Minutes

North Carolina Association of Local Health Directors
Full Association Meeting

April 24, 2003

Brownstone-Holiday Inn Hotel
Raleigh, NC

Joy Reed opened the meeting time with her presentation that had been scheduled for the lunch break. Tim Green reminded the group that the final presentation of the Standards and Efficiencies Workgroup would take place in June, with a vote anticipated for July. Involvement in this process is critical for all members of the association.

Call to Order

President Jim Baluss called the meeting to order at 1:30pm. He thanked the Standards and Efficiencies Committee for the work that was showcased during the morning session. The appointment of Wayne Raynor as the Cumberland County Health Director on June 1st and the October retirement of Harold Gabel as Guildford County Health Director were noted. Fifty-five members were noted as present, which constituted a quorum for a full association meeting.

Fellowship

Ray Rabe, Region IV Representative, provided the fellowship. He opened with a moment of silent prayer in memory of Jim Baluss’ mother. In closing he lead a quartet of fellow health directors in singing the ever-appropriate chorus of the “Mickey Mouse” theme song.

Approval of the Minutes

The minutes of March 2003 meeting were posted on the web site, ncalhd.org. Motion: The March minutes are approved as posted. The motion was seconded and approved unanimously.

Treasurer's Report

Secretary Elaine Russell presented the Treasurer’s report with balances as of March 25, 2003.

• Checking: $52,630.18
• Savings: $36.31
• Money Market: $362.39
• CD: $40,000.00

President's Report--Jim Baluss

Jim was pleased to announce the appointment of Tim Green to the Board of Sanitarians by Governor Easley. He also reminded the group that Terrie Snowden of Marsh and Associates would be with the group at the May meeting to review malpractice information for the upcoming year.

HIPAA--Francis Taylor

Francis opened her remarks by thank everyone for their diligence in preparing for the security compliance deadline. A draft of the cover memo/e-mail that was to accompany the HSIS users Medicare survey and the draft survey were distributed. The Division continues to seek clarification related to the issues of billing methods and scope of practice in relation to Medicare. The completion of the survey will be of benefit in this process. Motion: To support the distribution and completion of the HSIS Users Medicare Survey. The motion was seconded and approved unanimously. (See attachment) With regard to the consent recommended by IOG, the question was raised if billing could still occur if the client refused to sign the consent. Unfortunately, a clear answer has not emerged at this time. Francis would like to shape the Division policy to reflect the final answer to the question.

Special Note--Barry Blick

Contrary to media reports, Catawba does not have a case of human rabies.

Executive Director--Deb Rowe

Deb noted that a legislative update would be provided during the Policy and Planning presentation. Appropriations is calendared to meet concurrent with this afternoon’s meeting. The Senate budget has been completed and is anticipated to be passed by next week. It is a critical time for contacting Appropriation Chairs in the House and Senate due to the $300M in eligibles, which will create an increased burden of uncompensated care on local public health. In closing Deb noted the next orientation session for new health directors will be held in August, not May as previously published. Contract negotiations will be the topic of discussion and training.

State Health Director's Report--Dennis Harrington

The Medicaid cost settlement has been approved to date. The summaries of the cost report are available at the front of the room. Dennis shared the news of Stephen Garner’s departure, however he has agreed to some future contract work for cost reports. He also highlighted the two presentations scheduled for the meeting. PCG of Boston was approved unanimously at the last meeting to pursue a revenue maximization review for Medicaid administrative costs. Local health departments will be asked to participate in a Random Moment Time Study. The focus will be on administrative costs for direct service with a focus on programs that are not part of the cost settlement. A local liaison will need to be identified for PCG for the work to be conducted. This is viewed as an on-going project, not a one-time reimbursement endeavor. The Medicaid eligibility rate (45.2%) for the State will be used as the benchmark, not the local rate. (See attachment) Patrick McCoy with State Personnel has undertaken a re-write and streamlining task for the State Personnel Act. Intent includes: accommodation of market availability, incorporation of federal merit standards, and delegation of authority. Please direct all questions or comments to: Steve Davis (919.733.7934) or sdavis@ncsop.us. (See attachment) In closing Dennis provided an update on the status of “Goodness of Fit.” The project will not go forward as it is currently known to the association. The detailed design of the business requirements must be done in six months. EDS will not be eligible to bid on this round, but will be eligible to bid on the final product contract. The name has been changed to “Public Health Information Systems.” The funds made available to have not been used and remain destined for the final product to serve public health. DRM has been most helpful since these recent developments.

