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)

APPROVAL OF THE MINUTES - The motion duly made and seconded to approve the November 20, 1997 meeting minutes. The motion passed unanimously.

TREASURER'S REPORT - Tom Bridges

Tom Bridges presented the December Treasurer's Report as of December 9, 1997. (See Attachments, pp. 6 - 7, December 9, 1997 Treasurer's Report). It was noted that only Cabarrus County has not paid its 1997 member dues. President Bass said that he thought that next month as Past President he will be Chair of the Nominations and Bylaws Committee. He will address the issue of non-paying agencies.

Dr. Louis Latour wanted to go on record for commending and recognizing Tom Bridges for the good job he has done this year as Secretary-Treasurer.

The motion was duly made to accept the Treasurer's Report with an edit corrections. The motion passed unanimously.

ANNOUNCEMENTS - President Bass

1. Asked members to keep Shelly Carraway, Health Director, Alexander County, in our thoughts and prayers. Her baby was born last week with many medical complications.

2. Outgoing Health Directors:

a. Tom Johnson, Henderson County, has announced his Retirement.

b. Bill Johnson, Stokes County, has Retired. Colleen Bridger is new Health Director

c. Dan Reimer, Orange County, has resigned to pursue other opportunities. Rosmary Summer will serve as Interim.

President Bass wanted to recognize Tom, Bill and Dan for the contributions they have made to the NCALHD.

3. Health Directors needed to help plan for the NACCHO annual conference to convene in Charlotte, year 2000. Steve Keener has agreed to Chair this group.

4. Jane Ford, NACCHO, has sent out a letter announcing a report/publication from the "New York Academy on Medicine and Public Health - Power of Collaboration". About the role of public health departments in this new managed care environment and fostering medical partnerships in public health. This study was sponsored by the Robert Woods Johnson Foundation, the American Public Health Association and the American Medical Association.

5. An Action Alert has been received to contact our Congressmen and Senators. The Centers for Disease Control is looking for $ 8 million to provide local health departments upgrades in technology.

6. Healthy Communities Project wants information from local health departments about their successes working in community health. Their WEB site is www.healthycommunities.org

7. The Robert Woods Johnson Foundation has sent out a Request For Proposals addressing preventive activities on smoking cessation.

8. Home Health regulatory update. NACo is in negotiation with HCFA to exempt local health departments from the $ 50,000 Surety Bond requirement. Ron Aycock advises us at this time to go ahead with applying for the Surety Bond since he has not yet received clarification.

9. President Bass will be giving a $ 200 allocation from "President's Expenses Budget Line" to the Tri-State Public Health Leadership. Ten people from North Carolina are enrolled in the program. Mike Hanes, Montgomery County, was accepted into this new program.

COMMITTEE REPORTS

VISIONING COMMITTEE - President Bass

Wide range of issues were discussed yesterday during Visioning Committee meeting. Looking at alliances and services. Also the group discussed issues around single stream funding and cost accounting, as well as standardization/accreditation for managed care environment.

Other discussions were about how we are going to interface with the state on such projects as the Healthy 2010 Project, Turning Point as well as Project Assist kinds of activities.

All were in agreement that changes need to be made. The overall question is what is it that we are trying to do? What is it that we are trying to define? Other groups, such as the Hospital Association, are already moving ahead and they have already decided where they are going. We also need to move on. As the result of these discussions, the strategy is to set down what we are about and what needs to happen, and that this would be put in the form of a letter to Dr. Bruton, Secretary of the Department of Health and Human Resources. Therefore the following three motions were presented as follows:

Motion 1. That the NCALHD craft a letter to Dr. Bruton what we are about with managed care and what needs to happen. The motion was seconded.

Suggestion was made to present all three motions before voting. President Bass consented.

Motion 2. To investigate procurement of a firm or an individual with the technical expertise to research and advise the NCALHD on the role of public health and managed care especially from the preventive health perspective.

Motion 3. That the NCALHD provide the funds to develop the paper.

In the sequence of events, need to have this underway by January 1998. This process will be both internal (about us) and external (other groups).

