Harnett County Board of Health Minutes of Regular Meeting May 18, 2023  The Harnett County Board ofHealth met in regular session on Thursday, May 18, 2023 in the Health Department Board Room, Harnett County Governmental Complex, Members present: Dr. Laura Smith, OD, Chairwoman, Ms. Gayle Adams, Dr. Amanda Langdon, DVM, Ms. Linda Sturdivant, Dr. Kim Fowler, PhD, Ms. Staci Hogan, RPH, Dr. Brandon Washington, DDS, Dr. Catherine Evans, DDS, and Mr. John Rouse, Jr., Others present: Oliver Tolksdorf, Ainsley Johnson, Debra Harris-Hawkins, Mary Jane  307 W. Cornelius Harnett Blvd., Lillington, North Carolina.  Health Director.  Sauls, and Natasha Johnson.  Chairwoman Smith called meeting to order at 7:00 p.m.  Announcements - Mr. Rouse announced Ms. Amy Allen, Ms. Emily Barefoot and Commissioner Barbara McKoy are not available to attend tonight's meeting. Ms. Gayle Adams 2nd term on the Board of Health will expire on May 31, 2023, she has asked not to be reappointed, and tonight will be her last meeting. Mr. Rouse presented Ms. Mr. Rouse announced Dr. Lori Langdon, M.D. has been appointed by the Board of Commissioners to serve on the Board of Health. She will move into the Physician position. The Board of Commissioners also appointed Dr. Brandon Washington, DDS, to be moved to the Public Member position with a 1st term effective date of May 15, Consent Agenda = Minutes - Motion made by Dr. Catherine Evans, DDS, for the March 2, 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. Seeing no one, Chairwoman Smith closed the informal comments. Health Disparities Report - Debra Harris-Hawkins presented a power point presentation for the annual Health Disparities report. Many factors can create or limit opportunities for good health. Whether families have access to quality health care, nutritious foods, and neighborhoods with safe outdoor spaces, all impact health. Reducing health disparities is a 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.  Adams with a plaque for her service.  2023.  Langdon, DVM. Motion Carried.    Page 2 Board of Health May 18, 2023  Harnett County Health Department Board Room  Programmatic data was reviewed for the clinical services, Women Infants and Children (WIC), mammography screening program and several community outreach programs. The purpose of the review is to assess service use and identify what changes could be  made to improve access.  Women Infants and Children (WIC) is a special supplemental nutrition program for Women, Infants, and Children (WIC). The priority population includes low-income pregnant, breastteeding, and non-breastteeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. To qualify for WIC there are income requirements at or below 185% of the federal poverty income level. Approximately 42,973 participants received services in 2022. WIC monthly participation average 3,580 participants each month. For Harnett County persons in poverty, is Clinical programs, data was provided anuary-December 2022. Overall approximately 10,149 persons were reported. By gender, the number of women seen 6,908 was almost twice as the number of males 3,241. By race, oft the 10,149 identified as the following, approximately 70% identified as Whites, 7,073 through various Health Department clinics compared to 27% African Americans with approximately 2,707, and 3% listed as other. This is very similar to the overall county population data. Data regarding insurance status, 30% identified as uninsured with 70% indicating having health insurance. Mobile mammography, 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 women too obtain a screening mammogram. The priority population for the Health Department includes, minority and uninsured women. The Health Department is working to implement programs and services for the priority populations to assure needs are being met. Approximately 177 women were seen in 2022 with Community outreach, in the 2022 Community Health Assessment, racial and ethnicity minorities were identified as priority population. The Health Department's outreach efforts, included faith based initiatives within AA churches, migrant farms and public housing communities. Hawkins stated, the main goal of these types of programs are to identify and carry out public health activities specific to selected communities to address differences in health outcomes. Staff have worked to extend access to health information, resources and screenings to community groups, during non-traditional hours. We work  approximately 13%.  over 42% identified an uninsured.    Page 3 Board of Health May 18, 2023  Harnett County Health Department Board Room  to educate individuals and community members about health, health  interventions, and available public health services.  Clinical Patient Fees, Eligibility and Bad Debt-Write Off Policy Revision - Ainsley Johnson reported The Clinical Patient Fee policy was revised per Accreditation review in regards to the fee setting process. The changes made are functions that we are currently doing, but had not been specifically included in our policy. This includes the process ofhaving all fees approved by the Board of Health and Board of Commissioners. Also included were the yearly review of all fees to include Environmental Health fees. Another change recommended by the State Administrative Consultant, was to add the following under the eligibility section, self-paying, non- insured clients requesting program services are encouraged to apply for Medicaid assistance. Motion by Gayle Adams, to approve the changes to the clinical fee policy as presented and seconded by Dr. Catherine Evans, DDS. Motion Carried. Debt Setoff- - Mr. Rouse reported that since the last meeting, the Debt Setoff program has collected an additional $3,427.88 and the collection year to date total is Health Director's Report and Program Reports = John Rouse, Jr.  $3,427.88.  COVID-19 Report - On May 11, 2023, The US Department of Health and Human Services ended the federal public health emergency for COVID-19. COVID-19 vaccines are still available at no cost. Once the federal government is no longer purchasing or distributing vaccines and treatments, payment and access many change. We anticipate the commercialization of COVID-19 vaccine in the future. The Food and Drug Administration (FDA) emergency use authorizations (EUAs) for COVID-19 procedures including tests, treatments, and vaccines are not affected. Medicare and Medicaid waivers and flexibilities have change. We are educating our patients on Medicaid recertification during visits and Department of Health and Human Services (DHHS) handouts are given. Certain COVID-19 data reporting and surveillance have changed. Laboratories and physicians are no longer legally required to report positive or negative COVID-19 labs or deaths unless it is deemed a novel coronavirus. SARS-CoV2 will no longer be considered novel. The decrease in reported tests will affect the ability to calculate percent positive for COVID-19 tests. DHHS will now only be reporting COVID-like illness (very similar to our flu reports), COVID-19 hospital admissions, death certificate data, and wastewater surveillance. Some Health Insurance Portability and Accountablity Act (HIPAA) Notification of Enforcement Discretions (NED) will end. The NEDS that affect the use of certain telehealth platforms, business associate agreements dealing with protected health information (PHI) and community based testing sites. These    Page 4 Board of Health May 18, 2023  Harnett County Health Department Board Room  sites will be held to the same enforcement standings to safeguard public health COVID-19 vaccines recommendations have changed since our last Board of Health meeting. Monovalent Moderna and Pfizer are no longer authorized for use. Persons age 6 years or older for Moderna and 5 years and older for Pfizer, who are not immunocompromised and unvaccinated will received only one Bivalent mRNA vaccine. Persons age 65 years and older, now have the option to receive one additional bivalent mRNA vaccine dose at least four months after the first dose of bivalent vaccine. The Health Department continues to see patients for walk in COVID-19 vaccine appointments and scheduled appointments throughout the week. Our last report went out at the end of April 2023. We will continue to report and provide guidance for outbreaks, and at Financial Reports - Mr. Rouse reviewed the expenditure summary and revenues summary from July 2022 - March 2023. Federal and state funds are coming in as expected. Aging funds and revenues are coming in as expected also, and the Client Assistance Program (CAP) program is doing well. Family Planning revenues have decreased slightly for the third quarter. April 28, 2023 was the last date for staff to have year-end purchase orders turned in to our Finance Department to process; except when an emergency purchase order is needed. The budget proposal for FY 2023-2024 has been presented to the county, and is awaiting approval. Mr. Rouse reported the Employee Clinic saved the county $246,279.00 through the third quarter and remains to be an active clinic among county employees. The Senate has passed the state budget for the new year. Several Public Health Bills have been included in the House and Senate Bills this included several new Environmental Health Bills. We will continue to monitor these Bills. Mr. Rouse discussed the Opioid Settlement of 6.5 million that Harnett County will receive over a period of eighteen years. Harnett County and Campbell University Masters of Public Health have formed  information instead of the previous good faith efforts.  this time, we have no reporting outbreaks.  ag group for the settlement. Clinical Reports - Ainsley Johnson  Flu Update - The month of May 2023 is typiçal the end for Flu season. The peak week ofi influenza for the 2022-2023 season was the week of November 5, 2022. This Flu season resulted in 192 North Carolina adult deaths and 3 pediatric deaths. In the coming month the Health Department staff will begin preparation for next Flu season and schedule Flu vaccination offsite events.    