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SENATE DOCKET, NO. 969 FILED ON: 1/18/2023
SENATE . . . . . . . . . . . . . . No. 1400
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Jason M. Lewis
_________________
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 to promote public health through the prevention and wellness trust fund.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Jason M. LewisFifth MiddlesexMichael J. BarrettThird Middlesex2/1/2023Sal N. DiDomenicoMiddlesex and Suffolk2/10/2023Vanna Howard17th Middlesex2/10/2023James B. EldridgeMiddlesex and Worcester2/13/2023 1 of 10
SENATE DOCKET, NO. 969 FILED ON: 1/18/2023
SENATE . . . . . . . . . . . . . . No. 1400
By Mr. Lewis, a petition (accompanied by bill, Senate, No. 1400) of Jason M. Lewis, Michael J.
Barrett, Sal N. DiDomenico, Vanna Howard and others for legislation to promote public health
through the prevention and wellness trust fund. Public Health.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 791 OF 2021-2022.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act to promote public health through the prevention and wellness trust fund.
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. Section 2G of Chapter 111 of the MGL is hereby amended by striking in its
2entirety and replacing it with the following new section:-
3 Section 2G. (a) There shall be established and set upon the books of the Commonwealth a
4separate fund to be known as the Prevention and Wellness Trust Fund to be expended, without
5further appropriation, by the department of public health. The fund shall consist of revenues
6collected by the commonwealth including: (1) any revenue from appropriations or other monies
7authorized by the general court and specifically designated to be credited to the fund; (2) any
8fines and penalties allocated to the fund under the General Laws; (3) any funds from public and
9private sources such as gifts, grants and donations to further community-based prevention
10activities; (4) any interest earned on such revenues; and (5) any funds provided from other 2 of 10
11sources. The commissioner of public health, as trustee, shall administer the fund. The
12commissioner, in consultation with the Prevention and Wellness Advisory Board established
13under section 2H, shall make expenditures from the fund consistent with subsections (d) and (e);
14provided, that not more than 10 per cent of the amounts held in the fund shall be used by the
15department for the cost of program administration and not more than 10 per cent of amounts held
16in the fund shall be used for technical assistance to grantees, program evaluation and data
17analytics.
18 (b) The department may incur expenses and the comptroller may certify payment of
19amounts in anticipation of expected receipts; provided, however, that no expenditure shall be
20made from the fund which shall cause the fund to be in deficit at the close of a fiscal year.
21Revenues deposited in the fund that are unexpended at the end of the fiscal year shall not revert
22to the General Fund and shall be available for expenditure in the following fiscal year.
23 (c) All expenditures from the Prevention and Wellness Trust Fund shall support 1 or
24more of the following purposes: (1) increase access to community-based preventive services and
25strategies which complement and expand the ability of MassHealth to promote coordinated care,
26integrate community-based services with clinical care, and develop innovative ways of
27addressing social determinants of health; (2) reduce the largest drivers of poor health, health
28disparities, reduced quality of life, and high health care costs though community-based
29strategies; (3) increase access to health promoting conditions and opportunities to improve
30quality of life and reduce health care costs for populations experiencing health outcome
31inequities through community-based strategies including policy, systems, and environmental
32changes or (4) develop a stronger evidence-base of effective primary prevention strategies. 3 of 10
33 (d) The commissioner shall award not less than 80 per cent of the Prevention and
34Wellness Trust Fund through a competitive grant process to municipalities, community-based
35organizations, health care providers, regional-planning agencies, and health plans that apply for
36the implementation, evaluation and dissemination of evidence-based community preventive
37health strategies. To be eligible to receive a grant under this subsection, a recipient shall be a
38partnership that includes at minimum: (1) a municipality or regional planning agency; (2) a
39community-based health or social service provider; (3) a public health or community action
40agency with expertise in implementing community-wide health strategies (4) a health care
41provider or a health plan; (5) where feasible, a Medicaid-certified accountable care organization
42or a Medicaid-certified Community Partner organization. Expenditures from the fund for such
43purposes shall supplement and not replace existing local, state, private or federal public health-
44related funding. All entities awarded funds through this program must demonstrate the ability to
45utilize best practices in accounting, contract with a fiscal agent who will perform accounting
46functions on their behalf, or be provided with technical assistance by the Department to ensure
47best practices are followed.
