Group: Health & Human Services - Department of Health

Agency: Health

Line Item: Health Systems Improvement

Function

The Division of Health Systems Improvement assures and improves the quality of the Utah health care system, with an emphasis on care delivered to the most vulnerable populations. Its mission is fulfilled through the examination, analysis, and regulatory actions to improve service availability, accessibility, safety, continuity, quality, and cost.

The Division includes the Director's office, the Bureau of Health Facility Licensing, Certification, and Resident Assessment, the Bureau of Emergency Medical Services (EMS), the Bureau of Child Care Licensing, and the Office of Primary Care and Rural Health. Health Systems Improvement directs the regulation and oversight of the health care industry. Division-wide improvement strategies include training, certification, licensing, and inspection. Additionally the Division provides pre-admission screenings for all Utah Medicaid recipients seeking nursing home or institutional care and promoting primary care services to underserved populations. The Division additionally supports the Patient Safety Initiative, the Primary Care Grants Program, the Health Care Workforce Financial Assistance Program, and the Assistance to Persons with Bleeding Disorders Program.

Statutory Authority

The Division of Health Systems Improvement is governed by the Utah Health Code in Title 26 of the Utah Code.

• UCA 26-6a sets up criteria for testing and workers' compensation for emergency medical services providers who are exposed to various diseases
• UCA 26-8a creates the State Emergency Medical Services Committee, establishes the Statewide Trauma System, and outlines the criteria for emergency medical service personnel.
• UCA 26-9 outlines the Health Department's efforts in relation to primary health care services in rural areas of the State.
• UCA 26-18, Part 3 'Access to Health Care' outlines the requirements for the Department to make grants to public and nonprofit entities for the cost of operation of providing primary health care services to medically underserved populations.
• UCA 26-21 outlines the necessary requirements for State licensing of various health care facilities.
• UCA 26-21a requires the Department to license facilities using diagnostic mammography.
• UCA 26-39 details the licensing requirements for child care providers.
• UCA 26-47-103 creates the Assistance to Persons with Bleeding Disorders Program. It outlines the criteria for granting awards for assistance with the cost of obtaining hemophilia services or the cost of insurance premiums for coverage of hemophilia services.

Intent Language

Under Section 63J-1-402 of the Utah Code, the Legislature intends that up to $400,000 of Item 102, Chapter 2, Laws of Utah 2008, Volume 1 appropriated for Primary Care Grants Program not lapse at the close of Fiscal Year 2009.

Under Section 63J-1-402 of the Utah Code, the Legislature intends that up to $210,000 of Item 102, Chapter 2, Laws of Utah 2008, Volume 1 from fees collected for the purpose of plan reviews by the Bureau of Health Facility Licensure, Certification and Resident Assessment not lapse at the close of Fiscal Year 2009.

Under Section 63J-1-402 of the Utah Code, the Legislature intends that up to $50,000 of Item 102, Chapter 2, Laws of Utah 2008, Volume 1 of unused funds appropriated for Health Systems Improvement assistance for people with bleeding disorders not lapse at the close of Fiscal Year 2009.

Under Section 63J-1-402 of the Utah Code, the Legislature intends that civil penalties money collected for Item 102, Chapter 2, Laws of Utah 2008, Volume 1 from childcare and health care provider violations not lapse at the close of Fiscal Year 2009.

Funding Detail

For analysis of current budget requests and discussion of issues related to this budget click here.

Program: Director's Office

Function

The administrative function of the Division of Health Systems Improvement includes planning and budget analysis, coordination of intradivisional activities, oversight of the three bureaus and one office, identification and implementation of information systems improvement, patient safety initiative, and Division liaison with other public and private agencies and organizations.

Funding Detail

Program: Facility Licensure, Certification, and Resident Assessment

Function

The Bureau of Health Facility Licensing, Certification, and Resident Assessment has the responsibility for licensing and inspecting health care facilities including hospitals, nursing homes, Intermediate Care Facilities for the Mentally Retarded, home health agencies, assisted living facilities and many other provider types. Additionally, the Bureau inspects those health care facilities choosing to be certified for Medicare/Medicaid programs. The Bureau also investigates complaints made about these providers, and performs pre-admission/continued stay health screenings for all Utah Medicaid recipients seeking nursing home or institutional care.

The Bureau performs background screening for all direct care staff of all nursing homes, small health care facilities, assisted living, home health agencies, hospice agencies, and end stage renal disease facilities. The Bureau is responsible for managing two federal grants: Title 18 (Medicare) Certification Grant and Title 19 (Medicaid) Certification. These grants are funded at different federal matching rates. Title 18 Certification is 100 percent federally-funded and Title 19 is matched at either 75 percent or 50 percent Federal Financial Participation (FFP). In addition, the Bureau participates in the regular Title 19, general Medicaid administration program. This program is matched at 75 percent or 50 percent FFP. Overall, the average match rate is 87.5 percent federal and 12.5 percent State.

The Bureau reviews building plans for new construction and remodeling of health care facilities. Some of the building design and construction requirements for health care facilities that are much more stringent than private structures include: ventilation systems, sprinkler systems, size of hallways, access and egress points, adequacy of plumbing, emergency power supplies, and many others. Due to the fact that construction and reviews often span multiple fiscal years, the Legislature has approved the designation of plan review fees as nonlapsing.

Funding Detail

Program: Emergency Medical Services

Function

The Bureau of Emergency Medical Services is a leadership team functioning as a resource and providing assurance of a quality emergency medical system in the State. The Bureau of Emergency Medical Services (EMS) has as its mission to promote a statewide system of emergency and trauma care to reduce morbidity and mortality, through prevention, awareness, and quality intervention.

