Harnett County Board of Health Minutes of Regular Meeting January 17, 2019  The Harnett County Board of Health met in regular session on Thursday, January 17, 2019 in the Health Department Board Room, Harnett County Governmental Complex, Members present: Ms. Patricia Chalmers, Chairwoman, Ms. Amy Allen, RN, Ms. Emily Barefoot, Ms. Gayle Adams, Ms. Barbara McKoy, Ms. Linda Sturdivant, Dr. Laura Smith, Dr. Nicholas Pennings and Mr. John Rouse, Jr., Health Director. Others present: Mary Jane Sauls, Donna Surles, Oliver Tolksdorf, Gail Hobbs, and  307 W. Cornelius Harnett Blvd., Lillington, North Carolina.  Natasha Johnson.  Chairwoman Chalmers called meeting to order at 7:00 p.m.  Announcements - Chairwoman Chalmers reported that she and Vice Chairwoman Judy Herrin met on November 20, 2018 and performed Mr. Rouse's annual performance appraisal and reviewed his job description with him. We are not making Consent Agenda - Minutes - Motion made by Ms. Emily Barefoot, for the November 15, 2018 agenda and minutes to be approved and seconded by Ms. 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. Seeing no one, Chairwoman Chalmers closed the informal comments. County Finance System Munis/Tyler - Mr. Rouse and Gail Hobbs provided information to the Board regarding the County's new financial software Munis/Tyler. Staff attended numerous training sessions in preparation for this implementation of the system which went live in October 2018. The new software enables the County to be paperless and shifts more of the daily processes to the individual departments that were previously handled at the Finance office. This change requires approval steps to review items online before they will be processed. The goal of the system is to allow for more accurate reporting of financial components than our previous system that the County used for over 20 years. Moving forward we are beginning the budgeting process this coming month and have attended training. Also in April 2019 the County  any recommended changes at this time.  Gayle Adams. Motion Carried.  will roll out    Page 2 Board of Health January 17,2019  Harnett County Health Department Board Room  the Human Resources portion of the software, Finance has been working to prepare Strategic Plan - Mr. Rouse provided the annual update and review regarding the Health Department's Strategic plan. A power point presentation was provided for the 2018-2021 Strategic Plan. The plan along with updates were reviewed. Through this plan, we intend to achieve measurable improvement in critical public health areas. The strategic priority areas included are both internally and externally focused, ensuring continuous quality improvement across the division and the provision of needed services and activities to meet the community's needs. This plan includes strategic directions with objectives that represent our firm commitment to assuring a healthy community for all of our residents. Some of our priority outcomes, department goals include: Reduce the number of persons who are at risk for overweight/obesity, prevent teen pregnancy/reduce infant mortality, prevent/reduce communicable diseases, develop qualified public health workforce, and increase revenue collections for services. We utilize the data from the Community Health Assessment (CHA) to identify the health conditions affecting our residents to establish work plans, identify opportunities for partnership and develop action plans. We used health status data and information to set goals and objectives and will continue to monitor progress, and  for this date.  report progress and outcomes.  Health Director's Report and Program Reports - John Rouse  Medicaid Transformation- Mr. Rouse reviewed how Medicaid would be managed through Medicaid managed care plans through large insurance companies. The health plans will be placing bids and the state will decide on three-four vendors for all of North Carolina. The vendors for North Carolina will be decided by February 2019. Community Care of North Carolina will possibly be one of the vendors for North Carolina; we currently work with Community Care through our Case Management now. We have recently completed the attestation to Tier 3 Advanced Medical Home program with the North Carolina Department of Health and Human Services for Medicaid Managed Care. Financial Report - Mr. Rouse provided a handout of the second quarter's finance report July 2018 through December 2018. Finance recently reviewed the six-month budget with supervisors, and they are currently working on the 2019-2020 budget. The federal and state money is coming in, as they should. Revenues are currently down a little due to patient visits are low.    Page 3 Board of Health January 17,2019  Harnett County Health Department Board Room  Programs Child Service Coordination (CC4C) and Maternity Care Coordination (OBCM) recently changed over to a new IT system, changing the amount of visits and length of time you must follow a patient. This has affected the amount of patients being seen by each social worker, causing a decrease in  monthly numbers. Clinical Reports - Donna Surles  Child Health (CH) visits are lower since the last Board of Health meeting. This pattern has been in previous years where the visit numbers decrease during the months of December and January and then increase again as cold and flu season begins. CH is starting to see several cases of flu in our pediatric clinic; We have received state funding for the purposes of promoting child safety. With these funds, we are planning to send four of our staff to training for car seat certification. We are hoping to have enough staff trained sO that we can offer car seat safety checks on a: regular basis and will be able to purchase car seats for children who need them. We are working in collaboration with Partnership for Employee Clinic visits in December were up and the clinic continues to see a large number of employees. Allison Beam, Physician Assistant, Employee Health provider was accepted into the Primary Care Fellowship Program at  so far, we have only seen type A.  children to promote this initiative.  