CALL TO ORDER Ð President Tom Bridges called the meeting to order at 2:00 p.m. Tim Green extended fellowship to the group. No new Health Directors were attending. New Health Directors were announced as follows: Kathleen Jones-Montgomery County, and Janet Linblaum-Cumberland County.

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

TREASURERÕS REPORT Ð Jim Baluss presented the TreasurerÕs report through May 1, 2000. Account balances were as follows:

Checking-$45,619.41 Savings-$33.88 Money Market-$322.83 CD-$40,000.00

• In response to a question, Tom provided explanation and thanked Bruce Parsons for reimbursed travel to represent NCALHD at an important Dental Health meeting.
• President Bridges welcomed everyone to this meeting and commended Cherokee Health Director Elaine Russell for "farthest traveled" to this meeting in association with EDNCPHA.
• Tom reminded those present of the process and deadlines for the Glaxo Awards.
• The Ecology and Health Conference is June 28-29, in Raleigh, NC, at the Sheraton. Registration forms have been mailed to Health Directors. Dennis Harrington encouraged all to attend this meeting which features "world class" speakers and experts.
• CDC Telecast/Survey of local Health Departments preparedness for bioterrorism attacks. Email from CDC has been sent out.
• J.T. Garrett, Carteret County Health Director, extended his welcome to Carteret County, and he suggested those Health Directors who could attend, to meet for lunch and networking the following day at the Sanitary Fish Market on the waterfront in Morehead City, NC.
• Tom reminded Health Directors to assure the immunization status of clinical staff in view of recent rubella outbreaks in his and other counties in NC. Tom stated there is a meeting in Raleigh on May 3, 2000, for counties in which rubella has been confirmed recently. In response to a discussion, Tom said MMR should be administered to appropriate staff not current.

Dr. Andrew McBride was not present , but will be in attendance throughout the remainder of EDNCPHA conference.

Susan Smith-Wharton updated directors on the status of the DOT contract. She said reimbursements for "physicals" in participating Departments will be about $55.00. The 4 pilot counties will start up this summer. These are "Enhanced Role RN-Level" adult physical assessments. Susan also reported on recent discussions Ð now on going with BCBSNC, which is interested in patching up "holes" in their statewide panel of provider networks. They need primary care providers. More meetings are planned and Susan needs to hear from counties which are interested in inclusion in an alliance negotiated panel of providers. Discussion then followed about 2417 physician coverage. This is required for BCBSNC Primary/Preventive Care but not necessary for the DOT contract.

NCQA and HIPPA will eventually reduce or eliminate the ability to "bill" any payors (Medicaid included) without CPT codes and "conditions of participation" which are primary care and preventive medicine driven, thus requiring local Health Departments to have Board Certified Physicians in order to follow the funding and the Alliance is the vehicle "to get us there".

Susan reported that a survey is being sent to Home Health Agencies membership to opt for reduced rate subscriptions to Eli and other subscriptions.

Nominating & Bylaws Ð No Action Items.

Policy & Planning Ð Chair Tim Green brought several action items based on motion from the Policy and Planning Committee.

1. The Committee recommends NCALHD Resolution (See Attachments) on regulation of CAFOs. MOTION/RESOLUTION PASSED (with revisions) as shown in attachment.
2. Tim discussed a bill before the legislature that requires local Health Departments to administer flu and pneumonia vaccinations to certain residents of residential care facilities (rest homes or adult care homes). The Community Health Committee is also concerned about the provisions of this bill as well. Bill number, title, and sponsors was not available, but will be mailed to Health DirectorÕs. This proposed legislation does not speak to any funding issues, but the committees feel it needs to allow for "local option" by Health Departments providing these adult immunizations. MOTION: That NCALHD work with the sponsors of this legislation to insure adequate funding and "local option" within new legislation specifying Health Departments provide adult immunizations to residents and staff of adult care homes. MOTION PASSED.
3. Tim called on Bruce Parsons who has been in communication with researchers at UNC concerning grant appointments to fund research on model practices of collaboration between the criminal justice system and local Health Departments in the implementation of control measures for communicable diseases. Bruce emphasized the core responsibility of protecting "uninfected persons" in control measures. MOTION: NCALHD support and endorse grant application for funding by UNC-SPH for research on this legislation issue. MOTION PASSED.

