Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S860 Compare Versions

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

Old	New	Differences
1	1	1 of 1
2	2	SENATE DOCKET, NO. 2341 FILED ON: 1/17/2025
3	3	SENATE . . . . . . . . . . . . . . No. 860
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	James B. Eldridge
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 establishing medicare for all in Massachusetts.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :James B. EldridgeMiddlesex and WorcesterLindsay N. Sabadosa1st HampshireMargaret R. Scarsdale1st MiddlesexJoanne M. ComerfordHampshire, Franklin and Worcester1/27/2025Paul W. MarkBerkshire, Hampden, Franklin and
16	16	Hampshire
17	17	1/27/2025Vanna Howard17th Middlesex2/11/2025Jason M. LewisFifth Middlesex2/11/2025John F. KeenanNorfolk and Plymouth2/11/2025Michael D. BradySecond Plymouth and Norfolk2/11/2025Paul R. FeeneyBristol and Norfolk2/11/2025Sal N. DiDomenicoMiddlesex and Suffolk2/11/2025Adam GomezHampden2/11/2025Jacob R. OliveiraHampden, Hampshire and Worcester2/11/2025Mike Connolly26th Middlesex2/11/2025Manny Cruz7th Essex2/11/2025Julian CyrCape and Islands2/27/2025Patricia D. JehlenSecond Middlesex2/27/2025 1 of 35
18	18	SENATE DOCKET, NO. 2341 FILED ON: 1/17/2025
19	19	SENATE . . . . . . . . . . . . . . No. 860
20	20	By Mr. Eldridge, a petition (accompanied by bill, Senate, No. 860) of James B. Eldridge,
21	21	Lindsay N. Sabadosa, Margaret R. Scarsdale, Joanne M. Comerford and other members of the
22	22	General Court for legislation to establish medicare for all in Massachusetts. Health Care
23	23	Financing.
24	24	[SIMILAR MATTER FILED IN PREVIOUS SESSION
25	25	SEE SENATE, NO. 744 OF 2023-2024.]
26	26	The Commonwealth of Massachusetts
27	27	_______________
28	28	In the One Hundred and Ninety-Fourth General Court
29	29	(2025-2026)
30	30	_______________
31	31	An Act establishing medicare for all in Massachusetts.
32	32	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
33	33	of the same, as follows:
34	34	1 SECTION 1. The General Laws are hereby amended by inserting after chapter 175M the
35	35	2following chapter:-
36	36	3 CHAPTER 175N. MASSACHUSETTS HEALTH CARE TRUST
37	37	4 Section 1. Definitions
38	38	5 The following words and phrases shall have the following meanings, except where the
39	39	6context clearly requires otherwise:
40	40	7 “Board”, the Board of Trustees of the Massachusetts Health Care Trust.
41	41	8 “Executive Director”, the Executive Director of the Massachusetts Health Care Trust. 2 of 35
42	42	9 “Health care”, care provided to a specific individual by a licensed health care
43	43	10professional to promote physical and mental health, to treat illness and injury, and to prevent
44	44	11illness and injury.
45	45	12 “Health care provider”, any professional person, medical group, independent practice
46	46	13association, organization, health care facility, or other person or institution licensed or authorized
47	47	14by law to provide professional health care services to an individual in the Commonwealth.
48	48	15 “Institutional provider” means an inpatient hospital, nursing facility, rehabilitation
49	49	16facility, and other health care facilities that provide overnight or ambulatory care.
50	50	17 "Noninstitutional provider" means an individual provider and other health care
51	51	18practitioner that does not provide overnight or ambulatory care.
52	52	19 “Professional advisory committee”, a committee of advisors appointed by the director of
53	53	20the Administrative, Planning, Information, Technology, or any Regional division of the
54	54	21Massachusetts Health Care Trust.
55	55	22 “Resident”, a person who lives in Massachusetts as evidenced by an intent to continue to
56	56	23live in Massachusetts and to return to Massachusetts if temporarily absent, coupled with an act or
57	57	24acts consistent with that intent. The Trust shall adopt standards and procedures for determining
58	58	25whether a person is a resident. Such rules shall include: (1) a provision requiring that the person
59	59	26seeking resident status has the burden of proof in such determination; (2) a provision that a
60	60	27residence established for the purpose of seeking health care shall not by itself establish that a
61	61	28person is a resident of the Commonwealth; and (3) a provision that, for the purposes of this
62	62	29chapter, the terms “domicile” and “dwelling place” are not limited to any particular structure or 3 of 35
63	63	30interest in real property and specifically include homeless individuals, individuals incarcerated in
64	64	31Massachusetts, and undocumented individuals.
65	65	32 “Secretary”, the Secretary of the Executive Office of Health and Human Services.
66	66	33 “Trust”, the Massachusetts Health Care Trust.
67	67	34 “Trust Fund”, the Massachusetts Health Care Trust Fund.
68	68	35 Section 2. Policy and Goals
69	69	36 It is hereby declared to be the policy of the Commonwealth to provide equitable access to
70	70	37quality, health care services for all its residents as a right, responsive to the needs of the
71	71	38Commonwealth and its residents, without co-insurance, co-payments, deductibles, or any other
72	72	39form of patient cost sharing, and be accountable to its citizens though the Trust. The Trust shall
73	73	40be responsible for the collection and disbursement of funds required to provide health care
74	74	41services for every resident of the Commonwealth.
75	75	42 It is hereby declared that the Trust shall guarantee health care access to all residents of
76	76	43the Commonwealth without regard to financial or employment status, ethnicity, race, religion,
77	77	44gender, gender identity, sexual orientation, previous health problems or diagnoses, or geographic
78	78	45location.
79	79	46 It is hereby declared that the Trust shall provide access to health care services that is
80	80	47continuous, without the current need for repeated re-enrollments or changes when employers
81	81	48choose new plans and residents change jobs. Coverage under the Health Care Trust shall be
82	82	49comprehensive for individuals and families. It shall have no co-insurance, co-payments,
83	83	50deductibles, or any other form of patient cost sharing. 4 of 35
84	84	51 It is hereby declared that providing access to health care services for all Massachusetts
85	85	52residents through a single payer health care financing system is essential for achieving and
86	86	53sustaining universal equitable access, affordability, cost control, and high quality medical care.
87	87	54 It is hereby further declared that in pursuit of universal access to quality care, the
88	88	55Commonwealth supports the following goals:
89	89	56 (a) to guarantee every resident of the Commonwealth access to high quality health care
90	90	57by: (i) providing reimbursement for all medically appropriate health care services offered by the
91	91	58eligible health care providers of each resident’s choice; and (ii) funding capital investments for
92	92	59adequate health care facilities and resources statewide.
93	93	60 (b) to ensure that all residents have access to dental care, behavioral health, eyeglasses,
94	94	61hearing aids, home health care, nursing home care, long-term care, hospice care, and other
95	95	62important health care needs.
