Minutes

North Carolina Association of Local Health Directors
Full Association Meeting

May 19 , 2004

Holiday Inn Sunspree
Asheville, NC

Call to Order

Meeting was called to order at 9:05

Approval of the Minutes

After the correction of two spelling errors (thank you so much George Bond) and the correction of the reporting member of the Reimbursement and Finance Committee (apologies to Doug Urland) the minutes of the April meeting were approved.

Treasurer's Report -- Deborah Rowe

Deborah presented the treasurer’s report. Copy attached. Only three counties have not yet paid dues. Thanks to everyone who paid promptly.

President's Report -- Mimi Cooper

Mimi informed us that the Governor was proclaiming September, 2004 as Healthy North Carolina Month today. A number of state folks would not make it here today because of the “event” of this announcement in Raleigh.

Mimi also let her subjects know that she was forced to make a royal executive decision to sign a letter endorsing the Reduce Teen Suicide Initiative. Timing was such that to have us listed as endorsing this initiative, the letter had to be in. Obviously, there were no questions or concerns.

Mimi appointed Dorothy Cilenti to represent NCALHD and be our official liaison to the CDSA transition process. There are still a number of inconsistencies in interpretation of the changing roles of agencies in this process.

Executive Director's Report -- Deborah Rowe

Deb reminded everyone about upcoming awards and mini grants. She urges applications to the Ann Wolfe Endowment which will be two $5,000 grants this year. These are designated for Health Department projects in child health or reduction of infant mortality. The application is user friendly, and NCPHA is looking for record numbers of applications. Remember too the GlaxoSmithKline Award and the scholarships. One scholarship is for the child of an NCPHA member. Check the web site for details and forms for nominations.

Environmental Health -- Terry Pierce

Terry commented on the status of his department in budget proposals so far. One vacant position is frozen, but there are no reductions in aid-to-county funds. Two petitions to the Commission for approval of the systems – E-Z Flow and Infiltrator Were not approved.
He is looking at changing how we order forms, since ordering once a year makes it difficult for local health departments, they are looking to changing the system to twice per year. The EH List serve is having some problems. Some on the list are saying they are not receiving messages. They are trying to locate the problem. Get your expenditure reports out right away for use of state funds. If you have a problem, call Pam Curray.

Local Support -- Dennis Harrington

The Medicaid Cost Settlement should go out the end of next week. Take a look at the e-mail you received on Delegation of Candidate Qualification. Dennis urged everyone to read this document carefully.

See the attachment on the Task Force on Training Technologies. It addresses the acquisition of videoconferencing equipment. Health departments are urges to obtain as much connectivity as possible. Note that the purchase of this equipment does NOT guarantee access PHTIN programming. Please respond promptly to the email from Joy Reed asking your intentions regarding this equipment.

Dennis distributed the notices on the Governor’s proclamation of September as Healthy North Carolina Month. (copy attached) The purpose will be to focus citizens on increasing physical activity. There is no funding for this. LHDs might want to schedule some regular activities during this month to capitalize on the state wide promotion. Some discussion followed regarding the significance of this event.

Dennis distributed a copy of budget cut options for HHS from the House. (Since these change constantly, and are lengthy, a copy was not attached here – watch your email) HHS is hit hard in this version, with a number of items that impact heavily on Health Departments. Among these are: reducing the Medicaid rates to the private providers (again), reducing public provider rates to those of the private sector or freezing public rates at the 03-04 level; a cut in health promotion, cutting the cancer control program in half; reducing Medicaid eligibility for pregnant women to below 151% of poverty; putting NC Health Choice children 0-5 on Medicaid, thereby reducing reimbursement rates for them; eliminating Medicaid for 18, 19, and 20 year olds; eliminating dental, hearing and vision coverage from Health Choice. Dennis finally sat down because we couldn’t take it any more.

Committee Reports (action items)

Policy and Planning -- Don Yousey

Don noted at the beginning of his presentation that he had seven action items from the previous day’s meeting to discuss. They were as follows:

1.Quarantine bill Changes (Section 130A-145) – The proposed statute change would extend the quarantine period from 10 days to 30 days to help preclude needing to go back to court every ten days. This was brought about by the SARS experience. The committee reviewed the proposed wording and agreed with it.

Motion: That NCALHD take a position in support of extending the quarantine period from 10 to 30 days.

Coming from Committee and needing no second, the Association voted unanimously in favor of the motion.

2. Meth Lab Clean Up (GS 130A-284) – The committee discussed the proposal to change the wording to require the person in charge of a contaminated dwelling to meet clean up standards before allowing the structure to be re-inhabited. There was some thought that the wording was too specific and might force us to adopt other rules for other contaminants in the future. Others felt that making the wording too general might cause others to come out in opposition to the change. Consensus was that it was probably best to leave the wording the way it was

Motion: That NCALHD support the rewriting of GS130A-284 requiring that contaminated sites be cleaned before they are allowed to be re-inhabited.

