S.F. 275 DIVISION I 1 IOWA PUBLIC HEALTH MODERNIZATION ACT 2 Section 1. Section 135A.2, Code 2015, 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 1210SV (1) 86 pf/nh 1/ 11

S.F. 275 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. 8. “Public health services” means the basic public 25 health 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 9. “Public health system” means all public, private, and 35 -2- LSB 1210SV (1) 86 pf/nh 2/ 11

S.F. 275 voluntary entities that contribute to the delivery of essential 1 public health services within a jurisdiction. 2 Sec. 2. Section 135A.3, Code 2015, 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 2015, is amended to read as 18 follows: 19 135A.4 Governmental public health advisory council. 20 1. A governmental public health advisory council is 21 established to advise the department and make policy 22 recommendations to the director of the department concerning 23 administration, implementation, and coordination of this 24 chapter and to make recommendations to the department and 25 the state board of health regarding the governmental public 26 health system. The council shall meet at least quarterly. The 27 council shall consist of no fewer than fifteen members and 28 no more than twenty-three twenty-eight members. The members 29 shall be appointed by the director. The director may solicit 30 and consider recommendations from professional organizations, 31 associations, and academic institutions in making appointments 32 to the council. 33 2. Council members shall not be members of the governmental 34 public health evaluation committee. 35 -3- LSB 1210SV (1) 86 pf/nh 3/ 11

S.F. 275 3. 2. Council members shall serve for a term of two years 1 and may be reappointed for a maximum of three consecutive 2 terms . Initial appointment shall be in staggered terms. 3 Vacancies shall be filled for the remainder of the original 4 appointment. 5 4. 3. The membership of the council shall satisfy all of 6 the following requirements: 7 a. One member who has expertise in injury prevention. 8 b. One member who has expertise in environmental health. 9 c. One member who has expertise in emergency preparedness. 10 d. One member who has expertise in health promotion and 11 chronic disease prevention. 12 e. One member who has epidemiological expertise in 13 communicable and infectious disease prevention and control. 14 f. a. One member Twelve members representing each of 15 Iowa’s six public health regions who is various subfields 16 of public health. These members shall provide geographical 17 representation from all areas of the state. Each of these 18 members shall be an employee of a designated local public 19 health agency or member of a local board of health. Such 20 members shall include a minimum of one local public health 21 administrator and one physician member of a local board of 22 health. 23 g. b. Two members who are representatives of the 24 department. 25 h. c. The director of the state hygienic laboratory at the 26 university of Iowa, or the director’s designee. 27 i. d. At least one representative two representatives 28 from academic institutions which grant undergraduate and 29 postgraduate degrees in public health or other related health 30 field and are accredited by a nationally recognized accrediting 31 agency as determined by the United States secretary of 32 education. For purposes of this paragraph, “accredited” means 33 a certification of the quality of an institution of higher 34 education . 35 -4- LSB 1210SV (1) 86 pf/nh 4/ 11

S.F. 275 j. e. Two members who serve on a county board of 1 supervisors. 2 f. At least one economist who has demonstrated experience in 3 public health, health care, or a health-related field. 4 g. At least one research analyst. 5 k. h. Four nonvoting , ex officio members who shall consist 6 of four members of the general assembly, two from the senate 7 and two from the house of representatives, with not more than 8 one member from each chamber being from the same political 9 party. The two senators shall be designated, one member each, 10 by the majority leader of the senate after consultation with 11 the president and by the minority leader of the senate. The 12 two representatives shall be designated, one member each, by 13 the speaker of the house of representatives after consultation 14 with the majority leader of the house of representatives and by 15 the minority leader of the house of representatives. 16 l. i. A member of the state board of health who shall be a 17 nonvoting , ex officio member. 18 5. 4. The council may utilize other relevant public 19 health expertise when necessary to carry out its roles and 20 responsibilities. 21 6. 5. The council shall do all of the following: 22 a. Advise the department and make policy recommendations to 23 the director of the department and the state board of health 24 concerning administration, implementation, and coordination of 25 this chapter and the governmental public health system. 26 b. Propose to the director public health standards 27 that should may be utilized for voluntary accreditation of 28 designated local public health agencies and the department that 29 include but are not limited to the organizational capacity and 30 by the governmental public health service components described 31 in section 135A.6, subsection 1 , by October 1, 2009 system . 32 c. Recommend to the department an accrediting entity and 33 identify the roles and responsibilities for the oversight and 34 implementation of the voluntary accreditation of designated 35 -5- LSB 1210SV (1) 86 pf/nh 5/ 11

