Local Health Department or District. Counties' legislative authorities are charged with establishing either a county health department or a health district to assure the public's health. Local health departments and health districts can take various forms and include a single county health department or district, a combined city and county health department, or several counties can join a health district.
Each local public health jurisdiction is governed by a local board of health (board), the membership of which depends on whether the county is a home rule county or part of a local health district. In home rule counties, the membership of the board is governed by the county charter. Elected officials from cities and towns in the county may be appointed to the board. The board may also include individuals who are not elected officials, but such individuals may not constitute a majority of the board. In non-home rule counties that are not part of a local health district, the county's board of commissioners constitutes the board. The county may expand the membership of the board to include elected officials from cities or towns. The board may also include individuals who are not elected officials, but such individuals may not constitute a majority of the board.
Each local health jurisdiction must appoint a local health officer, who must be an experienced physician or osteopathic physician who has a Master of Public Health degree or equivalent.
Foundational Public Health Services. "Foundational public health services" is defined as a limited statewide set of defined public health services within the following areas:
"Governmental public health system" means the Department of Health (DOH), the State Board of Health (BOH), local health jurisdictions, sovereign tribal nations, and Indian health programs located in Washington. "Service delivery models" means a systematic sharing of resources and function among state and local governmental public health entities, sovereign tribal nations, and Indian health programs to increase capacity and improve efficiency and effectiveness.
Foundational Public Health Services Funding. Funding for foundational public health services must be appropriated to the Office of Financial Management (OFM). OFM may only allocate funding to DOH if DOH, after consultation with federally recognized Indian tribes pursuant to the statutory consultation process, jointly certifies, with a state association representing local health jurisdictions and BOH, to OFM that there is an agreement on the distribution and uses of state foundational public health services funding. If joint certification is provided, DOH must distribute the funding according to the agreed-upon distribution and uses. If joint certification is not provided, the appropriation for foundational public health services lapses.
Regional Comprehensive Public Health District Centers. "Regional comprehensive public health district centers" or "regional shared service centers" (regional centers) are defined as a center established to provide coordination of shared public health services across the state in order to support local health jurisdictions. Four regional centers, split evenly between the east side and west side of the Cascades, are established. In addition to the duties and roles determined by the Foundational Public Health Services Steering Committee (steering committee), the regional centers may:
Each regional center must have a regional coordinator who is a DOH employee.
By January 1, 2024, counties must establish a formal relationship with one primary regional center on the same side of the Cascades as the county. A county may also enter into formal or informal relationships with other regional centers. Federally recognized Indian tribes and 501(c)(3) organizations registered in Washington that serve American Indian and Alaska Native people within Washington may enter into formal or informal relationships with the regional centers.
Foundational Public Health Services Steering Committee. DOH must convene a steering committee that includes members representing DOH, BOH, federally recognized Indian tribes, and a state association representing local health jurisdictions. These four groups may each select members to represent their agency or organization and a co-chair. The maximum number of voting members is 24. Staff support for the steering committee is provided by DOH. Members of the steering committee that represent local health jurisdictions and federally recognized Indian tribes, that travel more than 100 miles to attend a meeting, are eligible for reimbursement of travel expenses.
The steering committee shall make recommendations to the public health advisory board to:
Public Health Advisory Board. The Public Health Advisory Board (advisory board) is established within DOH. The advisory board consists of the following members appointed by the Governor, in addition to four nonvoting, ex officio legislative members:
The advisory board shall:
Funding for Foundational Public Health Services. For the2021-2023 biennium, amounts appropriated for foundational public health services funding that exceed $60 million per biennium, DOH must allocate 65 percent to new service delivery models, including establishing and operating the regional centers, the regional health officers, and the regional coordinators, unless the appropriations act specifies otherwise. Federal funding received in response to the COVID-19 pandemic must be included when calculating the amount to be provided for shared service delivery models.
Reporting. Annually, beginning October 1, 2023, DOH, in consultation with federally recognized Indian Tribes, local health jurisdictions, and BOH, must submit to the appropriate committees of the Legislature, the Governor, and advisory board a report on the distribution of the foundational public health services funding. The report must contain a statement of the funds provided to the governmental public health system for foundational public health services, a description of how the funds were distributed and used, the level of work funded for each service, and the progress of the governmental public health system meeting the standards and performance measures identified by the steering committee. The advisory board must, each October 1st, make recommendations to DOH, the steering committee, the Legislature, and Governor on the priorities for the governmental public health system and foundational public health services funding.
