The legislature finds the COVID-19 pandemic has been the most difficult challenge in Washington's public health history since the 1918 flu pandemic. More Americans have died from COVID-19 than the number of United States troops killed in combat during World War II. The COVID-19 pandemic response has stressed and strained every part of our society and far surpassed the capabilities of local, state, tribal, and even federal public health agencies. Before the COVID-19 pandemic, the legislature had initiated action to address the critical challenges Washington's public health system faces, including limited organizational capacity, financial resources, and understaffing through beginning to specifically fund foundational public health services. The COVID-19 pandemic laid bare the shortcomings of Washington's current public health system which have been studied and identified for over a decade. Washington's current public health system was not able to consistently monitor and track the pandemic, staff the many required missions, adequately address the health inequities, and implement standard approaches to disease containment.
The legislature further finds that, in Washington, local health services are currently provided through a decentralized means by 35 local health jurisdictions. In many cases, rural communities are served by smaller local health jurisdictions that have less capacity to provide the full spectrum of foundational public health services than their urban peers. Local health jurisdictions serving smaller populations face challenges providing the full spectrum of foundational public health services and activities to promote and protect the health of all people. In addition, local health jurisdictions are overseen by boards in which most the members do not have direct experience in public health or health care. Since April 2020, a Kaiser health news investigation reports at least 181 local and state health leaders have resigned, retired, or been fired, including 11 local health leaders in Washington. Diseases do not respect borders or boundaries, yet the current decentralized system in Washington creates a patchwork approach with limited accountability and consistency. National peer-review studies report larger jurisdictions perform better on most foundational comprehensive public health services.
The COVID-19 pandemic has amplified the health and social inequities in Washington that existed before its emergence. There are vast inequities in per capita spending for local public health services by population size and geographic location. National peer-review studies report communities with limited public health systems experience low levels of activity participation, low perceived effectiveness, and sparse organizational networks compared to comprehensive public health systems. The inequitable distribution of morbidity and mortality between Black, indigenous, and people of color and other populations demonstrates the large health inequities that must be addressed. Therefore, the legislature finds the state must determine adequate funding of comprehensive health services districts from cities, counties, and the state, with the goal of providing all people with equitable access to foundational public health services, and once this funding is determined, the legislature finds this investment in the public's health will continue to be prioritized.
The legislature recognizes that public health and health care staff have been overwhelmed, overworked, and their mental and physical health are at risk due to the pandemic. The legislature is thankful for the countless contributions that public health and health care staff have made to combat this deadly public health crisis and pandemic. These contributions and efforts have increased public awareness about the importance of strong infrastructure for our public health system. Therefore, the legislature finds that meaningful discourse about the current public health system is necessary to ensure public trust.
The legislature expects emergencies that threaten the health and well-being of all Washingtonians, emergent and routine, to increase. Restructuring state funding of foundational public health services is not enough to face these threats. The legislature intends for Washington to have a public health system that can respond to 21st century public health emergencies and public health issues, have the capacity to improve health outcomes of BIPOC communities, persons with disabilities, LGBTQ+, rural communities, limited English-speaking persons, and address health equity across the life span.
This section adds a new section to an existing chapter 43.20. Here is the modified chapter for context.
A work group is created to develop and recommend to the state board a public health system to provide foundational public health services to all people in Washington through local health jurisdictions, comprehensive health services districts, and the department.
Members of the work group must include:
Two representatives from the senate;
Two representatives from the house of representatives;
Three representatives of local public health;
Two representatives of state public health;
Three representatives of counties;
Two representatives of cities;
One tribal representative;
One representative with expertise in government finance;
One state association representative from the foundational public health services steering committee;
One public health representative from the foundational public health services steering committee;
One tribal public health representative from the foundational public health services steering committee; and
One technical work group member from the foundational public health services steering committee.
The governor shall appoint the members of the work group and ensure that members represent diverse geographic locations in both rural and urban communities.
The work group shall develop a transparent process, including opportunities for public comment.
By July 1, 2022, the work group must recommend to the state board the system for counties to form comprehensive health services districts as provided in section 6 of this act.
