No. 40049 (Amendment): Rule R380-40. Local Health Department Minimum Performance Standards

(Amendment)

DAR File No.: 40049
Filed: 12/31/2015 03:33:14 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The reason for the change is to update the rule to conform to current public health practice, remove out-of-date requirements, and improve clarity to guide implementation and monitoring of adherence to standards.

Summary of the rule or change:

The changes include the following: 1) definitions are updated to include "evidence-based services" and define "primary care specialty"; 2) the section requiring a joint negotiation of specific standards between the Utah Department of Health (UDOH) and each local health department (LHD) is removed so that the standards in this rule apply to all LHDs; 3) the section on corrective action is revised to clarify the process by which UDOH will communicate and the LHD will respond when a LHD might be or is out of compliance; 4) the requirements for a Local Health Officer (LHO) are separated into a separate section, and requirements are updated, including removing the requirement for a physician LHO to have a master's degree plus experience and requiring all nonphysician LHOs to have a master's degree. The requirements for a LHD to employ or contract with a physician if the LHO is not a physician are clarified. While an exemption to the standards may be granted for a LHO in position, the ability to grant an exemption after that time is removed; 5) a requirement is added for a LHD to employ an epidemiologist; 6) Personal Health Services is expanded to include population health services reflecting current public health practice. Several outdated requirements are removed and replaced by a simpler requirement to conduct community assessments and develop evidence-based programs to address identified priorities. A requirement to provide epidemiology services was added; 7) Environmental Health Programs is simplified to clarify that the LHD is responsible to enforce state rules in this area. Several responsibilities that relate to the Department of Environmental Quality (DEQ) were removed; 8) a Public Health Emergency Preparedness section is added to address this area that has emerged since the last rule revision; and 9) other out-of-date requirements are removed in several areas.

State statutory or constitutional authorization for this rule:

• Subsection 26A-1-106(1)(c)

Anticipated cost or savings to:

the state budget:

This change in the rule is not expected to result in new costs or savings to the state budget. This is an update to an existing rule with no change in the requirements to the state budget. It is possible that certain local health departments that have difficulty meeting the standards could request additional funding, but the rule doesn't require the state budget to fund those requests. There will be costs to monitor adherence to the standards that can be met with existing state budget resources.

local governments:

This change will remove outdated requirements and add some new requirements. Since the previous rule was not enforced for several years, it is possible that a clearer rule which can be consistently enforced will result in new costs for LHDs. The amount of those costs cannot be estimated based on available information, but the department believes that any costs should be minimal.

small businesses:

This change is not expected to result in costs or savings to small businesses because the rule does not contain provisions that apply to small businesses.

persons other than small businesses, businesses, or local governmental entities:

This change is not expected to result in costs or savings to businesses, individuals, or local governments other than as described above for LHDs.

Compliance costs for affected persons:

This rule change should not result in compliance costs for any persons with the possible exception of a LHD or a county that operates a LHD. The agency believes any costs for a LHD to comply should be minimal.

Comments by the department head on the fiscal impact the rule may have on businesses:

There is no fiscal impact to business because the rule changes affect only LHDs and do not change any payment or funding directed to business.

Joseph Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Administration
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Robert Rolfs at the above address, by phone at 801-538-6111, by FAX at 801-538-6306, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

02/16/2016

This rule may become effective on:

02/23/2016

Authorized by:

Joseph Miner, Executive Director

RULE TEXT

R380. Health, Administration.

R380-40. Local Health Department Minimum Performance Standards.

R380-40-1. Authority.

This rule is promulgated as required by Section 26A-1-106(1)(c). The minimum performance standards apply to all local health department services, regardless of funding sources.

 

R380-40-2. Definitions.

(1) "Department" means the Utah Department of Health.

[(2) "Local health department" means a city/county or district health department.]

(2) "District" means the area and population served by a local health department.

