President Wayne Raynor welcomed the members of the association and guests to the April Meeting at 9:05 a.m. A quorum of Executive Committee members were present (see attachments for attendance roster). Mr. Raynor announced that this was an Executive Committee meeting and only members of the Executive Committee should vote.
Ray Rabe gave the Fellowship sharing some insight on not taking ourselves too seriously.
The minutes of the April 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 April 17, 2002. Account balances were as follows:
Don reported that all the checks that were outstanding last month had come in and only one check was still outstanding. After subtracting that check, there was actually $34,893.67 left in the checking account. After motion and second, the treasurer’s report was approved without change. (See attachments for full treasurer’s report).
Ms. Rowe said that she wanted to thank all 16 health directors who were able to make it to the Appropriations Committee Public Hearing on proposed budget cuts. She noted that several members got to present, but also felt that the number of health directors in attendance made an impression on the committee members. Deborah urged members not to get complacent and to stay alert as she felt the budget was on a fast track and if we were going to be successful in averting some of the cuts we needed to do this as soon as possible. She asked that every health director talk to their legislators whether they were on appropriations or not as they can still bring pressure to bear on committee members to protect their districts. Deborah stressed that this is most important with Senators and that we should point out how the cuts will specifically affect their districts. Ms. Rowe closed by asking everyone to review the Health Directors’ Corner in the NCPHA Newsletter (see attachments from last month).
Mr. Raynor reiterated Ms. Rowe’s urging to stay active in this budget process and to make sure our legislators know what the cuts will mean to us and the citizens of North Carolina. Wayne also spoke of an effort he was mounting to try to get inactive association members more involved. He spoke of asking each active member to identify an inactive member they were familiar with and try to make one-on-one contact to try to re-involve them in the association and its activities. Wayne then asked for inputs for the Directors’ Corner mentioned by Ms. Rowe and announced that Steve Smith will be the new health director in Stokes County and that Danny Staly had volunteered to act as his mentor.
Mr. Raynor announced that a special presentation was being added in this space on the agenda to allow Ms. Beth Rowe-West and Ms. Marybeth Lister of the Immunizations Branch to make a special presentation on the New Immunization Registry. (See Attachment) Ms. Lister then discussed the new registry pointing out that it will be a great improvement over what we are doing now for several reasons. These included the fact that it will reduce significantly the amount of recording required to update the data in the system, allow access to outside providers (decreasing calls on health departments to research such data), and will prompt doctors to follow the immunization schedules versus making health departments police compliance. Ms. Lister spoke more specifically to the recording issue by stating that immunization data is now recorded in four or more places and this will not be necessary with the new registry. Additionally, a lot of the data now needing to be entered by health department staff will be entered automatically through linkages with Vital Records and Medicaid eligibility records. Further, some hand charting will be eliminated and will relieve health departments of having to do labor intensive immunization status assessments. Lastly, the new registry will simplify vaccine accountability as it is driven by the vaccine inventory data in it.
Ms. Lister then discussed the issue of billing that she said had been raised. She said sadly that the new registry would not fix that problem. Most notably in this decision are the problems raised by HIPAA constraints that adding billing would put on the registry.
Ms. Lister urged everyone to use the new registry because of the advantages listed earlier and the fact that continuing to use old systems will only add the cost of maintaining them. Ms. Lister announced that there would be a pilot project to test the registry that will be of 3-6 month’s duration. The pilot counties will be Cabarrus, Chatham, Henderson and Pitt.
Mr. Harrington opened by stressing that budget woes are front and center in their current work. Dennis noted that so far about $30,000,000 in cuts had been made (specifics will be discussed in committee reports). He applauded health directors’ recent efforts with the Appropriations Committee and offered that he felt we couldn’t over estimate the importance of health director’s presence in these discussions. Mr. Harrington reported that the Commission for Health Services and the Public Health Study Commission had both met. He noted that George Bond had represented the association well at the Public Health Study Commission. Dennis also reported that three days of bioterrorism training had just been completed for the regional teams being set up.
Mr. Harrington then distributed copies
of a proposed bill regarding smoke stack air pollution and a support document
pointing out health issues written by Dr. Clay Ballantine (See attachments).
