WITH THREE state-funded youth mental health programs at risk of closing, lawmakers and providers ramped up their opposition this week to Gov. Maura Healey’s proposed budget cuts that come as Massachusetts continues to grapple with a behavioral health care crisis.

Two 15-bed intensive residential treatment programs (IRTP), operated by NFI Massachusetts in Westborough, that serve teenagers with serious mental health and safety issues would close under Healey’s fiscal 2026 spending plan. That would leave just two other IRTPs in the state.

The governor’s budget would also shutter the state’s only clinically intensive residential treatment (CIRT) program, called Three Rivers in Belchertown, that has a dozen beds and treats children ages 6 to 12.

At a budget hearing Monday in Attleboro, Department of Mental Health Commissioner Brooke Doyle said those facilities are slated to close due to low patient counts, inadequate staffing and location hurdles. The cost-saving measure comes as DMH — which would receive a 7 percent overall budget increase under Healey’s proposal — looks to prioritize resources for its over-capacity psychiatric hospitals.

“These programs have been very difficult to maintain adequate and safe staffing within. They’ve been understaffed for extended periods of time, and that has contributed in large part to why we had difficulty keeping all the beds filled,” Doyle said in Attleboro. “The programs do provide a specialized service need, and the reality is, that we haven’t been able to operate them fully today. So what we’re proposing to do is to right-size the IRTP, reflecting the volume that does get utilized.”

Doyle said the state pays for those beds “in full,” regardless of whether or not they are occupied. She argued that makes it “not sustainable to continue to pay for 50 percent utilization.”

Doyle highlighted the state’s investment in community-based mental health resources, though the IRTP and CIRT programs are seen as a last resort to stabilize young patients who repeatedly end up in the hospital and pose significant safety risks to themselves and their family.

“Without these services, youth will continue to cycle through expensive and disruptive emergency and acute hospital services,” Lydia Todd, executive director of NFI Massachusetts, said at a State House budget hearing Tuesday, according to a copy of her prepared remarks. “Their families face income loss because it is impossible to maintain employment when they are regularly needed to respond to mental health crises.”

Todd added, “If this program is closed, the commonwealth will lose a recently renovated facility, a highly credentialed, experienced and skilled multi-disciplinary team of 95 staff, a Joint Commission-accredited program, and most importantly, the ability to help youth and families with the most serious needs to manage their mental health issues in their natural communities, and be less likely to end up in one of our adult systems.”

Todd told the News Service 95 out of 100 positions are filled. 

“We could be fully utilized — no problem,” she said. 

Program leaders and lawmakers contend the programs are underutilized due to a complicated DMH referral process that can leave youth languishing in hospitals for weeks or months before they secure placement. Due to high staff turnover during the COVID pandemic, some hospital mental health providers also were unaware the IRTP and CIRT programs existed, said Sen. Jake Oliveira of Ludlow. 

“It’s my hope that we can restore the funding for these critical programs because everything that we hear from constituents and everything that we read, there is a dire need for youth beds, particularly adolescent mental health beds throughout Massachusetts,” Oliveira told the News Service. “If we have programs that are underutilized, then DMH needs to do a better job with the referral process to get help to families across Massachusetts.”

Doyle admitted the referral process was “too clunky” at the hearing Monday.

“So I’ve actually made some changes to that referral process, going to preview it with stakeholders this month, with a go-live plan for May,” Doyle said.

In another major budget cut, DMH plans to slash the case management workforce in half, which would save the state $12.4 million. That move recently triggered DMH workers represented by SEIU Local 509 to take a vote of no confidence in Doyle. 

Gov. Maura Healey has already hit pause on a controversial plan to shutter a 16-bed psychiatric hospital in Cape Cod. That closure, combined with the three youth mental health programs, would have saved the state a total of $20.1 million, according to a presentation from the Executive Office of Health and Human Services.

As House Democrats prepare to release their budget next week, Rep. Aaron Saunders of Belchertown said he plans to fight to ensure the CIRT, operated by Cutchins Programs for Children & Families, receives funding.

“We need it to be there,” Saunders told the News Service. “It is a level of intervention and service that other programs are not designed to provide, and that to me really is the linchpin.”

Saunders added, “In my conversations with the administration, I’ve tried to impress upon them that there needs to be access, in some way, shape or form, to this level of service.”

Tina Champagne, CEO of Cutchins Programs for Children & Families, urged lawmakers Tuesday to “dig deeper and to save our programs.” In prepared remarks, Champagne said the state remains in the throes of a “children’s mental health crisis” and argued “this is no time for a reduction in intensive mental health services in our state.”

“The decision to cut the CIRT is not only in direct opposition to well-established evidence-based practices for children and families with some of the most persistent and challenging mental health and safety concerns, but also puts the the most vulnerable children and families in the commonwealth at even greater risk by perpetuating the cycle of ACES and traumatic experiences,” Champagne said, referring to adverse childhood experiences.

She added, “The degree of safety and mental health challenges that must occur for youth to be considered for a DMH referral for the CIRT is highly intensive and the youth’s safety concerns are typically quite serious. If these youth could be treated elsewhere in the community, they would have been referred to those services, and usually have already utilized these services, but they are not intensive enough to maintain safety and mental health stabilization.”

At the hearing, Oliveira told Doyle he was insulted by her remarks that signaled the Belchertown program was not viable due to its location in western Massachusetts.

“That’s insulting to any western Mass. lawmaker who might be sending people halfway across the state, hours away to get the programs to utilize them,” Oliveira said.

The commissioner told Oliveira she regretted if her testimony seemed to be “disrespectful.”

“It’s more of a matter that we have to weigh parents’ requests and parents’ priorities, as well,” Doyle said. “So, it has always been a western Mass.-located program. It’s not new. And what we’re seeing is that it is getting a bit more challenging, particularly with workforce constraints, that when we don’t have full staff operating, it requires that the department have to make decisions with parents about whether or not their their child can be safely treated in that environment, based on staff that are available at that time.”

Rep. Kelly Pease, a Westfield Republican, questioned whether the adolescent mental health programs represented the “smart place” for DMH to make cuts. Without providing sufficient care to young Bay Staters early on, the state may exacerbate the prison pipeline and end up incurring more costs in the future, Pease told Health and Human Services Secretary Kate Walsh.

