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SENATE DOCKET, NO. 2182 FILED ON: 1/20/2023
SENATE . . . . . . . . . . . . . . No. 744
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
James B. Eldridge
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act establishing medicare for all in Massachusetts.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :James B. EldridgeMiddlesex and WorcesterLindsay N. Sabadosa1st HampshireAdam GomezHampden2/23/2023Denise C. Garlick13th NorfolkJack Patrick Lewis7th Middlesex1/23/2023Sal N. DiDomenicoMiddlesex and Suffolk1/26/2023Paul R. FeeneyBristol and Norfolk1/27/2023Vanna Howard17th Middlesex1/31/2023Jacob R. OliveiraHampden, Hampshire and Worcester2/2/2023Carmine Lawrence Gentile13th Middlesex2/3/2023Paul W. MarkBerkshire, Hampden, Franklin and
Hampshire
2/7/2023Joanne M. ComerfordHampshire, Franklin and Worcester2/9/2023Cynthia Stone CreemNorfolk and Middlesex2/14/2023Mike Connolly26th Middlesex2/16/2023Patricia D. JehlenSecond Middlesex2/16/2023Patricia A. Duffy5th Hampden3/2/2023Liz MirandaSecond Suffolk3/3/2023 1 of 35
SENATE DOCKET, NO. 2182 FILED ON: 1/20/2023
SENATE . . . . . . . . . . . . . . No. 744
By Mr. Eldridge, a petition (accompanied by bill, Senate, No. 744) of James B. Eldridge,
Lindsay N. Sabadosa, Adam Gomez, Denise C. Garlick and other members of the General Court
for legislation to establish medicare for all in Massachusetts. Health Care Financing.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 766 OF 2021-2022.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act establishing medicare for all in Massachusetts.
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. The General Laws are hereby amended by inserting after chapter 175M the
2following chapter:-
3 CHAPTER 175N.
4 MASSACHUSETTS HEALTH CARE TRUST
5 Section 1. Definitions
6 The following words and phrases shall have the following meanings, except where the
7context clearly requires otherwise:
8 “Board”, the Board of Trustees of the Massachusetts Health Care Trust. 2 of 35
9 “Executive Director”, the Executive Director of the Massachusetts Health Care Trust.
10 “Health care”, care provided to a specific individual by a licensed health care
11professional to promote physical and mental health, to treat illness and injury, and to prevent
12illness and injury.
13 “Health care facility”, any facility or institution, whether public or private, proprietary or
14nonprofit, that is organized, maintained, and operated for health maintenance or for the
15prevention, diagnosis, care, and treatment of human illness, physical or mental, for one or more
16persons.
17 “Health care practitioner”, any professional person, medical group, independent practice
18association, organization, health care facility, or other person or institution licensed or authorized
19by law to provide professional health care services to an individual in the Commonwealth.
20 “Professional advisory committee”, a committee of advisors appointed by the director of
21the Administrative, Planning, Information, Technology, or any Regional division of the
22Massachusetts Health Care Trust.
23 “Resident”, a person who lives in Massachusetts as evidenced by an intent to continue to
24live in Massachusetts and to return to Massachusetts if temporarily absent, coupled with an act or
25acts consistent with that intent. The Trust shall adopt standards and procedures for determining
26whether a person is a resident. Such rules shall include: (1) a provision requiring that the person
27seeking resident status has the burden of proof in such determination; (2) a provision that a
28residence established for the purpose of seeking health care shall not by itself establish that a
29person is a resident of the Commonwealth; and (3) a provision that, for the purposes of this
30chapter, the terms “domicile” and “dwelling place” are not limited to any particular structure or 3 of 35
31interest in real property and specifically include homeless individuals, individuals incarcerated in
32Massachusetts, and undocumented individuals.
33 “Secretary”, the Secretary of the Executive Office of Health and Human Services.
34 “Trust”, the Massachusetts Health Care Trust.
35 “Trust Fund”, the Massachusetts Health Care Trust Fund.
36 Section 2. Policy and Goals
37 It is hereby declared to be the policy of the Commonwealth to provide equitable access to
38quality, affordable health care services for all its residents as a right, responsive to the needs of
39the Commonwealth and its residents, without co-insurance, co-payments, deductibles, or any
40other form of patient cost sharing, and be accountable to its citizens though the Trust. The Trust
41shall be responsible for the collection and disbursement of funds required to provide health care
42services for every resident of the Commonwealth.
43 It is hereby declared that the Trust shall guarantee health care access to all residents of
44the Commonwealth without regard to financial or employment status, ethnicity, race, religion,
45gender, gender identity, sexual orientation, previous health problems, or geographic location.
46 It is hereby declared that the Trust shall provide access to health care services that is
47continuous, without the current need for repeated re-enrollments or changes when employers
48choose new plans and residents change jobs. Coverage under the Health Care Trust shall be
49comprehensive and affordable for individuals and families. It shall have no co-insurance, co-
50payments, deductibles, or any other form of patient cost sharing. 4 of 35
51 It is hereby declared that providing access to health care services for all Massachusetts
52residents through a single payer health care financing system is essential for achieving and
53sustaining universal equitable access, affordability, cost control, and high quality medical care.
54 It is hereby further declared that in pursuit of universal access to quality, affordable care,
55the Commonwealth supports the following goals:
56 (a) to guarantee every resident of the Commonwealth access to high quality health care
57by: (i) providing reimbursement for all medically appropriate health care services offered by the
58eligible practitioner or facility of each resident’s choice; and (ii) funding capital investments for
59adequate health care facilities and resources statewide.
60 (b) to ensure that all residents have access to dental care, behavioral health, eyeglasses,
61hearing aids, home health care, nursing home care, and other important health care needs.
62 (c) to eliminate co-insurance, co-payments, deductibles, and any other form of patient
63cost sharing;
64 (d) to control costs as a key component of a sustainable health care system that will
65reduce health care costs for residents, municipalities, counties, businesses, health care facilities,
66and the Commonwealth.
