Loading...
HomeMy WebLinkAboutApproved Minutes of February 22, 2023 MINUTES ORANGE COUNTY BOARD OF HEALTH February 22, 2023 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 February 22, 2023, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, INC. BOARD OF HEALTH MEMBERS PRESENT: Aparna Jonnal —Vice-Chair, Bruce Baldwin, Commissioner Jamezetta Bedford, Brian Crandell, Lee Pickett, Rachel Royce, Alison Stuebe, and Tony Whitaker. BOARD OF HEALTH MEMBERS ABSENT: Keith Bagby and Shielda Rodgers. STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Health Services Director; Victoria Hudson, Environmental Health Director; Carla Julian, Compliance Manager; Jeremy McKoy, Community Health Aide; Thomas Privott, Environmental Health Supervisor; Kimberlee Quatrone, Business Officer II; Sandra Rimmer, Administrative Support I; La Toya Strange, Administrative Support I; and Marcy Williams, Public Health Education Manager. GUESTS/VISITORS PRESENT: None. I. Welcome New Employees Dr. Aparna Jonnal, Vice-Chair, called the meeting to order at 7:04pm. Dr. Jonnal introduced newly appointed BOCC Representative to the Board, Commissioner Jamezetta Bedford. The BOH members introduced themselves including their BOH seat representation and occupation. Quintana Stewart, Health Director, introduced the new employees in attendance, Jeremy McKoy and Sandra Rimmer. II. Public Comment for Items NOT on Printed Agenda: None. III. Approval of the February 22, 2023 Agenda Motion to approve the agenda of the February 22, 2023 BOH meeting with an edit to the presenter's name for the Proposed Fee Schedule agenda topic was made by Dr. Lee Pickett, seconded by Dr. Alison Stuebe and carried without dissent. IV. Action Items (Consent) A. Minutes of January 25, 2023 Motion to approve the minutes of the January 25, 2023 BOH meeting was made by Rachel Royce, seconded by Tony Whitaker and carried without dissent. V. Educational Sessions S:\Managers Working Files\BOH\Agenda &Abstracts\2023 Agenda &Abstracts/ February Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH February 22, 2023 A. Proposed Fee Schedule In reviewing Health Department fee schedules, which are done on an annual basis, the Department would like to make multiple fee changes in Environmental Health and Personal Health. The proposed changes are summarized below with a detailed list of the fees in the attached fee schedule: Environmental Health Environmental Health requests to adjust fees in multiple programs including Pools, On-Site Well & Septic and Food & Lodging. The Division proposes to reduce the New Well Construction Permit fee by an additional $50 to more closely align with neighboring Counties/State fees. They also would like to dispose of the Installer Renewal Fee. Installers are required to be certified by their own Board. Our local registration now serves as an "approved installer" list rather than credentialing. Additionally, four requested fee changes are to cover increased programmatic costs; these fees have not changed since 2017-2019. An additional $50 increase to the Mobile Food Unit Plan Review is requested. This was a planned three-year increase, this being year two. Lastly, the Health Department is requesting to add a credit card service fee to offset banking charges for using credit cards to pay for permits. This will mostly impact commercial and construction companies that pay for a great number of fees using a credit card. The total financial impact from Environmental Health fee changes is projected to be an increase of$16,405. Personal Health Personal Health requests to add 31 new fees to the fee schedule. About half of these are UNC Labs fees that are needed infrequently by patients. A few are new vaccines and the remainder are 340B oral contraceptives. They would also like to discontinue 8 fees that are no longer used. Finally, the Department requests to continue scheduled adjustments to the fees for 340B drugs to equal the County's cost to purchase them, as required by the state and federal government, and to reflect Medicaid, vendor, and Medicare rate changes. The total financial impact from Personal Health fee changes is projected to be a maximum increase of$20,004. Tony Whitaker commented that he appreciated that the credit card fees request as he didn't feel that this fee should come from a budget item. In response to Rachel Royce's question regarding 340B fees, Carla Julian replied that the states sets the fees. Ms. Julian also defined the three types of family planning according to NC statute. In response to Dr. Brian Crandell's question about the 340B drugs, Kimberlee Quatrone explained what the 340B drugs were for the OCHD. Dr. Aparna Jonnal commented on having to hire additional staff just to process claims due to Medicaid Transformation. Ms. Stewart informed the Board that many local health departments across the state are being affected financially and administratively due to the time it takes to resubmitting denied claims, reconciliation, etc. The PHPs are based on payment date vs the visit date. Some PHPs aren't honoring their agreement to pay claims within 6 months. Ms. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda &Abstracts/ February Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH February 22, 2023 Stewart continued by noting that it's affecting patients as some facilities aren't accepting Medicaid. Dr. Stuebe added that some facilities aren't accepting certain PHPs. B. FY 2023-24 Budget Quintana Stewart, Health Director, presented the Board with a summary of the proposed FY 2023-2024 budget for the Health Department. The Health Department will request a County General Fund budget in FY 23-24 of$8,431,535. This represents an increase to the FY 23-24 base budget of$34,380. The total increase in expenditures is $522,523 from the FY 23-24 Base Budget. • $257,578 comes from additional expenses for two fully funded state/federal programs. • $62,535 is primarily an increase in client transportation, training, medical supplies, pharmacy supplies, and interpreter services (of this $22,812 is training that was inadvertently left out of base and is being reinstated into the budget). • $202,410 is for an additional 3.575 FTE positions across multiple divisions Staff project a $488,143 increase in revenues for FY 23-24. This includes an overall increase in state/federal funding of$470,362. The balance of the revenue increase comes from Environmental Health fees, the bulk being a new credit card processing fee that will mostly impact contractors. The proposed total expenditure budget is $12,672,202 and the proposed total revenue budget is $4,240,667. The County General Fund request of$8,431,535 is less than 1% change from FY 23-24 base. New Staff Requests The Health Department requests 3.575 FTEs in personnel. Due to changes with Orange County Public Transit Department, the original cost-sharing of the MDC Driver position never came to fruition. The Dental Division requests to fill the other 0.5 FTE in order to mobilize the Mobile Dental Clinic. This position will be offset with $15,000 from Contract Services. Due to Medicaid Transformation, the Health Department requests 2.0 FTE in personnel to aid in processing Medicaid claims: 1.0 FTE for a Billing Technician which will assist with EPIC work queue processing and 1.0 FTE for an Accounting Technician II to assist with revenue collection and recording. Medicaid Transformation has resulted in a significant increase in the number of claims processed as well as number of denials that must be resubmitted. Currently a Billing Specialist processes claims and processes revenue collection and recording. By moving this to an Accounting Technician II, all of the Billing staff can concentrate on processing claims and denials. The OA II — Nutrition position is currently at a .925 FTE. The Health Department requests the additional .075 FTE to make this position a full 1.0 FTE not dependent on grant funding. The Health Department also requests a 1.0 FTE IT Support Specialist as the Department's IT and informatics demands have only continued to increase. The Department is in need of in- house technical support. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda &Abstracts/ February Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH February 22, 2023 State Funding The NC Department of Health and Human Services (NCDHHS) has provided us with a majority of the FY 23-24 Consolidated Agreement Addenda. We received an increase in Family Planning, BCCCP, CC4C, RIPS and CD Pandemic Recovery for a total amount of$631,315. We received a decline in funding for Healthy Communities, BT Preparedness and Refugee Health. Advancing Equity, COVID School Liaison and Speech and Hearing are no longer being funded and we have exhausted the funding provided by the COVID Testing and COVID Vaccine funding. This decrease is in the amount of$160,953. Staff anticipate various other public health allocations to be awarded in the coming months. Fee Changes The FY 23-24 requested budget includes fee changes and additions for the Personal Health and Environmental Health divisions. Staff recommends multiple fee changes for Personal Health, reflecting adjustments from vendors, Medicaid, Medicare, and as well as new UNC Labs, COVID-19 administration, and vaccine fees. Environmental Health fee changes include: lowering new well construction permit by another$50, adding a new Mobile Food Unit Plan Review fee to offset staffing costs for multiple site visits and increasing the Public Pool Plan Review which hasn't changed since 2018/19. Due to the large contractors/builders purchasing numerous permits and paying with credit cards, Environmental Health is losing a portion of each transaction to credit card fees, and therefore have requested a new fee for credit card processing. All proposed fee increases are described in more detail in a separate Fee Change abstract. In response to Dr. Alison Stuebe's question about wastewater sampling, Ms. Stewart stated that NC DHHS will be continue this program which tests wastewater for the virus that causes