North Carolina Association of Local Health Directors
Full Association Meeting
Date: July 16, 2015
Cardinal Room, DPH, Six Forks Road, Raleigh, NC
Minutes
Meeting 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 Champion
- Ms. 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 (www.first2000days.org). She can also be contacted for further information or possible presentations at .
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 Davies
- Clarified 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 Tolson
- Joint 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 Parks
- Reiterated the recent meeting of the three public health association officers and the goal of seeking opportunities to work more closely together.
NCPHA - Lisa Harrison
- Planning 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 Reports
Core Public Health –Denise Michaud:
Action/Motion: No Action
Information:
- Title X Grant Award for FY15-16 – Belinda Pettiford
- See 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 Pettiford
- Change 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 Anderson
- See attachment
- LHD Questionnaire (Draft) – Monecia Thomas
- November 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 Herndon
- Movement 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: None
Information:
- 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: None
Information: (Beth was unable to attend but provided the following notes from committee mtg.)
1. 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.
2. 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.
3. Update from Batch Interface and Reporting Workgroup: John Bryant presented the current “needs” list from the Workgroup.
a. 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.
b. 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.
c. There is a work-around now for the height/weight error on postpartum home visits. Details coming soon.
d. 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.
e. 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:
i. Not following the batch upload schedule.
ii. Batch files sent to the wrong directory (mostly by counties uploading their own data and do need additional training)
iii. Batch files not named properly – must be named based on the convention defined in the Batch Interface Layout on the HIS Website.
iv. Files sent in zip files cannot be accepted, must be in TXT file format.
f. 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.
4. Updates or questions:
a. Phyllis Rocco spoke about ICD-10 implementation. She suggested that health directors should ask staff:
i. What is our transition plan? How is it going?
ii. Have the batch vendors tested through their clearinghouse?
iii. 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.
b. 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.
5. Future Agenda Items
a. Heart Health Now – CCNC/AHEC
b. Care Apps – CCNC Informatics Center (August)
c. NCHIP – update on why it isn’t current
d. Rules for Scanning/Records Retention (August)
e. 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 Harrison
Action/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 approved.
Information:
1. Finance – Medicaid cost settlement
Guests present at the committee meeting included:
Steven Garner, independent consultant for cost settlement calculations, DPH/LHD
Trey Sutten, director of finance/chief financial officer, Div. of Medical Assistance (DMA)
Roger Barnes, DMA
Trey 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: Yes
Q: 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).