AN ACT
Relating to implementation of the public health improvement plan; amending RCW
41.05.240, 70.05.030, 70.05.035, 70.05.050, 70.08.040, 70.46.020, 43.72.902,
and 43.72.915; adding a new section to chapter 70.46 RCW; adding new sections
to chapter 43.70 RCW; recodifying RCW 41.05.240; repealing 1993 c 492 s 244;
repealing 1993 c 492 s 255; repealing 1993 c 492 s 256 (uncodified); providing effective
dates; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE
OF THE STATE OF WASHINGTON:
NEW SECTION. Sec.
1. The
legislature declares its intent to implement the recommendations of the public
health improvement plan by initiating a program to provide the public health
system with the necessary capacity to improve the health outcomes of the
population of Washington state and establishing the methodology by which
improvement in the health outcomes and delivery of public health activities
will be assessed.
NEW
SECTION. Sec. 2. Unless
the context clearly requires otherwise, the definitions in this section apply
throughout sections 1 through 3 of this act.
(1)
"Capacity" means actions that public health jurisdictions must do as
part of ongoing daily operations to adequately protect and promote health and
prevent disease, injury, and premature death. The public health improvement
plan identifies capacity necessary for assessment, policy development,
administration, prevention, including promotion and protection, and access and
quality.
(2)
"Department" means the department of health.
(3)
"Local health jurisdiction" means the local health agency, either
county or multicounty, operated by local government, with oversight and
direction from a local board of health, that provides public health services
throughout a defined geographic area.
(4)
"Health outcomes" means long-term objectives that define optimal,
measurable, future levels of health status, maximum acceptable levels of
disease, injury, or dysfunction, or prevalence of risk factors in areas such as
improving the rate of immunizations for infants and children to ninety percent
and controlling and reducing the spread of tuberculosis and that are stated in
the public health improvement plan.
(5)
"Public health improvement plan," also known as the public health
services improvement plan, means the public health services improvement plan
established under RCW 43.70.520, developed by the department, in consultation
with local health departments and districts, the state board of health, the
health services commission, area Indian health services, and other state
agencies, health services providers, and residents concerned about public
health, to provide a detailed accounting of deficits in the core functions of
assessment, policy development, and assurance of the current public health system,
how additional public health funding would be used, and to describe the
benefits expected from expanded expenditures.
(6)
"Public health" means activities that society does collectively to
assure the conditions in which people can be healthy. This includes organized
community efforts to prevent, identify, preempt, and counter threats to the
public's health.
(7)
"Public health system" means the department, the state board of
health, and local health jurisdictions.
NEW
SECTION. Sec. 3. The
primary responsibility of the public health system, is to take those actions
necessary to protect, promote, and improve the health of the population. In
order to accomplish this, the department shall:
(1)
Identify, as part of the public health improvement plan, the key health
outcomes sought for the population and the capacity needed by the public health
system to fulfill its responsibilities in improving health outcomes.
(2)(a)
Distribute state funds that, in conjunction with local revenues, are intended
to improve the capacity of the public health system. The distribution
methodology shall encourage system-wide effectiveness and efficiency and
provide local health jurisdictions with the flexibility both to determine
governance structures and address their unique needs.
(b)
Enter into with each local health jurisdiction performance-based contracts that
establish clear measures of the degree to which the local health jurisdiction
is attaining the capacity necessary to improve health outcomes. The contracts
negotiated between the local health jurisdictions and the department of health
must identify the specific measurable progress that local health jurisdictions
will make toward achieving health outcomes. A community assessment conducted
by the local health jurisdiction according to the public health improvement
plan, which shall include the results of the comprehensive plan prepared
according to RCW 70.190.130, will be used as the basis for identifying the
health outcomes. The contracts shall include provisions to encourage
collaboration among local health jurisdictions. State funds shall be used
solely to expand and complement, but not to supplant city and county government
support for public health programs.
(3)
Develop criteria to assess the degree to which capacity is being achieved and
ensure compliance by public health jurisdictions.
(4)
Adopt rules necessary to carry out the purposes of chapter . . .,
Laws of 1995 (this act).
(5)
Biennially, within the public health improvement plan, evaluate the
effectiveness of the public health system, assess the degree to which the
public health system is attaining the capacity to improve the status of the
public's health, and report progress made by each local health jurisdiction
toward improving health outcomes.
