CALL TO ORDER Ð President-Elect Tim Green called the meeting to order at 9:30 a.m. Tim was standing-in for President Tom Bridges who was attending a tabletop exercise in bio-terrorism response.

APPROVAL OF MINUTES Ð The minutes from the October meeting were approved as submitted.

TREASURERÕS REPORT Ð Jim Baluss presented the TreasurerÕs report through November 14, 2000. Account balances were as follows:

Checking-$17,921.20 Savings-$34.34 Money Market-$331.07 CD-$40,000.00

1. Curtis Holloman, Scotland County Health Director, has resigned effective the end of November and has accepted a position at the Penn State Medical Center. Scott Harrellson has been officially appointed Duplin County Health Director. Brian Repass, has been appointed Interim Health Director in Madison County. Jerry Parks has been appointed Health Director at Albemarle Regional Health Services. Dr. Fred Moore has been appointed Health Director in Caswell County.
2. NCALHD will hold an Executive Committee meeting on December 20, 2000 over PHTIN through many sites. Among these are UNC-SPH in Chapel Hill, Elizabeth City, Fayetteville, Hickory, Raleigh, Sylva, Wilson, Asheville, and Wilmington. A full Association meeting will be held on January 10, 2001 at 1:30 p.m. at a site to be announced.
3. On December 12 & 13, the Health Disparities Conference will be held in Raleigh at the Sheraton Capital Center.
4. On January 12, 2001, NCALBOH will be meeting in Raleigh.
5. A sign-up sheet for committee membership was circulated for NCALHD 2001 and all were encouraged to indicate their interest in participating on committees next year. (Preliminary listing attached Ð all interested directors may still sign-up for committees).
6. Officers, committee chairs, and regional representatives for NCALHD 2001 met on November 15, 2000 in Raleigh for a planning and goal setting meeting.
7. A UNC-SPH Liaison Report was given by Dr. Rachael Stevens. Dr. Stevens introduced Robert W. Ryder, M.D., Professor of Epidemiology and Medicine; and Lorraine K. Alexander, DrPh, Clinical Assistant Professor. They are heading up an exciting new project that affirms the commitment by Dean Roper to facilitate the Institute of Public Health faculty getting out into local Public Health agencies across the State. Dr. Stevens then called on Dr. Ryder, who briefly described his new CDC funded project in which Cumberland, Edgecombe, New Hanover, and Wake counties will participate in a study of "emerging infectious disease surveillance." Dr. Ryder described the program, which he hoped would emulate successful projects in the past in other parts of the country. Counties will be asked to select an emerging infectious disease to study, and how to best develop local surveillance mechanisms.
8. Institute of Government Liaison Report Ð Jill Moore, MPH, JD

Jill provided updated handouts on legal issues in consent to treatment. (See attachments). Jill also reported that a decision has been reached to fill the position in public health law recently vacated by Ann Dellinger. The Institute is recruiting at present. Jill also reported the InstituteÕs training for newly elected County Commissioners is currently underway, and that she provides the "Public Health Law" component that training to new Commissioners. Jill stated that she also discusses "hot button" issues with them, and the topic for this yearÕs session of training is on HIPPA and language barriers in delivering local Public Health services. Jill solicited other relevant topics from Health Directors in these important training sessions (3 across the State).

9. Tim then recognized Tommy Jarrell, Regional Representative (NCALHD Region 6), who stated Health Directors in that region are very concerned about the delays/shortage of flu vaccine. TommyÕs regional group voiced concern that some purchasers are seemingly able to get their allotments and administer vaccine to healthy adults long before local Health Departments. This despite public healthÕs preponderance of "high-risk"/higher prioritized patients. George Bond then stated that NACHO is very concerned about this issue, as is NALBOH, ASHTO & APHA. If the distribution system nationwide were as fickle and irrational, inefficient and inequitable in a bona fide pandemic, US citizens would be at terrible risk. Bill Smith suggested a letter be sent to NACHO in support of their advocacy for local Health Department clients in future vaccine distribution planning. NACHO is also considering a large single contract joint purchasing agreement to buy vaccine for its members in the future. Bill suggested that NACHO needs to hear about our problems, and give them support in their efforts nationwide on our behalf. There was also discussion around the potential benefits, or problems, in submitting a NCALHD "news release" expressing local Health DepartmentsÕ alarm and concern around the irrational, preferential, and erratic nature of the distribution of vaccine this season. It was agreed, as suggested by Chris Hoke, that Jim Baluss will consult with Bill Furney to discuss the content and pros and cons of such an approach. The desired outcome would be to more accurately pinpoint the source of the supply and distribution problems (e.g. manufacturers supplying discounted purchasers last) so as to educate increasingly angry public health system customers. Dr. Rosemary Summers spoke to the need for using caution and discretion in news releases to avoid a "panic situation". She felt an emphasis needs to be made on the fact that being vaccinated in December is probably adequate protection this year. After much discussion, a MOTION was made to write a letter from NCALHD to NACCHO in support of their national efforts to advocate for more efficient, predictable, and equitable distribution, and to recognize the need for public health agencies being given priority, rather than being considered last by suppliers.

