CALL TO ORDER - President Smith called the meeting to order at 9:00 a.m. (See Attachments, pp. 1-3, Attendance Roster.)

APPROVAL OF THE MINUTES - The minutes of the January 14, 1998 Full Association Meeting were approved on the motion of George Bond, seconded by Bob Wood. Several edits were noted. With agreement for a friendly amendment that the minutes be approved with corrections, the motion passed unanimously. 

1. George Bond moved, seconded by Wayne Sherman, that Donald Yousey be approved as the Region VIII representative to the Executive Committee. The motion carried unanimously. 
2. George Bond, Bob Wood and Donald Yousey were asked to serve as the Audit Committee and will contact Tom Bridges in order to set up a meeting to audit the Association's financial records for the past 12 months.. 

TREASURER'S REPORT - Tim Green 

Association dues statements have been mailed to all health departments. Mr. Green encouraged health directors to submit their dues payment as quickly as possible. In reviewing the report, Mr. Green indicated there have been limited expenses, mostly awards and postage. He is awaiting the AssociationÕs bank statement from the State Credit Union. Plans are to transfer monies from various accounts to invest in Certificates of Deposit to afford the opportunity of earning additional interest at a 5.9% rate over the next 12 months. The State Health Directors' Annual Meeting Fund will be closed out and transferred to a separate account. (See Attachments, pp. 4-5.) 

Motion was duly made and seconded to accept the Report as presented. The motion passed unanimously.  

ANNOUNCEMENTS 

Dr. Ronald Levine announced the addition of Dr. John Booker as the new Director of the State Center for Health Statistics. Dr. Booker is from the State of Alaska. 

George O'Daniel will serve on the Education and Awards Committee replacing Wayne Sherman. 

Wanda Robinson is serving as interim health director for Sampson County.

Curtis Holloman is now the Health Director in Scotland County. 

The next Association meeting will be held March 19 at the Brownstone. This will be immediately followed by the NC Association of Local Boards of Health Annual Meeting. (See Attachment, pp. 6.)  

The April Association meeting will be held April 21, 1998 beginning at 9:00 a.m. at the North Raleigh Hilton. The meeting will be followed by the Education Committee's spring workshop. Registration will be held from 8:30 - 9:00 a.m. 

The May Association meeting is scheduled for May 20, 1998 beginning at 10:00 a.m. at the Holiday Inn Select in Hickory.  

Nan Rideout mentioned that the North Carolina Governor's Conference on Rural Health is scheduled for March 31 and April 1. The preliminary conference is scheduled for March 30 and 31. 

Governor Hunt has proclaimed February 16 - 22 as Health Education Week in North Carolina. (See Attachments, pp. 9-10.)  

The NCSOPHE Meeting is scheduled for March 4 in Brown Summit. (See Attachments, pp. 11-15.) 

The Smart Start dinner meeting with Governor Hunt will be held Downtown Raleigh May 19 from 7:00 - 9:00 p.m. More details will be forthcoming.  

President Smith said a list is being circulated asking for the names of those health departments whose boards of health and/or boards of commissioners endorsed the White Paper. This information should be given to MiMi Cooper. 

President Smith expressed appreciation to the Wake County Health Department staff for allowing the meeting to be held in their facility. 

Tim Green mentioned that the attendance roster for today's meeting is being circulated. He explained that additional information is being requested from each health director such as mobile telephone number, pager number and home number. This information will be beneficial in the event we need to get crucial information to health directors such as legislative information which requires an immediate response. An updated mailing list and contact information will be sent to all health directors. 

President Smith said he received a letter from Sherman Kahn regarding the NC Medical Society and the Tobacco Policy Conference Sponsors. He reported the Health Director's Association is a sponsor and anyone wishing to set up a booth should notify the Medical Society by March 14. (See Attachment pp. 16.)

 President Smith elected to adjust the order of the agenda as follows:

• Dr. Levine was very pleased to announce that the State Budget Office has recognized that the Medicaid maximization monies earned belong to health departments. Staff are working to get these funds disbursed as soon as possible. Dr. Levine also mentioned staff are working to finalize details on the Health Systems Information System. 
• John Shaw gave an update concerning Health Check/Carolina ACCESS meetings that have taken place. As a result three significant areas have been addressed. 