WomenÕs & ChildrenÕs Health Ð Chair Wanda Sandele brought two action items from committee: (See Attached Committee Minutes)

1. MOTION to support DMA in their waiver request to extend Medicaid eligibility to women in family planning at 185% of poverty level as it is for pregnant women. NC DMA seeks to extend this benefit, as is done in some other states. MOTION PASSED.
2. WCH Division and Committee recommended sending a letter to school superintendents encouraging and supporting the "Youth Risk Behavior Survey" process. There was discussion and a suggestion to also send letter to School Board Chairman. The survey actually comes out of Department of Instruction, but the surveys are critical to programming in Public Health. MOTION PASSED.

Education & Awards Ð No Action Items.

Environmental Health Ð (See Attached Committee Minutes) Chair Mimi Cooper brought a motion from committee to support the Division of Environmental HealthÕs proposal to send out only one copy of all Rules to counties. This comes as a reluctant, but necessary, response by the Division to deep budget cuts. The Environmental Health Committee agreed that despite obvious inconveniences and shifting of copying costs to counties, it is necessary in light of deep budget cuts at the State level. However, the Environmental Health SupervisorÕs Association opposed this system. This caused the NCALHD Environmental Health to readdress the issue, and upon much deliberation a compromise of sorts was reached. MOTION: Because of the advantages of economics of scale and ability to insure current information, it is moved that the DEH continue to print copies of program rules and provide the local Health Departments, changed at state printing cost, to be reconciled at the end of the year from the $6,000 environmental aid to county funding.

Discussion: Jenny Lassiter, Pamlico County, stated her Board of Health was very much opposed to the new "single copy" distribution. They view this as a blatant shift of costs and an unfunded mandate for counties to assume the burden of getting rules out to all regulated citizens, business, etc. Committee member Don Yousey agreed it is not an ideal system, but necessary due to budget cuts at the state level. Dr. Chris Szwagiel noted that from his participation on the Technology Committee and attendance at the "Hap Council", the movement towards "paperless systems" is very extensive across all of state government, and it will effect local distribution of electronic submittals to local agencies. After further discussion, the MOTION PASSED.

Epidemiology Ð (See Attached Committee Minutes).

Hospital Association Liaison Ð No Action Items.

Managed Care & Reimbursement Ð No Action Items.

State & Local Relations Ð No Action Items.

Technology Ð No Action Items.

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

County Commissioners Association Network Ð No Action Items.

Education & Awards Ð Chair Jenny Lassiter directed attention to recent email regarding NACHO scholarships. She encouraged nominations for "Health Director of the Year" Award.

State & Local Relations Ð Chair Wayne Raynor reported the previously scheduled "Local Providers Workshop" meeting with Dr. Bruton set for May 3, 2000 has been cancelled, and is not yet rescheduled.

Technology Ð Chris Szwagiel reported for committee.

1. The CDC telecast on bioterrorism capabilities is a very important meeting to provide CDC with information on North CarolinaÕs readiness. This will inform the funding process.
2. Chris reported on recent activities of the HAP Council, particularly planning towards on-line governmental forms, rules, codes, etc.

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

1. Accountability data, by County, will be sent out by the end of May.
2. The "Care Coordinator Work Group" has been at work developing critical paths for CSC. This will go to DMA.
3. The Committee discussed the need for guidance to be sent out to local Health Departments on transferring funds from maternity services to other WCH programs within the WCH block grant. The large number of "ineligibles" is wreaking havoc on local budgets. A work group is being developed. Dennis Harrington said this is being "interpreted" at the state level.

