Title: Orientation for New Public Health Directors
1Orientation for New Public Health Directors
- Kentucky Health Departments Association140
Consumer LaneP.O. Box 1091Frankfort, KY
40602-1091Phone (502) 875-2255Fax (502)
226-5155Email khda_at_fewpb.netÂ
2Vision and Mission of Public Health
Vision Healthy People in Healthy
Communities Mission Promote Physical and Mental
Health and Prevent Disease, Injury and Disability
3What is Public Health?
- IOM
- Promote Physical Mental Health and Prevent
Disease, Injury and Disability - Kentucky Public Health Improvement Plan of 1998
- To Protect Ensure the Health of Citizens
Through Quality Individual and Population-based
Services Using Core Public Health Functions
4Why Perform Public Health Services?
- To Extend Individual Wellness Longevity
- For the Good of Society in General
- For Protection of the Available Workforce
- To Reduce Costs to Society, Government, Business
Individuals
5Public Health Services Are PopulationFocused
6Governmental Functions of Public Health
- Assessment
- Policy development
- Assurance
7Assessment
The regular collection, analysis and sharing of
information about health conditions, risks and
resources in a community
8Policy Development
Information is gathered from assessment is used
to develop local policies
9Assurance
Making sure that needed health services and
functions are available
10Evaluating Community Needs
- Assess the health of the community
- Identify health problems
- Develop plans to address the high-priority
problems
11Healthy People 2010 Goals
- Increase quality and years of healthy life
- Eliminate health disparities
12Mandated ServicesThese activities required of
all health departments
- Core Services (Statute/Regulation)
- Environmental Regulations
- Disaster Response
- Health Education
- Surveillance
- Communicable Disease Control
- Risk Identification and Reduction
- Policy Development
- Preventive Services for the Medically Homeless
- Family Planning
- Prenatal Care
- Well Child Care
- WIC Program
- Adult Preventive Services
- Chronic Disease Management and Support
13Services to Insured PersonsThese services are
authorized as local options but are not mandated
by statute, regulation or budget language.
- Population Based Services
- Home Visits
- Chronic Disease Education
- School Health
- Other Negotiated Services
- Services for Individuals
- Medicaid Preventive
- K-Chip Preventive
- HMO Preventive
- Other Negotiated Services
14Direct Care ServicesHealth Departments
participating in these activities are expected to
be able to compete effectively in the medical
market place without requiring funds obligated
for mandated services.
15Definitions of Health Departments
- Independent Health Departments
- Single County Health Department
- District Health Department
- Small Districts
- Large Districts
16Regional Definitions
- ADD Districts
- Funding Impacts
17District and County LHDs
- "County board" means the statutorily mandated
governing body of a single county health
department created pursuant to KRS 212.020, and
does not exist in a district. - "District board" means the statutorily mandated
governing body of a multi-county agency created
pursuant to KRS 212.855. - "Nongoverning board" means a city-county, or
county, board of health that is under the
governance of a district board.
) "
18 Functions of a Board.
(1) A Governing Board Shall (A) Assure That the
Services Provided Meet the Needs of the Local
Citizenry, to Protect and Promote Public
Health (B) Establish Priorities and Objectives
For 1. Service Delivery, Considering Federal
and State Disease Prevention Health Promotion
Objectives And 2. Specific Health and Safety
Needs of the Community And 3. Resources of the
Agency. (C) Assure That Financial Controls and
Program Evaluation Measures Are Ongoing to
Facilitate Effective and Efficient Agency
Services and Operations (D) Interview and Hire
an Agency Director in Accordance With 902 Kar
8040 Through 902 Kar 8140 (E) Communicate
Board Policies and Priorities to the Agency
Director (F) Evaluate the Performance of the
Agency Director And (G) Review Information and
Data Provided by the Agency Director to Assess
the Effectiveness and Efficiency of the Agency
in Complying With Federal and State Public
Health Laws, Regulations, and Board Policies.
