Minutes

North Carolina Association of Local Health Directors
Executive Committee Meeting

March 15, 2001

NC Hospital Association
Cary, NC

Call to Order:

President Tim Green welcomed the executive committee and guests to the March meeting at 9:00am. Eleven executive committee members were in attendance (see attachments for attendance roster) which constitutes a quorum. Elaine Russell of Cherokee County had Tom Bridges’ proxy to vote on his behalf.

Fellowship:

Danny Staley, Appalachian District, provided fellowship.

Approval of the Minutes:

The minutes of the February meeting were posted on the web site and approved as posted.

Treasurer’s Report:

MiMi Cooper presented the treasurer’s report as of March 7, 2001. Account balances were as follows:

Checking: $31,016.67 Savings: $34.69 Money Market: 338.01 CD: $40,000.00

(See attachments for full treasurer’s report). Dues are still outstanding for a number of health departments. If you need another copy of the invoice for dues, see MiMi. She also asked the executive committee to advise her on the dues for North Carolina Health Access Coalition and the Covenant with North Carolina’s Children. Our organization has belonged to both these groups in the past but they were not included in earlier versions of the budget.

MOTION: To pay dues to the NC Health Access Coalition in the amount of $50 and to the Covenant with Children for $300.

After a second to the motion and no further discussion, the motion passed unanimously.

MiMi also made the following suggestions to limit the number of attachments that are made to the monthly minutes.

1. If the document is to be mailed or emailed to all health directors, do not attach it.
2. If the information is available online, list the web address but don’t attach it.
3. If the minutes already do a good job of summarizing what is in the attachment, don’t attach it.

Liason Reports:

Rachel Stevens, UNC-SPH, NCIPH

Rachel announced that there is still space at the Friday Center for the Laurie Garrett Lecture on March 26^th as well as space at Greensboro AHEC, Asheville, one of the Raleigh Sites and in Greenville.

Joy Reed, Office of Public Health Nursing

Joy covered topics on dental varnish training, dental records retention, validation of maternity billing and reimbursement, filling of the nurse consultant position, and questions and answers to the 1-18 CPT Conference (see attachments for details).

Carmen Rocco, ANCBH

Carmen spoke to the association about the training of Board of Health members. This involves 200-300 people in a year. The challenge is to meet the need in a timely and cost-saving way. Carmen handed out a packet showing what is covered in the training (see attachment). He also asked that we get information on Board members back to Catherine Moon for the Board database. The Boards of Health Spring training program on Advocacy is scheduled for June 8^th at the Friday Center. Lt. Governor Purdue and Secretary Hooker-Buell are invited to speak. Carmen also noted that ANCBH is working with Sen. Hartsell on the Public Health Authority Act.

Executive Director’s Report:

Deborah thanked the association for their confidence in her and for making her feel at home in her new position as executive director. She stated that she would be calling on us for assistance as the legislature swings into action. She has not moved into the NCHA office yet because the lease on the NCPHA office has not run out. We can fax to Deborah at 919-789-8005 and reach her through the NCPHA phone. Her email address is deborah.rowe@ncpha.com. Deborah reminded us of the Legislative Conference on April 24 at the Sheraton Capitol. We will have speakers in the morning with time in the afternoon to visit legislators. Please plan to attend. It is time for NACCHO elections. Both George Bond and Bill Smith have served in elected positions for NACCHO. Bill is running again. To vote for George, you must be a member of the county forum. If you are interested in serving on a NACCHO committee or running for an office, let Deborah know. NACCHO will hold their annual meeting in Raleigh in June.

