| 1 | 1 | | 1 of 1 |
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| 2 | 2 | | HOUSE DOCKET, NO. 3708 FILED ON: 1/20/2023 |
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| 3 | 3 | | HOUSE . . . . . . . . . . . . . . . No. 2266 |
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| 4 | 4 | | The Commonwealth of Massachusetts |
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| 5 | 5 | | _________________ |
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| 6 | 6 | | PRESENTED BY: |
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| 7 | 7 | | Jon Santiago and Tram T. Nguyen |
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| 8 | 8 | | _________________ |
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| 9 | 9 | | To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General |
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| 10 | 10 | | Court assembled: |
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| 11 | 11 | | The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill: |
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| 12 | 12 | | An Act to promote public health through the Prevention and Wellness Trust Fund. |
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| 13 | 13 | | _______________ |
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| 14 | 14 | | PETITION OF: |
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| 15 | 15 | | NAME:DISTRICT/ADDRESS :DATE ADDED:Jon Santiago9th Suffolk1/17/2023Vanna Howard17th Middlesex2/7/2023James B. EldridgeMiddlesex and Worcester2/13/2023 1 of 10 |
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| 16 | 16 | | HOUSE DOCKET, NO. 3708 FILED ON: 1/20/2023 |
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| 17 | 17 | | HOUSE . . . . . . . . . . . . . . . No. 2266 |
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| 18 | 18 | | By Representatives Santiago of Boston and Nguyen of Andover, a petition (accompanied by bill, |
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| 19 | 19 | | House, No. 2266) of Jon Santiago, Vanna Howard and James B. Eldridge for legislation to |
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| 20 | 20 | | promote public health through the Prevention and Wellness Trust Fund. Public Health. |
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| 21 | 21 | | The Commonwealth of Massachusetts |
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| 22 | 22 | | _______________ |
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| 23 | 23 | | In the One Hundred and Ninety-Third General Court |
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| 24 | 24 | | (2023-2024) |
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| 25 | 25 | | _______________ |
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| 26 | 26 | | An Act to promote public health through the Prevention and Wellness Trust Fund. |
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| 27 | 27 | | Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority |
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| 28 | 28 | | of the same, as follows: |
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| 29 | 29 | | 1 SECTION 1. Section 2G of Chapter 111 of the MGL is hereby amended by striking in its |
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| 30 | 30 | | 2entirety and replacing it with the following new section:- |
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| 31 | 31 | | 3 Section 2G. (a) There shall be established and set upon the books of the Commonwealth a |
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| 32 | 32 | | 4separate fund to be known as the Prevention and Wellness Trust Fund to be expended, without |
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| 33 | 33 | | 5further appropriation, by the department of public health. The fund shall consist of revenues |
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| 34 | 34 | | 6collected by the commonwealth including: (1) any revenue from appropriations or other monies |
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| 35 | 35 | | 7authorized by the general court and specifically designated to be credited to the fund; (2) any |
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| 36 | 36 | | 8fines and penalties allocated to the fund under the General Laws; (3) any funds from public and |
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| 37 | 37 | | 9private sources such as gifts, grants and donations to further community-based prevention |
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| 38 | 38 | | 10activities; (4) any interest earned on such revenues; and (5) any funds provided from other |
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| 39 | 39 | | 11sources. The commissioner of public health, as trustee, shall administer the fund. The |
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| 40 | 40 | | 12commissioner, in consultation with the Prevention and Wellness Advisory Board established 2 of 10 |
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| 41 | 41 | | 13under section 2H, shall make expenditures from the fund consistent with subsections (d) and (e); |
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| 42 | 42 | | 14provided, that not more than 10 per cent of the amounts held in the fund shall be used by the |
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| 43 | 43 | | 15department for the cost of program administration and not more than 10 per cent of amounts held |
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| 44 | 44 | | 16in the fund shall be used for technical assistance to grantees, program evaluation and data |
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| 45 | 45 | | 17analytics. |
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| 46 | 46 | | 18 (b) The department may incur expenses and the comptroller may certify payment of |
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| 47 | 47 | | 19amounts in anticipation of expected receipts; provided, however, that no expenditure shall be |
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| 48 | 48 | | 20made from the fund which shall cause the fund to be in deficit at the close of a fiscal year. |
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| 49 | 49 | | 21Revenues deposited in the fund that are unexpended at the end of the fiscal year shall not revert |
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| 50 | 50 | | 22to the General Fund and shall be available for expenditure in the following fiscal year. |
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| 51 | 51 | | 23 (c) All expenditures from the Prevention and Wellness Trust Fund shall support 1 or |
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| 52 | 52 | | 24more of the following purposes: (1) increase access to community-based preventive services and |
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| 53 | 53 | | 25strategies which complement and expand the ability of MassHealth to promote coordinated care, |
