A BILL TO BE ENTITLED
AN ACT to improve the quality and accountability of the public health system by strengthening the public health INFRASTRUCTURE, to improve public health outcomes and reduce health disparities by the development AND IMPLEMENTATION of A state PLAN FOR public health SERVICES, and to improve the public health workforce.
Whereas, North Carolina has a rich local public health heritage and wishes to continue that heritage by strengthening the State's public health infrastructure; and
Whereas, the public health system must respond to: new serious public health emergencies, significant changes in population, decreasing funding, and significant variations in public health protection between counties and regions; and
Whereas, the mission of protecting and promoting the health of the public can most efficiently and effectively be addressed through the coordinated efforts of State and local public health agencies and the collaboration of the public and private sectors within the public health system; and
Whereas, a consensus for establishing, prioritizing, and implementing essential public health services and functions can be achieved through a comprehensive statewide public health plan; and
Whereas, the public and private sectors can demonstrate public accountability and provide high quality services through accreditation, certification, credentialing, and the implementation of performance standards; Now, therefore,
The General Assembly of North Carolina enacts:
SECTION 1.(a)  G.S. 130A‑1.1 is repealed.
SECTION 1.(b)  G.S. 130A‑2 reads as rewritten:
"§ 130A‑2.  Definitions.
The following definitions shall apply throughout this Chapter unless otherwise specified:
(1)	"Commission" means the Commission for Health Services.
(1a)	"Communicable condition" means the state of being infected with a communicable agent but without symptoms.
(1b)	"Communicable disease" means an illness due to an infectious agent or its toxic products which is transmitted directly or indirectly to a person from an infected person or animal through the agency of an intermediate animal, host, or vector, or through the inanimate environment.
(2)	"Department" means the Department of Health and Human Services.
(2a)	"Essential public health services and functions" means those services and functions listed in G.S. 130A-2.3.
(3)	"Imminent hazard" means a situation that is likely to cause an immediate threat to human life, an immediate threat of serious physical injury, an immediate threat of serious adverse health effects, or a serious risk of irreparable damage to the environment if no immediate action is taken.
(3a)	"Isolation authority" means the authority to issue an order to limit the freedom of movement or action of a person or animal with a communicable disease or communicable condition for the period of communicability to prevent the direct or indirect conveyance of the infectious agent from the person or animal to other persons or animals who are susceptible or who may spread the agent to others.
(4)	"Local board of health" means a district board of health or a public health authority board or a county board of health.
(5)	"Local health department" means a district health department or a public health authority or a county health department.
(6)	"Local health director" means the administrative head of a local health department appointed pursuant to this Chapter.
(6a)	"Local public health agency" means a local health director, a local board of health, and a local health department.
(6b)	"Outbreak" means an occurrence of a case or cases of a disease in a locale in excess of the usual number of cases of the disease.
(7)	"Person" means an individual, corporation, company, association, partnership, unit of local government or other legal entity.
(7a)	"Private sector partner" means nongovernmental persons, including community organizations, contractors, educational institutions, health care facilities, health insurers, private businesses, media, nonprofit organizations, and volunteers, that provide essential public health services and functions or work to improve public health outcomes in collaboration with the State or a local public health agency. 
(7b)	"Public health" means assuring the conditions in which the population can be healthy. The term includes population-based or individual efforts primarily aimed at the prevention of injury, disease, or premature mortality or the promotion of health in the community, such as assessing the health needs and status of the community through public health surveillance and epidemiological research, developing public health policy, and responding to public health needs and emergencies.
(7c)	"Public health agency" means a federal, State, or local public health agency.
(7d)	"Public health infrastructure" means the competencies and resources that enable public health agencies, in collaboration with other components of the public health system, to provide essential public health services and functions throughout the State.
(7e)	"Public health system" means State and local public health agencies and their public and private sector partners.
(7f)	"Public health workforce" means State and local public health agents and other persons working within the public health system to provide essential public health services and functions in the State.
