Mass. Gen. Laws ch. 29, sec. 2TTTTT — MA Code / Part I / Title III / Chapter 29 / Section 2TTTTT
Hospital Investment and Performance Trust Fund
Status: reserved

[ Text of section added by 2022, 126, Sec. 22. See, also, Section 2TTTTT added by 2022, 177, Sec. 24, below.] Section 2TTTTT. (a) There shall be a Hospital Investment and Performance Trust Fund. The secretary of health and human services shall be the trustee of the fund and shall expend all money in the fund to make payments to acute hospitals or to care organizations under contract with the executive office of health and human services to provide MassHealth services pursuant to an approved state plan or federal waiver; provided, however, that such care organizations shall use all such payments to make payments to qualifying acute hospitals. There shall be credited to the fund: (i) any transfers from the Health Safety Net Trust Fund established in section 66 of chapter 118E; (ii) an amount equal to any federal financial participation revenues claimed and received by the commonwealth for eligible expenditures made from the fund; (iii) any revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; and (iv) interest earned on any money in the fund. Amounts credited to the fund shall be expended without further appropriation. (b) Money in the fund shall be expended for Medicaid payments under an approved state plan or federal waiver; provided, however, that all payments from the fund shall be: (i) subject to the availability of federal financial participation; (ii) made only under federally-approved payment methods; (iii) consistent with federal funding requirements and all applicable federal payment limits as determined by the secretary; and (iv) subject to the terms and conditions of applicable agreements between acute hospitals or care organizations and the executive office of health and human services. To accommodate timing discrepancies between the receipt of revenue and related expenditures, the comptroller may certify for payment amounts not to exceed the most recent revenue estimates as certified by the secretary to be transferred, credited or deposited under this section. The secretary shall, to the maximum extent possible, administer the fund to obtain federal financial participation for the expenditures of non-federal money from the fund. Money remaining in the fund at the end of a fiscal year shall not revert to the General Fund and shall be available for expenditure in subsequent fiscal years. The payments from the fund shall supplement and not supplant Medicaid payments that would be made to providers in the absence of such payments. [ Subsection (c) effective until the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025. For text effective upon the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025, see below.] (c)(1) The secretary shall expend money in the fund, including all amounts credited to the fund, for payments to qualifying acute hospital providers under contract with the executive office of health and human services or under subcontracts with care organizations that contract with the executive office in connection with the MassHealth program as provided in this subsection. (2) The secretary shall annually expend amounts from the fund averaging, for the 3-year period from October 1, 2024 to September 30, 2027, inclusive, not less than $2,158,500,000 per year; provided, however, that all such payments shall fall into 1 of the following categories: (i) health equity incentive payments; (ii) clinical quality incentive payments; (iii) other incentive payments; (iv) rate payments for services provided to MassHealth members; (v) targeted payments to: (A) freestanding pediatric acute hospitals; (B) nonprofit teaching acute hospitals that provide medical, surgical, emergency and obstetrical services and are affiliated with a state-owned medical school; (C) freestanding cancer hospitals; (D) the acute hospital that had the lowest statewide commercial relative price in fiscal year 2019 as reported by the center for health information and analysis; or (E) the independent group 1 safety net hospital that had the largest percentile of operating loss in fiscal year 2022 as reported by the center for health information and analysis. The secretary may determine funding allocations within each such category within a given year; provided, however, that such allocations shall be consistent with all approved federal waivers and state plan provisions; and provided further, that the secretary shall allocate an average of not less than $1,192,000,000 per year, for the 3-year period from October 1, 2024 to September 30, 2027, for the rate payments described in clause (iv), with an average of not less than $92,000,000 allocated for group 1 safety net hospitals for such 3-year period, an average of not less than $460,000,000 allocated for group 2 safety net hospitals for such 3-year period and an average of not less than $640,000,000 allocated across all acute hospitals for such 3-year period. (3) Of the targeted payments described in clause (v) of the first sentence of paragraph (2), the secretary shall expend annually from the fund: (i) $70,000,000 to freestanding pediatric acute hospitals, of which at least 98 per cent shall be paid to the freestanding pediatric hospital that had the largest volume of inpatient discharges in fiscal year 2019; (ii) $35,000,000 to nonprofit teaching acute hospitals that provide medical, surgical, emergency and obstetrical services and are affiliated with a state-owned medical school; (iii) $11,000,000 to the acute hospital that had the lowest statewide commercial relative price in fiscal year 2019 as reported by the center for health information and analysis; (iv) $5,000,000 to freestanding cancer hospitals; and (v) $10,000,000 to the independent group 1 safety net hospital that had the largest operating percentile loss in fiscal year 2022 as reported by the center for health information and analysis. (4) Of the incentive payments described in clauses (i) and (ii) of paragraph (2), the secretary shall make interim payments to qualifying hospitals based on the secretary's estimate of each such hospital's final payment for the measurement period. As soon as practicable after the close of the measurement period, the secretary shall determine the final amount of each qualifying hospital's incentive payments and shall reconcile each hospital's interim payment with its final payment. [ Subsection (c) as amended by 2025, 73, Sec. 16 effective upon the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025. See 2025, 14, Sec. 198. For text effective until the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025, see above. For text effective October 1, 2027, see below.] (c)(1) The secretary shall expend money in the fund, including all amounts credited to the fund, for payments to qualifying acute hospital providers under contract with the executive office of health and human services or under subcontracts with care organizations that contract with the executive office in connection with the MassHealth program as provided in this subsection. (2) The secretary shall annually expend amounts from the fund averaging, for the 2-year period