Consolidated Amendment #B to H.4600

Consolidated Amendment "B" to H4600

Health and Human Services and Elder Affairs

Fiscal Note: $6,680,956

Amendments 28, 53, 62, 132, 173, 174, 587, 695, 772, 1130, 1158, and 1459 are recategorized from Health and Human Services to Public Safety

Amendments 136, 140, 141, 398, 916, and 1453 are recategorized from Elder Affairs to Public Safety

Health and Human Services: 70, 111, 124, 161, 166, 244, 248, 315, 364, 371, 380, 448, 459, 473, 521, 567, 597, 660, 682, 683, 756, 800, 848, 854, 857, 858, 866, 910, 949, 1037, 1041, 1042, 1109, 1111, 1114, 1139, 1168, 1180, 1233, 1241, 1254, 1279, 1302, 1304, 1311, 1317, 1363, 1372, 1373, 1388, 1447

Elder Affairs: 15, 41, 42, 84, 162, 181, 182, 212, 243, 250, 358, 374, 378, 382, 386, 391, 420, 422, 427, 428, 432, 436, 460, 464, 467, 568, 569, 570, 576, 580, 621, 752, 755, 893, 952, 1021, 1043, 1075, 1088, 1273, 1316, 1364, 1456, 1467, 1470

Mr. Michlewitz of Boston and others move to amend H.4600 in section 2, in item 4000-0005, by inserting after the words “fiscal year 2024”, the first time they appear, the following words:- ; provided further, that not less than $50,000 shall be expended to A.W.A.K.E., Inc. Youth Violence Prevention in the city of Springfield; provided further, that not less than $25,000 shall be expended for the SISU Center in the city of Lawrence to provide a safe space for structured education, health, and recreational programming for at-risk youth throughout the Merrimack valley

And further amend said item by striking out the figure “$13,000,000” and inserting in place thereof the following figure:- $13,075,000

And further amend said section 2, in item 4000-0009, by inserting after the words “obligations of the office” the following words:- ; provided further, that not less than $250,000 shall be expended for the Sickle Cell Disease Association of Massachusetts, Inc.

And further amend said item by striking out the figure “$354,360” and inserting in place thereof the following figure:- $604,360

And further amend said section 2, in item 4000-0050, by inserting after the words “General Laws” the following words:- ; provided, that not less than $500,000 shall be expended to establish a psychiatry residency training program at a tertiary academic medical center located in the town of Burlington to support training of psychiatrists and enhance access to psychiatry services in underserved and geographically isolated areas of the state

And further amend said item by striking out the figure “$3,515,396” and inserting in place thereof the following figure:- $4,015,396

And further amend said section 2, in item 4000-0300, by inserting after the words “education efforts” the following words:- ; provided further, that not less than $40,000 shall be expended to Beth Israel Deaconess Hospital-Needham, Inc. for behavioral health services; provided further, that not less than $150,000 shall be expended to support the critical care operations of New England Life Flight, Inc., d/b/a Boston MedFlight; provided further, that not less than $100,000 shall be expended to the Watertown Community Foundation, Inc. to increase access to health and human services and expand support and stabilization services for vulnerable populations in Watertown; provided further, that not less than $75,000 shall be expended for the Brookline Community Mental Health Center, Inc. to expand the healthy lives program

And further amend said item by striking out the figure “$300,000” and inserting in place thereof the following figure:- $500,000

And further amend said item by striking out the figure “$160,747,888” and inserting in place thereof the following figure:- $161,312,888

And further amend said section 2, in item 4000-0601, by inserting after the words “kosher food”, the second time it appears, the following words:- ; provided further, that not less than $150,000 shall be expended to Harbor Health Services, Inc. for the operation of its Program of All-Inclusive Care for the Elderly (PACE) day centers in Mattapan, Brockton and in any of the communities for which Harbor Health Services has been contracted to help meet the Commonwealth's PACE expansion goals

And further amend said item by striking out the figure “$4,580,139,945” and inserting in place thereof the following figure:- $4,580,289,945

And further amend said section 2, in item 4000-0641, by inserting after the words “nursing facility workers” the following words:- ; provided further, that not less than $2,773,456 shall be expended for the recognition of additional allowable costs to the standard base rate for nursing facilities located within 5 miles of 71 Hospital avenue in North Adams, Massachusetts

