New Jersey-2022-A4517-Introduced

An Act health equity and supplementing Title 26 of the Revised Statutes.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. The Legislature finds and declares that:

a. Race is a social construct with no biological basis that artificially divides people into distinct groups based on characteristics such as physical appearance, ancestral heritage, cultural affiliation, and the social, economic, and political needs of a society at a given period.

b. Racism is a social system with multiple dimensions that include individual racism that is internalized or interpersonal, systemic racism that is institutional or structural, and a system of structuring opportunity and assigning value based on the social interpretation of how one looks.

c. Racism unfairly disadvantages specific individuals and communities while giving unfair advantages to other individuals and communities, which undermines society as a whole through the waste of human resources necessary to promote prosperity and development in New Jersey and elsewhere.

d. Racism is rooted in the foundation of America, from the time chattel slavery began in the 1600s, to the Jim Crow era, to the declaration of the war on drugs that eventually led to the mass incarceration of Black people, and it has remained a presence in American society that causes Black, Hispanic, Native American, and other peoples of color to experience hardships and disadvantages in every aspect of life.

e. The American Public Health Association, the National Association of County and City Health Officials, and the American Academy of Pediatrics have each declared racism to be a public health crisis, and the federal Centers for Disease Control and prevention has declared racism to be a serious public health threat.

f. Communities of color, working class residents, and individuals with disabilities are more likely to experience poor health outcomes as a consequence of their social determinants of health.

g. Racism causes permanent discrimination and disparate outcomes in many areas of life, including housing, education, employment, criminal justice and incarceration, family stability, economic opportunity, access to health care, public safety, environmental safety, nutrition, voting rights, access to recreational resources, and access to health care resources.

h. More than 100 studies have linked racism to worse health outcomes.

i. Racism exacerbates health disparities among Black, Hispanic, and Native American residents, including disparities in the risk of heart disease, stroke, infant mortality, maternal mortality, low birth weight, obesity, hypertension, type 2 diabetes, cancer, respiratory disease, and autoimmune disease.

j. Specific physical and behavioral health conditions stemming from racism include depression, anxiety, anger, fear, trauma, terror, and long-term physical and mental health impairments.

k. The COVID-19 pandemic and ongoing protests against police brutality have helped to highlight that racism, not race, causes disparities in health and access to health care for Americans of color.

l. It is therefore necessary and appropriate to establish a permanent New Jersey Commission on Health Equity to develop strategies to counter and mitigate the effects of institutional racism in New Jersey.

2. As used in this act:

"Advisory committee" means the Health Equity Data Advisory Committee established pursuant to section 5 of P.L. , c. (C. ) (pending before the Legislature as this bill).

"Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State.

"Commission" means the New Jersey Commission on Health Equity established pursuant to section 3 of P.L. , c. (C. ) (pending before the Legislature as this bill).

"Health benefits plan" means a benefits plan which pays or provides hospital and medical expense benefits for covered services, and is delivered or issued for delivery in this State by or through a carrier. Health benefits plan includes, but is not limited to, Medicare supplement coverage and risk contracts to the extent not otherwise prohibited by federal law. For the purposes of P.L. , c. (C. ) (pending before the Legislature as this bill), health benefits plan shall not include the following plans, policies, or contracts: accident only, credit, disability, long-term care, CHAMPUS supplement coverage, coverage arising out of a workers' compensation or similar law, automobile medical payment insurance, personal injury protection insurance issued pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.), or hospital confinement indemnity coverage.

"Health equity framework" means a public health framework through which policymakers and stakeholders in the public and private sectors use a collaborative approach to improve health outcomes and reduce health inequities in the State by incorporating
health considerations into decision making across sectors and policy

areas.

3. a. There is established in the Department of Health the New Jersey Commission on Health Equity.

b. The commission shall comprise 27 members, as follows:

(1) one member of the Senate, appointed by the President of the Senate, who shall serve for the duration of the legislative term in which the member is appointed;

(2) one member of the General Assembly, appointed by the Speaker of the General Assembly, who shall serve for the duration of the legislative term in which the member is appointed;

(3) the Commissioner of Health, or the commissioner's designee, who shall serve ex officio;

(4) the Commissioner of Community Affairs, or the commissioner's designee, who shall serve ex officio;

(5) the Commissioner of Human Services, or the commissioner's designee, who shall serve ex officio;

