CALL TO ORDER Ð President Tom Bridges called the meeting to order at 1:00 p.m. He introduced Year 2000 officers ands thanked committee chairs for agreeing to serve. He expressed his enthusiasm and excitement for a productive year for the association.

APPROVAL OF MINUTES Ð Wayne Raynor presented the minutes of the December 16, 1999 meeting of the Executive Committee meeting. The minutes were approved as submitted.

TREASURERÕS REPORT Ð Wayne Raynor presented the TreasurerÕs report through the period January 19, 2000. As of January 19, 2000, account balances were as follows:

Checking-$22,837.47 Savings-$33.65 Money Market-$318.94 CD-$40,000

PRESENTATION OF BUDGET FOR NCALHD 2000 Ð Jim Baluss presented the budget for the upcoming year. Upon MOTION and second, the budget was approved as presented.

ANNOUNCEMENTS & INTRODUCTIONS Ð The new Health Director in Bertie County, Ron Freeman, was introduced. It was also announced that Russ Childers, former District Health Director, is serving as Interim Health Director at Martin-Tyrell-Washington District Health Department. The new Health Director for Wayne County, Kevin Watkins, MD, MPH, was also announced. Tom Bridges introduced Jim Haig, Vice President with NCHA. Mr. Haig warmly welcomed the Association members to the NCHA as new "tenants" in the Cary facility. President Tom Bridges then recognized outgoing NCALHD President Maggie Dollar for the outstanding service in 1999. She was presented with a plaque of appreciation and recognized at the evening meeting. Maggie thanked association members for their support during her tenure as President.

1. Tom discussed the availability of meeting space and facilities in the lease arrangement at NCHA and commended the facilities for committees, etc.
2. Barry Bass was recognized to introduce newly hired NCALHD/NCAPHA Executive Director Susan Smith-Wharton, MBA, BSN. By way of introduction to her impressive background, her "CV" is attached to these minutes. Susan expressed her appreciation in being named Executive Director, and that she looks forward to working with the membership of the Association.
3. Tom requested all committee chairs to send a roster of their committee members to Secretary/Treasurer Jim Baluss as soon as possible.
4. Tom requested committee chairs to use the "committee minutes template" as distributed (attachment).
5. Tom reported that he wrote a letter to Dr. Bruton expressing NCALHD concerns about "moving" DECÕs to a new division in DHHS.
6. Tom announced that according to Jill Moore, the Health DirectorÕs Legal Conference at the Institute of Government is scheduled for Wednesday and Thursday, October 18^th & 19^th, 2000 at the Friday Center at Chapel Hill, followed at 1:00 p.m. on the 19^th by the NCALHD meeting.
7. An invitation for later in the evening was extended for the annual reception by Terry Snowden with Seaberg & Smith (formerly Sedgewick James Insurance) at the Velvet Cloak Inn.
8. Dr. Sherman Kahn was then recognized, and he made a special appeal as President of the NCPHA for Health Directors to actively support NCPHA membership in their agencies Ð particularly with new employees. Health Directors were urged to attend the annual conference in Wilmington in September.
9. Dr. Steve Keener was recognized to provide an announcement and invitation to attend a conference in Charlotte on February 7^th & 8^th at the University Hilton on "Eliminating Racial & Ethnic Health Inequalities: A Challenge for the New Millennium". The conference features very notable speakers and collaborative partnership of sponsors.

1. Dr. McBride invited all present to the State Health Directors Conference on the following day at the McKimmon Center.
2. Dr. Leah Devlin announced and urged attendance by Health Directors to the "Be Active NC" Conference Thursday and Friday, January 27 & 28 in Raleigh. Dr. McBride noted the strong business and industry support of this initiative.
3. Dr. McBride outlined several important issues which need to be brought before the Legislative Public Health Study Commission. It has been frustrating that the commission has not announced a meeting date, and Dr. McBride is not confident of any real action by this critically important commission in the short session. He stated the need for the emergence of "Public Health Champions" on this commission. In response to a question, Dr. McBride enumerated several important issues that the Public Health "family" should push before this commission. They are:

1. The worth and value of Public Health.
2. Funding for Core Public Health Functions.
3. Accreditation for Public Health Agencies.
4. Public HealthÕs role in enhancing and reshaping mental health services in North Carolina.

Nominating & Bylaws Ð No Action Items.

