| 1 | 1 | | 1 of 2 |
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| 2 | 2 | | SENATE DOCKET, NO. 603 FILED ON: 1/17/2023 |
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| 3 | 3 | | SENATE . . . . . . . . . . . . . . No. 1334 |
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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 | | Joanne M. Comerford |
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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 relative to accelerating improvements to the local and regional public health system to |
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| 13 | 13 | | address disparities in the delivery of public health services. |
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| 14 | 14 | | _______________ |
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| 15 | 15 | | PETITION OF: |
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| 16 | 16 | | NAME:DISTRICT/ADDRESS :Joanne M. ComerfordHampshire, Franklin and WorcesterHannah Kane11th Worcester1/18/2023Jack Patrick Lewis7th Middlesex1/27/2023Sal N. DiDomenicoMiddlesex and Suffolk1/31/2023Jason M. LewisFifth Middlesex1/31/2023Vanna Howard17th Middlesex1/31/2023Brian M. Ashe2nd Hampden1/31/2023John F. KeenanNorfolk and Plymouth2/1/2023Jacob R. OliveiraHampden, Hampshire and Worcester2/2/2023Susannah M. Whipps2nd Franklin2/6/2023Rebecca L. RauschNorfolk, Worcester and Middlesex2/6/2023Julian CyrCape and Islands2/8/2023James B. EldridgeMiddlesex and Worcester2/9/2023Thomas M. Stanley9th Middlesex2/15/2023Mathew J. Muratore1st Plymouth2/23/2023Patricia D. JehlenSecond Middlesex3/2/2023Cindy F. FriedmanFourth Middlesex3/3/2023 2 of 2 |
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| 17 | 17 | | Michael D. BradySecond Plymouth and Norfolk3/3/2023Paul R. FeeneyBristol and Norfolk3/5/2023 1 of 10 |
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| 18 | 18 | | SENATE DOCKET, NO. 603 FILED ON: 1/17/2023 |
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| 19 | 19 | | SENATE . . . . . . . . . . . . . . No. 1334 |
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| 20 | 20 | | By Ms. Comerford, a petition (accompanied by bill, Senate, No. 1334) of Joanne M. Comerford, |
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| 21 | 21 | | Hannah Kane, Jack Patrick Lewis, Sal N. DiDomenico and other members of the General Court |
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| 22 | 22 | | for legislation relative to accelerate improvements to the local and regional public health system |
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| 23 | 23 | | to address disparities in the delivery of public health services. Public Health. |
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| 24 | 24 | | The Commonwealth of Massachusetts |
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| 25 | 25 | | _______________ |
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| 26 | 26 | | In the One Hundred and Ninety-Third General Court |
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| 27 | 27 | | (2023-2024) |
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| 28 | 28 | | _______________ |
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| 29 | 29 | | An Act relative to accelerating improvements to the local and regional public health system to |
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| 30 | 30 | | address disparities in the delivery of public health services. |
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| 31 | 31 | | Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority |
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| 32 | 32 | | of the same, as follows: |
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| 33 | 33 | | 1 SECTION 1. Chapter 111 of the General Laws is hereby amended by striking out section |
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| 34 | 34 | | 227D, as appearing in the 2020 Official Edition, and inserting in place thereof the |
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| 35 | 35 | | 3following section:- |
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| 36 | 36 | | 4 Section 27D. (a) As used in this section, the following words shall, unless the context |
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| 37 | 37 | | 5clearly requires otherwise, have the following meanings:- |
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| 38 | 38 | | 6 “Board of health”, any body politic or political subdivision of the commonwealth that |
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| 39 | 39 | | 7acts as a board of health, public health commission or a health department for a municipality, |
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| 40 | 40 | | 8region or district, including, but not limited to, municipal boards of health, regional health |
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| 41 | 41 | | 9districts established pursuant to section 27B and boards of health that share services pursuant to |
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| 42 | 42 | | 10section 4A of chapter 40. 2 of 10 |
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| 43 | 43 | | 11 “Foundational capabilities”, cross-cutting skills and capacities needed to support basic |
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| 44 | 44 | | 12public health programs and other protections and activities including, but not limited to: (i) |
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| 45 | 45 | | 13assessment and surveillance; (ii) emergency preparedness and response; (iii) policy development; |
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| 46 | 46 | | 14(iv) communications; (v) community partnership development; (vi) organizational administrative |
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| 47 | 47 | | 15competences; (vii) data-driven interventions; or (viii) accountability and performance |
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| 48 | 48 | | 16management. |
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| 49 | 49 | | 17 “Foundational public health services”, a nationally recognized framework for a minimum |
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| 50 | 50 | | 18set of public health services, including, but not limited to, public health programs and |
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| 51 | 51 | | 19foundational capabilities. |
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| 52 | 52 | | 20 “Public health programs”, programs including, but not limited to: (i) communicable |