S.F. 275 local public health agencies and the department by January 2, 1 2010. This shall include completion of a pilot accreditation 2 process for one designated local public health agency and the 3 department by July 1, 2011. Develop and implement processes for 4 longitudinal evaluation of the public health system including 5 collection of information about organizational capacity and 6 public health services delivery. 7 d. Recommend to the director strategies to implement 8 voluntary accreditation of designated local public health 9 agencies and the department effective January 2, 2012. 10 e. Periodically review and make recommendations to the 11 department regarding revisions to the public health standards 12 pursuant to paragraph “b” , as needed and based on reports 13 prepared by the governmental public health evaluation committee 14 pursuant to section 135A.5 . 15 d. Determine what process and outcome improvements in the 16 governmental public health system are attributable to voluntary 17 accreditation. 18 e. Assure that the evaluation process is capturing data to 19 support key research in public health system effectiveness and 20 health outcomes. 21 f. Develop and make recommendations for improvements to the 22 public health system and for the health outcomes of Iowans. 23 g. Make recommendations for resources to support the public 24 health system. 25 f. h. Review rules developed and adopted by the state board 26 of health under this chapter and make recommendations to the 27 department for revisions to further promote implementation 28 of this chapter and modernization of the governmental public 29 health system. 30 g. i. Form and utilize subcommittees as necessary to carry 31 out the duties of the council. 32 j. Annually submit a report on the activities of the council 33 to the state board of health by July 1. 34 Sec. 4. Section 135A.8, subsections 2 and 3, Code 2015, are 35 -6- LSB 1210SV (1) 86 pf/nh 6/ 11

S.F. 275 amended to read as follows: 1 2. The fund is established to assist local boards of health 2 and the department with the provision of governmental public 3 health system organizational capacity and public health service 4 delivery and to achieve and maintain voluntary accreditation 5 in accordance with the Iowa public health standards . At least 6 seventy percent of the funds shall be made available to local 7 boards of health and up to thirty percent of the funds may be 8 utilized by the department. 9 3. Moneys in the fund may be allocated by the department 10 to a local board of health for organizational capacity and 11 service delivery. Such allocation may be made on a matching, 12 dollar-for-dollar basis for the acquisition of equipment, 13 or by providing grants to achieve and maintain voluntary 14 accreditation in accordance with the Iowa public health 15 standards . 16 Sec. 5. Section 135A.9, Code 2015, is amended to read as 17 follows: 18 135A.9 Rules. 19 The state board of health shall adopt rules pursuant to 20 chapter 17A to implement this chapter which shall include but 21 are not limited to the following: 22 1. Incorporation of the Iowa public health standards 23 recommended to the department pursuant to section 135A.4, 24 subsection 6 . 25 2. A voluntary accreditation process to begin no later than 26 January 2, 2012, for designated local public health agencies 27 and the department. 28 3. 1. Rules relating to the operation of the governmental 29 public health advisory council. 30 4. Rules relating to the operation of the governmental 31 public health system evaluation committee. 32 5. 2. The application and award process for governmental 33 public health system fund moneys. 34 6. Rules relating to data collection for the governmental 35 -7- LSB 1210SV (1) 86 pf/nh 7/ 11

S.F. 275 public health system and the voluntary accreditation program. 1 7. 3. Rules otherwise necessary to implement the chapter. 2 Sec. 6. REPEAL. Sections 135A.5, 135A.6, 135A.7, and 3 135A.10, Code 2015, are repealed. 4 DIVISION II 5 STATE AND DISTRICT BOARDS OF HEALTH 6 Sec. 7. Section 136.3, subsection 5, Code 2015, is amended 7 by striking the subsection. 8 Sec. 8. Section 136.3, subsections 6 and 8, Code 2015, are 9 amended to read as follows: 10 6. Assure that the department complies with Iowa Code , and 11 administrative rules , and the Iowa public health standards . 12 For this purpose the board shall have access at any time to all 13 documents and records of the department. 14 8. Advise or make recommendations to the director of public 15 health, governor, and general assembly relative to public 16 health and advocate for state and local public health to comply 17 with the Iowa the importance of public health standards for 18 state and local public health . 19 Sec. 9. Section 137.102, subsection 10, Code 2015, is 20 amended by striking the subsection. 21 Sec. 10. Section 137.104, subsection 1, paragraph b, 22 unnumbered paragraph 1, Code 2015, is amended to read as 23 follows: 24 Make and enforce such reasonable rules and regulations not 25 inconsistent with law , and the rules of the state board , or 26 the Iowa public health standards as may be necessary for the 27 protection and improvement of the public health. 28 Sec. 11. Section 137.105, subsection 1, paragraph c, Code 29 2015, is amended to read as follows: 30 c. All members of a district board shall be appointed by 31 the county board of supervisors from each county represented by 32 the district. Each county board of supervisors shall appoint 33 at least one but no more than three members to the district 34 board , and each county board of supervisors shall appoint the 35 -8- LSB 1210SV (1) 86 pf/nh 8/ 11

