HLT-08-08-00012-P Qualifications of Local Health Department Personnel

2/20/08 N.Y. St. Reg. HLT-08-08-00012-P

NEW YORK STATE REGISTER

VOLUME XXX, ISSUE 8

February 20, 2008

RULE MAKING ACTIVITIES

DEPARTMENT OF HEALTH

PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. HLT-08-08-00012-P

Qualifications of Local Health Department Personnel

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:

Proposed action:

Amendment of Part 11 of Title 10 NYCRR.

Statutory authority:

Public Health Law, sections 225(4), (5) and 206(1)(a)

Subject:

Qualifications of local health department personnel.

Purpose:

To support hiring of competent appropriately trained local public health professionals; assist local health departments to hire and retain competent staff in positions affected by public health worker shortages; and increase training to strengthen the competencies of the current public health workforce in local health departments.

Text of proposed rule:

The table of contents for Part 11 is amended to read as follows:

PART 11

QUALIFICATIONS OF PUBLIC HEALTH PERSONNEL

(Statutory authority: Public Health Law, Section 225)

Sec.

GENERAL PROVISIONS

11.0 Purpose, scope and construction

* * *

PUBLIC HEALTH NURSE 1

11.40 Definition

11.41 Entry level qualifications

[11.42 Supervisory level qualifications]

PUBLIC HEALTH NURSE 2

11.42 Definition

11.43 Qualifications

11.44 Supervisory level definition

11.45 Supervisory level qualifications

* * *

ENVIRONMENTAL HEALTH DIRECTOR

11.90 Definitions

11.91 Qualifications

* * *

PUBLIC HEALTH [OFFICIAL] SOCIAL WORKER

* * *

PUBLIC HEALTH EPIDEMIOLOGIST

11.196 Definition

11.197 Minimum qualifications

11.198 Supervisory level qualifications

Subdivision (d) of Section 11.0 is amended to read as follows:

(d) All public health professionals in the employ of local health [units] departments on January 1, [1979] 2008, and [possessing current Health Department certification] in a title described in this part at the entry or supervisory level, shall be considered as meeting the qualifications prescribed by this Part for entry or supervisory levels, respectively.

Subdivision (a)(2)(i) and (ii) of Section 11.2 are amended to read as follows:

(i) a baccalaureate degree from a regionally accredited or New York State registered [four-year] college or university and two years of [supervisory] experience in the administration, enforcement or management of a health or public health related program, including one year of supervisory experience; or

(ii) a master's degree in public health or a related field from a regionally accredited or New York State registered college or university and one year of supervisory experience in the administration, enforcement or management of a health or public health related program; or

Section 11.11 is amended to read as follows:

11.11 Qualifications.

(a) A commissioner of health of a county, or a city having a population of 50,000 or more and having an established department of health, shall be a physician who is currently registered to practice medicine in New York State and possesses two [one] years of experience in administrative practice that demonstrates that the candidate possesses the knowledge and skills to administer public health programs including workforce and budget management, effective communications, effective establishment and implementation of policy or business goals, and compliance with legal requirements and:

(1) certification by the American Board of Preventive Medicine, or

(2) a master's degree in public health [or a related field] from a regionally accredited or New York State-registered college or university that demonstrates the core competencies of a masters in public health (Biostatistics, Environmental Health Sciences, Epidemiology, Health Policy and Management, and Social and Behavior Sciences) or a masters degree in a related field from a regionally accredited New York State-registered college or university.[; or]

[(3) an appropriate combination of education and experience deemed equivalent by the State Commissioner of Health.]

(b) All appointments to the position of commissioner of health must be approved by the State Commissioner of Health.

(c) Candidates who do not meet the education or experience requirements of this section may be conditionally approved by the State Commissioner of Health for an appointment of two years, with an opportunity for two additional one year conditional renewals. Final approval of these candidates shall be contingent on satisfactory progress in meeting a public health education or experience plan developed in conjunction with and approved by the State Commissioner of Health.

Sections 11.40 and 11.41 are amended to read as follows:

PUBLIC HEALTH NURSE 1

11.40 Definition.

The term public health nurse 1 shall mean a nurse who plans, provides, directs and evaluates nursing care in a variety of settings with the goal of improved health outcomes and [offers instruction and guidance in health practices for] is actively involved in the planning, development, provision and evaluation of public health programs designed to prevent disease and improve the health of individuals, [and] families , specific populations, high risk groups and/or communities.

