Minutes

North Carolina Association of Local Health Directors
Full Association Meeting

February 20, 2003

Wake County Human Services Building
Raleigh, NC

Call to Order

President Jim Baluss welcomed the members of the association and guests to the January meeting at 9:00 am. Thirty-one members were present at that time, which did not constitute a quorum; therefore the meeting proceeded as an Executive Committee meeting. Attendance would be monitored to determine if a quorum was reached during the meeting. (See attachment for attendance roster).

Fellowship

President Jim Baluss provided the fellowship.

Approval of the Minutes

The minutes of the January 2003 meeting were posted on the web site, ncalhd.org, and approved as posted with the noted correction to the Past-President’s Business. The motion should have stated 2003 Annual State and Local Health Directors Meeting, not 2002.

President's Report

President Jim Baluss introduced Mr. Teddy Locklear as the representative for Jane Murray, Scotland County Health Director. Mr. Locklear would join Jim in making the “Legislator of the Year” presentation to Senator Purcell later in the meeting. Jim again extended his congratulations to 2003 Ham Stevens recipient George Bond and 2002 Past-President Wayne Raynor for their contributions to public health. In initiating the business of 2003, the President announced the following committee/liaison appointments: Jim Jones to the “Forms Committee”; Tim Green “ANCBH Liaison”; Roxanne Frederick “Senior Vaccination Season Committee.”

Treasurer's Report

Secretary Elaine Russell presented the Treasurer’s report with balances as of January 23, 2003. Account balances were as follows:

• Checking: $17,041.30
• Savings: $36.21
• Money Market: $361.04
• CD: $40,000.00

Elaine also shared with the association that the pre-renewal notice for the $40,000 CD had been received. To the agreement of the association, she will renew the CD at the best yield/rate made available through SECU.

State Health Director's Report--Dr. Leah Devlin

Leah thanked all members for their work in addressing the bioterrorism issues to-date. The recent RFP process is a new way of doing business for the Division. Discussions are on going with Steve Cline to refine the process. The BCBS insurance coverage issue appears to be resolved. They will provide coverage for small pox adverse reactions not addressed by the federal government. With regard to other insurance products, Health Directors experiencing coverage issues should contact Chris Hoke immediately. The goal of the Division is to push for federal ownership of any small pox adverse reaction and associated consequences. The Division continues to work with the General Assembly to clarify the issue of NC workers compensation law and adverse reactions. Leah encouraged all Health Directors to address our representatives in Congress with these concerns. She reiterated how critical a united front is for public health at this time. When local public health speaks with legislators, please bear this approach in mind. Leah was also very complimentary of the groundwork being established with the legislature regarding a cigarette tax. Encouragement and support from the local level is critical for this type of initiative. With regard to the “Goodness of Fit Project,” Leah reported the latest position from the Secretary’s office. Secretary Hooker Odom has requested an individual statement of support from each county health director. The intent of this request is to acknowledge the relationship between timing and cost. MMIS is slated to rebid in July 2003, with a final product projection of 2007. The “Goodness of Fit” product for local public health, with a 2-year implementation schedule, would be in place in 2005 with a projected cost of $12M. This creates the potential of upgrading the “Goodness of Fit” product by 2007 to work with the MMIS product. The upgrade is an additional financial investment. Lanier Cansler will draft the letter to local health directors detailing this timing and cost dynamic. Leah and Dennis will have the opportunity to edit the letter before it is mailed. Local health directors would be asked to indicate their support and return the letter to the Secretary’s office. A statement of support from NCALHD, in lieu of individual response, was not acceptable to the Secretary. Although she would appreciate a 100% positive response, she realizes the response may fall short by a few counties. Leah again emphasized the importance and rarity of these factors aligning to address the data management needs of local public health. Public health must make the most of this opportunity.

Motion: The NCALHD endorses and supports local health directors in signing supportively on the “Good of Fit” timing and cost letter issued by Secretary Carmen Hooker Odom. The motion was seconded and approved unanimously.