(3) "Evidence-based services" are based on evidence-based practices. Evidence-based practices include interventions, programs, strategies, policies, procedures, processes or activities that have been chosen based on evidence that they improve health outcomes. Evidence-based practices indicate a continuum of practices and can include emerging, promising and best practices.

(4) " Minimum[General] performance standards" means the minimum duties performed by local health departments for public health administration, personal and population health, environmental health, [laboratory services, ]and emergency preparedness[health resources] in addition to the powers and duties listed in Section 26A-1-114 and is equivalent to the phrase "minimum performance standards" in Section 26A-1-[116]106(1)(c).

(5) "primary care specialty" means pediatrics, internal medicine, family medicine, or obstetrics and gynecology.

[(4) "Specific level of performance" means the measurable level of each general performance standard.]

 

[R380-40-3. Negotiation .

The local health department and the department shall jointly negotiate specific measurable levels of performance, not inconsistent with corresponding general performance standards, and record them in a negotiated standards document. The department and the local health department shall take into account in the negotiation process availability of local technical and financial resources, availability of department technical and financial assistance, and past practices between the department and local health departments in providing the programs under consideration.]

 

R380-40-3 [4]. Compliance.

The local health department and the department shall monitor compliance with minimum[general] performance standards[and specific levels of performance].

 

R380-40-4 [5]. Corrective Action.

(1) Except as provided in Subsection (3), i[I]f the department [finds ]has cause to believe that a local health department is out of compliance with minimum[general] performance standards [and specific levels of performance ]the department shall provide a preliminary assessment to the local health officer that identifies the suspected areas of noncompliance. The local health officer shall respond to each of the areas identified in the preliminary assessment within 30 days of receipt.[then the]

(2) After review of the local health officer's response, if the department determines that the local health department is out of compliance with the minimum performance standards and has not provided a satisfactory response, the department shall notify the local board of health and the local health officer in writing of its findings and establish a specific time frame for the correction of each area of noncompliance.

(3) The department shall notify the local board of health and the local health officer if the department has cause to believe that noncompliance with minimum performance standards represents an imminent danger to the safety or health of the people of the State or the district .

(4) The local board of health department shall submit a written [plan of] corrective action plan [to the department ]that is satisfactory to the department. At a minimum, t[T]he corrective action plan must[shall] include the following[but not be limited to]: [local health department name; the specific program under consideration; the general performance standard(s) and specific levels of performance in question;] date of report ,[;] areas of noncompliance , corrective actions,[;] responsible individual,[;] and dates of plan implementation and completion.

 

R380-40-5 [6]. [ General Performance Standards For ]Local Health Officers [ Department Administration.

(1) Local health departments shall exercise the powers and duties as outlined in Section 26A-1-114.

(2) The local board of health shall:

(a) establish local health department policies;

(b) adopt an annual budget;

(c) monitor expenditures;

(d) oversee compliance with general and specific performance standards;

(e) provide for long range planning;

(f) appoint a qualified local health officer, subject to ratification by the governing bodies of the participating jurisdictions;

(g) periodically, but at least annually, evaluate the performance of the local health officer; and

(h) report at least annually to county commissioners regarding health issues.

(3) Each local health department shall have an annual financial audit. The local board of health shall appoint an independent auditor or the audit may be conducted as part of the county audit and, in any event, the local board of health shall accept the audit.]

[(4)](1)(a) A local health officer who is a physician shall:

(i) be a graduate of a regularly chartered and legally constituted school of medicine or osteopathy;

(ii) be licensed to practice medicine in the state of Utah; and

(iii) [have successfully completed at least one year's graduate work in public health, public administration or business administration;

(iv) ]be board certified in preventive medicine or in a primary care specialty[such as family practice, pediatrics, or internal medicine;].[and

(v) have at least two years of professional full - time experience in public health or preventive medicine in a senior level administrative capacity.]

