The Virginia Department of Health is dedicated to protecting the health and promoting the well-being of all people in Virginia.

Become the healthiest state in the nation.

Our culture values service, equity and making data driven decisions.

The Virginia Department of Health (VDH) serves as the leader and coordinator of Virginia’s public health system. The definition of public health can be expressed as what society does collectively to create those conditions in which people can be healthy. In conjunction with localities, private sector, state/federal and government partners, VDH plays a fundamental role in promoting and protecting the health of all Virginians. VDH's public health role is distinguished from health care and private medicine in general due to the focus on the population, emphasis on prevention, orientation towards the community, efforts directed at systems, and an overarching role of leadership. Statutory Authority for VDH is provided in Title 32.1 of the Code of Virginia.

VDH is a highly decentralized and geographically dispersed agency. Generally, VDH services are delivered to the public by local health departments (LHDs) or by VDH field offices.  Each city & county in Virginia is required to establish and maintain a LHD.  Pursuant to statutory authority, VDH has organized these 119 LHDs into 35 health districts. This structure allows for a statewide presence, flexibility to adapt to local needs and operational efficiencies.

VDH and local governments jointly fund LHDs. VDH is the only agency in the Commonwealth that uses a state and local cooperative funding model. In this model, local governments commit funds to VDH to operate each LHD through a contractual agreement. The amount of each locality’s match payment is determined by a formula devised in 1989 by the Joint Legislative Audit and Review Commission and varies from 18% to 45% based on the estimated revenue generating capacity of each locality.

VDH collaborates with partners from all sectors to assess the health needs of the Commonwealth’s diverse communities. LHDs play a key role in facilitating solutions to assure that needs are met through cost effective and innovative solutions that leverage communities’ assets.

VDH continues to work every day to protect Virginians from public health threats and to promote long term health and well being.

Immunization: To address the growing number of refusals by parents to have their children immunized in accordance with the recommended schedules, VDH must ensure public & private healthcare providers have the resources to effectively respond to resistant parents.

Health Equity: Numerous Virginia localities are classified as medically underserved. To improve access to health and healthcare for those residents, new incentives are being identified to attract & retain the needed providers, and to impact the social determinants for health in order to create conditions for health promotion.

Infectious Diseases: Many infectious diseases that historically caused morbidity and mortality have been essentially controlled. However, demographic change in many parts of the state could potentially begin reversing the trend. Healthcare providers in many areas in the state now have to learn how to communicate effectively with patients with cultural differences.

Environmental Health: The demand for environmental health services has increased due to growth in the population, the number of restaurants/food festivals, milk plants, and real estate development. Several emerging issues with onsite sewage programs include: operation & maintenance requirements, wastewater reuse, rainwater harvesting, protecting the Chesapeake Bay for nutrient pollution, health equity initiatives for water and sewer, seeking ways to assist owners financially in upgrading/repairing onsite sewage systems, and increasing VDH’s collaboration with the private sector.

Emergency Preparedness & Response: Being prepared to prevent, respond, & rapidly recover from public health threats is critical. Utilizing the CDC Public Health Emergency Preparedness performance measures established in August 2011, VDH systematically evaluates and prioritizes a consistent set of public health preparedness capabilities.

The Virginia Department of Health’s mission to help Virginia become the healthiest state in the nation.  This mission is enabled by technology and technology’s ability to support the business. This requires a strong and qualified IT workforce with up-to-date skills and a commitment to public service. Today’s environment in terms of technology resources is somewhat limited.  This includes funding and staffing.  Securing the skill sets in the workforce to maintain and enhance VDH’s mission critical applications and technology infrastructure is often challenging. VDH utilizes IT staff augmentation services in order to supplement full time employee staffing levels so that projects are delivered on time.  In today’s environment, we often find ourselves competing for IT human resources with other Agencies requiring the same skill set. 

VDH continues to work towards becoming a more information-driven Agency, utilizing and sharing data as appropriate.  We are working to become more transparent with the data that we have, ensuring the privacy and confidentiality of that data.  Everything we do at VDH in terms of data, information sharing, infrastructure and applications development has a strong security influence.  We take our role as stewards of the Commonwealth’s data very seriously and ensure the appropriate security parameters are in place prior to any project going forward.  

VDH has several major information technology projects underway including the procurement and set up of an electronic health records system. This is will be a huge leap forward for VDH from the existing paper files used in clinical operations.

VDH must ensure that the agency has the requisite workforce numbers, skills, and competencies needed to accomplish the agency mission of promoting and protecting the health of all Virginians. The response to the COVID pandemic has led to a wave of retirements and staff departures and has dramatically increased the challenges in hiring key staff such as nurses.?

VDH works in partnership with 119 local jurisdictions in funding and maintaining local health departments (LHDs). In addition, there are numerous satellite offices statewide where client and patient services are offered. In the Capital area, VDH occupies state owned space in the James Madison and James Monroe buildings. In addition, other statewide facilities house the Shellfish Sanitation Program, Drinking Water Regional Offices, Public Health Preparedness, Medical Examiner District Offices, and Office of Licensure and Certification. In total, these offices and satellite locations represent no less than 175 facilities. VDH owns no facilities, but rather leases either local government (70%) or commercial sites (22%), with the remainder being Use Agreements.

Currently, VDH maintains leases at 20 facilities that are greater than 20 years old. VDH has concerns with these older, outdated facilities that challenges the agency to be ADA (Americans with Disabilities Act) and HIPAA (Health Insurance Portability and Accountability Act) compliant. In addition, these older facilities present potential safety hazards. Within the next five years, 23 facilities are projected to be in need of extensive renovations or require relocation.

Funding to address these facility needs will be significant over the next five years. Many leases with rental rates that were negotiated years ago with local jurisdictions will incur increases when these leases are renewed or when the LHD must relocate. In addition, renovations, facility improvements and telephone systems costs will add to the financial burden.

Aging Public Health Workforce: Within five years, 27.2% of VDH's workforce will be eligible to retire with unreduced benefits. This places a sense of urgency in succession planning and knowledge transfer.

Reliance on Non General Funds:To manage budget reductions while ensuring that core public health services are protected and remain available, VDH has become increasingly dependent on non general fund sources for delivery of a wide range of services.

Fifty percent of VDH’s total budget is dependent on federal funds. VDH cannot predict the federal budget and grant allocations for subsequent years; however, the outlook for stable federal funding is bleak. Any loss of these funds could have significant impact on core public health services. Special Funds represent 25 percent of VDH's budget.

Emergency Preparedness and Response (EP&R): The unpredictability of the number and types of public health threats from all hazards creates challenges for decision makers on how to allocate diminishing resources. VDH expects federal funding for EP&R staff to continue to decrease which requires seeking additional appropriation of general funds to maintain this critical public health infrastructure. In addition, due to the increased recognition in the agency’s response capabilities, VDH is increasingly called upon to participate and often serve as the lead for planned events and activities in Virginia as well as in bordering jurisdictions (i.e. national inaugurations, etc.).

Aging Infrastructure: Services are delivered at 175 facilities throughout the state. Currently, in many instances the agency is challenged with providing adequate services in facilities that are over 20 years old.  The older buildings have numerous safety and maintenance issues; some are non-ADA   (Americans with Disabilities Act) compliant, have asbestos and other safety problems as well as significant issues with ensuring the privacy of personal information and security of medical records required by the Health Insurance Portability and Accountability Act (HIPAA).

Longevity and Growth in the Elderly Population: An increasing aging population will seek out local health departments for risk reduction programs, wellness activities, immunizations and pre-admission nursing home screenings.

VDH funds are managed across an array of 45 service areas and fund appropriations. The specific breakdown of all fund sources of the agency budget is: federal grants and contracts (50 percent); general funds (24 percent); special funds (local government match portion of support  for local health departments (9 percent); fees and charges for services (13 percent); dedicated special revenues (4 percent); and private grants, donations, and gifts (less than 1 percent).



Through a contractual agreement, each locality commits funds to VDH to operate the local health department. The percentage of local match dollars is determined by an administrative formula and varies from locality to locality based on the estimated taxable wealth of each locality. Locality percentages range from 18 percent to 45 percent of the local health department budget, and state general funds represent the remainder.



VDH has approximately 193 federal grants and contracts, as well as 65 pass-through grants for which the Office of Financial Management is responsible for complying with cash management and federal reporting requirements. Federal grants fund a broad range of activities such as Public Health Preparedness and Response, Maternal and Child Health Services, Preventive Health Services, AIDS Prevention, Childhood Immunizations, Licensure and Medical Certification of Acute and Long Term Care Facilities, Women-Infants-Children (WIC) Nutrition, Chronic Disease Prevention, and Safe Drinking Water grants.  VDH experienced a large increase in grant funds during COVID response in order to meet that crisis but those funds are now receeding.



A substantial portion of the fees and charges for services are for environmental, medical, and personal care services provided in the local health departments; also included are those fees associated with waterworks operation, regulation of health care facilities, certified copies of vital records, and other miscellaneous services. Dedicated special revenues are those revenues generated from non-VDH related fees and fines such as the $4.25 surcharge on motor vehicle registrations earmarked for Emergency Medical Services and repayments on loans.

VDH is becoming increasingly dependent on federal grant funding as general fund resources diminish due to budget reductions. Currently, federal funds represent approximately 50% of the agency’s funding and special funds represent 25%.

 A substantial portion of the special revenues are fees and charges that include environmental and medical services provided in the local health departments; also included are those fees associated with waterworks operations, regulation of health care facilities, certified copies of vital records, and other public health services.

Dedicated special revenues are those revenues generated from non-VDH related fees and fines such as the surcharge on motor vehicle registrations earmarked for Emergency Medical Services (EMS) and repayments on loans.

The following annual statistics provide a snapshot of the wide range of VDH services.

No data

VDH has 41 Service Areas that reflect the extensive range of VDH's statutory responsibilities. VDH products and services benefit Virginians across their life span and can be broadly categorized as communicable disease prevention and control; preventive health services; environmental health hazards protection; drinking water protection; emergency preparedness response and recovery; emergency medical services; medical examiner and anatomical services; health assessment, promotion and education; health planning, quality oversight, and access to care; vital records and health statistics; and community health services.

VDH is uniquely tasked by law to provide services that are not available in the private sector. While VDH provides care and treatment for individuals who have diseases of public health significance, VDH is much more than a safety net provider. While many of the agency’s employees are public health nurses, VDH employs numerous other professionals including engineers who regulate public water supplies, epidemiologists who investigate disease outbreaks, shellfish specialists who inspect and regulate shellfish products to prevent the spread of foodborne disease, medical facility inspectors, forensic pathologists, death investigators, emergency coordinators, and environmental health specialists who inspect and permit restaurants, private wells and onsite sewage treatment systems.

In 2021 VDH was awarded fully accredited status by the Public Health Accreditation Board as a high performing public health department. 

VDH led the Commonwealth's respones to the COVID pandemic delivering testing, vaccination, and treament services and guidance as well as delivering guidance on how the public could protect themselves and updating that guidance regularly based on the updated science. Virginia is in the top 10 states with the highest vaccination rates and this is in large part due to VDH's continuing focus on reaching out to every community and group in Virginia to offer and encourage vaccination.

• Offer competitive compensation to VDH employees.

• Take a proactive approach to recruiting. Brand VDH as the employer of choice for those career seekers from the candidate pool. Build a career pipeline through career planning and mapping.

• Establish career paths and introduce training and development programs that support advancement.

• Determine the root causes of turnover and retention, then recommend proper corrective action then follow through with long-term tracking and implementation of whether the changes worked.

• Conduct employee engagement survey; analyze what employees need to feel valued at VDH.

• Study how VDH administers employee recognition implement necessary and appropriate changes to increase effectiveness.

• Help employees understand how important their work is to reaching the VDH goals and vision.

Improve community engagement through population health efforts and improving outreach and building engagement at the state and local level.

• Complete the State Health Assessment and State Health Improvement Process

• Increase the online accessibility of information regarding public health services

• Make our processes easy to view and use online


• Create easy ways for the public to view clinic services / hours in all districts or by searching geographically

• Create tailored messages and communication channels based on analysis of residents and their needs. Work to improve trust in rural communities and minority communities.

• Adopt proactive, long term approaches to determinants of health

• By 2018 assess and address training needs of VDH staff, tribal and community leaders to collect, interpret, analyze and apply health equity data.

• By 2018 develop and publish a biennial plan that includes strategies and barriers.

• Promote examples of approaches and activities that are successfully improving health opportunity

• Eliminate the racial disparity in infant and maternal mortality

• Reduce the non-fatal overdose rate

• Utilize ARPA funding to complete projects to improve agency systems, broadband connections, records management and to establish an electronic health record system.

• Improve agency organization and processes around administrative functions

• Assess agency informatic systems, create systems of data government and create a data exchange and system interoperability

This service area addresses access to health care services in underserved areas of the State through scholarship and loan repayment programs designed to provide incentives to health practitioners who agree to practice in areas of need in the Commonwealth. These programs include:

The Dental Scholarship Program,

The Dentist Loan Repayment Program,

The Virginia Physician Loan Repayment Program,

The Virginia State Loan Repayment Program,

The Mary Marshall Nursing Scholarship Program,

The Virginia Nurse Practitioner/Nurse Midwife Scholarship Program,

The Nursing Loan Repayment Program,

The National Health Service Corp Scholarship Program, and

The National Health Service Corp Loan Repayment Program.

This service area is aligned with the Virginia Department of Health's (VDH) mission to promote and protect the health of all Virginians by increasing the number of health care providers practicing in underserved communities in the state.

Describe the Statutory Authority of this Service

§ 32.1-122.9 of the Code of Virginia authorizes the Dental Scholarship Program and provides conditional grants for dental students to encourage them upon graduation from Virginia Commonwealth University School of Dentistry to practice in these areas.

§ 32.1-122.9:1 of the Code of Virginia authorizes the Dentist Loan Repayment Program.

§§ 32.1-122.5:1 and 32.1-122.6 of the Code of Virginia authorizes the Virginia Medical Scholarship Program and provides conditional grants for certain medical students.

§ 32.1-122.6:1 of the Code of Virginia authorizes the Virginia Physician Loan Repayment Program.

Public Health Service Act, Title III, Section 338I, 42 U.S.C. 254q-1 provides authorization for the Virginia State Loan Repayment Program.

§§ 32.1-122.6:01, 54.1-3011.1-2, and 23.1-614 of the Code of Virginia provide for the Board of Health to award nursing scholarships and the nursing loan repayment program.

§ 32.1-122.6:02 of the Code of Virginia establishes the Nurse Practitioner/Nurse Midwife Scholarship Program.

The Dentist Loan Repayment Program established in 2000 was first funded in FY 2006. It assists dentists who have graduated from any accredited dental school in the nation with repayment of their educational loans in exchange for service in an underserved area in the Commonwealth. Loan repayment awards will be made through state fiscal years 2015 with federal funding from the HRSA Oral Health Workforce Grant. These individuals will be tracked to completion of their contracts and must be practicing in a federal dental Health Professional Shortage Area.

The Virginia State Loan Repayment Program (SLRP), a federal grant through the Health Resources Services Administration, Bureau of Health Professions is state program that assists primary care physicians, psychiatrists, physician assistants, or nurse practitioners to repay educational loans in exchange for service in a federally designated primary care Health Professional Shortage Area (HPSA) or a mental HPSA (psychiatrists only). Applicants must specialize in primary care family or general practice, internal medicine, pediatrics, obstetrics/gynecology or psychiatry. An eligible practice site must be located in a HPSA, and must be a public or not­for­profit entity. Participants may receive up to $140,000 for a 4­year commitment in addition to the salary and benefit package offered by their employer. This program requires a state/community dollar­for­dollar  match.

The Mary Marshall Nursing Scholarship Program is for students earning a degree as a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) attending nursing school in Virginia. Scholarships are competitive and are awarded by a Nursing Scholarship Advisory Committee appointed by the Board of Health. Awards are based upon criteria determined by the committee including scholastic attainments, character, need, and adaptability of the applicant for the service contemplated in the award. The service obligation can be fulfilled anywhere in Virginia in the chosen field of the recipient, RN or LPN.

The Virginia Nurse Practitioner/Nurse Midwife Scholarship Program awards are competitive and are awarded by a Nurse Practitioner/Nurse Midwife Scholarship Advisory Committee appointed by the Board of Health. Awards are based upon criteria determined by the committee and include scholastic attainments, character, need, and adaptability of the applicant for the service contemplated in such award. Preference for a scholarship award is given to residents of the Commonwealth; minority students; students enrolled in adult primary care, obstetrics and gynecology, pediatrics, and geriatric nurse practitioner programs; and residents of medically underserved areas of Virginia. Scholarships are awarded for a single academic year. Scholarships must be repaid with service, one year for every year an award is received. The recipient must engage in full-time nurse practitioner or nurse midwife work in a medically underserved area of Virginia.

The Nursing Loan Repayment Program was established by the 2000 General Assembly, but was not funded. It established a loan repayment program requiring service anywhere in the Commonwealth with a preference for working in a long term care facility in the Commonwealth.

Assessment: Determine the primary care, dental and mental health underserved areas for the scholarship and loan repayment programs to meet the health needs of the state utilizing data from various sources, i.e., the Virginia Board of Dentistry, the American Dental Association, the Department of Health Professions, American Medical Association, Virginia Nurses Association, etc. Continue to conduct dentist manpower analyses based on regulatory requirements. Maintain ppova.org web site where interested practice sites and practitioners can post vacancies and/or resumes to pursue placements in medically underserved areas. Maintain a listing of all primary care physicians and psychiatrists and their practice locations in Virginia to use for designation purposes. Track the recipients of the scholarship and loan repayment programs to ensure compliance with the various programs. Ensure the practitioner is working in an approved underserved area of the Commonwealth.

Policy Development: Promulgate regulations and adopt rules and regulations related to the scholarship and loan repayment programs. Interact with agencies, divisions, academic institutions, offices, societies, coalitions, task forces, joint interagency work groups, commissions, boards, advisory councils, legislative hearings, governor’s staff, etc. concerning the scholarship and loan repayment programs.

Assurance: Link people in communities to primary care, dental and mental health services by providing students, dentists, primary care physicians, psychiatrists, nurse practitioners, physician assistants, and nurses with opportunities through the scholarship and loan repayment programs in order to increase access to primary care, oral, and mental health services in rural and underserved communities in the state. Dental scholarship and loan repayment recipients are tracked through the single provider of dental Medicaid services in the state, Dentaquest. Quarterly reports from Dentaquest provide data to determine if a dentist is meeting his/her obligation to serve in an area of need and provide access to care for underserved populations. Dentists who go into default will be tracked until they have repaid their financial obligation. The demand for nursing scholarships increases each year as tuition increases. However, funding for nursing scholarships decreased because the 2005 General Assembly approved a reciprocal agreement with surrounding states to accept licenses for nurses that have been issued by other states.

The Virginia Nurse Educator Scholarship Program was established by the 2006 General Assembly to provide annual nursing scholarships to students who are enrolled part- or full-time in a master's or doctoral level nursing program and who commit to full-time teaching after completion of their degree program within a nursing program in the Commonwealth.

The National Health Service Corp program places physicians who have received federal support in Virginia’s underserved communities. Recent activities include: •Reviewing site applications and providing technical assistance to help them become approved sites - Promoting NHSC program to eligible practice sites in Virginia • Participating in recruitment events throughout the Commonwealth • Creating a Virginia NHSC webpage in the newly developed Choose Virginia! recruitment website • Contacting recipients to assure they are still practicing in approved sites and • Assisting federal policymakers in assuring program compliance.

General appropriation was eliminated for the Dental Scholarship and Loan Repayment Programs in FY 2009. Federal funds from the HRSA Oral Health Workforce Grant will be utilized to fund the Dentist Loan Repayment program through state fiscal year 2015.

This service area includes the Virginia Rescue Squads Assistance Fund grants program, Financial Assistance to Localities to support Non Profit Emergency Medical Service (EMS) agencies, and funding provided to support the Virginia Association of Volunteer Rescue Squads (VAVRS). These items support the effective integration of personnel, transportation, communications, facilities, and education and training into a unified system that provides quality emergency medical care, thereby decreasing morbidity, mortality, and hospitalization. A comprehensive statewide system of emergency medical care offers an incentive for a business and industry considering locating in the state.

This service area directly aligns with the Virginia Department of Health’s (VDH) mission of protecting and promoting the well-being of all people in Virginia.  This is accomplished through funding support to nonprofit emergency medical services (EMS) agencies and localities in the development of a comprehensive, coordinated statewide EMS system to provide the highest quality emergency medical care possible to those in need.

• Describe the Statutory Authority of this Service

The Office of EMS (OEMS) is mandated by Virginia Code § 32.1-111.3 to coordinate a Statewide emergency medical care system. This section of the Code identifies 18 specific objectives that must be addressed.



Section § 32.1-111.12 of the Code of Virginia establishes the Virginia Rescue Squad Assistance Fund. The majority of this service area consists of funding provided through this grant process. These funds assist and support eligible EMS agencies in securing training, equipment and supplies.



§ 32.1-111.12:01 establishes a committee, appointed by the State EMS Advisory Board, to review and make recommendations for funding.



§ 46.2-694 provides that the EMS system is to be funded through a $4.25 surcharge on motor vehicle registration fees that is earmarked for EMS, commonly referred to as “Four for Life”. This section establishes a funding formula for the distribution of funds and specifies the purpose and use of funds. These funds also support VAVRS in providing training to member EMS agencies and personnel as well as other

Financial Assistance to Localities for Nonprofit EMS agencies provides non-supplanting funds to support training, equipment and supplies to eligible nonprofit EMS agencies and organizations within their jurisdiction. Annually, funds are transferred to the locality based upon the fees collected within that jurisdiction. The locality’s comptroller must report annually on the use of these funds before subsequent fiscal year funding is released.

Rescue Squads Assistance Fund program grants support training and equipment to eligible nonprofit EMS agencies and organizations. The grant application process and award criteria are established in regulations with two distinct grant cycles each year.

VAVRS funding is to be used solely for the purpose of recruitment, retention and training activities for volunteer EMS personnel and agencies. Funding is provided through quarterly payments, and § 32.1-111.13 requires VAVRS to submit an annual financial report on the use of its funds to the State EMS Advisory Board.

Section 46.2-694 of the Code of Virginia provides that the EMS system is to be funded through a $6.25 surcharge on motor vehicle registration fees that is earmarked for EMS, commonly referred to as “Four for Life”. This section establishes a funding formula for the distribution of funds and specifies the purpose and use of funds. The current funding distribution of $4.00 for this service area is:



32% Rescue Squad Assistance Fund grants

26% Return to Localities

2% Virginia Association of Volunteer Rescue Squads

10% Department of Health, EMS



The remaining 30% is allocated to the VDH Office of EMS for various purposes intended to develop and maintain a statewide coordinated EMS system.

$0.25 supports training, education and certification of EMS providers.

The Virginia Emergency Medical Services (EMS) system is very large and complex, involving a wide variety of EMS agencies and personnel, including volunteer and career providers functioning in volunteer rescue squads, municipal fire departments, commercial ambulance services, hospitals, Regional EMS Councils and, a number of other settings to enable the EMS community to provide the highest quality emergency medical care possible to those in need. Every person living in or traveling through the state is a potential recipient of emergency medical care. The Virginia Department of Health (VDH), Office of Emergency Medical Service (OEMS) is responsible for developing an efficient and effective statewide EMS system.

Products and services in this Service Area Plan include:

EMS System Coordination and Integration of Health Services
EMS Education, Training and Medical Direction
Critical Care, Trauma Centers, Stroke Centers, and other specialty centers(formerly PPCR)
EMS Registry (formerly PPCR)
Emergency Operations
EMS for Children
EMS System Evaluation and Research
Human Resources Management and Technical Assistance
Public Information and Education
Regulation and Compliance
Critical Incident Stress Management
Communication Systems
Regional EMS Councils

Statewide planning and coordination is essential to assure the availability of quality emergency medical care across the Commonwealth and to provide a more coordinated response in large scale or mass casualty events requiring resources from a large number of EMS agencies and personnel. All aspects of the EMS system are included in statewide planning and coordination. OEMS maintains and updates an EMS Plan every three years that addresses specific services including: technical assistance related to general EMS system design and operation, EMS communications system design and implementation, recruitment & retention of EMS personnel, EMS training and continuing education for all levels of EMS providers, specialty care center designation, Critical Incident Stress Debriefing, and public information and education. The State EMS Advisory Board, its many committees, and the 11 designated Regional EMS Councils are essential partners in the statewide and regional planning and coordination effort.

This service area directly aligns with the VDH’s mission to promote and protect the health of all Virginians. This is accomplished through planning and development of a comprehensive, coordinated statewide EMS system; and provision of other technical assistance and support to enable the EMS community to provide the highest quality emergency medical care possible to those in need.

• Describe the Statutory Authority of this Service

The Board of Health is mandated by the Code of Virginia to develop a comprehensive, coordinated, EMS system in the Commonwealth and OEMS is responsible for achieving the following objectives:



Section 32.1-111.3 of the Code of Virginia requires a comprehensive, coordinated EMS system in the Commonwealth and identifies 19 specific objectives that must be addressed.



Section 32.1-111.4. of the Code of Virginia requires the Board of Health to establish requirements, procedures, capabilities and classifications for the provision of emergency medical services.



Section 32.1-111.5 of the Code of Virginia prescribes by regulation the qualifications for certification and recertification of EMS personnel, including testing, continuing education, an appeals process, and the requirements that any person on or after July 1, 2013 who applies to be a volunteer with or employee of an EMS agency must submit fingerprints and provide personal descriptive information for the purposes of obtaining his criminal history record information.



Section 32.1-111.6 of the Code of Virginia requires all EMS agencies must be licensed and all EMS vehicles must be permitted.



Section 32.1-111.7 of the Code of Virginia requires each EMS vehicle to be inspected and a record maintained by OEMS.



Section 32.1-111.4:1 of the Code of Virginia establishes a 28 member Board to advise the State Health Commissioner, Board of Health, and OEMS on all EMS matters for the development and coordination of a comprehensive and effective EMS system.



Section 32.1-111.4.2 of the Code of Virginia authorize the Board of Health to designate regional EMS councils. Each of the eleven EMS councils contract with OEMS in a performance based contract to provide specific programs and services identified in the scope of work.



Section 32.1-111.12 of the Code of Virginia establishes the Virginia Rescue Squad Assistance Fund. The majority of Service Area “Financial Assistance for Non Profit EMS Organizations and Localities (40203)” is provided through this funding and grant process. These funds assist and support in the provision of training to support the 19 Code objectives as well as assist EMS agencies, personnel and localities meet Code requirements of regulations, certification, licensing and permitting.



Section 32.1-116.1 of the Code of Virginia establishes the Emergency Medical Services Patient Care Information System (EMSPCIS) which shall include the EMS Registry and the Virginia Statewide Trauma Registry. The EMSPCIS is administered by OEMS for the purpose of collecting data on the incidence, severity and cause of trauma, and for the purpose of improving the delivery of prehospital and hospital emergency medical services.



