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.
Jim Roosen gave the Fellowship sharing some insight on different perspectives that can be applied to the same situation with very different outcomes.
The minutes of the May 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 May 25, 2002. Account balances were as follows:
Don reported that all the checks that were outstanding last month had come in and only two checks were still outstanding. After subtracting these checks, there was actually $35,948.55 left in the checking account. After motion and second, the treasurer’s report was approved without change. (See attachments for full treasurer’s report).
Mr. Yousey also reported that 99.9 % of the dues had been paid! He noted that just one county still owed 50 % of their dues and had promised to pay them in July. He said he wanted to thank everyone for their assistance in achieving the 100 % membership goal.
Ms. Rowe thanked everyone who had worked on the four public health funding priorities. She noted that, while we did not get everything we hoped for, considerable progress had been made. She also noted that while we have agreed to stress working on these four issues as an association that did not preclude us from working on other issues individually. Deborah reviewed progress that she felt we had made so far. This including getting the Medicaid rate reductions taken out of the Senate Proposal, having $1,000,000 of the TANF funds put back and getting the proposed $750,000 Health Promotions cut reduced to $180,000. She did say that the $1,000,000 aid to county cut was still in the budget. Ms. Rowe then reported that the budget would now go to the House where problems with the revenue package will probably be discussed. She stressed that if the revenues are cut then funding will have to be cut as well. Mr. Raynor thanked Deborah for her leadership on the budget work.
Mr. Raynor announced that the July meeting would be a full association meeting to discuss the Public Health Functional Partners (A Proposal to Strengthen State and Local Public Health Services to Achieve Improved Health Outcomes). Copies of the most current version were distributed (see attachment). Mr. Raynor requested that all members attend the July meeting if possible or send a written proxy to the Secretary if they cannot be in attendance.
Mr. Raynor then thanked everyone who had worked with their legislators on the four prioritized budget concerns adopted last month. He noted that while we had not achieved 100% success on these issues that significant progress had been made on the Medicaid Rates and the TANF funding. He again thanked the 16 health directors who had made time in their busy schedules to attend the Appropriation Committee meeting regarding the proposed budget cutbacks.
Wayne also welcomes two new health directors. Steve Smith is the new health director in Stokes County and Judy Bennett has started in Graham County.
Mr. Raynor announced that a special presentation was being added in this space to review the work done by the Blue Ribbon Task Force headed by Dorothy Cilenti. He noted that this would be followed by a presentation on the Public Health Functional Partners (PHFP) proposal by Dr. Devlin and Dennis Harrington. Wayne gave a short review of the history of public health visioning work that has been done in the past and stressed that this most recent effort was looking at system and services versus governance. He said he felt this would help them not get bogged down in the “local autonomy” issue. Mr. Raynor also reported that the Task Force had hoped to expedite their work and not draw it out so a recommendation would be brought forward fairly quickly. (Please see the Reports to the Association Attachments – dated June 5th and 20th). Mr. Raynor closed his introduction by stating that the visioning work was tied to providing more cost-effective services while working to improve health outcomes in the communities we serve.
