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Home My WebLink About2025_09_18_BOH_Packet_Amendedr 7 �e�vcson Public Healt Board of Health Meeting September 18, 2025 Jefferson County Board of Health Agenda Minutes / Public H AOUF September 18, 2025 -f AM I--" Sl�1 V C Regular Meeting Agenda Jefferson County Board of Health Thursday, September 18, 2025 @ 2:30 PM Jefferson County Courthouse — Commissioners' Chambers 1820 Jefferson Street, Port Townsend, WA To view agenda items and meeting materials, click here: www.co.jefferson.wa.us — Services — Laserfiche Web Portal (usemame and password is: public) — Health — Agendas —Minutes —Packets — Board of Health Documents (then search by date: yyyy_mm_dd) To view public comments received, www.co.jefferson.wa.us — Services — Laserfiche Web Portal (username and password is: public) — Health — BOH Public Comments (search for folder of comments by date, year first) This is a hybrid meeting: Virtual and In -Person Attendance You can join this meeting by using these methods: ■ Zoom Meeting: httpLts06web-zoom.us/i 82378389363 This option will allow you to join the meeting live. You will need to enter an email address. If you wish to provide public comment, click on the hand icon at the bottom of the screen to "raise your hand." Participation will be up to the Chair and/or Clerk of the meeting. • Audio -only: Dial: 1-253-215-8782 and use Webinar ID: 823 7838 9363# This option will allow you to listen to the meeting live. If you wish to provide public comment, press *9 to "raise your hand." Participation will be up to the Chair and/or Clerk of the meeting. ■ In -Person: You are welcome to join the meeting in -person. In the event of technical difficulties, at least one of the methods above will be accessible to the public. Please try all methods first before calling 360-385-9100 to report any issues. Public comment will be accepted and can be emailed to: BOHraico jefferson.wa.us until 5:00 PM the evening prior to the start of the meeting. I:T" Do�I-In CALL TO ORDER — Chair Grace I. Public Comment (10 mins.) Public Comment Periods are dedicated to listening to the public. Each person may address the Board one time during these periods. To ensure equal opportunityfor the public to comment, all comments shall be limited to 2 or 3 minutes per person, depending on the volume of public in attendance. AT A REGULAR MEETING, THE MEMBERS MAY ADD AGENDA ITEMS AND TAKE ACTION ON OTHER ITEMS NOT LISTED ON THIS AGENDA. Americans with Disabilities Act (ADA) Accommodations Provided Upon Request II. Approval of Agenda III. Approval of Minutes of August 21, 2025 Board of Health Meeting IV. Old Business and Information Reports 1. Jefferson County Public Health (JCPH) Report (Apple Martine) (5 mins.) 2. Jefferson Healthcare Report (Dr. Kees Kolff) (10 mins.) 3. Infectious Diseases Update (Dr. Allison Berry) (15 mins.) V. New Business 1. Proclamation re Septic Smart Week (5 mins.) 2. Public Hearing Notice for a Public Hearing before the BOH on October 16 in re: Amendment to JCC 8.15.055(7) Exemption from the Annual Operations & Maintenance Fee (Carter Erickson, Ariel Speser) (20 mins.) 3. Rising Costs and SRH Clinic Fee Increases (Dr. Berry, Apple Martine) (45 mins.) VI. Future Potential Agenda Topics: Public Hearing in the Matter of Amending Jefferson County Ordinance No. 02-0220-25, Section 8.15.055(7) Local Management Plan for On -Site Sewage of the Jefferson County Code (JCC), Addressing the Exemption from the Annual Operations & Maintenance Fee (October meeting) Successes of Public Health Tobacco/Cannabis Prevention Program mini -grants (October) Award of Certificate of Completion for JCPH Summer Intern (October) The County Strategic Plan Salish Behavioral Health Administrative Services Organization Opioid Settlement spending Olympic Connect, the Community Care Hub model Board of Health 101 Homelessness Public Health Impacts resulting from Federal Initiatives Rural Reproductive Health Emergency Fund for Public Health The Child Development Center Sewer projects / wastewater AT A REGULAR MEETING, THE MEMBERS MAY ADD AGENDA ITEMS AND TAKE ACTION ON OTHER ITEMS NOT LISTED ON THIS AGENDA. Americans with Disabilities Act (ADA) Accommodations Provided Upon Request VII. Announcements ADJOURNMENT BY: 4:30 p.m. Next Scheduled Meeting: October 16, 2025 2:30 — 4:30 PM Jefferson County Public Health Hybrid Meeting AT A REGULAR MEETING, THE MEMBERS MAY ADD AGENDA ITEMS AND TAKE ACTION ON OTHER ITEMS NOT LISTED ON THIS AGENDA. Americans with Disabilities Act (ADA) Accommodations Provided Upon Request n �Lt6uon (oq;cbu„d, Public Health REGULAR MEETING MINUTES Jefferson County Board of Health Thursday, August 21, 2025 @ 2:30 p.m. Jefferson County Courthouse — Commissioners' Chambers 1820 Jefferson Street, Port Townsend, WA Hybrid Meeting Board Members Greg Brotherton, County Commissioner, District #3 Heather Dudley-Nollette, County Commissioner, District #1 Celeste Dybeck, Tribal Representative Heidi Eisenhour, County Commissioner, District #2 Amanda