19Training for Board Members (1) A New Member
Appointed to the Board Shall Receive Training
From the Agency Director or Other Appropriate
Agency Representative. (2) The Training Shall
Include Discussion or Written Materials on the
Following Topics (A) Statutory Responsibilities
and Functions of the Cabinet, Agency, and the
Board (B) Board Laws, Regulations, and Local
Ordinances (C) Board Members Responsibilities
and Functions (D) Agency Services Sites and the
Services Provided at These Sites (E) Agency
Staff by Discipline or Profession (F) Review of
Agency Medical and Environmental Services, Budget
and Annual Report (G) Board Minutes for the Last
Calendar Year And (H) Tour of the Agencys Main
Facility Or, If Feasible, a Tour of Satellite Â
20District and County Boards of Health
- Section 3. Functions of a Board. KAR 9028150
- (1) A governing board shall
- (a) Assure that the services provided meet the
needs of the local citizenry, to protect and
promote public health - (b) Establish priorities and objectives for
- 1. Service delivery, considering federal and
state disease prevention and health promotion
objectives - 2. Specific health and safety needs of the
community and - 3. Resources of the agency.
- (c) Assure that financial controls and program
evaluation measures are ongoing to facilitate
effective and efficient agency services and
operations - (d) Interview and hire an agency director in
accordance with 902 KAR 8040 through 902 KAR
8140 - (e) Communicate board policies and priorities
to the agency director - (f) Evaluate the performance of the agency
director and - (g) Review information and data provided by the
agency director to assess the effectiveness
and efficiency of the agency in complying with
federal and state public health laws,
regulations, and board policies. - (2) A nongoverning board shall
- (a) Maintain a membership on the county public
health taxing district board - (b) Prepare the annual public health tax
resolution - (c) Maintain trusteeship of the county public
health tax - (d) Provide for maintenance and upkeep of the
agency building - (e) Determine the appropriate use of the
facility by community groups and other
agencies and - (f) Provide the district board with information
regarding specific public health needs and
concerns of the city-county or county board.
21Single County Board of Health
- Section 3. Functions of a Board. KAR 9028150
- (1) A governing board shall
- (a) Assure that the services provided meet the
needs of the local citizenry, to protect and
promote public health - (b) Establish priorities and objectives for
- 1. Service delivery, considering federal and
state disease prevention and health promotion
objectives - 2. Specific health and safety needs of the
community and - 3. Resources of the agency.
- (c) Assure that financial controls and program
evaluation measures are ongoing to facilitate
effective and efficient agency services and
operations - (d) Interview and hire an agency director in
accordance with 902 KAR 8040 through 902 KAR
8140 - (e) Communicate board policies and priorities
to the agency director - (f) Evaluate the performance of the agency
director and - (g) Review information and data provided by the
agency director to assess the effectiveness
and efficiency of the agency in complying with
federal and state public health laws,
regulations, and board policies.
22Board of Health Membership
- KRS 902
- Membership of County by Population
- Judge Executives from Each County
- Board Appointments
- Election of Chairperson
23Revenues
- Revenues
- Taxing District Revenues
- Program allocations
- Service Fees
- State and Federal Dollars
- Local Contracts
24Programs
- Regional Programs Offered
- BT Coordinator
- Planners
- Diabetes Level I,II or III
- Tobacco Coordinator
- TB Coordinator
- Epidemiologist
25Statutes, Regulations and Other Rules
- Or
- How to Do Your Job and Stay Out of Trouble
26The Acronyms
- KRS Kentucky Revised Statute the laws the
General Assembly has passed - KAR Kentucky Administrative Regulation the
rules the bureaucrats have written to implement
the laws
27The Basic Requirements
- KRS 211 The Cabinets Statute
- KRS 212 LHDs Statute
- KAR, Title 902, Chapter 8 (902 KAR 8xxx)
- KAR, Title 901, Chapter 5
- Administrative Reference
- Public Health Practice Reference
- Disaster Response Recovery Plan
- Local Regs your Board may have passed
28The Next Step Up
- KRS 61.800, 61.870, 213, 214, 215, 217, 217B,
219, 221, 223 - KAR, Title 902, Chapters 1, 2, 4, 7, 9, 10, 11,
15, 45, 47, 48, 115
29So You Want to be an Expert
- KRS 39, 39A, 39B, 39C, 39D, 65, 100, 109, 224,
311, 314, 336 347, 383
30The Practical Rules
- Be a Rules Guy
- Dont go nipalatin the ragalations
- What the regulations do not specifically allow,
they disallow vs. What the regulations do not
specifically disallow, they allow. - Know the difference between shall and may.