The Bureau implements this mission by:

• Providing customer service and establishing a teamwork model of services.
• Providing information, technical assistance, and consultation to providers of emergency medical services to enhance the provision of quality emergency care.
• Assuring compliance by emergency medical providers to rules and regulations that promote quality emergency care.
• Promoting the highest standards possible for the statewide provision of emergency medical services, taking into consideration available resources, and investigating alternative funding sources.
• Establishing an infrastructure to provide administrative support that will continually seek to improve, streamline, and find the most cost-effective way to meet the needs throughout the State.
• Encouraging EMS involvement and coordination with existing and new injury prevention and health promotion activities.
• Promoting and supporting programs and activities that address the physical and mental health as well as the safety of EMS personnel.

EMS Grants Program

The portion of the criminal fines and forfeitures surcharge that is allocated to EMS has restrictions on its usage established in UCA 26-8a-207. After funding staff support, administrative expenses, and trauma system development, the Bureau then allocates for rural areas 50 percent for block grants for emergency medical services at the county level, determined by population and number of EMS employees, and the remaining 50 percent as competitive grants distributed to applicants based on the guidelines approved by the Emergency Medical Services Committee.

EMS Certification

EMS personnel must be certified to meet a statewide standard for emergency medical services. These statewide standards for training levels are based upon the standards and curricula established by the National Highway Traffic Safety Administration. The differences between levels of certification relate to the types and extent of procedures that may be performed by the EMS personnel, such as starting IV fluids, administering medications, or placing tubes to open a patient's airway.

Funding Detail

Program: Child Care Licensing

Function

The Bureau of Child Care Licensing is responsible for protecting the health and safety of children in regulated child care programs by: establishing and enforcing health and safety rules for child care programs, assisting providers in meeting the health and safety rules, and providing the public with accurate information about regulated child care. The Bureau of Child Care Licensing implements this mission by inspecting child care facilities to ensure compliance with licensing rules, investigating complaints about regulated providers, and providing training on the licensing rules. Child care licensing rules include requirements for the physical facility, personnel, emergency preparedness, supervision of children, child health and nutrition, injury prevention, and infection control.

A provider/facility may be issued a citation if the facility is found to be in violation of licensing rules. If cited findings are not corrected, then a civil money penalty is assessed. These monies are used to fund training activities for the Bureau.

The categories of providers regulated by the Bureau include Child Care Centers, Hourly Child Care Centers, Licensed Family Child Care (in-home), and Residential Certificate Care (in-home).

Funding Detail

Program: Primary Care and Rural Health

Function

The Office of Primary Care and Rural Health serves as a resource for Utah's rural, multi-cultural, and underserved communities. The office works with communities that need assistance in conducting needs assessments, recruiting health care professionals, grant writing, identifying sources of funding, and implementing other projects related to decreasing health disparities and increasing access to primary health care.

The office also serves as the federally-funded State Office of Rural Health and as the Primary Care Office for the federal National Health Service Corps and the Conrad State 30 J-1 Visa Waiver Program. The office tries to recruit and retain health care professionals to work in medically underserved areas of Utah. The Rural Hospital Flexibility Grant Program assists in strengthening rural health by: (1) allowing small hospitals the flexibility to reconfigure operations and be licensed as critical access hospitals, (2) offering cost-based reimbursement for Medicare acute inpatient and outpatient services, (3) encouraging the development of rural-centric health networks, and (4) offering grants to help implement a critical access hospital program in the context of broader initiatives to strengthen the rural health care infrastructure. The Small Rural Hospital Improvement Grant Program assists small rural hospitals to help them: (1) pay for costs related to the implementation of Medicare Prospective Payment Systems, (2) comply with provisions of Health Insurance Portability and Accountability Act (HIPAA), (3) reduce medical errors, and (4) support quality improvement.

Primary Care Grants Program

The State Primary Care Grants Program for Medically Underserved Populations makes grants to public and non-profit entities for the cost of providing primary health care services to medically underserved populations. The program strives to decrease the number of individuals without access to appropriate, high quality, post-effective primary health care by making these grants to qualified provider organizations. The program targets Utah's low-income populations, who have no health insurance, or whose health insurance does not cover primary health care services and do not qualify for Medicare, Medicaid, CHIP, or other government insurance programs. The scope of this program includes populations in medically underserved areas, including the working poor, individuals with chronic diseases, children of low-income families, the homeless, Native Americans, seasonal and migrant farm workers, and other disadvantaged groups.

Assistance to Persons with Bleeding Disorders

The Assistance to Persons with Bleeding Disorders Program makes grants available to assist persons with bleeding disorders with the cost of obtaining hemophilia services or the cost of insurance premiums for coverage of hemophilia services. The program assists persons who meet the following criteria:

1. medically diagnosed with hemophilia or a bleeding disorder
2. not eligible for Medicaid or Children's Health Insurance Program
3. one of of the following criteria:
   • insurance coverage that excludes coverage for hemophilia services
   • exceeded their insurance plan's annual maximum benefits
   • exceeded their annual or lifetime maximum benefits payable under the Comprehensive Health Insurance Pool (UCA 31A-29)
   • insurance coverage available under either private health insurance, Comprehensive Health Insurance Pool, Utah mini-COBRA coverage, or federal COBRA coverage, but the premiums for that coverage are at or greater than 7.5 percent of a person's annual adjusted gross income.

Funding Detail