President Wayne Raynor called the meeting to order at 9:00 am and welcomed members and guests. President Raynor conducted a count of members present and confirmed a quorum for a full association meeting (43 members were present at roll call). He announced that since a quorum was present, that this would be a full association meeting. Please see attached Attendance Roster for actual attendance.
Dr. Morrow shared a humorous story about his mother and grandmother and their perspectives on privacy.
President Raynor reminded members that the minutes were posted on the web site and asked for a motion to approve the minutes as posted. Joy Reed pointed out that a typo existed on page 6 where the last line of the OPHN Nursing Report read Medicaid. She noted that it should read MEDICARE. There was a motion to approve the minutes with the correction and a second. The motion was unanimously approved.
Don Yousey presented the treasurer's report (see attachments for full report). The balances are as follows:
There was a motion and a second to approve the Treasurer's Report as presented which passed unanimously. Don Yousey added that he was nearing the end to his update of the health directors’ roster and that some people had changed their info three times. Don said that he would be sending out the latest version in about two weeks and any further updates would be left to next year’s Secretary.
Deborah Rowe reported that everyone had a great time at the Annual NCPHA Conference in New Bern with 350 people attending the Awards Banquet. She noted that service pins had been distributed, but that not everyone could be in attendance. She said she had envelopes for those counties who had people who still needed to receive their pins and asked that these be handed out in a public way (i.e. staff meeting, etc.). Deborah reminded everyone that she had said she had an important announcement to make at the Awards Banquet and then announced that Dr. Anne Wolfe had left the bulk of her estate to be used in a trust fund to continue her life-long work in public health. Deborah said that the money would go to fund mini grants in local health departments to work on reducing infant mortality. It is thought the estate will produce between $30,000 and $50,000 available revenue per year. It was hoped that the interest from the trust fund would be enough to support the grants, but the legacy does allow some of the principal to be used if necessary. Deborah noted that a foundation board would be formed to oversee the foundation. Ms. Rowe said that they hoped the first grants would be awarded either later this year or next and the recipients would be announced at the annual NCPHA Meetings.
Ms. Rowe then announced that David Stone had been elected President-Elect of NCPHA and that strategy planning is ongoing for the upcoming year. She asked everyone to forward their ideas to David. Lastly, Deborah stressed the importance of health directors’ involvement in the legislative process citing George Bond and the help he gave by calling his legislator on an important issue this year during budget work.
None other than above.
Dr. Devlin spoke of reorganization that is taking place with her staff and shared a handout of the current organizational chart (O Chart) (see attachment). She noted Dennis Harrington’s expanded role that will encompass all financial work done by the division. She noted that Joy Reed would be taking over Local Services and thanked her for her wonderful support and noted that nurses are currently celebrating “100 Years of Nursing.” Dr. Devlin noted that the Oral Health Section was still be being shown in its own box so that it did not lose it identity. Danny Staley asked if an O chart for EHS could be obtained as well. Michael Rhodes said he would look into getting the current EHS O chart out to all health directors.
Dr. Devlin then reported that there was discussion about taking Carolina Access statewide next year. She noted that she had asked Jim Bernstein to keep local health directors involved in the process. Dr. Devlin also reported that the substantive legislative agenda is due by December 2nd and the Expansion Budget projections are due next week. Dr. Devlin said that she hoped to share this with the health directors next month. Some ideas that might be included were listed as: an initiative to work on health disparities, possibly West Nile Virus, and possibly Influenza and Pneumovax for infants Maggie Dollar made a pitch that some thought be given to providing some funds to help local health departments carry out the new bioterrorism taskings that have been coming down lately.
Dr. Devlin then reported that a lot of discussion is going on regarding the different ways that health departments work with community based organizations (CBOs) dealing with diversity, after hours services, etc. She noted that she would be putting together a draft of a survey to get an assessment of the ways we are collaborating with and the relationships we have with these groups. Jim Baluss asked if there was a leadership group in place to study this. Dr. Devlin replied that there are groups looking at pieces, but no group looking at the overall issue. Dr. Tim Monroe noted that he felt this was a good opportunity to educate CBOs about local health department limitations and lack of capacity to deal with every issue some groups would like us to. Lastly, Dr. Devlin said that she was thrilled about what had been done with the goodness of fit work.
