Agency: Health

Line Item: Family Health and Preparedness

Function

The Division of Family Health and Preparedness assures and improves the quality of the Utah health care system, with an emphasis on care delivered to the most vulnerable populations. This function is fulfilled through the examination, analysis, and regulatory actions to improve service availability, accessibility, safety, continuity, quality, and cost. The Division directs the regulation and oversight of the health care industry. Division-wide improvement strategies include training, certification, licensing, and inspection. The Division also strives to assure that women, infants, children, and their families have access to comprehensive, coordinated, affordable, community-based quality health care. These health care services are available to all citizens of the State according to their ability to pay. Primary clients are low income women, infants, and children who have special health care needs. The Division coordinates efforts, identifies needs, prioritizes programs, and develops resources necessary to reduce illness, disability and death from adverse pregnancy outcomes and disabling conditions.

The Division includes the Director's Office and the following seven programs: (1) Health Facility Licensing, Certification, and Resident Assessment, (2) Emergency Medical Services (EMS), (3) Child Development, (4) Public Health Preparedness Grants, (5) Children with Special Health Care Needs, (6) Primary Care, and (7) Maternal and Child Health. The Division also supports the Patient Safety Initiative, the Primary Care Grants Program, the Health Care Workforce Financial Assistance Program, the American Indian/Alaska Native Health Program, the Office of Health Disparities Reduction, and the Assistance to Persons with Bleeding Disorders Program. Additionally the Division (through the Resident Assessment program) provides pre-admission screenings for all Utah Medicaid recipients seeking nursing home or institutional care and promoting primary care services to underserved populations.

Statutory Authority

The Division of Family Health and Preparedness 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 26-7 authorizes the Department to create programs to promote good health practices and reduce major risk factors that contribute to injury, sickness, death, and disability.
• 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 26-8b-602 creates the Automatic External Defibrillator Restricted Account to fund automatic external defibrillators and related supplies for municipal, county, or state law enforcement agencies and schools with grades 7 through 12 and state institutions of higher education.
• UCA 26-9 outlines the Health Department's efforts in relation to primary health care services in rural areas of the State.
• UCA 26-9-5 establishes the Rural County Health Care Special Service District Retirement Grant Program.
• UCA 26-9f creates the Utah Digital Health Services Commission which deals with telehealth issues.
• UCA 26-10 establishes "Family Health Services" including the hearing testing as well as metabolic, endocrine, pulse oximetry, and hematologic testing of newborns.
• UCA 26-10b "Access to Health Care" outlines the criteria 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 26-10-1 defines maternal and child health and also services for children with disabilities.
• UCA 26-10-10 directs the Department to do public education regarding cytomegalovirus. This section also requires medical practitioners to test newborns who fail hearing tests for cytomegalovirus.
• UCA 26-10-11 creates the Children's Hearing Aid Pilot Program Restricted Account to provide hearing aids to qualifying children who are not eligible for Medicaid or the Children's Health Insurance Program.
• UCA 26-21 and UCA 26-21a outline the necessary requirements for State licensing of various health care facilities. It also details the direct patient care workers who must have a background check.
• 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.
• UCA 26-52 creates the Autism Treatment Account to provide services for treating autism for those children not already covered by Medicaid.

Intent Language

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $245,000 of Item 2 of Chapter 14, Laws of Utah 2012 for Family Health and Preparedness not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds is limited to health facility licensure and certification activities.

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $250,000 of Item 2 of Chapter 14, Laws of Utah 2012 for Emergency Medical Services not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds is limited to testing, certifications, background screenings, replacement testing equipment, and testing supplies.

Under Section 63J-1-603 of the Utah Code, the Legislature intends that criminal fines and forfeiture money collected for Emergency Medical Services in Item 2 of Chapter 14, Laws of Utah 2012 not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds is limited to purposes outlined in Section 26-8a-207(2).

Under Section 63J-1-603 of the Utah Code, the Legislature intends that civil money penalties collected for Item 2 of Chapter 14, Laws of Utah 2012 from childcare care provider violations not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds is limited to trainings for providers, staff and upgrades to the Child Care Licensing database.

