Chapter 3701-36 Local Health Departments

3701-36-01 Definitions.

As used in rules 3701-36-01 to 3701-36-13 of the Administrative Code:

(A) "Board of health" means the board of health of a city or general health district, or the authority having the duties of a board of health in any city as authorized by section 3709.05 of the Revised Code.

(B) "Department" means the department of health of the state of Ohio.

(C) "Director" means the director of health of the state of Ohio.

(D) "Health commissioner" means the person occupying the office created by section 3709.11 or 3709.14 of the Revised Code for the health district.

(E) "Health district" means each city and general health district provided for by section 3709.01 of the Revised Code or a union of two or more health districts as provided for by section 3709.07 , 3709.071 , or 3709.10 of the Revised Code.

(F) "Local funds" means locally generated funds, and includes but is not limited to local taxes, unspent and unobligated funds from the previous year, fees for services rendered, license fees, permit fees, contributions, revenues from contracting health districts and revenues from other contractual services provided.

(G) "Local health department" means the operational entity of a general or city health district.

(H) "Minimum standards" means the standards established by the public health council that health districts must meet to receive any state subsidy funds, pursuant to section 3701.342 of the Revised Code.

(I) "Optimal achievable standards" means a concept for distributing subsidy funds beyond those awarded for achieving minimum standards. These standards will be defined by the director on an annual basis when sufficient funds are allocated by the legislature.

(J) "Performance indicator" means certain criteria that may be used, with or without other criteria, to measure a local health department's compliance with the minimum and optimal achievable standards.

(K) "Physician" means an individual who is authorized under Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatry.

(L) "Public health council" means the public health council of the Ohio department of health as created by section 3701.33 of the Revised Code.

(M) "Public health accreditation board standards" or "PHAB standards" means the national public health standards published as the "Public Health Accreditation Board (May 2011). Version 1.0. Standards and Measures. Application Period 2011-2012. Alexandria, VA."

Effective: 12/25/2011
R.C. 119.032 review dates: 09/02/2011 and 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3702.342
Prior Effective Dates: 7/1/1984, 10/1/01, 1/1/05

3701-36-02 Purpose and scope.

(A) This chapter of the Administrative Code establishes minimum and optimal achievable standards for local health districts and a method for payment of subsidy to local health districts that meet the minimum standards of these rules and for payment of increased subsidy to local health districts that meet the optimal achievable standards of this chapter. This chapter is applicable to all health districts within the state.

(B) This chapter establishes the conditions under which the department of health will award subsidies pursuant to section 3709.32 of the Revised Code. This chapter does not alter:

(1) The responsibility of local health departments to conduct those programs or to enforce laws and rules that are otherwise required by any provision of the Revised Code or Administrative Code;

(2) The authority of the board of health of any health district in adopting orders and regulations otherwise authorized under sections 3709.20 and 3709.21 of the Revised Code, or any other provision of the Revised Code; or

(3) The responsibility of any person or any other entity for complying with any applicable provision otherwise required by the Revised Code, the Administrative Code or any board of health order or regulation.

Effective: 12/25/2011
R.C. 119.032 review dates: 09/02/2011 and 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 7/1/1984, 10/1/01, 1/1/05

3701-36-03 Minimum standards.

Each health district must meet the minimum standards to receive any state subsidy funds. (A) These minimum standards are:

(1) Submission of a state health district subsidy fund application to the department due March first of each year;

(2) Completion and submission of the department's on-line report which incorporates the PHAB standards on March first of every even numbered year;

(3) Submission of status of accreditation preparation and application efforts by March first of each year;

(4) Submission of a completed annual financial report to the department by March first of each year;

(5) Be represented by the health commissioner or the health commissioner's designee at each conference provided by the Ohio department of health pursuant to section 3701.29 of the Revised Code. The health commissioner shall personally attend one of these conferences and the medical director of a health district with a non-physician health commissioner shall attend at least one session of one of the conferences. The director shall review reasons for failure to comply with this paragraph and may grant an excuse when good cause for the absence has been documented;

