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ORANGE COUNTY BOARD OF HEALTH
August 23, 2017
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON August 23, 2017, at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey – Chair, Susan Elmore – Co-Chair;
Bruce Baldwin; Johanna Birchmayer, Commissioner Mia Burroughs, Barbara Chavious, Jennifer
Deyo, Jessica Frega, Sam Lasris and Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: Paul Chelminski.
STAFF PRESENT: Dr. Dorothy Cilenti, Interim Health Director; Coby Jansen Austin, Programs
and Policy Director; Alan Clapp, Environmental Health Director; Rebecca Crawford, Financial
and Administrative Services Director; Michael DeFranco, Public Health Nurse II; Robin
Gasparini, Public Health Nursing Supervisor; Donna King, Health Promotions and Education
Services Director; Pam McCall, Personal Health Services Director; Dr. Erica Pettigrew, Medical
Director; Kristin Prelipp, Communications Manager; Beverly Scurry, Board of Health Strategic
Plan Manager; La Toya Strange, Administrative Assistant II and Allison Young, Health
Informatics Manager.
GUESTS PRESENT: Caitlin Fenhagen, Criminal Justice Resource Director.
I. Welcome New Employees
Liska Lackey, Chair, called the meeting to order. She introduced new BOH member, Dr. Bruce
Baldwin. The BOH members introduced themselves. Dr. Cilenti welcomed new employees,
Michael DeFranco and Kristin Prelipp, in attendance.
II. Public Comment for Items NOT on Printed Agenda: None
III. Approval of the August 23, 2017 Agenda
Motion was made by Mia Burroughs to approve the agenda, seconded by Jessica Frega
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of June 28, 2017 Meeting
Motion was made by Sam Lasris to approve the minutes of June 2017, seconded by
Barbara Chavious and carried without dissent.
V. Educational Sessions
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A. Criminal Justice Resource Department Update
Caitlin Fenhagen, Criminal Justice Resource Director, began by giving an overview of her
department including staff, history, and programs. The Criminal Justice Resource Office (CJRO)
opened in November 2015 as a division of the County Manager’s Office. On July 1, 2017, it
became a department in Orange County Government. The department oversees and supports
jail alternatives programming in Orange County.
In addition to Ms. Fenhagen, the staff consists of the Pretrial Release Case Manager, the Drug
Treatment Coordinator and a Criminal Case Assessment Specialist. Misdemeanor Diversion
Program Coordinator, Mental Health Liaison for Court-Involved Youth and Administrative
Assistant are the positions in which they will hire for FY 17-18. These positions assist court and
criminal justice stakeholders by providing recommendations for pretrial release, diversion and
treatment opportunities in the community for individuals facing pretrial detention.
The department also provides support and case management services to individuals
participating in the Pretrial Release and Drug Court programs. In addition, the Criminal Case
Assessment Specialist works directly with individuals incarcerated in the Orange County
Detention Center with mental health and substance abuse issues in order to address specific
therapeutic needs and to link these individuals to appropriate services and resources in the
community.
The department’s objective is to reduce overall rates of pretrial detention, reduce the numbers
of individuals with mental illness in custody, reduce recidivism and address racial and economic
disparities in pretrial detention.
Some of the department’s collaborations include the Orange County Sheriff’s Office, Partnership
to End Homelessness, Cardinal Innovations, Jail Mental Health Work Group, Reentry Council
Planning, Justice Advisory Council and the Health Department. Ongoing Collaboration Needs
are:
Continuity of behavioral health care and case management needs after incarceration in
Jail and Prison.
Enhancement of health care and dental care referral process for criminal-justice involved
individuals.
Discussion of community crisis resource needs that will allow for increased law
enforcement diversion of minor offenses or those offenses committed by individuals
experiencing homelessness, mental illness and substance use disorders.
Health Department role in Drug Treatment Courts.
The BOH members had questions that were addressed by Ms. Fenhagen.
