Senate Bill No. 553
(By Senator Craigo)
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[Introduced February 20, 1995; referred to the Committee
on Health and Human Resources; and then to the Committee
on Finance.]
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A BILL to amend and reenact article one-a, chapter sixteen of the
code of West Virginia, one thousand nine hundred thirty-one,
as amended, to amend and reenact section three, article two,
of said chapter; and to amend and reenact sections two and
six, article two-a of said chapter, all relating to public
health improvements; redefining a public health system
composed of the department of health and human resources; a
volunteer public health advisory council; local boards of
health and new nonprofit local public health cooperatives;
developing a state health plan by such department; requiring
the funds received by each local board of health from funds appropriated by the Legislature for such boards to be
dependent upon its meeting minimum performance standards
established in rules of such department; granting local
public health organizations the right to be offered managed
health care contracts for selected services for five years;
and making the funding of public health programs an
obligation of counties.
Be it enacted by the Legislature of West Virginia:
That article one-a, chapter sixteen of the code of West
Virginia, one thousand nine hundred thirty-one, as amended, be
amended and reenacted; that section three, article two of said
chapter be amended and reenacted; and that sections two and six,
article two-a of said chapter be amended and reenacted, all to
read as follows:
ARTICLE 1A. PUBLIC HEALTH IMPROVEMENT.
§16-1A-1. Short title.
This article shall be known as the "Public Health
Improvement Act of 1995."
§16-1A-2. Legislative findings and purposes.
(a) The Legislature finds and declares that:
(1) The health problems of West Virginia demand an
aggressive public health initiative;
(2) West Virginians should have access to quality health
care;
(3) The mission and role of public health must be redefined,
the organizational structure must be reformed, adequate funding
must be assured, appropriate training must be implemented and a
transition effort must be developed to mesh public health changes
with the changing health care delivery system for individuals;
(4) Public health is unique in its emphasis on prevention
and its focus on the community;
(5) The public health system services as the base level for
the delivery of primary, secondary and tertiary health care
services to individuals and is thus a compliment to the personal
health care system;
(6) The mission of public health is to promote health and
prevent disease by:
(A) Preventing epidemics and the spread of disease;
(B) Protection against environmental hazards;
(C) Preventing injuries;
(D) Promoting and encouraging healthy behavior;
(E) Responding to disasters and assisting communities in
recovery; and
(F) Assuring the quality and accessibility of health
services.
(7) Public health's mission may be accomplished by providing
the essential public health services identified by the federal
centers for disease control and prevention, the institute of
medicine and national associations involved with public health.
Such essential public health services are to:
(A) Monitor health status to identify community problems;
(B) Diagnose and investigate health problems and health
hazards in the community;
(C) Inform, educate and empower people about health issues;
(D) Mobilize community partnerships and action to solve
health problems;
(E) Develop policies and plans that support individual and
community health efforts;
(F) Enforce laws and regulations that protect health and
ensure safety;
(G) Link people to needed personal health services and
assure the provision of health care when otherwise unavailable;
(H) Assure an expert public health work force;
(I) Evaluate effectiveness, accessibility and quality of health services; and
(J) Research for new insights and innovative solutions to
public health problems.
(8) Essential prevention services target the health status
of the entire population, as opposed to health care services
which target individuals; and
(9) As the public health role and mission is redefined and
as the health care delivery system evolves, many individuals
currently receiving primary care services from local health
departments will receive such care from other health care
providers as such providers become available to all individuals.
Care must be taken in a redesigned public health system to assure
that individuals will not lose needed services as the result of
any change of focus or method of funding local health services.
(b) The purposes of this article are to:
(1) Promote the achievement of the objectives of the above
findings through the establishment of an efficient and
coordinated system for carrying out many public health functions
through local boards of health and their local public health
cooperatives; and
(2) Provide a public health system, working actively to promote health and prevent disease, to ultimately result in cost
savings and less demand for more expensive illness care.
§16-1A-3. Public health advisory council.