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| 54 | 54 | | 26integrate community-based services with clinical care, and develop innovative ways of |
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| 55 | 55 | | 27addressing social determinants of health; (2) reduce the largest drivers of poor health, health |
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| 56 | 56 | | 28disparities, reduced quality of life, and high health care costs though community-based |
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| 57 | 57 | | 29strategies; (3) increase access to health promoting conditions and opportunities to improve |
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| 58 | 58 | | 30quality of life and reduce health care costs for populations experiencing health outcome |
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| 59 | 59 | | 31inequities through community-based strategies including policy, systems, and environmental |
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| 60 | 60 | | 32changes or (4) develop a stronger evidence-base of effective primary prevention strategies. |
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| 61 | 61 | | 33 (d) The commissioner shall award not less than 80 per cent of the Prevention and |
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| 62 | 62 | | 34Wellness Trust Fund through a competitive grant process to municipalities, community-based 3 of 10 |
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| 63 | 63 | | 35organizations, health care providers, regional-planning agencies, and health plans that apply for |
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| 64 | 64 | | 36the implementation, evaluation and dissemination of evidence-based community preventive |
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| 65 | 65 | | 37health strategies. To be eligible to receive a grant under this subsection, a recipient shall be a |
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| 66 | 66 | | 38partnership that includes at minimum: (1) a municipality or regional planning agency; (2) a |
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| 67 | 67 | | 39community-based health or social service provider; (3) a public health or community action |
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| 68 | 68 | | 40agency with expertise in implementing community-wide health strategies (4) a health care |
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| 69 | 69 | | 41provider or a health plan; (5) where feasible, a Medicaid-certified accountable care organization |
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| 70 | 70 | | 42or a Medicaid-certified Community Partner organization. Expenditures from the fund for such |
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| 71 | 71 | | 43purposes shall supplement and not replace existing local, state, private or federal public health- |
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| 72 | 72 | | 44related funding. All entities awarded funds through this program must demonstrate the ability to |
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| 73 | 73 | | 45utilize best practices in accounting, contract with a fiscal agent who will perform accounting |
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| 74 | 74 | | 46functions on their behalf, or be provided with technical assistance by the Department to ensure |
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| 75 | 75 | | 47best practices are followed. |
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| 76 | 76 | | 48 (e) A grant proposal submitted under subsection (d) shall include, but not be limited to: |
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| 77 | 77 | | 49(1) a plan that defines specific goals for the reduction in preventable health conditions and health |
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| 78 | 78 | | 50care costs over a multi-year period; (2) the evidence-based or evidence-informed programs the |
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| 79 | 79 | | 51applicant shall use to meet the goals; (3) a budget necessary to implement the plan, including a |
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| 80 | 80 | | 52detailed description of the funding or in-kind contributions the applicant or applicants will be |
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| 81 | 81 | | 53providing in support of the proposal; (4) any other private funding or private sector participation |
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| 82 | 82 | | 54the applicant anticipates in support of the proposal; (5) a description of how the proposed |
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| 83 | 83 | | 55strategies have been informed by community residents most at risk for health inequities, |
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| 84 | 84 | | 56including women, racial and ethnic minorities and low income individuals; and (6) the |
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| 85 | 85 | | 57anticipated number of individuals that would be affected by implementation of the plan. Priority 4 of 10 |
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| 86 | 86 | | 58may be given to proposals in a geographic region of the state with a higher than average |
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| 87 | 87 | | 59prevalence of preventable health conditions, as determined by the commissioner of public health, |
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| 88 | 88 | | 60in consultation with the Prevention and Wellness Advisory Board. If no proposals were offered |
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| 89 | 89 | | 61in areas of the state with particular need, the department shall ask for a specific request for |
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| 90 | 90 | | 62proposal for that specific region. If the commissioner determines that no suitable proposals have |
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| 91 | 91 | | 63been received, such that the specific needs remain unmet, the department may work directly with |
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| 92 | 92 | | 64municipalities or community-based organizations to develop grant proposals. The department of |
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| 93 | 93 | | 65public health shall, in consultation with the Prevention and Wellness Advisory Board, develop |
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| 94 | 94 | | 66guidelines for an annual review of the progress being made by each grantee. Each grantee shall |
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| 95 | 95 | | 67participate in any evaluation or accountability process implemented or authorized by the |
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| 96 | 96 | | 68department. |
