CALL TO ORDER - With the executive committee constituting a quorum, President Barry Bass called the meeting to order at 9:10 a.m. (See Attachments, pp. 2 - 5, Attendance Roster and Proxy Letter)

ANNOUNCEMENTS - President Bass

1. The December meeting of the Executive Committee will convene again at the Albert Coates Building, Raleigh on December 18, 1997 at 9:00 a.m. The PH-TIN could not be set up due to a scheduling conflict.

2. Recognize and welcome David Rice, Health Director, New Hanover County Health Department.

APPROVAL OF THE MINUTES - The motion duly made and seconded to approve the October 22, 1997 meeting minutes. Dr. Joy Reed noted a couple of edits. With agreement for a friendly amendment that the minutes be approved with correction, the motion passed unanimously.

TREASURER'S REPORT - Tom Bridges

1. Tom Bridges thanked the many members who sent him their condolences at the loss of his Stepfather. He also wanted to again thank Tim Green for recording and outlining the meeting minutes at the October 22d meeting.

2. The Report as of October 14 (See Attachments, pp. 6 - 7, Treasurer's Report: October 14, 1997) indicated that the Regular Savings Account dropped below the minimum $ 25.00 due to Federal Back-up Withholdings of $ 24.49 that was taken out. The calculations were based upon the previous Savings Account Balance of $ 25,000. He said that he corrected this in November with a transfer back from the Money Market Account of $ 30.00, and does not think that future Federal Backup Withholdings will be a problem in this regard.

In the 1997 Budget, Tom Bridges said he audited his more recent statements and needed to account for membership dues that needed to be shown. To date there are only 3 agencies that are not fully paid up. Two agencies are sending their 1997 dues in. This leaves only one agency that has not paid their 1997 dues.

The motion was duly made and seconded to accept the October 14, 1997 Treasurer's Report as presented with edit correction. Motion passed unanimously.

3. The Report as of November 11, 1997 (See Attachments, pp. 8 - 9, Treasurer's Report: November 11, 1997) reflects the $ 30.00 transfer back from Money Market to the Regular Savings Account to assure the minimum balance. The Federal Backup Withholding for November was only two cents.

Tom Bridges proposed an amendment to the 1997 Budget to delete the line item for Wood Endowment and add it to a new line item called Contributions to more accurately reflect the funds given to various causes during the year: The $ 2,000 to the Home Health Alliance and the $ 1,000 recently to the Institute of Government would be moved from Contractual Services and the balance remaining in NACCHO Scholarships and Dictaphone to the Contributions line to cover. This Tom Bridges thought would make the line description more appropriate to the expense. The amendment would be no net change in the dollar amount of the budget.

The motion was duly made to accept the Treasurer's Report with an edit correction, and the proposed Budget Amendment. The motion passed unanimously.

SPECIAL REPORT - Mr. Al Thompson who was scheduled to make a presentation on Special Needs Shelter Task Force is unable to attend due to a death in his family. President Bass said condolences on behalf of the Association were sent to Mr. Thompson. President Bass recognized Lynn Perrin, Assistant Secretary for Aging, Disability and Long Term Care with the Department of Health and Human Services, to make an informal presentation on the Long Term Care Project. He wanted to also inform the group that Howard Campbell, Health Director for PPCC Health District is the NCALHD's representative on the Long Term Care Roundtable.

Ms. Perrin shared the following: North Carolina has 97,000 individuals who are 85 years and older. In twelve years that number will grow to over 174,000. The Governor and the Legislature has drawn the line in the sand on the growth of the Medicaid program. They are to restrain that growth to 8 percent by 2001. In order to do that they are looking growing numbers of eligible, a growing inflation rate a decrease in the federal participation rate in the Medicaid program. To retain/moderate that growth in any way it will be quite a challenge for the state. They are looking very seriously at how managed care principles can be used in health and long term care delivery systems. Seventy-one percent of the total Medicaid dollars are spent on the elderly and disabled. The challenge is to deliver good quality services in an organized manner to a growing population of elderly and disabled and restrain or moderate the growth of the Medicaid dollars.

Internally, DHHS is establishing a section to just address Long Term Care. Long Term Care has for many years involved across many divisions, such as health, aging, medical assistance, social services, vocational services, services for the blind, services for the deaf. The needs components need to be pulled together to address the problem. A Policy Unit, will be headed by Bonnie Crammer. A Research and Demonstration Unit located in the Office of Rural Health under Jim Bernstein. Also, three demonstration projects are being developed in the state:

1. One is being established in Northeastern North Carolina, led by Howard Campbell and his staff, and other organizations in his region. A foundation grant from the Kate B. Reynolds will support this demonstration project. This is the primary site for testing some ideas, developing assessment instruments/tools, automation systems and working out the concepts of having two entities.

a. Access Management Organization. How folks find out about services and how they get to the appropriate services. Will do information and referral, outreach, counseling for services, screening, and assessments, eligibility determination for publicly funded programs, client advocacy, education, and ombudsman and oversight of the delivery system.

b. Managed Care Long Term Care Provider Network. They are trying to organize the home and community care base service providers into an organized network and also attach that to adult care homes as well as nursing home care, including hospitals. And we want to eventually work with physicians.

This may sound simple, but it is perhaps one of the most complex projects the state has ever been involved in because it will involve so many providers more than have been worked with in Carolina ACCESS.

