Public Health Agency Structure, Organization and Accreditation

Latest Resource for Public Health Agency Structure, Organization and Accreditation

Resource: Intergovernmental Cooperation Agreements Map

To reduce costs and meet increased demand for services, many local health departments (LHDs) are exploring innovative ways to improve efficiency by partnering with other LHDs, agencies and entities. This 50-state resource examines the interlocal agreements that permit LHDs to collaborate with other entities to provide health and other services.

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From the Legal Assistance Library

Preemption and Restricting Tobacco Sales to Minors

A local health department in Maryland recently asked the Network for guidance on whether state law preempted a local ordinance restricting the sale of tobacco products to minors. The issue isn’t simple or clear. While the State has the authority to preempt or preclude local jurisdictions from enacting local laws dealing with the same issue, this does not mean that counties cannot regulate in an area just because the State already has enacted a law on that issue. 

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Primary Legal Issues

State and local public health agencies, boards of health and other stakeholders often need legal assistance to address numerous legal and policy questions regarding changing organizational structures. They also need a strong legal and policy foundation to support participation in accreditation programs. Examples of health agency structure and accreditation questions:

  • What are the legal implications of different models of shared service delivery?
  • What legal changes may be needed within a particular state for jurisdictions to have the necessary legal authority to share the delivery of public health services?
  • What are the advantages and disadvantages of various legal and policy arrangements to support shared service delivery, such as memoranda of understanding, contracts or other documentation to permit local heath jurisdictions to share personnel and other resources?
  • How will issues concerning data sharing and privacy be addressed by collaborating organizations?
  • How do state inter-local agreement acts assist or limit the flexibility of local agencies to share service delivery across jurisdictions?
  • Would changing departmental organizational structure affect billing and reimbursement?
  • How does the Affordable Care Act affect restructuring decisions?
  • What legal considerations exist in the creation of backbone organizations to support new collaborations such as community coalition partnerships, cross-jurisdictional sharing activities, community health needs assessment initiatives and Accountable Care Organizations?
  • Will changes be needed in a state’s existing laws to align state-based accreditation programs with the national program?
  • How can legal approaches assist with accreditation funding issues and options?

Technical Assistance Capacity

Network attorneys are able to provide legal technical assistance and training on issues related to the structure and organization of local health agencies. The Network and its partners have extensive experience with reimbursement and payment programs as well as expertise regarding the Affordable Care Act. Additionally the Network has also developed expertise in legal structures supporting current state-based accreditation programs. Case studies developed by the Network and its partners provide lessons learned from states that implemented accreditation through three distinct legal structures: policy implementation, formal rule making (regulation) and statute.

For legal assistance and support on public health agency structure, organization and accreditation:


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The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided does not constitute legal advice or legal representation. For legal advice, please consult specific legal counsel. For more information on the type of legal assistance the Network can provide, please see frequently asked questions.