Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1416 Compare Versions

Only one version of the bill is available at this time.

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2	2	HOUSE DOCKET, NO. 3226 FILED ON: 1/16/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1416
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Bud L. Williams and Judith A. Garcia
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act to advance health equity.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Bud L. Williams11th Hampden1/16/2025Judith A. Garcia11th Suffolk1/16/2025Samantha Montaño15th Suffolk2/11/2025Danillo A. Sena37th Middlesex2/11/2025Lindsay N. Sabadosa1st Hampshire2/11/2025Manny Cruz7th Essex2/24/2025Erika Uyterhoeven27th Middlesex2/24/2025Natalie M. Higgins4th Worcester2/24/2025 1 of 45
16	16	HOUSE DOCKET, NO. 3226 FILED ON: 1/16/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1416
18	18	By Representatives Williams of Springfield and Garcia of Chelsea, a petition (accompanied by
19	19	bill, House, No. 1416) of Bud L. Williams, Judith A. Garcia and others for legislation to
20	20	establish the executive office of health equity and for an investigation by a special commission
21	21	(including members of the General Court) relative to health inequities. Health Care Financing.
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Fourth General Court
25	25	(2025-2026)
26	26	_______________
27	27	An Act to advance health equity.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Section 17A of chapter 6 of the General Laws is hereby amended by
31	31	2inserting after “the secretary of energy and environmental affairs,”, in line 4, the following
32	32	3words:- the secretary of equity,.
33	33	4 SECTION 2. Section 2 of chapter 6A of the General Laws is hereby amended by
34	34	5inserting after “energy and environmental affairs,”, in line 3, the following word:- equity,.
35	35	6 SECTION 3. Section 1 of chapter 6D is hereby further amended by inserting after the
36	36	7definition of “Health care services” the following definition:-
37	37	8 “Health equity”, as defined in section 1 of chapter 6F.
38	38	9 SECTION 4. Said section 1 of said chapter 6D, as so appearing, is hereby further
39	39	10amended by inserting after the definition of “Primary care provider” the following definition:- 2 of 45
40	40	11 “Priority population”, a population that is disproportionately affected by health
41	41	12disparities.
42	42	13 SECTION 5. Subsection (b) of section 2 of said chapter 6D, as so appearing, is hereby
43	43	14amended by inserting after the word “chairperson”, in line 12, the following words:- and 1 of
44	44	15whom shall be a person of color with lived experience of social inequities and a professional
45	45	16record of health equity advocacy.
46	46	17 SECTION 6. Clause (iv) of the fourth paragraph of subsection (e) of said section 2 of
47	47	18said chapter 6D, as so appearing, is hereby amended by striking out, in line 115, the word “and”,
48	48	19and by inserting after said clause (iv) the following clause:-
49	49	20 (v) incorporate health equity into the exercising of powers and duties under this chapter;
50	50	21and.
51	51	22 SECTION 7. Said subsection (e) of said section 2 of said chapter 6D, as so appearing, is
52	52	23hereby further amended by redesignating clause (v), as inserted by section 15 of chapter 224 of
53	53	24the acts of 2012, as clause (vi).
54	54	25 SECTION 8. Subsection (g) of said section 2 of said chapter 6D, as so appearing, is
55	55	26hereby amended by striking out, in line 140, “,” and inserting in place thereof the following
56	56	27words:- , including a chief health equity officer to assist in the carrying out of powers and duties
57	57	28relating to reducing health inequities experienced by priority populations.
58	58	29 SECTION 9. Section 3 of said chapter 6D, as so appearing, is hereby amended in
59	59	30subsection (k) by striking out, in line 38, the word “and”, in subsection (l) by striking out, in line
60	60	3141, “.” and inserting in place thereof the word:- ; and. 3 of 45
61	61	32 SECTION 10. Said section 3 of said chapter 6D, as so appearing, is hereby amended by
62	62	33inserting after said subsection (l) the following subsection:-
63	63	34 (m) to incorporate health equity into the exercising of powers and duties under this
64	64	35chapter.
65	65	36 SECTION 11. Section 4 of said chapter 6D, as so appearing, is hereby amended by
66	66	37inserting after “commission”, in line 3, the following words:- , including policies relating to
67	67	38reducing health inequities experienced by priority populations.
68	68	39 SECTION 12. Section 5 of said chapter 6D, as so appearing, is hereby amended by
69	69	40striking out, in line 11, “services” and inserting in place thereof the following words:- “services,
70	70	41including such access for priority populations to ensure health equity”.
71	71	42 SECTION 13. Subsection (a) of section 8 of said chapter 6D, as so appearing, is hereby
72	72	43amended by striking out, in line 6, “shall examine” and inserting in place thereof the following
73	73	44words:- shall examine: (1).
74	74	45 SECTION 14. Said subsection (a) of said section 8 of said chapter 6D, as so appearing, is
75	75	46hereby amended by striking out, in line 9, “health care system” and inserting in place thereof the
76	76	47following words:- health care system; and (2) health inequities experienced by priority
77	77	48populations.
78	78	49 SECTION 15. Clause (i) of subsection (e) of said section 8 of said chapter 6D, as so
79	79	50appearing, is hereby amended by striking out, in line 45, “and the impact of price transparency
80	80	51on prices” and inserting in place thereof the following words:- , the impact of price transparency
81	81	52on prices, and efforts to reduce health inequities experienced by priority populations. 4 of 45
82	82	53 SECTION 16. Clause (ii) of said subsection (e) of said section 8 of said chapter 6D, as so
83	83	54appearing, is hereby amended by striking out, in line 58, “and any” and inserting in place thereof
84	84	55the following words:- , efforts to reduce health inequities experienced by priority populations,
85	85	56and any.
86	86	57 SECTION 17. Subsection (g) of said section 8 of said chapter 6D, as so appearing, is
87	87	58hereby amended by striking out, in lines 93 to 96, “annual report concerning spending trends and
88	88	59underlying factors, along with any recommendations for strategies to increase the efficiency of
89	89	60the health care system” and inserting in place thereof the following words: annual report
90	90	61concerning: (1) spending trends and underlying factors (including estimates of the cost of
91	91	62inequity for the purpose of identifying the impact of health disparities on total costs of care); (2)
92	92	63any recommendations for strategies to increase the efficiency of the health care system; and (3)
93	93	64any recommendations to reduce health inequities for priority populations based on data and input
94	94	65received pursuant to sections 10A and 2A(c)(7) of chapter 12C, respectively.
95	95	66 SECTION 18. Said subsection (g) of said section 8 of said chapter 6D, as so appearing, is
96	96	67hereby amended by striking out, in line 100, “sections 8, 9 and 10” and inserting in place
97	97	68thereof:- sections 2A(c)(7), 8, 9, 10, and 10A.
98	98	69 SECTION 19. Said chapter 6D of the General Laws is hereby further amended by
99	99	70inserting after section 9 the following section:-
100	100	71 Section 9A. (a) The board shall establish aggregate primary care and behavioral health
101	101	72expenditure targets for the commonwealth, which the commission shall prominently publish on
102	102	73its website. 5 of 45
103	103	74 (b) Prior to establishing the target and aggregate target, the commission shall hold a
104	104	75public hearing. The public hearing shall be based on the report submitted by the center under
105	105	76section 16(a) of chapter 12C, comparing the actual aggregate expenditures on primary care and
106	106	77behavioral health services to the aggregate target, any other data submitted by the center and
107	107	78such other pertinent information or data as may be available to the board. The hearing shall
108	108	79examine the performance of health care entities in meeting the target and the commonwealth’s
109	109	80health care system in meeting the aggregate target. The commission shall provide public notice
110	110	81of the hearing at least 45 days prior to the date of the hearing, including notice to the joint
111	111	82committee on health care financing. The joint committee on health care financing may
112	112	83participate in the hearing. The commission shall identify as witnesses for the public hearing a
113	113	84representative sample of providers, provider organizations, payers, community-based
114	114	85organizations, and such other interested parties as the commission may determine. Any other
115	115	86interested parties may testify at the hearing.
116	116	87 SECTION 20. Paragraph (15) of subsection (c) of section 15 of said chapter 6D, as so
117	117	88appearing, is hereby amended by striking out, in line 168, “and”.
118	118	89 SECTION 21. Said subsection (c) of said chapter 6D, as so appearing, is hereby amended
119	119	90by inserting after said paragraph (15) the following paragraphs:-
120	120	91 (16) to advance health equity by meeting health equity standards that reflect best
121	121	92practices, including standards that the commission may develop as part of the certification
122	122	93process; and 6 of 45
123	123	94 SECTION 22. Said subsection (c) of section 15 of said chapter 6D, as so appearing, is
124	124	95hereby amended by redesignating paragraph (16), as inserted by section 15 of chapter 224 of the
125	125	96acts of 2012, as paragraph (18).