Grace, Chair, Community Stakeholder Dr. Kees Kolff, Public Hospital District #2 Commissioner Monica MickHager, Vice -Chair, Port Townsend City Council Gabrielle Vanwert, Consumer of Public Health Staff Members Denise Banker, Community Health Director Dr. Allison Berry, Health Officer Lara Cittadini, CHIP Manager Michael Dawson, Water Quality Manager Carter Erickson, Environmental Health Manager Apple Martine, Public Health Director Pinky Mingo, Environmental Public Health Director Jenn Mitchell, Finance Manager Veronica Shaw, Public Health Deputy Director Chair Grace called the August 21, 2025 meeting of the Jefferson County Board of Health to order at 2:32 p.m. Members Present: Chair Amanda Grace, Members Greg Brotherton, Heather Dudley-Nollette, Celeste Dybeck, Heidi Eisenhour, Dr. Kees Kolff, Monica MickHager and Gabrielle Vanwert. Staff Present: Staff Members Dr. Allison Berry, Carter Erickson, Apple Martine, and Pinky Mingo. PUBLIC COMMENT Chair Grace called for public comment. Commenter expressed concern for the sometimes sharply increased Public Health fees and the burdensome effect they will have on the most vulnerable in the community. Commenter urged the Board to review the fees. Board member MickHager queried whether it would be possible to have a more in-depth discussion of Public Health fees at a later meeting. Staff member Martine proposed an agenda item for the September Board meeting, and provided a brief discussion of factors figuring into the raised fees. APPROVAL OF AGENDA Chair Grace called for a motion to accept the agenda for September 18, 2025. MOTION: Member Eisenhour moved to approve the agenda. Member Dudley-Nollette seconded the motion, which carried by a unanimous vote. Respectfully submitted Page 1 of 3 G. Gilbert APPROVAL OF MINUTES Chair Grace requested a motion to approve the minutes of the July 17, 2025 meeting. MOTION: Member Dudley-Nollette moved to approve the minutes. Member Eisenhour seconded the motion, which carried (Chair Grace and Member Kolff abstained, as they did not attend the July 17 meeting). OLD BUSINESS AND INFORMATIONAL ITEMS 1. Jefferson County Public Health (JCPH) Report Staff member Martine announced the approaching end of budget season and described some of the complexities to Public Health budgeting. Staffing was also touched upon, as were various events and trainings. 2. Jefferson Healthcare Report Member Kolff described the progress of the new hospital build -out — ribbon cutting in September, hiring of new medical specialists going well, the hospital cafe to open to the public in September. Olympic Medical Center has hired an interim CEO and is partnering with University of Washington to assure OMC's survival. 3. Infectious Diseases Update Dr. Berry announced a summer surge of COVID (nationally and locally) with some severe cases, with young children more vulnerable, as well as elders and those with underlying conditions; boosters are recommended, particularly for those high risk groups. Infants are at particular high because they have under -developed immune systems and have not been exposed to COVID-19 the way the rest of the community has. Pertussis is present in the community, as is vibrio (transmitted by raw oysters). Malaria appeared in Pierce County (not here). Measles is not present in the community and is downtrending nationally. The best way for us all to reduce the likelihood of a future outbreak here is to be sure that we and our families are up to date on our measles vaccinations. NEW BUSINESS MOTION: Member MickHager moved that New Business 1 and 2 be taken in reverse order, to allow Dr. Berry to segue into further discussion of vaccines. Member Dudley-Nollette seconded the motion, which carried by a unanimous vote. 2. Vaccines Access and Recommendations, in light of recent federal changes (Dr. Berry) Federal Secretary of Health Kennedy unilaterally removed COVID from the vaccine schedules for children and those who are pregnant; the former experienced members of ACIP — the board who determined vaccine schedules, were replaced by new and unqualified members. In response, law suits are pending, brought by major medical groups. A group of infectious disease experts have formed called the Vaccine Integrity Project. They have reviewed the available evidence around the fall vaccines and have found that they remain as safe and effective as ever. Their deliberations are publicly available and can be viewed online. The past year there was an untick in influenza death among children, mostly unvaccinated. Major medical associations, universities and independent scientists are doing their best to spread accurate information, to counterbalance the influence of governmental appointees who were hired for willingness to spread misinformation. Currently, we don't know what vaccines will be available in the fall. Dr. Berry recommends vaccines for COVID-19 and influenza for everyone 6 months and up, and RSV for individuals at risk (babies, pregnant people, and the elderly) who have not been vaccinated in prior years. No issues are anticipated with influenza and RSV, but the federal government is messing with COVID. Medical associations and state governments are working hard to push back with accurate information and efforts to improve access, including the possibility of a standing order for the vaccine pressuring insurance companies to pay for vaccines. Respectfully submitted Page 2 of 3 G. Gilbert Dr. Berry responded to questions about shingles virus and vaccine. The shingles vaccine is recommended for everyone 50 years of age and older, and those who are immunocompromised, including those who have had prior cases of shingles. 