96	96	63 (c) to eliminate co-insurance, co-payments, deductibles, and any other form of patient
97	97	64cost sharing;
98	98	65 (d) to control costs as a key component of a sustainable health care system that will
99	99	66reduce health care costs for residents, municipalities, counties, businesses, health care facilities,
100	100	67and the Commonwealth.
101	101	68 (e) to save money by replacing the current mixture of public and private health insurance
102	102	69plans with a uniform and comprehensive health care plan available to every Massachusetts
103	103	70resident; 5 of 35
104	104	71 (f) to reduce administrative cost and inefficiencies and use savings to: (i) expand covered
105	105	72health care services; (ii) contain health care cost increases; (iii) create health care provider
106	106	73incentives to innovate and compete by improving health care service quality and delivery to
107	107	74patients; and (iv) expand preventive health care programs and the delivery of primary care.
108	108	75 (g) to fund, approve, and coordinate capital improvements in excess of a threshold to be
109	109	76determined annually by the Executive Director to health care facilities in order to: (i) avoid
110	110	77unnecessary duplication of health care facilities and resources; and (ii) encourage expansion or
111	111	78location of health care providers in underserved communities;
112	112	79 (h) to assure the continued excellence of professional training and research at health care
113	113	80facilities in the Commonwealth;
114	114	81 (i) to achieve measurable improvement in health care outcomes according to accepted
115	115	82health care industry standards;
116	116	83 (j) to prevent disease and disability and maintain or improve health and functionality;
117	117	84 (k) to ensure that all residents of the Commonwealth receive care appropriate to their
118	118	85special needs as well as care that is culturally and linguistically competent;
119	119	86 (l) to increase satisfaction with the health care system among health care practitioners,
120	120	87patients, and the employers and employees of the Commonwealth, using standardized
121	121	88measurement tools and techniques;
122	122	89 (m) to implement policies that strengthen and improve culturally and linguistically
123	123	90sensitive care; 6 of 35
124	124	91 (n) to develop an integrated population-based health care database to support health care
125	125	92planning; and
126	126	93 (o) to fund training and retraining programs for professional and non-professional
127	127	94workers in the health care sector displaced as a direct result of implementation of this chapter.
128	128	95 Section 3. Establishment of the Massachusetts Health Care Trust
129	129	96 (a) There shall be within the Executive Office of Health and Human Services, but not
130	130	97under its control or any political subdivision thereof in the Commonwealth, a division known as
131	131	98the Massachusetts Health Care Trust. The Trust shall be responsible for the collection and
132	132	99disbursement of funds required to provide health care services for every resident of the
133	133	100Commonwealth. The Trust is hereby constituted a public instrumentality of the Commonwealth
134	134	101and the exercise by the Trust of the powers conferred by this chapter shall be deemed and held
135	135	102the performance of an essential governmental function.
136	136	103 (b) The provisions of chapter 268A shall apply to all Trustees, officers, and employees of
137	137	104the Trust, except that the Trust may purchase from, contract with, or otherwise deal with any
138	138	105organization in which any Trustee is interested or involved, provided, however, that such interest
139	139	106or involvement is disclosed in advance to the Trustees and recorded in the minutes of the
140	140	107proceedings of the Trust, and provided, further, that a Trustee having such interest or
141	141	108involvement may not participate in any decision relating to such organization.
142	142	109 (c) Neither the Trust nor any of its officers, Trustees, employees, consultants, or advisors
143	143	110shall be subject to the provisions of section 3B of chapter 7, sections 9A, 45, 46, and 52 of
144	144	111chapter 30, chapter 30B, or chapter 31, provided, however, that in purchasing goods and
145	145	112services, the Trust shall at all times follow generally accepted good business practices. 7 of 35
146	146	113 (d) All officers and employees of the Trust having access to its cash or negotiable
147	147	114securities shall give bond to the Trust at its expense, in such amount and with such surety as the
148	148	115Board of Trustees shall prescribe. The persons required to give bond may be included in one or
149	149	116more blanket or scheduled bonds.
150	150	117 (e) Trustees, officers, and advisors who are not regular, compensated employees of the
151	151	118Trust shall not be liable to the Commonwealth, to the Trust, or to any other person as a result of
152	152	119their activities, whether ministerial or discretionary, as such Trustees, officers, or advisors except
153	153	120for willful dishonesty or intentional violations of law. The Board of the Trust may purchase
154	154	121liability insurance for Trustees, officers, advisors, and employees and may indemnify said
155	155	122persons against the claims of others.
156	156	123 Section 4: Powers of the Trust
157	157	124 (a) The Trust shall have the following powers:
158	158	125 (1) to make, amend, and repeal by-laws, rules, and regulations for the management of its
159	159	126affairs;
160	160	127 (2) to adopt an official seal;
161	161	128 (3) to sue and be sued in its own name;
162	162	129 (4) to make contracts and execute all instruments necessary or convenient for the carrying
163	163	130on of the purposes of this chapter;
164	164	131 (5) to acquire, own, hold, dispose of, and encumber personal, real or intellectual property
165	165	132of any nature or any interest therein; 8 of 35
166	166	133 (6) to enter into agreements or transactions with any federal, state, or municipal agency or
167	167	134other public institution or with any private individual, partnership, firm, corporation, association,
168	168	135or other entity;
169	169	136 (7) to appear on its own behalf before boards, commissions, departments, or other
170	170	137agencies of federal, state, or municipal government;
171	171	138 (8) to appoint officers and to engage and employ employees, including legal counsel,
172	172	139consultants, agents, and advisors, and prescribe their duties and fix their compensations;
173	173	140 (9) to establish advisory boards;
174	174	141 (10) to procure insurance against any losses in connection with its property in such
175	175	142amounts, and from such insurers, as may be necessary or desirable;
176	176	143 (11) to invest any funds held in reserves or sinking funds, or any funds not required for
177	177	144immediate disbursement, in such investments as may be lawful for fiduciaries in the
178	178	145Commonwealth pursuant to sections 38 and 38 A of chapter 29;
179	179	146 (12) to accept, hold, use, apply, and dispose of any and all donations, grants, bequests,
180	180	147and devises, conditional or otherwise, of money, property, services, or other things of value
181	181	148which may be received from the United States or any agency thereof, any governmental agency,
182	182	149any institution, person, firm, or corporation, public or private; such donations, grants, bequests,
183	183	150and devises to be held, used, applied, or disposed for any or all of the purposes specified in this
184	184	151chapter and in accordance with the terms and conditions of any such grant. A receipt of each
185	185	152such donation or grant shall be detailed in the annual report of the Trust; such annual report shall 9 of 35
186	186	153include the identity of the donor, lender, the nature of the transaction and any condition attaching
187	187	154thereto;
188	188	155 (13) to do any and all other things necessary and convenient to carry out the purposes of
189	189	156this chapter.
