such elective procedure, test or service. Every hospital shall provide written information about the patient’s ability to request an estimate of the payment amount pursuant to this section. Such written information shall be posted conspicuously in public areas of the hospital, including admissions or registration areas, and included on any website maintained by the hospital.
(c) The department shall promulgate regulations for the purpose of implementing this act.
(d) Notwithstanding any general or special law to the contrary, violations of this act shall be deemed an unfair and deceptive act pursuant to the provisions of chapter 93A, and the attorney general is hereby authorized to bring an action under section 4 of chapter 93A to enforce this provision and to obtain restitution, civil penalties, injunctive relief and any other relief awarded pursuant to chapter 93A.
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An Act to establish a Massachusetts children’s cabinet | S79 | SD2242 | 193 | {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-20T14:29:34.047'} | [{'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-20T14:29:34.0466667'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-05-01T12:52:22.8'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-12T17:17:55.0933333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S79/DocumentHistoryActions | Bill | By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 79) of Sal N. DiDomenico for legislation to establish a Massachusetts children’s cabinet. Children, Families and Persons with Disabilities. | Chapter 6A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding, after section 16CC, the following section:-
Section 16DD. There shall be established within the executive office of the governor a children's cabinet. The cabinet shall include, but not be limited to: the secretary of administration and finance; the secretary of health and human services; the secretary of education; the secretary of labor and workforce development; the commissioner of the department of children, and families; the secretary of the department of housing and community development; the commissioner of the department of youth services; the commissioner of the department of transitional assistance; the commissioner of the department of mental health, the commissioner of the department of public health; the commissioner of the department of early education and care; the commissioner of the department of elementary and secondary education; the commissioner of the department of higher education; the commissioner of the department of development services; the director of the office of the child advocate; and the assistant secretary of health and human services for MassHealth; The cabinet shall be co-chaired by the secretary of health and human services and the secretary of education.
(a) The cabinet shall ensure that the public policy of the Commonwealth relating to children and youth is developed to promote interdepartmental collaboration and program implementation in order that services designed for children and youth are planned, managed, and delivered in a holistic and integrated manner to improve the children’s self-sufficiency, safety, economic stability, health, and quality of life. The cabinet shall:
i. Develop and implement a shared and cohesive vision using integrated services to improve child, youth, and family outcomes, including but not limited to issues relating to child poverty, educational preparedness, mental health, homelessness, foster care, juvenile justice, and the health, safety and welfare of children.
ii. Develop a strategic plan to achieve the goals of the shared and cohesive vision. The plan shall be centered upon a long-term commitment to children and youth issues and align all public resources to serve children and youth and their families in a manner that supports the healthy growth and development of children. The plan shall include a continuum of services that will benefit children from prenatal care through services for youth in transition to adulthood.
iii. Develop and implement measurable outcomes for each state department, agency, and program that are consistent with the strategic plan. The cabinet shall establish a baseline measurement for each outcome and regularly report on the progress made toward achieving the desired outcome.
iv. Design and implement actions that will promote collaboration, creativity, increased efficiency, information sharing, and improved service delivery between and within state governmental organizations that provide services for children and youth and their families and shall include the long-range planning process mandated by clause ii.
v. Recommend improvements to existing services and programs, as well as new programs to meet unmet needs, based on data on current levels of use and outcomes wherever possible and recommending evidence-based programs wherever possible and appropriate.
vi. Foster public awareness of children and youth issues and develop new partners in the effort to serve children and youth.
vii Create a children and youth impact statement for evaluating proposed legislation, requested appropriations, and programs. The impact statement shall be shared with the legislature.
viii. Identify existing and potential funding streams and resources for children’s services, including, but not limited to, public funding, foundation and organization grants, and other forms of private funding opportunities, including public-private partnerships.
ix. Develop a children and youth-based budget structure and nomenclature that includes all relevant departments, funding streams, and programs. The budget shall facilitate improved coordination and efficiency, explore options for and allow maximization of federal financial participation, and implement the state’s vision and strategic plan.
x. Engage in other activities that will implement improved collaboration of agencies in order to create, manage, and promote coordinated policies, programs, and service delivery systems that support children and youth.
(b) The governor shall appoint an advisory committee that shall meet not less than four times a year and jointly with the children’s cabinet not less than two times a year. The advisory committee shall provide data-driven recommendations to address service gaps and regional equity concerns and will shall provide recommendations on coordinating services across the state. Members shall include the house and senate chairs of the joint committee on children, families and persons with disabilities, 6-4 representatives from family resource centers including representatives from the western, central, and southeastern regions of the state; the executive director of the children’s trust fund or their designee; the executive director of the parent/professional action league or their designee; the executive director of the center for health information and analysis or their designee; the director of the department of family and medical leave or their designee; a member of the Grandparents Raising Grandchildren Commission; the director of the Massachusetts cultural council or their designee; the executive director of the GLBTQ Legal Advocates & Defenders or their designee; the president of the Baker Center for Children and Families or their designee; the executive director of the Disability Law Center or their designee; an executive director of a non-profit child welfare agency; and an additional 5 members with backgrounds including, but not limited to, pediatricians or other health care professionals servicing children, early childhood educators, teachers, school administrators, parents, youth, and other relevant experts with attention to diversity reflecting the composition of the child population. The governor shall designate one of the members of the advisory committee to serve as chair.
(c) The children’s cabinet shall, by November 1 of each year, provide an annual report concerning its activities, the status of children and youth in the commonwealth, and progress towards achieving the goals outlined in this section to the governor, the legislature and the public. The report shall be filed with the clerks of the house of representatives and senate, the house and senate chairs of the joint committee on children, families and persons with disabilities; the joint committee on education; the joint committee on higher education; the joint committee on mental health and substance abuse; the joint committee on public health; the joint committee on health care financing and the house and senate committees on ways and means.
(d) The executive office of the governor shall provide administrative support and service to the cabinet. The cabinet shall meet at least four times each year and may solicit input from the public and any other individual offering testimony relevant to the issues considered. Each meeting must include a public comment session.
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An Act relative to hospital profit and fairness | S790 | SD1876 | 193 | {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-01-18T09:58:16.803'} | [{'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-01-18T09:58:16.8033333'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-26T14:56:34'}, {'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-01-26T14:56:34'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-15T12:57:47.6'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S790/DocumentHistoryActions | Bill | By Mr. Moore, a petition (accompanied by bill, Senate, No. 790) of Michael O. Moore, Jack Patrick Lewis, Paul R. Feeney and James B. Eldridge for legislation relative to hospital profit and fairness. Health Care Financing. | Chapter 111 of the General Laws is hereby amended by inserting after section 237 the following section:-
Section 238. Hospital Profit and Fairness
Definitions
(a) As used in this section, the following words shall have the following meanings:-
“Facility”, a hospital licensed under section 51 of chapter 111 of the General Laws, the teaching hospital of the University of Massachusetts medical school, any licensed private or state-owned and state-operated general acute care hospital, an acute psychiatric hospital, an acute care specialty hospital, or any acute care unit within a state operated healthcare facility. This definition shall not include rehabilitation facilities or long-term care facilities.
“Compensation”, salary; bonus payments, whether based on performance or otherwise; deferred compensation; incentive payments; severance payments; loans to be repaid on terms, including interest, less burdensome than market rate; value of use of facility-provided vehicles, housing or other perquisites not available to all employees; stock or stock options and any dividends or other incidents of the ownership thereof.
"Minimum facility compensation", the value of the annual compensation received by a full time employee of a facility earning minimum wage as set under G.L. c. 151 1, or if none, then the lowest-paid full time employee.
(b) If in any fiscal year a facility that accepts funds from the Commonwealth, and whose patient mix is less than 60% government payer, reports to the Center for Health Information and Analysis an annual operating margin, including amortization and depreciation, that exceeds 8%, that facility shall be subject to a civil penalty equal to the amount by which the annual operating margin exceeds 8%.
(c) If the chief executive officer of a facility that accepts funds from the Commonwealth receives annual compensation greater than 100 times the minimum facility compensation, the facility shall be subject to a civil penalty equal to the amount by which the Chief Executive Officer's annual compensation exceeds 100 times the value of the minimum facility compensation.
(d) Each facility that accepts funds from the Commonwealth shall report annually to the Center for Health Information and Analysis all financial assets owned by the facility, including those held in financial institutions outside the United States or invested outside the United States. Unless prohibited by other law, the Center for Health Information and Analysis shall make this information public within 7 calendar days of receipt.
(e) There is hereby established on the books of the Commonwealth a fund to be known as the Medicaid Reimbursement Enhancement Fund. Any penalties collected as a result of violations of this act shall be deposited into this fund, and subject to appropriation, shall be used to improve Medicaid reimbursement to eligible hospitals.
(f) This act shall not be construed to impair any contract or agreement in effect as of January 1, 2023.
(g) The Health Policy Commission shall promulgate regulations governing the implementation, operation, and enforcement of this act.
(h) Severability. The provisions of this act are severable, and if any clause, sentence, paragraph or section of this law or an application thereof shall be adjudged by any court of competent jurisdiction to be invalid, such judgment shall not affect, impair, or invalidate the remainder thereof but shall be confined in its operation to the clause, sentence, paragraph, section or application adjudged invalid and such clause, sentence, paragraph, section or application shall be reformed and construed so that it would be valid to the maximum extent permitted.
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An Act relative to infection control in nursing facilities | S791 | SD1999 | 193 | {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-01-20T11:41:51.39'} | [{'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-01-20T11:41:51.39'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-02-01T15:43:11.6433333'}, {'Id': 'RME1', 'Name': 'Rodney M. Elliott', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RME1', 'ResponseDate': '2023-02-28T16:32:39.0133333'}, {'Id': 'MJM2', 'Name': 'Mathew J. Muratore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJM2', 'ResponseDate': '2023-02-28T16:32:39.0133333'}, {'Id': 'DAL1', 'Name': 'David Henry Argosky LeBoeuf', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DAL1', 'ResponseDate': '2023-02-28T16:32:39.0133333'}, {'Id': 'DPL1', 'Name': 'David Paul Linsky', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DPL1', 'ResponseDate': '2023-03-02T13:40:52.6366667'}, {'Id': 'AJP1', 'Name': 'Angelo J. Puppolo, Jr.', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJP1', 'ResponseDate': '2023-03-02T13:40:52.6366667'}, {'Id': 'KNF1', 'Name': 'Kimberly N. Ferguson', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/KNF1', 'ResponseDate': '2023-03-02T17:07:57.2766667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S791/DocumentHistoryActions | Bill | By Mr. Moore, a petition (accompanied by bill, Senate, No. 791) of Michael O. Moore, Vanna Howard, Rodney M. Elliott, Mathew J. Muratore and other members of the General Court for legislation to control infection in nursing facilities. Health Care Financing. | SECTION 1. The department of public health shall use Civil Monetary Penalty (CMP) monies as authorized under 42 USC 488.433 federal law, to establish an Infection Preventionist training grant program for certified nursing facilities. Per §483.80(b)(4) under the State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities, Infection Preventionist must have completed specialized training in infection prevention and control. The grant should be sufficient to cover costs associated with nationally recognized, clinically robust training and education for Infection Preventionists.
SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after section 79 the following 2 sections:-
Section 80: In setting reimbursement rates for nursing homes, the executive office of health and human services shall reimburse facilities for compensation to employ a full-time Infection Preventionist.
Section 81. The executive office of health and human services shall provide supplemental payments to licensed nursing facilities that consistent with guidelines established by the executive office of health and human services, Centers for Disease Control and Prevention, and Centers for Medicare and Medicaid Services establish isolation and quarantine rooms in order to prevent the spread of infectious diseases. Daily payment for isolation rooms shall be no less than the facility’s average Medicaid daily rate for every isolation and quarantine room.
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An Act limiting facility fees | S792 | SD1717 | 193 | {'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-01-19T15:02:52.627'} | [{'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-01-19T15:02:52.6266667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-03-06T15:22:16.0566667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S792/DocumentHistoryActions | Bill | By Ms. Moran, a petition (accompanied by bill, Senate, No. 792) of Susan L. Moran and Joanne M. Comerford for legislation to limit facility fees. Health Care Financing. | SECTION 1. Chapter 111 of the General Laws is hereby amended by inserting after section 53H the following section:-
Section 53I - Facility Fees
As used in this section, the following words shall have the following meanings:
"Affiliated provider", a provider that is: (a) Employed by a hospital or health system, (b) under a professional services agreement with a hospital or health system that permits such hospital or health system to bill on behalf of such provider, or (c) a clinical faculty member of a medical school that is affiliated with a hospital or health system in a manner that permits such hospital or health system to bill on behalf of such clinical faculty member;
"Campus", (a) the physical area immediately adjacent to a hospital's main buildings and other areas and structures that are not strictly contiguous to the main buildings but are located within two hundred fifty yards of the main buildings, or (b) any other area that has been determined on an individual case basis by the Centers for Medicare and Medicaid Services to be part of a hospital's campus;
"Facility fee", any fee charged or billed by a hospital or health system for outpatient hospital services provided in a hospital-based facility that is: (a) Intended to compensate the hospital or health system for the operational expenses of the hospital or health system, and (b) separate and distinct from a professional fee.
"Health system", (a) a parent corporation of one or more hospitals and any entity affiliated with such parent corporation through ownership, governance, membership or other means, or (b) a hospital and any entity affiliated with such hospital through ownership, governance, membership or other means
"Hospital”, an establishment for the lodging, care and treatment of persons suffering from disease or other abnormal physical or mental conditions and includes inpatient psychiatric services in general hospitals.
"Hospital-based facility", a facility that is owned or operated, in whole or in part, by a hospital or health system where hospital or professional medical services are provided.
"Professional fee", means any fee charged or billed by a provider for professional medical services provided in a hospital-based facility; and
"Provider", an individual, entity, corporation or health care provider, whether for profit or nonprofit, whose primary purpose is to provide professional medical services.
A hospital, health system, or hospital-based facility shall not collect a facility fee of more than $30 per patient visit for:
(a) Outpatient health care services that use a current procedural terminology evaluation and management code and are provided at a hospital-based facility, other than a hospital emergency department, located off-site from a hospital campus; or
(b) Outpatient health care services, other than those provided in an emergency department located off-site from a hospital campus, received by a patient who is uninsured of more than the Medicare rate.
Notwithstanding the provisions of this section, if an insurance contract that is in effect on the date of passage of this act provides 100% reimbursement to the contract holder for facility fees, a hospital or health system may continue to collect reimbursement from the health insurer for facility fees over $30 until the date of expiration of such contract.
A violation of this section shall be considered an unfair trade practice pursuant to Chapter 93A.
SECTION 2. Section 228 of said chapter 111, as appearing in the 2020 Official Edition, is hereby amended by striking out the third paragraph and inserting thereof the following paragraph:-
(2) If the health care provider is participating in the patient's or prospective patient's health benefit plan, the health care provider shall, at the time of scheduling the admission, procedure or service: (i) provide the charge and the amount of any facility fees for the admission, procedure or service; (ii) inform the patient or prospective patient of the amount of the charge or facility fee that the patient or prospective patient will be responsible for that is not covered through the patient's health benefit plan; and (iii) inform the patient or prospective patient that the patient or prospective patient may obtain additional information about any applicable out-of-pocket costs pursuant to section 23 of chapter 176O; provided, however, that if a health care provider is unable to quote a specific amount in advance due to the health care provider's inability to predict the specific treatment or diagnostic code, the health care provider shall disclose the estimated maximum allowed amount for the admission, procedure or service and the amount of any anticipated facility fees. A health care provider may assist a patient or prospective patient in using the patient's or prospective patient's health plan's toll-free number and website pursuant to said section 23 of said chapter 176O.
SECTION 3. The Massachusetts Health Policy Commission shall conduct a study of potential strategies to raise awareness of the difference in cost to the patient for receiving outpatient services at a hospital outpatient department versus a non hospital setting, such as a physician office.
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Resolve establishing a task force on MassHealth reimbursement for schools | S793 | SD1733 | 193 | {'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-01-19T15:03:52.773'} | [{'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-01-19T15:03:52.7733333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S793/DocumentHistoryActions | Resolve | By Ms. Moran, a petition (accompanied by resolve, Senate, No. 793) of Susan L. Moran that provisions be made for an investigation and study by a task force (including members of the General Court) relative to MassHealth reimbursement for schools. Health Care Financing. | Resolved, (a) Notwithstanding any general or special law to the contrary, the executive office of health and human services shall establish a MassHealth reimbursement of school-based care task force to study and make recommendations with respect to direct MassHealth reimbursement to local education agencies for direct nursing services, administrative activities, and any other medical benefits provided by such local education authority to any school-age child who is an eligible beneficiary of MassHealth in accordance with chapter 118E of the General Laws, Title XIX, and Title XXI, as appropriate.
(b) The task force shall consist of: the secretary of the executive office of health and human services, or a designee, who shall serve as co-chair; the secretary of the executive office of education, or a designee, who shall serve as co-chair; a representative from the division of local services; 3 persons to be appointed by the secretary of the executive office of health and human services who shall have knowledge of school-based care; and 3 persons to be appointed by the secretary of the executive office of education who shall have knowledge of municipal and educational finance.
The task force shall also consist of 2 members of the senate to be appointed by the president of the senate and 1 member of the senate to be appointed by the minority leader of the senate, 2 members of the house of representatives to be appointed by the speaker of the house and 1 member of the house of representatives to be appointed by the minority leader of the house of representatives
(c) The task force shall: (1) determine the number of local education agencies enrolled with the division of medical assistance as MassHealth providers; (2) analyze the extent to which said local education agencies utilize MassHealth reimbursement of direct nursing services, administrative activities and any other medical benefits provided by such local education authority to any school-age child who is an eligible beneficiary of MassHealth; (3) investigate any impediments to seeking MassHealth reimbursement for said services, including but not limited to student eligibility; and (4) analyze common state and federal reimbursements and other sources of revenue for educational or other school-based services, and the extent to which said reimbursements and sources of revenue are allocated directly to the municipality versus the local educational agency.
(d) The task force shall submit its findings, recommendations, and any determinations regarding necessary legislation to the governor and the clerks of the house of representatives and the senate not later than July 31, 2023.
(e) For the purposes of this act, the following terms shall have the following meanings:
“Administrative activities,” those activities as defined in the local education authority’s provider contract with MassHealth, and shall include Medicaid outreach services, facilitation or assistance in the MassHealth application process, assistance in coordination and delivery of MassHealth covered services, individual care planning, monitoring, coordination and referrals of MassHealth covered services, and assistance in obtaining MassHealth-covered transportation or translation services that are related to MassHealth covered services.
“Local education authority,” any city, town, charter school, public health commission, or school district.
“Direct nursing services,” skilled nursing services as defined in the local educational authority’s provider contract with MassHealth, and shall include mandated grade-level physical, mental, and behavioral health screening, and nursing treatment/services.
“Individualized education program,” a written statement, developed and approved in accordance with federal special education law in a form established by the Department of Elementary and Secondary Education of the Commonwealth that identifies a student's special education needs and describes the services a local education authority shall provide to meet those needs.
“School-age child,” any person of ages three through twenty-two who has not attained a high school diploma or its equivalent.
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An Act relative to MassHealth reimbursement for schools | S794 | SD1871 | 193 | {'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-01-20T10:15:26.54'} | [{'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-01-20T10:15:26.54'}, {'Id': 'MJM2', 'Name': 'Mathew J. Muratore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJM2', 'ResponseDate': '2023-02-02T15:56:27.6033333'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-15T16:46:16.6433333'}, {'Id': 'DPL1', 'Name': 'David Paul Linsky', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DPL1', 'ResponseDate': '2023-03-06T15:22:07.6333333'}, {'Id': 'N_H1', 'Name': 'Natalie M. Higgins', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/N_H1', 'ResponseDate': '2023-03-29T16:43:32.8966667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S794/DocumentHistoryActions | Bill | By Ms. Moran, a petition (accompanied by bill, Senate, No. 794) of Susan L. Moran, Mathew J. Muratore, Michael O. Moore and David Paul Linsky for legislation relative to MassHealth reimbursement for schools. Health Care Financing. | SECTION 1. Section 72 of chapter 44 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking, in line 8, the words “local government entity” inserting in place thereof the following:- “local educational authority.”
SECTION 2. Said section 72 of chapter 44 of the General Laws, as so appearing, is hereby further amended by striking, in line 10, the words “local government entity” inserting in place thereof the following:- “local educational authority.”
SECTION 3. Said section 72 of chapter 44 of the General Laws, as so appearing, is hereby further amended by striking, in line 13, the words “local government entity” inserting in place thereof the following; “local educational authority.”
SECTION 4. Said section 72 of chapter 44 of the General Laws, as so appearing, is hereby further amended by striking the words “Any funds received by a local government entity pursuant to the provisions of this section shall be considered unrestricted revenue of the local government entity and may be spent in accordance with any general or special law governing the expenditure of the entity's revenues.” and inserting in place thereof the following:- “A local educational agency which obtains MassHealth reimbursement for providing school-based services, administrative activities or any other medical benefits to a school-age child under this chapter, by and through its employees and agents, shall maintain the proceeds of such reimbursement to fund school-based services and related administrative activities at any school facility or school system which it operates or over which it has direct supervision or jurisdiction. Said proceeds should not supplant existing or planned school health funding.”
SECTION 5. Chapter 71 of the General Laws is hereby amended by inserting after Section 98 the following section:-
Section 99. (a) For the purposes of this section, the following words shall have the following meanings:
“Administrative activities”, those activities as defined in the local educational agency’s provider contract with MassHealth.
“Local educational agency”, any city, town, charter school, public health commission, or school district.
“Individualized education program”, a written statement, developed and approved in accordance with federal special education law in a form established by the department of elementary and secondary education of the Commonwealth that identifies a student's special education needs and describes the services a local educational agency shall provide to meet those needs.
“School-age child”, any person of ages three through twenty-two who has not attained a high school diploma or its equivalent.
“School-based Medicaid provider”, any local educational agency that provides School Based Services to Members and performs administrative activities on behalf of the executive office of health and human services pursuant to their provider contract with MassHealth.
“School-based services”, any medically necessary MassHealth covered services, as delineated in the Medicaid State Plan, which are provided to a member by a school-based Medicaid provider.
“School personnel”, a School-Based Medicaid Provider’s salaried and/or contract staff operating under a contractual agreement with the School-Based Medicaid Provider. School Personnel include, but are not limited to, nurses, therapists, special education administrators, psychologists, social workers, school counselors, and clerical support.
(b) The executive office of health and human services together with the executive office of education shall ensure that each local educational agency enrolled with the division as a MassHealth provider shall implement a plan to obtain MassHealth reimbursement of school-based services, administrative activities and any other medical benefits provided by such local educational agency to any school-age child who is an eligible beneficiary of MassHealth in accordance with this chapter, Title XIX and Title XXI as appropriate.
(c) Notwithstanding any other law or regulation to the contrary, any local educational agency enrolled with the division as a MassHealth provider of school-based services, administrative activities and any other medical benefits shall be entitled to submit claims to MassHealth for reimbursement for providing, by and through its employees or agents, such services and medical benefits to any school-age child who is an eligible beneficiary. Any school-based services, administrative activities or other medical benefits provided by a local educational agency to a school-age child who is an eligible beneficiary under this chapter shall be reimbursable by MassHealth regardless of whether said school-age child participates in an individualized education program, an individual health care plan, or a plan under Section 504 of the Rehabilitation Act of 1973, or whether said school-based services, administrative activities or other medical benefits are provided at no charge to any school-age child who is not an eligible beneficiary.