1. New Schools Health and Safety Inspection Program (Hal -Wayne Woodward, Carter Erickson) Presenters introduced a program to improve environmental health and safety of Jefferson County schools, which will involve periodic inspections of schools looking at playground safety, classroom lighting, art and science (chemical safety), noise and lighting, indoor air quality and other issues. Discussion ensued, particularly in regard to air quality monitoring. 3. Environment and Energy ("E&E") Committee Tour (Chair Grace, Pinky Mingo) Presenters described offering a tour of the city water treatment plant to members of the E&E Committee. 4. Septic Smart Week (Chair Grace, Carter Erickson) Presenters announced an EPA event intending to educate septic system owners about taking care of their systems and being responsible. The Governor has issued a proclamation recognizing Septic Smart Week, September 14t` thru 19t', which corresponds with the next Board of Health meeting and also with Public Health's Homeowner Education Classes (classes being September 11t' and 25' and October 2nd ) No discussion. FUTURE POTENTIAL AGENDA TOPICS ANNOUNCEMENTS Mid -September will also bring (national) Diaper Needs Awareness Week (September 15 to 21), during which Public Health will host a "diaper drive" in its parking lot (September 2 thru 31). Discussion ensued. AGENDA PLANNING CALENDAR The Agenda Planning Meeting for the next regular meeting of the Board will be held on September 11, 2025 at 10:30 a.m. The next regular Board of Health meeting will be held as a hybrid meeting on Thursday, September 18, 2025 from 2:30 p.m. — 4:30 p.m. ADJOURNMENT Chair Grace adjourned the August 21, 2025 Jefferson County Board of Health meeting at 3:59 p.m. until the next Regular Meeting or Special Meeting as properly noticed. JEFFERSON COUNTY BOARD OF HEALTH Amanda Grace, Chair ado � Respectfully submitted G. Gilbert Glenn Gilbert, Pub . Health Assistant Page 3 of 3 Jefferson County Board of Health IV. Old Business and Information Reports Item 1 Jefferson County Public Health Report [No hand-out] k ,aeJtason Public H September 183 2025 it Jefferson County Board of Health w Old Business and Information Reports Item 2 Jefferson Healthcare Report Public H September 18, 2025 g r yr� I 1_q!_ r �,hvt f ilk Clockwise from top left: • 1890 St. Johns.. Sisters of Providence • 1929 addition • 1965 addition • 1995 addition 2016 addition • 2025 addition $250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000 $- 2014 Growth is Essential to Survival 117N 2015 2016 2017 2018 2019 137M M 2020 2021 2022 204M 161 M 2023 2024 2025 Budgeted je, fersm Healthcare Aaron says Sept 22nd for the public Hospital Shortfalls 2021- 2024 $o $1 billion $2 billion Hospital operations shortfalls 2021 2022 2023 2024 -$2.1 billion INIIMMI■ Smicr.WWNWd/ haViSoemRnmiddSurve�%2021 Zw4r4xe nthg9A6ofkuuWbed HR1 Affects on Jefferson Healthcare • Safety Net Assessment Program (SNAP) will reduce by 10% a year, starting 2027 - a $250K per year hit for JH • Jefferson County will lose 3-4,000 Medicaid enrollees. • There will be a $2-3 million increase in bad debt/charity care NOTE: We already provide $11.2 million of free care, which is about 25x our total local property tax allocation, which is about $500K and covers less than 1 day of operating budget • Increase in difficult to discharge patients due to decrease in funding to long term care facilities and other important services. je&rson Healthcare Who Is,eligible for charity care? Family Size 0% - 200% of Federal Poverty Line 201% - 300% of Federal Poverty Line 301% - 400% of Federal Poverty Line 1 $31, 300 $46, 950 $62, 600 2 $42, 300 $63,450 $84, 600 3 $53,300 $79,950 $106,600 $64,300 $96,450 $128,600 5 $75,300 $112,950 $1502600 Reduction in payments: 100% bill reduction 75% bill reduction 50% bill reduction More Creative Alliances and Partnerships • The PHA proposal sent to OMC is a great example • PHA proposal in Feb 2025 was our response to an RFP in fall of 2024 • Was developed by the entire leadership team at JH • ND/Confidentiality Agreements signed by Mike Glenn were required • These were not binding agreements, a standard business practice • OMC has selected UW as the potential partner from 4 finalists • The LOI with UW signed in September 2025, also not binding • Now the details get worked out in public, and we wish them well! Kees' org chart of the brilliant