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Floor Number: 551 Clerk Number: 72
PHYSICIAN REFERRALS FOR INNOVATIVE SERVICE
Mr. Moore and Mrs. Chandler move to amend the bill by adding
at the end thereof the following new section:-
SECTION
___ Notwithstanding the provisions of any general or special law to the contrary,
no for-profit individual physician or physician group under the solo or group
practice exclusion from the definition of "clinic" contained in section
52 of chapter 111 of the General Laws, other than a radiologist or any other physician
who is employed in an acute hospital, shall refer a patient for services to a
health care entity that operates diagnostic equipment that is used to provide
an innovative service or that is new technology, as such terms are defined in
section 25B of chapter 111 of the General Laws, if: (i) the physician holds a
direct or indirect ownership or investment interest in such diagnostic equipment
or entity; (ii) the physician's immediate family holds a direct or indirect ownership
or investment interest in such diagnostic equipment or entity; or (iii) the physician
or member of the physician's immediate family has any direct or indirect arrangement
involving compensation with such entity. For purposes of this section, "health
care entity" is defined as an entity that provides health care related testing
or diagnosis of individuals but does not include a hospital licensed by the department
of public health pursuant to section 51 of Chapter 111 of the General Laws. For
purposes of this section "investment interest" is defined as an ownership
or investment interest through equity, debt, leasehold interest, or other means,
or a compensation arrangement, regardless of whether such interest is direct or
indirect. The department of public health shall enforce this section. The Superior
Court shall have jurisdiction in equity to enforce the provisions of this section.
Upon an initial determination of a violation of this section, the department shall
forthwith seek injunctive relief in the Superior Court. A violation of this section
shall be punishable by a fine of not less than $25,000. Any continuing violation
of this section shall be punishable by a fine of not less than $25,000 and not
more than $100,000 per day of operation, and by one or both of: (i) referral of
the physician to the board of registration in medicine for appropriate disciplinary
action; and (ii) revocation of the health care entity's license.
Floor Number: 552 Clerk Number: 109
SAFE, AFFORDABLE PRESCRIPTION DRUGS
Ms. Melconian, Mr. Montigny, Mr. Barrios, Ms. Menard, Mr.
Moore, Ms. Chandler, Mr. Morrissey, Mr. O'Leary, Mr. McGee, Mr. Nuciforo, Mr.
Pacheco, Ms. Fargo, Ms. Creem, Ms. Wilkerson, Mr. Antonioni, Mr. Glodis, Mr.
Rosenberg, Mr. Magnani, Mr. Tolman, Mr. Hart, Mr. Shannon and Mr. Havern move
to amend the bill (S. 2400) by inserting after section 242 the following section:-
"SECTION
242A. (a) The governor or his designee shall request the United States Department
of Health and Human Services to provide a waiver to the office of pharmaceutical
information to act as an agent for residents of the commonwealth in providing
information regarding the purchase of prescription drugs from the commonwealth
and Canadian sources, as provided in sections (b) and (c). Once the waiver is
provided, said sections (b) and (c) shall apply.
(b) Subject to appropriation,
there shall be in the department of public health the office of pharmaceutical
information for the purpose of providing information to residents of the commonwealth
regarding the purchase of prescription drugs including from Canadian sources,
as provided in subsection (a). Notwithstanding any general or special law to the
contrary, the office of pharmaceutical information shall act as a central agency
through which residents of the commonwealth may obtain information on procuring
prescription drugs at reduced prices.
(c) The office, in providing advice
on purchasing prescription drugs from Canada, shall establish relationships only
with Canadian suppliers that are licensed by appropriate Canadian agencies. The
office shall maintain a registry providing the name, place of business, phone
number, fax number, or email address of: the establishment, the manufacturers
of the drugs the establishments distribute and of any of the establishment's agents
in the United States. The office shall periodically update this information on
the establishments.
(d) The office shall provide advice only on prescription
drugs that have been approved by appropriate federal agencies in Canada as to
the drugs' formulation, source and specification of active ingredients, processing
methods, manufacturing controls, container/closure/packaging system, appearance,
storage, shipping and handling practices; and the office shall advise only on
prescription drugs that are packaged and shipped using tamper-proof containers
and are certified by the importer as meeting all the requirements of the bill.
(e) In order to ensure the safety of prescription drugs procured from licensed
Canadian pharmacies, the office will only work with consumers in the commonwealth
who are purchasing prescriptions that:
(i) are for personal use only
(ii)
will not be used for resale
(iii) are for a quantity limited to 90 days or
less
(iv) accompanied by a copy of a valid prescription
(f) The office
may conduct, or contract with an entity to conduct, a study of prescription drug
imports permitted pursuant to this bill. The study shall include, but not be limited
to, evaluation of the importers' compliance with state and federal laws, including
Canadian laws.
(g) The office shall serve as a central agent to which any
safety concerns or adverse events occur regarding the process of procuring medications
from Canada may be reported by Massachusetts consumers and health care professionals.
If any safety concerns or adverse events occur with respect to the process of
importing prescriptions from Canada, such as if a particular distributor is found
to no longer meet the required safety standards, a safety report of the problem
shall be filed and a record kept in the office. Consumers and health care providers
in the database will be notified of the safety reports by the office.
(h)
The office of pharmaceutical information may promulgate a consent agreement explaining
the potential risks and injuries associated with obtaining services, materials,
or information from the office and disclaiming liability for those risks and injuries.
The office may require any resident of the commonwealth to sign the consent agreement
before receiving services, information or materials from the office. The office
shall keep any signed consent agreement on file.
(i) The office of pharmaceutical
information may develop an indemnification agreement designed to indemnify the
office for any injury or damage that results from a resident's use of a supplier's
product, and hold harmless any pharmacists who rely upon the information contained
in the website to advise consumers. The office may require any supplier listed
with the office to sign the indemnity agreement before its products are listed
with the office. The office shall keep any signed indemnification agreement on
file. Chapter 258 of the General Laws shall apply to this section.
(j) the
department of public health shall promulgate regulations to implement this section,
including but not limited to, the process by which the office of pharmaceutical
information may determine which pharmacies would be included on the informational
website; the certification process, if any, that Massachusetts pharmacists would
participate in before advising patients seeking assistance; and any other rules
and regulations necessary for implementation of this section."
Floor Number: 553 Clerk Number: 259
AN AMENDMENT TO PROTECT LISCENSED HOSPITAL BED CAPACITY
Mr. Tarr, Mr. Knapik, Ms. Sprague, Mr. Hedlund and Mr. Brown
move to amend the bill (Senate bill 2400) by adding, at the end thereof, the
following new section: -
"SECTION___.
Section 51 of chapter 111 of the General Laws, as appearing in the 2002 Official
Edition, is hereby amended:
by striking the word "shall" in line
29 and replacing it with the word "may", and further,
by striking
the text beginning with and the word "As" in line 32 and ending with
the word "five" in line 47.
Floor Number: 554 Clerk Number: 264
AN AMENDMENT TO ENSURE QUALITY HEALTH CARE COVERAGE
Mr. Tarr moves to amend the bill (Senate bill 2400) by adding,
at the end thereof, the following new section: -
"SECTION___. Section 51G of Chapter 111 of the General
Laws is hereby amended in Subsection (4) by adding, after the first sentence,
the following: -
Any such notification shall include, but not be limited to,
the following:
1. The reasons for which the closing or discontinuance is being
proposed.
2. An analysis of the economic feasibility of retaining the essential
health service or hospital and the economic impacts of the proposed closing or
discontinuance
3. An analysis of the clinical safety of retaining the essential
health service or hospital and any threats to public health and safety that would
be caused by the proposed closing or discontinuance
SECTION 2. Section 51G
of Chapter 111 of the General Laws is hereby amended in Subsection (4) by adding,
after the word "hospital" in the fourth sentence thereof the following:
The department shall consult as to economic issues contained in the notification
with the Division of Health Care Finance and Policy and may, if it determines
that an essential health service can be retained in a clinically safe manner without
depriving the hospital of a fair net operating income, deny the proposed discontinuance
and require the retention of the essential health service either in its original
condition or any modification which the department deems to be satisfactory.
In the event that a hospital proposed for closure is owned or controlled by an
entity which holds a license for facilities other than the hospital proposed for
closure, and the department determines that the hospital can be retained in a
clinically safe manner and without depriving that entity of a fair net operating
income, the department may require the retention of said hospital either in its
original configuration or any modification which the department deems to be satisfactory.
FLOOR NUMBER: 555 CLERK NUMBER: 282
ABSTINENCE EDUCATION
Mr. Havern and Mr. Antonioni move to amend the bill by inserting, at the end thereof the following new section: -
"SECTION_______. Notwithstanding the provisions of any general or special law to the contrary, all funding under the abstinence education project in the department of public health shall be directed towards teaching abstinence education as found in Sec. 510 [42 U.S.C. 710] (b) (2)(a-h) and not for advertisement or any other media campaigns."
Floor Number: 556 Clerk Number: 299
VISION SCREENING
Mr. Antonioni moves to amend the bill by inserting after
Section ____, the following new Section:-
SECTION ____. Upon entering kindergarten or within 30 days of
the start of the school year, each child shall present to school health personnel
certification of having passed a vision screening within the previous twelve months,
conducted by personnel as approved by the department of public health and trained
in the Massachusetts approved vision screening techniques to be developed by the
department of public health in consultation with the department of education.
In the event of failure to pass the approved Massachusetts vision screening and
for children diagnosed with neurodevelopmental delay, proof of a comprehensive
eye examination performed by a licensed optometrist or ophthalmologist chosen
by the child's parents or guardian indicating any pertinent diagnosis, treatment,
prognosis, recommendation and evidence of follow-up treatment if necessary must
be provided."
Floor Number: 557 Clerk Number: 430
HYPODERMIC NEEDLES AVAILABILITY
Mr. O'Leary, Ms. Wilkerson, Mr. Montigny and Ms. Fargo move
to amend the bill by inserting, after Section 362, the following new Section:-
"SECTION ___. Section
1 of chapter 94C of the General Laws, as appearing in the 1998 Official Edition,
is hereby amended by striking out in line 68 the word "injecting".
Section 2. Section 1 of chapter 94C of the General Laws, as appearing in the 1998 Official Edition, is hereby amended by striking out subsection (11), lines 100 to 102 inclusive.
Section 3. Chapter 94 C of the General Laws is hereby amended
by striking out section 27 and inserting in place thereof the following section:--
Section
27. (a) Hypodermic syringes, hypodermic needles and any other instrument adapted
for the administration of controlled substances by injection may be sold in the
commonwealth only to persons who have attained the age of 18 years and only by
a pharmacist or wholesale druggist, who is licensed under the provisions of chapter
112, a manufacturer of or dealer in surgical supplies, or a manufacturer of or
dealer in embalming supplies. No more than 10 such syringes, needles or instruments
may be purchased by one person at one time.
(b) All manufacturers of hypodermic
needles and syringes to be sold in the Commonwealth shall develop an educational
insert, which must be approved by the department of public health, to accompany
the sale of hypodermic syringes and needles. Such educational insert shall include,
but not be limited to, (1) information on the proper use of hypodermic syringes
and needles, (2) the risk of blood borne diseases that may result from the use
of hypodermic syringes and needles and methods for preventing the contraction
or transmission of such diseases, (3) proper hypodermic syringe and needle disposal
practices, (4) the toll-free telephone number of the Commonwealths AIDS hotline,
and (5) the toll-free number of the Massachusetts Substance Abuse Information
and Education Helpline. Such educational insert shall be provided to purchasers
of hypodermic syringes and needles at the point of sale.
Section 4. Section 32I of Chapter 94C of the General Laws is hereby amended by striking out in line 6 the word "inject".
Section 5. Section 32I of Chapter 94C of the General Laws
is hereby amended by adding at the end thereof the following paragraph:--
(d) The provisions of this section shall not apply to the sale
of hypodermic syringes, hypodermic needles or any other instrument adapted for
the administration of controlled substances by injection to persons over the age
of 18 pursuant to section 27.
Section 6. Chapter 175 of the General Laws, as most recently
amended by Chapter 141 of the Acts of 2000, is hereby amended by inserting after
section 47U, the following section:--
Section 47V. No
individual policy of accident and sickness insurance issued or renewed pursuant
to section 110, shall restrict or discontinue coverage for medically necessary
hypodermic syringes and needles, notwithstanding any changes made to section 27
of Chapter 94C of the General Laws.
Section 7. Chapter 176A of the General Laws, as most recently
amended by Chapter 141 of the Acts of 2000, is hereby amended by inserting after
section 8U, the following section:--
Section 8V. No contract
between a subscriber and the corporation under an individual or group hospital
service plan which is delivered, issued, or renewed in the commonwealth shall
restrict or discontinue coverage for medically necessary hypodermic syringes and
needles to any individual subscribers and members within the commonwealth and
to any group members having a principal place of employment within the commonwealth,
notwithstanding any changes made to section 27 of Chapter 94C of the General Laws.
Section 8. Chapter 176B of the General Laws, as most recently
amended by Chapter 141 of the Acts of 2000, is hereby amended by inserting after
section 4U, the following section:--
Section 4S. No subscription certificate, under
an individual or group medical service agreement, delivered, issued or renewed
in the commonwealth shall restrict or discontinue coverage for medically necessary
hypodermic syringes and needles to any individual subscribers and members within
the commonwealth and to any group members having a principal place of employment
within the commonwealth, notwithstanding any changes made to section 27 of Chapter
94C of the General Laws.
Section 9. Chapter 176G of the General Laws, as most recently
amended by Chapter 141 of the Acts of 2000, is hereby amended by inserting after
section 4M, the following section:--
Section 4N. No individual
or group health maintenance contract shall restrict or discontinue coverage for
medically necessary hypodermic syringes and needles, notwithstanding any changes
made to section 27 of Chapter 94C of the General Laws.
Section 10. Section 79 of chapter 277 of the General Laws,
as appearing in the 1998 Official Edition, is hereby amended by striking out,
in lines 463 to 466, inclusive, the words:--
Possession of hypodermic instrument. That A.B. did have in his possession
unlawfully a hypodermic syringe and needle.
Sale and delivery of hypodermic
instrument C That A.B. did unlawfully sell (or deliver) a hypodermic syringe (or
needle)."
Floor Number: 558 Clerk Number: 544
SAFE, AFFORDABLE PRESCRIPTION DRUGS
Ms. Melconian, Mr. Montigny, Mr. Barrios, Ms. Menard, Mr.
Moore, Ms. Chandler, Mr. Morrissey, Mr. O'Leary, Mr. McGee, Mr. Nuciforo, Mr.
Pacheco, Ms. Fargo, Ms. Creem, Ms. Wilkerson, Mr. Antonioni, Mr. Glodis, Mr.
Rosenberg, Mr. Magnani, Mr. Tolman, Mr. Hart, Mr. Shannon, Mr. Havern, Mr. Creedon
and Mr. Joyce move to amend the bill (S. 2400) by inserting after section 242
the following section:-
"SECTION
242A. (a) The governor or his designee shall request the United States Department
of Health and Human Services to provide a waiver to the office of pharmaceutical
information to act as an agent for residents of the commonwealth in providing
information regarding the purchase of prescription drugs from the commonwealth
and Canadian sources, as provided in sections (b) and (c). Once the waiver is
provided, said sections (b) and (c) shall apply.
(b) Subject to appropriation,
there shall be in the department of public health the office of pharmaceutical
information for the purpose of providing information to residents of the commonwealth
regarding the purchase of prescription drugs including from Canadian sources,
as provided in subsection (a). Notwithstanding any general or special law to the
contrary, the office of pharmaceutical information shall act as a central agency
through which residents of the commonwealth may obtain information on procuring
prescription drugs at reduced prices.
(c) The office, in providing advice
on purchasing prescription drugs from Canada, shall establish relationships only
with Canadian suppliers that are licensed by appropriate Canadian agencies. The
office shall maintain a registry providing the name, place of business, phone
number, fax number, or email address of: the establishment, the manufacturers
of the drugs the establishments distribute and of any of the establishment's agents
in the United States. The office shall periodically update this information on
the establishments.
(d) The office shall provide advice only on prescription
drugs that have been approved by appropriate federal agencies in Canada as to
the drugs' formulation, source and specification of active ingredients, processing
methods, manufacturing controls, container/closure/packaging system, appearance,
storage, shipping and handling practices; and the office shall advise only on
prescription drugs that are packaged and shipped using tamper-proof containers
and are certified by the importer as meeting all the requirements of the bill.
(e) In order to ensure the safety of prescription drugs procured from licensed
Canadian pharmacies, the office will only work with consumers in the commonwealth
who are purchasing prescriptions that:
(v) are for personal use only
(vi)
will not be used for resale
(vii) are for a quantity limited to 90 days or
less
(viii) accompanied by a copy of a valid prescription
(f) The office
may conduct, or contract with an entity to conduct, a study of prescription drug
imports permitted pursuant to this bill. The study shall include, but not be limited
to, evaluation of the importers' compliance with state and federal laws, including
Canadian laws.
(g) The office shall serve as a central agent to which any
safety concerns or adverse events occur regarding the process of procuring medications
from Canada may be reported by Massachusetts consumers and health care professionals.
If any safety concerns or adverse events occur with respect to the process of
importing prescriptions from Canada, such as if a particular distributor is found
to no longer meet the required safety standards, a safety report of the problem
shall be filed and a record kept in the office. Consumers and health care providers
in the database will be notified of the safety reports by the office.
(h)
The office of pharmaceutical information may promulgate a consent agreement explaining
the potential risks and injuries associated with obtaining services, materials,
or information from the office and disclaiming liability for those risks and injuries.
The office may require any resident of the commonwealth to sign the consent agreement
before receiving services, information or materials from the office. The office
shall keep any signed consent agreement on file.
(i) The office of pharmaceutical
information may develop an indemnification agreement designed to indemnify the
office for any injury or damage that results from a resident's use of a supplier's
product, and hold harmless any pharmacists who rely upon the information contained
in the website to advise consumers. The office may require any supplier listed
with the office to sign the indemnity agreement before its products are listed
with the office. The office shall keep any signed indemnification agreement on
file. Chapter 258 of the General Laws shall apply to this section.
(j) the
department of public health shall promulgate regulations to implement this section,
including but not limited to, the process by which the office of pharmaceutical
information may determine which pharmacies would be included on the informational
website; the certification process, if any, that Massachusetts pharmacists would
participate in before advising patients seeking assistance; and any other rules
and regulations necessary for implementation of this section."
Floor Number: 559 Clerk Number: 594
PATIENT SAFETY
Mr. Pacheco, Mr. Tolman, Mr. Barrios, Mr. Tisei, Mr. Glodis, Ms. Chandler, Ms. Tucker, Mr. Knapik, Ms. Resor, Mr. Antonioni, Mr. Montigny, Ms. Walsh, Mr. Hedlund, Mr. Hart, Mr. O'Leary, Mr. Joyce, Mr. Brewer, Ms. Melconian, Ms. Creem, Mr. Tarr, Ms. Fargo, Mr. McGee, Mr. Havern, Mr. Creedon, Mr. Baddour move to amend the bill in Section 328 by deleting the section in its entirety and replacing it with the following new section:-
"Section ____ Chapter 111 of the General Laws is hereby
amended by adding the following section:-
Section 219. (a) As used in this section, the following words, shall, unless
the context clearly require otherwise, have the following meanings:-
"Acuity-based patient classification system", a standardized set of
criteria based on scientific data that acts as a measurement instrument which
predicts registered nursing care requirements for individual patients based
on severity of patient illness, need for specialized equipment and technology,
intensity of nursing interventions required and the complexity of clinical nursing
judgment needed to design, implement and evaluate the patient's nursing care
plan consistent with professional standards of care, details the amount of registered
nursing care needed, both in number of direct-care registered nurses
and skill mix of nursing personnel required on a daily basis for each patient
in a nursing department or unit and is stated in terms that readily can be used
and understood by direct-care registered nurses. The acuity system criteria
shall take into consideration the patient care services provided not only by
registered nurses but also by licensed practical nurses and other health care
personnel.
"Assessment tool", a measurement system which compares the registered
nurse staffing level in each nursing department or unit against actual patient
nursing care requirements in order to review the accuracy of an acuity system.
"Board", the board of registration in nursing.
"Department", the department of public health.
"Direct-care registered nurse", a registered nurse who has accepted
direct responsibility and accountability to carry out medical regimens, nursing
or other bedside care for patients.
"Facility", a hospital licensed pursuant to 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 operated general acute
care hospital, an acute psychiatric hospital, a specialty hospital, or any acute
care unit within a state operated facility.
"Nursing care", care which falls within the scope of practice as prescribed
by state law or otherwise encompassed within recognized professional standards
of nursing practice, including assessment, nursing diagnosis, planning, intervention,
evaluation and patient advocacy.
"Ratio", the actual number of patients to be assigned to each direct
care registered nurse.(b) The department of public health shall have the power
and its duty shall be:
(1) to promulgate the rules and regulations necessary to carry out the purposes
and provisions of this chapter, including regulations defining terms, and prescribing
the process for establishing a standardized acuity-based patient classification
system.
(2) to assure that the provisions of this chapter and all rules and regulations
promulgated under this chapter are enforced; and to promulgate, within one year
of the effective date of this chapter, regulations providing for an accessible
and confidential system to report any failure to comply with requirements of
this chapter and public access to information regarding reports of inspections,
results, deficiencies and corrections under this chapter.
(3) to develop within one year of passage of this act a standardized acuity-based
patient classification system as defined in section (a) to be utilized by all
facilities to increase the number of direct care registered nurses to meet patient
needs.
(c) Each facility, as defined in paragraph (a) shall incorporate and maintain
the following minimum direct-care registered nurse-to-patient ratios:-
Intensive Care Unit: 1:2
Critical Care Unit 1:2
Neo-natal Intensive Care 1:2
Burn Unit 1:2
Step-down/Intermediate Care 1:3
Operating Room
Under anesthesia 1:1
Post Anesthesia 1:2
Post Anesthesia Care Unit
Under anesthesia 1:1
Post Anesthesia 1:2
Emergency Department 1:3*
Emergency Critical care 1:2*
Emergency Trauma 1:1*
* The triage, radio, or other specialty registered nurse shall not be
counted as part of this number.
Labor and Delivery
Active Labor 1:1
Immediate Postpartum 1:2 (one couplet)
Postpartum 1:6 (three couplets)
Intermediate Care Nursery 1:4
Well-Baby Nursery 1:6
Pediatrics 1:4
Psychiatric 1:4
Medical and Surgical 1:4
Telemetry 1:4
Observational/Out patient treatment 1:4
Transitional Care 1:5
Rehabilitation Unit 1:5
Specialty Care Unit, any unit not otherwise listed above shall be considered
a
specialty care unit 1:4
These ratios shall constitute the minimum number of direct-care registered nurses.
Additional direct-care registered nurses shall be added and the ratio adjusted
to ensure direct-care registered nurse staffing in accordance with an approved
acuity-based patient classification system. Nothing herein shall be deemed to
preclude any facility from increasing the number of direct-care registered nurses,
nor shall the requirements set forth be deemed to supersede or replace any requirements
otherwise mandated by law, regulation or collective bargaining contract so long
as the facility meets the minimum requirements outlined.
(d) As a condition of licensing, each facility annually shall submit to the
department a prospective staffing plan together with a written certification
that the staffing plan is sufficient to provide adequate and appropriate delivery
of health care services to patients for the ensuing year and does all of the
following:
1) meets the minimum direct care registered nurse-to-patient ratio requirements
of paragraph (c);
2) employs the acuity-based patient classification system for addressing fluctuations
in patient acuity levels requiring increased registered nurse staffing levels
above the minimums set forth in said paragraph (c);
3) provides for orientation of registered nursing staff to assigned clinical
practice areas, including temporary assignments;
4) includes other unit or department activity such as discharges, transfers
and admissions, administrative and support tasks that are expected to be done
by direct-care registered nurses in addition to direct nursing care;
5) submits the assessment tool used to validate the acuity system relied upon
in the plan.
As a condition of licensing, each facility annually shall submit to the department
an audit of the preceding year's staffing plan as dictated in clauses (1) to
(5), inclusive. The audit shall compare the staffing plan with measurements
of actual staffing as well as measurements of actual acuity for all units within
the facility.
(e) As a condition of licensing, a facility required to have a staffing
plan under this chapter shall:
(1) prominently post on each unit the daily written nurse staffing plan to reflect
the registered nurse-to-patient ratio means of consumer information and protection.
(2) provide each patient and/or family member with a toll-free hotline number
for the Division of Health Care Quality at the department, which may be Used
to report inadequate registered nurse staffing. Such complaint shall cause
investigation by the department within 24 hours to determine whether any violation
of law or regulation by the facility has occurred.
(f) No facility may directly assign any unlicensed personnel to perform nondelegatable
licensed nurse functions in-lieu of care delivered by a licensed registered
nurse. Additionally, unlicensed personnel are prohibited from performing tasks,
which require the clinical assessment, judgment and skill of a licensed registered
nurse. Such functions shall include, but are not limited:
(1) Nursing activities which require nursing assessment and judgment during
implementation;
(2) Physical, psychological, and social assessment which requires nursing judgment,
intervention, referral or follow-up;
(3) Formulation of the plan of nursing care and evaluation of the patient's/client's
response to the care provided; and
(4) Administration of medications.
