Harnett County Board of Health Minutes of Regular Meeting May 16, 2019  The Harnett County Board of Health met in regular session on Thursday, May 16, 2019 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, Ms. Linda Sturdivant, Dr. Laura Smith, Dr. Nicholas Pennings, Ms. Emily Barefoot and Mr. John Rouse, Jr., Health Director. Other present: Mary Jane Sauls, Oliver Tolksdorf, Debra Harris-Hawkins, Donna  307 W. Cornelius Harnett Blvd., Lillington, North Carolina.  Surles, Gail Hobbs, and Natasha Johnson.  Chairwoman Chalmers called meeting to order at 7:00 p.m.  Announcements - Mr. Rouse reported the HVAC system for the Health Department and the Department of Social Services will be shut off starting on Friday, May 17, 2019 and through the weekend. They are beginning the repairs on the chiller unit. We will continue to monitor the temperature throughout the buildings until the repairs are complete. Mr. Rouse stated that several Board of Health members will not be able to attend the meeting that is scheduled for July 18, 2019. The Board of Health members decided to reschedule the July 18, 2019 Board of Health meeting to July 25, Consent Agenda - Minutes - Motion made by Ms. Emily Barefoot for the March 14, 2019 minutes to be approved as presented and seconded by Ms. Judy Herrin, 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. Health Disparities Report = Debra Harris-Hawkins presented a power point presentation for the annual Health Disparities report. Reducing health disparities is a major goal of public health. Health disparities are differences in health outcomes and there causes among groups of people. If a health outcome is seen to a greater or lesser extent between populations, there can be a disparity. Data was provided on the utilization of various Health Department programs and services. The programs  2019.  RPH. Motion Carried.    Page 2 Board of Health May 16, 2019  Harnett County Health Department Board Room  included clinical services, Women Infants and Children (WIC), and the mammography screening program. The timeline for the report included January-December 2018. The Health Department's clinical programs data for 2018, approximately 39% of the 8,038 clients seen were uninsured. Those who are uninsured are more likely than those with insurance to postpone health care. The consequences can be serious, particularly when preventable conditions or chronic diseases go undetected. By gender, the number of women seen approximately 5,507 was almost twice as the number of males 2,529. By race, twice as many Whites approximately 5,309 were seen through the Health Department clinics compared to African Americans 2,371. WIC is a special supplemental nutrition program for Women, Infants, and Children (WIC). To qualify for WIC your household income must be at or below 185% of the federal poverty income level. Over 35,460 participants were seen in 2018, which averages approximately 2,955 participants each month. This program has three sites, Dunn, Lillington and Anderson Creek, to provide access to services close to where people reside. 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. In the U.S., while white women have the highest incidence of breast cancer, black women have higher breast cancer mortality rates. These disparities are likely attributable to a combination of factors, including access to screening. Information regarding the Health Department's collaboration with Rex Mobile Mammography which provides access to mobile mammography screenings. Approximately 273 women were seen in 2018 with approximately over 54% identified an uninsured. Currently this is the only program in the county that provides funding assistance for uninsured women to obtain a mammogram. Not having health insurance makes a difference in people's access to needed medical care. Even though the number ofi insured people increased, there are still many without health insurance and some individuals do not qualify for Medicaid, indicating a persistent gap in health care coverage. The mammography screening program is an example ofhow the Health Department is working to implement programs and services for the priority populations to assure needs are being met. Of the women screened by race and ethnicity approximately 39% were African American women, 35% identified as White and 17% Hispanic. An overview of the Health Department's outreach efforts to reach vulnerable population, was provided. Hawkins stated, the main goal of these types of programs are to identify and carry out public health activities specific to selected communities and to address differences in health  outcomes.    Page 3 Board of Health May 16, 2019  Harnett County Health Department Board Room  Clinical Patient Fees, Eligibility and Bad Debt-Write Off Policy Revision - Gail Hobbs stated the changes to the Clinical Patient Fees, Eligibility and Bad Debt-Write Off Policy. The changes were made due to the recommendations from State auditors. Motion by Judy Herrin, RPH to approve the changes to the clinical fee policy as presented and seconded by Dr. Nicholas Pennings. Motion Carried.  CPT CODE 82247  DESCRIPTION Total Serum Bilirubin  RECOMMENDED PRICE  $30.00  Bilirubin Machine purchased. Price established to bill for this lab. In the past, the Total Serum Bilirubin was sent to an outside laboratory for processing. Motion to approve the added new fee from Dr. Laura Smith and seconded by Ms. Debt Setoff - Gail Hobbs reported the total amount of Debt Setoff money received this  Amy Allen. Motion Carried.  