(b) A local health officer who is not a physician shall:

(i) have successfully completed a master's degree in public health, nursing or other health discipline related to public health, [or ]public administration, or business administration from an accredited school; and

(ii) have at least five years of professional full-time [public health] experience in the practice of public health, of which at least three years were in a senior [level ]administrative capacity.[; or

(ii) have successfully completed a bachelor's degree in a field closely related to public health work from an accredited school and have at least 12 years of professional full - time public health experience, of which at least 10 years have been in a senior level administrative capacity.]

(c) If the local health officer is not a physician, the local health department shall contract with or employ a physician that is:

(i) residing in Utah and licensed to practice medicine in the state;

(ii) competent and experienced in a primary care specialty medical care field[, such as family practice, pediatrics, OBGYN, or internal medicine];

(iii) board certified in preventive medicine or in a primary care specialty [such as family practice, pediatrics, or internal medicine];

(iv) able to supervise and oversee clinical services delivered within the local health department, including the approval of all clinical protocols, [and] standing orders, and prescriptions issued within the public health system as described in Section 58-17b-620; and

(v) able to [play a substantial role in] review[ing] policies and procedures addressing human disease outbreaks of public health importance including emergency procedures authorized under 58-1-307(6), (7), and (8).[; and

(vi) able to participate in the Department's local health department physician network.

(d) Local health officers serving as of November 1, 2004, as well as the contracted or employee physician, are deemed to meet the requirements of R380-40-6(4) for the period that the individual so identified serves in those capacities. Upon the hiring of a new local health officer or employing or contracting with a new physician, the requirements of R380-40-6(4)(a), (b), and (c) must be met.

(e) The Executive Director may grant an exception to the local health officer and physician requirements upon written request from a Local Board of Health documenting the failure of serious and substantial efforts to recruit candidates who meet the requirements or how the intent of the rule can be met by a method not specified in the rule.]

(d) The Executive Director may grant an exception to the requirements for a local health officer who was in the position before February 1, 2016.

[(5)](2) The local health officer shall[:

(a) ] promote and protect the health and wellness of the people within the district to include the following activities[jurisdiction];

( a[b]) function as the executive and administrative officer;

( b[c]) report to and receive policy direction from the local board of health;

( c[d]) coordinate public health services in the district;

( d[e]) direct programs assigned by statute to the local health department, including administering and enforcing state and local health laws, regulations and standards;

( e[f]) direct the investigation and control of diseases and conditions affecting public health;

( f[g]) be responsible for hiring, terminating, supervising, and evaluating all local health department employees;

( g[h]) oversee proposed budget preparation;

( h[i]) present the budget to the board of health for review and approval;

( i[j]) develop and propose policies for board consideration;

( j[k]) implement policies of the local board of health;

( k[l]) advise the department with regard to policy development as those policies impact [upon ]the mission, purpose, and capacity of the local health department; and

(l) ensure that available data on health status and health problems of the district are reviewed regularly including

(i) a report to the board of health at least annually, and

(ii) an assessment that includes community input at least every five years;

(m) ensure that information about health and health hazards is disseminated as appropriate to protect the health of people in the district; and

(n) perform other duties as assigned by the local board of health.

[(6)](3) The local health officer shall ensure that an ongoing planning process is initiated and maintained that includes mission statement; community needs assessments; problem statements; goals, outcomes, and process objectives or implementation activities; evaluation; public involvement; and use of available data sources.

[(7)](4) The local health officer shall ensure that fiscal management procedures are developed, implemented and maintained in accordance with federal, state, and local government requirements.

[(8)](5) Consistent with federal and state laws and local ordinances and policies, the local health officer shall ensure:

(a) that employees are recruited, hired, terminated, classified, trained, and compensated in accordance with relevant merit principles, federal civil rights requirements, and laws of general applicability, and that their qualifications are commensurate with job responsibilities;

(b) the orientation of all new employees to the local health department and its personnel policies;

(c) the maintenance of a personnel system that includes an accurate, current, and complete personnel record for each local health department employee;

(d) the verification of all current licensure and certification requirements;

(e) continued education and training for all employees commensurate with job responsibilities;

(f) that each employee receives an annual performance evaluation, based upon a job description and written performance expectations for each employee.[; and

(g) all training and certification programs for establishing and maintaining quality performance will be conducted as required by the Utah Department of Health and the Utah Department of Commerce.]