Announcements:

1. Tim reminded everyone of the importance of getting monthly expenditure reports in on time.
2. WNCPHA will be meeting in Asheville April 25-27^th at the Holiday Inn Sun Spree.
3. The contract has been completed and signed for Deborah Rowe to work for our Association as Executive Director at 20 hours a week with priorities in liaison, legislation, and conference planning.
4. The ANCBH may assist us with secretarial tasks and registrations for meetings. We are working with them on cost and a contract.
5. We currently don’t have anyone in the NCHA office to schedule meetings for us. Look for an email from Tim telling members of alternative space. Don’t schedule here until early April.
6. As tenants in the NCHA building we have rights to space but along with those rights come the responsibility not to break the rules. For example, we are not to exceed 60 chairs in the large meeting room. When we borrow chairs from the other meeting rooms, we have an impact on meeting scheduled for that space. We also need to let the person at the reception desk know who is in our meetings in case of emergencies. We will take her a copy of the roster at each meeting. We must also not have loud conversation in the outside room/lobby area. If you need to converse, go outside or downstairs to our office.
7. Guilford County Health Department is celebrating its 90^th birthday on April 4^th. Dr. Sarah Morrow is the keynote speaker.
8. Tim announced that Rosemary Summers has agreed to serve on the Healthy Carolinians Task Force, Bill Smith on the CDC Immunization Committee, and Chris Szwagiel on Public Health Bio-Terrorism. Wanda Sandele will find someone for the Senior Vaccination Season Committee.
9. Tim sent a letter to Congressman Burr concerning the Kennedy-Frisk Bill, Public Health Threats and Emergencies Act (see handout). This bill funds the infrastructure for the alert network. The bill is authorized but no money has been appropriated. The hope is to fund at $100 million, which would fund the things on the bottom of the pyramid. Burr is very interested in the alert network.

State Health Director’s Report:

Dr. McBride sent congratulations to the Association on our contractual association with Deborah Rowe. He also stated that the Division of Public Health would have a presence at the Legislative Conference and encouraged the same from local public health.

Dr. McBride stated that he wanted to alert us to three items:

1. WNV- The Division is beginning a state of readiness concerning west Nile virus to prepare in case we experience cases this spring and summer. The Division is meeting with the different players. Dr. Steve Cline is DPH’s lead on this effort. Written materials will be distributed online. Paul Webb in environmental epidemiology is the network person for all agencies involved.
2. Health Disparities- This is high on the State’s list of problems. The Association calls this same issue uncompensated care. If we focus on this we will be in concert with federal efforts, 2010 objectives. Follow-up to the health disparity conference has been planned. Guilford, Pitt, and Buncombe Counties are sites paired up with educational institutions. Best practices committees are focusing to close the gap between low income, race. Leah Devlin is leading this effort. Secretary Hooker-Buell gave a strong presentation on this issue and has made it clear that this is a focus area. It is important that we partner with community health centers who every year have gotten increases in funding. Think in terms of what we can do around these issues. Dr. McBride is working with the Board of Health Association to have a more diverse work force.
3. Budget- The Governor’s budget is out. The Division of Public Health took a lot of hits in recurring funds (asthma, healthy start, healthy Carolinians). The DPH is working hard to pay contracts in a timely manner and get information out to locals quickly. The flexibility to deal with issues has been curtailed but should return in future.

Maggie Dollar asked Dr. McBride about Governor Easely’s statement that he would not cut education or public health. Dr. McBride replied that he means the money paid to locals. Eighty-one percent of the money that DPH has in its budget goes to locals. Kevin Ryan said that some of the positions will continue to exist but state funding will come out and federal Medicaid will come in to maximize the funding. Dr. McBride said that through negotiations the division has been able to maximize the federal dollars. But it will still be a tough year. Some of the appropriations people in the legislature are looking line by line or at full programs for opportunities to cut. Now that we have the governor’s budget, we have to deal with how the legislature will change things. Sec. Hooker-Buell says it is a time for opportunities to be creative.

Bill Smith asked that in the future when a great deal of emphasis is put on attendance at a conference, such as the recent teleconference on contract addenda changes, that the information match the urgency. The content at the conference was not useful, new or urgent yet many of us changed schedules to get there due to the message that the meeting was urgent. Dr. McBride asked that we give him feedback when a conference or meeting was not useful and the division would improve. Tim Green reminded the group that the final part of the contract addenda training was to be held this afternoon and again on March 30^th.