(6) Provide administrative leadership by:

(a) Employing a health commissioner;

(b) Employing a registered nurse as nursing director;

(c) Employing a registered sanitarian as environmental health director;

(d) Employing as medical director a doctor of medicine or doctor of osteopathic medicine who is licensed to practice medicine in Ohio and who is actively involved in providing medical leadership to the local health department if the health district has a non-physician health commissioner;

(7) Provision of services for health education;

(8) Annual completion of two hours of continuing education by each member of a board of health. Each continuing education credit shall pertain to one or more of the following topics: ethics, public health principles, and a member's responsibilities. Credits may be earned in these topics at pertinent presentations that may occur during regularly scheduled board meetings throughout the calendar year or at other programs available for continuing education credit. The director of health may assist local boards of health of general and city health districts in coordinating approved continuing education programs sponsored by health care licensing boards, commissions, or associations. Continuing education credits earned for the purpose of license renewal or certification by licensed health professionals serving on boards of health may be counted to fulfill the two-hour continuing education requirement.

(a) For purposes of paragraph (A)(8) of this rule, "calendar year" means a period of twelve months beginning on January 1 and ending on December 31.

(b) Continuing education credits shall be reported as follows:

(i) One hour of continuing education credit is equal to sixty minutes. The smallest credit increment a member of a board of health may accrue toward the completion of one credit is one quarter credit or fifteen minutes. Each member of a board of health shall submit all continuing education records to the health commissioner along with all supporting documentation that the credit meets the requirements of paragraph (A)(8) of this rule; and

(ii) The health commissioner of each district shall keep all board of health members' continuing education credit records containing the date, topic, number of credits earned, location and presenter's name or copies of certificates of continuing education credits earned for the purpose of license renewal or certification by a licensed health professional serving on the board of health.

(c) If a board of health member fails to comply with the requirements of paragraph (A)(8) of this section, the director of health may provide:

(i) One calendar year for the board of health member to correct the deficiencies; or

(ii) The health commissioner an opportunity to request an in-person meeting or a telephone or video conference with a representative of the director of health to show good cause for the deficiencies. If good cause is not shown, the director may provide one calendar year for the board of health member to correct the deficiencies or take other appropriate action.

(9) Expenditure of a minimum of three dollars per capita in local funds for public health services per year.

Effective: 07/01/2014
R.C. 119.032 review dates: 03/26/2014 and 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 1/1/2005, 12/25/11

3701-36-04 Promoting the public's health.

(A) Each local health department shall provide programs in such a manner as to protect and promote the public's health for the communities each board of health serves.

(B) Each local health department shall complete and submit the report prescribed in paragraph (A)(2) of rule 3701-36-03 of the Administrative Code to demonstrate compliance with paragraph (A) of this rule.

Replaces: 3701-36-04

Effective: 12/25/2011
R.C. 119.032 review dates: 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 1/1/2005

3701-36-05 Collect, report, and share public health quality indicators.

(A) General and city health districts shall collect and report public health quality indicator information as categorized and defined in paragraph (B) of this rule. The information shall be submitted to the director on an annual basis in an approved format. The director shall not require general and city health districts to report information for public health quality indicators if such indicators have previously been reported to the director.

(B) For purposes of this rule information regarding the following public health quality indicators and associated measurements shall be collected pursuant to paragraph (A) of this rule:

(1) Access to birth and death records: measured by the access and usage of the secure Ohio public health information warehouse.

(2) Communicable disease control:

(a) Measured by meeting the median number of days between date of diagnosis and report to the health department in the Ohio disease reporting system for the following reportable infectious diseases:

(i) Campylobacteriosis;

(ii) Cryptosporidiosis;

(iii) E. coli O157:H7 and shiga toxin-producing (STEC) E. coli;

(iv) Giardiasis;

(v) Influenza-associated hospitalization;

(vi) Legionnaires' disease;

(vii) Pertussis;

(viii) Salmonellosis; and

(ix) Shigellosis.

