MINUTES
NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS
Executive Committee Meeting
August 20, 1998
Wake County Public Health Center
Raleigh, North Carolina
CALL TO ORDER - President Smith called the meeting to order at 9:00a.m. (See Attachments, pp. 1-3, Attendance Roster.)
APPROVAL OF MINUTES - The minutes of the July 16, 1998 Executive Committee Meeting were approved unanimously on the motion of Tom Bridges and second of Barry Bass.
TREASURER'S REPORT - Tim Green
Mr. Green presented the Treasurer's Report. Account balances as of July16, 1998: checking $22,343.55; savings $32.25; money market $11,078.80; certificates of deposit $40,000.00. Mr.Green stated he would have a budget amendment to present next month. All counties have paid their dues with the exception of Cabarrus County. Mr.Green requested each person in attendance list their current e-mail address on the attendance roster. A compiled listing will be prepared and mailed to each health department. (See Attachments, pp. 4-5.)
ANNOUNCEMENTS
Arthur Jones, Health Director of Jones County, has taken a job with the State.
Marc Kolman, Health Director in Anson County, will soon become the Person County Health Department Director.
STATE HEALTH DIRECTOR'S OFFICE - Dr. Andrew McBride
Dr.McBride said in the past emphasis was placed on state health staff to provide technical consultation assistance. This will continue, however, emphasis is being placed on a commitment to support the health departments in their endeavors and to share the responsibilities they encounter. Examples given were emerging illnesses, foodborne outbreaks, emergencies, etc. He emphasized he can be called directly and will return calls to health directors. Other priority items mentioned by Dr. McBride were budgets for the next term; school health and the need for additional school health nurses to work in the public health loop; and the need to strengthen preventative areas for the seniorsÕ population to include areas such as exercise, diet, and some chronic disease management. He plans to work with the Office of Aging in this area. Dr.McBride encouraged health departments to look at some of these areas in public health such as diabetes to see where we can contribute.
Another priority is that of the swine and lagoon situations that are health-related issues. Dr.McBride, Dr.Bruton, and others will be making a trip to Israel next month to look at their migrant program and other health programs.
Dr.McBride said there would be an organized planning effort at the state level with an agenda, dates, and a final summit on the health care plan for North Carolina.
INSTITUTE OF GOVERNMENT LEGAL ADVISORY - Jill Moore
The health directorsÕ legal conference scheduled for October20-21, 1998 will be held at the Friday Education Center. The Education Committee has worked hard on the agenda and programs will be mailed soon. County attorneys attending this conference will receive continuing legal education credits. All county attorneys will receive a notice of this conference.
ACTION ITEMS
NOMINATING COMMITTEE - Barry Bass
The following slate of offices was presented and will be voted upon at the October20, 1998 meeting.
President - Maggie Dollar
President Elect - Tom Bridges
Vice-President - Tim Green
Secretary-Treasurer - Wayne Raynor
Mr.Bass also mentioned that prior to the October meeting Regions 1, 3, 5, 7, and 9 will be conducting elections for regional representatives to serve a two-year term. The committee will meet to develop a time line for the visioning project which will be shared at the September meeting.
ENVIRONMENTAL HEALTH COMMITTEE - Mimi Cooper
Ms. Cooper presented the following motions:
Motion #1 - To ask the Association to write a letter to the Clean Water Trust Fund Trustees thanking them for allowing Madison County to use grant funds to administer their straight pipe elimination grant and asking that others who receive grants be allowed to do likewise. The motion was seconded and unanimously approved.
Motion #2 - That the Association take a position to support extending the ILO Moratorium until such time as activities required by the original legislation (i.e., Best Management Practices, Alternatives to Lagoons, etc.) are accomplished. The motion was unanimously approved.
COMMUNITY HEALTH COMMITTEE - Elaine Russell
Motion #1 from Committee that the NCALHD encourage its members to collaborate with local law enforcement in the pursuit of the Project Assist $1,000.00 mini-grants to further address tobacco sales to youth. The motion received unanimous approval.
Motion #2 from Committee that the NCALHD support the Environmental Committee in reviewing the Division of Community Health's request to include a review question on "heart healthy entrees" on the quarterly restaurant inspection sheet. The motion received unanimous approval.
