These changes update requirements for counties that withdraw from a multi-district LHD. The new Subsection R380-40-6(10) includes the authorizing statutes (Sections 26A-1-122 and 26A-1-115, and Rule R380-50) and the requirement of the withdrawing county to demonstrate to the Department of Health (Department) that it can meet the minimum performance standards set out in this rule. Subsection R380-40-6(10)(a) addresses the funding requirements of the withdrawing LHD which must have enough revenue in the county's budget at the time of the withdrawal to employ specific full-time employees. In Subsection R380-40-6(10)(a)(i), the specific employees to be employed full time within the LHD are: in Subsection R380-40-6(10)(a)(i)(A), a health officer who meets qualifications in Section R380-40-5; in Subsection R380-40-6(10)(a)(i)(B), a registered nurse who meets the qualifications in Subsection R380-40-6(4); in Subsection R380-40-6(10)(a)(i)(C), an environmental health scientist who meets the qualifications Subsection R380-40-6(6); and in Subsection R380-40-6(10)(a)(i)(D), a business manager who has experience in budget preparation and tracking, accounts receivable, accounts payable, purchasing, and if not provided to the new LHD by the county, human resources, including recruitment, hiring, and termination within a merit system. The new Subsection R380-40-6(10)(a)(ii) assures that physician oversight under Subsection R380-40-5(1)(c) can be met. The new Subsection R380-40-6(10)(a)(iii) provides the following staff on either a part-time or full-time basis: in Subsection R380-40-6(10)(a)(iii)(A), a health education specialist who meets the qualifications in Subsection R380-40-6(5); and in Subsection R380-40-6(10)(a)(iii)(B), an individual with epidemiology experience who meets the qualifications in Subsection R380-40-6(7). The new Subsection R380-40-6(10)(b) assures business operations support to include at a minimum budget/finance and human resources. The new Subsection R380-40-6(10)(c) provides, equip, and maintain suitable offices, facilities, and infrastructure as required in Subsection 26A-1-115(2). The new Subsection R380-40-6(10)(d) adds commitment and ability to continue funding the LHD with revenue from county and local funding sources at an amount not less than the amount needed for Subsection R380-40-6(10)(a). The new Subsection R380-40-6(10)(e) adopts a county ordinance to create and maintain a local board of health and a LHD charged with the responsibilities and duties outlined in Sections 26A-1-101 through 26A-1-127. The new Subsection R380-40-6(10)(f) adds a commitment from the county attorney to serve as the legal advisor to the LHD as derived in Section 26A-1-120. The new Subsection R380-40-6(10)(g) adds commitment from emergency response entities to work with the county health department as outlined in Subsections R380-40-9(1)(a), (b), (c), (d), and (e). The new Subsection R380-40-6(10)(h), adds the availability of laboratory services as outlined in Section R380-40-10.