By January 1, 2023, the work group must recommend performance measures and a measure set to the state board to track the efficiency and effectiveness of local health jurisdictions, comprehensive health services districts, and the department.
By July 1, 2023, the work group must submit recommendations to the legislature on adequate funding of local health jurisdictions and comprehensive health services districts, including the following:
Reasonable per capita estimates to deliver foundational public health services;
How new sources of revenue should be allocated; and
Adequate allocation levels to sustain the state public health system.
This section expires December 31, 2024.
This section adds a new section to an existing chapter 43.20. Here is the modified chapter for context.
The state board must adopt rules to provide foundational public health services to all people in Washington through local health jurisdictions, comprehensive health services districts, and the department. These rules must include:
A system and process for counties to create comprehensive health services districts as required by section 6 of this act;
Standard statewide performance measures and proposed benchmarks to track efficiency and effectiveness of local health jurisdictions, comprehensive health services districts, and the department. The performance measures must include dimensions of:
Improving morbidity and mortality of marginalized communities;
Improving health equity for all people;
Data modernization and interoperability across the state public health system;
Community engagement; and
Emergency preparedness and response;
A measure set that:
Is of manageable size;
Is based on readily available data;
Gives preference to nationally reported measures; and
Focuses on the overall performance of the system, including outcomes and total costs;
A process for the department to certify comprehensive health services districts;
A process to evaluate local health jurisdictions, comprehensive health services districts, and department performance of the measure set developed under (c) of this subsection; and
A process for information and data elements to be reported by comprehensive health services districts to the department.
By November 1, 2024, the state board shall submit a report to the appropriate committees of the legislature on local health jurisdictions and comprehensive health services districts performance based on the performance measures established under subsection (1)(b) of this section.
This section modifies existing section 43.70.515. Here is the modified chapter for context.
With any state funding of foundational public health services, the state expects that measurable benefits will be realized to the health of communities in Washington as a result of the improved capacity of the governmental public health system. Close coordination and sharing of services are integral to increasing system capacity.
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Funding for foundational public health services shall be appropriated to the office of financial management. The office of financial management may only allocate funding to the department if the department, after consultation with federally recognized Indian tribes pursuant to chapter 43.376 RCW, jointly certifies with a state association representing local health jurisdictions**, comprehensive health services districts,** and the state board of health, to the office of financial management that they are in agreement on the distribution and uses of state foundational public health services funding across the public health system. The department must evaluate comprehensive health services districts' performances to satisfy the measure set identified in section 3 of this act before allocation on January 1, 2027, and biennially thereafter.
If joint certification is provided, the department shall distribute foundational public health services funding according to the agreed-upon distribution and uses. If joint certification is not provided, appropriations for this purpose shall lapse.
By October 1, 2020, the department, in partnership with sovereign tribal nations, local health jurisdictions, and the state board of health, shall report on:
Service delivery models, and a plan for further implementation of successful models;
Changes in capacity of the governmental public health system; and
Progress made to improve health outcomes.
For purposes of this section and sections 2 and 3 of this act:
"Comprehensive health services districts" means the districts established under section 6 of this act to provide coordination and shared services to local health jurisdictions.
"Foundational public health services" means a limited statewide set of defined public health services within the following areas:
Control of communicable diseases and other notifiable conditions;
Chronic disease and injury prevention;
Environmental public health;
Maternal, child, and family health;
Access to and linkage with medical, oral, and behavioral health services;
Vital records; and
Cross-cutting capabilities, including:
(A) Assessing the health of populations;
(B) Public health emergency planning;
(C) Communications;
(D) Policy development and support;
(E) Community partnership development; and
(F) Business competencies.
c. "Governmental public health system" means the state department of health, state board of health, local health jurisdictions**, comprehensive health services districts**, sovereign tribal nations, and Indian health programs located within Washington.
d. "Indian health programs" means tribally operated health programs, urban Indian health programs, tribal epidemiology centers, the American Indian health commission for Washington state, and the Northwest Portland area Indian health board.
e. "Local health jurisdictions" means a public health agency organized under chapter 70.05, 70.08, or 70.46 RCW.
f. "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.