Dennis reported that everyone involved with this issue supports the bill and
asked that the association consider endorsing it.
Mr. Harrington then reported on a problem that is occurring with the Steps Out
Payment Program. He noted that some items are not aligned properly with the
system and this is causing some problems with payments. He asked that we notify
our budget people so they do not over react. Dennis said it will look like money
is being taken back, but that they were diligently working on the problem and
the money owed would be forthcoming.
Mr. Harrington then reported that the Media Training that is scheduled by Chris Cooke is having a limited enrollment. Dennis encouraged folks to participate as the training and travel is being covered by a grant. (Please see attachment)
Dennis then reported that Frances Taylor could not be available for the meeting as she was busy participating in the HIPAA training that is going on now. Dennis submitted Frances’ monthly report to bring folks up to date on progress being made on this issue. (See attachment)
Lastly, Dennis reported that the cost settlement money (Maximization) should have been distributed yesterday. He reminded folks that if they borrowed money ahead during the ICD9 conversion that the amount they borrowed would be deducted from the amount of their cost settlement. .
Policy and Planning -- Jim Baluss
Mr. Baluss reported that the Policy and Planning Committee had discussed the long list of proposed budget cuts and how they would affect public health. He noted that the committee felt it would water down our arguments if we fought all the cuts and had agreed to prioritize the cuts and try focus our energy on overturning the most harmful of them. The hope is that we intervene and try to get the highest priority cuts off the list before the recommendation leaves the Appropriations Committee as it was felt that it would be very difficult to get them removed once the committee’s recommendations have been published. Don Yousey offered that he felt the State was trying to balance its budget on the backs of locals. He said that they were suggesting the Medicaid rate cut in the hopes that locals could sustain the services by upfronting money and hoping to get it back during the cost settlement process 2 years down the road. Don said that it was not doable in many counties and would result in a loss of services in those locations. Dorothy Cilenti said that she felt there were some thoughts that health departments were not making the best use of available funds and we needed to be ready to deal with that criticism. After further discussion about uncompensated care, the problems with non-English speaking clients and the fact that DMA does not want them included in this discussion, Jim offered the following motion:
That in recognition of the profound challenges facing the state of NC to meet its current fiscal crisis, the NCALHD does not advance a position in blanket opposition to each and every one of the proposed deep cuts in the funding of essential public health services. However, the NCALHD strongly opposes and calls on our collective representation in the NC General Assembly to strongly oppose four (4) of the most damaging of the proposed cuts to the ability of local public health to provide a safety net of health services and promotion of our citizens. These are:
- Cuts through a rate reduction in Medicaid Reimbursement to local health departments;
- Cuts in Aid to Counties;
- Family Planning cuts through reduction of TANF, APP, and cost shifts in cancer service; and
- Health Promotion and Prevention funding cuts.
Coming from Committee and needing no second, the motion carried unanimously.
Mr. Baluss then went on state that the Policy and Planning had also discussed that there were other options besides just cutting funding. He noted that during the presentations at the Appropriations Committee there were a large group of sister organizations who advocated revenue enhancements. Now on the table is increasing the cigarette tax to 50 cents. This would move NC from one of the lowest cigarette taxes to the mid range. Jim said that the committee felt that they should not advocate for just one of the revenue enhancement options but should instead vote to take a position with our sister agencies to support a wide range of enhancements and let the Legislature decide which was best. He noted that this would also allow the association president to write in support of any revenue enhancements that were on the table. There was general consensus for this approach by those present and the following motion was offered from committee:
That the NCALHD believes it is not responsible governance to attempt to rely solely on deep, and harmful cuts to meet budget shortfalls – in a way that truly harms our most vulnerable and needed citizens. Accordingly, the NCALHD herein joins the many and varied organizations and groups calling on the NC General Assembly to adopt a more balanced approach to meeting this fiscal crisis by enacting responsible and equitable revenue enhancements to retain a safety net of public health and environmental health and health protection to the neediest and most vulnerable of our citizens. Coming from Committee and needing no second, the motion carried unanimously.