(6) the Secretary of Agriculture, or the commissioner's designee, who shall serve ex officio;

(7) the Attorney General, or the Attorney General's designee, who shall serve ex officio;

(8) the Commissioner of Banking and Insurance, or the commissioner's designee, who shall serve ex officio;

(9) the Commissioner of Children and Families, or the commissioner's designee, who shall serve ex officio;

(10) the Commissioner of Corrections, or the commissioner's designee, who shall serve ex officio;

(11) the Commissioner of Education, or the commissioner's designee, who shall serve ex officio;

(12) the Commissioner of Environmental Protection, or the commissioner's designee, who shall serve ex officio;

(13) the Commissioner of Labor and Workforce Development, or the commissioner's designee, who shall serve ex officio;

(14) the Commissioner of Military and Veterans Affairs, or the commissioner's designee, who shall serve ex officio;

(15) the Secretary of State, or the secretary's designee, who shall serve ex officio;

(16) the Commissioner of Transportation, or the commissioner's designee, who shall serve ex officio;

(17) the Deputy Commissioner of Public Health Services in the Department of Health, or the deputy commissioner's designee, who shall serve ex officio;

(18) the Director of the Division of Aging Services in the Department of Human Services, or the director's designee, who shall serve ex officio;

(19) the Executive Director of the Division of Disability Services in the Department of Human Services, or the executive director's designee, who shall serve ex officio;

(20) the Assistant Commissioner for the Division of Medical Assistance and Health Services in the Department of Human Services, or the assistant commissioner's designee, who shall serve ex officio;

(21) the Assistant Commissioner for the Division of Mental Health and Addiction Services in the Department of Human Services, or the assistant commissioner's designee, who shall serve ex officio;

(22) the Director of the Office of Management and Budget in the Department of the Treasury, or the director's designee, who shall serve ex officio;

(23) the chief technology officer in the New Jersey Office of Information Technology, or the chief technology officer's designee, who shall serve ex officio;

(24) the Assistant Commissioner of Child Protection and Permanency in the Department of Children and Families, or the assistant commissioner's designee, who shall serve ex officio;

(25) the Chair of the New Jersey State Planning Commission, or the chair's designee, who shall serve ex officio;

(26) the Superintendent of the State Police, or the superintendent's designee, who shall serve ex officio; and

(27) one representative of a local health department, designated by the New Jersey Association of County and City Health Officials, who shall serve for a term of four years and who shall be eligible for reappointment to the commission.

c. The Governor shall designate a chair and a vice-chair of the commission from among the membership. The chair shall appoint a secretary, who need not be a member of the commission.

d. The commission shall meet at least four times each year at a location to be determined by the chair, but may meet at such additional times and places as the commission may determine to be necessary. A majority of the authorized membership shall constitute a quorum for the purposes of undertaking official business.

e. The members of the commission shall serve without compensation, but may be reimbursed for reasonable expenses incurred in the performance of their duties, within the limits of funds made available to the commission for this purpose.

f. The Department of Health shall provide such stenographic, clerical, and other administrative assistants, and such professional staff, as the commission requires to carry out its work. The commission shall be entitled to call to its assistance and avail itself of the services of the employees of any State, county, or municipal department, board, bureau, commission, or agency as it may require and as may be available for its purposes.

4. a. The purpose of the commission shall be to:

(1) employ a health equity framework to examine:

(a) the health of residents of the State to the extent necessary to carry out the requirements of this section;

(b) ways for units of State and local government to collaborate to implement policies that will have a positive impact on the health of the residents of New Jersey; and

(i) access to safe and affordable housing;

(ii) educational attainment;

(iii) opportunities for employment;

(iv) economic stability;

(v) inclusion, diversity, and equity in the workplace;

(vi) barriers to career success and promotion in the workplace;

(vii) access to transportation and mobility;

(viii) social justice;

(ix) environmental factors;

(x) public safety, including the impact of crime, citizen unrest, the criminal justice system, and governmental policies that affect individuals who are incarcerated or who have been released from incarceration; and

(xi) food insecurity;

(2) provide direct advice to the Commissioner of Health, and, through the commissioner, indirect advice to the Department of Health's senior administrators and planners, regarding issues of racial, ethnic, cultural, or socioeconomic health disparities;

