CALL TO ORDER - With the Association constituting a quorum, President Barry Bass called the meeting to order at 1:12 p.m. See Attachments, pp. 2-4 for attendance roster.

APPROVAL OF THE MINUTES - Motion was duly made and seconded that the minutes of the May 15, 1997 meeting be approved as written. The motion passed unanimously.

TREASURER'S REPORT - Tom Bridges reported that there are still 10 local health departments that have not yet paid their annual dues. Please note dues payment as indicated on the attendance roster. As of June 13, 1997 the checking balance excluding the State Health Director's Meeting fund was $ 44,761.24 and savings balance was $ 25,128.51. The 1997 Budget shows year to date receipts of $ 30,924.02 and expenditures of $ 9,831.73. See Attachments, pp. 5-6 for more detailed treasurer's report. Motion was duly made and seconded to approve the treasurer's report as presented. Motion passed unanimously.

ANNOUNCEMENTS - President Bass had the following announcements:

1. He wanted to thank the membership for their efforts in calling legislators about the Blue Cross Blue Shield matter (SB 993).

2. The July 17, 1997 NCALHD meeting will be at the Bermuda Run Country Club in Davie County. To date there are only 17 confirmed reservations and the deadline is tomorrow. Please call Betty Cassidy at the Davie County Health Department and let her know if you plan to attend so she can complete arrangements for the meeting.

3. Reminder of the Adult Health/Health Promotion Symposium on August 12-14, 1997 in Greensboro.

4. Congratulations to George Bond on being elected to the NACCHO Board of Directors.

5. Next month, Barbara Pullen-Smith will give a brief presentation on interpretive services.

COMMITTEE REPORTS

HEALTH PROMOTION - Curtis Holloman reported the following:

1. Some outstanding bills important to Health Promotion include:

Cancer plan

Genetic testing

Heart disease and stroke prevention task force

Healthy Carolinians seems to be still alive. Jim Boehm urges everyone to contact members of the Conference Committee on SB 352. See Attachments pp. 7-8 for listing of House and Senate members. The fax number 919/715-5815 can be used to inform the committee on your concerns.

There is a bill to create an Office of Women's Health. This bill also would provide $ 60,000 funding for first year.

See Attachments, pp. 9-13 for a legislative report on these and other important bills.

2. Report on a cancer prevention project in Johnston County studied by the Division of Health Promotion to show if cancer screening partnerships with other groups have a positive impact on early detection. Findings have indicated that the project was successful and the Division hopes to introduce this project in up to 10 additional counties. See Attachments, pp.14-18 for the Johnston County project report.

3. Project Assist Manual was developed as the result of a meeting last January that included several local health directors. Manual titled, "Enter the Clean Air Zone". The NCALHD may be offered an opportunity to participate in sponsoring the manual.

4. Interpretation services - Spanish speaking. Suzanne Young, Office of Migrant Health, presented new directory which provides standards for translation of documents and working with Spanish speaking clients. See Attachments, pp. 19-22 for pamphlet on these services.

5. Beth Joyner made a presentation on "Pride in Public Health". Some concern has been raised over the departmental reorganization and its impact on this effort. We need to continue this effort to keep public health visible in the community.

6. There is an Immunization Coordination Guide Book to help local agencies in planning their activities/events.

7. Funding from CDC, if it is forthcoming could provide money for

a. Skin cancer prevention focus

b. Injury prevention with attention to fire and bicycle helmet safety.

c. School health activities at state level to bring about more partnerships between health departments and the Department of Public Instruction.

8. The Adult Health Symposium is scheduled for August 12-14, 1997 in Greensboro and is titled, "Growing Partnerships: Collaboration for Healthier Communities" The last day (Thursday) there will be a program designed for participation and involvement among several groups.

9. Dr. Robert Ross, Director of Health and Human Services, County of San Diego, will make a special presentation at the August NCALHD meeting on managed care and public health in collaboration with other partners.

HOME HEALTH ALLIANCE - Dennis Harrington presented the following:

1. Approved three contracts which provide home health therapy pieces.

2. Working on a major grant application to Kate B. Reynolds on long term care and case management Medicaid patients and Alliance being the model.

