SB 194: The Public Health Reauthorization Act Archuleta County Staff Presentation

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SB 194 The Public Health Reauthorization Act
Archuleta County Staff Presentation

• March 31, 2009

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Presentation Available Online

• httparchuletacounty.org

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Purpose of the Presentation

• To discuss the legal requirements of SB 194
• To discuss implementation strategies
• To prepare for the April 7th Board of County
  Commissioners Meeting
• To provide background and understanding of public
  health and Senate Bill 194

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Expected Outcomes

• Provide data-driven public health services based
  on community assessments and analyze results to
  determine program success.
• Assure accountability of funds to 10 essential
  services.
• Increase oversight of public health with the goal
  of assuring that services provided create
  meaningful improvement to our publics health.

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Public Health vs. Health Care

• Public health is primarily preventative
• Public health is community-based and focuses on
  populations

• Medical care is primarily curative
• Medical care focuses on individuals

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Ten Essential Public Health Services

• Assessment
• 1. Monitor health status to identify community
  health problems.
• 2. Diagnosis and investigate health problems and
  health hazards in the community.
• 3. Research for new insights and innovative
  solutions to health problems.
• Center for Disease Control and Prevention (CDC)
  National Public Health Performance Standards
  Program

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Ten Essential Public Health Services

• Assurance
• 4. Assure a competent public health and personal
  health care workforce.
• 5. Evaluate effectiveness, accessibility and
  quality of personal and population-based health
  services.
• 6. Link people to needed personal health
  services and assure the provision of health care
  when otherwise unavailable.
• Center for Disease Control and Prevention (CDC)
  National Public Health Performance Standards
  Program

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Ten Essential Public Health Services

• Policy Development
• 7. Enforce laws and regulations that protect the
  health and ensure safety.
• 8. Mobilize community partnership to identify
  and solve health problems.
• 9. Inform, evaluate and empower people about
  health issues.
• 10.Develop policies and plans that support
  individual and community health efforts.
• Center for Disease Control and Prevention (CDC)
  National Public Health Performance Standards
  Program

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Activities of Public Health

• Disease prevention Investments in public health
  activities can ultimately ease the burden on our
  primary care system (and ultimately reduce costs)
  by reducing the number of people who need medical
  care.
• Examples chronic disease management, promotion
  of healthy lifestyles, tobacco cessation and use
  prevention.
• Environmental health prevention and control of
  human health problems related to the environment.

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Activities of Public Health

• Emergency preparedness and response Plan, train
  and prepare for public health emergencies such as
  pandemic influenza, foodborne illness, pertussis,
  etc.
• Personal health Evaluate effectiveness,
  accessibility and quality of personal and
  population-based health services. Links people
  to needed personal health services and assures
  the provision of health care when otherwise
  unavailable.
• Vital Statistics Birth and death certificates.

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Activities of Public Health

• Our public health system protects against,
  prevents and controls public health problems at a
  community level.
• Our medical system treats individuals affected.

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SB 194 Overview

• The Colorado Public Health Reauthorization Act
  (the Act) signed June 4, 2008 by Gov. Ritter.
• Obligates the County to examine its local public
  health agency, San Juan Basin Health, and our
  local public health care needs and priorities.
• Enacted to assure that core public health
  services are available to every Coloradoan with
  consistent standards of quality.
• Revamps administrative duties and structure of
  state, county and local health agencies in
  Colorado.

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Role of Colorado County Commissioners in Public
Health

• Establish by resolution a county public health
  agency or participate in a district public health
  agency by July 1, 2009.
• Determine the services needed to carry out the
  state public health laws and rules according to
  the specific needs and resources available within
  the community and as set out in the state and
  local plans.

From Colorado Public Health Reauthorization Act
SB 08-194 Executive Summary (CDPHE)
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Legal Authority of Countys for Public Health

• 25-1-506. County or district public health agency
  Formerly 25-1-501
• Each county, by resolution of its board of county
  commissioners, shall establish and maintain a
  county public health agency or shall participate
  in a district public health agency.

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Then and Now

• Prior to the Act, Colorado law provided for the
  following three different types of local or
  regional public health care agencies
• Part 5 Agencies County and District Health
  Departments
• Part 6 Agencies Public Health Nursing
  Services
• Part 7 Agencies Regional Health Departments
• The Act creates one type of local public health
  agency which is intended to fit the needs and
  resources of the community it serves.

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Background of San Juan Basin Health Department
(SJBHD)

• August 4, 1947, SJBHD formed by La Plata,
  Montezuma, Archuleta, San Juan, and Dolores
  counties.
• SJBHD district health department
• Currently, the District is comprised of only La
  Plata and Archuleta Counties.

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Background continued

• SJBHD is a political subdivision of the State,
  separate and distinct from La Plata and Archuleta
  Counties.
• Governed by a Board of Health, rather than one
  Board of County Commissioners.
• Administered by a Public Health Director.

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SJBHD Programs

• Mission enhance the personal and environmental
  health of the community through education,
  collaboration, advocacy and direct provision of
  services.
• Administers approximately 70 different programs.
• Maintains offices in Durango and Pagosa Springs.
  
• 15 of state per capita funds were to be expended
  on regional public health activities this
  amounts to approximately 22,750 for FY 2008.
  This funding structure is no longer required by
  the new legislation.

