S.F. 2266 Section 1. NEW SECTION . 137.100 Title and purpose. 1 This chapter shall be known and may be cited as the “Local 2 Public Health Governance Act” . The purpose of this chapter is 3 to define the structure, powers, and duties of local boards 4 of health. This chapter also provides an optional process 5 for counties to merge to form a district board of health in 6 order to increase efficiencies and enhance the delivery and 7 availability of public health services. 8 Sec. 2. NEW SECTION . 137.101 Definitions. 9 As used in this chapter unless the context otherwise 10 requires: 11 1. “City board” means a city board of health in existence 12 prior to July 1, 2010. 13 2. “City health department” refers to the personnel and 14 property under the jurisdiction of a city board in existence 15 prior to July 1, 2010. 16 3. “Council” means a city council. 17 4. “County board” means a county board of health. 18 5. “County health department” refers to the personnel and 19 property under the jurisdiction of a county board. 20 6. “Director” means the director of public health. 21 7. “District” means any two or more geographically 22 contiguous counties. 23 8. “District board” means a board of health representing 24 at least two geographically contiguous counties formed with 25 approval of the state department in accordance with this 26 chapter, or any district board of health in existence prior to 27 July 1, 2010. 28 9. “District health department” refers to the personnel and 29 property under the jurisdiction of a district board. 30 10. “Iowa public health standards” means Iowa public health 31 standards as defined in section 135A.2. 32 11. “Local board of health” means a city, county, or 33 district board of health. 34 12. “Officers” means a local board of health chairperson, 35 -1- LSB 5268SV (3) 83 pf/nh 1/ 11

S.F. 2266 vice chairperson, and secretary, and other officers which may 1 be named at the discretion of the local board of health. 2 13. “State board” means the state board of health. 3 14. “State department” means the Iowa department of public 4 health. 5 Sec. 3. NEW SECTION . 137.102 Local boards of health —— 6 jurisdiction. 7 1. A city board shall have jurisdiction over public health 8 matters within the city. 9 2. A county board shall have jurisdiction over public health 10 matters within the county. 11 3. A district board shall have jurisdiction over public 12 health matters within the district. 13 Sec. 4. NEW SECTION . 137.103 Local boards of health —— 14 powers and duties. 15 Local boards of health shall have the following powers and 16 duties: 17 1. A local board of health shall: 18 a. Enforce state health laws and the rules and lawful orders 19 of the state department. 20 b. Make and enforce such reasonable rules and regulations 21 not inconsistent with law, the rules of the state board, or 22 the Iowa public health standards as may be necessary for the 23 protection and improvement of the public health. 24 (1) Rules of a city board shall become effective upon 25 approval by the council and publication in a newspaper having 26 general circulation in the city. 27 (2) Rules of a county board shall become effective upon 28 approval by the county board of supervisors by a motion or 29 resolution as defined in section 331.101, subsection 13, and 30 publication in a newspaper having general circulation in the 31 county. 32 (3) Rules of a district board shall become effective upon 33 approval by the district board and publication in a newspaper 34 having general circulation in the district. 35 -2- LSB 5268SV (3) 83 pf/nh 2/ 11

S.F. 2266 (4) Before approving any rule or regulation the local board 1 of health shall hold a public hearing on the proposed rule. 2 Any citizen may appear and be heard at the public hearing. A 3 notice of the public hearing, stating the time and place and 4 the general nature of the proposed rule or regulation shall be 5 published in a newspaper having general circulation as provided 6 in section 331.305 in the area served by the local board of 7 health. 8 c. Employ persons as necessary for the efficient 9 discharge of its duties. Employment practices shall meet the 10 requirements of chapter 8A, subchapter IV, or any civil service 11 provision adopted under chapter 400. 12 d. Provide the names of all local board of health members 13 and officers to the state department. 14 e. Provide minutes of local board of health meetings 15 and reports of the local board of health’s operations and 16 activities to the state department as may be required by the 17 director, by rule, or by contract. 18 2. A local board of health may: 19 a. Provide such population-based and personal health 20 services as may be deemed necessary for the promotion and 21 protection of the health of the public and charge reasonable 22 fees for personal health services. A person shall not be 23 denied necessary services within the limits of available 24 resources because of inability to pay the cost of such 25 services. 26 b. Provide such environmental health services as may 27 be deemed necessary for the protection and improvement of 28 the public health and issue licenses and permits and charge 29 reasonable fees in relation to the construction or operation of 30 nonpublic water supplies or private sewage disposal systems. 31 c. Engage in joint operations and contract with colleges and 32 universities, the state department, other public, private, and 33 nonprofit agencies, and individuals or form a district health 34 department to provide personal and population-based public 35 -3- LSB 5268SV (3) 83 pf/nh 3/ 11

