BILL NUMBER: SB 269 CHAPTERED 09/28/00 CHAPTER 794 FILED WITH SECRETARY OF STATE SEPTEMBER 28, 2000 PASSED THE SENATE AUGUST 31, 2000 PASSED THE ASSEMBLY AUGUST 30, 2000 AMENDED IN ASSEMBLY AUGUST 29, 2000 AMENDED IN ASSEMBLY AUGUST 25, 2000 AMENDED IN ASSEMBLY AUGUST 7, 2000 AMENDED IN ASSEMBLY APRIL 24, 2000 AMENDED IN SENATE JANUARY 6, 2000 INTRODUCED BY Senators Ortiz and Leslie (Coauthor: Assembly Member Shelley) FEBRUARY 1, 1999 An act to amend Section 101230 of the Health and Safety Code, relating to public health administration, and making an appropriation therefor. (Approved by Governor September 28, 2000. Filed with Secretary of State September 28, 2000.) I am signing Senate Bill No. 269 with a reduction. This bill would set a funding allocation methodology for local communicable disease control and public health surveillance activities which are important public health functions. I included $1.6 million in the Budget Act of 2000 for local public health activities. Therefore, I am reducing the appropriation from $4.9 million to $1 million to be allocated on a proportional basis according to the formula in the bill. GRAY DAVIS, Governor LEGISLATIVE COUNSEL'S DIGEST SB 269, Ortiz. Local public health administration: state aid. Under existing law, state aid is provided to local health departments for purposes of public health administration, including for communicable disease control and community and public health surveillance activities. Under existing law, allocation of these funds is made to the administrative bodies of qualifying local health jurisdictions described as public health administrative organizations, and includes a basic allotment of $100,000 per local health jurisdiction or $0.212426630 per capita, whichever is greater. This bill would enact the "Public Health Improvement Act of 1999," which would make the allocation of these funds subject to the availability of funds in the annual Budget Act or some other act, appropriate $4,935,000 from the General Fund for this purpose, provide for a specified allocation of the funds appropriated, and would state related legislative intent. Appropriation: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. (a) This act shall be known and may be cited as the "Public Health Improvement Act of 1999." (b) The Legislature finds and declares as follows: (1) Local control of communicable diseases is a well recognized core public health function, comparable to the public safety mission of law enforcement. (2) The tools to battle communicable diseases are well known and time honored. These tools involve basic prevention, identification, and control efforts that result in a benefit to all in society. These tools include disease surveillance systems, diagnostic capabilities, disease intervention, health education, and a broad disease prevention program. (3) Local communicable disease control surveillance and reporting activities are the backbone of the state's communicable disease control efforts. Without an effective local reporting and surveillance system, control of communicable disease is not possible in California. (4) The local reporting and surveillance system is severely strained and underfunded. Scientific and professional capacity has not grown with the state's increasing population and complexity of problems. There are many instances where key medical and public health laboratory personnel have been reduced in local health departments. (5) The number of infectious diseases newly emerging or reemerging in California has increased sharply in just the past few years. Diseases including bloody diarrhea due to E. Coli 0157:H7, hantavirus pulmonary syndrome, Cyclospora, egg-associated salmonellosis, and bacterial infections resistant to all antibiotics have appeared within the last three years, in addition to the eight new sexually transmitted diseases recognized since 1980. Multiple drug resistant TB, and valley fever have reemerged as major health threats. (6) The federal Centers of Disease Control and Prevention and the United States Food and Drug Administration have both urged state action as a critical part of their emerging pathogens prevention strategy. The FDA has pointed out that only two states, Minnesota and Washington, are well prepared to identify and manage E. Coli 0157:H7 outbreaks. In fact, despite sporadic cases in contiguous California counties, it was Washington state that alerted California about the recent multistate outbreak initially attributed to raw apple juice. (7) A joint survey of local health departments conducted by the California Conference of Local Health Officers and the State Department of Health Services in 1998 determined that over 22 million dollars ($22,000,000) would have to be spent on basic scientific personnel to fill this gap in the capability to control and prevent the spread of disease. (8) In 1947, the Legislature allotted 3 million dollars ($3,000,000) to local health jurisdictions for the basic core disease prevention services. The current amount is seven hundred eight thousand dollars ($708,000). As a result, basic public health programs, such as communicable disease control and disease surveillance, have eroded. (9) Rural county health jurisdictions in California have a unique and chronic need for additional resources to provide basic disease prevention services. Rural health agencies currently operate under tightly constrained budgets. Nonetheless, rural health agencies are responsible for controlling infectious outbreaks covering vast geographic distances where accessible health facilities are few and far apart. Rural health agencies are under pressure from the special needs of resident populations and from the increasingly large