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Cross-Jurisdictional Sharing and the Law

posted on Fri, Mar 27 2015 11:38 am by Andy Baker-White

Cross-jurisdictional sharing (CJS) can be an effective way for public health and other agencies to address increasing demands for services with limited resources. For example, health departments in different jurisdictions can share laboratory or inspection services. 

The Center for Sharing Public Health Services, a national initiative funded by the Robert Wood Johnson Foundation and managed by the Kansas Health Institute, is a resource for public health practitioners, policymakers, and communities on the cross-jurisdictional sharing  of public health services by local, state, and tribal public health agencies and organizations. The Center’s goals are to build the evidence of CJS as well as develop and distribute CJS tools, methods, and models for those who are debating and implementing CJS approaches.

Earlier this year, the Center’s Shared Services Learning Community (SSLC) celebrated two years of exploring, implementing and improving CJS arrangements. The SSLC, comprised of 16 teams in 14 states, served as a learning laboratory and provided real world CJS experiences that the Center collected and analyzed. The Center provided technical assistance and the opportunity for the SSLC to share lessons learned and understandings.

A quick look at the work of the SSLC teams reveals how integral law is to CJS arrangements. The work of the teams from Michigan, New York, and Nevada (Carson City and Douglas County) illustrates the use of law.

The Michigan team, comprised of six local health departments, explored the ways under state law by which the team members could strengthen existing collaboration into a more formalized arrangement. By using existing statutory authority the Michigan team members entered into a memorandum of understanding to create the Northern Michigan Public Health Alliance to “develop, implement, and sustain models of shared public health services that increase capacity, contain costs, maximize assets, and more effectively impact health outcomes.” One of the key observations the Center made about the Michigan team’s Public Health Alliance is that the alliance creates a unified voice for team members, allowing them to participate in other efforts, such as hospital and community health planning as well as accountable care organizations.

The New York SSLC team, made up of two rural counties, Orleans and Genesee Counties, explored ways the county health departments could jointly hire key health department personnel. New York State law allows three or fewer counties with a population of less than 150,000 to share a public health director with the approval of the New York State Commissioner of Health. The New York team members were able to use this law to enter into an agreement to share a public health director and other key leadership positions. Analysis of the team’s work was presented at the 2014 American Public Health Association Annual Meeting and revealed that the sharing arrangement resulted in a savings to the two counties of over $400,000.  Also, during the team’s site visit the Center observed that the County Administrators for each of the two counties agreed that they are providing more effective services working jointly than either could have alone.

For the Nevada - Carson City and Douglas County team, a recent change to Nevada law prompted an exploration of the sharing of environmental health services (e.g., inspections of restaurants, bars, pools, septic systems, schools, child care facilities, jails, hotels, motels, spas, and RV parks). In 2011, a new Nevada law required counties to pay an assessment to the Nevada Division of Public and Behavioral Health (DPBH) for the provision of certain services, including environmental health services. Counties can request an exemption from the assessment if they provide their own services or purchase the services elsewhere. Using the new law, Carson City and Douglas County received approval from the state government and contracted with Carson City Health and Human Services to provide environmental health services in Carson City and Douglas County. Key lessons learned from the Nevada – Carson City and Douglas County experience include the importance of specifically and strategically communicating with policy makers and the way to use pre-existing, informal relationships to build more formal CJS arrangements.

A final example of the use of statutory authority to implement CJS is how the SSLC teams from New York and Nevada used their state’s intergovernmental cooperation agreements law to achieve their CJS arrangements. The intergovernmental cooperation agreements laws authorize the team members to enter into agreements with each other to provide or share public health services. Most states have such laws and further information about them can be found at the Network’s Intergovernmental Cooperation Agreements Map. To learn more about the Center for Sharing Public Health Services’ SSLC teams and CJS resources please visit the Center’s Website. If you have questions about the legal aspects of CJS please feel free to contact the Network.

This blog post was prepared by Andy Baker-White, J.D., M.P.H., associate director for the Network for Public Health Law – Mid-States Region at the University of Michigan School of Public Health. 

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.

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