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HomeMy WebLinkAboutBOH Agenda 082620 ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: August 26, 2020 TIME: 7:00 P.M. PLACE: Go to Meeting Please join my meeting from your computer, tablet or smartphone. https://qlobal.gotomeeting.com/moin/999250181 You can also dial in using your phone. United States: +1 (408) 650-3123 Access Code: 999-250-181 New to GoToMeeting? Get the app now and be ready when your first meeting starts: https://qlobal.gotomeeting.com/install/999250181 TIME ITEM 7:00 p.m. I. Public Comment for Items NOT on Printed Agenda public Comment for Items ON Printed Agenda will be handled during that agenda item (Please sign up for both on the chat section of the screen.) Please limit your comments to 3 minutes. 7:00—7:05 II. Approval of August 26, 2020 Agenda 7:05—7:10 III. Action Items (Consent) A. Minutes of June 24, 2020 7:05—7:55 IV. Educational Sessions A. Nutritional Update/Employee Health and Wellness Renee Kemske (20 minutes) B. Child Fatality Task Force Report Quintana Stewart (15 minutes)(relative to BOH Strategic Plan Priority: Accreditation) C. 4t" Quarter Financial and Billing Dashboard Rebecca Crawford (15 minutes) 7:55—8:15 V. Action Items (Non-Consent) A. Policy Review Beverly Scurry (20 minutes) 8:15—8:40 VI. Reports and Discussion with Possible Action A. Health Director Report Quintana Stewart B. COVID-19 Update Quintana Stewart C. Media Items Kristin Prelipp 8:40—8:45 VI I. Board Comments 8:45 Vill. Adjournment BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to Istran_ge(d_)oranpecountync._gov advising her of your attendance at this meeting OR CALL 919-245-2411. Compliance with the"Americans with Disabilities Act"and Title VI-Interpreter services and/or special sound equipment are available on request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter or other accommodation. Conforme a la"Ley sobre Estadounidenses con Discapacidades"(ADA)y el Titulo VI—los servicios de interprete y/o equipo de sonido especial estan disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes y Refugiados al 919-245-2387 para solicitar un interprete u otros arreglos o adaptaciones. MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH June 24,2020 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 June 24, 2020 virtually via Go To Meeting. BOARD OF HEALTH MEMBERS PRESENT: Jessica Frega, Chair, Keith Bagby, Bruce Baldwin, Aparna Jonnal, Liska Lackey, Sam Lasris, Lee Pickett, Timothy Smith and Alison Stuebe. BOARD OF HEALTH MEMBERS ABSENT: Commissioner Earl McKee. STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and Administrative Services Director; Michael DeFranco, Public Health Services Manager; Victoria Hudson, Environmental Health Director; Pamela McCall, Public Health Nursing Director; Asuka Nakamura, Community Outreach Specialist; Kristin Prelipp, Communications Manager; Beverly Scurry, BOH Strategic Plan Manager; and La Toya Strange, Administrative Support I. GUESTS PRESENT: Dr. Shielda Rodgers. Jessica Frega, Chair, called the meeting to order at 7:02pm. Ms. Stewart introduced the new employee in attendance, Asuka Nakamura. I. Public Comment for Items NOT on Printed Agenda: None. II. Approval of the June 24, 2020 Agenda *Motion was made by Lee Pickett to approve the agenda, seconded by Sam Lasris and carried without dissent. III. Action Items (Consent) A. Minutes of May 27, 2020 Meeting *Motion was made by Alison Stuebe to approve the minutes of May 2020, seconded by Aparna Jonnal and carried without dissent. IV. Educational Sessions A. Annual Communicable Disease Report Michael DeFranco, Personal Health Services Manager, gave an overview of the communicable disease (CD) data for the year 2019 which began with the purpose of the CD program within the health department. He also noted that this met the Accreditation Benchmark 2.5. Below are some of the presentation highlights. S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ June Page 1 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH June 24,2020 Enteric "Foodborne" Illnesses— • Campylobacter and salmonella make up the greatest amounts of gastrointestinal illnesses that occur in Orange County. Vaccine Preventable Diseases— • Pertussis—Orange County normally sees consistent rates of pertussis. • Influenza — Orange County did not have any influenza deaths last year. Vectorborne Illnesses — • There was a multivariate spike in 2019. • Rocky Mountain spotted fever (RMSF) and Ehrlichiosis are the two most prevalent tick borne illnesses seen in Orange County. The data includes suspected cases. One of the problems is the confirmation of these diseases because they're serological diseases. Optimally, acute and convalescent specimens need to be collected. Most practitioners have been conditioned that if they suspect this disease, to simply treat it versus collect specimens. Waterborne Illnesses— • Legionella hasn't been an issue in Orange County in the last two years. The county only gets occasional cases of cryptosporidium. Sexually Transmitted Illnesses (STI)— • The numbers are strong even with the large amount of education and intervention our clinic provides. • Chlamydia and gonorrhea cases are usually the highest cases of STIs. Other Relevant Data — • There was an increase in Tuberculosis. Two of the confirmed cases were nonpulmonary. COVID-19— • The first case originated on the west coast of the U.S., Seattle, Washington area, then traveled across the country, not necessarily in just a west to east motion. • The COVID-19 initial response included: o conversations with the OCHD health director, medical director and OCHC CD team, o state health department involvement, o strategic planning at OCHD in February 2020 which involved ■ EOC and partnerships ■ ICS structure ■ Reallocation of OCHD personnel and resources ■ scale-up capabilities • Incident Organization Chart was shown that provided a diagram of all of the members and their roles. • Strike Team was created which consists of a public health CD Registered Nurse (RN), Emergency Management Services, Personal Protection Equipment expert, community paramedic and a preventive health medicine doctor. It focuses on long term care facilities, group homes, recovery homes, assisted living facilities, and vulnerable populations in Orange County such as migrant farms and the refugee/immigrant/Latinx S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ June Page 2 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH June 24,2020 populations by assisting with testing, monitoring, educating, preventive planning, well checks, etc. • Case investigation and contact tracing are completed by members of the clinical staff, environmental health, health educators, Family Success Alliance Navigators, retired/former OCHD personnel working part time, school RNs and data/IT specialists. The BOH members had questions that were addressed by Mr. DeFranco and Ms. Stewart. B. BOH Strategic Plan Discussion Beverly Scurry, BOH Strategic Plan Manager, led a discussion regarding the three BOH priorities for the next four years. A brief summary of the discussion is below. • Terminology was discussed regarding the most effective and inclusive terms for the priorities. • The suggestion of aligning with some of the Healthy 2030 goals and objectives was made. • The three BOH priorities are Access to Care, Substance Use Disorders and Health Equity. • Ms. Scurry will begin researching strategies to use in the BOH subcommittees. The BOH subcommittees will meet in August. A draft plan will be created for the subcommittees and the Board as a whole to review in September. Afterwards, work will begin to finalize a strategic plan. The Board was asked to send any ideas on strategies/suggestions to Ms. Scurry. The BOH members had questions that were addressed by Ms. Scurry and Ms. Stewart. V. Action Items (Non-Consent) A. BOH Subcommittees The Board members volunteered to serve on the BOH subcommittees. There is a maximum of 5 members on each subcommittee to avoid having a quorum. The results are below. Only the vacant position of Pharmacist representative and Commissioner Earl McKee were not included and will be added later. There was a stipulation that whoever serves on the Health Equity Subcommittee either has taken or will complete racial equity training. Access to Care— Bruce Baldwin, Alison Stuebe, Shielda Rodgers Substance Use Disorders—Timothy Smith, Sam Lasris, Jessica Frega, Aparna Jonnal Health Equity— Lee Pickett, Keith Bagby, Alison Stuebe, Shielda Rodgers V. Reports and Discussion with Possible Action Action Items A. BOH Open Seats Discussion (Pharmacist and Vice-Chair) Jessica Frega, Chair, led the discussion on the fulfillment of the Pharmacist representative. Dr. Brian Crandell, board certified oncology pharmacist and clinical pharmacist practitioner, was recommended. Dr. Pickett and Ms. Frega interviewed Dr. Crandell. Some of the interview's takeaways were: S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ June Page 3 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH June 24,2020 • He works at the UNC Hospital in Hillsborough. • He put a lot of emphasis on evidence-based medicine, data-driven interventions and was very interested in getting more educated on racial equity issues. • He also expressed his concern regarding access to care as he's also a foster parent and has seen, firsthand, the problems that come with children not having access to care. As the BOCC is in summer session, it may be September before they're able to review the BOH's recommended appointment. Motion to appoint Brian Crandell to the BOCC was made by Lee Pickett, seconded by Jessica Frega, and carried without dissent. The Board members voted on selecting a member to fill the vacant Vice-Chair seat. Ms. Frega nominated Sam Lasris, noting his experience and background knowledge regarding how the Board operates. There were no other nominations. Motion to appoint Sam Lasris as the Vice-Chair was made by Bruce Baldwin, seconded by Keith Bagby, and carried without dissent. Sam Lasris abstained. B. Health Director Report Ms. Stewart began by thanking Mr. DeFranco for the CD update report as he covered some of the items she was going to cover in her COVID-19 update. Some of the items Ms. Stewart mentioned from her report are below. • Northern Orange Testing Event at Mt. Zion A.M.E. Church in Hillsborough held on June 51" in which 147 individuals were tested. This was collaboration between the OCHD, UNC PNC and UNC Health RDC. There's talk to do more mass testing including having one at the southern end of Orange County. • The first Long-Term Recover Group (LTRG) meeting occurred. The group, comprised of local leaders, was established to ensure a coordinated recovery process for COVID-19 as it is understood that this pandemic will have long-term devastating effects on the aimed at a whole-community approach. The county hired a consultant from the Haggerty Group to lead this process. The LTRG is divided into 7 Recovery Support Functions of which there is one specifically for health. While we're trying to address the recovery, we're still very much in COVID-19 response mode. Ms. Stewart thanked Aparna Jonnal for participating in the LTRG as the physician representative of the BOH. • Ed Kerwin, Executive Director of OWASA, will be retiring effective July 6, 2020. OWASA has shared the BOH's Fluoridation report online and it's open for public comment. • Pam McCall, our Personal Health Services Director, also known as our Nursing Director, will be retiring effective August 121". Ms. McCall was congratulated by the board and Ms. Stewart on her upcoming retirement. Ms. Frega added that she's always been impressed by her Board presentations and her off the cuff knowledge whenever the Board had questions for her as Ms. McCall always knew the answer. • Interviews for the Dental Director position are being scheduled. Sam Lasris was thanked for agreeing to serve on the interview panel. C. COVID-19 Update S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ June Page 4 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH June 24,2020 Quintana Stewart, Health Director, gave an update on the COVID-19 status in Orange County as well as took questions from the Board. Some highlights are below. • The Governor announced at the briefing today that the state will remain in Phase 2 another 3 weeks until July 17th as we're not meeting the metrics he previously spoke about. He'll revisit that decision at that time. On this Friday at 5pm, the statewide mask/face covering mandate goes into effect. The Governor would like to see a percentage positive ideal rate at 5% for the state. Currently, the state is at a rate of 9- 11%. • Today, o NC had a record high 1721 new cases reported today. o Orange County had a record high of cases last Saturday and Sunday. Both days had 16 new cases each. o The number of hospitalizations increased over the last 14 days with yesterday having a record high 915. o Hospitals state they still have the capacity to see or take care of more covid patients. • Testing o Overall the State has completed 17,000 tests a day. Labs are experiencing a shortage of reagent supplies. The State has reached out to the federal government for assistance. • Locally today, o There are 568 cases. o As of this morning, there are 29 hospitalizations. o There have been 1 additonal death since the BOH has met. o There have been 3 outbreaks in 3 nursing facilities with no new outbreaks. In order for them to come off of that outbreak status, they must go 28 straight days with no new cases. • The DHHS website has a new function. County-specific information can be obtained by a simple click allowing demographic information to be seen. • DHHS will also start to report clusters/outbreaks in schools and daycare centers. As of today, there aren't any in Orange County. • The OCHD is working on ramping up its outreach and testing in the Latinx community as hispanic cases are very high. A Spanish website has been created identical to the English version including the dashboard and all of its data. Public service and radio announcements have been broadcasted. The Strike Team has also turned focus on reaching out to migrant workers and immigrant populations. There was a dashboard titled "Board of Health Dashboard — OCHD COVID-19 Response" displayed. Ms. Stewart stated the link is on the OCHD website. This dashboard was created by Rebecca Crawford to show how the OCHD clinics responses have been affected by COVID-19. Below are some highlights. • Patient encounters for the medical clinic remain the same as last month; although, numbers are still down due to the abbreviated schedule. • Patients are still being seen at both the SHSC Clinic, deemed the "well clinic" where primary care visits occur, and the Whitted Clinic, deemed the "sick clinic" for those symptomatic patients. Telehealth appointments are also increasing. • The Dental Clinic continues to see emergency appointment only. • In regards to data on communications, S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ June Page 5 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH June 24,2020 o Social media, COVID calls and emails increased in volume due to the mask mandate being introduced in June. o COVID testing numbers include those patients that had a telehealth appointment and were instructed by the provider to come into the office for testing based off of their symptoms and those tests performed by the Strike Team. o We still have a strong social media presence thanks to Kristin Prelipp and the Joint Information Center (JIC). They're still doing a great job. o Our Immigration and Refugee Health program served 350 families in collaboration with DSS with food boxes over the last five weeks. Ms. Frega provided guidance to the BOH in reference to responding to emails received from the public to ensure that consistent messaging occurs, that the proper information is shared and that Ms. Stewart, Mr. Lasris and Ms. Frega are looped in before replying. It was also reiterated that the BOH wants to respond to the public in a timely manner and to include the entire BOH so that everyone is aware of the conversation. Ms. Stuebe asked if there is a platform we could use such as Microsoft Teams to communicate as a board versus over email. Ms. Scurry brought up the issue of quorums and meetings. Ms. Stewart will check on this issue and get back to the Board. Ms. Pickett would like for the OCHD newsletter to get a wider audience, possibly subscribing to the OCHD's newsletter as there is a lot of great information in those newsletters. D. Media Items Kristin Prelipp, Communications Manager, mentioned that all of the articles were COVID-19 related. The articles were about high school graduations, COVID in nursing homes, a Hillsborough restaurant praising the guidance they received from the Environmental Health division, incomplete COVID race and ethnicity data, NC surpassing over 1000 COVID-related deaths and the face covering requirement. There's a page dedicated to face coverings with FAQs that include answers on a 61" grade reading level which is available in 7 different languages. Media items were in the packet which focused on Orange County's events and our involvement in various efforts. VI. Board Comments. Ms. Frega stated that Ms. Stewart has been sending out the NALBOH webinars. Board members were instructed to contact La Toya if they have any difficulties accessing the webinars. Ms. Frega commented that tonight is BOH member, Nurse Representative, Liska Lackey's last meeting. Ms. Frega stated that Ms. Lackey has served the maximum amount of terms as a BOH representative. She also mentioned that Ms. Lackey served as a representative with the Healthy Carolinians of Orange County and the Family Success Alliance. Ms. Stewart virtually presented an appreciation plaque to Ms. Lackey while expressing her gratitude for Ms. Lackey's service. She also stated how much she appreciated Liska's faith and confidence in hiring her as the new health director. S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ June Page 6 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH June 24,2020 Ms. Lackey expressed that she will miss spending time with the Board, that it's been a privilege, and will be keeping up with the board's activities. Dr. Shielda Rodgers, while attending tonight as a guest, will be participating at the next board meeting as the Nurse Representative. *Ms. Strange asked Ms. Frega to get a verbal approval from Ms. Bagby on minutes and agenda as earlier in the meeting, we weren't able to hear him. VII. Adjournment Keith Bagby moved to adjourn the meeting at 9:07pm and Alison Stuebe seconded. The next Board of Health Meeting will be held August 26, 2020 at 7:00pm via Go To Meeting. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ June Page 7 Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 26, 2020 Agenda Item Subject: Nutrition Services Update Attachment(s): Staff or Board Member Reporting: Renee Kemske, Nutrition Program Manager Purpose: Action X Information only Information with possible action Summary Information: OCHD's Nutrition Services section has historically offered medical nutrition therapy and diabetes self-management education services to community members. With grant funding, staff have been able to use innovative approaches to increase access to these services and to expand community partnerships with the goal of improving health outcomes. As a result of these collaborations and funding opportunities, Nutrition Services now offers the CDC minority diabetes prevention program (MDPP) and employee wellness services. With funding from the Office of Rural Health (9/17, renewed FY19-21), OCHD was able to implement several initiatives to increase access to primary care and support services: A nutrition services voucher program (FY19-20, 228 vouchers); Enhanced interpretation support (4 Spanish diabetes classes); Diabetes testing supplies/resources; And a transportation assistance program (FY19-20, 45 rides). The grant also advanced community partnerships (Dept. on Aging, CCPHD, UNC Family Medicine). With COVID-19, Nutrition Services initiated telehealth services (12% decreased no show rate), developed protocols to disseminate self-management tools, facilitated remote MDPP services (Average 6.6% weight loss and 154minutes PA/week), and continued individual and group employee wellness services (FY19-20, 100 encounters). Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward to _X_Accept as information Revise & schedule for future action Other (detail): Nutrition Services Update ORANGE COUNTY HEALTH DEPARTMENT NUTRITION SERVICES Al Renee Kemske, MPH, RD, LDN, Nutrition Program Manager GRANGECOUNTY OBJECTIVES ■ Provide an overview of Nutrition Services �r °n ■ Discuss goals/progress of �1( " r Community Health Grant ■ Provide update on Diabetes Prevention Program ■ Highlight Employee Wellness Successes � Gaoa.GEaounnv IlA171H YdMR7tO1T OVERVIEW OF SERVICES ■ Medical Nutrition Therapy ■ Diabetes Self-Management Education Services ■ CDC Minority Diabetes Prevention Program ■ Employee Wellness Services Orange County Health Department NUTRITION SERVICES I NUTRITION COUNSELING Orange County Health Department Nutrition Counseling Healthier Eating for a Healthier Lifestyle Proper nutrition is an important component of overall good health.The Orange County Health Department offers nutrition counseling(Medical Nutrition Therapy)to help you prevent or manage certain medical conditions.Meet with a Registered Dietitian to develop a personalized plan to help you meet your nutrition, wellness,and overall health goals. availableMedical Nutrition Therapy is Weight Management(adults and children) Cholesterol Diabetes High Blood Pressure High Risk Pregnancy Conditions Feeding Issues in Children Ask your medical provider for a referral then call us to make an appointment. Hillsborough Chapel Hill Whihed Human Services Center I Southern Human services Center 300 West Tryon street 2501 Homestead Rd Hillsborough,NC 27278 Chapel Hill,NC 27516 919-245-2400 919-945-2400 L /ORANGECOUNTY Fees are charged on a sliding scale;some insurances accepted. H¢urx oawurrmsrrr are COUP NUTRITION COUNSELING Medical Nutrition Therapy (MNT) ■ Provided by an RD who works with the referring medical provider to improve conditions such as diabetes, heart disease, and obesity ■ Conducts thorough review of medical history, medications, labs, diet, and lifestyle patterns ■ Develops a personalized nutrition treatment plan/goals to improve health outcomes < �oaANGEooUr,n-r IlA171H YdMR7tO1T MEDICAL NUTRITION THERAPY (MNTI Types of clients Count T MNT Data Maternal Health 111 13% Total Encounters for Child Health 151 18% FY 2019-2020: 852 PC 98 1 2% FP 18 2% Health 378 44% Adult Non Department Health-Dept 353 41 % Non-Health 474 56% Referrals Department � Child Non Health-Dept 121 14% Referrals � Gaoa.GEaounnv IlA171H YdMR7tO1T MEDICAL NUTRITION THERAPY (MNT) Clients by Payment Type (852 Total Payer Count Medicaid 285 33% Insurance 293 , 34% f Self-Pay 274 32% L J {,�aoa.GEaounnv IlA171H YdMR7tO1T i DIABETES SELFMANAGEMENT EDUCATION SERVICES (DSME jot , to Orange County � � Ak labetes E4xatian Self-Management Education Program HEALTH DEPARTMENT GRANGECOUNTY FFAL*FI DEPAW SIT iiiii� DIABETES SELF-MANAGEMENT EDUCATION SERVICES (DSME) Participants will receive 1 0-hours of education : ■ Initial health assessment ■ Two 4-hours group education classes on the basics of diabetes care ■ Follow-up appointment 3-months after the group class ( 1 -hour group) oarNGEmunrrr IlA171H YdMR7tO1T DSME CLASS EVALUATION DAI A Customer Comments : � � Diabetes Self-Management Education(DSME)Services Class Evaluation UffW: tocetwn: "This i s a n excellent class. The ' ��Ia.;ng�v� y��_•1nTermaFlon,�re6a6Ye and ukllle 35UL da. ■ Ilax mudr do Y 3ew5i�r3ce ui+i in wl LW.(Uax ANy mE Vjll t �aGS sam'f5'I:: strcf�ry• .:araa Neutral 6IBBge9 a°1�1' approach is very holistic and the _ 3: I icd c ide ♦, Icar sac♦x rnmai�e and Mlle loarud in fie instructors are well-prepared ��arn rn a . Thc ire[mom ws wJl­gxiud. :kirdurn�u w�--- and communicate effectively." J a.c n u Iv rn.rs Iu)mt a.'ra ATdjj 1_+Ia"�t ay rr a4op 7 DFa—0—a— 7 Divi—0-- 7 DiA.—M--ng ] DMF—ua;v;� ] liv].if,G. •xs ] lung ril,DiA» ] HNii..iv as.— ] N.�rn fa DiaV� ] =cd ArNV ] Phyad ASniy 111 ] %��PAedimiQa ] Didr�pedrsivs ] M..Wg A—Prdi ] A1arQQ A—Prd%—. ■ "Before these classes I was ] �ogTcrn ] lagTcrn feeling a bit overwhelmed and Si&WM 13 3 T K 11w g se>oollt wAatyou Ieamec Tf4m tAe 6SME cWBB I—.,dd.,,. ygecU1 ing ;t wha✓o em n*d f msaes W sbr-gM Agree Neutr9 Dlaegee ffia�y now I see I can take control and A: IIc Adk dAr"—ofd L,. 3: I Ioarad fie 3 ova tr.."q g use my new found knowledge to l w preserve and promote my overall health ." GR GE COUNTY HEALTH DEPART NEW DIABETES SELFMANAGEMENT EDUCATION SERVICES (DSME The O C H D D S M E program -VA was awarded the 2019 John '- �"°'� - A� ' - - ac lac ,�AC Vi _ e _�.