There is hereby created in the department of health and
human resources a public health advisory council consisting of
one member appointed by each local public health cooperative
created in accordance with this article who shall serve until
replaced by their cooperative and eight members appointed by the
commissioner of the bureau for public health in the department of
health and human resources who shall also appoint the chair of
the council from among the members. The commissioner's
appointments to the advisory council shall be knowledgeable of
public health issues and be from diverse segments of the public.
When the commissioner appoints the initial members, two shall be
appointed for a term ending the thirtieth day of June, one
thousand nine hundred ninety-six, and two each shall be appointed
for terms ending one, two and three years thereafter. After the
initial appointments, the term of members appointed by the
commissioner shall be for four years, except in the case of a
vacancy on the council of a member appointed by the commissioner,
the commissioner shall make an appointment for the unexpired term. The commissioner may not appoint a member successively to
more than two full terms.
The advisory council members shall serve without
compensation, except they may be reimbursed for reasonable
expenses incurred in the performance of their duties. Meetings
of the advisory council shall be called by the chair.
The public health advisory council shall advise the
commissioner of the bureau for public health in the department of
health and human resources as to the development of the public
health improvements envisioned by this article, health planning
and health care reform. Specifically the public health advisory
council shall recommend to the commissioner:
(a) The role of local public health cooperatives and local
boards of health in a public health system;
(b) The means of funding such boards and cooperatives;
(c) The training needs required by those cooperative, local
health departments and others involved in public health;
(d) The contents of a state public health component for a
state health plan;
(e) Actions to accomplish health care reform within the
state; and
(f) Such other matters as the advisory council deems
appropriate to promote the public health improvements envisioned
by this article.
The department of health and human resources shall, within
funds available, provide the public health advisory council with
such staff support, information and consultants as the council
deems necessary.
The public health advisory council consisting of the initial
appointees of the commissioner of the bureau for public health
shall recommend to the commissioner the number and geographic
boundaries for local public health cooperatives, but if by the
first day of July, one thousand nine hundred ninety-five, the
advisory council has not made such a recommendation, the
department of health and human resources may designate, without
recommendation, those geographic boundaries.
§16-1A-4. Local boards of health.
In addition to duties performed by local boards of health
under articles two or two-a of this chapter, such boards shall
comply with the minimum performance standards for local boards of
health as established in rules of the department of health and
human resources and, to the extent funds are available, conduct community health assessment and assurance activities, develop
local policy recommendations based on their findings, deliver or
contract for the delivery of certain essential prevention
services and other public heath services and may create or join
the local public health cooperative for their designated
geographic area.
The department of health and human resources' allocations to
local boards of health of the Legislature's appropriations for
state aid to local agencies shall continue to be allocated to
such boards meeting the minimum performance standards for such
boards after those standards are established in rules of such
department.
§16-1A-5. Local public health cooperatives.
For each geographic area designated by the department of
health and human resources, such department may authorize two or
more of the local public health boards created under articles two
or two-a of this chapter to incorporate a nonprofit corporation
known as a local public health cooperative. Membership in such
a cooperative shall be open to the county boards of health and
the combined boards of health within the designated geographic
area of the cooperative. Each such cooperative may determine the composition of this board: Provided, That each local board of
health which becomes a member of the cooperative for its
geographic area may appoint one member of the cooperative's
board, except a board of health formed by the combination of
boards of health under section three, article two of this chapter
which becomes a member of such a cooperative may appoint as many
members of the cooperative's board as there are counties within
the jurisdiction of the combined board of health.
Local public health cooperatives shall provide technical
assistance to their member local boards of health, assist them in
the delivery of public health services, provide recommendations
to the public health advisory council regarding state public
health planning and may perform public health programs under
contract with the department of health and human resources. Such
department may fund local public health cooperatives to carry out
public health programs which are funded from other than the
Legislature's appropriation for state aid to local agencies.
Local public health cooperatives may engage in other public
health activities and obtain funds from sources other than the
department of health and human resources.
