HomeMy WebLinkAboutBOH minutes 082416MINUTES-Final
ORANGE COUNTY BOARD OF HEALTH
August 24, 2016
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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 24, 2016, at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey, Vice Chair; Nick Galvez – Vice-
Chair, Commissioner Mia Burroughs, Barbara Chavious, Paul Chelminski, Dan Dewitya, Susan
Elmore, Jessica Frega and Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: Sam Lasris and Reena Mehta.
STAFF PRESENT: Dr. Colleen Bridger, Health Director; Coby Austin, Director of Programs and
Policy; Alan Clapp, Environmental Health Director; Kenyatta Clark, Temporary Zone Navigator;
Rebecca Crawford, Finance & Administrative Services Division Director; Robin Gasparini,
Public Health Nursing Supervisor; Carolyn Hall, Public Health Nurse I; Janina Hernandez, Billing
Technician; Daniel Kashdan, Public Health Nurse II – Preparedness Coordinator ; Donna King,
Health Promotion & Education Services Director; Karen Kyes, Integrated Behavioral Health -
Clinical Social Worker II; Meghann Johnson, Public Health Nurse I; Pam McCall, Public Health
Nursing Director; Nikki Thorpe, Nursing Assistant; Stacy Shelp, Communication Manager and
La Toya Strange, Administrative Assistant II.
GUESTS PRESENT: None.
I. Welcome
Liska Lackey, Chair, called the meeting to order. Dr. Bridger introduced the new employees in
attendance: Kenyatta Clark, Carolyn Hall, Janina Hernandez, Meghann Johnson, Daniel
Kashdan, Karen Kyes and Nikki Thorpe.
II. Public Comment for Items NOT on Printed Agenda: None
III. Approval of the August 24, 2016 Agenda
Motion was made by Susan Elmore to approve the agenda, seconded by Nick Galvez and
carried without dissent.
IV. Action Items (Consent)
A. Minutes Approval of May 25, 2016 Meeting
Motion to approve Consent Agenda without corrections to the May 25, 2016 minutes was
made by Susan Elmore, seconded by Mia Burroughs and carried without dissent.
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V. Educational Sessions
A. 4th Quarter Financial Reports and B. 4th Quarter Billing Dashboard Reports
Rebecca Crawford, Finance & Administrative Services Division Director, gave a report on the 4th
quarter revenue and billing accuracy. Her report is as follows:
Total Health Department Revenue: Average YTD monthly revenue in FY16 after the 4th
quarter is $242k/month or $2.8 million YTD, representing 97% of our overall budgeted
revenue for the year. This is an increase from an average of $210k/month in FY15.
Expenses were slightly lower than revenues at 94%.
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 15-16 is 91% as compared
to 92% in FY 14-15 and the average rate for dental for FY 15-16 is 100% as compared
to 86% in FY 14-15.
Dental Earned Revenue by Source: The FY 15-16 average monthly revenue
($40k/month) ended the fiscal year slightly below our budget projection ($45k/month) but
still above our FY 14-15 average of $35k/month. FY 15-16 dental revenue totaled $485k
at the end of the fourth quarter.
Medical Earned Revenue by Source: Medical earned revenue is currently below the
budgeted projection for FY 15-16. The monthly average after the fourth quarter
($50k/month) leaving us level with FY15 and on target with our budget projection
($50k/month). Medical revenue totaled $596k for FY 15-16.
