CALL TO ORDER Ð President Tom Bridges called the meeting to order at 9:00 a.m. Barry Bass extended fellowship, and introduced new Health Director from Wilkes County, Beth Lovette. (See Attachments)

APPROVAL OF MINUTES Ð The minutes from the January 19^th meeting of the Executive Committee were approved as submitted.

TREASURERÕS REPORT Ð Jim Baluss presented the TreasurerÕs report through the period February 18, 2000. Account balances were as follows:

Checking-$ 26,279.51 Savings-$ 33.65 Money Market-$ 318.94 CD-$ 40,000.00

• President Bridges announced that Sen. Perdue, formerly scheduled to address the Health Directors today, was unable to attend. Tom then recognized Tamara Hower Williams, MPH, who announced her resignation as Beaufort County Health Director to accept a position at University Health Systems/Pitt Memorial Hospital in Greenville, NC. She expressed her admiration and respect for her Health Director colleagues and vowed to "stay in touch".

• Tom reminded committee chairs to use "minutes template".

• There will be a very important "kick-off" luncheon at the Health DirectorÕs Spring Workshop sponsored by NCPHA on April 4, 2000 at the RTP Sheraton. Deborah Rowe distributed fliers for this "Celebration of Volunteerism in Public Health". (See Attachments)

• The Eastern District NCPHA will be in Atlantic Beach at the Sheraton. NCALHD May meeting will be held there concurrently with NCPHA.

• Tom reported on Secretary BrutonÕs response to the recent position NCALHD has taken expressing concern about DHHS reorganization placing DECÕs in a new Division of Education in DHHS outside the Division of Public Health.

• Dr. Louis Latour was recognized for the purpose of bringing a motion for NCALHD to match up to $500.00 in member contributions in memory of Mr. Hugh G. Young, MPH, to the Hospice Foundation of Edgecombe, Inc. MOTION APPROVED. Checks should be mailed to NCALHD Treasurer, Jim Baluss.

• Danny Staley was then recognized for the purpose of encouraging Health Directors to avail themselves and local management team members to participate in the very fine services of the Management Academy for Public Health at UNCÕs Public Health Institute. Danny stated that applications are currently being accepted. Pre-application is required in the new cycle, even for those local health departments that applied in previous cycles. (See Attachments)

• Tom then recognized special guest, Mr. Lee K. Allen. Mr. Allen is a Craven County Commissioner, a Board Member of the NC Association of Local Boards of Health, and a leader in the NC Association of County Commissioners (NCACC). Mr. Allen has been an ardent supporter of Public Health in a number of capacities. He spoke today on behalf of the Board of Health Association. He emphasized the importance of continued close collaborative and cooperative relationship between NCALHD and NCALBH. Further, he emphasized the need to further strengthen and unify the voice of public health advocacy in NC. He extended an invitation to Health Directors to host regional Board of Health Association meetings, and solicited and encouraged participation in the State Association by all local Board of Health members. Tom thanked Mr. Allen for his tireless and courageous stands for Public Health, and invited him back anytime to NCALHD meetings. Tom also encouraged Health Directors to invite Board of Health members to NCALHD meetings as a way of furthering this critical relationship.

Jill requested help from local Health Directors on a project on which she is currently working. A Program Review Process is underway at the Institute. She solicited input and ideas from Health Directors as to needs of the Institutes "public health clients". Jill emphasized that local government based public health is the primary client for the health care area of the Institute of Government. Current Public Health law issues she is working on are: (1) HIPPA; (2) Minors Consent for Health Care and related confidentiality and medical records issues; and "ad hoc" legal questions (i.e. jail health, contracting, serving immigrants, etc.). She stated she bases her topical issues in legal training for Public Health clients on questions from local Public Health professionals. She encouraged Health Directors to call her with legal questions.

Dr. Andrew McBride greeted the Health Directors. He reported on the following current issues and concerns:

1. He announced a conference on "Health & Ecology" on June 28 & 29, 2000, dealing with the "science of health and the environment". Dr. William Friday is on the steering committee for this important conference.
2. In early April, Dr. McBride will be going to the Netherlands to look at Intensive Livestock Operations and their innovations in waste management. In response to a concern raised by Bill Smith, Dr. McBride agreed that all ILOÕs (poultry, etc.) need to be more highly regulated, not just swine. Dr. McBride agreed.
3. Dr. McBride then expressed his belief that the practice and advocacy for Public Health can, and should, be vastly increased by increasing the diversity of its leadership and management to include more minorities. He stated the lack of minorities in Public Health leadership at the local level is a "weakness in our system" needing attention. Considering the well recognized need for initiatives to address "health disparities" among minorities, Dr. McBride emphasized not only the moral and ethical imperatives, but a practical imperative to be more inclusive and diverse in making public management "look more like its constituents" at the local level. He suggested mentoring and internships as examples of strategies to bring more minorities into our ranks.

