Harnett County Board of Health Minutes of Regular Meeting September 24, 2020  The Harnett County Board of Health met in regular session on Thursday, September 24, 2020 in the Health Department Board Room, Harnett County Governmental Complex, 307 W. Cornelius Harnett Blvd., Lillington, North Carolina. A virtual Board ofHealth meeting using audio conference call was held for the September 24, 2020 meeting. Due to COVID-19 the Board of Health meeting was not open to members of the public to attend in person however, citizens were provided options to listen to the meeting. Only Public Health staff necessary to conduct the meeting or to speak on scheduled agenda items were in attendance. As the Board demonstrated compliance Tonight's meeting has been reconvened from the original scheduled meeting date of September 17, 2020, due to the rain from remnants of Hurricane Sally and concern Members present by conference call: Ms. Amy Allen, RN, Vice-Chairwoman, Dr. Amanda Langdon, DVM, Ms. Barbara McKoy, Ms. Stacie Hogan, RPH, Ms. Linda Members present: Dr. Laura Smith, Chairwoman and Mr. John Rouse, Jr., Health Others present: Mary Jane Sauls, Oliver Tolksdorf, Debra Harris-Hawkins, Patricia  with State law and prudent public health practices. for staff's safety the meeting was recessed.  Sturdivant, and Ms. Emily Barefoot.  Director.  Davis, Gail Hobbs and Natasha Johnson.  Chairwoman Smith called meeting to order at 7:00 p.m.  Announcements Mr. Rouse reported no announcements for tonight's meeting. Consent Agenda = Minutes - Motion made by Ms. Amy Allen, RN for the July 16, 2020 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 Smith opened the floor for informal comments by the public, allowing 3 minutes for each presentation up to 30 minutes. Nomination Committee - Chairwoman Smith appointed Ms. Emily Barefoot as Committee Chair, and Ms. Amy Allen as Committee Member to serve on the nominating  Motion Carried.  Seeing no one, Chairwoman Smith closed the informal comments.    Page 2 Board of Health September 24, 2020  Harnett County Health Department Board Room  committee. The committee will report at the next regular meeting in November 2020 Recommendation to Establish Fees: Gail Hobbs reported on the recommendation to increase fees to reflect 40% increase due to the North Carolina (NC) Division of Medical Assistance (DMA) Medicaid Reimbursement Rates for Health Departments during the pandemic. The: master fee schedule for Harnett County Health Department was: reviewed and attached current procedural terminology (CPT) codes need to be increased to reflect full Medicaid reimbursement during this time. The fees will remain in effect until NC DMA: rescinds the 40% increase at which time fees will revert to prior rates. The declared Public Health emergency end date is currently set for October 23, 2020.  and at the January meeting, the officers will be nominated.  CPT CODE G2023 U0003 90662  DESCRIPTION  RECOMMENDED PRICE  Specimen Collection for COVID-19 COVID-19 Testing (previously CPT 87635) Fluzone High Dose Quadrivalent Influenza $61.59 Vaccine Pre-Filled Syringe (PFS) For Age 65 & Older  $26.00 $51.31  Motion to approve the new and increased fees from Ms. Amy Allen, RN and Debt Setoff - Gail Hobbs reported we have received an additional $1,657.15 since the last Board of Health meeting in July. The total amount of Debt Setoff money received  seconded by Dr. Amanda Langdon, DVM. Motion Carried.  year to date is $7,445.10.  Accreditation Activities Report - John Rouse  Review of Operating Procedures - Mr. Rouse reviewed and presented the Operating Procedures with the Board through handouts provided in the member's packets. There were no recommended changes. Mr. Rouse reviewed the Rule Making/Procedures and Authority section, the Board of Health has not had a need for any ordinances or local ruling since the last Operating Procedure review on September 19, 2019. Mr. Rouse related that we will have the Chair sign the Operating Procedures yearly on a signature log format rather than having to actually sign the Operating  Procedure.    