(d) A local educational agency which obtains MassHealth reimbursement for providing school-based services, administrative activities or any other medical benefits to a school-age child under this chapter, by and through its employees and agents, shall maintain the proceeds of such reimbursement to fund school-based services and related administrative activities at any school facility or school system which it operates or over which it has direct supervision or jurisdiction. Said proceeds should not supplant existing or planned school health funding, and shall be used for such purposes including, without limitation, school-based services and other school health programming, which may include enhanced capacity to provide comprehensive behavioral health support, case management, health education, social emotional learning and health support, outreach and enrollment, school health infrastructure development, and other related school health services.
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An Act relative to maintaining independent authority over nursing licensure in the commonwealth | S795 | SD324 | 193 | {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-01-12T19:17:11.957'} | [{'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-01-12T19:17:11.9566667'}, {'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-01-26T14:51:25.79'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-13T10:48:57.6966667'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-03-13T10:18:37.4366667'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-03-27T12:16:16.4433333'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-06-12T10:47:59.3733333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S795/DocumentHistoryActions | Bill | By Mr. O'Connor, a petition (accompanied by bill, Senate, No. 795) of Patrick M. O'Connor, Paul R. Feeney and James B. Eldridge for legislation to maintain independent authority over nursing licensure in the commonwealth. Health Care Financing. | Section 14 of Chapter 13 of the General Laws is hereby amended by inserting the following section:-
(l) maintain independent control over the practice and licensure of nursing in the Commonwealth.
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An Act relative to reciprocity clarification | S796 | SD1480 | 193 | {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-01-18T22:11:21.933'} | [{'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-01-18T22:11:21.9333333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S796/DocumentHistoryActions | Bill | By Mr. O'Connor, a petition (accompanied by bill, Senate, No. 796) of Patrick M. O'Connor for legislation relative to reciprocity clarification. Health Care Financing. | SECTION 1. Section 41 of Chapter 118E of the General Laws shall be amended by inserting at the end thereof the following:-
“Nothing in this section shall be interpreted or construed to conflict with 42 U.S.C. § 1320a-7b(b), as amended, or with federal common law, federal agency interpretations or federal agency legal opinions regarding 42 U.S.C. § 1320a-7b(b).”
SECTION 2. Section 3 of Chapter 175H of the General Laws shall be amended by inserting at the end thereof the following new subsection:-
“(e) Nothing in this section shall be interpreted or construed to conflict with 42 U.S.C. § 1320a-7b(b), as amended, or with federal common law, federal agency interpretations or federal agency legal opinions regarding 42 U.S.C. § 1320a-7b(b).”
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An Act to bring down the cost of prescription drugs | S797 | SD1625 | 193 | {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-01-19T18:18:11.903'} | [{'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-01-19T18:18:11.9033333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S797/DocumentHistoryActions | Bill | By Mr. Oliveira, a petition (accompanied by bill, Senate, No. 797) of Jacob R. Oliveira for legislation to bring down the cost of prescription drugs. Health Care Financing. | Notwithstanding any general or special law to the contrary, the health policy commission shall conduct a study examining the feasibility of establishing a program for the commonwealth to direct the manufacture of generic or biosimilar prescription drugs.
The study shall analyze whether the creation of a state-directed prescription drug manufacturing program would have the intended result of increasing competition, lowering prices, and addressing shortages in the market for prescription drugs; reducing the cost of prescription drugs for public and private purchasers, taxpayers, and consumers; and increasing patient access to affordable drugs. The study shall examine the factors that most greatly contribute to drug costs in the commonwealth, the ways in which the cost of generic prescription drugs factors into MassHealth spending and healthcare costs across the Massachusetts healthcare system, and whether establishing a state-directed prescription drug manufacturing program related to generic or biosimilar drugs would be reasonable and effective at reducing drug prices and the cost of healthcare to patients and payors in Massachusetts including, but not limited to: (i) factors that contribute towards the increase of prescription drug prices for older, off-patent, or generic drugs; (ii) identifying generic prescription drugs that comprise the greatest proportion or a disproportionate amount of generic prescription drug spending; (iii) identifying generic prescription drugs that comprise the greatest proportion or a disproportionate amount of generic prescription drug price increases; (iv) the competitive landscape of generic and biosimilar drug manufacturing and its effects on prescription drugs prices in Massachusetts; (v) the degree of competition in regards to the generic prescription drugs that comprise the greatest degree or a disproportionate amount of spending; and (vi) the potential impact on prescription drug costs and healthcare costs by establishing a state-run program to direct the manufacture generic or biosimilar prescription drugs.
The commission shall submit a report of its findings and recommendations to the governor, speaker of the house, senate president, clerks of the house and senate, chairs of the joint committee on ways and means and chairs of the joint committee on health care finance no later than 1 year after the passage of this act. Recommendations of the report shall include, but not be limited to: (i) a cost-benefit analysis of establishing a state-run program to direct the manufacture generic prescription drugs; (ii) whether such a program would be sensible for the commonwealth to establish; (iii) a plan for the establishment of such a program if believed to be effective; (iv) the generic or biosimilar prescription drugs that would be most beneficial to manufacture; and (v) any legislative recommendations.
| Whereas, The deferred operation of this act would tend to defeat its purpose, which is to determine the feasibility of state-directed manufacture of certain prescription drugs, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public health.
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An Act to promote primary care through Medicaid graduate medical education funding
| S798 | SD1793 | 193 | {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-01-19T00:32:22.7'} | [{'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-01-19T00:32:22.7'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-16T10:38:33.4166667'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-06T13:52:01.8866667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S798/DocumentHistoryActions | Bill | By Mr. Oliveira, a petition (accompanied by bill, Senate, No. 798) of Jacob R. Oliveira and Michael O. Moore for legislation to promote primary care through Medicaid graduate medical education funding. Health Care Financing. | SECTION 1. Chapter 118E of the General Laws is hereby amended by inserting at the end thereof the following new section:-
Section 80. (a) Notwithstanding any general or special law to the contrary, the executive office shall include in its reimbursement rates to qualifying acute care hospitals for graduate medical education in primary care, behavioral health, and other physician residency training in fields experiencing physician shortages, as determined by the secretary. Payments for graduate medical education shall be based on the Medicare direct graduate medical education methodology, Section 1886(h) of the Social Security Act, as implemented by 42 CFR 413.75 through 42 CFR 413.83 taking into consideration MassHealth utilization and primary care, behavioral health, and other physician residents in fields identified by the executive office
(b) No later than July 1, 2024, the secretary, in consultation with the executive office of administration and finance, shall identify an adequate amount of annual Medicaid graduate medical education funding necessary to fulfill the requirements of this section, as well as state and other funding sources for use for graduate medical education expenditures. The secretary shall report its recommendations to the joint committee on healthcare finance and committees on ways and means.
(c) The first annual payment to qualifying acute care hospitals and community health centers under this section must be made no later than October 1, 2025.
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An Act to advance health equity | S799 | SD1351 | 193 | {'Id': 'PMP0', 'Name': 'Pavel M. Payano', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMP0', 'ResponseDate': '2023-01-19T13:02:56.09'} | [{'Id': 'PMP0', 'Name': 'Pavel M. Payano', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMP0', 'ResponseDate': '2023-01-19T13:02:56.09'}, {'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-01-19T16:34:46.13'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-23T12:18:53.07'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-01-30T12:18:57.9666667'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-02-06T11:50:46.46'}, {'Id': 'M_C3', 'Name': 'Manny Cruz', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/M_C3', 'ResponseDate': '2023-02-21T10:27:00.98'}, {'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-03-28T11:15:46.5733333'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-03-30T10:29:03.85'}, {'Id': 'FEP1', 'Name': 'Francisco E. Paulino', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/FEP1', 'ResponseDate': '2023-05-11T10:41:31.2833333'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-10T16:36:14.0566667'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-09-12T13:38:12.7866667'}, {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-09-22T12:28:58.88'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S799/DocumentHistoryActions | Bill | By Mr. Payano, a petition (accompanied by bill, Senate, No. 799) of Pavel M. Payano, Liz Miranda, Joanne M. Comerford, Vanna Howard and other members of the General Court for legislation to advance health equity. Health Care Financing. | SECTION 1. Section 17A of chapter 6 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after “the secretary of energy and environmental affairs,”, in line 4, the following words:- the secretary of equity,.
SECTION 2. Section 2 of chapter 6A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after “energy and environmental affairs,”, in line 3, the following word:- equity,.
SECTION 3. Section 1 of chapter 6D, as appearing in the 2020 Official Edition, is hereby further amended by inserting after the definition of “Health care services” the following definition:-
“Health equity”, as defined in section 1 of chapter 6F.
SECTION 4. Said section 1 of said chapter 6D, as so appearing, is hereby further amended by inserting after the definition of “Primary care provider” the following definition:-
“Priority population”, a population that is disproportionately impacted by health disparities.
SECTION 5. Subsection (b) of section 2 of said chapter 6D, as so appearing, is hereby amended by inserting after the word “chairperson”, in line 12, the following words:- and 1 of whom shall have professional experience related to health equity and be Black, Indigenous, or a person of color.
SECTION 6. Clause (iv) of the fourth paragraph of subsection (e) of said section 2 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 115, the word “and”, and by inserting after said clause (iv) the following clause:-
(v) incorporate health equity into the exercising of powers and duties under this chapter; and.
SECTION 7. Said subsection (e) of said section 2 of said chapter 6D, as so appearing, is hereby further amended by redesignating clause (v), as inserted by section 15 of chapter 224 of the acts of 2012, as clause (vi).
SECTION 8. Subsection (g) of said section 2 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 140, “,” and inserting in place thereof the following words:- , including a chief health equity officer to assist in the carrying out of powers and duties relating to reducing health inequities experienced by priority populations.
SECTION 9. Section 3 of said chapter 6D, as so appearing, is hereby amended in subsection (k) by striking out, in line 38, the word “and”, in subsection (l) by striking out, in line 41, “.” and inserting in place thereof the word:- ; and.
SECTION 10. Said section 3 of said chapter 6D, as so appearing, is hereby amended by inserting after said subsection (l) the following subsection:-
(m) to incorporate health equity into the exercising of powers and duties under this chapter.
SECTION 11. Section 4 of said chapter 6D, as so appearing, is hereby amended by inserting after “commission”, in line 3, the following words:- , including policies relating to reducing health inequities experienced by priority populations.
SECTION 12. Section 5 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 11, “services” and inserting in place thereof the following words:- “services, including such access for priority populations to ensure health equity”.
SECTION 13. Subsection (d) of section 7 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 35, “those treatments; and (vi)” and inserting in place thereof the following words:- those treatments; (vi) to reduce identified disparities or otherwise advance equity in care delivery; and (vii).
SECTION 14. Subsection (a) of section 8 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 6, “shall examine” and inserting in place thereof the following words:- shall examine: (1).
SECTION 15. Said subsection (a) of said section 8 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 9, “health care system” and inserting in place thereof the following words:- health care system; and (2) health inequities experienced by priority populations.
SECTION 16. Clause (i) of subsection (e) of said section 8 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 45, “and the impact of price transparency on prices” and inserting in place thereof the following words:- , the impact of price transparency on prices, and efforts to reduce health inequities experienced by priority populations.
SECTION 17. Clause (ii) of said subsection (e) of said section 8 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 58, “and any” and inserting in place thereof the following words:- , efforts to reduce health inequities experienced by priority populations, and any.
SECTION 18. Subsection (g) of said section 8 of said chapter 6D, as so appearing, is hereby amended by striking out, in lines 93 to 96, “annual report concerning spending trends and underlying factors, along with any recommendations for strategies to increase the efficiency of the health care system” and inserting in place thereof the following words: annual report concerning: (1) spending trends and underlying factors (including estimates of the cost of inequity for the purpose of identifying the impact of health disparities on total costs of care); (2) any recommendations for strategies to increase the efficiency of the health care system; and (3) any recommendations to reduce health inequities for priority populations based on data and input received pursuant to sections 10A and 2A(c)(7), respectively.
SECTION 19. Said subsection (g) of said section 8 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 100, “sections 8, 9 and 10” and inserting in place thereof:- sections 2A(c)(7), 8, 9, 10, and 10A.
SECTION 20. Said chapter 6D of the General Laws is hereby further amended by inserting after section 9 the following section:-
Section 9A. (a) The board shall establish aggregate primary care and behavioral health expenditure targets for the commonwealth, which the commission shall prominently publish on its website.
(b) The commission shall establish the aggregate primary care and behavioral health expenditure targets as follows:
(1) For the 3-year period ending with calendar year 2026, the aggregate target shall be equal to a 30 per cent increase above aggregate baseline expenditures and the target shall be equal to a 30 per cent increase above baseline expenditures.
(2) For calendar years 2027 and beyond, the commission may modify the target and aggregate target, to be effective for a 3-year period provided that the target and aggregate target shall be approved by a two-thirds vote of the board not later than December 31 of the final calendar year of the preceding 3-year period. If the commission does not act to establish an updated target and aggregate target pursuant to this subsection, the target shall be equal to a 30 per cent increase above baseline expenditures, and the aggregate target shall be equal to a 30 per cent increase above aggregate baseline expenditures until such time as the commission acts to modify the target and aggregate target. If the commission modifies the target and aggregate target, the modification shall not take effect until the 3-year period beginning with the next full calendar year.
(c) Prior to establishing the target and aggregate target, the commission shall hold a public hearing. The public hearing shall be based on the report submitted by the center under section 16(a) of chapter 12C, comparing the actual aggregate expenditures on primary care and behavioral health services to the aggregate target, any other data submitted by the center and such other pertinent information or data as may be available to the board. The hearing shall examine the performance of health care entities in meeting the target and the commonwealth’s health care system in meeting the aggregate target. The commission shall provide public notice of the hearing at least 45 days prior to the date of the hearing, including notice to the joint committee on health care financing. The joint committee on health care financing may participate in the hearing. The commission shall identify as witnesses for the public hearing a representative sample of providers, provider organizations, payers, community-based organizations, and such other interested parties as the commission may determine. Any other interested parties may testify at the hearing.
SECTION 21. Paragraph (15) of subsection (c) of section 15 of said chapter 6D, as so appearing, is hereby amended by striking out, in line 168, “and”.
SECTION 22. Said subsection (c) of said chapter 6D, as so appearing, is hereby amended by inserting after said paragraph (15) the following paragraphs:-
(16) to ensure ACOs demonstrate compliance with standards that meet or exceed the national culturally and linguistically appropriate services standards of the United States Department of Health and Human Services, which also take into account care that is delivered in-person or via telehealth;
(17) to ensure ACOs demonstrate compliance with standards that meet or exceed the standards to attain the certification of the National Committee for Quality Assurance for the distinction in multicultural health care, which also take into account care that is delivered in-person or via telehealth; and.
SECTION 23. Said subsection (c) of section 15 of said chapter 6D, as so appearing, is hereby amended by redesignating paragraph (16), as inserted by section 15 of chapter 224 of the acts of 2012, as paragraph (18).
SECTION 24. The General Laws are hereby amended by inserting after chapter 6E the following chapter:-
CHAPTER 6F
EXECUTIVE OFFICE OF EQUITY
Section 1. Definitions
As used in this chapter, the following words shall, unless the context clearly requires otherwise, have the following meanings:-
“Data dashboards”, information management tools used to track, analyze, and display in a user-friendly and accessible format important performance indicators, metrics, and data points for review by the general public and others.
“Equity”, the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have historically been denied such treatment, including: (1) Black, Latino, Indigenous and Native American persons, Asian Americans and Pacific Islanders, and other persons of color; (2) members of religious minorities; lesbian, gay, bisexual, transgender, and queer persons; (3) persons with disabilities; persons who live in rural areas; and (4) persons otherwise adversely affected by persistent poverty or inequality.
“Health equity”, the state in which everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health and to health care services. Achieving health equity requires focused and ongoing efforts to address historical and contemporary injustices such as poverty and racism and efforts to address social determinants of health, including lack of access to good jobs with fair pay, quality education, safe and affordable housing, public transportation, safe and healthy environments, and health care. For the purposes of measurement, advancing health equity means reducing and ultimately eliminating disparities in health outcomes that adversely affect underserved, excluded, or marginalized groups.
“Office”, executive office of equity.
“Secretary”, secretary of equity.
“Social determinants of health”, the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health outcomes, functioning, and quality-of-life outcomes and risks, including economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community contexts.
Section 2. Establishment of office
There shall be an executive office of equity, which shall serve directly under the governor.
Section 3. Principal agency of executive department; purposes
The executive office of equity shall serve as the principal agency of the executive department for the following purposes:
(a) leading efforts toward equity, diversity, and inclusion across state government, within each executive office, and throughout the commonwealth; promoting access to equitable opportunities and resources that reduce disparities; and improving outcomes statewide across state government;
(b) developing multi-year strategic plans to advance equity within each executive office;
(c) developing standards for the collection, analysis, and public reporting of disaggregated data by race, ethnicity, language, and other socio-demographic factors as it pertains to tracking population level outcomes of communities; and creating statewide and executive office-specific process and outcome measures using outcome-based methodologies to determine the effectiveness of agency programs and services on reducing disparities;
(d) developing and implementing equity impact analyses at the request of any constitutional, executive, or legislative office and from time to time as deemed necessary by the secretary;
(e) creating and publishing data dashboards stratified and disaggregated by race, ethnicity, language, and other socio-demographic factors. Said dashboards shall include data relative to population level outcomes and to the process and outcome measures described in subsection (c) as well as any additional data the office deems important for the general public and decision makers. These dashboards shall comply with applicable privacy law but shall be publicly presented in a user-friendly format, with a focus on ensuring accessibility in its design; and
(f) coordinating with quasi-public entities in the commonwealth, including the health policy commission under chapter 6D and the center for health information and analysis under chapter 12C, for the purposes described in subsection (a).
Section 4. Secretary of equity; appointment; salary; powers and duties; undersecretaries of equity
The governor shall appoint the secretary of equity. Said secretary shall serve at the pleasure of the governor, shall receive such salary as the governor may determine, and shall devote full time to the duties of this office.
The secretary, in consultation with each respective secretary of each Massachusetts executive office, shall appoint an undersecretary of equity to assist each other Massachusetts executive office in applying an equity lens in all aspects of agency decision making, including service delivery, program development, policy development, and budgeting. The secretary shall appoint an undersecretary of equity for administration and finance, an undersecretary of equity for education, an undersecretary of equity for energy and environmental affairs, an undersecretary of equity for health and human services, an undersecretary of equity for housing, an undersecretary of economic development, an undersecretary of equity for labor and workforce development, an undersecretary of equity for public safety and security, an undersecretary of equity for transportation, an undersecretary of equity for veterans affairs, and an undersecretary of equity for climate innovation and resilience. Each person appointed as an undersecretary shall serve at the pleasure of her appointing secretary, shall have experience, and shall know the field or functions of such position.
The undersecretaries shall provide assistance to the executive offices by:
(a) facilitating information sharing between agencies related to diversity, equity, and inclusion;
(b) convening work groups or stakeholder advisory boards as needed;
(c) developing and providing assessment tools for agencies to use in the development and evaluation of agency programs, services, policies, and budgets;
(d) training the appropriate executive office staff on how to effectively use the assessment tools developed under subsection (c), including developing guidance on how to apply an equity lens to the executive office’s work when carrying out duties under this chapter;
(e) developing a form that will serve as each appropriate executive office’s diversity, equity, and inclusion plan, required to be submitted by the secretary of the executive office of equity under section 7 in a manner and at frequency determined appropriate by the undersecretaries. The office must post each final plan on the dashboard described in section 3;
(f) maintaining an inventory of the appropriate executive office’s work in the area of diversity, equity, and inclusion; and
(g) compiling and creating resources for executive offices to use as guidance when carrying out the requirements of this chapter.
Section 5. Advisory board
(a) There shall be an advisory board to the executive office of equity. The advisory board shall consist of: 3 persons appointed by the governor; 3 persons appointed by the president of the senate; 3 persons appointed by the speaker of the house of representatives; 3 persons appointed by the Massachusetts Black and Latino Legislative Caucus; 1 person appointed by the Secretary of Administration and Finance who shall have expertise in economic matters; 1 person appointed by the Secretary of Education who shall have expertise in education matters; 1 person appointed by the Secretary of Energy and Environmental Affairs who shall have expertise in environmental justice; 1 person appointed by the Secretary of Health and Human Services who shall have expertise in health equity and the social determinants of health; 1 person appointed by the Secretary of Housing who shall have expertise in housing policy; 1 person appointed by the Secretary of Economic Development who shall have expertise in economic development policy; 1 person appointed by the Secretary of Labor and Workforce Development who shall have expertise in labor and workforce development policy; 1 person appointed by the Secretary of Public Safety and Security who shall have expertise in criminal justice matters; 1 person appointed by the Secretary of Transportation who shall have expertise in transportation matters; 1 person appointed by the Secretary of Veterans Affairs who shall have expertise in matters related to veterans, and 1 person appointed by the Secretary of Office of Climate Innovation and Resilience who shall have experience in climate matters.
All members of the advisory board shall be residents of the commonwealth who are not employed by the commonwealth who have demonstrated a commitment to advancing equity and expertise in utilizing policy, systems and environmental strategies to address inequities. Criteria for selection of members shall consider diversity of geography; diversity of race and ethnicity; diversity of age; inclusion of individuals living with disabilities; and inclusion of individuals from the LGBTQ+ community. All members must have expertise in utilizing policy, systems and environmental strategies to address inequities. Members shall be considered special state employees for purposes of chapter 268A. All community representatives serving on the board shall be compensated for their time. The appointing authorities shall confer prior to making final appointments to ensure compliance with this provision.
(b) A member of the board shall serve a term of 3 years and until they vacate their membership or until a successor is appointed. Vacancies in the membership of the board shall be filled by the original appointing authority for the balance of the unexpired term.
(c) The board shall annually elect from among its members a chair, a vice chair, a treasurer, and any other officers it considers necessary. Notwithstanding the foregoing, the members of the board shall receive no compensation for their services; provided however that members shall be reimbursed for any usual and customary expenses incurred in the performance of their duties.
(d) The board shall advise the executive office of equity on the overall operation and policies of the office.
(e) The board shall meet no less than quarterly to discuss and debate matters related to the overall operation and policies of the executive office of equity.
(f) The board may request information and assistance from executive offices as the board requires.
Section 6. Strategic Plan; data dashboards; equity impact analysis
(a) The secretary, in collaboration with other secretaries in the governor’s cabinet, shall develop a multi-year equity strategy to improve equity across government and the commonwealth, including improved access to affordable health care, quality food and housing, safe communities, quality education, employment for which people are paid a living wage and that includes good working conditions, and affordable transportation and child care.
(b) Notwithstanding any general or special law to the contrary, the secretary, in collaboration with other secretaries in the governor’s cabinet, shall publish and regularly update data dashboards on the executive office of equity’s website. To the extent possible, all data dashboards shall include data able to be disaggregated by (1) gender; (2) race; (3) ethnicity; (4) primary city or town of residence; (5) age; (6) disability; (7) primary language; (8) occupation; and (9) any other demographic information that the secretary deems important to understand inequities and disparities in the commonwealth.