And further amend said item by striking out the figure “$632,100,000” and inserting in place thereof the following figure:- $634,873,456

And further amend said section 2, in item 4000-0700, by striking out the figure “$750,000” and inserting in place thereof the following figure:- $900,000

And further amend said item by inserting after the words “city of Boston” the following words:- ; provided further, that not less than $100,000 shall be made available to the family medicine program at Franklin medical center

And further amend said item by striking out the figure “$4,232,605,644” and inserting in place thereof the following figure:- $4,232,855,644

And further amend said section 2, in item 9110-1455, by inserting after the words “and others” the following words:- ; provided further, that not less than $75,000 shall be divided equally by the Fall River housing authority between 6 senior centers including Mitchell heights, Oliveira apartments, Doolan senior apartments, O'Brien senior apartments, Niagara senior center and South main street senior center for their recreational use

And further amend said item by striking out the figure “$18,757,247” and inserting in place thereof the following figure:- $18,832,247

And further amend said section 2, in item 9110-1604, by inserting after the words “fiscal year 2024” the following:- ; and provided further, that not less than $200,000 shall be granted to Hearth, Inc. for upgrades and other improvements, including those necessary for the operation of facilities operated by Hearth, Inc. in the city of Boston

And further amend said item by striking out the figure “$11,369,484” and inserting in place thereof the following figure:- $11,569,484

And further amend said section 2, in item 9110-1900, by striking out the figure “$11,057,217” and inserting in place thereof the following figure:- $11,807,217

And further amend said section 2, in item 9110-9002, by inserting after the words “$15 per elder” the following:- ; provided further, that not less than $50,000 shall be expended to the town of Millis for a study to examine the strategies that could be utilized by both Millis and Medway to share senior services; provided further, that not less than $25,000 shall be expended to the Woodhaven Elderly Housing Complex in Sherborn for updated security features, including exterior lighting improvements; provided further, that not less than $60,000 be expended to the Monson Senior Center for an ADA compliant van to transport seniors to medical appointments, adult day care facilities and events as well as a small cargo van to deliver meals on wheels to home bound seniors; provided further, that not less than $12,500 shall be expended for programming at the Adams Senior Center; provided further, that not less than $12,500 shall be expended for programming at the North Adams Senior Center; provided further, that not less than $12,500 shall be expended for programming at the Williamstown Senior Center; provided further, that not less than $15,000 shall be expended to the Amherst Senior Center to furnish and equip a game room and create materials to promote participation; provided further, that not less than $25,000 be expended to the Chelsea Senior Center; provided further, that not less than $75,000 shall be expended to the Burlington Council on Aging in the town of Burlington for the salary of a full-time social worker; provided further, that not less than $50,000 shall be expended to the Maynard Council on Aging to support programming for seniors in the town of Maynard; provided further, that not less than $20,000 shall be expended to the town of Rowley for structural and ADA improvements at Town Hall and the Senior Center; provided further, that not less than $25,000 shall be expended to the town of Sterling for an electronic sign at the Council on Aging; provided further, that not less than $30,000 shall be expended for the senior medical rides program and related elderly and veteran outreach efforts operated by Deja New Leicester, Incorporated, the Council on Aging in the town of Leicester, and Project New Hope, Incorporated; provided further, that not less than $250,000 shall be expended for Parkway in Motion, Inc. to provide programming for seniors in the SW Boston neighborhoods; provided further, that not less than $100,000 shall be expended for the costs associated with care and services provided at the Whipple Senior Center in the city known as the town of Weymouth; provided further, that not less than $160,000 shall be allocated to OutstandingLife, Inc. for the operation of a statewide virtual senior center for LGBTQIA+ older adults; provided further, that not less than $25,000 shall be expended for the Methuen Senior Activity Center for operational costs; provided further, that not less than $65,000 shall be expended to the city known as the town of North Attleborough to purchase furniture, exercise equipment, movie projection equipment, a welcome desk, and other needs associated with the establishment of the North Attleborough Council on Aging in its new location; provided further, that not less than $30,000 shall be expended for new kitchen appliances and upgrades for the Pepperell Council on Aging senior center kitchen; provided further, that not less than $25,000 shall be expended to the Brookline Council on Aging to support the Council’s food insecurity programs; provided further, that not less than $25,000 shall be expended for the Chelmsford Council on Aging to meet the nutritional needs of elders