Ms. Cilenti then discussed the report and noted how the Task Force had hoped to enhance the ways we work with the state. She reviewed the list of participants included in the report. Dorothy then reviewed the Task Force focus and summarized their activities to date and led those present through the steps the Task Force had taken in completing their work. Cilenti then reviewed the five recommendations from the task force (Please see attachment for specifics). The recommendations were as follows:
Dr. Devlin then discussed the Public Health Functional Partnership (PHFP) Proposal that had been reviewed by the Blue Ribbon Task Force and built into their recommendation (Please see PHFP). Mr. Raynor asked that questions be held until Dr. Devlin finished her presentation so as not to interfere with the continuity of the presentation. Dr. Devlin then explained that the proposal was about creating an environment for finding innovative, more positive outcome oriented ways of collaborating in public health. She reviewed critical environmental drivers, financial pressures and ongoing changes impacting public health at the present that call for change. Dr. Devlin then reviewed the entire proposal one section at a time (See PHFP for specifics). Dr. Devlin then announced that regional meetings had been set up for July 1st, 2nd and 3rd so that she and Dennis Harrington could meet with health directors to get their feedback on the proposal. (Please see attached meeting schedule and driving directions to meeting places)
After Dr. Devlin completed her presentation, she opened the meeting up to questions and suggestions. The following were offered:
Barry Blick offered that while the plan was very complex, it was very conceptual. He stressed that the tactical way we do business needs to be worked out. He cited that the redistribution of funding and services would cause some disagreement and in turn have an impact on local demand for services. Lastly, Barry felt we needed to build the needs of those we serve into the plan. Tim Green said that we all see the changes coming and we need to thank Leah, Dennis and Wayne for providing leadership (that has been lacking in the past) in designing the needed changes. Tim described the proposal as a “bold effort” to attempt looking at a better way to do business and hoped we did not miss this opportunity to make innovative changes for public health. Chris Szwagiel noted that others are making plans that will change the way public health does business and this option allows both the State and us locals to show what we are doing to make things better.
At this point, Mr. Raynor gave a summary of what had been covered. Wanda Sandele pointed out that the plan included several ideas we had hoped for in the past but did not have an environment of support for. Jim Baluss asked that we remember that in the grand scheme of things, this is not a big change, but is a better way for us to collaborate on in the agreement contract scheme approach. Dennis Harrington pointed out that there are some great health directors out there and encouraged them to bring their ideas to the regional meetings discussed earlier. George Bond pointed out the positive aspect of the proposal as it overcame the fear of the big county gobbling up the small county problem we had always met with in past plans. He also pointed out that the proposal would give locals some control over consultants and that this had been lacking in the past. George then pointed out that he felt we should be able to work out the liability issue and crossing county boundaries by working with Terry Snowden and our insurers. Bill Smith offered that the accreditation aspect of the plan might be crucial to driving folks into the clusters. Leonard Wood worried that changes seem to be coming too quickly and felt maybe July was too fast to get a response from all the health directors. Dorothy Cilenti recommended having another presentation at the July meeting and deciding then if we feel comfortable voting or want to delay the vote until the August meeting. Jerry Parks wondered if maybe we needed to look at scheduling a special association meeting just to deal with this issue instead of trying to fit it into our other meeting schedule and agenda. Mr. Raynor said he would give this option some consideration. For now, the group seemed to have consensus to follow Ms. Cilenti’s recommendation.
Ms. Snowden started her presentation by giving a short review of how recent events (9/11) have impacted malpractice insurance. She noted that she had hoped that these events would not have a significant impact on our rates because we had such a good track record. She said that she was sorry to report that, since many companies had recently opted to not provide this insurance any longer, this was not the case. After getting quotes from several insurance providers, the best rate came from our current insurer and the new rate shows an increase of 26.5%. Chris Szwagiel commented on what a great job Terry had done for us in negotiating rates in the past with the understanding that she had no control over this recent increase. Bill Smith noted how lucky we were that the recent hurricanes had not driven the cost up earlier. Terry then passed around several options (see attachment) that showed some savings if the association decided to increase our deductible or decrease our “excess limits.” Terry noted that with recent financial constraints being placed on health departments that we may be forced to take one of the cost-saving options, but recommended staying with the current coverage if at all possible. She asked for a show of hands on each option so that she would know what direction to continue on in her negotiations on our behalf. The vote was unanimous for staying with the current coverage and accepting the rate increase of 26.5%.
Dr. Devlin stated that she would keep her comments very short, as committees would discuss most of her items. She then thanked all those involved in the work with legislators on the budget and proposed reductions in public health funding. She noted that her staff is till busy on other issues (bioterrorism). Lastly, Dr. Devlin reported that she would be attending a signing session with Governor Easley today as he signs into law the smoke stack bill we had all endorsed last month. Mr. Raynor thanked Dr. Devlin and her staff for the wonderful work they did in helping us gather the statistical information we used in our deliberations with our legislators.