3. Apria wants to use Alliance members exclusively. Alliance members, please meet after this meeting with Dennis Harrington for additional information.

4. Other contracts working on include:

a. Qual Choice (Baptist)

b. Partners (Forsythe) Tier II clinical services. This result from survey on clinical services that was completed by most local health departments.

HOSPITAL & COUNTY COMMISSIONERS ASSOCIATION NETWORK - Jim Baluss reported the following:

1. The committee did not meet this month, however he wanted to reinforce the importance of attending the Adult Health Symposium and its facilitation of networks among community health providers and county commissioners.

2. He recommends that NCALHD membership gets to know Jeff Spade, Rural Health Center, NC Hospital Association. He is available for technical assistance. AHEC has been called on in the East to facilitate collaboration among health providers.

INSTITUTE OF GOVERNMENT - No report.

MANAGED CARE AND REIMBURSEMENT - Dennis Harrington reported that the committee met on June 11, 1997.

1. Bruce Parsons presented a model for Carolina ACCESS II which he and others (hospital included) are working on in Gaston County. Carolina ACCESS I is going statewide and local health departments need to consider becoming a provider.

2. DMA informed the State Health Director's Office that there will be no Medicaid rate adjustments for public health. Home health aides and HH skilled nursing reimbursements will get some reductions. This was reported by Alan Gamble.

3. Patient flow analysis via CDC training for consultants has been completed. This tool can be taught to local staff to use. See Joy Reed about this resource.

4. CPT & ICD9 training will be offered this fall via the PH-TIN. Look for announcement.

5. Sixty-seven out of 87 local health departments have asked for technical assistance from Dale Simmons and Nan Rideout. Dennis Harrington thanked them for their efforts to respond to these requests.

6. Dr. Dale Simmons will be retiring from full-time employment at end of June. He will continue remainder of the calendar year on a half-time basis providing assistance to local health departments.

Motion from Committee: That the state contract for resource to help in this consultative role to local agencies along with Nan Rideout to fill the need in this important role. Motion passed unanimously.

7. NC Prevention Coalition starting. Meg Malloy gave a presentation last month to the Managed Care committee. She is looking for partners in these managed care efforts. Dennis Harrington attended their most recent meeting.

Dale Simmons reported that he and Nan Rideout have visited 63 counties and have given 1 - 3 presentations in each. He said that what seems to work best is for them to first provide a 1.5 hour managed care orientation to health department staff. Then to follow with a full day (8 hour) evaluation of resource capacity with staff. Finally, to meet with the local Board of Health, county manager, etc. This has worked best so far to get local health departments along their way.

Some counties are now making intense efforts. Dale Simmons wanted to thank Joy Reed for her efforts in providing training in three key areas:

(1) good management practices

(2) customer service

(3) assistance on dealing with stress and morale problems brought about by organizational change. Also, assistance from AHEC is available on this. They can provide services via a registration fee.

The state is also looking to support effort by providing national expertise to provide additional training. Need a task force appointed to help on this along with Nan and Joy. Jacqueline Wynn, AHEC, to offer help/assistance in this effort.

This is Dale's last meeting with NCALHD in full-time capacity. He will continue to monitor e-mail and voice mail. He said that he has enjoyed immensely this final role in his public health career.

Also, counties planning to set up primary care should consider telephone triage training via PH-TIN. Notice was recently sent out about this offering.

MCH/DENTAL - Dr. Harold Gabel reported the following:

1. Streamlining so far has gotten mixed reviews. Harold Gable said he has asked Dr. Anne Wolfe to send out a complete summary of changes made. He hopes to hear from as many as possible by early July about their assessment of the recommendations for streamlining.

2. Report on new TANF funding proposed with DSS needs to be made first. TANF provides federal funds ($ 6 million) for prevention of out-of-wedlock births. See Attachments, p. 23 for copy of proposed budgets for this and other MCH programs.

3. Dental: sealant program. See handout, Attachments, pp. 24-25.

4. Training for public health nurses (Joy Reed) changes made cutting out 12 days of training piece.

POLICY & PLANNING - Bill Smith reported the following:

1. SB 993 had four different amendments. The 4th amendment had the most teeth. It is not 100% of what public health wanted but it did provide for some overview by state. From the current perspective, it was a success.

