HOUSE . . . . . . . No. 4643
The Commonwealth of Massachusetts
______________________________________
HOUSE OF REPRESENTATIVES, May 14, 2024.
The committee on Ways and Means, to whom was referred the Bill
enhancing the market review process (House, No. 4620), reports
recommending that the same ought to pass with an amendment
substituting therefor the accompanying bill (House, No. 4643).
For the committee,
AARON MICHLEWITZ.
 FILED ON: 5/14/2024
HOUSE . . . . . . . . . . . . . . . No. 4643
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act enhancing the market review process.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Section 16 of chapter 6A of the General Laws, as appearing in the 2022
2 Official Edition, is hereby amended by striking out, in lines 24 to 26, inclusive, the words “, the
3 division of medical assistance and the Betsy Lehman center for patient safety and medical error
4 reduction” and inserting in place thereof the following words:- and the division of medical
5 assistance.
6 SECTION 2. Section 16D of said chapter 6A, as so appearing, is hereby amended by
7 striking out, in lines 4 and 5, the words “commissioner of insurance” and inserting in place
8 thereof the following words:- commissioner of health insurance.
9 SECTION 3. Said section 16D of said chapter 6A, as so appearing, is hereby further
10 amended by striking out, in lines 22 to 24, inclusive, the words “department of public health
11 established by section 217 of chapter 111, and the managed care bureau in the division of
12 insurance” and inserting in place thereof the following words:- health policy commission
1 of 101
13 established by section 16 of chapter 6D, and the managed care bureau in the division of health
14 insurance.
15 SECTION 4. Section 16G of said chapter 6A, as amended by section 16 of chapter 7 of
16 the acts of 2023, is hereby further amended by striking out subsection (b) and inserting in place
17 thereof the following subsection:-
18 (b) The following divisions and agencies shall be within the department of consumer
19 affairs and business regulation: the division of banks, the division of insurance, the division of
20 health insurance, the division of standards, the division of occupational licensure and the
21 department of telecommunications and cable.
22 SECTION 5. Section 16N of said chapter 6A of the General Laws is hereby repealed.
23 SECTION 6. Section 16Q of said chapter 6A of the General Laws, as appearing in the
24 2022 Official Edition, is hereby amended by striking out, in line 13, the word “insurance” and
25 inserting in place thereof the following words:- health insurance.
26 SECTION 7. Section 16T of chapter 6A of the General Laws is hereby repealed.
27 SECTION 8. Section 16Z of said chapter 6A, as appearing in the 2022 Official Edition, is
28 hereby amended by striking out, in line 7, the word “insurance” and inserting in place thereof the
29 following words:- health insurance.
30 SECTION 9. Section 1 of chapter 6D of the General Laws, as so appearing, is hereby
31 amended by inserting after the definition of “Alternative payment methodologies or methods”
32 the following definition:-
2 of 101
33 “Benchmark cycle”, a fixed, predetermined period of 3 consecutive calendar years during
34 which the projected average annual percentage change in total health care expenditures in the
35 commonwealth is calculated pursuant to section 9 and monitored pursuant to section 10.
36 SECTION 10. Said section 1 of said chapter 6D, as so appearing, is hereby further
37 amended by striking out the definition of “Health care cost growth benchmark” and inserting in
38 place thereof the following definition:-
39 “Health care cost growth benchmark”, the projected average annual percentage change in
40 total health care expenditures in the commonwealth during a benchmark cycle, as established in
41 section 9.
42 SECTION 11. Said section 1 of said chapter 6D, as so appearing, is hereby further
43 amended by inserting after the definition of “Health care provider” the following 2 definitions:-
44 “Health care real estate investment trust”, a real estate investment trust, as defined by 26
45 U.S.C section 856, whose assets consist of real property held in connection with the use or
46 operations of a provider or provider organization.
47 “Health care resource”, any resource, whether personal or institutional in nature and
48 whether owned or operated by any person, the commonwealth or political subdivision thereof,
49 the principal purpose of which is to provide, or facilitate the provision of, services for the
50 prevention, detection, diagnosis or treatment of those physical and mental conditions
51 experienced by humans which usually are the result of, or result in, disease, injury, deformity or
52 pain; provided, that the term “treatment” shall include custodial and rehabilitative care incident
53 to infirmity, developmental disability or old age.
3 of 101
54 SECTION 12. Said section 1 of said chapter 6D, as so appearing, is hereby further
55 amended by inserting after the definition of “Health care services” the following 2 definitions:-
56 “Health disparities”, preventable differences in the opportunities to achieve optimal
57 health experienced by socially disadvantaged racial, ethnic and other population groups and
58 communities, including, but not limited to, preventable differences between groups in health
59 insurance coverage, affordability and access to quality health care services.
