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MINUTES
NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS
Full Association Meeting
April 17, 1997
Carolina Inn
Chapel Hill, North Carolina


CALL TO ORDER - With the Association constituting a quorum, President Barry Bass called the meeting to order at 9:00 a.m. See Attachments, pp. 1-3 for attendance roster.

APPROVAL OF THE MINUTES - Dr. Louis Latour made the motion to approve the March 20, 1997 meeting minutes with corrections. Dennis Harrington seconded and the motion passed unanimously.

TREASURER'S REPORT - Tom Bridges requested that all health departments that had not already sent in their dues should do so now. See Attachments, pp. 4-5 for Treasurer's Report. He reported that as of April 11, 1997 the NCALHD assets include $ 44,231.77 in checking and $ 25,022.05 in savings. The 1997 NCALHD Budget has receipts as of April 11, 1997 of $ 29,165.22 and total expenses to date of $ 6,849.69. Tom Bridges noted that the Treasurer's Report should be corrected to read Treasurer's Report as of April 11, 1997, rather than March 14, 1997. Louis Latour made the motion to approve the reading of the Treasurer's Report as amended. Dennis Harrington seconded and the motion passed unanimously.

ANNOUNCEMENTS - President Bass had the following announcements:

1. He thanked the efforts made by Bill Smith, Dennis Harrington, and especially Terry Pierce and his staff on SB 383 to explain to legislators public health concerns about this legislation. Its outcome is still pending.

2. Four NCALHD members are running for Member-At-Large offices with the National City and County Health Officials (NACCHO). They are Louis Latour (who is currently serving out Bob Parker's term until 6/97), Wayne Raynor, George Bond and Wayne Sherman.

3. Leonard Wood sent a letter to Secretary Bruton regarding the status of the Medicaid Maximization fund. No response to date.

4. The NC Community Foundation has sent a letter of appreciation for the NCALHD's recent contribution to the Wood Endowment.

5. NC GASP is to host Fred Sweeta, Boston, American Liability part to discuss litigation issues in North Carolina on tobacco. Meeting will be Friday, April 18, 1997 from 12:30 p.m. to 2:30 p.m. in the Piedmont Room of the Carolina Inn. Health directors are encouraged to attend.

6. Glaxco-Wellcome has a display in the lobby of the Carolina Inn. They are urging local health departments to participate in the Child Health Recognition Awards this year. Application deadline is May 30, 1997 at 5:00 p.m. See Attachments, pp. 6-13 for exerpts from their brochure.

7. Bonnie Sperling representing Channing L. Bete shared information about a new state contract pricing for their educational literature. She said mailings would be forthcoming to local health departments about their new contract prices available to local health departments. See Attachments, pp. 14-15 for information.

8. Partners in Change: Redesigning Human Services Conference is scheduled for June 12-13, 1997 at the Ramada Plaza Hotel, Greenville, NC. This conference is being conducted with participation and input from The NC Association of County Directors of Social Services, The NC Association of Local Health Directors, The NC Council of Community MH, DD, SA Programs, The Association of Local Boards of Health, The NC Association on Aging and the NC Division of Youth Services. President Bass urged all health directors to plan to attend. See brochure in attachments. See Attachments, pp. 16-18 for brochure.

COMMITTEE REPORTS

ENVIRONMENTAL - The committee met yesterday. Terry Pierce shared the following:

1. The Restaurant Rules Review Committee meets today. Doug Urland and Tommy Jarrell represent NCALHD.

2. Malcolm Blalock reported the Public Water Supply Survey letter is almost complete and will be sent directly to local health departments.

3. Reorganization of DEHNR and DHR. Environmental Review Commission will study and make recommendation after one (1) year. Appointments to the ERC will be crucial to keeping Environmental Health programs with Public Health (appointments by Speaker of the House and the Lieutenant Governor).

4. Previously discussed discontinuing inspections of family foster homes. The NCALHD opposed this previously. The Division of Environmental Health is pursuing another option for well set back variances. This involves a memorandum of understanding between DWQ and DEH to delegate authority to grant variances for setbacks. Authority would be granted to DEH agents. EH Committee supports the MOU, but is divided as to whether delegation should be granted to LHD employees. Would like LHD input.



