Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S1628 Compare Versions

Only one version of the bill is available at this time.

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2	2	SENATE DOCKET, NO. 2325 FILED ON: 1/17/2025
3	3	SENATE . . . . . . . . . . . . . . No. 1628
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Bruce E. Tarr
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act to protect the independence of clinical decision making.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :Bruce E. TarrFirst Essex and Middlesex 1 of 8
16	16	SENATE DOCKET, NO. 2325 FILED ON: 1/17/2025
17	17	SENATE . . . . . . . . . . . . . . No. 1628
18	18	By Mr. Tarr, a petition (accompanied by bill, Senate, No. 1628) of Bruce E. Tarr for legislation
19	19	to allow an independent health care practice to have ultimate control over clinical decision
20	20	making. Public Health.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Fourth General Court
24	24	(2025-2026)
25	25	_______________
26	26	An Act to protect the independence of clinical decision making.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 SECTION 1. Chapter 112 of the General Laws is hereby amended by inserting after
30	30	2section 4 the following sections:-
31	31	3 Section 4A. (a) For the purposes of sections 4A and 4B, the following words shall have
32	32	4the following meanings:-
33	33	5 “Board of Registration in Medicine”, the board of registration in medicine established
34	34	6pursuant to section 10 of chapter 13.
35	35	7 “Board of Registration in Nursing”, the board of registration in nursing established
36	36	8pursuant to section 13 of chapter 13.
37	37	9 “Clinician”, a physician, nurse, physician assistant, psychologist, or independent clinical
38	38	10social worker, who is licensed to provide health services and registered in the commonwealth
39	39	11pursuant to chapter 112 to provide such services, and any other individual who is licensed to 2 of 8
40	40	12provide health services and registered in the commonwealth pursuant to chapter 112 to provide
41	41	13such services.
42	42	14 “Clinician with independent practice authority”, a physician registered to practice
43	43	15medicine in the commonwealth or a nurse practitioner, psychiatric nurse mental health clinical
44	44	16specialist, or nurse anesthetist who is registered to practice medicine in the commonwealth and
45	45	17who has independent practice authority pursuant to sections 80E and 80J of said chapter 112.
46	46	18 “Management services organization,” a business that provides management or
47	47	19administrative services to a health care provider or provider organization for compensation.
48	48	20 “Health care practice”, a business, regardless of form, through which a clinician with
49	49	21independent practice authority licensed by the Board of Registration in Medicine or the Board of
50	50	22Registration in Nursing offers health services; provided, however, that health care practice shall
51	51	23not include any entity that holds a license issued by the department of public health pursuant to
52	52	24sections 51, 51M, 51N or 52 of chapter 111.
53	53	25 “Physician”, a doctor of medicine or doctor of osteopathy who is registered to practice
54	54	26medicine in the commonwealth pursuant to section 2 of chapter 112.
55	55	27 (b) A clinician with independent practice authority may practice at a health care practice
56	56	28that meets the following requirements: (1) the health care practice is wholly owned and
57	57	29controlled by one or more clinicians with independent practice authority who hold a certificate of
58	58	30registration that (i) is issued by the board of registration in medicine or the board of registration
59	59	31in nursing pursuant to the requirements of sections 2 and 80B of this chapter, and (ii) has not
60	60	32been suspended or revoked; or (2) the health care practice is conducted through a business
61	61	33organization formed as: (i) a professional corporation pursuant to chapter 156A; (ii) a nonprofit 3 of 8
62	62	34organization, a nonprofit hospital services corporation organized under chapter 176A, a nonprofit
63	63	35medical services corporation organized under chapter 176B; (iii) a limited liability company
64	64	36organized under chapter 156C; provided, however, that there are no LLC provisions limiting or
65	65	37eliminating the licensee’s liability for intentional tort or negligence; (iv) a partnership organized
66	66	38under chapter 108A, including, but not limited to, a registered limited liability partnership;
67	67	39provided, however, that the partnership has no provisions limiting or eliminating the licensee's
68	68	40liability for intentional torts or negligence; or (v) an organization similar to those organizations
69	69	41described in clauses (i) through (iv) of this subsection and organized under a comparable law of
70	70	42any other United States jurisdiction; organized under a comparable law of any other jurisdiction
71	71	43within the United States; provided, however, that all shares of the organization shall be owned by
72	72	44clinicians with independent practice authority.