Environmental Health -- Terry Pierce
Mr. Pierce reminded everyone that last month the committee had submitted a draft grade card that they thought they had consensus for. However, it turned out that the EHS Supervisors and Restaurant Association did not support the proposed “compromise.” The EHS Section of NCPHA had come out supporting leaving the grade card as it has always been and the Restaurant Association advocates expanding the pilot project statewide. Once the Division and the EHS Committee understood that the so-called compromise had fallen apart, they revisited the compromise grade card. They felt like the two inch letters called for looked too crowded and now asked this association to support the compromise card but with 1.5 inch letters and numbers. With that in mind, the following motion was offered from Committee: That the Association support the recommendation of the Division of Environmental Health to discontinue the pilot project and to develop and implement a combination alpha-numeric card, with the letter grade and numerical score to be 1 _ inches in height and the printing be black on a white background.
Terry added that draft rule changes have been developed to implement the option approved by the Commission. Additionally, the Division will promote educational efforts re: the meaning of grade cards to coincide with the changes. Ms. Sandele and others wondered that since there was no consensus for the compromise card why this association would want to support it and maybe we should support the score cards in their original format (like the EHS Supervisors). Tim Monroe stated that he was against the change as we were giving up the color coding without getting anything in return. In fact, since there was probably going to be some cost to health departments for the educational component to making the change, this could be seen as a negative. Terry Pierce reminded everyone that the idea of the benefits from an educational component came from the health directors and had not been put forth by the Division. Terry then pointed out that we really had four options as he saw it:
- Leave the program like it always was and drop the pilot project;
- Adopt the pilot project statewide;
- Use the compromise card being offered today; or
- Allow each Board of Health to choose which it like best.
Glenn Martin said he worried that voting for the motion made it look like the association was advocating for the motion rather than just going along with it. George Bond noted that this action was not really substantial and asked that the Division look at high risk versus low risk establishments, frequency of inspections (when many counties are only completing 60% of required inspections), etc. Mr. Rhodes said that the ideas Mr. Bond was proposing were going to be looked at by the Division in the near future. After this and other lively debate, the question was called and it carried with 35 for the motion and 7 against. .
Policy and Planning Committee -- Jim Baluss
Mr. Baluss noted that while he did not have a motion from committee, he did have an administrative matter that he needed association action on. Jim then pointed out that we have been having some problem booking meeting space at the North Carolina Hospital Association (NCHA) building and there have been some complaints about noise when we do have our meetings there. Additionally, Gibbie Harris has been gracious enough to offer the current meeting space if we needed it. Gibbie added that it was already booked for the coming year starting in January. Deborah Rowe noted that she does most of her work from home and thus NCPHA had decided that use of the office space was too expensive for just mail pick up. Thus, NCPHA was pulling out of the rental for next year. Barry Bass said that the Alliance also wanted out of the rental agreement and thus if the association voted to continue to rent the space we would be going it on our own. We had split the rent three ways between the three organizations in the past. With the above discussion in mind, Louis Latour moved to ask the President of the Association to notify the NCHA by October 31st that we will not be renewing our lease on the office space in January. Barry Bass seconded the motion and it carried unanimously.
E pi Committee -- Dr. Morrow
Dr. Morrow reported that the committee had discussed the importance of early identification of new HIV cases. He noted that with better testing techniques and earlier identification that education could be started earlier on how to prevent the spread of HIV. Dr. Morrow also reported that those wanting to attend an upcoming teleconference on this issue could contact Leslie Driver at 919-733-7300 to sign up. Dr. Morrow said that the idea is just to get people into treatment early and prevent the spread during early infection when the viral count is highest. Dr. Morrow then reminded everyone that the first case of Influenza in NC had been identified this week in Wake County. John said that the state was asking for increased flu surveillance and would be providing test kits with swabs to help identify causative agents for any outbreaks that occur. Dr. Morrow then reported that Civil Surgeon guidance is coming out soon and will delineate the immigration process from our normal duties. John noted that normal funding should not be used for processing immigration people. Dr. Morrow stressed that this effort should not be confused with refugee care that we are allowed to provide with public health money. Dr. Morrow then made several short announcements that included:
- Public Health Regional Surveillance Teams (PHRST) will be responsible for assisting all counties within their regions for Small Pox Planning and interfacing with the National Pharmaceutical Stockpile;
- UNC is offering a certificate program in disaster preparedness that Mr. Whiteside will discuss in greater depth later;
- The State Epi staff would like to follow the WCH model for streamlining services and is soliciting inputs from anyone interested; and
- The new safety needles may be drawing down more flu vaccine than the old ones causing a loss of one dose per 10-dose vial. It was thought this could be costly if the higher dollar vaccine was being purchased.