Under Section 63J-1-603 of the Utah Code, the Legislature intends that civil money penalties collected for Item 2 of Chapter 14, Laws of Utah 2012 from health care provider violations not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds is limited to providing services to nursing home facility residents or as specifically directed by the Centers for Medicare and Medicaid Services.

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $210,000 of Item 2 of Chapter 14, Laws of Utah 2012 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 2013. The use of any nonlapsing funds is limited to plan review activities.

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $50,000 of Item 2 of Chapter 14, Laws of Utah 2012 of unused funds appropriated for the Assistance for People with Bleeding Disorders Program not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds is limited to services to eligible clients.

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $400,000 of Item 2 of Chapter 14, Laws of Utah 2012 for Primary Care Grants Program not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds is limited to final Fiscal Year 2013 contract payments or additional distributions to eligible primary care providers.

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $220,000 of the appropriations provided for the Family Health and Preparedness line item not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds is limited to early intervention services in the baby watch program.

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $130,000 of the appropriations provided for the Family Health and Preparedness line item not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds is limited to health facility and licensing activities.

Funding Detail

Because of the Department's budget reorganization in FY 2011, some of the detail between FY 2010 and FY 2011 nonlapsing balances do not tie out by line item. For analysis of current budget requests and discussion of issues related to this budget click here.

During the 2013 General Session the Legislature moved $100,000 of beginning nonlapsing from Medicaid Sanctions to Family Health and Preparedness for FY 2013.

Program: Director's Office

Function

The Office of the Director includes planning and budget analysis, coordination of intradivisional activities, oversight of the various programs, identification and implementation of information systems improvement, patient safety initiative, and Division liaison with other public and private organizations. The office consists of the Director, the Office of Health Disparities Reduction, the Financial Resources Program, the Patient Safety Program, and the American Indian/Alaska Native Health Program.

The Office of Health Disparities Reduction addresses health disparities among community groups through health programs in the Health Department and in the community. The Office aims to foster accessible, high-quality programs and policies that help all Utah citizens achieve optimal health, dignity, and independence. The Office tries to increase public and health professional awareness of persistent health disparities and develop effective health policies and culturally competent programs that lead to better access to quality health care services and improved health status.

The Financial Resources Program provides financial management for the Division by managing budgets, contracts and grants; ensuring compliance with financial policies and regulations; ensuring the accuracy of all financial transactions; and providing billing services for public services.

Patient Safety Initiative

The Patient Safety Initiative coordinated with the Utah Hospital Association and HealthInsight, provides monitoring of numerous health outcomes in an effort to improve the safety of Utah's health care delivery systems.

Office of American Indian/Alaska Native Health Affairs

The Office of American Indian/Alaska Native Health Affairs in cooperation with Utah Medicaid supports efforts to improve the health status of this population and address consultation requirements for these government-to-government relationships.

Funding Detail

Prior to FY 2011, the funding for this program was for two director's offices, one in the Health Systems Improvement line item and the other in the Community and Family Health Services line item.

Program: Maternal and Child Health

Function

The Bureau of Maternal and Child Health supports the Health Department's mission to reduce illness, disability, and death among women of childbearing ages, children, and youth in the State. The Bureau identifies health concerns, prioritizes strategies to address needs, develops programs, coordinates efforts, and develops resources to address health issues for mothers and children. The Bureau is responsible for the State's Title V Maternal and Child Health Block Grant Annual Application and Report.

The Bureau of Maternal and Child Health provides leadership for many maternal and child health efforts in the State through its programs, contracts with local health departments and other entities, federal grant opportunities, and involvement at a national level to learn from other states about programs to apply in Utah. The Bureau is responsible for most maternal and child health issues, such as promotion of health among women of childbearing ages, health prior to pregnancy to promote healthy mothers and babies, access to health care before and during pregnancy, healthy weight and nutrition, oral health, and promotion of healthy pregnancies and breastfeeding by providing information on the potential impact of exposures to medications, chemicals, and infectious agents. Additionally, the programs promote healthy children and adolescents through oral health, healthy weight, and nutrition. The Bureau conducts surveillance and analysis of data related to pregnancy and factors associated with poor pregnancy outcomes, such as prematurity. The Bureau reviews maternal, fetal, and infant deaths. The information is used to identify factors that relate to prevention of poor outcomes and future deaths. The Bureau conducts surveillance and analysis of data related to children's health, such as dental screenings for young school-aged children to determine the degree of dental disease, or parents' experiences with health care for their children.