(c) The secretary, in collaboration with other secretaries in the governor’s cabinet, shall develop and implement equity impact analyses at the request of any constitutional, executive, or legislative office and from time to time as deemed necessary by the secretary. Equity impact analyses shall include, at a minimum, and to the extent that information is available, an analysis of whether the proposed policy is likely to promote or undermine equity, including health equity, in the commonwealth. Equity impact analyses may consider:
(1) direct impacts on disparities, inequities, the social determinants of health, and the determinants of equity, with special attention to the impacts on populations that have experienced marginalization or oppression;
(2) the quality and relevance of studies to evaluate said impacts;
(3) the availability of measures that would minimize any anticipated adverse equity consequences;
(4) the existence of adverse short-term and long-term equity consequences that cannot be avoided should the proposed policy be implemented;
(5) the availability of reasonable alternatives to the proposed policy; and
(6) the impact of the proposed policy on factors, including:
(A) income security, including adequate wages, relevant tax policies, access to affordable health insurance, retirement benefits, and paid leave;
(B) food security and nutrition, including food assistance program eligibility, enrollment, and assessments of food access and rates of access to unhealthy food and beverages;
(C) child development, education, and literacy rates, including opportunities for early childhood development and parenting support, rates of graduation compared to dropout rates, college attainment and adult literacy;
(D) housing, including access to affordable, safe and healthy housing; housing near parks and with access to healthy foods; and housing that incorporates universal design and visitability features;
(E) environmental quality, including exposure to toxins in the air, water and soil;
(F) accessible built environments that promote health and safety, including mixed-used land; active transportation such as improved pedestrian, bicycle and automobile safety; parks and green space; and healthy school siting;
(G) health care access, including accessible chronic disease management programs, access to affordable, high-quality health and behavioral health care, and the recruitment and retention of a diverse health care workforce;
(H) prevention efforts, including community-based education and availability of preventive services;
(I) assessing ongoing discrimination and minority stressors against individuals and groups in populations that have experienced marginalization or oppression based upon race, gender, gender identity, gender expression, ethnicity, marital status, language, sexual orientation, disability, and other factors, including discrimination that is based upon bias and negative attitudes of health professionals and providers;
(J) neighborhood safety and collective efficacy, including rates of violence, increases or decreases in community cohesion, and collaborative efforts to improve the health and well-being of the community;
(K) culturally appropriate and competent services and training in all sectors, including training to eliminate bias, discrimination and mistreatment of persons in populations that have experienced marginalization or oppression;
(L) linguistically appropriate and competent services and training in all sectors, including the availability of information in alternative formats such as large font, braille and American Sign Language; and
(M) accessible, affordable and appropriate mental health services.
Section 7. Annual Report
The secretary shall, on or before the first Wednesday in December of each year, submit a report to the governor, the president of the senate, the speaker of the house of representatives, the chair of the senate committee on ways and means, and the chair of the house committee on ways and means. Such report shall list and discuss the proposals which have been made and the accomplishments which have been achieved during the preceding two years towards advancing equity within the executive office of equity, each other executive office and throughout the commonwealth. Said report shall contain a summary of the objectives of such proposals, their disposition, and such further recommendations for legislative or executive actions concerning these proposals or additional proposals as, in the judgment of the secretary, should be made to improve equity in the programs, services and business affairs of the commonwealth.
SECTION 25. Section 1 of said chapter 12C, as appearing in the 2020 Official Edition, is hereby amended by inserting after the definition of “Health care services” the following definition:-
“Health equity”, as defined in section 1 of chapter 6F.
SECTION 26. Said section 1 of said chapter 12C, as so appearing, is hereby further amended by inserting after the definition of “Primary service area” the following definition:-
“Priority population”, as defined in section 1 of chapter 6D.
SECTION 27. Subsection (a) of section 2A of said chapter 12C, as so appearing, is hereby amended by inserting after “cybersecurity”, in line 9, the following words:- and 1 of whom shall have professional experience related to health equity and be Black, Indigenous, or a person of color.
SECTION 28. Paragraph (4) of subsection (c) of said section 2A of said chapter 12C, as so appearing, is hereby amended by striking out, in line 42, “center” and inserting in place thereof the following words:- center, including research and analysis concerning health disparities and health equity for priority populations of the commonwealth.
SECTION 29. Said section 2A of said chapter 12C, as so appearing, is hereby amended in paragraph (5) by striking out, in line 47, “and”, in paragraph (6) by striking out, in line 50, “.” and inserting in place thereof the following “; and”, and by inserting after said paragraph (6) the following new paragraph:-
(7) develop a process to hold annual public hearings to obtain input relating to health equity research and analysis priorities from healthcare consumers in the commonwealth, and it shall be the goal of the council for such hearings to obtain input from priority populations, the health disparities council under section 16O of chapter 6A, the division of medical assistance, and the department of public health. The council shall analyze the input received for the purposes of inclusion in the annual report described in section 16(a).
SECTION 30. Clause (v) of section 3 of said chapter 12C, as so appearing, is hereby amended by striking out, in line 25, the following word:- “and”, and in clause (vi) by striking out, in line 27, “.” and inserting in place thereof:- ; (vii) to conduct research to improve the center’s understanding of: (I) barriers to health equity data collection under sections 10A; and (II) how to restore trust and respectfully engage with individuals from priority populations who are paid participants in such research; and (viii) to conduct research to improve the center’s understanding of how racial ethnic, cultural, and linguistic diversity in the healthcare workforce impacts health care access and care quality for priority populations. The center shall prepare a report on the research described in clauses (vii) and (viii), which shall include recommendations for policy improvements based on the center’s improved understanding and plans to implement such improvements.
SECTION 31. Said section 3 of said chapter 12C, as so appearing, is hereby amended by inserting after the first paragraph the following paragraph:-
The executive director shall appoint and may remove a chief health equity officer to assist in the carrying out of powers and duties under this chapter relating to reducing health inequities experienced by priority populations.
SECTION 32. Chapter 12C of the General Laws is hereby amended by inserting after section 10 the following section:-
Section 10A. (a) The center shall promulgate regulations that identify the types of entities specified in sections 8, 9, and 10 which the center determines possess data necessary to analyze health inequities experienced by priority populations in the commonwealth.
(b)(1) The center shall promulgate regulations necessary to ensure, to the extent practicable, the uniform reporting of information from such entities identified pursuant to the regulations described in subsection (a) and any other information the center determines appropriate. In promulgating such regulations, the center shall consult with: (A) the department of public health; and (B) the division of medical assistance.
(2) To ensure that standards with respect to health equity data for accountable care organizations under MassHealth are incorporated into such regulations, the regulations shall specify standardized measures for data collection to: (A) standardize and strengthen social risk factors data collection, including race (including meaningful capture of multi-racial), ethnicity, language, disability, sexual orientation, gender identity, ZIP code or census tract, and health-related social needs; (B) maintain robust structures to identify and understand disparities, including through stratified reporting on key performance indicators; and (C) account for social determinants of health, including food insecurity, housing stability, and community violence.
(c) The center shall provide technical assistance to such entities to ensure the data is reported in a manner consistent with such regulations.
(d) The center shall analyze such data and input received pursuant to subsection (b) and section 2A(c)(7), respectively.
(e) The center shall coordinate with the office of equity with respect to such data for the purpose of section 6 of chapter 6F.
SECTION 33. Section 11 of said chapter 12C, as so appearing, is hereby amended by striking out, in line 2, “sections 8, 9 and 10” and inserting in place thereof the following words:- sections 8, 9, 10, and 10A.
SECTION 34. Section 16 of said chapter 12C, as so appearing, is hereby amended by striking out subsection (a) and inserting in place thereof the following subsection:-
(a) The center shall publish an annual report based on the information submitted under this chapter concerning health care provider, provider organization and private and public health care payer costs and cost trends, section 13 of chapter 6D relative to market power reviews and section 15 relative to quality data. The center shall compare the costs, cost trends, and expenditures with the health care cost growth benchmark established under section 9A of said chapter 6D, analyzed by regions of the commonwealth, and shall compare the costs, cost trends, and expenditures with the aggregate primary care and behavioral health expenditure targets established under section 9A of said chapter 6D, and shall detail: (1) baseline information about cost, price, quality, utilization and market power in the commonwealth’s health care system; (2) cost growth trends for care provided within and outside of accountable care organizations and patient-centered medical homes; (3) cost growth trends by provider sector, including but not limited to, hospitals, hospital systems, non-acute providers, pharmaceuticals, medical devices and durable medical equipment; provided, however, that any detailed cost growth trend in the pharmaceutical sector shall consider the effect of drug rebates and other price concessions in the aggregate without disclosure of any product or manufacturer-specific rebate or price concession information, and without limiting or otherwise affecting the confidential or proprietary nature of any rebate or price concession agreement; (4) factors that contribute to cost growth within the commonwealth’s health care system and to the relationship between provider costs and payer premium rates; (5) primary care and behavioral health expenditure trends as compared to the aggregate baseline expenditures, as defined in section 1 of said chapter 6D; (6) the proportion of health care expenditures reimbursed under fee-for-service and alternative payment methodologies; (7) the impact of health care payment and delivery reform efforts on health care costs including, but not limited to, the development of limited and tiered networks, increased price transparency, increased utilization of electronic medical records and other health technology; (8) the impact of any assessments including, but not limited to, the health system benefit surcharge collected under section 68 of chapter 118E, on health insurance premiums; (9) trends in utilization of unnecessary or duplicative services, with particular emphasis on imaging and other high-cost services; (10) the prevalence and trends in adoption of alternative payment methodologies and impact of alternative payment methodologies on overall health care spending, insurance premiums and provider rates; (11) the development and status of provider organizations in the commonwealth including, but not limited to, acquisitions, mergers, consolidations and any evidence of excess consolidation or anti-competitive behavior by provider organizations; and (12) the impact of health care payment and delivery reform on the quality of care delivered in the commonwealth.
As part of its annual report, the center shall report on price variation between health care providers, by payer and provider type. The center’s report shall include: (1) baseline information about price variation between health care providers by payer including, but not limited to, identifying providers or provider organizations that are paid more than 10 per cent above or more than 10 per cent below the average relative price and identifying payers which have entered into alternative payment contracts that vary by more than 10 per cent; (2) the annual change in price variation, by payer, among the payer’s participating providers; (3) factors that contribute to price variation in the commonwealth’s health care system; (4) the impact of price variations on disproportionate share hospitals and other safety net providers; and (5) the impact of health reform efforts on price variation including, but not limited to, the impact of increased price transparency, increased prevalence of alternative payment contracts and increased prevalence of accountable care organizations and patient centered medical homes.
As part of its annual report, the center shall report on data and information received pursuant to section 10A and input received pursuant to section 2A(c)(7), including an analysis of the factors that may lead to health inequities for priority populations.
The center shall publish and provide the report to health policy commission at least 30 days before any hearing required under section 8 of chapter 6D. The center may contract with an outside organization with expertise in issues related to the topics of the hearings to produce this report.
The center shall publish the aggregate baseline expenditures starting in the 2024 annual report.
The center, in consultation with the commission, shall hold a public hearing and adopt or amend rules and regulations establishing the methodology for calculating baseline and subsequent years’ expenditures for individual health care entities within 90 days of the effective date.
The center, in consultation with the commission, shall determine the baseline expenditures for individual health care entities and shall report to each health care entity its respective baseline expenditures by not less than thirty days before publishing the results.
SECTION 35. Subsection (c) section 2GGGG of chapter 29 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking out, in line 36, “and (6) to improve the affordability and quality of care” and inserting in place thereof the following words:- (6) to improve the affordability and quality of care; and (7) to reduce identified disparities or otherwise advance equity in care delivery.
SECTION 36. Chapter 111 of the General Laws is hereby amended by inserting after section 2J the following sections:-
Section 2K. (a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:-
“Environmental justice population”, as defined in section 62 of chapter 30.
"Health equity zone", a contiguous geographic area that: (1) demonstrates measurable and documented health inequities and poor health outcomes (including disproportionately high rates of maternal mortality and morbidity, infant and child health conditions, or chronic and infectious disease in the general population); and (2) meets criteria to be an environmental justice population or other definition of social inequity as determined by the department.
(b) There shall be established and set upon the books of the commonwealth a separate fund to be known as the Health Equity Zone Trust Fund to be expended, without further appropriation, by the department of public health. The fund shall consist of revenues collected by the commonwealth including: (1) any revenue from appropriations or other monies authorized by the general court and specifically designated to be credited to the fund; (2) any fines and penalties allocated to the fund under the General Laws; (3) any funds from public and private sources such as gifts, grants and donations to further community-based prevention activities; (4) any interest earned on such revenues; and (5) any funds provided from other sources.
The commissioner of public health, as trustee, shall administer the fund. The commissioner, in consultation with the Health Equity Zone Advisory Board established under section 2L, shall make expenditures from the fund consistent with subsection (e).
(c) Revenues deposited in the fund that are unexpended at the end of the fiscal year shall not revert to the General Fund and shall be available for expenditure in the following fiscal year.
(d) All expenditures from the Health Equity Zone Trust Fund shall support the state’s efforts to address health disparities and develop a stronger evidence base of effective place-based health equity interventions.
(e) The purpose of the Health Equity Zone Trust Fund is to enable the creation of so-called health equity zones, namely geographic areas where existing opportunities emerge and investments are made to address inequities in health outcomes. The Health Equity Zone Trust Fund will equip multi-sector partnerships which may include residents, businesses, community-organizations, municipal agencies to identify and create community determined solutions necessary to create just and fair conditions for health. Investments shall prioritize investment in the communities that have been systematically oppressed and where decades of disinvestment have created inequitable health outcomes.
The commissioner shall award not less than 85 per cent of the Health Equity Zone Trust Fund through a competitive grant process to municipalities, community-based organizations, regional-planning agencies that apply for the implementation, technical assistance, and evaluation of health equity activities. To be eligible to receive a grant to lead Health Equity Zone under this subsection, a recipient shall be: (1) a community-based organization or group of community-based organizations working in collaboration; (2) a community-based organization working in collaboration with 1 or more municipality; or (3) a regional planning agency. Expenditures from the fund for such purposes shall supplement and not replace existing local, state, private or federal public health-related funding.
(f) Priority shall be given to proposals in a geographic region of the state with a higher than average prevalence of preventable health conditions, as determined by the commissioner of public health, in consultation with the Health Equity Zone Advisory Board. If no proposals were offered in areas of the state with particular need, the department shall ask for a specific request for proposal for that specific region. If the commissioner determines that no suitable proposals have been received, such that the specific needs remain unmet, the department may work directly with municipalities or community-based organizations to develop grant proposals.
The department of public health shall, in consultation with the Health Equity Zone Advisory Board, develop guidelines for an annual review of the progress being made by each grantee. Each grantee shall participate in any evaluation or accountability process implemented or authorized by the department, provided, however, that the department shall make evaluation and accountability processes as minimally burdensome as is possible.
(g) The department of public health shall, annually on or before January 31, report on expenditures from the Health Equity Zone Trust Fund. The report shall include, but not be limited to: (1) the revenue credited to the fund; (2) the amount of fund expenditures attributable to the administrative costs of the department of public health; (3) an itemized list of the funds expended through the competitive grant process and a description of the grantee activities; (4) the results of the evaluation assessing the activities funded through grants; and (5) an itemized list of expenditures used to support place-based health equity interventions. The report shall be provided to the chairpersons of the house and senate committees on ways and means and the joint committee on public health and shall be posted on the department of public health’s website.
(h) The department of public health shall, under the advice and guidance of the Health Equity Zone Advisory Board, annually report on its strategy for administration and allocation of the fund, including relevant evaluation criteria. The report shall set forth the rationale for such strategy.
(i) The department of public health shall promulgate regulations necessary to carry out this section.
Section 2L. There shall be a Health Equity Zone Advisory Board to make recommendations to the commissioner concerning the administration and allocation of the Health Equity Zone Trust Fund established in section 2K, establish evaluation criteria and perform any other functions specifically granted to it by law.
The board shall consist of: the commissioner of public health or a designee, who shall serve as co-chairperson; and 10 persons to be appointed by the commissioner through a public nomination process, 4 of whom shall be community representatives with lived experience of health inequities in their communities (one of whom shall serve as co-chair); 1 of whom shall be a person with expertise in the field of health equity; 1 of whom shall be a person from a local board of health for a city or town with a population greater than 50,000; 1 of whom shall be a person of a board of health for a city or town with a population of fewer than 50,000; 1 of whom shall be a person from a hospital association; 1 of whom shall be a person from a statewide public health organization; 1 of whom shall be a representative of a community development corporation or association representing community development corporations and 1 of whom shall be a community health worker or a person from an association representing community health workers. Criteria for selection of members shall consider diversity of geography; diversity by race and ethnicity; expertise in program design and implementation; expertise in health equity; expertise in utilizing policy, systems and environmental strategies to address health inequities. All community representatives serving on the board shall be compensated for their time at an amount determined by the Commissioner.
SECTION 37. Subsection (g) of section 25C of chapter 111 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended, by inserting after “account”, in line 103, the following words:- the findings of the health equity assessment described in subsection (o) and.
SECTION 38. Said subsection (g) of section 25C of chapter 111, as so appearing, is hereby amended by striking out, in line 104, “from” and inserting in place thereof the following words:- “from the office of equity,”.
SECTION 39. Said section 25C of chapter 111, as so appearing, is hereby amended, by inserting after subsection (n) the following subsection:-
(o) A determination of need under this section shall take into account a health equity assessment, which shall be included in the application described in subsection (h). Such application shall include: (1) a demonstration of whether, and if so how, the extent to which such populations in the applicant’s service area access the applicant’s facility or services at the time of the application and the extent to which the proposed construction or change of services is expected to impact that access; (2) a description of the amount of indigent care, both free and below cost, that will be offered by the applicant if the construction or service change is approved; (3) an assessment of any impacts on access by public or private transportation, including applicant-sponsored transportation services, to the applicant’s facility if the construction or change in services is implemented, highlighting access by public transportation; and (4) a description of the proposed means of assuring effective communication between the applicant’s facility, health-related service staff, people of limited English-speaking ability, and those with speech, hearing or visual impairments handicaps if the construction or change in services is implemented.
SECTION 40. Clause (ii) of paragraph (4) of subsection (a) of section 25L of chapter 111, as so appearing, is hereby amended by striking out, in line 47, “comprehensive recruitment initiatives” and inserting in place thereof the following words:- comprehensive recruitment initiatives (including initiatives to support the recruitment and retention of individuals, notwithstanding immigration status, who work in health care settings and are not traditionally recipients of scholarship and student loan repayment programs).
SECTION 41.Chapter 112 of the General Laws is hereby amended by inserting after section 51A the following section:-
Section 51B. (a) As used in this section, the following words shall have the following meanings:
“Board”, each board of registration authorized to establish continuing education requirements for healthcare professions under this chapter (as determined by the commissioner of public health) and the Massachusetts Board of Registration in Medicine.
“Cultural safety”, an examination by health care professionals of themselves and the potential impact of their own culture on clinical interactions and health care service delivery. This requires individual health care professionals and health care organizations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures, and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a critical consciousness where health care professionals and health care organizations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities, and as measured through progress towards achieving health equity. Cultural safety requires health care professionals and their associated health care organizations to influence health care to reduce bias and achieve equity within the workforce and working environment.
“Structural competency”, a shift in medical education away from pedagogic approaches to stigma and inequalities that emphasize cross-cultural understandings of individual patients, toward attention to forces that influence health outcomes at levels above individual interactions. Structural competency reviews existing structural approaches to stigma and health inequities developed outside of medicine and proposes changes to United States medical education that will infuse clinical training with a structural focus.
(b) By January 1, 2026, the board shall adopt rules requiring a licensee to complete health equity continuing education training at least once every four years.
(c) Health equity continuing education courses may be taken in addition to or, if the board determines the course fulfills existing continuing education requirements, in place of other continuing education requirements imposed by the board.
(d)(1) The secretary and the board must work collaboratively to provide information to licensees about available courses. The secretary and board shall consult with patients and communities with lived experiences of health inequities or racism in the health care system and relevant professional organizations when developing the information and must make this information available by July 1, 2025. The information should include a course option that is free of charge to licensees.
(2) By January 1, 2026, the department, in consultation with the board, shall adopt model rules establishing the minimum standards for continuing education programs meeting the requirements of this section. The department shall consult with patients and communities with lived experience of health inequities or racism in the health care system, relevant professional organizations, and the board in the development of these rules.
(3) The minimum standards must include instruction on skills to address the structural factors, such as bias, racism, and poverty, that manifest as health inequities. These skills include individual-level and system-level intervention, and self-reflection to assess how the licensee’s social position can influence their relationship with patients and their communities. These skills enable a health care professional to care effectively for patients from diverse cultures, groups, and communities, varying in race, ethnicity, gender identity, sexuality, religion, age, ability, socioeconomic status, and other categories of identity. The courses must assess the licensee’s ability to apply health equity concepts into practice. Course topics may include, but are not limited to: (A) strategies for recognizing patterns of health care disparities on an individual, institutional, and structural level and eliminating factors that influence them; (B) intercultural communication skills training, including how to work effectively with an interpreter and how communication styles differ across cultures; (C) implicit bias training to identify strategies to reduce bias during assessment and diagnosis; (D) methods for addressing the emotional well-being of children and youth of diverse backgrounds; (E) ensuring equity and antiracism in care delivery pertaining to medical developments and emerging therapies; (F) structural competency training addressing five core competencies, which are: (i) recognizing the structures that shape clinical interactions; (ii) developing an extra clinical language of structure; (iii) rearticulating cultural formulations in structural terms; (iv) observing and imagining structural interventions; and (v) developing structural humility; and (G) cultural safety training.
(e) The board may adopt rules to implement and administer this section, including rules to establish a process to determine if a continuing education course meets the health equity continuing education requirement established in this section.
SECTION 42. Chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding after section 16D the following sections:-
Section 16E. (a) Notwithstanding any other law, there is hereby established a program of comprehensive health coverage for children and young adults under the age of 21 who are residents of the commonwealth, as defined under section 8 of this chapter, who are not otherwise eligible for comprehensive benefits under Title XIX or XXI of the Social Security Act or under the demonstration pursuant to Section 9A of this chapter solely due to their immigration status. Children and young adults shall be eligible to receive comprehensive MassHealth benefits equivalent to the benefits available to individuals of like age and income under categorical and financial eligibility requirements established by the executive office pursuant to said Title XIX and Title XXI.
(b) The executive office shall maximize federal financial participation for the benefits provided under this section, however benefits under this section shall not be conditioned on the availability of federal financial participation.
(c) The program shall be implemented no later than January 1, 2025.
Section 16F. (a) Notwithstanding any other law, there is hereby established a program of comprehensive health coverage for individuals who are residents of the commonwealth, as defined under section 8 of chapter 118E, who are not otherwise eligible for comprehensive benefits under Title XIX or XXI of the Social Security Act or under the demonstration pursuant to Section 9A of chapter 118E solely due to their immigration status, except in the case of children or young adults otherwise eligible for comprehensive health coverage pursuant to section 16E. Such individuals shall be eligible to receive comprehensive MassHealth benefits equivalent to the benefits available to individuals of like age and income under categorical and financial eligibility requirements established by the Executive Office pursuant to said Title XIX and Title XXI.
(b) The Executive Office shall maximize federal financial participation for the benefits provided under this section, provided, however, that benefits under this section shall not be conditioned on the availability of federal financial participation.
(c) The program shall be implemented no later than January 1, 2025.
SECTION 43. Paragraph (5) of section 36 of chapter 118E of the General Laws, as so appearing, is hereby amended by striking out, in line 14, “.” and inserting in place thereof the following:- ;.
SECTION 44. Said section 36 of said chapter 118E, as so appearing, is hereby amended by inserting after said paragraph (5) the following paragraphs:-
(6) with respect to institutional providers, agree to implement measurable diversity, equity, and inclusion initiatives (including recruitment, hiring, and retention); and
(7) with respect to institutional providers, agree to expand mental health and wellness benefits for employees.
SECTION 45. Section 76 of chapter 260 of the Acts of 2020 is hereby amended by striking out the words “Sections 63 and 69 are hereby repealed” and inserting in place thereof the following words:- Section 63 is hereby repealed.