(3) facilitate coordination of the expertise and experience of the Departments of Health, Human Services, Community Affairs, Transportation, Education, Environment, and Labor and Workforce Development in developing a comprehensive health equity plan addressing the social determinants of health; and

(4) set goals for health equity and prepare a plan for the State to achieve health equity in alignment with any other Statewide planning activities.

b. The commission, using a health equity framework, shall:

(1) examine and make recommendations regarding:

(a) health considerations that may be incorporated into the decision-making processes of government agencies and private sector stakeholders who interact with government agencies;

(b) requirements for implicit bias training for clinicians engaged in patient care and whether the State should provide the training;

(c) training for health care providers on consistent and proper collection of self-identified patient data on race, ethnicity, and language to accurately identify disparities; and

(d) requirements to comply with, and for enforcement of, National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, or "CLAS Standards";

(2) foster collaboration between units of State and local government and develop policies to improve health and reduce health inequities;

(3) identify measures for monitoring and advancing health equity in the State;

(4) establish a State plan for achieving health equity in alignment with other Statewide planning activities in coordination with the State's health, human services, housing, transportation, education, environment, community development, and labor systems; and

(5) make recommendations and provide advice, including direct advice to the Commissioner of Health, on implementing laws and policies to improve health and reduce health inequities.

c. The commission may establish advisory committees to assist the commission in the performance of its duties under this section. An advisory committee established pursuant to this subsection may include individuals who are not members of the commission.

d. The New Jersey Health Information Network shall maintain a data set for the commission and provide data from the data set consistent with the parameters established by the advisory committee pursuant to section 5 of P.L. , c. (C. ) (pending before the Legislature as this bill).

e. No later than 18 months after the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill), and annually thereafter, the commission shall prepare and submit a report to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature, concerning the activities of the commission, which report shall include the commission's findings with regard to any changes in health equity in the State resulting from the commission's activities, and the commission's recommendations for legislation or administrative action as may be necessary to implement the commission's findings and recommendations and support the commission's activities.

5. a. The commission shall, in coordination with the New Jersey Health Information Network, establish a Health Equity Data Advisory Committee to make recommendations on data collection, needs, quality, reporting, evaluation, and visualization for the commission to carry out the purposes of P.L. , c. (C. ) (pending before the Legislature as this bill). The advisory committee shall include representatives from the New Jersey Health Information Network.

b. (1) The advisory committee shall define the parameters of a health equity data set to be maintained by the New Jersey Health Information Network, including indicators for:

(a) social and economic conditions;

(b) environmental conditions;

(d) behaviors;

(e) health care; and

(f) priority health outcomes for monitoring health equity for racial and ethnic minority populations in New Jersey.

(2) The data set for which parameters are defined under paragraph (1) of this subsection shall include data from:

(a) health care facilities that report to the Department of Health;

(b) health benefits plans that report to the Department of Banking and Insurance; and

c. (1) The commission may request data consistent with the recommendations of the advisory committee. Data requested by the commission shall be provided, to the extent authorized under State and federal privacy laws, either directly to the commission or to the commission through the New Jersey Health Information Network.

(2) The advisory committee may recommend that data be reported or otherwise made available to the public, in which case the commission may publish or otherwise provide to the public any data provided to the commission pursuant to this section, consistent with the recommendations of the advisory committee.

(3) Data provided to the commission and data reported or otherwise made available to the public pursuant to this section shall be provided in the aggregate.

6. This act shall take effect the first day of the seventh month next following enactment.

STATEMENT

This bill establishes, in the Department of Health, the New Jersey Commission on Health Equity.

The purpose of the commission will be to:

1) employ a health equity framework to examine: the health of New Jersey residents; ways for units of State and local government to collaborate to implement policies that will positively impact the health of New Jersey residents; and the impact of certain enumerated factors on the health of New Jersey residents;

2) provide direct advice to the DOH regarding issues of racial, ethnic, cultural, or socioeconomic health disparities;

3) facilitate coordination of the expertise and experience of various State departments in developing a comprehensive health equity plan addressing the social determinants of health; and

4) set goals for health equity and prepare a plan for the State to achieve health equity in alignment with any other Statewide planning activities.

