This proposed law would set up a state Health Care Council to review and recommend legislation for a health care system that ensures comprehensive, high quality health care coverage for all Massachusetts residents. Until the Council decided that such a system had been set up, the proposed law would prohibit the conversion of non-profit hospitals, health maintenance organizations (HMOs), and health insurance firms to for-profit status. The proposed law would also require health insurance carriers to provide certain rights to patients and health care professionals, starting January 1, 2001.

The Council would recommend laws to set up, and would decide whether laws had been passed to ensure, a health care system that provides:

• barrier-free access to health care services;

• patients' freedom to choose their health care providers, get second opinions, and appeal denials of care;

• health care professionals' freedom to act solely in the best interests of their patients;

• affordable coverage, with cost increases no greater than national averages;

• preserving and increasing the quality of care and encouraging research;

• at least 90% of all premiums to be used for patient care, public health, and training/research, and no more than 10% for administrative costs, with simpler paperwork and administration;

• a prohibition of financial incentives that limit patient access to health care, and limits on incentives for inappropriate care.

The Council would include 17 members representing health care and other organizations. It would hold public hearings, study proposals, and make recommendations to the state Commissioner of Public Health and the Legislature on laws and other steps needed to set up a system meeting the above requirements. The proposed law would also create a special legislative committee, including legislators and members of the Council, to make recommendations by September 30,2001, for laws to set up a system meeting the above requirements by July 1, 2002.

Starting January 1, 2001, the proposed law would require health insurance carriers to guarantee certain rights to their insured patients and to health care professionals. These rights would include;

• patients' right to choose all of their health care providers, subject to the approval of a freely chosen primary care provider who has no financial incentive to deny care, and subject to payment of a reasonable extra fee to see a provider outside the carrier's network;

• health care professionals' right to make medical decisions in consultation with the patients;

• patients' right to transitional insurance coverage when they are under going a course of treatment from a health care provider whose contract with a carrier is being terminated;

• patients' right to medically necessary referrals to specialists;

• limits on and disclosure of contracts between carriers and health care providers that create financial incentives to delay or limit care or provide inappropriate care;

• health care professionals' right to discuss health benefit plans with insured patients and to advocate on behalf of their patients;

• carriers could not terminate health care providers' contracts without cause;

• patients' right to receive emergency services, subject to authorization procedures, and to be reimbursed when they pay cash for emergency services from providers not affiliated with their carrier;

• utilization review procedures that meet specific standards, including patients' right to appeal to the Commissioner of Public Health;

• in any year at least 90% of a carrier's Massachusetts revenue must be spent on Massachusetts health care, and a carrier that spent more than 10% for non-health care purposes would have to refund the excess to its insured patients. Each carrier would have to report its revenues, premiums, and expenditures to the state Commissioner of Insurance every year.

The proposed law states that it would not interfere with any existing contract, including contract terms (such as automatic renewal or option clauses) that may go into effect after January 1, 2001. The proposed law states that if any of its parts were declared invalid, the rest of the law would stay in effect.