INSIDE THE ISSUE

> PROTECT Act Guidance
> AG Brief Against ICE
> Primary Care Task Force Report
> Council Approve Baystate-Mercy Sale
> Workplace Violence Bill
> Vaccine Recommendations
> Reforming No Surprises Act?

MONDAY REPORT

Governor, State Agencies Issue PROTECT Act Guidance

In August, Governor Maura Healey signed the PROTECT Act that, among other things, prevents U.S. Immigration and Customs Enforcement (ICE) from conducting warrantless immigrant arrests at courthouses, schools, childcare centers, and healthcare facilities, including hospitals, community health centers and nursing homes. To make an arrest in such spaces, ICE agents will need a judicial warrant.

This month, the governor’s office, along with the Executive Office of Health and Human Services (EOHHS) , Department of Public Health, Department of Mental Health, and Department of Developmental Services issued guidance and an accompanying model policy for providers to help them conform to the law. Earlier this year, the governor’s Executive Order 650 directed EOHHS to ensure hospitals and other providers had guidance on staff interacting with federal immigration officers and requiring a judicial warrant or judicial order for entry into nonpublic areas. The new guidance released this month replaces the earlier guidance the state released related to the Executive Order.

Two major components of the guidance and policy involve having providers designate “nonpublic spaces” as well as a contact person to be notified if law enforcement officers engaged in civil law enforcement arrive on site or request information. Nonpublic areas are defined in the PROTECT Act as areas (1) where individuals are receiving treatment, services or care; (2) where individuals discuss protected health information, or (3) that are not open to the public. If a patient is in the custody of law enforcement, then law enforcement personnel may be allowed into treatment areas. As for a contact person designated to deal with law enforcement, the guidance from the state notes that different people may serve as the contact at different times throughout the day, and that providers should always have a backup person listed for each care site.

What if ICE ignores the designated areas and the contact person and conducts a civil arrest in violation of the law? The state says don’t physically interfere with them; document the interaction according to protocols in the guidance and report it to the Attorney General’s office.

AG Campbell, Citing Healthcare, Joins Brief Against ICE Actions

A coalition of 22 Democratic Attorneys General, including Massachusetts AG Andrea Joy Campbell, have filed an amicus brief asking the U.S. Court of Appeals for the Tenth Circuit to affirm a preliminary injunction that prohibits ICE from making unlawful warrantless arrests without determining whether individuals are likely to escape before a warrant can be obtained.

“Congress has placed clear limits on immigration agents’ authority to make warrantless arrests, requiring individualized probable cause of both removability and a likelihood of escape,” the AGs wrote. “However, federal agents have repeatedly disregarded these statutory safeguards, resulting in unlawful arrests, improper detentions, and chaotic enforcement practices across multiple states.”

In the case at issue, Ramirez Ovando v. Mullin, a federal district found that ICE continued to make warrantless arrests outside of the law’s restrictions.

The AGs state that ICE’s actions have had negative consequences in a variety of areas, including healthcare. “[W]arrantless arrests have led to declines in medical visits, preventive care, and participation in state-funded health programs, as residents have been afraid to seek treatment,” the AGs wrote, citing cancelled community health events and patients deferring preventative care until they need emergency room treatment in the midst of a health crisis.

Federal officials appealed the district court injunction to the Tenth Circuit. The AGs ask the appeals court to affirm the preliminary injunction that forces ICE “to operate within the limits Congress established.”

Primary Care Task Force Releases Full Report

On Thursday, September 9, the Massachusetts Primary Care Access, Delivery, and Payment Task Force (PCTF) published a final report documenting its work over the past year.

The 25-member task force last December recommended that the state establish an aggregate primary care spending target for the commonwealth that is equivalent to either (1) doubling the share of healthcare spending on primary care as a percentage of total healthcare spending or (2) 15%, whichever is greater, within the next five years. The final recommendations come as a primary care bill moves through a House-Senate conference committee at the State House.