126	126	97 SECTION 23. Chapter 6D of the General Laws is hereby amended by inserting after
127	127	98section 21 the following Section:-
128	128	99 Section 22. Every 2 years, the commission, in consultation with the center for health
129	129	100information and analysis, the group insurance commission, the office of Medicaid, and the
130	130	101division of insurance shall evaluate the impact of section 17S of chapter 32A, section 10O of
131	131	102chapter 118E, section 47PP of 175, section 8RR of 176A, section 4RR of 176B, and section 4HH
132	132	103of 176G on health care costs, including premiums, pharmaceutical spending, aggregate rebates,
133	133	104and cost-sharing; drug treatment utilization and adherence; incidence of related acute events; and
134	134	105health equity. The commission shall file a report of its findings with the clerks of the house of
135	135	106representatives and senate, the chairs of the joint committee on public health, the chairs of the
136	136	107joint committee on health care financing and the chairs of house and senate committees on ways
137	137	108and means.
138	138	109 SECTION 24. a) There shall be a special commission to address areas of longstanding
139	139	110health inequities in the state by establishing benchmarks (i.e., specific, measurable targets) from
140	140	111which to measure statewide improvement. The commission shall consist of: the senate chair of
141	141	112the joint committee on health care financing who shall serve as co-chair; the house chair of the
142	142	113joint committee on health care financing who shall serve as co-chair; the senate chair of the joint
143	143	114committee on public health; the house chair of the joint committee on public health; the senate
144	144	115chair of the joint committee on racial equity, civil rights, and inclusion; the house chair of the 7 of 45
145	145	116joint committee on racial equity, civil rights, and inclusion; the attorney general or a designee;
146	146	117the secretary of health and human services or a designee; the commissioner of public health or a
147	147	118designee; the executive director of the health policy commission or a designee; the executive
148	148	119director of the center for health information and analysis or a designee; 1 person with a
149	149	120professional record of health equity advocacy or expertise who shall be appointed by the senate
150	150	121president; 1 person with a professional record of health equity advocacy or expertise who shall
151	151	122be appointed by the speaker of the house of representatives; 1 person with a professional record
152	152	123of health equity advocacy or expertise who shall be appointed by the minority leader of the
153	153	124senate; 1 person with a professional record of health equity advocacy or expertise who shall be
154	154	125appointed by the minority leader of the house of representatives; 11 persons who shall be
155	155	126appointed by the governor, 1 of whom shall be a health economist, 1 of whom shall represent a
156	156	127high-Medicaid and low-income public payer disproportionate share hospital, 1 of whom shall
157	157	128represent a hospital with not more than 200 beds, 1 of whom shall represent a hospital with at
158	158	129least 800 staffed beds, 1 of whom shall have demonstrated expertise in representing the health
159	159	130care workforce as a leader in a labor organization, 1 of whom shall be a representative of an
160	160	131employer with not more than 50 employees, 1 of whom shall be a representative of an employer
161	161	132with more than 50 employees, 1 of whom shall have significant experience in the health equity
162	162	133sub-sector of the life sciences sector, 1 of whom shall be an expert in health and social services
163	163	134for children,1 of whom shall be an expert in health and social services for seniors, 1 of whom
164	164	135shall be an expert in healthcare and social services for persons with disabilities, and 1 of whom
165	165	136shall be a representative of a healthcare consumer advocacy organization; 1 person who shall be
166	166	137a representative of the Massachusetts Health and Hospital Association; 1 person who shall be a
167	167	138representative of the Massachusetts League of Community Health Centers; 1 person who shall be 8 of 45
168	168	139a representative of the Massachusetts Association of Health Plans; 1 person who shall be a
169	169	140representative of Blue Cross Blue Shield of Massachusetts; 1 person who shall be a
170	170	141representative of the Massachusetts Medical Society; 1 person who shall be a representative of
171	171	142the Massachusetts Public Health Alliance; and 1 person who shall be a representative of the
172	172	143Health Equity Compact.
173	173	144 In making appointments, elected officials shall, to the maximum extent feasible, ensure
174	174	145that the commission represents a broad distribution of geographic regions and diverse
175	175	146perspectives, including persons of color with lived experience of social inequities and
176	176	147professional records of health equity advocacy.
177	177	148 b) The commission shall collaborate with relevant state agencies and external experts,
178	178	149both in public health and health care as well as other key sectors that influence health and well-
179	179	150being, including but not limited to housing and social services, to: agree upon the highest priority
180	180	151health inequities to address in the state; establish measurable benchmarks for achieving health
181	181	152equity in the state (“Health Equity Benchmarks”); and develop a framework for driving and
182	182	153assessing state performance on such Health Equity Benchmarks that promotes accountability
183	183	154with respect to achieving material progress in addressing health inequities in the state.
184	184	155 c) The Health Equity Benchmarks established by the commission shall include, but not be
185	185	156limited to, the following:
186	186	157 1) Reducing disparities in overarching metrics between racial and ethnic groups, such as,
187	187	158for example, reducing the life expectancy gap in Massachusetts;
188	188	159 2) Reducing disparities in overarching metrics across geographic regions within the state; 9 of 45
189	189	160 3) Improving performance with respect to certain population-based outcome metrics,
190	190	161such as, for example, reducing pregnancy-associated deaths among certain racial and ethnic
191	191	162groups;
192	192	163 4) Improving performance with respect to certain process metrics applicable to health
193	193	164equity including, for example, utilization metrics, financial investment, data collection, and
194	194	165structural reforms; and
195	195	166 5) Stakeholder-specific responsibilities and performance targets, where stakeholders
196	196	167include both public and private sector entities.
197	197	168 d) The framework for driving and assessing statewide performance shall include, but not
198	198	169be limited to, the following:
199	199	170 1) Data reporting, tracking, and transparency mechanisms for both public and private
200	200	171stakeholders, such as through the use of public data dashboards;
201	201	172 2) Enforcement mechanisms to hold public and private stakeholders accountable for
202	202	173making progress towards achieving the benchmarks;
203	203	174 3) Evaluation criteria, including allowance for periodic benchmark refinement;
204	204	175 4) Mechanisms to facilitate coordination, collaboration, and improvement among
205	205	176stakeholders in order to support progress towards achieving the benchmarks;
206	206	177 5) Mechanisms for financing the implementation of and progress towards the
207	207	178benchmarks; and 10 of 45
208	208	179 6) Identification of the relevant agency or agencies responsible for implementation of the
209	209	180above data reporting, tracking, accountability, evaluation, improvement support, and financing
210	210	181mechanisms.
211	211	182 e) In developing its recommendations, the commission shall identify and build on areas
212	212	183of alignment across other major frameworks, goals, benchmarks, and initiatives in Massachusetts
213	213	184related to health equity, in both the public and private sectors. In developing its
214	214	185recommendations, the commission shall consider and, to the extent possible, incorporate recent
215	215	186findings from significant community engagement initiatives and needs assessments in the most
216	216	187disproportionately impacted communities. The commission shall consult with external experts
217	217	188and focus on topics including but not limited to data collection and reporting, and inequities in
218	218	189health outcomes, healthcare access and quality in such consultations. The commission may hold
219	219	190public meetings and fact-finding hearings as it considers necessary. The commission may also
220	220	191establish working groups to further investigate and develop draft recommendations. To conduct
221	221	192its review and analysis, the commission may contract with an outside organization to assist the
222	222	193commission in carrying out its functions as described in this section. The center for health
223	223	194information and analysis and the health policy commission shall provide the commission and any
224	224	195contracted outside organization, to the extent possible, relevant data and analysis necessary for
225	225	196the evaluation.
226	226	197 f) The commission shall hold its first meeting not later than 90 days after enactment of
227	227	198this act, and shall meet periodically thereafter as determined necessary by the commission co-
228	228	199chairs to carry out the duties of the commission. 11 of 45
229	229	200 g) By no later than sixteen months after enactment of this act, the commission shall
230	230	201complete the activities described in the preceding paragraphs and submit a final report to the
231	231	202Governor’s office, the state legislature, and the health policy commission, which shall include,
232	232	203but not be limited to: the high-priority areas of health inequities in the state identified by the
233	233	204commission; the Health Equity Benchmarks drafted by the commission; the framework for
234	234	205driving and assessing state performance that promotes accountability with respect to achieving
235	235	206material progress in addressing health inequities in the state; and recommendations for
236	236	207operationalizing the Health Equity Benchmarks and the framework for driving and assessing
237	237	208state performance.
238	238	209 h) If the commission determines that legislation is necessary to operationalize its
239	239	210recommendations, the commission, as part of its final report, shall file proposals for such
240	240	211legislation not later than twenty months after enactment of this act with the clerks of the house of
241	241	212representatives and the senate, who shall forward a copy of the materials filed by the commission
242	242	213to the house and senate committees on ways and means and the joint committee on health care
243	243	214financing.