S.F. 2266 health services. 1 d. By written agreement, with the council of any city within 2 its jurisdiction, enforce appropriate ordinances of the city 3 relating to public health. 4 Sec. 5. NEW SECTION . 137.104 Local boards of health —— 5 membership and meetings. 6 1. Membership, terms, compensation, and vacancies. 7 a. All members of a city board shall be appointed by the 8 council. 9 b. All members of a county board shall be appointed by the 10 county board of supervisors. 11 c. All members of a district board shall be appointed by 12 the county board of supervisors from each county represented by 13 the district. Each county board of supervisors shall appoint 14 at least one but no more than three members to the district 15 board, and each county board of supervisors shall appoint the 16 same number of members to the district board. There shall 17 be no more than one board of supervisors member from any 18 participating county on the district board. 19 d. Local boards of health shall consist of at least five 20 members. At least one member shall be licensed as a physician 21 under chapter 148. 22 e. A local board of health member shall serve for a term of 23 three years. A member is eligible for reappointment. 24 f. A local board of health member shall serve without 25 compensation, but may be reimbursed for necessary expenses in 26 accordance with rules established by the state board or the 27 applicable jurisdiction. 28 g. A local board of health member vacancy due to death, 29 resignation, or other cause shall be filled as soon as possible 30 after the vacancy exists for the unexpired term of the original 31 appointment. 32 2. Meetings. A majority of the members of a local board 33 of health shall be considered a quorum and an affirmative 34 vote of the majority of the members present is necessary for 35 -4- LSB 5268SV (3) 83 pf/nh 4/ 11

S.F. 2266 action taken by a local board of health. The majority shall 1 not include any member who has a conflict of interest and a 2 statement by the member that a conflict of interest exists 3 shall be conclusive for this purpose. 4 Sec. 6. NEW SECTION . 137.105 District boards of health —— 5 request to form. 6 The county boards of any two or more geographically 7 contiguous counties may at any time submit a request to form a 8 district board to the state department. The formation request 9 shall be in writing, shall be executed by the county boards of 10 supervisors and the county boards of health for each county 11 comprising the proposed district board, and shall include but 12 not be limited to the following required elements: 13 1. A written narrative that explains how the formation of 14 a district board will increase organizational capacity and 15 capability to provide population-based and personal public 16 health services compared with operating as individual county 17 boards. 18 2. The composition of the district board, including the 19 number of members each county shall appoint pursuant to section 20 137.104 and the total number of members on the district board. 21 3. Proof of approval by all county boards of supervisors 22 and county boards of health involved in the request to form a 23 district board and of the elements included in the formation 24 plan. 25 4. The service delivery plan. 26 5. The budget and fiscal plan for the proposed district 27 board. The budget plan shall include an estimate of proposed 28 expenditures and revenues and an allocation of the revenue 29 responsibilities of each of the counties participating in the 30 proposed district board. 31 6. A table of organization. 32 7. A personnel system description, including identification 33 of the district treasurer and district auditor and a section 34 which addresses the employment issues contained in section 35 -5- LSB 5268SV (3) 83 pf/nh 5/ 11

S.F. 2266 137.109. 1 8. The location of the district board offices and workforce 2 throughout the jurisdiction. 3 9. An inventory of the property and equipment in the 4 custody of each county board and a description as to whether 5 such property and equipment shall remain in the custody of the 6 county or shall be transferred to the district board to become 7 property of the district board. 8 10. A timeline for the adoption of district board rules and 9 regulations. 10 11. Other criteria as established by rule of the state 11 department. 12 Sec. 7. NEW SECTION . 137.106 Request reviewed by state 13 department. 14 The state department shall review requests submitted 15 pursuant to section 137.105. The state department, upon 16 finding that all required elements are present, shall present 17 findings to the state board. The state board may approve the 18 formation of a district board and if the formation is approved, 19 shall notify the county boards from whom the request was 20 received. 21 Sec. 8. NEW SECTION . 137.107 Initial appointment of 22 district board of health. 23 Upon receipt of notice of approval as a district board, 24 district board members shall be appointed as specified in 25 section 137.104. 26 Sec. 9. NEW SECTION . 137.108 Organizational structure of 27 district board. 28 A district board is a governing body for purposes of chapter 29 670 and a district health department is a municipality for 30 purposes of chapter 670. All meetings of a district board 31 shall comply with the requirements of chapter 21 and all 32 records of a district board and a district health department 33 shall be maintained in accordance with chapter 22. 34 Sec. 10. NEW SECTION . 137.109 District personnel. 35 -6- LSB 5268SV (3) 83 pf/nh 6/ 11