(5) Health teaching and health counseling
(g) Such rules and regulations shall require that a full time registered nurse
executive leader be employed by each facility to be responsible for the overall
execution of resources to ensure sufficient registered nurse staffing is provided
by said facility.
(h) Such rules and regulations shall require that a full time registered nurse
be designated by the facility to be responsible for the overall quality assurance
of nursing care as provided by the facility.
(i) Such rules and regulations shall require that a full time registered nurse
be designated by each facility to ensure the overall occupational health and
safety of nursing staff employed by said facility.
(j) Appropriate Orientation. For purposes of compliance with the minimum registered
nurse staffing requirements set forth in this act, no registered nurse shall
be assigned, or be included in the count of assigned registered nursing staff
in a nursing department or unit or a clinical area within the health facility
unless that registered nurse has an appropriate orientation in
that clinical area sufficient to provide competent nursing care to the patients
in that area, and has demonstrated current competence in providing care in that
area.
(k) For purposes of compliance with the minimum staffing requirements set forth
under this chapter, except in cases of national or state declared emergencies,
no facility may employ mandatory overtime or mandatory on-call
policies. Mandatory overtime shall mean any employer request with respect to
overtime, which if refused or declined by the employee, may result in an adverse
employment consequence to the employee. The term overtime with respect
to an employee, means any hours that exceeds the predetermined number of hours
that the employer and employee have agreed that the employee would work during
the shift or week involved.
(l) The setting of staffing standards for registered nurses is not to be interpreted
as justifying the understaffing of other critical health care workers, including
licensed practical nurses and unlicensed assistive personnel. The availability
of these other health care workers enables registered nurses to focus on the
nursing care functions that only registered nurses, by law, are permitted to
perform and thereby helps to ensure adequate staffing levels.
(m) Any facility that fails to anticipate, design, maintain or adhere to a daily
written nurse staffing plan in accordance with the provisions of this section,
or any rule or regulation promulgated hereunder, (1) shall be subject to revocation
of said facility's license or registration, or by a fine of not more than twenty-five
thousand dollars, or both, (2) shall be subject to a
civil penalty of not more than twenty-five thousand dollars, for each such violation.
Each day each such violation occurs or continues shall be deemed a separate
offense. These penalties shall be in addition to any other penalties that may
be prescribed by law. The department shall have jurisdiction to coordinate enforcement
related activities. The civil penalty may be assessed in any action brought
on behalf of the Commonwealth or on behalf of any patient or resident aggrieved
hereunder in any court of competent jurisdiction. Fines relative to said violations
shall be collected and distributed to
the Betsy Lehman center for patient safety and medical error reduction, created
by section 7 of chapter 177 of the acts of 2001. Each facility found in violation
of said plan must prominently post its violation notice within each unit in
violation. Copies of the notice shall be posted by the facility immediately
upon receipt and maintained for 60 consecutive days in conspicuous places including
all places where notices to employees are customarily posted. Reasonable steps
shall be taken by the facility to ensure that the notices are not altered, defaced,
or covered by any other material. The department will post said violation notices
on its website immediately after a finding of a violation. The notice shall
remain on the
department's website for 60 consecutive days or until such violation is rectified,
whichever is greater."
Floor Number: 560 Clerk Number: 670
GRAY MARKET ENFORCEMENT
Mr. Panagiotakos of Lowell moves to amend the bill by adding
at the end thereof the following new section: -
SECTION___. Chapter 94E of the General Laws, as appearing
in the 2002 Official Edition, is hereby amended by inserting after Chapter 94E
the following new Chapter:-
Section 1. Chapter 94F. CIGARETTE ENFORCEMENT.
For purposes of this chapter, the following words shall have the following meanings:-
"Cigarette", cigarette as defined in section 1 of chapter 94E.
"Commissioner",
the commissioner of the department of public health.
"Package",
a pack, box, carton or container of any kind in which cigarettes are offered for
sale, sold or otherwise distributed to consumers.
"Counterfeit",
any unauthorized reproduction, copy, or colorable imitation offered in connection
with the sale, offering for sale, or advertising of any tobacco product.
"Person",
an individual, company, corporation or partnership.
Section 2. (a) It shall
be unlawful for any person:
(1) to sell, distribute, acquire, hold, own, possess,
transport, import or cause to be imported into or in the commonwealth for sale
or distribution in the commonwealth, any cigarettes that are counterfeit or do
not comply with all requirements imposed under federal law and implementing regulations,
including but not limited to the requirements on the filing of ingredients lists
under the \federal Cigarette Labeling and Advertising Act, 15 U.S.C. Jsection
1335a; the permanent imprinting of package warning labels in the precise format
specified under the federal Cigarette 'Labeling and Advertising Act, 15 U.S.C.
section 1333; the rotation of label statements under the federal Cigarette Labeling
and (Advertising Act, 15 U.S.C. section 1333(c); restrictions on the importation,
transfer and sale of previously exported tobacco (products pursuant to Section
9302 of Public Law 105-33, the Balanced Budget Act of 1997, as amended; the requirements
of Title |IV of the Imported Cigarette Compliance Act of 2000; and federal trademark
and copyright laws;
(2) to alter the package of any cigarettes, prior to sale
or distribution to the ultimate consumer, so as to remove, conceal or obscure:
I (i) any statement, label stamp, sticker, or notice indicating that !the manufacturer
did not intend the cigarettes to be sold, distributed or used in the United States,
including but not limited to labels stating "For Export Only," "U.S.
Tax Exempt," "For Use Outside U.S.," or similar wording; or (ii)
any health warning that is not the precise warning statement in the precise format
specified in the federal Cigarette Labeling /and Advertising Act, 15 U.S.C. section
1333; or I (3) to affix any tax stamp or meter impression required pursuant to
chapter 64C to the package of any cigarettes that does not i comply with the requirements
set forth in clause (1) or that is jaltered in violation of clause (2). j (b)
This chapter shall not apply to cigarettes allowed to be (imported or brought
into the United States for personal use, or to / cigarettes sold or intended to
be sold as duty-free merchandise by ja duty-free sales enterprise in accordance
with 19 U.S.C. I section 1555(b) and any implementing regulations. However, this
i chapter shall apply to any such cigarettes that are brought back I into the
customs territory for resale within the customs territory.
Section 3. Cigarettes
imported or reimported into the United ! States for sale or distribution under
any trade name, trade dress or I trademark that is the same as, or is confusingly
similar to, any , trade name, trade dress or trademark used for cigarettes manufac-
tured in the United States for sale or distribution in the United States shall
be presumed to have been purchased outside of the ordinary channels of trade.
Section 4. A violation of section 2 shall constitute an unfair trade practice under chapter 93A and a person who violates section 2 shall be subject the same penalties and remedies as available under chapter 93A in addition to any penalties or remedies set forth in this chapter.
Section 5. (a) The commissioner shall enforce this chapter. At the request of the commissioner, or the commissioner's duly authorized agent, the state police and all municipal police authorities shall also enforce this chapter. The attorney general shall have concurrent jurisdiction with the prosecuting attorneys to prosecute violations of this act. (b) For the purpose of enforcing this chapter, the commissioner and any agency or department to which the commissioner delegates enforcement responsibility under subsection (a) may request information from any state or local agency, and may share information with, and request information from, any federal, state or local agency in the United States.
Section 6. (a) The commissioner may revoke or suspend the
license of any licensee under chapter 64C upon finding, after notice and a hearing,
of a violation by the licensee of this chapter or any implementing regulation
promulgated thereunder by the commissioner. The commissioner may also impose
on any person a civil penalty in an amount not to exceed the greater of 500
per cent of the retail value, of the cigarettes involved or $5,000 upon finding
a violation by such person of this chapter or any regulation promulgated thereunder.
(b)
Cigarettes that are acquired, held, owned, possessed, transported in, imported
into, or sold or distributed in the commonwealth in violation of this chapter
shall be deemed contraband and shall be subject to seizure and forfeiture in the
same manner as provided for unstamped cigarettes under section 38A of chapter
64C. Any cigarettes so seized and forfeited shall be destroyed. Such cigarettes
shall be deemed contraband whether a violation of this act is knowing or otherwise.
Section 7. A person who commits any of the acts prohibited under section 2, either knowing or having reason to know he is doing so, shall be punished by a fine of not more than $5,000 or imprisonment in the state prison for not more than 5 years, or by both such fine and imprisonment.
Floor Number: 561 Clerk Number: 775
ELECTIVE ANGIOPLASTY
Mr. Hedlund moves to amend the bill by inserting after Section
_____, the following new Section:-
"SECTION____. Notwithstanding
any general or special law to the contrary the Department of Public Health shall,
subject to the following requirements, approve the development and operation of
elective cardiac angioplasty pilot programs in hospitals currently operating primary
cardiac angioplasty under Department of Public Health special project authorization.
In order to obtain approval, each hospital must have participated in the primary
angioplasty special project for at least one year and has performed the required
thirty-six angioplasties; meet American College of Cardiology/American Heart Association
guidelines for proficiency in physician operator volumes; agree to submit patient
specific outcome data as requires by the Cardiac Quality Advisory Commission.
The Department shall conduct an annual evaluation of all elective angioplasty
pilot programs and shall submit a report to the house and senate committee on
ways and means and the joint committee on health care.".
Floor Number: 562 Clerk Number: 786
NON-PROFIT HEALTH SYSTEMS
Mr. Panagiotakos moves to amend the bill by adding at the end thereof the following new section:
SECTION__.
Notwithstanding the provisions of any general or special law to the contrary, no individual physician or physician group under the solo or group practice exclusion from the definition of "clinic" contained in section 52 of chapter 111 of the General Laws, other than a radiologist, or any physician employed by a hospital or hospital affiliate, shall refer a patient for services to a health care entity that provides services through use of magnetic resonance imagining, positron emission tomography, or linear accelerator equipment, if: (i) the physician holds a direct or indirect ownership or investment interest in such entity; (ii) the physician's immediate family holds a direct or indirect ownership or investment interest in such or entity; or (iii) the physician or member of the physician's immediate family has any direct or indirect arrangement involving compensation with such entity. For purposes of this section, "health care entity" is defined as an entity that provides health care related testing, diagnosis or treatment of individuals but does not include a hospital, hospital affiliate, or hospital system. For purposes of this section, a "hospital" is defined as a hospital licensed under section 51 of Chapter 111; a "hospital affiliate" is defined as any entity that, directly or indirectly, is controlled by, controls, or is under common control with a hospital or a joint venture in which a hospital participates; "control" is defined as the ownership of at least fifty percent of the equity in an entity or the ability to appoint at least fifty percent of the members of the governing body of such entity; and "hospital system" is defined as an organized group of health care providers at least one constituent of which is a not-for-profit hospital. For purposes of this section "investment interest" is defined as an ownership or investment interest through equity, debt, leasehold interest, or other means, or a compensation arrangement, regardless of whether such interest is direct or indirect. The provisions of this section shall not apply to physicians practicing in a group practice who order magnetic resonance imagining, positron emission tomography, or linear accelerator services for their patients when such service is to be provided within such group practice if such service was being provided by such group practice, or such group practice had made substantial steps to implementing the provision of such service, on or before May 1, 2004. The department of public health shall enforce this section. The Superior Court shall have jurisdiction in equity to enforce the provisions of this section. Upon an initial determination of a violation of this section, the department shall forthwith seek injunctive relief in the Superior Court. A violation of this section shall be punishable by a fine of not less than $25,000. Any continuing violation of this section shall be punishable by a fine of not less than $25,000 and not more than $100,000 per day of operation, and by one or both of: (i) referral of the physician to the board of registration in medicine for appropriate disciplinary action; and (ii) revocation of the health care entity's license.
Floor Number: 563 Clerk Number: 4
DSS ADMINISTRATION
Ms. Tucker moves to amend the bill, in section 2, in item 4800-0015, by striking out the figure "64,488,643" and inserting in place thereof the following figure:- "$66,288,643".
Floor Number: 564 Clerk Number: 761
REIMBURSEMENT PROGRAMS FOR DSS SOCIAL WORKERS
Mr. Barrios moves to amend the bill (S. 2400), in line item
4800-0015, by inserting at the end thereof the following:-
"provided
further, that not less than $900,000 shall be expended for the continuation of
auto expense reimbursement programs for DSS Social Workers."
Floor Number: 565 Clerk Number: 215
REGION 1 COMMUNITY-BASED FAMILY UNIFICATION FUNDS
Mr. Nuciforo moves to amend the bill, in section 2, in line item 4800-0038, by inserting after the words "Big Brothers and Sisters of Cape Cod and the Islands;", the following:- "provided further, that the department shall provide a sum of not more than $48,000 in region 1 for a community-based family unification counseling program to prevent juvenile delinquency;"
Floor Number: 566 Clerk Number: 375
COMPREHENSIVE SCHOOL AGE PARENTING PROGRAM SERVICES
Ms. Wilkerson moves to amend the bill (Senate, No. 2400) in section 2, line item 4800-0038, by inserting at the end thereof the following: --
"; and provided further, that not less than $140,000 shall be expended for the Comprehensive School Age Parenting Program, Inc. for a year-round school based program in Boston high schools and middle schools for pregnant teens, young mothers and fathers, and other youth at risk for school drop out"
Floor Number: 567 Clerk Number: 788
DSS FUNDING TRANSFER:
Mr. Tisei moves to amend the bill, in section 2, by striking out item 4800-0092, and further amends the bill, in section 2, item 4800-1100, by striking the figure "$132,888,750" and inserting the following new figure :- "$133,888,750."
Floor Number: 568 Clerk Number: 38
CASE LOADS FOR SOCIAL WORKERS
Mr. Moore moves to amend the bill, in section 2, in line item 4800-1100, by inserting after the words "ratio by region" the following:- "provided further that the department shall develop and implement a management plan so that no social worker shall be over the 18 to 1 caseload standard for more than two consecutive months; provided further, that the department shall implement such plan by November 15, 2004 and report on said management plan to House Ways and Means and Senate Ways and Means by January 15, 2005;"
Floor Number: 569 Clerk Number: 349
DSS CASELOADS MANAGEMENT PLAN
Mr. Tolman moves to amend the bill, in section 2, in line item 4800-1100, in line 9, by inserting the following language:- "Provided further that the department shall develop and implement a management plan so that no social worker shall be over the 18 to 1 caseload standard for more than two consecutive months; provided further, that the department shall implement such plan by November 15, 2004 and report on said management plan to House Ways & Means and Senate Ways & Means by January 15, 2005;"
Floor Number: 570 Clerk Number: 20
DOMESTIC VIOLENCE SERVICES FOR IMMIGRANTS AND REFUGEES
Ms. Tucker moves to amend the bill, in section 2, in line item 4800-1400, by inserting after "violence hotline;" the following words:- "provided further, that procurement of services for immigrant and refugee victims shall be coordinated with the department of public health;" and in said item striking out the figures "$19,254,292" and inserting in place thereof the figures "19,654,292."
Floor Number: 571 Clerk Number: 28
AN AMENDMENT RELATIVE TO DOMESTIC ABUSE FUNDING
Mr. Tarr moves to amend the bill (Senate bill 2400) by adding,
in section 2, in item 4800-1400, at the end thereof the following:-
"Provided further, that not less than $10,000 shall be
expended for the purposes of the domestic abuse response team which serves the
Ipswich District Court."
Floor Number: 572 Clerk Number: 377
NEW BEDFORD BATERER PREVENTION
Mr. Montigny moves to amend the bill, in section 2, in line item 4800-1400 by inserting after the word "Cambridge", the following:- "provided further, that not less that $90,000 shall be expended for a baterer prevention program in the city of New Bedford;."
Floor Number: 573 Clerk Number: 63
COMMISSION ON PSYCHOTROPIC DRUGS FOR CHILDREN UNDER THE PROTECTION AND CARE OF THE DSS
Mr. Moore moves to amend the bill by adding at the end thereof
the following new Section:- SECTION________.
There shall be a special commission for the purpose of making an investigation
and study relative to the prescribing of psychotropic drugs for children under
the protection and care of the department of social services. The commission shall
consist of three members of the Senate, five members of the House of Representatives
and five persons appointed by the governor. Said commission shall report to the
house of representatives and the Senate the results of its investigation and study,
and its recommendations, if any, together with drafts of legislation necessary
to carry its recommendations into effect by filing the same with the clerk of
the house of representatives and Clerk of the senate on or before the last Wednesday
in December, 2004."
Floor Number: 574 Clerk Number: 116
DYS COMMUNITY-BASED SERVICES
Ms. Tucker moves to amend the bill, in section 2, in item 4200-0100, by striking out the figure "$20,141,916" and inserting in place thereof the following figure:- "$20,450,552".
Floor Number: 575 Clerk Number: 156
BAKER HOUSE - MENTORING SERVICES
Mr. Hart of Boston moves to amend the bill in section 2, in item 4200-0100, in line 2, by inserting after the word "department" the following: "provided further, that not more than $50,000 shall be expended for mentoring services provided by the Ella J. Baker House for high-risk youth;"
Floor Number: 576 Clerk Number: 113
DYS PRETRIAL DETENTION PROGRAMS
Ms. Tucker moves to amend the bill, in section 2, in item 4200-0200, by striking out the figure "$18, 907,464" and inserting in place thereof the following figure:- "$19,183,261".
Floor Number: 577 Clerk Number: 23
NON-PROFIT COMMUNITY CENTERS
Ms. Menard moves to amend the bill, in section 2, in item
4000-0112, by striking out the wording and inserting in place thereof the following
wording:-
" For
matching grants to boys' and girls' clubs, YMCA and YWCA organizations and non-profit
community centers; provided, that the secretary of health and human services shall
award the full amount of each grant to each organization upon commitment of matching
funds from the organization; provided further, that the secretary shall report
to the house and senate committees on ways and means on the exact amounts distributed
in fiscal year 2005 by March 1, 2005; provided further, that not less than $920,000
shall be expended for the Massachusetts Alliance of Boys and Girls Clubs to provide
grants to boys and girls of Massachusetts; provided further, that not less than
$10,000 shall be expended for the Scantic Valley YMCA; provided further, that
not less than $500,000 shall be expended for the YMCA of greater Boston to facilitate
capital projects approved by the board of directors of the YMCA; provided further,
that not less than $40,000 shall be expended for the public partnership program
between the greater Lynn YMCA and YWCA and the public partnership program between
the town of Saugus and the Saugus YMCA and YWCA; provided further, that not less
than $80,000 shall be expended for the young parents program of the Newton Community
Service Centers;.........$1,550,000"
Floor Number: 578 Clerk Number: 33
NON-PROFIT COMMUNITY CENTERS
Mr. Moore moves to amend the bill, in section 2, in item 4000-0112, by striking out the wording and inserting in place thereof the following:- "For matching grants to boys' and girls' clubs, YMCA and YWCA organizations and non-profit community centers; provided, that the secretary of health and human services shall award the full amount of each grant to each organization upon commitment of matching funds from the organization; provided further, that the secretary shall report to the house and senate committees on ways and means on the exact amounts distributed in fiscal year 2005 by March1, 2005; provided further, that not less than $920,000 shall be expended for the Massachusetts Alliance of Boys & Girls Clubs to provide grants to boys and girls clubs of Massachusetts; provided further, that not less than $10,000 shall be expended for the Scantic Valley YMCA; provided further, that not less than $500,000 shall be expended for the YMCA of greater Boston to facilitate capital projects approved by the board of directors of the YMCA; provided further, that not less than $40,000 shall be expended for the public partnership program between the greater Lynn YMCA and YWCA and the public partnership program between the town of Saugus and the Saugus YMCA and YWCA; provided further, that not less than $80,000 shall be expended for the young parents program of the Newton Community Service Centers:………$1,550,000"
Floor Number: 579 Clerk Number: 79
NON-PROFIT COMMUNITY CENTERS
Mr. O'Leary moves to amend the bill, in section 2, by striking out item 4000-0112 and inserting in place thereof the following item:-
"4000-0112 For matching grants to boys' and girls' clubs, YMCA and YWCA organizations and non-profit community centers; provided, that the secretary of health and human services shall award the full amount of each grant to each organization upon commitment of matching funds from the organization; provided further, that the secretary shall report to the house and senate committees on ways and means on the exact amounts distributed in fiscal year 2005 by March1, 2005; provided further, that not less than $920,000 shall be expended for the Massachusetts Alliance of Boys & Girls Clubs to provide grants to boys and girls clubs of Massachusetts; provided further, that not less than $10,000 shall be expended for the Scantic Valley YMCA; provided further, that not less than $500,000 shall be expended for the YMCA of greater Boston to facilitate capital projects approved by the board of directors of the YMCA; provided further, that not less than $40,000 shall be expended for the public partnership program between the greater Lynn YMCA and YWCA and the public partnership program between the town of Saugus and the Saugus YMCA and YWCA; provided further, that not less than $80,000 shall be expended for the young parents program of the Newton Community Service Centers:………$1,550,000"
Floor Number: 580 Clerk Number: 133
RELATIVE TO GRANTS TO BOYS AND GIRLS CLUBS
Ms. Fargo moves to amend the bill, in section 2, in line
item 4000-0112, by inserting at the end thereof the following: -
"provided
further, that not less than $50,000 shall be expended for the Waltham Boys and
Girls Club."