73	73	45 (c) It shall constitute the unauthorized practice of medicine in violation of section 6 of
74	74	46this chapter for any person or entity to own a health care practice other than a clinician with
75	75	47independent practice authority who holds a certificate of registration that is issued by the board
76	76	48of registration in medicine or the board of registration in nursing pursuant to the requirements of
77	77	49sections 2 or 80B and has not been suspended or revoked. This section shall not apply to a health
78	78	50care facility or entity that holds a license issued by the department of public health pursuant to
79	79	51sections 51, 51M, 51N or 52 of chapter 111.
80	80	52 (d)(1) Nothing in this section shall prohibit a clinician with independent practice
81	81	53authority from practicing medicine as an employee of a health care facility or entity that holds a
82	82	54license issued by the department of public health pursuant to sections 51, 51M, 51N or 52 of
83	83	55chapter 111. 4 of 8
84	84	56 (2) An entity that provides compensation to one or more clinicians with independent
85	85	57practice authority, including, but not limited to a health care facility licensed pursuant to sections
86	86	5851, 51M, 51N or 51, shall not directly or indirectly interfere with, control, or otherwise direct the
87	87	59professional judgment or clinical decisions of such clinicians with independent practice
88	88	60authority. Conduct prohibited under this paragraph shall include, but not be limited to,
89	89	61controlling, either directly or indirectly through discipline, punishment, threats, adverse
90	90	62employment actions, coercion, retaliation or excessive pressure, regarding: (i) the amount of time
91	91	63spent with patients, including the time permitted to triage patients in the emergency department
92	92	64or evaluate admitted patients; (ii) the time period within which a patient must be discharged; (iii)
93	93	65decisions involving the patient’s clinical status, including, but not limited to, whether the patient
94	94	66should be kept in observation status, whether the patient should receive palliative care and where
95	95	67the patient should be placed upon discharge; (iv) the diagnosis, diagnostic terminology or codes
96	96	68that are entered into the medical record; or (v) any other conduct the department of public health
97	97	69determines by regulation would interfere with, control or otherwise direct the professional
98	98	70judgement or clinical decisions of clinicians with independent practice authority. Such entities
99	99	71shall not limit the range of clinical orders available to clinicians either directly or by configuring
100	100	72the medical record to prohibit or significantly limit the clinical order options available.
101	101	73Nondisclosure or non-disparagement agreements regarding subsections (i) through (v), inclusive,
102	102	74between a clinician with independent practice authority and any person or entity shall be
103	103	75considered void and unenforceable. If a court of competent jurisdiction finds a policy, contract or
104	104	76contract provision void and unenforceable pursuant to this section, the court shall award the
105	105	77plaintiff reasonable attorney’s fees and costs. Nothing in this section shall limit the ability of any 5 of 8
106	106	78person to bring any action relating to defamation, disclosure of confidential or proprietary
107	107	79information or trade secrets or similar torts.
108	108	80 (e) All health care practices shall provide written certification that the health care practice
109	109	81meets the requirements in this section to the board of registration in medicine or the board of
110	110	82registration in nursing at the time of formation and on a biennial basis thereafter. If a practice’s
111	111	83owners consist of individuals registered solely with the board of registration in medicine or the
112	112	84board of registration in nursing, the practice shall provide the certification to the applicable
113	113	85board. If the practice’s owners consist of individuals registered with both boards, the practice
114	114	86shall provide the certification to the board of registration in medicine, which shall transmit a
115	115	87copy to the board of registration in nursing. Health care practices shall, at the time that such
116	116	88clinicians with independent practice authority are hired or affiliated with the practice and within
117	117	8930 days of providing certification to the applicable board pursuant to this section, provide a copy
118	118	90of the most recent certification to all clinicians with independent practice authority who: (i)
119	119	91engage in providing health services at the practice; and (ii) do not hold any ownership interest in
120	120	92the practice.
121	121	93 (f) All health care practices shall file with the applicable board a registration application
122	122	94containing such information as the board may reasonably require, including, but not limited to:
123	123	95(i) the identity of the applicant and of the clinicians with independent practice authority which
124	124	96constitute the practice; (ii) any management services organization under contract with the health
125	125	97care practice; (iii) a certified copy of the health care practice’s certificate of organization, if any,
126	126	98as filed with the secretary of the commonwealth, or any applicable partnership agreement; (iv)
127	127	99the address of the health care practice; (v) the services provided by the health care practice; and
128	128	100(vi) any information the board, in consultation with the health policy commission and the center 6 of 8
129	129	101for health information and analysis, deems relevant for the state health plan and focused
130	130	102assessments pursuant to section 22 of chapter 6D and the health care resources inventory
131	131	103pursuant to section 9 of chapter 12C. The application shall be accompanied by a fee in an amount
132	132	104to be determined pursuant to section 3B of chapter 7. All health care practices registered in the
133	133	105commonwealth shall renew their certificates of registration with the board every 2 years. The
134	134	106board shall share information relevant to the state health plan and focused assessments pursuant
135	135	107to section 22 of chapter 6D with the commission and information relevant to the health care
136	136	108resources inventory pursuant to section 9 of section 12C with the center.
