VIRGINIA DEPARTMENT OF HEALTH (VDH) SUMMARY OF …

VIRGINIA DEPARTMENT OF HEALTH (VDH) SUMMARY OF MANDATES REQUIRED BY FEDERAL LAW, STATE LAW,

CONTRACT OR INTERAGENCY AGREEMENT Revised for Virginia Beach Department of Public Health March 2017

Note: The majority of Public Health Laws in the State of Virginia are found in Title 32 in the State Legislative Information System. Specific chapters of the law are referenced in the table below.

1. OVERARCHING AGENCY MISSION, CONTEXT AND STRUCTURE

Mandated Service or Activity Establishment of the State Board of Health and the State Department of Health Purpose of the Board and Department

Development of Programs Necessity for adopting regulations

Existence of local health departments Independent local health departments

Authority (and Obligating Instrument, if any):

?? 32.1-2, 32.1-16 ?32.1-2

?32.1-11 ??32.1-12, 32.1-12.1, 32.1-13

?32.1-30 ?32.1-32

Description of Mandate or Authorizing Text

There shall be a State Board of Health and a State Department of Health in the executive department responsible to the Secretary of Health and Human Resources.

The General Assembly finds that the protection, improvement and preservation of the public health and of the environment are essential to the general welfare of the citizens of the Commonwealth. For this reason, the State Board of Health and the State Health Commissioner, assisted by the State Department of Health, shall administer and provide a comprehensive program of preventive, curative, restorative and environmental health services, educate the citizenry in health and environmental matters, develop and implement health resource plans, collect and preserve vital records and health statistics, assist in research, and abate hazards and nuisances to the health and to the environment, both emergency and otherwise, thereby improving the quality of life in the Commonwealth. The Board may formulate a program of environmental health, laboratory services, and preventive, curative and restorative medical care services, including home and clinic health services. The Board may make, adopt, promulgate and enforce such regulations and provide for reasonable variances there from as may be necessary to carry out its mission, as set forth in law. The Board shall promulgate regulations to carry out the law regarding human research to be conducted or authorized by the Department or related facilities; the Board may make separate orders and regulations to meet any emergency to suppress nuisances dangerous to the public health. Each county and city shall establish and maintain a local department of health which shall be headed by a local health director, who shall be a physician licensed to practice medicine in this Commonwealth. The governing body of any county or city which does not enter into a contract with the Board for the operation of the local health department shall appoint the local health director and may appoint a local board of health to establish policies and to advise the local health department. Each local health director and local board of health appointed by a governing body shall enforce all health laws of this Commonwealth and regulations of the State Board of Health.

Providing direct

?32.1-11 (B)

medical care services

Page 1 Revised for VBDPH March, 2017

Persons deemed to be medically indigent shall receive the medical care services of the Department without charge; the Board of Health may prescribe charges to be paid for such services by persons who are not indigent and a scale of charges based on ability to pay. Board shall

Operation of local health departments under contract with Board

Surveillance and investigation of diseases

Emergency rules and regulations

Authority of State Health Commissioner to require quarantine, etc.

Providing childhood immunizations

?32.1-31

review periodically the program and the charges adopted. The Commissioner shall appoint the health director for the local health department or district health director who shall be deemed to be the local health director of each county and city in the district, whenever a contract is entered into between a county or city and the Board. Each health director shall perform such duties as may be prescribed in the contract or contracts and, with the approval of the Commissioner, any other health-related duties prescribed by local ordinances.

