Public Health Foundational Package of Local Public Health Services (Core Functions) And

Public Health Foundational Package of Local Public Health Services (Core Functions) and

Community Health Planning and Reporting

Table of Contents

Note: This section is a work in progress. Therefore, there will be references to foundational capabilities and core services included that may not be synonymous with each other. Additional information will be provided in the future.

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Core Public Health Services Matrix...... 1

Core Public HealthDefinitions...... 2

Division of Women’s Health...... 2

Divisionof Maternal and Child Health...... 10

Public Health Protection and Safety...... 23

Epidemiologyand HealthPlanning...... 29

Laboratory Services...... 48

Administration and Financial Management...... 50

Prevention and Quality Improvement...... 51

Community HealthPlanning...... 52

Community Health Reporting...... 52

Page 1 of 52

Administrative Reference - Public Health Foundational Package of Local Public Health Services (Core Functions) andCommunity

Health Planning and Reporting

August 1, 2017

Page 1 of 52

Administrative Reference - Public Health Foundational Package of Local Public Health Services (Core Functions) andCommunity

Health Planning and Reporting

August 1, 2017

Core Public Health Definitions

Foundational Package of Local Public Health Services

In an effort to clarify the programs and services a local health department (LHD) must provide, the Core Public Health Services matrix has been replaced with the Kentucky Foundational Package of Local Public Health Services matrix on the previous page. The Foundational Package has three components:

-Foundational Capabilities – those skills and resources that cross program lines and are necessary to provide the foundation for the LHD’s programs and services.

-Core Public Health Services [Foundational Services] – the services that every LHD must provide in each county.

-Enhanced Services – the services that a LHD may choose to offer over and above the core services offered by the LHD. (Note: An enhanced service should not be offered at the detriment of the core services or foundational capabilities.)

Programs and services may be provided either directly or indirectly by the LHD as follows:

A Directly Provided Program or Service is aservice that a LHD must provide in each countyaccording to the program specific criteria set forth in the Administrative Reference, Core Clinical Service Guide (CCSG), and the WIC and Nutrition Manual.

An Indirectly Provided Program or Service is a program or service provided in each county that a LHD may arrange for another LHD or a local provider to provide or contract with an outside entity to provide in their jurisdiction according to the program specific criteria set forth in the Administrative Reference, Core Clinical Service Guide (CCSG), and/or WIC and Nutrition Manual.

Division of Women’s Health

FAMILY PLANNING

Background

The Kentucky Cabinet for Health and Family Services, Department for Public Health (DPH), Family Planning Program (FPP) is the grantee for federal Title X funds. The Title X Family Planning program ["Population Research and Voluntary Family Planning Programs" (Public Law 91-572)], was enacted in 1970 as Title X of the Public Health Service Act. Title X is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services. The Title X program is designed to provide access to contraceptive services, supplies and information to all who want and need them.

Definition

The FPP is intended to assist individuals in determining the number and spacing of their children. This promotes positive birth outcomes and healthy families. The education, counseling, and medical services available in Title X funded clinic settings assist in achieving these goals. Through local health departments (LHDs), the FPP is the largest provider of family planning services to women, men, and teens throughout the state to provide access to publicly funded contraception. In addition to contraceptive services and related counseling, Title X funded clinics provide a number preventive health services such as: patient education and counseling; breast and pelvic examinations; breast and cervical cancer screening; sexually transmitted disease (STD) and Human Immunodeficiency Virus (HIV) prevention education, counseling, testing and referral; preconception care; and pregnancy diagnosis and counseling.

Eligibility

Women, men, and teens are eligible for Title X funded family planning services. By law, the priority population to be served is low-income individuals.

Expectations

Title X funded clinics must assure compliance with all federal and state regulations. Federal Regulation (42 CFR Part 59) requires that Family Planning services be provided without regard to religion, race, color, national origin, handicapping condition, age, sex, number of pregnancies or marital status. All information as to personal facts and circumstances obtained by the project staff about individuals receiving services must be held confidential and must not be disclosed without the individual’s documented consent, except as may be necessary to provide services to the patient or as required by law, with appropriate safeguards for confidentiality. Otherwise, information may be disclosed only in summary, statistical, or other form which does not identify particular individuals. Kentucky regulation regarding family planning services is 902 KAR 4:050, and relates to KRS 211.090 and KRS 211.180. Sterilizations provided with federal funds shall meet all requirements as identified in Chapter 1, Public Health Services 43FR52165 Subpart B, 50.209. KRS 214.185 states that a minor as a patient with the consent of such minor may seek and be provided family planning services without the consent of or notification to the parent, parents, or guardians of such minor patient; or to any other person having custody of such minor patient.