67 (e) to save money by replacing the current mixture of public and private health insurance
68plans with a uniform and comprehensive health care plan available to every Massachusetts
69resident;
70 (f) to reduce administrative cost and inefficiencies and use savings to: (i) expand covered
71health care services; (ii) contain health care cost increases; (iii) create practitioner incentives to 5 of 35
72innovate and compete by improving health care service quality and delivery to patients; and (iv)
73expand preventive health care programs and the delivery of primary care.
74 (g) to fund, approve, and coordinate capital improvements in excess of a threshold to be
75determined annually by the Executive Director to qualified health care facilities in order to: (i)
76avoid unnecessary duplication of health care facilities and resources; and (ii) encourage
77expansion or location of health care practitioners and health care facilities in underserved
78communities;
79 (h) to assure the continued excellence of professional training and research at health care
80facilities in the Commonwealth;
81 (i) to achieve measurable improvement in health care outcomes;
82 (j) to prevent disease and disability and maintain or improve health and functionality;
83 (k) to ensure that all residents of the Commonwealth receive care appropriate to their
84special needs as well as care that is culturally and linguistically competent;
85 (l) to increase satisfaction with the health care system among health care practitioners,
86patients, and the employers and employees of the Commonwealth;
87 (m) to implement policies that strengthen and improve culturally and linguistically
88sensitive care;
89 (n) to develop an integrated population-based health care database to support health care
90planning; and 6 of 35
91 (o) to fund training and retraining programs for professional and non-professional
92workers in the health care sector displaced as a direct result of implementation of this chapter.
93 Section 3. Establishment of the Massachusetts Health Care Trust
94 (a) There shall be within the Executive Office of Health and Human Services, but not
95under its control or any political subdivision thereof in the Commonwealth, a division known as
96the Massachusetts Health Care Trust. The Trust shall be responsible for the collection and
97disbursement of funds required to provide health care services for every resident of the
98Commonwealth. The Trust is hereby constituted a public instrumentality of the Commonwealth
99and the exercise by the Trust of the powers conferred by this chapter shall be deemed and held
100the performance of an essential governmental function.
101 (b) The provisions of chapter 268A shall apply to all Trustees, officers, and employees of
102the Trust, except that the Trust may purchase from, contract with, or otherwise deal with any
103organization in which any Trustee is interested or involved, provided, however, that such interest
104or involvement is disclosed in advance to the Trustees and recorded in the minutes of the
105proceedings of the Trust, and provided, further, that a Trustee having such interest or
106involvement may not participate in any decision relating to such organization.
107 (c) Neither the Trust nor any of its officers, Trustees, employees, consultants, or advisors
108shall be subject to the provisions of section 3B of chapter 7, sections 9A, 45, 46, and 52 of
109chapter 30, chapter 30B, or chapter 31, provided, however, that in purchasing goods and
110services, the Trust shall at all times follow generally accepted good business practices.
111 (d) All officers and employees of the Trust having access to its cash or negotiable
112securities shall give bond to the Trust at its expense, in such amount and with such surety as the 7 of 35
113Board of Trustees shall prescribe. The persons required to give bond may be included in one or
114more blanket or scheduled bonds.
115 (e) Trustees, officers, and advisors who are not regular, compensated employees of the
116Trust shall not be liable to the Commonwealth, to the Trust, or to any other person as a result of
117their activities, whether ministerial or discretionary, as such Trustees, officers, or advisors except
118for willful dishonesty or intentional violations of law. The Board of the Trust may purchase
119liability insurance for Trustees, officers, advisors, and employees and may indemnify said
120persons against the claims of others.
121 Section 4: Powers of the Trust
122 (a) The Trust shall have the following powers:
123 (1) to make, amend, and repeal by-laws, rules, and regulations for the management of its
124affairs;
125 (2) to adopt an official seal;
126 (3) to sue and be sued in its own name;
127 (4) to make contracts and execute all instruments necessary or convenient for the carrying
128on of the purposes of this chapter;
129 (5) to acquire, own, hold, dispose of, and encumber personal, real or intellectual property
130of any nature or any interest therein; 8 of 35
131 (6) to enter into agreements or transactions with any federal, state, or municipal agency or
132other public institution or with any private individual, partnership, firm, corporation, association,
133or other entity;
134 (7) to appear on its own behalf before boards, commissions, departments, or other
135agencies of federal, state, or municipal government;
136 (8) to appoint officers and to engage and employ employees, including legal counsel,
137consultants, agents, and advisors, and prescribe their duties and fix their compensations;
138 (9) to establish advisory boards;
139 (10) to procure insurance against any losses in connection with its property in such
140amounts, and from such insurers, as may be necessary or desirable;
141 (11) to invest any funds held in reserves or sinking funds, or any funds not required for
142immediate disbursement, in such investments as may be lawful for fiduciaries in the
143Commonwealth pursuant to sections 38 and 38 A of chapter 29;
144 (12) to accept, hold, use, apply, and dispose of any and all donations, grants, bequests,
145and devises, conditional or otherwise, of money, property, services, or other things of value
146which may be received from the United States or any agency thereof, any governmental agency,
147any institution, person, firm, or corporation, public or private; such donations, grants, bequests,
148and devises to be held, used, applied, or disposed for any or all of the purposes specified in this
149chapter and in accordance with the terms and conditions of any such grant. A receipt of each
150such donation or grant shall be detailed in the annual report of the Trust; such annual report shall 9 of 35
151include the identity of the donor, lender, the nature of the transaction and any condition attaching
152thereto;
153 (13) to do any and all other things necessary and convenient to carry out the purposes of
154this chapter.
