HOUSE . . . . . . . No. 4643
The Commonwealth of Massachusetts
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HOUSE OF REPRESENTATIVES, May 14, 2024.
The committee on Ways and Means, to whom was referred the Bill
enhancing the market review process (House, No. 4620), reports
recommending that the same ought to pass with an amendment
substituting therefor the accompanying bill (House, No. 4643).
For the committee,
AARON MICHLEWITZ.
1 of 101
FILED ON: 5/14/2024
HOUSE . . . . . . . . . . . . . . . No. 4643
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 enhancing the market review process.
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. Section 16 of chapter 6A of the General Laws, as appearing in the 2022
2Official Edition, is hereby amended by striking out, in lines 24 to 26, inclusive, the words “, the
3division of medical assistance and the Betsy Lehman center for patient safety and medical error
4reduction” and inserting in place thereof the following words:- and the division of medical
5assistance.
6 SECTION 2. Section 16D of said chapter 6A, as so appearing, is hereby amended by
7striking out, in lines 4 and 5, the words “commissioner of insurance” and inserting in place
8thereof the following words:- commissioner of health insurance.
9 SECTION 3. Said section 16D of said chapter 6A, as so appearing, is hereby further
10amended by striking out, in lines 22 to 24, inclusive, the words “department of public health
11established by section 217 of chapter 111, and the managed care bureau in the division of
12insurance” and inserting in place thereof the following words:- health policy commission 2 of 101
13established by section 16 of chapter 6D, and the managed care bureau in the division of health
14insurance.
15 SECTION 4. Section 16G of said chapter 6A, as amended by section 16 of chapter 7 of
16the acts of 2023, is hereby further amended by striking out subsection (b) and inserting in place
17thereof the following subsection:-
18 (b) The following divisions and agencies shall be within the department of consumer
19affairs and business regulation: the division of banks, the division of insurance, the division of
20health insurance, the division of standards, the division of occupational licensure and the
21department of telecommunications and cable.
22 SECTION 5. Section 16N of said chapter 6A of the General Laws is hereby repealed.
23 SECTION 6. Section 16Q of said chapter 6A of the General Laws, as appearing in the
242022 Official Edition, is hereby amended by striking out, in line 13, the word “insurance” and
25inserting in place thereof the following words:- health insurance.
26 SECTION 7. Section 16T of chapter 6A of the General Laws is hereby repealed.
27 SECTION 8. Section 16Z of said chapter 6A, as appearing in the 2022 Official Edition, is
28hereby amended by striking out, in line 7, the word “insurance” and inserting in place thereof the
29following words:- health insurance.
30 SECTION 9. Section 1 of chapter 6D of the General Laws, as so appearing, is hereby
31amended by inserting after the definition of “Alternative payment methodologies or methods”
32the following definition:- 3 of 101
33 “Benchmark cycle”, a fixed, predetermined period of 3 consecutive calendar years during
34which the projected average annual percentage change in total health care expenditures in the
35commonwealth is calculated pursuant to section 9 and monitored pursuant to section 10.
36 SECTION 10. Said section 1 of said chapter 6D, as so appearing, is hereby further
37amended by striking out the definition of “Health care cost growth benchmark” and inserting in
38place thereof the following definition:-
39 “Health care cost growth benchmark”, the projected average annual percentage change in
40total health care expenditures in the commonwealth during a benchmark cycle, as established in
41section 9.
42 SECTION 11. Said section 1 of said chapter 6D, as so appearing, is hereby further
43amended by inserting after the definition of “Health care provider” the following 2 definitions:-
44 “Health care real estate investment trust”, a real estate investment trust, as defined by 26
45U.S.C section 856, whose assets consist of real property held in connection with the use or
46operations of a provider or provider organization.
47 “Health care resource”, any resource, whether personal or institutional in nature and
48whether owned or operated by any person, the commonwealth or political subdivision thereof,
49the principal purpose of which is to provide, or facilitate the provision of, services for the
50prevention, detection, diagnosis or treatment of those physical and mental conditions
51experienced by humans which usually are the result of, or result in, disease, injury, deformity or
52pain; provided, that the term “treatment” shall include custodial and rehabilitative care incident
53to infirmity, developmental disability or old age. 4 of 101
54 SECTION 12. Said section 1 of said chapter 6D, as so appearing, is hereby further
55amended by inserting after the definition of “Health care services” the following 2 definitions:-
56 “Health disparities”, preventable differences in the opportunities to achieve optimal
57health experienced by socially disadvantaged racial, ethnic and other population groups and
58communities, including, but not limited to, preventable differences between groups in health
59insurance coverage, affordability and access to quality health care services.
60 “Health equity”, the state in which a health system offers the infrastructure, facilities,
61services, geographic coverage, affordability and all other relevant features, conditions and
62capabilities that will provide all people with the opportunity and reasonable expectation that they
63can reach their full health potential and well-being and are not disadvantaged in access to health
64care by their race, ethnicity, language, disability, age, gender, gender identity, sexual orientation,
65social class, intersections among these communities or identities, or their socially determined
66circumstances.
67 SECTION 13. Said section 1 of said chapter 6D, as so appearing, is hereby further
68amended by inserting after the definition of “Hospital service corporation” the following
69definition:-
70 “Management services organization”, any organization that is contracted by a provider or
71provider organization to perform management or administrative services relating to, supporting
72or facilitating the provision of patient care.
73 SECTION 14. Said section 1 of said chapter 6D, as so appearing, is hereby further
74amended by striking out, in lines 168 and 169, the word “insurance” and inserting in place
75thereof the following words:- health insurance. 5 of 101
76 SECTION 15. Said section 1 of said chapter 6D, as so appearing, is hereby further
77amended by striking out, in line 189, the word “excludes”.
78 SECTION 16. Said section 1 of said chapter 6D, as so appearing, is hereby further
79amended by inserting after the definition of “Primary care provider” the following definition:-
80 “Private equity company”, any company that collects capital investments from
81individuals or entities and purchases a direct or indirect ownership share of a provider or
82provider organization.
83 SECTION 17. Said section 1 of said chapter 6D, as so appearing, is hereby further
84amended by inserting after the definition of “Shared decision-making” the following definition:-
85 “Significant equity investor”, (i) any private equity company with a financial interest in a
86provider or provider organization, or (ii) an investor, group of investors or other entity with a
87direct or indirect possession of equity in the capital, stock or profits totaling more than 10 per
88cent of a provider or provider organization.
89 SECTION 18. Said section 1 of said chapter 6D, as so appearing, is hereby further
90amended by inserting after the definition of “Surcharge payor” the following definition:-
91 “Technical advisory committee”, the technical advisory committee of the health policy
92commission established by section 4A.
93 SECTION 19. Section 2 of said chapter 6D, as so appearing, is hereby amended by
94striking out subsections (b) and (c) and inserting in place thereof the following subsections:-
95 (b)(1) There shall be a board, with duties and powers established by this chapter, which
96shall govern the commission. The board shall consist of 9 members: 1 of whom shall be the 6 of 101
97secretary of health and human services, or a designee; 1 of whom shall be the commissioner of
98health insurance, or a designee; 5 of whom shall be appointed by the governor, 1 of whom shall
99serve as chairperson, 1 of whom shall be selected from a list of 3 nominees submitted by the
100president of the senate, and 1 of whom shall be selected from a list of 3 nominees submitted by
101the speaker of the house or representatives; and 2 of whom shall be appointed by the attorney
102general. All appointed members shall serve for a term of 5 years, but a person appointed to fill a
103vacancy shall serve only for the unexpired term. An appointed member of the board shall be
104eligible for reappointment; provided, however, no appointed member shall hold full or part-time
105employment in the executive branch of state government. The board shall annually elect 1 of its
106members to serve as vice-chairperson. Each member of the board shall be a resident of the
107commonwealth.
108 (2) The person appointed by the governor to serve as chairperson shall have demonstrated
109expertise in health care administration, finance and management at a senior level. The second
110person appointed by the governor, shall have demonstrated expertise in representing hospitals or
111hospital health systems. The third person appointed by the governor shall have demonstrated
112expertise in health plan administration, benefits management or health insurance brokerage. The
113fourth person appointed by the governor, from the list of nominees submitted by the president of
114the senate, shall have demonstrated expertise in representing the health care workforce as a
115leader in a labor organization. The fifth person appointed by the governor, from the list of
116nominees submitted by the speaker of the house of representatives, shall have demonstrated
117expertise in health care innovation, including pharmaceuticals, biotechnology or medical
118devices. The first person appointed by the attorney general shall be a health economist. The 7 of 101
119second person appointed by the attorney general shall have demonstrated expertise in health care
120consumer advocacy or population health.
121 (c) Five members of the board shall constitute a quorum, and the affirmative vote of 5
122members of the board shall be necessary and sufficient for any action taken by the board. No
123vacancy in the membership of the board shall impair the right of a quorum to exercise all the
124rights and duties of the commission. The appointed members of the board shall receive a stipend
125in an amount not greater than 10 per cent of the salary of the secretary of administration and
126finance under section 4 of chapter 7; provided, however, that the chairperson shall receive a
127stipend in an amount not greater than 12 per cent of the salary of the secretary. The secretary of
128health and human services and the commissioner of health insurance shall not receive a stipend
129for their service as board members. Appointed members of the board shall be special state
130employees subject to chapter 268A. An appointed member of the board shall disclose any
131employment by, affiliation with, or financial interest in a health care entity, and the governor and
132attorney general shall consider, in light of the requirements of said chapter 268A, any such
133employment, affiliation or financial interest prior to appointing a member of the board.
134 SECTION 20. Said chapter 6D is hereby further amended by inserting after section 4 the
135following section:-
136 Section 4A. (a) There is hereby established a technical advisory committee consisting of
137appointed members with demonstrated experience in a broad range of provider sectors and
138public and private health care payers. The technical advisory committee shall: (i) establish the
139adjustment factor as part of the health care cost growth benchmark setting process pursuant to
140subsection (c) of section 9; (ii) provide technical advice to the commission upon request; (iii) 8 of 101
141provide the commission with operational, policy, regulatory or legislative recommendations for
142the commission’s consideration; and (iv) produce an annual report and other reports pursuant to
143subsection (c).
144 (b) The technical advisory committee shall consist of the following 16 members: the
145executive director of the commission, who shall serve as non-voting chairperson; the assistant
146secretary for MassHealth, or a designee; the executive director of the commonwealth health
147insurance connector authority, or a designee; the executive director of the group insurance
148commission, or a designee; and 12 members appointed by the executive director of the
149commission for their technical experience in specific health care sectors, 1 of whom shall be
150selected from a list of 3 nominees submitted by the Massachusetts Hospital Association, Inc., 1
151of whom shall be selected from a list of 3 nominees submitted by the Massachusetts Senior Care
152Association, Inc., 1 of whom shall be selected from a list of 3 nominees submitted by the
153Massachusetts Medical Society, 1 of whom shall be selected from a list of 3 nominees submitted
154by the Massachusetts League of Community Health Centers, Inc., 1 of whom shall be selected
155from a list of 3 nominees submitted by the Massachusetts Biotechnology Council, Inc., 1 of
156whom shall be selected from a list of 3 nominees submitted by the Massachusetts Association of
157Health Plans, Inc., 1 of whom shall be selected from a list of 3 nominees submitted by Blue
158Cross Blue Shield of Massachusetts, Inc., and 5 of whom shall be selected by the executive
159director from applications submitted by candidates with demonstrated experience in health care
160delivery, health care economics, health care data analysis, clinical research and innovation in
161health care delivery, or health care benefits management. In selecting members, the executive
162director shall ensure that the composition of the committee reflects a diversity of expertise in
163health care providers, purchasers, and consumer advocacy groups. Each member of the 9 of 101
164committee shall serve without compensation for a term of 3 years, or until a successor is
165appointed; provided, that no member shall serve more than 2 consecutive terms. Members of the
166committee shall be special state employees subject to chapter 268A. The technical advisory
167committee shall meet at least quarterly or at other times as specified by the commission and shall
168annually elect 1 of its members to serve as vice-chairperson.
169 (c) The technical advisory committee shall report a summary of its activities to the
170commission at least annually, and shall submit additional reports with technical
171recommendations, as requested by the commission. In developing any reports or
172recommendations to the commission, the technical advisory committee shall consider the
173availability, timeliness, quality and usefulness of existing data, including the data collected by
174the center under chapter 12C, and assess the need for additional investments in data collection,
175data validation or data analysis capacity to support the committee in performing its duties.
176 SECTION 21. Section 5 of said chapter 6D, as so appearing, is hereby amended by
177striking out, in line 10, the words “and (vii)” and inserting in place thereof the following words:-
178; (vii) monitor the location and distribution of health care services and health care resources; and
179(viii).
180 SECTION 22. Section 6 of said chapter 6D, as so appearing, is hereby amended by
181striking out the first and second paragraphs and inserting in place thereof the following
182paragraphs:-
183 Each acute hospital, ambulatory surgical center, non-hospital provider organization and
184surcharge payor shall pay to the commonwealth an amount for the estimated expenses of the
185commission. For the purposes of this section, “non-hospital provider organization” shall mean a 10 of 101
186provider organization required to register under section 11 that is: (i) a non-hospital-based
187physician practice with not less than $500,000,000 in annual gross patient service revenue; (ii) a
188clinical laboratory; (iii) an imaging facility; or (iv) a network of affiliated urgent care centers.
189 The assessed amount for hospitals, ambulatory surgical centers and non-hospital provider
190organizations shall be not less than 33 per cent of the amount appropriated by the general court
191for the expenses of the commission minus amounts collected from: (i) filing fees; (ii) fees and
192charges generated by the commission; and (iii) federal matching revenues received for these
193expenses or received retroactively for expenses of predecessor agencies; provided, that non-
194hospital provider organizations shall be assessed not less than 5 per cent of the assessed amount
195for hospitals, ambulatory surgical centers and non-hospital provider organizations. Each acute
196hospital, ambulatory surgical center, and non-hospital provider organization shall pay such
197assessed amount multiplied by the ratio of the hospital’s, ambulatory surgical center’s or non-
198hospital provider organization’s gross patient service revenues to the total gross patient service
199revenues of all such hospitals, ambulatory surgical centers, and non-hospital provider
200organizations. Each acute hospital, ambulatory surgical center and non-hospital provider
201organization shall make a preliminary payment to the commission on October 1 of each year in
202an amount equal to 1/2 of the previous year’s total assessment. Thereafter, each hospital,
203ambulatory surgical center and non-hospital provider organization shall pay, within 30 days’
204notice from the commission, the balance of the total assessment for the current year based upon
205its most current projected gross patient service revenue. The commission shall subsequently
206adjust the assessment for any variation in actual and estimated expenses of the commission and
207for changes in hospital, ambulatory surgical center and non-hospital provider organization gross
208patient service revenue. Such estimated and actual expenses shall include an amount equal to the 11 of 101
209cost of fringe benefits and indirect expenses, as established by the comptroller under section 5D
210of chapter 29. In the event of late payment by any such hospital, ambulatory surgical center or
211non-hospital provider organization, the treasurer shall advance the amount of due and unpaid
212funds to the commission prior to the receipt of such monies in anticipation of such revenues up
213to the amount authorized in the then current budget attributable to such assessments and the
214commission shall reimburse the treasurer for such advances upon receipt of such revenues. This
215section shall not apply to any state institution or to any acute hospital which is operated by a city
216or town.
217 SECTION 23. Section 7 of said chapter 6D, as so appearing, is hereby amended by
218striking out, in line 35, the words “and (vi)” and inserting in place thereof the following words:-
219(vi) advance health equity; and (vii).
220 SECTION 24. Section 8 of said chapter 6D, as so appearing, is hereby further amended
221by striking out the words “for the previous calendar year”, in lines 5 and 6, and inserting in place
222thereof the following words:- established under section 9.
223 SECTION 25. Said section 8 of said chapter 6D, as so appearing, is hereby further
224amended by striking out, in lines 33 and 34, the words “and (xi) any witness identified by the
225attorney general or the center” and inserting in place thereof the following words:- (xi) any
226significant equity investor, health care real estate investment trust or management services
227organization associated with a provider or provider organization; (xii) a representative from the
228division of health insurance; (xiii) the executive director of the commonwealth health insurance
229connector authority; (xiv) the assistant secretary for MassHealth; and (xv) any witness identified 12 of 101
230by the attorney general or the center. The commission shall also request testimony from officials
231representing the federal Centers for Medicare and Medicaid Services.
232 SECTION 26. Said section 8 of said chapter 6D, as so appearing, is hereby further
233amended by striking out, in line 49, the first time it appears, the word “and”.
234 SECTION 27. Said section 8 of said chapter 6D, as so appearing, is hereby further
235amended by inserting after the word “commission”, in line 60, the first time it appears, the
236following words:- ; and (iii) in the case of the assistant secretary for MassHealth, testimony
237concerning the structure, benefits, eligibility, caseload and financing of MassHealth and other
238Medicaid programs administered by the office of Medicaid or in partnership with other state and
239federal agencies and the agency’s activities to align or redesign those programs in order to
240encourage the development of more integrated and efficient health care delivery systems.
241 SECTION 28. Said section 8 of said chapter 6D, as so appearing, is hereby amended, in
242lines 71 and 72, by striking out the words “exceeded the health care cost benchmark in the
243previous calendar year” and inserting in place thereof the following words:- in the previous
244calendar year exceeded the average annual growth established in the health care cost growth
245benchmark.
246 SECTION 29. Said section 8 of said chapter 6D, as so appearing, is hereby amended by
247striking out subsection (g) and inserting in place thereof the following subsection:-
248 (g) The commission shall compile an annual health care cost growth progress report
249concerning spending trends, including primary care and behavioral health expenditures, and the
250underlying factors influencing said spending trends. The commission shall issue a final
251benchmark cycle report after the third year of a benchmark cycle which shall analyze spending 13 of 101
252trends for the entire benchmark cycle. The reports shall be based on the commission’s analysis of
253information provided at the hearings by witnesses, providers, provider organizations and payers,
254registration data collected pursuant to section 11, data collected or analyzed by the center
255pursuant to sections 8, 9 and 10 of chapter 12C and any other available information that the
256commission considers necessary to fulfill its duties under this section, as defined in regulations
257promulgated by the commission. The reports shall be submitted to the chairs of the house and
258senate committees on ways and means and the chairs of the joint committee on health care
259financing and shall be published and available to the public not later than December 31 of each
260year. The reports shall include recommendations for strategies to increase the efficiency of the
261health care system and, in the case of annual progress reports, recommendations on the specific
262spending trends that threaten the commonwealth’s ability to meet the health care cost growth
263benchmark, along with legislative language necessary to implement said recommendations.
