Legislature passes sweeping public health reform

With just days left in the formal legislative session, the House and Senate both passed a bill designed to strengthen the ability of state and local health departments to serve public health needs across the state.

The bill (H. 5104), also known as SAPHE 2.0, aims to establish minimum standards for local public health departments, create a unified standard public health reporting and data collection system, and advance the capacity of state and local public health departments. It builds on initial recommendations of the Special Commission on Local and Regional Public Health in 2019 and gained urgency during the COVID pandemic.

The bill calls for the Massachusetts Department of Public Health to develop, by June 1, 2023, a state action plan for public health excellence to:
• Provide every resident of the Commonwealth with foundational public health services
• Assist local boards of health in adopting practices to improve the efficiency and effectiveness of the delivery of foundational public health services
• Develop a set of standards for foundational public health services across the Commonwealth
• Promote and provide adequate resources for boards of health by:
– supporting boards of health to meet the standards
– increasing cross-jurisdictional sharing of public health programs to strengthen the service delivery capabilities
– improving planning and system accountability of the municipal and regional public health systems, including statewide data collection and reporting
– establishing workforce credentialing standards
– expanding access to professional development, training and technical assistance for municipal and regional public health officials and staff

The bill directs the DPH to file a report with the Legislature by June 1, 2023, providing an analysis of the needs, opportunities, challenges, timeline and cost analysis for the implementation of the new mandated standards.

The legislation calls on the DPH to provide funding to local boards of health to implement and comply with new state-set minimum operational and service standards, known as “foundational public health services.” This funding may include competitive grants to improve delivery across three or more municipalities through shared services and annual non-competitive formula funding, as well as grants and technical assistance for municipalities that have limited operational capacity to meet local public health responsibilities as required by law or regulations.

The bill allows for the state’s financial obligations to be subject to appropriation, however, while municipalities will be required to meet the responsibilities and standards of the legislation regardless of whether state funding levels are adequate. While there is no comprehensive fiscal analysis of the cost to municipalities, the 2019 preliminary estimate for pre-pandemic standards developed by the special commission put the number at roughly $140 million. Given the cost of inflation and labor shortages, the MMA maintains that the cost is likely to be significantly higher.

In late 2021, the Legislature allocated $200 million for local and regional boards of public health as part of its $4 billion COVID recovery bill, which used part of the state’s American Rescue Plan Act funding. The MMA points out that the federal dollars are a one-time resource, and future funding will require annual state appropriations.

While the MMA supports the intent of the legislation, it has expressed strong concerns that the measure as written could impose a new annual unfunded mandate on municipalities, especially if the state fails to deliver the promised funding after the ARPA funds are depleted. The MMA has written to Gov. Charlie Baker and legislative leaders regarding the unfunded mandate and requested language making it clear that municipalities should be held to the same subject-to-appropriation standard in the bill.

Gov. Baker has 10 days to sign, amend or veto the bill.