Sec.
4. RCW
41.05.240 and 1993 c 492 s 468 are each amended to read as follows:
Consistent
with funds appropriated specifically for this purpose, the ((authority))
department shall establish in conjunction with the area Indian health
services system and providers an advisory group comprised of Indian and
non-Indian health care facilities and providers to formulate an American Indian
health care delivery plan. The plan shall include:
(1)
Recommendations to providers and facilities methods for coordinating and joint
venturing with the Indian health services for service delivery;
(2)
Methods to improve American Indian-specific health programming; and
(3)
Creation of co-funding recommendations and opportunities for the unmet health
services programming needs of American Indians.
NEW
SECTION. Sec. 5. RCW
41.05.240 shall be recodified as a new section in chapter 43.70 RCW.
Sec.
6. RCW
70.05.030 and 1993 c 492 s 235 are each amended to read as follows:
In
counties without a home rule charter, the board of county commissioners shall
constitute the local board of health, unless the county is part of a health
district pursuant to chapter 70.46 RCW. The jurisdiction of the local board of
health shall be coextensive with the boundaries of said county. The board
of county commissioners may, at its discretion, adopt an ordinance expanding
the size and composition of the board of health to include elected officials
from cities and towns and persons other than elected officials as members so
long as persons other than elected officials do not constitute a majority. An
ordinance adopted under this section shall include provisions for the
appointment, term, and compensation, or reimbursement of expenses.
Sec.
7. RCW
70.05.035 and 1993 c 492 s 237 are each amended to read as follows:
In
counties with a home rule charter, the county legislative authority shall
establish a local board of health and may prescribe the membership and
selection process for the board. The county legislative authority may
appoint to the board of health elected officials from cities and towns and
persons other than elected officials as members so long as persons other than
elected officials do not constitute a majority. The county legislative
authority shall specify the appointment, term, and compensation or
reimbursement of expenses. The jurisdiction of the local board of health
shall be coextensive with the boundaries of the county. The local health
officer, as described in RCW 70.05.050, shall be appointed by the official
designated under the provisions of the county charter. The same official
designated under the provisions of the county charter may appoint an
administrative officer, as described in RCW 70.05.045.
Sec.
8. RCW
70.05.050 and 1993 c 492 s 238 are each amended to read as follows:
The
local health officer shall be an experienced physician licensed to practice
medicine and surgery or osteopathy and surgery in this state and who is
qualified or provisionally qualified in accordance with the standards
prescribed in RCW 70.05.051 through 70.05.055 to hold the office of local
health officer. No term of office shall be established for the local health
officer but the local health officer shall not be removed until after notice is
given, and an opportunity for a hearing before the board or official
responsible for his or her appointment under this section as to the reason for
his or her removal. The local health officer shall act as executive secretary
to, and administrative officer for the local board of health and shall also be
empowered to employ such technical and other personnel as approved by the local
board of health except where the local board of health has appointed an
administrative officer under RCW 70.05.040. The local health officer shall be
paid such salary and allowed such expenses as shall be determined by the local
board of health. In home rule counties that are part of a health district
under this chapter and chapter 70.46 RCW the local health officer and
administrative officer shall be appointed by the local board of health.
Sec.
9. RCW
70.08.040 and 1985 c 124 s 4 are each amended to read as follows:
Notwithstanding
any provisions to the contrary contained in any city or county charter, where a
combined department is established under this chapter, the director of public
health under this chapter shall be appointed by the county executive of the
county and the mayor of the city ((for a term of four years and until a
successor is appointed and confirmed. The director of public health may be
reappointed by the county executive of the county and the mayor of the city for
additional four year terms)). The appointment shall be effective only upon
a majority vote confirmation of the legislative authority of the county and the
legislative authority of the city. The director may be removed by the county
executive of the county, after consultation with the mayor of the city, upon
filing a statement of reasons therefor with the legislative authorities of the
county and the city.
Sec.