244	244	215 SECTION 25. The General Laws are hereby amended by inserting after chapter 6E the
245	245	216following chapter:-
246	246	217 CHAPTER 6F
247	247	218 EXECUTIVE OFFICE OF EQUITY
248	248	219 Section 1. Definitions 12 of 45
249	249	220 As used in this chapter, the following words shall, unless the context clearly requires
250	250	221otherwise, have the following meanings:-
251	251	222 “Data dashboards”, information management tools used to track, analyze, and display in
252	252	223a user-friendly and accessible format important performance indicators, metrics, and data points
253	253	224for review by the general public and others.
254	254	225 “Equity”, the consistent and systematic fair, just, and impartial treatment of all
255	255	226individuals, including individuals who belong to underserved communities that have historically
256	256	227been denied such treatment, including: (1) Black, Latino, Indigenous and Native American
257	257	228persons, Asian Americans and Pacific Islanders, and other persons of color; (2) members of
258	258	229religious minorities; lesbian, gay, bisexual, transgender, and queer persons; (3) persons with
259	259	230disabilities; persons who live in rural areas; and (4) persons otherwise adversely affected by
260	260	231persistent poverty or inequality.
261	261	232 “Health equity”, the state in which everyone has a fair and just opportunity to be as
262	262	233healthy as possible. Such a state requires removing obstacles to health and to health care
263	263	234services, and promoting individuals’ ability to control their own healthcare and set their own care
264	264	235goals. For purposes of the preceding sentences, achieving health equity requires focused and
265	265	236ongoing efforts to address historical and contemporary injustices such as poverty and racism and
266	266	237efforts to address social determinants of health, including lack of access to good jobs with fair
267	267	238pay; quality education; safe, accessible, and affordable housing; public transportation; safe and
268	268	239healthy environments; and health care. In this term, health includes physical health, oral health,
269	269	240and behavioral health. For the purposes of measurement, advancing health equity means 13 of 45
270	270	241reducing and ultimately eliminating disparities in health outcomes that adversely affect
271	271	242underserved, excluded, or marginalized groups.
272	272	243 “Office”, executive office of equity.
273	273	244 “Secretary”, secretary of equity.
274	274	245 “Social determinants of health”, the conditions in the environments where people are
275	275	246born, live, learn, work, play, worship, and age that affect a wide range of health outcomes,
276	276	247functioning, and quality-of-life outcomes and risks, including economic stability, education
277	277	248access and quality, health care access and quality, neighborhood and built environment, and
278	278	249social and community contexts.
279	279	250 Section 2. Establishment of office
280	280	251 There shall be an executive office of equity, which shall serve directly under the
281	281	252governor.
282	282	253 Section 3. Principal agency of executive department; purposes
283	283	254 The executive office of equity shall serve as the principal agency of the executive
284	284	255department for the following purposes:
285	285	256 (a) leading efforts toward equity, diversity, and inclusion across state government, within
286	286	257each executive office, and throughout the commonwealth; promoting access to equitable
287	287	258opportunities and resources that reduce disparities; and improving outcomes statewide across
288	288	259state government;
289	289	260 (b) developing multi-year strategic plans to advance equity within each executive office; 14 of 45
290	290	261 (c) developing standards for the collection, analysis, and public reporting of
291	291	262disaggregated data by race, ethnicity, language, disability, gender, income and other socio-
292	292	263demographic factors as it pertains to tracking population level outcomes of communities; and
293	293	264creating statewide and executive office-specific process and outcome measures using outcome-
294	294	265based methodologies to determine the effectiveness of agency programs and services on reducing
295	295	266disparities;
296	296	267 (d) developing and implementing equity impact analyses at the request of any
297	297	268constitutional, executive, or legislative office and from time to time as deemed necessary by the
298	298	269secretary;
299	299	270 (e) creating and publishing data dashboards stratified and disaggregated by race,
300	300	271ethnicity, language, disability, and other socio-demographic factors. Said dashboards shall
301	301	272include data relative to population level outcomes and to the process and outcome measures
302	302	273described in subsection (c) as well as any additional data the office deems important for the
303	303	274general public and decision makers. These dashboards shall comply with applicable privacy law
304	304	275but shall be publicly presented in a user-friendly format, with a focus on ensuring accessibility in
305	305	276its design; and
306	306	277 (f) coordinating with public and quasi-public entities in the commonwealth, including the
307	307	278health policy commission under chapter 6D and the center for health information and analysis
308	308	279under chapter 12C, for the purposes described in subsection (a).
309	309	280 Section 4. Secretary of equity; appointment; salary; powers and duties; undersecretaries
310	310	281of equity 15 of 45
311	311	282 The governor shall appoint the secretary of equity. Said secretary shall serve at the
312	312	283pleasure of the governor, shall receive such salary as the governor may determine, and shall
313	313	284devote full time to the duties of this office.
314	314	285 The secretary, in consultation with each respective secretary of each Massachusetts
315	315	286executive office, shall appoint an undersecretary of equity to assist each other Massachusetts
316	316	287executive office in applying an equity lens in all aspects of agency decision making, including
317	317	288service delivery, program development, policy development, and budgeting. The secretary shall
318	318	289appoint an undersecretary of equity for administration and finance, an undersecretary of equity
319	319	290for education, an undersecretary of equity for energy and environmental affairs, an
320	320	291undersecretary of equity for health and human services, an undersecretary of equity for housing,
321	321	292an undersecretary of economic development, an undersecretary of equity for labor and workforce
322	322	293development, an undersecretary of equity for public safety and security, an undersecretary of
323	323	294equity for transportation, an undersecretary of equity for veterans affairs, and an undersecretary
324	324	295of equity for climate innovation and resilience. Each person appointed as an undersecretary shall
325	325	296have experience, and shall know the field or functions of such position.
326	326	297 The undersecretaries shall provide assistance to the executive offices by:
327	327	298 (a) facilitating information sharing between agencies related to diversity, equity, and
328	328	299inclusion;
329	329	300 (b) convening work groups or stakeholder advisory boards as needed;
330	330	301 (c) developing and providing assessment tools for agencies to use in the development and
331	331	302evaluation of agency programs, services, policies, and budgets; 16 of 45
332	332	303 (d) training the appropriate executive office staff on how to effectively use the
333	333	304assessment tools developed under subsection (c), including developing guidance on how to apply
334	334	305an equity lens to the executive office’s work when carrying out duties under this chapter;
335	335	306 (e) developing a form that will serve as each appropriate executive office’s diversity,
336	336	307equity, and inclusion plan, required to be submitted by the secretary of the executive office of
337	337	308equity under section 7 in a manner and at frequency determined appropriate by the
338	338	309undersecretaries. The office must post each final plan on the dashboard described in section 3;
339	339	310 (f) maintaining an inventory of the appropriate executive office’s work in the area of
340	340	311diversity, equity, and inclusion; and
341	341	312 (g) compiling and creating resources for executive offices to use as guidance when
342	342	313carrying out the requirements of this chapter.
343	343	314 Section 5. Advisory board
344	344	315 (a) There shall be an advisory board to the executive office of equity. The advisory board
345	345	316shall consist of: 3 persons appointed by the governor; 3 persons appointed by the president of the
346	346	317senate; 3 persons appointed by the speaker of the house of representatives; 3 persons appointed
347	347	318by the Massachusetts Black and Latino Legislative Caucus; 1 person appointed by the Secretary
348	348	319of Administration and Finance who shall have expertise in economic matters; 1 person appointed
349	349	320by the Secretary of Education who shall have expertise in education matters; 1 person appointed
350	350	321by the Secretary of Energy and Environmental Affairs who shall have expertise in environmental
351	351	322justice; 1 person appointed by the Secretary of Health and Human Services who shall have
352	352	323expertise in health equity and the social determinants of health; 1 person appointed by the
353	353	324Secretary of Housing who shall have expertise in housing policy; 1 person appointed by the 17 of 45
354	354	325Secretary of Economic Development who shall have expertise in economic development policy;
355	355	3261 person appointed by the Secretary of Labor and Workforce Development who shall have
356	356	327expertise in labor and workforce development policy; 1 person appointed by the Secretary of
357	357	328Public Safety and Security who shall have expertise in criminal justice matters; 1 person
358	358	329appointed by the Secretary of Transportation who shall have expertise in transportation matters;
359	359	3301 person appointed by the Secretary of Veterans Affairs who shall have expertise in matters
360	360	331related to veterans, and 1 person appointed by the Secretary of Office of Climate Innovation and
361	361	332Resilience who shall have experience in climate matters.
