The last sentence of the first paragraph of section 2FF of chapter 29 of the General Laws, is hereby amended by striking out the words “(c) a program of primary and preventive health care for children from birth through age 18 authorized pursuant to the provisions of section 24G of chapter 111” and inserting in place thereof the following words:-  (c) a program of primary and preventive health care for children from birth through age 18 authorized pursuant to the provisions of section 24G of chapter 111;  and (d) a program of primary and preventive health care for adults authorized pursuant to the provisions of section 24K of chapter 111.

SECTION 2. Chapter 111 of the General Laws is hereby amended by inserting after section 24J the following section:-

Section 24K. There is hereby established the Adult Medical Security Plan, a program of managed care to provide primary and preventive health care services for eligible uninsured residents of the commonwealth above age 18. The department shall establish eligibility criteria for the program, which shall require that

(a) an eligible person’s financial eligibility, as determined by the department, shall be less than 300 percent of the federal poverty level;

(b) an eligible person shall be ineligible for medical benefits pursuant to chapter 118E and ineligible for any similar program of comprehensive medical benefits from the commonwealth;

(c) an eligible person shall be ineligible for benefits under the Medicare program; and

(d) an eligible person shall not be eligible for employer-provided health insurance; provided, however, that the department shall specify by regulation minimum standards for employer-provided health insurance, including cost-sharing requirements, premium contribution requirements, medical benefits and other criteria of employer-provided health insurance that disqualifies a person for eligibility for said program.

Said program shall be administered by the department subject to appropriation from the Children’s and Seniors’ Health Care Assistance Fund established pursuant to section 2FF of chapter 29 and other appropriated funds.

The department shall determine the benefits and services available to participants in said program; provided, that the average cost per enrolled person of such benefits and services shall not generally exceed one-half of the average cost of benefits provided to non-disabled beneficiaries enrolled in the MassHealth Standard plan, so called; and provided further, that the benefits and services of the program shall include:

(1) preventive care in a participating doctor’s office, community health center, or health maintenance organization; provided that services provided by a participating independent laboratory for diagnostic laboratory tests shall be reimbursed by said program;

(2) sick visits in a participating doctor's office, community health center, or health maintenance organization; and

(3) smoking and tobacco use cessation treatment and information and the provision of smoking and tobacco use prevention educational information and materials.

In determining such other benefits and services that may be offered by the program, the department shall use as a model the services provided under section 24G, as appropriate.

The department shall establish cost-containment measures designed to ensure that only medically necessary services are reimbursed by said program. The schedule, scope, maximum dollar coverage and duration of the benefits established by this section may be revised by the department to ensure that the costs of said program are limited to the funds appropriated therefor.

Enrollees whose household income is 200 percent or less of the federal poverty level shall not pay premiums to participate in the program. Such enrollees shall be deemed financially unable to pay for hospital services for purposes of the definition of “free care” in section 1 of chapter 118G, and such status shall be noted on any enrollment card or notification materials provided to such enrollees.

 The cost of said program shall be funded in part by premiums contributed by enrollees whose household income is greater than 200 percent of the federal poverty level. Such enrollees shall pay a monthly premium of 50 dollars. Household earnings may be defined on the basis of gross earnings, or on an adjusted basis according to criteria deemed appropriate by the department. The department may also require all enrollees to pay reasonable co-payments in connection with the use of services, provided, that the division may waive copayments upon a finding of substantial financial or medical hardship. Said co-payments shall be designed to encourage the cost-effective and cost-conscious use of services.

Premiums and copayments contributed by enrollees shall be deposited in the Children's and Seniors' Health Care Assistance Fund, established by section 2FF of chapter 29 and may be used for said program subject to appropriation.

The department shall promulgate regulations necessary to implement the requirements of this section.

Applications for said program shall be coordinated with applications for medical benefits pursuant to chapter 118E, and shall use the single application form provided for by section 41 of chapter 170 of the acts of 1997. The department shall use funds made available for this program for community outreach services to encourage enrollment and promote the public health. Priority for such grants shall be given to organizations that work with communities with high rates of uninsurance.