2. COMMUNICABLE DISEASE SERVICES AND PREVENTION

??32.1-35, 32.1-39

? 32.1-42 ? 32.1-43 ?32.1-46 ?63.2-603 ?32.1-46

The Board shall promulgate a list of diseases which shall be reported. The Board shall provide for the surveillance of and investigation into all preventable diseases and epidemics in this Commonwealth and into the means for the prevention of such diseases and epidemics. Surveillance and investigation may include contact tracing in accordance with the regulations of the Board. When any outbreak or unusual occurrence of a preventable disease shall be identified through reports required pursuant to Article 1 (? 32.1-35 et seq.) of Title 32.1 of the Code, the Commissioner or his designee shall investigate the disease in cooperation with the local health director or directors in the area of the disease. If in the judgment of the Commissioner the resources of the locality are insufficient to provide for adequate investigation, he may assume direct responsibility and exclusive control of the investigation, applying such resources as he may have at his disposal. The Board may issue emergency regulations and orders to accomplish the investigation. The Board of Health may promulgate regulations and orders to meet any emergency or to prevent a potential emergency caused by a disease dangerous to public health, including, but not limited to, procedures specifically responding to any disease listed pursuant to ? 32.1-35 that is determined to be caused by an agent or substance used as a weapon or any communicable disease of public health threat that is involved in an order of quarantine or an order of isolation pursuant to Article 3.02 (? 32.1-48.05 et seq.) of this chapter. The State Health Commissioner shall have the authority to require quarantine, isolation, immunization, decontamination, or treatment of any individual or group of individuals when he determines any such measure to be necessary to control the spread of any disease of public health importance and the authority to issue orders of isolation pursuant to Article 3.01 (? 32.1-48.01 et seq.) of this chapter and orders of quarantine and orders of isolation under exceptional circumstances involving any communicable disease of public health threat pursuant to Article 3.02 (? 32.1-48.05 et seq.) of this chapter. Local health departments must provide immunizations required for school attendance without charge. (Sections 22.1-271.1 and 22.1-271.2 of the Code require documentary proof of immunization in order for a child to enter school.) Recipients of Aid to Families with Dependent Children (AFDC) must provide verification of receipt of immunizations for all children not enrolled in school or licensed day care; local health departments are required to provide assistance to AFDC recipients in obtaining verification from immunization providers. Local health departments must provide immunizations to a child to provide documentary proof to the child or his parent or guardian of all immunizations administered. Local health departments are also required to evaluate any immunization record which does not contain

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Sexually transmitted disease (STD) screening, diagnosis, treatment, & surveillance Advising courts in instances where public safety employees may be exposed to bloodborne pathogens Tuberculosis (TB) control screening, diagnosis, treatment, and surveillance

?32.1-57 et seq. ?32.1-45.2 ?32.1-49 et seq.

Tuberculosis treatment ?32.1-50.1 plan

HIV/AIDS surveillance, investigation, and Seroprevalence Survey

??32.1-36, 32.1-36.1, 32.1-39

Submission of morbidity data and reports Administering HIV Medications

HIV Care Consortia

Public Health Service Act, ?? 3101 (A), 311, 317 (K) (3) PHS Act, Public Law (P.L.) 104-146 (Ryan White) PHS Act, P.L. 104-146 (Ryan White)

HIV Client-Level Data Demonstration Grant

Providing grants for regional HIV/AIDS resource and consultation centers Regional AIDS resource and consultation centers (HIV early intervention centers) AIDS services and education grants

Office of Management and Budget (OMB) No. 06050010 Contract No. 24094.0049 ?32.1-11.2

?32.1-11.2

?32.1-11-1

the month/day/year of administration to determine that such student is adequately immunized. Local health departments may require a person suspected of being infected with an STD to be examined, tested and treated; if any such person refuses, the local health director may apply to circuit court for an order compelling submission to such care; if the local health director requires such a person to receive treatment, no fee shall be charged. The Commissioner shall advise a court that is considering issuance of an order requiring blood testing in an instance where a public safety employee may have been exposed to a blood-borne pathogen and the person whose body fluids are involved refuses to be tested.