Walsh insisted those programs were 50 percent occupied and emphasized EOHHS’s push to “right-size our behavioral health infrastructure.” Pease argued the low patient census was a function of DMH’s “antiquated process to get a referral.”

“I think the question for the Legislature is: Do you want to pay for standby capacity in two or three programs across the state that may or may not be used?” Walsh said at the hearing Monday. “In the meantime, you should challenge us to significantly improve our antiquated or very complicated processes to get people into these systems — some of which, I will remind us, were the result of court decisions. So we have patient referral pathways for people with, for children with behavioral health challenges that were built by lawyers, with due respect.”

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AFTER THEIR BRAIN injury treatment legislation cleared one committee but then fizzled out last session, Sen. Paul Feeney and Rep. Kimberly Ferguson urged survivors Tuesday to share personal stories with lawmakers to help get the policy over the finish line in the new session.

The advocacy push came as the leader of the Massachusetts Association of Health Plans (MAHP) voiced her opposition to the insurance mandate, which she said would raise costs for consumers and small businesses. The proposed benefit also leaves a major coverage gap for Bay Staters on certain insurance plans, CEO Lora Pellegrini pointed out.

At a Brain Injury Association of Massachusetts (BIA-MA) event, Feeney recalled the good news he shared with advocates last year: The bills he sponsored with Ferguson requiring commercial insurers to cover cognitive rehabilitation therapy to treat brain injuries received a favorable report from the Financial Services Committee, which the Foxborough Democrat co-chaired.

While the Health Care Financing Committee later sent the bills to study, Feeney and Ferguson said they’re optimistic about the fate of their refiled proposals (SD 1890 / HD 866). Massachusetts may be a leader in health care, but “if it’s not affordable, it’s not accessible,” Feeney said.

“I want to urge you to have the optimism that I have, that as we start here today at the beginning of the session, we will not only get that bill out again and move it forward, but we will get it over the finish line this year. And I don’t say that lightly,” Feeney told advocates before they headed to meetings with lawmakers.

He added, “I promise you all that nothing motivates us and moves policy like your personal stories, like the stories of courage and persistence, the stories that turn pain into purpose.”

Insurance coverage would extend to people with an acquired brain injury (ABI), such as a traumatic brain injury, tumor, stroke and aneurysm. 

Pellegrini warned the proposals would add to seven new coverage mandates from last session, which she said will raise premium costs by $750 million over the next five years.

“In Massachusetts, those costs are borne primarily by small businesses and individuals who make up less than 40 percent of the employer-sponsored market,” Pellegrini said. “Self-insured plans, which comprise over 60 percent of the commercial market, are not required to add this mandate or others as part of a benefits package. “

Lawmakers and supporters emphasized their advocacy builds on a narrower success story from a 2021 health care law, which required commercial health insurance plans, the Group Insurance Commission and MassHealth to cover cognitive rehabilitation for COVID-19 patients.

More than 72,000 Bay Staters each year sustain a traumatic brain injury, which can cause impaired thinking, memory, movement, sensation and emotional functioning, according to BIA-MA. Only 12% of affected individuals receive inpatient rehab, and the legislation would help more Bay Staters access treatment with the aim of living more independently, the association says.

A former speech language pathologist, Ferguson said cognitive rehab therapy allows patients to retrain their brains, including by working on word retrieval and comprehension. 

Aside from questions about how much the policy would cost, Ferguson said she’s heard “very, very little opposition.” A 2016 analysis from the Center for Health Insurance and Analysis (CHIA) found the coverage mandate would raise monthly insurance premiums between 1 cent and 19 cents.

“It’s several years old, so we’ve been told maybe we need to go back to CHIA again and say, can you update those numbers for us? But I mean, no one really has an argument against helping ABI survivors improve their skills and become more functional in their day-to-day lives,” Ferguson said. “I’ve said it year after year: This is one of the most important bills that we can pass to change lives for people with ABI, their families and their caregivers.”

Demanding that lawmakers not raise costs for small business, Pellegrini said the Legislature should impose a “moratorium on new health care spending.”

“Without such action, continued coverage expansions and cost-sharing eliminations will only contribute to our affordability crisis,” Pellegrini said.

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THE GROUP OF Senate Democrats tasked with handling Auditor Diana DiZoglio’s quest to probe the Legislature agreed Monday to meet with her office. While senators said they are looking for “prompt and constructive engagement,” DiZoglio said the response to her audit launch is the latest example of lawmakers “breaking the law.”

In a five-page letter responding to DiZoglio’s repeated outreach, subcommittee chair Sen. Cindy Friedman and Sens. Will Brownsberger, Jo Comerford and Paul Feeney proposed three possible times to meet on either January 29 or January 30.

The senators said they’re looking for a “comprehensive and productive discussion” with the Office of the State Auditor about its proposed performance audit of the Legislature, but also outlined a string of concerns, including constitutional separation of powers and the time period the audit is allowed to cover.

“There is no historical precedent for the OSA’s proposed audit,” the letter, shared by Friedman’s office, said. “Therefore, appropriate scope is very much an open question and one that raises unprecedented constitutional issues.”

DiZoglio told the News Service the Senate “has indeed drafted a letter explaining why they are breaking the law.”

“They’ve invited us to meet with them so they may reiterate the concerns they raised throughout their campaign against this issue becoming law,” DiZoglio told the News Service on Monday afternoon. “But the people don’t want another committee report full of excuses, they want the audit they voted for. We will be discussing the Senate’s letter with the AG’s office since we have already initiated the process of pursuing legal action.”

Following voters’ overwhelming support for Question 1, DiZoglio’s new authority to audit the Legislature took effect January 3. DiZoglio has since sent letters to House Speaker Ron Mariano and Senate President Karen Spilka seeking to revive her probe and requesting specific documents as part of her initial audit, including financial receipts and state contracting and procurement documents.

“No other entity of the Commonwealth gets a special privilege of withholding requested financial records from our office and instead forming a subcommittee to avoid abiding by the law,” said DiZoglio, who for weeks has asked for Attorney General Andrea Campbell to step in to enforce the new voter law.

Campbell’s office has said it will not intervene until a legal dispute arises, and DiZoglio warned Monday that an outside group will “likely file a lawsuit” if the AG doesn’t act “soon.” Massachusetts Fiscal Alliance spokesperson Paul Craney, who’s part of the coalition that’s threatened to sue the Legislature to force it to comply with the voter law, called the subcommittee’s letter a “clear delay tactic.”