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| 53 | 53 | | 21disease control; (ii) public health nursing services; (iii) epidemiology; (iv) food and water |
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| 54 | 54 | | 22protection; (v) chronic disease and injury prevention; (vi) environmental public health; (vii) |
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| 55 | 55 | | 23maternal, child and family health; or (viii) access to and linkage with clinical care, where |
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| 56 | 56 | | 24applicable. |
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| 57 | 57 | | 25 (b) The department, in consultation with municipalities and other stakeholders, shall |
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| 58 | 58 | | 26establish a state action for public health excellence program to: (i) provide uniform access for |
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| 59 | 59 | | 27every resident of the commonwealth foundational public health services; provided, that |
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| 60 | 60 | | 28foundational public health services shall further racial and health equity, including for |
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| 61 | 61 | | 29historically underrepresented communities; (ii) assist boards of health to adopt practices to |
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| 62 | 62 | | 30improve the efficiency and effectiveness of the delivery of foundational public health services; |
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| 63 | 63 | | 31(iii) develop a set of standards for foundational public health services across the commonwealth; 3 of 10 |
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| 64 | 64 | | 32and (iv) promote and provide adequate resources for boards of health that shall include, but shall |
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| 65 | 65 | | 33not be limited to: |
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| 66 | 66 | | 34 (A) supporting boards of health to meet the standards established pursuant to subsection |
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| 67 | 67 | | 35(c) to improve the municipal and regional health systems; |
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| 68 | 68 | | 36 (B) increasing cross-jurisdictional sharing of public health programs to strengthen the |
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| 69 | 69 | | 37service delivery capabilities of the municipal and regional public health systems; |
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| 70 | 70 | | 38 (C) improving planning and system accountability of the municipal and regional public |
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| 71 | 71 | | 39health systems, including, but not limited to, statewide data collection and reporting systems; |
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| 72 | 72 | | 40 (D) establishing workforce credentialing standards, including, but not limited to, |
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| 73 | 73 | | 41education and training standards for municipal and regional public health officials and staff; and |
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| 74 | 74 | | 42 (E) expanding access to professional development, training and technical assistance for |
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| 75 | 75 | | 43municipal and regional public health officials and staff. |
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| 76 | 76 | | 44 (c) The standards for local foundational public health services developed pursuant to |
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| 77 | 77 | | 45clause (iii) of subsection (b) shall include, but not be limited to, the standards for: (i) inspections, |
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| 78 | 78 | | 46epidemiology and communicable disease investigation and reporting, permitting and other local |
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| 79 | 79 | | 47public health responsibilities as required by law or under regulations of the department or the |
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| 80 | 80 | | 48department of environmental protection; (ii) workforce education, training and credentialing |
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| 81 | 81 | | 49standards; and (iii) contributing required data. The standards shall consider national standards |
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| 82 | 82 | | 50and shall be developed in consultation with local boards of health, public health organizations, |
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| 83 | 83 | | 51academic experts in the field of public health and members of the special commission on local |
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| 84 | 84 | | 52and regional public health established in chapter 3 of the resolves of 2016. 4 of 10 |
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| 85 | 85 | | 53 (d)(i) Subject to appropriation, boards of health shall implement and comply with the |
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| 86 | 86 | | 54standards developed pursuant to subsections (b) and (c), individually or through cross- |
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| 87 | 87 | | 55jurisdictional sharing of public health programs in the form of comprehensive public health |
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| 88 | 88 | | 56districts, formal shared services or other arrangements for sharing public health programs. |
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| 89 | 89 | | 57 (ii) Annually, not later than August 31, boards of health shall submit a report to the |
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| 90 | 90 | | 58department including information demonstrating compliance during the preceding fiscal year |
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| 91 | 91 | | 59with the standards pursuant to subsections (b) and (c). |
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| 92 | 92 | | 60 (e) Subject to appropriation, the department and the department of environmental |
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| 93 | 93 | | 61protection shall, according to each agency’s jurisdiction and authority, provide comprehensive |
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| 94 | 94 | | 62core public health educational and training opportunities and technical assistance to municipal |
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| 95 | 95 | | 63and regional public health officials and staff to support them in obtaining credentials and |