155 Section 5. Board of Trustees: Composition, Powers, and Duties
156 (a) The Trust shall be governed by a Board of Trustees with 29 members including:
157 (1) the Secretary of Health and Human Services; the Secretary of Administration and
158Finance, and the Commissioner of Public Health;
159 (2) eight Trustees appointed by the Governor, three of whom shall be nominated by
160organizations of health care professionals who deliver direct patient care, one of whom shall be
161nominated by a statewide organization of health care facilities, one of whom shall be nominated
162by an organization representing non-health care employers, one of whom shall be nominated by
163a disability rights organization, one of whom shall be nominated by an organization advocating
164for mental health care, and one of whom shall be a health care economist;
165 (3) ten Trustees appointed by the Attorney General, two of whom shall be nominated by a
166statewide labor organization, two of whom shall be nominated by statewide organizations who
167have a record of advocating for universal single payer health care in Massachusetts, one of whom
168shall be nominated by an organization representing Massachusetts senior citizens, one of whom
169shall be nominated by a statewide organization defending the rights of children, one of whom
170shall be nominated by an organization providing legal services to low-income clients, one of
171whom shall be an epidemiologist, one of whom shall be an expert in racial disparities in health 10 of 35
172care nominated by a statewide public health organization, and one of whom shall be an expert in
173women’s health care nominated by a statewide public health organization;
174 (4) and eight Trustees elected by the citizens of the Commonwealth pursuant to
175subsection (b).
176 (5) Before appointing members to the Board of Trustees, the Governor and the Attorney
177General shall conduct a public awareness process, encourage representation from different racial,
178ethnic, and gender populations, and take nominations from all interested organizations.
179 (b) Each of the eight citizen-elected Trustees must: (1) reside in a different Governor’s
180Council district than the other seven elected Trustees; (2) be ineligible for any Trustee positions
181appointed by the Governor or the Attorney General; (3) run in accordance with Fair Campaign
182Financing Rules; and (4) serve staggered four-year terms; provided, however, that two of the first
183eight elected Trustees shall be elected for two years, three for three years, and three for four
184years. Each elected Trustee shall be eligible for reelection to a second term only.
185 (c) Each appointed Trustee shall serve a term of five years; provided, however, that
186initially six appointed Trustees shall serve three-year terms, six appointed Trustees shall serve
187four-year terms, and six appointed Trustees shall serve five-year terms. The initial appointed
188Trustees shall be assigned to a three-, four-, or five- year term by lot. Any person appointed to
189fill a vacancy on the Board shall serve for the unexpired term of the predecessor Trustee. Any
190appointed Trustee shall be eligible for reappointment to a second term only. Any appointed
191Trustee may be removed from the Trustee’s appointment by the Governor or Attorney General,
192respectively, for just cause. 11 of 35
193 (d) The Board shall elect a chair from among its members every two years. A majority of
194the Trustees shall constitute a quorum and the affirmative vote of a majority of the Trustees
195present and eligible to vote at a meeting shall be necessary for any action to be taken by the
196Board. The Board of Trustees shall meet at least ten times annually and shall have final authority
197over the activities of the Trust.
198 (e) The Trustees shall be reimbursed for actual and necessary expenses and loss of
199income incurred for each full day serving in the performance of their duties to the extent that
200reimbursement of those expenses is not otherwise provided or payable by another public agency
201or agencies. For purposes of this section, “full day of attending a meeting” shall mean presence
202at, and participation in, not less than 75 percent of the total meeting time of the Board during any
203particular 24-hour period.
204 (f) No member of the Board of Trustees shall make, participate in making, or in any way
205attempt to use his or her official position to influence a governmental decision in which the
206Trustee knows or has reason to know that the Trustee, or a family member, business partner, or
207colleague, has a financial interest.
208 (g) The Board is responsible for ensuring universal access to high quality, affordable
209health care for every resident of the Commonwealth and shall specifically address the following:
210 (1) establish policy on medical issues, population-based public health issues, research
211priorities, scope of services, expanding access to care, and evaluation of the performance of the
212system; 12 of 35
213 (2) evaluate proposals from the Executive Director and others for innovative approaches
214to health promotion, disease and injury prevention, health education and research, and health
215care delivery; and
216 (3) establish standards and criteria by which requests by health facilities for capital
217improvements shall be evaluated.
218 Section 6. Executive Director; Purpose and Duties
219 (a) The Board of Trustees shall hire an Executive Director who shall be the executive and
220administrative head of the Trust and shall be responsible for administering and enforcing the
221provisions of law relative to the Trust.
222 (b) The Executive Director may, as she or he deems necessary or suitable for the effective
223administration and proper performance of the duties of the Trust and subject to the approval of
224the Board of Trustees, do the following: (1) adopt, amend, alter, repeal, and enforce, all such
225reasonable rules, regulations, and orders as may be necessary; and (2) appoint and remove
226employees and consultants: provided, however, that, subject to the availability of funds in the
227Trust, at least one employee shall be hired to serve as director of each of the divisions created in
228Sections 7 through 11, inclusive, of this chapter.
229 (c) The Executive Director shall: (1) establish an enrollment system that will ensure that
230all eligible Massachusetts residents are formally enrolled; (2) use the purchasing power of the
231state to negotiate price discounts for prescription drugs and all needed durable and nondurable
232medical equipment and supplies; (3) negotiate or establish terms and conditions for the provision
233of high quality health care services and rates of reimbursement for such services on behalf of the
234residents of the Commonwealth; (4) develop prospective and retrospective payment systems for 13 of 35
235covered services to provide prompt and fair payment to eligible practitioners and facilities; (5)
236oversee preparation of annual operating and capital budgets for the statewide delivery of health
237care services; (6) oversee preparation of annual benefits reviews to determine the adequacy of
238covered services; and (7) prepare an annual report to be submitted to the Governor, the President
239of the Senate, and Speaker of the House of Representatives and to be easily accessible to every
240Massachusetts resident.
241 (d) The Executive Director of the Trust may utilize and shall coordinate with the offices,
242staff, and resources of any agencies of the executive branch including, but not limited to, the
243Executive Office of Health and Human Services and all line agencies under its jurisdiction, the
244Center for Health Information and Analysis, the Department of Revenue, the Division of
245Insurance, the Group Insurance Commission, the Department of Employment and Training, the
246Industrial Accidents Board, the Health and Educational Finance Authority, and all other
247executive agencies.