190	190	157 Section 5. Board of Trustees: Composition, Powers, and Duties
191	191	158 (a) The Trust shall be governed by a Board of Trustees with 29 members including:
192	192	159 (1) the Secretary of Health and Human Services; the Secretary of Administration and
193	193	160Finance, and the Commissioner of Public Health;
194	194	161 (2) eight Trustees appointed by the Governor, three of whom shall be nominated by
195	195	162organizations of health care professionals who deliver direct patient care, one of whom shall be
196	196	163nominated by a statewide organization of health care facilities, one of whom shall be nominated
197	197	164by an organization representing non-health care employers, one of whom shall be nominated by
198	198	165a disability rights organization, one of whom shall be nominated by an organization advocating
199	199	166for mental health care, and one of whom shall be a health care economist;
200	200	167 (3) ten Trustees appointed by the Attorney General, two of whom shall be nominated by a
201	201	168statewide labor organization, two of whom shall be nominated by statewide organizations who
202	202	169have a record of advocating for universal single payer health care in Massachusetts, one of whom
203	203	170shall be nominated by an organization representing Massachusetts senior citizens, one of whom
204	204	171shall be nominated by a statewide organization defending the rights of children, one of whom
205	205	172shall be nominated by an organization providing legal services to low-income clients, one of
206	206	173whom shall be an epidemiologist, one of whom shall be an expert in racial disparities in health 10 of 35
207	207	174care nominated by a statewide public health organization, and one of whom shall be an expert in
208	208	175women’s health care nominated by a statewide public health organization;
209	209	176 (4) and eight Trustees each appointed by one of the eight Governor’s Councillors, with
210	210	177each Trustee required to reside in the same Governor’s Council district as the Councillor who
211	211	178appoints them.
212	212	179 (5) Of these 29 members, one shall be an expert or have professional, lived, or academic
213	213	180experience related to homelessness; one shall be an expert or have professional, lived, or
214	214	181academic experience related to LGBTQIA+ rights or advocacy; and one shall be an expert or
215	215	182have professional, lived, or academic experience related to patients' rights or advocacy.
216	216	183 (6) Before appointing members to the Board of Trustees, the Governor, the Attorney
217	217	184General, and the Governor’s Councillors shall conduct a public awareness process, encourage
218	218	185representation from different racial, ethnic, sexual orientation and gender identity populations,
219	219	186and take nominations from all interested organizations.
220	220	187 (b) Each appointed Trustee shall serve a term of five years; provided, however, that
221	221	188initially eight appointed Trustees shall serve three-year terms, nine appointed Trustees shall
222	222	189serve four-year terms, and nine appointed Trustees shall serve five-year terms. The initial
223	223	190appointed Trustees shall be assigned to a three-, four-, or five- year term by lot. Any person
224	224	191appointed to fill a vacancy on the Board shall serve for the unexpired term of the predecessor
225	225	192Trustee. Any appointed Trustee shall be eligible for reappointment to a second term only. Any
226	226	193appointed Trustee may be removed from the Trustee’s appointment by the Governor or Attorney
227	227	194General, respectively, for just cause. 11 of 35
228	228	195 (c) The Board shall elect a chair from among its members every two years. A majority of
229	229	196the Trustees shall constitute a quorum and the affirmative vote of a majority of the Trustees
230	230	197present and eligible to vote at a meeting shall be necessary for any action to be taken by the
231	231	198Board. The Board of Trustees shall meet at least ten times annually and shall have final authority
232	232	199over the activities of the Trust.
233	233	200 (d) The Trustees shall be reimbursed for actual and necessary expenses and loss of
234	234	201income incurred for each full day serving in the performance of their duties to the extent that
235	235	202reimbursement of those expenses is not otherwise provided or payable by another public agency
236	236	203or agencies. For purposes of this section, “full day of attending a meeting” shall mean presence
237	237	204at, and participation in, not less than 75 percent of the total meeting time of the Board during any
238	238	205particular 24-hour period.
239	239	206 (e) No member of the Board of Trustees shall make, participate in making, or in any way
240	240	207attempt to use his or her official position to influence a governmental decision in which the
241	241	208Trustee knows or has reason to know that the Trustee, or a family member, business partner, or
242	242	209colleague, has a financial interest.
243	243	210 (f) The Board is responsible for ensuring universal access to high quality health care for
244	244	211every resident of the Commonwealth and shall specifically address the following:
245	245	212 (1) establish policy on medical issues, population-based public health issues, research
246	246	213priorities, scope of services, expanding access to care, and evaluation of the performance of the
247	247	214system; 12 of 35
248	248	215 (2) evaluate proposals from the Executive Director and others for innovative approaches
249	249	216to health promotion, disease and injury prevention, health education and research, and health
250	250	217care delivery; and
251	251	218 (3) establish standards and criteria by which requests by health facilities for capital
252	252	219improvements shall be evaluated.
253	253	220 Section 6. Executive Director; Purpose and Duties
254	254	221 (a) The Board of Trustees shall hire an Executive Director who shall be the executive and
255	255	222administrative head of the Trust and shall be responsible for administering and enforcing the
256	256	223provisions of law relative to the Trust.
257	257	224 (b) The Executive Director may, as she or he deems necessary or suitable for the effective
258	258	225administration and proper performance of the duties of the Trust and subject to the approval of
259	259	226the Board of Trustees, do the following: (1) adopt, amend, alter, repeal, and enforce, all such
260	260	227reasonable rules, regulations, and orders as may be necessary; and (2) appoint and remove
261	261	228employees and consultants: provided, however, that, subject to the availability of funds in the
262	262	229Trust, at least one employee shall be hired to serve as director of each of the divisions created in
263	263	230Sections 7 through 11, inclusive, of this chapter.
264	264	231 (c) The Executive Director shall: (1) establish an enrollment system that will ensure that
265	265	232all eligible Massachusetts residents are formally enrolled; (2) use the purchasing power of the
266	266	233state to negotiate price discounts for prescription drugs and all needed durable and nondurable
267	267	234medical equipment and supplies; (3) negotiate or establish terms and conditions for the provision
268	268	235of high quality health care services and rates of reimbursement for such services on behalf of the
269	269	236residents of the Commonwealth; (4) develop prospective and retrospective payment systems for 13 of 35
270	270	237covered services to provide prompt and fair payment to eligible providers; (5) oversee
271	271	238preparation of annual operating and capital budgets for the statewide delivery of health care
272	272	239services; (6) oversee preparation of annual benefits reviews to determine the adequacy of
273	273	240covered services; and (7) prepare an annual report to be submitted to the Governor, the President
274	274	241of the Senate, and Speaker of the House of Representatives and to be easily accessible to every
275	275	242Massachusetts resident.
276	276	243 (d) The Executive Director of the Trust may utilize and shall coordinate with the offices,
277	277	244staff, and resources of any agencies of the executive branch including, but not limited to, the
278	278	245Executive Office of Health and Human Services and all line agencies under its jurisdiction, the
279	279	246Center for Health Information and Analysis, the Department of Revenue, the Division of
280	280	247Insurance, the Group Insurance Commission, the Department of Employment and Training, the
281	281	248Industrial Accidents Board, the Health and Educational Finance Authority, and all other
282	282	249executive agencies.