The Bureau includes six programs that work to achieve the Bureau's goal of healthy mothers and children: Maternal and Infant Health, Data Resources, Oral Health, Pregnancy RiskLine, and the Women, Infants and Children Programs (WIC). The Bureau is responsible for the Pregnancy Risk Assessment Monitoring System, the USDA-funded WIC Program, and the Commodity Supplemental Food Program.

Maternal and Infant Health

The mission of the Maternal and Infant Health Program is to improve the health of women of childbearing age and their infants by reducing preventable illness, disability, and death related to pregnancy, birth, and infancy through the promotion of healthy lifestyles and optimal health care. The various components of the Maternal and Infant Health Program include Prenatal/Family Planning, WeeCare, Pregnancy Risk Assessment Monitoring System (PRAMS), and the Perinatal Mortality Review component. The program creates and disseminates pertinent health education messages based on information identified through the program's various data collection resources. These messages go in an Internet website (www.health.utah.gov/mihp), brochures, television, radio, poster displays and presentations at schools, churches, and health fairs.

The program is guided by a strategic plan that includes nine outcome objectives:

1. Reduce the number of unintended pregnancies.
2. Increase percentage of women accessing quality early and adequate prenatal care.
3. Decrease maternal death rates and morbidity.
4. Reduce percentage of infants born before the 37^th week of pregnancy and/or weighing less than 5 pounds and 9 ounces.
5. Decrease fetal and neonatal deaths.
6. Increase the percentage of women who initiate and continue to breast-feed their infants through the first year of life.
7. Increase the recognition and treatment of depression among women of childbearing age in Utah.
8. Increase the proportion of women who practice healthy behaviors before becoming pregnant.
9. Decrease the prevalence of intimate partner violence during the perinatal time period.

The prenatal component of the program seeks to improve access to prenatal care through expedited eligibility to Medicaid, enhanced prenatal and delivery services within Medicaid, and by covering prenatal care for uninsured women. The family planning component assures access to family planning services in underserved areas of the State. It also assures reproductive health services through technical assistance and contracts with local health departments, community health centers, and other providers. The WeeCare component offers nurse case management of moderate and high-risk Public Employees Health Program pregnant participants throughout the State via telephone.

The Pregnancy Risk Assessment Monitoring System (PRAMS) is a Centers for Disease Control and Prevention-developed, population-based surveillance system that queries a sample of Utah mothers about their experiences before, during and after pregnancy. Utah is among 39 states throughout the country who implement the survey. PRAMS is intended to help answer questions that birth certificate data alone cannot answer. The system uses data to provide important information that can guide policy interventions, and other efforts to improve care and outcomes for pregnant women and infants in Utah. One example of the use of PRAMS data is to educate prenatal care providers about the link between overweight/obesity and pregnancy outcomes.

The Perinatal Mortality Review component of the program is a process aimed at identifying and examining the factors that contribute to perinatal deaths (fetal, infant, and maternal) through the systematic evaluation of individual cases. Through individual case review, the Perinatal Mortality Review coordinator, in conjunction with a committee of perinatal professionals, identifies contributing factors that may have led to the death. Information is obtained through hospital records, public health records, autopsy reports, birth/death certificates and health care provider records. Committee members make recommendations based on findings that may lead to public health recommendations for changes that could improve the outcome of future cases.

Data Resources Program

The Data Resources Program provides health data and information support to programs within Maternal and Child Health and Children with Special Health Care Needs programs, local health departments, community-based health organizations, and the public. The program is two-pronged in its approach as it aims to (1) increase access to health information and data, and (2) provide analytic consultation and data training.

