HomeMy WebLinkAboutAgenda - 06-02-2009 - 4ffORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 2, 2009
Action Agen~l~
Item No. !!~~
SUBJECT: Resolution Opposing Section 10.26 of Senate Bill 202 - "Public Health
Improvement Plan"
DEPARTMENT: Health PUBLIC HEARING: (Y/N) No
ATTACHMENT(S):
Resolution
Section 10.26 of Senate Bill 202
INFORMATION CONTACT:
Rosemary Summers, 245-2411
PURPOSE: To approve a Resolution Opposing Section 10.26 of Senate Bill 202, "Public Health
Improvement Plan", and forwarding the resolution to Orange County's legislative delegation.
BACKGROUND: The North Carolina Senate's Appropriation Act of 2009 (Senate Bill 202)
contains a special provision (Section 10.26) to establish a Public Health Task Force to develop
a Public Health Improvement Plan. The entire provision was added without input from local
government officials or local and State public health professionals. The Public Health
Improvement Plan includes the establishment of the flexible spending formula and the flexible
spending account would be based upon funds already received by public health. The flexible
spending account is equivalent to single stream funding which would disrupt the reallocation in
funding streams and be unnecessarily stressful to an already fragile public health system, a
system that is funded with too few dollars. State dollars directly provided to local public health
amount to less than 5% of the total local expenditures. In addition the Plan is directed to
redefine core public health services and directs the North Carolina Department of Health and
Human Services (DHHS) on the distribution of funds beginning July 2010. The majority of
funds currently allocated to local public health are federal block grant funds that carry federal
restrictions on their use and require a certain level of state match to draw these funds into the
state.
A comprehensive statewide Public Health Improvement Plan, updated in 2008 by a Task Force
with broad representation from across the State, was reviewed and approved by the legislatively
appointed Public Health Study Commission. In addition, in 2008, the NC Division of Public
Health commissioned the NC Institute of Medicine to establish a 1-year Prevention Task Force.
This group is charged with collecting and sanctioning evidence-based strategies to improve
public health. An interim report has been published and the study concludes this fall.
The Senate has passed the budget bill and it is now in the House for consideration. This
provision is being heard in the House Health Subcommittee. Representative Verla Insko is one
of the co-chairs of the Health Subcommittee.
The North Carolina Association of County Commissioners (NCACC) staff have also expressed
concern about this action as a further shift from state to local resources for public health.
The attached resolution opposes Section 10.26 of Senate Bill 202 and calls for input from local
government officials and local public health professionals should any reform be proposed.
FINANCIAL IMPACT: There is no financial impact with adoption of this resolution. There may
be significant financial impact should Section 10.26 of Senate Bill 202 be adopted.
RECOMMENDATION(S): The Manager recommends the Board approve the Resolution
Opposing Section 10.26 of Senate Bill 202, authorize the Chair to sign the resolution, and direct
the Clerk to the Board and the Health Director to draft a letter for the Chair's signature
forwarding the resolution to Orange County's legislative delegation.
J
ORANGE COUNTY BOARD OF COMMISSIONERS
Resolution
Whereas, Section 10.26 of Senate Bill 202 contains a provision entitled "Public
Health Improvement Plan", and
Whereas, the Public Health Improvement Plan was proposed with no input from
local government officials or local and State public health professionals, and
Whereas, the plan sets out an unreasonable timeline for such reform of the current
public health system, and
Whereas, the plan calls for no addition 1 public health funding, rather a
redistribution of the existing, insufficient funds with no defined distribution
formulas, and
Whereas, the plan calls for the creation of a ublic Health Improvement Plan Task
Force which is a duplication of the existing P blic Health Task Force, and
Whereas, many North Carolina counties re in the process of rebuilding the
Mental Health infrastructure requiring greate contributions of local funds, and
Whereas, Orange County can ill afford alteration of the public health
infrastructure requiring greater local funding o provide core public health services;
Now Therefore Be It Resolved that the Ors
is opposed to Section 10.26 of Senate Bil:
entitled "Public Health Improvement Plan"
reform public health absent appropriate plane
officials and local public health professionals
ge County Board of Commissioners
202 or any other budget provision
nd stands opposed to any efforts to
ng and input from local government
Adopted, this 2°d day of June 2009.
ATTEST:
alerie Foushee, Chair
Donna Baker, Clerk
Excerpt from Senate Bi11202
PUBLIC HEALTH IMPROVEMENT PLAN
SECTION 10.26.(a) The Department of Health
develop afive-year Public Health Improvement I
developing the Plan the Secretary shall:
(1) Adopt a list of services and activities
that qualify as core public health function
(2) Adopt a list of performance measures
status indicators applicable to core pub
significance that local health departmer
(3) Identify a set of health status indicato.
Under the Plan, all priorities and health status ind
activity the disparity of diseases amongst populat
Human Services (DHHS) shall
(Plan) by March 31, 2010. In
:rformed by local health departments
of statewide significance.
nth the intent of improving health
health functions of statewide
(LHDs) must provide.
to be given priority by LHDs.
ators must incorporate as an essential
ns and locales.
SECTION 10.26.(b) In order for measurable ben~fits to be realized through the
implementation of the Plan, the Plan shall includ the adoption of levels of performance
necessary to promote:
(1) Uniformity across local health depart
(2) Best evidence-based services,
(3) National standards of performance,
(4) Innovations in public health practice,
(5) Reduction of geographic and racial he
LHDs shall have the flexibility and opportunity t
the required performance measures in a manner t
th disparities.
use the resources available to achieve
it best suits the LHD.
