NCALHD



North Carolina Association of Local Health DirectorsFull Association MeetingDate: July 16, 2015Cardinal Room, DPH, Six Forks Road, Raleigh, NCMinutesMeeting Called To Order: 9:30 a.m. Approve Minutes of Previous Meeting: Motion to approve minutes of the June 18, 2015 meeting was made and seconded; motion carried.Approve Treasurer/Financial Report: Motion to approve the Treasurer/Financial Report was made and seconded; motion carried. First 2000 Days Presentation – Erika Taylor, Miss NC International & First 2000 Days ChampionMs. Taylor gave a presentation on her campaign platform, “from prenatal to pre-K” with a focus on raising awareness of the importance of children’s development during their first 2000 days of life. (See attached presentation). Ms. Lisa Finaldi with the NC Early Childhood Foundation also shared information about resources available on their website (). She can also be contacted for further information or possible presentations at lfinaldi@. President’s Report – Buck Wilson- Still some discussion in the legislature about Medicaid reform; our message to legislators is that public health departments need to be a part of any model(s) that are developed. Encouraged members to convey that message to legislators.-Medicaid Cost Settlement – Continuing to make progress and appreciates everyone’s patience. DMA’s Trey Sutton and Roger Barnes met with our Policy and Finance Committee on Wednesday and indicated they would have answers to our main questions by next Friday (Jul 24). The 2014 cost report has not been filed yet because as it stands about half of the health departments lose money and others would be in a “pay back” situation. We need questions and discrepancies settled before moving forward. Taking the issue to CMS would prolong the process so the focus is on working through DMA at this point. Mr. Sutton and Mr. Barnes indicated that we would have the cost settlement money by September. At this point we are trying to maximize the dollars by working through the discrepancies with DMA. -President Wilson asked if the membership was in favor of the association advocating/lobbying for continuing the “Maintenance of Effort” local funding requirement that was stipulated in HB 438 from a couple years ago? Consensus was to support that position. HB44 Amendment would discontinue that requirement.-Doug Urland will be working on some policies and procedures updates as well as reviewing the regional structure and county designations.- Still planning to identify two weeks next year to have our association meet during the same week as the DSS Directors’ meeting.-NCALHD will have a booth, along with NCPHA & NCAPHAduring the Commissioner’s Association meeting in Pitt County August 20-21. An informational brochure of the three associations has also been developed. Lynette’s staff will cover the booth on Thursday of the conference. If other members are interested in participating and/or helping please let Buck know. -There’s been some interest in better understanding uses of text messaging in public health work and Colleen Bridger will be chairing an ad-hoc committee regarding this for those interested.- President Wilson mentioned that there are budgetary concerns regarding future funding cuts to the PAN Branch. While the specific amounts are still unclear, he requested that the association allow the officers to work through these issues with Lynette to determine how best to lobby efforts as information becomes clearer. Motion was made, seconded and approved.State Health Director’s Report – Dr. Megan DaviesClarified her role as Acting State Health Director. The Division of Public Health is still being led by Danny Staley as Acting Division Director. Dr. Davies also continues as Epidemiology Section Chief (responsible for communicable disease, occupational & environmental epidemiology, public health preparedness). Her State Health Director role primarily covers the public health authority statutory requirements. NC Division of Public Health Report – Phyllis Rocco:The Division maintains a database of local public health nurse employees and due to numerous changes in local PH nursing directors/supervisors, that information needs updating. Encourage local nursing director’s to update that information with the State as appropriate.ICD-10 – Please check to see that your agency is moving forward with an implementation plan for ICD-10. There’s still concern that some counties may not be giving the necessary attention to this as needed. The Essential Services Report for how LHDs spent their aid to county funding for FY 14-15 was due July 15. Please send in if you’ve not already done so. Lynette requested that a summary report be provided of this information.State Environmental Health Report – Nancy Deal for Larry Michael:Provided update on H765 concerning on-site privatization option. The division has been working on a complete review of the 1900 rules and they are ready to distribute new set of recommended rules