248 Section 7. Regional Division: Director, Offices, Purposes, and Duties
249 (a) There shall be a regional division within the Trust which shall be under the
250supervision and control of a director. The powers and duties given the director in this chapter and
251in any other general or special law shall be exercised and discharged subject to the control and
252supervision of the Executive Director of the Trust. The director of the regional division shall be
253appointed by the Executive Director of the Trust, with the approval of the Board of Trustees, and
254may, with like approval, be removed. The director shall establish a professional advisory
255committee to provide expert advice: provided, however, that such committee shall have at least
25625% representation from the general public. 14 of 35
257 (b) The Trust shall have a reasonable number of regional offices located throughout the
258state. The number and location of these offices shall be proposed to the Executive Director and
259Board of Trustees by the director of the regional division after consultation with the directors of
260the planning, administration, quality assurance, and information technology divisions and
261consideration of convenience and equity. The adequacy and appropriateness of the number and
262location of regional offices shall be reviewed by the Board at least once every 3 years.
263 (c) The regional division shall establish a statewide education program that ensures that
264all residents understand how the Trust affects their health care costs, including, but not limited
265to, information about the following: (1) tax increases; (2) elimination of premiums, co-payments,
266deductibles, and any other form of patient cost sharing; (3) state-issued health care cards; and (4)
267choosing practitioners. Each regional office shall be professionally staffed to perform local
268outreach and informational functions and to respond to questions, complaints, and suggestions.
269 (d) Each regional office shall hold public hearings annually to determine unmet health
270care needs and for other relevant reasons. Regional office staff shall immediately refer evidence
271of unmet needs or of poor quality care to the director of the regional division who will plan and
272implement remedies in consultation with the directors of the administrative, planning, quality
273assurance, and information technology divisions.
274 Section 8. Administrative Division: Director, Purpose, and Duties
275 (a) There shall be an administrative division within the Trust which shall be under the
276supervision and control of a director. The powers and duties given the director in this chapter and
277in any other general or special law shall be exercised and discharged subject to the direction,
278control, and supervision of the Executive Director of the Trust. The director of the administrative 15 of 35
279division shall be appointed by the Executive Director of the Trust, with the approval of the Board
280of Trustees, and may, with like approval, be removed. The director may, at the director’s
281discretion, establish a professional advisory committee to provide expert advice: provided,
282however, that such committee shall have at least 25% representation from the general public.
283 (b) The administrative division shall have day-to-day responsibility for: (1) making
284prompt payments to practitioners and facilities for covered services; (2) collecting
285reimbursement from private and public third party payers and individuals for services not
286covered by this chapter or covered services rendered to non-eligible patients; (3) developing
287information management systems needed for practitioner payment, rebate collection, and
288utilization review; (4) investing Trust Fund assets consistent with state law and Section 18 of this
289chapter; (5) developing operational budgets for the Trust; and (6) assisting the planning division
290to develop capital budgets for the Trust.
291 Section 9. Planning Division: Director, Purpose, and Duties
292 (a) There shall be a planning division within the Trust which shall be under the
293supervision and control of a director. The powers and duties given the director in this chapter and
294in any other general or special law shall be exercised and discharged subject to the direction,
295control, and supervision of the Executive Director of the Trust. The director of the planning
296division shall be appointed by the Executive Director of the Trust, with the approval of the Board
297of Trustees, and may, with like approval, be removed. The director may, at the director’s
298discretion, establish a professional advisory committee to provide expert advice: provided,
299however, that such committee shall have at least 25% representation from the general public. 16 of 35
300 (b) The planning division shall have responsibility for coordinating health care resources
301and capital expenditures to ensure all eligible participants reasonable access to covered services.
302The responsibilities shall include but are not limited to:
303 (1) An annual review of the adequacy of health care resources throughout the
304Commonwealth and recommendations for changes. Specific areas to be evaluated include but are
305not limited to the resources needed for underserved populations and geographic areas, for
306recruitment of primary care physicians, dentists, and other specialists needed to provide quality
307health care, for culturally and linguistically competent care, and for emergency and trauma care.
308The director shall develop short term and long term plans to meet health care needs; and
309 (2) An annual review of capital health care needs, including but not limited to
310recommendations for a budget for all health care facilities, evaluating all capital expenses in
311excess of a threshold amount to be determined annually by the Executive Director, and
312collaborating with local and statewide government and health care institutions to coordinate
313capital health planning and investment. The director shall develop short term and long term plans
314to meet capital expenditure needs.
315 (c) In making its review, the planning division shall consult with the regional offices of
316the Trust and shall hold public hearings throughout the state on proposed recommendations. The
317division shall submit to the Board of Trustees its final annual review and recommendations by
318October 1. Subject to Board approval, the Trust shall adopt the recommendations.
319 Section 10. Information Technology Division: Director, Purpose, and Duties
320 (a) There shall be an information technology division within the Trust which shall be
321under the supervision and control of a director. The powers and duties given the director in this 17 of 35
322chapter and in any other general or special law shall be exercised and discharged subject to the
323direction, control, and supervision of the Executive Director of the Trust. The director of the
324information technology division shall be appointed by the Executive Director of the Trust, with
325the approval of the Board of Trustees, and may, with like approval, be removed. The director
326may, at the director’s discretion, establish a professional advisory committee to provide expert
327advice: provided, however, that such committee shall have at least 25% representation from the
328general public.
329 (b) The responsibilities of the information technology division shall include but are not
330limited to: (1) developing an information technology system that is compatible with all medical
331and dental facilities in Massachusetts; (2) maintaining a confidential electronic medical records
332system and prescription system in accordance with laws and regulations to maintain accurate
333patient records and to simplify the billing process, thereby reducing medical errors and
334bureaucracy; and (3) developing a tracking system to monitor quality of care, establish a patient
335database, and promote preventive care guidelines and medical alerts to avoid errors.