- Bowdish Community Award �� --a from the North Carolina � �a� �A�_ �� � _ f ^cJ -DAC Diabetes Advisory Council at t the Division of Public kc Health for providing outstanding service to ac community members with an emphasis of increasing access . '• - S to care. r .s=• = GRANGECOUNTY 1H DEPAWMEWr DIABETES SELF-MANAGEMENT EDUCATION SERVICES (DSME) NCDiabetesSmart featured OCHD's DSME program in a video for a statewide marketing initiative. DiabetesSmart NC o https://diabetesmanagementnc.com/diabetessmart/ A( ,4 oaAWSEaounnv IlAl7N YdMR7tO1T TELEHEALTHe. MNT ■ Started March 30th No-show rate for MNT decreased by 12% TRAGKLN ■ Mailing educational x . �. materials and behavior change tools BATHROOM SCALE a a Orange County Health Department NUTRITION SERVICES GRANGECOUNTY 4P N DEPAWWWr TELEHEALTHe. DSME ■ Started May 14t" using doxy. me and Zoom ■ Provided DSME class in ., Spanish in June using 4 simultaneous Tasty Recipes interpretation via Zoom ■ Mailing resources to participants GRANGECOUNTY 1HDEPAWWWr COMMUNITY HEALTH GRANT Background ■ Original Award FY17-18; 2"d award FY18-19- 20-21 ■ Community Health Grant through the Office of Rural Health ■ To increase access to primary care and self- management support services for residents with chronic disease I� GRANGECOUNTY s COMMUNITY HEALTH GRANT Target Population : ■ Adults who are uninsured or who have Medicaid or Medicare ■ Adults with any of the following conditions: 91L ■ Obesity ■ Pre-diabetes or diabetes ■ Abnormal lipids ■ Hypertension ►,� 4� oaoJ.GEaour,nv IlA171H YdMR7tO1T GRANT SPIP' FIC AIMS/OUTCOMES ■ Voucher Program ■ Cover minimum fee for nutrition services � ■ CCPHD replicated program Allow ■ Provided 226 appointments (CCPHD 62 appts) ■ Diabetes Testing Supplies ■ Continue protocol to offer Al C tests and diabetes testing supplies at no cost for uninsured clients � Gaoa.GEaounnv IlA171H YdMR7tO1T GRANT SP1FV-1FIC AIMS/OUTCOMES ■ Increase accessibility of interpretation services for LEP clients (MNT/DSME) ■ Held 2 DSME classes (4 sessions) • Used simultaneous interpretation � devices to aid in interpretation ■ Offer Behavior Change Incentives ■ Providing water bottles, calorie tracking books, step trackers . a Gaoa.GEaounnv IlA171H YdMR7tO1T GRANT SP FIC AIMS/OUTCOMES �0999@17z�g ■ Piloted transportation assistance program for adults • and pregnant women to increase To podemos proveer transporte a to cita de nutrici6n, medica o de diabetes sin costo alguno! access to care Para ver si calificas,por favor contactanos al 919-245-2380 o preguntale a to proveedor de servicios medicos en su pr6xima cita. ■ Provided 45 rides ■ Reallocated funds for telehealth services We can provide transportation to and from your medical, nutrition or diabetes appointment at no cost to you! To find out if you qualify, please contact us at 919-245-2380 or ask your provider at your next appointment. GRANGECOUNTY FFALTIH DINMRTNEW PRIMARY CARE BAG INITIATIVE ■ Goal is to help people with . . HTN and DM self-monitor at home COUNTY MEALTH ■ Participants receiveDEPAqTKENT necessary labs along with tools for home use ■ Participants also are scheduled for telehealth MNT appointments 4 aoJ.GEaour,nv IlA171H YdMR7tO1T COMMUNITY PARTNER-9HIPS ■ Funds to supplement costs for UNC Family Medicine to offer Living Healthy classes ■ Stanford Curriculum chronic disease classes ■ Coordinated Community Health Collaborative ■ Local partners to establish a formalized referral network. ■ Expand Collaboration with OC Department on Aging ■ Screenings and health promotion programming � Gaoa.GEaounnv IlA171H YdMR7tO1T COMMUNITY HEALTI WORKER ■ Enhance the Community Health Worker Role ■ Establish relationships with people in the community offering support to better manage chronic � F conditions � U1 ■ Increase awareness of services/ 1 �' link people to services (outreach and marketing) ■ Teach Living Healthy classes 4 aoJ.GEaour,nv IlA171H YdMR7tO1T DIABETES PREVENTION PROGRAM (DPP) Overview: A 16-week class for people with prediabetes or who are at risk for Type 2 Diabetes make realistic and achievable lifestyle changes that can cut their risk of developing Type 2 Diabetes by 50%. Goals: Lose > 5% body weight & achieve >150 minutes physical activity/week Prizes: Provide over $200 worth of prizes to aid in behavior change. Contact Information: x2380 ❑ D TY GRAWSEMU HFA91H DIABETES PREVENTION PROGRAM (DPP) ■ Now offering by Zoom (no disruption in service) ■ Data: Average 6.6% weight loss and 154 of physical activity minutes per week ■ Mailing behavior change tools to participants (EOI.GI OWLL r GRANGECOUNTY N DEPAWWWr EMPLOYEE WELLNESS ■ Available for Employees Staying Well at Home LVIRTUAL If you're interested in staying active,eating a nutritious diet, Friday, May 1, 2020 and managing stress while at home,please register forthe Virtual Staying Well at Home class! In this class you will learn: ■ Individual/Group Appits •Myths and truths about dietand supplements and CO 1pare Contact ReneeKemsketoregister. Safe,simple,and budget friendty ways to shop and preparemeals rkemskeporangecountync.gov Methods of exercise that you can do at home or safely outside or 919-245-2380 .Stress management skills to help fight the quarantine blues DcurtMeal Planning adonta eofyouitfounty sass essbern take advantage of your wellness benefit NUTRITION SERVICES by scheduling a FREE nutrition counseling appointment with one of our regictered dietitians. ' We am nw offering 9frtual Appointments. ■ New Years Weight ORANGE C°�NT� I \ .�— HEALTH OEP UNTV Management � - ■ Stay Well at Home ■ Provided 100 appts (61 individual, 39 group) ■ Department-Specific Presentation GRANGECOUNTY 1HDEPAW!"NEW!"' SUMMARY/QUESTIONS ■ Provided an overview of Nutrition Services Better ■ Discussed goals/progress of Heath AHEAD Community Health Grant ■ Provided an update on MDPP and Employee Wellness 4 aar.�cnur.nv HFAuN o�nvir Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 26, 2020 Agenda Item Subject: Child Fatality Prevention Team Annual Report Attachment(s): 2019 Child Fatality Prevention Team Annual Report Staff or Board Member Reporting: Quintana Stewart Purpose: Action X Information only Information with possible action Summary Information: The report is a review of the 2019 Orange County CFPT activities. Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward to _X_Accept as information Revise & schedule for future action Other (detail): 2019 Child Fatality Prevention Team Annual Report I. Introduction In 1993,the North Carolina General Assembly established a network of local Child Fatality Prevention Teams (CFPT's)across the state to confidentially review medical examiner reports, death certificates and other records of deceased residents under age 18. Each local team consists of representatives of public and nonpublic agencies in the community such as law enforcement, Guardian Ad Litem,health departments, among others, that provide services to children and their families. The purpose of this report is to give a summary of the causes of death,the number of cases reviewed, recommendations for prevention, if any,that have been made and to share local team activities and accomplishments. II. Role of the Orange County Commissioners and Board of Health • Receive annual reports which contain recommendations and advocate for system improvements and needed resources,if requested. • Appoint members of the local team as identified by the membership. III. Child Deaths by Cause, System Problems Identified,Recommendations for Prevention& Proposed Action In 2019,the Orange County CFPT reviewed met four times and reviewed seven child deaths. In one case there was a system issue identified: unsafe sleep environment. The team's recommendation is to strengthen the message of safe sleep habits to parents.A plan was developed to produce a video on Safe Sleep to run in waiting rooms and other places where caregivers will be able to view. IV. Orange County CFPT Activities and Accomplishments Examples: • The annual CFPT Activity Summary was completed and sent by the date requested. • The CFPT Chairperson and other members of the CFPT participated in a 3 day intensive review of a child fatality in April,2019. • Information on multiple webinars regarding child safety issues was forwarded to team members. • Training surveys were disseminated to team members • Individual reports were completed on child deaths reviewed by the team and were forwarded to the State Coordinator. V. Conclusion Thank you to the members of the Board of Health for the opportunity to share with you the successes and dedicated work of the local team as we continue to review child fatalities,make recommendations, and take actions to prevent future child deaths. Please feel free to contact the Chairperson at 245-2402, should you have any questions about this report. Pam McCall,Public Health Nursing Director Chairperson June 18,2020 Date Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 26, 2020 Agenda Item Subject: 4th Quarter Financial Report FY 19-20 Attachment(s): 4th Quarter Financial Report 4th Quarter Billing Dashboard Staff or Board Member Reporting: Rebecca Crawford Purpose: Action X Information only Information with possible action Summary Information: Total Health Department Budget vs. Actuals: Average YTD monthly revenue in FY19-20 after the fourth quarter is $271 k/month or $3.31VI YTD, representing 91.8% of our overall budgeted revenue for the year compared to last year, which was 91.6%. Expenses are above revenues, at 92% of the overall budget. This shows how well staff did in reducing expenditures in order to match decreased revenues during office closures. Additional state and federal funding to offset revenue shortages and support the pandemic response contributed to an almost equal percent of overall revenue received of what was budgeted to the prior fiscal year. Total Billing Accuracy: The medical and dental billing accuracy measure continues to be a challenge as we work with UNC and the Dental EHR, Eaglesoft, to improve the accuracy of the reporting system for Health Department revenue and is not included in this quarter's dashboard. Dental Earned Revenue by Source: The FY 19-20 average monthly revenue ($39k/month) for the fourth quarter is below our budget projection ($45k/month) and our FY 18-19 average of $46.6k/month. As anticipated, the dental clinic saw a more immediate, negative impact on revenues than the medical clinics as a result of the severely decreased operations and very limited appointments. We began seeing more patients in June when PPE was more readily available, which led to slightly higher than anticipated revenue totals for that time period. FY 19-20 dental earned revenue totaled $468k at the end of the fourth quarter compared to $559k at the end of the FY 18-19 fourth quarter. Medical Earned Revenue by Source: Medical earned revenue is below the budgeted projection for FY 19-20 ($57k/month) at $40.1 k/month. Our billing team worked hard over the last quarter to correct and submit outstanding claims in the medical clinic in order to bring in as much revenue as possible, which helped insulate the medical clinic from the large revenue decrease experienced by the dental clinic. The medical clinic continued to have many telehealth visits and some in-person visits, which contributed to revenue receipts. Medical clinic revenue totals $482k after the fourth quarter FY 19-20 compared to $487k after fourth quarter FY 18-19. Environmental Health Earned Revenue by Source: Environmental Health earned revenue is below the budgeted projection for FY 19-20 ($54k/month) at $46k/month. Permanent staff in EH added WTMP inspections to their current workloads in order to complete them as required by the end of the fiscal year. EH staff did an amazing job and continued to inspect where able during the Stay at Home Order, which resulted in only a slight decrease in projected revenue for the remainder of the FY. FY 19-20 YTD revenue totals $552k compared to FY 18-19 YTD revenue of $594k. Grants Fund Revenue: FSA has drawn $200k of the multi-year Kenan grant. Expenditures are tracking as anticipated and will continue to increase since we filled the vacant Navigator position in November. This position was dependent upon additional United Way funds in order to hire at the full time equivalent level, which were approved by the BOCC in September. Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward to X Accept as information Revise & schedule for future action Other (detail): TOTAL HEALTH DEPARTMENT REVENUE ENVIRONMENTAL(EH)EARNED REVENUE BY SOURCE vs.Budget Projections&Prior Year vs.Budget Projection&Prior Year $700 $80 613 = $70 o 5 $600 59 58 $60 52 55 $500 ■ ■ ■ 147■ ■ ■ ■ ■ ■ ■ ■ ■ ■ W100 ■ ■ ■ ■ $50 $400 342 $40 3.7 33 34 $300 ■ ■ ■ ■ ■ ■ ■ ■ ■246 ■ ■ ■ ■ ■ ■ ■ ■ 43! ■ ■2 3 ■ ■ 2420 ■ 158d ■ & $30 209 212 226 213 219 $200 son $20 $100 — $10 _ $0 ■ ' 1 A s 0 N D 1 F M A M 1 J A s O N D 1 F M A M 1 —Wells Tattoo Parlors Personal Health iiiiiiiiiiiii■HPES Septic Samples iiiiiiiiiiiii■Public Pools iiiiiiiiiiiii■Food and Lodging = FAS Environ Health Fees • Total Earned Revenue($552k YTD) Dental • Total OCHD Revenue($3.3M/y) . ■ ■FY19-20 Budget Proj($54k/m,$649k/y) YTD Mth Avg($46.k/m,-$552k/y est) — YTD Mth Avg($271k/m,-$3.3M/y) . ■ ■FY19-20 Budget Proj($294k/m,-$3.5M/y) FY18-19 Mth Revenue($594k/y) FY18-19 Mth Revenue-Avg($49.5k/m) DENTAL EARNED REVENUE BY SOURCE MEDICAL(PH)EARNED REVENUE BY SOURCE $70 vs.Budget Projection&Prior Year N $60 55 vs.Budget Projection&Prior Year ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 58 58 $60 54 $50 47 50 L49 41 2 42 4 41 $50 Eft45 47 45 $40 -■ ■ ■ ■-■ ■ ■ ■ ■ ■ ■ ■ ■\ 34 34 $40 29 Z $30 MINE $30 $20 $20 14 $0 Minas $0 1 A s O N D J F M A M 1 J A s 0 N D 1 F M A M 1 SELF PAY �INSURANCE SELF PAY INSURANCE MEDICAID • Total Earned Revenue($468k YTD) MEDICAID • Total Earned Revenue($482k YTD) a ■ ■FY19-20 Budget Proj($45k/m,$S41k/y) YTD Mth Avg($39.k/m,-$468k/y est) ■ ■FY19-20 Budget Proj($57k/m,$681k/y) YTD Mth Avg($40.1k/m,-$482k/y est) FY18-19 Mth Revenue($559k/y) FY18-19 Mth Revenue-Avg($46.6k/m) FY18-19 Mth Revenue($487k/y) FY18-19 Mth Revenue-Avg($40.6k/m) Orange County Health Department Fourth Quarter Financial Report FY 2019-2020 General Fund % OF ANNUAL TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET BUDGET Revenue Donations Health Promotion & Edu 0 (400) (5,310) 7.53% Personal Health (52,125) (56,076) (4,000) 1401.89% Donations Total (52,125) (56,476) (9,310) 606.61% Internal Allocations Dental Health (41,477) (41,477) (41,477) 100.00% Health Promotion & Edu 0 0 0 0.00% Personal Health (334,658) (334,658) (334,658) 100.00% Internal Allocations Total (376,135) (376,135) (376,135) 100.00% Service Revenue Dental Health (23,544) (468,088) (541,000) 86.52% Environmental Health (150,846) (551,863) (648,761) 85.06% Personal Health (104,036) (481,677) (681,125) 70.72% Service Revenue Total (278,426) (1,501,628) (1,870,886) 80.26% State Allocations Finance and Admin Services (125,672) (161,204) (42,921) 375.58% Health Promotion & Edu (23,686) (71,706) (71,706) 100.00% Environmental Health (37,788) (41,555) (44,600) 93.17% Personal Health (187,872) (583,401) (591,491) 98.63% State Allocations Total (375,019) (857,865) (750,718) 114.27% Grants Project Revenue AFDO Grant 0 (1,557) (3,000) 51.89% CC4C Accesscare (43,046) (131,989) (147,686) 89.37% Community Health Grant (47,998) (106,680) (145,914) 73.11% MDPP (10,678) (18,174) (18,174) 100.00% PCM Accesscare (48,375) (145,477) (167,334) 86.94% Piedmont Hlth Sry-Nutr (15,374) (39,576) (33,800) 117.09% FIT Grant (7,261) (17,110) (19,561) 87.47% Dental Grant 0 (2,500) (2,500) 100.00% Grants Project Revenue Total (172,733) (463,062) (537,969) 86.08% Revenue Total (1,254,437) (3,255,165) (3,545,018) 91.82% Grand Total (1,254,437) (3,255,165) (3,545,018) 91.82% Orange County Health Department Fourth Quarter Financial Report FY 2019-2020 General Fund % OF ANNUAL TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET BUDGET Expenditures Salaries 2,330,936 6,139,211 6,149,017 99.84% Benefits 817,325 2,313,694 2,406,364 96.15% Travel 70 11,471 25,231 45.46% Training (2,474) 28,803 61,289 47.00% Certifications&Licensing 925 5,807 10,987 52.85% Mileage 4,690 29,324 56,126 52.25% Telephone 3,904 79,012 113,249 69.77% Postage 4,745 14,627 14,278 102.44% Equip Repairs 11575 5,889 15,100 39.00% Equip Rent 211 1,345 1,345 100.00% Duplicating 1,129 6,738 12,250 55.00% Printing 5,598 7,807 15,875 49.18% Advertising 178 995 9,235 10.78% Dues 320 5,505 6,300 87.38% Subscriptions 386 1,614 1,600 100.90% Dept Supplies 10,833 32,646 43,504 75.04% Edu Supplies 9,293 11,797 23,623 49.94% Office Supplies 2,780 16,815 26,675 63.04% Medical Supplies 19,464 108,857 148,961 73.08% Bloodborn Path Supplies 344 1,287 1,200 107.24% Pharmacy Supplies 13,500 100,058 157,308 63.61% Comp Supp/Software 1,141 4,919 6,433 76.47% Contracted Sry 212,718 673,116 1,033,636 65.12% X-Ray 974 4,957 22,625 21.91% Lab Sry 23,736 84,059 143,669 58.51% Bonds&Insurance 10,815 10,815 10,815 100.00% Uniforms 100 2,738 6,100 44.88% Community Proj 14,129 32,923 51,095 64.43% Innovations Project 724 5,925 15,000 39.50% Accreditation Project 0 3,250 3,250 100.00% Credit Card Exp 2,739 11,401 11,000 103.64% Nicotine Replacement Therapy 5,949 9,852 10,000 98.52% Capital Exp Under$500 1,212 12,545 9,774 128.36% Equipment (1,303) 8,406 8,728 96.31% IT Equipment 374 1,552 2,499 62.09% Expenditures Total 3,499,041 9,789,761 10,634,141 92.06% TOTAL HEALTH 3,499,041 9,789,761 10,634,141 92.06% Orange County Health Department Fourth Quarter Financial Report FY 2019-2020 Grants Fund YTD ANNUAL % OF ANNUAL TOTAL HEALTH Q4 ACTUAL BUDGET BUDGET Revenue Kenan Grant (100,000) (200,000) (300,000) 66.67% Meaningful Use Incentive (15,905) (79,523) (95,427) 83.33% Revenue Total (115,905) (279,523) (395,427) 70.69% YTD ANNUAL % OF ANNUAL TOTAL HEALTH Q4 ACTUAL BUDGET BUDGET Expenditures Salaries 27,216 232,263 505,083 45.99% Benefits 12,386 100,416 147,375 68.14% Training (625) 7,785 12,288 63.35% Mileage 52 2,781 34,918 7.97% Contracted Sry 0 0 82,704 0.00% Community Proj 0 0 22,006 0.00% IT Equipment 0 0 6,451 0.00% Expenditures Total 39,028 343,245 810,824 42.33% Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 26, 2020 Agenda Item Subject: BOH Policy Approval Attachment(s): Policies I.A., I.C., I.E., II, and III Staff or Board Member Reporting: Beverly Scurry Purpose: Action Information only X Information with possible action Summary Information: The Board of Health did an in-depth policy review in 2019. There were not many changes identified for 2020. Policy I.B. will be presented at the September BOH meeting. Please review the policies for potential approval at the August meeting. Recommended Action: X Approve Approve & forward to Board of Commissioners for action Approve & forward to Accept as information Revise & schedule for future action Other (detail): ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy B: Fee and Eligibility Policy Reviewed by: Financial Review Committee,Health Director Approved by: Board of Health,Health Director I. Purpose A. Public health services are increasingly costly to provide. The Health Department serves the public's interest best by assuring that all legally required public health services are furnished to all citizens. The department provides recommended and requested public health services based upon the priorities established by the Board of Health. B. Fees are a means to help provide services to the residents of Orange County. Fees help finance and extend public health services when government funding is not sufficient to support the full cost of providing all required and requested services. C. Fees for Orange County Health Department services are authorized under North Carolina G.S. 130A-39,provided that: 1. They are in accordance with a plan recommended by the Health Director and approved by the Board of Health and the Orange County Board of Commissioners. 2. They are not otherwise prohibited by law. 3. They are deposited to the account of the local Health Department for public health purposes in accordance with the provisions of the Local Government Budget and Fiscal Control Act. D. Fees for services must also be in compliance with N.C.Administrative Code,Title X Regulations, and Women's and Children's Health Program Rules. E. There will be no charge for Title X Services provided for individuals with income less than 100%of the Federal Poverty Level(FPL.) II. Policy Implementation The implementation of this policy is delegated to appropriate financial or support staff in each division of the health department. III. Income Eligibility A. Definitions 1. Definition: A family is defined as a group of individuals who are living together as one economic unit. Individuals are considered members of a single family or economic unit when their production of income and consumption of goods are related. A pregnant woman is counted as a family of two in determining family size. 2. Income eli ig bili , requirements apply to: Dental Health,Family Planning, Child Health,Maternal Health,Adult Health,Nutrition Services,Family Home Visiting, and Primary Care Services. 3. The Health Department utilizes a sliding fee scale based on Federal Poverty Guidelines in accordance with the Fee Schedule approved annually during the County Budget process. NC DPH updates and issues the scale yearly. Specifically, Page 1 of 8 Original Effective Date:January 25,2001 Revision Dates:, 4/2016,9/2018,10/2019,10/2020 ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy B: Fee and Eligibility Policy Reviewed by: Financial Review Committee,Health Director Approved by: Board of Health,Health Director the health department uses the 101%-250%Federal Poverty Level sliding scale. Determination of Sliding Fee percentage is based on gross income and family size. 4. Verification of income is required at time of enrollment for services, at the annual financial interview,or if there is a change in the work status in the family unit for clients to be eligible for the sliding fee scale. a. An annual gross income statement is preferred for evaluation. i. Gross income is defined as the total of all cash income before deductions for income taxes, employee social security taxes, insurance premiums,bonds, etc. For self-employed applicants,net income after business expenses. Gross income does NOT include money earned by children for babysitting, lawn mowing and other tasks. ii. In engross income includes: salary,wages,commissions,fees,tips, overtime pay,unemployment compensation,public assistance money, alimony and child support payments, Social Security benefits,VA benefits, Supplemental Security Income(SSI)benefits,retirement&pension payments,worker's compensation,bonuses,prize winnings and other sources of cash income except those specifically excluded. B. Sources 1. Sources of income verification may include,but are not limited to: a. Current pay stub b. Self-employment accounting records c. Letter documenting current employment and wages from employer d. Recent income tax return e. Unemployment or workers compensation receipt f. Public assistance letter g. Prior income verification through enrollment in other Health Department programs 2. If an individual claims"no income"(except for minors consenting to specific services under G.S. 90-21.5), a signed"Verification of Income and/or Residency" form(Attachment A)indicating financial support from another party must be submitted. 3. Failure to provide verification within 30 days or less of date of service will result in charges being assessed at 100%of sliding fee scale. The client will receive notification of required income verification at the time the initial appointment is made. 4. The client must read, sign and understand the"Determination of Eligibility Payment Plan for Clinical Services"and"Statement of Financial Responsibility Payment Plan"form(Attachment B)at their initial visit and annual financial reviews. C. Environmental Health Persons seeking Environmental Health services must obtain and properly complete an application for service and pay the corresponding fee for service(all applicants pay at the 100%pay status)before an appointment for a field visit will be scheduled. Sometimes Page 2 of 8 Original Effective Date:January 25,2001 Revision Dates:, 4/2016,9/2018,10/2019,10/2020 ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy B: Fee and Eligibility Policy Reviewed by: Financial Review Committee,Health Director Approved by: Board of Health,Health Director additional fees may be necessary if during service delivery it is determined that the correct fees were not initially paid, or services requested are more than applied for. Wastewater Treatment Management Program(WTMP)and Mobile Home Park fees are the only Environmental Health services invoiced after the inspection. These inspections are not application based but occur on a regulated,recurring schedule. IV. Residency Requirements A. Any individual,Orange County resident or non-resident,may be eligible for services provided by the Health Department. Exceptions include non-STD Communicable Disease cases, designated Family Home Visiting programs (Orange County residents only), and when prohibited by law or regulation. B. Proof of Residency may be determined b, u�the US Postal and/or Orange County GIS website and one of the following: Driver's License, Government-issued identification,Pay Stub (Within the last 30 days),Utility bill(Within the last 45 days); Current rental or lease agreement; Personal or property tax bill; Student identification, and Matricula Consular(Mexican ID Card'). Clients without one of the above identifying information sources but reportedly living within the county will be required to produce a written statement or letter from the head of household,verifying that the person resides in their home. Special cases will be referred to the Clinic Manager or Supervisor. Failure to provide proof of residency may result in referral to another resource. C. Proof of Residency in Orange County is required for self-pay patients to be eligible for the sliding fee scale when requesting Maternal Health,Child Health,Primary Care, Nutrition Services,and Dental Health Services. Out-of-county residents will be assessed at 100%of charges not covered by a third party payer source. V. Service Limitation/Denial A. Services will not be denied based solely on the inability to pay,with the exception of those services that require a flat or minimum fee. Emergency dental services and urgent primary care services will be provided to clients regardless of any outstanding balance due. B. Otherwise, services may be denied if the department does not have the resources needed to provide a quality non-mandated service or the individual does not meet the residency or financial requirement. 