The 2023-2024 legislative session officially closed on December 31, 2024. Before the clock struck midnight, my colleagues and I worked to pass important health care-focused bills and send them to Governor Maura Healey for her consideration.
On Monday, December 30, the House and Senate passed two critical health care bills, An Act relative to pharmaceutical access, costs and transparency and An Act enhancing the market review process. The bills have been sent to Governor Maura Healey for her consideration.
Earlier in December, Governor Healey signed An Act relative to treatments and coverage for substance use disorder and recovery coach licensure. This law expands non-opioid pain treatment and training, establishes a licensure process for recovery coaches, and more. A bill I filed, An Act to support families, was included in the omnibus and is now law.
The Massachusetts Senate also passed An Act relative to student mental health in late December, which I filed with Representatives Jack Lewis and Natalie Higgins. Though the bill did not make it to the Governor’s desk before the end of the 2023-2024 legislative session, I am proud of the progress it made and look forward to working with my colleagues to pass this early in the new session.
Read on for more information on each of the bills.
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An Act relative to pharmaceutical access, costs and transparency
An Act relative to pharmaceutical access, costs and transparency requires health insurers to cover life-saving medications for diabetes, asthma, and certain heart conditions with no or limited out-of-pocket costs for patients. The measure is particularly critical for residents of color, who disproportionately face chronic illnesses.
The bill takes bold action to lower out-of-pocket costs and ensure access to life saving medications by offering immediate price relief for prescription drugs used to treat diabetes, asthma, and certain heart conditions. For each condition, the bill requires insurers to eliminate cost-sharing requirements for one generic drug and to cap co-payments on one brand-name drug at $25 per 30-day supply.
It further brings down consumer costs by ensuring that consumers are not charged a cost-sharing amount, such as a co-pay, if it would be cheaper for them to purchase the drug without using their insurance.
Approximately nine per cent of Massachusetts residents have diagnosed diabetes and 6.2 per cent of adults over 35 live with heart disease. In 2015, more than 10 per cent of residents lived with asthma. Black residents face each at a higher rate—over 12 per cent live with diabetes and nearly 14 per cent of Black adults live with asthma.
The bill drastically increases state oversight of pharmacy benefit managers (PBMs), which currently negotiate prescription drug prices with little oversight, making it unclear if they consistently act in the best interest of consumers. To do so, the legislation authorizes the Division of Insurance (DOI) to license and regulate PBMs. PBMs are also prohibited from making payments to pharmacy benefit consultants or brokers who work on behalf of health plan sponsors during a contracting or bidding process.
To create a more complete data-driven picture of drug costs in Massachusetts, the Center for Health Information and Analysis (CHIA) will collect a range of drug cost information from pharmaceutical manufacturers andPBMs. With the data, CHIA can offer a more complete examination of the drivers of health care costs in its annual health care cost report, allowing policymakers and consumers to better understand the role of pharmaceutical manufacturers and PBMs in the health care system.
In addition to CHIA’s cost analysis, pharmaceutical manufacturers and PBMs will be included in the Health Policy Commission (HPC)’s Annual Health Care Cost Trends Hearing for the first time. Participation in the hearings will require manufacturers and PBMs to provide public testimony on the factors that influence drug costs, allowing those factors to be taken into account as the commission identifies how to improve care and reduce costs for residents.
Further, the legislation establishes the Office for Pharmaceutical Policy and Analysis within HPC, which will be tasked with analyzing trends related to pharmaceutical access, affordability, and spending in Massachusetts. The office will publish an annual report with recommendations for strategies to mitigate pharmaceutical spending growth, promote affordability and enhance pharmaceutical access.
An Act enhancing the market review process
An Act enhancing the market review process closes loopholes in the health care market regulatory process exposed by the collapse of Steward Health Care, increases financial transparency by gathering more information regarding hospital finances, and assists in maintaining a more stable and sustainable health care system.
Strengthening Oversight
The bill contains important updates to the Commonwealth’s laws governing the oversight of hospital systems and provider organizations so the gaps exploited by Steward Health Care cannot be exploited again. Oversight measures include:
- Bolstering the reporting authority of the Center for Health Analysis and Information (CHIA) and scope of the oversight of the Health Policy Commission (HPC) by adding reporting requirements for hospitals and registered provider organizations (RPOs), including significant equity investors. Audited financial statement reporting is mandated for out-of-state operators of a hospital or RPO parent company, private equity investors, and management services organizations (MSOs).
- Enhancing penalties for not complying with CHIA data reporting requirements, including increasing and removing the cap on financial penalties.
- Requiring CHIA to notify HPC and the Department of Public Health (DPH) of failure to report, which will be considered during a review by the HPC in the Cost and Market Impact Review (CMIR) process and by DPH when considering a Determination of Need (DON) application or when reviewing licensure and suitability.
- Expanding DPH authority over the Board of Registration in Medicine to improve oversight and align Board activities with broader state market oversight goals.
- Requiring DPH to hold a public hearing prior to hospital and essential service closures, and authorizing DPH to seek an impact analysis of a hospital closure of any essential health service from HPC.
The bill expands the Attorney General’s authority to monitor health care trends and enforce the False Claims Act by allowing the office to seek information from significant equity investors, real estate investment trusts (REITs), and MSOs, and to hold entities with an ownership or controlling interest in a provider organization liable if they are aware of false claims submitted to the government.
The bill makes significant reforms to prevent acute care hospitals from selling land to REITs. When Steward Health Care sold hospital properties to Medical Properties Trust (MPT) in 2016 for $1.25 billion, the hospital network agreed to lease back their former properties from MPT for exorbitant rents, siphoning away necessary resources and depriving the hospital operations and patients of needed investments. The legislation prohibits the future leasing of an acute hospital’s main campus from REITs. It requires increased disclosure of other lease arrangements as part of the licensure process with DPH.