5. Discussed the status of several bills and legislative actions:

a. One late breaking item involves the reissuance of expired Improvement Permits. See Attachments, p. 19 for handout. Motion from committee is to recommend that members of the NCALHD promptly contact Senators and House members on the Appropriation Committees to oppose the Special Provision, "Reissue Certain Wastewater Permits", CODE NO. 97ENV-S020. The motion needing no second passed unanimously.

b. HB 469 "Permit Fees" Committee substitute introduced yesterday. Late fee - $ 75.00 (initially $ 250.00) Reinstatement $ 150.00 (initially recommended $ 900.00). Favorable report yesterday in Human Resources -- goes to Finance.

c. SB 138 passed. Bring state consistent with federal drinking water standards.

d. SB 193 Fund evaluation of septic tank problems. $ 150,000 in Neuse River Basin - no action yet.

e. SB 208 HB 165 Utensils. Committee substitute: if it is a setting when they are doing cooking in the room, sanitation is not necessary. Slowly moving along

f. SB 259 Backup Power for Wastewater System for discharging system Permitted by DWQ. Not out of committee yet Ag. & Resources Committee.

g. SB 261 Well Driller Certification. Not heard yet.

h. SB 287 Monitor Coastal Water Quality: Shellfish folks would look at water quality. No action yet.

i. SB 477 Septic Tank System - BMP Develop guidelines for BMP and given tax credits to people who follow BMP. No action yet.

j. SB 856 Lead Based Paint Management - Clarify existing laws. Fix it so you don't always have to abate but manage. Sets up a monitoring system. No action yet. (another lead based that certifies managers: SB 516)

6. Expansion Budget -- Still in: Two people $ 125,000 for local help (was 4 and $ 250,000) Straight pipe elimination (2 people $ 100,000 was out then in) $ 100,000 nonrecurring to support centralized training. Match money 9.4 million.

Terry Pierce thanked health directors and staff for keeping him appraised of activities regarding Environmental Health.


EPIDEMIOLOGY - No report.
HEALTH PROMOTION - Curtis Holloman reported the following issues:

1. Senior Vaccination Sunday. A letter from Beth Joyner will be coming out soon to announce that the name of the event will be changed to Senior Vaccination Season to align with local vaccination programs. Season will be October 12 - October 25.

2. Letter regarding Senior Vaccination Sunday. Dr. Peter Anderson is sending memo encouraging local health departments to purchase remaining vaccine. Originally cost $ 9.11, now offered at $ 5.00 per dose. Option will be available to LHDs until August if agency must purchase in next fiscal year.

3. Expansion Budget and some of the items in it that will impact our programs, such as reorganization of the Department.

4. Computer purchase. Letter from Charles Reed about using Health Promotion funds for computer purchases in order to utilize EHSIS.

5. Legislative chart prepared on legislative bills pending. See Attachments, pp. 20-24 for chart.

6. SB 728 HB 827 Healthy Carolinians funding. Thank efforts made there by everyone who worked on its support. Its status is unknown. Would provide $ 36,000 to each county.

HOME HEALTH ALLIANCE (NCAPHHA) - Dennis Harrington reported that his committee met on March 9 and had the following items to report:

1. Jody Vogelzang has sent out a survey in the mail. Need 86 local health departments to respond to the clinical services component of questionnaire. Please fill out and send back to Dennis Harrington. This may be of enormous benefit to marketing efforts in local health departments' clinical services. See Attachments, pp. 25-26 for Clinical Survey tool.

2. HH alliance tax status: We are very close to officially get IRS tax exempt status.

3. DMA Workgroups.

a. Rick Steeves and Anne Scott have competed a grant application to Kate B. Reynolds which would help set up a gatekeeping role for personal care services. May also inpact on non-Home Health counties (health departments).

Don Yousey, Streamlining Committee, have expanded this effort/model to a greater role in Long Term Care. Jim Baluss will take a lead role in presenting these concepts to Dennis Williams.

b. We are moving towards the linking the Alliance's 37 different cost report to one format report to assist Jody in compiling information vital in dealing with managed care contracts.
c. Marian Duncan has worked on comparison of Wisconsin model looking at appropriateness of Medicare/Medicaid billings. She found that Wisconsin had 70 percent client billings to Medicaid when much of that should have been to Medicare. NC public home health agencies surveyed found that billings were more appropriately made to Medicare. Of those NC public home health agencies surveyed (37), she found that 11 billed < 10% to Medicaid, 18 billed 10 - 15% to Medicaid, 2 billed 16 - 20% to Medicaid, 3 agencies 21 - 25% Medicaid caseload and only 1 billed as much as 27% to Medicaid caseload. It is therefore the thinking that Public Home Health agencies are doing a good job with appropriateness of billing. See Attachments, pp. 27-32 for this report.

d. A standardized patient satisfaction survey is being finalized.