for review by LHDs and other private level stakeholders. The division will present to the legislators that in the same amount of time that it would take to implement changes and actions in the bill, they could have a more comprehensive set of rules to the Rules Commission for their consideration and it would be more comprehensive. Executive Director’s Report – Lynette TolsonJoint meeting was held on Tuesday of the officers of the three public health associations (NCALHD, NCPHA, NCAPHA) to review how they work together and effectively move forward in meeting future goals and needs. Two groups will be working on a communication/marketing plan and lobbying. Exploring purchasing new microphones and conferencing capabilities for the Cardinal Room. All LHDs have paid their current NCALHD dues.NCAPHA Report – Jerry ParksReiterated the recent meeting of the three public health association officers and the goal of seeking opportunities to work more closely together.NCPHA - Lisa HarrisonPlanning sessions are going well for the Fall Conference. Want to make time on the conference agenda to recognize those local staff who have been involved in communicable disease/traveler monitoring over the past year. Let Lisa know the names of local staff who have worked in that capacity so they can be recognized at the Thursday night dinner. Encouraged LHDs to support these staff attending the conference either fully or one-day registration. If the LHD cannot cover their staff expense for the dinner, NCPHA will cover that cost. (Travel cost would need to be covered by the LHD.) Action/Information Items - Committee ReportsCore Public Health –Denise Michaud:Action/Motion: No ActionInformation: Title X Grant Award for FY15-16 – Belinda PettifordSee Attachment; Section received notice of award for Title X funding (3 years) though an 11% reduction due to more funding going to Planned Parrenthood; DPH has reduced operating costs and connot offer bonus funding yet there is another $75,000 in cuts needed. Staff reviewed HIS data to calculate a proportional reduction based on 2010-13 data; this will affect 33 health departments (those with greater than or equal to 5% reduction in the number of FP clients).- Question from LHD regarding collaboration between FP and STD due to increase in syphilis cases; Belinda will confer with Epi.Presumptive eligibility – Belinda PettifordChange in Agreement Addenda to screen all pregnant women for presumptive eligibility (PE); feedback from local agency staff: lack of sufficient resources to meet this requirement resulting in less women receiving prenatal care in the first trimester; staff not focusing effort on those who qualify; DPH is working with CCNC to determine which providers accept PE; will reach out to DPH staff to assist with streamlining application process; goal is to get women in prenatal care ASAP.- Comments by LHDs: work with DSS staff; use of e-pass (no one indicated familiarity with this); point was made that DSS staff cannot do PE; question regarding impact of women with insurance via marketplace (ADA) that is discontinued if the premiums are not paid.FY15-16 Budget Impact for LHDs – Peter AndersonSee attachmentLHD Questionnaire (Draft) – Monecia ThomasNovember 2014 NCALHD meeting, members voted to regionally develop a series of health department questions regarding the provision of certain services; each region submitted 10 questions for the purpose of developing a report; questions and results will be posted on the NCALHD website; draft questionnaire posted on the association website; request for feedback on questions in “orange” by the end of the month; Eleanor Howell (SCHS) offered to provide feedback in an effort to coordinate data collection efforts since SCHS does a survey every 2 years.Tobacco resolution – Sally HerndonMovement to increase minimum legal sale age for tobacco products to 21 (see attachments); Orange County initiated a resolution (attached); Durham, Chatham, Pitt and Cumberland Boards of Health have passed the resolution; Orange County Board of Health and County Commissioners have passed the resolution.Public Health Promotion & Prevention –Janet Clayton:Action/Motion: NoneInformation: Sarah Tomlinson, DDS, Oral Health Section Chief, gave a brief overview of the section’s new strategic plan. Key points include a shift in adding new population groups such as pre-school children and some efforts with the adult population. (See attached presentation) Dr. Tomlinson noted that some of the presentation maps indicating types of dental services provided by LHDs may be incorrect; please let her know of corrections as needed. Technology – Beth Lovette: Action/Motion: NoneInformation: (Beth was unable to attend but provided the following notes from committee mtg.)Overview of proposed Meaningful Use rule changes: Mary McCaskill, AHEC, Informatics Director, provided a presentation of the proposed rule changes. (Presentation to be forwarded to Phyllis Rocco for broad distribution.) Overall, the