“They should be complying with the law, not stalling,” Craney said. “Further meetings at the end of the month to discuss their concerns with compliance are only designed to delay the implementation of the law.”

Senators in their letter said “both the subcommittee and the wider Senate recognize the significance of the recent election, in which voters approved Question 1.”

“Thus, the Subcommittee, driven by a sincere regard for the will of the voters and a duty to fulfill its charge by the Senate, now seeks prompt and constructive engagement with the OSA about its proposed audit,” the letter states.

DiZoglio told the News Service she is “happy to meet with the subcommittee.” Still, she said her office’s “pursuit of legal action regarding their ongoing failure to produce financial records in accordance with the law remains in place.”

The letter to DiZoglio highlighted five main concerns: the audit’s scope, the time period to be audited, how the audit will be conducted, potential conflicts of interest, and “process issues.”

Senators wrote the proposed scope of the audit “raises fundamental constitutional questions of separation of powers, Article 21 immunity, and independent legislative rule-making guarantees.” Article 21 of the state constitution states the “freedom of deliberation, speech and debate, in either house of the legislature, is so essential to the rights of the people, that it cannot be the foundation of any accusation or prosecution, action or complaint, in any other court or place whatsoever.”

The subcommittee expressed uncertainty over the intended time period for the audit to cover and suggested DiZoglio’s new authority may not be retroactive. DiZoglio’s office previously sought information stretching back to July 1, 2020.

“…[T]he authority purportedly granted to the OSA under Question 1 is presumptively prospective,” the letter said. “Thus, it would appear that any authority to audit or access legislative records under the new law must be limited to the period after its effective date, January 3, 2025.”

About two weeks before Election Day, DiZoglio’s office released an audit of the Legislature spanning January 1, 2021 through December 31, 2022, though the Methuen Democrat said top Democrats refused to participate. The subcommittee that the Senate established last week suggested DiZoglio, a former senator, might have violated “ethics, independence and professional judgment” policies contained in the “Yellow Book” of Government Auditing Standards since that probe covered a time when she was a state lawmaker.

DiZoglio also actively campaigned for Question 1, the subcommittee noted.

“This kind of directly relevant political activity may pose a conflict, not only for the 2024 Audit Report, but for any proposed audit in the near future,” the letter said. “The advice of independent ethics experts could be helpful in carefully considering such a potential conflict.”

The subcommittee also said it “might be highly beneficial” to seek advice from independent auditing experts on determining an objective standard for auditing the Legislature.

Craney said lawmakers’ concerns can be addressed in court, as he urged Campbell to defend the voter law. 

“The Attorney General cannot sit by any longer, she needs to side with the people of Massachusetts as lawmakers are now officially not in compliance,” Craney said.

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REP. SUSAN WILLIAMS GIFFORD, the House minority whip who represented Middleborough, Carver and Wareham, died of cancer Tuesday at her home surrounded by loved ones.  She was 64.

“Representative Gifford was a strong advocate for her district, her community, and her Constituents,” former Gov. Charlie Baker said in a statement. “I am grateful for her friendship, and the more than two decades of service she provided to the 2nd Plymouth District and beyond. My heart goes out to her family and friends as we mourn the loss of an incredible advocate for the Commonwealth of Massachusetts.”

First elected to the 2nd Plymouth House seat in 2002, Gifford of Wareham previously served on that municipality’s Board of Selectmen.

“Susan often said her number one priority as a legislator was ‘putting people first’ and she excelled at doing that, whether she was helping constituents resolve a problem or working on behalf of the residents of Carver, Middleboro, and Wareham to secure funding for critical local programs and projects,” said House Minority Leader Bradley Jones Jr.

Speaker Ronald Mariano remembered her as a “tireless public servant.”

“Susan was also kind, and a person of integrity, traits that allowed her to bring an invaluable perspective to her work here in the Legislature. On behalf of the entire House, I want to offer my condolences to Susan’s family and loved ones as we mourn this devastating loss,” Mariano said.

In addition to her position as third assistant minority leader, Gifford was the ranking Republican on the Joint Committee on Agriculture.

House Republicans said in a caucus statement that they were “deeply saddened” by her passing.

Former Lt. Gov. Karyn Polito also expressed condolences. “Susan reminded us all what it truly means to serve the people of the Commonwealth,” Polito said. “The ripple effect of her loss will be felt throughout the communities that she served. Our hearts go out to her husband Mark and her family as we all mourn her loss.”

In September, Gifford lost her primary contest to John Robert Gaskey of Carver, a Republican who is unopposed in the November election.

“Susan inspired conservative women across Massachusetts to engage in politics,” MassGOP Chair Amy Carnevale said Wednesday.  “Her leadership was defined by unwavering commitment to her values, coupled with a unique kindness that touched everyone she encountered. Susan’s unyielding commitment to the residents of Carver, Middleboro, and Wareham was truly inspirational and serves as a high standard for all civil servants. This is an immeasurable loss for all of us.”

Gov. Maura Healey ordered that state and U.S. flags be lowered to half-staff immediately on Wednesday, and remain at half-staff until Gifford’s burial.  Funeral plans were not immediately available.

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Massachusetts has officially exercised its eminent domain powers to seize St. Elizabeth’s Medical Center in Brighton, Gov. Maura Healey’s office said Friday, days before Steward Health Care’s hospitals are poised to transfer to new operators.

Healey in mid-August announced her plan to take St. Elizabeth’s through eminent domain, knocking Steward’s landlord and lenders at the time for failing to agree to a deal that would allow the hospital to stay open. The seizure ultimately allows Boston Medical Center to take over operations at St. Elizabeth’s.

The governor’s office said that as part of the legal process to take the hospital, Healey declared that if St. Elizabeth’s were to close, “it would create a public health emergency due to the large volume of patients currently served by the hospital and the resulting disruption to the delivery of medical services in the region.” But a key Steward lender signaled Friday afternoon it would fight Healey’s “unconstitutional use of eminent domain.”

“While Apollo continues to put its greed ahead of the health and wellbeing of the people of Massachusetts, we are taking action to make sure St. Elizabeth’s remains open,” Healey said in a statement Friday morning. “By transferring operations to Boston Medical Center, we will protect access to care for tens of thousands of patients and save thousands of jobs. Our administration is committed to ensuring smooth transitions at the five Steward hospitals that we were able to save, and supporting the communities impacted by Steward’s closure of Nashoba Valley Medical Center and Carney Hospital.”