C. 2014-2016 Strategic Plan Accomplishments
Coby Jansen, Director of Programs and Policy, gave highlights of the accomplishments from the
2014-2016 Board of Health Strategic Plan. She began by identifying the four priority areas –
Access to Care, Childhood and Family Obesity Prevention, Substance Abuse & Mental Health
and Engagement. Highlights of some of the priorities and focus areas include:
Priority #1 Access to Care
Focus #1 Family Success Alliance
o Two cohorts of K-Readiness students
o Second cohort of families now enrolling with navigators
Focus #2 Policies improving access to care
o Health literacy policy, toolkit and trainings
Focus # 3 Culture of Innovation
o Projects included Whitted bike share pilot, video remote interpretation
software/hardware and mindfulness training
Priority #2 Childhood and Family Obesity
Focus #1 Catalyst for partnerships
o BOH seat on OUTBoard
o Go NAP-SACC pilot
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Focus #2 Evidence-based PA/nutrition interventions
o Universal breakfast – continued implementation
o OCHD lactation room
Priority #3 Substance Abuse & Mental Health (SA&MH)
Focus #1 Advocate for SA&MH services
o Town & Gown Task Force to address underage drinking and binge drinking
o OCHD now offers PrEP counseling and prescriptions for individuals at high-
risk HIV infection
o Our Safe Syringe Initiative was launched and is in accordance with the new
state law. We were ahead of the curve.
o The OCHD Naloxone Access Program designed to reduce deaths caused by
drug overdoses. There are 75% of OC law enforcement agencies are
equipped with naloxone.
Focus #4 Support OC Smoke-Free Public Places
o OC continues to be smoke-free.
o E-cigarette rule – still awaiting Surgeon General’s report prior to moving
forward
Engagement
Stay up to date on actions from other boards
Develop policy statements on priority health areas
D. NALBOH Update
Board members, Susan Elmore and Timothy Smith, attended this year’s NALBOH 2016 Annual
Conference that was held on August 10-12, 2016. The three keynote presentations were:
What Can We Do To Improve Community Health?;
Collaborative Governance in Era of Population Health Management; and
The Flint Financial and Water Crisis Through a Board of Health Lens
NALBOH’s six functions of public health goveranance were reiterated throughout the
conference. According to NALBOH, all public health governing entities are responsible for
some aspects of each function. No one function is more important than another.
The Six Functions Include:
1. Policy Development
2. Resource Stewardship
3. Legal Authority
4. Partner Engagement
5. Continuous Improvement
6. Oversight
As there were about fifteen breakout sessions available, Ms. Elmore and Ms. Smith attended
separate sessions. Ms. Elmore stated that she will share the downloaded presentations to the
Board members via Dropbox. Some of the sessions that they highlighted included:
Tackling Tobacco Use Among the Underserved,
Overlooked and Addicted: A Basic Duty of Public Health,
A Board Governance Conundrum: Legalized Marijuana,
Evidence in Action: How to Choose Effective Strategies,
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Lessons Learned From Indiana’s HIV Outbreak; and
Building Community Centered Partnerships between Local Health Departments and Non-
Traditional Partners.
Mr. Smith was very thankful for the opportunity to attend and was amazed by the NALBOH
organization. He also stated that the OCHD does a great job of collaborating with other
resources, partners, etc.
VI. Action Items (Non-Consent)
A. FY 15/16 Environmental Health Delinquent Accounts
Alan Clapp, Environmental Health Director, began by describing the two services in which the
consumer is either billed yearly or after the service has been completed. Wastewater Treatment
Management Program inspections occur every 3 or 5 years. Mobile homes with wells and
septic systems are inspected yearly. They are billed on January 1 of every year. There are 2
accounts that haven’t been paid totaling $875.00 which had decreased from last fiscal year’s
amount of $2,900.00.
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
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.
Rebecca Crawford, Director of Finance and Administrative Services, continued by informing the
Board of all the uncollectible debt from clients for FY 2015-2016 which is summarized below.
Division Number of Uncollectable Accounts Write-Off Amount
Personal Health 80 $1,401.15
Dental Health 73 $2,222.56
Environmental Health 13 $2,049.19
Total 166 $5,672.90
Ms. Crawford also notified the Board that debt set off involves any amount from $50.00 to
$4,000.00. These debts can be sent to the state for collection. Any amounts under $50.00 can
be written off. The customer shall 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. Dr. Bridger added that it is more
cost effective to write off the debt as it will cost more money to attempt to try to recoup it.
The BOH members had questions that were addressed by Mr. Clapp, Ms. Crawford and
Dr. Bridger.
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Motion to administratively move a total of $5,672.90 in uncollectable debt from “active” to
“inactive” status was made by Susan Elmore, seconded by Jessica Frega and carried
without dissent.