Women and Children’s Health -- Wanda Sandele
Wanda Sandele reported that her committee had discussed a recent DMA decision not to fund billing from Maternity Outreach Workers (MOWs) if the positions had been vacant for more than six months. Jim Baluss noted that there were some who felt that MOWs were not as successful as people thought they would be, but still felt we should try to correct this problem. Wanda said that with the positions freezes in may counties, that many of the positions may be open more than six months and this decision during this fiscal crisis did not seem appropriate. Bill Smith said that all the coordination programs were under attack and maybe we should save our reaction for the bigger ones like Child Services Coordination (CSC) and Maternity Care Coordination (MCC). Don Yousey said that he had experienced more success than just about anyone else in reducing infant mortality and stressed that a successful program needed to include beefing up the entire gamut of maternity support programs. He said he felt MOWs were crucial to the success he has seen and asked others not to diminish their importance. At this point, Wanda offered the following motion from committee:
That the committee recommends that the President of the Association send a letter to DMA regarding suspension of the freeze on reimbursement for MOW services when the position has been vacant for over six months. Given freezes on filling personnel vacancies in many counties, these vacancies may be imposed even on viable programs. Coming from committee and needing no second, the motion carried unanimously.
Women and Children’s Health -- Wanda Sandele
Wanda reported that a recent survey done for Family Planning did not show significant problems with lead time for appointments. Another survey will be performed in the fall to measure the impact of budget cuts on the program.Beth Rowe-West gave a summary of recent rule changes relative to immunization: 1) The Immunization Advisory Committee recommended and the Health services commission approved the rule that immunizations could not be given more than four days early. Waivers were being given up to seven days and some even longer when it was determined that the rules did not give authority for a waiver. 2) In the event of an outbreak of rubella, vaccination can be required even of those exempt in the current rules (e.g. over 50, or entered college after 30th birthday if prior to 1989) This was the result of a local health department employee refusing the vaccine though exposed as a child service coordinator to a high risk population. 3) The third dose of Hep B can not be given prior to six months of age, it is not effective prior to that age.
Technology Committee -- Ray Rabe
Mr. Rabe asked Dennis Harrington to discuss "Goodness of Fit" progress.
Dennis noted that good progress is being made on the development of a "functionality matrix" with the help and support of state staff and local health directors and their staff. The next important step will be the awarding of a contract for the formal study. Dennis reported that the contract for the study has moved out of the Budget and Analysis to the State Budget office with the Secretary's strong notation that she "expects it to be signed." If the study concludes that MMIS is not a good fit, then other options will need to be explored. with the technical support of PCG (Public Consulting Group of Boston). Joy Reed reported that the contract had been sent to EDS so they can begin studying it even though it hasn't been signed yet by state budget. Further, Joy reported an okay has been received from the State Controller's Office for permission to modify the state accounting system should such changes go forward based on a "good" fit between our needs and MMIS's capabilities.Lastly, we are told the specifications for the interface between a HIPAA compliant HSIS and local health department software vendors were sent early this month. This is several months later than originally planned, but the cut in HIPAA compliance funding at the State PMO has impacted the work that DIRM has been able to do in getting these specifications out.
Ray asked Dr. Steve Keener to give an overview of his recent trip to Atlanta. Dr. Keener reported that he had attended a meeting on the National Electronic Data Surveillance System (NEDSS). He noted that this is a concept being developed by the CDC. If followed by all states, it should allow for a seamless system for states to share information. Steve further said that the system would allow for a central repository of secured information that we could all access (with proper clearance) when necessary to obtain information on disease outbreaks and threats. Dr. Keener closed by stating that he felt NC was right on track with their bioterrorism planning and felt the CDC plan should dovetail well with our efforts.
Education and Award -- Janet Lindbloom
Ms. Lindbloom reported that the committee had met via conference call. She reminded everyone that the Legal Conference will be held in conjunction with NCPHA in New Bern September 25th and 26th. She listed numerous proposed topics and said the committee would try to pick those that had the widest applicability to all the health directors. Included on the list was:
Legislative Update;
Legal Issues Regarding Bioterrorism – Liabilities;
Legal Requirements for the Public to Speak at Open Meetings;
Inter-Local Agreements;
HIPAA Update;
Environmental Health Across Jurisdictional Lines;
Guardianship;
DNR Orders in Schools;
Subpoena of Medical Records; and
Legal Ramifications of Not Being Able to Provide Mandated Services.