Page 3 Board of Health September 24, 2020  Harnett County Health Department Board Room  Communicable Disease Report Patricia Davis provided incidence data of confirmed disease cases using the North Carolina Electronic Disease Surveillance System (NCEDSS). Data from NCEDSS to compare the incidence of cases of Salmonella, Gonorrhea and Chlamydia for this report. The number of Salmonella cases increased slightly in 2019 with 38 cases compared to 34 in 2018 and 30 in 2017. The Health Department continues to promote safe food preparation and storage in the local newspaper, website, and social media. Chlamydia cases remain the highest of all reportable Sexually Transmitted Diseases (STD) and the numbers continue to increase each year. In 2019, there were 786 cases reported which is similar to 2018 with 798 cases, and up from 738 in 2017 and 640 cases in 2016. The incidence of Gonorrhea also increased slightly in 2019 with 283 cases reported. In 2018, there were 262 cases reported, up from 228 cases in 2017 and 181 in 2016. The Health Department continues to see a large number of STD clients in the clinic. We offer express STD visits (labs only) and full STD assessment visits (includes exam). The STD clinic also provides Expedited Partner Therapy for positive chlamydia cases in In fiscal year 2019, the Health Department reported one Tuberculosis (TB) case. This is down from four cases reported in 2018 and two in 2017. We have two nurses who work the TB cases and perform Direct Observational Therapy visits Workforce Development Plan = Patricia Davis reported the Health Department continues to promote continuous quality improvement with our programs. Each year at the performance appraisal, we complete a competency evaluation on each employee to determine strengths, improvement toward goals, and to determine training needs. Annually during the performance evaluation, we continue to review Nursing Core Competencies for Tier 1 and Tier 2 nursing staff. Communication occurs regularly between supervisors and staff to receive and give feedback on pertormance and satisfaction. The Health Management Team also meets regularly to discuss any upcoming events, ideas, suggestions and concerns in all areas. The Health Department focuses on the training and staff development needs of our employees, which we feel, helps improve employee satisfaction and staff retention. All clinical staff are certified in Basic Life Support, with some of our clinical staff being certified in Advanced Cardiovascular Life Support. We conduct bi-annual staff training for all employees in the spring and fall. The next staff training is Monday, October 5, 2020. Due to COVID-19, training will be online and will focus on Customer Service, Policy Review, and Preparedness. We provide customer service tips and Health Insurance Portability and Accountability Act (HIPAA) updates quarterly  efforts to decrease the number of cases.  face-to-face or using skype.    Page 4 Board of Health September 24, 2020  Harnett County Health Department Board Room  in the Health Department newsletter, which is sent via email to all Health Department staff. Continuing education is encouraged to staff and is required by the licensing board. We are looking at Health Department employees who have advanced degrees, and where certifications could be obtained. In the past year, the Health Department has had one nurse, Ainsley Johnson, RN became certified in Healthcare Privacy and Security through American Health Information Management Association (AHIMA), and completed her Masters in nursing this year. Ainsley Johnson, RN and Allison Beam, PA-C also obtained a Public Health Certification through National Board of Public Health Examiners (NBPHE). Allison Beam is also currently working to obtain a post-masters certificate in Public Health and plans to complete this in December 2020. We want to look at utilizing the talents, skills, and experience of our trained staff. Accreditation Workgroup - Mr. Rouse reviewed the information from the Accreditation Workgroup, which has been formed by the Health Director's Association, they are working with the Chapel Hill Institute of Government and the state to review standards in the Accreditation program. The workgroup has been meeting for the past fifteen months. The original Accreditation standards were established in 2004, when Accreditation started. The workgroup will recommend some standards to be changed and others to be removed. The recommendations will then go to the Accreditation Board; the board can make some changes however, some changes will have to be sent to the General  Assembly.  