PHA proposal February 2025 Pq 4 D Wt- '�-- SED2-uICE S (z 5 ��►� Aso How Can You Help? • Attend our Board meetings • Let us know how we are doing • Get your care here whenever possible • Consider us as your primary care provider • Spread the word about our services • Support our need for more local revenue when the time comes r,!genon Healthcare Public Hospital District Tax Support, 2023 Hospital District 2023 Operating 2023 Tax revenues Property tax revenues as expenses % of operating expenses Whidbey Health $135,840,455 $16,769,630 12.35% Coupeville Olympic Medical $261,180,187 $5,175,807 1.98% Center, P.A. Island Hospital $118,995,363 $5,999,330 5.04% Anacortes Mason General $128,254,400 $2,444,828 1.91% Hospital, Shelton Jefferson $170,565,097 $531,604 0.31% Healthcare, P.T. J!!F rson Healthcare Tax Distribution Tax Area Code: 011 0 STATE SCHOOL PART 1 STATE SCHOOL PART 2 COUNTY CURRENT EXPENSE DEVELOPMENTAL DISABILITIES MENTAL HEALTH VETERANS RELIEF CONSERVATION FUTURES CITY OF PT - LIBRARY LID LIFT CITY OF PT GENERAL CITY OF PT MV BOND PORT OF PT GENERAL PORT OF PT IDD 2019 PLID #1 GENERAL HOSP DIST #2 GENERAL SCHOOL DIST #50 BOND 2016 SCHOOL DIST #50 CAP PRO. SCHOOL DIST #50 EP & O FIRE DIST #1 GENERAL FIRE DIST #1 EMS A $28.41 is 0.640/o of my 2024 property taxes 740.56 397.26 478.60 2.75 2.75 2.78 14.60 213.60 455.39 26.69 60.12 220.11 392.49 643.77 245.90 4406.69 c - Total Levy Rate per $1006:. 8.96042'14329 Voted Levy Rate: 1.9260812382 Voted Levy Amount: - 947.24 Questions and Discussion Jefferson County Board of Health IV. Old Business and Information Reports Item 3 Infectious Diseases Update [No hand-out] f tehson Public H September 18, 2025 Jefferson County Board of Health V. New Business Item 1 Proclamation re Septic Smart Week V ;ffe&son Public H September 18, 2025 PROCLAMATION SEPTICSNIART WEEK WHEREAS, proper septic system use and routine care are vital to protecting public health, preserving our highly valued groundwater, lakes, streams and waterways, and avoiding costly repairs that can result from neglect; and WHEREAS, there are 11,397 septic systems in Jefferson. County that treat wastewater from homes and businesses; and WHEREAS, wastewater professionals of Jefferson County use their expertise in the design, installation, maintenance and regulation of septic systems in Jefferson County; and WHEREAS, the U.S. Environmental Protection Agency's SepticSmart program used by Jefferson County health officials educates homeowners about the need for proper septic system use and routine maintenance; and WHEREAS, residents and the environment of Jefferson County benefit from properly designed, installed, operated, and maintained septic systems; NOW, THEREFORE, the Jefferson County Board of County Commissioners hereby proclaims the week of September 15th through September 19th. 2025, as SEPTICSNIART WEEK PROCLAIMED this 151h day of September, 2025. 4�ERSDry 'c'•. o SEAL: ❑�Ayc ATTEST: Carolyn 11away. CMC. Clerk- the Board :RSON COUNTY tq OF COMMISSIONERS Chair ml� ollette, Member Member Jefferson County Board of Health 0 New Business Item 2 Public Hearing Notice for a Public Hearing before the BOH on October 16 in re: Amendment to JCC 8.15.055(7) Exemption from the Annual Operations &Maintenance Fee f f ehsa Public Health September 18, 2025 "'.=^ac _. •�,r.'s ;SFr u' ....R{!� ly NI l 1 mil. r='y•t s �+t:7' �1-. ��l •dV�s',�+�r'- .r�r .+m'�r: s: �%.�"°�'.,'�. VET ... i L47 Board of Health Amendments to On -Site Sewage Code Workshop September 18, 2025 Carter Erickson, Environmental Health Manager Ariel Speser, Civil DPA On -Site Sewage Code Annual Fee &Proposed Agenda Public Process � Next Steps �� Questions Amendments On -Site Sewage Code September 18. 2025 Chapter 8.15 ON -SITE SEWAGE CODE Sections: 8.15.010 Authority - Scope. 8.15.020 Purpose. 8.15.030 Adoption by reference. 8.15.040 Administration. 8.15.043 Director authorized to establish administrative rules and policy. 8.15.050 Definitions and rules of construction. 8.15.055 Local management plan. 8.15.060 Adequate sewage disposal required. 8.15.065 Areas where OSS may pose a significant risk to public health. 8.15.070 No discharge to surface water or ground surface. 8.15.075 Minimum land area requirements. 8.15.080 OSS permit required. 8.15.081 OSS permit for repair or replacement. 8.15.082 Pending OSS application or permit - Transferability, extension, and cancellation. 8.15.083 OSS permit expiration and partial installation. 8.15.084 Revocation of issued OSS permit or denial of OSS permit application. 8.15.085 Operational permits. 