Harnett County Board of Health Minutes of Regular Meeting May 17,2018  The Harnett County Board of Health met in regular session on Thursday, May 17, 2018 in the Health Department Board Room, Harnett County Governmental Complex, Members present: Ms. Patricia Chalmers, Chairwoman, Ms. Judy Herrin, RPH, Vice- Chairwoman, Ms. Amy Allen, RN, Dr. Catherine Evans, Ms. Emily Barefoot, Ms. Barbara McKoy, Dr. Laura Smith, Ms. Gayle Adams, Dr. Nicholas Pennings and Mr.  307 W. Cornelius Harnett Blvd., Lillington, North Carolina.  John Rouse, Jr., Health Director. Public Guest present: Ms. Lara Davis, RN. Surles, and Natasha Johnson.  Other present: Mary Jane Sauls, Oliver Tolksdorf, Debra Harris-Hawkins, Donna  Chairwoman Chalmers called meeting to order at 7:00 p.m. related we have a public guest tonight, Ms. Lara Davis, RN.  Announcements - Mr. Rouse would like to welcome Dr. Catherine Evans the newest Board of Health member, she received her orientation on May 14, 2018. Mr. Rouse Consent Agenda - Minutes - Motion made by Ms. Emily Barefoot for the March 8, 2018 minutes to be approved as presented and seconded by Ms. Barbara McKoy. 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 Chalmers opened the floor for informal comments by the public, allowing 3 minutes for each presentation up to 30 minutes. Ms. Lara Davis who is an Registered Nurse at Cape Fear Valley Heart & Vascular Center and she is attending UNC Wilmington and working on a Community 21st Century Cure Act - Mr. Rouse discussed the newest grant money received from the government on the Opioid crisis in the United States. The money was appropriated in 2016. The project is 6.3 billion with 4.8 billion going to the Institute of Public Health and 1 billion to be divided among all 50 states. North Carolina received a total of31 million and will be using the money for treatment centers, purchasing Naloxone for law enforcement and other public safety workers, and community education. Harnett County applied for, but did not receive the Opioid Grant for $10,000. We will  Motion Carried.  Health Project.  monitor grant applications as they become available.    Page 2 Board of Health May 17, 2018  Harnett County Health Department Board Room  Mr. Rouse reviewed the most recent data on the Opioid deaths in hospital emergency room visits in North Carolina counties, through a power point presentation. Health Disparities Report - Debra Harris-Hawkins presented a power point presentation for the annual Health Disparities report. The report provides information and assess use of public health programs and health care services by underserved, at- risk and vulnerable populations. Reducing health disparities is ai major goal of public health. Health disparities are differences in health outcomes and there causes among groups of people. Data was provided on the utilization of various health department programs and services. Programmatic data was reviewed, for the Clinical services, Women Infants and Children (WIC), Mammography screening program and Community Outreach programs, the timeline for the report included January- December 2017. Clinical programs, for 2017, there were fewer patients, seen in the clinics however, there was an increase in the number of visits reported. Approximately 36% of the clients seen were uninsured. By gender, the number of women seen was almost twice as the number of males. By race, twice as many Whites were seen through the Health Department clinics compared to African Americans. WIC is a special supplemental nutrition program for Women, Infants, and Children (WIC). The priority population includes low-income pregnant, breastfeeding, and non- breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. To qualify for WIC your household income must be at or below 185% of the federal poverty income level. Over 36, 000 participants were seen in 2017, which averages approximately 3, 000 participants each month. This program has three sites in the county, Dunn, Lillington and Anderson Creek, toj provide access to services close to where people reside. Not having health insurance makes a difference in people's access to needed medical care. Some groups of people get cancer, or die from cancer, more often than other groups. These differences in health are called health disparities. Information regarding the Health Department's collaboration with Rex Mobile Mammography which provides access for uninsured women to mammography screening, this was cited as an example of how the Health Department is working to implement programs and services for the priority populations to assure needs are being met. Approximately 200 women were seen in 2017 with over 50% identified an uninsured. The Health Department's outreach efforts tor reach vulnerable population, included faith based initiatives and include other outreach programs within laundry mats, grocery stores, salons, barbershops and throughout the community. Hawkins stated, the main goal of these types of programs are toi identify and carry out public health activities specific to selected communities to address differences in health outcomes. Utilization data was reviewed for these  programs.    