TB shall be included in the list of reportable diseases required by ?32.1-35 of the Code. Local health directors may request a person suspected of having TB to be examined immediately tested and treated; the Board may build hospitals for the treatment of TB and the Commissioner may charge patients for care. Each physician practicing in the Commonwealth or facility who assumes responsibility for the treatment of a person for active TB shall develop, maintain and update as indicted an individualized written plan of treatment tailored to the person's medical and personal needs and identifying the method for effective treatment and prevention of transmission. Written treatment plan shall upon request be submitted by the provider to the local health director and shall be subject to approval by the local health director. The Commissioner shall have the authority to settle disagreements between the written plan submitted and standards of care established by the local health director. Physicians must report persons with HIV and AIDS to the local health department, which will investigate; the patient's identity shall remain confidential, and disclosed only as authorized.. The Board may conduct counseling and contact tracing and issue emergency orders to accomplish the investigation. The Centers for Disease Control and Prevention (CDC) provides funding to conduct surveillance activities. As a funding requirement, morbidity data and annual progress reports must be submitted to CDC. The Health Resources and Services Administration (HRSA) provides funding for HIV medication. They require quarterly reports on program utilization. Funds direct care to individuals with HIV. VDH is required to negotiate and monitor contracts with consortia and provide data and quality assurance information to HRSA. HRSA contracts with VDH to provide client-level data on individuals receiving Ryan White services. Monthly reports are required.

From available funds, the Board of Health shall provide grants for no more than five regional resource centers for education/training of health care professionals about HIV and establish criteria for awarding such grants. Using available facilities and such funds as are appropriated, the Board shall provide grants for no more than five regional AIDS resource and consultation centers. (Funds have been provided for two.) The Board must establish criteria for awarding the grants.

The Board must establish an AIDS services and education grants program.

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HIV Prevention

HIV Counseling, Testing and Referral

Sexually Transmitted Disease Services Rabies protection

Rabies protection (continued) Ophthalmia neonatorum

PHS Act, Sect. 301(A),317

?32.1-37.2

?32.1-55.1 PHS Act, Sect. 318(A, B, C), 212 CFR, Parts 51B/, Subpart A/D ?3.2-6500 et seq.

?3.2-6522 ?32.1-48 thru 48.4 ?32.1-64

The CDC provides funding to conduct HIV prevention activities (health education risk reduction, public information, counseling, testing, referral and partner notification, minority initiatives, etc.). As a funding requirement, HIV counseling and testing data must be submitted quarterly. Annual progress reports are also required. Informed consent for HIV testing is required, a patient must be afforded the opportunity for face to face disclosure of test results and counseling. With such funds as are appropriated, the Board shall make available in all health services areas anonymous testing for HIV. The CDC provides funding for the control and prevention of sexually transmitted diseases (STD). As a funding requirement, screening data, morbidity, and comprehensive narrative progress reports are required on an annual basis. Requires that appropriate health department and local governing body approve the holding or rabies clinics if the local governing body finds that the number of resident veterinarians in inadequate to meet the need. Gives authority to local health director to confine or have euthanized "potentially rabid animal[s]." Gives authority to Commissioner of Health to adopt regulations to control rabies. Treatment for ophthalmia neonatorum is required.

3. ENVIRONMENTAL HEALTH SERVICES AND PROTECTION

Regulations governing hotels Regulations governing restaurants; advisory standards for exempt entities.

?35.1.13 ?35.1.14

Providing restaurant training materials

?35.1.15

Regulation of radiation, X-ray machine registration and certification

?32.1-229

X-ray machine inspections

Mammography Quality

U.S. Food and Drug Administration (FDA) Contract 223-95-4160

FDA Contract 223-94-

Regulations of the Board governing hotels shall provide minimum standards for such facilities. While considering the accepted standards of health, the Board shall adopt regulations governing restaurants including provisions requiring procedures for obtaining a license; the safe and sanitary maintenance, storage, operation, and use of equipment, the sanitary maintenance and use of a restaurant's physical plant, the safe preparation, handling, protection, and preservation of food, including necessary refrigeration or heating methods, procedures for vector and pest control, requirements for toilet and cleansing facilities for employees and customers, lighting and ventilation, an approved water supply and sewage disposal system, personal hygiene standards for employees, and the appropriate use of precautions to prevent the transmission of communicable diseases. The Board may issue advisory standards for the safe preparation, handling, protection, and preservation of food by entities exempt from Title 35.1 of the Code. The Commissioner shall cause to be written materials designed for the training of restaurant personnel. The Commissioner may, if he desires, provide personnel for the training of employees of restaurants in the handling of food. The Board may establish a program of effective regulation of sources of radiation, adopt regulations, and shall require registration, inspection and certification of all diagnostic and therapeutic X-ray machines. The program inspects all x-ray machines used in local health departments; the program provides inspections to the private sector on demand. VDH is required to inspect a specified number of new x-ray machine installations in accordance with federal compliance regulations.

