SECTION 1. Section 16 of Chapter 6A of the General Laws is hereby amended by inserting after the words “(7) the health facilities appeal board,” the following: ¾

(8) the office of health equity.

SECTION 2. The second sentence of the first paragraph of Section 16O of Chapter 6A of the General Laws is hereby amended by inserting after the words, “The council shall make recommendations,” the following: ¾ to the director of the office of health equity.

SECTION 3. The first sentence of the second paragraph of Section 16O of Chapter 6A of the General Laws is hereby amended by striking the figure “34” and inserting in place thereof the following:- 35, and by inserting after the words “secretary of health and human services,” the following:¾ the director of the office of health equity,.

SECTION 4. Chapter 6A of the General Laws is hereby amended by inserting after section 16O the following section: ¾

Section 16P. (a) There shall be an office of health equity within the executive office of health and human services. The office shall be in the charge of a director, who shall report directly to the secretary of health and human services. The health disparities council, described in section 160, shall serve as an advisory board to the office of health equity. The director shall administer the provisions of chapter 111N. Any agency within any executive office, seeking to implement, create or evaluate a program or policy to reduce or eliminate racial or ethnic health and health care disparities, as defined in Chapter 111N, shall notify the director of the office of health disparities before beginning such project or evaluation or instituting such policy. The director shall coordinate any such activities to ensure that they are complimentary, rather than redundant or contradictory.

(b) The office shall establish an expert advisory council on women of color. The expert advisory council shall provide information and recommendations to the office on the impact of its activities on health and health care disparities affecting women of color. The director shall appoint 9 members of the council, seeking to achieve balance in geographic representation, expertise, and experience in the field. The office may establish other advisory councils, as determined by the director.

SECTION 5. The General Laws are hereby amended by inserting after Chapter 111M the following chapter: ¾

CHAPTER 111N.

OFFICE OF HEALTH EQUITY

Section 1. As used in this chapter, the following words shall, unless the context clearly requires otherwise, have the following meanings: ¾

"Community-based health agency'', an organization that provides health services or health education, including a hospital, a community health center, a community mental health or substance abuse center, and other health-related organization as defined by the office.

“Disparities” or “Racial and Ethnic Health and Health Care Disparities”, differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific racial and ethnic groups.

“Office”, the office of health equity, as created in section 16P of chapter 6A.

Section 2. (Mission of the office) The office shall coordinate all activities of the commonwealth to eliminate racial and ethnic health and health care disparities. The office shall set goals for the reduction of disparities, and prepare an annual plan for the commonwealth to eliminate disparities. The office shall educate other agencies of the commonwealth on disparities, including social factors that play a role in creating and maintaining disparities. The office shall implement the provisions of this chapter.

Section 3. (Disparities Impact Statement) The secretary of health and human services shall annually, on the day assigned for submission of the budget to the general court pursuant to section 7H of chapter 29, designate major initiatives of the Commonwealth affecting the health and health care of residents of the Commonwealth. Such initiatives may include any activity of the Commonwealth, including, but not limited to, transportation, housing, education, labor and public safety, in addition to health. For each such major initiative, the office shall prepare a disparities impact statement evaluating the likely positive or negative impact of each initiative on eliminating or reducing racial and ethnic health disparities. The statements shall, to the extent possible, include quantifiable impacts and evaluation benchmarks. The statements shall be posted on the internet site of the executive office of health and human services and submitted to the clerks of the house and senate, members of the health disparities council, appropriate legislative committees, and the house and senate committees on ways and means.

Section 4. (report card) The office shall prepare an annual health disparities report card. The report card shall evaluate the progress of the commonwealth towards eliminating racial and ethnic health disparities, using, where possible, quantifiable measures and comparative benchmarks. The report card shall report on progress on a regional basis, based on regions designated by the office. The report shall include information on issues relating to disparities affecting women of color and other designated subpopulations. The office shall hold public hearings in several regions of the state to get public information on the topics of the report card. The report card shall summarize the activities of the office and provide information on any evaluations of programs of the office. The report card shall be delivered to the governor, speaker of the house of representatives and president of the senate and the members of the health disparities council, created under section 16O of Chapter 6A, before July 1 each year, and shall be posted on an internet site of the office or executive office of health and human services.

Section 5. (Community agency grants program) The office shall, subject to appropriation, administer a community-based health agency disparities reduction grant program. The grants shall support efforts by community-based health agencies to eliminate racial and ethnic health disparities among predominantly underserved populations, including efforts addressing social factors integral to such disparities. Grants shall be awarded following a competitive application process. In awarding grants, the office shall give priority to innovative programs replicable by other community care facilities. No community-based health agency may receive more than one grant concurrently. All grants shall include an evaluation component.

Grants shall not exceed $250,000 and shall be awarded for not more than a three-year term, provided that a grant may be renewed by the office.

Section 6. (data collection coordination) The office shall, in consultation with the department of public health, the health care quality and cost council established under section 16K of chapter 6A, and the division of health care finance and policy, coordinate the data collection, analysis and dissemination activities of all entities involved in the collection of patient and health care professional race, ethnicity and language data.