8.15.090 Design requirements for all OSS. 8.15.095 Commercial OSS. 8.15.100 Community OSS. N September 18, 2025 4 P, Annual Fee & Proposed Amendments September 18, 2025 •Section 8.15.055 Local management plan •The purpose of the annual O&M Fee is to fund the Operation and Maintenance program, which maintains an inventory of all known OSS in operation in Jefferson County and identifies OSS that pose an increased risk to public health. •The O&M Fee was established in 2016 under Ordinance # 05- 1103-16. •The 2025 fee is $43 per year. During the 2024 tax year, 11,397 OSS were charged the annual fee. • 3) An annual 0&M fee shall support implementation of the above items and provide Support and maintenance of a data base system for the records of OSS permitting,' ipstallation, 0&M and communication with the responsible parties, • (4) To implement the requirements of the Jefferson County local management plan as adopted or amended, each OSS shall be charged the annual 0&M fee as adopted in the department's fee schedule. • (5) The department's fee schedule shall be revised on an annual basis concurrent with budget adoption by the board of county commissioners pursuant to Chapter 3.80 JCC. • (6) The annual fee shall be collected via the property owner's property tax statement to implement the requirements of this chapter. September 18, 2025 7 Certain parcels exempt from fee, section 8.15.055(7) JCC At the time Ordinance No. 02-0220-25 was adopted on March 20, 2025, there was no intention to expand the exemption criteria in JCC 8.15.055(7). .AN Jefferson County Board of Health has consistently found monitoring of on -site sewage systems to be a matter of environmental and public health safety and importance. Annual 0&M Fee is part of Local Management Plan and essential to Environment Health Programming. The exemption is meant to be limited in scope because the policy goal is to include as many properties as possible because that is what is best for public health. Proposed amendments reflected in Appendix A attached to proposed ordinance. Public Process September 18, 2025 •Board of Health Workshop on September 18, 2025. • Publication in The Port Townsend & Jefferson County Leader on September 24, 2025. • Board of Health Public Hearing on Thursday, October 16, 2025. September 18, 2025 10 Next Steps September 18, 2025 11 - uvaiu vi I IVOILI i vvvi NOI IUV kVVI I Uif—%J j • Approve Public Hearing Notice • Publication in The Port Townsend &Jefferson County Leader (09/24/2025) • Public Hearing 10/16/2025 at 2:30 pm September 18, 2025 12 Questions? September 18, 2025 13 STATE OF WASHINGTON County of Jefferson In the Matter of Amending Jefferson County Ordinance No. 02-0220-25, Section 8.15.055(7) Local Management Plan for On - Site Sewage of the Jefferson County Code (JCC), Addressing the Exemption from the Annual Operations & Maintenance Fee. ORDINANCE NO. WHEREAS, Article XI, section 11 of the Washington Constitution, confers upon county legislative authorities the police power to adopt such local police, sanitary and other regulations as are not in conflict with general laws; and WHEREAS, Article XI, section 11 of the Washington Constitution is a direct delegation of the police power to cities and counties, and the power delegated is as extensive within their sphere as that possessed by the legislature; and WHEREAS, police power is that inherent and plenary power which enables prohibition of all things hurtful to the comfort, safety and welfare of society; and WHEREAS, the scope of police power is broad, encompassing all those measures which bear a reasonable and substantial relation to promotion of the general welfare of the people; and WHEREAS, the Washington State Department of Health made amendments to chapter 246-272A WAC (On -Site Sewage Systems Rules and Regulations of the State Board of Health), effective April 1, 2025; and WHEREAS, Jefferson County implements chapter 246-272A WAC through chapter 8.15 JCC (On -site Sewage Code); and WHEREAS, WAC 246-272A-0013 authorizes the Jefferson County Board of Health to adopt and enforce local rules governing On -site Septic Systems when the local regulations are: (1) Consistent with, and at least as stringent as in chapter 246-272A WAC; and (b) Approved by the Washington State Department of Health prior to the effective date of local regulations; and WHEREAS, Jefferson County revised chapter 8.15 JCC (On -site Sewage Code) to implement changes to chapter 246-272A WAC that become effective on April, 1, 2025, while complying with Jefferson County Resolution No. 17-19 on regulatory reform adopted by the Jefferson County Board of Commissioners and the Jefferson County Board of Health on March 25, 2019; and WHEREAS, on March 20, 2025, the Jefferson County Board of Health adopted Ordinance No. 02-0220-25 repeal and replacing Ordinance No. 06-0517-12, chapter 8.15 JCC Page 1 of 6 (On -site Sewage Code), for Jefferson County Environmental Health; WHEREAS, Ordinance No. 02-0220-25 inadvertently expanded the exemption criteria in section 8.15.055(7) JCC regarding the exemption for parcels required to pay the annual operations & maintenance fee; and WHEREAS, there was never any intention to expand the exemption criteria in section 8.15.055(7) JCC and the annual fee is a critical part of funding essential county services related to environmental health and safety; NOW THEREFORE, BE IT ORDAINED BY THE BOARD OF HEALTH OF JEFFERSON COUNTY, STATE OF WASHINGTON, AS FOLLOWS: Section 1. Whereas Clauses