BOARD OF HEALTH MINUTES November 3, 2016

The Greene County Board of Health met in regular session Thursday, November 3, 2016, at the Greene County Public Health office. The meeting convened at approximately 6:34 p.m. In attendance: Scott Filson, President; Melvin Johnson, Charlene Montague, Andrew Root, Kathy Saunders, Thomas Selden, and Nancy Terwoord. Excused: William Beeman, Scott Hammond, Elaine Hughes, June Johnson, and Teresa Zryd. Staff in attendance: Melissa Branum, Health Commissioner; Robyn Fosnaugh, Jeanette Ghand, and Susan Martin. Guests in attendance: Sharon Christman and David Graham, Greene County Auditor.

ADOPTION OF AGENDA Mr. Filson requested an amendment to the agenda adding a report from the Nominating Committee under Committee Reports.

#16-11-03-2. Ms. Montague moved to adopt the amended agenda. Mr. Selden seconded the motion.

The amended agenda was adopted by acclamation.

MINUTES OF PREVIOUS MEETING #16-11-03-3. Ms. Terwoord moved for the approval of the minutes of the October 6, 2016, Greene County Board of Health meeting. Mr. Root seconded the motion.

The motion carried by acclamation.

ENVIRONMENTAL HEALTH No Report.

PRESENTATION David Graham, Greene County Auditor, provided an overview of the role and relationship between the Greene County Auditor and Greene County Public Health. Mr. Graham detailed the process of getting bills paid.

Mr. Selden asked Mr. Graham if the board could pass a motion authorizing the health commissioner to approve bill payments on a limited basis. Mr. Graham suggested drafting a policy for review by the prosecutor's office.

Ms. Terwoord asked Mrs. Branum if the board had already passed a motion authorizing the health commissioner to do something similar. Mrs. Branum noted that motion was emergency authority to make small expenditures. Mrs. Branum felt Mr. Selden is suggesting options to keep bills paid without accumulating late fees if there should not be a quorum. Mrs. Branum expressed that the law requires the board to approve each expenditure and suggested a way to have the board president approve payment and then confirm that payment at the next meeting of the board of health. Mr. Graham asked what if the board didn't approve the payment and noted

that as the county auditor he is personally liable for any money that is misspent or misappropriated. Mrs. Branum noted that the payment process is much more proficient now. Mr. Root suggested a committee to approve bills if necessary. Mr. Selden suggested that the Finance Committee review the process at their next meeting. Mr. Selden asked if members could observe the bill paying process. Mr. Graham explained the generic purchase order process. Mr. Selden expressed his appreciation for Mr. Graham's presentation and felt he was getting a clearer understanding of the process. Mr. Selden suggested that the board might consider going public. Mr. Graham stated that he could come to the health district and have Ms. Ghand demonstrate the health district process and then Mr. Graham could demonstrate the auditor's office process. Mrs. Branum suggested arranging that demonstration after the first of the year. Mr. Graham also reported that his team is working with a software developer on budgetary software. Mrs. Branum suggested some additions to the software to provide necessary information for the health district. Mr. Selden asked if health district grant funds were deposited electronically to the treasurer's office. Mr. Graham and Mrs. Branum confirmed.

FINANCIAL REPORTS Ms. Ghand highlighted items from the Appropriation Transfers, Between Meeting Appropriation Transfers, Fund Transfer(s)/Temporary Loan(s) and the October Income and Expenditure Report.

Ms. Ghand updated the board on the annual audit for 2015. Mr. Filson asked if the state did the audit this year. Mrs. Branum confirmed that the audit was completed by the state this year and provided information regarding the choice of auditors. Mr. Selden asked if Mrs. Branum had a preference of the state auditing the health district or an approved private auditor. Mrs. Branum does not have a preference. Ms. Ghand noted that this year was the state's auditors first year to audit a health district and they experienced some difficulty in adjusting to the requirements and processes required of health districts. Mr. Filson asked about the comparison in costs. Ms. Ghand doesn't have a good idea of the actual costs. Mrs. Branum noted that there were issues with the original auditor and the audit basically had to be completed a second time. Mrs. Branum noted that Ms. Ghand had to work diligently to get the auditors educated on health district financial procedures to bring the number of items in the management letter from five items to one due to their lack of understanding. Mrs. Branum expressed her appreciation of Ms. Ghand's abilities. Mrs. Branum noted that the health district will be placed in a high risk category since the audit was not completed by September 30 and all health districts will be placed in a high risk category since they do cash basis accounting not accrual accounting. Mr. Selden stated that the systems have been at odds for his tenure. Mrs. Branum expected the final audit report shortly.

Mrs. Branum noted that the percentage of budget spent does not include carryover.

