Section 66: Health Safety Net Trust Fund
Section 66. (a) There shall be established and set up on the books of the commonwealth a fund to be known as the Health Safety Net Trust Fund, in this section and in sections 67 to 69, inclusive, called the fund, which shall be administered by the health safety net office, hereinafter the office. Expenditures from the fund shall not be subject to appropriation unless otherwise required by law. The purposes of the fund shall be to: (i) maintain a health care safety net by reimbursing hospitals and community health centers for a portion of the cost of reimbursable health services provided to low-income, uninsured or underinsured residents; (ii) support the estimated expenses of the executive office in administering the health safety net and related assessments under sections 65 to 69, inclusive; and (iii) support a portion of the costs of the Medicaid program under this chapter. The office shall administer the fund using methods, policies, procedures, standards and criteria for the proper and efficient operation of the fund and programs supported by it in a manner designed to distribute the fund resources as equitably as possible. The secretary of administration and finance, in consultation with the secretary of health and human services, shall determine annually the estimated expenses to administer the fund.
[ Subsection (b) effective until as provided by 2025, 73, Sec. 197. For text effective as provided by 2025, 73, Sec. 197, see below.]
(b) The fund shall consist of: (i) all amounts paid by hospitals and managed care organizations under sections 67 and 68; (ii) all appropriations for the purpose of payments to acute hospitals or community health centers for health services provided to uninsured and underinsured residents; (iii) any transfers from the Commonwealth Care Trust Fund established in section 2OOO of chapter 29; (iv) any transfers from the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29; (v) any transfers from the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29; (vi) any transfers from the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29; and (vii) all property and securities acquired by and through the use of money belonging to the fund and all interest thereon. There shall also be credited to the fund an amount equal to any federal financial participation claimed and received by the commonwealth for eligible expenditures made from the fund and financed by money transferred from the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29, the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29 or from the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29. To accommodate timing discrepancies between the receipt of such 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 under this subsection. Annually, the office shall transfer from the non-federal money in the fund: (A) $149,300,000 to the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29; (B) $994,000,000 to the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29; (C) $115,500,000 to the Population Health Investment Trust Fund established in section 2UUUUU of chapter 29; (D) $30,250,000 to the Non-Acute Care Hospital Reimbursement Trust Fund established in section 2WWWW of chapter 29; (E) an amount equal to the managed care organization reinvestment revenue amount to the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29; (F) an amount equal to the Massachusetts Child Psychiatry Access Project revenue amount to the Massachusetts Child Psychiatry Access Project Fund established in section 2EEEEEE of chapter 29; (G) an amount equal to the health policy commission revenue amount to the Healthcare Payment Reform Fund established in section 7 of chapter 6D; (H) an amount equal to the immunization revenue amount to the Vaccine Purchase Fund established in section 24N of chapter 111; (I) $33,700,000 to the Behavioral Health Access and Crisis Intervention Trust Fund established in section 2WWWWW of chapter 29; (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. The office shall expend amounts in the fund, except for amounts transferred to the Safety Net Provider Trust Fund, the Hospital Investment and Performance Trust Fund, the Population Health Investment Trust Fund, the Non-Acute Care Hospital Reimbursement Trust Fund, the Managed Care Organization Services Reinvestment Fund, the Massachusetts Child Psychiatry Access Project Fund, the Vaccine Purchase Fund, the Center for Health and Information Analysis Fund, the Healthcare Payment Reform Fund and the Behavioral Health Access and Crisis Intervention Trust Fund, for payments to hospitals and community health centers for reimbursable health services provided to uninsured and underinsured residents, consistent with the requirements of this section, section 69 and the regulations adopted by the office. The amount collected pursuant to clause (vii) of the definition of total managed care organization services assessment amount in section 64 shall be dedicated to reducing the shortfall, as described in subsection (b) of section 69, for the year prior to the assessment year. The office shall also annually expend money from the fund for the expenses of the executive office, including the health safety net office under subsection (a), for the administration of the health safety net and related assessments. The office shall also expend not more than $6,000,000 annually from the fund for demonstration projects that use case management and other methods to reduce the liability of the fund to acute hospitals. All interest earned on the amounts in the fund shall be deposited or retained in the fund. The director shall from time-to-time requisition from the fund amounts that the director considers necessary to meet the current obligations of the office for the purposes of the fund and estimated obligations for a reasonable future period.