60 “Health equity”, the state in which a health system offers the infrastructure, facilities,
61 services, geographic coverage, affordability and all other relevant features, conditions and
62 capabilities that will provide all people with the opportunity and reasonable expectation that they
63 can reach their full health potential and well-being and are not disadvantaged in access to health
64 care by their race, ethnicity, language, disability, age, gender, gender identity, sexual orientation,
65 social class, intersections among these communities or identities, or their socially determined
66 circumstances.
67 SECTION 13. Said section 1 of said chapter 6D, as so appearing, is hereby further
68 amended by inserting after the definition of “Hospital service corporation” the following
69 definition:-
70 “Management services organization”, any organization that is contracted by a provider or
71 provider organization to perform management or administrative services relating to, supporting
72 or facilitating the provision of patient care.
73 SECTION 14. Said section 1 of said chapter 6D, as so appearing, is hereby further
74 amended by striking out, in lines 168 and 169, the word “insurance” and inserting in place
75 thereof the following words:- health insurance.
4 of 101
76 SECTION 15. Said section 1 of said chapter 6D, as so appearing, is hereby further
77 amended by striking out, in line 189, the word “excludes”.
78 SECTION 16. Said section 1 of said chapter 6D, as so appearing, is hereby further
79 amended by inserting after the definition of “Primary care provider” the following definition:-
80 “Private equity company”, any company that collects capital investments from
81 individuals or entities and purchases a direct or indirect ownership share of a provider or
82 provider organization.
83 SECTION 17. Said section 1 of said chapter 6D, as so appearing, is hereby further
84 amended by inserting after the definition of “Shared decision-making” the following definition:-
85 “Significant equity investor”, (i) any private equity company with a financial interest in a
86 provider or provider organization, or (ii) an investor, group of investors or other entity with a
87 direct or indirect possession of equity in the capital, stock or profits totaling more than 10 per
88 cent of a provider or provider organization.
89 SECTION 18. Said section 1 of said chapter 6D, as so appearing, is hereby further
90 amended by inserting after the definition of “Surcharge payor” the following definition:-
91 “Technical advisory committee”, the technical advisory committee of the health policy
92 commission established by section 4A.
93 SECTION 19. Section 2 of said chapter 6D, as so appearing, is hereby amended by
94 striking out subsections (b) and (c) and inserting in place thereof the following subsections:-
95 (b)(1) There shall be a board, with duties and powers established by this chapter, which
96 shall govern the commission. The board shall consist of 9 members: 1 of whom shall be the
5 of 101
 97 secretary of health and human services, or a designee; 1 of whom shall be the commissioner of
98 health insurance, or a designee; 5 of whom shall be appointed by the governor, 1 of whom shall
99 serve as chairperson, 1 of whom shall be selected from a list of 3 nominees submitted by the
100 president of the senate, and 1 of whom shall be selected from a list of 3 nominees submitted by
101 the speaker of the house or representatives; and 2 of whom shall be appointed by the attorney
102 general. All appointed members shall serve for a term of 5 years, but a person appointed to fill a
103 vacancy shall serve only for the unexpired term. An appointed member of the board shall be
104 eligible for reappointment; provided, however, no appointed member shall hold full or part-time
105 employment in the executive branch of state government. The board shall annually elect 1 of its
106 members to serve as vice-chairperson. Each member of the board shall be a resident of the
107 commonwealth.
108 (2) The person appointed by the governor to serve as chairperson shall have demonstrated
109 expertise in health care administration, finance and management at a senior level. The second
110 person appointed by the governor, shall have demonstrated expertise in representing hospitals or
111 hospital health systems. The third person appointed by the governor shall have demonstrated
112 expertise in health plan administration, benefits management or health insurance brokerage. The
113 fourth person appointed by the governor, from the list of nominees submitted by the president of
114 the senate, shall have demonstrated expertise in representing the health care workforce as a
115 leader in a labor organization. The fifth person appointed by the governor, from the list of
116 nominees submitted by the speaker of the house of representatives, shall have demonstrated
117 expertise in health care innovation, including pharmaceuticals, biotechnology or medical
118 devices. The first person appointed by the attorney general shall be a health economist. The
6 of 101
119 second person appointed by the attorney general shall have demonstrated expertise in health care
120 consumer advocacy or population health.
