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  • Acts
  • 2007
  • Chapter 205 AN ACT FURTHER REGULATING HEALTH CARE ACCESS.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same as follows:

SECTION 1. Subsection (e) of section 16L of chapter 6A of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by adding the following 4 sentences:- Data submitted to the health care quality and cost council under this section and the regulations promulgated thereunder shall not be a public record under clause Twenty-sixth of section 7 of chapter 4 and under chapter 66, except as specifically provided otherwise in the regulations or as approved by the council for display on the council’s website. The council shall promulgate regulations providing access to such data, provided that such regulations take into account the need to: (1) achieve the goals identified by the council; (2) protect patient privacy; (3) prevent collusion or anti-competitive conduct; and (4) prevent the release of data that could reasonably be expected to increase the cost of health care. The regulations may limit access to data based on its proposed use, the credentials of the requesting party, the type of data requested or other criteria required to make a determination regarding the appropriate release of the data. The regulations shall also provide for limitations on the requesting party's use and release of any data to which that party has been given access by the council.

SECTION 2. Said chapter 6A is hereby further amended by striking out section 16O, as so appearing, and inserting in place thereof the following section:—
Section 16O. (a) There shall be a health disparities council located within, but not subject to the control of, the executive office of health and human services. The council shall make recommendations to reduce and eliminate racial and ethnic disparities in access to quality health care and in health outcomes within the commonwealth, including disparities related to breast, cervical, prostate and colorectal cancers, strokes, and heart attacks, heart disease, diabetes, infant mortality, lupus, HIV/AIDS, asthma and other respiratory illnesses. The council may consider environmental, housing and other relevant matters contributing to these disparities. The council shall make recommendations to increase racial and ethnic diversity in the health care workforce, including doctors, nurses and physician assistants. The council shall maintain ongoing communication and coordination with the health care quality and cost council, established in section 16K of chapter 6A.

(b) The council shall consist of 37 members and shall be comprised of: 3 members of the house of representatives, 1 of whom shall be designated as co-chair by the speaker; 3 members of the senate, 1 of whom shall be designated as co-chair by the senate president; the secretary of health and human services or his designee, who shall serve ex officio; the commissioner of public health or his designee, who shall serve ex officio; the director of multicultural health in the department of public health or his designee, who shall serve ex officio; the director of Medicaid or his designee, who shall serve ex officio; the attorney general or her designee, who shall serve ex officio; 8 persons from communities disproportionately affected by health disparities, 4 of whom shall be appointed by the speaker and 4 of whom shall be appointed by the senate president; and 18 persons appointed by the co-chairs, 1 from each list of nominees submitted by each of the following organizations: the American Cancer Society, Massachusetts Division, Inc.; the American Heart Association, Massachusetts Affiliate, Inc.; the Massachusetts General Hospital; Brigham and Women's/Faulkner Hospitals, Inc.; the Dana Farber Cancer Institute, Inc.; the Massachusetts League of Community Health Centers, Inc.; the Massachusetts Medical Society; the Massachusetts Hospital Association; the Boston public health commission, established in chapter 147 of the acts of 1995; the health department of the city of Springfield; the health department of the city of Worcester; the Massachusetts School Nurse Organization, Inc.; the Massachusetts Association of Public Health Nurses, Inc.; the Massachusetts Association of Health Plans, Inc.; Blue Cross Blue Shield of Massachusetts, Inc.; the Program to Eliminate Health Disparities at the Harvard School of Public Health; the Boston Medical Center Corporation; and the Massachusetts Public Health Association. The representatives of nongovernmental organizations shall serve staggered 3-year terms. Vacancies of unexpired terms shall be filled within 60 days by the appropriate appointing authority.

(c) The council shall meet at least bimonthly, at other times as determined by its rules, and when requested either by both co-chairs or by 1 co-chair and any 9 members.

(d) The council shall submit a report annually by July 1 to the governor, the health care cost and quality council and the general court, by filing the same with the clerks of the senate and house of representatives, the joint committee on health care financing and the joint committee on public health. The report shall include: (i) data on disparities in health care access and health outcomes; (ii) data on diversity in the health care workforce; (iii) recommendations for designing, implementing and improving programs and services; (iv) proposals for statutory and regulatory changes to reduce and eliminate disparities in access to quality health care services and health outcomes in the commonwealth; and (v) recommendations for improving diversity and cultural competency in the health care workforce.

