S.F. _____ H.F. _____ DIVISION I 1 IOWA PUBLIC HEALTH MODERNIZATION ACT 2 Section 1. Section 135A.2, Code 2016, is amended to read as 3 follows: 4 135A.2 Definitions. 5 As used in this chapter , unless the context otherwise 6 requires, the following definitions apply: 7 1. “Academic institution” means an institution of higher 8 education in the state which grants undergraduate and 9 postgraduate degrees in public health or another health-related 10 field and is accredited by a nationally recognized accrediting 11 agency as determined by the United States secretary of 12 education. For purposes of this definition, “accredited” means 13 a certification of the quality of an institution of higher 14 education. 15 2. “Accrediting entity” means a legal, independent, 16 nonprofit or governmental entity or entities approved by the 17 state board of health for the purpose of accrediting designated 18 local public health agencies and the department pursuant to the 19 voluntary accreditation program developed under this chapter . 20 3. “Administration” means the operational procedures, 21 personnel and fiscal management systems, and facility 22 requirements that must be in place for the delivery and 23 assurance of public health services. 24 4. “Committee” means the governmental public health 25 evaluation committee as established in this chapter . 26 5. “Communication and information technology” means the 27 processes, procedures, and equipment needed to provide public 28 information and transmit and receive information among public 29 health entities and community partners; and applies to the 30 procedures, physical hardware, and software required to 31 transmit, receive, and process electronic information. 32 6. 2. “Council” means the governmental public health 33 advisory council as established in this chapter . 34 7. 3. “Department” means the department of public health. 35 -1- LSB 5249DP (9) 86 pf/nh 1/ 11

S.F. _____ H.F. _____ 8. 4. “Designated local public health agency” means an 1 entity that is either governed by or contractually responsible 2 to a local board of health and designated by the local 3 board to comply with the Iowa public health standards for a 4 jurisdiction . 5 9. “Governance” means the functions and responsibilities 6 of the local boards of health and the state board of health to 7 oversee governmental public health matters. 8 10. 5. “Governmental public health system” means the system 9 described in section 135A.6 local boards of health, the state 10 board of health, designated local public health agencies, the 11 state hygienic laboratory, and the department . 12 11. “Iowa public health standards” means the governmental 13 public health standards adopted by rule by the state board of 14 health. 15 12. 6. “Local board of health” means a county or district 16 board of health. 17 13. 7. “Organizational capacity” means the governmental 18 public health infrastructure that must be in place in order to 19 deliver public health services. 20 14. “Public health region” means, at a minimum, one of six 21 geographical areas approved by the state board of health for 22 the purposes of coordination, resource sharing, and planning 23 and to improve delivery of public health services. 24 15. “Public health services” means the basic public health 25 services that all Iowans should reasonably expect to be 26 provided by designated local public health agencies and the 27 department. 28 16. “Voluntary accreditation” means verification of a 29 designated local public health agency or the department that 30 demonstrates compliance with the Iowa public health standards 31 by an accrediting entity. 32 17. “Workforce” means the necessary qualified and competent 33 staff required to deliver public health services. 34 8. “Public health system ” means all public, private, and 35 -2- LSB 5249DP (9) 86 pf/nh 2/ 11

S.F. _____ H.F. _____ voluntary entities that contribute to the delivery of public 1 health services within a jurisdiction. 2 Sec. 2. Section 135A.3, Code 2016, is amended to read as 3 follows: 4 135A.3 Governmental public health system modernization —— 5 lead agency. 6 1. The department is designated as the lead agency in this 7 state to administer this chapter . 8 2. The department, in collaboration with the governmental 9 public health advisory council and the governmental public 10 health evaluation committee, shall coordinate implementation 11 of this chapter including but not limited to the voluntary 12 accreditation of designated local public health agencies and 13 the department in accordance with the Iowa public health 14 standards. Such implementation administration shall include 15 evaluation of and quality improvement measures for the 16 governmental public health system. 17 Sec. 3. Section 135A.4, Code 2016, is amended to read as 18 follows: 19 135A.4 Governmental public health advisory council —— 20 legislative intent . 21 1. It is the intent of the general assembly that Iowa’s 22 governmentally sponsored public health system be effective, 23 efficient, well-organized, and well-coordinated in order to 24 have the greatest impact on the improvement of health status 25 for all Iowans. The governmental public health advisory 26 council is intended to support this goal, and is established to 27 provide recommendations to the director of the department to 28 support improved organization and delivery of critical public 29 health services across the state. 30 1. 2. A governmental public health advisory council 31 is established to advise the department and make policy 32 recommendations to the director of the department concerning 33 administration, implementation, and coordination of this 34 chapter and to make recommendations to the department and 35 -3- LSB 5249DP (9) 86 pf/nh 3/ 11

