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