Regional Health Officer. The position of regional health officer is created within DOH. The secretary must appoint four regional health officers. One regional health officer on each side of the Cascades must be appointed by January 1, 2023. Regional health officers may:
A regional health officer must meet the same qualifications as a local health officer.
Local Boards of Health. Beginning July 1, 2023, in addition to existing members of the board, each board must include unelected members from the following three categories that must be approved by a majority vote of the board of county commissioners:
If the number of board members selected from these three categories is evenly divisible by three, there must be an equal number of members selected from each of the three categories. If there are one or two members over the nearest multiple of three, those members may be selected from any of the three categories. If the board demonstrates it attempted to recruit members from all three categories and was unable to do so, the board may select members only from the other two categories. There may be no more than one member selected from one type of background or position.
If a federally recognized Indian tribe holds reservation, trust lands, or has usual and accustomed areas within the county, or if a 501(c)(3) organization registered in Washington that serves American Indian and Alaska Native people and provides services within the county, the board must include a tribal representative selected by the American Indian Health Commission. The number of members selected from the three categories and the tribal representative must equal the number of city and county elected officials on the board.
Any decision by the board related to setting or modifying permit, licensing, and application fees may only be determined by the city and county elected officials on the board.
A local board of health comprised solely of elected officials may retain its current composition if the local health jurisdiction had a public health advisory committee or board with its own bylaws established on January 1, 2021. By January 1, 2022, the public health advisory committee or board must meet the requirements for community health advisory boards established in the bill. Any future changes to local board of health composition must meet the requirements for elected and unelected membership.
The BOH must adopt rules establishing the appointment process for members of the board who are not elected officials.
Counties must pay for expenses incurred by the health district or county for enforcing proclamations of the Governor during a public health emergency.
Community Health Advisory Boards. Community health advisory boards must:
The advisory board must consist of 9 to 21 members appointed by the local board of health. The membership must be diverse and include:
Notice Requirements for Termination of a Local Health Department or District. Before terminating an agreement to operate a city and county health department or a health district, the terminating party must:
Rulemaking. DOH may adopt rules necessary to implement the act.
Repealed Statutes. Statutes related to establishing a DOH study on uniform quality assurance and improvement are repealed.
Null and Void Clause. If at least $60 million is not appropriated for foundational public health services by June 30,2021, provisions relating to the steering committee, regional shared services centers, and regional health officers are null and void.
The committee recommended a different version of the bill than what was heard. PRO: Anyone anywhere in the state should be able to rely on the same level of public health services. This bill will allow for more consistent and equitable delivery of public health services and build on existing work. Many of the changes to the public health system only go into effect with a significant increase in funding. There would be no hierarchy between regional centers and local health jurisdictions, it would be a cooperative partnership. The bill would bring in needed expertise to local health boards.
CON: This bill would diminish the public's ability to engage in policy decisions at the local level.
OTHER: Insulating public health from politics is needed, but this bill does not achieve that. There has not been enough time for stakeholder engagement. The bill would be another administrative layer without helping to deliver services. The bill does not address lack of funding. There should be a facilitated discussion among all stakeholders on improving the public health system after the pandemic has ended. There should be assurance that a regional approach will not stop local decision making. The provisions of the bill can be implemented without legislation if it is determined that they are needed.
The committee recommended a different version of the bill than what was heard. PRO: I have served on a Board of Health for eight years. I have seen how well boards do or do not do the work. One of the most important aspects of this bill is the balance of elected officials with public health experts. Of the 34 boards of health, eight have a person with experience in health on their board. You would not expect to have other professional boards without those who have expertise in those areas. This bill strengthens and enhances the public health system. This goes hand in hand with the significant public health resources in the Senate budget, and we urge you to maintain those investments. Nurses depend on public health, especially evident with the COVID-19 pandemic. We must set our public health system up for success. The four regional districts included in the bill will help communication and coordination.
OTHER: Public health officers have mixed opinions on this bill and it is not a priority. We need to work to leverage federal funds in the system to address foundational public health needs.