121 (c) Five members of the board shall constitute a quorum, and the affirmative vote of 5
122 members of the board shall be necessary and sufficient for any action taken by the board. No
123 vacancy in the membership of the board shall impair the right of a quorum to exercise all the
124 rights and duties of the commission. The appointed members of the board shall receive a stipend
125 in an amount not greater than 10 per cent of the salary of the secretary of administration and
126 finance under section 4 of chapter 7; provided, however, that the chairperson shall receive a
127 stipend in an amount not greater than 12 per cent of the salary of the secretary. The secretary of
128 health and human services and the commissioner of health insurance shall not receive a stipend
129 for their service as board members. Appointed members of the board shall be special state
130 employees subject to chapter 268A. An appointed member of the board shall disclose any
131 employment by, affiliation with, or financial interest in a health care entity, and the governor and
132 attorney general shall consider, in light of the requirements of said chapter 268A, any such
133 employment, affiliation or financial interest prior to appointing a member of the board.
134 SECTION 20. Said chapter 6D is hereby further amended by inserting after section 4 the
135 following section:-
136 Section 4A. (a) There is hereby established a technical advisory committee consisting of
137 appointed members with demonstrated experience in a broad range of provider sectors and
138 public and private health care payers. The technical advisory committee shall: (i) establish the
139 adjustment factor as part of the health care cost growth benchmark setting process pursuant to
140 subsection (c) of section 9; (ii) provide technical advice to the commission upon request; (iii)
7 of 101
141 provide the commission with operational, policy, regulatory or legislative recommendations for
142 the commission’s consideration; and (iv) produce an annual report and other reports pursuant to
143 subsection (c).
144 (b) The technical advisory committee shall consist of the following 16 members: the
145 executive director of the commission, who shall serve as non-voting chairperson; the assistant
146 secretary for MassHealth, or a designee; the executive director of the commonwealth health
147 insurance connector authority, or a designee; the executive director of the group insurance
148 commission, or a designee; and 12 members appointed by the executive director of the
149 commission for their technical experience in specific health care sectors, 1 of whom shall be
150 selected from a list of 3 nominees submitted by the Massachusetts Hospital Association, Inc., 1
151 of whom shall be selected from a list of 3 nominees submitted by the Massachusetts Senior Care
152 Association, Inc., 1 of whom shall be selected from a list of 3 nominees submitted by the
153 Massachusetts Medical Society, 1 of whom shall be selected from a list of 3 nominees submitted
154 by the Massachusetts League of Community Health Centers, Inc., 1 of whom shall be selected
155 from a list of 3 nominees submitted by the Massachusetts Biotechnology Council, Inc., 1 of
156 whom shall be selected from a list of 3 nominees submitted by the Massachusetts Association of
157 Health Plans, Inc., 1 of whom shall be selected from a list of 3 nominees submitted by Blue
158 Cross Blue Shield of Massachusetts, Inc., and 5 of whom shall be selected by the executive
159 director from applications submitted by candidates with demonstrated experience in health care
160 delivery, health care economics, health care data analysis, clinical research and innovation in
161 health care delivery, or health care benefits management. In selecting members, the executive
162 director shall ensure that the composition of the committee reflects a diversity of expertise in
163 health care providers, purchasers, and consumer advocacy groups. Each member of the
8 of 101
164 committee shall serve without compensation for a term of 3 years, or until a successor is
165 appointed; provided, that no member shall serve more than 2 consecutive terms. Members of the
166 committee shall be special state employees subject to chapter 268A. The technical advisory
167 committee shall meet at least quarterly or at other times as specified by the commission and shall
168 annually elect 1 of its members to serve as vice-chairperson.
169 (c) The technical advisory committee shall report a summary of its activities to the
170 commission at least annually, and shall submit additional reports with technical
171 recommendations, as requested by the commission. In developing any reports or
172 recommendations to the commission, the technical advisory committee shall consider the
173 availability, timeliness, quality and usefulness of existing data, including the data collected by
174 the center under chapter 12C, and assess the need for additional investments in data collection,
175 data validation or data analysis capacity to support the committee in performing its duties.
176 SECTION 21. Section 5 of said chapter 6D, as so appearing, is hereby amended by
177 striking out, in line 10, the words “and (vii)” and inserting in place thereof the following words:-
178 ; (vii) monitor the location and distribution of health care services and health care resources; and
179 (viii).
180 SECTION 22. Section 6 of said chapter 6D, as so appearing, is hereby amended by
181 striking out the first and second paragraphs and inserting in place thereof the following
182 paragraphs:-
183 Each acute hospital, ambulatory surgical center, non-hospital provider organization and
184 surcharge payor shall pay to the commonwealth an amount for the estimated expenses of the
185 commission. For the purposes of this section, “non-hospital provider organization” shall mean a
9 of 101
186 provider organization required to register under section 11 that is: (i) a non-hospital-based
187 physician practice with not less than $500,000,000 in annual gross patient service revenue; (ii) a
188 clinical laboratory; (iii)