11.41 Entry level qualifications.

A public health nurse 1 must possess a baccalaureate degree in nursing from a regionally accredited or New York State-registered [four-year] college or university, as well as licensure and current registration[,] to practice as a registered professional nurse in New York State.

Section 11.42 is repealed and a new section 11.42 is added to read as follows:

PUBLIC HEALTH NURSE 2

11.42 Definition.

The term public health nurse 2 shall mean a nurse who plans, provides, directs and evaluates nursing care in a variety of settings with the goal of improving health outcomes and is actively involved in the planning, development, provision and evaluation of public health programs designed to prevent disease and improve the health of individuals, families, specific populations, high-risk groups and/or communities. The public health nurse 2 is also involved in program administration and/or program budget development and monitoring and/or quality improvement initiatives, and/or acting as advocate and liaison for constituents.

New sections 11.43, 11.44 and 11.45 are added to read as follows:

11.43 Qualifications.

A public health nurse 2 must meet the qualifications for public health nurse 1 and have one year of experience in public health nursing.

A public health nurse 2 must complete 15 hours of continuing education in public health related topics approved by the New York State Department of Health within the first year of employment in the title.

11.44 Supervisory level definition.

The term supervising public health nurse shall mean a nurse who supervises public health nurses 1 and 2 and other staff. A supervising public health nurse plans, provides, and evaluates nursing care in a variety of settings with the goal of improving health outcomes and is actively involved in the planning, development, provision and evaluation of public health programs designed to prevent disease and improve the health of individuals, families, specific populations, high-risk groups and/or communities. A supervising public health nurse may be involved in program administration and/or program budget development and monitoring and/or quality improvement initiatives, and/or acting as advocate and liaison for constituents and/or policy development.

11.45 Supervisory level qualifications.

A supervising public health nurse must meet the qualifications for public health nurse 1 and have two year's experience in public health nursing; or a master's degree in nursing from a regionally accredited or New York State-registered college or university and one year of experience in public health nursing.

A supervising public health nurse must complete 15 hours of continuing education in public health and management related topics approved by the New York State Department of Health within the first year of employment in this title.

New sections 11.90 and 11.91 are added to read as follows:

ENVIRONMENTAL HEALTH DIRECTOR

11.90 Definitions.

(a) The term environmental health director shall mean a person who administers and manages the environmental health programs of a county, or a city having a population of 50,000 or more.

(b) The term natural science shall mean a science such as biology, chemistry or physics that deals with the objects, phenomena, or laws of nature and the physical world. It shall include all physical and biological sciences.

(c) The term applied science shall mean science based courses in environmental technology, sanitation technology, medical technology, public health, infection control or food science.

11.91 Qualifications.

An environmental health director must possess:

(a) a baccalaureate degree from a regionally accredited or New York State registered college or university in sanitary, environmental, chemical, civil or public health engineering or a related engineering field; or a bachelor's degree from a regionally accredited or New York State registered college or university with thirty (30) credit hours in the natural sciences, of which not more than twelve (12) credit hours may be in the applied sciences; and

(b) two years of administrative and supervisory experience as a supervising engineer or supervising sanitarian as defined in this Part; or five years of environmental health experience, including two years of supervisory responsibility that demonstrates that the candidate has the technical and administrative skills necessary to manage programs that can anticipate, recognize and respond to environmental health challenges. A master's degree in public or environmental health or a related field that demonstrates the five core competencies of a public health education (Biostatistics, Environmental Health Services, Epidemiology, Health Policy and Management and Social and Behavior Sciences) may be substituted for up to two (2) years of the required environmental health experience.

Sections 11.100 and 11.101 are amended to read as follows:

11.100 Definition.

The term public health engineer shall mean a person who applies engineering principles for the detection, evaluation, control and management of those factors in the environment which influence the public's [man's] health.

11.101 Entry level qualifications.

A public health engineer must possess a baccalaureate degree in engineering from a regionally accredited or New York State registered [four-year] college or university or a license to practice as a professional engineer in New York State.

Section 11.110 is amended to read as follows:

11.110 [Definition.] Definitions.