SECTION 46. (a) Notwithstanding any general or special law to the contrary, there shall be established a program for cost-sharing eliminations for targeted high-value services, treatments and prescription drugs used to treat certain chronic conditions. In order to implement said program, the secretary of health and human services, in consultation with the secretary of equity, the commissioner of insurance, the commissioner of public health and the center for health information and analysis, shall identify one to three services, treatments and prescription drugs in total used to treat each of the following chronic conditions: diabetes, asthma, chronic obstructive pulmonary disease, hypertension, coronary artery disease, congestive heart failure, opioid use disorder, bipolar disorder, and schizophrenia.
In determining the targeted high-value services, treatments and prescription drugs, the secretary shall consider appropriate services, treatments and prescription drugs that are: (1) out-patient or ambulatory services, including medications, lab tests, procedures, and office visits, generally offered in the primary care or medical home setting; (2) of clear benefit, strongly supported by clinical evidence to be cost-effective; (3) likely to reduce hospitalizations or emergency department visits, or reduce future exacerbations of illness progression, or improve quality of life; (4) relatively low cost when compared to the cost of an acute illness or incident prevented or delayed by the use of the service, treatment or drug; and (5) at low risk for overutilization, abuse, addiction, diversion or fraud.
The secretary may further take into consideration other independent resources or models proven effective in reducing financial barriers to high-value care.
(b) Any policy, contract or certificate of health insurance subject to chapters 32A, 118E, 175, 176A, 176B, 176G or 176Q of the General Laws shall provide coverage for the identified services, treatments and prescription drugs. Such coverage shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible, pursuant to guidance from the secretary of health and human services, notwithstanding whether an identified service or treatment was delivered in-person or via telehealth (as defined in section 79(a) of chapter 118E). The commissioner of the division of insurance shall adopt any written policies, procedures or regulations necessary to implement said program.
(c) Every two years, the center for health information and analysis shall evaluate the effect of this section and update the targeted high-value services, treatments and prescription drugs specified pursuant to subsection (a). Said evaluation shall include the impact of this section on treatment adherence, incidence of related acute events, premiums and cost sharing, overall health, long-term health costs, and other issues that the center may determine necessary. The center may collaborate with an independent research organization to conduct said evaluation. The center shall file a report on its findings, which shall be filed with the clerks of the house of representatives and senate, the joint committee on public health, the joint committee on health care financing and the house and senate committees on ways and means.
(d) The program shall be implemented no later than January 1, 2026.
SECTION 47. The first sentence of the first paragraph of section 410 of chapter 159 of the Acts of 2000 is hereby amended by striking out “upgrade skills of certified nurse's aides and entry-level workers entry-level workers” and inserting in place thereof the following words:- in nursing homes and in safety net hospitals and other providers (as determined by the Corporation).
(b) The first sentence of the second paragraph of said section 410 of said chapter 159 is hereby amended by striking out “nursing homes or consortiums of nursing homes” and inserting in place thereof the following words:- nursing homes or consortiums of nursing homes, and safety net hospitals and other providers as determined by the Corporation.
SECTION 48. Notwithstanding any general or special law to the contrary, the commissioner of public health shall revise the licensing requirements under chapter 112 of the General Laws of foreign-trained health professionals to increase healthcare access in underserved areas of the commonwealth. Such revisions shall maintain licensure standards that are substantially similar to standards applicable to domestically-trained health professionals licensed under this chapter.
SECTION 49. Notwithstanding any general or special law to the contrary, the commissioner of public health, in consultation with the assistant secretary for MassHealth, shall develop standardized, tiered, and stackable credentials for certification of lower-wage positions furnishing services funded through the MassHealth program.
SECTION 50. (a) Notwithstanding any general or special law to the contrary, the secretary of health and human services or designee shall, subject to appropriation, provide funding, in consultation with the secretary of equity and commissioner of public health, to safety net hospitals and community-based providers with a high Medicaid payer mix (as determined by the secretary) to advance health equity and to address disparities in resources for facilities serving priority populations who predominantly rely on Medicaid. In providing such funding, the secretary shall prioritize safety net hospitals that: (1) have a high Medicaid payer mix; (2) have an average statewide average acute hospital commercial relative price of less than 0.90 (as calculated by the center for health information and analysis); and (3) are not a part of a large health system (as determined by the secretary). Such support may be used as the safety net hospital or community-based provider determines appropriate, including for such purposes as patient care operations, access, infrastructure, or capacity building.
(b) The executive office shall maximize federal financial participation for the funding under this section, provided, however, that funding under this section shall not be conditioned on the availability of federal financial participation.
SECTION 51. (a) Notwithstanding any general or special law to the contrary, the assistant secretary for MassHealth shall establish payment models that incentivize the integration of behavioral health, oral health, and pharmacy services in primary care settings under the MassHealth program.
(b) The executive office shall maximize federal financial participation for the benefits provided under this section, provided, however, that benefits under this section shall not be conditioned on the availability of federal financial participation.
SECTION 52. (a) Notwithstanding any general or special law to the contrary, the appointive boards and commissions of the commonwealth identified pursuant to subsection (b) shall, to the extent practicable, be composed of at least 50 percent women, and at least 25 percent Black, Indigenous, or other people of color. The appointing authorities for the board shall consult each other to ensure compliance with this provision.
(b) For purposes of subsection (a), the appointive boards and commissions of the commonwealth identified in this subsection are the following:
(1) the governing board of the health policy commission under section 2 of chapter 6D of the General Laws;
(2) the advisory board to the executive office of equity under section 5 of chapter 6F of the General Laws;
(3) the health information and analysis oversight council under section 2A of chapter 12C of the General Laws;
(4) the board of registration in medicine, the board of registration of nursing, and the board of certification of community health workers under sections 10, 13, and 108 of chapter 13 of the General Laws, respectively;
(5) the public health council under section 3 of chapter 17 of the General Laws; and
(6) any other board or commission under the supervision of the commissioner of public health that the commissioner determines appropriate.
SECTION 53. Sections 5, 8, 27, and 31 shall take effect 90 days after passage of this act.
SECTION 54. Sections 6, 7, 9, 10, 11, 12, 28, 34, 40, 43, 44, 47, 48, 49, and 52 shall take effect 180 days after passage of this act.
SECTION 55. Sections 29, 32, 33, and 51 shall take effect 1 year after passage of this act.
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Proposal for a legislative amendment to the Constitution relative to voting rights | S8 | SD1464 | 193 | {'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-01-19T13:57:33.887'} | [{'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-01-19T13:57:33.8866667'}, {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-01-19T16:36:56.1366667'}, {'Id': 'L_S1', 'Name': 'Lindsay N. Sabadosa', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L_S1', 'ResponseDate': '2023-01-20T15:43:25.28'}, {'Id': 'M_C1', 'Name': 'Mike Connolly', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/M_C1', 'ResponseDate': '2023-02-08T13:43:29.3733333'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-13T11:53:12.1666667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S8/DocumentHistoryActions | Proposal for Constitutional Amendment | By Ms. Miranda, a petition (accompanied by proposal, Senate, No. 8) of Liz Miranda, Adam Gomez and Lindsay N. Sabadosa for a legislative amendment to the Constitution relative to voting rights. Election Laws. | Article III of the Amendments to the Constitution, as amended, is hereby further amended by striking out the words “, excepting persons who are incarcerated in a correctional facility due to a felony conviction, and”, inserted by Article CXX of the Amendments to the Constitution.
| null | [] | [] | [{'Action': 'Favorable', 'FiscalAmounts': [], 'Committee': {'CommitteeCode': 'J15', 'GeneralCourtNumber': 193, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/Committees/J15'}, 'Votes': []}] | [] |
An Act creating an electronic backpack for foster children’s educational records | S80 | SD2076 | 193 | {'Id': 'RCF0', 'Name': 'Ryan C. Fattman', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RCF0', 'ResponseDate': '2023-01-18T19:06:08.01'} | [{'Id': 'RCF0', 'Name': 'Ryan C. Fattman', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RCF0', 'ResponseDate': '2023-01-18T19:06:08.01'}, {'Id': 'AUD7', 'Name': 'Diana Dizoglio', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AUD7', 'ResponseDate': '2023-01-20T12:53:07.8866667'}, {'Id': 'K_K1', 'Name': 'Kay Khan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/K_K1', 'ResponseDate': '2023-01-20T12:53:07.8866667'}, {'Id': 'DAL1', 'Name': 'David Henry Argosky LeBoeuf', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DAL1', 'ResponseDate': '2023-01-20T12:53:07.8866667'}, {'Id': 'BMA1', 'Name': 'Brian M. Ashe', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BMA1', 'ResponseDate': '2023-02-16T16:01:15.7333333'}, {'Id': 'JDM1', 'Name': 'Joseph D. McKenna', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JDM1', 'ResponseDate': '2023-02-16T16:01:15.7333333'}, {'Id': 'HEK1', 'Name': 'Hannah Kane', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/HEK1', 'ResponseDate': '2023-02-17T10:10:35.4033333'}, {'Id': 'AMG0', 'Name': 'Anne M. Gobi', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AMG0', 'ResponseDate': '2023-02-21T13:59:12.8166667'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-03-28T12:15:39.8533333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S80/DocumentHistoryActions | Bill | By Mr. Fattman, a petition (accompanied by bill, Senate, No. 80) of Ryan C. Fattman, Diana Dizoglio, Kay Khan, David Henry Argosky LeBoeuf and other members of the General Court for legislation to create an electronic backpack for foster children. Children, Families and Persons with Disabilities. | SECTION 1. Chapter 71 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting at the end thereof the following section:-
Section 98. (a) As used in this section, the following terms shall, unless the context requires otherwise, have the following meanings:-
“Department”, shall mean the department of elementary and secondary education..
“Foster child or youth”, shall mean a child under the care or custody of the department of children and families or a young adult who has signed a voluntary placement agreement with the department of children and families.
“Electronic backpack”, shall mean an electronic repository of a foster child or youth’s educational records.
(b) Notwithstanding any general or special law to the contrary, the commissioner of the department, in consultation with the office of the child advocate and the commissioner of the department of children and families, shall develop and implement an electronic backpack system for the educational stability of foster child or youth.
(c) The department shall create an electronic backpack for each foster child or youth. The department, in conjunction with the department of children and families, shall promulgate regulations on the format and function of the electronic backpack system. Each electronic backpack system shall contain, but is not limited to, the educational records of the foster child or youth, including the names and addresses of educational providers, the name and contact of the child’s DCF case worker if applicable, the foster child or youth’s grade-level performance, transcript, the foster child or youth’s school attendance records, individual education plan if applicable, the name and contact information of the individual or individuals who are designated as the child’s educational decision makers, the name of the legal guardian with signing rights to release the child from school, visit notes from the school nurse, guidance counselor, or other administrators, detailed notes on best interest determination meetings, if applicable, and any other educational information that the department requires. The department shall maintain the electronic backpack as part of the department’s records for the foster child or youth as long as the foster child or youth remains in foster care.
(d) The department shall make the electronic backpack available to:
(i) Any person authorized by law to make educational decisions for the foster child or youth;
(ii) The teacher/teachers, school and school district that the child or youth is enrolled in;
(iii) Any person authorized to consent to medical care for the foster child or youth; and
(iv) Any provider of medical care to the foster child or youth if access to the foster child or youth’s educational information is necessary for the provision of medical care and is not prohibited by law.
(e) The department shall collaborate with the department of children and families to develop policies and procedures to ensure that the needs of foster child or youths are met in every school district.
SECTION 2. The department shall implement the electronic backpack program within one year of the passage of this act.
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An Act relative to the fair treatment of life estates in MassHealth Eligibility | S800 | SD378 | 193 | {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-01-13T17:15:47.753'} | [{'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-01-13T17:15:47.7533333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S800/DocumentHistoryActions | Bill | By Ms. Rausch, a petition (accompanied by bill, Senate, No. 800) of Rebecca L. Rausch for legislation relative to the fair treatment of life estates in MassHealth Eligibility. Health Care Financing. | SECTION 1. Section 28 of chapter 118E of the general laws is hereby amended by adding at the end thereof the following:-
“In determining the eligibility of an individual who has disposed of a life estate or remainder interest in property, the Division shall determine the percentage interest of such life estate or remainder interest in accordance with federal internal revenue service regulations governing the valuation of annuities, interests for life or term of years, and remainder or reversionary interests”
SECTION 2. Section 31 of said chapter 118E is hereby amended in subsection (d) by inserting after the word “sold.” The following:-
“If the property against which the division has a lien or encumbrance is a life estate or remainder interest, the percentage interest against which the division may recover upon a sale shall be determined in accordance with federal internal revenue service regulations governing the valuation of annuities, interests for life or term of years, and remainder or reversionary interests”
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An Act strengthening health spending accountability processes within the health policy commission and the center for health information and analysis | S801 | SD1600 | 193 | {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-01-19T18:07:07.9'} | [{'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-01-19T18:07:07.9'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S801/DocumentHistoryActions | Bill | By Ms. Rausch, a petition (accompanied by bill, Senate, No. 801) of Rebecca L. Rausch for legislation to strengthen health spending accountability processes within the health policy commission and the center for health information and analysis. Health Care Financing. | SECTION 1. Chapter 6D of the General Laws is hereby amended by striking out section 10, as appearing in the 2020 Official Edition, and inserting in place thereof the following section:-
Section 10. (a) For the purposes of this section, “health care entity” shall mean any entity identified by the center under section 18 of chapter 12C.
(b) The commission shall provide notice to all health care entities that have been identified by the center under section 18 of chapter 12C. Such notice shall state that the commission may analyze the health care spending performance of individual health care entities and may require certain actions, as established in this section, from health care entities so identified.
(c) In addition to the notice provided under subsection (b), the commission may require any health care entity that is identified by the center under section 18 of chapter 12C to file a performance improvement plan with the commission. The commission shall provide written notice to such health care entity that they are required to file a performance improvement plan. Within 45 days of receipt of such written notice, the health care entity shall either: (1) file a performance improvement plan with the commission; or (2) file an application with the commission to waive or extend the requirement to file a performance improvement plan.
(d) The health care entity may file any documentation or supporting evidence with the commission to support the health care entity’s application to waive or extend the requirement to file a performance improvement plan. The commission shall require the health care entity to submit any other relevant information it deems necessary in considering the waiver or extension application; provided, however, that such information shall be made public at the discretion of the commission.
(e) The commission may waive or delay the requirement for a health care entity to file a performance improvement plan in response to a waiver or extension request filed under subsection (c) in light of all information received from the health care entity, based on a consideration of the following factors:
(1) the spending, price and utilization trends of the health care entity over time, and any demonstrated improvement to reduce spending or total medical expenses;
(2) any ongoing strategies or investments that the health care entity is implementing to improve future long-term efficiency and spending performance;
(3) whether the factors that led to increased spending for the health care entity can reasonably be considered to be unanticipated and outside of the control of the entity. Such factors may include, but shall not be limited to, age and other health status factors and other cost inputs such as pharmaceutical expenses and medical device expenses;
(4) the overall financial condition of the health care entity;
(5) a significant difference between the growth rate of potential gross state product and the growth rate of actual gross state product, as determined under section 7H 1/2 of chapter 29; and
(6) any other factors the commission considers relevant.
(f) If the commission declines to waive or extend the requirement for the health care entity to file a performance improvement plan, the commission shall provide written notice to the health care entity that its application for a waiver or extension was denied and the health care entity shall file a performance improvement plan.
(g) A health care entity shall file a performance improvement plan: (1) within 45 days of receipt of a notice under subsection (c); (2) if the health care entity has requested a waiver or extension, within 45 days of receipt of a notice that such waiver or extension has been denied; or (3) if the health care entity is granted an extension, on the date given on such extension. The performance improvement plan shall identify the causes of the entity's spending performance and shall include, but not be limited to, specific strategies, adjustments and action steps the entity proposes to implement to improve spending performance. The proposed performance improvement plan shall include specific identifiable and measurable expected outcomes and a timetable for implementation. The timetable for a performance improvement plan shall not exceed 18 months.
(h) The commission shall approve any performance improvement plan that it determines is reasonably likely to address the underlying cause of the entity's spending performance and has a reasonable expectation for successful implementation.
(i) If the board determines that the performance improvement plan is unacceptable or incomplete, the commission may provide consultation on the criteria that have not been met and may allow an additional time period, up to 30 calendar days, for resubmission.
(j) Upon approval of the proposed performance improvement plan, the commission shall notify the health care entity to begin immediate implementation of the performance improvement plan. Public notice shall be provided by the commission on its website, identifying that the health care entity is implementing a performance improvement plan. All health care entities implementing an approved performance improvement plan shall be subject to additional reporting requirements and compliance monitoring, as determined by the commission. The commission shall provide assistance to the health care entity in the successful implementation of the performance improvement plan.
(k) All health care entities shall, in good faith, work to implement the performance improvement plan. At any point during the implementation of the performance improvement plan the health care entity may file amendments to the performance improvement plan, subject to approval of the commission.
(l) At the conclusion of the timetable established in the performance improvement plan, the health care entity shall report to the commission regarding the outcome of the performance improvement plan. If the commission finds that the performance improvement plan was unsuccessful, the commission shall either: (i) extend the implementation timetable of the existing performance improvement plan; (ii) approve amendments to the performance improvement plan as proposed by the health care entity; (iii) require the health care entity to submit a new performance improvement plan under subsection (c); (iv) waive or delay the requirement to file any additional performance improvement plans or (v) assess a civil penalty to the health care entity of not more than the spending attributable to the health care entity that is in excess of the health care cost growth benchmark minus any savings achieved through the performance improvement plan. A civil penalty assessed under this subsection shall be deposited into the Payment Reform Fund established under section 100 of chapter 194 of the Acts of 2011.
(m) Upon the successful completion of the performance improvement plan, the identity of the health care entity shall be removed from the list of entities currently implementing a performance improvement plan on the commission's website.
(n) The commission may submit a recommendation for proposed legislation to the joint committee on health care financing if the commission determines that further legislative authority is needed to achieve the health care quality and spending sustainability objectives of this act, assist health care entities with the implementation of performance improvement plans, or otherwise ensure compliance with the provisions of this section.
(o) (1) If the commission determines that a health care entity has: (i) willfully neglected to file a performance improvement plan with the commission within 45 days as required under subsection (c); (ii) failed to file an acceptable performance improvement plan in good faith with the commission; (iii) failed to implement the performance improvement plan in good faith; or (iv) knowingly failed to provide information required by this section to the commission or that knowingly falsifies the same, the commission may assess a civil penalty to the health care entity of not more than the spending attributable to the health care entity that is in excess of the health care cost growth benchmark. A civil penalty assessed under this subsection shall be deposited into the Payment Reform Fund established under section 100 of chapter 194 of the Acts of 2011. The commission shall seek to promote compliance with this section and shall only impose a civil penalty as a last resort.
(2) For entities for whom the commission has required a performance improvement plan in the past, in lieu of requiring a performance improvement plan pursuant to this section, the commission may assess a civil penalty on a health care entity identified by the center pursuant to section 18 of chapter 12C if the commission determines that an additional performance improvement plan is not an appropriate remedial measure. The civil penalty may be an amount up to the spending attributable to the health care entity that is in excess of the health care cost growth benchmark and shall be deposited into the Payment Reform Fund established under section 100 of chapter 194 of the Acts of 2011.
(p) The commission shall promulgate regulations necessary to implement this section; provided, however, that notice of any proposed regulations shall be filed with the joint committee on state administration and regulatory oversight and the joint committee on health care financing at least 180 days before adoption.
SECTION 2. Section 13 of said chapter 6D, as so appearing, is hereby amended by striking out subsection (b) and inserting in place thereof the following subsection:-
(b) In addition to the grounds for a cost and market impact review set forth in subsection (a), if the commission finds, based on the center’s annual report, that the percentage change in total health care expenditures exceeded the health care cost growth benchmark in the previous calendar year, the commission may conduct a cost and market impact review of any provider or provider organization identified by the center under section 18 of chapter 12C.
SECTION 3. Chapter 12C of the General Laws is hereby amended by striking out section 18, as appearing in the 2020 Official Edition, and inserting in place thereof the following section:-
Section 18. The center shall perform ongoing analysis of data it receives under this chapter to identify any entity, including but not limited to payers, providers or provider organizations whose: (1) contribution to health care spending growth, including but not limited to spending levels and growth as measured by total medical expense, is considered excessive and who threaten the ability of the state to meet the health care cost growth benchmark established by the health policy commission under section 9 of chapter 6D; or (2) data is not submitted to the center in a proper, timely, or complete manner. The center shall provide a list of such entities to the health policy commission such that the commission may pursue further action under section 10 of chapter 6D and post such list on its website. Referrals under this section shall not preclude the center from using its authority under section 11 of this chapter.
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An Act to improve health care cost accountability | S802 | SD543 | 193 | {'Id': 'MFR0', 'Name': 'Michael F. Rush', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MFR0', 'ResponseDate': '2023-01-12T13:42:24.357'} | [{'Id': 'MFR0', 'Name': 'Michael F. Rush', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MFR0', 'ResponseDate': '2023-01-12T13:42:24.3566667'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-01-31T15:17:23.68'}, {'Id': 'P_M1', 'Name': 'Paul McMurtry', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/P_M1', 'ResponseDate': '2023-02-08T12:47:02.23'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S802/DocumentHistoryActions | Bill | By Mr. Rush, a petition (accompanied by bill, Senate, No. 802) of Michael F. Rush, Vanna Howard and Paul McMurtry for legislation to improve health care cost accountability. Health Care Financing. | SECTION 1. Section 1 of Chapter 224 6D of the Acts of 2012 is amended by adding the following:-
“Weighted Average Payer Rate” or “WAPR”, a measure by which a sum of the inpatient revenue per discharge and outpatient revenue per visit is separately calculated for Commercial, Medicare, and Medicaid. A weighted average of the three resulting values is derived, with the Net Patient Service Revenue - based payer mix of the three payers serving as weights.
SECTION 2. Section 8(a) of Chapter 224 6D of the Acts of 2012 is amended by striking out Section 8(a) and adding the following
(a) Not later than October 1 of every year, the commission shall hold public hearings based on the report submitted by the center for health information and analysis under section 16 of chapter 12C comparing the growth in total health care expenditures to the health care growth benchmark for the previous calendar year. The hearings shall examine health care provider, provider organization, and private and public health care payer costs, prices, weighted average payer rates, and cost trends, with particular attention to factors that contribute to cost growth within the commonwealth’s health care system.
SECTION 3. Section 8(e) of Chapter 224 6D of the Acts of 2012 is amended by striking out Section 8(e)(i) and adding the following
(i) in the case of providers and provider organizations, testimony concerning payment systems, care delivery models, payer mix, cost structures, administrative and labor costs, capital and technology cost, adequacy of public payer reimbursement levels, reserve levels, utilization trends, relative price, weighted average payer rate, quality improvement and care-coordination strategies, investments in health information technology, the relation of private payer reimbursement levels to public payer reimbursements for similar services, efforts to improve the efficiency of the delivery system, efforts to reduce the inappropriate or duplicative use of technology and the impact of price transparency on prices
SECTION 4. Section 13(d) of Chapter 224 6D of the Acts of 2012 is amended by striking out Section 10(d)(v) and adding the following
(v) provider cost and cost trends including the weighted average payer rate in comparison to total health care expenditures statewide
SECTION 5. Section 13(d) of Chapter 224 6D of the Acts of 2012 is amended by striking out Section 13(d)(xii) and adding the following
(xii) the weighted average payer rate paid to each acute hospital and physician organization; (xiii) any other factors that the commission determines to be in the public interest.