S.F. _____ H.F. _____ the state board of health regarding the governmental public 1 health system. The council shall meet at least quarterly. The 2 council shall consist of no fewer than fifteen members and 3 no more than twenty-three twenty-eight members. The members 4 shall be appointed by the director. The director may solicit 5 and consider recommendations from professional organizations, 6 associations, and academic institutions in making appointments 7 to the council. 8 2. Council members shall not be members of the governmental 9 public health evaluation committee. 10 3. Council members shall serve for a term of two years and 11 may be reappointed for a maximum of three consecutive terms . 12 Initial appointment shall be in staggered terms. Vacancies 13 shall be filled for the remainder of the original appointment. 14 4. The membership of the council shall consist of all 15 of the following members who satisfy all of the following 16 requirements: 17 a. One member who has expertise in injury prevention. 18 b. One member who has expertise in environmental health. 19 c. One member who has expertise in emergency preparedness. 20 d. One member who has expertise in health promotion and 21 chronic disease prevention. 22 e. One member who has epidemiological expertise in 23 communicable and infectious disease prevention and control. 24 f. a. One member representing each of Iowa’s six public 25 health regions Twelve members who is represent various 26 subfields of public health. These members shall provide 27 geographical representation from all areas of the state. Each 28 of these members shall be an employee of a designated local 29 public health agency or member of a local board of health. 30 Such members shall include a minimum of one local public health 31 administrator and one physician member of a local board of 32 health. 33 g. b. Two members who are representatives of the 34 department. 35 -4- LSB 5249DP (9) 86 pf/nh 4/ 11

S.F. _____ H.F. _____ h. c. The director of the state hygienic laboratory at the 1 university of Iowa, or the director’s designee. 2 i. d. At least one representative two representatives 3 from academic institutions which grant undergraduate and 4 postgraduate degrees in public health or other related health 5 field and are accredited by a nationally recognized accrediting 6 agency as determined by the United States secretary of 7 education. For purposes of this paragraph, “accredited” means 8 a certification of the quality of an institution of higher 9 education . 10 j. e. Two members who serve on a county board of 11 supervisors. 12 f. At least one economist who has demonstrated experience in 13 public health, health care, or a health-related field. 14 g. At least one research analyst. 15 k. h. Four nonvoting , ex officio members who shall consist 16 of four members of the general assembly, two from the senate 17 and two from the house of representatives, with not more than 18 one member from each chamber being from the same political 19 party. The two senators shall be designated, one member each, 20 by the majority leader of the senate after consultation with 21 the president and by the minority leader of the senate. The 22 two representatives shall be designated, one member each, by 23 the speaker of the house of representatives after consultation 24 with the majority leader of the house of representatives and by 25 the minority leader of the house of representatives. 26 l. i. A member of the state board of health who shall be a 27 nonvoting , ex officio member. 28 5. The council may utilize other relevant public 29 health expertise when necessary to carry out its roles and 30 responsibilities. 31 6. The council shall do all of the following: 32 a. Advise the department and make policy recommendations to 33 the director of the department and the state board of health 34 concerning administration, implementation , and coordination of 35 -5- LSB 5249DP (9) 86 pf/nh 5/ 11

S.F. _____ H.F. _____ this chapter and the governmental public health system . 1 b. Propose to the director public health standards 2 that should may be utilized for voluntary accreditation of 3 designated local public health agencies and the department that 4 include but are not limited to the organizational capacity and 5 by the governmental public health service components described 6 in section 135A.6, subsection 1 , by October 1, 2009 system . 7 c. Recommend to the department an accrediting entity and 8 identify the roles and responsibilities for the oversight and 9 implementation of the voluntary accreditation of designated 10 local public health agencies and the department by January 2, 11 2010. This shall include completion of a pilot accreditation 12 process for one designated local public health agency and the 13 department by July 1, 2011 Develop and implement processes for 14 longitudinal evaluation of the public health system including 15 collection of information about organizational capacity and 16 public health service delivery . 17 d. Recommend to the director strategies to implement 18 voluntary accreditation of designated local public health 19 agencies and the department effective January 2, 2012. 20 e. Periodically review and make recommendations to the 21 department regarding revisions to the public health standards 22 pursuant to paragraph “b” , as needed and based on reports 23 prepared by the governmental public health evaluation committee 24 pursuant to section 135A.5 . 25 d. Determine what process and outcome improvements in the 26 governmental public health system are attributable to voluntary 27 accreditation. 28 e. Assure that the evaluation process is capturing data to 29 support key research in public health system effectiveness and 30 health outcomes. 31 f. Develop and make recommendations for improvements to the 32 public health system. 33 g. Make recommendations for resources to support the public 34 health system. 35 -6- LSB 5249DP (9) 86 pf/nh 6/ 11