31The Practical Rules
- It is easier to ask forgiveness than permission.
- Understand Administrative Law and Fair
Administrative Procedure. - Dont ever be afraid to ask a question.
- Dont ask the question if you cant stand the
answer. - Dont bluff and dont overplay your hand.
32The Practical Rules
- If you aint got it in writing, you aint got it.
- Remember, everything you put in writing is
ultimately an open record. - Come to KHDA on a regular basis where else are
you going to find 55 other people who are going
through the same things you are going through
everyday?
33And Finally
- You dont have to know everything, you just have
to know where and how to look. - http//www.lrc.state.ky.us/home.htm
- http//chfs.ky.gov/dph/
34FINANCIALS
- LOCAL HEALTH DEPARTMENT FINANCIALS
35THE BASICS
- BASICS
- REVENUES EXPENDITURES
- MEMORANDUMS OF AGREEMENT
- TAXING DISTRICTS
- CONTRACTS
- TIME REPORTING
- TRAVEL
- AUDITS
- INTERNAL CONTROLS
36FINANCIALS
- ADMINISTRATIVE REFERENCE MANUAL
- SECTION IV
- FINANCIAL MANAGEMENT REQUIREMENTS 902 KAR 8170
- AUDIT REQUIREMENTS 902 KAR 8165
37REVENUES
- A. REVENUES -
- STATE RECEIPT ACCOUNTS 421-425
- FEDERAL RECEIPT ACCOUNTS 431- 440
- LOCAL RECEIPT ACCOUNTS 451- 456
- SERVICE FEES RECEIPT ACCOUNTS 459-490
38EXPENDITURES
- EXPENDITURES -
- PAYROLL SALARIES, LEAVE, AND FRINGE BENEFITS
- OTHER CONTRACTS, TRAVEL, SPACE, OFFICE
ADMINISTRATION, - MEDICAL SUPPLIES, AUTO COSTS, OTHER COSTS, AND
CAPITAL EXPENDITURES
39MOAs
- B. MEMORANDUM OF AGREEMENT
- YOUR CONTRACT WITH DPH
- YOU PROMISE TO CONDUCT
- PROGRAMS ACCORDING TO DPH PROTOCOLS. DPH
PROMISES - THAT YOU MIGHT GET MONEY TO PAY FOR THEM
- READ THE ABOVE AGREEMENT VERY CLOSELY. ITS
IMPORTANT! - MASTER AGREEMENT MODIFICATION
- ALLOCATION ADJUSTMENTS MADE BY DPH DURING THE
FISCAL YEAR, MAY BE MORE OR LESS
40TAXING DISTRICTS
- C. TAXING DISTRICTS
- 1) CREATED BY STATUTES KRS 212.720 AND
212.750 - 2) KNOW WHICH STATUTE CREATED YOUR DISTRICT
- 3) DPH REQUIRES A MINIMUM RATE SET ANNUALLY BY
THE - COMMISSIONER OF PUBLIC HEALTH
- BOARD OF HEALTH ANNUALLY SETS RATE UP TO 10
CENTS, MUST - BE LEVIED BY FISCAL COURT
- 5) WORDING DIFFERS BY STATUTE REGARDING FISCAL
COURT - RESPONSIBILITIES
- 6) TAXING DISTRICT ACCOUNT CONTROLLED BY THE
BOARD RATHER - THAN THE PUBLIC HEALTH DIRECTOR
- 7) FORMULA FOR ESTIMATED TAX REVENUES
DISTRIBUTED - ANNUALLY BY DPH
- 8) NOT NECESSARY TO DIRECT ALL TAX REVENUE TO
LHD BUDGET
41CONTRACTS
- D. CONTRACTS
- 1) SHALL NOT EXCEED ONE YEAR IN DURATION,
AUTOMATICALLY ENDING ON OR BEFORE JUNE 30 OF EACH
