CALL TO ORDER Ð President Elect Tim Greene called the meeting to order at 9:05 a.m. filling in for President Tom Bridges who was out of state due to family illness.

APPROVAL OF MINUTES Ð The minutes from the February 2000 meeting of the Executive Committee were approved as submitted.

TREASURERÕS REPORT Ð Jim Baluss presented the TreasurerÕs report through March 17, 2000. Account balances were as follows:

Checking-$ 40,785.12 Savings-$ 33.72 Money Market-$ 320.18 CD-$ 40,000.00

• It was announced that Emma Waldroup will be leaving Swain County Health Department to assume a position as a regional Family Planning Consultant.

Dr. Andrew McBride was out of the country. Various State staff gave reports. They were as follows:

1. Dr. Rick Mumford asked for "volunteer" Health Departments with dental clinics to participate in a data collection/survey project. For a one month period, Dr. Mumford is seeking county data for a "rate setting" study to aid DMA in the conversion to ADA coding reimbursement.
2. Dennis Harrington reported that Dr. Ann Wolfe has written a letter to Dick Peruzi, DMA Director, requesting postponement until October 1, 2000, of the conversion to ADA coding. Dennis then called attention to certain changes in the consolidated contract/MOU. These changes were detailed in the cover letter to counties recently. He urged Health Directors to carefully review these and call him with any questions.

Dennis also urged Health Directors to carefully review all information provided on the NCALHD home page, directory listing of DirectorÕs email addresses, phone numbers, beepers, faxes, home telephone numbers, etc.

Dennis announced that Medicaid CPT codes for "preventive medicine" are not in the "cross-walk documents" previously provided.

Dennis stated he has met with DMA about rate setting for the new unbundled CPT coded services. We continue to receive assurances this conversion will, through cost studies and settlements, be "revenue neutral". Dennis called for volunteer Health Departments willing to undergo a survey using a "super billing" data entry form for 2 weeks showing both bundled and CPT-corrected units of service, to enable DMA to set cost-based rates of reimbursement. Interested? Call Dennis Harrington.

3. Question to Joy Reed: "Can/Will child health well child screening be unbundled?"

Answer: "NO"

A discussion followed about Denver Development Screening. These seem to be an inequity in standards for developmental screening public health providers to higher standards. "Unbundling" elements of the well child screening protocol might provide an opportunity Public Health Departments to contract with private providers doe doing Denver Screening. Joy said DHHS had advocated for unbundling well child screening, but to no avail with DMA.

4. Joy Reed then announced scheduled HSIS training by EDS, and ADA Dental Coding training by EDS. Dr. Mumford encouraged Health Directors to send Dental coding staff to both the EDS/ADA coding and CPT coding training. (See Attachments)
5. Tim Green stated that he had discussions with Dr. Sutton, DMA Dentist, who had reaffirmed the commitment that DMA will do whatever rate surveys are necessary to assure ADA conversion will be "revenue neutral".

Susan Smith-Wharton provided a handout on the "HealthTrust" (See Attachments). This has been developed by NCPHA. She also discussed the very promising contract being negotiated between NCDOT and the "Alliance" for the provision of a "rule out" type of health examination for bus drivers. It may be performed by an Enhanced Role RN or midlevel practitioner. Pricing has not been finalized, but a figure in the range of $50-$55 is likely.

This project is initially intended to be a pilot, involving Halifax, Caldwell, and Robeson County Health Departments. "New Hire" physicals for teachers are also planned by DPI. This could create quite a lot of "business" for local Health Departments and promote new family centered outreach. Wake County alone has over 600 new hires a year.

Susan reported that she has spent her first several weeks getting oriented and organized. She sees her 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 Chair Tim Green brought the following MOTION from committee: That NCALHD adopt the committeeÕs recommendation for legislative goals in the upcoming session.

1. To establish a HealthTrust using 25% of the tobacco settlement monies.
2. Legislative action on the issue of Environmental Health reorganization to align Environmental Health and Public Health.
3. Restoration of funding to programs cut from HHS/DHS due to Hurricane Floyd relief (Healthy Carolinians Minority Health Initiatives, Asthma Initiatives, etc.) MOTION PASSED.

WomenÕs & ChildrenÕs Health Ð No Action Items.

Education & Awards Ð No Action Items.

Environmental Health Ð No Action Items.

Epidemiology Ð No Action Items.

Hospital Association Liaison Ð No Action Items.