The Data Resources Program acts as a resource for Maternal and Child Health and Children with Special Health Care Needs programs and provides expertise on research methodology, database design, survey development, and grant applications. The program also facilitates the coordination of multi-program projects and reports. The program also plays an active role in designing website and web-based applications for the Division of Family Health and Preparedness and ensures that they are in compliance with Health Department and State web standards.

The Data Resources Program collaborates with programs to publish surveillance updates and research reports. An important responsibility of the Data Resources Program is to provide coordination, compilation, and submission of the Federal Title V Maternal and Child Health Block Grant Application.

Oral Health Program

The Oral Health Program tries to improve the oral health status of Utah residents by developing, implementing, and promoting prevention and dental access programs at both the State and local levels. The Oral Health Program strives to prevent dental caries by community water fluoridation, fluoride mouth rinse programs, tooth sealant programs, and early childhood interventions. The evaluation and dissemination of statewide dental health surveys, Head Start data, and other Utah-specific dental health information by Oral Health Program provide needs assessment information for the State, local health departments, and dental societies in the State. The program works with the Utah Dental Association and the Utah Dental Hygiene Association to promote the role of public health in promoting good oral health.

In collaboration with the Utah Oral Health Coalition, the Oral Health Program has developed and maintains the Utah Oral Health Action Plan, which emphasizes implementation of appropriate prevention and access strategies for target populations and promotes development of policies for better oral health and improved oral health systems statewide. Additionally, the Oral Health Program encourages and facilitates the formation of local oral health coalitions by conducting needs assessments and oral health surveys, providing technical consultation, and reporting progress toward Healthy People 2020 oral health objectives. The Oral Health Program collaborates with local health departments and community health centers and partners with many community public health and private practice dental and health professionals, stakeholders, and advocates to implement programs which serve the needs of local communities. The Oral Health Program has developed and maintains an oral health website that provides educational and resource information for public and private partners as well as the general population of the State.

Pregnancy RiskLine

The Pregnancy RiskLine provides information regarding exposure to drugs, chemicals, and infections in pregnancy and lactation and the possible effect on the developing fetus, breast-fed, infant and mother. The Pregnancy RiskLine was established to provide health care practitioners and consumers with accurate, up-to-date information regarding potential risks to a fetus or breast-fed infant in order to prevent unjustified anxiety leading to unnecessary abortions, costly prenatal and postnatal screening, diagnostics, and testing of an exposed fetus or infant.

The program's major goals are the prevention of poor pregnancy outcomes and adverse health effects in children. The desired outcomes include the prevention of low birth weight, infant mortality, and birth defects.

By offering accurate and current information about fetal effects of maternal exposure to medications, drugs, chemicals, infections and diseases, the Pregnancy RiskLine may prevent untoward effects of some of these agents on a developing fetus, resulting in a decreased incidence of low birth weight, infant mortality, and birth defects.

Women, Infants and Children (WIC)

Women, Infants and Children (WIC) is a federally-funded program designed to provide supplemental food and nutritional education to pregnant, breast-feeding or postpartum women, infants and children up to five years of age. The federal funds come from the United States Department of Agriculture.

WIC authorized foods has the following eligibility criteria:

• A resident of Utah and a member of the population served by the 49 local clinics.
• Income at or below 185 percent of the Federal Poverty Level.
• Certified to be at nutritional need through a medical and/or nutritional assessment.

Commodity Supplemental Food Program

Commodity Supplemental Food Program is a federally funded program designed to provide supplemental food and nutritional education to seniors over 60, children age 5-6, and pregnant or post-partum women. The program is not available statewide. Seniors must have incomes under 130% of the Federal Poverty Level and women and children must have incomes under 185% of the Federal Poverty Level in order to qualify.

Funding Detail

Effective FY 2011 the Immunization Program is now part of the Epidemiology Program within the Disease Control and Prevention line item. Immunization was previously part of the Maternal and Child Health Program.

Program: Child Development

Function

The Bureau of Child Development is responsible for protecting the health and safety of young children. This is done through four programs: Baby Watch Early Intervention Program, Child Care Licensing Program, Office of Home Visiting, and the State Early Childhood Comprehensive Systems Grant.

