Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H2266 Compare Versions

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22 HOUSE DOCKET, NO. 3708 FILED ON: 1/20/2023
33 HOUSE . . . . . . . . . . . . . . . No. 2266
44 The Commonwealth of Massachusetts
55 _________________
66 PRESENTED BY:
77 Jon Santiago and Tram T. Nguyen
88 _________________
99 To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
1010 Court assembled:
1111 The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
1212 An Act to promote public health through the Prevention and Wellness Trust Fund.
1313 _______________
1414 PETITION OF:
1515 NAME:DISTRICT/ADDRESS :DATE ADDED:Jon Santiago9th Suffolk1/17/2023Vanna Howard17th Middlesex2/7/2023James B. EldridgeMiddlesex and Worcester2/13/2023 1 of 10
1616 HOUSE DOCKET, NO. 3708 FILED ON: 1/20/2023
1717 HOUSE . . . . . . . . . . . . . . . No. 2266
1818 By Representatives Santiago of Boston and Nguyen of Andover, a petition (accompanied by bill,
1919 House, No. 2266) of Jon Santiago, Vanna Howard and James B. Eldridge for legislation to
2020 promote public health through the Prevention and Wellness Trust Fund. Public Health.
2121 The Commonwealth of Massachusetts
2222 _______________
2323 In the One Hundred and Ninety-Third General Court
2424 (2023-2024)
2525 _______________
2626 An Act to promote public health through the Prevention and Wellness Trust Fund.
2727 Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
2828 of the same, as follows:
2929 1 SECTION 1. Section 2G of Chapter 111 of the MGL is hereby amended by striking in its
3030 2entirety and replacing it with the following new section:-
3131 3 Section 2G. (a) There shall be established and set upon the books of the Commonwealth a
3232 4separate fund to be known as the Prevention and Wellness Trust Fund to be expended, without
3333 5further appropriation, by the department of public health. The fund shall consist of revenues
3434 6collected by the commonwealth including: (1) any revenue from appropriations or other monies
3535 7authorized by the general court and specifically designated to be credited to the fund; (2) any
3636 8fines and penalties allocated to the fund under the General Laws; (3) any funds from public and
3737 9private sources such as gifts, grants and donations to further community-based prevention
3838 10activities; (4) any interest earned on such revenues; and (5) any funds provided from other
3939 11sources. The commissioner of public health, as trustee, shall administer the fund. The
4040 12commissioner, in consultation with the Prevention and Wellness Advisory Board established 2 of 10
4141 13under section 2H, shall make expenditures from the fund consistent with subsections (d) and (e);
4242 14provided, that not more than 10 per cent of the amounts held in the fund shall be used by the
4343 15department for the cost of program administration and not more than 10 per cent of amounts held
4444 16in the fund shall be used for technical assistance to grantees, program evaluation and data
4545 17analytics.
4646 18 (b) The department may incur expenses and the comptroller may certify payment of
4747 19amounts in anticipation of expected receipts; provided, however, that no expenditure shall be
4848 20made from the fund which shall cause the fund to be in deficit at the close of a fiscal year.
4949 21Revenues deposited in the fund that are unexpended at the end of the fiscal year shall not revert
5050 22to the General Fund and shall be available for expenditure in the following fiscal year.
5151 23 (c) All expenditures from the Prevention and Wellness Trust Fund shall support 1 or
5252 24more of the following purposes: (1) increase access to community-based preventive services and
5353 25strategies which complement and expand the ability of MassHealth to promote coordinated care,
5454 26integrate community-based services with clinical care, and develop innovative ways of
5555 27addressing social determinants of health; (2) reduce the largest drivers of poor health, health
5656 28disparities, reduced quality of life, and high health care costs though community-based
5757 29strategies; (3) increase access to health promoting conditions and opportunities to improve
5858 30quality of life and reduce health care costs for populations experiencing health outcome
5959 31inequities through community-based strategies including policy, systems, and environmental
6060 32changes or (4) develop a stronger evidence-base of effective primary prevention strategies.