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SJBHD Funding

• Annual budget in excess of 6 million.
• 2009 Budgeted Revenues
• Federal, state, local and private grants
• Fees, Medicaid and donations
• Direct funding from counties participating
• Archuleta County 2009 Budgeted Amount
• 118,412.00

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SB 194 Requirements for Organizing a PH Agency

• By July 1, 2009, establish or become a part of a
  Local Public Health Agency either a County
  Agency or a District Agency.
• District Agency two or more contiguous counties
  through resolution of the BoCCs of the respective
  counties. A municipal corporation may also join
  either a District Agency or a County Agency.
  C.R.S. 25-1-506(2)(a).

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SB 194 Requirements for Organizing a PH Agency

• If the County joins a District Agency it cannot
  withdraw until two-years following the
  establishment of the District or the Countys
  joinder in the District.
• A one years written notice to the District
  Agency is required prior to withdrawal. C.R.S.
  25-1-513(2).
• If the County were to withdraw, it must
  thereafter establish a County Agency.

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Designation of Board of Health

• Within 90 days, a Local Board of Health (BOH)
  must be appointed.
• The previously elected health boards are
  dissolved and the BOH elects officers.
• County Agency BOH
• At least 3 members. C.R.S. 25-1-508(2)(a).
• Can be the BOCC, but not necessarily.
• District Agency BOH
• At least 5 members, with one member being from
  each county
• BOH members appointed by a committee 1 member
  from each BoCC in the District. C.R.S.
  25-1-508(3)(a).
• No governmental entity may constitute a majority
  of the Local BOH.

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Creation of Local Plan

• Local PH agency must prepare a Local Plan as
  soon as practicable after the approval of the
  State Plan. C.R.S. 25-1-505(1). Must be
  revised every 5 years thereafter.
• State Plan must be developed on or before
  December 31, 2009, and at a minimum, every five
  years thereafter.
• It is recommended that individual community
  assessments and Local Plans be completed for each
  county participating in a district agency, if
  such an agency is formed.

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Local Plan Minimum Requirements

• Examine health risk factors of the community.
• Assess the capacity and performance of the public
  health system.
• Describe how local community develops and
  implements the local plan. Address the
  coordination of the public health agency with the
  state plan.
• Identify public resources available to meet the
  needs and to meet requirements for the provision
  of core public health services. C.R.S.
  25-1-505(1).

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SB 194 Summary

• Prior to July 1, 2009, Archuleta County must
  resolve to create a County Agency or District
  Agency.
• Until this resolution, the San Basin Health
  Department and Board continues to retain the same
  authority, duties, and powers.
• The BoCC weighs the commitment it would face with
  participating in a District and potential issues
  surrounding partnership, against the advantages
  of pooling resources.

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Public and Partner Input

• State statute requires direct action by the Board
  of County Commissioners for the organization of
  PH.
• Public and partner input will be actively sought
  and is critical to the success of the Community
  Assessment and Local Plan processes.
• The organizational resolution is the kick off to
  a vigorous, participatory process.

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Proposed Action

• Step 1 No Later Than July 1, 2009
• Create Public Health Agency
• Recommended Archuleta County and La Plata County
  create a District Agency SJBHD.

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Proposed Action

• Step 2 Simultaneous with Step 1
• Appointment Committee 1 member of each BoCC of
  the counties comprising the District

• Recommended Chair of Each BOCC
• Chair Bob Moomaw and Chair Kellie Hotter

Appointment Committee designates of board
members

• Recommended 7 Members 3 from each county, and
  1 at large

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Proposed Action

• Step 3 NLT 90 Days after Step 1
• Appointment Committee appoints BOH
• BOH Min. 5 members
• at least 1 representative from each county in
  the District
• must be resident of one of the counties
  comprising District
• no business or professional group or governmental
  entity shall constitute a majority of the
  District board

• Recommended 3 County Commissioners of each
  County, and 1 member at large

Upon establishment of District Board, all
previously existing boards are dissolved.
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Proposed Action
Step 4 NLT 90 Days after Step 1 At
organizational meeting of the new District Board,
officers are elected and bylaws are adopted.  

• Recommended New District Board creates job
  description and performance standards for Public
  Health Director in accordance with State Minimum
  Qualifications, as well as BOH additional
  requirements.

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Proposed Action
Step 5 NLT 90 Days after Step 1 New District BOH
selects a Public Health Director to serve at the
pleasure of the District Board

• Recommended Public Health Director performance
  standards and reporting requirements implemented.

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Proposed Action
Step 6 NLT 90 Days after Step 1 If Public Health
Director is not a MD, a Medical Officer must also
be appointed
Public Health Director selects all other
personnel required by the District and performs
duties prescribed by Director
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Next Steps

• Resolutions by Boards of County Commissioners by
  mid-April
• Appointment Committee Selection
• Board of Health Appointments
• Public Health Director Appointment
• Medical Officer Appointment (if PH Director is
  not an MD)

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Resource List

• National Association of County and City Health
  Officials (NACCHO) http//www.naccho.org/
• Operational Definition of a Functional Local
  Health Department
• 2005 National Profile of Local Health Departments
  
• 2008 Conference address by Dr. Risa
  Laviszzo-Mourey
• Colorado Department of Public Health and
  Environment (CDPHE) SB 194 Documents
• CDPHE Office of Planning Partnerships
  Introduction to Public Health in Colorado
  http//www.cdphe.state.co.us/oll/intro/index.html
  
• Colorado Health Report Card 
• http//www.coloradohealthreportcard.org/ReportCar
  d/2008/default.aspx
• Healthy People 2010 www.healthypeople.gov
• Colorado Revised Statutes
• Public Health Alliance of Colorado (includes The
  Colorado Association of Local Public Health
  Officials (CALPHO))
• http//www.publichealthalliance.org
• Acknowledgement of thanks to the La Plata County
  Staff for the preparation of this presentation.

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Comments/Questions?