Amendment #1149 to H4000

Affirming Health Care Trust Fund and Assessment Fee

Representatives Montaño of Boston and Decker of Cambridge move to amend the bill in section 2, in item 4510-0110, in lines 6 to 9, inclusive, by striking out the following: “; and provided further, that not less than $1,000,000 shall be expended for the establishment of a Massachusetts gender affirming care access program to provide support to federally qualified health centers specializing in gender affirming care”; and in said item by striking out the figures “$10,398,660” and inserting in place thereof the figures “$9,368,660”.

and to further amend the bill, in section 2, by inserting after item 4590-1507 the following item:-

“XXXX-XXXX For the operation of the Affirming Health Care Trust Fund, as established under section 24N ½ of chapter 111 of the General Laws, as inserted by section XX of this act … $1,000,000”.

and to further amend the bill by inserting the following section:-

“SECTION XX. Chapter 111 of the General Laws is hereby amended by inserting after section 24N the following section:-

Section 24N 1/2. (a) As used in this section, the following words shall have the following meaning unless the context clearly requires otherwise:

“Commercial payor”, an insurer licensed or otherwise authorized to transact accident or health insurance under chapter 175; a nonprofit hospital service corporation organized under chapter 176A; a nonprofit medical service corporation organized under chapter 176B; a health maintenance organization organized under chapter 176G; an organization entering into a preferred provider arrangement under chapter 176I.

“Gender-affirming health care services”, all supplies, care and services of a medical, behavioral health, mental health, surgical, psychiatric, therapeutic, diagnostic, preventative, rehabilitative or supportive nature relating to the treatment of gender dysphoria.

“Payor surcharge”, a surcharge fee imposed on commercial payors in the commonwealth in an amount determined by the commissioner of public health.

“Total gender-affirming health care cost”, the estimated total annual cost of gender-affirming health care services provided by all carriers, as defined in section 1 of chapter 6D, in the commonwealth as determined by the commissioner of public health by January 1 of each year, and the costs associated with medical malpractice liability and general liability of any health care provider involved in the provision of gender-affirming health care services, less the amount of federal revenue available to the commonwealth to reimburse for such services.

(b) There shall be established and set up on the books of the commonwealth a separate fund to be known as the Affirming Health Care Trust Fund. The fund shall be administered by the department of public health. The fund shall consist of: (i) all revenue from the payor surcharge as described under subsection (c) of this section; (ii) revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; (iii) funds from public or private sources, including, but not limited to, gifts, grants, donations, rebates and settlements; (iv) interest earned on such revenues; and (v) funds provided from other sources.

(c) Under regulations adopted by the commissioner of public health, each commercial payor in the commonwealth shall pay to the commissioner a payor surcharge, in an amount determined by the commissioner, for deposit in the fund. The commissioner shall, in establishing the payor surcharge amount for each commercial payor, consider the proportion of total gender-affirming health care services provided by each commercial payor during the most recent period for which data is available relative to the total gender-affirming health case cost for the succeeding period. The department of public health shall promulgate regulations for implementation of the payor surcharge, including a payment schedule for commercial payors.

(d) The department shall expend monies in the fund, without further appropriation, for the provision of gender-affirming health care services, including but not limited to at institutions over which the commissioner has supervision and control pursuant to section 69E of chapter 111, provided that the department may also expend monies in the fund to cover costs of medical malpractice liability and general liability insurance for health care providers involved in the provision of gender-affirming health care services and to support research relating to LGBTQ+ health promotion and gender-affirming health care services. All such fund expenditures shall be expended exclusively for the purposes set forth in this section.

(e) Amounts credited to the fund shall not be subject to further appropriation and any money remaining in the fund at the end of a fiscal year shall not revert to the General Fund. The department shall report annually, not later than October 1, to the house and senate clerks, house and senate committees on ways and means and the joint committee on health care financing on the fund's activity. The report shall include, but not be limited to, revenue received by the fund, revenue and expenditure projections for the forthcoming fiscal year, details of all expenditures from the fund and the results from any funded research efforts.

Additional co-sponsor(s) added to Amendment #1149 to H4000

Affirming Health Care Trust Fund and Assessment Fee