6161 33 (d) The commissioner shall award not less than 80 per cent of the Prevention and
6262 34Wellness Trust Fund through a competitive grant process to municipalities, community-based 3 of 10
6363 35organizations, health care providers, regional-planning agencies, and health plans that apply for
6464 36the implementation, evaluation and dissemination of evidence-based community preventive
6565 37health strategies. To be eligible to receive a grant under this subsection, a recipient shall be a
6666 38partnership that includes at minimum: (1) a municipality or regional planning agency; (2) a
6767 39community-based health or social service provider; (3) a public health or community action
6868 40agency with expertise in implementing community-wide health strategies (4) a health care
6969 41provider or a health plan; (5) where feasible, a Medicaid-certified accountable care organization
7070 42or a Medicaid-certified Community Partner organization. Expenditures from the fund for such
7171 43purposes shall supplement and not replace existing local, state, private or federal public health-
7272 44related funding. All entities awarded funds through this program must demonstrate the ability to
7373 45utilize best practices in accounting, contract with a fiscal agent who will perform accounting
7474 46functions on their behalf, or be provided with technical assistance by the Department to ensure
7575 47best practices are followed.
7676 48 (e) A grant proposal submitted under subsection (d) shall include, but not be limited to:
7777 49(1) a plan that defines specific goals for the reduction in preventable health conditions and health
7878 50care costs over a multi-year period; (2) the evidence-based or evidence-informed programs the
7979 51applicant shall use to meet the goals; (3) a budget necessary to implement the plan, including a
8080 52detailed description of the funding or in-kind contributions the applicant or applicants will be
8181 53providing in support of the proposal; (4) any other private funding or private sector participation
8282 54the applicant anticipates in support of the proposal; (5) a description of how the proposed
8383 55strategies have been informed by community residents most at risk for health inequities,
8484 56including women, racial and ethnic minorities and low income individuals; and (6) the
8585 57anticipated number of individuals that would be affected by implementation of the plan. Priority 4 of 10
8686 58may be given to proposals in a geographic region of the state with a higher than average
8787 59prevalence of preventable health conditions, as determined by the commissioner of public health,
8888 60in consultation with the Prevention and Wellness Advisory Board. If no proposals were offered
8989 61in areas of the state with particular need, the department shall ask for a specific request for
9090 62proposal for that specific region. If the commissioner determines that no suitable proposals have
9191 63been received, such that the specific needs remain unmet, the department may work directly with
9292 64municipalities or community-based organizations to develop grant proposals. The department of
9393 65public health shall, in consultation with the Prevention and Wellness Advisory Board, develop
9494 66guidelines for an annual review of the progress being made by each grantee. Each grantee shall
9595 67participate in any evaluation or accountability process implemented or authorized by the
9696 68department.
9797 69 (f) The department of public health shall, annually on or before January 31, report on
9898 70expenditures from the Prevention and Wellness Trust Fund. The report shall include, but not be
9999 71limited to: (1) the revenue credited to the fund; (2) the amount of fund expenditures attributable
100100 72to the administrative costs of the department of public health; (3) an itemized list of the funds
101101 73expended through the competitive grant process and a description of the grantee activities; and
102102 74(4) status report of the evaluation of the effectiveness of the activities funded through grants. The
103103 75report shall be provided to the chairpersons of the house and senate committees on ways and
104104 76means, the joint committee on public health, and the joint committee on health care financing
105105 77and shall be posted on the department of public health’s website, and shall be posted on the
106106 78department’s website.
107107 79 (g) The department of public health shall, under the advice and guidance of the
108108 80Prevention and Wellness Advisory Board, report periodically on its strategy for administration 5 of 10
109109 81and allocation of the fund, including relevant evaluation criteria. The report shall set forth the
110110 82rationale for such strategy, which may include: (1) a list of the most prevalent preventable health
111111 83conditions in the commonwealth, including health disparities experienced by populations based
112112 84on race, ethnicity, gender, disability status, sexual orientation or socio-economic status; (2) a list
113113 85of the most costly preventable health conditions in the commonwealth; (3) a list of community-
114114 86level risk factors and precursors to the health conditions identified in (1) and (2); and (4) a list of
115115 87evidence-based or promising community-based strategies related to the conditions identified in
116116 88clauses (1) and (2). The report shall recommend specific areas of focus for allocation of funds. If
117117 89appropriate, the report shall reference goals and best practices established by the National
118118 90Prevention and Public Health Promotion Council, the Centers for Disease Control and
119119 91Prevention, and other relevant experts, including but not limited to MassUP, the Hi-5 Initiative,
120120 92the national prevention strategy, the healthy people report, the guide to community preventive
121121 93services, and the Robert Wood Johnson culture of health initiative.