Ms. Moore reported that most of the materials from the recent HIPAA Training sessions was now available at their website (www.medicalprivacy.unc.edu). Jill also reported that the IOG was doing a session just for county attorneys to help them understand their county’s liabilities and responsibilities in drawing up HIPAA plans. It will be at Atlantic Beach on July 18th and she asked us to encourage our county attorneys to attend.
Environmental Health -- Terry Pierce
Motion 1. Mr. Pierce reported work continues on legislation to increase food and lodging fees. He passed out the most recent version of the proposed bill (see attachment). He noted that this bill would make some changes from the last draft as follows:
- changes funds distribution to State from 33.33% to 25% (reduction applies only if increases are improved);
- increased some fees and added some categories;
- deleted fees for child care facilities;
The previous draft increased existing fees, added establishments that will be charged fees, allowed state and local health departments to charge for plan review, allowed locals to charge for temporary stands. Terry noted that they are looking for legislative sponsor for the bill and noted that there have been several resolutions and letters of support from Boards of Health and County Commissioners on this issue.
Motion: NCALHD support the revised bill entitled “An Act to Amend the Fees for Food and Lodging Establishments” and the attached fee schedule. Coming from Committee and needing no second, the motion passed unanimously.
Motion 2. Mr. Pierce reported that discussion has been ongoing to try to identify the least harmful way to meet the proposed 13% reduction in Environmental Health aid to county funds. The division and the committee felt that a proposed reduction in lead hazard abatement would be the least intrusive for 85% of the counties. The proposed reductions would reduce reimbursement for voluntary investigations from $250 to $190 and mandatory investigations from $2500 to $2000, and eliminate other related expenditures. See attachment for numbers of investigations per county last year. The action would also eliminate the mini-grants and training reimbursements for lead training for local staff. The proposed cuts would not impact the $6000 general environmental health funds for counties nor include any reductions in the funds for mosquito control. Lastly, Mr. Pierce explained that the proposed cuts would not have any impact on Medicaid funds collected for the lead work and distributed to counties.
Motion: That the proposed 13%, $134,281, reduction in Environmental Health Aid to County Funds be taken from the Lead Hazard Abatement Program. Coming from committee and needing no second, the motion passed unanimously.
Technology Committee -- Leonard Wood
Mr. Wood explained that the North Carolina Healthcare Information and Communications Alliance, INC. (NCHICA) was willing to make the HIPAA Earlyview software package available to local health departments at a special rate ($75 per site). The committee was asking that the association approve a letter of agreement (See attachment) spelling out the specifics of the agreement and the responsibilities of both organizations in the agreement. Tom Bridges noted that the software would help us go through the preparation process and provided templates for forms, etc. Tom also explained that the agreement just made the software available to us all and did not require anyone to purchase it.
Motion 1. The Technology Committee motions to approve the letter of agreement between NCALHD and NCHICA to purchase the HIPAA Earlyview software tool. Coming from committee and needing no second, the motion carried unanimously.
As part of the above action and to facilitate members being able to contact NCHICA regarding the software, a link between our webpage and theirs was proposed.
Motion 2. The Technology Committee motions to approve the association adding a link to our webpage as well as a link to the instructions page for completing the purchase of the Earlyview tool. Coming from committee and needing no second, the motion carried unanimously.
Policy and Planning -- Jim Baluss
Mr. Baluss discussed a proposed budget cut that was not in our original discussions as it had not been proposed at the time. This cut would do away with “oversampling services” in some counties and this information was key to prioritizing services to help fill gaps. He noted that this committee had taken up this issue at the recommendation of the Health Promotion Committee. With that in mind, the following motion was offered:
Motion 1. Upon recommendation by Health Promotion Committee, and upon motion by Policy and Planning Committee, that NCALHD supports and encourages the State Center for Health Statistics to contract with the NC Alliance of Public Health Agencies, Inc. for “oversampling services” in their annual BRFSS process. Coming from committee and needing no second, the motion carried unanimously.