362	362	333 All members of the advisory board shall be residents of the commonwealth who are not
363	363	334employed by the commonwealth who have demonstrated a commitment to advancing equity and
364	364	335expertise in utilizing policy, systems and environmental strategies to address inequities. Criteria
365	365	336for selection of members shall consider diversity of geography; diversity of race and ethnicity;
366	366	337diversity of age; inclusion of individuals living with disabilities; and inclusion of individuals
367	367	338from the LGBTQ+ community. All members must have expertise in utilizing policy, systems and
368	368	339environmental strategies to address inequities. Members shall be considered special state
369	369	340employees for purposes of chapter 268A. All community representatives serving on the board
370	370	341shall be compensated for their time. The appointing authorities shall confer prior to making final
371	371	342appointments to ensure compliance with this provision.
372	372	343 (b) A member of the board shall serve a term of 3 years and until they vacate their
373	373	344membership or until a successor is appointed. Vacancies in the membership of the board shall be
374	374	345filled by the original appointing authority for the balance of the unexpired term. 18 of 45
375	375	346 (c) The board shall annually elect from among its members a chair, a vice chair, a
376	376	347treasurer, and any other officers it considers necessary.
377	377	348 (d) The board shall advise the executive office of equity on the overall operation and
378	378	349policies of the office.
379	379	350 (e) The board shall meet no less than quarterly to discuss and debate matters related to the
380	380	351overall operation and policies of the executive office of equity.
381	381	352 (f) The board may request information and assistance from executive offices as the board
382	382	353requires.
383	383	354 Section 6. Strategic Plan; data dashboards; equity impact analysis
384	384	355 (a) The secretary, in collaboration with other secretaries in the governor’s cabinet, shall
385	385	356develop a multi-year equity strategy to improve equity across government and the
386	386	357commonwealth, including improved access to affordable health care (including oral and
387	387	358behavioral health care), quality food and housing, safe communities, quality education,
388	388	359employment for which people are paid a living wage and that includes good working conditions,
389	389	360and affordable transportation and child care.
390	390	361 (b) Notwithstanding any general or special law to the contrary, the secretary, in
391	391	362collaboration with other secretaries in the governor’s cabinet, shall publish and regularly update
392	392	363data dashboards on the executive office of equity’s website. To the extent possible, all data
393	393	364dashboards shall include data able to be disaggregated by (1) gender; (2) race; (3) ethnicity; (4)
394	394	365geographic location; (5) age; (6) disability; (7) primary language; (8) occupation; and (9) any 19 of 45
395	395	366other demographic information that the secretary deems important to understand inequities and
396	396	367disparities in the commonwealth.
397	397	368 (c) The secretary, in collaboration with other secretaries in the governor’s cabinet, shall
398	398	369develop and implement equity impact analyses at the request of any constitutional, executive, or
399	399	370legislative office and from time to time as deemed necessary by the secretary. Equity impact
400	400	371analyses shall include, at a minimum, and to the extent that information is available, an analysis
401	401	372of whether the proposed policy is likely to promote or undermine equity, including health equity,
402	402	373in the commonwealth. Equity impact analyses may consider:
403	403	374 (1) direct impacts on disparities, inequities, the social determinants of health, and the
404	404	375determinants of equity, with special attention to the impacts on populations that have
405	405	376experienced marginalization or oppression;
406	406	377 (2) the quality and relevance of studies to evaluate said impacts;
407	407	378 (3) the availability of measures that would minimize any anticipated adverse equity
408	408	379consequences;
409	409	380 (4) the existence of adverse short-term and long-term equity consequences that cannot be
410	410	381avoided should the proposed policy be implemented;
411	411	382 (5) the availability of reasonable alternatives to the proposed policy; and
412	412	383 (6) the impact of the proposed policy on factors, including:
413	413	384 (A) income security, including adequate wages, relevant tax policies, access to affordable
414	414	385health insurance, retirement benefits, and paid leave; 20 of 45
415	415	386 (B) food security and nutrition, including food assistance program eligibility, enrollment,
416	416	387and assessments of food access and rates of access to unhealthy food and beverages;
417	417	388 (C) child development, education, and literacy rates, including opportunities for early
418	418	389childhood development and parenting support, rates of graduation compared to dropout rates,
419	419	390college attainment and adult literacy;
420	420	391 (D) housing, including access to affordable, safe, accessible, and healthy housing;
421	421	392housing near parks and with access to healthy foods; and housing that incorporates universal
422	422	393design and visitability features;
423	423	394 (E) environmental quality, including exposure to toxins in the air, water and soil;
424	424	395 (F) accessible built environments that promote health and safety, including mixed-used
425	425	396land; active transportation such as improved pedestrian, bicycle and automobile safety; parks and
426	426	397green space; and healthy school siting;
427	427	398 (G) health care access, including accessible chronic disease management programs,
428	428	399access to affordable, high-quality health and behavioral health care, access to home and
429	429	400community based services, and the recruitment and retention of a diverse health care workforce;
430	430	401 (H) prevention efforts, including community-based education and availability of
431	431	402preventive services;
432	432	403 (I) assessing ongoing discrimination and minority stressors against individuals and
433	433	404groups in populations that have experienced marginalization or oppression based upon race,
434	434	405gender, gender identity, gender expression, ethnicity, marital status, language, sexual orientation, 21 of 45
435	435	406disability, and other factors, including discrimination that is based upon bias and negative
436	436	407attitudes of health professionals and providers;
437	437	408 (J) neighborhood safety and collective efficacy, including rates of violence, increases or
438	438	409decreases in community cohesion, and collaborative efforts to improve the health and well-being
439	439	410of the community;
440	440	411 (K) culturally appropriate and competent services and training in all sectors, including
441	441	412training to eliminate bias, discrimination and mistreatment of persons in populations that have
442	442	413experienced marginalization or oppression;
443	443	414 (L) linguistically appropriate and competent services and training in all sectors, including
444	444	415the availability of information in alternative formats such as large font, braille and American
445	445	416Sign Language;
446	446	417 (M) accessible, affordable and appropriate mental health and substance use disorder
447	447	418services; and
448	448	419 (N) accessible, affordable, and appropriate oral health services.
449	449	420 Section 7. Annual Report
450	450	421 The secretary shall, on or before the first Wednesday in December of each year, submit a
451	451	422report to the governor, the president of the senate, the speaker of the house of representatives, the
452	452	423chair of the senate committee on ways and means, and the chair of the house committee on ways
453	453	424and means. Such report shall list and discuss the proposals which have been made and the
454	454	425accomplishments which have been achieved during the preceding two years towards advancing
455	455	426equity within the executive office of equity, each other executive office and throughout the 22 of 45
456	456	427commonwealth. Said report shall contain a summary of the objectives of such proposals, their
457	457	428disposition, and such further recommendations for legislative or executive actions concerning
458	458	429these proposals or additional proposals as, in the judgment of the secretary, should be made to
459	459	430improve equity in the programs, services and business affairs of the commonwealth.
460	460	431 SECTION 26. Section 1 of said chapter 12C is hereby amended by inserting after the
461	461	432definition of “Health care services” the following definition:-
462	462	433 “Health equity”, as defined in section 1 of chapter 6F.
463	463	434 SECTION 27. Said section 1 of said chapter 12C, as so appearing, is hereby further
464	464	435amended by inserting after the definition of “Primary service area” the following definition:-
465	465	436 “Priority population”, as defined in section 1 of chapter 6D.
466	466	437 SECTION 28. Paragraph (4) of subsection (c) of said section 2A of said chapter 12C, as
467	467	438so appearing, is hereby amended by striking out, in line 42, “center” and inserting in place
468	468	439thereof the following words:- center, including research and analysis concerning health
469	469	440disparities and health equity for priority populations of the commonwealth.
470	470	441 SECTION 29. Said section 2A of said chapter 12C, as so appearing, is hereby amended
471	471	442in paragraph (5) by striking out, in line 47, “and”, in paragraph (6) by striking out, in line 50, “.”
472	472	443and inserting in place thereof the following “; and”, and by inserting after said paragraph (6) the
473	473	444following new paragraph:-
474	474	445 (7) develop a process to hold annual public hearings to obtain input relating to health
475	475	446equity research and analysis priorities from healthcare consumers in the commonwealth, and it
476	476	447shall be the goal of the council for such hearings to obtain input from priority populations, the 23 of 45
477	477	448health disparities council under section 16O of chapter 6A, the division of medical assistance,
478	478	449and the department of public health. The council shall analyze the input received for the
479	479	450purposes of inclusion in the annual report described in section 16(a).
480	480	451 SECTION 30. Clause (v) of section 3 of said chapter 12C, as so appearing, is hereby
481	481	452amended by striking out, in line 25, the following word:- “and”, and in clause (vi) by striking
482	482	453out, in line 27, “.” and inserting in place thereof:- ; (vii) to conduct research to improve the
483	483	454center’s understanding of: (I) barriers to health equity data collection under sections 10A; and
484	484	455(II) how to restore trust and respectfully engage with individuals from priority populations who
485	485	456are paid participants in such research; and (viii) to conduct research to improve the center’s
486	486	457understanding of how racial ethnic, cultural, ability, and linguistic diversity in the healthcare
487	487	458workforce impacts health care access and care quality for priority populations. The center shall
488	488	459report on the research described in clauses (vii) and (viii).
