President Wayne Raynor welcomed the members of the association and guests to the April Meeting at 9:00 a.m. A quorum of members were present (see attachments for attendance roster). Mr. Raynor announced that this was a full association meeting and all members in good standing could vote. Wayne also thanked the County Commissioners for allowing the association the use of the meeting room.
Danny Staley Gave the Fellowship sharing a short course in human relations.
The minutes of the March meeting were posted on the web site, ncalhd.org, and approved as written.
Don Yousey presented the treasurer's report with the balances as of March 20, 2002. Account balances were as follows:
Don reported that he had updated this report to include outstanding checks so that the real balance of $34,638.15 was actually reflected. Mr. Yousey also reported that all but six counties had paid this year's dues and that he had contacted all those who had not paid within the past two weeks. After motion and second, the treasurer's report was approved without change. (See attachments for full treasurer's report).
Mr. Raynor announced that a special presentation was being added in this space on the agenda to allow John Shaw the opportunity to provide a briefing on a Project Proposal he is were working on (See attachment for handout provided). John reviewed some historical information regarding work that had been done in the past regarding the structuring of local public health services. He cited an Institute of Health report of about ten years ago that described public health in the United States as being is disarray. Subsequent to that, several studies had been completed to see what needed to be done to correct the problems. John noted that since consensus had not been found that little had been done to fix the public health service delivery system. Mr. Shaw then noted that the current project was hoping to look at population changes that have occurred over the past ten years (and look at changes that are expected in the next ten years) and look at different delivery systems that might better meet the needs of North Carolina's citizens over time. He stressed that his group hoped to include local health directors in their efforts as they were seen as a key component to this project. Mr. Shaw stressed that the main goal of the project was to seek consensus on how to improve the public health delivery system. He then reviewed the eight strategies listed on his handout giving examples of how he felt each was applicable to current public health needs. The strategies included:
Dr. Morrow pointed out the Environmental Health had been left off the key players list. Wanda Sandele pointed out that she felt the opposition to change was with County Managers and County Commissioners who don't want to give up local autonomy rather than health directors. Don Yousey replied that it was unrealistic to ask local government to fund public health programs without local government having some say about how the work is carried out. Mr. Shaw noted that with so many different departments and no central plan, that there is a wide variance from county to county on what services are being offered. Tom Bridges said he felt like a good credentialing or accreditation program could do a lot to standardize care across the state. Mr. Shaw added that he felt that accountability needed to be built into any program that was offered. He further stated that we also need to look at sustainability so that we build programs that will last. Danny Staly stated that he felt any change should be driven by strengths versus making changes secondary to weaknesses. Mr. Raynor talked of the ever expanding role of public health (West Nile Virus, bioterrorism, etc.) that keep getting added to our duties and often without adequate funding. Mr. Shaw noted that funding will be key to any program changes that get presented so that our programs don't get driven by "chasing Medicaid dollars."
Mr. Regan, Deputy Director of the North Carolina Association of County Commissioners, welcomed the health directors to the Albert Coates Building. Mr. Raynor offered Mr. Regan the time to make a few comments. Mr. Regan said he would like to review the State budget crisis and noted that the state government had withheld a large portion of the tax collections that was supposed go to counties. He said that we would hear within ten days if the money would be released like it was last year, but felt there was little hope this would happen. He noted that County Commissioners are asking that counties include the money in their budgets as if it were coming, but to use it on non-recurrent items just in case it is not released. He further noted that to assume it was not coming would make it too easy for the state to just keep it. The projected deficit looks like $1.8 billion without taking into consideration personnel raises, etc. Mr. Regan noted there has been some discussion of revenue enhancement in the Senate, but felt like it would be a much harder sell in the House. Mr. Regan then discussed the different options on how the sales tax might be used next year or the possibility of a local sales tax. He noted there had been some discussion of accelerating this process. Mr. Regan stated he felt the County Commissioners thought the public might accept a _ cent tax increase if one considers the cuts in services that would be required without it. Another option was for the State to keep the _ cent sales tax and assume the counties' portion of the Medicaid bill. Mr. Regan closed his summation of the budget crisis by saying that the state was also looking a simply abandoning some services (i.e., building inspections and erosion studies).