(b) Measured by increasing the per cent completeness for the following reportable infectious diseases in the Ohio disease reporting system by age, race, ethnicity, and gender:

(i) Campylobacteriosis;

(ii) Cryptosporidiosis;

(iii) E. coli O157:H7 and shiga toxin-producing (STEC) E. coli (iv) Giardiasis;

(v) Influenza-associated hospitalization;

(vi) Legionnaires' disease;

(vii) Pertussis;

(viii) Salmonellosis; and

(ix) Shigellosis.

(3) Community engagement: measured by reporting engagement with the community (clinical and non-clinical) about policies and/or strategies that will promote the public's health.

(4) Emergency preparedness: measured by the ability to receive and respond to an emergency preparedness twenty-four hours per day, seven days per week on-call drill initiated by the department of health within one hour.

(5) Environmental health services: measured by meeting the annual required inspection frequency and providing verification of registered sanitarian/sanitarian in training conducting inspections for food safety, public swimming pools and campground programs.

(6) Epidemiology: measured by demonstrating one full-time equivalent epidemiologist per three hundred thousand population.

(7) Health promotion and prevention- chronic disease:

(a) Measured by the reporting of at least one evidence-based tobacco prevention or control intervention; and

(b) Measured by the reporting of at least one evidence-based healthy eating and/or active living intervention for children birth to eighteen years.

(8) Health promotion and prevention- injury prevention: measured by the reporting of at least one evidence-based injury prevention intervention.

(9) Health promotion and prevention- infant mortality/preterm birth prevention:

measured by the infant mortality rate by race.

(10) Immunizations: measured by increasing the percentage of children entering kindergarten who are fully vaccinated.

(11) Information management and analysis: measured by expanding the use of electronic data management system(s) in the administration of public health programs (e.g., clinical, environmental and/or administration).

(12) Linking people to health services: measured by the participation in the medicaid administrative claiming program to promote access to healthcare.

(C) The director shall provide access to public health quality indicator information on a designated website for each general and city health district. The director shall issue on the department website an annual report providing a summary of the public health quality indicator information to payers, providers, general and city health districts and public health professionals.

Effective: 07/01/2014
R.C. 119.032 review dates: 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.98
Rule Amplifies: 3701.98

3701-36-06 [Rescinded]Assure a safe and healthy environment.

Effective: 12/25/2011
R.C. 119.032 review dates: 09/02/2011
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 1/1/2005

3701-36-07 [Rescinded]Promote healthy lifestyles.

Effective: 12/25/2011
R.C. 119.032 review dates: 09/02/2011
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 1/1/05

3701-36-08 [Rescinded]Address the need for personal health services.

Effective: 12/25/2011
R.C. 119.032 review dates: 09/02/2011
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 1/1/05

3701-36-09 [Rescinded]Administer the health district.

Effective: 12/25/2011
R.C. 119.032 review dates: 09/02/2011
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 1/1/2005

3701-36-10 Payment of health district subsidies.

Pursuant to section 3709.32 of the Revised Code, state subsidy to general and city health districts by the department of health is subject to the following:

(A) No health district shall be eligible for or be paid a state subsidy unless:

(1) The health district has been provided local funds for public health services, as determined by the health commissioner and board of health, totaling at least three dollars per capita, according to the most recent federal decennial census or the United States census bureau's most recent population estimate, however, the director may grant an exception to the requirements of this paragraph when it is shown to his satisfaction that unusually severe economic conditions prevent the health district from receiving adequate tax revenues.

(2) The certification of funds expended by the health district is endorsed by the director.

(3) The health district has submitted, by the time requested, all data, reports, and other information concerning services and costs associated with state subsidy distribution required by the director of health.

(4) The health district has not decreased local funds in the local health department budget in anticipation of using state subsidy funds to provide services normally supported by local revenues.