489	489	460 SECTION 31. Said section 3 of said chapter 12C, as so appearing, is hereby amended by
490	490	461inserting after the first paragraph the following paragraph:-
491	491	462 The executive director shall appoint and may remove a chief health equity officer to
492	492	463assist in the carrying out of powers and duties under this chapter relating to reducing health
493	493	464inequities experienced by priority populations.
494	494	465 SECTION 32. Chapter 12C of the General Laws is hereby amended by inserting after
495	495	466section 10 the following section:-
496	496	467 Section 10A. (a) The center shall promulgate regulations that identify the types of entities
497	497	468specified in sections 8, 9, and 10 which the center determines possess data necessary to analyze
498	498	469health inequities experienced by priority populations in the commonwealth. 24 of 45
499	499	470 (b)(1) The center shall promulgate regulations necessary to ensure, to the extent
500	500	471practicable, the uniform reporting of information from such entities identified pursuant to the
501	501	472regulations described in subsection (a) and any other information the center determines
502	502	473appropriate. In promulgating such regulations, the center shall consult with: (A) the department
503	503	474of public health; and (B) the division of medical assistance.
504	504	475 (2) To ensure that standards with respect to health equity data for accountable care
505	505	476organizations under MassHealth are incorporated into such regulations, the regulations shall
506	506	477specify standardized measures for data collection to: (A) standardize and strengthen social risk
507	507	478factors data collection, including race (including meaningful capture of multi-racial), ethnicity,
508	508	479language, disability, sexual orientation, gender identity, geographic location (including, for
509	509	480example, ZIP code, census tract, and/or primary city or town of residence), and health-related
510	510	481social needs; (B) maintain robust structures to identify and understand disparities, including
511	511	482through stratified reporting on key performance indicators; and (C) account for social
512	512	483determinants of health, including food insecurity, housing stability, and community violence.
513	513	484 (c) The center shall provide technical assistance to such entities to ensure the data is
514	514	485reported in a manner consistent with such regulations.
515	515	486 (d) The center shall analyze such data and input received pursuant to subsection (b) and
516	516	487section 2A(c)(7), respectively.
517	517	488 (e) The center shall coordinate with the office of equity with respect to such data for the
518	518	489purpose of section 6 of chapter 6F. 25 of 45
519	519	490 SECTION 33. Section 11 of said chapter 12C, as so appearing, is hereby amended by
520	520	491striking out, in line 2, “sections 8, 9 and 10” and inserting in place thereof the following words:-
521	521	492sections 8, 9, 10, and 10A.
522	522	493 SECTION 34. Section 16 of said chapter 12C, as so appearing, is hereby amended by
523	523	494striking out subsection (a) and inserting in place thereof the following subsection:-
524	524	495 (a) The center shall publish an annual report based on the information submitted under
525	525	496this chapter concerning health care provider, provider organization and private and public health
526	526	497care payer costs and cost trends, section 13 of chapter 6D relative to market power reviews and
527	527	498section 15 relative to quality data. The center shall compare the costs, cost trends, and
528	528	499expenditures with the health care cost growth benchmark established under section 9A of said
529	529	500chapter 6D, analyzed by regions of the commonwealth, and shall compare the costs, cost trends,
530	530	501and expenditures with the aggregate primary care and behavioral health expenditure targets
531	531	502established under section 9A of said chapter 6D, and shall detail: (1) baseline information about
532	532	503cost, price, quality, utilization and market power in the commonwealth’s health care system; (2)
533	533	504cost growth trends for care provided within and outside of accountable care organizations and
534	534	505patient-centered medical homes; (3) cost growth trends by provider sector, including but not
535	535	506limited to, hospitals, hospital systems, non-acute providers, pharmaceuticals, medical devices
536	536	507and durable medical equipment; provided, however, that any detailed cost growth trend in the
537	537	508pharmaceutical sector shall consider the effect of drug rebates and other price concessions in the
538	538	509aggregate without disclosure of any product or manufacturer-specific rebate or price concession
539	539	510information, and without limiting or otherwise affecting the confidential or proprietary nature of
540	540	511any rebate or price concession agreement; (4) factors that contribute to cost growth within the
541	541	512commonwealth’s health care system and to the relationship between provider costs and payer 26 of 45
542	542	513premium rates; (5) primary care and behavioral health expenditure trends as compared to the
543	543	514aggregate baseline expenditures, as defined in section 1 of said chapter 6D; (6) the proportion of
544	544	515health care expenditures reimbursed under fee-for-service and alternative payment
545	545	516methodologies; (7) the impact of health care payment and delivery reform efforts on health care
546	546	517costs including, but not limited to, the development of limited and tiered networks, increased
547	547	518price transparency, increased utilization of electronic medical records and other health
548	548	519technology; (8) the impact of any assessments including, but not limited to, the health system
549	549	520benefit surcharge collected under section 68 of chapter 118E, on health insurance premiums; (9)
550	550	521trends in utilization of unnecessary or duplicative services, with particular emphasis on imaging
551	551	522and other high-cost services; (10) the prevalence and trends in adoption of alternative payment
552	552	523methodologies and impact of alternative payment methodologies on overall health care spending,
553	553	524insurance premiums and provider rates; (11) the development and status of provider
554	554	525organizations in the commonwealth including, but not limited to, acquisitions, mergers,
555	555	526consolidations and any evidence of excess consolidation or anti-competitive behavior by
556	556	527provider organizations; and (12) the impact of health care payment and delivery reform on the
557	557	528quality of care delivered in the commonwealth.
558	558	529 As part of its annual report, the center shall report on price variation between health care
559	559	530providers, by payer and provider type. The center’s report shall include: (1) baseline information
560	560	531about price variation between health care providers by payer including, but not limited to,
561	561	532identifying providers or provider organizations that are paid more than 10 per cent above or more
562	562	533than 10 per cent below the average relative price and identifying payers which have entered into
563	563	534alternative payment contracts that vary by more than 10 per cent; (2) the annual change in price
564	564	535variation, by payer, among the payer’s participating providers; (3) factors that contribute to price 27 of 45
565	565	536variation in the commonwealth’s health care system; (4) the impact of price variations on
566	566	537disproportionate share hospitals and other safety net providers; and (5) the impact of health
567	567	538reform efforts on price variation including, but not limited to, the impact of increased price
568	568	539transparency, increased prevalence of alternative payment contracts and increased prevalence of
569	569	540accountable care organizations and patient centered medical homes.
570	570	541 As part of its annual report, the center shall report on data and information received
571	571	542pursuant to section 10A and input received pursuant to section 2A(c)(7), including an analysis of
572	572	543the factors that may lead to health inequities for priority populations.
573	573	544 The center shall publish and provide the report to health policy commission at least 30
574	574	545days before any hearing required under section 8 of chapter 6D. The center may contract with an
575	575	546outside organization with expertise in issues related to the topics of the hearings to produce this
576	576	547report.
577	577	548 The center shall publish the aggregate baseline expenditures starting in the 2025 annual
578	578	549report.
579	579	550 The center, in consultation with the commission, shall hold a public hearing and adopt or
580	580	551amend rules and regulations establishing the methodology for calculating baseline and
581	581	552subsequent years’ expenditures for individual health care entities within 90 days of the effective
582	582	553date.
583	583	554 The center, in consultation with the commission, shall determine the baseline
584	584	555expenditures for individual health care entities and shall report to each health care entity its
585	585	556respective baseline expenditures by not less than thirty days before publishing the results. 28 of 45
586	586	557 SECTION 35. Subsection (c) section 2GGGG of chapter 29 of the General Laws is
587	587	558hereby amended by striking out, in line 36, “and (6) to improve the affordability and quality of
588	588	559care” and inserting in place thereof the following words:- (6) to improve the affordability and
589	589	560quality of care; and (7) to reduce identified disparities or otherwise advance equity in care
590	590	561delivery.
591	591	562 SECTION 36. Chapter 111 of the General Laws is hereby amended by inserting after
592	592	563section 2J the following sections:-
593	593	564 Section 2K. (a) As used in this section, the following words shall, unless the context
594	594	565clearly requires otherwise, have the following meanings:-
595	595	566 “Environmental justice population”, as defined in section 62 of chapter 30.
596	596	567 "Health equity zone", a contiguous geographic area that: (1) demonstrates measurable
597	597	568and documented health inequities and poor health outcomes (including disproportionately high
598	598	569rates of maternal mortality and morbidity, infant and child health conditions, chronic and
599	599	570infectious disease in the general population, oral health conditions, or behavioral health
600	600	571conditions); and (2) meets criteria to be an environmental justice population or other definition of
601	601	572social inequity as determined by the department.