336 (c) Notwithstanding that all billing shall be performed electronically, patients shall have
337the option of keeping any portion of their medical records separate from their electronic medical
338record. The information technology director shall work closely with the directors of the regional,
339administrative, planning, and quality assurance divisions. The information technology division
340shall make an annual report to the Board of Trustees by October 1. Subject to Board approval,
341the Trust shall adopt the recommendations.
342 Section 11. Quality Assurance Division: Director, Purpose, and Duties 18 of 35
343 (a) There shall be a quality assurance division within the Trust which shall be under the
344supervision and control of a director. The powers and duties given the director in this chapter and
345in any other general or special law shall be exercised and discharged subject to the direction,
346control, and supervision of the Executive Director of the Trust. The director of the quality
347assurance division shall be appointed by the Executive Director of the Trust, with the approval of
348the Board of Trustees, and may, with like approval, be removed. The director may, at the
349director’s discretion, establish a professional advisory committee to provide expert advice:
350provided, however, that such committee shall have at least 25% representation from the general
351public.
352 (b) The quality assurance division shall support the establishment of a universal, best
353quality of standard of care with respect to: (1) appropriate hospital staffing levels for quality
354care; (2) evidence-based best clinical practices developed from analysis of outcomes of medical
355interventions; appropriate medical technology; (3) design and scope of work in the health
356workplace; and development of clinical practices that lead toward elimination of medical errors;
357(4) timely access to needed medical and dental care; (5) development of medical homes that
358provide efficient patient-centered integrated care; and (6) compassionate end-of-life care that
359provides comfort and relief of pain in an appropriate setting evidence-based best clinical
360practices.
361 (c) The director shall conduct a comprehensive annual review of the quality of health care
362services and outcomes throughout the Commonwealth and submit such recommendations to the
363Board of Trustees as may be required to maintain and improve the quality of health care service
364delivery and the overall health of Massachusetts residents. In making its reviews, the quality
365assurance division shall consult with the regional, administrative, and planning divisions and 19 of 35
366hold public hearings throughout the state on quality of care issues. The division shall submit to
367the Board of Trustees its final annual review and recommendations on how to ensure the highest
368quality health care service delivery by October 1. Subject to Board approval, the Trust shall
369adopt the recommendations.
370 Section 12. Eligible Participants
371 (a) The following persons shall be eligible participants in the Massachusetts Health Care
372Trust:
373 (1) all Massachusetts residents, as defined in Section 1;
374 (2) all non-residents who:
375 (i) work 20 hours or more per week in Massachusetts;
376 (ii) pay all applicable Massachusetts personal income and payroll taxes; and
377 (iii) pay any additional premiums established by the Trust to cover non-residents.
378 (3) All non-resident patients requiring emergency treatment for illness or injury:
379provided, however, that the Trust shall recoup expenses for such patients wherever possible.
380 (b) Payment for emergency care of Massachusetts residents obtained out of state shall be
381at prevailing local rates. Payment for non-emergency care of Massachusetts residents obtained
382out of state shall be according to rates and conditions established by the Executive Director. The
383Executive Director may require that a resident be transported back to Massachusetts when
384prolonged treatment of an emergency condition is necessary if transportation is safe for the
385patient in light of the patient’s medical condition. 20 of 35
386 (c) Visitors to Massachusetts shall be billed for all services received under the system.
387The Executive Director of the Trust may establish intergovernmental arrangements with other
388states and countries to provide reciprocal coverage for temporary visitors.
389 Section 13. Eligible Health Care Practitioners and Facilities
390 (a) Eligible health care practitioners and facilities shall include an agency, facility,
391corporation, individual, or other entity directly rendering any covered benefit to an eligible
392patient: provided, however, that the practitioner or facility:
393 (1) is licensed to operate or practice in the Commonwealth;
394 (2) does not accept payment from other sources for services provided for by the Trust;
395 (3) furnishes a signed agreement that:
396 (i) all health care services will be provided without discrimination on the basis of factors
397including, but not limited to age, sex, race, national origin, sexual orientation, gender identity,
398income status, preexisting condition, or citizenship status;
399 (ii) the practitioner or facility will comply with all state and federal laws regarding the
400confidentiality of patient records and information;
401 (iii) no balance billing or out-of-pocket charges will be made for covered services unless
402otherwise provided in this chapter; and
403 (iv) the practitioner or facility will furnish such information as may be reasonably
404required by the Trust for making payment, verifying reimbursement and rebate information, 21 of 35
405utilization review analyses, statistical and fiscal studies of operations, and compliance with state
406and federal law;
407 (4) meets state and federal quality guidelines including guidance for safe staffing, quality
408of care, and efficient use of funds for direct patient care; and
409 (5) meets whatever additional requirements that may be established by the Trust.
410 Section 14. Budgeting and Payments to Eligible Health Care Practitioners and Facilities
411 (a) To carry out this Act there are established on an annual basis:
412 (1) an operating budget;
413 (2) a capital expenditures budget; and
414 (3) reimbursement levels for practitioners consistent with rates set by the Trust that
415ensure that: (i) the total costs of all services offered by or through the practitioner are reasonable;
416and (ii) the aggregate rates of the practitioner are related reasonably to the aggregate costs of the
417health care practitioner.
418 (b) The operating budget shall be used for:
419 (1) payment for services rendered by physicians and other clinicians;
420 (2) global budgets for institutional practitioners;
421 (3) capitation payments for capitated groups; and
422 (4) administration of the Trust. 22 of 35
423 (c) Payments for operating expenses shall not be used to finance capital expenditures;
424payment of exorbitant salaries; or for activities to assist, promote, deter, or discourage union
425organizing. Any prospective payments made in excess of actual costs for covered services shall
426be returned to the Trust. Prospective payment rates and schedules shall be adjusted annually to
427incorporate retrospective adjustments. Except as provided in Section 15 of this chapter,
428reimbursement for covered services by the Trust shall constitute full payment for the services
429rendered.