are Findings of Fact. The Jefferson County Board of Health hereby adopts the above "Whereas" clauses as Findings of Fact supporting this ordinance. Section 2. Purpose. The purpose of this ordinance is to amend section 8.15.055(7) to reflect' appropriate exemption criteria as identified in Appendix A. Section 3. Severability. If any section, subsection, sentence, clause, or phrase of this ordinance or its application to any person or circumstance is held invalid, the remainder of this ordinance or its application to other persons or circumstances shall be fully valid and shall not be affected. Section 4. SEPA. This ordinance is categorically exempt from the State Environmental Policy Act under WAC 197-11-800(19). Section 5. Effective Date. This ordinance shall take effect upon adoption and approval by the Jefferson County Board of Health. (SIGNATURES FOLLOW ON NEXT PAGE) Page 2 of 6 APPROVED and ADOPTED this day of October, 2025. JEFFERSON COUNTY BOARD OF HEALTH JEFFERSON COUNTY BOARD OF HEALTH MEMBERS Amanda Grace, Chair Other Community Stakeholder Kees Kolff, Public Hospital District Commissioner Gabrielle Vanwert, Consumer of Public Health Celeste Dybeck, Tribal Representative Monica MickHager, City of Port Townsend Heather Dudley-Nollette, Jefferson County Commissioner, District 1 Heidi Eisenhour, Jefferson County Commissioner, District 2 Greg Brotherton, Jefferson County Commissioner, District 3 ATTEST: APPROVED AS TO FORM: Carolyn Gallaway, CMC, Date Philip C. Hunsucker, Date: Clerk of the Board Chief Civil Deputy Prosecuting Attorney Page 3 of 6 APPENDIX A Chapter 8.15 ON -SITE SEWAGE CODE 8.15.055 Local management plan. (1) Management and oversight of OSS is intended to result in an effective means of regulating sewage disposal and necessary to protect the public health, by promoting a comprehensive approach to sewage treatment and disposal. (2) A local management plan was adopted in July 2007 as required by chapter 246-272A WAC. The local management plan has the following requirements: a. Identify all OSS in Jefferson County; b. Progressively develop and maintain an inventory, including the type and location of all known OSS in operation; c. Facilitate education of property owners regarding the requirements of chapter 246-272A WAC and this chapter, and provide O&M information for all types of OSS in use; d. Remind and encourage property owners to complete the O&M inspections required by WAC 246-272A-0270 and this chapter; e. Maintain records required; f. Enforce OSS owner permit application, O&M and failure repair requirements; g. Identify unknown, undocumented or failing OSS; and h. Identify areas where OSS pose an increased public health risk. (3) An annual O&M fee shall support implementation of the above items and provide support and maintenance of a data base system for the records of OSS permitting, installation, O&M and communication with the responsible parties. (4) To implement the requirements of the Jefferson County local management plan as adopted or amended, each OSS shall be charged the annual O&M fee as adopted in the department's fee schedule. (5) The department's fee schedule shall be revised on an annual basis concurrent with budget adoption by the board of county commissioners pursuant to chapter 3.80 JCC. (6) The annual fee shall be collected via the property owner's property tax statement to implement the requirements of this chapter. Page 4 of 6 (7) Exemption from the annual O&M fee. The following parcels shall be exempt from the annual O&M fee, provided the property owner shall demonstrate that at least one of the following exemptions apply to the satisfaction of the health officer: a. The OSS is located on a parcel ; pt f a.,s,fn.,, is .'�.,pief 81.36 T�C�GITCCFrL43 Downed by a federally recown-zed tribal government or the federal governinent; b. The parcel is connected to an approved sewer system; c. The parcel is connected to a large OSS permitted by DOH, provided all components to include septic tanks and pump chambers are managed and inspected by an approved third Ply; d. No structure on the parcel is connected to a water supply and the parcel is not capable of creating or discharging sewage; �rC- az�r. ivrcVtjand`{. as de -&-A d R f'W 4 •f 2 1 nZ G��CTrS�• = O ��5 � t. - tRN e ptioii , ..rye,- RGIA; 4-1 q6 ''_L i f•..,...+.-a- i s of !he !RN ,_ .� .. .�'V'� iiii .ru��«[[a) i.J[ is �.�v .