The commission, using a health equity framework, will be required to:

1) examine and make recommendations regarding: health considerations that may be incorporated into the decision-making processes of government agencies and private sector stakeholders who interact with government agencies; requirements for implicit bias training for clinicians engaged in patient care and whether the State should provide the training; training for health care providers on consistent and proper collection of self-identified patient data on race, ethnicity, and language to identify disparities accurately; and requirements to comply with, and for enforcement of, National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards);

2) foster collaboration between units of State and local government and develop policies to improve health and reduce health inequities;

3) identify measures for monitoring and advancing health equity in the State;

4) establish a State plan for achieving health equity in alignment with other Statewide planning activities in coordination with the State's health, human services, housing, transportation, education, environment, community development, and labor systems; and

5) make recommendations and provide advice, including direct advice to the Commissioner of Health, on implementing laws and policies to improve health and reduce health inequities.

The commission will be authorized to establish advisory committees to assist the commission in the performance of its duties. Any such advisory committee may include individuals who are not members of the commission.

The commission will comprise 27 members, including:

1) one member of the Senate appointed by the President of the Senate and one member of the General Assembly appointed by the Speaker of the General Assembly, each of whom will serve for the duration of the legislative term in which they are appointed;

2) the heads of the Department of Health (DOH), the Department of Human Services (DHS), the Department of Agriculture, the Department of Community Affairs, the Department of Banking and Insurance, the Department of Children and Families, the Department of Corrections, the Department of Education, the Department of Environmental Protection, the Department of Labor and Workforce Development, the Department of Law and Public Safety, the Department of Military and Veterans Affairs, the Department of State, the Department of Transportation, Public Health Services in DOH, the Division of Aging Services in DHS, the Division of Disability Services in DHS, the Division of Medical Assistance and Health Services in DHS, the Division of Mental Health and Addiction Services in DHS, the New Jersey Office of Information Technology, the Division of Child Protection and Permanency in the Department of Children and Families, the New Jersey State Planning Commission, the State Police, and the Office of Management and Budget in the Department of the Treasury, or their designees, who will serve ex officio; and

3) one representative of a local health department, designated by the New Jersey Association of County and City Health Officials, who will serve for a term of four years and will be eligible for reappointment to the commission.

The Governor will designate a chair and a vice-chair of the commission from among the membership. The chair will appoint a secretary, who need not be a member of the commission. The commission will be required to meet at least four times each year at a location to be determined by the chair, but may meet at such additional times and places as by the commission determines to be necessary. A majority of the authorized membership will constitute a quorum for the purpose of undertaking official business. The members of the commission will serve without compensation, but may be reimbursed for reasonable expenses incurred in the performance of their duties, within the limits of funds made available to the commission for this purpose.

The DOH will provide stenographic, clerical, and other administrative assistants, as well as any professional staff, as the commission requires to carry out its work. The commission will be entitled to call to its assistance and avail itself of the services of the employees of any State, county, or municipal department, board, bureau, commission, or agency as it may require and as may be available for its purposes.

In coordination with the New Jersey Health Information Network (NJHIN), the commission will be required to establish a Health Equity Data Advisory Committee to make recommendations on data collection, needs, quality, reporting, evaluation, and visualization for the commission to carry out the purposes of the bill. The advisory committee is to include representatives from the NJHIN.

Specifically, the advisory committee will define the parameters of a health equity data set to be maintained by the NJHIN, including indicators for: social and economic conditions; environmental conditions; health status; behaviors; health care; and priority health outcomes for monitoring health equity for racial and ethnic minority populations in New Jersey. The data set for which these parameters are defined are to include data from: health care facilities that report to the DOH; health benefits plans that report to the Department of Banking and Insurance; and any other data source the advisory committee determines necessary.

The commission may request data consistent with the recommendations of the advisory committee. Data requested by the commission is to be provided either directly to the commission or to the commission through the NJHIN. The advisory committee may recommend that data be reported or otherwise made available to the public, in which case the commission will be authorized to publish or otherwise provide the data to the public. Data provided to the commission and data reported or otherwise made available to the public is to be provided in the aggregate and in compliance with applicable State and federal privacy laws.

No later than 18 months after the effective date of the bill, and annually thereafter, the commission will be required to prepare and submit a report to the Governor and the Legislature concerning the activities of the commission, including the commission's findings with regard to any changes in health equity in the State resulting from the commission's activities, and the commission's recommendations for legislation or administrative action as may be necessary to implement the commission's findings and recommendations and support the commission's activities.

The bill will take effect the first day of the seventh month next following enactment.