430 (d) The Trust shall provide for retrospective adjustment of payments to eligible health
431care facilities and practitioners to:
432 (1) assure that payments to such practitioners and facilities reflect the difference between
433actual and projected use and expenditures for covered services; and
434 (2) protect health care practitioners and facilities who serve a disproportionate share of
435eligible participants whose expected use of covered health care services and expected health care
436expenditures for such services are greater than the average use and expenditure rates for eligible
437participants statewide.
438 (e) The capital expenditures budget shall be used for funds needed for:
439 (1) the construction or renovation of health facilities; and
440 (2) major equipment purchases.
441 (f) Payment provided under this section shall be used only to pay for the capital costs of
442eligible health care practitioners or facilities, including reasonable expenditures, as determined
443through budget negotiations with the Trust, for the replacement and purchase of equipment. 23 of 35
444 (g) The Trust shall provide funding for payment of debt service on outstanding bonds as
445of the effective date of this Act and shall be the sole source of future funding, whether directly or
446indirectly, through the payment of debt service, for capital expenditures by health care
447practitioners and facilities covered by the Trust in excess of a threshold amount to be determined
448annually by the Executive Director.
449 Section 15. Covered Benefits
450 (a) The Trust shall pay for all professional services provided by eligible practitioners and
451facilities to eligible participants needed to:
452 (1) provide high quality, appropriate, and medically necessary health care services;
453 (2) encourage reductions in health risks and increase use of preventive and primary care
454services; and
455 (3) integrate physical health, mental and behavioral health, and substance abuse services.
456 (b) Covered benefits shall include all high quality health care determined to be medically
457necessary or appropriate by the Trust, including, but not limited to, the following:
458 (1) prevention, diagnosis, and treatment of illness and injury, including laboratory,
459diagnostic imaging, inpatient, ambulatory, and emergency medical care, blood and blood
460products, dialysis, mental health services, palliative care, dental care, acupuncture, physical
461therapy, chiropractic, and podiatric services;
462 (2) promotion and maintenance of individual health through appropriate screening,
463counseling, and health education; 24 of 35
464 (3) the rehabilitation of sick and disabled persons, including physical, psychological, and
465other specialized therapies;
466 (4) mental health services, including supportive residences, occupational therapy, and
467ongoing outpatient services;
468 (5) behavioral health services, including supportive residences, occupational therapy, and
469ongoing outpatient services;
470 (6) substance misuse services, including supportive residences and ongoing outpatient
471service;
472 (7) prenatal, perinatal and maternity care, family planning, fertility, and reproductive
473health care, including abortion;
474 (8) long-term services and supports including home health care and personal support
475care;
476 (9) long term care in institutional and community-based settings;
477 (10) hospice care;
478 (11) language interpretation and such other medical or remedial services as the Trust
479shall determine;
480 (12) emergency and other medically necessary transportation;
481 (13) the full scale of dental services, other than cosmetic dentistry; 25 of 35
482 (14) basic vision care and correction, including glasses, other than laser vision correction
483for cosmetic purposes;
484 (15) hearing evaluation and treatment including hearing aids;
485 (16) prescription drugs;
486 (17) durable and non-durable medical equipment, supplies, and appliances, including
487complex rehabilitation technology products and services as medically necessary, individually-
488configured manual and power wheelchair systems, adaptive seating systems, alternative
489positioning systems, and other mobility devices that require evaluation, fitting, configuration,
490adjustment, or programming; and
491 (18) all new emerging technologies irrespective of where the parent company is located,
492such as telemedicine and telehealth practitioners.
493 (19) infection by the virus that causes COVID-19 and any long-term effects, known as
494post-COVID conditions (PCC) or Long COVID.
495 (c) No deductibles, co-payments, co-insurance, or other cost sharing shall be imposed
496with respect to covered benefits. Patients shall have free choice of participating physicians and
497other clinicians, hospitals, inpatient care facilities, and other practitioners and facilities.
498 Section 16. Wraparound Coverage for Federal Health Programs
499 (a) Prior to obtaining any federal program's waivers to receive federal funds through the
500Health Care Trust, the Trust shall seek to ensure that participants eligible for federal program
501coverage receive access to care and coverage equal to that of all other Massachusetts
502participants. It shall do so by (1) paying for all services enumerated under Section 15 not covered 26 of 35
503by the relevant federal plans; (2) paying for all such services during any federally mandated gaps
504in participants’ coverage; and (3) paying for any deductibles, co-payments, co-insurance, or
505other cost sharing incurred by such participants.
506 Section 17. Establishment of the Health Care Trust Fund
507 (a) In order to support the Trust effectively, there is hereby established the health care
508trust fund, hereinafter the Trust Fund, which shall be administered and expended by the
509Executive Director of the Trust subject to the approval of the Board. The Trust Fund shall consist
510of all revenue sources defined in Section 19, and all property and securities acquired by and
511through the use of monies deposited to the Trust Fund, and all interest thereon less payments
512therefrom to meet liabilities incurred by the Trust in the exercise of its powers and the
513performance of its duties.
514 (b) All claims for health care services rendered shall be made to the Trust Fund and all
515payments made for health care services shall be disbursed from the Trust Fund.