1. Carolina ACCESS and health departments would be recognized as partners. The Medicaid client will have an opportunity to choose the health department as a provider source for child health immunizations and screenings, and the health department will be allowed to bill direct without prior approval from the primary care provider. Health departments will transmit information to the primary care provider. This would necessitate an agreement being worked out with the primary care provider prior to October 1. It is important that a draft of an agreement be developed and shared with health departments. 
2. A letter distributed in the fall addressing exemptions was never an actual policy. This area will be clarified in the next Medicaid monthly bulletin which will state health departments can provide prenatal care, family planning services, and wraparound services without being a primary care provider. 
3. Currently when the Medicaid eligible signs up for Medicaid, the recipient is given a pamphlet listing providers available. The health department has been excluded in this listing. Secretary Bruton has instructed that an insert be developed recognizing the role of the health department and that it be given to Medicaid recipients. It is important that the Association have someone actively participate in the design of this insert. Mr. Shaw said it is also important that the health departments develop some means of informing Medicaid recipients today that health department services are available to them. Some health departments are using posters in the area where recipients sign up. These changes open the door for health departments to provide expanded care even if they are not a primary care provider. 

President Smith said he had written a note on behalf of the Association to Ron Levine; Ann Wolfe; and Chris, Jim, and Tom Vitaglione thanking them for getting us to the table and for their untiring efforts. Anyone who did not get a copy of the letter should let him know. Appreciation by the Association members was also extended to Bill Smith and John Shaw for their hard work. 

George Bond recommended a letter be written on behalf of the Association to Secretary Bruton indicating that the goals of the Association have always been the same and we recognize the complexity of the situation. 

COMMITTEE REPORTS 

STATE AND LOCAL RELATIONS COMMITTEE - Tom Bridges 

Motions from the Committee: 

1. That the North Carolina Association of Local Health Directors accept Mel Crocker's proposal as presented (see handout for summary of his proposal) which for non-physician local health directors establishes a single classification and establishes a minimum salary range at least 20% above but no more than 60% above the minimum of the salary range of the highest classification level supervised, excluding physicians, physician extenders and dentists.  

Motion was duly made and seconded to accept this motion as presented. The motion carried.

2. That the North Carolina Association of Local Health Directors urge the Office of State Personnel to do a market survey of health educator salaries by comparing them to private industry. This would not necessarily require any work being done on current classifications. 

Motion was duly made and seconded to accept this motion as presented. The motion carried.  

3. That the North Carolina Association of Local Health Directors endorse and encourage participation in the survey "Strategic Consultation with Local Health Departments" which will be used to provide the State with a clearer understanding of local needs and priorities for consultation services from the State.  

STATE HEALTH DIRECTOR'S OFFICE - Dr. Ronald Levine 

Dr. Levine said the search for the state health director continues. There have been some excellent candidates. 

Dr. Levine discussed health care reform, managed care and Carolina ACCESS II. He said Carolina ACCESS II was very promising and encouraged everyone to become familiar with this program. The health department working with physicians and hospitals can become a network or alliance in providing health services to Medicaid clients. He indicated this could be the model for the future. Dr. Levine also suggested health departments establish a new bond and relationship at the statewide level in pediatrics and family practice across the State which will assist in getting people together with the emphasis on putting children first. 

TECHNOLOGY COMMITTEE - George Bond 

Motion made and duly seconded to purchase letters instead of numbers, i.e. wwwncalhd.com, as an address on the Internet for the NCLHDA at $250 for two years and $50 each year thereafter for renewal.  

NOMINATING AND BY-LAWS COMMITTEE - Barry Bass 

Mr. Bass said two proposals were reviewed regarding the RFP for the Visioning Project. One was submitted by the Sheps Center for Health Policy Research in Chapel Hill and one from HealthQuest Consulting, Inglewood, Colorado. It was the recommendation of the Committee to move forward with the VISIONING PROJECT and contract with HealthQuest. Both proposals were well done but the HealthQuest proposal would provide a greater perspective on the issues identified as most crucial to our adaptation. Another key component of this proposal is a half-day retreat of local health directors to determine local input into the feasibility of each recommended model. Could include $5,000 to $7,000 out-of-pocket expenses in addition to $26,742.00 contractual amount. There would be 90 days for completion of the study. (See Attachment, pp. 21.)  

WOMEN'S & CHILDREN'S HEALTH COMMITTEE - Dr. John Morrow 

Motion duly made and seconded that the NCALHD in recognition of the new spirit of partnership between public health and private providers draft a letter of strong support for the new CHIP program presently proposed by the North Carolina Department of Health and Human Services. Motion carried with dissention. Mr. Baluss indicated the County Commissioners Association has endorsed this version. It was also suggested the Association reinforce with the County Commissioners Association our position and ask for their assistance. (See Attachments, pp. 22-25.) 