283	283	250 Section 7. Regional Division: Director, Offices, Purposes, and Duties
284	284	251 (a) There shall be a regional division within the Trust which shall be under the
285	285	252supervision and control of a director. The powers and duties given the director in this chapter and
286	286	253in any other general or special law shall be exercised and discharged subject to the control and
287	287	254supervision of the Executive Director of the Trust. The director of the regional division shall be
288	288	255appointed by the Executive Director of the Trust, with the approval of the Board of Trustees, and
289	289	256may, with like approval, be removed. The director shall establish a professional advisory
290	290	257committee to provide expert advice: provided, however, that such committee shall have at least
291	291	25825% representation from the general public. 14 of 35
292	292	259 (b) The Trust shall have a reasonable number of regional offices located throughout the
293	293	260state. The number and location of these offices shall be proposed to the Executive Director and
294	294	261Board of Trustees by the director of the regional division after consultation with the directors of
295	295	262the planning, administration, quality assurance, and information technology divisions and
296	296	263consideration of convenience and equity. The adequacy and appropriateness of the number and
297	297	264location of regional offices shall be reviewed by the Board at least once every 3 years.
298	298	265 (c) The regional division shall establish a statewide education program that ensures that
299	299	266all residents understand how the Trust affects their health care costs, including, but not limited
300	300	267to, information about the following: (1) tax increases; (2) elimination of premiums, co-payments,
301	301	268deductibles, and any other form of patient cost sharing; (3) state-issued health care cards; and (4)
302	302	269choosing health care providers. Each regional office shall be professionally staffed to perform
303	303	270local outreach and informational functions and to respond to questions, complaints, and
304	304	271suggestions.
305	305	272 (d) Each regional office shall hold public hearings annually to determine unmet health
306	306	273care needs and for other relevant reasons. Regional office staff shall immediately refer evidence
307	307	274of unmet needs or of poor quality care to the director of the regional division who will plan and
308	308	275implement remedies in consultation with the directors of the administrative, planning, quality
309	309	276assurance, and information technology divisions.
310	310	277 Section 8. Administrative Division: Director, Purpose, and Duties
311	311	278 (a) There shall be an administrative division within the Trust which shall be under the
312	312	279supervision and control of a director. The powers and duties given the director in this chapter and
313	313	280in any other general or special law shall be exercised and discharged subject to the direction, 15 of 35
314	314	281control, and supervision of the Executive Director of the Trust. The director of the administrative
315	315	282division shall be appointed by the Executive Director of the Trust, with the approval of the Board
316	316	283of Trustees, and may, with like approval, be removed. The director may, at the director’s
317	317	284discretion, establish a professional advisory committee to provide expert advice: provided,
318	318	285however, that such committee shall have at least 25% representation from the general public.
319	319	286 (b) The administrative division shall have day-to-day responsibility for: (1) making
320	320	287prompt payments to health care providers for covered services; (2) collecting reimbursement
321	321	288from private and public third party payers and individuals for services not covered by this
322	322	289chapter or covered services rendered to non-eligible patients; (3) developing information
323	323	290management systems needed for health care provider payment, rebate collection, and utilization
324	324	291review; (4) investing Trust Fund assets consistent with state law and Section 18 of this chapter;
325	325	292(5) developing operational budgets for the Trust; and (6) assisting the planning division to
326	326	293develop capital budgets for the Trust.
327	327	294 Section 9. Planning Division: Director, Purpose, and Duties
328	328	295 (a) There shall be a planning division within the Trust which shall be under the
329	329	296supervision and control of a director. The powers and duties given the director in this chapter and
330	330	297in any other general or special law shall be exercised and discharged subject to the direction,
331	331	298control, and supervision of the Executive Director of the Trust. The director of the planning
332	332	299division shall be appointed by the Executive Director of the Trust, with the approval of the Board
333	333	300of Trustees, and may, with like approval, be removed. The director may, at the director’s
334	334	301discretion, establish a professional advisory committee to provide expert advice: provided,
335	335	302however, that such committee shall have at least 25% representation from the general public. 16 of 35
336	336	303 (b) The planning division shall have responsibility for coordinating health care resources
337	337	304and capital expenditures to ensure all eligible participants reasonable access to covered services.
338	338	305The responsibilities shall include but are not limited to:
339	339	306 (1) An annual review of the adequacy of health care resources throughout the
340	340	307Commonwealth and recommendations for changes. Specific areas to be evaluated include but are
341	341	308not limited to the resources needed for underserved populations and geographic areas, for
342	342	309recruitment of primary care physicians, dentists, and other specialists needed to provide quality
343	343	310health care, for culturally and linguistically competent care, and for emergency and trauma care.
344	344	311The director shall develop short term and long term plans to meet health care needs; and
345	345	312 (2) An annual review of capital health care needs, including but not limited to
346	346	313recommendations for a budget for all health care facilities, evaluating all capital expenses in
347	347	314excess of a threshold amount to be determined annually by the Executive Director, and
348	348	315collaborating with local and statewide government and health care institutions to coordinate
349	349	316capital health planning and investment. The director shall develop short term and long term plans
350	350	317to meet capital expenditure needs.
351	351	318 (c) In making its review, the planning division shall consult with the regional offices of
352	352	319the Trust and shall hold public hearings throughout the state on proposed recommendations. The
353	353	320division shall submit to the Board of Trustees its final annual review and recommendations by
354	354	321October 1. Subject to Board approval, the Trust shall adopt the recommendations.
355	355	322 Section 10. Information Technology Division: Director, Purpose, and Duties
356	356	323 (a) There shall be an information technology division within the Trust which shall be
357	357	324under the supervision and control of a director. The powers and duties given the director in this 17 of 35
358	358	325chapter and in any other general or special law shall be exercised and discharged subject to the
359	359	326direction, control, and supervision of the Executive Director of the Trust. The director of the
360	360	327information technology division shall be appointed by the Executive Director of the Trust, with
361	361	328the approval of the Board of Trustees, and may, with like approval, be removed. The director
362	362	329may, at the director’s discretion, establish a professional advisory committee to provide expert
363	363	330advice: provided, however, that such committee shall have at least 25% representation from the
364	364	331general public.
365	365	332 (b) The responsibilities of the information technology division shall include but are not
366	366	333limited to: (1) developing an information technology system that is compatible with all medical
367	367	334and dental facilities in Massachusetts; (2) maintaining a confidential electronic medical records
368	368	335system and prescription system in accordance with laws and regulations to maintain accurate
369	369	336patient records and to simplify the billing process, thereby reducing medical errors and
370	370	337bureaucracy; and (3) developing a tracking system to monitor quality of care, establish a patient
371	371	338database, and promote preventive care guidelines and medical alerts to avoid errors.