(a) The term public health sanitarian shall mean a person who applies the principles of the [physical, biological] natural and social sciences for the detection, evaluation, control and management of those factors in the environment which influence the public's [man's] health.

(b) The term natural science shall mean a science such as biology, chemistry or physics that deals with the objects, phenomena, or laws of nature and the physical world. It shall include all physical and biological sciences.

(c) The term applied science shall mean science based courses in environmental technology, sanitation technology, medical technology, public health, infection control or food science.

Section 11.111 is amended to read as follows:

11.111 Entry level qualifications.

A public health sanitarian:

(a) must possess a baccalaureate degree from a regionally accredited or New York State registered [four-year] college or university with 30 credit hours in the [physical and biological] natural sciences, of which not more than twelve (12) credit hours may be in the applied sciences, and have satisfactorily completed a public health training course approved by the State Health Department within [one] two year s of appointment; or

(b) may be a public health technician who possesses five years of experience as a public health technician deemed satisfactory by the local commissioner of health or public health director and have satisfactorily completed a public health training course approved by the State Health Department.

Section 11.112 is amended to read as follows:

A supervising public health sanitarian must meet the qualifications for a public health sanitarian and have two years [,] of experience as a public health sanitarian.

Section 11.121 is amended to read as follows:

11.121 Entry level qualifications.

A public health technician must possess an associate degree from a regionally accredited or New York State registered [two-year] college or university or have completed 60 credit hours, with a minimum of [12] 15 credit hours in the [physical and biological] natural sciences [in either case], of which not more than six (6) credit hours may be in the applied sciences, and have satisfactorily completed a public health training course approved by the State Health Department within two years of appointment.

Section 11.130 is repealed and a new Section 11.130 is added to read as follows:

11.130 Definition.

The term local public health nutritionist shall mean a person who plans, develops, implements and evaluates nutrition services within the community and is actively involved in the planning, development, provision and evaluation of nutritional programs and services designed to prevent disease and improve the health of individuals, families, and communities.

Sections 11.131 and 11.132 are amended to read as follows:

11.131 Entry level qualifications.

A local public health nutritionist must possess a baccalaureate degree, with major studies in food and nutrition, from a regionally accredited or New York State-registered [four-year] college or university, and be registered as a dietician [or be eligible for registration] by the American Dietetic Association.

11.132 Supervisory level qualifications.

A supervising public health nutritionist must meet the qualifications for a public health nutritionist and have two years' experience as a public health nutritionist, or have a master's degree in nutrition or public health nutrition from a regionally accredited or New York State-registered college or university, and one year of experience as a public health nutritionist.

Sections 11.150, 11.151 and 11.152 are amended to read as follows:

11.150 Definitions.

The term local public health educator shall mean a person who applies the principles of behavioral sciences in public health programs to foster the voluntary adaptation of behavior to improve or maintain health.

11.151 Entry level qualifications.

A local public health educator must possess:

(a) a baccalaureate degree in health education, health science, public health, health promotion, community health, or health communications from a regionally accredited or New York State-registered [four-year] college or university; or

(b) a baccalaureate degree in education, nursing, epidemiology, wellness and fitness, or nutrition from a regionally accredited or New York State-registered college or university and one year experience in health education; or [a health-related field and two years experience in health education.]

(c) a baccalaureate degree in marketing, human services, social work or psychology from a regionally accredited or New York State-registered college or university and two years experience in health education; or

(d) a master's degree in public health or health education from a regionally accredited or New York State-registered college or university.

A local public health educator must satisfactorily complete 15 hours of continuing education in health education related topics approved by the New York State Health Department within one year of appointment.

11.152 Supervisory level qualifications.

A supervising public health educator must meet the qualifications for local public health educator and have two years['] of experience as a public health educator or have a master's degree in public health or health education from a regionally accredited or New York State registered college or university and one year['s] of experience as a public health educator.

Section 11.171 is amended to read as follows:

11.171 Entry level qualifications.

A public health social worker must [possess certification in social work] be licensed as a certified social worker by the New York State Education Department.