from October 1, 2025 to September 30, 2027, inclusive, not less than $2,264,500,000 per year; provided, however, that all such payments shall fall into 1 of the following categories: (i) health equity incentive payments; (ii) clinical quality incentive payments; (iii) other incentive payments; (iv) rate payments for services provided to MassHealth members; or (v) targeted payments to: (A) freestanding pediatric acute hospitals; (B) nonprofit teaching acute hospitals that provide medical, surgical, emergency and obstetrical services and are affiliated with a state-owned medical school; (C) freestanding cancer hospitals; (D) the acute hospital that had the lowest statewide commercial relative price in fiscal year 2019 as reported by the center for health information and analysis; (E) the independent group 1 safety net hospital that had the largest percentile of operating loss in fiscal year 2022 as reported by the center for health information and analysis; (F) the acute hospital that had the highest statewide public payer mix in fiscal year 2023 as determined by the secretary; (G) the acute hospital affiliated with a health system with 2 or more critical access hospitals operating in the commonwealth in calendar year 2025, as determined by the secretary; or (H) to any non-state-owned public hospital in the commonwealth, as determined by the secretary. The secretary may determine funding allocations among and within each such category within a given year; provided, however, that such allocations shall be consistent with all approved federal waivers and state plan provisions; and provided further, that the secretary shall allocate an average of not less than $1,280,000,000 per year, for the 2-year period from October 1, 2025 to September 30, 2027, inclusive, for the rate payments described in clause (iv), with an average of not less than $92,000,000 allocated for group 1 safety net hospitals for such 2-year period, an average of not less than $460,000,000 allocated for group 2 safety net hospitals for such 2-year period and an average of not less than $728,000,000 allocated across all acute hospitals for such 2-year period. (3) Of the targeted payments described in clause (v) of paragraph (2), the secretary shall expend annually from the fund: (i) $70,000,000 to freestanding pediatric acute hospitals, of which at least 98 per cent shall be paid to the freestanding pediatric hospital that had the largest volume of inpatient discharges in fiscal year 2019; (ii) $35,000,000 to nonprofit teaching acute hospitals that provide medical, surgical, emergency and obstetrical services and are affiliated with a state-owned medical school; (iii) $14,000,000 to the acute hospital that had the lowest statewide commercial relative price in fiscal year 2019 as reported by the center for health information and analysis; (iv) $6,000,000 to freestanding cancer hospitals; (v) $10,000,000 to the independent group 1 safety net hospital that had the largest operating percentile loss in fiscal year 2022 as reported by the center for health information and analysis; (vi) $6,000,000 to the acute hospital that had the highest statewide public payer mix in fiscal year 2023, as determined by the secretary; (vii) $6,000,000 to the acute hospital affiliated with a health system with 2 or more critical access hospitals operating in the commonwealth in calendar year 2025, as determined by the secretary; and (viii) $2,000,000 to any non-state-owned public hospital in the commonwealth, as determined by the secretary. (4) Of the incentive payments described in clauses (i) and (ii) of paragraph (2), the secretary shall make interim payments to qualifying hospitals based on the secretary's estimate of each such hospital's final payment for the measurement period. As soon as practicable after the close of the measurement period, the secretary shall determine the final amount of each qualifying hospital's incentive payments and shall reconcile each hospital's interim payment with its final payment. (5) If, in any fiscal year, the commonwealth fails to secure federal financial participation necessary to make expenditures described in this section, or if the total hospital assessment amount described in section 67 of chapter 118E is insufficient to support the distributions to the fund required to be made from the Health Safety Net Trust Fund established in section 66 of said chapter 118E, or if such distributions are otherwise not made due to limitations on federal matching, applicable payment ceilings or other restrictions under state or federal law, then the expenditures otherwise required to be made from the fund shall be reduced proportionally based on the total amount available for expenditure. [ Subsection (c) as amended by 2022, 126, Sec. 23 effective October 1, 2027 applicable as provided by 2022, 126, Sec. 186 and 2024, 140, Sec. 239. For text effective until October 1, 2027, see above.] (c) [reserved]. (d) If any portion of the final annual amount allocated by the secretary to health equity incentive payments, clinical quality incentive payments or other incentive payments is unearned during the relevant measurement period for such payment, as determined by the secretary, the secretary shall transfer the state's share of that unearned amount to the Health Safety Net Trust Fund established in section 66 of chapter 118E. (e) If the amount in the fund exceeds, for a reason other than that described in subsection (d), the amount sufficient to make the payments described in subsection (c), at any point in time, as determined by the secretary, the secretary may transfer the state's share of such amount to the Health Safety Net Trust Fund established in said section 66 of said chapter 118E. Chapter 29: Section 2TTTTT. Interagency services reserve fund [ Text of section added by 2022, 177, Sec. 24. See, also, Section 2TTTTT added by 2022, 126, Sec. 22, above.] Section 2TTTTT. (a) There shall be an interagency services reserve fund established on the books of the commonwealth to be expended without prior appropriation. The fund shall be credited with money from public and private sources, including gifts, grants and donations, interest earned on such money, any other money authorized by the general court and specifically designated to be credited to the fund and any funds provided from other sources. Money in the fund shall be used to fund the operations of the interagency review team established under section 16R of chapter 6A. The secretary of health and human services shall administer the fund and shall make expenditures for the purpose of covering the cost of providing additional evaluation as needed by the interagency review team for an individual eligible under said section 16R of said chapter 6A. Any unexpended balance in the fund at the end of a fiscal year shall not revert to the General Fund and shall be available for expenditure in the subsequent fiscal year. (b) Annually, not later than August 1, the interagency review team shall submit required financial reporting on the fund, including reporting of expenditures from the fund, to the secretary of health and human services, the secretary of education and the house and senate committees on ways and means.