The department shall report quarterly to the house and senate committees on ways and means and to the joint committee on health care on enrollment demographics, claims expenditures and the annualized costs of said program. The department shall file notice with said committees and the secretaries of the executive office of administration and finance and family services not less than thirty days before modifying program benefits and eligibility standards that are intended to ensure that program costs are limited to the funds appropriated therefor.

The program established by this section shall not give rise to enforceable legal rights in any party or an enforceable entitlement to the services funded herein and nothing stated herein shall be construed as giving rise to such enforceable legal rights or such enforceable entitlement.

SECTION 3. The definition of “eligible employee” in subsection (1) of section 9C of chapter 118E of the General Laws is hereby amended by striking out the figure “200” and inserting in place thereof the figure:– 300.

SECTION 4. Subsection (4) of said section 9C of said chapter 118E is hereby amended by striking out the figure “$400” and inserting in place thereof the figure:– $600.

SECTION 5. Said subsection (4) of said section 9C of said chapter 118E is hereby further amended by striking out the figure “$800” and inserting in place thereof the figure:– $1,200.

SECTION 6. Said subsection (4) of said section 9C of said chapter 118E is hereby further amended by striking out the figure “$1,000” and inserting in place thereof the figure:– $1,500.

SECTION 7. Subsection (5) of said section 9C of said chapter 118E is hereby amended by striking out the figure “$400” and inserting in place thereof the figure:– $600.

SECTION 8. Said subsection (5) of said section 9C of said chapter 118E is hereby further amended by striking out the figure “$800” and inserting in place thereof the figure:– $1,200.

SECTION 9. Said subsection (5) of said section 9C of said chapter 118E is hereby further amended by striking out the figure “$1,000” and inserting in place thereof the figure:– $1,500.

SECTION 10. Chapter 118G of the General Laws is hereby amended by adding the following section:–

            Section 24. (a) Each employer with more than 99 employees subject to the provisions of sections 14, 14A, and 14C of chapter 151A shall pay, in the same manner and at the same times as the commissioner of employment and training prescribes for the contribution required by said section 14 of said chapter 151A, an employer fair share health care assessment for each employee pursuant to this section.  For the purposes of this section, “employee” shall not include the following employees of any employer:  (i) any employee who has been employed by such employer for fewer than ninety days from date of hire; and (ii) any employee who is covered by a group or non-group health benefit plan which is financed without any participation by the employer or who is enrolled in the medicare program or a medical assistance program.  Each employee as defined in section 1 of chapter 151A shall be presumed to be an employee as included in this section unless the employer certifies to the commissioner, in such form and manner as the commissioner may require, that such employee should not be included under the provisions of this section.  Each employer may require any employee to verify his health insurance status pursuant to such rules and regulations as the commissioner shall promulgate.  No employer may require an applicant for employment to disclose his health insurance status or that of his spouse, dependents, or other family members.  In no case may an employer discriminate against such applicant on the basis of said applicant's health insurance status.  Any person aggrieved by a violation of the preceding two sentences may institute within three years of such violation a civil action for injunctive relief and any damages thereby incurred.  Any employer found to be in violation pursuant to the action of the aggrieved person shall reimburse such reasonable attorney fees and court costs incurred in the protection of rights granted as shall be determined by the court.

(b) The commissioner shall annually determine by regulation the maximum employer fair share health care assessment to be paid for each employee subject to such assessment. Said maximum assessment shall approximate one half of the cost of an individual comprehensive group managed care health benefits plan. The commissioner shall by regulation establish a maximum assessable wage and an assessment percentage to implement this section. The commissioner shall by regulation establish such other reasonable rules and regulations required to implement this section, including reasonable exemptions for hardship or inequity.

(c) An employer may deduct from the amount owed under this section its cost for providing health insurance coverage or other health care benefits for its employees, allowable for the current quarter by the Internal Revenue Service as a deductible business expense; provided, however, that any nonincorporated employer may deduct from the amount owed for each employee under this section its cost for providing health insurance coverage or other health care benefits for its employees as reported and allowed pursuant to rules and regulations promulgated by the commissioner; and provided, further that such deduction for any employer shall not reduce the assessment for any employee below zero. The commissioner, in consultation with the commissioner of revenue, shall promulgate rules and regulations enforcing the provisions of this subsection.

