Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1417 Compare Versions

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

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1	1	1 of 1
2	2	HOUSE DOCKET, NO. 138 FILED ON: 1/6/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1417
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Bud L. Williams
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 Hampden1/6/2025Lindsay N. Sabadosa1st Hampshire1/15/2025 1 of 39
16	16	HOUSE DOCKET, NO. 138 FILED ON: 1/6/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1417
18	18	By Representative Williams of Springfield, a petition (accompanied by bill, House, No. 1417) of
19	19	Bud L. Williams and Lindsay N. Sabadosa for legislation to advance health equity and to
20	20	establish a secretary of equity. Health Care Financing.
21	21	[SIMILAR MATTER FILED IN PREVIOUS SESSION
22	22	SEE HOUSE, NO. 1250 OF 2023-2024.]
23	23	The Commonwealth of Massachusetts
24	24	_______________
25	25	In the One Hundred and Ninety-Fourth General Court
26	26	(2025-2026)
27	27	_______________
28	28	An Act to advance health equity.
29	29	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
30	30	of the same, as follows:
31	31	1 SECTION 1. Section 17A of chapter 6 of the General Laws, as appearing in the 2020
32	32	2Official Edition, is hereby amended by inserting after “the secretary of energy and environmental
33	33	3affairs,”, in line 4, the following words:- the secretary of equity,.
34	34	4 SECTION 2. Section 2 of chapter 6A of the General Laws, as appearing in the 2020
35	35	5Official Edition, is hereby amended by inserting after “energy and environmental affairs,”, in
36	36	6line 3, the following word:- equity,.
37	37	7 SECTION 3. Section 1 of chapter 6D, as appearing in the 2020 Official Edition, is
38	38	8hereby further amended by inserting after the definition of “Health care services” the following
39	39	9definition:- 2 of 39
40	40	10 “Health equity”, as defined in section 1 of chapter 6F.
41	41	11 SECTION 4. Said section 1 of said chapter 6D, as so appearing, is hereby further
42	42	12amended by inserting after the definition of “Primary care provider” the following definition:-
43	43	13 “Priority population”, a population that is disproportionately impacted by health
44	44	14disparities.
45	45	15 SECTION 5. Subsection (b) of section 2 of said chapter 6D, as so appearing, is hereby
46	46	16amended by inserting after the word “chairperson”, in line 12, the following words:- and 1 of
47	47	17whom shall have professional experience related to health equity and be Black, Indigenous, or a
48	48	18person of color.
49	49	19 SECTION 6. Clause (iv) of the fourth paragraph of subsection (e) of said section 2 of
50	50	20said chapter 6D, as so appearing, is hereby amended by striking out, in line 115, the word “and”,
51	51	21and by inserting after said clause (iv) the following clause:-
52	52	22 (v) incorporate health equity into the exercising of powers and duties under this chapter;
53	53	23and.
54	54	24 SECTION 7. Said subsection (e) of said section 2 of said chapter 6D, as so appearing, is
55	55	25hereby further amended by redesignating clause (v), as inserted by section 15 of chapter 224 of
56	56	26the acts of 2012, as clause (vi).
57	57	27 SECTION 8. Subsection (g) of said section 2 of said chapter 6D, as so appearing, is
58	58	28hereby amended by striking out, in line 140, “,” and inserting in place thereof the following
59	59	29words:- , including a chief health equity officer to assist in the carrying out of powers and duties
60	60	30relating to reducing health inequities experienced by priority populations. 3 of 39
61	61	31 SECTION 9. Section 3 of said chapter 6D, as so appearing, is hereby amended in
62	62	32subsection (k) by striking out, in line 38, the word “and”, in subsection (l) by striking out, in line
63	63	3341, “.” and inserting in place thereof the word:- ; and.
64	64	34 SECTION 10. Said section 3 of said chapter 6D, as so appearing, is hereby amended by
65	65	35inserting after said subsection (l) the following subsection:-
66	66	36 (m) to incorporate health equity into the exercising of powers and duties under this
67	67	37chapter.
68	68	38 SECTION 11. Section 4 of said chapter 6D, as so appearing, is hereby amended by
69	69	39inserting after “commission”, in line 3, the following words:- , including policies relating to
70	70	40reducing health inequities experienced by priority populations.
71	71	41 SECTION 12. Section 5 of said chapter 6D, as so appearing, is hereby amended by
72	72	42striking out, in line 11, “services” and inserting in place thereof the following words:- “services,
73	73	43including such access for priority populations to ensure health equity”.
74	74	44 SECTION 13. Subsection (d) of section 7 of said chapter 6D, as so appearing, is hereby
75	75	45amended by striking out, in line 35, “those treatments; and (vi)” and inserting in place thereof the
76	76	46following words:- those treatments; (vi) to reduce identified disparities or otherwise advance
77	77	47equity in care delivery; and (vii).
78	78	48 SECTION 14. Subsection (a) of section 8 of said chapter 6D, as so appearing, is hereby
79	79	49amended by striking out, in line 6, “shall examine” and inserting in place thereof the following
80	80	50words:- shall examine: (1). 4 of 39
81	81	51 SECTION 15. Said subsection (a) of said section 8 of said chapter 6D, as so appearing, is
82	82	52hereby amended by striking out, in line 9, “health care system” and inserting in place thereof the
83	83	53following words:- health care system; and (2) health inequities experienced by priority
84	84	54populations.
85	85	55 SECTION 16. Clause (i) of subsection (e) of said section 8 of said chapter 6D, as so
86	86	56appearing, is hereby amended by striking out, in line 45, “and the impact of price transparency
87	87	57on prices” and inserting in place thereof the following words:- , the impact of price transparency
88	88	58on prices, and efforts to reduce health inequities experienced by priority populations.
89	89	59 SECTION 17. Clause (ii) of said subsection (e) of said section 8 of said chapter 6D, as so
90	90	60appearing, is hereby amended by striking out, in line 58, “and any” and inserting in place thereof
91	91	61the following words:- , efforts to reduce health inequities experienced by priority populations,
92	92	62and any.
93	93	63 SECTION 18. Subsection (g) of said section 8 of said chapter 6D, as so appearing, is
94	94	64hereby amended by striking out, in lines 93 to 96, “annual report concerning spending trends and
95	95	65underlying factors, along with any recommendations for strategies to increase the efficiency of
96	96	66the health care system” and inserting in place thereof the following words: annual report
97	97	67concerning: (1) spending trends and underlying factors (including estimates of the cost of
98	98	68inequity for the purpose of identifying the impact of health disparities on total costs of care); (2)
99	99	69any recommendations for strategies to increase the efficiency of the health care system; and (3)
100	100	70any recommendations to reduce health inequities for priority populations based on data and input
101	101	71received pursuant to sections 10A and 2A(c)(7), respectively. 5 of 39
102	102	72 SECTION 19. Said subsection (g) of said section 8 of said chapter 6D, as so appearing, is
103	103	73hereby amended by striking out, in line 100, “sections 8, 9 and 10” and inserting in place
104	104	74thereof:- sections 2A(c)(7), 8, 9, 10, and 10A.
105	105	75 SECTION 20. Said chapter 6D of the General Laws is hereby further amended by
106	106	76inserting after section 9 the following section:-
107	107	77 Section 9A. (a) The board shall establish aggregate primary care and behavioral health
108	108	78expenditure targets for the commonwealth, which the commission shall prominently publish on
109	109	79its website.
110	110	80 (b) The commission shall establish the aggregate primary care and behavioral health
111	111	81expenditure targets as follows:
112	112	82 (1) For the 3-year period ending with calendar year 2026, the aggregate target shall be
113	113	83equal to a 30 per cent increase above aggregate baseline expenditures and the target shall be
114	114	84equal to a 30 per cent increase above baseline expenditures.