Epidemiology Ð No action items.

Managed Care & Reimbursement Ð No action items.

Chronic Disease/Dental Ð Chair Elaine Russell stated the committee had met recently and had 2 action items:

1. MOTION: That NCALHD send a letter to DMA in support of Medicaid funding for treatment of women diagnosed with cancer through the BCCCP program who have no other pay source. Discussion: This is a small number (in the range of 5-60 women per year). DMA says they need a letter of support. MOTION PASSED.
2. MOTION: The NCALHD support the Division of Health Promotions proposal to address BCCCP participation rates in 26 low performing counties by seeking partnerships within those counties. Discussion: BCCCP has completed its review of performance rates in health departments. As has been noted for several years, a number of counties continue to miss performance/participation targets. (See attachments). In order for North CarolinaÕs program to stay in good standing with CDC, we are going to have to address this problem in 26 county projects across the State. This will be done by going out to the counties and working in a supportive way to enhance participation rates, or seek partnerships to enhance rates. Elaine stated each of these counties has had on-site consultations and program reviews, and this matter comes as no surprise to these counties. Dr. Gabel noted that reaching the "targets", even with aggressive outreach, has proven difficult. He questioned the ability of other local providers to reach them any more effectively than local health departments. Elaine stated that CDC is requiring action in this motion. Bill Smith asked for a definition of BCCCPÕs performance measurements on "average penetration rates" of target populations. Following several questions on this topic, a number of those present expressed concern about the lack of Division of Health Promotion staff present at todayÕs meeting to provide further information. A MOTION was made and PASSED, which tabled action on this request until the next meeting, and where upon State BCCCP staff could be present.

Environmental Health Ð No action items.

Nominations & By-Laws Ð No action items.

Alliance (NCAPHA) Ð No action items.

Policy & Planning Ð Chair Tim Green stated the committee met on November 15 and brought the following action items:

1. MOTION: That 2 items be added to the NCALHD 2001 legislative goals list. These are (1) repeal legislation passed in 1993 which pre-empted local rule making authority of Boards of Health in smoking control. Discussion: Bill Smith spoke in favor of the motion, noting this pre-emption has had a chilling effect on all local rules adopted by Boards of Health. In response to comments on strategy, Tim stressed that there will also be support for this position by a number of the usual "coalition" members in public health advocacy. Wanda Sandele spoke in favor of NCALHD going on record in support of removing the "pre-emption" in addition to any other coalition groups, she felt NCALHD should "visibly take responsibility" for this public health initiative. MOTION PASSED.
2. Tim Green brought another MOTION from the committee that NCALHD add an additional legislative goal to seek 10 million dollars for "uncompensated care" delivered through local health departments. MOTION PASSED. Tim stated his intentions to meet with the Legislative Goals Committee of the NCAC next week to present NCALHD goals. Maggie Dollar then asked Tim if the current list of goals for 2001 includes a call for "statewide well construction standards". Tim stated it was not on the currently approved list. Maggie asked if it could be added. Mimi Cooper, Chair of Environmental Health Committee, stated she felt her committee was under the presumption that statewide well rules were on the 2001 list. Tim stated the NCAC timetable calls for affiliate goals to be in by early September, and this item was not on that list. However, NCALHD can add it to the list going forward, but not for inclusion in the NCAC process. Mimi stated it is not in the GovernorÕs expansion budget anyway, and we need a "legislative champion" to emerge for a statewide well program. Maggie then made a MOTION that support of legislation to enact statewide well construction standards be added to the NCALHD Goal 2001. MOTION PASSED.

These 3 items will be added to the list.

State & Local Relations Ð No action items.

Education & Awards Ð Chair Jenny Lassiter brought forth a MOTION that NCALHD meet in January at the NCHA building in Cary. Discussion: Jenny and Susan Smith-Wharton have experienced some frustration with lack of conflicting communication with the Planning Committee for the State Health DirectorÕs Conference in Raleigh in January (this has been shown as the planned meeting for NCALHD meeting in January). Susan has reserved our normal meeting room in Cary for January, and the MOTION PASSED to schedule the January meeting in Cary at NCHA. Jenny reported that Terri SnowdenÕs plans to hold a reception for Health Directors again this year, and will schedule it in a location convenient to NCALHD meeting place.

Carmine Rocco, Executive Director, NCALBOH, highlighted activities planned by his organization in conjunction with the State Health DirectorÕs Conference and encouraged Health Directors to attend.