changes would make meeting the Meaningful Use requirements a bit easier. The final decision about the proposed rule change should be made by HRSA by the end of July or early August. AHEC staff is available to help LHDs with Meaningful Use issues. Jerry Parks reported that Albemarle used AHEC and was very pleased with the support provided.NC HIE from the DHHS perspective: Darryl Meeks had an unexpected emergency and was unable to attend. We will ask him to participate in August.Update from Batch Interface and Reporting Workgroup: John Bryant presented the current “needs” list from the Workgroup. Training needed for local staff to “work” the batch interface error report. DPH/DIRM staff has been focused on ICD-10 implementation but this training is still on the list. Lynette also reported on several other IT related trainings planned for the NCPHA Fall Education Conference.One vendor shifted the monthly batch data upload to the LHDs. This has caused more upload errors, so now John is considering how to provide training for local staff using the VPN.There is a work-around now for the height/weight error on postpartum home visits. Details coming soon.Still working on compiling a comprehensive list from DPH programs on what is required for the batch interface report. This has required education for DPH staff, as they try to discern the difference between data that must be gathered for aggregate state data reporting vs data input that is required within a clinical service vs data the program wishes they could get.Batch Error Reports vary across LHDs, depending on whether the LHD has established a tight process to manage the batch error reports. Current top errors are:Not following the batch upload schedule.Batch files sent to the wrong directory (mostly by counties uploading their own data and do need additional training)Batch files not named properly – must be named based on the convention defined in the Batch Interface Layout on the HIS Website.Files sent in zip files cannot be accepted, must be in TXT file format.John will work to pull together a batch interface history report by county so that the LHDs can see if error rates are improving over time.Updates or questions:Phyllis Rocco spoke about ICD-10 implementation. She suggested that health directors should ask staff:What is our transition plan? How is it going?Have the batch vendors tested through their clearinghouse?Have you set up agency specific crosswalks from the most frequently used ICD-9 codes to the ICD-10 codes? NC TRACKS has this available.Beth Lovette mentioned two data gathering projects in progress using a small portion of the Uniform Data System (UDS) that FQHCs are required to use. Bob Martin and Beth are on a NC HIE Safety Net Committee where this is in progress. There is also a small project with CureMD and Patagonia with the Diabetes Program.Future Agenda ItemsHeart Health Now – CCNC/AHECCare Apps – CCNC Informatics Center (August)NCHIP – update on why it isn’t currentRules for Scanning/Records Retention (August)NC HIE – Darryl Meeks -- in addition to state perspective of the transition from CCNC to DHHS, how will the analytics portion of the HIE be impacted? As we attempt to monitor outcome measures for various programs, it will be crucial to have the data analytics.Policy and Finance – Lisa HarrisonAction/Motion: Amend language in HB 765 to update rules by 2016 and require al engaged/appropriate stakeholders to collaborate on the rules to go back to the Public Health Commission. Motion was rmation: Finance – Medicaid cost settlement Guests present at the committee meeting included:Steven Garner, independent consultant for cost settlement calculations, DPH/LHDTrey Sutten, director of finance/chief financial officer, Div. of Medical Assistance (DMA)Roger Barnes, DMATrey stressed that DMA has been working with Danny Staley and Steve Garner to move forward supporting the mission you are (public health is) committed to. Buck noted that we (local health directors) are trying to better understand the basic challenge that is holding up the current year’s pay out of cost settlement and apparently, retroactively applying interpretation of CMS guidance to previous years’ hold-back. Trey stated that they aim to solve this delay and answer our questions within in the next two weeks - “A week from Friday.”Questions/ seeking clarity from the committee:Q: Isn’t it true that 100% of these dollars paid out to counties in cost settlement are federal dollars?A: YesQ: Can we agree / all understand that this delay in payment and the discussion about the way this is calculated is holding up local budgets and could cost jobs at the local level? (Jerry Parks emphasized the importance especially to districts and authorities whereby cash flow is impacted in real time). A: YesLisa asked all three guests to edit/ provide corrections to a bulleted list that summarizes the narrative around the issues holding up payment of cost settlement and interpretation differences about