S.F. _____ H.F. _____ f. h. Review rules developed and adopted by the state board 1 of health under this chapter and make recommendations to the 2 department for revisions to further promote implementation 3 of this chapter and modernization of the governmental public 4 health system. 5 g. i. Form and utilize subcommittees as necessary to carry 6 out the duties of the council. 7 j. Annually submit a report on the activities of the council 8 to the state board of health by July 1. 9 Sec. 4. Section 135A.8, subsections 2 and 3, Code 2016, are 10 amended to read as follows: 11 2. The fund is established to assist local boards of health 12 and the department with the provision of governmental public 13 health system organizational capacity and public health service 14 delivery and to achieve and maintain voluntary accreditation 15 in accordance with the Iowa public health standards . At least 16 seventy percent of the funds shall be made available to local 17 boards of health and up to thirty percent of the funds may be 18 utilized by the department. 19 3. Moneys in the fund may be allocated by the department 20 to a local board of health for organizational capacity and 21 service delivery. Such allocation may be made on a matching, 22 dollar-for-dollar basis for the acquisition of equipment, 23 or by providing grants to achieve and maintain voluntary 24 accreditation in accordance with the Iowa public health 25 standards . 26 Sec. 5. Section 135A.9, Code 2016, is amended to read as 27 follows: 28 135A.9 Rules. 29 The state board of health shall adopt rules pursuant to 30 chapter 17A to implement this chapter which shall include but 31 are not limited to the following: 32 1. Incorporation of the Iowa public health standards 33 recommended to the department pursuant to section 135A.4, 34 subsection 6 . 35 -7- LSB 5249DP (9) 86 pf/nh 7/ 11

S.F. _____ H.F. _____ 2. A voluntary accreditation process to begin no later than 1 January 2, 2012, for designated local public health agencies 2 and the department. 3 3. 1. Rules relating to the operation of the governmental 4 public health advisory council. 5 4. Rules relating to the operation of the governmental 6 public health system evaluation committee. 7 5. 2. The application and award process for governmental 8 public health system fund moneys. 9 6. Rules relating to data collection for the governmental 10 public health system and the voluntary accreditation program. 11 7. 3. Rules otherwise necessary to implement the chapter. 12 Sec. 6. REPEAL. Sections 135A.5, 135A.6, 135A.7, and 13 135A.10, Code 2016, are repealed. 14 DIVISION II 15 STATE AND DISTRICT BOARDS OF HEALTH 16 Sec. 7. Section 136.3, subsection 5, Code 2016, is amended 17 by striking the subsection. 18 Sec. 8. Section 136.3, subsections 6 and 8, Code 2016, are 19 amended to read as follows: 20 6. Assure that the department complies with Iowa Code , and 21 administrative rules , and the Iowa public health standards . 22 For this purpose the board shall have access at any time to all 23 documents and records of the department. 24 8. Advise or make recommendations to the director of public 25 health, governor, and general assembly relative to public 26 health and advocate for state and local public health to comply 27 with the Iowa the importance of public health standards for 28 state and local public health . 29 Sec. 9. Section 137.102, subsection 10, Code 2016, is 30 amended by striking the subsection. 31 Sec. 10. Section 137.104, subsection 1, paragraph b, 32 unnumbered paragraph 1, Code 2016, is amended to read as 33 follows: 34 Make and enforce such reasonable rules and regulations not 35 -8- LSB 5249DP (9) 86 pf/nh 8/ 11