The absence of numerous health directors was noted and discussed.

Amendment to Motion: Regional Representatives will contact absent members to ensure their understanding and participation in regard to the Secretary’s forthcoming letter. The amendment was seconded and approved unanimously.

Leah reminded everyone of the need to be positioned to participate in Access II/III. This is an excellent opportunity for local public health. However, concern was expressed from the local level regarding the intent and communication associated with the initiative thus far. President Jim Baluss charged a new committee to help address these issues. Joy Reed will be working with those committee volunteers. Leah closed her remarks by thanking the Standards and Efficiencies Committee for their on-going work.

UNC-SPH--Penny Whiteside (liasion report)

Penny reminded everyone of the March 28th Grand Rounds which will focus on the impact of HIPAA on public health practice. He also has the video of a previous broadcast outlining a connectivity project for public health, other providers and the community that took place in Virginia. With regard to upcoming training opportunities Penny shared the following announcements: the 2003 Spring/Summer CEU Catalog has been mailed; the second cohort for Bioterrorism Certification will begin at the end of June 2003; the Forensic Epidemiology pilot course has been refined, it is a 1 _ day exercise for public health and law enforcement to develop an understand of each discipline’s role during scene investigation. An ultimate goal is to link the information in Forensic Epidemiology to the CDC website.

Office of Public Health Nursing--Joy Reed (liasion report)

Joy continues to review options to assist local health departments with CSC billing. The request to round up to 15 minutes was declined. She reported that Ann Nance is working on a system’s fix to allow billing for unbilled units between October and January. The fix would avoid repaying the original billing payments. Joy encouraged everyone in this situation to wait for Ann’s “fix.” With regard to billing for STD services in maternity and family planning, she advised of a forthcoming memo which details added codes for the various technologies in use. Joy’s request for local expenditures on interpreter service has yielded only 28 responses. Please communicate this information to Joy as soon as possible. HIPAA preparations are on going. Health directors should anticipate receiving “Permission to Release” which will replace “Permission to Use and Disclose” among current forms. The new form is “Patient Authorization” as required under HIPAA. With regard to upcoming trainings: “New Health Director Orientation” has become a 1 _ day quarterly event; Finance 101, a 1 _ day course, will be offered in March at Raleigh and in April at Hickory. In closing, Joy addressed the pending changes at local DECs. These changes present new opportunities for local health departments to provide service through the CDSAs (formerly DEC): care coordination for Early Intervention children; community based services, and nursing services. (See attachments) Kevin Ryan also addressed several concerns surrounding the CSC relationship with local DECs. The different pay for Health Department CSC service has long been a concern of the Division. These changes may prove useful for addressing that disparity. All 17 services available to Early Intervention children will be authorized through the CDSA (formerly DEC). Several counties will undergo this transition July 2003; the remainder of the State will transition July 2004. Kevin also reminded Health Directors local public health departments still have their exemption status, but referrals to specialists must still be made through the designated primary care giver.

Dennis Harrington

Dennis shared news of changes in reimbursement rates. Medicaid rates are 95% of the Medicare rate for the code. The E&M codes will have a 4% reduction, while the remaining Medicare codes will have a 1.6% increase thanks to a recent Congressional bill. Dennis shared that he continues to work with Joy on the CSC solution. He also reminded the group that in cases of financial hardship, the Division could advance projected revenues. However, the situation needs to be reviewed on an individual basis with Dennis. In closing, Dennis noted a hardcopy and email delivery of the HIPAA materials discussed earlier. He also provided feedback from Jeffery Simms regarding Health Check. The Coordinators are allowed to communicate with clients regarding well-child services available through the local health department.