B. 4th Quarter Financial Reports and C. 4th Quarter Billing Dashboard Reports
Rebecca Crawford, Finance and Administrative Services Director, gave a report on the 2nd
quarter revenue and billing accuracy. Her report is as follows:
• Total Health Department Revenue: Average YTD monthly revenue in FY17 after the
fourth quarter is $247k/month or $2.97 million YTD, representing 95% of our overall
budgeted revenue for the year. This is an increase from an average of $225k/month in
FY16. Expenses were level with revenues at 95%.
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• Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14-15,
the average billing accuracy rate for medical at the end of FY 16-17 is 90% as compared
to 95% in FY 15-16 and the average rate for dental for FY 16-17 is 98% as compared to
97% in FY 15-16.
• Dental Earned Revenue by Source: The FY 16-17 average monthly revenue
($41k/month) ended the fiscal year below our budget projection ($47.5k/month) due to
decreased Medicaid and Commercial Insurance patients (Self-pay receipts exceeded
budget) and level with our FY 15-16 average of $40k/month. FY 16-17 dental revenue
totaled $497k at the end of the fourth quarter.
• Medical Earned Revenue by Source: Medical earned revenue is currently below the
budgeted projection for FY 16-17. The monthly average after the fourth quarter
($55k/month) exceeded FY16 ($50k/month) but lower than our budget projection
($59.6k/month). Medical revenue totaled $663k for FY 16-17.
The BOH had questions that were addressed by Ms. Crawford.
D. 2013 Medicaid Cost Settlement Program Reimbursement
Rebecca Crawford, Financial and Administrative Services Director, updated the Board of the
ongoing 2103 Medicaid Cost Settlement. The Health Department received official notification of
a Notice of Program Reimbursement on August 3rd from the NC DHHS Department of Medical
Assistance (DMA). This notice referenced the 2013 Medicaid Cost Settlement report (period
ending June 30, 2013.) As you may remember, the Medicaid cost settlement process has been
contested since DMA required a new cost report methodology beginning in State Fiscal Year
(SFY) 2011. The main point of contention is the calculation of the Medicaid population statistic.
After a long debate, the primary issue of the Medicaid population statistic has been clarified by a
recent ruling in a lawsuit between DMA and Cabarrus County. DMA prevailed and will
retroactively settle all Local Health Department (LHD) cost settlements beginning with SFY
2013. SFY 2013 will be the only year where an overpayment (by DMA) is applied since DMA
started using the new statistic prior to payments made in SFY 2014.
Orange County is in a payback situation and owes a total of $200,524 to DMA. We received
funds in 2015 from the state legislature to offset the loss incurred by the SFY 2013 overpayment
in the amount of $219,043.90, which when combined with the payback amount referenced
above, leaves us with a net gain of $18,519.90.
DMA has offered LHD’s the option to either accept the payback amount and remit payment or
appeal the proposed payback by “scrubbing” our data according to the agreed upon process
listed in the Cabarrus County court ruling. We’ve learned this made a significant reduction in the
payback amount for Cabarrus County. Our staff have determined it is in our best interest to work
with the NC Public Health Association (who historically has prepared our annual cost settlement
report) to “scrub” our 2013 data. Ms. Crawford also stated that, for FY 15/16, Orange County
will receive $800,000. She also mentioned that DMA now requires patient names and birth
dates to be included in the coding/billing process.
The BOH had questions that were addressed by Ms. Crawford and Dr. Cilenti.
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E. Senate Bill 16
Alan Clapp, Environmental Health Director, discussed Senate Bill 16 Section 19 Wastewater
System Permit Extension and its impact to Environmental Health. The legislature recently
ratified Senate Bill 16. This Act is a regulatory reform bill that among other things extends the
expiration of wastewater permits. This Act differs from previous extension legislation in that the
extension affects long expired wastewater permits. The three previous extension acts only
extended the life of currently valid permits. The amended new subsection in the act reads “any
improvement permit or authorization for wastewater system construction issued by a local
health department from January 1, 2000 to January 1, 2005, which has not been acted on and
would have otherwise expired, shall remain valid until January 1, 2020, without penalty, unless
there are changes in the hydraulic flows or wastewater characteristics from the original local
health department evaluation....”