SECTION 6. Section 1 of Chapter 224 12C of the Acts of 2012 is amended by inserting the following
“Weighted Average Payer Rate” or “WAPR”, a measure by which a sum of the inpatient revenue per discharge and outpatient revenue per visit is separately calculated for Commercial, Medicare, and Medicaid. A weighted average of the three resulting values is derived, with the Net Patient Service Revenue- based payer mix of the three payers serving as weights.
SECTION 7. Section 10(b) of Chapter 224 12C of the Acts of 2012 is amended by inserting following section
(12) the weighted average payer rate paid to each acute care hospital and physician organization
SECTION 8. Section 16(a) of Chapter 224 12C of the Acts of 2012 is amended by adding the following after the words “patient centered medical homes.”
(6) the weighted average payer rate paid to each acute care hospital, and physician organization, respectively.
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An Act relative to health care non-discrimination | S803 | SD544 | 193 | {'Id': 'MFR0', 'Name': 'Michael F. Rush', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MFR0', 'ResponseDate': '2023-01-12T13:42:41.56'} | [{'Id': 'MFR0', 'Name': 'Michael F. Rush', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MFR0', 'ResponseDate': '2023-01-12T13:42:41.56'}, {'Id': 'P_M1', 'Name': 'Paul McMurtry', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/P_M1', 'ResponseDate': '2023-02-08T12:47:06.1233333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S803/DocumentHistoryActions | Bill | By Mr. Rush, a petition (accompanied by bill, Senate, No. 803) of Michael F. Rush and Paul McMurtry for legislation relative to health care non-discrimination. Health Care Financing. | SECTION 1. Chapter 176O of the General Laws is amended by adding the following Section.
Section 28. (a) When establishing alternative payment arrangements, a carrier may take into account patient population characteristics including age, acuity, social determinants of health, and behavioral health service needs. The measures of total medical expense used to establish an alternative payment arrangement should include expenses incurred by all providers in the carrier’s provider network, uniformly applied by provider type. When establishing alternative payment arrangements, a carrier shall not take into account provider prices or historic medical spending attributable only to a subset of its provider network or the historic medical expenses of members based on their attribution to specific providers in the carrier’s network.
(b) In addition to the factors set forth in subsection (a) of this section, an alternative payment arrangement may include adjustments for claims processing and administrative costs and incentive payments based on attainment of quality measures or outcomes, as negotiated between a carrier and providers participating in the alternative payment arrangement.
(c) Each carrier shall file with the center for health information and analysis data on its alternative payment arrangements sufficient for the verification of compliance with subsection (a) of this section, in a form determined by the center for health information and analysis.
(d) A violation of subsection (a) or (c) of this section shall be a violation of chapter 93A of the general laws.
SECTION 2. Chapter 176O is amended by adding the following definition after the definition of adverse determination:
“Alternative payment arrangement” means a contract between a carrier and a health care provider or group of providers under which payment is made by capitation, shared savings, reconciliation of fee-for-service payments against a global budget or per-member-per month target, or any other method that bases payments to the provider on a projection of the medical expenses to be incurred by a population of individuals.
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An Act to strengthen the management of the health care connector | S804 | SD83 | 193 | {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-10T14:35:45.873'} | [{'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-10T14:35:45.8733333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S804/DocumentHistoryActions | Bill | By Mr. Tarr, a petition (accompanied by bill, Senate, No. 804) of Bruce E. Tarr for legislation to strengthen the management of the health care connector. Health Care Financing. | SECTION 1. Section 2 of Chapter 176Q of the General Laws is hereby amended by striking subsection (b) in its entirety and replacing it with the following:-
(b) There shall be a board, with duties and powers established by this chapter, which shall govern the connector. The connector board shall consist of 13 members: the secretary for administration and finance, or a designee, who shall serve as chairperson; the director of Medicaid or a designee; the commissioner of insurance or a designee; the executive director of the group insurance commission; 6 members appointed by the governor, 1 of whom shall be a member in good standing of the American Academy of Actuaries, 1 of whom shall be a health economist, 1 of whom shall represent the interests of small businesses, 2 of whom shall be from organizations representing employers, and 1 of whom shall be a member of the Massachusetts chapter of the National Association of Health Underwriters; and 3 members appointed by the attorney general, 1 of whom shall be an employee health benefits plan specialist, 1 of whom shall be a representative of a health consumer organization and 1 of whom shall be a representative of organized labor. No appointee shall be an employee of any licensed carrier authorized to do business in the commonwealth. All appointments shall serve a term of 3 years, but a person appointed to fill a vacancy shall serve only for the unexpired term. An appointed member of the board shall be eligible for reappointment. The board shall annually elect 1 of its members to serve as vice-chairperson.
SECTION 2. Said Chapter 176Q, as so appearing, is hereby amended by inserting after section 18 the following two new sections:-
176Q:19 Health Connector Transparency
Section 19. The connector shall be subject to the open meeting law as established under G.L.c. 30A, §§18-25 and subject to public records request as established under G.L.c. 66. A public record for purposes of this section shall include but not be limited to board votes, meeting minutes, financial records, contract, and staff salaries. This information shall also be made publicly available on the website of the connector.
176Q:20 Return on Investment
Section 20. The secretary of administration and finance shall on an annual basis review and evaluate the return on investments made by the connector. Said review and evaluation along with any recommendations shall be filed with the clerks of the house and senate, the house and senate committee on ways, and joint committee on health care financing no later than December 31 annually.
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An Act relative to association health plans | S805 | SD84 | 193 | {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-10T14:36:21.607'} | [{'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-10T14:36:21.6066667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S805/DocumentHistoryActions | Bill | By Mr. Tarr, a petition (accompanied by bill, Senate, No. 805) of Bruce E. Tarr for legislation relative to association health plans. Health Care Financing. | Nothwithstanding any general or special rule to the contrary to the maximum extent allowed by federal law a Multiple Employer Welfare Arrangement or Association Health Plan shall be allowed to operate in the Commonwealth, provided that it meets the following requirements:
1. The arrangement shall at all times be in compliance with federal law and regulation, including but not limited to the US Department of Labor’s regulations regarding Association Health Plans.
2. The arrangement’s governing documents shall require the arrangement to be actuarially sound, and the arrangement shall in fact be actuarially sound.
3. The arrangement shall be conducted in accordance with (insert citation to state rules regarding fraud, trade practices, and other behavioral requirements).
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An Act establishing a healthcare insurance premium payment pool for working families | S806 | SD88 | 193 | {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-10T14:39:18.353'} | [{'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-10T14:39:18.3533333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S806/DocumentHistoryActions | Bill | By Mr. Tarr, a petition (accompanied by bill, Senate, No. 806) of Bruce E. Tarr for legislation to establish a healthcare insurance premium payment pool for working families. Health Care Financing. | SECTION 1. Section 3 of chapter 176Q of the General Laws is hereby amended by inserting at the end thereof the following new subsection:-
(w) to facilitate a private sector method for the collection of health insurance premium payments made for a health benefit plan by multiple payers, including the policyholder, one or more employers of one or more individuals covered by the policy, government programs, and others by educating employers and insurers about collection services available through a vendor(s).
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An Act empowering patients and entrepreneurs with real transparency on cost | S807 | SD93 | 193 | {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-10T14:44:47.92'} | [{'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-10T14:44:47.92'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S807/DocumentHistoryActions | Bill | By Mr. Tarr, a petition (accompanied by bill, Senate, No. 807) of Bruce E. Tarr for legislation to empower patients and entrepreneurs with real transparency on cost. Health Care Financing. | SECTION 1. Section 10 of said chapter 12C, as so appearing, is hereby amended by striking out subsection (e) and inserting in place thereof the following:- (e) The center shall under the procedures established by Medicare release at least annually all hospital data including payment and utilization information for services that may be provided in connection with at least the 100 most common inpatient stays. The center may release claims data on at least the 10 most expensive kinds of inpatient stays on average by payer. The center shall release claims data on the 100 most common outpatient procedures. The center may release claims data on the 10 most expensive kinds of outpatient procedures. The center shall release physician, practitioner, and other supplier utilization and payment data that consists of information on services and procedures provided to patients by physicians and other healthcare professionals. The data shall show at least allowed amounts and submitted charges, for those services and procedures by provider. It should allow for comparisons by physician, specialty, location, types of medical services and procedures delivered, payment and submitted charges. Claims for providers that have provided less than five of a certain procedures or service to patients may be excluded by the center. The center shall release claims data on the 100 most commonly prescribed drugs, and the 10 most expensive drugs on average by payer. The center may release any other related claims data the center already collects as part of the categories listed above.
The center shall not be required to build a consumer tool to sort the date, but at a minimum must make it available to the public on their website on an annual basis in a raw but useable form. The center may also incorporate any of the released data listed above into their consumer health information website as established in section 20 of chapter 12C.
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An Act relative to spouses as caregivers | S808 | SD697 | 193 | {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-17T18:12:04.947'} | [{'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-17T18:12:04.9466667'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-03-06T11:06:07.3066667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S808/DocumentHistoryActions | Bill | By Mr. Tarr, a petition (accompanied by bill, Senate, No. 808) of Bruce E. Tarr and Michael D. Brady for legislation relative to spouses as caregivers. Health Care Financing. | SECTION 1. Notwithstanding any general or special law to the contrary, the Secretary of Health and Human Services in conjunction with the Secretary of Elder Affairs shall file an application to seek a waiver with the Center for Medicaid and Medicare Services (CMS) to amend the Commonwealth of Massachusetts’ 1915(c) elderly waiver, and that any program of home and community based services in which family members are permitted to serve as paid caregivers, funded pursuant to Section 9 of Chapter 118E shall include spouses within the definition of a family member.
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An Act to stabilize adult day health services | S809 | SD700 | 193 | {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-17T18:34:23.313'} | [{'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-17T18:34:23.3133333'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-02-05T20:21:17.0333333'}, {'Id': 'BRF0', 'Name': 'Barry R. Finegold', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BRF0', 'ResponseDate': '2023-02-05T20:21:17.0333333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S809/DocumentHistoryActions | Bill | By Mr. Tarr, a petition (accompanied by bill, Senate, No. 809) of Bruce E. Tarr, Michael O. Moore and Barry R. Finegold for legislation to stabilize adult day health services. Health Care Financing. | SECTION 1. Chapter 118 E, Section 13C is hereby amended by inserting at the end thereof the
following:
The secretary of the executive office shall have the responsibility for establishing rates of payment for by efficiently and economically operated Adult Day Health Service providers in providing Adult Day Health Services in conformity with federal and state law, regulations and quality and safety standards; provided, that the secretary may designate another governmental unit to perform such ratemaking functions.
When establishing rates of payment for Adult Day Health Services, the secretary of the executive office shall adjust rates to
take into account factors, including, but not limited to:
(i) the reasonable cost to Adult Day Health Service providers of any existing or new governmental mandate that has been enacted, promulgated or imposed by any governmental unit or federal governmental authority;
(ii) a cost adjustment actor, to reflect changes in reasonable costs of goods, services, and transportation, of Adult Day
Health programs including those attributed to wages and benefits, which shall not be less than the HCP CPI;
(iii) establishing wages and benefits comparable to direct care staff in other health care settings;
(iv) individual ADH Provider differences in real estate and capital costs, including rent, furniture, fixtures, and equipment, and any other capital costs.
SECTION 2. Chapter 118E, Section 13D is amended after the second paragraph by inserting the
following:
Such rates for Adult Day Services shall be established as of July 1 biennially.
SECTION 3. Chapter 118E, Section 13D is amended by inserting at the end thereof the following:
Notwithstanding the provisions of any general or special law to the contrary, MassHealth shall reimburse Adult Day Health Programs to reserve a program slot for members for up to 20 medical leave-of-absence days per year and for up to 10 non-medical leave-of-absence annually; provided further, that no Adult Day Health Programs shall reassign a participant’s slot during a leave of absence that is eligible for reimbursement under this section a medical leave of absence shall include any medically necessary absence on a schedule day, a non-medical leave of absence shall include any other absence on a scheduled day.
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An Act requiring licensure for use of graduated electronic decelerators | S81 | SD1146 | 193 | {'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-01-17T11:15:24.49'} | [{'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-01-17T11:15:24.49'}, {'Id': 'HEK1', 'Name': 'Hannah Kane', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/HEK1', 'ResponseDate': '2023-01-25T20:49:24.5933333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S81/DocumentHistoryActions | Bill | By Mr. Feeney, a petition (accompanied by bill, Senate, No. 81) of Paul R. Feeney and Hannah Kane for legislation relative to licensure for the use of graduated electronic decelerators to alter behavior of persons with disabilities. Children, Families and Persons with Disabilities. | SECTION 1. Chapter 32A of the General Laws, as appearing in the 2020 Official edition, is hereby amended by inserting after section 17R the following section:-
Section 17S. (a) For purposes of this section, the following terms shall have the following meanings:-
“Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen, brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain injury.
“Cognitive communication therapy” treats problems with communication which have an underlying cause in a cognitive deficit rather than a primary language or speech deficit.
“Cognitive rehabilitation therapy (CRT)” is a process of re-learning cognitive skills essential for daily living through the coordinated specialized, integrated therapeutic treatments which are provided in dynamic settings designed for efficient and effective re-learning following damage to brain cells or brain chemistry due to brain injury.
“Community reintegration services” provide incremental guided real-world therapeutic training to develop skills essential for an individual to participate in life: to re-enter employment; to go to school and engage in other productive activity; to safely live independently; and to participate in their community while avoiding re-hospitalization and long-term support needs.
“Functional rehabilitation therapy and remediation” is a structured approach to rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a specific task in a prescribed format, with maximum opportunity for repeated correct practice. Compensatory strategies are developed for those skills which are persistently impaired and individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-learning those skills essential for safe daily living in the environment in which they will be used: home and community settings.
“Medical necessity” or “medically necessary,” health care services that are consistent with generally accepted principles of professional medical practice.
“Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments focused on behavioral impairments associated with brain disease or injury and the amelioration of these impairments through the development of pro-social behavior.
“Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is in cognitive function which has not been present since birth and is a decline from a previously attained level of function.
“Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a form of biofeedback whereby a patient can learn to control brain activity that is measured and recorded by an electroencephalogram.
“Neuropsychological testing” is a set of medical and therapeutic assessment and treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits caused by brain injury.
“Psychophysiological testing and treatment” is a set of medical and therapeutic assessment and treatments focused on psychophysiological disorders or physical disorders with psychological overlay.
“Post-acute residential treatment” includes integrated medical and therapeutic services, treatment, education, and skills training within a 24/7 real-world environment of care- a home and community setting. Maximum opportunity to for correct practice of skill in the context of use develops new neural pathways which ensure ongoing skill use and avoidance of re-hospitalization and long term care.
(b) Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for medically necessary treatment related to or as a result of an acquired brain injury. Medically necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral, neurophysiological, neuropsychological and psychophysiological testing and treatment; neurofeedback therapy; functional rehabilitation therapy and remediation; community reintegration services; post-acute residential treatment services; inpatient services; outpatient and day treatment services; home and community based treatment. The benefits in this section shall not include any lifetime limitation or unreasonable annual limitation of the number of days or sessions of treatment services. Any limitations shall be separately stated by the commission. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket limits than any other benefit provided by the commission.
(c) The commissioner of insurance shall require a health benefit plan issuer to provide adequate training to personnel responsible for preauthorization of coverage or utilization review for services under this section, in consultation with the Brain Injury Association of Massachusetts.
(d) Individual practitioners and treatment facilities shall be qualified to provide acute care and post-acute care rehabilitation services through possession of the appropriate licenses, accreditation, training and experience deemed customary and routine in the trade practice.
SECTION 2. Chapter 175 of the General Laws, as so appearing, is hereby amended by inserting after section 47KK, the following section:-
Section 47LL. (a) For purposes of this section, the following terms shall have the following meanings:-
“Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen, brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain injury.
“Cognitive communication therapy” treats problems with communication which have an underlying cause in a cognitive deficit rather than a primary language or speech deficit.
“Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills essential for daily living through the coordinated specialized, integrated therapeutic treatments which are provided in dynamic settings designed for efficient and effective re-learning following damage to brain cells or brain chemistry due to brain injury.
“Community reintegration services” provide incremental guided real-world therapeutic training to develop skills essential for an individual to participate in life: to re-enter employment; to go to school and engage in other productive activity; to safely live independently; and to participate in their community while avoiding re-hospitalization and long-term support needs.
“Functional rehabilitation therapy and remediation” is a structured approach to rehabilitation for brain disorders which emphasizes learning by doing, and focuses relearning a specific task in a prescribed format, with maximum opportunity for repeated correct practice. Compensatory strategies are developed for those skills which are persistently impaired and individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-learning those skills essential for safe daily living in the environment in which they will be used: home and community settings.
“Medical necessity” or “medically necessary,” health care services that are consistent with generally accepted principles of professional medical practice.
“Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments focused on behavioral impairments associated with brain disease or injury and the amelioration of these impairments through the development of pro-social behavior.
“Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is in cognitive function which has not been present since birth and is a decline from a previously attained level of function.
“Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a form of biofeedback whereby a patient can learn to control brain activity that is measured and recorded by an electroencephalogram.
“Neuropsychological testing” is a set of medical and therapeutic assessment and treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits caused by brain injury.
“Psychophysiological testing and treatment” is a set of medical and therapeutic assessment and treatments focused on psychophysiological disorders or physical disorders with psychological overlay.
“Post-acute residential treatment” includes integrated medical and therapeutic services, treatment, education, and skills training within a 24/7 real-world environment of care - a home and community setting. Maximum opportunity for correct practice of skill in the context of use develops new neural pathways which ensure ongoing skill use and avoidance of re-hospitalization and long term care.
(b) The following shall provide coverage for medically necessary treatment related to or as a result of an acquired brain injury: (ii)any policy of accident and sickness insurance, as described in section 108, which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in subdivision (A), (C) or (D) of section 110 which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder in or outside of the commonwealth; or (iii) any employees’ health and welfare fund which provides hospital expense and surgical expense benefits and which is delivered, issued or renewed to any person or group of persons in the commonwealth. Medically necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral, neurophysiological, neuropsychological and psychophysiological testing and treatment; neurofeedback therapy; functional rehabilitation therapy and remediation; community reintegration services; post-acute residential treatment services; inpatient services; outpatient and day treatment services; home and community based treatment. The benefits in this section shall not include any lifetime limitation or unreasonable annual limitation of the number of days or sessions of treatment services. Any limitations shall be separately stated by the insurer. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket limits than any other benefit provided by the insurer.
(c) The commissioner of insurance shall require a health benefit plan issuer to provide adequate training to personnel responsible for preauthorization of coverage or utilization review for services under this section, in consultation with the Brain Injury Association of Massachusetts.
(d) Individual practitioners and treatment facilities shall be qualified to provide acute care and post-acute care rehabilitation services through possession of the appropriate licenses, accreditation, training and experience deemed customary and routine in the trade practice.
SECTION 3. Chapter 176A of the General Law, as so appearing, is hereby amended by inserting after section 8MM the following section:-
Section 8NN. (a) For purposes of this section, the following terms shall have the following meanings:-
“Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen, brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain injury.
“Cognitive communication therapy” treats problems with communication which have an underlying cause in a cognitive deficit rather than a primary language or speech deficit.
“Cognitive rehabilitation therapy (CRT)” is a process of re-learning cognitive skills essential for daily living through the coordinated specialized, integrated therapeutic treatments which are provided in dynamic settings designed for efficient and effective re-learning following damage to brain cells or brain chemistry due to brain injury.
“Community reintegration services” provide incremental guided real-world therapeutic training to develop skills essential for an individual to participate in life: to re-enter employment; to go to school and engage in other productive activity; to safely live independently; and to participate in their community while avoiding re-hospitalization and long term support needs.
“Functional rehabilitation therapy and remediation” is a structured approach to rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a specific task in a prescribed format with maximum opportunity for repeated correct practice. Compensatory strategies are developed for those skills which are persistently impaired and individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-learning those skills essential for safe daily living in the environment in which they will be used: home and community settings.
“Medical necessity” or “medically necessary,” health care services that are consistent with generally accepted principles of professional medical practice.
“Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments focused on behavioral impairments associated with brain disease or injury and the amelioration of these impairments through the development of pro-social behavior.
“Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is in cognitive function which has not been present since birth and is a decline from a previously attained level of function.
“Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a form of biofeedback whereby a patient can learn to control brain activity that is measured and recorded by an electroencephalogram.
“Neuropsychological testing” is a set of medical and therapeutic assessment and treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits caused by brain injury.
“Psychophysiological testing and treatment” is a set of medical and therapeutic assessment and treatments focused on psychophysiological disorders or physical disorders with psychological overlay.
“Post-acute residential treatment” includes integrated medical and therapeutic services, treatment, education, and skills training within a 24/7 real-world environment of care- a home and community setting. Maximum opportunity for correct practice of skill in the context of use develops new neural pathways which ensure ongoing skill use and avoidance of re-hospitalization and long term care.
(b) Any contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth shall provide coverage for medically necessary treatment related to or as a result of an acquired brain injury. Medically necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral, neurophysiological, neuropsychological and psychophysiological testing and treatment; neurofeedback therapy; functional rehabilitation therapy and remediation; community reintegration services; post-acute residential treatment services; inpatient services; outpatient and day treatment services; home and community based treatment. The benefits in this section shall not include any lifetime limitation or unreasonable annual limitation of the number of days or sessions of treatment services. Any limitations shall be separately stated by the insurer. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket limits than any other benefit provided by the insurer.
(c) The commissioner of insurance shall require a health benefit plan issuer to provide adequate training to personnel responsible for preauthorization of coverage or utilization review for services under this section, in consultation with the Brain Injury Association of Massachusetts.
(d) Individual practitioners and treatment facilities shall be qualified to provide acute care and post-acute care rehabilitation services through possession of the appropriate licenses, accreditation, training and experience deemed customary and routine in the trade practice.
SECTION 4. Chapter 176B of the General Laws, as so appearing, is hereby amended by inserting after section 4MM the following section:-
Section 4NN. (a) For purposes of this section, the following terms shall have the following meanings:-
“Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen, brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain injury.
“Cognitive communication therapy” treats problems with communication which have an underlying cause in a cognitive deficit rather than a primary language or speech deficit.
“Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills essential for daily living through the coordinated specialized, integrated therapeutic treatments which are provided in dynamic settings designed for efficient and effective re-learning following damage to brain cells or brain chemistry due to brain injury.
“Community reintegration services” provide incremental guided real-world therapeutic training to develop skills essential for an individual to participate in life: to re-enter employment; to go to school and engage in other productive activity; to safely live independently; and to participate in their community while avoiding re-hospitalization and long term support needs.
“Functional rehabilitation therapy and remediation” is a structured approach to rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a specific task in a prescribed format, with maximum opportunity for repeated correct practice. Compensatory strategies are developed for those skills which are persistently impaired and individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-learning those skills essential for safe on daily living in the environment in which they will be used: home and community settings.
“Medical necessity” or “medically necessary,” health care services that are consistent with generally accepted principles of professional medical practice.
“Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments focused on behavioral impairments associated with brain disease or injury and the amelioration of these impairments through the development of pro-social behavior.
“Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is in cognitive function which has not been present since birth and is a decline from a previously attained level of function.
“Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a form of biofeedback whereby a patient can learn to control brain activity that is measured and recorded by an electroencephalogram.
“Neuropsychological testing” is a set of medical and therapeutic assessment and treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits caused by brain injury;
“Psychophysiological testing and treatment” is a set of medical and therapeutic assessment and treatments focused on psychophysiological disorders or physical disorders with psychological overlay.
