CALL TO ORDER Ð President Tom Bridges called the meeting to order at 1:00 p.m. Tommy Jarrell, Health Director, Richmond County, extended fellowship to the group. The new Health Directors present were Roxanne Frederick, Beaufort County; Dr. Janet Lindbloom, Cumberland County; and Kathleen DeVore-Jones, Montgomery County.

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

TREASURERÕS REPORT Ð Jim Baluss presented the TreasurerÕs report through June 26, 2000. Account balances were as follows:

Checking-$30,909.47 Savings-$34.04 Money Market-$325.54 CD-$40,000.00

Tom Bridges announced the following:

• TodayÕs meeting will be adjourned at 3:00 p.m. at which time an important special meeting will be held to make "last minute" announcements by Dennis Harrington and Joy Reed on CPT conversion.
• Tom thanked Curtis Holloman for representing NCALHD at the recent meeting of the Old North State Medical Society.
• Tom issued a reminder about the NACHO Conference in the 3^rd week of July. No scholarships were sought this year by NCALHD members (as of today).
• The NALBOH meeting in Raleigh in July was announced at the Sheraton Capital.
• Tom encouraged attendance at the Ecology and Health Conference beginning tomorrow, June 28, in Raleigh.
• Next month a very important called full association meeting of NCALHD will be held to receive the report and recommendation from the Technology Committee on the developing Health Information System. All Health Directors are urged to attend this decision-making and educational meeting of great importance.
• The August meeting of NCALHD has been changed to August 10^th at 2:00 p.m. at the Sheraton Imperial in Raleigh. This was done to coincide with the annual conference of the NC Association of County Commissioners.

Dr. Andrew McBride extended greetings to the group. He provided the following report/announcements:

• The retirement of Dr. Ann Wolfe was announced. Dr. McBride recognized her many contributions to NC Public Health over the years of her dedicated service.
• Priorities to be sought by DHS in the "expansion budget" are being deliberated within the management team. Although it will be "rushed", Dr. McBride wants local Health DirectorsÕ input on priorities by July 10^th. He then sketched out several of the priorities thus far:

1. A major initiative on "Health Disparities". Dr. McBride then announced the statewide conference on Health Disparities on December 12 & 13, 2000.
2. Information Technology & Systems Development for Public Health. Dr. McBride stated this will be a "tough sell" but that Public Health, after all, is really all about "information". Particularly, Bioterrorism initiatives; immunization registry, etc., are examples of Public Health imperatives that will require major "systems development".
3. A School Health initiative, to expand Public Health services in schools, not just school based clinics, but also an increase in the School RN to pupil ratio.
4. Dr. McBride also listed "next level" priorities as Environmental Health; Preventive Services, especially in the area of chronic diseases, with an emphasis on the "older adult" population.

Susan Smith-Wharton reported on the following matters:

• She reminded Health Directors that dues for the Alliance are now due.
• The NC Department of Corrections is very interested in having local Health Departments do physical exams for new hires along the same lines as those currently being piloted for the NC Department of Transportation. This represents another opportunity for Alliance members to expand revenue base.
• Susan directed attention to the recently developed spread sheet showing the status of local Health Departments which meet "conditions of participation" Blue Cross.
• A handout was provided which showed a synopsis of pending legislation in the General Assembly.
• Susan introduced representatives from Gulf South Medical Ð a medical supply company which is proposing very competitive pricing and service to local Health Departments in the Alliance. Paul Morgan and Evan Rush, Account Executives with Gulf South, provided information and handouts on their company and its products.

Nominating & Bylaws Ð No Action Items.

Policy & Planning Ð No Action Items.

WomenÕs & ChildrenÕs Health Ð Chair Wanda Sandele stated that considerable discussion in committee, and with representatives of DMA, has centered around expanding Health Check to counties currently having no DMA funded Health Check Coordinator positions. Since no "new money" is expected, the only real solution (and admittedly a controversial solution) is in redistribution of Health Check Coordinators from counties with more than one to counties which have none. DMA would like to create a "work group" to study the feasibility, advisability, and willingness of the "have counties" to consider distributing some of these allocated positions to "have not counties" Ð particularly when allocated positions are vacant. MOTION: That NCALHD concurs with the request of DMA to form a work group of Health Directors to assist them in looking over the allocation of Health Check Coordinators in order to develop a methodology for bringing this service to all counties. The work group is to have a maximum of two months to accomplish this task, during which existing vacancies will not be filled in counties with more than one position. After considerable discussion and several "nay" votes, the MOTION PASSED.

Education & Awards Ð No Action Items.

Environmental Health Ð No Action Items.

Epidemiology 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.

Community Health Ð No Action Items.

County Commissioners Association Network Ð No Action Items.

Nominating & Bylaws Ð No Information Items.