Next meeting will be on May 14, 1997 at 10:00 a.m. in Room 297, Kirby Building, Dorothy Dix Campus.

HOSPITAL & COUNTY COMMISSIONERS ASSOCIATION NETWORK - Jim Baluss reported that his committee met yesterday in Raleigh. Jeff Spade, Executive Director of the NC Rural Health Center, NC Hospital Foundation who replaced Hugh Tilson, Jr., as designated liaison of the NC Hospital Association with the NCALHD is assisting on the following goals:

1. Plan one event in which NCALHD members and the hospital administrators association members attend jointly. The event planned is to be held the last day and in conjunction with the Adult Health/Health Promotion Symposium (three day conference in August) and overlapping the first day of the County Commissioners Conference. Hugh Tilson, Jr. and others doing a panel -- two sessions on collaborative arrangements between local health departments and hospitals.

2. Stephen Keener is taking the year long study through the Public Health Leadership Institute. There is a similar program for hospital administrators. There may be opportunities for networking between these programs. An outgrowth of leadership training provided health directors is the Tri-State Leadership Institute (NC, WVa and Va). The Rural Health Center offers funding opportunities and other facilitative services that could be available to us. Pilot conversations/dialogue among various players in community health via Area L AHEC meeting in Rocky Mount. This is being planned by health directors. Jeff will convene this meeting among various competitors.

3. Ed Regan was not able to attend yesterday's meeting. Hope to have his input in future meetings.


# INSTITUTE OF GOVERNMENT LEGAL ADVISORY - no report.




MANAGED CARE & REIMBURSEMENT - Dennis Harrington reported:

Announcement: Jeff Koeze will be visiting with us tonight.

1. SB 455 HMO Licensing bill in North Carolina. Governs what HMO needs to do to be licensed. Provision that we are trying to get a provision in that bill that the HMOs shall fully cooperate with local public health.

2. As far as Managed Care, we also met on April 9th. Health Benefit's Advocacy role for public health. Dr. Levine's office to help in staffing that effort. Leah Devlin will check on progress with this piece. See Attachments, pp. 33-34 for letter from Dennis Harrington to Dr. Levine.

4. Presentation by Dale Simmons to local agencies. Presentation of about 1 1/2 hours on what managed care is and then concerns how will impact on public health. Health directors need to take advantage of this resource.

5. MCH wrap around services proposal has been presented to Dennis Williams and is under review. Ann Wolfe says Dick Perruzzi is now officially the new Director of the Division of Medical Assistance. Motion was duly made and seconded that President Bass send a letter to Dick Perruzi, with copies to Secretary Bruton and Dr. Levine encouraging that the MCH wrap around services proposed be seriously considered and acted upon as soon as possible. Motion passed unanimously.

6. Meeting in March with Duncan Yaggy (Duke) regarding the 12 large NC hospital HMO development efforts. He said that he intends to include public health in the network and would be interested in further discussions in the future.

7. UNC Memorial Hospital and Wake Medical Center have obtained licensure to operate an HMO - "Generations Family Health Plan" . Spoke to Ann Christ, Executive Director who previously worked in an HMO in Minnesota where initial attempts failed until they included public health. She said she hopes to include public health in this new HMO.

8. Dale Simmons introduced Lisa Nugent from Office of Rural Health who made a presentation on CPT/ICD9 coding. We have requested that DMA do a study on benefits of health departments utilizing this coding method in regards to public health activities. See Attachments, pp. 35-40 for handout.

9. Memo from Mike Bell of Home Care Association. Excellent data on DMA payments - what targeted reductions are. See Attachments, pp. 41-46 for memo.