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| 97 | 97 | | 69 (f) The department of public health shall, annually on or before January 31, report on |
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| 98 | 98 | | 70expenditures from the Prevention and Wellness Trust Fund. The report shall include, but not be |
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| 99 | 99 | | 71limited to: (1) the revenue credited to the fund; (2) the amount of fund expenditures attributable |
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| 100 | 100 | | 72to the administrative costs of the department of public health; (3) an itemized list of the funds |
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| 101 | 101 | | 73expended through the competitive grant process and a description of the grantee activities; and |
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| 102 | 102 | | 74(4) status report of the evaluation of the effectiveness of the activities funded through grants. The |
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| 103 | 103 | | 75report shall be provided to the chairpersons of the house and senate committees on ways and |
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| 104 | 104 | | 76means, the joint committee on public health, and the joint committee on health care financing |
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| 105 | 105 | | 77and shall be posted on the department of public health’s website, and shall be posted on the |
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| 106 | 106 | | 78department’s website. |
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| 107 | 107 | | 79 (g) The department of public health shall, under the advice and guidance of the |
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| 108 | 108 | | 80Prevention and Wellness Advisory Board, report periodically on its strategy for administration 5 of 10 |
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| 109 | 109 | | 81and allocation of the fund, including relevant evaluation criteria. The report shall set forth the |
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| 110 | 110 | | 82rationale for such strategy, which may include: (1) a list of the most prevalent preventable health |
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| 111 | 111 | | 83conditions in the commonwealth, including health disparities experienced by populations based |
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| 112 | 112 | | 84on race, ethnicity, gender, disability status, sexual orientation or socio-economic status; (2) a list |
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| 113 | 113 | | 85of the most costly preventable health conditions in the commonwealth; (3) a list of community- |
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| 114 | 114 | | 86level risk factors and precursors to the health conditions identified in (1) and (2); and (4) a list of |
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| 115 | 115 | | 87evidence-based or promising community-based strategies related to the conditions identified in |
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| 116 | 116 | | 88clauses (1) and (2). The report shall recommend specific areas of focus for allocation of funds. If |
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| 117 | 117 | | 89appropriate, the report shall reference goals and best practices established by the National |
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| 118 | 118 | | 90Prevention and Public Health Promotion Council, the Centers for Disease Control and |
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| 119 | 119 | | 91Prevention, and other relevant experts, including but not limited to MassUP, the Hi-5 Initiative, |
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| 120 | 120 | | 92the national prevention strategy, the healthy people report, the guide to community preventive |
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| 121 | 121 | | 93services, and the Robert Wood Johnson culture of health initiative. |
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| 122 | 122 | | 94 (h) The department of public health shall promulgate regulations necessary to carry out |
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| 123 | 123 | | 95this section. |
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| 124 | 124 | | 96 SECTION 2. Section 2H of Chapter 111 of the General Laws is hereby amended by |
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| 125 | 125 | | 97striking in its entirety and replacing it with the following new section:- |
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| 126 | 126 | | 98 Section 2H. (a) There shall be a Prevention and Wellness Advisory Board to make |
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| 127 | 127 | | 99recommendations to the commissioner concerning the administration and allocation of the |
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| 128 | 128 | | 100Prevention and Wellness Trust Fund established in section 2G, establish evaluation criteria and |
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| 129 | 129 | | 101perform any other functions specifically granted to it by law. 6 of 10 |
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| 130 | 130 | | 102 (b) The board shall consist of the commissioner of public health or a designee, who shall |
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| 131 | 131 | | 103serve as chairperson; the house and senate chairs of the joint committee on public health or their |
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| 132 | 132 | | 104designees; the house and senate chairs of the joint committee on health care financing or their |
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| 133 | 133 | | 105designees; the secretary of health and human services or a designee; the executive director of the |
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| 134 | 134 | | 106center for health information and analysis or a designee; the executive director of the health |
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| 135 | 135 | | 107policy commission established in section 2 of chapter 6D of the MGL or a designee; and 16 |
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| 136 | 136 | | 108persons to be appointed by the governor, 1 of whom shall be a person with expertise in the field |
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| 137 | 137 | | 109of public health economics; 1 of whom shall be a person with expertise in public health research; |
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| 138 | 138 | | 1101 of whom shall be a person with expertise in the field of health equity; 1 of whom shall be a |
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| 139 | 139 | | 111person from a local board of health for a city or town with a population greater than 50,000; 1 of |
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| 140 | 140 | | 112whom shall be a person of a board of health for a city or town with a population of fewer than |