WOMEN'S & CHILDREN'S HEALTH COMMITTEE - Dr. John Morrow
Motion #1 from Committee for the NCALHD to support Senate Bill 1366 and the companion House Bill to allow the division to establish a six-county pilot project with increased budget flexibility with State funding. Furthermore, to support the use of a proposed lottery system for the choice of five of the six counties. The motion was approved unanimously.
Motion #2 from Committee for the NCALHD to support recommendations from the Women's and Children's Health Accountability Workgroup to establish review teams to assist local health departments who received the lowest ranking in attaining contract addendum deliverables and that the members of these review teams be jointly decided upon by the local health departments and the division. The motion was approved unanimously.
INFORMATION ITEMS
Lois Veeder, Vaccine Account Manager for Smith, Kline and Beechum Pharmaceuticals, spoke to the Association concerning Hepatitis A and Havrix, a vaccine produced by her company. She indicated last year 211 cases of Hepatitis A were reported in North Carolina. A brochure "A Shot In The Arm For Food Safety" developed by the National Restaurant Association encourages foodhandlers to receive this vaccine. Vaccine cost to health departments has been reduced from $32.08 to $16.17 per dose. Wake County Health Department has made this vaccine available to the public since February 1995. Ms.Veeder can be reached at 919-462-8836.
TECHNOLOGY COMMITTEE - Dennis Harrington reporting for George Bond
An RFP is being developed and should be mailed soon.
STATE AND LOCAL RELATIONS COMMITTEE - Tom Bridges
Mr. Bridges gave an update concerning progress in studying health educator salaries. The health education consultant with the state has agreed to assist in this study and will be checking with those health departments who have had a high rate of turnover in health education.
The proposal relating to changing the classification of non-physician health directors which was previously approved by the Association will be presented to the State Personnel Commission on August27, 1998. If approved, beginning October1, 1998 counties may voluntarily implement this plan. The plan will become mandatory effective July 1, 1999.
EDUCATION AND AWARDS COMMITTEE - Wayne Raynor
The October Legal Conference and Association meeting will be held at the Friday Center on October20-21, 1998. The conference will be held all day on October20 and until mid-day on October21. The Association meeting will be held on October21 following lunch. Anne Dellinger is looking for space for committee meetings or committee chairs may schedule meetings in their motel rooms. Registration materials will be mailed in September.
The Ham Stevens Award announcement and nomination forms will go out in early October and are due back by December 1, 1998.
Tom Bridges will deliver a retirement clock to Tom Johnson who is unable to attend the next meeting.
EPIDEMIOLOGY COMMITTEE Ð Dr. Sherman Kahn
There are plans to provide health departments with additional information and guidance on this subject in the near future.
Motion was made by Bill Smith to support funds going through to local health units and sub-contract out and also in opposition to local health departments being the sole providers of HIV medications if they have a full-time pharmacy. The motion received a second and was passed.
President Smith announced there is an AIDS Advisory Council press conference at 1:00p.m. today. Dr.John Morrow will represent the Association at this conference.
HOME HEALTH ALLIANCE (NCAPHHA) - Dr. Louis Latour
The "Alliance" held its regular Board Meeting on August 12, 1998.
At present the Alliance membership stands at ten (10) home-health-only agencies, two (2) clinic-only members and nineteen (19) agencies representing home health and clinic. The new dues structure is set at $2,000 for clinic only, $2,500 for home health only, and $3,000 for agencies that join as both home health and clinic.
A reminder was given as to the Alliance's Home Page which is located at the same address as the Health DirectorsÕ Home Page.
It was reported that the Alliance has now negotiated several notable contracts with HMO's and insurance carriers for services through the Alliance. It was announced that a contract will be executed this coming Friday with VICARE which has covered lives in numerous companies in both the Carolinas and Virginia.
It was announced that the Board of the Alliance was increased from ten (10) to twelve (12) members to reflect the broader scope of the Alliance. These new board slots would be filled by a "Clinical" RN Director and a "Home Health" Director.
