Throughout this report, the committee references a number of Department of Homeland Security (DHS) and Office of Personnel Management (OPM) policy documents used to inform its work. This appendix provides these documents for the reader’s reference.
|Delegation to the Assistant Secretary for Health Affairs and Chief Medical Officer
Delegates authority to the Chief Medical Officer (CMO) to exercise oversight over all medical and public health activities of DHS.
|DHS Directive 066-01: Safety and Health Programs Establishes DHS policy, responsibilities, and requirements regarding safety and health programs.||276|
|Memorandum of Understanding Between the Office of the Chief Administrative Officer and the Office of Health Affairs
Delineates the areas of responsibility for administration and execution of DHS occupational safety, occupational health, and occupational medicine programs.
|DHS Directive 248-01: Medical Quality Management Establishes DHS policy on medical quality management, applicable to policies and programs related to the provision of medical services by all DHS health care providers (excepting the U.S. Coast Guard, as noted within).||290|
|5 CFR 339: Medical Qualifications Determinations Defines the circumstances under which medical documentation may be acquired and examinations and evaluations conducted to determine the nature of a medical condition that may affect safe and efficient performance.||293|
Department of Homeland Security
DHS Delegation Number: 5001
Revision Number: 00
Issue Date: 07/24/2008
DELEGATION TO THE
FOR HEALTH AFFAIRS
AND CHIEF MEDICAL
This delegation vests authority in the Assistant Secretary for Health Affairs and Chief Medical Officer to execute and administer the programs and responsibilities set forth herein.
Subject to my oversight, direction, and guidance, I hereby delegate to the Assistant Secretary for Health Affairs and Chief Medical Officer the authority to exercise oversight over all medical and public health activities of the Department of Homeland Security (DHS). This authority shall include, but not be limited to:
A. Leading the Department's biodefense activities, to include oversight and management responsibility for implementation of Homeland Security Presidential Directive 10, Biodefense for the 21st Century, consistent with formal DHS planning processes, end-to-end planning for biological attacks, bio-surveillance integration, operational early warning systems, veterinary, food and agrodefense, and, in collaboration with the Directorate for Science and Technology, guiding and informing medical countermeasure requirements.
B. Managing the Department's operational biodefense programs, to include BioWatch, the National Biosurveillance Integration System, and successor programs, as well as operational chemical detection programs, including the Rapidly Deployable Chemical Detection System.
C. Providing oversight and management of the Department's implementation of Homeland Security Presidential Directive - 9, Defense of United States Agriculture and Food, integrating the efforts of other DHS Components, and coordinating those efforts with appropriate Federal Departments and agencies, tribal, state and local governments, and the private sector.
Component Medical Services
D. Providing medical guidance for the Department’s personnel programs, including fitness-for-duty, return-to-work, drug testing, health screening and monitoring, pre-placement evaluations, immunizations, medical surveillance, medical recordkeeping, deployment physicals, and medical exam protocols.
E. Medical credentialing and development of quality assurance and clinical policy, requirements, standards, and metrics for all human and veterinary clinical activities within DHS. This includes responsibility for the professional oversight of medical activities by medical service personnel within or detailed to the Department, including any credentialing or de-credentialing activities within DHS, as well as responsibility as the senior intra-departmental medical review authority for determinations regarding whether the standard of care has been met when there are claims or allegations of improper or substandard healthcare against the Department or any of its Components, employees, detailees, or contractors.
F. Except for Officers of the U.S. Public Health Service (USPHS) assigned to the United States Coast Guard (USCG), serving as the single official liaison between DHS and the Department of Health and Human Services (HHS) for administration of personnel actions between DHS and HHS related to USPHS Commissioned Corps Officers. Individual Components retain authority for funding, determination of specific duties, and supervision of USPHS officers detailed to them. A Component utilizing a USPHS officer shall also be responsible for resourcing and providing support to the Office of the General Counsel for the handling and payment of claims arising out of the service of USPHS officers to that Component.
G. Assuring an effective coordinated medical response to natural or manmade disasters or acts of terrorism. This authority shall include, but is not limited to:
1. Supporting the Department, including FEMA and its regional components, in providing medical advice and assistance in developing response requirements related to chemical, biological, nuclear, or radiological agents or mass casualty events.
2. Supporting the National Operations Center, National Response Coordination Center, and Component leadership to ensure that operations have appropriate medical support, to specifically include coordination of medical activities for any level of incident with biological or medical consequences.
H. Leading the development of strategy, policy, and requirements for any DHS funding mechanisms for medical and public health activities, including assistance programs related thereto. Policy derived in the course of these activities will be developed jointly with the DHS Office of Policy and in coordination with the DHS Office of Occupational Safety and Environmental Programs.
I. Entering into agreements and contracts to discharge the authorities, duties, and responsibilities of the Office of Health Affairs or activities associated with this delegation, to include:
1. In coordination with the Chief Financial Officer, the Chief Procurement Officer, and the Office of the General Counsel entering into grants, cooperative agreements, interagency agreements, and contracts and distribute funds as necessary.
2. In coordination with the Chief Procurement Officer and the Office of the General Counsel, entering into work agreements, joint sponsorships, contracts, or any other agreements with the Department of Energy regarding the use of the national laboratories or sites.
3. Entering into Memoranda of Understanding and Memoranda of Agreement.
4. Contracting with one or more Federally funded research and development centers to accomplish the duties of the Office of Health Affairs.
5. In coordination with the Under Secretary for Management and the Office of the General Counsel, Regulatory Affairs, issuing necessary regulations.
