CALL TO ORDER Ð President Tom Bridges called the meeting to order at 1:00 p.m. This was an Executive Committee Meeting. A quorum was present. The meeting was held in the Piedmont room of the Sheraton Imperial in conjunction with the annual convention of the NC Association of County Commissioners. Tom extended greetings and recognition to Craven County Commissioner Mr. Lee K. Allen, President of the NC Association of Local Boards of Health and Mr. Ed Regan of the NCACC staff. (See Attendance Roster).

APPROVAL OF MINUTES Ð The minutes from the July 2000 special called meeting of NCALHD were approved as submitted.

TREASURERÕS REPORT Ð Jim Baluss presented the TreasurerÕs report through Account balances were as follows:

Checking-$29,375.86 Savings-$34.11 Money Market-$326.92 CD-$40,000.00

Tom Bridges announced the following:

• Lou Brewer has left Wake County Health Department and gone to work in Texas. Gibby Harris was present and introduced herself as Health Director representative from Wake during interim period.
• Diana Bradshaw introduced herself as the new Health Director at Martin-Tyrrel-Washington District Health Department. Diana is a former Regional Nursing Consultant (welcome aboard Diana!).
• Tom announced several upcoming, important training events, including NCHEKA training on HIPPA and various offerings by UNC-SPH, etc.
• Tom stated that he has had a wide array of requests for "endorsements" for persons being placed in nomination for the Board of the Health Trust (pursuant to the legislative design for that portion of tobacco settlement funds to advise health needs). There is not a designated Health Director seat in the Trust, however, the names of a member of noted "friends" of Public Health are being advanced through this nomination process Ð and here Tom is being asked to provide "endorsement" in his capacity as NCALHD President. Due to time constraints, Tom could not wait for a full NCALHD action/input on recent requests for "endorsements". He therefore recently appointed an ad hoc committee to quickly, but carefully, take action on the endorsement requests. The committee consisted of Tim Greene, Bill Smith, Howard Campbell, George Bond, Dr. Leah Devlin, Dr. McBride, Dennis Harrington, Wayne Raynor, and Chris Hoke. The committee considered a number of excellent candidates submitted by various persons and organizations requesting endorsement. They selected the following: Dr. Jessie Williams, Mr. George Bond, Dr. Sarah Morrow, and Howard Campbell. Dr. Williams has recently retired as a local health director, and Howard Campbell is retiring very soon. A MOTION was made and seconded that NCALHD adopt these persons as the NCALHD list of recommended appointees. DISCUSSION ON THE MOTION: Tom stated that there will be other ways to advocate and advance other names and organizations in the future, but these persons were felt to have very special qualities (including time commitments) and proven commitment to the mission of Public Health in North Carolina. In response to a question, Tom said some (but not all) of these persons had been asked if they would serve. It is expected they will serve if appointed. Discussion then ensued around the difference between "endorsement" by NCALHD and NCALHDÕs actual list of submitted recommended appointees. MOTION PASSED to authorize Tom to submit NCALHD list of recommended appointees, but is authorized to "endorse" other nominees as appropriate from many fine "friends" of Public Health, making certain we primarily endorse the above noted "NCALHD list".
• In other announcements, Tom stated he is continuing to advocate with officials to advance the work of the Public Health Study Commission.

Jill Moore reported that she has been providing input to the committee at the IOG which is determining whether to hire another Health Lawyer to replace Ann Dellinger, or to reallocate the position to a "courts" position. There is still no final decision on this question, but she hopes it will be a Public Health Lawyer and that perhaps in a week or so there will be closure. She stated she is advocating for a Public Health Lawyer. Jill shared the final agenda for the Fall Health Directors Legal Conference set for October 18 and 19 at the Friday Center. There will be a follow-up to last SpringÕs Communicable Disease Summit in a 3-hour session, among other timely topics. (See Attachments).

Jill also addressed an issue raised recently as to when to use contracts, Memoranda of Understanding, "letters of agreement", etc. Jill consulted with IOG contracts lawyer Frayda Bluestein to provide handout information. (See Attachments).

Nominating & Bylaws Ð No Action Items.

Policy & Planning Ð Chair Tim Green brought a MOTION from committee: To revise NCALHD timing on development of legislative goals to coincide with our affiliate organization, the NC Association of County Commissioners (NCACC). MOTION PASSED. (See Attachments).

Tim then presented the NCALHD Legislative Goals and Priorities 2001. (See Attachments). These critically important issues were developed through the Policy and Planning Committee with input solicited from all the NCALHD membership. Curtis Dixon, Health Director for Hertford-Gates District Health Department, was then recognized to give a brief synopsis of one of the goals (#4 on the attached document) known as the "Tier 1 Demonstration Project for Funding Core Public Health Services". Dr. Gabel suggested that language be added or refined to more clearly differentiate between goal #4 and #2.