SECTION 3. Section 7B of chapter 26 of the General Laws, as so appearing, is hereby amended by striking out subsection (b) and inserting in place thereof the following subsection:

(b) Upon request, carriers licensed under chapters 175, 176A, 176B and 176G and the office of Medicaid shall make information available to the bureau for the purposes of chapter 111M. Such information shall be limited to the minimum amount of personal information necessary, shall not include information about diagnoses or treatments and, except for the office of Medicaid, shall not include social security numbers. The information acquired under this section shall be confidential and shall not constitute a public record.

SECTION 4. Section 2PPP of chapter 29 of the General Laws, as so appearing, is hereby amended by striking out, in line 16, the words “paragraph (b) of section 56” and inserting in place thereof the following words:- subsection (b) of section 35 of chapter 118G.

SECTION 5. Section 2 of chapter 32A of the General Laws, as so appearing, is hereby amended by striking out, in lines 49 and 50, the words “following loss of dependent status under the Internal Revenue Code” and inserting in place thereof the following words:- after the end of the calendar year in which such persons last qualified as dependents under 26 U.S.C. 106.

SECTION 6. Paragraph (2) of subsection (a) of section 2 of chapter 62 of the General Laws, as so appearing, is hereby amended by adding the following subparagraph:-

(Q) If an employee participates in an employer-provided health insurance plan, any amount which, but for this section, would be included in gross income of the employee by reason of coverage under the plan of any person other than the employee, to the extent such coverage is mandated by law.

SECTION 7. Section 8B of chapter 62C of the General Laws, as so appearing, is hereby amended by striking out subsection (c) and inserting in place thereof the following subsection:-

(c) The statements and reports shall identify the carrier or employer, the covered individual and covered dependents, the insurance policy or similar numbers and the dates of coverage during the year, and shall provide other information as required by the commissioner of revenue for the purposes of chapter 111M. Such information shall be limited to the minimum amount of personal information necessary, shall not include information about diagnoses or treatments and, except for the office of Medicaid, shall not include social security numbers. The commissioner of revenue, in consultation with the commissioner of insurance, may specify the content and format of the statements and reports. The commissioner of revenue may disclose the information in the statements and reports to the division of insurance, the division of health care finance and policy and the commonwealth health insurance connector. The information in the statements and reports shall be confidential and shall not constitute a public record.

SECTION 8. Subsection (b) of section 21 of said chapter 62C, as so appearing, is hereby amended by adding the following clause:-

(23) the disclosure of information contained in a return filed pursuant to this chapter to the division of health care finance and policy to allow the department to determine if a taxpayer who claimed an exemption under section 3 of chapter 111 received health services that were reimbursed from the Health Safety Net Trust Fund under section 39 of chapter 118G or to the executive office of health and human services, in its capacity as the single state agency for the purposes of Title XIX of the Social Security Act to allow the department to verify MassHealth coverage.

SECTION 9. Section 1 of chapter 62D of the General Laws, as so appearing, is hereby amended by striking out, in lines 73 and 74, the words “paragraph (c) of section 60 of chapter 118E” and inserting in place thereof the following words:— subsection (c) of section 39 of chapter 118G.

SECTION 10. Section 13 of said chapter 62D, as so appearing, is hereby amended by striking out clause (viii) and inserting in place thereof the following clause:-

(viii) the health safety net office for obligations to the Health Safety Net Trust Fund for the cost of health care services paid from the fund under section 39 of chapter 118G;.

SECTION 11. Section 12 of chapter 62E of the General Laws, as so appearing, is hereby amended by striking out, in lines 32 and 33, the words “55 to 60, inclusive of chapter 118E” and inserting in place thereof the following words:- 34 to 39, inclusive, of chapter 118G.