A. This delegation is not intended to supplant or supersede statutory responsibilities of other DHS Components or other Federal departments or agencies. Nothing in this delegation shall be construed as superseding or circumventing the authorities vested:
1. by Title VII of the Homeland Security Act in the Under Secretary for Management regarding procurement and grants;
2. by Title VIII of the Homeland Security Act in the Under Secretary for Science and Technology; and
3. by Title I of the Homeland Security Act in the General Counsel. Nothing in this delegation provides the authority to contract for legal services.
B. Exercise of the authorities delineated in Section II shall be coordinated with other Department Components and other federal departments and agencies where appropriate.
C. With respect to the USCG’s medical program, including Commissioned Corps Officers of the USPHS assigned to the USCG, exercise of the authorities listed in Section II.D, II.E, and II.F will account for military policy, requirements, and standards, including the requirements of consistency and interoperability with the military services of the Department of Defense. Perceived conflicts with military policy, requirements, surveillance capabilities, standards or metrics that cannot be resolved at lower levels will be resolved by the Secretary or his/her designee.
To the extent that previously exercised authority consistent with this order may require verification, it is hereby affirmed and ratified.
Unless re-delegation is otherwise prohibited by law, the authorities delegated herein may be re-delegated in writing to an appropriate subordinate official of the Assistant Secretary for Health Affairs and Chief Medical Officer and to Component heads.
A. Homeland Security Act of 2002, Public Law 107-296, 116 Stat. 2135 (2002), as amended
B. Post-Katrina Emergency Management Reform Act of 2006, Public Law 109-295, 120 Stat. 1355 (2006)
C. Implementing Recommendations of the 9/11 Commission Act of 2007 Public Law 110-53, 121 Stat. 266 (2007)
D. Title 5, United States Code, Section 301, “Department regulations”
E. Title 6, United States Code, Section 321(e), “Chief Medical Officer”
F. Title 6, United States Code, Section 195b, “National Biosurveillance Center”
Department of Homeland Security
DHS Directives System
Directive Number: 066-01
Revision Number: 00
Issue Date: 07/25/2008
SAFETY AND HEALTH
This Directive establishes the Department of Homeland Security (DHS) policy, responsibilities and requirements regarding safety and health programs.
A. This Directive applies throughout DHS.
B. Military personnel and uniquely military equipment, systems, and operations are not covered by Executive Order (E.O.) 12196 and, therefore, are not within the scope of this Directive. The scope does include U.S. Coast Guard civilian personnel, equipment, operations and worksites that are not characterized as uniquely military.
C. DHS Management Directive 5200.1, Occupational Safety and Health Programs, is hereby canceled.
A. Title 29, United States Code, Section 668, “Programs of Federal agencies”
B. E.O. 12196, “Occupational safety and health programs for Federal employees”
C. Title 29, Code of Federal Regulations (CFR), Part 1960, “Basic Program Elements for Federal Employee Occupational Safety and Health Programs and Related Matters”
D. Title 41, CFR, Chapter 102, “Federal Management Regulation”
A. The Under Secretary for Management is responsible for establishing a Departmental safety and health program, delegating authority as required for efficient program execution, and integrating safety and health principles into the management of the Department’s operations.
B. The Chief Administrative Officer serves as the Designated Agency Safety and Health Official (DASHO) for the Department; oversees the development of policy, instructions, standards, requirements and metrics related to safety and health programs; provides direction and advice to DHS management for safety and health matters, including radiation, aviation, and marine safety; and, serves as Co-Chair on the Department’s Safety, Health, and Medical Council. The Council determines collective actions necessary to achieve safety, health, and medical program objectives and assists top management with program coordination and oversight through the DASHO.
C. The Assistant Secretary for Health Affairs oversees the development of policies, standards, requirements and metrics for medical services and related programs; provides medical guidance for personnel programs; and, serves as Co-Chair on the Department’s Safety, Health, and Medical Council.
D. The Chief Human Capital Officer ensures that safety, health, and medical principles and best practices are incorporated into all aspects of personnel management, including, but not limited to; performance measures, position descriptions, pre-placement evaluations, health-related worker screening and physical qualification monitoring, absentee minimization, and workers’ injury/compensation/disability management. The Chief Human Capital Officer also serves on the Department’s Safety, Health, and Medical Council.
E. Component heads are responsible for establishing and maintaining effective and comprehensive safety and health programs for their respective Components and organizations consistent with this Directive. Component heads shall serve as or designate a Designated Safety and Health Official (DSHO), with sufficient authority and responsibility to represent effectively the interest and support of the Component head in the management and administration of the Component safety and health program.
F. Component DSHOs provide operational program management and oversight for safety and health programs, and develop policy, instructions, standards, requirements and metrics related to safety and health programs within the Component. For the purposes of the DHS Safety and Health Program, a Component DSHO has the same responsibilities as a DASHO, as described under 29 CFR 1960, serving within their Component organization. DHSOs for the following Components will also serve as members on the Department’s Safety, Health, and Medical Council:
- United States Citizenship and Immigration Services
- United States Coast Guard
- United States Customs and Border Protection
- Domestic Nuclear Detection Office
- Federal Emergency Management Agency
- Federal Law Enforcement Training Center
- United States Immigration and Customs Enforcement
- Science and Technology
- United States Secret Service
- Transportation Security Administration.
G. The Director, Occupational Safety and Environmental Programs coordinates the development of safety and health policy and procedures for the Department, develops goals for program performance, and provides direction and support for safety and health programs.