115	115	85 (2) For calendar years 2027 and beyond, the commission may modify the target and
116	116	86aggregate target, to be effective for a 3-year period provided that the target and aggregate target
117	117	87shall be approved by a two-thirds vote of the board not later than December 31 of the final
118	118	88calendar year of the preceding 3-year period. If the commission does not act to establish an
119	119	89updated target and aggregate target pursuant to this subsection, the target shall be equal to a 30
120	120	90per cent increase above baseline expenditures, and the aggregate target shall be equal to a 30 per
121	121	91cent increase above aggregate baseline expenditures until such time as the commission acts to
122	122	92modify the target and aggregate target. If the commission modifies the target and aggregate 6 of 39
123	123	93target, the modification shall not take effect until the 3-year period beginning with the next full
124	124	94calendar year.
125	125	95 (c) Prior to establishing the target and aggregate target, the commission shall hold a
126	126	96public hearing. The public hearing shall be based on the report submitted by the center under
127	127	97section 16(a) of chapter 12C, comparing the actual aggregate expenditures on primary care and
128	128	98behavioral health services to the aggregate target, any other data submitted by the center and
129	129	99such other pertinent information or data as may be available to the board. The hearing shall
130	130	100examine the performance of health care entities in meeting the target and the commonwealth’s
131	131	101health care system in meeting the aggregate target. The commission shall provide public notice
132	132	102of the hearing at least 45 days prior to the date of the hearing, including notice to the joint
133	133	103committee on health care financing. The joint committee on health care financing may
134	134	104participate in the hearing. The commission shall identify as witnesses for the public hearing a
135	135	105representative sample of providers, provider organizations, payers, community-based
136	136	106organizations, and such other interested parties as the commission may determine. Any other
137	137	107interested parties may testify at the hearing.
138	138	108 SECTION 21. Paragraph (15) of subsection (c) of section 15 of said chapter 6D, as so
139	139	109appearing, is hereby amended by striking out, in line 168, “and”.
140	140	110 SECTION 22. Said subsection (c) of said chapter 6D, as so appearing, is hereby amended
141	141	111by inserting after said paragraph (15) the following paragraphs:-
142	142	112 (16) to ensure ACOs demonstrate compliance with standards that meet or exceed the
143	143	113national culturally and linguistically appropriate services standards of the United States 7 of 39
144	144	114Department of Health and Human Services, which also take into account care that is delivered
145	145	115in-person or via telehealth;
146	146	116 (17) to ensure ACOs demonstrate compliance with standards that meet or exceed the
147	147	117standards to attain the certification of the National Committee for Quality Assurance for the
148	148	118distinction in multicultural health care, which also take into account care that is delivered in-
149	149	119person or via telehealth; and.
150	150	120 SECTION 23. Said subsection (c) of section 15 of said chapter 6D, as so appearing, is
151	151	121hereby amended by redesignating paragraph (16), as inserted by section 15 of chapter 224 of the
152	152	122acts of 2012, as paragraph (18).
153	153	123 SECTION 24. The General Laws are hereby amended by inserting after chapter 6E the
154	154	124following chapter:-
155	155	125 CHAPTER 6F
156	156	126 EXECUTIVE OFFICE OF EQUITY
157	157	127 Section 1. Definitions
158	158	128 As used in this chapter, the following words shall, unless the context clearly requires
159	159	129otherwise, have the following meanings:-
160	160	130 “Data dashboards”, information management tools used to track, analyze, and display in
161	161	131a user-friendly and accessible format important performance indicators, metrics, and data points
162	162	132for review by the general public and others. 8 of 39
163	163	133 “Equity”, the consistent and systematic fair, just, and impartial treatment of all
164	164	134individuals, including individuals who belong to underserved communities that have historically
165	165	135been denied such treatment, including: (1) Black, Latino, Indigenous and Native American
166	166	136persons, Asian Americans and Pacific Islanders, and other persons of color; (2) members of
167	167	137religious minorities; lesbian, gay, bisexual, transgender, and queer persons; (3) persons with
168	168	138disabilities; persons who live in rural areas; and (4) persons otherwise adversely affected by
169	169	139persistent poverty or inequality.
170	170	140 “Health equity”, the state in which everyone has a fair and just opportunity to be as
171	171	141healthy as possible. This requires removing obstacles to health and to health care services.
172	172	142Achieving health equity requires focused and ongoing efforts to address historical and
173	173	143contemporary injustices such as poverty and racism and efforts to address social determinants of
174	174	144health, including lack of access to good jobs with fair pay, quality education, safe and affordable
175	175	145housing, public transportation, safe and healthy environments, and health care. For the purposes
176	176	146of measurement, advancing health equity means reducing and ultimately eliminating disparities
177	177	147in health outcomes that adversely affect underserved, excluded, or marginalized groups.
178	178	148 “Office”, executive office of equity.
179	179	149 “Secretary”, secretary of equity.
180	180	150 “Social determinants of health”, the conditions in the environments where people are
181	181	151born, live, learn, work, play, worship, and age that affect a wide range of health outcomes,
182	182	152functioning, and quality-of-life outcomes and risks, including economic stability, education
183	183	153access and quality, health care access and quality, neighborhood and built environment, and
184	184	154social and community contexts. 9 of 39
185	185	155 Section 2. Establishment of office
186	186	156 There shall be an executive office of equity, which shall serve directly under the
187	187	157governor.
188	188	158 Section 3. Principal agency of executive department; purposes
189	189	159 The executive office of equity shall serve as the principal agency of the executive
190	190	160department for the following purposes:
191	191	161 (a) leading efforts toward equity, diversity, and inclusion across state government, within
192	192	162each executive office, and throughout the commonwealth; promoting access to equitable
193	193	163opportunities and resources that reduce disparities; and improving outcomes statewide across
194	194	164state government;
195	195	165 (b) developing multi-year strategic plans to advance equity within each executive office;
196	196	166 (c) developing standards for the collection, analysis, and public reporting of
197	197	167disaggregated data by race, ethnicity, language, and other socio-demographic factors as it
198	198	168pertains to tracking population level outcomes of communities; and creating statewide and
199	199	169executive office-specific process and outcome measures using outcome-based methodologies to
200	200	170determine the effectiveness of agency programs and services on reducing disparities;
201	201	171 (d) developing and implementing equity impact analyses at the request of any
202	202	172constitutional, executive, or legislative office and from time to time as deemed necessary by the
203	203	173secretary;
204	204	174 (e) creating and publishing data dashboards stratified and disaggregated by race,
205	205	175ethnicity, language, and other socio-demographic factors. Said dashboards shall include data 10 of 39
206	206	176relative to population level outcomes and to the process and outcome measures described in
207	207	177subsection (c) as well as any additional data the office deems important for the general public
208	208	178and decision makers. These dashboards shall comply with applicable privacy law but shall be
209	209	179publicly presented in a user-friendly format, with a focus on ensuring accessibility in its design;
210	210	180and
211	211	181 (f) coordinating with quasi-public entities in the commonwealth, including the health
212	212	182policy commission under chapter 6D and the center for health information and analysis under
213	213	183chapter 12C, for the purposes described in subsection (a).
214	214	184 Section 4. Secretary of equity; appointment; salary; powers and duties; undersecretaries
215	215	185of equity
216	216	186 The governor shall appoint the secretary of equity. Said secretary shall serve at the
217	217	187pleasure of the governor, shall receive such salary as the governor may determine, and shall
218	218	188devote full time to the duties of this office.