And further amend said item by striking out the figure “$28,000,000” and inserting in place thereof the following figure:- $29,092,500

And further amend the bill by inserting after section 30 the following section:-

SECTION 30A. Said chapter 29 is hereby further amended by striking out section 2PPP and inserting in place thereof the following section:-

Section 2PPP. There shall be established and set up on the books of the commonwealth a separate, non-budgeted special revenue fund known as the Essential Community Provider Trust Fund, in this section called the trust fund. There shall be credited to the trust fund: (i) any funds that may be appropriated or transferred into the trust fund; and (ii) any income derived from investment of amounts credited to the trust fund. In conjunction with the preparation of the commonwealth’s annual financial report, the comptroller shall prepare and issue an annual report detailing the revenues and expenditures of the trust fund. Amounts credited to the fund shall not be subject to further appropriation. Money remaining in the fund at the end of a fiscal year shall not revert to the General Fund and shall be available for expenditure in subsequent fiscal years. To accommodate timing discrepancies between the receipt of revenue and related expenditures, the comptroller may certify for payment amounts not to exceed the most recent revenue estimates as certified by the secretary of health and human services to be transferred, credited or deposited to the trust fund. The secretary of health and human services shall administer the trust fund and disburse funds from the trust fund to make payments to acute hospitals and community health centers to maintain financial stability for the provision of healthcare services in the commonwealth, to ensure access to care, provide for public health and promote equity.

And further amend the bill in section 31 by striking out the words “subsection (c)”, in line 480, and inserting in place thereof the following words:- subsections (c) and (d).

And further amend the bill in said section 31 by striking out paragraphs (2) and (3) and inserting in place thereof the following 2 paragraphs:-

(2) The secretary shall annually expend amounts from the fund averaging, for the 3-year period from October 1, 2024 through September 30, 2027, not less than $2,158,500,000 per year; provided, however, that all such payments shall fall into 1 of the following categories: (i) health equity incentive payments; (ii) clinical quality incentive payments; (iii) other incentive payments; (iv) rate payments for services provided to MassHealth members; or (v) targeted payments to: (A) freestanding pediatric acute hospitals; (B) nonprofit teaching acute hospitals that provide medical, surgical, emergency and obstetrical services and are affiliated with a state-owned medical school; (C) freestanding cancer hospitals; (D) the acute hospital with the lowest statewide commercial relative price in fiscal year 2019 as reported by the center for health information and analysis; or (E) the independent group 1 safety net hospital with the largest percentile of operating loss in fiscal year 2022 as reported by the center for health information and analysis. The secretary may determine funding allocations among and within each such category within a given year; provided, however, that such allocations shall be consistent with all approved federal waivers and state plan provisions; and provided further, that the secretary shall allocate an average of not less than $1,192,000,000 per year, for the 3-year period from October 1, 2024 through September 30, 2027, for the rate payments described in clause (iv), with an average of not less than $92,000,000 allocated for group 1 safety net hospitals for the 3-year period, an average of not less than $460,000,000 allocated for group 2 safety net hospitals for the 3-year period, and an average of not less than $640,000,000 allocated across all acute hospitals for the 3-year period.

(3) Of the targeted payments described in clause (v) of paragraph (2), the secretary shall expend annually from the fund: (i) $70,000,000 to freestanding pediatric acute hospitals, of which at least 98 per cent shall be paid to the freestanding pediatric hospital with the largest volume of inpatient discharges in fiscal year 2019; (ii) $35,000,000 to nonprofit teaching acute hospitals that provide medical, surgical, emergency and obstetrical services and are affiliated with a state-owned medical school; (iii) $11,000,000 to the acute hospital with the lowest statewide commercial relative price in fiscal year 2019 as reported by the center for health information and analysis; (iv) $5,000,000 to the freestanding cancer hospitals; and (v) $10,000,000 to the independent group 1 safety net hospital with the largest operating percentile loss in fiscal year 2022 as reported by the center for health information and analysis.

