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HomeMy WebLinkAboutBOH minutes 102209MINUTES ORANGE COUNTY BOARD OF HEALTH October 22, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 October 22, 2009 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 October 22, 2009 at the Southern Human Services Center, Chapel Hill, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Anissa Vines, Vice-Chair; Jim Stefanadis; Michael Wood; Tony Whitaker; DeWana Anderson; Steve Yuhasz; Christopher Cooke; Mike Carstens BOARD OF HEALTH MEMBERS ABSENT: Chris Harlan, Dr. Paul Chelminsky, and Dr. Jessica Lee, out of town. STAFF PRESENT: Wayne Sherman, Personal Health Services Division Director; Tom Konsler, Environmental Health Services Division Director; Donna King, Health Promotion and Education Services Division Director; Angela Cooke, Dental Health Services Division Director; Carla Julian, Risk Management/Quality Assurance Director; Letitia Burns, Business Officer; Anne Miles Cassell, Administrative Assistant; GUESTS PRESENT: Daniel Kim, UNC School of Pharmacy; Chris Heaney, UNCSPH; Rev. Robert T. Campbell, RENA; Patsy Polsten, UNCSPH; Erica Roedder, UNCSPH I. Funding Streams for Public Health Rosemary Summers gave an educational Power Point presentation on Public Health Funding Streams. There are many sources of funding although many of them are small. Among sources are federal block grants, federal one time allocations, state appropriations, fees, third party reimbursements, county general fund, contract for services, special project grants, and contributions. Federal Block Grants are program specific and the Department is accountable to the State for reporting how these funds are spent. These funds usually require a state match of funds. Bio-terrorism funding began as a federal special allocation. H1N1 is a one-time special allocation. They are generally distributed by the state on a population basis. Steve Yuhasz asked what formula is used to determine allocation of state funds. Rosemary Summers replied that a complex formula is used to determine need using per capita income and health need by certain indicators such as people living in poverty. The North Carolina Association of Local Health Directors’ formula has been in place for many years and is reviewed periodically. This same formula in reverse is used to determine reductions in funds. Fees are established by determining the delivery cost of each service. Each fee must be approved by the Board of Health and the Board of County Commissioners as required by statute. Some services require fee determination on a sliding scale based MINUTES ORANGE COUNTY BOARD OF HEALTH October 22, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 October 22, 2009 on the federal poverty level. The Board can recommend a certain “recovery level” that is less than 100% of costs when setting fees for some services. The 100% pay level for OCHD is generally set at 250% of the federal poverty level for services that must be offered on a sliding scale. Christopher Cooke asked if there was a relationship between per capita spending and health outcomes on any particular measure and what would the ideal mix of funds to most effectively and efficiently run the Health Department. Rosemary Summers explained that there are 13 indicators that are measured for every health department’s outcomes. For most of those outcomes Orange County is above the mark, however, for childhood obesity Orange County is one of the worst in the state. She also added that research has not focused on correlating between health status and funding. II. Welcome and Introductions Anissa Vines, Vice-Chair, called the meeting to order at 7:30 P.M. and introduced the guests present. III. Approval of October 22, 2009 Agenda The motion to approve the Agenda of October 22, 2009 was made by Jim Stefanadis, seconded by Steve Yuhasz, and carried without dissent. IV. Public Comment for Items NOT on Printed Agenda None V. Action Items on CONSENT Agenda A. Minutes of September 23, 2009 meeting. B. Accept Additional Immunization and H1N1 Funds. The Immunization Branch notified the Health Department that we have been awarded $7,000 in immunization funds that must be spent by December 31, 2009. These funds can only be used for cold chain vaccine preservation. The Department plans to buy an additional refrigerator for additional vaccine storage and two vaxcools that may be used to transport vaccine and hold it at the proper temperature for mass clinics. The Public Health Preparedness Office in the NC Division of Public Health informed us that we will receive $301,601 for Phase III of the H1N1 Vaccination Program. These funds are intended to address gaps in capabilities for mass vaccination implementation and to support activities related to implementation of a mass vaccination campaign. Preliminary guidance summarizing uses of these funds was provided to Board members. C. 1st Quarter Financial Statement MINUTES ORANGE COUNTY BOARD OF HEALTH October 22, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 October 22, 2009 The 1st Quarter Fiscal Year 09-10 Financial Report was presented to Board members. Some important items to note were: • Personnel costs for several divisions