219	219	189 The secretary, in consultation with each respective secretary of each Massachusetts
220	220	190executive office, shall appoint an undersecretary of equity to assist each other Massachusetts
221	221	191executive office in applying an equity lens in all aspects of agency decision making, including
222	222	192service delivery, program development, policy development, and budgeting. The secretary shall
223	223	193appoint an undersecretary of equity for administration and finance, an undersecretary of equity
224	224	194for education, an undersecretary of equity for energy and environmental affairs, an
225	225	195undersecretary of equity for health and human services, an undersecretary of equity for housing,
226	226	196an undersecretary of economic development, an undersecretary of equity for labor and
227	227	197workforce development, an undersecretary of equity for public safety and security, an 11 of 39
228	228	198undersecretary of equity for transportation, an undersecretary of equity for veterans affairs, and
229	229	199an undersecretary of equity for climate innovation and resilience. Each person appointed as an
230	230	200undersecretary shall serve at the pleasure of her appointing secretary, shall have experience, and
231	231	201shall know the field or functions of such position.
232	232	202 The undersecretaries shall provide assistance to the executive offices by:
233	233	203 (a) facilitating information sharing between agencies related to diversity, equity, and
234	234	204inclusion;
235	235	205 (b) convening work groups or stakeholder advisory boards as needed;
236	236	206 (c) developing and providing assessment tools for agencies to use in the development and
237	237	207evaluation of agency programs, services, policies, and budgets;
238	238	208 (d) training the appropriate executive office staff on how to effectively use the
239	239	209assessment tools developed under subsection (c), including developing guidance on how to apply
240	240	210an equity lens to the executive office’s work when carrying out duties under this chapter;
241	241	211 (e) developing a form that will serve as each appropriate executive office’s diversity,
242	242	212equity, and inclusion plan, required to be submitted by the secretary of the executive office of
243	243	213equity under section 7 in a manner and at frequency determined appropriate by the
244	244	214undersecretaries. The office must post each final plan on the dashboard described in section 3;
245	245	215 (f) maintaining an inventory of the appropriate executive office’s work in the area of
246	246	216diversity, equity, and inclusion; and
247	247	217 (g) compiling and creating resources for executive offices to use as guidance when
248	248	218carrying out the requirements of this chapter. 12 of 39
249	249	219 Section 5. Advisory board
250	250	220 (a) There shall be an advisory board to the executive office of equity. The advisory board
251	251	221shall consist of: 3 persons appointed by the governor; 3 persons appointed by the president of the
252	252	222senate; 3 persons appointed by the speaker of the house of representatives; 3 persons appointed
253	253	223by the Massachusetts Black and Latino Legislative Caucus; 1 person appointed by the Secretary
254	254	224of Administration and Finance who shall have expertise in economic matters; 1 person appointed
255	255	225by the Secretary of Education who shall have expertise in education matters; 1 person appointed
256	256	226by the Secretary of Energy and Environmental Affairs who shall have expertise in environmental
257	257	227justice; 1 person appointed by the Secretary of Health and Human Services who shall have
258	258	228expertise in health equity and the social determinants of health; 1 person appointed by the
259	259	229Secretary of Housing who shall have expertise in housing policy; 1 person appointed by the
260	260	230Secretary of Economic Development who shall have expertise in economic development policy;
261	261	2311 person appointed by the Secretary of Labor and Workforce Development who shall have
262	262	232expertise in labor and workforce development policy; 1 person appointed by the Secretary of
263	263	233Public Safety and Security who shall have expertise in criminal justice matters; 1 person
264	264	234appointed by the Secretary of Transportation who shall have expertise in transportation matters;
265	265	2351 person appointed by the Secretary of Veterans Affairs who shall have expertise in matters
266	266	236related to veterans, and 1 person appointed by the Secretary of Office of Climate Innovation and
267	267	237Resilience who shall have experience in climate matters.
268	268	238 All members of the advisory board shall be residents of the commonwealth who are not
269	269	239employed by the commonwealth who have demonstrated a commitment to advancing equity and
270	270	240expertise in utilizing policy, systems and environmental strategies to address inequities. Criteria
271	271	241for selection of members shall consider diversity of geography; diversity of race and ethnicity; 13 of 39
272	272	242diversity of age; inclusion of individuals living with disabilities; and inclusion of individuals
273	273	243from the LGBTQ+ community. All members must have expertise in utilizing policy, systems and
274	274	244environmental strategies to address inequities. Members shall be considered special state
275	275	245employees for purposes of chapter 268A. All community representatives serving on the board
276	276	246shall be compensated for their time. The appointing authorities shall confer prior to making final
277	277	247appointments to ensure compliance with this provision.
278	278	248 (b) A member of the board shall serve a term of 3 years and until they vacate their
279	279	249membership or until a successor is appointed. Vacancies in the membership of the board shall be
280	280	250filled by the original appointing authority for the balance of the unexpired term.
281	281	251 (c) The board shall annually elect from among its members a chair, a vice chair, a
282	282	252treasurer, and any other officers it considers necessary. Notwithstanding the foregoing, the
283	283	253members of the board shall receive no compensation for their services; provided however that
284	284	254members shall be reimbursed for any usual and customary expenses incurred in the performance
285	285	255of their duties.
286	286	256 (d) The board shall advise the executive office of equity on the overall operation and
287	287	257policies of the office.
288	288	258 (e) The board shall meet no less than quarterly to discuss and debate matters related to the
289	289	259overall operation and policies of the executive office of equity.
290	290	260 (f) The board may request information and assistance from executive offices as the board
291	291	261requires.
292	292	262 Section 6. Strategic Plan; data dashboards; equity impact analysis 14 of 39
293	293	263 (a) The secretary, in collaboration with other secretaries in the governor’s cabinet, shall
294	294	264develop a multi-year equity strategy to improve equity across government and the
295	295	265commonwealth, including improved access to affordable health care, quality food and housing,
296	296	266safe communities, quality education, employment for which people are paid a living wage and
297	297	267that includes good working conditions, and affordable transportation and child care.
298	298	268 (b) Notwithstanding any general or special law to the contrary, the secretary, in
299	299	269collaboration with other secretaries in the governor’s cabinet, shall publish and regularly update
300	300	270data dashboards on the executive office of equity’s website. To the extent possible, all data
301	301	271dashboards shall include data able to be disaggregated by (1) gender; (2) race; (3) ethnicity; (4)
302	302	272primary city or town of residence; (5) age; (6) disability; (7) primary language; (8) occupation;
303	303	273and (9) any other demographic information that the secretary deems important to understand
304	304	274inequities and disparities in the commonwealth.
