CALL TO ORDER - President Smith called the meeting to order at 9:00 a.m. (See Attachments, pp. 1-2, Attendance Roster.)

TREASURER'S REPORT - Tim Green

Mr. Green presented the Treasurer's Report for information. As of November 1, 1998, balances are as follows:  checking $1,579.31; savings $32.63; money market $5,233.69; certificate of deposit $40,000.00. A summary of budget activities was presented. (See Attachments, pp. 3-4, Treasurer's Report.)

ENVIRONMENTAL HEALTH COMMITTEE - Mimi Cooper

At the October meeting of the NCALHD, the Environmental Health Committee presented a motion to support the proposal from the Environmental Health Supervisors' Association on a model for the "Supercommission," also known as the "green paper." Because the proposal was lengthy and needed local input, President Smith suggested the vote on this proposal be delayed until the November meeting. This would also provide each health director an opportunity to receive a copy of the proposal and to review the proposal at regional meetings.

STATE AND LOCAL RELATIONS COMMITTEE - Tom Bridges

Motion from Committee:  That the NCALHD endorse the attendance of social workers or social work related staff employed by local health departments at social work orientation and basic training. Motion received a second and was approved. (See Attachments, pp. 13-14, Social Work Orientation and Basic Skills Training.)

NOMINATION AND BY-LAWS COMMITTEE - Barry Bass

Region VII is in need of a regional representative. The committee is in the process of electing a representative to take office by January 1999. This will be brought to the Executive Committee at the December meeting.

EPIDEMIOLOGY COMMITTEE - Dr. Sherman Kahn

COMMUNITY HEALTH COMMITTEE - Wayne Sherman for Elaine Russell

MANAGED CARE COMMITTEE - Dennis Retzlaff

1. Motion from Committee:  Because the ability of local health departments to bill using CPT coding is crucial to successful competition in providing clinical services in today's environment, and because the capacity of state and regional staff does not appear to be equal to current needs, a motion was made to ask Dr. McBride to place a high priority on shifting resources to dramatically increase the capacity of paid consultants to provide consultation necessary to facilitate the ability of local health departments to bill using CPT codes. Motion received a second and was approved.
2. Because one of the greatest strengths of local health departments is the ability to provide community-based, family-oriented and environmentally sensitive patient management and support services; and because such services are crucial to public health's ability to successfully market partnering services with private medicine and standalone clinic and home health services; and because a menu of targeted, standardized and high-quality comprehensive case management services are needed as soon as possible, a motion was made to request that Dr. McBride place the highest priority on directing state program staff and appropriate regional consultants to work with representatives of this Association to identify existing protocols or produce new comprehensive patient care management protocols with a public health emphasis and work for the adoption of these public-health-based protocols as the standard of care. Protocols addressed should be prioritized through consultation with various stakeholders and include, but not be limited to, such items as management of diabetes, asthma, pneumonia, GI disturbances, obesity, teen pregnancy, lead-based paint poisoning, etc. Motion was received and seconded. The motion carried.
3. Because the North Carolina Alliance of Public Health Agencies is recognized as a significant tool for working to keep public health department services clinic and support services competitive and because the Alliance's ability to carry out needed activities is hampered by the lack of a paid executive, a motion was made to urge the Alliance to move quickly to hire a new Executive Director. Motion received a second and carried. (See Attachment, p. 15, Managed Care and Reimbursement Committee Motions.)

Russell Jones has accepted a position with the Person County Tax Department, however, he will continue working with the Association concerning our homepage and minutes on the Internet. Russell can be reached at 336-597-1723 and receives mail at the Person County Tax Department, P.O. Box 1701, Roxboro, NC 27573.

Ms. Edna Proctor from the Edgecombe County Health Department has been elected to serve as the 1999 President of the North Carolina Local Public Health Management Support Supervisors' Association.

Ms. Shirley Cotton, RN, BSN has been appointed interim health director of Lee County Health Department.

Dr. Joy Reed addressed several issues including the use of PAs, Billing for Treatment Provided by a RN Under Standing Orders, Billing for Lab Services When the Specimen is Sent to the State Lab or Other Reference Lab, and Immunization/Vaccine. Dr. Reed said a letter of clarification would be sent to all health departments concerning these issues. (See Attachment, p. 16, Report Given by Dr. Joy Reed.)

Mr. Chris Hoke announced the 1996-97 Medicaid maximization monies amount to 13 million dollars.

Mr. Dennis Harrington announced the Association did not get the accreditation grant from the Kate B. Reynolds Charitable Trust. This issue will be readdressed in March 1999. President Smith extended his appreciation to Mr. Harrington and Ms. Anne Scott for their work on this project.

NCPHA - Debra Rowe

The NCPHA, in addition to the NCALHD, put forth a nomination for Adam Searing for the Robert W. Johnson Community Health Leadership Program National Award. Mr. Searing is very deserving of this award through his work with Blue Cross/Blue Shield.

ANCBH - Carmine Rocco

Mr. Rocco mentioned the Public Health Authority Act amendment was not approved because it was subjective and not a correction. Staff will return with the request in January. Appreciation was expressed to everyone who submitted nominations for the various awards that will be presented in January. Mr. Rocco requested a health director liaison to serve on the ANCBH.