(5) The local health department is in compliance with the minimum standards contained in this chapter of the Administrative Code adopted pursuant to section 3701.342 of the Revised Code, including:

(a) The requirement as provided in rule 3701-36-03 of the Administrative Code that the health district has been represented by the health commissioner or a designee at each conference provided by the Ohio department of health pursuant to section 3701.29 of the Revised Code, and the health commissioner has personally attended one of these conferences and the medical director of a health district with a non-physician health commissioner has attended at least one session of one of the conferences; and

(b) The requirement that all funds received by the health district, including any state subsidy awarded during the preceding year under section 3709.32 of the Revised Code, have been credited to the budget of the local health department and expended for purposes determined by the health commissioner and board of health in accordance with all applicable laws and rules governing the expenditure of funds.

(B) Each health district meeting the improvement minimum standards and which is otherwise eligible for a state subsidy shall be paid the subsidy to be computed as follows:

(1) Health districts that are in compliance with the minimum standards contained in this chapter of the Administrative Code may be paid a pro rata amount not to total more than fifty cents on a per capita basis according to the most recent federal decennial census or the United States census bureau's most recent population estimate .

(2) If the amount appropriated by the general assembly in any fiscal year for state health district subsidy exceeds fifty cents per capita for health districts that qualify for any subsidy under this rule, health districts that are in compliance with one or more of the optimal achievable standards contained in this chapter of the Administrative Code may be paid an additional subsidy amount for each optimal achievable standard met, on a per capita basis according to the most recent United States census bureau's population figures, as determined by the director. In addition to compliance with one or more of the optimal achievable standards, a health district must comply with all minimum standards to qualify for an additional subsidy.

Effective: 12/25/2011
R.C. 119.032 review dates: 09/02/2011 and 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 7/1/84, 1/1/2005

3701-36-11 Certification of compliance and financial disclosure.

(A) To apply for state subsidy payments under section 3709.32 of the Revised Code and this chapter of the Administrative Code, the president of each board of health and the health commissioner of each local health department shall submit to the director on forms provided by the director and shall be submitted no later than the first day of March of each year, the following:

(1) An annual application for state subsidy. The application shall include a certification of the extent of the local health department's compliance with the improvement standards established by rules 3701-36-03 and 3701-36- 04 of the Administrative Code;

(2) An annual subsidy compliance statement; and

(3) Submission of the department's on-line report on improvement standards and the centers for disease control and prevention national performance standards survey, as set forth in rule 3701-36-03 of the Administrative Code or, as determined by the director.

(B) The president of each board of health providing health services in one or more health districts and the chief executive officer of each local health department providing services in one or more health districts shall, on or before the first day of March of each year, submit to the director on forms provided by the director an annual financial report for the preceding calendar year, describing amounts expended which qualify for state health district subsidy funds under section 3701.342 of the Revised Code and this chapter of the Administrative Code. This report shall be certified by the health commissioner and the auditor of the health district specified by section 3709.31 of the Revised Code.

Effective: 12/25/2011
R.C. 119.032 review dates: 09/02/2011 and 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 1/01/2005

3701-36-12 Review process for assessing compliance.

(A) The director may evaluate the extent to which local health departments comply with the minimum and optimal achievable standards established by Chapter 3701-36 of the Administrative Code by means of the review process provided in this rule. Each local health department which has certified that it is in compliance with minimum or optimal achievable standards in accordance with paragraph (A) of rule 3701-36-11 of the Administrative Code may be evaluated as frequently as the director deems necessary.Such an evaluation shall be conducted as follows:

(1) The director shall select at least one review team to conduct evaluations of compliance that may be composed of but not limited to one or more members of the staff of local health departments other than that which is being evaluated and of one member of the director's staff who shall serve as coordinator for the team. The review team shall perform an on-site visit to the local health department and may observe any activities and examine any records of the local health department ;

(2) A local health department shall not refuse a review visit, fail to provide team members access to records, or otherwise interfere with the evaluation. The director may base a determination of noncompliance with one or more minimum or optimal achievable standards upon violation of this paragraph ; and

(3) Within sixty days after the coordinator has received the reviewers' written reports of the on-site evaluation the director shall notify the local health department of a proposed determination as to the extent of the local health department's compliance with minimum and optimal achievable standards and of the right to an informal hearing under rule 3701-36-13 of the Administrative Code. The proposed determination shall become final if an informal hearing is not requested within the time specified by paragraph (A) of rule 3701-36-13 of the Administrative Code. If the hearing request is timely, the director shall issue a final determination in accordance with paragraph (B) of rule 3701-36-13 of the Administrative Code.