Apollo Global Management, asked whether the company plans to challenge Healey’s land taking, provided a statement from attorney Bill Reid of Reid Collins & Tsai LLP. 

“Despite our repeated attempts to engage in reasonable negotiations, the Governor has initiated an unconstitutional use of eminent domain at the expense of Apollo’s third-party investors,” Reid said. “Taking the property for a fraction of the assessed value is theft and everyone in Massachusetts–every business owner and homeowner–should be concerned about this threat. As a fiduciary, Apollo is left with no choice but to continue pursuing litigation aimed at challenging the Governor’s unconstitutional use of eminent domain.”

Unlike with St. Elizabeth’s, the administration did not intervene to halt the closure of Carney in Dorchester and Nashoba in Ayer, which Healey attributed to the hospitals not receiving qualified bidders.

Healey’s office described St. Elizabeth’s as a “crucial provider” for underserved communities.

“Its closure would put vulnerable patients at risk who would no longer have access to emergency services, maternity care, behavioral health services and inpatient care,” Healey’s office said. “Further, inpatient capacity in the Boston area remains at record highs, and the more than 60 patients currently at St. Elizabeth’s would not have immediate access to health care.”

In the first step toward the eminent domain land taking, the state on Aug. 16 offered Steward’s landlord and lenders $4.5 million “to purchase the fee and any other necessary property interests in St. Elizabeth’s Medical Center.”

The governor called that amount the “appropriate and fair market value of that property.” Boston assessor’s office lists the assessed land value at 736 Cambridge St., where St. Elizabeth’s is located, at just under $51 million.

Under state law, the governor has the authority to take property by eminent domain. The law says the governor “having first complied with all the preliminary requirements prescribed by law, may adopt an order of taking, which shall contain a description of the land taken sufficiently accurate for identification, and shall state the interest therein taken and the purpose for which such property is taken, and in case such taking is for an improvement for which betterments may be assessed shall state whether betterments are to be assessed therefor.”

The firms controlling St. Elizabeth’s real estate rejected the Healey administration’s offer, saying it “significantly undervalues the real property underlying St. Elizabeth’s.”

“Accordingly, should the Commonwealth move forward with its proposed plan to exercise eminent domain and compensate ACREFI only $4.5 million for the property, ACREFI will have no choice but to exercise its constitutional and statutory rights and take any and all actions necessary to protect the interests of the investors to which it has fiduciary obligations,” an Aug. 20 letter from the lender said. “ACREFI believes there are numerous procedural and constitutional issues raised by the Commonwealth’s proposed plan and conduct to date that it will vigorously challenge.”

A Healey spokesperson did not answer a News Service question about the cost of the taking but said the payment isn’t due yet.

All of Steward’s remaining Massachusetts hospitals are expected to be sold to their new operators on Monday.

State health regulators this week approved emergency determination of need applications to transfer ownership of Morton Hospital in Taunton and St. Anne’s Hospital in Fall River to Lifespan, Holy Family Hospital with campuses in Haverhill and Methuen to Lawrence General Hospital, and Good Samaritan Medical Center in Brockton and St. Elizabeth’s Medical Center to Boston Medical Center.

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WITH THE SALES of Steward Health Care’s Massachusetts hospitals targeted to close in less than two weeks, state health regulators emphasized Thursday they are under a particularly compressed timeline to review the transactions — since their analyses, which have no binding impacts, typically span weeks or months.

The Health Policy Commission has more time to assess the proposed sale of Steward’s physician network to the subsidiary of a private equity firm, and board members pressed for greater scrutiny to understand the firm’s long-term plan for its Massachusetts operations.

HPC staff signaled they are bogged down reviewing the material change notices they received this month for Steward hospitals, which call for Lifespan to buy St. Anne’s Hospital in Fall River and Morton Hospital in Taunton; for Lawrence General Hospital to acquire Holy Family Hospital with campuses in Methuen and Haverhill; and for Boston Medical Center to take over St. Elizabeth’s Medical Center in Brighton and Good Samaritan Medical Center in Brockton.

“We understand that the hospitals are hoping for a closing date of September 30, and we are reviewing these [material change notices] as expeditiously as possible with that date in mind,” Megan Wulff, the HPC’s director of market oversight and monitoring, said.

Regulators must weigh how the proposed hospital sales will impact health care costs, quality, and access. The HPC conducts its preliminary reviews within 30 days of receiving completed notices, and officials can choose to pursue more in-depth reviews that may span six months.

The HPC lacks the authority to approve or block transactions, though reviews can help guide the work of other state and federal regulatory agencies, said Kate Mills, the HPC’s senior director for market oversight and transparency.

“Even without a full cost and market impact review, or CMIR, the material change notice review process is itself quite a powerful tool,” Mills said. “With the extensive data and analytic resources that are available to the HPC, we can actually do quite a lot to assess the potential impacts of a given transaction, even in a relatively short time frame. So I did want to just reassure our commissioners, we are very much hard at work on all of these analyses, even with the somewhat short time frames.”

Along with the HPC reviews, the Department of Public Health is also currently handling emergency determination of need applications for the Steward hospitals, Mills said.

HPC executive director David Seltz described this period as the busiest stretch so far at the agency, which on Thursday marked its 300th meeting.

“We have more transactions before us at this particular moment than we have ever had in all of those 300 meetings in the 12 years of the HPC,” Seltz said. “But we have the right team, and we have the right experts that we have brought on board to be able to do this, and we need to be able to meet this moment as well because there are a lot of questions, and the public is rightly trying to understand what the future will be here.”

HPC Commissioner Alecia McGregor asked agency staff to explain what would happen if a “red flag” comes up during the review process. Mills responded that all agency findings will be reported to HPC leaders and commissioners.

“So if we encountered a red flag, you would hear about it from us, and then it would be part of the decision-making process as to whether or not a cost and market impact review would be warranted,” said Mills, who predicted staff will have findings “very soon.”

The material change notices to the HPC, which are largely similar across the Steward hospitals, state the new owners will preserve access to essential care. For the Holy Family facilities, the notice says the acquisition will “improve patient outcomes through the development of innovative care coordination between hospitals and other care providers in the Merrimack Valley.”

Lifespan, Lawrence General and BMC in their notices have indicated they plan to continue the employment of certain physicians, the HPC said.

