HBA-MPM C.S.H.B. 1444 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1444 By: Delisi Public Health 4/19/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE At the request of the 75th Legislature, a study of the role of local government in providing public health services was conducted by the Texas Department of Health (department), the Lyndon Baines Johnson School of Public Affairs of the University of Texas, the Blackland Research Center, and the School of Rural Public Health of the Texas A&M University System. Public health services are defined as population-based services that are directed to protecting the health of the general public. The study found that there was a need to address public health issues at a local level. C.S.H.B. 1444 amends Chapter 121, Health and Safety Code, to define essential public health services, and creates a program which provides program-based grants, determined on a per capita basis, for essential public health services. Additionally, this bill creates a local public health consortium consisting of health science facilities to work with local health departments and the department. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly granted to the Texas Board of Health in SECTION 2 (Section 121.0065, Health and Safety Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 121.002, Health and Safety Code, as follows: Sec. 121.002. New title: DEFINITIONS. Changes title from "definition" to "definitions." Defines "essential public health services." Makes a nonsubstantive change. SECTION 2. Amends Subchapter A, Chapter 121, Health and Safety Code, by adding Sections 121.0065, 121.0066, and 121.0067, as follows: Sec. 121.0065. GRANTS FOR ESSENTIAL PUBLIC HEALTH SERVICES. (a) Requires the Texas Department of Health (department), subject to the availability of funds, to administer a program to appropriate money granted to counties, municipalities, and public health districts for use by those entities to provide or pay for essential public health services (services). (b) Authorizes the Texas Board of Health (board) to adopt rules governing the allocation formula for grants awarded under this section, the manner in which a municipality, county, or public health district applies for a grant, the procedures for awarding grants, and the minimum services provided under the grant and other applicable service standards. (c) Requires a municipality, county, or public health district that receives a grant to develop in consultation with the department a plan to evaluate the effectiveness, accessibility, and quality of services provided under the grant. Provides that the plan must identify intended outcomes resulting from the use of the grant money and establish a way to measure those outcomes. Provides that the plan must also establish performance standards for the delivery of the services and a mechanism to measure compliance with those standards. (d) Authorizes the governing body of the municipality, the commissioners court of the county, or the members of a public health district to appoint a local health board to monitor the use of money received under this section. (e) Authorizes a public health board established under Section 121.034 (Public Health Board) or Section 121.046 (Public Health Board), Health and Safety Code, to serve as the local health board authorized under Subsection (d). (f) Authorizes the governing body of a municipality or the commissioners court of a county to serve as the local health board authorized under Subsection (d). Authorizes the governing board of the municipality or the commissioners court of the county to appoint an advisory committee to advise either body with respect to the use of the money granted under this section, if either body elects to serve as the local health board. (g) Makes Chapter 783 (Uniform Grant and Contract Management), Government Code, and standards adopted under it control, if applicable to a grant made under this section. Sec. 121.0066. ESSENTIAL PUBLIC HEALTH SERVICES PROVIDED BY DEPARTMENT. Requires the department, subject to the availability of funds, to provide services for a population for which a municipality, county, or public health district is not receiving a grant to provide those services under Section 121.0065, Health and Safety Code. Requires the department to develop a plan that complies with Section 121.0065(c) to evaluate the effectiveness, accessibility, and quality of services provided under this section. Sec. 121.0067. EVALUATION AND REPORT OF DELIVERY OF ESSENTIAL PUBLIC HEALTH SERVICES. Requires the department, in cooperation with municipalities, counties, and public health districts receiving grants, as well as the consortium established under Subchapter F, to evaluate the effectiveness, accessibility, and quality of services provided under the grant program established by Sections 121.0065 and 121.0066, Health and Safety Code, and the adequacy of funding for those services. Requires the department to file a report detailing the results of this evaluation with the governor and the presiding officer of each house of the legislature. Authorizes the report to include recommendations relating to legislation to improve the effectiveness, accessibility, and quality of the services and the appropriate funding for those services. SECTION 3. Amends Section 121.007(c), Health and Safety Code, to require a regional director of a public health region to perform the duties of a health authority in a jurisdiction in a region where there is no health authority, rather than to do so at the authorization of the board or its designee. Makes conforming and nonsubstantive changes. SECTION 4. Amends Section 121.028, Health and Safety Code, as follows: Sec. 121.028. APPOINTMENT OF HEALTH AUTHORITY. Requires a governing body or commissioners court that is receiving a grant to appoint a physician as health authority. Authorizes an individual appointed as health authority to serve for one or more other jurisdictions under an interlocal contract made in accordance with Chapter 791 (Interlocal Cooperation Contracts), Government Code. SECTION 5. Amends Section 121.032, Health and Safety Code, as follows: Sec. 121.032. POWERS AND DUTIES. Deletes Subsection (b) regarding provisions required of a local health department. Makes a conforming change. SECTION 6. Amends Chapter 121, Health and Safety Code, by adding Subchapter F, as follows: SUBCHAPTER F. PUBLIC HEALTH CONSORTIUM Sec. 121.101. DEFINITION. Defines "consortium" for purposes of this subchapter. Sec. 121.102. CONSORTIUM ESTABLISHED. Requires the department, subject to availability of funds, to establish a public health consortium composed of certain health science facilities. Sec. 121.103. GENERAL DUTIES. Sets forth the required duties of the consortium in consultation with the department and local health units, local health departments, and public health districts, subject to the availability of funds. SECTION 7. Repealer: Sections 121.007(d) and (e) (Public Health Regions), Health and Safety Code. These repealed subsections authorize a regional director to serve as health authority for a city, county, or public health district in the absence or incapacity of the jurisdiction's appointed health authority at the request of the governing body of a municipality, the commissioners court of a county, the members of a public health district, or other entity appointed as health authority. Deletes text requiring the board to adopt procedural rules for requesting and concurring in the service by a regional director as appointed health authority, and further deletes text requiring these rules to adopt procedures to prevent duplication of authority by the appointed health authority and regional director. SECTION 8. Emergency clause. Effective date: upon passage. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1444 differs from the original bill as follows: SECTION 1. The substitute modifies amendments to Section 121.002, Health and Safety Code, in the original by altering the proposed definition of "essential public health services." It also changes the title of this section from "Definitions" to "Definitions." SECTION 2. The substitute modifies amendments to Subchapter A, Chapter 121, Health and Safety Code, in the original by deleting proposed conforming and nonsubstantive changes to Section 121.006, and making changes to proposed Sections 121.0065, 121.0066, and 121.0067, as follows: Sec. 121.0065. The substitute changes the title of this section from "Population-Based Grants for Essential Public Health Services" to "Grants for Essential Public Health Services." (a) Includes public health districts among those entities to which the Texas Department of Health (department) is required to administer a program under which appropriated money, rather than funds, may be granted. Adds the stipulation that this grant is subject to the availability of funds. (b) Redesignated from proposed Subsection (c). The substitute expands and modifies the rules the board is required to adopt. Proposed Subsection (b) of the original bill requiring the department to determine the amount of a grant made under the program based on the ratio that the population to be served under the grant bears to the total number of individuals to be served under all grants and by the department under Section 121.0066, Health and Safety Code, is deleted. (c) Redesignated from proposed Subsection (d). Makes a conforming change. (d) The substitute presents completely new text for this subsection, authorizing the governing body of the municipality, the commissioners court of the county, or the members of a public health district to appoint a local health board to monitor the use of money received under this section. (e) The substitute presents completely new text for this subsection, authorizing a public health board established under Section 121.034 (Public Health Board) or Section 121.046 (Public Health Board), Health and Safety Code, to serve as the local health board authorized under Subsection (d). Deletes Subsection (e) of the original, regarding eligibility requirements for receiving a grant under this section. (f) The substitute presents new completely text for this subsection, authorizing the governing body of a municipality or the commissioners court of a county to serve as the local health board authorized under Subsection (d). Authorizes the governing board of the municipality or the commissioners court of the county to appoint an advisory committee to advise either body with respect to the use of the money granted under this section, if either body elects to serve as the local health board. (g) Redesignated from proposed Subsection (f) of the original. Sec. 121.0066. The substitute makes conforming and nonsubstantive changes to this section. Sec. 121.0067. The substitute changes the original by including public health districts and the consortium established under Subchapter F among those entities required to evaluate the effectiveness, accessibility, and quality of services provided under the grant program established by Sections 121.0065 and 121.0066, Health and Safety Code, and the adequacy of funding for those services. The substitute does not delete existing Subsection 121.006(d), Health and Safety Code, which was deleted in the original, to make a conforming change with respect to the definition of "public health services." SECTION 3. Makes no change. SECTION 4. The substitute modifies amendments to the original Section 121.028, Health and Safety Code, by deleting the qualification that a municipality or county is receiving a grant under Section 121.0065, Health and Safety Code for purposes of appointing a physician as health authority to administer certain laws relating to public health. Requires, rather than authorizes, the governing body of a municipality or the commissioners court of a county described by Subsection (a) that is receiving a grant, rather than is "not" receiving a grant, under Section 121.0065, Health and Safety Code, to appoint a physician as health authority. SECTION 5. Makes no change. SECTION 6. The substitute modifies Chapter 121, Health and Safety Code, by changing proposed Subchapter F, as follows: SUBCHAPTER F: The substitute changes the title from "Local Public Health Consortium" to "Public Health Consortium." Sec. 121.101. The substitute changes the title from "Definitions" to "Definition," and deletes the definition of "health science facilities" set forth in the original. Sec. 121.102. The substitute stipulates that the department's establishment of a public health consortium (consortium) is subject to the availability of funds, and sets forth a list of health science facilities" composing the consortium. Sec. 121.103. The substitute changes the title of this section from "Duties of Consortium" to "General Duties." Requires the department, in consultation with the consortium and local health units, local health departments, and public health districts to perform certain duties subject to the availability of funds. The original bill required the consortium, in consultation with the department and local health units, local health departments, and public health districts to perform certain duties. The substitute further expands and modifies the duties set forth in the original bill. Provides that training curricula described by this section may include training for local health authorities, rather than training related to providing prevention services in conjunction with the delivery of other public health services. The substitute deletes SECTION 7 of the original, which sets forth a procedure with respect to the appointment of the public health task force, as well as the definitions of "board" and "department." SECTION 7 of the substitute is redesignated from SECTION 8 of the original, and SECTION 9 (long emergency clause) of the original is redesignated as SECTION 8 in the substitute.