(B) The director shall not pay state subsidy to a local health department after the date a final determination that the local health department does not comply with one or more minimum standards is issued. The director shall not pay state subsidy to a local health district for an optimal achievable standard after the date a final determination that the local health department does not comply with the standard is issued. For six months after the date the director issues a final determination that a local health department does not comply with minimum standards, the local health department shall not reapply for and shall not be paid state subsidy. Payments shall resume after the local health department is determined to have achieved compliance with the relevant standards.

Effective: 12/25/2011
R.C. 119.032 review dates: 09/02/2011 and 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 1/1/2005

3701-36-13 Informal hearing process.

(A) A local health department shall be afforded an informal hearing concerning the director's proposed determination of the extent of the local health department's compliance with minimum and optimal achievable standards issued under paragraph ( A)(3) of rule 3701-36-12 of the Administrative Code if a written request for the hearing is received by the director no later than fifteen days after the date of mailing of the proposed determination.

(B) The informal hearing shall be conducted before the director or the director's authorized representative no later than thirty days after the director's receipt of the request. For the hearing, the local health district may present information orally and in writing. The director shall issue a written final determination of the extent of the local health department's compliance no later than thirty days after the conclusion of the informal hearing.

Effective: 12/25/2011
R.C. 119.032 review dates: 09/02/2011 and 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.342
Rule Amplifies: 3701.342
Prior Effective Dates: 1/1/2005

3701-36-14 Cost methodology.

(A) The city or general health district shall utilize the cost methodology specified in this rule to calculate costs of providing services specified in sections 3701.344 , 3711.10 , 3729.07 , 3730.03 , 3733.04 , 3733.25 and 3749.04 of the Revised Code to the extent that section 3717.07 of the Revised Code does not require the use of a different methodology for calculation of costs of providing services.

(B) The actual cost to a city or general health district of providing services specified in sections 3701.344 , 3711.10 , 3729.07 , 3730.03 , 3733.04 , and 3749.04 of the Revised Code shall be calculated through utilization of the following data from its previous fiscal year. Such costs shall not include any costs which are otherwise recovered by grant, contract or declared match support for any grant or contract.

(1) List all employees working in each program for the purpose of administering and enforcing the chapter and rules;

(2) Determine the percentage of time worked in each program by each employee, calculated by dividing the amount determined under paragraph (B)(2)(a) of this rule by the amount determined under paragraph (B)(2)(b) of this rule.

(a) Total hours worked in each program subject to this rule by each employee

(b) The total hours worked in all programs for which each employee was paid in the last year;

(3) Determine the percentage of time worked in each program by all employees subject to this rule, calculated by dividing the amount determined under paragraph (B)(3)(a) of this rule by the amount determined under paragraph (B)(3)(b) of this rule.

(a) Total hours worked in each program subject to this rule by all employees

(b) The total hours worked in all programs by all employees for which all employees were paid in the last year;

(4) The total annual wages or salary paid to each employee;

(5) The total amount for fringe benefits paid on behalf of each employee;

(6) The total travel costs attributable to each program subject to this rule by determining the actual cost of mileage reimbursement or vehicle depreciation, repair, and fuel incurred for each program;

(7) The total program direct costs of equipment, supplies, and materials specific to each program;

(8) The support costs for the program as determined by one of the following methods:

(a) Use of actual support cost items which may include, but are not limited to, the salary and fringe benefits of the health commissioner, utilities, rent, supplies, equipment, liability insurance, training and other costs as allowable in circular A-87 as published by the United States office of management and budget.

