Massachusetts remains a leader on the healthcare cost containment, price transparency, and market regulation fronts. Massachusetts’ Health Policy Commission (HPC), a unique and independent state agency, monitors healthcare spending growth in the state. Based upon the data it collects, the Commission recommends delivery and payment reform policies with the goal of improving healthcare and lowering costs.
The state is a staunch supporter of price transparency. The Massachusetts Center for Health Information and Analysis (CHIA) operates an active, comprehensive all-payer claims database with claims from public and private insurance payers in the state. Statute requires CHIA to maintain and annually update the online database that compares the quality and costs of several healthcare services, provides standardized quality measures, lists services available for persons with disabilities, and more. The state also requires health insurance carriers to notify consumers of any additional charges for out-of-network providers with a summary and description of the services provided. Finally, the state prohibits gag clauses that would limit the ability of health insurance carriers or providers from disclosing out-of-pocket costs to an insured.
Additionally, state law requires coverage parity for telemedicine when given by an in-network provider who would be covered for in-person services. The law further requires a form of cost-sharing parity by prohibiting the costs that patients pay for telemedicine services from exceeding those applicable to in-person consultations.
Massachusetts has the most robust antitrust laws that protect consumers from anticompetitive practices in health care. Statutes prohibit health insurance carriers from using provision including most-favored nation, guaranteed participation, non-compete, all-or-nothing, anti-tiering/anti-steering, exclusive contracting, and gag clauses in contracts with healthcare providers. In merger review, the state requires notice prior to any merger or acquisition of hospitals or physician groups. Major antitrust cases in recent years demonstrate that the state practices strong antitrust enforcement, including the merger of Beth Israel Deaconess Medical Center-Lahey Health and multiple consolidation efforts involving Partners Healthcare.
Massachusetts operates a state-based health insurance exchange under the Affordable Care Act named Health Connector. The state unsuccessfully applied for a federal 1332 innovation waiver in 2017, which the Centers for Medicare and Medicaid Services deemed incomplete. Various pieces of legislation introduced in recent years have also called for a public option health insurance plan or a single payer system, but neither of these proposals have passed yet.
See below for an overview of existing Massachusetts state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
2020 Legislative Session: 1/1/2020 - 1/5/2021 (2019-2020 term). *Current session bill updates are ongoing. Check back weekly for updates.
Massachusetts operates on an annual budget cycle. The fiscal year runs from July 1 through June 30. The Governor is expected to sign the new budget at the end of June.
REGULATION & ENFORCEMENT
- State AG Conditional Approval of Beth Israel-Lahey Health Merger: In November 2018, Massachusetts Attorney General Maura Healey gave her approval to the merger of Beth Israel and Lahey Health to create the second-largest healthcare system in the state. Healey imposed conditions on the merger through an assurance of discontinuance. The restrictions include over $70 million in community investments for low-income populations, as well as a seven-year price cap to ensure the merged entity’s price increases remain below the state’s annual healthcare cost growth benchmark of 3.1%. See The Source Blog for details.
- Rejected Consent Decree on Partners Healthcare Acquisition: In June 2014, former Massachusetts AG Martha Coakley reached a controversial consent decree with Partners Healthcare after five years of investigation and negotiation that would allow the provider to acquire three Boston hospitals. The proposed agreement received substantial criticism from antitrust experts and others who warned it would have anti-competitive effects. On Jan. 30, 2015, Suffolk Superior Court Judge Sanders declined to enter the consent judgment, after newly elected Attorney General Maura Healey filed a Notice of her office’s opposition of the deal. In declining to enter the judgment, Judge Sanders expressed concerns about the provider’s market power. In February 2015, Partners Healthcare abandoned its attempt to take over one of the Boston hospitals, South Shore Hospital. In December 2015, Partners also gave up on its bid to acquire a second Boston hospital, Hallmark Health System. See post on The Source Blog.
- Southcoast Hospitals Group sued a rival hospital chain Steward St. Anne’s and the state health agency in October 2015 in Suffolk County superior court, seeking to stop the competitor from opening a cardiac service and alleging that the move was made possible by the improper influence of a former health official. The case centers on a 2014 Mass. Dept. of Health Circular providing an exception for ACOs, allowing them to transfer licenses to provide cardiac care which were otherwise subject to a moratorium. Read the Boston Globe article and the complaint. The lawsuit was dismissed in March 2016.
- Massachusetts State Legislature
- Massachusetts Office of the Attorney General
- Massachusetts Health Policy Commission
- Massachusetts ACPD
- Massachusetts Office of Consumer Affairs and Business Regulation