“Post-acute residential treatment” includes integrated medical and therapeutic services, treatment, education, and skills training within a 24/7 real-world environment of care, – a home and community setting. Maximum opportunity for correct practice of skill in the context of use develops new neural pathways which ensure ongoing skill use and avoidance of re-hospitalization and long term care.
(b) Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for medically necessary treatment related to or as a result of an acquired brain injury. Medically necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral, neurophysiological, neuropsychological and psychophysiological testing and treatment; neurofeedback therapy; functional rehabilitation therapy and remediation; community reintegration services; post-acute residential treatment services; inpatient services; outpatient and day treatment services; home and community based treatment. The benefits in this section shall not include any lifetime limitation or unreasonable annual limitation of the number of days or sessions of treatment services. Any limitations shall be separately stated by the insurer. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket limits than any other benefit provided by the insurer.
(c) The commissioner of insurance shall require a health benefit plan issuer to provide adequate training to personnel responsible for preauthorization of coverage or utilization review for services under this section, in consultation with the Brain Injury Association of Massachusetts.
(d) Individual practitioners and treatment facilities shall be qualified to provide acute care and post-acute care rehabilitation services through possession of the appropriate licenses, accreditation, training and experience deemed customary and routine in the trade practice.
SECTION 5. Chapter 176G of the General Laws, as so appearing, is hereby amended by inserting after section 4EE the following section:-
Section 4FF. (a) For purposes of this section, the following terms shall have the following meanings:-
“Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen, brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain injury.
“Cognitive communication therapy” treats problems with communication which have an underlying cause in a cognitive deficit rather than a primary language or speech deficit.
“Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills essential for daily living through the coordinated specialized, integrated therapeutic treatments which are provided in dynamic settings designed for efficient and effective re-learning following damage to brain cells or brain chemistry due to brain injury.
“Community reintegration services” provide incremental guided real-world therapeutic training to develop skills essential for an individual to participate in life: to re-enter employment; to go to school or engage in other productive activity; to safely live independently; and to participate in their community while avoiding re-hospitalization and long term support needs.
“Functional rehabilitation therapy and remediation” is a structured approach to rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a specific task in a prescribed format, with maximum opportunity for repeated correct practice. Compensatory strategies are developed for those skills which are persistently impaired and individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-learning those skills essential for safe daily living in the environment in which they will be used: home and community settings.
“Medical necessity” or “medically necessary,” health care services that are consistent with generally accepted principles of professional medical practice.
“Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments focused on behavioral impairments associated with brain disease or injury and the amelioration of these impairments through the development of pro-social behavior.
“Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is in cognitive function which has not been present since birth and is a decline from a previously attained level of function.
“Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a form of biofeedback whereby a patient can learn to control brain activity that is measured and recorded by an electroencephalogram.
“Neuropsychological testing” is a set of medical and therapeutic assessment and treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits caused by brain injury.
“Psychophysiological testing and treatment” is a set of medical and therapeutic assessment and treatments focused on psychophysiological disorders or physical disorders with psychological overlay.
“Post-acute residential treatment” includes integrated medical and therapeutic services, treatment, education, and skills training within a 24/7 real-world environment of care– a home and community setting. Maximum opportunity for correct practice of skill in the context of use develops new neural pathways which ensure ongoing skill use and avoidance of re-hospitalization and long term care.
(b) Any individual or group health maintenance contract shall provide coverage for medically necessary treatment related to or as a result of an acquired brain injury. Medically necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral, neurophysiological, neuropsychological and psychophysiological testing and treatment; neurofeedback therapy; functional rehabilitation therapy and remediation; community reintegration services; post-acute residential treatment services; inpatient services; outpatient and day treatment services; home and community based treatment. The benefits in this section shall not include any lifetime limitation or unreasonable annual limitation of the number of days or sessions of treatment services. Any limitations shall be separately stated by the insurer. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket limits than any other benefit provided by the insurer.
(c) The commissioner of insurance shall require a health benefit plan issuer to provide adequate training to personnel responsible for preauthorization of coverage or utilization review for services under this section, in consultation with the Brain Injury Association of Massachusetts.
(d) Individual practitioners and treatment facilities shall be qualified to provide acute care and post-acute care rehabilitation services through possession of the appropriate licenses, accreditation, training and experience deemed customary and routine in the trade practice.
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An Act ensuring temporary nursing service agency quality | S810 | SD2389 | 193 | {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-20T16:33:42.873'} | [{'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-01-20T16:33:42.8733333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S810/DocumentHistoryActions | Bill | By Mr. Tarr, a petition (accompanied by bill, Senate, No. 810) of Bruce E. Tarr for legislation to ensure temporary nursing service agency quality. Health Care Financing. | SECTION 1. Section 13D of Chapter 118E, as appearing in the Massachusetts General Laws 2020 Edition, is hereby amended by striking paragraph 7 and replacing it with the following new paragraph
In establishing rates for nursing pools under section 72Y of chapter 111, the executive office shall establish annually the limit for the rate for service provided by nursing pools to licensed facilities. The executive office shall establish industry-wide class rates for such services and shall establish separate class rates for services provided to nursing facilities and hospitals. The executive office shall establish separate rates for registered nurses, licensed practical nurses and certified nursing assistants. The executive office may establish rates by geographic region. The rates shall include an allowance for wages, payroll taxes and fringe benefits, which shall be based upon, and shall not exceed, median wages, payroll taxes and fringe benefits paid to permanent medical personnel of the same type at health care facilities in the same geographic region. The rates shall also include an allowance for reasonable administrative expenses and a reasonable profit factor, as determined by the executive office. The executive office may exempt from the rates certain categories, as defined by the executive office, of fixed-term employees that work exclusively at a particular health care facility for a period of at least 90 days and for whose services there is a contract between a facility and a nursing pool registered with the department of public health. The maximum rates shall be no higher than 130% of the average hourly base rate for regular registered nurses, licensed practical nurses and certified nursing assistants. The executive office shall establish procedures by which nursing pools shall submit cost reports, which may be subject to audit, to the executive office to establish rates. The executive office shall determine the nursing pool rate contained in this paragraph by considering wage and benefit data collected from cost reports received from nursing pools and from health care facilities and other relevant information gathered through other collection tools or reasonable methodologies. For purposes of quality, accountability and transparency, the executive office shall annually ensure that temporary nursing service agencies are (1) meeting their obligation to provide temporary personal work consistent with the requirements of the Department of Public Health regulation at 105 CMR 157.00 and (2) assigning staff in conformance with Department of Public Health regulations, including CMR 105 CMR 157.00. The executive office shall establish a Temporary Nursing Service Agency Performance Report Card and make this information publicly available on the Internet as a means to increase the reliability of evaluating a temporary nursing services agency before a medical provider contracts for its services. The temporary nurse services agency shall be responsible for any employees scheduled to work and fail to work due by providing replacement staff to ensure that shifts are covered. The Department of Public Health shall subject temporary nursing services agency to periodic audits, surveys, and cost reports. Temporary nursing service agencies shall not have more than 5 percent in overhead costs and shall not make more than 5% in profit. The Performance Report Card shall include, but not be limited to: (a) auditing whether the temporary nursing service agencies are adhering to the reporting standards of conduct for nurses set forth at 244 CMR 9.03, Standards of Conduct for Nurses, and (b) assessing performance of nursing pool personnel assigned to facilities including at a minimum: (i) review and response to facility complaints; (ii) record of staff reliability in fulfilling assignments; and (iii) policies to establish on-site assessments of staff placed in facilities on each assigned shift. The annual report shall also include, at a minimum, the following information by geographic area which the health care personnel performed the work by facility type of hospital and nursing: (a) The average amount charged by nursing pools for health care personnel by license type; (b) The average amount paid by the nursing pool to health care personnel by license type; (c) The average amount of labor-related costs paid by the nursing pool by health care personnel license type, such as payroll taxes, workers’ compensation insurance, professional liability coverage, credentialling, and other employee-related costs.
SECTION 2. Nursing pools certified under section 72Y of chapter 111 of general laws, or any of their affiliated parties, shall be prohibited from soliciting and/or hiring nursing facility employees from nursing facilities in which the temporary nurse staffing agency has an active contract for the period of the contract plus 12 months. Operators shall under 101 CMR 206 provided annual reports on their use of temporary nursing service agencies.
SECTION 3. The Department of Public Health shall amend the “long term care facility operating regulations” (105 CMR 150) to require that temp nursing agency workers are compliant with all applicable qualifications, and training requirements now required of nursing care staff regularly employed in their position. In addition, require temporary nursing service agencies pay all fines as assessed by the Department of Public Health or other regulatory body generated as a result of assigned agency staff and pertaining to quality of care or documentation issues.
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An Act to address the financial sustainability of the Health Safety Net | S811 | SD224 | 193 | {'Id': 'JCV0', 'Name': 'John C. Velis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JCV0', 'ResponseDate': '2023-01-12T14:11:13.577'} | [{'Id': 'JCV0', 'Name': 'John C. Velis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JCV0', 'ResponseDate': '2023-01-12T14:11:13.59'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S811/DocumentHistoryActions | Bill | By Mr. Velis, a petition (accompanied by bill, Senate, No. 811) of John C. Velis for legislation to address the financial sustainability of the Health Safety Net. Health Care Financing. | SECTION 1. Section 2OOO of Chapter 29 of the general laws is hereby amended by striking the third sentence in the second paragraph in its entirety and inserting in place thereof the following:-
Money from the fund shall be transferred to the Health Safety Net Trust Fund, or any successor fund, as necessary to provide payments to acute hospitals and community health centers for reimbursable health services. No less than the amounts in subsection (b) of section 189 of chapter 149 of the general laws shall be annually transferred to the Health Safety Net Trust Fund.
SECTION 2. Section 64 of Chapter 118E of the general laws is hereby amended by inserting after the definition of “Resident” the following new definition:-
"Supplemental surcharge amount'', an amount equal to 50 per cent of the annual revenue shortfall in the Health Safety Net Trust fund as estimated by the health safety net office no later than 60 days after the fund fiscal year end.
SECTION 3. Section 66 of Chapter 118E of the general laws is hereby amended in subsection (b) by striking the first sentence in its entirety and inserting in place thereof the following:-
The fund shall consist of: (i) all amounts paid by acute hospitals and surcharge payors under sections 67 and 68; (ii) all appropriations for the purpose of payments to acute hospitals or community health centers for health services provided to uninsured and underinsured residents; (iii) any transfers from the Commonwealth Care Trust Fund, established under section 2OOO of chapter 29; (iv) all property and securities acquired by and through the use of monies belonging to the fund and all interest thereon; and (v) an amount equal to any federal financial participation revenues claimed and received by the commonwealth for eligible expenditures made from the fund.
SECTION 4. Section 68 of Chapter 118E of the general laws is hereby amended in subsection (a) by inserting in the fourth sentence following the words “total surcharge amount” the following:-
“and the supplemental surcharge amount”,
and by inserting in the fifth sentence following the words “total surcharge amount” each time it appears the following:-
“and the supplemental surcharge amount”
SECTION 5. Section 69 of Chapter 118E of the general laws is hereby amended by striking subsection (b) in its entirety and inserting in place thereof the following:-
(b) By April 1 of the year preceding the start of the fund fiscal year, the office shall, after consultation with the office of Medicaid, and using the best data available, provide an estimate of the projected total reimbursable health services provided by acute hospitals and community health centers and emergency bad debt costs, the total funding available and any projected shortfall after adjusting for reimbursement payments to community health centers. If a shortfall in revenue exists in any fund fiscal year to cover projected costs for reimbursement of health services, the office shall allocate half of that shortfall in a manner that reflects each hospital's proportional financial requirement for reimbursements from the fund, including, but not limited to, the establishment of a graduated reimbursement system and under any additional regulations promulgated by the office. The remaining half of the shortfall shall be accounted for through a supplemental surcharge amount that is paid in accordance with section 64 and 68.
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An Act establishing a fund to further educational opportunities for caregivers to adults with disabilities | S812 | SD2348 | 193 | {'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-01-20T16:09:40.14'} | [{'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-01-20T16:09:40.14'}, {'Id': 'S_G1', 'Name': 'Sean Garballey', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/S_G1', 'ResponseDate': '2023-01-24T13:44:11.27'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-26T10:13:16.4466667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-26T10:13:16.4466667'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-01-26T15:53:07.6533333'}, {'Id': 'MJM2', 'Name': 'Mathew J. Muratore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJM2', 'ResponseDate': '2023-01-26T15:53:07.6533333'}, {'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-01-26T15:53:07.6533333'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-01-26T15:53:07.6533333'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-01-27T15:49:54.1733333'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-27T15:49:54.1733333'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-01-27T16:24:19.7833333'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-02-03T09:15:14'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-07T16:15:53.8166667'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-02-08T11:35:53.1366667'}, {'Id': 'DMD1', 'Name': 'Daniel M. Donahue', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DMD1', 'ResponseDate': '2023-02-10T13:15:46.2433333'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-10T15:42:46.8'}, {'Id': 'AMG0', 'Name': 'Anne M. Gobi', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AMG0', 'ResponseDate': '2023-02-21T14:47:50.76'}, {'Id': 'DAS1', 'Name': 'Danillo A. Sena', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/DAS1', 'ResponseDate': '2023-02-26T15:06:46.9066667'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-15T16:49:04.49'}, {'Id': 'BET0', 'Name': 'Bruce E. Tarr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BET0', 'ResponseDate': '2023-03-23T15:08:27.1733333'}, {'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-03-30T09:23:09.1866667'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-05-12T07:38:49.1366667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S812/DocumentHistoryActions | Bill | By Mr. Barrett, a petition (accompanied by bill, Senate, No. 812) of Michael J. Barrett, Sean Garballey, Jack Patrick Lewis, Joanne M. Comerford and other members of the General Court for legislation to establish a fund to further educational opportunities for caregivers to adults with disabilities. Higher Education. | SECTION 1. Chapter 29 of the General Laws is hereby amended by inserting after section 2QQQQQ the following section:-
Section 2RRRRR. (a) There shall be established and set up on the books of the commonwealth a separate fund to be known as the Caregivers to Adults with Disabilities Fund. The board of higher education, hereinafter the board, shall administer the fund. The fund shall be credited with: (1) revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; (2) interest earned on such revenue; and (3) funds from public and private sources and other gifts, grants and donations. All amounts credited to the fund shall be used solely for activities and expenditures consistent with the public purpose of the fund as set forth in subsection (b), including the ordinary and necessary expenses of administration and operation associated with the fund. All amounts credited to the fund shall be held in trust and shall be available for expenditure, without further appropriation, by the board. Any unexpended balance in the fund at the close of a fiscal year shall remain in the fund and shall be available for expenditure in subsequent fiscal years.
Annually, not later than December 1, the board shall issue a report to the clerks of the house of representatives and the senate, the chairs of the house and senate committees on ways and means, the chairs of the joint committee on education and the chairs of the joint committee on children, families and persons with disabilities on the fund’s activities including, but not limited to, amounts credited to the fund, amounts expended from the fund and any unexpended balance.
(b) The board shall make expenditures from the fund for the purpose of furthering the educational opportunities of those who serve as caregivers to adults with disabilities by subsidizing tuition and fees for community college courses at eligible postsecondary institutions.
(c) The board shall promulgate regulations to effectuate the purposes of this section.
SECTION 2. Notwithstanding any general or special law to the contrary, not later than 14 days after the effective date of this act, the state comptroller shall transfer from the General Fund $4,125,000 to the Caregivers to Adults with Disabilities Fund established in chapter 29.
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An Act improving access to affordable higher education | S813 | SD262 | 193 | {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-12T11:39:11.7'} | [{'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-12T11:39:11.7'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-03-15T13:00:57.1766667'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S813/DocumentHistoryActions | Bill | By Ms. Comerford, a petition (accompanied by bill, Senate, No. 813) of Joanne M. Comerford for legislation to improve access to affordable higher education. Higher Education. | The department of higher education shall review programs of financial aid for students attending public institutions of higher education in the commonwealth, including grants, tuition waivers and loan programs. Based on the review, the department shall make recommendations, including legislation, for a comprehensive redesign and reform of the financial aid system to increase student access to higher education, improve affordability of higher education for students and families, and reduce opportunity and achievement gaps among students, particularly for students of color and disadvantaged populations.
The goals of the financial aid redesign and reform shall include:
(1) consolidating multiple overlapping assistance programs to improve efficiency and reduce duplication;
(2) reducing the burden of the application process and improving transparency, predictability and the ease of navigation for students and their families applying for and renewing financial assistance;
(3) lessening administrative costs, including the costs of oversight; and
(4) strengthening the ability of the general court to appropriately monitor, oversee and appropriate funds provided for student financial assistance.
In preparing its recommendations, the department shall consult with institutional financial aid officers, the office of student financial assistance and its financial aid advisory committee, groups representing students at the University of Massachusetts, state universities and community colleges, students and parents who navigate and use state financial aid, and other stakeholders. The department shall review the design of financial aid programs in other states and recommendations of experts. The department shall also solicit information from the chairs and vice chairs of the committee on higher education.
Before releasing its recommendations, the department shall hold an open public listening session to receive public input.
The department shall file its findings, recommendations and accompanying legislation, if any, with the clerks of the house of representatives and the senate and the joint committee on higher education not later than December 31, 2023.
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An Act expanding access to the higher education endowment matching program | S814 | SD287 | 193 | {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-12T12:02:31.23'} | [{'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-12T12:02:31.23'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S814/DocumentHistoryActions | Bill | By Ms. Comerford, a petition (accompanied by bill, Senate, No. 814) of Joanne M. Comerford for legislation to expand access to the higher education endowment matching program. Higher Education. | Section 15E of chapter 15A of the General Laws is hereby amended by inserting after the second paragraph the following paragraph:-
Notwithstanding the provisions of this section, subject to appropriation, the commonwealth shall contribute funds to the recognized foundation of a non-profit institution of higher education that provides a 2-year, accredited academic program that grants associate degrees to low income women and that does not charge tuition or fees, in an amount necessary to match private contributions in the current fiscal year to the institution’s or a foundation’s endowment or capital outlay program based on the following matching formula: subject to appropriation, the commonwealth’s contribution shall be equal to $1 for every $2 privately contributed to the institution’s board of trustees or a foundation, or $1 dollar for such greater number of dollars as may be established by the board of higher education.
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An Act improving access to affordable community college | S815 | SD610 | 193 | {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-16T10:59:26.62'} | [{'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-16T10:59:26.62'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S815/DocumentHistoryActions | Bill | By Ms. Comerford, a petition (accompanied by bill, Senate, No. 815) of Joanne M. Comerford for legislation to improve access to affordable community college. Higher Education. | SECTION 1. Section 19 of chapter 15A of the General Laws is hereby amended by adding the following paragraph:-
Notwithstanding the provisions of this section, tuition and fee waivers under this section for students attending community college shall include courses that are not state-supported, including summer sessions, evening classes and online courses.
SECTION 2. Chapter 69 of the General Laws is hereby amended by inserting after section 1T the following section:-
Section 1U. (a) Before graduating from high school, each student shall complete and submit a free application for federal student aid (FAFSA) form.
(b) A student shall not be required to comply with subsection (a) if the student’s parent or guardian, or school counselor submits a signed waiver form indicating that the parent or guardian understands the use and benefits of a FAFSA and declines to complete and submit a free FAFSA form; provided, that a student over age 18 may sign such waiver on the student’s own behalf.
(c) The commissioner of the department of elementary and secondary education shall determine procedures to implement this section, including any forms necessary under subsection (b). The procedures shall include processes to ensure compliance with federal law regarding confidentiality of family financial information and student educational information, including the Family Educational Rights and Privacy Act of 1974 (20 U.S.C. Section 1232g), and any other state or federal law relating to the privacy of student information. The commissioner shall direct high schools to provide information to students and parents on the value of completing the FAFSA form, including an explanation to each high school senior of the state-sponsored scholarships, financial aid and assistance available to students attending college or post-secondary education.
(d) The department of elementary and secondary education shall work with the office of student financial assistance of the department of higher education to inform high school students prior to their senior year on the availability of financial assistance for college and other post-secondary education and the role of the FAFSA form in accessing the assistance.
(e) Each school district shall report to the department of elementary and secondary education (i) the number of students who completed and submitted a financial aid application under subsection (a) and (ii) the number of students who received an exception from complying with subsection (a) under subsection (b). The department shall annually report data collected under this subsection, along with an analysis of the data, including trends. The report and analysis shall be provided to the secretary of education, the commissioner of higher education, the joint committee on education and shall be posted on the website of the department.
(f) The department of elementary and secondary education shall establish an advisory committee to advise the department in implementing this section. The advisory committee shall be composed of persons representing: (i) high school counselors; (ii) high school teachers and administrators; (iii) high school students and parents; (iv) higher education admissions and financial aid staff, from all segments of public higher education and private higher education institutions; and (v) the department of higher education. In implementing this section, the commissioner shall review the implementation of similar requirements in other states.
SECTION 3. The department of higher education, in consultation with department of elementary and secondary education, the Massachusetts Educational Financing Authority, and the Massachusetts Association of Community Colleges shall develop materials, including an informational pamphlet and web site, to inform high school juniors and seniors of affordable and accessible higher educational opportunities, particularly opportunities at public community colleges. The materials shall include information highlighting the ease of the application process, including online applications and applications that do not require an application fee. The materials shall provide information on the availability of financial aid and the financial aid application process. The materials shall include a map showing the location of community colleges in the commonwealth.
The materials may include other information as determined by the department of higher education. In preparing the materials, the department of higher education shall consult with admissions and financial aid counselors at community colleges and students in high school and community college from various regions of the commonwealth. The online materials shall include a form to allow students and parents to request further information and provide feedback regarding the web site.
The department of elementary and secondary education shall distribute the materials to all high school juniors and seniors in the commonwealth.