[ Subsection (b) as amended by 2025, 73, Secs. 36 and 37 effective upon as provided by 2025, 73, Sec. 197. For text effective until as provided by 2025, 73, Sec. 197, see above. For text effective upon the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025, see below.]
(b) The fund shall consist of: (i) all amounts paid by hospitals and managed care organizations under sections 67 and 68; (ii) all appropriations for the purpose of payments to acute hospitals or community health centers for health services provided to uninsured and underinsured residents; (iii) any transfers from the Commonwealth Care Trust Fund established in section 2OOO of chapter 29; (iv) any transfers from the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29; (v) any transfers from the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29; (vi) any transfers from the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29; and (vii) all property and securities acquired by and through the use of money belonging to the fund and all interest thereon. There shall also be credited to the fund an amount equal to any federal financial participation claimed and received by the commonwealth for eligible expenditures made from the fund and financed by money transferred from the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29, the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29 or from the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29. To accommodate timing discrepancies between the receipt of such 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 under this subsection. Annually, the office shall transfer from the non-federal money in the fund: (A) $149,300,000 to the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29; (B) $994,000,000 to the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29; (C) $115,500,000 to the Population Health Investment Trust Fund established in section 2UUUUU of chapter 29; (D) $30,250,000 to the Non-Acute Care Hospital Reimbursement Trust Fund established in section 2WWWW of chapter 29; (E) an amount equal to the Medicaid managed care organization revenue amount to the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29; (F) an amount equal to the Massachusetts Child Psychiatry Access Project revenue amount to the Massachusetts Child Psychiatry Access Project Fund established in section 2EEEEEE of chapter 29; (G) an amount equal to the health policy commission revenue amount to the Healthcare Payment Reform Fund established in section 7 of chapter 6D; (H) an amount equal to the immunization revenue amount to the Vaccine Purchase Fund established in section 24N of chapter 111; (I) $33,700,000 to the Behavioral Health Access and Crisis Intervention Trust Fund established in section 2WWWWW of chapter 29; (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. The office shall expend amounts in the fund, except for amounts transferred to the Safety Net Provider Trust Fund, the Hospital Investment and Performance Trust Fund, the Population Health Investment Trust Fund, the Non-Acute Care Hospital Reimbursement Trust Fund, the Managed Care Organization Services Reinvestment Fund, the Massachusetts Child Psychiatry Access Project Fund, the Vaccine Purchase Fund, the Center for Health and Information Analysis Fund, the Healthcare Payment Reform Fund and the Behavioral Health Access and Crisis Intervention Trust Fund, for payments to hospitals and community health centers for reimbursable health services provided to uninsured and underinsured residents, consistent with the requirements of this section, section 69 and the regulations adopted by the office. The amount collected pursuant to clause (vii) of the definition of non-Medicaid managed care organization revenue amount in section 64 shall be dedicated to reducing the shortfall, as described in subsection (b) of section 69, for the year prior to the assessment year. The office shall also annually expend money from the fund for the expenses of the executive office, including the health safety net office under subsection (a), for the administration of the health safety net and related assessments. The office shall also expend not more than $6,000,000 annually from the fund for demonstration projects that use case management and other methods to reduce the liability of the fund to acute hospitals. All interest earned on the amounts in the fund shall be deposited or retained in the fund. The director shall from time-to-time requisition from the fund amounts that the director considers necessary to meet the current obligations of the office for the purposes of the fund and estimated obligations for a reasonable future period.
[ Subsection (b) as amended by 2025, 73, Sec. 38 effective upon the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025. See 2025, 73, Sec. 198. For text effective until the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025, see above. For text effective October 1, 2027, see below.]