264 SECTION 30. Said chapter 6D is hereby further amended by striking out sections 9 and
26510, as so appearing, and inserting in place thereof the following 3 sections:-
266 Section 9. (a) The board shall establish a health care cost growth benchmark for the
267average annual growth in total health care expenditures in the commonwealth during a period of
2683 consecutive calendar years. The commission shall establish the health care cost growth
269benchmark not later than April 15 of the year immediately preceding the first calendar year of a
270benchmark cycle.
271 (b) The health care cost growth benchmark shall be equal to the growth rate of potential
272gross state product established under section 7H½ of chapter 29, plus the adjustment factor
273adopted by the commission upon the recommendation of the technical advisory committee 14 of 101
274pursuant to subsections (c) and (d). The commission shall establish procedures to prominently
275publish the health care cost growth benchmark on the commission’s website.
276 (c) The technical advisory committee shall recommend an adjustment factor to the
277commission not later than February 15 of the year immediately preceding the first calendar year
278of the benchmark cycle; provided, that the adjustment factor shall not be greater than 1 per cent
279or less than minus 1 per cent. The adjustment factor shall be based on economic and market
280factors specific to the health care industry including, but not limited to, the following factors: (i)
281medical inflation as measured by the medical care index within the consumer price index
282calculated by the United States Bureau of Labor Statistics; (ii) labor and workforce development
283costs; (iii) the introduction of new pharmaceuticals, medical devices and other health
284technologies; (iv) historical growth rate in the commonwealth’s gross state product; and (v) any
285other factors as determined by the technical advisory committee. The recommended adjustment
286factor shall be approved by a majority vote of the technical advisory committee; provided,
287however, that should the technical advisory committee fail to approve a recommended
288adjustment factor, the adjustment factor shall be 0 per cent. The technical advisory committee
289shall submit its recommendation to the commission in a public report that shall include an
290analysis supporting the technical advisory committee’s recommended adjustment factor.
291 (d) The commission shall hold a public hearing prior to accepting or rejecting the
292technical advisory committee’s recommended adjustment factor. The public hearing shall be
293based on the report submitted by the technical advisory committee pursuant to subsection (c), the
294report submitted by the center pursuant to section 16 of chapter 12C, any other data provided by
295the technical advisory committee and the center, and such other pertinent information or data as
296may be available to the commission. The commission shall provide public notice of such hearing 15 of 101
297at least 45 days prior to the date of the hearing, including notice to the joint committee on health
298care financing. The joint committee on health care financing may participate in the hearing. The
299commission shall identify as witnesses for the public hearing a representative sample of
300providers, provider organizations, payers and such other interested parties as the commission
301may determine. Any other interested parties may testify at the hearing. The hearing shall
302examine health care provider, provider organization and private and public health care payer
303costs, prices and cost trends, with particular attention to factors that contribute to cost growth
304within the commonwealth’s health care system, and whether, based on the testimony,
305information and data presented at the hearing, it is appropriate to accept the recommended
306adjustment factor.
307 (e) The commission shall approve the recommended adjustment factor by a majority vote
308of the board.
309 Section 9A. (a) For the purposes of this section, “low historic relative price hospital”
310shall mean an acute hospital (i) with an average statewide relative price across all carriers during
311a 5-year period of less than 0.85, and (ii) that is either corporately independent or is corporately
312affiliated with 2 or more acute hospitals but negotiates carrier contracts separately and on its own
313behalf.
314 (b) The commission shall establish a rate equity target to advance the equitable
315reimbursement of low historic relative price hospitals:
316 (1) For the benchmark cycle of calendar years 2026 to 2029, inclusive, a carrier shall not
317pay any in-network low historic relative price hospital a payment rate that is less than 15 per cent
318below the average relative price of all acute hospitals in the carrier’s network; 16 of 101
319 (2) For the benchmark cycle of calendar years 2029 to 2032, inclusive, the average
320annual reimbursement rate increase from a carrier to a low historic relative price hospital shall be
321not less than 2 per cent above the health care cost growth benchmark;
322 (3) For the benchmark cycle of calendar years 2032 to 2035, inclusive, the average
323annual reimbursement rate increase from a carrier to a low historic relative price hospital shall be
324not less than 1 per cent above the health care cost growth benchmark; and
325 (4) Beginning in the benchmark cycle of calendar years 2035 to 2038, inclusive, and
326beyond, the average annual reimbursement rate increase from a carrier to a low historic relative
327price hospital shall be not less than the health care cost growth benchmark.
328 Section 10. (a) As used in this section the following words shall, unless the context
329clearly requires otherwise, have the following meanings:
330 “Health care entity”, a clinic, hospital, ambulatory surgical center, physician
331organization, carrier or accountable care organization required to register under section 11.
332 (b) The commission shall provide notice to all health care entities that have been
333identified by the center under section 18 of chapter 12C. Such notice shall state that the
334commission may analyze the cost growth and the health care spending performance of the
335individual health care entity and that the commission may require certain actions, as established
336in this section, from health care entities so identified.
337 (c)(1) If the commission finds, based on the center’s benchmark cycle report issued under
338subsection (d) of section 16, that the percentage change in total health care expenditures during
339the benchmark period exceeded the health care cost growth benchmark, the commission may 17 of 101
340require certain health care entities to file and implement a performance improvement plan,
341subject to the factors in subsection (f).
342 (2) The commission may require a carrier to file and implement a performance
343improvement plan if the commission determines that the carrier has both: (i) exceeded the health
344care cost growth benchmark; and (ii) failed to meet the rate equity target established by section
3459A.
346 (d) In addition to the notice provided under subsection (b), the commission shall provide
347written notice to any health care entity it determines must file a performance improvement plan.
348Within 45 days of receipt of such written notice, the health care entity shall either:
349 (1) file a performance improvement plan with the commission; or
350 (2) file an application with the commission to waive or extend the requirement to file a
351performance improvement plan.
352 (e) The health care entity may file any documentation or supporting evidence with the
353commission to support the health care entity’s application to waive or extend the requirement to
354file a performance improvement plan. The commission shall require the health care entity to
355submit any other relevant information it deems necessary in considering the waiver or extension
356application; provided, however, that such information shall be made public at the discretion of
357the commission.
358 (f) The commission may waive or delay the requirement for a health care entity to file a
359performance improvement plan in response to a waiver or extension request filed under 18 of 101
360subsection (d) in light of all information received from the health care entity, based on a
361consideration of the following factors:
362 (1) the baseline spending and trends relative to cost, price, utilization and payer mix of
363the health care entity over time, independently and as compared to similar entities, and any
364demonstrated improvement to reduce health status adjusted total medical expenses;
365 (2) any ongoing strategies or investments that the health care entity is implementing to
366improve future long-term efficiency and reduce cost growth;
367 (3) whether the factors that led to increased costs for the health care entity can reasonably
368be considered to be unanticipated and outside of the control of the entity. Such factors may
369include, but shall not be limited to, age and other health status adjusted factors and other cost
370inputs such as pharmaceutical expenses, medical device expenses and labor costs;
371 (4) the overall financial condition of the health care entity;
372 (5) a significant difference between the growth rate of potential gross state product and
373the growth rate of actual gross state product, as determined under section 7H½ of chapter 29; and
374 (6) any other factors the commission considers relevant.
375 (g) If the commission declines to waive or extend the requirement for the health care
376entity to file a performance improvement plan, the commission shall provide written notice to the
377health care entity that its application for a waiver or extension was denied and the health care
378entity shall file a performance improvement plan.
379 (h) A health care entity shall file a performance improvement plan: (1) within 45 days of
380receipt of a notice under subsection (d); (2) if the health care entity has requested a waiver or 19 of 101
381extension, within 45 days of receipt of a notice that such waiver or extension has been denied; or
382(3) if the health care entity is granted an extension, on the date given on such extension. The
383performance improvement plan shall be generated by the health care entity and shall identify the
384causes of the entity's cost growth and, in the case of carriers, the causes for the carrier’s failure to
385meet the rate equity target under section 9A, and shall include, but not be limited to, specific
386strategies, adjustments and action steps the entity proposes to implement to improve cost
387performance and performance against the rate equity target. The proposed performance
388improvement plan shall include specific identifiable and measurable expected outcomes and a
389timetable for implementation. The timetable for a performance improvement plan shall not
390exceed 3 years.
391 (i) The commission shall approve any performance improvement plan that it determines
392is reasonably likely to address the underlying cause of the health care entity’s cost growth and
393has a reasonable expectation for successful implementation.
394 (j) If the board determines that the performance improvement plan is unacceptable or
395incomplete, the commission may provide consultation on the criteria that have not been met and
396may allow an additional time period, up to 30 calendar days, for resubmission; provided,
397however, that all aspects of the performance improvement plan shall be proposed by the health
398care entity and the commission shall not require specific elements for approval.
399 (k) Upon approval of the proposed performance improvement plan, the commission shall
400notify the health care entity to begin implementation of the performance improvement plan.
401Public notice shall be provided by the commission on its website, identifying that the health care
402entity is implementing a performance improvement plan. All health care entities implementing 20 of 101
403an approved performance improvement plan shall be subject to additional reporting requirements
404and compliance monitoring, as determined by the commission. The commission shall provide
405assistance to the health care entity in the successful implementation of the performance
406improvement plan.
407 (l) All health care entities shall, in good faith, work to implement the performance
408improvement plan. A health care entity may file amendments to the performance improvement
409plan at any point during the implementation of the performance improvement plan, subject to
410approval of the commission.
411 (m) At the conclusion of the timetable established in the performance improvement plan,
412the health care entity shall report to the commission regarding the outcome of the performance
413improvement plan. If the commission finds that the performance improvement plan was
414unsuccessful, the commission shall either: (i) extend the implementation timetable of the existing
415performance improvement plan; (ii) approve amendments to the performance improvement plan
416as proposed by the health care entity; (iii) require the health care entity to submit a new
417performance improvement plan, including requiring specific elements for approval,
418notwithstanding the limitation in subsection (j) on the commission’s authority during its review
419of an initial plan proposal; (iv) waive or delay the requirement to file any additional performance
420improvement plans; or (v) conduct a cost and market impact review of the health care entity
421under section 13.
422 (n) Upon the successful completion of the performance improvement plan, the identity of
423the health care entity shall be removed from the list of entities currently implementing a
424performance improvement plan on the commission’s website. 21 of 101
425 (o) The commission may submit a recommendation for proposed legislation to the joint
426committee on health care financing if the commission determines that further legislative
427authority is needed to achieve the commonwealth’s health care quality and spending
428sustainability objectives, assist health care entities with the implementation of performance
429improvement plans or otherwise ensure compliance with the provisions of this section.
430 (p) If the commission determines that a health care entity has: (i) willfully neglected to
431file a performance improvement plan with the commission within 45 days as required under
432subsection (d); (ii) failed to file an acceptable performance improvement plan in good faith with
433the commission; (iii) failed to implement the performance improvement plan in good faith; or
434(iv) knowingly failed to provide information required by this section to the commission or
435knowingly falsified the same, the commission may: (i) assess a civil penalty to the health care
436entity of not more than $500,000 for a first violation, not more than $750,000 for a second
437violation and not more than $1,000,000 for a third or subsequent violation; (ii) stay consideration
438of any material change notice submitted under section 13 by the health care entity until the
439commission determines that the health care entity is in compliance with this section; and (iii)
440notify the department of public health that the health care entity, if applying for a notice of
441determination of need, is not in compliance with this section. The commission shall seek to
442promote compliance with this section and shall only impose a civil penalty as a last resort.
443 (q) The commission shall promulgate regulations necessary to implement this section;
444provided, however, that notice of any proposed regulations shall be filed with the joint
445committee on health care financing at least 180 days before adoption. 22 of 101
446 SECTION 31. Section 11 of said chapter 6D of the General Laws, as appearing in the
4472022 Official Edition, is hereby amended by striking out, in lines 5, 34 and 40 the words
448“division of insurance” and inserting in place thereof, in each instance, the following words:-
449division of health insurance.
450 SECTION 32. Said section 11 of chapter 6D, as so appearing, is hereby amended by
451inserting after the word “affiliates”, in line 17, the following words:- , significant equity
452investors, health care real estate investment trusts, management services organizations.
453 SECTION 33. Section 12 of said chapter 6D, as so appearing, is hereby amended by
454striking out, in lines 8 and 9, the words “carriers or third party administrators” and inserting in
455place thereof the following word:- payers.
456 SECTION 34. Chapter 6D of the General Laws is hereby further amended by striking out
457section 13, as so appearing, and inserting in place thereof the following section:-
458 Section 13. (a) Every provider or provider organization shall, before making any material
459change to its operations or governance structure, submit notice to the commission, the center and
460the attorney general of such change, not fewer than 60 days before the date of the proposed
461change. Material changes shall include, but not be limited to: (i) significant expansions in a
462provider or provider organization’s capacity; (ii) a corporate merger, acquisition or affiliation of
463a provider or provider organization and a carrier; (iii) mergers or acquisitions of hospitals or
464hospital systems; (iv) acquisition of insolvent provider organizations; (v) transactions involving a
465significant equity investor which result in a change of ownership or control of a provider,
466provider organization or a carrier; (vi) significant transfers of assets including, but not limited to,
467real estate sale lease-back arrangements; (vii) conversion of a provider or provider organization 23 of 101
468from a non-profit entity to a for-profit entity; and (viii) mergers or acquisitions of provider
469organizations which will result in a provider organization having a dominant market share in a
470given service or region.
471 Within 30 days of receipt of a notice filed under the commission’s regulations, the
472commission shall conduct a preliminary review to determine whether the material change is
473likely to result in a significant impact on the commonwealth’s ability to meet the health care cost
474growth benchmark established in section 9, or on the competitive market. If the commission
475finds that the material change is likely to have a significant impact on the commonwealth’s
476ability to meet the health care cost growth benchmark, or on the competitive market, the
477commission may conduct a cost and market impact review under this section.
478 (b) In addition to the grounds for a cost and market impact review set forth in subsection
479(a), if the commission finds, based on the center’s final benchmark cycle report under subsection
480(d) of section 16 of chapter 12C, that the percentage change in total health care expenditures
481during the benchmark cycle exceeded the health care cost growth benchmark, the commission
482may conduct a cost and market impact review of any provider organization identified by the
483center under section 18 of chapter 12C.
484 (c) The commission shall initiate a cost and market impact review by sending the
485provider or provider organization notice of a cost and market impact review, which shall explain
486the basis for the review and the particular factors that the commission seeks to examine through
487the review. The provider or provider organization shall submit to the commission, within 21 days
488of the commission’s notice, a written response to the notice, including, but not limited to, any
489information or documents sought by the commission that are described in the commission’s 24 of 101
490notice. The commission may require that any provider or provider organization submit
491documents and information in connection with a notice of material change or a cost and market
492impact review under this section. The commission shall keep confidential all nonpublic
493information and documents obtained under this section and shall not disclose the information or
494documents to any person without the consent of the provider or payer that produced the
495information or documents, except in a preliminary report or final report under this section if the
496commission believes that such disclosure should be made in the public interest after taking into
497account any privacy, trade secret or anti-competitive considerations. The confidential
498information and documents shall not be public records and shall be exempt from disclosure
499under clause Twenty-sixth of section 7 of chapter 4 or section 10 of chapter 66.
500 (d) A cost and market impact review may examine factors relating to the provider or
501provider organization’s business and its relative market position, including, but not limited to: (i)
502the provider or provider organization’s size and market share within its primary service areas by
503major service category, and within its dispersed service areas; (ii) the provider or provider
504organization’s prices for services, including its relative price compared to other providers for the
505same services in the same market; (iii) the provider or provider organization’s health status
506adjusted total medical expense, including its health status adjusted total medical expense
507compared to similar providers; (iv) the quality of the services provided by the provider or
508provider organization, including patient experience; (v) provider cost and cost trends in
509comparison to total health care expenditures statewide; (vi) the availability and accessibility of
510services similar to those provided, or proposed to be provided, through the provider or provider
511organization within its primary service areas and dispersed service areas; (vii) the provider or
512provider organization’s impact on competing options for the delivery of health care services 25 of 101
513within its primary service areas and dispersed service areas including, if applicable, the impact
514on existing service providers of a provider or provider organization’s expansion, affiliation,
515merger or acquisition, to enter a primary or dispersed service area in which it did not previously
516operate; (viii) the methods used by the provider or provider organization to attract patient volume
517and to recruit or acquire health care professionals or facilities; (ix) the role of the provider or
518provider organization in serving at-risk, underserved and government payer patient populations,
519including those with behavioral, substance use disorder and mental health conditions, within its
520primary service areas and dispersed service areas; (x) the role of the provider or provider
521organization in providing low margin or negative margin services within its primary service
522areas and dispersed service areas; (xi) consumer concerns, including but not limited to,
523complaints or other allegations that the provider or provider organization has engaged in any
524unfair method of competition or any unfair or deceptive act or practice; (xii) the size and market
525share of any corporate affiliates or significant equity investors of the provider or provider
526organization; (xiii) the inventory of health care resources maintained by the department of public
527health, pursuant to section 25A of chapter 111, and any related data or reports from the health
528resource planning council, established in section 22; and (xiv) any other factors that the
529commission determines to be in the public interest.
530 (e) The commission shall make factual findings and issue a preliminary report on the cost
531and market impact review. In the report, the commission shall identify any provider or provider
532organization that meets all of the following criteria: (i) the provider or provider organization has,
533or likely will have as a result of the proposed material change, a dominant market share for the
534services it provides; (ii) the provider or provider organization charges, or likely will charge as a
535result of the proposed material change, prices for services that are materially higher than the 26 of 101
536median prices charged by all other providers for the same services in the same market; and (iii)
537the provider or provider organization has, or likely will have as a result of the proposed material
538change, a health status adjusted total medical expense that is materially higher than the median
539total medical expense for all other providers for the same service in the same market.
