MINUTES

NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS

Executive Committee Meeting

March 18, 1999

Wake County Public Health Center

Raleigh, North Carolina

CALL TO ORDER Ð President Dollar called the meeting to order at 9:10 am. (SeeAttachments, pp 1-2, Attendance Roster.)

APPROVAL OF MINUTES Ð The minutes of the February 18, 1999 Full Association Meeting were approved as submitted.

TREASURERÕS REPORT Ð Wayne Raynor Ð Motion from Bill Smith to accept TreasurerÕs Report as presented. Seconded by Tom Bridges. Motion passed.

President Dollar announced the audit will take place following todayÕs meeting.

President Dollar requested volunteers to serve on a "Core Public Health Services Work Group" to work with Dr. McBrideÕs Office.

President Dollar announced that the N. C. Academy of Family Physicians is requesting a survey of Local Health DirectorÕs with regard to Infant Mortality data.

President Dollar announced April business meeting to be held April 13^th in conjunction with Spring Conference at the Friday Center in Chapel Hill.

President Dollar promoted participation in Senior Vaccination Sunday Coalition and Planning Committee. President Dollar requested volunteers to participate.

President Dollar announced a fax that went out to health departments from the FEDS to call your Congressman asking for Dental support and to vote for more money for the Public Health Alert Response System.

• Provided update of Tobacco settlement, 50% for Foundation, and 25% for farmers, 25% for health of the $2.3 billion available. Some concerns about using funds to "supplant" existing dollars in Local Health Departments. We must have strong public health presence on both the Foundation side and the Trust side.

• Widespread support exists for school health nurses, Supreme Court mandated School Health to provide services for Children with special needs. School nurses should be public health oriented. Funds for school nurses may come from Medicaid and perhaps from tobacco settlement funds. Dr. McBride was very complimentary of Catawba County efforts at school health program.

• Our lead screening levels have been going down. Nationally approximately 400,000 children that would have been identified with elevated lead levels last year were not found because of a laxing of awareness and testing efforts. Medicaid and HCFA are now beginning to work together on funding support for core public health functions. Bill Smith stated that decrease may be due to program moving from a child health to an Environmental Health issue.

• State will work with local communities, have two at present interested in local program.

• UNC-School of Public Health has grant with CDC for a Management Training Program in VA, NC, SC, GA; provides training for 600 managers. Program will focus on fiscal management and other "hard" management practice issues. Project is for three years and UNC/State Office looking at ways to sustain beyond the grant period. AHECÕs will be involved.

• Placement of Environmental Health program is still unsettled at this time. ThereÕs a new "Public Health Committee" in the House of Representatives. Jim Baluss asked about how Local Health Departments can appropriately prepare to respond to state enforced "hog odor" rules in local areas? Dr. McBride stated that we should begin to establish/document sentinel events and take an organized approach in doing so through Environmental Epidemiology.

State & Local Relations Committee

No action items.

Technology Committee

• George Bond presented a Resolution for consideration by NCALHD regarding public health and the fact that there currently exists no statewide integrated, secure, and dedicated network of public health telecommunications and informatics. - see attachment

Motion to accept resolution. Motion passed.

Environmental Health Committee

• Environmental Review Commission will not likely be appointed during this legislative session.

Epidemiology Committee

• By the meeting on March 12^th the committee had also heard about a second anthrax threat in North Carolina in the past two weeks, work being done in Wake County on their bioterrorism plan, and the recent incidents in Asheville and Robeson Counties were discussed. Committee members and health directors are reminded it is important to read Bioterroism report February 5, 1999 from CDC/MMWR and email report from Dr. MacCormick on March 5, 1999. We need a better process for dealing with Bioterroism issues.

• Local Health DepartmentÕs should touch base with local host/hostesses for Special Olympics Host Towns to let them know local public health is available to assist with potential communicable disease outbreaks, etc. The competition is scheduled to begin on June 26^th.

Community Health/Dental Committee

No action items.

Alliance for Public Health Agencies

No action items.

Hospital Association Network

No action items.

County Commissioners Association Network

No action items.

Managed Care & Reimbursement

No action items.

WomenÕs & ChildrenÕs Health Committee

Policy & Planning Committee

Social Work Report

Mary Linker Ð President, NCAPHSW

Mary Ann Thornton Ð Director, Harnett County Social Work Division

Gave overview of overall Social Work Mission and promoted creation of separate Social Work Divisions in Local Health Departments.

Local Health Services

• Dennis Harrington distributed New Medicaid Rates schedule. Medicaid Max payments will be somewhat less due to increase in reimbursement. Apologized for changes in due date for consolidated contracts budgets to be returned to office of Local Health Services. Budgets and consolidated contracts must be signed by Local Finance Officer. Controllers Office is really reviewing fiscal accountability issues such as timely expenditure reporting, time keeping, etc. "We must get our fiscal accounting house in order".

