(A) Except as provided in division (F) of this section, not later than the date that is eighteen months after the official announcement of the result of a federal decennial census taken in a particular census year, including the 2020 census, a city with a population less than fifty thousand that is represented by a board of health of a city health district shall complete a study examining the efficiency and effectiveness of the city health district merging with the general health district of the county in which the city is located. As part of the study, the city shall compare the merger’s efficiency and effectiveness with that of remaining as a separate health district.

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(B) The director of health shall develop criteria to be used by the city described in division (A) of this section in determining whether such a merger is advisable. The criteria may include accreditation standards promulgated by the public health accreditation board.

(C) The director of health shall provide technical and financial assistance to each city described in division (A) of this section and shall oversee any efficiency and effectiveness study conducted.

(D) If, based on the criteria described in division (B) of this section, the study indicates that a merger would be efficient and effective, then the chief executive of the city shall enter into a contract with the district advisory council of the general health district that includes the city for the administration of health affairs in the former city health district and the merged general health district.

(E) If a merger is required by this section, the merger shall be completed not later than thirty months after the official announcement of the result of a federal decennial census, unless either of the following, as applicable, acts for good cause to delay implementation of the merger:

(1) In the case of a general health district consisting of a single county, the district advisory council of the general health district;

(2) In the case of a general health district consisting of more than one county as a result of a union of general health districts under section 3709.10 of the Revised Code, the district advisory council representing the county within the district where a majority of the population to be served by the merged general health district resides.

(F) This section does not apply to a city with a population less than fifty thousand whose city health district meets either of the following conditions regarding accreditation by an accreditation body approved by the director of health:

(1) The district has received accreditation and maintains its accreditation.

(2) The district is in the process of applying for accreditation on the effective date of this section , receives accreditation not later than December 31, 2025, and maintains its accreditation.