Senate, No. 2660, printed as amended

[SENATE, APRIL 17, 2008 – S2660, being the text of Senate, No. 2660, printed as amended) as a new text of Senate, No. 2650]

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The Commonwealth of Massachusetts

Seal of the Commonwealth of Massachusetts

In the Year Two Thousand and Seven.


AN ACT TO PROMOTE COST CONTAINMENT, TRANSPARENCY AND EFFICIENCY IN THE DELIVERY OF QUALITY HEALTH CARE.

Whereas, The deferred operation of this act would tend to defeat its purpose, which is to expand forthwith access to health care for Massachusetts residents, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public health.

Be it enacted by the Senate and House of Representatives in General Court assembled, a nd by the authority of the same, as follows:

SECTION 1. Section 16J of chapter 6A of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by striking out the words “and 16L”, in line 1, and inserting in place thereof the following words:- ,16L and 16P.

SECTION 2.  Said section 16J of said chapter 6A, as so appearing, is hereby further amended by inserting before the definition of “Clinician” the following 2 definitions:-

“Adverse”, a negative consequence of care that results in an unintended injury or illness, which may or may not have been preventable.

“Associated with”, that it is reasonable to initially assume that the adverse event was directly due to the referenced course of care.

SECTION 3.  Said section 16J of said chapter 6A, as so appearing, is hereby further amended by adding the following definition:-
“Preventable”, an event that could have been reasonably anticipated and prepared for but which occurred because of an error or other system failure.
           
SECTION 4.  Said chapter 6A is hereby further amended by striking out section 16K, as so appearing, and inserting in place thereof the following section:-
           
Section 16K. There shall be a health care quality and cost council within, but not subject to the control of, the executive office of health and human services.  The council shall promote public transparency of the quality and cost of health care in the commonwealth by establishing health care quality improvement and cost containment goals.  The goals shall be designed to promote high-quality, safe, effective, timely, efficient, equitable and patient-centered health care.  The council shall receive staff assistance from the executive office of health and human services and may, subject to appropriation, employ such additional staff or consultants as it may deem necessary.  The council shall consist of the secretary of health and human services who shall be the chairperson, the auditor of the commonwealth or his designee, the inspector general or his designee, the attorney general or his designee, the commissioner of insurance, the executive director of the group insurance commission, the executive director of the commonwealth health insurance connector authority, the secretary of administration and finance or his designee and 7 persons to be appointed by the governor, 1 of whom shall be a representative of a health care quality improvement organization recognized by the Centers for Medicare and Medicaid Services, 1 of whom shall be a representative of the Institute for Healthcare Improvement, Inc. recommended by the organization’s board of directors, 1 of whom shall be a representative of the Massachusetts Chapter of the National Association of Insurance and Financial Advisors, 1 of whom shall be a representative of the Massachusetts Association of Health Underwriters, 1 of whom shall be a representative of the Massachusetts Medicaid Policy Institute, 1 of whom shall be an expert in health care policy from a foundation or academic institution and 1 of whom shall represent a nongovernmental purchaser of health insurance.  The representatives of nongovernmental organizations shall serve staggered 3-year terms.  
           
SECTION 4A.  Section 16L of said chapter 6A, as so appearing, is hereby amended by inserting after the word “Business”, in lines 144 and 145, the following words:-  ,1 member representing the Retailers Association of Massachusetts.
           
SECTION 4B.  Section 16L of chapter 6A of the General Laws is hereby amended, in subsection (l), by inserting after the words “Trust Funds”, the following words:-  “geographically representative Independent Practice Association medical directors coordinated through the Massachusetts Medical Society,”.

SECTION 5.  Said section 16L of said chapter 6A, as so appearing, is hereby further amended by adding the following 2 subsections:-

(r) A subcommittee of the council shall be established to pursue public and private reform of health care purchasing.  The subcommittee shall convene public and private health care purchasers for the purpose of collaborating on common purchasing principles and strategies for promoting and rewarding higher value health care.  The subcommittee shall identify and develop nonbinding payment guidelines and best practices that will align purchasing incentives around shared quality goals.  The subcommittee shall focus on, but shall not be limited to: (i) encouraging quality, coordinated and effective care as opposed to volume of care; (ii) emphasizing chronic disease management programs; (iii) developing appropriate and feasible measures of quality performance and rewarding providers for improving quality performance; (iv) improving compensation and support for primary care providers; (v) developing a medical home payment model that emphasizes a comprehensive approach to patient care; (vi) reducing waste and duplication in clinical care; (vii) investing in and accelerating the adoption of health information technology, specifically computerized physician order entry systems, e-prescribing and electronic health records; (viii) aligning incentives with Medicare payment policies; (ix) promoting health and wellness programs; and (x) empowering consumers with access to health care information.  The subcommittee members shall be determined by the chair of the council and shall consult with an advisory committee consisting of 1 person representing the Massachusetts Association of Health Plans, Inc., 1 person representing Blue Cross and Blue Shield of Massachusetts, Inc., 1 person representing Associated Industries of Massachusetts, 1 person representing the Massachusetts Municipal Association and 4 persons to be appointed by the governor, 1 of whom shall be a health economist, 1 of whom shall be an expert in Medicare payment policy, 1 of whom shall be a representative of a self-insured labor union and 1 of whom shall be a health care consumer advocate. The council shall provide the subcommittee with staff as necessary to complete its research and analysis.  The subcommittee shall meet at least once every 2 months and at such other times as required by its rules.  The subcommittee shall submit an annual report of its progress and activities and its recommendations, if any, together with drafts of legislation or regulations necessary to carry those recommendations into effect, by filing the same with the governor, the health care cost and quality council, the clerks of the senate and house of representatives, the joint committee on health care financing and the joint committee on public health not later than July 1.

(s) The council shall establish goals for the adoption of health information technology including, but not limited to, electronic prescription transactions for new prescriptions, prescription renewals, cancellations, changes between prescribers and dispensers, ancillary messages and administrative transactions, hereinafter referred to as e-prescribing, the process of electronic entry of physician instructions for the treatment of patients, whether inpatient or outpatient, under the care of that physician, hereinafter referred to as computerized physician order entry, and individual patient records in digital format or electronic health records; provided, however, that any system, network, software or equipment utilized in the attainment of those goals shall be certified by the certification commission for health care information technology, an independent, nonprofit organization designated by the federal government as the recognized certification body for health information technology products and networks; and provided further, that the goals shall state the percentage adoption by providers expected by a given year, any incentives or other provisions for attainment of the goals and any penalties for failure to attain the goals.

SECTION 6.  Said chapter 6A is hereby further amended by inserting after section 16O the following section:-

Section 16P. (a) The secretary of health and human services shall adopt regulations to create a list of serious reportable events consistent with the list established by the National Quality Forum.  The executive office of health and human services, its agencies and the health care quality and cost council shall utilize the list created by the secretary’s regulations for all standardized reporting of serious reportable events.  Each serious reportable event shall be reported on the consumer health information website created by subsection (h) of section 16L.  The website shall identify each serious reportable event and the facility at which it occurred but shall not include any other identifying information, including, but not limited to, the identities of any of the health care professionals, facility employees or patients involved.

 (b) The secretary shall adopt regulations prohibiting a health care facility from charging or seeking reimbursement for services associated with a serious reportable event.  In adopting the regulations, the secretary shall consider that the list of serious reportable events established under subsection (a) is intended to facilitate public reporting and was not designed to serve as a basis for determining whether reimbursement shall be sought or forgone.  A health care facility shall not charge or seek reimbursement for a serious reportable event that the health care facility has determined, through a documented review process, was: (i) preventable; (ii) within its control; and (iii) unambiguously the result of a system failure based on the health care provider’s policies and procedures.
           
(c) The health care facility shall include in any ongoing reporting of serious reportable events to the department of public health, the decision to seek or forgo reimbursement and charges for the serious reportable event.  The department may review any such reports for consistency with the regulations promulgated under subsection (b). 
 
(d) Notwithstanding any general or special law to the contrary, all communications and documentation regarding whether reimbursement for health care services that are directly associated with an occurrence of a serious reportable event shall be sought or forgone shall be privileged and confidential, shall be exempt from the disclosure of public records under section 10 of chapter 66 and shall not be subject to subpoena or discovery or introduced into evidence in any judicial or administrative proceeding. 

SECTION 7.  Clause (b) of the sixth paragraph of section 11A of chapter 13 of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by adding the following sentence:-  The board shall require, as a standard of eligibility for licensure, that applicants show a predetermined level of competency in the use of computerized physician order entry, e-prescribing, electronic health records and other forms of health information technology, as determined by the board. 
           
SECTION 8.  Chapter 26 of the General Laws is hereby amended by inserting after section 8J the following section:-
           
Section 8K.  (a) As used in this section, “insurer” shall mean a carrier authorized to transact accident and health insurance under chapter 175, a nonprofit hospital service corporation licensed under chapter 176A, a nonprofit medical service corporation licensed under chapter 176B, a dental service corporation organized under chapter 176E, an optometric service corporation organized under chapter 176F and a health maintenance organization licensed under chapter 176G.

(b) Notwithstanding any general or special law to the contrary, all insurers marketing small group or large group plans shall annually submit to the division of insurance, on or before April 1, the following information: current average individual and family plan premiums for the insurer’s prototype or alternative prototype plan, as defined in section 1 of chapter 176S, for groups of 1 to 5 employees, 6 to 10 employees, 11 to 25 employees, 26 to 50 employees, 51 to 100 employees, 101 to 500 employees, 501 to 1000 employees, 1001 to 2500 employees, 2501 to 5000 employees and 5001 or more employees.  Public employer plans shall be similarly aggregated and reported separately.  All reports shall include plan design summaries, including average benefits and co-pays. 

(c) On or before April 1 of each year, the division of insurance shall compile,  through confidential surveys, division filings and other means, average individual and family plan costs for ERISA exempt self-insured health plans operating in the commonwealth using the most commonly offered plan design. 

(d) On or before April 1 of each year, the division of insurance and the division of health care finance and policy shall collaborate to compile, through confidential surveys, division filings and other means, a list of all the state-mandated health benefits and the percentages to which ERISA exempt self-insured health plans operating in the commonwealth include each mandated benefit within each health plan offered to or administered on behalf of residents in the commonwealth.

(e) On or before July 1 of each year, the division of insurance and the division of health care finance and policy shall make available the Massachusetts health insurance transparency report for consumer and employer use.  This report shall be completed using data collected during the preceding year pursuant to this section, and shall include the average premium cost data required to be reported under subsection (b) by insurer, employer size and category and by insurer’s prototype or alternative prototype plan, as defined in section 1 of chapter 176S.  The data required to be reported under subsection (c) shall be reported in aggregate form.

SECTION 9.  Chapter 40J of the General Laws is hereby amended by inserting after section 6C the following section:-
 
Section 6D.  (a)  The corporation shall establish an institute for health care innovation, technology and competitiveness, to be known as the e-health institute, and a fund to be known as the e-Health Institute Fund, to be held by the corporation separate and apart from its other funds, to finance the activities of the institute. The institute shall transform care delivery and the utilization of care process redesign supported by a statewide, secure, interoperable electronic health records system in order to improve patient safety and quality, and to lower costs in the state’s health care system, with a particular emphasis on the deployment of quality improvement efforts and health information technology in discrete and underserved regions by harnessing local support and involvement in such development activities and by improving the health information technology infrastructure for those regions. In furtherance of these public purposes, the institute shall endeavor to identify regions where compelling opportunities to make strategic investments appear to be present and develop strategies therefor. The institute may also provide development support more generally to organizations to assist in quality improvement activities and the formation and growth of emerging health technology sectors in those regions and may provide support to departments, agencies and quasi-public entities of the commonwealth for activities that are consistent with the purposes of the institute.

