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