are at or exceed 25% of the budget (or 100% for the quarter). This is due to the budget office calculating personnel costs at 96% of actual costs to allow for vacancies. • Also affecting the Personnel costs: some staff have taken (or are going to take) the early retirement incentive, which will still cost the department salary money, even though there is a vacancy. OCHD will not realize a savings until the spring or even end of the year in personnel costs. • State and Federal revenues are much lower than at this same time last fiscal year. This is due in part to the State budget crisis. The state is not allowing the counties to draw down all the money at once, as has been possible in the past. We are limited to drawing 1/12 to preserve cash flow for the state. Motion to accept items on the Consent Agenda was made by Steve Yuhasz, seconded by Tony Whitaker, and carried without dissent. VI. Reports and Discussion with Possible Action A. Adopt Well Rule Revisions North Carolina General Statute (Chapter 130A) grants boards of health the authority to adopt rules necessary to protect public health. Article 7 of NCGS Chapter 87 gives the Board of Health specific authority to adopt rules that are more stringent than those adopted by the Environmental Management Commission (EMC) in the area of well construction when necessary to protect public health. The Orange County Board of Health adopted well construction rules in 1980 which have been administered by the Environmental Health staff since that time. Tom Konsler reported that last July, the Board adopted a revision to those rules to bring them into alignment with the new statewide well rules adopted by the EMC. The Orange County rules retain several areas where they are more stringent than the state rules. The EMC adopted changes to the well construction regulations in September 2009 which has prompted several changes to the Orange County local rules in order to maintain consistency and stringency requirements. The State allows the use of bentonite chips or pellets; however, as Mr. Konsler explained, Orange County does not. He stated that bentonite is a clay-like slurry that is used as a grout that when used in chip or pellet form makes it difficult to obtain a good seal. Steve Yuhasz asked the difference between bentonite and other types of grout. Tom explained that bentonite does not set up hard like cement but is more like quicksand, and therefore poses a safety hazard if used to cap off a well. Tony Whitaker asked for clarification of regulation in Section D. Permitting and in Section 7) the revocation of a permit or the intent to revoke a permit. Tom MINUTES ORANGE COUNTY BOARD OF HEALTH October 22, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 October 22, 2009 Konsler stated that the situation has never arisen and he would seek an opinion from the County Attorney. Also, changes have been added requiring a “threadless” sampling tap at the well head for sampling purposes. The additional requirement that the sampling spigot must be smooth was added to assure that the sampling point can be properly disinfected. These rules have been advertised for public comment as required. Upon adoption of these rules, they will be come effective October 23, 2009. Motion to approve the Well Rule Revisions with an effective date of October 23, 2009 was made by Jim Stefanadis, seconded by DeWana Anderson, and carried without dissent. B. Roger’s Road Community Well and Septic Study Request The Board has been updated for the past two months on staff meetings with the Rogers Eubanks Neighborhood Association (RENA) regarding their concerns about the safety of well water supplies and septic systems in this neighborhood. Tom Konsler provided the Board with a Draft survey proposal in response to a community request for a survey and stated that it is still a work in progress. Staff has worked with the community and with UNC School of Public Health to organize a well and septic survey using collaborative survey teams. This should help offset the county staff resources that would otherwise be needed. Because only 36 homes have been identified by RENA that are on drinking water wells, cost estimates are lower than previously estimated. In accordance with the Board’s Policy 1.0 Requests for Environmental Services and Assessments, it appears that this request meets the criteria for county funding of the department operating expenses which are projected to be approximately $3,500. The time required for the survey is estimated at 330 staff hours at a cost of $14,000. Rosemary Summers stated that in the past when a similar study was done staff did the study and analysis and that without the study it is impossible for the Department to make an informed judgment of the community’s needs. Tony Whitaker asked for clarification on data management protocol. Mr. Konsler replied that if a significant number of systems are shown to be in need of repair a grant application could be filed to help funding of onsite repairs or sewer hookups. Christopher Cooke asked what the burden of responsibility would be on the county if the findings of a study were to find that the community had unsafe well water and septic systems. Steve Yuhasz wanted