SECTION 12. The definition of “Creditable coverage” in section 1 of chapter 111M of the General Laws, as so appearing, is hereby amended by striking out clause (d) and inserting in place thereof the following clause:-

(d) Title XXI or XIX of the Social Security Act, other than coverage consisting solely of benefits under section 1928 or section 1903 (v) of said Title XIX.
SECTION 13. Section 2 of said chapter 111M is hereby amended by striking out subsection (b), as appearing in section 12 of chapter 58 of the acts of 2006, and inserting in place thereof the following paragraph:-

(b) Every person who files or is required to file an individual return as a resident of the commonwealth, either separately or jointly with a spouse, shall indicate on the return, in a manner prescribed by the commissioner of revenue, whether such person, as of the last day of the taxable year for which the return is filed: (i) had creditable coverage in force as required under paragraph (a) whether covered as an individual or as a named beneficiary of a policy covering multiple individuals; (ii) claims an exemption under section 3; or (iii) had a certificate issued under section 3 of chapter 176Q. If the person does not so indicate, or indicates that he did not have such coverage in force, then the tax shall be computed on the return without benefit of the personal exemption set forth in paragraph (b) of Part B of section 3 of chapter 62, or, in the case of a person who files jointly with a spouse, without benefit of one-half of the personal exemption set forth in said paragraph (b). If the person indicates that he had such creditable coverage in force but the commissioner determines, based on the information available to him, that the requirement of paragraph (a) was not met, then the commissioner shall compute the tax for the taxable year without benefit of the personal exemption set forth in said paragraph (b) of said Part B of said section 3 of said chapter 62, or, in the case of a person who files jointly with a spouse, without benefit of one-half of the personal exemption set forth in said paragraph (b). The commissioner shall first give notice to such person of his intent to do so and provide an opportunity for a hearing, under rules prescribed by the commissioner. Whenever, under this section, the tax is computed without benefit of the personal exemption, or without benefit of one-half of the personal exemption, the difference between the tax so computed and the tax that would be computed in the absence of this section shall constitute a penalty assessed under this section. The commissioner shall have all enforcement and collection procedures available under chapter 62C to collect the penalty assessed under this section.

SECTION 14. The first paragraph of said paragraph (b) of said section 2 of said chapter 111M, as appearing in section 13 of said chapter 58, is hereby amended by inserting after the word “files”, in line 34, the following words:- or is required to file.

SECTION 15. Said section 2 of said chapter 111M, as appearing in the 2006 Official Edition, is hereby further amended by striking out, in line 66, the word “collected” and inserting in place thereof the following words:- assessed under this section that he collects.

SECTION 16. Section 3 of said chapter 111M, as so appearing, is hereby amended by striking out, in line 9, the words “penalties in subsection (b) of” and inserting in place thereof the following words:- penalty assessed under.

SECTION 17. Section 9C of chapter 118E of the General Laws, as so appearing, is hereby amended by striking out, in lines 29 and 37, the figure “200” and inserting in place thereof, in each instance, the following figure:- 300.

SECTION 18. Subclause (ii) of clause (a) of the first sentence of the eighth paragraph of section 23 of said chapter 118E, as appearing in section 4 of chapter 42 of the acts of 2007, is hereby amended by striking out the words “uncompensated care pool under” and inserting in place thereof the following words:- Health Safety Net Trust Fund under section 39 of.

SECTION 19. Said eighth paragraph of said section 23 of said chapter 118E, as so appearing, is hereby further amended by inserting after the first sentence the following sentence:- Upon request from the department of revenue, the division shall make information received from holders of health insurance information available to the department to determine whether a person is covered by insurance as required by chapter 111M.

SECTION 20. Section 54 of said chapter 118E, as appearing in the 2006 Official Edition, is hereby amended by striking out the second and third sentences and inserting in place thereof the following 3 sentences:— The executive office may reduce MassHealth premiums or copayments, or offer other incentives to encourage enrollees to comply with wellness goals. The executive office shall publish a report annually on: (1) the number of enrollees who meet at least 1 wellness goal; (2) any reduction of copayments or premiums; and (3) any other incentives provided because enrollees met wellness goals. The report shall be submitted to the general court, by filing it with the joint committee on health care financing and the house and senate committees on ways and means.

SECTION 21. Section 5 of chapter 118G of the General Laws, as so appearing, is hereby amended by striking out, in line 32, the words “56 of chapter 118E” and inserting in place thereof the following figure:- 35.

SECTION 22. Section 6C of said chapter 118G, as so appearing, is hereby amended by striking out, in line 6, the words “more than 10” and inserting in place thereof the following words:— 11 or more full-time equivalent.

