CERTIFICATION OF ENROLLMENT
ENGROSSED SECOND SUBSTITUTE HOUSE BILL 1152
Chapter 205, Laws of 2021
67th Legislature
2021 Regular Session
COMPREHENSIVE PUBLIC HEALTH DISTRICTS
EFFECTIVE DATE: July 25, 2021—Except for sections 3 through 6, which
take effect July 1, 2022.
Passed by the House April 15, 2021 CERTIFICATE
Yeas 60 Nays 37
I, Bernard Dean, Chief Clerk of the
House of Representatives of the
LAURIE JINKINS State of Washington, do hereby
Speaker of the House of certify that the attached is
Representatives ENGROSSED SECOND SUBSTITUTE HOUSE
BILL 1152 as passed by the House of
Representatives and the Senate on
the dates hereon set forth.
Passed by the Senate April 11, 2021
Yeas 26 Nays 22
BERNARD DEAN
DENNY HECK Chief Clerk
President of the Senate
Approved May 10, 2021 3:01 PM FILED
May 10, 2021
Secretary of State
JAY INSLEE State of Washington
Governor of the State of Washington
 ENGROSSED SECOND SUBSTITUTE HOUSE BILL 1152
AS AMENDED BY THE SENATE
Passed Legislature - 2021 Regular Session
State of Washington 67th Legislature 2021 Regular Session
By House Appropriations (originally sponsored by Representatives
Riccelli, Leavitt, Stonier, Ormsby, Lekanoff, Pollet, Bronoske, and
Bateman; by request of Office of the Governor)
READ FIRST TIME 02/22/21.
1 AN ACT Relating to supporting measures to create comprehensive
2 public health districts; amending RCW 70.05.030, 70.05.035,
3 70.46.020, and 70.46.031; adding a new section to chapter 43.70 RCW;
4 adding a new section to chapter 70.46 RCW; adding a new section to
5 chapter 43.20 RCW; creating a new section; and providing an effective
6 date.
7 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
8 NEW SECTION. Sec. 1. The legislature finds that everyone in
9 Washington state, no matter what community they live in, should be
10 able to rely on a public health system that is able to support a
11 standard level of public health service. Like public safety, there is
12 a foundational level of public health delivery that must exist
13 everywhere for services to work. A strong public health system is
14 only possible with intentional investments into our state's public
15 health system. Services should be delivered efficiently, equitably,
16 and effectively, in ways that make the best use of technology,
17 science, expertise, and leveraged resources and in a manner that is
18 responsive to local communities.
19 NEW SECTION. Sec. 2. A new section is added to chapter 43.70
20 RCW to read as follows:
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 1 (1) The public health advisory board is established within the
2 department. The advisory board shall:
3 (a) Advise and provide feedback to the governmental public health
4 system and provide formal public recommendations on public health;
5 (b) Monitor the performance of the governmental public health
6 system;
7 (c) Develop goals and a direction for public health in Washington
8 and provide recommendations to improve public health performance and
9 to achieve the identified goals and direction;
10 (d) Advise and report to the secretary;
11 (e) Coordinate with the governor's office, department, state
12 board of health, local health jurisdictions, and the secretary;
13 (f) Evaluate public health emergency response and provide
14 recommendations for future response, including coordinating with
15 relevant committees, task forces, and stakeholders to analyze the
16 COVID-19 public health response; and
17 (g) Evaluate the use of foundational public health services
18 funding by the governmental public health system.
19 (2) The public health advisory board shall consist of
20 representatives from each of the following appointed by the governor:
21 (a) The governor's office;
22 (b) The director of the state board of health or the director's
23 designee;
24 (c) The secretary of the department or the secretary's designee;
25 (d) The chair of the governor's interagency council on health
26 disparities;
27 (e) Two representatives from the tribal government public health
28 sector selected by the American Indian health commission;
29 (f) One member of the county legislative authority from a eastern
30 Washington county selected by a statewide association representing
31 counties;
32 (g) One member of the county legislative authority from a western
33 Washington county selected by a statewide association representing
34 counties;
35 (h) An organization representing businesses in a region of the
36 state;
37 (i) A statewide association representing community and migrant
38 health centers;
39 (j) A statewide association representing Washington cities;
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 1 (k) Four representatives from local health jurisdictions selected
2 by a statewide association representing local public health
3 officials, including one from a jurisdiction east of the Cascade
4 mountains with a population between 200,000 and 600,000, one from a
5 jurisdiction east of the Cascade mountains with a population under
6 200,000, one from a jurisdiction west of the Cascade mountains with a
7 population between 200,000 and 600,000, and one from a jurisdiction
8 west of the Cascade mountains with a population less than 200,000;
9 (l) A statewide association representing Washington hospitals;
10 (m) A statewide association representing Washington physicians;
11 (n) A statewide association representing Washington nurses;
12 (o) A statewide association representing Washington public health
13 or public health professionals; and
14 (p) A consumer nonprofit organization representing marginalized
15 populations.