For the fiscal years ending the thirtieth of June, one thousand nine hundred ninety-six and ninety-seven, the department
of health and human resources may, to the extent funds are
appropriated for such purposes, make available to local public
health cooperatives funds for their development and for them to
conduct: Public health training; public health data collection
and automation; community health assessments; epidemiological
services; and their development of plans for the department to
fund in ensuing years the cooperatives to carry out public health
programs which are funded from other than the Legislature's
appropriation for state aid to local agencies. A local public
health cooperative seeking such ensuing year funding shall enter
into discussion with the department of health and human resources
and provide their service and funding plan to such department.
After receiving such plan from a local public health cooperative,
the department may fund the cooperative to carry out some or all
of the public health programs which are funded from other than
the Legislature's appropriation for state aid to local agencies.
For purposes of the provisions of this code concerning open
governmental proceedings and freedom of information, article
nine-a, chapter six and article one, chapter twenty-nine-b
respectively, the local public health cooperatives authorized under this article shall be considered public bodies.
A person hired by a local public health cooperative, who on
the effective date of this article is a member of the West
Virginia public employees retirement system created in article
ten, chapter five of this code or is an employee participating in
benefit programs of the public employees insurance agency created
in article sixteen of said chapter, shall have the right to
continue participating in such retirement and benefit programs,
and the person's local public health cooperative shall, as to
such employee, be considered an employer under the West Virginia
Public Employee Insurance Act and a participating public employer
under the West Virginia Public Employee Retirement Act. Local
public health cooperatives may, for their other qualified
employees, elect to be considered employers and participating
public employers under such acts respectively.
§16-1A-6. Duties and powers of the department of health and
human resources.
The department of health and human resources shall, to the
extent resources are available, develop public health policy
including a state health plan, provide technical assistance to
local boards of health and local public health cooperatives, promulgate rules in accordance with chapter twenty-nine-a of this
code to establish performance standards for local boards of
health, provide assistance to the public health advisory council
and carry out its recommendations or take other actions in
furtherance of the public health improvements envisioned by this
article.
§16-1A-7. Guaranteed opportunity to compete for managed
health
care contracts.
If an organization subject to the provisions of chapter
thirty-three of this code enters into a contract with a West
Virginia health care provider and such contract includes the
provision of health related services which are also offered by
local boards of health or local public health cooperatives, then
for five years from the effective date of this section, such
organization subject to the provisions of said chapter shall
offer to such local boards and cooperatives contracts similar to
those it offers to purchase such services from other providers,
if the services of the local boards and cooperatives: Are
certified by the federal government; meet the minimum performance
standards for such services as established by the department of
health and human resources; or are comparable to the quality of the services of the organization's other contract providers. The
services offered by local boards of health or local public health
cooperatives include, but are not limited to, home health care,
immunizations, family planning, disease and accident prevention,
control of communicable and sexually transmitted diseases,
laboratory testing, health education and promotion, case
management of pregnant women, newborn infants and new mothers and
preventive health screenings including those for breast and
cervical cancer and early periodic screenings, diagnosis and
treatment of children.
§16-1A-8. Public health improvement revenue account.
On the effective date of this section, and subject to the
provisions in section two, article two, chapter twelve of this
code, there is established in the state treasury a separate
account which shall be designated the "public health improvement
revenue account" for the purpose of receiving deposits.
The secretary of the department of health and human
resources is authorized to expend money deposited in the public
health improvement revenue account in accordance with the laws of
this state as is necessary for the public health improvements
envisioned in this article, and at least one-third of such expenditures shall be for essential public health services of
local boards of health.
Any balance including accrued interest in the public health
improvement revenue account at the end of any fiscal year may not
revert to the general revenue fund but shall remain in the
account for use by the secretary of the department of health and
human resources for funding public health improvements in the
ensuing fiscal year.
ARTICLE 2. LOCAL HEALTH OFFICERS.
§16-2-3. Counties, or counties and municipalities, may combine
in employment of officers and installation and
maintenance of equipment; combined local boards of
health.
