Budget Amendment ID: FY2018-S3-529-R1

Redraft EHS 529

Prevention and Wellness Trust Fund

Messrs. Lewis, Moore and Boncore, Ms. Chandler, Messrs. Keenan, Cyr, Welch, Eldridge, McGee and Brady, Ms. Flanagan, Messrs. Hinds and Brownsberger, Ms. Chang-Diaz, Messrs. O'Connor, Barrett, Montigny and Lesser, Ms. Forry and Ms. Creem moved that the proposed new text be amended by inserting after section 34 the following section:-

“SECTION 34A. Subsection (b) of section 7B of said chapter 64C, as so appearing, is hereby amended by adding the following paragraph:-

In addition to the excise imposed by the first paragraph, an excise shall be imposed on fruit-flavored or other nontobacco-flavored cigars and smoking tobacco at the rate of 170 per cent of the wholesale price of such products. The excise shall be imposed on cigar distributors at the time the fruit-flavored or other nontobacco-flavored cigars or smoking tobacco are manufactured, purchased, imported, received or acquired in the commonwealth. The excise shall not be imposed on any such cigars or smoking tobacco that: (i) are exported from the commonwealth; or (ii) are not subject to taxation by the commonwealth pursuant to any federal law. The excise imposed pursuant to this paragraph shall be deposited in the Prevention and Wellness Trust Fund established under section 2G of chapter 111.”; and

by inserting after section 43 the following section:-

“SECTION 43A. Chapter 111 of the General Laws is hereby amended by striking out section 2G, as so appearing, and inserting in place thereof the following 2 sections:-

Section 2G. (a) There shall be a Prevention and Wellness Trust Fund to be expended, without further appropriation, by the department of public health. The fund shall consist of revenues collected by the commonwealth, including: (i) revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund including, but not limited to, revenue received pursuant to the second paragraph of section 7B of chapter 64C; (ii) fines and penalties allocated to the fund; (iii) funds from public and private sources, including gifts, grants and donations to further community-based prevention activities; (iv) interest earned on revenues in the fund; and (v) funds provided from any other source. The commissioner of public health, as trustee, shall administer the fund. The commissioner, in consultation with the prevention and wellness advisory board established in section 2H shall make expenditures from the fund consistent with subsections (d) and (e); provided, however, that not more than 10 per cent of the amounts held in the fund in any 1 year shall be used by the department for the combined cost of program administration, technical assistance to grantees and program evaluation.

(b) The department may incur expenses and the comptroller may certify for payment, amounts in anticipation of expected receipts; provided, however, that no expenditure shall be made from the fund which shall cause the fund to be in deficit at the close of a fiscal year. Revenues deposited in the fund that are unexpended at the end of a fiscal year shall not revert to the General Fund and shall be available for expenditure in the following fiscal year.

(c) All expenditures from the fund shall support the commonwealth’s efforts to meet the health care cost growth benchmark established in section 9 of chapter 6D and  at least 1 of the following purposes: (i) increase access to community-based preventive services and interventions which complement and expand the ability of MassHealth to promote coordinated care, integrate community-based services with clinical care and develop innovative ways of addressing social determinants of health; (ii) reduce the impact of health conditions which are the largest drivers of poor health, health disparities, reduced quality of life and high health care costs though community-based interventions; or (iii) develop a stronger evidence-base of effective prevention interventions.

(d) Using a competitive grant process, the commissioner shall annually award not less than 90 per cent of the money in the fund to municipalities, community-based organizations, health care providers, regional planning agencies and health plans that apply for the implementation, evaluation and dissemination of evidence-based community preventive health activities. To be eligible to receive a grant under this subsection, a recipient shall be a partnership that includes at minimum: (i) a municipality or regional planning agency; (ii) a community-based health or social service provider; (iii) a public health or community action agency with expertise in implementing communitywide health interventions; (iv) a health care provider or a health plan; and (v) where feasible, a Medicaid-certified accountable care organization or a Medicaid-certified community partner organization. Expenditures from the fund for such purposes shall supplement and not replace existing local, state, private or federal public health related funding. An entity that is awarded funds through this program shall demonstrate the ability to: (A) utilize best practices in accounting; (B) contract with a fiscal agent who will perform accounting functions on its behalf; or (C) be provided with technical assistance by the department to ensure best practices are followed.

(e)(1) A grant proposal submitted under subsection (d) shall include, but not be limited to: (i) a plan that defines specific goals for the reduction in preventable health conditions and health care costs over a multi-year period; (ii) the evidence-based or evidence-informed programs the applicant shall use to meet the goals; (iii) a budget necessary to implement the plan, including a detailed description of the funding or in-kind contributions the applicant will be providing in support of the proposal; (iv) any other private funding or private sector participation that the applicant anticipates in support of the proposal; (v) a commitment to include women, racial and ethnic minorities and low-income individuals; and (vi) the anticipated number of individuals that would be affected by the implementation of the plan.

(2) Priority may be given to proposals in a geographic region of the state with a higher than average prevalence of preventable health conditions as determined by the commissioner of public health, in consultation with the prevention and wellness advisory board. If no proposals were offered in areas of the commonwealth with particular need, the department shall ask for a specific request for proposals for that specific region. If the commissioner determines that no suitable proposals have been received such that the specific needs remain unmet, the department may work directly with municipalities or community-based organizations to develop grant proposals.