Letter will ultimately be brought before the full association. It is an attempt to bring us together as a group philosophically with a set of goals (a shared vision) and will inform Dr. Bruton about our point of view and to ask for his support.

Tom Bridges said he just received a memorandum from Dr. Bruton saying that he wants to meet monthly with various State and Local Relations type committees jointly rather than to meet with them individually. The committees he addresses are with the NCALHD, NC Association of County DSS Directors, Council of Community Programs and the County Managers. His first proposed meeting would take place on January 13, 1998, from 2:00 p.m. to 5:00 p.m., in the Adams Building, Dorothea Dix Campus, Raleigh. Tom Bridges thought that, in addition to the letter, these meetings would provide an opportunity to discuss the common issues that are surfacing with delivery of human services and how managed care is impacting upon this effort.

John Shaw said that we need to very soon be very sure as to what our vision is and where we want to go, and the consequence of what we face, otherwise we may lose our credibility.

Dr. Garrett felt that it would be beneficial to inform Dr. Bruton in advance of the process rather than to do this lastly. This in effect would put him on notice.

Motion 1 passed unanimously.

Motion 2 passed unanimously.

Motion 3 passed. One no vote (John Shaw who felt that the state should fund study)

Dr. Louis Latour made the motion that a letter initially be sent to Dr. Bruton to inform him that this activity was underway and that he can expect a letter to follow at the completion of the research project. Bob Wood seconded and the motion passed unanimously.

POLICY & PLANNING - Bill Smith called upon Jill Moore, Institute of Government, to provide an update on the issue regarding provision of services to illegal aliens. Jill Moore reported from her handout as follows:

Welfare Reform Update

Background.

The federal welfare reform law declared that not-qualified aliens are generally ineligible for federal public benefits. The definition of federal public benefits included "any...welfare, health, disability, ... or other similar benefit for which payments or assistance are provided to an individual, household, or family" by an agency of the United States. The federal welfare reform law also established several exceptions to this ban that are relevant to public health. These exceptions included: Medicaid benefits for emergency services, immunizations, testing and treatment of the symptoms of communicable diseases, and programs and services specified by the U.S. Attorney General that deliver in-kind (non-cash) services, do not condition assistance on the recipient's income or resources, and are necessary for the protection of life or safety.

U.S. Attorney General Reno released a provisional specification identifying the programs and services that may be provide to individuals regardless of their alien status, provided that the programs/services do not condition the provision of assistance, the amount of assistance provided, or the cost of assistance on the individual recipient's income or resources. The Attorney General's list of programs/services included medical and public health services necessary to protect life and safety; activities designed to protect the life and safety of workers, children and youths, or community residents, and any other programs, services, or assistance necessary for the protection of life and safety. The specification did not provide any further interpretation or guidance regarding the meaning of the phrase "necessary to protect life or safety."

Update - Current as of 12/16/97

Guidance on Verification of Alien Status Now Available

The U.S. Department of Justice has released a notice of interim guidance on verification of citizenship, qualified alien status, eligibility for federally funded benefits under the federal welfare reform law of 1996. Federal Register Vol. 62, pages 61344-61416 (November 17, 1997)

I do not attempt to summarize all aspects of this very lengthy document here. The guidance document makes two points, however, which should be borne in mind:

(1) Title VI of the Civil Rights Act of 1964 prohibits discrimination by governmental entities on the basis of race, color, or national origin (among other things). The guidance therefore cautions as follows: "in operating or participating in a federally assisted program and implementing the requirements of the (Welfare Reform) Act, including those set forth in this Guidance, a provider should not, on the basis of race, color, national origin, directly or indirectly differentiate among persons in the types of program services, aids or benefits it provides or the manner in which it provides them. for example, benefit providers should treat all similarly situated individuals in the same manner, and should not single out individuals who look or sound foreign for closer scrutiny or require them to provide additional documentation of citizenship or immigration status."