SECTION 23.
Said section 6C of said chapter 118G, as so appearing, is hereby further amended by striking out, in line 9, the words “more than 10” and inserting in place thereof the following words:— 11 or more full-time equivalent.

SECTION 24. Section 18B of said chapter 118G, as so appearing, is hereby amended by striking out, in line 9, the figure "90" and inserting in place thereof the following figure:- 180.

SECTION 25. Said section 18B of said chapter 118G, as so appearing, is hereby further amended by striking out, in lines 25 and 26, the words “from the uncompensated care pool, under chapter 118E” and inserting in place thereof the following words:- reimbursed by the health safety net office under section 39.

SECTION 26. Section 35 of said chapter 118G, inserted by section 15 of chapter 61 of the acts of 2007, is hereby amended by adding the following subsection:-

(c) The office shall enter into an interdepartmental service agreement with the office of Medicaid to develop and implement a plan to enhance oversight and improve the operations, management, payment processes and data integrity of the Health Safety Net Trust Fund, consistent with clauses (2) to (5), inclusive, of subsection (b).

The plan shall include: (i) an analysis of free care and emergency bad debt claims submitted in the most recent 3-year period to determine patterns most appropriate and promising for targeted audits and reviews; (ii) a cost-effective approach to maximizing the identification of all sources of third-party liability for patients receiving free care or emergency services; (iii) a cost-effective approach to establishing an ongoing claims and utilization review system for uncompensated care claims that effectively identifies and disallows inappropriate claims, but also takes into consideration the practicality of that approach considering the small volume of claims relative to other payers that make routine use of claims and utilization review systems; (iv) an approach that maximizes the use of existing eligibility determination and review systems, coordination of benefits, claims review and provider integrity systems, interdepartmental service agreements and related program and provider integrity contracts available to the office of Medicaid for achieving the management improvements required under this section; and (v) a proposed timeline for implementation.

The health safety net office shall annually submit a progress report on the plan to the general court by filing it with the clerks of the senate and house of representatives, the joint committee on health care financing and the house and senate committees on ways and means.

SECTION 27. Subsection (a) of section 188 of chapter 149 of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by striking out the definition of “Employer” and inserting in place thereof the following definition:-

“Employer”, an employing unit as defined in section 1 of chapter 151A or in section 1 of chapter 152.

SECTION 28. Subsection (d) of said section 188 of said chapter 149, as so appearing, is hereby amended by adding the following sentence:- The division of unemployment assistance shall promulgate regulations necessary to implement this section.

SECTION 29. The definition of “Employer” in section 1 of chapter 151F of the General Laws, as so appearing, is hereby amended by striking the last sentence and inserting in place thereof the following sentence:- The word “employer” shall not include a sole proprietor or tax exempt organization, as described in 26 U.S.C. 501, that is exclusively staffed by volunteers.

SECTION 30. Said chapter 151F is hereby further amended by striking out section 2, as so appearing, and inserting in place thereof the following section:-
Section 2. Each employer with 11 or more full-time equivalent employees in the commonwealth shall adopt and maintain a cafeteria plan that satisfies 26 U.S.C. 125 and the regulations promulgated by the connector. The employer shall provide a copy of the cafeteria plan if requested by the connector.

SECTION 31. Section 108 of chapter 175 of the General Laws, as so appearing, is hereby amended by striking out, in lines 33 and 34, the words “following loss of dependent status under the Internal Revenue Code” and inserting in place thereof the following words:- after the end of the calendar year in which such persons last qualified as dependents under 26 U.S.C. 106.

SECTION 32. Section 110 of said chapter 175, as so appearing, is hereby amended by striking out, in lines 379 and 380, the words “loss of dependent status under the Internal Revenue Code” and inserting in place thereof the following words:- end of the calendar year in which such persons last qualified as dependents under 26 U.S.C. 106.

SECTION 33. Chapter 176A of the General Laws is hereby amended by striking out section 8Z, inserted by section 53 of chapter 58 of the acts of 2006.

SECTION 34. Said chapter 176A is hereby further amended by inserting after section 8AA the following section:-

Section 8BB. Any subscription certificate under a group nonprofit hospital service agreement, except certificates which provide stand-alone dental services, supplemental coverage to Medicare or other governmental programs, that is delivered, issued or renewed in the commonwealth, shall provide, as benefits to all group members having a principal place of employment within the commonwealth, coverage to persons under 26 years of age or for 2 years after the end of the calendar year in which such persons last qualified as dependents under 26 U.S.C. 106, whichever occurs first.