In a related matter, Dr. McBride "pre-announced" a conference on "health disparities" in the Fall of 2000. It will be a convocation of stakeholders to take a comprehensive look at health disparities, environmental justice issues, and minority representation in the Public Health workplace.

4. Dr. McBride stressed the need to continue efforts to strengthen Public Health infrastructure to provide "core functions". In light of no expected movement in the legislative Public Health Study Commission, he said a strategy change is necessary. New Public Health advocates need to be identified and cultivated in the future administrations and legislature.
5. No new or expanded funding is anticipated in the upcoming short session of the General Assembly. The chief strategy will be to "hold on" to current resources and guard the tobacco settlement for healthÕs share (25%).
6. He reminded Health Directors of the "State wide Middle School Asthma Survey Initiative" in all 100 counties, and encouraged local support and collaboration with schools or this process Ð which should lead to new and powerful data for advocacy for enhanced asthma initiatives and school health.
7. Dr. McBride then responded to questions and comments as follows:

1. Tim Green asked if funding initiatives would follow asthma survey initiatives. Dr. McBride said "yes".
2. The issue of increasing minority representation in local Public Health management brought several questions about specific ideas and the need to gather data.
3. Tommy Jarrell expressed his appreciation to Dr. McBride for coming to Richmond County to meet with local officials and citizens around concerns with the building from the tragic chicken processing plant fire several years ago.

NCALHD Executive Director Susan Smith-Wharton, ED, reported that she has spent her first several weeks getting oriented and organized. She sees her two main areas of focus at this time as local support, internal in-servicing and legislative liaison.

Nominating & Bylaws Ð No Action Items.

Policy & Planning Ð Tim Green presented 3 motions from committee.

The first was that NCALHD, along with NCAC representatives, meet with co-chairs of the ERC (Env-Rules Commission) to stress to them that the Environmental Health reorganization issue remains vital to our interests and concerns; and, to formally request the reorganization issue be brought before their commission during the 2001 session. MOTION APPROVED.

A second motion was presented that based on recommendation of the Policy and Planning Committee, NCALHD dues and contributions be and hereby are approved for this year, as shown in ATTACHMENT entitled "NCALHD 2000 Contributions/Dues". MOTION APPROVED.

Thirdly, Tim motioned that in lieu of a statewide legislative conference (and scheduled meetings with legislators in Raleigh during the busy General Assembly schedules), regional meetings in NCALHD districts be held in April 2000. These regional meetings will afford more time to be scheduled with legislators "back home" prior to their coming to Raleigh for the Session. Regional Reps will be given legislative briefings and consensus "talking points" on NCALHD/NCPHA/NCALBH legislative goals for use at the regional meetings. MOTION APPROVED.

WomenÕs & ChildrenÕs Health Ð Wanda Sandele brought a motion from committee that NCALHD adopt a Resolution calling on local school Boards to ensure "smoke free campuses". MOTION/RESOLUTION APPROVED. (See Attachments)

Education & Awards Ð No Action Items.

Environmental Health Ð Mimi Cooper brought forth a motion that NCALHD support the recommendation from the ChildrenÕs Environmental Health Branch establishing priority in funding "mini grants". Those prioritized are: (1) purchase of XRF analyzers to increase local capacity for environmental investigations; and (2) WIC/Lead screening efforts. MOTION APPROVED.

Epidemiology Ð No Action Items.

Hospital Association Network Ð No Action Items.

Managed Care & Reimbursement Ð Bill Smith brought forth a motion that NCALHD meet with as many statewide candidates as possible, and that consistent, standard messages be delivered to each candidate, and they be related to important Public Health (service) delivery systems, as opposed to administrative issues. MOTION APPROVED.

State & Local Relations Ð No Action Items.

Technology Ð No Action Items.

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 on the Spring Workshop. (1) She stated there will be a "kick-off" luncheon (included in registration) on April 4, 2000, in conjunction with NCPHA to honor and celebrate volunteerism in Public Health. (2) HIPPA Legislative issues and technology are topical areas which will be featured at the conference. (3) The Epi Committee will sponsor a full day or 3Ú4 day "Control Measures" workshop at the conference.

Epidemiology Ð Ray Rabe reported for the Epi Committee. The Committee met twice in February. Flu is waning across the sentinel sites in NC. Vaccination for Hepatitis A among food service workers was discussed by the committee. Also discussed was the need for enhanced communication among local Health Directors in time of communicable disease outbreaks; the backlog in turnaround time of PAP results by the State Lab; John Morrow has been appointed to be liaison to the AIDS Care Unit State TB is doing a study of conversion time of TB patients relative to treatment patterns. Local Health Directors will receive requests for data. Please respond to this request; and the statewide meeting to discuss "control measures" is being planned for the Spring Conference.