This section adds a new section to an existing chapter 70.05. Here is the modified chapter for context.
Members of the comprehensive health services district board of health include:
The following city and county elected officials:
Each county in the district must have one elected official who serves on a local board of health chosen by that local board of health; and
One elected official from a city in the district that is selected by a statewide association representing cities;
The regional health officer assigned for the district by the department;
A tribal representative from within the district selected by the Indian health board and appointed by the governor;
At least one representative from the following categories to be appointed by the governor:
(A) Medical ethicists;
(B) Epidemiologists;
(C) Experienced in environmental public health, such as a registered sanitarian;
(D) Community health workers;
(E) Holders of master's degrees or higher in public health or the equivalent;
(F) Employees of a hospital located in the county;
(G) Physicians or osteopathic physicians;
(H) Advanced registered nurse practitioners;
(I) Physician assistants or osteopathic physician assistants;
(J) Registered nurses;
(K) Dentists;
(L) Naturopaths; or
(M) Pharmacists;
ii. Consumers of public health. This category consists of county residents who have self-identified as having faced significant health inequities or as having lived experiences with public health-related programs such as: The special supplemental nutrition program for women, infants, and children; the supplemental nutrition program; home visiting; or treatment services. It is strongly encouraged that individuals from historically marginalized and underrepresented communities are given preference. These individuals may not be elected officials and may not have any fiduciary obligation to a health facility or other health agency and may not have a material financial interest in the rendering of health services; and
iii. Other community stakeholders. This category consists of persons representing the following types of organizations located in the county:
(A) Community-based organizations or nonprofits that work with populations experiencing health inequities in the county;
(B) The business community; or
(C) The environmental public health regulated community.
In the event of a vacancy of a comprehensive health services district board position that was occupied by a member who was selected under subsection (1)(d) of this section, the board must promptly notify:
Statewide organizations representing physicians, nurses, public health officials, counties, and cities;
Accountable communities of health; and
Any other organizations deemed appropriate by the board.
City and county elected officials who are members of the comprehensive health services district board may not constitute a majority of the board.
Governor appointed members may serve three-year terms and may serve two terms.
The comprehensive health services district board may establish bylaws to govern the board.
This section adds a new section to an existing chapter 70.05. Here is the modified chapter for context.
By January 1, 2024, counties must form comprehensive health services districts as established by this section. The department must certify each comprehensive health services district.
The following nine comprehensive health services districts are established and consist of the following counties:
Skamania, Clark, Cowlitz, and Wahkiakum;
Lewis, Thurston, Mason, Pacific, and Grays Harbor;
Jefferson, Clallam, and Kitsap;
Pierce and King;
Island, Snohomish, Skagit, Whatcom, and San Juan;
Chelan, Okanogan, Douglas, and Grant;
Ferry, Stevens, Pend Oreille, Spokane, Lincoln, Adams, and Whitman;
Benton, Franklin, Walla Walla, Columbia, Garfield, and Asotin; and
Kittitas, Yakima, and Klickitat.
Counties with a population over 800,000 may be considered a comprehensive health services district without joining with other counties when the county legislative authority of the county passes a resolution or ordinance to organize a comprehensive health services district under this section.
This section adds a new section to an existing chapter 70.05. Here is the modified chapter for context.
Comprehensive health services districts are established to help diversify and stabilize funding services for public health and to encourage the systemic sharing of resources and functions among state and local governmental public health entities, sovereign tribal nations, and Indian health programs to increase capacity and improve efficiency and effectiveness.
Comprehensive health services districts shall:
Provide a mechanism for local health jurisdictions in each comprehensive health services district to convene, collaborate, plan, and work together with the goal of delivering foundational public health services equitably across the region;
Develop a district plan for identification and implementation of shared service delivery options, models, and strategies;
Coordinate with other comprehensive health services districts, to identify strategies to coordinate public health services and programs within the region;
Identify what programs and services can be delivered through a shared or regional system within the district such as data collection, regional assessment-focused epidemiologists, regional health assessments, foodborne illness, health care associated infection programs, vaccine preventable disease investigation, emergency strike teams, and toxicology;
Administer and allocate foundational public health services funding to each local health jurisdiction comprising the district;
Provide funding to local health jurisdictions to deliver or purchase shared services from other local health jurisdictions, districts, counties, nonprofits, or other jurisdictions, businesses, or entities;
Undertake accountability measures for implementation of foundational public health services within the district;
Report the adequacy of foundational public health services resources for the district to the department; and
As authorized by the district board of health, provide direct or shared services to local health jurisdictions within the district or to other districts through contracts or other agreements including, but not limited to:
Public health services;
Business, fiscal, and administrative services;
Acquisition of capital and equipment;
Communications; and
Data collection.
