Minutes

North Carolina Association of Local Health Directors
Full Association Meeting

February 19, 2004

Wake County Human Services Building
Raleigh, NC

Call to Order

Mimi Cooper called the meeting to order at 9:15 am. A quorum having been established, this was determined to be a full association meeting. (Effective this meeting, a quorum consists of 30% of the membership.).

Approval of the Minutes

Minutes of the January meeting were approved.

Treasurer's Report and Recommended Budget for 2004

See attached Treasurer’s Report and budget as presented by Elaine Russell. There are cuts in line items compared to last year as a result of considerably lower CD interest rates. There is less money to work with. There was a discussion regarding the possibility of increasing membership dues. Danny Staley made a motion that the proposal be referred to the Finance Committee. The motion was seconded by Tom Bridges. Motion passed.

Executive Director's Report --Deborah Rowe

• Please contact members of the Commission for Children and Youth to advocate on behalf of the Childhood Obesity, Physical Activity in Schools, and Tobacco/Substance Abuse programs. The names of members of the Commission were emailed to health directors a couple of weeks ago.
• The State Board of Education has recommended increasing the school health nurse/student ratio to the standard of 1:750 over a ten year timeframe. The NC Association of County Commissioner’s Human Resources Steering Committee passed a resolution in support of this recommendation. This resolution will also go to the NCACC Board of Directors on March 18th. Call your commissioners to encourage them to support this resolution.
• The House Interim Committee on Prevention and Disposition of Unwanted and Abandoned Companion Animals is meeting this morning. Rep. Carolyn Justice advised that they are close to making their recommendations and she will speak to those recommendations at our March meeting. She will also be presented her plaque for Legislator of the Year at that meeting.
• The Covenant with NC’S Children has reached their first goal of raising $14,000 for the Chief Lobbyist Fund Drive which will allow the continuation of a full time lobbyist through August 31, 2004. They will continue to collect donations to extend that position beyond August 31.
• Deb urged us to register for and attend Town Hall Meetings on the Public Health Task Force Draft Recommendations.

State Health Director's Report--Dennis Harrington

On Leah’s behalf, Dennis thanks Association members for help on the Task Force. They are working on getting the draft recommendations updated for the next Task Force meeting. There is a book for everyone to pick up that is on per capita spending in public health for all sources of funding. There are twelve rankings and all done by county for comparison. All health departments are urged to participate in the management academy. The state subsidizes this participation.

Environmental Health--Terry Pierce

Terry informed the membership that he will be directly over food and lodging, onsite wastewater and pest management. He will be working on improving communication between state and local agencies. There are rules before the Commission relative to on site, meat markets and primitive camps rules that you may want to be aware of. He has been asked to prepare budgets with cuts of 1, 2, and 3 percent for next year. Bruce Harrison has had a sub species of mosquitoes named after him. This is a great honor, for those of us who may not be well versed in the world of entomologists.

Committee Reports (action items)

Environmental Health -- David Rust

Recommendation: That the Association be on record in support of the reunification of Environmental Health and Public Health under the State Health Director, that the /state Health Director become an Assistant Secretary of public health and environmental health and that they both become part of the DENR.

There was considerable discussion regarding the timing of such a recommendation. Don Yousey reported on the discussions that took place in the Policy and Planning Committee regarding the larger context of the draft recommendations vs an item that might be considered less than ideal. There is likely to be input incorporated into the recommendations as a result of the scheduled Town Meetings. David explained that the Environmental Health Committee thought it best to have this position on record before the recommendations are finalized. All agreed that this is a controversial issue, but timing could be sensitive. There was some consensus that the item could wait a bit longer.

David Rice made a motion, seconded by Jenny Lassiter that the motion from the Environmental Health Committee be tabled. Motion passed.

Recommendation: Environmental Health Liaison Committee recommends approval of revised Lead Poisoning Prevention Aid-to-County Allocation Formula for 2004/2005 as follows:

$2000 per lead-poisoned child (≥20ug/dL) = 38 X 2000 = $ 76,000

$300 per EBL case (10-19ug/dl) = 465 X 300 = 139,500

$250 training funds for local health dept. staff = 33,312

Total = $248,713

Info: number of cases of lead poisoned children has declined.

Motion from Committee needed no second. Motion passed. .

Reimbursement and Finance -- Tim Green

Recommendation: That the Association concur with the recommendation of the State staff that we accept the newly established private rates for dental services with the understanding that the cost settlement would still take place for dental care.

Tim explained that the final analysis of these rates vs current public health rates showed that we will do very slightly better with these rates. Originally, it was believed that we would lose the benefit of the cost neutral settlement, but it has been determined that the dental cost settlement will continue for health departments.