Janet noted that she was sill open to feedback on other topics and asked anyone with something special they feel is needed to send it to her.
Policy and Planning -- Jim Baluss
Mr. Baluss reported that the committee had discussed policy and planning implications of the proposed deep budget cuts. He thanked Dennis Harrington for understanding the need for flexibility in using what funds are left. Jim noted the dilemma of how do we work for flexibility in utilizing available funds without drawing undue attention to them and increasing the risk of them being taken by counties and used elsewhere? Those present agreed this was a tickly situation and care should be given when working this issue.
Alliance (NCHAPHA): -- Barry Bass
Mr. Bass reported that the Alliance would be meeting immediately after this meeting at 12:30 PM in this room. He noted that the Alliance will be discussing dues, but did not feel there would be an increase in dues this year. In fact, Barry said he thought the gist of the debate would be to try to get counties to maintain their membership during the fiscal crisis. He also said they would be discussing pricing for the staff arm of the alliance and the Board and Officer slate for next year.
Reimbursment and Finance -- Bill Smith
Mr. Smith reported that Medicaid is no longer publishing their Bulletin in hardcopy. He said that we would need to visit their webpage to view it in the future. Bill recommended setting up a system of checking the webpage monthly as changes listed in the electronic version of the webpage are still binding once it is displayed.
Environmental Health Committee -- Terry Pierce
Mr. Pierce reported that the committee had met the day before the association meeting, but that there were not many people in attendance from the association. Terry then gave a summary of several topics of interest that were covered by the committee (See three Attachments [Minutes, Pilot Project Summary, Act to Amend Fees for Food and Lodging]). These included an update on the Pilot Project, a proposed bill to change the fees for food and lodging and the subsequent use of the extra money generated, and the problem with the three vacant positions for Regional Soil Specialists. Additionally, Malcolm Blalock will be retiring August1, 2002.
Tim Green said that he wanted to thank Mr. Raynor for the excellent job he had done presenting the Association’s position on the Pilot Project to the Health Services Commission. Ray Rabe commented on the need for a secure system to electronically discuss such issues as he felt some of the correspondence on this issue was less than professional. Ms. Rowe noted that she had a subset of the Local Health Director List Serve that she would be happy to forward stuff through for us if we felt distribution needed to be limited to members only. Mr. Raynor said that while increasing the fees for food and lodging would be beneficial, that little incremental increases that do not really cover the cost of the service were probably not the answer. He asked that the Environmental Health Committee look into the possibility of allowing locals to set their own fees for these services like we do in several others areas.
School of Public Health -- Penny Whiteside
Mr. Whiteside reported that the school was working on training the state team on bioterrorism. He further noted that they would be looking at doing a training needs assessment for the rest of us as well as establishing a training database. Penny also spoke of an upcoming Acute Disease Surveillance Class (See Attachment) and that the School is working with the Institute of Government on HIPAA training as well. In response to a question on whether the North Carolina Association of Local Board of Health was still a viable organization, Mr. Whiteside replied that they were but that they were working on their business plan right now. Lastly, Penny reminded everyone of the upcoming “The Epidemic of Obesity” teleconference that is scheduled for June 7th (See Attachment).
Office of Public Health Nursing -- Joy Reed, RN
Ms. Reed reported as a carry over from last month that research did show that health departments are indeed exempt from having to collect co-pays for any Medicaid reimbursed service. She also spoke of the “Crosswalk – Round II” teleconference scheduled for August 13th. She then reported that due to budget constraints, re-rostering forms for nurses will be mailed to one person (DON) in each health department instead of sending them out individually. Additionally, these same budget constraints may require that enhanced nurse training either be offered in a different format or at a higher fee to local health departments. Lastly, Joy reported that health departments have been listed as service areas that are Okayed for repayment of educational loan worksites (i.e. RNs who work in health departments can have up to 60% of their loans forgiven). (See Attachment for specifics)
None
There being no further business, the meeting was adjourned at 12:30 p.m. Wayne Raynor announced that the next meeting would be at this location June 20th.
Respectfully Submitted,
Don Yousey
Secretary/Treasurer