The executive director of the corporation shall appoint a qualified individual as director to manage the affairs of the institute, who shall be an employee of the corporation, report to the executive director and manage the affairs of the institute.  The corporation shall establish a governing board to assist it in matters related to the institute.  The governing board shall be comprised of not less than 9 individuals, including the executive director of the corporation and the secretary of health and human services who shall serve ex-officio.  The corporation, on recommendation of the executive director, shall appoint not less than 7 persons to a governing board to assist the corporation in matters related to the institute, 1 of whom shall be a dean of a medical school, 1 of whom shall be a head of an emerging health technology company, 1 of whom shall be a chief information officer of a major teaching hospital, 1 of whom shall be an expert in health information privacy and security and 1 of whom shall be a technology transfer officer or individual qualified in technology commercialization from a university in the commonwealth.  Each member of the governing board appointed by the corporation shall serve for such term as the corporation may designate upon such member’s appointment, but no term shall be for less than 1 year and nor more than three years. The corporation may appoint a member for an unlimited number of additional terms, the length of each such term being determined by the corporation at the time of appointment to each such additional term.  The members of the governing board shall develop and submit to the board, for its review, modification and approval, a detailed plan for the operation of the institute and the administration of the fund.  Upon approval of such detailed plan by the board of directors of the corporation, it shall delegate such authority to the governing board as it deems necessary to implement the plan.

Upon consultation with the advisory committee established in subsection (b), the governing board shall prepare, and update annually, a statewide electronic health records plan and submit such plan and each update to the board for approval.  In developing the plan, the governing board may consult with any individual, agency or organization including, but not limited to, the Massachusetts Technology Collaborative, the New England Healthcare Institute, Masspro, the Massachusetts Health Data Consortium, MA-SHARE, the Institute for Health Improvement, the Massachusetts League of Community Health Centers, Inc., the Massachusetts Hospital Association, the Massachusetts Association of Community Hospitals, Blue Cross and Blue Shield of Massachusetts, Inc., the Massachusetts Association of Health Plans, the Mental Health and Substance Abuse Corporations of Massachusetts and other quasi-public agencies and not-for-profit organizations. The institute may make grants in support of Massachusetts-based public and private enterprises developing and deploying new technologies to significantly increase the efficiency, safety and quality of the health care system.  Successful grants shall incorporate regional involvement through alliances among municipalities, colleges, hospitals, health centers, skilled nursing facilities, business and industry, community-based organizations, community-based behavioral health care providers, nonprofit organizations and labor unions. The governing board may apply the provisions of this chapter that apply to centers and to the center fund to the institute and to the e-Health Institute Fund. Without limiting the generality of the foregoing, the corporation may apply moneys in said fund to pay for start-up expenses, project costs and current expenses associated with said institute and related activities, grants or loans to nonprofit or other organizations to promote its purposes consistent with the purposes of this section.  The institute shall file a report annually, not later than January 31, with the joint committee on health care financing and the house and senate committees on ways and means addressing the activities of the institute, in general, and describing progress to date in implementation of a statewide electronic health records system and recommendations for any further legislative action that it may deem necessary or appropriate. 

(b) There shall be an e-health advisory committee to advise the institute and the governing board relative to the electronic health records plan and implementing the institute’s purposes and responsibilities under this section.  The advisory committee shall review and offer guidance on the establishment and implementation of the statewide electronic health records system, as well as the financing and technical assistance required to enable all health care providers to acquire and implement electronic medical records necessary to participate in the statewide system.  The members of the advisory committee shall include the secretary of health and human services, who shall serve as the chair, the secretary of administration and finance or his designee, the executive director of the Massachusetts e-health institute, the executive director of the health care cost and quality council established in section 16K of chapter 6A and such additional members as the secretary may determine; provided, however, that the such appointees shall include persons with expertise and experience in 1 or more of the following areas:  health information privacy and security, the development and dissemination of electronic health records systems, implementation of electronic health record systems by small physician groups or ambulatory care providers or the interoperability of systems of electronic health records systems; and provided further, that such appointees shall include persons representing organizations within the commonwealth interested in and affected by the development of networks and electronic health records systems including, but not limited to, persons representing local public health agencies, licensed hospitals and other licensed facilities and providers, private purchasers, the medical and nursing professions, physicians, health insurers and health plans, the state quality improvement organization, academic and research institutions, consumer advisory organizations with expertise in health information technology and other stakeholders as identified by the secretary of health and human services. Each member of the advisory committee appointed by the secretary shall serve for such term as the secretary may designate upon such member’s appointment, but no term shall be less than 1 year nor more than 3 years.  The secretary may appoint a member for an unlimited number of additional terms, the length of each such term being determined by the secretary at the time of appointment to each such additional term. The members of the advisory committee shall be deemed to be directors for purposes of the fourth paragraph of section 3; provided, however, that notwithstanding said section 3 and sections 5, 6 and 7 of chapter 268A, no member of the advisory committee shall be precluded from participating in matters before the committee because he, or a related party within the scope of said section 6 of said chapter 268A, has a financial interest in a matter being considered by the committee, if such interest or involvement was disclosed in advance to the advisory committee and recorded in the minutes of the advisory committee’s proceedings; and provided further, that no member shall be deemed to violate section 4 of said chapter 268A because of his receipt of his usual and regular compensation from his employer during the time in which the member participates in the activities of the advisory committee.

(c) Each electronic health records plan developed and approved pursuant to subsection (a) shall address the development, implementation and dissemination of systems of electronic health records among ambulatory care providers, with a particular focus on those ambulatory care providers, such as community health centers, that care for a significant number of persons in underserved populations.  Each plan shall also address the establishment and implementation throughout the commonwealth of  networks that: (i) allow the seamless and secure electronic sharing of health information among health care providers, health plans, and other authorized users; (ii) provide consumers with secure electronic access to their own health information; (iii) meet standards for interoperability adopted by the institute; (iv) meet all applicable federal and state-specific privacy and security requirements; (v) give patients the option of allowing only designated health care providers to access their individually identifiable information concerning diagnosis and treatment of sexually transmitted diseases, addiction, mental illnesses and termination of pregnancy; (vi) provide such public health reporting capability as the secretary of health and human services may determine; (vii) allow for reporting of, and access to, health information, other than identifiable personal health information, for purposes of such research activities as the secretary of health and human services may determine; (viii) provide for the development and maintenance of a data warehouse for research purposes, which shall not contain identifiable personal health information; (ix) allow for the reporting of provider-specific health information required for the calculation of any voluntary consensus standard endorsed by the National Quality Forum.  
           
(d) Before awarding any grant from the e-Health Institute Fund, the corporation shall consult with the commissioner of public health and the e-health advisory committee. The request for consultation shall be submitted not less than 15 business days before the execution of any grant award contract. All successful grant applications shall define specific goals and expected outcomes and contain corresponding accountability measures. Applicants who fail to meet these accountability measures shall be prohibited from pursuing any additional grants under this section for 5 years after the effective date of the grant.
             
(e) In awarding grants, which are to be distributed from the e-Health Institute Fund, not more than $25,000,000 annually shall be allocated to implement the objectives and priorities of this section and of the e-health plan in a manner that is equitable across all geographic regions of the commonwealth, including the central area, the greater Boston area, the northeast area, the southeast area and the western area, based on an allocation plan that the institute will prepare annually and submit, prior to awarding grants under this subsection, for approval of the joint committee on health care financing; provided, however, that if the committee does not act upon such plan within 30 days of its receipt the plan shall be deemed to be approved.
           
(f) In making grants under this section to health services providers or to health plans, the institute shall receive assurances from the grant recipient that the grant shall be used to: (1) redesign care processes; (2) utilize care management techniques; (3) develop and implement an electronic health records system; and (4) begin implementation of the plan not later than the beginning of the second year of the grant.
           
(g)   In selecting grant or loan recipients under this section, the institute shall consider: (i) existing technological and organizational infrastructure upon which the health information network can build; (ii)  the extent of stakeholder participation; (iii) health care provider participation commitments; (iv) capacity to measure quality and efficiency improvements; (v) replicability; (vi) the extent of the opportunity for a plan to improve health care quality and the health outcomes of patients in the region to be served; (vii) the participation in health information exchange efforts; (viii)  care redesign and management efforts; (ix) technological capacity to maintain the security of identifiable health data by means of data segregation, encryption, the use of unique alpha-numerical identifiers to track stored or transferred patient records, and other administrative protections; (x) any history of security and data breaches; and (xi) such other factors as it deems relevant.

(h) Any health information network funded in whole or in part under this section shall: (1) be required to establish within the system a mechanism to allow patients to opt-in to the health information network and to opt-out at any time; (2) comply with any applicable regulatory privacy protections; (3) upon request, provide individuals with a list of individuals and entities who have accessed their identifiable health information and what identifiable health information about them is made available through the health information network; (4) develop and distribute to authorized users of the health information network and to prospective network patient participants, written guidelines addressing privacy, confidentiality and security of health information and inform individuals of what information about them is available, who may access their information and the purposes for which their information may be accessed and shall implement a training program regarding such guidelines for all persons who acquire, use, disclose or store identifiable health information to ensure compliance with such policies; and (5) shall undertake continuous review and assessment of security standards and conduct periodic audits of all security systems for potential and actual security breaches.

(i)    In the event of an unauthorized access to or disclosure of individually identifiable patient health information by or through the statewide health information network or by or through any technology grantees funded in whole or in part under this section, the operator of such network or grantee shall: (i) report the conditions of such unauthorized access or disclosure as required by the Massachusetts Technology Collaborative; and (ii) provide notice, as defined in section 1 of chapter 93H of the General Laws, as soon as practicable, but not later than 10 business days, to person whose patient health information may have been compromised as a result of such unauthorized access or disclosure, and shall report the conditions of such unauthorized access or disclosure.

(j)    To apply for a grant under this section, an applicant shall submit an application to the collaborative in such form and manner, and containing such information and assurances as the collaborative may require. No material containing information received by the Massachusetts Technology Collaborative in connection with the procurement, performance and evaluation of contracts, including grants, under this section shall constitute a public record if such information constitutes a private party's trade secret, proprietary commercial or financial information or strategically sensitive information.  Notwithstanding the aforementioned, all materials created or received by the collaborative shall be open to inspection by the state auditor and the inspector general.

(k)  (1) The Massachusetts Technology Collaborative shall provide to the statewide health information technology network and to individual technology grantees such technical assistance as it deems appropriate to carry out this section, including assistance relating to questions of governance, financing and technological approaches to the creation of health information networks.