SPECIAL PRESENTATION - Barry Goldstein

Barry Goldstein presented the following:  

• When an activity is added to the consolidated contract, an amendment be made to the consolidated contract. This requirement had been dropped. 
• When health departments receive their budgets for the coming year, they will no longer be required to report expenditures by line item. Total budget will be submitted along with total state and local expenditures. There will no longer be an equipment line item, however, the contract will indicate prior approval must be obtained to purchase equipment. 
• Changes being considered of a policy nature.
• Funding Stipulations (Translation Services) 

• Fiscal Control (Subcontracting) 

• Fiscal Control (TXIX fees) 

1. A local account shall be maintained for unexpended TXIX fees. Accounts shall be maintained in sufficient detail to identify the program source generating the fees.  
2. The amount of Title XIX fees budgeted in FY 1998-99 must equal or exceed the amount of Title XIX revenues earned during FY 1996-97. The State will not approve program activity budgets that do not include an amount of Title XIX fees sufficient to meet the requirements of this section. The State may waive this requirement if the Department provides sufficient justification. The motion carried.  

ENVIRONMENTAL HEALTH COMMITTEE - MiMi Cooper 

Motion duly made and seconded that the Association support the concept of allowing reduced separation distances (wells from structures) with the added protection of increased monitoring when inspecting foster homes. The motion carried.  

EPIDEMIOLOGY COMMITTEE - Ray Rabe reporting for Sherman Kahn(See Attachments, pp. 28-37.)  

Proposed wording: "All local health department staff performing HIV pre- and post-test counseling and/or HIV/STD interviews and partner notifications will have received training in accordance with federal guidelines." 

Motion was duly made and seconded to approve the above recommended change in wording. The motion carried.  

Proposed wording: "By June 30, 1999, 80% of TB cases were placed on directly observed therapy (DOT)." After discussion a motion was duly made and amended with the following wording to read: "By June 30, 1999, 80% of Active TB cases were placed on directly observed therapy (DOT), where appropriate."

COMMUNITY HEALTH COMMITTEE - Elaine Russell 

Motion made and seconded that the NCALHD support the 20th Anniversary of Public Health Month Celebration to be held in Greensboro on April 7, 1998 with a $500 donation. The motion carried.  

This donation will assist in covering expenses for the workshop room, exhibit areas, and keynote speaker. Other organizations are also supporting the event. 

POLICY & PLANNING (LEGISLATIVE) COMMITTEE - Maggie Dollar 

MANAGED CARE COMMITTEE Ð Dennis Retzlaff 

Report from committee given. (See Attachments, pp. 45-48.)  

HOME HEALTH ALLIANCE (NCAPHHA) Ð Louis Latour 

Motion duly made and seconded that the NCALHD support the expansion of the membership of the NCAPHHP to include departments without Home Health services for the purpose of marketing a broader range of health services and further resolve that the Association urge directors to give strong consideration to joining the Alliance. The motion carried. (See Attachment, pp. 49-50.) 

Motion made and seconded to approve to prorate our present dues, which are now $2,500 per year, on a quarterly basis to allow health departments who want to join the Alliance immediately. This would allow them to pay $625 (for the last quarter of this fiscal year) to join the Alliance. The motion carried.

OFFICE OF PUBLIC HEALTH NURSING - Joy Reed

Report from Committee given. (See Attachments, pp. 51-53.)

NORTH CAROLINA BOARDS OF HEALTH COMMITTEE - Carmine Rocco

EDUCATION & AWARDS COMMITTEE - Wayne Raynor

 The Annual Spring Workshop will be held at the North Raleigh Hilton beginning at 8:30 a.m. on April 21, 1998. (The monthly health director's meeting will be from 9:00 a.m. to 12:00 noon on April 21. It is incorporated into the workshop schedule.) The workshop will continue through April 22 at 12:00 noon. Speakers are to be confirmed by February 20, 1998. Announcement is to be posted on NCALHD WebPages by February 26, 1998 with announcement mailings going out March 1, 1998. 

Please contact Dennis Retzlaff in Warren County if you are interested in a Family Social on the afternoon/evening of April 21, 1998 during the Spring Conference. 

NACCHO Scholarships--one to date (Richmond County)--$3,000 available.

 NCPHA - Debra Rowe 

Encouraged health departments and staff to join this organization. Currently only 16 health directors are members. (See Attachment, pp. 58.) 

WOMEN'S & CHILDREN'S HEALTH - John Morrow 

Limited comments received by Committee concerning information mailed last month regarding the contract addenda and lead screening. Maternal Health State Guidelines will be incorporated into the contract addenda. 

President Smith mentioned the meeting next month will be at the Brownstone Hotel on March 19, 1998 at 9:00 a.m. and will begin in conjunction with the meeting of the North Carolina Local Boards of Health. A reception is scheduled for the previous evening. 

Everyone was encouraged to read the minutes which will include information that was not discussed at the meeting. 

Leah Devlin discussed Health Promotion and Hypertension. She indicated there has been a reduction in block funding, a total of over $140,000 will be reduced from local health departments. 

Respectfully submitted,

Tim Green

Secretary/Treasurer