Harnett County Board of Health Minutes of Regular Meeting March 2, 2023  The Harnett County Board of Health met in regular session on Thursday, March 2, 2023 in the Health Department Board Room, Harnett County Governmental Complex, Members present: Dr. Laura Smith, OD, Chairwoman, Ms. Emily Barefoot, Commissioner Barbara McKoy, Dr. Amanda Langdon, DVM, Dr. Kim Fowler, PhD, Dr. Brandon Washington, DDS, Ms. Amy Allen, Ms. Staci Hogan, RPH, Ms. Gayle Adams, Ms. Linda Sturdivant, and Mr. John Rouse, Jr., Health Director. Other present: Mary Jane Sauls, Oliver Tolksdorf, Debra Harris-Hawkins, Ainsley  307 W. Cornelius Harnett Blvd., Lillington, North Carolina.  Johnson, Gail Hobbs, and Natasha Johnson.  Chairwoman Smith called meeting to order at 7:00 p.m.  Announcements - Mr. Rouse announced Dr. Brandon Washington, DDS, completed his Board of Health training on February 17, 2023. Dr. Laura Smith was reappointed for her third term, and Ms. Staci Hogan, RPH, was reappointed her second term by the Board of Commissioners. Mr. Rouse discussed the Board of Health was presented with the following revised policies: Policy on Policies, Board of Health Delegation of Duties to Health Director and Board of Health Orientation and On-going Training Policy. All policies were adapted and approved by the Board of Health. Board of Health Chairwoman, Dr. Laura Smith signed all three revised policies.  Consent Agenda = Minutes Motion made by Ms. Emily Barefoot, for the January 19, 2023 agenda and minutes to be approved and seconded by Dr. Amanda Consider additions and deletions to the published agenda - None made. Public Comment - Period of up to 30 minutes for informal comments allowing 3 minutes for each presentation = Chairwoman Smith opened the floor for informal comments by the public, allowing 3 minutes for each presentation up to 30 minutes. FY 2023-2024 Budget Proposal - Mr. Rouse discussed the overall budget proposal and fee schedule for FY 2023-2024 budget. Mr. Rouse reviewed each line item including increases and decreases, and reviewed the fee schedule. Mr. Rouse related the overall budget decrease for FY 2023-2024 is $2,563,555. COVID-19 funds have been removed from the budget due to not being guaranteed in the upcoming FY as well as carryforward money being deducted. COVID-19 funds received in FY 2023- 2024 will be budgeted later in revenues; Medicaid Cost Settlement fees have been reduced due to payments have started coming quarterly. The Local/County  Langdon, DVM. Motion Carried.  Seeing no one, Chairwoman Smith closed the informal comments.    Page 2 Board of Health March 2, 2023  Harnett County Health Department Board Room  Appropriations additional funds needed are $118,122. The largest part of these funds are due to medical and laboratory supplies increase and the reduction in Medicaid Cost Settlement funds. We are also asking for $22,351 in funds for the Employee Clinic due to increases in medical and lab supplies. Included in the budget for FY 2023-2024, is an Expansion Budget Request for Aging- CAP and Health for a reclassification on two positions from a Social Worker III to a Social Worker Supervisor II. This would be a one-step pay grade change with a 5% increase for the position. The other Expansion Budget Request for Health is for two Environmental Health Specialist positions, one for Onsite Wastewater and one for Food & Lodging. The request is due to the increased demand in Environmental Health, with the Manpower study supporting the request. Environmental Health Onsite Wastewater and Food & Lodging have been combined into one program for the FY 2023-2024. For previous years, the programs have been separated; this is due to the changes in Munis the Finance system requested by the Finance Department. We will continue to keep an internal system as backup for state/federal funds and Medicaid Cost Settlement. Environmental Health has proposed fee increases for food establishment plan review, swimming pool permits, swimming pools re-inspections and pool plan reviews. Mr. Rouse discussed that Aging Program increased CAP Medicaid revenue $30,000, which resulted in a $16,000 reduction in county funding overall. Mr. Rouse requested that we be allowed to purchase influenza vaccine using one vendor for adults. Henry Schein continues to be the Health Department's vendor for flu vaccine, the Health Department pre-books before March with Henry Schein sO that we are guaranteed the influenza vaccine. Mr. Rouse announced the fee schedule including Clinical and Environmental Health fees have been reviewed during the annual budget process. The recommended fee increases were included in the Board of Health packet for review and Motion made by Ms. Amy Allen to adopt proposed budget FY 2023-2024 which includes the fee schedule as presented and seconded by Ms. Gayle Adams,  approval.  Motion Carried.  Health Director's Report and Program Reports - John Rouse, Jr.  