(b) The fund shall consist of: (i) all amounts paid by hospitals and managed care organizations under sections 67 and 68; (ii) all appropriations for the purpose of payments to acute hospitals or community health centers for health services provided to uninsured and underinsured residents; (iii) any transfers from the Commonwealth Care Trust Fund established in section 2OOO of chapter 29; (iv) any transfers from the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29; (v) any transfers from the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29; (vi) any transfers from the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29; and (vii) all property and securities acquired by and through the use of money belonging to the fund and all interest thereon. There shall also be credited to the fund an amount equal to any federal financial participation claimed and received by the commonwealth for eligible expenditures made from the fund and financed by money transferred from the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29, the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29, or from the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29. To accommodate timing discrepancies between the receipt of such 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 under this subsection. Annually, the office shall transfer from the non-federal money in the fund: (A) $149,300,000 to the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29; (B) $1,041,170,000 to the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29; (C) $115,500,000 to the Population Health Investment Trust Fund established in section 2UUUUU of chapter 29; (D) $ 33,169,685 to the Non-Acute Care Hospital Reimbursement Trust Fund established in section 2WWWW of chapter 29; (E) an amount equal to the managed care reinvestment revenue amount to the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29; (F) an amount equal to the Massachusetts Child Psychiatry Access Project revenue amount to the Massachusetts Child Psychiatry Access Project Fund established in section 2EEEEEE of chapter 29; (G) an amount equal to the health policy commission revenue amount to the Healthcare Payment Reform Fund established in section 100 of chapter 194 of the acts of 2011; (H) an amount equal to the immunization revenue amount to the Vaccine Purchase Fund established in section 24N of chapter 111; (I) $33,700,000 to the Behavioral Health Access and Crisis Intervention Trust Fund established in section 2WWWWW of chapter 29; (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. The office shall expend amounts in the fund, except for amounts transferred to the Safety Net Provider Trust Fund, the Hospital Investment and Performance Trust Fund, the Population Health Investment Trust Fund, the Non-Acute Care Hospital Reimbursement Trust Fund, the Managed Care Organization Services Reinvestment Fund, the Massachusetts Child Psychiatry Access Project Fund, the Vaccine Purchase Fund, the Center for Health and Information Analysis Fund, the Healthcare Payment Reform Fund and the Behavioral Health Access and Crisis Intervention Trust Fund, for payments to hospitals and community health centers for reimbursable health services provided to uninsured and underinsured residents, consistent with the requirements of this section, section 69 and the regulations adopted by the office. The amount collected pursuant to clause (vii) of the definition of total managed care organization services revenue amount in section 64 shall be dedicated to reducing the shortfall, as described in subsection (b) of section 69, for the year prior to the assessment year. The office shall also annually expend money from the fund for the expenses of the executive office, including the health safety net office under subsection (a), for the administration of the health safety net and related assessments. The office shall also expend not more than $6,000,000 annually from the fund for demonstration projects that use case management and other methods to reduce the liability of the fund to acute hospitals. Any annual balance remaining in the fund after these payments have been made shall be retained in the fund and shall not revert to the General Fund. All interest earned on the amounts in the fund shall be deposited or retained in the fund. The director shall from time-to-time requisition from the fund amounts that the director considers necessary to meet the current obligations of the office for the purposes of the fund and estimated obligations for a reasonable future period.
[ Subsection (b) as amended by 2024, 140, Sec. 127 and 2025, 73, Secs. 151 and 152, effective October 1, 2027. See 2024, 140, Sec. 258 and 2025, 73, Sec. 197. For text of subsection (b) effective until October 1, 2027, see above.]