(d) Employer fair share health care assessments shall be deposited as follows:

(i) 50 percent in the Children’s and Seniors’ Health Care Assistance Fund established by section 2FF of chapter 29, to be divided equally among medical benefits under the MassHealth program authorized by section 9A of chapter 118E and a program of primary and preventive care for uninsured adults pursuant to section 24K of chapter 111;

(ii) 50 percent in the Uncompensated Care Trust Fund established pursuant to section 18 of chapter 118G, to be divided equally among the uncompensated care pool and the Insurance Partnership program, so called, authorized by section 9C of chapter 118E.

(e) The commissioner and the commissioner of employment and training are hereby authorized and directed to enter into an interagency agreement to carry out the provisions of this section in a mutually agreeable and cost-effective manner.

(f) Except where inconsistent with the provisions of this section, the terms and conditions of chapter 151A which are applicable to the payment of and the collection of contributions or payments in lieu of contributions shall apply to the same extent to the payment of and the collection of employer fair share health care assessments; provided, however, that said contributions shall not be credited to any account established pursuant to said chapter 151A.

(g) Any employer who fails to file any report or form as required by this section shall pay a penalty equal to ten percent of the contribution due under this section; provided, however, that the penalty assessed shall not exceed one hundred dollars nor be less than twenty-five dollars for each such failure to file, in addition to restitution for any amounts owed as employer fair share health care assessments as a result of such failure to make a correct contribution.  Any penalties collected pursuant to this section shall be deposited as provided by subsection (d). Any employer, in accordance with rules and regulations promulgated by the commissioner, who relies in good faith on statements by employees relative to their health insurance status shall not be liable for any penalty or restitution for failure to comply with the provisions of this section caused by misstatements of such employees. Any contribution under this section shall be allowable as a business expense.

(h) Any employer notified of a determination of the commissioner or the commissioner of employment and training that it is subject to the provisions of this section or notified of a determination of either said commissioner that an individual is an employee for the purposes of this section, may request a hearing on such determination.  The request for hearing shall be filed within ten days after mailing of the notice of the determination. If a hearing is requested, either said commissioner shall give the employer a reasonable opportunity for a fair hearing before an impartial hearing officer designated by the commissioner.  The conduct of such hearing shall be in accordance with the procedures prescribed by subsection (b) of section 39 of chapter 151A.  Any employer aggrieved by the decision following such hearing may appeal such decision. Such appeal shall be in accordance with the procedures prescribed by sections 40 to 42 of chapter 151A, inclusive.  Unless action is taken under said section 40, the decision of either said commissioner shall be final on all questions of fact and law. 

SECTION 11. The division of medical assistance and the division of health care finance and policy shall prepare a plan to increase health insurance coverage to employees of private human service providers who deliver human and social services under contract with departments within the executive office of health and human services and the executive office of elder affairs. In preparing the plan, said divisions shall estimate the number of said employees who are uninsured, the number of said employees offered employer-sponsored health insurance, the cost of offering health insurance coverage, the capacity of human service providers and employees to afford coverage, and any special considerations for these employers. Said plan shall also estimate the cost to the uncompensated care pool due to the rate of uninsurance among such employees. The plan may include such other information as said divisions deem important to understanding the problem of uninsurance among said employees.

            Said plan shall investigate options for receiving federal financial participation for a portion of the cost of coverage, including extending the insurance partnership program, so called, to such employers, or permitting human service providers or employees to receive partially-subsidized health benefits from the division of medical assistance. Said plan shall detail any waivers of federal requirements that may be necessary for implementation.

            In preparing said plan, said divisions shall consult with groups concerned with reducing uninsurance in the Commonwealth and with groups representing human service workers and employers.

            Said plan and accompanying materials shall be filed with the joint committee on health care and the house and senate committees on ways and means no later than six months after passage of this act.