540 (f) Within 30 days after issuance of a preliminary report, the provider or provider
541organization may respond in writing to the findings in the report. The commission shall then
542issue its final report. The commission shall refer to the attorney general its report on any provider
543or provider organization that meets all 3 criteria under subsection (e). The commission shall
544issue its final report on the cost and market impact review within 185 days from the date that the
545provider or provider organization has submitted notice to the commission; provided, that the
546provider or provider organization has certified substantial compliance with the commission’s
547requests for data and information pursuant to subsection (c) within 21 days of the commission’s
548notice, or by a later date set by mutual agreement of the provider or provider organization and
549the commission.
550 (g) Nothing in this section shall prohibit a proposed material change under subsection (a);
551provided, however, that any proposed material change shall not be completed: (i) until at least 30
552days after the commission has issued its final report; or (ii) if the attorney general brings an
553action as described in subsection (h), while such action is pending and prior to a final judgment
554being issued by a court of competent jurisdiction, whichever is later.
555 (h) A provider or provider organization that meets the criteria in subsection (e) has
556engaged, or through a material change will engage, in an unfair method of competition or unfair
557and deceptive trade practice subject to challenge pursuant to section 4, but not sections 9 or 11, 27 of 101
558of chapter 93A. When the commission, under subsection (f), refers a report on a provider or
559provider organization to the attorney general, the report shall create a presumption that the
560provider or provider organization has met or through the material change addressed in the report
561will meet the 3 criteria in subsection (e) and therefore has engaged, or through a material change
562will engage, in an unfair method of competition or unfair and deceptive trade practice in
563violation of chapter 93A. The attorney general may take action under chapter 93A or any other
564law to protect consumers in the health care market, including by bringing an action seeking to
565restrain such violation of chapter 93A. The commission’s final report may be evidence in any
566such action brought by the attorney general.
567 (i) Nothing in this section shall limit the authority of the attorney general to protect
568consumers in the health care market under any other law.
569 (j) The commission shall adopt regulations for conducting cost and market impact
570reviews and for administering this section. These regulations shall include definitions of material
571change and non-material change, primary service areas, dispersed service areas, dominant market
572share, materially higher prices and materially higher health status adjusted total medical
573expenses, and any other terms as necessary. All regulations promulgated by the commission shall
574comply with chapter 30A.
575 (k) Nothing in this section shall limit the application of other laws or regulations that may
576be applicable to a provider or provider organization, including laws and regulations governing
577insurance.
578 (l) Upon issuance of its final report pursuant to subsection (f), the commission shall
579provide a copy of said final report to the department of public health. The final report shall be 28 of 101
580included in the written record and considered by the department of public health during its
581review of an application for determination of need and considered where relevant in connection
582with licensure or other regulatory actions involving the provider or provider organization.
583 SECTION 35. Section 15 of said chapter 6D, as so appearing, is hereby amended by
584striking out, in line 38, the words “division of insurance” and inserting in place thereof the
585following words:- division of health insurance.
586 SECTION 36. Paragraph (15) of subsection (c) of said section 15 of said chapter 6D, as
587so appearing, is hereby amended by striking out, in line 168, the word “and”.
588 SECTION 37. Said subsection (c) of said section 15 of said chapter 6D, as so appearing,
589is hereby further amended by striking out paragraph (16) and inserting in place thereof the
590following 2 paragraphs:-
591 (16) to ensure ACOs demonstrate, in care delivered in-person and via telehealth,
592compliance with standards that meet or exceed the standards to attain the certification of the
593National Committee for Quality Assurance for the distinction in multicultural health care; and
594 (17) any other requirements the commission considers necessary.
595 SECTION 38. Section 16 of said chapter 6D, as so appearing, is hereby amended by
596striking out, in lines 9, 12 and 67, each time they appear, the words “division of insurance” and
597inserting in place thereof, in each instance, the following words:- division of health insurance.
598 SECTION 39. Said section 16 of said chapter 6D, as so appearing, is hereby further
599amended by striking out, in lines 43 and 44, the words “commissioner of insurance” and
600inserting in place thereof the following words:- commissioner of health insurance. 29 of 101
601 SECTION 40. Said chapter 6D is hereby further amended by adding the following
602section:-
603 Section 22. (a) There is hereby established within the commission a health resource
604planning council, consisting of the executive director of the health policy commission, who shall
605serve as co-chair; the secretary of health and human services or a designee, who shall serve as
606co-chair; the commissioner of public health or a designee; the director of the office of Medicaid
607or a designee; the commissioner of mental health or a designee; the commissioner of health
608insurance or a designee; the secretary of elder affairs or a designee; the executive director of the
609center for health information and analysis or a designee; and 3 members appointed by the
610governor, 1 of whom shall be a health economist, 1 of whom shall have experience in health care
611market planning and service line analysis and 1 of whom shall have experience in health care
612administration and delivery.
613 (b)(1) The council shall develop a state health plan to identify: (i) the anticipated needs of
614the commonwealth for health care services and facilities; (ii) the existing health care resources
615available to meet those needs; (iii) the projected resources, including the health care workforce,
616necessary to meet those anticipated needs; and (iv) the priorities for addressing those needs.
617 (2) The state health plan developed by the council shall be a forecast of anticipated
618demand, supply and distribution of health care resources during a 5-year planning period, and
619shall include the location, distribution and nature of all health care resources in the
620commonwealth, including: (i) acute care units; (ii) non-acute care units; (iii) specialty care units,
621including, but not limited to, burn, coronary care, cancer care, neonatal care, post-obstetric and
622post-operative recovery care, pulmonary care, renal dialysis and surgical, including trauma and 30 of 101
623intensive care units; (iv) skilled nursing facilities; (v) assisted living facilities; (vi) long-term care
624facilities; (vii) ambulatory surgical centers; (viii) office-based surgical centers; (ix) urgent care
625centers; (x) home health; (xi) adult and pediatric behavioral health and mental health services
626and supports; (xii) substance use disorder treatment and recovery services; (xiii) emergency care;
627(xiv) ambulatory care services; (xv) primary care resources; (xvi) pediatric care services; (xvii)
628family planning services; (xviii) obstetrics and gynecology and maternal health services; (xix)
629allied health services including, but not limited to, optometric care, chiropractic services, oral
630health care and midwifery services; (xx) federally qualified health centers and free clinics; (xxi)
631numbers of technologies or equipment defined as innovative services or new technologies by the
632department of public health pursuant to section 25C of chapter 111; (xxii) hospice and palliative
633care service; (xxiii) health screening and early intervention services; and (xxiv) any other service
634or resource identified by the council.
635 (3) The state health plan shall also make recommendations for the supply and distribution
636of health care resources on a state-wide or regional basis based on an assessment of need during
637the 5-year plan and options for implementing such recommendations. The recommendations
638shall reflect, at a minimum, the following goals: (i) to maintain or improve the quality of and
639access to health care services; (ii) to ensure a stable and adequate health care workforce; (iii) to
640support the commonwealth’s efforts to meet the health care cost growth benchmark established
641pursuant to section 9; (iv) to support innovative health care delivery and alternative payment
642models as identified by the commission; (v) to reduce unnecessary duplication of health care
643resources; (vi) to advance health equity and to address health disparities based on the needs of
644particular demographic factors, including, but not limited to, race, ethnicity, immigration status,
645sexual orientation, gender identity, geographic location, age, language spoken, ability and 31 of 101
646socioeconomic status; (vii) to support efforts to integrate oral health, mental health, behavioral
647and substance use disorder treatment services with overall medical care; (viii) to support efforts
648to align housing, health care and home care to improve overall health outcomes and reduce costs;
649(ix) to reflect the latest trends in utilization and support the best standards of care; and (x) to
650ensure equitable access to health care resources across geographic regions of the commonwealth.
651 (c) The council shall provide direction to the department of public health to establish and
652maintain on a current basis an inventory of all such health care resources together with all other
653reasonably pertinent information concerning such resources. Agencies of the commonwealth that
654license, register, regulate or otherwise collect cost, quality or other data concerning health care
655resources shall cooperate with the council and the department of public health in coordinating
656such data and information collected pursuant to this section and section 25A of chapter 111. The
657inventory compiled pursuant to this section and said section 25A of said chapter 111 and all
658related information shall be maintained in a form usable by the general public and shall
659constitute a public record; provided, however, that any item of information which is confidential
660or privileged in nature under any other law shall not be regarded as a public record pursuant to
661this section.
662 (d) The council shall establish an advisory committee of not more than 15 members who
663shall reflect a broad distribution of diverse perspectives on the health care system, including
664health care providers and provider organizations, public and private third-party payers, consumer
665representatives and labor organizations representing health care workers. Not fewer than 2
666members of the advisory committee shall have expertise in rural health matters and rural health
667needs in the commonwealth. The advisory committee shall review drafts and provide 32 of 101
668recommendations to the council during the development of the state health plan described in
669subsection (b).
670 (e) The council shall conduct at least 5 public hearings, in geographically diverse areas
671throughout the commonwealth, during the development of the state health plan and shall give
672interested persons an opportunity to submit their views orally and in writing. In addition, the
673council may create and maintain a website to allow members of the public to submit comments
674electronically and review comments submitted by others.
675 (f) The council shall publish analyses, reports and interpretations of information collected
676pursuant to this section to promote awareness of the distribution and nature of health care
677resources in the commonwealth.
678 (g) The council shall file a report annually by January 1 with the joint committee on
679health care financing concerning the activities of the council in general and, in particular,
680describing the progress to date in developing the state health plan and recommending such
681further legislative action as it considers appropriate.
682 (h) Nothing in this section shall be construed to impose caps on health care resources in
683the commonwealth or a particular region in the commonwealth.
684 SECTION 41. Section 5A of chapter 12 of the General Laws, as appearing in the 2022
685Official Edition, is hereby amended by striking out the words “or “knowingly””, in line 26, and
686inserting in place thereof the following words:- , “knowingly” or “knows”.
687 SECTION 42. Said section 5A of said chapter 12, as so appearing, is hereby further
688amended by inserting after the definition of “Overpayment” the following definition:- 33 of 101
689 “Ownership or investment interest”, any: (1) direct or indirect possession of equity in the
690capital, stock or profits totaling more than 10 per cent of an entity; (2) interest held by an
691investor or group of investors who engages in the raising or returning of capital and who invests,
692develops or disposes of specified assets; or (3) interest held by a pool of funds by investors,
693including a pool of funds managed or controlled by private limited partnerships, if those
694investors or the management of that pool or private limited partnership employ investment
695strategies of any kind to earn a return on that pool of funds.
696 SECTION 43. Said section 5B of said chapter 12, as so appearing, is hereby further
697amended by striking out, in line 29, the word “or”, the second time it appears.
698 SECTION 44. Said section 5B of said chapter 12, as so appearing, is hereby further
699amended by inserting after the word “applicable” in lines 38 and 39, the following words:- ; or
700(11) has an ownership or investment interest in any person who violates clauses (1) through (10),
701knows about the violation, and fails to disclose the violation to the commonwealth or a political
702subdivision thereof within 60 days of identifying the violation.
703 SECTION 45. Section 11F of said chapter 12, as so appearing, is hereby amended by
704striking out, in lines 6 and 7, the words “division of insurance within the department of banking
705and insurance” and inserting in place thereof the following words:- division of insurance or the
706division of health insurance within the department of banking, insurance and health insurance.
707 SECTION 46. Section 11N of said chapter 12, as so appearing, is hereby amended by
708striking out the words “or provider organization”, in line 7, and inserting in place thereof the
709following words:- , provider organization, significant equity investor, health care real estate
710investment trust or management services organization. 34 of 101
711 SECTION 47. Said section 11N of said chapter 12, as so appearing, is hereby further
712amended by striking out subsection (b) and inserting in place thereof the following subsection:-
713 (b) The attorney general may investigate any provider organization referred to the
714attorney general by the health policy commission under section 13 of chapter 6D to determine
715whether the provider organization engaged in unfair methods of competition or anti-competitive
716behavior in violation of chapter 93A or any other law, and, if appropriate, take action under
717chapter 93A or any other law to protect consumers in the health care market including, but not
718limited to, an action for injunctive relief.
719 SECTION 48. Section 1 of chapter 12C of the General Laws, as appearing in the 2022
720Official Edition, is hereby amended by inserting after the definition of “Ambulatory surgical
721center services”, the following definition:-
722 “Benchmark cycle”, a fixed, predetermined period of 3 consecutive calendar years during
723which the projected average annual percentage change in total health care expenditures in the
724commonwealth is calculated pursuant to section 9 of chapter 6D and monitored pursuant to
725section 10 of said chapter 6D.
726 SECTION 49. Said section 1 of said chapter 12C, as so appearing, is hereby further
727amended by striking out the definitions of “Health care professional” and “Health care cost
728growth benchmark” and inserting in place thereof the following 3 definitions:-
729 “Health care cost growth benchmark”, the projected average annual percentage change in
730total health care expenditures in the commonwealth during a benchmark cycle, as established in
731section 9 of chapter 6D. 35 of 101
732 “Health care professional”, a physician or other health care practitioner licensed,
733accredited, or certified to perform specified health services consistent with law.
734 “Health care real estate investment trust”, a real estate investment trust, as defined by 28
735U.S.C section 856, whose assets consist of real property held in connection with the use or
736operations of a provider or provider organization.
737 SECTION 50. Said section 1 of said chapter 12C, as so appearing, is hereby further
738amended by inserting after the definition of “Health care services” the following 2 definitions:-
739 “Health disparities”, preventable differences in the opportunities to achieve optimal
740health experienced by socially disadvantaged racial, ethnic and other population groups and
741communities, including, but not limited to, preventable differences between groups in health
742insurance coverage, affordability and access to quality health care services.
743 “Health equity”, the state in which a health system offers the infrastructure, facilities,
744services, geographic coverage, affordability and all other relevant features, conditions and
745capabilities that will provide all people with the opportunity and reasonable expectation that they
746can reach their full health potential and well-being and are not disadvantaged in access to health
747care by their race, ethnicity, language, disability, age, gender, gender identity, sexual orientation,
748social class, intersections among these communities or identities or their socially determined
749circumstances.
750 SECTION 51. Said section 1 of said chapter 12C, as so appearing, is hereby further
751amended by inserting after the definition of “Major service category” the following definition:- 36 of 101
752 “Management services organization”, any organization that is contracted by a provider or
753provider organization to perform management or administrative services relating to, supporting
754or facilitating the provision of patient care.
755 SECTION 52. Said section 1 of said chapter 12C, as so appearing, is hereby amended by
756striking out, in lines 189 and 190, the words “division of insurance” and inserting in place
757thereof the following words:- division of health insurance.
758 SECTION 53. Said section 1 of said chapter 12C, as so appearing, is hereby further
759amended by inserting after the definition of “Patient-centered medical home” the following
760definition:-
761 “Payer”, any entity, other than an individual, that pays providers for the provision of
762health care services; provided, that “payer” shall include both governmental and private entities;
763provided further, that “payer” shall not include ERISA plans.
764 SECTION 54. Said section 1 of said chapter 12C, as so appearing, is hereby further
765amended by inserting after the definition of “Primary service area” the following definition:-
766 “Private equity company”, a publicly traded or non-publicly traded company that collects
767capital investments from individuals or entities and purchases a direct or indirect ownership
768share of a provider or provider organization.
769 SECTION 55. Said section 1 of said chapter 12C, as so appearing, is hereby further
770amended by inserting after the definition of “Self-insured group” the following definition:-
771 “Significant equity investor”, (i) any private equity company with a financial interest in a
772provider or provider organization, or (ii) an investor, group of investors or other entity with a 37 of 101
773direct or indirect possession of equity in the capital, stock or profits totaling more than 10 per
774cent of a provider or provider organization.
775 SECTION 56. Section 2A of said chapter 12C, as so appearing, is hereby amended by
776striking out, in lines 6 and 7, the words “commissioner of insurance” and inserting in place
777thereof the following words:- commissioner of health insurance.
778 SECTION 57. Section 3 of said chapter 12C, as so appearing, is hereby amended by
779striking out, in lines 19 and 20, the words “division of insurance” and inserting in place thereof
780the following words:- division of health insurance.
781 SECTION 58. Section 7 of said chapter 12C, as so appearing, is hereby amended by
782striking out the first two paragraphs and inserting in place thereof the following paragraphs:-
783 Each acute hospital, ambulatory surgical center, non-hospital provider organization and
784surcharge payor shall pay to the commonwealth an amount for the estimated expenses of the
785center and for the other purposes described in this chapter which shall include any transfer made
786to the Community Hospital Reinvestment Trust Fund established in section 2TTTT of chapter
78729. For the purposes of this section, “non-hospital provider organization” shall mean a provider
788organization required to register under section 11 that is: (i) a non-hospital-based physician
789practice with not less than $500,000,000 in annual gross patient service revenue; (ii) a clinical
790laboratory; (iii) an imaging facility; or (iv) a network of affiliated urgent care centers.
791 The assessed amount for hospitals, ambulatory surgical centers and non-hospital provider
792organizations shall be not less than 33 per cent of the amount appropriated by the general court
793for the expenses of the center and for the other purposes described in this chapter which shall
794include any transfer made to the Community Hospital Reinvestment Trust Fund established in 38 of 101
795section 2TTTT of chapter 29 minus amounts collected from (i) filing fees; (ii) fees and charges
796generated by the center’s publication or dissemination of reports and information; and (iii)
797federal matching revenues received for these expenses or received retroactively for expenses of
798predecessor agencies; provided, that non-hospital provider organizations shall be assessed not
799less than 5 per cent of the assessed amount for hospitals, ambulatory surgical centers and non-
800hospital provider organizations. Each acute hospital, ambulatory surgical center and non-hospital
801provider organization shall pay such assessed amount multiplied by the ratio of the hospital’s,
802ambulatory surgical center’s or non-hospital provider organization’s gross patient service
803revenues to the total gross patient services revenues of all such hospitals, ambulatory surgical
804centers and non-hospital provider organizations. Each acute hospital, ambulatory surgical center
805and non-hospital provider organization shall make a preliminary payment to the center on
806October 1 of each year in an amount equal to 1/2 of the previous year’s total assessment.