Policy & Planning Ð Tim Green presented 2 motions from committee:

1. Based on resolutions originating from Boards of County Commissioners in several counties, calling on the General Assembly to rescind North CarolinaÕs current "consent by minors" for STD treatment and contraception, the MOTION from committee called on NCALHD County Commissioners Association Liaison to meet with NCACC staff to share information and rationale for the NCALHD resolution in support of existing "consent by minors" for health care statutes, and to highlight the potential adverse consequences to adolescents in removing their ability to consent for certain medical procedures and treatment. In response to a question, it was stated that to date, 4 county Boards of CommissionerÕs have adopted resolutions calling on the legislative to repeal North CarolinaÕs "consent by minors" statute. MOTION PASSED.
2. MOTION from committee that NCALHD actively engage the North Carolina Association of County Commissioners (NCACC) to gain their support to have the Environmental Health reorganization issue placed on the Environmental Review Commission agenda and actively considered. It was noted by Mimi Cooper, Chair of Environmental Health Committee, that the issue is on the agenda, but apparently not under active consideration.

WomenÕs & ChildrenÕs Health Ð No Action Items.

Education & Awards Ð No Action Items.

Environmental Health Committee Ð Mimi Cooper brought forth a MOTION from the Environmental Health Committee that NCALHD approve a 1 year, temporary change in the distribution of "bonus funds" to more equitably divide the funds without penalty based on impacts from Hurricane Floyd.

Discussion: Many counties were directly affected by Hurricane Floyd, and others contributed manpower to affected counties, thus causing an aberration in percentage of completion of grading in licensed establishments. This does not apply to previous years distribution just received by local departments. MOTION PASSED.

Tom then announced that Malcolm Blaylock has requested a NCALHD appointee to an advisory committee being reconstituted for Centralized Training. Don Yousey has agreed to serve for a 3-year appointment.

Epidemiology Committee Ð George Bond brought forth several motions from the Epidemiology Committee.

1. Support change to contract addenda in HIV/STD "nonnegotiable" ITEM 5; Syphilis Testing during pregnancy. Adopt a new minimum standard of syphilis test on initial visit ands repeat test between 30 to 34 weeks.

Discussion: It was clarified by Dr. Kevin Ryan that this is a minimum requirement and should a "higher standard" need to be adopted for "high risk" patients, it would be acceptable. Dr. Ann Wolfe stated a "letter of explanation" would be mailed with contract addenda. MOTION PASSED.

2. In Item 8, HIV/STD Contract, to adopt new language to "encourage" HIV testing versus "be offered" testing in old contract language. MOTION PASSED.
3. Approve adoption of new language in HIV/STD Contract Addenda in partner notification, prevention, counseling to specify "training in accordance with current CDC guidelines and recommendations". State sponsored training will be planned and implemented to track CDC guidelines and recommendations Ð or alternatively, local departments may develop their own CDC based training as approved by the Branch.

Discussion: A concern was raised about "attachments" to contract addenda specifying standards for training in HIV/STD contracts as compared to other contracts. Dr. Wolfe clarified that the carious alternatives to staff training could be specified in the Addenda without an "attachment" to retain the "purity" of the document. In a voice vote some dissenting votes were cast the chair then determined the "aye vote" carried. MOTION PASSED.

4. MOTION from committee (as amended from the floor): Approve model. "All staff providing HIV and Syphilis partner notification shall successfully complete training as approved by the Branch. MOTION PASSED.
5. MOTION from Committee: Approve language revision in Contract Addenda for HIV/STD to revise the standard goal for directly observed therapy (DOT) for Tuberculosis patients from 65% to 80%.

Hospital Association Network Ð No Action Items.

Managed Care & Reimbursement Ð No Action Items.

State & Local Relations Ð No Action Items.

Technology Ð Marc Kolman brought a MOTION from committee seeking NCALHD Resolution in support of paperless person-centered health record by the year 2010. (See attachment). MOTION PASSED.

Alliance for Public Health Agencies (NCAPHA) Ð No Action Items.

Dental Ð No Action Items.

Chronic Disease Ð No Action Items.

County Commissioners Association Network Ð No Action Items.

Education & Awards Ð Jenny Lassiter reported that the Spring Health DirectorÕs Conference has tentatively been set for April 4, 5, & 6 Ð a 2-day conference with the Association meeting following. The meeting will be "somewhere in the Triad". More information will follow.

Epidemiology Committee Ð George Bond reported: (a) That 11% of patients presenting to influenza surveillance sites have flu symptoms compared to 6% at the same time in the surveillance "season" last year. Dr. McCormickÕs flu surveillance email will now be sent weekly on Monday afternoons. (b) Steve Martin will be retiring in February. SteveÕs last official act will be to start a 20 county pilot of "Minnesota Plan" for vaccine supply distribution which is seen to be a significant improvement. (c) Control measure violations continue to be discussed by Epi Committee. What seems to be needed are control measures, and a one-day summit on control measures is being planned. Several Health Directors volunteered to plan the summit with the Epi Committee for a Spring meeting.

Managed Care & Reimbursement Ð No Information Items.

State & Local Relations Ð No Information Items.

Technology Ð No Information Items.

