SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1943

Text of amendment (806) (offered by Senator Donnelly et al) to the Ways and Means amendment (Senate, No. 3) to the House Bill making appropriations for the fiscal year 2016 for the maintenance of the departments, boards, commissions, institutions and certain activities of the Commonwealth, for interest, sinking fund and serial bond requirements and for certain permanent improvements


The Commonwealth of Massachusetts



In the One Hundred and Eighty-Ninth General Court



by inserting the following new sections:-

"SECTION XX. The General Laws are hereby amended by inserting after chapter 111N, as appearing in the 2012 Official Edition, the following chapter:-

Chapter 111O. Mobile Integrated Health Care.

Section 1. As used in this chapter, the following words shall have the following meanings, unless the context or subject matter clearly requires otherwise:-

“Advisory council”, the group of advisors established pursuant to section 4.

“Commissioner”, the commissioner of public health.

“Department”, the department of public health.

“Community EMS program”, a program developed by the primary ambulance service with the approval of the local jurisdiction and the affiliate hospital medical director utilizing EMS providers acting within their scope of practice to provide community outreach and assistance to residents in order to advance injury and illness prevention within its community.

“Community paramedic provider”, a person who (1) is certified as a paramedic in accordance with the provisions of chapter 111C and department regulations; and (2) has successfully completed an education program for mobile integrated health care, in accordance with department regulations.

“EMS provider”, an EMS first response service, an ambulance service, a hospital including, without limitation, a trauma center or any individual associated with an EMS first response service, an ambulance service or a hospital engaged in providing EMS, including, without limitation, an EMS first responder, a medical communications system operator, an emergency medical technician and a medical control physician, to the extent such physician provides EMS.

“Health care facility”, a licensed institution providing health care services or a health care setting, including, but not limited to, hospitals, and other inpatient centers, ambulatory surgical or treatment centers, behavioral health centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health centers.

“Health care entity”, a provider or provider organization, including, but not limited to, ambulance services licensed under chapter 111C, visiting nurse associations, accountable care organizations, and home health agencies.

“Health care provider”, a provider of medical, behavioral or health services or any other person or organization that furnishes bills or is paid for health care services delivery in the normal course of business.

“Mobile integrated health care” or “MIH”, a health care program approved by the department that utilizes mobile resources to deliver care and services to patients in an out-of-hospital environment in coordination with health care facilities or other health care providers. Such medical care and services include, but are not limited to, community paramedic provider services, chronic disease management, behavioral health, preventative care, post-discharge follow-up visits, or transport or referral to facilities other than hospital emergency departments.

“Medical control”, the clinical oversight provided by a qualified physician or existing primary care provider to all components of the MIH program, including, without limitation, medical direction, training, scope of practice and authorization to practice of a community paramedic provider, continuous quality assurance and improvement, and clinical protocols.

“Medical direction”, the authorization for treatment provided by a qualified physician or existing primary care provider in accordance with clinical protocols, whether on-line, through direct communication or telecommunication, or off-line through standing orders.

“Patient”, an individual identified by a healthcare facility, entity or provider as requiring MIH services.

“Person”, an individual, an entity or an agency or political subdivision of the commonwealth.

“Physician”, a medical or osteopathic doctor licensed to practice medicine in the commonwealth.

“Scope of practice”, the clinical skills or functions (1) as defined by the Statewide Treatment Protocols governing the delivery of emergency medical services under chapter 111C; and (2) clinical protocols established under this chapter by the department in regulation.

Section 2.  (a) The department shall take any action consistent with its role as state lead agency for mobile integrated health services.  As state lead agency, the department shall take into consideration relevant standards and criteria developed or adopted by nationally recognized agencies or organizations, and the recommendations of interested stakeholders, including, without limitation, the statewide mobile integrated health advisory council, established in section 4.