Baby Watch Early Intervention Program

• Target Population: Children from birth to age three with at least a moderate developmental delay or a diagnosed condition that has a high probability of resulting in a developmental delay.
• Services Provided: Multi-disciplinary evaluation, service coordination, specialty and therapy services such as nursing, physical therapy, occupational therapy, speech therapy, special instruction, and family support services.
• Delivery System: Contracted regional providers provide services statewide. As conditions for accepting Individuals with Disabilities Education Act Part C federal funds, the State and contracted providers must serve all children who meet the State-established eligibility criteria for the program. Parents pay a sliding scale fee for their children to receive services. The program bills Medicaid and the Children's Health Insurance Program for eligible children.

Child Care Licensing Program

The Child Care Licensing Program regulates 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 Child Care Licensing Program inspects child care facilities to ensure compliance with licensing rules, investigates complaints against regulated providers, and provides 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.

The Program issues citations to a provider/facility for violations of licensing rules. For repeat violations of the same rule, the Program assesses a civil money penalty. The State uses these funds for training for child care providers.

The categories of providers regulated by the Bureau include Child Care Centers, Hourly Child Care Centers, Out of School Time Programs, Licensed Family Child Care (in-home), and Residential Certificate Care (in-home). In general anyone caring for five or more unrelated children must comply with licensing requirements. UCA 26-39 exempts from licensing requirements child care programs operating under the supervision of the following groups:

• Federal government
• Higher education
• Public education or programs located on the property of public education institutions
• Local governments

Office of Home Visiting

The Office of Home Visiting administers a federal grant that provides and supports voluntary home visits to at-risk expectant or new parents. Home visiting is an evidence-based prevention strategy intended to improve the health and well-being of at-risk women, children and families. Trained home visitors, nurses or social workers, provide regular home visits to provide information about prenatal care, infant care, child development and parenting skills, and connect parents to important resources in their community.

State Early Childhood Comprehensive Systems Grant

The Bureau administers the State Early Childhood Comprehensive Systems grant, which is funded with federal Title V funds, to improve the system of services for children from birth to age eight by coordinating efforts of statewide agencies and organizations to ensure children enter school healthy and ready to learn.

Funding Detail

Program: Children with Special Health Care Needs

Function

The Bureau of Children with Special Health Care Needs encompasses eight programs serving special needs children: Fostering Healthy Children, Developmental Consultative Services, Utah Birth Defect Network, Newborn Screening Program, Specialty Services Program, Neonatal Follow-up Program, Child Health Advanced Records Management, and Technology Dependent Waiver/Family Involvement. Children with Special Health Care Needs programs work to reduce preventable death, disability, and illness due to chronic and disabling conditions by providing access to affordable high-quality health screening, specialty health care, and coordination of health services. Bureau programs try to improve the system of care for Utah children with special needs through direct or population-based services and the promotion of system infrastructure building.

Fostering Healthy Children

• Goal: Meet the health care needs of children in the Utah Child Welfare System in a timely manner.
• Target Population: All children in the Utah Child Welfare System.
• Services Provided: Due to a 1994 court settlement agreement the State is required to provide medical, dental, and mental health care to all children in foster care custody on an ongoing basis. Additionally, the State must make sure they receive any follow up care deemed necessary by their medical providers and refer children with developmental delays noted on the Ages and Stages Questionnaire to Early Intervention.
• Delivery System: The Division of Child and Family Services in the Department of Human Services contracts this service with the Department of Health to provide coordination of Medicaid services for all children entering foster care across the State. The Department of Health uses registered nurses to coordinate the healthcare of youth in foster care.

