Text of MA S 860 (2026)

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