This section adds a new section to an existing chapter 70.05. Here is the modified chapter for context.
Each comprehensive health services district shall establish a district health fund in the custody of the county treasurer of the county in which the headquarters office of the comprehensive health services district is located. All receipts received by the district must be deposited into the fund. Expenditures by the district must be authorized by the district board of health and must be disbursed through the fund. The county auditor of the county shall keep the record of the receipts and disbursements.
The treasurer shall keep all funds and moneys of the district separate and apart from all other funds and moneys in the treasurer's custody.
This section adds a new section to an existing chapter 70.05. Here is the modified chapter for context.
A comprehensive health services district may own, construct, purchase, lease, add to, and maintain any real and personal property or property rights necessary to conduct the affairs of the district. A comprehensive health services district may sell, lease, convey, or otherwise dispose of any district real or personal property no longer necessary to conduct district affairs. A comprehensive health services district may enter into contracts to carry out this section.
This section adds a new section to an existing chapter 70.05. Here is the modified chapter for context.
Notwithstanding any provisions to the contrary contained in any city or county charter, and to the extent provided by the city and the county under appropriate legislative enactment, employees of the comprehensive health services district may be included in the personnel system or civil service and retirement plans of the city or the county or a personnel system for the comprehensive health services district that is separate from the personnel system or civil service of either county or city if residential requirements for these positions are coextensive with the county boundaries. The city or county may pay parts of the expense of operating and maintaining the personnel system or civil service and retirement system and contribute to the retirement fund on behalf of employees sums as may be agreed upon between the legislative authorities of the city and county.
This section adds a new section to an existing chapter 70.05. Here is the modified chapter for context.
The administrative officer, an employee of the comprehensive health services district, shall act as executive secretary and administrative officer for the comprehensive health services district and shall be responsible for administering the operations of the district. The administrative officer's salary must be paid by the department.
This section adds a new section to an existing chapter 43.70. Here is the modified chapter for context.
The position of regional health officer is created within the department. The secretary shall appoint six regional health officers, who are each assigned to a comprehensive health services district.
This section modifies existing section 70.05.030. Here is the modified chapter for context.
In counties without a home rule charter, the board of county commissioners**, a tribal appointee selected by the Indian health board, and members selected under subsection (2) of this section,** 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.
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The remaining board members must be persons who are not elected officials and must be selected from the following categories:
(A) Medical ethicists;
(B) Epidemiologists;
(C) Experienced in environmental public health, such as a registered sanitarian;
(D) Community health workers;
(E) Holders of master's degrees or higher in public health or the equivalent;
(F) Employees of a hospital located in the county;
(G) Physicians or osteopathic physicians;
(H) Advanced registered nurse practitioners;
(I) Physician assistants or osteopathic physician assistants;
(J) Registered nurses;
(K) Dentists;
(L) Naturopaths; or
(M) Pharmacists;
ii. **Consumers of public health. This category consists of county residents who have self-identified as having faced significant health inequities or as having lived experiences with public health-related programs such as: The special supplemental nutrition program for women, infants, and children; the supplemental nutrition program; home visiting; or treatment services. It is strongly encouraged that individuals from historically marginalized and underrepresented communities are given preference. These individuals may not be elected officials and may not have any fiduciary obligation to a health facility or other health agency, and may not have a material financial interest in the rendering of health services; and**
iii. **Other community stakeholders. This category consists of persons representing the following types of organizations located in the county:**
(A) Community-based organizations or nonprofits that work with populations experiencing health inequities in the county;
(B) The business community; or
(C) The environmental public health regulated community.