Managed Care & Reimbursement Ð Chair Bill Smith brought forth a MOTION from committee which met on March 8, 2000, and recommends that NCALHD institute a meeting between UNC SPH; DHHS, NCALHD and other stakeholders to initiate a plan to implement Dr. Paul HaversonÕs model of Public Health accreditation. MOTION PASSED. (See Attachments)

A discussion was then held about how to select pilot/model sites (County of District Health Departments). Any interested Health Directors should contact Dennis Harrington.

State & Local Relations Ð No Action Items.

Technology Ð No Action Items.

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

Chronic Disease/Dental Ð Chair Elaine Russell brought a MOTION from the committee which met on March 1, 2000, as follows: That NCALHD support DHHS Dental Public Health and DMA initiative to promote a statewide "Smart Smiles" project. Barry Bass spoke in favor of the motion. Discussion about timeline for compliance and selection process required to take the program statewide. MOTION PASSED.

County Commissioners Association Network Ð No Action Items.

Education & Awards Ð Chair Jenny Lassiter reported on plans being finalized for Spring Health DirectorÕs Workshop at the Holiday Inn in Cary. She urged to register ASAP Ð particularly for "kick off" "Volunteer Celebration Luncheon" in collaboration with NCPHA.

Chronic Disease/Dental Ð Chair Elaine Russell provided handouts from committee as follows: (See Attachments)

1. BCCCP County Performance Stats
2. A letter from Governor Hunt promoting "Tobacco Free School Zones"

Epidemiology Ð Ray Rabe reported from committee as follows: (See Attachments)

1. The Epi Committee has met extensively in the last month. A subcommittee has been hard at work to plan the very important April 5^th workshop at the Spring Health DirectorÕs Conference on "control measures".
2. The Committee has asked DHS for more time to review and comment on proposed Hep A recommendations.
3. Dr. Newt McCormick reports that for all practical purposes "flu season" is over.
4. Dr. Turner, Department of Justice and CDC, are planning to implement a survey of Local Health DirectorÕs readiness to respond to incidents of bio-terrorism.
5. Dr. Steve Cline will soon send out a memorandum to Local Health Departments and private physicians providing prenatal care to encourage HIV counseling and testing for prenatal patients. Dr. Gabel suggested adding syphilis testing to the language in the memo. Dr. Cline said that was a good idea, but too late, for the memo on HIV has already been sent. It was noted by Dr. Kahn that the memo does mention "rules" about STD testing in addition to HIV.
6. Dr. Turner advised the Epi Committee that improvements continue in "turn around time" for pap tests.
7. Dr. Cline has sent out RFPÕs for "Ryan White" funding for expanded primary care for persons with HIV disease. These went out to community based organizations (CBOÕs) as well as local health departments.
8. DHS expansion budget issues were discussed in committee.
9. Steve Cline and Jenny Lassiter strongly encouraged attendance at the April 5^th "control measures" workshop.
10. Barbara Chavious encouraged registration, and indicated "day registration" for staff is allowed Ð but need to pre-register.

Managed Care & Reimbursement Ð Chair Bill Smith reported information items from the March 8^th committee meeting:

1. DMA Audit Ð Discussed the recent DMA test audit held in Robeson County and shared the summary sheets between members. Most of the exceptions noted were for wrong date of service given. Another issue noted was billing for CSC monthly although client only seen quarterly (with the explanation provided "Billed for monthly only seen quarterly, but following Health Department guidelines. Policy changed 1/1/2000"). There were also questions about documentation that care coordinators received mandatory training, the role of the expanded nurse and that several billable services were not billed for. In Robeson, all financial documents had been imaged for FY98 so retrieval was somewhat slower that DMA anticipated. There still remained much confusion about the reading of the chart. In discussions with DMA they feel that the monitoring required by the State should be used to capture errors in the charts. Additionally, they will not want to audit years that have been imaged so they will start with FY99. While most if not all of us have audit teams in place, few if any utilize this vehicle to compare billing information with the chart. This should be incorporated in the process. It was noted that we needed to build positive relations with Program Integrity for future discussions.
2. School Bus Driver Physicals Ð Discussed the school bus driver physicals that are being led by the Alliance. It would be effective July 1, 2001 (so the schools will have adequate budget time), but there may be test pilots prior to that. Joy has looked at the form which initially was too technical for the client to fill out, but is being revised. She will monitor with the appropriate people. As a reminder, it was Dr. Bapat who initiated the contract for public health to serve this population. The ED will make a formal report to NCALHD at its next meeting.