(2) The first step the guidance document advises agencies to take, before seeking to verify any person's citizenship or alien status, is to determine if the program in question provides a "federal public benefit" subject to the Welfare Reform Act's verification requirements. "If the federal program does not provide a 'federal public benefit' covered by the Act ..., the benefit provider is not required to, and should not attempt to, verify an applicant's status, unless otherwise required or authorized to do so by law, because all aliens, regardless of their immigration status, are eligible for such benefits." (emphasis in original).

The guidance document provides the following preliminary guidance on which programs provide "federal public benefits" subject to the Act:

- "In determining whether a program provides a 'federal public benefit,' you should first consider whether the program provides one of the benefits expressly enumerated in either (a) or (b)" of the statutory definition.

- "To fall within (b), the benefit provided by your program must be one of the types of benefits described (retirement, welfare, health, disability, public or assisted housing, post-secondary education, food assistance, unemployment benefit, or any other similar benefit)."

- The benefit "must be provided by an agency of the United States or by appropriated funds of the United States,' and it must be provided to one of the enumerated (in the Act) categories of recipients (an 'individual, household, or family eligibility unit')."

- "Finally, you should consider who is actually receiving the benefits that you provide. although the Act prohibits certain aliens from receiving non-exempted 'federal public benefits,' it does not prohibit governmental or private entities from receiving federal public benefits that they might then use to provide assistance to aliens, so long as the benefit ultimately provided to the non-qualified aliens does not itself constitute a 'federal public benefit.' " (emphasis in original)

No Other Federal Guidance Yet Available Regarding Effect on Public Health Services

I asked David Nielsen, a human services program specialist and policy analyst with the U.S. Department of Health and Human Services, if the federal DHHS can offer any additional guidance regarding which public health services may be provided to not-qualified aliens. Mr. Nielsen said that policies and guidance are currently under development but are not yet available. He added that, in his opinion, it is not entirely clear which federally funded programs and services constitute federal public benefits; several federal agencies are in the process of further defining "federal public benefits" and the final definition may exclude some programs or services that receive federal funds. I asked Mr. Nielsen whether a local health department could get in trouble by failing to institute changes in its services to aliens in the meantime. He responded that he does not anticipate any negative actions being taken by DHHS with respect to any confusion that arises in implementing these policies pending the DHHS's guidance statements. He added that he cannot speak for the Inspector General or offer any guarantees, however.

Bill Smith reported that the charge of the Policy and Planning Committee is to come back with two position papers in January 1998. Because there are some leeway with the State to possibly allow some services to be provided, we want the NCALHD to take a stand on what the rights of immigrants are and then the second will be on the language barriers. Family Planning is a sliding fee scale (because of Title X) and is one of the biggest issues. Because it is a means test, you cannot give that service. Perhaps the State can assist us with this dilemma. Chris Hoke said that progress is being made on this issue.

STATE & LOCAL RELATIONS - Margaret Dollar. Committee did not meet in December. Tom Bridges will be setting up the meeting for January 1998.

STATE HEALTH DIRECTOR'S OFFICE - Chris Hoke

1. Visioning Committee. Good thing that you are taking this on. He personally feels that we need to have some kind of structure to put local health departments in a better bargaining position. As Louis Latour said earlier, alliances may be the vehicle, but this is not statewide yet.

2. Health Check. There was a recent meeting with Jim Bernstein, Tork Wade, Daphanie Lyons, Dick Perruzzi. Was a pretty rough and tumble meeting, but conclusion was a good one. He thinks that the Medicaid folks have a better picture of Health Check and what Medicaid needs to be doing. He felt that Jim Bernstein, being in the position to be more objective, did a superb job in driving home the point. Jim Bernstein suggested to look at some 4 - 5 pilot projects of how to do Health Check differently. There are a number of issues with Health Check that we would like to do better. We are not screening at the federal goal of 80% of our eligible children. We are closer to only 48%. Let Local Health Departments to take a more lead role in insuring that the entire (Medicaid) population is provided Health Check services. The group will meet again in January to discuss this proposal on pilots.