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| 141 | 141 | | 11350,000; 1 of whom shall be representatives of health insurance carriers; 1 of whom shall be a |
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| 142 | 142 | | 114person from a consumer health advocacy organization; 1 of whom shall be a person from a |
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| 143 | 143 | | 115hospital association; 1 of whom shall be a person from a statewide public health organization; 1 |
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| 144 | 144 | | 116of whom shall be a representative of the interest of businesses; 1 of whom shall be a public |
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| 145 | 145 | | 117health nurse or a school nurse; 1 of whom shall be a person from an association representing |
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| 146 | 146 | | 118community health workers; 2 of whom shall represent a statewide association of community- |
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| 147 | 147 | | 119based service providers addressing public health; and 2 of whom shall be a person with expertise |
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| 148 | 148 | | 120in the design and implementation of community-wide public health strategies. In selecting |
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| 149 | 149 | | 121appointees, the governor shall consider diverse representation on the board by race, ethnicity, |
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| 150 | 150 | | 122gender, and geographic region. |
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| 151 | 151 | | 123 (c) The Prevention and Wellness Advisory Board shall evaluate the program authorized |
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| 152 | 152 | | 124in section 2G of said chapter 111 and shall issue an evaluation report at an interval to be 7 of 10 |
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| 153 | 153 | | 125determined by the Board, but not less than every 5 years from the beginning of each grant period. |
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| 154 | 154 | | 126The report shall include an analysis of all relevant data to determine the effectiveness of the |
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| 155 | 155 | | 127program including, but not limited to, an analysis of: (i) the extent to which the program |
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| 156 | 156 | | 128impacted the prevalence, severity, or control of preventable health conditions and the extent to |
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| 157 | 157 | | 129which the program is projected to impact such factors in the future; (ii) the extent to which the |
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| 158 | 158 | | 130program reduced health care costs or the growth in health care cost trends and the extent to |
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| 159 | 159 | | 131which the program is projected to reduce such costs in the future; (iii) whether health care or |
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| 160 | 160 | | 132other costs were reduced and who benefited from the reduction; (iv) the extent that health |
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| 161 | 161 | | 133outcomes or health behaviors were positively impacted; (v) the extent that access to evidence- |
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| 162 | 162 | | 134based community strategies was increased; (vi) the extent to which the social determinants of |
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| 163 | 163 | | 135health were addressed by grantees; (vii) the extent that community wide risk factors for poor |
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| 164 | 164 | | 136health were reduced or mitigated; (viii) the extent that grantees increased their ability to |
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| 165 | 165 | | 137collaborate, share data, and align services with other providers and community-based |
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| 166 | 166 | | 138organizations for greater impact; (ix) the extent to which health inequities experienced by |
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| 167 | 167 | | 139populations based on race, ethnicity, gender, disability status, sexual orientation or socio- |
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| 168 | 168 | | 140economic status were reduced across all metrics; and (x) recommendations for whether the |
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| 169 | 169 | | 141program should be discontinued, amended or expanded and a timetable for implementation of the |
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| 170 | 170 | | 142recommendations. |
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| 171 | 171 | | 143 The department of public health shall coordinate with grantees to contract with an outside |
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| 172 | 172 | | 144organization that has expertise in the analysis of public health and health care financing to assist |
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| 173 | 173 | | 145the board in conducting its evaluation. The outside organization shall be provided access to |
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| 174 | 174 | | 146actual health plan data from the all-payer claims database as administered by the center for |
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| 175 | 175 | | 147health information and analysis and data from MassHealth, to the extent permitted by law; 8 of 10 |
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| 176 | 176 | | 148provided, however, that the data shall be confidential and shall not be a public record under |
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| 177 | 177 | | 149clause Twenty-sixth of section 7 of chapter 4 of the General Laws. |
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| 178 | 178 | | 150 The board shall report the results of its evaluation and its recommendations, if any, and |
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| 179 | 179 | | 151drafts of legislation necessary to carry out the recommendations to the house and senate |
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| 180 | 180 | | 152committees on ways and means, the joint committee on public health, and the joint committee on |
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| 181 | 181 | | 153health care financing and shall post the board’s report on the website of the department of public |
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| 182 | 182 | | 154health. |
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| 183 | 183 | | 155 SECTION 3. Section 68 of Chapter 118E of the General Laws is hereby amended by |