Motion from committee needed no second. Motion passed.

Women and Children's Health -- Jenny Lassiter

Recommendation Recommendation: That the Association accept the proposal from the division to redirect $600,000 in high risk maternity funding from the tertiary care centers to health departments that do not currently receive high risk funding to assist with the burden of uncompensated prenatal care.

Motion from Committee needed no second. Motion passed.

Recommendation: That the Division be requested to examine the use of high risk maternity funding over the coming fiscal year.

Motion from Committee needed no second. Motion passed.

Recommendation: That the Association send a letter to DMA requesting that reimbursement for Early Intervention case management services be directly billed by participating health departments rather than having the CDSA act as a pass through fro this billing.

Discussion reiterated that Health Departments would not be charged a fee by the CDSA for processing the billing as private providers might be. There is, however, concern about processing time and delay of cash flow to the Health Department if they do not do their own billing and receive payment directly.

Motion from Committee needed no second. Motion passed.

Committee Reports (information items)

Environmental Health -- David Rust

Arsenic still an issue for some drinking water supplies. Be aware that the press has been looking and commenting on this, so Health Directors may want to familiarize themselves with this issue. The. FDA system for restaurant inspections is still being looked at. Soil wetness rules currently before the Commission are being followed by the committee. There was discussion about the need for timely notification from the state when information is going to be released to the press, so local health departments are not caught off guard by reporter’s questions.

Reimbursement and Finance -- Tim Green

Tim urges everyone to join this Committee. They are a sophisticated group, and there was some relationship between that, a peach being pleasant, Leah out on a limb and Dennis being the pit, but the secretary didn’t get it all straight. ( See Mimi’s rule number 9 and apply it to minutes)
He said the topics they are looking at covering this year are best practices related to business and finance, CSC billing, Medicaid shifts, fees for service, uncompensated care and revenue for core functions. Meetings will be held at 10:30 at St. Mary’s Street on Wednesdays before the Association meeting.

Policy and Planning -- Don Yousey

Don related that there had been some discussion regarding the preemptive smoking law and smoking in county buildings. If your health department shares a building with another county department, please get in touch with Wanda regarding how smoking is regulated in the building.

He also reminded all that we will have to keep track of what is happening with the rewrite of the State Personnel Act. The workgroup realizes that they made a mistake writing us out of the act, but since we have no representation on the committee, we will need to monitor happenings, though we believe they are on the right track at this point. Policy and Planning discussed the draft task force recommendations. The Committee decided that we needed to wait to see what input the Town Meetings provide regarding the draft, and what, if any, changes get made. We will have another opportunity to discuss our response prior to the final recommendations being published. Please discuss this in your regions.

The state employees assoc. has come out with support for increased tobacco tax.

Epidemiology -- John Morrow

Epidemiology did not meet this month. The next meeting is via conference call on March 9, at 2:00 PM.

Technology -- Ray Rabe

Ray reported that the immunization registry RFP will be posed by the end of this week. We have also heard that Georgia has designed a system with a two way interface that eliminates the double entry problem we have been concerned about. This can be handled as an enhancement to the RFP at a later date.

Sherry Botts gave the committee an update on Phase Two of the state level HIPAA adjustments. User acceptance testing is underway and about 25% complete. DMA/EDS has a crosswalk on the web. Francis Taylor will be sending out the address and a telephone number at EDS to call if there are questions about a denial.

Francis Taylor and Bob Martin shared information regarding a scheduled NCHICS/AHEC training in the spring on the HIPAA security issues. That are suggesting that the Privacy Officer and Security Officer attend at a minimum. However, they emphasized that they will be providing a training oriented to public health in March that will be free. This will include a demonstration and training on the use of Early View Tool on Security. The IOG will not be providing specific guidance on this aspect of HIPAA because this is really an IT matter, and not in their expertise.

Dennis Harrington gave an update on the new HIS project. PCG is in the process of writing the detailed business requirement. This is expected to be completed by the end of May. This will provide that basis for a new RFP.

Ed Riley an Ed Carter gave a report on the effort to deal with the billing problems in HSIS. They have fixed most of the errors, but can’t get back to the aged claims due to limited staff. They suggested that we try to rebill the aged claims, and they believe that 90% should go through and be paid. There is a concern about the change in format since the implementation of HIPAA during the time in question. There may be the need to change some of the fields, e.g. code sets and rates, on some of the older claims. We will be working with them to experiment with a few claims to verify whether rebilling will work. They will let everyone know if this is a viable option.