Dennis Harrington and others discussed the need to add a "placeholder" for stating a goal that reflected NCALHDÕs Technology Project. There was strong consensus on this. It was therefore decided to add a #6 legislative goal and priority to the document Ð that being "Technology". A MOTION was made to adopt these six (6) as NCALHDÕs 2001 Legislative Goals and Priorities. MOTION PASSED. Tim then expressed his appreciation to all who participated in the development of these goals, and he particularly paid tribute to Executive Director Susan Smith-Wharton for her savvy,, effective and energetic contributions in the "short session".

Tom Bridges expressed NCALHD appreciation to Deborah Rowe, NCPHA, as well.

WomenÕs & ChildrenÕs Health Ð No Action Items

Education & Awards Ð Chair Jenny Lassiter presented several items for action and made one very important announcement and presentation.

1. MOTION: That NCALHD provide funding up to $500 to hold a reception honoring recently retired Dr. Anne Wolf. The reception will be held in Wilmington in September in conjunction with NCPHA. MOTION PASSED.
2. MOTION: To change the timing of naming Health Director of the year to April, thus to coincide with Public Health Month. Following discussion, the MOTION PASSED.
3. Announcement and presentation of (HEALTH DIRECTOR OF THE YEAR) this yearÕs award goes to Barry Bass, Health Director, Davie County. Barry expressed his honor and gratitude, and introduced loving members of his family who made a surprise visit (thanks to Jenny LassiterÕs obvious wiles).

Environmental Health Ð No Action Items.

Epidemiology Ð No Action Items.

Managed Care & Reimbursement Ð The committee met in August 10, 2000. (See Attachments). Chair Bill Smith reported on an issue of serious concern regarding an organizational change at the state level which has placed Steven Gardner and Carol Chandler in the Office of the Controller. The committee is concerned that timely Medicaid cost accounting and settlement by Steven and Carol will be inhibited by this move. The committee is recommending an inter-agency agreement, with assistance from Dr. Joy Reed, to specify the importance of local health departments retaining timely Medicaid cost accounting/settlement assistance. MOTION from committee: NCALHD requests that the inter-agency agreement between Public Health, Early Intervention, IRM, DMA and ControllerÕs Office contain language that states that the ControllerÕs Medicaid Reimbursement Staff will "provide the necessary cost analysis on an annual basis to support reimbursement rates established for all Medicaid reimbursed services provided by the local health departments and DECs". MOTION PASSED.

State & Local Relations Ð No Action Items.

Technology Ð Tom Bridges advised that Marc Kolman was unable to be present today, and he called on Ann Nance to give a report from the steering committee. Ann stated a meeting was held subsequent to the special meeting held on July 27^th. An MOU has not been developed as yet. It is felt more time is needed to develop an adequate MOU. Ray Rabe then reported on the Technology committee meeting held earlier today. The feedback the committee has been getting from across the state following the special NCALHD meeting reflects the following concerns:

1. Many local health departments are financially stressed right now and want to do more analysis of the funding currently "in the bank" (e.g. 2.8 million dollars).
2. Related to feedback concern #1 is a "trust issue" or confidence factor as to dependability on the state to deliver on "partnership money" seemingly offered by the state in comments at the recent special meeting.
3. The steering committeeÕs current charge is to develop DRAFT MOU for wide dissemination, and it is a very daunting and extremely complex task.

At this time, Ray brought a MOTION from the committee that asks NCALHD Executive Committee to authorize the HSMS Steering Committee to make recommendations to the NCALHD for approval of a draft Memorandum of Understanding between DEH, DPH, DIRM, and the NCALHD to coordinate the development of a statewide public health automation solution for action at the September NCALHD meeting. The draft will be sent out electronically to the Association membership and DPH, DIRM, DEH representatives as soon as possible. Feedback to the HSMS Steering Committee will be provided and considered prior to the September meeting. The motion that was adopted at the July 27 NCALHD meeting will also be included in this mailing. (See Attachments).

Discussion: A question was raised as to whether there has been an agreement in principle between all the partners involved. Ray said, "No, not yet Ð that would be part of the MOU development process." Tom stressed the need for Directors to respond quickly after receipt of the DRAFT. There is a very short timeline.

Question: It is an expectation the state will put some money up for this? Tom Bridges answered "yes". Dr. Steve Cline stated that DIRM has made an expansion budget request for 20 million dollars Ð if which a part would be used for this project. Dr. Cline stated the NCALHD and "the state" need to be in partnership in seeking funding from the legislature.