305	305	275 (c) The secretary, in collaboration with other secretaries in the governor’s cabinet, shall
306	306	276develop and implement equity impact analyses at the request of any constitutional, executive, or
307	307	277legislative office and from time to time as deemed necessary by the secretary. Equity impact
308	308	278analyses shall include, at a minimum, and to the extent that information is available, an analysis
309	309	279of whether the proposed policy is likely to promote or undermine equity, including health equity,
310	310	280in the commonwealth. Equity impact analyses may consider:
311	311	281 (1) direct impacts on disparities, inequities, the social determinants of health, and the
312	312	282determinants of equity, with special attention to the impacts on populations that have
313	313	283experienced marginalization or oppression;
314	314	284 (2) the quality and relevance of studies to evaluate said impacts; 15 of 39
315	315	285 (3) the availability of measures that would minimize any anticipated adverse equity
316	316	286consequences;
317	317	287 (4) the existence of adverse short-term and long-term equity consequences that cannot be
318	318	288avoided should the proposed policy be implemented;
319	319	289 (5) the availability of reasonable alternatives to the proposed policy; and
320	320	290 (6) the impact of the proposed policy on factors, including:
321	321	291 (A) income security, including adequate wages, relevant tax policies, access to affordable
322	322	292health insurance, retirement benefits, and paid leave;
323	323	293 (B) food security and nutrition, including food assistance program eligibility, enrollment,
324	324	294and assessments of food access and rates of access to unhealthy food and beverages;
325	325	295 (C) child development, education, and literacy rates, including opportunities for early
326	326	296childhood development and parenting support, rates of graduation compared to dropout rates,
327	327	297college attainment and adult literacy;
328	328	298 (D) housing, including access to affordable, safe and healthy housing; housing near parks
329	329	299and with access to healthy foods; and housing that incorporates universal design and visitability
330	330	300features;
331	331	301 (E) environmental quality, including exposure to toxins in the air, water and soil;
332	332	302 (F) accessible built environments that promote health and safety, including mixed-used
333	333	303land; active transportation such as improved pedestrian, bicycle and automobile safety; parks and
334	334	304green space; and healthy school siting; 16 of 39
335	335	305 (G) health care access, including accessible chronic disease management programs,
336	336	306access to affordable, high-quality health and behavioral health care, and the recruitment and
337	337	307retention of a diverse health care workforce;
338	338	308 (H) prevention efforts, including community-based education and availability of
339	339	309preventive services;
340	340	310 (I) assessing ongoing discrimination and minority stressors against individuals and
341	341	311groups in populations that have experienced marginalization or oppression based upon race,
342	342	312gender, gender identity, gender expression, ethnicity, marital status, language, sexual orientation,
343	343	313disability, and other factors, including discrimination that is based upon bias and negative
344	344	314attitudes of health professionals and providers;
345	345	315 (J) neighborhood safety and collective efficacy, including rates of violence, increases or
346	346	316decreases in community cohesion, and collaborative efforts to improve the health and well-being
347	347	317of the community;
348	348	318 (K) culturally appropriate and competent services and training in all sectors, including
349	349	319training to eliminate bias, discrimination and mistreatment of persons in populations that have
350	350	320experienced marginalization or oppression;
351	351	321 (L) linguistically appropriate and competent services and training in all sectors, including
352	352	322the availability of information in alternative formats such as large font, braille and American
353	353	323Sign Language; and
354	354	324 (M) accessible, affordable and appropriate mental health services.
355	355	325 Section 7. Annual Report 17 of 39
356	356	326 The secretary shall, on or before the first Wednesday in December of each year, submit a
357	357	327report to the governor, the president of the senate, the speaker of the house of representatives, the
358	358	328chair of the senate committee on ways and means, and the chair of the house committee on ways
359	359	329and means. Such report shall list and discuss the proposals which have been made and the
360	360	330accomplishments which have been achieved during the preceding two years towards advancing
361	361	331equity within the executive office of equity, each other executive office and throughout the
362	362	332commonwealth. Said report shall contain a summary of the objectives of such proposals, their
363	363	333disposition, and such further recommendations for legislative or executive actions concerning
364	364	334these proposals or additional proposals as, in the judgment of the secretary, should be made to
365	365	335improve equity in the programs, services and business affairs of the commonwealth.
366	366	336 SECTION 25. Section 1 of said chapter 12C, as appearing in the 2020 Official Edition, is
367	367	337hereby amended by inserting after the definition of “Health care services” the following
368	368	338definition:-
369	369	339 “Health equity”, as defined in section 1 of chapter 6F.
370	370	340 SECTION 26. Said section 1 of said chapter 12C, as so appearing, is hereby further
371	371	341amended by inserting after the definition of “Primary service area” the following definition:-
372	372	342 “Priority population”, as defined in section 1 of chapter 6D.
373	373	343 SECTION 27. Subsection (a) of section 2A of said chapter 12C, as so appearing, is
374	374	344hereby amended by inserting after “cybersecurity”, in line 9, the following words:- and 1 of
375	375	345whom shall have professional experience related to health equity and be Black, Indigenous, or a
376	376	346person of color. 18 of 39
377	377	347 SECTION 28. Paragraph (4) of subsection (c) of said section 2A of said chapter 12C, as
378	378	348so appearing, is hereby amended by striking out, in line 42, “center” and inserting in place
379	379	349thereof the following words:- center, including research and analysis concerning health
380	380	350disparities and health equity for priority populations of the commonwealth.
381	381	351 SECTION 29. Said section 2A of said chapter 12C, as so appearing, is hereby amended
382	382	352in paragraph (5) by striking out, in line 47, “and”, in paragraph (6) by striking out, in line 50, “.”
383	383	353and inserting in place thereof the following “; and”, and by inserting after said paragraph (6) the
384	384	354following new paragraph:-
385	385	355 (7) develop a process to hold annual public hearings to obtain input relating to health
386	386	356equity research and analysis priorities from healthcare consumers in the commonwealth, and it
387	387	357shall be the goal of the council for such hearings to obtain input from priority populations, the
388	388	358health disparities council under section 16O of chapter 6A, the division of medical assistance,
389	389	359and the department of public health. The council shall analyze the input received for the
390	390	360purposes of inclusion in the annual report described in section 16(a).
391	391	361 SECTION 30. Clause (v) of section 3 of said chapter 12C, as so appearing, is hereby
392	392	362amended by striking out, in line 25, the following word:- “and”, and in clause (vi) by striking
393	393	363out, in line 27, “.” and inserting in place thereof:- ; (vii) to conduct research to improve the
394	394	364center’s understanding of: (I) barriers to health equity data collection under sections 10A; and
395	395	365(II) how to restore trust and respectfully engage with individuals from priority populations who
396	396	366are paid participants in such research; and (viii) to conduct research to improve the center’s
397	397	367understanding of how racial ethnic, cultural, and linguistic diversity in the healthcare workforce
398	398	368impacts health care access and care quality for priority populations. The center shall prepare a 19 of 39
399	399	369report on the research described in clauses (vii) and (viii), which shall include recommendations
400	400	370for policy improvements based on the center’s improved understanding and plans to implement
401	401	371such improvements.
402	402	372 SECTION 31. Said section 3 of said chapter 12C, as so appearing, is hereby amended by
403	403	373inserting after the first paragraph the following paragraph:-
404	404	374 The executive director shall appoint and may remove a chief health equity officer to
405	405	375assist in the carrying out of powers and duties under this chapter relating to reducing health
406	406	376inequities experienced by priority populations.
407	407	377 SECTION 32. Chapter 12C of the General Laws is hereby amended by inserting after
408	408	378section 10 the following section:-
409	409	379 Section 10A. (a) The center shall promulgate regulations that identify the types of entities
410	410	380specified in sections 8, 9, and 10 which the center determines possess data necessary to analyze
411	411	381health inequities experienced by priority populations in the commonwealth.
412	412	382 (b)(1) The center shall promulgate regulations necessary to ensure, to the extent
413	413	383practicable, the uniform reporting of information from such entities identified pursuant to the
414	414	384regulations described in subsection (a) and any other information the center determines
415	415	385appropriate. In promulgating such regulations, the center shall consult with: (A) the department
416	416	386of public health; and (B) the division of medical assistance.
417	417	387 (2) To ensure that standards with respect to health equity data for accountable care
418	418	388organizations under MassHealth are incorporated into such regulations, the regulations shall
419	419	389specify standardized measures for data collection to: (A) standardize and strengthen social risk 20 of 39
420	420	390factors data collection, including race (including meaningful capture of multi-racial), ethnicity,
421	421	391language, disability, sexual orientation, gender identity, ZIP code or census tract, and health-
422	422	392related social needs; (B) maintain robust structures to identify and understand disparities,
423	423	393including through stratified reporting on key performance indicators; and (C) account for social
424	424	394determinants of health, including food insecurity, housing stability, and community violence.
425	425	395 (c) The center shall provide technical assistance to such entities to ensure the data is
426	426	396reported in a manner consistent with such regulations.