calendar year is $6,031.96 in debt setoff funds.  Health Director's Report and Program Reports - Mr. John Rouse  Legal Counsel - Mr. Rouse reminded the Board that Harnett County Staff Attorney, Monica Jackson and her staff are accessible to the Board and health department for any legal issues. Ms. Jackson is readily available to our department on an as needed bases. Ms. Jackson has previously provided her background to the Board. She works with the health department reviewing contracts, handles recoupment appeals with Medicare and when we have an initiative with problem property that associates Environmental Health. Financial Reports - Mr. Rouse reviewed the Expenditure Summary from July 2018 - March 2019 and Revenue Summary from July 2018 - March 2019. Revenues within our programs in the Health Department are doing very well at this time. The Aging and Community Alternative Program (CAP) revenues and caseloads are in line to receive full reimbursement by the end of the fiscal year. Their program billing cycle runs a month behind. The budget has been submitted to the County and is still being reviewed by the Board of Commissioners. Environmental Health revenues are increasing due to the amount of permits that are coming in. Due to the past amount of wetness in the soil, onsite wastewater work was slow but since the soil has dried they are steady and busy. The Environmental Health staff is also currently short one  employee who is out on maternity leave.    Page 4 Board of Health May 16, 2019  Harnett County Health Department Board Room  Medicaid Transformation - Mr. Rouse presented a power point presentation on the current information about the Medicaid transformation. The current contracts are with United Healthcare, WellCare Health Plans, and Carolina Complete Health. Contracts that are still under negotiation are Blue Cross Blue Shield Anthem and Amerihealth Caritas. The plans that did not: receive a bid were My Health by Health Providers, Optima Health, and Aetna. Maximus will be the enrollment broker who will assist beneficiaries in enrolling for the Managed Care Plans. Beneficiaries who do not enroll their selves in the plans will be auto enrolled. Once beneficiaries are auto enrolled they have 90 days to change their plan. If beneficiaries contact the Department of Social Services (DSS) for plan information they will be directed to contact the enrollment broker. During the open enrollment period the enrollment broker will have 250 individuals available through call centers to assist beneficiaries. Each Managed Care company will have a DSS liaison for a region, which will consist of several county DSS agencies. The transportation providers that will provide transportation for the five health providers will reach out to each county transportation agency. Phase 1 of the process has already started for some  counties and Harnett County will be in Phase 2.  Measles Cases and Outbreaks - Mr. Rouse presented a power point presentation on the increased cases of measles that have been confirmed in 23 states for 2019. From January 1, 2019 to May 10, 2019 there has been 839 individual cases of measles. This is the greatest number of cases reported in the United States since 1994. The large amount of outbreaks is linked to travelers who have visited countries with occurring measles outbreaks, such as Israel, Ukraine, and the Philippines. The majority spread of measles is when it iss spread through communities where groups ofindividuals are unvaccinated. Complications from measles include ear infections and diarrhea. Severe complications include pneumonia and encephalitis. Children age 5 and older, and adults age 20 and older are most likely to suffer from measles  complications.  Clinical Reports - Donna Surles  Child Health on May 2, 2019 the Harnett County Health Department hosted a Child Health Community Fair from 5:00pm-7:00pm. There was several vendors and community partners that participated in the event. Pizza was provided by Partnership for Children, and car seat checks were conducted by Child Health nurses who are certified in car seat safety. Approximately 150 people were in attendance. Child Health is now scheduling appointments for car seat checks in the Child Health Clinic. On May 8, 2019 the new Teen Clinic started in Child    Page 5 Board of Health May 16, 2019  Harnett County Health Department Board Room  Health and Adult Health, and it is designed for ages 13-19. The rooms are designed to be teen friendly with posters, chairs, lighting and other décor that is more favorable to teen patients. We continue to provide the same services as The Newborn and Postpartum home visits are down in April 2019-May 2019, and we are working to get the visits back up. In the preparation to get the new Sexually Transmitted Disease (STD) Express Clinic running the home visiting nurses were assigned in other clinics to help provide coverage. Adult Health on April 29, 2019 we began offering a new program for asymptomatic patients who want to be screened for STDs. The STD Express Clinic is designed to be efficient for those not needing a full exam. Patients without