MINUTES

NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS

Executive Committee Meeting

March 19, 1998

Brownstone Hotel, Hillsborough Street

Raleigh, North Carolina

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 February 19, 1998 Executive Committee Meeting were approved unanimously.

TREASURER'S REPORT - Tim Green

Mr. Green presented the Treasurer's Report. (See Attachments, pp 4-5.)

ANNOUNCEMENTS

Bryan Letourneau was introduced. He is Health Director at the Durham County Health Department.

The April 21, 1998 meeting will be a Full Association Meeting of the NCALHD.

Terry Pierce suggested that health directors who do not wish to receive a copy of the minutes through the U.S. mail, please indicate this on the roster sheet.

COMMITTEE REPORTS

STATE HEALTH DIRECTOR'S OFFICE - Leah Devlin

A statement on Carolina ACCESS and Health Check was presented along with a listing of Department of Health and Human Services Grant awards totalling approximately four million dollars. (See Attachments, pp. 7-14.)

President Smith commended Dr. Wolfe for her timely and significant contributions involving Health Check.

Ms. Devlin also presented for Joy Reed the following report for the Local Health Services Section and Office of Public Health Nursing and Professional Development.

1. If your county has not yet returned the survey on consultation needs, please do so even though the deadline has passed. At this point we have heard from 48 of 100 counties and would like a better response rate. The results will be presented to the State and Local Relations Committee next month for discussion and possible recommendations to NCALHD.

 

2. The CPT-4/ICD9 Task Force met on March 11. At that time, we heard from the State Center for Health Statistics that it would be at least February of 1999 before they change HSIS to provide for billing Medicaid using CPT-4/ICD9 codes. That work is anticipated to take another 12 to 15 months, putting the timing of such a switch at 90% (for systems) administrative match for this project in hopes that we could use the money to contract with programmers to work on CPT-4/ICD9 changes concurrent with the Y2K work. It also appears that there is an immediate need to provide assistance to those counties wishing to begin billing insurance, since the Medicaid switch is going to be a long-term project.

 

3. A memo will be going out on March 23, 1998 to all nursing directors and supervisors related to appropriate functioning of public health nurses under standing orders. This is an attempt to be proactive in assisting health departments in being certain their standing orders do not violate the scope of practice of the RN based on recent discussions/negotiations with the NC Board of Nursing.

EPIDEMIOLOGY COMMITTEE - Sherman Kahn

1. By June 30, 1999 assure that the TB Program staff members attend at least one TB-related training course sponsored by or endorsed by the Division of Epidemiology. The local health departments which employ TB nurses who have not attended the Introduction to Tuberculosis Course shall send the nurse to this course within FY98-99 or at the next date the course is offered.

 

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

 

2. That the NCALHD's Association go on record in support of increased funding for both DIS/Prevention and for medications through the AIDS Drug Assistance Program.

Local health departments are encouraged to work with their local veterinary associations in support of a statewide Rabies Clinic Day on Saturday, May 2, 1998, sponsored by the NC Veterinary Medical Association. (See Attachments, pp. 15-27.)

COMMUNITY HEALTH COMMITTEE MEETING - Jenny Lassiter presented the report for Elaine Russell.

A report formulated by the Dental Task Force will be released jointly by the NC Pediatric Society and the NC Dental Society to the Governor and General Assembly.

That the NCALHD fully supports the work of the Task Force and endorses the recommendations found in the Summary Report dated March 1998, and be it further resolved that the NCALHD will work to see that the recommendations are adopted.

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

Under the Balanced Budget Act, Medicare will cover mammograms annually and screening pap smears every three years. However, women with Medicare Part-B will no longer be eligible to enroll in the BCCCP program. Larry Jenkins would like to petition HCFA for a dedicated Medicare provider number to allow health departments to continue providing the service to women.

That the NCALHD write a letter of support to HCFA for the establishment of a special Medicare provider number to allow local health departments to continue providing billable breast and cervical screening to women covered under Medicare Part-B.

Motion was duly made and seconded to approve the motion as presented. The motion carried.

(See Attachments, pp. 28-44.)

MANAGED CARE/REIMBURSEMENT COMMITTEE - Dennis Retzlaff

The committee voted to endorse the revised wording concerning the message to go out from the Department regarding Carolina ACCESS without referring it to the Executive Committee since the meeting to present the revision to the Secretary would occur before the Executive Committee met.

The Report from ICD9/CPT4 code billing indicated that unless a separate process for software development could be achieved, it could be as far away as the new millennium before code billing through HSIS could be possible.