to know what percentage of the 85 homes would be needed to form a conclusion in a study. Michael Wood asked percentage of the homes in the study would indicate that the subdivision was not up to par. Staff responded that the analysis would be comparing the health of systems to a MINUTES ORANGE COUNTY BOARD OF HEALTH October 22, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 October 22, 2009 standard of operation and there might be comparisons to the overall county experience. Advanced statistical methodologies have not been applied in the past. Motion to recommend the Department proceed with a request for funding from the Board of Commissioners to conduct a study of septic and well water needs in the Rogers Road Community was made by Tony Whitaker, seconded by Christopher Cooke, and carried without dissent. C. Biosolids Update Environmental Health staff in partnership with NCSU and Cooperative Extension began planning for a biosolids forum to be held in October. The focus was to educate participants about the current state of practice, available and proposed research, and risk management of the land application of biosolids. Rosemary Summers reported that the BOCC denied the request to redirect a portion of the funds originally appropriated for a biosolids research project after opposition was voiced by the Commission for the Environment and members of activist groups. At their October 13th work session the BOCC discussed biosolids issues. At the conclusion, there was a general consensus to move ahead with a forum. Cooperative Extension, the Health Department, and ERCD were tasked with putting together a proposal and moving ahead with a forum. There was no consensus or direction on any other points discussed. It was noted that the Legislature passed a legislative study bill that directed the Department of Agriculture and Consumer Sciences to report on various aspects of land application of sludge and septage including whether there were health risks associated with current regulations and practices. Septage and biosolids are two separate things and fall under two different governing bodies. The Department of Agriculture has not yet formed a group to develop the report which is due to the legislature in May 2010. Tom Konsler reported that staff has learned that NCSU has decided to proceed with a 2-day forum on biosolids in early spring 2010. NCSU has decided that biosolids is a big enough issue that there should be looked at more closely. It is anticipated that the content of the forum may be similar to the one originally planned for October. The University will be asking for a representative from the Health Department to participate in the planning committee and may be interested in a collaborative effort. Anissa Vines asked if the Department of Agriculture has been in touch with NCSU or the task force to talk about what has been discussed here in Orange County with regard to the forum. Tom Konsler replied that he was not aware of any discussion as of this date. Tony Whitaker stated that the Department would be totally remiss if we missed the opportunity to participate fully in the NCSU technical forum. Anissa Vines stated her agreement. Steve Yuhasz recommended sending a letter to BOCC MINUTES ORANGE COUNTY BOARD OF HEALTH October 22, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 October 22, 2009 informing them on the Department’s position in this matter and for the Health Department to be represented and able to contribute to that study. Rosemary Summers brought up the point that if local regulations are put in place it would take staff to enforce the regulations. D. Restructuring of Case Management Services Rosemary Summers reported that the NC General Assembly faced a severe shortfall of funds to balance the state budget. As one means of balancing the budget, the Legislature directed the Division of Medical Assistance (DMA) to cut $41 million of state funds from case management services in the 09-10 fiscal year and $72 million in the 10-11 year. These services include 22 separate case management programs in health, social services, community based programs, and mental health. Health Department programs affected by this are Child Service Coordination (CSC), Maternity Care Coordination (MCC), Maternal Outreach Workers (MOW), and Health Check. Populations affected include pregnant women, children from 0-3 at risk for development delays, and all Medicaid recipients in Orange County. 