2. The second project area will take place in Alexander, Caldwell, Burke and Catawba Counties. Are in the process of completing a feasibility analysis. Interviews with all the providers (about 50 interviews) to determine what the project should look like to meet the goals and objectives, particularly how to moderate the growth of Medicaid.

3. The third site will be in the Mecklinburg area. At this point, just in conversation with some of the providers in that area.

As they move along in these projects, they will be using their Long Term Care Roundtable to share information, get input and answer questions, and share information from the above three project sites as it comes available so other communities across the state can begin deciding how they can reform their health and long term care system for older and disabled adults.

Invitations have been sent out for various groups to attend the Roundtable discussions. It is expected about 50 - 60 to attend. The meeting will be held on November 25, 1997. Information will be gathered there and then shared with the NCALHD and others. Ms. Perrin said that they need to know what NCALHD and others think, with all the advise and suggestions.

It appears at the start, however, that what is needed is for multi-counties to come together. Cannot have 100 long term care delivery systems. The Secretary (Bruton) wants to move very deliberately, but realistically it is understood this will be over many years to complete.

ANNOUNCEMENTS -

1. President Bass passed out a brief report on the October 30, 1997 Vision Forum and follow up. (See Attachments, pp. 10 - 11, October 30, 1997 Visioning Forum Report) He has appointed the following individuals to the Vision Work Group: Barry Blick, George Bond, Howard Campbell, Leah Devlin, Dennis Harrington, Richard House, Louis Latour, Fred Pilkington, Joy Reed, Wayne Sherman, Bill Smith, Danny Staley, Denese Stallings and Barry Bass. The Work Group will meet following the NCALHD Executive Committee meeting today.

2. Dale Simmons was recognized to give out his report on what he and Nan Rideout have been doing throughout the state. (See Attachments, pp. 12 - 25, Dr. Dale Simmon's Report on Local Health Department Managed Care Preparedness Evaluation) His report provides findings and recommendations. He said that more recently his findings seem to be repeated over and over -- nothing new. Nan Rideout has been working with some local agencies more in depth, while Dale Simmons has been mostly making presentations.

December 15, 1997 is Dale's last day. Nan will still be in her office. Until a replacement can be found for Dale, Joy Reed announced that Faye Hoffman, the Nurse Consultant out of OPHNPD, will continue leading those evaluations during a transition phase until the Local Health Improvement Section Chief is hired. (Faye has been participating in this process with Dr. Simmons over the past three months) When that person is "on board," he/she will take over that responsibility. Faye will also be a primary liaison in connecting counties with appropriate resources at the state based on the needs they identify during the evaluations and following up with counties to see what progress has been made and what additional help they need; that role will continue after the Section Chief is hired.

3. President Bass received correspondence from Mike Smith, Director, and Anne Dellinger, of the Institute of Government thanking the NCALHD for its contribution to their building fund.

4. Meg Malloy , NC Prevention Partners, requests the NCALHD join them formerly. This will be covered in the Health Promotion Committee report.

5. President Bass has received correspondence from Jim Bernstein and Tork Wade regarding the NC Foundation for Alternative Health Programs. Twelve proposals for Carolina ACCESS II demonstration projects were received. They have selected one large network model which is comprised of 20 Carolina ACCESS practice groups. Then there are six local network models which have been selected. Those include Buncombe, Cleveland, Durham, Gaston, Guilford, and Surry Counties as demonstration projects. George Bond and Denese Stallings gave updates on their projects. Both said that they are working to have a strong case management component.

6. White Paper on the structuring at the state level of programs in Environmental Health. (See Attachments, pp. 26 - 29, White Paper for Organizing and Structuring of Programs in Environmental Health at the NC State Government Level) The EH Supervisors Association and the Environmental Health Section of the NCPHA have encouraged support on getting this White Paper accepted and adopted by Local Boards of Health and local Boards of County Commissioners. Motions will be coming in this regard in the Environmental Health Committee report. Last week, Rick Rowe presented the White Paper to the Human Resources Steering Committee of the NC Association of County Commissioners. They adopted the Paper and are going to present it to their Board of Directors.

7. President Bass reported that the NCALHD sent out a letter of support for a Centers for Disease Control grant application from the State Center for Health Statistics to promote integrated public health information infrastructure with a focus on improving immunizations. This letter had come through the Technology Committee.

8. There is a regional workshop on TeleHealth financing network development and reimbursement of services. This is offered out of George Mason University, Fairfax, Virginia. The focus is going to be primarily at funding opportunities for telemedicine networks.

9. As mentioned earlier, Howard Campbell has been appointed to represent the NCALHD on the Long Term Care Roundtable.

10. Will be looking for two health directors to be appointed to serve on a state and local partnership in enhancement committee that has been established by Environmental Health. President Bass will be working with Michael Rhodes on making these and any other appointments/reappointments.

11. The advisory committee of the North Carolina Public Health Awareness Program will be retreating (informally) on Tuesday, December 2, 1997 to discuss future directions, etc. Dr. Christopher Cooke has requested to have a local health director to join them for part or all of the discussion. The meeting will be from 9:00 a.m. to 4:00 p.m. at Rollingview Marina, Falls Lake, Durham. Lunch will be provided. Anyone interested should call Dr. Cooke at 919/733-1537 or 919/966-8450.