MATERNAL AND CHILD HEALTH/DENTAL - Dr. Harold Gabel reported that his committee met yesterday with the following:

1. Dr. Steve Cline is working on Sealant Initiative to meet Year 2000 goal of 50% Children to have this. Work to increase activity for second graders. He also reported that HB 564 allows Dental Hygienists to practice with indirect supervision. Dental Society not in favor of this, but it is important to the Hygienists. This bill has been referred to committee. (Hygienists already have this latitude in local health departments).

2. Healthy Start II (second round) to go to 30 communities. Our MCH folks have assisted ECU, Pitt County and other surrounding counties to plan strategies. Funding $ 2 M average award.

3. Title V Block Grant has been augmented $ 50 M funded for sexual abstinence education. NC share would be $ 1.15 M. Kevin Ryan would appreciate local assistance/input on the grant application.

4. Barbara Sterritt reported that $ 750,000 available for local health departments for tracking and f/u enhancements. Memo to come out. Allocations should be coming in July.

5. Religious exemptions from immunization is a growing problem with the string of new religious fringe groups. Need to get better definition of what constitutes religious exemption.

6. Dr. Wolfe reported that Div. MCH will be reducing by 7 positions, 6 being regional consultants. Most affected will be the Wilmington Region.

7. Barry Goldstein on finishing Contract Addenda revisions will begin working on accountability piece for local health departments. This will affect the funding provided to local health departments. He will talk about this at the next MCH meeting on May 15, 1997 at 10:00 a.m., St. Mary's Street. See Attachments, pp. 47-56 for Proposed Accountability System.

8. Rewriting SSBG. Restoration of $ 1.6 M out of Temporary Assistance for Needy Families (TANF) Grant (replaces AFDC) in Senate. Fund targets reduction of out of wedlock births. In House, the Social Services Block Grant there was a restoration of $ 239,000 adolescent pregnancy prevention projects. See handout.

POLICY & PLANNING - Bill Smith reported that

1. SB 799 Discipline Disclosure Act - would allow for open records of personnel files. Includes all public agencies/ officials.

2. Ad Hoc Task Force on Districting prepared a report that was sent out in minutes packet. Seven recommendations were made. Motion from committee is that the NCALHD adopt these recommendations. Request was made to delay action on the motion because of inadequate time to completely review and consider the document. Question was raised about providing new funds to new districts while older districts do not get anything -- equity question. Also, there was question as to why additional funding is needed for a new district formation if they are supposed to save money as a result of the new organization. Motion was duly made and seconded to table motion. The motion passed. The tabled motion on the report will not preclude any health departments from forming alliances. This goes back to Policy and Planning. Please send your written comments to Bill Smith, Chair, Policy & Planning Committee. Policy & Planning will meet and bring their report and recommendations back to the NCALHD May 15, 1997 meeting. See NCALHD March 20, 1997 meeting minutes attachments for the Ad Hoc Task Force on Districting report.

STATE & LOCAL RELATIONS - Margaret Dollar reports her committee met this morning with Secretary Howes.

1. Reorganization Bill has passed Senate and sent to House. a. Environmental Health to remain in current Department (DEHNR) with Dr. Levine over program. The Environmental Review Commission to be appointed by the end of this session to a one year study of reorganization and report findings to short session next year. The NCALHD will need to make sure that it has adequate input and representation on that body. Looking at key issues which may be looked at could include: Offering compromise splitting out multi-users/package treatment plants and leave smaller septic systems with public health. Please send your feedback on this to Margaret Dollar.

2. Senator Carr is introducing a $ 1 B Environmental Bond Issue that will require voter approval. Help municipal water treatment plants. Hog Industry.

3. Reorganize Individual programs. Public Health pretty much going to DHHS. Sec Bruton's focus on the health piece. Public Health and all health access and access . The next meeting will be very import: will meet with Secretary Howes and Secretary Bruton. Will be held in the Archdale Building, 3rd Floor, Wildlife conference room, Raleigh, on May 13, 1997 from 3:00 p.m. until 4:30 p.m.

# STATE HEALTH DIRECTOR'S OFFICE - Dr. Leah Devlin reported

1. Combined the Office of Chief Nurse and Local Support. Dr. Joy Reed to head up these responsibilities. She reports to Chris Hoke and will supervise the Administrative Consultants, coordinate PHTIN activities, and health director orientation, recruitment, etc. She can be reached at telephone 919/733-6850 and voice mail message at 919/715-4385.