President Bass told Chris Hoke that whatever the group could do to advocate to the Secretary (Bruton) in continuing the exemption (of local health departments to provide its limited services to Carolina ACCESS patients without prior approval) beyond July 1, 1998, perhaps for another year, or until the point where we can achieve that 80 - 90% participation in Health Check.

Other questions arose as to the impact that HMO's serving Medicaid clients will have on local health departments and if or how exemptions will be allowed.

3. Medicaid Maximization. State Budget Office told Chris Hoke that they need to hold it but will look in January as to where things are with budget cuts and revenue projections, and look at what they are going to do then. Maggie Dollar asked when it would be appropriate to share with Secretary Bruton with what this holdup and loss of revenues, including Health Check, it is costing local health departments. Chris Hoke said that he thought Health Check issue has been turned around and should improve. It is not a good feeling in Medicaid about public providers. They turn off when we talk about our revenue status. We must also keep in mind that these folks are under a tremendous amount of pressure.

Jim Baluss said he felt that we have a strong responsibility to let local government how serious some of these potential losses are. He offered to share a report (See Attachments, pp. 8 - 9, Report of Ad Hoc Task Force on Public Health Systems) which indicates revenues by source to local health departments, a big chunk being Medicaid. He said this report may give some idea to the relative "at risk" status of local health departments affected by new Medicaid policies (Carolina ACCESS), which further states our case for getting the Medicaid Maximization funds out to local health departments. He hopes that the County Commissioners Association could help us here.

George Bond said that due to the withholding of Medicaid Maximization funds he had the unfortunate chore of laying off six employees in his health department. This hasn't been done in over fifteen years. He said his department has $ 300,000 on the fly and if they don't get that soon, additional layoffs will occur. This impacts on twenty positions in January. He said it's really critical and he wonders if we should not delay approaching the County Commissioners about this dilemma. George Bond said he would have his County Attorney send a letter on behalf of his county about the problem caused by further delay of the Medicaid Maximization funds. Chris Hoke said that it may be helpful if counties shared such letters with him.

Chris Hoke said the good news on Medicaid Maximization is that he has submitted a bill for the remainder of the funds for '94-'95, and for the full year of '95-'96. Once Alan Gamble does his calculations on the numbers, that money will be transmitted directly by EDS and not "held hostage."

Carmine Rocco, Executive Director, Association NC Boards of Health, said he felt there are some influential members who can work with County Commissioners on the Medicaid Maximization issue.

MATERNAL AND CHILD HEALTH/DENTAL - Dr. Harold Gabel

Thanked Association members who sent him well wishes as he was convalescing from his recent illness. He also thanked the members of the MCH/Dental Committee who served with him during the past year, especially those members who covered for him over the last three months.

He passed out a summary report of Committee activities over the past year (See Attachments, pp. 10 - 11, Maternal and Child Health/Dental Liaison Committee Activities for 1997). One issue he wanted to bring to the Association's attention that needs some doing. He reminded the group that local health directors had been appointed to serve on the task force that was to explore ways to enhance childrens' access to additional health insurance. A report was made for Secretary Bruton, who presented it to the Governor. It has now been presented to the Legislature. It is a broad, comprehensive package for children up to 200% of poverty (approximately 70,000 children). It does include case management but from talking with Tom Vitaglione, we do need to advocate with our state legislators to make sure they don't cut the package, or make it any less comprehensive than it is. It is a Medicaid "look alike" -- it is not Medicaid -- but it is a very good program.

TECHNOLOGY COMMITTEE - George Bond

1. There is some new money to help offset the cost for technology enhancements. He called on Marc Kolman to present a motion out of committee. Motion from Committee that a letter would be sent on behalf of the NCALHD to support efforts at setting up state universal access at reduced cost for Rural Health to distance learning and other telecommunications applications. Motion passed unanimously. Marc Kolman also shared a brochure (See Attachments, pp. 12 - 13, Paying for Telehealth) about an upcoming one-day regional workshop.