Oral Health/School Health Initiative--Rick Mumford

Rick gave a power point presentation on the newly organized School Health Initiative known as “The Matrix.” The group is comprised of 90-95 public health from: the NC Oral Health Section, WCH – C&Y Branch School Health Staff, WCH – Nutrition Branch School Nutrition Consultant, DPH Healthy Schools Advisor, and the CD&IP – Tobacco Control and Prevention Branch Tobacco Free Schools Consultant. The top priorities of the Matrix as reported by Rick: 1) oral health prevention and promotion services; 2) expanding school health advisory councils in all 117 school districts; 3) implementing a NC School Health Index tool for data collection, evaluation and reporting.

Committee Reports (action items)

Education and Awards -- Scott Harrelson

Scott provided a synopsis of the benefits of combining the Spring Conference and the April NCALHD meeting to a date of April 24th at the Brownstone. The conference portion will be an informational meeting on the work to-date of the Demonstrations, Accreditation and Best Practices Task Force. The conference expenditure would include lunch, notebook of “Best Practices”, morning break refreshments, and the actual meeting space. Motion from Committee: NCALHD will cover the $25 registration fee associated with the Spring Conference. The motion was approved unanimously.

Scott briefed the group on the continuing renovations at IOG. The facility will not be ready to host the Annual Fall Legal Conference in 2003. Numerous members had indicated the conflict of trying to attend the Legal Conference and NCPHA when the events were combined last fall. Motion from Committee: The 2004 Legal Conference will be held at the new IOG facility as a stand-alone conference in the Spring of 2004. NCPHA could serve as the Fall Conference. The motion was approved with two votes of dissent noted. Per recommendation from the floor, the by-laws will be reviewed to determine if the motion necessitates an amendment to the by-laws.

Women and Children’s Health -- Wanda Sandele

Wanda reported that the Division is interested in determining health department participation in providing psychological services with the July 1, 2003, billing change. The Division would like to gather this data via a 5-minute survey. Motion from Committee: NCALHD endorses and supports the participation in a survey to determine local health department participation in the provision of psychological services. The motion was approved unanimously.

Committee Reports (information items)

Region 4

A thank you was extended to Rosemary Summers for her Taskforce outreach. As a result of her efforts, the Region feels a better understanding of the Taskforce’s work to-date.

Epidemiology -- John Morrow

John reported that phase one of the small pox initiative has proceeded very well thus far. An e-mail detailing the side effects for 100,000 has been distributed. Flu data continues to be collected by the State. Type B has been the predominant strain identified and is covered by this year’s vaccine. John also discussed the recent e-mail for flu vaccine for FY03-04. The fact that one product was not approved for children was discussed. The State will be purchasing the child-approved product for use with high-risk children. In closing, John discussed the work of the Epi-Streamlining Committee. Participants on the committee include Rosemary Summers, Joy Reed, State Lab staff, Epidemiology staff and John. The goal is to streamline and simplify the process, much like the originating concept in WCH. The next meeting of the Epi Committee will be on March 19th at 1 or 2pm and will include a tour of the State Public Health Lab at the Bath Building. Photo id will be required for admission. Louis Latour posed 2 questions to the group related to epi function: 1) Have any health departments been contacted by a staffing agency seeking to contract with nurses for delivering smallpox vaccinations? 2) What flu-related absenteeism threshold is being used to declare a close to school systems? Comments from the Division staff regarding the staffing agency was to use extreme caution when dealing with this type of request. No clear threshold was identified in response to the second question.

Women and Children's Health -- Wanda Sandele

Wanda reported that 90-day pilots for “MCC Pathways of Care” would be starting in 10 counties on July 1, 2003 and closing on September 30, 2003. Belinda Pettiford is the contact person for the pilot. Several inquiries had been directed to WCH regarding a newly advertised 5-in-1-childhood vaccine. The cost of the vaccine, at this time, is a deterrent to widespread use. The use of the vaccine will not reduce the number of well-child visits with a provider.