2. Injury Prevention has been moved from Division of Epidemiology to Division of Health Promotion with Brenda Motzinger to head. (Funding for Injury Prevention from MCH Block Grant money) Peter Anderson still Interim Division Director of Health Promotion.

3. Looking into integrating the Policy Development of HIV Control and the AIDS Care Section. To have one section, one Director, Emily Blakenship-Foust. Some concerns regarding confidentiality were raised and discussed. Motion duly made and seconded that the NCALHD support the consolidation. Motion passed.

4. Streamlining ideas MCH and others. If you have any problems/comments, please feel free to call Leah Devlin and/or Division Heads and let them know.

5. Budget. In Senate, everything in except for MOW funds lost. 16 positions cut/ $ 875,000 cut with 1/2 from MCH.

6. Coding training on ICD-9/CPT to be offered. Administrative Consultants and Nursing Consultants will be initially trained. One to two state wide teleconferences (PHTIN) to be offered.

7. NC Supreme Court has ruled that anonymous testing HIV to stop May 1, 1997.


TECHNOLOGY - George Bond had the following items to report:

1. Adobe Acrobat - is not a gymnast who lives in a mud hut. CD-ROM software will be made available and Tom Bridges has arranged for a brief presentation here at 5:00 p.m. on its application. The Adobe software will allow scanning documents into the NCALHD homepage minutes. Motion was duly made and seconded that the minutes NCALHD continue mailed after July 1, 1997 at no cost. Motion failed.

2. Finalized MOU between NCALHD and the Office of the State Health Director. Will mail out for comment period over next thirty (30) days and will come to Executive Committee for adoption in May.

3. "Worker Bee Task Force" met April 7-8 and again next Thursday. Will present to the Technology Committee the EHSIS workplan/evaluation, then to Executive Committee in May.

4. Joy Reed reported that PHTIN is short $ 148,448.54 for next fiscal year. Locals are the beneficiaries of the $ 480,000 program. We need to support but how. Fees cost too much to collect (ex. $ 20.00 per person) Motion from Committee: NCALHD strongly supports PHTIN and authorizes division to transfer up to $ 148,448.54 from Aid to Counties prior to application of formula distribution. Friendly amendment was then made that the NCALHD supports PHTIN network, but that other funding sources from state should be found. Motion passed.

NOMINATIONS & BYLAWS - No report.

EDUCATION & AWARDS - Leonard Wood reported the following:

1. Health Director of the Year form is in the NCALHD March 20, 1997 meeting minutes attachments. (Also: check the NCALHD homepage on Health Director of the Year) He hopes to see many nominations.

2. Legal Conference. Motion from Committee requesting that the schedule be arranged to allow for all day on Tuesday, October 21 and Wednesday am on October 22. To hold NCALHD meeting the afternoon of Wednesday, October 22. This change was necessitated to accommodate speakers for the Legal Conference. Motion passed unanimously.

3. Due to plans to rennovate/remodel the Institute of Government, the 1998 Legal Conference will take place at the Friday Center, which has been reserved for this conference.

4. Jill Moore to fill vacancy left by Jeff Koeze. She is to begin on September 1, 1997.

5. Four local health directors were previously awarded travel scholarships to attend the NACCHO annual meeting in Houston, TX. Tim Green has declined his award and recommendation and consent from the Association that Tim's allocation of $ 750.00 go to the other three awardees.

LIAISONS & OTHERS

ANCBH - No report.

NCPHA - Debra Rowe reported that Glaxco-Wellcome Award nominations are requested. This is the fourth of a five year award program, so you have only a little more time remaining before the awards program goes nationally by Glaxco-Wellcome. Please take time to see their display in lobby.

PHTIN - No additional report.

OPHN - Reminder: Focus Groups on April 29th on how to use Nurse Consultants more effectively. Joy Reed requests feedback.

Other Liaisons: Western NCPHA meets May 21 - 23, 1997 in Boone.

ADJOURNMENT - With no further business the meeting was adjourned at 12:00 p.m. The next meeting is scheduled for 1:00 p.m., May 15, 1997 at the Auditorium, Albert Coates Building, Raleigh.

Respectfully submitted,



Thomas D. Bridges, MPH
Secretary