Page 5 Board of Health May 18, 2023  Harnett County Health Department Board Room  Child Health and Employee Health Clinics -Health Department staff are working to reach out to patients to come in during the summer months for physicals and immunizations prior to the start of the school year. New employee Laura Hardison will be starting on Monday, May 22, 2023 to fill our Public Preparedness - The Health Department's Preparedness Coordinator attended the North Carolina Public Health Preparedness and Response Annual Symposium last week, and participated in trainings in a range of preparedness and response topics. This is the first symposium in three years to COVID-19. Adult Health - Adult health services continue to remain steady, with reportable disease cases decreasing in the last month. Our recent Community and Consumer Survey indicated that our clients and community members were interested in after-hours services. Clinical staff conducted a focus after-hours survey, which indicated Family Planning was the most requested clinic. Staff were also surveyed to gauge their interest in working after-hours one night per week. We had positive response and have plans to start After Hours Family Planning Clinic on the first Thursday for the next four months. The clinic will operate until 7 pm. This will allow three additional Family Planning physical appointments and one additional Family Planning problem visit. We will start this clinic on June 1, 2023 and reevaluate its effectiveness in September 2023. Pharmacy Training - The Health Department is in the initial process of planning for Naloxone distribution. We are waiting for confirmation from DHHS, that we will obtain state funded Naloxone kits. These kits can be distributed to individuals who request due to being at risk for opiate related overdose or if they are in the position to assist a person at risk for experience in opiate-related overdose. All staff that will be distributing test will participate in a mandatory training in the Harnett County Resource Center and Library on May 19, 2023 at 1:00pm. In addition, the nursing staff will have their annual pharmacy dispensing training. More information will be released when this distribution Environmental Health - Oliver Tolksdorf discussed the changes in the Virginia Graeme Baker Pool and Spa Safety Act (VGBA) and the challenges that swimming pools face with getting permits. The VGBA's purpose is to prevent drain entrapment and child drowning in swimming pools and spas. Oliver reviewed the pending Bills in the General Assembly that affect Onsite Wastewater and Food & Lodging sections of Environmental Health.  Health Nurse II position.  plan is confirmed.    Page 6 Board ofH Health May 18, 2023  Harnett County Health Department Board Room  Aging & Case Management - Mary Jane Sauls reported the Elderly Nutrition Program is currently serving meals to 233 clients monthly. During the month of May 2023, over the counter medications were delivered to some of the homebound clients through a partnership with the Med Assist Program. The Senior Farmers Market will begin in June 2023, vouchers will be provided for clients to spend on fresh produce at a state certified farmers' market. Anderson Creek Senior Center will be partnering with the Harnett County Library to provide nutrition education and a hands on experience by utilizing the "Charlie Cart" on May 23, 2023. The Community Alternatives Program for Disabled Adults (CAP/DA) program is currently serving 119 beneficiaries. Home visits have resumed as we have reached the official end of the Public Health Emergency. Prior to scheduling their quarterly home visit case managers contact beneficiaries to assure the beneficiary and caregivers are comfortable with face to face contact and that no one in the home is symptomatic or has been recently exposed to Covid-19. The Grandparents Raising Grandchildren Support Group and the Caregiver Support Group had a speaker from Legal Aid to discuss issues such as legal verses physical custody, guardianship through the courts and services offered through the Department of Social Services (DSS) for the grandchildren in their care. The grandparent support group meets on the third Tuesday of every month at the Harnett County Resource Center and Library from 10:00 am -12 pm. On Friday, May 5, 2023, the Harnett County Division on Aging in partnership with the NC Department of Insurance and NC Med Assist Program hosted a Shred-a-Thon and Over the Counter Medication give-away at the Harnett County Commons area. The event was staffed by volunteers from Med-Assist, NC Department of Insurance, county employees, and volunteers in the community. The event hosted 835 pre-registered and walk-in individuals, including 28 homebound consumers. Recipients received a variety of over the counter medications, reading glasses, gloves, masks, compression socks and supplements. The NC Department of Insurance provided funding for the shred truck and collected over 6,000 pounds of shredding. On Thursday, May 11, 2023, the Harnett County Division on Aging hosted a Blood Drive in the Commons area from 1:00 pm = 5:30 pm, and 38 units of blood were collected, which surpassed the goal by three units. The next blood drive will be held on Thursday, July 13, 2023, in the Commons Area where the volunteers will serve homemade ice cream in the canteen. Mobile Health Unit - Mr. Rouse announced the Mobile Health Unit arrived on May 1, 2023. Mr. Rouse provided a walk-through of the unit to the Board of Health members at the end of the meeting. The mobile unit will be utilized by the Health Department as part of program improvement efforts. The vehicle will    Page 7 Board of Health May 18, 2023  Harnett County Health Department Board Room  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.  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, Qnwwn John Rouse, Jr. Health Director  Chairwoman  882