FISCAL YEAR - 2) MUST BE FOR AN ESSENTIAL SERVICE
- 3) TEMPLATES PROVIDED ON THE L DRIVE
- 4) MAY BE MODIFIED DURING THE YEAR IF NECESSARY
- 5) DOS AND DONTS EXPLAINED IN DETAIL IN
SECTION 7 OF 902 KAR 8170
42TIME REPORTING
- E. TIME REPORTING
- 1) ADMINISTRATIVE REFERENCE, SECTION IV, PAGE 6
- 2) CHECK TIME SHEET REPORTING AGAINST TRAVEL
REPORTING
43TRAVEL
- F. TRAVEL
- 1) 902 KAR 8170, SECTION 5, PAGES 4 THROUGH 7
- 2) BE ECONOMICAL NEVER USE A HELICOPTER WHEN
A GOLF CART WILL DO
44AUDITS
- G. AUDITS
- POLICIES DESCRIBED IN 902 KAR 8165, SECTION 2
- LHDS SOLICIT PROPOSALS EVERY THREE YEARS
- FIRM SELECTED IS FOR ONE FISCAL YEAR, MAY BE
UTILIZED - FOR THREE CONSECUTIVE YEARS IF LHD DESIRES ( IF
SCOPE OF CONTRACT AND PRICE REMAIN UNCHANGED ) - AFTER THREE YEARS, LHD MUST SOLICIT NEW PROPOSALS
- MAY STILL UTILIZE SAME AUDITOR DEPENDING UPON
PROPOSALS
45INTERNAL CONTROLS
- H. INTERNAL CONTROLS
- 1) LHD MUST HAVE WRITTEN PROCEDURES IN PLACE
- 2) DETAILED DESCRIPTION IN ADMINISTRATIVE
REFERENCE, SECTION IV, PAGES 14 AND 15
46OTHER ADVICE
- I. OTHER
- 1) EXPECT AN ON-SITE FISCAL REVIEW ANNUALLY BY
DPH - 2) IF YOU HAVE A HEALTH TAX, KNOW WHAT EACH RATE
POINT IS WORTH (THESE VALUES CHANGE ANUALLY) - 3) LEARN YOUR BALANCE SHEET ACCOUNTS AND COST
CENTERS - 4) UNDERSTAND THAT, BY KRS 212.120(2), DPH ONLY
HAS TO ALLOCATE 2,500.00 PER YEAR TO YOUR HEALTH
DEPARTMENT (THATS CALLED LEVERAGE) - 5) YOUR STATE AND FEDERAL DOLLARS COME TO YOU
THROUGH ELECTRONIC FUND TRANSFERS TRY TO GET A
HANDLE ON THIS SYSTEM -
47OTHER ADVICE (cont)
- 6) COME CLOSEOUT, HAVE A FAST WAY TO TRACK WHERE
YOU BUDGETED YOUR 799 MONEY BECAUSE ITS MOVEABLE - 7) KNOW WHAT YOU CAN LEGALLY INVEST IN
- 8) KNOW THE PARAMETERS OF BONDING
- 9) THE EXPLANATION FOR YOUR INDIRECT COST POOLS
IS ON PAGES 7 8 OF SECTION IV IN THE
ADMINISTRATIVE REFERENCE - 10) IF YOU UTILIZE A FUNCTION CODE MATRIX, KNOW
THAT ITS A GUIDE AND NOT A RULE - 11) ALTHOUGH ITS IMPORTANT TO KNOW HOW AND WHY
YOUR ALLOCATIONS COME TO YOU, ITS MORE IMPORTANT
TO SPEND THEM
48TEAMWORK LHD BUDGET PROCESS
49LHD Operating Budget Process
- Preparation paving the way
- Training designating and educating staff
- Compile entering the data
- Submit/Revisions Board of Health, DPH
- Approval Congratulations!
50LHD Operating Budget Process
- I. Preparation
- A. Thoroughly read budget instructions from DPH
- B. Review YTD Clinical Radiology/Laboratory
Services - C. Request Projected Clinical
Radiology/Laboratory Services from data
processing company (CDP) if applicable.