16 (3) In addition to the members of the public health advisory
17 board listed in subsection (2) of this section, there must be four
18 nonvoting ex officio members from the legislature consisting of one
19 legislator from each of the two largest caucuses in both the house of
20 representatives and the senate.
21 (4) Staff support for the public health advisory board, including
22 arranging meetings, must be provided by the department.
23 (5) Legislative members of the public health advisory board may
24 be reimbursed for travel expenses in accordance with RCW 44.04.120.
25 Nonlegislative members are not entitled to be reimbursed for travel
26 expenses if they are elected officials or are participating on behalf
27 of an employer, governmental entity, or other organization. Any
28 reimbursement for other nonlegislative members is subject to chapter
29 43.03 RCW.
30 (6) The public health advisory board is a class one group under
31 chapter 43.03 RCW.
32 Sec. 3. RCW 70.05.030 and 1995 c 43 s 6 are each amended to read
33 as follows:
34 ((In counties without a home rule charter, the board of county
35 commissioners shall constitute the local board of health, unless the
36 county is part of a health district pursuant to chapter 70.46 RCW.
37 The jurisdiction of the local board of health shall be coextensive
38 with the boundaries of said county. The board of county commissioners
39 may, at its discretion, adopt an ordinance expanding the size and
p. 3 E2SHB 1152.SL
 1 composition of the board of health to include elected officials from
2 cities and towns and persons other than elected officials as members
3 so long as persons other than elected officials do not constitute a
4 majority. An ordinance adopted under this section shall include
5 provisions for the appointment, term, and compensation, or
6 reimbursement of expenses.))
7 (1) Except as provided in subsection (2) of this section, for
8 counties without a home rule charter, the board of county
9 commissioners and the members selected under (a) and (e) of this
10 subsection, shall constitute the local board of health, unless the
11 county is part of a health district pursuant to chapter 70.46 RCW.
12 The jurisdiction of the local board of health shall be coextensive
13 with the boundaries of the county.
14 (a) The remaining board members must be persons who are not
15 elected officials and must be selected from the following categories
16 consistent with the requirements of this section and the rules
17 adopted by the state board of health under section 8 of this act:
18 (i) Public health, health care facilities, and providers. This
19 category consists of persons practicing or employed in the county who
20 are:
21 (A) Medical ethicists;
22 (B) Epidemiologists;
23 (C) Experienced in environmental public health, such as a
24 registered sanitarian;
25 (D) Community health workers;
26 (E) Holders of master's degrees or higher in public health or the
27 equivalent;
28 (F) Employees of a hospital located in the county; or
29 (G) Any of the following providers holding an active or retired
30 license in good standing under Title 18 RCW:
31 (I) Physicians or osteopathic physicians;
32 (II) Advanced registered nurse practitioners;
33 (III) Physician assistants or osteopathic physician assistants;
34 (IV) Registered nurses;
35 (V) Dentists;
36 (VI) Naturopaths; or
37 (VII) Pharmacists;
38 (ii) Consumers of public health. This category consists of county
39 residents who have self-identified as having faced significant health
40 inequities or as having lived experiences with public health-related
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 1 programs such as: The special supplemental nutrition program for
2 women, infants, and children; the supplemental nutrition program;
3 home visiting; or treatment services. It is strongly encouraged that
4 individuals from historically marginalized and underrepresented
5 communities are given preference. These individuals may not be
6 elected officials and may not have any fiduciary obligation to a
7 health facility or other health agency, and may not have a material
8 financial interest in the rendering of health services; and
9 (iii) Other community stakeholders. This category consists of
10 persons representing the following types of organizations located in
11 the county:
12 (A) Community-based organizations or nonprofits that work with
13 populations experiencing health inequities in the county;
14 (B) Active, reserve, or retired armed services members;
15 (C) The business community; or
16 (D) The environmental public health regulated community.
17 (b) The board members selected under (a) of this subsection must
18 be approved by a majority vote of the board of county commissioners.
19 (c) If the number of board members selected under (a) of this
20 subsection is evenly divisible by three, there must be an equal
21 number of members selected from each of the three categories. If
22 there are one or two members over the nearest multiple of three,
23 those members may be selected from any of the three categories.
24 However, if the board of health demonstrates that it attempted to
25 recruit members from all three categories and was unable to do so,
26 the board may select members only from the other two categories.
27 (d) There may be no more than one member selected under (a) of
28 this subsection from one type of background or position.
29 (e) If a federally recognized Indian tribe holds reservation,
30 trust lands, or has usual and accustomed areas within the county, or
31 if a 501(c)(3) organization registered in Washington that serves
32 American Indian and Alaska Native people and provides services within
33 the county, the board of health must include a tribal representative
34 selected by the American Indian health commission.
35 (f) The board of county commissioners may, at its discretion,
36 adopt an ordinance expanding the size and composition of the board of
37 health to include elected officials from cities and towns and persons
38 other than elected officials as members so long as the city and
39 county elected officials do not constitute a majority of the total
40 membership of the board.
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 1 (g) Except as provided in (a) and (e) of this subsection, an
2 ordinance adopted under this section shall include provisions for the
3 appointment, term, and compensation, or reimbursement of expenses.
4 (h) The jurisdiction of the local board of health shall be
5 coextensive with the boundaries of the county.
6 (i) The local health officer, as described in RCW 70.05.050,
7 shall be appointed by the official designated under the provisions of
8 the county charter. The same official designated under the provisions
9 of the county charter may appoint an administrative officer, as
10 described in RCW 70.05.045.
11 (j) The number of members selected under (a) and (e) of this
12 subsection must equal the number of city and county elected officials
13 on the board of health.
14 (k) At the first meeting of a district board of health the
15 members shall elect a chair to serve for a period of one year.
16 (l) Any decision by the board of health related to the setting or
17 modification of permit, licensing, and application fees may only be
18 determined by the city and county elected officials on the board.
19 (2) A local board of health comprised solely of elected officials
20 may retain this composition if the local health jurisdiction had a
21 public health advisory committee or board with its own bylaws
22 established on January 1, 2021. By January 1, 2022, the public health
23 advisory committee or board must meet the requirements established in
24 section 7 of this act for community health advisory boards. Any
25 future changes to local board of health composition must meet the
26 requirements of subsection (1) of this section.
27 Sec. 4. RCW 70.05.035 and 1995 c 43 s 7 are each amended to read
28 as follows:
29 ((In counties with a home rule charter, the county legislative
30 authority shall establish a local board of health and may prescribe
31 the membership and selection process for the board. The county
32 legislative authority may appoint to the board of health elected
33 officials from cities and towns and persons other than elected
34 officials as members so long as persons other than elected officials
35 do not constitute a majority. The county legislative authority shall
36 specify the appointment, term, and compensation or reimbursement of
37 expenses. The jurisdiction of the local board of health shall be
38 coextensive with the boundaries of the county. The local health
39 officer, as described in RCW 70.05.050, shall be appointed by the
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 1 official designated under the provisions of the county charter. The
2 same official designated under the provisions of the county charter
3 may appoint an administrative officer, as described in RCW
4 70.05.045.))
5 (1) Except as provided in subsection (2) of this section, for
6 home rule charter counties, the county legislative authority shall
7 establish a local board of health and may prescribe the membership
8 and selection process for the board. The membership of the local
9 board of health must also include the members selected under (a) and
10 (e) of this subsection.
11 (a) The remaining board members must be persons who are not
12 elected officials and must be selected from the following categories
13 consistent with the requirements of this section and the rules
14 adopted by the state board of health under section 8 of this act:
15 (i) Public health, health care facilities, and providers. This
16 category consists of persons practicing or employed in the county who
17 are:
18 (A) Medical ethicists;
19 (B) Epidemiologists;
20 (C) Experienced in environmental public health, such as a
21 registered sanitarian;
22 (D) Community health workers;
23 (E) Holders of master's degrees or higher in public health or the
24 equivalent;
25 (F) Employees of a hospital located in the county; or
26 (G) Any of the following providers holding an active or retired
27 license in good standing under Title 18 RCW:
28 (I) Physicians or osteopathic physicians;
29 (II) Advanced registered nurse practitioners;
30 (III) Physician assistants or osteopathic physician assistants;
31 (IV) Registered nurses;
32 (V) Dentists;
33 (VI) Naturopaths; or
34 (VII) Pharmacists;
35 (ii) Consumers of public health. This category consists of county
36 residents who have self-identified as having faced sign