602	602	573 (b) There shall be established and set upon the books of the commonwealth a separate
603	603	574fund to be known as the Health Equity Zone Trust Fund to be expended, without further
604	604	575appropriation, by the department of public health. The fund shall consist of revenues collected by
605	605	576the commonwealth including: (1) any revenue from appropriations or other monies authorized by
606	606	577the general court and specifically designated to be credited to the fund; (2) any fines and
607	607	578penalties allocated to the fund under the General Laws; (3) any funds from public and private 29 of 45
608	608	579sources such as gifts, grants and donations to further community-based prevention activities; (4)
609	609	580any interest earned on such revenues; and (5) any funds provided from other sources, including
610	610	581financial contributions from private organizations.
611	611	582 The department of public health shall establish a framework to incentivize private sector
612	612	583participation to implement the activities described in this section, that includes, but is not limited
613	613	584to, establishing a mechanism to facilitate financial contributions from private organizations to the
614	614	585Health Equity Zone Trust Fund to supplement public revenues allocated by the commonwealth,
615	615	586and the ability of private organizations to participate as part of a multi-sector partnership,
616	616	587consistent with subsection (e).
617	617	588 The commissioner of public health, as trustee, shall administer the fund. The
618	618	589commissioner, in consultation with the Health Equity Zone Advisory Board established under
619	619	590section 2L, shall make expenditures from the fund consistent with subsection (e).
620	620	591 (c) Revenues deposited in the fund that are unexpended at the end of the fiscal year shall
621	621	592not revert to the General Fund and shall be available for expenditure in the following fiscal year.
622	622	593 (d) All expenditures from the Health Equity Zone Trust Fund shall support the state’s
623	623	594efforts to address health disparities and develop a stronger evidence base of effective place-based
624	624	595health equity interventions.
625	625	596 (e) The purpose of the Health Equity Zone Trust Fund is to enable the creation of so-
626	626	597called health equity zones, namely geographic areas where existing opportunities emerge and
627	627	598investments are made to address inequities in health outcomes. The Health Equity Zone Trust
628	628	599Fund will equip multi-sector partnerships which may include residents, businesses and other
629	629	600private sector stakeholders, community-organizations, and municipal agencies to identify and 30 of 45
630	630	601create community determined solutions necessary to create just and fair conditions for health.
631	631	602The Health Equity Zone Trust Fund shall prioritize investment in the communities that have been
632	632	603systematically oppressed and where decades of disinvestment have created inequitable health
633	633	604outcomes.
634	634	605 The commissioner shall award not less than 85 per cent of the Health Equity Zone Trust
635	635	606Fund through a competitive grant process to municipalities, community-based organizations, and
636	636	607regional-planning agencies that apply for the implementation, technical assistance, and
637	637	608evaluation of health equity activities, consistent with the below. To be eligible to receive a grant
638	638	609under this subsection, a recipient shall be: (1) a community-based organization or group of
639	639	610community-based organizations working in collaboration; (2) a community-based organization
640	640	611working in collaboration with 1 or more municipality; or (3) a regional planning agency.
641	641	612Expenditures from the fund for such purposes shall supplement and not replace existing local,
642	642	613state, private or federal public health-related funding.
643	643	614 (f) Priority shall be given to proposals in a geographic region of the state with a higher
644	644	615than average prevalence of preventable health conditions (including oral and behavioral health
645	645	616conditions), as determined by the commissioner of public health, in consultation with the Health
646	646	617Equity Zone Advisory Board. If no proposals were offered in areas of the state with particular
647	647	618need, the department shall ask for a specific request for proposal for that specific region. If the
648	648	619commissioner determines that no suitable proposals have been received, such that the specific
649	649	620needs remain unmet, the department may work directly with municipalities or community-based
650	650	621organizations to develop grant proposals. The department should also gather feedback from
651	651	622community-based organizations and municipalities in such region(s) in order to understand the
652	652	623barriers to applying and make every effort to mitigate these barriers for future rounds of funding. 31 of 45
653	653	624 The department of public health shall, in consultation with the Health Equity Zone
654	654	625Advisory Board, conduct a periodic review of the funding allocations, grant activities, and
655	655	626progress being made by each grantee as well as the overall grant program, for the purposes of
656	656	627program improvement. Each grantee shall participate in any evaluation, transparency and
657	657	628accountability processes, and reporting requirements implemented or authorized by the
658	658	629department in carrying out its duties to conduct the periodic review described herein, provided,
659	659	630however, that the department shall make such evaluation, transparency and accountability
660	660	631processes, and reporting requirements as minimally burdensome as is possible.
661	661	632 (g) The department of public health shall, annually on or before January 31, report on
662	662	633expenditures from the Health Equity Zone Trust Fund. The report shall include, but not be
663	663	634limited to: (1) the revenue credited to the fund; (2) the amount of fund expenditures attributable
664	664	635to the administrative costs of the department of public health; (3) an itemized list of the funds
665	665	636expended through the competitive grant process and a description of the grantee activities; (4)
666	666	637the results of the evaluation assessing the activities funded through grants conducted pursuant to
667	667	638the periodic review described in subsection (f); and (5) an itemized list of expenditures used to
668	668	639support place-based health equity interventions. The report shall be provided to the chairpersons
669	669	640of the house and senate committees on ways and means and the joint committee on public health
670	670	641and shall be posted on the department of public health’s website.
671	671	642 (h) The department of public health shall, under the advice and guidance of the Health
672	672	643Equity Zone Advisory Board, regularly report on its strategy for administration and allocation of
673	673	644the fund, including relevant evaluation criteria. The report shall set forth the rationale for such
674	674	645strategy. 32 of 45
675	675	646 (i) The department of public health shall promulgate regulations necessary to carry out
676	676	647this section.
677	677	648 Section 2L. There shall be a Health Equity Zone Advisory Board to make
678	678	649recommendations to the commissioner concerning the administration and allocation of the
679	679	650Health Equity Zone Trust Fund established in section 2K, establish evaluation criteria, and
680	680	651perform any other functions specifically granted to it by law.
681	681	652 The board shall consist of: the commissioner of public health or a designee, who shall
682	682	653serve as co-chairperson; and 10 persons to be appointed by the commissioner through a public
683	683	654nomination process, 4 of whom shall be community representatives with lived experience of
684	684	655health inequities in their communities (one of whom shall serve as co-chair); 1 of whom shall be
685	685	656a person with expertise in the field of health equity; 1 of whom shall be a person from a local
686	686	657board of health for a city or town with a population greater than 50,000; 1 of whom shall be a
687	687	658person of a board of health for a city or town with a population of fewer than 50,000; 1 of whom
688	688	659shall be a person from a hospital association; 1 of whom shall be a person from a statewide
689	689	660public health organization; 1 of whom shall be a representative of a community development
690	690	661corporation or association representing community development corporations and 1 of whom
691	691	662shall be a community health worker or a person from an association representing community
692	692	663health workers. Criteria for selection of members shall consider diversity of geography; diversity
693	693	664by race, ethnicity, gender, and ability; expertise in program design and implementation; expertise
694	694	665in health equity; expertise in utilizing policy, systems and environmental strategies to address
695	695	666health inequities. All community representatives serving on the board shall be compensated for
696	696	667their time at an amount determined by the Commissioner. 33 of 45
697	697	668 SECTION 37. Subsection (g) of section 25C of chapter 111 of the General Laws is
698	698	669hereby amended by inserting after “account”, in line 103, the following words:- the findings of
699	699	670the health equity assessment described in subsection (o) and.
700	700	671 SECTION 38. Said subsection (g) of section 25C of chapter 111, as so appearing, is
701	701	672hereby amended by striking out, in line 104, “from” and inserting in place thereof the following
702	702	673words:- “from the office of equity,”.
703	703	674 SECTION 39. Clause (ii) of paragraph (4) of subsection (a) of section 25L of chapter
704	704	675111, as so appearing, is hereby amended by striking out, in line 47, “comprehensive recruitment
705	705	676initiatives” and inserting in place thereof the following words:- comprehensive recruitment
706	706	677initiatives (including initiatives to support the recruitment and retention of individuals,
707	707	678notwithstanding immigration status, who work in health care settings and are from priority
708	708	679populations).
709	709	680 SECTION 40. Chapter 112 of the General Laws is hereby amended by inserting after
710	710	681section 51A the following section:-
711	711	682 Section 51B. (a) As used in this section, the following words shall have the following
712	712	683meanings:
713	713	684 “Board”, each board of registration authorized to establish continuing education
714	714	685requirements for healthcare professions under this chapter (as determined by the commissioner
715	715	686of public health) and the Massachusetts Board of Registration in Medicine.