Additionally, LHD must assure compliance with the Title X guidelines related to family planning services, which includes administrative, financial, clinical, and community outreach requirements. Title X administrative requirements include but are not limited to: assuring a competently trained health care staff to provide services; adherence to state mandatory reporting for abuse, neglect, violence and human trafficking; minors are counseled to encourage family participation in the decision of the minor seeking family planning services and how to resist coercive attempts to engage in sexual activities; assure access to a broad range of acceptable and effective family planning methods and related preventive health services that include natural family planning methods, infertility services, and services for adolescents, emphasizing the important role Title X plays in teen pregnancy prevention; assure services does not include abortion as a method of family planning.

Title X financial requirements include but not limited to: ensure that inability to pay is not a barrier to services; charges for services must be based on a cost analysis; bills showing total charges shall be given directly to the patient even if the amount is zero; ensure that patients at or below 100% of poverty are not charged for services; all obligated third party payers shall be billed total charges; ensure that discounts for minors obtaining confidential services are based on the income of the minor; maintain reasonable efforts to collect charges without jeopardizing patient confidentiality; assure patients between 101% and 250% FPL are billed utilizing a sliding fee scale.

Title X clinical requirements include but are not limited to: provide preventive health care services in accordance with nationally recognized standards of care; assure informed consent for pregnancy prevention; testicular, breast and cervical cancer screening and prevention services; STD prevention, detection and prevention; HIV prevention education, testing, and referral; pregnancy testing and options counseling; emphasizing the importance of counseling family planning clients on establishing a reproductive life plan; and providing preconception counseling as a part of family planning services.

Title X community outreach requirements include but are not limited to: addressing the comprehensive family planning and other health needs of individuals, families, and communities through outreach to hard-to-reach and/or vulnerable populations, and partnering with other community-based health and social service providers that provide needed services for low income persons. Services determined to be necessary, but which are beyond the scope of the family planning clinic services, must be recommended for follow up care from appropriate healthcare providers. Family planning clinics must maintain a current list of health care providers, local health and human services departments, hospitals, voluntary agencies, and health services projects supported by other federal programs available in the community.

Allowable Expenditures

Clinical examinations (including education and counseling) for initial, annual, contraceptive supply, follow up, pregnancy test and emergency contraception family planning visits; contraceptive supplies; testicular, breast and cervical cancer screening and prevention services; STD prevention, detection, and treatment; HIV prevention education, testing, and referral; pregnancy testing and options counseling; emphasizing the importance of counseling family planning clients on establishing a reproductive life plan; and providing preconception counseling as a part of family planning services.

DPH Responsibility

DPH responsibilities include: completion of a statewide needs assessment of reproductive health issues and outcomes; collection of family planning user data to complete the mandated Family Planning Annual Report (FPAR); Administrative Reference and Public Health Practice reviews with appropriate revisions based on federal site visit findings, assurance of national standards or care, and identified improvements to family planning services; monitor the fiscal management of Title X funds; provide LHD training related to Title X and state financial requirements; provide technical assistance to LHD support staff, nursing staff, nurse leaders, and directors; monitor LHD budgets; allocate Title X awarded funds; distribute relevant federal and state information related to family planning services, including training opportunities, to all Title X funded clinic sites; and write and submit the annual Title X grant application to assure continued funding.

Indirect Policy

INDIRECT CLINICAL SERVICE PROVIDER (ICSP)

For the purpose of this document, the indirect clinical service provider (ICSP) is defined as a medical provider who is contracted by a Local Health Department (LHD) to provide family planning services in lieu of the LHD providing direct clinical services for Family Planning Program patients. LHDs must provide all Family Planning Program clinical services or contract with ICSPs to provide all Family Planning Program clinical services throughout the fiscal year.

For services provided through an ICSP:

LHDs must not retain more than 10% of their Family Planning Program allocation for administrative fees.
LHDs must provide a copy of the ICSP contract to the Family Planning Program for review and approval prior to implementation of the contract.
LHD contracts with ICSPs must include the Family Planning Program guidelines as outlined in the Core Clinical Service Guide (CCSG) and the Administrative Reference (AR).
LHD contracts with ICSPs must include language to allow the LHD, the Family Planning Program, and the Office of Population Affairs to conduct on-site reviews and have direct access to Family Planning Program patient charts.
LHD contracts with ICSPs must include language to allow the Family Planning Program direct contact with the ICSP to dispense or collect information as needed.
LHDs must educate, train, and monitor all ICSPs on the following:

-Title X Requirements and federal regulations regarding Title X funding;

-Family Planning Program guidelines outlined in the CCSG and AR;

-Family Planning Annual Report (FPAR) data collection requirements and procedures; and

-Division of Women’s Health (DWH) Quality Assurance/Quality Improvement Policy as outlined in the AR.