2. Last month George Bond reported 18 to 2 vote from the Technology Committee to drop EHSIS (HSMS) development in favor of looking to private proprietary software. When presented to the Executive Committee last month they voted 6 for and 5 against. With this lackluster support, the Technology Committee took to task to resolve some of the major concerns/questions expressed regarding going proprietary. After yesterday's Technology Committee meeting, George Bond said that it seemed things have begun to fall into place:

a. SIPS supports private proprietary software -- they do it all the time.

b. Bill Cox, DHHS Information Resource Management Director, said that a "siphon function" could be programmed into private software to enable the state to get the data they need, allowing the local agency to conduct its office functions.

c. Suggestion was made (with apparent support of the State Center folks) to just fix the year 2000 problem for HSIS even if we go with the private proprietary software. Good news is that Bill Cox has identified money for the year 2000 problem (called "Y2K"). This could then be our backstop if all else fails. Let's then use the $ 3 million (Medicaid Maximization) money to buy the proprietary software for all counties in North Carolina for those who want it. In working with Bill Cox, see if there is a way that we can get a "preferred provider list", so that local health departments have some choice in software. For example, the two software products that so far have been identified to meet IRMC standards are Human Soft and CMHC. These could be made available at a state contract price. The mechanism would be in place such that vendors would work cooperatively with the State Center on any new enhancements/changes as they occur, rather than leaving this to the local agencies.

Dennis Retzlaff said that he and his Region still had reservations about venturing into this new direction, especially since no one knows exactly what type services many health departments will provide. He said clinic services may not be a future area of local health departments and why invest into software programs when we are not really clear -- why now? He wondered if perhaps a group of health directors could get together to discuss further details of the proposal.

Tom Bridges said that the reason why now is that, in hindsight, it's what we should have done ten years ago. All health departments, regardless of services provided need to have a better tracking system for service delivery and for cost analysis -- to get to unit costs for services. It's what local and state government wants, not to mention what managed care operates from.

George Bond said he has sought local health director participation in the Technology Committee meetings where all the discussions have been occuring and he has had few takers. He felt that with the new options now available, local health departments can choose to get new private proprietary software, or stay with the HSIS system with the modifications for Y2K.

NOMINATIONS/BYLAWS - Dr. Louis Latour. No report from Committee, however, he wanted to recognize and commend the excellent work that President Barry Bass has done over the past year.

AWARDS/EDUCATION - Leonard Wood

1. Wanted to urge support of George Bond and what the Technology Committee is trying to do. This is absolutely important to all of us.

2. Wanted to recognize and thank President Barry Bass for the great job he has done over the past year.

3. There will be a Ham Stevens Award presented in January.

4. Please check the NCALHD homepage for information and application for the NACCHO scholarships, which provide funding for travel to the annual meeting. It will be held this summer in St. Louis, Missouri. Return your application to Wayne Raynor who will serve as the new chair of the Awards/Education Committee.

ENVIRONMENTAL HEALTH - Terry Pierce. The Environmental Health Committee did not meet in December, however they had been working on several unfinished items:

1. Mimi Cooper and Diane Crouse produced an attachment to accompany and provide additional information for the White Paper. Notes from White Pater Committee members, Don Yousey and Don Stephens were used to expound on the position paper. Many Local Boards of Health and County Commissioners have endorsed this position paper. support has also been pledged from the Board of Sanitarian Examiners, Association of County Commissioners, Environmental Health Supervisors Association, Association of North Carolina Boards of Health and several other organizations. The Environmental Review Commission will not take up this time at the meeting on December 22, as previously scheduled. Moving this to the first meeting in 1998, January or February, will allow additional time to garner support from your respective Boards. This prospect of having the restructuring of the EH State programs as described in the White Paper is looking very encouraging. Send correspondence to Rick Rowe, Wake County (POB 550, Raleigh NC 27602, telephone 919/856-7407).

2. After negotiation between the Division Staff and the local EH representatives, the Commission for Health Services approved the remaining Authorization Rules on December 12. this would require 45 hours of continuing education over three years, with a specified number of hours for each authorization. Credit for approved, non-sepcific training will be given for up to 1/2 of the total required hours for each authorization. Videotapes with an examination will be an acceptable method to gain these hours. The R.S. Board is reviewing its policy for approving continuing education hours to ensure consistency with the authorization rules. A group composed of state and local EH representatives will approve the training.