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An Act committing to higher education the resources to insure a strong and healthy public higher education system | S816 | SD2092 | 193 | {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-20T10:42:41.513'} | [{'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-20T10:42:41.5133333'}, {'Id': 'RKK0', 'Name': 'Robyn K. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RKK0', 'ResponseDate': '2023-01-30T11:10:56.4933333'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-01-27T09:17:03.23'}, {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-01-23T11:39:59.7933333'}, {'Id': 'M_C3', 'Name': 'Manny Cruz', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/M_C3', 'ResponseDate': '2023-01-24T09:34:03.9366667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-24T09:33:59.92'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-24T09:33:49.7033333'}, {'Id': 'AJP1', 'Name': 'Angelo J. Puppolo, Jr.', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/AJP1', 'ResponseDate': '2023-01-27T09:24:33.44'}, {'Id': 'SLG1', 'Name': 'Susannah M. Whipps', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLG1', 'ResponseDate': '2023-01-27T09:24:33.44'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-01-27T09:24:33.44'}, {'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-01-31T12:00:29.6166667'}, {'Id': 'MDB0', 'Name': 'Michael D. Brady', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MDB0', 'ResponseDate': '2023-02-06T14:18:57.71'}, {'Id': 'N_C0', 'Name': 'Nick Collins', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/N_C0', 'ResponseDate': '2023-09-14T11:15:40.71'}, {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-03-20T14:48:49.1966667'}, {'Id': 'JJC0', 'Name': 'John J. Cronin', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JJC0', 'ResponseDate': '2023-01-30T16:12:38.33'}, {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-02-08T16:25:51.0633333'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-03-03T12:38:10.47'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-10T14:40:21.3666667'}, {'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-03-21T12:24:33.8366667'}, {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-03-08T12:11:47.1233333'}, {'Id': 'JFK0', 'Name': 'John F. Keenan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JFK0', 'ResponseDate': '2023-07-24T15:08:08.0733333'}, {'Id': 'EDJ0', 'Name': 'Edward J. Kennedy', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/EDJ0', 'ResponseDate': '2023-04-24T10:23:08.0733333'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-01-31T12:41:05.1233333'}, {'Id': 'JBL0', 'Name': 'Joan B. Lovely', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBL0', 'ResponseDate': '2023-06-13T11:24:19.3266667'}, {'Id': 'L M0', 'Name': 'Liz Miranda', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/L%20M0', 'ResponseDate': '2023-02-09T10:56:21.56'}, {'Id': 'MOM0', 'Name': 'Michael O. Moore', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MOM0', 'ResponseDate': '2023-08-21T14:25:13.6633333'}, {'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-07-24T12:43:17.2766667'}, {'Id': 'PMO', 'Name': "Patrick M. O'Connor", 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMO', 'ResponseDate': '2023-02-07T10:17:39.19'}, {'Id': 'MRP0', 'Name': 'Marc R. Pacheco', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MRP0', 'ResponseDate': '2023-01-27T14:45:25.2966667'}, {'Id': 'PMP0', 'Name': 'Pavel M. Payano', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMP0', 'ResponseDate': '2023-04-27T10:01:17.5233333'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-02-06T11:16:29.8633333'}, {'Id': 'JCV0', 'Name': 'John C. Velis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JCV0', 'ResponseDate': '2023-02-07T11:06:21.88'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-01-29T12:31:25.46'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-01-30T18:09:07.31'}, {'Id': 'M_C1', 'Name': 'Mike Connolly', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/M_C1', 'ResponseDate': '2023-02-06T12:07:03.5166667'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-06T12:07:03.5166667'}, {'Id': 'JKH1', 'Name': 'James K. Hawkins', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JKH1', 'ResponseDate': '2023-02-23T22:30:39.8933333'}, {'Id': 'K_K1', 'Name': 'Kay Khan', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/K_K1', 'ResponseDate': '2023-03-29T15:24:55.69'}, {'Id': 'RME1', 'Name': 'Rodney M. Elliott', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RME1', 'ResponseDate': '2023-05-17T14:10:21.88'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S816/DocumentHistoryActions | Bill | By Ms. Comerford, a petition (accompanied by bill, Senate, No. 816) of Joanne M. Comerford, Paul W. Mark, Sal N. DiDomenico, Jack Patrick Lewis and other members of the General Court for legislation to commit to higher education the resources to insure a strong and healthy public higher education system. Higher Education. | SECTION 1. Chapter 15A of the General Laws is hereby amended by inserting after section 15 the following section:-
Section 15A. It is the intention of the general court to assure fair and adequate funding for the commonwealth’s public institutions of higher education. Notwithstanding section 15B or any other general or special law to the contrary, the annual budget request for the public institutions of higher education shall be determined by the board of higher education and the secretary under this section for the University of Massachusetts, the state university system, the community college system, and needs-based financial assistance administered by the council under section 9B; provided, that in order to achieve equity for students and workers, the council shall allocate state appropriations to individual public colleges and universities in a manner which: (i) establishes scholarship funding in accordance with section 1 of this act; (ii) emphasizes full-time over part-time employment and fair wages and benefits for adjunct faculty and staff; (iii) realigns resources toward teaching, research, and student supports; (iv) enhances the ability of colleges to provide support for students by providing an additional $2,000 per eligible student to fund supports services to improve outcomes for the most vulnerable students, which may include, but shall not be limited to, low-income, first-generation, minority, and disabled students and lesbian, gay, bisexual, transgender, queer and questioning students; (v) supports the full curricular offerings and research endeavors appropriate to each institution; (vi) provides up-to-date technology and other resources for student learning; and (vii) prioritizes public operation of our public campuses over privatization; provided further, that the council shall annually report the details of the funding distribution to the governor and to the house and senate committees on ways and means and the joint committee on higher education; and provided further, that notwithstanding section 7H of chapter 29 of the General Laws or any other general or special law to the contrary, the governor shall submit to the general court annually a request for an appropriation based on the recommendations of the Public Higher Education Wage Equity and Working Conditions Commission, as created in Chapter ___ of the Acts of 2023.
SECTION 2. Chapter 15A of the General Laws is hereby further amended by inserting, after section 45, the following section:-
Section 46. Green and Healthy Public College and University Building Planning Commission
(a) There shall be a Green and Healthy Public College and University Building Planning Commission, which shall consist of: the commissioner of higher education, who shall serve as chair, or a designee; the commissioner of public health, who shall serve as vice chair, or a designee; the secretary of energy and environmental affairs, who shall serve as vice chair, or a designee; the speaker of the house of representatives, or a designee; the president of the senate, or a designee; the minority leader of the house of representatives, or a designee; the minority leader of the senate, or a designee; the chairs of the joint committee on ways and means, or their designees; the chairs of the joint committee on higher education, or their designees; the president of the university of Massachusetts, or a designee; the executive director of the Massachusetts Association of Community Colleges, or a designee; the executive officer of the Massachusetts State University Council of Presidents, or a designee; 4 representatives of the Massachusetts Teachers Association, 1 of whom shall be employed by the university of Massachusetts, 1 of whom shall be employed by a state university, and 1 of whom shall be employed by a community college; a representative of the American Federation of Teachers, Massachusetts; a representative of the American Institute of Architects-Massachusetts; a representative of the Massachusetts State Building Trades Council; a representative of the Massachusetts Coalition for Occupational Safety and Health; and a representative of the Massachusetts Department of Higher Education’s Student Advisory Council.
(b) The commission shall assess and make recommendations for public higher education buildings relative to energy efficiency, spatial adequacy, life safety, accessibility, indoor environmental quality and public health. The commission shall be established not less than every 10 years to monitor the implementation of its recommendations, and to conduct a new assessment if determined to be necessary by the commission.
(c) The commission shall determine the means of conducting its work, which shall include, but not be limited to:
(1) assessing the extent to which public higher education buildings in the commonwealth provide students a healthy environment that is conducive to learning while efficiently using energy and resources and limiting exposure to toxic building materials, referred to in this section as “green and healthy public higher education buildings”. Factors to be considered shall include, but not be limited to: (i) protection against infectious disease, including COVID-19 and influenza; (ii) sufficient ventilation and air circulation, including adequate outdoor air exchange, filtration and circulation; (iii) healthy indoor air quality, including limits on pollutants, exposure to toxic substances, chemical emissions and vapor intrusion; (iv) adequate availability of clean and safe water; (v) appropriate thermal comfort, humidity and temperature controls; (vi) protections against pests with effective use of integrated pest management; (vii) limits on pollutants, dust, mold and allergens; (viii) appropriate artificial lighting and plentiful natural light; (ix) proper acoustic and noise control; (x) proper maintenance of mechanical systems; (xi) design that promotes physical activity and meets accessibility standards; (xii) opportunities to increase energy efficiency and efficient use of resources including low-flow fixtures; (xiii) opportunities to shift to fossil-free fuels; (xiv) proper access to greenspace; and (xv) opportunities for architectural design to enhance occupant safety. The assessment may rely on existing data or be objectively measured. The assessment shall include a public searchable online dashboard with the findings for all public higher education buildings in the commonwealth; and
(2) developing standards for green and healthy public higher education buildings.
(d) Members of the commission shall not receive compensation for their services but may receive reimbursement for the reasonable expenses incurred in carrying out their responsibilities as members of the commission. The commissioner of higher education shall furnish reasonable staff and other support for the work of the commission.
SECTION 3. Section 16 of Chapter 15A is hereby amended by inserting after the eleventh paragraph the following paragraphs:
There shall be a debt free college scholarship program that creates a path for debt free college completion for all students, which shall include reasonable contributions from students and families. This program shall support pathways for lifelong learning, shall provide support to students enrolled in Massachusetts institutions of public higher education to earn professional or vocational certifications, associate, or baccalaureate degrees, and shall be administered without bias or undue burden whether students choose to directly enroll to earn four-year degrees or earn stackable certificates and degrees over time.
The program shall meet the following criteria:
(1) the department shall identify the full cost of attendance, including tuition, fees and living expenses, which include but are not limited to food and housing. Other costs to consider include childcare and transportation costs;
(2) the department shall require the student to make a reasonable contribution towards the full cost of attendance. This contribution may include Pell grants, existing institutional financial aid, a reasonable family contribution, and earnings from a reasonable amount of work. The calculation of reasonable family contribution shall address issues associated with the current calculation of Expected Family Contribution and shall examine individual circumstances; and
(3) the department shall provide state financial aid to fill the gap between resources available to students, as described in paragraph (2), and the total cost of attendance, which shall include living expenses. State financial aid shall be sufficient to cover the cost of achieving up to a 4-year degree at a Massachusetts public higher education institution for in-state students of any age. Part-time students, those pursuing workforce training or vocational certificate degrees, and adults re-entering higher education also shall be eligible. Undocumented in-state residents shall be eligible to participate in the program, shall be charged in-state tuition, and shall be eligible for all other program benefits. If alternative processes are required to determine the financial needs of these students, the department shall develop such processes. The department shall also provide a path for debt free college for incarcerated students.
SECTION 4. Chapter 29 of the General Laws is hereby amended by inserting after section 2QQQQQ the following 3 sections:-
Section 2RRRRR. Public College and University Capital Debt Relief Fund
(a) There shall be a separate fund, to be administered by the board of higher education, which shall be known as the Public College and University Capital Debt Relief Fund. The fund shall be credited with: (i) appropriations, bond proceeds or other money authorized or transferred by the general court and specifically designated to be credited to the fund; (ii) funds from public and private sources, including, but not limited to gifts, grants and donations; and (iii) any interest earned on such funds. Amounts credited to the fund shall be used, without further appropriation, to provide financial relief for debt service associated with capital construction projects at commonwealth institutions of public higher education, as defined in section 5 of chapter 15A; provided, however, that, students shall not be charged fees for that portion of the debt service paid out of the fund. The board of higher education, in consultation with the trustees of the university of Massachusetts, shall determine the amounts to be allocated to each public higher education institution to cover debt service obligations; and provided further, that funds allocated from this reserve shall only be used to cover said debt service obligations and that public higher education institutions shall invest funds made available by relieving debt service obligations for hiring full-time faculty and staff, providing pay increases or other benefits for adjunct faculty, and in other student success programs including, but not limited to, additional supports for low-income students and students of color, using methods that improve the college experience and graduation rates.
Section 2SSSSS. Green and Healthy Public College and University Building Fund
(a) There shall be a separate fund, to be administered by the board of higher education, which shall be known as the Green and Healthy Public College and University Building Fund. The fund shall be credited with: (i) appropriations, bond proceeds or other money authorized or transferred by the general court and specifically designated to be credited to the fund; (ii) funds from public and private sources, including, but not limited to gifts, grants and donations; and (iii) any interest earned on such funds. Amounts credited to the fund shall be used, without further appropriation, to fund and implement the recommendations of the Green and Healthy Public College and University Building Planning Commission, established in section 46 of chapter 15A, for the renovation and rehabilitation of existing buildings and new building construction to meet the recommended green and healthy public higher education buildings standards.
Section 2TTTTT. Public Higher Education Wage Equity and Working Conditions Fund
(a) There shall be a separate fund, to be administered by the board of higher education, which shall be known as the Public Higher Education Wage Equity and Working Conditions Fund. The fund shall be credited with: (i) appropriations, bond proceeds or other money authorized or transferred by the general court and specifically designated to be credited to the fund; (ii) funds from public and private sources, including, but not limited to gifts, grants and donations; and (iii) any interest earned on such funds. Amounts credited to the fund shall be used, without further appropriation, to fund and implement the recommendations of the Public Higher Education Wage Equity and Working Conditions Commission established by this section.
SECTION 5. Section 6 of said chapter 29 is hereby amended by adding the following paragraph:-
The operating budget in the current and ensuing fiscal years shall include the appropriation necessary to fund all incremental cost items for all years covered by any collective bargaining agreement to which either the board of trustees of the university of Massachusetts or the board of higher education is a party, separate and apart from any appropriation for the general maintenance of the university or public institutions of higher education where the board of higher education is the employer for purposes of collective bargaining under chapter 150E, excluding grant funded and auxiliary enterprises accounts funded positions.
SECTION 6. Chapter 32 of the General Laws is hereby amended by adding the following section:-
Section 106. For purposes of this chapter and notwithstanding this chapter or any other general or special law, rule or regulation to the contrary, any employee who teaches the equivalent of at least 2 three-credit courses per semester or 4 three-or-more credit courses per calendar year at 1 or more of the public institutions of higher education, including a division of continuing education, regardless of funding source, including but not limited to subsidiary account CC, or any staff working at 1 or more public institutions of higher education whose cumulative weekly hours worked at all campuses, including hours teaching courses if applicable, is half-time or more for two or more semesters per calendar year, shall be considered an employee eligible for membership in the state employees’ retirement system and shall earn creditable service for such time and shall be regarded as regular compensation and shall be included in the salary on which deductions are to be paid to the annuity savings fund and the board shall credit as at least one-half year of service, actual service teaching at 1 or more public institutions of higher education the equivalent of at least 4 three-credit courses per calendar year; provided further, however, that said faculty and staff shall be eligible for the optional retirement system established in section 40 of chapter 15A.
SECTION 7. (a) There shall be a Public Higher Education Wage Equity and Working Conditions Commission, which shall consist of the following: the secretary of administration and finance, who shall serve as co-chair, or a designee; the commissioner of higher education, who shall serve as co-chair, or a designee; the speaker of the house of representatives, or a designee; the president of the senate, or a designee; the minority leader of the house of representatives, or a designee; the minority leader of the senate, or a designee; the chairs of the joint committee on ways and means, or their designees; the chairs of the joint committee on higher education, or their designees; the president of the university of Massachusetts, or a designee; the executive director of the Massachusetts Association of Community Colleges, or a designee; the executive officer of the Massachusetts State University Council of Presidents, or a designee; 3 representatives of the Massachusetts Teachers Association, 1 of whom shall be employed by the university of Massachusetts, 1 of whom shall be employed by a state university, and 1 of whom shall be employed by a community college; a representative of the American Federation of Teachers, Massachusetts; a representative of the Massachusetts AFL-CIO; a representative of AFSCME Council 93; the student member of the board of higher education; a representative of the Massachusetts Association of Teachers of Speakers of Other Languages; a representative of the Graduate Employee Organization; and a representative of the Massachusetts Education Justice Alliance.
(b) The commission shall determine the means of conducting its work, which shall include, but not be limited to: (1) assessing the salaries and working conditions of employees of private institutions of higher education in the commonwealth, as well as employees of public higher education institutions nationwide, and making recommendations to ensure that commonwealth public higher education employee salaries and benefits are at least commensurate with those other employees; (2) identifying programs, services and salaries that shall help to recruit and retain high quality faculty and staff at institutions of public higher education with a focus on prioritizing the recruitment and retention of a racially, culturally, ethnically and linguistically diverse workforce; (3) ensuring that there are sufficient full-time faculty and staff to provide reasonable workloads so educators can provide all students with the support they need to thrive; (4) identifying programs and methods to enhance faculty and staff professional development including, but not limited to, creating improved employee tuition waiver benefits for faculty and staff who enroll in institutions of public higher education; (5) performing an analysis looking at equity by race, gender, and other non-dominant identities, in all faculty and staff positions, by examining all wages and benefits and inequities that arise for any other reason; (6) recommend a base salary for faculty that would allow faculty to support themselves and their families without being required to teach additional courses beyond a full course load; (7) recommend a base salary for professional and classified staff salaries to the salaries that would allow them to support themselves and their families; and (8) recommend a base salary for adjunct faculty that would allow faculty to support themselves and their families without being required to teach additional courses beyond a full course load, including the cost of health insurance and retirement security.
The Commission shall issue budgetary recommendations and submit legislation to implement their findings not later than December 31, 2023. The commission should be made up of representatives from student groups, campus administrations, unions representing campus faculty and staff, equity focused community groups and designees from the House, Senate, and the executive offices of administration and finance and education.
SECTION 8. For the fiscal years 2024 through 2028, inclusive, no tuition or fees shall increase for students enrolled at commonwealth public institution of higher education in any fiscal year where the appropriation for public institutions of higher education is at least the amount requested by the council, as provided in section 15A of chapter 15A of the General Laws.
SECTION 9. Notwithstanding section 8 of chapter 32A of the General Laws or any other general or special law to the contrary, the cost of fringe benefits, including, but not limited to, the cost of pensions and health insurance, associated with employees of a public institution of higher education as defined in section 5 of chapter 15A, shall be the obligation of the commonwealth, excluding grant funded and auxiliary enterprises accounts funded positions.
SECTION 10. Notwithstanding any general or special law, rule or regulation to the contrary, after January 1, 2023, the costs associated with the construction of an academic, administrative or auxiliary building at a commonwealth institution of public higher education, as defined in section 5 of chapter 15A of the General Laws, shall be paid in full by the commonwealth from state funds or eligible federal funds and shall not be paid for with any public higher education institutional funds or financed through public building authorities or private entities; provided, however, that the costs associated with the assessment, upgrade or repair of any existing academic, administrative or auxiliary building at an institution of public higher education that is under the control and supervision of the department of capital asset management and maintenance shall be paid in full by the commonwealth.
SECTION 11. The Green and Healthy Public College and University Building Planning Commission, as established in section 46 of chapter 15A of the General Laws, shall create and recommend a plan for all existing and new public higher education buildings to equitably meet the standards for green and healthy public higher education buildings developed pursuant to paragraph (c) of section 46 of said chapter 15A, by 2035. The commission shall issue recommendations, including an analysis that summarizes the findings of its assessment of public higher education buildings in the commonwealth, for implementing green and healthy public higher education buildings standards for cost-effective renovation and rehabilitation of existing buildings and for new building construction, and a plan for implementing these standards for all public higher education buildings, by 2035. The recommendations shall prioritize addressing buildings with the greatest needs first. The recommendations shall consider the unique environmental conditions of buildings located in urban, industrial, and other areas facing particular site challenges and shall consider the need to address historic patterns of injustice and inequity in public higher education. The recommendations shall estimate the cost of bringing all buildings into compliance with the standards by 2035, including the ongoing cost of maintenance and repair, and recommend a plan to fund these costs, and shall also compare those costs with long-term savings in health and medical costs, energy costs, maintenance, life cycle assessment and other savings, and the growth in economic activity of bringing buildings to the standards, including increased jobs and job training. The first plan of the commission shall be published and submitted to the joint committee on ways and means and the joint committee on higher education not later than December 31, 2024. Prior to completing its assessment and issuing its recommendations, the commission shall conduct public hearings at every commonwealth institution of public higher education and shall consult with employee organizations, as defined in chapter 150E, representing employees at each institution of public higher education.
SECTION 12. The department of higher education shall implement the debt free program outlined in Section 3 of this Act for all students at community colleges in fiscal year 2024 and for all students at four-year Massachusetts public higher education institutions in fiscal year 2025.
SECTION 13. (a) Notwithstanding any general or special law to the contrary, the board of higher education shall establish a 5-year funding schedule, beginning in fiscal year 2024, to provide the level of funding needed to implement all provisions of this Act; to assure fair and adequate funding for the commonwealth public institutions of higher education, which shall include needs-based financial assistance developed under section 15B of chapter 15A of the General Laws; and shall be adjusted to recognize the fixed costs of those institutions. Notwithstanding any general or special law to the contrary, the budget request to the secretary of administration and finance for the system of institutions of public higher education and needs-based financial assistance developed under said section 15B shall be not less than the amount determined by said schedule. The council shall submit its annual budget request to the secretary of administration and finance, the house and senate committees on ways and means and the joint committee on higher education.
(b) Notwithstanding section 7H of chapter 29 of the General Laws or any other general or special law to the contrary, effective for fiscal years starting in fiscal year 2024, the governor shall submit to the general court annually a request for an appropriation that complies with the funding requirements of this section and section 15A of chapter 15A of the General Laws. Said appropriation request shall not propose any direct or indirect reductions in any other state appropriation including, but not limited to, collective bargaining agreements under chapter 150E, scholarships and need-based financial assistance authorized by said chapter 15A.
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An Act providing access to higher education for high school graduates in the Commonwealth | S817 | SD81 | 193 | {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-01-10T14:35:05.117'} | [{'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-01-10T14:35:05.1166667'}, {'Id': 'JMC0', 'Name': 'Joanne M. Comerford', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JMC0', 'ResponseDate': '2023-01-27T15:54:02.6366667'}, {'Id': 'JRO0', 'Name': 'Jacob R. Oliveira', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JRO0', 'ResponseDate': '2023-01-27T15:54:02.6366667'}, {'Id': 'JPL1', 'Name': 'Jack Patrick Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JPL1', 'ResponseDate': '2023-01-30T14:18:01.8333333'}, {'Id': 'PMP0', 'Name': 'Pavel M. Payano', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PMP0', 'ResponseDate': '2023-02-08T15:23:57.1333333'}, {'Id': 'MJB0', 'Name': 'Michael J. Barrett', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/MJB0', 'ResponseDate': '2023-02-08T15:23:57.1333333'}, {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-02-08T19:08:18.41'}, {'Id': 'jml0', 'Name': 'Jason M. Lewis', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/jml0', 'ResponseDate': '2023-02-14T11:52:42.7233333'}, {'Id': 'CLG1', 'Name': 'Carmine Lawrence Gentile', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/CLG1', 'ResponseDate': '2023-02-14T11:52:42.7233333'}, {'Id': 'V_H1', 'Name': 'Vanna Howard', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/V_H1', 'ResponseDate': '2023-02-24T12:58:14.37'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-24T12:58:14.37'}, {'Id': 'A_G0', 'Name': 'Adam Gomez', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/A_G0', 'ResponseDate': '2023-02-24T12:58:14.37'}, {'Id': 'S_M1', 'Name': 'Samantha Montaño', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/S_M1', 'ResponseDate': '2023-02-24T12:58:14.37'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-03-06T14:08:20.5366667'}, {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-03-13T14:06:36.1366667'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-03-23T13:46:15.4333333'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-03-30T10:12:11.7'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S817/DocumentHistoryActions | Bill | By Mr. Crighton, a petition (accompanied by bill, Senate, No. 817) of Brendan P. Crighton, Joanne M. Comerford, Jacob R. Oliveira, Jack Patrick Lewis and other members of the General Court for legislation to provide access to higher education opportunities for high school graduates in the Commonwealth. Higher Education. | SECTION 1. Section 9 of chapter 15A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding at the end thereof the following paragraph:-
"Notwithstanding any general or special law to the contrary, for the purpose of determining eligibility for in-state tuition rates and fees and for state-funded financial assistance at public institutions of higher education, except the University of Massachusetts Medical School and the University of Massachusetts School of Law, any person admitted to such public institutions of higher education, other than a nonimmigrant alien within the meaning of paragraph 15 of subsection (a)(A) through (S) of 8 U.S.C., section 1101 of the federal act, who has attended high school in the commonwealth for 3 or more years and has graduated from a high school in the commonwealth or attained the equivalent thereof in the commonwealth, shall be eligible to pay in-state tuition rates and fees, and shall be eligible on the same terms as other persons for state-funded financial assistance, at the University of Massachusetts, or any other state university or state college or community college in the commonwealth; provided, however, that any person who is eligible for the military selective service under the federal Military Selective Service Act, as amended by 50 U.S.C.,14 App. 453, section 3, shall register for such. No person qualified for in-state tuition rates and fees under this chapter shall be denied in-state tuition and fees as a result of the granting of eligibility under this paragraph. An eligible person shall provide the University of Massachusetts, or any other state university or state college or community college in the commonwealth with (i) a valid social security number or a document reflecting issuance of an individual taxpayer identification number (ITIN) in lieu of a social security number; (ii) if that person is not a citizen of the United States or a legal permanent resident of the United States, an affidavit signed under the pains and penalties of perjury stating that the person has applied for citizenship or legal permanent residence or will apply for citizenship or legal permanent residence in accordance with federal statute and federal regulations within 120 days of eligibility for such status and (iii) documentation of registration with the selective service, if applicable. The Legislature finds that this is a state law within the meaning of 8 U.S.C. 1621(d). "
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An Act relative to college in high school | S818 | SD2124 | 193 | {'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-01-20T14:02:15.777'} | [{'Id': 'BPC0', 'Name': 'Brendan P. Crighton', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/BPC0', 'ResponseDate': '2023-01-20T14:02:15.7766667'}, {'Id': 'M_C3', 'Name': 'Manny Cruz', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/M_C3', 'ResponseDate': '2023-01-27T15:53:28.9966667'}, {'Id': 'TMS1', 'Name': 'Thomas M. Stanley', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/TMS1', 'ResponseDate': '2023-02-14T11:52:57.2133333'}, {'Id': 'JBE0', 'Name': 'James B. Eldridge', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JBE0', 'ResponseDate': '2023-02-24T12:59:38.3733333'}, {'Id': 'PWM0', 'Name': 'Paul W. Mark', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PWM0', 'ResponseDate': '2023-03-27T13:19:28.89'}, {'Id': 'SLM0', 'Name': 'Susan L. Moran', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SLM0', 'ResponseDate': '2023-03-30T10:11:10.6833333'}, {'Id': 'RLR0', 'Name': 'Rebecca L. Rausch', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/RLR0', 'ResponseDate': '2023-07-05T13:54:18.0633333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S818/DocumentHistoryActions | Bill | By Mr. Crighton, a petition (accompanied by bill, Senate, No. 818) of Brendan P. Crighton, Manny Cruz, Thomas M. Stanley and James B. Eldridge for legislation relative to college credits while attending high school. Higher Education. | SECTION 1. Section 9B of chapter 15A, as appearing in the 2018 Official Edition, is amended by adding the following after the word “commonwealth” in line 6: “or any college in high school program administered pursuant to section 37 of chapter 69.”