12. Wayne Raynor has sent out a warning about three viruses in Internet: "Join the Crew", Pen Pal" and a version "aol." The viruses could render your hard disk inoperable.

COMMITTEE REPORTS

MATERNAL AND CHILD HEALTH/DENTAL - Bob Wood reporting.

1. Dr. Harold Gabel is back at work on a limited schedule.

2. Information regarding the Organizational chart for DHHS and the placement of the Division of Women's and Children's Health. Details for this can be found in Senate Bill 626. (See Attachments, pp. 30 - 31, Senate Bill 626)

3. The North Carolina Family Resource Coalition is providing a training and credentialing program for front-line workers. It provides skills and competencies needed to effectively practice family support and development. (See Attachments, pp. 32 - 40, North Carolina Family Resource Coalition: Family Support Training and Credentialing Initiative)

4. "Celebrating 80 Years: Seal the State in '98 Symposium" has been planned for January 8 & 9, 1998, Embassy Suites Hotel, Greensboro, North Carolina, to review the accomplishments of 80 years of dental public health services to North Carolinians and to set an agenda for prevention for the next decade. (See Attachments, p. 41, Seal the State in '98 flyer)

5. The Adolescent Parenting program has been moved from a DSS related Division in DHHS to the Division of Women's and Children's Health. There are 26 local projects around the state.

6. New federal program for expansion of health care services to cover children through age 18. Children in families at or below 200% of poverty would be eligible for the coverage. The federal portion to North Carolina would be $ 79 million and the state share would be $ 37 million. The insurance could be offered either as an expansion of the Medicaid program, as a separate insurance product or as a combination of the two. It is estimated that 71,000 children will qualify for this expanded coverage. Also, it estimated that another 67, 000 children currently qualifying for Medicaid but not enrolled would also be brought into the program. (See Attachments, pp. 42 - 72, Review of Final Draft Report on Children's Health Insurance)

Motion from Committee: That the NCALHD send a letter of support to Secretary Bruton to support the most comprehensive package available that will expand the new Child Health Insurance Program. This would in essence be in support for expanded Medicaid coverage with certain enhancement services, such as case management services, which will have direct benefit to public health. Motion passed unanimously.

7. There are new ACIP recommendations for immunizations. Expectations are that there will also be additional federal money to purchase the vaccine for eligible children. State dollars would be needed to provide a seamless coverage for all children (to include children who would not qualify for the federally purchased vaccine). This will amount to $ 4 million for all the vaccine. More specifically, it would take $ 2.5 million state dollars for Varicella. The planned implementations for this vaccination enhancement program for eligible children is January 1998. We will be requested to support the effort to get additional state dollars to cover the additional children.

Draft Estimates on Expanding New ACIP Recommendations September 4, 1997 to be included in the minutes. (See Attachments, pp. 73 - 76, DRAFT Estimates on Expanding New ACIP Recommendations, September 4, 1997: Measles, Mumps & Rubella; Tetanus Diphtheria Toxoid; Varicella; and Hepatitis B)

8. A letter came out announcing that as of January 1, 1998, private providers will no longer be able to enroll Carolina ACCESS clients. They must be enrolled by DSS.

POLICY & PLANNING (Legislative) - Bill Smith.

1. Next meeting will be December 17, 1997 at 2:00 p.m., Conference Room, G-1, 1330 St. Mary's Street. They will be meeting with Barbara Pullen-Smith and others regarding the issue surrounding service provisions/restrictions to the non-US citizens.

2. Committee chairs for NCALHD calendar year 1998 are mostly in place. Bill Smith has asked them to identify five or so members for their committees. Others will be assigned. Committee attendance is spotty, except for Environmental Health, Technology and maybe one or two others. MCH may be considering a million dollar decision, only one or two members would be making a recommendation. Bill Smith urges more health director involvement and to try serving on some different committees next year.

3. Bill Smith has formed an Ad-Hoc Committee of Past Presidents to develop a plan for consideration by the Association for an Executive Director position. this is being chaired by Leonard Wood. Concurrently, he has asked Leah Devlin to chair a similar committee from NCPHA as they also will be looking at an Executive Director position.

STATE & LOCAL RELATIONS - Margaret Dollar. Committee met on October 15, 1997 with Secretary Bruton.

1. Discussed uninsured children and the new policies regarding Health Check and Carolina ACCESS II and dropping the exemptions for local health departments. Dr. Bruton wants to do things differently to meet his goals of serving all children. He is firmly committed to private-public working together to do what is best in the interest of children. He wants to reduce fragmented care. The Committee pointed out to him the serious consequences to his plan if public health is not included in helping him reach his goal -- that dropping the exemption with Carolina ACCESS could be harmful. The Committee suggested that local health departments could help get to 90% goal serving children not all being seen in the private sector. (See Attachments, p. 77, Premise: LHD's should continue as local service providers...) Denise Stallings said that school based clinics would be negatively impacted by the proposed policy and also need to continue to be exempted, too.

2. Meetings of the State & Local Relations Committee during calendar year 1998 have been set for 2nd Wednesdays at 9:00 a.m. with Dr. Bruton. Tom Bridges will chair the committee.