State & Local Relations Ð Chair Wayne Raynor reported the following information items from committee:

1. The State/Local Providers Group met with Dr. Bruton on March 1^st. Dr. Bruton forecasts a "painful" short session of the General Assembly. One of Dr. BrutonÕs goals is to revise CHIP/NC Health Choice eligibility to 300% (vs. current 200%) of federal poverty level guidelines.
2. Dr. Bruton advised of the GovernorÕs budget proposal to increase Smart Start by 80 million dollars.
3. Dr. Iverson Riddle, new Director of Mental Health, spoke at the meeting on his vision for reform and improvement of the mental health system.
4. Dr. Peter Leosis heads up the project in DHHS for the reorganization and creation of a new "Division of Early Instruction". As previously noted by NCALHD, DECÕs have "moved into" this new division from DHS, with some concern.
5. Wayne also stated his committee continues to have a great deal of interest in continuing to work with NC SOPHE to enhance retention and OSP classification difficulties facing the practice of Health Education statewide in local Public Health agencies.

Technology Ð Marc Kolman reported for Doug Harr who was described as being predisposed by reason of childbirth (!!?). The committee plans meetings on March 23, 24, 30 & 31 at Cary, NC, to hold demoÕs by those responding to the RFP. Additionally, a meeting will be held in Raleigh for a demo of the internet based immunization registry. (See Attachments)

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

1. At the last meeting, Mr. Jeffrey Sims, DMA Managed Care Manager, came and talked to the committee. Health Check Coordinator positions were discussed. These are not expected to be expanded by DMA beyond counties currently funded. The fact that Smart Start is funding a number of Health Check Coordinators was discussed with Jeffrey Sims. Dialogue will continue.
2. On April 11, 2000, Health DirectorÕs and local "worker bee" staff in MCC, CSC, and MOW will meet to develop recommended "content" standards for DMA funded care coordination.
3. In response to several questions from the membership, Wanda stressed that DMA seems receptive to Health Departments coming up with "content standards" to document encounters for billing.
4. Wanda stated an updated report on Health Choice enrollment will be coming out to Local Health DirectorÕs in April. Discussion followed around the matter of Health Choice outreach, by DSS (funded outreach) and Health Departments (essentially unfunded). Data is needed on where enrollment is originating, as well as where health care services are being provided for Health Choice enrollees.

Environmental Health Ð Chair Mimi Cooper reported the following from the committee meeting on March 16^th: (See Attachments)

1. Barry Engber met with the committee and reported on West Nile Virus Surveillance. The strategy is to: (1) get "out ahead" of any outbreak later in the season by public information about the mosquito borne virus; (2) to maintain a sentinel flock of chickens in central and western NC in addition to the current eastern sites; (3) to upgrade the NC lab to "biosafety level 3" to enable lab analysis for this virus; and (4) establishment of a "1-800" number to report dead birds (most likely crows) which is a sentinel event in surveillance for W. Nile Virus.

Policy & Planning Ð No Information Items.

1. Dr. Harold Gabel reported in his capacity as NCALHD Liaison to NC Medical SocietyÕs "Medical Access Committee". He stated that Jim Bernstein and Barbara Matula are working with physicians in a 14 county project. Physicians are expressing an interest in starting "volunteer clinics", similar to the Buncombe County model.
2. Bill Smith reported as a NACHO representative NC membership in NACHO is 86%. If a few more Health Directors joined, NC would be eligible for a rebate against next years dues. Bill will present a proposal to NCALHD in the future.

Dr. Joy Reed reported on the following matters:

1. She met with Office of State Personnel on March 16^th to changes recommended by NCALHD in PHN classifications. The Enhanced Role (PHNIII) issue will be classified by Mel Crocker. No changes are expected in the PHNII classifications.
2. Hep B for children in schools can be billed to Health Choice. If vaccine is "free" to Health Department, use modifier and bill "administration fee".
3. "Y coding" will be retained for "refugee health exams" in CPT conversion.
4. Final rules for HIPPA have been delayed until after June 2000.

Deborah reported on the excellent progress in planning the "kick off" luncheon, celebrating Volunteers in Public Health, in association with the Health DirectorÕs Spring Workshop. She stated:

1. Legislators are registering. Health Directors will be notified when "their" legislators register.
2. She asked Health Directors for the names of Health Department staff who have volunteered in any capacity (not just "Floyd") over the last two years. These will be sent to legislators.

3. Also, she needs "stories" showcasing volunteerism in Public Health.

There being no further business coming before NCALHD Executive Committee, the meeting was adjourned at 11:30 a.m.

Respectfully Submitted by,

Jim Baluss, Secretary/Treasurer