symptoms can be screened, labs collected and the patients are finished. Since the Express Clinic has been opened for two weeks they have seen 22 patients. Patients who are experiencing symptoms will continue to be seen in The Health Department will host a "Special Delivery Pregnancy Health Fair" on May 16, 2019 from 4:00pm-6:00pm in the Governmental Complex, Commons Area. This event is being held to provide health information during pregnancy and about making healthy choices. We want the public to know about the health services the Health Department offers, and the "Special Delivery Pregnancy Health Fair" is an opportunity to meet the providers and the staff. Other vendors will provide information about Women Infant & Children (WIC), safe sleep, breastfeeding and postpartum. Information will also be available for couples who are planning a pregnancy. The Maternal Health and Family Planning clinic visits were up in April 2019, and the STD clinic visits remain Immunizations/Communicable Disease the Health Department continues to administer Hepatitis A vaccine to inmates at the Harnett County Detention Center weekly and monthly at the Morse Substance Abuse Clinic. We are working with other county departments to administer the vaccine to employees. Hepatitis and other vaccines are available for employees through the Employee Clinic. The Health Department has received the revised North Carolina Immunization Program (NCIP) Coverage Criteria for state vaccine eligibility which was effective May 6, 2019. We now offer the Shingrix vaccine for ages 50- 64 in Adult Health and the Employee Clinic. The shingles vaccine can be given at age 50 and is more effective than the Zostavax, which is usually given at age 60. The Health Department met with the Harnett County School nurses and the Assistant Superintendent, Jermaine White to discuss the new: immunization requirements for the 2019-2020 new school year, and to provide information  before the upgrade. just in a different setting.  our regular STD Clinic.  fairly constant from month to month.  about the Teen Clinic.    Page 6 Board of Health May 16, 2019  Harnett County Health Department Board Room  Flu Report as the flu season comes to an end the state reported 203 Influenza associated deaths this season as of May 11, 2019. It seems the flu vaccine this year was more effective than last year's vaccine with 391 reported deaths Environmental Health - Oliver Tolksdorf discussed the new onsite wastewater rules update. Forty-two of the Ninety-nine new onsite wastewater rules were sent to the Legislature for review during the. January 2019 session. A ten- member Task Force will be created under the bill that will include members from both private and public sector. The Task Force will issue a report to recommend new wastewater rules to the Commission of Public Health by February 1, 2020. The bill also creates an Authorized Onsite Wastewater Evaluator (AOWE), and the they can submit an Intent to Construct similar to an Engineer Option Permit (EOP) and no county site visit is required. The AOWE must be a Lead Soil Scientist (LSS) and certified under the conditions developed by the North Carolina Onsite Wastewater Contractors and Certification Board. This will become effective when the bill becomes law, and the AOWE permits can be issued based on the existing rules before the new Aging & Case Management - Mary Jane Sauls reported The 25th Annual Retired Senior Volunteer Program (RSVP) Senior Fair sponsored by the Harnett County Division on Aging was held on May 9, 2019 at the Dunn Community Building and Dr. P.K. Vyas Recreation Center. A total of37 vendors offered services such as hearing screenings, blood pressure checks, health information and updates on the latest health insurance options. An estimated 250 to 300 people were in attendance. The Kiwanis Club of Coats served hotdogs and chips. There was also a shredding truck onsite that was provided by the Department ofInsurance. The RSVP volunteer recognition banquet was held on April 5, 2019 at the Dunn Community Center from 5:00pm 8:00pm. Volunteers were recognized for their service, and they enjoyed a nice meal and music. April was Public Health Month and during the month, we applauded the power of prevention and celebrated Public Health's successes. As an organization we. had many activities for staff that included a luncheon, goody days, observance of national walking day and spirit weeks. Marketing/communty Outreach - We have completed several community outreach programs which included annual Girls are Great program which was held on Saturday, May 4, 2019. The Pregnancy Health fair was held today from 4:00-6:00pm in the Commons, the purpose of the event is to increase awareness and to provide information on various health and community services. Hard copies of the State of the County Health Report were provided.  associated with the flu.  rule issue has been resolved.    Page 7 Board of Health May 16, 2019  Harnett County Health Department Board Room  Closed Session - There was no need for closed session.  New Business Chairwoman Chalmers opened the floor for New Business. Being  none Chairwoman Chalmers closed New Business.  Chairwoman Chalmers adjourned the meeting.  Respectfully subAnitted, Oly John Rouse, Jr. Health Director  Bhacbc Patricia Chalmers, Chairwoman