(2)  The institute shall by contract or grant establish and maintain a statewide technical assistance center to provide assistance to physicians to facilitate successful practice redesign, adoption of electronic health records, utilization of care management strategies and participation in advanced programs such as the statewide health information network, medical homes program, pay for performance and other incentive programs by such physicians.  The statewide technical assistance center shall assist physicians in all geographical areas served by a health information network.  In assisting physicians under this paragraph, the statewide technical assistance centers shall prioritize physicians in small physician groups and, as resources allow, shall assist physicians in larger groups.  Technical assistance provided under this paragraph shall, at a minimum, include the following: (i)  a clearinghouse of best practices, guidelines and implementation strategies directed at the small medical practices that plan to redesign their practices; (ii)  a change management tool kit to enable physicians and their staff to successfully prepare practice workflows for adoption of electronic medical records and electronic prescribing, to receive guidance in the selection of vendors of health information technology products and services that are appropriate within the context of the individual practice and the community setting, to implement health information technology solutions and manage the project at the practice level and to address the ongoing need for upgrades, maintenance and security of office-based health information technologies; and  (iii) the capability to provide consultations and advice to small medical practices to facilitate adoption of health information technologies.

(l) No databases developed with funds made available under this section and to be used for research or to support reporting provider-specific health information required for the calculation of any voluntary consensus standard endorsed by the National Quality Forum shall contain individually identifiable patient health information.;

(m)  No funds shall be made available to an entity under this section for the purchase of a health information technology product unless the product or network, as the case may be, is certified by the Certification Commission on Healthcare Information Technology, or a successor agency or organization established for the purpose of certifying that health information technology shall meet interoperability standards.

SECTION 10.  Chapter 111 of the General Laws is hereby amended by inserting after section 4M the following section:–

Section 4N. (a) The department of public health shall develop, in cooperation with the Division of Commonwealth Medicine at the University of Massachusetts Medical School, implement and promote an evidence-based outreach and education program designed to provide information and education on the therapeutic and cost-effective utilization of prescription drugs to physicians, pharmacists and other health care professionals authorized to prescribe and dispense prescription drugs, subject to appropriation. In developing the program, the department shall consult with physicians, pharmacists, private insurers, hospitals, pharmacy benefit managers, the MassHealth drug utilization review board and the University of Massachusetts Medical School.  The program shall include the following elements:

(1) the opportunity for physicians, pharmacists and nurses under contract with the program to conduct face-to-face visits with prescribers, utilizing evidence-based materials and borrowing methods from behavioral science, educational theory and, where appropriate, pharmaceutical industry data and outreach techniques; provided, however, that to the extent possible, the program shall inform prescribers about drug marketing that is intended to circumvent competition from generic or other therapeutically-equivalent pharmaceutical alternatives or other evidence-based treatment options; and

(2) outreach to physicians and other health care practitioners who participate in MassHealth, the subsidized catastrophic prescription drug insurance program authorized in section 39 of chapter 19A, the commonwealth care health insurance program, to other publicly-funded, contracted or subsidized health care programs, to academic medical centers and to other prescribers.

(b) The program shall be made available to private payors on a subscription basis.

(c)  The department shall, to the extent possible, also utilize or incorporate into its program other independent educational resources or models proven effective in promoting high quality, evidenced-based, cost-effective information regarding the effectiveness and safety of prescription drugs, including, but not limited to:

(1) the Pennsylvania PACE/Harvard University Independent Drug Information Service; (2) the Academic Detailing Program of the University of Vermont College of Medicine Area Health Education Centers; (3) the Oregon Health and Science University Evidence-based Practice Center’s Drug Effectiveness Review project; and (4) the North Carolina evidence-based peer-to-peer education program outreach program.
 
(d) The department may establish and collect fees for subscriptions and contracts with private payors and to seek funding from nongovernmental health access foundations and undesignated drug litigation settlement funds associated with pharmaceutical marketing and pricing practices.

SECTION 11. Section 25B of said chapter 111, as appearing in the 2006 Official Edition, is hereby amended by striking out the definition of “Expenditure minimum with respect to substantial capital expenditures” and inserting in place thereof the following definition:-

“Expenditure minimum with respect to substantial capital expenditures”, with respect to expenditures and acquisitions made by or for: (1) acute care hospitals and comprehensive cancer centers as defined in section 31 of chapter 6A, only, $7,500,000, except that expenditures for, or the acquisition of, major movable equipment not otherwise defined by the department as new technology or innovative services shall not require a determination of need and shall not be included in the calculation of the expenditure minimum; and (2) health care facilities, other than acute care hospitals, and facilities subject to licensing under chapter 111B, with respect to: (a) expenditures for, or the acquisition of, medical, diagnostic or therapeutic equipment, $400,000 and (b) all other expenditures and acquisitions, eight $800,000; provided, however, that expenditures for, or the acquisition of, any replacement of medical, diagnostic or therapeutic equipment defined as new technology or innovative services for which a determination of need has issued or which was exempt from determination of need, shall not require a determination of need and shall not be included in the calculation of the expenditure minimum; provided further, that expenditures and acquisitions concerned solely with outpatient services other than ambulatory surgery, not otherwise defined as new technology or innovative services by the department, shall not require a determination of need and shall not be included in the calculation of the expenditure minimum, unless the expenditures and acquisitions are at lease $25,000,000, in which case a determination of need shall be required. Notwithstanding the above limitations, acute care hospitals only may elect at their option to apply for determination of need for expenditures and acquisitions less than the expenditure minimum.

SECTION 12.  Said chapter 111 hereby further amended by inserting after section 25K the following section:-

Section 25L.  There shall be in the department a center for primary care recruitment and placement to improve access to primary care services. 
The center shall:  (i) coordinate the department’s primary care workforce activities with other state agencies and public and private entities involved in health care workforce training, recruitment and retention; (ii) monitor trends in access to primary care and primary care workforce capacity, including regional disparities; (iii) determine statewide target areas for provider placement based on level of access to primary care; (iv) maintain a public web-based statewide primary care job database; (v) conduct outreach and marketing to recruit primary care providers, regionally and nationally, to practice in the commonwealth; (vi) coordinate state and federal loan repayment and incentive programs for primary care providers; (vii) assist and support communities, physician groups, community health centers and community hospitals in developing cost-effective and comprehensive recruitment initiatives; (viii) act as a career service center to assist and support primary care professionals and provide job placement assistance; and (ix) maximize all sources of public and private funds for recruitment initiatives.

The center shall submit an annual report, not later than October 1, to the joint committee on public health, the joint committee on health care financing and the house and senate committees on ways and means regarding the center's activities in recruiting and retaining health care providers for underserved populations and areas throughout the commonwealth. The annual report shall include, but not be limited to, information about: (i) the activities and accomplishments of the center during the report period; (ii) planned activities for the next year; (iii) the number and type of providers who have been recruited to work in the commonwealth as a result of center activities; (iv) the retention rate of providers who have located in target areas as a result of center activities; (v) the utilization rate of the scholarship and loan repayment programs and other programs or activities authorized for provider recruitment and retention; and (vi) recommendations for pilot programs and regulatory or legislative proposals to address workforce needs, shortages, recruitment and retention. 

SECTION 13. Section 51 of said chapter 111, as appearing in the 2006 Official Edition, is hereby amended by inserting after the fourth paragraph the following paragraph:-

A hospital licensed under this chapter shall report each serious reportable event listed in regulations promulgated under subsection (a) of section 16P of chapter 6A to the Betsy Lehman center for patient safety and medical error reduction and the department of public health as soon as is reasonably and practically possible, but not later than 15 working days after the discovery of the serious reportable event.  Any licensed hospital that fails to comply with this section and the rules and regulation of the department may have its license revoked or suspended by the department, be fined up to $1,000 per day per violation, or both.

SECTION 14.  Said chapter 111 is hereby further amended by inserting after section 53D the following 3 sections:-

Section 53E. The department shall promulgate regulations for the establishment of patient and family advisory councils by hospitals.  The councils may advise the hospital on matters including, but not limited to, patient and provider relationships, institutional review boards, quality improvement initiatives and patient education on safety and quality matters.  Members of a council may act as reviewers of publicly reported quality information, members of task forces, members of awards committees for patient safety activities, members of advisory boards, participants on search committees and hiring of new staff, co-trainers for clinical and nonclinical staff, in-service programs, health professional trainees and participants in reward and recognition programs.  The department may require hospitals to report annually on the membership and work of their councils.
             
Section 53F. (a) The department shall promulgate regulations requiring acute care hospitals to implement a suitable method that enables health care staff members, patients and families to directly request additional assistance from a specially-trained individual when the patient’s condition appears to be deteriorating.  The regulations shall require an early recognition and response method most suitable for the hospital’s needs and resources, such as a rapid response team. The method shall be available 24 hours per day.

(b) The regulations shall include criteria for calling additional assistance to respond to a change or perception of change in a patient’s condition by the staff, patients or families.  The regulations shall include criteria for hospitals to educate patients and family members about the methods for recognition and response to changes in patients’ conditions, their purposes and how to activate the methods.

Section 53G.  Notwithstanding any general or special law to the contrary, any entity that is certified or intends to be certified as an Ambulatory Surgical Center by the Centers for Medicare and Services for participation in the Medicare program shall be a clinic for the purposes of licensure under section 51, and shall be deemed to be in compliance with the conditions for licensure as a clinic under said section 51 if it is accredited to provide ambulatory surgery services by the Accreditation Association for Ambulatory Health Care, Inc., the Joint Commission on Accreditation of Healthcare Organizations, the American Association for Accreditation of Ambulatory Surgery Facilities or any other national accrediting body that the department of public health determines provides reasonable assurances that such conditions are met.  No original license shall be issued pursuant to said section 51 to establish any such ambulatory surgical clinic unless there is a determination by the department that there is a need for such a facility.  For purposes of this section, “clinic” shall not include a clinic conducted by a hospital licensed under said section 51 or by the federal government or the commonwealth.  The department shall promulgate regulations to implement this section.

SECTION 15.  The first paragraph of section 70 of said chapter 111, as appearing in the 2006 Official Edition, is hereby amended by striking out the second and third sentences and inserting in place thereof the following 3 sentences- Such records may be handwritten, printed, typed or in electronic digital media or converted to electronic digital media as originally created by such hospital or clinic, by the photographic or microphotographic process, or any combination thereof.  Such hospital or clinic, may only destroy records after notifying the department of public health and the patient that the applicable retention period has elapsed and the records will be destroyed.  Such notification shall occur through appropriate notice, which may include, but shall not be limited to, the hospital or clinic’s privacy notice, that records will be destroyed after the applicable retention period has elapsed.  Such hospital or clinic shall further provide information through applicable provisions contained in the hospital or clinic notice of privacy practices that records will be terminated after the applicable retention period has elapsed since the last date of service.

SECTION 16.  Said section 70 of said chapter 111, as so appearing, is hereby further amended by striking out, in line 66, the word “thirty” and inserting in place thereof the following figure:- 15.

SECTION 17.  Section 9E of chapter 112 of the General Laws, as so appearing, is hereby amended by striking out, in line 6, the word “two” and inserting in place thereof the following figure:- 4.

SECTION 17A.  Said chapter 112 is hereby further amended by inserting after section 39C the following section:-
Section 39D.  Stores or pharmacies engaged in the drug business, as defined in section 37, shall be mandatory reporters required to inform the department of public health of any improper dispensing of prescription drugs resulting in serious injury or death, as soon as is reasonably and practically possible, but not later than 15 working days after discovery of the error.