48 (e) A grant proposal submitted under subsection (d) shall include, but not be limited to:
49(1) a plan that defines specific goals for the reduction in preventable health conditions and health
50care costs over a multi-year period; (2) the evidence-based or evidence-informed programs the
51applicant shall use to meet the goals; (3) a budget necessary to implement the plan, including a
52detailed description of the funding or in-kind contributions the applicant or applicants will be
53providing in support of the proposal; (4) any other private funding or private sector participation
54the applicant anticipates in support of the proposal; (5) a description of how the proposed
55strategies have been informed by community residents most at risk for health inequities, 4 of 10
56including women, racial and ethnic minorities and low income individuals; and (6) the
57anticipated number of individuals that would be affected by implementation of the plan. Priority
58may be given to proposals in a geographic region of the state with a higher than average
59prevalence of preventable health conditions, as determined by the commissioner of public health,
60in consultation with the Prevention and Wellness Advisory Board. If no proposals were offered
61in areas of the state with particular need, the department shall ask for a specific request for
62proposal for that specific region. If the commissioner determines that no suitable proposals have
63been received, such that the specific needs remain unmet, the department may work directly with
64municipalities or community-based organizations to develop grant proposals. The department of
65public health shall, in consultation with the Prevention and Wellness Advisory Board, develop
66guidelines for an annual review of the progress being made by each grantee. Each grantee shall
67participate in any evaluation or accountability process implemented or authorized by the
68department.
69 (f) The department of public health shall, annually on or before January 31, report on
70expenditures from the Prevention and Wellness Trust Fund. The report shall include, but not be
71limited to: (1) the revenue credited to the fund; (2) the amount of fund expenditures attributable
72to the administrative costs of the department of public health; (3) an itemized list of the funds
73expended through the competitive grant process and a description of the grantee activities; and
74(4) status report of the evaluation of the effectiveness of the activities funded through grants. The
75report shall be provided to the chairpersons of the house and senate committees on ways and
76means, the joint committee on public health, and the joint committee on health care financing
77and shall be posted on the department of public health’s website, and shall be posted on the
78department’s website. 5 of 10
79 (g) The department of public health shall, under the advice and guidance of the
80Prevention and Wellness Advisory Board, report periodically on its strategy for administration
81and allocation of the fund, including relevant evaluation criteria. The report shall set forth the
82rationale for such strategy, which may include: (1) a list of the most prevalent preventable health
83conditions in the commonwealth, including health disparities experienced by populations based
84on race, ethnicity, gender, disability status, sexual orientation or socio-economic status; (2) a list
85of the most costly preventable health conditions in the commonwealth; (3) a list of community-
86level risk factors and precursors to the health conditions identified in (1) and (2); and (4) a list of
87evidence-based or promising community-based strategies related to the conditions identified in
88clauses (1) and (2). The report shall recommend specific areas of focus for allocation of funds. If
89appropriate, the report shall reference goals and best practices established by the National
90Prevention and Public Health Promotion Council, the Centers for Disease Control and
91Prevention, and other relevant experts, including but not limited to MassUP, the Hi-5 Initiative,
92the national prevention strategy, the healthy people report, the guide to community preventive
93services, and the Robert Wood Johnson culture of health initiative.
94 (h) The department of public health shall promulgate regulations necessary to carry out
95this section.
96 SECTION 2. Section 2H of Chapter 111 of the General Laws is hereby amended by
97striking in its entirety and replacing it with the following new section:-
98 Section 2H. (a) There shall be a Prevention and Wellness Advisory Board to make
99recommendations to the commissioner concerning the administration and allocation of the 6 of 10
100Prevention and Wellness Trust Fund established in section 2G, establish evaluation criteria and
101perform any other functions specifically granted to it by law.
102 (b) The board shall consist of the commissioner of public health or a designee, who shall
103serve as chairperson; the house and senate chairs of the joint committee on public health or their
104designees; the house and senate chairs of the joint committee on health care financing or their
105designees; the secretary of health and human services or a designee; the executive director of the
106center for health information and analysis or a designee; the executive director of the health
107policy commission established in section 2 of chapter 6D of the MGL or a designee; and 16
108persons to be appointed by the governor, 1 of whom shall be a person with expertise in the field
109of public health economics; 1 of whom shall be a person with expertise in public health research;
1101 of whom shall be a person with expertise in the field of health equity; 1 of whom shall be a
111person from a local board of health for a city or town with a population greater than 50,000; 1 of
112whom shall be a person of a board of health for a city or town with a population of fewer than
11350,000; 1 of whom shall be representatives of health insurance carriers; 1 of whom shall be a
114person from a consumer health advocacy organization; 1 of whom shall be a person from a
115hospital association; 1 of whom shall be a person from a statewide public health organization; 1
116of whom shall be a representative of the interest of businesses; 1 of whom shall be a public
117health nurse or a school nurse; 1 of whom shall be a person from an association representing
118community health workers; 2 of whom shall represent a statewide association of community-
119based service providers addressing public health; and 2 of whom shall be a person with expertise
120in the design and implementation of community-wide public health strategies. In selecting
121appointees, the governor shall consider diverse representation on the board by race, ethnicity,
122gender, and geographic region. 7 of 10
123 (c) The Prevention and Wellness Advisory Board shall evaluate the program authorized
124in section 2G of said chapter 111 and shall issue an evaluation report at an interval to be
125determined by the Board, but not less than every 5 years from the beginning of each grant period.
