No. 42863 (Amendment): Rule R380-40. Local Health Department Minimum Performance Standards

(Amendment)

DAR File No.: 42863
Filed: 04/30/2018 04:43:32 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment makes changes in the local health department (LHD) administration portion. Also, adds additional standards/requirements to be followed.

Summary of the rule or change:

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.

Statutory or constitutional authorization for this rule:

Subsection 26A-1-106(1)(c)
Section 26A-1-115
Sections 26A-1-120 through 26A-1-127
Section 26A-1-114

Anticipated cost or savings to:

the state budget:

These changes in the rule are not expected to result in new costs or savings to the state budget.

local governments:

These changes in the rule are not expected to result in new costs or savings to local governments, with the exception of any county withdrawing from a multi-district LHD.

small businesses:

These changes are not expected to result in any costs or savings to small businesses because this rule does not contain provisions that apply to small businesses.

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

These changes are not expected to result in costs or savings to persons other than businesses or local governments other than as described above for LHDs.

Compliance costs for affected persons:

These rule changes should not result in compliance costs for any persons with the possible exception of a LHD or a county that operates a LHD. The Department believes that 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:

These proposed amendments update requirements for counties withdrawing from multi-district LHDs. Withdrawing counties must show that they can meet LHD minimum performance standards, including employment of key personnel through county revenue. There is no fiscal impact on existing business of LHDs except for those counties withdrawing from multi-county LHDs.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office 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:

Tamara Hampton at the above address, by phone at 801-538-6622, by FAX at 801-538-6306, or by Internet E-mail at thampton@utah.gov

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:

06/14/2018

This rule may become effective on:

06/21/2018

Authorized by:

Joseph Miner, Executive Director

RULE TEXT

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs

FY 2018

FY 2019

FY 2020

State Government

Local Government

Small Businesses

Non-Small Businesses

Other Person

Total Fiscal Costs:

Fiscal Benefits

State Government

Local Government

Small Businesses

Non-Small Businesses

Other Persons

Total Fiscal Benefits:

Net Fiscal Benefits:

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non - Small Businesses are described below.

The regulatory impact for this rule amendment cannot be estimated, as the funding is contingent on the state budget and allocation from the state legislature and Executive Appropriations Committee.

Appendix 2: Regulatory Impact to Non - Small Businesses

There is no regulatory impact to non-small business because this rule does not apply to them. The only impact would be to the counties, and local health departments in Utah.

The director of the Utah Department of Health, Joseph K. Miner, MD, has reviewed and approved this fiscal analysis

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) "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 performance standards" means the minimum duties performed by local health departments for public health administration, personal and population health, environmental health, and emergency preparedness 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-1-106(1)(c).

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

R380-40-3. Compliance.

The local health department and the department shall monitor compliance with minimum performance standards.

R380-40-4. Corrective Action.

(1) Except as provided in Subsection (3), if the department has cause to believe that a local health department is out of compliance with minimum performance standards 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.

(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 shall submit a written corrective action plan that is satisfactory to the department. At a minimum, the corrective action plan must include the following: date of report, areas of noncompliance, corrective actions, responsible individual, and dates of plan implementation and completion.

R380-40-5. Local Health Officers.

(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) be board certified in preventive medicine or in a primary care specialty.

(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, public administration, or business administration from an accredited school; and

(ii) have at least five years of professional full-time experience in the practice of public health, of which at least three years were in a senior 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;

(iii) board certified in preventive medicine or in a primary care specialty;

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

(v) able to review policies and procedures addressing human disease outbreaks of public health importance including emergency procedures authorized under 58-1-307(6), (7), and (8).

(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.

(2) The local health officer shall promote and protect the health and wellness of the people within the district to include the following activities;

(a) function as the executive and administrative officer;

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

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

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

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

(g) oversee proposed budget preparation;

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

(i) develop and propose policies for board consideration;

(j) implement policies of the local board of health;

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

(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.

(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.

(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.

(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.

(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;

(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.

(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.

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

(6) Each local health department shall employ an environmental health scientist 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.

(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.

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

(10) If a county withdraws from a multi-district local health department in accordance with Section 26A-1-122, the withdrawing county must demonstrate to the department that it can meet the minimum performance standards set out in this rule through the use of county and local funding sources in order to enter into a contract with the department for allocation state funds pursuant to Section 26A-1-115 and R380-50. Specifically, the county shall demonstrate to the department it:

(a) has the revenue within the county budget at the time the local health department begins operation to:

(i) employ the following full time employees:

(A) a health officer who meets the qualifications in R380-40-5;

(B) a registered nurse who meets the qualifications in subsection (4);

(D) a business manager who has experience in budget preparation and tracking, accounts receivable, accounts payable, purchasing, and if not provided to the new local health department by a county, human resources, including recruitment, hiring, and termination within a merit system.

(ii) assure the requirement for physician oversight in R380-40-5(1)(c) can be met;

(iii) employ the following additional staff on either a part-time or full-time basis:

(A) a health education on specialist who meets the qualifications in subsection (5);

(B) an individual with epidemiology experience who meets the qualifications in subsection (7);

(b) assure business operations support to include a minimum budget/finance and human resources;

(d) has the commitment and ability to continue funding the health department with revenue from county and local funding sources at an amount not less than the amount needed for (a) above;

(e) has adopted a county ordinance to create and maintain a local board of health and health department charged with the responsibilities and duties outlined in Section 26A-1-101 through 26A-1-127;

(f) has a commitment from the county attorney to serve as the legal advisor to the health department as derived in 26A-1-120;

(g) has a commitment from emergency response entities to work with the local health department as outlined in R380-40-9(1)(a), (b), (c), (d), and (e); and

(h) has the availability of laboratory services as outlined in R380-40-10.

R380-40-7. Local Health Department Personal and Population Health Services.

(1) Each local health department shall provide health education and health promotion 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.

(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 diseases and other communicable diseases of public health concern.

(3) Each local health department shall 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.

(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.

(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.

(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

R380-40-8. 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;

(b) schools consistent with R392-200;

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

(e) public pools consistent with R392-302 and R392-303;

(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

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

(2) Each local health department shall develop, implement, and maintain environmental health programs 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;

(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.

R380-40-10. 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.

KEY: local health departments, performance standards

Date of Enactment or Last Substantive Amendment: [~~March 2, 2016~~]2018

Notice of Continuation: March 6, 2015

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