SECTION 18.  Chapter 118E of the General Laws is hereby amended by inserting after section 10F the following section:-          

Section 10G.  (a) As used in this section, the following term shall have the following meaning:-

“Medical home,” a primary care practice that utilizes a comprehensive approach to providing patient-centered care that is accessible, continuous and coordinated so that the relationship between the provider and patient is directed at maintaining a healthy lifestyle with preventive and ongoing health services and is respectful of, and responsive to, individual patient preference, needs and values.
           
(b) Notwithstanding any general or special law to the contrary,  the office of Medicaid, subject to appropriation and the availability of federal financial participation, shall establish a medical home demonstration program for the purpose of redesigning the health care delivery system to provide targeted, accessible, continuous and coordinated family-centered care to high need populations including, but not limited to, those with multiple chronic illnesses that require regular monitoring, advising or treatment. The office of Medicaid shall work with Medicaid managed care organizations to develop and implement the program.
           
(c) Under the demonstration program, case management fees shall be paid to personal physicians and incentive payments shall be paid to physicians and providers participating in practices that provide medical home services.  Medical homes shall be responsible for: (1) targeting eligible individuals for program participation; (2) providing safe and secure technology to promote patient access to personal health information; (3) developing a health assessment tool for the targeted individuals; and (4) providing training for personnel involved in the coordination of care.
           
(d) The program shall operate for 3 years in urban, rural and underserved areas in up to 10 communities and shall include physician practices with less than 3 full-time equivalent physicians, as well as larger practices, particularly in rural and underserved areas.
           
(e) Personal physicians who provide first contact and continuous care for their patients shall be board certified.  Such personal physicians shall also have a staff and resources to manage the comprehensive and coordinated care of each of their patients.  Participating providers may be specialists or sub-specialists for patients requiring ongoing care for specific conditions, multiple chronic conditions including, but not limited to severe asthma, complex diabetes, cardiovascular disease and rheumatologic disorders or for those with prolonged illnesses.
           
(f) Personal physicians shall perform or provide for the performance of: (1) advocates for and providing ongoing support, oversight and guidance to implement a plan of care; that provides an integrated, coherent, cross-discipline plan for ongoing medical care developed in partnership with patients and including all other physicians furnishing care to the patient involved and other appropriate health care providers or agencies, such as home health agencies; (2) evidence-based medicine and clinical decision support tools to guide decision-making at the point-of-care based on patient-specific factors; (3) health information technology that may include remote monitoring and patient registries; and (4) encouraging patients to engage in management of their own health through education and support systems.
           
(g) The office of Medicaid may establish a system of supplemental payments for care management to personal physicians through the establishment of a care management fee and, for that purpose, shall establish a care management fee code and a value for those payments.
           
(h) The office of Medicaid may also establish a system of supplemental payments for a medical home to physician group practices through the establishment of a medical home fee and, for that purpose, shall establish a medical home fee code and a value for these payments.
           
(i) The office of Medicaid shall provide a yearly program evaluation and submit a report to the senate and house chairs of the joint committee on health care financing and the chairs of the senate and house committees on ways and means.

SECTION 19.  Said chapter 118E is hereby further amended by adding the following section:-

Section 61.  (a) Subject to subsection (c), for the purposes of processing claims for health care services submitted by a health care provider and to provide uniformity and consistency in the reporting of patient diagnostic information, patient care service and procedure information as it relates to the submission and processing of health care claims, the executive office of health and human services and its subcontractors shall, without local customization, accept and recognize patient diagnostic information and patient care service and procedure information submitted pursuant to, and consistent with, the current Health Insurance Portability and Accountability Act compliant code sets as adopted by: the Centers for Medicare and Medicaid Services; the International Classification of Diseases; the American Medical Association's Current Procedural Terminology codes, reporting guidelines and conventions; and the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System.  The executive office and its subcontractors shall adopt the aforementioned coding standards and guidelines, and all changes thereto, in their entirety, which shall be effective on the same date as the national implementation date established by the entity implementing the coding standards.

(b) Subject to subsection (c), the executive office and its subcontractors shall, without local customization, use the standardized claim formats for processing health care claims as adopted by the National Uniform Claim Committee and the National Uniform Billing Committee and implemented pursuant to the federal Health Insurance Portability and Accountability Act.  The executive office and its subcontractors shall, without local customization, adopt and routinely process all changes to such formats which shall be effective on the same date as the implementation date established by the entity implementing the formats.

(c) Except for the requirements for consistency and uniformity in coding patient diagnostic information and patient care service and procedure information, this section shall not affect the executive office’s or its subcontractor’s payment policy or utilization review policy.  Nothing in this section shall preclude the executive office or a subcontractor thereof from adjudicating a claim pursuant to its billing guidelines, payment policies or provider contracts.

(d) The executive office and its subcontractors shall accept and recognize at least 85 per cent of all claims submitted by health care providers pursuant to this section. 

SECTION 20.  Section 61 of said chapter 118E, as appearing in section 19, is hereby amended by striking out subsection (d) and inserting in place thereof the following section:-

(d) The executive office and its subcontractors shall accept and recognize all claims submitted by health care providers pursuant to this section.

SECTION 21.  Chapter 118G of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by adding the following section:-

Section 40. (a) The division shall hold an annual public hearing to examine the factors that contribute to the cost increases of the health care delivery system and strategies employed by the provider community to reduce cost growth. While considering size, payor mix, geographic representation and specialty, the division shall identify a broad representative sample of providers in each of the following categories: integrated delivery systems; acute care hospitals; community health centers; freestanding ambulatory surgical centers; physician group practices; rehabilitation hospitals; and skilled nursing facilities.  Each identified provider shall be required to provide oral and written testimony at the hearing in a format determined by the division.   The division shall require providers to provide testimony relative to: payment systems; utilization trends, including volume of services and intensity of services; demographics of populations served; labor and supply costs; community benefits programs; endowment contributions; executive compensation; administrative costs; capital investments; strategies to contain the rate of cost growth including, but not limited to, provider efforts to minimize medical errors, eliminate waste and duplication in clinical care, manage chronic diseases, reduce the use of ineffective or inappropriate medical technology or devices, prioritize technology investments for computerized physician support systems and electronic health records, determine capital expenditures based on public health needs, and cut administrative costs; and other matters as determined by the division. 

(b) Within 60 days following the hearing conducted pursuant to subsection (a), the division shall issue a public report summarizing its findings and any recommendations.  The report shall include, but shall not be limited to, the following: (i) a standard measurement of the annual total health care spending in the commonwealth, or the Massachusetts Global Health Cost Indicator, as determined by the health care quality and cost council; (ii) the rate of annual increase or decrease of health care costs in total and within health care sectors; (iii) an analysis of the primary cost drivers in the health care delivery system; (iv) an  evaluation of the scope and effectiveness of provider cost containment efforts; and (v)  regulatory, legislative and other recommendations to control health care costs, as developed by the division.

SECTION 22.   Section 36 of chapter 123 of the General Laws, as so appearing, is hereby amended by adding the following 4 sentences:- 

Each facility, subject to this chapter and section 19 of chapter 19, that provides mental health care and treatment shall maintain patient records, as defined in the first paragraph of section 70 of chapter 111, for at least 15 years after the closing of the record due to discharge, death or last date of service.  No facility shall destroy such records unless it first provides notice to the department of public health and to patients that the applicable retention period has elapsed and that records will be destroyed.  The means of providing such notice shall include, but not be limited to, the provision of the hospital or clinic’s privacy notice that records will be destroyed after the applicable retention period has elapsed.  A facility shall further provide information through a provision of the hospital or clinic notice of privacy practices that records will be terminated after the applicable retention period has elapsed after the last date of service.

SECTION 23.  Chapter 176O of the General Laws is hereby amended by inserting after section 5 the following 2 sections:-

Section 5A.  (a)  Subject to subsection (c), for the purposes of processing claims for health care services submitted by a health care provider and to provide uniformity and consistency in the reporting of patient diagnostic information, patient care service and procedure information as it relates to the submission and processing of health care claims, a carrier and its subcontractors shall, without local customization, accept and recognize patient diagnostic information and patient care service and procedure information submitted pursuant to, and consistent with the current Health Insurance Portability and Accountability Act compliant code sets as adopted by the Centers for Medicare and Medicaid Services: the International Classification of Diseases; the American Medical Association's Current Procedural Terminology codes, reporting guidelines and conventions; and the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System.  A carrier and its subcontractors shall adopt the aforementioned coding standards and guidelines, and all changes thereto, in their entirety, which shall be effective on the same date as the national implementation date established by the entity implementing the coding standards.
(b) Subject to subsection (c), a carrier and its subcontractors shall, without local customization, use the standardized claim formats for processing health care claims as adopted by the National Uniform Claim Committee and the National Uniform Billing Committee and implemented pursuant to the Health Insurance Portability and Accountability Act.  A carrier and its subcontractors shall, without local customization, adopt and routinely process all changes to such formats which shall be effective on the same date as the implementation date established by the entity implementing the formats.

(c) Except for the requirements for consistency and uniformity in coding patient diagnostic information and patient care service and procedure information, this section shall not affect a carrier’s or its subcontractor’s payment policy, utilization review policy or benefits under a health benefit plan.  Nothing in this section shall preclude a carrier or a subcontractor thereof from adjudicating a claim pursuant to its billing guidelines, payment policies, provider contracts or health benefit plans.

(d) Carriers and subcontractors thereof shall accept and recognize at least 85 per cent of all claims submitted by health care providers pursuant to this section. 
Section 5B. To ensure uniformity and consistency in the submission and processing of claims for health care services pursuant to section 5A, the bureau of managed care within the division of insurance, after consultation with a statewide advisory committee including, but not limited to, members of the Massachusetts Hospital Association, the Massachusetts Medical Society, the Massachusetts Association of Health Plans, the Blue Cross and Blue Shield of Massachusetts, the Massachusetts Health Information Management Association, the Massachusetts Health Data Consortium, a representative of America's Health Insurance Plans, a representative of a MassHealth contracted managed care organization, the executive office of health and human services, the division of health care finance and policy, the health care quality and cost council, the house of representatives and the senate, shall adopt policies and procedures to enforce said section 5A.  The policies and procedures shall include a system for reporting inconsistencies related to a carrier’s compliance with said section 5A.  The bureau shall work jointly with the executive office of health and human services to resolve reports of noncompliance with the requirements of section 53 of chapter 118E.  The bureau shall convene the advisory committee annually to review and discuss issues reported by health care providers pursuant to this section and to discuss further recommendations to improve the uniformity and consistency of the reporting of patient diagnostic information and patient care service and procedure information as it relates to the submission and processing of health care claims.

SECTION 24. Section 5A of said chapter 176O, as appearing in section 23, is hereby amended by striking out subsection (d) and inserting in place thereof the following subsection:-

(d) Carriers and their subcontractors shall accept and recognize all claims submitted by health care providers pursuant to this section.