Creation of the 25-member task force was mandated by Chapter 343 of the Acts of 2024, An Act Enhancing the Market Review Process, which Governor Maura Healey signed in January 2025. The task force, co-chaired by EOHHS and the Massachusetts Health Policy Commission, first met in April 2025.

Health Council Approves Baystate Acquisition of Mercy

The state’s Public Health Council last Wednesday voted 13-0 to approve Baystate Health’s acquisition of Mercy Medical Center (MMC) in Springfield from Trinity Health of New England.

The acquisition plan was first announced in April, with the parties noting at that time the “significant challenges and financial pressures that threatened” Mercy’s long-term viability.

A report by council staff on the transaction is here. MMC is licensed for 251 beds but because of its financial difficulties it is not fully staffing them, and has suspended its maternity services and a number of outpatient programs. Through the purchase, Baystate hopes to leverage the close proximity of MMC to Baystate Medical Center (BMC) to “to support acuity-based, clinically appropriate utilization of services, as well as adequate staffing at both locations.” The sale is expected to be completed by November 1.

In giving its approval to the acquisition, the Public Health Council required Baystate to “maintain all essential services at MMC for a minimum of 5 years,” although Baystate may consolidate essential services at BMC or MMC. Baystate must regularly report to the state on any prolonged reduction of a service, and must provide DPH with an assessment of the transaction after one year. Baystate must also make a good faith effort to keep the same insurance plans in which MMC now participates.

Conference Committee Meets on Workplace Violence Bill

The conference committee formed to resolve the differences between the House- and Senate-passed versions of a workplace violence prevention bill met for the first time this month and have until the end of the year to work out a compromise law to send to Governor Healey for her signature.

While various proposals had been put forth in the past, the issue gained traction when MHA, the Massachusetts Nurses Association (MNA), and the Massachusetts Division of 1199SEIU collaborated on consensus legislation. Those three groups recently sent a letter to the conferees noting the critical importance in passing a bill before year’s end and suggesting what language from each bill should be included in the final version.

The main difference between the House and Senate bills involve the penalties for those who commit violence. The Senate bill does not include the felony language the House had passed, but makes the misdemeanor charge that it included an arrestable offense regardless of whether it was witnessed by law enforcement. This would allow for immediate removal of the offending party from a healthcare facility.

“Our organizations’ priority is ensuring that an assailant can be removed from a healthcare facility after committing an assault, regardless of the legal mechanisms or consequences,” the leaders of MHA, MNA, and 1199SEIU wrote. “Whichever legal reforms that the Conference Committee adopts, the final bill must allow for the removal of anyone who assaults a healthcare employee. Frontline healthcare workers have identified this as a top concern for many years, and these provisions are critical to meaningfully improving safety in healthcare facilities. Our intention is not to exact excessively punitive measures, but simply to mitigate violence by patients and visitors that are able to fathom intent, hold those who willfully and knowingly assault a healthcare worker accountable, treat the violence seriously, and allow for the removal of assailants from the healthcare facility.”

The conferees attempting to hammer out a compromise are Senators Kelly Dooner (R-Taunton), Cindy Friedman (D-Arlington), and Joan Lovely (D-Salem), and Representatives Michael Day (D-Stoneham), Brandy Fluker-Reid (D-Boston), and Hannah Kane (R-Shrewsbury). The letter was signed by MHA President & CEO Steve Walsh, MNA Executive Director Joe-Ann Fergus, R.N., and 1199 SEIU-Massachusetts Executive VP Cari Medina.

DPH Issues Influenza and COVID-19 Vaccine Guidance

The Massachusetts Department of Public Health last week released its guidance for influenza and COVID-19 vaccinations, saying the guidance is “informed by leading physician professional organizations, including the American Medical Association, American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians (AAFP).”

The main difference between what the state and federal government recommend involves the COVID-19 vaccine. The state’s default position is that children ages 6 to 23 months “should receive” an age-appropriate dose of the vaccine; the state bolded the “should receive” language. The Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices, under the direction of Health & Human Services Secretary Robert Kennedy, endorse a “shared decision-making process” between healthcare providers and a child’s parent or guardian, noting “There is not a prescribed set of considerations or decision points in the decision-making process.”