Section 11.182 is amended to read as follows:

11.182 Qualifications.

(a) A public health director shall possess:

(1) a master's degree in public health [or a related field] from a regionally accredited or New York State-registered college or university [ and] that demonstrates the core competencies of a public health education (Biostatistics, Environmental Health Sciences, Epidemiology, Health Policy and Management, and Social and Behavior Sciences) or a masters degree in a related field from a regionally accredited or New York State-registered college or university. Related fields include public health nursing, health administration, community health education or environmental health; and

(2) two [three] years of [public health administration] administrative experience in a health related organization or government agency that demonstrates that the candidate possesses the knowledge and skills necessary to administer public health programs including workforce and budget management, effective communication, effective establishment and implementation of policy or business goals, and compliance with legal requirements. [, or an appropriate combination of education and experience deemed equivalent by the State Commissioner of Health.]

(b) All appointments to the position of public health director and the appointment and arrangements for the medical consultant are subject to the approval of the State Commissioner of Health.

(c) Candidates who do not meet the education or experience requirements of this section may be conditionally approved for an appointment of two years by the State Commissioner of Health with an opportunity for two additional one year conditional renewals. Final approval of these candidates shall be contingent on satisfactory progress in meeting a public health education or experience plan developed in conjunction with and approved by the State Commissioner of Health.

[(c) Persons occupying a similar position as of January 1, 1979 with current health department certification shall be considered as meeting the qualifications for this position.]

New sections 11.196, 11.197 and 11.198 are added to read as follows:

PUBLIC HEALTH EPIDEMIOLOGIST

11.196 Definition.

The term local public health epidemiologist shall mean a person who investigates the occurrence of disease, injury or other health-related conditions or events in populations to describe the distribution of disease or risk factors for disease occurrence for the purpose of population-based prevention and control.

11.197 Minimum qualifications.

A local public health epidemiologist must possess:

(a) a master's degree from a regionally accredited or New York State-registered college or university in epidemiology, or in public health with a concentration in epidemiology, or a health related field with a minimum of six credits in epidemiology and six additional credits in epidemiology or biostatistics; or

(b) a bachelor's degree or higher from a regionally accredited or New York State-registered college or university and two years experience conducting data collection, analysis and reporting in support of surveillance and epidemiologic investigations.

11.198 Supervisory level qualifications.

A supervising local public health epidemiologist must meet the qualifications for a public health epidemiologist and have two additional years of experience conducting data collection, analysis and reporting in support of surveillance and epidemiologic investigations.

Text of proposed rule and any required statements and analyses may be obtained from:

Katherine E. Ceroalo, Department of Health, Office of Regulatory Affairs, Corning Tower, Rm. 2438, Empire State Plaza, Albany, NY 12237-0097, [phone], fax: [phone], e-mail: [e-mail]

Data, views or arguments may be submitted to:

Same as above.

Public comment will be received until:

45 days after publication of this notice.

Regulatory Impact Statement

Part 11 of the New York State Sanitary Code in Chapter I of Title 10 (Health) of the Official Compilation of Codes, Rules and Regulations of the State of New York establishes the minimum qualifications and job definitions of key public health professionals employed by local health departments. The proposed revisions affect the following job titles: commissioner of health and public health director, public health nurse, environmental health director, public health engineer, public health sanitarian, public health technician, public health nutritionist, public health educator, public health social worker and public health epidemiologist. These changes modernize job definitions and qualifications and are necessary to ensure that local health departments are able to fill key public health positions with competent, appropriately trained individuals able to meet the ongoing and emerging public health needs of local communities. These sections of the Code have not been amended since 1979. The proposed changes have the goal of assisting local health departments to hire and retain competent staff in positions affected by public health worker shortages. The proposed changes also have the goal of ensuring that first year employees in a number of positions obtain continuing education so that they can be prepared to address the increasing number of responsibilities facing the public health workforce, including both traditional and emerging public health issues. The benefit is a set of regulations that reflect up to date professional job definitions and qualifications and the training needs of the public health workforce.

The statutory authority for these regulations comes from Section 225(4) and (5) (b) of the Public Health Law (“PHL”) that authorize the Public Health Council to establish and amend State Sanitary Code provisions related to the qualifications of public health personnel working in county and city health departments. PHL Section 225(5)(a) provides that the State Sanitary Code may deal with any matters affecting the security of life or health or the preservation and improvement of public health in the state. PHL Section 206(1)(b) authorizes the Commissioner of Health “to exercise general supervision over the work of all local boards of health and health officers.”