SECTION 25.  The General Laws are hereby amended by inserting after chapter 176Q the following 2 chapters:-

CHAPTER 176R
CONSUMER CHOICE OF NURSE PRACTITIONER SERVICES

Section 1.  As used in this chapter, the following words shall have the following meanings unless the context clearly requires otherwise:

"Carrier", an insurer licensed or otherwise authorized to transact accident or health insurance under chapter 175; a nonprofit hospital service corporation organized under chapter 176A; a nonprofit medical service corporation organized under chapter 176B; a health maintenance organization organized under chapter 176G; an organization entering into a preferred provider arrangement under chapter 176I; a contributory group general or blanket insurance for persons in the service of the commonwealth under chapter 32A; a contributory group general or blanket insurance for persons in the service of counties, cities, towns and districts, and their dependents under chapter 32B; the medical assistance program administered by the division of medical assistance pursuant to chapter 118E and in accordance with Title XIX of the Social Security Act or any successor statute; and any other medical assistance program operated by a governmental unit for persons categorically eligible for such program.

"Commissioner", the commissioner of insurance. 

"Insured", an enrollee, covered person, insured, member, policyholder or subscriber of a carrier.

"Nondiscriminatory basis", a carrier shall be deemed to be providing coverage on a non-discriminatory basis if its plan does not contain any annual or lifetime dollar or unit of service limitation imposed on coverage for the care provided by a nurse practitioner which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the same services by other participating providers.

"Nurse practitioner", a registered nurse who holds authorization in advanced nursing practice as a nurse practitioner under section 80B of chapter 112 and regulations promulgated thereunder.

"Participating provider", a provider who, under a contract with the carrier or with its contractor or subcontractor, has agreed to provide health care services to an insured with an expectation of receiving payment, other than coinsurance, co-payments or deductibles, directly or indirectly from the carrier.

"Primary care provider", a health care professional qualified to provide general medical care for common health care problems, supervises, coordinates, prescribes, or otherwise provides or proposes health care services, initiates referrals for specialist care, and maintains continuity of care within the scope of practice.

Section 2.  The commissioner and the group insurance commission shall require that all carriers recognize nurse practitioners as participating providers subject to section 3 and shall include coverage on a nondiscriminatory basis to their insureds for care provided by nurse practitioners for the purposes of health maintenance, diagnosis and treatment. Such coverage shall include benefits for primary care, intermediate care and inpatient care, including care provided in a hospital, clinic, professional office, home care setting, long-term care setting, mental health or substance abuse program, or any other setting when rendered by a nurse practitioner who is a participating provider and is practicing within the scope of his professional license to the extent that such policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the commonwealth.
           
Section 3.  A participating nurse practitioner practicing within the scope of his license including all regulations requiring collaboration with a physician under section 80B of chapter 112, shall be considered qualified within the carrier’s definition of primary care provider to an insured.
           
Section 4.  Notwithstanding any general or special law to the contrary, a carrier that requires the designation of a primary care provider shall provide its insured with an opportunity to select a participating provider nurse practitioner as a primary care provider or to change its primary care provider to a participating provider nurse practitioner at any time during their coverage period.

Section 5.  Notwithstanding any general or special law to the contrary, a carrier shall ensure that all participating provider nurse practitioners are included on any publicly accessible list of participating providers for the carrier.
           
Section 6.  A complaint for noncompliance against a carrier shall be filed with and investigated by the commissioner or the group insurance commission, whichever shall have regulatory authority over the carrier. The commissioner and the group insurance commission shall promulgate regulations to enforce this chapter.

CHAPTER 176S
HEALTH INSURANCE RATE HEARINGS

Section 1.  As used in this chapter, the following words shall have the following meanings unless the context clearly requires otherwise:-

“Actual loss ratio”, the ratio between provider claims incurred by a carrier and premiums earned by that carrier under a health plan, which shall be calculated in a manner established by the commissioner pursuant to regulation.

"Adjusted weighted average market premium price'', the arithmetic mean of all premium rates for a given prototype plan sold to eligible insureds with similar rate basis type by all carriers selling prototype plans or alternative prototype plans in the commonwealth, weighted pursuant to regulations promulgated by the commissioner.

“Alternative prototype plan”, a health plan which meets the criteria established by the commissioner and which is intended for sale under section 4 of chapter 176Q, to eligible individuals and to eligible small groups, as defined in section 1 of said chapter 176Q.

"Carrier'', an insurer licensed or otherwise authorized to transact accident and health insurance under chapter 175; a nonprofit hospital service corporation organized under chapter 176A; a nonprofit medical service corporation organized under chapter 176B; or a health maintenance organization organized under chapter 176G.

“Commissioner”, the commissioner of insurance.
           
“Health plan”,  any individual, general, blanket or group policy of health, accident or sickness insurance issued by an insurer licensed under chapter 175 or the laws of any other jurisdiction; a hospital service plan issued by a nonprofit hospital service corporation under chapter 176A or the laws of any other jurisdiction; a medical service plan issued by a nonprofit hospital service corporation under chapter 176B or the laws of any other jurisdiction; a health maintenance contract issued by a health maintenance organization organized under chapter 176G or the laws of any other jurisdiction; and an insured health benefit plan that includes a preferred provider arrangement issued under chapter 176I or the laws of any other jurisdiction; provided, however, that “Health plan” shall not include accident only, credit only, limited scope dental or vision benefits if offered separately, hospital indemnity insurance policies if offered as independent, noncoordinated benefits, which for the purposes of this chapter, shall mean policies issued pursuant to chapter 175 which provide a benefit not to exceed $500 per day, as adjusted on an annual basis by the amount of increase in the average weekly wages in the commonwealth as defined in section 1 of chapter 152, to be paid to an insured or a dependent, including the spouse of an insured, on the basis of a hospitalization of the insured or a dependent, disability income insurance, coverage issued as a supplement to liability insurance, specified disease insurance that is purchased as a supplement and not as a substitute for a health plan and meets any requirements the commissioner may set by regulation, insurance arising out of a workers’ compensation law or similar law, automobile medical payment insurance, insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in a liability insurance policy or equivalent self insurance, long-term care insurance if offered separately, coverage supplemental to the coverage provided under 10 U.S.C. 55 if offered as a separate insurance policy or any policy subject to chapter 176K; and provided further, that the commissioner may, by regulation, define other health coverage as a health plan for the purposes of this chapter.

"Prototype plan'', a health plan which meets the criteria established by the commissioner.

“Rate basis type”, each category of individual or family composition for which separate rates are charged for a health benefit plan as determined by the carrier, subject to restrictions set forth in regulations promulgated by the commissioner.

Section 2.  After a date established annually by the commissioner pursuant to regulation, every carrier seeking to increase or decrease premiums for any health insurance policy or desiring to set the initial premium for a new health insurance policy under any health plan shall file its rates with the commissioner at least 90 days before the proposed effective date of such new health insurance rates. 

Section 3.    Any increase in premium rates shall continue in effect for not less than 12 months, except that an increase in benefits or decrease in rates may be permitted at any time.

Section 4.  A carrier shall annually report to the commissioner and to the health care quality and cost council, established in section 16K of chapter 6A, not later than May 1, the actual loss ratio calculated for each health plan for the previous calendar year. 
           
Section 5.  The commissioner shall hold a hearing conducted pursuant to chapter 30A on any filing under section 2 prior to its effective date on at least 10 days’ notice.  The commissioner may consolidate hearings for more than 1 carrier and may consolidate hearings for multiple health plans filed by 1 carrier.  The carrier shall provide information on the reasons for the proposed premium change, and members of the public may testify. All testimony and evidence received shall be public records.  The commissioner may promulgate guidelines to safeguard the confidentiality of contracts that establish rates between insurers and institutional providers licensed under section 51 of chapter 111 which shall apply when the commissioner obtains such contracts pursuant to section 8A of chapter 175 for purposes of a hearing under this section. 

The attorney general may intervene in any hearing called for under this section and may require that a party to such a hearing produce any documents related to the proposed premium change or documents that the attorney general deems necessary to enable him or the commissioner to evaluate the merits of the proposed premium change.  The attorney general shall keep all information and documents obtained under this section confidential and shall not disclose such information or documents to any person except as necessary in a case brought by the attorney general under this chapter.  Such information and documents shall not be public records and shall be exempt from disclosure under section 10 of chapter 66.

Such requested premium change or initial premium request shall be filed at least 90 days before the proposed effective date of such increase, and shall be communicated to the insureds at least 90 days before the proposed effective date of such change, in the manner directed by the commissioner.
           
The rate filer shall advertise any public hearing conducted under this section in newspapers in Boston, Brockton, Fall River, Pittsfield, Springfield, Worcester, New Bedford and Lowell. 

Within 90 days after the conclusion of any hearing initiated under this section, the commissioner shall issue a report containing findings of fact from the evidence presented in the carrier’s filing and in the hearing.  The findings of fact shall include, but shall not be limited to:

(1) the carrier’s administrative expenses including, but not limited to, the carrier’s salary structure, advertising and other marketing expenses and commissions, brokerage fees and other distribution expenses, as compared to other carriers within and without the commonwealth;
(2) the carrier’s expenses related to health care contracts, including but not limited to the costs of services rendered by health care providers, the rates at which it pays for such services and the volume of services provided;
(3) the carrier’s loss experience under the health plan, including evaluations of the carrier’s actual loss ratio and of utilization by the carrier’s insureds and of identifiable cost drivers for that health plan, as compared to other carriers within and without the commonwealth;
(4) cost-sharing assumptions made in the health plan, including, but not limited to, the use of deductibles, co-payments and coinsurance;
(5) the carrier’s provisions in the rates for reserves and surplus; and
(6) the carrier’s programs of cost containment, as compared to other carriers within and without the commonwealth.

Nothing in this section shall prohibit the attorney general from publishing any report concerning a hearing under this section.  Nothing in this section shall affect any procedures for the approval or disapproval of health plan rates provided elsewhere in the General Laws, except as specifically provided herein.
           
The commissioner shall promulgate regulations to specify the conduct and scheduling of the hearings required pursuant to this section; provided, however, that any such regulation shall facilitate adequate discovery of information related to the filed rates.
           
Section 6. The supreme judicial court shall have jurisdiction in equity upon the petition of the attorney general, on behalf of the commissioner and upon a summary hearing to enforce all orders of the commissioner.
           
Any person aggrieved by any final action, order, finding or decision of the commissioner under this section may, within 20 days after the filing of such final action, order, finding or decision in his office, file a petition in the supreme judicial court for the county of Suffolk for a review of such action, order, finding or decision.  The final action, order, finding or decision of the commissioner shall remain in full force and effect, pending the final decision of the court unless the court or a justice thereof, after notice to the commissioner, shall by special order otherwise direct.  Review by the court on the merits shall be limited to the record of proceedings before the commissioner.  The court shall have jurisdiction to modify, amend, annul, reverse or affirm such action, order, finding or decision and shall uphold the commissioner's action, order, finding, or decision if it is consistent with the standards set forth in clause (7) of section 14 of chapter 30A.  The court may make any appropriate order or decree and may make such order as to costs as it deems equitable.  The court may make such rules or orders as it deems proper governing proceedings under this section to secure prompt and speedy hearings and to expedite final decisions thereon.
           
Section 7.  The commissioner may promulgate regulations to facilitate the administration and enforcement of this chapter and to govern hearings and investigations thereunder and may issue such orders as he deems necessary to enforce and administer this chapter and to secure compliance with any rules and regulations made hereunder.
           