Women and Children's Health -- Jenny Lassiter

There was extra immunization money for this year mixed in with the contract addenda package for next year. Spend this money THIS year!

The Immunization branch staff will be calling to ask your opinion of the value of the newsletter. The budget is tight and they want to be sure you find this item useful. They will no longer be able to provide plastic sleeves for immunization cards. These cost the state $100,000 per year and they can no longer afford it. They will also no longer be able to provide copies of the vaccine information sheets. It is not required that a copy be given to the parent, nor is it required that they sign that they have read it. They suggest that we laminate the sheet and give it to the parent to read at the time the vaccine is given. Make a copy only if the parent wants one.

There was a discussion regarding the possibility of having the state purchase flu vaccine for all health departments. This might mean a more reliable supply, with the state dispensing doses wherever they are needed. Certainly there are also some disadvantages to centralizing this process. Please volunteer to work on a sub committee.

WCH has identified one time money to cover the 10% cost share for the Medicaid Waiver for Family Planning for this year, so we will not see a reduction in block grant funding for this year. They are also looking into the possibility that the local contribution for family planning could be used as the matching funding. Of course, the implementation of the FP Waiver is not set.

Health Promotion/Oral Health -- Curtis Dickson

A sub committee was formed to look at the nine standards for health Carolinians for certification of the local task force. They have suggested adding the requirement that the Health Director sign off on both the application and the action plans in order to assure a proper level of involvement of the Health Department. These recommendations have gone to Mary Bobbett Cooke, so they are not ready for a formal recommendation for support. They also discussed the need to have the Governor’s Task Force provide direct feedback to the Health Directors on their findings relative to task force application. We are also asking for a direct appeals process for local members to appear in person before the Governor’s Task Force if an application is denied.

Performance based allocations proposals are still being working on. Some counties will lose money, but the concept has been around long enough for counties to have made these adjustments. Performance based measures will insure that the policy is being implemented. The amount of money that counties receive varies greatly, and some counties with less funding perform more effectively than ones with higher levels of funding. It is felt, however, that anything less than $35,000 does not allow a county to support an effective program. Money varies greatly between counties. A number of options are being looked at here, including performance ranking, base funding, and extra money for high performance.

State and Local -- John Morrow

There will be an August round table meeting with Sonia Bruton’s office related to Community Health Centers. The focus will be on best practices and areas that need improvement. Twenty five counties have Community Health Centers and all counties are invited to participate.

Regional Reports

Region 10 -- Jenny Lassiter

Jenny urged everyone to get other community participants to attend and make comments at the Town Meetings. It will be important than there is input from other than health department staff and health directors.

Motion: Jenny made a motion that the Environmental Health and Technology Committees work together on how Environmental Health will report information in the new information system.

Motion passed.

Region 1 and 2

Concern expressed about flu vaccine orders. With hospitals, etc ordering large amounts of vaccine, and in some cases, dispensing it free, it is suggested that you talk to those agencies that might do this to determine the impact on demand for health department doses.

Danny Staley commented on meth labs. Sudafed is a significant ingredient for these labs. In his area they have asked pharmacies to voluntarily limit the amount of Sudafed that a customer can purchase. They have been very willing to help with this community problem.

Liaison Reports

IOG

Legal conference will be held April 21 -22

Public Health Institute -- Ed Baker

Mimi Cooper and Leah Devlin are to serve on the advisory committee to the institute. Bill Roper has gone to work for the university hospital, and an interim dean will be named soon. A search committee will be set up. There is a role for the institute in the recommendations of the public health task force in : Accreditation, Work Force Development, Public Health Incubators intended to support and demonstrate collaborative efforts, as well as Academic Health Departments.

Nursing Administrators Liaison

Please encourage nurses to attend the annual meeting of the NCPHNA.

Dennis Harrington for Joy Reed

There are resources available from Joy to help departments that want to start dental programs. The oral health section does not have staff to address clinical delivery of dental services, the following resources have been developed: Clinical Operations Fact Sheet, Dental Health Professional Shortage Area Fact Sheet, Facilities and Equipment Fact Sheet, Staff Recruitment Fact Sheet.

As of 2/16/04, 54 of 85 local health departments had returned the latest MOU so that PCG can continue to bill on behalf of the local health department claims more that 12 months old which have never been billed.

Leah Devlin

The next month allows for input on the task force recommendations. She is looking forward to further conversation.

Comment form the Floor

“Reciprocity” is not doing enough to improve the availability of dentists in North Carolina, especially for public health programs.

Adjournment

With no further business, the motion to adjourn was made, seconded and unanimously approved at 12:30 pm.

The next meeting of the Association will be March 18th, at 9:00 am at the Wake County Health Department.