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| 2 | 2 | | HOUSE DOCKET, NO. 1375 FILED ON: 1/18/2023 |
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| 3 | 3 | | HOUSE . . . . . . . . . . . . . . . No. 3617 |
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| 4 | 4 | | The Commonwealth of Massachusetts |
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| 5 | 5 | | _________________ |
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| 6 | 6 | | PRESENTED BY: |
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| 7 | 7 | | Mark J. Cusack |
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| 8 | 8 | | _________________ |
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| 9 | 9 | | To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General |
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| 10 | 10 | | Court assembled: |
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| 11 | 11 | | The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill: |
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| 12 | 12 | | An Act relative to the joint negotiation prohibition for integrated systems. |
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| 13 | 13 | | _______________ |
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| 14 | 14 | | PETITION OF: |
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| 15 | 15 | | NAME:DISTRICT/ADDRESS :DATE ADDED:Mark J. Cusack5th Norfolk1/18/2023 1 of 3 |
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| 16 | 16 | | HOUSE DOCKET, NO. 1375 FILED ON: 1/18/2023 |
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| 17 | 17 | | HOUSE . . . . . . . . . . . . . . . No. 3617 |
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| 18 | 18 | | By Representative Cusack of Braintree, a petition (accompanied by bill, House, No. 3617) of |
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| 19 | 19 | | Mark J. Cusack relative to the joint negotiation prohibition for integrated systems in health care. |
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| 20 | 20 | | Public Health. |
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| 21 | 21 | | [SIMILAR MATTER FILED IN PREVIOUS SESSION |
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| 22 | 22 | | SEE HOUSE, NO. 2252 OF 2021-2022.] |
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| 23 | 23 | | The Commonwealth of Massachusetts |
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| 24 | 24 | | _______________ |
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| 25 | 25 | | In the One Hundred and Ninety-Third General Court |
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| 26 | 26 | | (2023-2024) |
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| 27 | 27 | | _______________ |
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| 28 | 28 | | An Act relative to the joint negotiation prohibition for integrated systems. |
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| 29 | 29 | | Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority |
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| 30 | 30 | | of the same, as follows: |
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| 31 | 31 | | 1 SECTION 1. Chapter 111 of the General Laws, as so appearing in the 2020 edition, is |
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| 32 | 32 | | 2hereby amended by inserting after section 51K the following new section:- |
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| 33 | 33 | | 3 Section 51L. (a) As used in this section, the following word shall have the following |
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| 34 | 34 | | 4meaning: -- |
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| 35 | 35 | | 5 “Facility”, any hospital, as defined in section 52, or clinic conducted by a hospital, as |
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| 36 | 36 | | 6licensed under section 51, which receives a separate on-site review survey by the Joint |
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| 37 | 37 | | 7Commission on the Accreditation of Healthcare Organizations. |
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| 38 | 38 | | 8 (b) A facility that is either affiliated or owned by a system shall negotiate separate |
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| 39 | 39 | | 9contracts by facility with public and private payers. 2 of 3 |
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| 40 | 40 | | 10 (c) Each facility that is subject to this section that is within a larger system shall establish |
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| 41 | 41 | | 11separate negotiating teams. |
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| 42 | 42 | | 12 (d) Every facility that is subject to this section shall establish a firewall mechanism that |
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| 43 | 43 | | 13prevents the separate contract negotiating teams from sharing any information that would inhibit |
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| 44 | 44 | | 14them from competing with each other and with other hospitals and physician practice groups. |
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| 45 | 45 | | 15 (e) Contracts between a facility and carrier may not be contingent on entering into a |
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| 46 | 46 | | 16contract with another health care provider within a system. |
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| 47 | 47 | | 17 (f) Contracts between a facility and carrier may not make the availability of any price or |
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| 48 | 48 | | 18term for a contract contingent on the carrier entering into a contract with another health care |
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| 49 | 49 | | 19facility. |
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| 50 | 50 | | 20 (g) Separate negotiations shall apply for both inpatient and outpatient services. |
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| 51 | 51 | | 21 (h) The department and the office of the attorney general shall have the authority to |
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| 52 | 52 | | 22enforce the requirements of this section. |
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| 53 | 53 | | 23 (i) The department may grant exemptions from the requirements of this section if a |
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| 54 | 54 | | 24system demonstrates to the satisfaction of the department that the system is integrated pursuant |
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| 55 | 55 | | 25to regulations which the department, in consultation with the division of insurance, shall adopt. |
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| 56 | 56 | | 26In promulgating said regulations, the department shall consider as factors of integration whether: |
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| 57 | 57 | | 27 1. The provider system receives over 50 percent of its revenue from alterative |
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| 58 | 58 | | 28payment arrangements; |
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| 59 | 59 | | 29 2. The provider system has fully implemented one unifying, interoperable electronic |
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| 60 | 60 | | 30medical record system across all providers and facilities within the system; 3 of 3 |
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| 61 | 61 | | 31 3. The provider system has implemented quality improvement initiatives with |
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| 62 | 62 | | 32demonstrable improvements in quality of care provided; |
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| 63 | 63 | | 33 4. The provider system has successfully implemented programs to direct care to the |
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| 64 | 64 | | 34appropriate and lowest costing setting within its system; and |
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| 65 | 65 | | 35 5. The provider system can demonstrate that is has implemented appropriate |
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| 66 | 66 | | 36measures to eliminate unnecessary duplication of health care services within the system. |
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| 67 | 67 | | 37 (j) Health care facilities shall negotiate under the requirements of this section at the time |
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| 68 | 68 | | 38of renewal or expiration of their current contracts with payers. |
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