807Thereafter, each hospital, ambulatory surgical center and non-hospital provider organization
808shall pay, within 30 days’ notice from the center, the balance of the total assessment for the
809current year based upon its most current projected gross patient service revenue. The center shall
810subsequently adjust the assessment for any variation in actual and estimated expenses of the
811center and for changes in hospital, ambulatory surgical center and non-hospital provider
812organization gross patient service revenue. Such estimated and actual expenses shall include an
813amount equal to the cost of fringe benefits and indirect expenses, as established by the
814comptroller under section 5D of chapter 29. In the event of late payment by any such hospital,
815ambulatory surgical center or non-hospital provider organization, the treasurer shall advance the
816amount of due and unpaid funds to the center prior to the receipt of such monies in anticipation
817of such revenues up to the amount authorized in the then current budget attributable to such 39 of 101
818assessments and the center shall reimburse the treasurer for such advances upon receipt of such
819revenues. This section shall not apply to any state institution or to any acute hospital which is
820operated by a city or town.
821 SECTION 59. Section 8 of chapter 12C, as so appearing, is hereby amended by inserting
822after the word “entities”, in line 5, the following words:- including significant equity investors,
823health care real estate investment trusts and management services organizations.
824 SECTION 60. Said section 8 of said chapter 12C, as so appearing, is hereby further
825amended by inserting after the word “statements”, in line 23, the following words:- , including
826the audited financial statements of the parent organization’s out-of-state operations, significant
827equity investors, health care real estate investment trusts and management services
828organizations,.
829 SECTION 61. Said section 8 of said chapter 12C, as so appearing, is hereby further
830amended by striking out, in line 49, the words “and (6)” and inserting in place thereof the
831following words:- (6) margins, including margins by payer type; (7) investments; (8) information
832on any relationships with significant equity investors, health care real estate investment trusts
833and management service organizations; and (9).
834 SECTION 62. Section 9 of said chapter 12C, as so appearing, is hereby amended by
835striking out the words “entities and corporate affiliates”, in line 21, and inserting in place thereof
836the following words:- entities, including their out-of-state operations, and corporate affiliates,
837including significant equity investors, health care real estate investment trusts and management
838services organizations,. 40 of 101
839 SECTION 63. Said section 9 of said chapter 12C, as so appearing, is hereby further
840amended by striking out, in lines 31, 34 and 35, and 36, each time they appear, the words
841“division of insurance” and inserting in place thereof, in each instance, the following words:-
842division of health insurance.
843 SECTION 64. Said section 9 of said chapter 12C, as so appearing, is hereby further
844amended by striking out, in line 32, the words “and (10)” and inserting in place thereof the
845following words:- (10) information regarding other assets and liabilities that may affect the
846financial condition of the provider organization or the provider organization’s facilities,
847including, but not limited to, real estate sale-leaseback arrangements with health care real estate
848investment trusts; and (11).
849 SECTION 65. Section 10 of said chapter 12C, as so appearing, is hereby amended by
850striking out, in lines 24 and 25, the words “division of insurance” and inserting in place thereof
851the following words:- division of health insurance.
852 SECTION 66. Said section 10 of said chapter 12C, as so appearing, is hereby further
853amended by striking out, in lines 96 and 97, the words “commissioner of insurance” and
854inserting in place thereof the following words:- commissioner of health insurance.
855 SECTION 67. Section 11 of said chapter 12C, as so appearing, is hereby further amended
856by striking out, in line 11, the figure “$1,000” and inserting in place thereof the following
857figure:- $25,000.
858 SECTION 68. Said section 11 of said chapter 12C, as so appearing, is hereby further
859amended by striking out, in lines 13 to 16, inclusive, the words “notice; provided, however, that 41 of 101
860the maximum annual penalty against a private payer, provider or provider organization under this
861section shall be $50,000” and inserting in place thereof the following word:- notice.
862 SECTION 69. Said section 11 of said chapter 12C, as so appearing, is hereby further
863amended by adding the following 2 sentences:- The center shall notify the commission and the
864department of public health if a provider or provider organization fails to timely report in
865accordance with this section, or if the center has assessed a penalty under this section. Such
866notification shall be considered by the commission in a cost and market impact review under
867section 13 of chapter 6D, and by the department in determining licensure and suitability in
868accordance with section 51 of chapter 111 and for a determination of need under section 25C of
869chapter 111.
870 SECTION 70. Said chapter 12C of the General Laws is hereby further amended by
871striking out section 14, as so appearing, and inserting in place thereof the following section:-
872 Section 14. (a)(1) The center, in consultation with the statewide advisory committee
873established pursuant to subsection (c), shall, not later than March 1 in each even-numbered year,
874establish a standard set of measures of health care provider quality and health system
875performance, hereinafter referred to as the “standard quality measure set”, for use in: (i) contracts
876between payers, including the commonwealth and carriers, and health care providers, provider
877organizations and accountable care organizations, which incorporate quality measures into
878payment terms, including the designation of a set of core measures and a set of non-core
879measures; (ii) assigning tiers to health care providers in the design of any health plan; (iii)
880consumer transparency websites and other methods of providing consumer information; and (iv)
881monitoring system-wide performance. 42 of 101
882 (2) The standard quality measure set shall designate: (i) core measures that shall be used
883in contracts that incorporate quality measures into payment terms between payers, including the
884commonwealth and carriers, and health care providers, including provider organizations and
885accountable care organizations, and shall meet the core criteria set by the statewide advisory
886committee pursuant to paragraph (3) of subsection (c); and (ii) a menu of non-core measures that
887may be used in such contracts. The standard quality measure set shall allow for innovation and
888the development of outcome measures. If the standard quality measure set established by the
889center differs from the recommendations of the statewide advisory committee, the center shall
890issue a written report detailing each area of disagreement and the rationale for the center’s
891decision.
892 (b) The center shall develop uniform reporting requirements for the standard quality
893measure set for each health care provider facility, medical group or provider group in the
894commonwealth.
895 (c)(1) The center shall convene a statewide advisory committee which shall make
896recommendations for the standard quality measure set to: (i) ensure consistency in the use of
897quality measures in contracts between payers, including the commonwealth and carriers, and
898health care providers in the commonwealth; (ii) ensure consistency in methods for the
899assignment of tiers to providers in the design of any health plan; (iii) improve quality of care;
900(iv) improve transparency for consumers and employers; (v) improve health system monitoring
901and oversight by relevant state agencies; and (vi) reduce administrative burden.
902 (2) The statewide advisory committee shall consist of commissioner of health insurance
903and the executive director of the health policy commission, or their designees, who shall serve as 43 of 101
904co-chairs, and shall include the following members or their designees: the executive director of
905the center; the executive director of the Betsy Lehman center for patient safety and medical error
906reduction; the executive director of the group insurance commission; the secretary of elder
907affairs; the assistant secretary for MassHealth; the commissioner of the department of public
908health; the commissioner of the department of mental health; and 11 members who shall be
909appointed by the governor, 1 of whom shall be a representative of the Massachusetts Health and
910Hospital Association, Inc., 1 of whom shall be a representative of the Massachusetts League of
911Community Health Centers, Inc., 1 of whom shall be a representative the Massachusetts Medical
912Society, 1 of whom shall be a registered nurse licensed to practice in Massachusetts who
913practices in a patient care setting, 1 of whom shall be a representative of a labor organization
914representing health care workers, 1 of whom shall be a behavioral health provider, 1 of whom
915shall be a long-term supports and services provider, 1 of whom shall be a representative of Blue
916Cross and Blue Shield of Massachusetts, Inc., 1 of whom shall be a representative of the
917Massachusetts Association of Health Plans, Inc., 1 of whom shall be a representative of a
918specialty pediatric provider, and 1 of whom shall be a representative for consumers. Members
919appointed to the statewide advisory committee shall have experience with and expertise in health
920care quality measurement.
921 (3) The statewide advisory committee shall meet quarterly to develop recommendations
922for the core measure and non-core measures to be adopted in the standard quality measure set for
923use in: (i) contracts between payers, including the commonwealth and carriers, and health care
924providers, provider organizations and accountable care organizations, including the designation
925of a set of core measures and a set of non-core measures; (ii) assigning tiers to health care 44 of 101
926providers in the design of any health plan; (iii) consumer transparency websites and other
927methods of providing consumer information; and (iv) monitoring system-wide performance.
928 (4) In developing its recommendations for the standard quality measure set, the statewide
929advisory committee shall incorporate recognized quality measures including, but not limited to,
930measures used by the Centers for Medicare and Medicaid Services, the group insurance
931commission, carriers and providers and provider organizations in the commonwealth and other
932states, as well as other valid measures of health care provider performance and outcomes,
933including patient-reported outcomes and functional status, patient experience, health disparities
934and population health. The statewide advisory committee shall consider measures applicable to
935primary care providers, specialists, hospitals, provider organizations, accountable care
936organizations, oral health providers and other types of providers and measures applicable to
937different patient populations.
938 (5) The statewide advisory committee shall, not later than January 1 in each even-
939numbered year, submit to the center its recommendations on the core measures and non-core
940measures to be adopted, changed or updated by the center in the standard quality measure set,
941along with a report in support of its recommendations.
942 SECTION 71. Section 15 of said chapter 12C is hereby amended by striking out, in line
9434, the word “injury” and inserting in place thereof the following word:- harm.
944 SECTION 72. Said section 15 of said chapter 12C is hereby further amended by striking
945out the definition of “Board” and inserting in place thereof the following 3 definitions:-
946 “Agency”, any agency of the executive branch of the commonwealth, including but not
947limited to any constitutional or other office, executive office, department, division, bureau, 45 of 101
948board, commission or committee thereof; or any authority created by the general court to serve a
949public purpose, having either statewide or local jurisdiction.
950 “Board”, the patient safety and medical errors reduction board.
951 “Healthcare-associated infection”, an infection that a patient acquires during the course of
952receiving treatment for other conditions within a health care setting.
953 SECTION 73. Said section 15 of said chapter 12C, as so appearing, is hereby further
954amended by inserting after the definition of “Patient safety” the following definition:-
955 “Patient safety information”, data and information related to patient safety, including
956adverse events, incidents, medical errors or health care-associated infections, that is collected or
957maintained by agencies.
958 SECTION 74. Said section 15 of said chapter 12C, as so appearing, is hereby further
959amended by striking out subsection (f) and inserting in place thereof the following 3
960subsections:-
961 (f) Notwithstanding any general or special law to the contrary, the Lehman center and
962any agency that collects or maintains patient safety information may transmit such information,
963including personal data as defined in section 1 of chapter 66A, to each other through an
964agreement, which may be an interagency service agreement, that provides for any safeguards
965necessary to protect the privacy and security of the information; provided, that the transmission
966of such information shall be consistent with federal law.
967 (g) The Lehman center may adopt rules and regulations necessary to carry out the
968purpose of this section. The Lehman center may contract with any federal, state or municipal 46 of 101
969entity or other public institution or with any private individual, partnership, firm, corporation,
970association or other entity to manage its affairs or carry out the purpose of this section.
971 (h) The Lehman center shall report annually to the joint committee on health care
972financing regarding the progress made in improving patient safety and medical error reduction.
973The Lehman center shall seek federal and foundation support to supplement state resources to
974carry out the Lehman center’s patient safety and medical error reduction goals.
975 SECTION 75. Section 16 of said chapter 12C, as so appearing, is hereby amended by
976inserting after subsection (c) the following subsection:-
977 (d) The center’s report on the third year of a benchmark cycle shall be a final benchmark
978cycle report and shall compare the costs and cost trends for the entire benchmark cycle with the
979health care cost growth benchmark established by the health policy commission under section 9
980of chapter 6D.
981 SECTION 76. Chapter 12C of the General Laws is hereby amended by striking out
982section 17, as so appearing, and inserting in place thereof the following section:-
983 Section 17. The attorney general may review and analyze any information submitted to
984the center by a provider, provider organization, significant equity investor, health care real estate
985investment trust, management services organization or payer pursuant to sections 8, 9 and 10,
986and to the health policy commission under section 8 of chapter 6D. The attorney general may
987require that such entities produce documents, answer interrogatories and provide testimony under
988oath related to health care costs and cost trends, factors that contribute to cost growth within the
989commonwealth’s health care system and the relationship between provider costs and payer
990premium rates. The attorney general shall keep confidential all nonpublic information and 47 of 101
991documents obtained under this section and shall not disclose the information or documents to any
992person without the consent of the entity that produced the information or documents; provided,
993however that the attorney general may disclose such information or documents during (i) the
994annual hearing conducted under section 8 of chapter 6D, (ii) a rate hearing before the division of
995health insurance, or (iii) in a case brought by the attorney general, if the attorney general believes
996that such disclosure will promote the health care cost containment goals of the commonwealth
997and that the disclosure would be in the public interest after taking into account any privacy, trade
998secret or anti-competitive considerations. The confidential information and documents shall not
999be public records and shall be exempt from disclosure under clause Twenty-sixth of section 7 of
1000chapter 4 or section 10 of chapter 66.
1001 SECTION 77. Said chapter 12C is hereby further amended by striking out section 18 and
1002inserting in place thereof the following section:-
1003 Section 18. (a) For the purposes of this section, “health care entity” shall mean a clinic,
1004hospital, ambulatory surgical center, physician organization, carrier or an accountable care
1005organization required to register under section 11.
1006 (b) The center shall perform ongoing analysis of data it receives under this chapter to
1007identify any health care entity whose:
1008 (1) contribution to health care spending growth, including but not limited to, spending
1009levels and growth as measured by health status adjusted total medical expense, is considered
1010excessive and who threaten the ability of the state to meet the health care cost growth benchmark
1011established by the health policy commission under section 9 of chapter 6D; provided, that the
1012center shall identify cohorts for similar health care entities and establish differential standards for 48 of 101
1013excessive growth rates, based on a health care entity’s baseline spending, pricing levels and
1014payer mix; or
1015 (2) data is not submitted to the center in a proper, timely or complete manner.
1016 (c) The center shall confidentially provide a list of the health care entities to the health
1017policy commission such that the commission may pursue further action under section 10 of
1018chapter 6D. Confidential referrals under this section shall not preclude the center from using its
1019authority to assess penalties for noncompliance under section 11.
1020 SECTION 78. Section 10 of chapter 13 of the General Laws, as so appearing, is hereby
1021amended by striking out the last paragraph and inserting in place thereof the following
1022paragraph:-
1023 The board shall adopt, amend and rescind such rules and regulations as it deems
1024necessary to carry out this chapter; provided, however, that prior to adoption, amendment or
1025rescission, any rule or regulation shall be submitted to the commissioner of public health for
1026approval. The board may, subject to the approval of the commissioner of public health, appoint
1027appropriate staff, including an executive director, legal counsel and any such other assistants as
1028the board may require. The board may also make contracts and arrangements for the
1029performance of administrative and similar services required, or appropriate, in the performance
1030of the duties of the board.
1031 SECTION 79. Said chapter 13 is hereby further amended by striking out section 10A, as
1032so appearing, and inserting in place thereof the following section:- 49 of 101
1033 Section 10A. The commissioner of public health shall review and approve any rule or
1034regulation proposed by the board of registration in medicine pursuant to section 10. Such rule or
1035regulation shall be deemed disapproved unless approved within 30 days of submission to the
1036commissioner pursuant to said section 10.
1037 SECTION 80. Section 1 of chapter 24A of the General Laws is hereby further amended
1038by striking out, in lines 18 and 19, as so appearing, the words “department of banking and
1039insurance” and inserting in place thereof the following words:- department of banking, insurance
1040and health insurance.
1041 SECTION 81. Chapter 26 of the General Laws is hereby amended by striking out the title
1042and inserting in place thereof the following title:- DEPARTMENT OF BANKING,
1043INSURANCE AND HEALTH INSURANCE
1044 SECTION 82. Chapter 26 of the General Laws is hereby further amended by striking out
1045section 1, as appearing in the 2022 Official Edition, and inserting in place thereof the following
1046section:-
1047 Section 1. (a) There shall be a department of banking, insurance and health insurance
1048consisting of a division of banks and loan agencies, a division of insurance and a division of
1049health insurance.
1050 (b)(1) The division of health insurance shall have authority to oversee the health
1051insurance market in the commonwealth and regulate companies organized to transact business
1052and offering policies of accident and sickness insurance under chapter 175; nonprofit hospital
1053service corporations under chapter 176A; nonprofit medical service corporations under chapter
1054176B; nonprofit medical service plans under chapter 176C; dental service corporations under 50 of 101
1055chapter 176E; optometric service corporations under chapter 176F; health maintenance
1056organizations under chapter 176G; preferred provider arrangements under chapter 176I; health
1057benefit plans under chapter 176J; Medicare supplemental insurance or Medicare select insurance
1058contracts authorized under chapter 176K; nongroup health plans under chapter 176M; risk-
1059bearing provider organizations under chapter 176T; long-term care insurance policies under
1060chapter 176U; and dental benefit insurance plans under chapter 176X.
1061 (2) The division of insurance shall have authority for oversight over all other insurance
1062markets not included in paragraph 1.
1063 (c) Each division shall have a commissioner who shall be known, respectively, as the
1064commissioner of banks, the commissioner of insurance and the commissioner of health
1065insurance. The commissioners shall act as a board in all matters concerning the department as a
1066whole.
1067 SECTION 83. Said chapter 26 is hereby further amended by striking out section 7A, as
1068so appearing, and inserting in place thereof the following section:-
1069 Section 7A. (a) As used in this section, the following words shall, unless the context
1070clearly requires otherwise, have the following meanings:-
1071 “Commissioner”, the commissioner of the division of health insurance.
1072 “Division”, the division of health insurance.
1073 “Rate review”, any examination performed by the commissioner of the aggregate rates of
1074payment pursuant to sections 5, 6 and 10 of chapter 176A; section 4 of chapter 176B; section 16
1075of chapter 176G; section 6 of chapter 176J; and section 7 of chapter 176K. 51 of 101
1076 (b) There shall be a commissioner within the division of health insurance who shall be
1077the executive and administrative head of the division, with the authority to oversee the health
1078insurance market in the commonwealth. The commissioner shall: (i) protect the interests of
1079consumers of health insurance; (ii) encourage fair treatment of health care providers by health
1080insurers; (iii) enhance equity, access, quality and affordability in the health care system; (iv)
1081guard the solvency of health insurers; (v) work cooperatively with the health policy commission
1082and the center for health information and analysis to monitor health care spending; and (vi)
1083prioritize affordability of health insurance products during rate review.
