DRAFT Michigan Association of Local Public Health Nurse Administrators Forum






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The purpose of the Nurse Administrators Forum is to enhance the health of Michigan citizens, based on our knowledge of Public Health Nursing practice, by providing effective leadership, collaboration, legislative outreach and professional

mentoring for Public Health Nurse Administrators.


Michigan Association of Local Public Health

Nurse Administrators Forum


Tuesday, November 10, 2015 9:30 am - 12:30 pm Location: MPHI, Okemos, MI

1. Call to Order: The meeting was called to order by Andrea Tabor at 9:30 am.

2. Roll Call: Jennifer Casarez, Michelle Klein, Peggy Hamel, Kim Wilhelm, Michele Thorne, Mari Pat Terpening, Renee Tschirhart, Debbie Poquette, Dranoel Knox, Joyce Zigler, Lisa Dault, Sheryl Slocum, Anne Young, Jodi Kelly, Cindy Rochefort, Angie Videto, Renee Marks, JoAnn Hoganson, Christopher Bendekey (Guest), April Hight, Kathy Haskins, Deidre Reed, Elaine Brown, Cheryl Woods, Andrea Tabor (Chair), Bridget Huss, Pat Fralick, Lynn McDaniels (Secretary), Lisa Hahn, Janine Chittenden, Dawn Dotson, Tawnya Simon, Michelle McDonald, Liz King.

Guest: Danielle Bengel, U-M Student 3. Administrative Items

A. Approval of the Agenda: Motion by Lisa Hahn, support by Tawnya Simon to accept the agenda as revised to include a demonstration of the Dropbox process if time allows. Motion approved. B. Approval of the Minutes: Motion to approve the October 13, 2015 minutes by Angie Videto, support by Anne Young. Motion approved.

C. Treasurer’s Report: Reminder to send in your dues as soon as possible if you haven’t already. Motion to accept the Treasurer’s report for October 2015 by JoAnn Hoganson, support by Michele Thorne.

4. Speakers: Craig Boyce and Micki Smith, MCHHS STD Section. Craig discussed the barriers to STD billing that relate primarily to LHDs not having a nurse practitioner, physician’s assistant of physician on site when billing for an initial visit. Difficulties hiring nurse practitioners were discussed. Craig identified that the requirement for having a NP on site to bill for services is written into law. Changes will need to be enacted through the legislative process. It was also identified that many state residents are unable to afford health insurance through the Affordable Care Act or are undocumented residents and will continue to seek care at the LHD.

5. Administrative Items, continued. D. Correspondence: none

E. Chair’s Report: Andrea Tabor reports that Jane Nickert (Washtenaw) is having surgery and will not be able to attend until February. Everyone conveyed their best wishes for a speedy recovery.


2 Andrea Tabor reported on the MALPH Board Meeting, November 9, 2015

 Medical Directors (MD)–Discussion occurred regarding the difficulty with hiring MDs as many are retiring - as well as difficulty with billing for services when the MD is not on site (primarily for private insurances). It was suggested that LHDs considering cross

jurisdictional sharing for direction as well as aligning standing orders throughout LHDs. Another suggestion was to have the State Medical Director cover if a local health department loses their Medical Director without warning. The Executive Committee is going to be reaching out to the MAPP for their thoughts. Jim Rutherford shared Calhoun’s experience with suddenly losing their Medical Director and had to shut clinics down for a week. MALPH is considering forming a work group to deal with the Medical Director issue (coverage, MPH requirement, etc.). Stay tuned.

 Lobbyist – Senate and House will be meeting tomorrow. After tomorrow – they don’t come back to Lansing until December. Now that the Road Bill is on the Governor’s desk – there are no major projects that have to be done by the end of the year. Rewrite of the energy package is the next thing they will work on (last rewrite was in 2008). Short funding schools are an issue that the Governor has brought up to the legislature, particularly with the issue in Detroit. Governor is proposing a much smaller Detroit Public Schools and partnering with Charter Schools. A bill has been introduced to prohibit guns in schools, hospitals and other particular locations. Governor has vetoed a similar bill in the past. Issues that could affect the budget – CMS waiver required is by the end of December for continuation of the HMP (600,000 covered folks). Use tax is going away - 130 mil/year. HMP costs – State is going to have to begin paying – up to 10% by the end (100s of millions of dollars/year). When the costs exceed the savings – the plan will end per the legislature. Federal Medicaid match rate – will begin to drop as the economy continues to improve. Road package – ultimately 600 mil has to come from the General Fund. (150 mil in 2017 and it goes up to 600 mil in four years).  Premier PH Conference – registration numbers were up!