demands placed upon rural health agencies by tourists and visitors to California's great natural or scenic recreational areas. (c) (1) It is therefore the intent of the Legislature that local geographically based prevention services be strengthened and enhanced in California to provide for communicable disease control and community health surveillance activities. (2) It is the further intent of the Legislature that, in conjunction with a proposal to enhance funding for an emerging infectious disease program at the state level, that the Legislature seek to enhance and strengthen the capability of local health jurisdictions to form a state-local system to control communicable disease and to closely monitor the health status of the state's population. SEC. 2. Section 101230 of the Health and Safety Code is amended to read: 101230. From the appropriation made for the purposes of this article, allocation shall be made to the administrative bodies of qualifying local health jurisdictions described as public health administrative organizations in Section 101185 in the following manner: (a) A basic allotment as follows: To the administrative bodies of local health jurisdictions a basic allotment of one hundred thousand dollars ($100,000) per local health jurisdiction or $0.212426630 per capita, whichever is greater, subject to the availability of funds appropriated in the annual Budget Act or some other act. The population estimates used for the calculation of the per capita allotment shall be based on the Department of Finance's E-1 Report, "City/County Population Estimates with Annual Percentage Changes" as of January 1 of the previous fiscal year. However, if within a county there are one or more city health jurisdictions, the county shall subtract the population of the city or cities from the county total population for purposes of calculating the per capita total. If the amounts appropriated are insufficient to fully fund the allocations specified in this subdivision, the State Department of Health Services shall prorate and adjust each local health jurisdiction's allocation using the same percentage that each local health jurisdiction's allocation represents to the total appropriation under the allocation methodology specified in this subdivision. (b) A per capita allotment, determined as follows: After deducting the amounts allowed for the basic allotment as provided in subdivision (a), the balance of the appropriation, if any, shall be allotted on a per capita basis to the administrative body of each local health jurisdiction in the proportion that the population of that local health jurisdiction bears to the population of all qualified local health jurisdictions of the state. (c) Beginning in the fiscal year 1998-99, funds appropriated for the purposes of this article shall be used to supplement existing levels of the services described in paragraphs (1) and (2) of subdivision (d) provided by qualifying participating local health jurisdictions. As part of a county's or city's annual realignment trust fund report to the Controller, a participating county or city shall annually certify to the Controller that it has deposited county or city funds equal to or exceeding the amount described in subdivisions (a) and (b) of Section 17608.10. The county or city shall not be required to submit any additional reports or modifications to existing reports to document compliance with this subdivision. Funds shall be disbursed quarterly in advance to local health jurisdictions beginning July 1, 1998. If a county or city does not accept its allocation, any unallocated funds provided under this section shall be redistributed according to subdivision (b) to the participating counties and cities that remain. (d) Funds shall be used for the following: (1) Communicable disease control activities. Communicable disease control activities shall include, but not be limited to, communicable disease prevention, epidemiologic services, public health laboratory identification, surveillance, immunizations, followup care for sexually transmitted disease and tuberculosis control, and support services. (2) Community and public health surveillance activities. These activities shall include, but not be limited to, epidemiological analyses, and monitoring and investigating communicable diseases and illnesses due to other untoward health events. (e) Funds shall not be used for medical services, including jail medical treatment, except as provided in subdivision (d). SEC. 3. (a) The sum of four million nine hundred thirty-five thousand dollars ($4,935,000) is hereby appropriated from the General Fund to the State Department of Health Services for allocation to administrative bodies of qualifying local health jurisdictions for purposes of implementing Section 101230 of the Health and Safety Code. (b) (1) Notwithstanding subdivision (a) of Section 101230 of the Health and Safety Code, the funds shall be allocated so that each jurisdiction receives one hundred thousand dollars ($100,000) or its allocation for the 1999-2000 fiscal year, whichever is greater. (2) Notwithstanding paragraph (1), if the funds appropriated are insufficient to completely implement paragraph (1), allocations shall be made pursuant to this paragraph. In the first instance, no jurisdiction shall receive less than its allocation for the 1999-2000 fiscal year. Secondly, for those jurisdictions for which the allocation pursuant to paragraph (1) would have been less than one hundred thousand dollars ($100,000), the allocation shall be reduced proportionately, by dividing the number of those jurisdictions by the funds remaining after the minimum allocations to all jurisdictions are made under this paragraph.