Mr. Baluss then reminded those present that the association had voted last month to support revenue enhancements generally versus picking and choosing which ones were best. He noted that Bill Smith had recently been working with folks considering an increase in the cigarette tax and had asked the association to support this effort. Don Yousey said he felt the previous vote was to generally support revenue enhancement did not preclude the association from supporting an individual effort such as a cigarette tax increase. With that in mind, the following motion was offered:
Motion 2. That NCALHD, in addition to its previously adopted position supporting “revenue enhancements” in general (to avoid deep and damaging funding cuts in Health and Human Services by the NC General Assembly), also specifically supports an increase in North Carolina’s tax on cigarettes at a level at least equal to the national average. Coming from Committee and needing no second, the motion carried unanimously.
Epidemiology Committee -- Dr. John Morrow
Dr. Morrow reported that the committee had met on June 11th and received a bioterrorism update from Steve Cline, received a briefing on two HIV/Mental Health Demonstration Projects, the cutting of CD 4 Testing and received a report from Dr. Roger McDaniel on the Biomonitoring Grant (See attached Minutes for specifics).
Women and Children's Health -- Wanda Sandele
Wanda reported that a recent change was made regarding retention of immunization records. With people starting school later in life, they have found that often immunization records have been destroyed. The AMA now recommends that these records be retained forever. Please do so. There will be new software for the immunization registry. Any record that is in the existing registry will be uploaded to the new software when it is
implemented. Ms. Sandele also reported that the DEC's have been tasked with being the lead agency for case management for the infant-toddler program. They are to assure that someone in each county is providing this service. Many mental health agencies do not wish to continue with this service. In regard to the overall cuts in case management, Kevin Ryan stated that the wording in the budget proposal regarding a 30% reduction in the cost of case management was very brief and felt it would allow the Department to decide which Medicaid line items should be involved. The purpose was to eliminate redundancies and overlap with multiple providers going into the same home and a variety of case management types could be considered. Dennis Harrington added that these services had been involved in the unbundling process with the hopes of being revenue neutral but with the proposed cuts this effort would be complicated. Glenn Martin said that a lot of these positions had been sold to County Commissioners (CCs) as self-sufficient because they raised enough money to pay for themselves. If this was no longer the case, some of these services may well have to be curtailed or stopped all together.
Technology Committee -- Leonard Wood filling in for Ray Rabe
Leonard Wood reported that he was sorry that Frances Taylor could not be here due to budget constraints. However, she did supply her usual HIPAA Consultant Activity Report (See attachment). Leonard then stressed that it is critical that we all ask for our extension on our HIPAA Plans. The committee had quite a bit of discussion on who should be the covered entity on this issue and Leonard shared that Ms. Wall felt the County should be. He added that if the county is not the covered entity then we would all need contract agreements between us and the other county departments. Leonard noted that the extension request is not a complicated process and Ms. Taylor has already provided most of the answers to the required questions. Mr. Wood also reported that Bob Martin of the Division of Information and Research Management (DIRM) has set a time line to get HSIS HIPAA compliant by the deadline in 2003 (Please see milestones attachment). Lastly, Leonard reported that Ms. Taylor would be working on getting templates out on all the privacy issues by December. He noted that they would not all come out at once, but would be released one at a time as they are completed. The Consent portions are scheduled to be done last as details on the rules are still to be worked out.
Education and Award -- Janet Lindbloom
Ms. Lindbloom was not present but sent a report that the Legal Conference agenda had been formalized and that the Committee would be meeting to select the Health Director of the Year Award recipient.