WomenÕs & ChildrenÕs Health Ð Wanda Sandele cautioned that DMA Auditing is underway in local departments and 2 specific suggestions were given: (1) to make sure all billable services are provided by "qualified providers" (i.e. Health Check screeners, Family Planning and Maternity Enhanced Role Nurses, etc.); (2) make sure you are doing the full range of service for all billable encounters.

Wanda discussed DMAÕs implementation of acceptable vs. unacceptable "cost shifting". It is not unexpected or inappropriate to generate revenues over expenditures in certain cost centers (especially in low salary counties). However, she cautioned against any manipulation of time reporting/equivalencies between programs. Dr. Ann Wolfe and Tom Bridges cautioned against Health Directors protesting to DMA on cost based reimbursement methodologies (e.g. recent Child Service Coordination changes) in such a manner as to give the impression local departments are inappropriately funding other services (cost shifting) with Medicaid receipts. Dennis Harrington emphasized that Medicaid cost settlements are a "snapshot in time" with many costs considered a "balloon of revenues" for that specific period of time. Dr. Joy Reed reported that DMA auditors have contacted the NC Board of Nursing about "Category II" approval for enhanced role nursing in Medicaid billable services in Health Departments.

Environmental Health Committee Ð Mimi Cooper advised of a recent letter from the Soil ScientistÕs Association has asked legislators to consider granting them authority to design onsite/ground absorption sewage systems. The tone of the letter was disturbing in that it implied the current system (e.g. local Environmental Health Specialists) is seriously flawed and in need of private soil scientist "rescue". Linda Sewall has been asked by Legislators to respond to this letter.

Policy & Planning Committee Ð Tim Green thanked the Year 2000 Committee Members, and invited and encouraged all Health Directors to attend these meetings from time to time. He also reported:

1. A challenge is expected in the legislative short session to maintain the tobacco settlement percentage for health.
2. Public Health Study Commission has been inactive.
3. Environmental reorganization issue will be a key concern during the short session where an "end run" attempt may occur. Vigilance is needed.
4. "Minors Consent to Health Care"/Parental Consent Issue is commended to Health Directors for a "quiet" but proactive discussion, at the discretion of Health Directors, Boards of Health, and Boards of Commissioners. Tim called on Dr. Kevin Ryan to report on what his office is hearing about counties considering petitions and resolutions to repeal the current statute.

Dr. Ryan stated that he periodically receives calls from local officials on this matter and agreed that vigilance sensitive to local sentiment is very important.

Tim stated that Margaret Woodcock and Debra Rowe can provide background "talking points" position papers on this issue.

5. Tim reported that Debra Rowe is very interested in working with the Policy & Planning Committee to reinstitute a "legislative day" as was done in past years to bring a unified Public Health voice to the front when the legislature is in session. The committee is very interested in resuming this practice but needs to be assured of Health Director interest and commitment to attend. Supportive comments to this idea were generally expressed by the group.

Local Providers Workgroup Ð Chairman Wayne Raynor announced that the committee will meet in Raleigh on January 26, 2000 at the Dix Campus. Agenda items include SB 10; Mental Health reorganization; high-risk intervention; and short session issues.

Tom Bridges, on behalf of the Association of Boards of Health, attended an invitation to the reception and annual meeting in Raleigh following the State Health DirectorÕs meeting.

Dr. Joy Reed gave a brief update on publication of federal rules on HPPA Ð National Standardization of Codes Ð Medicaid. She also gave an update on the important "crosswalk" process in converting to CPT codes.

Joy also announced recent staff additions: Mitzi Parris has been hired as an Eastern Regional Administrative Consultant and Eunice Inman as Nurse Consultant for the Southeastern Region.

Dennis Harrington responded to questions as to when "Medicaid Maximization" funding will be received by local departments. He said in a matter of days the letters will go out to counties.

The passing of Hugh Young, MPH, was noted with regret. Dr. Leah Devlin reported that the State Diabetes Advisory Council, chaired by Hugh Young, will make their nursing scholarships for diabetic education in his name.

There followed a discussion on Health DirectorÕs Listserv for email. Tom advised all those expressing problems to contact him if problems persist after attempts are made through Danny Hite, our Listserv manager. DannyÕs email address is danny.hite@ncmail.net.

Barry Bass thanked all who worked so diligently in the selection process of our new Executive Director.

George Bond reported that he and Bill Smith, NACHO representatives, have informed NACHO of the serious nationwide implications of HPPA. NACHOÕs first "heads up" on this critical issue came from concerns through Joy Reed to NCALHD.

Jim Baluss asked that anyone wanting hard copies of minutes instead of accessing by email should request it as soon as possible.

There being no further business, the meeting adjourned at approximately 4:15 p.m.

Respectfully Submitted by,

Jim Baluss

Secretary/Treasurer