Floor Number: 581 Clerk Number: 158
BAKER HOUSE - MLK AFTERSCHOOL
Mr. Hart of Boston moves to amend the bill in section 2, in item 4000-0112, in line 8, by inserting after the word "club" the following: - "provided further, that not more than $150,000 shall be expended for the Martin Luther King Jr. after school computer and cultural literacy program operated by the Ella J. Baker House;"
Floor Number: 582 Clerk Number: 395
NON-PROFIT COMMUNITY CENTERS
Mr. Tolman moves to amend the bill, in section 2, in item
4000-0112, by striking out the wording and inserting in place thereof the following
wording:-
"For matching grants to boys' and girls' clubs, YMCA and YWCA organizations
and non-profit community centers; provided, that the secretary of health and human
services shall award the full amount of each grant to each organization upon commitment
of matching funds from the organization; provided further, that the secretary
shall report to the house and senate committees on ways and means on the exact
amounts distributed in fiscal year 2005 by March 1, 2005; provided further, that
not less than $920,000 shall be expended for the Massachusetts Alliance of Boys
and Girls Clubs to provide grants to boys and girls clubs of Massachusetts; provided
further, that not less than $10,000 shall be expended for the Scantic Valley YMCA;
provided further, that not less than $500,000 shall be expended for the YMCA of
greater Boston to facilitate capital projects approved by the board of directors
of the YMCA; provided further, that not less than $40,000 shall be expended for
the public partnership program between the greater Lynn YMCA and YWCA and the
public partnership program between the town of Saugus and the Saugus YMCA and
YWCA; provided further, that not less than $80,000 shall be expended for the young
parents program of the Newton Community Service Centers;.........$1,550,000"
Floor Number: 583 Clerk Number: 532
NON-PROFIT COMMUNITY CENTERS
Mr. Creedon moves to amend the bill, Senate 2400, in section
2, in item 4000-0112, by striking out the wording
and inserting in place thereof
the following wording:- "For matching grants to boys' and girls' clubs, YMCA
and YWCA organizations and non-profit community centers; provided, that the secretary
of health and human services shall award the full amount of each grant to each
organization upon commitment of matching funds from the organization; provided
further, that the secretary shall report to the house and senate committees on
ways and means on the exact amounts distributed in fiscal year 2005 by MarchI,
2005; provided further, that not less than $920,000 shall be expended for the
Massachusetts Alliance of Boys & Girls Clubs to provide grants to boys and
girls clubs of Massachusetts; provided further, that not less than $10,000 shall
be expended for the Scantic Valley YMCA; provided further, that not less than
$500,000 shall be expended for the YMCA of greater Boston to facilitate capital
projects approved by the board of directors of the YMCA; provided further, that
not less than $40,000 shall be expended for the public partnership program between
the greater Lynn YMCA and YWCA and the public partnership program between
the town of Saugus and the Saugus YMCA and YWCA; provided further, that not less
than $80,000 shall be expended for the young parents program of the Newton Community
Service Centers: $1,550,000"
Floor Number: 584 Clerk Number: 589
NON-PROFIT COMMUNITY CENTERS
Mr. Lees moves to amend the bill, in section 2, in item
4000-0112, by striking out the wording and inserting in place thereof the following
wording:-
"For matching grants to boys' and girls' clubs, YMCA and YWCA organizations
and non-profit community centers; provided, that the secretary of health and
human services shall award the full amount of each grant to each organization
upon commitment of matching funds from the organization; provided further, that
the secretary shall report to the house and senate committees on ways and means
on the exact amounts distributed in fiscal year 2005 by March 1, 2005; provided
further, that not less than $920,00 shall be expended for the Massachusetts
Alliance of Boys and Girls Clubs to provide grants to boys and girls clubs of
Massachusetts; provided further, that not less than $10,000 shall be expended
for the Scantic Valley YMCA; provided further, that not less than $500,000 shall
be expended for the YMCA of greater Boston to facilitate capital projects approved
by the board of directors of the YMCA; provided further, that not less than
$40,000 shall be expended for the public partnership program between the greater
Lynn YMCA and YWCA and the public partnership program between the town of Saugus
and the Saugus YMCA and YWCA; provided further, that not less than $80,000 shall
be expended for the young parents program of the Newton Community Service Centers………………….$1,550,000"
Floor Number: 585 Clerk Number: 611
LYNN YMCA
Mr. McGee moves that the bill be amended in section 2, in
item 4000-0112, in line 24, by inserting after "Boston" the following:
"and not less
than $200,000 be expended to the YMCA of Greater Lynn, to facilitate capital projects
approved by the board of directors of said YMCA"
Floor Number: 586 Clerk Number: 618
NON-PROFIT COMMUNITY CENTERS
Mr. McGee moves to amend the bill, in section 2, by striking out item 4000-0112 and inserting in place thereof the following item:-
"For matching grants to boys' and girls' clubs, YMCA and YWCA organizations and non-profit community centers; provided, that the secretary of health and human services shall award the full amount of each grant to each organization upon commitment of matching funds from the organization; provided further, that the secretary shall report to the house and senate committees on ways and means on the exact amounts distributed in fiscal year 2005 by March1, 2005; provided further, that not less than $920,000 shall be expended for the Massachusetts Alliance of Boys & Girls Clubs to provide grants to boys and girls clubs of Massachusetts; provided further, that not less than $10,000 shall be expended for the Scantic Valley YMCA; provided further, that not less than $500,000 shall be expended for the YMCA of greater Boston to facilitate capital projects approved by the board of directors of the YMCA; provided further, that not less than $40,000 shall be expended for the public partnership program between the greater Lynn YMCA and YWCA and the public partnership program between the town of Saugus and the Saugus YMCA and YWCA; provided further, that not less than $80,000 shall be expended for the young parents program of the Newton Community Service Centers:………$1,550,000"
Floor Number: 587 Clerk Number: 646
NON PROFIT COMMUNITY CENTERS
Ms. Resor moves to amend the bill, in section 2, in line
item 4000-0112, by striking out the wording, and inserting in place thereof
the following wording:-
"For matching grants to boys' and girls' clubs, YMCA and YWCA organizations
and non-profit community centers; provided, that the secretary of health and
human services shall award the full amount of each grant to each organization
upon commitment of matching funds from the organization; provided further, that
the secretary shall report to the house and senate committees on ways and means
on the exact amounts distributed in fiscal year 2005 by March 1, 2005; provided
further, that not less than $920,000 shall be expended for the Massachusetts
Alliance of Boys & Girls Clubs to provide grants to boy and girls clubs
of Massachusetts; provided further, that not less than $10,000 shall be expended
for the Scantic Valley YMCA; provided further, that not less than $500,000 shall
be expended for the YMCA of greater Boston to facilitate capital projects approved
by the board of directors of the YMCA; provided further, that not less than
$40,000 shall be expended for the public partnership program between the town
of Saugus and the Saugus YMCA and YWCA; provided further, that not less than
$80,000 shall be expended for the young parents program of the Newton Community
Service Centers:………"$1,550,000"
Floor Number: 588 Clerk Number: 458
MEDICAID DATA WAREHOUSE
Mr. Hart of Boston moves to amend the bill, in Section 2, Item 4000-0300, in line 88 by inserting after the word "members" the following: - "Provided further, that not less than $500,000, of which a minimum of 75% must be eligible for federal financial participation, shall be available for said office to acquire through procurement professional and consulting services to enhance the fraud and abuse detection, program management, budgeting, and performance measurement capabilities of said executive office's existing or planned! data warehouse to achieve cost-savings in the Medicaid program and identify program and policy efficiencies across all human service programs; provided further that such procurement must be completed no later than January 1, 2005; provided further that any vendor or vendors engaged contractually by said executive office must have prior Medicaid data warehouse experience in states whose Medicaid budgets are equal to or greater than Massachusetts to ensure a greater likelihood of success"
Floor Number: 589 Clerk Number: 459
EOHHS
Mr. Lees moves that the bill be amended in section 2 in item 4200-0010 by striking the figure "$4,526,404" and inserting in place thereof the figure: "$4,613,663'; and
and moves to further amend said section 2 in item 4400-1000 by striking the figure "$117,806,865" and inserting in place thereof the figure: "$118,743,340"; and
and moves to further amend said section 2 in item 4510-0100 by striking the figure "$18,302,427" and inserting in place thereof the figure: "$18,807,843"; and
and moves to further amend said section 2 in item 4800-0015 by striking the figure "$64,488,643" and inserting in place thereof the figure: "$66,679,223"; and
and moves to further amend said section 2 in item 5011-0100 by striking the figure "$35,376,100" and inserting in place thereof the figure: "$35,781,161"; and
and moves to further amend said section 2 in item 5911-1000 by striking the figure "$12,536,658" and inserting in place thereof the figure: "$13,306,658"; and
and moves to further amend said section 2 in item 9110-0100 by striking the figure "$1,665,860" and inserting in place thereof the figure: "$1,710,208"; and
and moves to further amend said section 2 in item 4130-0001 by striking the figure $1,368,287 and inserting in place thereof the figure: $1,413,164; and
and moves to further amend said section 2, in item 4510-0723, by striking out the figure "$1,639,554" and inserting in place thereof the figure "2,128,072".
Floor Number: 590 Clerk Number: 304
WESTFIELD YMCA
Mr. Knapik moves to amend the bill, in section 2, in item 4000-0112, by inserting after the word "MetroWest" the following:- "provided further, that not less than $40,000 shall be allocated to the YMCA in Westfield."
Floor Number: 591 Clerk Number: 305
WESTFIELD BOYS' AND GIRLS' CLUB
Mr. Knapik moves to amend the bill, in section 2, in item 4000-0112, by inserting after the word "MetroWest" the following:- "provided further, that not less than $40,000 shall be allocated to the Westfield Boys' and Girls' Club."
Floor Number: 592 Clerk Number: 49
CONCIERGE MEDICINE
Mr. Moore moves to amend the bill by inserting at the end thereof the following new section:-
SECTION ____. Notwithstanding the provisions of any general or special law to the contrary, there shall be established a special commission for the purpose of conducting a study into the impact of concierge medical practices on citizens of the commonwealth. Said commission shall consist of the commissioner of the division of insurance or his designee, the Attorney General or his designee, the chairs of the joint committee on health care or their designees, the chairs of the joint committee on insurance or their designees, the commissioner of public health or his designee, the executive director of the board of registration in medicine or his designee, one representative from the Massachusetts Association of Health Plans, one representative from Blue Cross Blue Shield, one representative from the Massachusetts Medical Society, one representative from Health Care for All, and 2 physicians engaged in the practice of concierge medicine, one of whom is to be appointed by the speaker of the house of representatives and one of whom is to be appointed by the president of the senate. The study shall include, but shall not be limited to, the impact of concierge medical practices on the state's health care system particularly as it relates to patient access. The commission shall examine the number of physicians engaging in the practice of concierge medicine and the number of concierge practices operating in Massachusetts, the number of consumers enrolled in concierge practices and an assessment of the impact on patients displaced due to physicians engaging in these types of practices. The commission shall review the fees charged by concierge physicians and ascertain whether these fees are being charged for services that are already part of the patient's coverage with the health insurance carrier. The commission shall examine whether concierge practices violate state insurance and consumer protection statutes. The commission shall convene on or before September 1, 2004 and shall file a report not later than August 31, 2005 with the clerks of the house and senate and the joint committee on health care with recommendations relative to further regulation of concierge medical practices.
Floor Number: 593 Clerk Number: 51
CREATION OF THE HEALTH CARE COST CONTAINMENT COUNCIL
Mr. Moore and Brewer move to amend the bill by adding at the end thereof the following new Section:- SECTION________.
SECTION XX:
Short Title
This act shall be known and may be cited as the Health
Care Cost Containment Act.
SECTION 2. Declaration
The Commonwealth finds
that there exists in this State a major crisis because of the continuing escalation
of costs for health care services. Because of the continuing escalation of costs,
an increasingly large number of Massachusetts citizens have severely limited access
to appropriate and timely health care. Increasing costs are also undermining the
quality of health care services currently being provided. Further, the continuing
escalation is negatively affecting the economy of this Commonwealth, is restricting
new economic growth and is impeding the creation of new job opportunities in this
Commonwealth. The continuing escalation of health care costs is attributable to
a number of interrelated causes, including: (1) inefficiency in the present configuration
of health care service systems and in their operation; (2) the present system
of health care cost payments by third parties; (3) the increasing burden of indigent
care which encourages cost shifting; and (4) the absence of a concentrated and
continuous effort in all segments of the health care industry to contain health
care costs. Therefore, it is hereby declared to be the policy of the Commonwealth
of Massachusetts to promote health care cost containment by creating an independent
council to be known as the Health Care Cost Containment Council. It is the purpose
of this legislation to promote the public interest by encouraging the development
of competitive health care services, in which health care costs are contained
and to assure that all citizens have reasonable access to quality health care.
It is further the intent of this act to facilitate the continuing provision of
quality, cost-effective health services throughout the Commonwealth by providing
data and information to the purchasers and consumers of health care on both cost
and quality of health care services, and to assure access to health care services.
Nothing in this act shall prohibit a purchaser from obtaining from its third-party
insurer, carrier or administrator, nor relieve said third-party insurer, carrier
or administrator from the obligation of providing, on terms consistent with past
practices, data previously provided to a purchaser pursuant to any existing or
future arrangement, agreement or understanding.
SECTION 3. Creation
Chapter 118G of the General Laws as appearing in the 2000 Official Edition is hereby amended by striking out sections one through twenty-four and inserting in place the following sections:-
Section 1. Definitions
As used in this chapter, the following words shall, unless the context clearly requires otherwise, have the following meanings:-
""Actual costs'', all direct and indirect costs incurred by a hospital or a community health center in providing medically necessary care and treatment to its patients, determined in accordance with generally accepted accounting principles.
""Acute hospital'', the teaching hospital of the University of Massachusetts Medical School and any hospital licensed under section fifty-one of chapter one hundred and eleven and which contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the department of public health.
"Ambulatory service facility." A facility licensed in this Commonwealth, not part of a hospital, which provides medical, diagnostic or surgical treatment to patients not requiring hospitalization, including ambulatory surgical facilities, ambulatory imaging or diagnostic centers, birthing centers, freestanding emergency rooms and any other facilities providing ambulatory care which charge a separate facility charge. This term does not include the offices of private physicians or dentists, whether for individual or group practices.
""Bad debt'', an account receivable based on services furnished to any patient which (i) is regarded as uncollectable, following reasonable collection efforts consistent with regulations of the division, which regulations shall allow third party payers to negotiate with hospitals to collect the bad debt of its enrollees, (ii) is charged as a credit loss, (iii) is not the obligation of any governmental unit or of the federal government or any agency thereof, and (iv) is not free care.
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;
""Case mix'', the description and categorization of a hospital's patient population according to criteria approved by the division including, but not limited to, primary and secondary diagnoses, primary and secondary procedures, illness severity, patient age and source of payment.
"Charge" or "rate." The amount billed by a provider for specific goods or services provided to a patient, prior to any adjustment for contractual allowances.
""Child'', a person who is under eighteen years of age.
""Community health centers'', health centers operating in conformance with the requirements of Section 330 of United States Public Law 95-626 and shall include all community health centers which file cost reports as requested by the division.
""Comprehensive cancer center'', the hospital of any institution so designated by the national cancer institute under the authority of 42 USC sections 408(a) and 408(b) organized solely for the treatment of cancer, and offered exemption from the medicare diagnosis related group payment system under 42 C.F.R. 405.475(f).
"Council." The Health Care Cost Containment Council.
"Covered services." Any health care services or procedures connected with episodes of illness that require either inpatient hospital care or major ambulatory service such as surgical, medical or major radiological procedures, including any initial and follow-up outpatient services associated with the episode of illness before, during or after inpatient hospital care or major ambulatory service. The term does not include routine outpatient services connected with episodes of illness that do not require hospitalization or major ambulatory service.
"Data source." A hospital; ambulatory service facility; physician; health maintenance organization, professional health services corporation; commercial insurer providing health or accident insurance; self-insured employer providing health or accident coverage or benefits for employees employed in the Commonwealth; administrator of a self-insured or partially self-insured health or accident plan providing covered services in the Commonwealth; any health and welfare fund that provides health or accident benefits or insurance pertaining to covered service in the Commonwealth; the Department of Medical Assistance for those covered services it purchases or provides through the medical assistance program and any other payor for covered services in the Commonwealth other than an individual.
""Dependent'', the spouse and children of any employee if such persons would qualify for dependent status under the Internal Revenue Code or for whom a support order could be granted under chapters two hundred and eight, two hundred and nine or two hundred and nine C.
""Disproportionate share hospital'', any acute hospital that exhibits a payer mix where a minimum of sixty-three per cent of the acute hospital's gross patient service revenue is attributable to Title XVIII and Title XIX of the federal Social Security Act other government payors and free care.
""DRG'', a patient classification scheme which provides a means of relating the type of patients a hospital treats, such as its case mix, to the cost incurred by the hospital.
""Eligible person'', a person who qualifies for financial assistance from a governmental unit in meeting all or part of the cost of general health supplies, care or rehabilitative services and accommodations.
""Employee'', a person who performs services primarily in the commonwealth for remuneration for a commonwealth employer. A person who is self-employed shall not be deemed to be an employee.
""Employer'', an employer as defined in section one of chapter one hundred and fifty-one A.
""Enrollee'', a person who becomes a member of an insurance program of the division either individually or as a member of a family.
""Financial requirements'', a hospital's requirement for revenue which shall include, but not be limited to, reasonable operating, capital and working capital costs, the reasonable costs of depreciation of plant and equipment and the reasonable costs associated with changes in medical practice and technology.
""Fiscal year'', the twelve month period during which a hospital keeps its accounts and which ends in the calendar year by which it is identified.
""Free care'', unpaid hospital charges of medically necessary services to (1) patients deemed financially unable to pay, in whole or in part, for their care, pursuant to regulations of the division; (2) uninsured patients who receive emergency care in a hospital emergency room or who receive other hospital care associated with such emergency care services, for which the costs have not been collected after despite reasonable efforts in accordance with regulations of the division; or (3) patients in situations of medical hardship in which major expenditures for health care have depleted or can reasonably be expected to deplete the financial resources of the individual to the extent that medical services cannot be paid, as determined by regulations of the division. For purposes of this section, ""emergency care'' shall include, but not be limited to: hospital services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity which include, but not be limited to, severe pain which pain reasonably appears may result in jeopardizing the patients' health if immediate medical attention is withheld; serious impairment to bodily functions or serious dysfunction of any bodily organ or part, examination or treatment for emergency medical condition; active labor in women; or any such other service rendered to the extent required pursuant to 42 USC 1395(dd).
""General health supplies, care or rehabilitative services and accommodations'', all supplies, care and services of medical, optometric, dental, surgical, podiatric, psychiatric, therapeutic, diagnostic, rehabilitative, supportive or geriatric nature, including inpatient and outpatient hospital care and services, and accommodations in hospitals, sanatoria, infirmaries, convalescent and nursing homes, retirement homes, facilities established, licensed or approved pursuant to the provisions of chapter one hundred and eleven B and providing services of a medical or health-related nature, and similar institutions including those providing treatment, training, instruction and care of children and adults; provided, however, that rehabilitative service shall include only rehabilitative services of a medical or health-related nature which are eligible for reimbursement under the provisions of Title XIX of the Social Security Act.
""Governmental unit'', the commonwealth, any department, agency board or commission of the commonwealth, and any political subdivision of the commonwealth.
""Gross inpatient service revenue'', the total dollar amount of a hospital's charges for inpatient services rendered in a fiscal year.
""Gross patient service revenue'', the total dollar amount of a hospital's charges for services rendered in a fiscal year.
""Health care services'', supplies, care and services of medical, surgical, optometric, dental, podiatric, chiropractic, psychiatric, therapeutic, diagnostic, preventative, rehabilitative, supportive or geriatric nature including, but not limited to, inpatient and outpatient acute hospital care and services; services provided by a community health center or by a sanatorium, as included in the definition of ""hospital'' in Title XVIII of the federal Social Security Act, and treatment and care compatible with such services or by a health maintenance organization.
"Health care facility." A general or special hospital, including tuberculosis and psychiatric hospitals, kidney disease treatment centers, including freestanding hemodialysis units, and ambulatory service facilities as defined in this section, and hospices, both profit and nonprofit, and including those operated by an agency of State or local government.
"Health care insurer." Any person, corporation or other entity that offers administrative, indemnity or payment services for health care in exchange for a premium or service charge under a program of health care benefits, including, but not limited to, an insurance company, association or exchange issuing health insurance policies in this Commonwealth; hospital plan corporation; professional health services plan; health maintenance organization; preferred provider organization; fraternal benefit societies; beneficial societies; and third-party administrators; but excluding employers, labor unions or health and welfare funds jointly or separately administered by employers or labor unions that purchase or self-fund a program of health care benefits for their employees or members and their dependents.
"Health maintenance organization." An organized system licensed pursuant to chapter 176G.
"Hospital." An institution, licensed in this Commonwealth, which is a general, tuberculosis, mental, chronic disease or other type of hospital, or kidney disease treatment center, whether profit or nonprofit, and including those operated by an agency of State or local government.
""Health insurance company'', a company as defined in section one of chapter one hundred and seventy-five which engages in the business of health insurance.
""Health insurance plan'', the medicare program or an individual or group contract or other plan providing coverage of health care services and which is issued by a health insurance company, a hospital service corporation, a medical service corporation or a health maintenance organization.
""Health maintenance organization'', a company which provides or arranges for the provision of health care services to enrolled members in exchange primarily for a prepaid per capita or aggregate fixed sum as further defined in section one of chapter one hundred and seventy-six G.
""Hospital'', any hospital licensed under section fifty-one of chapter one hundred and eleven, the teaching hospital of the University of Massachusetts Medical School and any psychiatric facility licensed under section nineteen of chapter nineteen.
""Hospital agreement'', an agreement between a nonprofit hospital service corporation and the hospital signatory thereto approved by the division under section five of chapter one hundred and seventy-six A.
""Hospital service corporation'', a corporation established for the purpose of operating a nonprofit hospital service plan as provided in chapter one hundred and seventy-six A.
"Indigent care." The actual costs, as determined by the council, for the provision of appropriate health care, on an inpatient or outpatient basis, given to individuals who cannot pay for their care because they are above the medical assistance eligibility levels and have no health insurance or other financial resources which can cover their health care.
"Major ambulatory service." Surgical or medical procedures, including diagnostic and therapeutic radiological procedures, commonly performed in hospitals or ambulatory service facilities, which are not of a type commonly performed or which cannot be safely performed in physicians' offices and which require special facilities such as operating rooms or suites or special equipment such as fluoroscopic equipment or computed tomographic scanners, or a postprocedure recovery room or short-term convalescent room.
""Managed health care plan'', a health insurance plan which provides or arranges for, supervises and coordinates health care services to enrolled participants, including plans administered by health maintenance organizations and preferred provider organizations.
"Medical procedure incidence variations." The
variation in the incidence in the population of specific medical, surgical and
radiological procedures in any given year, expressed as a deviation from the
norm, as these terms are defined in the
classical
statistical definition of "variation," "incidence," "deviation"
and "norm."
"Medically indigent" or "indigent." The status of a person as described in the definition of indigent care.
""Medicaid program'', the medical assistance program administered by the division of medical assistance pursuant to chapter one hundred and eighteen E and in accordance with Title XIX of the Federal Social Security Act or any successor statute.
""Medical assistance program'', the medicaid program, the Veterans Administration health and hospital programs and any other medical assistance program operated by a governmental unit for persons categorically eligible for such program.
""Medically necessary services'', medically necessary inpatient and outpatient services as mandated under Title XIX of the Federal Social Security Act. Medically necessary services shall not include: (1) non-medical services, such as social, educational and vocational services; (2) cosmetic surgery; (3) canceled or missed appointments; (4) telephone conversations and consultations; (5) court testimony; (6) research or the provision of experimental or unproven procedures including, but not limited to, treatment related to sex-reassignment surgery, and pre-surgery hormone therapy; and (7) the provision of whole blood; and provided, however, that administrative and processing costs associated with the provision of blood and its derivatives shall be payable.
""Medical service corporation'', a corporation established for the purpose of operating a nonprofit medical service plan as provided in chapter one hundred and seventy-six B.
""Medicare program'', the medical insurance program established by Title XVIII of the Social Security Act.
""Non-acute hospital'', any hospital which is not an acute hospital.
""Patient'', any natural person receiving health care services from a hospital.
"Payment." The payments that providers actually accept for their services, exclusive of charity care, rather than the charges they bill.
"Payor." Any person or entity, including, but not limited to, health care insurers and purchasers, that make direct payments to providers for covered services.
"Physician." An individual licensed under the laws of thisCommonwealth to practice medicine and surgery
""Pool'', the uncompensated care pool established pursuant to section 18.
""Payments subject to surcharge'', all amounts paid, directly or indirectly, by surcharge payors to acute hospitals for health services and ambulatory surgical centers for ambulatory surgical center services on or after the effective date of this section; provided, however, that ""payments subject to surcharge'' shall not include (i) payments, settlements, and judgments arising out of third party liability claims for bodily injury which are paid under the terms of property or casualty insurance policies, (ii) payments made on behalf of Medicaid recipients, Medicare beneficiaries, or persons enrolled in policies issued pursuant to chapter 176K or similar policies issued on a group basis; and provided further, that ""payments subject to surcharge'' may exclude amounts established in regulations promulgated by the division for which the costs and efficiency of billing a surcharge payor or enforcing collection of the surcharge from a surcharge payor would not be cost effective.
""Private sector charges'', gross patient service revenue attributable to all patients less gross patient service revenue attributable to Titles XVIII and XIX, other publicly aided patients, free care and bad debt.
"Preferred provider organization." Any arrangement between a health care insurer and providers of health care services which specifies rates of payment to such providers which differ from their usual and customary charges to the general public and which encourage enrollees to receive health services from such providers.
"Provider." A hospital, an ambulatory service facility or a physician.
"Provider quality." The extent to which a provider
renders care that, within the capabilities of modern medicine, obtains for patients
medically acceptable health outcomes and prognoses, adjusted for patient severity,
and treats patients
compassionately and responsively.
"Provider service effectiveness." The effectiveness of services rendered by a provider, determined by measurement of the medical outcome of patients grouped by severity receiving those services.
""Publicly aided patient'', a person who receives hospital care and services for which a governmental unit is liable, in whole or in part, under a statutory program of public assistance.
""Public payer-dependent non-acute hospital'', any non-acute hospital that (1) was certified by the Secretary of the United States Department of Health and Human Services as participating in the federal medicare program pursuant to clause (iv) of 42 USC section 1395ww (d)(1)(B) on January first, nineteen hundred and ninety-six; (2) is not owned by the commonwealth; and (3) exhibits a payor mix in which a minimum of fifteen per cent of such hospital's gross patient service revenue, as reported on the RSC-403 for hospital fiscal year nineteen hundred and ninety-four, was attributable to Title XIX of the federal Social Security Act. Such term does not include a hospital that was reimbursed for services provided to individuals entitled to medical assistance under chapter one hundred and eighteen E for fiscal year nineteen hundred and ninety-six pursuant to a contract between the hospital and the division of medical assistance.
"Purchaser." All corporations, labor organizations and other entities that purchase benefits which provide covered services for their employees or members, either through a health care insurer or by means of a self-funded program of benefits, and a certified bargaining representative that represents a group or groups of employees for whom employers purchase a program of benefits which provide covered services, but excluding entities defined in this section as "health care insurers."
"Raw data" or "data." Data collected by the council under section 6 in the form initially received. No data shall be released by the council except as provided for in section 11.
""Revenue center'', a functioning unit of a hospital which provides distinctive services to a patient for a charge.
""Resident'', a person living in the commonwealth, as defined by the division by regulation; provided, however, that such regulation shall not define a resident as a person who moved into the commonwealth for the sole purpose of securing health insurance under this chapter. Confinement of a person in a nursing home, hospital or other medical institution shall not in and of itself, suffice to qualify such person as a resident.
""Self-employed'', a person who, at common law, is not considered to be an employee and whose primary source of income is derived from the pursuit of a bona fide business.
""Self-insurance health plan'', a plan which provides health benefits to the employees of a business, which is not a health insurance plan, and in which the business is liable for the actual costs of the health care services provided by the plan and administrative costs.
"Severity." In any patient, the measureable degree of the potential for failure of one or more vital organs.
""Small business'', a business in which the total number of full-time employees, when averaged on an annual basis, does not exceed fifty, including only of the self-employed.
""Sole community provider'', any acute hospital which qualifies as a sole community provider under medicare regulations or under regulations promulgated by the division, which regulations shall consider factors including, but not limited to, such as isolated location, weather conditions, travel conditions, percentage of Medicare, Medicaid and free care provided and the absence of other reasonably accessible hospitals in the area. Such hospitals shall include those which are located more than twenty-five miles from other such hospitals in the commonwealth and which provide services for at least sixty percent of their primary service area.
""Specialty hospital'', an acute hospital which qualifies for an exemption from the medicare prospective payment system regulations or any acute hospital which limits its admissions to patients under active diagnosis and treatment of eyes, ears, nose and throat or to children or patients under obstetrical care.