1 The Matricula Consular de Alta Seguridad(MCAS)(Consular Identification Card)is an identification card issued by the Government of Mexico through its consulate offices to Mexican nationals residing outside of Mexico.Retrieved from hiip:Hen.wikipedia.org/wiki/Matr%C3%ADcula_Consular on October 14,2012. Page 3 of 8 Original Effective Date:January 25,2001 Revision Dates:, 4/2016,9/2018,10/2019,10/2020 ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy B: Fee and Eligibility Policy Reviewed by: Financial Review Committee,Health Director Approved by: Board of Health,Health Director C. Family Planning,Maternal Health, and Child Health clients will never be refused service or be subject to variations in service due to an outstanding balance or inability to provide proof of income. Health Department clients are eligible to receive these services regardless of their participation in other programs. Family Planning,Maternal Health, and Child Health services are voluntary to all clients. D. Falsification of eligibility by the client may result in denial or limitation of services. E. The Health Department shall not deny a service due to religion,race,national origin, creed, sex,marital status,familial status, sexual orientation,veteran status or age. F. The Health Department shall assure that no otherwise qualified handicapped individual, solely by reason of his/her handicap,be excluded from participation in,be denied the benefits of, or be subjected to discrimination under any program or activity covered by this agreement. G. The Health Director can override any decision to deny or limit services to a client in accordance with the existing fee waiver process. VI. Fees for Services A. In order to facilitate early entry into prenatal care or family planning services,pregnancy test charges will be adjusted to 0%on the sliding fee unless they are required as part of another service. B. Fees are not charged to self-pay clients for diagnosis and treatment of sexually transmitted diseases,or investigation and control of communicable diseases. There is also no charge to clients for any State-provided vaccine. C. Fees are charged for health and dental services provided to individuals unless prohibited by law or regulation. Fees are established based upon cost analysis,Medicaid and Medicare rates, comparable provider rates and/or state or contractual agreements. The Health Director shall inform the Board of Health and the Orange County Board of Commissioners of these adjustments in a timely manner. D. Fees may be charged to clients for"non-program" specific services without being adjusted on a sliding fee scale(flat fees). E. Fees may be charged for education,community-based limited clinical services (such as influenza shots)and screening services provided to individuals or groups. The following applies to these services: Page 4 of 8 Original Effective Date:January 25,2001 Revision Dates:, 4/2016,9/2018,10/2019,10/2020 ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy B: Fee and Eligibility Policy Reviewed by: Financial Review Committee,Health Director Approved by: Board of Health,Health Director 1. They include orientation, field training,dental screening and education, and/or other health promotion activities such as infant and toddler car seats,bike helmets, or equipment rental. 2. The Health Director will negotiate fees for services where fees have not been previously determined. 3. Income eligibility requirements do not apply to these services. F. Per NC General Statute Chapter 713, Subchapter 4,Article 35,and confidentiality regulations, emancipated minors and other individuals requesting confidential services will be considered a family of one for determination of charges. Private insurance will also not be billed for minors receiving services for which they can consent unless permission is received from the minor. G. Persons requesting any program services may be encouraged to apply for Medicaid, as applicable. H. The Personal Health Services Division clinical and nutrition services will use the appropriate sliding fee schedule for services when adjustable fees are allowed; all other fees will be charged at 100%. 1. Clients,who require services provided on the sliding fee schedule, are expected to pay the appropriate fee in full based on sliding fee guidelines. 2. This schedule will require assessment of the client's financial status on an annual basis or when a financial status change occurs, as specified in section III. I. Dental Health Services,Primary Care Services,and Nutrition Services will use a sliding fee schedule for all services,with a minimum charge to be established at the annual fee review during the budget preparation process. 1. The minimum charge for dental,primary care,and nutrition services will apply regardless of the determination of the client's financial status. 2. If a client is determined to fall at the 0%pay level,the minimum charge will be the only charge levied and collected unless the client is deemed homeless. 3. Minimum charge is due at time of service. J. Fee schedules will be reviewed annually during the budget process and adjusted as appropriate; a complete cost analysis for purposes of fee adjustments will be performed every five years. The process for this cost analysis includes a review of the following elements: a. Most recent vaccine and drug purchase costs b. Most recent lab pricing lists c. Most recent Medicaid Cost Settlement data for procedure costs d. Environmental Health equipment, labor, and staff costs e. Review of fee schedules of surrounding jurisdictions £ Analysis of existing self-pay client base and how increased costs would affect their ability to get necessary care Page 5 of 8 Original Effective Date:January 25,2001 Revision Dates:, 4/2016,9/2018,10/2019,10/2020 ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy B: Fee and Eligibility Policy Reviewed by: Financial Review Committee,Health Director Approved by: Board of Health,Health Director K. Based on G.S. 130A-41,the Health Director is authorized to enter into contracts,which may include negotiated reimbursement rates. L. The Health Director may not make exceptions to the Fee Policy except to accommodate specific situations through the fee waiver process(Attachment Q. M. Any minimum administrative fee or flat fees shall be applied without discrimination to all patients. N. There will be no"schedule of donations",bills for donations, or any other implied coercion for donations from clients as a condition for being seen at the Health Department. Donations to the health department can be made through the Orange County Community Giving Fund. Fees for services will not be waived because of client donations. O. 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. VII. Fee Collection A. Environmental Health service fees are paid before an appointment is scheduled. Field staff cannot accept fees in the field. B. Fees collected from Medicaid and Medicare and other third party insurance for a covered service, combined with payment of any applicable co-pays and co-insurance, constitutes full payment for that service. C. A co-payment, deductible,or balance of charge can be collected at the time of service from individuals covered by other third party insurance plans when OCHD is a member of their provider panel(exception family planning). For Family Planning clients, family income should be assessed before determining whether co-payments or additional fees are charged; if their family income is verified to be at or below 250%FPL,they should not pay more (in copayments or additional fees)than what they would otherwise pay when the schedule of discounts is applied.With regard to other insured clients,payments towards a deductible for clients whose family income is verified to be at or below 250% FPL should have the appropriate sliding fee schedule applied. D. If OCHD is not on the insurance provider panel,the client will be charged for the service(s)based on the Health Department's fee schedule. The client will be provided with documentation of services for submission of a claim to their insurance company. E. After charges are processed,the client will be given a statement showing the cost of services for that visit as well as their total account balance upon request. F. Payment is due at the time services are rendered. Page 6 of 8 Original Effective Date:January 25,2001 Revision Dates:, 4/2016,9/2018,10/2019,10/2020 ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy B: Fee and Eligibility Policy Reviewed by: Financial Review Committee,Health Director Approved by: Board of Health,Health Director G. When the client is unable to pay in full at the time services are rendered,a payment plan is established, and the client must sign a"Payment Agreement Form"(Attachment D) except for minimum-fee or flat-fee charges. Client must then make a payment in any amount in order to activate the payment plan. H. When a client requests"no mail", discussion of payment of outstanding debt shall occur at the time the service is rendered. A remark regarding"no mail"is entered into the medical data system. No letters or other correspondence concerning insurance or past due accounts will be sent to any client that requests"no mail". Reasonable efforts will be made to collect charges without jeopardizing client confidentiality. I. The Billing Cycle for the Health Department(by Division)is as follows: 1. Personal Health Division a. Billing statements will be sent no more than three days after charges post to client ledger. Statements will be sent to clients for the next two consecutive months for balances due. After three consecutive months with a past due balance,accounts will be forwarded to the County Attorney Office and pursued through debt set-off in accordance with the county policy. Accounts with a balance of less than$50 will remain delinquent until paid or written-off. 2. Dental Health Divisions a. Bill statements will be sent monthly by the tenth of the month for two months after services have been rendered indicating a statement of balance due. Every quarter, all accounts with a balance$50 or more that are more than 60 days past due will be forwarded to the County Attorney Office and pursued through debt set-off in accordance with the county policy. Accounts with a balance of less than $50 will remain delinquent until paid or written-off. b. If a debt is not paid,when the client attempts to make another appointment,the client will be told they have a previous balance, and they must have an active payment plan or make a payment at time of next service except for Family Planning clients. 3. Environmental Health Division a. An initial invoice for additional or miscellaneous Wastewater Treatment Management Program(WTMP) charges is mailed with the inspection form. b. If no payment is received within 90 days, a second notice is mailed. c. If no payment is received after an additional 30 days and the debt is $50 or greater,the account is forwarded to the County Attorney's Office,which will pursue it through the county's debt set-off procedure. d. Debt owed by a corporation or non-individual is dissolved upon sale of property. e. The county attorney's office has deemed debt that becomes part of an estate will become dissolved. f. If the client presents and voluntarily wishes to pay on the account, any amount the client offers will be accepted, documented in the client file, and a receipt will be provided. Page 7 of 8 Original Effective Date:January 25,2001 Revision Dates:, 4/2016,9/2018,10/2019,10/2020 ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy B: Fee and Eligibility Policy Reviewed by: Financial Review Committee,Health Director Approved by: Board of Health,Health Director g. Mobile Home Parks are billed annually on the calendar year. The procedure is the same as noted above. J. Insurance and Third Party Billing 1. Where a third party is responsible,bills are to be submitted to that parry; 2. Third parties authorized or legally obligated to pay for clients at or below 100%FPL are properly billed. 3. Third parry bills(including Medicaid) show total charges without any discounts unless there is a contracted reimbursement rate that must be billed per the third party agreement. 4. The health department will bill insurance and managed care organizations for which provider approval has been established. The patient will be responsible for all deductibles, coinsurance and non-covered charges. 5. Patient or parent/guardian signature is required to give authorization to file claims and provide necessary information to the insurance company(Attachment E). 6. Patients, or the accompanying parent/guardian of an un-emancipated minor with appropriate insurance benefits,who receive public health services will be given the opportunity to choose whether to have insurance filed in order to avoid breach of confidentiality or pay the associated fee according to where the patient falls on the sliding fee scale. VIII. Review and Approval A. This Policy shall be reviewed annually by members of the Financial Review Committee. The committee shall have representatives from each division, and must also include the Health Department's Finance and Administrative Services Director B. Any policy revisions must be approved by the Health Director and the Board of Health. Page 8 of 8 Original Effective Date:January 25,2001 Revision Dates:, 4/2016,9/2018,10/2019,10/2020 ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section I: Board Adopted Policies Policy A: Requests for Environmental Services and Assessments Reviewed By: Board of Health&Health Director&Environmental Health Division Director Approved By: Board of Health Policy I.A. This policy covers processing and budgetary considerations regarding requests from citizens and communities for environmental services and assessments to determine whether environmental contaminants are present, environmental degradation has occurred or for the applicant's information for future reference. Purpose: The purpose of this policy is to determine when environmental services, surveys or assessments will be conducted and also to set forth the funding mechanisms for those actions. Also covered within the policy scope are the decision tree for when community assessments will be considered and the ensuing financial responsibilities for those expanded efforts. This policy is not intended to cover nor does it cover applications, inspections, approvals or other processes for regulatory programs generally administered in the Environmental Health Services Division. Section I Policy Overview 1.0 Environmental Health routinely receives concerns and queries from Orange County residents regarding environmental investigations to determine whether an environmental exposure exists and also whether unusual disease prevalence is occurring. These requests may arise from an individual or from communities. This policy addresses general and specific practices for these requests and assigns responsibilities for their dispensation. Section II Individual Requests 1.0 Individual residents may request services and environmental assessments for their property, whether owned outright, leased, rented, or otherwise legally occupied. These services include septic inspections, water samples, indoor air quality(IAQ) assessments, vector control inspections, single disease case investigations, or other services germane to current or future environmental health programs. Section III Community or Collective Requests 1.0 The following types of community or collective studies and assessments will be considered and acted upon by staff with the appropriate approval(s) when environmental conditions are suspected as a causative factor: 1.1 Acute and Chronic Disease a. Airborne, vector-borne and waterborne diseases are environmentally related in their transmissions and may affect a community as a whole. Chronic diseases such as asthma and cancer can have causative factors Review Annually(July) Pagel of 4 Original Effective Date: August 24,2006 Revision Dates: 11/2013,11/2014,8/2015,10/2019,8/2020 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\I.A.Environmental Assessment Policy BOH Manual August 2019.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section I: Board Adopted Policies Policy A: Requests for Environmental Services and Assessments Reviewed By: Board of Health&Health Director&Environmental Health Division Director Approved By: Board of Health related to environmental conditions and exposures. The investigation of acute and chronic diseases would be indicated with confirmed cases of those diseases in rates extraordinary to baseline rates for Orange County or statistically expected rates for that community. Investigations will be carried out in accordance with best epidemiological practices established by the EPI Team* in each community or collective request. b. OCHD will conduct community studies for acute and chronic diseases suspected of originating from environmental exposures and for wells and septic systems failures when data or reports indicate that study beyond the individual level is needed to confirm or deny multiple sources of contamination leading to acute and/or chronic disease under investigation. 1.2 Wastewater and Well Water Studies a. Community studies will be considered and acted on or deferred by OCHD based on several risk factors and other defined considerations. Those include the following: 1. The study area consists of more than 5 households. 2. Known disease-causing environmental contamination (chemical releases, improper biosolids applications, underground storage tanks,junkyards, etc.)that could adversely affect a natural resource (groundwater, stream, etc.) or negatively impact more than a single property in that community. 3. Known geophysical conditions (e.g.,underlying rock structure that might lead to high levels of natural radon release, severe disturbances of the underlying structure)with a scientifically documented negative environmental impact potential that could affect the intended use and sustainability of property in the community. 4. More than 30% of the individual wells in a given geographical community were drilled prior to 1981 or more than 30% of the septic systems in the community are more than 20 years old. 5. Protection of water supply resources (protected water supply watersheds, water quality critical areas, wellhead protection areas, etc.). b. Statistical Studies may be considered in order to gain important information about septic system failure rates or groundwater quality or quantity characteristics. Examples in this category might include: Review Annually(July) Page 2 of 4 Original Effective Date: August 24,2006 Revision Dates: 11/2013,11/2014,8/2015,10/2019,8/2020 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\I.A.Environmental Assessment Policy BOH Manual August 2019.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section I: Board Adopted Policies Policy A: Requests for Environmental Services and Assessments Reviewed By: Board of Health&Health Director&Environmental Health Division Director Approved By: Board of Health 1. comparing septic system failure rates in mobile home parks with those of neighborhoods with stick built construction; 2. examining the existing data for septic system repairs to identify common characteristics of failed systems; 3. studying the effect of water softener systems on septic system failures; 4. exploring the relationship between well water quality and the age of the well, length of casing, landscape position, etc. 5. gathering baseline water quality data and tracking water quality over time in a defined geographical study area near a suspected environmental hazard(such as a biosolid application site) Section IV Funding 1.0 Individual Requests: The cost recovery for individual testing and assessments will come from fees for service administered according to the Environmental Health Division's Fee and Application Policy and from the fee schedule approved by the Board of Health and the Board of County Commissioners. In the case of an individual disease investigation that is a direct follow-up to an outbreak, the individual charge is waived. 2.0 Community Surveys: The direct operational costs for materials needed for community related surveys, assessments and other studies will be paid for by Orange County as specified in Section V of this policy if: a. surveillance data or other confirmed and documented medical or scientific reports indicate a potentially environmentally caused or transmitted disease prevalence at abnormal levels in that community, or b. at least three of the five items in Section III. 1.2a are met. 3.0 Studies requested by other governmental agencies will be evaluated by the Health Director and County Manager as appropriate. Section V Community Study Funding Approvals 1.0 When estimated operational costs are less than or equal to $250, the Orange County Health Director will approve or deny the study and the study will be funded through the Environmental Health Services budget. 2.0 When estimated operational costs are greater than $250 but less than or equal to $2,500, the Orange County Health Director will approve or deny the study based on current availability of budgetary and staff resources and present it to the Orange County Board of Health for final decision. The Health Director will determine the specific funding source for an approved study. Review Annually(July) Page 3 of 4 Original Effective Date: August 24,2006 Revision Dates: 11/2013,11/2014,8/2015,10/2019,8/2020 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\I.A.Environmental Assessment Policy BOH Manual August 2019.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section I: Board Adopted Policies Policy A: Requests for Environmental Services and Assessments Reviewed By: Board of Health&Health Director&Environmental Health Division Director Approved By: Board of Health 3.0 When estimated operational costs are greater than $2,500, or if the budgetary and staff resource needs are greater than available in the Health Department budget, the Orange County Health Director will recommend to approve or deny the study and present the recommendation to the Orange County Board of Health for consideration. The Board of Health's recommendation will be presented to the Orange County Board of County Commissioners for final decision and funding source identification if approved. *The EPI Team is the interdisciplinary health department staff team that is responsible for all outbreak investigations. Review Annually(July) Page 4 of 4 Original Effective Date: August 24,2006 Revision Dates: 11/2013,11/2014,8/2015,10/2019,8/2020 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\I.A.Environmental Assessment Policy BOH Manual August 2019.doc Confidentiality& Conflict of Interest Statement For New Board of Health Member Board Adopted Policy I.C. Appendix A Confidentiality In connection with my responsibilities as a member of the Orange County Board of Health, I agree to treat all information concerning health department clients,personnel, and financial matters in a confidential manner as required by state and federal statute and will not divulge this information to unauthorized personnel or the public. I understand that if I wrongfully and/or willfully disclose such information, I may be subject to removal from the Orange County Board of Health. Conflict of Interest 1. Each board member,upon accepting a seat on the board, agrees in writing by signing below, to carefully guard against any conflict of interest that might develop between his or her personal interest and that of the Orange County Health Department. 2. If an issue arises in which a member of the board has a conflict of interest, the member shall promptly disclose the conflict to the Chair of the Board prior to consideration of the issue by the board. 3. In matters involving a conflict of interest, a board member must state the reason for which they reasonably think a conflict exists and the board member shall not vote on such policies or transactions unless requested by the board. 4. The abstention and the reason for it shall be recorded in the minutes. 5. A board member may not directly or indirectly benefit except as provided for as members of the board of directors, from the county's disbursement of funds. 6. Violation of this policy shall be grounds for recommending dismissal of a board member. The Board of Health will forward recommendation for dismissal to the Board of County Commissioners for action. I have read and understand the confidentiality and conflict of interest statements. I agree to abide by these policies. Board Member Signature Date Board Member Name (Printed) Staff initials Date S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\I.C.Appendix A_Confidentiality and Conflict of Interest Statement.doc Document History: Original 1998; Revised 10/24/2007, 10/8/2014, 10/2019,8/2020 ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section I: Board Adopted Policies Policy C: Community Assessment Policy Reviewed by: Board of Health Approved by: Board of Health,Health Director Policy I.C. This policy establishes that the Orange County Health Department will complete a Community Health Assessment(CHA) every four years that ensures community input and a State of the County Health(SOTCH)report in the interim years between assessments, according to guidelines published by the North Carolina Division of Public Health. Purpose The purpose of this policy is to provide guidelines for the development of the CHA and SOTCH report and to ensure that these are collaborative efforts that include input from community members, county agencies and organizations, the Board of Health and other county stakeholders. Delegation The development and implementation of procedures for the CHA and SOTCH reports are delegated to the Division of Health Promotion and Education Services through the Health Director. Procedures 1. Community Health Assessment process procedures: a. This process will be coordinated through the Health Promotion and Education Division every four years. b. Health education staff will recruit a diverse group of partners to form a CHA team. Partners that will be approached about serving on this team include representatives from but not limited to the following: i. Various ethnic and cultural backgrounds (Hispanic,Native American, etc.) ii. Economic development and industry iii. Educational systems iv. Human service agencies V. Organizations that serve children through senior adults Vi. Law enforcement vii. Community-based organizing groups viii. And others as identified. c. As funding is available, the Department will contract with an educational institution or consultant to facilitate the team in the collection, analysis, and reporting of the primary and secondary data. Review Annually(July) Page 1 of 4 Original Effective Date: February 28,2008 Revision Dates:10/15/12,11/2013,11/2014,8/2015,10/2019,8/2020 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\I.C.Community Assessment Policy August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section I: Board Adopted Policies Policy C: Community Assessment Policy Reviewed by: Board of Health Approved by: Board of Health,Health Director d. The Community Health Assessment Guide Book available on the North Carolina Division of Public Health website will be used as a resource document or toolkit throughout the community health assessment process. This book will guide the team on the various components (i.e. demographics, economic factors, health needs, etc.)that need to be included in this process and the final document. e. Primary data will be collected from community members, clients receiving direct services from the health department, the Board of Health and other county stakeholders through their participation in written surveys, focus groups, or interviews. f. Secondary data will be obtained from the North Carolina State Center for Health Statistics (NC SCHS) and other resources identified and available to CHA team members. g. CHA team members, OCHD staff, and community volunteers will assist with the collection of primary and secondary data. h. Primary and secondary data collected should be disaggregated by race, ethnicity, gender, sexual identity, etc. when possible to account for racial and health disparities among marginalized groups. i. The CHA team will collaborate with county stakeholders to prioritize health concerns according to the primary and secondary data collected. The CHA team will reference the CHA Guidebook for guidance on reporting data findings and involving community members, the Board of Health and other county stakeholders in the process to establish health priorities for the county. j. Designated members of the CHA team will summarize the data and priority health topics to produce a document to report the community health assessment process and its findings. k. The CHA document will be submitted to the North Carolina Division of Public Health by first Monday in March following the year of assessment and will be disseminated to community and county stakeholders as specified in the North Carolina Local Health Department Accreditation Standards. This may include electronically via the department's website as well as presentations of findings and copies of reports to partner agencies and community organizations for public access. Review Annually(July) Page 2 of 4 Original Effective Date: February 28,2008 Revision Dates:10/15/12,11/2013,11/2014,8/2015,10/2019,8/2020 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\I.C.Community Assessment Policy August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section I: Board Adopted Policies Policy C: Community Assessment Policy Reviewed by: Board of Health Approved by: Board of Health,Health Director 1. The CHA document will be used by the Orange County Health Department in the development of the department-wide strategic plan, grant writing, program planning and advocacy for funding. This document will be available as a resource for other individuals, agencies, and organizations. m. Using the CHA, Health Promotion and Education staff and the CHA team will create Community Health Action Plans to describe plans for health activities to be carried out in the county. The Community Health Action Plan form is due the first Monday in September following the year of assessment. The form is available through the NC Division of Public Health website. 