Otherwise, suggest averaging services take the
number of services performed and divide by the
number of months completed to equal the average
number of services performed per month X 12
months. - D. Review YTD Community Services
- E. Community Assessment top 5 identified
issues - F. Review YTD Environmental Services
- G. Review YTD Supplemental (Hands Services)
- H. Review Salaries
- I. Review Financial data Revenues Expenses
51LHD Operating Budget Process
- II. Training
- Designate appropriate staff responsibilities
- Attend DPH training
- Enlist assistance of consultants
- Enforce submission deadline
52LHD Operating Budget Process
- Compile
- Review all tentative budgeted services
- Review allocation of all funding streams
- federal
- state (799 funding)
- receipts generated by anticipated services
- interest historical data
- contracts
53LHD Operating Budget Process
- Enter all data into Budget Excel Spreadsheet
- Save ALL data including revisions
- Contact Resource Management contact or specific
program coordinator with questions
54LHD Operating Budget Process
- IV. Submit/Revisions
- Present to Board of Health for approval
- Board of Health determines salary increment for
budget - Submit to LDrive for Resource Management to
review - Revisions may be requested as the budget is
reviewed must resubmit data to the LDrive
55LHD Operating Budget Process
- V. Approval
- LHD will receive a letter from Resource
Management once approved - Will receive comments on all cost centers
- Share appropriate information with designated
staff members for implementation
56Working With The Kentucky General Assembly
57Background
- The Kentucky General Assembly has utilized Local
Health Departments as a Safety Net. - Presentations to better educate Legislators
- Preparation
58 GENERAL ASSEMBLY Legislative Sessions
Even-numbered years Odd-numbered years
Working Visitors Lobbyist (legislative
agents) represent particular groups
59Legislative Process
- Standing Committees
- Sub-Committees
60Bills
61Process of Becoming Law
- Introduction and Committee Referral
- Committee Consideration
62- Process of Becoming Law
- First Reading
- Second Reading
- Third Reading
63Process of Becoming Law Enrollment Governors
Action Law Your Involvement
64Summary
It takes a lot of commitment and teamwork to get
the Public Health message heard. You are a part
of that Team and knowing your legislators is very
important.
65Resources
Kentucky Legislature http//www.lcr.ky.gov Kentuc
ky Legislative Ethics Commission http//klec.ky.go
v KY State Government http//kentucky.gov
66Environmental Health Services
67Environmental Health ServicesFood Service
Kentucky Food Drug and Cosmetic Act KRS 217.005
to 217.285
- Limited Food Concessions
- Temporary Food Establishments
- Food Service
- Vending Machines
- Retail Food Establishments (combination)
- Bed and Breakfast Establishments
- Retail Food Stores
- Food Processing and Distributing Establishments
- Agriculture Samples
68Environmental Health ServicesPublic Facilities
- KY. Hotel Establishment Act
- KRS 211.760, 194.050
- KY. Mobile Home and Recreational Vehicle Park Law
- KRS 219.310 to 219.410
- KY. Public Restrooms Regulation
- KRS 212.210
- KY School Sanitation Regulation
- KRS 211.180, 212.210 and 212.990
- KY Septic Tank Vehicle Cleaning Law
- KRS 224.220 to 224.237 and 224.992
- KY Youth Camp Regulation
- KRS 211.180
- KY Public Swimming and Bathing Facilities Reg.
- KRS 211.180, 211.990
- KY Tattooing and Body Piercing Law
- KRS 211.760, 194.050
69Environmental Health Services
Outcome Standards
- Each Establishment shall possess a valid permit
- Operates under a satisfactory compliance level
- Achieve administrative compliance
-
70Environmental Health ServicesGeneral Sanitation
- KY Public Health Nuisance Law
- KRS 212.210 and 211.180
- KY Private Sewage Regulation
- KRS 211.180 and 212.210
- KY Rabies Control Law
- KRS 258.005 to 258.085, 258.990
- Includes
- Private Water Supplies, Vector and Rodent
Control
71Environmental Health ServicesProgram Standards
- METHODS
- Personnel must have a 4 year degree and receive
state training - Maintain all records, reports, and documents
- Transmit state fees to Frankfort by 10th of month
- Ensure use of proper equipment
- Conduct inspections at required frequency
- Conduct enforcement inspections as law requires
- Notices served in accordance with section 39 of
code (timely and with correction date) - Program publicity, education construction review
72Environmental Health ServicesObjective
- Onsite Sewage Law
- KRS 211.350
- To Prevent the Spread of Disease Into Groundwater
Sources by Proper Treatment and Safe Disposal of
Wastewater.