Mr. Regan than wondered if anything good might come out of the budget crisis? He noted that the governor sees this crisis as more than a recession and has charted a commission to study modernizing state financing. Also, the state is looking at how we tax certain services but do not capture all of those served as a way to broaden the tax base without actually increasing the rate. The budget crisis also offers the chance to reform the Executive Budget Process into something more like local government with its built in protections. Lastly, there is some thought from the business community regarding limiting how long the General Assembly is allowed to stay in session. Mr. Regan noted that while the legislature is a deliberative process there had to be some realistic limits to how long the process can be drawn out.
Wayne Welcomed Carmine Rocco as the new Health Director in Warren County.
Deborah said that she just wanted to remind everyone that NCPHA and this association had agreed to share space in the NCPHA Newsletter rather than have to produce two separate information items that frequently covered the same material (were frequently redundant). As part of this, she showed where NCPHA had dedicated a portion of their Newsletter as "Health Director's Corner" and urged everyone to read this update from Mr. Raynor (see attachment). Deborah also reminded everyone that the Glaxo Awards are coming up again soon and asked everyone to consider putting up their programs for this important recognition. She noted that there are new judges this year and encouraged everyone to dust off their old submissions for possible reconsideration as well.
Dr. Devlin noted that a lot of what she has to say will be covered in committee reports so she planned on keeping her comments brief. She noted that there are three processes going on that are looking at public health. First there is the Health Directors' Association effort and then there is John Shaw's work. Lastly, Dr. Devlin said the department wants to look at how they support us as well. Leah then noted that the department had finally been asked to submit budget cuts at the 15 percent level (We had all feared this might come) and the department has also been put on notice to begin talking with legislative committees. Dr. Devlin noted that her folks would continue to look at making the cuts without affecting local delivery of services if at all possible. Dr. Devlin then talked about possible areas that might see cuts at the 15 percent level, but did not want to commit to any final decision at this point. Some areas discussed as possibilities were DEC's, Intensive Home Visitation Program, Home Health, and Family Planning. Ray Rabe wondered if it wasn't time to start talking to with the federal people regarding the continued down flow of unfunded mandates (HIPAA, safety syringes, interpreters, etc.).
Dr. Devlin also noted that cuts in Medicaid are being looked at. This might come from cutting rates, services or both. Dr. Gabel discussed the issue of non-Medicaid eligible clients taking up more and more slots so that programs are less able to be self-sufficient. Deborah noted that the survey on unfunded care showed that the 51 responding health departments had provided $34,635,133 worth of care to uninsured clients. This has forced health departments to redeploy staff from other areas to help in these not earning their own way. Jim Baluss asked if the restrictions on moving funds from program to program might be eased to help us during these hard times. Dr. Devlin said she would look into this.
Dr. Devlin then reported that 900 refugees from Vietnam would be coming to North Carolina soon and the funding is in place to deal with this. She noted that these people had fought along side our troops during the Vietnam War and were now in refugee camps in Cambodia. She stressed that they refugees will have a big impact on the counties they are going to.
Lastly, Dr. Devlin reported that the bioterrorism grants had been submitted on time. She said that she had heard that us when we said the state had not included enough local funding and that this had been included in the final draft (see summary handout). She noted that money had been added to look at communication and training needs at the local level.
Dennis Harrington reiterated that local needs were put into the bioterrorism grants. Additionally, Dennis asked that we warn our financial assistants that there will some squirrelly things going on this month with the step out payments. Dennis asked that we not overreact as the problem will be resolved in the May payment. Also, the $1,000,000 cut in Health Promotion will be coming down soon. Lastly, the Medicaid Maximization deadline has been met and the money will be coming out after July 1st. Don Yousey asked if Dennis would be sharing the estimates due each county and he agreed to have them out soon.