3. The next Legislative Conference is scheduled for Tuesday, June 9, 1998, Raleigh. Speakers and topics are being scheduled. NCALHD co-sponsors this program with the NCPHA. Maggie Dollar wanted to recommend the NCALHD budget $ 1,000 for this program.

# STATE HEALTH DIRECTOR'S OFFICE - Chris Hoke

1. The offer of the State Health Director position to Dr. Nichols was turned down. There is not an immediate fall back.

2. New Appropriations Committee in Legislature. New mechanism of oversight. They are meeting once/month. Lot of activity going on in Legislature. Asked for presentation on District Health Departments. Chris Hoke and Danny Staley are to meet with them.

3. Jim Bernstein, Chris Hoke and Leah Devlin have been looking into issues with regard to moving some money from Medicaid Clinical Care to fund Core public health.

4. Medicaid Maximization: This came up in Appropriations Committee. Charlotte Gardner said she had a newspaper account. She asked Sec. Bruton and Jim Edgerton about it, plus others with state budget. Some state folks are trying to determine if there is some state claim to some of the money. Chris Hoke said that the state has no justifiable claim to the money and he is working with them on clarification. The language is in the contract. Situation is very tense. He is still hopeful that the money will soon be released.

5. Even though the Governor's priorities list does not say anything about health, Sec. Bruton wants his goal with Medicaid savings should come from higher cost areas to public health prevention issues. Anne Wolf and Daffney Lyons are working on a position paper/"white paper" on this.

Bob Wood requested to amend his earlier motion concerning the New Child Health Insurance that the NCALHD would send a letter to Sec. Bruton that he be encouraged to utilize public health in the role of advocacy, outreach and quality assurance in the Insurance plan. The motion was seconded by Dennis Retzlaff. Motion passed unanimously.

TECHNOLOGY - George Bond. The Technology Committee met on November 6 and again on November 19, 1997.

1. Motion from Committee: That the NCALHD send a letter to Dean Roper in support of Dr. Christine Moe's $ 21,000 project that would provide Internet access to School of Public Health, State Epidemiology and Local Health Departments to work together on disease outbreaks. Dr. Richard House clarified that the issue was with the Chancellor's Technology Funds, not with Dean Roper. George Bond requested an amendment to the motion that the letter be directed to the Chancellor and copy sent to Dean Roper. Tom Bridges seconded and the motion with amendment passed unanimously.

2. Motion from Committee: That the NCALHD initiate a contract with Russell Jones (beginning January 1998) at $ 250.00 per month for maintenance of the homepage. Motion passed unanimously. (See Attachments, p. 78, Russell Jones' Proposal for Homepage Services)

3. The Technology Committee in addition to having the MOU with the State Center also sent out an RFI to look into what kind of private proprietary software was available and if it could be made available statewide at a reasonable price with good functionality and within a reasonable time frame. Five companies responded and the Technology Committee invited two companies in to each make 2 hour presentations on their product. The rationale was not to determine between these two products which we liked the best, but rather to consider if the Technology Committee should consider dropping the HSMS and pursue a private vendor. Some thoughts in this were that many local health departments purchased private software for their data management and more transactions are entered via these software than via the current HSIS. After considering the options the Technology Committee brings the following motion: That the NCALHD immediately initiate a process for a statewide request for formal bids to put in place a new statewide data management system to replace HSIS, utilizing the $ 3 million of Medicaid Maximization money.

Concerns about this motion are who will take the lead role in the RFP process? Is additional funding available to DHHS from Year 2000 funds that could be used for the software? There is no instant fix because it will take time to develop the RFP. It may take just about as long to get up and running as projections are for the HSMS version. George Bond said that this is in no way a reflection on the State Center -- they are some of our strongest supporters. They will be the ones who would have to apply this system and keep it up and running statewide. The Technology Committee vote was 18 - 2 to go for the RFP.

Concerns raised by some Executive Committee members were about what is needed for future needs that we do not fully know about for managed care. Others said you can't stop and that you have to start somewhere and you have got to realize that things are going to change constantly. If you keep waiting for something else to fall in place, it could be too late in the future. George Bond said that we are at a crossroads and we cannot go in five different directions with this matter. The RFP will be a process taking at least 6 months because all kinds of parameters need to be considered. Concern about the $ 3 million availability, but this should not be the only way the system could be paid for. The motion was that if the $ 3 million comes available, then it could be used to fund the project. What is the cost for purchasing the system and what is the on-going maintenance of such a system? George Bond said the typical cost is the cost for acquisition and a 10 - 15 percent annual fee for maintenance which is based upon the acquisition cost. It was also felt that any state and local standards that would be required must be met by the vendor.

Considerations about the State Center's efforts is that they have never had the funds to do what they needed to do. They have not been successful in showing a new product over the past couple of years that works. Question is why wait on the State Center when much of the product is already out there.

Andy Fenlayson, Assistant Director of the State Center said that they have some very serious concerns about the bidding process. They don't think it would be appropriate for them to develop the RFP, since obviously they can't be trusted to develop the HSMS. He said he has worked for many years in writing the RFP and that it is very difficult to get what you think you want. Another problem is that once a vendor is selected, another vendor may tie up the movement in court over your decision to go with a competitor. This could mean additional time and court costs. George Bond said that it is not a question of trust. He said that the TB module was rolled out over the last 9 - 11 months and many things were found wrong with that one module. Also, if the module is not at least as good as what many already have from private software, then they will not go with the new HSMS. Merle Green said that once you go outside the State Center to the private vendor, you have to trust the private vendor to develop and maintain the system you need. This isn't always assured either.