""State institution'', any hospital, sanatorium, infirmary, clinic and other such facility owned, operated or administered by the commonwealth, which furnishes general health supplies, care or rehabilitative services and accommodations.
""Surcharge payor,'' an individual or entity that pays for or arranges for the purchase of health care services provided by acute hospitals and ambulatory surgical center services provided by ambulatory surgical centers; provided, however, that the terms ""surcharge payor'' shall not include Title XVIII and Title XIX programs and their beneficiaries or recipients, other governmental programs of public assistance and their beneficiaries or recipients, and the workers compensation program established pursuant to chapter 152.
""Third party payer'', an entity including, but not limited to, Title XVIII and Title XIX programs, other governmental payers, insurance companies, health maintenance organizations and nonprofit hospital service corporations. Third party payer shall not include a purchaser responsible for payment for health care services rendered by a hospital, either to the purchaser or to the hospital.
""Title XIX,'' Title XIX of the Social Security Act, 42 USC 1396 et seq., or any successor statute enacted into federal law for the same purposes as Title XIX.
""Uninsured patient'', a patient who is not covered by a health insurance plan, a self-insurance health plan, or a medical assistance program.
Section 2. Health Care Cost Containment Council.
(a) Establishment.-- There is hereby established an independent
council to be known as the Health Care Cost Containment Council.
(b) Composition.-- The council shall consist of 13 voting members, composed
of and appointed in accordance with the following:
a. The Secretary of the
Executive Office of Health and Human Services;
b. The Commissioner of the
Division of Insurance;
c. The Commissioner of the Division of Medical Assistance;
d. Two representatives of the business community, at least one of whom represents
small business, who are purchasers of health care as defined in section 3, none
of which is primarily involved in the provision of health care or health insurance,
one of which shall be appointed by the President of the Senate and one of which
shall be appointed by the Speaker of the House of Representatives from a list
of seven qualified persons recommended by the Associated Industries Association
of which three nominees shall be representatives of small business;
e. Two
representatives of organized labor, one of which shall be appointed by the President
of the Senate and one of which shall be appointed by the Speaker of the House
of Representatives from a list of five qualified persons recommended by the Massachusetts
AFL-CIO;
f. One representative of consumers who is not primarily involved
in the provision of health care or health care insurance, appointed by the Governor
from a list of three qualified persons recommended jointly by the President of
the Senate and the Speaker of the House;
g. One representative of hospitals,
appointed by the Governor from a list of three qualified hospital representatives
recommended by the Massachusetts Hospital Association. The representative under
this paragraph may appoint a delegate to act for the representative only at meetings
of committees as provided for in subsection (f)
h. One representative of physicians,
appointed by the Governor from a list of three qualified physician representatives
recommended by the Massachusetts Medical Society. The representative under this
paragraph may appoint a delegate to act for the representative only at meetings
of committees as provided for in subsection (f);
i. One representative of
nurses, appointed by the Governor from a list of three qualified persons recommended
by the Massachusetts Nurses Association and the Massachusetts Organization of
Nurses Executives;
j. One representative from a health maintenance organization,
appointed by the Governor from a list of three qualified persons recommended by
the Massachusetts Association of Health Plans; and
k. One representative
of a carrier, appointed by the Governor from a list of three qualified persons
recommended by the Massachusetts Association of Health Plans.
l. In the case
of each appointment to be made from a list supplied by a specified organization,
it is incumbent upon that organization to consult with and provide a list that
reflects the input of other equivalent organizations representing similar interests.
Each appointing authority will have the discretion to request additions to the
list originally submitted. Additional names will be provided not later than 15
days after such request. Appointments shall be made by the appointing authority
no later than 90 days after receipt of the original list. If, for any reason,
any specified organization supplying a list should cease to exist, then the respective
appointing authority shall specify a new equivalent organization to fulfill the
responsibilities of this act.
(c) Chairs.-- The members shall annually elect,
by a majority vote of the members, a chairperson and a vice chairperson of the
council from among the business and labor representatives on the council.
(d) Quorum.-- Seven members shall constitute a quorum for the transaction of any
business, and the act by the majority of the members present at any meeting in
which there is a quorum shall be deemed to be the act of the council.
(e)
Meetings.-- All meetings of the council shall be advertised and conducted pursuant
to Chapter 30A unless otherwise provided in this section.
a. The council
shall meet at least once every two months, and may provide for special meetings
as it deems necessary. Meeting dates shall be set by a majority vote of the members
of the council or by the call of the chairperson upon seven days' notice to all
council members.
b. All meetings of the council shall be publicly advertised,
as provided for in this subsection, and shall be open to the public, except that
the council, through its bylaws, may provide for executive sessions of the council.
No act of the council shall be taken in an executive session.
c. The council
shall file a schedule of its meetings with the Secretary of State and shall publish
a schedule of its meetings in at least two newspapers, one newspaper in general
circulation in the Commonwealth. Such notice shall be published and filed at least
once in each calendar quarter and shall list the schedule of meetings of the council
to be held in the subsequent calendar quarter. Such notice shall specify the date,
time and place of the meeting and shall state that the council's meetings are
open to the general public, except that no such notice shall be required for executive
sessions of the council.
d. All action taken by the council shall be taken
in open public session, and action of the council shall not be taken except upon
the affirmative vote of a majority of the members of the council present during
meetings at which a quorum is present.
(f) Bylaws.-- The council shall adopt
bylaws, not inconsistent with this act, and may appoint such committees or elect
such officers subordinate to those provided for in subsection (c) as it deems
advisable. The council shall provide for the approval and participation of additional
delegates appointed under subsection b (g) and (h) so that each organization represented
by delegates under those paragraphs shall not have more than one vote on any committee
to which they are appointed. The council shall also appoint a technical advisory
group which shall, on an ad hoc basis, respond to issues presented to it by the
council or committees of the council and shall make recommendations to the council.
The technical advisory group shall include physicians, researchers and biostatisticians.
In appointing the technical advisory group, the council shall consult with, and
take nominations from, the representatives of the Massachusetts Hospital Association,
the Massachusetts Medical Society or other like organizations. At its discretion,
nominations shall be approved by the executive committee of the council. If the
subject matter of any project exceeds the expertise of the technical advisory
group, physicians in appropriate specialties who possess current knowledge of
the issue under study may be consulted. The technical advisory group shall also
review the availability and reliability of severity of illness measurements as
they relate to small hospitals and psychiatric, rehabilitation and children's
hospitals and shall make recommendations to the council based upon this review.
(g) Compensation.-- The members of the council shall not receive a salary or per
diem allowance for serving as members of the council but shall be reimbursed for
actual and necessary expenses incurred in the performance of their duties. Said
expenses may include reimbursement of travel and living expenses while engaged
in council business.
(h) Terms.--
a. The terms of the Secretary of the
Executive Office of Health and Human Services, the Commissioner of the Division
Medical Assistance and the Commissioner of the Division of Insurance shall be
concurrent with their holding of public office. The nine appointed council members
shall each serve for a term of three years and shall continue to serve thereafter
until their successor is appointed, except that, of the members first appointed:
i. One of the representatives of business and the representative of consumers
shall serve for a term to expire on June 30 of the year following their appointment.
ii. One of the representatives of organized labor and the representative
of a carrier shall serve for a term to expire on June 30 of the second year following
their appointment.
iii. The other representatives of business and organized
labor and the representatives of hospitals, physicians and health maintenance
organizations shall serve for a term to expire on June 30 of the third year following
their appointment.
b. Vacancies on the council shall be filled in the same
manner in which they were originally designated under subsection (b), within 60
days of the vacancy, except that when vacancies occur among the representatives
of business or organized labor, two nominations shall be submitted by the organization
specified in subsection (b) for each vacancy on the council. If the officer required
in subsection (b) to make appointments to the council fails to act within 60 days
of the vacancy, the council chairperson may appoint one of the persons recommended
for the vacancy, until the appointing authority makes the appointment.
c.
A member may be removed for just cause by the appointing authority after recommendation
by a vote of at least 8 members of the council.
(i) Commencement of Operations.
a. Within 60 days after the effective date of this act, each organization or individual
required to submit a list of recommended persons to the Governor, the President
of the Senate or the Speaker of the House of Representatives under subsection
(b) shall submit said list.
b. Within 90 days of the effective date of this
act, the Governor, the President of the Senate and the Speaker of the House of
Representatives shall make all of the appointments called for in subsection (b),
and the council shall begin operations immediately following these appointments.
(j) Subsequent appointments.-Submission of lists of recommended persons and appointments
of council members for the second and succeeding terms shall be made in the same
manner as prescribed in subsection (b), except that:
a. Organizations required
under subsection (b) to submit lists of recommended persons shall do so at least
60 days prior to expiration of the council members' terms.
b. The officer
required under subsection (b) to make appointments to the council shall make said
appointments at least 30 days prior to expiration of the council members' terms.
If the appointments are not made within the specified time, the council chairperson
may make interim appointments from the lists of recommended individuals. An interim
appointment shall be valid only until the appropriate officer under subsection
(b) makes the required appointment. Whether the appointment is by the required
officer or by the chairperson of the council, the appointment shall become effective
immediately upon expiration of the incumbent member's term.
(k) Appointments
of acting councilors.-Should any organization or individual fail to submit a list
of recommended persons as required under subsection (b) within the time limits
in subsection (i) or (j), the officer designated to make the appointment under
subsection (b) shall appoint as many acting councilors as required under subsection
(b) until such time as the list of recommended persons is submitted by the original
organization as required in subsection (b).
Section 3. Powers and duties of the council.
(a) General powers.-The council shall exercise all powers
necessary and appropriate to carry out its duties, including the following:
a. To employ an executive director, investigators and other staff necessary to
comply with the provisions of this act and regulations promulgated thereunder,
to employ or retain legal counsel, and to engage professional consultants, as
it deems necessary to the performance of its duties. Any consultants, other than
sole source consultants, engaged by the council shall be selected in accordance
with the provisions for contracting with vendors set forth in section 12.
b. To fix the compensation of all employees and to prescribe their duties. Notwithstanding
the independence of the council under section 2(a), employees under this paragraph
shall be deemed employees of the commonwealth for the purpose of benefits provided
for under Chapter 32 and 32A of the General Laws.
c. To make and execute contracts
and other instruments, including those for purchase of services and purchase or
leasing of equipment and supplies, necessary or convenient to the exercise of
the powers of the council. Any such contract shall be let only in accordance with
the provision for contracting with vendors set forth in section 12.
d. To
enter into agreement 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;
e. To acquire, own, hold, dispose
of, and encumber personal property and to lease real property in the exercise
of its powers and the performance of its duties;
f. To maintain a prudent
level of reserve funds to protect the solvency of any trust funds under the operations
and control of the council;
g. To conduct examinations and investigations,
to conduct audits, pursuant to the provisions of subsection (c), and to hear testimony
and take proof, under oath or affirmation, at public or private hearings, on any
matter necessary to its duties.
h. To do all things necessary to carry out
its duties under the provisions of this act.
(b) Rules and regulations.-The
council may adopt and amend rules and regulations in accordance with chapter 30A
for the administration of its duties and power and to effectuate the provision
and purposes of this act.
(c) Audit powers.-The council shall have the right
to independently audit all information required to be submitted by data sources
as needed to corroborate the accuracy of the submitted data, pursuant to the following:
a. Audits of information submitted by providers or health care insurers shall
be performed on a sample and issue-specific basis, as needed by the council, and
shall be coordinated, to the extent practicable, with audits performed by the
Commonwealth. All health care insurers and providers are hereby required to make
those books, records of accounts and any other data needed by the auditors available
to the council at a convenient location within 30 days of a written notification
by the council.
b. Audits of information submitted by purchasers shall be
performed on a sample basis, unless there exists reasonable cause to audit specific
purchasers, but in no case shall the council have the power to audit financial
statements of purchasers.
c. All audits performed by the council shall be
performed at the expense of the council.
(d) General duties and functions.-The
council is hereby authorized to and shall perform the following duties and functions:
a. Develop a computerized system for the collection, analysis and dissemination
of data. The council may contract with a vendor who will provide such data processing
services. The council shall assure that the system will be capable of processing
all data required to be collected under this act. Any vendor selected by the council
shall be selected in accordance with the provisions of section 12, and said vendor
shall relinquish any and all proprietary rights or claims to the database created
as a result of implementation of the data processing system.
b. Establish
a Massachusetts Uniform Claims and Billing Form for all data sources and all providers
that shall be utilized and maintained by all data sources and all providers for
all services covered under this act.
c. Collect and disseminate data, as specified
in section 4, and other information from data sources to which the council is
entitled, prepared according to formats, time frames and confidentiality provisions
as specified in sections 4 and 6, and by the council.
d. Adopt and implement
a methodology to collect and disseminate data reflecting provider quality and
provider service effectiveness pursuant to section 4 and to continuously study
quality of care systems.
e. Subject to the restrictions on access to raw data
set forth in section 6, issue special reports and make available raw data as defined
in section 1 to any purchaser requesting it. Sale by any recipient or exchange
or publication by a recipient, other than a purchaser, of raw council data to
other parties without the express written consent of, and under terms approved
by, the council shall be unauthorized use of data pursuant to section 6(c).
f. On an annual basis, file with the General Court on the first Wednesday in November,
a list of all the raw data reports it has prepared under section 6(f) and a description
of the data obtained through each computer-to-computer access it has provided
under section 6(f) and of the names of the parties to whom the council provided
the reports or the computer-to-computer access during the previous month.
g. Promote competition in the health care and health insurance markets.
h.
Assure that the use of council data does not raise access barriers to care.
i. Make annual reports to the General Court on the first Wednesday in March on
the rate of increase in the cost of health care in the Commonwealth and the effectiveness
of the council in carrying out the legislative intent of this act. In addition,
the council may make recommendations on the need for further health care cost
containment legislation. The council shall also make annual reports to the General
Court on the quality and effectiveness of health care and access to health care
for all citizens of the Commonwealth.
j. Adopt, within one year, a model patient
itemized statement for all providers, which itemizes all charges for services,
equipment, supplies and medicine, designed to be more understandable than current
patient bills. Each provider shall be required to utilize said model patient itemized
statement for covered services within 90 days of adoption of said form by the
council. Such model patient itemized statements shall be written in language that
is understandable to the average person and be presented to each patient upon
discharge from a health care facility or provision of patient services or within
a reasonable time thereafter. Patients may request a copy of their Massachusetts
Uniform Claims and Billing Form; and, upon request, the provider shall furnish
this form to the patient within 30 days.
k. Conduct studies and publish reports
thereon analyzing the effects that non-inpatient, alternative health care delivery
systems have on health care costs. These systems shall include, but not be limited
to: health maintenance organizations; preferred provider organizations; primary
health care facilities; home health care; attendant care; ambulatory service facilities;
freestanding emergency centers; birthing centers; and hospice care. These reports
shall be submitted to the General Court and shall be made available to the public.
l. Conduct studies and make reports concerning the utilization of experimental
and nonexperimental transplant surgery and other highly technical and experimental
procedures, including costs and mortality rates;
m. Review and comment upon
all capital expenditure projects requiring a determination of need pursuant to
the provisions of section twenty-five of chapter one hundred and eleven of the
General Laws, including, but not limited to, less costly or more effective alternative
financing methods for such projects; the immediate and long-term financial feasibility
of such projects; the probable impact of the project on costs of and charges for
services; and the availability of funds for capital and operating needs. The council
shall transmit to the department of public health its written recommendations
on each project, which shall become part of the written record compiled by said
department during its review of such project. The council executive director shall
appear and comment on any application for a determination of need where a public
hearing is required pursuant to the provisions of said section twenty-five C of
said chapter. To carry out the purposes of this paragraph, the council executive
director shall act as a liaison with said department.
n. To contract pursuant
to section 12, with a third part administrator to administer the uncompensated
care pool established by section 22;
o. To oversee the health finance unit
established pursuant to section 14.
Section 4. Data submission and collection.
(a) Submission of data.-The council is hereby authorized
to collect and data sources are hereby required to submit, upon request of the
council, all data required in this section, according to uniform submission
formats, coding systems and other technical specifications necessary to render
the incoming data substantially valid, consistent, compatible and manageable
using electronic data processing according to data submission schedules, such
schedules to avoid, to the extent possible, submission of identical data from
more than one data source, established and promulgated by the council in regulations
pursuant to its authority under section 3(b). If payor data is requested by
the council, it shall, to the extent possible, be obtained from primary payor
sources.
(b) Massachusetts Uniform Claims and Billing Form.-The
council shall adopt, within 180 days of the commencement of its operations pursuant
to section 2(i), a Massachusetts Uniform Claims and Billing Form format. The council
shall furnish said claims and billing form format to all data sources, and said
claims and billing form shall be utilized and maintained by all data sources for
all services covered by this act. The Massachusetts Uniform Claims and Billing
Form shall consist of the Uniform Hospital Billing Form UB-82/HCFA-1450, and the
HCFA-1500, or their successors, as developed by the National Uniform Billing Committee,
with additional fields as necessary to provide all of the data set forth in subsections
(c) and (d).
(c) Data elements.-For each covered service performed in Massachusetts,
the council shall be required to collect the following data elements:
a.
uniform patient identifier, continuous across multiple episodes and providers;
b. patient date of birth;
c. patient sex;
d. patient race, consistent
with the method of collection of race/ethnicity data by the United States Bureau
of the Census and the United States Standard Certificates of Live Birth and Death;
e. patient ZIP Code number;
f. date of admission;
g. date of discharge;
h. principal and up to five secondary diagnoses by standard code, including
external cause code;
i. principal procedure by council-specified standard
code and date;
j. up to three secondary procedures by council- specified
standard codes and dates;
k. uniform health care facility identifier, continuous
across episodes, patients and providers;
l. uniform identifier of admitting
physician, by unique physician identification number established by the council,
continuous across episodes, patients and providers;
m. uniform identifier
of consulting physicians, by unique physician identification number established
by the council, continuous across episodes, patients and providers;
n. total
charges of health care facility, segregated into major categories, including,
but not limited to, room and board, radiology, laboratory, operating room, drugs,
medical supplies and other goods and services according to guidelines specified
by the council;
o. actual payments to health care facility, segregated, if
available, according to the categories specified in paragraph n;
p. charges
of each physician or professional rendering service relating to an incident of
hospitalization or treatment in an ambulatory service facility;
q. actual
payments to each physician or professional rendering service pursuant to paragraph
p;
r. uniform identifier of primary payor;
s. ZIP Code number of facility
where health care service is rendered;
t. uniform identifier for payor group
contract number;
u. patient discharge status; and
v. provider service
effectiveness and provider quality pursuant to section 3(d)(d) and subsection
(d).
(d) Provider quality and provider service effectiveness data elements.-In
carrying out its duty to collect data on provider quality and provider service
effectiveness under section 3(d)(d) and subsection (c)(v), the council shall define
a methodology to measure provider service effectiveness which may include additional
data elements to be specified by the council sufficient to carry out its responsibilities
under section 3(d)(d). The council may adopt a nationally recognized methodology
of quantifying and collecting data on provider quality and provider service effectiveness
until such time as the council has the capability of developing its own methodology
and standard data elements. The council shall include in the Massachusetts Uniform
Claims and Billing Form a field consisting of the data elements required pursuant
to subsection (c)(v) to provide information on each provision of covered services
sufficient to permit analysis of provider quality and provider service effectiveness
within 180 days of commencement of its operations pursuant to section 2.
(e)
Reserve field utilization and addition or deletion of data elements.-The council
shall include in the Massachusetts Uniform Claims and Billing Form a reserve field.
The council may utilize the reserve field by adding other data elements beyond
those required to carry out its responsibilities under section 3(d)(c) and (d)
and subsections (c) and (d), or the council may delete data elements from the
Massachusetts Uniform Claims and Billing Form only by a majority vote of the council
and only pursuant to the following procedure:
a. The council shall obtain
a cost-benefit analysis of the proposed addition or deletion, which shall include
the cost to data sources of any proposed additions.
b. The council shall
publish notice of the proposed addition or deletion, along with a copy or summary
of the cost-benefit analysis, with the General Court, and such notice shall include
provision for a 60-day comment period.
c. The council may hold additional
hearings or request such other reports as it deems necessary and shall consider
the comments received during the 60-day comment period and any additional information
gained through such hearings or other reports in making a final determination
on the proposed addition or deletion.
(f) Other data required to be submitted.-Providers
are hereby required to submit and the council is hereby authorized to collect,
in accordance with submission dates and schedules established by the council,
the following additional data, provided such data is not available to the council
from public records:
a. Audited annual financial reports of all hospitals
and ambulatory service facilities providing covered services as defined in section
1.
b. The Medicare cost report OMB Form 2552 or equivalent Federal form, or
the AG-12 form for Medical Assistance or successor forms, whether completed or
partially completed, and including the settled Medicare cost report and the certified
AG-12 form.
c. Additional data, including, but not limited to, data which
can be used to provide at least the following information:
i. the incidence
of medical and surgical procedures in the population for individual providers;
ii. physicians who provide covered services and accept medical assistance patients;
iii. physicians who provide covered services and accept Medicare assignment as
full payment;
iv. mortality rates for specified diagnoses and treatments,
grouped by severity, for individual providers;
v. rates of infection for
specified diagnoses and treatments, grouped by severity, for individual providers;
vi. morbidity rates for specified diagnoses and treatments, grouped by severity,
for individual providers;
vii. readmission rates for specified diagnoses and
treatments, grouped by severity, for individual providers; and rate of incidence
of postdischarge professional care for selected diagnoses and procedures, grouped
by severity, for individual providers.
d. Any other data the council requires
to carry out its responsibilities pursuant to section 3(d).
(g) Allowance
for clarification or dissents.-The council shall maintain a file of written statements
submitted by data sources who wish to provide an explanation of data that they
feel might be misleading or misinterpreted. The council shall provide access to
such file to any person and shall, where practical, in its reports and data files
indicate the availability of such statements. When the council agrees with such
statements, it shall correct the appropriate data and comments in its data files
and subsequent reports.
(h) Availability of data.-Nothing in this act shall
prohibit a purchaser from obtaining from its health care insurer, nor relieve
said health care insurer from the obligation of providing said purchaser, on terms
consistent with past practices, data previously provided or additional data not
currently provided to said purchaser by said health care insurer pursuant to any
existing or future arrangement, agreement or understanding.
SECTION 5. Data dissemination and publication.
(a) Public reports.-Subject to the restrictions on access
to council data set forth in section 6 and utilizing the data collected under
section 4 as well as other data, records and matters of record available to
it, the council shall prepare and issue reports to the General Court and to
the general public, according to the following provisions:
a. The council
shall, for every provider within the Commonwealth and within appropriate regions
and subregions within the Commonwealth and for those inpatient and outpatient
services which, when ranked by order of frequency, account for at least 65% of
all covered services and which, when ranked by order of total payments, account
for at least 65% of total payments, prepare and issue reports that at least provide
information on the following:
i. Comparisons among all providers of payments
received, charges, population-based admission or incidence rates, and provider
service effectiveness, such comparisons to be grouped according to diagnosis and
severity, and to identify each provider by name and type or specialty.
ii.
Comparisons among all providers, except physicians, of inpatient and outpatient
charges and payments for room and board, ancillary services, drugs, equipment
and supplies and total services, such comparisons to be grouped according to provider
quality and provider service effectiveness and according to diagnosis and severity,
and to identify each health care facility by name and type.
iii. Until and
unless a methodology to measure provider quality and provider service effectiveness
pursuant to sections 3(d)(d) and 4(c) and (d) is available to the council, comparisons
among all providers, grouped according to diagnosis, procedure and severity, which
identify facilities by name and type and physicians by name and specialty, of
charges and payments received, readmission rates, mortality rates, morbidity rates
and infection rates. Following adoption of the methodology specified in sections
3(d)(d) and 4(c) and (d), the council may, at its discretion, discontinue publication
of this component of the report.
iv. The incidence rate of selected medical
or surgical procedures, the provider service effectiveness and the payments received
for those providers, identified by the name and type or specialty, for which these
elements vary significantly from the norms for all providers.
b. In preparing
its reports under paragraph a, the council shall ensure that factors that have
the effect of either reducing provider revenue or increasing provider costs, and
other factors beyond a provider's control which reduce provider competitiveness
in the market place, are explained in the reports. It shall also ensure that any
clarifications and dissents submitted by individual providers under section 4(g)
are noted in any reports that include release of data on that individual provider.
c. The council shall, for all providers within the Commonwealth and within appropriate
regions and subregions within the Commonwealth, prepare and issue quarterly reports
that at least provide information on the:
i. number of physicians, by specialty,
on the staff of each hospital or ambulatory service facility and those physicians
on the staff that accept Medicare assignment as full payment and that accept Medical
Assistance patients.
d. The council shall publish all reports required in
this section with the General Court and shall publish, in at least one newspaper
of general circulation in each subregion within the Commonwealth, reports on the
providers in that subregion and subregions adjacent to it. In addition, the council
shall advertise annually the availability of these reports and the charge for
duplication and in at least one newspaper of general circulation in each subregion
within the Commonwealth at least once in each calendar quarter.