Managed Care & Reimbursement Ð Chair Bill Smith gave a HIPPA update and stated this issue is being followed nationally by NACHO. Joy Reed has worked up a "matrix" on mid-level practitioner practice issues. Accreditation and standards have been discussed in committee. Bill reported that the DMA auditor currently looking at Local Health Director has been invited to the March Committee meeting to discuss "findings". The potential for provision of Hepatitis B immunizations for school personnel has been discussed by the committee. Potential for negotiation of statewide or local contracts between DPI and Public Health needs to be explored. (See Attachments)

State & Local Relations Ð Chair Wayne Raynor reported the next meeting will be held March 1, 2000, at the Dix Campus in Raleigh.

Technology Ð Doug Harr expressed his appreciation for the Committee Chair assignment this year. He reported that the HSMS project is moving forward. He announced an important meeting of NCHICA at the Grove Park Inn in Asheville on September 10-12, 2000. (See Attachments)

WomenÕs & ChildrenÕs Health Ð Chair Wanda Sandele reported the following information items:

1. "Voluntary" surveys have been mailed out from WCH branch.
2. A "mandatory" survey is coming out from the comptrollers office on WIC, which will facilitate electronic benefits payments and voter registration.
3. Hepatitis B funding for dose 3 will be available at $1.00 per dose in the "6^th grade" initiative.
4. WIC reimbursement has been clarified in regards to reduced workload. Wanda emphasized that WIC reimbursement is directly to caseload, but that if workload cannot be restored to 97% by June, reductions in Federal fiscal year funding (October) will be seen.
5. A committee is being established to define critical pathways for Care Coordinators to assure accountability and productivity in DMA funded CSC, MCC, and MOW encounters.
6. Wanda then called on Jenny Lassiter who reported on the "Accountability Groupings Committee". These groupings are a "cluster" of redefinitions of accountability measures comparing counties to the state or region. This is an important management tool intended to shape and improve service delivery and priority, and to enable certain counties to share best practices. Counties will not be "ranked" per se, but the data should be useful to address specific needs.

Environmental Health Ð Mimi Cooper reported that an RFP has been sent out to Health Departments announcing DEHNR funding within the state flood relief package for private well sampling. (See Attachments)

Policy & Planning Ð Chair Tim Green reported the following matters:

1. Following up last months NCALHD action item, Maggie Dollar and Tim have been in contact with NCACC to express concerns about the "consent to medical treatment by minors" issue. So far, about 5 County Boards of Commissioners have adopted resolutions seeking repeal of the current laws. NCALHD supports the current statutes on consent by minors to preventive health care in North Carolina.
2. Chris Hoke and Glen Wells (Public Health legislative liaisons in DHHS) came to the last Policy and Planning Committee to report on the upcoming legislative session. In short, no new funding initiatives for Public Health are anticipated. A $2 million expansion in Smart Start may provide some indirect Public Health funding opportunities on local level. Additionally, the State revenue picture is made even more bleak due to the snowstormÕs effect on sales taxes.
3. The primary legislative agenda will be to (1) guard "HealthÕs" 25% share of the Tobacco settlement and "hold the line" against cuts in existing programs.
4. Barry Bass emphasized the value that NCALHDÕs new Executive Director will have on monitoring legislative matters.
5. Tom Bridges exhorted the NCALHD Regional Reps to participate in the legislative workshops on the Spring.

Alliance Chair Dr. Chris Szwagiel reported that Executive Director Susan Smith Wharton has been learning about the history, mission, and organization of the Alliance. He reported on the significant potential in contracting with State agencies for physical exams, and encouraged membership in the Alliance for all Health Departments across the State. Chris advised of the setting of dates for Alliance Board meetings at the Cary offices for the upcoming year, and urged attendance, especially among the Alliance Board.

Joy Reed handed out the completed "crosswalk document" which should be utilized in the conversion to CPT coding for Health Departments. She also handed out a comparison

Table comparing FNPÕs, nurse midwives, etc., in terms of allowable practices under the Nurse Practice Act. (See Attachments)

Joy reminded Health Directors of the opportunity for State training for enhanced role nurses. She stated enrollments are down.

Upcoming nursing training opportunities were announced as follows:

1. CPT/ICD-9 Training (last call prior to implementation)
2. EDS/HSIS in June
3. EDS dental code training in May
4. Web based CPT/ICD-9 training is under development.

Dennis Harrington reported on the following:

1. SFY 2000-2001 budgeting guidance packages are "in the mail" to counties. Consolidated contracts are coming out shortly thereafter under separate cover.
2. DennisÕ office will be focusing a lot of attention on keeping current the email addressing/list service addressing in close connection with Danny Hite and Russell Jones and all users of this critically important system.
3. Dennis commended Joy "Pandora" Reed for her outstanding leadership in the various projects associated with the "crosswalk" from bundled coding to CPT codes, etc.

Tom Bridges reported for Nutrition Directors. (See Attachments)

1. Deborah encouraged attendance at NCPHAÕs "Public Health Luncheon & Celebration".
2. NCPHA web page is under development. Hope to be finished in March. Can be used for networking, information sharing, etc.
3. Urged all present to join NCPHA! (See Attachments)

There being no further business coming before NCALHD Executive Committee, the meeting was adjourned at 12:00 noon.

Respectfully Submitted by,