Women and Children's Health -- Wanda Sandele
Ms. Sandele reported that committee discussed a meeting that was held in the east regarding streamlining. She noted that they reviewed what needed to be done to meet Medicaid billing requirements and what did not need to be done. Wanda said she felt the discussion identified even other areas that could benefit from more streamlining. Ms. Sandele also reported that work is going on regarding the use of self-histories and asked anyone interested in piloting this tool to contact April Privette at 919-715-3396. Ms. Sandele then reported that work continues on the Immunization Registry and that a survey will be going out soon regarding each county’s ability to participate in the new registry. Wanda noted that another survey would be coming out soon to measure what county’s are doing regarding pregnant women and tobacco usage. Ray Rabe said that a letter had gone out from Dr. Devlin asking that all duplication of data entering be removed from the new Immunization Registry to ensure that it saves work as was intended (and not increase work). Lastly, Dr. Susan Mums, Medical Director, Buncombe County was introduced as a quest to the meeting (please attached minutes for details).
Technology Committee -- Ray Rabe
Ray indicated his belief that we are finally making serious progress with regard to bringing the HSIS system into HIPAA compliance and that the Goodness of Fit Study was very, very encouraging on the development of the new automated data and information management system. He turned the committee presentation over to Francis Taylor for the monthly HIPAA/HSIS update. Ms. Taylor thanked the association for the financial support she received to attend the NCHICA annual conference. She said that what she learned at the conference reinforced her belief that we are on the right track in our HIPAA work. Ms. Taylor said that she had asked a prominent presenter at the conference about the possibly for an extension to the HIPAA deadline and got the distinct feeling that no such extension would be coming. "So, we need to press on with becoming compliant." Ms. Taylor also noted that present efforts to make HSIS HIPAA compliant should be seen as just a bridge until some better programs are available down the road. She also reported that local health departments will be asked to identify an HSIS Administrator within the next 4 to 8 weeks. This person will help develop policies and procedures and educate the staff on how to comply with HIPAA. Ms. Taylor noted that HSIS screens will be changing in the future to limit access to those who need the controlled information on each page. She said that local departments will need to identify members of their staff who need access to which screens to meet the "limited access" rule. This will require local capability to set HSIS passwords. Lastly, Ms. Taylor said that they hoped to test the new controls in 3 – 6 counties to work out the bugs.
Mr. Rabe then introduced Ms. Tara Riley of EDS to discuss the "Goodness of Fit" study. Ms. Riley noted that an electronic handout would be sent at some time in the near future to support today’s briefing. She reported that much of what she was discussing had been demonstrated at the Technology Committee meeting the previous day. She then said that the study proposed using the MMIS plus as the basic billing and operational system in the future. This system along with other components for other functions will eventually replace and expand what HSIS does in the online counties. It will also allow the vendor counties to interface with the system in much the same way they currently interface with HSIS. The case management component being recommended was reviewed with the Technology Committee yesterday. That component, called Atlantes, will perform a very wide variety of functions. Ms. Riley noted the system would have a funding source distribution process to deal with the LHD "very complex funding sources." For example, it would automatically determine where to send some billings and automatically deposit the money earned into the correct budgets.
Ms. Riley noted that while the presentation yesterday showed that there would be different components to the system, it would appear seamless. Many present the previous day said they were very excited about the goodness of fit outcome as it indicated that instead of a Band-Aid to the future, we may in fact have a system that will function itself way into the future. Ms. Riley said that the system would help with eligibility determinations, managing receivables, demographic data reporting and a myriad of other public health applications. These would include case management; utilization, care and disease management; cross-referencing between programs and assessments; and lastly, acuity series (to make referrals and to ensure follow up is provided). Ms. Riley closed her remarks by stating that the new system would have a high level of security but allows information to be shared when necessary or access limited when need be as in the case of communicable disease.
Tim Greene asked if Ms. Riley had any idea of the cost of the new system and she said she was not prepared to discuss this at this time. That information will be provided to the state within the next two weeks, however.
George Bond said that he just couldn’t express how excited he was that this new system would finally do what we had hoped for, for so long..
Education and Awards -- Janet Daly
Ms. Daly reported that work has begun on the January 2003 State Health Director’s Conference. The theme this year is preparedness. She said that the Ham Stevens and Partnership Awards will be given out at that event and asked for inputs for who should receive these awards from the health directors.
Policy and Planning -- Jim Baluss
Mr. Baluss reported that the committee has begun mapping out this year’s legislative agenda for the Long Session. He noted that we had already received a request from the County Commissioners for inputs into their legislative agenda as well. Jim said that the committee was producing a list of substantive issues they feel need to be dealt with. These include but are not limited to the problem of preemptive rule making issue and the Public Health Study Commission.
