President Wayne Raynor called the meeting to order at 9:07 am and welcomed members and guests. President Raynor conducted a count of members present and found a quorum for a full association meeting (43 members) did not exist (only 32 members were present). He announced that since a quorum was not present, that this would be an Executive Committee meeting. Please see attached Attendance Roster for actual attendance.
Mr. Raynor shared a humorous story about "getting along."
President Raynor reminded members that the minutes were posted on the web site and asked for a motion to approve the minutes as posted. There was a motion to approve the minutes as written 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 reported that he had begun receiving suggestions for next year’s proposed budget. He said he would try to have it completed with asterisks by the changes for distribution via email after next month’s meeting so all members have time to review it and make suggestions at the January meeting.
Deborah Rowe reported that she had received a request for the health directors’ roster in a format that could be downloaded into palm pilots. She said she had completed this, but did not want to send it via email as it had private numbers on it. She said anyone wanting a copy should contact her and she would provide a copy on disk. Ms. Rowe then cautioned those present that newspapers are accessing material that we are sending out over the restricted list and some of this material is sensitive. To help protect his such sensitive material, John Rowe will be attaching a “message board” to our webpage. This will only be accessible with a “user name” and “pass code.” However, John has not found a way to delete such messages once they are posted and Ms. Rowe cautioned health directors to use the message board only for sensitive material so as not to tie up the webpage needlessly. She then passed around a sheet asking that those present sign up the user name and pass code they wanted to use.
Ms. Rowe then asked any other counties passing the cigarette resolution to send her a copy so she can keep track of this for future legislative reference. Lastly, Ms. Rowe noted that New Health Directors’ Orientation will be ongoing on a quarterly basis will focus on things that will be helpful to new health directors getting familiar with what is required of them.
Mr. Raynor said that he had only once announcement. That is that the State Health Director’s Meeting is scheduled for January 29th and will be billed as the State and Local Health Director’s Meeting as it was some time in the past. He noted that we will have an awards luncheon just before our usual meeting.
Mr. Tim Green was called forward and thanked those present for the opportunity to address them. He reported that the Task Force on Standards and Efficiencies along with the three subcommittees (Accreditation, Best Practices and Demonstrations) would be having a joint meeting at 1:30 PM this afternoon. He noted that this is important work and asked anyone interested to attend. Tim also reported that the subcommittees would be meeting separately right after the joint session. Mr. Green then talked about recent changes to public health and what might be driving such changes. He noted that the work being done by the subcommittees was a great opportunity for us to participate in designing changes and improving productivity. Tim then noted that there are 8,500 public health workers across the state and emphasized that if we could just improve our efficiency by 10% this would be a significant growth of resources. Tim then closed by again encouraging everyone to participate, if at all possible.
Mr. Harrington started his discussion by stating that the economy continues to look bad with more budget cuts looming on the horizon. He noted that last year public health got 1% of the budget, but were hit with 10% of the cuts. However, last year at this time, we were 8% down in estimated tax collection and are only 7% percent down so far this year. He thought that if this continued that further cuts may not be needed this year. However, this years budget was not balanced and 5.8 million dollars will need to be cut between now and July 2003. Dorothy Cilenti asked if this was all of DHHS or public health. Dennis replied public health.
Mr. Harrington then reported that Volunteer Income Tax Assistance (VITA) folks had asked if they could get space to work with those who need their services within the health departments. They help folks identify “earned credit” and this will save millions of dollars for those we serve. The VITA folks will also be asking other agencies to share space with them as well. They mainly need space during the evenings and weekends with internet access. There was some discussion on whether such a vote would commit us to provide the space. It was generally thought this should be done on a county by county basis and no vote was taken. Lastly, Mr. Harrington distributed a handout listing the budget expansion items from their department. He noted that two of the top three proposals matched those that have come out of the Policy and Planning Committee (see attachment).
Chris Hoke then gave a report on
action taken by the Health Services Commission regarding the new grade cards.
He noted that the compromise grade card had been taken to the commission with
the support of the Division, the Health Directors and the Restaurant Association.
However, some commission members felt there had been enough positive feedback
from the pilot project counties that they felt they should make a change in
that direction. A motion to go with the grade only card state-wide failed (5
to 6). A subsequent motion on the compromise grade card passed unanimously.