Tobacco Free/Smoke Free Policy - Mr. Rouse discussed beginning April 1, 2023, North Carolina Standard and Tailored Prepaid Health Plans serving Medicaid patients to provide a 100% tobacco free campus. This will include the front parking lot, 50 feet from the front entrance of the Health Department and the entire back employee parking lot area. The Harnett County Board of Health communicated support for the Tobacco Free Policy at the Health Department that will go into effect on April 1, 2023. The board acknowledged support for this rule change and public health intervention.    Page 3 Board of Health March 2, 2023  Harnett County Health Department Board Room  Community Health Assessment = Mr. Rouse announced at the January 19, 2023 meeting the Community Health Assessment (CHA) was presented and the Board ofHealth members ranked the priorities. Through the CHA the team identified six potential priority areas. However, the top three Harnett County's CHA health priorities are (1) Behavioral Health (including substance use disorder and overdose prevention), (2) Chronic Disease (3) Motor Vehicle Injuries. Community members have rated these concerns as significant with regard to the urgency, severity, and feasibility ofi improvement efforts. Results from the 2022 Community Health Assessment will be disseminated to the community via online access, community organizations, media, and promotion Mobile Health Unit Mr. Rouse provided the Board of Health a status report regarding the mobile unit, including a power point slide. The mobile unit will be utilized by the Health Department as part of program improvement effort. The vehicle will allow for additional outreach programs and services, and expand our efforts to address the essential public health services and social determinants of health for county residents. It is our goal to promote preventative health, and improve outcomes among communities as well as Medicaid Expansion - Mr. Rouse discussed updates on Medicaid Expansion and House Bill 108 with the Board. The Board acknowledged support for Medicaid Expansion and House Bill 108. House Bill 108 provides funding for local Health Departments to respond to Communicable Diseases and to retain and hire additional Communicable Disease staff to ensure that essential Public Health services are available and accessible to the population served by the  through partnerships.  among the general population.  local Health Departments.  Clinical Reports - Ainsley Johnson  COVID-19 - COVID-19 reporting for our county is changing to monthly report starting this month. Currently, Harnett County is at a LOW COVID-19 Community Transmission level per Centers for Disease Control and Prevention (CDC). The overall total reported case count as of February 24, 2023, was 43,387 with 375 associated deaths reported, this number does not include unreported at home COVID-19 testing. The Health Department reported 474 positive COVID-19 test results last month, and in addition, we currently have one active outbreak in facilities in our county. Outbreaks in facilities have went down over the last month. Our At home testing distribution program continues    Page 4 Board of Health March 2, 2023  Harnett County Health Department Board Room  to be successful. We have received additional shipments of at home tests, and we have an adequate supply for the public. Kits are available every weekday from 8am-1lam and 1pm-4pm. In the past four weeks, we have distributed 1,373 test kits. Our testing clinic in the Commons will end on Friday, March 31, 2023. We have had decreased demand for the clinic over the last 6 months. On March 31, 2023, we will no longer have in house Community Care of NC contract COVID-19 (CCTC) staff. Community Care of North Carolina will offer remote assistance after this date. We continue to encourage COVID-19 vaccination for all ages. Vaccines are available every day of the week by appointment or by walk-in. Bivalent COVID-19 booster administration has decreased over the last month. Bivalent boosters are now available for ages 6 months and older. The Health Department will attend a community event in the Influenza - Current surveillance in our county and state has shown a decrease in respiratory viruses including influenza, RSV, and rhinovirus. We did not see our usual seasonal peak in February 2023. So far this season, North Carolina has reported 175 influenza associated adult deaths and three pediatric deaths. The peak for influenza like illness in our region was the week of November 5, Employee Clinic and Child Health - Child Health continues to offer car seat safety checks to the community by appointment. We are participating with Harnett County Emergency Managements Paramedic Academy to provide a clinical rotation site for current EMT's that are advancing their career to become paramedics. Students toured the facility this week. Preparedness - On March 30, 2023, we will have our Preparedness and Response monitoring visit with the Division of Public Health. In addition, our Preparedness Coordinator, Carla Nuesmeyer and Director of Nursing, Ainsley Johnson will participate in a full-scale exercise with Harnett County Emergency Management on April 4, 2023, and this is a Harris Nuclear Plant Federal Adult Health - Adult Health has increased Sexually Transmitted Disease (STD) visits to ensure availability every day of the week. Express STD Visits are now available on Thursdays all day and Fridays during the mornings. STD rates continue to be elevated across the state. One nurse in Adult Health is currently enrolled in the state STD Enhanced Role Registered Nurse (ERRN) course and  month of April to offer bivalent COVID-19 boosters.  