Gov. Charlie Baker on Aug. 8 sent a public health reform bill back to the Legislature unsigned with an amendment.

The legislation (H. 5104), 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.

The governor’s proposed amendment would allow municipalities to opt in to foundational standards to be developed by the Department of Public Health. By opting in, municipalities would be eligible to receive funding appropriated to the DPH for the implementation of the foundational standards for boards of public health, as determined by the remainder of the legislation.

In filing his amendment, Gov. Baker stated that he “strongly support[s] the aim of [the] bill,” but “while the bill clearly contemplates the provision of state support for boards to implement these standards, such funding is not guaranteed. … This aspect of the bill is likely to give rise to the sorts of budgeting and funding disputes that [state law (M.G.L. Ch. 29, Sec. 27C)] seeks to prevent by prohibiting unfunded local mandates.”

Under the governor’s amendment, access to additional state aid would be contingent on the municipality opting in and maintaining public health funding at the same level as the immediate preceding year.

Legislators must decide whether to accept the governor’s amendment, reject it, or return a bill back to him — either a new version or the same one they enacted in late July. Because formal legislative sessions ended on July 31, any action would require unanimous consent among legislators, since just one objection can stop legislation during informal sessions. The original bill passed both the House and Senate unanimously.

The legislation builds on initial recommendations of the Special Commission on Local and Regional Public Health in 2019 and gained new urgency during the COVID pandemic.

It 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 charges the DPH with developing, 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 bill passed by the Legislature would allow the state’s financial obligations to be subject to appropriation, while municipalities would be required to meet the responsibilities and standards of the legislation regardless of whether state funding is adequate. In a July 28 letter to a House-Senate conference committee, the MMA expressed support for the intent of the legislation, but strong opposition to this aspect of the bill.

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.

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