CALL TO ORDER - With the executive committee constituting a quorum utilizing proxies (See Attachments pp. 2 - 6 Proxies and Roster). President Barry Bass called the meeting to order at 1:00 p.m.

APPROVAL OF THE MINUTES - The motion duly made and seconded to approve the July 17, 1997 meeting minutes as written. The motion passed unanimously.

Due to some difficulty experienced by local health departments in getting meeting minutes and attachments from the Internet, a motion was duly made and seconded to resume printing and mailing NCALHD meeting minutes for the remainder of the calendar year, unless local health directors indicated to the Secretary that they did not need minutes mailed to them. The motion passed.

TREASURER'S REPORT - Tom Bridges gave the July 1997 and August 1997 Treasurer's reports. (See Attachments, pp. 7 - 10 July 1997 and August 1997 Treasurer's Reports) The motion was duly made and seconded that the Treasurer's reports for July 1997 and August 1997 be approved as presented. The motion passed.

The motion was duly made and seconded to authorize the Treasurer to identify a larger yielding investment account (such as a money market account) and to place the NCALHD savings and undesignated funds from the checking account into that investment program.

ANNOUNCEMENTS - President Bass had the following announcements:

1. No incoming or outgoing health directors.

2. The Board of (County) Commissioners Association in considering the NCALHD resolution regarding equity in the retirement system. That was being considered last night and a call yesterday from Jim Blackburn saying that they were favorable with what we wanted to do -- that they have historically favored equity between the two systems. This will be routed to their Legislative Committee for action in the next session of the State Legislature. It may come up during the Short Session if they find opportunity to do that, otherwise it would go to the next Long Session in 1999.

2. Six counties are still outstanding in not having paid their 1997 dues.

3. Orientation program for new local health directors will be August 28-29, 1997 at the Brownstone Hotel, Raleigh. Hope many of you will have opportunity to participate with them.

4. The Association of North Carolina Boards of Health will be holding their first Academy (training) October 10-11, 1997 at the Blockade Runner Hotel, Wrightsville Beach, North Carolina. A letter has been received from Susan Adams, President of the ANCBH asking for the endorsement of the NCALHD. The motion was duly made and seconded that the NCALHD endorse the ANCBH's Academy and encourage their Board of Health members to attend. The motion passed.

5. Jeannie Kirksey sent a letter thanking everyone for the flowers, cards, phone calls to express their condolences for her mother's passing.

6. Janice Patterson's mother died unexpectedly on August 11, 1997.

7. Denise Stallings has been awarded Health Director of the Year.

8. President Bass and George Bond have been asked to submit a list of local health directors to serve on a DHHS organization team to integrate DHR's information system with that of the State Center for Health Statistics into a seamless system. (See Attachments, p. 11 Information Needs Assessment Project) George Bond did not have his list of names available.

9. Visioning Sub-Committee met last Wednesday (August 6) to plan for a Consensus Conference in September (Re: to July 17, 1997 NCALHD meeting minutes). They plan to meet again on August 19 via telephone conference, after which a report/recommendations will be given.

10. Executive Committee will meet again immediately following the regular meeting today to discuss with Chris Hoke the Medicaid Maximization funds.

COMMITTEE REPORTS

HOSPITAL & COUNTY COMMISSIONERS ASSOCIATION NETWORK - Jim Baluss reported the committee met yesterday and discussed the need to develop points of concern and a "wish list" in regards to Carolina ACCESS II. County Commissioners representative was not involved in the discussion at this time. It was suggested that the Managed Care and Reimbursement Committee has been working on many of these areas and the Hospital & County Commissioners Association Network Committee may want to look into their findings.

# INSTITUTE OF GOVERNMENT LEGAL ADVISORY - No report.

MANAGED CARE & REIMBURSEMENT - Dennis Harrington reported that Dr. Dale Simmons, Marian Spaulding and he will be holding a work session this Saturday with the County Commissioners during their annual meeting to discuss managed care issues as it relates to local health departments.

Managed Care & Reimbursement Committee met on August 6, 1997 and have the following to report:

1. MCH Medicaid proposed "carve out" to protect wrap arounds. Proposal has gone through several versions. Third version proposed by MCH folks takes a much more aggressive stand. It would be renewed only on a yearly basis, however. Major points include:

a. DMA feasibility for bundled billing to CPT coding to begin sooner (July 1, 1998) -- at end of year, recoup costs.

b. The services identified for carve out/wrap arounds would be cost based, i.e.., not capped as will eventually be the other Medicaid services.

c. Health Benefits Management would be provided by local health departments.

2. Tork Wade, Office of Rural Health, shared information on Carolina ACCESS II (See Attachments, pp. 12 - 19 Carolina ACCESS II & Q/A).