Page 3 Board of Health May 17, 2018  Harnett County Health Department Board Room  Staff have worked to extend access to health information, resources and screenings to community groups, during non-traditional hours. We work to educate individuals and community members about health, health interventions, and available public health services. The purpose of the review is to assess services use by these populations and  identify what changes could be made to improve access.  Recommendation to Establish Fees: Mr. Rouse presented the following fees for new  fees or an increase to established fees:  CPT CODE 90716  DESCRIPTION Varicella  RECOMMENDED PRICE  $133.00 (old rate $115)  This increase is a result of purchase price increase from $112.76 to $119.48/dose. Motion to approve the new and increased fees from Ms. Judy Herrin, RPH and Debt Setoff-Mr. Rouse reported that we have received $7,871.32 this year on patient  seconded by Dr. Nicholas Pennings. Motion Carried. accounts through the debt setoff program.  Health Director's Report and Program Reports - Mr. John Rouse  Health Director's Report - Mr. Rouse reminded the board about the floating reception that will be held on Monday, May 21, 2018 from 4:30 pm to 6:00 pm in the Commons. The Harnett County Board of Commissioners provided the reception for staff and citizens to say thank you to those who volunteer in Mr. Rouse discussed the Home Health Rack Audit, the audit was due to the federal government hired a company to come in and review Medicare payments that were made to Home Health Agencies. The Harnett County Home Health audit included 2011-2014 and the total amount owed was $9,336. After appealing all cases and being denied the Administrative Law Hearings review was filed. Medicare has agreed to resolve the audit by requesting 38% of the $9,336 and the county keeping the remaining 62%. After consulting with legal and then presenting to the Board of Commissioners it has been recommended  Harnett County.  to settle the agreement with Medicare.    Page 4 Board of Health May 17, 2018  Harnett County Health Department Board Room  Financial Reports - Mr. Rouse reviewed the Expenditure Summary from July 2017 - March 2018 and Revenue Summary from July 2017 - March 2018. Revenues within our programs in the Health Department are doing very well at this time. The Medicaid Cost Settlement amount for 2016-2017 was determined to be $406,000 by our Cost Settlement Consultant, after receiving the notice from Division of Medical Assistance (DMA) the amount we are receiving is $395,000. The reduction is due to prenatal incentive money that we received prior. The budget has been submitted to the County and is still being reviewed by the Board of Commissioners. The Health Director's Association are working with the state to have a Communicable Disease nurse assigned to each of the 87 counties in North Carolina, there will be more  information to come on this.  Clinical Report - Donna Surles  Child Health (CH) hosted a Child Health Community Fair on April 20, 2018. The event was an opportunity for the public to meet our staff and to learn about the services that the health department provides. The free event focused on the children's health and safety, and provided car safety checks, community resources, and other fun activities. We had a good response from the community on the event. The newborn and post-partum home visiting staff continue to see many clients with a total of 58 in April. With the school year ending our CH visits are consistent for this time of the year. Back to school and kindergarten physicals usually begin to increase throughout the summer as the new school year approaches. The CH staff continues to stress the importance of immunizations, on Mondays CH offers immunizations in the Dunn office to WIC clients. The health department serves as a clinical site for Nursing, Family Nurse Practitioner, and Physician Assistant students, as well Adult Health (AH) The family planning (FP) clinic numbers have increased from 118 in March to 171 in April. We have been able to open the FP schedule with more appointments since the hiring of Melissa Fenn, PA-C. Melissa has done exceptionally well during her orientation and has adapted well here in all of the clinics. We have been offering the Mirena intrauterine contraceptive device (IUD) since February and we continue to receive a lot ofinterest in this long acting contraceptive. Sheley Eldridge, WHNP has been trained by Dr. Gray and has been inserting IUDs without any issues reported. The other providers will be training in the near future. On May 8, 2018 the health department hosted a "Special Delivery" Pregnancy Health Fair. The health fair was open to mothers to be, dads, and those who are planning a pregnancy.  as the Doctor of Osteopathic residents.    