Any two or more counties, or any county or counties and any
one or more municipalities within or partially within the said
county or counties, may combine to cooperate with the state
department of health and human resources, by vote of the county
commission in the case of a county and by vote of the council or
other governing body in the case of a municipality, and may
participate in the employment of trained health officers and
other agents and employees, or in the installation and
maintenance of a common laboratory and other equipment. Whenever any such units shall decide so to cooperate and shall appropriate
a sum or sums of money for such joint or cooperative action, the
state department of health and human resources is authorized and
empowered to pay over and contribute to such cooperating units,
and the cooperating units are authorized and empowered to receive
and expend for public purposes, such sum or sums of money as may
be available from funds included in appropriations made for the
state department of health and human resources for such purposes:
Provided, That the general plan of cooperation, as well as the
principal health officers, executive agent or laboratory director
employed by the cooperating units, shall first have been approved
by the director of the department of health and human resources.
The amount of any such payment or contribution by the state
department of health and human resources to such cooperating
units shall be determined in accordance with regulations
established by the state board of health secretary of the
department of health and human resources. Such regulations shall
establish performance standards for such local boards of health,
provide a method for determining the amount of any payment or
contribution to local boards which meet minimum standards and
this method shall be uniformly applied in determining the amount of any payment or contribution to any such local governmental
unit or units.
Each county commission of a county participating in any such
combined board of health, whether or not it has exercised the
power to lay the special levy provided for by this chapter in
section two, article two and section six, article two-a of this
chapter, shall appropriate and expend money from the county
general fund to pay the expenses of operation and administration
of the combined board of health and the public health facilities
operated thereby or in conjunction therewith, except in the case
of a combined board of health including more than one county,
each such county shall appropriate and expend money from this
county general fund for its population-based pro rata share to
pay the expenses of operation and administration of the combined
board of health and the public health facilities operated thereby
or in conjunction therewith.
Each county or municipality participating in any such
cooperative action shall select and appoint by vote of the county
commission in the case of a county, and by vote of the council or
other governing body in the case of a municipality, not less than
one nor more than three persons to be members of a combined board of health. No such person shall may be selected by, nor
represent on, any such combined board, more than one such county
or municipality. The number of persons to be selected by each
participating county or municipality as members of such board,
subject to the limitation contained in the two preceding
sentences, shall be agreed upon by the several counties or
municipalities participating.
All members of such combined board of health shall be
appointed for terms of five years each, except that the persons
first appointed pursuant to the provisions of this section, if
more than one such person is appointed at the same time by any
one county commission or municipal governing body, shall be
individually designated to serve for terms of one, two and three
years, respectively, and if only one such person is appointed at
such time by each participating county or municipality, the
several participating counties or municipalities shall initially
appoint such persons to serve for individually designated terms,
which shall be agreed upon by the several appointing authorities,
of one, two, three, four and five years, respectively. Upon the
expiration of the term of such initial appointments, the term of
each new appointee shall be five years. Any vacancy on such board shall be filled by appointment, by the original appointing
authority, for the unexpired term. All members shall serve until
their duly qualified successors have been appointed. The number
of members of such board belonging to one political party shall
may not exceed by more than one the number of members of such
board belonging to any other political party.
All members of any such board shall be citizens and
residents of the county or municipality they are appointed to
represent. All members shall be eligible for reappointment.
No member of such board may be removed from office during
the term for which he or she is appointed, except for official
misconduct, incompetence, neglect of duty or gross immorality.
No Each member of such board shall receive any a sum set by
the county commission governing body as compensation for his or
her services, but each in attending each meeting of the board as
required by law and may be reimbursed for all reasonable and
necessary travel and other expenses actually incurred by him or
her in the performance of his or her duties as a member of such
board.