372	372	339 (c) Notwithstanding that all billing shall be performed electronically, patients shall have
373	373	340the option of keeping any portion of their medical records separate from their electronic medical
374	374	341record. The information technology director shall work closely with the directors of the regional,
375	375	342administrative, planning, and quality assurance divisions. The information technology division
376	376	343shall make an annual report to the Board of Trustees by October 1. Subject to Board approval,
377	377	344the Trust shall adopt the recommendations.
378	378	345 Section 11. Quality Assurance Division: Director, Purpose, and Duties 18 of 35
379	379	346 (a) There shall be a quality assurance division within the Trust which shall be under the
380	380	347supervision and control of a director. The powers and duties given the director in this chapter and
381	381	348in any other general or special law shall be exercised and discharged subject to the direction,
382	382	349control, and supervision of the Executive Director of the Trust. The director of the quality
383	383	350assurance division shall be appointed by the Executive Director of the Trust, with the approval of
384	384	351the Board of Trustees, and may, with like approval, be removed. The director may, at the
385	385	352director’s discretion, establish a professional advisory committee to provide expert advice:
386	386	353provided, however, that such committee shall have at least 25% representation from the general
387	387	354public.
388	388	355 (b) The quality assurance division shall support the establishment of a universal, best
389	389	356quality of standard of care using best practices with respect to: (1) appropriate hospital staffing
390	390	357levels for quality care; (2) evidence-based best clinical practices developed from analysis of
391	391	358outcomes of medical interventions; appropriate medical technology; (3) design and scope of
392	392	359work in the health workplace; and development of clinical practices that lead toward elimination
393	393	360of medical errors; (4) timely access to needed medical and dental care; (5) development of
394	394	361medical homes that provide efficient patient-centered integrated care; and (6) compassionate
395	395	362end-of-life care that provides comfort and relief of pain in an appropriate setting evidence-based
396	396	363best clinical practices.
397	397	364 (c) The director shall conduct a comprehensive annual review of the quality of health care
398	398	365services and outcomes throughout the Commonwealth and submit such recommendations to the
399	399	366Board of Trustees as may be required to maintain and improve the quality of health care service
400	400	367delivery and the overall health of Massachusetts residents. In making its reviews, the quality
401	401	368assurance division shall consult with the regional, administrative, and planning divisions and 19 of 35
402	402	369hold public hearings throughout the state on quality of care issues. The division shall submit to
403	403	370the Board of Trustees its final annual review and recommendations on how to ensure the highest
404	404	371quality health care service delivery by October 1. Subject to Board approval, the Trust shall
405	405	372adopt the recommendations.
406	406	373 Section 12. Eligible Participants
407	407	374 (a) The following persons shall be eligible participants in the Massachusetts Health Care
408	408	375Trust:
409	409	376 (1) all Massachusetts residents, as defined in Section 1;
410	410	377 (2) all non-residents who:
411	411	378 (i) work 20 hours or more per week in Massachusetts;
412	412	379 (ii) pay all applicable Massachusetts personal income and payroll taxes; and
413	413	380 (iii) pay any additional premiums established by the Trust to cover non-residents.
414	414	381 (3) All non-resident patients requiring emergency treatment for illness or injury:
415	415	382provided, however, that the Trust shall recoup expenses for such patients wherever possible.
416	416	383 (b) Payment for emergency care of Massachusetts residents obtained out of state shall be
417	417	384at prevailing rates where service occurred. Payment for non-emergency care of Massachusetts
418	418	385residents obtained out of state shall be according to rates and conditions established by the
419	419	386Executive Director. The Executive Director may require that a resident be transported back to
420	420	387Massachusetts when prolonged treatment of an emergency condition is necessary if
421	421	388transportation is safe for the patient in light of the patient’s medical condition. 20 of 35
422	422	389 (c) Visitors to Massachusetts shall be billed for all services received under the system.
423	423	390The Executive Director of the Trust may establish intergovernmental arrangements with other
424	424	391states and countries to provide reciprocal coverage for temporary visitors.
425	425	392 Section 13. Eligible Health Care Providers
426	426	393 (a) Eligible health care providers shall include an agency, facility, corporation,
427	427	394individual, or other entity directly rendering any covered benefit to an eligible patient: provided,
428	428	395however, that the health care provider:
429	429	396 (1) is licensed to operate or practice in the Commonwealth;
430	430	397 (2) does not accept payment from other sources for services provided for by the Trust;
431	431	398 (3) furnishes a signed agreement that:
432	432	399 (i) all health care services will be provided without discrimination on the basis of factors
433	433	400including, but not limited to age, sex, race, national origin, sexual orientation, gender identity,
434	434	401income status, preexisting condition, or citizenship status;
435	435	402 (ii) the health care provider will comply with all state and federal laws regarding the
436	436	403confidentiality of patient records and information;
437	437	404 (iii) no balance billing or out-of-pocket charges will be made for covered services unless
438	438	405otherwise provided in this chapter; and
439	439	406 (iv) the health care provider will furnish such information as may be reasonably required
440	440	407by the Trust for making payment, verifying reimbursement and rebate information, utilization 21 of 35
441	441	408review analyses, statistical and fiscal studies of operations, and compliance with state and federal
442	442	409law;
443	443	410 (4) meets state and federal quality guidelines including guidance for safe staffing, quality
444	444	411of care, and efficient use of funds for direct patient care; and
445	445	412 (5) meets whatever additional requirements that may be established by the Trust.
446	446	413 (6) Since a hospital’s purpose is to serve patients and not to enrich private shareholders,
447	447	414the department of public health shall not issue a license or renew a license for a hospital under
448	448	415section 51 of chapter 111 unless said hospital is organized as a non-profit entity under section
449	449	416501(c)(3) of the Internal Revenue Code .
450	450	417 Section 14. Budgeting and Payments to Eligible Health Care Providers
451	451	418 (a) To carry out this Act there are established on an annual basis:
452	452	419 (1) an operating budget;
453	453	420 (2) a capital expenditures budget;
454	454	421 (3) reimbursement levels for non-institutional providers consistent with rates set by the
455	455	422Trust that ensure that: (i) the total costs of all services offered by or through the provider are
456	456	423reasonable; and (ii) the aggregate rates of the provider are related reasonably to the aggregate
457	457	424costs of the health care provider; and
458	458	425 (4) budgets for institutional providers. These budgets shall consist of an operating and a
459	459	426capital budget. An institution’s annual budget shall be set to cover its anticipated health care
460	460	427services for the next year based on past performance and projected changes in prices and health 22 of 35
461	461	428care service and utilization levels. The annual budget for each individual institutional provider
462	462	429shall be set separately. The board shall not set a joint budget for a group of more than one
463	463	430institutional provider nor for a parent corporation that owns or operates one or more institutional
464	464	431providers.
465	465	432 (b) The operating budget shall be used for:
466	466	433 (1) payment for services rendered by physicians and other clinicians and non-institutional
467	467	434providers;
468	468	435 (2) budgets for institutional providers; and
469	469	436 (3) administration of the Trust.