Section 46.2-694 of the Code of Virginia authorizes an additional fee of $4.25 per year to be charged and collected at the time of registration of each pickup or panel truck and each motor vehicle. All funds collected pursuant to this subdivision shall be paid into the state treasury and shall be set aside as a special fund to be used only for emergency medical service purposes.



Section 18.2-270.01 of the Code of Virginia establishes within the state treasury a special non-reverting fund known as the Trauma Center Fund. The Fund shall consist of any moneys paid into it by virtue of operation of subsection A hereof and any moneys appropriated thereto by the General Assembly and designated for the fund. The fund is administered by OEMS and distributed to designated Trauma Centers.



Section 54.1-2987.1 of the Code of Virginia defines the requirements for OEMS to administer the Durable Do Not Resuscitate (DDNR) orders program.



In addition to the requirements in the Code of Virginia, the Board of Health is responsible for promulgating the Virginia EMS Regulations (12 VAC 5-31). The regulations cover a variety of areas, including EMS agency licensure and requirements, vehicle classifications and requirements, EMS personnel requirements, EMS education and certification, and EMS physician requirements, regulations governing regional EMS councils, and regulations governing financial assistance for EMS agencies.

• EMS Education, Training and Medical Direction - Regulatory authority to establish certification and re-certification qualifications and standards for EMS personnel: EMT Basic Life Support educational standards and competency standards; Advanced Life Support educational standards and competency standards; EMS educator standards and competency standards; and certification examinations standards. Maintain certification records of EMS personnel: Initial certification candidates and re-certification candidates. Maintain accreditation criteria and standards for training sites/programs. Perform accreditation site visits of training centers/programs. Requiring national accreditation for all paramedic programs and state accreditation for all other Advanced Life Support programs.


• Critical Care, Stroke Center, and Trauma - Trauma Center Regulatory Authority: Designation criteria development and designation inspections. Trauma System Planning (State Trauma System Plan): Oversight & Management Committee; Statewide Trauma Triage Plan Development & Compliance Monitoring; and Regional Trauma Triage Plan monitoring/administration. Trauma Center Fund Administration.  State Stroke Triage Plan development and compliance monitoring.  Emergency Medical Services Patient Care Information System data collection and analysis: Statewide Trauma Registry administration; and, participation in the Traffic Records Electronic Data System (TREDS). Crash Outcomes Data Evaluation System (CODES).


• Emergency Operations - OEMS is responsible for developing a comprehensive and coordinated response during a declared “state of emergency” and/or large scale emergency and non-emergency events. This is achieved through Health and Medical Emergency Response Teams (HMERT) and the training of EMS personnel and other first responders. Disaster Response Teams: Health and Medical Emergency Response Teams (HMERT) and Disaster Task Forces. Training Programs: Vehicle Rescue, HMERT Team Member; HMERT Team Leader; and Mass Casualty Incident Management - Modules I –II, and instructor trainer programs.


• Emergency Medical Services for Children (EMSC) - Integrate EMSC within the EMS system in Virginia. Incorporate pediatric issues in all aspects of clinical care through outreach and education in the prehospital setting, emergency departments and primary care offices. Administer and maintain an EMSC program to provide coordination and support for emergency pediatric care. Assess the existence of a statewide, territorial, or regional system that recognizes hospitals that are able to stabilize and/or manage pediatric emergencies. Assess the percentage of Virginia licensed hospitals that have written interfacility critical care transfer agreements, and written guidelines for effecting interfacility transfers. Improve and expand pediatric emergency care education systems. Improve EMS/EMSC systems development. Ensure that integration of health services meets children’s needs by increasing the availability of pediatric injury prevention, first aid and CPR programs throughout Virginia. Develop broad-based support for prevention activities. Increase both unintentional and intentional injury prevention programs. Increase community linkages between EMSC and the Children with Special Health Care Needs (CSHCN) program. Identify and recommend pediatric equipment for EMS vehicles.


• EMS System Evaluation & Research - Assist all areas of EMS system development with supportive data from the EMS Patient care Information System to ensure prehospital emergency care is developed in an evidence based fashion. EMS Research can contribute to high quality EMS and to drive improvements in patient outcome. Vast amounts of money are being spent for patient care with little rigorous evaluation of the effectiveness of that care. Methodologically sound research must be incorporated into all facets of the EMS system. EMS Research can assure new technologies and therapeutic approaches are scientifically and rapidly evaluated prior to or at the initiation of their use and for continued monitoring.


• Human Resources Management and Technical Assistance - Technical Assistance – OEMS will coordinate with regional EMS councils and other state organizations to assist local EMS and government officials with specific system issues. Technical Resources – Develop, produce and distribute manuals, tool kits, curriculums, and self assessment guides to help local EMS and government officials to identify solutions to their own retention, leadership and management related issues. Resource Coordination - Partner with regional EMS councils and statewide EMS organizations and agencies to pool resources and assist volunteer and governmental EMS agencies. Financial Support - Promote the Rescue Squad Assistance Fund grant program to localities to help fund management and leadership and recruitment programs. Workshop and Seminars - Sponsor leadership and management workshops and seminars at EMS Symposium and other state-wide conferences.


• Public Information and Education - Provide public education and awareness programs to increase interest, knowledge and participation in Virginia’s emergency medical services system; promote and publicize Office of EMS programs and services identified under the Service Area Description of this plan; assist EMS agencies in recruitment efforts; coordinate Virginia’s Durable Do Not Resuscitate (DDNR) program; and education of the public, EMS providers and health care facilities on EMS rules and regulations.


• EMS Regulation and Compliance - EMS Agency Licensure and Vehicle Permits: Inspect and license new and existing EMS agencies and inspect and permit EMS vehicles. Compliance and review of EMS Regulations; conduct investigations of EMS agencies and/or personnel; periodic review and revision of EMS regulations; and review and evaluate EMS agency or personnel requests for variances and exemptions to regulations. EMS Field Services: provide technical assistance to EMS personnel and agencies, in conjunction with Community Health and Technical Resources Division provide assistance to local governments and organizations; and verification of RSAF grant awards  Establishment and ongoing processing for background checks utilizing the FBI fingerprinting process in accordance with § 32.1-111.5.


• Critical Incident Stress Management: - Maintain a process for crisis intervention and peer support services for emergency medical services and public safety personnel, including statewide availability and accreditation of critical incident stress management teams.


• Communications - Establish and maintain a program to improve dispatching of emergency medical services including support for emergency medical dispatch training, accreditation of Public Safety Answering Points and coordination of FCC licensure authorization for EMS agency radio communication.


• EMS Registry - Conduct regular statewide EMS system needs assessments and report the results through the appropriate committees of the EMS Advisory Board; perform monitoring of the quality of emergency medical care being provided in both the out of hospital and in hospital environments; submission to the National EMS Information System (NEMSIS) database hosted at the National Highway Traffic Safety Administration (NHTSA). OEMS signed an MOU with NEMSIS in 2004 to use the NHTSA 2.2 datasets and submit to the national database; support the Code mandated monitoring of patient transfer patterns of trauma patients throughout the Commonwealth. Conduct regular evaluations of EMS System performance and support requests for analysis of system resources to improve Commonwealth preparedness, homeland security, and other functions.


• Regional EMS Councils - Develop, coordinate and improve the delivery of EMS in the region through implementation of Regional EMS Plan, Regional EMS protocols, Regional Mass Casualty Incident Plan, regional coordination of basic and continuing education of EMS providers and other services as defined in the performance based contract with the Office of Emergency Medical Services.

Section 46.2-694 of the Code of Virginia provides that the EMS system is to be funded through a $4.25 surcharge on motor vehicle registration fees that is earmarked for EMS, commonly referred to as “Four for Life”. This section of the Code establishes a funding formula for the distribution of funds and specifies the purpose and use of funds. The funding distribution for this service area is 10% for OEMS and 30% for EMS systems development, training and the Regional EMS Councils. The remaining 60% is distributed to Financial Assistance for Non Profit Emergency Medical Services Organizations and Localities (Service Area Plan 40203).

The Virginia Acts of Assembly (Chapter 3) increased the $4.25 surcharge on motor vehicle registration fees by $2.00 to $6.25 (§ 3-6.02). In addition, Section 18.2-270.01 of the Code of Virginia, established the State Trauma Center Fund. Sources of revenue include a $40 charge from DMV for Reinstatement Fee for Drivers Licenses and a $50 fine from the Courts system for multiple offenders convicted of driving while intoxicated. These fees were increased in the 2010 General Assembly to $50 and $100, respectively. From these sources of funds ($2.00 and Fees), $9,055,000 is transferred to the General Fund with the remaining balance distributed to designated trauma centers.

This service area provides donated cadavers to medical schools and research centers in the Commonwealth of Virginia for anatomical study. The nonprofit Virginia State Anatomical Program (VSAP), supervised by the Office of the Chief Medical Examiner (OCME) within the Virginia Department of Health (VDH), is the only program in Virginia authorized to receive donations of human bodies for scientific study for the teaching of anatomy, and surgery, and performing research in Virginia’s medical schools, colleges, universities, and research facilities.

The Mission of the Virginia Department of Health is to promote and protect the health of all Virginians.  The Virginia State Anatomical Program assists in accomplishing this goal in a very unique manner by providing donors for the education of future physician’s and healthcare providers.

Specialized methods of preservation allow for educators and researchers to study the human body in a natural state offering the opportunity to improve and expand upon traditional pedagogy.  The ability to prepare those donors in this manner expands the ability to study, develop and discover new methods of treatment therefore helping maintain the quality of life of Virginians. The flexibility, range of motion and lack of distortion provides the ability to simulate methods of treatment and provide for a improved “hands-on” experiences.

Describe the Statutory Authority of this Service

The State Anatomical Gift Act, § 32.1, Chapter 8, Article 2 and Article 3 of the Code of Virginia, provides the authority by which the program is operated through the State Health Commissioner. The sale of body parts is prohibited in Virginia. The Code of Virginia states who is eligible to donate their bodies, how bodies should be distributed, the records to be kept, the cremation or burial criteria, the importation of anatomical material, and the penalty for trafficking in bodies.

·Responding to inquiries and providing information regarding “Anatomical Donation”

·Provide information to healthcare partners and other death care related organizations

·Serving the needs of donors and donor families once death has occurred

·Determining suitability for donation in a timely manner

·Maintaining documentation related to the “Anatomical Donation” process and individual donors.

·Processing of required documents

·Transportation of Donors

·Processing of Donors for placement

·Coordination of placement of donors with programs

·Providing support for user programs

·Coordination of “Return of Cremated Remains” of donors once study is complete

·Program evaluation

·Preparation of budget

·Research and development of additional services to user programs as related to “Anatomical Donation”

·Maintaining transparency and trust with the public

The State Anatomical Program  is funded 100 percent  by Special Funds. Funding comes from the fees paid by the schools and research programs for each cadaver to cover the expense of staff, supplies, transport, embalming, and administrative costs. The current cost per cadaver is $1,500.00.

This service area provides medicolegal death investigation. In Virginia, the first line of death investigation is the medicolegal death investigator in the district office.  They receive the initial notification of death, collect the history of events surrounding the death, and determine if the death should come under the jurisdiction of the medical examiner. A medicolegal death investigator or local city/county Medical Examiners (ME) may conduct a scene investigation and serve as the principal case investigator in the locality for deaths falling within their jurisdiction and statutory authority. The VDH Office of the Chief Medical Examiner (OCME) currently supports more than 170 local medical examiners. In addition to attending death scenes, local Medical Examiners also conduct external examinations of the body and sign the certificate of death on medical examiner cases.  In accordance with OCME professionally established guidelines, the medicolegal death investigator will refer certain types of cases for more intensive death investigation and medicolegal autopsy at a district office performed by a forensic pathologist.

This service area is aligned with Virginia Department of Health’s mission to promote and protect the health of Virginian’s by maintaining an effective and efficient system for the investigations of deaths that are unexplained or violent as well as suspicious deaths of public interest. This service area is aligned with the mission of promoting and protecting public health by diagnosing the cause of sudden and unexpected deaths, conducting surveillance for deaths that present a hazard to Virginia’s residents, identifying emerging infectious deaths, bioterrorism deaths, and documenting injuries associated with violent deaths.

Describe the Statutory Authority of this Service

Pursuant to § 32.1-283 of the Code of Virginia, all of the following types of deaths are investigated by the OCME:

• any death from trauma, injury, violence, or poisoning attributable to accident, suicide or homicide;

• sudden deaths of persons in apparent good health or deaths unattended by a physician;

• deaths of persons in jail, prison, or another correctional institution, or in police custody (this includes any deaths

associated with legal intervention);

• deaths of individuals receiving services in a state hospital or training center operated by the Department of Behavioral Health and Developmental Services;

• the sudden death of any infant; and

• any other suspicious, unusual, or unnatural death.

Perform medicolegal death investigation, external examinations, medicolegal autopsies, evidence collection, anthropological review, and assist with the scientific identification of decedents.

 Certify the cause and manner of death for courts, vital records, families and others.

 Collect toxicology and other specimens for testing, process digital photography at scene and autopsy, document all findings. Perform collections of DNA samples, fingerprints, x-rays, and records for identification of unknown decedents.

Enter all information into a database and stores case files and records.

 Establish and maintain unidentified persons files through the National Missing and Unidentified Persons System (NamUs)

 Provide reports and consultation on cases to law enforcement, attorneys, insurance companies, families, and other state and federal agencies. Provide court testimony and depositions.

Provide training to forensic pathology fellows, medical students, residents, law enforcement, local medical examiners, EMS, attorneys, community groups, and many others.

 Teach courses at universities and colleges throughout Virginia

 Provide data to various agencies (Dept. of Labor, Dept. of Criminal Justice Services, and others), CDC, pharmaceutical research oversight companies, Fatality Teams, and more.

 Administer the State Child Fatality Review Team, Maternal Mortality Review Team, Family and Intimate Partner Violence Review, and the National Violent Death Reporting System.

 Partner with VCU to administer the Department of Legal Medicine (teach courses, train forensic pathology fellows, and house a forensic epidemiologist position for the university)

 Partner with the CDC to continue to conduct population based studies and to provide specimens from emerging infectious diseases.

 Provide detail statistics on unnatural deaths in response to media and state government inquiries.

 Compile an annual report that summarizes the deaths the OCME investigates as well as other activities of the office.

General Funds comprise the majority (91%) of the service area's budget and support most of the code mandated, core mission activities of the OCME, which includes: personnel costs, body transport, local medical examiner fees, supplies, utilities, x-ray equipment, digital cameras for scene and morgue photography, computers, database, fingerprinting, archiving, transcription, biohazard waste, training, court travel, vehicles, maintenance, office supply, communications equipment and other needs. Non-general funds comprise the remaining nine percent of the service area's budget. The fatality review teams, surveillance teams, forensic pathology fellows, and one staff forensic pathologist are supported by federal grants. These grant positions support mandated core functions.

Personnel costs account for 68 percent of the service area's budget.

This service area is responsible for the dissemination of health (vital events)  statistics information. This information is processed and made available to the various offices and divisions of the Virginia Department of Health (VDH), legislators, other government agencies, the National Center for Health Statistics (NCHS), and the general public. There are six principal categories of statistical data managed by this service area: births, deaths, natural fetal deaths, induced terminations of pregnancy (ITOPs), marriages and divorces. These statistical insights are presented in the form of annual reports, special reports, electronic data exchange, public requests, and consultation. This service area is administered by the Data Management team of the Office of Information Management (OIM).

This service area supports the core VDH mission to promote and protect the health of all Virginians by providing one source of health status measurements to gauge the success of the mission.

 Authority:

32.1-276.1 mandates that the Board of Health provide a Center for Health Statistics to perform data program development, reporting, systems operations, analysis and consultation, for the Department of Health, for county and city departments of health and other public agencies having health-related duties. It further mandates the establishment of a Director of the Center for Health Statistics, who under the supervision of the Commissioner, shall:

1. Supervise the Center for Health Statistics.

2. Collect other health-related records and reports and prepare, tabulate, analyze, and publish vital events statistics and other health statistical data of this Commonwealth and such other reports as may be required by the Commissioner or the Board.

32.1-272 the federal agency responsible for national vital statistics may be furnished copies or other data from the system of vital records as it may require for national statistics if such federal agency shares in the cost of collecting, processing and transmitting such data. Such data may be used for research and medical investigations of public health importance. Other federal, state and local, public or private agencies or persons in the conduct of their official duties may, upon request and payment of a reasonable fee, be furnished copies or other data from the system of vital records for statistical or administrative purposes upon such terms or conditions as may be prescribed by the Board.

31.1-14 the Board of Health shall submit an annual report to the Governor and General Assembly. Such report shall contain information on the Commonwealth's vital records and health statistics and an analysis and summary of health care issues affecting the citizens of Virginia, including but not limited to, health status indicators, the effectiveness of delivery of health care, progress toward meeting standards and goals, the financial and geographic accessibility of health care, and the distribution of health care resources, with particular attention to health care access for those Virginia citizens in rural areas, inner cities, and with greatest economic need. Such report shall also contain statistics and analysis regarding the health status and conditions of minority populations in the Commonwealth by age, gender, and locality.

32.1-46.01 the Board of Health has established the Virginia Immunization Information System (VIIS), a statewide immunization registry that consolidates patient immunization histories from birth to death into a complete, accurate, and definitive record that may be made available to participating health care providers throughout Virginia. One of the regulations addresses implementing procedures for the use of vital events statistics data, including, but not necessarily limited to, the linking of birth certificates and death certificates.

32.1-2 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.

22.1-261 Mandates the provision of assistance to the attendance officials of each public school system concerning vital events statistics and health statistics data.

Annual Report on Health Statistics: A three volume set of reports is available on the DHS website and provides detailed demographics and other characteristics of births, deaths, fetal deaths, induced terminations of pregnancy, marriages, and divorces. Statistics produced are relevant to the customer base and compiled consistent with analyses provided at the national level. Numbers and rates are produced by city/county level of detail. Aggregations are also provided at various levels where planning is performed, i.e. planning districts, health districts, perinatal regions, medical examiner regions, etc. A report specific to vital events occurring to teenagers is one of the three volumes produced. Reports will continue to be available in multiple formats: hard copy, CD ROM and spreadsheet format.

Report on the Health of Minorities: DHS collaborates with the Office of Minority Health and Health Equity to publish periodic reports aimed at describing health equity and health disparities. The report is produced in multiple formats with the Division contributing detailed race/sex and Hispanic origin data as it relates to health statistics. Numbers and rates (where population is available) are produced mostly at the health district level. If confidentiality of individuals is not threatened, data are reported down to the city/county level of detail.

Ad Hoc Reporting System: Existing databases are used for ad hoc reports that include different aggregations, combinations of years, or different output formats. These requests come in via the phone, written media and via email.

VDH/DHS Website: This website contains modules with the most popular tables from the six statistics systems. It also contains maps and graphics on trends and city/county profiles which are summary pages containing the most popular data items from all six vital events. Data on population are also made available as communicated to the Division from the Census Bureau and NCHS. The website continues to be expanded. More detailed cancer death information is available. Additional graphics and charts are being added to the graphics and charts module. A data module specifically for infant mortality statistics is being created. Future reports will provide more data on focus groups such as males, Asians, and Hispanics.

Shared Electronic Files: A semi-monthly client level vital event data set is produced under contractual agreement with NCHS and SSA. Data are exchanged with all other states under a formal interstate agreement to supply vital event information for residents of their state. DHS has established an onboarding methodology for requests for sensitive data from the general public.  This methodology expands the rules and security measures for exchanging sensitive data.

Data Cleansing/Nosology Activities: DHS works closely with the Division of Vital Records to do ongoing editing and file maintenance on incoming vital event data ensuring the data collected are of high quality and completeness. The nosology coders were reassigned to Vital Records in 2014. Health Statistics continues to assist the nosology team in proper completion of the cause of death on death certificates and the sending of data to NCHS. The division’s clerical staff also works closely with the Medical Examiner’s Offices which supply causes of death to complete pending deaths and certificates with incomplete information.

Services are funded with non-general funds. Seventy-three percent of the funding is derived from performance based contracts with the federal government. Twenty-six percent comes from supplemental funds mandated to be provided by the Division of Vital Statistics. The remainder of the funding comes from the sale of health statistics and services.

This service area is responsible for the registration, collection, preservation, amendment and certification of vital records. The vital records system consists of births, deaths, spontaneous fetal deaths, induced termination of pregnancy, marriages, divorces or annulments, adoptions and amendments (alteration to a vital record). This service area is administered by the Virginia Department of Health's (VDH) Division of Vital Records.

This service area directly aligns with the VDH mission in promoting and protecting the health of Virginians by serving as the official custodian of all vital records in Virginia. The statistical data collected on these vital records are used by VDH and other stakeholders to generate annual reports and special reports that address health related issues.

Describe the Statutory Authority of this Service

Chapter 7 (§§ 32.1-249 et seq.) establishes the administration of the system of vital records. This chapter includes the duties of the State Regist rar, filing birth, death, spontaneous fetal death, induced termination of pregnancy, marriage and divorce certificates, amending vital records, issuing certified copies of a vital record and automating the vital records system.

Certified Copies of Vital Records ­ To preserve the original documents, the State Registrar issues a certified copy of a vital record (birth, marriage, divorce, death or stillbirth) when the eligible applicant has submitted a written request, identification and payment. Certified vital records can be obtained from the Division of Vital Records, Local Health Departments and the Department of Motor Vehicles.

 Supplies and Forms ­ The State Registrar prepares, prints and supplies all blank paper and forms that are used in registering, recording and preserving vital records. These forms are sent to hospitals, courts, funeral homes, local health departments, medical examiner offices, attorneys and any individual filing a vital record.

 Virginia Vital Events and Screening Tracking System (VVESTS) – Is an online web-based suite of applications primarily used by the Division of Vital Records and stakeholders for the electronic filing of vital events; births, deaths, fetal deaths and the induced terminations of pregnancy.  The Electronic Birth Certificate (EBC), Electronic Death Registration System (EDRS), Spontaneous Fetal Death and Induced Termination of Pregnancy are modules in VVESTS.

 Amending Vital Records ­ Upon receipt of a certified copy of a court order changing the name, sworn acknowledgment of paternity, court determination of paternity order, adoption report, surrogate consent form, correction affidavit and court order and supporting documentation for a gender change, a new birth certificate will be established or the existing vital record is amended.

 Delayed Birth Registration ­ When the birth of a person has not been registered, a delayed birth certificate may be prepared and filed. Documentary evidence that establishes the registrant’s name, date of birth, place of birth and parents’ names is required before the certificate can be filed.

 Call Center ­ The Call Center provides assistance to customers seeking information on how to obtain a vital record, hours of operation, cost of a vital record, directions to the office, status of their request, and what type of identification they must  submit.

Division of Vital Records Website ­ This website contains information on items such as how to apply for a vital record, DVR’s hours of operation, frequently asked questions, Code and Regulations Governing Vital Records, and genealogy information.

 Vital Records Index – In accordance with SB660 the Division of Vital Records has an online index of all vital records.  The index contains the registrant’s name, date of event and place of event.

 Electronic Verification of Vital Events (EVVE) – This is an application developed by the National Association for Public Health and Information Systems (NAPHSIS). NAPHSIS is the national nonprofit organization representing the 57 vital records jurisdictions in the United States.  EVVE provides customers (state and federal agencies) with the ability, reliably, and securely verify and certify birth and death information.  VVESTS is integrated with EVVE.

VDH is authorized by § 32.1-274 of the Code of Virginia to charge a fee for a certified copy of vital records or for a search of the files or records when no copy is made. When a vital record is amended or a delayed birth certificate if filed an administrative fee (12VAC5-550-520) is charged.  Fees collected under this section provide 100% of the service area's budget.

This service area has responsibility for the support and oversight of statewide immunization activities. Through a variety of activities, the service area strives to maintain and distribute an adequate and viable vaccine supply. The program also conducts quality assurance site visits, oversees the investigation of suspected cases of vaccine preventable disease, assesses immunization coverage statewide and maintains a statewide immunization registry. These and other program activities are effective in protecting the health of all Virginians.

This service area directly aligns with the Virginia Department of Health's (VDH) mission of promoting and protecting the health of Virginians. The Immunization Program ensures that an adequate and viable inventory of vaccine is available to local health departments and to private physicians participating in the Vaccines for Children (VFC) program. This is essential to protecting the public from the spread of communicable disease.

Describe the Statutory Authority of this Service

Section 32.1-46 authorizes the State Board of Health, the State Health Commissioner and the VDH to administer this service area.

Section 32.1-46 also provides for the immunization of children against certain diseases in accordance with regulations established by the Board of Health and for the implementation of a statewide immunization registry.

Section 23.1-800 requires full-time students enrolling in public baccalaureate institutions to be immunized against certain diseases.

Vaccine Supply: Maintain and appropriately ship an inventory of viable vaccine to public and private health care providers statewide.

 Statewide Policy Development: Develop and implement statewide policy on vaccine preventable diseases in accordance with the harmonized recommendations of the CDC Advisory Committee on Immunization Practices, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

 Grants Management and Resource Allocation: Develop and manage annual federal grant and allocate resources to districts for support of immunization services. Perform quarterly evaluation of program fiscal activity.

 Quality Assurance: Conduct annual quality assurance reviews in all local health department sites to ensure compliance with State and Federal program guidelines. Conduct quality assurance reviews in all Vaccines for Children Program (VFC) private provider sites to ensure compliance with State and Federal program guidelines.

 Statewide Assessment and Program Evaluation: Conduct annual assessment of the immunization records of kindergarten and sixth students to determine immunization coverage, medical and religious exemptions and school regulatory compliance. Conduct annual assessment of child care and Head Start centers to determine immunization coverage and regulatory compliance. Conduct quarterly assessment of the immunization coverage rates in health districts. Conduct quarterly evaluation of program objectives.

 Immunization Registry: Implement and manage the statewide immunization registry. Actively recruit additional providers and enhance system functionality. Support private physicians and hospitals in documenting the “Meaningful Use” of their electronic health records   (EHR).

 Technical Assistance: Provide vaccine preventable disease related technical assistance to public and private health care providers statewide. Maintain  the statewide Pandemic Influenza Emergency Response plan. Provide technical guidance on Pandemic Influenza Preparedness planning and operations. Provide guidance and support to local health department staff on investigation of suspected cases of vaccine preventable diseases.

Perform statewide oversight and provide guidance to district health department staff on the identification and follow­up of cases of perinatal hepatitis   B.

Education and Training: Ensure availability of CDC and other vaccine preventable disease training courses to public and private health care providers. Ensure that both patient and provider educational materials are available electronically.  Provide computer based assessment training for health department staff. Support off­site, job related training for program staff. Use multiple training modalities to train health department staff and private providers on registry utilization.

The total budget for the service area has two funding streams consisting of general and non-general funds. Non-general funds are received in a federal, categorical, cooperative agreement from the Centers for Disease Control and Prevention.

The purpose of this service area is to control, prevent, and eventually eliminate tuberculosis (TB) from the Commonwealth. Through a variety of activities, the service area strives to detect every case of TB, assure the adequacy and completeness of treatment, and prevent further disease transmission. This service area is administered by the Division of Disease Prevention/TB (DDP/TB). The service area also includes the Newcomer Health Program (NHP), which focuses on the health needs of refugees newly resettled in Virginia. Major activities include:



Disease surveillance for all TB cases from time of initial suspicion through case disposition,



Consultation to local health departments on treatment, diagnosis, case management, contact investigations, discharge planning, and media relations,



Direct assistance in large-scale contact investigations, when clusters are identified, and when needed on individual cases,



Development of policies ranging from preventing disease transmission to the proper use of personal protection equipment,



Oversight of TB awareness activities for the public and training opportunities for local health department personnel,



Assistance and guidance to local health departments when involuntary isolation of a recalcitrant patient is required to minimize risks to others in the community,



Application and administration of federal grants to fund the TB program,



Coordination and facilitation of the initial health assessments of all newly arriving immigrants with a refugee or asylee status,



Collection of data on refugee arrivals, health conditions and outcome of their assessment data , and



Notification to local health districts that a newly arrived immigrant or refugee requires screening for tuberculosis.

This service area aligns directly with the mission of the Virginia Department of Health (VDH) by reducing morbidity and preventing the transmission of TB.

Describe the Statutory Authority of this Service

Section 32.1-46 authorizes the State Board of Health, the State Health Commissioner and the VDH to administer this service area.

Consultation and Technical Assistance- Consultation on TB prevention, diagnosis and treatment for health departments and health care providers in the public and private sector; consultation on health screening of refugees and asylees; development of guidelines and procedures related to core mission – examples include contact investigation and sputum collection guidelines; development of products to facilitate service delivery – examples include TB record forms, risk assessment tools, investigation and evaluation algorithms; technical assistance to hospitals, clinics, long term care facilities, congregate living facilities, health departments and other facilities on matters related to facility design and maintenance, TB screening of employees and clients, and investigation of exposures; and implementation of statutory and regulatory requirements by development and publication of policies, procedures, and guidelines

Direct assistance to health departments to assess possible outbreaks and facilitate large contact investigations: coordination of referrals and information exchange for cases, suspected cases, contacts and other clients who move in or out of Virginia; facilitate communication between local health districts for those moving within Virginia; support (personnel and financial) for health departments to ensure that CDC mandated activities are carried out at the local level; support (personnel and financial) for health departments experiencing increased numbers of TB cases; direct assistance in management of difficult cases with complicating factors such as homelessness

Education and Training Activities: provision of training for health care providers in public and private sector; development and dissemination of educational materials for patients and the public (including pamphlets, fact sheets, web site, media presentations in English and other languages); preparation of informational materials for elected officials and other decision-makers; serve as speakers at conferences and meetings on matters related to TB prevention and control and refugee health conditions of public health importance; serve as subject matter experts required to address media requests

Planning and Evaluation: periodic evaluation of local district TB prevention and control activities; production of reports for local, regional and national use in TB program planning and evaluation; participation in local, regional and national TB control planning activities; and participation in local, regional and national refugee resettlement planning and evaluation activities

Surveillance and Data Analysis: collection of TB case reports and other surveillance data from health departments; verification of data; data analysis; transmission of data for inclusion in the national TB registry; collection of data on health screening of refugees and asylees from local health departments; verification of data; data analysis; production of reports for local, regional and national use in program planning and evaluation

Tuberculosis Prevention and Control is supported by both general funds and federal funds. The federal funds come through a categorical cooperative agreement from the Centers for Disease Control and Prevention and are intended to supplement (not replace or supplant) state and local resources.

Sexually Transmitted Disease (STD) prevention and Control Services provides for the prevention and control of morbidity and mortality associated with STDs and their complications, including assistance to local health departments and safety net providers for clinical prevention services. Activities include:

Oversight of statewide program activities;



Policy and guidelines development;



Grants management for STD Prevention and Control;



Diagnostic and laboratory support for gonorrhea and chlamydia clinical testing;



Partner services (patient/partner risk reduction counseling, interviewing and  referral for early detection and treatment services);



Technical assistance and consultation;



Targeted outreach to high-risk individuals;



Field screening;



Support to safety net service providers to increase availability of STD screening, diagnosis and treatment;

Supplemental staffing for outbreak situations;



Oversight and management of surveillance activities, including forms completion and mandated reporting, data and database management, trend analyses and disease monitoring and STD program science research initiatives;



Program evaluation and quality assurance assessments; and



Health care provider training and education. 

This service area directly aligns with the Virginia Department of Health (VDH) mission by reducing STD transmission and health impact through prevention initiatives, referral and treatment services, and surveillance activities.

Describe the Statutory Authority of this Service

Chapter 2 of Title 32.1 of the Code of Virginia pertains to the reporting and control of diseases.

§ 32.1-35 and 12-VAC-5 90-80 and 12-VAC-90-90 of the Board of Health Regulations for Disease Reporting and

Control specify which STDs are to be reported and the method by which they are to be reported.

§ 32.1-36 requires physicians to report persons with STDs to the local health department.

§ 32.1-39 provides for STD surveillance, investigation of reports, and conducting counseling and partner notification.

§ 32.1-57 through 32.1-60 requires STD examination, testing, and treatment.

§ 32.1-64 requires treatment for ophthalmia neonatorum.

Leadership and Program Management: Thorough and consistent oversight, policy development and guidance are provided for STD prevention services, including technical assistance to local health departments and community organizations. Grants related to STD Prevention and Control are managed and maintained. Allocation of personnel resources to local health departments is handled through Memoranda of Agreement.

Program Evaluation:  

• Assessments of  local health department STD programs are conducted upon request and/or on an ad hoc basis as a means of assessing reporting requirements (timeliness and completeness), disease intervention specialist performance management, morbidity trends, and review of internal processes.  Findings and recommendations are reviewed and subsequently disseminated as a report to the applicable  local health directors.  Best practices are shared with other LHDs.


• Programmatic evaluation of internal STD/hepatitis operations will be conducted as a means of assessing programmatic requirements.  An annual survey will be developed and disseminated to LHDs and community partners in order to assess existing program operations, identify and correct problems and enhance internal capacity.  

Surveillance, Field Operations, and  Data Administration: Surveillance and Field Operations staff work with LHD disease intervention specialists regarding patient and partner interviews and follow-up procedures. Surveillance staff conducts data management activities, including forms, data collection and entry, epidemiologic analyses and quality assurance. Time-scaled reports are provided to relevant VDH personnel and the public via internal networks, the internet, and data publications.

Training and Professional Development: Health care provider training and education is provided on an ongoing basis. Knowledgeable staff are assigned to provide consultation services and technical assistance for specified areas of the Commonwealth. The DDP has a collaborative partnership with the Region III HIV/STD Prevention Training Center to provide STD clinical training to providers. Training that addresses hepatitis procedures for medical providers is conducted by the Virginia HIV/AIDS Resource and Consultation Center.

Medical and Laboratory Services: Diagnostic and therapeutic services for gonorrhea and chlamydia are supported through a contract with the Division of Consolidated Laboratory Services and the provision of laboratory testing supplies to local health departments. Funding for the provision of additional clinical prevention services is also provided to some community health clinics. Assessment to determine implementation of new testing technology is also performed in order to improve service delivery. Testing, vaccines and medications related to Hepatitis are provided to specific populations and/or locations, based on available funding.

Partner Services: Field Operations staff work with local health department disease intervention specialists related to risk reduction counseling, interviewing and referral services for STD patients and sexual partners. Early detection, referral and treatment are paramount to avoiding lasting health consequences such as Pelvic Inflammatory Disease or infertility.

Outbreak Response Plan: The DDP is in the final stage of developing a new Outbreak Response Plan to replace the existing plan.  This new plan will provide for more comprehensive assessment of outbreak situations, internal procedures for staff engagement/deployment, ongoing assessment and communications.  Areas of Special Interest: 1) Targeted clinical and field screening for  gonorrhea and chlamydia, targeting specific high-risk populations, including MSM and young adults; 2) Development of improved surveillance data system capacity; 3) Incorporation of sentinel surveillance activities throughout the state; 4) Improved policy, planning and communications strategies; 5) Improved program evaluation capacity; 6) Enhanced capacity to assess gonococcal resistance; 7) Provision of Hepatitis screening and/or vaccines  in some health departments, as funds are available; 8) Incorporation of effective program science approaches to enhance STD prevention  outcomes.

The chief source of funding for Sexually Transmitted Disease Prevention and Control is federal funds from the Centers for Disease Control and Prevention. Federal funds are intended to supplement (not replace or supplant) state and local resources but matching of these funds is not required. The service area also receives some general funds. 

Disease Investigation and Control Services works to detect, assess, and control the spread of various communicable diseases. This service area focuses on approximately 50 different diseases of public health importance, including diarrheal diseases, hepatitis, meningitis, rabies, and vector-borne diseases (such as Lyme disease and West Nile Virus). Disease surveillance contains a variety of components, such as the following:
Receiving reports from physicians, hospitals, and laboratories about people possibly diagnosed with a communicable disease of public health importance;
Monitoring for the occurrence of disease in mosquitoes, birds, other animals, or contamination in the environment that could potentially lead to illness in humans;
Tracking trends in daily utilization of medical care by reviewing data from emergency departments, provider claims, and pharmaceutical sales to detect unusual occurrences of disease;
Compiling statistics to identify trends and patterns in disease activity in order to detect outbreaks or other disease events and producing reports summarizing disease activity data;
Disease consultation and policy development to provide recommendations regarding interventions that can be implemented to interrupt the spread of disease;
Outbreak investigations to identify the source of an outbreak and prevent other people from being exposed to the source; and
Monitoring for and responding to emerging infections and terrorism-related illnesses.

This service area directly aligns with the mission of the Virginia Department of Health to promote and protect the health of Virginians by preventing the spread of communicable diseases.

Describe the Statutory Authority of this Service

Chapter 2 of Title 32.1 of the Code of Virginia pertains to the reporting and control of diseases.

Section 32.1-35 requires the Board of Health to establish a list of diseases that must be reported to the health department. Sections 32.1-36 and 32.1-37 require physicians, laboratories, and persons in charge of medical care facilities, school, or summer camps to report diseases to the health department. Section 32.1-39 requires the Department to provide for surveillance and investigation of preventable diseases and epidemics, including outbreak investigations.

Articles 3, 3.01, and 3.1 of Chapter 2 address disease control measures that may be implemented, including quarantine, isolation of persons with communicable diseases, and control of rabies.

Disease control policies and procedures for each disease, contained in the Virginia Disease Control Manual.

Databases and other tools for conducting disease surveillance.

Disease statistics posted on the website and published in the Disease Surveillance Annual Report.

Disease-specific emergency response plans and other guidance materials posted on the VDH web site. For example, specific plans have been produced for smallpox, severe acute respiratory syndrome (SARS), monkeypox, and pandemic influenza.

Consultation services to local health departments and private practitioners.

Training to ensure consistency of disease reporting and control operations.

Monitoring and issuing advisories for environmental exposures, such as marine beach waters.

Regulatory and legislative documents and testimony.

Press releases and brochures to inform the public about reportable and emerging diseases.

Informational notices to local health departments and other medical care partners about new diseases occurring that have the potential to affect the health of Virginia’s citizens. (This has occurred with SARS, monkeypox, and anthrax, for example).

Grant management and statewide program review and oversight.

This service area receives state general fund dollars for general epidemiologic services and for terrorism preparedness. In addition, federal funds are awarded from the Centers for Disease Control and Prevention’s Epidemiology and Laboratory Capacity Program and Expanding Existing Surveillance to include Pfiesteria, Other Harmful Algal Blooms, and Marine Toxins. The Environmental Protection Agency also supplies federal funds from the Beach Monitoring and Notification program.

Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency (AIDS) Prevention and Treatment Services seeks to reduce the burden of HIV/AIDS on the Commonwealth. This service area identifies populations at greatest risk for becoming infected, provides services to prevent new HIV infections among individuals at risk, tracks the disease, links infected individuals into care, and provides treatment/medication to individuals who would otherwise be unable to access care. Additional activities include, but are not limited to:



Development of policies and guidelines;



Grants management for HIV prevention, surveillance and care;



Funding of community-based organizations to provide HIV Prevention Services to individuals at risk for acquiring or transmitting the disease;



HIV testing and partner services to identify people who are HIV-infected and don’t know their status;



Ensure HIV infected individuals receive appropriate treatment to reduce viral load and HIV transmission.



Public information for both the general public and targeted groups through hotline services, social media and public information campaigns;



Quality assurance for both health department and community-based service provision; and



Provision of pharmaceutical services and medications, directly or via health insurance, to low income, uninsured persons for the treatment of HIV infection through the AIDS Drug Assistance Program (ADAP).

This service area directly aligns with the agency mission by improving the health of individuals and reducing the risk of transmission. By reducing risk behaviors, tracking disease trends and assisting individuals with accessing care and medications, the program improves the health of both people and their communities, particularly those populations infected with and impacted by HIV.

Describe the Statutory Authority of this Service

Chapter 2 of Title 32.1 of the Code of Virginia pertains to the reporting and control of diseases.

§ 32.1-36 of the Code of Virginia and 12 VAC 5-90-80 and 12 VAC 5-90-90 of the Board of Health Regulations for Disease Reporting and Control mandate reporting of specific diseases, including AIDS and HIV infection.

§§ 32.1-36.1, 32.1-37.2, and 32.1-55.1 of the Code of Virginia respectively establish mandatory confidentiality of testing, conditions for HIV testing, and the establishment of additional anonymous testing sites.

§ 32.1-11.2 established the AIDS Services and Education Grants program which provides outreach, education and support services to high-risk populations.

§ 32.1-36 allows for the voluntary reporting of additional information at the request of the Virginia Department of Health for special surveillance or epidemiological studies.

§ 32.1-37.2 requires that partner notification services (partner counseling and referral services) be offered to individuals who test positive for HIV.

§ 32.1-11.2 established pilot treatment centers and regional AIDS resource and consultation centers.

Chapter 24, §54.1-2403.01, requires practitioners to advise pregnant women in their care about the value of HIV testing and to request that they consent to testing.

HIV Prevention and Treatment Services program manages federal grants/cooperative agreements for HIV Prevention, Surveillance and HIV Care services. Responsibilities include awarding funds to local agencies/providers, providing oversight and technical assistance.

Prevention Services funds multiple competitive grant programs to provide high impact prevention, HIV testing and related services.

The Disease Prevention Hotline provides information, crisis counseling and referral to over 4,000 people per year either on the phone or through the internet. This staff also responds to calls on the General Assembly mandated Medication Assistance Hotline. The Hotline distributes more than 200,000 pamphlets, posters and educational materials annually. Staff develops and/or identifies appropriate educational materials for populations at risk.

The Virginia HIV Community Planning Group integrates HIV prevention and care planning and advises VDH on the development of federally mandated plan submissions.

Training to improve the scientific base of prevention programs is conducted for health educators, outreach workers and other service providers. Specific curriculum training on interventions identified by the CDC is also provided.

Training of health department and community-based staff is conducted in order to provide client services in a culturally competent and non-judgmental manner.

Capacity building support such as training in grant writing, fiscal management, board development, program evaluation, quality assurance and use of logic models is conducted to support community agency infrastructure.

Quality assurance through site visits and report reviews is conducted. Staff develops and monitors standards for HIV prevention interventions and preparation of educators and outreach workers.

Confidential HIV testing is offered through a variety of venues including STD clinics, TB clinics and family health clinics.  A Memoranda of Agreement (MOA) with the Department of General Services funds HIV testing conducted at the local health departments.

Memoranda of Agreement (MOA) with local health districts are implemented to support partner services.

HIV testing is provided through contracts with community-based organizations and offered in non-traditional settings such as drug treatment centers, detention centers, outreach vans and other street/community venues. Rapid testing is offered through select STD clinics, hospital emergency departments, community health centers and substance abuse treatment centers.

Training on HIV testing technology, including quality assurance measures, is provided.

HIV/AIDS-related morbidity and mortality trend data on adults and children are compiled from public and private providers, hospitals, and labs, then cleaned and analyzed for emerging trends. These data are disseminated via mailings, web distribution, and various postings statewide to internal and external customers.

HIV/AIDS information and statistics are presented to customers throughout the year.

Trainings on Virginia HIV/AIDS reporting regulations, testing technology, and HIV investigations of special epidemiological significance, e.g. unusual mode of transmission, are routinely provided to internal and external customers.

Core surveillance epidemiology consultants provide technical assistance on HIV and AIDS adult and pediatric case definitions and clinical characteristics as well as HIV/AIDS-related policies and procedures to public and private health care practitioners.

Linked medical record abstractions and patient interviews are conducted to estimate statewide access to HIV care, clinical outcomes, risk behaviors, health care utilization, and unmet needs among HIV-infected persons receiving medical care.

AIDS Drug Assistance Program (ADAP) provides life sustaining medications to people with HIV who have no other access to treatment via health insurance cost assistance or direct distribution drugs. The formulary includes medications for the treatment of HIV infection and the prevention and treatment of HIV related co-morbidities.  The program currently is able to serve all eligible individuals and submits an annual report to the General Assembly describing its capacity to meet projected demands. The State Pharmaceutical Assistance Program (SPAP) was established in 2006 to provide ADAP eligible clients enrolled in Medicare with Part D cost sharing assistance. Core services and essential support services are provided to low income, uninsured individuals with HIV infection through direct service agreements, and a network of four regional consortia. Core services include primary medical care, medications not covered by ADAP, dental care, case management, mental health services and substance abuse services. Supportive services, such as transportation, assist clients to access medical care and remain adherent to antiretroviral therapy. Ryan White Part B Minority AIDS Initiative  funds sites to increase access to ADAP, primary medical care and related services for racial and ethnic minorities. This program focuses on identifying and referring individuals at risk for or infected with HIV, or those lost to care in order to link/re-engage them into needed services. These individuals are at high risk of disease progression and transmission of HIV to others.

Training for health care providers on all aspects of HIV/AIDS, hepatitis and sexually transmitted diseases diagnosis and treatment is provided through a contract agreement with the Virginia HIV/AIDS Resource and Consultation Centers. A variety of mechanisms including consultation, education and clinical training sessions are used to train providers.

Health care services utilization trends and projections are identified via data collected through ADAP and service providers. This information is used for statewide services coordination and planning.

Public awareness campaigns are conducted annually for Black HIV/AIDS Awareness Day, National HIV Testing Day, National Gay Men’s HIV Awareness Day, Latino AIDS Awareness Day and World AIDS Day. Fact sheets are developed and distributed to local health districts and community-based organizations. Advertising is conducted through social media sites and/or the radio. A Facebook page is maintained.

A condom distribution program was launched in 2012. Free condoms are provided to all health districts, HIV care providers and community based organizations.

HIV Care Services has a four year Special Projects of National Significance (SPNS) grant to increase linkage to care and retention in care for HIV-positive persons. Currently, sites are funded to develop a patient navigation and mental health network under their grant.

HIV Prevention Services participates in The Care and Prevention in the United States (CAPUS) Demonstration Project.  This is a 3-year cross-agency demonstration project led by the Centers for Disease Control and Prevention (CDC). The purpose of the project is to reduce HIV and AIDS-related morbidity and mortality among racial and ethnic minorities living in the United States.

HIV prevention, including HIV counseling, testing, and partner services, is supported through state and federal funds. The U.S. Centers for Disease Control and Prevention provides the majority of these funds with approximately $$ 7,177,126 annually..



HIV treatment services receive both federal and state funding. The largest portion of funding for these services, approximately $27.4million annually, is provided by Part B of the Ryan White Treatment and Modernization Act, which is administered federally by the Health Resources and Services Administration.



The HIV Surveillance program receives approximately $1.8 million federal dollars annually from the U.S. Centers for Disease Control and Prevention to support the program activities of Core, Incidence, Capacity Building, and Medical Monitoring; these multi-faceted programs are essential to monitoring the epidemic, planning, and evaluating HIV prevention and care services. 

Pharmacy services are essential to enable local health departments to effectively treat communicable diseases, treat chronic diseases, and to respond to public health emergencies such as pandemic influenza, bioterrorism events and natural disasters that displace individuals with a loss of their prescription medications. The capacity of this support service varies based on the volume of prescriptions and clinic services offered by the local health departments. All local health departments using guidelines provided by pharmacy services maintain core competencies in inventory and proper storage of drugs and biologicals; administration and dispensing pharmaceuticals; and proper handling of pharmaceuticals for disposal.



All Pharmacy Services comply with all state and federal laws including The Pharmacy Act, The Drug Control Act and all regulations promulgated by the Virginia Board of Pharmacy related to the practice of Pharmacy, as well as all applicable Virginia Department of Health policies and procedures.



Pharmacy Services serves all 119 local health departments by providing patient specific prescriptions in support of various agency programs as well by providing pharmaceuticals, vaccines and biological that support local health department clinic operations. Each local health department is also capable of dispensing and administering vaccines and medications in the event of an emergency as declared by the Governor.



As a government agency, Virginia Department of Health purchases prescription drugs through federal contracts and multi-state purchasing compacts at prices that are substantially lower than average wholesale prices. As a condition of this preferential pricing, public health facilities are prohibited from competing against public retail entities for non-public health treatments under the federal Robinson-Patman Act. Pharmacy Services does not provide services to the general public but only to patients of the local health department as evidenced by the requirement that all patients that receive pharmacy services must have a medical chart on site.



The prescription needs of patients seen in local health departments are met through the Virginia Department of Health's Central Pharmacy. These services include: treatment or support for sexually transmitted and communicable diseases, prenatal services, family planning; provision of pharmaceuticals to HIV infected patients under the AIDS Drug Assistance Program; provision of pharmaceuticals in support of the Children Specialty Services Program; provision of pharmaceuticals in support of the Hemophilia Program; provision of vaccines for patients not eligible for the Vaccines for Children Program and for foreign travel; provision of pharmaceuticals in response to natural emergencies, national emergencies, and bioterrorism related events; and the provision of guidance and information to local health departments on State and Federal laws that pertain to the storage, distribution, and dispensing of medications.

This service area aligns with the Virginia Department of Health mission to promote and protect the health of Virginians by assuring pharmacy support services to detect, prevent, and treat diseases, promote health, and respond to public health emergencies.

Describe the Statutory Authority of this Service

Chapter 2 of Title 32.1 of the Code of Virginia pertains to the reporting and control of diseases.

The Chapter defines the authority for this particular Service Area and includes reporting of disease, investigation of disease, disease control measures, quarantine, isolation of persons with communicable diseases, and control of rabies.

§ 32.1-36 of the Code of Virginia and 12 VAC 5-90-80 and 12 VAC 5-90-90 of the Board of Health Regulations for Disease Reporting and Control mandate reporting of specific diseases.

§ 32.1-37.2 requires that partner notification services (partner counseling and referral services) be offered to individuals who test positive for HIV.

§ 32.1-39 provides for Sexually Transmitted Disease surveillance, investigation of reports, and conducting counseling and contact tracing (partner notification).

§ 32.1-46 provides for the immunization of children against certain diseases in accordance with regulations established by the Board of Health and the implementation of a statewide immunization registry.

Title 23, Chapter 1, § 23-7.5 requires full time students enrolling in public institutions to be immunized against certain diseases in accordance with the recommendations of the American College Health Association.

§ 32.1-57 through 32.1-60 requires Sexually Transmitted Disease examination, testing, and treatment.

Prescription dispensing services in support of designated agency programs that include AIDS Drug Assistance Program, TB Control, Hemophilia Treatment Center, Care Connection for Children, Metabolic Disorders Program, and General Medical Clinics operated by the Office of Community Health Services

Provision of specialty packaging products for TB patients receiving Direct Observed Therapy

Provision of pharmaceutical services to local health departments in support of all clinic operations including Family Planning and Sexually Transmitted Diseases

Provision of Vaccines and Biologicals to local health departments

Procurement , storage and inventory management of the Commonwealth’s emergency cache of antivirals and mass dispensing antibiotics for response to a bioterrorism event

Continued development and management of the agency's Antiviral Distribution Network

Consultation and education provided to other agency programs and local health departments on proper storage, distribution and administration of pharmaceuticals. In addition provide legal guidance to agency senior management and local health departments regarding state and federal laws that apply to pharmaceuticals and the practice of pharmacy.

With the elimination of local laboratories and pharmacies in the health districts in FY 2010 as part of a budget reduction, the overall importance of the central pharmacy has increased significantly. The remaining pharmacy service was transferred to the Department of Epidemiology and a new service area was created beginning in FY13. The revenue source of funding is fees charged for pharmacy services.

This service area is administered by the Virginia Department of Health's (VDH) Office of Minority Health and Health Equity (OMHHE). The purpose of this service area is to advance health equity for all Virginians. The mission of the Office of Minority Health and Health Equity is to identify health inequities and their root causes and promote equitable opportunities to be healthy. In support of that mission, OMHHE 1) analyzes data to characterize inequities in health and healthcare, their geographic distribution and their association with social determinants of health; 2) facilitates equitable access to quality healthcare and providers; 3) empowers communities to promote health equity; 4) informs health, healthcare, and public policy in order to promote health equity (“health equity in all policies”); 5) enhances the capacity of public health and our partners to promote health equity.



Products and services include:



State Office of Minority Health,

State Office of Rural Health,

State Primary Care Office,

Data analysis and research to identify high priority target areas for focusing policies, programs, and limited resources,

Designations of medically underserved areas or health professional shortage areas,

Healthcare practitioner recruitment and retention programs,

Critical Access Hospital Program and Flex Rural Veterans Program,

Culturally and Linguistically Appropriate Health Care Services Program,

Small Rural Hospital Improvement Program,

Minority Health Program,

State Health Access Grant Program,

State Health Workforce Implementation Grant Program,

Community Engagement with high priority target area communities to address social determinants of health and promote health equity,

Technical assistance to VDH office and programs and external partners to support programmatic and policy efforts to advance health equity.

This service area is aligned with the VDH mission of protecting and promoting the health of Virginians. This service area supports the healthy development of Virginia’s rural, racial/ethnic minority, and low income residents by providing resources to communities that will help them develop and support programs that improve health and access to care for all residents.

Describe the Statutory Authority of this Service

Section 32.1-2 of the Code of Virginia directs the State Health Commissioner, in part, to "develop and implement health resource plans" and to "assist in research", as part of a comprehensive program of preventive, curative, restorative, and environmental health services.

Section 32.1-122.07 of the Code of Virginia requires the Commissioner to develop a rural health plan for the Commonwealth.

Section 32.1-122.21 of the Code of Virginia requires the Commissioner to establish a Health Workforce Advisory Committee to advise him on all aspects of the Department's health workforce duties and responsibilities.

Section 1820(g)(3) of the Social Security Act provides funds to states to help small rural hospitals to (1) pay for costs related to the implementation of the Prospective Payment System; (2) comply with provisions of the Health Insurance Portability and Accountability Act; and (3) reduce medical errors and support quality improvement.

Section 32.1- 122.5 of the Code of Virginia requires the Board of Health to establish criteria to identify medically underserved areas within the Commonwealth.

The Office of Minority Health and Health Equity serves as the State Office of Rural Health. In this capacity, the Office helps individual rural communities build health care delivery systems by collecting and disseminating information; providing technical assistance; helping to coordinate rural health interests state-wide; and by supporting efforts to improve recruitment and retention of health professionals. Rural Health products and activities are: Disseminate information regarding federal initiatives to improve access to care for rural residents, Provide technical assistance to rural community leaders, Co-sponsor Rural Health Conferences, and Engage in strategic planning efforts to leverage resources and engage stakeholders in order to improve access to quality care, support the development of models of care and address barriers related to rurality.

Virginia’s eligibility for federal funding to improve access to health care is increased by the Primary Care Office program. The Office of Minority Health and Health Equity submits applications to the federal Health Resources and Services Administration to designate areas and facilities as having a health professional shortage or for being a medically underserved population. General activities include: Submit applications to Federal HRSA for geographic areas and facilities to receive designation as medically underserved, Maps and Website information regarding Virginia’s designated areas, Provide technical assistance to community groups interested in submitting applications for federally qualified health center or rural health center, and Technical assistance to community groups for demonstration projects to increase access to health care.

In an effort to improve access to care by increasing the supply of practitioners working in medically underserved areas or health professional shortage areas the Recruitment and Retention program seeks to interest a range of different types of medical practitioners to come to or continue to work in Virginia. Products include but are not limited to: membership to a National Rural Recruitment and Retention recruitment website (3RNet) that lists available healthcare positions in Virginia, establishment of the Virginia Health Workforce Development Authority, •Presentations at Virginia’s Medical Schools and Residency Programs, Marketing Tool Development, Participate on the Virginia Recruitment and Retention Collaborative Team development of a student health professions registry and annual statewide professional student and resident recruitment conference (Choose Virginia Conference).

An additional programmatic effort to improve access to care by increasing the supply of practitioners working in underserved areas is the Conrad J-1 visa waiver program. International medical graduates who would otherwise have to return to their country of origin upon completion of their residency training as a condition of their J-1 visa may serve in an underserved area of the state as an alternative way to meet this federal requirement. Activities include: Utilize 3RNet recruitment website to access information on available positions, Advertise availability of J-1s, Process J-1 Application to U.S. Department of State, Administer verification of employment, and Process National Interest Waiver.

The Rural Hospital Medical Flexibility (FLEX) program that authorizes the Critical Access Hospital (CAH) Program allows small, rural hospitals to receive Medicare cost-based reimbursement and includes activities that promote the regionalization of rural health services, the creation of rural health networks, and the improvement of emergency medical services. CAH activities include: Coordinate CAH and SHIP hospital (CASH-IN) activities to leverage state and federal resources for the benefit of small rural hospitals, Provide funding for equipment, Provide funds for hospital administrators to attend national health conferences, Coordinate financial analysis and community assessment activities for small, rural hospitals interested in CAH conversion, Promulgate regulations to benefit small, rural hospitals; develop, update and oversee implementation of recommendations from Virginia's State Rural Health Plan in partnership with the Virginia Rural Health Association. The FLEX-veterans grant is collaboration with the Department of Veterans Services to increase access to quality and culturally competent health care among veterans in rural Virginia.

The Culturally and Linguistically Appropriate Services Program seeks to improve access to culturally and linguistically appropriate health care services for Virginia’s Limited English Proficient residents. Recent activities include: Translation of health forms, Technical assistance regarding Title VI, •Development and disbursement of resources targeted to assist Virginia's limited English proficient populations, Coordination of community-wide grant application efforts for medical interpretation services. Partial funding of coordinator to assist with community education activities.

The Office of Minority Health and Health Equity promotes the elimination of racial/ethnic health inequities and improves access to care by building capacity in community health systems to provide integrated, efficient, and effective health services. These efforts also improve minority health status and promote health equity. Activities have included: Staff Commissioner’s Minority Health and Health Equity Advisory Committee and data, legislative, and community engagement subcommittees, Develop Healthy People 2020 training modules to promote health (equity) in all policies.

Other data analysis and research conducted by the Office focuses on identifying high priority target areas characterized by inequities in health status, adverse social determinants of health, and inadequate access to health care.

The Small Rural Hospital Improvement Program (SHIP) provides funding to small rural hospitals to pay for costs related to quality improvement and investments towards meaningful use of health information technology.  Hospitals must utilize the funds to 1) pay for costs related to maintaining accurate PPS billing and coding such as updating chargemasters or providing training in billing and coding, 2) pay for the costs related to delivery system changes as outlined in the ACA such as value-based purchasing (VBP), accountable care organizations (ACO) and payment bundling.

The Health Workforce Implementation Grant is a 2-year, $1.9 million grant to fund the Virginia Health Workforce Development Authority, which will serve as the coordinating body within Virginia to develop a health workforce pipeline and facilitate the placement of healthcare providers in underserved areas. 

The funding for Health Research, Planning, and Coordination comes from federal funds (67%) and general fund dollars (33%). Federal funds are from the following grants: State Office of Rural Health Grant, Rural Hospital Flexibility Grant (Critical Access Hospitals), and the Primary Care Office Grant. All grants are funded through the U. S. Department of Health and Human Services, Health Resources and Services Administration. 

This service area administers the Virginia medical facilities and services licensure laws and regulations in order to assure quality of care and to protect the public. This is accomplished through: Licensure of eight categories of medical care facilities or services: hospitals, abortion facilities, outpatient surgical hospitals, nursing facilities, home care organizations, hospice programs, and managed care health insurance plans and private review agents; Regulatory development to establish minimum requirements to assure quality health care, while assuring efficient and effective program operation; Certification and registration programs for managed care health insurance plans and private review agents; Investigation of consumer complaints regarding the quality of health care services received in facilities; Providing training and technical assistance to medical facilities and practitioners; and Inspection and enforcement of medical care facility licensing laws and regulation. The Office of Licensure and Certification (OLC) is also the designated state survey agency and conducts the federal certification surveys for the Centers for Medicare and Medicaid Services (CMS).

This service area aligns with the Virginia Department of Health's (VDH) mission to protect and promote public health by establishing and enforcing minimum standards of quality and safety in the delivery of health care services. The regulatory process is supported by state licensure and regulations in addition to federal certification regulations.

Describe the Statutory Authority of this Service

Chapter 5 of Title 32.1 of the Code of Virginia establishes the state licensure program and directs implementation of regulations to ensure providers are meeting the minimum standards for operating nursing facilities, hospitals, outpatient surgical hospitals, home care organizations, hospice programs, as well as the managed care health insurance plan certification program, and peer review agency registration.

Licensing: OLC conducts review of licensing applications and handle coordination with other agencies’ regulatory requirements; Licensing assures service providers are acting within the law. The Office is in the process of updating state regulations for several programs.



Inspection and enforcement: Thorough and consistent inspection and enforcement of laws and regulations addressing health care quality is provided. Assessment of provider and individual responsibility is performed as appropriate. Investigation of complaints; Inspection and enforcement services assist consumers by maintaining safe and protective facilities and services in compliance with regulatory requirements; Medical facility inspectors, who conduct both state and federal regulatory inspections, are health care professionals such as nurses, dietitians, social workers, speech pathologists and laboratory medical technologists.



OLC is the state survey agency for the federal survey and certification program under agreement with CMS. Inspection activities satisfy both state licensure and federal certification requirements. The majority of service area activities regarding medical facilities, services or programs involve the federal certification process. Title XVIII and XIX of the Social Security Act establishes the federal certification program for medical care entities receiving federal reimbursement and mandates the minimum health and safety standards that must be met by providers and suppliers participating in Medicare and Medicaid. OLC is the state survey agency for the federal Clinical Laboratory Improvement Act (CLIA) mandating all laboratories that conduct tests on human specimens, including physician offices and meet applicable federal requirements and have a CLIA certificate in order to operate. VDH has interagency agreements with the: (i) Department of Medical Assistance Services (DMAS) to conduct the federal survey and certification requirements of CMS, (ii) State Fire Marshal’s Office to conduct Life Safety Code inspections. To receive Medicare certification, medical facilities must comply with the Life Safety Code. Under the interagency agreement with VDH, the Fire Marshal’s offices conducts life safety code surveys and certifies compliance/noncompliance to VDH; and, (iii) Department of Health Professions (DHP) to administer the nurse aide training and registration program required by CMS. Under the interagency agreement with VDH and DMAS, DHP is responsible for examining approximately 250 LTC nurse aide training and education programs for compliance with federal standards, and; maintains a registry of approximately 35,000 trained and certified nurse aides employed in federally certified LTC facilities; Confirmed cases of resident abuse and neglect are reported to the Adult Protective Services Unit of the Department of Social Services; VDH communicates with the Office of the State Ombudsman regarding individual client issues related to delivery and quality of services;



Regulatory development: Minimum operational requirements are established consistent with governing laws and nationally accepted standards of practice. OLC highly trained medical facility surveyors assure consumers that uniform quality assurance standards are being maintained; Invite consumer and provider input in development.



Customer assistance: OLC provides training, consultation and technical assistance, education, and cooperative projects in areas such as abuse/neglect/exploitation, disaster planning and recovery, pressure ulcer reduction, emergent care, evolving service delivery processes and inspection of facilities. Efforts are provided in collaboration with various industry groups and associated state agencies. Resident Assessment Instrument training: States are required by the CMS to use the Resident Assessment Instrument (RAI) in federally certified facilities to assess the clinical characteristics and care needs of residents. Currently, federally certified nursing homes and home health agencies are required to encode and transmit RAI records to a repository maintained by OLC. The primary goal of the federal RAI system is to target potential problem facilities by focusing onsite survey activities on the identified problem areas. The RAI system has grown each year as new federal provider categories are added. The RAI system is central to improving the state’s ability to evaluate the cost-effectiveness and quality of care. The high degree of consistency and accuracy currently shown by providers in transmitting RAI data to OLC is attributable to the education and training programs that have been presented to federally certified providers, provider associations and consumer groups. Complaint services are responsive to ensure safe and protective environments in compliance with statutory and regulatory requirements. OLC receives approximately 1,000 consumer complaints annually. The Office conducts informal dispute resolution conferences for nursing facility providers disputing the results of a federal certification inspection; OLC responds to Freedom of Information requests, specifically in long term care. OLC continues to expand the information available to providers via the internet.

The Medicare and Medicaid certification programs are funded by the Centers for Medicare and Medicaid Services (CMS) from separate federal fund sources. Title XIX of the Social Security Act provides for federal grant mechanisms to pay the State agencies a percentage of the cost certification activities each quarter. There is a 75% federal/25% state matching requirement for all state Medicaid survey and certification program costs.

The Clinical Laboratory Improvement Act program is funded entirely by the collection of inspection fees by CMS. The State Licensing Programs covers the cost of licensing general and outpatient hospitals, nursing homes, home care and hospice. Funding is also available from Managed Care Health Insurance Provider (MCHIP) Funding, which is a percentage of the total amount of the premiums paid by the respective program’s enrollees in Virginia, up to a maximum of $10,000.

This service area implements the Virginia Medical Care Facilities Certificate of Public Need (COPN) laws and regulations. The COPN program requires that a provider of health care services must demonstrate that a public need exists for certain listed equipment and services before establishing the service or adding capacity. The program was established in Virginia in 1973. The statutory objectives of the program are: (i) promoting comprehensive health planning to meet the needs of the public; (ii) promoting the highest quality of care at the lowest possible cost; (iii) avoiding unnecessary duplication of medical care facilities; and (iv) providing an orderly procedure for resolving questions concerning the need to construct or modify medical care facilities. In essence, the program seeks to contain health care costs while ensuring financial and geographic access to quality health care for Virginia citizens.

Products and services include: Permitting of 11 categories of medical care facilities or services; Review, analysis and formulation of recommendations for COPN request based on eight criteria for determining need; Assist the State Health Commissioner in the administration of the COPN program; Regulatory development to provide an orderly procedure for resolving questions concerning the need to construct or modify medical care facilities; The State Medical Facilities Plan; Assessing and tracking of charity care obligations from COPN applicants; Participating in informal fact finding conferences; The Request for Applications (RFA) process; Release of monthly and annual reports on the status of COPN projects reviewed; Quadrennial nursing home utilization study.

This service area directly aligns with Virginia Department of Health's (VDH) mission of promoting and protecting the health of Virginians by promoting the development of new services when and where they are needed and limiting the unnecessary duplication of expensive technologies and services.

Describe the Statutory Authority of this Service

Article 1.1 (Section 32.1-102.1 et seq.) of Chapter 4 of Title 32.1 of the Code of Virginia establishes the medical care facilities COPN program and directs implementation of a regulatory framework to assist applicants and reviewing agencies with examining the need for these projects.

Reporting: Provide written recommendations addressing the merits of the approval or denial of COPN applications; Provide advisory reports on all completed applications that are not subsequently withdrawn; Provide advisory reports on all completed requests for significant changes to projects with COPN authorization; Web based report of COPN requests currently under review or that have recently received a decision.



Permitting: Application review and granting of a COPN to provide a facility or service; Tracking of compliance with conditioned obligations to ensure that applicants have met the intent of the conditions on granted COPNs; Issuance of the RFA targeting geographic areas for consideration of increased bed supply and establish competitive review cycles for submission of applications; Annual monitoring of authorized projects for consistency with the plan as authorized and for continuing progress.



Regulatory development: Establish minimum operational requirements consistent with governing laws and nationally accepted medical practices; Regulatory services provide a consistent framework for applicants and state agencies to examine and approve projects; Establish ‘batching cycles” for review of similar projects.



Customer assistance: Technical assistance and consultation to applicants; Expand information available to providers on the Internet. As information is more readily available in electronic form, additional customers will become aware of this resource, thus increasing VDH’s customer base; Provide responses to frequent FOIA requests for project documentation.

The COPN program is supported entirely with application fees. 

This service area administers much of the child health services component of the federal Maternal Child Health Services Title V Block Grant, including   the program for children with special health care needs. It provides surveillance of child and adolescent health as well as  assessment, screening, referral; and follow up as necessary;  analyzes and develops policy related to child and adolescent health; works to assure that children and their families are linked to needed health services; and provides training and technical assistance to partners promoting safe and healthy environments for children.

This service area implements the following programs and initiatives statewide or agency wide:

Children (and Youth) with Special Health Care Needs programs, including: Care Connection for Children, Child Development Services, Bleeding Disorders Program; Surveillance including Newborn Screening Services, Early Hearing Detection and Intervention Services, Virginia Congenital Anomalies Reporting and Education (VaCARES, the birth defects registry); ZIka Pregnancy registry; Early Childhood Health Consultation; ­ promotion of Bright Futures as the best practice in pediatric care, anticipatory guidance, developmental screening, and medical homes; transition from adolescent to adult health care; and training and technical assistance on clinical issues related to the early childhood (birth – age 5)and  school age, populations in the preschool and school settings K-12 grade.

Programs and services offered by this service area directly align with VDH’s mission to promote and protect the health of all Virginians. Screening, referral and follow up  activities, anticipatory guidance, and promotion of medical homes and transition of care are conducted or supported to address health promotion and disease prevention. Tools and technical assistance are provided to professionals in childcare and school settings on clinical interventions and health maintenance, emergency preparedness, and environmental safety and health.

Describe the Statutory Authority of this Service

United States Code § 701-709, subchapter V of the Social Security Act provides for primary and preventive care for children, and services for children with special health care needs.

Section 32.1-77 of Code of Virginia authorizes preparation, amendment and submission to the Secretary of the U.S. Department of Health and Human Services state plans for services to children with special health care needs.

Sections 32.1-64.1 through 32.1-64.2 of Code of Virginia provide for the establishment and maintenance of a system for the screening of newborns for hearing loss and monitoring those who are at risk to assure that such infants receive appropriate early intervention

Section 32.1-65 through 32.1-67 of Code of Virginia provides for a system for screening newborns for certain heritable disorders and genetic diseases through dried blood-spot screening.

Sections 32.1-69.1 through 32.1-69.2 of Code of Virginia requires the establishment and maintenance of a Virginia Congenital Anomalies Reporting and Education System, including collection of data to evaluate the possible causes of birth defects, improve the diagnosis and treatment of birth defects and establish a mechanism for informing the parents of children identified as having birth defects and their physicians about the health resources available to aid such children.

Section 32.1-89 of Code of Virginia provides for the establishment of a program for caring for and treating persons with hemophilia and other related bleeding disorders who are unable to pay for the entire costs of such treatment.

Section 22.1-275.1 of Code of Virginia requires school health advisory boards to assist with the development of health policy in the school division and the evaluation of the status of school health, health education, the school environment, and health services and to annually report on the status of needs of student health in the school division to VDH, and the Virginia Department of Education.

Section 22.1-270 of Code of Virginia requires documentation of a comprehensive pre school entry physical examination of a scope prescribed by the Commissioner of Health.

Monitor trends in child health status indicators and identify emerging issues of statewide significance.

Develop or participate in the development of statewide strategic plans regarding child health.

Represent VDH on statewide interagency councils, task forces, and committees related to child health.

Propose and/or respond to state legislative and budgetary initiatives; track pertinent legislation.

Monitor federal legislation for potential impact at the state level.

Respond to requests for information from constituents, policy makers, media, and stakeholders.

Assure follow-up services are provided to newborns with screened abnormal test results for heritable disorders and genetic diseases, and hearing impairment.

Assure care coordination services are offered to children with special health care needs through identified centers of excellence.

Manage contracts that assure medical management and genetic services are available to newborns with diagnosed genetic and/or metabolic disorders.

Develop and manage contracts or agreements with local health departments, community based organizations, and provider systems to implement programs.

Develop and manage regulations and guidance documents in support of mandated programs.

Provide staff support to advisory committees (e.g., , Early Hearing Detection and Intervention Advisory Committee, Genetics Advisory Committee, Virginia Interagency Coordinating Council; Early Childhood Advisory Committee.)Obtain and administer grants.

Review literature and identify and share best practices with partners and contractors.

Develop and deliver training and technical assistance to partners and stakeholders.

Develop and implement social marketing campaigns and materials related to child health promotion and disease prevention.

Provide public and professional education in support of program messages.

Assure sound fiscal management through budgeting and expense monitoring.

Conduct surveillance on birth defects, including heritable disorders and genetic diseases and hearing impairment and utilization of services by, and outcomes for, children with special health care needs.

The chief source of funding for the service area is the Maternal and Child Health (Title V) Block Grant from the Health Resources and Services Administration. This requires a state match ($3 state to $4 federal). Approximately half of the federal funds is derived from categorical federal grants that do not require a state match.

This service area seeks to improve the health of women and infants in the Commonwealth by assessing their needs, developing policies, building capacity and strengthening the infrastructure to meet these needs, and assuring that quality services are provided to this population. This is accomplished through resource development and allocation; program monitoring and evaluation; public and customer education; technical assistance, consultation and training; and provision of direct services.

This service area directly aligns with the Virginia Department of Health’s mission by promoting and protecting the health of all women in Virginia across their lifespan.

Describe the Statutory Authority of this Service

§ 32.1-2 of the Code of Virginia charges the State Board of Health, the State Health Commissioner and the Virginia Department of Health to provide a comprehensive program of preventive, curative, restorative and environmental health services including education of the citizenry and developing and implementing health resource plans.

§ 32.1-40 of the Code of Virginia requires every practitioner of the healing arts and every person in charge of any medical care facility to permit disclosure of medical records to the State Health Commissioner or his designee. Under the provisions of the Code the local health officer may obtain access to medical records for the purpose of public health investigation of fetal and infant deaths, or to investigate an illness for the purpose of disease surveillance.

§ 32.1-67 of the Code of Virginia requires the Board of Health to recommend procedures for the treatment of sickle cell diseases and provide such treatment for infants.

§ 32.1-68 of the Code of Virginia requires the Commissioner of Health to establish a voluntary program for the screening of individuals for the disease of sickle cell anemia, sickle cell trait, and other genetically related diseases and genetic traits.

 Title V of the Social Security Act, Section 501 (42 USC 701) requires that the state agency administering the state’s program will fulfill agreements to ensure coordination of care and services available under Title V and Title XIX. Title V grantees will also provide, directly and through providers and institutional contractors, services to identify pregnant women and infants who are eligible for medical assistance and once identified, to assist them in applying for such assistance.

Title V of the Social Security Act (42 USC 701-709) also provides assurance that mothers and children, in particular those with low income or with limited availability of health services, have access to quality maternal and child health services including, but not limited, to efforts to reduce infant mortality and morbidity and the incidence of preventable diseases. It promotes the health of mothers and infants by providing prenatal, delivery and postpartum care.

Title X of the Public Health Services Act (42 U.S.C. 300, et seq.) provides funding for family planning agencies and is an outgrowth of the Family Planning Services and Population Research Act of 1970, P.L. 91-572. This law was amended in 1975 and 1978 to require Title X projects to provide access to natural family planning, infertility, and adolescent services. These amendments require that economic status not be a deterrent to receiving family planning services.

Conduct surveillance and routine needs assessment activities including review and analysis of birth certificate data, hospital discharge data, PRAMS and maternal mortality review in order to monitor and describe the status of women’s and infants’ health in the Commonwealth.

 Identify gaps in services for high­risk populations such as pregnant teens, women experiencing complications of pregnancy or postpartum, or women not receiving the recommended screening and treatment for  cancer.

 Coordinate with other state agencies to examine policies affecting women’s physical and mental  health: including reproductive health and perinatal health, e.g., Virginia Department of Behavioral Health and Developmental Services, Virginia Department of Social Services, and Virginia Department of Medical Assistance   Services.

 Provide technical assistance to other agency staff, legislators and persons in other public and private organizations working to improve women’s and infants’ health.

 Identify policy issues having an impact on women’s and infants’ health at community, state, regional, and national  levels.

 Provide leadership in developing appropriate policy to address women’s and infants’ issues in cooperation with internal and external partners.

 Improve the access to care provided to women and infants who would otherwise not obtain needed health care through resource allocation and/or seeking external funding.

 Increase the knowledge of health care professionals who provide direct care services to women and infants through providing technical assistance, education, standards of care and guidelines, and sharing findings from legislative or community needs assessments.

 Provide targeted media campaigns regarding healthy behaviors in order to improve the health of women and their infants. Provide resources and/or technical assistance to community­based groups to initiate services for women and infants in need.

Monitor all program activities to assure the goals, objectives and strategies are based upon data and are being implemented accordingly. Develop and implement appropriate recommendations and evaluate program effectiveness using all available data sources.

Support local health departments as needed within underserved communities in providing prenatal care by purchasing multi­vitamins, iron supplements, RhoGam and certain laboratory tests.

 The Virginia Healthy Start initiative/Loving Steps Program (VHSI), a grant program in three communities with high rates of infant deaths, provides  funding for nurse case management, nutrition therapy, lay home visiting, and health education for pregnant and parenting women with infants and toddlers with the goal to reduce infant mortality and morbidity.

 Family Planning Program provides comprehensive family planning services to assist low­income citizens to plan and space their pregnancies. This includes a birth control method of choice, cervical cancer screening, physical and gynecological examinations, sexually transmitted infection  prevention, screening, and treatment and other laboratory testing, preconception counseling and health education and referral. VDH will continue to assure family planning services through the development of partnerships with community providers or, if necessary, provision of direct services in underserved communities.

 Resource Mothers Program provides  education and support for pregnant and parenting teens. Trained community health workers educate teens about prenatal care and parenting. The goals are to decrease infant mortality, decrease the rate of low weight births, encourage return to school   or work, and prevent repeat pregnancy in the teen years.

Early Impact Virginia (formerly The Virginia Home Visiting Consortium), collaborates with Smart Beginnings Coalitions across the state and is charged to improve efficiency and effectiveness of the state’s early childhood home visiting services. The approach has been to build coalitions at the state and local level among existing home visiting programs, increasing collaboration, improving quality through training, and collecting common data elements. The Consortium membership consists of Project Link, BabyCare, Healthy Start, Healthy Families, CHIP of Virginia, Resource Mothers, Early Head Start / Head Start, Part C Early Intervention, Special Education Early Education, and Medicaid Managed Care. While some states have chosen to sponsor only one program model, Virginia has sought to build better linkages between the local communities’ existing programs, creating a continuum from birth to aged 5, so that the diverse needs of families in the early years can be more appropriately addressed and matched with the appropriate program.

 Continued Federal funding allows abstinence education programs (AEP) to be continue in health districts  with high need and capacity to conduct the program.

 The Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant supports increased evidenced­based home visiting program services in at­ risk communities identified in the Virginia Updated State Home Visiting Plan. Coordinated by VDH, and reporting to the interagency Early Childhood Advisory Council, the grant will provide technical assistance and enhanced staff training to all communities, measure progress on benchmarks, will connect the home visiting data to the early childhood data system, and will increase efficiency at the state and local levels.

The majority of funding in this service area is from federal grants including Title X Family Planning, Loving Steps, and Title V Maternal and Child Health Block Grant (Title V MCH). The Title V MCH combined with state funds supports other activities such as the Resource Mothers Program, The Resource Mothers Program also includes funding from Medicaid. Seventy-five percent of the administrative budget comes from the Title V MCH Block Grant with the remaining funds from the state. The administrative funds support salaries for the leadership, policy activities, and two program managers not funded through grants or contracts, and administrative support for the service area. Besides personnel costs, the administrative funds support a variety of activities including general office support, periodic special projects, data collection and analysis, day to day operations, laboratory services for maternity clients in local health departments, state supported abortion services, and staff travel and training. 

This service area implements programs that address chronic diseases that have serious long-term health and social consequences. Chronic diseases including cardiovascular disease (heart disease and stroke), cancer, diabetes and oral diseases are among the most prevalent, costly, and preventable of all health problems. In spite of improvements in prevention in oral health, dental caries (tooth decay) remains the most common chronic disease in Virginia’s children.



This service area implements a number of strategies including: (1) gathering, analyzing and disseminating data and information to key stakeholders and the public to inform, prioritize, and monitor programs and population health, (2) implementing environmental approaches  that promote health and support  and reinforce healthful behaviors; (3) implementing health system interventions to improve the effective delivery and cause of clinical and other preventive services to prevent disease, detect disease early or reduce or eliminate disease risk factors; (4) implementing strategies to improve community-clinical linkages by ensuring people have access to programs that prevent chronic conditions or assist people in the management of their chronic condition; (5) working with partners to affect change in systems which influence the prevention or control of chronic diseases including access for persons with health disparities; and (6) collaborating across individual disease prevention project areas to achieve a state comprehensive chronic disease prevention approach.

In oral health, specific strategies include: Developing oral health educational materials and programs for parents and providers; Providing professional training including training to dental and non-dental providers to increase access to oral health services; Implementing evidence-based oral health prevention programs including dental sealant projects targeted to school age children; Providing evidence-based prevention programs for maternal, early child, children with special needs and adult/older adult populations; Developing, conducting and evaluating oral health prevention programs utilizing topical and systemic fluorides to reduce the incidence of tooth decay; Partnering with private and public providers of dental care through the statewide oral health coalition to increase access to safety net care; And providing technical assistance to local health departments and communities regarding the practice of public health dentistry through on-site clinic reviews, tracking clinical services provided, and assisting in the recruitment, training, and orientation of local health department dentists. 

This service area directly aligns with the Virginia Department of Health’s (VDH) mission to promote the health and protect the wellbeing of all people in Virginia  by promoting the early detection of disease conditions, providing education, and addressing behaviors that promote good health and reduce the development of chronic disease including oral disease. The VDH mission is also supported through providing quality assurance of local health department clinical dental programs and developing population based oral health prevention programs.

Describe the Statutory Authority of this Service

§ 32.1-2 of the Code of Virginia states that the Virginia Department of Health (VDH) shall administer and provide a comprehensive program of preventive, curative, restorative and environmental health services, educate the citizenry in health preservation of the public health” and collect and preserve health statistics.

§ 32.1-11.3 of the Code of Virginia establishes the authority for the development of community health education services including health promotion and disease prevention efforts.

§ 32.1-23 of the Code of Virginia provides for the publication and distribution of disease prevention information.

§§ 32.1-70 and 32.1-71 of the Code of Virginia require the Virginia Department of Health (VDH) to maintain a population-based central cancer registry based on reports from hospitals, clinics, pathology laboratories, and physicians.

The Virginia Waterworks Regulations § 12VAC 5-590 et seq., effective date November 15, 1995 govern the design, maintenance and operation of waterworks in the Commonwealth and serve to implement the Safe Drinking Water Act 1996 (42 U.S. C. 300f et seq.) and the National Primary Drinking Water Regulations (40 C. F. R. Part 141.) §§ 32.1-12 and 32.1-170 Code of Virginia and corresponding sections of Virginia Waterworks Regulations describe fluoridation of water systems.

Federal EPA Regulations Title 40-Protection of Environment Chapter I - Environmental Protection Agency Part 141-National Primary Drinking Water Regulations (7-1-2002 edition) §§ 141.24-141.25, 141.31 and 141.203-208 provide regulations regarding organic contaminates specific to fluoride, including mandatory templates for exceeding primary Maximum Contaminant Level And Secondary Maximum Contaminant Level.

Major projects/programs include: Coordinated Chronic Disease Prevention Project (CDP), Breast and Cervical Cancer Early Detection Program (BCCEDP),Comprehensive Cancer Control Project (CCCP), Virginia Cancer Registry (VCR), Heart Disease, Diabetes, Nutrition, Physical Activity and Obesity and School Health Project (DP-1305) Tobacco Use Control Project (TUCP), Diabetes Self-Management Education Program, Diabetes Prevention Program (DPP), Adult and Older Adult Oral Health  Program, Oral Health Education, Community Water Fluoridation, , Oral Health Data Surveillance and Evaluation, School Based Preventive Services Program, Dental Quality Assurance Program, Children with Special Needs Oral Health Program, and the Bright Smiles for Babies Fluoride Varnish Program. This service area also addresses issues such as physical activity, nutrition, cultural competency and diversity.

Monitor Health Status: - Periodically review available data sources for chronic disease information to determine: 1) the leading causes of death, illness, and disability due to chronic diseases in Virginia, 2) specific groups who are at higher risk, 3) the extent of risk factors that contribute to chronic diseases,  and 4) the economic impact of chronic diseases. - Develop surveillance data systems where none exist, if feasible. -Develop and disseminate publications, reports and fact sheets on the burden of chronic diseases in Virginia, including oral health. - Educate health professionals, legislators, institutions and the general public on the burden of chronic diseases and oral health in Virginia. - Monitor the oral health status of targeted populations (preschool, school age, adults, elders, and children with special needs) through collection, analysis and reporting of data. Evaluate existing prevention programs regarding impact and cost effectiveness, survey clients and citizens regarding oral health knowledge and practices, and identify those indicators that place segments of the population at highest risk for oral disease. Use data collected to plan or modify existing oral health programs.

Assure a Competent Workforce: - Collaborate with other state agencies, academic institutions, and organizations to provide professional education and resources to Virginia’s health professionals. - - Provide technical assistance, consultation and guidance to local health districts and other community health professionals. - Ensure a competent oral health work force in public health dentistry through providing professional training and education to local health department dental staff that is certified by the Board of Dentistry for CEUs. - Provide professional expertise and resources for recruitment and retention of the public health dentist work force. - Provide training to professionals and service providers about oral health promotion, oral disease prevention, recognition and detection of oral health problems through screening. - Train and educate dental, dental hygiene and medical students at Virginia’s professional schools regarding dental public health statewide and programs.

Link People to Health Services: - Assure that high-risk populations have access to chronic disease prevention and control information and programs through partnerships, leveraging resources, and grants to community-based organizations, health systems, local health departments, and faith-based organizations. - Develop, implement and monitor statewide population based prevention programs including community water fluoridation, school fluoride rinse, school based dental sealant programs, and fluoride varnish programs. - Provide consultation, technical assistance and on site review of clinical local health department dental programs using standardized guidelines. - Provide technical assistance and training to ensure oral health integration in WIC, Head Start and Early Child Care, school-based programs, nursing home services, and community-based services, etc. - Provide biopsy services for VDH dental patients statewide in order to improve early screening for oral cancer. -Monitor and continually update a directory of dentists serving very young children and children with special healthcare needs.

Mobilize Community Partnerships:- Convene and facilitate state coalitions and task forces to draw upon the full range of knowledge and resources available in Virginia to prevent and control chronic diseases. - Develop working relationships with communities for the support of community mobilization and action including the development of local grassroots coalitions. - Serve on coalitions, advisory boards, and public or private task forces or groups whose focus is to improve chronic disease prevention and oral health in the state by providing expert consultation on chronic disease prevention and oral health delivery and programs. - Provide technical assistance and chronic disease and oral health data to local consortia in developing, preparing, and submitting funding proposals related to access to chronic disease prevention programs and oral health.

Develop Policies and Plans: - Lead state planning for chronic disease prevention and control and the development of state plans that contain priorities, partners and resources needed to prevent and control chronic diseases. - Monitor chronic disease prevention and oral health related legislation and complete legislative studies or assignments. Promulgate regulations and adopt rules and regulations related to chronic diseases and oral health. - Provide expertise to governmental bodies (at all levels) developing chronic disease prevention and oral health related laws, policies, and regulations. - Interact with agencies, divisions, offices, societies, coalitions, task forces, commissions, boards and advisory councils to reduce barriers and improve availability of effective chronic disease and oral health services statewide. Assist these groups in the development of state chronic disease and oral health plans. - Provide leadership, expertise and participate actively in statutory, regulatory, legislative and standards development related to chronic disease and oral health care benefits, insurer/health plans, and public health standards.

Inform and Empower People: - Develop and conduct social marketing and health communication campaigns that educate Virginians about ways to prevent and control chronic diseases. - Provide expertise, resources, and technical assistance to educate and empower the public about current chronic disease and oral health problems and solutions. - Promote positive health attitudes and behaviors through population-based health education, training and promotion campaigns in various community settings. - Develop scientifically based and culturally appropriate chronic disease and oral health materials that are linguistically and age appropriate including materials in other languages. - Serve as a central resource for teachers, early childhood providers and community partners, and education and prevention materials for chronic disease and oral health.

Evaluate Effectiveness, Accessibility and Quality: - Conduct ongoing evaluation of chronic disease programs and services to assess and improve program effectiveness and to provide information necessary for allocating resources and reshaping programs and services. - Collect and report dental clinical services and services of the local health department dental programs statewide. - Survey and maintain data regarding the fluoridation status of adjusted water systems to include population served, equipment age, sources of fluoride and local Office of Drinking Water Field Inspection Reports. - Monitor water systems for compliance. Export the data to the Centers for Disease Control and Prevention Water Fluoridation Reporting System. - Collect, maintain and refer from a resource directory on the availability of safety net dental services statewide. - Evaluate existing and newly implemented population-based oral health programs including the school-based dental sealant program, and fluoride varnish program.

The Chronic Disease Prevention and Control Program receives multiple CDC categorical grants for services including: comprehensive cancer control ($229,383), cancer registry program ($595,000), breast and cervical cancer early detection program ($2,474,054), heart disease and stroke, diabetes, nutrition, physical activity, and obesity, and school health ($1,912,645) and tobacco use control ($1,625,358). Approximately $755,097 of state general funds are received and used as federal grant matches for categorical grants.

A categorical HRSA Oral Health Workforce grant currently provides funding through FFY15 for increased clinical and population based preventive services and safety net programs including the Mission of Mercy. The DPHP has been awarded a CDC infrastructure grant through FFY18 which provides funding to establish, strengthen, and enhance the infrastructure and capacity of states to plan, implement, and evaluate population-based oral disease prevention and promotion programs. 

This service area implements programs toreduce the burden of injury and violence across the lifespan. Injury is the leading cause of death of Virginians ages 1­44. Injuries include physical and psychological trauma that results from unintentional, self­inflicted and violent acts. Programs and policies that increase safe behaviors, eliminate unsafe products, enhance social and physical environments, and assure adoption of protective devices or technology can reduce or eliminate injury risk and severity. Programs address leading mechanisms of unintentional injury (transportation, home and recreation), suicide and self­inflicted injury, and violence (sexual assault, domestic,  youth).

This service area implements a number of strategies including 1) gathering, analyzing and disseminating data and information to key stakeholders and the public to inform, prioritize, and monitor programs and population health,2) working with partners to affect change in systems and policies which influence the prevention of injury and violence, 3) enhancing workforce capacity through professional training, 4) promotion and dissemination of safety devices and 5) implementing community-based injury and violence prevention projects.

This service area directly aligns with VDH’s mission to promote and protect the health of all Virginians by promoting the primary prevention and early intervention of injuries, providing education and addressing behaviors that promote health.

Describe the Statutory Authority of this Service

Code of Virginia § 32.1-2 requires VDH to assist in providing a comprehensive program of preventive, curative, restorative and environmental health services, health education, and emergency and other health hazard abatement.

Code of Virginia § 32.1-73.7 assigns the lead responsibility for youth suicide prevention to the health department.

Code of Virginia § 32.1-77 authorizes the Commissioner of Health to administer state plans for maternal and child health services and children’s specialty services pursuant to Title V of the United States Social Security Act and to receive and expend federal funds for the administration thereof in accordance with applicable federal and state laws and regulations (note: this section is relevant to public health initiatives to address injury and violence which are included as Title V performance measures).

Code of Virginia § 46.2-1097 requires VDH to operate a child restraint promotion and distribution program for low income families.

Code of Virginia  § 46.2-749.2:1 requires VDH to use funds from the Children’s Programs Support Fund acquired through the sale of special license plates to support injury prevention work coordinated by the Safe Kids Coalition.

Major programs/projects include: Child Safety Seat Check Station, Low Income Safety Seat Distribution and Education Program, Rape Prevention Education Program, Suicide Prevention Program, Youth Bullying Prevention Program, Prescription Drug Prevention Project and Injury Prevention Program

Research and assessment: Analyzes death and hospital discharge data to provide an accurate picture of the scope, demographic distribution and cost of injuries in Virginia. Periodic surveys are conducted on risk and protective behaviors and the programmatic impact of prevention efforts is evaluated.

Policy and program development: Provides data, information, consultation and training to support injury, suicide and violence prevention policy and program development at the state and local level.

Training of providers: Provides training on injury prevention, youth violence, suicide, sexual violence and domestic violence to the diverse groups of health, education, law enforcement and social service providers that reach children, adolescents, women, men and the elderly.

Community projects: This service area offers grant funding, training and technical assistance to support community-based injury, suicide and violence prevention projects.

Promotion and dissemination of safety devices: Provides child safety seats and installation education and other safety devices (e.g. smoke alarms, bicycle helmets) to high risk groups through a variety of community providers.

Information dissemination: Provides electronic information about national, state and local injury prevention programs, funding opportunities, available trainings, data, injury prevention news, and resources to the variety of public and private providers involved in injury, suicide and violence prevention in Virginia; public and provider awareness campaigns and educational workshops; and statewide information resource dissemination to and through medical, school and community provider groups, and a toll free hotline to answer questions about the child safety seat law and low income safety seat program.

The majority of funding for this service area comes from federal grants, including those from:
• Substance Abuse and Mental Health Services Administration (categorical funding)
• Centers for Disease Control and Prevention (categorical funding)
• Federal Highway Safety (categorical funding)
• Preventive Health and Human Services block grant
• Maternal and Child Health block grant

This service area administers the U. S. Department of Agriculture’s (USDA) Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Child and Adult Care Food Program (CACFP) and Summer Food Service program (SFSP) to eligible residents of the Commonwealth. This service area is administered by the Virginia Department of Health's (VDH) Division Community Nutrition. In addition, the service area supports public health community nutrition throughout the Commonwealth.



The Virginia WIC Program serves women who are breastfeeding, pregnant or have just given birth; infants less than one year-old and children less than five years-old. WIC participants must be Virginia residents and meet the financial and nutritional requirements set forth by regulations. Financial eligibility is defined as income below 185% of the federal poverty level while nutritional eligibility is defined by risk factors such as a medical conditions or an unhealthy diet. Mothers, fathers and legal guardians may apply for WIC benefits on behalf of the children in their care.



The purpose of the program is to assure healthy diets during pregnancy and breast-feeding, infancy and early childhood to age five for eligible families who might otherwise not be able to afford proper nutrition. The provision of education for mothers and/or primary care-givers about healthy eating is coupled with benefits to purchase a defined package of high nutrient foods at community groceries. Increasing attention is being paid to educating families about ways to avoid the risks of childhood obesity while assuring proper nutrition. Breastfeeding is promoted while regular and specially prescribed formulas are provided for infants who are not breastfed.



The Virginia CACFP plays a vital role in improving the quality of day care and making it more affordable for many families by providing nutritious meals and snacks to eligible children and adults enrolled at participating child care centers, family day care homes, at-risk afterschool centers, adult day care homes, and emergency shelters.

The SFSP was established to provide meals and snacks to children during the summer when the School Breakfast Program and National School Lunch Program are not available. Meals and snacks that meet Federal nutrition guidelines are provided free to children who attend approved SFSP meal sites; these sites are located in areas with significant concentrations of poverty. Virginia’s SFSP operates in locations such as schools, public housing centers, playgrounds, camps, parks and churches. 

This service area directly aligns with VDH’s mission to promote and protect the health of all Virginians by providing better nutrition and access to health care to Virginians participating in WIC, the CACFP and the SFSP. The service area further supports the agency mission through its leadership in the Commonwealth’s effort to prevent obesity and childhood hunger through the provision of educational materials relative to community nutrition and collaboration with public and private stakeholders.

Describe the Statutory Authority of this Service

The Special Supplemental Nutrition Program for Women, Infants and children (WIC) was authorized as part of the Child Nutrition Act of 1966, Section 17 [42 U.S.C. 1786] to provide supplemental foods and nutrition education to pregnant, postpartum and breastfeeding women, infants and young children from families with inadequate income.

WIC Regulations are published in the Code of Federal Regulations, 7 C.F.R. Part 246 – Special Supplemental Nutrition Program for Women, Infants and Children and the Virginia Administrative Code, 12 VAC 5-195.

Code of Virginia § 32.1-351.2 establishes the Children’s Health Insurance Program Advisory Committee. WIC eligibility is incorporated into the Committee’s work, as the Department of Medical Assistance Services is required to enter into agreements with the Department of Education and VDH to identify children who are eligible for free or reduced school lunches or WIC in order to expedite the eligibility for FAMIS.

Code of Virginia § 32.1-77 authorizes the development and submission of state plans for maternal and child health and children with special health care needs to the federal government and authorizes the state health commissioner to administer and expend federal Title V funds. The Title V Grant is listed in Title 42 of United States Code §§ 701-710, subchapter V, chapter 7.

The Preventive Health and Health Services Block Grant (PHHSBG) is listed in Chapter 42 of the United States Code, Chapter 6A, Sections 1901-1907 and 1910A.

WIC Program - WIC provides Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, to infants less than one year old and children less than five years old who are found to be at nutritional risk. WIC is operated through local health districts in Virginia. WIC provides high-quality nutritional care and food to eligible participants. In addition to access to healthy foods, WIC also provides nutrition education, healthy recipes, private and group sessions with a nutrition expert, free nutrition checkups, support and help with breastfeeding and referrals to other community services.

WIC Grant Administration - Federal funds are awarded to each state through a complex formula utilizing food package cost and past program participation. Maximizing the amount awarded to Virginia, as well as assuring the state pays no penalties, requires constant monitoring. Inflation in food costs can reduce the number of clients the grant will support during the year, requiring administrative action. Likewise, local agency failure to provide services to the anticipated number of clients can cause the state to under-spend their food grant resulting in penalty. In order to reduce overall food costs, and as required by federal regulations, Virginia contracts for a single brand of infant formula. This relationship adds $25 million to the federal grant but requires significant administrative management, reporting and billing. USDA requires the state to obtain prior approval for many actions, and significant routine reporting as well. In order to assure maximum utilization of the grant by participants, the service area manages a comprehensive marketing effort throughout the state. To facilitate local agency client services as well as collect all needed data, a central automated system is developed and managed for the entire state.

WIC Nutrition Education - Nutrition education is a core service provided by the WIC Program. Local agencies must make nutrition education available to all participants at no cost. Nutrition education is designed to meet the two basic goals of teaching participants the relationship between proper nutrition and good health, and assisting participants in making positive changes in their food habits. Methods of nutrition education include individual and group counseling as well as web-based and multi-media educational opportunities. These services are also coordinated and integrated with other clinics and services. Virginia WIC local agencies are required to make obesity prevention a major goal for WIC services each year.

WIC Retail Store Management - The Division of Community Nutrition recruits, trains, authorizes and monitors more than 800 retail stores which provide food and formula benefits to eligible participants. Authorized stores consist of small, independent businesses, military commissaries, and multi-state grocery chain stores. Authorized stores are selected based upon objective factors such as store location, variety of foods sold and prices charged to the WIC Program. Individual store’s level of program compliance is monitored using both overt, onsite visits, as well as “covert” undercover compliance investigations. All stores are required to carry a minimal stock of WIC approved foods and demonstrate cost control. Stores documented to be non-compliant with state and federal WIC Program requirements can face substantial financial penalties, e.g., up to $40,000 fine.

Local Agency Management Oversight - The Division of Community Nutrition is responsible for the development, implementation, and management of an ongoing monitoring and evaluation system of local health departments and has developed the Local Agency Management Evaluations (LAME) automated process for this service. The LAME process provides a mechanism to monitor local agency operations, review financial and participation reports and require corrective action plans to resolve deficiencies as needed. Operations subject to evaluation include, but are not limited to, management, referrals, outreach, participation, eligibility, certification, time and effort reporting, civil rights compliance, accountability, financial management systems and food delivery systems. On-site evaluations of local agencies are performed every two years; the local agency performs a self-evaluation during the years in which an on-site evaluation is not conducted. The Division also works in conjunction with the USDA to complete State Technical Assistance Reviews (STAR). STAR reviews are conducted by the USDA and assist the Division in performing quality assurance tests. STAR reviews routinely consist of: Caseload and Food Funds Management; Certification and Eligibility; Civil Rights; Food Delivery Systems & Food Instrument Accountability; and Post Implementation and Monitoring - Audit. The State WIC Office enters into a Memorandum of Agreement (MOA) with each local agency upon receipt and approval of that local agency’s WIC Services Plan (WSP). The WSP is another method by which the State WIC Office helps to ensure that the local agencies are in-line with both State and Federal goals.

Child and Adult Care Food Program – The CACFP provides nutritious meals and snacks to eligible children and adults who are enrolled for care at participating child care centers, day care homes, after-school care programs, emergency shelters and adult day care centers. Independent centers and sponsoring organizations receive cash reimbursement for serving meals to enrolled children and adults that meet Federal nutritional guidelines. The CACFP meal pattern varies according to age and types of meal served. In addition to cash reimbursement, USDA makes donated agricultural commodities or cash-in-lieu of commodities available to institutions participating in the CACFP.

CACFP and SFSP Program Administration – This service area is responsible for the following: Training and Technical Assistance: Division staff provides training and technical assistance to CACFP and SFSP providers through telephone and written correspondence, and on-site visits. To meet federal requirements, the Division provides training and review for newly approved CACFP institutions as well as annual training for institutions currently participating in the program. SFSP training is also done on an annual basis through six regional sessions required for new sponsor organizations, new SFSP managers of returning sponsors, and any other sponsor who may be in need of remedial training. All areas of program administration and operations are covered during these training sessions including meal service; site management; program payments; recordkeeping; monitoring site operations; and marketing.

Program Monitoring: This service area performs the required monitoring of program sponsors and institutions to ensure compliance with program regulations. Division staff conducts the initial review, performs follow-up visits, and provides technical assistance and second reviews when necessary. Chapter 7 of the Code of Federal regulations requires reviews of all sponsors every 3 years and 10% of their sites receive a review as well. Approximately 150 reviews will be conducted for CACFP in FFY 2015. SFSP reviews in FFY 2015 will include approximately 80 sponsors and 120 sites.

 Claiming: The Division utilizes an online claims processing system, which processes provider’s claims though the VDH financial and accounting system, conducts required edits, and makes an electronic payment through the Virginia Department of Accounts. The online claims processing system generates the reports to compare with VDH financial and accounting system for completion of required federal reports. This system was transferred to VDH from USDA. The system is outdated and will need to be replaced .The RFP for the new payment system is in the final review stage and will be put out for bid by the end of 2014

Policy Development and Implementation: As the State administrators of the CACFP and the SFSP, this service area is developing policies, procedures, and process plans for effective program administration. The USDA released Program Handbooks in 2013 for State agencies and sponsors to be used as guidance when operating the Programs.

Statistical Analysis/Data Management - This service area provides data-related support for all products and services, delivers participation and financial data to USDA and disseminates various program reports to the central office and local WIC agencies. Tabular reports, charts and maps are needed for the central office on an on-going basis to support outreach efforts, local agency and retailer monitoring and local agency performance measuring. Program data is collected and analyzed using a variety of established research methods, procedures, statistical formulas and techniques. Trends are identified and projections are developed for financial and participation data in order to report program expenditures and participation projections to USDA.

WIC Training Program - This service area provides a variety of both mandatory and voluntary training opportunities to Virginia WIC employees including: WIC Nutrition 101 – an introductory course regarding the purpose and goals of the WIC Program; Civil Rights Training – to train WIC Program staff with all applicable Civil Rights requirements and provide an understanding of pertinent, proper procedures; Racial/Ethnic Data Collection Training – to inform the user of the purpose for collecting racial and ethnic information of enrolled WIC participants, as well as the proper procedures for doing so; Vendor Training- to ensure retail vendors are aware of all WIC policies and regulations

Breastfeeding Promotion: This service area promotes breastfeeding as the preferred infant feeding method by creating a positive health care setting environment, providing information on the health benefits of breastfeeding and supporting breastfeeding women. The goals of this program are to improve infant and family health by making breastfeeding the cultural norm and to increase the rates of breastfeeding initiation and duration among the general public and WIC participants. In addition, breastfeeding has been shown to have an effect of preventing obesity for children who are breastfed. Goals are accomplished through efforts such as the Electric Breast Pump Loan Program and the Statewide Breastfeeding Advisory Committee of Virginia. The WIC Breastfeeding Peer Counselor Program also supports breastfeeding by providing counseling from peers to WIC participants. This project receives special funding from USDA through a separate grant.

Virginia /Maryland WIC Dietetic Internship Program: This program provides an educational opportunity for WIC nutritionists seeking the Registered Dietitian credential in Virginia and Maryland. The program provides a broad based, entry level supervised experience based on Commission for Accreditation for Dietetics Education core competencies with a community emphasis.

The primary source of funding for the Division of WIC and Community Nutrition Services is provided by Federal grants from the United States Department of Agriculture. The Division works closely with the USDA throughout the year, providing the agency with monthly financial reports, mid-year and year-end reports.

This service area provides a range of oral health services for the community including education, prevention, screening, diagnosis and treatment. The focus is primarily on the provision of quality services to the indigent population and other special population groups, especially children who, for various reasons, lack access to basic oral health care. In addition, the service area recruits volunteers or staff to administer the fluoride mouth rinse programs in schools where lack of fluoridated water places children at higher risk of dental caries. The service area also monitors the oral health status of the community using standard measures of need, including evaluation of demographic data, availability of fluoridated water supplies and supplemental fluoride programs, prevalence of dental disease both past and present, appropriate utilization of dental sealants, and availability and accessibility of dental education, prevention, screening, diagnostic and treatment services.

This service area directly aligns with the Virginia Department of Health mission to promote and protect the health of all Virginians by educating the public about oral health and oral disease and improving oral health through population and individual dental services.

Describe the Statutory Authority of this Service

Section 32.1-2 of the Code of Virginia requires the Virginia Department of Health to 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.

Section 32.1-11 of the Code of Virginia authorizes the Virginia Department of Health to formulate a program of environmental health services, laboratory services and preventive, curative and restorative medical care services, including home and clinic health services described in Titles V, XVIII and XIX of the United States Social Security Act and amendments thereto, to be provided by the Department on a regional, district or local basis.

Preventive dental services, including sealants, fluoride application, prophy, etc.in selected localities.

Fluoride mouth rinse programs administered to populations of children with no access to fluoridated water in targeted areas only

Funding for local dental services is shared by the state and local governments based on an ability-to-pay measure. Local government matching contributions range from a low of 20% to a maximum of 45%.

This service area assures that residents of and visitors to the Commonwealth are protected from disease-causing factors in the environment. This mission is accomplished by maintaining surveillance of the environment, educating the public, responding to enquiries from health and environmental professionals, and enforcing regulations pertaining to food, hotels, summer camps, campgrounds, migrant labor camps, swimming pools, private wells, onsite sewage disposal, and other environmental health laws.

Products and services include providing technical assistance to the general public , to health and environmental professionals and to local governmental agencies;  providing training to food handlers, responding to Freedom of Information Act (FOIA) requests and otherwise providing information to stakeholders, including the general public; and maintaining of records; permitting and inspecting restaurants, swimming pools, hotels, campgrounds, summer camps, milk plants, migrant labor camps, private wells and onsite sewage disposal systems; responding to complaints and inquiries about general environmental hazards; and responding to potential exposures of humans and domestic animals to rabies.

This service area directly aligns with VDH’s mission of protecting the health and promoting the wellbeing of all Virginians by reducing environmental and communicable disease hazards.

Describe the Statutory Authority of this Service

Va Code § 3.2-5200 et seq. establishes the State Health Commissioner’s authority to implement and enforce regulations adopted by the Board of Agriculture and Consumer Services pertaining to  inspections and permitting of plants that process and distribute Grade A market milk and Grade A market milk products.

Va Code § 3.2-6522 establishes requirements for notifying VDH of any animal suspected to have rabies or that may have exposed a person to rabies and for the Health

Department to approve of confinement facilities, to confine suspected animals and to test suspected animals for rabies.

Title 32.1, Chapter 6 establishes requirements for inspections and permitting of private wells, onsite sewage systems (septic systems), alternative onsite sewage systems, alternative discharging sewage systems, migrant labor camps, and marinas and for regulations pertaining to the posting of swimming pool water quality.  This chapter also authorizes the Health Department to administer the Onsite Sewage Indemnification Fund, the Onsite Operation and Maintenance Fund, and the Environmental Health Education and Training Fund.

Va Code §32.1-11.7 requires VDH to develop guidelines for cleanup of methamphetamine laboratories and procedures for certifying cleanup

Title 35.1 of the Code of Virginia establishes requirements for inspections and permitting of food establishments (restaurants), hotels, bed and breakfast establishments, summer camps, campgrounds, tourist establishment pools, and state institutions.

Inspection and enforcement.  Thorough and consistent inspection and enforcement of laws and regulations address structural design and operational practices for food facilities, swimming pools, milk plants, hotels, summer camps, campgrounds, migrant labor camps, private wells, and onsite sewage disposal systems. The goal of inspection and enforcement is to protect the public from injury and disease by significantly reducing the environmental risk that can arise from health hazards associated with permitted facilities.

Permitting:  The permitting and plan review services ensure the facility meets all applicable health codes. The issuing of permits is based on well-established health, safety, and environmental considerations intended to protect the public from health and safety hazards.

Rabies prevention:  The goal of this service is to prevent any human death due to rabies. Although immunizations can be given to prevent the disease even after exposure to rabies, post-exposure immunization is costly, and treatment must begin relatively quickly once an exposure is recognized.  Therefore, VDH has an extensive program to investigate all cases in which persons are bitten by any animal in order to determine the need for post-exposure treatment.  Local health departments also investigate incidents in which domestic animals are potentially exposed to rabies by a wild animal, since this increases the risk of exposure to humans.  Local health departments also working with veterinarians and local animal control officers to educate the public about how to rabies prevention and to encourage the routine vaccination of cats and dogs.

Respond to individual complaints.  This service involves responding to individual complaints concerning environmental health issues in a timely and customer focused manner. Where a violation is confirmed to exist, this service involves initiating and carrying out the administrative processes established to bring about compliance with all health codes.

Provide customer service.  Good customer service is implicit in all our relationships, whether information sharing, Freedom of Information Act requests, inspections or enforcement actions. Our goal is to be honest, professional courteous, responsive, open, timely, flexible, credible, and accurate. Providing outstanding customer service is one of the best ways we can fulfill our mission to protect human health.

The chief source of funding for Environmental Health Services is from the General Fund, local matching funds, and revenue from environmental health permitting fees. Some districts receive funds from various federal nongeneral funds, state and local grant programs.

Local family planning services provide primary and secondary prevention, as well as health promotion, diagnosis and treatment. Family planning counseling is an example of primary prevention. The counseling involves specific intervention to protect against an unintended pregnancy or to plan for a future pregnancy. This voluntary program is offered to men and women in the Commonwealth, regardless of financial status, a means to exercise personal choice in determining the number and spacing of their children. Secondary prevention such as cervical cancer screening or chlamydia screening promotes early case finding for cervical cancer and infertility. Health promotion activities such as nutrition counseling, smoking cessation, and behavioral risk reduction counseling all focus on activities that increase a person’s overall level of health and health awareness. Family planning services assist individuals in preventing sexually transmitted infections and play a major role in the early detection of breast and cervical cancer. Local family planning services also include:

• Promotion of abstinence education and family involvement messages to minors seeking services,


• Provision of acceptable and effective methods of contraception,


• Pre-conception counseling,


• Provision of multivitamins with folic acid to women of childbearing age, and


• Improved access to family planning services through assistance in applying for Plan First, a Medicaid insurance program for coverage of contraceptive methods.

This service area is directly aligned with the mission of the Virginia Department of Health to promote and protect the health of Virginians by providing primary and secondary prevention, health promotion, diagnosis and treatment. Family planning allows sexually active persons the option of postponing children until they are financially, emotionally and physically able to bear the responsibilities of parenthood. Promoting abstinence is the only sure way of preventing unwanted pregnancies and sexually transmitted infections among those not married. Prevention of teen pregnancy helps teens to meet education and career goals prior to childbearing, increasing their potential to become independent contributing citizens of Virginia. The development of sexual responsibility encourages healthy attitudes towards marriage and family.

Describe the Statutory Authority of this Service

Code of Virginia § 32.1-2 requires the Virginia Department of Health to administer a comprehensive program of preventive, curative, restorative and environmental health services, including prevention and education activities focused on women’s health.

Code of Virginia Section 32.1-11 authorizes the Board of Health to formulate a program of environmental health services, laboratory services and preventive, curative and restorative medical care service, including home and clinic health services.

Title X of the Public Health Service Act, 42 U.S.C. 300, et, seq Public Law 91-572, Section 1001.

Title X (42 CFR Part 59, Subpart A) – Regulations governing Title X set out the requirements of the Secretary of Health and Human Services, for the provision of family planning services funded under Title X and implement the statute as authorized under Section 1001 of the Public Health service Act.

Federal Title X funding for family planning agencies originates from the Family Planning Services and Population Research Act of 1970, P.L. 91-572. This law was amended in 1975 and 1978 to require Title X projects to  provide access to natural family planning, infertility, and adolescent services. These amendments require that economic status not be a deterrent to receiving family planning services.

Service Evaluation: Determine customer satisfaction through annual survey. Maintain contact with area professionals to communicate and receive feedback of effectiveness of services being provided. Monitor changes in demographics so the proper numbers of trained staff are available to serve customers. Recognize shifts in customers who do not speak English so bilingual staff or volunteers are available



Two kinds of prevention services are provided: primary, which includes health promotion, and secondary. Prevention products and services are provided primarily through education and screening. Primary Prevention and Health Promotion includes the following: counseling involving specific intervention to protect against an unintended pregnancy, or to plan for a future pregnancy, and sexual risk reduction. Abstinence is promoted in teens and unmarried individuals. Current standard and acceptable contraception methods provided; barrier methods, male & female condoms, vaginal foam, hormonal based methods. Risk reduction counseling includes limiting the number of sexual partners and safer sex practices. Nutrition counseling, folic acid supplements, and fluoride supplements are provided if appropriate. In addition, clients are counseled, or referred for smoking cessation classes, drug / alcohol / addiction referrals to Mental Health. Patients are also referred for dental care and Immunizations. Pregnancy testing and management of early prenatal care with referral to Social Services for Medicaid eligibility (Plan First). Refer pregnant women for prenatal care and delivery with a health care provider, preconception counseling and testing, Infertility counseling and referrals. Secondary Prevention-These screenings promote early case finding of blood pressure, breast & cervical cancer and infertility. This would include, but not be limited to, breast diseases including cancer, cervical cancer screening, Chlamydia and other sexual transmitted disease screening, blood pressure checks and referral.



Community Involvement: Information dissemination on populations being served. Outreach efforts to at risk populations and the community at large Partnerships, collaborations, and coalition building with community agencies/providers/programs both internal and external.

Local health department family planning services are funded by a variety of sources. The major source of funding is through the Cooperative Budget including both state and local matching funds. The service area receives state funds for the purchase of contraceptives and cervical cancer screening services. The service area also receives federal Title X funds to supplement family planning services in the local health departments.

This service area provides leadership, programmatic direction, and management of all resources for local health departments (LHDs) operations. LHDs are organized into districts to achieve management efficiencies and comprise between one and ten political subdivisions. This service area includes the strategic business functions such as budgeting, accounting, procurement, human resources and internal business function controls. Management personnel determines resource allocation decisions among political subdivisions based on community need, available local matching funds, and estimates of earned revenue. Resources include local health department staff, community partners, funding, equipment, supplies, office and service specific location space, and vehicles. Support encompasses ongoing assessment and evaluation to assure that services and programs of local health departments continue to match local community needs. Sound management and close oversight ensure that expenditures for essential local public health services remain at the lowest efficient cost level possible; and that programs are effective in attaining required goals and comply with all applicable federal, state, and local laws, regulations, and policies.

 Local health departments operate under two models. The vast majority of cities and counties contract with the Virginia Department of Health (VDH) for   the services provided. Two local governments (Arlington and Fairfax counties) sought and obtained legislative approval to administer LHDs as a unit of local government. Locally administered health departments must comply with the same programmatic requirements, policies, regulations, and laws   as other LHDs.

This service area aligns with the Virginia Department of Health’s mission to promote and protect the health of Virginians by providing a strong foundation of local leadership, business support, and overall management for local health departments.

Describe the Statutory Authority of this Service

Code of Virginia § 32.1-30 requires every city and county to establish and maintain a local health department in each county and city.

Code of Virginia § 32.1-11 (B) provides that persons deemed to be medically indigent shall receive the medical care services of the Department without charge.

Code of Virginia § 32.1-31 establishes operation of local health departments

In addition to these specific citations, LHDs must comply with all federal and state human resource, procurement and general services -specific statutes and Executive Orders issued by the Governor.

Budgeting and planning for use of locally available fiscal and human resources.



Management of district revenue, funds, staff, supplies, procurement, equipment, facilities and properties.



Prioritization of the use of resources in such a manner as to enable the mandated provision of care to the indigent without charge.



Appropriate stewardship of funds and other resources allocated to local health departments.



Provision of service to customers that assures compliance with all applicable federal, state and local requirements.



Staff recruitment, training, and personnel management.



Community assessment.



Assure there are adequate facilities to deliver services that are accessible to all Virginians.

Funding for local health departments is shared by the State and local governments based on an ability-to-pay measure developed by JLARC and last updated in 1988. Local government matching contributions range from a low of 20% to a maximum of 45%. The ‘cooperative health department budget’ arrangement was established by the General Assembly in 1954. Revenue earned by local health departments for patient care, permits, and issuance of death certificates also supports the operation of LHDs. Finally, this service area is responsible for managing federal grant funds that may be allocated to LHDs by statewide program offices through memoranda of understanding.

Maternal and Child Health at the local level provides essential public health service functions which are necessary to protect and improve the health of pregnant women, infants, children and adolescents in a healthy environment, whether that is the family, an external setting such as daycare, or the broader community. Maternal and child health services include assuring provision of direct or facilitative care services, assuring provider and parent capabilities, and mobilizing community partnerships in identifying and achieving solutions. Services include:

• Assure pregnancy identification, and prenatal care, follow up and referral services through postpartum care;


• Provide case coordination and/or case management services in order to increase the ability of the client to meet prenatal care guidelines, understand and practice healthy behaviors prior to and during pregnancy, and achieve healthy pregnancy outcomes;


• Mobilize groups, coalitions and systems within the community that promote and assure services (families, providers, voluntary, corporate or other organizations);


• Facilitate health insurance enrollment for children and families;


• Provide safety net ambulatory care for sick and well children in coordination with community health care resources;


• Screen and identify early intervention for physical and developmental conditions that affect health and learning readiness, and health problems related to environmental factors, such as lead and asthma;


• Provide infant and child case management services, developmental assessment, anticipatory guidance and injury prevention;


• Promote provider education on public health principles, practices, and professional care standards as they affect health outcomes; and


• Assure care of children with health needs in group settings such as day care, preschool and school, including identification of individual and group health and safety needs.

This service area aligns with the Virginia Department of Health mission to promote and protect the health of Virginians through strategies designed for reduction of risk factors, and increase in prevention, support and care contributing to the reduction of morbidity and mortality. The status of maternal and child health is affected by community behavioral norms, access to state of the art care, culture and language competencies, and access to family and community support systems. Service strategies at the local level are key for improvement of state health status indicators and outcomes.

Describe the Statutory Authority of this Service

Sections 32.1-30, 32.1-31, and 32.1-32 of the Code of Virginia require each county and city to establish and maintain a local department of health.

Section 32.1-77 provides for Virginia’s Title V plan for maternal and child health services and services for children with special health care needs.

Section 32.1-11 provides that 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 by persons who are not indigent and a scale of charges based on ability to pay.

Section 22.1-270 provides for preschool physical examinations for medically indigent children without charge.

Section 22.1-274 authorizes local health departments to provide personnel for health services for the local school division.

Section 32.1-78 requires a report to the Superintendent of Public Instruction or appropriate school division the identity of and pertinent information about children with health problems or handicapping conditions.

Sections 32.1-46.1 and 46.2 establishes a protocol for the identification of children at risk for elevated blood lead levels.

Cooperative agreement with Department of Medical Assistance Services for Developmental Disability Waiver Eligibility Determinations.

Sections 46.2-1095 and 46.2-1097 provide requirements for child motor vehicle restraints; VDH is required to operate a program to promote, purchase and distribute child restraint devices to applicants who need a child restraint device but are unable to acquire one because of financial inability.

Section 2.2-5204 provides for health department participation in the local teams under the Comprehensive Services Act.

Section 2.2-5305 provides for health department participation on Part C of Individuals with Disabilities

Local health departments vary in methods and capacity of service delivery, but all either provide these services or assure they are available:

Screenings for physical and developmental conditions that affect health and learning readiness, including the care of children with special health needs in the primary care settings.

Home visiting to provide parental education and technical assistance, including use of specific assessments of environment and child interaction to guide parents.

Home assessments and other assessments, including collaboration with environmental health, code enforcement, social services, community services boards, police and fire for unusual circumstances.

Community maternal and child health needs assessments of overall or specific service gaps; assessment of practice and referral patterns; assessment of community use of protocols, such as asthma management.

Providing linkage of need and service actions within the community to increase understanding of healthy behaviors, to monitor health status, and to mobilize groups, coalitions and systems within the community that promote and assure services (families, providers, voluntary, corporate or other organizations).

Providing public information concerning maternal and child health risks and responses, including general child growth and development, hand washing, sanitation, infection control, animal safety, substance avoidance, and signs of premature labor.

Assuring or providing pregnancy identification and referral; prenatal and post partum care consistent with the Virginia Department of Health Prenatal Care Guidelines include prenatal care directly and/or through case coordination and/or case management services. Services such as family planning, immunization, and chronic disease prevention are addressed in separate service areas, although they share a continuum of care prior to and following pregnancy which will affect birth outcomes.

Assuring services which are integral to care, such as culture and language competencies and including interpretative services.

Assuring, identifying, and accessing health care, health care plan enrollment, as well as safety net functions of direct child health care, ambulatory care for sick, and provision of well-child care consistent with Early Periodic Screening Diagnosis and Treatment and Bright Futures, sick child care, reporting of child abuse and neglect, and providing childhood immunizations as part of care.

Care coordination and case management through field public health nursing, or named programs such as Healthy Start, Resource Mothers, Healthy Families, and Child Health Investment Program of Virginia.

Participating in provider education concerning the health of the child in group settings such as child care, preschool and school, including identification of individual and group health and safety needs.

Promoting fatherhood initiatives.

Provision of child health specialist consultation and education for out of home child care.

Assessment for eligibility for programs: financial and programmatic. Facilitation of enrollment in Family Access to Medical Insurance Security Plan and Family Access to Medical Insurance Security Plus.

Provision of, or coordination with, school health nursing: Assessment and assurance of health care status and development of healthcare plans for school aged children; skilled nursing care; care of minor injuries and major events prior to transport; review of safety, environmental health related issues; surveillance for communicable disease.

Provision of child safety motor vehicle restraint education and placement for low income infants and children.

Coordination with child nutrition education, including support for Women, Infant and Children and food safety.

Coordination with dental health education, services, and referral.

Addressing improvement to healthy community norms through awareness, education, and behavior changes in groups of interest. Presentation of assessments and district strategic health plans to groups, including jurisdictional policy groups. Participation on School Health Advisory Boards, Part C of the Individuals with Disabilities Education Act, Comprehensive Services Act teams, and community child health coalitions.

Surveillance for childhood health conditions such as blood lead screenings, screening for growth parameters, screening for nutrition and obesity, screening for vision, hearing, immunization status.

The general fund increase of $1,332,385 and nongeneral fund increase of $1,559,882 in “change to base” is part of a technical amendment. The amendment transferred appropriation among Community Health Services’ service areas to reflect spending patterns and to facilitate the elimination of the Local Laboratory and Pharmacy Services’ service area. The elimination of the service area was prompted by the transfer of the primary functions to the central pharmacy during the 2010 Session of the General Assembly. While this amount is reflected as an increase of $4,286,133 in the department’s general fund and $3,777,659 nongeneral fund “change to base”, it is actually a net-sum-zero fund transfer - Technical Amendment. 

Local health departments have statutory responsibility to maintain and operate effective immunization programs which provide vaccines to the public with an emphasis on the vaccine-preventable diseases of childhood such as chicken pox, diphtheria, pertusses, tetanus, haemophilus influenza, hepatitis A and B, measles, mumps, rubella, polio, pneumonia, influenza and rotovirus. Additional targeted groups for the provision of influenza vaccine are the very young, those with certain environmental or medically high risk conditions, and the elderly who are also targeted for bacterial pneumonia vaccination. Local health departments maintain an inventory or assure access to rabies vaccine and biologicals for administration to those individuals exposed to wild or domestic animals when rabies disease is suspected or proven in the animal. Local health departments participate in and implement on an as-needed basis emergency preparedness measures such as the novel 2009 influenza vaccination program. All local health departments develop and maintain mass vaccination plans in accordance with state and federal emergency preparedness guidelines. Many local departments offer meningitis vaccinations for beginning students at higher education institutions. Many local health departments provide immunizations required or recommended for foreign travel.

This service area directly aligns with the Virginia Department of Health’s mission of promoting and protecting the health of Virginians by preventing and controlling the spread or occurrence of vaccine-preventable disease in the community.

Describe the Statutory Authority of this Service

Section 32.1-2 authorizes the State Board of Health, the State Health Commissioner and the State Department of Health to administer a program of preventive, curative, restorative, and environmental health services.

Section 32.1-46 provides for the immunization of children against certain diseases in accordance with regulations established by the Board of Health and the implementation of a statewide immunization registry.

Section 23-7.5 requires full time students enrolling in public institutions of higher education to be immunized against certain diseases in accordance with the recommendations of the American College.

Vaccine Supply; An inventory of viable vaccine is maintained and properly stored in each Local Health Department to meet current and future community needs.



Local Policy Implementation; Implement and interpret statewide policy on vaccine-preventable diseases in accordance with the joint recommendations of the Centers for Disease Control Advisory Committee on Immunization Practices, the American Academy of Pediatrics and Academy of Family Physicians.



Community Assessment; On a regular basis, Local Health Department communities are assessed for adequacy of vaccination coverage for both mandated and voluntary immunization and appropriate action plans are developed and implemented to address changes needed.



Vaccine Promotion; Promote the individual and community health benefits of vaccination through regular issuance of local press releases, radio and television public service announcements, and other assorted media contacts.



Clinic Logistics; Set hours of operation, numbers and locations of clinics, staffing patterns, patient flow to assure appropriate response to community need. Assess need for non-routine clinic hours at times or seasons of peak demand, conditions of shortage, or emergency requirements.



Grants Participation and Reporting; Locally manage grant resources received from state, federal, or other sources, including application, implementation, fiscal and operational reporting, local evaluation, and audit participation and response.



Quality Assurance; Participate and cooperate with state officials during annual quality assurance reviews conducted in all local health department sites to ensure compliance with State and Federal program guidelines, including the Vaccines for Children Program.



Adverse Event Reporting; Participate with the federal vaccine adverse event reporting system.



Immunization Registry; Implementation of the statewide immunization registry as required by state law.



Technical Assistance; Provide vaccine preventable disease related technical assistance to local private health care providers. Maintain the local Pandemic Influenza Emergency Response plan. With assistance from state Immunization program staff, investigate suspected cases of vaccine-preventable diseases. Provide follow-up of cases of perinatal hepatitis B.



Education and Training; Ensure local availability of Centers for Disease Control and Prevention and other vaccine preventable disease training courses to public and private health care providers. Distribute patient and provider educational material. Facilitate local computer-based assessment training for pertinent health department staff.

The Local Immunization Services area is supported by federal, state and local government funds. Federal funds are received through a categorical, cooperative agreement from the Centers of Disease Control and Prevention (CDC). Federal funds are intended to supplement rather than supplant state and local dollars.

 

The local health departments' Communicable Disease Prevention, Investigation, Treatment and Control services work with partners to prevent, detect, assess, respond, treat and control communicable diseases, emerging infections and terrorism related illnesses. These activities are performed in accordance with guidance, policies and procedures of Virginia Department of Health’s Surveillance and Investigation, Immunization, Sexually Transmitted Disease, HIV/AIDS, Tuberculosis, and Newcomer Health programs.



Local Health Department Communicable Disease Services include:

Disease prevention services, Disease surveillance to detect the occurrence of disease as quickly as possible,

Consultation and technical assistance to health care providers, schools and institutions, Media relations, press releases and education material, Development of disease-specific emergency response plans,

Health screenings for refugees, Disease record management, Outbreaks and individual disease investigations,

Disease exposure notification and counseling services, Monitoring for and responding to emerging infections and terrorism-related illnesses, Clinical diagnoses and treatment of communicable diseases (including STD, HIV/AIDS and Tuberculosis), Medical treatment case management, and Assist providers in reporting vaccine adverse events.

These services directly align with the mission of the Virginia Department of Health to promote and protect the health of Virginians by preventing the spread of communicable diseases. By collaborating with community partners and coordinating services with the Virginia Department of Health, local health departments directly provide prevention marketing and disease intervention through appropriate use of therapeutic and regulatory strategies.

Describe the Statutory Authority of this Service

Chapter 2 of Title 32.1 of the Code of Virginia pertains to the reporting and control of diseases.

Articles 1 through 3.1 of that Chapter define the authority for this particular Service Area and include reporting of disease, investigation of disease, disease control measures, isolation of persons with communicable diseases, and control of rabies.

§ 32.1-36 of the Code of Virginia and 12 VAC 5-90-80 and 12 VAC 5-90-90 of the Board of Health Regulations for Disease Reporting and Control mandate reporting of specific diseases.

§ 32.1-37.2 requires that partner notification services (partner counseling and referral services) be offered to individuals who test positive for HIV.

§ 32.1-39 provides for STD surveillance, investigation of reports, and conducting counseling and contact tracing (partner notification).

§ 32.1-46 provides for the immunization of children against certain diseases in accordance with regulations established by the Board of Health and the implementation of a statewide immunization registry.

Title 23, Chapter 1, §23-7.5 requires full time students enrolling in public institutions to be immunized against certain diseases in accordance with the recommendations of the American College Health Association.

§ 32.1-57 through 32.1-60 requires Sexually Transmitted Disease examination, testing, and treatment.

Prevention Services Risk reduction counseling Education Health alerts Partner notification Surveillance: Receiving reports from physicians, hospitals, and laboratories about people diagnosed with a disease of public health importance; Monitoring the occurrence of disease in animals and environmental contamination that could potentially lead to illness in humans; Screening at-risk populations for disease Tracking trends in daily utilization of medical care by reviewing data from emergency departments, provider insurance claims, and pharmaceutical sales to detect unusual occurrences of illness; Compiling statistics to identify trends and patterns of disease in populations to detect outbreaks or other disease events. Confirm disease report meets case definition of diagnosis Consultation and technical assistance. Work closely with health care providers to effectively manage their patients. Advise local and state governments regarding policies and regulations that can interrupt the spread of disease. Recommend procedures and policies to hospitals and residential care facilities, including prisons and jails, to prevent the spread of communicable diseases. Conduct training for care providers on disease identification, treatment and management. Monitor and assist day care, schools and colleges with disease prevention and outbreak response. Assist employers in preventing communicable diseases from entering the workplace. Media relations, press releases and education material to inform the public about the diseases we track. Diagnosis and Treatment Diagnostic and laboratory support Disease treatment Prophylaxis of exposed contacts and treatment of infected individuals Treatment case management, including Directly Observed Therapy for Tuberculosis B patients Immunizations to exposed or at-risk persons Pharmaceutical services for treating communicable diseases in outbreak situations. Disease exposure notification services (patient counseling, interviewing, contact notification and partner referral) Disease-specific emergency response plans. Enhanced surveillance methods will help identify and respond to behavioral and co-morbidity indicators of disease transmission. Monitoring and issuing advisories for environmental exposures, such as marine beach waters. Informational notices to local health departments and other medical care partners about new diseases occurring that have the potential to affect the health of our residents. (This has occurred with Sudden Acute Respiratory Syndrome, monkeypox, and anthrax, for example). Outbreak response teams. Collaborations with community-based organizations to educate populations, identify infected person and refer to appropriate care providers.

The primary sources of funding for Local Communicable Disease Prevention, Investigation, Treatment and Control are general fund appropriations for local health departments and nongeneral fund local budget matching requirements, patient and revenue. Local government cooperative budget match payments are based on a percentage of the general fund contribution provide to each local health department. Nongeneral funding also includes some federal funding and grant funding obtained by health departments from outside sources.

This service area provides personal care and pre-admission screening for nursing home placement.



The legislation that established Medicare also established the Medicaid insurance program under Title XIX of the Social Security Act as a jointly funded federal and state program to provide medical assistance to low-income individuals. Federal Medicaid law allows states to craft Medicaid waiver programs to meet specific state needs. In 1984, Virginia established the Personal Care program to offer in-home care in lieu of nursing home placement to Medicaid-eligible individuals if the in-home care was less expensive than the cost of a nursing home. A number of local health departments in Virginia elected to contract with the Department of Medical Assistance Services as personal care providers. Over the next 20 years, however, nearly all local health departments closed their Personal Care programs when private sector personal care agencies became robust enough to meet the needs of the community.

Virginia has initiated other Medicaid waiver programs to improve health care access for specific low-income populations. Among others, they include an AIDS waiver, and Respite services for Personal Care recipients.

The Medicaid program requires Nursing Home Pre-admission Screening (PAS)  to assure that extended care facility admission is appropriate. The Code of Virginia requires that local health department staff serve as members of the community-based screening teams. All local health departments in Virginia provide a physician and nurse as members of the local screening team.

This service area aligns with the Virginia Department of Health mission to promote and protect the health of all Virginians by assuring that a continuum of care exists for individuals at-risk for nursing home placement and for individuals in need of personal care and other Medicaid waiver services.

Describe the Statutory Authority of this Service

Code of Virginia, Section 32.1-330 requires preadmission screening for all individuals who are eligible for Medicaid at the time of admission to a certified nursing facility or who will become eligible within six months.

Section 32.1-2 authorizes the State Department of Health to provide a comprehensive program of preventive, curative and restorative services.

Section 32.1-11authorizes the State Board of Health to formulate a program of preventive, curative, and restorative medical care services, including home health.

Personal Care Aide Medicaid-reimbursed Personal Care and Respite Care services. Respite services for eligible self-paying or privately-subsidized individuals. Medicaid-reimbursed and non-Medicaid funded Personal Care services.

Community-based Nursing Home Pre-admission Screening services

The Virginia Department of Health (VDH) is reimbursed for Nursing Home Pre-admission screenings by D M AS.  A cost settlement is conducted and submitted to DMAS for reimbursement of the difference between the cost of conducting PAS and the reimbursement rate that is a set reimbursement rate determined by DMAS.  This is according to VDH’s Cost Allocation Plan, which is still in the process of being approved by DMAS and CMS (July 2014).

The Personal Care programs are funded through charges for services provided.

Chronic Disease Prevention and Control includes two broad areas of local health department services; 1) prevention of chronic diseases before they occur through health promotion and disease prevention activities and 2) provision of clinical services for indigent patients with chronic diseases (provided by some local health departments).



Health promotion and disease prevention services are activities directed to reducing mortality and morbidity or premature mortality and morbidity associated with chronic diseases such as heart disease, cancer, diabetes, and stroke. The main focus of these programs is to reduce controllable risk factors such as high blood pressure, cholesterol, smoking, physical activity and obesity. This includes a wide range of services to assist individuals such as blood pressure and cholesterol screening and counseling, social marketing programs focusing on improving physical activity, nutrition and smoking prevention/reduction, working with community partners to assess the community’s health status and prioritize issues, implementing environmental and policy changes, and providing traditional health education classes. This includes services to groups and individuals that are clinic, community or home-based, and the local health departments' Breast and Cervical Cancer Screening Program that provides clinical breast exams and screening mammography to detect breast cancer in the presymptomatic stage. Pap smear testing is performed to detect precancerous changes in the cervix.



A few local health departments provide support to indigent adults needing medical care for chronic disease conditions such as diabetes and hypertension. This may include laboratory and pharmacologic support, follow-up, and referrals to private specialists for complex medical conditions.

This service area is directly aligned with the Virginia Department of Health mission to promote and protect the health of all Virginians. The fundamental purpose of chronic disease prevention and control efforts is to promote and protect the health of all Virginians through various environmental and policy interventions intended to reduce the burden of chronic disease.

Describe the Statutory Authority of this Service

The Code of Virginia §32.1-11 provides that the Board of Health may formulate a program of preventive, curative and restorative medical care services to be provided at the district or local level. Clinical preventive services are focused on the indigent, and the Code provides that the Virginia Department of Health shall define the income limitations within which a person shall be deemed to be medically indigent.

In addition, the Code of Virginia § 32.1-11.3 provides that VDH shall formulate a program of patient and community health education services to be provided by the Department on a district or local basis. The Code notes that the program shall include services addressing health promotion and disease prevention and shall encourage the coordination of local and private sector health education services.

Community Assessment: Applying the science of epidemiology, using health outcome data and demographics in assessing the community’s health.

Public Information, Education and Social Marketing: Increasing knowledge, changing attitude and behaviors regarding chronic disease prevention and control through: Providing leadership to a community partnership to design and implement initiatives such as Heart Health month education and awareness events. Implementing media campaigns: Providing web based information through various links with the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, U.S. Department of Agriculture, etc.

Chronic Disease Screening Services: School-based health screening program for height/weight/BMI-for-age, education and individual counseling and case management for overweight public school children with parent permission. Blood pressure, cholesterol, and glucose screening, and health consumerism education. Marketing and conducting health screenings for hypertension, high cholesterol, elevated glucose levels and health risk appraisals at numerous work sites, health fairs and churches. Follow up with risk reduction education programs for participants. Lipid panel and Hemoglobin A1C screening in various venues. Every Woman’s Life Program—an early breast and cervical cancer detection program for women 40-64 years of age in which health department staff provide screening for these two specific diseases and referral to other health care providers for diagnostic follow-up and treatment.

School Based Services and Education: Several health departments work in partnership with local schools to implement programs that are directed to improve knowledge, change attitude and behavior regarding chronic disease prevention such as: Work with school districts in providing after school education programs in the area of chronic disease prevention; health department staff present programs on nutrition, exercise and smoking prevention including educational programs designed with identified Virginia Department of Education Standards of Leaning Sun/safety/skin cancer prevention initiative implemented in middle and high schools utilizing display board, brochures, sun safety practice survey and related incentives (sunscreen and Chapstick). Individual counseling and case management for students with chronic diseases (asthma, diabetes-Type I and Type II, cardiac, etc.). Implement guidelines for managing asthma in Virginia schools including instructing school personnel in proper use of nebulizers and educate physical education teachers to control environment for asthmatic children on high-pollen days.

Community Partnerships: Many health departments participate in community partnerships that are usually community driven initiatives targeting a specific chronic disease related issue such as: A community walking program in partnership with Parks and Recreation or other organizations providing pedometers and other incentives to continue health enhancing activity. Nutrition and physical activity education in child care centers. Child Care Health Consultants, who are Public Health Nurses, that work with staff of child care centers on nutrition and physical activity issues. Educational classes targeting the prevention and control of a number of chronic diseases, risk factor reduction and safety with senior groups and retirement communities. Nutrition and physical activity programs implemented as an after-school program with the Young Mens Christian Association and Boys and Girls Clubs.

Community Based Programs and Services: Several local health departments initiate chronic disease prevention programs using a variety of local, state and federal resources.

Access to Chronic Disease Medical Care: Provide assistance with application to ACA Health Exchanges, Family Access to Medical Insurance Security Plan, Family Access to Medical Insurance Security Plan Plus and Medicaid. Partnerships with local physicians, free clinics and community health centers to provide medical care, access to medications and referral to specialty care.

Most of the nongeneral funds are federal grants allocated to local health departments, with additional funds coming from local governments as either match funds for general funds allocated to local health departments, or 100 percent local funds. Other nongeneral funds are service related fee revenues from a variety of sources including Medicaid, Medicare, other insurance and patient self-pay, and from other grant/foundation resources received by local health departments for chronic disease prevention.

The purpose of the service area is to assure healthy diets for mothers during pregnancy and breast-feeding and for their children ages 0 to five who might otherwise not be able to afford to eat properly. The service is offered for families with income under 185% of the federal poverty level.



Virginia’s Special Supplemental Nutrition Program for Women, Infants and Children operates pursuant to United States Department of Agriculture regulations in response to increasing scientific evidence that children’s ability to learn and excel in school is directly related to the quality of nutrition received during the critical period of prenatal and early childhood brain development. Women, Infants and Children differs from the Food Stamp program by covering only these high risk population groups, providing only specified high nutrition food items and requiring nutritional assessment and education for the participants.



The provision of electronic benefits to purchase a package of specifically prescribed high nutrient foods at local groceries is coupled with education for the mothers and/or primary care-givers about healthy eating. Increasing attention is being paid to educating families about ways to avoid the risks of childhood obesity while assuring proper nutrition. Breastfeeding is promoted while regular and specially prescribed formulas are provided for infants who are not breastfed. Offering the services of this program though local health departments allows linkage and referrals to be made assuring that the low-income recipients obtain primary health care services and specific preventive services such as childhood immunizations and lead-screening. 

This service area directly aligns to the mission of the Virginia Department of Health to protect and promote the health of Virginians. It accomplishes this by providing information and specific resources for lower income families to assure optimal nutrition during the times of greatest brain development and growth of Virginia’s future citizens.

Describe the Statutory Authority of this Service

The Federal Child Nutrition Act of 1966, Section 17 [42 U.S.C. 1786] established the Special Supplemental Nutrition Program for Women, Infants and children to provide supplemental foods and nutrition. Women, Infants and Children Regulations are found in the Code of Federal Regulations, 7 C.F.R. Part 246.

Public Law 102-314 established the Women, Infants and children Farmers’ Market Nutrition Program (Code of Federal Regulations, 7 C.F.R. Part 248).

• Code of Virginia Section 32.1-351.2 established the Children’s Health Insurance Program Family Access to Medical Insurance Security Plan). VDH helps expedite Family Access to Medical Insurance Security (FAMIS) enrollment for WIC eligible children.

Information and support services for breastfeeding,

Weight and height measurement,

Testing for anemia,

Blood lead risk information and referral (testing may be provided with non-Women, Infant and Children resources),

Individual and group education about nutritional topics of interest to the participants,

Individual nutritional counseling for certain special health needs,

Infant formulas provided including many as a result of physician prescription,

Electronic benefits to purchase packages of specified high nutrition foods,

Referrals to other primary and preventive health services,

Immunization screening for children under age two and referral as indicated; immunizations often provided with other Health Department resources, and

Multi-vitamins and iron supplements provided with non-Women, Infant and Children funds to some participants under local medical protocols.

Federal funds from the United States Department of Agriculture fully support a grant to Virginia to operate the Women, Infant and Children program. This service area includes the funds from the state grant that the state Women, Infant and Children office allocates to support local operation of the Women, Infant and Children program. No state or local matching funds are imposed by Virginia's acceptance of this grant.



These funds represent more than 80 percent of the funds United States Department of Agriculture allocates to Virginia to administer the Women, Infant and Children program. Local health departments' funding levels are determined by a formula primarily based on client caseload. Funds received by local health departments are split among four areas: 4% administration, 20% nutrition education, 4% breastfeeding, and 72% client services.



Local health departments use these funds almost exclusively for salaries and benefits for the nutritionists and other staff who enroll client in the program and provide services to those eligible individuals who participate in the Women, Infant and Children program. To varying degrees, most local health departments provide in-kind contributions such as office space and telephones for the Women, Infant and Children staff. As needed, many local health departments must also use staff paid by the cooperative budget in order to comply with United States Department of Agriculture program and record keeping requirements and to maintain current services. This staff time is indeterminate and varies considerably depending on such factors as the number of delivery sites, staff turnover, and increasing salaries. The cooperative budget staff time spent delivering Women, Infant and Children services is not usually reimbursed by the grant. Virginia has received increased WIC funding in the last few years.



Virginia's Women, Infant and Children grant funds that support the purchase of food packages and infant formula as well as state office services and administration of the program are reflected in the Women, Infant and Children and Community Nutrition Service Area.

Population health has also been summarized as referring broadly to the distribution of health outcomes within a population, the range of personal, social, economic, and environmental factors that influence the distribution of health outcomes, and the policies and interventions that affect those factors. Local health departments are conducting community health assessments and community health improvement plans in parternship with local government, private non-pofits, community and faith-based organizations, and healthcare providers to improve health outcomes for all Virgininians in their locality.    In this work, VDH and the local health departments serve as a convener and organizer, a provider of data and a subject matter expert.

Once communities have adopted community health improvement plans then the local health departments work to carry out the implementation of the parts of the plan they are responsible for.   The specific activiies will vary, as they are determined by local community priorities, but include such things as working on access to healthy food, access to health care, chronic disease education and management, etc.

This service area directly aligns with the Virginia Department of Health’s mission of promoting and protecting the health of Virginians by promoting better health outcomes for all Virginians, measureing those outcomes and working to achieve them.

The initial code section defining the purpose and authority for the Commissioner and the Department of Health mandates the agency to provide "a comprehensive program of preventive, curative, restorative, and environmental health services,..... and abate the hazards and nuisances to the health and to the environement, both emergency and otherwise, thereby improving the quality of life in the Commonwealth."   Population Health is a series of activities designed to "abate the hazards and nuiseances to the health and to the environment" and to "improve the quyality of life in the Commonwealth."  The Department of Health knows that it cannot achieve those ends on its own so much of the work in Population Health is in collaboration with other stakeholders to accomplish these goals.

This service area provides payments of funds appropriated to the Virginia Department of Health (VDH) by the General Assembly for specifically identified organizations following the execution of a contract.

This service area aligns with the agency’s mission to promote and protect the health of Virginians by providing resources in support of the execution of those designated programs.

Authority

The specific organizations and the amounts they receive are detailed in Item 296 of the current Appropriation Act.

Regional AIDS Resource and Consultation Centers ­ There are three regional early intervention centers and one local consultation center that provide medical treatment and support services to HIV infected low income, underinsured, and uninsured persons.

 Alexandria Neighborhood Health Services, Inc. This is a one­stop health center providing accessible, culturally sensitive, preventive, prenatal, primary and minor pediatric illness care to medically indigent women and children in a predominantly Hispanic neighborhood in Alexandria.

Arthur Ashe Health Center ­ This center provides support for the AIDS early intervention and counseling programs in Richmond.

 Comprehensive Health Investment Project of Virginia (CHIP) ­ The Comprehensive Health Investment Project of Virginia focuses largely on making the connection between family and the provider to develop, expand, and operate a network of local public­private partnerships providing comprehensive care coordination, family support and preventive medical and dental services to low­income, at­risk children. A portion of these funds will go to CHIP of Roanoke to be used as matching funds for three public health nurse positions to expand services in the Roanoke Valley and Allegheny highlands.

Fan Free Clinic ­ This clinic provides areas of care that include financial assistance and support groups as well educational services.

Louisa County Resource Council ­ This council implements initiatives to connect indigent individuals to medical and dental services. Services include locating appropriate care, transportation, and payment of medical services.

Old Towne Medical Center ­ This center provides general medical, pediatric, women’s health, immunizations, family planning, dental, and home visit health care services in Williamsburg.

Poison Control Centers ­ The mission of the poison control centers includes poison prevention, poison morbidity and mortality reduction, and health care cost reduction. In response to poison emergencies, the centers are instrumental in the surveillance of adverse effects of foods, drugs, marketed products and promotion of poison prevention. The centers collect detailed poison exposure data which is computerized in real time therefore plays an important role in bioterrorism surveillance. Case data is submitted to the American Association of Poison Control Centers’ (AAPCC) Toxic Exposure Surveillance Center (TESS). There are three poison control programs serving Virginia. They are located at the University of Virginia in Charlottesville, Virginia Commonwealth University in Richmond, and the National Capital Poison Center in Washington, D.C.

Southwest Virginia Graduate Medical Education Consortium (SWVA GMEC) ­ The SWVA GMEC was established as a 501 3C Non­Profit Consortium to create and support medical residency preceptor sites in rural and underserved communities in Southwest Virginia. The GMEC program is a part of the University of Virginia at Wise and was developed to attract and retain qualified primary care physician practices to impoverished regions of Southwest Virginia.

St. Mary's Health Wagon, Medical & Dental Care in Central Appalachia ­ This health wagon provides medical and dental services in the Central Appalachia area.

Virginia Association of Free Clinics – Pharmaceuticals (VAFC) ­ This clinic provides funding to purchase pharmaceuticals, medically necessary pharmacy supplies, and services to low­income uninsured patients of free clinics throughout Virginia.

Virginia Health Care Foundation (VHCF) ­ This foundation provides primary care for medically underserved families in the Commonwealth. The foundation is also directed to expand the Pharmacy Connection Software program to unserved or underserved regions of the Commonwealth, to improve access to free medications for low income Virginians through an Rx Partnership and to increase the capacity of the Commonwealth’s health safety net providers to expand services to unserved and underserved Virginians. Funds are matched with local public and private resources not appropriated by the state.

Virginia Health Information (VHI) ­ This non­profit health data organization develops and implements health data projects that provide useful information to consumers and purchasers of health care, to providers including health plans, to hospitals, nursing facilities, and physicians.

Virginia Community Healthcare Association – Pharmaceuticals and Community Health Centers (VPCA) ­ This association provides pharmacy    services, pharmaceuticals, and pharmaceutical supplies to low­income uninsured patients of the Community and Migrant Health Centers throughout Virginia. A portion of these funds will be used to expand existing or develop new community health centers in medically underserved and economically disadvantaged areas of the Commonwealth and expand access to care provided through community health centers. Funding shall be used to match funding solicited by the Virginia Primary Care Association from local and federal sources, and other public or private organizations.

Community Based Sickle Cell Grants ­ VDH provides grants to community based programs that provide patient assistance, education, and family centered support for individuals suffering from sickle cell disease.

HealthWorks of Herndon  ­ This is a free clinic operating in Fairfax County.

Rappahannock Regional Health Center ­ VDH provides funds to the Community Health Center in the Rappahannock Region.

Mission of Mercy (MOM) ­ Funds are provided to the Virginia Dental Health Foundation to fund the Mission of Mercy (MOM) dental project.

Hampton Roads Proton Beam Therapy Institute at Hampton University – The Institute supports efforts for proton therapy in the treatment of cancerous tumors with fewer side effects.

The funding for this service area is a combination of general and federal funds appropriated each year to designated entities. Payments are processed based on the terms in the executed contract.

This service area provides agency wide leadership and direction from the Commissioner’s Office and Deputy Commissioners to include policy development, programmatic direction, management of human and financial resources, quality and business process improvements, standards of business practice, and information management. This service area includes core business functions and systems of auditing, budgeting, accounting, human resources, in house information technology, and procurement that meet the needs of the agency. Sound management and oversight are provided to ensure ethical stewardship of resources and compliance with all applicable federal and state regulations, policies, and mandates.

This service area aligns with the Virginia Department of Health's (VDH) mission to promote and protect the health of Virginians by providing agency-wide leadership, direction, stewardship and management resources, and business support.

Authority: §§ 3.2-5206 through 3.2-5216, 32.1-11.3 through 32.1-16 through 32.1-23, 35.1-1 through 35.1-7, and 35.1-9 through 35.1-28, Code of Virginia.

Leadership, direction, policy development.   Organizational management.



 

The chief source of funding for Administrative and Support Services is general funds (62%). From the general funds, 21% are allocated for General Management; 45% for Computer Services; 17% for Accounting and Budgeting Services; 12% for Human Resources; and 5% for Procurement and General Services.

The second source of funding for this service area is special funds (38%). From the special funds, 5% is generated from fees Accounting Services receives for outstanding accounts collected through the Debt Set Off process; Procurement and General Services collects 7% as cost recoveries from users to support the operation of the Central Services Stockroom Operation. General Management receives 20% of the special funds as well as 64% for Computer Services and 3% for Human Resources.

This service area provides agency wide leadership and direction from the Commissioner’s Office and Deputy Commissioners to include policy development, programmatic direction, management of human and financial resources, quality and business process improvements, standards of business practice, and information management. This service area includes core business functions and systems of auditing, budgeting, accounting, human resources, in house information technology, and procurement that meet the needs of the agency. 

This service area aligns with the departments mission to promote and protect the health of all Virginians through sound management and administration of the agency. 

GENERAL MANAGEMENT: Office of the Commissioner: provides leadership and direction to public health programs, administration, community health services, and emergency preparedness and response by the Commissioner, four deputy commissioners (Chief Deputy for Public Health, Deputy for Administration, Deputy for Community Health Services, and Deputy for Public Health and Emergency Preparedness), and other key office staff; leads public health program management which provides support and technical assistance to health districts and the public in environmental health, water programs, family health, epidemiology, emergency medical services, vital records and health statistics, as well as information technology, medical examiner’s office, and other health care services and consumer protection; leads administration, financial (including financial internal control/risk management), human resource, procurement, general services management; leads community health services management for 35 health districts; monitors Virginians’ health status; identifies existing and emerging health problems and develops plans to address them; establishes partnerships to improve community health; provides uniform application of regulatory authority; provides timely and complete legislative studies; monitors and analyzes legislation and develops effective partnerships/cooperation with other state agencies in shared or complementary missions. Except for the Deputy for Public Health and Emergency Preparedness, the Commissioner and deputies are funded by this service area.

GENERAL MANAGEMENT: Board of Health: provides administrative and programmatic support to the Board of Health.

GENERAL MANAGEMENT: Internal Audit: provides agency management with an independent and objective assessment of each departmental operation; reviews the propriety and completeness of financial and managerial information and compliance with federal, state and agency regulations; performs fraud and complaint investigations and serves as primary contact with the Auditor of Public Accounts.

The chief source of funding for Administrative and Support Services is general funds (55%). From the general funds, 28% are allocated for General Management; 27% for Computer Services; 22% for Accounting and Budgeting Services; 16% for Human Resources; and 7% for Procurement and General Services.



The second source of funding for this service area is special funds (45%). From the special funds, 5% is generated from fees Accounting Services receives for outstanding accounts collected through the Debt Set Off process; Procurement and General Services collects 7% as cost recoveries from users to support the operation of the Central Services Stockroom Operation. General Management receives 20% of the special funds as well as 64% for Computer Services and 3% for Human Resources. 

Technology plays a key role in VDH’s mission to promote and protect the health of Virginians. Like most agencies, VDH continues to operate in an environment where resources are somewhat limited. This includes financial and human resources. Securing the skill sets needed to maintain and grow VDH’s applications and technology infrastructure is often challenging. In particular, the skill sets involving secure messaging (HL7 Messaging and Rhapsody) are often difficult to obtain. 

This service area aligns to the mission of promoting and protecting the health through all Virginians through continuing to provide the services necessary to support the agency's technology needs. 

TECHNOLOGY SERVICES: Application development and maintenance: Applications are built following the full systems development life cycle and project management methodology. An extensive testing process is used to ensure the application meets the business requirements. The process for developing an application is extensive and involves comprehensive requirements gathering, user group participation, quality assurance and security testing, documentation (both technical and user manuals), auditing and security reviews. Once placed in production, the application moves into maintenance mode, meaning all updates are made to the application as required to ensure compliance with federal and state regulations and security policies.

TECHNOLOGY SERVICES: Training: Create training materials and documentation and provide formal training to customers as new applications or changes to existing applications are implemented.

TECHNOLOGY SERVICES: Applications Support: provides an agency wide Help Desk to support customers with applications problems or issues. The goal is to troubleshoot the issue at first call and escalate as necessary.

TECHNOLOGY SERVICES: Data Warehouse: develops reports based on unique customer requests; provides training on data warehousing tools that can be used by staff to generate standard reports to meet individual and program data reporting requirements.

The chief source of funding for Administrative and Support Services is general funds (55%). From the general funds, 27% are allocated for Computer Services.

VDH funds are managed across an array of 45 service areas and fund appropriations. The specific breakdown of all fund sources of the agency budget is: federal grants and contracts (50 percent); general funds (24 percent); special funds (local government match portion of support  for local health departments (9 percent); fees and charges for services ( 13 percent); dedicated special revenues (4 percent); and private grants, donations, and gifts (less than 1 percent).



Through a contractual agreement, each locality commits funds to VDH to operate the local health department. The percentage of local match dollars is determined by an administrative formula and varies from locality to locality based on the estimated taxable wealth of each locality. Locality percentages range from 18 percent to 45 percent of the local health department budget, and state general funds represent the remainder.



VDH has approximately 193 federal grants and contracts, as well as 65 pass-through grants for which the Office of Financial Management is responsible for complying with cash management and federal reporting requirements. Federal grants fund a broad range of activities such as Public Health Preparedness and Response, Maternal and Child Health Services, Preventive Health Services, AIDS Prevention, Childhood Immunizations, Licensure and Medical Certification of Acute and Long Term Care Facilities, Women-Infants-Children (WIC) Nutrition, Chronic Disease Prevention, and Safe Drinking Water grants.  ts.



A substantial portion of the fees and charges for services are for environmental, medical, and personal care services provided in the local health departments; also included are those fees associated with waterworks operation, regulation of health care facilities, certified copies of vital records, and other miscellaneous services. Dedicated special revenues are those revenues generated from non-VDH related fees and fines such as the $4.25 surcharge on motor vehicle registrations earmarked for Emergency Medical Services and repayments on loans.

This service area aligns with the agency mission to promote and protect the health of all Virginians through ensuring sound fiscal stewardship of the agencies programs. 

ACCOUNTING AND BUDGETING SERVICES: Accounts Receivable and Revenue Processing: receives and deposits revenue for central office programs and services; coordinates the collection of agency wide past due receivables to include state’s Debt/Vendor Set-Off program with the Virginia Department of Taxation; establishes and maintains central office accounts and receivable records; prepares agency quarterly accounts receivable reports and coordinates receivables collection distribution.

ACCOUNTING AND BUDGETING SERVICES: Accounts Payable and Travel Management: processes payments for goods and services and provides leadership in prompt pay compliance; reviews for compliance and reimburses employees for travel expenditures through checks and Electronic Data Interchange (EDI) processing and prepares and distributes 1099 statements as required by the Internal Revenue Service (IRS).

ACCOUNTING AND BUDGETING SERVICES: Leases and Fixed Asset Accounting: reviews and records leases and capital fixed assets; coordinates the annual fiscal inventory and provides guidance to agency offices/districts and reconciles and submits required reports to the Department of Accounts (DOA)

ACCOUNTING AND BUDGETING SERVICES: Financial Reporting: prepares internal management reports, Auditor of Public Accounts (APA) Reports, and State Comptroller Reports.

ACCOUNTING AND BUDGETING SERVICES: Reconciliation: processes and resolves service area reconciliation discrepancies; reconciles the internal accounting system to Commonwealth Accounting and Reporting System (CARS) and prepares general ledger reconciliations.

ACCOUNTING AND BUDGETING SERVICES: Petty Cash: maintains the agency’s petty cash account; issues checks, processes reimbursements from service areas and reconciles account records.

ACCOUNTING AND BUDGETING SERVICES: Payroll: prepares agency payroll that timely and accurately compensates all agency employees within the guidelines of federal and state law; reconciles payroll expenditures and submits quarterly reports to DOA and prepares and distributes W-2’s as required by the IRS.

ACCOUNTING AND BUDGETING SERVICES: Grants Cash Management and Accounting: projects cash flow needs for agency grants; and draws down funds for deposit in accordance within federal and state regulations and policies; maintains systems necessary for federal grant reporting requirements; reconciles grant records; prepares agency internal and external federal grant reports.

ACCOUNTING AND BUDGETING SERVICES: Automated Systems Administration: maintains agency chart of accounts and accounting code tables; maintains security tables and financial system automation planning.

ACCOUNTING AND BUDGETING SERVICES: Financial Policy and Procedure Development, Technical Assistance, and Training: develops and updates agency’s budgeting and accounting policies and procedures and guidance consistent with those promulgated by DPB,DOA, APA, the Code of Virginia, Department of Treasury, and the federal government; provides system, policy, and procedural training to agency districts/offices.

ACCOUNTING AND BUDGETING SERVICES: Budget Formulation, Monitoring, and Execution: formulates, monitors and executes biennial and operating budget to include cooperative, program, and grant funding; develops cost center budget development guidance; develops and implements financial management tools and systems and provides guidance and technical assistance.

ACCOUNTING AND BUDGETING SERVICES: Financial and Analytical Support: conducts special evaluation and management analysis on a wide range of complex resource issues; provides consultation and analytical support to agency Senior Management, Department of Planning and Budget, Secretary of Health and Human Resources, Office of the Governor, and the General Assembly, and management throughout the agency.

ACCOUNTING AND BUDGETING SERVICES: Forecasting Agency Expenditures and Revenues: forecasts agency nongeneral fund revenue and forecasts agency expenditures by fund source and management areas.

ACCOUNTING AND BUDGETING SERVICES: Financial Reporting, Evaluation, and Analysis: tracks agency appropriation by management areas and cost centers; generates routine and ad hoc reports and track local government matching fund requirements.

ACCOUNTING AND BUDGETING SERVICES: Legislative Fiscal Impact Analysis and Reporting: coordinates, reviews and develops financial impact statements.

ACCOUNTING AND BUDGETING SERVICES: Risk Management and Internal Control: conducts annual assessment of agency internal control systems and identifies weaknesses, opportunities for improvements, and best practices

The chief source of funding for Administrative and Support Services is general funds (55%) and of this funding, 22%  is allocated for Accounting and Budgeting Services. 