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| 96 | 96 | | 64foundational capabilities required by the standards developed pursuant to subsections (b) and (c); |
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| 97 | 97 | | 65provided, that said educational and training opportunities and technical assistance shall be |
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| 98 | 98 | | 66offered in diverse geographic locations throughout the commonwealth or online. The department |
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| 99 | 99 | | 67and the department of environmental protection shall provide such training and technical |
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| 100 | 100 | | 68assistance opportunities free of charge. The department and the department of environmental |
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| 101 | 101 | | 69protection may contract with other state agencies or external entities to provide said educational |
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| 102 | 102 | | 70and training and technical assistance. |
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| 103 | 103 | | 71 (f)(1) Subject to appropriation, the department shall provide funds to boards of health to |
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| 104 | 104 | | 72implement and comply with the standards developed pursuant to subsections (b) and (c), |
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| 105 | 105 | | 73including through cross-jurisdictional sharing of public health programs in the form of 5 of 10 |
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| 106 | 106 | | 74comprehensive public health districts, formal shared services and other arrangements for sharing |
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| 107 | 107 | | 75public health programs. |
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| 108 | 108 | | 76 (2) The funds may be used to provide: |
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| 109 | 109 | | 77 (i) grants and technical assistance to municipalities that demonstrate limited operational |
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| 110 | 110 | | 78capacity to meet local public health responsibilities as required by law or regulations; |
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| 111 | 111 | | 79 (ii) competitive grants to increase the efficiency and effectiveness of the delivery of |
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| 112 | 112 | | 80public health programs across 3 or more municipalities through: |
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| 113 | 113 | | 81 (A) expanding shared services arrangements to include more municipalities; |
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| 114 | 114 | | 82 (B) expanding shared services arrangements to provide a more comprehensive and |
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| 115 | 115 | | 83equitable set of public health programs or sustainable business model; or |
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| 116 | 116 | | 84 (C) supporting new cross-jurisdictional sharing arrangements; provided however, that |
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| 117 | 117 | | 85grants provided pursuant to this clause shall supplement and shall not replace existing state, |
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| 118 | 118 | | 86local, private or federal funding to boards of health and regional health districts; provided |
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| 119 | 119 | | 87further, that boards of health shall apply for funds pursuant to this clause in a manner determined |
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| 120 | 120 | | 88by the department; provided further, that the application shall include, but not be limited to: (1) a |
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| 121 | 121 | | 89description of how the applicant will increase the efficiency and effectiveness in the delivery of |
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| 122 | 122 | | 90public health programs; (2) certification that, at the time of the application, the applicant meets |
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| 123 | 123 | | 91or will use funding to meet workforce standards as determined by the department; (3) |
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| 124 | 124 | | 92certification that the applicant shall submit written documentation on the implementation of |
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| 125 | 125 | | 93systems to increase efficiency in providing local public health programs, including data, to the |
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| 126 | 126 | | 94department in a manner to be prescribed by the department; and (4) a plan for the long-term 6 of 10 |
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| 127 | 127 | | 95sustainability of strengthening local public health programs; provided further, that the |
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| 128 | 128 | | 96department shall adopt rules, regulations or guidelines for the administration and enforcement of |
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| 129 | 129 | | 97this clause, including, but not limited to, establishing applicant selection criteria, funding |
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| 130 | 130 | | 98priorities, application forms and procedures, grant distribution and other requirements; and |
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| 131 | 131 | | 99provided further, that not less than 33 per cent of the grants awarded shall be distributed to |
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| 132 | 132 | | 100municipalities with a median household income below the median income of the commonwealth; |
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| 133 | 133 | | 101and |
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| 134 | 134 | | 102 (iii) annual non-competitive funding to ensure that all residents of the commonwealth |
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| 135 | 135 | | 103are provided with foundational public health services that meet or exceed the standards set |
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| 136 | 136 | | 104pursuant to this section; provided, however, that funds provided pursuant to this clause shall be |
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| 137 | 137 | | 105distributed based on the level of implementation of the standards established in this section and |