And further amend the bill in said section 31 by adding the following subsection:-

(d) If any portion of the final annual amount allocated by the secretary to health equity incentive payments, clinical quality incentive payments or other incentive payments is unearned during the relevant measurement period for such payment, as determined by the secretary, the secretary shall transfer the state’s share of that unearned amount to the Health Safety Net Trust Fund established in section 66 of chapter 118E.

And further amend the bill in section 37 by inserting after the word “waiver”, in line 599, the following words:- or for the administration of the assessment established in section 68 of chapter 118E.

And further amend the bill in said section 37 by inserting after the word “all,” in line 599, the following word:- Medicaid.

And further amend the bill by inserting after section 38 the following section:-

SECTION 38A. Chapter 32A of the General Laws is hereby amended by inserting after section 17S the following section:-

Section 17T. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:

“Directly or indirectly cause impairment of fertility”, to cause circumstances where a disease, or the necessary treatment for a disease, has a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.

“Standard fertility preservation services”, procedures or treatments to preserve fertility as recommended by a board-certified obstetrician gynecologist, reproductive endocrinologist or other physician; provided, that the recommendation shall be made in accordance with current medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.

(b) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for standard fertility preservation services, including, but not limited to, coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures.

And further amend the bill by inserting after section 49 the following section:-

SECTION 49A. Section 9D of chapter 118E of the General Laws, as so appearing, is hereby amended by striking out paragraph (6) of subsection (e) and inserting in place thereof the following subsection:-

(6)(i) The executive office shall direct MassHealth to provide notice to each individual age 55 or older of the options for enrolling in voluntary programs, including, but not limited to, Program of All Inclusive Care for the Elderly or PACE plans, Senior Care Options or SCO plans, One Care plans and Home and the Community-Based Services Waiver program for frail elders when: (A) the individual first becomes eligible for Medicare or MassHealth; and (B) the individual inquires about long term nursing home placement. Notice provided pursuant to this clause shall be consistent with the notice requirement pursuant to subparagraph (ii).

(ii) The executive office shall direct MassHealth to provide each beneficiary age 65 and older with an annual notice of the options for enrolling in voluntary programs, including Program of All Inclusive Care for the Elderly or PACE plans, Senior Care Options or SCO plans, One Care plans, the Home and Community-Based Services Waiver program for frail elders or any other voluntary, elective benefit to which the beneficiary is entitled to supplement or replace their MassHealth benefits. If MassHealth receives approval from the Centers for Medicare and Medicaid Services, MassHealth shall arrange for the annual notice to include the names and contact information for the program providers, general contact information for MassHealth and a general description of the benefits of joining particular programs in clear and simple language and a method to request the same information in a language other than English. The notice shall include a method for the beneficiary to indicate interest in receiving additional information on any programs identified that may be of interest to them. The notice shall be supplied to a beneficiary every time the beneficiary is subject to a redetermination of eligibility. A draft of the proposed language and format for providing information to beneficiaries shall be circulated to the providers contracted to provide each of these programs for review and comment prior to finalization. The division shall work with the program providers and other appropriate stakeholders to assess whether and to what extent barriers to program enrollment shall be alleviated through modifications to the program or the enrollment process.

And further amend the bill in section 50 by striking out the words “chapter 118E of the General Laws”, in line 861, and inserting in place thereof the following words:- said chapter 118E.

And further amend the bill by striking out section 53 and inserting in place thereof the following section:-

SECTION 53. Said section 64 of said chapter 118E, as so appearing, is hereby further amended by inserting after the definition of “Gross patient service revenue” the following 3 definitions:-

“Group 1 safety net hospital”, any hospital identified as a group 1 safety net hospital, as set forth in Attachment N as approved on March 29, 2023, to the MassHealth demonstration waiver approved September 28, 2022, effective October 1, 2022 through December 31, 2027, pursuant to subsection (a) of section 1115 of Title XI of the federal Social Security Act.

“Group 2 safety net hospital”, any hospital identified as a group 2 safety net hospital, as set forth in Attachment N as approved on March 29, 2023, to the MassHealth demonstration waiver approved September 28, 2022, effective October 1, 2022 through December 31, 2027, pursuant to subsection (a) of section 1115 of Title XI of the federal Social Security Act.

“Health policy commission revenue amount”, the amount collected by the health policy commission from hospitals and ambulatory surgical centers pursuant to section 6 of chapter 6D.