SECTION 26.  The General Laws are hereby amended by inserting after chapter 268B the following chapter:-

CHAPTER 268C 
HEALTH CARE PRACTITIONER AND PHARMACEUTICAL AND MEDICAL DEVICE MANUFACTURER CONDUCT

Section 1.  As used in this chapter, the following words shall have the following meanings:-
           
"Gift", a payment, entertainment, meals, travel, honorarium, subscription, advance, services or anything of value, unless consideration of equal or greater value is received and for which there is a contract with specific deliverables which are not related to marketing and are restricted to medical or scientific issues; provided, however, that a gift shall not include anything of value received by inheritance, a gift received from a member of the health care practitioner’s immediate family or from a relative within the third degree of consanguinity of the health care practitioner or of the health care practitioner’s spouse or from the spouse of any such relative, or prescription drugs provided to a health care practitioner solely and exclusively for use by the health care practitioner’s patients.
           
“Health care practitioner”, a person who prescribes prescription drugs for any person and is licensed to provide health care, or a partnership or corporation comprised of such persons, or an officer, employee, agent or contractor of such person acting in the course and scope of his employment, agency or contract related to or in support of the provision of health care to individuals. 
           
"Immediate family", a spouse and any dependent children residing in the reporting person's household.
           
“Medical device”, an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent or other similar or related article, including any component, part or accessory, which is: (1) recognized in the official National Formulary or the United States Pharmacopeia or any supplement thereto; (2) intended for use in the diagnosis of disease or other conditions or in the cure, mitigation, treatment or prevention of disease, in persons or animals; or (3) intended to affect the structure or function of the body of a person or animal, and which does not achieve its primary intended purposes through chemical action within or on such body and which is not dependent upon being metabolized for the achievement of its primary intended purposes.
           
"Person", a business, individual, corporation, union, association, firm, partnership, committee or other organization.
           
“Pharmaceutical or medical device manufacturer agent”, a pharmaceutical or medical device marketer or any other person who for compensation or reward does any act to promote, oppose or influence the prescribing of a particular prescription drug, medical device, or category of prescription drugs or medical devices; provided, however, that “pharmaceutical or medical device manufacturer agent” shall not include a licensed pharmacist, licensed physician or any other licensed health care practitioner with authority to prescribe prescription drugs who is acting within the ordinary scope of the practice for which he is licensed.
           
“Pharmaceutical or medical device manufacturing company”, any entity that participates in a commonwealth health care program and which is engaged in the production, preparation, propagation, compounding, conversion or processing of prescription drugs or medical devices, either directly or indirectly, by extraction from substances of natural origin, or independently by means of chemical synthesis or by a combination of extraction and chemical synthesis, or any entity engaged in the packaging, repackaging, labeling, relabeling or distribution of prescription drugs; provided, however, that “pharmaceutical or medical device manufacturing company” shall not include a wholesale drug distributor licensed under section 36A of chapter 112 or a retail pharmacist registered under section 37 of said chapter 112.

“Pharmaceutical or medical device marketer”, a person who, while employed by or under contract with a pharmaceutical or medical device manufacturing company that participates in a commonwealth health care program, engages in detailing, promotional activities or other marketing of prescription drugs or medical devices in the commonwealth to any physician, hospital, nursing home, pharmacist, health benefits plan administrator, other health care practitioner or person authorized to prescribe, dispense or purchase prescription drugs; provided, however, that the “pharmaceutical or medical device marketer” shall not include a wholesale drug distributor licensed under section 36A of chapter 112, 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 of said chapter 112 if such person is not engaging in such practices under contract with a manufacturing company.
           
“Physician”, a person licensed to practice medicine by the board of registration in medicine under section 2 of chapter 112 who prescribes prescription drugs, or the physician’s employees or agents.
           
“Prescription drugs”, drugs upon which the manufacturer or distributor has placed or is required by federal law and regulations to place the following or a comparable warning: “Caution federal law prohibits dispensing without prescription”.

Section 2.  No pharmaceutical or medical device manufacturer agent shall knowingly and willfully offer or give to a health care practitioner, a member of a health care practitioner’s immediate family, a health care practitioner’s employee or agent, a health care facility or an employee or agent of a health care facility, a gift of any value. Nothing in the section shall prohibit the provision, distribution, dissemination, or receipt of peer reviewed academic, scientific or clinical information.  Nothing in this section shall prohibit the purchase of advertising in peer reviewed academic, scientific or clinical journals.

Section 3.  (a)(1) By July 1 of each year, every pharmaceutical or medical device manufacturing company shall disclose to the department of public health the value, nature, purpose and recipient of any fee, payment, subsidy or other economic benefit not prohibited in Section 2, which the company provides, directly or through its agents, to any physician, hospital, nursing home, pharmacist, health benefit plan administrator, health care practitioner or other person in the commonwealth authorized to prescribe, dispense, or purchase prescription drugs or medical devices in this state.  For each expenditure, the company shall identify the recipient and the recipient’s address, credentials, institutional affiliation and state board or Drug Enforcement Administration numbers.
           
(2) Each company subject to this section shall disclose to the department of public health the name and address of the individual responsible for the company's compliance with this section or, if this information has been previously reported to the department, any changes to the name or address of the individual responsible for such compliance.
           
(3) The report shall be accompanied by the payment of a fee, to be determined by the department of public health, to pay the costs of administering this section.

(b)(1) Information submitted to the department of public health pursuant to this section shall constitute public records except to the extent that it includes information that is protected by state or federal law as a trade secret. 

(2) Notwithstanding any other law to the contrary, the identities of health care practitioners and other recipients of gifts, payments and materials required by this chapter to be reported shall not constitute confidential information or trade secrets protected by this section.
           
(3) The department of public health shall make all disclosed data publicly available and
easily searchable on its website.
           
(c) The department of public health shall report to the attorney general any payment, entertainment, meals, travel, honorarium, subscription, advance, services or anything of value provided in violation of this chapter, including anything of value provided when consideration of equal or greater value was not received or which was not subject to a contract with specific deliverables restricted to medical or scientific issues. 

Section 4.  The department of public health, in consultation with the board of registration in pharmacy and board of registration in medicine, shall adopt regulations requiring the licensing of all pharmaceutical and medical device manufacturer agents.  As a prerequisite to such licensing, pharmaceutical and medical device manufacturer agents shall complete such training as may be deemed appropriate by the department.  As a prerequisite to the renewal of such licenses, pharmaceutical and medical device manufacturer agents shall complete continuing education as the department deems appropriate.  The fee for such licenses shall be determined by the department of public health, in conjunction with the board of registration in pharmacy and the board of registration in medicine at a rate sufficient to provide for the administration and enforcement of this chapter.  Revenue generated from this fee shall be divided in equal shares, with 75 per cent allocated for the use of the department of public health and 25 per cent allocated for the use of the office of attorney general for the administration of this chapter.
           
Section 5.  This chapter shall be enforced by the attorney general, the district attorney with jurisdiction over a violation or the department of public health.  A person who violates this chapter shall be punished by a fine of not more than $5,000 for each transaction, occurrence or event that violates this chapter.

SECTION 27.  Notwithstanding any general or special law to the contrary, the trustees of the University of Massachusetts shall expand the entering class at its medical school and increase residencies for medical school graduates for students committed to entering the primary care field and to working in underserved regions of the commonwealth.  The trustees shall develop a master plan for expanding medical student enrollment and increasing internships and residencies for medical school graduates who are committed to primary care and work in underserved regions without reducing academic quality, together with a financial plan to support such expansion, and shall report that plan to the joint committee on health care financing and the house and senate committees on ways and means not later than January 1, 2009.

SECTION 28.  Notwithstanding any general or special law to the contrary, the center for primary care recruitment and placement established in section 25L of chapter 111 of the General Laws, in consultation with the board of higher education and the executive office of health and human services, shall, subject to appropriation, establish a primary care workforce development and loan forgiveness grant program at community health centers, community hospitals, nonprofit community-based primary care providers and other facilities in target areas, as determined by the center pursuant to said section 25L of said chapter 111, for the purpose of enhancing the recruitment and retention of primary care physicians and nurse practitioners authorized to practice pursuant to section 80B of chapter 112 of the General Laws.  Recruitment and placement shall focus on the practice of primary care but, at the discretion of the center, may also include geriatric health services, obstetrics and gynecology, psychiatry and neurosurgery. Loan forgiveness programs, zero interest loan programs or other forms of assistance utilizing public funds, in whole or in part, shall require each medical or nursing student recipient to enter into a contract with the commonwealth as a primary care fellow which shall obligate the recipient to perform a term of service, as determined by the center, within the commonwealth in areas of primary care, geriatric health services, obstetrics and gynecology, psychiatry or neurosurgery.

SECTION 29.  Notwithstanding any general or special law to the contrary, the trustees of the University of Massachusetts, in conjunction with the state health education center at the University of Massachusetts Medical Center, shall establish and maintain an enhanced learning contract program available to medical students every academic year. The program shall provide full waivers of tuition and fees at the University of Massachusetts Medical School. The contract shall require payback service, of at least 4 years of service within the commonwealth in areas of primary care, public or community service or underserved areas, as determined by the center for primary care recruitment and placement and the learning contract committee, in coordination with the area health education center and state and regional health planning agencies.  If a student fails to perform payback service as required by an enhanced learning contract, that student shall pay the difference between the tuition paid and double the amount of the tuition charged together with an origination fee, interest per annum at prime rate as reported at the time of origination by the Federal Reserve, a margin and repayment fee as set by the board. No payback service or tuition loan repayment shall be required prior to the termination of any internship and residency requirements. Interest shall begin to accrue upon completion of the requirements for the degree.  The commonwealth shall bear the cost of such tuition and fee waivers for enhanced learning contracts. The dean of the medical school shall report annually the number of students participating in enhanced learning contracts, the area of medicine within which payback is to be performed and the number of students utilizing the repayment option. The report shall also outline the effects of payback in the underserved areas of the commonwealth.

SECTION 30.  (a) Notwithstanding any general or special law to the contrary, there is hereby established and set up on the books of the commonwealth a separate fund to be known as the Massachusetts Nursing and Allied Health Workforce Development Trust Fund to which shall be credited any appropriations, bond proceeds or other monies authorized by the general court and specifically designated to be credited thereto, and additional funds, including federal grants or loans or private donations made available to the commissioner of higher education for this purpose. The department of higher education shall hold the fund in an account separate and apart from other funds or accounts. Amounts credited to the fund shall be expended by the commissioner of higher education to carry out subsection (b).  Any balance in the fund at the close of a fiscal year shall be available for expenditure in subsequent fiscal years and shall not revert to the General Fund.