Follow the discussion, the MOTION PASSED.

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 No Information Items.

Education & Awards Ð No Information Items.

Environmental Health Ð No Information Items.

Epidemiology Ð Beth Rowe West , DHS, DPH/Immunizations, reported that there will definitely be a delay in flu vaccine production/delivery this season. The delay is expected to be about 1 month in the shipment of vaccine. In October, CDC will put out information on guidance/guidelines for delayed/re4duced vaccine dosage for healthy populations.

In response to a question about rubella, Beth stated that CDC is considering demonstration projects in NC. Further announcements will be made in the Fall.

Managed Care & Reimbursement Ð No Information Items.

State & Local Relations Ð Chair Wayne Raynor stated that after a 3 month break in meetings with Dr. BrutonÕs "Local Providers" group (due to the legislature being in session), meetings will begin again in September.

Technology Ð Ray Rabe reported that 2 years from today we will be implementing HPPA. Conferences and workshops will be planned to prepare for this monumental challenge.

Alliance for Public Health Agencies (NCAPHA) Ð Executive Director Report: Susan Smith-Wharton reported that negotiations with the NC Department of Corrections (DOC) have resulted in proposed contracts (which have been transmitted to member agencies) for physical examinations. This could be a 3 year contract. These must be turned in before September 1, 2000. (See Attachments).

Susan thanked all member agencies for participating in a survey which is needed to update and build a database on Alliance member agencies.

Community Health/Dental Ð No Information Items.

Dennis extended greetings and expressed appreciation for all the work done by NCALHD in the recent months with all the changes and challenges facing the local and state public health system.

1. Dennis discussed the recent collaborative efforts to complete the Medicaid dental "cost" survey. The ranges of costs are extensive and troubling in terms of rate setting. Dennis has negotiated with DMA to fast track the rate setting process and it looks like there will be about a 24% increase over private sector dental rates in our public health dental clinics. He reiterated DMAÕs commitment to keeping this transition "revenue neutral" (e.g. through cost analysis and settlement). October 1, 2000 is still the date of implementation. The Ôrevenue neutralÕ principle applies not only to dental, but all Medicaid services upon CPT conversion. Dennis stressed the importance of revenue coding practices to assure we are capturing all costs for Medicaid patients.
2. Dennis thanked Directors for timely submittal of quarterly expenditure reports. 75% of departments submitted these reports on time for last quarter. August 20, 2000 is the due date for the 1^st quarter expenditure.

1. Dr. Joy Reed provided a handout with a memo detailing procedures and requirements for "rostering" public health nurses for provision of Medicaid reimbursable procedures (e.g. child health nurses). Joy has discovered number of departments may have not fully understood the requirements for training, particularly for continuing education (See Attachments).
2. Joy announced an important website on CPT coding. It is www.sph.unc.edu/courses/coding.
3. Due to high demand, another PHTN open forum training session on CPT coding issues has been set for September 27^th from 8:30 a.m. to 12:30 p.m. At that point, we should have 2 months of billing data, denials, etc. Ð so it should present a new set of issues to discuss.
4. Joy has set up 2 training events for dental coding training Ð September 5^th and September 10^th on PHTN.
5. Two vacant RN consultant positions have been filled.
6. Joy stressed the need for Health Directors to respond to "Local Codes" survey by August 15^th.

Deborah issued a special invitation to all Directors to attend 3 days of great meetings and important networking at NCPHA in September. She has set aside rooms for committee meetings on the morning of the 19^th. Call her ASAP committee chairs. She particularly invited Board of Health and County Commissioners to NCPHA. Registration fees have been waived for them this year.

1. Carmine announced a 72% rate of institutional membership in ANCBH by Boards of Health in North Carolina.
2. A video given to recent NCALBH conference attendees is available from ANCBH.
3. ANCBH is supporting certain candidates for appointment to the "Health Trust".

Dr. Steve Cline provided a handout on the work of a recent statewide emergency management planning process dealing with "animal response" (e.g. "SART/CART" document). (See Attachments).

Terri Snowden, representative from Seaburg & Smith (formerly Sedgewick James) discussed the Health Department group medical malpractice insurance. 4 new health departments have just joined the group. Terri invited all new Health Directors to contact her or a colleague in health department which is members of the group. Risk Management Services were highlighted by Ms. Snowden.

Tom reminded members of the next meeting set for Tuesday, September 19^th, the day before NCPHA starts in Wilmington, NC. Tom then thanked all who provided input into the "School of Public Health Survey" process recently.

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

Respectfully Submitted by,

Jim Baluss, Secretary/Treasurer