Developmental Consultative Services

• Goals:
  • Recognize the need for early diagnosis and treatment
  • Provide timely detection of sensory, cognitive, and emotional disorders
  • Assist the family in identifying their child's strengths and weaknesses
  • Develop and monitor a written plan of service
  • Provide parents with support and information
  • Coordinate the delivery of services with local agencies
  • Promote and develop appropriate community-wide services for the prevention of disabilities
• Target Population: children birth to 18 years of age who have developmental disabilities or chronic illness associated with developmental delay.
• Services Provided: developmental assessment services and access to multi-disciplinary medical services such as pediatric, genetic, neurological, psychological, speech, occupational/physical therapy, social work/case management evaluations, and support.
• Delivery System: services offered in the Salt Lake, Ogden, and Logan areas as well as itinerant clinics coordinated with the local health departments at the following sites: Blanding/Montezuma Creek, Moab, Price, Richfield, St. George, and Vernal.

Utah Birth Defect Network

The Utah Birth Defect Network is a statewide surveillance system monitoring the occurrence of major structural birth defects in Utah. The Utah Birth Defect Network uses this information to assess the prevalence of birth defects occurring in Utah; conduct epidemiological studies to determine risk factors; educate women and health care providers about these risk factors; evaluate whether education has decreased specific birth defects; and respond to reported clusters of birth defects. Birth defects are the leading cause of infant mortality, contribute to premature births, and are the major reason for hospitalizations during the first year of life. There are economic costs to families and society for children born with birth defects and the costs extend beyond medical and surgical care to behavioral and educational service issues. Because the cause of most birth defects is unknown, Utah Birth Defect Network participates in a national study of birth defects to increase understanding of modifiable risk factors.

The Utah Birth Defect Network's works toward primary prevention of birth defects by monitoring occurrence, conducting educational outreach, and participating in collaborative epidemiologic studies. Evaluation of the Utah Birth Defect Network epidemiologic data provides information in order to assess risk factors for birth defects and develop primary prevention activities directed at reducing these risk factors. Primary prevention activities target high-risk populations. The continuous tracking of all major birth defects statewide provides an evaluation of the effectiveness of the prevention programs. The Utah Birth Defect Network serves as a resource and referral system for families and physicians.

The Utah Birth Defect Network measures: (1) accurate and timely tracking of birth defects statewide; (2) folic acid educational campaign and evaluation of neural tube prevalence over time to evaluate effectiveness of prevention activities; and (3) estimated number of individuals reached through general education and outreach activities.

Newborn Screening Program

• Goal: Provide rapid identification of all newborn screening test results within 24 to 72 hours.
• Target Population: All newborns.
• Services Provided: Statewide system for early identification and referral of newborns with certain metabolic, endocrine, or hematologic disorders that can produce long-term mental or physical disabilities or death if not treated early. The disorders are: congenital hypothyroidism, galactosemia, cystic fibrosis, hemoglobinopathy, biotinidase, congenital adrenal hyperplasia, amino acid disorders, fatty acid disorders, and organic acid disorders. Services include education and counseling to families of an affected newborn.
• Delivery System: Developing and dispersing newborn screening kits. Training and educating institutions of birth (hospitals, birthing centers, midwives) on the importance of screening, screening practices, proper collection techniques and submission parameters. Reporting abnormal screening results to medical home (provider) and providing education/direction on follow-up needs for each specific disorder. Coordinating any necessary testing beyond the screening test to identify a possible disease.

Specialty Services Program

• Goal: help assure optimal development in Utah's children with special needs, through a collaborative statewide system of education, prevention, early identification, early intervention, and care coordination.
• Target Population: children under age 8 with special health care needs.
• Services Provided: statewide screening, evaluation, and referral of infants and children with hearing, speech, vision, motor, movement, and transition problems. Once testing identifies a problem, children receive referrals to appropriate local resources for continued management. Public education, professional education, consultation, and technical assistance are also available. Specialty Services also oversees the legislatively mandated hearing screening of all Utah newborns. Hospital screening programs and audiologists receive help tracking and following up with infants that require additional testing.
• Delivery System: clinical facilities in Salt Lake City and Price as well as rural clinics held in cooperation with local health departments. Charges vary based on ability to pay, utilizing a sliding fee schedule. Clinics deny no services due to a family's inability to pay.