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| 138 | 138 | | 106using a formula based on population, level of cross-jurisdictional sharing and sociodemographic |
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| 139 | 139 | | 107data; provided further, that, to receive funding pursuant to this clause, a board of health shall |
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| 140 | 140 | | 108submit an annual report to the department of public health and department of environmental |
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| 141 | 141 | | 109protection that (A) demonstrates progress or implementation of the standards; and (B) confirms |
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| 142 | 142 | | 110that funding provided pursuant to this clause shall supplement and shall not replace existing |
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| 143 | 143 | | 111state, local, private or federal funding to boards of health and regional health districts; provided |
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| 144 | 144 | | 112further, that the report shall not require data that is otherwise reported to the department under |
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| 145 | 145 | | 113subsection (d); and provided further, that data demonstrating implementation and compliance |
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| 146 | 146 | | 114with the standards shall be submitted in a form prescribed by the department. |
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| 147 | 147 | | 115 (g) Subject to appropriation, the department and the department of environmental |
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| 148 | 148 | | 116protection, shall develop systems to provide for increased standardization, integration and |
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| 149 | 149 | | 117unification of public health reporting and systems for the measuring of standard 7 of 10 |
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| 150 | 150 | | 118responsibilities of boards of health, including, but not limited to, inspections, code enforcement, |
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| 151 | 151 | | 119communicable disease management and local regulations. Where feasible and in compliance |
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| 152 | 152 | | 120with state and federal privacy requirements, the data and an analysis of the data shall be available |
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| 153 | 153 | | 121on the department’s and department of environmental protection’s websites in a form that allows |
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| 154 | 154 | | 122the public to conduct further analysis; provided, however, that any such published data shall |
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| 155 | 155 | | 123exclude personal identifying information. |
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| 156 | 156 | | 124 (h) The department shall estimate the amount of funds necessary to meet the |
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| 157 | 157 | | 125requirements of this section for each fiscal year. The department shall report the estimate to the |
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| 158 | 158 | | 126secretary of administration and finance and the house and senate committees on ways and means |
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| 159 | 159 | | 127for the upcoming fiscal year in advance of the day assigned for submission of the budget by the |
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| 160 | 160 | | 128governor to the general court pursuant to section 7H of chapter 29 and shall publish the estimate |
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| 161 | 161 | | 129on the website of the department. |
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| 162 | 162 | | 130 (i) In the event of an outbreak of a disease or health care situation important to the public |
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| 163 | 163 | | 131health, as determined by the commissioner or the commissioner of the department of |
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| 164 | 164 | | 132environmental protection affecting more than 1 board of health, the department may coordinate |
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| 165 | 165 | | 133the affected boards of health, assemble and share data on affected residents and organize the |
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| 166 | 166 | | 134public health response within and across the affected communities. |
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| 167 | 167 | | 135 (j) Biennially, not later than December 1, in every even numbered year, the department, |
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| 168 | 168 | | 136in consultation with the department of environmental protection, shall submit a report detailing |
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| 169 | 169 | | 137the impact of the state action for public health excellence program established under subsection |
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| 170 | 170 | | 138(b), the status of the local public health programs and their ability to meet the requirements under |
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| 171 | 171 | | 139this section, including, but not limited to: (i) the number of board of health and regional health 8 of 10 |
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| 172 | 172 | | 140district officials and staff that meet workforce standards as determined by the department; (ii) the |
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| 173 | 173 | | 141number of board of health and regional health district officials and staff that attended educational |
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| 174 | 174 | | 142and training opportunities; (iii) the number of boards of health and regional health districts that |
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| 175 | 175 | | 143are in compliance with data reporting requirements under this section; and (iv) the number of |
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| 176 | 176 | | 144municipalities participating in regional public health collaborations. In preparing the report, the |
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| 177 | 177 | | 145department shall consult with the department of environmental protection. The report shall be |