[ Text of section added by 2022, 126, Sec. 22. See, also, Section 2TTTTT added by 2022, 177, Sec. 24, below.]

Section 2TTTTT. (a) There shall be a Hospital Investment and Performance Trust Fund. The secretary of health and human services shall be the trustee of the fund and shall expend all money in the fund to make payments to acute hospitals or to care organizations under contract with the executive office of health and human services to provide MassHealth services pursuant to an approved state plan or federal waiver; provided, however, that such care organizations shall use all such payments to make payments to qualifying acute hospitals. There shall be credited to the fund: (i) any transfers from the Health Safety Net Trust Fund established in section 66 of chapter 118E; (ii) an amount equal to any federal financial participation revenues claimed and received by the commonwealth for eligible expenditures made from the fund; (iii) any revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; and (iv) interest earned on any money in the fund. Amounts credited to the fund shall be expended without further appropriation.

(b) Money in the fund shall be expended for Medicaid payments under an approved state plan or federal waiver; provided, however, that all payments from the fund shall be: (i) subject to the availability of federal financial participation; (ii) made only under federally-approved payment methods; (iii) consistent with federal funding requirements and all applicable federal payment limits as determined by the secretary; and (iv) subject to the terms and conditions of applicable agreements between acute hospitals or care organizations and the executive office of health and human services. To accommodate timing discrepancies between the receipt of revenue and related expenditures, the comptroller may certify for payment amounts not to exceed the most recent revenue estimates as certified by the secretary to be transferred, credited or deposited under this section. The secretary shall, to the maximum extent possible, administer the fund to obtain federal financial participation for the expenditures of non-federal money from the fund. Money remaining in the fund at the end of a fiscal year shall not revert to the General Fund and shall be available for expenditure in subsequent fiscal years. The payments from the fund shall supplement and not supplant Medicaid payments that would be made to providers in the absence of such payments.

[ Subsection (c) effective until the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025. For text effective upon the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025, see below.]

(c)(1) The secretary shall expend money in the fund, including all amounts credited to the fund, for payments to qualifying acute hospital providers under contract with the executive office of health and human services or under subcontracts with care organizations that contract with the executive office in connection with the MassHealth program as provided in this subsection.