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| 184 | 184 | | 156inserting after subsection (f) the following subsection:– |
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| 185 | 185 | | 157 (g) (1) In addition to the surcharge assessed under subsection (a), acute hospitals and |
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| 186 | 186 | | 158ambulatory surgical centers shall assess a prevention and wellness surcharge on all payments |
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| 187 | 187 | | 159subject to surcharge as defined in section 64. The prevention and wellness surcharge amount |
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| 188 | 188 | | 160shall equal the product of (i) the prevention wellness surcharge percentage and (ii) amounts paid |
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| 189 | 189 | | 161for these services by a surcharge payor. The office shall calculate the prevention and cost control |
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| 190 | 190 | | 162surcharge percentage by dividing $15,000,000 by the projected annual aggregate payments |
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| 191 | 191 | | 163subject to the surcharge, excluding projected annual aggregate payments based on payments |
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| 192 | 192 | | 164made by managed care organizations. The office shall determine the prevention and wellness |
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| 193 | 193 | | 165surcharge percentage before the start of each fund fiscal year and may redetermine the |
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| 194 | 194 | | 166prevention and wellness surcharge percentage before April 1 of each fund fiscal year if the |
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| 195 | 195 | | 167division projects that the initial prevention and wellness surcharge established the previous |
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| 196 | 196 | | 168October will produce less than $10,000,000 or more than $20,000,000. Before each succeeding |
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| 197 | 197 | | 169October 1, the office shall redetermine the prevention and wellness surcharge percentage 9 of 10 |
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| 198 | 198 | | 170incorporating any adjustments from earlier years. In each determination or redetermination of the |
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| 199 | 199 | | 171prevention and wellness surcharge percentage, the office shall use the best data available as |
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| 200 | 200 | | 172determined by the office and may consider the effect on projected prevention and wellness |
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| 201 | 201 | | 173surcharge payments of any modified or waived enforcement under subsection (e). The office |
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| 202 | 202 | | 174shall incorporate all adjustments, including, but not limited to, updates or corrections or final |
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| 203 | 203 | | 175settlement amounts, by prospective adjustment rather than by retrospective payments or |
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| 204 | 204 | | 176assessments. |
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| 205 | 205 | | 177 (2) Prevention and wellness surcharge payments shall be deposited in the Prevention and |
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| 206 | 206 | | 178Wellness Trust Fund, established in section 2G of chapter 111. |
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| 207 | 207 | | 179 (3) All provisions of subsections (a) to (f) and section 64 shall apply to the prevention |
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| 208 | 208 | | 180and wellness surcharge, to the extent not inconsistent with the provisions of this subsection. |
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| 209 | 209 | | 181 SECTION 4. Section 14 of Chapter 94G is hereby amended by striking out subsection |
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| 210 | 210 | | 182 (b), inserted by section 40 of chapter 55 of the acts of 2017, and inserting in place thereof |
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| 211 | 211 | | 183the following subsection:- |
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| 212 | 212 | | 184 (b) Money in the fund shall be subject to appropriation. Money in the fund shall be |
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| 213 | 213 | | 185expended for the implementation, administration and enforcement of this chapter by the |
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| 214 | 214 | | 186commission and by the department of agricultural resources for the implementation, |
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| 215 | 215 | | 187administration and enforcement of sections 116 to 123, inclusive, of chapter 128 and the |
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| 216 | 216 | | 188provision of pesticide control pursuant to chapter 132B; provided, that 10 per cent of the |
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| 217 | 217 | | 189amounts held in the fund in any 1 year shall be transferred annually to the Prevention and |
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| 218 | 218 | | 190Wellness Trust Fund established in section 2G of chapter 111, not later than June 30. Thereafter, |
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| 219 | 219 | | 191money in the fund shall be expended for: (i) public and behavioral health including but not 10 of 10 |
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| 220 | 220 | | 192limited to, evidence-based and evidence-informed substance use prevention and treatment and |
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| 221 | 221 | | 193substance use early intervention services in a recurring grant for school districts or community |
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| 222 | 222 | | 194coalitions who operate on the strategic prevention framework or similar structure for youth |
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| 223 | 223 | | 195substance use education and prevention; (ii) public safety; (iii) municipal police training; and (iv) |
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| 224 | 224 | | 196programming for restorative justice, jail diversion, workforce development, industry specific |
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| 225 | 225 | | 197technical assistance, and mentoring services for economically-disadvantaged persons in |
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| 226 | 226 | | 198communities disproportionately impacted by high rates of arrest and incarceration for marijuana |
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| 227 | 227 | | 199offenses pursuant to chapter 94C. |
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