(b) Raw data
reports and computer access to council data.- The council shall provide special
reports derived from raw data and a means for computer-to-computer access to its
raw data to any purchaser, pursuant to section 6(f). The council shall provide
such reports and computer-to-computer access, at its discretion, to other parties,
pursuant to section 6(g). The council shall provide these special reports and
computer-to-computer access in as timely a fashion as the council's responsibilities
to publish the public reports required in this section will allow. Any such provision
of special reports or computer-to-computer access by the council shall be made
only subject to the restrictions on access to raw data set forth in section 6(b)
and only after payment for costs of preparation or duplication pursuant to section
6(f) or (g).
Section 6. Access to council data.
(a) Public access.-The information and data received by
the council shall be utilized by the council for the benefit of the public and
public officials. Subject to the specific limitations set forth in this section,
the council shall make determinations on requests for information in favor of
access.
a. Outreach programs.-The council shall develop
and implement outreach programs designed to make its information understandable
and usable to purchasers, providers, other Commonwealth agencies and the general
public. The programs shall include efforts to educate, through pamphlets, booklets,
seminars and other appropriate measures and to facilitate making more informed
health care choices.
(b) Limitations on access.-Unless specifically provided
for in this act, neither the council nor any contracting system vendor shall release
and no data source, person, member of the public or other user of any data of
the council shall gain access to:
a. Any raw data of the council that does
not simultaneously disclose payment, as well as provider quality and provider
service effectiveness pursuant to sections 3(d)(d) and 4(d) or 5(a)(a)(iii).
b. Any raw data of the council which could reasonably be expected to reveal the
identity of an individual patient.
c. Any raw data of the council which could
reasonably be expected to reveal the identity of any purchaser, as defined in
section 1, other than a purchaser requesting data on its own group or an entity
entitled to said purchaser's data pursuant to subsection (f).
d. Any raw data
of the council relating to actual payments to any identified provider made by
any purchaser, except that this provision shall not apply to access by a purchaser
requesting data on the group for which it purchases or otherwise provides covered
services or to access to that same data by an entity entitled to the purchaser's
data pursuant to subsection (f).
e. Any raw data disclosing discounts or differentials
between payments accepted by providers for services and their billed charges obtained
by identified payors from identified providers unless comparable data on all other
payors is also released and the council determines that the release of such information
is not prejudicial or inequitable to any individual payor or provider or group
thereof. In making such determination the council shall consider that it is primarily
concerned with the analysis and dissemination of payments to providers, not with
discounts.
(c) Unauthorized use of data.-Any person who knowingly releases
council data violating the patient confidentiality, actual payments, discount
data or raw data safeguards set forth in this section to an unauthorized person
commits a misdemeanor of the first degree and shall, upon conviction, be sentenced
to pay a fine of $10,000 or to imprisonment for not more than five years, or both.
An unauthorized person who knowingly receives or possesses such data commits a
misdemeanor.
(d) Unauthorized access to data.-Should any person inadvertently
or by council error gain access to data that violates the safeguards set forth
in this section, the data must immediately be returned, without duplication, to
the council with proper notification.
(e) Public access to records.-All public
reports prepared by the council shall be public records and shall be available
to the public for a reasonable fee.
(f) Access to raw council data by purchasers.-Pursuant
to sections 3(d)(e) and 5(b) and subject to the limitations on access set forth
in subsection (b) in this section, the council shall provide access to its raw
data to purchasers in accordance with the following procedure:
a. Special
reports derived from raw data of the council shall be provided by the council
to any purchaser requesting such reports.
b. A means to enable computer-to-computer
access by any purchaser to raw data of the council as defined in section 1 shall
be developed, adopted and implemented by the council, and the council shall provide
such access to its raw data to any purchaser upon request.
c. In the event
that any employer obtains from the council, pursuant to paragraph a or (b), data
pertaining to its employees and their dependents for whom said employer purchases
or otherwise provides covered services as defined in section 1 and who are represented
by a certified collective bargaining representative, said collective bargaining
representative shall be entitled to that same data, after payment of fees as specified
in paragraph d. Likewise, should a certified collective bargaining representative
obtain from the council, pursuant to paragraph (a) or (b), data pertaining to
its members and their dependents who are employed by and for whom covered services
are purchased or otherwise provided by any employer, said employer shall be entitled
to that same data, after payment of fees as specified in paragraph d.
d. In
providing for access to its raw data, the council shall charge the purchasers
which originally obtained such access a fee sufficient to cover its costs to prepare
and provide special reports requested pursuant to paragraph a or to provide computer-to-computer
access to its raw data requested pursuant to paragraph b. Should a second or subsequent
party or parties request this same information pursuant to paragraph c, the council
shall charge said party a reasonable fee.
(g) Access to raw council data by
other parties.-Subject to the limitations on access to raw council data set forth
in subsection (b) in this section, the council may, at its discretion, provide
special reports derived from its raw data or computer-to- computer access to parties
other than purchasers. The council shall publish regulations that set forth the
criteria and the procedure it shall use in making determinations on such access,
pursuant to the powers vested in the council in section 2. In providing such access,
the council shall charge the party requesting the access a reasonable fee.
Section 7. Special studies and reports.
(a) Special studies.--The council may publish or contract
for publication of special studies. Any special study so published shall become
a public document.
(b) Special reports.-
a.
Any council may study and issue a report on the special medical needs, demographic
characteristics, access or lack thereof to health care services and need for financing
of health care services of:
i. Senior citizens, particularly low-income senior
citizens, senior citizens who are members of minority groups and senior citizens
residing in low-income urban or rural areas.
ii. Low-income urban or rural
areas.
iii. Minority communities.
iv. Women.
v. Children.
vi.
Unemployed workers.
vii. Veterans.
b. The reports shall include information
on the current availability of services to these targeted parts of the population,
and whether access to such services has increased or decreased over the past ten
years, and specific recommendations for the improvement of their primary care
and health delivery systems, including disease prevention and comprehensive health
care services. The council may also study and report on the effects of using prepaid,
capitated or HMO health delivery systems as ways to promote the delivery of primary
health care services to the underserved segments of the population enumerated
above.
c. The council may study and report on the short- term and long-term
fiscal and programmatic impact on the health care consumer of changes in ownership
of hospitals from nonprofit to profit, whether through purchase, merger or the
like. The department may also study and report on factors, which have the effect
of either reducing provider revenue or increasing provider cost, and other factors
beyond a provider's control, which reduce provider competitiveness in the marketplace,
are explained in the reports.
Section 8. Enforcement; penalty.
(a) Compliance
enforcement.-The council shall have standing to bring an action in law or in equity
through private counsel in any court of common pleas to enforce compliance with
any provision of this act, except section 7, or any requirement or appropriate
request of the council made pursuant to this act. In addition, the Attorney General
is authorized and shall bring any such enforcement action in aid of the council
in any court of common pleas at the request of the council in the name of the
Commonwealth.
(b) Penalty.-Any person who fails to supply data pursuant to
section 4 commits a misdemeanor and shall, upon conviction, be sentenced to pay
a fine not to exceed $1,000. Each day on which the required data is not submitted
constitutes a separate offense under this paragraph. Any person who, after being
sentenced under paragraph (a), fails to supply data pursuant to section 4 commits
a misdemeanor and shall, upon conviction, be sentenced to pay a fine of $10,000
or to imprisonment for not more than five years, or both. In addition, the appropriate
licensing authority may suspend or revoke, after an adjudicatory proceeding in
accordance with chapter thirty A, the license of any provider of services that
knowingly fails to file with the council data, statistics, schedules or other
information required by this section or by any regulation of the council or that
knowingly falsifies the same.
Section 9. Research and demonstration projects.
The council shall actively encourage research and demonstrations
to design and test improved methods of assessing provider quality, provider
service effectiveness and efficiency. To that end, provided that no data submission
requirements in a mandated demonstration may exceed the current reserve field
on the Massachusetts Uniform Claims and Billing Form, the council may:
a. Authorize contractors
engaged in health services research selected by the council, pursuant to the provisions
of section 12, to have access to the council's raw data files, providing such
entities assume any contractual obligations imposed by the council to assure patient
identity confidentiality.
b. Place data sources participating in research
and demonstrations on different data submission requirements from other data sources
in this Commonwealth.
c. Require data source participation in research and
demonstration projects when this is the only testing method the council determines
is promising.
Section 10. Grievances and Hearings
(a) Procedures
and requirements.-Pursuant to its powers to publish regulations under section
3(b) and with the requirements of this section, the council is hereby authorized
and directed to establish procedures and requirements for the filing, hearing
and adjudication of grievances against the council of any data source. Such procedures
and requirements shall be published with the General Court.
(b) Claims; hearings.-Grievance
claims of any data source shall be submitted to the council or to a third party
designated by the council, and the council or the designated third party shall
convene a hearing, if requested, and adjudicate the grievance.
Section 11. Antitrust provisions.
Persons or entities required to submit data or information
under this act or receiving data or information from the council in accordance
with this act are declared to be acting pursuant to State requirements embodied
in this act and shall be exempt from antitrust claims or actions grounded upon
submission or receipt of such data or information.
Section 12. Contracts with vendors.
(a) Any contract with any vendor other than a sole source vendor
for purchase of services or for purchase or lease of supplies and equipment related
to the council's powers and duties shall be let only after a public bidding process
and only in accordance with the following provisions, and no contract shall be
let by the council that does not conform to these provisions:
a. The council
shall prepare specifications fully describing the services to be rendered or equipment
or supplies to be provided by a vendor and shall make these specifications available
for inspection by any person at the council's offices during normal working hours
and at such other places and such other times as the council deems advisable.
b. The council shall publish notice of invitations to bid. The council shall
also publish such notice in at least four newspapers in general circulation in
the Commonwealth on at least three occasions at intervals of not less than three
days. Said notice shall include at least the following:
i. The deadline for
submission of bids by prospective vendors, which shall be no sooner than 30 days
following the latest publication of the notice as prescribed in this paragraph.
ii. The locations, dates and times during which prospective vendors can examine
the specifications required in paragraph (a).
iii. The date, time and place
of the meeting or meetings of the council at which bids will be opened and accepted.
iv. A statement to the effect that any person is eligible to bid.
c.
Bids shall be accepted as follows:
i. No council member who is affiliated
in any way with any bidder shall vote on the awarding of any contract for which
said bidder has submitted a bid, and any council member who has an affiliation
with a bidder shall state the nature of the affiliation prior to any vote of the
council.
ii. Bids shall be opened and reviewed by the appropriate council
committee, which shall make recommendations to the council on approval. Bids shall
be accepted and such acceptance shall be announced only at a public meeting of
the council as defined in section 2(e), and no bids shall be accepted at an executive
session of the council.
iii. The council may require that a certified check,
in an amount determined by the council, accompany every bid, and, when so required,
no bid shall be accepted unless so accompanied.
d. In order to prevent any
party from deliberately underbidding contracts in order to gain or prevent access
to council data, the council may award any contract at its discretion, regardless
of the amount of the bid, pursuant to the following:
i. Any bid accepted
must reasonably reflect the actual cost of services provided.
ii. Any vendor
so selected by the council shall be found by the council to be of such character
and such integrity as to assure, to the maximum extent possible, adherence to
all the provisions of this act in the provision of contracted services.
iii.
The council may require the selected vendor to furnish, within 20 days after the
contract has been awarded, a bond with suitable and reasonable requirements guaranteeing
the services to be performed with sufficient surety in an amount determined by
the council, and upon failure to furnish such bond within the time specified,
the previous award shall be void.
iv. The council shall make efforts to assure
that its vendors have established affirmative action plans to assure equal opportunity
policies for hiring and promoting employees.
Section 13. Reporting.
The council shall provide an annual report of its financial expenditures to the
House Ways and Means Committee and the Senate Ways and Means Committee of the
Massachusetts Legislature.
Section 14. Health Care Finance Unit.
The
Health Care Finance Unit is hereby established within the Health Care Cost Containment
Council. The council shall oversee the unit and shall employee other staff necessary
pursuant to section 3 to comply with the following provisions in this section.
The executive director pursuant to section 3 shall oversee the duties and functions
of the unit.
(a) General Duties and Functions of the unit.
a. To make
an annual report to the council and the general court the first Wednesday in November
specifying the management of its affairs, an analysis of reimbursement policy
for each class of providers of services and for state institutions, a projection
of the percentage change and fiscal impact of any changes in rates or regulations
for every provider and program under its jurisdiction for the fiscal year beginning
July first in the year following such November first, a detailed analysis of the
factors influencing each increase and an explanation for any rate increase in
excess of the consumer price index. Said report shall further detail efforts of
the unit to coordinate its rate making function with rule making functions of
other state agencies regulating said providers and institutions, and its recommendations
for legislation, if any.
b. To provide, on a basis calculated to reduce or
contain the costs of the program, a program of insurance coverage for health care
services for persons in the commonwealth who are not otherwise eligible for or
covered by a health insurance plan, a self-insurance health plan, a medical assistance
program or any other plan or program which provides for payment by a third-party
payer for health care services;
c. To design and to revise, consistent with
this chapter, a basic schedule of health care services that enrollees in any health
insurance program implemented by the unit shall be eligible to receive. Such covered
services shall include those which typically are included in employer-sponsored
health benefit plans in the commonwealth. The unit may promulgate schedules of
covered health care services which differ from the basic schedule and which apply
to specific classes of enrollees. The unit may promulgate a schedule of premium
contributions, co-payments, co-insurance, and deductibles for said programs, including
reduced premiums based on a sliding fee, and other fees and revise them from time
to time, subject to the approval of the division of insurance; and provided, however,
that such schedule shall provide for such enrollees to pay one hundred per cent
of such premium contributions if their income substantially exceeds the non-farm
poverty guidelines of the United States office of management and budget;
d.
To establish rates pursuant to this section to be paid providers of health care
services by governmental units, including the division of industrial accidents
which are reasonable and adequate to meet the costs which are incurred by efficiently
and economically operated facilities in order to provide care and services in
conformity with applicable state and federal law, regulations and quality and
safety standards, and which are within the financial capacity of the commonwealth.
The unit shall have the responsibility for establishing fair and adequate charges
to be used by state institutions for general health supplies, care or rehabilitative
services and accommodations, which charges shall be based on the actual costs
of each state institution reasonably related, in the circumstances of each institution,
to the efficient production of such services in such institution and shall also
have sole responsibility for determining rates paid for educational assessments
conducted or performed by psychologists and other trained certified educational
personnel pursuant to the tenth paragraph of section 3 of chapter 71B of the general
laws, notwithstanding the provisions of an other special or general law or rule
or regulation to the contrary;
i. The unit (1) shall determine, after public
hearing, at least annually for institutional providers, and at least biennially
for non-institutional providers, the rates to be paid by each governmental unit
to providers of health care services; (2) shall determine, after public hearing,
at least annually, the rates to be charged by each state institution for general
health supplies, care or rehabilitative services and accommodations; (3) shall
certify to each affected governmental unit the rates so determined; (4) shall
determine, after public hearing, at least annually, and certify to the division
of industrial accidents of the department of labor and industries, rates of payment
for general health supplies, care or rehabilitative services and accommodations,
which rates shall be paid for services under chapter 152; (5) shall, upon request
of the division of insurance, assist the division of insurance in the performance
of its duties as set forth in section four of chapter one hundred and seventy-six
B; (6) may establish fair and reasonable classifications upon which any rates
may be based for rest homes, nursing homes and convalescent homes; provided, however,
that the unit shall not cause a decrease in a rate or add a penalty to a rate
because such home has an equity position which is less than zero.
ii. The
unit shall establish such rates for nursing homes and rest homes, as defined under
section seventy-one of chapter one hundred and eleven, as of October first of
each year for facilities whose rate is set on a retrospective basis and as of
January first of each year for facilities whose rate is set on a prospective basis.
In setting such prospective or retrospective rates of reimbursement, the unit
shall use as base year costs for rate determination purposes the reported costs
of the calendar year not more than four years prior to the current rate year,
adjusted for reasonableness and to incorporate any audit findings applicable to
said base year costs; provided, however, that no base year cost shall be incorporated
unless a comprehensive desk audit has been completed for the costs incurred in
that base year. In any appeal of any matter arising out of the setting of such
prospective rates of reimbursement, the aggrieved party shall not be permitted
to introduce into the record of such an appeal evidence of costs for any year
other than the base year used to establish the rate. Notwithstanding any other
general or special law or regulation to the contrary, except as provided in chapter
one hundred and eighteen E, each governmental unit shall pay to a provider of
services and each state institution shall charge as a provider of health care
services, as the case may be, the rates for general health supplies, care and
rehabilitative services and accommodations determined and certified by the unit.
iii. The unit, in establishing rates of payment to providers of services, shall
control rate increases and shall impose such methods and standards as are necessary
to ensure reimbursement for those costs which must be incurred by efficiently
and economically operated facilities and providers. Such methods and standards
may include, but are not limited to the following: peer group cost analyses; ceilings
on capital and operating costs; productivity standards; caps or other limitations
on the utilization of temporary nursing or other personnel services; use of national
or regional indices to measure increases or decreases in reasonable costs; limits
on administrative costs associated with the use of management companies; the availability
of discounts for large volume purchasers; the revision of existing historical
cost bases, where applicable, to reflect norms or models of efficient service
delivery; and other means to encourage the cost-efficient delivery of services.
Rates produced using these methods and standards shall be in conformance with
Title XIX, including the upper limit on provider payments.
iv. The unit, in
determining rates to be paid by governmental units to providers of services, shall
include as an operating expense of a provider of services any contribution made
in lieu of taxes by such provider of services to a city or town and shall establish
by regulation those expenses treated as business deductions under the Internal
Revenue Code, which shall be included as allowable operating expenses in determining
rates of reimbursement. Except for ceilings or maximum rates of reimbursement,
which are determined in accordance with rate determination methods imposed on
nursing homes, any ceiling or maximum imposed by the unit upon the rate of reimbursement
to be paid to rest homes shall reflect the actual costs of rest home providers
and shall not prevent any such rest home provider from receiving full payment
for costs necessarily incurred in the provision of services in compliance with
federal or state regulations and requirements.
v. The unit, in determining
rates to be paid by governmental units to acute-care hospitals, as defined in
section 25B of chapter 111, and any hospital or separate unit of a hospital that
provides acute psychiatric services, as defined in said section 25B, shall include
as an operating expense the reasonable cost of providing competent interpreter
services as required by section 25J of said chapter 111 or section 23A of chapter
123. No hospital shall receive reimbursement or payment from any governmental
unit for amounts paid to employees, as salary, or to consultant or other firms,
as fees, where the primary responsibility of the employees or consultants is,
either directly or indirectly, to persuade or seek to persuade the employees of
the hospital to support or oppose unionization. Attorney's fees for services rendered
in dealing directly with a union, in advising hospital management of its responsibilities
under the National Labor Relations Act, or for services at an administrative agency
or court or for services by an attorney in preparation for the agency or in court
proceeding shall not be deemed to be support or opposition to unionization.
vi. The unit shall establish rates on a prospective basis, subject to rules and
regulations promulgated by the unit whenever possible; provided, however, that
whenever the unit by regulation provides that a final rate for a reporting period
shall be computed on the actual cost of a provider of services, or a state institution,
for such period, it shall establish an interim rate for said provider or institution
within twenty-one days of the beginning of said interim rate period, from which
interim rate said provider may appeal as provided under section thirty-six.
vii. The unit shall also adopt regulations pursuant to council approval to enable
each provider or institution to secure adjustment in said interim rate from time
to time to meet current reasonable costs. Said provider or institution shall have
the right at any time to petition the unit for an increase in said interim rate.
A petition for an adjustment in an interim rate shall include a certified statement
that such a petition is not interposed for delay, a detailed explanation, under
oath, of the basis upon which said increase is sought, together with a sworn statement
of an independent licensed accountant or independent certified public accountant
that he has examined the pertinent data relative to the accounts forming the basis
of the petition and that in his opinion, said accounts are as represented by the
petitioner. The petitioner shall provide such other information as the unit shall
require. The unit, subject to council approval, may create such rules and regulations
that may waive the required independent audit for non-institutional providers
whenever the unit determines that such audit would create a financial hardship.
The executive director shall report in writing his recommendations to the petitioner,
giving his reasons therefore in detail, and the petitioner shall have ten days
to file objections, arguments and comments to the unit. The unit shall thereupon
make a rate determination, which shall become effective when filed with the state
secretary. No appeal under section nine of this chapter shall be allowed from
an interim rate determined under the provisions of this paragraph.
viii. The
unit shall, whenever a final rate for a filing period is to be determined after
the end of such period, calculate a preliminary final rate within 60 days after
receipt of a satisfactory financial and operating cost report from a provider
of services or state institution for such filing period. If such reports provide
all the information required by the unit and are attested to by an independent
licensed accountant or an independent certified public accountant in such a manner
and form as the unit may require, the unit may, prior to a field audit, establish
such preliminary final rate on the basis of such information submitted. No appeal
may be taken from such preliminary final rate. Ninety percent of the difference
between the interim rate and said preliminary final rate shall become payable
by or to governmental units when certified to the state secretary. Said preliminary
final rate may be promulgated as the final rate of a provider of services or state
institution if the unit is satisfied with a provider's report. In the event that
a final rate is determined without a field audit, the unit shall institute such
procedures, including random field audits, as are required to assure accurate
reporting by providers of health care services and state institutions. If the
unit is not satisfied with the provider's report, the unit shall within six months
and after a field audit promulgate a different rate of payment.
ix. The unit,
in establishing rates for nursing pools pursuant to section seventy-two Y of chapter
one hundred and eleven, shall take into consideration wages and benefits paid
by the pool to the medical personnel supplied to a health care facility and that
portion of the rate attributable to wages and benefits shall not exceed the prevailing
wages and benefits allowed for permanent medical personnel of the same type at
such health care facilities. Such rate shall also take into consideration the
reasonable administrative expenses and an allowance, which shall provide a reasonable
return on equity. The unit shall establish procedures whereby nursing pools shall
submit accountable cost reports, which may be subject to audit, to the unit for
the purpose of establishing such rates. The unit shall establish interim rates
for nursing pools until such time as said reports are complete.
x. The unit
shall set rates for rest homes, nursing homes and convalescent homes, beginning
with interim rates for the rate year beginning October first, nineteen hundred
and eighty-nine, by recalculating the base year whenever estimated costs for payments
to nursing pools are no longer reflective of or are higher than actual costs to
such facilities for such payments.
xi. Notwithstanding the provisions of any
general or special law or any rule or regulation to the contrary, the unit, in
determining the rate of payment for prescribed drugs dispensed to publicly-aided
or industrial accident patients by pharmacy providers, shall not apply or use,
either directly or indirectly, a discount from the primary standard used by the
unit in establishing such rate.
xii. Except as otherwise provided in this
section any person aggrieved by any rate determination made under this section
shall have a right of appeal as provided under section nine.
xiii. The unit
may enter into such contracts or agreements with the federal government, a political
subdivision of the commonwealth, or any public or private corporation or organization,
as it deems necessary; provided, however, that the unit shall not enter into any
contract or agreement with a private corporation or organization to furnish information
and statistical data to be used by said unit as its sole basis for setting rates,
if such private corporation or organization is to make or receive payments based
upon the rates so set.
xiv. Each governmental unit shall cooperate with the
health finance unit at all times in the furtherance of the unit's purposes. Each
state institution shall permit the unit or any designated representatives thereof,
to examine its books and accounts and shall file with the unit from time to time
or upon request such data, statistics, schedules or other information as the unit
may reasonably require.
xv. Each rate established by the unit shall be deemed
a regulation and shall be subject to review as hereinafter provided. The unit
shall promulgate rules and regulations for the administration of its duties and
the determination of rates as are herein required subject to the procedures prescribed
by chapter thirty A. Every rate, classification and other regulation established
by the unit shall be consistent where applicable with the principles of reimbursement
for provider costs in effect from time to time under Titles XVIII and XIX of the
Social Security Act governing reimbursements or grants available to the commonwealth,
its departments, agencies, boards, divisions or political subdivisions for general
health supplies, care, and rehabilitative services and accommodations.
xvi.
In the event that any aggregate rates certified by the unit exceed the upper limit
of payment in effect for any period under Titles XVIII or Title XIX of the Social
Security Act or any other requirement of said Titles, where applicable, the unit
shall redetermine and recertify any such aggregate rates in order to bring them
into compliance with such federal requirement for the entire period during which
such upper limit is effective. The provisions of this section shall not apply
to acute or non-acute hospitals; provided, however, that the provisions of this
section shall apply to acute and non-acute hospitals for services under the workers'
compensation act. Upon petition of a receiver appointed under section seventy-two
N of chapter one hundred and eleven, the unit shall, in accordance with regulations
to be promulgated hereunder, adjust the facility's rate, if necessary, to insure
compensation of the receiver and payment for a bond. Such adjustment shall not
be in effect if the licensee is under the jurisdiction of the United States Bankruptcy
Court.
xvii. All rates of payment to acute hospitals and non-acute hospitals
under Title XIX shall be established by contract between the provider of such
hospital services and the unit of medical assistance, except as provided in subsections
(a) and (b), or otherwise permitted by law. All rates shall be subject to all
applicable Title XIX statutory and regulatory requirements.
xviii. All such
rates for non-acute hospitals shall be effective as of the date specified in section
thirteen A of chapter one hundred and eighteen E of the General Laws, unless otherwise
specified by law.
xix. For disproportionate share hospitals, the unit shall
establish rates that equal the financial requirements of providing care to recipients
of medical assistance.
xx. The unit shall establish rates of payment which
shall apply to emergency services and continuing emergency care provided in acute
hospitals to medical assistance program recipients, including examination or treatment
for an emergency medical condition or active labor in women or any other care
rendered to the extent required by 42 USC 1395(dd), unless such services are provided
pursuant to an agreement between the division of medical assistance and the acute
hospital. Such rates of payment shall reflect the reasonable costs of providing
such care and shall take into account the characteristics of the hospital in which
such care is provided, including, but not limited to, its status as a teaching
hospital, specialty hospital, disproportionate share hospital or sole community
provider. An acute hospital shall, when a medical assistance program recipient
requires post emergency room care and, after screening and stabilizing the patient's
condition, notify the division of medical assistance or its designated representative
and assist said division, to the extent possible, in transferring the recipient
to an appropriate medical setting in accordance with said division's direction.