S.F. 2266 1. A district board may employ persons as necessary for 1 the efficient discharge of its duties. A district board shall 2 have all the duties and powers in employing such persons as 3 a county board of supervisors is granted pursuant to section 4 331.324, with the exception of the authority to provide for 5 support of the civil service commission for deputy sheriffs 6 as specified in section 331.324, subsection 1, paragraph “k” . 7 A district board may employ persons who were employed at the 8 time of the formation of the district board by the counties 9 represented by the district board, or may employ persons who 10 were not employed by such counties. The county boards involved 11 shall specify in the request submitted pursuant to section 12 137.105 whether the individual counties or the district board 13 will be responsible for payment of unemployment compensation 14 for any county employees employed by the county board at the 15 time of formation of the district board but not employed by the 16 district board following formation. 17 2. If the district board employs persons who were employed 18 by the counties represented by the district board at the time 19 of formation of the district board, the district board shall 20 recognize the term of service of the former county employees 21 for purposes of all employee benefits offered by the district 22 board to such employees and such employees shall not forfeit 23 accrued vacation, accrued sick leave, or longevity by becoming 24 district board employees. 25 3. Persons who were covered by county employee life 26 insurance, accident insurance, and health insurance plans prior 27 to becoming district board employees pursuant to this chapter 28 shall be permitted to apply prior to becoming district board 29 employees for life, accident, and health insurance plans that 30 are available to district board employees so that those persons 31 do not suffer a lapse of insurance coverage as a result of 32 becoming district board employees. 33 4. The district board may employ or contract with legal 34 counsel to enforce this chapter and district board rules, 35 -7- LSB 5268SV (3) 83 pf/nh 7/ 11

S.F. 2266 represent and defend the district board and its officers and 1 employees, provide legal advice to the district board, and 2 perform any other legal duties required by law or assigned by 3 the district board. The district board may employ or contract 4 with the county attorney of a county within its jurisdiction. 5 Sec. 11. NEW SECTION . 137.110 District treasurer and 6 auditor. 7 Upon establishment of a district board, the district board 8 shall designate a treasurer of a county within its jurisdiction 9 to serve as treasurer of the district health department, and 10 shall designate the auditor of the same county to serve as 11 auditor of the district health department. The treasurer’s 12 and the auditor’s official bonds shall extend to cover their 13 respective duties performed on behalf of the district health 14 department. A county treasurer shall not serve in the capacity 15 of district health department treasurer without consent from 16 the county and agreement from the treasurer to perform this 17 function, and a county auditor shall not serve in the capacity 18 of district health department auditor without consent from the 19 county and agreement from the auditor to perform this function. 20 Sec. 12. NEW SECTION . 137.111 District public health fund. 21 1. The district treasurer shall establish a district public 22 health fund from which disbursements may be made in the manner 23 specified for disbursements by law for the disbursement of 24 county funds. 25 2. All moneys received by a district board or district 26 health department for local public health purposes from federal 27 appropriations, state appropriations, local appropriations, 28 fees, gifts, grants, bequests, or other sources shall be 29 deposited in the district public health fund. Expenditures 30 shall be made from the fund on order of the district board for 31 the purpose of carrying out its duties. No more than twenty 32 percent of the unexpended balance remaining in the fund at the 33 end of each fiscal year shall be maintained in the district 34 public health fund. The remainder of the unexpended balance 35 -8- LSB 5268SV (3) 83 pf/nh 8/ 11