President Smith introduced Mr. David L. Rust, Health Director for Burke County Health Department. Mr. John Shaw is retiring at the end of January.

Dr. Ann Wolfe mentioned that Dr. McBride has requested she lead the effort to consolidate our health department divisions within the department into one, in addition to being the Director of the Division of Women's Health. A planning committee has been developed and is working on this. Dr. Wolfe invited President Bill Smith and Maggie Dollar to be a part of this committee. She announced the Division of Environmental Health is also represented. Immediate changes are that Dennis Harrington will head the local health department services and Barbara-Pullen Smith is in charge of the Office of Minority Health. Both report to her. Dr. Wolfe said Leah Devlin, Steve Cline and Chris Hoke have been working together very effectively and she appreciates their leadership. Several challenges ahead are that a budget for the unified public health division be completed, that a personnel office be developed, and that planning and lab administration efforts be addressed. (See Attachments, pp. 17-18, Reorganization.)

POLICY AND PLANNING COMMITTEE - Maggie Dollar

The Policy and Planning Committee met. Jim Baluss gave an update regarding the status of the resolutions this Association sent through to the NC Association of County Commissioners to be considered by its Association in January. The resolutions addressed were:  Future of Public Health; Well Water Program for the State; Computer Technology for the Local Health Departments; Healthy Carolinians, and the Consolidation of Human Resources Services Boards.

One issue tabled by the Committee regarded Public Health Services for Aliens. This will be addressed at a later date.

Legislative goals for next year include: Public Health Authority, Consolidation of Human Services Boards, and the Promotion of Healthy Carolinians.

Barbara-Pullen Smith addressed the Executive Committee relating to a survey sent to all health departments from the NC Center of Public Policy Research, Inc. This survey relates to translation services. She requested that all health directors complete the survey and return. (See Attachments, pp. 19-22, North Carolina Center for Public Policy Research, Inc., Survey of County Health Departments, Community/Migrant Health Centers, Rural Health Centers, and Rural Hospitals.)

Ms. Dollar said a subcommittee was appointed to work together to review the tobacco settlement and related issues. Those on the subcommittee are Bill Smith, Debra Rowe, Carmine Rocco, Jim Baluss and Bob Woods.

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

The Committee met and discussed the contract addenda for next year. They reviewed and made minor changes. Also discussed were emergency contraception fees and whether Medicaid would establish a fee for this. Kits are available for this at a cost of approximately $20.00 each. If interested in purchasing these, they can be put on Part B Deliverables. It was determined to be less expensive to use birth control pills and make own kits. If so, the cost of the pills should be included in the visit.

The immunization survey relating to vaccine accountability has been mailed. It is important that comments are completed and the survey returned to Dr. Morrow as soon as possible. Data is needed to take back to the General Assembly.

Dr. Morrow requested information anyone has on job sharing.

MANAGED CARE COMMITTEE - Dennis Retzlaff

Mr. Retzlaff urged the Association to look very seriously at the use of Medicaid maximization funds. He also mentioned Carolina ACCESS II and that Wayne Sherman has been chairing a committee looking at ACCESS Care, a part of Carolina ACCESS II. Mr. Sherman mentioned one of the problems is the lack of knowledge by physicians regarding public health.

The Committee also heard a report from Harold Gabel about the contract Guilford, Forsyth, Rockingham, and Davidson Counties have with United Health Care, a managed care company.

THE NORTH CAROLINA ALLIANCE OF PUBLIC HEALTH AGENCIES (NCAPHA) - Dr. Louis Latour

The Alliance met and discussed the hiring of an executive director along with other issues. (See Attachments, pp. 23-43, North Carolina Alliance of Public Health Agencies.)

COMMUNITY HEALTH COMMITTEE - Wayne Sherman

Mr. Sherman reviewed the handouts. (See Attachments, pp. 44-56, Community Health Meeting Minutes, North Carolina Public Health Priorities Subsequent to a Tobacco Settlement, and Proposed Tobacco Settlement News Article, "Tobacco Cash to Aid State Health Care.")

EPIDEMIOLOGY COMMITTEE - Dr. Sherman Kahn

VISION WORK GROUP - Barry Bass

EDUCATION COMMITTEE - Wayne Raynor

The Education Committee did not meet. Mr. Raynor encouraged everyone to submit nominations for the Ham Stevens Award by December 4, 1998.

STATE AND LOCAL RELATIONS COMMITTEE - Tom Bridges

State and Local Relations Committee has been involved this year in sending health director representatives to the Local Providers' Work Group meetings. These meetings convened every two months and were composed of public health, mental health and social services directors; county managers; and Secretary Bruton and his staff.

At the November 4, 1998 meeting, Allan Spader, Executive Director, Area Mental Health Association, agreed to chair a task force to address issues on competition between public and private service provision. (See Attachment: "Proposal to Form Work Group on Competivization.") Barry Blick (HD Catawba) and Bruce Parsons (HD Gaston) have agreed to represent public health concerns on this task force. A report from the task force is due in early 1999. (See Attachments, pp. 103-104, Proposal to Form Work Group on Competivization.)

ENVIRONMENTAL HEALTH COMMITTEE - Don Yousey for Mimi Cooper

Respectfully submitted,

 Tim Green

Secretary/Treasurer