(3) The department of public health shall, in consultation with the prevention and wellness advisory board, develop guidelines for an annual review of the progress being made by each grantee. Each grantee shall participate in an evaluation or accountability process implemented or authorized by the department.

(f) The department of public health shall, annually on or before November 1, report on expenditures from the fund from the previous fiscal year and anticipated revenues for the forthcoming fiscal year. The report shall include, but not be limited to: (i) the revenue credited to the fund; (ii) revenue and expenditure projections and details of all anticipated expenditures from the fund for the next fiscal year; (iii) the amount of fund expenditures attributable to the administrative costs of the department of public health; (iv) an itemized list of the funds expended through the competitive grant process and a description of the grantee activities; and (v) the results of the evaluation of the effectiveness of the activities funded through the grants. The report shall be provided to the chairs of the house and senate committees on ways and means, the joint committee on public health and the joint committee on health care financing and shall be posted on the department of public health’s website.

(g) With the advice and guidance of the prevention and wellness advisory board, the department of public health shall report annually on its strategy for administration and allocation of the fund, including relevant evaluation criteria. The report shall set forth the rationale for such strategy, which may include: (i) a list of the most prevalent preventable health conditions in the commonwealth, including health disparities experienced by populations based on race, ethnicity, gender, disability status, sexual orientation or socioeconomic status; (ii) a list of the most costly preventable health conditions in the commonwealth; and (iii) a list of evidence-based or promising community-based programs related to the conditions identified in clauses (i) and (ii). The report shall recommend specific areas of focus for allocation of funds. If appropriate, the report shall reference goals and best practices established by the National Prevention, Health Promotion  and Public Health Council and the Centers for Disease Control and Prevention including, but not limited to the HI-5 Initiative, the National Prevention Strategy, the Healthy People report and the Guide to Community Prevention.

(h) The department of public health shall promulgate regulations necessary to carry out this section.

Section 2H. (a) There shall be a prevention and wellness advisory board to: (i) make recommendations to the commissioner concerning the administration and allocation of the Prevention and Wellness Trust Fund established in section 2G; (ii) establish evaluation criteria; and (iii) perform any other functions specifically granted to it by law.

(b) The board shall consist of the commissioner of public health or a designee who shall serve as chair; the house and senate chairs of the joint committee on public health or their designees; the house and senate chairs of the joint committee on health care financing or their designees; the  secretary of health and human services or a designee; the executive director of the center for health information and analysis or a designee; the executive director of the health policy commission or a designee; and 15 persons to be appointed by the governor, 1 of whom shall be a person with expertise in the field of public health economics, 1 of whom shall be a person with expertise in public health research, 1 of whom shall be a person with expertise in the field of health equity, 1 of whom shall be a person from a local board of health for a city or town with a population of at least 50,000, 1 of whom shall be a member of a board of health for a city or town with a population of less than 50,000; 2 of whom shall be representatives of health insurance carriers, 1 of whom shall be a person from a consumer health advocacy organization, 1 of whom shall be a person from a hospital association, 1 of whom shall be a person from a statewide public health organization, 1 of whom shall be a representative of business interests, 1 of whom shall be a public health nurse or a school nurse, 1 of whom shall be a person from an association representing community health workers, 1 of whom shall represent a statewide association of community-based service providers addressing public health and 1 of whom shall be a person with expertise in the design and implementation of communitywide public health interventions.

(c)(1) The board shall evaluate the grant program authorized in section 2G and shall issue a report at intervals to be determined by the board, but not less than every 5 years from the beginning of each grant period. The report shall include an analysis of all relevant data to determine the effectiveness of the program including, but not limited to: (i) the extent to which the program impacted the prevalence, severity or control of preventable health conditions and the extent to which the program is projected to impact those factors in the future; (ii) the extent to which the program reduced health care costs or the growth in health care cost trends and the extent to which the program is projected to reduce those costs in the future; (iii) whether health care costs were reduced and who benefited from the reduction; (iv) the extent to which health outcomes or health behaviors were positively impacted; (v) the extent to which access to evidence-based community services was increased; (vi) the extent to which social determinants of health or other communitywide risk factors for poor health were reduced or mitigated; (vii) the extent to which grantees increased their ability to collaborate, share data and align services with other providers and community-based organizations for greater impact; (viii) the extent to which health disparities experienced by populations based on race, ethnicity, gender, disability status, sexual orientation or socioeconomic status were reduced across all metrics; and (ix) recommendations for whether the program should be discontinued, amended or expanded and a timetable for implementation of those recommendations.

(2) The department of public health shall contract with an outside organization that has expertise in the analysis of public health and health care financing to assist the board in conducting its evaluation. The outside organization shall be provided access to actual health plan data from the all-payer claims database as administered by the center for health information and analysis and data from MassHealth; provided, however, that the data shall be confidential and shall not be a public record under clause twenty-sixth of section 7 of chapter 4.

(3) The board shall report the results of its evaluation and its recommendations, if any, and drafts of legislation necessary to carry out the recommendations to the house and senate committees on ways and means, the joint committee on public health and the joint committee on health care financing and shall post the board’s report on the department of public health’s website.”; and

by inserting after section 108 the following section:-

SECTION 108A.  Section 2G of chapter 111 of the General Laws, inserted by section 43A, and shall take effect on September 1, 2017.