S.F. 2266 shall revert to the general funds of the member counties in the 1 manner determined by the district board. 2 3. The district board shall adopt and certify an 3 annual budget in accordance with section 24.17 relating 4 to certification of budgets and section 24.27 relating to 5 protesting budgets. 6 Sec. 13. NEW SECTION . 137.112 Adding to district. 7 A county may be added to an existing district board by 8 submission and approval of a request, as specified in sections 9 137.105 and 137.106. 10 Sec. 14. NEW SECTION . 137.113 Withdrawal from district. 11 A county may withdraw from an existing district board upon 12 submission of a request for withdrawal to and approval by 13 the state department. The request shall include a plan to 14 reform its county board or join a different district board, 15 information specified in section 137.105, and approval of the 16 request by the district board and, at the recommendation of 17 the state department, the state board. Any county choosing to 18 withdraw from the district board shall commit to the continuity 19 of services in its county by reestablishing its county 20 board or joining a different district board. The remaining 21 counties in the district shall submit an application including 22 the information specified in section 137.105 to the state 23 department for review as provided in section 137.106. 24 Sec. 15. NEW SECTION . 137.114 Dissolution of county boards. 25 Upon appointment of a district board, the county boards 26 involved shall be dissolved and their powers and duties 27 specified in section 137.103 transferred to the district board. 28 All property and equipment in the custody of the county board 29 shall either remain the property of the county or shall become 30 the property of the district board, as so provided in the 31 district board formation request submitted pursuant to section 32 137.105. 33 Sec. 16. NEW SECTION . 137.115 Emergency request for funds. 34 A local board of health may, during a public health disaster 35 -9- LSB 5268SV (3) 83 pf/nh 9/ 11

S.F. 2266 as defined in section 135.140 or in preparation for or 1 response to such disaster, request additional appropriations 2 which may upon approval of the director be allotted from the 3 funds reserved for that purpose to the extent that funds 4 are appropriated and available. Upon termination of the 5 disaster response, the local board of health shall report its 6 expenditures of emergency funds to the director. 7 Sec. 17. NEW SECTION . 137.116 Penalties —— criminal and 8 civil. 9 1. Any person who violates any provision of this chapter or 10 the rules of a local board of health or any lawful order of the 11 board, its officers, or authorized agents is guilty of a simple 12 misdemeanor. Each additional day of neglect or failure to 13 comply with such provision, rule, or lawful order after notice 14 of violation by the local board of health shall constitute a 15 separate offense. 16 2. A local board of health may impose a civil penalty not to 17 exceed seven hundred fifty dollars for each violation of this 18 chapter or the rules of the local board of health or any lawful 19 order of the board, its officers, or authorized agents. If the 20 violation is a repeat offense a civil penalty not to exceed one 21 thousand dollars may be imposed. The local board of health 22 shall impose and enforce such penalties in the manner provided 23 in section 331.307 for county infractions. 24 Sec. 18. NEW SECTION . 137.117 Individual choice of 25 treatment. 26 Nothing in this chapter shall be construed to impede, limit, 27 or restrict the right of free choice by an individual to the 28 health care or treatment that the individual may select. 29 Sec. 19. NEW SECTION . 137.118 Adoption of rules. 30 The state board of health shall adopt rules to implement this 31 chapter. The department is vested with discretionary authority 32 to interpret the provisions of this chapter. 33 Sec. 20. Section 135I.1, subsection 2, Code 2009, is amended 34 to read as follows: 35 -10- LSB 5268SV (3) 83 pf/nh 10/ 11

S.F. 2266 2. “Local board of health” means a county, city, county, or 1 district board of health as defined in section 137.2 137.101 . 2 Sec. 21. Section 331.321, subsection 1, paragraph c, Code 3 Supplement 2009, is amended to read as follows: 4 c. The members of the county board of health in accordance 5 with section 137.4 137.104 . 6 Sec. 22. REPEAL. Chapter 137, Code and Code Supplement 7 2009, is repealed. 8 EXPLANATION 9 This bill amends Code chapter 137, relating to local 10 boards of health. The bill provides definitions; establishes 11 jurisdiction of city, county, and district boards of health; 12 specifies powers and duties of local boards of health, their 13 membership, and meeting requirements; provides a process for 14 two or more geographically contiguous counties to form a 15 district board; specifies the organizational structure of a 16 district board as a governing body for the purposes of tort 17 liability of governmental subdivisions and a process for 18 employing personnel; provides for the use of a county treasurer 19 and auditor of a county within the district of the district 20 board to serve the district health department; provides for 21 the establishment of a district public health fund including 22 the unexpended balance of the fund at the end of each fiscal 23 year; provides a process for counties to join or withdraw 24 from a district board; provides for dissolution of county 25 boards joining a district board; provides civil and criminal 26 penalties for violations of the Code chapter; and provides for 27 adoption of rules by the state board of health to implement the 28 Code chapter and the department is vested with discretionary 29 authority to interpret the provisions of the Code chapter. 30 -11- LSB 5268SV (3) 83 pf/nh 11/ 11