122122 94 (h) The department of public health shall promulgate regulations necessary to carry out
123123 95this section.
124124 96 SECTION 2. Section 2H of Chapter 111 of the General Laws is hereby amended by
125125 97striking in its entirety and replacing it with the following new section:-
126126 98 Section 2H. (a) There shall be a Prevention and Wellness Advisory Board to make
127127 99recommendations to the commissioner concerning the administration and allocation of the
128128 100Prevention and Wellness Trust Fund established in section 2G, establish evaluation criteria and
129129 101perform any other functions specifically granted to it by law. 6 of 10
130130 102 (b) The board shall consist of the commissioner of public health or a designee, who shall
131131 103serve as chairperson; the house and senate chairs of the joint committee on public health or their
132132 104designees; the house and senate chairs of the joint committee on health care financing or their
133133 105designees; the secretary of health and human services or a designee; the executive director of the
134134 106center for health information and analysis or a designee; the executive director of the health
135135 107policy commission established in section 2 of chapter 6D of the MGL or a designee; and 16
136136 108persons to be appointed by the governor, 1 of whom shall be a person with expertise in the field
137137 109of public health economics; 1 of whom shall be a person with expertise in public health research;
138138 1101 of whom shall be a person with expertise in the field of health equity; 1 of whom shall be a
139139 111person from a local board of health for a city or town with a population greater than 50,000; 1 of
140140 112whom shall be a person of a board of health for a city or town with a population of fewer than
141141 11350,000; 1 of whom shall be representatives of health insurance carriers; 1 of whom shall be a
142142 114person from a consumer health advocacy organization; 1 of whom shall be a person from a
143143 115hospital association; 1 of whom shall be a person from a statewide public health organization; 1
144144 116of whom shall be a representative of the interest of businesses; 1 of whom shall be a public
145145 117health nurse or a school nurse; 1 of whom shall be a person from an association representing
146146 118community health workers; 2 of whom shall represent a statewide association of community-
147147 119based service providers addressing public health; and 2 of whom shall be a person with expertise
148148 120in the design and implementation of community-wide public health strategies. In selecting
149149 121appointees, the governor shall consider diverse representation on the board by race, ethnicity,
150150 122gender, and geographic region.
151151 123 (c) The Prevention and Wellness Advisory Board shall evaluate the program authorized
152152 124in section 2G of said chapter 111 and shall issue an evaluation report at an interval to be 7 of 10
153153 125determined by the Board, but not less than every 5 years from the beginning of each grant period.
154154 126The report shall include an analysis of all relevant data to determine the effectiveness of the
155155 127program including, but not limited to, an analysis of: (i) the extent to which the program
156156 128impacted the prevalence, severity, or control of preventable health conditions and the extent to
157157 129which the program is projected to impact such factors in the future; (ii) the extent to which the
158158 130program reduced health care costs or the growth in health care cost trends and the extent to
159159 131which the program is projected to reduce such costs in the future; (iii) whether health care or
160160 132other costs were reduced and who benefited from the reduction; (iv) the extent that health
161161 133outcomes or health behaviors were positively impacted; (v) the extent that access to evidence-
162162 134based community strategies was increased; (vi) the extent to which the social determinants of
163163 135health were addressed by grantees; (vii) the extent that community wide risk factors for poor
164164 136health were reduced or mitigated; (viii) the extent that grantees increased their ability to
165165 137collaborate, share data, and align services with other providers and community-based
166166 138organizations for greater impact; (ix) the extent to which health inequities experienced by
167167 139populations based on race, ethnicity, gender, disability status, sexual orientation or socio-
168168 140economic status were reduced across all metrics; and (x) recommendations for whether the
169169 141program should be discontinued, amended or expanded and a timetable for implementation of the
170170 142recommendations.