Page 5 Board of Health May 17,2018  Harnett County Health Department Board Room  The event provided information about prenatal care as well as valuable resources for new mothers as well as expectant mothers. The maternal health staff was available to meet and greet those in attendance and to answer questions about obstetrics (OB) services provided at the health department. We Communicable Disease (CD) program has two staff who recently completed the CD Course provided by the State CD Branch. They will attend the CD Conference next week, which is a requirement to complete the CD program. Currently the CD program are following two tuberculosis (TB) cases that are in treatment. We have completed round one of the investigation and will continue to monitor these cases. In North Carolina, 82 of 100 counties have had at least one TB case in the past 5 years, and in 2017, 46 counties had at least one case. Two cases of Rocky Mount Spotted Fever have been reported and are being investigated. Spring is the time of year when we will begin to see more tick related cases. According to the latest North Carolina Flu Surveillance report, there have been 386 influenza associated deaths this season with the majority age 65 and older. The most significant type identified overall has been Subgroup Type A. According to the report from the Public Health Epidemiologist Network, which includes 7 of the largest hospital networks in North Carolina, there have been 12,375 positive flu cases reported this season. The clinic and Health Education have been working on Human mmunodeliciency Virus (HIV) and Syphilis testing in the community. These community outreach programs provide opportunities to educate and inform the citizens on services provided by the health department. Sexually Transmitted Diseases (STD) rates continue to be the highest of all communicable diseases. This trend has continued to show an increase in our county and across the state. With the increase in drug use and the opioid epidemic we worked with Campbell University Masters of Public Health (MPH) Program on a research project to determine if there was an association between STDs and substance abuse. Courtney Davis, MPH student conducted the research as her Senior Capstone Project. Donna shared the project findings and reviewed a poster presentation provided by Courtney Davis. On April 4, 2018 several of the staff attended Mental Health First Aid Training and received certification. The course trained staff on how to recognize a mental health emergency and how to provide initial help to people experiencing problems such as depression, anxiety, psychosis, and substance use disorders. The health department's annual staff training was held on April 2, 2018. Several of the staff are required to complete Title X Family Planning Training annually and will be completed by June. The North Carolina Occupational and Environmental Epidemiology conducted an Opiate and Meth Awareness Training for health and department of social services staff who work out in the community doing field, the training was held on April 18, 2018. Donna Surles is working with the North Carolina  had excellent community participation at the event.    Page 6 Board of Health May 17, 2018  Harnett County Health Department Board Room  Public Health HIPAA Alliance Policy and Procedure Committee in trying to standardize HIPAA policies for local health departments across the state. We are currently in the process of updating the HIPAA Privacy and Security Environmental Health - Oliver Tolksdorf reported that the Food & Lodging Program has been busy with swimming pool permits this time of the year. Most area pools are getting ready to open Memorial Day weekend. Onsite wastewater applications have increased due to the developing of many new subdivisions in Aging & Case Management - Mary Jane Sauls reported that April was volunteer appreciation month. On April 3, 2018 aj proclamation was issued by the Harnett County Board of Commissioners for volunteers serving throughout Harnett County. Harnett Health Systems provided a banquet for their 121 volunteers serving both hospitals in Harnett County, with 51 being Retired Senior Volunteer Program (RSVP) volunteers. The RSVP Director, LeAnn Blackmon and RSVP Administrative Assistant, Vicky Walden were invited to attend and present awards to the volunteers. Harnett Health Systems applied for and received the Presidents Volunteer Service Award for volunteers with 100 or more hours of service for the year 2017. May is Older Americans Month and the annual Senior Health Fair will be on Thursday, May 24, 2018 at the Dunn Community Center from 10:00 am to 2:00 pm. The New to Medicare class will be held on Thursday, May 31, 2018 at the Division on Aging. Marketing/Communty Outreach Debra Harris-Hawkins announced that the Health Department will have a lunch and learn "Don't Miss a Beat Control High Blood Pressure" on Wednesday, May 30, 2018 in the Governmental Complex Commons area from 12:00 pm to 1:00 pm. It will be an informative session on how to prevent and control high blood pressure. Special guest speaker will be North Carolina Heart and Vascular Ashley Lewis, MD, FACC Active Shooter Drill - Mr. Rouse reminded the board about the upcoming Active Shooter Drill for staff that will be held on Friday, June 1, 2018. The event will involve the Health Department, Department of Social Services and Sherriff's Department. More information will be provided to employees before the drill.  Policies and Forms.  Harnett County.    Page 7 Board of Health May 17, 2018  Harnett County Health Department Board Room  Closed Session - There was no need for closed session. none Chairwoman Chalmers closed New Business. Chairwoman Chalmers adjourned the meeting.  New Business - Chairwoman Chalmers opened the floor for New Business. Being  Respectfully submitted, auu  John Rouse, Jr. Health Director  hhe  -   Ms. Patricia Chalmers, Chairwoman