And further amend the bill in section 54 by striking out the figure “7”, in line 899, and inserting in place thereof the following figure:- 8.

And further amend the bill in said section 54 by inserting after the definition of “Medicaid managed care organization”, the following definition:-

“Medicaid managed care organization services subject to assessment”, managed care organization services subject to assessment provided to a Medicaid member.

And further amend the bill in section 56 by striking out the figure “$1,226,715,133”, in line 943, and inserting in place thereof the following figure:- $1,484,050,000.

And further amend the bill in section 58 by striking out the figure “$791,915,133”, in line 960, and inserting in place thereof the following figure:- $994,000,000.

And further amend the bill in said section 58 by striking out the words “and (D) $10,000,000 to the Non-Acute Care Hospital Reimbursement Trust Fund established in section 2WWWW of said chapter 29”, in lines 963 and 964, and inserting in place thereof the following words:- (D) $30,250,000 to the Non-Acute Care Hospital Reimbursement Trust Fund established in section 2WWWW of said chapter 29; and (E) $35,000,000 to the Essential Community Provider Trust Fund established in section 2PPP of said chapter 29.

And further amend the bill in section 59 by striking out the figure “$791,915,133”, in line 988, and inserting in place thereof the following figure:- $994,000,000.

And further amend the bill in said section 59 by striking out the figure “$10,000,000”, in line 991, and inserting in place thereof the following figure:- $30,250,000.

And further amend the bill in said section 59 by striking out the words “and (J) an amount equal to the center for health information and analysis revenue amount to the Center for Health Information and Analysis Fund established in section 7A of chapter 12C”, in lines 1000 to 1002, inclusive, and inserting in place thereof the following words:- (J) an amount equal to the center for health information and analysis revenue amount to the Center for Health Information and Analysis Fund established in section 7A of chapter 12C; and (K) $35,000,000 to the Essential Community Provider Trust Fund established in section 2PPP of chapter 29.

And further amend the bill in section 61 by striking out subsections (d) and (e), in lines 1090 to 1131, inclusive, and inserting in place thereof the following 2 subsections:-

(d) For the purposes of the assessment described in this section, all hospitals in the commonwealth shall be divided into the following groups, as determined by the secretary of health and human services:

(i) large group 1 safety net hospitals, defined for the purposes of this section as any group 1 safety net hospital with 355 or more staffed beds in fiscal year 2022, as reported by the center for health information and analysis;

(ii) small group 1 safety net hospitals, defined for the purposes of this section as any group 1 safety net hospital with less than 355 staffed beds in fiscal year 2022, as reported by the center for health information and analysis;

(iii) large group 2 safety net hospitals, defined for the purposes of this section as any group 2 safety net hospitals with 355 or more staffed beds in fiscal year 2022, as reported by the center for health information and analysis;

(iv) small group 2 safety net hospitals, defined for the purposes of this section as any group 2 safety net hospitals with less than 355 staffed beds in fiscal year 2022, as reported by the center for health information and analysis;

(v) freestanding pediatric acute hospitals;

(vi) academic, teaching and specialty hospitals, defined for the purposes of this section as any academic medical center, teaching hospital or specialty hospital, as determined by the center for health information and analysis as of September 30, 2019, but excluding any high public payer hospital;

(vii) private acute hospitals, defined for the purposes of this section as any private hospital licensed under section 51 of chapter 111 and that contains a majority of medical-surgical, pediatric, obstetric and maternity beds, as defined by the department of public health, and operating as of September 30, 2019, but excluding any safety net hospital or academic, teaching and specialty hospital;

(viii) non-state public hospitals, defined for the purposes of this section as any non-state-owned public hospital in the commonwealth, as determined by the secretary of health and human services; and

(ix) non-acute hospitals, defined for the purposes of this section as any nonpublic hospital licensed by the department of public health under section 51 of chapter 111 but not defined as an acute care hospital under section 25B of chapter 111 or any nonpublic hospital licensed as an inpatient facility by the department of mental health under section 19 of chapter 19 and any regulations promulgated thereunder but not categorized as a class VII licensee under any regulations.

