HBA-MPM H.B. 1444 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1444 By: Delisi Public Health 3/15/1999 Introduced 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. 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" and "physician." Makes a nonsubstantive change. SECTION 2. Amends Subchapter A, Chapter 121, Health and Safety Code, by amending Section 121.006 and adding Sections 121.0065, 121.0066, and 121.0067, as follows: Sec. 121.006. New title: PUBLIC HEALTH SERVICES FEES. Deletes "state support" from title. Makes conforming changes. Redesignates Subsection (c) to Section 121.0065, Subsection (f). Deletes existing Subsection (d), which defines "public health services." Sec. 121.0065. POPULATION-BASED GRANTS FOR ESSENTIAL PUBLIC HEALTH SERVICES. (a) Requires the Texas Department of Health (department) to administer a program to appropriate funds granted to counties and municipalities to provide or pay for essential public health services (services). (b) Requires the department to determine the amount of a grant made based on the ratio of the population to be served under the grant to the total number of individuals to be served under all grants and by the department under proposed Section 121.0066. (c) Authorizes the Texas Board of Health (board) to adopt rules governing the manner in which a municipality or county applies for a grant, the procedures for awarding grants, and the minimum services provided under the grant and other applicable service standards. (d) Requires a municipality or county that receives a grant to develop in consultation with the department a plan to evaluate the effectiveness, accessibility, and quality of the 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. (e) Provides that in order to qualify for a grant, the governing body of the municipality or the commissioners court of the county must appoint or serve as a local health board to monitor the use of the money received. Authorizes a public health board established under Section 121.034 (Public Health Board) or 121.046 (Public Health Board), Health and Safety Code, to serve as the local health board. Authorizes the governing body or commissioners court to appoint an advisory board committee to provide consultation regarding the use of the grant money, should either entity elect to serve as the local health board. (f) Provides that Chapter 783 (Uniform Grant and Contract Management), Government Code, rather than the Uniform Grant and Contract Management Act of 1981 (Article 4413 (32g), V.T.C.S.), and standards adopted under that chapter control, if applicable, to a grant made under this section, rather than if the local health unit, local health department, or public health district receives state support for the provision of public health services. Makes a conforming change. Sec. 121.0066. ESSENTIAL PUBLIC HEALTH SERVICES PROVIDED BY DEPARTMENT. Requires the department to provide services for a population for which a municipality or county 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(d) to evaluate the effectiveness, accessibility, and quality of services provided. Sec. 121.0067. EVALUATION AND REPORT OF DELIVERY OF ESSENTIAL PUBLIC HEALTH SERVICES. Requires the department, in cooperation with municipalities and counties receiving grants, 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. (a) Created from existing text. Requires, rather than authorizes, a governing body of a municipality or the commissioners court of a county that has not established a local health department or public health district and that is receiving a grant under Section 121.0065 to appoint a physician as health authority to administer state and local laws relating to public health in the respective jurisdiction. (b) Authorizes a governing body or commissioners court that is not receiving a grant to appoint a physician as health authority. (c) 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 Subtitle F, Chapter 121, Health and Safety Code, by adding Subchapter F, as follows: SUBCHAPTER F. LOCAL PUBLIC HEALTH CONSORTIUM Sec. 121.101. DEFINITIONS. Defines "consortium" as the local public health consortium established under this subchapter and "health science facility" as a list of specific state university science, medical, health, and cancer centers. Sec. 121.102. CONSORTIUM ESTABLISHED. Requires the department to establish a local public health consortium composed of health science facilities. Sec. 121.103. DUTIES OF CONSORTIUM. Sets forth the required duties of the consortium in consultation with the department and local health units, local health departments, and public health districts. SECTION 7. Defines "board" as the Texas Board of Health; "department" as the Texas Department of Health; and "task force" as the public health task force established under this section. Requires the department to establish a public health task force to make recommendations to the board with respect to improving the competency and capacity of the health care providers providing public health services in this state and sets forth the composition of the task force. Requires the task force to make recommendations to the board no later than June 1, 2001 [sic], and the board to submit a written report to the governor, lieutenant governor, and speaker of the house of representatives concerning these recommendations no later than December 1, 2000. Requires the report to include a plan for implementing the recommendations, if appropriate, and recommendations for legislation that the board considers necessary to implement the recommendations of the task force. Requires the department to provide administrative support and services to the task force. Provides that this section expires and the task force is abolished June 1, 2001. SECTION 8. Repealer: Sections 121.007(d) and (e) (Public Health Regions), Health and Safety Code. These subsections delete, respectively, text authorizing 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 9. Emergency clause. Effective date: upon passage.