The office may designate and implement a training curriculum for primary data collectors, test and recommend software and other technological means to facilitate data collection, and disseminate best practices for collection of race, ethnicity and language data.

Section 7. (community health workers) The office shall administer a community health worker program. The program shall provide grants to community-based health agencies and non-profit community organizations to recruit, assign, train, and employ community health workers who have direct knowledge of the communities they serve to facilitate the care of individuals, including by performing some or all of the following duties:

(1) Assisting in the coordination of health care services and provider referrals, for individuals who are seeking prevention or early detection services for, or who following a screening or early detection service are found to have a symptom, abnormal finding, or diagnosis of disease.

(2) Facilitating the involvement of community organizations in assisting individuals who are at risk for or who have chronic diseases to receive better access to high-quality health care services.

(3) Notifying individuals of clinical trials and, on request, facilitating enrollment of eligible individuals in these trials.

(4) Anticipating, identifying, and helping patients to overcome barriers within the health care system to ensure prompt diagnostic and treatment resolution of an abnormal finding.

(5) Coordinating with the relevant health programs to provide information to individuals who are at risk for diseases about health coverage, including MassHealth, the Commonwealth Care Health insurance program, care reimbursable by the Health Safety Net Trust Fund, coverage made available by the Commonwealth Health Insurance Connector Authority, and other sources of health coverage.

Grants shall be awarded following a competitive application process. In awarding grants, the office shall give priority to applicants that demonstrate in their applications plans to utilize community health worker services to overcome significant barriers in order to reduce disparities and improve health care outcomes in their respective communities. All grants shall include an evaluation component.

No awardee may receive more than one grant concurrently. Grants shall not exceed $250,000 and shall be awarded for not more than a three-year term, provided that a grant may be renewed by the office.

Section 8. (Community based participatory research grants) The office shall, subject to appropriation, administer a community-based participatory research grants program. The grants shall support research partnerships between community-based health agencies and academic researchers to eliminate health disparities among predominantly underserved populations. Grants shall be awarded to research partnerships only through the community-based health agency partner as the lead agency, in an effort to build community capacity and infrastructure for engaging in research to eliminate health disparities, including efforts addressing social factors integral to such disparities. Grants shall be awarded following a competitive application process. In awarding grants, the office shall give priority to community based health agencies experienced in community-based participatory research and health disparities.

Grants shall not exceed $250,000 and shall be awarded for not more than a three year term, provided that a grant may be renewed by the office.

Section 9. (health literacy) The office shall, in consultation with the department of public health and the office of Medicaid, establish health information communication guidelines and promote health literacy. The guidelines shall reflect best practices for health-related materials distributed by the commonwealth and the commonwealth health insurance connector authority so they are understandable by a broad cross-section of the population, including those without advanced education and those whose first language is not English. The guidelines shall be consistent with relevant federal standards.

The office shall establish a working group on health literacy to promote culturally competent care, disseminate best practices, and issue recommendations relative to health literacy to state agencies.

Section 10. (workforce diversity) The office shall establish a health workforce diversity council to coordinate state, local and private sector efforts, including the health professional worker training grant program established in section 9 of chapter 23H to develop a more racially and ethnically diverse health care workforce. The council may make recommendations to facilitate more effective use of financial and other resources to achieve its purposes.

Section 11. (regulatory authority) The office shall promulgate regulations consistent with this chapter. Any such regulations shall require a public notice and a hearing under section 2 of Chapter 30A. The office shall provide notice of any hearing to all members of the health disparities council created under section 16O of Chapter 6A.

SECTION 6. Section 9 of Chapter 23H of the General Laws is hereby amended by striking out the first 4 paragraphs and inserting in place thereof the following paragraphs:–

A health professions worker training grant program is established for the purpose of responding to the need for workers in various health care professions, subject to the requirements of section 2RR of chapter 29. The health professions worker training program shall place a particular focus meeting the needs of underserved populations, diversifying the health care workforce and creating a workforce that can provide culturally competent care.

A qualifying consortium shall apply for grant funding from the fund in the manner specified by the director.

Applications for grants must describe targeted participants of the proposed grant application and must describe the specific critical work force shortage or lack of diversity or culturally appropriate care in the health care work force the program is designed to alleviate. The application must include verification that in the process of determining that a critical work force shortage exists in the target area, the applicant has (1) consulted available data on worker shortages and (2) conferred with employers in the target area.

Within the limits of available appropriations, the director shall make grants not to exceed $200,000 each to qualifying consortium to provide workforce development services which may lead to employment and greater diversity in the health professions. Grant awards must establish specific, measurable outcomes and timelines for achieving those outcomes.

SECTION 7. Section 10 of Chapter 23H of the General Laws, as so appearing, is hereby amended by striking out the fourth sentence and inserting in place thereof the following two sentences:- The state workforce investment board shall consult with stakeholder advocacy groups, community-based nonprofit service providers, local workforce investment boards, and the office of health equity, as created by section 16P of chapter 6A, in the development of both performance standards and reporting requirements. The office of health equity shall recommend standards that measure the success of the program in diversifying the health care workforce in each community it serves.