Opponents’ Talking Points
Contradicts SL 2014-120 which says that the Health Department can advise owner of
new systems and technologies available.
Rule changes and new septic system technologies that have been developed since the
original permit were issued cannot be used since the original permit must be honored.
No provisions for changes in site plan or altered site conditions from manmade or natural
causes.
Altered site conditions would not result in letter of revocation and appeal rights.
Greater chance that conditions on the site have changed resulting in increased potential
for tort claims.
Permits issued in error would now be valid again.
The public would benefit from a new evaluation that may allow a gravity system where
the old permit required a pump system.
Sites may have been permitted multiple times since 2000 due to normal course of
expiration.
Well permits issued on valid permit site plans may now be invalid by resurrecting expired
wastewater permits.
Proponents’ Talking Points
Altered site conditions would not result in letter of revocation and appeal rights.
Greater chance that conditions on the site have changed resulting in increased potential
for tort claims.
Permits issued in error would now be valid again.
The public would benefit from a new evaluation that may allow a gravity system where
the old permit required a pump system.
Sites may have been permitted multiple times since 2000 due to normal course of
expiration.
Well permits issued on valid permit site plans may now be invalid by resurrecting expired
wastewater permits.
Mr. Clapp also mentioned some local effects of the bill which include:
Altered site conditions would not result in letter of revocation and appeal rights.
Greater chance that conditions on the site have changed resulting in increased potential
for tort claims.
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Permits issued in error would now be valid again.
The public would benefit from a new evaluation that may allow a gravity system where
the old permit required a pump system.
Sites may have been permitted multiple times since 2000 due to normal course of
expiration.
Well permits issued on valid permit site plans may now be invalid by resurrecting expired
wastewater permits.
The bill status is as follows:
Ratified by the Legislature 8/3/17
Vetoed by the Governor 8/14/17
Legislature back in Session in September
Override of veto is quite possible
All House and Senate Republicans voted in favor of the Bill
Some Democrat House members voted in favor of the Bill
The BOH had questions that were addressed by Mr. Clapp.
F. NALBOH Update
BOH Strategic Plan Manager, Beverly Scurry and Susan Elmore, BOH Co-chair, attended this
year’s NALBOH 2017 Annual Conference that was held in Cleveland, OH on August 2-4, 2017.
Ms. Scurry began by thanking the Board for the opportunity to attend. Ms. Elmore had emailed
a link to the BOH members with session links. Some of the concepts covered at the conference
were innovation, partnership building, community engagement and involvement. Ms. Scurry
recalled a session that dealt with the opioid crisis in Wake County. She also mentioned that
Orange County has been more proactive through our usage of needle boxes and naloxone.
There was another session whose focus was on the tobacco age limit raise. Unfortunately,
Orange County BOH cannot raise the legal buying age to 21; however, the BOH has passed a
resolution in support of the age limit increase. Ms. Elmore also praised a pre-conference
workshop titled “How Can I be a Public Health Leader?”. Lastly, Ms. Scurry stated that next
year’s NALBOH conference will be held in Raleigh and that abstracts will be requested soon.
VI. Action Items (Non Consent)
A. FY 16/17 Delinquent Accounts
Per the department’s Delinquent and Uncollectable Accounts policy (15.0), uncollectible
accounts are to be administratively written off the books. The purpose of this accounting
function is to precisely account for and pursue funds which are truly unrecoverable. The last
administrative write-offs were performed by the Board of Health in August 2016 (Personal
Health, Dental Health, and Environmental Health) for FY 2015.
Personal Health, Dental Health, and Environmental Health continue to participate in the NC
Debt Set-Off Program, which allows the county to collect debts on delinquent accounts with a
balance between $50 and $4,000 through the customer’s tax refund. The Health Department
anticipate Per the department’s Delinquent and Uncollectable Accounts policy (15.0),
uncollectible accounts are to be administratively written off the books. The purpose of this
accounting function is to precisely account for and pursue funds which are truly unrecoverable.
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The last administrative write-offs were performed by the Board of Health in August 2016
(Personal Health, Dental Health, and Environmental Health) for FY 2015-2016.