Any such combined board of health shall consist of the
several members so selected. Such board shall organize by electing a chairman from among its members. It shall have the
power to adopt, and from time to time amend, such rules and
regulations as it may deem necessary concerning the time and
place of its meetings, the procedure and method of conducting its
meetings or business, and any other matters affecting, or
necessary to, the orderly and efficient discharge of its duties
or exercise of its powers. All powers and duties belonging to or
vested in county boards of health or municipal boards of health
under any provision of the code are hereby vested in, conferred
upon, and declared to be, the powers and duties of any combined
board of health created pursuant to the provisions of this
section. All powers and duties belonging to or vested in county
or municipal health officers, so far as they are applicable and
not in conflict with the provisions of this section, are hereby
vested in, conferred upon, and declared to be, the powers and
duties of any health officer appointed and employed by any
combined board of health. Any health officer or other employee
appointed or employed by any combined board of health shall be
employed and serve, and may be discharged, at the will and
pleasure of such board. The territorial jurisdiction of any such
combined board of health shall be coextensive with the boundaries of all of the counties and municipalities which have been
combined to cooperate as herein provided.
Upon the formation of a combined local board of health as
herein provided, and during the period that it continues to
exist, there shall may be no separate county board of health or
municipal board of health in any county or municipality
represented on the combined board of health.
ARTICLE 2A. ALTERNATIVE METHOD OF ORGANIZING LOCAL HEALTH
AGENCIES.
§16-2A-2. Membership and organization of county and municipal
boards of health; appointment and qualification;
terms; removal; compensation.
A county board of health or municipal board of health
created and establish under the provisions of this article shall
be composed of five members appointed by the county court
commission or the governing body of the municipality. Where any
county board of education contributes funds to a county court
commission or a municipality, which creates such board of health,
for health purposes, such board of education may nominate one
member of such local board of health. Such nominee shall be
appointed to such board of health by the appointing authority, if
otherwise qualified. In the event such nominee is rejected by the appointing authority, or in the event his or her position on
the board of health is vacated during the term for which he or
she is appointed, such county board of education may nominate
another person, who, if otherwise qualified, shall be appointed
to the board of health by the appointing authority. In the event
such county board of education fails or refuses to nominate some
person for such appointment within thirty days of the date of the
receipt of a request, in writing, from the appointing authority
for a nomination, the appointing authority shall proceed to make
such appointment without any nomination by the county board of
education.
All members of any such board of health shall be citizens
and residents of the county or municipality they are appointed to
represent. No more than three of the members of such board shall
may belong to the same political party, nor shall may more than
two of such members be residents of the same magisterial district
or municipal ward, nor shall may more than two such members be
personally and individually licensed in, engaged in, or actively
participating in or carrying on, the same business, profession,
or occupation. All members shall be eligible for reappointment.
All members of such board shall be appointed for terms of five years each, except that the persons appointed when the board
is initially created shall be individually designated to serve
for terms of one, two, three, four and five years, respectively.
Upon the expiration of such initial appointments the terms for
each new appointee shall be five years. Each member shall serve
until the appointment of his or her duly qualified successor.
Any vacancy on such board shall be filled by appointment for the
unexpired term.
Such county or municipal board of health shall organize by
electing from its members a chairman who shall serve as such for
a period of one year. Such chairman shall have the power to sign
documents, execute contracts and otherwise act for and in the
name of such board in all matters within its lawful powers and
duly authorized by a majority of its members.
No member of such board may be removed from office during
the term for which he or she is appointed except for official
misconduct, incompetence, neglect of duty or gross immorality:
Provided, That the revocation of a professional license issued by
this state to any such member shall be sufficient reason and
cause for the removal of such member from office.
Each member of such board shall receive a sum set by the county court commission or governing body but not exceeding ten
dollars as compensation for his or her services in attending each
meeting of the board as required by law and may be reimbursed for
actual and necessary travel and other expenses incurred by him or
her in the performance of his or her duties as a member of such
board.
§16-2A-6. Levy for payment of county, municipal, combined
boards of health; collection, receipt and
disposition of funds by local boards of health.