171171 143 The department of public health shall coordinate with grantees to contract with an outside
172172 144organization that has expertise in the analysis of public health and health care financing to assist
173173 145the board in conducting its evaluation. The outside organization shall be provided access to
174174 146actual health plan data from the all-payer claims database as administered by the center for
175175 147health information and analysis and data from MassHealth, to the extent permitted by law; 8 of 10
176176 148provided, however, that the data shall be confidential and shall not be a public record under
177177 149clause Twenty-sixth of section 7 of chapter 4 of the General Laws.
178178 150 The board shall report the results of its evaluation and its recommendations, if any, and
179179 151drafts of legislation necessary to carry out the recommendations to the house and senate
180180 152committees on ways and means, the joint committee on public health, and the joint committee on
181181 153health care financing and shall post the board’s report on the website of the department of public
182182 154health.
183183 155 SECTION 3. Section 68 of Chapter 118E of the General Laws is hereby amended by
184184 156inserting after subsection (f) the following subsection:–
185185 157 (g) (1) In addition to the surcharge assessed under subsection (a), acute hospitals and
186186 158ambulatory surgical centers shall assess a prevention and wellness surcharge on all payments
187187 159subject to surcharge as defined in section 64. The prevention and wellness surcharge amount
188188 160shall equal the product of (i) the prevention wellness surcharge percentage and (ii) amounts paid
189189 161for these services by a surcharge payor. The office shall calculate the prevention and cost control
190190 162surcharge percentage by dividing $15,000,000 by the projected annual aggregate payments
191191 163subject to the surcharge, excluding projected annual aggregate payments based on payments
192192 164made by managed care organizations. The office shall determine the prevention and wellness
193193 165surcharge percentage before the start of each fund fiscal year and may redetermine the
194194 166prevention and wellness surcharge percentage before April 1 of each fund fiscal year if the
195195 167division projects that the initial prevention and wellness surcharge established the previous
196196 168October will produce less than $10,000,000 or more than $20,000,000. Before each succeeding
197197 169October 1, the office shall redetermine the prevention and wellness surcharge percentage 9 of 10
198198 170incorporating any adjustments from earlier years. In each determination or redetermination of the
199199 171prevention and wellness surcharge percentage, the office shall use the best data available as
200200 172determined by the office and may consider the effect on projected prevention and wellness
201201 173surcharge payments of any modified or waived enforcement under subsection (e). The office
202202 174shall incorporate all adjustments, including, but not limited to, updates or corrections or final
203203 175settlement amounts, by prospective adjustment rather than by retrospective payments or
204204 176assessments.
205205 177 (2) Prevention and wellness surcharge payments shall be deposited in the Prevention and
206206 178Wellness Trust Fund, established in section 2G of chapter 111.
207207 179 (3) All provisions of subsections (a) to (f) and section 64 shall apply to the prevention
208208 180and wellness surcharge, to the extent not inconsistent with the provisions of this subsection.
209209 181 SECTION 4. Section 14 of Chapter 94G is hereby amended by striking out subsection
210210 182 (b), inserted by section 40 of chapter 55 of the acts of 2017, and inserting in place thereof
211211 183the following subsection:-
212212 184 (b) Money in the fund shall be subject to appropriation. Money in the fund shall be
213213 185expended for the implementation, administration and enforcement of this chapter by the
214214 186commission and by the department of agricultural resources for the implementation,
215215 187administration and enforcement of sections 116 to 123, inclusive, of chapter 128 and the
216216 188provision of pesticide control pursuant to chapter 132B; provided, that 10 per cent of the
217217 189amounts held in the fund in any 1 year shall be transferred annually to the Prevention and
218218 190Wellness Trust Fund established in section 2G of chapter 111, not later than June 30. Thereafter,
219219 191money in the fund shall be expended for: (i) public and behavioral health including but not 10 of 10
220220 192limited to, evidence-based and evidence-informed substance use prevention and treatment and
221221 193substance use early intervention services in a recurring grant for school districts or community
222222 194coalitions who operate on the strategic prevention framework or similar structure for youth
223223 195substance use education and prevention; (ii) public safety; (iii) municipal police training; and (iv)
224224 196programming for restorative justice, jail diversion, workforce development, industry specific
225225 197technical assistance, and mentoring services for economically-disadvantaged persons in
226226 198communities disproportionately impacted by high rates of arrest and incarceration for marijuana
227227 199offenses pursuant to chapter 94C.