What does this mean? This means that the Division will now begin the process
of building the compromise grade card into the rules. First the proposal will
be taken to public hearing in January and come back to the commission for final
vote in February (at their regular quarterly meeting). If this happens, the
grade card should go into effect in August 2004. There was some discussion on
how cumbersome this process was, but Chris pointed out that this process was
put in place by the Legislature and must be followed.
Joe Holiday, wearing the two hats of Health Promotion and Disease Prevention,
reminded those present that health promotion funds for the rest of the year
will remain intact. That is the good news! However, the size of the cuts discussed
earlier has led to a recall of funds and this will force a 32% decrease in funding
for home health. This will be for both private and public agencies.
Joy Reed then distributed a “Summary of Mid-Year Changes to FY 02-03 Consolidated Agreement” handout (please see attachments for specifics). These changes will include things to accommodate HIPAA Privacy requirements, changes to the section on use of the Public Health Awareness Program logo/slogan, changes in the sections on reporting of Environmental Health services and expenditures, changes in the sections dealing with expenditure reporting for state and federal funds, and the addition of a signature block for the Secretary of DENR.
Dr. Steve Cline then reported on Bioterrorism (BT) progress. He thanked everyone for the great response to the Phase I Small Pox Survey. He said that 90% of health departments had responded. Steve noted that the state will be following up with locals through the PHRST Teams to clarify how some numbers were arrived at. Dr. Cline then reported that he would be sharing the state small pox plan this coming Wednesday, but that this would be done through a “secure” channel as this is considered a “secure document.” A one page summary without the secure material will be shared via email for discussion with the media. Steve noted that there is a lot of interest in this document, but that it is not pubic information. Tom Bridges asked if the local plans could be handled this was as well? Steve (with Jill Moore’s agreement) replied that since the local plan was based on the state plan that this would most likely be defendable legally. Dorothy Cilenti then asked if this then allowed discussion of the local plan in Closed Session? Jill Moore said that she believed so, but added she would check on this and get back to us (An email from Jill later that date did in fact state this could be done). Dr. Cline then reported that he had hoped the Homeland Security Act would answer a lot of questions regarding liability issues in BT, but this had not been the case and work still needs to be done on this. Wanda Sandele noted that much of the CSC Plan for small pox response was just not realistic for many counties. Steve replied that there is a lot of cloudiness on this issue yet. He noted that his folks had shared what the CDC had said, but had not said that locals must comply with all of it. Dr. Cline then noted that all prevention vaccination is still voluntary at this point and that no action can be taken against those who refuse to take it presently. Lastly, Dr. Cline reported that a teleconference was planned for December 3rd as an overview to the State Small Pox Vaccination Plan and handout out an announcement with particulars (see attachment).
Ms. Moore distributed a handout entitled "Outline Summary: New N.C. Public Bioterrorism Law" (please see attachment). Jill briefly reviewed the contents of this document covering such issues as: When the State Health Director should exercise new powers, powers over property, powers over persons and animals, State Health Director's and Secretary of CCPS's duty to notify the Governor and each other, and the that these new powers do not limit existing powers of local health directors and other public officials, Additionally, Ms. Moore reviewed abatement powers, limiting owners' culpability for costs if not involved in cause of a hazard, the definition of "quarantine authority", restriction of access to quarantine or isolation premises, and numerous other items. Reader is directed to the attached handout for further details.
Policy and Planning Committee -- Jim Baluss
MMr. Baluss reported that he had one motion to report on. He said that the committee had agreed it was time to move on the Medicaid Waiver for Family Planning and that this action was seen as a "no brainer" by everyone involved. Jim presented the motion as follows: Recognizing the significant multiple adverse health and societal consequences of unintended pregnancies – particularly affecting low-income women and families in NC, NCALHD urgently recommends and requests the Secretary of the NC Department of Health and Human Services take immediate steps to accomplish the Medicaid Waiver for Family Planning Servcies in NC. Coming from Committee and needing no second, the motion carried by unanimous vote.
Technology Committee -- Ray Rabe
Mr. Rabe reported that he had two motions from committee for approval by the association. The first motion read as follows: That the NCALHD supports the continued funding of the Public Health Training and Information Network (PHTIN) in the current and succeeding fiscal years. Coming from committee and needing no second, the motion carried unanimously. Mr. Rabe then offered the second motion as follows: That NCALHD supports the expansion of the PHTIN to include additional sites and associated line charges. The total number of sites should be consistent with the highest limits possible given current technology. Again, coming from committee and needing no second, the second motion carried unanimously.