H. The Department Safety and Health Manager serves as the principal safety and health officer of the Department; manages an effective and comprehensive Department safety and health program; conducts program management evaluations or audits of Component safety and health programs; develops and assists management in implementing Departmental policy, programs, initiatives, and other management actions to promote safer, healthier work environments; and chairs the DHS Safety and Health Manager’s Committee. The Committee recommends goals and objectives for safety and health programs, coordinates the development of policy and programs to address safety and health issues, identifies opportunities to leverage resources for effective and efficient safety and health program management, and reviews the effectiveness of safety and health programs.
I. Component Safety and Health Managers serve as the principal safety and health program officers of their Components and:
1. Manage an effective and comprehensive Component safety and health program.
2. Conduct safety and health program evaluations of their Component programs.
3. Develop and assist management in implementing Component policy, programs, initiatives, and other management actions to reduce safety and health risks and promote safer, healthier, work environments.
4. Report occupational fatalities or catastrophic accidents in less than eight hours to the Department Safety and Health Manager.
5. Serve on the DHS Safety and Health Manager’s Committee.
J. The Safety and Health Manager in the Office of the Chief Administrative Officer, Administrative Operations (OCAO/AO) serves as the principal safety and health officer for the Office of the Secretary and the following Components:
- Ombudsman, Citizenship and Immigration Services
- Civil Rights and Civil Liberties
- Office of Counternarcotics Enforcement
- Executive Secretariat
- Office of the General Counsel
- Gulf Coast Region
- Office of Health Affairs
- Office of Inspector General
- Office of Intelligence and Analysis
- Office of Legislative Affairs
- Military Advisor’s Office
- National Protection and Programs Directorate
- Office of Operations Coordination
- Office of Policy
- Chief Privacy Officer
- Office of Public Affairs.
The OCAO/AO Safety and Health Manager manages an effective and comprehensive safety and health program for the Office of the Secretary and these Components; conducts safety inspections of their work areas; develops and assists management in implementing policy, programs, initiatives, and other management actions to promote safer, healthier work environments in the Office of the Secretary and these Components; and serves on the DHS Safety and Health Manager’s Committee.
K. Managers and Supervisors are responsible for:
1. Implementing, maintaining and operating safety and health programs.
2. Assuring employees are furnished a safe work environment and suitable equipment.
3. Assuring all employees receive training in safe and healthful practices, principles of risk management, and the safeguards associated with their work.
4. Encouraging employee performance that demonstrates positive safety and health behavior, and rewarding outstanding safety or health performance.
5. Assuring employees comply with DHS safety rules, standards, and policies, including the use of personal protective equipment.
6. Assuring prompt, accurate reporting of injuries, illnesses and fatalities.
7. Identifying workplace hazards, assessing risks, promptly reducing risks, and correcting unsafe conditions and practices in order to safeguard employees, visitors, property, and operations.
L. DHS Employees are responsible for:
1. Performing their duties in a safe and healthful manner.
2. Complying with the Occupational Safety and Health Act, and DHS safety and health requirements.
3. Immediately reporting all accidental fatalities, injuries, illnesses, property losses and mission degradation incidents as well as hazards or unsafe acts to others at imminent risk and to their supervisor or other competent authority for appropriate action.
V. Policy and Requirements
A. Manage safety and health risks and exercise the tenets of operational risk management.
B. Provide a safe and healthful work environment for employees, contractors, and the visiting public.
C. Protect the public from risk of accidental death, injury, illness, or property damage resulting from DHS activities.
D. Support safety and health programs in order to protect personnel from accidental death, injury, or illness, and to prevent or minimize accidental property loss and mission interruption.
E. Use safety and health considerations and resources in mission planning and execution across all departmental operations, including acquisition, procurement, logistics, facility management, and human capital management, and operations.
Any questions or concerns regarding this Directive should be addressed to the Office of the Chief Administrative Officer.
MEMORANDUM OF UNDERSTANDING
OFFICE OF THE CHIEF ADMINISTRATIVE OFFICER
OFFICE OF HEALTH AFFAIRS
The purpose of this Memorandum of Understanding (MOU) between the Office of the Chief Administrative Officer (OCAO) and the Office of Health Affairs (OHA) is to delineate the areas of responsibility for administration and execution of the Department of Homeland Security’s (DHS) Occupational Safety, Occupational Health, and Occupational Medicine Programs.
This MOU sets forth the basic principles and guidelines under which the parties will work together to develop tools to track occupational injuries and illnesses, establish programs that effectively reduce work-related injuries and illnesses, and establish processes and procedures to communicate and effectively manage risk.
In addition, this MOU will delineate emergency procedures and shared responsibilities necessary to guarantee the successful coordination of the safety, health and medical response to an event.
Through this MOU, the parties agree to delineate specific areas of responsibility and formalize their respective office’s collaboration to achieve the goal of improving the safety and health of DHS employees.
The role of the DHS Safety and Health Program, as described in Directive 066-01 is to support mission effectiveness and the protection of people and resources by identifying, evaluating, and managing safety and health risks. The Office of Health Affairs, as described in Delegation 5001, has oversight over all medical and public health activities of DHS, and, as stated in Title 6, United States Code (U.S.C.), Section 321e, is the Principal Advisor to the Secretary of Homeland Security on medical and public health issues for medical issues related to natural disasters, acts of terrorism and other man-made disasters and ensures internal and external coordination of all medical preparedness and response activities of the Department.