Commissioners peppered agency staff with questions about the proposed sale of Stewardship Health, the company’s physician network, to Brady Health Buyers LLC, which the HPC described as an affiliate of Rural Healthcare Group and a subsidiary of Kinderhook Industries.

HPC said the Steward Health Care Network, which is part of Stewardship, is the “third largest-physician contracting network in Massachusetts” with about 2,950 physicians.

The deal has a targeted closing date of October 30, and commissioners are seeking more information about the types of employees that could be protected — including support personnel at physician practices — under the arrangement. Commissioners are also interested in evaluating Kinderhook’s track record and how the company can be held accountable, if necessary, in the future.

“One of the things that I’m concerned about, and frankly very nervous about, is that even though the remaining Steward hospitals will be in the hands of nonprofit operators — that’s encouraging — we’re still looking at a for-profit acquisition of the physician group,” McGregor, an assistant professor at the Harvard T.H. Chan School of Public Health, said. “And I want to know, what are the ways that we can hold them accountable for doing right by patients, doing right by the people of the Commonwealth? What are the ways that we’ll be able to do that over time, in the absence of oversight legislation which hasn’t been passed yet?”

Wulff responded that the firms will be subject to HPC reporting requirements once they become providers in Massachusetts, and that regulators would analyze their spending through the agency’s performance review process. Board chair Deborah Devaux added that leaders from Rural Health Group and Kinderhook have “indicated their interest in understanding our expectations of them.”

Commissioner Barbara Blakeney urged HPC staff to explore Kinderhook’s history “very aggressively.”

“Past is prelude to future, and it would be helpful to know of their past history in terms of acquiring, especially health care organizations, and tracking the history of what happens during the time of that acquisition,” Blakeney, past president of the American Nurses Association, said. 

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PREGNANT PEOPLE and those who recently gave birth could gain access to expanded care options in Massachusetts under compromise maternal health legislation released Wednesday.

The conference committee accord, which lead House negotiator Rep. Marjorie Decker filed just after 3:30 p.m. Wednesday, is the first big piece of legislation to emerge from closed-door talks after lawmakers ended formal sessions this month with major loose ends.

Decker told reporters the House will take up the bill on Thursday during an informal session, where recorded votes are not allowed and there is usually no debate. All six conferees signed the conference report, said Decker, co-chair of the Public Health Committee.

“I’m not sure there’s a whole lot of compromise,” Decker said when asked about the highlights of the compromise. “It was really just taking the strengths of each bill, which they were so closely aligned.”

Decker was not joined by any other conferees at the House Clerk’s office, though her mother — a Cambridge constituent — was there.

The House and Senate had passed largely similar omnibus maternal health bills enabling certified professional midwives to be licensed in the Commonwealth, eliminating regulatory barriers for opening birth centers for low-risk pregnancies, boosting access to postpartum depression screenings, and expanding resources for perinatal mood and anxiety disorders, among other parameters.

The compromise bill allows lactation consultants to be licensed, a policy included in the House version but not the Senate. The agreement also requires insurance coverage of donor human breast milk or milk-derived products, bolsters MassHealth coverage of doula care, and strengthens oversight of ultrasound services.

“I think most importantly, what this bill does is it really allows us to take a very strong, comprehensive approach to maternal health,” said Decker, who noted the bill is rooted in recommendations from the Special Commission on Racial Inequities in Maternal Health. “I think to the House leadership, to myself, and to our colleagues on the other side, that this was not going to be a commission report that wasn’t also acted on, so I’m really proud.”

The Cambridge Democrat added the bill “goes a long way in providing a lot more autonomy, and choices, and care, and coverage for maternal health.”

Decker and lead Senate negotiator Sen. Cindy Friedman issued a joint statement, saying the bill “expands coverage for mental health care and services provided by midwives and doulas, creates a pathway for licensure for certified professional midwives and lactation consultants and bolsters out-of-hospital delivery options for our residents.”

In the early afternoon hours of July 31, Decker and conferee Rep. Mike Moran were poised to be appointed to the maternal health conference committee, but lamented they were still awaiting papers from the Senate to jumpstart negotiations. The House unanimously passed its maternal health legislation on June 20, while the Senate unanimously approved its version on July 30.

After lawmakers gaveled out on August 1, Moran said the maternal health conference committee had not managed to meet yet. Decker offered a more optimistic outlook last week, saying negotiators were “very, very close.”

Advocates and lawmakers have pitched the bills as a response to worsening maternal health outcomes that are disproportionately impacting people of color. The rate of severe maternal morbidity nearly doubled from 2011 to 2020, with Black individuals experiencing the highest rate of complications from pregnancy or delivery.

“The Massachusetts Legislature clearly understands that the right to reproductive health care, including care for pregnancy, delivery, miscarriage care, and abortion care, is not a realized right unless every person is able to safely access that care with dignity,” Rebecca Hart Holder, president of Reproductive Equity Now, said in a statement Wednesday. “By empowering midwives and removing burdensome barriers to the opening of freestanding birth centers, this legislation can deliver real advancements in birthing justice and work to address a worsening maternal health crisis in the Bay State. An agreement on this legislation signifies that our Legislature is ready to turn a corner in the fight for maternal health equity in Massachusetts, and we look forward to getting it across the finish line together.”

Department of Public Health Commissioner Dr. Robbie Goldstein called the maternal health bill a priority Wednesday morning.

“While you may have seen in the news that many of our public health priority bills did not make it through last-minute conference negotiations, including comprehensive maternal health and substance use disorder bills, we’re confident that the work we did to foster greater understanding and acceptance on issues such as overdose prevention centers, workforce supports for certified professional midwives and recovery coaches, and the possibility for a non-punitive pathway for substance-exposed newborns, puts us in a particularly strong position to move these issues forward,” Goldstein told the Public Health Council.

Top Democrats have said they intend to keep working on other major bills during informal sessions, which under legislative rules are often limited to non-controversial matters.

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GOV. MAURA HEALEY on Monday doubled down on her inability to prevent the closure of Steward Health Care’s hospitals, including those that received qualified bids but still face an uncertain future during bankruptcy proceedings.

Up to five Steward hospitals could transition to new owners after a sales hearing in bankruptcy court, which was slated for Tuesday but is now postponed until Friday.