2. Motion from Committee: Resolution that the NCALHD urge the County Commissioners Association to take lead role to get local and state retirement and other benefits equalized. Motion passed unanimously.

3. Public Health Authority Bill - Add-on that one member on the Public Health Authority be from Hospital. Motion from Committee to oppose this add-on since many counties do not have hospital and in others may have over representation by individuals with hospital ties. Motion passed unanimously. Bill is currently in Human Resources Committee.

STATE & LOCAL RELATIONS - Margaret Dollar reported the following:

1. The Departmental reorganization bill in House in the Human Resources Committee. Expect it to come out and pass. Will be effective July 1, 1997. Space allocations -- don't see majority of staff moving. DEHNR to become Department of Environment and Natural Resources (DENR).

2. There are to be appointments by Sen. Basnight and Rep. Brubaker to the Environmental Review Commission.

3. Dr. (Sec.) Bruton plans to meet monthly with State & Local Relations Committee. Margaret Dollar said that for the next few monthly meetings, she may have to schedule at other times to accommodate Dr. Bruton's schedule.

4. For the reorganization of the Department of Health and Human Services, he is establishing teams to work on resources, public information and governmental affairs which are to involve public health, mental health and social services. Need to address regional offices, consultants, etc. Joy Reed will be sharing information gathered from focus groups regarding consultants.

The question was raised by Jim Baluss to President Bass about which NCALHD committee should local health departments share impact/concerns about Carolina ACCESS. President Bass said that Managed Care & Reimbursement should be contacted. E-mail can be sent to Dennis Harrington, Chair.

STATE HEALTH DIRECTOR'S OFFICE - Dr. Levine reported the following:

1. Dr. William Roper is the new Dean of the UNC School of Public Health. He comes by way of Alabama and has at one time served as a health director. He begins in July. Dr. M. Ibriham will return to research studies on managed care and public health.

2. Two study commissions are to commense upon the adjournment of the Legislature:

a. Financing and funding of public health to be addressed by the Public Health Study Commission.

b. Environmental Review Commission will consider all aspects of environmental health and its organizational fit. During this one year study, the public health Environmental Health programs will remain in DENR but will be under the direction of the State Health Director via Chris Hoke, Deputy Director.

There are a number of vacancies to fill on these two committees. Dr. Levine asked for suggestions from local health directors as to which Senators and Representatives would be positive about public health. There are to be 3 additional Senators and 1 additional House member to be appointed to the Environmental Review Commission.

For the Public Health Study Commission, the Legislative appointments are set. Vacancies to fill that are not members of the Legislature include 2 appointments by Speaker of House, 2 appointments by the Pres. Pro-Tem, 1 appointment by the Governor, and 1 appointment by the Lt. Gov. These appointments are further delineated according to GS 120-197 as follows:

Pres. Pro-Tem appoints 2 members from either of the following:

NCALHD

NCPHA

PH Nursing Assoc.

NC Envir. Supervisors Assoc.

SOPHE

House Speaker appoints 2 members from either of the following:

School of Public Health

Primary Care Assoc.

Home Care Assoc.

Pediatric Society

NC Citizens for Public Health

Lt. Gov. appoints 1 member from either of the following:

NC Assoc. County Commissioners

NC Assoc. Boards of Health

Governor appoints 1 member from either of the following:

NC Medical Society

Hospital Assoc.

The Senators on the Commission are: Lucas (Co-Chair), Ballentine, Cooper, Forrester, and Martin. House members include: Esposito (Co-Chair), McCombs, Gamble, Nichols, and Aldridge.

TECHNOLOGY - George Bond expressed his appreciation and gratitude to local health directors who loaned local staff to work on the Task Force ("worker bees"). Eighteen of these people have been meeting over the past two days with the State Center, WIC and Environmental Health to address areas of concern. They also worked on the Annual Work Plan for HSMS.

1. WIC. On-site printing has been a problem for QS, Anne Presnell, Unix users. Rebecca Troutman, County Commissioners Association, was especially helpful in resolving many of the policy matters in this regard. A follow-up on this issue will occur about 120 days.