3. Secretary Bruton proposes that Carolina Access is the appropriate way to serve the Medicaid population. He does not want to see a wholesale turnover of Medicaid to managed care operated by private HMO's. The motion was duly made and seconded to oppose wholesale turnover of Medicaid to private HMO's. Motion passed.

4. With the passage of the federal budget, $ 4 billion will go to provide health coverage to additional uninsured children and 10% of the funds can be used for administration costs. (See Attachments, pp. 20 - 21 Highlights of Child Health Insurance Provisions in the Budget Bill) Motion from committee: That local health departments provide outreach services to these children for enrollment into a medical care plan. Motion passed.

5. Dr. Carolyn Farree, NC Medical Society, sent a letter (See Attachments, p. 22 Letter from Carolyn R. Ferree, MD) to ask for support from the NCALHD to oppose the hospital "Consortium" proposed statewide HMO via this consortium. The motion was duly made and amended to oppose any statewide HMO until Carolina ACCESS has been given adequate opportunity to work. Motion passed.

6. A resolution is being drafted by Dr. Harold Gabel at the consent of Dr. Farree (NC Medical Society) that the NC Medical Society recognize the importance of Public Health's role in education and to urge for their strong and active support in this role in Managed Care. This resolution is to go to the House of Delegates. Dr. Harold Gabel and Dr. Sherman Kahn are both working closely with the NC Medical Society on this issue.

7. Training courses on CPT/ICD-9 are set up and fast filling up. George Bond shared a recent experiment where Buncombe County Health Center took a previous month's billings and converted them to CPT versions of payments and came up short 38%. He said he realizes that many services provided by local health departments aren't covered and some expertise needs to be called upon to address this issue.

MATERNAL AND CHILD HEALTH/DENTAL - No report

POLICY & PLANNING (Legislative) - No report, however, Bill Smith wanted to recognize the outstanding effort made by Deborah Rowe in communicating the issues on the Blue Cross/Blue Shield legislation. Also he has sent a letter to Adam Searing, Health Care Access commending him for taking point on this very important issue.

STATE & LOCAL RELATIONS - No report. Margaret Dollar is working with Secretary Bruton to establish a standard time for future committee meetings which will all be held in Raleigh.

TECHNOLOGY - George Bond reported the following:

Motions from committee:

1. HSMS Dues. Motion that the allocation of the dues structure for the local share of financial support for HSMS be revised annually and to be based upon the most currently available encounter data of the HSMS system. Motion passed.

2. On-Site Printing of WIC Vouchers. Given that the State WIC Program is now prepared to allow interfaces by proprietary computer systems with HSMS thereby allowing the on-site printing of vouchers: Motion with friendly amendment that the NCALHD express their appreciation for the flexibility displayed by the State and that local health directors both individually and collectively agree to their willingness to accept the additional local financial and programmatic responsibilities that will be come a part of new ad revised local agreements as a pre-requisite for the development and utilization of the new interface software. Motion passed.

3. Technology Committee Makeup. Given that the Technology Committee of the NCALHD from its inception has been unique in that only a few local health directors have been members and the bulk of the committee has been made up of clerical, administrative, and management information personnel from the local level. Further, given that the HSIS council in many ways is redundant of the Technology Committee and its related task forces but lacks the strong local focus desired by the State Center for Health Statistics, it is therefore moved by the Technology Committee that the NCALHD adopt the attached model (See Attachments, p. 23 for Model) for the makeup of the Technology Committee, its related Task Forces, and its relationship to both the NCALHD, the State Health Director, the HAPP Council and the IRMC. Due to NCALHD Bylaws on composition of committees, the motion amended to refer to the Bylaws Committee for recommendation for action. The Bylaws Committee is to also check with the DHR composition for representation on the Technology Committee. Motion passed.

George Bond asked that health directors recommend individuals to serve on the two Task Forces serving the Technology Committee. (See Attachments, pp. 24 - 25 Nomination Form for Task Force Members)

NACCHO Report. As the elected NACCHO Board Member, George Bond gave a written report on the Annual NACCHO Meeting, July 16-19, 1997, Houston, Texas. He said it was his opinion that more good information and ideas came from this meeting that he has experienced at any other national forum. (See Attachments, p. 26 for NACCHO Report)

NOMINATIONS & BYLAWS - No report. Dr. Louis Latour will be mailing out a nomination form for Secretary/Treasurer and a nomination form for Regional Representatives for the 1998 NCALHD Executive Committee. Elections will be held in October.

EDUCATION & AWARDS - No report. It was announced earlier that Denise Stallings was awarded Health Director of the Year.

ENVIRONMENTAL - Terry Pierce shared the following from committee meeting on Aug 14:

1. Legislative Update from Linda Sewell:

* 189 & 194 Ratified

* $ for State Revolving Fund match is agreed upon but not passed yet (9.2 million)

* Well Contractor Certification 251 ratified 8/5

* SB 208 Sanitation of dishes ratified

* HB 469 & HB 486 still pending - probably won't get through this year.