�.. _ ..,. t9)L�LTo receive an exemption authorized by this section: a. The property owner shall submit to the department a completed application on a form approved by the department between January 31 st and March 1 st of the year for which an exemption is requested. b. For the exemption in subsection (7)(b), the property owner shall submit in addition to the application required by subsection (84)(a), a sewer bill for the property showing an account number and the sewer provider's contact information. c_For the exemption in subsection (7)(c), the property owner shall submit in addition to the application required by subsection (814)(a), the contact information for the third party managing and inspecting the large OSS. (4-0)ja The annual fee exemption in this section does not apply to partial reductions of the OSS operation or the O&M program charge. (144-) Whether an OSS shall be assessed the fee shall be determined based on OSS records. (11-2) The director shall provide the county assessor and the county treasurer sufficient information to collect the annual fee to implement the requirements of this chapter, including the number of new OSS and decommissioned OSS annually. The coordination required by this Page 5 of 6 subsection shall occur at least once annually before the deadline that county department's proposed budgets shall be submitted for consideration by the board of county commissioners. Page 6 of 6 Please publish 1 time: Wednesday. Se tember 24 2025 Contact Person: Carter Erickson Bill to: Jefferson County Environmental Public Health 615 Sheridan St Port Townsend, WA 98368 NOTICE OF PUBLIC HEARING In the Matter of Amending Jefferson County Ordinance No. 02-0220-25, Section 8.15.055( ) Local Management Plan for On -Site Sewage of the Jefferson County Code (JCC), Addressing the Exemption from the Annual Operations & Maintenance Fee. NOTICE IS HEREBY GIVEN that a public hearing is scheduled by the Jefferson County Board of Health for _Thursday, October 16, 2025 at 2:30 p.m. in the Commissioners' Chambers, County Courthouse, 1820 Jefferson Street, Port Townsend, WA 98368 (HYBRID). Notice of said hearing is to be published in the official newspaper of Jefferson County. During the hearing, testimony will be taken concerning proposed amendments to section 8.15.055(7) JCC, Local management plan for on -site sewage, which are intended to correct the exemption criteria for the annual operations and maintenance fee. The information is available for viewing on the County website by visiting: 'AwW.co.'efferson.wa.us and follow this pathway — Services — Laserfiche Web Portal (username and password is: public) — Health — Agendas —Minutes —Packets — Board of Health Documents — 2025_10 16 Packet. You are welcome to participate in this hearing. You will need to join the meeting by 2:30 p.m. using the following methods: VIRTUALLY: Via the following Zoom, link: https-//iisO6web.zoom.us/i/92378389363, PHONE: Dial 1-253-215-8782 and enter access code: 823 7838 9363# and press *9 to "raise your hand" to be called upon. Access for the hearing impaired can be accommodated using Washington Relay Service at 1-800-833-6384, or IN -PERSON: In the BOCC Chambers. If you experience difficulties joining the meeting or viewing documents, please call 360-385- 9100 to report any issues. In addition, written testimony is also invited beginning on September 18, 2025, and ending on October 16, 2025, at the end of the Public Hearing, unless extended by the Board of Health. Written public testimony may be submitted by Email to: BOHPaco.jefferson.wa.us. You may view testimony received by visiting: www.co.ietTerson.wa-us and follow this pathway — Services — Laserfiche Web Portal (username and password is: public) — Health — BOH Public Comments —2025 October 16 Meeting. You can also Mail your testimony to: Jefferson County Public Health; 615 Sheridan St., Port Townsend, WA 98368. Written testimony must be received to Board of Health by the end of the hearing testimony period. Signed this 18'h day of September, 2025. JEFFERSON COUNTY BOARD OF HEALTH /S/Amanda Grace, Chair Jefferson County Board of Health New Business Item 3 Rising Costs and Sexual and Reproductive Health Clinic Fee Increases Public H September 18, 2025 Sexual & Reproductive Health Programming @ JCPH: Access to Care, Rising Costs, and Fee Adjustments in 2025 Background & Discussion LI \� IAffC;Pw* Public Health Presentation to Jefferson County BOH — 9/18/25 Apple Martine, JCPH Director I. How We Serve Community 11. What It Takes to Operate III. Which Funds Support this Service IV. How Fees are Adjusted V. What Augmentations We Can Make How We Serve Community • Operate six (6) Sexual &Reproductive Health (SRH) Clinics across East Jefferson County e Provide SRH services to people across the lifespan • Provide direct healthcare services where access is limited across our rural setting Offer a full menu of healthcare with 3 clinicians and 2 clinic assistants Braided Funding Framework for SRH @ JCPH Federal Funds: Title X ❑ Provides grants for affordable reproductive health care services is Contraception, cancer screenings, and STI testing ❑ Title X Family Planning Fund (4/1/25-3/31/26): $17,023 ❑ WA opted out of Title X in 2019; unknown strategy in 2025 per current federal administration State Funds: DOH Consolidated Contracts ❑ SRH126 (7/1/25-12/31/25): $47,404 ❑ SRH126 (1/1/26-6/30/26): $47,404 • Family Planning Only (FPO) through HCA Local Funds: m Jefferson Healthcare annual contribution via ILA <(C HHS ❑ Strong collaboration with financial support of SBHCs & contributions to clinical advisory committee ® Generous citizen donations ongoing in support of protecting