Technology Ð Chair Ray Rabe brought forth the following MOTION from committee: (See MOTION is attachments) NCALHD to release $25,000 of the Medicaid Max. Funds held for health insurance system development for Phase I activities in accordance with the MOA; and that the State do likewise; and that NCALHD release funds for Phase II activities when "advisable and necessary". Discussion: Ray reminded the group that in September 2000 NCALHD approved implementation of an MOA with the State to develop the Health Information System. A steering committee was to be established to carry forth the implementation stages of the project as specified within the MOA. Ray reported little or no progress on development of this all-important steering committee at the State level. We are simply not making progress on HIPPA compliance and systems development, and the steering committee is essential to that process. Ray stated that to move the project along NCALHD needed to release Medicaid Max. Funds, and the State should match these (at $25,000 each) further, that NCALHD should recommend that the State hire a consultant. In response to questions and discussion, Dennis Harrington clarified the StateÕs commitment of up to $250,000 available for Phase I and Phase II; so the motion was amended to insert language enabling Medicaid Maximization Funding up to $250,000 to match State funding. An additional amendment was made, offered, and accepted to make it clear that NCALHD request the State to fund the hiring of a HIPPA consultant.

Women & ChildrenÕs Health Ð No action items.

Women & ChildrenÕs Health Ð No information items.

Epidemiology Ð No information items.

Managed Care & Reimbursement Ð No information items.

Chronic Disease/Dental Ð No information items.

Environmental Health Ð No information items.

Nominations & By-Laws Ð No information items.

Policy & Planning Ð No information items.

State & Local Relations Ð No information items.

Education & Awards Ð Chair Jenny Lassiter reminded those present that nominations for the Ham Stevens Award are due by December 20, 2000. Applications are available on the NCALHD web site.

Technology Ð Chair Ray Rabe requested suggestions and input from the membership on the NCALHD web page, and suggestions on projects for the committee. Marc Kolman reminded members on the Technical Steering Committee of the next meeting on November 30.

Dennis reported that Dr. McBride was unable to attend today due to his participation in the bioterrorism response tabletop exercise. Dennis then reported:

1. We are getting very close to successfully transmitting data between HSIS and DMA. Dennis believes the vendor counties are in pretty good shape.
2. Billing is almost caught up.
3. More Medicaid cost studies are being planned to assure that CPT conversion is Medicaid "revenue neutral" to local health departments. Dennis is hearing from counties that have received payment under CPTÕs that conversion is not neutral. This could be a matter of rates Ð but it also is probably a matter of assuming proper and inclusive coding for a "services rendered Medicaid patients in local health departments. Dr. Joy Reed has deployed "coding consultants" out to local agencies and it is clear that although clinics are learning coding well, there is reason to believe that as we get further along on the CPT learning curve, services will be more increasingly captured for funding by Medicaid. These coding consultants will work with Carol Chandler and Steven Gardner in collecting data out in the counties to do rate studies.
4. New Medicaid clinical rates will be coming out shortly.
5. Due to a lack of reliable data in quarter IV, cost settlement may be based on the first 3 quarters of the federal fiscal year.
6. Recent PHTIN "Q & A" sessions on coding were seen as very helpful by local staff.

Dennis then responses to a question about why contracted block grant funding has not been received. She and others expressed alarm and concern about the hardships this is causing counties, as well as dismay as to how and why the State could simply not honor contractual payments to counties upon proper submission of expenditure reports.

Jenny Lassiter requested that a letter be sent to Dr. McBride, Dr. Bruton, and the State office to request immediate payments for all reported expenditures by counties in accordance with contracted (grant) services. JennyÕs request was re-stated in the form of a MOTION, which PASSED unanimously. It was suggested that this letter be copied to county finance officers as well, so they may be advised of Health Directors efforts to solve this serious fiscal problem.

Following regular agenda items, an additional concern was raised about the State Health DirectorÕs office. State Health Director Dr. McBride recently advised Susan Smith-Wharton that it was only appropriate for her to be in attendance at the "large" monthly staff meeting. She was requested not to attend further "weekly" meetings of Senior DHS staff and Dr. McBride. Tim and others stated that this ran counter to Dr. McBrideÕs previous offer and commitment for Health DirectorÕs (or our representative) to attend the weekly meetings in an effort to improve and enhance "communication" between his office and NCALHD. A number of Health Directors present expressed their disappointment and frustration over this action Ð at precisely the time when NCALHD leadership had hoped to address concerns about leadership and communication from the State Health DirectorÕs office. A MOTION was made to have a letter be sent to Dr. McBride from NCALHD stating that this has called into question previously stated commitment to improved communication and relationship between Dr. McBride and local Health Directors. MOTION PASSED.

There being no further business, the meeting was adjourned at 11:40 a.m.

NOTE: Next NCALHD meeting is December 20, 2000, through PHTIN.

Respectfully submitted,

Jim Baluss, Secretary