Motion from Committee to the Executive Committee to request DMA to carefully review reimbursement for rabies treatment to bring reimbursement in line with actual cost.

Motion was duly made and seconded to approve the motion as presented. The motion carried. (See Attachment, p. 45.)

POLICY AND PLANNING COMMITTEE - Maggie Dollar

Legislative priorities were presented. (See Attachments, pp. 46-48.)

The Committee received a compilation of legislative priorities submitted by health directors statewide. They also discussed a policy issue with potentially serious ramifications to the public health delivery system...the fact that there is no state policy for verifying that emerging health models comply with the new Public Health Authority Act . The Committee agreed to support such experiments, but felt strongly that to ensure their success it is imperative that proposed PHA models be deemed in compliance with the PHA Act before they are voted on by Local Boards of Commissioners, and moreover, that each model be assessed for potential ability to achieve the individual county's stated objectives while adequately assuring protection of the public's health.

The Committee made no motions, but requested this be brought before the Association for discussion. Ms. Dollar will present the need for a statewide policy that clearly delineates the criteria or principles which should form the basis of such a "pre-adoption" model review as well as who is the appropriate entity to conduct such a review. This function should be carried out on the front end (regardless of and in addition to post-implementation monitoring and evaluation).

LEGISLATIVE OVERSIGHT COMMITTEE/HEALTH CARE SUBCOMMITTEE - Dennis Harrington

Presented the following information from the March 11, 1998 meeting:

Predictions of the long-term impact of Managed Care on Access, Quality and Choice of Health Care Services for NC Citizens. Specific focus: Public Health Services.

Public health has as its mission to protect and promote the public health which includes education, direct services provision, and referral. In areas where services are not available or not readily accessible to certain at-risk populations, public health has provided varying degrees of primary care in fulfilling its assurance function.

Public health has a genuine concern for the Medicaid population (especially children and pregnant women) in NC having developed many of its direct services to meet the needs of this population, specifically primary care services, intensive case management (CSC and MCC), parenting classes, outreach services to assist with getting to health appointments and understanding the instructions provided in same, linking health care services with other support activity at one location (WIC, immunization, breast feeding support, etc.) and interpreter services when needed.

Managed Care - Potential impact on Public Health Services

Scenario # 1 - Public health could be excluded as an "equal player"/provider of basic screening services, educational services, and primary care (when available in local health departments) for the Medicaid population.

Scenario #2 - Public Health could be recognized as the quality provider of basic screening services, basic primary care (when it exists), and preventive health care services that it has become.

Of course, we do not want to see Scenario #1 above ever come to fruition. However, we cannot afford to leave it to chance! Without strong and decisive state policy to support and guarantee public health services, we will see this public health meltdown occur.

How do we assure that Scenario #2 becomes our reality???

1. Provide a legislative mandate that all programs provided to Medicaid clients include public health as a qualified (reimbursable) provider, and that unnecessary administrative barriers (authorizations) are not placed in the way of clients receiving services at health departments should they choose that service site.

 

2. Mandate that HMOs in the state (especially those targeting Medicaid clients) must recognize public health departments as providers, and that covered clients be allowed to choose to receive available services there. It must be provided that health departments are reimbursed for such care by the respective plan.

 

3. As is evidenced in our own NC Medicaid Program, providing eligibility through a formal program does not guarantee that clients will receive health care. Current statewide data documents that only 48% of the Medicaid-eligible children birth to 21 years old received a preventive health care screening. Statewide attempts to assure that the uninsured and underinsured are covered with some type of health insurance will not in itself assure that all needs are met. A safety net for citizens through the local health departments will still be critical. Such a need reinforces the essential requirements that (a) health departments be allowed to participate equally in the delivery of care in the respective communities, and (b) basic state and federal grant funding needs to be continued at growing levels of support to also support the safety net. (See Attachments, pp. 49-55.)

HOME HEALTH ALLIANCE (NCAPHHA) - Louis Latour

Mr. Latour spoke briefly and provided a handout. (See Attachments, pp. 56-57.)

STATE AND LOCAL RELATIONS COMMITTEE - Tom Bridges

Welfare Reform took a major portion of the meeting. Other items discussed were Carolina ACCESS and the Child Health Insurance Bill. Jim Bernstein made a presentation on Carolina ACCESS II. Bill Smith and Dennis Harrington presented the local public health perspectives on the progress made with the Division of Medical Assistance in regard to Health Check and the final version which is to come out in the next Medicaid bulletin.