1084 (c) The commissioner shall develop affordability standards to consider during rate
1085review; provided, however, that the commissioner’s review of a carrier’s rates shall adhere to
1086principles of solvency and actuarial soundness. Such standards shall consider the following:
1087 (i) affordability for consumers, including the totality of costs paid by consumers of health
1088insurance for covered benefits including, but not limited to, the enrollee’s share of premium, out-
1089of-pocket maximum amounts, deductibles, copays, coinsurance and other forms of cost sharing
1090for health insurance coverage;
1091 (ii) affordability for purchasers, including the totality of costs paid by purchasers of
1092health insurance including, but not limited to, premium costs, actuarial value of coverage for
1093covered benefits and the value delivered on health care spending in terms of improved quality
1094and cost efficiency; and
1095 (iii) the impact of proposed rates on the commonwealth’s performance against the health
1096care cost growth benchmark established in section 9 of chapter 6D. 52 of 101
1097 (d) The commissioner shall review data and documents submitted to the division
1098including, but not limited to, any materials submitted as part of rate reviews, to examine the
1099causes of premium rate increases and excessive provider price variation.
1100 (e) The commissioner shall be appointed by the governor to serve for a term coterminous
1101with that of the governor and shall devote their full time during business hours to the duties of
1102the office. The position of commissioner shall be classified in accordance with section 45 of
1103chapter 30 and the salary shall be determined in accordance with section 46C of said chapter 30.
1104The commissioner shall appoint, at a minimum, the following employees: a first deputy, a
1105general counsel, a chief health economist, a chief actuary, a chief research analyst, and a chief
1106examiner. The appointed employees shall devote their full time to the duties of their offices, shall
1107be exempt from chapters 30 and 31 and shall serve at the pleasure of the commissioner. In case
1108of a vacancy in the office of commissioner, and during their absence or disability, the first deputy
1109shall perform the duties of the office, or in case of the absence or disability of such first deputy,
1110the general counsel. The commissioner may appoint and remove additional employees, including
1111deputies, economists, analysts, examiners, assistant actuaries, inspectors, clerks and other
1112assistants as the work of the division may require. Such additional employees shall perform such
1113duties as the commissioner may prescribe.
1114 (f) The commissioner shall make and collect an assessment against the carriers licensed
1115under chapters 175, 176A, 176B, 176E, 176F and 176G to pay for the expenses of the division.
1116The assessment shall be at a rate sufficient to produce $2,000,000 annually. In addition to that
1117amount, the assessment shall include an amount to be credited to the General Fund which shall
1118be equal to the total amount of funds estimated by the secretary of administration and finance to
1119be expended from the General Fund for indirect and fringe benefit costs attributable to the 53 of 101
1120personnel costs of the division. The assessment shall be allocated on a fair and reasonable basis
1121among all carriers licensed under said chapters. The funds produced by the assessments shall be
1122expended by the division, in addition to any other funds which may be appropriated, to assist in
1123defraying the general operating expenses of the division, and may be used to compensate
1124consultants retained by the division. A carrier licensed under said chapters shall pay the amount
1125assessed against it within 30 days after the date of the notice of assessment from the
1126commissioner.
1127 SECTION 84. Section 7B of said chapter 26, as so appearing, is hereby amended by
1128inserting after the word “commissioner”, in line 2, the following words:- of health insurance.
1129 SECTION 85. Said section 7B of said chapter 26, as so appearing, is hereby further
1130amended by striking out, in line 9, the word “bureau” and inserting in place thereof the following
1131words:- division of health insurance.
1132 SECTION 86. Section 8H of said chapter 26, as so appearing, is hereby amended by
1133striking out the first and second paragraphs.
1134 SECTION 87. Said section 8H of said chapter 26, as so appearing, is hereby further
1135amended by striking out, in lines 48, 55 and 73 and 74, the words “division of insurance” and
1136inserting in place thereof, in each instance, the following words:- division of health insurance.
1137 SECTION 88. Said section 8H of said chapter 26, as so appearing, is hereby further
1138amended by striking out, in line 90, the words “commissioner of insurance” and inserting in
1139place thereof the following words:- commissioner of health insurance. 54 of 101
1140 SECTION 89. Section 8K of said chapter 26, as so appearing, is hereby amended by
1141striking out, in line 1, the words “commissioner of insurance” and inserting in place thereof the
1142following words:- commissioner of health insurance.
1143 SECTION 90. Said section 8K of said chapter 26, as so appearing, is hereby further
1144amended by striking out, in line 28, the words “division of insurance” and inserting in place
1145thereof the following words:- division of health insurance.
1146 SECTION 91. Section 8M of said chapter 26, as so appearing, is hereby amended by
1147striking out, in lines 6 and 74 and 75, the words “commissioner of insurance” and inserting in
1148place thereof, in each instance, the following words:- commissioner of health insurance.
1149 SECTION 92. Said section 8M of said chapter 26, as so appearing, is hereby further
1150amended by striking out, in lines 128 and 129, the words “division of insurance” and inserting in
1151place thereof the following words:- division of health insurance.
1152 SECTION 93. Subsection (b) of section 7H½ of chapter 29 of the General Laws, as so
1153appearing, is hereby amended by striking out the first sentence and inserting in place thereof the
1154following sentence:- On or before January 15 in the year immediately preceding the start of a
1155benchmark cycle, as defined in section 1 of chapter 6D, the secretary of administration and
1156finance shall meet with the house and senate committees on ways and means and shall jointly
1157develop a growth rate of potential gross state product for the ensuing benchmark cycle which
1158shall be agreed to by the secretary and the committees.
1159 SECTION 94. Section 3 of chapter 32A of the General Laws, as so appearing, is hereby
1160amended by striking out, in line 5, the words “commissioner of insurance” and inserting in place
1161thereof the following words:- commissioner of health insurance. 55 of 101
1162 SECTION 95. Section 17Q of said chapter 32A, as so appearing, is hereby amended by
1163striking out, in lines 5 and 6 and 7, the words “division of insurance” and inserting in place
1164thereof, in each instance, the following words:- division of health insurance.
1165 SECTION 96. Section 22B of said chapter 32A, as so appearing, is hereby amended by
1166striking out, in lines 7 and 101 and 102, the words “commissioner of insurance” and inserting in
1167place thereof, in each instance, the following words:- commissioner of health insurance.
1168 SECTION 97. Section 25 of said chapter 32A, as so appearing, is hereby amended by
1169striking out, in lines 78 and 79 and 94, the words “commissioner of insurance” and inserting in
1170place thereof, in each instance, the following words:- commissioner of health insurance.
1171 SECTION 98. Subsection (c) of section 8B of chapter 62C of the General Laws, as so
1172appearing, is hereby amended by striking out the third and fourth sentences and inserting in place
1173thereof the following 2 sentences:- The commissioner of revenue, in consultation with the
1174commissioner of health insurance, may specify the content and format of the statements and
1175reports. The commissioner of revenue may disclose the information in the statements and reports
1176to the division of health insurance, the center for health information and analysis and the
1177commonwealth health insurance connector.
1178 SECTION 99. Said section 8B of said chapter 62C, as so appearing, is hereby further
1179amended by striking out, in lines 35 and 36, the words “commissioner of insurance” and
1180inserting in place thereof the following words:- commissioner of health insurance.
1181 SECTION 100. Section 21 of said chapter 62C is hereby amended by inserting after the
1182word “insurance”, in line 146, as so appearing, the following words:- , the division of health
1183insurance. 56 of 101
1184 SECTION 101. Section 12 of chapter 62E of the General Laws, as so appearing, is
1185hereby amended by inserting after the word “insurance”, in lines 19 and 20, the following
1186words:- , the division of health insurance.
1187 SECTION 102. Section 26 of chapter 63 of the General Laws, as so appearing, is hereby
1188amended by striking out, in lines 3 and 4, the words “and the commissioner of insurance” and
1189inserting in place thereof the following words:- , the commissioner of insurance and the
1190commissioner of health insurance.
1191 SECTION 103. Section 9-609 of chapter 106 of the General Laws, as so appearing, is
1192hereby amended by adding the following subsection:-
1193 (d) Notwithstanding subsection (a), in the case of a debtor that is a hospital licensed by
1194the department of public health under section 51 of chapter 111, and collateral that is a medical
1195device, a secured party shall send notice to the debtor and the department of public health 60
1196days prior to taking possession of the collateral, rendering equipment unusable or disposing of
1197the collateral on the debtor’s premises pursuant to subsection (a). For the purposes of this
1198subsection, “medical device” shall have the same meaning as that term is defined in section 1 of
1199chapter 111N.
1200 SECTION 104. Chapter 110C of the General Laws is hereby amended by striking out
1201section 11, as so appearing, and inserting in place thereof the following section:-
1202 Section 11. If the offeror or a target company is an insurance company subject to
1203regulation under chapter 175 to chapter 175C, inclusive, the commissioner of insurance
1204appointed pursuant to section 6 of chapter 26 or their designee, or the commissioner of health
1205insurance appointed pursuant to section 7A of chapter 26, or their designee, as appropriate, shall 57 of 101
1206for all purposes of this section be substituted for the secretary. This section shall not be construed
1207to limit or modify in any way any responsibility, authority, power or jurisdiction of the secretary,
1208the commissioner of insurance or the commissioner of health insurance pursuant to any other
1209provisions of law.
1210 SECTION 105. Section 24N of chapter 111 of the General Laws, as so appearing, is
1211hereby amended by striking out, in line 71, the words “commissioner of insurance” and inserting
1212in place thereof the following words:- commissioner of health insurance.
1213 SECTION 106. The first paragraph of section 25A of said chapter 111, as so appearing, is
1214hereby amended by striking out the first sentence and inserting in place thereof the following
1215sentence:- Under the direction of the health resource planning council established in section 22
1216of chapter 6D, the department shall establish and maintain, on a current basis, an inventory of all
1217health care resources together with all other reasonably pertinent information concerning such
1218resources, in order to identify the location, distribution and nature of all such resources in the
1219commonwealth.
1220 SECTION 107. Said section 25A of said chapter 111, as so appearing, is hereby further
1221amended by striking out, in lines 16 and 17, the words “in a designated office of the department”
1222and inserting in place thereof the following words:- as determined by the health resource
1223planning council established in section 22 of chapter 6D.
1224 SECTION 108. Said section 25A of said chapter 111, as so appearing, is hereby further
1225amended by striking out the fourth paragraph.
1226 SECTION 109. Section 25C of said chapter 111, as so appearing, is hereby amended by
1227striking out subsection (g) and inserting in place thereof the following subsection:- 58 of 101
1228 (g) The department, in making any determination of need, shall encourage appropriate
1229allocation of private and public health care resources and the development of alternative or
1230substitute methods of delivering health care services so that adequate health care services will be
1231made reasonably available to every person within the commonwealth at the lowest reasonable
1232aggregate cost. The department, in making any determination of need, shall consider: (i) the state
1233health plan developed pursuant to section 22 of chapter 6D; (ii) the commonwealth’s cost
1234containment goals; (iii) the impacts on the applicant’s patients, the workforce of surrounding
1235health care providers and on other residents of the commonwealth; and (iv) any comments and
1236relevant data from the center for health information and analysis, the health policy commission
1237including, but not limited to, any cost and market impact review report pursuant to subsection (l)
1238of section 13 of chapter 6D and any other state agency. The department may impose reasonable
1239terms and conditions on the approval of a determination of need as the department determines
1240are necessary to achieve the purposes and intent of this section. The department may also
1241recognize the special needs and circumstances of projects that: (1) are essential to the conduct of
1242research in basic biomedical or health care delivery areas or to the training of health care
1243personnel; (2) are unlikely to result in any increase in the clinical bed capacity or outpatient load
1244capacity of the facility; and (3) are unlikely to cause an increase in the total patient care charges
1245of the facility to the public for health care services, supplies and accommodations, as such
1246charges shall be defined from time to time in accordance with section 5 of chapter 409 of the acts
1247of 1976.
1248 SECTION 110. Said section 25C of said chapter 111, as so appearing, is hereby further
1249amended by inserting after the word “applicant”, in line 129, the following words:- by an entity
1250selected by the department from a list of 3 entities submitted by the applicant. 59 of 101
1251 SECTION 111. Said section 25C of said chapter 111, as so appearing, is hereby further
1252amended by striking out subsection (i) and inserting in place thereof the following subsection:-
1253 (i) Except in the case of an emergency situation determined by the department as
1254requiring immediate action to prevent further damage to the public health or to a health care
1255facility, the department shall not act upon an application for such determination unless: (i) the
1256application has been on file with the department for at least 30 days; (ii) the center for health
1257information and analysis, the health policy commission, the state and appropriate regional
1258comprehensive health planning agencies and, in the case of long-term care facilities only, the
1259department of elder affairs, or in the case of any facility providing inpatient services for
1260individuals with intellectual or developmentally disabilities, the departments of mental health or
1261developmental services, respectively, have been provided copies of such application and
1262supporting documents and given reasonable opportunity to supply required information and
1263comment on such application; and (iii) a public hearing has been held on such application when
1264requested by the applicant, the state or appropriate regional comprehensive health planning
1265agency, any 10 taxpayers of the commonwealth and any other party of record as defined in
1266section 25C¼. If, in any filing period, an individual application is filed that would implicitly
1267decide any other application filed during such period, the department shall not act only upon an
1268individual.
1269 SECTION 112. Said section 25C of said chapter 111, as so appearing, is hereby further
1270amended by striking out subsection (j) and inserting in place thereof the following subsection:-
1271 (j) The department shall so approve or disapprove, in whole or in part, each such
1272application for a determination of need within 4 months after filing with the department; 60 of 101
1273provided, however, that the department may, on 1 occasion only, delay the action for up to 2
1274months after the applicant has provided information which the department has reasonably
1275requested; and provided further, that the period for review of an application for which an
1276independent cost-analysis is required pursuant to subsection (h) shall be stayed until a completed
1277independent cost-analysis is received and accepted by the department. Any determination of
1278need issued to a holder that is subject to a cost and market impact review under section 13 of
1279chapter 6D shall not go into effect until a minimum of 30 days after the issuance of a final report
1280under subsection (f) of said section 13 of said chapter 6D. Any determination of need issued to a
1281holder that is subject to a performance improvement plan pursuant to section 10 of said chapter
12826D shall not go into effect until 30 days after a determination by the health policy commission
1283that the holder is implementing or has implemented said performance improvement plan;
1284provided, however, that the health policy commission may rescind its determination that the
1285holder is implementing a performance improvement plan at any time prior to successful
1286completion of the performance improvement plan. Applications remanded to the department by
1287the health facilities appeals board under section 25E shall be acted upon by the department
1288within the same time limits provided in this section for the department to approve or disapprove
1289applications for a determination of need. If an application has not been acted upon by the
1290department within such time limits, the applicant may, within a reasonable period of time, bring
1291an action in the nature of mandamus in the superior court to require the department to act upon
1292the application.
1293 SECTION 113. Said chapter 111 is hereby further amended by inserting after section 25C
1294the following section:- 61 of 101
1295 Section 25C¼. (a) As used in this section, the following words shall, unless the context
1296clearly requires otherwise, have the following meanings:-
1297 “Independent community hospital”, any hospital that has been: (i) designated by the
1298health policy commission as an independent community hospital for the year in which an
1299application for a determination of need is filed; or (ii) qualified in the year 2021 as an eligible
1300hospital as defined in subsection (d) of section 63 of chapter 260 of the acts of 2020.
1301 “Party of record”, an applicant for a determination of need; the attorney general; the
1302center for health information and analysis; the health policy commission; any government
1303agency with relevant oversight or licensure authority over the proposed project or components
1304therein; any 10 taxpayers of the commonwealth; or an independent community hospital whose
1305primary service area overlaps with the primary service area of the applicant’s proposed project.
1306A party of record may review an application for determination of need as well as provide written
1307comment for consideration by the department.
1308 “Primary service area”, the contiguous geographic area from which a health care facility
1309draws 75 per cent of its commercial discharges, as measured by the zip codes closest to the
1310facility by drive time, and for which the facility represents a minimum proportion of the total
1311discharges in a zip code, as determined by the department in consultation with the health policy
1312commission and based on the best available data using a methodology determined by the
1313department in consultation with the health policy commission.
1314 “Proposed project”, a project for the construction of a freestanding ambulatory surgery
1315center for which a notice of determination of need is a prerequisite of licensure. 62 of 101
1316 (b) For any application for a determination of need for which the primary service area of
1317the proposed project overlaps with the primary service area of an existing independent
1318community hospital, the applicant shall obtain and include in such application a letter of support
1319from the independent community hospital’s chief executive officer and board chair; provided,
1320however, that a proposed project that constitutes a joint venture between the applicant and the
1321independent community hospital shall be exempt from this subsection. The department shall
1322conduct a preliminary review of each application to determine compliance with this subsection.
1323If the department determines that an application is not in compliance, the department shall
1324identify to the applicant any independent community hospital whose support is required by this
1325subsection and dismiss said application without prejudice. If the department fails to conduct a
1326preliminary review of an application or fails to dismiss an application that does not satisfy the
1327requirements of this subsection, the independent community hospital whose primary service area
1328overlaps with the primary service area of the proposed project may, within a reasonable period of
1329time, bring a civil action in the nature of mandamus in the superior court to require the
1330department to act in accordance with this subsection.
1331 SECTION 114. Section 25F of said chapter 111, as appearing in the 2022 Official
1332Edition, is hereby amended by inserting after the word “care”, in line 7, the following word:-
1333financing.
1334 SECTION 115. Section 25G of said chapter 111, as so appearing, is hereby amended by
1335inserting after the word “agency”, in line 3, the following words:- , an independent community
1336hospital, as defined by section 25C¼, whose primary service area overlaps with the primary
1337service area of a proposed project under said section 25C¼. 63 of 101
1338 SECTION 116. Section 51G of said chapter 111, as so appearing, is hereby amended by
1339striking out paragraph (4) and inserting in place thereof the following paragraph:-
1340 (4)(a) Any hospital shall inform the department 90 days prior to the closing of the
1341hospital or the discontinuance of any essential health service provided therein. The department
1342shall by regulation define the words “essential health service” for the purposes of this section.