Neonatal Follow-up Program

• Goals:
  • Improve long-term outcome by identifying and treating significant findings in a timely fashion
  • Coordinate services with existing resources and partner in long-term care
  • Provide feedback to Utah newborn intensive care units and allow for reassessment of treatment practices
  • Ultimately reduce cost of family stress, health care, and educational resources
• Target Population: Very low birth weight babies. Of the extremely low birth weight babies, 44% will need special education resources, 33% will test in the mentally retarded range, and 13% will have cerebral palsy.
• Services Provided: Two and one half years of follow-up for the very low birth weight babies. Four and one half years of follow-up for the extremely low birth weight babies. Follow up includes periodic screening by multiple providers (neurologist, ophthalmologist, pediatrician, audiologist, speech pathologist, dietitian, psychologist, occupational/physical therapist, social worker, and nurse).
• Delivery System: Clinics in Salt Lake City, Ogden, and Provo.

Child Health Advanced Records Management (CHARM)

Currently, data exists in an array of public and private health sectors and each database serves its own users, but with no capacity to share data across organizations or health programs. This lack of coordination typically does not provide a network of care for families and results in many children not receiving critical follow-up. The Child Health Advanced Records Management (CHARM) Project is a coordinated, Department-wide effort to create an electronic virtual health profile for every child in Utah that allows real-time digital access and data sharing among appropriate health care programs and partners. The CHARM vision is to create a shareable repository of child-specific public health information with secure role-based confidential access to a comprehensive set of integrated public health data accessible by people with a need to know, that promotes timely and efficient access to needed services, and supports program planning and evaluation. Integrating the State's health care databases provides for immediate access to information that is stored in specific databases to track and monitor health status for children and their families.

In the last few years, CHARM has linked the databases from Vital Records, (Birth and Death Certificates), Utah Statewide Immunization Information System, Early Hearing Detection and Intervention, Baby Watch Early Intervention Program, and the Office of Recovery Services. In the near future CHARM will link to the following databases the Newborn Screening (heelstick) Program, the Utah Birth Defect Network, and clinical information from the Neonatal Follow-up Program. Through data-sharing and tracking among integrated programs, CHARM's goal is to reduce the number of children lost to follow up statewide and provide more accurate and timely information to the child's medical home through web access. The Department is developing strategic and technical implementation plans to incorporate the CHARM data integration system into the Utah statewide Department's Clinical Health Information Exchange (cHIE) initiative.

Funding for this project has come from braiding multiple funding streams including Health Resources Services Administration grants, Centers for Disease Control and Prevention grants, and the Maternal and Child Health Block Grant. Management of the funds is performed by an oversight committee (CHARM Governing Board) to ensure accountability and coordinated use. The CHARM Project is managed by a "hands on" work group consisting of a program manager, an operations manager, and technical data services and support.

Technology Dependent Waiver/Family Involvement

The Division of Medicaid and Health Financing shares the responsibility for the day-to-day administrative activities for Utah's Waiver for Technology Dependent, Medically Fragile Individuals with the Technology Dependent Waiver Program. The waiver program tries to prevent institutionalization and to facilitate transition from an institutional setting to a home and community-based setting for technology dependent, medically-fragile children with complex medical conditions.

The Family Involvement Program/Family Voices provides information, training, and support regarding health care and community services to families of children and youth with special health care needs. Family Voices facilitates partnerships between families and professionals on behalf of children and youth with special health care needs.

Performance

Funding Detail

Program: Public Health Preparedness

Function

The federal government funds a nationwide grant program for bioterrorism preparedness through the Centers for Disease Control and Prevention. The grant has six categories under nine preparedness goals. They are:

Prevent:

1. Increase the use and development of interventions known to prevent human illness from chemical, biological, radiological agents, and naturally occurring health threats.

2. Decrease the time needed to classify health events as terrorism or naturally occurring in partnership with other agencies.
3. Decrease the time needed to detect and report chemical, biological, radiological agents in tissue, food or environmental samples that cause threats to the public's health.
4. Improve the timeliness and accuracy of communications regarding threats to the public's health.

5. Decrease the time to identify causes, risk factors, and appropriate interventions.

6. Decrease the time needed to provide countermeasures and health guidance to those affected by threats to the public's health.