[(9)](6) A local health officer or designee who is a physician or osteopath licensed to practice medicine in Utah shall supervise and be accountable for medical practice conducted by local health department employees. If the local health officer is not a physician or osteopath licensed in Utah, he shall appoint a medical director licensed to practice medicine or osteopathy in Utah to supervise and be accountable for medical practice conducted by local health department employees.

 

R380-40-6. Local Health Department Administration.

(1) Local health departments shall exercise the powers and duties as outlined in Section 26A-1-114.

(2) In addition to the duties outlined in 26A-1-109 and 26A-1-110, the local board of health shall:

(a) establish local health department policies;

(b) adopt an annual budget;

(c) monitor revenue and expenditures;

(d) oversee compliance with minimum performance standards;

(e) provide for planning as defined in R380-40-5(3);

(f) periodically, but at least annually, evaluate the performance of the local health officer; and

(g) report at least annually to the county governing body or bodies of the district served by the local health department regarding health issues and the health status of residents of the district.

(3) Each local health department shall have an annual financial audit. The local board of health shall appoint an independent auditor or the audit may be conducted as part of the county audit and, in any event, the local board of health shall accept the audit or accept responsibility for findings in the audit that apply to the local health department .

[(10)](4) Each local health department shall employ a registered nurse with education, experience, and Utah licensure consistent with the position requirements to supervise, evaluate, and be accountable for nursing practice conducted by local health department nurses in order to provide quality public health nursing service.

[(11)](5) Each local health department shall employ a certified health education specialist [health educator] or other qualified person with education,[and] experience , or a combination of education and experience resulting in comparable expertise [consistent with the position requirements] to direct health education and promotion activities.

[(12)](6) Each local health department shall employ a n environmental health scientist [sanitarian] registered in Utah with education and experience consistent with the position requirements to supervise, evaluate, and be accountable for environmental health activities in order to protect and promote public health and safety and protect the environment.

[(13)](7) Each local health department shall employ an individual with training and experience in epidemiology to conduct and oversee epidemiology activities conducted by the local health department.

(8)(a) Programs provided by local health departments shall be developed, directed, and organized in response to community needs; delivered and controlled in accordance with approved budget; and evaluated for effectiveness and impact.[by using a management information system. The management information system, when consistent with program objectives, shall include a method to determine client satisfaction.

(a) Each local health department shall collect and manage data in accordance with the needs of local health department programs, department programs, and other funding sources.]

(b) Each local health department shall provide all public health services in compliance with federal, state, and local [(including district) ]laws, regulations, rules, policies and procedures; and accepted standards of public health, medical and nursing practice.

[(c) Each local health department shall maintain an ongoing quality assurance program for public health services designed to objectively and systematically monitor and evaluate the quality of public health services and resolve identified problems.]

 

R380 - 40 - 7. [ General Performance Standards For ]Local Health Department Personal and Population Health Services.

(1) Each local health department shall provide health education[,] and health promotion [and risk reduction] services to include: conducting community health assessments, identifying leading causes of disease, death, disability and poor health; and implementing evidence - based services to address the identified priorities. [assist residents to:

(a) obtain the necessary knowledge, skills, capacity, and opportunity to improve and maintain individual, family, and community health;

(b) use preventive health services, practices, and facilities appropriately;

(c) understand and participate, where feasible, in decision - making concerning their health care;

(d) understand and encourage compliance with prescribed medical instructions;

(e) participate in community health decision making; and

(f) prevent or delay premature death, disease, injury, or disability through services that encourage the long - term adoption of healthy behavior.]