(b) The fund shall consist of: (i) all amounts paid by hospitals and managed care organizations under sections 67 and 68; (ii) all appropriations for the purpose of payments to acute hospitals or community health centers for health services provided to uninsured and underinsured residents; (iii) any transfers from the Commonwealth Care Trust Fund established in section 2OOO of chapter 29; (iv) any transfers from the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29; (v) any transfers from the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29; (vi) any transfers from the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29; and (vii) all property and securities acquired by and through the use of money belonging to the fund and all interest thereon. There shall also be credited to the fund an amount equal to any federal financial participation claimed and received by the commonwealth for eligible expenditures made from the fund and financed by money transferred from the Hospital Investment and Performance Trust Fund established in section 2TTTTT of chapter 29, the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29 or from the Safety Net Provider Trust Fund established in section 2AAAAA of chapter 29. To accommodate timing discrepancies between the receipt of such 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 under this subsection. Annually, the office shall transfer an amount equal to all amounts paid by privately-owned, nonfederal hospitals under subsection (b) of section 67 to the Non-Acute Care Hospital Reimbursement Trust Fund established in section 2WWWW of chapter 29. The office shall annually transfer from the non-federal money in the fund: (A) an amount equal to the Medicaid managed care organization revenue amount to the Managed Care Organization Services Reinvestment Fund established in section 2FFFFFF of chapter 29; (B) an amount equal to the Massachusetts Child Psychiatry Access Project revenue amount to the Massachusetts Child Psychiatry Access Project Fund established in section 2EEEEEE of chapter 29; (C) an amount equal to the health policy commission revenue amount to the Healthcare Payment Reform Fund established in section 7 of chapter 6D; (D) an amount equal to the immunization revenue amount to the Vaccine Purchase Fund established in section 24N of chapter 111; (E) $33,700,000 to the Behavioral Health Access and Crisis Intervention Trust Fund established in section 2WWWWW of chapter 29; and (F) 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. The office shall expend amounts in the fund, except for amounts transferred to the Non-Acute Care Hospital Reimbursement Trust Fund, the Managed Care Organization Services Reinvestment Fund, the Massachusetts Child Psychiatry Access Project Fund, the Vaccine Purchase Fund, the Center for Health Information and Analysis Fund, the Healthcare Payment Reform Fund and the Behavioral Health Access and Crisis Intervention Trust Fund, for payments to hospitals and community health centers for reimbursable health services provided to uninsured and underinsured residents, consistent with the requirements of this section, section 69 and the regulations adopted by the office. The amount collected pursuant to clause (vii) of the definition of non-Medicaid managed care organization revenue amount in section 64 shall be dedicated to reducing the shortfall, as described in subsection (b) of section 69, for the year prior to the assessment year. The office shall also annually expend money from the fund for the expenses of the executive office, including the health safety net office under subsection (a), for the administration of the health safety net and related assessments. The office shall also expend not more than $6,000,000 annually from the fund for demonstration projects that use case management and other methods to reduce the liability of the fund to acute hospitals. Any annual balance remaining in the fund after these payments have been made shall be retained in the fund and shall not revert to the General Fund. All interest earned on the amounts in the fund shall be deposited or retained in the fund. The director shall from time-to-time requisition from the fund amounts that the director considers necessary to meet the current obligations of the office for the purposes of the fund and estimated obligations for a reasonable future period.
[ Subsection (c) as added by 2025, 73, Sec. 38 effective upon the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025. See 2025, 73, Sec. 198.]
(c) For each fiscal year, in the event that federal financial participation is not available for any of the Medicaid expenditures made or to be made from this fund or from amounts transferred from the fund pursuant to clauses (A), (B), (C), (D) or (K) of subsection (b), or hospital assessment funding serving as the non-federal share of such expenditures is not available due to the application of any federal law, regulation or policy, such as federal expenditure limits or federal health care-related tax rules, or for any other reason, the amount of each such forementioned transfer from the fund shall be reduced on a pro-rata basis by multiplying each such expenditure or transfer by a fraction, the numerator of which is the aggregate amount of the transfers from the fund pursuant to said clauses (A), (B), (C), (D) or (K) of said subsection (b) for which federal financial participation will be available and the denominator of which is the aggregate amount the expenditures and transfers from the fund pursuant to said clauses (A), (B), (C), (D) or (K) of said subsection (b) that would otherwise be made.