Harnett County Board of Health Minutes of Regular Meeting July:20,2017  The Harnett County Board of Health met in regular session on Thursday, July 20, 2017 in the Health Department Board Room, Harnett County Governmental Complex, Members present: Dr. Auston "Trey" C. Williams, III, Chairman, Mrs. Amy Allen, Mr. C. Tyrus Clayton, Jr., Ms. Judy Herrin, RPH, Ms. Barbara McKoy, Ms. Linda Sturdivant, Dr. Laura Smith, Ms. Gayle Adams and Mr. John Rouse, Jr., Health Others present: Debra Harris-Hawkins, Allison Beam, Gail Hobbs, Natasha Johnson  307 W. Cornelius Harnett Blvd., Lillington, North Carolina.  Director.  and Mary Jane Sauls.  Chairman Williams called meeting to order at 7:00 p.m.  Announcements Mr. Rouse related Dr. Nicholas Pennings will not be attending tonight. Donna Surles, Director of Nursing is on vacation and Allison Beam, Physician Extender will be covering her reports. Graham Byrd, Environment Health Supervisor will also not be here tonight. Mr. Rouse would like to welcome Ms. Gayle Adams the newest Board of Health member, she received her orientation on June 27,2017. Consent Agenda - Minutes Motion made by Ms. Judy Herrin, RPH for the May 18, 2017 agenda and minutes to be approved and seconded by Ms. Linda 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 = Chairman Williams opened the floor for informal comments by the public, allowing 3 minutes for each presentation up to 30 minutes. Accreditation = Debra Harris-Hawkins reported that our Re-Accreditation site visit is scheduled for September 14-15, 2017. A copy of the draft agenda is in the packet. There will be a two day site visit by a multidisciplnary team. The Site Visit Team shall be composed of four individuals with expertise or experience in local public health, including expertise or experience in Environment Health, Public Health Nursing, Public Health Administration or Policy Development/Governance. The process comprises three functional components; An agency sell-assessment, which includes 41 benchmarks and 148 activities. We have submitted the evidence from the past four years, 2014-2017, all evidence is required to be submitted electronically. Accreditation is achieved by meeting a set of capacity based benchmarks.  Sturdivant. Motion Carried.  Seeing no one, Chairman Williams closed the informal comments.    Page 2 Board of Health July 20, 2017  Harnett County Health Department Board Room  There are three sections Standard 1: Agency Core Functions and Essential Services contains 29 benchmarks and 93 activities. Standard 2: Agency Facilities and Administrative Services contains 4 benchmarks and 27 activities. Standard 3: Board ofH Fcaltn/Governance, contains eight benchmarks and 27 activities. Established Fees - Ms. Gail Hobbs presented the recommendation to establish new  fees. CPTCODE S0281  DESCRIPTION Medical Home Program Management Fee (Postpartum Home Visit) Ingrown Toenail Removal Mirena IUD (5) year) Skyla IUD (3 year)  RECOMMENDED PRICE $150.00 $105.00  11765 J7298 J7301  $900.00 (340b pricing $235) $700.00 (340b pricing $235)  Motion to approve the new fees from Ms. Judy Herrin, RPH and seconded by Mr. Debt Setoff Collection Policy & Update - Gail Hobbs reported that we have received $6,663.93 this year on patient accounts through the debt setoff program. She stated the changes to the Debt Setoff Collection Policy. The added statement was in Section VII. Service Plan - Statement of charges for confidential services shall be given to patient at their next office visit in addition to informing them of any Motion by Ms. Barbara McKoy to approve the changes to the Debt Setoff Collections Policy as presented and seconded by Dr. Auston "Trey" C. Williams, Program Review; Aging & Case Management - Mary Jane Sauls provided a presentation that outlined the programs provided through the Harnett County Division on Aging. The Division of Aging offers many programs that service the disabled and or the age 55 and older population. These programs are funded through state, local and federal funds. Programs offered include Retired and Senior Volunteer Program, Community Alternatives for Disabled Adults, Elderly Nutrition, Family Caregiver Support, Grandparents Raising Grandchildren, The SHIIP Program-Medicare Counseling, Operation Fan Heat Relief and In-Home Aide Services. Ms. Sauls also provided information regarding the Care Management programs offered at the  C. Tyrus Clayton, Jr., Motion Carried.  outstanding balance.  III, Chairman. Motion Carried.  Health Department.    