PROPOSED ORDER OF
DEPARTMENT OF HEALTH SERVICES
TO ADOPT PERMANENT RULES
The Wisconsin Department of Health Services (“department”) proposes an order to repeal DHS 140.02, to repeal and recreate DHS 140.04 to 140.07, and to create DHS 140.03 (1m), 140.08 and 140.09.
Explanation of agency authority
The department serves as the state lead agency for public health. The department is responsible for developing policy and providing leadership in public health throughout the state that fosters local involvement and commitment, that emphasizes public health needs and that advocates for equitable distribution of public health resources and complementary private activities commensurate with public health needs. The Wisconsin State Legislature directs the department to promulgate rules that specify required services for each of Levels I, II and III local health departments, as well as any additional required services for Level II and Level III local health department that address objectives or services specified in the most recent public health agenda.
Related statute or rule
Plain language analysis
The department, through the Division of Public Health (DPH), oversees the provision of public health services throughout the state. It is the lead agency for public health and maintains the public health system in cooperation with local health departments and the 11 federally recognized tribes which operate health programs.
There are currently 86 local health departments in Wisconsin—a mix of county and city units—that are responsible for implementing public health programs and providing public health services at the community level. Local health departments are divided into 3 levels (I, II, and III) based on the number and type of services they provide. The number of LHDs at each level is fluid and may change as the current DHS 140 review process progresses. As of September 14, 2017, there were 3 Level I departments, 50 Level II departments and 33 Level III departments in Wisconsin.
Chapter DHS 140 specifies the required services for Levels I, II, and III local health departments, and additional required services for Level II and Level III local health departments. The required services include surveillance, investigation, control and prevention of communicable disease, other disease prevention, health promotion, and human health hazard and control. This chapter has not been updated since the rule was created in 1998. The field and science of public health have evolved, making the currently stated services outdated. The outdated required services in Chapter DHS 140 do not reflect modern services currently provided by local health departments within their jurisdictions. Additionally, some portions of the rule are unclear and are redundant.
The objective of the proposed rulemaking is to revise the required services of Levels I, II, and III local health departments. The department proposes this revision to clarify the rule, remove any duplication, and reflect current trends and practices in public health and required services of local health departments. Through this rule revision, Wisconsin statutes 250 and 251 are further defined and strengthened.
The proposed changes in required services are based on the Foundational Public Health Services Model, nationally recognized for modernizing public health practice. The model encompasses a basic set of public health services that should be made available in all jurisdictions. It consists of the following services essential to all health departments: assessment, all hazards preparedness and response, communications, policy development and support, community partnership development, organizational competencies, communicable disease control, chronic disease and injury prevention, environmental public health, maternal child and family health and access and linkage with clinical healthcare. Inclusion of the Foundational Public Health Services Model within Chapter DHS 140 lays a solid foundation of the minimum level of services for local health departments to protect and promote the health and safety of the people of Wisconsin. The department also proposes to incorporate updated references, including the most recent public health agenda. Chapter DHS 140 includes numerous citations to a previous version of the state public health agenda, which are now outdated. It also incorporates concepts that align with nationally public health accreditation requirements. The proposed rule change will impact local health departments. The impact is expected to be insignificant for most departments. There is no change to proposed Level I services as they are required by statute and current rule or are services that local health departments are already providing. The food safety and recreational licensing program was transferred from the Department of Health Services to the Department of Agriculture Trade and Consumer Protection. This transfer led to the necessity to remove the Level III food safety and recreational licensing requirement from Chapter DHS 140 which may result in a slight increase in the number of Level III local health departments. No reasonable alternatives exist to the rulemaking. Without proposed revisions to Chapter DHS 140, the array of services provided by Wisconsin local health departments will be outdated and will fail to reflect current, national trends and practices in public health.
Summary of, and comparison with, existing or proposed federal regulations
There appears to be no existing or proposed federal regulations that address the activities to be regulated by the proposed rules.
Comparison with rules in adjacent states
The Illinois Department of Public Health outlines local health department’s required personnel and practice standards in 77 Ill. Admin. Code 600. An executive officer, public health administrator, and medical health officer are required personnel. Practice standards are activities that demonstrate a local health department is fulfilling the core functions of public health. To obtain provisional certification, local health departments must commit to a series of planning activities conducted within the local health department jurisdiction resulting in the development of an organizational capacity assessment, a community health needs assessment, and a community health plan. A 5-year certification may be granted once the community health needs assessment and a community health plan are submitted.
641 Iowa Admin. Code Chap. 80 outlines local public health services. The purpose of the local public health services contract is to implement the core public health functions, deliver essential public health services, and increase the capacity of local boards of health to promote health people and healthy communities. Local health departments are or may be contractors of the Iowa Department of Public Health and are required to provide evidence that they engage in an annual evaluation. Additionally, the Iowa Department of Public Health participates in the national Gaining Ground initiative to support voluntary accreditation and quality improvement. See http://idph.iowa.gov/mphi/gaining-ground.
Requirements of local health departments are set forth in MCL 333.2431. Local health departments are required to report annually to the Michigan Department of Community Health on their satisfaction of requirements, including having a plan of organization and demonstrated ability to provide required services. Local health departments must keep records and afford access to the records by authorized state, federal, and local officials for audit and review purposes necessary to verify and assure the accuracy and acceptability of the reports, as a condition of receiving state funding. The state engages in an annual review of the program statement and budget for local health departments.
The Minnesota Department of Health enters into agreements with community health boards for the development and maintenance of a system of community health services. Community health boards must submit a community health assessment and community health improvement plan to the Minnesota Department of Health at least every five years, implementing a performance management process, and annually report to the commissioner on a set of performance measures and be prepared to provide document of ability to meet performance measures. Minn. Stat. 145A.07 subd. 1a. (2)-(4).
Summary of factual data and analytical methodologies
The department relied on the following sources to draft the proposed rule and to determine the impact on local health departments.
The department formed an Advisory Committee consisting of local health officers from the State of Wisconsin as well as a member from the Wisconsin Counties Association. Advisory Committee members reviewed current services offered by local health departments and considered numerous public health models. The Advisory Committee also considered the impact of the proposed rule on local health departments. Committee members recommended utilizing the Foundational Public Health Service model as the basis for revising this rule. Proposed rule revision language was drafted based on the recommendations of this committee.
In addition, the department reviewed the following: