Department of Health and Senior Services

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					      EXECUTIVE DEPARTMENTS — DEPARTMENT OF HEALTH & SENIOR SERVICES                                       455

  of Health and
  Senior Services
                                                     DEBORAH A. JANTSCH, M.D.   JEFFERY A. KERR, D.O.
PO Box 570, Jefferson City 65102                     Chair                      Chair
Telephone: (573) 751-6400                            State Board of Health      State Board of Senior Services
                                                     Fischer, Ollie C., D.M.D., (R), St. Louis;
    The Department of Health and Senior Ser-         Forand, Joseph M., M.D., (R), St. Louis;
vices was created by the passage of House Bill       Jantsch, Deborah A., M.D., (D), chair, Kansas
603 in May 2001. The bill transferred the roles          City;
and responsibilities of the Division of Aging in     Mannello, Donna, D.C., (D), St. Louis;
the Department of Social Services to the Depart-     Slack, Annette, R.N., J.D., (D), Florissant.
ment of Health creating the Department of
Health and Senior Services. This change has          State Board of Senior Services
resulted in better integration, closer coordina-         The State Board of Senior Services serves as
tion and communication regarding health, pub-        an advisory body for activities of the Department
lic health, regulation and senior services for all   of Health and Senior Services. It consists of
Missourians.                                         seven members appointed by the governor with
                                                     advice and consent of the Missouri Senate.
State Board of Health                                Members serve four-year terms and may serve a
     The State Board of Health serves as an advi-    maximum of two terms. Missouri law (RSMo
sory body for activities of the Department of        660.062) specifies that board members shall
Health and Senior Services. It consists of seven     currently be working in the field of gerontology,
members appointed by the governor with advice        geriatrics, mental health issues, nutrition and
and consent of the Missouri Senate. Members          rehabilitation services of persons with disabili-
serve four-year terms and may serve a maximum        ties. Four of the seven members appointed must
of two terms. Missouri law (RSMo 191.400)            belong to the Governor’s Advisory Council on
specifies that three members shall be licensed       Aging.
physicians; one member shall be a licensed den-         The State Board of Senior Services advises
tist; one member shall be a licensed chiropractic    the director in planning for and operating the
physician; and the other two members shall be        department, and acts in an advisory capacity
persons other than those licensed by the State       regarding rules promulgated by the department.
Board of Registration for the Healing Arts, the
Missouri Dental Board, or the Missouri State         Members of the State Board of Senior
Board of Chiropractic Examiners and shall be
representative of those persons, professions, and    Services
businesses which are regulated and supervised        Jeffery A. Kerr, D.O., (R), chair, Rolla;
by the Department of Health and Senior Services      James M. Caccamo, Ph.D., (D), Kansas City;
and the State Board of Health.                       Melinda Clark, M.P.A., (R), St. Louis;
    The State Board of Health advises the direc-     Debra Cochran, (R), Chesterfield;
tor of the department in planning for and operat-    Lisa G. Conrad, (D), Clarence;
ing the department, and acts in an advisory          Lillian D. Eunice, (D), Normandy;
capacity regarding rules promulgated by the          Mary Updyke, R.D., (R), Kirksville.
                                                     Office of the Director
Members of the State Board of                            The governor, with the advice and consent of
                                                     the Senate, appoints the director of the Depart-
Health                                               ment of Health and Senior Services. Under the
Berry, James E., (R), Forsyth;                       director of health and senior services, the
Buckner, John III, M.D., (R), Springfield;           department is functionally organized into four
456           OFFICIAL MANUAL

Director                    Executive Assistant to Director   Deputy Director            Executive Assistant to Deputy

Regulation and Licensure    Department Operations             General Counsel            Public Information

divisions: Administration; Community and Pub-                 protect the health of Missourians during a public
lic Health; Senior and Disability Services; and               health emergency.
Regulation and Licensure.                                         The Department Situation Room (DSR) serves
    The director is the chief liaison officer of the          as the coordination point for all Department of
Department of Health and Senior Services for                  Health and Senior Services’ responses to emer-
joint efforts with other governmental agencies                gencies, both natural and deliberate. It operates
and with private organizations that conduct or                at a non-threat level 24 hours a day, 7 days a
sponsor programs that relate to health and sen-               week and can be staffed and function as a com-
ior services in Missouri. A deputy director                   mand and control center in the event of an
responsible for management of the department                  emergency. The DSR monitors the day-to-day
and administration of its programs and services               emergency preparedness of the public health
assists the director.                                         system and allied systems. The DSR also serves
                                                              as part of the Health Alert Network to rapidly
    The director’s office also oversees the Center            receive and disperse communications among
for Emergency Response and Terrorism; State                   public health and healthcare partners at the
Public Health Laboratory; and the offices of pub-             local, regional, state and federal levels, and
lic information; personnel; planning and devel-               assign and track follow-up activities. The DSR
opment; general counsel; special investigations;              hotline is the contact point for the general pub-
and governmental policy and regulation.                       lic and public health partners. The number is 1-
    The Center for Emergency Response and Ter-                800-392-0272.
rorism is responsible for coordinating regional                   Missouri is taking steps at the state and local
and state planning for public health emergencies              level to increase preparedness for and response
and disasters, including biological, chemical                 to bioterrorism, outbreaks of infectious disease,
and nuclear terrorism. Through partnerships with              and public health threats and emergencies.
hospitals and other health care organizations,                These efforts focus on: assessment and planning;
local entities including government and law                   education and training; disease reporting; hospi-
enforcement agencies, and other partners, the                 tal and laboratory surveillance; laboratory
Center works to assure systems are in place to                capacity; communications technology; public
  EXECUTIVE DEPARTMENTS — DEPARTMENT OF HEALTH & SENIOR SERVICES                                                457

MARY M. HOSKINS, M.P.A.    ANDREW WANKUM             MIKE ROTH                           GLENDA MILLER
Personnel                  Governmental Policy and   President, Board of Nursing         Community and Public Health
                           Legislation               Home Administrators

                           BRET FISCHER              H. BRUCE NETHINGTON
                           Administration            Chair, Missouri Health Facilities
                                                     Review Committee

information and media relations; and Geograph-       Mental Health, Natural Resources, Agriculture
ic Information Systems or GIS.                       and law enforcement agencies.
    Local public health agencies and regional            The chemistry unit conducts chemical analy-
response planners are working to develop inte-       ses of water and other environmental samples to
grated emergency regional response/terrorism         determine the presence of toxic chemicals or
plans that will coordinate with the state’s emer-    substances. It also performs blood lead testing
gency response plan. The Center is working           and provides analyses to support investigations
closely with hospitals to assess their needs and     of suspected acts of terrorism where poisons or
complete preparedness planning on the regional       other toxic substances may have been used.
level.                                                   The environmental bacteriology unit tests
                                                     public and private water supplies for the pres-
     The State Public Health Laboratory each
                                                     ence of coliform bacteria, and milk for the bac-
year receives approximately a half million sam-      terial counts and food suspected of causing dis-
ples through the central laboratory, its branch      ease outbreaks (food poisoning).
laboratory in Poplar Bluff, and the State Tubercu-
losis Laboratory in Mt. Vernon. The laboratory           The metabolic disease unit examines blood
                                                     samples from newborn babies to find those who
provides testing services in the fields of chem-
                                                     need treatment for metabolic diseases such as
istry, environmental bacteriology, microbiology,
                                                     phenylketonuria (PKU), hypothyroidism, galac-
serology and virology. The laboratory also           tosemia and sickle cell disease.
approves breath alcohol testing equipment used
in Missouri; issues permits to persons qualified         The microbiology unit provides reference
to supervise and operate these devices and peri-     services for the identification of bacteria and
                                                     parasitic organisms especially those which pose
odically inspects breath-testing instruments used
                                                     a threat to public health, i.e., toxigenic E. coli,
in the state.
                                                     salmonella and shigella, such as the causative
    In addition to programs of the department,       agents of whooping cough, tularemia, plague,
the laboratory performs tests in support of activ-   anthrax, and dysentery. This unit provides the
ities of the state departments of Corrections,       laboratory support to law enforcement and pub-

lic health in the investigation of suspected acts    promoting constituency development and devel-
of bioterrorism.                                     oping culturally sensitive health education ini-
    The serology unit performs tests to help diag-   tiatives. The office also works collaboratively
nose syphilis and AIDS; performs blood tests for     with community-based organizations and lead-
measles, rubella and hepatitis and conducts test-    ers to identify and implement specialized strate-
ing for gonorrhea and chlamydia.                     gies that address the unique health needs of Af-
                                                     rican-American, Native American, Hispanic/La-
    The virology unit examines clinical speci-       tino, and Asian American populations in Mis-
mens to detect influenza, West Nile virus, SARS,     souri.
and other viral diseases that threaten public
                                                         The Office of Epidemiology provides epi-
health and examines animals for rabies. This
                                                     demiological consultation to all divisions, cen-
unit, along with the microbiology unit, also pro-
                                                     ters and offices to develop and implement
vides the laboratory support for the investigation
                                                     research projects that assist in needs assessment,
of suspected acts of bioterrorism.
                                                     policy development, planning and implementa-
    The State Tuberculosis Laboratory conducts       tion of programs. The office also provides con-
diagnostic tests on clinical specimens for the       sultation to local agencies in response to threats
presence of the causative agent of tuberculosis      to their population and participates in training
in support of the state’s TB prevention program.     courses and presentations regarding various
It also serves as a reference center for the state   aspects of epidemiology. The office publishes
and region for identifying other mycobacterial       prevention research in peer-reviewed journals
infections.                                          and departmental publications.
     Working in conjunction with the scientific          The Section for Local Public Health Services
units of the laboratory are two support units —      strengthens the public health system by support-
administrative services and central services. The    ing the continued development of a population-
administrative services unit supports the fiscal     based approach to health issues in Missouri
management and budget preparation for the            communities. The section promotes a strong
SPHL, collects fees paid for laboratory services,    local public health system by defining and sup-
completes the administrative part of the procure-    porting the implementation of core public health
ment process and performs the administrative         functions throughout the state. The section facil-
activities related to personnel management. The      itates development of professional standards and
central services unit prepares glassware, culture    continuous learning opportunities for the local
media and reagents for use in the various scien-     public health workforce. It provides leadership
tific units, oversees the state-wide courier con-    and technical assistance to local public health
tract, and performs all shipping and receiving       agencies and their community partners to
functions for the laboratory including the mail-     improve their services through strategic plan-
ing of reports.                                      ning, continuous quality improvement and other
    The SPHL also has an office for Emergency        initiatives. The section works closely with multi-
Response and Outreach that is responsible for        ple partners and stakeholders to develop and
coordinating statewide laboratory response to        communicate a common vision and direction
emergencies, including acts of bioterrorism, and     for public health in Missouri. The section works
to assure that the SPHL’s response is coordinated    with policymakers and the public to improve
with state and national responses to those acts.     understanding of the importance of public
                                                     health and the responsibility of government to
    The Division of Administration provides          assure that a strong public health system is in
administrative and technical services that assist    place.
department programs to achieve their goals. The
division’s business support services include             The Section for Community Health focuses
budget; grant and contract administration;           on primary prevention strategies to address opti-
accounting; procurement; general office servic-      mum health across the lifespan. Parallel to these
es; and internal auditing.                           primary prevention strategies, are services and
                                                     programs to assist individuals who have already
   The Division of Community and Public              developed a disease or disability, as well as pro-
Health encompasses all public and community          motion of screenings and early intervention
health programs. This division is supported by       strategies to lessen the impact of disease and dis-
units focusing on women’s health; minority           ability. The section provides leadership and
health; epidemiology and health information          coordination for efforts to combat the major
management and evaluation.                           causes of illness, disability and premature death
    The Office of Minority Health established by     in Missouri across the lifespan, including the
statute to eliminate minority health disparities     major chronic diseases, genetic disorders, caus-
through monitoring departmental policies and         es of infant mortality and prevention of uninten-
programs, providing technical assistance, and        tional and intentional injuries.
 EXECUTIVE DEPARTMENTS — DEPARTMENT OF HEALTH & SENIOR SERVICES                                      459

    The section helps Missouri communities            are half as likely to develop cancer of the diges-
enhance the quality of life and health of their       tive and respiratory tracts, as well as other
residents by building local capacity to develop,      chronic diseases, than those who consume
implement and maintain effective community            fewer than two servings a day. A variety of other
health initiatives, programs and systems with a       community interventions promote healthy eat-
focus on primary and secondary preventive care.       ing. The Health Community Nutrition Education
The section offers training, technical assistance     Initiative provides funding to local coalitions to
and financial resources to assist communities         coordinate, conduct and evaluate nutrition edu-
with assessing needs; identifying resources;          cation initiatives that are designed to increase
planning, implementing, and evaluating inter-         the likelihood of healthy food choices by food
ventions; and promoting collaborative agree-          stamp eligible families with children. Three pro-
ments.                                                grams operate within schools and preschools,
    Primary prevention programs promote               Changing the Scene: Improving the Nutrition
healthy lifestyle choices among youths and            Environment Program and School Nutrition
adults. Programs and initiatives focus on increas-    Education and Team Nutrition, to develop life-
ing physical activity and reducing tobacco use        long eating behaviors that promote appropriate
and unhealthy eating-the primary risk factors for     growth and development, decrease overweight
chronic diseases, including obesity. The section      and obesity, improve test scores, decrease
conducts and promotes early screening and             behavior problems and improve attendance as a
intervention to include newborn metabolic and         result of good nutrition. These programs provide
hearing screening. The section supports primary       training, resources and technical assistance, as
prevention strategies for injury prevention. The      well as promoting policies that promote a
section supports local programs through con-          healthy nutritional environment. Additionally,
tracts, training and technical assistance in imple-   Nutrition for Children with Special Health Care
menting evidence-based strategies to reduce the       Needs Program improves nutrition services for
risk factors.                                         children with special health care needs in Mis-
                                                      souri. It is estimated that 60 percent of children
     The Physical Activity Initiatives include
                                                      with special health care needs have a need for
working with schools to assess school policies,
                                                      nutrition services. The Folic Acid Program works
programs and environmental supports, and iden-
                                                      to increase the number of Missourians who are
tifying areas for improvement, such as imple-
                                                      aware of the importance of folic acid intake in
menting an evidence-based curriculum, adopt-
                                                      helping to prevent certain birth defects, diseases
ing a policy to reduce students’ access to
                                                      and health conditions. The Lactation Education
unhealthy snacks, or increasing the amount of
                                                      Training Project is designed to inform health
physical education students receive. The pro-
                                                      care providers and students on the best practices
gram also helps communities identify barriers to
                                                      related to breastfeeding that are linked to de-
physical inactivity and prepare a plan to over-
                                                      creased rates of obesity in adulthood and
come the barriers, such as by increasing access
                                                      increased health for infants and children.
to affordable facilities for physical activity and
distributing information and resources for con-           The Newborn Metabolic Program provides
ducting community physical activity campaigns.        early identification and follow-up of phenylke-
    The Tobacco Use Prevention Program works          tonuria (PKU), galactosemia, congenital hypo-
to educate the public about the dangers of            thyroidism, congenital adrenal hyperplasia and
tobacco use and secondhand smoke. It also             hemoglobinopathies that suggest the presence of
works with youth groups and community coali-          disease in affected but asymptomatic infants.
tions to advocate for policies to ban tobacco and     Follow-up is done to ensure that either a repeat
smoking on school property and in public              newborn screen or a confirmatory test is done.
places; encourages worksites to implement poli-       In addition, infants found to be positive are
cies to ban smoking; encourages health care           referred to a system of health care.
professionals to assess patients’ risk for chronic        The Newborn Hearing Screening Program
diseases and counsels those who use tobacco           seeks to screen all babies before three months of
products to quit. The program advocates for           age, and for those with hearing loss, refer them
employers to include effective cessation services     to the First Steps Program for appropriate servic-
in employee health insurance coverage; and            es by six months of age. Since 2002, Missouri
provides information about tobacco use, sec-          state law requires all babies born in Missouri to
ondhand smoke, and tobacco cessation.                 have their hearing tested before discharge from
    The 5-A-Day for Better Health Program is          the hospital.
designed to increase the consumption of fruits            The Sickle Cell Anemia Program provides
and vegetables in the Missouri population. Sci-       information to the public and health profession-
entific research shows that people who consume        als about sickle cell disease and sickle cell trait;
about five servings of fruits and vegetables daily    and promotes and provides screening, testing,

referral, education, counseling and follow-up         Regional Arthritis Centers located throughout
services for Missouri citizens at risk for sickle     the state.
cell disease.                                             The Missouri Heart Disease and Stroke Pro-
    The Injury Prevention Program collaborates        gram seeks to decrease the risks that contribute
with other agencies addressing injury causes,         to heart disease and stroke by promoting policy
and supports the collection and analysis of           and environmental change programs to improve
injury data. It also contracts with each of the       heart disease and stroke prevention in the com-
nine local Safe Kids Coalitions located through-      munity, schools and worksites. The program also
out the state to conduct primary injury preven-       plans activities and promotions advocating
tion interventions in communities. The nine           smoking cessation, physical activity and good
coalitions are in Jefferson City, Columbia, Han-      nutrition.
nibal, St. Louis, St. Charles, Springfield, Joplin,
Cape Girardeau and Kansas City. The injury pre-           The Missouri Diabetes Prevention and Con-
vention program also contracts with the Univer-       trol Program creates awareness of risk factors for
sity of Missouri to conduct the Think First Mis-      diabetes and control of diabetes to reduce and
souri Educational Program that provides primary       prevent complications of the disease. The pro-
prevention activities addressing the prevention       gram works to improve the lives of people with
of head and spinal cord injury.                       diabetes through community awareness and
                                                      interventions; National Diabetes Education Pro-
    Secondary prevention and treatment servic-
                                                      gram; improvement of health care systems
es focus on preventing and detecting chronic
                                                      through continuing education for health care
and genetic diseases that reduce the quality of
life and shorten life expectancy. The programs        professionals; and professional education,
address numerous chronic diseases including           including a resource guide for school personnel.
asthma, cardiovascular disease, stroke, diabetes,     This is accomplished through partnerships with
arthritis, osteoporosis and lupus, as well as         a variety of state, local and national organiza-
genetic disorders such as cystic fibrosis, sickle     tions.
cell and hemophilia. Major disparities exist in           The Missouri Asthma Prevention and Con-
the health status and disease and death rates         trol Program works to improve the capacity of
experienced by minorities and low socioeco-           Missouri’s public health system to define and
nomic groups when compared with all other             reduce the burden of asthma for people with the
Missourians.                                          disease through effective linkages and compre-
    The Comprehensive Cancer Control Pro-             hensive surveillance and evaluation. The pro-
gram provides professional training in the area       gram works to raise asthma awareness within
of cancer control as well as promoting and            schools, worksites and communities and among
assisting providers in the implementation of can-     health care providers statewide. The program’s
cer control. It also maintains and disseminates       advisory board plays a key role in areas includ-
information on cancer prevention and control          ing the development of a statewide focus on
resources in Missouri; and develops and assists       asthma surveillance, prevention and control;
regional cancer control coalitions. This includes     providing advice regarding asthma-related
the Show Me Healthy Women Program which               issues; assisting in the development of a state
provides funding and program resources for            plan and serving as an outside partner to gain
screening and diagnostic services for breast and      support for the program and its services.
cervical cancers. It also provides cardiovascular
                                                           The Organ Donor Program maintains a
health screenings and life-style interventions
through more than 90 provider networks                statewide confidential registry of potential
statewide and the Cancer Inquiry Program              donors. The program is funded by donations of
responds to public and professional inquiries         one dollar received by the driver’s license offices
about cancer, as well as public concerns about        throughout the state at the time an individual
cancer and the environment.                           makes application for a driver’s license or iden-
                                                      tification card.
    The Missouri Arthritis and Osteoporosis Pro-
gram promotes optimal health and quality of life          A number of Section of Community Health
for all Missourians affected by arthritis, rheumat-   programs focus on ensuring access to and avail-
ic disease and musculoskeletal conditions             ability of primary health care services for all of
including, osteoporosis, lupus, fibromyalgia, and     Missouri’s populations, including residents in
gout. The program’s focus is on prevention, early     the rural areas of the state. This effort involves
intervention, education, service and collabora-       work to reduce the shortage of medical profes-
tion. The program collaborates with a variety of      sionals throughout Missouri. In addition, the
local, state and federal partners to address and      state’s oral health program provides a broad
support key issues related to arthritis and osteo-    range of core public health activities for oral
porosis and works with a network of seven             health.

    The Health Care Workforce Development                  underserved Missouri communities. An
Program works to reduce the shortage of health             additional 15 to 20 professional nurses are
care professionals and to increase access to               provided loan repayments in exchange for
health care for Missouri citizens. The program             service in public and non-profit health
provides health professional student loans to              care agencies in underserved Missouri
medical, dental, dental hygienist and nursing              communities.
students. The loans are “forgiven” when the              The Primary Care Systems Program works
recipient graduates and works in a Health Pro-       through public/private partnerships to ensure
fessional Shortage Area in Missouri. This pro-       access to and availability of primary health care
gram also provides assistance in the recruitment     services for all of Missouri’s populations. Efforts
of foreign medical graduates into underserved
                                                     to increase access include evaluating availabili-
areas to assure the staffing of that health care
                                                     ty and accessibility of medical, psychiatric, and
delivery system. The initiatives include:
                                                     dental health professionals (Health Professional
   • The Health Professional Loan Repayment          Shortage Areas); developing resources to
      Program provides financial incentives for      enhance and expand community-based health
      licensed primary care physicians (family       care delivery systems; working with state and
      or general practice, pediatrics or general     federal partners in the recruitment and retention
      internal medicine), general practice den-      of health care professionals in health profession-
      tists and primary care nurse practitioners.    al shortage areas; development of a population-
      Participants agree to accept Medicare and      based workforce model for primary medical,
      Medicaid patients, as well as provide a        dental and mental health services and assessing
      discounted fee schedule, based on family       the extent, impact and characteristics of the lack
      size and income, for all uninsured individ-    of insurance on the health care delivery systems,
      uals.                                          communities and individuals in Missouri. The
   • J-1   Visa/State 30 Waiver Program and          initiatives include:
      National Interest Waiver Program helps
      foreign medical graduates to remain in
                                                        • Health    Professional Placement Services
                                                           provide an internet-based program to
      Missouri after completion of their                   match health care practitioners to commu-
      advanced medical training in exchange for            nities in areas of need around the state.
      service in underserved communities. Prac-            Service is provided at no cost.
      titioners are recruited and sponsored by a
      Missouri health care facility or organiza-        • The Primary Care Resource Initiative for
      tion to serve the specific needs of that             Missouri provides funds to communities in
      community. The National Interest Waiver              underserved areas to develop community-
      programs allow participants to pursue U.S.           based health care delivery systems, devel-
      citizenship.                                         ops clinical training sites in rural and
                                                           underserved area clinics, and develops
   • PRIMO Health Professional Recruitment                 recruitment programs for primary care
      and Loan Programs assist in the develop-             physicians, dentists and nurse practition-
      ment and implementation of early recruit-            ers.
      ment (high school) programs for health
      professional     students,   emphasizing            The Rural Health Systems Program works to
      recruitment of individuals from rural and      assure the availability of and access to essential
      inner city, underserved communities in         health care services for all rural Missouri resi-
      Missouri. In addition, educational loans       dents through private/public partnerships. Efforts
      are provided to health professional stu-       include those to support the health care delivery
      dents in exchange for an obligation to pro-    system infrastructure in rural areas (particularly
      vide health care services in underserved       small rural hospitals) through resources for ini-
      areas, upon completion of training. Disci-     tiatives to reduce medical errors and support
      plines eligible include primary medical,       quality improvement, comply with new regula-
      dental, dental hygiene and advanced prac-      tions, and implement technology enhancements
      tice nursing.                                  in order to improve services and health out-
                                                     comes. The initiatives under this program
   • The    Professional and Practical Nursing
      Student Loan and Loan Repayment Pro-
      gram provides support for nursing students        • The   Medicare Rural Hospital Flexibility
      and nursing professionals, in exchange for           Program provides support to critical
      service in Missouri’s underserved commu-             access hospitals to implement or expand
      nities. Student loans are provided for up to         quality improvement programs and to
      70 nursing students annually in return for           develop rural health networks among
      an obligation to provide service in public           these hospitals and their community/
      and non-profit health care agencies in               health system partners. The program also

      coordinates activities with the Missouri         to improve health status; contribute to optimum
      Hospital Association and the Missouri            growth and development; and decrease the risk
      Quality Improvement Office to evaluate           of chronic diseases later in life. The assistance
      the quality improvement programs in the          includes meal subsidies to eligible organizations
      critical access hospitals and develop a          that feed infants, children and youth and food
      model program for all. Other program             packages for low-income elderly persons,
      activities are under development to              women, infants and children.
      expand training opportunities for integrat-          The Special Supplemental Nutrition Pro-
      ing local Emergency Medical Services sys-        gram for Women, Infants and Children (WIC)
      tems to improve health outcomes in rural         prescribes and pays for nutritious foods to sup-
      Missouri.                                        plement the diets of pregnant women, new
   • The   Rural Access to Emergency Devices           mothers, infants and children up to their fifth
      Program provides automatic external              birthday, who qualify as "nutritionally at-risk,"
      defibrillators to first responders in selected   based on a medical and nutrition assessment,
      rural areas of Missouri. In addition to pur-     and who meet state income guidelines (185 per-
      chasing and placing the devices, the pro-        cent of federal poverty guidelines or eligible for
      gram provides training on the equipment          Medicaid TANF or Food Stamps in Missouri).
      use and standards of care in order to            Program participants are reassessed periodically
      improve outcomes from out-of-hospital            to determine eligibility status. These services are
      cardiac arrests for residents of rural Mis-      provided at the local level through contracts
      souri.                                           with county and city health departments, com-
   • The   Small Rural Hospital Improvement            munity health centers, community action agen-
      Program provides financial and technical         cies and hospitals. WIC contracts with retail gro-
      assistance to small rural hospitals to           cers and pharmacies where participants pur-
      implement the Prospective Payment Sys-           chase the prescribed supplemental foods. The
      tem; become compliant with provisions of         WIC program provides nutrition education to
      the Health Insurance Protection and              program participants to change eating patterns
      Accountability Act; reduce medical errors;       in a positive way to improve their health status;
      and support quality improvement.                 breastfeeding counseling and support to preg-
                                                       nant women and new mothers; conducts immu-
    The Oral Health Program provides a broad
                                                       nization screenings and referrals to assure chil-
range of core public health activities for oral
                                                       dren are age-appropriately immunized; and pro-
health. Activities include access to oral health
                                                       vides appropriate referrals to address the WIC
care, oral health education and technical assis-
                                                       participant’s need.
tance on fluoride mouth rinse program and com-
munity water fluoridation. It also serves as a             The Child and Adult Care Food Program pro-
resource on oral health issues for other states        vides reimbursement for nutritious meals and
and federal agencies, the dental profession and        snacks served to eligible participants in child
the public. The initiatives include:                   care centers, family day care homes, homeless
                                                       shelters, outside-school-hours programs, and
   • The Elks Mobile Dental Program provides           adult day care centers. The program’s goal is to
      mobile dental units in a public/private
      partnership with the Elks’ Benevolent Trust      see that well-balanced meals are served and
      of Missouri to offer oral health care for        good eating habits are taught in child and adult
      children with special health care needs          care settings. The program serves children under
      and children who are mentally retarded or        the age of 13, children of migrant workers age
      developmentally disabled in a communi-           15 and under, physically and mentally handi-
      ty-based setting.                                capped persons receiving care in a center where
                                                       most children are 18 years and under and adults
   • The  Fluoride Mouth Rinse Program pro-            who are functionally impaired or over 60 years
      vides supplies and technical assistance to       old. CACFP provides training and technical
      public schools in Missouri to conduct a          assistance on nutrition, food-service operations,
      school-based fluoride mouth rinse pro-           program management and record keeping.
                                                           The Summer Food Service Program helps
   • The Water Fluoridation Program provides           assure that eligible populations have access to
      technical assistance on best practices,          nutritious meals during the summer months by
      health outcomes and state and national           providing reimbursement to community agen-
      resources to assist communities to fluori-       cies that can offer the required continuum of
      date the public water supply.                    meals. Eligible participants include children 0-
    The Section of Community Health adminis-           18 years of age whose family incomes are less
ters several programs that provide supplemental        than or equal to 185 percent of the federal
nutrition assistance to vulnerable populations         poverty guidelines. Income-eligible adults over

18 years of age who have been determined by a        an adequate nurse to student ratio. Technical
state educational agency to have a disability and    assistance and consultation are available. The
who participate in a school-based program for        program is a collaborative effort of Missouri’s
the disabled during the school year also are able    departments of Health and Senior Services, Ele-
to participate in the program. The program con-      mentary and Secondary Education and Social
tracts with schools and other community-based        Services.
organizations to sponsor the local programs and          The Adolescent Health Program contracts for
provide the meals that must meet established         adolescent medicine consultation and educa-
guidelines. These guidelines increase the nutri-     tional programs for adolescents, parents, profes-
ent intake of program participants, thereby          sionals and communities to improve the overall
reducing their risk for health problems and
                                                     health status of adolescents. The statewide
enhancing their learning capacities.
                                                     Council for Adolescent and School Health advis-
    The Commodity Supplemental Food Pro-             es the Missouri Department of Health and Senior
gram works to improve the health of low income       Services in assessing adolescent health needs
pregnant and breastfeeding women, other new          and in planning effective strategies to promote
mothers up to one year postpartum, infants, chil-    protective factors and reduce risks to the health
dren up to their sixth birthday, and older persons   of adolescents. In addition, Title V funding is
at least 60 years of age by supplementing their      used to promote abstinence-only education
diets with nutritious U.S. Department of Agricul-    through schools and community-based organi-
ture commodity foods. The program also pro-          zations. The purpose of the program is to edu-
vides health referral services and nutrition edu-    cate adolescents to delay involvement in sexual
cation. Eligible women, infants, and children        activity until marriage, and to decrease out-of-
must meet income eligibility requirements (cur-      wedlock pregnancies, adolescent pregnancy and
rently 185 percent of the federal poverty guide-     birth rates, and sexually transmitted diseases.
lines), while older persons must have income at
or below 130 percent of the federal poverty              The Building Blocks Program is an evidence-
guidelines. Women, infants, children, and the        based prenatal and early childhood nurse home
elderly must reside in the state of Missouri and     visiting program. Participants in the program are
cannot be eligible for the WIC Program.              low income, first time mothers who enter the
                                                     program prior to the 28th week of pregnancy. In
    The Section of Community Health provides         the program, nurse home visitors work with the
leadership to both the public and private sectors    women and their families in their homes during
in assessing the health care needs of families       pregnancy and the first two years of the child’s
and communities and in assuring that the health      life to improve pregnancy outcomes; improve
system responds appropriately. The section also      child health and development; and improve
develops policy; plans systems of care; and          family’s economic self-sufficiency.
designs, implements and evaluates programs to
meet the health care needs of families in Mis-          The Missouri Community-Based Home Visit-
souri, including specific at risk populations such   ing Program utilizes the Families at Risk model
as children with special health care needs and       developed by the University of Missouri/Sinclair
individuals with genetic disorders.                  School of Nursing in collaboration with the Mis-
                                                     souri Department of Health and Senior Services.
    The Maternal and Child Health Coordinated
                                                     The model utilizes nurses and paraprofessionals
Systems distribute federal block grant funds to
                                                     and provides intensive sustained visits and com-
local public health agencies to maintain and
                                                     munity services over a long period (two to three
improve the health status of maternal and child
                                                     years), with a small number of families. The
populations in Missouri. This is done by estab-
                                                     goals of this program are to increase healthy
lishing and maintaining an integrated multi-
                                                     pregnancies and positive birth outcomes and
tiered service coordination system capable of
                                                     decrease child abuse and neglect through home-
addressing targeted maternal and child health
                                                     based services.
issues. Each contractor has a contractual obliga-
tion to utilize evidence-based interventions and         The Missouri Fetal Alcohol Syndrome Rural
address identified maternal and child health risk    Awareness and Prevention Project is a collabo-
indicators which are the most disparate from the     rative effort between state government, academ-
state rates.                                         ic researchers, service providers and medical
    The School Health Program provides con-          professionals that are working together to reduce
tracts to public school districts and local public   the number of pregnancies exposed to alcohol
health agencies to establish or expand popula-       and ultimately reduce the number of children
tion-based health services for school-age chil-      diagnosed with Fetal Alcohol Syndrome.
dren in defined geographic areas. The program            The SAFE-CARE Network is composed of
focus is on increasing access to primary and pre-    physicians and nurse practitioners who are
ventive health care. An effort is made to assure     trained to provide comprehensive, state-of-the

art medical evaluations to alleged victims of        adults (21 years of age and older) with cystic
child sexual assault. The program responds to        fibrosis, hemophilia and sickle cell disease. The
the need for a coordinated, effective response to    program provides applicants meeting financial
child sexual assault and utilizes electronic link-   and medical guidelines with limited financial
ages between SAFE-CARE Network providers to          assistance for inpatient and outpatient services,
improve medical consultation in rural and            medication and blood factor products, emer-
underserved areas.                                   gency care and home equipment. Service coor-
    The Rape Prevention and Services to Victims      dination is provided for those meeting the med-
Program contracts with rape crisis centers and       ical eligibility.
other community-based counseling agencies to             The Metabolic Formula Distribution Pro-
provide services for community and profession-       gram provides prescribed dietary formula to
al education, counseling for victims and families    individuals with covered metabolic disorders
and crisis hotline services.                         such as Phenylketonuria (PKU) or Maple Syrup
    The Medical Examination for Victims of           Urine Disease. Use of the dietary formula com-
Rape Program provides reimbursement for med-         bined with a medically supervised diet elimi-
ical examinations for victims of rape when per-      nates or reduces the adverse consequences of
formed for the purpose of gathering evidence for     the disorders.
prosecution and when the cost is not covered by
                                                         Service Coordination is a collaborative
other sources (insurance, Medicaid or Medicare)
                                                     process that assists an individual/family to assess
with the following conditions:
                                                     their needs and resources, and develop a plan to
   • Victim consents in writing to the examina-      address those needs, including assessment for
      tion.                                          home-based services. This program facilitates,
   • Report is made on a form approved by the        implements, coordinates, monitors and evalu-
      attorney general.                              ates services and outcomes, and encourages an
                                                     individual/family to develop the skills needed to
   • Report is filed with the prosecuting attor-     function at their maximum level of independ-
      ney in the county where the rape
      occurred.                                      ence. Service coordinators continue to monitor
                                                     and evaluate individual services as long as the
    The Hope Service Program provides assis-
                                                     participant remains in the service.
tance for children under the age of 21 who meet
financial and medical eligibility guidelines. This       The Adult Head Injury Service provides
service focuses on early identification of chil-     assistance in locating, coordinating and pur-
dren with special needs; funding for preventive,     chasing rehabilitation and psychological servic-
diagnostic and treatment services; and provision     es for individuals 21 years of age and older who
of service coordination activities for families.     have survived a traumatic brain injury, which is
Service coordination is provided through 13          defined as “a sudden insult or damage to the
regional contracts and by unit staff located in      brain or its coverings, not of a degenerative
eight area offices throughout the state.             nature.” Service coordination is available free of
    Healthy Children and Youth-Administrative        charge, regardless of financial status of the indi-
Case Management provides preventive health           vidual. Rehabilitation funding is available
services to children under the age of 21 who are     statewide to survivors whose income is 185 per-
enrolled in Medicaid. The objectives of this pro-    cent of poverty or lower. The Head Injury Advi-
gram are improved access to health services;         sory Council provides information, advice and
increased frequency of health screenings;            expertise to the department on head injuries and
improved provider participation in Medicaid;         rehabilitation of people affected by traumatic
and expansion of diagnostic and treatment serv-      head injuries. The council also studies current
ices.                                                prevention, treatment and rehabilitation tech-
    The Physical Disabilities Waiver Program         nologies; advises the department on appropriate
provides home and community-based services           distribution of resources to provide specialized
to individuals with serious and complex medical      services to people with traumatic head injuries;
needs who have reached the age of 21 and are         and recommends methods to improve the state’s
no longer eligible for home care services avail-     delivery of service.
able through the Healthy Children and Youth              The Section of Community Health is also
program in Missouri. This waiver is designed to      responsible for communicating with the general
provide a cost-effective alternative to placement    public about health issues and providing infor-
in an intermediate care facility for the mentally    mation about programs available to prevent and
retarded/developmentally delayed.                    address a multitude of health concerns. Public
   The Adult Genetics Program provides limit-        education programs help link people with the
ed assistance with health care costs for Missouri    health services they need.
 EXECUTIVE DEPARTMENTS — DEPARTMENT OF HEALTH & SENIOR SERVICES                                      465

    TEL-LINK, the Department of Health and             state level that can be added with data from
Senior Services’ toll-free telephone line for          other states to form a picture of the health status
maternal, child and family health services, pro-       of the nation. The data are made accessible
vides information and referrals to Missouri resi-      through the department’s web site.
dents about a wide range of health services. All           The Health Data Analysis unit analyzes and
callers are given referral telephone numbers and       reports data related to births, deaths, marriages,
then are transferred immediately to the appropri-      marriage dissolutions, abortions, and other
ate agency or treatment center. TEL-LINK can           health statistics. These vital statistics are pub-
connect callers to services for: family planning,      lished in a monthly news bulletin, an annual
prenatal care, prenatal drug abuse, immuniza-          report and periodic special reports. The unit also
tions, adoption, non-emergency medical trans-          prepares annual population estimates. Births and
portation (Medicaid only), alcohol and drug            death data and special surveys are used to eval-
abuse, WIC, Medicaid, children with special            uate the effectiveness of maternal and child
health care needs, sexual assault or rape, family      health programs in Missouri.
violence, etc. Calls, which are confidential, are
answered 8 a.m. to 5 p.m., Monday through Fri-             The Health Services Statistics unit analyzes
day. Recorded messages are taken after 5 p.m.          data related to injuries in Missouri. These data
on weekdays and throughout the day and night           sets include ambulance trip ticket data, Head
on weekends and holidays.                              and Spinal Cord Injury Registry data, mortality
                                                       data, hospital inpatient and outpatient data,
    The division also works to improve health          motor vehicle crash data and data related to the
outcomes in Missouri through statistical and           sexual abuse of children. The unit also assists
information systems activities and surveillance        other programs in designing, conducting and
and epidemiology research related to maternal,         analyzing surveys. The unit collects and ana-
infant, child and general adult health status;         lyzes patient abstract data filed by hospitals and
chronic disease risk factors and behaviors; envi-      ambulatory surgical centers. The unit publishes
ronmental influences; and access and utilization       the Managed Care Consumer’s Guides on com-
of public health and health services. Surveil-         mercial, Medicare, and MC+ managed care
lance activities include tracking selected indica-     plans on the quality of care and access to care of
tors, disseminating data reports, analyzing, and       Missouri’s HMO and POS products and their
interpreting the health data to develop interven-      members’ reports of satisfaction.
tions to improve the health of all Missourians.
                                                           The Behavioral Risk Factor Surveillance Sys-
     The Bureau of Vital Records serves as the         tem Program tracks the prevalence of chronic-
state archives for vital records. All births and       disease related characteristics and monitors
deaths in Missouri are registered with the bureau      progress toward national health objectives relat-
that, in turn, issues copies of birth and death cer-   ed to decreasing high-risk behaviors, increasing
tificates to eligible persons. In 2004, the bureau     awareness of medical conditions, and increasing
issued nearly 75,000 copies of vital records on        the use of preventive health services of individu-
file. Other records on file are for marriages and      als age 18 years and older.
marriage dissolutions in Missouri. Approximate-
ly 210,000 records of births, deaths, fetal deaths,        The Missouri Cancer Registry Program tracks
marriages, divorces, and abortions were filed          the incidence (new cases) of cancer, the types of
with the Bureau of Vital Records in 2004. Mis-         cancers that occur, their locations within the
souri’s files for resident births and deaths date      body, the disease stage of the cancer at the time
from 1910 and the files for marriage dissolutions      of diagnosis, and the kinds of treatment that
date from 1948.                                        patients receive.
    The Health Statistics units collect, analyze          The Fetal Alcohol Syndrome Surveillance
and distribute information which promotes bet-         Network monitors the incidence of fetal alcohol
ter understanding of problems and needs in Mis-        syndrome in children.
souri, as well as spotlighting progress achieved           The Pediatric Nutrition Surveillance System
in the general health status of Missourians. Data      analyzes the growth, anemia, and breastfeeding
generated by the section aid and guide the plan-       status and trends of children in federally funded
ning, development and evaluation of programs           child health and nutrition programs such as the
and services of the department as well as the          Special Supplemental Nutrition Program for
related activities of other agencies, institutions     Women, Infants, and Children (WIC) to monitor
and organizations.                                     progress toward national health objectives and
    While the data collected by these units are        to evaluate interventions to improve the nutri-
primarily valuable to help solve Missouri prob-        tional health of children.
lems, much of the activity is coordinated with             The Pregnancy Nutrition Surveillance Sys-
the National Center for Health Statistics. This        tem analyzes behavioral and nutritional risk fac-
allows comparable data to be collected at the          tors among pregnant and postpartum women in

the state enrolled in public health programs to        AIDS, community sanitation, environmentally
monitor progress toward national health objec-         related health hazards and hazardous substance
tives and to evaluate interventions designed to        control.
improve the nutritional health of the women of             The section is integral to the Department of
childbearing age.                                      Health and Senior Services’ emergency respons-
    Through the Nutrition Screening Program,           es to public health emergencies and natural dis-
students in participating schools are weighed          asters, including biological, chemical and radio-
and measured using U.S. Centers for Disease            logical terrorism. The section assures rapid
Control and Prevention guidelines. From this           detection through a comprehensive surveillance
information, a Body Mass Index-for-age is calcu-       system operated by public health staff prepared
lated and compared to age and sex-specific             through expertise and training to detect dis-
national norms. School nurses make appropriate         eases/conditions that may indicate an emer-
referrals of students who are identified as at         gency/bioterrorism event. Rapid response is
nutritional risk.                                      assured through emergency response planning
    The Oral Health Screening and Surveillance         by public health staff deployed strategically and
Program establishes a state-based oral health          prepared through expertise and training to
surveillance system to evaluate the oral health of     respond to a possible emergency/bioterrorism
Missouri populations, beginning with selected          event.
school-aged children and to evaluate access to             The Environmental Public Health Unit is
dental services for those children and provide         involved in the investigation and prevention of
technical assistance to schools conducting den-        diseases related to the environment and admin-
tal screens.                                           istration of environmental sanitation programs in
    The Fetal and Infant Mortality Review ana-         accordance with Missouri statutes. The unit’s
lyzes infant and fetal death records to develop        efforts focus on diseases associated with expo-
recommendations for community change, if               sure to chemical, bacteriological and physical
appropriate, to reduce fetal and infant mortality.     agents in our environment and in the food and
The communities then determine and implement           water we consume.
interventions based upon recommendations                   Services include: conducting epidemiologi-
received that may improve outcomes for future          cal studies of environmentally-related outbreaks
families.                                              of disease; performing health assessments and
    The Pregnancy Associated Mortality Review          quantitative risk assessments of hazardous waste
monitors death certificates, relevant birth or fetal   sites; providing public health consultation and
death certifications and medical records for data      toxicological consultation for emergencies
abstraction to determine if the deaths were pre-       involving chemicals; providing technical advice
ventable. Data is analyzed for association of          related to pesticides and other hazardous sub-
variables and trends.                                  stances; implementing the state Childhood Lead
                                                       Poisoning Prevention Program and administer-
    The Missouri Pregnancy Related Assessment
                                                       ing lead grants from the Centers for Disease
and Monitoring System expands Missouri’s
                                                       Control and Prevention and the Environmental
reproductive health surveillance and survey
                                                       Protection Agency; assuring safe lead abatement
infrastructure by carrying out a pilot survey that
collects state-specific, population-based data on      activities by accrediting lead abatement training
maternal attitudes and experiences prior to, dur-      programs and licensing lead abatement person-
ing and immediately following pregnancy, with          nel; providing health physics consultation to
the overall goal to improve maternal and infant        those involved with radiation-producing devices
health and for future comparison with other            and materials; reviewing and evaluating plans
states.                                                for radiation facilities; keeping a register that
                                                       includes all owners and possessors of radiation
    The Section of Environmental Health and            machines and radioactive materials used in a
Communicable Disease Prevention is the princi-         nonmedical setting; evaluating radiological
pal unit involved in the investigation of the          health risks associated with various work envi-
cause, origin, and method of transmission of           ronments; responding to all radiological emer-
communicable diseases and diseases caused by           gencies; responding to emergencies affecting
environmental hazards. These diseases and con-         food safety, lodging safety, and private water
ditions are major public health concerns in Mis-       supplies; providing professional and public
souri.                                                 information on radon; providing technical
    The interrelated services of this section focus    advice related to indoor air quality issues; pro-
on disease surveillance, prevention and control.       viding technical assistance to local public health
Included are specific responsibilities related to      agencies on environmental public health issues;
communicable diseases, immunizations, tuber-           assuring inspection of food establishments for
culosis, zoonoses, sexually transmitted diseases,      compliance with sanitation codes and standards;

providing food sanitation training for local          system of community-based organizations,
health agency personnel, personnel of food            local, district and state health departments;
establishments and public education; providing        administering the Missouri Medicaid AIDS
technical assistance to other state agencies relat-   Waiver service to eligible individuals in lieu of
ing to food sanitation activities; administering      inpatient nursing or hospital facilities; providing
food protection licensure programs as required        consultation, education, and guidelines/recom-
by statute; certifying food sources located in        mendations on zoonotic disease outbreak inves-
Missouri for interstate and international trans-      tigations, human prophylaxis and management
port; assuring that salvage operations do not         of animals with diseases capable of transmission
allow food products potentially harmful to            to humans; acting as liaison with other agencies
human health to enter commerce; conducting            such as the Missouri Department of Agriculture
sanitation ratings of all grade A milk supplies       to maintain current knowledge of diseases and
and certifying them for sale in accordance with       environmental conditions occurring in animal
the Interstate Milk Shippers Agreement; provid-       populations that may affect humans; acting as
ing technical assistance to local and state offi-     liaison between the Department of Health and
cials on matters relating to food and drug sanita-    Senior Services and the federal Centers for Dis-
tion; working in partnership with the U.S. Food       ease Control and Prevention and other federal
and Drug Administration to assure food products       and state agencies concerned with communica-
are manufactured, stored and distributed in a         ble disease control; collaborating with commu-
safe, wholesome manner; providing technical           nity groups to affect action plans for preventing
assistance for general sanitation; providing con-     and controlling diseases of high prevalence
sultation, technical assistance and inspection        within the community; providing, without
services related to private water supplies; provid-   charge, prescribed drugs for the treatment of TB
ing consultation on recreational water supplies,      disease or infection; providing tuberculin skin
including swimming pools; assuring sanitation         testing materials for use in contact testing pro-
and safety inspections of commercial lodging          grams; maintaining a registry of known tubercu-
establishments; license commercial lodging            losis cases and tuberculosis infection in Mis-
establishments; assuring all new and repaired         souri; disseminating guidelines for TB control in
on-site sewage treatment facilities are construct-    Missouri; coordinating case management for TB
ed/repaired in compliance with state standards        on a statewide basis; providing assistance to
through a permit and inspection program; pro-         local health officials in the screening and treat-
viding training courses for onsite sewage             ment of public health conditions in newly arriv-
installers, inspectors/evaluators and local regula-   ing refugees; administering the federal Vaccines
tory authorities; and registering onsite sewage       for Children program, which provides immu-
installers.                                           nizations for Medicaid, uninsured, underin-
                                                      sured, Native American, Alaskan Native and
    The Communicable Disease Prevention Unit          Pacific Islander children; coordinating the peri-
is dedicated to the prevention and control of         natal hepatitis B program, in which pregnant
communicable diseases. The unit includes the          women carrying hepatitis B are followed
following: the Disease Investigation program;         through delivery so newborns are treated to pre-
and the Prevention and Care program.                  vent transmission of the disease to them; provid-
    Services include: establishing rules and poli-    ing education and information to the public, as
cies pertaining to the control and prevention of      well as to private and public health care
communicable diseases; consulting with local          providers, about appropriate administration,
health officers, practicing physicians and others     storage and handling of vaccines for children,
regarding diagnosis and control measures for          adolescents and adults; conducting surveys with
specific communicable diseases; consulting            all school and daycare providers to assure com-
with local public health agencies on coordina-        pliance with state immunization requirements;
tion of disease outbreak investigations, disease      and collaborating with other programs within
investigation control activities and analysis of      the Missouri Department of Health and Senior
data; collecting and analyzing disease case           Services, other state and federal agencies and
reports and providing feedback reports; working       community-based organizations in emergency
with physicians and laboratories to encourage         event planning and response.
complete reporting of communicable diseases;              The Office of Surveillance tracks and docu-
assuring rapid response to public health emer-        ments occurrence and distribution of communi-
gencies and natural disasters, including bioter-      cable, vaccine preventable, sexually transmitted,
rorism events; collaborating with community           and environmentally induced diseases in Mis-
members throughout the state who serve on the         souri, as well as potential intentional introduc-
HIV/STD Prevention Community Planning                 tion of disease by terrorist agents, through devel-
Group; coordinating comprehensive services to         opment and improvement of the statewide sur-
individuals with HIV/AIDS through a statewide         veillance system.

    Services include: identifying surveillance        ual for a private employment arrangement, many
data needs, designing data collection process-        employers of child-care, elder-care and person-
es/systems, developing and maintaining data           al-care workers are required to obtain back-
systems and datasets, analyzing and interpreting      ground screening information for staff in order to
data and producing reports; analyzing surveil-        obtain or maintain licensure or to be in compli-
lance data at regular intervals to track trends and   ance with state regulations. Employers, such as
providing regular reports on these analyses;          child-care centers and nursing homes, often
establishing and/or modifying rules pertaining to     have difficulty in recruiting and maintaining
the reporting of communicable disease and             skilled staff. The delays they currently experi-
environmentally-induced illnesses/conditions;         ence in obtaining background screening results
working with hospitals, physicians, laboratories      can impact their ability to hire and retain staff.
and others to report diseases and environmental       These employers are required to contact several
conditions; performing epidemiological analy-         state agencies in order to comply with statutes or
ses to answer inquiries and help target disease       regulations for background screening. The reg-
intervention activities; providing consultation to    istry offers these employers an alternative to their
programs regarding application of surveillance        current method of obtaining background screen-
data to program policy/practice; developing and
                                                      ing information.
coordinating ongoing quality assurance process-
es on data gathered in surveillance databases;            The registry maintains a toll-free access line
working in partnership with the Agency for Toxic      to respond to requested information and allows
Substances Disease Registry on hazardous sub-         the requestor to receive an immediate response
stances emergency events surveillance; working        as often as they like at no cost. The access line is
in partnership with Tulane University, the            staffed from 7:00 a.m. to 6:00 p.m., Monday
Department of Natural Resources, the City of St.      through Friday and an Internet site is also main-
Louis, and other agencies and organizations on        tained for easy access.
childhood blood lead and environmental hazard             The Missouri Board of Nursing Home
identification and reduction; conducting bioter-      Administrators was established in 1970. The
rorism surveillance by obtaining syndromic sur-       board is responsible for adopting, amending and
veillance data from hospitals, physicians and
                                                      repealing rules necessary to carry out the provi-
others and analyzing the results to ensure
                                                      sions of Chapter 344, RSMo; establishing mini-
prompt response to incidences and unusual
                                                      mum standards for licensing nursing home
trends of diseases or syndromes of public health
                                                      administrators; providing testing opportunities
importance; and providing heightened surveil-
lance when national and/or state threat levels        for qualified applicants; approving and monitor-
are raised or in response to known or suspected       ing continuing education programs designed for
disease outbreak.                                     nursing home administrators; auditing license
                                                      renewal applications and renewing the licenses
   The Division of Regulation and Licensure           of qualified licensees; and conducting hearings
oversees the health care regulatory programs of       affording due process of law, upon charges call-
the department, and assures the safety, health,       ing for discipline of a licensee.
welfare and rights of persons residing in long
term care facilities.                                     The board, appointed by the director of the
                                                      department, consists of 10 members who serve
    The Family Care Safety Registry serves as a
                                                      three-year staggered terms. Membership of the
resource for background screening information
                                                      board consists of one licensed physician, two
maintained by various state agencies. Those
                                                      licensed health professionals, one person from
wishing to hire a child-care, elder-care or per-
sonal-care worker may contact the registry using      the field of health care education, four people
a toll-free access line and obtain background         who have been in general administrative charge
information about a caregiver. The registry           of a licensed nursing home for at least five years
became operational January 1, 2001, and uti-          immediately preceding their appointment and
lizes a computer interface to streamline the          two public members.
process to obtain background information from             The Section for Health Standards and Licen-
various state agencies.                               sure oversees the health care and child care reg-
    Information accessed by the registry              ulatory programs of the department. Supervision
includes: criminal history, Sex Offender Registry,    is provided for hospital licensure and certifica-
substantiated claims of child abuse/neglect, the      tion activities, hospice and home health licen-
DHSS Employee Disqualification List, the DMH          sure and certification activities, emergency med-
Employee Disqualification Registry, child care        ical services, registration of handlers of con-
license revocations and foster parent license         trolled substances, child care provider licensure
denials, revocations and suspensions. In addi-        activities, and inspection of license-exempt
tion to the needs of families selecting an individ-   child care providers.
  EXECUTIVE DEPARTMENTS — DEPARTMENT OF HEALTH & SENIOR SERVICES                                       469

     The Bureau of Healthcare Oversight is               response agencies, emergency medical service
responsible for health facility licensing and cer-       training entities, and trauma centers.
tification services, home health agencies, hos-              Currently, Missouri’s ground ambulance
pices, outpatient physical therapy/speech reha-          services, air ambulance services and fixed-wing
bilitation agencies and comprehensive outpa-             air ambulance services make approximately
tient rehabilitation facilities licensing and certifi-   700,000 runs per year. These ambulance servic-
cation services, emergency medical services and          es are inspected for licensure every five years. At
trauma services and related programs adminis-            least one paramedic, nurse or physician with the
tered by the Department of Health and Senior             capability of providing an advanced level of care
Services. The bureau consists of three units: the        to the patient staffs ninety percent of the emer-
Unit of Health Facility Regulation, the Unit of          gency ambulance transports of a patient to a
Home Care and Rehabilitative Standards and the           hospital. This is one of the highest rates in the
Unit of Emergency Medical Services.                      nation.
    The Unit of Health Facility Regulation is                The trauma program was formally estab-
responsible for the regulation and licensing of          lished by state law in 1987 and revised in 1998.
Missouri’s hospitals, ambulatory surgical centers        Regulations that specify the criteria for trauma
and abortion facilities that are required to renew       center designation went into effect in January
their licenses annually in accordance with cur-
                                                         1990 and September 1998. A network of trauma
rent statutes. License renewals are based upon
                                                         centers designated according to capability
compliance with state regulations in the areas of
                                                         serves Missouri. Missouri’s trauma center hospi-
fire safety, environment, organization and
                                                         tals see over 12,000 severely injured patients per
administration, and all aspects of patient care.
The unit also contracts with the Center for
Medicare/Medicaid Services to survey and rec-                This unit administers the ambulance report-
ommend certification of providers and suppliers          ing system, head and spinal cord injury registry,
of services as participants under Title XVIII            and trauma registry. These are among the most
(Medicare) of the Social Security Act. Providers         comprehensive reporting systems of their type in
include hospitals, independent laboratories,             the United States.
end-stage renal disease facilities, portable x-ray         The governor-appointed State Advisory
providers, ambulatory surgical centers, rural            Council on EMS provides advice to the depart-
health clinics, and long-term care units in hospi-       ment on EMS regulatory issues.
                                                             The Bureau of Narcotics and Dangerous
   The unit also registers medical sources of            Drugs (BNDD) is responsible for ensuring the
ionizing radiation throughout the state, includ-         proper management and distribution of con-
ing x-ray machines. The unit contracts with the          trolled substances for legitimate medical and
Federal Drug Administration to perform surveys           manufacturing purposes. Controlled substances
of mammography screening providers.                      include medications and chemicals used in the
    The Unit of Home Care and Rehabilitative             manufacture of these medications that have
Standards is responsible for regulating and              been determined to be abusable or addictive.
licensing Missouri’s home health agencies and                All individuals and firms who manufacture,
hospices. Home health agencies and hospices              distribute, prescribe, dispense or handle con-
are required to renew their state licenses annu-         trolled substances in the state of Missouri must
ally, in accordance with current statutes.               register with the BNDD every two years. Those
     Additionally, through contracts with the Cen-       required to register with the BNDD include
ters for Medicare/Medicaid Services, surveys are         physicians, hospitals, pharmacies, dentists,
conducted for certifying home health agencies,           ambulance services, veterinarians, optometrists,
hospice organizations, outpatient rehabilitation         podiatrists, manufacturers, distributors, labs and
facilities, and comprehensive outpatient rehabil-        importers and exporters who desire authority to
itation facilities as providers under Title XVIII        possess or perform functions with controlled
(Medicare) of the Social Security Act. Consulta-         substances.
tion is provided regarding licensing require-                The BNDD is active in the education of
ments and compliance with Medicare Condi-                health professionals who handle controlled sub-
tions and Participation.                                 stances. The records of all registrants are subject
    The Unit of Emergency Medical Services               to inspections, audits, or investigations (if need-
administers the laws relating to emergency med-          ed). Violations of controlled substance laws can
ical technicians-basic, emergency medical tech-          lead to administrative sanctions. Criminal viola-
nicians-paramedic, air ambulance services,               tions are referred to appropriate law enforce-
ground ambulance services, emergency medical             ment agencies.

   The bureau’s surveillance helps prevent the
diversion of drugs or chemicals from their prop-
                                                          • inspects, conducts utilization reviews, and
                                                             determines client eligibility for intermedi-
er channels of distribution. This helps protect              ate care facilities for persons with mental
against the misuse or abuse of these substances.             retardation (ICF/MR); and
    The Bureau of Child Care is responsible for
the regulation and licensing of child care facili-        • implements appropriate rules and regula-
                                                             tions in accordance with the Omnibus
ties. The bureau is also responsible for the annu-           Nursing Home Act; and with the U.S.
al safety, health and sanitation inspections of              Department of Health and Human Ser-
child care facilities operated by religious organ-           vices, determines Medicaid/Medicare cer-
izations.                                                    tification of intermediate care and skilled
    Child care staff conduct on-site inspections             facilities.
service of child care facilities and provide tech-         The Division of Senior and Disability Ser-
nical and consultative assistance. The bureau’s        vices serves as the State Unit on Aging and car-
mission is to ensure that all facilities provide a     ries out the mandates of the state of Missouri
healthy, safe and developmentally-appropriate          regarding programs and services for seniors and
environment for Missouri’s children.                   adults with disabilities. Mandates for the division
    The goal for the bureau is to have a positive      include oversight and implementation of pro-
impact on the overall health, safety and well          grams designed to maximize independence and
being of children in child care programs. The          safety for adults who choose to remain inde-
bureau works to meet this goal through health          pendent in the community by administering
promotion and education, facilitating immu-            state and federal community-based programs.
nizations, improved meals and nutrition educa-
                                                           The Elder Abuse and Neglect Hotline or Cen-
tion, communicable disease prevention, im-
                                                       tral Registry Unit (CRU) was established in 1980
proved cleanliness and sanitation, injury reduc-
                                                       and responds to reports of alleged abuse, neglect
tion, prevention of child abuse and neglect, and
                                                       or financial exploitation of persons 60 years of
serving children with special needs. Training for
                                                       age or older and other eligible adults between
child care providers is partially provided through
                                                       age 18 and 59. Calls are received at this central-
contracts with training organizations. Consulta-
                                                       ized registry, summarized into a report, and sent
tion and technical assistance for child care
                                                       to the appropriate investigative authority. A
providers is provided by local community health
                                                       trained Social Services Worker will respond
nurses through a contracted program. In addi-
                                                       within a specified time period depending on the
tion, referral services, consultation and technical
                                                       severity of the case: within 24 hours for the most
services are provided to families of special needs
                                                       dangerous situations and within seven days for
children and the providers who serve those fam-
                                                       most others.
                                                           The DHSS Section for Long Term Care Regu-
    The Section for Long Term Care Regulation,
                                                       lation staff conduct investigations of reported
in accordance with the Omnibus Nursing Home
                                                       abuse, neglect and exploitation of individuals
Act, is responsible for assuring the safety, health,
                                                       residing in long term care facilities. Complaint
welfare and rights of persons residing in nursing
                                                       investigations are handled in accordance with
homes (long term care facilities). The section has
                                                       state statute, and all information obtained during
the legal authority to intervene in cases of abuse,
neglect or exploitation among elderly or dis-          investigations is handled in a confidential man-
abled persons who reside in nursing homes. The         ner. Reports or complaints are generally initiated
section:                                               within 24 hours. The hotline 1-800-392-0210
                                                       operates 24 hours per day, 365 days per year and
   • inspects and licenses adult day care cen-         is staffed by 12 Social Service Workers.
      ters, adult residential care, intermediate
      care and skilled nursing facilities;                 The Bureau of Program Integrity is responsi-
                                                       ble for the interpretation, development, imple-
   • investigates   complaints of abuse or neg-        mentation and maintenance of Missouri protec-
      lect at long term care facilities;               tive services and case management policies.
   • reviews and approves plans for proposed           Staff interpret and promulgate state regulations,
      long term care facilities;                       coordinate and develop protocols and operating
                                                       procedures to maximize efficiency and effective-
   • investigates complaints for any allegation        ness in the provision of adult protective and
      of failure to comply with all rules and reg-
      ulations;                                        home and community based services. The
                                                       bureau provides oversight, support and program
   • investigates complaints of misuse of resi-        evaluation in the administration of the Aged and
      dent funds in long term care facilities;         Disabled Medicaid Waiver in coordination with
   • reviews applications for licenses to oper-        the Department of Social Services/Division of
      ate a long term care facility;                   Medical Services. The bureau also oversees the
 EXECUTIVE DEPARTMENTS — DEPARTMENT OF HEALTH & SENIOR SERVICES                                      471

development, improvement and training of the                reassessment, adjustments to care plans
information systems used for tracking statistical           and discharge;
information, authorization and reimbursement
for care authorized by Social Service Workers.
                                                         • authorize in-home services in the home or
                                                            community under the Missouri Care
Policies are developed in compliance with                   Options (MCO) program through state and
applicable Code of State Regulations, state and             federal funding to include basic and
federal statutes, guidelines and rules.                     advanced personal care, homemaker,
    The Bureau of Quality Assurance conducts                chore, nursing services, counseling, basic
formal reviews, provides technical assistance,              and advanced respite, and adult day
and conducts complaint investigations of con-               health care;
tracted in-home services providers that deliver
services to clients of the division. The bureau is
                                                         • oversee care plans developed in conjunc-
                                                            tion with seniors and persons with disabil-
responsible to:                                             ities in community based settings who are
   • conduct on-site quality assurance reviews              screened and determined to be medically
      of provider’s files, primarily client and             eligible for nursing facility care and Med-
      employee files.                                       icaid eligible (or potentially Medicaid eli-
                                                            gible); and
   • conduct on-site technical assistance visits
      with new providers to answer questions             • coordinate     with other organizations
      the provider may have about the program.              involved in care planning to include state
                                                            (SSBG/GR) and Medicaid funded in-home
   • conduct  on-site complaint investigations
                                                            services, home health, and local commu-
      upon receipt of provider complaints.
                                                            nity resource providers on behalf of clients
   • provide education and the required certi-              to strengthen the support system necessary
      fied manager quarterly training for the in-           to maintain independence and ensure the
      home services providers and their staff,              highest available quality of service deliv-
      and participate in quarterly regional in-             ery.
      home services provider meetings.
                                                          The Bureau of Senior Programs is responsi-
    The Bureau of Home and Community Ser-             ble for activities on behalf of the division and
vices is responsible for services and programs        ensures the effective and efficient management
directly administered by the division for eligible    of state and local activities associated with the
persons 60 years of age or older and adults with      Older Americans Act. As a result of the 1973
disabilities between the ages of 18 and 59. Gen-      amendments to the Older Americans Act, states
erally, to be eligible for services, adults must      must designate planning and service areas to
meet specific guidelines pertaining to protective,    develop and implement programs and services
economic, social, and care needs. Through a           for older persons at the local level. Missouri has
comprehensive investigative or assessment             ten Area Agencies on Aging (AAAs), each re-
process, the bureau determines the intervention       sponsible for providing services and overseeing
and/or services necessary to meet the needs of        programs within specifically defined geographic
each eligible adult. Professionally trained social    boundaries. Within the mandates of the Act, pri-
service workers, and long-term care specialists       ority is given to serving older adults in the great-
carry out state mandates for direct services to       est social and economic need with a focus on
adults in Missouri. Field staff are responsible to:   serving low-income and minority elderly. Staff
   • investigate reports of elder abuse, neglect
      and exploitation of non-institutionalized          • conduct   periodic monitoring reviews of
      elderly;                                              the local programs to verify compliance
                                                            with state and federal guidelines and to
   • intervene   on behalf of eligible adults
                                                            validate program and service effective-
      believed to be at risk of injury or harm
      including preparing cases for litigation              ness.
      based on investigative findings;                   • provide training and technical assistance
                                                            to AAA staff and their boards as requested,
   • screen   individuals considering long term
                                                            keeping them apprised of new develop-
      care to ensure individuals have the ability
      to make an informed decision about care               ments in the aging field, and federal and
      and care settings;                                    state policies and procedures.
                                                         Each AAA is allowed flexibility in providing
   • provide case management services to indi-        the services most needed within their planning
      viduals requiring assistance to remain in
      their homes, including intake and screen-       and service area. Each AAA:
      ing, assessment, service planning and              • is  required to submit an area plan for
      authorization, care monitoring, eligibility           review and approval in order to receive

      funding to carry out various provisions of        The Missouri Health Facilities Review Com-
      the Older Americans Act at the local level.   mittee carries out its function as the administra-
                                                    tor of the Missouri CON law with the support of
   • administers  the nutrition program - both
                                                    CONP staff.
      congregate and home-delivered meals,
      including nutrition education activities.         The agency assists with program planning,
   • provides funding for access services, legal    development and analysis of health data, policy
      services and in-home services. Access         planning, identification of program needs,
      services include transportation and Infor-    graphics development, strategic assessments and
      mation and Assistance, and general out-       other special projects in cooperation with the
      reach and advocacy activities. (In-home       director of the department and other state
      services include, homemaker chore, per-       departments.
      sonal care and respite.)
   • provides  disease prevention and health        Missouri SenioRx Program
      promotion activities or services to encour-
      age the employment of older workers,          Jefferson Bldg., Rm. 1310
      services to support family caregivers,        205 Jefferson St.
      ombudsman services, and information           Jefferson City 65101
      about the prevention of abuse, neglect        Telephone: (573) 522-3070 / Fax: (573) 522-3073
      and exploitation of seniors.                  Toll Free: 1-866-256-3937

   • AAAs may also provide one or more of the            During the 2001 Special Legislative Session,
      following services: minor home modifica-      the Missouri General Assembly passed House
      tion, counseling, adult day care, tele-       Bill 3 and Senate Bill 4, which created the Mis-
      phone reassurance, friendly visiting, case    souri SenioRx Program to help defray the cost of
      management, and volunteer recruitment.        prescription drugs for seniors. The program is
                                                    designed to aid those individual seniors with
                                                    incomes less than $17,000 and married couples
Certificate of Need Program                         with income less than $23,000. In addition to
                                                    the income requirements of the program, a sen-
PO Box 570
                                                    ior must meet the following eligibility criteria to
Jefferson City 65102
Telephone: (573) 751-6403 / Fax: (573) 751-7894
                                                    qualify: be 65 years of age; be a resident of the
                                                    state of Missouri for 12 months; not be a recipi-
   The primary cost containment agency for          ent of Veterans Administration pharmacy bene-
Missouri is the Certificate of Need Program         fits or Medicaid; and not have adequate pre-
(CONP). CONP, designated in 1976 as a state-        scription drug coverage.
wide health planning agency, has been an ad-
                                                        Applications for enrollment are accepted
ministrative unit of the department since 1981.
                                                    during the annual enrollment period of January
    CONP functions in three categories: plan-       1 through February 28 with benefits beginning
ning, review and support activities. The agency     July 1. Applications may be obtained from the
conducts some of the health planning activities     program’s website (,
of the state and determines the needs of Missouri   or by contacting Missouri SenioRx Customer
for substantial health capital expenditures and
                                                    Service toll-free at 1-866-556-9316 (available 24
major medical equipment. It prepares, reviews
                                                    hours a day, 7 days a week).
and revises health models for Missouri for use in
the CONP.

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