E pi Committee -- Dr. Morrow
Dr. Morrow reported that the committee had met by conference call (please see attachments for minutes of the meeting). John then noted that Dr. Cline had covered the bioterrorism material already. The committee also discussed the expansion budget proposal that included $13.7 million to raise eligibility for ADAP to 200% of the Federal Poverty Level; $12 million for additional flu and pneumococcal vaccine to comply with CDC recommendations and $1.3 million for West Nile Virus response. Lastly, the expansion proposal included $11.9 million for decreasing minority health disparity. Dr. Morrow also reported that Dr. Engel had discussed the changes to the new yellow CD cards and had apologized for the short notice of their arrival at local health departments. Lastly, Dr. Morrow shared a poster that is being sent out that stresses that it is not too late to get flue shots and said the committee will review the agreement addenda for the 2003-2004 budget during it's December meeting.
Women and Children's Health -- Wanda Sandele
Ms. Sandele reported that the Medicaid waiver had finally been shaken loose. She noted that they had finally been successful in convincing DMA that this was a cost-savings and not an expansion of services. It is hoped that this will be worked out with the Feds and be in place by November 2003. Ms. Sandele also reported that they had reviewed the agreement addenda to clear up confusion on what is really required. The changes will also build in some flexibility to the agreement. Lastly, Wanda noted that there is still ongoing discussion about the $7 million reduction in service coordination that is being sought. However, there is still no definitive answer about how much of this will fall on public health (we make up about1/3rd of the overall cost of service coordination).
Technology Committee -- Ray Rabe
Ray introduced Tara Riley of EDS who gave an update of continuing work on the Goodness of Fit Study. She distributed a large document that covers the study that was too large to include as an attachment. But copies will be made available to anyone who wants them (Page 79 of the document entitled Goodness of Fit Solution Overview was used for Tara’s discussion and is included as an attachment). Tara reviewed much of what had been discussed last month regarding the ability of the new system to bill and allocate revenues to appropriate budget line items. She again noted that they were recommending the ATLANTES system for support of recording lab tests, progress notes, and eligibility and enrollment functionalities. Ms. Riley noted that the State of Oklahoma was utilizing ATLANTES for its Medicaid system and stated that the security aspects of it allow it to be used by different agencies at the same time. Tara then reiterated that it will help assess risk factors and assign clients specific care providers based on this assessment. Don Yousey asked if there was any further information on the cost of the proposed system? Ms. Riley then referred everyone to the cost estimate handout (see attachments for cover sheet) and noted that the overall cost would be “approximately” $12 million. She stressed that this was a “ball park” figure since there are still details of requirements of the system that are unknown at present. Mr. Yousey asked how this would compare to the price if we were a private organization? Ms. Riley replied that since there is interest is seeing how the program will work with a large entity like a state-wide public health system that the offer was a fraction of what a private group might pay because of this. Dennis Harrington noted that he is looking at the possibility of getting Medicaid to shoulder the larger portion of this cost if possible.
Policy and Planning -- Jim Baluss
Mr. Baluss reported that the committee continued mapping out this year’s legislative agenda for the Long Session. The list included such things as seeking legislation to allow counties to set fees for local Environmental Health programs including restaurant inspections, to implement state-wide locally enforced private well water supply rules, to increase the cigarette tax, to restore funding for TANF APPP, and Healthy Carolinians, etc. (please see the attachment for the complete list). Jim then asked that regional meetings be held to garner inputs from each region on things they felt needed to be included in the list. He asked that such recommendations be forwarded to him for discussion and possible inclusion by our January meeting.
OPHN -- Joy Reed
The OPHN reported that new race codes are being put in HSIS. Additionally, training for MEDICARE billing was to be held the following day and MEDICARE no longer requires physician coverage in-house 24 hours per day seven days a week. Also, the first runs for billing on the new codes are being completed and it looks like MOW services are coming in considerably lower than last year. Each health department should look at this to see how it will impact them. Lastly, work has begun on the New Finance 101 Course since all the rules and procedures have changed since the last class cycle.
Time constraints forced the meeting to be closed at this juncture due to two meetings following this one that could not be pushed back. Mr. Raynor apologized for this and asked others and liaisons to submit write-ups of anything they want included in the minutes to Don Yousey via email.
There being no time for further business and after motion and second, the meeting adjourned at 12:05 pm. The next meeting of the Health Directors' Association will be December 19, 2002 in the North Carolina Hospital Center in Cary.
Respectfully Submitted,
Don Yousey
Secretary/Treasurer