2. The MOU between the NCALHD and the State Health Director's Office/State Center has been revised as agreed from last NCALHD meeting and is ready for signatures. The work plan outline sets an 18 month target time for completion of the work plan. See Attachments, pp. 26-27 for HSMS - Health Services Management System 06/19/97 Proposed Priority Plan Submitted by Technology Sub-Committee. George Bond reviewed the draft work plan which needs review and agreement by the State Center. George Bond said that a major change that the Task Force took was to develop the work plan around a systematic approach rather than a programmatic approach.

Motion from Committee: NCALHD present the document to Delton Atkinson as the proposed Work Plan for Fiscal Year 97-98.

Discussion around motion included need to include managed care concerns, such as HEDIS 3.0 as well as standardization of data. Review of progress report will be made by Delton Atkinson at the State Health Directors Annual Meeting for consideration of the NCALHD to proceed further. Also, quarterly reviews of developed work and timelines will be done by the Technology Committee. If state does not fulfill its obligation as agreed to, Technology is concurrently working on Request for Information from interested software vendors and ballpark estimation for statewide pricing by modules/package and time frame in getting operational.

Motion passed unanimously.

AWARDS & EDUCATION - Leonard Wood reported the following:

1. Annual Legal Conference (October 21-22, 1997) planning underway. Some time (1 hr) will be set aside to allow NCALHD members to further discuss Public Health Authority and a Vision Committee update. So far, topics for the Legal Conference include: Legislative Summary by Chris Hoke, ILO's by Milton Heath, Employer Liability re: references, Welfare Reform by Jill Moore (replacement for Jeff Koeze), Tobacco Litigation, Health Director litigation, and Non-English speaking access to health care. Leonard Wood welcomes input from health directors.

Anne Dellinger said that Jill Moore will not have adequate time upon arriving in September to prepare for a discussion of health authorities and other re-structuring concepts for health departments. The price of the first day's lunch will be in the registration fee.

2. Health Director of the Year has been selected and presentation will be made at August meeting of the County Commissioners Association.

3. New Health Directors Orientation is being developed by Joy Reed. Motion from Leonard Wood that the NCALHD provide funding to send new health directors to the training, however after discussion on the issue, Leonard Wood withdrew his motion. President Bass, upon reaching a consensus, will make funds available out of his discretionary budget to pay for training upon written request from the health director in such need. Joy Reed will plan for a 2 day orientation to be offered by mid-August/September.

ENVIRONMENTAL HEALTH - Terry Pierce reported the following:

1. Legislative update from Malcolm Blalock.

SB 193 - On-site Wastewater Systems. $ 200,000 appropriation. Study septic tanks and other sewage disposal systems by NCSU: how systems function and their impact on the environment.

SB 208 / HB 165 - Lodging Establishments Sanitation. Sanitizing of cooking utensils not required for guests' rooms when food is prepared by guests. Passed House and Senate. Will be ratified.

SB 261 - Well Contractors Certification. Passed House. Has a chance.

SB 352 - Current Operations Appropriations "The Budget Bill" Tentative schedule: agreement by June 27th and "Go Home" by July 4th. Need to oppose Section 13.25 Senate version which deals with reissue certain wastewater permits which goes back to 1982. House earlier deleted this provision. Need to look at list of conferees distributed at today's meeting during Curtis Holloman's report on Health Promotion. See Attachment, pp. for list of conferees.

SB 477 - Septic Tank Systems Best Management Practice. Develop guidelines and give a 50% tax credit for using system. No movement.

SB 486 / HB 469 - Permit Fees. $ 75.00 late payment; reinstatement fee $ 150.00. No movement on House side.

SB 806 - Childhood Lead Exposure Control. Lab reporting for children under 6 years. Advise owners in writing of levels greater than 10 ug/dl for under 6. Revised and passed Senate.

HB 189 - Drinking Water Amendments. NC Drinking Water Act conforms to Federal law. Ratified.

HB 194 - State Revolving Water Fund Act. State loan and grant funding. Ratified.

HB 215 - Backup Power for Wastewater Systems. Require on-site backup generator. Probably dead.

SB 671 / HB 475 - Wastewater Improvement Permits. Allows preliminary evaluations under local boards of health programs. Senate substitute: Replaces with a Study Bill - lumps in with Air Quality Studies - probably be approved for committee to study this fall.

