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SENATE DOCKET, NO. 2274 FILED ON: 1/17/2025
SENATE . . . . . . . . . . . . . . No. 1534
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Paul R. Feeney
_________________
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 to protect the independence of clinical decision making.
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PETITION OF:
NAME:DISTRICT/ADDRESS :Paul R. FeeneyBristol and Norfolk 1 of 8
SENATE DOCKET, NO. 2274 FILED ON: 1/17/2025
SENATE . . . . . . . . . . . . . . No. 1534
By Mr. Feeney, a petition (accompanied by bill, Senate, No. 1534) of Paul R. Feeney for
legislation to protect the independence of clinical decision making. Public Health.
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Fourth General Court
(2025-2026)
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An Act to protect the independence of clinical decision making.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 112 of the General Laws is hereby amended by inserting after
2section 4 the following sections:-
3 Section 4A. (a) For the purposes of sections 4A and 4B, the following words shall have
4the following meanings:-
5 “Board of Registration in Medicine”, the board of registration in medicine established
6pursuant to section 10 of chapter 13.
7 “Board of Registration in Nursing”, the board of registration in nursing established
8pursuant to section 13 of chapter 13.
9 “Clinician”, a physician, nurse, physician assistant, psychologist, or independent clinical
10social worker, who is licensed to provide health services and registered in the commonwealth
11pursuant to chapter 112 to provide such services, and any other individual who is licensed to 2 of 8
12provide health services and registered in the commonwealth pursuant to chapter 112 to provide
13such services.
14 “Clinician with independent practice authority”, a physician registered to practice
15medicine in the commonwealth or a nurse practitioner, psychiatric nurse mental health clinical
16specialist, or nurse anesthetist who is registered to practice medicine in the commonwealth and
17who has independent practice authority pursuant to sections 80E and 80J of said chapter 112.
18 “Management services organization,” a business that provides management or
19administrative services to a health care provider or provider organization for compensation.
20 “Health care practice”, a business, regardless of form, through which a clinician with
21independent practice authority licensed by the Board of Registration in Medicine or the Board of
22Registration in Nursing offers health services; provided, however, that health care practice shall
23not include any entity that holds a license issued by the department of public health pursuant to
24sections 51, 51M, 51N or 52 of chapter 111.
25 “Physician”, a doctor of medicine or doctor of osteopathy who is registered to practice
26medicine in the commonwealth pursuant to section 2 of chapter 112.
27 (b) A clinician with independent practice authority may practice at a health care practice
28that meets the following requirements: (1) the health care practice is wholly owned and
29controlled by one or more clinicians with independent practice authority who hold a certificate of
30registration that (i) is issued by the board of registration in medicine or the board of registration
31in nursing pursuant to the requirements of sections 2 and 80B of this chapter, and (ii) has not
32been suspended or revoked; or (2) the health care practice is conducted through a business
33organization formed as: (i) a professional corporation pursuant to chapter 156A; (ii) a nonprofit 3 of 8
34organization, a nonprofit hospital services corporation organized under chapter 176A, a nonprofit
35medical services corporation organized under chapter 176B; (iii) a limited liability company
36organized under chapter 156C; provided, however, that there are no LLC provisions limiting or
37eliminating the licensee's liability for intentional tort or negligence; (iv) a partnership organized
38under chapter 108A, including, but not limited to, a registered limited liability partnership;
39provided, however, that the partnership has no provisions limiting or eliminating the licensee's
40liability for intentional torts or negligence; or (v) an organization similar to those organizations
41described in clauses (i) through (iv) of this subsection and organized under a comparable law of
42any other United States jurisdiction; organized under a comparable law of any other jurisdiction
43within the United States; provided, however, that all shares of the organization shall be owned by
44clinicians with independent practice authority.