b. **The board members selected under this subsection must be approved by a majority vote of the board of county commissioners.**
c. **In the event of a vacancy of a board position that was occupied by a member who was selected under this subsection, the board must promptly notify:**
i. **Statewide organizations representing physicians, nurses, public health officials, counties, and cities;**
ii. **Accountable communities of health; and**
iii. **Any other organizations deemed appropriate by the board.**
d. **If the number of board members selected under this subsection is evenly divisible by three, there must be an equal number of members selected from each of the three categories.**
e. **If the number of board members selected under this subsection is not evenly divisible by three, there must be an equal number of members selected from each of the three categories up to the nearest multiple of three. If there is one member over the nearest multiple of three, that member may be selected from any of the three categories. If there are two members over the nearest multiple of three, each member over the nearest multiple of three must be selected from a different category.**
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 the city and county elected officials do not constitute a majority of the total membership of the board.
Except as provided in subsection (2) of this section, an ordinance adopted under this section shall include provisions for the appointment, term, and compensation, or reimbursement of expenses.
The number of city and county elected officials on the board of health may not constitute a majority of the board.
Any decision by the board of health related to the setting or modification of permit, licensing, and application fees may only be determined by the city and county elected officials on the board.
This section modifies existing section 70.05.035. Here is the modified chapter for context.
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**, a tribal appointee selected by the Indian health board, and members selected under subsection (2) of this section.**
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The remaining board members must be persons who are not elected officials and must be selected from the following categories:
(A) Medical ethicists;
(B) Epidemiologists;
(C) Experienced in environmental public health, such as a registered sanitarian;
(D) Community health workers;
(E) Holders of master's degrees or higher in public health or the equivalent;
(F) Employees of a hospital located in the county;
(G) Physicians or osteopathic physicians;
(H) Advanced registered nurse practitioners;
(I) Physician assistants or osteopathic physician assistants;
(J) Registered nurses;
(K) Dentists;
(L) Naturopaths; or
(M) Pharmacists;
ii. **Consumers of public health. This category consists of county residents who have self-identified as having faced significant health inequities or as having lived experiences with public health-related programs such as: The special supplemental nutrition program for women, infants, and children; the supplemental nutrition program; home visiting; or treatment services. It is strongly encouraged that individuals from historically marginalized and underrepresented communities are given preference. These individuals may not be elected officials and may not have any fiduciary obligation to a health facility or other health agency, and may not have a material financial interest in the rendering of health services; and**
iii. **Other community stakeholders. This category consists of persons representing the following types of organizations located in the county:**
(A) Community-based organizations or nonprofits that work with populations experiencing health inequities in the county;
(B) The business community; or
(C) The environmental public health regulated community.
b. **The board members selected under this subsection must be approved by a majority vote of the board of county commissioners.**
c. **In the event of a vacancy of a board position that was occupied by a member who was selected under this subsection, the board must promptly notify:**
i. **Statewide organizations representing physicians, nurses, public health officials, counties, and cities;**
ii. **Accountable communities of health; and**
iii. **Any other organizations deemed appropriate by the board.**
d. **If the number of board members selected under this subsection is evenly divisible by three, there must be an equal number of members selected from each of the three categories.**
e. **If the number of board members selected under this subsection is not evenly divisible by three, there must be an equal number of members selected from each of the three categories up to the nearest multiple of three. If there is one member over the nearest multiple of three, that member may be selected from any of the three categories. If there are two members over the nearest multiple of three, each member over the nearest multiple of three must be selected from a different category**.
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 the city and county elected officials do not constitute a majority of the total membership of the board.
Except as provided in subsection (2) of this section, 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.
The number of city and county elected officials on the board of health may not constitute a majority of the board.
Any decision by the board of health related to the setting or modification of permit, licensing, and application fees may only be determined by the city and county elected officials on the board.
This section modifies existing section 70.46.020. Here is the modified chapter for context.
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, a tribal appointee selected by the Indian health board, and members selected under subsection (3) of this section, and shall have a jurisdiction coextensive with the combined boundaries.