7. Decrease the time needed to restore health services and environmental safety to pre-event levels.
8. Improve the long-term follow-up provided to those affected by threats to the public's health.

9. Decrease the time needed to implement recommendations from after-action reports following threats to the public's health.

In addition to the Centers for Disease Control and Prevention's Bioterrorism grant, the Health Resources and Services Administration Hospital Preparedness Bioterrorism Grant provides money to Utah. The grant is for hospitals to increase training, education, and supplies. The grant has the following priority areas:

• Administration
• Surge Capacity
• Communications and Information Technology
• Links to Public Health Departments
• Education and Preparedness Training
• Terrorism Preparedness Exercises

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.
• Assuring compliance by emergency medical providers to rules and regulations.
• 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 at least 25% (actual percentage determined by the Emergency Medical Services Committee) for per capita block grants for emergency medical services at the county level, determined by population and number of EMS employees. The remaining percentage is allocated as competitive grants distributed to applicants based on the guidelines approved by the Emergency Medical Services Committee.

EMS Certification

There are statewide standards for emergency medical services. EMS personnel must obtain certification to prove their proficiency. The National Highway Traffic Safety Administration's standards and curricula provide the basis for Utah's statewide standards for training levels. The differences between levels of certification relate to the types and extent of procedures that EMS personnel may perform, such as starting IV fluids, administering medications, or placing tubes to open a patient's airway.

Performance

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 inspection of health care facilities including hospitals, nursing homes, Intermediate Care Facilities for Individuals with Intellectual Disabilities, home health agencies, assisted living facilities and other provider types. Licensing is required to operate a health facility in Utah, and also serves to meet federal requirements for certification 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 licensing rules for health facilities can be found in the Utah Administrative Code R432.

The Bureau performs pre-admission and continued stay health reviews every six months for all Utah Medicaid recipients seeking nursing home or institutional care. The federal government requires pre-admission assessments for medical eligibility level of care.

The Bureau performs background screening for all staff that have access to patients of all nursing homes, small health care facilities, assisted living facilities, home health agencies, hospice agencies, long term acute care hospitals, 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 have 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. In addition, the Bureau participates in the regular Title 19, general Medicaid administration program. This program is matched at 75 percent or 50 percent Federal Financial Participation. Overall, the average match rate is 87.5 percent federal and 12.5 percent State.

The Bureau also 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 others.

Performance

Funding Detail

Program: Primary Care

Function

The Bureau of Primary Care includes several programs focusing on health care for some of Utah's most vulnerable populations.

Office of Primary Care and Rural Health

The Office of Primary Care and Rural Health serves as a resource for Utah's rural, multi-cultural, and medically 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.

Federally-funded Functions

The office also serves as the federally-funded State Office of Rural Health and as the Primary Care Office which both manage the federal National Health Service Corps and the Conrad State 30 J-1 Visa Waiver Program. The federal funds require the office to assist in the recruitment and retention of health care professionals to work in medically underserved areas of Utah. The Rural Hospital Flexibility Grant Program assists in strengthening rural health by: (1) helping small hospitals obtain critical access hospitals licenses, which qualifies them for cost-based reimbursement for Medicare acute inpatient and outpatient services, (2) encouraging the development of rural-centric health networks, and (3) 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) become accountable care organizations focused on improving quality outcomes, (3) fund payment bundling in order to build accountability across the continuum of care, and (4) fund value-based purchasing in order to improve data collection activities in order to facilitate reporting to hospital compare.

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, 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, Children's Health Insurance Program, or other government insurance programs. The scope of this program includes populations in medically underserved areas, individuals with chronic diseases, 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 services for hemophilia or the cost of insurance premiums for coverage of 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 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 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

Program: Rural County Health Care Special Service District Retirement Gran Program

Function

The Rural County Health Care Special Service District Retirement Grant Program provides one-time grants to rural county health care special service districts with retirement obligations above $750,000 owed to the Utah State Retirement System. The special district must provide matching funds for at least 40% of the grant.

Funding Detail