In its guidance, DPH writes, “Severe COVID-19 disease can occur in children and is particularly prevalent in younger children. Rates of COVID-19-associated hospitalizations among infants ages 6-23 months are comparable to rates among adults aged 50-64 years during the period of October 2025 to April 2026. The majority of children aged 6-23 months hospitalized for COVID-19 had no underlying medical conditions.”

Earlier this month, DPH and the Massachusetts Chapter of the American Academy of Pediatrics (MCAAP) weighed in on childhood vaccinations in general, noting that vax rates across the nation are declining at the same time the country is experiencing the highest number of measles cases in more than 35 years.

“MCAAP and DPH continue to recommend the American Academy of Pediatrics’ 2026 Recommended Child and Adolescent Immunization Schedule,” stated DPH Commissioner Robbie Goldstein, M.D. and MCAAP President David A. Lyczkowski, M.D. “This guidance is based on decades of scientific evidence and protects children against measles, mumps, rubella, polio, pertussis, hepatitis B, chickenpox, and other serious vaccine-preventable diseases.”

The two medical leaders added, “MCAAP and DPH do not support the proposed restructuring of the childhood immunization schedule as outlined in an executive order signed August 10, 2026, by President Trump. The order calls for reducing the recommended childhood immunization schedule from 17 vaccines to 11, splitting the combined MMR shot into three separate injections, and directing the Department of Justice to challenge state laws that protect school vaccination requirements. This sweeping rewrite of federal guidance is inconsistent with scientific evidence about the safety, effectiveness, and timing of the childhood immunization schedule that has protected children for decades.”

Mass. and D.C. Address Out-of-Network Billing

Several members of Congress have ramped up discussions around the No Surprises Act (NSA) – the 2020 law that was enacted to protect patients from unexpected medical bills when treated they are treated by out-of-network (OON) physicians at in-network health systems. The Congressional focus is on the direction the arbitration process has taken over the past few years and its effect on patients, providers, health plans and employers.

Massachusetts policymakers are also focused on OON costs with the Division of Insurance (DOI) last week holding its first listening session on the issue.

The NSA seeks to resolve payment disputes between the providers and health plans by creating a binding independent dispute resolution (IDR) process. Since the implementation of the IDR portal in 2022, more than 5 million disputes have been initiated, far exceeding expectations as well as significantly expanding the administrative cost of the program and generating much higher awards than anticipated.

House Ways and Means Committee member Representatives Greg Murphy (R-N.C.) and Jimmy Panetta (D-Cal.) introduced the No Surprises Act Enforcement Act (HR 4710) to increase penalties on health plans that fail to comply with payment deadlines. House Energy and Commerce Committee Ranking member Frank Pallone (D-N.J.) sent letters to six arbitration firms last week asking for information on their process, noting the high awards and rising consumer costs. Senate Health, Education, Labor and Pension Committee Chair Bill Cassidy (R-La.) may be considering legislation to limit disproportionate payment awards. The Department of Health and Human Services is organizing a November public hearing on reform ideas for the NSA. And patient and business groups have expanded their focus on the NSA, claiming that it is contributing to rising health costs. With around six weeks left in the session for the 119th Congress, short-term legislative action seems unlikely, but it is expected to be an area of focus for 2027.

At the DOI last week, MHA’s Karen Granoff, senior director of payer relations and managed care policy, spoke of the hospital community’s support for sustainable patient affordability measures and the need – in light of the NSA and federal reform efforts – to clearly define the scope, issue, and prevalence of the potential problem that DOI is trying to solve.

“Before moving forward with specific solutions, we encourage the division to clearly identify the problem, the services and the providers affected, as well as the intended outcome,” Granoff said. “Each approach would affect different services, policy objectives, and contracting relationships – with real ripple effects and potential unintended consequences throughout the system.”

John LoDico, Editor