S.F. 275 same number of members to the district board. There shall 1 be no more than one board of supervisors member from any 2 participating county on the district board . 3 Sec. 12. Section 137.106, subsection 1, Code 2015, is 4 amended to read as follows: 5 1. A written narrative that explains how the formation of a 6 district board will increase organizational capacity and attain 7 the capability to provide population-based and personal public 8 health services compared with operating as individual county 9 boards . 10 Sec. 13. Section 137.111, Code 2015, is amended to read as 11 follows: 12 137.111 District treasurer and auditor. 13 Upon establishment of a district board, the district board 14 shall designate a treasurer of a county within its jurisdiction 15 to serve as treasurer of the district health department, and 16 shall designate the an auditor of the same county to serve as 17 auditor of the district health department. A treasurer or 18 auditor of any county within the district may also serve in 19 the capacity as treasurer or auditor of the district health 20 department, respectively, or the district board may contract 21 with a third party to act as the treasurer or auditor of the 22 district health department. The A county treasurer’s and 23 the or county auditor’s official bonds shall bond may extend 24 to cover their respective duties performed on behalf of the 25 district health department. A county treasurer shall not serve 26 in the capacity of district health department treasurer without 27 consent from the county and agreement from the treasurer to 28 perform this function, and a county auditor shall not serve 29 in the capacity of district health department auditor without 30 consent from the county and agreement from the auditor to 31 perform this function. 32 EXPLANATION 33 The inclusion of this explanation does not constitute agreement with 34 the explanation’s substance by the members of the general assembly. 35 -9- LSB 1210SV (1) 86 pf/nh 9/ 11

S.F. 275 This bill relates to public health including the Iowa public 1 health modernization Act and the state and district boards of 2 health. 3 The bill amends provisions in Code chapter 135A (public 4 health modernization Act). The bill eliminates and amends 5 definitions used in the Code chapter and eliminates the 6 requirements for voluntary accreditation of designated local 7 public health agencies and the department of public health 8 and the required development and use of Iowa public health 9 standards. 10 The bill changes the size and composition of the 11 governmental public health advisory council to include a 12 maximum of 28 members and to specifically include 12 members 13 representing various subfields of public health from local 14 public health agencies and local boards of health from all 15 geographic areas of the state, at least two representatives 16 from academic institutions, at least one economist who has 17 demonstrated experience in public health, health care, or a 18 health-related field, and at least one research analyst. The 19 bill eliminates certain duties of the council and prescribes 20 additional duties including to develop and implement processes 21 for longitudinal evaluation of the public health system 22 including collection of information about organizational 23 capacity and public health services delivery, to determine what 24 process and outcome improvements in the governmental public 25 health system are attributable to voluntary accreditation, to 26 assure that the evaluation process is capturing data to support 27 key research in public health system effectiveness and health 28 outcomes, to develop and make recommendations for improvements 29 to the public health system and for the health outcomes of 30 Iowans, to make recommendations for resources to support the 31 public health system, and to annually submit a report on the 32 activities of the council to the state board of health by July 33 1. 34 The bill eliminates the governmental public health 35 -10- LSB 1210SV (1) 86 pf/nh 10/ 11

S.F. 275 evaluation committee which was established to develop and 1 implement the evaluation of the governmental public health 2 system and voluntary accreditation program, the specified 3 organizational capacity components and public health service 4 components of a governmental public health system, and the 5 governmental public health system and accreditation data 6 collection system which was to monitor the implementation and 7 effectiveness of the governmental public health system based on 8 the Iowa public health standards. 9 The bill eliminates directives to adopt rules that relate 10 to the provisions of the Act eliminated in the bill and also 11 eliminates the section of the Act that established a civil 12 penalty for a local board of health or local public health 13 agency fraudulently claiming accreditation. The bill also 14 makes conforming changes in the Code chapters relating to state 15 and district boards of health to reflect the changes to the 16 public health modernization Act. 17 -11- LSB 1210SV (1) 86 pf/nh 11/ 11