Joy Reed is compiling the "Survey on Strategic Consultation with Local Health Departments" that was previously mailed.

A request has been made of Dr. Paul Halverson, CDC to obtain accreditation standards being developed for local public health departments.

EDUCATION AND AWARDS COMMITTEE - Wayne Raynor

Mr. Raynor mentioned the Annual Spring Workshop to be held at the North Raleigh Hilton beginning at 8:30 a.m. on Tuesday, April 21,1998. The monthly health director's meeting will be from 9:00 a.m. to 12:00 noon on April 21. The workshop will continue through April 22 and conclude at 12: 00 noon. The reception will be from 5:30 until 7:00 p.m. on April 21. He also mentioned the Legal Conference in October, 1998. Possible dates under consideration are October 14 Ð 16 or October 21 Ð 23. (See Attachment, p. 58.)

ENVIRONMENTAL HEALTH COMMITTEE REPORT - MiMi Cooper

Environmental Review Commission Meeting (ERC)

As a result of a meeting, the DENR group felt they could not defend their position at all and decided to make a recommendation to form another organization that would include all of EHS and health. The other two groups did study their positions and make recommendations, but there was no consensus from those present on what to recommend to the ERC. Those representing public environmental groups admitted they would feel much like the health folks if they were confronted with this problem, but still felt there were some benefits to be derived from moving on-site to EENR. Those who opposed this felt they did not want to give up their position. At the end of the meeting, the group agreed they needed more time to study this problem.

Water Supply Issues

Foster HomesÕ Water Supply: Jim Hayes discussed the proposed standard changing the setback for wells from all foster homes (no matter the age of the building) to 25 feet. He said that departments of social services are not in favor of this. He added that the Division had proposed using 10 to 25 feet as the setback if the water is tested for pesticides and nitrates when the facility is first inspected and after the foundation is retreated. There was no action of this item as it was just an informational presentation to the committee from the Division.

List Server Problem

Ms. Sewall reviewed problems that have occurred when outside agencies have gotten into our list services and sent unwanted E-mail to all the health departments. She said Mr. Blalock has been working on this problem and believes the system will not allow this activity to occur in the future.

Expansion Budget

Ms. Sewall explained that if Health Directors see a priority they would like to champion that they endeavor to locate someone in the Legislature to sponsor. (See Attachments, pp. 59-63.)

HOSPITAL AND COMMISSIONERS ASSOCIATION NETWORK - Jim Baluss

The following information was shared:

1. The letter of appreciation sent to Ron Aycock and staff for support of release of Medicaid Maximization funds was shared with the committee (copy to Bill Smith).

 

2. Discussion was held regarding how to assure and solicit formal support from the NC Hospital Association of Healthy Carolinian funding legislative proposal (as an inclusion in Secretary Bruton's expansion budget). Jeff Spade was unable to attend this meeting but has assured us of his confidence in NCHA's support.

 

3. Concern has been expressed by County Managers and County Commissioners about the local, new cost of CHIP due to "woodwork problem of previously undiscovered" Medicaid eligibles. NCALHD needs to proactively offer to assist adolescent prevention project costs and provide cost containment in this group.

OTHER REPORTS

Barry Bass updated the group regarding the Visioning progress. He discussed the possibility of meeting dates in May. Several possible meeting sites were mentioned, the Friday Center in Chapel Hill and the Koury Center in Greensboro.

Leonard Wood gave an ad-hoc committee report regarding the subject of an executive director for the NCALHD. He requested information from health directors regarding whether or not they feel the Association needs an executive director and options as to how this might relate to other groups or organizations that the health directorsÕ association has strong linkages with.

Djuana Register, President of the NCLPHMSSA gave a brief report. (See Attachment, p. 64.)

Debra Rowe spoke on behalf of the NCPHA. She reminded the Association of the NCPHA Annual Meeting in Fayetteville, September 16-18, 1998.

President Smith recognized and expressed appreciation to board of health members in attendance for their contributions and service to public health.

Richard House with the UNC School of Public Health stated that Dean Roper will hold meetings across the State to gather input regarding the role and function of the School of Public Health in the future.

A report of the NC Office of Rural Health and Resource Development dated February 1998 regarding Public Health in Montgomery County was discussed at some length. The report includes options and alternatives for Reform of Public Health Services in Montgomery County. (See Attachments, pp. 65-77.)

Respectfully submitted,

Tim Green

Secretary/Treasurer