45 (c) It shall constitute the unauthorized practice of medicine in violation of section 6 of
46this chapter for any person or entity to own a health care practice other than a clinician with
47independent practice authority who holds a certificate of registration that is issued by the board
48of registration in medicine or the board of registration in nursing pursuant to the requirements of
49sections 2 or 80B and has not been suspended or revoked. This section shall not apply to a health
50care facility or entity that holds a license issued by the department of public health pursuant to
51sections 51, 51M, 51N or 52 of chapter 111.
52 (d)(1) Nothing in this section shall prohibit a clinician with independent practice
53authority from practicing medicine as an employee of a health care facility or entity that holds a
54license issued by the department of public health pursuant to sections 51, 51M, 51N or 52 of
55chapter 111. 4 of 8
56 (2) An entity that provides compensation to one or more clinicians with independent
57practice authority, including, but not limited to a health care facility licensed pursuant to sections
5851, 51M, 51N or 51, shall not directly or indirectly interfere with, control, or otherwise direct the
59professional judgment or clinical decisions of such clinicians with independent practice
60authority. Conduct prohibited under this paragraph shall include, but not be limited to,
61controlling, either directly or indirectly through discipline, punishment, threats, adverse
62employment actions, coercion, retaliation or excessive pressure, regarding: (i) the amount of time
63spent with patients, including the time permitted to triage patients in the emergency department
64or evaluate admitted patients; (ii) the time period within which a patient must be discharged; (iii)
65decisions involving the patient’s clinical status, including, but not limited to, whether the patient
66should be kept in observation status, whether the patient should receive palliative care and where
67the patient should be placed upon discharge; (iv) the diagnosis, diagnostic terminology or codes
68that are entered into the medical record; or (v) any other conduct the department of public health
69determines by regulation would interfere with, control or otherwise direct the professional
70judgement or clinical decisions of clinicians with independent practice authority. Such entities
71shall not limit the range of clinical orders available to clinicians either directly or by configuring
72the medical record to prohibit or significantly limit the clinical order options available.
73Nondisclosure or non-disparagement agreements regarding subsections (i) through (v), inclusive,
74between a clinician with independent practice authority and any person or entity shall be
75considered void and unenforceable. If a court of competent jurisdiction finds a policy, contract or
76contract provision void and unenforceable pursuant to this section, the court shall award the
77plaintiff reasonable attorney’s fees and costs. Nothing in this section shall limit the ability of any 5 of 8
78person to bring any action relating to defamation, disclosure of confidential or proprietary
79information or trade secrets or similar torts.
80 (e) All health care practices shall provide written certification that the health care practice
81meets the requirements in this section to the board of registration in medicine or the board of
82registration in nursing at the time of formation and on a biennial basis thereafter. If a practice’s
83owners consist of individuals registered solely with the board of registration in medicine or the
84board of registration in nursing, the practice shall provide the certification to the applicable
85board. If the practice’s owners consist of individuals registered with both boards, the practice
86shall provide the certification to the board of registration in medicine, which shall transmit a
87copy to the board of registration in nursing. Health care practices shall, at the time that such
88clinicians with independent practice authority are hired or affiliated with the practice and within
8930 days of providing certification to the applicable board pursuant to this section, provide a copy
90of the most recent certification to all clinicians with independent practice authority who: (i)
91engage in providing health services at the practice; and (ii) do not hold any ownership interest in
92the practice.
93 (f) All health care practices shall file with the applicable board a registration application
94containing such information as the board may reasonably require, including, but not limited to:
95(i) the identity of the applicant and of the clinicians with independent practice authority which
96constitute the practice; (ii) any management services organization under contract with the health
97care practice; (iii) a certified copy of the health care practice’s certificate of organization, if any,
98as filed with the secretary of the commonwealth, or any applicable partnership agreement; (iv)
99the address of the health care practice; (v) the services provided by the health care practice; and
100(vi) any information the board, in consultation with the health policy commission and the center 6 of 8
101for health information and analysis, deems relevant for the state health plan and focused
102assessments pursuant to section 22 of chapter 6D and the health care resources inventory
103pursuant to section 9 of chapter 12C. The application shall be accompanied by a fee in an amount
104to be determined pursuant to section 3B of chapter 7. All health care practices registered in the
105commonwealth shall renew their certificates of registration with the board every 2 years. The
106board shall share information relevant to the state health plan and focused assessments pursuant
107to section 22 of chapter 6D with the commission and information relevant to the health care
108resources inventory pursuant to section 9 of section 12C with the center.