SECTION 8. (DPH wellness program) Chapter 111 of the General Laws is hereby amended by inserting after section 25K the following section:-

Section 25L. The department shall establish a chronic disease self management program to support organizations engaged in education and training to enable economically vulnerable individuals with chronic disease to develop skills and capacities to manage and improve their own health. Subject to appropriation, the department shall provide grants to non-profit community based organizations to implement chronic disease self management programs. Grantees shall include non-profit community based organizations who work with populations to be served by the program. For the purposes of this section, “chronic disease self management programs” shall mean workshops or other programs for people with chronic diseases that teach the skills needed in the day-to-day management of treatment and to maintain and/or improve life activities. These programs shall: (a) enhance targeted individuals’ ability to deal with problems such as frustration, fatigue, pain and isolation; (b) teach skills to engage in appropriate exercise for maintaining and improving strength, flexibility, and endurance; (c) teach appropriate use of medications; (d) train in effective communication skills with family, friends and health professionals; (e) teach effective nutrition skills; and (f) train in how to evaluate new treatments.

SECTION 9. (translation reimbursement for physicians) Section 7 of Chapter 118G of the General Laws is hereby amended by inserting after the sixth paragraph the following paragraph:–

In determining rates to be paid by governmental units to physicians the division shall include as an operating expense the reasonable cost of providing competent interpreter services.

SECTION 10. (Office role in hospital rate increases) Section 13B of chapter 118E of the General Laws, as appearing in section 25 of chapter 58 of the Acts of 2006, is hereby amended by inserting after the second sentence the following sentence:- Standards and benchmarks relating to the reduction of racial and ethnic disparities shall be developed by the office of health equity established by section 16P of chapter 6A.

SECTION 11. (environmental justice) The General Laws are hereby amended by inserting after chapter 111K the following chapter:–

Chapter 111L: Community Environmental Health Disparities

Section 1. As used in this chapter the following words shall have the following meanings:

“Communities Health Index”, a cumulative evaluation of the health of communities based on specific health outcome indicators that ranks communities based on their health status so as to identify communities whose residents suffer disproportionately high rates of disease and premature death.

“Department”, the department of public health.

Section 2. There is hereby established in the department a community environmental health disparities program. The purpose of the program is to establish a communities health index and require certain proposed projects to complete a health impact assessment to help protect the health of community residents. The department shall adopt regulations to implement the community health disparities program

Section 3. (a) No less often than once every five years the department shall create and publish a communities health index using the most recent three years of health data it has available.

(b) The communities health index shall be based on the following:

(1) Primary indicators for a community:

(i)Total age adjusted mortality, 25% or more above the commonwealth rate;

(ii) Total age adjusted emergency room visits, 10% or more above the commonwealth rate;

(iii) Elevated blood lead levels in children under age 15, 10% or more above the commonwealth rate;

(iv) Asthma and asthma-related hospital admissions or prevalence in children under age 15, 10% or more above the commonwealth rate; and

(v) Infant mortality 10% or more above the commonwealth rate.

(2) Secondary indictors for a community:

(i) Total age adjusted non-congenital cardiovascular disease and stroke morbidity, 10% or more above the commonwealth rate;

(ii) Total age adjusted heart attack hospitalizations, 10% or more above the commonwealth rate;

(iii) Total age adjusted stroke and stroke-related hospitalizations, 10% or more above the commonwealth rate; and

(iv) Bronchitis and bronchitis-related hospitalizations in children under age 15 and younger and adults age 65 and older, 10% or more above the commonwealth rate.

(3) Other indicators for a community:

(i) Other health outcome indicators, if any, chosen by the department to compare community health; and

(ii) Environmental indicators (such as elevated levels of particulate matter in the air), if any, chosen by the department as predictive of negative health outcomes.

(c) The department shall weight the indicators, giving more weight to the primary indicators than to the secondary indicators, to determine which communities’ residents suffer disproportionately high levels of serious disease, disability, and premature death and shall index the communities from worst to best health outcomes. A community in the top 50^th percentile of the index for poor health outcomes is determined to have the worst health outcomes and deemed to be most vulnerable. The department may adjust the percentile up or down by no more than 10 percent to identify the communities with the worst health outcomes in the commonwealth.

(d) For purposes of creating the communities health index:

(1) A community shall include at least 10,000 residents. If a municipality has fewer than 10,000 residents, the department shall cluster the municipality with one or more contiguous municipalities to create a combined community with at least 10,000 and no more than 100,000 residents.

(2) A community shall not exceed 100,000 residents. If a municipality has more than 100,000 residents, the department shall divide the municipality into geographically contiguous communities of 10,000-50,000 residents.

(3) The department may divide municipalities of 50,000-100,000 residents into geographically contiguous communities of 10,000-50,000 residents if there are distinct differences in indicators within areas of the municipality.

SECTION 12. The Department of Public Health shall adopt regulations to implement chapter 111L of the General Laws, inserted by section 12 of this act, within one year after the effective date of this act.