DAR File No. 27571

Health, Administration

R380-40

Local Health Department Minimum Performance Standards

NOTICE OF PROPOSED RULE

DAR File No.: 27571
Filed: 12/01/2004, 11:21
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This proposed amendment updates the rule that sets the minimum qualifications for a local health officer.

Summary of the rule or change:

This amendment proposes modified qualifications that a local health officer must possess. Urban health districts, as well as rural, will have the option of hiring a non-physician health officer, supported by a qualified contract or employee physician. Waiver authority is granted to the Executive Director and existing employees are deemed to meet the rule.

State statutory or constitutional authorization for this rule:

Subsection 26A-1-106(1)(c)

Anticipated cost or savings to:

the state budget:

Any costs imposed by the waiver authority granted to the Executive Director can be met within existing budgets.

local governments:

Local governments fund local health districts to a varying extent. The additional flexibility in the amendment to hire non-physician health officers provides the possibility of some savings for local governments.

other persons:

For the same reason that local government may enjoy some savings, other persons who pay fees to local health departments have the possibility of some savings.

Compliance costs for affected persons:

The amendments increase the pool of potential candidates to fill the role of local health officer without the need to apply for a waiver. Compliance costs should therefore be reduced.

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

Local Boards of Health, Local Health Officers and the Utah Department of Health collaborated to develop this proposed amendment. When an urban district wanted to hire a non-physician health officer, a waiver was required from the Executive Director. The need for waivers will be greatly reduced under this change, and the fiscal impact should be positive. Scott D. Williams, MD

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

Direct questions regarding this rule to:

Doug Springmeyer at the above address, by phone at 801-538-6971, by FAX at 801-538-6306, or by Internet E-mail at dspringm@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:

01/14/2005

This rule may become effective on:

01/15/2005

Authorized by:

Scott D. Williams, 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.

[A.](1) "Department" means the Utah Department of Health.

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

[C.](3) "General performance standards" means the minimum duties performed by local health departments for public health administration, personal health, environmental health, laboratory services, and 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(1)(c).

[D.](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.

R380-40-4. Compliance.

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

R380-40-5. Corrective Action.

If the department finds that a local health department is out of compliance with general performance standards and specific levels of performance then the local health department shall submit a plan of corrective action to the department that is satisfactory to the department. The corrective action plan shall include 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; corrective actions; responsible individual; date of plan implementation.

R380-40-6. General Performance Standards For Local Health Department Administration.

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

[B.](2) The local board of health shall:

[1.](a) establish local health department policies;

[2.](b) adopt an annual budget;

[3.](c) monitor expenditures;

[4.](d) oversee compliance with general and specific performance standards;

[5.](e) provide for long range planning;

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

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

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

[C.](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.

[D.](4) [Local health officers shall have the qualifications of training and experience as required by the Utah Department of Health Approved Class Specifications:

1. District Director of Health 27, Class Code 4399, 3/7/81;

2. District Director of Health 29, Class Code 4400, 3/7/81;

3. District Director of Health 37, Class Code 4033, 3/1/72;

4. District Director of Health 38, Class Code 4034, 11/1/77.](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;

(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 have at least five years of professional full-time public health experience, 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 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 protocols and standing orders;

(v) able to play a substantial role in reviewing policies and procedures addressing human disease outbreaks of public health importance; 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.

[E. Health districts having a population of 100,000 or greater shall hire a physician health officer. An exception would occur if a health district's population exceeds the 100,000 population threshold during the tenure of a non-physician health officer, in which case the district may retain the non-physician health officer.

F.](5) The local health officer shall:

[1.](a) promote and protect the health and wellness of the people within the jurisdiction;

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

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

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

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

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

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

[8.](h) oversee proposed budget preparation;

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

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

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

[12.](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

[13.](m) perform other duties as assigned by the board of health.

[G.](6) 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.

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

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

[1.](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;

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

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

[4.](d) the verification of all current licensure and certification requirements;

[5.](e) continued education and training for all employees;

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

[7.](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.

[J.](9) 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.

[K.](10) 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.

[L.](11) Each local health department shall employ a health educator or other qualified person with education and experience consistent with the position requirements to direct health education activities.

[M.](12) Each local health department shall employ a 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 protect the environment.

[N.](13) 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 by using a management information system. The management information system, when consistent with program objectives, shall include a method to determine client satisfaction.

[1.](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.

[2.](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.

[3.](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 Health Services.

[A.](1) Each local health department shall provide health education, health promotion and risk reduction services to assist residents to:

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

[2.](b) use preventive health services, practices, and facilities appropriately;

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

[4.](d) understand and encourage compliance with prescribed medical instructions;

[5.](e) participate in community health decision making; and

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

[B.](2) Each local health department shall provide communicable disease control services to include: reporting, surveillance, assessment, epidemiological investigation, and appropriate control measures for vaccine-preventable diseases, sexually transmitted diseases, tuberculosis, AIDS, and other communicable diseases 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.

[C.](3) Each local health department shall provide infant and child health services 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.

[D.](4) Each local health department shall 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.

[E.](5) Each local health department shall advocate and promote preventive health services and health instruction for school-aged children.

[F.](6) Each local health department shall ensure that injury control needs are identified and programs or services are available to reduce the occurrence of injury and unintentional death.

[G.](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.

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

[I.](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.

[J.](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.

[A.](1) Each local health department shall ensure that there is a program for:

[1.](a) 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;

[2.](b) public swimming pools 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;

[3.](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;

[4.](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;

[5.](e) nuisance complaints to include: inspections including corrective actions; an information management system; and the dissemination of public information;

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

[7.](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;

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

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

[10.](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

[11.](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.

[B.](2) Each local health department shall develop, implement, and maintain special 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.

R380-40-9. General Performance Standards For Local Health Department Laboratory Services.

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.

[A.](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.

[B.](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

[1990]2005

Notice of Continuation June 19, 2000

26A-1-106(1)(c)

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Doug Springmeyer at the above address, by phone at 801-538-6971, by FAX at 801-538-6306, or by Internet E-mail at dspringm@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.