Presentation Title Office/Division Name if desired Wisconsin Department of Health Services The Local Health Department 140 Review Process Dennis Hibray.

Presentation Title Office/Division Name if desired

Wisconsin Department of Health Services

The Local Health Department 140 Review Process

Dennis HibrayDHS – Division of Public Health

July 17, 2012

Dennis HibrayDHS – Division of Public Health

July 17, 2012New Health Officer Orientation



Statutory and Administrative Rule 140

Review History• 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• Chapter DHS 140 - REQUIRED SERVICES OF LOCAL HEALTH

DEPARTMENTSo 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.



140 Review History• 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:o City HDo County HD o City/County HD o Health and Human Service HD



140 Review History• 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.



• The review started with: o Letter to Mayor, City Manager, County Board Chair,

County Administrator … stating that a review will take place on ----- date. (example letter)

o Identified the DPH review team.o Contained the 140 review evaluation tool. (example)

140 Review History - 1999



140 Review History• 140 evaluation tool consisted of 3 sections:

o Local Board of Healtho Local Health Departmento 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 - 1999• All local health departments must meet Level I requirements:

o CD control, Prevention and Suppressiono Human Health Hazard Controlo Health Promotiono Generalized Public Health Nursing Programo Full time Health Officero 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.



Following the 140 review the LHD received: o A letter to the LHD administration from the DPH Administrator

that reported the findings of the review.o An attachment that contained the written findings and

recommendations on correction.o Once the violations were corrected, a “LHD level”

determination was finalized and a “Certificate of Designation” was presented.

140 Review History



2005 -140 Review History

• Next five year 140 review cycle tool place in 2005.• Major changes from the 1999 140 review process were:

o Used Healthiest Wisconsin 2010 (not HW 2000) as the standard.

o Reduced redundancy of similar questions/evidence during the 140 review process.

o CO/RO team reviewed but did not collect evidence.o 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.




• Major changes from the 1999 140 review process:o Created a separate justification document for Level II

and Level III LHDs.o Used “Health Priorities” as a means to determine

Level II or Level III status.



2005 – 140 Review History

• Level II Health Departmento - 7 programs or services that address at least 5

health priorities of the current state health plan (Healthiest Wisconsin 2010).

o - Health Officer with at least 3 years of supervisory experience in a full time position with a PH agency.



2005 -140 Review History• Level III agency

o 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.




• Added Essential Services • Did not collect documentation but the LHD

had it available for viewing • Drastically reduced duplication of

information. s.251.06 (3) (e) Stats.

The local health officer appoints all necessary subordinate personnel and assures such personnel possess necessary qualifications (including licenses and certifications required by the department and State of Wisconsin) and has supervisory power over all subordinate personnel in the health department. (Health Officer)

Evidence provided in #58 and #84 Evidence was provided under #58 and

#84. The Health Officer is the Director of the agency and has oversight responsibility of all staff. Authority to supervise staff is delegated to middle managers.

Elimination of duplication of information





*



Chapter HFS 140 Review Addendum – Level III

Review of: Brown County Health Department

Review date: October 6, 2005

Review participants: Brown Co. Public Health Staff: Judy Friederichs, Ricki Krautkramer, Chua Xiong, John Paul, Juli Gray; Board of Health Chair: Audrey Murphy; DHFS/DPH Staff Northeast Region: Dennis Hibray, Becky Hovarter, Jean Zastrow, and Central Office: June Doyle, Chris Hill-Sampson.

YES NO As required under administrative rule HFS 140.06(1)(a), a Level III local health department shall provide or arrange for the provision of

all programs or services required under s. HFS 140.04 for a Level I health department.

As required under s.251.06(1)(c), Stats., A local health officer of a Level III local health department shall have at least one of the following:

1. A master's degree in public health, public administration, health administration or, as defined in rules promulgated by the department, a similar field and 3 years of experience in a full-time administrative position in either a public health agency or public health work.

2. A bachelor's degree and 16 graduate semester credits towards a master's degree in public health, public administration, health administration or, as defined in rules promulgated by the department, a similar field and 5 years of experience in a full-time administrative position in either a public health agency or public health work.

3. A license to practice medicine and surgery under ch. 448 and at least one of the following: a. Three years of experience in a full-time administrative position in either a public health agency or public health work. b. Eligibility for certification by the American board of preventive medicine in public health or general preventive medicine. c. A master's degree in public health, public administration, health administration or, as defined in rules promulgated by the department, a similar field.

For DPH use only (reviewer note): Judy Friederichs graduated from Marquette University with a BSN in 1969. Judy has 46 credits toward her Masters in Public Health Education. Judy was appointed to the position of Brown County Health Officer in 1996.

As required under s.251.06 (2), Stats., a local health officer shall be a full-time employee.

Additional requirements for Level III designation: YES NO

1. The local health department conducts an environmental health program, with environmental health staff who meet the qualifications under s.250.05, Stats., and ch. HFS 139.



Program Information

Agency addition






• 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.




• 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.





Added by LHD



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.







140 Reviews and Impact on You

• As a new Health Officer, past practice has resulted that all new Health Officer are subject to a complete 140 review.o Documentation has been required.o Filling out the forms has been required.o Face to face (LHD/DPH) meeting has been

conducted.o Board of Health members have (and always have )

been invited to participate.



140 Reviews – What’s Next?

• 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?



Questions?

Presentation Title Office/Division Name if desired Wisconsin Department of Health Services The Local Health Department 140 Review Process Dennis Hibray.

Documents

county health departments

field of public health

state health officer

recent public health

department personnel

review tools

review evaluation tool

dph review team