2022.  Emergency Management Agency (FEMA) exercise.    Page 5 Board ofHealth March 2, 2023  Harnett County Health Department Board Room  will complete this by the end of 2023. We will then have three STD ERRN nurses. We are cross training a Physician Extender II provider in the Prenatal clinic, and this position will also train to be a backup for our women's health nurse practitioner (WHNP). Staff are currently working on Title X training that is required annually. Title Xi is the only federal grant program dedicated solely to providing family planning and related preventive health services with a focus Environmental Health - Oliver Tolksdorf reported the North Carolina Environmental Health Regional Representatives have been onsite reviewing the Environmental Health programs for the Accreditation reports. Currently the lead program has been completed and they are reviewing the childcare program, Aging & Case Management - Mary Jane Sauls reported the Harnett County Family Caregiver Program facilitates two support groups; The Family Caregiver Support Group which meets on the third Wednesday of the month and the Grandparents Raising Grandchildren Support Group which meets the third Tuesday of the month. The meetings are held at the Harnett County Resource Center/Library from 10:00am - 12:00pm. The Family Caregiver Program was monitored by Mid-Carolina Area Agency on Aging (AAA) on March 2, 2023 and had a good review. Mid-Carolina AAA: is the funding source for this program. The Harnett County Senior Volunteer Program currently has 200 active volunteers, ages 55 and older who serve at 14 different volunteer sites across the county. The Medicare/SHIIP Program is registering New to Medicare Beneficiaries and helping people navigate the Medicare Advantage Plan enrollment period ends on March 31, 2023. Medicare counselors are receiving calls with concerns that are passed to the North Carolina Department of Insurance Senior Medicare Patrol (SMP) which handles Medicare complaints, fraud and abuse. The Harnett County Division on Aging is hosting a Blood Drive from 1:00 pm = 5:30 pm on Thursday, March 9, 2023. The Harnett County Division on Aging continues to schedule appointments for free tax filing by our volunteers at the Erwin Library on Wednesdays and Thursdays and at the Coats Senior Center on Tuesdays. Our volunteers report that they are seeing folks from Sampson and Cumberland County, as both these counties no longer have the Volunteer Income Tax Assistance Program. They have added extra counselors at both locations to help meet the increased number of people they are serving. The Community Alternative Program for Disabled Adults is serving 108 beneficiaries. Last month the program received seven new: referrals; six initials and one transfer from Lee County. There are three home modifications in process. Last month the Elderly Nutrition Program served  on low income and uninsured person.  onsite wastewater program and food & lodging at this time.    Page 6 Board of Health March 2, 2023  Harnett County Health Department Board Room  4,152 meals throughout Harnett County. Since January 1, 2023, our office has received 32 referrals for meals on wheels. Mairyn Cruz, Care Management for High-Risk Pregnancies/Care Management for At-Risk Children CMHRP/CMARC) Care Manager has accepted a position with the Division on Aging as the Elderly Nutrition Coordinator. The Division on. Aging will be applying for the Medicare Improvements for Patients and Providers (MIPPA) grant. This money is part of a federal award that was received thru the North Carolina Department of insurance in 2022; the money will now be distributed to the counties in this fiscal year 2023. The amount is for $4,190.00. The money will be used to provide Medicare counseling. The board acknowledged support for obtaining this funding and it will move forward to the Board of Marketing/Communty Outreach - Debra Harris-Hawkins presented the Health Education Division has a community health and education event scheduled in the coming weeks. "Step into Fitness" will be held starting April 3- April 30, 2023. Physical activity and exercise can have immediate and long- term health benefits. This program works to promote and increase physical activity. This is a: free program and registration can be completed by calling or online. Chronic disease was selected as a priority area in the 2019 and 2022 Community Health Assessments. This is one of the programs being offered to address this priority area as physical activity helps improve overall health,  Commissioners.  fitness, and reduces the risk of chronic diseases. Closed Session - There was no need for closed session.  New Business - Chairwoman Smith opened the floor for New Business.  Being none Chairwoman Smith closed New Business. Chairwoman Smith adjourned the meeting.  Respectfully submitted, John ww Rouse, Jr. Health Director  Dr. Laura Smith,  e