3. The Commission for Health Services also approved the proposed Restaurant Rules as discussed at the last NCALHD meeting. Several health directors were present, including Doug Urland and Tommy Jarrell, members of the Restaurant Rules Review Committee. I gave a brief presentation re: The Association's position on these revisions. All the concerns expressed by the NCALHD were addressed, except for a couple definitions, which can be clarified in another manner. allows for posting numerical scores in lieu of letter grades for up to seven pilot counties. There was a lot of concern and discussion re: how pilot counties would be selected. rules will include 2 point credit for educational training for the manager/operator, a streamlined appeals process, and a process for "time only" display for foods.

Terry Pierce said he was pleased with the overall outcome of the EH issues that were considered by the EH Committee in 1997, which is due largely to the hard, dedicated efforts of the faithful members of the EH Committee.

EPIDEMIOLOGY - No report. President Bass said that Dean Roper, UNC School of Public Health, has responded to a letter from the NCALHD urging that support for a $ 21,000 grant for electronic communications among the School of Public Health, the Division of Epidemiology and Local Health Departments. (See Attachments, p. Letter from Dean Roper)

HEALTH PROMOTION - Curtis Holloman. The HP Committee did not meet in December. Elaine Russell, Health Director Cherokee County, will chair Committee during CY 1998. Curtis Holloman wanted to thank the Health Promotion Committee members for their faithful efforts over the past year.

President Bass said that one of the Visioning Committee recommendations was to work together with the Turning Point project.

HOME HEALTH ALLIANCE - Dr. Louis Latour

1. The Alliance is looking at "widening the road" to include other local health departments (that do not have home health agencies). The Alliance may be a vehicle to deal with managed care and other issues that confront local health departments.

2. The Alliance now has three staff on board.

a. Jody Vogelzang, Executive Director

b. Sharon Halzia, former Director of Home Health in Toe River Health District, who will be in charge of a Personnel Staffing Pool. Two weeks ago application was sent through, and it looks good. So, in the future, local health departments can get staff support through this vehicle.

c. Mary Delany, recently hired. She will be doing the marketing for the Personnel Pool and for the Alliance.

3. The 39 local health departments with home health agencies have been confronted with the issue of surety bonds to have in place by January 1998. Jody Vogelzang has been able to secure a proposal from BB&T to supply a surety bond for $5/1000, the least expensive found. This bond issue affects more than just home health. It includes outpatient clinics, Medicaid bond on the back of it, too. This will have a large impact on hospitals and other large agencies.

4. In the East, there have been two CON situations:

a. Health Departments in the east and one hospital sat down in a room across from Tar Heel, ECU and about 29 other hospitals to mediate the process. They came to a joint agreement and, as a result, will not have to go to court.

b. In another CON, Interim out of Charlotte tried to have a CON in the east. A public hearing was held and once again a lot of health departments and one private provider was at that hearing and spoke against this CON application. Just last week it was announced that it was ruled in favor of the view of the health departments.

HOSPITAL/COUNTY COMMISSIONERS - Jim Baluss Committee was not able to meet in December, but expect that more to come with regard to the Medicaid Maximization funds. There will be a concerted effort to get better coordination of messages coming from DSS and Public Health in communicating issues such as the Child Health Insurance Program (CHIP). Ed Regan, who is involved with Carolina ACCESS and Health Check, has wanted to know if there is some consensus positions held by both DSS Directors and Public Health Directors. At this point, there is not. This is why involvement in this effort next year will be very import.

MANAGED CARE/REIMBURSEMENT - President Bass

Motions from Committee:

Motion 1. That the NCALHD strongly and actively support the Child Health Insurance Program (CHIP), with the expansion of the Medicaid program, or at least, the development of a Medicaid look-alike with as comprehensive a benefits package as possible. (This should support Secretary Bruton's announcement) Aggressive lobbying needs to occur with the Appropriations Committee of the NC General Assembly. Additionally, it is critical that this occur as soon as possible before the first of the year. The state legislature goes back into (short) session in May 1998, so local health directors need to inform their legislators about why this issue is import to provide health care to more children in North Carolina. Motion passed unanimously.