Institute of Government Report:

Jill Moore stated that she had been looking into an issue at the request of a local health director concerning releasing information to parents of minors. She summarized her findings in a handout (see attachments). Jill corrected an earlier date given to this group. The federal Privacy Act, which includes HIPAA, becomes effective April 14^th. We have two years to be in compliance. The (Federal) Secretary of DHHS has reopened the comment period on this act.

Special Report from Ann Nance, Immunization Reimbursement Information:

Ann said that HSIS was held up due to HIPAA regulations but we were unaware of the holdup. They had a test tape ready in December. Many changes took place in CPT conversion that required program changes. HSIS made the changes but EDS wasn’t ready. May 1^st is the next date for immunization reimbursement testing but in the mean time we are owed around $600,000 in reimbursements. There are things going on at EDS that are making things move slowly. Ann has made it clear to them that we must have this money before July 1^st to show as current budget receipts. Colleen Bridger asked if there is a way to find out what we should be getting in order to do our budget estimates. Ann said that by running a pending report at the local level we should be able to determine what is outstanding.

Committee Reports (action items):

Technology-Ray Rabe

A resolution from NACCHO was handed out regarding EDI Technology.

MOTION: to support the NACCHO resolution on EDI Technology.

There was no further discussion. Motion passed unanimously.

Last month the association approved a motion to rework our web site but the motion did not include ongoing costs.

MOTION: to increase the funding to complete the transition and maintenance of the website not to exceed $1500.00 through calendar year 2001.

There was no further discussion. The motion passed unanimously.

The National Governor’s Association adopted a position to delay the implementation of HIPAA

MOTION: to support the National Association of Governor’s proposal to delay the implementation of HIPAA.

There was no further discussion. The motion passed unanimously.

It was announced at the HAP Council meeting that the legislature has sent down information that there will be no funding for our technology project within the State. Now we know the State won’t have any money and ours is not enough. We have to have a data and information system. We must decide at what level we are going to invest. It will take $500,000 more of our money to continue the process we have started.

MOTION: to continue participating in the Public Health Enterprise Visioning Process and increase the funding available up to $500,000 to complete the understanding phase.

Lively discussion ensued that included these questions and answers:

Did the committee support this motion unanimously? Yes. But we need to build in accountability for what the money will be spent for.

Is this a state problem or a local problem? We have taken ownership of the problem.

The County Manager from one county came back from a meeting where he heard about a DSS data management system that the state is working on. Why is the State not doing the same for Public Health? There is no federal mandate for automation in public health like there is in DSS. Mental Health’s mandate for improved technology came out of litigation. Public health never caught the attention of federal/state for automation needs. Bioterrorism is our back door in.

Are we dancing with ourselves? How can anything happen without full cooperation from the State? What we will get even without automation is a joint effort between State and Local that defines the needs.

Vincent Bass with DIRM addressed the association and said, yes, there were large pots of money behind the DSS automation. This was because TANF required seamless service delivery. DIRM went through the same process with DSS of visioning and understanding. The CDC concerns about Bio threats appear that it may do the same thing for public health as TANF did for DSS. But its not just about information technology but policy changes with an action plan as a final result. We can’t move forward without a core team of 3-4 locals, 3-4 state in addition to a vendor to do the technical piece (and we pay the vendor based on deliverables). From Mr. Bass’ perspective this is not a state project but a vision process with includes the state, locals, and others. Ray and Vincent closed the discussion with a handout that shows the process we hope to follow.

The motion passed unanimously.

Tim Green asked the technology committee to find out why our money is still not in an interest bearing account and report back at the next meeting.

Health Promotion and Oral Health-Rosemary Summers

MOTION: to endorse the Heart Healthy Survey for restaurants and to encourage health departments to participate in carrying out the survey by any means they feel will work in their county.

There was no further discussion. The motion passed unanimously.

MOTION: to authorize the President to write a letter to Secretary Hooker-Buell to thank her for signing the grant to the American Legacy Foundation and to request her to assist the Division of Public Health in finding the matching funds for FY01-02.