Dennis Retzlaff said that he felt very uncomfortable voting now on such a critical matter without more time (2 months) for thought. Dr. Louis Latour said that he hesitated to vote on such an important matter as the Executive Committee vote, rather than a Full-Association vote. Bill Smith said that the Executive Committee is supposed to handle matters that come up between Full-Association meeting times. That the Executive Committee is representative and should take responsibility to make hard decisions, otherwise we should do away with the Executive Committee and have all open meetings. It was also his opinion that he is opposed to the motion and that with an infusion of $ 3 million that the State Center could still resurrect the best system.

George Bond said that a positive vote would sent the Technology Committee on a trail which would start with Dr. Levine, it would start with the IRMC, with Rebecca Troutman of the County Commissioners Association, etc., to determine the efficacy of the process. Call for the vote: Motion to proceed with the RFP passed 6 yes and 5 no. George Bond said that the Technology Committee would start as he stated earlier and would come back with an implementation plan between December and have some of the questions answered to give the group more security, or that the group could vote it down if desired. Also, the January NCALHD meeting will be a Full Association Meeting and could be a time where everyone would have a chance to vote again on this matter.

NOMINATIONS & BYLAWS - Dr. Louis Latour

1. Thanks to all who are willing to serve in the various offices and to those who participated in the voting process to get offices filled.

2. Idea with bearing on Nominations & Bylaws: NACCHO is planning 5 year agenda for their national meetings. They will be in St. Louis next year, September 22, 1998, in Detroit July 21, 1999, and in Charlotte July 19, 2000. Dr. Latour would like President Bass to appoint a committee to work with George Bond (who serves on Executive Board of NACCHO) and Dr. Latour (serves on Education Committee of NACCHO) or any other arrangement of his desire to work with NACCHO on planning the Charlotte conference. This is a well recognized conference. They are also associating this year with ASTHO and this will undoubtedly continue in the years to come. It is expected that the Year 2000 conference will be a very large one. President Bass said that he will put together a committee of 5 - 7 members, and he will include Mecklinburg County since they will be hosting the meeting.

EDUCATION & AWARDS - No report.

ENVIRONMENTAL HEALTH - Terry Pierce. The Environmental Health Committee met yesterday. Items discussed included:

1. The Position Paper/White Paper that involves reorganization of the Division of Environmental Health. (See Attachments, pp. 26 - 29, White Paper for Organizing and Structuring of Programs in Environmental Health at the NC State Government Level) Two motions coming from Committee:

a. Motion that NCALHD support and endorse the White Paper as written. Some Executive Committee members said they had not received the Paper. The final copy completed on November 4, 1997 was approved by the Environmental Health Supervisors Association on November 6, 1997. Terry Pierce said this is something the NCALHD asked the EH Supervisors to do. Terry Pierce said that to him the only controversial elements are that it proposes to move the wastewater systems greater than 3,000 gallons from the Health to the Environment side. There is also a shift in the water program. Rick Rowe reported that Don Yousey and Ken Ring were the two representatives of the NCALHD to work on the Paper. There are certain programs, such as Food and Lodging, Tattoos, etc., that are straight up and down "Health Programs" -- no argument there.

The real issues seem to be on water and waste water. Where should these programs fall in the state organization. The Committee decided to place anything that had to do in the water area from the time that it is processed and that it came to the consumer, we considered this to be a "Health" issue -- consumption. This had to do with water supply, wells for human consumption was a "Health" issue. When we dealt with water on the Environment side we looked at watershed protection, capacity, resource, groundwater kind of issues -- these are "Environmental" component and needs to be in the Environmental side of the state structure.

The wastewater side when it comes to on site systems, in particular and the problems associated with malfunctions around businesses, homes, etc., that should be dealt on the "Health" side. Since there are some counties that do not have the staff to handle the larger systems, the Committee came up with a break level on those larger systems. The Committee therefore chose to use the break at the 3,000 gallons since that has been used in the past. Anything that is 3,000 gallons or larger would be on the "Environmental" side. Also, the Committee said that there would be the opportunity for delegation by the state to local health departments to do the larger systems at the county level.

This Paper is intended to go as a recommendation to the Environmental Review Commission as the position of local concerns/groups and how the state structure should deal with these programs organizationally. Terry Pierce said that all the programs that local health departments have dealt with DEHNR would be therefore be the same and would be transferred to the Division of Health and Human Services. The only two that would change would be those wastewater systems 3,000 gallons or more, and the well and drinking water private systems would move to Health and Human Services. The issue about monitoring wells is already covered and would be placed in the Division of Waste Management. This is a monitoring well issue and it is already covered by a permit through a currently existing agency. This would not place any local agency in having to deal with monitoring these wells. Funding is a critical factor and that there is not enough funding for these programs.

The White Paper was presented last week by Rick Rowe to the Human Resources Steering Committee of the North Carolina Association of County Commissioners. They voted unanimously to endorse the Paper and to present it to their Board of Directors.

Call the vote: Motion to endorse and support the White Paper as written/presented passed unanimously.