It was mentioned that "Alliance Home Care," the staffing company of the Alliance, is presently supplying supplemental staffing to eight counties with 22 RNs and 17 CNAs. In addition, the company is negotiating for a staffing arrangement with Kimberly Olsten for additional staffing. At present, the monthly payroll is approaching $20,000 which is significant given the short time the company has been in existence. Counties were urged to consider this resource when contractural staffing is needed.
Dr. Latour urged the Association members to not only join the Alliance but to consider the many components (i.e., being a corporation, having a 501c status, having a financially viable company in place) all of which have been established, paid for, and are already in place as part of a statewide movement that will be needed by health departments of the future. He also requested that serious consideration be given as to whether or not the Alliance becomes the vehicle the Association uses in its visioning.
It was mentioned that the next Alliance meeting is scheduled for September9 but that date may be changed to September16 to coincide with the NCPHA Conference in Fayetteville. (See Attachment, p. 9.)
MS. ROSEMARY SUMMERS - ORANGE COUNTY HEALTH DEPARTMENT - The Orange County Health Department will be participating in the Latino Festival in Chapel Hill to be held September12-13, 1998. Last year more than 200 individuals came through their health booth with many being determined as high-risk. Ms.Summers requested counties do follow-up on referrals made to their county. A sign-up sheet was circulated asking if counties are willing to do follow-up. (See Attachment, p. 10.)
MANAGED CARE COMMITTEE AND REIMBURSEMENT COMMITTEE - Dennis Retzlaff
The Committee met on August12, 1998 in Chapel Hill. A report from Torque Wade and Jeffrey Sims of the Office of Rural Health and Development was given. They reported implementation of ACCESSII is proceeding with each site having hired or on the path to hiring a program coordinator. It is expected that each Carolina ACCESSII site will communicate with the local health department to develop cooperative activities. It was emphasized that ACCESSII is a true demonstration effort with different approaches and emphasis being tried in the initial sites. Public health is the lead at some sites, actively involved in others, and as yet not involved at all in some. ACCESSII will also be developing care management protocols for specific problems such as diabetes and asthma. Bruce Parson reported that protocols for diabetes have already been developed and will be reviewed by the committee next month.
With the implementation of Health Choice (CHIPS) just around the corner, the committee expressed several concerns including whether the process for getting the appropriate Blue Cross provider number can be completed in time for the October1 deadline. Concern was also expressed that the $50.00 per child and $100. 00 per family up-front payment required for families above 150% of poverty may discourage parents from enrolling their children.
Jim Baluss requested the committee address the issue of inequitable treatment of public health by insurance companies and other payers. His contention, which was supported by others, is that many payers reject payments to Public Health for services for which other providers are automatically provided reimbursement. Jim and Dennis will flesh out these concerns in written form prior to the September meeting. Chris Hoke indicated he would bring up the concern in an upcoming meeting with the Secretary. (See Attachment, p. 11.)
The committee endorsed a proposal from Joy Reed to make available a training program of self-care, chronic disease management.
NCPHA COMMITTEE - Debra Rowe
The NCPHA Conference will be held September16-18, 1998. Ms.Rowe said to let her know prior to the conference if a meeting room is needed.
WOMEN'S & CHILDREN'S HEALTH COMMITTEE - Dr. John Morrow
The Adolescent Parenting Program, formerly under the Department of Social Services, was moved to the Division of Women's and Children's Health the first of this year. Funds remain in Senate version. Legislatively $2,000,000 in the DSS block grant has been moved from the Division of Women's Health to prevent adolescent pregnancy. The school-based centers of Health Choice have been reinstated in the Senate version of the budget bill. The House Bill has a checklist added that will be for parents. Please contact your legislators to render support for the Senate version of the bill.
JOY REED - mentioned that orientation for new health directors is scheduled for August28, 1998. Her office has received numerous calls about Adult Day Health Centers. These centers require health department involvement.
DENNIS HARRINGTON - Expenditure Reports were due August15, 1998. If extensions are needed, contact him. A 15-day extension may be possible.
ANCBH - Carmine Rocco
Assessment and infrastructure is still being copied; accreditation came up several times; Website is www.ancbh.org.
OTHER ANNOUNCEMENTS
Gaston County won the NACHO Award for Maternal Care.
Phyllis Gray is now Special Assistant to Dr.McBride.
Respectfully submitted,
Tim Green
Secretary/Treasurer