In furtherance of the DHS Safety and Health Program, the Chief Administrative Officer (CAO) is responsible for serving as the principal occupational safety, health, and environmental officer for DHS, and for leading a team that is responsible for managing all aspects of the Department’s occupational safety and health programs. The Assistant Secretary for Health Affairs (ASHA) provides medical guidance for personnel programs, including fitness-for-duty, return-to-work,
drug testing, health screening and monitoring, pre-placement evaluations, immunizations, medical surveillance, medical recordkeeping, deployment physicals, and medical exam protocols. The ASHA also oversees the development of policies, procedures, standards, requirements and metrics for medical services and related programs. In addition, the ASHA oversees quality assurance, credentialing and all Operational Medicine Programs.
The ASHA is the primary policy advisor to the Secretary on occupational medicine and public health aspects of the occupational safety and health program, and is charged with developing and maintaining consistent medical standards, guidance, policy, requirements and metrics for DHS employees. The ASHA’s authority extends to entering into agreements and contracts to discharge the authorities, duties and responsibilities of the Office of Health Affairs, which includes the procurement of medical countermeasures to protect the DHS workforce. The overlapping responsibilities between the CAO and the ASHA require a balance of resources and definition of management processes within the Department to optimize occupational safety, health, and medical program performance.
The Department’s overarching occupational safety and health policy is to provide DHS personnel safe and healthful employment; to comply with the requirements of applicable safety and occupational health laws, Executive Orders, and regulations; and to protect the public from risk of death, injury, illness, or property damage as a result of DHS activities. At a minimum, DHS must maintain comprehensive and effective safety and health programs that meet the requirements of Section 19 of the Occupational Safety and Health Act of 1970, as amended; Executive Order (E.O.) 12196, as amended; and 29 Code of Federal Regulations (CFR) Part 1960.
In accordance with existing policy, DHS must:
- Provide support and adequate resources for occupational safety and health programs and safety risk management at all levels;
- Ensure that accidental fatalities, injuries, occupational illnesses, and incidents involving property loss or mission degradation are investigated and analyzed in accordance with Departmental directives, and that appropriate measures are taken to control risks and reduce the probability of recurrence;
- Ensure that employees are not subject to restraint, interference, coercion, discrimination, or reprisal for exercising their rights under E.O. 12196, 29 CFR Part 1960, or for participating in Component safety and health programs;
- Provide safety and risk management education and training for managers and employees, and professional development education, training, and appropriate supplies and equipment for full time and collateral duty safety and health staff, committee/council members, and other employees with safety and health duties and responsibilities; and
- Ensure response to employee reports of hazardous conditions and require inspections of hazardous conditions in accordance with E.O. 12196.
For the purposes of this MOU, occupational medicine is understood to include those program areas that require specialized medical expertise, such as employee immunizations, medical exam protocols, medication dispensing protocols, deployment physicals, post deployment medical monitoring, post exposure prophylaxis and similar programs. Occupational health programs are those program areas that require knowledge in a combination of areas including traditional medical expertise, public health mitigation, hazard analysis, engineering control measures, protective equipment, and hazard communication.
III. OBJECTIVES AND PROGRAM ELEMENTS
Based on programmatic responsibilities for OCAO and OHA, three levels of program integration are required to optimize program performance and efficiency. First, OCAO and OHA must work collaboratively on several fronts to address common occupational safety, health, and medical issues affecting the DHS working community. One of these areas includes the establishment of a senior level Safety, Health, and Medical Council for the development of overarching safety, health, and medical program policy, and the development of integrated tools and processes to support program functions. Second, there are other areas where it is clearly necessary that both organizations’ input is critical, and support as needed must be made available to cooperatively manage program activities to focus resources, ensure that appropriate policies and guidelines are established, and ensure proper oversight is given to Component programs. These program areas include, but are not limited to, activities such as hearing conservation, accident investigation, and respiratory protection, which require both safety and medical expertise. Coordination may best occur by designating cooperatively an OCAO and OHA lead, and creating a taskforce of members of both organizations to provide guidance and recommendations. Third, there are other program areas that are clearly within the purview of one organization. For example, OHA, in an oversight role, provides medical guidance, standards, policy, requirements, and metrics for all human medical activities within the Department, including those activities that involve the provision of services being performed by a DHS Component such as drug testing and deployment physicals. Appendix A provides a program matrix that illustrates these relationships. This MOU delineates program areas of responsibility, identifies areas that may overlap, and explains the processes for conflict resolution when these boundaries are unclear and difficult to resolve.
A. Shared Responsibilities
OCAO and OHA will work collaboratively:
1. To establish a senior level DHS Safety, Health, and Medical Council to support, guide, and monitor the performance of Department-wide safety, health, and medical programs.
2. Delineate emergency procedures necessary for council co leads to generate the successful coordination during an event. Procedures should include:
a. Direct communication procedures
b. Event notification procedures
c. Pre release Concurrence procedures
3. To develop overarching policy that addresses occupational safety, health, and medical issues in the Department.
B. OCAO’s Responsibilities
1. Develop policy, standards, requirements, and metrics related to occupational safety and health programs, such as, but not limited to: fire and life safety, electrical safety, fall protection, construction safety, radiation safety, motor vehicle safety, bloodborne pathogens, hearing conservation, respiratory protection, chemical hygiene, lead, asbestos, indoor air quality, and ergonomics. These programs will incorporate input and medical guidance from OHA and the ASHA.
2. Provide operational program management and oversight for occupational safety and health programs. Typical management and oversight functions include evaluating injury and illness trends, conducting program evaluations and inspections, providing program advice and counsel, and developing and implementing program initiatives to promote occupational safety and health. Procure and write all policy and guidance for Personal Protective Equipment, with OHA input. Provide input to OHA on the policies, guidance and procurement of Medical Counter Measures.