Personal Health, Dental Health, and Environmental Health continue to participate in the NC
Debt Set-Off Program, which allows the county to collect debts on delinquent accounts with a
balance between $50 and $4,000 through the customer’s tax refund. The Health Department
anticipates collecting payments on delinquent accounts being pursued through the NC Debt
Set-Off program; therefore, those accounts are not included in this write-off request.
Based on the definitions of uncollectible accounts in the department’s policy, Rebecca
Crawford, Director of Financial and Administrative Services, informed the BOH of the
uncollectible debt from clients for FY 2016-17 which is displayed in the table below.
Division
Number of
Uncollectable
Accounts
Write-Off
Amount
Personal Health 80 $1,401.15
Dental Health 89 $2,348.10
Environmental
Health 6 $780.00
Total 175 $4,529.25
We request to administratively move a total of $4,529.25 in uncollectible debt from ‘active’ to
‘inactive’ status for the reasons indicted in the table above.
The customer will never be informed that a debt has been written off. If a customer whose
account had been determined uncollectible returns to clinic within three years, the delinquent
write-off amount will be reactivated and the billing process resumed. Likewise, if a customer
requests a non-required service from Environmental Health, the delinquent write -off amount will
be reactivated and the billing process resumed.
Motion to administratively move a total of $4,529.25 in uncollectable debt from “active” to
“inactive” status was made by Susan Elmore, seconded by Jessica Frega and carried
without dissent.
B. Mid-Year Fee Request
Rebecca Crawford, Director of Financial and Administrative Services, presented a proposed fee
change to the Board. The Health Department reviews fee schedules on an annual basis through
the budget approval process; however, the Nutrition Program was awarded funding from a
regional Minority Disease Prevention Program (led by Alamance County) through NCDHHS for
FY 17-18 after the FY 17-18 budget was approved. The Agreement Addendum associated with
this funding requires that all funding recipients charge program participants a one-time fee of
$25 unless a scholarship (i.e. fee waiver) is provided (see Section III.7 of the attached
Addendum). As this is a newly identified fee, it is necessary to add it to our fee schedule in an
effort to remain in compliance with our Agreement Addendum. The proposed change is detailed
below:
Name of Fee 2017-18 2017-18 Proposed 2017-18 Budget
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Current Fee Fee Impact
MDPP Flat Fee $0 $25 $1,875
Motion to approve the proposed fee changes for 2017-2018 as presented and forward to
the Board of County Commissioners for action was made by Barbara Chavious,
seconded by Jennifer Deyo and carried without dissent.
C. FIT Program
Pam McCall, Personal Health Services Director, gave an overview of the Formerly Incarcerated
Transitions (FIT) Program which is a project funded by the Duke Endowment to provide people
released from NC prisons assistance in accessing medical services and other community
reentry services. She began with some statistics and reasons detailing the need for the FIT
Program. They include:
There are over 36,000 incarcerated in NC State Prisons.
Chronic disease are burden high (80%). Those include chronic medical problems,
mental illness, and substance use disorders.
There is no system in place to transition into health care.
Only 15%-25% see a medical provider in first year post-release.
Death rate is 12 times normal in the first 2 weeks post-release.
The NC Department of Public Safety (DPS) is in the process of improving the reentry process.
Transition sites, which are existing prisons that will create protocols to facilitate coordination of
services with local reentry service providers, are being created. Prisoners will be relocated to a
transition site near their county of residence up to a year prior to release, enhancing
opportunities to establish a reentry plan prior to discharge. To organize these efforts, DPS has
encouraged regional reentry councils, where local organizations and agencies collaborate in
supporting successful reentry. The missing component in the reentry process has been
coordination of medical care. Presently, there is no system in place to link released prisoners
with comprehensive health care services.
The FIT Program will utilize a Community Health Worker who will engage people with chronic
disease prior to release at a Transition Site, and along with the local reentry council, develop a
comprehensive reentry plan. OCHD is partnering with UNC Family Medicine to implement the
program by hiring and supervising a Community Health Worker to provide case management
services to people being released from prison in Orange County. For year one, the funding
amount will be $35,594.