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The remaining board members must be persons who are not elected officials and must be selected from the following categories:
(A) Medical ethicists;
(B) Epidemiologists;
(C) Experienced in environmental public health, such as a registered sanitarian;
(D) Community health workers;
(E) Holders of master's degrees or higher in public health or the equivalent;
(F) Employees of a hospital located in the county;
(G) Physicians or osteopathic physicians;
(H) Advanced registered nurse practitioners;
(I) Physician assistants or osteopathic physician assistants;
(J) Registered nurses;
(K) Dentists;
(L) Naturopaths; or
(M) Pharmacists;
ii. **Consumers of public health. This category consists of county residents who have self-identified as having faced significant health inequities or as having lived experiences with public health-related programs such as: The special supplemental nutrition program for women, infants, and children; the supplemental nutrition program; home visiting; or treatment services. It is strongly encouraged that individuals from historically marginalized and underrepresented communities are given preference. These individuals may not be elected officials, and may not have any fiduciary obligation to a health facility or other health agency, and may not have a material financial interest in the rendering of health services; and**
iii. **Other community stakeholders. This category consists of persons representing the following types of organizations located in the county:**
(A) Community-based organizations or nonprofits that work with populations experiencing health inequities in the county;
(B) The business community; or
(C) The environmental public health regulated community.
b. **The board members selected under this subsection must be approved by a majority vote of the board of county commissioners.**
c. **In the event of a vacancy of a board position that was occupied by a member who was selected under this subsection, the board must promptly notify:**
i. **Statewide organizations representing physicians, nurses, public health officials, counties, and cities;**
ii. **Accountable communities of health; and**
iii. **Any other organizations deemed appropriate by the board.**
d. **If the number of board members selected under this subsection is evenly divisible by three, there must be an equal number of members selected from each of the three categories.**
e. **If the number of board members selected under this subsection is not evenly divisible by three, there must be an equal number of members selected from each of the three categories up to the nearest multiple of three. If there is one member over the nearest multiple of three, that member may be selected from any of the three categories. If there are two members over the nearest multiple of three, each member over the nearest multiple of three must be selected from a different category.**
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 the city and county elected officials do not constitute a majority of the total membership of the board.
Except as provided in subsection (3) of this section, a resolution or ordinance adopted under this section must specify the provisions for the appointment, term, and compensation, or reimbursement of expenses.
At the first meeting of a district board of health the members shall elect a chair to serve for a period of one year.
The number of city and county elected officials on the board of health may not constitute a majority of the board.
Any decision by the board of health related to the setting or modification of permit, licensing, and application fees may only be determined by the city and county elected officials on the board.
This section modifies existing section 70.46.031. Here is the modified chapter for context.
Except as provided in subsection (3) of this section, 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.
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In addition to the membership of the district health board determined through resolution or ordinance under subsection (1) of this section, the board must also include a tribal appointee selected by the Indian health board, and members selected under (b) of this subsection.
The remaining board members must be persons who are not elected officials and must be selected from the following categories:
(A) Medical ethicists;
(B) Epidemiologists;
(C) Experienced in environmental public health, such as a registered sanitarian;
(D) Community health workers;
(E) Holders of master's degrees or higher in public health or the equivalent;
(F) Employees of a hospital located in the county;
(G) Physicians or osteopathic physicians;
(H) Advanced registered nurse practitioners;
(I) Physician assistants or osteopathic physician assistants;
(J) Registered nurses;
(K) Dentists;
(L) Naturopaths; or
(M) Pharmacists;
ii. **Consumers of public health. This category consists of county residents who have self-identified as having faced significant health inequities or as having lived experiences with public health-related programs such as: The special supplemental nutrition program for women, infants, and children; the supplemental nutrition program; home visiting; or treatment services. It is strongly encouraged that individuals from historically marginalized and underrepresented communities are given preference. These individuals may not be elected officials and may not have any fiduciary obligation to a health facility or other health agency, and may not have a material financial interest in the rendering of health services; and**
iii. **Other community stakeholders. This category consists of persons representing the following types of organizations located in the county:**
(A) Community-based organizations or nonprofits that work with populations experiencing health inequities in the county;
(B) The business community; or
(C) The environmental public health regulated community.