109 (g) All health care practices with more than 1 clinician with independent practice
110authority that constitutes the practice shall designate a clinician with independent practice
111authority at the practice to serve as medical director; provided, however, that the designated
112clinician shall hold a certificate of registration that (i) is issued by the Board of Registration in
113Medicine or the Board of Registration in Nursing pursuant to the requirements of sections 2 or
11480B of this chapter that is not suspended or revoked; and (2) is present in the state and is
115substantially engaged in delivering care or managing the practice. The director shall be
116responsible for implementing policies and procedures to ensure compliance with local
117ordinances and state and federal statutes and regulations governing the practice of medicine or
118the practice of nursing, including regulations promulgated and policies established by the
119applicable board. The board may impose discipline against the licenses of the medical director
120and the clinicians with independent practice authority who own and control the health care
121practice for failure of the practice to comply with local ordinances and state and federal statutes
122and regulations governing the practice of medicine or the practice of nursing, including
123regulations promulgated and policies established by the applicable board. 7 of 8
124 (h) The board of registration in medicine and board of registration in nursing may
125promulgate regulations to establish minimum requirements for the conduct of a health care
126practice, including, but not limited to: (i) compliance with section 4A of chapter 112; (ii)
127maintenance and access to medical records; and (iii) in the event of a planned closure of the
128health care practice or an unplanned event that prevents the health care practice from continuing
129operations, the development of a continuity plan to: (1) ensure access to medical records, (2)
130provide notice to patients; and (3) assist patients with transitioning to a new provider. If a
131practice’s owners consist of individuals registered solely with the board of registration in
132medicine or the board of registration in nursing, the practice shall comply with the applicable
133board’s regulations. If the practice’s owners consist of individuals registered with both boards,
134the practice shall comply with the regulations issued by the board of registration in medicine.
135Each board shall consult with the other when promulgating regulations.
136 Section 4B. (a) A health care practice shall maintain ultimate control over clinical
137decisions.
138 (b) A management services organization shall not exercise control over, or be delegated
139the power to do, any of the following: (i) owning or otherwise determining the content of patient
140medical records; (ii) selecting, hiring or firing any owner of or clinician associated with the
141health care practice based, in whole or in part, on clinical competency or proficiency; (iii) setting
142the parameters under which a practice shall enter into contractual relationships with third-party
143payers; (iiiv) setting the parameters under which a practice shall enter into contractual
144relationships with clinicians for the delivery of care; (iv) making final decisions regarding coding
145and billing procedures for patient care services; or (vi) approving the selection of medical
146equipment and medical supplies for the practice. 8 of 8
147 (c) A health care practice shall maintain ultimate decision-making authority over: (i)
148personnel decisions involving clinicians, including, but not limited to, employment status,
149compensation, hours or working conditions; (ii) coding or billing decisions; (iii) the selection and
150use of property, including, but not limited to, real property, medical equipment or medical
151supplies for the delivery of patient care services; (iv) the number of patients seen in a given
152period of time or the amount of time spent with each patient; (v) the appropriate diagnostic test
153for medical conditions; (vi) the use of patient medical records; and (vii) referral decisions.
154 (d) A violation of this section shall constitute the unauthorized practice of medicine in
155violation of section 6 or the unauthorized practice of nursing in violation of section 80E, 80H or
15680J. Any provision of a contract or agreement that has the effect of violating this section shall be
157void and unenforceable. If a court of competent jurisdiction finds a policy, contract or contract
158provision void and unenforceable pursuant to this section, the court shall award the plaintiff
159reasonable attorney’s fees and costs.
160 (e) The department of public health shall promulgate regulations to effectuate the
161purposes of this section.