Overview
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).
State Action
Latest Legislative Session: 1/4/2023 - 1/2/2024 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
H 1133 (see companion bill S 706) – Massachusetts
Introduced: 2019 Status: Inactive / Dead
Relative to the pricing of prescription drugs. Health Care Financing. To ensure prescription drug cost transparency and affordability
H 1136 – Massachusetts
Introduced: 2021 Status: Inactive / Dead
Relative to health plan coverage for medically necessary mental health crisis stabilization services. Financial Services.
H 1140 – Massachusetts
Introduced: 2023 Status: In Process
An Act assuring prompt access to health care. Relative to reimbursements of costs for medically appropriate evaluations and management services in outpatient settings.
H 1143 – Massachusetts
Introduced: 2023 Status: In Process
An Act to improve the health insurance prior authorization process
H 1144 – Massachusetts
Introduced: 2019 Status: Inactive / Dead
Relative to hospital profit transparency and fairness and the establishment of a Medicaid reimbursement enhancement fund. Health Care Financing.
105 Mass. Code Regs. 130.109. Transfer of Ownership or Location: Hospital Licensure – Massachusetts
Introduced: Status: Enacted
Provides requirements governing change of ownership or location of hospitals.
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Mass. Gen. Laws ch. 109, § 16A. Consolidation or merger: Limited Partnerships – Massachusetts
Introduced: Status: Enacted
Statute governs consolidations and mergers of limited partnerships.
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Mass. Gen. Laws ch. 111, § 1. Definitions: Public Health – Massachusetts
Introduced: Status: Enacted
Defines terms used in the Public Health Chapter.
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Mass. Gen. Laws ch. 111, § 228. Advance disclosure of allowed amount or charge for admission, procedure or service: Public Health – Massachusetts
Introduced: Status: Enacted
Requires providers and plans to provide information about costs of proposed services.
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Mass. Gen. Laws ch. 111, § 70E. Patients’ and residents’ rights: Public Health – Massachusetts
Introduced: Status: Enacted
Every patient or resident so said facility in which billing for service is applicable to such patient or resident, upon reasonable request, shall receive from a person designated by the facility an itemized bill reflecting …
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Southcoast Hospitals v. Steward St. Anne’s – Massachusetts
District Court: Superior Court of Massachusetts, Suffolk County Status: Decided
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 …
Mass v. Partners Healthcare System Inc. et al. – Massachusetts
District Court: Superior Court of Massachusetts, Suffolk County Status: Decided
In June 2014, former Massachusetts AG Martha Coakley reached a controversial consent decree in with Partners Healthcare that would allow the provider to acquire three …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
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.
KEY RESOURCES
- Massachusetts State Legislature
- Massachusetts Office of the Attorney General
- Massachusetts Health Policy Commission
- Massachusetts ACPD
- Massachusetts Office of Consumer Affairs and Business Regulation