2. State of the County Health(SOTCH)report process procedures: a. The SOTCH report will primarily be produced by the Department's Health Promotion and Education staff in the interim years between community health assessments. b. This report will include: i. A review of major morbidity and mortality data for the county ii. A review of health concerns selected as priorities iii. Progress made in the last year on these priorities iv. A review of any changes in the data that guided the selection of these priorities v. Other changes in the county that affect health concerns (such as economic or political changes, new funds or grants available to address health problems, etc.) vi. New and emerging issues that affect health status vii. A review of disaggregated data by race, ethnicity, gender, sexual identity, etc. to account for health disparities in the county among marginalized groups. viii. Methods of direct community involvement with ongoing efforts c. The primary source of data for this report will be the NC SCHS website. d. The SOTCH report will be submitted to the state by the first Monday in March during the years a CHA is not submitted and will be disseminated to the community and county stakeholders according to North Carolina Local Health Department Accreditation Standards. Review Annually(July) Page 3 of 4 Original Effective Date: February 28,2008 Revision Dates:10/15/12,11/2013,11/2014,8/2015,10/2019,8/2020 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\I.C.Community Assessment Policy August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section I: Board Adopted Policies Policy C: Community Assessment Policy Reviewed by: Board of Health Approved by: Board of Health,Health Director References: Community Health Assessment Guidebook online at: https://publichealth.nc.gov/lhd/docs/cha/Archived-CHA-Guidebook.pdf Community Health Action Plan Form online at: https://publichealth.nc.gov/lhd/docs/cha/Product-CommunityActionPlanForm-Au 2g 016.pdf Community Health Assessment, SOTCH, and Accreditation Related Information: https://publichealth.nc.gov/lhd/index.htm Review Annually(July) Page 4 of 4 Original Effective Date: February 28,2008 Revision Dates:10/15/12,11/2013,11/2014,8/2015,10/2019,8/2020 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\I.C.Community Assessment Policy August 2020.doc Board of Health P&P Manual,Section I Policy E,Attachment A VERIFICACION DE INGRESO Y/O RESIDENCIA A Quien Concierna: El Departamento de Salud del Condado de Orange esta intentando determinar la elegibilidad de para los servicios solicitados en nuestra agencia. INGRESO (Si esta marcado, se necesita verificacion del ingreso) Nuestra politica es cobrar los honorarios en base al ingreso y a la cantidad de personas en el hogar. La persona nombrada arriba informa que el/ella y su familia no tienen ningun ingreso y no reciben Medicaid o asistencia publica. informa que el/ella esta recibiendo ayuda financiera de usted. Por favor verifique aqui abajo la cantidad de apoyo financiero que usted le da mensualmente a esta persona y firme su nombre al final del formulario. $ por (elija uno) semana quincena mes RESIDENCIA (Si esta marcado, se necesita verificacion del lugar de residencia) informa que el/ella y su familia viven en la direccion anotada abajo. Antes de poder determinar elegibilidad para nuestros servicios, necesitamos que una tercera persona confirme esta informacion. Al firmar este formulario usted esta indicando que, a su entender, esta persona/familia vive en esta direccion en el condado de Calle/Apartamento Ciudad Estado Codigo Postal Firme Su Nombre Fecha Escriba Su Nombre en Letra de Imprenta Gracias por esta informacion. Esto nos ayudara a determinar como podemos brindar un mejor servicio a esta persona. Firma del Asistente de Oficina Fecha Firma del Interprete Fecha S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.E.Attachment A-Income& Resid Verification-Nov 2014-Spanish.doc Updated 11/2014 919 24S 2400 1 300 West Tryon Street ) Hillsborough, NC 27278 1 orangecountync.gov Board of Health P&P Manual, Section I Policy E,Attachment A VERIFICATION OF INCOME AND/OR RESIDENCY To Whom It May Concern: The Orange County Health Department is trying to determine the eligibility of for services requested at our agency. INCOME ( Check if required to provide) It is our policy to charge fees based on the income and household size. The above named person reports that he/she and his/her family has no income and does not receive Medicaid or public assistance. reports that he/she receives financial support from you. Please verify below the amount of monthly support that you currently give to this person and sign your name at the bottom of the form. $ per (check) _week _bi-weekly _month RESIDENCY Check if required to provide) reports that he/she and his/her family live at the address listed below. Before we can determine eligibility,we need a third party to confirm this information. By signing this form, you are saying that, to the best of your knowledge, this person/family lives at this address in County. Street/Apt City State Zip Sign Your Name Date Print Your Name Thank you for this information. This will help us determine how we can best serve this person. Office Assistant Signature Date Interpreter Signature Date S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.E. Attachment A-Income&Resid Verification.docx Updated 11/2014 919 245 2400 ) 300 West Tryon Street ) Hillsborough, NC 27278 ) orangecountync.gov Board of Health P&P Manual, Section I Policy E,Attachment B DETERMINATION OF ELIGIBILITY FOR CLINICAL SERVICES The Orange County Health Department, following approved policy and procedures,has determined that (Client Name) is eligible for [circle] Medical/Dental services and will be charged percent(%)of the total fees,based on the number of people living in the home and the total amount of gross income in the home. STATEMENT OF FINANCIAL RESPONSIBILITY I understand that I am responsible for all fees involved in receiving services at the Orange Initial County Health Department(as stated above) I understand that I am required to provide income verification to be eligible for the Initial sliding fee scale. If I do not provide income verification in the next 10 business days (by ),any services I receive that are not covered by insurance,with the exception of Family Planning services,will be billed at 100% on the sliding fee scale. I understand that if I report that I am pending Medicaid eligibility,but I do not follow- Initial through with the Medicaid application or do not receive coverage,I will be responsible for all charges based on the sliding fee scale determination. I understand that payment is due at the time services are provided. I further understand Initial that, if circumstances do not allow full payment on the day of service, a payment plan will be established. I understand I will receive a statement and an overdue notice for balances older than 30 Initial days that are equal to or greater than$50.00. 1 also understand that if I do not submit payment in full or honor a monthly payment plan within 30 days of that statement date; my account will be sent to the Orange County attorney for debt setoff. I understand that if I do not make a"good faith"effort to pay on any past bills due, future Initial services may be limited or denied. However, emergency services will not be denied. I understand I must notify the clinic as soon as possible if I cannot keep my appointment. Medical Clinics: 919-245-2400 Dental Clinic: 919-245-2435 Signature of Client/Responsible Party Date Signature of Interpreter Date Signature of OCHD Employee Date Updated 11/2014,4/2017 S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.E.Attachment B-Eligibility&Finan Resp(4-2017)docx.docx Board of Health P&P Manual, Section I Policy E,Attachment B DETERMINACION DE ELEGIBILIDAD PARA LOS SERVICIOS DE LA CLINICA El Departamento de Salud del Condado de Orange, siguiendo las politicas y los procedimientos aprobados,ha determinado que (Hombre del ClientelClientName) es elegible para servicios [circule uno/circle] Medicos/Dentales, y se le cobrara por ciento(%)de la tarifa total,basado en la cantidad de personas que viven en el hogar y la cantidad total del ingreso bruto en el hogar. DECLARACION DE RESPONSABILIDAD FINANCIERA Entiendo que soy responsable de todos los cargos incurridos al recibir servicios en el Iniciales Departamento de Salud del Condado de Orange(segun to indicado arriba) Entiendo que para ser elegible a la escala movil de tarifa, es necesario que proporcione Iniciales verificacion del ingreso. De no proporcionar la verificaci6n del ingreso en los proximos 10 dias habiles(a mas tardar el ),todos los servicios recibidos, que no esten cubiertos por un seguro,con excepcion de los servicios de Planificacion Familiar, seran facturados al 100%en la escala movil de tarifas. Entiendo que si indico que estoy pendiente para elegibilidad de Medicaid,pero no Iniciales completo el proceso de aplicacion para Medicaid o no recibo la cobertura,yo sere responsable de todos los cargos basado en to determinado en la escala movil de tarifas. Entiendo que los pagos son requeridos al momento de recibir los servicios. Ademas Iniciales entiendo que, si por alguna circunstancia no puedo hacer el pago completo el dia de los servicios,un plan de pago sera establecido. Entiendo que para saldos de $50.00 o mas,recibire un estado de cuenta y una notificaci6n Iniciales de pago atrasado para los saldos de mas de 30 dias. Ademas entiendo que si no hago el pago en su totalidad o no cumplo con un plan de pago mensual dentro de 30 dias de la fecha del estado de cuenta;mi cuenta sera enviada al abogado del Condado de Orange para la compensacion de la deuda. Entiendo que si no hago un esfuerzo de"buena fe"para hacer pagos en cualquiera de mis Iniciales cuentas pendientes,los servicios futuros podrian ser limitados o negados. Sin embargo, no se negaran los servicios de emergencia. Entiendo que debo notificar a la clinica to antes posible si no puedo asistir a mi cita. Clinicas Medicas: 919-245-2400 Clinica Dental: 919-245-2435 Linea Telefonica para dejar Mensajes en Espanol: 919-644-3350 Firma del Cliente/Persona Responsable Fecha Firma del Interprete Fecha Firma del Empleado del OCHD Fecha Updated 11/2014,4/2017 S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.E.Attachment B-Eligibility& Finan Resp(4-2017)-Spanish.docx Board of Health P&P Manual, Section I Policy E,Attachment C Request for Waiver of Certain Fees Orange County Health Department • The Health Department's Fee and Eligibility Policy states: "The Health Director may not make exceptions to the Fee Policy except to accommodate specific situations" Section IV N.•Fees for Services • It is recognized by OCHD that in certain rare or unusual situations, a client's health and/or safety may be severely impacted by the inability to pay the sliding scale co-pay for services, pharmaceuticals, etc. In such cases the p3=evi ler- supervisor may submit this request for a—one-time waiver of fee(s)toby the Division44ealth Director. The Division Director will obtain Health Director approval. If proven to be homeless, client will be eligible for waiver until financial status changes. • Complete the following information: Division requesting waiver: ❑ PHSD ❑ Dental ❑ HPES ❑ Environmental Health Information submitted by: Employee Name Date Submitted Client Information Name: DOB: Last First MI Address: Street City State Zip Code Medicaid Eligibility Status: ❑ N/A ❑ Applied ❑ Has Not Applied ❑ Pending ❑ Presumptive ❑ Does Not Qualify Sliding Fee Determination: % ❑ N/A Request for Waiver of Fee SAMANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.E.Attachment C-Fee Waiver Updated 05 2016.docx Updated 5/2016,8/2020 Board of Health P&P Manual, Section I Policy E,Attachment C Request for Waiver of Certain Fees Explain concisely the circumstances that you feel requires consideration of fee waiver, including the type of fee and what potential effect the lack of service would have on the client (Continued onBack) SAMANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.E.Attachment C-Fee Waiver Updated 05 2016.docx Updated 5/2016,8/2020 Board of Health P&P Manual, Section I Policy E,Attachment C Continuation of Narrative Reviewed by the Division Director: Signature Date Received by the Health Director: / / _ Fee Waiver: ❑ Approved ❑ Not Approved Health Director's Signature Date Health Director's Comments: and— the eriginal ; t r e,]t the is ]IiT,,, ,,e ,nt Coordinate ** **If thefee waiver is disapproved-, the lkalth Direetor shaU rettirn Mis form to the Risk th. a SAMANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.E.Attachment C-Fee Waiver Updated 05 2016.docx Updated 5/2016,8/2020 Board of Health P&P Manual,Section I Policy E,Attachment D PAYMENT AGREEMENT FORM In accordance with the policy of the Orange County Health Department, payment is due when service is provided. However, we realize that there are times when an individual does not have the total amount of money owed to the clinic, therefore, this written agreement is established as a method of adopting a payment plan for those patients who have an outstanding balance. Name Date of Birth Address I, , agree to establish a payment plan for my account and agree to the following: My account balance is $ I will pay the amount of$ on my bill. Monthly Weekly Bi-weekly I understand that I am responsible for any balance left owing if my insurance company should not pay the bill in full and that it will be based on my sliding fee scale status. Signature of Client Date Signature of OCHD Staff Date S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\2015 BOH P&P Manual\I.E. Attachment D-Prat Agreement.docx Original:2008 Revised:8/2013, 11/2014 919 245 2400 ) 300 West Tryon Street ) Hillsborough, NC 27278 1 orangecountync.gov Board of Health P&P Manual,Section I Policy E,Attachment D FORMULARIO DE ACUERDO DE PAGO De acuerdo con la politica del Departamento de Salud del Condado de Orange, el pago debe realizarse al momento de recibir los servicios. Sin embargo, sabemos que hay momentos en que la persona no tiene la cantidad total del dinero que adeuda a la clinica, por to tanto, se establece este acuerdo escrito como una manera de adoptar un plan de pago para los pacientes que tienen un balance pendiente. Nombre Fecha de Nacimiento Direcci6n Yo, , estoy de acuerdo con establecer un plan de pago para mi cuenta y acepto to siguiente: El balance de mi cuenta es $ Pagare a mi cuenta la cantidad de $ Mensualmente Semanalmente Quincenalmente Entiendo que soy responsable por cualquier balance que quede pendiente si mi compania de seguro no paga la cuenta en su totalidad y el balance se basara en mi posici6n (porcentaje) en la escala m6vil de tarifas. Firma del Cliente Fecha Firma del Interprete Fecha Firma del Empleado del OCHD Fecha S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\2015 BOH P&P Manual\I.E. Attachment D-Prat Agreement-Nov 2014-Spanish.docx Updated 11/2014 919 245 2400 ) 300 West Tryon Street ) Hillsborough, NC 27278 ) orangecountync.gov Board of Health P&P Manual,Section I Policy E,Attachment E Assignment of Benefits Client Name (Last,First,Middle Initial) Date of Birth(DOB) Insurance Provider Client's Insurance ID# Subscriber's Name Subscriber's DOB Policy# Subscriber's Address(If different from client) Subscriber's phone# I authorize Orange County Health Department to file insurance claims for services provided to me. These claims may be filed with Medicare,Medicaid,private insurance,or any other medical/dental plan. I understand that it is my responsibility to report any changes in insurance coverage. I understand that I am financially responsible for any amount not covered by insurance,unless otherwise stated in the provider agreement. I understand that any co-payment or deductible is due at the time that services are rendered. If insurance coverage is denied,I understand that I will be responsible for all charges for these services. I understand that I may be eligible for the sliding fee scale,based on residency and income, if I provide verification within 10 business days of being notified. I authorize the release of any medical or pertinent information necessary to obtain these benefits to my insurance carrier or any other medical entity for continued medical care. Please state any records you want excluded from information that may have to be released: Client Signature Date Interpreter Signature Date OCHD Employee Signature/Witness Date S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.E.Attachment E-Assign of Benefits.docx Updated 11/2014 919 245 2400 ) 300 West Tryon Street ) Hillsborough, NC 27278 1 orangecountync.gov Board of Health P&P Manual,Section I Policy E,Attachment E Asignacion de Beneficios Nombre del Cliente (apellido,nombre,inicial del segundo nombre) Fecha de Nacimiento Compaiiia de Seguro(aseguradora) #de identificacion del seguro del cliente Nombre del Subscriptor(persona que obtuvo la poliza) Fecha de Nacimiento Numero de Poliza del Subscriptor 1 - Direccion del Subscriptor(si es diferente de la del cliente) Telefono del Subscriptor Autorizo al Departamento de Salud del Condado de Orange a hacer los reclamos de seguro por los servicios que me fueron proveidos. Estos reclamos pueden ser realizados a Medicaid, Medicare, seguro privado, y cualquier otro plan medico o dental. Entiendo que es mi responsabilidad informar sobre cualquier cambio en mi cobertura de seguro. Entiendo que soy financieramente responsable de cualquier cantidad que no este cubierta por el seguro; a menos que este indicado de otra manera en el acuerdo con el proveedor. Entiendo que cualquier copago o deducible es adeudado al momento de recibir los servicios. Si la cobertura de seguros es denegada, entiendo que yo sere responsable de todos los cargos por estos servicios. Entiendo que, podria ser elegible para la escala movil de tarifa(basada en el lugar de residencia a ingresos) si proveo verificacion dentro de 10 dias habiles de esta notificacion. Autorizo que sea compartida cualquier informacion medica o la informacion pertinente necesaria para obtener estos beneficios, con mi proveedor de seguros, o con cualquier otra entidad medica para continuar el cuidado medico. Por favor indique cualquier expediente que usted quiera que sea excluido de la informacion que pudiera ser compartida: Firma de Autorizacion del Cliente Fecha Firma del Interprete Fecha Firma del Empleado del OCHD/Testigo Fecha S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.E.Attachment E- Assign of Benefits-Nov 2014-Spanish.doc Updated 11/2014 919 246 2400 ) 300 West Tryon Street ) Hillsborough, NC 27278 1 orangecountync.gov ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section II: Board Adopted Policies Policy II.A.: Board Review of Reports and Documents Reviewed by: Board of Health Approved by: Board of Health,Health Director Policy II.A. It shall be the policy of the Orange County Board of Health to provide input and guidance on the work of the Health Department as it affects the health and well-being of county residents by review of key documents. Purpose: The purpose of this policy is to ensure that the Board of Health provides guidance and input for community and departmental planning that affects the health and well being of county residents and to meet the requirements for program review as specified by law or regulation. Procedures: 1. The Board of Health will review the documents listed below and take appropriate action as described for each document. 2. A particular document or program may have differing review and adoption requirements. Annually, the Health Director and Division Directors will review program requirements and recommend changes to the reports or documents and actions required that are listed in this Section. a. Community Health Assessment: Policy 1.C.: Community Assessment Policy b. State of the County Health Report (SOTCH): Policy 1.C.: Community Assessment Policy c. Health Department Budget: The Board annually reviews and approves for forwarding to the Board of Commissioners, the proposed budget for the Health Department in accordance with the county adopted schedule for budget completion. The review and approval includes but is not limited to new position requests, capital requests, technology requests, fee schedules, and new program requests. d. Board of Health Strategic Plan: The Board of Health develops and adopts a strategic plan every four years to define the Board's policy and programmatic goals. These goals are shaped by the Community Health Assessment, available primary and secondary data, and available department resources. The Board adopts the plan and provides updates to the Board of Commissioners at joint meetings of the Board of Commissioners and Board of Health. e. Child Fatality Prevention Task Force Report: The Board of Health receives and forwards annually to the Board of Commissioners a report and recommendations for improvement from the Orange County combined Child Fatality Prevention Task Force and the Child Protection Task Force as required by state law. f. Fiscal Oversight: In order to exercise fiscal oversight, the Board receives quarterly financial summaries on revenues and expenditures by Division for the Health Department. Review Annually(July) Page 1 of 2 Original Effective Date: October 24,2007 Revision Dates:11/2013,11/2014,8/2015,10/2019 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\II.Board Review of Reports and Documents August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section II: Board Adopted Policies Policy II.A.: Board Review of Reports and Documents Reviewed by: Board of Health Approved by: Board of Health,Health Director g. Research Project Requests and Reports: The Board receives information on all research project requests that are made to the Health Department and on final reports as a result of research approved by the Health Director. Projects that are conducted by health department staff members require a written or oral report to be submitted to the Board of Health. h. Annual Communicable Disease Report: The Board receives an annual report on communicable disease activity. i. Annual Immigrant and Refu export: The Board receives an annual report on activities from the Immigrant and Refugee Section. j. Cardinal Innovations Healthcare Report: The Board receives an annual report on the use of county funds to support Cardinal programming in Orange County. Review Annually(July) Page 2 of 2 Original Effective Date: October 24,2007 Revision Dates:11/2013,11/2014,8/2015,10/2019 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\II.Board Review of Reports and Documents August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health Policy III. A. This policy covers the routine operations of the Board of Health. Operating,procedures documents processes the board follows to ensure local and state standards are met. Purpose To outline operating procedures for the Board of Health in accordance with pertinent state, local and federal requirements for the operation of the Board. I. Name and Office The name of this organization is the Orange County Board of Health(hereinafter "Board"). The principal office of the Board is located at 300 West Tryon Street, Hillsborough,NC 27278. II. Charge to the Board The Board is the primary policy-making, rule-making, and adjudicatory body(NCGS 130A-35 —Appendix A 130A-35) for the health department and is charged to protect and promote the public health of Orange County(NCGS 130A-39—Appendix B 130A-39). A. Policy-Making: All decisions related to changes in essential public health services or other changes in fundamental services and activities of the Department will be presented to the Board for final approval. Changes will be submitted by the Health Director. The Board delegates to the Health Director the responsibility for policies and procedures that relate to the operations of the Department. B. Rule-making: The Board shall exercise its authority when it sees fit to adopt