427	427	397 (d) The center shall analyze such data and input received pursuant to subsection (b) and
428	428	398section 2A(c)(7), respectively.
429	429	399 (e) The center shall coordinate with the office of equity with respect to such data for the
430	430	400purpose of section 6 of chapter 6F.
431	431	401 SECTION 33. Section 11 of said chapter 12C, as so appearing, is hereby amended by
432	432	402striking out, in line 2, “sections 8, 9 and 10” and inserting in place thereof the following words:-
433	433	403sections 8, 9, 10, and 10A.
434	434	404 SECTION 34. Section 16 of said chapter 12C, as so appearing, is hereby amended by
435	435	405striking out subsection (a) and inserting in place thereof the following subsection:-
436	436	406 (a) The center shall publish an annual report based on the information submitted under
437	437	407this chapter concerning health care provider, provider organization and private and public health
438	438	408care payer costs and cost trends, section 13 of chapter 6D relative to market power reviews and
439	439	409section 15 relative to quality data. The center shall compare the costs, cost trends, and
440	440	410expenditures with the health care cost growth benchmark established under section 9A of said 21 of 39
441	441	411chapter 6D, analyzed by regions of the commonwealth, and shall compare the costs, cost trends,
442	442	412and expenditures with the aggregate primary care and behavioral health expenditure targets
443	443	413established under section 9A of said chapter 6D, and shall detail: (1) baseline information about
444	444	414cost, price, quality, utilization and market power in the commonwealth’s health care system; (2)
445	445	415cost growth trends for care provided within and outside of accountable care organizations and
446	446	416patient-centered medical homes; (3) cost growth trends by provider sector, including but not
447	447	417limited to, hospitals, hospital systems, non-acute providers, pharmaceuticals, medical devices
448	448	418and durable medical equipment; provided, however, that any detailed cost growth trend in the
449	449	419pharmaceutical sector shall consider the effect of drug rebates and other price concessions in the
450	450	420aggregate without disclosure of any product or manufacturer-specific rebate or price concession
451	451	421information, and without limiting or otherwise affecting the confidential or proprietary nature of
452	452	422any rebate or price concession agreement; (4) factors that contribute to cost growth within the
453	453	423commonwealth’s health care system and to the relationship between provider costs and payer
454	454	424premium rates; (5) primary care and behavioral health expenditure trends as compared to the
455	455	425aggregate baseline expenditures, as defined in section 1 of said chapter 6D; (6) the proportion of
456	456	426health care expenditures reimbursed under fee-for-service and alternative payment
457	457	427methodologies; (7) the impact of health care payment and delivery reform efforts on health care
458	458	428costs including, but not limited to, the development of limited and tiered networks, increased
459	459	429price transparency, increased utilization of electronic medical records and other health
460	460	430technology; (8) the impact of any assessments including, but not limited to, the health system
461	461	431benefit surcharge collected under section 68 of chapter 118E, on health insurance premiums; (9)
462	462	432trends in utilization of unnecessary or duplicative services, with particular emphasis on imaging
463	463	433and other high-cost services; (10) the prevalence and trends in adoption of alternative payment 22 of 39
464	464	434methodologies and impact of alternative payment methodologies on overall health care spending,
465	465	435insurance premiums and provider rates; (11) the development and status of provider
466	466	436organizations in the commonwealth including, but not limited to, acquisitions, mergers,
467	467	437consolidations and any evidence of excess consolidation or anti-competitive behavior by
468	468	438provider organizations; and (12) the impact of health care payment and delivery reform on the
469	469	439quality of care delivered in the commonwealth.
470	470	440 As part of its annual report, the center shall report on price variation between health care
471	471	441providers, by payer and provider type. The center’s report shall include: (1) baseline information
472	472	442about price variation between health care providers by payer including, but not limited to,
473	473	443identifying providers or provider organizations that are paid more than 10 per cent above or more
474	474	444than 10 per cent below the average relative price and identifying payers which have entered into
475	475	445alternative payment contracts that vary by more than 10 per cent; (2) the annual change in price
476	476	446variation, by payer, among the payer’s participating providers; (3) factors that contribute to price
477	477	447variation in the commonwealth’s health care system; (4) the impact of price variations on
478	478	448disproportionate share hospitals and other safety net providers; and (5) the impact of health
479	479	449reform efforts on price variation including, but not limited to, the impact of increased price
480	480	450transparency, increased prevalence of alternative payment contracts and increased prevalence of
481	481	451accountable care organizations and patient centered medical homes.
482	482	452 As part of its annual report, the center shall report on data and information received
483	483	453pursuant to section 10A and input received pursuant to section 2A(c)(7), including an analysis of
484	484	454the factors that may lead to health inequities for priority populations. 23 of 39
485	485	455 The center shall publish and provide the report to health policy commission at least 30
486	486	456days before any hearing required under section 8 of chapter 6D. The center may contract with an
487	487	457outside organization with expertise in issues related to the topics of the hearings to produce this
488	488	458report.
489	489	459 The center shall publish the aggregate baseline expenditures starting in the 2024 annual
490	490	460report.
491	491	461 The center, in consultation with the commission, shall hold a public hearing and adopt or
492	492	462amend rules and regulations establishing the methodology for calculating baseline and
493	493	463subsequent years’ expenditures for individual health care entities within 90 days of the effective
494	494	464date.
495	495	465 The center, in consultation with the commission, shall determine the baseline
496	496	466expenditures for individual health care entities and shall report to each health care entity its
497	497	467respective baseline expenditures by not less than thirty days before publishing the results.
498	498	468 SECTION 35. Subsection (c) section 2GGGG of chapter 29 of the General Laws, as
499	499	469appearing in the 2020 Official Edition, is hereby amended by striking out, in line 36, “and (6) to
500	500	470improve the affordability and quality of care” and inserting in place thereof the following
501	501	471words:- (6) to improve the affordability and quality of care; and (7) to reduce identified
502	502	472disparities or otherwise advance equity in care delivery.
503	503	473 SECTION 36. Chapter 111 of the General Laws is hereby amended by inserting after
504	504	474section 2J the following sections:- 24 of 39
505	505	475 Section 2K. (a) As used in this section, the following words shall, unless the context
506	506	476clearly requires otherwise, have the following meanings:-
507	507	477 “Environmental justice population”, as defined in section 62 of chapter 30.
508	508	478 "Health equity zone", a contiguous geographic area that: (1) demonstrates measurable
509	509	479and documented health inequities and poor health outcomes (including disproportionately high
510	510	480rates of maternal mortality and morbidity, infant and child health conditions, or chronic and
511	511	481infectious disease in the general population); and (2) meets criteria to be an environmental justice
512	512	482population or other definition of social inequity as determined by the department.
513	513	483 (b) There shall be established and set upon the books of the commonwealth a separate
514	514	484fund to be known as the Health Equity Zone Trust Fund to be expended, without further
515	515	485appropriation, by the department of public health. The fund shall consist of revenues collected by
516	516	486the commonwealth including: (1) any revenue from appropriations or other monies authorized by
517	517	487the general court and specifically designated to be credited to the fund; (2) any fines and
518	518	488penalties allocated to the fund under the General Laws; (3) any funds from public and private
519	519	489sources such as gifts, grants and donations to further community-based prevention activities; (4)
520	520	490any interest earned on such revenues; and (5) any funds provided from other sources.
521	521	491 The commissioner of public health, as trustee, shall administer the fund. The
522	522	492commissioner, in consultation with the Health Equity Zone Advisory Board established under
523	523	493section 2L, shall make expenditures from the fund consistent with subsection (e).