(7g)	"Public sector partner" means international, federal, tribal, or other State or local governments and their public health agencies that provide essential public health services and functions or work to improve public health outcomes with a State or local public health agency.
(7h)	"Quarantine authority" means the authority to issue an order to limit the freedom of movement or action of persons or animals which have been exposed to or are reasonably suspected of having been exposed to a communicable disease or communicable condition for a period of time as may be necessary to prevent the spread of that disease. Quarantine authority also means the authority to issue an order to limit access by any person or animal to an area or facility that may be contaminated with an infectious agent. The term also means the authority to issue an order to limit the freedom of movement or action of persons who have not received immunizations against a communicable disease when the State Health Director or a local health director determines that the immunizations are required to control an outbreak of that disease.
(8)	"Secretary" means the Secretary of Health and Human Services.
(8a)	"State public health agency" means the Commission for Health Services, the Department of Health and Human Services, and the Department of Environment and Natural Resources to the extent that the Department of Environment and Natural Resources has jurisdiction to protect the public's health.
(9)	"Unit of local government" means a county, city, consolidated city‑county, sanitary district or other local political subdivision, authority or agency of local government.
(10)	"Vital records" means birth, death, fetal death, marriage, annulment and divorce records registered under the provisions of Article 4 of this Chapter."
SECTION 1.(c)  Part 1 of Article 1 of Chapter 130A of the General Statutes is amended by adding the following new sections to read:
"§ 130A-2.1.  Policy statement; responsibilities of State and local government.
(a)	The policy of the State is to protect and promote the health of the public to the greatest extent possible through the public health system while respecting individual rights to bodily integrity, health information privacy, nondiscrimination, due process, and other legally protected interests.
(b)	The State and counties are responsible for assuring that the public health system accomplishes the mission of public health.
(c)	State and local public health agencies shall encourage collaboration with public and private sector partners within the public health system to provide essential public health services and functions listed in G.S. 130A-2.3.
"§ 130A-2.2.  Accreditation of State and local public health agencies.
(a)	Not later than January 1, 2005, all local public health agencies shall be accredited. Accreditation shall be conditioned upon the local public health agency's capacity to provide all essential public health services and functions listed in G.S. 130A-2.3 in a manner that promotes quality of services and financial sustainability. 
(b)	The State public health agency shall obtain an accreditation directed at the duties and functions of a state-level public health agency from a national accrediting body.
"§ 130A-2.3.  Essential public health services and functions.
(a)	State and local public health agencies shall provide the following essential public health services and functions:
(1)	Monitor health status to identify and solve community health problems.
(2)	Mobilize public and private sector collaboration and action to identify and solve health problems.
(3)	Diagnose and investigate health problems and health hazards in the community.
(4)	Inform people about health issues.
(5)	Develop policies and plans that support individual and community health efforts.
(6)	Enforce laws and regulations that protect health and ensure a safe and healthful environment.
(7)	Promote access to and availability of needed personal health care services and collaborate with other public and private sector partners to promote or provide preventative and primary health care services according to identified community needs. For the purposes of this subdivision, preventative and primary health care services include acute and episodic care, prenatal and postpartum care, child health, family planning, school health, chronic disease prevention, child and adult immunization, dental health, nutrition, and health education and promotion services.
(8)	Monitor and ensure the competency of the State and local public health workforce.
(9)	Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
(10)	Conduct research to identify new insights and innovative solutions to health problems.
(11)	Promote the availability and accessibility of quality health care services through health care facilities or providers.
(12)	Establish and maintain an effective public health preparedness and  response capacity for all hazards.
(b)	The essential public health services and functions listed in subsection (a) of this section shall not be construed to limit or restrict the powers and duties of the Commission, the Department, rules adopted by local boards of health, or the Department of Environment and Natural Resources as otherwise conferred by State law."