Local Assistance and Training/Public Health Nursing--Joy Reed

See attachment.

Committee Reports (action items)

Health Promotion -- John Rouse for Rosemary Summers

John reported that for the past two years, the committee has struggled along with State staff to devise a sensible performance based allocation process for health promotion funs to local health departments. State staff is in the process of forming a working group to develop this process to begin in the next fiscal year (2004-2005). The working group will be composed of: 3 State staff, 3 local health promotion coordinators, and 3 local health directors. The work of the group will be completed no later than the beginning of October 2003, and presented at the association meeting in October. Motion: The association, through the President, appoints three health directors to serve on the health promotion funding allocation work group. The motion was supported unanimously.

Policy and Planning -- Mimi Cooper

Motion: The association will oppose S672/H1004 (Public Health Infrastructure Bill) as written. The motion was supported unanimously.
Motion: The association will oppose S433 (Educational Requirements for Local Health Director). The motion was supported unanimously.
Motion: The association will support S587/H634 (Funding of Core Public Health Functions). The motion was supported unanimously
Motion: The association will support H1094 (Restore BOH’s ability to make rules concerning animal operations). The motion was supported unanimously.
Motion: The association will oppose S624 (Allows local EH authorization). The motion was supported unanimously.
Motion: The association will oppose H1206 (Abolish EMC for replacement based on Utilities Commission). The motion was supported unanimously.

Committee Reports (information items)

Epidemiology -- John Morrow

See attachment.

Women and Children's Health -- Wanda Sandele

Wanda reported the freeze on Healthcheck positions has been lifted. Please direct all questions to Angela Floyd. Access II/III will have a significant role in utilization review for emergency department usage. This could be difficult for Healthcheck positions funded through Smart Start. The Women’s Health Branch will introduce a concentrated 1-day monitoring process with intent of reducing health disparities. The self-administered history form, which originated with part of the streamlining, has been a successful endeavor, contrary to what most anticipated. In closing Wanda noted the WIC computers purchase through Gateway are in shipment now, the Dell order will not be shipped until the end of May.

Education and Awards -- Shott Harrellson

Scott thanked everyone for the support and participation in the morning workshop.

Policy and Planning -- Mimi Cooper

The Senate Appropriations for HHS is operating on the fast track. Subcommittees will finish the budget by the end of the current day and return the document to appropriations. Please call or write regarding these 5 points:

1. Support efforts to keep MPW at 185% of poverty
2. Oppose efforts to eliminate Medicaid eligibility for 19 and 20 year olds
3. Oppose efforts to cut transitional Medicaid eligibility (maintain at current 18 months)
4. Remove the provision that counts parents income for pregnant teens
5. Put $1M back in TANF funds for pregnancy prevention

Contact now: Purcell (919-733-5953) or Reaves (919-715-6400)

The association took action in January to oppose a bill such as S907 (Certified Soil Evaluators), but this bill bears watching. The committee will work on securing a commitment from legislative staff to inform the association if the bill is calendared.

The Alliance -- Barry Bass

The Alliance met yesterday per Barry’s comments. Due for the upcoming year will be $250. Officers are being accepted for nomination, pleas contact Barry with any recommendations. Work continues with BCBS on contracts. The Alliance is also working on collecting best practices for business operations, please contact the Alliance if your agency has something worth sharing.

Environmental Health -- David Rust

David reported an increased participation, with 6 local health departments represented at the meeting. A presentation was made on the Coastal Waters Program. Coastal residents can anticipate more postings this year. The USDA Food Code is under strong consideration for adoption by the State, participation in the committee will help with knowledge of this trend. Advocacy for reunification and a voice in the replacement of Linda Sewall when be major themes for the meeting with DENR Secretary Ross.

Nomination and By-Laws -- Wayne Raynor

Wayne encouraged everyone to review the by-laws for recommendations on changes and updates.

Liaison Reports

ANCBH

Please forward names of potential board members to the association officers. During the March meeting, the ANCBH voted to purchase equipment for the School of Public Health.

Excise Cigarrette Tax Update -- Bill Smith

The House did have debate on the matter of a cigarette tax, which is a major step forward. The perspective of the Senate is to present the matter as economic stimulus. The revenue from a 60-cent per pack tax would provide for 3 cancer centers across the State and cover the current local Medicaid match. Alcohol sales tax would also be lost in the package deal. This proposal seems to have viability among legislators.

Adjournment

With no further business, the motion to adjourn was made, seconded, and approved unanimously at 4:00 pm.

Respectfully Submitted,

J. Elaine Russell, MPH
Secretary-Treasurer