524	524	494 (c) Revenues deposited in the fund that are unexpended at the end of the fiscal year shall
525	525	495not revert to the General Fund and shall be available for expenditure in the following fiscal year. 25 of 39
526	526	496 (d) All expenditures from the Health Equity Zone Trust Fund shall support the state’s
527	527	497efforts to address health disparities and develop a stronger evidence base of effective place-based
528	528	498health equity interventions.
529	529	499 (e) The purpose of the Health Equity Zone Trust Fund is to enable the creation of so-
530	530	500called health equity zones, namely geographic areas where existing opportunities emerge and
531	531	501investments are made to address inequities in health outcomes. The Health Equity Zone Trust
532	532	502Fund will equip multi-sector partnerships which may include residents, businesses, community-
533	533	503organizations, municipal agencies to identify and create community determined solutions
534	534	504necessary to create just and fair conditions for health. Investments shall prioritize investment in
535	535	505the communities that have been systematically oppressed and where decades of disinvestment
536	536	506have created inequitable health outcomes.
537	537	507 The commissioner shall award not less than 85 per cent of the Health Equity Zone Trust
538	538	508Fund through a competitive grant process to municipalities, community-based organizations,
539	539	509regional-planning agencies that apply for the implementation, technical assistance, and
540	540	510evaluation of health equity activities. To be eligible to receive a grant to lead Health Equity Zone
541	541	511under this subsection, a recipient shall be: (1) a community-based organization or group of
542	542	512community-based organizations working in collaboration; (2) a community-based organization
543	543	513working in collaboration with 1 or more municipality; or (3) a regional planning agency.
544	544	514Expenditures from the fund for such purposes shall supplement and not replace existing local,
545	545	515state, private or federal public health-related funding.
546	546	516 (f) Priority shall be given to proposals in a geographic region of the state with a higher
547	547	517than average prevalence of preventable health conditions, as determined by the commissioner of 26 of 39
548	548	518public health, in consultation with the Health Equity Zone Advisory Board. If no proposals were
549	549	519offered in areas of the state with particular need, the department shall ask for a specific request
550	550	520for proposal for that specific region. If the commissioner determines that no suitable proposals
551	551	521have been received, such that the specific needs remain unmet, the department may work directly
552	552	522with municipalities or community-based organizations to develop grant proposals.
553	553	523 The department of public health shall, in consultation with the Health Equity Zone
554	554	524Advisory Board, develop guidelines for an annual review of the progress being made by each
555	555	525grantee. Each grantee shall participate in any evaluation or accountability process implemented
556	556	526or authorized by the department, provided, however, that the department shall make evaluation
557	557	527and accountability processes as minimally burdensome as is possible.
558	558	528 (g) The department of public health shall, annually on or before January 31, report on
559	559	529expenditures from the Health Equity Zone Trust Fund. The report shall include, but not be
560	560	530limited to: (1) the revenue credited to the fund; (2) the amount of fund expenditures attributable
561	561	531to the administrative costs of the department of public health; (3) an itemized list of the funds
562	562	532expended through the competitive grant process and a description of the grantee activities; (4)
563	563	533the results of the evaluation assessing the activities funded through grants; and (5) an itemized
564	564	534list of expenditures used to support place-based health equity interventions. The report shall be
565	565	535provided to the chairpersons of the house and senate committees on ways and means and the
566	566	536joint committee on public health and shall be posted on the department of public health’s
567	567	537website.
568	568	538 (h) The department of public health shall, under the advice and guidance of the Health
569	569	539Equity Zone Advisory Board, annually report on its strategy for administration and allocation of 27 of 39
570	570	540the fund, including relevant evaluation criteria. The report shall set forth the rationale for such
571	571	541strategy.
572	572	542 (i) The department of public health shall promulgate regulations necessary to carry out
573	573	543this section.
574	574	544 Section 2L. There shall be a Health Equity Zone Advisory Board to make
575	575	545recommendations to the commissioner concerning the administration and allocation of the
576	576	546Health Equity Zone Trust Fund established in section 2K, establish evaluation criteria and
577	577	547perform any other functions specifically granted to it by law.
578	578	548 The board shall consist of: the commissioner of public health or a designee, who shall
579	579	549serve as co-chairperson; and 10 persons to be appointed by the commissioner through a public
580	580	550nomination process, 4 of whom shall be community representatives with lived experience of
581	581	551health inequities in their communities (one of whom shall serve as co-chair); 1 of whom shall be
582	582	552a person with expertise in the field of health equity; 1 of whom shall be a person from a local
583	583	553board of health for a city or town with a population greater than 50,000; 1 of whom shall be a
584	584	554person of a board of health for a city or town with a population of fewer than 50,000; 1 of whom
585	585	555shall be a person from a hospital association; 1 of whom shall be a person from a statewide
586	586	556public health organization; 1 of whom shall be a representative of a community development
587	587	557corporation or association representing community development corporations and 1 of whom
588	588	558shall be a community health worker or a person from an association representing community
589	589	559health workers. Criteria for selection of members shall consider diversity of geography; diversity
590	590	560by race and ethnicity; expertise in program design and implementation; expertise in health
591	591	561equity; expertise in utilizing policy, systems and environmental strategies to address health 28 of 39
592	592	562inequities. All community representatives serving on the board shall be compensated for their
593	593	563time at an amount determined by the Commissioner.
594	594	564 SECTION 37. Subsection (g) of section 25C of chapter 111 of the General Laws, as
595	595	565appearing in the 2020 Official Edition, is hereby amended, by inserting after “account”, in line
596	596	566103, the following words:- the findings of the health equity assessment described in subsection
597	597	567(o) and.
598	598	568 SECTION 38. Said subsection (g) of section 25C of chapter 111, as so appearing, is
599	599	569hereby amended by striking out, in line 104, “from” and inserting in place thereof the following
600	600	570words:- “from the office of equity,”.
601	601	571 SECTION 39. Said section 25C of chapter 111, as so appearing, is hereby amended, by
602	602	572inserting after subsection (n) the following subsection:-
603	603	573 (o) A determination of need under this section shall take into account a health equity
604	604	574assessment, which shall be included in the application described in subsection (h). Such
605	605	575application shall include: (1) a demonstration of whether, and if so how, the extent to which such
606	606	576populations in the applicant’s service area access the applicant’s facility or services at the time of
607	607	577the application and the extent to which the proposed construction or change of services is
608	608	578expected to impact that access; (2) a description of the amount of indigent care, both free and
609	609	579below cost, that will be offered by the applicant if the construction or service change is
610	610	580approved; (3) an assessment of any impacts on access by public or private transportation,
611	611	581including applicant-sponsored transportation services, to the applicant’s facility if the
612	612	582construction or change in services is implemented, highlighting access by public transportation;
613	613	583and (4) a description of the proposed means of assuring effective communication between the 29 of 39
614	614	584applicant’s facility, health-related service staff, people of limited English-speaking ability, and
615	615	585those with speech, hearing or visual impairments handicaps if the construction or change in
616	616	586services is implemented.
617	617	587 SECTION 40. Clause (ii) of paragraph (4) of subsection (a) of section 25L of chapter
618	618	588111, as so appearing, is hereby amended by striking out, in line 47, “comprehensive recruitment
619	619	589initiatives” and inserting in place thereof the following words:- comprehensive recruitment
620	620	590initiatives (including initiatives to support the recruitment and retention of individuals,
621	621	591notwithstanding immigration status, who work in health care settings and are not traditionally
622	622	592recipients of scholarship and student loan repayment programs).
623	623	593 SECTION 41. Chapter 112 of the General Laws is hereby amended by inserting after
624	624	594section 51A the following section:-
625	625	595 Section 51B. (a) As used in this section, the following words shall have the following
626	626	596meanings:
627	627	597 “Board”, each board of registration authorized to establish continuing education
628	628	598requirements for healthcare professions under this chapter (as determined by the commissioner
629	629	599of public health) and the Massachusetts Board of Registration in Medicine.
