Wisconsin Local Public Health: Requirement Updates

Updates to Wis. Admin. Code ch. DHS 140 went into effect on July 1, 2019. Wis. Admin. Code ch. DHS 140 specifies the required services for Levels I, II, and III local health departments (LHDs).

This chapter was created in 1998, and the 2019 update aligns local requirements with changes in public health practice since that time, as well as with the latest innovations modernizing Wisconsin’s public health system.

This page describes updates to local health department requirements as a result of updates to Wis. Admin. Code ch. DHS 140.

Summary of updates to Wis. Admin. Code ch. DHS 140

Level I

  • Rule headings expanded to further reflect current public health practice and align with Wis. Stat. ch. 251
  • Annual report required to be submitted to the Division of Public Health
  • Public health nursing services embedded throughout

Level II

  • Organizational performance through performance management and quality improvement incorporated
  • Capacity building and workforce development incorporated
  • Public health nursing services embedded throughout

Level III

  • Community health strategist focus
  • Environmental health program required, Department of Agriculture, Trade, and Consumer Protection (DATCAP) agent status not required
  • Public health nursing services embedded throughout
 

Information on this page has been organized into three categories. Please choose one of the following tabs.

Level I

The requirement for all LHDs to provide at least Level I services remains. Level I LHD requirements focus on the public health core functions, the 10 Essential Public Health Services, national public health performance standards, and the Foundational Public Health Services model.

Note: The Advisory Committee recommended these changes to reflect current public health practice.

  • The health promotion section now includes promoting policy and system practices, inclusive communication to and from the public, and informing and guiding the public during emergencies.
  • The public health nursing services requirement is now embedded throughout Level I requirements.
  • The Level I required services includes the reporting of public health data, in a way determined by the Department of Health Services (DHS).

  What's New?

  • Emergency preparedness and response
  • Policy and planning
  • Leadership and organizational competencies

 

Definitions

Emergency Preparedness and Response is defined as the preparing for, and responding to, events that pose a substantial risk to the health of residents. Examples of events that pose a substantial risk to the health of residents include communicable disease outbreaks, large scale community events, and natural disasters.

Policy and Planning is defined as translating science into appropriate plans, policies, and regulations. This includes developing and translating plans and polices at the community and systems levels in collaboration with community partners.

Leadership and Organizational Competencies is defined as leading internal and external stakeholders to consensus and action, with a particular focus on advancing health equity in communities. These competencies include leadership and governance, health equity, information technology services including privacy and security, human resources, financial management, legal services, and analysis.

Level II

The requirement for Level II LHDs to provide Level II services in addition to Level I services remains intact. Level II LHD requirements focus on organizational performance and capacity-building, which is a change from the previously required specified number of services.

  • A Level II health department must provide services in the following areas: communicable disease; chronic disease and injury prevention; environmental public health; maternal child family health; and access to, or linkage with, clinical health care. These align with the foundational areas of the Foundational Public Health Services model.

Note: This refers to community efforts underway in addition to CHIP priority implementation.

  • A Level II health department must assure workforce development by doing the following: maintaining a workforce development plan, including core public health competencies in job descriptions, and assessing staff core public health competencies every two years. Performance reviews and development plans are also required unless prohibited by the local governing body.
  • A Level II health department must engage in quality improvement efforts. This includes providing training and resources to staff and the governing body.
  • A Level II health department must set engage in performance management by setting performance measures for the mission, vision, values, and goals of the agency.
  • A Level II health department must embed public health nursing services throughout the Level III requirements.

  What's New?

  • Removal of specified number of services
  • Workforce development
  • Quality improvement
  • Performance management
  • Public health nursing services embedded

Definitions

Quality Improvement is defined as the utilization of a deliberate and defined improvement process which is focused on activities responsive to community needs for improving population health.

Performance Management is defined as a systematic process which helps an organization achieve its mission and strategic goals by improving effectiveness, empowering employees, and streamlining decision making.

Level III

The requirement that Level III LHDs must provide all levels of service remains intact. Level III LHD services focus on supporting LHD role as health strategists within their communities, which is a change from the previously required specified number of services.

  • Level III health departments serve as community health strategists. This role requires leading data collection to guide local public health plans and decisions; providing public health expertise, data, and research to the community; and a focus on impacting population health.
  • A Level III health department must develop, put in place, and advocate for policies addressing the social determinants of health.
  • Level III health departments are still required to have an environmental health program, but, agreements with state agencies for food safety and recreational licensing are not required. Instead, there is a broader definition of environmental health with a community and systems focus.
  • A Level III health department must ensure additional services that align with the most recent state public health agenda.
  • Besides the Level II performance management requirements, a Level III health department must maintain a performance management system. The agency’s system must collect performance data, evaluate goals, conduct quality improvement, and use the system to advise agency decisions.
  • Besides the Level II quality improvement requirements, a Level III health department must develop and put in place a quality improvement plan.
  • A Level III health department must embed public health nursing services throughout the Level III requirements.

  What's New?

  • Removal of specified number of services
  • Community health strategist
  • Population health expertise
  • Social determinants of health
  • Removal of DATCAP agent status
  • Performance management
  • Quality improvement
  • Public health nursing services embedded

Definitions

Community Health Strategist is defined as an engaged change leader or group of leaders who build community coalitions that investigate and take action to make meaningful progress on a community health issue.

Last Revised: March 3, 2020