Community Health Ð The Committee met by conference call on April 27, 2000. The following items were discussed.

1. Fluoride varnish for all Health Departments across the state will be available in October.
2. Flu and pneumonia vaccinations for residents of adult day homes and resthomes to be administered by local Health Departments is in proposed legislation. (See action item, Policy & Planning Committee).
3. Elaine reported that a "Heart Healthy Survey" was done in about 15 counties, administered by Environmental Health and volunteers. Greater participation and more counties will be surveyed in the future.
4. BCCCP participation is down across the state.

Policy & Planning Ð Chair Tim Green reported the following information items from the committee:

1. He recognized Dr. Steve Cline who shared proposed legislative goals of the Epidemiology and Communicable Disease Section. (See Attachment).
2. Tim alerted Health Directors to a plan by a consortium of major minorities to "carve out" some of the tobacco settlement money designated for health initiatives.
3. Tim urged Health Directors attention to study and communicate the NCALHD legislative goals package. Short session begins on May 8^th. JT Garrett stated he has taken these goals to the Minority Health Council. He sought clarification we are supporting protection of funds which are already protected via SB6. Tim stated the legislative goal to "protect" these funds reflects the "unease" by the Health Access Coalition (which NCALHD is a part) that these funds are not "safe" in the current fiscal shortfall facing the State. Deborah Rowe, ED, NCPHA, reinforced the need. President Bridges thanked JT Garrett for representing NCALHD on the Minority Health Council.

1. Steve Cline reported a new branch head, Dr. Bill Tynan has been hired.
2. Steve also reported that funding for Pfisteria surveillance has been extended for three years.
3. A recent site visit was conducted in NC by CDC officials on the "syphilis elimination project".

1. Dr. Chris Szwagiel again urged Departments to join the Alliance. Particularly the benefits of contracts (e.g., DOT), bulk rates, discounts, and staffing agency are very tangible benefits of membership in the Alliance. President Bridges also encouraged membership in the Alliance.

No report as Joy Reed is currently out on leave due to a serious back problem. [Joy as you read these minutes, please know we are all thinking of you and wishing you a speedy recovery.]

Deborah reminded Health Directors of the Glaxo Award process and deadlines. NCPHA award nominations are also due.

Dennis extended greetings on behalf of Dr. Wolfe who was unable to attend today. Dennis called attention to the completed report from the recent survey document on "community based capital needs and financing" done by "NC Self-Help". This documents enormous needs in facilities and may be very helpful in "making the case" locally.

Dennis reported that recently a conference on "Tele-Health" at UNC was sponsored by Sen. Edwards. Public Health was regrettably absent from this conference.

Dennis briefed the group on background and purpose of a recent email from the controllers office designed to test email response and capability for further electronic funds transfer.

If Directors did not receive the test email, they should contact DHHS ControllerÕs Office and request to be on the email or fax notification listing. Call 919-715-0863 and ask for Lem Harris and request to be on the electronic funds transfer list.

Dennis called attention to a correction letter coming out following Q & A document on CPT coding, relating to changes in DMA policy on giving 12 months supply of contraceptives to Family Planning patients. This is an ongoing, not yet resolved issue.

Dennis called attention to the recently marked RFAÕs for competitive funding for Title X Family Planning funding.

Lastly, Dennis reported that the new project manager for the RFP vendor applications is Norman Kirkman. Dennis commended Marc Kolman for his laborious efforts on behalf of NCALHD on this project.

Carmine reported that dues invoices are being mailed out to local health departments and Board Chairs. He also stated his Association is working closely with NALBOH in hosting their annual conference being held in Raleigh this year. It will be held July 26-29. Many timely informative workshops and speakers are scheduled.

There being no further business coming before the NCALHD Executive Committee, the meeting was adjourned at 4:00 p.m.

The next meeting will be held in Cary on June 27, 2000, at 1:00 p.m. at NCHA.

Respectfully Submitted by,

Jim Baluss, Secretary/Treasurer