3. Provide guidance and support, when requested by OHA, for occupational health and medical program areas for which the ASHA has a leadership role. Guidance and support may include reviewing draft policies, providing advice and counsel, participating in planning-sessions, and supporting program evaluations.
4. Coordinate safety, health, medical, and legal expertise to advise the Under Secretary for Management on an acquisition strategy for a Departmental OSH-related information infrastructure.
C. OHA’s Responsibilities
1. Develop policy, standards, requirements, and metrics for medical services and related programs, including fitness-for-duty, return-to-work, drug testing, health screening and monitoring, pre-placement evaluations, immunizations, medical surveillance, medical recordkeeping, deployment physicals, medical exam protocols, and automated external defibrillators and cardiopulmonary resuscitation programs.
2. Provide guidance, protocols and support to DHS components and offices for all medications, medical programs, and medical countermeasures.
3. Provide operational program management and oversight for medical services and related programs. Typical management and oversight functions include authoring department wide medical protocols, creating medical programs, evaluating trends, conducting program evaluations and inspections, providing program advice and counsel, and developing and implementing program initiatives.
4. Coordinate all safety, health, medical and legal information related to medical decision-making to support DHS Department-wide policy and acquisition strategies of medical equipment, medications, and medical supplies and medical information architectures. Procure and write all policy and guidance for Medical Counter Measures with OCAO input. Provide input to OCAO on the policies, guidance and procurement of personal protective equipment.
5. Provide guidance and support, when requested by OCAO for occupational safety and health program areas for which the CAO has a leadership role. Guidance and support may include reviewing draft policies, providing advice and counsel, participating in planning sessions, and supporting program evaluations.
D. Individual Responsibilities of the CAO and the ASHA
The CAO will:
1. Co-Chair the DHS Safety, Health, and Medical Council;
2. Represent the Department, when requested, on the Federal Advisory Council on Occupational Safety and Health; and
3. Serve as the Designated Agency Safely and Health Official (DASHO) for the Department. The DASHO, whose responsibilities are defined in E.O. 12196 and 29 CFR Part 1960, provides executive leadership in the development, promulgation, and implementation of occupational safety and health policies and procedures.
The ASHA will:
1. Co-Chair the DHS Safety, Health, and Medical Council; and
2. Serve as the primary policy advisor to the Secretary and to the DASHO on occupational medicine and health aspects of the occupational safety and health program.
IV. IMPLEMENTATION OF AGREEMENT
A. In order to enable close and effective collaboration, it is agreed that the scope of cooperative activity will be reviewed annually. Both the CAO and ASHA will designate managers to implement and coordinate this MOU. The designated managers shall meet on a regular basis to discuss and direct activities conducted under the MOU.
B. In the event of any disagreement arising between the parties to this MOU, the Parties shall use their best efforts to negotiate a resolution in good faith. If the disagreement cannot be resolved at the operating level, the dispute will be elevated to successively higher levels of management up to, and including, the Secretary.
V. EFFECTIVE DATE
This MOU is effective upon signature of the Parties.
This MOU may be modified or amended by written agreement among the Parties hereto.
This MOU may be terminated by mutual agreement of both Parties.
Occupational Safety and Health Program
|Program||Office of the Chief Administrative Officer||Office of Health Affairs|
|Shared Program Areas|
|Safety, Health, and Medical Council||S||S|
|Safety, Health, and Medical Programs Policy||S||S|
|Primary Lead Programs|
|Information System Development and Management*||Ρ||A|
|Indoor Air Quality||Ρ||A|
|Personal Protective Equipment and Respiratory Protection||Ρ||A|
|Medical Counter Measures||Α||Ρ|
|System and Process Safety||Ρ||A|
|End of Employment Evaluations*||Α||Ρ|
|AEDs and CPR||Α||Ρ|
|Occupational Medicine Program Policy||Α||Ρ|
|Occupational Medicine Program Oversight and Auditing||Α||Ρ|
|Occupational Medicine Program Management||Α||Ρ|
|Occupational Medicine Program Training and||Α||Ρ|
|Independent Program Areas|
|Safety Program Policy||Ρ|
|Safety Program Oversight and Monitoring||Ρ|
|Safety Program Management||Ρ|
|Safety Program Training and Education||Ρ|
|Motor Vehicle Safety||Ρ|
|Fire and Life Safety||Ρ|
|Administrative and Engineering Controls||Ρ|
|System and Process Safety||Ρ|
|Medical Program Policy||Ρ|
|Medical Program Oversight and Auditing||Ρ|
|Medical Program Management||Ρ|
|Medical Program Training and Education||Ρ|
|Occupational Injury Treatment||Ρ|
|Medical Exam Protocols*||Ρ|
|Health Screening and Monitoring||Ρ|
|Health Promotion and Management||Ρ|
* The ASHA plays an oversight role in these activities, providing medical guidance, standards, policy, requirements, and metrics. Therefore, any reference to the ASHA as having primary responsibility for these activities refers to the ASHA’s primary responsibility in an oversight role. The Chief Human Capital Officer (CHCO) may provide services for these activities under CHCO’s authority and the ASHA will communicate with the CHCO where the authorities and responsibilities of the CHCO intersect with the ASHA’s oversight responsibilities. If necessary, the ASHA and the CHCO may enter into a separate agreement regarding responsibilities with respect to the noted activities.