Policy & Planning Ð Chair Tim Green reported his committee met on 6/26/00. The following were items of information from committee:

1. Tim commended the work by Chris Hoke, Glen Wells, Debra Rowe, Susan Smith-Wharton and others in the short session thus far. Remarkable success has occurred in a session where, frankly, very little was expected. For example: Budget cuts have been restored in non-recurring funds; the Health Trust, at present, is still in tact; Asthma mini-grants are looking good; and Health Carolinians was funded successfully.
2. There has also been strong support for Environmental Health centralized training and success in DMAÕs waiver request for expansion of Family Planning services. Tim asked that all Health Directors call or write legislators to seek support of H.B.1431, but not the "front loading" element of this bill. Particularly important contacts are in the Senate (for H.B.1431). These are Rand, Hoyle, Forrester, Carrington, Cooper, Gulley, Albertson, Horton, and Jordan.
3. Finally, Tim solicited input from all NCALHD membership on legislative priorities for the long session. He asked that this be provided by August.

WomenÕs & ChildrenÕs Health Ð No Information Items.

Education & Awards Ð No Information Items.

Environmental Health (See Attachments) Ð Chair Mimi Cooper reported that the committee discussed several important issues. They are:

Epidemiology Ð Dr. John Marrow reported the following from the Epi Committee:

1. The letter to Dr. Bruton from NCALHD sounding the alarm about the "DIS hiring crisis" has been received by Dr. Bruton.
2. The Committee discussed the recent outbreak of TB at a homeless shelter in Wake County.
3. Dr. Lee Hunter reported to Committee the "leveling off" of the rabies epidemic seen last year is now increasing somewhat based on reports from counties. The Committee is concerned about variability across counties in treatment and administration of PEP (post-exposure prophylaxis).
4. In the Legislature, Hep C awareness funding has been restored in the budget.

Managed Care & Reimbursement Ð No Information Items.

State & Local Relations Ð Chair Wayne Raynor stated the Local Providers meetings with Dr. Bruton have been cancelled in recent months. Meetings are expected to be resumed soon, after legislature pressures begin winding down.

Technology (See Attachments) Ð Chair Mark Kolman reiterated TomÕs emphasis on the importance of the called "full association" meeting next month at which time the Technology Committee will provide its report and recommendation as charged by NCALHD on the RFP for Public Health automation. This will be an educational session as well as a decision-making opportunity for all NCALHD members. This has been an intense and comprehensive RFP process by the committee and many significant collaborators. Moving forward on recommendations will be a very big and long step requiring education and advocacy by all NCALHD members. Marc also reported on the NCALHD/Alliance web page (now being consolidated by Susan Smith-Wharton). He also stressed the serious importance of all Health Directors responding to the Health Alert Network Survey in terms of laying the groundwork for future funding of infrastructure for local public health response to emergencies, disasters, bioterrorism threats, disease outbreaks, etc.

Community Health/Dental Ð Chair Elaine Russell reported the following from committee:

2. The "2010 Health Objectives" are now on the web.

Dennis and Joy Reed conducted a special session of this meeting to address last minute items and concerns about the looming (July 1) start-up for ICD-9/CPT conversion. Dennis offered reasons why delay of the start-up date is not feasible or practical Ð or beneficial in terms of readiness issues. Many of those present expressed a feeling of unreadiness Ð but Dennis discussed a plan to assure that no county will experience near-term cash flow problems (by way of an "advance" of Medicaid funds). Dennis and Joy corrected several guidance memos on CPT coding and Medicaid rates. These have been emailed. Joy discussed the importance of each agency designating a "contact person" through whom questions and answers on coding issues can be funneled in the next several months. Considerable discussion was held on the issue of "sliding scale fee" patients who will not be able to pay for unbundled elements of family planning and maternal health. Dennis also stressed that DMA now understands and has discontinued requirements for provider numbers for "Attending Physicians". Clarification by email and regular mail is on the way to clarify this question. State new DMA policy wherein a single number for all local health departments will be arranged. Dennis also discussed the methodology for rate setting by DMA. Quarterly costs and reimbursements will be analyzed by DMA with an eye towards avoiding large settlements, either positive or negative.

Deborah, as did Tim, pointed to remarkable successes in the legislature thus far, encouraging continued hard work on priority issues for Public Health. She encouraged Directors to support agency wide NCPHA membership, and to plan to attend the Annual Education Conference in Wilmington in September.

Carmine reminded the group of the importance of the National Conference in our State of NALBOH (Raleigh in July), and encouraged attendance of Directors and Board Members.

• Dr. John Marrow, reporting for Citizens for Public Health, stated that their website is under development and is seeking "links" to other sites.
• Dr. Harold Gabel spoke as a liaison to the NC Medical Supply Society. He advised the group of the Medical Supply initiative to establish local indigent care clinics in all counties of the state using their members across the State. Dr. Gabel said his role has been to emphasize Public HealthÕs potential contributions to planning and implementing such initiatives. He offered to arrange for speakers from the State Medical Supply Society to come to local affiliates to share the ideas and vision for locally supported physician based indigent care initiatives.
• Curtis Holloman spoke as a representative of the Healthy Carolinians Task Force to thank all those who contributed to the recent legislative victory in getting State funding for Healthy Carolinians initiatives. This has been a long sought goal of the entire Public Health family.

There being no further business coming before the NCALHD Executive Committee, the meeting was adjourned at 3:00 p.m.

The next meeting will be held in Cary at the NCHA Building on July 27, 2000.

Respectfully Submitted by,

Jim Baluss, Secretary/Treasurer