Technology -- Jerry Parks

Jerry reported that Marc Kolman would continue to represent NCALHD at NCHICA. A new committee has been established at NCHICA, Clinical Program Oversight, Jerry will be looking for a representative to that committee. The growing interest in H.323 desktop technology for teleconferencing was discussed. The connection between this type of technology and the PHTIN system was also a point of discussion. The growth of both types of technology has been closely monitored to ensure the quality of the transmission and associated communication. It was agreed that ultimately every county needs teleconferencing capacity. Determining a path to that end that ensures quality for all participants is the challenge. Jerry also reported that due to weather, the IBEAM presentation would be rescheduled. (See attachment)

Policy and Planning -- Mimi Cooper

The NCALHD Legislative Goals brochure will be printed soon. Mimi reported that work continues on gathering supportive data related to local restaurant plan review fees and local positions on the cigarette tax increase. (See attachment)

The Alliance -- Barry Bass

Barry reported that the Alliance would meet in the current room at 12:30. Among the items on the agenda, was a presentation on palm pilot technology for use by environmental health. Barry plans to forward all relevant data to Environmental and Technology Committees. He also thanked everyone for his or her participation in the recent survey.

Environmental Health-- David Rust

The committee addressing the issue of proprietary soil scientist work expanding in the field of on-site wastewater has continued to meet according to David. Bill Jeter provided an update to the committee. It is the perception of most involved in the dialogue, that the interests of a few individuals in the private sector drive the proposed changes. The demand for faster service in the on-site wastewater application process will always be a factor to spur the argument for privatization of the process. David also provided a technology update. The IBEAM product (the State product) remains to be scheduled for a demonstration to the group. The Garrison product (the proprietary product) continues forward with those counties thus far involved. Motion: IBEAM and Garrison should be scheduled for demonstrations to the Environmental Health Committee to facility a report back to the full Association. The motion was seconded and approved unanimously. Motion: The Technology and Environmental Health Committees should have joint meeting for the purpose of the demonstrations at the upcoming meeting. The motion was seconded and approved. In closing David gave a brief overview of the State Auditor’s Report on Food Safety. In summary the food inspection system is fragmented, suffers from limited bilingual support, has no embargo power, and has a significant amount of unsupervised production. The Legislature is expected to appoint a committee to review the document. (See attachment)

Health Promotion -- Rosemary Summers

Rosemary reported that the 5 counties at risk with their Health Promotion funding had been notified in December 20, 2002, memo from the Division. The Division will be working with those counties to determine a plan a corrective action to ensure continued funding.

Institute of Government -- Aimee Wall (liaison report)

Aimee reported on the NC Worker Compensation Advisory which has been posted to the IOG website. She also reported that Jill Moore has finished her most recent Health Law Summary. In conclusion she reminded the group of the next level of HIPAA preparedness, the security standards. This is a very technical set of standards and will hopefully be covered by another branch at IOG. Aimee will keep the group posted on the assignment of the task at IOG.

TaskForce on Standards, Efficiencies and Best Practices -- Tim Green

The work of the task force continues with Tim’s thanks to those who have participated thus far in the process. The survey to determine best practices will be used to build the notebook for the Spring Conference. Tim closed in reminding everyone of how interdependent the topics were. Many good things are occurring in local public health, we need to capture those examples and build on their success. The next meeting of the Task Force will be on March 19th in the morning, everyone is encouraged to participate.

Executive Director -- Deborah Rowe

Deb Rowe reviewed the purpose of the message board included in the NCALHD website. All communication from Deb on sensitive items, such as legislative business, will post exclusively to the message board. She plans to send a prompting e-mail when such material is posted. Routine and public correspondence will continue to be posted via the LHD list-serve. Deb reminded everyone of the public nature of e-mail and the 300+ recipient list associated with the LHD list-serve. She also spoke briefly to the role of a $0.75 sales tax on cigarettes. Taxation in that amount would generate a projected $550M. These are funds that could easily address the Medicaid match issue and free other dollars at the local level.

Adjournment

With no further business, the motion to adjourn was made, seconded, and approved unanimously at 12 noon.

Respectfully Submitted,

J. Elaine Russell, MPH
Secretary-Treasurer