470	470	437 (c) Payments for operating expenses shall not be used to finance capital expenditures or
471	471	438for activities to assist, promote, deter, or discourage union organizing. Any prospective payments
472	472	439made in excess of actual costs for covered services shall be returned to the Trust. Prospective
473	473	440payment rates and schedules shall be adjusted annually to incorporate retrospective adjustments.
474	474	441Except as provided in Section 15 of this chapter, reimbursement for covered services by the
475	475	442Trust shall constitute full payment for the services rendered.
476	476	443 (d) The Trust shall provide for retrospective adjustment of payments to eligible health
477	477	444care providers to:
478	478	445 (1) assure that payments to such health care providers reflect the difference between
479	479	446actual and projected use and expenditures for covered services; and
480	480	447 (2) protect health care providers who serve a disproportionate share of eligible
481	481	448participants whose expected use of covered health care services and expected health care 23 of 35
482	482	449expenditures for such services are greater than the average use and expenditure rates for eligible
483	483	450participants statewide.
484	484	451 (e) The capital expenditures budget shall be used for funds needed for:
485	485	452 (1) the construction or renovation of health facilities; and
486	486	453 (2) major equipment purchases.
487	487	454 (f) Payment provided under this section shall be used only to pay for the capital costs of
488	488	455eligible health care providers, including reasonable expenditures, as determined through budget
489	489	456negotiations with the Trust, for the replacement and purchase of equipment.
490	490	457 (g) The Trust shall provide funding for payment of debt service on outstanding bonds as
491	491	458of the effective date of this Act and shall be the sole source of future funding, whether directly or
492	492	459indirectly, through the payment of debt service, for capital expenditures by health care providers
493	493	460covered by the Trust in excess of a threshold amount to be determined annually by the Executive
494	494	461Director.
495	495	462 Section 15. Covered Benefits
496	496	463 (a) The Trust shall pay for all professional services provided by eligible health care
497	497	464providers to eligible participants needed to:
498	498	465 (1) provide high quality, appropriate, and medically necessary health care services;
499	499	466 (2) encourage reductions in health risks and increase use of preventive and primary care
500	500	467services; and
501	501	468 (3) integrate physical health, mental and behavioral health, and substance abuse services. 24 of 35
502	502	469 (b) Covered benefits shall include all high quality health care determined to be medically
503	503	470necessary or appropriate by the Trust, including, but not limited to, the following:
504	504	471 (1) prevention, diagnosis, and treatment of illness and injury, including but not limited to
505	505	472laboratory, diagnostic imaging, inpatient, ambulatory, and emergency medical care, blood and
506	506	473blood products, dialysis, mental health services, palliative care, dental care, vision care,
507	507	474audiology care, acupuncture, physical therapy, chiropractic, and podiatric services;
508	508	475 (2) promotion and maintenance of individual health through appropriate screening,
509	509	476counseling, and health education;
510	510	477 (3) the rehabilitation of sick and disabled persons, including physical, psychological, and
511	511	478other specialized therapies;
512	512	479 (4) behavioral health services, including supportive residences, occupational therapy, and
513	513	480ongoing outpatient services;
514	514	481 (5) substance use disorder services, including supportive residences and ongoing
515	515	482outpatient service;
516	516	483 (6) prenatal, perinatal and maternity care, family planning, fertility, and reproductive
517	517	484health care, including abortion;
518	518	485 (7) long-term services and supports including home health care and personal support
519	519	486care;
520	520	487 (8) long term care in institutional and community-based settings;
521	521	488 (9) hospice care; 25 of 35
522	522	489 (10) language interpretation and such other medical or remedial services as the Trust
523	523	490shall determine;
524	524	491 (11) emergency and other medically necessary transportation;
525	525	492 (12) the full scale of dental services, other than cosmetic dentistry;
526	526	493 (13) basic vision care and correction, including glasses, other than laser vision correction
527	527	494for cosmetic purposes;
528	528	495 (14) hearing evaluation and treatment including hearing aids;
529	529	496 (15) prescription drugs;
530	530	497 (16) durable and non-durable medical equipment, supplies, and appliances, including
531	531	498complex rehabilitation technology products and services as medically necessary, individually-
532	532	499configured manual and power wheelchair systems, adaptive seating systems, alternative
533	533	500positioning systems, and other mobility devices that require evaluation, fitting, configuration,
534	534	501adjustment, or programming; and
535	535	502 (17) all new emerging technologies irrespective of where the parent company is located,
536	536	503such as telemedicine and telehealth health care providers.
537	537	504 (18) infection by the virus that causes COVID-19 and any long-term effects, known as
538	538	505post-COVID conditions (PCC) or Long COVID.
539	539	506 (c) No deductibles, co-payments, co-insurance, or other cost sharing shall be imposed
540	540	507with respect to covered benefits. Patients shall have free choice of participating physicians and
541	541	508other clinicians, hospitals, inpatient care facilities, and other health care providers. 26 of 35
542	542	509 Section 16. Wraparound Coverage for Federal Health Programs
543	543	510 (a) Prior to obtaining any federal program's waivers to receive federal funds through the
544	544	511Health Care Trust, the Trust shall seek to ensure that participants eligible for federal program
545	545	512coverage receive access to care and coverage equal to that of all other Massachusetts
546	546	513participants. It shall do so by (1) paying for all services enumerated under Section 15 not covered
547	547	514by the relevant federal plans; (2) paying for all such services during any federally mandated gaps
548	548	515in participants’ coverage; and (3) paying for any deductibles, co-payments, co-insurance, or
549	549	516other cost sharing incurred by such participants.
550	550	517 Section 17. Establishment of the Health Care Trust Fund
551	551	518 (a) In order to support the Trust effectively, there is hereby established the health care
552	552	519trust fund, hereinafter the Trust Fund, which shall be administered and expended by the
553	553	520Executive Director of the Trust subject to the approval of the Board. The Trust Fund shall consist
554	554	521of all revenue sources defined in Section 19, and all property and securities acquired by and
555	555	522through the use of monies deposited to the Trust Fund, and all interest thereon less payments
556	556	523therefrom to meet liabilities incurred by the Trust in the exercise of its powers and the
557	557	524performance of its duties.
558	558	525 (b) All claims for health care services rendered shall be made to the Trust Fund and all
559	559	526payments made for health care services shall be disbursed from the Trust Fund.