SECTION 10.26.(c) The Plan will address the ne d to provide county health departments
with financial incentives to encourage and increa a local investment in public health
functions. County governments shall not supplant existing local funding with State
incentive resources. The Secretary may revise the list of activities and performance
measures as appropriate, but before doing so, the ecretary shall provide a written
explanation of the rationale for the addition, delet on, or revision.
SECTION 10.26.(d) In developing the Plan the
the Public Health Improvement Plan Task Force
expertise of which shall include:
(1) Local health departments,
(2) Department staff,
(3) Individuals and entities with expertise
measures, accountability, and systems ma
(4) Experts in development of evidence-1
practice guidelines, and
(5) Individuals and entities that will be afj
cretary shall establish and chair
ask Force), the members and
the development of performance
;ement,
~d medical guidelines or public health
by the performance measures.
SECTION 10.26.(e) The implementation schedule for the Plan shall be as follows:
(1) July 1, 2009, establish the Task Force to develop the Plan,
(2) March 31, 2010, submit the Plan to the 2010 Regular Session of the 2009
General Assembly,
(3) July 1, 2010, implement the Plan, and
(4) November 15, 2011, and annually thereafter, report on Plan implementation.
SECTION 10.26.(fJ The Department will identify the programmatic activities and
funding in the Division of Public Health associated with the core functions and activities
in the Plan. Funds associated with these activities shall be subject to a flexible spending
formula adopted by the Department, as follows:
(1) Beginning in SFY 2010-2011, the flexible spending formula will begin to
replace the current spending with a more effective method of funding public
health activities at the local level and achieving the results expected.
(2) The Task Force shall identify a reliable and consistent source of State
revenue to fund the flexible spending formula.
(3) If sufficient additional revenue is available to implement the Plan, a separate
set-aside of available funds would be created. This set-aside would be available to
contiguous LHDs that seek to address a specific women's health, child health, or
adult health disease or chronic condition, and in doing so, choose to merge into a
single Local Health District, thus saving administrative dollars to be focused on
public health issues.
SECTION 10.26.(g) Funds appropriated to the Department for flexible spending
shall be distributed to county health departments as follows:
(1) Each of the county health departments will receive a base amount to be
determined by the DHHS.
(2) The balance of funds in the Flexible Spending Account is to be distributed to
the counties on the basis of a formula that takes into consideration the
following elements:
a. Population,
b. Per capita income,
c. Rates o£
1. Infant mortality,
2. Teenage pregnancy,
3. Tobacco use,
4. Cancer,
5. Heart disease,
6. Diabetes, and
7. Stroke.
d. Percent of minorities in the county,
e. Body Mass Index (BMI) of public school students, and
f. Other factors as the Secretary may find necessary to achieve the
goals of the Plan.
(3) The use of the funds by the LHD would reflect the core public health
functions. It will be incumbent upon the LHD to use the funds in a manner
that assures its achievement of the performance measures adopted by the
Secretary.
SECTION 10.26.(h) To ensure compliance with Department directives, the Task
Force shall consider requiring each county health department to submit to the Secretary
such data as the Secretary determines is necessary to allow the Secretary to assess
whether the county health department has used the funds in a manner consistent with
achieving the performance measures associated with this Plan.
SECTION 10.26.(1) Beginning November 15, 2011, and biannually thereafter, the
Secretary shall report to the Governor and the General Assembly on:
(1) The distribution of funds to LHDs,
(2) The use of these funds by LHDs,
(3) The specific effect the funding from this Plan has had on:
a. LHDs' performance,
b. Health status indicators, and
c. Health disparities.
The Secretary's initial report will focus on implementation. Subsequent reports will
evaluate trends in performance and expenditures.
~.~~o~
F '~
Resolution
Whereas, Section 10.26 of Senate Bill 202 contains a provision entitled "Public
Health Improvement Plan", and
Whereas, the Public Health Improvement Plan was proposed with no input from
local government officials or local and State public health professionals, and
Whereas, the plan sets out an unreasonable timeline for such reform of the current
public health system, and
Whereas, the plan calls for no additional public health funding, rather a
redistnbution of the existing, insufficient funds with no defined distnbution
formulas, and
Whereas, the plan calls for the creation of a Public Health Improvement Plan
Task Force which is a duplication of the existing Public Health Task Force, and
Whereas, many North Carolina counties are in the process of rebuilding the
Mental Health infrastructure requiring greater contributions of local funds, and
Whereas, Orange County can ill afford alteration of the public health
infrastructure requiring greater local funding to provide core public health services,
and
Now Therefore Be It Resolved, that the Orange County Board of Health is
opposed to Section 10.26 of Senate Bi11202 or any other budget provision entitled
"Public Health Improvement Plan" and stands opposed to any efforts to reform
public health absent appropriate planning and input from local government
officials and local public health professionals.
~tla~~~tcrl, t$t,~; ~?~~~~ ci~~ cif s~€ t.
ATTEST:
Rosemary ~ ~ : ; ~~ ~~ ~ ~ ~~ , Health Director
Chris Harlan, Chair -- - -_
Orange County Board of Health