LHDs or their contracted ICSPs must plan to use part of their yearly allocation to provide at least one sterilization through contract with a qualified provider per year. Contracts with providers for sterilizations must adhere to the federal requirements, including but not limited to the following language: The federal sterilization consent form shall be signed at least 30 days (no less) prior to the date of surgery and the procedure performed within 180 days of the signature.
LHDs or their contracted ICSPs must plan to use part of their yearly allocation to provide at least one Long Acting Reversible Contraceptive (LARC) (an IUD or contraceptive implant) per year either on site or through contract with a qualified provider.

Contracts between ICSPs and other providers to perform sterilizations, IUD placement, contraceptive implant placement, etc. for Family Planning Program Patients must contain the same language required by the LHDs when contracting for these services. Copies of these contracts must be provided to the Family Planning Program.

LHDs are responsible for auditing ICSP service sites quarterly as outlined in the DWH QA/QI Policy and must include language regarding this requirement in the contracts.
LHDs must submit in writing to the Family Planning Program, for approval by the Office of Population Affairs (OPA), any proposed changes to clinic sites and/or services offered (including but not limited to closing a clinic, opening a new clinic, or contracting with an ICSP). OPA must approve the change prior to implementation of the change.

Regulations and Mandates

The Kentucky Family Planning/Title X Program is authorized by the Public Health Service Act through the Family Planning Services and Population Research Act of 1970 (Public Law 91-572). The act was created “to promote public health and welfare by expanding, improving, and better coordinating the family planning services and population research activities of the Federal Government, and for other purposes.

The federal regulation, 42 CFR, Part 59, Subpart A, Grants for Family Planning Services, are the requirements in the provision of voluntary family planning services funded under Title X and to implement the statute as authorized under Section 1001 of the Public Health Service Act. Section 1001 of the Act (as amended) authorizes grants “to assist in the establishment and operation of voluntary family planning projects, which offer a broad range of acceptable and effective family planning methods, including natural family planning methods and services, including infertility services, and services to adolescents.” The mission of Title X is to provide individuals the information and means to exercise personal choice in determining the number and spacing of their children.

The following legislative mandates are part of the Title X appropriations language. Title X family planning services projects should include administrative, clinical, counseling, and referral services necessary to ensure adherence to these requirements:

None of the funds appropriated in this Act may be made available to any entity under Title X of the Public Health Service Act unless the applicant for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual activities.

Notwithstanding any other provision of law, no provider of services under Title X of the Public Health Service Act shall be exempt from any State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.

Section 205 of Public Law 94-63 states: ``Any (1) officer or employee of the United States, (2) officer or employee of any State, political subdivision of a State, or any other entity, which administers or supervises the administration of any program receiving Federal financial assistance, or (3) person who receives, under any program receiving Federal assistance, compensation for services, who coerces or endeavors to coerce any person to undergo an abortion or sterilization procedure by threatening such person with the loss of, or disqualification for the receipt of, any benefit or service under a program receiving Federal financial assistance shall be fined not more than $1,000 or imprisoned for not more than one year, or both.''

Additional federal regulations include but are not limited to:

Provide services without subjecting individuals to any coercion to accept services or coercion to employ or not to employ any particular methods of family planning; Acceptance of services must be solely on a voluntary basis and may not be made a prerequisite to eligibility for, or receipt of, any other service;
Provide services in a manner which protects the dignity of the individual; Provide services without regard to religion, race, color, national origin, handicapping condition, age, sex, number of pregnancies, or marital status;
Not provide abortions as a method of family planning;
Ensure a broad range of all Food and Drug Administration (FDA) approved methods of contraception to some extent shall be available directly or through referral; Only FDA approved drugs and devices may be provided; and No funds may be used to purchase experimental or ineffective drugs.
Provide services without the imposition of any durational residency requirement or requirement that the patient be referred by a physician.

Federal Regulations:

Kentucky regulation regarding family planning services is 902 KAR 4:050, and relates to KRS 211.090 and KRS 211.180.

Quality Monitoring and Quality Assurance:

All LHDs providing program services commit to carrying out initiatives consistent with program standards and applicable regulations.

KENTUCKY WOMEN’S CANCER SCREENING (KWCSP)

Background

In 1990, legislation (KRS 214.554) established the Kentucky Women’s Cancer Screening Program (KWCSP) in the Department for Public Health, Division of Women’s Health. The KWCSP provides breast and cervical cancer screenings, diagnostic follow-up services and case management utilizing federal grant monies from the Center for Disease Control’s (CDC’s) National Breast and Cervical Early Detection Program (NBCCEDP).

Definition

KWCSP services include clinical breast exams, pap tests, bimanual examinations, mammograms, follow-up diagnostic services, case management and treatment referrals for eligible clients. All other program components are related to and in support of the delivery of screening and diagnostic services to women most in need.