CMS guidelines. The guests agreed to provide feedback & correct the document and reiterated they are committed to addressing this issue in the coming weeks.Policy – Enroll America UpdateBuilding on the Enthusiasm from?King v. BurwellSorien Schmidt, Director, Enroll America/North Carolina, was present to provide a brief overview of how coalition partners are building on the enthusiasm to make sure North Carolinians know that premium assistance is available during the current Special Enrollment Period and the upcoming Open Enrollment—November 1.Enroll America is a grassroots non-profit that exists in 11 states – the states that are rolling out insurance enrollment assistance through the federal marketplace. People are much more likely to have success enrolling in if they have assistance with the process with an in-person assister.A key success point so far for NC and these other high-enrollment states, is a scheduling system online called the Get Connected Assister at . There is a strong consortium of volunteer and non-profit organizations that are working together on this called a navigator consortium. Legal Aid of NC is organizing our state’s consortium. They can be reached at 855-733-3711. Assisters in NC have been very well organized. As local health departments, feel free to join this consortium and make available computers and assisters on site – let Sorien know or call the number if you want to be a formal partner.Question: If a patient doesn’t qualify for the subsidy (falls in the gap being too poor to qualify for a subsidy but does not quite qualify for Medicaid), do we pass those names along or is there a way you are keeping up with a list of those to assist?A: Yes, we are glad to take those names and try to assist – there is not a formal process for taking those names otherwise, but yes, do pass people along who are having trouble.Q: Is there anything being done to help pay providers during the “grace period” for enrollment (between enrollment and premium payment).A: Enroll America is operating in a Federal government environment so it’s easy to connect properly with what’s not working well and we send those issues not only up the chain federally, but also, we let BCBS and other networked insurance companies know. Do remind everyone that individuals need to select a new plan for the next year. Encourage people to go online by December 15th and we’ll be working to help educate people how to pay the premium.Q: Is there any discussion between the General Assembly and the Department of Insurance about a state run marketplace in the future? A: Not really, although people seem more and more informed lately. There is not much incentive for NC to run their own marketplace at this point now that the federal marketplace has been relatively successful. Policy – Legislative UpdatesEnvironmental Health and Regulatory Reform Nancy Deal was present to educate us about the updates around House Bill 765 which has already passed the House and gone to the Senate and is back in the House for concurrence. Lynette sent out a 3 page summary of the language regarding environmental health and privatization of on site. So far, we’re pleased to see some changes have already been made from original language and Chris Hoke as been consulted at this point. There are still concerns. The bill requires us to implement privatization of on site by 2016. The Division will be required to produce 3 reports: 1. Treatment standards, 2. update on the rule-writing effort, and 3.wholesale rules revision.It is true that, so far, there is nothing included about an expiration date for the on site inspections made by Professional Engineers (PE).Nancy conveyed that we all agree that we have to drag these rules into the present and this is an opportunity for that. We would like however, a chance to complete the re-write thoroughly. Lynette reminded the group there has been no action given by the association to date. NCALHD supports the bill review for changes in House Bill 765.A motion was made, properly seconded, and unanimously voted to “Amend language in HB 765 to update rules by 2016 and require all engaged/appropriate stakeholders to collaborate on the rules go back to the public health commission.” (Read: stop current legislation as written and pause for improvement through rules review process).We should have a completely vetted revision of the 1900 rules by June in 2016.Concern was raised about a current regulatory reform bill that includes a provision that would allow a child to ride/operate an ATV at the age of 6 instead of the current minimum age of 8. Safety measures, including setting the minimum ATV operator age of 8, that was passed in 2005 saw significant improvement in child death rates due to ATVs over an 18 month study period. Consensus of the association is to support the position of NC Child which calls on the House to reject the current version of HB 765 and remove the provisions that roll back child safety standards for ATVs.Planning