The goals of the FIT program are:
Increase utilization of Primary Care and Behavioral Health Services.
Decrease rates of ED visits and hospitalization.
Increase adherence with use of medications and treatment plans.
Decrease recidivism.
Improve health outcomes and satisfaction with health care services.
The BOH had questions that were addressed by Ms. McCall.
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Motion to approve acceptanvce of Duke Endowment grant funds to employ community
health worker and forward to the BOCC for their approval was made by Susan Elmore,
seconded by Sam Lasris and carried without dissent.
D. Youth Tobacco Prevention Funding
Donna King, Health Promotion and Education Services Director, presented the Board with a
background on the acquisition of the funds. The North Carolina General Assembly appropriated
$500,000 per year in non-recurring funds in FY17-18 and FY18-19 for youth tobacco use
prevention. The budget provides funding to develop strategies to prevent the use of all tobacco
products, with a focus on new and emerging tobacco products, including electronic cigarettes by
youth and people of childbearing age.
Orange County Health Department was recognized as a leader in youth tobacco use prevention
by the Region 5 Health Directors and will receive $45,500 to support and enhance current youth
tobacco use prevention programming. April Richard, Tobacco Prevention and Control, is
currently collaborating with all five local high schools; engaging youth in peer prevention work
through TRU Clubs. Most of these high school clubs are running on very low funds.
The BOH members had questions that were addressed by Ms. King and Dr. Cilenti.
Motion to approve OCHD receiving funds to support and enhance current youth tobacco
use prevention programming and forward to the BOCC for their approval was made by
Jessica Frega, seconded by and Sam Lasris and carried without dissent.
E. BOH Policy Updates
Beverly Scurry, Board of Health Strategic Plan Manager, began by informing the BOH members
that the BOH is required to review their Policies and Procedures each year to meet accreditation
standards. Updates to the Fee and Eligibility Policy recommendations are below:
I.E. Fee and Eligibility Policy
• Addition of Family Home Visiting under income eligibility.
• Change from 10 days to 30 days or less in which patients must provide verification of income
and/or residency
• Residency requirements specify residents or non-resident ‘may’ be eligible instead of ‘is’
eligible. Also excludes Family Home Visiting programs.
• Fee for service statement added - Fees for 340b drugs dispensed to Medicaid patients will be
reviewed and set annually based on the average, annual cost to the County to purchase
the drugs.
Section I.E. Attachment B
• Reflects the change from 10 business days to 30 business days or less
Motion to update the BOH Fee and Eligibility Policy and Complaint Policy as staff
recommends was made by Mia Burroughs, seconded by Timothy Smith and carried
without dissent.
VII. Reports and Discussion with Possible Action
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A. Health Director Report
In addition to her report, Dr. Cilenti thanked Commissioner Burroughs for forwarding the Family
Success Alliance’s (FSA) Impact Report to the BOCC. The Impact Report highlights what the
FSA’s accomplishments over the last couple of years. It included various data and outcomes
including feedback received from families receiving services. The FSA will continue to measure
their activities. Dr. Cilenti also praised Nancy Largent, Communications Specialist, as she was
the graphic designer that made the document visually appealing.
B. Update on Health Director Search
Liska Lackey, Chair, informed the Board that although, Miguel Ozuna has left Springsted
Waters; the recruitment process hasn’t been affected. The health director position was posted
on various sites including state and national associations. Springsted Waters has reached out
to selected candidates to solicit their interest or to ask if they are aware of qualified candidates.
Active outreach will continue until the first review date of August 28th. They’ll give the list of
qualified applicants to the Board for review.
C. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
X. Board Comments.
New BOH member, Dr. Bruce Baldwin reintroduced himself and informed the BOH of his
personal and professional background.
XI. Adjournment
Jessica Frega moved to adjourn the meeting at 8:45pm and Mia Burroughs seconded.
The next Board of Health Meeting will be held September 20, 2017 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Dorothy Cilenti, MSW, MPH, DrPH
Orange County Interim Health Director
Secretary to the Board