Healey has already said there’s nothing she can do stop Steward from closing Carney Hospital in Dorchester and Nashoba Valley Medical Center in Ayer, and on WBUR “Radio Boston” Monday morning she underscored her administration’s lack of authority to intervene in any other major health care service disruptions.

“This really isn’t up to me. This is all on Steward and the lenders at this point,” Healey said when asked whether she would allow other Steward hospitals to close depending on the sales process.

“We have been very active, I have been very active, our secretary of health and human services and our commissioner of public health have been very active in working with and helping to save these hospitals,” Healey continued. “I’ll just say at the outset, it breaks my heart to see a hospital close. It breaks my heart to see patients or residents worry about where they’re going to access care. It breaks my heart to see nurses and health care workers facing the specter of losing jobs. I hate it.”

Healey again again criticized Steward CEO Ralph de la Torre, who was spotted vacationing in France, at the Olympic dressage events at the Palace of Versailles. The governor, acknowledging there are 16,000 workers across the Steward system, said, “Which is why what Ralph de la Torre did is so disgusting.”

She continued, “Why I wanted them to seize Ralph’s horse at the Olympics that’s performing, why I wanted them to go after his yachts, why I wanted the feds to do an investigation and bring that money back into saving our system.”

The fate of Steward’s Holy Family Hospital in Haverhill is also in the mix. Sen. Barry Finegold, whose district includes the hospital, said Friday that he heard the facility was not going to be included in the bidding process alongside Holy Family Hospital in Methuen.

Steward officials have said they received binding bids for six Massachusetts hospitals, including Holy Family Hospital in Haverhill. 

A spokesperson for the Executive Office of Health and Human Services said the Executive Office of Health and Human Services “cannot comment on ongoing negotiations” when asked about the fate of the Haverhill hospital.

“Our administration remains focused on saving jobs, preserving access to care, and ensuring that Steward and its lender transfer all remaining hospitals to new ownership,” the spokesperson said.

Sen. Jamie Eldridge, who is pushing to save Nashoba Valley Medical Center from closing, said last week that he believes the Healey administration is “intricately involved” behind the scenes in the maneuvering regarding Steward hospitals.

Eldridge said that “credible sources” in union, municipal, and health care circles have told him “there are legitimate bidders for Nashoba Valley but the message they keep getting is the administration is not truly interested in having these hospitals remain open, which I think is a complete outrage.”

Eldridge said last week that he was “pleading” for the governor to send the public message that the state is interested in bidders for Nashoba Valley and interested in “bridge funding to keep these hospitals open while potential negotiations could happen.”

Sen. Nick Collins of South Boston said the news of Holy Family’s deal being on “life support” should be a cause for concern.

“Our state health officials can’t just blame Steward anymore,” he said. “The state has the power and money to save and stabilize all our community hospitals. We are already in, what medical professionals categorize, as an acute care crisis. Allowing community hospitals to be closed amidst this crisis would deprive vulnerable residents of their access to health care and particularly emergency care and that is simply unsafe.”   

Filaine Deronnette, vice president at-large of 1199SEIU United Healthcare Workers East, said members are “angered by the reported breakdown in negotiations to transfer both campuses of Holy Family Hospital to a new owner.”

“The Massachusetts healthcare system is on the brink of collapse and action is needed now,” Deronnette said. “We call upon the Healey administration and the state Legislature to do what is necessary for patients, caregivers, the patients, and the communities they serve by taking action to ensure the transfer of all six hospitals, including Holy Family Hospital in Haverhill, to new ownership. Inaction puts lives at risk and Massachusetts residents deserve better.”

Local officials in Ayer and Boston have called on the governor to declare a public health emergency to keep the Carney and Nashoba open. Healey acknowledged on WBUR that while a declaration represents an option, it does not address financial concerns.

“The question is the funding, right? Somebody has to pay to continue to operate these hospitals so that they’re able to buy the supplies and workers are able to be paid — all of these things,” Healey said, as she referenced the state’s payments to help Steward’s hospitals stay operational.

Without mentioning problems in Haverhill, Healey said there is a path to keeping five Steward hospitals open.

“I am continuing to, and our administration is continuing to, round the clock, press on negotiations, press in the bankruptcy court for the lenders to finalize the deal that’s on the table so that we can save hospitals, protect jobs and most importantly, protect patients,” Healey said.

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ALL OF STEWARD Health Care’s Massachusetts hospitals received bids as the for-profit company looks to sell off its facilities during ongoing bankruptcy proceedings, Gov. Maura Healey said Tuesday.

“We have qualified bids for all the hospitals,” Healey told reporters Tuesday afternoon when asked whether any of Steward’s hospitals had not received bids, which were due on Monday July 15.

The governor’s disclosure, made as Healey was exiting a press scrum after a meeting with legislators, comes after Department of Public Health Commissioner Dr. Robbie Goldstein last Wednesday said state officials had no information on how the bidding process worked out.

“We’ve received qualified bids. We are evaluating those now, and it’s currently with the parties right now in New York,” Healey said. “So we’re gonna wait to see what happens at the end of today. My focus remains on protecting jobs, protecting patients and protecting the stability of the health market here in Massachusetts. So something that’s evolving — we’ll continue to keep you updated and apprised on developments.”

A Steward spokesperson declined to comment on the bids Tuesday.A sales hearing is scheduled for the hospitals in US Bankruptcy Court on July 31.

Steward was taking bids on its seven hospitals operating in Massachusetts: Good Samaritan Medical Center in Brockton, Morton Hospital in Taunton, St. Anne’s Hospital in Fall River, St. Elizabeth’s Hospital in Brighton, Carney Hospital in Dorchester, Holy Family Hospital with campuses in Methuen and Haverhill, and Nashoba Valley Medical Center in Ayer. Norwood Hospital, which is temporarily closed, was not included in the sale process.

The overseer monitoring the quality of care at Steward Health Care facilities in Massachusetts reported to the bankruptcy court on Tuesday that services could be improved in some areas, but she found no “material issues impacting patient care” that put patients at risk and need immediate attention.

The first report from Suzanne Koenig, a senior living facility owner and health care management consultant tapped in May to serve as patient care ombudsman for Steward’s hospitals in Massachusetts, Ohio, Pennsylvania, and Miami-Dade County in Florida, said the hospitals are run down and staff at all levels are stretched thin. But she also reported that doctors, nurses, and other staffers remain dedicated to providing the best care they can as Steward tries to line up buyers for each of the hospitals by the end of this month.