Department of Homeland Security
DHS Directives System
Directive Number: 248-01
Revision Number: 00
Issue Date: 10/02/2009
This Directive establishes the policy on Medical Quality Management (MQM) for the Department of Homeland Security (DHS).
A. With the exception of the United States Coast Guard (USCG), as further stated below, this Directive applies to policies and programs related to the provision of medical services by all DHS health care providers.
B. This Directive does not apply to:
1. Health services provided by, for, or on behalf of the United States Coast Guard (USCG) that are in alignment and compliant with Department of Defense, TRICARE, and USCG Commandant Directives and Instructions related to the provision of health services.
2. Individual medical decisions made with respect to individual patients,
A. Title 6, United States Code, § 321e, “Chief Medical Officer”
B. DHS Delegation 5001, “Delegation to the Assistant Secretary for Health Affairs and Chief Medical Officer”
A. Certification: The external verification of the competencies that an individual has achieved; typically involves an external process such as the National Registry for Emergency Medical Technicians, National Commission on Certification of Physician Assistants, or a Board recognized by the American Board of Medical Specialties, the American Board of Nursing Specialties, or the American Dental Association.
B. Credentialing: The process by which an organization assesses the qualifications and background of professional or paraprofessional personnel prior to permitting the person to practice designated medical services/skills on behalf of the organization. Such assessment includes the primary verification of professionals’ or para-professionals’ education, licenses or certifications/registrations. It does not include the issuing of licenses, certifications or registrations to professionals and paraprofessionals for the practice of designated medical health services.
C. Health Care Provider: An organization or person who delivers authorized health care in a systematic way to individuals or groups in need of health care services, including any employees assigned to provide professional or para-professional healthcare services as a part of their DHS duties. This term also applies to detailees from other federal agencies and contractors whenever the purpose of the detail/contract includes performance of healthcare services.
D. License: The permission granted to an individual by a State or U.S. Territory or Possession to perform certain medical activities.
E. MQM Program: A program which provides for measurement of system performance and adjustments through training and/or policy to improve quality.
A. The Assistant Secretary for Health Affairs and Chief Medical Officer (ASHA/CMO):
1. Provides oversight of medical professional activities within DHS, and ensures this Directive is appropriately implemented within Components providing health services.
2. Ensures consistent application of MQM Programs across the Department.
3. Performs credentialing on behalf of DHS for those personnel (or applicants) whose position descriptions explicitly require that the individual or applicant have the duties/qualifications to provide designated medical services. Specific duty assignments remain solely within the purview of the employing Component.
4. Develops a Centralized Credentials Management System.
B. The Component Heads:
1. Exercise oversight of the implementation of this Directive within
their components and ensure consistent application.
2. Ensure detailees and contractors have the qualifications (licenses, certifications and/or registrations) necessary to perform designated medical services before they are permitted to deliver health care services for, or on behalf of, the Department.
VI. Policy and Requirements
A. All Components providing health services maintain an active and effective MQM Program. The ASHA/CMO oversees Component MQM Programs through the Office of Health Affairs.
B. Component MQM Programs include a quality assurance and improvement program that includes oversight, peer review, risk management, patient safety, and training; and documentation of organizational structures, standard of care, health care policies, and protocols.
C. Component MQM Programs seek ASHA/CMO credentialing of DHS medical services personnel and applicants for positions in the Component with position descriptions that include the requirement that the personnel or applicants have the duties/qualifications to provide designated medical services.
D. Detailees from other federal agencies. Components rely upon the detailing federal agency’s credentialing of the detailee. Components request verification of the detailing federal agency’s credentialing and provide copy to the ASHA/CMO.
E. Records created by, for, or on behalf of DHS as part of a MQM Program are maintained and protected in compliance with applicable Federal law including the Privacy Act of 1974 (5 U.S.C. §552a).
Address any questions or issues related to this Directive to the Office of Health Affairs.
Office Of Personnel Management
well as to other noncompetitive appointments, and to conversion to career or career-conditional employment.
[33 FR 12429, Sept. 4, 1968, as amended at 57 FR 10124, Mar. 24, 1992]
Subpart Β [Reserved]
Subpart C—Consideration for Appointment
§338.301 Competitive service appointment.
Agencies must ensure that employees who are given competitive service appointments meet the requirements included in the Office of Personnel Management’s Operating Manual: Qualification Standards for General Schedule Positions. The Operating Manual is available to the public for review at agency personnel offices and Federal depository libraries, and for purchase from the Government Printing Office.
[62 FR 44535, Aug. 22, 1997]
Subparts D-E [Reserved]
Subpart F—Age Requirements
§338.601 Prohibition of maximum-age requirements.
A maximum-age requirement may not be applied in either competitive or noncompetitive examinations for positions in the competitive service except as provided by:
(a) Section 3307 of title 5, United States Code; or
(b) Public Law 93-259 which authorizes OPM to establish a maximum-age requirement after determining that age is an occupational qualification necessary to the performance of the duties of the position.
[40 FR 42734, Sept. 16, 1975]
PART 339—MEDICAL QUALIFICATION DETERMINATIONS
AUTHORITY: 5 U.S.C. 3301, 3302, 5112; E.O. 9830, February 24, 1947.
SOURCE: 54 FR 9763, Mar. 8, 1989, unless otherwise noted.
This part applies to all applicants for and employees in competitive service positions; and to excepted service employees when medical issues arise in connection with an OPM regulation which governs a particular personnel decision, for example, removal of a preference eligible employee in the excepted service under part 752.