VDH is required to inspect all mammography facilities for compliance

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Standards Act Inspections Radioactive Materials Licensing and Inspection Program

4446 ?32.1-229

Indoor Radon

?32.1-229

Radon Projects

Environmental Monitoring

U.S. Environmental Protection Agency (EPA) State Indoor Radon Grant NRC Contract 29-83-623

Emergency Response, Planning, and Training

?44-146.18, the State Emergency Operations Plan;

?32.1-229 (A) (6)

Toxic Substances Information

?32.1-241

Prevent Exposure of Citizens to Toxic Substances

??32.1-241 and 32.1-248

Biennial Report to the Governor and the General Assembly Regulations governing summer camps

?32.1-245 ?35.1.16

Regulations governing ?35.1.17 campgrounds.

State Health Commissioner to advise on the regulation of milk

?3.1-530.1

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with federal regulations.

VDH is required to license the use of radioactive materials that are not regulated by the U.S. Nuclear Regulatory Commission (NRC). The program also conducts inspections to ensure the public health and safety. VDH is required to provide technical and educational assistance to the private sector on testing for and mitigating radon problems in homes, schools and private business. VDH is required to perform specific radon projects as outlined in the radon grant and to provide activity reports to the EPA.

VDH is required to conduct environmental monitoring around the North Anna and Surry Power Stations, and Babcock and the Wilcox Nuclear Fuels Processing and Fabrication Plant. The analyzed data is compared with the facilities' data, and a report is submitted to the NRC.

VDH collaborates with the Department of Emergency Services to perform specific tasks in response to a radiation emergency when either declared by a nuclear power station or upon request by the Department of Emergency Services. Services provided are field monitoring, laboratory analysis and accident assessment. VDH is authorized to coordinate with DES in responding adequately to radiation emergencies. This activity requires participation in several exercises and drills each year. The program provides training to state and local government participants. The Board shall provide advice to the Governor, legislators, other state agencies, federal government, local governing bodies, health care personnel, industry, and citizens on human health and environmental effects of chemical exposures via air, water and food. The Board shall conduct human health risk assessment and prevent exposure of citizens to toxic substances by issuance of health advisories and closure of bodies of water to fishing, boating, swimming, and other activities. The Board shall submit a biennial report on toxic substances in the Commonwealth to the Governor and General Assembly.

Regulations of the Board shall include, but not limited to: (i) an approved drinking water supply; (ii) an approved sewage disposal system; (iii) an approved solid waste disposal system; (iv) the adequate and sanitary preparation, handling, protection and preservation of food; (v) the proper maintenance of buildings, grounds, and equipment; (vi) vector and pest control; (vii) toilet, swimming, and bathing facilities, including shower facilities; (viii) a procedure for obtaining a license. The regulations shall include minimum standards for (i) an approved drinking water supply; (ii) an approved sewage disposal system; (iii) and approved solid waste disposal system; (iv) the proper maintenance of buildings, grounds, and equipment; (v) vector and pest control; (vi) toilet, swimming, and bathing facilities, including shower facilities; (vii) effective measures for the control of animals and pets; (viii) appropriate procedures and safeguards for hazardous situations, including specifically the maintenance and sale of propane gas or other explosives and combustibles; and (ix) a procedure for obtaining a license. Regulations concerning the processing and distributing of Grade A market milk and Grade A market milk products shall be adopted by the Board of Agriculture and Consumer Affairs with the advice and guidance of the State Health Commissioner or his authorized

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