“Although staffing across various positions at certain hospitals has proved challenging, the ombudsman did not observe any issues that made her believe patients were in immediate danger or otherwise receiving unsafe care due to staffing issues,” Koenig wrote in her filing, which was accompanied by an individual report for each hospital.

Koenig was chosen by the US Trustee Program after the bankruptcy judge ordered an ombudsman to be appointed.

She added, “The patient census at many of the hospitals has declined and appears to be partly related to negative press concerning the debtors’ hospitals and these bankruptcy cases. The ombudsman observed staff committed to providing excellent care to the patients and urges all parties in interest and the communities to continue supporting these hospitals, many of which are critical to their localities.”

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Koenig’s hospital-specific reports go into great detail on the patient experience as well as some behind-the-scenes operations, like hospital kitchens. Her report on her June 3 visit to St. Elizabeth’s in Brighton begins with her impressions of the parking garage — noting a security guard on duty, non-functioning elevators, and dirty entrance doors to the hospital — and continues with detailed descriptions of numerous hospital departments. She noted that hospital leadership and the nursing staff alike were engaged and dedicated to making improvements throughout the hospital.

“Except for many non-functioning elevators, the ombudsman did not observe anything on the day of the visit to indicate that patients are receiving unsafe care or are in immediate jeopardy,” Koenig wrote about St. Elizabeth’s.

Across the 15 hospital facilities she visited and observed (eight of which are in Massachusetts), Koenig said that staffing has been “challenging,” but levels “appear to be sufficient.” And she said she found no sign of “concerns related to procurement of adequate supplies, such as food and medical supplies, among other necessary items.”

But Koenig did note that each hospital is “in need of repairs and new or repaired equipment,” especially kitchen equipment, elevators, endoscopy scopes, and hospital chillers. And the facilities showed signs of age, with Koenig specifically pointing out old and worn furniture, various areas where paint was chipped, countertops that had laminate peeling off, and flooring that needed to be replaced either because it is a tripping hazard or is soiled.

The state Department of Public Health has had monitors closely watching for staffing, capacity, or other issues at Steward’s hospitals since the system’s financial situation began to attract public attention earlier this year. Koenig notes in her report that DPH’s involvement was helpful to her work, and she makes no similar references to her collaboration with the other three states where she is overseeing hospitals.

“As this Court is aware, the Commonwealth of Massachusetts is carefully monitoring these cases and has representatives on site at the Massachusetts hospitals on a daily basis. Therefore, the ombudsman, who may only visit the hospitals once during each report period, appreciates the Commonwealth of Massachusetts’s willingness to share reports and other information regarding the Massachusetts hospitals,” she wrote.

Koenig filed an individual report on her visits to each of the eight Steward campuses in Massachusetts. Her reports offered the following observations about the facilities:

St. Elizabeth’s Medical Center in Brighton: “Except for many non-functioning elevators, the ombudsman did not observe anything on the day of the visit to indicate that patients are receiving unsafe care or are in immediate jeopardy.”

Carney Hospital in Dorchester: “There is a concern that a patient in the ED, while under 1:1 supervision, was allowed to go to the bathroom unattended and attempted suicide. The ombudsman’s representative was told that hospital leadership will thoroughly evaluate that incident and input measures going forward to mitigate another occurrence. The ombudsman will continue to monitor this issue. Outside of that incident, the ombudsman’s representative did not observe other issues that would put patients and their care in immediate danger.”

Morton Hospital in Taunton: “The hospital has an engaged leadership team that works together to provide the best experience possible for the patients. There is an active patient advocate that performs rounds on patients and follows up on any patient complaints. … The nursing staff told the ombudsman that they love the hospital and are very concerned with all the ‘negative publicity.’ Throughout the tour, the ombudsman did not note or observe anything that caused concern regarding patient care and safety. The ombudsman plans to return for an unannounced visit.”

Good Samaritan Medical Center in Brockton: “There is a concern regarding Brockton [Hospital] calling back staffing assets out of Good Samaritan to work from home for four weeks while the staff prepare to return to their original employer, Brockton Hospital. The concern is that a sudden loss of approximately 25 RN FTEs would cause possible nursing gaps that wouldn’t allow Good Samaritan to staff appropriately to care for the increased patient load at Good Samaritan due to Brockton Hospital’s ongoing closure through end of August, 2024. … While on site, the ombudsman held a joint call with the president, north region and system CMO for Steward Healthcare System LLC and the Commissioner of the Massachusetts’ Department of Public Health. In conjunction with Brockton Hospital, the group is creating a plan to continue to provide safe and appropriate care to all patients at the Hospital while Brockton Hospital prepares its staff to return to work on their campus.”

St. Anne’s Hospital in Fall River: “Other than the plant and equipment issues noted above at the hospital, the ombudsman did not note any areas of concern during her visit. The ombudsman did not observe any concerns with respect to patient care and safety at this hospital during her visit.”

Nashoba Valley Medical Center in Ayer: “The Ombudsman interviewed a patient in the ICU without the presence of hospital staff. The room environment was clean. The patient was seated upright in a chair with oxygen being administered through an oxygen conserving device and pendant. The patients bed linens and pads were clean and orderly. The patient was a mid-60-year-old who had never been sick before. The patient arrived at the hospital with severe pneumonia upon admission. The patient had a limited ability to carry on a conversation due to the respiratory status. The patient told the ombudsman that the patient had been in the hjspital for more than one month and had received phenomenal care from all of the staff. … The patient was smiling and told the ombudsman that ‘they saved my life.'”

Holy Family Hospital – Methuen campus: “The ombudsman and her representative did not observe anything that would make the care that the patients are receiving unsafe or in immediate jeopardy. Infection control rates are excellent and appropriate. Successful sepsis care in the emergency department is at a 75 percent success rate — much higher than the Massachusetts average of 58 percent.”

Holy Family Hospital – Haverhill campus: “Hospital leadership is engaged and actively trying to solve any Hospital issues. The staff is engaged with the leadership. The ombudsman and her representative did not witness anything concerning that would put a patient is in danger or immediate jeopardy.”

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THREE LONG-TERM care facilities were placed under temporary receivership as lawmakers on Beacon Hill scrambled to act on legislation that would strengthen state oversight of nursing homes and other long-term care facilities.

Facilities owned by Blupoint Healthcare in South Hadley, Whitinsville, and Amesbury were experiencing financial difficulties, with workers complaining they weren’t being paid and even when they were paid the checks bounced.