* Reorganization bill still on hold.

* NER subcommittee on appropriations seems to be in agreement with Envir. budget items. Approximately 4 positions in OSWW, 3 in Lead, 6 in Coastal Water Quality, 6 F/L & Institutions.

* Special provision - reissue waste water permits is still in the same language - in Senate

* SB 929 Child day Care Law - passed Senate but yesterday House added language to allow daycares (anysize) to use domestic kitchen equipment if it holds temperatures appropriately. If frying foods, must use commercial hoods. Also, inspections of all day cares of any size.

* Neuse River study funded.

* Centralized Training funds still in - total should be $ 200,000

Commission for Health Services Meeting - Revisions to On-Site rules on agenda. No real opposition in committee. John Shaw will not be able to attend meeting to represent Association.

2. Restaurant Rules Review Committee - Progress Report from Michael Rhodes

Probably last meeting before the report goes to the register for printing. All LHD's will get a copy and have an opportunity to comment. committee will debate a few of the more serious issues today and works toward consensus (Appeals, Correcting On-Site, Grading Cards) To go to commission Nov 14th.

3. Temporary Registration Period for Sanitarian Interns. Issue resolved by Mel Crocker, State Personnel. (See Attachments, pp. 27 - 28 Letter from Mel Crocker to David Rust)

4. Transient Non-Community Water Systems - Health Director should have received a memo about participating in identifying Transient Non-Community Water System. Received @ 8/7 calls for a response by 8/29 to ask if you are going to participate. If you didn't receive, contact Jessica Miles at (919) 715-3232.

5. New Business

A. Proprietary Septic Tank Systems. There has been a letter written to the Attorney General's Office saying that some health departments are unfairly excluding certain kinds of proprietary septic tank systems or recommending one kind of system by name. AG's Office will address specific questions or concerns. Layton Long handed out the policy that Transylvania County uses that calls systems by their generic name not the proprietary name. (See Attachments, pp. 29 - 31 Policy adopted by Board of Health) The property owner is given a list of options for systems and the owner or their agent selects. County attorney has approved this document. This came about because contractors were changing the product without the property owner approval.

B. Confusion Regarding Rule 1961 Repairs. "Best professional judgment" Don Yousey's concern is that repairs are becoming prohibitive and out of reach of low-income homeowners, i.e., rather than adding line in poor soils, removing entire system and going to mound systems. Some EHS are coming away from training sessions about repairs with confusion over how to permit repairs. The workshop does not say you have to use current standards. When permitting repairs, the guidance is do no great harm. Eastern North Carolina has specific problems with distance to groundwater and limited area to repair. You cannot knowingly discharge to ground water. Each repair is unique.

C. Committee to Review Reorganization. The EH Supervisors Association has been asked to put together a committee to study reorganization and submit a position paper.

Members Representing

Rick Rowe EH Supervisor

Linda Sewell Div. EH

Ken Ring NCALHD

David Rust R.S. Board

Trenton Davis University

Don Yousey NCALHD

Donald Stephens EH Supervisor

Carol Ann Gibson President NCEHSA

Newsome Williams NCPHA

TBA Environmental Health Section, NCPHA

Debora Rowe has been hired to serve as Secretary to the R.S. Board

EPIDEMIOLOGY - No report.

HEALTH PROMOTION - Committee held telephone conference. Curtis Holloman reported the following issues were discussed:

1. Legislative update from Dr. Peter Anderson.

* Osteoporosis (pending) $ 200,000 to support Task Force.

* Restricts Purchase/Sale of tobacco to minors (pending) Youth Access Bill.

* Fire Mortality Prevention. Requires land lords to install fire detectors.

* Diabetes management support. Third Party insurance required to cover.

* $ 100,000 Cardiovascular Control. Data surveillance.

* State Cancer Control Program - support

* Graduated Driver's License

* Genetic Information - Protects from being shared and used to determine insurance coverage risk

2. Behavior Risk Factor Surveillance Survey Data

* nationally collected data, telephone survey of behavior patterns. CDC Surveillance System

* conducted 3 community surveys (Orange, Wake, Chatham)

* state added questions to CDC. Questions: tobacco use, sexual assault, etc.

* information will be on Webb (Internet) within a few weeks

* call Gene Langerich with questions: 919/715-3131

3. Move of Injury Prevention in Epidemiology to Health Promotion/Disease Prevention Section.

4. Grant Seeking - submitted to CDC proposal which addresses fire mortality. the RFP called for South Eastern States with high incident of fire mortality to submit demonstration projects to identify strategies to address fire prevention. Will update at future meetings.

5. Turning Point Grant. RWJ & Kellogg Foundation RFP. The state and four local community proposals are still in the running. Site visits are taking place today (this week).