Page 3 Board of Health July 20, 2017  Harnett County Health Department Board Room  The health department offers two formal care management programs designed to support children, expectant parents and families. Care coordination for children (CC4C) is a free voluntary program designed to help families improve the health outcomes of their children from birth to age five. Care Managers access current and ongoing medical and family needs and concerns. The target population for this service includes children experiencing developmental delay, disability, chronic illness or social/emotional stress disorders. The CC4C Care Managers work closely with the child's doctor to assure that the child's medical and social needs are addressed. Pregnancy Care Management (PCM) is a statewide program in North Carolina that promotes healthy mothers and healthy babies. This program provides care management services for high risk women during pregnancy and for two months after  delivery.  Health Director's Report and Program Reports = Mr. John Rouse  Financial Reports - Mr. Rouse stated the county has not closed out the year and he would bring the final year-end report to the September meeting. Mr. Rouse presented the Activity Summary report and stated that on the fiscal year 2017-2018 Activity Summary Home Health will not be listed on the report. Mr. Rouse provided an Employee Clinic chart demonstrating the three quarters showing the amount of savings that insurance would have been billed for those services. The most recent 4th quarter was $60,697.00 with a summary total for During fiscal year 2012-2013 the North Carolina Division of Medical Assistance (DMA) conducted their Medicaid cost settlement by doing a 10% hold back every year since 2012. DMA is in the process of sending a packet regarding Mr. Rouse informed the board Dr. Elizabeth (Betsey) C. Tilson, MD, MPH will be joining the North Carolina Department of Health and Human Services (DHHS) as the new Chief Medical Officer, position formally known as the State Health Rabies Senate Bill 74 - Mr. Rouse spoke about the Ratified Senate Bill 74, Updated Rabies Control Laws, was signed by the Governor this past week and goes into effect October 1, 2017. This is an act implementing the recommendations and guidelines of the National Association of State Public Health Veterinarians regarding the management of dogs, cats, and ferrets exposed to rabies. Mr. Rouse stated at the next Board of Health meeting scheduled for September 21, 2017 the board will vote to get with the local  2016-2017 was $295,535.00 total in savings.  each year of the cost settlement.  Director.  ordinance sunset effective October 1, 2017.    Page 4 Board of Health July 20, 2017  Harnett County Health Department Board Room  County Leadership Forum on Opioid Abuse - Mr. Rouse related information that under the County Leadership Forum on Opioid Abuse each county will have a policy in place. The purpose of the forum is to engage elected and county officials on the opioid epidemic in Harnett County, and develop strategies for prevention, education, and treatment. Mr. Rouse is currently working with Campbell University Pharmacy School and the Harnett County Sheriff's  Department to schedule a future event.  Clinical Report and Activity Summary - Ms. Allison Beam  Child Health - Clinic numbers have been down for May and June. They usually decrease as the summer season approaches, then increase again towards the end of the summer for back to school physicals and immunizations. In June we began offering child health physicals in the Dunn clinic on Tuesdays and Thursdays to improve access to services in the Dunn community. Currently there has not been a lot ofi interest and we are hoping the the demand will increase as we approach the new school year with kindergarten physicals. The Dunn site is only opened if there are appointments scheduled. We are planning to work with Harnett County Schools again this fall to conduct on site clinics at the schools to provide required immunizations. We will also provide an after-hours immunization clinic for children one evening at the health department. Last year we reported that we were working on a Quality Improvement project to increase our Welcome Baby and Post-Partum Home visit numbers. At that time we had two child health nurses who were only making visits on Fridays due to working clinics Monday-Thursday. Since the sell of the home health agency, and with the transferring of one home health nurse we are nearing our goal of 64 visits a month. In June we made 56 visits and 50 visits in May. Flu vaccine has been pre-ordered and we anticipate it will arrive in September. Flu clinics have been scheduled at the assisted living facilities, senior sites and currently working to set up schedules with Harnett County schools. We will be administering flu vaccine this year at the Employee Health Fair on October 12, 2017. Our employee clinic continues to stay busy and we receive positive feedback from county employees regarding the services Women's Health - The clinic continues to see a large number of Prenatal and Family Planning clients. At the last board meeting we reported that we would begin offering the Kyleena Intrauterine Contraceptive Device (IUD). Last week we were notified that Family Planning Waiver Medicaid was not reimbursing for the Kyleena although Medicaid and private insurance are reimbursing.  