SECTION 2.(a)  Every county, through its local public health agency, shall develop local priorities for public health. These priorities shall be the basis for development of a State Plan for Public Health Services.  To ensure the involvement of consumers and providers and other interested parties in the development of priorities the local board of health and board of county commissioners shall hold a public hearing with notice published at least 10 days prior to the hearing.  The priorities shall include the following:
(1)	A description of the demographics and health indicators of the population being served by the local public health agency.
(2)	A description of the numbers and types of professionals in the local public health workforce.
(3)	A description of the local public health workforce training needs.
(4)	A description of how the local public health agency is accountable to the public in ensuring the provision of essential public health services and functions.
(5)	A description of how the local public health agency provides the necessary leadership to ensure that public health services are managed, monitored, and of the highest quality possible.
(6)	A description of how the local public health agency manages its finances and accounts for expenditures of State, local, and all other sources of revenue.
(7)	Identification of public and private sector partners.
(8)	A description of how the local public health agency will coordinate with the State public health agency and others within the local public health system to accomplish identified priorities.
(9)	Other matters necessary to effectively and efficiently provide essential public health services and functions by a local public health agency.
At the request of a county, the State public health agency shall provide technical assistance to the county in developing the priorities required under this subsection. Every county shall submit its priorities to the Secretary of Health and Human Services not later than January 1, 2004.
SECTION 2.(b)  Part 1 of Article 1 of Chapter 130A of the General Statutes, as amended by Section 1(c) of this act, is amended by adding the following new section to read:
"§ 130A-2.4.  State Plan for Public Health Services.
(a)	The Secretary shall develop and implement a State Plan for Public Health Services. The State Plan shall cover five years and shall be reviewed annually in consultation with the planning committee. Future plans shall be developed every five years. The State Plan shall address the following:(1)	The vision and mission of the State Public Health System.
(2)	Strategies for strengthening and maintaining stability of the public health infrastructure, including the following:
a.	Comprehensive planning and setting of priorities for the efficient and effective accomplishment of essential public health services and functions.
b.	Management standards for the State and local public health workforce that are tied to improvements in public health outcomes or other measures.
In developing strategies under this subdivision, the Secretary shall consult with and utilize national guidelines, initiatives, programs, and recommendations relating to improvements in public health infrastructure that are consistent with accomplishing the mission of public health in the State.
(3)	Strategies for strengthening the competencies of the State and local public health workforce, including performance standards, measures, and processes for quality or performance improvement that are accessible, affordable, and nonpunitive. These strategies shall include all of the following:
a.	Certification or credentialing programs that are consistent with any approved and recognized system of public health workforce certification or credentialing and that are designed to develop knowledge, skills, and abilities in relevant and contemporary public health practice areas.
1.	Basic, core, or technical competencies for public health workers;
2.	Professional codes for public health professionals.
b.	Continuing education or other tools for ongoing training of public health practitioners within the public health system.
c.	Minimal training requirements for individuals that provide essential public health services.
d.	Incentives to meet performance management or training requirements, including:
1.	Organizational accountability awards.
2.	Accreditation recognition for public health agencies or their contractors or volunteers.
3.	Certification or credentialing titles or recognition for individuals.
4.	Other career development initiatives, including financial benefits.
e.	A framework for the evaluation of the performance of the State and local public health agency workforce.
f.	Standards to evaluate the effectiveness and delivery of training programs, continuing education, and other tools.
(4)	Priorities and goals for the State Public Health System concerning public health outcomes and improvements. These priorities and goals shall reflect local public health agency priorities and goals and shall include the following:
a.	Identification and quantification of existing public health problems, disparities, or threats at the State and local levels.
b.	Identification of areas needing greater resource allocation to effectively combat public health threats or decrease disparities in the provision of essential public health services and functions.
c.	Goals for targeting essential public health services and functions to address prioritized public health problems, disparities, or threats through program development, implementation, and evaluation and specific recommendations, strategies, and schedules for meeting these goals.
d.	Identification of specific at-risk populations targeted, including criteria for identifying targeted populations.
e.	Goals for increasing the efficiency and effectiveness of the public health system and specific recommendations, strategies, and schedules for meeting these goals.
f.	Strategies for coordinating service delivery within the public health system.
g.	Measurable indicators of effectiveness and success.
h.	Identification of public and private sector partners.