SECTION 2. Section 16 of chapter 15A is amended by adding the following after the word “nursing” in line 5: “or any college in high school program administered pursuant to section 37 of chapter 69,”
SECTION 3. Chapter 15A of the General Laws is hereby amended by inserting after section 39 the following section:-
Section 39A. (a) All public institutions of higher education shall develop written policies and procedures for accepting for the purposes of course credit to satisfy degree requirements certain scores on the College Board’s advanced placement examinations, successful completion of college in high school courses as provided in section 37 of chapter 69, successful completion of the International Baccalaureate Diploma Program, or and successful completion of dual enrollment courses. In the said policy, the institution shall:
(1) establish its conditions for granting course credit, including the minimum required scores on Advanced Placement examinations and examinations for courses constituting the International Baccalaureate Diploma Program; and
(2) establish whether credit will be granted for general education, major or elective requirements at the institution; and
(3) include procedures related to the transferability of these credits to another institution of higher education.
(b) On request of an applicant for admission as an entering student, a public institution of higher education, based on information provided by the applicant, shall determine and notify the applicant regarding:
(1) the amount and type of any course credit that would be granted to the applicant under the policy required in subsection (a); and
(2) any other academic requirement that the applicant would satisfy under the policy.
(c) All policies and procedures governing the award of credit shall be posted on the institution’s website under the category of admission, which the institution shall update as necessary to reflect any changes in policies and procedures. In addition, each institution shall submit its policies and procedures, or any changes thereto, to the department of higher education which shall post each institution’s policies and procedures on the department’s website.
(d) The board of higher education, in cooperation with the board of trustees of each public institution including the University of Massachusetts, shall annually review the college in high school course-granting policies of each public institution of higher education in accordance with the requirements of this section and file a report with its findings and any recommendations with the clerks of the senate and the house of representatives and chairs of the joint committee on higher education not later than July 1. Each public institution of higher education shall provide the board of higher education with all necessary data, in accordance with the federal Family Educational Rights and Privacy Act of 1974, to conduct the analysis.
SECTION 4. Chapter 29 of the General Law is hereby amended by inserting after section 2CCCCC the following new section:-
Section 2DDDDD. (a) There shall be established and set up on the books of the commonwealth a separate fund to be known as the Massachusetts College in High School Trust Fund. The fund shall be administered by the commissioner of the department of elementary and secondary education, in consultation with the commissioner of the department of higher education. The fund shall be credited with: (i) revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; (ii) interest earned on such revenues; and (iii) funds from public and private sources such as gifts, grants, and donations to further the rates of student preparedness for workforce and postgraduate success. Amounts credited to the fund shall not be subject to further appropriation and any money remaining in the fund at the end of a fiscal year shall not revert to the General Fund.
(b) Amounts credited to the fund may focus on underserved communities across the Commonwealth, including those school districts with high concentrations of economically disadvantaged students.
(c) Amounts received from private sources shall be approved by the commissioner of elementary and secondary education and subject to review before being deposited in the fund to ensure that pledged funds are not accompanied by conditions, explicit or implicit, on the implementation of college in high school programming that may be detrimental to the neutral education policy. The review shall be made publicly available.
(d) Annually, not later than October 1, the commissioner shall report to the clerks of the house of representatives and senate, the joint committee on education, the joint committee on higher education, and the house and senate committees on ways and means on the fund's activity. The report shall include, but not be limited to: (i) the source and amount of funds received; (ii) the amounts distributed and the purpose of expenditures from the fund, including but not limited to, funds expended to assist school districts in meeting the requirements in section 37 of chapter 69; (iii) any grants provided to institutions of higher education and other stakeholder organizations; and (iv) anticipated revenue and expenditure projections for the next year.
SECTION 5. Chapter 69 of the General Laws is hereby amended by inserting after section 36 the following two sections:-
Section 37. (a) There shall be a Massachusetts Office of College in High School, herein the office. The office shall be overseen by the commissioner of the department of elementary and secondary education in consultation with the commissioner of the department of higher education. The office will administer high school programs that expand student access to college and postsecondary opportunities through high-quality instructional programming, hereinafter referred to as college in high school, in order to increase the rates of student success in postsecondary attainment and in the workforce. All programs established under this section shall:
(1) Offer a coherent sequence of courses that allows a student to earn a high school diploma and achieve at least one of the following:
(i) the accumulation of transferable college credits; provided that, academic courses that count for college credit shall be those agreed to by the institutions of higher education participating in the partnership with the high school,
(ii) an industry-recognized credential or certificate, including those determined to be necessary for occupations with high employment value as defined in section 38 of this chapter; or
(iii) participation in a registered apprenticeship, pre-apprenticeship, or apprentice readiness program;
(2) Prepare students adequately for future success in the workforce or in an institution of higher education;
(3) Encourage the cooperative or shared use of resources, personnel and facilities between public high schools, public and independent colleges or universities and employers;
(4) Emphasize parental involvement and provide consistent counseling, advising and parent conferencing so that parents and students can make responsible decisions regarding course selection and can track the student's academic progress and success;
(5) Develop methods for early identification of potential participating students in the middle grades and through high school and provide outreach to those students to promote academic preparation and awareness of college in high school programs; and
(6) Develop strategies to identify and engage underserved populations including by income, race, ethnicity, sex, English language learner status and students with disabilities.
(b) The office shall oversee all necessary college in high school programs, including but not limited to programs that incorporate one or more of the following: (1) early college; (2) dual enrollment; (3) industry-recognized credentialing in high school, including those for credentials determined to be necessary for occupations with high employment value as defined in section 38 of this chapter; (4) advanced placement; (5) international baccalaureate programs; or (6) other approaches for college and career programs. The office shall develop and, as needed, refine all college in high school program designations offered in the Commonwealth and shall have the authority to set and raise credit attainment targets, recommend any designations to be awarded to applicants, administer all aspects of state support for the programs, track and report on the performance of participants in the aggregate and identify and pursue further innovative approaches. Academic courses that count for college credit shall be those agreed to by the institutions of higher education participating in any partnership with the high school.
(c) Pursuant to regulations to be promulgated by the board, all high schools shall offer an affordable college in high school program to students before the completion of their 12th grade year that incorporates one or more of the following: (1) early college; (2) dual enrollment; (3) industry-recognized credentialing in high school; (4) advanced placement courses; (5) international baccalaureate programs; or (6) other approaches for college and career programs.
(d) There shall be a College in High School Joint Committee, hereinafter the CIHS Joint Committee, charged with governing and overseeing the work of the office and making recommendations to the board of elementary and secondary education and the board of higher education. The CIHS Joint Committee shall develop recommendations that include but are not limited to the following: (1) helping drive the commonwealth’s efforts to grow and expand college in high school programs; (2) assisting the office in establishing and monitoring robust performance requirements and targeted enrollments for all participating programs statewide and (3) aiding the office in identifying and certifying new college in high school programs. The CIHS Joint Committee shall consist of the secretary of the executive office of education or a designee; the commissioner of the department of elementary and secondary education or designee; the commissioner of the department of higher education or designee; two members of the board of elementary and secondary education, who shall be appointed by the chair of the board of elementary and secondary education; and two members of the board of higher education, who shall be appointed by the chair of the board of higher education.
(e) The office shall create and annually review a set of per-credit charges that the public and private institutions of higher education participating in a designated college in high school program require for providing credit-earning courses. The per-credit charge may be subject to factors, including but not limited to: (1) the segment of colleges offering certain courses; (2) the site where the course is taught; (3) whether the course has extra costs associated with enrollment and (4) whether there are minimum numbers of participating students per section offered.
(f) The office may develop, subject to the approval of the CIHS Joint Committee, recommendations for college in high school programs to continue to enroll participating students to extend and expand their graduation requirements such that they may continue to be considered students of the high school for purposes of chapter 70 calculations for up to two more years in order to complete certificates, degrees or up to two years of transferable credit to a four-year college.
(g) The office shall propose a budget to the commissioner of the department of elementary and secondary education that reflects the goals and objectives of the office.
(h) The college in high school programs shall be open to all enrolled students, on a space available basis, and shall not discriminate on the basis of race, color, national origin, creed, sex, gender identity, ethnicity, sexual orientation, mental or physical disability, age, ancestry, special needs, proficiency in the English language or academic achievement. A lottery shall be held if more students apply than can be accommodated.
(i) The office shall establish the information and requirements it deems necessary to be included in any application for designation as a college in high school program in order to ensure a high-quality and rigorous college in high school program. The office, after consultation with the department of higher education, shall establish standards for approving and designating college in high school programs.
(j) Where required, each designated college in high school program shall enter into an agreement with at least one postsecondary institution that provides students with opportunities to receive postsecondary credits during the student's participation in the program. Partner high schools and colleges shall work together to ensure that college credits automatically transfer to Massachusetts public postsecondary institutions upon completion of the program and admittance to one of those public institutions. In addition, partnering high schools and colleges should reduce barriers to college and consider automatic admission to the participating college upon successful completion of the college in high school program. The agreement shall establish how the program will be sustainable on current funding plus any anticipated annual state supplement for designated college in high school programs as well as the designated duties for the high school, in the areas of program coordination, student support, faculty support, career partnership coordination and performance monitoring.
(k) Designation as a college in high school program shall be for an initial period of five years, subject to review after the first three years, and renewable subject to performance. The department of elementary and secondary education shall, subject to appropriation, provide additional funding to designated programs for each participating student.
(l) Annually, by December 31, each college in high school program shall file a report with the commissioner of the department of elementary and secondary education and the commissioner of higher education, on performance measures, including, but not limited to the following categories:
(i) high school graduation rates of participating students;
(ii) percentage of participating students who complete the program;
(iii) percentage of participating students who gain any postsecondary credits;
(iv) credits earned by participating students in college in high school programs, including the percentage of each program incorporating early college to gain at least 12 credits;
(v) percentage of participating students in a 6-year cohort who attain postsecondary degrees; and
(vi) college and career outcomes of participating students.
The commissioners shall prepare an aggregate report for the senate and house chairs of the joint committee on higher education, and the joint committee on education.
(m) The office shall propose, subject to approval by the CIHS Joint Committee and the boards of elementary and secondary education and higher education, multi-year goals for the commonwealth for the attainment of college degrees and qualifying, industry-recognized certificates for students participating in college in high school programs. Such goals shall include overall goals as well as goals for historically underserved populations including by income, race, ethnicity, sex, English language learner status and students with disabilities. Goals should include statewide-, district-, and school-level goals. The office shall be responsible for ensuring annual, timely public reporting of progress statewide and by district and school towards those goals.
(n) The office shall establish a publicly accessible online dashboard using data from the reports filed pursuant to subsections (g) and (h) of the section to generate information on each college in high school program. The purpose of the dashboard shall be to create user-friendly displays of the overall success of the individual programs in achieving the goals and shall be written in terms understandable to the general public and to help students and their families identify available college in high school opportunities.
SECTION 6. Chapter 71 of the General Laws is hereby amended by adding the following section:-
Section 98. All public high school students shall complete and submit a free application for federal student aid or an application with the Massachusetts Educational Financing Authority. The Massachusetts Office of College in High School, established in section 37 of chapter 69, shall promulgate regulations and provide guidelines for implementation of this subsection, subject to the approval of the board of elementary and secondary education. A student is not required to comply with this section if: (1) the student’s parent or legal guardian submits a signed form indicating that the parent or legal guardian authorizes the student to decline to complete and submit the financial aid application; or (2) the student signs and submits a form on the student’s own behalf if the student is 18 years of age or older.
SECTION 7. The commissioner may expend funds from the Twenty-First Century Education Trust Fund established in section 35NNN of chapter 10 for college in high school programs.
SECTION 8. The first annual report required under section 38 of chapter 69, established in section 2 of this act shall be submitted no later than December 31, 2025.
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An Act relative to tuition waivers for children raised by a grandparent or other relative | S819 | SD495 | 193 | {'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-16T22:13:42.83'} | [{'Id': 'JAC0', 'Name': 'Julian Cyr', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JAC0', 'ResponseDate': '2023-01-16T22:13:42.83'}, {'Id': 'PDJ0', 'Name': 'Patricia D. Jehlen', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PDJ0', 'ResponseDate': '2023-08-09T10:56:07.2866667'}, {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-10-11T13:48:59.7'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S819/DocumentHistoryActions | Bill | By Mr. Cyr, a petition (accompanied by bill, Senate, No. 819) of Julian Cyr for legislation relative to tuition waivers for children raised by a grandparent or other relative. Higher Education. | Section 19 of chapter 15A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the ninth paragraph the following paragraph:-
The program shall provide tuition and fee waivers for any resident of the commonwealth who has been the subject of a legal guardianship pursuant to section 5-201 of chapter 190B of the General Laws and who, upon reaching the age of 18 or upon enrolling in a Massachusetts institution of higher education, is living with a grandparent or other relative, including any person related by consanguinity, marriage or affinity except for a parent. The commonwealth, not the institutions of public higher education, shall bear the cost of these waivers after all reimbursements from the federal government have been exhausted.
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An Act authorizing the Commonwealth of Massachusetts to establish additional mandated reporters for the purpose of the protection and care of children | S82 | SD2171 | 193 | {'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-01-19T23:04:19.607'} | [{'Id': 'PRF0', 'Name': 'Paul R. Feeney', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/PRF0', 'ResponseDate': '2023-01-19T23:04:19.6066667'}, {'Id': 'FJB1', 'Name': 'F. Jay Barrows', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/FJB1', 'ResponseDate': '2023-01-20T14:11:22.0633333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S82/DocumentHistoryActions | Bill | By Mr. Feeney, a petition (accompanied by bill, Senate, No. 82) of Paul R. Feeney and F. Jay Barrows for legislation to authorize the Commonwealth of Massachusetts to establish additional mandated reporters for the purpose of the protection and care of children. Children, Families and Persons with Disabilities. | SECTION 1. Section 21 of Chapter 119of the General Laws is hereby amended by striking out the definition of “Mandated reporter” and inserting in place thereof the following definition:-
"Mandated reporter'', a person 18 years old or older who is either a paid or unpaid employee, or a paid or unpaid volunteer, working in a profession or role listed herein, or any other person, paid or unpaid, contracted by any entity to perform the functions of a profession or role listed herein, if such person resides in the commonwealth or performs the functions of the profession or role listed herein for any person whose residence is in the commonwealth or who is physically in the commonwealth, including but not limited to any of the following professions or roles:
(i) a physician, medical intern, hospital personnel engaged in the examination, care or treatment of persons, medical examiner, psychologist, emergency medical technician, dentist, nurse, chiropractor, podiatrist, optometrist, osteopath, allied mental health and human services professional licensed under section 165 of chapter 112, drug and alcoholism counselor, psychiatrist or clinical social worker; (ii) a public or private school teacher, educational administrator, guidance or family counselor, child care worker, person paid to care for or work with a child in any public or private facility or organized setting including but not limited to athletic coaches and higher education personnel, or home or program funded by the commonwealth or licensed under chapter 15D that provides child care or residential services to children or that provides the services of child care resource and referral agencies, voucher management agencies or family child care systems or child care food programs, licensor of the department of early education and care or school attendance officer; (iii) a probation officer, clerk-magistrate of a district court, parole officer, social worker, foster parent, firefighter, police officer or animal control officer; (iv) a priest, rabbi, clergy member, ordained or licensed minister, leader of any church or religious body, accredited Christian Science practitioner, person performing official duties on behalf of a church or religious body that are recognized as the duties of a priest, rabbi, clergy, ordained or licensed minister, leader of any church or religious body, accredited Christian Science practitioner, or person employed by a church or religious body to supervise, educate, coach, train or counsel a child on a regular basis; (v) in charge of a medical or other public or private institution, school or facility or that person's designated agent; (vi) a recreational service provider, including but not limited to any personnel of a public, private, or religious organization providing recreational activities or services on a regular basis that are specifically designed for children and require direct supervision of children, including but not limited to day camps, summer camps, youth programs, sports organizations, and scouting groups, personnel of a public library; or (vii) the child advocate.
SECTION 2. Section 51A of Chapter 119 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking out subsection (k) and inserting in place thereof the following subsection:
(k) All persons considered mandated reporters under chapter 119 shall, within 180 days of their designation as a mandated reporter under this section, be required by the entity for which such person performs the functions or role listed herein, to participate in evidence-based training, approved by the Office of the Child Advocate, that specializes in the prevention of child sexual abuse, other forms of abuse, neglect, and mandated reporting. Such training, as approved by the Office of the Child Advocate, in consultation with the Attorney General of the Commonwealth, may be conducted in-person with a facilitator or online. Refresher training may be required by the entity for mandated reporters that have completed initial training.
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An Act protecting students abroad | S820 | SD1090 | 193 | {'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-18T21:09:14.797'} | [{'Id': 'SND0', 'Name': 'Sal N. DiDomenico', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/SND0', 'ResponseDate': '2023-01-18T21:09:14.7966667'}, {'Id': 'JKH1', 'Name': 'James K. Hawkins', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/JKH1', 'ResponseDate': '2023-06-01T10:33:16.3533333'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S820/DocumentHistoryActions | Bill | By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 820) of Sal N. DiDomenico for legislation to protect students abroad. Higher Education. | Chapter 15A of the General Laws as appearing in the 2020 Official Edition, shall be amended by inserting after Section 44 the following section:-
Section 45. (a) (1) Secondary and postsecondary institutions involved with providing student services abroad, located in the commonwealth and which require waivers for students participating in these programs shall prioritize health, safety and security in program development, implementation and management of study abroad programs. They shall achieve this by conducting risk assessments for program sites and activities to include assessments of lodging locations, maintaining written emergency plans and protocols specific to the destination and base of travel, and identifying and leveraging relevant authorities, networks, and resources to establish statistical reporting of any student injured, assaulted or subjected to a criminal act while participating in the student-sponsored travel. These plans, protocols and statistics shall be available for review upon request and prior to travel, by any consumer interested in participating in the sponsored program.
(2) Staff on study abroad trips shall be trained to anticipate and respond responsibly to student health, safety and security issues, including but not limited to basic first aid and familiarization with established emergency action plans. Prior to said study abroad trips, said institutions shall provide training to students to mitigate the risk of injury by providing updates on activities involving health, safety and security issues occurring at the proposed destination.
(b) (1) Said institutions shall file by November 1 of each year a report on its programs with the secretary of the commonwealth. Said report shall contain the following information from the previous academic year, including summer terms: (i) deaths of program participants that occurred during program participation as a result of program participation; (ii) accidents and illnesses that occurred during program participation as a result of program participation and that required hospitalization; (iii) sexual assaults and crimes against program participants, and details of the incidents, including date, time, location, and whether it was during participation in the program; and (iv) country, primary program host, and program type.
(2) For purposes of paragraph (1), "primary program host" shall have the following meaning:- an institution or organization responsible for or in control of the majority of decisions being made on the program including, but not limited to, student housing, local transportation, and emergency response and support.
(3) Information reported under paragraph (1), clause (i), may be supplemented by a brief explanatory statement.
(4) Said institutions shall request hospitalization and incident disclosure from students upon completion of the program.
(c) (1) The secretary of the commonwealth shall publish on its website: (i) the reports required by subsection (b) paragraph (1) in a format that facilitates identifying information related to said institutions; (ii) links to the United States Department of State's Consular Information Program informing the public of conditions abroad that may affect their safety and security; and (iii) links to the publicly available reports on sexual assaults and other criminal acts affecting study abroad program participants during program participation. This information shall not be limited to programs subject to this section.
(2) The secretary of state shall provide the information it posts on its website as required by paragraph (1) to the Department of Higher Education, in electronic format, at the time it posts the information. The Department shall post the information on its website and may otherwise distribute the information. In materials distributed or posted, the Department must reference this section.
(3) Said institutions shall include in its written materials provided to prospective program participants a link to the secretary of state website stating that program health and safety information is available at the website.
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An Act banning legacy preferences in higher education | S821 | SD1529 | 193 | {'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-01-17T12:20:54.08'} | [{'Id': 'LME0', 'Name': 'Lydia Edwards', 'Type': 1, 'Details': 'http://malegislature.gov/api/GeneralCourts/193/LegislativeMembers/LME0', 'ResponseDate': '2023-01-17T12:20:54.08'}] | null | http://malegislature.gov/api/GeneralCourts/193/Documents/S821/DocumentHistoryActions | Bill | By Ms. Edwards, a petition (accompanied by bill, Senate, No. 821) of Lydia Edwards for legislation to ban legacy preferences in higher education. Higher Education. | An Act banning legacy preferences in higher education
SECTION 1. Section 9 of Chapter 15A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the fourth paragraph the following:
For purposes of this paragraph, a public higher education institution shall mean a school in the University of Massachusetts segment or in the state university segment of the system of public institutions of higher education established in section 5 of chapter 15A. When deciding whether to grant admission to an applicant, a public higher education institution shall not consider the applicant’s familial relationship to a graduate of the institution. A public higher education institution shall not include in the documents that it uses to consider an applicant for admission information that discloses the name of any college or university that any relative of the applicant attended.
SECTION 2. Chapter 69 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 30A the following:
Section 30B. When deciding whether to grant admission to an applicant, a degree-granting institution of higher education located in the commonwealth authorized to grant degrees by the board of higher education shall not consider the applicant’s familial relationship to a graduate of the institution. Such institution shall not include in the documents that it uses to consider an applicant for admission information that discloses the name of any college or university that any relative of the applicant attended.
SECTION 3. Sections 1 and 2 shall take effect for admission decisions that lead to an applicant’s initial enrollment in a public higher education institution in the 2024-2025 school year.
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Subsets and Splits