(e) Each of the groups described in subsection (d) shall be subject to the following assessment rates: (i) large group 1 safety net hospitals shall be subject to a rate of 24.000 per cent for inpatient services and 5.950 per cent for outpatient services; (ii) small group 1 safety net hospitals shall be subject to a rate of 14.500 per cent for inpatient services and 5.500 per cent for outpatient services; (iii) large group 2 safety net hospitals shall be subject to a rate of 18.000 per cent for inpatient services and 18.200 per cent for outpatient services; (iv) small group 2 safety net hospitals shall be subject to a rate of 18.000 per cent for inpatient services and 10.200 per cent for outpatient services; (v) freestanding pediatric hospitals shall be subject to a rate of 4.800 per cent for inpatient services and 4.250 per cent for outpatient services; (vi) academic, teaching and specialty hospitals shall be subject to a rate of 4.701 per cent for inpatient services and 1.065 per cent for outpatient services; (vii) private acute hospitals shall be subject to a rate of 8.500 per cent for inpatient services and 1.045 per cent for outpatient services; (viii) non-state public hospitals shall be subject to a rate of 1.615 per cent for inpatient services and 1.500 per cent for outpatient services; and (ix) non-acute hospitals shall be subject to a rate of 3.300 per cent for inpatient services and 3.300 per cent for outpatient services; provided, however, that the office shall increase each such rate by the amount necessary to generate 50 per cent of the estimated cost, as determined by the secretary of administration and finance, of administering the health safety net and related assessments in accordance with sections 65 to 69, inclusive. In the event that a hospital closure or a hospital change in status to a different type of provider results in a reduction of the total hospital assessment amount, the secretary of health and human services may, through regulation, adjust the assessment rates to ensure the total hospital assessment amount is not reduced by more than $10,000,000 on an annual basis; provided, that any such adjustments to the rates shall ensure the rates remain in the same proportion to each other as established in this subsection.

And further amend the bill in said section 61 by adding the following subsection:-

(h) The secretary of health and human services may enforce the payment of assessments required pursuant to this section by: (i) notifying the department of public health of any unpaid assessments regarding hospitals licensed by the department of health and such information shall be considered by the department of public health in determining suitability, in accordance with section 51 of chapter 111, for the hospital or its affiliate provider entities; (ii) offsetting payments from the office of Medicaid against the claims for payment by the delinquent hospital, against other hospitals or MassHealth contracted entities under common ownership as the delinquent hospital or against any successor in interest to the hospital or such provider entities under common ownership, in the amount of the delinquent fees owed, including any interest, penalties or reasonable attorneys’ fees, and by transferring such funds into the fund; or (iii) creating, after demand for payment, a lien in favor of the commonwealth in an amount not to exceed the delinquent fees owed, including any interest, penalties or reasonable attorneys’ fees, encumbering the building in which the delinquent hospital is located, the real property upon which the delinquent hospital is located, any fixtures, equipment or goods used in the operation of the delinquent hospital or any real property in which the delinquent hospital holds an interest.

And further amend the bill in section 62 by striking out clauses (i) through (iii), inclusive, of subsection (c), in lines 1162 to 1170, inclusive, and inserting in place there of the following 3 clauses:-

(i) managed care organization services subject to assessment that are not Medicaid managed care organization services subject to assessment provided by a managed care organization;

(ii) Medicaid managed care organization services subject to assessment provided by a managed care organization that has an average total Medicaid member per month enrollment below a threshold established by the secretary of health and human services through regulations; and

(iii) Medicaid managed care organization services subject to assessment provided by a managed care organization that has an average total Medicaid member per month enrollment at or above a threshold established by the secretary of health and human services through regulations.

And further amend the bill by inserting after section 65 the following section:-

SECTION 65A. Chapter 175 of the General Laws is hereby amended by inserting after section 47UU, inserted by section 56 of chapter 28 of the acts of 2023, the following section:-

Section 47VV. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:

(b) The following shall provide coverage for standard fertility preservation services, including, but not limited to, coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes: (i) any policy of accident and sickness insurance, as described in section 108, that provides hospital expense and surgical expense insurance and that is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in subdivision (A), (C) or (D) of section 110 that provides hospital expense and surgical expense insurance and that is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth; and (iii) any employees’ health and welfare fund that provides hospital expense and surgical expense benefits and that is delivered, issued or renewed to any person or group of persons in the commonwealth. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures.