c. **The board members selected under this subsection must be approved by a majority vote of the board of county commissioners.**
d. **In the event of a vacancy of a board position that was occupied by a member who was selected under this subsection, the board must promptly notify:**
i. **Statewide organizations representing physicians, nurses, public health officials, counties, and cities;**
ii. **Accountable communities of health; and**
iii. **Any other organizations deemed appropriate by the board.**
e. **If the number of board members selected under this subsection is evenly divisible by three, there must be an equal number of members selected from each of the three categories.**
f. **If the number of board members selected under this subsection is not evenly divisible by three, there must be an equal number of members selected from each of the three categories up to the nearest multiple of three. If there is one member over the nearest multiple of three, that member may be selected from any of the three categories. If there are two members over the nearest multiple of three, each member over the nearest multiple of three must be selected from a different category.**
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 the city and county elected officials do not constitute a majority of the total membership of the board.
The number of city and county elected officials on the board of health may not constitute a majority of the board.
Any decision by the board of health related to the setting or modification of permit, licensing, and application fees may only be determined by the city and county elected officials on the board.
This section modifies existing section 70.05.130. Here is the modified chapter for context.
All expenses incurred by the state, health district, or county in carrying out the provisions of this chapter and chapter 70.46 RCW or any other public health law, the rules of the department of health enacted under such laws, or enforcing proclamations of the governor during a public health emergency, shall be paid by the comprehensive health services district the county is located in and such expenses shall constitute a claim against the general fund as provided in this section.
This section adds a new section to an existing chapter 43.20. Here is the modified chapter for context.
A county may not make a material change to its public health governance structure unless:
The county notifies the state board of its intention to make the material change. The notification must, at a minimum, include:
A description of the current governance structure, including the relationships between its component parts;
Whether the current governance structure is meeting the county's governance, legal requirements, and objectives;
The county's rationale for the planned material change, including:
(A) Opportunities for new collaborations or funding; and
(B) Effects on health and equity;
iv. The impact the planned material change will have on current public health programs, staffing, or funding; and
v. The populations most likely to be affected by the planned material change, including:
(A) How the change would change staffing and capacity;
(B) How the change in staffing capacity will affect services to the community; and
(C) The communities that will be most directly affected;
b. The state board has found that the planned material change would not have an adverse effect on health disparities, social determinants of health, or the provision of public health services in the county. For a combined city-county health department established under chapter 70.08 RCW, the state board has also found that the planned material change would not have an adverse effect on health disparities, social determinants of health, or the provision of public health services in the partner city; and
c. Based on the findings in (b) of this subsection, the state board has approved the material change.
Prior to making a material change to a county's public health governance structure, the county legislative authority shall:
Provide notice and a meaningful opportunity for the public to comment on the material change including, but not limited to, at least two public meetings held at different locations within the county. For a combined city-county health department established under chapter 70.08 RCW, the county and city must jointly conduct a third public meeting within the boundaries of the partner city;
Participate in good faith in a mediation process with any affected county, city, or town that objects to the material change. The mediator must be appointed by the state board and be paid for by the county seeking the material change; and
Approve the material change by a majority vote of the county legislative authority taken in an open public meeting. Upon approval of the material change under subsection (1)(c) of this section, the county legislative authority shall immediately transmit notice of the approval to the state board.
The material change may not go into effect less than 12 months after the vote of the county legislative authority under subsection (1) of this section. The county may not reduce the amount of funding it appropriates for public health purposes for at least 36 months after the vote of the county legislative authority under subsection (1) of this section.
For purposes of this section, a material change to a county's public health governance structure includes, but is not limited to:
Joining or withdrawing from a local health district under chapter 70.46 RCW;
Entering or terminating an agreement for a combined city-county health department under chapter 70.08 RCW; or
Amending the county charter or enacting an ordinance altering the composition of the local board of health.
This section expires January 1, 2024.
This section adds a new section to an existing chapter 43.20. Here is the modified chapter for context.
The state board shall monitor the implementation of any material change to a county's public health governance structure to ensure the county's compliance with section 18 of this act.