1343The department shall, in the event that a hospital proposes to discontinue an essential health
1344service or services, conduct a public hearing on the closure of said essential services or of the
1345hospital. The department shall determine whether any such discontinued services are necessary
1346for preserving access and health status in the hospital’s service area and shall require hospitals to
1347submit a plan for assuring access to such necessary services following the hospital’s closure of
1348the service and assure continuing access to such services in the event that the department
1349determines that their closure will significantly reduce access to necessary services. The
1350department shall conduct a public hearing prior to a determination on the closure of said essential
1351services or of the hospital.
1352 (b) The health policy commission may conduct and submit to the department an essential
1353service closure impact assessment to analyze the impact of the proposed essential service closure
1354on health care access, cost, quality or market function. To support its analysis, the health policy
1355commission may require the hospital to submit information concerning the essential service
1356closure, including, but not limited to, its organizational structure, input costs, pricing, utilization
1357and revenue. The service closure impact assessment shall evaluate factors that impact the
1358hospital’s ability to maintain the essential health service and shall include, but shall not be
1359limited to, an analysis of the following: (i) the hospital’s overall financial position and the
1360financial position of the service line, including quality of earnings assessment; (ii) significant 64 of 101
1361factors influencing the hospital’s financial position, including those within and outside of the
1362hospital’s control; (iii) other operating conditions including, but not limited to, staffing, supplies
1363and patient demand; and (iv) the impact of the service closure on the functioning of the health
1364care system, particularly on vulnerable populations and on the state health plan developed
1365pursuant to section 22 of chapter 6D. The commission shall keep confidential all nonpublic
1366information and documents obtained under this paragraph and shall not disclose the information
1367or documents to any person without the consent of the hospital that produced the information or
1368documents, except in summary form if the commission believes that such disclosure should be
1369made in the public interest after taking into account any privacy, trade secret or anti-competitive
1370considerations. The confidential information and documents shall not be public records and shall
1371be exempt from disclosure under clause Twenty-sixth of section 7 of chapter 4 or section 10 of
1372chapter 66. The essential service closure impact assessment may include recommendations on an
1373appropriate hospital plan for ensuring access following the essential service closure or
1374recommendations to the department concerning strategies to address challenges in maintaining
1375such services.
1376 (c) No original license shall be granted to establish or maintain an acute-care hospital, as
1377defined in section 25B, unless the applicant submits a plan, to be approved by the department,
1378for the provision of community benefits, including the identification and provision of essential
1379health services. In approving the plan, the department may take into account the applicant’s
1380existing commitment to primary and preventive health care services and community
1381contributions as well as the primary and preventive health care services and community
1382contributions of the predecessor hospital. The department may waive this requirement, in whole
1383or in part, at the request of the applicant that has provided or at the time the application is filed, is 65 of 101
1384providing, substantial primary and preventive health care services and community contributions
1385in its service area.
1386 SECTION 117. Said section 51G of said chapter 111, as so appearing, is hereby further
1387amended by adding the following 2 paragraphs:-
1388 (7)(a) No original license shall be granted to establish or maintain an acute-care hospital,
1389as defined in section 25B, if the main campus of the acute-care hospital is leased from a health
1390care real estate investment trust, as defined in section 1 of chapter 6D; provided, however, that
1391any acute-care hospital that, as of April 1, 2024, is leasing its main campus from a health care
1392real estate investment trust shall be exempt from the requirements of this subsection. An exempt
1393acute-care hospital under this subsection shall maintain its exempt status after a transfer to any
1394transferee and subsequent transferees. A transferee or subsequent transferee of an acute-care
1395hospital that is exempt from the requirements of this subsection shall be issued a license if the
1396transferee otherwise satisfies all other requirements for licensure under this chapter. For the
1397purposes of this subsection, “main campus” shall mean the licensed premises within which the
1398majority of inpatient beds are located.
1399 (b) No original license shall be granted to establish or maintain an acute-care hospital
1400unless all documents related to any lease, master lease, sublease, license or any other agreement
1401for the use, occupancy or utilization of the premises occupied by the acute-care hospital are
1402disclosed to the department upon application for licensure.
1403 (8) No original license shall be granted to establish or maintain an acute-care hospital, as
1404defined in section 25B, unless the applicant is in compliance with the reporting requirements
1405established in sections 8, 9 and 10 of chapter 12C. 66 of 101
1406 SECTION 118. Section 51H of said chapter 111, as so appearing, is hereby amended by
1407striking out the definition of “Facility” and inserting in place thereof the following definition:-
1408 “Facility”, a hospital, institution for the care of unwed mothers, clinic providing
1409ambulatory surgery as defined in section 25B, limited service clinic licensed pursuant to section
141051J, office-based surgical center licensed pursuant to section 51M or urgent care center licensed
1411pursuant to section 51N.
1412 SECTION 119. Said section 51H of said chapter 111, as so appearing, is hereby further
1413amended by inserting after the definition of “Healthcare-associated infection” the following
1414definition:-
1415 “Operational impairment event”, any action, or notice of impending action, including a
1416notice of financial delinquency, concerning the repossession of medical equipment or supplies
1417necessary for the provision of patient care.
1418 SECTION 120. Subsection (b) of said section 51H of said chapter 111, as so appearing, is
1419hereby amended by adding the following paragraph:-
1420 An operational impairment event shall be reported by a facility not later than 1 calendar
1421day after it occurs. Notwithstanding any general or special law to the contrary, no contract
1422between a facility and a lessor of medical equipment shall authorize the repossession of medical
1423equipment or supplies unless the lessor provides a notice of financial delinquency to the
1424department not less than 60 days prior to repossession of any medical equipment or supplies
1425necessary for the provision of patient care. Any provision of any contract or other document
1426between a lessor of medical equipment and a facility which does not comply with this paragraph
1427shall be void as against public policy of the commonwealth. 67 of 101
1428 SECTION 121. Said chapter 111 is hereby further amended by inserting after section 51L
1429the following 2 sections:-
1430 Section 51M. (a) As used in this section, the following words shall, unless the context
1431clearly requires otherwise, have the following meanings:-
1432 “Deep sedation”, a drug-induced depression of consciousness during which: (i) the
1433patient cannot be easily awakened but responds purposefully following repeated painful
1434stimulation; (ii) the patient’s ability to maintain independent ventilatory function may be
1435impaired; (iii) the patient may require assistance in maintaining a patent airway and spontaneous
1436ventilation may be inadequate; and (iv) the patient’s cardiovascular function is usually
1437maintained without assistance.
1438 “General anesthesia”, a drug-induced depression of consciousness during which: (i) the
1439patient is not able to be awakened, even by painful stimulation; (ii) the patient’s ability to
1440maintain independent ventilatory function is often impaired; (iii) the patient, in many cases, often
1441requires assistance in maintaining a patent airway and positive pressure ventilation may be
1442required because of depressed spontaneous ventilation or drug-induced depression of
1443neuromuscular function; and (iv) the patient’s cardiovascular function may be impaired.
1444 “Minimal sedation”, a drug-induced state during which: (i) patients respond normally to
1445verbal commands; (ii) cognitive function and coordination may be impaired; and (iii) ventilatory
1446and cardiovascular functions are unaffected.
1447 “Minor procedures”, (i) procedures that can be performed safely with a minimum of
1448discomfort where the likelihood of complications requiring hospitalization is minimal; (ii) 68 of 101
1449procedures performed with local or topical anesthesia; or (iii) liposuction with removal of less
1450than 500cc of fat under un-supplemented local anesthesia.
1451 “Moderate sedation”, a drug-induced depression of consciousness during which: (i) the
1452patient responds purposefully to verbal commands, either alone or accompanied by light tactile
1453stimulation; (ii) no interventions are required to maintain a patent airway; (iii) spontaneous
1454ventilation is adequate; and (iv) the patient’s cardiovascular function is usually maintained
1455without assistance.
1456 “Office-based surgical center”, an office, group of offices, a facility or any portion
1457thereof owned, leased or operated by 1 or more practitioners engaged in a solo or group practice,
1458however organized, whether conducted for profit or not for profit, which is advertised,
1459announced, established or maintained for the purpose of providing office-based surgical services;
1460provided, however, that “office-based surgical center” shall not include: (i) a hospital licensed
1461under section 51 or by the federal government; (ii) an ambulatory surgical center as defined
1462pursuant to section 25B and licensed under said section 51; or (iii) a surgical center performing
1463services in accordance with section 12M of chapter 112.
1464 “Office-based surgical services”, any ambulatory surgical or other invasive procedure
1465requiring: (i) general anesthesia; (ii) moderate sedation; or (iii) deep sedation and any liposuction
1466procedure, excluding minor procedures and procedures requiring minimal sedation, where such
1467surgical or other invasive procedure or liposuction is performed by a practitioner at an office-
1468based surgical center.
1469 (b) The department shall establish rules, regulations and practice standards for the
1470licensing of office-based surgical centers. In determining rules, regulations and practice 69 of 101
1471standards necessary for licensure as an office-based surgical center, the department may, at its
1472discretion, determine which regulations applicable to an ambulatory surgical center, as defined in
1473section 25B, shall apply to an office-based surgical center.
1474 (c) The department shall issue for a term of 2 years and renew for a like term, a license to
1475maintain an office-based surgical center to an entity or organization that demonstrates to the
1476department that it is responsible and suitable to maintain such a center. An office-based surgical
1477center license shall list the specific locations on the premises where surgical services are
1478provided. In the case of the transfer of ownership of an office-based surgical center, the
1479application of the new owner for a license, when filed with the department on the date of transfer
1480of ownership, shall have the effect of a license for a period of 3 months.
1481 (d) An office-based surgical center license shall be subject to suspension, revocation or
1482refusal to issue or to renew for cause if, in its reasonable discretion, the department determines
1483that the issuance of such license would be inconsistent with the best interests of the public health,
1484welfare or safety. Nothing in this subsection shall limit the authority of the department to require
1485a fee, impose a fine, conduct surveys and investigations or to suspend, revoke or refuse to renew
1486a license issued pursuant to subsection (c).
1487 (e) Initial application and renewal fees for the license shall be established pursuant to
1488section 3B of chapter 7.
1489 (f) The department may impose a fine of up to $10,000 on a person or entity that
1490advertises, announces, establishes or maintains an office-based surgical center without a license
1491granted by the department. The department may impose a fine of not more than $10,000 on a
1492licensed office-based surgical center for violations of this section or any rule or regulation 70 of 101
1493promulgated pursuant to this section. Each day during which a violation continues shall
1494constitute a separate offense. The department may conduct surveys and investigations to enforce
1495compliance with this section.
1496 (g) Notwithstanding any general or special law or rule to the contrary, the department
1497may issue a 1-time provisional license to an applicant for an office-based surgical center licensed
1498pursuant to this section if such office-based surgical center holds: (i) a current accreditation from
1499the Accreditation Association for Ambulatory Health Care, American Association for
1500Accreditation of Ambulatory Surgery Facilities, Inc., or the Joint Commission, or (ii) a current
1501certification for participation in either Medicare or Medicaid. The department may approve such
1502a provisional application upon a finding of responsibility and suitability and that the office-based
1503surgical center meets all other licensure requirements as determined by the department. Such
1504provisional license issued to an office-based surgical center shall not be extended or renewed.
1505 Section 51N. (a) As used in this section, the following words shall, unless the context
1506clearly requires otherwise, have the following meanings:-
1507 “Emergency services”, as defined in section 1 of chapter 6D.
1508 “Urgent care center”, a clinic owned or operated by an entity that is not corporately
1509affiliated with a hospital licensed under section 51, however organized, whether conducted for
1510profit or not for profit, that is advertised, announced, established or maintained for the purpose of
1511providing urgent care services in an office or a group of offices, or any portion thereof, or an
1512entity that is advertised, announced, established or maintained under a name that includes the
1513words “urgent care” or that suggests that urgent care services are provided therein; provided,
1514however, that an urgent care center shall not include: (i) a hospital licensed under said section 51 71 of 101
1515or operated by the federal government or by the commonwealth; (ii) a clinic licensed under said
1516section 51; (iii) a limited service clinic licensed under section 51J; or (iv) a community health
1517center receiving a grant under 42 U.S.C. 254b.
1518 “Urgent care services”, a model of episodic care for the diagnosis, treatment,
1519management or monitoring of acute and chronic disease or injury that is: (i) for the treatment of
1520illness or injury that is immediate in nature but does not require emergency services; (ii)
1521provided on a walk-in basis without a prior appointment; (iii) available to the general public
1522during times of the day, weekends or holidays when primary care provider offices are not
1523customarily open; and (iv) is not intended, and should not be used for, preventative or routine
1524services.
1525 (b) The department shall establish rules, regulations, and practice standards for the
1526licensing of urgent care centers. In determining regulations and practice standards necessary for
1527licensure as an urgent care center, the department may, at its discretion determine which
1528regulations applicable to a clinic licensed under section 51, shall apply to an urgent care center.
1529 (c) The department shall issue for a term of 2 years and renew for a like term, a license to
1530maintain an urgent care center to an entity or organization that demonstrates to the department
1531that it is responsible and suitable to maintain such an urgent care center. In the case of the
1532transfer of ownership of an urgent care center, the application of the new owner for a license,
1533when filed with the department on the date of transfer of ownership, shall have the effect of a
1534license for a period of 3 months.
1535 (d) An urgent care center license shall be subject to suspension, revocation or refusal to
1536issue or to renew for cause if, in its reasonable discretion, the department determines that the 72 of 101
1537issuance of such license would be inconsistent with or opposed to the best interests of the public
1538health, welfare or safety. Nothing in this subsection shall limit the authority of the department to
1539require a fee, impose a fine, conduct surveys and investigations or to suspend, revoke or refuse to
1540renew a license issued pursuant to subsection (c).
1541 (e) Initial application and renewal fees for the license shall be established pursuant to
1542section 3B of chapter 7.
1543 (f) The department may impose a fine of up to $10,000 on a person or entity that
1544advertises, announces, establishes or maintains an urgent care center without a license granted by
1545the department. The department may impose a fine of not more than $10,000 on a licensed
1546urgent care center for violations of this section or any rule or regulation promulgated pursuant to
1547this section. Each day during which a violation continues shall constitute a separate offense. The
1548department may conduct surveys and investigations to enforce compliance with this section.
1549 (g) Notwithstanding any general or special law or rule to the contrary, the department
1550may issue a 1-time provisional license to an applicant for an urgent care center if such urgent
1551care center holds: (i) a current accreditation from the Accreditation Association for Ambulatory
1552Health Care, Urgent Care Association of America, or the Joint Commission or (ii) a current
1553certification for participation in either Medicare or Medicaid. The department may approve such
1554provisional application upon a finding of responsibility and suitability and that the urgent care
1555center meets all other licensure requirements as determined by the department. Such provisional
1556license issued to an urgent care center shall not be extended or renewed.
1557 SECTION 122. Said chapter 111 is hereby further amended by inserting after section
155853H the following section:- 73 of 101
1559 Section 53I. (a) A clinic or physician practice registered under section 4A of chapter 112,
1560hereinafter referred to as registered physician practice, shall notify the department not less than
1561180 days prior to any sale, relocation or closure. The department may conduct a public hearing
1562on the proposed sale, relocation or closure not less than 90 days prior to the proposed date of
1563such event. The hearing shall consider the potential impacts of the proposed transaction,
1564including, but not limited to:
1565 (i) the potential loss or change in access to services for the population served by the clinic
1566or registered physician practice in the 24 months immediately preceding the notice to sell,
1567relocate or close;
1568 (ii) alternative providers and locations where the population served by the clinic or
1569registered physician practice will be able to obtain the health care services that were provided by
1570the clinic or registered physician practice during the 24 months following the sale, relocation or
1571closure; and
1572 (iii) options available to the department to mitigate the impact of the sale, relocation or
1573closure on patients.
1574 (b) Any clinic or registered physician practice that intends to sell, relocate or close shall
1575notify their patients in writing not less than 90 days prior to the date of such sale, relocation or
1576closure. The written notice shall be sent in a manner prescribed by the department and shall
1577notify the patient that the clinic or registered physician practice shall continue to provide services
1578to the patient for 90 days. Such notice shall also offer the patient resources to assist in finding a
1579substitute health care provider and include the name and contact information for the entity
1580assuming responsibility for the management of the patient’s medical records. 74 of 101
1581 SECTION 123. Section 206A of said chapter 111, as appearing in the 2022 Official
1582Editions, is hereby amended by striking out, in lines 1 and 2, the words “division of insurance”
1583and inserting in place thereof the following words:- division of health insurance.
1584 SECTION 124. Section 218 of said chapter 111, as so appearing, is hereby amended by
1585striking out, in line 2, the words “commissioner of insurance” and inserting in place thereof the
1586following words:- commissioner of health insurance.
1587 SECTION 125. Said section 218 of said chapter 111, as so appearing, is hereby further
1588amended by striking out, in line 28, the words “Maintenance Organizations” and inserting in
1589place thereof the following word:- Plans.
1590 SECTION 126. Section 2 of chapter 111K of the General Laws, as so appearing, is
1591hereby amended by striking out, in lines 4 and 5, the words “commissioner of insurance” and
1592inserting in place thereof the following words:- commissioner of health insurance.
1593 SECTION 127. Section 1 of chapter 111M of the General Laws, as so appearing, is
1594hereby amended by striking out, in lines 34 and 35, the words “commissioner of insurance” and
1595inserting in place thereof the following words:- commissioner of health insurance.