public health rules. The Health Director and/or Department staff may from time to time propose rules and/or rule changes for the Board's consideration. C. Adjudication: The Board will hear appeals to the implementation or findings of public health rules adopted by the Board. III. Composition A. The composition of the Board of Health is governed by NCGS 130A-35(b)-(d) (Appendix A)which states the composition of the board shall reasonably reflect the population and makeup of the county. B. The Board of County Commissioners will appoint the members of the Board of Health. The Board of Health is composed of eleven(11)members: 1. A licensed physician 2. A licensed dentist 3. A licensed optometrist 4. A licensed veterinarian 5. A licensed pharmacist Review Annually(July) Page 1 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health 6. A registered nurse 7. A professional engineer 8. A county commissioner 9. Three representatives of the general public C. For purposes of Board composition, diversity includes, but is not limited to, professional experience, cultural and educational background, geography, age, gender, race and ethnicity. When assessing Board composition or identifying suitable candidates for appointment/re-appointment, the Board will consider candidates on merit and statutory requirement with consideration to the benefits of diversity. D. The Orange County Board of Health is committed to ensuring diversity among members and values the benefits that diversity brings. Diversity promotes the inclusion of different perspectives and ideas, mitigates against group think and ensures that the Board has the opportunity to benefit from a variety of skills, backgrounds, and experiences. E. The Board's commitment to diversity shows internal and external stakeholders that the organization emphasizes diverse constituencies and does not discriminate against minorities, thereby enhancing the Board's reputation with county government and residents. IV. New Board Member Tasks A. Each new Board of Health member must complete requirements prior to assuming their seat as an Orange County Board of Health member. These include completing a Confidentiality Agreement, Conflict of Interest statements, and the "Oath of Office" B. Each new Board of Health member must sign a Confidentiality Agreement and Conflict of Interest Statement (Appendix H)prior to attending their first meeting of the Board of Health. a. Members of the Orange County Board of Health agree to treat all information concerning health department clients, personnel, and financial matters in a confidential manner as required by state and federal statute and will not divulge this information to unauthorized personnel or the public. BOH members may be subject to removal from the Orange County Board of Health if they wrongfully and/or willfully disclose such information. b. Each board member agrees to carefully guard against any conflict of interest that might develop between his or her personal or professional interest and that of the Orange County Health Department. c. If an issue arises in which a member of the board has a conflict of interest, the member shall promptly disclose the conflict to the Chair of the Board prior to consideration of the issue by the board. Review Annually(July) Page 2 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health d. In matters involving a conflict of interest, a board member must state the reason for which they reasonably think a conflict exists and the board member shall not vote on such policies or transactions unless requested by the board. e. The abstention and the reason for it shall be recorded in the minutes. f. A board member may not directly or indirectly benefit except as provided for as members of the board of directors, from the county's disbursement of funds. g. Violation of this policy shall be grounds for recommending dismissal of a board member. The Board of Health will forward recommendation for dismissal to the Board of County Commissioners for action. C. The Oath of Office is administered to a new Board member by a notary public either at or before the first regular meeting of the Board of Health after the member's appointment by the Orange County Board of Commissioners. The oath may be administered with or without a Bible, Torah, Qu'ran, etc. The original of the signed and notarized oath is placed in the official health department file and a copy is provided to the Board member. The oath is as follows: a. " I, [name], do solemnly swear(or affirm) that I will support and maintain the Constitution and laws of the United States, and the Constitution and laws of North Carolina not inconsistent therewith, and that I will faithfully discharge the duties of my office as a member of the Orange County Board of Health, (so help me God). }NCGS 11-7.1} "I [name], do swear(or affirm) that I will well and truly execute the duties of the office of member of the Orange County Board of Health according to the best of my skill and ability, according to law, (so help me God). }NCGS 11.11} V. Terms of Office A. By NCGS 130A-35(c) (Appendix A), members shall serve three year terms and no member may serve more than three consecutive three-year terms unless the members is the only person residing in the county who represents one of the professions designated in the Composition section above. B. It is the policy of the Orange County Board of Health that members may serve three, consecutive three-year terms. Members appointed to fill unexpired terms are eligible to subsequently be appointed to three additional terms. VI. Resignation of Board Member from Current Term of Office A. In the event that a Board member resigns prior to the official end of his/her term of office, the Board member shall send a letter to the Secretary(Health Director) or the Board Chair with the date of his/her resignation. The Secretary will transmit the letter to the County Commissioners Clerk's Office and ask that Review Annually(July) Page 3 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health recruitment for the slot be activated. The Board shall be informed at the next regularly scheduled meeting of the Board. VII. Removal from the Board A. By majority vote of a quorum present at a regular or duly called meeting, the Board of Health may recommend to the Board of Commissioners that a member be removed for cause. Before recommending removal, the Board shall,by written notice, inform the member of the reasons for recommending removal with copies of this correspondence sent to all members. If the member desires a hearing on the recommendation for removal, then the member must submit a request for such a hearing in writing within ten days after receipt of the notice of recommendation for removal. The hearing shall be set within 30 days following receipt of the request for hearing. B. Causes for removal from the Board shall include but not be limited to: 1. Commission of a felony or other crime involving moral turpitude. 2. Conflict of interest violation of state law or of written"conflict of interest" policies adopted by the Board of Health. 3. Violation of a written policy adopted by the county board of commissioners. 4. Conduct that tends to bring the office into disrepute 5. Failure to maintain qualifications for appointment required under GS 130A- 35(g6) (Appendix A). 6. Unexcused non-attendance at three consecutive board meetings. The Board deems it essential to its ability to effectively and efficiently discharge its responsibilities that meetings are attended regularly. Quorum problems harm the ability to conduct public business and irregular and/or infrequent attendance results in inefficiency and uninformed voting. VIII. Compensation Members shall receive a per diem reimbursement for subsistence and travel as established by the Board of County Commissioners for each properly called and scheduled meeting of the Board of Health for attendance at official meetings and conferences. IX. Officers and Committees A. Chair and Vice-Chair The Board members shall select a Chair and Vice-Chair by majority vote each year at the last meeting of the calendar year. B. Secretary The Orange County Health Director shall serve as Secretary to the Board, but the Director is not a member of the Board. The Health Director may delegate the Review Annually(July) Page 4 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health duties of the secretary that are set forth in these operating procedures to an appropriate local health department employee. C. Committees The Board shall review the existing committee structure annually and make decisions regarding the number and types of standing committees. Board members are appointed to committees annually. Only Board members may serve as committee members of standing Board committees and the number of Board members on any single committee must be at least two members and may not exceed five members. All standing committees are subject to the North Carolina open meetings laws and shall comply with the provisions of those laws. The Board shall have the following standing committees: 1. Executive Committee To provide the structure for the work of the Board of Health and act as an advisor to the health director and senior management staff as needed. Chair and Vice-Chair are committee members. 2. Nominating and Operating Procedures Committee To develop and present an annual slate of officers for Board consideration, to oversee the board recruitment process, and to recommend operating procedure changes as needed. Members are appointed by the Chair on an ad hoc basis. i. The Nominating and Operating Procedures Committee of the Board of Health is delegated to carry out recruitment for vacant slots on the Board of Health. In order to meet a timely transition the process should begin four months prior to expiration of term. The procedure is as follows: For representatives of professional slots: a. Recommendations for replacements may be solicited from the "retiring"Board member. Applicants must apply through the County Commissioner's Clerk's Office. b. If there are no suitable applicants in the current database, mailing list/labels from appropriate licensing board or association may be obtained. c. If a list is used to solicit suitable applicants, a recruitment letter is prepared by the Health Director for Committee approval. Recruitment letter is signed by current board chair and current board member occupying the slot or nominating committee chair. d. Applicants send applications to Clerk's Office. Application period open until filled. Committee reviews Review Annually(July) Page 5 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health applications no sooner than 15 working days after mailing of letter. e. Nominating Committee may add current professional representative, related division director, and health director to review applications, apply criteria, and may choose to interview top two or three applicants. At a minimum, committee interviews top candidate to solicit interest, commitment, and understanding of expectations of service on the Board. Committee makes recommendation to Board of Health. f. Board of Health receives roster of all applicants and applications from top selections. Board makes recommendation to Board of Commissioners. For at-large representative slots: a. Recommendations for replacements may be solicited from the"retiring" Board member. Applicants must apply through the County Commissioner's Clerk's Office. b. If there are no suitable candidates in the current database, the Committee meets with all three at-large representatives and the Health Director to determine community groups from which to recruit and mailing labels/list are obtained from those community groups. c. If a list is used to solicit suitable applicants, a recruitment letter is prepared by the Health Director for Committee approval. The letter is signed by the current board chair and current at-large representative occupying the slot or by nominating committee chair. d. Applicants send applications to Clerk's Office or apply on- line through the county website. Application period open until filled. Committee will look at applicants no sooner than 15 working days after letters were mailed. e. Nominating Committee reviews applications, applies criteria, and may choose to interview top two or three applicants. At a minimum, committee interviews top candidate to solicit interest, commitment, and understanding of expectations of service on the Board. Committee makes recommendation to Board of Health. f. Board of Health receives roster of all applicants and applications from top selections. Board makes recommendation to Board of Commissioners. Review Annually(July) Page 6 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health Criteria for Board of Health applicant review. The following criteria are meant to be ,guidelines for assessing applicants and are not meant to be exclusive. a.Full-time resident of Orange County, with commitment to stay in the county for at least nine years (3 terms) b. Must hold required degree for service if in a professional slot: RN, MD/DO, DVM, OD, BS Pharm, PE, DDS c.Public health training or experience preferred for professional slots d. For professional slots, actively employed in their profession(e.g., as a pharmacist or in a pharmacy administrative role). Priority given to practicing professionals (non-researchers). e.Prior experience with community work(e.g., Red Cross, mission work, school health, equity work) f.Willingness to engage as an active member of the Board, serve in a leadership position, and/or serve as an active member on a committee g. Currently serving on not more than one other Board or committee that requires significant amounts of time h. Geographic representation of the county(balance on the current board) i. Gender and culturally diverse representation on the current board j.No former employees of the health department k. No employees of other county departments Reappointment of Existing Board of Health Members a. A Board of Health member is appointed to a three-year term beginning the month of their appointment, unless serving in an unexpired term slot. Generally, members are eligible for reappointment for second and third terms. As members become eligible for reappointment, the Nominating Committee reviews the attendance records of members who are eligible for reappointment, contacts each member to assess willingness to continue and makes a recommendation to the Board of Health. The Board Secretary(Health Director) sends a letter to the Clerk of the Commissioners indicating the Board of Health's review and endorsement for reappointment. 3. Physical Activity and Nutrition To oversee the action steps and deliverables outlined in the Physical Activity and Nutrition section of the Board of Health Strategic Plan. Review Annually(July) Page 7 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health 4. Mental Health and Substance Abuse To oversee the action steps and deliverables outlined in the Mental Health and Substance Abuse section of the Board of Health Strategic Plan. 5. Social Determinants of Health To oversee the action steps and deliverables outlined in the Social Determinants of Health section of the Board of Health Strategic Plan. 6. Temporary Committees The Board may establish and appoint members for temporary committees as needed to carry out the Board's work. Temporary committees must limit their work to the specific charge outlined by Board motion and may include members that are not serving on the Board of Health. All temporary committees are subject to the North Carolina open meetings laws and shall comply with the provisions of those laws. X. Meetings A. Regular Meetings The Board shall hold regular meetings no less than quarterly. As a general rule, the Board will meet monthly. A calendar of regular meetings and location of each meeting will be established at the last regular meeting of the calendar year for the next calendar year. The dates may be adjusted annually based on Commissioner meeting dates for the year to enable the Commissioner member of the Board to attend. The requirements of the open meetings law shall apply to all regular board, regular or ad hoc committee or task for meetings. Notification of the public will be in compliance with open meeting law notification. B. Special Meetings The Chairperson or any three members may call special meetings. The Secretary to the Board is to be informed of the special meeting and shall give proper notice of the meeting at least 48 hours before the special meeting is to occur. A special meeting may also be called or scheduled by vote of the board in open session during another duly called meeting. The motion or resolution calling or scheduling the special meeting shall specify its time,place, and purpose. Notification procedures remain the same. Only those items of business specified in the notice may be discussed or transacted at a special meeting, unless (1) all members are present and(2)the board determines in good faith at the meeting that it is essential to discuss or act on the item immediately. C. Agenda The Secretary to the Board shall prepare an agenda for each meeting. Any board member who wishes to place an item of business on the agenda shall submit a request to the Secretary at least five working days before the meeting. For regular meetings, the Board may add items to the agenda or subtract items from the agenda by a majority vote. The agenda for a special or emergency meeting may Review Annually(July) Page 8 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health be altered only if permitted by and in accordance with the North Carolina open meetings laws. D. Presiding Officer The Chair of the Board shall preside at Board meetings if present. If the Chair is absent, the Vice-Chair shall preside. If the Chair and Vice-Chair are both absent, another member designated by a majority vote of members present at the meeting shall preside. E. Quorum A majority of the actual membership of the Board, excluding vacant seats, shall constitute a quorum. A member who has withdrawn from a meeting without being excused by a majority vote of the remaining members shall be counted as present for purposes of determining whether or not a quorum is present. F. Voting Each Board member shall be permitted to abstain from voting, by so indicating when the vote is taken. A member must abstain from voting in cases involving conflicts of interest as defined by North Carolina law. If a member has withdrawn from a meeting without being excused by a majority vote of the remaining members, the member's vote shall be recorded as an abstention. G. Minutes The Secretary shall prepare minutes of each Board meeting. Copies of the minutes shall be made available to each Board member before the next regular Board meeting. At each regular meeting, the Board shall review the minutes of the previous regular meeting as well as any special or emergency meetings that have occurred since the previous regular meeting, make any necessary revisions, and approve the minutes as originally drafted or as revised. The public may obtain copies of Board meeting minutes at the Board of Health website http://server3.co.orange.nc.us:808 8/WebLinkBrowse.aspx?dbid=0&startid=4811 4&row=1&cr=1. H. Closed Session The Board may hold a closed session only upon a motion adopted in open session when a quorum is present. The motion must state the general purpose of the closed session and the matter to be considered must be one or more of the subjects listed in NCGS 143-318.11 (see Appendix C). Furthermore, if the motion to go into closed session is to prevent the disclosure of information privileged or confidential pursuant to the law of this State or of the United States, or not considered public record within the meaning of Chapter 132 of the General Statutes (Appendix D), the Board shall also state the name or citation of the law that renders the information to be discussed privileged or confidential. XI. Contract Negotiations Review Annually(July) Page 9 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health The Health Director is authorized to enter into a contract with any governmental or private agency or with any person, for the provision or receipt of public health services. The Board of Commissioners or its designee must approve contracts requiring payment for services rendered to the Health Department. The Health Director will discuss with the Board contracts that represent significant deviation from current Board of Health policy prior to authorizing that contract. XII. Amendments to Operating Procedures These operating procedures may be amended at any regular meeting or at any properly called special meeting that includes amendment of the operating procedures as one of the stated purposes of the meeting. A quorum must be present at the meeting at which amendments are discussed and approved, and any amendments must be approved by a majority of the members present at the meeting. XIII. Other Procedural Matters The Board shall refer to Bell, II, A. Fleming. Suggested Rules of Procedure for Small Local Government Boards, Second Edition, Institute of Government, The University of North Carolina at Chapel Hill, 1998 to answer procedural questions not addressed in this document, so long as the procedures prescribed in Suggested Rules of Procedure for Small Local Government Boards do not conflict with North Carolina law. A. Parliamentary Procedures The Board shall refer to the current edition of Robert's Rules of Order Newly Revised(RONR) to answer procedural questions not addressed in this document, so long as the procedures prescribed in RONR do not conflict with North Carolina law. B. Public Comment 1. The BOH will ensure that policies and services of the Orange County Board of Health and Orange County Health Department have considered the health and environmental safety needs of the general population and any at-risk populations of Orange County. The BOH will accomplish this by ensuring that reasonable mechanisms for community/public input are available 2. The Board of Health will reserve a public comment period on each regularly scheduled Board meeting. Each individual will be given a maximum of three minutes for comments, and the public comment period will be limited to 15 minutes each meeting. 3. Annually the Board of Health will receive from the staff of the Health Department the results of patient and client input on services received, including any corrective actions deemed necessary to improve services. C. Procedure for Complaints Review Annually(July) Page 10 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health The Orange County Board of Health and Orange County Health Department will have reasonable means in place to ensure that timely appeals can be heard from clients, patients, or members of the public. The Department will follow all provisions and requirements outlined by North Carolina General Statutes governing Health Departments, including but not limited to GS 130A. If any provision of the following procedures is in conflict with General Statutes, the current Statute will govern. Complaint procedures can be found in the following locations: 1. Orange County Health Department Administrative Policy and Procedure Manual a. Section X, Policy 13.0 Nondiscrimination and Complaint Process b. Section X, Policy 14.0 General Complaint Response Process c. Section X, Policy 15.0 HIPAA Breach Policy i. Attachment 9 OCHD HIPAA Complaint Form 2. Environmental Health Services Policy and Procedure Manual a. Policy 2.0 Environmental Health Complaint Response Procedures XIV. Policy-Making Procedures The Orange County Board of Health authorizes and delegates the implementation of all programs and services as defined by North Carolina General Statute 130A (Appendix F), the related NC Administrative Code, and other programs approved by the Board to the staff of the Orange County Health Department under the direction of the Health Director. The Orange County Board of Health will provide guidance for programs and policies that affect the entire Health Department. a. The Orange County Board of Health, upon recommendation of the Health Director, shall review and approve policies or programs that commit the Health Department to utilize significant additional or new resources outside of the scope of the approved annual budget. b. The Board of Health authorizes continuation of program activities through the annual approval of a Health Department budget. c. The Board of Health delegates the approval of all administrative policies and procedures for the general functioning of the Health Department to the Health Director. d. The Board of Health reviews and approves policies as requested or in response to a Board of County Commissioner initiative and forwards recommendations to the Board of Commissioners on relevant changes. The Board of Health delegates the implementation of these policies to the appropriate division staff through the Health Director. e. The Orange County Board of Health shall review at least annually all policies adopted by the Board of Health. Review Annually(July) Page 11 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health XV. Rules Development Procedure The board shall evaluate the need for adoption of rules to protect and promote the public health. In addition, existing rules should be evaluated periodically for the need for revisions to respond to new risks, advances in technology, or changes in statutes or state regulations. A. The Board will follow the procedures outlined in NCGS 130A-39 (Appendix B). i. Not less than 10 days before the adoption, amendment or repeal of any local board of health rule, the proposed rule shall be made available at the office of the county clerk, and a notice shall be published in a newspaper having general circulation within Orange County. The notice shall contain: a. A statement of the substance of the proposed rule or a description of the subjects and issues involved. b. The proposed effective date of the rule, and c. A statement that copies of the proposed rule are available at the local health department. A local board of health rule shall become effective upon adoption unless a later effective date is specified in the rule. ii. Copies of all rules shall be filed with the secretary of the local board of health and will be made available to all Board of Health members. iii. A local board of health may, in its rules, adopt by reference any code, standard, rule or regulation, which has been adopted by any agency