Terry Pierce shared for the minutes a notice of the meetings for the Environmental Review Commission. (See Attachments, pp. 79 - 80, ERC: Notice of Meeting; Schedule of Future Meetings)

b. Motion from Committee: That the NCALHD encourage all health directors to recommend to their local Boards of Health and County Commissioners to support this document. Motion passed unanimously.

MiMi Cooper and Diane Crouse have been gathering extraneous material that came out of the discussions and will prepare a summary sheet on the White Paper. Local Health Directors can then use the summary sheet to help explain the concepts of the White Paper to their local Boards. The deadline to share the White Paper is December 19, 1997 and let Terry Pierce or Rick Rowe know about your local endorsements.

3. Authorization Rules were taken to the Commission for Health Services. This is basically a process that deals with the education hours, peer review of suspensions and revocation of authorizations. The peer review would be from a group of three Regional Environmental Health Specialists. The Environmental Health Committee of the NCALHD has taken the position to support these Authorization Rules and did not feel the need to change any of the language. The EH Supervisors did not support this.

4. The Restaurant Rules: All the things that we asked to be incorporated with the exception of the definition of food grade material has been addressed in one way or another. There were several major changes. The grading system on averaging the minimum all have been taken out. Bottom line is there is going to be the opportunity for seven counties to pilot a new grading system that does not have "A" , "B" or "C", but has a numerical score with fairly large numbers. The reasoning behind this is there are seven Regions in North Carolina and there would be a pilot county in each Region. On the spot corrections has been changed and it now has a section that the EH Specialist shall take zero, half of full deductions. The two point bonus for education on managers/owners are still in there, has been changed so that they must successfully complete the course. Also, if their score is below 70 they don't get the bonus points.

A few technical changes in that the appeals procedure. The attorney did not like the terms and it now reads "informal review process." It must be post marked or hand delivered within 10 days of the inspection.

The Restaurant Rules Committee has not finished and meets again next Tuesday. On December 12, 1997 the Commission for Health Services meets and will vote on this (Restaurant Rules), plus the Authorization Rules. In view that the Restaurant Rules Committee continues to revise/change the language, John Shaw asked for advisement of the EH Committee regarding the Commission for Health Services.

Terry Pierce said that for whatever reason, whether it was public outcry or whatever, the Restaurant Association member on the Restaurant Rules Committee has backed off on a lot of former demands.

5. There is another List Server that has been designated for Environmental Health. To subscribe to this e-mail directory, send an e-mail message to:

maiser@deh.enr.state.nc.us

(leave "SUBJECT" blank)

In body of message, type the following message: subscribe ehl

Then send this message as you would any other e-mail message. The DENR server ("Maiser") will afterward include you on the mailing list.

6. Family Foster Homes: Committee chaired by Malcolm Blalock is meeting with some public health/health directors and some DSS folks to come up with some solutions. Most foster homes are denied because of a water/sewage problem and the whole question of variances is a sticky one.

7. Appointments to 3 sub-committees on a state and local partnership in Environmental Health enhancement discussed earlier today. President Bass will get with Michael Rhodes on the needs and will appoint these health directors.

8. The old rules that were in effect for permits that had since expired, but can now be revised again will require the EH Specialist to refer back to those old rules. Most local agencies probably don't have those old rules, so copies will be made available on CD-ROM and on the Internet so the rules can be retrieved rather quickly and copies can be then printed locally.

EPIDEMIOLOGY - President Bass reported that Dr. Walter Linz said he would defer his report to the December NCALHD meeting.

HEALTH PROMOTION - Curtis Holloman. HP Committee met yesterday with Dr. Leah Devlin, new Director of the Division of Community Health.

1. Initiative funded by the Centers for Disease Control a five year project for bringing together the Community Diagnosis Process and enhance that process. The goals are as follows:

a. To turn Community Diagnosis process into a truer assessment of the community and it will be done by the local residents. It is to include some of the aspects of the Healthy Carolinians Task Force and other local groups.

b. The purpose of the initiative is to develop a continuous local community health assessment and also to coordinate and expand the work of existing local Healthy Carolinians Task Forces.

c. The first year is a developmental year to develop a new assessment tool. A Steering Committee will be established. They will hire a Project Director, a Statistician and a Trainer who will work with the local communities. This is not an academic activity, but rather to bring together the various community assessments to use and complement or replace the Community Diagnosis process that we currently use.

2. Turning Point grant, which is collaboration for a new century in public health has been unofficially awarded to North Carolina along with two local partners, Lee and Onslow Counties. The two year project totaling $ 150,000 per year. Some of the goals of the initiative will be:

a. To improve the communication between state and local agencies.

b. To address the core functions of public health in the areas of clinical and environmental

strategies.

c. To identify changes needed to strengthen the capacity of a public health system. and

d. To develop a statewide plan for improving public health.

Turning Point initiative could therefor be a vehicle for the NCALHD's current Visions efforts.

Motion from Committee: That the Vision Committee discuss ways of collaboration with Healthy Carolinians 2000, Turning Point Committee, and the Healthy Objectives 2010. Motion passed unanimously.

As an outgrowth of this collaboration would be the Turning Point staff could assist the Vision Committee with administrative functions.