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| 178 | 178 | | 146filed with the clerks of the house of representatives and the senate, the house and senate |
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| 179 | 179 | | 147committees on ways and means and the joint committee on public health and publicly posted on |
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| 180 | 180 | | 148the websites of the department and the department of environmental protection. |
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| 181 | 181 | | 149 (k) Notwithstanding any general or special law to the contrary, if the commissioner, the |
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| 182 | 182 | | 150commissioner of the department of environmental protection or their authorized representatives, |
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| 183 | 183 | | 151determine that failure to meet standards established under subsection (c) in a timeframe |
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| 184 | 184 | | 152consistent with the timeframe established in subsection (d), constitutes a threat to public health, |
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| 185 | 185 | | 153they shall, in writing, notify the appropriate board of health of such determination and request |
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| 186 | 186 | | 154that the board of health, in writing, notify the department of actions taken to effect appropriate |
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| 187 | 187 | | 155protection. If the commissioner is not so notified, or if after notification the commissioner |
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| 188 | 188 | | 156determines the actions are not sufficient to protect public health, the department may restrict |
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| 189 | 189 | | 157future funding provided under clause (iii) of subsection (f) and will report these insufficiencies in |
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| 190 | 190 | | 158its report issued under subsection (i). |
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| 191 | 191 | | 159 (l) Nothing in this section shall limit the authority or responsibility of a board of health |
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| 192 | 192 | | 160otherwise established by the general laws, including, but not limited to, section 127A. 9 of 10 |
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| 193 | 193 | | 161 SECTION 2. (a) Not more than 1 year after the effective date of this act and before the |
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| 194 | 194 | | 162adoption of any regulation for the administration of the state action for public health excellence |
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| 195 | 195 | | 163program pursuant to section 27D of chapter 111 of the General Laws, the department of public |
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| 196 | 196 | | 164health shall hold not fewer than 3 public hearings in diverse geographic locations throughout the |
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| 197 | 197 | | 165commonwealth or online to identify ways to improve the efficiency and effectiveness of the |
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| 198 | 198 | | 166delivery of local public health services, in alignment with the recommendations of the special |
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| 199 | 199 | | 167commission on local and regional public health established in chapter 3 of the resolves of 2016. |
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| 200 | 200 | | 168 (b) Not later than December 31, 2023, the department of public health shall submit a |
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| 201 | 201 | | 169report to the clerks of the house of representatives and the senate, the house and senate |
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| 202 | 202 | | 170committee on ways and means and the joint committee on public health. The report shall include |
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| 203 | 203 | | 171an analysis of needs, opportunities, challenges, timeline and cost analysis for the implementation |
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| 204 | 204 | | 172of said section 27D of said chapter 111. |
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| 205 | 205 | | 173 SECTION 3. The special commission on local and regional public health established in |
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| 206 | 206 | | 174chapter 3 of the resolves of 2016 is hereby revived and continued to December 31, 2024. The |
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| 207 | 207 | | 175special commission shall convene at least once not later than 120 days following the effective |
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| 208 | 208 | | 176date of this act to review the changes made to section 27D of chapter 111 of the General Laws, |
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| 209 | 209 | | 177inserted by section 1, and funding available to support and enhance the commonwealth’s local |
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| 210 | 210 | | 178and regional public health system. |
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| 211 | 211 | | 179 SECTION 4. The standards for foundational public health services developed pursuant to |
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| 212 | 212 | | 180subsections (b) and (c) of section 27D of chapter 111 of the General Laws, as inserted by section |
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| 213 | 213 | | 1811, shall be consistent with the recommendations of the report of the special commission on local |
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| 214 | 214 | | 182and regional and public health approved in June 2019 and shall be implemented and complied 10 of 10 |
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| 215 | 215 | | 183with by a phased schedule adopted by the department of public health. The department of public |
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| 216 | 216 | | 184health shall publish a list of minimum statutory and regulatory local public health standards |
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| 217 | 217 | | 185established pursuant to said subsections (b) and (c) of said section 27D of said chapter 111 not |
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| 218 | 218 | | 186later than 90 days after the effective date of this act. |
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