Nothing herein shall be construed to require the hospital to breach its obligation
under said 42 USC 1395(dd) or require the recipient to forego any right to refuse
transfer pursuant to said 42 USC 1395(dd). If an acute hospital is unable or prohibited
by law or regulation from transferring the patient in accordance with said division's
direction, said division shall pay for any and all care associated with such patient's
treatment including, but not limited to, care or services provided in the emergency
room or in an inpatient or outpatient setting. Whenever said division is required
to pay for such care rendered in a non-emergency room setting, said division shall
pay all reasonable costs for such services in such hospital, as determined by
the division of health care finance and policy pursuant to this chapter and consistent
with the provisions of Title XIX laws.
xxi. All rates of payment to acute
hospitals and non-acute hospitals under Title XIX shall be established by contract
between the provider of such hospital services and the division of medical assistance,
except as provided in subsections (a) and (b), or otherwise permitted by law.
All rates shall be subject to all applicable Title XIX statutory and regulatory
requirements and shall include reimbursement for the reasonable cost of providing
competent interpreter services pursuant to section 25J of chapter 111 or section
23A of chapter 123.
xxii. All such rates for non-acute hospitals shall be
effective as of the date specified in section thirteen A of chapter one hundred
and eighteen E of the General Laws, unless otherwise specified by law.
xxiii.
For disproportionate share hospitals, the unit shall establish rates that equal
the financial requirements of providing care to recipients of medical assistance.
xxiv. The unit shall establish rates of payment which shall apply to emergency
services and continuing emergency care provided in acute hospitals to medical
assistance program recipients, including examination or treatment for an emergency
medical condition or active labor in women or any other care rendered to the extent
required by 42 USC 1395(dd), unless such services are provided pursuant to an
agreement between the division of medical assistance and the acute hospital. Such
rates of payment shall reflect the reasonable costs of providing such care, including
the costs of providing competent interpreter services pursuant to section 25J
of chapter 111 or section 23A of chapter 123 and shall take into account the characteristics
of the hospital in which such care is provided, including, but not limited to,
its status as a teaching hospital, specialty hospital, disproportionate share
hospital or sole community provider. An acute hospital shall, when a medical assistance
program recipient requires post emergency room care and, after screening and stabilizing
the patient's condition, notify the division of medical assistance or its designated
representative and assist said division, to the extent possible, in transferring
the recipient to an appropriate medical setting in accordance with said division's
direction. Nothing herein shall be construed to require the hospital to breach
its obligation under said 42 USC 1395(dd) or require the recipient to forego any
right to refuse transfer pursuant to said 42 USC 1395(dd). If an acute hospital
is unable or prohibited by law or regulation from transferring the patient in
accordance with said division's direction, said division shall pay for any and
all care associated with such patient's treatment including, but not limited to,
care or services provided in the emergency room or in an inpatient or outpatient
setting. Whenever said division is required to pay for such care rendered in a
non-emergency room setting, said division shall pay all reasonable costs for such
services in such hospital, as determined by the unit pursuant to this chapter
and consistent with the provisions of Title XIX laws.
xxv. No acute hospital
may charge to a governmental unit for services provided to publicly aided patients
at a rate higher than the rate payable by the division of medical assistance under
Title XIX for the same service, unless such service is provided by said division
pursuant to a unique arrangement such as a selective contract or a managed care
contract.
xxvi. Nothing in this chapter shall be construed to conflict with
the provisions of a waiver of otherwise applicable federal requirements which
the division of medical assistance may obtain from the secretary of health and
human services for the purpose of implementing a primary care case management
system for delivering services, or for the purpose of implementing any other type
of managed care service delivery system in which the eligible recipient is directed
to obtain services exclusively from one provider or one group of providers.
xxvii. If the division of medical assistance contracts with any third party payer
for the provision of medical benefits for medical assistance recipients under
Title XIX, said division shall assure that on a quarterly basis such contracted
third party payers notify each acute hospital of the number of inpatient days
of service provided by the hospital to such recipients covered by such contracts.
xxviii. The unit shall establish rates of payment which shall apply to community
hospitals located in rural and isolated areas where access to other such providers
is not reasonably available. Such hospitals, specially designated by the commonwealth
as sole community providers, shall receive payment rates calculated to reflect
the rural characteristics of such community hospital and the essential nature
of the services they provide, which rates shall not be less than ninety-seven
per cent of such hospitals' reasonable financial requirements.
xxix. The unit
shall not consider the following as resources of such hospitals in the establishment,
review or approval of acute and non-acute hospital rates and charges: restricted
and unrestricted grants; gifts; contributions; bequests; fund principle; term
endowments and endowment balances; restricted gifts; unrestricted gifts and all
income from any of the foregoing, including unrestricted income from endowment
funds and income and gains from investment of unrestricted funds. The following
words shall have the following meanings as used in this paragraph:
1. ""Income
and gains from investment of unrestricted funds'', interest, dividends, rents
or other income on investments, including net gains or losses resulting from investment
transactions.
2. ""Term endowment'', funds available upon termination
of restrictions.
3. ""Unrestricted gifts'', gifts, grants, contributions
and bequests, upon which there are no restrictions imposed by the donor.
4.
""Unrestricted income from endowment funds'', income earned on investment
of endowment funds which have no restrictions on income.
5. An acute or non-acute
care hospital aggrieved by any action or failure to act by the unit under this
chapter may file an appeal pursuant to the provision of section nine.
xxx.
Except for rates established pursuant to section eleven, any person, corporation
or other party aggrieved by an interim rate or a final rate established by the
unit, or by failure of the unit to set a rate or to take other action required
by law and desiring a review thereof shall, within thirty days after said rate
is filed with the state secretary or may, at any time, if there is a failure to
determine a rate or take any action required by law, file an appeal with the division
of hearings officers established by section four H of chapter seven. Any appeal
filed under this section shall be accompanied by a certified statement that said
appeal is not interposed for delay. On appeal, the rate determined for any provider
of services shall be adequate, fair and reasonable for such provider, based upon,
the costs of such provider, but not limited thereto.
xxxi. On an appeal from
an interim rate or a final rate the division of hearings officers shall conduct
an adjudicatory proceeding in accordance with chapter thirty A, and said division
shall file its decision with the unit and the state secretary within thirty days
after the conclusion of the hearing.
xxxii. Said decision shall contain a
statement of the reasons therefore, including a determination of each issue of
fact or law upon which such decision was based. If such decision results in a
recommendation for a rate different from that certified, the unit shall establish
a new rate based upon such statement of reasons. If the executive director determines
that the statement of reasons is inadequate to determine a fair, reasonable and
adequate rate, it may remand the appeal to the hearing officer for further investigation.
Any party aggrieved by a decision of the unit may, within thirty days of the receipt
of such decision, file a petition for review in superior court for the county
of Suffolk, which shall have exclusive jurisdiction thereof.
xxxiii. A provider
may appeal as an aggrieved party in accordance with the provisions of the preceding
sentence, in the event that a remand by the unit to a hearing officer does not
result in a final decision within twenty-one days of the date of remand. The petition
shall set forth the grounds upon which the decision of the unit should be set
aside. The aggrieved party shall, within seven days after the petition for review
is filed, notify the unit and all the parties to the appeal that a petition for
review has been filed by sending each a copy thereof. Within forty days after
the petition for review is filed, or within such further time as the court may
allow, the division of hearings officers shall file in court the original or a
certified copy of the record under review. The court may affirm, modify or set
aside the decision of the unit in whole or in part, remand the decision to the
unit for further proceedings, or enter such other order as justice may require.
Nothing herein shall be construed to prevent the division of hearing from granting
temporary relief if, in its discretion, such relief is justified nor, from informally
adjusting or settling controversies with the consent of all parties. Judicial
review shall be governed by section fourteen of chapter thirty A to the extent
not inconsistent with the provisions of this section.
Section 15. Payment of Expenses by Acute Hospitals
Each acute hospital shall pay to the commonwealth
an amount for the estimated expenses of the unit. Such amount shall be equal to
the amount appropriated by the general court for the expenses of the unit minus
amounts collected from (1) filing fees, (2) fees and charges generated by the
unit's publication or dissemination of reports and information, and (3) federal
matching revenues received for such expenses or received retroactively for expenses
of predecessor agencies. Each acute hospital shall pay such net amount multiplied
by the ratio of the hospital's gross patient service revenues to the total of
all such hospital's gross patient services revenues. Each acute hospital shall
make a preliminary payment to the unit on October first of each year in an amount
equal to one-half of the previous year's total assessment. Thereafter, each hospital
shall pay, within thirty days notice from the unit, the balance of the total assessment
for the current year based upon its most current projected gross patient service
revenue. The unit shall subsequently adjust the assessment for any variation in
actual and estimated expenses of the unit and for changes in hospital gross patient
service revenue. Such estimated and actual expenses shall include an amount equal
to the cost of fringe benefits, as established by the division of administration
pursuant to section six B of chapter twenty-nine. In the event of late payment
by any such hospital, the treasurer shall advance the amount of due and unpaid
funds to the unit prior to the receipt of such monies in anticipation of such
revenues up to the amount authorized in the then current budget attributable to
such assessments, and the unit shall reimburse the treasurer for such advances
upon receipt of such revenues. The provisions of this paragraph shall not apply
to any state institution or to any acute hospital which is operated by a city
or town.
Section 16. Conditions for reimbursement
Any provider of health
care services that receives reimbursement or payment for treatment of injured
workers under chapter one hundred fifty-two and any provider of health care services
other than an acute or non-acute hospital that receives reimbursement or payment
from any governmental unit for general health supplies, care and rehabilitative
services and accommodations, shall, as a condition of such reimbursement or payment:
(1) permit the unit, or any designated representative thereof, the attorney general
or his designee, to examine such books and accounts as may reasonably be required
for it to perform its duties; (2) file with the unit from time to time or on request,
such data, statistics, schedules, or other information as it may reasonably require,
including outcome data and such information regarding the costs, if any, of such
provider for research in the basic biomedical or health delivery areas or for
the training of health care personnel which are included in its charges to the
public for health care services, supplies and accommodations; and (3) accept reimbursement
or payment at the rates established by the unit, subject to a right of appeal
under section nine, as discharging in full any and all obligations of an eligible
person and the governmental unit to pay, reimburse or compensate the provider
of health care services in any way for general health supplies, care, and rehabilitative
services or accommodations provided.
Section 17.
All purchasers and
third party payers, excluding purchasers and payers under the workers' compensation
act, except as provided in chapter one hundred fifty-two, may enter into contractual
arrangements with acute and non-acute hospitals for services. No such arrangement,
including but not limited to prices or charges which may be charged for non-contracted
services or which may be negotiated in individual contracts between such purchasers
or third party payers and such acute or non-acute hospitals, shall be subject
to prior approval by any public agency; provided, however, that nothing in this
section or chapter shall limit the authority of the unit to establish rates of
payment for all health care services adjudged compensable under chapter one hundred
fifty-two, and provided, further, that charges established by an acute or non-acute
hospital for health care services rendered shall be uniform for all patients receiving
comparable services.
Any acute or non-acute hospital that makes a charge or
accepts payment based upon a charge in excess of that filed required or approved
by the unit or that fails to file any data, statistics or schedules or other information
required under this chapter or by any regulation promulgated by the council or
which falsifies the same, shall be subject to a civil penalty of not more than
one thousand dollars for each day on which such violation occurs or continues,
which penalty may be assessed in an action brought on behalf of the commonwealth
in any court of competent jurisdiction. The attorney general shall bring any appropriate
action, including injunctive relief, as may be necessary for the enforcement of
the provisions of this chapter.
Section 18. Access to care and services for chapter 117A
recipients.
No acute hospital shall deny access to care
and services which the hospital would provide under chapter one hundred and
eighteen E to recipients of benefits under chapter one hundred and seventeen
A.
Section 19. Surcharges for residents of other countries.
Notwithstanding any provisions
of this chapter to the contrary, all costs and charges for patients who are residents
of other countries shall, as provided herein, be exempted from the limitations
imposed by this chapter. Any hospital shall be allowed to impose a surcharge on
the normal charges that would otherwise be allowed for such residents of other
countries. Such surcharges shall not be included in the calculation of gross patient
service revenues. The normal charge and the patient discharge statistics shall
otherwise be included under the provisions of this chapter.
Section 20. Contract rights of HMOs.
A health maintenance organization organized under
chapter one hundred and seventy-six G may (i) negotiate directly with any hospital
with respect to such health maintenance organization's rate of payment for hospital
services and (ii) enter into an agreement with such hospital reflecting such rate
of payment without the approval of the council established under chapter one hundred
eighteen G. The specification in this section of contracting rights of health
maintenance organizations shall not be construed as affirming or denying such
rights with respect to any other third party payer.
Section 21. Small business health insurance programs.
(a) The unit may establish programs to enable small
businesses to purchase health insurance for their employees at rates which are
as equivalent as possible to the rates at which large employers can purchase health
insurance. Such programs shall include, but not be limited to, the following:
a. the study of the insurance market and the practices of insurance companies,
hospital service corporations, medical service corporations and health maintenance
organizations, to determine the causes of the relative unavailability of health
insurance plans for small businesses and of disproportionate health insurance
premium costs for small businesses and to recommend and develop initiatives and
strategies to improve the availability and reduce the relative cost of health
insurance for small businesses;
b. the awarding of technical assistance grants
to private organizations to assist them to act as brokers on behalf of small businesses
seeking to procure health insurance plans;
c. the establishment of a small
business health insurance pool for businesses consisting of six or fewer full-time
employees, for the purpose of purchasing health insurance plans for employees
and their dependents of businesses in the pool, and the study of the expansion
of such pool to cover small businesses of up to ten full-time employees; provided,
however, that not more than thirty per cent in the aggregate of the employees
may be enrolled in a health insurance plan of a single health insurance company,
hospital service corporation, or health maintenance organization;
d. the evaluation
of the effectiveness of the initiatives of the unit and tax incentives in reducing
the cost of health insurance to small businesses and the impact of such voluntary
incentives on the number of small businesses offering health insurance to their
employees.
(b) Any small business health insurance pool program established
by the unit may, subject to appropriation or the availability of unappropriated
funds, establish by negotiation with private third-party payors, and purchase
on such terms as it deems to be in the best interest of the commonwealth and enrollees
in said program, from one or more insurance companies, hospital service corporations,
medical service corporations, or health maintenance organizations, a policy of
group general or blanket insurance providing hospital, surgical, medical, and
other health insurance benefits covering persons who are the employees and their
dependents of small businesses in which the number of full-time employees does
not exceed six. The council shall oversee all the unit's agreements and the unit
shall execute all agreements or contracts pertaining to said policies or any amendments
thereto for and on behalf of and in the name of the unit, pursuant to section
12 and upon final approval of the council. Said unit may negotiate a contract
for such term not to exceed three years as it may, in its discretion, deem to
be the most advantageous to the unit and the eligible small business employees.
The unit shall endeavor to purchase health insurance plans in an economical manner
and shall enroll individuals in managed health care plans whenever practicable;
and provided, further, that the unit shall ensure that every enrollee shall have
a choice of at least two policies providing health care insurance benefits. The
unit shall promulgate regulations regarding eligibility criteria, enrollment,
and termination policies. The unit shall allow, on an annual basis, an opportunity
for enrollees to transfer their enrollments among participating health insurance
plans. The unit shall establish a schedule of premium contributions, co-payments,
deductibles, or co-insurance amounts to be paid by eligible small businesses and
individual enrollees; provided, however that such schedule shall provide for enrollees
to pay one hundred per cent of such premium contributions if their income substantially
exceeds the non-farm poverty guidelines of the United States Office of Management
and Budget.
Section 22. Uncompensated Care Pool
(a) The third party
administrator shall, without imposing undue hardship upon any individual, to secure
payment for unpaid bills owed to acute hospitals by persons ineligible for free
care which have been accounted for as bad debt by the hospital and which are voluntarily
referred by a hospital to the department for collection; provided, however, that
such unpaid charges shall be considered debts owed to the commonwealth and that
all payments received shall be credited to the Uncompensated Care Trust Fund;
and provided, further, that all actions to secure such payments shall be conducted
in compliance with a protocol previously submitted by the former division of health
care finance and policy to the committee on health care and the house and senate
committees on ways and means.
(b) There is hereby established an Uncompensated
Care Trust Fund, which shall be administered by the third party administrator.
Expenditures from said Trust Fund shall not be subject to appropriation unless
otherwise required by law. The purpose of said fund shall be to provide access
to health care for low income uninsured and underinsured residents of the commonwealth.
The third party administrator shall administer said fund using such methods, policies,
procedures, standards and criteria that the unit has approved as necessary for
the proper and efficient operation of said fund and the programs funded thereby
in a manner consistent with simplicity of administration, the provisions of this
chapter and the best interests of low income uninsured and underinsured persons.
(b) The Uncompensated Care Trust Fund shall consist of all amounts paid by acute
hospitals and surcharge payors for the purposes of the uncompensated care pool
pursuant to this act; all appropriations for the purpose of uncompensated acute
hospital care or uncompensated community health center care; any sums paid by
acute hospitals pursuant to section 56 of chapter 495 of the acts of 1991; all
property and securities acquired by and through the use of monies belonging to
said fund and all interest thereon; less payments therefrom for the purposes of
the uncompensated care pool and amounts transferred to the separate MassHealth
account established by subsection (c). All interest earned on the amounts in said
fund shall be deposited or retained in said fund. The unit shall from time to
time requisition from said fund such amounts as it deems necessary in order for
the third party administrator to meet its current obligations for the purposes
of said fund and estimated obligations for a reasonable future period.
(c)
Within said fund, the unit shall establish a separate account for the insurance
reimbursement program component of the MassHealth demonstration program established
by section 9C of chapter 118E. This separate account shall consist of amounts
transferred from the Uncompensated Care Trust Fund, any federal funds transferred
from the Children's and Seniors' Health Care Assistance Fund established by section
2FF of chapter 29, and any funds as may be appropriated for deposit into this
account. The unit shall administer this account and disburse funds from this account
for the purposes of said insurance reimbursement program component of said MassHealth
program. Funds deposited in this account shall be kept separate and shall not
be commingled with funds of the uncompensated care pool. The comptroller is hereby
authorized and directed to effect the transfers authorized by this subsection
pursuant to a spending plan filed by the division of medical assistance with the
secretary of administration and finance and the house and senate committees on
ways and means.
(d) Within said fund, the third party administrator shall
administer an uncompensated care pool consisting of revenues produced by acute
hospital assessments and the surcharge percentage calculated by the third party
administrator pursuant to this section and section 18A and all appropriations
for the purpose of uncompensated care provided by acute hospitals, or community
health centers, including, but not limited to, federal funds made available for
uncompensated care payments to certain acute hospitals as may be appropriated
from the General Fund or any other fund. For purposes of this subsection, the
words ""revenues produced by acute hospital assessments'' shall equal
the value of and have the same meaning as the words ""acute hospitals'
liability to the pool'' established pursuant to subsection (e) and the words ""revenues
produced by the surcharge percentage'' shall equal the value of and have the same
meaning as the words ""surcharge payors' liability to the pool'' as
established pursuant to section 18A. Amounts placed in the Uncompensated Care
Trust Fund, except for amounts transferred into the separate MassHealth account
established in subsection (c), shall be expended by the third party administrator
for the purposes of the uncompensated care pool. The third party administrator
shall administer the uncompensated care pool and require payments to the pool
and disburse funds from the pool consistent with the surcharge payors' and acute
hospitals' liability to the pool and the pool's liability to an acute hospital
or a community health center. The unit shall specify by regulation, appropriate
mechanisms that provide for interim determination and payment of a surcharge payor's
liability to the pool and an acute hospital's liability to and from the pool during
each fiscal year and for final settlement of the pool for each fiscal year. The
unit may promulgate regulations, which authorize the assessment of interest on
any unpaid liability at a rate not to exceed an annual percentage rate of 18 per
cent and late fees at a rate not to exceed 5 per cent per month. The unit may
calculate final settlements when it determines that data for a fiscal year are
substantially complete and that further refinements would not materially affect
the calculation. The unit may incorporate final settlement amounts by prospective
adjustment of acute hospitals' and surcharge payors' liability rather than by
retrospective payments or assessments.
(e) An acute hospital's liability to
said pool shall equal the product of (1) the ratio of its private sector charges
to all acute hospitals' private sector charges; and (2) the private sector liability
to the uncompensated care pool as determined by law less the surcharge payors'
liability established pursuant to section 18A. Before October 1 of each year,
the unit shall establish each acute hospital's liability to the pool using the
best data available, as determined by the unit. The unit shall update each acute
hospital's liability to the pool as updated information becomes available. For
any fiscal year, an acute hospital's final liability to said pool shall be calculated
in accordance with subsection (d). The unit shall specify by regulation an appropriate
mechanism for interim determination and payment of an acute hospital's liability
to and from said pool.
(f) An acute hospital's liability to said pool shall
in the case of a transfer of ownership be assumed by the successor in interest
to the acute hospital.
(g) The unit shall establish by regulation an appropriate
mechanism for enforcing an acute hospital's liability to the pool in the event
that an acute hospital does not make a scheduled payment to said pool. Such enforcement
mechanism may include notification to the division of medical assistance requiring
an offset of payments on the Title XIX claims of any such acute hospital, any
health care provider under common ownership with the acute hospital or any successor
in interest to the acute hospital, from the division of medical assistance in
the amount of payment owed to said pool including any interest and late fees,
and to transfer the withheld funds into said pool. If the division of medical
assistance offsets claims payments as ordered by the division, it shall be deemed
not to be in breach of contract or any other obligation for payment of noncontracted
services, and providers to which payment is offset under order of the division
shall serve all Title XIX recipients in accordance with the contract then in effect
with the division of medical assistance, or, in the case of a noncontracting or
disproportionate share hospital, in accordance with its obligation for providing
services to Title XIX recipients pursuant to this chapter. In no event shall the
division direct the division of medical assistance to offset claims unless an
acute hospital has maintained an outstanding obligation to the uncompensated care
pool for a period longer than 45 days and has received proper notice that said
division intends to initiate enforcement actions in accordance with the regulations
of said division.
(h) Said pool's liability to an acute hospital shall be
calculated periodically by the unit based on the best data available. Such data
shall include, but not be limited to, allowable free care charges as determined
by the division and the cost-to-charge ratio, which shall be calculated by the
unit for each acute hospital. The final settlement of the pool's liability to
a hospital shall equal the product of allowable actual free care charges, adjusted
for any audit findings, multiplied by its final cost-to-charge ratio. In the case
of non-disproportionate share hospitals, such calculation shall represent the
ratio of the reasonable actual costs of patient care services, as determined by
the unit, to gross patient service revenue for the most recent year for which
audited financial statements for the hospital are available. In the case of disproportionate
share hospitals, such calculation shall represent the ratio of the hospital's
reasonable financial requirements, as determined by the unit, to gross patient
service revenue for the most recent year for which audited financial statements
for such hospital are available. The unit shall, throughout the year, update each
acute hospital's ratio in the event more current audited financial statement information
becomes available. Said unit shall further establish, for each non-disproportionate
share acute hospital for any given fiscal year, a final ratio using the reasonable
costs for patient care services and gross patient service revenues as appearing
in the audited financial statements for the fiscal year. For disproportionate
share hospitals, said unit shall establish a final ratio based upon its reasonable
financial requirements, as defined by the unit, and actual gross patient service
revenues as appearing in the audited financial statements for the fiscal year.
The final settlement of the pool's liability to an acute hospital shall be calculated
in accordance with subsection (d). The pool's liability to a community health
center shall be calculated periodically by the unit based on the best data available
as determined by the division. Such data shall include, but not be limited to,
allowable free care charges as determined by the unit and the rates established
by the unit to be paid for free care services. Such rates shall represent the
community health center's reasonable financial requirements, as determined by
the unit.