(2) Each local health department shall provide evidence-based communicable disease prevention and control services to include: reporting, surveillance, assessment, epidemiological investigation, and appropriate control measures as defined in State disease plans for reportable communicable [vaccine-preventable] diseases[, sexually transmitted diseases, tuberculosis, AIDS,] and other communicable diseases of public health concern . [to attempt to prevent, control, or prevent and control epidemics, cases of vaccine - preventable diseases, and the spread of sexually transmitted diseases, AIDS, and tuberculosis.]

(3) Each local health department shall [provide infant and child] ensure health services by assessing the availability of health-related services and health providers in local communities; identifying gaps and barriers in services; convening or participating with community partners to improve community health systems; and providing services identified as priorities by the local assessment and planning process if approved by the local board of health.[to help prevent illness, injury, and disability; reduce the preventable complications of illness, injury, and disability; maintain health; and foster healthy growth and development. These services shall include: periodic health assessments; screening for and early identification of health and developmental problems; and provision of appropriate treatment, education, or referral.]

(4) Each local health department shall provide epidemiology services including surveillance for reportable conditions, tracking occurrence of conditions affecting the health of communities, and obtaining or preparing epidemiologic data to guide prioritization of problems, and development and evaluation of prevention and control programs. [ensure that families of referred cases of infant and childhood death including Sudden Infant Death Syndrome cases, are offered counseling services or referred to counseling services.]

(5) Each local health department designated as a local registrar of vital statistics shall ensure the registration of appropriate certificates for all live births, deaths, and fetal deaths that occur in the registration area, as required by Utah Code Annotated Section 26-2.[shall advocate and promote preventive health services and health instruction for school-aged children.]

(6) Each local health department shall provide evidence-based services as guided by local community assessment and planning to include:

(a) maternal and child health services,

(b) injury control services; and

(c) chronic disease control services .

[ensure that injury control needs are identified and programs or services are available to reduce the occurrence of injury and unintentional death.

(7) Each local health department shall provide chronic disease control services which may include screening, referral, education, promotion, and preventive activities related to the prevention of cardiovascular disease, cancer, diabetes, and other chronic diseases to reduce premature morbidity and mortality associated with these diseases.

(8) Each local health department shall provide family planning services including information to clients who request it and referral in accordance with State law.

(9) Each local health department shall ensure that women and families have access to risk appropriate preconceptional, interconceptional, prenatal, intrapartum, and postpartum health services with the objective of lowering the frequency of maternal and infant death, disease and disability, and promoting the development and maintenance of a healthy, nurturing family unit.

(10) Each local health department shall provide dental health services which may include dental health screening, referral, education, promotion, and preventive activities.]

 

R380-40-8. [ General Performance Standards For ]Local Health Department Environmental Health Programs.

(1) Each local health department shall ensure that there is a program including the maintenance of an inventory of regulated entities or complaints for:

(a) food safety consistent with R392-100, R392-101, R392-103, R392-104, and R392-110; and[food service establishments to include: the maintenance of an inventory, directory, or listing of establishments]; [inspections including corrective actions; plan reviews; an information management system; and the dissemination of public information;]

(b) schools consistent with R392-200;

(c) recreation camps consistent with R392-300;

(d) recreational vehicle parks consistent with R392-301;

([b]e) public [swimming ]pools consistent with R392-302 and R392-303[to include: the maintenance of an inventory,];[directory, or listing of facilities; inspections including corrective actions; plan reviews; an information management system; and the dissemination of public information;]

(f) temporary mass gatherings consistent with R392-400;

(g) roadway rest stops consistent with R392-401;

(h) mobile home parks consistent with R392-402;

(i) labor camps consistent with R392-501;

(j) hotels, motels and resorts consistent with R392-502;

(k) indoor clean air consistent with Section 26-38 and R392-510;

(l) illegal drug operations decontamination consistent with R392-600;

(m) indoor tanning beds consistent with R392-700; and

(c) [institutions, public facilities, and indoor and outdoor facilities to include: the maintenance of an inventory, directory, or listing of facilities; inspections including corrective actions; plan reviews; an information management system; and the dissemination of public information];

[(d) safe drinking water to include: the maintenance of an inventory, directory, or listing of systems; inspections including corrective actions; an information management system; and the dissemination of public information;]

([e]n) investigation of complaints about public health hazards, including vector control, [nuisance complaints] to include[:] inspections including corrective actions and an information system that documents the process of receiving, investigating and the final disposition of complaints[; an information management system; and the dissemination of public information;].