they receive.    Page 5 Board of Health July 20, 2017  Harnett County Health Department Board Room  Due to the reimbursement issues we are now planning to offer two other IUDs which are Skyla that is a 3 year contraceptive and Mirena which is a 5 year contraceptive. We are in the process of getting the account set up with Bayer to order these long acting reversible contraceptive devices and hope to receive them this month. We continue to offer the Nexplanon contraceptive implant and have not had any negative responses or issues associated with the device. Communicable Disease - The Sexually Transmitted Disease (STD) clinic continues to see a large volume of patients. We have one STD Enhanced Role nurse and another nurse in STD Enhanced Role training who will complete the course in the next couple of months. Several of our nurses have taken the Communicable Disease course and are able to help investigate the North Carolina Electronic Disease Surveillance System (NCEDSS) reports. We continue to see Tuberculosis (TB) patients and have been doing Direct Observation Therapy (DOT) with them. TB monitoring and treatment is time consuming and requires a lot of effort from our nurses to package and directly monitor the administration of these medicines. We are able to Skype with some of those clients for DOT. In conjunction with the North Carolina State Lab we are now offering Hepatitis C testing for clients who are uninsured and meet Based on feedback from our staff requesting shelter training after being called upon to staff emergency shelters during Hurricane Matthew we have scheduled for October 2, 2017. We will be providing emergency evacuation shelter training for our staff. Our Bioterrorism (BT) Preparedness contractor, On Target Family Medicine Residency Training Program - Mr. Rouse stated the health department currently has two residents from Harnett Health, one is in the child health clinic and the other is in the prenatal clinic. They will be training in the clinics and follow patients through their care in certain clinics like prenatal clinic, from the start Environmental Health - Mr. Rouse reported numbers for onsite wastewater are high and they have received a lot of new permits due to new developments within the county. There has been a relatively large number of repair permits for this time of the year. Food & Lodging inspections continue to have good numbers however they are currently short staff due to Jamie Turlington, Environmental Health Specialist being on maternity leave. The Environmental Health and Inspections department are currently in the process of replacing their permitting software program that they have had for many years. The new software is called Track-It and will be designed based on the need of the county. The program will be implemented the summer of 2018. We are continuing to distribute the mosquito briquetes to the public and will be  certain high risk criteria specified by the state lab.  Preparedness will be conducting the training.  of pregnancy to the end of the pregnancy.  releasing another newspaper article soon.    Page 6 Board of Health July 20, 2017  Harnett County Health Department Board Room  Current/Upcoming Events - Debra Harris-Hawkins related we have a couple of community events scheduled for the month of August. The "Community Day/Back to School" event is a joint collaboration with the health department and other community organizations to provide free school supplies, information and resources for children and families. A series of educational sessions on fall prevention using "A Matter of Balance" fall prevention program is scheduled to begin August 22, 2017 at the Coats  Senior Center.  Closed Session - There was no need for closed session.  New Business - Chairman Williams opened the floor for New Business. Being none  Chairman Williams closed New Business. Chairman Williams adjourned the meeting.  Respectfully submitted, oVn John Rouse, Jr. Health Director  Chidb)  Dr. Auston "Trey"C. Williams, III, Chairman