Coming from committee and needing no second, the motion carried unanimously.

3. Emergency Department Data Reporting (GS130A-479) – Under this rewrite, a process for hospitals to report disease data that would be helpful to public health in carrying out its bioterrorism (BT) response duties would be put into effect. Dr. Keener had reported to the committee that this was an agreement for hospitals to use software that would support the needed reporting. The committee had felt that this would give public health greater access to needed data and that we should support the rewrite.

Motion: That NCALHD support the rewrite of GS130A–479 Titled: Emergency Department Data Reporting in its current format.

Coming from committee and needing no second, the motion carried unanimously.

4. NC Aids Advisory Council Legislative Agenda – This was a request that was received after the committee agenda was set. It asked that NCALHD sign a draft letter in support of the legislative agenda set by the Advisory Council. Specifically the letter addressed giving more people access to Aids medication and treatment. The draft letter was read by Tom Bridges as it had not been available during the committee meeting the previous day. The committee had felt the need to move now as the short session would be over before our next meeting. The original motion offered from committee was “That NCALHD President sign the letter of support for the NC Aids Advisory Council if its contents were in agreement with what we had supported in the past.”

Now that the letter was available, a friendly amendment was made to limit the support letter to support greater access to Aids medication and treatment and not the whole legislative agenda.

The group voted unanimously (secondary to appropriate motion and second) to accept the friendly amendment and then voted unanimously to approve the original motion with the friendly amendment change.

5. Bill to Study Medicaid Cost Share in NC – The committee discussed this bill that Rep. Ed Nye put forth that would appropriate $50,000 and establish a 2 year study to look at how we are funding Medicaid in NC. Some felt establishing a study guaranteed that fixing this problem of local match for Medicaid would not be fixed for at least two years. Since the Bill is very new and the County Commissioners’ (CCs) Association hasn’t taken a position on it yet, the committee felt we should structure our position to go along with what the CC’s might be.

Motion: That NCALHD delay taking a position on this bill until the NCACC makes its position known and then adopt their position as ours.

Coming from committee and needing no second, the motion carried unanimously.

6. HB 1368 – Bill to Appropriate $8,000,000 to Help Pay for Uncompensated Care – While the committee felt that any action to help with uncompensated care would be helpful, the fact that we have already documented that public health provides upwards of $17,000,000 of uncompensated care per year, the amount in the bill is inadequate. Coupled with that, the money in the bill is not targeted towards public health. Such a large group (i.e. hospitals, clinics, etc.) would qualify for the funding that when it finally got doled out, the committee felt there would be such a small amount for each qualifying agency as to make it almost inconsequential.

Motion: That NCALHD not support HB1368 in its present wording.

Coming from committee and needing no second, the motion carried unanimously.

7. Motor Cycle Helmet Law – Rumors of efforts to overturn the motor cycle helmet law are circulating again. While we don’t have specific legislation in hand, the committee felt we should be ready if something came up. With that in mind, the following motion was offered.

Motion: That NCALHD take the standing position that we are in opposition to any legislation that would overturn the current motor cycle helmet requirement.

Coming from committee and needing no second, the motion carried unanimously..

Committee Reports (information items)

Environmental Health -- David Rust

Everyone is reminded to check expenditure reports and make sure you have expended state funds by May 15th. If you have questions, call Pam Curray at 919-733-2884.

On October 1, meat market rules will be incorporated into food rules. The Critical Items Committee has merged with the Food Code Committee to form what is now known as the Food Safety Committee.

Reimbursement and Finance -- Tim Green

Did not meet this month, the next meeting is June 15th. The group will be discussing CSC and MCC billing changes. Tim hopes to be able to send out information on how to use the system appropriately.

Policy and Planning -- Don Yousey

Don noted at the beginning of his presentation that he had three info items from the previous day’s meeting to discuss. They were as follows:

1. SB672 – The committee discussed the fact that the cross over version of the bill is still out there that contains wording that was not acceptable to the association. Deborah Rowe volunteered to check with Sen. Hartsell’s office to see what his intent is regarding this. General feeling was that nothing will probably happen with this right now as the County Commissioners’ Association has taken a position in opposition to it.

2. Companion Animal Bill – Don noted that committee discussion showed that some of the better points in the original bill had been removed secondary to opposition from breeders and hunting dog owners. There was still some fear in the committee that some form of euthanasia ban might still be put through even though the bill in its present format states any form of euthanasia approved by the American Veterinary Association is okay. The committee also discussed that the wording requiring that animals be spayed or neutered before leaving shelters would hamper the way many county shelters are doing business. Deborah Rowe volunteered to help take alternate wording to the task force members. Don urged those with concerns to forward suggested wording changes to Deborah. Due to the wide diversity between counties on how Animal Services/Animal Control is handled, the committee felt the association should not take a unified position on the overall bill – “for now!”