VII. Reports and Discussion with Possible Action
A. BOH Policy Review
Coby Austin, Director of Programs and Policy, began by informing the BOH members that the
BOH is required to review their Policies and Procedures each year to meet accreditation
standards. Ms. Austin briefly summarized the recommended updates which are:
I.E. Fee and Eligibility Policy
Staff recommends making the following revisions to the Fee and Eligibility Policy
for the purpose of clarification and to be in compliance with federal Medicaid
requirements:
- Residency Requirements (Section IV.A.): The Residency Requirements section
was revised to replace “is” with “may” regarding whether any Orange County resident
or non-resident can/will be eligible for services. This change was made to clarify that
non-residents are not automatically eligible for all services (certain Communicable
Disease services, etc.) and to clarify that only Orange County residents qualify for
the Family Home Visiting program.
- Fees for Services (Section VI.O.): The Fees for Services section was revised to
add language explaining that Medicaid patients will be charged only the cost for
OCHD to purchase 340b drugs (a federal drug pricing program that reduces the cost
of certain medications for eligible healthcare providers only). Since 340b drug pricing
changes quarterly, the department will be reviewed and set annually based on an
average purchase price throughout the year. This additional section is required in
order to remain in compliance with DHHS and our ability to bill for Medicaid
reimbursement for these drugs. OCHD typically purchases Family Planning related
340b drugs only.
I.H. Complaint Policy
Staff recommends streamlining the current BOH Complaint Policy by 1) removing
the language about the procedure for handling a general complaint from the
Board of Health policy manual, and 2) including that language in the complaint
section of the Health Department’s Administrative Policy and Procedure manual,
alongside other existing complaint forms and procedures.
Background: The NC Local Health Department accreditation benchmarks include a
standard to have written policies and procedures in place for handling of complaints
related to enforcement of laws, rules and ordinances. Policy H of the Board of Health
Policy Manual meets that requirement by stating its policy regarding complaints.
However, it would be most efficient to locate the procedures and forms for implementing
that policy in the Health Department’s Administrative Policy and Procedure manual.
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Type of complaints covered through existing procedures include: Complaints that are
general in nature and those related to HIPAA privacy and security, Title VI of the Civil
Rights Act of 1964, and Executive Order 13166 (meaningful access to services for
persons with limited English proficiency). The Environmental Health Policy and
Procedure Manual also includes a process for responding to, documenting, and
resolving environmental complaints.
Motion to update the BOH Fee and Eligibility Policy and Complaint Policy as staff
recommends was made by Jessica Frega, seconded by Dan Dewitya and carried without
dissent.
B. Health Director Report
In addition to the Health Director’s report, Dr. Bridger mentioned that she appreciated the
working in Orange County. As president of the NCALHD, she’s also able to help the other 84
health departments. As Orange County takes the lead in the state and is first with many of its
programs and initiatives, we share our educational materials and policies with the state. Our
efforts not only benefit Orange County but North Carolina as a whole. Robin Gasparini, Public
Health Nursing Supervisor, added that the OCHD had recently received a Mother-Baby Award
for Outpatient Healthcare Clinics and have been recognized as a breastfeeding friendly
healthcare organization.
Dr. Bridger also spoke briefly on the success of our “Spray Before You Play” initiative to reduce
exposure to mosquito bites and illness. We pride ourselves as being proactive instead of
reactive. Seven County parks have boxes at their entrance to make insect repellent available to
park visitors. The “Spray before you Play” stations will include cans of spray and a sign with
instructions in English and Spanish on to how to apply the spray. There’s proof that residents
are using it and leaving it for others as we’re replacing empty cans.
The BOH members did not have any questions.
C. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
VIII. Board Comments
None.
IX. Adjournment
A motion was made by Mia Burroughs to adjourn the meeting at 8:05 p.m., was seconded
by Dan Dewitya and carried without dissent.
The next Board of Health Meeting will be held September 28, 2016 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
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ORANGE COUNTY BOARD OF HEALTH
August 24, 2016
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Colleen Bridger, MPH, PhD
Orange County Health Director
Secretary to the Board