560	560	527 Section 18. Purpose of the Trust Fund
561	561	528 (a) Amounts credited to the Trust Fund shall be used for the following purposes:
562	562	529 (1) to pay eligible health care providers covered services rendered to eligible individuals; 27 of 35
563	563	530 (2) to fund capital expenditures for eligible health care providers for approved capital
564	564	531investments in excess of a threshold amount to be determined annually by the Executive
565	565	532Director;
566	566	533 (3) to pay for preventive care, education, outreach, and public health risk reduction
567	567	534initiatives, not to exceed 5% of Trust income in any fiscal year;
568	568	535 (4) to supplement other sources of financing for education and training of the health care
569	569	536workforce, not to exceed 2% of Trust income in any fiscal year;
570	570	537 (5) to supplement other sources of financing for medical research and innovation, not to
571	571	538exceed 1% of Trust income in any fiscal year;
572	572	539 (6) to supplement other sources of financing for training and retraining programs for
573	573	540workers displaced as a result of administrative streamlining gained by moving from a multi-
574	574	541payer to a single payer health care system, not to exceed 2% of Trust income in any fiscal year:
575	575	542provided, however, that eligible workers must have enrolled by June 20 of the third year
576	576	543following full implementation of this chapter;
577	577	544 (7) to fund a reserve account to finance anticipated long-term cost increases due to
578	578	545demographic changes, inflation, or other foreseeable trends that would increase Trust Fund
579	579	546liabilities, and for budgetary shortfall, epidemics, and other extraordinary events, not to exceed
580	580	5471% of Trust income in any fiscal year: provided, however, that the Trust reserve account shall at
581	581	548no time constitute more than 5% of total Trust assets;
582	582	549 (8) to pay the administrative costs of the Trust which, within two years of full
583	583	550implementation of this chapter shall not exceed 5% of Trust income in any fiscal year. 28 of 35
584	584	551 (b) Unexpended Trust assets shall not be deemed to be “surplus” funds as defined by
585	585	552chapter twenty-nine of the general laws.
586	586	553 Section 19. Funding Sources
587	587	554 (a) The Trust shall be the repository for all health care funds and related administrative
588	588	555funds. A fairly apportioned, dedicated health care tax on employers, workers, and residents will
589	589	556replace spending on insurance premiums and out-of-pocket spending for services covered by the
590	590	557Trust. The Trust shall enable the state to pass lower health care costs on to residents and
591	591	558employers through savings from administrative simplification, negotiating prices, discounts on
592	592	559pharmaceuticals and medical supplies, and through early detection and intervention by
593	593	560universally available primary and preventive care. Additionally, collateral sources of revenue –
594	594	561such as from the federal government, non-residents receiving care in the state, or from personal
595	595	562liability – shall be recovered by the Trust. The Trust shall be funded by dedicated revenue
596	596	563streams and its budget shall not affect other public health programs run by the state. Lastly, the
597	597	564Trust shall enact provisions ensuring a smooth transition to a universal health care system for
598	598	565employers and residents.
599	599	566 (b) The following dedicated health care taxes will replace spending on insurance
600	600	567premiums and out-of-pocket spending for services covered by the Trust. Prior to each state fiscal
601	601	568year of operation, the Trust will prepare for the Legislature a projected budget for the coming
602	602	569fiscal year, with recommendations for rising or declining revenue needs.
603	603	570 (1) An employer payroll tax of 7.5 percent will be assessed on employee W-2 wages,
604	604	571exempting the first $20,000 of payroll per establishment, replacing previous spending by 29 of 35
605	605	572employers on health premiums. An additional employer payroll tax of 0.5 per cent will be
606	606	573assessed on establishments with 100 or more employees;
607	607	574 (2) An employee payroll tax of 2.5 percent will be assessed, exempting the first $20,000
608	608	575of income, replacing previous spending by employees on health premiums and out-of-pocket
609	609	576expenses; all W-2 wages will be combined for each taxpayer and one $20,000 exemption will be
610	610	577allowed;
611	611	578 (3) A 10 percent payroll tax on the self-employed, including general partnership income
612	612	579and other income subject to self-employment tax for Federal purposes, will be assessed,
613	613	580exempting the first $20,000 of payroll per self-employed taxpayer; income from all sources
614	614	581subject to tax in this section shall be combined and allowed one $20,000 exemption per taxpayer;
615	615	582and
616	616	583 (4) For the purposes of sections (2) and (3) above, each taxpayer will combine all income
617	617	584reported on from IRS Form W-2s and self-employment income and be allowed one $20,000
618	618	585exemption. The exemption will apply first to W-2 income and then to self-employment income.
619	619	586 (5) A 10 percent tax on taxable unearned income and all other income not specifically
620	620	587excluded will be assessed on such income above $20,000. Exclusions not taxed: Social Security,
621	621	588Supplemental Security Income (SSI), Social Security Disability Income (SSDI), unemployment
622	622	589benefits, workers compensation benefits, sick pay, paid family and medical leave, capital gains
623	623	590resulting from the sale of owner-occupied two- or three-family rental property, and defined
624	624	591contribution and defined benefit pension payments. Capital gains from the portion attributed to a
625	625	592primary residence in excess of the exclusion allowed by Massachusetts law will be subject to the
626	626	593tax. The $20,000 exemption for this section shall be applied to each individual taxpayer. 30 of 35
627	627	594 (c) An employer, private or public, may agree to pay all or part of an employee’s payroll
628	628	595tax obligation. Such payment shall not be considered income to the employee for Massachusetts
629	629	596income tax purposes.
630	630	597 (d) Default, underpayment, or late payment of any tax or other obligation imposed by the
631	631	598Trust shall result in the remedies and penalties provided by law, except as provided in this
632	632	599section.
633	633	600 (e) Eligibility for benefits shall not be impaired by any default, underpayment, or late
634	634	601payment of any tax or other obligation imposed by the Trust.
635	635	602 (f) It is the intent of this act to establish a single public payer for all health care in the
636	636	603Commonwealth. Towards this end, public spending on health insurance shall be consolidated
637	637	604into the Trust to the greatest extent possible. Until such time as the role of all other payers for
638	638	605health care has been terminated, health care costs shall be collected from collateral sources
639	639	606whenever medical services provided to an individual are, or may be, covered services under a
640	640	607policy of insurance, health care service plan, or other collateral source available to that
641	641	608individual, or for which the individual has a right of action for compensation to the extent
642	642	609permitted by law.
643	643	610 (g) The Legislature shall be empowered to transfer funds from the General Fund
644	644	611sufficient to meet the Trust’s projected expenses beyond projected income from dedicated tax
645	645	612revenues. This lump transfer shall replace current General Fund spending on health benefits for
646	646	613state employees, services for patients at public in-patient facilities, and all means- or needs-tested
647	647	614health benefit programs. 31 of 35
648	648	615 (h) The Trust shall receive all monies paid to the Commonwealth by the federal
649	649	616government for health care services covered by the Trust. The Trust shall seek to maximize all
650	650	617sources of federal financial support for health care services in Massachusetts. Accordingly, the
651	651	618Executive Director shall seek all necessary waivers, exemptions, agreements, or legislation, if
652	652	619needed, so that all current federal payments for health care shall, consistent with the federal law,
653	653	620be paid directly to the Trust Fund. In obtaining the waivers, exemptions, agreements, or
654	654	621legislation, the Executive Director shall seek from the federal government a contribution for
655	655	622health care services in Massachusetts that shall not decrease in relation to the contribution to
656	656	623other states as a result of the waivers, exemptions, agreements, or legislation.