137	137	109 (g) All health care practices with more than 1 clinician with independent practice
138	138	110authority that constitutes the practice shall designate a clinician with independent practice
139	139	111authority at the practice to serve as medical director; provided, however, that the designated
140	140	112clinician shall hold a certificate of registration that (i) is issued by the Board of Registration in
141	141	113Medicine or the Board of Registration in Nursing pursuant to the requirements of sections 2 or
142	142	11480B of this chapter that is not suspended or revoked; and (2) is present in the state and is
143	143	115substantially engaged in delivering care or managing the practice. The director shall be
144	144	116responsible for implementing policies and procedures to ensure compliance with local
145	145	117ordinances and state and federal statutes and regulations governing the practice of medicine or
146	146	118the practice of nursing, including regulations promulgated and policies established by the
147	147	119applicable board. The board may impose discipline against the licenses of the medical director
148	148	120and the clinicians with independent practice authority who own and control the health care
149	149	121practice for failure of the practice to comply with local ordinances and state and federal statutes
150	150	122and regulations governing the practice of medicine or the practice of nursing, including
151	151	123regulations promulgated and policies established by the applicable board. 7 of 8
152	152	124 (h) The board of registration in medicine and board of registration in nursing may
153	153	125promulgate regulations to establish minimum requirements for the conduct of a health care
154	154	126practice, including, but not limited to: (i) compliance with section 4A of chapter 112; (ii)
155	155	127maintenance and access to medical records; and (iii) in the event of a planned closure of the
156	156	128health care practice or an unplanned event that prevents the health care practice from continuing
157	157	129operations, the development of a continuity plan to: (1) ensure access to medical records, (2)
158	158	130provide notice to patients; and (3) assist patients with transitioning to a new provider. If a
159	159	131practice’s owners consist of individuals registered solely with the board of registration in
160	160	132medicine or the board of registration in nursing, the practice shall comply with the applicable
161	161	133board’s regulations. If the practice’s owners consist of individuals registered with both boards,
162	162	134the practice shall comply with the regulations issued by the board of registration in medicine.
163	163	135Each board shall consult with the other when promulgating regulations.
164	164	136
165	165	137 Section 4B. (a) A health care practice shall maintain ultimate control over clinical
166	166	138decisions.
167	167	139 (b) A management services organization shall not exercise control over, or be delegated
168	168	140the power to do, any of the following: (i) owning or otherwise determining the content of patient
169	169	141medical records; (ii) selecting, hiring or firing any owner of or clinician associated with the
170	170	142health care practice based, in whole or in part, on clinical competency or proficiency;; (iii)
171	171	143setting the parameters under which a practice shall enter into contractual relationships with
172	172	144clinicians for the delivery of care; (iv) making final decisions regarding coding and billing 8 of 8
173	173	145procedures for patient care services; or (v) approving the selection of medical equipment and
174	174	146medical supplies for the practice.
175	175	147 (c) A health care practice shall maintain ultimate decision-making authority over: (i)
176	176	148personnel decisions involving clinicians, including, but not limited to, employment status,
177	177	149compensation, hours or working conditions; (ii) coding or billing decisions; (iii) the selection and
178	178	150use of property, including, but not limited to, real property, medical equipment or medical
179	179	151supplies for the delivery of patient care services; (iv) the number of patients seen in a given
180	180	152period of time or the amount of time spent with each patient; (v) the appropriate diagnostic test
181	181	153for medical conditions; (vi) the use of patient medical records; and (vii) referral decisions.
182	182	154 (d) A violation of this section shall constitute the unauthorized practice of medicine in
183	183	155violation of section 6 or the unauthorized practice of nursing in violation of section 80E, 80H or
184	184	15680J. Any provision of a contract or agreement that has the effect of violating this section shall be
185	185	157void and unenforceable. If a court of competent jurisdiction finds a policy, contract or contract
186	186	158provision void and unenforceable pursuant to this section, the court shall award the plaintiff
187	187	159reasonable attorney’s fees and costs.
188	188	160 (e) The department of public health shall promulgate regulations to effectuate the
189	189	161purposes of this section.