If the state board determines that the county has not complied with section 18 of this act, it shall issue a preliminary notice of violation to the county.
Upon receipt of a preliminary notice of violation, the county must immediately cease all activities related to the material change and cure the violation within 30 calendar days.
If the county fails to cure the violation within 30 calendar days, the state board shall issue a final notice of violation to the county and send a copy of the final notice to the state treasurer.
This section expires January 1, 2024.
This section modifies existing section 70.08.100. Here is the modified chapter for context.
Agreement to operate a combined city and county health department made under this chapter may after two years from the date of such agreement, be terminated by either party at the end of any calendar year upon notice in writing given at least 12 months prior thereto. The termination of such agreement shall not relieve either party of any obligations to which it has been previously committed. Termination of the agreement is subject to the requirements of section 18 of this act.
This section modifies existing section 70.46.090. Here is the modified chapter for context.
Any county may withdraw from membership in said health district any time after it has been within the district for a period of two years, but no withdrawal shall be effective except at the end of the calendar year in which the county gives at least 12 months' notice of its intention to withdraw at the end of the calendar year. No withdrawal shall entitle any member to a refund of any moneys paid to the district nor relieve it of any obligations to pay to the district all sums for which it obligated itself due and owing by it to the district for the year at the end of which the withdrawal is to be effective. Any county which withdraws from membership in said health district shall immediately establish a health department or provide health services which shall meet the standards for health services promulgated by the state board of health. No local health department may be deemed to provide adequate public health services unless there is at least one full time professionally trained and qualified physician as set forth in RCW 70.05.050. Withdrawal from a health district is subject to the requirements of section 18 of this act.
This section modifies existing section 82.08.170. Here is the modified chapter for context.
Except as provided in subsections (4) through (6) of this section, during the months of January, April, July, and October of each year, the state treasurer must make the transfers required under subsections (2) and (3) of this section from the liquor excise tax fund and then the apportionment and distribution of all remaining moneys in the liquor excise tax fund to the counties, cities, and towns in the following proportions: (a) 20 percent of the moneys in the liquor excise tax fund must be divided among and distributed to the counties of the state in accordance with the provisions of RCW 66.08.200; and (b) 80 percent of the moneys in the liquor excise tax fund must be divided among and distributed to the cities and towns of the state in accordance with the provisions of RCW 66.08.210.
Each fiscal quarter and prior to making the 20 percent distribution to counties under subsection (1)(a) of this section, the treasurer shall transfer to the liquor revolving fund created in RCW 66.08.170 sufficient moneys to fund the allotments from any legislative appropriations for county research and services as provided under chapter 43.110 RCW.
During the months of January, April, July, and October of each year, the state treasurer must transfer $2,500,000 from the liquor excise tax fund to the state general fund.
During calendar year 2012, the October distribution under subsection (1) of this section and the July and October transfers under subsections (2) and (3) of this section must not be made. During calendar year 2013, the January, April, and July distributions under subsection (1) of this section and transfers under subsections (2) and (3) of this section must not be made.
During the 2015-2017 and 2019-2021 fiscal biennia, the liquor excise tax fund may be appropriated for the local government fiscal note program in the department of commerce. It is the intent of the legislature to continue this policy in the subsequent fiscal biennium.
Upon receipt of a final notice from the state board of health under section 19(4) of this act that a county has failed to comply with section 18 of this act, the treasurer shall cease all future distributions to the county under this section.
If sufficient funding for the purposes of sections 1, 3 through 12, and 17 of this act, referencing this act by bill or chapter number, and sections 1, 3 through 12, and 17 of this act by section number, is not provided by June 30, 2022, in either the 2021-2023 omnibus appropriations act or the 2022 supplemental appropriations act, sections 1, 3 through 12, and 17 of this act are null and void. The requirement of sufficient funding is satisfied if, by June 30, 2022, the department of health, after consultation with the state board of health, local health jurisdictions, and tribes, provides written notice of the sufficiency of funding to the office of financial management, which must provide notice of satisfaction of this contingency to affected parties, the chief clerk of the house of representatives, the secretary of the senate, the office of the code reviser, and others as deemed appropriate by the office of financial management.