State officials became alarmed at what Attorney General Andrea Campbell called “dangerous understaffing and poor quality of care,” so they filed an emergency petition in Suffolk Superior Court seeking a temporary receiver who could assess the situation and possibly shut the facilities down and transfer residents elsewhere.

“Receivership will help stabilize the situation by taking control of finances and supporting daily operations, while protecting the welfare of residents and staff,” Campbell said in a statement. .A court hearing is scheduled for Thursday.

The situation at Blupoint is increasingly common. The number of nursing homes is falling faster in New England than any other region of the country, according to a May report from the Federal Reserve Bank of Boston. The area has seen a net loss of more than 150 nursing facilities between 2011 and 2024.

Blupoint officials, who oversee Pioneer Valley Health and Rehabilitation in South Hadley, Blackstone Valley Health and Rehabilitation in Whitinsville, and Mill Town Health and Rehabilitation in Amesbury, could not be reached for comment.

Legislation focused on long-term care facilities is coming up for debate in the Senate on Thursday, eight after the House passed its version of the bill. The Senate bill is meant to reform the long-term care sector — an idea whose roots predate the COVID-19 pandemic that cast a harsh spotlight on lackluster infection controls, staffing shortages, and other pitfalls in the senior care system.

House Speaker Ron Mariano has identified the bill as one of his priorities for the session. Elder Affairs Committee Co-chair Rep. Thomas Stanley said earlier this month that the legislation could thwart the spate of nursing home closures seen in recent years, which have sent families scrambling to find new care options for their loved ones.

The Senate Ways and Means bill would create a “stronger” licensure process for long-term care facilities under the Department of Public Health, per Senate Ways and Means spokesman Sean Fitzgerald, and require every long-term care center to be inspected at least once every nine to 15 months, according to a bill summary.

Fitzgerald said that, under the bill, owners or management companies with at least 5 percent controlling interest in a facility would be required to disclose information to the Department of Public Health, which could review their criminal and civil litigation history and financial capacity, including filing for bankruptcy, any default under a lending agreement, the appointment of a receiver, or the recording of any lien.

The Massachusetts Assisted Living Association issued a statement encouraging the Senate to ease up on the requirement. “At a time when more assisted living is needed for our aging population, we also hope the ownership disclosure threshold will be increased to 15 percent, as the current 5 percent would disincentivize critical investments,” said Brian Doherty, president and CEO of the association.

The bill would also add providing basic health services into the certification process for assisted living facilities and have the Executive Office of Elder Affairs annually review all of the residences certified to provide such services.

Nurses could not provide certain services, such as administering insulin injections or basic wound care, in assisted living facilities under state law. The arrival of the COVID pandemic temporarily changed that, with an emergency order that allowed nurses to temporarily provide this basic care.

The COVID-era temporary health services, staffing and training flexibilities in assisted living were extended through March 31, 2024, as part of a supplemental budget approved earlier this year, and this bill would allow for some of those changes to become permanent.

“We applaud the Senate Ways and Means Committee for advancing basic health services in assisted living … It is important that the health services be made permanent so that more older adults have access to care from their nurses in assisted living,” Doherty’s statement said.

Along with the House, the Senate Ways and Means bill would require all long-term care facilities to develop individualized infection outbreak response plans.

High numbers of COVID deaths were reported across the country during the early days of the pandemic, and many facilities lacked resources and response plans to stop the spread of the highly contagious virus between elderly residents.

Like other sectors, the industry has long been grappling with staffing shortages, particularly during and after the pandemic. Last year, the Massachusetts Senior Care Association published results of a survey that found most facilities were near capacity with an average occupancy rate of 93 percent, coupled with thousands of job vacancies.

To address some workers’ concerns, the Senate Ways and Means bill creates some protections for employees. It forbids assisted living residences from discharging and disciplining employees who file a complaint with the Executive Office of Elder Affairs.

It also creates long-term facilities transfer requirements, including that a facility provide notice to its staff and to any union representing their employees at the time of the notice of intent to acquire.

The DPH would also have to issue regulations for the operation of small house nursing homes, facilities designed as residential homes that include a living room, kitchen, dining area, and outdoor space. The House bill limited newly constructed small house nursing homes to no more than 14 individuals per unit, with resident rooms accommodating only one person except in the cases of spouses, family members, or friends; the Senate Ways and Means summary did not include details about the committee’s preferred model.

To give state enforcement more teeth, the bill would quintuple penalties the attorney general can seek for abuse and neglect of patients, to $25,000 if the resident is not hurt, $50,000 if someone is hurt, $100,000 if an employee sexually assaults or seriously injures a resident, and $250,000 if a resident dies. This language matches the House bill.

Doherty said the Massachusetts Assisted Living Association will be supporting an amendment to limit the scopes of fines in the bill “as unlimited fines could be a major challenge for providers.”

One section of the Senate bill that was not included in what the House passed last fall is building-specific protections for older adults who are members of the LGBTQ+ community.

It would require that every long-term care facility provide staff training on the care of LGBTQ+ adults who have HIV. It would also explicitly forbid centers to discriminate against residents based on their sexual orientation, gender identity, or HIV status.

Centers would also be required to provide transgender residents with access to therapy and treatments recommended by their health care providers, and “ensure that resident records, including records generated at the time of admission, include the resident’s gender and the name and pronouns by which the resident would like to be identified, as indicated by the resident,” according to the bill summary.

The Senate bill includes another major provision of the House legislation — allowing for the Department of Public Health to institute a hand-picked “temporary manager” at a long-term care facility if the center isn’t in compliance with state and federal laws.

That mechanism could have staunched financial and payroll challenges at the Edgar P. Benjamin Healthcare Center, a Mission Hill nursing home that a court ultimately placed into state receivership, said Tara Gregorio, president of the Massachusetts Senior Care Association.

“If the bill does not pass, I worry that we’ll have missed an opportunity to really improve patient care and safety, address our workforce issues, and ensure that we have greater accountability and transparency in the sector, which I think is what everybody wants,” Gregorio said earlier this month. 

Other reforms in the bill have to do with reforming Medicaid rates for skilled nurses working at these facilities, requiring the Department of Insurance to develop a uniform prior-authorization form for admission to a post-acute care facility, and increasing penalties for those who advertise or run a long-term care center without a license.

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