(i) The unit shall manage said pool in order to encourage maximum
efficiency and appropriateness in the utilization of services. The unit shall
promulgate regulations detailing the definition of free care, including, but not
limited to, defining the qualifications of eligible persons and the scope of eligible
services, setting standards for reasonable efforts to notify uninsured or underinsured
persons of the various insurance options as well as the availability of free care,
and setting standards for reasonable efforts to collect costs of emergency care
and setting standards to determine medical hardship. Said regulations shall include
provision for the review of determinations of eligibility for free care and the
establishment of penalties for acute hospitals or community health centers which
upon audit show an excessive rate of incorrect eligibility determinations. The
unit shall adopt regulations prohibiting payments from said pool for non-urgent
and non-emergency health care services provided to residents of other states and
foreign countries. The unit may require utilization review. After consultation
with consumer representatives and representatives of acute hospitals and community
health centers, the unit shall develop programs and guidelines to encourage maximum
enrollment of pool beneficiaries into health care plans and programs of health
insurance offered by public and private sources, and to promote the delivery of
care in the most appropriate setting, through coordination of care and referral
of primary care cases to community health centers. Such programs and guidelines
shall not deny payments on the ground that services should have been provided
in a more appropriate setting if the hospital was required to provide such services
pursuant to 42 USC 1395(dd). The unit may adopt regulations requiring disproportionate
share hospitals to use a portion of payments received from said pool to reimburse
physicians for the costs of free care which such physicians provide in such hospitals.
In adopting regulations under this subsection, the unit shall consult and work
cooperatively with representatives of low income uninsured and underinsured persons,
health care providers who provide health care to such persons, and organizations
representing said persons and providers.
(j) The unit shall adopt any other
regulations necessary for the third party administrator to manage said pool including,
but not limited to, regulations: requiring data submissions, setting pool audit
standards, establishing enforcement mechanisms consistent with this section, and
establishing reasonable controls on utilization. The unit shall require acute
hospitals and community health centers to submit data to the administrator that
the unit determines necessary to efficiently and effectively administer the uncompensated
care pool. Said data may include, but shall not be limited to, charge and cost
data, patient diagnoses and types of uncompensated service provided, patient demographics,
write-off amounts, unique patient identifiers and other such data that would enable
the unit to conduct analyses, verify eligibility and calculate settlements on
a case-by-case basis. The unit shall consider all available options for collecting
said data, including claims and electronic data submission, and shall implement
the most efficient and effective method after consultation with interested parties.
If the unit finds that hospitals are not complying with the data submission requirements
or if the data submitted are not sufficient to enable the unit to verify eligibility
and calculate settlements on a case-by-case basis, the unit may adopt regulations
providing for a claims adjudication process for payments from the uncompensated
care pool. Such claims adjudication process shall maximize administrative simplicity
to the extent practicable and shall not significantly delay cash flow from said
pool. The unit shall consult with interested parties, including the Massachusetts
hospital association, in developing the methodology for such claims adjudication
process and shall submit the methodology to the joint committee on health care
90 days in advance of adopting such regulations. The third party administrator
shall analyze the data collected under this section in conjunction with any other
pertinent data to determine the demographic characteristics and the clinical and
social needs of uncompensated care recipients. If said analysis indicates that
one or more managed care or case management programs would better meet the needs
of low income individuals, the division shall consult with representatives of
the uninsured and underinsured and the providers who serve them and other interested
parties regarding the potential for managed care or case management approaches
to improve care provided under said pool. If the unit determines that such approaches
would improve care, the unit may contract pursuant to council approval and section
12 with health care delivery or management organizations or to enter interagency
service agreements with the division of medical assistance or the department of
public health for the purpose of contracts with health care or managed care providers
to deliver services to individuals eligible for free care or; provided, however,
that no such contract shall be entered into until the unit finds that the cost
of such contract does not exceed the amounts that would otherwise have been expended
on free care for these individuals; and, provided further, that the expenditures
for such contracts shall not exceed $5,000,000 in any hospital fiscal year.
(k) The unit shall promulgate regulations to develop and implement methods and
procedures to verify the eligibility of individuals for free care and to ensure
that other coverage options are utilized fully before free care is granted. These
systems may include but are not limited to investigation and recovery of third
party liabilities, and penalties for noncompliance. The unit shall compile and
maintain a catalog of program information for all programs of health care coverage
for low income persons including those sponsored by public and private organizations.
The catalog shall include, at a minimum, eligibility criteria, benefits and services
offered, enrollment procedures and information necessary for contact and follow-up.
The unit shall ensure that if free care is granted for the copayment and deductible
of an eligible person with other coverage, no payments shall be made from the
uncompensated care pool which would cause the total payment to the provider to
exceed the applicable rates for free care services. The unit shall refuse to allow
payments or shall disallow payments to acute hospitals and community health centers
for free care provided to individuals if reimbursement is available from other
public or private sources including, but not limited to, the Medicaid or Medicare
program, or if the individual is not eligible for free care. The unit shall require
acute hospitals and community health centers to screen each free care applicant
for other sources of coverage and for potential eligibility for government programs,
and to document the results of such screening. If an acute hospital or community
health center determines that an applicant is potentially eligible for Medicaid
or another government program, said acute hospital or community health center
shall assist the applicant in applying for benefits under such program. The third
party administrator shall audit free care accounts of acute hospitals and community
health centers to determine compliance with this section and shall deny pool payment
for any audited account for any acute hospital or community health center that
fails to document compliance with this section.
(l) The unit may enter into
interagency agreements with the department of revenue to verify income data for
recipients of free care. Such written agreements shall include provisions permitting
the unit to provide a list of persons receiving or applying for free care, including
any applicable members of the households of such recipients or applicants which
would be counted in determining eligibility, and to furnish relevant information
including, but not limited to, name, social security number, if available, and
other data required to assure positive identification. Such written agreements
shall include provisions permitting the department of revenue to examine the data
available under the wage reporting system established under section 3 of chapter
62E and make positive identification of cases in which recipients or applicants
for free care, individually or as part of a household unit, are receiving wages
in excess of any threshold eligibility requirements established by the division.
The department of revenue is hereby authorized to furnish the unit with information
on the cases of persons so identified, including, but not limited to, name, social
security number and other data to ensure positive identification, name and identification
number of employer, and amount of wages received. The unit may inform acute hospitals
and community health centers only of an individuals eligibility or noneligibility
for free care based on information obtained from the department of revenue, but
may not release any specific information concerning the individual.
(m) The
third party administrator shall deposit any amounts received pursuant to chapter
62D in the Uncompensated Care Trust Fund to reimburse the uncompensated care pool
for expenditures made for persons who received free care through said pool and
who, upon review, was determined to be ineligible for uncompensated care based
upon applicable income standards.
(n) The third party administrator shall
not at any time make payments from said pool for any period in excess of amounts
that have been paid into or are available in said pool for such period; provided,
however, that the unit may temporarily prorate payments from said pool for cash
flow purposes. In the event that after making allowable free care payments to
community health centers, there exists a shortfall of pool revenue, excluding
any revenue in the separate MassHealth insurance reimbursement program account,
in any fiscal year to cover allowable free care payments to acute hospitals, the
administrator shall allocate such payments so that those acute hospitals with
the greatest proportional requirement for pool income shall receive a greater
proportional payment from said pool. In the event that there exists a surplus
of pool revenue in any fiscal year over that necessary to cover allowable free
care payments, the administrator shall apply such surplus to allowable free care
payments for any succeeding fiscal year in which there is a shortfall of pool
revenue.
(o) Within the Uncompensated Care Trust Fund, there shall be established
a medical assistance intergovernmental transfer account, administered by the commissioner
of the division of medical assistance, consisting of any transfers to the commonwealth
from publicly-operated entities providing Title XIX or Title XXI reimbursable
services, and federal reimbursements related to medical assistance payments, so
called, to publicly-operated entities. All amounts credited to this account shall
be held in trust and shall be available for expenditure by the commissioner of
the division of medical assistance to be used for medical assistance payments
to entities designated and authorized by the general court, or which have contractually
agreed to make intergovernmental transfers to said account; provided, however,
that any amount in excess of such medical assistance payments may be credited
to the General Fund; provided, further, that the amount of all such expenditures
shall be subject to annual approval by the general court. The maximum payments
and transfers from said account shall not exceed those permissible for federal
reimbursement under Title XIX or Title XXI of the Social Security Act or any successor
federal statute. The comptroller may make payments, including payments during
the accounts payable period, in anticipation of revenues, including receivables
due and collectibles during the months of July and August, and shall establish
procedures for reconciling overpayments or underpayments from said account to
publicly-operated entities; provided, that said procedures shall include, but
not be limited to, appropriate mechanisms for refunding intergovernmental transfers
and federal reimbursements upon recoupment of any such overpayments. The division
of medical assistance shall notify the unit regarding revenue and expenditure
activity within said account and submit to the secretary of administration and
finance and the house and senate committees on ways and means a schedule of said
payments ten days prior to any expenditures, and no funds shall be expended without
an enforceable agreement with or legal obligation imposed upon the recipient public
entity to make an intergovernmental transfer in an appropriate amount to said
account.
Section 23. Health care for the medically indigent.
(a) Declaration
of policy.-The General Court finds that every person in this Commonwealth should
receive timely and appropriate health care services from any provider operating
in this Commonwealth; that, as a continuing condition of licensure, each provider
should offer and provide medically necessary, lifesaving and emergency health
care services to every person in this Commonwealth, regardless of financial status
or ability to pay; and that health care facilities may transfer patients only
in instances where the facility lacks the staff or facilities to properly render
definitive treatment.
(b) Studies on indigent care.-To reduce the undue burden
on the several providers that disproportionately treat medically indigent people
on an uncompensated basis, to contain the long-term costs generated by untreated
or delayed treatment of illness and disease and to determine the most appropriate
means of treating and financing the treatment of medically indigent persons, the
council, at the request of the Governor or the General Court, may undertake studies
and utilize its current data base to:
a. Study and analyze the medically indigent
population, the magnitude of uncompensated care for the medically indigent, the
degree of access to and the result of any lack of access by the medically indigent
to appropriate care, the types of providers and the settings in which they provide
indigent care and the cost of the provision of that care pursuant to subsection
(c).
b. Determine, from studies undertaken under paragraph (b), a definition
of the medically indigent population and the most appropriate method for the delivery
of timely and appropriate health care services to the medically indigent.
(c) Studies.-The council shall conduct studies pursuant to subsection (b)(1) and
thereafter report to the General Court the results of the studies and its recommendations.
The council may contract with an independent vendor to conduct studies in accordance
with the provisions for selecting vendors in section 12. The studies shall include,
but not be limited to, the following:
a. the number and characteristics of
the medically indigent population, including such factors as income, employment
status, health status, patterns of health care utilization, type of health care
needed and utilized, eligibility for health care insurance, distribution of this
population on a geographic basis and by age, sex and racial or linguistic characteristics,
and the changes in these characteristics, including the following:
i. the
needs and problems of indigent persons in urban areas;
ii. the needs and
problems of indigent persons in rural areas;
iii. the needs and problems
of indigent persons who are members of racial or linguistic minorities;
iv.
the needs and problems of indigent persons in areas of high unemployment; and
v. the needs and problems of the underinsured;
b. the degree of and
any change in access of this population to sources of health care, including hospitals,
physicians and other providers; the distribution and means of financing indigent
care between and among providers, insurers, government, purchasers and consumers,
and the effect of that distribution on each;
c. the major types of care rendered
to the indigent, the setting in which each type of care is rendered and the need
for additional care of each type by the indigent;
d. the likely impact of
changes in the health delivery system, including managed care entities, and the
effects of cost containment in the Commonwealth on the access to, availability
of and financing of needed care for the indigent, including the impact on providers
which provide a disproportionate amount of care to the indigent;
e. the distribution
of delivered care and actual cost to render such care by provider, region and
subregion;
f. the provision of care to the indigent through improvements
in the primary health care system, including the management of needed hospital
care by primary care providers;
g. innovative means to finance and deliver
care to the medically indigent; and
h. reduction in the dependence of indigent
persons on hospital services through improvements in preventive health measures.
Section 24. Effective date.
This act shall take effect immediately.
Floor Number: 594 Clerk Number: 56
WITHDRAWN
oor Number: 595 Clerk Number: 142
BULK PURCHASING
Mr. Moore and Brewer move to amend the bill by adding at
the end thereof the following new Section:- SECTION________.
Section ___. Chapter 6A of the General Laws is hereby amended
by inserting after Section 16B the following section:"-
Section 16B ½
(a) Notwithstanding any general or special law to the contrary, the Secretary
of the Executive Office of Health and Human Services, in consultation with the
Secretary of Administration and Finance and the Secretary of Public Safety shall
develop a coordinated, aggregate prescription drug procurement plan to manage
and administer the disbursement, payment and reimbursement of prescription drugs,
including claims processing, adjudication and client services for all pharmacy
benefit plans funded or subsidized, in whole or in part by the Commonwealth. Said
aggregate procurement plan shall separately manage any and all benefits, rules
and functions regarding drug utilization and cost for programs subject to Section
1927(a)(1) of the Social Security Act, Title XIX. The plan shall maximize cost
savings, efficiencies, enhance affordable access to prescriptions and be designed
to improve health outcomes, benefits and coverage in said pharmacy benefit plans.
(b) Notwithstanding the provisions of any general or special law, as part
of said aggregate procurement plan, the Secretary shall seek competitive bids
from third party pharmacy benefits managers who are interested in providing such
procurement services to the Commonwealth. The Secretary shall consider those pharmacy
benefits managers with experience in the administration of publicly-funded health
benefit plans and who are qualified to assess and manage the clinical efficacy
and cost effectiveness of said pharmacy benefit plans on behalf of the Commonwealth.
Nothing in this section shall preclude a not-for-profit entity from participating
in such competitive bid process; provided, that during such competitive bid process,
a not-for-profit pharmacy benefit manager shall demonstrate the capacity to provide
the same level of service quality, assessment and ability to manage the clinical
efficacy and cost effectiveness of the administration of such aggregate procurement
plan as that of a for-profit pharmacy benefit manager, provided further, that
the Secretary may establish an inter-governmental service agreement between or
among agencies of the Commonwealth for the provision of pharmacy benefit management
services if said not-for-profit pharmacy benefit manager is selected for the provision
of such services, and provided further, that the Secretary may request such aggregate
pharmacy benefit manager plan to disclose information regarding its marketing
practices.
(c) A contract currently in existence with any agency or pharmacy
benefits management company shall not be renewed or extended in a manner inconsistent
with the provisions of this section, provided, that a contract in existence with
any agency or pharmacy benefits management company shall not be terminated before
its expiration date if such termination would cause substantial financial cost
or service interruption to the commonwealth.
(d) The Secretary shall ensure
that said aggregate procurement plan employs clinically-based tools to maximize
cost savings, efficiencies, affordability, and to improve health outcomes and
access to pharmacy benefits and coverage and effectively manage the pharmacy plans
of the commonwealth.
(e) The Secretary shall implement said aggregate procurement
plan not later than November 5, 2004 and shall submit, on April 15 of each year,
a report detailing the coordinated aggregate or bulk purchasing arrangement results
for the previous year to the House and Senate Clerks, the Chairs of the House
and Senate Committees on Ways and Means and the Chairs of the Joint Committee
on Healthcare. The report shall include, but not be limited to, a review of said
aggregate procurement plan's achievement relative to: (1) cost savings achieved
during the previous fiscal year; (2) administrative costs relating to the management
of the program for the previous fiscal year; (3) any recommendations for enhancing
the benefits provided by each plan, savings costs, reducing inefficiencies and
improving access and quality and, (4) a cost-benefit analysis of the inclusion
of other governmental entities, including but not limited to county, municipal
and quasi-governmental entities within the aggregate pharmaceutical procurement
plan.
Floor Number: 596 Clerk Number: 252
TO CREATE A STATEWIDE PHYSICIANS ADVISORY COUNCIL
Mr. Montigny moves to amend the bill, S 2400, by inserting
the following new section:-
SECTION ___. There shall be established a statewide physicians advisory council
to annually advise the governor and the general court on the state of physician
practice in the commonwealth and its impact on patient care. The council shall
consist of the following twelve members: the secretary of the executive office
of health and human services, who shall serve as chairman; the commissioner
of the division of health care finance and policy; the commissioner of the division
of medical assistance; and nine members to be appointed by the secretary and
approved by the governor including the president of the Massachusetts Medical
Society or his designee; the governor of the Massachusetts Chapter of the American
College of Physicians or his designee; the executive director of Health Care
for All or his designee; the executive director of the Massachusetts League
of Community Health Centers or his designee; a physician licensed under chapter
112 of the general laws, and serving as the president of a health care system
physician's organization or his designee; and four licensed physicians to be
appointed by the governor who shall have experience caring for patients of programs
administered by the division of medical assistance, one of whom shall be a pediatrician,
one of whom shall have substantial experience providing mental health care,
and two of whom shall represent a cross-section of licensed physicians in the
Commonwealth in terms of academic and community settings, geography and specialty,
including primary care physicians. All appointed or elected members shall serve
for terms of three years without compensation, except that four of the initial
appointees shall be appointed to terms of two years each. The physicians advisory
council shall adopt its own rules for conducting business, but shall meet at
least quarterly. The secretary may provide staffing and other support as may
reasonably be needed by the council, and the council may consult with such public
or private persons and organizations as it deems necessary or appropriate, including
the commissioner of the department of mental health, the commissioner of the
department of mental retardation, the commissioner of the department of public
health, the commissioner of the division of insurance, and the executive director
of the group insurance commission. The statewide physicians advisory council
shall:
(1) Examine and evaluate the state of physician practice in the Commonwealth
and the impact on patient care;
(2) Gather existing payment, cost and quality data as the council deems reasonable
and appropriate in order to evaluate and monitor the cost, quality and effectiveness
of health care services provided by physicians in conjunction with programs
administered by the division of medical assistance and the group insurance commission.
The data shall include, but not be limited to, physician reimbursement rates
and fee schedules from the division of medical assistance and the group insurance
commission for previous and current fiscal years. The council shall evaluate
the adequacy of adjustments, if any, in such rates and fee schedules, as compared
with inflation and other factors including prevailing fees and practice costs,
and shall make annual recommendations regarding the adequacy of such rates and
fee schedules and recommended changes in such rates and fee schedules, including
annual inflation adjustments, in its report filed pursuant to paragraph (10);
(3) Gather and evaluate data on costs of delivering care as compared to payments
to physicians providing health care services to patients of programs administered
by the division of medical assistance, and conduct a comparative analysis of
physician revenues as compared to costs in other states and in the Medicare
program, with such analysis adjusted for variations in wages, cost-of-living
and other statistically significant factors;
(4) Survey the free care provided by physicians to uninsured and underinsured
patients within the commonwealth;
(5) Gather and evaluate data and information on factors affecting the recruitment
and retention of physicians in the commonwealth and the impact of such factors
on patient care;
(6) Determine the availability of primary care and specialty care physician
services statewide to patients enrolled in programs administered by the division
of medical assistance;
(7) Review and evaluate the timeliness of payment to physician practices by
public and private payors, and identify potential reforms to the administration
of claims payment processes;
(8) Identify and recommend demonstration or pilot projects that test innovative
ways to manage patient care for patients in programs administered by the division
of medical assistance and the group insurance commission. Such projects shall
be designed to improve the delivery and quality of patient care while lowering
overall patient care costs and improving efficiency, and may include, but not
be limited to cardiovascular disease management, catastrophic case care coordination,
and improved pharmacy management. Recommendation for permanent implementation
of such projects shall be included in the council's annual report, required
by paragraph (10), and the council shall consult with physicians statewide in
identifying such projects;
(9) Examine such other issues as the council determines necessary in order to
evaluate the state of physician practice in the commonwealth and the impact
on patient care; and
(10) Report annually to the governor and the general court on the second Monday
of January. The report shall include, but not be limited to, a report of the
council's work and activities for the previous year, including any findings
and recommendations, which may include proposed administrative, regulatory,
legislative or executive action, and shall include an estimate of the aggregate
costs of such recommendations, if any. The council may supplement such reports
from time to time.
Floor Number: 597 Clerk Number: 734
ESTABLISHING THE MASSACHUSETTS PRESCRIPTION DRUG FAIR PRICING PROGRAM
Mr. Montigny, Mr. Barrios, Ms. Melconian, Ms. Chandler, Mr. O'Leary, Mr. McGee, Ms. Wilkerson, Mr. Tisei, Mr. Nuciforo, and Mr. Joyce and move to amend the bill, S 2400, by inserting the following 5 sections:-
SECTION ___. Chapter 112 of the General Laws is hereby amended
by adding, after section 42A, the following new section:-
Section 42B. Registration and Disclosure of Pharmaceutical Marketing Activities
(a) As used in this section, the following words shall have the following meanings:
"Gift", a payment, entertainment, subscription, advance, services or
anything of value, unless consideration of equal or greater value is received.
"Gift" shall not include a commercially reasonable loan made in the
ordinary course of business, anything of value received by inheritance, or a gift
received from a member of the reporting person's immediate family or from a relative
within the third degree of consanguinity of the reporting person or of the reporting
person's spouse or from the spouse of any such relative.
"Immediate family",
a spouse and any dependent children residing in the reporting person's household.
"Person", a business, individual, corporation, union, association, firm,
partnership, committee, or other organization or group of persons.
"Pharmaceutical
marketer", a person who, while employed by or under contract to represent
a pharmaceutical manufacturing company, engages in pharmaceutical detailing, promotional
activities, or other marketing of prescription drugs in this state to any physician,
hospital, nursing home, pharmacist, health benefit plan administrator, or any
other person authorized to prescribe, dispense, or purchase prescription drugs.
The term does not include a wholesale drug distributor licensed under section
36A, a representative of such a distributor who promotes or otherwise markets
the services of the wholesale drug distributor in connection with a prescription
drug, or a retail pharmacist registered under section 37 if such person is not
engaging in such practices under contract with a manufacturing company.
"Pharmaceutical
manufacturing company", any entity which is 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. The term does not include a wholesale drug
distributor licensed under section 36A or a retail pharmacist registered under
section 37.
"Prescription drugs", any and all drugs upon which
the manufacturer or distributor has placed or must, in compliance with federal
law and regulations, place the following or a comparable warning: "Caution
federal law prohibits dispensing without prescription."
(b) Every pharmaceutical
manufacturing company shall annually disclose to the board of pharmacy the value,
nature and purpose of any gift, fee, payment, subsidy or other economic benefit
provided in connection with detailing, promotional or other marketing activities
by the company, directly or through its pharmaceutical marketers, to any physician,
hospital, nursing home, pharmacist, health benefit plan administrator or any other
person in the commonwealth authorized to prescribe, dispense, or purchase prescription
drugs in this state.
(c) Disclosure shall be made on a form and in a manner
prescribed by the board. The board shall provide to the office of the attorney
general complete access to the information disclosed under this section. The board,
after consultation with the office of the attorney general and subject to paragraph
(e), shall report annually to the General Court on the disclosures made under
this section on or before March 1 of each year.
(d) Each company subject to
the provisions of this section shall also disclose annually to the board the name
and address of the individual responsible for the company?s compliance with the
provisions of this section.
(e) The board of pharmacy and the office of the
attorney general shall keep confidential all trade secret information, as determined
by the attorney general. The disclosure form prescribed by the board shall permit
the company to identify any information that it believes is a trade secret.
(f) Any gift, fee, payment, subsidy or other economic benefit the value of which
is less than $25.00 shall be exempt from disclosure.
(g) The attorney general
on behalf of the board may bring an action in superior court for injunctive relief,
costs, and attorney's fees, and to impose on a pharmaceutical manufacturing company
that fails to disclose as required by this section a civil penalty of no more
than $10,000.00 per violation. Each unlawful failure to disclose shall constitute
a separate violation.
(h) The board shall promulgate regulations to implement
this section. The board may require, if necessary to the efficient implementation
of this section, pharmaceutical manufacturing companies to be registered or licensed
as a condition of doing business in the commonwealth, and may collect fees necessary
to cover the costs of administering this section.
SECTION ___. Chapter 118E of the General Laws is hereby
amended by inserting after section 12 the following sections:
Section 12A. Consumer Protection Rules; Prior Authorization of Prescription
Drugs
(a) Any prior authorization process required by the division before
it authorizes coverage for a prescription drug shall comply with the consumer
protections in this section and with 42 U.S.C. section 1396r-8(d).
(b) Coverage
for a prescription drug that is not covered by the division without prior authorization
shall be authorized if a patient's health care provider certifies, in a manner
determined by the division, that:
(i) the drug is medically necessary; and
(ii) in the case of a prescription drug that is not the preferred choice
in a therapeutic category on the preferred drug list,
(A) the preferred choice
has not been effective, or with reasonable certainty is not expected to be effective
in treating the patient's condition; or
(B) the preferred choice causes or
is reasonably expected to cause adverse or harmful reactions in the patient.
(c) The prescriber's certification concerning whether a particular drug has been
ineffective, is expected to be ineffective in treating the patient, or is expected
to cause an adverse or harmful reaction shall be final.
(d)(1) The division's
prior authorization process shall be designed to minimize administrative burdens
on prescribers, pharmacists, and consumers.
(2) The prior authorization process
shall ensure real-time receipt of requests, by telephone, voice mail, facsimile,
electronic transmission, or mail on a 24-hour basis, seven days a week.
(3)
The prior authorization process shall provide an in-person response to emergency
requests by a prescriber with telephone answering queues that do not exceed 10
minutes.
(4) Any request for authorization or approval of a drug that the
prescriber indicates, including the clinical reasons for the request, is for an
emergency or urgent condition shall be responded to in no more than 4 hours from
the time the program or participating health benefit plan receives the request.