 Chippewa shared an issue with aerial pesticides and that the Department of Agriculture rules are very loose. The applicator must retain a record for one year after application. There was an incident in Chippewa where there was a spray that missed the target – and killed trees, gardens, etc. MALPH Exec. Will talk with the MDARD at their next meeting regarding this.  CSHCS Accreditation - CSHCS frequently missed accreditation indicators – Lonnie and

Courtney, who is responsible for CSHCS accreditation, attended the meeting. She shared what MDHHS did between Cycle 5 and 6. A small group was formed at reviewed the accreditation indicators between Cycle 5 and Cycle 6. After the process we shared the changes with the LHDs via a summary document – and a webinar was done. Following Cycle 5 – meetings occurred between the reviewers in an attempt to increase consistency between reviewers. They are hoping to have a better tool and experience with Cycle 6. A health department that has gone through Cycle 6 stated the process was much improved for their agency.

 Draft Policy Proposal for Oral Assessment for Kindergarten Entry - Power Point was shared by Public Sector Consultants and Delta Dental with the goal of getting feedback from the Board on whether or not they’d support a requirement for all kindergarteners to have an oral health screen by a dentist or dental hygienist prior to starting school. With the expansion of Healthy Kids Dental state-wide, the infrastructure is in place to implement this type of proposal. It is estimated that 10% of children in Michigan are underinsured for dental coverage. Delta Dental is interested in partnering with LHDs, since we administer the

Hearing and Vision program. Discussed including at the policy that other professionals (H/V tech, nurse (like FV program) can do the assessment. It was also shared that this policy may invite Mobile Dentist into the area which is counterproductive to getting the child a dental


3 home. Those health departments that have a PA 161 for their Fluoride Varnish program would be able to bill for services. Overall, the group was supportive of the concept – but details need to be worked out to assure that funding is available and the program is logistically possible for LHDs.

 MDARD - Strategic Planning has been occurring; Food Safety Alliance will be occurring in February 2016 to focus on partnerships with LHDs, industries, etc. Three Food Code Law trainings will occur in 2016 (Jan 5, 6 for Southeast, Jan 21, 22 for Central Michigan; May 10, 11 for North Michigan). Would like to have some individuals from LHDs participate in providing the training. MPR work group – working with MIHLEA on reviewing the indicators for accreditation.

 Environmental Quality – Most of the programs are being audited by the Attorney General and there will probably be visits out to local health departments. There is a lot of staff in the Flint area that are testing the water in the schools. The Department doesn’t think they did anything wrong in interpreting data.

 The department has contacted 15 non-community water sites across the State that owes fines to the State – enforcement meetings will be occurring with those that do not respond and settle. LHDs will be informed of the meetings when they are scheduled.

 Health and Human Services – Joline Miller and Mary McQueen. Joline had given a

presentation at the Administrator’s Forum Meeting on expediting administrative procedures during an emergency– and she provided a shortened version at the Board meeting. This type of preparedness work is going to most likely be an annex to the local health departments EP plan – and the Health Officers were asked to “move this type of work forward”. NACCHO has useful information on their website related on this topic.

 Mark Miller – mentioned there are a lot of agency’s involved in the Flint situation. DHS partners have been instrumental in getting filters distributed (approx. 15,000). There is case management occurring for those children who have high lead levels. A large workgroup has formed to guide the work.

 Five health departments received the innovation grants – Branch/Hillsdale, Grand Traverse, Delta Menominee, Genesee and Kent.

6. Old Business

A. Leadership Award: Michele Thorne presented the 2015 Leadership Award to Janine

Chittenden. Congratulations, Janine and thank you for all of your work on behalf of NAF and local public health!

B. Higgins Lake Speaker Decision: Anne Young asked that this item be deferred. C. Organizational Membership Requests:

 Andrea facilitated submitting the NAF organization membership for Michigan Public Health Association

 Andrea has begun the process for NAF becoming a member of the Michigan Council for Maternal Child Health.

D. MIHP MSA Bulletin Discussion: MDHHS received the NAF comments to the proposed policy changes and responded. The bulletin proposes that if clients do not have a specific risk identified, approval must be obtained from the MIHP Consultant for services. Concerns related to the difficulty in contacting a consultant as well as the potential loss of clients were identified. Further discussion occurred. Andrea will convene a meeting in December to discuss this issue further.


4 7. New Business:

A. New Members/Leadership Pins: No New members. Andrea has leadership pins for those members that do not have one.

B. Dropbox Demonstration: Lynn McDaniels demonstrated access to the Dropbox files. Please contact Lynn if you need assistance in accessing the files uploaded to Dropbox.