Alliance -- Barry Bass
Mr. Bass discussed the following:
- The Alliance will have an open membership meeting on Thursday, October 24th at 2:00 PM at NCHA in Cary. Speakers will be Ziya Gizlice regarding Behavioral Risk Factor Survey System (BFRSS) and Jim Pfeiffer regarding Carolina Interpreting and Consulting Services (CICS) also, Jen will review last year's survey on needed services;
- NCAPHA has 28 members, there were 52 last year (Barry encouraged folks to join); and
- the staffing agency is doing well, promoted it as a member benefit.
Environmental Health -- Terry Pierce
Mr. Pierce reported that in addition to the grade card discussion already covered that the committee had discussed the local option of charging for food service facility plan reviews, had a Division report from Ms. Sewall and Mr. Kelly, and had been informed that the RS website would be operational by the end of the year (see attachment). Mr. Pierce thanked health directors for allowing their EH staffs to participate in EH State of Practice (SOP) Workshops, as both participants and instructors. By using local health department and state employees, UNC provides quality training for a reasonable cost.
Health Promotion/Oral Health -- Rosemary Summers
Ms. Summers reported that the next Health Promotion Committee meeting will be November 13, 2002 at 501 St. Mary's Street from 1:30-3:30 pm. They will be looking at the performance standards for local health departments in the area of health promotion and discussing the possibilities of combining various chronic disease and community programs into a single stream for local departments.
UNC School of Public Health -- Penny Whiteside
- Mr. Whiteside offered the following items:
A new chart on chemical exposure produced by the SPICE group (same folks that brought us the bio-agent exposure wall chart) will be available soon. The NC Institute for Public Health will provide one copy for each local health dept. As with the previous chart, this one will be downloadable from the SPICE homepage;- The NC Institute for Public Health is continuing to provide training for boards of health. To schedule training sessions, please contact Dr. Teme Levbarg at the NC Institute for Public Health (Tel: 919-966-4917; Email: teme_levbarg@unc.edu);
- The UNC School of Public Health will offer a certificate program in bioterrorism management starting January 2003. A representative of the School will be available to discuss the program during the month of October at a number of local health departments around the state. The sites and dates are as follows: Raleigh--Oct 15, Greenville--Oct 16, Fayetteville--Oct 17, Hickory--Oct 18, Wilmington--Oct 22, Asheville--Oct 23, Elizabeth City--Oct 25. The deadline for receipt of applications is Dec 1. For additional information, contact Dr. Jim Porto (Tel: 919-966-7354; Email: jim_porto@unc.edu); and
- The CDC in collaboration with the NC Division of Public Health and the NC Center for Public Health Preparedness at the UNC School of Public Health will pilot a course on Forensic Epidemiology in Chapel Hill on Nov 4-5. This course is a prototype that CDC plans to package and make available around the country
OPHN -- Joy Reed
Ms. Reed distributed a handout with details of the items she was going to discuss (see attachment). She then reminded everyone that with the recent change to DMA Bulletin distribution that someone from each health department will need to be designated to go to the DMA website monthly and print out the bulletins. She noted that the October Bulletin did point out the correction regarding billing for TB services (i.e. only the lead nurse needs to have completed the TB training). Joy also reported that each health director received an email and a faxed copy of a memo explaining new Program Type codes which will go into effect 1/1/03 as well as the end-dating of the GB Program Type code on 12/31/02. Ms. Reed also announced that the Public Health Nursing & Professional Development Unit is applying for a federal grant to improve the public health nursing field experiences of baccalaureate nursing students. Joy then reported that the nurses were celebrating “North Carolina Nurses: A Century of Caring” to highlight the fact that North Carolina was the first state to require licensure of nurses 100 years ago. Joy also reported that effective October 1st, we must ask minors if they live at home and if so, we must include the parent’s income when we do Medicaid determination. George Bond noted that his department had done a study and this will apply to 40% of their cases. He worried that this might drive kids away from care. Lastly, Ms. Reed reported that she will be sending out a phone number to request copies of the form to get in the Seniors’ Prescription Program.
Region 3: Danny Staley
Mr. Staley reported that his region had discussed the recent changes to CSC/MCC billing. He noted that everything that was billable under CSC before is still billable under the new system codes. He also noted that people are having problems with the new MCC rates and most will lose money as they are. Joy and Dennis noted that this was still be worked on and it was hoped to change the rates so that they will be revenue neutral with two units per month. Mr. Staley said that the region was asking that Reimbursement and Finance look at this issue.
Region 4: Ray Rabe
Mr. Rabe reported that his region had spent many hours getting ready to distribute KI and will finally get started this coming Saturday. He wondered if there was not some way to get financial support for such issues?
There being no further business and after motion and second, the meeting adjourned at 12:30 pm. The next meeting of the Health Directors' Association will be November 21, 2002 in the North Carolina Hospital Center in Cary.
Respectfully Submitted,
Don Yousey
Secretary/Treasurer