1596 SECTION 128. Section 2 of chapter 112 of the General Laws, as so appearing, is hereby
1597amended by striking out the last sentence of the sixth paragraph and inserting in place thereof the
1598following sentence:- The renewal application shall be accompanied by a fee determined under
1599the aforementioned provision and shall include the physician’s name, license number, home
1600address, office address, specialties, the principal setting of their practice, and whether they are an
1601active or inactive practitioner. 75 of 101
1602 SECTION 129. Said chapter 112 is hereby further amended by inserting after section 4
1603the following section:-
1604 Section 4A. (a) The board shall establish and maintain a registry of all physician practices
1605of greater than 10 physicians engaged in a wholly-owned and controlled group practice;
1606provided, however, that a provider organization registered pursuant to section 11 of chapter 6D
1607shall not be required to register under this section. Any person seeking to maintain a physician
1608practice shall file with the board a registration application containing such information as the
1609board may reasonably require including, but not limited to: (i) the identity of the applicant and of
1610the physicians which constitute the practice; (ii) the identity of any substantial equity investor, as
1611defined in section 1 of said chapter 6D, of the practice; (iii) any management services
1612organization, as defined in said section 1 of said chapter 6D, under contract with the practice;
1613and (iv) a certified copy of the physician practice’s certificate of organization, if any, as filed
1614with the secretary of the commonwealth, or any applicable partnership agreement. The
1615application shall be accompanied by a fee in an amount to be determined pursuant to section 3B
1616of chapter 7. All physician practices registered in the commonwealth shall renew their
1617certificates of registration with the board every 2 years.
1618 SECTION 130. Said chapter 112 is hereby further amended by inserting after section 5O
1619the following section:-
1620 Section 5P. (a) Any physician licensed by the board who intends to terminate a bona fide
1621physician-patient relationship where the physician has a role in the ongoing care and treatment of
1622the patient, shall notify the patient in writing not less than 90 days prior to the date of such
1623termination in a manner prescribed through guidance established by the board. The requirements 76 of 101
1624of this section may be satisfied through notice otherwise consistent with the requirements of this
1625section delivered by the physician’s employing entity, including, but not limited to, a physician
1626practice registered pursuant to section 4A.
1627 (b) The notice required under this section shall also offer the patient resources to assist in
1628finding a substitute health care provider and include the name and contact information for the
1629entity assuming responsibility for the management of the patient’s medical records. Any
1630physician who terminates a physician-patient relationship without providing notice to a patient as
1631provided for in this section shall be subject to discipline by the board of registration in medicine.
1632 SECTION 131. Section 9C of chapter 118E of the General Laws, as appearing in the
16332022 Official Edition, is hereby amended by striking out, in lines 43 and 44 and lines 147 and
1634148, the words “commissioner of insurance” and inserting in place thereof, in each instance, the
1635following words:- commissioner of health insurance.
1636 SECTION 132. Said section 9C of said chapter 118E, as so appearing, is hereby further
1637amended by striking out, in line 161, the words “committee on health care” and inserting in place
1638thereof the following words:- joint committee on health care financing.
1639 SECTION 133. Section 9D of said chapter 118E, as so appearing, is hereby amended by
1640striking out, in line 183, the words “division of insurance” and inserting in place thereof the
1641following words:- division of health insurance.
1642 SECTION 134. Section 13D of said chapter 118E, as so appearing, is hereby amended by
1643striking out, in line 17, each time they appear, the words “division of insurance” and inserting in
1644place thereof, in each instance, the following words:- division of health insurance. 77 of 101
1645 SECTION 135. Section 69 of said chapter 118E, as so appearing, is hereby amended by
1646striking out, in line 58, the words “division of insurance” and inserting in place thereof the
1647following words:- division of health insurance.
1648 SECTION 136. Section 189 of chapter 149 of the General Laws, as so appearing, is
1649hereby amended by striking out, in lines 68 and 69, the words “and (iv) the commissioner of
1650insurance or a designee” and inserting in place thereof the following words:- (iv) the
1651commissioner of insurance or a designee; and (v) the commissioner of health insurance or a
1652designee.
1653 SECTION 137. Section 1 of chapter 175 of the General Laws, as so appearing, is hereby
1654amended by striking out the definition of “Commissioner” and inserting in place thereof the
1655following definition:-
1656 “Commissioner”, (i) the commissioner of insurance appointed pursuant to section 6 of
1657chapter 26, or their designee, or, as appropriate, (ii) the commissioner of health insurance
1658appointed pursuant to section 7A of said chapter 26, or their designee, to the extent that this
1659chapter applies to companies that are regulated by the division of health insurance pursuant to
1660section 1 of said chapter 26.
1661 SECTION 138. Said section 1 of said chapter 175, as so appearing, is hereby further
1662amended by inserting after the definition of “Contract on a Variable Basis” the following
1663definition:-
1664 “Division”, the division of insurance or the division of health insurance, as appropriate. 78 of 101
1665 SECTION 139. Section 4 of said chapter 175, as so appearing, is hereby amended by
1666striking out, in line 9, the words “of insurance”.
1667 SECTION 140. Section 24D of said chapter 175, as so appearing, is hereby amended, in
1668lines 19, 32 and 33, 59 and 99, by inserting after the words “commissioner of insurance”, the
1669following words, in each instance:- and the commissioner of health insurance.
1670 SECTION 141. Section 24E of said chapter 175, as so appearing, is hereby amended by
1671inserting after the word “insurance”, in line 70, the following words:- and the commissioner of
1672health insurance.
1673 SECTION 142. Said section 24E of said chapter 175, as so appearing, is hereby further
1674amended by inserting after the word “insurance”, in line 102, the following words:- or the
1675commissioner of health insurance.
1676 SECTION 143. Section 24F of said chapter 175, as so appearing, is hereby amended, in
1677lines 17, 29 and 30, 65 and 83, by inserting after the words “commissioner of insurance”, the
1678following words, in each instance:- and the commissioner of health insurance.
1679 SECTION 144. Said section 24F of said chapter 175, as so appearing, is hereby further
1680amended by inserting after the word “insurance”, in line 100, the following words:- or the
1681commissioner of health insurance.
1682 SECTION 145. Section 47B of said chapter 175, as so appearing, is hereby amended by
1683striking out, in line 142, the words “division of insurance” and inserting in place thereof the
1684following words:- division of health insurance. 79 of 101
1685 SECTION 146. Section 47J of said chapter 175, as so appearing, is hereby amended by
1686striking out, in line 1, the words “commissioner of insurance” and inserting in place thereof the
1687following words:- commissioner of health insurance.
1688 SECTION 147. Section 47W of said chapter 175, as so appearing, is hereby amended by
1689striking out, in line 117, the words “commissioner of insurance” and inserting in place thereof
1690the following words:- commissioner of health insurance.
1691 SECTION 148. Section 47AA of said chapter 175, as so appearing, is hereby amended by
1692striking out, in lines 83 and 84 and line 99, the words “commissioner of insurance” and inserting
1693in place thereof, in each instance, the following words:- commissioner of health insurance.
1694 SECTION 149. Section 47KK of said chapter 175, as so appearing, is hereby amended by
1695striking out, in lines 7 and 8 and line 10, the words “division of insurance” and inserting in place
1696thereof, in each instance, the following words:- division of health insurance.
1697 SECTION 150. Section 47TT of said chapter 175, as so appearing, is hereby amended by
1698striking out, in line 51, the words “division of insurance” and inserting in place thereof the
1699following words:- division of health insurance.
1700 SECTION 151. Section 108 of said chapter 175, as so appearing, is hereby amended by
1701striking out, in lines 681 and 682, the words “commissioner of insurance” and inserting in place
1702thereof the following words:- commissioner of health insurance.
1703 SECTION 152. Section 108I of said chapter 175, as so appearing, is hereby amended by
1704striking out, in line 58, the words “of insurance”. 80 of 101
1705 SECTION 153. Section 108M of said chapter 175, as so appearing, is hereby amended by
1706striking out, in line 10, the words “of insurance”.
1707 SECTION 154. Section 110I of said chapter 175, as so appearing, is hereby amended by
1708striking out, in line 23, the words “of insurance”.
1709 SECTION 155. Section 110J of said chapter 175, as so appearing, is hereby amended by
1710striking out, in line 22, the words “of insurance”.
1711 SECTION 156. Section 206 of said chapter 175, as so appearing, is hereby amended by
1712striking out the definition of “Commissioner” and inserting in place thereof the following
1713definition:-
1714 “Commissioner”, (i) the commissioner of insurance appointed pursuant to section 6 of
1715chapter 26, or their designee, or, as appropriate, (ii) the commissioner of health insurance
1716appointed pursuant to section 7A of said chapter 26, or their designee, to the extent that this
1717chapter applies to companies that are regulated by the division of health insurance pursuant to
1718section 1 of said chapter 26.
1719 SECTION 157. Said section 206 of said chapter 175, as so appearing, is hereby further
1720amended by striking out the definition of “Division” and inserting in place thereof the following
1721definition:-
1722 “Division”, the division of insurance or the division of health insurance, as appropriate.
1723 SECTION 158. Section 206C of said chapter 175, as so appearing, is hereby amended by
1724striking out, in lines 647 and 648, the words “division of insurance’s” and inserting in place
1725thereof the following words:- division’s. 81 of 101
1726 SECTION 159. Chapter 175B of the General Laws is hereby amended by inserting after
1727section 1 the following section:-
1728 Section 1A. For the purposes of this chapter, the term “commissioner” shall mean: (i) the
1729commissioner of insurance appointed pursuant to section 6 of chapter 26, or their designee, or, as
1730appropriate, (ii) the commissioner of health insurance appointed pursuant to section 7A of said
1731chapter 26, or their designee, to the extent that this chapter applies to companies that are
1732regulated by the division of health insurance pursuant to section 1 of said chapter 26.
1733 SECTION 160. Section 2 of said chapter 175B, as appearing in the 2022 Official Edition,
1734is hereby amended by striking out, in lines 9, 18, and 20 and 21, each time they appear, the
1735words “of insurance”.
1736 SECTION 161. Section 3A of said chapter 175B, as so appearing, is hereby amended by
1737striking out, in line 7, the words “of insurance”.
1738 SECTION 162. Section 1 of chapter 175D of the General Laws, as so appearing, is
1739hereby amended by striking out paragraph (1) and inserting in place thereof the following
1740paragraph:-
1741 (1) “Commissioner”, (i) the commissioner of insurance appointed pursuant to section 6 of
1742chapter 26, or their designee, or, as appropriate, (ii) the commissioner of health insurance
1743appointed pursuant to section 7A of said chapter 26, or their designee, to the extent that this
1744chapter applies to companies that are regulated by the division of health insurance pursuant to
1745section 1 of said chapter 26. 82 of 101
1746 SECTION 163. Section 2 of chapter 175I of the General Laws, as so appearing, is hereby
1747amended by striking out the definition of “Commissioner” and inserting in place thereof the
1748following definition:-
1749 “Commissioner”, (i) the commissioner of insurance appointed pursuant to section 6 of
1750chapter 26, or their designee, or, as appropriate, (ii) the commissioner of health insurance
1751appointed pursuant to section 7A of said chapter 26, or their designee, to the extent that this
1752chapter applies to companies that are regulated by the division of health insurance pursuant to
1753section 1 of said chapter 26.
1754 SECTION 164. Section 9 of said chapter 175I, as so appearing, is hereby amended by
1755striking out, in lines 21 and 22, the words “of insurance”.
1756 SECTION 165. Section 2 of chapter 176A of the General Laws, as so appearing, is
1757hereby amended by striking out, in lines 11 and 12, and lines 13 and 14, the words
1758“commissioner of insurance” and inserting in place thereof, in each instance, the following
1759words:- commissioner of health insurance.
1760 SECTION 166. Section 3 of said chapter 176A, as so appearing, is hereby amended by
1761striking out, in lines 3 and 4, the words “commissioner of insurance” and inserting in place
1762thereof the following words:- commissioner of health insurance.
1763 SECTION 167. Section 5 of said chapter 176A, as so appearing, is hereby amended by
1764inserting after the word “corporation.”, in line 44, the following sentence:- For the purposes of
1765the review of rates of payment under this section, “not excessive” shall include considerations of
1766affordability for consumers and purchasers of health insurance products. 83 of 101
1767 SECTION 168. Said section 5 of said chapter 176A, as so appearing, is hereby further
1768amended by striking out, in lines 205 and 206, the words “commissioner of insurance shall on
1769December thirty-first, nineteen hundred and seventy and annually thereafter require” and
1770inserting in place thereof the following words:- commissioner of health insurance shall require
1771annually, on December 31,.
1772 SECTION 169. The second paragraph of section 6 of said chapter 176A, as so appearing,
1773is hereby amended by adding the following sentence:- For the purposes of the review of rates of
1774payment under this section, whether a contract is not excessive shall include considerations of
1775affordability for consumers and purchasers of health insurance products.
1776 SECTION 170. Section 7 of said chapter 176A, as so appearing, is hereby amended by
1777striking out, in lines 1 and 11, the words “commissioner of insurance” and inserting in place
1778thereof, in each instance, the following words:- commissioner of health insurance.
1779 SECTION 171. Section 8 of said chapter 176A, as so appearing, is hereby amended by
1780striking out, in line 27, the words “commissioner of insurance” and inserting in place thereof the
1781following words:- commissioner of health insurance.
1782 SECTION 172. Section 8A of said chapter 176A, as so appearing, is hereby amended by
1783striking out, in line 142, the words “division of insurance” and inserting in place thereof the
1784following words:- division of health insurance.
1785 SECTION 173. Section 8F of said chapter 176A, as so appearing, is hereby amended by
1786striking out, in line 19, the words “commissioner of insurance” and inserting in place thereof the
1787following words:- commissioner of health insurance. 84 of 101
1788 SECTION 174. Section 8M of said chapter 176A, as so appearing, is hereby amended by
1789striking out, in line 1, the words “commissioner of insurance” and inserting in place thereof the
1790following words:- commissioner of health insurance.
1791 SECTION 175. Section 8W of said chapter 176A, as so appearing, is hereby amended by
1792striking out, in line 114, the words “commissioner of insurance” and inserting in place thereof
1793the following words:- commissioner of health insurance.
1794 SECTION 176. Section 8DD of said chapter 176A, as so appearing, is hereby amended
1795by striking out, in lines 81 and 82 and line 97, the words “commissioner of insurance” and
1796inserting in place thereof, in each instance, the following words:- commissioner of health
1797insurance.
1798 SECTION 177. Section 8MM of said chapter 176A, as so appearing, is hereby amended
1799by striking out, in lines 7 and 9, the words “division of insurance” and inserting in place thereof,
1800in each instance, the following words:- division of health insurance.
1801 SECTION 178. Section 8UU of said chapter 176A, as so appearing, is hereby amended
1802by striking out, in line 41, the words “division of insurance” and inserting in place thereof the
1803following words:- division of health insurance.
1804 SECTION 179. Section 10 of said chapter 176A, as so appearing, is hereby amended by
1805striking out, in line 25, the words “commissioner of insurance” and inserting in place thereof the
1806following words:- commissioner of health insurance.
1807 SECTION 180. The third paragraph of said section 10 of said chapter 176A, as so
1808appearing, is hereby further amended by inserting after the first sentence the following sentence:- 85 of 101
1809For the purposes of the review of rates of payment under this section, whether a contract is not
1810excessive shall include considerations of affordability for consumers and purchasers of health
1811insurance products.
1812 SECTION 181. Section 11 of said chapter 176A, as so appearing, is hereby amended by
1813striking out, in line 13, the words “commissioner of insurance” and inserting in place thereof the
1814following words:- commissioner of health insurance.
1815 SECTION 182. Section 15 of said chapter 176A, as so appearing, is hereby amended by
1816striking out, in line 3, the words “commissioner of insurance” and inserting in place thereof the
1817following words:- commissioner of health insurance.
1818 SECTION 183. Section 16 of said chapter 176A, as so appearing, is hereby amended by
1819striking out, in line 1, the words “commissioner of insurance” and inserting in place thereof the
1820words:- commissioner of health insurance.
1821 SECTION 184. Section 17 of said chapter 176A, as so appearing, is hereby amended, in
1822lines 9 and 11, by inserting after the words “commissioner of insurance”, each time they appear,
1823the following words, in each instance:- and the commissioner of health insurance.
1824 SECTION 185. Section 18 of said chapter 176A, as so appearing, is hereby amended by
1825striking out, in line 3, the words “commissioner of insurance” and inserting in place thereof the
1826following words:- commissioner of health insurance.
1827 SECTION 186. Section 20 of said chapter 176A, as so appearing, is hereby amended by
1828striking out, in line 3, the words “commissioner of insurance” and inserting in place thereof the
1829following words:- commissioner of health insurance. 86 of 101
1830 SECTION 187. Section 21 of said chapter 176A, as so appearing, is hereby amended by
1831striking out, in line 1, the words “commissioner of insurance” and inserting in place thereof the
1832following words:- commissioner of health insurance.
1833 SECTION 188. Section 22 of said chapter 176A, as so appearing, is hereby amended by
1834striking out, in line 3, the words “commissioner of insurance” and inserting in place thereof the
1835following words:- commissioner of health insurance.
1836 SECTION 189. Section 23 of said chapter 176A, as so appearing, is hereby amended by
1837striking out, in line 1, the words “commissioner of insurance” and inserting in place thereof the
1838following words:- commissioner of health insurance.
1839 SECTION 190. Section 24 of said chapter 176A, as so appearing, is hereby amended by
1840striking out, in line 19, the words “commissioner of insurance” and inserting in place thereof the
1841following words:- commissioner of health insurance.
1842 SECTION 191. Section 25 of said chapter 176A, as so appearing, is hereby amended by
1843striking out, in line 4, the words “commissioner of insurance” and inserting in place thereof the
1844following words:- commissioner of health insurance.
1845 SECTION 192. Section 31 of said chapter 176A, as so appearing, is hereby amended by
1846striking out, in line 5, the words “commissioner of insurance” and inserting in place thereof the
1847following words:- commissioner of health insurance.
1848 SECTION 193. Section 37 of said chapter 176A, as so appearing, is hereby amended by
1849striking out, in line 10, the words “division of insurance” and inserting in place thereof the
1850following words:- division of health insurance. 87 of 101
1851 SECTION 194. Section 1 of chapter 176B of the General Laws, as so appearing, is
1852hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
1853the following definition:-
1854 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
1855of chapter 26, or their designee.
1856 SECTION 195. Said section 1 of said chapter 176B, as so appearing, is hereby further
1857amended by inserting after the definition of “Dependent” the following definition:-
1858 “Division”, the division of health insurance.