There was no further discussion. The motion passed unanimously.

MOTION: to authorize the President to write a letter to the Governor and the members of the Health Trust to encourage them to address issues of tobacco prevention and control as it’s top priority.

There was no further discussion. The motion passed unanimously.

MOTION: to support the 100% tobacco-free school policy through encouraging Boards of Health to write a letter of support to be sent to local school boards.

There was no further discussion. The motion passed unanimously.

Environmental Health — Terry Pierce

MOTION: Support full funding of Centralized Intern Training in the amount of $260,000 and encourage health directors to contact members of the NER Appropriations Committee in support of CIT being fully funded.

Discussion: Governor’s budget only contained money for $100,000 for CIT. The funds also need to be made recurring so that we don’t have to fight every year for this valuable program.

The motion passed unanimously.

MOTION: To oppose Senate DRS 6586-LN-35, Family Foster Homes/Springwater test as written, because springs are considered as unprotected water sources, there are no construction standards for springs in the rules, springs are subject to contamination and occasional random sampling gives false security and the proposed rules would not adequately protect the public’s health.

Discussion: There was discussion about the requirements for testing/treating springs for family foster homes.

The motion passed with ten for and one against.

Policy and Planning — Wayne Raynor

MOTION: That the Association support the draft language in the uncompensated care bill (see attachment).

There was no further discussion. The motion passed unanimously.

MOTION: That the Association endorse the leaflet format presented in the uncompensated care bill as standard format for all other bills proposed by the Association.

There was no further discussion. The motion passed unanimously.

MOTION: That the Association endorse the development of a resolution supporting the elimination of health disparities in North Carolina.

There was no further discussion. The motion passed unanimously.

MOTION: That the Association support the pouring bill when introduced by the legislature (see attachment).

There was no further discussion. The motion passed unanimously.

MOTION: That the Association support Senate Bill 132 short title, "Health Insurance/Colorectal Cancer Screening".

Discussion: John Morrow asked for a definition of screening and it was explained that this includes colonoscopy.

There was no further discussion. The motion passed unanimously.

State and Local Relations — Jim Baluss

Jim reports that there have been no meetings this year as were held in the past with Secretary Bruton. There have been questions about the value of these meetings among some participants.

MOTION: That the president write a letter to Secretary Hooker-Buell asking that the meetings be reinstated.

Discussion: Barry Blick reported that County Managers were one of the groups that thought these meeting were a waste of time. Tim Green reported that they are agenda driven. The meeting is not called unless there are items to discuss. The responsibility then falls to the participants to put only critical items on the agenda; not busy work.

The discussion ended and the motion passed unanimously.

Committee Reports (information items):

Epidemiology — John Morrow

• The committee heard from Steve Cline about a task force which met on the 12^th to develop a state plan for WNV readiness and outbreak situations. They will also develop a template for local health departments to use to prepare local plans.
• Evelyn Foust informed the group about new Ryan White money in the amount of $573,000 that will be allocated to three NC communities: Charlotte, Winston -Salem, Greensboro, Raleigh-Durham. These are title II dollars which provide for improving quality access and organization of health care and support of PLWHA. HRSA is developing guidelines for these funds. The State is unsure whether any of these dollars can be spent in any other areas of the State
• Todd McPherson discussed the new policy on weekend rabies testing as a result of decreased staffing. The memo went out on Feb. 26^th and policy becomes effective April 1^st.
• Lou Turner updated the group on the status of PAP testing with the state lab. Using the new method, turnaround time for negative PAPs is two weeks, Positives are coming back in three and a half to four weeks and likely will not get better than three weeks ever. The committee has requested a comparison with the private sector for next meeting.
• Jim Wilson gave a report on the role of GIS (geographic information systems) in public health. To learn more about this role go to www.cdc.gov/nchs/about/otheract/GIS/GIS_home.htm
• John Booker of the Vital Records unit reported that they are planning to purchase a secure web-based information system to handle vital records. The State has to meet new Federal certificate standards by 2003. They are presently searching for a vendor. There is an RFP out now with plans for contracts in place by January 2002. They will start testing in July of 2002. The start-up budget is $500,000. DIRM is supportive. The birth dose of hepatitis B will be appended to the birth certificate and passed to the immunization registry.
• Newt McCormack updated the committee on recent clusters of Group A strep cases in Buncombe County. There are seven confirmed cases, only two of which were in physical proximity to one another. Also, Dr. Maillard reported that the state has already had 26 cases of meningococcal meningitis compared with only 15 cases in all of 2000. Again no ties are noted between the cases.
• In closing the committee looked at the new Communicable Disease Agreement Addenda with no further changes.