COVID-19. In response to Rachel Royce's question about CD Pandemic funds and outreach, Ms. Stewart replied that our new Communications Manager will assist with outreach and the dissemination of information. COVID-19 will be treated the same as flu in that cost will not be a deterrent for those needing vaccinations. In response to Dr. Stuebe's question regarding whether CD Pandemic funds can be used for mental health associated with the pandemic, Kimberlee Quatrone noted that there is statement that mentioned "reduce morbidity, etc." as an allowable expense. In response to Tony Whitaker's question regarding the requested IT position, Ms. Stewart clarified that it is indeed an IT person and not informatics. In response to Ms. Royce's question about interpreter services, Ms. Stewart stated that the visit is coded appropriately as each division uses those services. VII. Reports and Discussion with Possible Action A. Media Items Marcy Williams, Public Health Education Manager, briefly mentioned the article that was included in the agenda packet that was on UNC lead testing at its facilities on campus. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda &Abstracts/ February Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH February 22, 2023 Media items were in the packet, which focused on Orange County's events and our involvement in various efforts. B. Health Directors Report Some of the highlights provided by Ms. Stewart are below. • As of yesterday, February 21, 2023, the OCHD has a vacancy rate of 16% with 19 positions currently vacant. • The Dental Director position has been filled with an internal hire, Dr. Stephanie George. Dr. George completed 2 years practicum at the OCHD and has been employed as a dentist in OCHD's Dental Clinic for 7 years. With her promotion, we now have a vacant dentist position to fill. • The Personal Health Services Director interviewing process will be wrapping up this week. The Finance and Administrative Services Director is the next executive position to begin the interviewing and hiring process. • HB 108 which provides recurring funds in the amount of 25 million from the General Fund to the DHHS, Division of Public Health has been approved in the House. • Ms. Stewart will be meeting with Representative Allen Buansi next week. • The Federal Public Health Emergency Declaration ends on May 11, 2023. The OCHD still have at-home COVID tests. Dr. Jonnal asked if vacancies are an issue across other local health departments, to which Ms. Stewart replied yes. Ms. Stewart further commented that pay is not the cause for all of the vacancies and thanked the County HR and County Manager for their efforts in trying to stay competitive. Dr. Pickett added that many baby boomers are retiring. Dr. Baldwin chimed in by stating that many people want to work from home. Dr. Crandell asked whether the vacancies are crippling one division. Ms. Stewart responded by stating that it's spread out over all of the divisions, noting that the FAS division only has 1 vacancy. In response to Ms. Royce's question if training was a contributing issue, to which Ms. Stewart said no. In response to Mr. Whitaker's Question asking how to combat the vacancy issue in public health, Ms. Stewart replied by mentioned the statewide "I Am Public Health" campaign. Ms. Royce asked where to go for PCR tests. Ms. Stewart stated that they're available at primary care facilities; however, PCR testing isn't required anymore. Dr. Baldwin stated that at- home tests are still available via mail. Ms. Stewart added that anyone in need can call their local health departments as they have many. VIII. Board Comments BOH member, Tony Walker, expressed that the moving of the Communications Manager's supervision from Health Director Stewart falls in line with the plans that the Board had for her (concern was previously discussed about Ms. Stewart's workload). Dr. Stuebe aired her concerns regarding the abortion bans and how this may affect clinicians. She feared that this ban may affect medical students' decision to apply for gynecological specialty. In response to Dr. Crandell's question about the BOH Retreat date, Ms. Stewart stated S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda &Abstracts/ February Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH February 22, 2023 Saturday, March 1111. She also conveyed that, among other things, there will be opportunities for teambuilding and for the Board to voice their wants for how they want their meetings to run, etc. She also reiterated that she heard the Board when they mentioned decreasing the educational sessions. Ms. Strange will resend the BOH Retreat agenda to the Board members. XI. Adjournment A motion was made by Dr. Bruce Baldwin to adjourn the meeting at 8:26 p.m. was seconded by Dr. Lee Pickett and carried without dissent. The next Board of Health Meeting will be held March 22, 2023 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board S:\Managers Working Files\BOH\Agenda &Abstracts\2023 Agenda &Abstracts/ February Page 6