HB 1021 - Septic Tank Standards / Process Study. Establish wastewater systems permit Study Commission. No environmental health representation on Commission per se (ex-officio member by State Health Director). Probably will be approved.

SB 486 / HB 471 - Clarify Food Establishment Definition. Juice Bar regulations. Passed Senate.

SB 516 - Lead Based Paint Management. Certification required for abatement contractor. Passed Senate. Could be Short Session item.

SB 790 - Food & Lodging Sanitation Funds. New state positions plus $ 500,000 to counties for training. Not looking good.

2. Family foster homes well setbacks. Previous discussion that family foster homes not being approved because failed to meet setback requirements for wells (usually from house foundation to well). DWQ can't grant variance because no rules were in effect when well drilled. Legal remedy 3 options: (a) Leave as is - homes are denied - best legally, worst politically. (b) Rule change - "lesser" (lower) standard for family foster homes. Could use performance standard only, i.e.., sampling. Rule change probably not in effect until 1999. (c) Law change. Amend statute to no longer require Commission on Health Services to regulate family foster homes. DSS will probably not like unless recommendations for local health department as consultants for monitoring certain parameters This is preferred option - private homes already using water with no apparent health problems. Could be done in Short Session.

Motion from Committee: NCALHD appoint Tom Johnson as Local Health Director representative to work with Malcolm Blalock, DSS Directors' Association and other agencies to develop a solution to the well setback problems for family foster homes. Motion passed unanimously.

3. Restaurant Rules Review Committee Report. Tommy Jarrell and Doug Urland working with this committee. Starting to get bogged down again - "horror stories" and "war stories" re: isolated events. All rules have been reviewed. Moving to Grading System, Appeals Process and Transitional Permits (the subjects of bigger debate). Would like local health directors' comments on Appeals (next subject) to Doug or Tommy.

4. Health Services Management System (HSMS) - Environmental Health Component. Further discussion of the use of laptop computers for Food & Lodging inspections and HSMS generated reports. Hardware and software issues. Moving toward a Windows environment.

5. RS Board and State Personnel inconsistency. From Bill Smith - 3 years maximum for EH Intern to become registered. RS Board starts time when Intern is registered. State Personnel apparently starts time at date of employment. Terry Pierce will take up with RS Board to negotiate with State Personnel on when to start 3 year time frame.

6. Proposal to Develop a Position Paper/White Paper re: reasons Environmental Health programs should remain with Public Health. Would produce a formal paper to be used with legislators, county commissioners and other groups to state a united position. EH Supervisors' Association is planning to produce a position paper and want local health director representation. President Barry Bass will make this appointment.

7. Authorization Work Group. Met yesterday - one change: presenters at EH meetings would get 2 times as much credit hours as individuals just attending.

All rules formatted. Time frame:

To State Registrar for comment - July

Receive commentary - October, revise

To Commission on Health Services - November

Rules Review Commission - December

Legislative Oversight Committee - May

Short Session for approval

Dr. Ron Levine noted that there is growing interest in placing pets in nursing homes. The state will be providing material about whether to permit/not permit.

EPIDEMIOLOGY - Dr. Walter Linz reported the following:

1. Rabies is getting more attention. Some positive signs from State Legislature in areas of

a. Funding made available for hiring a second veterinarian.

b. Increase fees for dog tags will raise $ 50,000 towards rabies education efforts.

c. Additional $ 100,000 per year for increasing laboratory testing for rabies.

Human deaths from rabies seem predominately to come from exposure to rabid bats. The state is rethinking its policy/guidelines about post-exposure from bats. Dr. Lee Hunter is preparing a draft letter which will be sent out to local health directors to put on local health department stationary and send out to their community physicians. Recommendations will be to treat humans even when no visible signs of exposure on skin.

2. Due to Hurricane Fran, this year is expected to be a record for mosquitoes. Concern for potential outbreak of Equine Encephalitis. Press report will be coming out advising citizens to rid habitats for mosquitoes. The state does have some funds available to counties on a cost-share basis, although these funds have been decreased.