The county commission of any county or the governing body of
any municipality in which a county or municipal health officer is
appointed pursuant to the provisions of this article, shall have
the power and authority to provide funds for the payment of such
health officer and the expenses of his or her administration, and
for that purpose may levy a county or municipal tax, as the case
may be, of not exceeding three cents on each one hundred dollars'
assessed valuation of the taxable property in such county or
municipality according to the last assessment thereof.
Any county or municipality may, whether it has exercised the
power to lay the special levy hereinbefore provided for or not,
appropriate and expend money from the county or municipal general fund for public health purposes and to pay the expenses of
operation and administration of a county or municipal board of
health and the public health facilities operated thereby or in
conjunction therewith.
Any county shall, whether it has exercised the power to lay
the special levy hereinbefore provided for or not, appropriate
and expend money from the county general fund for public health
purposes and to pay the expenses of operation and administration
of a county board of health and the public health facilities
operated thereby or in conjunction therewith.
Any county or municipality in which there is a board of
health created and maintained pursuant to the provisions of this
article, may accept, receive and receipt for money or property
from any federal, state or local governmental agency, or from any
public or private source, to be used for public health purposes,
or for the establishment or construction of public health
facilities. The state department of health and human resources
is hereby authorized and empowered to pay over and contribute to
any board of health created and maintained pursuant to the
provisions of this article such sum or sums of money as may be
available from funds included in appropriations made for the state department of health and human resources for such purpose.
The amount of any such payment or contribution by the state
department of health and human resources to any such local board
of health shall be determined in accordance with regulations
established by the state board of health secretary of the
department of health and human resources. Such regulations shall
establish performance standards for such local boards of health
and provide a fixed formula for determining the amount of any
payment or contribution to local boards which meet minimum
standards, and this formula shall be uniformly applied in
determining the amount of any payment or contribution to any such
local board.
Notwithstanding any other provision of this chapter, any
county, municipal or combined board of health, whether created
and maintained pursuant to the provisions of this article or
article two of this chapter, may assess and charge fees for
permits and licenses for the provision of public health services:
Provided, That no such fees may be assessed or charged pursuant
to the provisions of this section for permits and licenses
required for agricultural activities. Such fees shall be
established by regulation promulgated in accordance with the provisions of chapter twenty-nine-a of the code, by the state
board of health secretary of the department of health and human
resources.
All moneys accepted by any county, municipal or combined
board of health shall be deposited in the county or municipal
treasury, and unless otherwise prescribed by the authority from
which the money is received, shall be kept in separate funds,
designated according to the purposes for which the money was made
available, and held by the county or municipality in trust for
such purposes: Provided, That nothing contained in this section
shall may be construed to conflict with the provisions of section
fifteen, article one, chapter sixteen of this code.
Expenditures from the county or municipal public health
funds established under this article shall be paid out by the
county or municipal treasurer upon submission of vouchers
approved by the county or municipal board of health and signed by
the county or municipal health officer.
NOTE: The purpose of this bill is to promote public health
improvements and redefine the mission of public health to essential public health services. The bill reaffirms the public
health responsibility for the provision of personal clinical,
preventive health care services which are otherwise unavailable.
A volunteer public health advisory council is created to
provide recommendations for: A public health system composed of
the state bureau for public health, local boards of health and
their nonprofit local public health cooperatives which they may
create; and the development of a state public health component
for a state health plan to be developed by the department of
health and human resources.
The funds received by local boards of health from funds
appropriated by the Legislature for such boards will be dependent
upon such boards meeting minimum performance standards
established in rules of the department of health and human
resources, and the funding of local boards of health is made an
obligation of counties.
Local public health organizations are given the right to be
offered managed health care contracts for selected services of
five years, provided quality requirements are met. Excess
revenues from those organizations' delivery of personal health
care services currently subsidize essential public health
services. This is necessary to continue while adjustments are
made to the changes in health care delivery being brought about
by the expansion of managed care organizations.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.
Article one-a is new; therefore, strike-throughs and
underscoring have been omitted.