of this State, another state, any agency of the United States or by a generally recognized association. Copies of any material adopted by reference shall be filed with the rules. XVI. Adjudication Procedures A. The Board will follow all procedures as specified in NCGS 130A-24 (Appendix E). In the case where a member of the public is appealing a decision on the application of an Orange County Board of Health adopted rule or concerning the imposition of administrative penalties by a local health director, the process will include the following steps: i. The aggrieved party shall provide written notice of appeal to the Health Director within 30 days of the challenged action. The notice shall contain the name and address of the aggrieved person, a description of the challenged action and a statement of the reasons why the challenged action is incorrect. ii. The Health Director shall notify the Board within five working days of receipt of the appeal and transmit all documents upon which the challenged action was taken. Review Annually(July) Page 12 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health iii. The Board of Health shall hold a hearing within 15 days of the receipt of the notice of appeal from the health director to the Board. The Board will give the person not less than 10 days notice of the date, time and place of the hearing. The local board of health shall issue a written decision based on the evidence presented at the hearing. The decision shall contain a concise statement of the reasons for the decision. The hearing must meet the requirements of procedural due process. a. No contact outside the hearing with parties involved or between board members. b. Board members with any bias must not participate. c. Board must allow the appellant's attorney to attend and advise his/her client. d. Board must take sworn and relevant testimony. e. Board must provide for cross-examination of witnesses. f. Board must keep detailed or verbatim minutes. iv. The proceedings shall be recorded and a transcript of the hearing shall be prepared and be available to the appellant and/or the Board upon request. v. At the next regularly scheduled Board meeting following the hearing, the Board must issue a written decision based on the evidence presented at the hearing. The decision shall contain a concise statement of the reasons for the decision and the Secretary will transmit the final written decision of the Board to the person appealing via certified US mail. vi. A person who wishes to contest a decision of the Board of Health shall have a right of appeal to the district court having jurisdiction within 30 days after the date of the decision. XVII. Annual Review of the Health Director The Board of Health will use the following guidelines to accomplish the required annual review of the health director's performance in accordance with the statutory requirement GS 130A-41 (Appendix H) Guidelines: A. Orange County Personnel Policies are followed in conducting this review. Steps in the standard process are: a. Preparation of an annual work plan by the employee and supervisor. b. Preparation of performance notes at the end of the plan year that relate to the objectives contained in the work plan. Review Annually(July) Page 13 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health c. A conference between the employee and the supervisor regarding the employee's performance for the year. d. Supervisor prepares a Work Planning and Performance Summary after the conference which outlines the findings of the discussion and makes the final recommendation as to performance. e. Supervisor forwards all paperwork to Human Resource Director. B. In the case of the Health Director, the "supervisor" of the Director is the entire Board. The Chair assumes the responsibility of managing the information flow and input into the performance evaluation. This may include the formation of an ad-hoc committee to assist in the completion of the performance evaluation. a. The Health Director prepares performance notes relevant to the year and emails them to all Board members. b. The Chair schedules a meeting with the County Manager to obtain input on the Health Director's performance. c. The Chair may or may not solicit additional feedback, including from senior management staff and direct reports at the Health Department through electronic or in-person methods each year. A 3600 evaluation should be conducted at least every 5 years. d. The Chair presents these findings to the full Board at a closed session of the Board and a general discussion of performance is then held. The Board reaches agreement on a recommendation and then the health director is called into the room and the Chair guides the discussion by Board members. e. The Board is required to keep minutes during the closed session, including any motions made and actions resulting from such motions and transmit them to the Secretary(Health Director) for the permanent record. f. Board members indicate changes they would like to see included in the following year's work plan and those areas are discussed with the Health Director in the meeting. Following the meeting, the Chair writes the performance summary, finalizes the paperwork, obtains the Health Director's signature and sends it to the Human Resources Director for the County. The Human Resources Director processes the remaining paperwork. The goal should be to have the performance review complete within 30 days of the hiring date anniversary. XVIII.Compliance with North Carolina Law A. In conducting its business, the Board shall comply with all applicable North Carolina laws, including but not limited to open meetings laws,public records laws, and the laws setting forth the responsibilities and duties of local boards of Review Annually(July) Page 14 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section III: Board Adopted Policies Policy III.A.: Operating Procedures Reviewed by: Health Director Approved by: Health Director,Board of Health health. To assist the Board in compliance, the local health director shall maintain a current copy of relevant North Carolina General Statutes and make them available to Board members on request. B. The Board of Health must consult legal counsel such as the Orange County attorney, the NC Attorney General or the UNC School of Government whenever legal assistance is indicated to interpret laws and rules. C. The NCGS 130A (Appendix F) and related statutes on public health law and administrative codes shall be maintained in the Health Director's Office and in a Board of Health Manual. APPENDIX NC General Statute (NCGS) References Appendix A— 130A-35 Appendix B— 130A-39 Appendix C— 143-318.11 Appendix D— 132 Appendix E— 130A-24 Appendix F— 130A Appendix G— 130A-41 Appendix H—Statement of Confidentiality and Conflict of Interest Review Annually(July) Page 15 of 15 Original Effective Date: February 8, 1979 Revision Dates: 12/18/1980,4/16/1981;4/26/1984; 11/16/2000;2/23/2007; 10/24/2007;4/23/2009,7/24/12, 11/5/13, 11/14,8/15,9/18, 10/19 S:\MANAGERS WORKING FILES\BOH\AGENDAS&ABSTRACTS\2020 Agenda&Abstracts\August 2020\Pdfs for webpage\V.A. Policy Review Attachments\III.Operating Procedures August 2020.doc Health Director's Report July-August 2020 • July 8 & 10, 2020—participated on State Health Coordinating Council Public Hearings • July 8-10, 2020—conducted first round of Dental Director Interviews; Thank You Sam Lasris for participating on the panel as our Dentist Representative from the Board of Health. • July 13, 2020—NCALHD Executive Committee Call • July 16, 2020—NC Association of Local Health Directors Meeting(Virtual) • July 10, 2020—United Way interview to discuss impact of COVID-19 on community and disproportionate impact in communities of color. • July 21, 2020—planning meeting with UNC Game Day staff • July 22, 2020— Southern Orange Testing Event at Carrboro High School. We tested 203 individuals; provided mask and community health information/resources. StarMed Urgent and Family Care, P.A. provided the testing. • July 23, 2020—UNC Public Safety/Health Partner Call; reopening planning and response • August 5 — 8, 2020—2nd round of Dental Director interviews for 2 finalist • August 11, 2020—Child Fatality Prevention Team Meeting (Virtual) • August 12, 2020—Meeting with Clinic Supervisors to discuss clinic schedule and staffing needs • August 14, 2020—NCALHD New Health Director Orientation(Virtual) • August 16, 2020—COVID-19 Update for Northern Orange NAACP Meeting • August 20, 2020—COVID-19 Update for Chamber's Big Bold Ideas Steering Committee • NC DHHS is sending additional COVID-19 testing capacity to 7 counties across the State. Orange is included in this group. StarMed Urgent and Family Care, P.A. will coordinate the new testing sites with local health departments, prioritize a community testing approach by connecting individuals with medical homes, provide services with culturally and linguistically appropriate standards and work within existing trusted community partnerships. • NC DHHS is expanding mental health supports for teachers, school personnel and families. They are expanding the expanding the Hope4Healers Helpline (919-226-2002). Hope4Healers is available 24 hours per day, seven days a week. When teachers, school personnel or family members call the helpline, they will speak to someone who is trained to listen and offer support. They then will be contacted within about a day by a licensed mental health professional for a free, confidential, short-term follow-up by phone or video chat. • Key activities related to UNC Re-opening—working closely with campus health to complete contact tracing and case investigation; setting up testing opportunities for off campus students; working with Greek life to get a handle on testing and reporting and appropriate pandemic behavior. Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 26, 2020 Agenda Item Subject: COVID-19 Update Attachment(s): Staff or Board Member Reporting: Quintana Stewart Purpose: Action X Information only Information with possible action Summary Information: Quintana Stewart will give an update on COVID-19 status in Orange County. Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward to _X_Accept as information Revise & schedule for future action Other (detail): Its Local Health Department Urged a Virtual Fall.UNC Is Reopening Anyway. Sign In ADVERTISEMENT PUBLIC HEALTH Its Local Health Department Urged a Virtual Fall . UNC Is Reopening Anyway. By Francie Diep AUGUST 5, 2020 https://www.chronicle.com/article/its-local-health-department-urged-a-virtual-fall-unc-is-reopening-anyway[8/6/20,10:02:10 AM] Its Local Health Department Urged a Virtual Fall.UNC Is Reopening Anyway. f � { 1 f AI 4 ENARANCE 1 k • #arfi JON GARDINER The Orange County, N.C., health department asked the University of North Carolina at Chapel Hill last week to move the campus online for the fall semester, but the university has declined to take the health department's recommendations, moving forward with in-person operations. "If students begin to move back on campus next week, we could quickly become a hot spot for new cases, as thousands of students from all https://www.chronicle.com/article/its-local-health-department-urged-a-virtual-fall-unc-is-reopening-anyway[8/6/20,10:02:10 AM] Its Local Health Department Urged a Virtual Fall.UNC Is Reopening Anyway. across the country/world merge onto the UNC campus," wrote Quintana Stewart, Orange County's health director, in a memo to UNC's chancellor, provost, and vice chancellor, dated July 29. Stewart's major recommendations were for the university to restrict on-campus housing only to those students who need it most, so that everyone can have a single room, and for the university to hold all classes online for the fall. Barring a move to a virtual fall, Stewart recommended the university teach online-only for the first five weeks of the semester to give the department and university additional time to monitor the coronavirus's spread after students' return. The university did not respond to The Chronicle's questions about the letter on Wednesday. Late in the afternoon, the chancellor, Kevin M. Guskiewicz, posted a public statement. "While the OCHD letter was not an order or a mandate for the university to take any specific action, as always, I took their recommendations very seriously," he wrote. "We believe we have made significant progress towards aligning with the OCHD's general recommendations and considerations." The statement then listed actions UNC has taken, including reducing classroom- and dorm-occupancy levels, but it didn't say whether the new occupancy level means students will have single rooms, as Stewart recommended. The health department's memo pointed to clusters of Covid-19 cases among UNC's athletes, who returned for voluntary workouts, and cleaning staff. "We've seen the off-campus parties and gatherings at Greek houses," Stewart wrote. And when health officials tried to do contact tracing, some students wouldn't cooperate. "All of that has added to the concern of bringing basically 30,000 people back into one very small community," Todd McGee, a spokesperson for the health department, said. Orange County has a population of about 146,000. "That's just going to multiply the potential for problems, so that's why she felt the need to go ahead and get it on the record what the recommendations would be." Community opposition also played a role in Stewart's call for closing. "I have received a massive amount of emails from community members, UNC staff, faculty, and students," she wrote, "sharing their concern for fully reopening campus for the fall semester." The UNC system has said it would move as one regarding whether campuses are open for in-person instruction; across the system, campuses are welcoming students back. Generally, individual campuses's chancellors would need to consult with the system president and Board of Governors if they wished to go all virtual, Josh Ellis, a system spokesperson, told The Chronicle last month. However, the chancellors are also "being directed to follow what the county health director is saying," Ellis said at the time. Ellis didn't return a Wednesday request from The Chronicle seeking more detail on the system's guidance to campuses. https://www.chronicle.com/article/its-local-health-department-urged-a-virtual-fall-unc-is-reopening-anyway[8/6/20,10:02:10 AM] Its Local Health Department Urged a Virtual Fall.UNC Is Reopening Anyway. The county has the legal authority to close a property by declaring it an "imminent hazard to public safety," McGee said. "That's a very high bar to leap over. That's not an option at this point." North Carolina law defines "imminent hazard" as "a situation that is likely to cause an immediate threat to human life." One part of the law makes the county potentially liable for any financial losses UNC incurs, as a result of being called an imminent hazard, according to McGee. The health department's letter prompted Guskiewicz and the provost, Robert A. Blouin, to appear at an emergency meeting of the faculty executive committee, late Wednesday afternoon. During the meeting, committee members seemed to assume the health department made the memo public; McGee later emailed to say it had not. Guskiewicz and Blouin said at the meeting that they received no warning that the health- department letter would be made public and did not know the department's motivation for doing so. When a committee member asked if it was a sign that the health department felt that university leaders were not listening to them, Blouin demurred. "I have really enjoyed our conversations. They have all been positive, collaborative, and collegial," he said. "Even in our conversations since we received the letter, it's been the same. Nothing really has changed." ADVERTISEMENT Clarification (Aug. 6, 2020, 9:25 a.m.): This story has been updated to clarify that, at a Wednesday meeting of the faculty executive committee, committee members appeared to assume the health department had made the memo public. A spokesperson for the health department said it had not. If you have questions or concerns about this article, please email the editors or submit a letter for publication. STUDENT LIFE ADMINISTRATION POLITICS Francie Diep <� ` Francie Diep is a staff reporter covering money in higher education. https://www.chronicle.com/article/its-local-health-department-urged-a-virtual-fall-unc-is-reopening-anyway[8/6/20,10:02:10 AM] Orange County Health Director to UNC-Chapel Hill:Go online as default for Fall semester,restrict on-campus housing I The Progressive Pulse THE PROGRESSIVE PULSE . , EDUCATION, Orange County Health Director to UNC-Chapel Hill: Go online as default for Fall semester, restrict on-campus housing it By Joe Killian ❑ 13 days ago rl 1 Comment ❑ In COVID-19, Education, Higher Ed, News The Orange County Health Director has urged the University of North Carolina at Chapel Hill to move to online education as the default for the Fall semester and to restrict on-campus housing as the COVID-19 pandemic in the county worsens. Health Director Quintana Stewart made the recommendations in a July 29 letter to UNC-Chapel Hill Chancellor Kevin Guskiewicz. As of this week, UNC-Chapel Hill is moving forward with in-person classes. Thousands of students began moving into residence halls this week in a full-capacity dorm plan that the Centers for Disease Control considers to be Ohighest risk.0 In the letter, Stewart expressed concern over signs that student returns have already contributed to spikes and clusters of infections. From the letter: To date, Orange County has been home of approximately 1,241 lab confirmed positive COVID-19 cases and 45 deaths. Over the past month we've watched our daily case count nearly double with record highs in early July of 38 new cases per day. We've also seen an increase in cases for those in the 18-24 age group (22%) and the 24-49 age group (37%). While the data reports that our local cases appear to be stabilizing the last couple of weeks, we at public health know this is not a totally accurate picture of what is happening in our community. As the State moved into Phase 2 and things began to open up, we saw an increase in our cases. As students have begun to return to campus prior to the http://pulse.ncpolicywatch.org/...e-county-health-director-to-unc-chapel-hill-go-online-as-default-for-fall-semester-restrict-on-campus-housing/[8/18/20,8:36:31 AM] Orange County Health Director to UNC-Chapel Hill:Go online as default for Fall semester,restrict on-campus housing I The Progressive Pulse official start of the Fall Semester we've experienced a small fraction of what we will see if the campus fully reopens and all the students return for in-person class. In the last 4 weeks we've seen positive COVID clusters among UNC staff and athletic teams. We've experienced the increased activity and gathering on Franklin Street that resulted in clusters that visited a couple of local restaurant/bar establishments. We've seen the off campus parties and gatherings at Greek Houses. We've also experienced the lack of cooperation from students with the communicable disease investigation and control measures mandated by NC General Statute §130A-144. For multiple cases staff had to spend several hours trying to gather information and cooperation from students. As a last resort, legal remedies were suggested to gain cooperation. This is absolutely not the desired outcome for our campus students. Due to the reporting structure for positive cases, our data does not necessarily capture each of these cases as they are attributed to the home county of residence, however the reality is Orange County Health Department Staff and UNC Campus Health Staff have been tasked with the monitoring and investigation of these cases here in Orange County. UNC-Chapel Hill students are already reporting invitations to large house parties organized by student athletes and in-person fraternity and sorority rush events that do not include masks or social distancing. On Monday a UNC-Chapel Hill student posted a video to Twitter depicting what he said was a large group of young women engaging in a sorority rush event. None were wearing masks or practicing distancing. While fraternity and sorority recruitment is officially entirely virtual this year, sources in Greek organizations at UNC-Chapel Hill confirmed to Policy Watch last week and again this week that a number of unofficial Odirty rush0 events are being held off campus. The events are promoted via word of mouth, closed social media groups and text messages, several of which have been examined by Policy Watch. UNC Faculty have also noticed the lack of distancing and mask compliance to exhibited by students returning to campus and around town in Chapel Hill. OI hope all will go well,6 said Deb Aikat, associate professor in UNC-Chapel HillOs school of http://pulse.ncpolicywatch.org/...e-county-health-director-to-unc-chapel-hill-go-online-as-default-for-fall-semester-restrict-on-campus-housing/[8/18/20,8:36:31 AM] Orange County Health Director to UNC-Chapel Hill:Go online as default for Fall semester,restrict on-campus housing I The Progressive Pulse Journalism and Media. OBut there is already some evidence that students and employees and faculty are being affected by COVID.O It is not difficult for those on and around campus to see that some students and community members aren6t taking the pandemic seriously enough. OIf you take a walk on Franklin Street nobody is wearing a mask nobody is social distancing0 Aikat said. OI was there yesterday on Franklin Street. I was appalled.0 While the school is not requiring tests for all students, the new COVID-19 campus dashboard shows 175 total infections among those tested on campus N 139 of them students. That6s a cumulative positive rate of 10.6 percent. The dashboard shows 13 student infections the week of 7/20 and a positive rate of 11.1 percent. It shows 13 student infections for the week of 7/27, the last week before most students began to move onto campus, for a positive rate of 8.6 percent. The current statewide infection rate is 8 percent. In her letter, Stewart advised going to online instruction for the entire Fall semester but at a minimum for at least the first five weeks of classes. She also calls for restricting on campus housing to Oat-risk students with no access to equitable educational resources and those with true housing needs (i.e. International students, Carolina Covenant & marginalized students) in order to provide single-occupancy rooms, which should significantly slow community spread. http://pulse.ncpolicywatch.org/...e-county-health-director-to-unc-chapel-hill-go-online-as-default-for-fall-semester-restrict-on-campus-housing/[8/18/20,8:36:31 AM] Orange County Health Director to UNC-Chapel Hill:Go online as default for Fall semester,restrict on-campus housing I The Progressive Pulse Orange County has attempted to control the spread of COVID-19 by adopting policies and mandates to encourage healthy and safe behaviors during this pandemic.We adopted a Countywide Mask Mandate and we close restaurants at IOpm daily to prevent the pop-up clublbar scene during late night operations as observed in early July. W h i I a these are valiant efforts, I fear it will not be enough to contain the full campus community upon return for the Fall Semester_ At this time, the Orange Gounty Health Department recommends that the University of North Carolina at Chapel Hill consider the fallowing: ■ Restrict on campus housing to at-risk students with no access to equitable educational resources and those with true housing needs(i.e. International students, Carolina Covenant&marginalized students) ■ Consider virtual classes for the entire Fall Semester but at minimum begin the first 5 weeks of the semester with online instruction only with plans to reassess the situation at the 5 week mark Dry-Campus Housing The goal of limiting on-campus housing is to create a situation where students that need to return to campus are able to do so in a single occupancy room. Significantly lowering the census of students in the dorms will also allow for additional capacity for isolation&quarantine measures as needed. First Five Weeks-Online Instruction cnly As we continue to watch the data 1n Orange County, we want to ensure the community's ab11ity to respond to new cases. Earlier jn this Pandemic, our numbers were driven by the older age group, most of whom lived in one of the long-term care facilities in our community. Today we are seeing more cases with the younger age group and more community transmission and asymptomatic cases than originally seen. For this reason, if the first five weeks of instruction is virtual, we may be able to reduce further spread of the virus by eliminating in class instruction which would create mare opportunities for close contact and possible viral spread. Possibly related posts: 1. UNC-Chapel Hill considering timing of graduation, return for fall semester 2. UNC-Chapel Hill begins sharing ORoadmap for Fall 2020,0 details about return to campus 3. New UNC student survey gives insight into concerns, safety measures for return to campus 4. New COVID outbreaks at UNC system schools lead to growing concern about return to campuses 5. UNC-Chapel Hill launches COVID-19 dashboard, shows 173 infections as students return to dorms this week ORANGE COUNTY HEALTH DEPARTMENT ORANGE COUNTY •. • CHANCELLORUNC-CHAPEL HILL ❑ Previous Post Next Post ❑ http://putse.ncpolicywatch.org/...e-county-health-director-to-unc-chapel-hill-go-online-as-default-for-fall-semester-restrict-on-campus-housing/[8/18/20,8:36:31 AM] Orange County Health Director to UNC-Chapel Hill:Go online as default for Fall semester,restrict on-campus housing I The Progressive Pulse Another conservative state opts tor Medicaid I op Homeland Securityotticial vows tederal agents expansion Owill not back awayO from violent protests ONE COMMENT NERYS LEVY II August 5, 2020 at 7:09 pm I would like to know how much interaction there was between Orange County Health Department and UNC Amin planning this return of the students to UNC Chapel Hill. Over 100,000 tax payers live within reach of the UNC CH campus/ surely their health and safety should have been a factor in determining the feasibility of returning to campus during a raging pandemic ? . If only we could count on the students to practice social distancing and to wear masks. We who live here need to be consulted and considered D UNC admin needs to now be responsible for monitoring its students closely in order to safeguard our communityOs well being and safety. LEAVE A REPLY Your email address will not be published. Required fields are marked Comment Name Email Website http://putse.ncpolicywatch.org/...e-county-health-director-to-unc-chapel-hill-go-online-as-default-for-fall-semester-restrict-on-campus-housing/[8/18/20,8:36:31 AM] Can Orange County Shut Down Classes at UNC? HereOs What We Know Posted by Elle Kehres I Aug 6,2020 1 UNC �.c 111' DO 1 44* ENTER a ■CAMPAIGM FOR LOCAL Are you a nonprofit in need of advertising? r ig to 10 Communit 9)oupro�t J4duerhsia land _ In the wake of the Orange County Health Department0s letter of recommendations to UNC,questions have arose regarding why this letter wasnOt immediately made public and what power the health department has over the university. Quintana Stewart director of the health department,addressed campus leaders in aJuy 29letter,asking UNC to limit on-campus housing to at-risk students with housing needs.Following the public release of Stewart0s letter, UNCOs faculty executive committee held an emergency meeting to get answers from Chancellor Kevin Guskiewia about where things stand A and why the letter wasnOt made public for a week Orange County Commissioner Penny Rich said the role of the health department director is not to answer elected officials N it is to answer to the health department0s board of directors and the state. 