126The report shall include an analysis of all relevant data to determine the effectiveness of the
127program including, but not limited to, an analysis of: (i) the extent to which the program
128impacted the prevalence, severity, or control of preventable health conditions and the extent to
129which the program is projected to impact such factors in the future; (ii) the extent to which the
130program reduced health care costs or the growth in health care cost trends and the extent to
131which the program is projected to reduce such costs in the future; (iii) whether health care or
132other costs were reduced and who benefited from the reduction; (iv) the extent that health
133outcomes or health behaviors were positively impacted; (v) the extent that access to evidence-
134based community strategies was increased; (vi) the extent to which the social determinants of
135health were addressed by grantees; (vii) the extent that community wide risk factors for poor
136health were reduced or mitigated; (viii) the extent that grantees increased their ability to
137collaborate, share data, and align services with other providers and community-based
138organizations for greater impact; (ix) the extent to which health inequities experienced by
139populations based on race, ethnicity, gender, disability status, sexual orientation or socio-
140economic status were reduced across all metrics; and (x) recommendations for whether the
141program should be discontinued, amended or expanded and a timetable for implementation of the
142recommendations.
143 The department of public health shall coordinate with grantees to contract with an outside
144organization that has expertise in the analysis of public health and health care financing to assist
145the board in conducting its evaluation. The outside organization shall be provided access to 8 of 10
146actual health plan data from the all-payer claims database as administered by the center for
147health information and analysis and data from MassHealth, to the extent permitted by law;
148provided, however, that the data shall be confidential and shall not be a public record under
149clause Twenty-sixth of section 7 of chapter 4 of the General Laws.
150 The board shall report the results of its evaluation and its recommendations, if any, and
151drafts of legislation necessary to carry out the recommendations to the house and senate
152committees on ways and means, the joint committee on public health, and the joint committee on
153health care financing and shall post the board’s report on the website of the department of public
154health.
155 SECTION 3. Section 68 of Chapter 118E of the General Laws is hereby amended by
156inserting after subsection (f) the following subsection:–
157 (g) (1) In addition to the surcharge assessed under subsection (a), acute hospitals and
158ambulatory surgical centers shall assess a prevention and wellness surcharge on all payments
159subject to surcharge as defined in section 64. The prevention and wellness surcharge amount
160shall equal the product of (i) the prevention wellness surcharge percentage and (ii) amounts paid
161for these services by a surcharge payor. The office shall calculate the prevention and cost control
162surcharge percentage by dividing $15,000,000 by the projected annual aggregate payments
163subject to the surcharge, excluding projected annual aggregate payments based on payments
164made by managed care organizations. The office shall determine the prevention and wellness
165surcharge percentage before the start of each fund fiscal year and may redetermine the
166prevention and wellness surcharge percentage before April 1 of each fund fiscal year if the
167division projects that the initial prevention and wellness surcharge established the previous 9 of 10
168October will produce less than $10,000,000 or more than $20,000,000. Before each succeeding
169October 1, the office shall redetermine the prevention and wellness surcharge percentage
170incorporating any adjustments from earlier years. In each determination or redetermination of the
171prevention and wellness surcharge percentage, the office shall use the best data available as
172determined by the office and may consider the effect on projected prevention and wellness
173surcharge payments of any modified or waived enforcement under subsection (e). The office
174shall incorporate all adjustments, including, but not limited to, updates or corrections or final
175settlement amounts, by prospective adjustment rather than by retrospective payments or
176assessments.
177 (2) Prevention and wellness surcharge payments shall be deposited in the Prevention and
178Wellness Trust Fund, established in section 2G of chapter 111.
179 (3) All provisions of subsections (a) to (f) and section 64 shall apply to the prevention
180and wellness surcharge, to the extent not inconsistent with the provisions of this subsection.
181 SECTION 4. Section 14 of Chapter 94G is hereby amended by striking out subsection
182 (b), inserted by section 40 of chapter 55 of the acts of 2017, and inserting in place thereof
183the following subsection:-
184 (b) Money in the fund shall be subject to appropriation. Money in the fund shall be
185expended for the implementation, administration and enforcement of this chapter by the
186commission and by the department of agricultural resources for the implementation,
187administration and enforcement of sections 116 to 123, inclusive, of chapter 128 and the
188provision of pesticide control pursuant to chapter 132B; provided, that 10 per cent of the
189amounts held in the fund in any 1 year shall be transferred annually to the Prevention and 10 of 10
190Wellness Trust Fund established in section 2G of chapter 111, not later than June 30. Thereafter,
191money in the fund shall be expended for: (i) public and behavioral health including but not
192limited to, evidence-based and evidence-informed substance use prevention and treatment and
193substance use early intervention services in a recurring grant for school districts or community
194coalitions who operate on the strategic prevention framework or similar structure for youth
195substance use education and prevention; (ii) public safety; (iii) municipal police training; and (iv)
196programming for restorative justice, jail diversion, workforce development, industry specific
197technical assistance, and mentoring services for economically-disadvantaged persons in
198communities disproportionately impacted by high rates of arrest and incarceration for marijuana
199offenses pursuant to chapter 94C.