3. Mary Bobbitt Cooke presented and gave a update on the Healthy Carolinians program. An effort to bring that program to every county with funding ($ 36,000 per county) from the Legislature failed last session. She proposes a renewing the effort for funding. Her strategy includes:

a. Prioritizing the legislative agenda with the Association and with the DHHS.

b. Letter writing -- contacting your local legislator.

c. Having a Legislative Day, where we can educate our Legislators on the importance of Healthy Carolinas.

d. Develop other partners, such as local hospitals, to work with us on getting this Legislative item passed.

4. North Carolina Partners in Prevention. (See Attachments, pp. 100 - 102, Brochure: NC Prevention Partners) Meg Malloy requests that the NCALHD join formally this partnership. Membership is based upon the size of the entity's operating budget. In this case, the NCALHD's membership would be $ 50.00. The NCPP will be housed at the Sheps Center in Chapel Hill. The Shep's Center think it is a very good initiative for Public Health and has adopted it. Jenny Lassiter has been representing the NCALHD on the NCPP. The NCPP will be holding a big kickoff in February 1998 of the Partnership to bring more attention to this new coalition.

Motion from Committee is that the NCALHD formally join the North Carolina Partners in Prevention. Motion passed unanimously.

5. In looking over the organizational chart for the new Department of Health and Human Services, the HP Committee was concerned about the name for the Local Health "Improvement" Section. They are concerned about what "Improvement" connotates. They wonder if perhaps the name should be changed to "Local Health Support" or some other such name.

Also, concern was raised about the location for the Office of Public Health Nursing. Its status there. Concerned that the Office within the Section/Division not prominent has it once was. Need to look into how it has traditionally been placed.

6. The HP Committee discussed the Call for Comments on the Proposed 2010 Framework and the Call for Healthy People 2010 Objectives. (See Attachments, pp. 103 - 109, Call for Comments) Refer to page 14 (third page of handout) shows a fan in Figure 2: Proposed Healthy People Framework, titled, " Vision of 2010: Healthy People in Healthy Communities".

Motion from Committee that the NCALHD support the 2010 effort and respond to the Call for Comments with the following 5 general points/comments:

a. Endorse the vision.

b. The over reaching goals/objectives are useful and appropriate.

c. Moving from individual health to a broader focus on the community.

d. Agree with eliminating disparities.

e. Recommend visual model, i.e., "FAN" be reworked: The statements are too confusing and the pilons create artificial limiting boxes that are not true and need not be there.

The HP Committee would like to respond on behalf of the NCALHD with these comments, and that each local health director become familiarized with this document and provide individual feedback.

Motion passed unanimously.

December 15, 1997 is the deadline to respond. The WEB site for more information, check the Healthy People Homepage at: http://odphp.osophs.dhhs.gov/pubs/hp2000

To submit comments: http://web.health.gov/healthypeople

HOSPITAL & COUNTY COMMISSIONERS ASSOCIATION NETWORK - Danny Jacob

The Committee met on November 19, 1997. The Committee discussed two main issues of concern, both of which involve the Committee's important liaison responsibility to the NC Association of County Commissioners. These issues, one of which much involves a motion as follows:

1. The Committee continues to feel concern that the potential for significant negative impact on local public health infrastructure from Carolina ACCESS is not fully appreciated, nor understood by the County Commissioners Association. One briefing by NCACC staff has been held, more needs to be done as opportunities to influence Carolina ACCESS policy arise. Medicaid Managed Care has tremendous implications from local public health delivery systems. The Health Directors Association must take leadership in articulating and advocating a strong local government perspective in Carolina ACCESS as affiliates of the NC Association of County Commissioners.

2. The Committee also discussed the continued uncertainty of the Medicaid Maximization payments to local health departments. The potential loss of this long expected funding is very disturbing. The potential of receiving the funds has actually been a liability. We have become an attractive target for funding cuts in anticipation of the "windfall" that still has not arrived! The Committee is submitting a motion at this time to receive feedback and direction on seeking County Commissioners Association support for the release of these funds to local health departments. The Committee recognizes this is a "touchy" subject. Nevertheless, the implications on local health department funding are so important that a "sense of the Health Directors Association" is needed as to timing and content of requesting the County Commissioners Association to take an active role in release of documented Medicaid Maximization funds due to local departments. The following motion is offered, therefore, from our committee to cause discussion and thereby direction as to the question of seeking immediate, strong support from the NC Association of County Commissioners.

Motion: A recent memorandum from Chris Hoke, dated November 3, 1997, stated that electronic transfer of Medicaid Maximization Funds would be made to counties "shortly". Subsequent to that memorandum, it has been learned that the funds may not be forthcoming. It is moved by the County Commissioner/Hospital Association Networking Committee that the NCALHD seek immediate and strong support of the NCACC in the matter of pending Medicaid Maximization Funds to local health departments. Motion passed unanimously.

HOME HEALTH ALLIANCE (NCAPHHA) - No report

# INSTITUTE OF GOVERNMENT LEGAL ADVISORY - Jill Moore

Gave an update on Implications of Federal Welfare Reform: Providing Public Health Services for Legal and Illegal Aliens. (See Attachments, pp. 110 - 114, UPDATE: Implications of Federal Welfare Reform: Providing Public Health Services for Legal and Illegal Aliens) This information supersedes that given by her at the Legal Conference in October and should replace that section in the manual. The rule is very ambiguous and the interpretation of the rule for whether to provide certain services to illegal aliens is currently left to the local health director to determine if the services would be rendered for the protection of life and safety and under the Welfare Reform Act. To do so or not to do so may place the local health department in some problems with either improper provision of the program or law suit on behalf of the illegal alien.