(a) This part defines the circumstances under which medical documentation may be acquired and examinations and evaluations conducted to determine the nature of a medical condition which may affect safe and efficient performance.
(b) Personnel decisions based wholly or in part on the review of medical documentation and the results of medical examinations and evaluations shall be made in accordance with appropriate parts of this title.
(c) Failure to meet a properly established medical standard or physical requirement under this part means that the individual is not qualified for the position unless a waiver or reasonable
accommodation is indicated, as described in §§339.103 and 339.204. An employee’s refusal to be examined in accordance with a proper agency order authorized under this part is grounds for appropriate disciplinary or adverse action.
[54 FR 9763, Mar. 8, 1989, as amended at 60 FR 3061, Jan. 13, 1995]
Actions under this part must be consistent with 29 CFR 1613. 701 et seq. Particularly relevant to medical qualification determinations are §1613.704 (requiring reasonable accommodation of individuals with handicaps); §1613.705 (prohibiting use of employment criteria that screen out individuals with handicaps unless shown to be related to the job in question) and §1614.706 (prohibiting pre-employment inquiries related to handicap and pre-employment medical examinations, except under specified circumstances). In addition, use of the term “qualified” in these regulations shall be interpreted consistently with § 1613.702(f), which provides that a “qualified handicapped person” is a handicapped person “who, with or without reasonable accommodation, can perform the essential functions of the position in question without endangering the health and safety of the individual or others.”
For purposes of this part—
Accommodation means reasonable accommodation as described in 29 CFR 1613.704.
Arduous of hazardous positions means positions that are dangerous or physically demanding to such a degree that an incumbent’s medical condition is necessarily an important consideration in determining ability to perform safely and efficiently.
Medical condition means health impairment which results from injury or disease, including psychiatric disease.
Medical documentation or documentation of a medical condition means a statement from a licensed physician or other appropriate practitioner which provides information the agency considers necessary to enable it to make an employment decision. To be acceptable, the diagnosis or clinical impression must be justified according to established diagnostic criteria and the conclusions and recommendations must not be inconsistent with generally accepted professional standards. The determination that the diagnosis meets these criteria is made by or in coordination with a physician or, if appropriate, a practitioner of the same discipline as the one who issued the statement. An acceptable diagnosis must include the following information, or parts identified by the agency as necessary and relevant:
(a) The history of the medical conditions, including references to findings from previous examinations, treatment, and responses to treatment;
(b) Clinical findings from the most recent medical evaluation, including any of the following which have been obtained: Findings of physical examination; results of laboratory tests; X- rays; EKG’s and other special evaluations or diagnostic procedures; and, in the case of psychiatric evaluation of psychological assessment, the findings of a mental status examination and the results of psychological tests, if appropriate;
(c) Diagnosis, including the current clinical status;
(d) Prognosis, including plans for future treatment and an estimate of the expected date of full or partial recovery;
(e) An explanation of the impact of the medical condition on overall health and activities, including the basis for any conclusion that restrictions or accommodations are or are not warranted, and where they are warranted, an explanation of their therapeutic of risk avoiding value;
(f) An explanation of the medical basis for any conclusion which indicates the likelihood that the individual is or is not expected to suffer sudden or subtle incapacitation by carrying out, with or without accommodation, the tasks or duties of a specific position;
(g) Narrative explanation of the medical basis for any conclusion that the medical condition has or has not become static or well stabilized and the
likelihood that the individual may experience sudden or subtle incapacitation as a result of the medical condition. In this context, “static or well- stabilized medical condition” means a medical condition which is not likely to change as a consequence of the natural progression of the condition, specifically as a result of the normal aging process, or in response to the work environment or the work itself. “Subtle incapacitation” means gradual, initially imperceptible impairment of physical or mental function whether reversible or not which is likely to result in performance or conduct deficiencies. “Sudden incapacitation” means abrupt onset of loss of control of physical or mental function.
Medical evaluation program means a program of recurring medical examinations or tests established by written agency policy or directive, to safeguard the health of employees whose work may subject them or others to significant health or safety risks due to occupational or environmental exposure or demands.
Medical standard is a written description of the medical requirements for a particular occupation based on a determination that a certian level of fitness of health status is required for successful performance.
Physical requirement is a written description of job-related physical abilities which are normally considered essential for successful performance in a specific position.
Physician means a licensed Doctor of Medicine or Doctor of Osteopathy, or a physician who is serving on active duty in the uniformed services and is designated by the uniformed service to conduct examinations under this part.
Practitioner means a person providing health services who is not a medical doctor, but who is certified by a national organization and licensed by a State to provide the service in question.
Subject to subpart C of part 731 of this chapter, OPM may deny an applicant examination, deny an eligible appointment, and instruct an agency to remove an appointee by reason of physical or mental unfitness for the position for which he or she has applied, or to which he or she has been appointed. An OPM decision under this section is separate and distinct from a determination of disability under §831.502, 844.103, 844.202, or subpart L of part 831 of this title, and does not necessarily entitle the employee to disability retirement under sections 8337 or 8451 of title 5, United States Code.
OPM may establish or approve medical standards for a Governmentwide occupation (i.e., an occupation common to more than one agency). An agency may establish medical standards for positions that predominate in that agency (i.e., where the agency has 50 percent or more of the positions in a particular occupation). Such standards must be justified on the basis that the duties of the position are arduous or hazardous, or require a certain level of health status or fitness because the nature of the positions involve a high degree of responsibility toward the public or sensitive national security concerns. The rationale for establishing the standard must be documented. Standards established by OPM or an agency must be:
(a) Established by written directive and uniformly applied,
(b) Directly related to the actual requirements of the position.