SECTION 35.
Chapter 176B of the General Laws is hereby amended by striking out section 4Z, inserted by section 56 of chapter 58 of the acts of 2000.

SECTION 36.
Said chapter 176B is hereby further amended by inserting after section 4AA the following section:-
Section 4BB. Any subscription certificate under an individual or group medical service agreement, except certificates that provide stand-alone dental services, that is delivered or issued or renewed in the commonwealth, shall provide, as benefits to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth, coverage to persons under 26 years of age or for 2 years after the end of the calendar year in which such persons last qualified as dependents under 26 U.S.C. 106, whichever occurs first.

SECTION 37.
Chapter 176G of the General Laws is hereby amended by striking out section 4R, inserted by section 58 of chapter 58 of the acts of 2006.

SECTION 38.
Said chapter 176G is hereby further amended by inserting after section 4S the following section:-
Section 4T. A health maintenance contract, excluding contracts for stand-alone dental services, shall provide coverage to persons under 26 years of age or for 2 years after the end of the calendar year in which such persons last qualified as dependents under 26 U.S.C. 106, whichever occurs first.

SECTION 39.
The definition of “Group health plan” in section 1 of chapter 176J of the General Laws, as so appearing, is hereby amended by adding the following sentence:- For purposes of this definition, “partnership” shall include a limited liability company with more than 1 member, and a member of such a limited liability company shall be deemed to be a partner.

SECTION 40. Section 10 of said chapter 176J, as so appearing, is hereby amended by striking out, in line 5, the figure “19” and inserting in place thereof the following figure:- 18.

SECTION 41.
Chapter 176Q of the General Laws, as so appearing, is hereby amended by inserting after section 15 the following section:-

Section 15A. There shall be a special commission to investigate and study the role of the connector in providing access to health insurance products. The commission shall examine the connector’s utilization of private sector entities, including insurance brokers, and shall investigate ways to promote efficient enrollment of uninsured individuals into health insurance and prevent unnecessary duplications in the market. The commission shall consist of the house and senate chairs of the joint committee on financial services and the house and senate chairs of the joint committee on health care financing, 1 member of the house who shall be appointed by the minority leader and 1 member of the senate who shall be appointed by the minority leader. The commission shall report its findings and recommendations, including any recommendations for proposed legislation, at least annually, to the clerks of the senate and house of representatives.

SECTION 42. Chapter 58 of the acts of 2006 is hereby amended by striking out section 136 and inserting in place thereof the following section:-
Section 136. The website established pursuant to section 16L of chapter 6A of the General Laws shall be operational and shall include links to other websites that display comparative cost and quality information not later than September 1, 2007. The website shall include comparative cost information by facility, clinician or physician group practice for obstetrical services, physician office visits, high-volume elective surgical procedures, high-volume diagnostic tests and high-volume therapeutic procedures, not later than March 1, 2008; provided, however, that such cost information shall include the average payment made on behalf of insured patients for each service or category of service received by each facility, clinician or physician group practice.

SECTION 43. The commonwealth health insurance connector, established in chapter 176Q of the General Laws, shall publish a report on implementation of subsection (b) of section 3 of chapter 118H of the General Laws, including the number of eligible individuals enrolled in the commonwealth care health insurance program and the projected premium contribution amounts to be paid by employers. The report shall be submitted not later than January 1, 2008 to the general court, by filing the same with the clerks of the senate and house of representatives, the joint committee on health care financing and the house and senate committees on ways and means.

SECTION 44.
The first progress report on the plan for oversight and improvement of the Health Safety Net Trust Fund, required under subsection (c) of section 35 of chapter 118G of the General Laws, shall be submitted not later than April 30, 2008.

SECTION 45.
The first report required by section 15A of chapter 176Q shall be made not later than October 1, 2008.

SECTION 46.
Section 6 shall take effect for taxable years beginning on or after January 1, 2007.

SECTION 47.
Sections 3, 5, 7 and 14, and sections 31 to 38, inclusive, shall take effect on January 1, 2008.

Approved November 29, 2007.