516 Section 18. Purpose of the Trust Fund
517 (a) Amounts credited to the Trust Fund shall be used for the following purposes:
518 (1) to pay eligible health care practitioners and health care facilities for covered services
519rendered to eligible individuals;
520 (2) to fund capital expenditures for eligible health care practitioners and health care
521facilities for approved capital investments in excess of a threshold amount to be determined
522annually by the Executive Director; 27 of 35
523 (3) to pay for preventive care, education, outreach, and public health risk reduction
524initiatives, not to exceed 5% of Trust income in any fiscal year;
525 (4) to supplement other sources of financing for education and training of the health care
526workforce, not to exceed 2% of Trust income in any fiscal year;
527 (5) to supplement other sources of financing for medical research and innovation, not to
528exceed 1% of Trust income in any fiscal year;
529 (6) to supplement other sources of financing for training and retraining programs for
530workers displaced as a result of administrative streamlining gained by moving from a multi-
531payer to a single payer health care system, not to exceed 2% of Trust income in any fiscal year:
532provided, however, that eligible workers must have enrolled by June 20 of the third year
533following full implementation of this chapter;
534 (7) to fund a reserve account to finance anticipated long-term cost increases due to
535demographic changes, inflation, or other foreseeable trends that would increase Trust Fund
536liabilities, and for budgetary shortfall, epidemics, and other extraordinary events, not to exceed
5371% of Trust income in any fiscal year: provided, however, that the Trust reserve account shall at
538no time constitute more than 5% of total Trust assets;
539 (8) to pay the administrative costs of the Trust which, within two years of full
540implementation of this chapter shall not exceed 5% of Trust income in any fiscal year.
541 (b) Unexpended Trust assets shall not be deemed to be “surplus” funds as defined by
542chapter twenty-nine of the general laws.
543 Section 19. Funding Sources 28 of 35
544 (a) The Trust shall be the repository for all health care funds and related administrative
545funds. A fairly apportioned, dedicated health care tax on employers, workers, and residents will
546replace spending on insurance premiums and out-of-pocket spending for services covered by the
547Trust. The Trust shall enable the state to pass lower health care costs on to residents and
548employers through savings from administrative simplification, negotiating prices, discounts on
549pharmaceuticals and medical supplies, and through early detection and intervention by
550universally available primary and preventive care. Additionally, collateral sources of revenue –
551such as from the federal government, non-residents receiving care in the state, or from personal
552liability – shall be recovered by the Trust. The Trust shall be funded by dedicated revenue
553streams and its budget shall not affect other public health programs run by the state. Lastly, the
554Trust shall enact provisions ensuring a smooth transition to a universal health care system for
555employers and residents.
556 (b) The following dedicated health care taxes will replace spending on insurance
557premiums and out-of-pocket spending for services covered by the Trust. Prior to each state fiscal
558year of operation, the Trust will prepare for the Legislature a projected budget for the coming
559fiscal year, with recommendations for rising or declining revenue needs.
560 (1) An employer payroll tax of 7.5 percent will be assessed on employee W-2 wages,
561exempting the first $20,000 of payroll per establishment, replacing previous spending by
562employers on health premiums. An additional employer payroll tax of 0.5 per cent will be
563assessed on establishments with 100 or more employees;
564 (2) An employee payroll tax of 2.5 percent will be assessed, exempting the first $20,000
565of income, replacing previous spending by employees on health premiums and out-of-pocket 29 of 35
566expenses; all W-2 wages will be combined for each taxpayer and one $20,000 exemption will be
567allowed;
568 (3) A 10 percent payroll tax on the self-employed, including general partnership income
569and other income subject to self-employment tax for Federal purposes, will be assessed,
570exempting the first $20,000 of payroll per self-employed taxpayer; income from all sources
571subject to tax in this section shall be combined and allowed one $20,000 exemption per taxpayer;
572and
573 (4) For the purposes of sections (2) and (3) above, each taxpayer will combine all income
574reported on from IRS Form W-2s and self-employment income and be allowed one $20,000
575exemption. The exemption will apply first to W-2 income and then to self-employment income.
576 (5) A 10 percent tax on taxable unearned income and all other income not specifically
577excluded will be assessed on such income above $20,000. Exclusions not taxed: Social Security,
578Supplemental Security Income (SSI), Social Security Disability Income (SSDI), unemployment
579benefits, workers compensation benefits, sick pay, paid family and medical leave, capital gains
580resulting from the sale of owner-occupied two- or three-family rental property, and defined
581contribution and defined benefit pension payments. Capital gains from the portion attributed to a
582primary residence in excess of the exclusion allowed by Massachusetts law will be subject to the
583tax. The $20,000 exemption for this section shall be applied to each individual taxpayer.
584 (c) An employer, private or public, may agree to pay all or part of an employee’s payroll
585tax obligation. Such payment shall not be considered income to the employee for Massachusetts
586income tax purposes. 30 of 35
587 (d) Default, underpayment, or late payment of any tax or other obligation imposed by the
588Trust shall result in the remedies and penalties provided by law, except as provided in this
589section.
590 (e) Eligibility for benefits shall not be impaired by any default, underpayment, or late
591payment of any tax or other obligation imposed by the Trust.
592 (f) It is the intent of this act to establish a single public payer for all health care in the
593Commonwealth. Towards this end, public spending on health insurance shall be consolidated
594into the Trust to the greatest extent possible. Until such time as the role of all other payers for
595health care has been terminated, health care costs shall be collected from collateral sources
596whenever medical services provided to an individual are, or may be, covered services under a
597policy of insurance, health care service plan, or other collateral source available to that
598individual, or for which the individual has a right of action for compensation to the extent
599permitted by law.
600 (g) The Legislature shall be empowered to transfer funds from the General Fund
601sufficient to meet the Trust’s projected expenses beyond projected income from dedicated tax
602revenues. This lump transfer shall replace current General Fund spending on health benefits for
603state employees, services for patients at public in-patient facilities, and all means- or needs-tested
604health benefit programs.
605 (h) The Trust shall receive all monies paid to the Commonwealth by the federal
606government for health care services covered by the Trust. The Trust shall seek to maximize all
607sources of federal financial support for health care services in Massachusetts. Accordingly, the
608Executive Director shall seek all necessary waivers, exemptions, agreements, or legislation, if 31 of 35
609needed, so that all current federal payments for health care shall, consistent with the federal law,
610be paid directly to the Trust Fund. In obtaining the waivers, exemptions, agreements, or
611legislation, the Executive Director shall seek from the federal government a contribution for
612health care services in Massachusetts that shall not decrease in relation to the contribution to
613other states as a result of the waivers, exemptions, agreements, or legislation.