Frances Taylor provided her monthly report on progress being made toward HIPAA compliance (see attachment). Frances reported that the website is up and running. She noted that the Deliverables section of her report speaks for itself. Frances further reported that she had fielded about 129 questions regarding HIPAA this past month. Someone asked if there was any work being done to provide these questions to all health departments to help prevent redundant requests. Ms. Taylor replied that all the questions were being put on the website. Frances then reported that the discussion on who is the legal entity that needs to ask for an extension if necessary was still being debated. There has been some verbal feedback that extension requests need to come from the County Managers and Attorneys and Aimee Wall will be providing this feedback to County Attorneys in the near future. Ms. Taylor then reported that the template for the HIPAA Plans is now available at the HIPAA website, but recommends we wait until some of the legal questions are settled before submitting. Frances does recommend using the electronic submittal method when we do submit them as it will result in a written receipt where hardcopy submissions will not. Lastly, Ms. Taylor reported that while numerous counties had volunteered to be pilot HIPAA sites, only four could be chosen. The sites chosen are Durham, Guilford, Orange and Person Counties.
Environmental Health -- Maggie Dollar filling in for Terry Pierce
Maggie said she had two motions to deal with. She noted that she would deal with the simple one first as the second might take some discussion to clarify it. Maggie then discussed how there are only two real four-year college programs in Environmental Health and ECU was planning on cutting their program as an answer to the budget crunch. The EHS Committee offered the following motion: That the Association (NCALHD) send a letter to the ECU Chancellor in support of the University continuing to provide the EH baccalaureate program, as it is one of the only two accredited programs in NC producing EH graduates who meet the RS Board's requirements for a 1-year RS internship (instead of the usual 2-year internship). Coming from committee and needing no second, the motion carried unanimously.
Maggie passed out a handout (see attachment) that held two resolutions regarding the Pilot Project that has been discussed for several months by this committee. The motions were essentially the same except for the last paragraph. The first was the one sent to all health departments via email calling for a grade card with both a letter grade and large numerical score versus the score alone as was being proposed by the Pilot Project. The second resolution called for posting the actual Inspection Report with the score earned superimposed over the front page in large numbers. Barry Glick spoke of the progress his county had made since volunteering to do the Pilot Project and how the education process had greatly improved the relationship between his staff the food service industry in his county. Barry also spoke of a recent new look at the data from the project that showed significant improvement in sanitation grades over time. Barry noted that his Board of Health felt strongly that the sanitation improvement shown made making the Pilot Project statewide worthwhile. Barry stressed that the EHS Committee had worked on this issue over four hours the day before this meeting and Malcolm Blalock had offered the second option as a compromise. Don Yousey said that the committee felt strongly that we too often go before the Health Services Commission to argue differing points of view on subjects rather than looking for compromise. Don said he felt that the second proposal would allow us to move forward in unison with the Division rather than force us to go before the Commission once again debating rather than compromising. Both Barry and Don thought having the Inspection Sheet available to the customers would better allow them to see what was actually found during the inspection as well. George Bond countered that he had a problem with using the Inspection Report as he was not sure anyone could read the ones produced by his staff and felt that was probably true across the state. Several others also spoke of favoring the original resolution that was send out earlier and again stated that this option was offered by us as a compromise in the beginning of this whole debate. After some further debate back and forth, the motion from committee (and needing no second) was restated as "That two proposals regarding the Restaurant Grading Pilot Project be presented to the Association (NCALHD) for its consideration and vote, so that a consensus recommendation can be presented to the Commission on Health Services." The motion calling for a grade card with a letter and numerical grade carried by a large margin.
Please note that the brevity of committee reports was due to shortness of time and does not reflect a lack of interest or work by committee members.
Health Promotion/Oral Health -- Rick Mumford
Rick Mumford passed around a handout on oral health that he wished to share with the health directors. The handout covered Dental Access for Low-Income Citizens, an Evaluation of the Cost-Effectiveness of the Flouride Mouthrinse Program, the NC Oral Hygiene Section Action Plan and maps comparing the number of Dental Care Safety Net Facilities between 1996 and 2002 (see attachment).
Environmental Health -- Maggie Dollar filling in for Terry Pierce
Maggie reported that the greater portion of the EHS committee meeting dealt with the Pilot Project as discussed earlier. She did say the Division asked her to announce that they finally gotten permission to order the printed materials that we had all been asked to pay for recently.
Alliance -- Barry Bass
Mr. Bass reported that the Alliance would be meeting immediately after the association meeting in this same room. He also noted that the Alliance dues invoices would be sent out soon. Lastly, Barry said that Mr. Keith Garner would be providing a presentation of safe syringe devices during the Alliance meeting.
