The Local Health Department 140 Review Process

1. Dennis Hibray DHS – Division of Public Health July 17, 2012 The Local Health Department 140 Review Process Dennis Hibray DHS – Division of Public Health July 17, 2012 New Health Officer Orientation

2. 1993 Public Health Statutes revised to say: WI statute 251.20 (1) Rule making. The department shall promulgate rules that specify all of the following: (1) Required services for each of Levels I, II and III local health departments under s. 251.05 (2). (2) Additional required services for Level II and Level III local health departments under s. 251.05 (2) (b) and (c), including services that the department of health services determines appropriately address objectives or services specified in the most recent public health agenda under s. 250.07 (1) (a). Statutory and Administrative Rule 140 Review History

3. Chapter DHS 140 - REQUIRED SERVICES OF LOCAL HEALTH DEPARTMENTS • DHS 140.07 Designation of level of local health department. (1) Under the authority of s. 251.20 (1), Stats., the department shall direct a process to formally review the operations of all local health departments in a county or municipality at least every 5 years. A review of the operations of a local health department shall result in a written finding issued by the state health officer as to whether the local health department satisfies the requirements for a level I, II or III local health department. (2) In directing the review under sub. (1), the state health officer shall use department personnel and other appropriate local health officials who have expertise in the field of public health and are knowledgeable about the requirements for local health departments. Statutory and Administrative Rule 140 Review History

4. 140 reviews began in 1999 with the 140 review of all city and county health departments. The 140 review tools were developed that addressed various health department organizational styles: • City HD • County HD • City/County HD • Health and Human Service HD 140 Review History

5. The 140 tool also addressed the various Level of health department. • Level I, II, III criteria and • Incorporated Healthier People in Wisconsin – A Public Health Agenda for the Year 2000 as our defining document. 140 Review History

6. The review started with: • Letter to Mayor, City Manager, County Board Chair, County Administrator … stating that a review will take place on ----- date. (example letter) • Identified the DPH review team. • Contained the 140 review evaluation tool. (example) 140 Review History - 1999

7. 140 evaluation tool consisted of 3 sections: • Local Board of Health • Local Health Department • Local Health Officer Review team consisted of RO and CO staff plus LHD staff. Process took 3-5 hours Evidence of compliance was provided by LHD and collected by the review team and stored at the regional office. Official document is stored at central office. 140 Review History

8. All local health departments must meet Level I requirements: • CD control, Prevention and Suppression • Human Health Hazard Control • Health Promotion • Generalized Public Health Nursing Program • Full time Health Officer • Board of Health (HHS Board) In 1999 Level II health departments had to prove via “evidence” that they addressed one objective for each section of Healthy WI 2000. (7 sections) For a Level III health Department had to document three objectives for each section of Healthy WI 2000. 140 Review History - 1999

9. Following the 140 review the LHD received: • A letter to the LHD administration from the DPH Administrator that reported the findings of the review. • An attachment that contained the written findings and recommendations on correction. • Once the violations were corrected, a “LHD level” determination was finalized and a “Certificate of Designation” was presented. 140 Review History

10. Next five year 140 review cycle tool place in 2005. Major changes from the 1999 140 review process were: • Used Healthiest Wisconsin 2010 (not HW 2000) as the standard. • Reduced redundancy of similar questions/evidence during the 140 review process. • CO/RO team reviewed but did not collect evidence. • Replaced the 3 main areas of the 1999 review (BOH, HO, LHD) with the “Twelve Essential PH Services” and placed specific questions under the specific Essential Service. 2005 -140 Review History

11. Major changes from the 1999 140 review process: • Created a separate justification document for Level II and Level III LHDs. • Used “Health Priorities” as a means to determine Level II or Level III status. 2005 -140 Review History

12. Level II Health Department • - 7 programs or services that address at least 5 health priorities of the current state health plan (Healthiest Wisconsin 2010). • - Health Officer with at least 3 years of supervisory experience in a full time position with a PH agency. 2005 – 140 Review History

13. Level III agency • Level III - 14 programs or services that address at least 7 health priorities of the current state health plan. - Agent of the state for the Hotel and Restaurant program. - Agent of the state for the Tattoo and Body Piercing program. - Health Officer with a Master degree in public health, public administration, or similar field and 3 years of full time administrative experience in a public health agency or public health work. - BS and 16 graduate credits toward a degree in public health, public or health administration, and 5 years of experience in a full time administrative position in a public health agency or public health work. 2005 -140 Review History

14. Added Essential Services Did not collect documentation but the LHD had it available for viewing Drastically reduced duplication of information. 2005 -140 Review History Elimination of duplication of information

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18. Program Information Agency addition

20. 2009 was the last major 140 review of all LHDs by DPH. Continued to use Healthy Wisconsin 2010 as the resource. LHDs filled out 140 review form. LHDs e-mailed the completed form to their respective regional office. 2009 – 140 Review History

21. Information is reviewed and if no changes or clarifications satisfactory addressed, approved and level is assigned. If additional information needed, RO requested and determined acceptability. Letter sent to LHD, press release was put together and Certificate of Designation presented to LHD/Board. 2009 – 140 Review History

23. Added by LHD

24. In addition, as required under HFS 140.06 (1) (b), a level III local health department shall provide or arrange for at least 14 programs or services that address at least 7 health priorities in the current state health plan (Healthiest Wisconsin 2010). Have any of the 14 programs you identified in your last review changed? YES If yes, identify the name of the program or service from the last review that is discontinued and identify the name of the new program or service.

27. As a new Health Officer, past practice has resulted that all new Health Officer are subject to a complete 140 review. • Documentation has been required. • Filling out the forms has been required. • Face to face (LHD/DPH) meeting has been conducted. • Board of Health members have (and always have ) been invited to participate. 140 Reviews and Impact on You

28. Next 140 review is expected to take place in 2014. How do we incorporate Healthy Wisconsin 2020 into the 2014 140 review process? How do we make sure that Level II & III criteria in the 2009 140 review is comparable in the 2014 140 review process? How does or should Accreditation be considered as part of the 2014 review process and if so, how do we compare or relate evidence to existing statutes and administrative rules? Other issues? 140 Reviews – What’s Next?

29. Questions?