630	630	600 “Cultural safety”, an examination by health care professionals of themselves and the
631	631	601potential impact of their own culture on clinical interactions and health care service delivery.
632	632	602This requires individual health care professionals and health care organizations to acknowledge
633	633	603and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures, and
634	634	604characteristics that may affect the quality of care provided. In doing so, cultural safety
635	635	605encompasses a critical consciousness where health care professionals and health care 30 of 39
636	636	606organizations engage in ongoing self-reflection and self-awareness and hold themselves
637	637	607accountable for providing culturally safe care, as defined by the patient and their communities,
638	638	608and as measured through progress towards achieving health equity. Cultural safety requires
639	639	609health care professionals and their associated health care organizations to influence health care to
640	640	610reduce bias and achieve equity within the workforce and working environment.
641	641	611 “Structural competency”, a shift in medical education away from pedagogic approaches
642	642	612to stigma and inequalities that emphasize cross-cultural understandings of individual patients,
643	643	613toward attention to forces that influence health outcomes at levels above individual interactions.
644	644	614Structural competency reviews existing structural approaches to stigma and health inequities
645	645	615developed outside of medicine and proposes changes to United States medical education that will
646	646	616infuse clinical training with a structural focus.
647	647	617 (b) By January 1, 2026, the board shall adopt rules requiring a licensee to complete health
648	648	618equity continuing education training at least once every four years.
649	649	619 (c) Health equity continuing education courses may be taken in addition to or, if the
650	650	620board determines the course fulfills existing continuing education requirements, in place of other
651	651	621continuing education requirements imposed by the board.
652	652	622 (d)(1) The secretary and the board must work collaboratively to provide information to
653	653	623licensees about available courses. The secretary and board shall consult with patients and
654	654	624communities with lived experiences of health inequities or racism in the health care system and
655	655	625relevant professional organizations when developing the information and must make this
656	656	626information available by July 1, 2025. The information should include a course option that is free
657	657	627of charge to licensees. 31 of 39
658	658	628 (2) By January 1, 2026, the department, in consultation with the board, shall adopt model
659	659	629rules establishing the minimum standards for continuing education programs meeting the
660	660	630requirements of this section. The department shall consult with patients and communities with
661	661	631lived experience of health inequities or racism in the health care system, relevant professional
662	662	632organizations, and the board in the development of these rules.
663	663	633 (3) The minimum standards must include instruction on skills to address the structural
664	664	634factors, such as bias, racism, and poverty, that manifest as health inequities. These skills include
665	665	635individual-level and system-level intervention, and self-reflection to assess how the licensee’s
666	666	636social position can influence their relationship with patients and their communities. These skills
667	667	637enable a health care professional to care effectively for patients from diverse cultures, groups,
668	668	638and communities, varying in race, ethnicity, gender identity, sexuality, religion, age, ability,
669	669	639socioeconomic status, and other categories of identity. The courses must assess the licensee’s
670	670	640ability to apply health equity concepts into practice. Course topics may include, but are not
671	671	641limited to: (A) strategies for recognizing patterns of health care disparities on an individual,
672	672	642institutional, and structural level and eliminating factors that influence them; (B) intercultural
673	673	643communication skills training, including how to work effectively with an interpreter and how
674	674	644communication styles differ across cultures; (C) implicit bias training to identify strategies to
675	675	645reduce bias during assessment and diagnosis; (D) methods for addressing the emotional well-
676	676	646being of children and youth of diverse backgrounds; (E) ensuring equity and antiracism in care
677	677	647delivery pertaining to medical developments and emerging therapies; (F) structural competency
678	678	648training addressing five core competencies, which are: (i) recognizing the structures that shape
679	679	649clinical interactions; (ii) developing an extra clinical language of structure; (iii) rearticulating 32 of 39
680	680	650cultural formulations in structural terms; (iv) observing and imagining structural interventions;
681	681	651and (v) developing structural humility; and (G) cultural safety training.
682	682	652 (e) The board may adopt rules to implement and administer this section, including rules
683	683	653to establish a process to determine if a continuing education course meets the health equity
684	684	654continuing education requirement established in this section.
685	685	655 SECTION 42. Chapter 118E of the General Laws, as appearing in the 2020 Official
686	686	656Edition, is hereby amended by adding after section 16D the following sections:-
687	687	657 Section 16E. (a) Notwithstanding any other law, there is hereby established a program of
688	688	658comprehensive health coverage for children and young adults under the age of 21 who are
689	689	659residents of the commonwealth, as defined under section 8 of this chapter, who are not otherwise
690	690	660eligible for comprehensive benefits under Title XIX or XXI of the Social Security Act or under
691	691	661the demonstration pursuant to Section 9A of this chapter solely due to their immigration status.
692	692	662Children and young adults shall be eligible to receive comprehensive MassHealth benefits
693	693	663equivalent to the benefits available to individuals of like age and income under categorical and
694	694	664financial eligibility requirements established by the executive office pursuant to said Title XIX
695	695	665and Title XXI.
696	696	666 (b) The executive office shall maximize federal financial participation for the benefits
697	697	667provided under this section, however benefits under this section shall not be conditioned on the
698	698	668availability of federal financial participation.
699	699	669 (c) The program shall be implemented no later than January 1, 2025. 33 of 39
700	700	670 Section 16F. (a) Notwithstanding any other law, there is hereby established a program of
701	701	671comprehensive health coverage for individuals who are residents of the commonwealth, as
702	702	672defined under section 8 of chapter 118E, who are not otherwise eligible for comprehensive
703	703	673benefits under Title XIX or XXI of the Social Security Act or under the demonstration pursuant
704	704	674to Section 9A of chapter 118E solely due to their immigration status, except in the case of
705	705	675children or young adults otherwise eligible for comprehensive health coverage pursuant to
706	706	676section 16E. Such individuals shall be eligible to receive comprehensive MassHealth benefits
707	707	677equivalent to the benefits available to individuals of like age and income under categorical and
708	708	678financial eligibility requirements established by the Executive Office pursuant to said Title XIX
709	709	679and Title XXI.
710	710	680 (b) The Executive Office shall maximize federal financial participation for the benefits
711	711	681provided under this section, provided, however, that benefits under this section shall not be
712	712	682conditioned on the availability of federal financial participation.
713	713	683 (c) The program shall be implemented no later than January 1, 2025.
714	714	684 SECTION 43. Paragraph (5) of section 36 of chapter 118E of the General Laws, as so
715	715	685appearing, is hereby amended by striking out, in line 14, “.” and inserting in place thereof the
716	716	686following:- ;.
717	717	687 SECTION 44. Said section 36 of said chapter 118E, as so appearing, is hereby amended
718	718	688by inserting after said paragraph (5) the following paragraphs:-
719	719	689 (6) with respect to institutional providers, agree to implement measurable diversity,
720	720	690equity, and inclusion initiatives (including recruitment, hiring, and retention); and 34 of 39
721	721	691 (7) with respect to institutional providers, agree to expand mental health and wellness
722	722	692benefits for employees.
723	723	693 SECTION 45. Section 76 of chapter 260 of the Acts of 2020 is hereby amended by
724	724	694striking out the words “Sections 63 and 69 are hereby repealed” and inserting in place thereof the
725	725	695following words:- Section 63 is hereby repealed.