(2) The secretary shall annually expend amounts from the fund averaging, for the 3-year period from October 1, 2024 to September 30, 2027, inclusive, not less than $2,158,500,000 per year; provided, however, that all such payments shall fall into 1 of the following categories: (i) health equity incentive payments; (ii) clinical quality incentive payments; (iii) other incentive payments; (iv) rate payments for services provided to MassHealth members; (v) targeted payments to: (A) freestanding pediatric acute hospitals; (B) nonprofit teaching acute hospitals that provide medical, surgical, emergency and obstetrical services and are affiliated with a state-owned medical school; (C) freestanding cancer hospitals; (D) the acute hospital that had the lowest statewide commercial relative price in fiscal year 2019 as reported by the center for health information and analysis; or (E) the independent group 1 safety net hospital that had the largest percentile of operating loss in fiscal year 2022 as reported by the center for health information and analysis. The secretary may determine funding allocations within each such category within a given year; provided, however, that such allocations shall be consistent with all approved federal waivers and state plan provisions; and provided further, that the secretary shall allocate an average of not less than $1,192,000,000 per year, for the 3-year period from October 1, 2024 to September 30, 2027, for the rate payments described in clause (iv), with an average of not less than $92,000,000 allocated for group 1 safety net hospitals for such 3-year period, an average of not less than $460,000,000 allocated for group 2 safety net hospitals for such 3-year period and an average of not less than $640,000,000 allocated across all acute hospitals for such 3-year period.

(3) Of the targeted payments described in clause (v) of the first sentence of paragraph (2), the secretary shall expend annually from the fund: (i) $70,000,000 to freestanding pediatric acute hospitals, of which at least 98 per cent shall be paid to the freestanding pediatric hospital that had the largest volume of inpatient discharges in fiscal year 2019; (ii) $35,000,000 to nonprofit teaching acute hospitals that provide medical, surgical, emergency and obstetrical services and are affiliated with a state-owned medical school; (iii) $11,000,000 to the acute hospital that had the lowest statewide commercial relative price in fiscal year 2019 as reported by the center for health information and analysis; (iv) $5,000,000 to freestanding cancer hospitals; and (v) $10,000,000 to the independent group 1 safety net hospital that had the largest operating percentile loss in fiscal year 2022 as reported by the center for health information and analysis.

(4) Of the incentive payments described in clauses (i) and (ii) of paragraph (2), the secretary shall make interim payments to qualifying hospitals based on the secretary's estimate of each such hospital's final payment for the measurement period. As soon as practicable after the close of the measurement period, the secretary shall determine the final amount of each qualifying hospital's incentive payments and shall reconcile each hospital's interim payment with its final payment.

[ Subsection (c) as amended by 2025, 73, Sec. 16 effective upon the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025. See 2025, 14, Sec. 198. For text effective until the later of: (i) the date for which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2025, see above. For text effective October 1, 2027, see below.]

(c)(1) The secretary shall expend money in the fund, including all amounts credited to the fund, for payments to qualifying acute hospital providers under contract with the executive office of health and human services or under subcontracts with care organizations that contract with the executive office in connection with the MassHealth program as provided in this subsection.

(2) The secretary shall annually expend amounts from the fund averaging, for the 2-year period from October 1, 2025 to September 30, 2027, inclusive, not less than $2,264,500,000 per year; provided, however, that all such payments shall fall into 1 of the following categories: (i) health equity incentive payments; (ii) clinical quality incentive payments; (iii) other incentive payments; (iv) rate payments for services provided to MassHealth members; or (v) targeted payments to: (A) freestanding pediatric acute hospitals; (B) nonprofit teaching acute hospitals that provide medical, surgical, emergency and obstetrical services and are affiliated with a state-owned medical school; (C) freestanding cancer hospitals; (D) the acute hospital that had the lowest statewide commercial relative price in fiscal year 2019 as reported by the center for health information and analysis; (E) the independent group 1 safety net hospital that had the largest percentile of operating loss in fiscal year 2022 as reported by the center for health information and analysis; (F) the acute hospital that had the highest statewide public payer mix in fiscal year 2023 as determined by the secretary; (G) the acute hospital affiliated with a health system with 2 or more critical access hospitals operating in the commonwealth in calendar year 2025, as determined by the secretary; or (H) to any non-state-owned public hospital in the commonwealth, as determined by the secretary. The secretary may determine funding allocations among and within each such category within a given year; provided, however, that such allocations shall be consistent with all approved federal waivers and state plan provisions; and provided further, that the secretary shall allocate an average of not less than $1,280,000,000 per year, for the 2-year period from October 1, 2025 to September 30, 2027, inclusive, for the rate payments described in clause (iv), with an average of not less than $92,000,000 allocated for group 1 safety net hospitals for such 2-year period, an average of not less than $460,000,000 allocated for group 2 safety net hospitals for such 2-year period and an average of not less than $728,000,000 allocated across all acute hospitals for such 2-year period.