Office of Public Health Nursing (OPHN)

• It appears that some agencies are utilizing "restricted delivery mail" to communicate with minors related to appointments and treatment for which the minor has given, and legally can give , consent without parental knowledge. If this is your agencyÕs policy, you should be aware that the rules under which the postal service functions provide that: "Mail for minors or person under guardianship may be delivered to their parents or guardians."

Office of Public Health Nursing (OPHN) Continued

• On April 1, 1999 a conference call will be held to explore a mechanism/forum for promoting communication among Medical Directors/Physician Health Directors on issues of common concern.

• Several activities related to public healthÕs switch to billing via CPT/ICD-9 codes are occurring: - two workshops for clinical staff were held in February, two workshops for administrative support staff were also held and another scheduled for April 13-14, work on development of an HSIS screen which would allow local health departments to bill via CPT/ICD-9 is occurring.

• Finance 101 workshop has been scheduled for April 21-23 in Burlington.

• Plans are in the works to hold a teleconference in May to provide training for local health department nurses who function as Adult Day Health Specialists (i.e., they serve with an Adult Day Health Coordinator from the local DSS to approve and monitor Adult Day Health Centers in the county.)

Association of N. C. Boards of Health (ANCBH)

• Requesting Local Health DepartmentÕs support in contacting Senator Hartzells office to support bill to modify Public Health authority rules. Carmen thanked group for updated list of Board of Health Chairs and willingness to host ANCBH meetings.

North Carolina Public Health Association (NCPHA)

• House substitute of Senate Bill 6 was ratified this week. Make up of board on Foundation does not require health representation but permits health representation. General Assembly retains the authority to divert funds under the Foundations stewardship during any given point in time. The GA also has the authority to dissolve the Foundation.

Potential User of Funds from Tobacco Settlement

1. Tobacco prevention and control
2. Expanding School Health
3. Providing Medicaid reimbursement for dental patients
4. Major funding for Core Public Health Functions
5. Public Health and Hospital Association

State & Local Relations Committee - see attached Local Provider Work Group

1. Need support for sealants & extractions to be covered by Medicaid
2. Dr. Steve Cline shared a report on "Proposed Additional Dental Care Benefits" (see attachment)

• Dr. Cline Ð school health funds were cut because children are now eligible for services through N. C. Health Choice. State is pressing to get school heath funds restored to cover dental care services not covered by N C Health Choice.

Technology Committee

• RFP being sent to technical writer and will be out by end of FY1999.

Nominating & Bylaws

• Reminder that NACCHO Board elections are due and April 16^th is deadline.

Education & Awards

• Final plans being made for Spring Conference to be held April 13-14 in Chapel Hill at the Friday Center and registration is $70. (see attached Draft Program) Consider bringing additional staff from health departments.

Environmental Health Committee

• Hog odor temporary rules went into effect March 1, 1999

Epidemiology Committee

• Raoult Ratard, new TB Medical Officer in Epidemiology. TB conference scheduled and geared toward TB staff and Consultants.

Managed Care & Reimbursement

• Focus on streamlining process for billing insurance in Local Health Departments. (see attached Bill 90 regarding "Coverage for prescription contraceptive drugs")

• Diabetes, Hypertension, Obesity, Adolescent Pregnancy, Lead Protocols drafted and Asthma was rescheduled.
• Sliding fee schedule will be adjusted and mailed to Local Health Departments soon due to Medicaid rate changes.

WomenÕs & ChildrenÕs Health Committee

• WomenÕs & ChildrenÕs Health is going to be launching an educational campaign for communities and physicians to increase the utilization of lead testing. WIC will be tapped for lead screening to participate in lead testing. It will become a program requirement for the one year old certification and two year old certification that we do from 11Ð13 months and 2 year old to 23-25 months. Lead screening will be mandatory during that visit. They will help the cost by providing narratives and mailers. This will be piloted from May to July with statewide program requirement in August.

Policy & Planning Committee

• SOFFE & UNC Ð School of Public Health will be sponsoring Advocacy Training. This will be for Healthy Carolinians Group on April 7^th, Chapel Hill, Troy and Silva.

• Monday, April 26^th Legislative Day at Brownstone in Raleigh registration is $45.00.

• Executive Director for NCALHD is extremely important in view of the need for health representation at the legislature recently regarding tobacco settlement.

Meeting adjourned at 12:35 p.m.

Respectfully Submitted by,

1. Wayne Raynor

Secretary/Treasurer