* Healthy Carolinians closely related "Turning Point for Healthy Carolinians" - broadens the Governor's Task Force. Establishes a broader vision of public health for North Carolina.

6. Senior Vaccination Season. Update:

* The local coordinators have received forms to be used for consent, information, and data collection.

* Audio Public Service Announcements and a video tape will be made available to local health department.

* Medicaid to reimburse for influenza & pneumonia

* Guidebook updates to local coordinator

7. BCCCP & CVD. Grant updates: Dr. Holiday sent memo out a couple of weeks ago regarding grant and outreach funding. Notices are forthcoming. Outreach funds were cut.

HOME HEALTH ALLIANCE (NCAPHHA) - Dennis Harrington reported

1. The NCAPHHA first annual meeting will be held October 8-9 in Greensboro. Site TBA.

2. November 5, 1997 will be a regular Board meeting. Also, that day will be an educational offering via the Public Health Training Information Network (PH-TIN). The session will air from 8:00 a.m. - 11:30 a.m. and is targeted to Home Health Nursing Supervisors and Home Health staff.

3. In process of getting a Clinical Coordinator for Alliance staffing agency.

4. Contesting a recent negotiated CON agreement in Region VI where ECU and Tar Heel were each given sites.

5. Recent telecast gave negative report about home health situation in California. Home Care Association sent useful information on countering this. NC should not be viewed as having the same problem as California. Public health has vested interest in home health care.

6. Eastern Alliance meets August 27th at Martin Community College, Room 114, 1:00 p.m. Call Marilyn Hinson for details.

# STATE HEALTH DIRECTOR'S OFFICE - Chris Hoke reported the following:

1. House/Senate agreement on the funding for the budget, but must wrestle with the Welfare Reform piece. This has now become the holdup.

Budget Items

EH items good reaction on funding.

* Funding for osteoporosis and other items got resolved, including rabies. Rabies got lab funding and one new veterinarian position..

* Worked with Governor's office on authority to spend other monies not in expansion budget.

* Healthy Carolinians $ 0. Turning Point Grant tied closely to Healthy Carolinians -- this grant will make visibility to Healthy Carolinians.

2. Reorganization Bill - some movement. Favorable from committee but stalled by Committee Chair who has not reported it out to floor.

3. Day Care Bill. Hit us very cold. Makes significant last minutes changes. Issue of equipment and inspections. Need to share concerns to legislators.

4. Public Health Authority Bill caught in same game as Reorganization, but not as confident (in getting through) as Reorganization.

5. Two ILO bills. Working on them. Stuck in this provision, Office of Administrative Hearings that hears all of Appeals -- State Health Director makes decision. Administrative Law Judge is final authority.

6. Legislation $ 3 million for mosquito control from federal government -- no additional state money.

7. Lead abatement bill: Did get some movement out of Finance Committee (Doug Dixon) agreed to bring up next Tuesday (8:30 a.m.)

8. Thanks again for BC/BS efforts.

9. Medicaid maximization. Funds available within week. Additional unofficial word is that it is a done deal. Instead of two years back funds, only one year back funds would be paid (about 1/2 original amount). These funds are the difference in what had been originally paid and what actual cost was for providing services (This is federal share that has not been paid). HCFA said only one year, but would offer in perpetuity. This federal money should not impact on state budget.

Working on a provision that even with CPT billing, keeping cost settlement aspect tied to billing so we don't lose many $ if any.

10. No financial incentives are being made available for Districting (health departments) at this point.

LIAISONS & OTHERS

NCPHA -

1. Deborah Rowe needs names of public healthers who have worked 25+ years so that NCPHA can recognize them.

2. NCALHD Executive Committee meets in Forsyth Ballroom A on September 9th at 1:00 p.m.

This will be held in conjunction with the NCPHA annual meeting at the Adams-Mark Hotel in Winston-Salem.

3. Stay vigilant on BC/BS issue. Will be in Study Commission for now.

Office of Public Health Nursing and Local Health Services - (See Attachments, pp. 32 - 35 Report of the Office of Public Health Nursing and Local Health Services)

ANCBH - No report. NCALHD endorsement of Academy dealt with earlier.

Nutrition Directors - Four one hundred dollar scholarships will be offered this year to nutritionists seeking higher education. These funds were raised through a silent auction conducted during State WIC Directors' meeting, which will be held this year, October 20 - 22, 1997 in the Sheraton Hotel, Research Triangle Park.

REGIONAL REPORTS - No reports.

ADJOURNMENT - With no further business, President Bass adjourned the meeting. The next scheduled meeting of the NCALHD Executive Committee will be held at 1:00 p.m., September 9, 1997, Forsyth Ballroom A, Adams-Mark Hotel, Winston-Salem.

Respectfully submitted,

Tom Bridges, Secretary