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.