10. RCW
70.46.020 and 1993 c 492 s 247 are each amended to read as follows:
Health
districts consisting of two or more counties may be created whenever two or
more boards of county commissioners shall by resolution establish a district
for such purpose. Such a district shall consist of all the area of the
combined counties. The district board of health of such a district shall
consist of not less than five members for districts of two counties and seven
members for districts of more than two counties, including two representatives
from each county who are members of the board of county commissioners and who
are appointed by the board of county commissioners of each county within the
district, and shall have a jurisdiction coextensive with the combined
boundaries. The boards of county commissioners may by resolution or
ordinance provide for elected officials from cities and towns and persons other
than elected officials as members of the district board of health so long as
persons other than elected officials do not constitute a majority. A
resolution or ordinance adopted under this section must specify the provisions
for the appointment, term, and compensation, or reimbursement of expenses. Any
multicounty health district existing on the effective date of this act shall
continue in existence unless and until changed by affirmative action of all
boards of county commissioners or one or more counties withdraws pursuant to
RCW 70.46.090.
At the
first meeting of a district board of health the members shall elect a chair to
serve for a period of one year.
NEW
SECTION. Sec. 11. A new
section is added to chapter 70.46 RCW to read as follows:
A
health district to consist of one county may be created whenever the county
legislative authority of the county shall pass a resolution or ordinance to
organize such a health district under chapter 70.05 RCW and this chapter.
The
resolution or ordinance may specify the membership, representation on the
district health board, or other matters relative to the formation or operation
of the health district. The county legislative authority may appoint elected
officials from cities and towns and persons other than elected officials as
members of the health district board so long as persons other than elected
officials do not constitute a majority.
Any
single county health district existing on the effective date of this act shall
continue in existence unless and until changed by affirmative action of the
county legislative authority.
Sec.
12. RCW
43.72.902 and 1993 c 492 s 470 are each amended to read as follows:
The
public health services account is created in the state treasury. Moneys in the
account may be spent only after appropriation. Moneys in the account may be
expended only for maintaining and improving the health of Washington residents
through the public health system. For purposes of this section, the public
health system shall consist of the state board of health, the state department
of health, and local health departments and districts. ((Funds appropriated
from this account to local health departments and districts shall be
distributed ratably based on county population as last determined by the office
of financial management.))
NEW
SECTION. Sec. 13. Sections
1 through 3 of this act are each added to chapter 43.70 RCW.
NEW
SECTION. Sec. 14. If any
provision of this act or its application to any person or circumstance is held
invalid, the remainder of the act or the application of the provision to other
persons or circumstances is not affected.
Sec.
15. RCW
43.72.915 and 1993 sp.s. c 25 s 603 are each amended to read as follows:
This
act is necessary for the immediate preservation of the public peace, health, or
safety, or support of the state government and its existing public
institutions, and shall take effect July 1, 1993, except for:
(1)
Sections 234 through 243, 245 through 254, and 257 of this act, which
shall take effect ((July 1, 1995)) January 1, 1996 or January 1,
1998, if funding is not provided as set forth in section 17(4) of this act;
and
(2)
Sections 301 through 303 of this act, which shall take effect January 1, 1994.
NEW
SECTION. Sec. 16. The following
acts or parts of acts are each repealed, effective June 30, 1995:
(1) 1993 c 492
s 244;
(2) 1993 c 492
s 256 (uncodified); and
(3) 1993 c 492
s 255.
NEW
SECTION. Sec. 17. (1)
Sections 15 and 16 of this act are necessary for the immediate preservation of
the public peace, health, or safety, or support of the state government and its
existing public institutions, and shall take effect June 30, 1995.
(2)
Sections 1 through 5, 12, and 13 of this act are necessary for the immediate
preservation of the public peace, health, or safety, or support of the state
government and its existing public institutions, and shall take effect July 1,
1995.
(3)
Section 9 of this act is necessary for the immediate preservation of the public
peace, health, or safety, or support of the state government and its existing
public institutions, and shall take effect immediately.
(4)
Sections 6 through 8, 10, and 11 of this act take effect January 1, 1996, if
funding of at least two million two hundred fifty thousand dollars, is provided
by June 30, 1995, in the 1995 omnibus appropriations act or as a result of the
passage of Senate Bill No. 6058, to implement the changes in public health
governance as outlined in this act. If such funding is not provided, sections
6 through 8, 10, and 11 of this act shall take effect January 1, 1998.