614 (i) As used in this section, “collateral source” includes all of the following:
615 (1) insurance policies written by insurers, including the medical components of
616automobile, homeowners, workers’ compensation, and other forms of insurance;
617 (2) health care service plans and pension plans;
618 (3) employee benefit contracts;
619 (4) government benefit programs;
620 (5) a judgment for damages for personal injury;
621 (6) any third party who is or may be liable to an individual for health care services or
622costs;
623 (j) As used in this section, “collateral sources” does not include either of the following:
624 (1) a contract or plan that is subject to federal preemption; and
625 (2) any governmental unit, agency, or service, to the extent that subrogation is prohibited
626by law. 32 of 35
627 (k) An entity described as a collateral source is not excluded from the obligations
628imposed by this section by virtue of a contract or relationship with a governmental unit, agency,
629or service.
630 (l) Whenever an individual receives health care services under the system Trust and the
631individual is entitled to coverage, reimbursement, indemnity, or other compensation from a
632collateral source, the individual shall notify the health care practitioner or facility and provide
633information identifying the collateral source other than federal sources, the nature and extent of
634coverage or entitlement, and other relevant information. The health care practitioner or facility
635shall forward this information to the Executive Director. The individual entitled to coverage,
636reimbursement, indemnity, or other compensation from a collateral source shall provide
637additional information as requested by the Executive Director.
638 (m) The Trust shall seek reimbursement from the collateral source for services provided
639to the individual, and may institute appropriate action, including suit, to recover the costs to the
640Trust. Upon demand, the collateral source shall pay to the Trust Fund the sums it would have
641paid or expended on behalf of the individuals for the health care services provided by the Trust.
642 (n) If a collateral source is exempt from subrogation or the obligation to reimburse the
643Trust as provided in this section, the Executive Director may require that an individual who is
644entitled to medical services from the collateral source first seek those services from that source
645before seeking those services from the Trust.
646 (o) To the extent permitted by federal law, contractual retiree health benefits provided by
647employers shall be subject to the same subrogation as other contracts, allowing the Trust to 33 of 35
648recover the cost of services provided to individuals covered by the retiree benefits, unless and
649until arrangements are made to transfer the revenues of the benefits directly to the Trust.
650 (p) The Trust shall retain:
651 (1) all charitable donations, gifts, grants, or bequests made to it from whatever source
652consistent with state and federal law;
653 (2) payments from third party payers for covered services rendered by eligible
654practitioners to non-eligible patients but paid for by the Trust; and
655 (3) income from the investment of Trust assets, consistent with state and federal law.
656 (q) Any employer who has a contract with an insurer, health services corporation, or
657health maintenance organization to provide health care services or benefits for its employees,
658which is in effect on the effective date of this section, shall be entitled to an income tax credit
659against premiums otherwise due in an amount equal to the Trust Fund tax due pursuant to this
660section.
661 (r) Any insurer, self-insured employers, union health and welfare fund, health services
662corporation, or health maintenance organization which provides health care services or benefits
663under a contract with an employer or group of employers, which is in effect on the effective date
664of this act, shall pay to the Trust Fund an amount equal to the Health Care Trust employer
665payroll tax based on the number of employees of each employer.
666 (s) Six months prior to the establishment of the Health Care Trust, all laws and
667regulations requiring health insurance carriers to maintain cash reserves for purposes of
668commercial stability (such as under Chapter 176G, Section 25 of the General Laws) shall be 34 of 35
669repealed. In their place, the Executive Director of the Trust shall assess an annual health care
670stabilization fee upon the same carriers, amounting to the same sum previously required to be
671held in reserves, which shall be credited to the Health Care Trust Fund.
672 Section 20. Insurance Reforms
673 Insurers regulated by the division of insurance are prohibited from charging premiums to
674eligible participants for coverage of services already covered by the Trust. The commissioner of
675insurance shall adopt, amend, alter, repeal, and enforce all such reasonable rules and regulations
676and orders as may be necessary to implement this section.
677 Section 21. Health Care Trust Regulatory Authority
678 The Trust shall adopt and promulgate regulations to implement the provisions of this
679chapter. The initial regulations may be adopted as emergency regulations but those emergency
680regulations shall be in effect only from the effective date of this chapter until the conclusion of
681the transition period.
682 Section 22. Implementation of the Health Care Trust
683 Not later than sixty days after enactment of this legislation, the Governor and Attorney
684General shall make the initial appointments to the Board of the Massachusetts Health Care Trust
685and coordinate with the Secretary of the Commonwealth to set the date for public elections of the
686eight Trustees elected by the citizens of the Commonwealth within four months of the
687appointments. The first meeting of the Board shall take place within 30 days of the election of
688the Trustees. 35 of 35
689 The Board shall immediately begin the process of hiring an Executive Director of the
690Trust, review enabling legislation, educating itself regarding general purposes, economics, and
691authority of the Trust. The Board shall develop a budget for the first year of transition and
692initiate the process of obtaining federal waivers and agreements concerning payments from
693Medicare, Medicaid, and other public programs. The Board shall also set a general timeframe
694for establishing the Trust with a launch date no less than one year and no more than 18 months
695after the first meeting of the Board.
696 In the first phase of transition, the Executive Director shall begin hiring staff, establishing
697the administrative and information technology infrastructure for the Trust, and negotiating
698reimbursement rates for health care services, pharmaceuticals, and medical equipment. Health
699care practitioners shall develop plans for transitioning to the Trust.
700 In the second phase of transition, the infrastructure of the Trust shall be established,
701including Regional Offices to provide public education about the new system; training of health
702care practitioners staff on systems for processing bills to the Trust; and introduction of
703accounting regulations to employers for payment of payroll taxes. Private insurers shall pay the
704annual health care stabilization fee. Residents of the Commonwealth shall receive health care
705identification cards with an explanation of benefits and contact information for their Regional
706office.
707 Funding for the establishment of the Trust during the transition period shall be provided
708by the Legislature, supplemented by the reserve funds of private insurers.