(b) The Massachusetts Nursing and Allied Health Workforce Development Trust Fund shall be used to develop and support, in consultation with the Massachusetts Nursing and Allied Health Workforce Development Advisory Committee, short-term and long-term strategies to increase the number of public and private higher education faculty and students who participate in programs that support careers in fields related to nursing and allied health.  The commissioner of higher education may expend such funds as may be necessary for the administration of the Massachusetts Nursing and Allied Health Workforce Development Initiative.  In furtherance of these public purposes, the commissioner of higher education shall expend funds in the fund for activities that are calculated to increase the number of qualified nursing and allied health faculty and students and improve the nursing and allied health educational offerings available in public higher education institutions.  Grants and other disbursements and activities may involve, without limitation, the University of Massachusetts, state and community colleges, private institutions of higher education institutions in partnership with public institutions of higher education, business and industry partnerships, regional alliances, workforce investment boards, organizations granted tax-exempt status under section 501(c)(3) of the Internal Revenue Code and other community groups which promote the nursing profession. Grants and other disbursements and activities may support, without limitation: (i) the goal of rapidly increasing the number of nurses and allied health workers; (ii) enhancing the role of the system of public higher education, as institutions and in partnerships with other stakeholders, in meeting the short-term and long-term workforce challenges in the nursing and allied health professions;
(iii) the development and use of innovative curricula, courses, programs and modes of delivering education in nursing and allied health professions for faculty and students in these fields; (iv) activities with the growing network of stakeholders in the nursing and allied health professions to create, implement, share and make broadly and publicly available best practices and innovative programs relative to instruction, development of partnerships and expanding and maintaining faculty and student involvement in careers in these fields; and (v) strengthening the institutional capacity to develop and implement long-term programs and policies to effectively respond to these challenges.

SECTION 31.  Notwithstanding any general or special law to the contrary, the department of housing and community development, in consultation with the executive office of health and human services and the department of workforce development, shall establish a pilot program to assist hospitals, community health centers, and physician practices in providing housing grants or loans for health care professionals in underserved areas.  The department of housing and community development shall establish an Assisted Housing Fund to provide grants or loans for health care professionals who contract to provide care in underserved areas and whose incomes do not exceed certain benchmarks, as established by said department.  Grants and loans from the fund shall be made available for expenditure in the commonwealth and may be used for: (i) the cost to purchase housing that is to be a principal residence, including cooperative housing, and that falls within price guidelines established by the department, including costs for down payments, mortgage interest rate buy-downs, closing costs and other costs determined to be eligible by the department; and (ii) payments for security deposits and advance payments for rental housing.  The department shall, subject to appropriation, contribute $1 to the fund for every $2 expended by the hospital, community health center or physician practice from the fund. 
The assistance granted pursuant to this section shall be determined by the department.  The department shall adopt written procedures for the establishment and operation of the assisted fund.  The procedures shall include provisions for eligibility and shall specify the expenses for which grants and loans may be made and shall determine the documentation and procedures necessary to qualify for the assistance. Two years after the commencement of the pilot program, the department shall report to the house and senate committees on ways and means, the joint committee on housing and the joint committee on health care financing, the results of the pilot program and shall recommend it for expansion, continuation or discontinuation.

SECTION 32.  Notwithstanding any special or general law to the contrary, the center for primary care recruitment and placement, in conjunction with the University of Massachusetts Medical School and area health education centers, shall study the efforts of Massachusetts-based public and private graduate medical education institutions to foster and expand the supply of primary care physicians.  The study shall include, but shall not be limited to, a survey of institutional efforts to increase the percentage of medical residents who choose a primary care specialty and the overall enrollment of medical students committed to entering the primary care field.  The study shall recommend innovative primary care educational programs and strategies that foster a culture within graduate medical education which embraces primary care. The center shall report its findings and recommendations to the house and senate committee on ways and means and the joint committee on health care financing not later than January 1, 2009.  

SECTION 33.  (a)  Notwithstanding any general or special laws to the contrary, there shall be a special commission to examine options and alternatives available to the commonwealth  to provide regulation, oversight and disposition of the reserves, endowments and surpluses of health insurers and hospitals.

(b) The commission shall consist of the inspector general, who shall serve as the chair, the commissioner of insurance or his designee, the commissioner of health care finance and policy or his designee, the secretary of administration and finance or his designee, the attorney general or his designee, the commissioner of public health or his designee and 3 persons to be appointed by the governor, 1 of whom shall be a health care consumer advocate and 1 of whom shall be a health economist.
           
(c) The commission shall conduct a study relative to health insurers, including health maintenance organizations and acute care and non-acute care hospitals.  The study shall include, but not be limited to: (1) an analysis of the laws, regulations and other measures currently in effect in the commonwealth which regulate the amount, nature and disposition of surpluses held by or for the benefit of health insurers in excess of amounts reasonably anticipated to be required to pay claims, taking into account the level of such reserves and surpluses necessary to safeguard the solvency of health insurers against unanticipated events and other circumstances which may cause extraordinary medical losses; (2) an analysis of federal and state law, regulations and other measures currently in effect which regulate the amount, nature and disposition of surpluses and endowments held by or for the benefit of hospitals in excess of amounts reasonably anticipated to be required to perform and support services provided by the hospital and to guard against unanticipated events and other circumstances; (3) a review of recent fiscal practices and financial reporting by health insurers relative to reserves and surpluses and of hospital fiscal practices and financial reporting required by general or special law; (4) a comparison of the commonwealth’s current statutes and regulations with those of other states which the commission deems to be reasonably comparable to those of the commonwealth; (5) a review and assessment of model acts and regulations and any other information which the commission finds to be relevant to its inquiry; (6) a summary of alternative approaches to regulation of reserves and surpluses, including the disposition of amounts held by or on behalf of health insurers, with particular consideration of alternatives that would govern the use of those amounts to reduce premiums or to delay or to moderate premium increases; (7) a summary of approaches to regulation of surpluses and endowments held by or on behalf of hospitals, with particular consideration of alternatives that would govern the use of those amounts to reduce the cost of care; and (8) a review of the method by which health insurers and hospitals fund community benefit programs including, but not limited to, the manner by which funding is regulated by other states as to the appropriate amount, monitoring and direction of such funding.  In compiling this report, the commission shall seek input from health plans and hospitals operating in the commonwealth, the attorney general, the executive office of health and human services, and the health care quality and cost council, established in section 16K of section 6A of the General Laws.  In conducting its examination, the commission shall, to the extent possible, obtain and use actual health plan and hospital data and such data shall be confidential and shall not be a public record under clause twenty-sixth of section 7 of chapter 4 of the General Laws or section 10 of chapter 66 of the General Laws. 
           
(f)  The commission may contract with another entity with the requisite financial expertise to assist the commission in conducting its study. 

(g)  The commission shall meet not later than October 1, 2008 and shall hold at least 2 public hearings.  The commission shall file a report of its findings and recommendations with the clerks of the senate and house of representatives, the house and senate committees on ways and means and the joint committee on health care financing not later than July 1, 2009.

SECTION 34.  Notwithstanding any general or special law to the contrary, the department of public health, in consultation with the health care quality and cost council, shall adopt regulations requiring hospitals, as a standard of eligibility for original licensure and renewal of licensure, to register with the National Healthcare Safety Network.  Each hospital that registers with the network shall grant access to the department and the Betsy Lehman center for patient safety and medical error reduction, in accordance with guidelines of the department to: (1) health care-associated infection data elements reportable to the network; and (2) hospital-specific reports generated by the network.  Each registered hospital shall collect and submit to the network health care-associated infection data elements in accordance with guidelines of the department. 

SECTION 35.  Notwithstanding any general or special law to the contrary and not later than October 1, 2012, the department of public health, in consultation with the health care quality and cost council, shall adopt regulations requiring hospitals and community health centers, as a standard of eligibility for original licensure and renewal of licensure, to implement computerized physician order entry systems as defined by the department. The systems shall be certified by the Certification Commission for Healthcare Information Technology or a successor agency or organization established for the purpose of certifying that health information technology meets national interoperability standards. 

SECTION 36.  Notwithstanding any general or special law to the contrary and not later than October 1, 2015, the department of public health, in consultation with the health care quality and cost council, shall adopt regulations requiring hospitals and community health centers, as a standard of eligibility for original licensure and renewal of licensure, to implement interoperable electronic health records systems, as defined by the department. The system shall be certified by the Certification Commission for Healthcare Information Technology or a successor agency or organization established for the purpose of certifying that health information technology meets national interoperability standards. 

SECTION 37.  Notwithstanding any general or special law to the contrary, the executive office of health and human services shall maximize enrollment of eligible persons in the MassHealth Senior Care Options program, the Program of All Inclusive Care for the Elderly, the Enhanced Community Options Program and the Community Choices program, or comparable successor programs, and shall develop dual eligible plans.  For the purposes of this section, “dual eligible plans” shall be plans that offer similar coverage to Medicaid and Medicare-eligible disabled persons under age 65.
           
Not later than 6 months after the effective date of this act, the executive office of health and human services shall prepare a report identifying clinical, administrative and financial barriers to expanded dual eligible plans, and shall recommend steps to remove the barriers and implement the plans. Before finalizing the report, the executive office shall hold a public consultative session that shall include organizations representing seniors, organizations representing disabled persons, organizations representing health care consumers, organizations representing racial and ethnic minorities, health delivery systems and health care providers.  The report shall include consideration of changes in procurement standards and MassHealth payment methodologies to promote enrollment in dual eligible plans.  The report shall include estimates of the costs and benefits of implementing steps to remove barriers to expanded enrollment in dual eligible plans, including financial savings and improved quality of care.

The report shall be provided to the committee on health care financing and the house and senate committees on ways and means.  Subject to appropriation, the executive office of health and human services shall implement any steps recommended by the report.  Not later than 1 year after the filing of the report, the executive office shall issue a progress statement on expanded enrollment in dual eligible plans

SECTION 38.   The department of public health shall, not later than July 1, 2009, establish a registry of exemptions granted by the department pursuant to section 6 of chapter 350 of the acts of 1993 and the department’s regulations to any person who filed with the department by December 23, 1993, a notice of intent to acquire medical, diagnostic or therapeutic equipment used to provide an innovative service or which is a new technology, as defined in section 25B of chapter 111 of the General Laws.  Registered exemptions shall be nontransferable.  After July 1, 2009, all exemptions qualifying for this registry that have not been registered with the department shall be void.  Holders of registered exemptions for medical, diagnostic or therapeutic equipment not placed in regular service by July 1, 2009, shall, upon application, be eligible for an expedited determination of need process, as determined by the department.  Exemptions granted by the department under said section 6 of said chapter 350 and the department’s regulations to any person who filed with the department, by December 23, 1993, a notice of intent to acquire medical, diagnostic or therapeutic equipment used to provide an innovative service or which is a new technology shall expire on July 1, 2010, if the equipment for which the exemption was granted was not placed in regular service by July 1, 2009 and if no determination of need was granted by the department.

SECTION 39.   The division of insurance shall conduct an investigation and study of the costs of medical malpractice coverage for health care providers, as defined in section 193U of chapter 175 of the General Laws.  The investigation and study shall include, but not be limited to, an examination and analysis of the following: (1) the availability and affordability of medical malpractice insurance; (2) the factors considered by medical malpractice insurers when increasing premiums; (3) options for decreasing premiums including, but not limited to, establishing a reinsurance pool with additional stop loss coverage, subsidizing premium payments of providers practicing in certain high-risk specialties or in specialties for which the cost of premiums represents a disproportionately high proportion of a health care provider’s income, subsidizing premium payments of providers who do not qualify for group coverage rates and pay higher premiums for commercial market insurance and prorating premiums for providers who practice less than full-time; and (4) funding mechanisms that would facilitate the implementation of recommendations arising out of the study which may include, but shall not be limited to, charges borne by the health care industry or other entities.  The division shall hold at least 2 public hearings to take testimony relating to the investigation and study, 1 of which shall be held outside the metropolitan Boston area.  The division shall report its findings and recommendations to the house and senate committee on ways and means and the joint committee on health care financing not later than January 1, 2009. 