716	716	687 “Cultural safety”, an examination by health care professionals of themselves and the
717	717	688potential impact of their own culture on clinical interactions and health care service delivery. 34 of 45
718	718	689This requires individual health care professionals and health care organizations to acknowledge
719	719	690and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures, and
720	720	691characteristics that may affect the quality of care provided. In doing so, cultural safety
721	721	692encompasses a critical consciousness where health care professionals and health care
722	722	693organizations engage in ongoing self-reflection and self-awareness and hold themselves
723	723	694accountable for providing culturally safe care, as defined by the patient and their communities,
724	724	695and as measured through progress towards achieving health equity. Cultural safety requires
725	725	696health care professionals and their associated health care organizations to influence health care to
726	726	697reduce bias and achieve equity within the workforce and working environment.
727	727	698 “Structural competency”, a shift in medical education away from pedagogic approaches
728	728	699to stigma and inequalities that emphasize cross-cultural understandings of individual patients,
729	729	700toward attention to forces that influence health outcomes at levels above individual interactions.
730	730	701Structural competency reviews existing structural approaches to stigma and health inequities
731	731	702developed outside of medicine and proposes changes to United States medical education that will
732	732	703infuse clinical training with a structural focus.
733	733	704 (b) By January 1, 2028, the board shall adopt rules requiring a licensee to complete health
734	734	705equity continuing education training at least once per licensing cycle, as determined by the
735	735	706licensing requirements for each respective profession.
736	736	707 (c) Health equity continuing education courses may be taken in addition to or, if the
737	737	708board determines the course fulfills existing continuing education requirements, in place of other
738	738	709continuing education requirements imposed by the board. 35 of 45
739	739	710 (d)(1) The secretary and the board must work collaboratively to provide information to
740	740	711licensees about available courses. The secretary and board shall consult with patients from
741	741	712priority populations and communities with lived experiences of health inequities or racism in the
742	742	713health care system and relevant professional organizations when developing the information and
743	743	714must make this information available by July 1, 2027. The information should include a course
744	744	715option that is free of charge to licensees.
745	745	716 (2) By January 1, 2028, the department, in consultation with the board, shall adopt model
746	746	717rules establishing the minimum standards for continuing education programs meeting the
747	747	718requirements of this section. The department shall consult with patients and communities with
748	748	719lived experience of health inequities or racism in the health care system, relevant professional
749	749	720organizations, and the board in the development of these rules.
750	750	721 (3) The minimum standards must include instruction on skills to address the structural
751	751	722factors, such as bias, racism, ableism, and poverty, that manifest as health inequities. These skills
752	752	723include individual-level and system-level intervention, and self-reflection to assess how the
753	753	724licensee’s social position can influence their relationship with patients and their communities.
754	754	725These skills enable a health care professional to care effectively for patients from diverse
755	755	726cultures, groups, and communities, varying in race, ethnicity, gender identity, sexuality, religion,
756	756	727age, ability, socioeconomic status, and other categories of identity. The courses must assess the
757	757	728licensee’s ability to apply health equity concepts into practice. Course topics may include, but
758	758	729are not limited to: (A) strategies for recognizing patterns of health care disparities on an
759	759	730individual, institutional, and structural level and eliminating factors that influence them; (B)
760	760	731intercultural communication skills training, including how to work effectively with an interpreter
761	761	732and how communication styles differ across cultures; (C) implicit bias training to identify 36 of 45
762	762	733strategies to reduce bias during assessment and diagnosis; (D) methods for addressing the
763	763	734emotional well-being of children and youth of diverse backgrounds; (E) ensuring equity and
764	764	735antiracism in care delivery pertaining to medical developments and emerging therapies; (F)
765	765	736structural competency training addressing five core competencies, which are: (i) recognizing the
766	766	737structures that shape clinical interactions; (ii) developing an extra clinical language of structure;
767	767	738(iii) rearticulating cultural formulations in structural terms; (iv) observing and imagining
768	768	739structural interventions; and (v) developing structural humility; (G) cultural safety training; and
769	769	740(H) providing effective care to individuals with disabilities and behavioral health diagnoses.
770	770	741 (e) The board may adopt rules to implement and administer this section, including rules
771	771	742to establish a process to determine if a continuing education course meets the health equity
772	772	743continuing education requirement established in this section.
773	773	744
774	774	745 SECTION 41. Chapter 118E of the General Laws is hereby amended by adding after
775	775	746section 16D the following sections:-
776	776	747 Section 16E. (a) Notwithstanding any other law, there is hereby established a program of
777	777	748comprehensive health coverage for children and young adults under the age of 21 who are
778	778	749residents of the commonwealth, as defined under section 8 of this chapter, who are not otherwise
779	779	750eligible for comprehensive benefits under Title XIX or XXI of the Social Security Act or under
780	780	751the demonstration pursuant to Section 9A of this chapter solely due to their immigration status.
781	781	752Children and young adults shall be eligible to receive comprehensive MassHealth benefits
782	782	753equivalent to the benefits available to individuals of like age and income under categorical and 37 of 45
783	783	754financial eligibility requirements established by the executive office pursuant to said Title XIX
784	784	755and Title XXI.
785	785	756 (b) The executive office shall maximize federal financial participation for the benefits
786	786	757provided under this section, however benefits under this section shall not be conditioned on the
787	787	758availability of federal financial participation.
788	788	759 (c) The program shall be implemented no later than January 1, 2027.
789	789	760 Section 16F. (a) Notwithstanding any other law, there is hereby established a program of
790	790	761comprehensive health coverage for individuals who are residents of the commonwealth, as
791	791	762defined under section 8 of chapter 118E, who are not otherwise eligible for comprehensive
792	792	763benefits under Title XIX or XXI of the Social Security Act or under the demonstration pursuant
793	793	764to Section 9A of chapter 118E solely due to their immigration status, except in the case of
794	794	765children or young adults otherwise eligible for comprehensive health coverage pursuant to
795	795	766section 16E. Such individuals shall be eligible to receive comprehensive MassHealth benefits
796	796	767equivalent to the benefits available to individuals of like age and income under categorical and
797	797	768financial eligibility requirements established by the Executive Office pursuant to said Title XIX
798	798	769and Title XXI.
799	799	770 (b) The Executive Office shall maximize federal financial participation for the benefits
800	800	771provided under this section, provided, however, that benefits under this section shall not be
801	801	772conditioned on the availability of federal financial participation.
802	802	773 (c) The program shall be implemented no later than January 1, 2027. 38 of 45
803	803	774 SECTION 42. Paragraph (5) of section 36 of chapter 118E of the General Laws, as so
804	804	775appearing, is hereby amended by striking out, in line 14, “.” and inserting in place thereof the
805	805	776following:- ;.
806	806	777 SECTION 43. Said section 36 of said chapter 118E, as so appearing, is hereby amended
807	807	778by inserting after said paragraph (5) the following paragraphs:-
808	808	779 (6) with respect to institutional providers, agree to implement measurable diversity,
809	809	780equity, and inclusion initiatives (including recruitment, hiring, and retention); and
810	810	781 (7) with respect to institutional providers, agree to expand mental health and wellness
811	811	782benefits for employees.
812	812	783 SECTION 44. Section 76 of chapter 260 of the Acts of 2020 is hereby amended by
813	813	784striking out the words “Sections 63 and 69 are hereby repealed” and inserting in place thereof the
814	814	785following words:- Section 63 is hereby repealed.
815	815	786 SECTION 45. (a) The first sentence of the first paragraph of section 410 of chapter 159
816	816	787of the Acts of 2000 is hereby amended by striking out “in nursing homes,” and inserting in place
817	817	788thereof the following words:- in nursing homes, in safety net hospitals, community health
818	818	789centers, and other providers (as determined by the Corporation).
819	819	790 (b) The first sentence of the second paragraph of said section 410 of said chapter 159 is
820	820	791hereby amended by striking out “nursing homes or consortiums of nursing homes” and inserting
821	821	792in place thereof the following words:- nursing homes or consortiums of nursing homes, safety
822	822	793net hospitals, community health centers, other providers as determined by the Corporation, and
823	823	794consortiums of each such entity. 39 of 45
824	824	795 (c) The first sentence of the third paragraph of said section 410 of said chapter 159 is
825	825	796hereby amended by striking out “nursing homes and nursing home employees” and inserting in
826	826	797place thereof the following words:- nursing homes, safety net hospitals, community health
827	827	798centers, other providers determined by the Corporation and employees of such entities.
828	828	799 SECTION 46. Notwithstanding any general or special law to the contrary, the
829	829	800commissioner of public health, in consultation with the assistant secretary for MassHealth, shall
830	830	801develop standardized, tiered, and stackable credentials for certification of lower-wage positions
831	831	802furnishing services funded through the MassHealth program.