726	726	696 SECTION 46. (a) Notwithstanding any general or special law to the contrary, there shall
727	727	697be established a program for cost-sharing eliminations for targeted high-value services,
728	728	698treatments and prescription drugs used to treat certain chronic conditions. In order to implement
729	729	699said program, the secretary of health and human services, in consultation with the secretary of
730	730	700equity, the commissioner of insurance, the commissioner of public health and the center for
731	731	701health information and analysis, shall identify one to three services, treatments and prescription
732	732	702drugs in total used to treat each of the following chronic conditions: diabetes, asthma, chronic
733	733	703obstructive pulmonary disease, hypertension, coronary artery disease, congestive heart failure,
734	734	704opioid use disorder, bipolar disorder, and schizophrenia.
735	735	705 In determining the targeted high-value services, treatments and prescription drugs, the
736	736	706secretary shall consider appropriate services, treatments and prescription drugs that are: (1) out-
737	737	707patient or ambulatory services, including medications, lab tests, procedures, and office visits,
738	738	708generally offered in the primary care or medical home setting; (2) of clear benefit, strongly
739	739	709supported by clinical evidence to be cost-effective; (3) likely to reduce hospitalizations or
740	740	710emergency department visits, or reduce future exacerbations of illness progression, or improve
741	741	711quality of life; (4) relatively low cost when compared to the cost of an acute illness or incident 35 of 39
742	742	712prevented or delayed by the use of the service, treatment or drug; and (5) at low risk for
743	743	713overutilization, abuse, addiction, diversion or fraud.
744	744	714 The secretary may further take into consideration other independent resources or models
745	745	715proven effective in reducing financial barriers to high-value care.
746	746	716 (b) Any policy, contract or certificate of health insurance subject to chapters 32A, 118E,
747	747	717175, 176A, 176B, 176G or 176Q of the General Laws shall provide coverage for the identified
748	748	718services, treatments and prescription drugs. Such coverage shall not be subject to any cost-
749	749	719sharing, including co-payments and co-insurance, and shall not be subject to any deductible,
750	750	720pursuant to guidance from the secretary of health and human services, notwithstanding whether
751	751	721an identified service or treatment was delivered in-person or via telehealth (as defined in section
752	752	72279(a) of chapter 118E). The commissioner of the division of insurance shall adopt any written
753	753	723policies, procedures or regulations necessary to implement said program.
754	754	724 (c) Every two years, the center for health information and analysis shall evaluate the
755	755	725effect of this section and update the targeted high-value services, treatments and prescription
756	756	726drugs specified pursuant to subsection (a). Said evaluation shall include the impact of this section
757	757	727on treatment adherence, incidence of related acute events, premiums and cost sharing, overall
758	758	728health, long-term health costs, and other issues that the center may determine necessary. The
759	759	729center may collaborate with an independent research organization to conduct said evaluation.
760	760	730The center shall file a report on its findings, which shall be filed with the clerks of the house of
761	761	731representatives and senate, the joint committee on public health, the joint committee on health
762	762	732care financing and the house and senate committees on ways and means.
763	763	733 (d) The program shall be implemented no later than January 1, 2026. 36 of 39
764	764	734 SECTION 47. The first sentence of the first paragraph of section 410 of chapter 159 of
765	765	735the Acts of 2000 is hereby amended by striking out “upgrade skills of certified nurse's aides and
766	766	736entry-level workers entry-level workers” and inserting in place thereof the following words:- in
767	767	737nursing homes and in safety net hospitals and other providers (as determined by the
768	768	738Corporation).
769	769	739 (b) The first sentence of the second paragraph of said section 410 of said chapter 159 is
770	770	740hereby amended by striking out “nursing homes or consortiums of nursing homes” and inserting
771	771	741in place thereof the following words:- nursing homes or consortiums of nursing homes, and
772	772	742safety net hospitals and other providers as determined by the Corporation.
773	773	743 SECTION 48. Notwithstanding any general or special law to the contrary, the
774	774	744commissioner of public health shall revise the licensing requirements under chapter 112 of the
775	775	745General Laws of foreign-trained health professionals to increase healthcare access in
776	776	746underserved areas of the commonwealth. Such revisions shall maintain licensure standards that
777	777	747are substantially similar to standards applicable to domestically-trained health professionals
778	778	748licensed under this chapter.
779	779	749 SECTION 49. Notwithstanding any general or special law to the contrary, the
780	780	750commissioner of public health, in consultation with the assistant secretary for MassHealth, shall
781	781	751develop standardized, tiered, and stackable credentials for certification of lower-wage positions
782	782	752furnishing services funded through the MassHealth program.
783	783	753 SECTION 50. (a) Notwithstanding any general or special law to the contrary, the
784	784	754secretary of health and human services or designee shall, subject to appropriation, provide
785	785	755funding, in consultation with the secretary of equity and commissioner of public health, to safety 37 of 39
786	786	756net hospitals and community-based providers with a high Medicaid payer mix (as determined by
787	787	757the secretary) to advance health equity and to address disparities in resources for facilities
788	788	758serving priority populations who predominantly rely on Medicaid. In providing such funding,
789	789	759the secretary shall prioritize safety net hospitals that: (1) have a high Medicaid payer mix; (2)
790	790	760have an average statewide average acute hospital commercial relative price of less than 0.90 (as
791	791	761calculated by the center for health information and analysis); and (3) are not a part of a large
792	792	762health system (as determined by the secretary). Such support may be used as the safety net
793	793	763hospital or community-based provider determines appropriate, including for such purposes as
794	794	764patient care operations, access, infrastructure, or capacity building.
795	795	765 (b) The executive office shall maximize federal financial participation for the funding
796	796	766under this section, provided, however, that funding under this section shall not be conditioned on
797	797	767the availability of federal financial participation.
798	798	768 SECTION 51. (a) Notwithstanding any general or special law to the contrary, the
799	799	769assistant secretary for MassHealth shall establish payment models that incentivize the integration
800	800	770of behavioral health, oral health, and pharmacy services in primary care settings under the
801	801	771MassHealth program.
802	802	772 (b) The executive office shall maximize federal financial participation for the benefits
803	803	773provided under this section, provided, however, that benefits under this section shall not be
804	804	774conditioned on the availability of federal financial participation.
805	805	775 SECTION 52. (a) Notwithstanding any general or special law to the contrary, the
806	806	776appointive boards and commissions of the commonwealth identified pursuant to subsection (b)
807	807	777shall, to the extent practicable, be composed of at least 50 percent women, and at least 25 percent 38 of 39
808	808	778Black, Indigenous, or other people of color. The appointing authorities for the board shall consult
809	809	779each other to ensure compliance with this provision.
810	810	780 (b) For purposes of subsection (a), the appointive boards and commissions of the
811	811	781commonwealth identified in this subsection are the following:
812	812	782 (1) the governing board of the health policy commission under section 2 of chapter 6D of
813	813	783the General Laws;
814	814	784 (2) the advisory board to the executive office of equity under section 5 of chapter 6F of
815	815	785the General Laws;
816	816	786 (3) the health information and analysis oversight council under section 2A of chapter 12C
817	817	787of the General Laws;
818	818	788 (4) the board of registration in medicine, the board of registration of nursing, and the
819	819	789board of certification of community health workers under sections 10, 13, and 108 of chapter 13
820	820	790of the General Laws, respectively;
821	821	791 (5) the public health council under section 3 of chapter 17 of the General Laws; and
822	822	792 (6) any other board or commission under the supervision of the commissioner of public
823	823	793health that the commissioner determines appropriate.
824	824	794 SECTION 53. Sections 5, 8, 27, and 31 shall take effect 90 days after passage of this act.
825	825	795 SECTION 54. Sections 6, 7, 9, 10, 11, 12, 28, 34, 40, 43, 44, 47, 48, 49, and 52 shall take
826	826	796effect 180 days after passage of this act. 39 of 39
827	827	797 SECTION 55. Sections 29, 32, 33, and 51 shall take effect 1 year after passage of this
828	828	798act.