Motion 2. That the NCALHD again stress its former position that Public Health has a responsibility, and fully accepts it, to be actively involved in Eligibility Issues related to Health Coverage for citizens (children first priority) in NC including Carolina ACCESS/ Carolina ACCESS II/ The Children's Health Insurance Expansion (referenced above) and even Medicare for disabled and elderly as they are moved to HMO options. This activity to strongly involve Marketing (Public Awareness), Outreach, and benefits Advocacy. Motion passed unanimously. In this effort, local health departments will work cooperatively with DSS on this matter.

Informational Issues:

1. Medicaid Maximization Funds - no word from State Budget - $ 9 million (Medicaid Maximization) pending.

2. Office of Rural Health, Nan Rideout - Planning intensive workshop for Local Public Health Staff to involve concrete TA in dealing with staff and organizational change -- Plans currently are to hold workshop as a Preconference Activity to the Governor's Rural Health Conference -- Dates: March 30, 31, and April 1, 1998. It is hoped that the entire local health department management team will be able to attend and participate with their Health Director.

3. Will forward to Secretary two articles very pertinent to local public health issues: (See Attachments, pp. 15 - 19, "Is Altruism Killing Prevention?" Healthcare Forum Journal, and Attachments, pp. 20 - 29, "Trends in Health Care Coverage and Financing and their Implications for Policy" NEJM 10/02/91 Vol. 337, No. 14)

LIAISONS & OTHERS

LOCAL HEALTH SERVICES SECTION and OFFICE OF PUBLIC HEALTH NURSING AND PROFESSIONAL DEVELOPMENT - Dr. Joy Reed

1. Still need a representative of NCALHD to CPT-4/ICD9 Task Force. President Bass requests a volunteer to serve in this capacity.

2. Based on proposals submitted, the sites to be proposed for expansion of PHTIN have been selected. Final costs are being added to that proposed in preparation for its submission to Dr. Levine and others. Sites which have been selected are in the process of being notified. If you have questions, call Patty O'Leary-Cunningham at 919/966-9137.

3. Effective 1/1/98, the Local Health Services Section will have an architect who can assist local health departments in assessing their space needs and/or developing a schematic drawing of new space. His name is Andy Hensley and he can be reached at 919/733-2040. Until a new Section Chief is hired, he will be reporting directly to Dr. Reed.

4. Dr. Reed posed a question to the Association members, asking for ways/suggestions on the new health directors' orientation. At the last new health directors' orientation, the health directors asked for more than they got from the orientation. As a result, Dr. Reed is looking at the next three week course offered to new managers and supervisors in public health nursing and to look at topics which would also be of interest and benefit to health directors. Topics, such as physical issues, personnel issues (hiring and firing, etc.). President Bass suggested that the Education/Awards Committee provide some input to her.

Dr. Reed said that financial support for the Supervisors/Directors Orientation offered this spring has come from Glaxo-Wellcome, who will provide their site and meals.

ASSOCIATION OF NORTH CAROLINA BOARDS OF HEALTH - Carmine Rocco

1. The ANCBH's Annual Meeting will be held March 19, 1998.

2. Health Departments should have received by now nomination forms for the Outstanding Local Boards of Health, known as the Carl Durham Award. Please send in your nominations.

3. Asks for update on local boards of health rosters. It was suggested to Carmine Rocco to check with the Leah Devlin about this roster.

4. Introduced Catherine Moon, who now is on staff to assist him with educational activities of the Association.

NCPHA - Deborah Rowe. No report.

ADJOURN - With no further business or reports to discuss, President Bass adjourned the meeting at 12:30 p.m. The next meeting of the NCALHD will be a Full Association Meeting, to convene on January 14, 1998, 2:00 p.m., at the Brownstone Hotel, Hillsborough Street, Raleigh.

Respectfully submitted,

Tom Bridges, Secretary