S.F. _____ H.F. _____ inconsistent with law , and the rules of the state board , or 1 the Iowa public health standards as may be necessary for the 2 protection and improvement of the public health. 3 Sec. 11. Section 137.105, subsection 1, paragraph c, Code 4 2016, is amended to read as follows: 5 c. All members of a district board shall be appointed by 6 the county board of supervisors from each county represented by 7 the district. Each county board of supervisors shall appoint 8 at least one but no more than three members to the district 9 board , and each county board of supervisors shall appoint the 10 same number of members to the district board. There shall 11 be no more than one board of supervisors member from any 12 participating county on the district board . 13 Sec. 12. Section 137.106, subsection 1, Code 2016, is 14 amended to read as follows: 15 1. A written narrative that explains how the formation of a 16 district board will increase organizational capacity and attain 17 the capability to provide population-based and personal public 18 health services compared with operating as individual county 19 boards . 20 Sec. 13. Section 137.111, Code 2016, is amended to read as 21 follows: 22 137.111 District treasurer and auditor. 23 Upon establishment of a district board, the district board 24 shall designate a treasurer of a county within its jurisdiction 25 to serve as treasurer of the district health department, and 26 shall designate the an auditor of the same county to serve as 27 auditor of the district health department. The A treasurer or 28 auditor of any county within the district may also serve in 29 the capacity of treasurer or auditor of the district health 30 department, respectively, or the district board may contract 31 with a third party to act as the treasurer or auditor of the 32 district health department. A county treasurer’s and the or 33 county auditor’s official bonds shall bond may extend to cover 34 their respective duties performed on behalf of the district 35 -9- LSB 5249DP (9) 86 pf/nh 9/ 11

S.F. _____ H.F. _____ health department. A county treasurer shall not serve in 1 the capacity of district health department treasurer without 2 consent from the county and agreement from the treasurer to 3 perform this function, and a county auditor shall not serve 4 in the capacity of district health department auditor without 5 consent from the county and agreement from the auditor to 6 perform this function. 7 EXPLANATION 8 The inclusion of this explanation does not constitute agreement with 9 the explanation’s substance by the members of the general assembly. 10 This bill relates to public health, including the Iowa 11 public health modernization Act and the state and district 12 boards of health. 13 The bill amends provisions in Code chapter 135A (public 14 health modernization Act). The bill eliminates and amends 15 definitions used in the Code chapter and eliminates the 16 requirements for voluntary accreditation of designated local 17 public health agencies and the department of public health 18 and the required development and use of Iowa public health 19 standards. 20 The bill changes the size and composition of the 21 governmental public health advisory council to include a 22 maximum of 28 members and to specifically include 12 members 23 representing various subfields of public health from local 24 public health agencies and local boards of health from all 25 geographic areas of the state, at least two representatives 26 from academic institutions, at least one economist who has 27 demonstrated experience in public health, health care, or 28 a health-related field, and at least one research analyst. 29 The bill eliminates certain duties of the council and 30 prescribes additional duties including: (1) to develop and 31 implement processes for longitudinal evaluation of the public 32 health system including collection of information about 33 organizational capacity and public health services delivery, 34 (2) to determine what process and outcome improvements in the 35 -10- LSB 5249DP (9) 86 pf/nh 10/ 11

S.F. _____ H.F. _____ governmental public health system are attributable to voluntary 1 accreditation, (3) to assure that the evaluation process is 2 capturing data to support key research in public health system 3 effectiveness and health outcomes, (4) to develop and make 4 recommendations for improvements to the public health system, 5 (5) to make recommendations for resources to support the public 6 health system, and (6) to annually submit a report on the 7 activities of the council to the state board of health by July 8 1. 9 The bill eliminates the governmental public health 10 evaluation committee which was established to develop and 11 implement the evaluation of the governmental public health 12 system and voluntary accreditation program, the specified 13 organizational capacity components and public health service 14 components of a governmental public health system, and the 15 governmental public health system and accreditation data 16 collection system which was to monitor the implementation and 17 effectiveness of the governmental public health system based on 18 the Iowa public health standards. 19 The bill eliminates directives to adopt rules that relate 20 to the provisions of the Act eliminated in the bill and also 21 eliminates the section of the Act that established a civil 22 penalty for a local board of health or local public health 23 agency fraudulently claiming accreditation. The bill also 24 makes conforming changes in the Code chapters relating to state 25 and district boards of health to reflect the changes to the 26 public health modernization Act. 27 -11- LSB 5249DP (9) 86 pf/nh 11/ 11