(3) Of the targeted payments described in clause (v) of paragraph (2), the secretary shall expend annually from the fund: (i) $70,000,000 to freestanding pediatric acute hospitals, of which at least 98 per cent shall be paid to the freestanding pediatric hospital that had the largest volume of inpatient discharges in fiscal year 2019; (ii) $35,000,000 to nonprofit teaching acute hospitals that provide medical, surgical, emergency and obstetrical services and are affiliated with a state-owned medical school; (iii) $14,000,000 to the acute hospital that had the lowest statewide commercial relative price in fiscal year 2019 as reported by the center for health information and analysis; (iv) $6,000,000 to freestanding cancer hospitals; (v) $10,000,000 to the independent group 1 safety net hospital that had the largest operating percentile loss in fiscal year 2022 as reported by the center for health information and analysis; (vi) $6,000,000 to the acute hospital that had the highest statewide public payer mix in fiscal year 2023, as determined by the secretary; (vii) $6,000,000 to the acute hospital affiliated with a health system with 2 or more critical access hospitals operating in the commonwealth in calendar year 2025, as determined by the secretary; and (viii) $2,000,000 to any non-state-owned public hospital in the commonwealth, as determined by the secretary.

(4) Of the incentive payments described in clauses (i) and (ii) of paragraph (2), the secretary shall make interim payments to qualifying hospitals based on the secretary's estimate of each such hospital's final payment for the measurement period. As soon as practicable after the close of the measurement period, the secretary shall determine the final amount of each qualifying hospital's incentive payments and shall reconcile each hospital's interim payment with its final payment.

(5) If, in any fiscal year, the commonwealth fails to secure federal financial participation necessary to make expenditures described in this section, or if the total hospital assessment amount described in section 67 of chapter 118E is insufficient to support the distributions to the fund required to be made from the Health Safety Net Trust Fund established in section 66 of said chapter 118E, or if such distributions are otherwise not made due to limitations on federal matching, applicable payment ceilings or other restrictions under state or federal law, then the expenditures otherwise required to be made from the fund shall be reduced proportionally based on the total amount available for expenditure.

[ Subsection (c) as amended by 2022, 126, Sec. 23 effective October 1, 2027 applicable as provided by 2022, 126, Sec. 186 and 2024, 140, Sec. 239. For text effective until October 1, 2027, see above.]

(c) [reserved].

(d) If any portion of the final annual amount allocated by the secretary to health equity incentive payments, clinical quality incentive payments or other incentive payments is unearned during the relevant measurement period for such payment, as determined by the secretary, the secretary shall transfer the state's share of that unearned amount to the Health Safety Net Trust Fund established in section 66 of chapter 118E.

(e) If the amount in the fund exceeds, for a reason other than that described in subsection (d), the amount sufficient to make the payments described in subsection (c), at any point in time, as determined by the secretary, the secretary may transfer the state's share of such amount to the Health Safety Net Trust Fund established in said section 66 of said chapter 118E.

Chapter 29: Section 2TTTTT. Interagency services reserve fund

[ Text of section added by 2022, 177, Sec. 24. See, also, Section 2TTTTT added by 2022, 126, Sec. 22, above.]

Section 2TTTTT. (a) There shall be an interagency services reserve fund established on the books of the commonwealth to be expended without prior appropriation. The fund shall be credited with money from public and private sources, including gifts, grants and donations, interest earned on such money, any other money authorized by the general court and specifically designated to be credited to the fund and any funds provided from other sources. Money in the fund shall be used to fund the operations of the interagency review team established under section 16R of chapter 6A. The secretary of health and human services shall administer the fund and shall make expenditures for the purpose of covering the cost of providing additional evaluation as needed by the interagency review team for an individual eligible under said section 16R of said chapter 6A. Any unexpended balance in the fund at the end of a fiscal year shall not revert to the General Fund and shall be available for expenditure in the subsequent fiscal year.

(b) Annually, not later than August 1, the interagency review team shall submit required financial reporting on the fund, including reporting of expenditures from the fund, to the secretary of health and human services, the secretary of education and the house and senate committees on ways and means.