Campbell University.  Immunization numbers are back to normal after the large number of flu clinics that we held throughout the county. The regional consultant was here on January 8, 2019 to review our immunization compliance rates for children age 24-35 months. Our Health Department goal for 2017-2018 was 90% and we are currently at 92%, meeting the benchmark. The statewide average for local health departments is 85%. Our immunization coordinator and staff do a great job at reaching out to children, daycares and families regarding vaccines. Flu Reports that we receive from the North Carolina Communicable Disease branch shows a slight decrease in flu cases across the state. According to the report received today, the most prevalent has been Type A (H1N1). Throughout the state, there have been 22 reported deaths with two of those deaths being reported in the past week. Last year at this time, there were 67 reported deaths.    Page 4 Board of Health January 17,2019  Harnett County Health Department Board Room  Most of the deaths have been age 65 and older, followed by age 25-49. We have Family Planning (FP) clinic continues to offer long acting contraceptives such We are planning to have the "Girls are Great" event again in 2019 for young girls. This year we will have our first outreach event for boys' ages 9-15, "Boys Lace Up for Health" will be held at Harnett Central Middle School on March 9, The event will focus on puberty, body changes, nutrition, exercise and positive health practices for young males. We are working in collaboration with other community partners such as Cooperative Extension, Angier Fire Department and the Fire Academy to allow the participants to learn about community services and programs, and they will be able to participate in various sports The Health Department has received state funding that we plan to use to promote teen friendly services. Items that will be purchased are educational tools, posters, and changing stations for our teens to access when here for Prenatal Clinic (PNC) provides pregnancy care services Monday thru Friday. PNC will be planning to hold a Maternal Health Lunch and Learn event in spring 2019 and a Prenatal Fair in late spring or early summer of2019. These programs will focus on health during pregnancy. Last year's Prenatal Fair was very successful. This event will be open to all pregnant women and for women that are thinking about becoming pregnant. We would like to invite other departments and community partners to participate in the event. The PNC will be implementing a Prenatal Home Visiting Program for pregnant women. These visits would be for patients who are unable to make regular appointments due to transportation or other issues. The visits are reimbursable by Medicaid and would be billable twice a month, and must be ordered by the physician and or the provider. Such visits would be for 17P injections, blood pressure checks for HTN hypertension) patients and other problems identified by the provider that Sexually Transmitted Disease (STD) services are provided Monday thru Friday with two Enhanced Role Registered Nurses available to provide assessment and Communicable Disease has been handling the ongoing statewide outbreak of Hepatitis A since January 2018. Outbreaks have been reported in 15 counties with 75% being hospitalized and one death has occurred. North Carolina has  as small amount of flu vaccine remaining. as Intra-Uterine Devices (IUD) and Nexplanon.  2019.  drills.  services.  would necessitate a visit by the prenatal nurse.  treatment per standing orders.    Page 5 Board of Health January 17,2019  Harnett County Health Department Board Room  issued a liberal use policy and has asked for assistance with this outbreak by providing Hepatitis A vaccine to high-risk people. The Health Department has been provided with state vaccine to administer to the high-risk population. High-risk groups are homeless, incarcerated, persons with chronic liver disease, drug users and men who have sex with men (MSM). The vaccine is being administered weekly at the Harnett County Detention Center and monthly at Preparedness Epidemiology (EPI) team has attended the EPI team training, which was offered by the North Carolina Department of Health and Human Services at no charge to Health Department EPI team staff. We had six employees to take this training, which focused on EPI response and resources toi involve when an outbreak or emergency event occurs. On December 4, 2018 the Health Department held a Potassium Iodide (KI) distribution event at Duncan Junction for residents within the 10 mile Emergency Planning Zone (EPZ) of Shearon Harris Nuclear Plant. Over 450 KI Health Insurance Portability and Accountability Act (HIPAA) Carolinas Information Technology (IT) conducted our HIPAA Risk Assessment on January 17, 2019. They worked with the Health Department and Harnett County IT to perform the assessment, which includes a scan of all