509 women and children I Orange County received either MCC or CSC services in 2008-2009, with long-term vacancies in 3 positions. DMA staff were directed to return to the Legislature with a plan for achieving the savings by August 1, later extended to September 1 to accommodate a stakeholder approach to developing a plan. During July and August a stakeholder group met weekly to discuss definitions and data presented by DMA. Models of case management coordination were discussed, with DMA favoring a single entity managing all case management and care coordination services feeling that a single case manager should be able to handle any client, regardless of their specific need. Experiencing frustration with the lack of movement on actual development of a plan, the Division of Public Health along with the Health Director’s Association developed and presented a plan to the DMA that met many of its goals over the biennium with a phased approach. DMA rejected the plan outright. The Association of Local Health Directors has been working with the Division of Public Health to propose alternatives to the DMA on different funding scenarios to retain these critical services at the local level. At least two different proposals have been offered and rejected by either the Secretary or the DMA, the latest being October 15, 2009. In September, the Board reviewed a draft proposal for re-directing staff to continue to serve these vulnerable populations in a different service delivery structure. Since that time, rate reductions that became effective October 1 were posted on September 25. The posted rates enabled staff to work with actual projections and adjust the proposal to provide continuity of these services MINUTES ORANGE COUNTY BOARD OF HEALTH October 22, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 October 22, 2009 for a limited number of pregnant women and children. The rate cuts for the services per unit of services delivered (measured in 15 minute increments) in question are: Maternity Care Coordination: Old rate 29.30 New rate 17.76 Child Service Coordination: Old rate 21.74 New rate 14.43 Maternal Outreach: Old rate 15.25 New rate 14.43 Maternal Outreach services cannot be provided unless the patient is also enrolled in Maternity Care Coordination but you can only bill for one service per month under the new billing requirements, effectively making it impossible to bill for both services. If no changes are made to the current delivery model, the Department will be short of earned Medicaid revenue by $145,347 for FY 09-10 for these programs. This is approximately a 38% reduction in actual revenue for the current fiscal year. FY 10-11 will see a higher deficit because we will not have a first quarter of higher earnings to mitigate the shortfall and we are anticipating further cuts in these reimbursement rates. The re-drafted plan focuses on services to pregnant women, young infants and school age children in order to meet our mandate to ensure that babies are born healthy. The re-drafted plan may require some additional county funding in the 09-10 fiscal year, while staff learn new duties and are able to reach full productivity. The 2010-2011 year, shows a projected decrease in county funding for these services. Staff has met with Human Resources, Financial Services, and the Staff Attorney to review the plan and received positive feedback. Final approval of the County Manager is needed for this plan to move forward. Anissa Vines asked when the decision to unfreeze the vacant positions by the County Manager will take place. Rosemary Summers stated she has put in a request to meet with the County Manager and expected the meeting to occur very soon. Mike Carstens asked for clarification on billing. Dr. Summers stated that billing is done in 15 minutes increments with no difference between telephone contacts and in-person visits as far as billable amounts. There is a maximum realignment plan limit of 6 “units” per month that can be billed. Motion to support the Health Director in efforts for approval of reorganization was made by Steve Yuhasz, seconded by Tony Whitaker, and carried without dissent. E. Informational Items a. Pending and Recurring Items: The monthly listing of upcoming Board agenda items was provided to the Board for informational purposes. b. Healthy Carolinians Recertification: Orange County Healthy Carolinians received its third recertification on October 2 at the annual Statewide Conference. MINUTES ORANGE COUNTY BOARD OF HEALTH October 22, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 October 22, 2009 c. Prevention Task Force Report Executive Summary: The NC Institute of Medicine released its “Prevention Task Force Report and Recommendations” on October 2 in a joint conference with Healthy Carolinians. An executive summary was provided for the Board. The Department will be using this document as it looks toward the next health department strategic plan. d. Kathy Kerr Health Education Award: Pam Diggs, Senior Public Health Educator for the Teen Tobacco Prevention Project received the prestigious Kathy Kerr Health Education Award from North Carolina Society of Public Health Educators for her work with youth in Tobacco Prevention. e. Project Homeless Connect: Health Department staff were key partners and participants in the third very successful Project Homeless Connect. Dental staff provided more than $4,000 of free dental services to clients before and during the event. f. Media Clips: Various newsworthy media clips involving the Health Department were included for the Board’s review. VI. Board Comments/Announcements A. None VII. Adjournment Motion to adjourn the meeting was made by Steve Yuhasz, seconded by Mike Carstens, and carried without dissent. The next Board of Health meeting will be held on November 18, 2009 at the Link Government Services Center, Hillsborough, North Carolina at 7:00 PM. Respectfully submitted, Rosemary L. Summers, MPH, DrPH Health Director Secretary to the Board