Actual support costs of each program are calculated by multiplying the amount determined under paragraph (B)(8)(a)(i) of this rule by the amount determined under paragraph (B)(8)(a)(ii) of this rule.

(i) The portion of total departmental support costs allocated to the environmental health subdivision.

(ii) The percentage of total time worked in each program by all employees subject to this rule as determined in paragraph (B)(3) of this rule.

(b) Use of an indirect cost rate determined by the board of health provided the indirect cost used is consistent with the requirements of circular A-87 as published by the United States office of management and budget.

(c) Use of an indirect cost rate of thirty per cent of the sum of wages or salaries, fringe benefits of employees, attributable to each program. The wages or salaries and fringe benefits of employees attributable to each program shall be determined by multiplying the amounts determined for each employee under paragraphs (B)(4) and (B)(5) of this rule by the percentage for all employees determined under paragraph (B)(3) of this rule and adding the products;

(d) Application of a negotiated indirect cost rate and calculation method approved by an agency of the federal government for the local health district to each program; and

(9) The laboratory, training, and educational costs for each program subject to this rule.

(C) The costs for each program may also include, but are not limited to, the amounts of any known or anticipated increases in costs or expenses for such items as rent, utilities, equipment, and current personnel, as well as the costs for additional personnel identified by the board of health of the city or general health district.

(D) The total costs for each program shall be calculated in the following manner:

(1) For each employee, multiply the amount of total annual wages or salary determined under paragraph (B)(4) of this rule by the percentage determined pursuant to paragraph (B)(2) of this rule. Sum the products;

(2) For each employee, multiply the fringe benefits determined under paragraph (B)(5) of this rule by the percentage determined pursuant to paragraph (B)(2) of this rule. Sum the products;

(3) For each employee, the actual travel costs for each employee attributable to each program may be used. Sum the costs. As an alternative, multiply the total travel costs determined under paragraph (B)(6) of this rule by the percentage determined pursuant to paragraph (B)(2) of this rule. Sum the actual products;

(4) Add the amounts determined under paragraphs (B)(7), (B)(8), (B)(9) and (C) of this rule for each program to the totals calculated in paragraphs (D)(1), (D)(2), and (D)(3) of this rule. This total is the cost for each program.

(E) For any license fee that includes an amount established by the public health council, the city or general health district shall remit all amounts due to the department of health within forty-five days of the conclusion of each calendar quarter, unless another timeframe is specified in law.

R.C. 119.032 review dates: 09/14/2011 and 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 3701.344 , 3729.07 , 3730.03 , 3733.04 , 3733.25 , 3749.04
Rule Amplifies: 3701.344 , 3729.07 , 3730.03 , 3733.04 , 3733.25 , 3749.04
Prior Effective Dates: 10/12/2009

3701-36-15 Nuisance control. [Rescinded].

Rescinded eff 1-1-05

3701-36-16 Maternal health. [Rescinded].

Rescinded eff 1-1-05

3701-36-17 Child health. [Rescinded].

Rescinded eff 1-1-05

3701-36-18 Nutrition services. [Rescinded].

Rescinded eff 1-1-05

3701-36-19 School health. [Rescinded].

Rescinded eff 1-1-05

3701-36-20 Family planning. [Rescinded].

Rescinded eff 1-1-05

3701-36-21 Substance abuse. [Rescinded].

Rescinded eff 1-1-05

3701-36-22 Disaster preparedness. [Rescinded].

Rescinded eff 1-1-05

3701-36-23 Injury prevention. [Rescinded].

Rescinded eff 1-1-05

3701-36-27 State subsidy. [Rescinded].

Rescinded eff 1-1-05

3701-36-28 Certification of compliance and financial disclosure. [Rescinded].

Rescinded eff 1-1-05

3701-36-29 Peer review process for assessing compliance. [Rescinded].

Rescinded eff 1-1-05

3701-36-30 Informal hearing process. [Rescinded].

Rescinded eff 1-1-05