6ihere0s some really good reasons for that because the health director is not a political position,6 Rich said. 6She should not be influenced by politics.She needs to stay neutral.6 Rich said as soon as the health department0s letter became public to county commissioners Monday night it was intercepted by social media and went viral.According to Rich,there was a delay in getting this information to the Board because Stewart needed to go through her own advisory board first. 6The reason why it has to go through a process before it becomes public is because she[Stewart]needs to clarify and make sure she goes over everything with her board before it becomes public,6 Rich said. In a note to the campus community,Chancellor Guskewi¢said he met with Orange County Health Officials on Friday,two days after he received the letter,back before it was released to the county commissioners and public. Some of the recommendations listed by Stewart in her letter include restricting on-campus housing to at-risk students and to consider virtual classes for the entire fall semester D or at least the first five weeks. Rich said whether or not university leadership decides to accept these recommendations,the health department does not have the ability to shut down campus operations. 6The county commissioners,the health department,any of the boards in Orange County cannot shirt down the university,0 Rich said.61 know that there has been some articles that stated that N that if health department recommends the shutdown then it gets shutdown N but that is absolutely not true.6 In a media release sent Thursday,Stewart confirmed that it is not within her capabilities to shut down the university. 6while it is true the local health director can determine an imminent hazard exists,6 she said,Othere is a high legal bar for this to survive a judicial challenge and there is also cost associated with shutting down the UNC campus. 6The statute provides a single method for the recovery of costs,Olocal health department shall have a lien on the property of the owner,lessee,operator,or other person In control of the property where the imminent hazard existed for the cost of the abatement of the Imminent hazard.0 Since this is the only means of recovering the costs the full cost most likely becomes the burden of the County.This is not a realistic option.0 Despite Orange County0s recommendations,UNC is welcoming students back to campus and classes have already started for graduate students. 6Personaly,I donOt think the university should open,6 Rich said.61 donOt think there should be any in-person classes right now.6 In wake of the Orange County Health Department0s letter becoming public,Rich,alongside the mayors of Chapel Hill,Carrboro and Hillsborough sent their own letter to the university D backing up the health departments recommendations. 61 think that,just like everyone else,theyOre making it up as they go along D which is unfortunate because we0re putting a lot of people0s lives at risk by having these congregated living situations,6 Rich said.610m not real happy with some of the answers we have.It feels like to me that a lot of the UNC officials have their hands tied.TheyOre being directed by the Board of Governors,The Board of Trustees and the General Assembly and we all know when that happens it0s not conducive to the values that we have here in Orange County.0 To read the Orange County Health Department0s letter,Penny Rich and the MayorOs letter as well as Kevin Guskiewia0s response,click here. Chopelboro.com does not charge subscription fees.You can support local journalism and our mission to serve the community.Contribute today D every single dollar matters. Related Read Letters From the Orange Orange County Recommends UNC Students,Faculty Hold'Die- County Health Department,UNC UNC Begin Fall Semester Virtually, In'Protest,Call for Virtual Classes Faculty,Local Elected Officials Restrict On-Campus Housing Amid the Pandemic Regarding UNC's Reopening August 5,2020 August 6,2020 August 6,2020 Sponsored Content Itutb nl [Pics]When Magic Johnson's The Common Signs of Psoriatic Worst Colleges In America: Son Came Out,HereOsE Arthritis North Carolina Tops Thet Info on psoriatic arthritis According to the data,these are the worst 1— colleges in the unitedt ,C. w This Is Where the Majority of Plastic Surgeon Tells:6Doing 14 Movies That Totally Singles Over 50 Ares This Every Morning Cant Shattered Celebrity Marriages SHARE: e e e e e e e e e e Cunningham:UNC Athletics OCould Lose up to$52 Million 1-40 in Orange County Reopens Following Major Crash in RevenueO Leave a Reply Email(required) (Address never made public) Name(required) Website 0 Save my name,email,and website in this browser for the next time I comment. 0 Notify me of new posts via email. Post Comment Chair of UNC-CH faculty: "a serious breach of trust"campus not aware of Orange County health recommendation I The Progressive Pulse THE PROGRFESSIVE PULSE EDUCATION,HIGHER ED,NEWS,PUBLIC HEALTH Chair of UNC-CH faculty: "a serious breach of trust" campus not aware of Orange County health recommendation Joe Killian ❑ 20 hours ago ❑ Leave a comment ❑ In Education, Higher Ed. News, public health The chair of the UNC-Chapel Hill faculty sent an email to Chancellor Kevin Guskiewicz and Provost Bob Blouin Wednesday expressing Odismay0 faculty were not made aware that the Orange County Health director last week recommended the school move to online-only instruction and restrict student housing due to mounting evidence of widening COVID-19 infection. OIt feels like a serious breach of trust to have kept such recommendations from the campus community of faculty, staff and students,0 wrote Dr. Mimi Chapman, chair of the faculty. In the email, whose subject line is ODismay,O Chapman goes on to say that she has personally changed her plans to hold an in- person orientation for doctoral students this week and that the class she planned to teach in person this semester will change to 4 remote. OI could not possibly do otherwise in the face of such a letter from our local health department,0 Chapman wrote. Chapman pointed to already rampant flouting of mask and distancing rules on campus, in student stores and at off campus gatherings. OThese look like off ramps to me,0 referring to the term UNC-Chapel Hill has used to indicate things that would lead them off of their Oroadmap to return0 and back to the online-only instruction of last semester. http://pulse.ncpolicywatch.org/...-recommendation/?fbclid=IwAR3_g5um-lYOaaewVNUmTXj3ylfPoSZke-08VcOgnABaraGZ-A1SH1kTDaA[8/6/20, 10:10:37 AM] Chair of UNC-CH faculty: "a serious breach of trust"campus not aware of Orange County health recommendation I The Progressive Pulse Policy Watch has reached out to UNC-Chapel Hill, the UNC System office and UNC Board of Governors for response to the Orange County health director0s letter. They have not yet responded. 11 ChapmanOs letter, in its entirety: Dear Kevin and Bob: This morning members of the FEC had the attached letter forwarded to us. We are completely shocked that such a letter would've been received last week and that none of us have known about it until now— hours before it has turned up in the News and Observer. It feels like a serious breech of trust to have kept such recommendations from the campus community of faculty, staff, and students. Yesterday, I received word from a faculty member that in student stores, which was packed, only a third of people there were wearing masks. Just now I received a video from a citizen who videotaped a line of what appeared to be sorority women —at least 50—coming out from an indoor, unmasked gathering at 210 Ransom Street. These look like off ramps to me. For myself, I am changing my plans to hold a in in person orientation for our doctoral students tomorrow, and my class that was planned to be delivered in person will change to remote. I could not possibly do otherwise in the face of such a letter from our local health department. Since assuming this role, it has been my intention to interact collaboratively. I recognize that people occupying roles such as yours are balancing many competing priorities and, that in the current environment, the choices are very difficult. However, with outside guidance from public health authorities such as is included in this letter, to proceed without completely candid discussion with your faculty, as well as other interested parties, feels like a betrayal. I urge you to call a meeting of the general faculty immediately and to address the concerns that are outlined in this letter. Or if you would like me to call it, I will. If the implications of this letter means that we must send some students home, that is how it will have to be. If it means bringing this information to the BOG so that they might grapple with the implications of ignoring these warnings, then by all http://pulse.ncpolicywatch.org/...-recommendation/?fbclid=IwAR3_g5um-lYOaaewVNUmTXj3ylfPoSZke-08VcOgnABaraGZ-A1SH1kTDaA[8/6/20, 10:10:37 AM] Chair of UNC-CH faculty:"a serious breach of trust"campus not aware of Orange County health recommendation I The Progressive Pulse means do that, and I will stand with you. I look forward to speaking soon. With best regards, i Mimi Possibly related posts: 1. UNC-Chapel Hill considering timing of graduation, return for fall semester 2. UNC-Chapel Hill outlines plans for return to campus 3. UNC-Chapel Hill instructor petition calls for masks, testing, option to teach online-only 4. Faculty urge UNC System leaders to move Fall semester online as COVID-19 pandemic worsens 5. UNC-Chapel Hill Faculty Chair to UNC Board of Governors: OAllow decision- making at the local IevelO on COVID-19 pandemic • ® UNC :•A•• OF • •• CHANCELLORUNC-CHAPEL HILL Previous Post Next Post op Homeland Secure o icia vows a era agen s is corpora ions are enjoying record profits an Owill not back away0 from violent protests how are they contributing to the recovery? LEAVE A REPLY Your email address will not be published. Required fields are marked Comment L AEL http://pulse.ncpolicywatch.org/...-recommendation/?fbclid=IwAR3_g5um-IYOaaewVNUmTXj3ylfPoSZke-08VcOgnABaraGZ-A1SH1kTDaA[8/6/20, 10:10:37 AM] Message from Chancellor Guskiewicz on letter from the Orange County Health Department I UNC-Chapel Hill DISCOVER Navigate Search Vivivc Message from Chancellor Guskiewicz on letter from the Orange County Health Department "We reviewed their recommendations, and carefully analyzed our current status and the steps we were actively taking to de-densify our campus. We believe we have made significant progress towards aligning with the OCHD's general recommendations and considerations." Posted by University Communications,Wednesday,August 5th, 2020 AMC r4r .y p ! 7 % y 9 View of the Morehead-Patterson Bell Tower on June 5, 2019, on the campus of the University of North https://www.unc.edu/posts/2020/08/05/message-f om-guskiewicz-on-letter-from-the-orange-county-health-departmen/[8/6/20, 10:08:00 AM] Message from Chancellor Guskiewicz on letter from the Orange County Health Department I UNC-Chapel Hill I am writing to update you on a letter I received late last Wednesday night (July 29, 2020) from the Orange County Health Department (OCHD), my subsequent conversations to clarify the points made in that letter and specific actions we have taken that we believe address their concerns. It is important to note that we have had a very cooperative and collegial working relationship with the OCHD for many years, but especially over the past months with direct and weekly interactions between the OCHD and Executive Vice Chancellor and Provost Bob Blouin and Vice Chancellor for Institutional Integrity and Risk Management George Battle. In the letter, the OCHD "...recommends that the University of North Carolina at Chapel Hill consider..." and offered two recommendations for consideration : 1. "*Restrict on campus housing to at-risk students with no access to equitable educational resources and those with true housing needs (i.e. International students, Carolina Covenant & marginalized students)" 2. "Consider virtual classes for the entire Fall Semester but at minimum begin the first 5 weeks of the semester with online instruction only with plans to reassess the situation at the 5 week mark" They also raised questions regarding testing capacity and transportation. While the OCHD letter was not an order or a mandate for the University to take any specific action, as always, I took their recommendations very seriously and convened a meeting Thursday morning of our infectious disease and public health experts, as well as senior leaders on our Roadmap Implementation Team, just hours after receiving the letter. We reviewed their recommendations, and carefully analyzed our current status and the steps we were actively taking to de-densify our campus. We believe we have made significant progress towards aligning with the OCHD's general recommendations and considerations. https://www.unc.edu/posts/2020/08/05/message-from-guskiewicz-on-letter-from-the-orange-county-health-department/[8/6/20, 10:08:00 AM] Message from Chancellor Guskiewicz on letter from the Orange County Health Department I UNC-Chapel Hill • We have increased the number of courses with hybrid capacity thereby limiting on- campus in-person classroom occupancy to only 30%. • We reduced our on-campus residential capacity to 64%. • We have worked closely with UNC Health Care to increase our testing capacity. We have a robust testing program consistent with the CDC's guidelines for colleges and universities. • The Town of Chapel Hill and our regional transit partners have increased the frequency of routes and added additional vehicles to compensate for the reduced bus capacities. In addition, we have added bus capacity through Carolina Livery to supplement Chapel Hill Transit service. • We are offering increased daily on-campus parking options. Weeknight parking now begins earlier, at 4 p.m. in designated lots, and students are eligible for weeknight parking through reduced student fees. Employee and student permits are now virtual, and reduced pricing is available for commuters and teleworkers. We had several immediate follow-up meetings. Early Thursday morning (July 30) Provost Blouin had a meeting with both the OCHD Health Director Quintana Stewart and the OCHD Medical Director Dr. Erica Pettigrew and briefly discussed the communication. On Friday I personally called Quintana and Erica separately to clarify the intent of their letter and we had a very constructive conversation. During the call, I updated them with our progress toward campus de-densification as well as other initiatives we are employing throughout our campus to create a safe learning and working environment. I also reiterated that we believe we are well prepared for the start of the fall semester and we will continue to track trends that could lead us to recommend a modification to our plans. Soon after, I discussed this matter with the UNC System and we were advised by the UNC System to stay the course with our current plan. The University will continue to regularly advise and consult our partners at the OCHD as we navigate the days and weeks ahead. Sincerely, Kevin M. Guskiewicz https://www.unc.edu/posts/2020/08/05/message-from-guskiewicz-on-letter-from-the-orange-county-health-department/[8/6/20, 10:08:00 AM] UNC-Chapel Hill provost defends withholding county health department pandemic recommendations I The Progressive Pulse THE PROGRESSIVE PULSE . . EDUCATION, UNC-Chapel Hill provost defends withholding county health department pandemic recommendations Joe Killian ❑ 6 days ago ❑ Leave a comment ❑ In COVID-19, Education, Higher Ed, News This week UNC-Chapel Hill Provost Bob Blouin defended withholding the Orange County Health Department directorOs recommendation that the school move completely online for the Fall semester and cut on-campus housing to a bare minimum. BlouinOs explanation came during a Faculty Executive Committee meeting Monday afternoon. The health department letter, which many faculty members first learned about through media reports, led to a tense faculty meeting last week at which Blouin and Chancellor Kevin Guskiewicz faced strong criticism. Many faculty members, who also heard about this summerOs cluster of infections among student athletes on campus through media reports, called the continued lack of transparency from school administrators disappointing. Dr. Mimi Chapman, chair of the schoolOs faculty, called the failure to disclose the health directorOs recommendation Oa serious breach of trust.6 On Monday Blouin returned to the letter, explaining that he and Guskiewicz did not believe that a memo from the countyOs health departmentOs http://pulse.ncpolicywatch.org/2020/08/11/unc-chapel-hill-provost-defends-withholding-county-health-department-pandemic-recommendations/[8/17/20,3:00:47 PM] UNC-Chapel Hill provost defends withholding county health department pandemic recommendations The Progressive Pulse r director was the G departmentOs official position. UNC-Chapel Hill Provost Bob Blouin OWas this an official position of the health department?O Blouin said. OI guess we didnOt treat it as a position statement. If it was, they would have posted it on their website as a public release.0 The retailed three page memo on health department letterhead, was addressed to Blouin, Guskiewicz and Vice Chancellor George Battle. It was copied to the county health department medical director and the medical director of occupational health care at UNC. It contained the following paragraph: OAt this time, the Orange County Health Department recommends that the University of North Carolina at Chapel Hill consider the following: * Restrict on campus housing to at-risk students with no access to equitable educational resources and those with true housing needs (i.e. International students, Carolina Covenant & marginalized students) * Consider virtual classes for the entire Fall Semester but at minimum begin the first 5 weeks of the semester with online instruction only with plans to reassess the situation at the 5 week mark.0 It also concluded that the departmentOs recommendation did not come lightly but Ofrom the public health perspective with the best information we have at the current http://pulse.ncpolicywatch.org/2020/08/11/unc-chapel-hill-provost-defends-withholding-county-health-department-pandemic-recommendations/[8/17/20,3:00:47 PM] UNC-Chapel Hill provost defends withholding county health department pandemic recommendations I The Progressive Pulse time during these extraordinary circumstances. Given all that, several faculty members seemed incredulous that the administration did not consider the memo an official position of the health department or something that warranted sharing with the wider community. Administrators thought of the memo as a more of an informal summation of ongoing conversations, Blouin said. He didnOt see it as a public document or bsomething that needed to be shared,O he said, and didnOt believe the health department did either. Sources inside the health department told Policy Watch last week that the memo was the result of the departmentOs suggestions not making any impact on the schoolbs decision making. When the memo itself did not change the schoolOs plan, the department ultimately sent the memo to local elected officials, who made it public. Eric Muller, a law professor at UNC-Chapel Hill and member of the Faculty Executive Committee, asked why the administration had come to the conclusion that those recommendations did not warrant immediate action whether or not it was made public. Blouin said they believed they were already addressing the health department concerns bin spirit.b That answer did not satisfy many faculty members. Rather than going online for the fall semester N or at least the first five weeks N the campus began classes Monday, with a mixture of online and in-person instruction. Instead of restricting housing to those without other available housing, the university pushed forward with a plan to have full capacity dorms. The density in the residence halls is down to 61 percent overall, Blouin said, Monday N but that is not the result of university restrictions but concerned students and their families getting out of their housing contracts. bWe thought it would be better if students made the determinations more on their own rather than being directed in one way or another,b Blouin said last week. The university extended the period in which students could withdraw from contracts, but did not encourage them to do so. The schoolOs Carolina Away online program has http://pulse.ncpolicywatch.org/2020/08/11/unc-chapel-hill-provost-defends-withholding-county-health-department-pandemic-recommendations/[8/17/20,3:00:47 PM] UNC-Chapel Hill provost defends withholding county health department pandemic recommendations I The Progressive Pulse been popular with students opting out of in-person instruction but, again, the university has not actively encouraged students to move online and away from residential, in- person instruction as a result of the pandemic. With the university having therefore followed none of the recommendations from the health department, several faculty members said, it was difficult to determine how administrators considered they were already well on their way to addressing the departmentOs concerns and didnOt need to make the community aware of them. Possibly related posts: 1. UNC-Chapel Hill instructor petition calls for masks, testing, option to teach online- only 2. Faculty urge UNC System leaders to move Fall semester online as COVID-19 pandemic worsens 3. UNC-Chapel Hill Faculty Chair to UNC Board of Governors: OAllow decision-making at the local IevelO on COVID-19 pandemic 4. Unions call for county health directors to shut down in-person instruction at UNC schools in pandemic 5. UNC System aiming for fall re-opening of campuses, avoiding tuition increases . •. UNC BOARD OF GOVERNORS Irevious Postj [Next Post ❑ nire calculator weighs risk of airborne Court denies Lt. GovernorOs request or COVID-19 transmission in classrooms injunction on GovernorOs pandemic orders LEAVE A REPLY Your email address will not be published. Required fields are marked Comment http://pulse.ncpolicywatch.org/2020/08/11/unc-chapel-hill-provost-defends-withholding-county-health-department-pandemic-recommendations/[8/17/20,3:00:47 PM] UNC-Chapel Hill leaders come under fire at emergency faculty meeting i NC Policy Watch AUGUST 7,2020 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ C POLICY WATC u stories 8� voices n that matter. Home / COVID-19 / UNC-Chapel Hill leaders come under fire at emergency faculty meeting UNC-Chapel Hill leaders come under fire at emergency faculty meeting By Joe Killian -8/6/2020 -in COVID-19,Higher Ed,Policy Watch Investigates,Top Story Print This Article a Facebook 782 d Twitter 30 v Email 40 _T r' '' Chancellor's failure - to share health - _ t department's f reopening recommendations a called a"breach of trust" The Orange County Health Director has urged the University of North Carolina at ' Chapel Hill to move to online education for the fall semester and - - ' keep on-campus housing to an absolute 7 minimum as the The campus of UNC-Chapel Hill. (Photo:Mx Granger/Creative Commons CCO) COVID-19 pandemic in the county worsens. The campus will be doing neither of those things,Chancellor Kevin Guskiewicz said Wednesday. Health Director Quintana Stewart made the recommendations in a July 29 memo to Guskiewicz.Faculty, staff,students and members of the community only became aware of the memo Wednesday,when it was reported by media outlets including Policy Watch. https://www.ncpolicywatch.com/2020/08/06/unc-chapel-hill-leaders-come-under-fire-at-emergency-faculty-meeting/[8/7/20, 10:18:52 AM] UNC-Chapel Hill leaders come under fire at emergency faculty meeting I NC Policy Watch In the memo, Stewart expressed concern over signs returning students have already contributed to spikes and clusters of infections. She recommended an all-online fall semester or,at a minimum,holding the first five weeks of the semester online-only. She also recommended the school restrict on-campus housing to those who would otherwise have nowhere to live,in order to slow community spread of the disease. Confronted with the letter and questions about why his office did not disclose the health department's concerns,Guskiewicz told an emergency Faculty Executive Committee meeting the school is taking several lesser steps to address them.These will include reducing classroom capacity to 30 percent and dorm capacity to 64 percent—an announcement that students,staff and faculty said they learned of for the first time at Wednesday's meeting. Guskiewicz emphasized the school has been meeting with the Orange County Health Department throughout the summer and met with it again Friday after Stewart's letter.But these were recommendations,Guskiewicz said—not an order.The UNC System has said schools would have to follow an order by the health department,but not recommendations. The chancellor described the Orange County Health Department's recommendations as"another