and Innovation –Colleen BridgerAction/Motion: NoneInformation: The Committee heard an update from Monecia Thomas on the Aligning and Streamlining Work Group. This is the group that did the great work on the accreditation toolkit. They are struggling a bit with figuring out their next project, especially with their transition out of the Center for Public Health Quality and subsequent lack of funding and staff support. Monecia is strategizing to see if there is a way to involve this group in the “Core Questions” project she is spearheading. The Committee participated in a webinar on “Leading Through Health System Change” offered by the Georgia Health Policy Center in collaboration with Gillings School of Global Public Health. This webinar focused on resources available through the National MCH Workforce Development Center . Please contact Dorothy Cilenti (cilenti@email.unc.edu) if you’d like more information or to pilot the adaptive leadership tool. Dorothy will be working with WCH staff at DPH to determine an appropriate topic for piloting the tool and taking advantage of the technical assistance offered through the Georgia Health Policy Center. Stay tuned for more information.Education & Awards – Dave Jenkins:Action/Motion: NoneInformation: NoneNominations & Bylaws – Doug Urland:Action/Motion: NoneInformation: Encouraged members to let him know if they are interested in participating on the committee. Also shared information about an October 26-27conference in RTP regarding “Safe Water from Every Tap: Where Does NC Stand 40 Years After the Safe Drinking Water Act.”Action/Information Items - Public Health RegionsRegion I – Janice Patterson:Action/Motion: NoneInformation: NoneRegion II – Jimmy Hines:Action/Motion: NoneInformation: NoneRegion III - Ann Absher:Action/Motion: NoneInformation: NoneRegion IV – Dorothea Wyant:Action/Motion: NoneInformation: NoneRegion V – Merle Green:Action/Motion: NoneInformation: NoneRegion VI – Tommy Jarrell:Action/Motion: NoneInformation: NoneRegion VII – Chris Szwagiel:Action/Motion: NoneInformation: NoneRegion VIII – Carolyn Moser:Action/Motion: NoneInformation: NoneRegion IX – Jerry Parks:Action/Motion: NoneInformation: NoneRegion X – Davin Madden:Action/Motion: NoneInformation: NoneLiaison ReportsNC SOPHE – Doranna Anderson: Annual conference will be Oct. 8-9 in Hickory and will be celebrating their 50th year anniversary. ANCBH – Barbara Ann Hughes, PresidentHeld second in- person Board meeting this year, Saturday morning July 11 at Guilford Co Social Services Department. Topic of discussion was the Comprehensive Cancer Plan from DPH. LHDs should have received their current year dues statements and the organization appreciates continued membership by local Boards of Health.Training teams have begun to use revised materials for training local boards of health.A board committee will be working on a model evaluation form for local health directors.The board is looking to fill two recent vacancies and particularly interested in someone from Western NC.NALBOHMember departments should have received 10 copies The NEWS BRIEF newsletter for distribution to local BOH members. Encouraged local departments to submit articles for the newsletter to promote our public health efforts. Articles can be sent to Jamie Michael at Jamie@badgerbay.co.Only 1 of their $500 scholarships has been requested to date to attend the August 5-7 annual conference in Louisville, KY. NC has 11 people registered to date. 40 local Boards of Health have paid NALBOH dues for this year and there are almost 200 local boards and members nationally.A committee has revised a draft of by-laws that will be voted on during the annual business meeting. Proposing for NC to possibly host the 2017 annual conference (NALBOH 25 year anniversary).NC Institute for Public Health – Rachel Wilfert TrainingReminder that Board of Health training is available; encourage LHDs to make requests if they know they need training this fiscal year since we receive more requests than we have training slots.Registration is open for fall courses including the following:Child Health Enhanced Role Nurse course – starts Aug. 24Physical Assessment/STD Enhanced Role course – starts Aug. 25Evidence-Based Strategies for Obesity Prevention, Sep, 2-3 (offered in collaboration with Northwest AHEC)Child Health Regional Meetings, throughout September32nd Annual NC School Nurse Conference - October 15-16Registration opens August 17 for Introduction to Public Health Nursing, to be held November 16-18, 2015AccreditationJoy Reed has agreed to serve as interim Accreditation Administrator while we are hiring for the new Technical Assistance Manager who will oversee the accreditation work. Search process is underway for this new position and there is a strong pool of candidates. Meeting Adjourned: 11:20 a.m.Next Meeting: August 20, 2015 9:30 am Location: Raleigh – Cardinal Room, DPH, 5605 Six Forks Road ................
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