(5)	A plan to identify resources to provide adequate funding to provide essential public health services and functions.
(6)	An organizational plan for the effective integration and monitoring of public health and environmental health services.
(7)	Provide a framework for local public health planning.
(b)	The Secretary shall develop the plan in consultation with the planning committee appointed by the Secretary.
SECTION 2.(c)  The Secretary of Health and Human Services shall appoint a planning committee to assist in the development of the State Plan for Public Health Services required by this act.  The planning committee shall include representatives of the Division of Public Health, the Division of Medical Assistance, and the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services in the Department of Health and Human Services, local health departments (including district health departments and rural and urban area health departments), boards of county commissioners, local boards of health, and consumers, appointed by the Secretary.  The planning committee shall also include four members of the General Assembly, two appointed by the President Pro Tempore of the Senate, and two appointed by the Speaker of the House of Representatives. The Secretary shall appoint the chair of the planning committee.  The Secretary shall provide to the Committee the priorities submitted by local public health agencies for consideration in the development of the State Plan for Public Health Services. The Secretary shall report to the Joint Legislative Health Care Oversight Committee on or before May 1, 2004, on the status of the State Plan for Public Health Services. The Secretary shall adopt a final plan no later than October 1, 2004.
SECTION 3.(a)  The lead sentence of G.S. 130A‑5 reads as rewritten:
"§ 130A‑5.  Duties of the Secretary.
…
"(a)	The Secretary shall have the authority:"
SECTION 3.(b)  G.S. 130A‑5, as amended by subsection (a) of this section, is amended by adding the following new subsection to read:
"(b)	The Secretary shall do the following:
(1)	Identify and provide leadership for the provision of essential public health services and functions.
(2)	Develop and provide effective training for members of the State and local public health workforce that is focused on performance-based standards.
(3)	Evaluate performance management standards and training efforts within State and local public health agencies.
(4)	Adopt and administer performance measurements within the public health system as a means of improving the quality of State and local public health practice and improving system accountability.
(5)	Adopt and administer State and local public health workforce certification or credentialing programs for members of public health agencies."
SECTION 4.  The Department of Health and Human Services shall do the following to prepare for the development and implementation of the State Plan for Public Health Services:
(1)	Ensure that local public health priorities required under Section 2(a) of this act are submitted no later than January 1, 2004.
(2)	In consultation with local public health agencies, the State public health agency shall adopt and administer an accreditation program. The accreditation program shall be uniformly applied to all local health agencies. The State public health agency shall provide technical assistance upon request to assist local health agencies obtain accreditation.
(3)	Review all rules currently in effect and adopted by the Commission for Health Services and the Secretary of Health and Human Services and identify rules that are inconsistent with this act.
(4)	Review all oversight and monitoring functions currently implemented for public health, including environmental health, with respect to the public health system to determine the effectiveness of the activities on achieving the intent of this act; improve the oversight and monitoring functions and activities, if necessary; and identify areas where additional training is needed and provide it; make recommendations for an organizational plan to improve effectiveness in the provision of public health and environmental health services consistent with this act.
(5)	Develop service standards, outcomes, and financing strategies necessary to implement this act.
(6)	Develop contractual agreements for the provision of technical assistance by the Department to local public health agencies in the development of local public health priorities.
(7)	Report to the Joint Legislative Health Care Oversight Committee on the Department's readiness to implement the State Plan for Public Health Services no later than May 1, 2004.
SECTION 5.  The Secretary may utilize new or existing resources during fiscal year 2003‑2004 to initiate the implementation of this act.
SECTION 6.  This act is effective when it becomes law.