[(f) vector control to include: complaint inspections including corrective actions; an information management system; and the dissemination of public information;

(g) air quality and air pollution control to include: conducting limited inspections of visible emissions including corrective actions; an information management system; and the dissemination of public information;

(h) injury control to include: inspections including corrective actions; an information management system; and the dissemination of public information;

(i) indoor clean air to include: inspections of public facilities including corrective actions; an information management system; and the dissemination of public information;

(j) solid waste to include: an inventory, directory, or listing of locations; inspections including corrective actions; an information management system; and the dissemination of public information; and

(k) subsurface waste water systems to include: the maintenance of an inventory, directory, or listing of facilities; inspections including corrective actions; plan reviews; an information management system; and the dissemination of public information.]

(2) Each local health department shall develop, implement, and maintain [special] environmental health programs[, such as programs to respond to noise, hazardous waste, and asbestos abatement control,] to meet the special or unique needs of its community as determined by local or state needs assessment and the local board of health.

 

R380-40-9. Local Health Department Public Health Emergency Preparedness.

(1) Each local health department shall conduct public health emergency preparedness efforts .

(a) conduct, or coordinate with emergency management agencies in the district to conduct, a community public health, medical, mental, and behavioral health hazard and risk assessment that considers populations with special needs to influence prioritization of public health emergency preparedness efforts;

(b) establish partnerships with volunteers, emergency response agencies, and other community organizations involved in emergency response;

(c) establish Memorandums of Agreement with response partners for assistance in emergency response;

(d) identify public health roles and responsibilities in local emergency response;

(e) function as the lead agency for Emergency Support Function #8---Public Health and Medical Services;

(f) maintain an all-hazards public health emergency operations plan that shall include priorities from hazard and risk assessment in R380-40-9(1)(a); hazard-specific response information for an infectious disease outbreak; and protocols or guidelines for dispensing of medical countermeasures, public health emergency messaging, non-pharmaceutical interventions, mass fatality response and requesting additional resources;

(g) maintain a continuity of operations plan that shall include employee notification, lines of authority and succession, and prioritized local health department functions;

(h) annually test public health preparedness through an emergency response drill or exercise;

(i) ensure access to and annually test emergency response communications equipment and systems that will be used in public health emergency response;

(j) the local health officer and at least one other employee shall complete FEMA ICS-100, ICS-200, ICS-300, ICS-400, IS-700, and IS-800 courses.

 

R380-40-[9]10 . General Performance Standards for Local Health Department Laboratory Services.

Each local health department shall ensure the availability of laboratory capacity to support public health programs by maintaining an on - site laboratory, through agreements with the Utah Public Health Laboratory, or by agreements or contracts with private laboratories to conduct needed tests in a timely manner.

[All local health departments that have a laboratory are not exempt from existing state and federal laboratory requirements.

 

R380-40-10. General Performance Standards for Local Health Department Health Resources.

(1) Epidemiology. Each local health department shall provide for the investigation, detection, control, and development of preventive strategies of any communicable, infectious, acute, chronic, or other disease, or environmental or occupational health hazard that is considered dangerous or important or which may affect the public health. Reportable diseases shall be reported.

(2) Vital Statistics. Each local health department designated as a local registrar of vital statistics shall ensure the registration of appropriate certificates for all live births, deaths, and fetal deaths that occur in the registration area, as required by State statute.]

 

KEY: local health departments, performance standards

Date of Enactment or Last Substantive Amendment: [February 2, 2005]2016

Notice of Continuation: March 6, 2015

Authorizing, and Implemented or Interpreted Law: 26A - 1 - 106(1)(c)

 

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