(b) The department shall evaluate and approve MIH programs that meet the following criteria:

(1) provide pre-hospital and post-hospital services as a coordinated continuum of care that fully supports the patient’s medical needs in the community;

(2) address gaps in service delivery and prevent unnecessary hospitalizations, or other harmful and wasteful resource delivery;

(3) focus on partnerships, through contracts or otherwise, between health care providers and health care entities that promote coordination and utilization of existing personnel and resources without duplication of services;

(4) adhere to clinical standards and protocols, established under this chapter by the department in regulation, with the guidance of the advisory council, to ensure that MIH community paramedic providers or other providers employed by a health care entity provide health care services or treatment within their scope of practice;

(5) dispatch only those community paramedic providers or other providers employed by a health care entity who have received appropriate training and demonstrate competency in the MIH clinical protocols;

(6) meet appropriate standards related to capacity, location, personnel and equipment;

(7) provide access to qualified medical control and medical direction;

(8) provide a secure and effective medical communication subsystem linkage for on-line medical direction;

(9) ensure activation of the 911 system in the event that a patient of an MIH program experiences a medical emergency, as determined through medical direction, in the course of an MIH visit provided such activation is in the best interest of patient safety and takes into account how MIH programs affect EMS first response services, and provided further that the department shall examine how 911 triage trees may be incorporated into MIH;

(10) ensure compliance with all state and federal privacy requirements with regard to patient medical records and other individually identified patient health information; and

(11) ensure that health care providers operating MIH programs collect and maintain data, including statistics on mortality and morbidity of consumers of mobile integrated health services, including but not limited to, information needed to review access, availability, quality, cost and third party reimbursement for such services, and coordinate and perform such data collection in conjunction with other data collection activities.

Section 3. The department shall evaluate and approve Community EMS Programs developed and operated by the primary ambulance service with the approval of the local jurisdiction and the affiliate hospital medical director to provide community outreach and assistance to residents of the local jurisdiction in order to advance injury and illness prevention within its community.

The programs may work with local public health and identify members of the community who use the 911 system or emergency department and connect them to their primary care providers, other health care providers, low-cost medication programs, and other social services.  The programs may also utilize EMS providers, including EMS first responders and emergency medical technicians, to provide follow-up and preventive measures including, but not limited to, fall prevention, vaccinations under the direction of local public health, and health screenings such as blood pressure and blood glucose checks.  

All EMS provider training and activities related to the program must be approved by the local jurisdiction and the affiliate hospital medical director. Nothing in this section authorizes an EMS provider to perform any medical procedures outside their scope of practice.

Section 4. (a) There shall be established a mobile integrated health advisory board, which shall assist and support the department in carrying out the provisions of this chapter and in developing and implementing a state mobile integrated health plan, by planning, guiding and coordinating the components of mobile integrated health services.

(b) The advisory council shall consist of the director of the bureau of health care safety and quality, or a designee, who shall serve as a non-voting chair, and 18 members who shall be appointed by the commissioner and who shall reflect a broad distribution of diverse perspectives on mobile integrated health care, including appointees or their designees from the following groups: the division of medical assistance; Massachusetts Hospital Association; Massachusetts Council of Community Hospitals; a for-profit hospital system that is not a member of another hospital advocacy group; Massachusetts Senior Care Association; Massachusetts Medical Society; Massachusetts Chapter of the American College of Emergency Physicians; Massachusetts Nurses Association; Home Care Alliance of Massachusetts; Professional Fire Fighters of Massachusetts; Fire Chiefs Association of Massachusetts; International Association of EMTs and Paramedics; Massachusetts Ambulance Association; Hospice and Palliative Care Association of Massachusetts; Association for Behavioral Healthcare; and 3 members representing payors, including one representative of the health care organization providing services to MassHealth members under section 9D and 9F of Chapter 118E.

SECTION XX. Clause (3) of section 19 of Chapter 111C, as appearing in the 2012 Official Edition, is hereby amended by striking the words “approved under this chapter;” and inserting in place thereof the following words:--

approved under this chapter or chapter 111O;"

SECTION XX. Community paramedic special project waivers that are currently approved pilot projects by the department of public health shall remain in effect until regulations to implement 111O of the General Laws are promulgated. The department of public health shall promulgate said regulations not later than December 31, 2015."