1859 SECTION 196. The second paragraph of section 4 of said chapter 176B, as so appearing,
1860is hereby amended by inserting after the second sentence, the following sentence:- For the
1861purposes of the review of rates of payment under this section, whether an agreement is not
1862excessive shall include considerations of affordability for consumers and purchasers of health
1863insurance products.
1864 SECTION 197. Said section 4 of said chapter 176B, as so appearing, is hereby further
1865amended by striking out, in line 48, the words “commissioner of insurance” and inserting in
1866place thereof the following words:- commissioner of health insurance.
1867 SECTION 198. Section 4A of said chapter 176B, as so appearing, is hereby amended by
1868striking out, in line 137, the words “division of insurance” and inserting in place thereof the
1869following words:- division of health insurance. 88 of 101
1870 SECTION 199. Section 4M of said chapter 176B, as so appearing, is hereby amended by
1871striking out, in line 1, the words “commissioner of insurance” and inserting in place thereof the
1872following words:- commissioner of health insurance.
1873 SECTION 200. Section 4DD of said chapter 176B, as so appearing, is hereby amended
1874by striking out, in lines 80 and 81 and line 96, the words “commissioner of insurance” and
1875inserting in place thereof, in each instance, the following words:- commissioner of health
1876insurance.
1877 SECTION 201. Section 4MM of said chapter 176B, as so appearing, is hereby amended
1878by striking out, in lines 7 and 9, the words “division of insurance” and inserting in place thereof,
1879in each instance, the following words:- division of health insurance.
1880 SECTION 202. Section 4UU of said chapter 176B, as so appearing, is hereby amended
1881by striking out, in line 40, the words “division of insurance” and inserting in place thereof the
1882following words:- division of health insurance.
1883 SECTION 203. Section 6 of said chapter 176B, as so appearing, is hereby amended by
1884striking out, in line 16, the words “commissioner of insurance” and inserting in place thereof the
1885following words:- commissioner of health insurance.
1886 SECTION 204. Section 6B of said chapter 176B, as so appearing, is hereby amended by
1887striking out, in lines 18 and 19, the words “commissioner of insurance” and inserting in place
1888thereof the following words:- commissioner of health insurance. 89 of 101
1889 SECTION 205. Section 10 of said chapter 176B, as so appearing, is hereby amended by
1890striking out, in line 34, the words “commissioner of insurance” and inserting in place thereof the
1891following words:- commissioner of health insurance.
1892 SECTION 206. Section 12 of said chapter 176B, as so appearing, is hereby amended by
1893striking out, in lines 8 and 9, the words “division of insurance” and inserting in place thereof the
1894following words:- division of health insurance.
1895 SECTION 207. Section 24 of said chapter 176B, as so appearing, is hereby amended by
1896striking out, in line 10, the words “division of insurance” and inserting in place thereof the
1897following words:- division of health insurance.
1898 SECTION 208. Section 9 of chapter 176C of the General Laws, as so appearing, is
1899hereby amended by striking out, in lines 2 and 3 and lines 6 and 7, the words “commissioner of
1900insurance” and inserting in place thereof, in each instance, the following words:- commissioner
1901of health insurance.
1902 SECTION 209. Section 10 of said chapter 176C, as so appearing, is hereby amended by
1903striking out, in lines 1, 9 and 13, the words “commissioner of insurance” and inserting in place
1904thereof, in each instance, the following words:- commissioner of health insurance.
1905 SECTION 210. Section 17 of said chapter 176C, as so appearing, is hereby amended by
1906striking out, in line 6, the words “commissioner of insurance” and inserting in place thereof the
1907following words:- commissioner of health insurance. 90 of 101
1908 SECTION 211. Section 1 of chapter 176D of the General Laws, as so appearing, is
1909hereby amended by striking out paragraph (b) and inserting in place thereof the following
1910paragraph:-
1911 (b) “Commissioner”, the commissioner of health insurance appointed pursuant to section
19127A of chapter 26, or their designee.
1913 SECTION 212. Section 3B of said chapter 176D, as so appearing, is hereby amended by
1914striking out, in line 120, the words “commissioner of the division of insurance” and inserting in
1915place thereof the following words:- commissioner of health insurance.
1916 SECTION 213. Section 1 of chapter 176E of the General Laws, as so appearing, is
1917hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
1918the following definition:-
1919 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
1920of chapter 26, or their designee.
1921 SECTION 214. Section 6 of said chapter 176E, as so appearing, is hereby amended by
1922striking out, in line 22, the words “commissioner of insurance” and inserting in place thereof the
1923following words:- commissioner of health insurance.
1924 SECTION 215. Section 12 of said chapter 176E, as so appearing, is hereby amended by
1925striking out, in lines 6 and 7, the words “division of insurance” and inserting in place thereof the
1926following words:- division of health insurance. 91 of 101
1927 SECTION 216. Section 1 of chapter 176F of the General Laws, as so appearing, is hereby
1928amended by striking out the definition of “Commissioner” and inserting in place thereof the
1929following definition:-
1930 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
1931of chapter 26, or their designee.
1932 SECTION 217. Section 12 of said chapter 176F, as so appearing, is hereby amended by
1933striking out, in line 7, the words “division of insurance” and inserting in place thereof the
1934following words:- division of health insurance.
1935 SECTION 218. Section 1 of chapter 176G of the General Laws, as so appearing, is
1936hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
1937the following definition:-
1938 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
1939of chapter 26, or their designee.
1940 SECTION 219. Section 4M of said chapter 176G, as so appearing, is hereby amended by
1941striking out, in line 134, the words “division of insurance” and inserting in place thereof the
1942following words:- division of health insurance.
1943 SECTION 220. Section 4V of said chapter 176G, as so appearing, is hereby amended by
1944striking out, in lines 80 and 81 and line 96, the words “commissioner of insurance” and inserting
1945in place thereof, in each instance, the following words:- commissioner of health insurance. 92 of 101
1946 SECTION 221. Section 4EE of said chapter 176G, as so appearing, is hereby amended by
1947striking out, in lines 6 and 8, each time they appear, the words “division of insurance” and
1948inserting in place thereof the following words:- division of health insurance.
1949 SECTION 222. Section 4MM of said chapter 176G, as so appearing, is hereby amended
1950by striking out, in line 40, the words “division of insurance” and inserting in place thereof the
1951following words:- division of health insurance.
1952 SECTION 223. Section 5A of said chapter 176G, as so appearing, is hereby amended by
1953striking out, in lines 18 and 19, the words “commissioner of insurance” and inserting in place
1954thereof the following words:- commissioner of health insurance.
1955 SECTION 224. Section 8 of said chapter 176G, as so appearing, is hereby amended by
1956striking out, in line 7, the words “division of insurance” and inserting in place thereof the
1957following words:- division of health insurance.
1958 SECTION 225. The first paragraph of section 16 of said chapter 176G, as so appearing, is
1959hereby amended by inserting after the second sentence the following sentence:- For the purposes
1960of the review of rates of payment under this section, whether a contract is not excessive shall
1961include considerations of affordability for consumers and purchasers of health insurance
1962products.
1963 SECTION 226. Section 17 of said chapter 176G, as so appearing, is hereby amended by
1964striking out, in line 8, the words “commissioner of insurance” and inserting in place thereof the
1965following words:- commissioner of health insurance. 93 of 101
1966 SECTION 227. Section 32 of said chapter 176G, as so appearing, is hereby amended by
1967striking out, in line 10, the words “division of insurance” and inserting in place thereof the
1968following words:- division of health insurance.
1969 SECTION 228. Section 1 of chapter 176I of the General Laws, as so appearing, is hereby
1970amended by striking out the definition of “Commissioner” and inserting in place thereof the
1971following definition:-
1972 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
1973of chapter 26, or their designee.
1974 SECTION 229. Section 8 of said chapter 176I, as so appearing, is hereby amended by
1975striking out, in line 16, the words “commissioner of insurance” and inserting in place thereof the
1976following words:- commissioner of health insurance.
1977 SECTION 230. Section 1 of chapter 176J of the General Laws, as so appearing, is hereby
1978amended by striking out the definition of “Commissioner” and inserting in place thereof the
1979following definition:-
1980 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
1981of chapter 26, or their designee.
1982 SECTION 231. Section 4 of said section 176J, as so appearing, is hereby amended by
1983striking out, in lines 75 and 80, the words “commissioner of insurance” and inserting in place
1984thereof, in each instance, the following words:- commissioner of health insurance.
1985 SECTION 232. Section 6 of said section 176J, as so appearing, is hereby amended by
1986striking out, in lines 3, 110 and 111, and 125, each time they appear, the words “division of 94 of 101
1987insurance” and inserting in place thereof, in each instance, the following words:- division of
1988health insurance.
1989 SECTION 233. Subsection (c) of said section 6 of said chapter 176J, as so appearing, is
1990hereby amended by inserting after the second sentence the following sentence:- For the purposes
1991of the review of rates of payment under this section, whether the proposed changes to base rates
1992are excessive shall include considerations of affordability for consumers and purchasers of health
1993insurance products.
1994 SECTION 234. Section 10 of said section 176J, as so appearing, is hereby amended by
1995striking out, in lines 1 and 11, the words “division of insurance” and inserting in place thereof, in
1996each instance, the following words:- division of health insurance.
1997 SECTION 235. Section 11 of said section 176J, as so appearing, is hereby amended by
1998striking out, in lines 16 and 69 and 70, the words “commissioner of insurance” and inserting in
1999place thereof, in each instance, the following words:- commissioner of health insurance.
2000 SECTION 236. Said section 11 of said section 176J, as so appearing, is hereby further
2001amended by striking out, in lines 35, 93, 95 and 107, the words “division of insurance” and
2002inserting in place thereof, in each instance, the following words:- division of health insurance.
2003 SECTION 237. Said section 11A of said chapter 176J, as so appearing, is hereby further
2004amended by striking out, in lines 31 and 32, the words “division of health care finance and
2005policy” and inserting in place thereof the following words:- center for health information and
2006analysis. 95 of 101
2007 SECTION 238. Section 17 of said chapter 176J, as so appearing, is hereby amended by
2008striking out, in line 10, the words “division of insurance” and inserting in place thereof the
2009following words:- division of health insurance.
2010 SECTION 239. Section 1 of chapter 176K of the General Laws, as so appearing, is
2011hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
2012the following definition:-
2013 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
2014of chapter 26, or their designee.
2015 SECTION 240. The second paragraph of subsection (g) of section 7 of said chapter
2016176K, as so appearing, is hereby amended by adding the following sentence:- For the purposes
2017of the review of rates of payment under this section, whether rates are excessive shall include
2018considerations of affordability for consumers and purchasers of health insurance products.
2019 SECTION 241. Section 1 of chapter 176M of the General Laws, as so appearing, is
2020hereby amended by striking out, in lines 21 and 22, the words “commissioner of insurance” and
2021inserting in place thereof the following words:- commissioner of health insurance.
2022 SECTION 242. Said section 1 of said chapter 176M, as so appearing, is hereby further
2023amended by striking out the definition of “Commissioner” and inserting in place thereof the
2024following definition:-
2025 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
2026of chapter 26, or their designee. 96 of 101
2027 SECTION 243. Section 2 of said chapter 176M, as so appearing, is hereby amended by
2028striking out, in line 156, the words “commissioner of insurance” and inserting in place thereof
2029the following words:- commissioner of health insurance.
2030 SECTION 244. Section 3 said chapter 176M, as so appearing, is hereby amended by
2031striking out, in line 107, the words “commissioner of insurance” and inserting in place thereof
2032the following words:- commissioner of health insurance.
2033 SECTION 245. Section 1 of chapter 176N of the General Laws, as so appearing, is
2034hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
2035the following definition:-
2036 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
2037of chapter 26, or their designee.
2038 SECTION 246. Section 1 of chapter 176O of the General Laws, as so appearing, is
2039hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
2040the following definition:-
2041 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
2042of chapter 26, or their designee.
2043 SECTION 247. Said section 1 of said chapter 176O, as so appearing, is hereby further
2044amended by striking out the definition of “Division” and inserting in place thereof the following
2045definition:-
2046 “Division”, the division of health insurance. 97 of 101
2047 SECTION 248. Section 2 of said chapter 176O, as so appearing, is hereby amended by
2048striking out, in lines 79, 83 and 90, the words “commissioner of insurance” and inserting in place
2049thereof, in each instance, the following words:- commissioner of health insurance.
2050 SECTION 249. Section 5B of said chapter 176O, as so appearing, is hereby amended by
2051striking out, in lines 3 and 4, the words “division of insurance” and inserting in place thereof the
2052following words:- division of health insurance.
2053 SECTION 250. Section 12B said chapter 176O, as so appearing, is hereby amended by
2054striking out, in line 3, the words “commissioner of insurance” and inserting in place thereof the
2055following words:- commissioner of health insurance.
2056 SECTION 251. Section 14 said chapter 176O is hereby amended by striking out, in lines
205714 and 15, as so appearing, the words “commissioner of insurance” and inserting in place thereof
2058the following words:- commissioner of health insurance.
2059 SECTION 252. Said section 14 said chapter 176O is hereby further amended by striking
2060out, in lines 93 and 94 and 108 and 109, as so appearing, the words “division of insurance”, each
2061time they appear, and inserting in place thereof, in each instance, the following words:- division
2062of health insurance.
2063 SECTION 253. Section 1 of chapter 176Q of the General Laws, as so appearing, is
2064hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
2065the following definition:-
2066 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
2067of chapter 26, or their designee. 98 of 101
2068 SECTION 254. Section 2 of said chapter 176Q, as so appearing, is hereby amended by
2069striking out, in lines 18 and 19, the words “commissioner of insurance” and inserting in place
2070thereof the following words:- commissioner of health insurance.
2071 SECTION 255. Section 3 of said chapter 176Q, as so appearing, is hereby amended by
2072striking out, in line 86, the words “division of insurance” and inserting in place thereof the
2073following words:- division of health insurance.
2074 SECTION 256. Section 1 of chapter 176R of the General Laws, as so appearing, is
2075hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
2076the following definition:-
2077 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
2078of chapter 26, or their designee.
2079 SECTION 257. Section 1 of chapter 176S of the General Laws, as so appearing, is hereby
2080amended by striking out the definition of “Commissioner” and inserting in place thereof the
2081following definition:-
2082 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
2083of chapter 26, or their designee.
2084 SECTION 258. Section 1 of chapter 176T of the General Laws, as so appearing, is
2085hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
2086the following definition:-
2087 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
2088of chapter 26, or their designee. 99 of 101
2089 SECTION 259. Section 1 of chapter 176U of the General Laws, as so appearing, is
2090hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
2091the following definition:-
2092 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
2093of chapter 26, or their designee.
2094 SECTION 260. Section 6 of said chapter 176U, as so appearing, is hereby amended by
2095striking out, in lines 42 and 43, the words “division of insurance” and inserting in place thereof
2096the following words:- division of health insurance.
2097 SECTION 261. Section 7 of said chapter 176U, as so appearing, is hereby amended by
2098striking out, in line 26, the words “division of insurance” and inserting in place thereof the
2099following words:- division of health insurance.
2100 SECTION 262. Section 1 of chapter 176V of the General Laws, as so appearing, is
2101hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
2102the following definition:-
2103 “Commissioner”, (i) the commissioner of insurance appointed pursuant to section 6 of
2104chapter 26, or their designee, or, as appropriate, (ii) the commissioner of health insurance
2105appointed pursuant to section 7A of said chapter 26, or their designee, to the extent that this
2106chapter applies to companies that are regulated by the division of health insurance pursuant to
2107section 1 of said chapter 26. 100 of 101
2108 SECTION 263. Section 1 of chapter 176W of the General Laws, as so appearing, is
2109hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
2110the following definition:-
2111 “Commissioner”, (i) the commissioner of insurance appointed pursuant to section 6 of
2112chapter 26, or their designee, or, as appropriate, (ii) the commissioner of health insurance
2113appointed pursuant to section 7A of said chapter 26, or their designee, to the extent that this
2114chapter applies to companies that are regulated by the division of health insurance pursuant to
2115section 1 of said chapter 26.
2116 SECTION 264. Said section 1 of said chapter 176W, as so appearing, is hereby further
2117amended by striking out the definition of “Division” and inserting in place thereof the following
2118definition:-
2119 “Division”, the division of insurance or the division of health insurance, as appropriate.
2120 SECTION 265. Section 1 of chapter 176X of the General Laws, as so appearing, is
2121hereby amended by striking out the definition of “Commissioner” and inserting in place thereof
2122the following definition:-
2123 “Commissioner”, the commissioner of health insurance appointed pursuant to section 7A
2124of chapter 26, or their designee.
2125 SECTION 266. Section 2 of said chapter 176X, as so appearing, is hereby amended by
2126striking out, in lines 3, 75 and 76, and 90, the words “division of insurance” and inserting in
2127place thereof the following words:- division of health insurance. 101 of 101
2128 SECTION 267. (a) Notwithstanding any general or special law to the contrary, for the
2129purposes of monitoring and enforcing the health care cost growth benchmark for calendar years
21302021 to 2025, inclusive, the center for health information and analysis shall apply sections 8, 9,
213110, 16 and 18 of chapter 12C of the General Laws as in effect on May 1, 2024.
2132 (b) Notwithstanding any general or special law to the contrary, for the purposes of
2133monitoring and enforcing the health care cost growth benchmark for calendar years 2021 to
21342025, inclusive, the health policy commission shall apply sections 9 and 10 of chapter 6D of the
2135General Laws as in effect on May 1, 2024; provided, however, that the commission shall not
2136require a health care entity to file and implement a performance improvement plan unless a
2137health care entity’s average annual growth in health status adjusted total medical expense during
2138any 3-year period, the final year of which occurring in calendar year 2021 to 2025, inclusive, is
2139greater than 4 per cent.
2140 SECTION 268. Notwithstanding any general or special law, rule or regulation to the
2141contrary, the health resource planning council established in section 22 of chapter 6D of the
2142General Laws shall submit a state health plan to the governor and the general court, as required
2143by said section 22 of said chapter 6D, on or before January 1, 2026.
2144 SECTION 269. Section 19 shall take effect January 1, 2025.
2145 SECTION 270. All physician practices required to register pursuant to section 4A of
2146chapter 112 of the General Laws, as inserted by section 129, shall register with the board of
2147registration in medicine not later than January 1, 2026.