(5) In emergency circumstances, or if the response to a request for prior
authorization is not provided within the time period established in subdivision
(4) of this subsection, a 72-hour supply of the drug prescribed shall be deemed
to be authorized by the program or the participating health benefit plan, provided
it is a prescription drug approved by the United States Food and Drug Administration,
and provided, for drugs dispensed to a Medicaid beneficiary, it is subject to
a rebate agreement with the Centers for Medicare and Medicaid Services.
(6)
The division shall provide to participating providers a prior authorization request
form designed to permit the prescriber to make prior authorization requests in
advance of the need to fill the prescription, and designed to be completed without
unnecessary delay. The form shall be capable of being stamped with information
relating to the participating provider and, if feasible, at least one form capable
of being copied shall contain known patient information.
(e) The division's
prior authorization process shall require that the prescriber, not the pharmacy,
request a prior authorization exception to the requirements of this section. The
division may exempt a prescriber from the need to secure prior authorization for
a specific drug category if the division determines that the prescriber has written
a minimum number of scripts in that category, and the prescriber prescribes prescription
drugs on the preferred drug list at or above the minimum threshold for that category.
(f) If the patient is denied authorization of coverage, the denial shall be subject
to an administrative fair hearing and to all rights under section 14 of chapter
30A of the general laws.
(g) The division shall, using bulletins, manuals,
notices or other appropriate means, educate prescribers and pharmacists who treat
MassHealth patients about the requirements of the prior authorization process,
including the obligations of providers and pharmacists and the rights of consumers.
Section 12B. Supplemental Rebates
(a) The commissioner, separately or in
concert with the authorized representatives of any health benefit plan participating
in the prescription drug fair pricing program established by chapter 118H, shall
use the division's preferred drug list of prescription drugs covered without a
prior authorization requirement to negotiate with pharmaceutical companies for
the payment to the commissioner of supplemental rebates or price discounts for
Medicaid. The commissioner may also use the preferred drug list to negotiate for
the payment of rebates or price discounts in connection with drugs covered under
any other health benefit plan within or outside this state participating in the
prescription drug fair pricing program established by chapter 118H. Such negotiations
and any subsequent agreement shall comply with the provisions of 42 U.S.C. section
1396r-8. The program established by chapter 118H, or such portions of the program
as the commissioner shall designate, shall constitute a state pharmaceutical assistance
program under 42 U.S.C. section 1396r-8(c)(1)(C). The provisions of this section
do not authorize agreements with pharmaceutical manufacturers whereby financial
support for medical services covered by the Medicaid program is accepted as consideration
for placement of one or more prescription drugs on the preferred drug list or
for excluding a drug from any prior authorization requirement.
(b) The commissioner
shall provide quarterly reports on the progress of negotiating supplemental rebates
pursuant to this section to the joint committee on health care and the house and
senate committees on ways and means. By September 1, 2003, the commissioner shall
provide with the next occurring quarterly report a cost?benefit analysis of alternative
negotiation strategies, including strategies used by the state Medicaid agencies
in states of Florida and Michigan to secure supplemental rebates and any other
alternative negotiation strategy that might secure lower net prescription drug
costs.
(c) The commissioner shall prohibit the public disclosure of information
revealing company-identifiable trade secrets obtained by the department, and by
any officer, employee or contractor of the department in the course of negotiations
conducted pursuant to this section. Such confidential information shall be exempt
from public disclosure.
Section 12C. Discount Program Waiver
(a) The
division shall seek a prescription drug discount program waiver from the Centers
for Medicare and Medicaid Services pursuant to section 1115(a) of the Social Security
Act. The prescription drug discount program shall provide eligible individuals
with a financial subsidy for prescription drugs equal to the average rebate paid
to the Medicaid program by pharmaceutical manufacturers. Eligible individuals
shall include Medicare-eligible individuals whose financial eligibility exceeds
188 per cent of federal poverty level and who do not have an insurance policy
that covers drugs and other individuals whose financial eligibility does not exceed
300 per cent of the federal poverty level who do not have an insurance program
that includes a prescription drug benefit.
(b) The division may establish,
as part of the discount program, an annual enrollment fee. Subject to appropriation,
the division shall make a payment of at least 2 percent of the cost of each prescription
or refill dispensed to individuals enrolled in the program.
(c) In implementing
the program, the division may contract with a nonprofit corporation or other entity
to administer the program. Such corporation or entity shall agree to assist individuals
enrolled in the program to access other free or discount prescription drug programs
offered by private entities, including pharmaceutical manufacturers.
(d)
The division shall report to the house and senate committees on ways and means
and the joint committee on health care, not later than 60 days after the effective
date of this section, on the division's progress in implementing this section
and shall report every 90 days thereafter on its progress in obtaining the waiver
to those committees.
SECTION __. The General Laws are hereby amended by inserting
the following new chapter:
Chapter 118H. The Massachusetts Prescription
Drug Fair Pricing Program
Section 1. Program Established
(a) There is
hereby established a program to reduce the cost to the Commonwealth of providing
prescription drugs to its citizens while maintaining high quality in prescription
drug therapies. The program shall include, but shall not be limited to, the following
components:
(1) the development and use of a statewide, uniform preferred
list of covered prescription drugs that identifies preferred choices within therapeutic
classes for particular diseases and conditions, including generic and therapeutic
equivalents;
(2) the creation of a single purchasing unit for the purchase
of prescription drugs by the commonwealth;
(3) the use of strategies to negotiate
with pharmaceutical manufacturers to lower the cost of prescription drugs for
program participants, including a supplemental rebate program;
(4) the development
of educational programs, including a counterdetailing program, designed to provide
information and education on the therapeutic and cost-effective utilization of
prescription drugs to consumers, physicians, pharmacists and other health care
professionals authorized to prescribe and dispense prescription drugs;
(5)
the utilization of any available cost containment tools that meet program objectives
by reducing the cost to the commonwealth of obtaining and providing prescription
drugs, including clinical management tools, utilization review procedures, a prior
authorization review process, duplicate prescription monitoring, and refill and
supply controls;
(6) the observance of consumer protection rules to maintain
high quality in prescription drug therapies and to protect access to needed prescriptions;
and
(7) the operation of a discount program to provide the benefit of negotiated
price discounts to uninsured citizens.
(b) The following state agencies shall
participate in the program authorized in this chapter, to the extent permitted
by federal law:
(1) the division of medical assistance;
(2) the executive
office of elder affairs;
(3) the group insurance commission;
(4) the
department of public health;
(5) the department of mental health;
(6)
the department of mental retardation;
(7) the department of corrections; and
(8) the division of employment and training.
(c) Any other public or private
health benefit plan that purchases prescription drugs may elect to participate
in all or portions of the program.
Section 2. Bulk Purchasing Agreements
(a) State agencies and other participants in the program shall act as a single
purchasing unit for the negotiation of a contract to purchase prescription drugs
on behalf of the commonwealth.
(b) The prescription drug procurement unit
created by section 62 of chapter 177 of the Acts of 2001 shall implement all or
part of the program to the extent permitted by federal law. The secretary of the
executive office of elder affairs, the commissioner of the group insurance commission
and the commissioners of the departments of public health, mental health and mental
retardation may renegotiate or amend existing contracts for the purchase of prescription
drugs, including a contract made in conformance with said section 62, if such
renegotiation or amendment is necessary to implement all or part of the program
and will be of economic benefit to the health benefit plans subject to such contracts,
and to the beneficiaries of such plans. Any renegotiated or substituted contract
shall be designed to improve the overall quality of integrated health care services
provided to beneficiaries of such plans.
Section 3. Pharmaceutical Benefits
Manager
(a) State agencies and other participants in the program may contract
with a third party pharmacy benefit manager to assist in implementation of the
program. Such pharmacy benefit manager shall be a non-profit corporation with
expertise in the management of pharmacy benefits.
(b) No contract shall be
signed with a pharmacy benefit manager unless the pharmacy benefit manager has
agreed to disclose to the commonwealth, in a manner that preserves the confidentiality
of any proprietary information:
(1) operating statements of the pharmacy benefit
manager;
(2) total revenue attributable to pharmaceutical manufacturer rebates
and total revenue not attributable to pharmaceutical manufacturer rebates;
(3) all sources of rebate revenue and non-rebate revenue, and amounts of revenue
from such sources;
(4) rebate management fees collected;
(5) the terms
and conditions of any contract with any subcontractor, including contracts with
the pharmacy benefit manager's pharmacy network; and
(6) the terms and conditions
of any sale or exchange of prescription drug data concerning beneficiaries or
the prescribing practices of the providers.
(c) No contract shall be signed
with a pharmacy benefit manager that has entered into an agreement or engaged
in one or more of the following practices unless a majority of state agency participants
in the program determines, after consideration of all relevant circumstances,
that such agreement or practice furthers the financial interests of the commonwealth,
and does not adversely affect the financial or medical interests of beneficiaries:
(1) any agreement with a pharmaceutical manufacturer to favor the manufacturer's
products over a competitor's products, or to switch the drug prescribed by the
patient's health care provider with a drug agreed to by the pharmacy benefit manager
and the manufacturer;
(2) any agreement with a pharmaceutical manufacturer
to share manufacturer rebates and discounts with the pharmacy benefit manager,
or to pay soft money, so-called, or other economic benefits to the pharmacy benefit
manager;
(3) any agreement to share revenue with a mail order or internet
pharmacy company;
(4) any agreement or practice to bill the commonwealth's
health benefit plans for prescription drugs at a cost higher than the pharmacy
benefit manager pays the pharmacy; or
(5) any agreement to sell prescription
drug data concerning beneficiaries, or data concerning the prescribing practices
of health care providers.
Section 4. Cost Containment Tools
(a) The program
shall include the following components:
(1) A preferred list of covered prescription
drugs that identifies preferred choices within therapeutic classes for particular
diseases and conditions, including generic alternatives.
(i) The preferred
drug list shall be implemented as a uniform, statewide, preferred drug list for
use by state agencies participating in the program and health benefit plans in
the Commonwealth shall be encouraged to participate in the program.
(ii)
The program may utilize the MassHealth Drug List developed by the division of
medical assistance as its preferred drug list. In order to assist the state agencies
participating in the program with the development, modification and timely revision
of the preferred drug list, such agencies shall appoint a Drug List Review Board.
The board may be comprised in whole or in part of representatives of state agencies,
including the Drug Use Board established by the division of medical assistance
pursuant to federal law, or may be established by contract with a public or private
non-profit organization. The board shall:
(A) make recommendations for the
adoption and maintenance of the preferred drug list based upon considerations
of clinical efficacy, safety, and cost-effectiveness;
(B) meet at least quarterly;
(C) to the extent feasible, review all drug classes included in the preferred
drug list at least every 12 months, and recommend additions to or deletions from
the preferred drug list;.
(D) establish board procedures for the timely review
of prescription drugs newly approved by the federal Food and Drug Administration,
including procedures for the review of newly?approved prescription drugs in emergency
circumstances, including early refill review standards, a prior authorization
review process, duplicate prescription monitoring, and quality and supply controls;
(E) encourage health benefit plans to implement the preferred drug list as
a uniform, statewide preferred drug list by inviting the representatives of each
health benefit plan providing prescription drug coverage to residents of the commonwealth
to participate as observers or nonvoting members in the commissioners drug utilization
review board, and by inviting such plans to use the preferred drug list in connection
with the plans' prescription drug coverage.
(iii) Members of the board shall
receive per diem compensation and reimbursement of board related expenses. The
board shall consult with a preferred drug list advisory group which shall include
1 designee of the commissioner of mental health; 1 designee of the commissioner
of public health; 1 designee of the secretary of the executive office of elder
affairs; 1 physician with experience treating MassHealth patients; 1 practicing
pediatrician with experience treating MassHealth patients; 1 practicing pharmacist
with experience serving MassHealth patients; 1 pharmacologist with expertise in
psychiatric drugs; 1 representative of a senior citizens advocacy group; 1 representative
of a disability advocacy group; and 1 representative of a statewide advocacy group
representing the interests of MassHealth members.
(2) A series of educational
programs including a counterdetailing program, designed to provide information
and education on the therapeutic and cost?effective utilization of prescription
drugs to consumers, physicians, pharmacists and other health care professionals
authorized to prescribe and dispense prescription drugs.
(3) Consideration
of alternative pricing mechanisms including consideration of using maximum allowable
cost pricing for generic and other prescription drugs.
(4) Consideration of
alternative coverage terms, including consideration of providing coverage of over-the-counter
drugs where cost-effective in comparison to prescription drugs, and authorizing
coverage of dosages capable of permitting the consumer to split each pill if cost-effective
and medically appropriate for the consumer.
(5) Development of a simple, uniform
prescription form, designed to implement the preferred drug list, and to enable
prescribers and consumers to request an exception to the preferred drug list choice
with a minimum of cost and time to prescribers, pharmacists and consumers.
Section 5. Consumer Protection Rules
(a) The program shall authorize pharmacy
benefit coverage when a patient's health care provider prescribes a prescription
drug not on the preferred drug list, if a patient's health care provider certifies
that:
(i) the drug is medically necessary; and
(ii) in the case of a
prescription drug that is not the preferred choice in a therapeutic category on
the preferred drug list,
(A) the preferred choice has not been effective,
or with reasonable certainty is not expected to be effective in treating the patient's
condition; or
(B) the preferred choice causes or is reasonably expected to
cause adverse or harmful reactions in the patient.
(b) The prescriber's certification
concerning whether a particular drug has been ineffective, is expected to be ineffective
in treating the patient, or is expected to cause an adverse or harmful reaction
shall be final.
(c) The program shall authorize coverage notwithstanding any
prior authorization requirement if the patient agrees to pay any additional cost
in excess of the benefits provided by the patient's health benefit plan. The provisions
of this paragraph shall not apply in circumstances in which their application
is inconsistent with federal Medicaid laws and regulations. The provisions of
this paragraph shall not affect implementation by a participating health benefit
plan of tiered co-payments or other similar cost sharing systems.
(d) The
program or any participating health benefit plan shall provide information on
how prescribers, pharmacists, beneficiaries, and other interested parties can
obtain a copy of the preferred drug list, whether any change has been made to
the preferred drug list since it was last issued, and the process by which exceptions
to the preferred list may be made.
(e)(1) The program's prior authorization
process shall be designed to minimize administrative burdens on prescribers, pharmacists,
and consumers.
(2) The prior authorization process shall ensure real-time
receipt of requests, by telephone, voice mail, facsimile, electronic transmission,
or mail on a 24-hour basis, seven days a week.
(3) The prior authorization
process shall provide an in-person response to emergency requests by a prescriber
with telephone answering queues that do not exceed 10 minutes.
(4) Any request
for authorization or approval of a drug that the prescriber indicates, including
the clinical reasons for the request, is for an emergency or urgent condition
shall be responded to in no more than 4 hours from the time the program or participating
health benefit plan receives the request.
(5) In emergency circumstances,
or if the response to a request for prior authorization is not provided within
the time period established in subdivision (4) of this subsection, a 72-hour supply
of the drug prescribed shall be deemed to be authorized by the program or the
participating health benefit plan, provided it is a prescription drug approved
by the United States Food and Drug Administration, and provided, for drugs dispensed
to a Medicaid beneficiary, it is subject to a rebate agreement with the Centers
for Medicare and Medicaid Services.
(6) The program or participating plan
shall provide to participating providers a prior authorization request form designed
to permit the prescriber to make prior authorization requests in advance of the
need to fill the prescription, and designed to be completed without unnecessary
delay. The form shall be capable of being stamped with information relating to
the participating provider and, if feasible, at least one form capable of being
copied shall contain known patient information.
(f) The program's prior authorization
process shall require that the prescriber, not the pharmacy, request a prior authorization
exception to the requirements of this section. The program may exempt a prescriber
from the need to secure prior authorization for a specific drug category if the
program determines that the prescriber has written a minimum number of scripts
in that category, and the prescriber prescribes prescription drugs on the preferred
drug list at or above the minimum threshold for that category.
(g) If the
patient is denied authorization of coverage, the denial shall be subject to an
administrative fair hearing and to all rights under section 14 of chapter 30A
of the general laws.
Section 6. Discount Card Program.
(a) The commissioner
of health and human services or another commissioner of a participating state
agency designated by program participants shall implement a pharmacy discount
plan, to be known as the Healthy Massachusetts Discount Card Plan, for residents
without adequate coverage for prescription drugs. As used in this section, a resident
without adequate coverage means a resident of the commonwealth with no insurance
coverage for prescription drugs or with coverage for which the annual maximum
coverage limit under his health benefit plan has been reached. Such plan shall
establish a system through which residents without adequate coverage are able
to take advantage of discounted prices for prescription drugs negotiated pursuant
to this chapter. Such commissioner shall implement the pharmacy discount program
authorized by this section without any financial contribution by the state, and
may establish an enrollment fee in such amount as is necessary to support the
administrative costs of the plan. The plan shall be designed to work cooperatively
with other state prescription drug assistance programs, including any program
created pursuant to a discount program waiver granted by the Centers for Medicare
and Medicaid Services to the division of medical assistance. Such commissioner
may contract with a nonprofit corporation or other entity to administer the program.
Such corporation or entity shall agree to assist individuals eligible for the
program to access other free or discount prescription drug programs offered by
private entities, including pharmaceutical manufacturers.
Section 7. Reporting
and Legislative Oversight
(a) The commissioner of health and human services
or another commissioner of a participating state agency designated by program
participants shall report quarterly to the joint committee on health care and
the house and senate committees on ways and means on progress of the program in
implementing a single state purchasing unit for prescription drugs pursuant to
section 2. The report shall provide a status report on the formation of or operation
of the contract negotiated pursuant to section 2, and shall identify any barriers
to full implementation of section 2 and recommend any changes to the program or
other legislative changes advisable to eliminate such barriers. The report shall
also report on the program's progress in securing the participation of other health
benefit plans with the commonwealth by means of joint purchasing agreements to
enhance the commonwealth's purchasing power.
(b) Each year for the duration
of the pharmacy benefit manager contract pursuant to section 3, the commissioner
of health and human services or another commissioner of a participating state
agency designated by program participants shall provide a status report on the
contract and the operations of the pharmacy benefit manager to the joint committee
on health care and the house and senate committees on ways and means. The report
shall include:
(1) a description of the activities of the pharmacy benefit
manager;
(2) an analysis of the success of the pharmacy benefit manager in
achieving each of the department's public policy goals, together with the pharmacy
benefit manager's report of its activities and achievements;
(3) an assessment,
based upon information learned in contracting with the pharmacy benefits manager,
of administrative costs relating to prescription drug benefits in the Medicaid
program and the Prescription Advantage program established pursuant to section
39 of chapter 19A, including any recommendations for increasing the administrative
efficiency of such programs;
(4) any recommendations for enhancing the benefits
of or minimizing inefficiencies of the pharmacy benefit manager contract or advancing
the commonwealth's public policy goals relating to pharmaceutical costs, quality
and access;
(5) a fiscal report on the costs and savings to the commonwealth
of the pharmacy benefit manager contract, including the information disclosed
pursuant to paragraph (b) of section 3, in a manner that preserves the confidentiality
of any proprietary information; and
(6) if the pharmacy benefit manager engages
in any of the activities described in paragraph (c) of section 3, an explanation
of the reasons for finding that such agreement or practice furthers the financial
interests of the commonwealth, and does not adversely affect the financial or
medical interests of beneficiaries.
(c) The commissioner of health and human
services or another commissioner of a participating state agency designated by
program participants shall report quarterly to the joint committee on health care
and the house and senate committees on ways and means concerning the cost containment
aspects of the program undertaken pursuant to section 4. Such report shall include:
(1) a copy of the preferred drug list, an explanation of the list, a summary of
the operation of the prior authorization process or any other cost savings measures
instituted as a part of the list, and an estimate of expected cost savings as
a result of the preferred drug list;
(2) a description of the efforts undertaken
to educate consumers and health care providers about the preferred drug list and
the program's utilization review procedures;
(3) a description of the efforts
undertaken to establish programs to educate health care providers about the costs
of prescribing patterns, including counterdetailing programs;
(4) a report
of other cost containment strategies undertaken, including, but not limited to,
alternative pricing mechanisms and alternative coverage terms, the expected savings
from such strategies, and the effect of such strategies on access to prescription
drugs for consumers; and
(5) a status report on the development of a uniform
prescription form and any barriers to such development.
(d) The joint committee
on health care shall closely monitor implementation of the program, including
the preferred drug list and utilization review procedures, to ensure that the
consumer protection standards are not diminished as a result of implementing the
preferred drug list and the utilization review procedures, including any unnecessary
delay in access to appropriate medications. Such joint committee shall, by means
of an oversight hearing or otherwise, ensure that all affected interests, including
consumers, health care providers, pharmacists and others with pharmaceutical expertise
have an opportunity to comment on the operation of the program, the preferred
drug list, and other procedural aspects of the program.
SECTION ___. The
commissioner of the division of medical assistance, the secretary of the executive
office of elder affairs, the commissioner of the group insurance commission and
the commissioners of state agencies participating in the Massachusetts prescription
drug fair pricing program established by chapter 118H of the general laws shall
take all steps necessary to enable the commonwealth to participate in joint prescription
drug purchasing agreements with other states and other health benefit plans. Such
steps shall include:
(1) Active collaboration with the National Legislative
Association on Prescription Drug Prices in the Association's efforts;
(2)
Active collaboration with the Pharmacy RFP Issuing States Initiative, so-called,
organized by the West Virginia Public Employees Insurance Agency; and
(3)
The execution of any joint purchasing agreements or other contracts with any health
benefit plan or organization within or outside the state which such commissioners
determines will lower the cost of prescription drugs for the commonwealth and
its citizens while maintaining high quality in prescription drug therapies.
SECTION
___. (a) The General Court finds that the National Legislative Association on
Prescription Drug Prices is a nonprofit organization of legislators formed for
the purpose of making prescription drugs more affordable and accessible to citizens
of the member states, including the commonwealth. The General Court further finds
that the activities of the Association provide a public benefit to the people
of the commonwealth.
(b) Three members of the senate, including one member
of the minority party, shall be appointed directors of the Association by the
senate president, and three members of the house of representatives, including
one member of the minority party, shall be appointed directors of the Association
by the speaker of the house. Directors so appointed shall serve until new members
are appointed.
(c) The directors of the Association shall report to the house
and senate committees on ways and means and the joint committees on health care
and insurance on or before January 1 of each year with a summary of the activities
of the Association, and any findings and recommendations for making prescription
drugs more affordable and accessible to citizens of the commonwealth.
Floor Number: 598 Clerk Number: 263
RELATIVE TO THE COMMITTEE TO END ELDER HOMELESSNESS
Ms. Creem and Ms. Wilkerson move to amend the bill (S.2400) in section 2, in
item 9110-1660, by striking out the figures " 100,000" and inserting
in place thereof the figures "125,000".
Floor Number: 599 Clerk Number: 292
SOLDIERS' HOMES CAPITAL MAINTENANCE TRUST FUNDS
Mr. Knapik, Mr. Lees, Mr. Rosenberg, Mr. Brewer and Ms.
Melconian moves to amend the bill by inserting the following new Section:-
"SECTION
. There shall be established on the books of the commonwealth separate funds to
be known as the Soldiers' Home in Massachusetts Capital Maintenance Trust Fund
and the Soldiers' Home in Holyoke Capital Maintenance Trust Fund. Said funds shall
consist of federal reimbursements recovered or collected from any and all capital
improvement projects at the Soldiers" Homes; any amounts received from any
appropriation, grant, gift, bequest or other contribution explicitly made to said
funds, and any income derived from the investment of amounts credited to said
funds. The amounts so received shall be credited and invested by the treasurer
of the commonwealth and held in trust by the secretary of health and human services.
Amounts expended from said funds shall not be subject to further appropriation,
and shall not exceed the amount earned in interest and other income derived from
the investment of the principle amount credited to said fund. Any expenditures
from said funds shall be at the direction of said secretary solely for the purposes
of capital maintenance at said Soldiers' Homes. No expenditure from said funds
shall be made for any direct or indirect costs associated with personnel. The
secretary shall file, with the House and Senate committees on Ways and Means not
later than September first of each fiscal year, an annual financial plan of the
projected revenues and expenditures for the ensuing fiscal year. All revenues
credited to and expenditures made from such funds shall be reported, by subsidiary,
on the Massachusetts management accounting and reporting system."
Floor Number: 600 Clerk Number: 269
AN AMENDMENT TO PROMOTE TTY MESSAGING
Mr. Tarr moves to amend the bill (Senate bill 2400) by adding,
at the end thereof, the following new section: -
"SECTION___. Notwithstanding the provisions of any general or special law
to the contrary, the secretary of administration and finance shall study the
feasibility of requiring each division and agency of the Commonwealth of Massachusetts
to activate all TTY messaging. Said study shall include analysis, recommendations
and costs implications of: (1) requiring said activation for each active mailbox
as compared to assigning at least one TTY enabled mailbox for each member's
office and administrative unit of government; (2) requiring any work group that
employs or may employ individuals with visual impairments to download and install
helper applications that allow individuals who are blind or who have visual
impairments to work job functions that require the perception of information
that is only visually discernable on a telephone; (3) requiring any agency of
the Commonwealth of Massachusetts that employs Interactive Voice Response self-service
applications to include prompts that would allow individuals who use TTY's to
communicate over the phone to access the self-service applications. Said study
and all accompanying recommendations shall be submitted to the house and senate
committees on ways and means no later than October 1, 2004"