832	832	803 SECTION 47. (a) Notwithstanding any general or special law to the contrary, the
833	833	804secretary of health and human services or designee shall, subject to appropriation, provide
834	834	805funding, in consultation with the secretary of equity and commissioner of public health, to safety
835	835	806net hospitals and community-based providers with a high Medicaid payer mix (as determined by
836	836	807the secretary) to advance health equity and to address disparities in resources for facilities
837	837	808serving priority populations who predominantly rely on Medicaid. In providing such funding,
838	838	809the secretary shall prioritize safety net hospitals that: (1) have a high Medicaid payer mix; (2)
839	839	810have an average statewide average acute hospital commercial relative price of less than 0.90 (as
840	840	811calculated by the center for health information and analysis); and (3) are not a part of a large
841	841	812health system (as determined by the secretary). Such support may be used as the safety net
842	842	813hospital or community-based provider determines appropriate, including for such purposes as
843	843	814patient care operations, access, infrastructure, or capacity building. 40 of 45
844	844	815 (b) The executive office shall maximize federal financial participation for the funding
845	845	816under this section, provided, however, that funding under this section shall not be conditioned on
846	846	817the availability of federal financial participation.
847	847	818 SECTION 48. (a) Notwithstanding any general or special law to the contrary, the
848	848	819assistant secretary for MassHealth shall establish payment models that incentivize the integration
849	849	820of behavioral health, oral health, and pharmacy services in primary care settings under the
850	850	821MassHealth program.
851	851	822 (b) The executive office shall maximize federal financial participation for the benefits
852	852	823provided under this section, provided, however, that benefits under this section shall not be
853	853	824conditioned on the availability of federal financial participation.
854	854	825 SECTION 49. Section 259 of Chapter 112 of the General Laws is hereby amended by
855	855	826striking out the definition of “Core competencies” and inserting in place thereof the following:-
856	856	827 ''Core competencies'', a set of overlapping and mutually reinforcing skills and knowledge
857	857	828essential for effective community health work in core areas that include, but are not limited to:
858	858	829 (a) outreach methods and strategies;
859	859	830 (b) client and community assessment;
860	860	831 (c) effective communication;
861	861	832 (d) culturally-based communication and care;
862	862	833 (e) health education for behavior change;
863	863	834 (f) support, advocacy and coordination of care for clients; 41 of 45
864	864	835 (g) application of public health concepts and approaches;
865	865	836 (h) community capacity building;
866	866	837 (i) writing and technical communication skills; and
867	867	838 (j) patient navigation services.
868	868	839 SECTION 50. Section 259 of said Chapter 112 of the General Laws is hereby further
869	869	840amended by inserting after the definition of “Core competencies” the following definition:-
870	870	841 “Patient navigation services, the following services furnished by a community health
871	871	842worker to patients in their communities:
872	872	843 a) Services to prevent or screen for chronic diseases and services designed to slow the
873	873	844progression of chronic diseases; and
874	874	845 b) Screenings for nonclinical and social needs and referrals to appropriate services and
875	875	846agencies to meet those needs.
876	876	847 SECTION 51. Section 260 of said chapter 112 is hereby amended by striking out the
877	877	848third paragraph in its entirety.
878	878	849 SECTION 52. Notwithstanding any general or special law to the contrary, the group
879	879	850insurance commission public employee plans under Chapter 32A; the division of medical
880	880	851assistance under chapter 118E and its contracted health insurers, health plans, health
881	881	852maintenance organizations, behavioral health management firms and third-party administrators
882	882	853under contract to a Medicaid managed care organization or primary care clinician plan; insurance
883	883	854companies organized under Chapter 175; non-profit hospital service corporations organized 42 of 45
884	884	855under Chapter 176A; medical service corporations organized under chapter 176B; and health
885	885	856maintenance organizations organized under chapter 176G shall not decline to provide coverage
886	886	857and reimbursement for covered health care services solely on the basis that those services were
887	887	858delivered by a certified community health worker, as defined by Section 259 of Chapter 112,
888	888	859employed by health care providers or provider groups, including but not limited, an acute care
889	889	860hospital, health system, community health center, school-based health center, community
890	890	861behavioral health center, community mental health center, or behavioral health community
891	891	862partner.
892	892	863 SECTION 53. Section 13F of Chapter 118E of the General Laws is hereby amended by
893	893	864adding at the end of the first paragraph the following sentence:
894	894	865 Provided however, the costs of providing competent interpreter services through sign and
895	895	866spoken languages by facilities licensed under section 19 of chapter 19 of the general laws or
896	896	867Section 51 of Chapter 111 of the general laws, shall be recognized and separately reimbursed by
897	897	868the division and its contracted health insurers, health plans, health maintenance organizations,
898	898	869behavioral health management firms and third party contractors under contract to a division
899	899	870managed care organization or primary care clinician program.
900	900	871 SECTION 54. Notwithstanding any general or special law, rule or regulation to the
901	901	872contrary, “Carriers” and “Behavioral Health Managers” as defined in Section 1 of Chapter 176O
902	902	873and their contractors, shall recognize and separately reimburse facilities licensed under section
903	903	87419 of Chapter 19 of the general laws or Section 51 of Chapter 111 of the general laws for the
904	904	875costs of providing competent interpreter services through sign and spoken languages. 43 of 45
905	905	876 SECTION 55. (a) Notwithstanding any general or special law to the contrary, the
906	906	877appointive boards and commissions of the commonwealth identified pursuant to subsection (b)
907	907	878shall, to the extent practicable, be composed of at least 50 percent women, and at least 25 percent
908	908	879Black, Indigenous, or other people of color. The appointing authorities for the board shall consult
909	909	880each other to ensure compliance with this provision.
910	910	881 (b) For purposes of subsection (a), the appointive boards and commissions of the
911	911	882commonwealth identified in this subsection are the following:
912	912	883 (1) the governing board of the health policy commission under section 2 of chapter 6D of
913	913	884the General Laws;
914	914	885 (2) the advisory board to the executive office of equity under section 5 of chapter 6F of
915	915	886the General Laws;
916	916	887 (3) the health information and analysis oversight council under section 2A of chapter 12C
917	917	888of the General Laws;
918	918	889 (4) each board of registration under the bureau of health professions licensure and the
919	919	890board of registration in medicine;
920	920	891 (5) the public health council under section 3 of chapter 17 of the General Laws; and
921	921	892 (6) any other board or commission under the supervision of the commissioner of public
922	922	893health that the commissioner determines appropriate.
923	923	894 SECTION 56. (a) On an annual basis, each carrier shall report to the division the drugs
924	924	895selected to be provided with no or limited cost-sharing under section 17S of chapter 32A, section
925	925	89610O of chapter 118E, section 47PP of 175, section 8RR of 176A, section 4RR of 176B, and 44 of 45
926	926	897section 4HH of 176G. The commissioner shall review the drugs to verify that the selected drugs
927	927	898meet the criteria identified in those sections. Should a selected drug be deemed by the
928	928	899commissioner to not meet the criteria, the commissioner may require a different drug to be
929	929	900selected. The commissioner shall disclose the list of drugs selected by each entity annually on the
930	930	901division’s website.
931	931	902 SECTION 57. Chapter 118E of the General Laws is hereby amended by adding at the end
932	932	903thereof, the following Section:-
933	933	904 Section 83. (a) The office shall make Graduate Medical Education payments for primary
934	934	905care, including but not limited to internists, family medicine, pediatrics, and gerontology,
935	935	906behavioral health, maternal health, including obstetrics and gynecology, and other physician
936	936	907residency training in fields experiencing physician shortages, as determined by the secretary;
937	937	908provided, that said payments may support community-based training for other health
938	938	909professionals, including but not limited to, family medicine nurse practitioners, sexual and
939	939	910reproductive health practitioners, ophthalmologists, optometrists, dentists, and dental hygienists.
940	940	911Eligible recipients shall include community health centers and hospitals licensed in the
941	941	912Commonwealth. Payments shall take into consideration MassHealth utilization and primary care,
942	942	913behavioral health, and maternal health, including obstetrics and gynecology, and other physician
943	943	914residency training in fields experiencing physician shortages; provided further, that the executive
944	944	915office will prioritize placements at community-based settings, at organizations that serve a high
945	945	916public payer mix.
946	946	917 (b) No later than July 1, 2025, the secretary, in consultation with the executive office of
947	947	918administration and finance, shall identify an adequate amount of annual Medicaid graduate 45 of 45
948	948	919medical education funding necessary to fulfill the requirements of this section, as well as state
949	949	920and other funding sources for use for graduate medical education expenditures. The secretary
950	950	921shall report its recommendations to the joint committee on healthcare finance and committees on
951	951	922ways and means.
952	952	923 (c) The first annual payment to qualifying acute care hospitals and community health
953	953	924centers under this section shall be made no later than October 1, 2025.
954	954	925 SECTION 58. Sections 5, 8, and 31 shall take effect 90 days after passage of this act.
955	955	926 SECTION 59. Sections 6, 7, 9, 10, 11, 12, , 34, 39, 42, 43, 45, 46, and 55 shall take
956	956	927effect 180 days after passage of this act.
957	957	928 SECTION 60. Sections 29, 32, 33, and 48 shall take effect 1 year after passage of this act.
958	958	929 SECTION 61. Section 23 shall take effect on January 1, 2027.