3. HIV prevention funds to 18 rural counties may have some chance of being restored.

SPECIAL TOPIC: VISION COMMITTEE REPORT

President Bass reported that the Vision Committee met prior to this meeting. The group discussed need for a clear mission statement with achievable goals and to put into place a mechanism on where we want to go. Concern is the relatively short time table of approximately 12 months. We must be on a continuum of readiness for managed care. We have a very diverse group. One-third of counties do not seem to be doing anything to prepare for the managed care environment. If they do not get into the process, it may not bode well for public health. The Vision Committee will meet again on July 15, 1997 at Bermuda Run, Davie County (to be arranged by Dennis Harrington). This all-day meeting will be spent developing parameters on where to go. President Bass said that he expects work groups will be established and other players will eventually brought in. He urges participation by the NCALHD membership to help the Committee make the right contacts to bring about the greatest good for public health. This effort will certainly include environmental health issues. The existing NCALHD committees will be involved as much as possible rather than duplicating activities. President Bass said we need a unified uniform consensus on a strategy which reinforces and melds with local efforts.

Outside facilitation/consultation may be called upon. There will be a calendar time line and definitions on what will be achieved or produced.

Motion from the Vision Committee that the NCALHD endorse the formation of a group called the Configuration for the Delivery of Public Health Services. Motion passed unanimously.

LAIAISONS & OTHERS

ANCBH - Dr. Pam Horne reported that

1. Leadership Training for local boards of health October 10-11, 1997 at the Blockade Runner, Wrightsville Beach. Topics that will be offered include: Youth Access to Tobacco, ILOs, Helping your County Commissioners and Health Director develop a budget, Hiring a Health Director, New Restaurant Rules/Grading System, Boards of Health in Action, and Successful & Innovative Approaches. Pam Horne will be providing updates by e-mail.

2. A number of ANCBH members will be attending the national annual meeting next week in Boston.

3. Training continues for at home and consulting opportunities. Please refer to the ANCBH newsletter.

Dr. Louis Latour reported that the first annual meeting of the Home Health Alliance is scheduled for October 8-9, 1997 in Greensboro. More information to come.

NCPHA - Deborah Rowe reported that

1. She was gratified by local efforts made with SB993 (Blue Cross).

2. NCPHA Annual Conference, September 10-12, 1997, Adams-Mark Hotel, Winston-Salem. Look for program announcement to be mailed out by next week. If NCALHD committees need a meeting room, please get in touch with Deborah Rowe. Deborah has reserved a block of 300 rooms for conference attendees. The room rate is $ 85.00 single/double.

PH-TIN - No report

OFFICE OF PUBLIC HEALTH NURSING - Dr. Joy Reed reported that

1. She has been successful in reducing all of the Public Health Nursing Assessment courses by a total of 12 days, and the Public Health Orientation has been reduced by 3 days.

2. On July 1, the Office of Public Health Nursing will get one nurse consultant position. It will not programmatically attached.

NCAPHNA - Shirley Mozingo reported that

1. Public health nurses have been very actively writing letters opposing hospital administrator representation on the Public Health Authority.

2. They have been successful with getting two bills passed:

a. Nursing scholars amendment

b. Direct payment for nurse practitoners.

3. HB555 - School Nurse Funds - In Appropriations Committee on Education. Ask Legislature to fund $ 8 million to increase school health nurses across the state. They would like help from the NCALHD on this bill.

President Bass noted that previously the NCALHD opposed additional funds for school health nurses in light of what DPI/local school administrators have done with Basic Education Plan (BEP) funds. They had the option of using some of these funds for nurses from public health but chose not do so. President Bass asked that Bill Smith, Chair of Policy & Planning send him a letter on behalf of P&P stating the Association's previous position (which also reflects the position of the NCPHA). President Bass will in turn send a letter to the Nurses' Association restating the points of the NCALHD's position and what language reflecting a tie to funds to public health would be needed to reconsider its position.

NCALND - Annette Piner reported that the week of August 1st will be World Breast Feeding Week. Governor Hunt has signed a proclamation in recognition of this event.

ADJOURNMENT

With no further business to discuss, President Bass declared the meeting adjourned at 3:55 p.m. The next Executive Committee meeting of the NCALHD will be on July 17, 1997 at 9:00 a.m., Bermuda Run Country Club, Davie County.

Respectfully submitted,

Tom Bridges, Secretary