access to reproductive health services for all ❑ Specifically for covering the cost of birth control for those who cannot pay —L_!E Overall Financials for SRH Clinic &Programming 2023-2025 REVENUE vs EXPENSE EXPENSES DO NOT INCLUDE INDIRECT PROGRAM COSTS: Shared services such as Finance, Epidemiology, Communications 2023 2024 2025•PROJECfION ■ Revenue • Expense Revenue Sources & Expense Types 2023-2025 FUNDING SOURCES 2023-2025 AVERAGE PERCENTAGES ARE CONSISTENT OVER 3 YEARS Public Health Assistance 3% Jefferson nearrncare 8% Private 1 i15 ut ance _ 6% General Fund Ti an stem 1696 Client Fees 2% _Donation 0% Medicaid 23% Grants 32% Overhead expense (Rent, computers, phi office Supply, etc. 8% Supplies (Operating & pharmaceuticals) 10% EXPENSE TYPES 2023-2025 AVERAGE PERCENTAGES ARE CONSISTENT OVER 3 YEARS Other Expenses (Training, travel, etc.) 1% nd Benefits 6% Revenue & Expense: Actuals 2023-2025 TOM 2500 Donetlon 2,53200 7.J01 w0 Client Fees O,fi97.O M 4 2OtM 3 WD.DO Asshbnre.9,341500 ' O00 00 451.00 leffa tteahhcare � 4f i44A0 x5,anad r.= OO Prirete tisurance 71iwdO0 Ik2 O;OO 54,44010 iedel Purpose- Prop 1 39A00.00 26,367.00 _ '3 E2,000.00 General Fund Transfer d. top 61 540 00 9.00 nledlmld 112.d4F cD m 124 T44 W Grants !O0_M.op ala,7sn.vg • 462,722.00 50,000-00 100,00000 150,00000 2aD,000.m 250,000.W 300,000.00 350,01)(L00 400,000.00 450.00000 500.000.00 e 2023 2024 n 2025 Expenses 2023-2025 70TILL 436,182.00 Sqk!>d Dlher Expc"`5 !Training, trwel, etc.) 7^7Q C0 3,>ill.m 3aasaw Pmkssional5erv'res Sa Sm OC lubP, medical retards, elc.)Ir 2]rLl9 00 3za7a oo- Overhead atpmnac )Rent.computers, Phones, office supply, etc)' id.6W-OC 41,Se7.11 Supplies 41,656.00 (Oparating i pharmace W calPl 41,706.00 y2C9j4.116 Salaries and Ben.fit. ]15�3U.06 262,14700 • 50,00000 10D,000.00 150,000.00 200,000.00 2SD,000.00 300,OOD.00 350,000.00 40D,000.00 450,000.00 500,000.0D 'al: .:G4 ..__ Cost Analysis and Fee Calculations • The cost analysis calculates the cost of providing services, labs, and supplies in the SRH program Fees must be based on a cost analysis conducted, at a minimum, once per grant cycle • The cost analysis uses relative value units (RVUs) which represents time and effort required for each service provided Once RVU is established, service utilization for each procedure is multiplied. This is then totaled to acquire an average cost per service unit. The average cost per service unit is multiplied to the RVU value to achieve the total service cost. If applicable, you may add a COLA to this total. • This amount is then compared to Medicaid rates where the higher rate is applied. Augmenting Funds Locally • Met with leadership of Jefferson Healthcare (JHC) — Dec'24, Feb'25, Aug '26 • Met with leadership at Jefferson Community Foundation (JCF) — 8/20/25 • Met with leadership of Jefferson Healthcare Foundation (JHCF) — 9/12/25 • Looking at option for: J Developing a potential "Agency Fund" at JCF for supporters of Public Health and Sexual & Reproductive Health programming to invest in with their donations. J JCF takes on the administrative, financial, and fundraising responsibilities to support this effort on behalf of JCPH. ® Develop fundraising element of the Agency Fund w/ known, longstanding advocates of the reproductive health work and access in Jeff Co -- serve as fundraising ambassadors COMPARITIVE PRICING OFFICE VISITS Service Description CPT JCPH 2O24 JCPH 2O25 %INCREASE JEFFERSON HEALTHCARE PLANNED PARENTHOOD RHNTC SUGGESTED COST** GRAYS HARBOR COUNTY NEW PATIENT Low complexity, 15-29 minutes 99202 $177 $299 69 $232 $123 162-202 185 Moderate complexity, 30-44 min 99203 * $253 $460 82 $357.28 $253 250-313 265 Moderate complexity, 45-59 min 99204 $386 $689 78 $541.71 $365 373-466 400 High complexity, 60-74 min 99205 $485 $908 87 $709.03 Exam age 18-39 99385 $309 $533 72 $319.91 $295 299-373 320 Exam age 40-64 99386 $359 $614 71 $375.33 $341 343-429 340 ESTABLISHED PATIENT Low complexity, 10-19 minutes 99212 $104 $235 130 $169 $126 128-160 120 Problem based, low level of decision making, 20-29 min 99213 * $172 $376 119 $271 $205 205-256 190 Moderate complexity, 30-39 minutes 99214 $253 $530 109 $381 $291 286-357 280 High complexity, 40-54 minutes 99215 $341 $745 118 $535 Exam age 18-39 99395 $279 $481 72 $256.15 $266 269-337 290 Exam age 40-64 99396 $279 $511 83 $280.19 $284 285-357 310 Sports Physical 99394S $70 $70 $116.06 PROCEDURES Insert drug implant device 11981 336 415 24 511.24 376 130-162 450 Remove drug implant device 11982 340 457 34 433.87 260 141-177 390 Remove/insert drug implant device 11983 541 583 8 760.05 396 181-226 540 Insert IUD 58300 382 457 20 224.78 236 400 Remove IUD 58301 224 457 104 373.24 247 140-176 230 Injection (Depo) 1 963721 49 60 22 184 32 18-23 65 **2 prices listed for < * = most frequently used 21 y.o and > 21 y.o., level higher cost used for calculations Jefferson County Board of Health M Agenda Planning r.� Public H September 18, 2025 Jefferson County Board of Health Announcements Public H September 18, 2025 Public H