Policy and Planning -- Jim Baluss
Mr. Baluss reported that the committee had discussed unfunded mandates and the need for flexibility for restricted funds and contracts, revenue enhance needs (see motion above), reviewed the four budget proposal priorities adopted last month, and received liaison reports. He reiterated thanks for the work done with legislators on the budget priorities. He noted that the committee had discussed a recent report to DHHS on the need to provide more training and leadership to local health departments on serving Limited English Proficiency (LEP) clients. Lastly, Jim asked everyone to be aware that, while the agreed upon increase in fees for thin preps done by the State Lab may not occur immediately on July 1st, once the increase occurs later it will be retroactive to that date.
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 made a plea for all health directors to consider joining the Alliance as it makes it efforts to move forward. Barry then thanked Jen for getting the business end of the Alliance in better order. Mr. Bass then announced the new officers for the Alliance as follows:
Barry Bass Louis Latour Secretary
Debra Harris Bill Smith Barry Blick Dorothy Cilenti Bill Smith
Nominations and Bylaws -- Tim Green
Mr. Green reported that the committee would be meeting in Greensboro July 2nd. He noted that the meeting is open to all members. Tim then distributed a chronology for the committee work (Please see attachment) and indicated that the committee is beginning the process of selecting new regional representatives for those regions up this year.
Environmental Health Committee -- Terry Pierce
Mr. Pierce reported that the committee had met the day before the association meeting and sent forward the motions discussed earlier. He noted that they had also received a Restaurant Grading Pilot Project Status Report from Michael Rhodes. Michael reported that statistical significance of the project data was being evaluated by t-tests for validity. Michael had also reported that he and Linda Sewall had met with Chris Hoke to discuss the development of rules that address the directives from the Commission for Health Services, including elimination of one of the two grading systems currently in use. The Division is seeking a recommendation from the Food Service Advisory Committee (FSAC). They are also seeking health directors to serve on the FSAC and Ken Ring volunteered to serve. They would also like a health director from a non-pilot project county to serve if possible. Once all this is completed, the Division will be taking a recommendation to the November Commission Meeting. Lastly, since funding for the regional flocks is being cut, the committee thought that Local Health Departments may want to consider maintaining the flocks so this data is not lost.
Added Special Presentation -- Samara Adrian
Ms. Adrian reported that binders have been put together regarding the bioterrorism plans. One had been done for each county with specific guidance for upgrading each county’s plan. She said she would be outside in the hallway distributing the plans to each health director present.
School of Public Health -- Penny Whiteside
Mr. Whiteside reported that the school was doing a training assessment for the regional bioterrorism teams. He noted that most of them have completed the assessment tool. He will be contacting those who have not responded yet for their inputs. Penny noted that the Epi Teams will be the next group who will receive an assessment of their training needs. A letter has been sent out to begin to collect a list of Epi Team Members to include in the assessment process (See attached letter). An email has been sent out on this as well.
Region 2
George Bond reported that region 2 was working on an agreed upon time when all the health departments in the region can start their Flu Shot Programs. This is being done so as to provide a unified approach this year versus trying to scramble to compete with each other and private providers, as we have had to do in the past.
Region 4
Maggie Dollar reported that their region had discussed bioterrorism and had recommended that the 7 new “PHRSTs” (Public Health Regional Surveillance Teams) take the lead in developing the Regional Bioterrorism Plans, and that they assist counties in developing or revising local plans as needed. Also, that all the regional plans in North Carolina should follow a consistent format for integration into the state plan.
Maggie also said that their region offered the following motion for consideration.
Motion: Of the 19.4 million dollars coming to North Carolina in June, Region 4 requests that the state specify the process by which funds will be distributed to LHD’s, the dollar amounts, and the time frame so that these funds can be utilized to support our regional planning and implementation. Not coming from committee, the motion needed a second and George Bond seconded it. After some discussion, the motion passed.
There being no further business, the meeting was adjourned at 1:30 p.m. Wayne Raynor announced that the next meeting would be at this location July 20th.
Respectfully Submitted,
Don Yousey
Secretary/Treasurer