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