73Environmental Health ServicesOther Activities
- Radon Testing, U.S. EPA/Grant
- Class V Injection Wells, U.S. EPA/Grant
- Confinement Facility
- Lead Assessment
- Epidemiology Investigations
- (Food and Communicable Diseases)
- Emergency /Disaster Services
74Environmental Health ServicesSummary of Services
- FY-2003
- Planned (unannounced) Inspections (Enforcement
Inspections - Complaint Inspections
- Soil Evaluations
- Lab Samples
- Field Visits
- Office Services
- Animal Bites
75Environmental Health ServicesState and Local Fees
TOTAL FEES COLLECTED
LOCAL FEES
STATE FEES
FOOD SERVICE
PRIVATE WATER
ONSITE SEWAGE
76Environmental Health ServicesFunding Services
77Personnel
78PERSONNEL
- Salary and fringe benefits will account for
approximately 80 of the LHDs annual budget.
79Bob Nelson, ManagerLocal Health Personnel
80MERIT REGULATIONS
81The Rules
- Kentucky Revised Statutes (KRS)
- KRS 211.1751, 211.1752, 211.1755
- Kentucky Administrative Regs (KAR)
- 902 KAR 8040 through 902 KAR 8140
- 902 KAR 8160
- Administrative Reference for Local Health
Departments in Kentucky - Local Personnel Policies (approved by the Board
of Health)
82More Rules
- FMLA Family Medical Leave Act
- EEO Equal Employment Opportunity
- ADA Americans with Disabilities Act
- Fair Labor Standards Act
- Equal Pay Act
- ADEA Age Discrimination in Employment Act
83Merit vs. Non Merit (Unclassified)
- Public Health Director is the only non-merit
employee. - Serve at the pleasure of the BOH and the
department. - BOH not required to use progressive discipline.
84Exempt vs. Non-exempt
- Compensatory time
- Supervisory/ management responsibilities
- Overtime
-
85Classifications
- Pay Grades
- Job Classifications
- Job Descriptions/ P65
- http//chfs.ky.gov/dph/ lhdmeritclass.htm
- Review with employee
- Review periodically
- Reclassifications
- Promotions
Other duties as assigned.
86Recruitment
- Advertising for a position.
- Hard to fill.
- Open register.
87Compensation
- Evaluation
- Pay range
- Tweener
- Lump sum merit
88Discipline
- Progressive
- Verbal
- Written
- Suspension
- Termination
- Appeal
- Administrative Hearing
- Personnel Council
89Trainings/ Changes
- Take advantage of supervisory trainings offered
by the state. - Stay current on changes in regulations.
- Inform your staff of changes.
90Tips
- Be fair.
- Be deliberate.
- Always call Frankfort if youre unsure.
- Take care of your staff and they will take care
of you.
91Public Health Department Directors Guide
- Contacts and Communications
92Ways to Communicate One-On-One
- E-mail
- Effective, Guaranteed Contact
- Phone calls
- When you need information ASAP
- Person to Person
- The best way to build partnerships
93Communicating as a Group
- Inviting
- Conference Calls
- E-mails
94Protocol for Problems
- Programs
- Finances
- Urgent needs
95Dont waste Your time On
- Trying to Change things that are already a
done deal - Complaining
96Focus your Energy On
- Surveys and reporting for Programs
- Budgets and Grants
- Building Networks
- Coalitions
- Peers
- Partnerships
- Equity with Personnel
- Stay fully staffed
- Utilize different talents
- Expect the best from everyone
97Importance of Training to
- Learn everything you can
- Get to know program directors
- Implement your programs correctly
98Looking to the Future
- Get answers before deadlines arrive
- Good Organization can head off emergency
meetings - Secure commitments from people who can help
99Advice from Other Directors
- Listen Carefully Grasshopper
100- Learn what you can, then do what you think is
right - Dont panic. CHS will let you know if you are
doing things wrong - Spend your allocation money
- Stay in touch with your Board of Directors
- There will never be a dull momentwhich makes
life very interesting - Always form a committee when hiring
101ENJOY!