electronic devices and a walk through of the facility. A full report will be issued based on their findings. They suggested some additions to our policies during the visit, however we will Environmental Health - Oliver Tolksdorf discussed the new Food & Lodging North Carolina Food Code changes to cold holding temperatures that was effective on January 1, 2019. The cold holding temperature requirement for Tme/Temperature Control for Safety (TCS) foods has changed from 45 degrees to41 degrees. If temperature is between 42 degrees and 45 degrees, it is noted as a violation but no points deducted at the first visit only. Onsite wastewater repairs are up due to the excess water: from the amount of rainfall we have had over the past few months. This has also been an issue for onsite being able to conduct soil evaluations and issuing permits. Aging & Case Management = Mary Jane Sauls reported that Medicare open enrollment was scheduled to run from October 15, 2018 until December 7, 2018. During the Annual Enrollment Period (AEP) you can make changes to various aspects of your coverage. Harnett County was one of the 34 counties  the Morse Clinic in Dunn.  tablets were distributed during the event.  wait for the full written report before making any changes.    Page 6 Board of Health January 17,2019  Harnett County Health Department Board Room  that was impacted by Hurricane Florence and was granted an extended Special Enrollment Period (SEP) to sign up for benefits. This extended period gave that was impacted by Hurricane Florence and was granted an extended Special Enrollment Period (SEP) to sign up for benefits. This extended period gave beneficiaries an extra month to enroll in a Medicare health or prescription drug plan due to the unforeseen circumstances that accompany a natural disaster. The SEP allowed those affected by the storm to enroll through Jan. 7, 2019 with coverage to begin Feb. 1, 2019. The Division on Aging served approximately 567 beneficiaries during open enrollment. Savings data is not yet  available at the state level due to the extension.  The Community Alternatives Program for Disabled Adults (CAP/DA) program is al North Carolina Medicaid and Community Based Service. This program allows low-income disabled residents to have an alternative to nursing home placement. Iti is time for the wavier to be renewed for the program. The S 1915 (c) HCBS waiver for the CAP/DA program five-year approval cycle (Oct. 1, 2013- Sept. 30, 2018) has expired. The Centers for Medicare & Medicaid Services (CMS) has granted North Carolina Medicaid an extension period to continue to administer the CAP/DA waiver through March 29, 2019. A draft application Home and Community-Based Services is posted for public comments through  Monday, February 4, 2019.  Some of the Highlights of the Draft Waiver include:  Introduction of another priority group to allow immediate waiver entry. This group includes an individual who is actively dying and who is in jeopardy of going into an institution, not institutional Hospice, because An independent assessment entity model will be used to ensure safeguards of conflict of interest in the areas of eligibility and services. This entity will solely be responsible for determining the clinical and need-based eligibility for newly interested individuals wanting to participate in this home and community based services (HCBS) program, and during annual reviews for individuals currently participating in this A90-day conditional waiver participation period for a waiver participant who willingly places their self in an unsafe situation which impacts health, safety and well-being. Currently we have 93 slots and additional  care needs cannot be met by current resources.  HCBS program.  Alzheimer's slots as needed.    Page 7 Board of Health January 17, 2019  Harnett County Health Department Board Room  The Harnett County Health Department administered the Community and Patient/Consumer surveys December 5, 2018 through December 19, 2018. These survey results will be used for future program planning. We are currently working with a Campbell University student to compile the data.  This will be shared with the Board of Health, Management Team and staff once Tax assistance services are available for the elderly and disabled January 31, 2017 through April 13, 2017. The Volunteer Income Tax Assistance Program (VITA) grant and the Harnett County Retired Senior Volunteer Program sponsor this program. The Coats Senior Center will offer assistance with tax returns on Tuesday mornings appointments are made through the Coats Senior Center. In addition, Harnett County Retired Senior Volunteer Program (RSVP) is accepting appointments to provide tax assistance at the Erwin Public Library on Thursday Marketing/Communty Outreach - Mr. Rouse announced The "Go Red Lunch and Learn" will be held on Friday, February 22, 2019, this program is a collaboration with the Harnett Health Hospital which includes an educational session on heart disease and the current heart health information and  iti is complete to determine any appropriate action.  mornings.  recommendations.  Closed Session = There was no need for closed session.  New Business - Chairwoman Chalmers opened the floor for New Business. Being none  Vice-Chairwoman Chalmers closed New Business.    Page 8 Board of Health January 17, 2019  Harnett County Health Department Board Room  Chairwoman Chalmers adjourned the meeting.  Respectfully submitted, quwwl John Rouse, Jr. Health Director  heahes Patricia Chalmers, Chairwoman