This service area implements the federal Safe Drinking Water Act, Virginia’s Public Water Supply Law and Virginia’s Waterworks Regulations to protect public health by regulating Virginia’s public waterworks. Virginia Department of Health (VDH) is designated as the “primacy” agency with primary enforcement responsibility for implementing and enforcing the federal drinking water standards in Virginia.

Products and services include:
Inspections and investigations of waterworks,
Evaluations of engineering reports, plans and specifications,
Training for waterworks owners and operators,
Technical assistance to waterworks owners and operators,
Establishment and implementation of a drinking water quality monitoring program,
Emergency assistance provided to waterworks owners and operators (droughts, floods, etc.),
Database development and maintenance to include an inventory of all of Virginia’s public waterworks and compliance information on those waterworks,
Enforcement/compliance actions to ensure compliance with regulations, and
Serve as a resource to other state and federal agencies.

This service area is administered by the VDH Office of Drinking Water (ODW).

This service area directly aligns with VDH’s mission of promoting and protecting the health of Virginians by assuring an adequate quality and quantity of safe drinking water to consumers.

Describe the Statutory Authority of this Service

Sections 32.1-167 through 32.1-176 of the Code of Virginia establish VDH's authority to regulate construction and operation of waterworks in Virginia.

The Federal Safe Drinking Water Act of 1974 (SDWA), as amended in 1986 and 1996, was enacted to protect the quality of drinking water in the United States.

40 Code of Federal Regulations Part 142, Subpart B governs the primary enforcement responsibility for federal drinking water standards.

Inspections and Investigation of Waterworks: Scheduled on-site inspections are conducted within the prescribed EPA timeframe to evaluate the capability of waterworks to consistently and reliably deliver an adequate quality and quantity of safe drinking water to consumers and to comply with state and federal drinking water standards. Special on-site investigations are conducted to provide requested technical assistance, evaluate new or upgrading public waterworks, and meet special enforcement needs. Complaint investigations are conducted as necessary to follow-up on consumer complaints.

Evaluation of Engineering Reports, Plans and Specifications: Evaluate engineering reports, plans and specifications of new and modified public water supply facilities to ensure that design and construction of those facilities will be capable of complying with the drinking water regulations as well as addressing the priority problems that exist. Issue permits to construct or modify waterworks upon approval of plans and specifications. Issue operation permits after construction is completed. Conduct in depth review of new water treatment technologies.

Training Assistance to Waterworks Owners and Operators: Hold or participate in seminars and workshops concerning the implementation of new drinking water rules or regulations, emerging technologies, techniques and professional development for waterworks managers and operators, etc. Conduct operator training for operators of very small systems on need-to-know subjects, such as disinfection, pumps, chemical feeders, and well operations.

Technical Assistance to Waterworks Owners and Operators: Assist waterworks in implementing new and revised drinking water regulations. Assist in problem identification to solve operational problems or to prioritize construction needs. Identify events that point to the development of drought conditions and alert waterworks to review their water conservation measures and attend meetings as necessary. Monitor the source water assessment program. Encourage waterworks to assess the areas serving as their sources of drinking water in an effort to identify potential threats and initiate protection efforts. Provide necessary assistance to waterworks conducting vulnerability assessments on an "as-requested" basis. Vulnerability assessments aid waterworks in evaluating their susceptibility to potential threats and identify corrective actions to reduce or negate the risk of serious consequences from vandalism, insider sabotage, or terrorist attack. Implement the capacity development program in an effort to help waterworks improve their technical, managerial, and financial capabilities so that they can provide safe drinking water consistently, reliably and cost effectively. Periodically assess the technical, managerial and financial capacity of waterworks and offer assistance in making improvements. Assist all waterworks owners in the preparation and distribution of their annual Consumer Confidence Reports (CCR). A CCR is a water quality report to all consumers that summarizes information regarding safety, source, detected contaminants, and compliance for the waterworks. Review and respond to Bacteriological Siting Reports, Lead and Copper Rule Reports, Cross Connection Control Programs, and Comprehensive Business Plans that are required of waterworks by state and federal regulations.

Establishment and Implementation of a Water Quality Monitoring Program: Work with the Division of Consolidated Laboratory Services (DCLS), certified commercial laboratories, and waterworks to assure that drinking water quality analyses are performed in a timely manner. Periodically coordinate with DCLS to assure that its staff is aware of potential biological and chemical weapons that could be employed against waterworks and is moving towards having a rapid response capability if an incident occurs or may have occurred. Evaluate the results of drinking water tests to ensure the public is being provided safe drinking water.

Emergency Assistance: Maintain an emergency pollution response system which would quickly notify any potentially affected waterworks of any reported pollution event (e.g., accidental or intentional chemical spill, raw sewage discharge, terrorist attack, etc.) Continuously maintain coordination with the State Epidemiologist and Bioterrorism Program Coordinator on security issues related to potential weapons of mass destruction attacks and incidents of tampering with waterworks. Assist in developing any waterworks actions deemed necessary as a result of any terrorist threat or increased security activities. Recommend appropriate emergency preparedness responses for waterworks owners and operators and other involved parties. Provide waterworks owners counter measure guidance on strengthening critical assets and other facilities. Securing and protecting drinking water is critical to ensuring the availability of a safe supply. Provide security audits on an "as-requested" basis.

Data Base Development and Maintenance: Maintain State Safe Drinking Water Information System (SDWIS/State) to ensure a complete and accurate inventory of all of Virginia’s waterworks. Coordinate and maintain the electronic data interchange of drinking water quality analysis data from DCLS and private laboratories. Maintain the automated billing system to assist and expedite the receipt of funds from the annual waterworks operation fee. Ensure continuing coordination with the Virginia Information Technologies Agency (VITA).

Enforcement and Compliance with Regulations: Implement all drinking water regulations within prescribed timeframe. Alert all affected Virginia waterworks owners of their responsibilities under any new federal drinking water regulations as soon as the new rule summary is available. Ensure that affected waterworks owners provide the required Consumer Confidence Report to consumers on an annual basis. Take timely, appropriate, fair, consistent, and effective enforcement actions using a variety of enforcement tools to bring waterworks into compliance. Such enforcement tools include informal telephone calls, letters, meetings, conferences, informal fact finding proceedings, administrative orders, consent orders, formal hearings, civil suits, and criminal actions. Prepare enforcement cases for referral to the Office of the Attorney General to initiate civil action. Issue emergency orders in any case where there is an imminent danger to the public health resulting from the operation of any waterworks or the source of a water supply.

Resource to Other State and Federal Agencies: Serve on the Virginia Drought Monitoring Task Force. Serve as liaison to the Department of Professional and Occupational Regulation (DPOR) to assure that: (1) waterworks operator license testing is appropriate and that the licensure rule is being applied fairly, and (2) changes to DPOR regulations are in compliance with the Safe Drinking Water Act.

This service area is funded by general and non-general fund revenues. Non-general fund revenues consist of waterworks operation fees and the Public Water System Supervision federal grant. The waterworks operation fees are fees that are assessed annually on Virginia's waterworks based on the number of connections or the classification of the waterworks. 

This service area implements the federal Drinking Water State Revolving Fund Program (DWSRF) and the Virginia Water Supply Assistance Grant Program (WSAG). The purpose of this service area is to help public waterworks make infrastructure improvements necessary to ensure continued provision of safe drinking water and to help protect public health.

This service area directly aligns with Virginia Department of Health's (VDH’s) mission of promoting and protecting the health of Virginians by assuring an adequate quality and quantity of safe and affordable drinking water to  consumers.

Describe the Statutory Authority of this Service

Code of Virginia Title 32.1 Chapter 6 Sections 32.1-167 through 32.1-176 establishes authority to regulate construction and operation of waterworks in Virginia.

Code of Virginia Title 32.1 Chapter 6 Sections 32.1-171.2 establishes the Virginia Water Supply Assistance Fund Program in Virginia.

Federal Safe Drinking Water Act, 1974, as amended in 1986 and 1996 establishes the DWSRF Program in Section 1452, “State Revolving Loan Funds,” of the Act.

Virginia’s Appropriation Act establishes that VDH will control and manage monies appropriated for safe drinking water.

Code of Virginia Title 2.2 Chapter 6 Section 2.2-611 authorizes state agencies to accept grants from agencies and departments of the United States.

Financial assistance: Provide zero to below market interest rate loans for a term not to exceed 30 years to community and non­profit non­community waterworks for eligible drinking water infrastructure projects. Provide grants to community and non­profit non­community waterworks to fund eligible drinking water infrastructure projects costs. Affordable financing helps to ensure delivery of safe and affordable drinking water to residents of the Commonwealth.

 Planning and design awards: 100% grant funds awarded to small community waterworks for eligible planning and design costs. Assist waterworks owners in recognizing problems and producing needed planning and design documents that identify optimal solutions. Assist waterworks owners to qualify for various construction  funding.

 Technical oversight: Provide oversight of funded projects to ensure that waterworks fully understand and follow all state, federal and program requirements. Determination that funded projects have undergone an environmental review in accordance with VDH’s approved   process.

Determination that funded projects have properly followed federal and state procurement regulations including Minority Business Enterprise/Women Business Enterprise. Determination that funded projects have complied with federal cross­cutting authorities. Determination that funded projects have undergone the proper public notices.

 Construction progress review: Onsite project evaluations to ensure construction scope and progress are consistent with approved project and funds disbursed. Offer assistance to keep project on track and progressing towards completion.

 Customer service: Provide various services to a variety of customers including waterworks owners, consulting engineers, contractors, non­profit organizations, other state and federal funding partners, and universities. Provide training through  regional funding workshops held annually.

This service area's funding comes from the federal Drinking Water State Revolving Fund, required state match, repayment funds, general funds, and miscellaneous sources such as interest earnings and enforcement penalties. 

This service area implements the Virginia Toxic Substances Information Act by assessing, advising, and communicating health hazards of chemical and certain biological agents which pose a threat to human health and the environment. Products and services include:



• Advise the Governor, General Assembly, other state agencies, and local governing bodies on matters pertaining to chemical exposures posing a threat to public health or the environment;

• Evaluate information regarding toxicity of chemicals and certain biological agents and determine the risk to human health and the environment;

• Disseminate information concerning toxic substances to other state agencies, political subdivisions of the Commonwealth, health professionals, the media, and the public by communicating the risk of chemical exposure through documents, technical reports, information sheets, advisories, health alerts, and press releases;

• Investigate potential human health effects associated with exposure to chemical and biological agents in the environment.

• Conduct surveillance of diseases related to chemical exposure;

•Conduct public health assessments or health consultations to assess community health risks associated with exposure to harmful levels of chemicals ; and

• Make recommendations to prevent exposure of residents to chemical substances including fish consumption advisories. 

This service area directly aligns with VDH’s mission of promoting and protecting the health of Virginians by assessing, advising, and communicating health hazards of chemical and certain biological agents which pose a threat to human health and the environment.

Describe the Statutory Authority of this Service

Chapter 6, Article 9 of Title 32.1 of the Code of Virginia provides the authority and defines the activities of this Service Area. Secton 32.1-240 designates VDH as the state toxic substances information agency. The activities listed under the service area description are mandated by Sections 32.1-241 and 32.1-248.01. Section 32.1-245 requires VDH to submit a biennial report to the Governor and General Assembly on all matters relating to toxic substances in the Commonwealth.

Respond to all residents of the Commonwealth who have concerns regarding public health hazards from exposure to chemicals and certain biological agents.

Conduct public health assessments or health consultations to assess community health risks associated with exposure to harmful levels of chemicals

Produce fact sheets and information sheets concerning relative subjects, such as a local spill or identified environmental hazard, and disseminate to affected constituents.

Post information on the VDH Web site to improve its accessibility to Virginians.

Disseminate information to communities and work with local governing bodies to assess exposure, risk, and identify protective actions in relation to specific toxic substance occurrences.

Provide recommendations when a toxic substance exposure has occurred or is imminent.

Issue and monitor Fish Consumption Advisories throughout Virginia’s waterways based on fish tissue sample analysis and degree of contamination.

Monitor reports by physicians, hospitals, and labs to detect trends that suggest an increase in exposure to toxic substances.

Maintain and analyze Childhood Elevated Blood Lead Level Database to collect incidence data for children with elevated blood lead levels.

Provide technical assistance and guidance to other state agencies in the development of regulatory standards and guidelines governing chemicals.

Provide information for healthcare and environmental health professionals regarding potential health effects of exposure to toxic substances.

Provide press releases and publications concerning health hazards and possible exposures within a community.

Attend public meetings and forums throughout the state to help address residents’ questions and provide information related to health hazards.

Review and evaluate hazardous waste permit applications for the Department of Environmental Quality upon request.

The source of funding for Public Health Toxicology is general fund and competitive cooperative agreement funding from the Agency for Toxic Substances and Disease Registry. The general base budget is the prior year's legislative appropriation.  

This area provides leadership by directing the operation of the environmental health programs (for example, food and shellfish safety, tourism safety, childhood lead poisoning prevention, safe drinking water from private wells, and safe wastewater treatment and disposal); developing policy; analyzing local, state and federal legislation; evaluating public health programs; providing liaison assistance; providing scientific and technical expertise; representing the agency in formal administrative proceedings involving the environmental health programs; and providing expertise in drafting, amending, administering and enforcing state environmental health regulations.

This service area directly aligns with VDH’s mission to promote and protect the health of Virginians. Environmental health services are intended to minimize and mitigate risks associated with diseases caused by contamination of food, water and the general environment.

Describe the Statutory Authority of this Service

Va Code § 3.2-5200 et seq. establishes the State Health Commissioner’s authority to implement and enforce regulations adopted by the Board of Agriculture and Consumer Services pertaining to  inspections and permitting of plants that process and distribute Grade A market milk and Grade A market milk products.

Va Code § 3.2-6522 establishes requirements for notifying VDH of any animal suspected to have rabies or that may have exposed a person to rabies and for the Health Department to approve of confinement facilities, to confine suspected animals and to test suspected animals for rabies.

Title 32.1, Chapter 6 establishes requirements for inspections and permitting of private wells, onsite sewage systems (septic systems), alternative onsite sewage systems, alternative discharging sewage systems, migrant labor camps, and marinas and for regulations pertaining to the posting of swimming pool water quality.  This chapter also authorizes the Health Department to administer the Onsite Sewage Indemnification Fund, the Onsite Operation and Maintenance Fund, and the Environmental Health Education and Training Fund.

Va Code §32.1-11.7 requires VDH to develop guidelines for cleanup of methamphetamine laboratories and procedures for certifying cleanup

Title 35.1 of the Code of Virginia establishes requirements for inspections and permitting of food establishments (restaurants), hotels, bed and breakfast establishments, summer camps, campgrounds, tourist establishment pools, and state institutions.

Inspection and enforcement: Thorough and consistent inspection and enforcement of laws and regulations addressing structural design and operational practices for food establishments, hotels, campgrounds, marinas, migrant labor camps, summer camps, swimming pools, and dairy plants. Inspection has long been a staple of public health. The goal of inspection and enforcement is to protect the public from injury and disease by educating the operators of these facilities in their safe and sanitary operation. If the education aspect of inspections fail, then enforcement is necessary to abate the risk to the public’s health and safety.

Permitting: The Department’s plan review and permitting services ensure the facility meets all construction requirements and that problems are not built into the facility. The issuing of permits is based on well-established health, safety, and environmental considerations intended to protect the public from health and safety hazards and also to assist the operator in maintaining his establishment.

Respond to Citizen Complaints: Citizens frequently file complaints concerning environmental and public health conditions they observe in any of the permitted facilities. When staff respond to these complaints it provides an opportunity to learn of problems that may have developed since their last inspection. Also, such complaints may help prevent an outbreak before it occurs. Follow-up with the complainant is important to provide feedback on how the response, what was found, what actions were taken and why.

Provide Customer Service: The citizens of the Commonwealth expect a high degree of professionalism from this service area. Responding to public concerns, providing helpful information, speaking at functions, and responding to Freedom of Information Act requests in a professional, courteous, and timely manner is essential. Through such customer service we can increase our “eyes and ears” in the community we serve.

Promulgation of Regulations: Promulgate regulations on behalf of the Board of Health. Regulation development is a labor intensive process, involving various stakeholders with differing agendas. The process attempts to achieve some degree of consensus and it often takes years to amend or adopt regulations.

Indemnification Fund Claims: Process claims resulting from the failure of onsite sewage systems that were constructed within the past three years and the Department’s negligence contributed to the failure.

Appeals Board: Represent the Department before the Appeals Review Board where the appellant has been denied a permit or certification letter by the local health department or where the appellant’s Indemnification Fund claim has been denied.

Enforcement: Represent the Department in cases where the local health department has been unable to obtain compliance through its own efforts.

Grants in Marina Program: The Marina Program administers two federal grants, the Clean Vessel Act and the Boating Infrastructure grants. Each grant is directed to improving marina facilities. The Clean Vessel Act ($3 million to date) is a grant program that gives money to Virginia for the installation of sewage holding tank pump-out stations and dump stations for use by recreational boaters and funds education campaigns that encourage recreational boaters to dispose of vessel sewage properly. The Boating Infrastructure Grant ($4.6 million to date) funds projects to construct, renovate, or maintain facilities for transient non-trailerable recreational vessels. Eligible projects, designed to accommodate boats 26 feet or greater in length, include buoys, day docks, restrooms, dockside utilities and similar structures.

Childhood Lead Prevention: Monitor trends in child health status indicators and identify emerging issues of statewide significance. Develop or participate in the development of statewide strategic plans regarding child lead exposure. Represent VDH on statewide interagency councils, task forces, and committees related to child lead exposure. Propose and/or respond to state legislative and budgetary initiatives; track pertinent legislation. Monitor federal legislation for potential impact at the state level. Respond to requests for data and information from constituents, policy makers, media, and stakeholders. Coordinate follow-up services for children under 6 years of age with lead exposure. Obtain and administer grants. Review literature and identify and share best practices with partners and contractors. Coordinate training and technical assistance to partners and stakeholders. Develop and implement social marketing campaigns and materials related to childhood lead poisoning prevention. Develop and/or purchase educational materials and distribute in support of programs. Assure sound fiscal management through budgeting and expense monitoring. Conduct surveillance on childhood lead poisoning. Conduct analysis of childhood data and produce and disseminate reports. Evaluate programs for effectiveness.

This service area is funded primarily by general funds, which support nearly 66 percent of the total budget. The remaining budget is funded by various federal and state grants and special funds.

This service area implements seafood regulatory and water quality assessment programs intended to minimize risks of foodborne illness from shellfish and crab meat consumption.  A significant portion of the work effort is dedicated to the implementation of the National Shellfish Sanitation Program, the national food safety program for oversight of bivalve molluscan shellfish. Services include:

l   Conducting water quality assessments and classification of shellfish growing areas throughout Tidewater Virginia,

l   Conducting risk assessments for naturally occurring pathogenic Vibrio species, and establishment of harvesting and processing controls to minimize illness risks.

l   Conducting monitoring for harmful algal species, and establishing regulatory harvest controls as necessary to prevent illness.

l   Conducting impaired area assessments to investigate potential sources of contamination, and to characterize spatial and temporal pollution patterns.  In cases where pollutant patterns are predictably associated with events such as rainfall, tides, seasons, etc.; establishes conditional management plans for regulatory harvest controls during times when pollution risks are present.

l   Emergency response:  Preparing for, and responding to, events that may cause the contamination of shellfish or shellfish growing areas such as floods and spills of sewage, fuels, or other toxic substances.

l Inspection and certification of shellfish and crab meat processing and shipping facilities, and

l  Customer service to concerned citizenry about shellfish growing areas and to production facility owners about processing techniques.

This service area directly aligns with the Virginia Department of Health's (VDH) mission to protect and promote public health by helping to prevent food­ borne disease.

Describe the Statutory Authority of this Service

 Title 28.2, Chapter 8, §§28.2-800 through 28.2-826.

§28.2-801 provides the State Health Commissioner with the authority to promulgate regulations

§28.2-802 provides the State Health Commissioner with the authority to enter establishments where shellfish are processed or stored and to conduct enforcement activities where violations occur. 

§28.2-803  provides the State Health Commissioner with the authority to conduct examination and analyses of harvest areas and adjacent lands for evidence of pollution; and authority to conduct inspections of seafood processing facilities.

§28.2-804 provides the State Health Commissioner with the authority to assess the suitability of harvest areas or processing facilities as sources of seafood.

§28.2-805 provides the State Health Commissioner with the authority to halt marketing of seafood from areas or establishments determined to be unsuitable.

§28.2-806 provides the State Health Commissioner the authority to establish standards.

§28.2-807 provides the State Health Commissioner with the authority to close growing areas determined to be unsuitable for harvest based on an examination of the area.

§28.2-809 provides the State Health Commissioner with the authority to temporarily close growing areas without an examination provided that substantial evidence exists that the area is polluted or likely to be polluted.

§ 32.1-2 defines the findings and purpose of the VDH’s efforts to protect public health.

§ 2.2-4002, B.16 provides that the State Health Commissioner may issue orders concerning the closure of shellfish growing waters to be effective immediately

.

Classification of shellfish growing areas: Collect and conduct microbiological analysis of environmental water (seawater) samples for evidence of fecal contamination. Collect environmental samples of shellfish for VDH analysis of naturally occurring pathogens using advanced laboratory techniques (DNA fingerprinting – real time Polymerase Chain Reaction (PCR)), and for analysis of heavy metals and toxic substances in other qualified laboratories (DCLS, VIMS, FDA, NOAA, etc). Collect seawater samples for toxic phytoplankton analysis by VDH, ODU and VIMS. Collect shellfish samples for analysis of phytoplankton biotoxins by the VDH, ODU, VIMS, the U.S. Food and Drug Administration, and qualified private laboratories. Conduct inspections and evaluation of actual and potential pollution sources in and adjacent to shellfish growing areas, and prepare reports of findings. Classify all potential shellfish growing waters in Virginia’s portion of the Chesapeake Bay and Territorial Sea utilizing multiple data sources including seawater, sediment, and shellfish samples; pollution source assessment data; and high resolution orthophotography, integrated for spatial analysis in a Geographic Information System (GIS) application.

Develop condemnation zones around marinas and waste water treatment facility discharges by using pollutant dilution, dieoff and dispersion models and GIS technology.

 Conducts advanced assessments of impaired waters to investigate potential contamination sources.  Works collaboratively with localities, water/sewer utilities, and advocacy organizations for remediation of identified sources.

Conducts field investigation and data analyses to characterize spatial and temporal pollution patterns.  Where predictable patterns exist, develops conditional management plans for implementation of growing area closures during times when pollution risks exist.

 Emergency response:  Prepare action plans for response to various threats to the safety of Virginia’s seafood.  Respond to events such as floods and discharges/spills of sewage, fuel, or other toxic substances.  Conduct environmental monitoring  and assessments to determine the extents of impacted areas.  Establishes growing area closures and product recalls as needed.

 Certification of processing facilities: Conduct US Food and Drug Administration standardized inspections of all certified shellfish and crab meat facilities using the Food and Drug Administration’s Hazard Analysis Critical Control Point regulation, the National Shellfish Sanitation Program requirements, and Virginia Department of Health regulations. Collect shellfish and crab meat product samples, along with processing water samples for microbiological analysis by Virginia Department of Health laboratories. Conduct and microbiologically analyze swab tests of processing facility surfaces and analyze microbiologically. Work closely with the US Food and Drug Administration and other states' agencies on suspected cases of shellfish­borne disease.

Enforcement: Advise the public of the regulatory requirement to be certified for the production of shellfish and crab meat products for market. Investigate and conduct enforcement actions for regulatory violations.

Regulatory development: Develop regulations in concert with the regulated industry and interested parties as needed.

Technical assistance to customers: Advise shellfish and crab meat processors of proper processing flow and techniques, new processing techniques, risk assessment, water supply problems, etc. Develop schematics for new processing facility owners for their use in developing architectural plans to ensure proper product flow and adequate facilities. Provide technical assistance to processors to promote safe processing and handling practices and to assist in compliance with state and federal requirements.  Advise the general public of the safest places that they can grow shellfish for personal consumption. Apply and interpret pollutant dilution and transport models to assess the size of closure areas needed around existing and proposed wastewater discharges and marinas.    Provide comments to state and federal agencies regarding environmental permit applications to provide notification of potential impacts to shellfish areas.

This service area implements the Regulations for Bedding and Upholstered Furniture Inspection Program.  The purpose of this service area is to protect Virginia consumers from diseases and insect pests spread through contaminated bedding and upholstered furniture.

Products and services include:

1. Issuing permits and licenses to bedding and upholstered manufacturers, re-upholsterers, bedding renovators, sanitizers, importers, distributors and supply dealers.


2. Providing customer service to individuals filing complaints regarding the regulated entities.


3. Inspecting bedding and upholstered furniture manufacturers, bedding renovators, re-upholsterers and sanitizers. 

This service area directly aligns with VDH’s mission to promote and protect public health by enforcing requirements that bedding and upholstered furniture are made from appropriate, clean materials and requirements that used items be cleaned and sanitized before being sold.

§ 32.1-215. Disposal restricted.

No person engaged in commerce shall rent, offer or expose for sale, barter, give away, or dispose of in any other commercial manner any article of bedding or upholstered furniture made, remade, reupholstered, or renovated in violation of § 32.1-213 or 32.1-214 or any secondhand article of bedding or upholstered furniture unless since last used such secondhand article has been sanitized by a reasonable process approved by the Commissioner. However, a retailer may sell, give away, or rent used upholstered furniture when the used upholstered furniture has been purchased by the retailer as new furniture and has been used in the course of business. Such used furniture shall be (i) conspicuously identified as used furniture and (ii) reduced in price, sold at auction, donated to charity, or made available for a rental fee, and so tagged.

§ 32.1-217. License and registration number; renewal; licenses not transferable; responsibility of branch factories.

A. Every importer and every person manufacturing, renovating or reupholstering any bedding or upholstered furniture or processing or selling any filling material to be used in articles of bedding or upholstered furniture shall first obtain a license from the Commissioner for each place of business, subsidiary or branch operated by him for such purpose. Such license shall be numbered, shall expire one year from the date of issue, shall be renewable annually unless sooner revoked and shall not be transferable. Each branch, branch factory and subsidiary shall be responsible for the contents and for the tagging, as provided in this article, of items of bedding and upholstered furniture made, remade, renovated, reupholstered or imported by it and offered for sale or use in the Commonwealth.

Issuance of permits to bedding and upholstered furniture manufacturers, renovators, re-upholsterers, importers, distributors and supply dealers.

Inspection of bedding and upholstered furniture manufacturers, renovators, re-upholsterers, importers, distributors and supply dealers upon receipt of complaint from an individual.

Enforcement of laws and regulations governing bedding and upholstered furniture.

Customer service to individuals filing complaints regarding any of the regulated entities.

The annual appropriation for the Bedding and Upholstered Furniture Inspection Program is completely comprised of Non-General funds.  License and permit fees are collected from bedding manufacturers, upholstered furniture manufacturers, bedding renovators, furniture re-upholsterers, importers of bedding and upholstered furniture, distributors, sanitizers and supply dealers. The majority of these fees are paid by out of state or out of country entities.