657	657	624 (i) As used in this section, “collateral source” includes all of the following:
658	658	625 (1) insurance policies written by insurers, including the medical components of
659	659	626automobile, homeowners, workers’ compensation, and other forms of insurance;
660	660	627 (2) health care service plans and pension plans;
661	661	628 (3) employee benefit contracts;
662	662	629 (4) government benefit programs;
663	663	630 (5) a judgment for damages for personal injury;
664	664	631 (6) any third party who is or may be liable to an individual for health care services or
665	665	632costs;
666	666	633 (j) As used in this section, “collateral sources” does not include either of the following:
667	667	634 (1) a contract or plan that is subject to federal preemption; and 32 of 35
668	668	635 (2) any governmental unit, agency, or service, to the extent that subrogation is prohibited
669	669	636by law.
670	670	637 (k) An entity described as a collateral source is not excluded from the obligations
671	671	638imposed by this section by virtue of a contract or relationship with a governmental unit, agency,
672	672	639or service.
673	673	640 (l) Whenever an individual receives health care services under the Trust and the
674	674	641individual is entitled to coverage, reimbursement, indemnity, or other compensation from a
675	675	642collateral source, the individual shall notify the health care provider and provide information
676	676	643identifying the collateral source other than federal sources, the nature and extent of coverage or
677	677	644entitlement, and other relevant information. The health care provider or facility shall forward this
678	678	645information to the Executive Director. The individual entitled to coverage, reimbursement,
679	679	646indemnity, or other compensation from a collateral source shall provide additional information as
680	680	647requested by the Executive Director.
681	681	648 (m) The Trust shall seek reimbursement from the collateral source for services provided
682	682	649to the individual, and may institute appropriate action, including suit, to recover the costs to the
683	683	650Trust. Upon demand, the collateral source shall pay to the Trust Fund the sums it would have
684	684	651paid or expended on behalf of the individuals for the health care services provided by the Trust.
685	685	652 (n) If a collateral source is exempt from subrogation or the obligation to reimburse the
686	686	653Trust as provided in this section, the Executive Director may require that an individual who is
687	687	654entitled to medical services from the collateral source first seek those services from that source
688	688	655before seeking those services from the Trust. 33 of 35
689	689	656 (o) To the extent permitted by federal law, contractual retiree health benefits provided by
690	690	657employers shall be subject to the same subrogation as other contracts, allowing the Trust to
691	691	658recover the cost of services provided to individuals covered by the retiree benefits, unless and
692	692	659until arrangements are made to transfer the revenues of the benefits directly to the Trust.
693	693	660 (p) The Trust shall retain:
694	694	661 (1) all charitable donations, gifts, grants, or bequests made to it from whatever source
695	695	662consistent with state and federal law;
696	696	663 (2) payments from third party payers for covered services rendered by eligible health care
697	697	664providers to non-eligible patients but paid for by the Trust; and
698	698	665 (3) income from the investment of Trust assets, consistent with state and federal law.
699	699	666 (q) Any employer who has a contract with an insurer, health services corporation, or
700	700	667health maintenance organization to provide health care services or benefits for its employees,
701	701	668which is in effect on the effective date of this section, shall be entitled to an income tax credit
702	702	669against premiums otherwise due in an amount equal to the Trust Fund tax due pursuant to this
703	703	670section.
704	704	671 (r) Any insurer, self-insured employers, union health and welfare fund, health services
705	705	672corporation, or health maintenance organization which provides health care services or benefits
706	706	673under a contract with an employer or group of employers, which is in effect on the effective date
707	707	674of this act, shall pay to the Trust Fund an amount equal to the Health Care Trust employer
708	708	675payroll tax based on the number of employees of each employer. 34 of 35
709	709	676 (s) Six months prior to the establishment of the Health Care Trust, all laws and
710	710	677regulations requiring health insurance carriers to maintain cash reserves for purposes of
711	711	678commercial stability (such as under Chapter 176G, Section 25 of the General Laws) shall be
712	712	679repealed. In their place, the Executive Director of the Trust shall assess an annual health care
713	713	680stabilization fee upon the same carriers, amounting to the same sum previously required to be
714	714	681held in reserves, which shall be credited to the Health Care Trust Fund.
715	715	682 Section 20. Insurance Reforms
716	716	683 Insurers regulated by the division of insurance are prohibited from charging premiums to
717	717	684eligible participants for coverage of services already covered by the Trust. The commissioner of
718	718	685insurance shall adopt, amend, alter, repeal, and enforce all such reasonable rules and regulations
719	719	686and orders as may be necessary to implement this section.
720	720	687 Section 21. Health Care Trust Regulatory Authority
721	721	688 The Trust shall adopt and promulgate regulations to implement the provisions of this
722	722	689chapter. The initial regulations may be adopted as emergency regulations but those emergency
723	723	690regulations shall be in effect only from the effective date of this chapter until the conclusion of
724	724	691the transition period in Section 22.
725	725	692 Section 22. Implementation of the Health Care Trust
726	726	693 This legislation shall be fully implemented within one year of the date of its enactment.
727	727	694 Not later than forty-five days after enactment of this legislation, the Governor, Attorney
728	728	695General, and Governor’s Councillors shall make their appointments to the Board of the 35 of 35
729	729	696Massachusetts Health Care Trust. The first meeting of the Board shall take place within 10 days
730	730	697of these appointments.
731	731	698 The Board shall immediately begin the process of hiring an Executive Director of the
732	732	699Trust, review enabling legislation, educating itself regarding general purposes, economics, and
733	733	700authority of the Trust. The Board shall develop a budget for the transition and initiate the
734	734	701process of obtaining federal waivers and agreements concerning payments from Medicare,
735	735	702Medicaid, and other public programs. The Board shall also set a general timeframe for
736	736	703establishing the Trust with a launch date no less than one year from the date of enactment.
737	737	704 In the first phase of transition, the Executive Director shall begin hiring staff, establishing
738	738	705the administrative and information technology infrastructure for the Trust, and negotiating
739	739	706reimbursement rates for health care services, pharmaceuticals, and medical equipment. health
740	740	707care providers shall develop plans for transitioning to the Trust.
741	741	708 In the second phase of transition, the infrastructure of the Trust shall be established,
742	742	709including Regional Offices to provide public education about the new system; training of health
743	743	710care providers’ staff on systems for processing bills to the Trust; and introduction of accounting
744	744	711regulations to employers for payment of payroll taxes. Private insurers shall pay the annual
745	745	712health care stabilization fee. Residents of the Commonwealth shall receive health care
746	746	713identification cards with an explanation of benefits and contact information for their Regional
747	747	714office.
748	748	715 Funding for the establishment of the Trust during the transition period shall be provided
749	749	716by the Legislature, supplemented by the reserve funds of private insurers.