Women and Children’s Health — Wanda Sandele

• ROCI funds are still included in the Governor’s budget as are high-risk maternity funds.
• The immunization registry is moving forward with Wisconsin Systems as their vendor.
• Uncompensated Care issues were discussed at length. Counties were reminded that title V money should be spent in Maternity or Child Health even if you don’t have a maternity clinic. You can’t move title V money to family planning in order to charge in maternity.
• Wanda will send a synopsis of the information on uncompensated care to all those who responded to her inquiry and would still like for those counties who have not responded to do so.

Education and Awards — Barry Blick

Policy and Planning — Wayne Raynor

Wayne reminded everyone to send email to support PHTIM and to respond to Wanda about uncompensated care.

Alliance of Public Health Agencies — Chris Szwagiel

In celebration of Public Health Month, the Alliance is sponsoring a Best Practices Seminar on April 3^rd. Jim Bernstein, Terrie Snowden and other are presenting.

Environmental Health — Terry Pierce

• The RS Board plans to formalize revisions to GS 90A to be submitted as a bill. There is no set time for introduction. The Board is currently working on rule modifications. The plan is to have the rules changed prior to law changes. Rules can be changed without opening up the RS Act in the legislature.
• Travel restrictions are still in effect for DEH as described in a memo to all departments received from Malcolm.
• Malcolm will email talking points about centralized intern training for members to use while talking with legislators about restoring those funds. Terry also handed out a list of legislators on the NER Appropriations Committee.
• Linda gave committee members a copy of the new organizational chart for DENR. All Division heads report to the Deputy Secretary and the Secretary.
• Terry Pierce, Arthur Mouberry and Linda Sewall talked about changes to the well construction standards (15A NCAC 2.C .0107(a)(3). The word "existing" was added to describe the dwellings to allow less than 100 feet separation from the well and sewage disposal system. This creates a problem for lots with (or without) permits but no dwelling. These permits would be in violation of the rules if the well were placed less than 100 feet from the septic system. Arthur Mouberry, Groundwater Section and Bill Jeter, On Site Wastewater Section issued joint memorandums which provided a policy that would allow platted lots /permitted lots to use the 50+ feet separation. Some Health Departments and Environmental Health Supervisors did not believe the policy was in accordance with the proposed rules and had a bill introduced to halt the implementation (filed on the last possible day). Terry Pierce will work with the bill writer to modify the language so it will on address .0107(2)(3)

Health Promotion — Rosemary Summers

• Leah Devlin told the committee about a $96,000 reduction in federal health promotion block grant funding. The State is looking to make up that money so counties don’t experience a cut.
• Physical Activities Mini Grants are available. Check into these on the Imagine NC Web site.
• June 19, 2001 is the Division of Public Health Legislative Day focused around cancer issues. This will be similar to the Legislative Heart Healthy Day.
• BCCCP Medicaid was included in the Governor’s Budget.

HIPAA Committee — Leonard Wood

• HIPAA orientation meetings will be held (tentative dates/locations)

17. 9:30-12:30 Greenville AHEC

Technology — Ray Rabe

Sixty-six counties are eligible for Federal money in regard to telecommunication services in support for health care. Check this out at rhc.universakservuce.org/overview.

Having no further business, the meeting was adjourned.

Respectfully Submitted,

MiMi Cooper
Secretary