Health Director's Report and Program Reports - John Rouse  Medicaid Transformation - Mr. Rouse announced the General Assembly and Governor Roy Cooper have decided to move forward with Medicaid Transformation in North Carolina. Open enrollment will begin on March 15, 2021 through May 14, 2021. Effective May 15, 2021 automatic enrollment will begin for recipients who did not enroll during the enrollment period. Medicaid Transformation start date is July 1, 2021. The Health Department has started preparing for the transition. Through the Medicaid enrollment program, the Health Departments Child Health clinic can see clients from birth through age 21. The Health Department listed; as primary care provider for Medicaid    Page 5 Board of Health September 24, 2020  Harnett County Health Department Board Room  recipients over age 21 had to be removed due to the department would be liable COVID-19 Updates - Mr. Rouse announced the most recent total of COVID-19 cases in Harnett County, with 2,150 confirmed cases, 329 active cases, 1,701 recovered and 52 deaths. Average age range is 1 week-101 and the average age is 38 years old. Health Education has been handling COVID-19 related phone calls from the public since March 2020. From March through August they have received 1,336 calls with July and August having the highest call rate; in July 326 calls were received and 249 in August. The Health Department continues to provide an Outreach Testing event weekly that is held in the Commons at the Governmental Complex, the clinic has an estimated 60% show rate. The clinic will be put on hold starting the week of October 12th due to early voting being held in the Commons. Campbell University has started providing testing in the The Health Department has received an estimated $560,000 from COVID-19 Crisis Response, most of the money can be carryforward into next fiscal year however $165,000 from the CARES ACT has a deadline for December 31, 2020. The Health Department is in the process of purchasing a rapid test machine for COVID-19. The machines would allow for in-house testing for immediate WIC Food Expenditures Report = Mr. Rouse reviewed the presentation for the Women, Infants and Children (WIC) program and the economic impact in Harnett County. The WIC program infused approximately $2,578,303 million in funds into the Harnett County retail food economy fiscal year 2019-June 2020. The benefits of this economic boost extend beyond WIC families to the local economy. In addition, through the Department of Social Services (DSS) Food and Nutrition Services/Food Stamps, issued approximately $26,954,741 million to the local income July 2019 - June 2020. Approximately $31 million dollars through these two programs, for 2019-2020, WIC and the DSS Food and Nutrition Services/ Food Stamps greatly impact the local economy.  for the client's health outcome.  community and at long-term care facilities.  results.  Financial Report 2019/2020 Year Ending - Mr. Rouse reviewed the closeout revenues summary report for FY19-20, the year ending on June 30, 2020. Mr. Rouse reviewed the expenditure summary report. The revenue report is showing money by programs, the Aging program was able to carryforward money into the new fiscal year due to COVID-19 money. Aging also had to eliminate    Page 6 Board of Health September 24, 2020  Harnett County Health Department Board Room  face-to-face, including the community centers due to COVID-19, which started in March 2020. Other program revenues also did well for the fiscal year even considering patient visits decreased starting in March 2020 due to COVID-19. The Health Department had $1,334,573.37 from Health and $187,842.01 from Aging in county funds not expended. Mr. Rouse reviewed the expenditure summary report. The staff has done a good job monitoring their expenditures. Expenditures included supplies such as personal protective equipment (PPE) for  COVID-19.  Clinical Report - Patricia Davis  Clinical Report is based on the Activities Summaries for July 2020. Clinic numbers are starting to increase and return more to baseline. There was a total of 1,388 clinical visits in July 2019 and 1,238 in July 2020. All clinics are open Child Health (CH) has been notified the law requiring immunizations and well visits for school entry has been extended until October 30, 2020. Child health staff are sending letters and making calls to encourage parents to go ahead and schedule well visit and immunization appointments for their children now. This has increased the clinic's appointments scheduled for these services. Employee Clinic for County Employees have been continuing to utilize the clinic for acute care visits and immunizations. This year we will be going to different county departments to offer flu vaccines since there will not be a Adult Health (AH) Family Planning (FP) clinics completed their monitoring site visit earlier this year and received a confirmation letter showing no compliance issues in June 2020. Maternal health numbers are remaining stable. Maternal Health clinic had 202 visits in August 2019 and 225 in August 2020. The Family Planning annual media review report was completed and approved by the state, and a confirmation letter was received on August 28,  and accepting appointments.  