piece of information we have received." But after consulting with UNC health experts and the UNC System—which will make the final decision on closures— the university decided not to follow the health department recommendations. "We believe,based on the advice of our public health and infectious disease experts who weighed in on this last week,that we still have a roadmap that can bring people back safely in this environment who have chosen to do so,"Guskiewicz said. a. a f Guskiewicz said he spoke to UNC System President Peter Hans and former Interim UNC President Bill Roper last week to discuss the health department recommendations. "We were advised to stay the course,"Guskiewicz said. AANLJ Chancellor Kevin Guskiewicz Orange County Health Department officials disagree with the decision,he said,and have made that clear. "They still had concerns,no question,"Guskeiwicz said,"But who doesn't have concerns?" Faculty `dismay' Guskiewicz's statements were not well received by faculty. The emergency faculty meeting came together quickly Wednesday after a letter was sent to the chancellor by Dr. Mimi Chapman, chair of the UNC-Chapel Hill faculty, regarding the health department recommendations. "It feels like a serious breach of trust to have kept such recommendations from https://www.ncpolicywatch.com/2020/08/06/unc-chapel-hill-leaders-come-under-fire-at-emergency-faculty-meeting/[8/7/20, 10:18:52 AM] UNC-Chapel Hill leaders come under fire at emergency faculty meeting I NC Policy Watch the campus community of faculty, staff and students,"Chapman said. In the email,for which the subject line was"Dismay,"Chapman went on to say 5 she has personally changed her plans to hold an in-person orientation for doctoral students this week.The class she planned to teach in person this semester will change to remote, she wrote. "I could not possibly do otherwise in the face of such a letter from our local health department,"Chapman wrote. Such a move by the faculty's chair could lead many UNC-Chapel Hill faculty already uncomfortable with teaching in-person this semester to follow suit,citing the health department recommendations. Chapman pointed to already rampant flouting of mask and distancing rules on campus, in student stores and at off campus gatherings. "These look like off-ramps to me,"referring to the term UNC-Chapel Hill has Dr.Mimi Chapman, chair of the UNC-Chapel Hill used to indicate things that would lead the school to detour from its"roadmap to faculty return"and back to the online-only instruction of last semester. Chapman reiterated her disappointment that the administration kept the recommendations from faculty,who have been working for months to make the university's return plan a success despite their reservations. "However,with outside guidance from public health authorities such as is included in this letter,to proceed without completely candid discussion with your faculty,as well as other interested parties, feels like a betrayal,"Chapman wrote. Deb Aikat, a member of the Faculty Executive Committee, said it is at least"a disconnect"in communication between the administration,faculty and the students. "Today the chancellor and the provost have shown almost a willing suspension of disbelief,"Aikat said. "Like, `Oh my God...the community,Orange County Health Department and campus community are not with us?"' That should have been obvious well before now,Aikat said,after months of repeated concerns,protests and petitions over the return plan.All of that seems to have had little impact on the administration's determination to open for in-person instruction in the fall, Aikat said. "It feels like they are struggling to say that everybody is wrong, and they feel like they are doing the right thing,"Aikat said. "`We think we're doing the right thing,'they say,"So this is the way we're going to go."' If even objections from the Orange County Health Department don't make a dent,Aikat said,it seems obvious that the administration does not have the power to change course. https://www.ncpolicywatch.com/2020/08/06/unc-chapel-hill-leaders-come-under-fire-at-emergency-faculty-meeting/[8/7/20, 10:18:52 AM] UNC-Chapel Hill leaders come under fire at emergency faculty meeting I NC Policy Watch "This is all going to be decided at the UNC System level,the Board of Governors,"Aikat said. "The chancellor is in a position where he does not have the power to make this decision." Chapman seemed to agree during the faculty meeting. "As I understand it,the system said`stay the course,'Chapman said. "So that's what's happening.We might not all be fine with that, but it sounds like that's what's happening." Policy Watch reached out to the UNC System office and UNC Board of Governors Wednesday. Emails and phone messages were not returned. Eric Muller,another Faculty Executive Committee member,also + expressed frustration such strong public health recommendations from Orange County could be dismissed because they were not in the form of an order. "Does that mean that someone or some group of people on our team affirmatively disagreed with the advice we received from the Orange County Health Department?"Muller asked Guskeiwicz during the faculty meeting. r, t Guskiewicz did not answer. Eric Muller,Faculty Executive Committee member, "There are a lot of opinions about what to do and the rationale for doing it,"Provost Bob Blouin said in answer to the question. "And there is sometimes unanimity around the experts and sometimes there is less than unanimity around the experts." Blouin also said the university had to consider that most students have either begun moving onto campus or had signed leases off- campus. They had to consider the impact on them of dramatically reversing course. Health department employees dispute UNC leaders'characterization of county-campus communications Both Blouin and Guskiewicz framed the Orange County Health Department recommendations as having come suddenly and at the last moment. Guskiewicz said he did not know the motivation of the health director in writing the letter rather than communicating the recommendations to the school in the course of their frequent meetings on the return plan. Two employees of the Orange County Health Department with knowledge of the discussions,however,told Policy Watch Wednesday that that is a mischaracterization. The employees,who Policy Watch agreed not to identify because they expressed concern about being fired for discussing health department discussions with the university, said the department has frequently expressed its concerns with the university's move-in plan.Those concerns have become more urgent in the last month,they said,as infection and hospitalization numbers have not improved and infection clusters among returning student athletes have made it clear students were not following masking or distancing rules. https://www.ncpolicywatch.com/2020/08/06/unc-chapel-hill-leaders-come-under-fire-at-emergency-faculty-meeting/[8/7/20, 10:18:52 AM] UNC-Chapel Hill leaders come under fire at emergency faculty meeting I NC Policy Watch "The department's recommendations were not having any effect on the university,which just wanted to continue with the plan it had,"one of the employees said. "So now there is a letter the public can read with those concerns spelled out and the chancellor announces,on the same day that it becomes public instead of a private conversation,that they are making changes to the housing and classroom plans. It's curious how that works." The employee pointed to the university own COVID-19 dashboard,which shows 175 infections on campus as of Tuesday,when it was last updated. Of those, 139 are students.While the university is not requiring tests of students moving back to campus,the infection rate among students who have been tested is 10.6%.The statewide infection rate is 8%. As most students have not yet moved onto campus,the health department source said,that elevated rate likely represents just the beginning. "Looking at that data, of course the health department has a problem with this plan,"the employee said. The lack of a public record of the county health department's position was a problem,the other employee said,because it allowed the university to say publicly that it was working in collaboration with the department without actually taking any of their recommendations. "You can't say that you are working with public health experts,public health authorities,on your plan and then overrule those experts and authorities in your actual plan,"the employee said. "If they are going to say that they think they know better than the Orange County Health Department,then they need to say that publicly,"the source said. "They need to say publicly that they've seen the recommendations but they're not going to follow it. People should know that." Q Print This Article O 782 O 30 000 40 Ft Joe Killian ❑ Joe Killian,Investigative Reporter,joined N.C.Policy Watch in August of 2016.His work takes a closer i look at government,politics and policy in North Carolina and their impact on the lives of everyday people. Before joining Policy Watch,Joe spent a decade at the News&Record in Greensboro,reporting on everything from cops and courts to higher education.He covered the city councils of High Point and Greensboro and the Guilford County Board of Commissioners before becoming the paper's full-time government and politics reporter.His work has also appeared in the Winston-Salem Journal, Go Triad,the Bristol Press in Bristol, Conn.,and the Cape Cod Times in Hyannis,Mass. joe@ncpolicywatch.com 919-863-2402 Follow . https://www.ncpolicywatch.com/2020/08/06/unc-chapel-hill-leaders-come-under-fire-at-emergency-faculty-meeting/[8/7/20, 10:18:52 AM] UNC-Chapel Hill leaders come under fire at emergency faculty meeting I NC Policy Watch Related Posts: College students,professors adjust to COVID-19 life Pandemic bringing changes to higher education that could be long-lasting Parents struggle with question of return to UNC campuses PW exclusive: UNC System exploring worst-case scenario budget cuts of up to 50% Previous article Next article ❑ Still white after all these years: One Lessons and legal scars from the failed woman's battle with racism and white Atlantic Coast Pipeline supremacy culture About © Like us on Facebook Subscribe Donate Follow us on Twitter Code of Ethics Careers NC Justice Center 13Find us on YouTube Follow us on Instagram ® Listen to our Podcasts Subscribe to our RSS Feed https://www.ncpolicywatch.com/2020/08/06/unc-chapel-hill-leaders-come-under-fire-at-emergency-faculty-meeting/[8/7/20, 10:18:52 AM] UNC Chapel Hill making changes in time for Monday reopening-ABC 11 Raleigh-Durham BREAKING NEWS NC has first reported case of coronavirus in a dog V •• In Ifabc • EDIT EDUCATION UNC Chapel Hill making changes in time for Monday reopening By Gloria Rodriguez SHARE TWEET EMAIL CHAPEL HILL, N.C. (WTVD) -- UNC Chapel Hill Executive Vice Chancellor, Provost Robert Blouin and Housing Director Allan Blattner responded Thursday to the Orange County Health Department's recommendation that the school reopen with exclusively virtual classes for the beginning of the semester. Blouin said they've been working on a reopening plan since May to: "Make sure that we can pursue the mission of this university-the mission of research, education and public service at this university. And it is our general https://abcl I.com/unc-chapel-hill-orange-county-reopening-college/6358161/[8/11/20,2:49:24 PM] UNC Chapel Hill making changes in time for Monday reopening-ABC 11 Raleigh-Durham belief that we can do that best when we come to campus and work together." TOMORROW-Orange County,N.C. leaders will talk about options for education and enforcement around gatherings, mask wearing and other safety requirements. This comes after video went viral of @ UNC students at a packed house party, not wearing masks or social distancing. #abcil — Gloria Rodriguez(@GloriaABCll)August 6, 2020 The letter from the Orange County Health Department to university administrators also recommended restricting on-campus housing to at-risk students such as international and marginalized students. LIST: North Carolina university, college COVID-ig plans for the 2020-2021 school year In an email sent to the campus community, including students, Chancellor Kevin M. Guskiewicz said the Orange County Health Department's letter was not a mandate but that they take their recommendations very seriously. WATCH THE MEETING https://abcl I.com/une-chapel-hill-orange-county-reopening-college/6358161/[8/11/20,2:49:24 PM] UNC Chapel Hill making changes in time for Monday reopening-ABC 11 Raleigh-Durham They've decided to make some changes including: • Limiting on-campus in-person classroom occupancy to 30 percent • Reducing on-campus residential capacity to 64 percent • Increasing their testing capacity • Increasing the frequency of bus routes with the town and transit partners • Increasing on-campus parking options FULL BACK-TO-SCHOOL COVERAGE In the letter, the Chancellor said they believe they are well-prepared to start the fall semester and will stick with their plan to reopen. He said they believe they made significant progress to align with the recommendations of the Orange County Health Department. Students must agree to the COVID-19 Student Acknowledgment and all on campus will get a kit including two reusable face masks, hand sanitizer and a thermometer. When students return to classes Monday, they won't be able to take the traditional "first sip" from the old well due to safety concerns. Students believe it brings good luck and good grades. If a student tests positive for COVID-19, Blattner said they'll be assigned an isolation dorm and receive https://abcl l.com/unc-chapel-hill-orange-county-reopening-college/6358161/[8/11/20,2:49:24 PM] UNC Chapel Hill making changes in time for Monday reopening-ABC 11 Raleigh-Durham "wraparound care." If an off-campus student does not have space for safe isolation or quarantine, on-campus isolation or quarantine space is available to them, university officials said. "We will deliver meals to them," Blattner said. "They will have health monitoring from our health center. Our Dean of Students' office will reach out to them. Obviously if they have a face-to-face class, they're going to need to not be present in that class for a period of time." University administrators say they've taken two buildings offline for isolation and quarantine. The bed count capacity for housing is 7,877 and they only have 4,990 contracts now. Blattner said that is because of the university taking the direction to reduce housing capacity. Some classes are going virtual and students may not need on-campus housing anymore. All residential students may cancel their housing contract for any reason and without penalty before 5 p.m. Friday, August 7, 202o, according to university officials. More information here. Report a correction or typo RELATED TOPICS: education chapel hill carolina comeback unc coronavirus college return to learn covid 19 pandemic SHARE TWEET EMAIL https://abcl I.com/une-chapel-hill-orange-county-reopening-college/6358161/[8/11/20,2:49:24 PM] ChapelUNC •. reopening Copyright @ 2020 WTVD-TV. All Rights Reserved. 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Editorial:We all saw this coming-The Daily Tar Heel Stay up-to-date with The Daily Tar Heel 0 LAST UP Edit Welcome to the 2020-21 edition of The Daily Tar Heel, now in our 128th year! c COVID-19 brings significant challenges to the UNC, Chapel Hill and Orange 0 r Daily Dar Nrrt Serving the students and the University community since 1893 IN THE NEWS 2020 CORONAVIRUS OUTBREAK THEOC REPORT ELEVATE:AMPLIFYING VOICES IN OUR COMMUNITY FOOTBA No, thank you LAST UPDATED 18 HOURS AGO Editorial; We all saw this coming clusterfuck{ny:a compiex and utterly disordered and mismanaged situation x •,""2J%1 r - Signs prom Close Wednesda Department c protest called letter of c Stewa Signs promoting social distancing and safety at the Die-In Protest on Wednesday,Aug.5,2020 as Jen nifer Standish,a UNC graduate student in the Department of History,speaks outside of South Building on Wednesday,Aug.5,2020.-the protest called far UNC to transition to fully remote classes for the Fall 2020 semester after letter of caution sent to Chancellor Guskiewia by the Orange County Health Director Quintana Stewart. ANGEL INA KATSANIS SHARE BY EDfTt3RIAL 90ARa cam We're only a week into the semester and four COVID-19 clusters have already 0 SHARE surfaced on and around campus. TWEET Two COVID-19 clusters—one at Granville Towers and one at Ehringhaus Residence Hall—were reported.Friday.On Saturday,UNIC confirmed reports https://www.dailytarheel.com/article/2020/08/covid-clusters-edit-0816[8/17/20,2:53:05 PM] Editorial:We all saw this coming-The Daily Tar Heel reported Friday. On Saturday, UNC confirmed reports of a third cluster at the Sigma Nu fraternity house, and a fourth, at Hinton James Residence Hall, was reported Sunday. In the messages, UNC clarified that a "cluster" is five or more cases deemed "close proximity in location," as defined by the N.C. Department of Health and Human Services. We all saw this coming. In his fall semester welcome message, Chancellor Kevin Guskiewicz wrote, "As always, remember that it is our shared responsibility to keep each other safe. Every person you walk by on campus will be counting on you to diligently work to prevent the spread of the virus." But University leadership should have expected students, many of whom are now living on their own for the first time, to be reckless. Reports of parties throughout the weekend come as no surprise. Though these students are not faultless, it was the University's responsibility to disincentivize such gatherings by reconsidering its plans to operate in-person earlier on. EDITORS PICKS kok k. Carrboro High School Heel Talk episode 17: New UNC community members students created a podcast campus technology raises write letters asking for to amplify minority data privacy concerns accountability, protection students' voices I The administration continues to prove they have no shame, and the bar for basic decency keeps getting lower. They chose to ignore the Orange County Health Department, which recommended that the University restrict on-campus housing to at-risk students and implement online-only instruction for the first five weeks of the semester. They chose to ignore the guidance of the CDC, which placed the University's housing plan in the "highest-risk" category. Even faculty though many of them continued to teach classes in-person— saw it coming. Now, as we prepare for a second week of classes, many questions remain unanswered. What factors will trigger the so-called off-ramps, and what will they look like? How many positive cases will it take for the University to realize the danger they've put us in? https://www.dailytarheel.com/article/2020/08/covid-clusters-edit-0816[8/17/20,2:53:05 PM] UNC-Chapel Hill Classes To Move Online After 130 Students Test Positive In First Week:Coronavirus Live Updates:NPR 6 1 1 �il:lollllil� S. Coronavirus Live Updates UNC-Chapel Hill Classes To Move Online After 130 Students Test Positive In First Week August 16, 2020 ' 10:18 PM ET RACHEL TREISMAN x 4 M 4 ,i• f # :7k + 4' 7 5 ^r w Starting Wednesday, all undergraduate in-person instruction will be remote at the University of North Carolina at Chapel Hill, pictured in 2015. https://www.npr.org/...irus-live-updates/2020/08/16/903071127/less-than-a-week-after-starting-classes-unc-chapel-hill-reports-4-covid-l9-clust[8/18/20,8:30:30 AM] UNC-Chapel Hill Classes To Move Online After 130 Students Test Positive In First Week:Coronavirus Live Updates:NPR Gerry Broome/AP Updated at 7:01 p.m. ET Monday The University of North Carolina at Chapel Hill is shifting undergraduate instruction entirely online after 130 students tested positive for the coronavirus during its first week of classes. Chancellor Kevin Guskiewicz and Provost Robert Blouin announced the reversal Monday, one week after classes started and two weeks after residence halls opened at limited capacity. They noted that less than 30% of"total classroom seats" were being taught in person. Even with guidelines and precautions in place, case counts soared in a matter of days. According to a campus dashboard, 130 students and five employees tested positive last week. Officials wrote that between Aug. 10 and Aug. 16, the positivity rate on campus rose from 2.8% to 13.6%. As of Monday morning, they said 177 students are in isolation, and 349 are in quarantine, and most have demonstrated only "mild symptoms." "As much as we believe we have worked diligently to help create a healthy and safe campus living and learning environment, the current data presents an untenable situation," officials wrote. Starting Wednesday, all undergraduate in-person instruction will be remote. Officials acknowledged that this change, and the "reduction of campus activities," means the majority of current undergraduate students living on campus will change their plans for the fall. "We are working with the UNC System office to identify the most effective way to https://www.npr.org/...irus-live-updates/2020/08/16/903071127/less-than-a-week-after-starting-classes-unc-chapel-hill-reports-4-covid-l9-clust[8/18/20,8:30:30 AM] UNC-Chapel Hill Classes To Move Online After 130 Students Test Positive In First Week:Coronavirus Live Updates:NPR further achieve de-densification of our residential halls and our campus facilities," Guskiewicz and Blouin wrote. They added that residents who "have hardships" such as lacking Internet access as well as international students and student athletes can choose to remain on campus. According to UNC System President Peter Hans, there are no current plans to modify operations at any of its other universities. Calls to reconsider in-person learning intensified over the weekend as the school reported four clusters of coronavirus cases in three days. On Saturday, Faculty Chair Mimi Chapman sent a letter to the UNC System board of governors advocating for more campus-based authority to respond to the pandemic. "We knew there would be positive cases on our campus," she wrote. "But clusters, five or more people that are connected in one place, are a different story. The presence of clusters should be triggering reconsideration of residential, in-person learning." Barbara Rimer, dean of the Gillings School of Global Public Health at UNC, called for taking an "off-ramp" in a blog post Monday in which she wrote that "we have tried to make this work but it is not working." Rimer said it seemed that students on campus were practicing social distancing and wearing masks, but "reports of off-campus behavior showed a different pattern." She tweeted later Monday that she was pleased with the administration's decision to move undergraduate classes online and accept residence hall cancellation requests with no penalty, calling it "the right path forward." The decision comes one day after the school announced it had identified its fourth cluster, which health officials define as five or more cases in a single residential https://www.npr.org/...irus-live-updates/2020/08/16/903071127/less-than-a-week-after-starting-classes-unc-chapel-hill-reports-4-covid-l9-clust[8/18/20,8:30:30 AM] UNC-Chapel Hill Classes To Move Online After 130 Students Test Positive In First Week:Coronavirus Live Updates:NPR hall or dwelling. The latest cluster is at Hinton James Residence Hall, the university said in an alert. According to the university's website, the living space typically houses more than goo students, many of whom are in their first year. The individuals in the cluster are isolating and receiving medical monitoring, the university said, and all dormitory residents have been given "additional information about this cluster and next steps." Contact tracing is underway, the university said. Reports of clusters have streamed in since fall classes started on Aug. lo. On Friday, the university announced it had identified SHOTS - two separate sets of clusters: one at a residence hall HEALTH NEWS heavily populated by first-year students and one at a To Keep privately managed apartment complex that houses CampusesSafe, Some UNC students. The following day, it announced an Colleges To Test Students additional cluster at an off-campus fraternity house. For Coronavirus Twice A Week UNC-Chapel Hill kicked off the school year with about 5,800 students in dorms, which accounted for more than half of the available beds, The Washington Post reported. Other students are living nearby off-campus. Classes have been offered through a handful of models, including face-to-face, remote only and a mix of both. The university said that it had been preparing for five months to identify, trace and isolate potential positive cases on and off-campus as part of its fall reopening plan. The plan included guidelines for face coverings, physical distancing and on- campus gatherings, which are limited to 25 people both indoors and outdoors. (State public health orders limit gatherings to a maximum of io people indoors https://www.npr.org/...irus-live-updates/2020/08/16/903071127/less-than-a-week-after-starting-classes-unc-chapel-hill-reports-4-covid-l9-clust[8/18/20,8:30:30 AM] UNC-Chapel Hill Classes To Move Online After 130 Students Test Positive In First Week:Coronavirus Live Updates:NPR and 25 outdoors.) The Daily Tar Heel reported on Thursday that police in Chapel Hill will ramp up patrols downtown and in student neighborhoods after receiving reports of people violating social distancing guidelines. As of Friday, 1,049 North Carolinians were THE hospitalized with the virus. CORONAVIRUS CRISIS Can Military Institutions of higher education across the country 's Academies Serve As A are starting their fall semesters as the global Road Map For pandemic stretches on. Some have already grappled Reopening Colleges? with a jump in infections, particularly in fraternity houses: Earlier this summer, both the University of Washington and the University of Mississippi dealt with outbreaks linked to Greek life. The New York Times reported at the end of July that more than 6,600 cases had been linked to about 270 colleges since the start of the pandemic. school reopening coronavirus in the u.s. university of north carolina chapel hill READ & LISTEN Home News Arts & Life Music Podcasts Programs https://www.npr.org/...irus-live-updates/2020/08/16/903071127/less-than-a-week-after-starting-classes-unc-chapel-hill-reports-4-covid-l9-clust[8/18/20,8:30:30 AM]