3. Need for Statutory Authority for Accreditation – The committee discussed this and felt without funding in the Governor’s Budget for accreditation, this exercise in setting it up may have actually weakened or held up our association’s efforts in this regard. Some felt the Secretary planned on finding the needed funding in her own budget to support establishing the accreditation process. There was general consensus in committee that if this effort failed, it did not preclude NCALHD from going back to our original plan of establishing accreditation ourselves over the next four years. There was also strong agreement in committee that we need to “bird dog” this, but should leave it alone for now and wait and see how it plays out.

Women and Children's Health -- Jenny Lassiter

WIC software is being worked on. There was an update on CDSAs and the transition of Early Intervention.. There were two more group meetings, one in Fayetteville, and one in Washington. Jenny stated that Health Directors have been left out of this process. Service coordination is being considered permissible for health departments only if the child is considered medically needy. Bill Smith asked about moving the health department social workers who will be doing this to the classification of Hab Specialist III. This was the classification for these workers in the mental health agencies. This classification is two grades higher than a Social Worker II, which our folks are. This change would have to take place at the state level. Jenny suggested that WCH and Reimbursement have this conversation with Leah Devlin. The committee has not seen a contract addendum for Early Intervention yet.

Eighty Three health departments have requested hearing equipment. Everyone should be aware that the state provides TWINRIX and there can be no charge for this vaccine in health departments. Scotland county has decided not to do high risk maternity any more. Their funding of $68,000 will be distributed among the five counties they were supposed to cover.

DMA is going to implement the changes in MCC processing and reimbursement and not wait until January, ’05 when the pilots are finished. Jenny stated that we need intervention with DMA.

Health Promotion/Oral Health -- Curtis Dickson

Curtis submitted the following written report that was read into the record by Mimi Cooper.

The Committee has sent a one page dental survey out to all local health directors via the local health directors list serve. Please respo9nd to this survey of interest in meeting by conference call or face to face to discuss dental program successes and possible expansion of efforts to other counties. The committee is still working on a comprehensive diabetes or chronic disease survey that will be coming to local health directors in a month or two. We have been asked to contact the Division of Aging and Health and Wellness Trust Fund to look at the effectiveness of the various state medication grant programs. The state health agency is proceeding with a grant application for the STEPS To A Healthier U.S. The grant will focus on diabetes, obesity, nutrition, physical activity, and youth tobacco use. Three local groups are being included in the proposal, including the Northeast NC Partnership for public Health, a four county Lumber River consortium, and Durham County. Several groups are examining the new Stroke Belt Initiative federal grant that is eyeing seven stroke belt states, including NC. There is a consortium involving Pitt County and two other counties along with the Northeast NX Partnership for Public Health, and a group from Robeson County that are looking at applying. The Committee will have a standing agenda item involving a report from the state Chronic Disease & Injury Section. The state will release food standards for schools on May 27th. Dr. Marcus Plescia and Dr. Leah Devlin were interviewed by the News & Observer regarding obesity. Be on the lookout for the article.

Education and Awards -- Colleen Bridger

Colleen announced that Wayne Reynor will not be able to go to NACCHO, so the committee will revisit the applications to re-award the scholarship. If you are interested let them know. She also reminded everyone to consider nominations for Health Director of the Year.

Regional Reports

David Stone - NCPHA will have two awards of up to 5000 each from the Ann Wolfe trust fund. The criteria for the grants are that they must go to a health department and be projects related to Child Health and Infant Mortality. In the future, these awards should be larger. This year the money has not had time to be invested long enough for greater earnings.

Bill Smith - The NC Alliance for Health is funded by Southern Neighbors. The organization is looking for help for salary for their Director. After some discussion, he made a motion that the Association make a $2,000 donation for this purpose. Don Yousey seconded the motion. Motion carried.

Liaison Reports

Alliance (NCAPHA) -- Barry Bass

The Alliance meeting will follow today’s Association meeting. Topics that will be discussed are contracts, dues and rates.

Institute of Public Health -- Bill Browder

Bill brought information on a Spanish course available on line. There are 10 full scholarships available. Call his office by the 27th if you are interested. This is an intermediate, not a beginner’s course. It covers cultural competency in addition to language. The course takes four months to complete. It will run from June to September and the October to December.

NCPHA -- David Stone

David reminded everyone to apply for the awards available, and urged joining NCPHA. The annual meeting is Aug 25-27th.

Bill Smith informed everyone that the NC Alliance for health thanks the association for their help. Momentum is being built for the Tobacco Tax increase. Thanks for the great job you have all done!

Jenny Lassiter suggested that everyone check their NACCHO ballots for a familiar name among candidates for regional reps.

Adjournment

With no further business, the motion to adjourn was made, seconded, and approved unanimously at 10:55AM.