health fair this fall.  2020.    Page 7 Board of Health September 24, 2020  Harnett County Health Department Board Room  Flu Vaccine - Due to COVID-19, the Health Department's process for giving flu vaccine has changed. We are now offering drive-up flu vaccine. Three marked parking spots are available and clients call a: number when they drive up. Management support completes registration at the car and the nurse then gives the flu vaccine while the patient remains in their car. A "Drive Thru Flu" event will be held on October 5, 2020 from 3-7 pm. All staff will participate in the event; the event is the Preparedness Medical Counter Measure (MCM) full-scale exercise that is required by the state every 5 years. The Health Department staff will be working with preparedness partners Emergency Management Services, Sheriff's Department, Department of Social Services and Public Buildings. On Target Preparedness will also be onsite during the event to evaluate and assist. Aging & Case Management - Mary Jane Sauls announced the Elderly Nutrition program continues to serve hot meals five days a week. Aging recently added an additional component to the meals, and have added a once a week delivery of five shelf meals which allows the recipients to have snacks or meals for the weekends. We have also distributed farmer's market coupons to the congregate recipients sO they can purchase fresh produce. Aging has extended the waiver to keep congregate centers closed until October 15, 2020. Money received through COVID-19 funding has been used to purchase cleaning supplies, masks and gloves in anticipation of opening in the future. Aging is currently serving 1,050 meals a week and always recruiting volunteers to assist. The Medicare Open Enrollment Period is an annual period, October 15, 2020 through December 7, 2020, when current Medicare beneficiaries can choose to re-evaluate part of their Medicare coverage, their Medicare Advantage/Part C and/or Part D plan, and compare it against all the other plans on the market. The Division on Aging will begin making appointments on October 1, 2020 to assist beneficiaries by phone or in person. Available appointments will include some after hour and Saturday clinics. Managed Care is scheduled to go live July 1, 2021. Member open enrollment will begin March 15, 2021. The Care Management staff will begin working with the prepaid health plans once all of the contracts are in place. Environmental Health = Oliver Tolksdorf reported that On-site Wastewater is on a steady pace of workload, with new construction continuing to increase. The Food & Lodging program continues to do the required inspections however,    Page 8 Board of Health September 24, 2020  Harnett County Health Department Board Room  guidance from the state is changing frequently. The program has created the best plan based on state guidance, along with input from Mr. Rouse. Marketing/Community Outreach - Debra Harris-Hawkins presented the Health Department has several community health and educational events Prevent Type 2 Diabetes, we will be providing the Prevent Type 2 Diabetes session starting on October 15, 2020 with a session at 5:30 pm -6:30 pm. Health Education staff will be utilizing the Centers for Disease Control (CDC) approved curriculum and trained lifestyle coach to implement this program. For Breast Cancer Awareness the annual "Pink Ribbon Breakfast," in recognition of National Breast Cancer Awareness Month has been cancelled due to increased health concerns regarding COVID-19. We are disappointed that we are unable to hold this event for our breast cancer survivors and families; however, the safety of attendees must always come first. Throughout the month of October, the Health Department will be providing access to mobile mammography screenings, and providing packets with health information and resources for women. The Health Department will be providing access to mobile mammograpny screenings in partnership with Rex Mobile Mammography. Screenings will be held October 16, 2020 and October 27, 2020, pre- registration is required. For women who are uninsured funding assistance is  scheduled in the coming month.  available for women who meet specific criteria. 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.  C8  John Rouse, Jr. Health Director  a  Dr. LauraSmith,  Pe  an