And further amend the bill by inserting after section 67 the following 3 sections:-

SECTION 67A. Chapter 176A of the General Laws is hereby amended by inserting after section 8VV, inserted by section 58 of chapter 28 of the acts of 2023, the following section:-

Section 8WW. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:

(b) Any contract between a subscriber and a corporation subject to this chapter, pursuant to an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall provide coverage for standard fertility preservation services, including, but not limited to, coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures.

SECTION 67B. Chapter 176B of the General Laws is hereby amended by inserting after section 4VV, inserted by section 59 of said chapter 28, the following section:-

Section 4WW. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:

(b) A subscription certificate under an individual or group medical service agreement that is delivered, issued or renewed within the commonwealth shall provide coverage for standard fertility preservation services, including, but not limited to, the coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures.

SECTION 67C. Chapter 176G of the General Laws is hereby amended by inserting after section 4NN, inserted by section 60 of said chapter 28, the following section:-

Section 4OO. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:

(b) An individual or group health maintenance contract that is issued, delivered or renewed within the commonwealth shall provide coverage for standard fertility preservation services, including, but not limited to, coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures.

And further amend the bill by inserting after section 83A, as inserted by Consolidated Amendment A, the following section:-

SECTION 83B. Not later than June 30, 2025, the executive office of health and human services and MassHealth shall establish rules and regulations for the implementation of paragraph 6 of section 9D of chapter 118E of the General Laws, as inserted by section 49A.

And further amend the bill in section 85 by inserting after the word “sections”, in lines 1581 and 1584, in each instance, the following words:- 30A,.

And further amend the bill in section 86 by inserting after the word “sections”, in lines 1607, 1610 and 1614, in each instance, the following words:- 30A,.

And further amend the bill by inserting after section 88A, as inserted by Consolidated Amendment A, the following 3 sections:-

SECTION 88B. Notwithstanding any general law or special law to the contrary, the secretary of health and human services shall implement new annual funding of not less than $63,600,000 total computable within the state-directed Medicaid managed care incentive initiative payment mechanisms to the non-state-owned public hospital for each of the fiscal years 2024 through 2027, inclusive, at full levels, including the 20 per cent increase to the maximum payment amounts listed in items 2, 4 and 5 of section 6 of Attachment Q of the MassHealth demonstration waiver approved May 15, 2023, effective October 1, 2022 through December 31, 2027, under subsection (a) of section 1115 of Title XI of the federal Social Security Act.

SECTION 88C. (a) Notwithstanding any general or special law to the contrary, the secretary of health and human services, in collaboration with the non-state-owned public hospital, shall seek any and all required federal approvals the secretary and the non-state-owned public hospital deem necessary to implement section 88B, including any required waivers and other applicable submissions necessary to implement the state-directed payment mechanisms under 42 CFR 438.6(c).

(b) Notwithstanding any general or special law to the contrary, the payments to the non-state-owned public hospital shall be authorized annually by the secretary and shall be made through the Medical Assistance Trust Fund established in section 2QQQ of chapter 29 of the General Laws.

(c) The secretary of health and human services shall notify the house and senate committees on ways and means and the joint committee on health care financing of any federal approval received or denied pursuant to this section.

SECTION 88D. (a) Notwithstanding any general or special law to the contrary, in the event that the commonwealth does not receive initial federal approvals pursuant to section 88B that the secretary of health and human services determines necessary to implement this section, the secretary, in collaboration with the non-state-owned public hospital, shall develop and pursue alternative federal funding mechanisms, as necessary, to achieve the specified incremental federal funding pursuant to section 88B and shall seek all necessary federal approvals.

(b) The secretary of health and human services shall notify the house and senate committees on ways and means and the joint committee on health care financing of any federal approval received or denied pursuant to this section.

And further amend the bill by inserting after section 102 the following section:-

SECTION 102A. Section 88B to 88D, inclusive, are hereby repealed.

And further amend the bill in section 104 by inserting after the word “Sections”, in line 1794, the following figure:- 30A,.

And further amend the bill in said section 104 by inserting after the figure “31”, in line 1794, the following figure:- , 53.

And further amend the bill in section 105 by striking out the figure “53,”, in line 1797.

And further amend the bill by inserting after section 111 the following section:-

SECTION 111A. Section 102A shall take effect as of October 1, 2028.