In October 2023, a new mother tragically died at a Steward hospital after medical equipment that could have saved her life was repossessed because Steward couldn’t pay its bills. To prevent a similar tragedy, the legislation requires creditors, vendors, and hospitals to notify the state 60 days before any possible repossession of medical or surgical equipment, and makes any incident like this a reportable event to the state, similar to reporting of medical and drug errors. To improve patient safety, the bill also expands the Betsy Lehman Center’s medical error and patient safety data collection and reporting authority and modernizes the state’s Standard Quality Measure Set to improve provider reporting on patient care.
Increasing Financial Transparency & Addressing the Rising Cost of Health Care
To address the rising cost of health care in Massachusetts, the bill reforms the HPC and expands the HPC cost trends examination while also raising expectations on providers to meet the Commonwealth’s cost containment goals. Provisions to combat the rising costs of health care include:
- Reconstituting the membership requirements for the HPC to include more current, relevant experience and insight into the trajectory of the healthcare market.
- Broadening the scope of HPC’s annual cost trends hearings and report to capture significant equity investors, health care REITs, MSOs, pharmaceutical manufacturing companies and pharmacy benefit managers (PBMs), MassHealth, the Division of Insurance (DOI), the Health Connector, and to request testimony from the Centers for Medicare and Medicaid Services.
- Expanding the HPC cost trends examination to include the new data collected by CHIA through the RPO process, and require submissions from significant equity investors, health care REITs, and MSOs.
- Requiring that expansions in capacity, transactions involving equity investor ownership, significant asset and real estate transfers, and for-profit conversions be added to the material change notice process.
- Requiring the submission of information including capital structure, general financial condition, ownership and management structure, and audited financial statements in transactions that involve a significant equity investor.
- Authorizing the HPC to examine the size and market share of any corporate affiliates or significant equity investors of the provider or provider organization, the inventory of health care resources maintained by the DPH, and any related data or reports from the office of health resource planning as part of a CMIR.
- Requiring that any final CMIR report issued by HPC must be referred to DPH for consideration during any pending determinations of need involving the provider or provider organization.
This bill broadens CHIA’s duty to monitor acute hospitals’ financial conditions by requiring them to file margins, investments, and information on any relationships with significant equity investors, health care REITs, and MSOs. It also codifies DPH regulation to pause the DON timeline for an independent cost analysis (ICA), CMIR, and performance improvement plan and authorizes DPH to choose the entity conducting the ICA from a list of three entities submitted by the applicant.
Stability and Sustainability
The bill moves state health resource planning to the HPC by establishing a new Office of Health Resource Planning to produce a state health plan as a forecast of anticipated demand, production, supply and distribution of health care resources on a state-wide and regional basis. The office will also conduct focused assessments of supply, distribution and capacity in relation to projected need of health care services.
The bill directs DOI to consider affordability when reviewing rates, while adhering to principles of actuarial soundness and solvency. It also creates a Primary Care Task Force to make recommendations to improve primary care access, delivery, and financial stability. The task force comprises 25 members and is chaired by the HPC and Executive Office of Health and Human Services (EOHHS). The task force’s recommendations will include defining primary care services, creating standardized data reporting, establishing a primary care spending target for public and private health care payers, assessing impacts of health plan design on health equity, and devising ways to increase the primary care workforce and improve employment conditions. The state will publish relevant data on a primary care dashboard maintained by CHIA and Massachusetts Health Quality Partners.
An Act relative to student mental health
An Act relative to student mental health requires all public schools, including charter schools, that serve students in grades 6 to 12, as well as public and private higher education institutions, to print the telephone and text numbers for the 988 Suicide and Crisis Lifeline on student identification cards.
In 2022, suicide was the third leading cause of death among individuals between the ages of 10-14 and the second leading cause of death among individuals between the ages of 15-24 and 25-34 in Massachusetts (Centers for Disease Control and Prevention). The state’s most recent Youth Risk Behavior Survey found that, in 2021, an alarming 18.4 percent of students seriously considered suicide, with 14 percent making a plan and 7.6 percent attempting suicide. Further, only 11.3 percent of students asked for help from a doctor, counselor, or hotline before their suicide attempt. That’s significantly lower than the 24.3 percent of students who asked for help in 2019 (Massachusetts Department of Elementary and Secondary Education).
Many challenges are involved in navigating middle school, high school, and college years. Anxiety, depression, and other mental health conditions can be triggered by significant life changes, which can then lead to suicidal thoughts or behavior. The risk is exceptionally high for LGBTIQA+ youth, who are more than four times as likely to experience suicidal ideation and attempt suicide than their heterosexual peers (Massachusetts Department of Elementary and Secondary Education).
While many districts and campuses offer school-based mental health services, they are often overbooked or cannot provide support outside of standard hours. Other students report being unaware of school-based support resources, perceive services as difficult to access, or feel stigmatized if school employees are aware of their struggles.
The 988 Suicide and Crisis Lifeline provides free and confidential emotional support to people in suicidal crisis or emotional distress and is one resource that young people can and should be able to count on and access in times of need. Printing the 988 phone number on the back of student identification cards, along with campus safety and other essential numbers which most often already exist on student ID cards, ensures that every student is aware of this critical resource, available to them at any time. Researchers from Columbia University found that suicide hotlines were an important and effective piece of the overall mental health care system.
This bill has received the support of the Massachusetts Superintendents Association. Similar legislation has passed in a growing number of states, including Arkansas, Delaware, Kentucky, Louisiana, Maryland, Michigan, Nebraska, New Hampshire, New York, Oklahoma, Texas, Tennessee, Washington, South Carolina, Illinois, Arizona, New Jersey, California, and Wisconsin.