Policy and Planning Committee -- Jim Baluss
Mr. Baluss reported that the committee had met via conference call secondary to travel restrictions caused by the budget crisis. Deborah reported that the ERC would not be taking up the question of hiring and firing of health directors until the May meeting. She did note that this item still needed to be watched as it was like the gopher game at the State Fair. Each time you hit it, it pops up someplace else. Jim reported that the committee had also discussed the continuing unfunded mandates that keep coming down even as the financial crisis threatens funding and wondered if a study needed to be done if funds are cut. The committee also discussed the possibility of local fees for restaurant inspections, but had deferred on this issue as it is being looked at in the EHS Committee. Chris Hoke then discussed the need to update NC Law as regards public health authorization in light of new bioterrorism responsibilities. He distributed a copy of the proposed law (see attachment) asking for feedback. Chris said that since the current law was already pretty good, this update focused on access to information and public health's authority to investigate when we feel an exposure has occurred. He added that the quarantine law also needed some tweaking. George Bond wondered if there shouldn't be more included about local health directors' authority versus just dealing with the State Health Director's authority. Chris replied that he felt most of the authority in the law needed to be at the State Health Director's level as he/she would most likely be the one needing the tools to determine if an exposure had in fact occurred. He felt locals would most likely be involved after this determination has been made.
Education and Awards Committee -- Lindbloom
Ms. Lindbloom reported that the committee had reviewed the NACCHO Scholarship applications and took into consideration whether those applying had gone before and would be willing to commit to serve actively in NACCHO work in the future. With this in mind, the committee had chosen Dorothy Celenti and Roxanne Frederick with funding being at the $750 level.
Technology Committee -- Ray Rabe
Ray reiterated that every county will need to submit a HIPAA compliance plan. He again recommended using the electronic format as it would result in each submitter getting a receipt. Ray also spoke of the Health Alert Network noting that the equipment given will be state-owned and maintained and that the equipment was being upgraded from the original 256K as planned to 768K. The April 17th Technology Committee minutes will be posted soon and inform members of other issues discussed.
Women and Children's Health -- Wanda Sandele
The Committee received a briefing on the System of Care (SOC) currently in effect in 22 counties for case management of children at risk for serious emotional problems. The goal is to expand this program to other counties with the eventual target of having this team approach for all children who need case management. Information will be put out on the list server to all health directors. This would appear to further the eventual goal of the Secretary of HHS for bringing Public Health and Mental Health together.
The committee inquired as to whether or not the Association has a liaison with Mental Health. Wanda will check on this and discuss appointing one with the President if necessary.
Health Departments interested in providing mental health services should consult the April Medicaid Bulletin for the codes that will be accepted from Health Departments after July 1st. Some health departments who provide primary care have expressed interest in being able to do this due to the limited resources of the local mental health agencies.
Tanf funding for health departments is expected to be totally eliminated n the next fiscal year.
Epidemiology Committee -- Dr. John Morrow
Dr. Morrow reported that the committee had met via conference call and discussed the final bioterrorism grants, had a West Nile Virus update, Aids Drug Assistance Program enrollment and a scheduled public information session on mercury in fish (see attachment for specifics).
School of Public Health -- Penny Whiteside
Mr. Whiteside reported that his office would be sending out a survey regarding how they can better serve our needs (see attachment). Penny reminded those present of the ongoing collaboration between the school and ANCBH. He submitted a handout regarding contact information on this (see attachment). Lastly, Mr. Whiteside reported that the next Grand Rounds will be "The Epidemic of Obesity".
Office of Public Health Nursing -- Joy Reed, RN
Ms. Reed reported that there were now mandatory co-payments for Medicaid patients and we had not been exempted from this as we had in the past. She asked that we not change how we are doing business as the State feels we have always had such an exemption and they are trying to work it out. Joy noted that October 1st is the date for the rest of the code conversion to take place. Training on this will be forth coming.
None
There being no further business, the meeting was adjourned at 12:20 p.m.
Respectfully Submitted,
Don Yousey
Secretary/Treasurer