The potential costs for implementing these changes will be minimal and are related to requiring local public health commissioners and directors who are conditionally appointed to develop and implement a public health experience and/or education plan during their conditional appointment and the potential loss of state aid to a county that fails to appoint a qualified candidate, establishing the new public health nurse 2 position, implementing the continuing education requirement for supervising public health nurses, public health educators and public health technicians, establishing the new position of local public health epidemiologist, and the administrative work of issuing new class specifications and announcements that reflect the Code changes. Implementing these changes will create minimal additional paperwork related to the need to monitor the progress of local commissioners of health and public health directors who are conditionally appointed toward achievement of education and experience requirements, and for tracking the completion of continuing education requirements for nurses, public health educators and sanitarians/technicians. Civil service agencies will be required to amend their class specifications to conform to the changes to Part 11, which establishes minimum standards for these positions. In addition, nurses in the public health nurse 2 and supervisory public health nurse positions, public health educators, public health sanitarians and technicians will be required to obtain continuing education. There is no duplication of this initiative in state or federal law, no significant alternatives for revising these job definitions and qualifications, and no federal standards for minimum qualifications of these professionals.

Regulatory Flexibility Analysis

Effect on Small Business and Local Government:

These proposed changes will have minimal or no impact on small businesses (local hospitals, health clinics and other settings that employ Bachelor's prepared nurses). There are approximately 6 hospitals and 15 nursing homes that employ less than 100 people in New York State. There are 397 licensed clinics; information about how many operate as small businesses is not available. These settings, if they hire bachelor's prepared nurses, may experience some impact if nurses choose to work at LHDs rather than other health care settings because of additional opportunities created by adding a title of Public Health Nurse 2.

These regulations will apply to all LHDs and county civil service agencies.

Compliance Requirements:

The county civil service agencies will be required to work with the LHDs to update their class specifications for the positions that are changed as a result of this reform.

Professional Services:

No additional professional services will be required. Updating class specifications is part of the regular work of local civil service offices.

Compliance Costs:

No capital costs of compliance are anticipated. One time compliance costs related to updating class specifications are minimal since updating is part of the regular work of local civil service offices. Annual costs related to training these titles are minimal and are described in the Regulatory Impact Statement.

Economic and Technological Feasibility Assessment:

There are no issues of technical feasibility.

Minimizing Adverse Impact:

The anticipated adverse impact of updating job definitions, changing the minimum qualifications and requiring training for public health professionals will be minimized by making training available on-line or by other distance learning formats.

Small Business and Local Government Participation:

LHDs have been consulted in this process through participation on the committees that developed the new language. The State Department of Civil Service Municipal Service Division has been consulted about these changes and has offered assistance in the development of the language. CSEA, the union that represents most LHD staff was also consulted.

Rural Area Flexibility Analysis

Effect on Rural Areas:

These proposed changes will apply statewide. These are expected to have minimal or no impact on LHDs and county civil service agencies in rural areas, except that they should make it easier for those LHDs to identify local public health educators eligible for positions.

Compliance Requirements:

The county civil service agencies in rural areas will be required to work with the LHDs to update their class specifications for the positions that are changed as a result of this reform.

Professional Services:

No additional professional services will be required. Updating class specifications is part of the regular work of local civil service offices in rural areas.

Costs:

No capital costs of compliance are anticipated. One time compliance costs related to updating class specifications are minimal since updating is part of the regular work of local civil service offices. Annual costs related to training these positions are minimal and are described in the Regulatory Impact Statement.

Minimizing Adverse Impact:

To strengthen the public health work force, there are no alternatives to updating job definitions, changing the minimum qualifications and requiring training for public health professionals. Adverse impacts have been minimized by making training available on-line or by other distance learning formats.

Rural Area Participation:

LHDs, including those in rural counties, have been consulted in this process through participation on the committees that considered the new language. The State Department of Civil Service Municipal Service Division has been consulted about these changes and has offered assistance in the development of the language. CSEA, the union that represents most LHD staff was also consulted.

Job Impact Statement

The Department of Health has determined that this regulatory change will not have an adverse impact on jobs and employment. It should increase staff retention by providing for promotional opportunities and training. It should also increase the number of qualified applicants for public health positions at LHDs. Because the State Department of Health uses different titles for public health professionals, the changes will have no impact on State Department of Health jobs or employment.