[54 FR 9763, Mar. 8, 1989, as amended at 66 FR 66710, Dec. 27, 2001]
Agencies are authorized to establish physical requirements for individual positions without OPM approval when such requirements are considered essential for successful job performance. The requirements must be clearly supported by the actual duties of the position and documented in the position description.
Agencies must waive a medical standard or physical requirement established under this part when there is sufficient evidence that an applicant or
employee, with or without reasonable accommodation, can perform the essential duties of the position without endangering the health and safety of the individual or others.
Agencies may establish periodic examination or immunization programs by written policies or directives to safeguard the health of employees whose work may subject them or others to significant health or safety risks due to occupational or environmental exposure or demands. The need for a medical evaluation program must be clearly supported by the nature of the work. The specific positions covered must be identified and the applicants or incumbents notified in writing of the reasons for including the positions in the program.
A candidate may not be disqualified for any position solely on the basis of medical history. For positions with medical standards or physical requirements, or positions subject to medical evaluation programs, a history of a particular medical problem may result in medical disqualification only if the condition at issue is itself disqualifying, recurrence cannot medically be ruled out, and the duties of the position are such that a recurrence would pose a reasonable probability of substantial harm.
(a) A routine preappointment examination is appropriate only for a position which has specific medical standards, physical requirements, or is covered by a medical evaluation program established under these regulations.
(b) Subject to §339.103 of this part, an agency may require an individual who has applied for or occupies a position which has medical standards or physical requirements or which is part of an established medical evaluation program, to report for a medical examination:
(1) Prior to appointment or selection (including reemployment on the basis of full or partial recovery from a medical condition);
(2) On a regularly recurring, periodic basis after appointment; or
(3) Whenever there is a direct question about an employee’s continued capacity to meet the physical or medical requirements of a position.
(c) An agency may require an employee who has applied for or is receiving continuation of pay or compensation as a result of an on-the-job injury or disease to report for an examination to determine medical limitations that may affect placement decisions.
(d) An agency may require an employee who is released from his or her competitive level in a reduction in force to undergo a relevant medical evaluation if the position to which the employee has reassignment rights has medical standards or specific physical requirements which are different from those required in the employee’s current position.
(e)(1) An agency may order a psychiatric examination (including a psychological assessment) only when:
(i) The result of a current general medical examination which the agency has the authority to order under this section indicates no physical explanation for behavior or actions which may affect the safe and efficient performance of the individual or others, or
(ii) A phychiatric examination is specifically called for in a position having medical standards or subject to a medical evaluation program established under this part.
(2) A psychiatric examination or psychological assessment authorized under (i) or (ii) above must be conducted in accordance with accepted professional standards, by a licensed practitioner or physician authorized to conduct such examinations, and may only be used to make legitimate inquiry into a person’s mental fitness to successfully perform the duties of his or her position without undue hazard to the individual or others.
An agency may, at its option, offer a medical examination (including a psychiatric evaluation) in any situation where the agency needs additional medical documentation to make an informed management decision. This may include situations where an individual requests for medical reasons a change in duty status, assignment, working conditions, or any other benefit or special treatment (including reasonable accommodation or reemployment on the basis of full or partial recovery from a medical condition) or where the individual has a performance or conduct problem which may require agency action. Reasons for offering an examination must be documented. An offer of an examination shall be carried out and used in accordance with 29 CFR 1613.706.
(a) When an agency orders or offers a medical examination under this subpart, it must inform the applicant or employee in writing of its reasons for doing so and the consequences of failure to cooperate. (A single notification is sufficient to cover a series of regularly recurring or periodic examinations ordered under this subpart.)
(b) The agency designates the examining physician or other appropriate practitioner, but must offer the individual an opportunity to submit medical documentation from his or her personal physician or practitioner. The agency must review and consider all such documentation supplied by the individual’s personal physician or practitioner.
Agencies shall pay for all examinations ordered or offered under this subpart, whether conducted by the agency’s physician or the applicant’s or employee’s physician. Applicants and employees must pay for a medical examination conducted by a private physician (or practitioner) where the purpose of the examination is to secure a benefit sought by the applicant or employee.
(a) Agencies will receive and maintain all medical documentation and records of examinations obtained under this part in accordance with instructions provided by OPM, under provisions of 5 CFR part 293, subpart E.
(b) The report of an examination conducted under this subpart must be made available to the applicant or employee under the provisions of part 297 of this chapter.
(c) Agencies must forward to the Office of Workers’ Compensation Programs (OWCP), Department of Labor, a copy of all medical documentation and reports of examinations of individuals who are receiving or have applied for injury compensation benefits including continuation of pay. The agency must also report to the OWCP the failure of such individuals to report for examinations that the agency orders under this subpart. When the individual has applied for disability retirement, this information must be forwarded to OPM.
(a) In accordance with the provisions of this part, agencies are authorized to medically disqualify a nonpreference eligible. A nonpreference eligible so disqualified has a right to a higher level review of the determination within the agency.
(b) OPM must approve the sufficiency of the agency’s reasons to:
(1) Medically disqualify or pass over a preference eligible on a certificate in place of a nonpreference eligible,
(2) Medically disqualify or pass over a 30 percent or more compensably disabled veteran for a position in the U.S. Postal Service in favor of a non- preference eligible,
(3) Medically disqualify a 30 percent or more compensably disabled veteran for assignment to another position in a reduction in force, or
(4) Medically disqualify a 30 percent or more disabled veteran for noncompetitive appointment.