Massachusetts Crowding Bill

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

Section 1.  Chapter 111 of the General Laws is hereby amended by inserting after Section 51G the following section:

Section 51H.  (a) The department of public health shall promulgate regulations establishing guidelines for the prompt admission by a hospital with an emergency department of those individuals presenting to the emergency department who are determined at the time of an emergency department visit to require inpatient hospital services at the hospital.  The guidelines promulgated by the department shall include but not be limited to:

(1)  Measures to substantially reduce or eliminate hospital crowding and boarding of patients in the emergency department which shall include the establishment of a reasonable median time within which an admitted patient should be moved to an appropriate inpatient destination.  Such median time shall be established to eliminate boarding, as defined by the department;

(2)  Development of protocols to be used by every hospital with an emergency department to track and identify the length of stay patterns and deviations for patients in the emergency department;

(3)  Creation of data collection  and monitoring programs to be reported to the department and the division of health care finance and policy that measure compliance by each hospital with the guidelines promulgated pursuant to this section;

(4)  Provide for exceptions for extraordinary circumstances involving mass casualties. 

In developing such regulations, the department shall consult with the Advisory Council on Hospital Crowding and Emergency Boarding established pursuant to paragraph (b) of this section.

(b) There shall be an advisory council on hospital crowding and emergency boarding within the department.  The advisory council shall consist of the commissioner or his designee who shall serve as chairman, the commissioner of the division of health care finance and policy or his designee, the commissioner of the department of mental health or his designee, the director of the office of Medicaid or his designee, one member appointed by the Massachusetts Hospital Association, one member appointed by the Massachusetts College of Emergency Physicians, one member appointed by the emergency medical services regional councils, one member appointed by the Massachusetts Medical Society, one member appointed by the Massachusetts Chapter of Emergency Nurses Association, one member appointed by the Massachusetts Association of Health Plans, one member appointed by Blue Cross Blue Shield of Massachusetts, and one member appointed by the commissioner representing consumers of health care.  The advisory council shall have the following powers and duties:

(1) collect and analyze data relating to a comprehensive assessment of emergency department visits for both admitted and discharged patients, including length of stay, the percentage of admitted patients who are boarders (as defined by the department of public health), and the length of time they boarded in the emergency department,  the number of hours an emergency department was on diversion status, broken down by day of the week, and the actual number of emergency diversions for the prior fiscal year;

(2) make recommendations to the department as to the measures by which to assess a hospital's success in eliminating crowding, such as the number of diversions, the average wait time to receive emergency services, the percentage of patients in an emergency treatment area within one hour of arriving in the emergency department, and the percentage of patients that are in an inpatient bed within the time frame established by the guidelines promulgated pursuant to paragraph (a).

The advisory council shall be consulted by the department in the development of the  regulations promulgated pursuant to paragraph (a) and the advisory council may make from time to time recommendations to the department to change such regulations.

SECTION 2.  The department of public health, in consultation with the Advisory Council on Hospital Crowding and Emergency Boarding shall develop recommendations relative to the establishment of an incentive payment program to be funded through the Uncompensated Care Trust Fund, or such other source of funding as the department may recommend, to provide supplemental payments to hospitals with emergency departments that meet the guidelines promulgated pursuant to paragraph (a) of section 51H of Chapter 111 of the General Laws.  The department shall file a report, with recommended legislation, with the clerks of the house of representatives and the senate no later than December 31, 2008.

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