SECTION 40.  Notwithstanding any general or special law to the contrary, the MassHealth payment advisory board, established in section 16M of chapter 6A of the General Laws, shall conduct a study of the need for an increase in Medicaid rates or bonuses for primary care physicians, nurse practitioners and subspecialists who provide primary care services, such as preventive care, certain evaluation and management procedures, early periodic screening, diagnosis and treatment and scheduled weekend and holiday services, in order to focus on prevention and wellness and delivery of primary care to identify illness earlier, to better manage chronic disease and to avoid costs associated with emergency room visits and hospitalizations.  The committee shall report its findings, including recommendations for the amount of funding and the sources of funding, to the joint committee on health care financing, and the house and senate committees on ways and means not later than January 1, 2009.

SECTION 41.  There shall be a community benefits taskforce, which shall include the attorney general, the commissioner of public health and other members as determined by the attorney general, which shall conduct a study of the community benefits contributions by nonprofit health care providers and insurers.  The study shall include, but not be limited to, examination and analysis of the following: (1) current community benefits programs including, but not limited to, plans filed with the attorney general’s voluntary community benefits program; (2) methods used to identify and define communities to be served by community benefit programs; (3) the process hospitals and insurers use to assess community needs, define target populations for programs and to make resource allocation decisions; (4) methods used to measure and evaluate the contributions by nonprofit health care providers and insurers to various communities; (5) the administrative and technological needs of nonprofit health care providers; (6) potential collaborations between providers to fund improved administrative and technological support systems and information infrastructures as part of a statewide community benefits program including, but not limited to, the creation of a statewide electronic medical records database and computerized physician order entry to improve access and the portability of health information; and (7) whether the commonwealth ought to mandate standards and amounts of community benefits spending and, if so, what standards ought to apply.  The task force shall hold at least 2 public hearings to hear testimony relating to the investigation and study, 1 of which shall be held outside the metropolitan Boston area.  The task force shall report its findings and recommendations to the house and senate committee on ways and means and the joint committee on health care financing not later than January 1, 2009.
     
SECTION 42.  Notwithstanding any general or special law to the contrary, the attorney general shall adopt rules, regulations or guidelines that permit 2 or more health insurers, health maintenance organizations, hospitals or other providers in the health care market to: (1)  discuss methods to standardize or simplify administrative standards, protocols or practices in order to reduce health care costs, improve access to health care services, improve the quality of care or reduce health care disparities; and (2) negotiate and enter into agreements to implements such standards, protocols or practices; provided, however, that no rule, regulation or guideline shall permit rate setting or price fixing, for insurance premiums or payments to providers.
     
Any person or entity acting under the authority of any rule, regulation or guideline adopted pursuant to this section shall be engaged in action under state policy and shall be immune from antitrust liability to the same degree and extent as the commonwealth.
     
SECTION 42A.  Notwithstanding any general or special law to the contrary, the division of health care finance and policy within the executive office of health and human services, in cooperation with the Betsy Lehman Center for Patient Safety and the Reduction of Medical Errors and the Massachusetts Commission on End of Life Care, shall convene an expert panel on quality and cost of end of life care for patients with serious chronic illness. The panel shall make an investigation and study of the health care delivery for this population and the variations in delivery of such care among health care providers in the commonwealth including, but not limited to, the report and findings of the Dartmouth Atlas of Health Care 2008 entitled “Tracking the Care of Patients with Severe Chronic Illness.” For the purposes of this investigation and study, “health care providers” shall mean facilities and health care professionals licensed to provide acute inpatient hospital care, outpatient services, skilled nursing, rehabilitation and long-term hospital care, home health care and hospice services. The panel shall present recommendations for legislation, regulation and policies based upon scientific evidence to identify best practices that ought to constitute the generally accepted standard of care for end of life care for patients with serious chronic illness and that minimize the care delivery disparities and chance variations in practice or spending among different geographic regions and different hospitals that cannot be explained on the basis of illness, strong scientific evidence or well-informed patient preferences.  The panel shall consider the development of an evidence-based physician education program for treating patients with serious chronic illness relative to such factors including: how often to see a patient; how to coordinate care among providers utilizing a single shared electronic health record or communication standards to ensure complete and reliable sharing of information amongst physicians and institutional providers; when to refer a patient to a specialist; when to admit a patient to a licensed health care facility, especially to an intensive care unit; when to order the use of imaging equipment; and the need for adherence to well-informed patient preference expressed through advance directive such as do-not-resuscitate orders and designated health care proxy and living will documents. The panel shall make recommendations relative to: the adoption by health care providers in the commonwealth of practice patterns observed in those regions of the United States considered to be the most efficient in delivery of care to those with serious chronic illness; steps to encourage physician groups and hospitals to be accountable for the coordination, overall costs and quality of care of patients with serious chronic illness; and the identification of incentives to organize, finance and promote such adoption. The report shall address the informational needs of patients and families to make end of life practice patterns transparent such that they may identify providers whose care patterns correspond more closely to their preferences.
           
SECTION 42B.  The group insurance commission, in consultation with the division of insurance, shall investigate and make findings regarding the establishment of a class of health insurance plans for persons in service of the commonwealth under chapter 32A, in addition to individual and family plans, to provide coverage to married couples without any additional dependents.  The investigation shall include an analysis of the cost or impact on existing plans, the anticipated administrative cost of offering such coverage, the anticipated cost to potential participants and any anticipated savings or reduction in premium costs for the commonwealth and potential participants.  The commission may make recommendations for any legislative changes necessary to permit the offering of such plans.  The commission’s findings and recommendations, if any, shall be submitted to the clerks of the house of representatives and the senate, the chairs of the joint committee on health care financing and the chairs of the house and senate committee on ways and means not later than December 31, 2008.
     
SECTION 43.  Any entity providing ambulatory surgical center services which is in operation or under construction, as determined by the department of public health, on the effective date of this act shall be exempt from the determination of need requirement of section 53G of chapter 111 of the General Laws and shall be eligible, pursuant to said section 53G of said chapter 111, to make application to the department for a clinic license for up to 6 months after the effective date of regulations adopted by the department pursuant to said section 53G of said chapter 111.
     
SECTION 43A.  Notwithstanding any general or special law or rule or regulation to the contrary and in recognition of the successful comparative outcomes from the Mass COMM Percutaneous Coronary Intervention trial between hospitals with cardiac surgery on-site and community hospitals without cardiac surgery on-site, the department of public health shall move these community hospitals from the Mass COMM trial to registry oversight, recording outcome data to the Mass-DAC registry not later than September 1, 2008.

SECTION 44.  Section 11 shall apply to any project seeking written approval of final architectural plans, pursuant to section 51 of chapter 111 of the General Laws 6 months or more after the effective day of this act. 

SECTION 45.   The secretary of health and human services shall promulgate the regulations required under subsection (a) of section 16P of chapter 6A of the General Laws not later than October 1, 2009.

SECTION 46.  The health care quality and cost council shall publish the serious reportable event occurrences as required under subsection (a) of section 16P of chapter 6A of the General Laws on its consumer health information website not later than 1 year after the effective date of this act.

SECTION 47.  The department of public health shall promulgate regulations as necessary to implement section 4N of chapter 111 of the General Laws in accordance with chapter 30A not later than October 1, 2008.  The department of public health shall begin implementing the outreach and education program established under said section 4N of said chapter 111 not later than January 1, 2009.

SECTION 48. The bureau of managed care within the division of insurance shall convene the first advisory committee required under section 5B of chapter 176O of the General Laws on January 1, 2009.

SECTION 49.  Notwithstanding any general or special law to the contrary, the secretary of administration and finance and the secretary of health and human services shall prepare and submit a report to the general court about the allocation for and use of state funds by acute care hospitals, non-acute care hospitals, Medicaid managed care organizations, other managed care organizations, community health centers and carriers contracting with the commonwealth health insurance connector authority. The report shall include: (1) a comprehensive review of the current manner, amount and purposes of annual state funding received by those entities, including a description of the source of the funding; (2) an assessment of the change in total state funding for those entities over the past 5 years, with particular attention paid to the impact of chapter 58 of the acts of 2006; (3) an assessment of how those entities use state funds; (4) an assessment of whether the current payment structure assures the delivery of quality health care in the most cost-effective way; (5) an analysis of financial and management practices of those entities by benchmarking performance with respect to quality and cost effectiveness against national performance levels and similar health care providers in the commonwealth; (6) identification of common factors that may contribute to the fiscal instability of those entities; (7) recommendations for the development of performance and operational benchmarks; (8) recommendations for ensuring that the entities are spending state and other funds in a fiscally-responsible manner and providing quality care; (9) recommendations for legislative and other action necessary to strengthen state oversight and ensure greater accountability of state resources; (10) an assessment of the manner in which hospitals seek payment from consumers, including an analysis of the impact that court filing fees have on their ability to collect payment; and (11) recommendations for regulations regarding the due diligence that facilities shall exercise in seeking to collect payment from consumers before seeking reimbursement from the commonwealth.

The secretaries shall have access to all documents of acute care hospitals, non-acute care hospitals, Medicaid managed care organizations, other managed care organizations, community health centers, carriers contracting with the commonwealth health insurance connector authority and any related entities that relate to that organization’s use of state funds; provided, however, that the secretaries shall not request any documents that are in the possession of any agencies of the executive office of administration and finance or the executive office of health and human services. The secretaries shall keep all information and documents obtained under this section confidential and shall not disclose such information or documents to any person except as necessary in a case brought by the attorney general under this chapter.  Such information and documents shall not be public records and shall be exempt from disclosure under section 10 of chapter 66.  

For the purpose of conducting their duties under this section, the secretaries may contract with an outside organization with the requisite financial expertise to enable the secretaries to prepare the report.  The secretaries shall submit the report, along with any recommendations for legislative or other action, to the clerks of the senate and house of representatives not later than December 31, 2008.

SECTION 50.  Not later than 4 years after the effective date of this act, the e-health institute established in section 6D of chapter 40J of the General Laws, shall submit a report to the joint committee on health care financing and the senate and house committees on ways and means on the progress in realizing the purposes of this act, with particular attention to the following: (i)  the capacity to exchange health information between and among components of the health system; (ii)  rates of provider participation in electronic health records; (iii)  rates of provider participation in practice redesign; (iv) quality measurement and improvement; (v) health care cost reduction; (vi) participation in advanced programs such as medical home and pay for performance programs; and (vii) the security and privacy of health information technology supported by this section.

SECTION 51.  Section 7 shall take effect on January 1, 2015.
           
SECTION 52.  Subsection (d) of section 61 of chapter 118E of the General Laws, as appearing in section 19, shall take effect on January 1, 2011.

SECTION 53.  Sections 20 and 24 shall take effect on July 1, 2012.
           
SECTION 54.  Subsection (d) of section 5A of chapter 176O of the General Law, as appearing section 23, shall take effect on January 1, 2011.

SECTION 55.  Section 25 shall take effect on January 1, 2009.

SECTION 56.  Section 34 shall take effect on October 1, 2008.