Janet Reno's specifications to the provisional to come out January 15, 1998.

MANAGED CARE & REIMBURSEMENT - No report.

SPECIAL REPORT: Early Brain Development - Dennis Retzlaff reported on meeting of the Blue Ribbon Panel of nationwide experts. This pannel came to North Carolina to share new information that early brain development depends on good prenatal care and good nutrition and good preventive care. Governor Hunt was at the Conference and said that he used to think that spending a lot of money on kindergarten and beyond helped in education, but he now realizes that a lot must be done for children before kindergarten, prior to 5 years of age. Early Brain Development fits very well with Smart Start initiatives.

LIAISONS & OTHERS

OFFICE OF PUBLIC HEALTH NURSING AND LOCAL HEALTH SERVICES - Dr. Joy Reed.

1. She has been asked by the Managed Care and Reimbursement Committee to pull together a task force to identify and propose solutions to all the issues related to transitioning to CPT/ICD-9 Coding for public health. She will be asking several health directors to allow staff who are knowledgeable about this system to serve on this group, but would also like an official representative from the NCALHD. President Bass will appoint the representative. (Please let him know if you are willing to serve in this capacity.)

2. The second round of Patient Flow Analysis training for the consultants has been completed. All local counties that gave her their names to go on the list of counties seeking PFA (who have not already had this done through various pilots) should be getting this week a letter asking for specific information about which clinics they want reviewed, etc. If you do not get one and thought your county was on the list, please call Dr. Reed at 919/733-6850 or 919/715-4385 (her direct voice mail line).

ANCBH - Carmine Rocco

1. Staff person, Catherine Moon, will be starting on December 1, 1997 to help in the education program of the ANCBH.

2. The Executive Committee of the ANCBH has sent a letter of support to the Commission for Health Services on the process by which the Restaurant Rules are being developed.

3. Moving the Annual Meeting back to March 1998 due to the time line, and will be looking into their Bylaws and in particular will be looking at the issue for Public Health Authorities.

4. Condolences were sent to Granville-Vance on the passing of Mr. Robert Ed Strouther, Sr.

5. Looking for local Board of Health members to fill unexpired terms. They especially need representatives from Eastern and Western North Carolina. Mr. Jon Laughter chairs the Nominations Committee.

PUBLIC HEALTH AWARENESS PROGRAM - No report other than information covered in Item # 11 in ANNOUNCEMENTS.

NCPHA - Deborah Rowe

Coalition for Public Trust has been actively looking at the Blue Cross Blue Shield issue. The News and Observer had an article that a lot more money is being spent by BCBS $ 2 million to Capital Strategies to lobby on their behalf. Also Health Access Coalition encourage NCALHD to join this coalition. (See Attachments, p. 115, Coalition for Public Trust) There is no membership fee to join. The motion was made by Dennis Retzlaff that the NCALHD join the Coalition for Public Trust. Dr. Louis Latour seconded and the motion passed unanimously.

MANAGEMENT SUPPORT - President recognized Ms. Djuana Register's attendance. No report.

NORTH CAROLINA NUTRITION DIRECTORS ASSOCIATION - President Bass recognized Donna Pettaway. No report.

REGIONAL REPORTS - No reports.

OTHER BUSINESS -

1. Jenny Lassiter requested to provide the following information from the Epidemiology Committee:

a. A copy of administrative rules for communicable diseases was presented to the Epi Committee by Dr. J. N. MacCormack. (See Attachments, pp. 81 - 95, Reportable Diseases and Conditions)

b. Dr. Lee Hunter presented to the Epi Committee a copy of the October 1997 Rabies Report. (See Attachments, pp. 96 - 99, October 1997 Rabies Report) He discussed his plans to hire another veterinarian and the plan for education of the community beginning with the providers and using an animal bite management manual. He has put together a bite protocol with the guidelines with how to get free vaccinations, and they are going to try to distribute them with the assistance of the Nursing Administrators group (as was done before) to get them out to local physicians. That should be distributed in December and January.

c. Discussion about the Division chief of Epidemiology remaining a medical physician. MiMi Cooper is serving on this committee for the Health Directors. No position was taken however the question was raised as to whether the selection committee had authority to change from its current status.

2. Margaret Dollar asked Dr. Leah Devlin about progress on the study on the role of Regional Consultants. Dr. Devlin said that all Regional services for DHHS are being studied. This is another study and will take 4 to 6 months process, led by Dr. Levine and Stephanie Bass. It is important to them to hear from Regional people and from the people served by the Regional consultants. Dr. Devlin said she would like to see the NCALHD make some serious recommendations about how there is interface between state and local levels. Does the NCALHD desire more technical/adminstrative support or more program support? Tell state what you need. The State and Local Relations Committee, which will be chaired by Tom Bridges, will take on this responsibility.

ADJOURNMENT - With no further business, President Bass adjourned the meeting at 1:10 p.m. The next scheduled meeting of the NCALHD Executive Committee will be held on December 18, 1997, 9:00 p.m., at the Auditorium, Albert Coates Building, Raleigh, NC.

Respectfully submitted,

Tom Bridges, Secretary