8. Reports

A. NAF Committee Reports 1. Awards: See above.

2. Bylaws: Revisions are in process. 3. Data: No report.

4. Education & Orientation: No report. 5. Nominating- No report.

6. Strategic Planning: Andrea suggested including the Action Plans for review on the NAF agenda.

B. NAF Representative Reports 1. COMON: No report.

2. MPHA: Janine Chittenden reports that MPHA is developing new member orientation and other procedures.

C. MALPH Committee Reports:

1. Governance- This committee is on hiatus until further notice. 2. Premier Conference- Janine Chittenden reports:

2016 conference is being planned for October 11-13 at the Kalamazoo Radisson.

2017 conference is being planned for the first week of October at Mackinac Island Mission Point. D. MDHHS Committee Reports:

1. CSHCS Advisory Committee: Janine Chittenden reports that in response to a recent CSHCS survey, most LHDs indicated they never used or no longer use EZ Link for electronic document storage. However, many indicated they have historical documents stored in EZ Link and, due to volume, need assistance extracting the documents from EZ Link for storage in an LHD-chosen repository.

•At a recent meeting of the MALPH MIS Forum, Kunz, Leigh and Associates (KL&A) provided information regarding a document extraction tool. Cost to deploy the tool varies by LHD, ranging from $1,000 to $12,500. The fee is based on your active caseload count. •When a health department chooses to contract with KL&A for this service, CSHCS will assist by adding funds to the FY16 CSHCS Outreach and Advocacy project contract in the next amendment cycle. The additional funds will be designated to the document extraction project.

•KL&A will attend the November 18 MALPH MIS Forum to respond to questions about the tool.


5 •In addition, the LHD may want to discuss specifics with KL&A to determine if the tool is suitable for your needs. Contact Kim Ivey at KL&A: k.ivey@kunzleigh.com.

•Advise Rebecca Start via email (startr@michigan.gov) once a decision is made regarding LHD intent to contract with KL&A for this service. that a data transfer process has been developed for the EZLink data and Lonnie Barnett is looking for funding.

 Accreditation-Janine reports on the difficulty of meeting requirements 100% of the time as stated in the evaluation criteria.

2. Family Planning: Billing concerns were discussed with Craig Boyce. Andrea Tabor reports:

 Plan First – State is working on a transition plan to end the program. Currently there are approximately 30,000 women on the program.

 There are multiple vacancies at MDHHS – Nurse Consultant, Public Health Consultant, and Breastfeeding Consultant.

 The State is currently working on a Statewide Breastfeeding Plan. Breastfeeding Summits will be held on March 15, 2016 (in Lansing) and April 19, 2016 (in Marquette)

 There is a Billing and Coding/ICD 10 training on Nov. 16th at MPHI.

 The STD Program will be holding clinical trainings in March 2016. Stay tuned for more information.

 Statewide marketing plan for FP will be rolled out the beginning of next year targeting hard-to-reach populations (teens involved in the court system, foster care system, victim advocacy services, migrants, etc).

 FPAR Data – Power point was presented on 2014 FPAR data. Takeaways include: typical client is female, 20-24 years of age, white, never married and 100% or below the poverty level; number of users state-wide declined 13% between 2013 and 2014; 65% of clients were uninsured in 2010 and that percentage decreased to 45% in 2014. The 2015 mid-year FPAR indicated that the number of clients served was down by approximately 12,000 statewide (served approx. 80,000 in 2014).

 Medical Advisory Committee has completed the revisions of the contraceptive protocols – which will be uploaded for agencies to use by January 1, 2016.

3. MACI – No report. 4. MIHP- See above.

5. MPHA PHN Section: Janine Chittenden asks members to SAVE THE DATE: The MPHA-PHN conference titled “Healthy Michigan: Nurses Making a Difference” will be held on 4-22-16. The conference will have a research and practice focus and speakers will discuss nurse led

environmental health programs in local communities.

Peggy Hamel states that there is no report regarding the Academic Practice Partnership. 6. Body Art- No report.

E. Free Forum (Open Discussion):

 JoAnn Hoganson asks if any LHDs are involved with naloxone (Narcan) distribution or training. Liz King reports that they have a grant to pay for a PHN to do training and distribution of the naloxone kits in the community (family members of users). Law


6 behavioral health staff are taking the lead in Mid-Michigan Health Department. Project Red staff have been helpful.

 All LHDs are reporting difficulties connecting with MI-WIC. Christopher Bendekey asks if NAF would like to convey these difficulties to the state. Andrea will check to see if the Health Officers are planning to respond; if not, NAF will explore following up on this issue.  Lisa Hahn queried which LHDs are testing for lead poisoning in WIC. Several LHDs

identified that they are testing. Employees track and charge their time to general funding for this activity.

The meeting was adjourned at 11:48 am.

The next meeting is scheduled for Tuesday, January 12, 2016 from 9:30am – 12:00 noon at MPHI in Okemos. There is no meeting in December.





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