#16-11-03-i. Mr. Selden moved to approve the bill/voucher summary, appropriation transfer(s), between meeting appropriation transfer(s), fund transfer(s) and the Income and Expenditure Report. Ms. Terwoord seconded the motion.

The motion carried by acclamation.

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PUBLIC HEARING A public hearing was on the agenda to encourage feedback on the 2017 Proposed Environmental Health fees. There being no one in attendance and nothing submitted in writing to the board there will be no need for a public hearing.

SECOND READING OF THE PROPJDO17 F'E The board had the second reading of the proposed 2017 Community Health Services and Environmental Health fees as presented.

COMMUNITY HEALTH SERVICES proposed changes in RED

CODE CHARGES PROPOSED! Office visit, initial 1 99201 60.00

$- 100-00 Office visit, initial 2 99202 Office visit, initial 3 99203 $ 150.00 Office visit, initial 4 99204 $ 700,00 Office visit, initial 5 99205 $ 250.00 Office visit, established 1 Office visit, established 2

99211 99212

$ 25.00 $ 60.00

Office visit, established 3 99213 $ 100,00 Office visit, established 4 99214 $ 150.00 Office visit, established 5 99215 200.00 Preventive Visits Preventive visit, initial 0-, .29.11 Preventive visit, initial 1-4 yrs 99382 $ 175.00 Preventive visit, initial 5j 11rs 99383 $175M0 Preventive visit, initial _12-l7s 99384 $175M0 Preventive visit, initial 18-39 yrs 99385 $ 175.00 Preventive visit, initial 40-64 yrs 99386 $ 175.00 Preventive visit, initial 65 & older 99387 $ 175.00 Preventive visit, established 0-1 yrs 99391 $ 175.00 Preventive visit, established 1-4 yrs Preventive visit, established 5-11 yrs

99392 99393

$ 175.00 $ 175.00

Preventive visit, _established _12-17rs 99394 $175.00 Preventive visit, established 18-3rs 99395 $175.00

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proposed changes in RED________,

COMMUNITY HEALTH SERVICES

PROPOSED Preventive visit, established 40-64 yrs 99396 $ 175.00 Preventive visit, established 65 & older Administration Fees-Adult

99397 $ 175.00

Administration-each 90471 $ 25.00

Administration-each add component 90472 $ 25.00

Administration oral/nasal-each 90473 $ 25.00 Administration oral/nasal-add component 90474 $ 25.00 Private Pay/VFC-each 99999 $ 20.00

Administration Fees-Child Administration-each 90460 $ 25.00

Administration-each add component 90461 $ 25.00 Administration oral/nasal-each 90473 $ 25.00 Administration oral/nasal-add component 90474 $ 25.00 Private Pay/VFC-each 99999 $ 20.00 LAB Blood Glucose 1 hr 82950 $ 15.00 Blood Glucose 3 hr 82951 $ 25.00 Blood Lead Test 83655 $ 25.00 Creatinine DELETE 82565 $ 6.00 Finger Stick 36416 $ 10.00 $ 15.00 Free T4 DELETE 84439 $ 49.00 Hemoglobin 85018 $ 5.00 Pregnancy Test 81025 $ 25.00 Rapid HIV 86701 $ 25.00 T3 Uptake DELETE 84479 $ 49.00 TSH DELETE 84443 $ 49.00 Urine Dip 81000 $ 15.00 Venipuncture 36415 $ 15.00 Child and Adolescent Health Clinic Denver Assessment (PDQ) 96110 $ 30.00 Education/Counseling 15 mm - 99401 $ 45.00 Education/Counseling 30 min 99402 $ 90.00 Hearing screen, Pure tone 92551 $ 45.00 Removal impact cerumen 69210 $ 30.00 Immunization Adult Hi- Dose Flu vaccine for seniors 90662 $50.00 new this year

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COMMUNITY HEALTH SERVICES

Flu 19+MVD Quad

proposed changes in RED

90688 $ 25.00 Flu Mist 19-49 yrs 90672 $ 25.00 HepatitisA 90632 $ 55.00 $ 61.00 Hepatitis A/Hepatitis B 90636 $ 104.50 $ 116.00 Hepatitis B 90746 $ 66.00 $ 73.00 HIB 90648 $ 35.00

HPV4 - 90649 $ 220.00 HPV9 - 90651 $ 242.00 IPV 90713 $ 45.00 Meningococcal Conjugate 90734 $ 175.00 MMR - 90707 $ 90.00 PNU 13 90670 $ 192.50 $ 212.00 PNU Polysaccharide 90732 $ 105.00 Shingles Vaccine - 90736 $ 280.00 TD 90714 $ 35.00 TDAP 90715 $ 55.00 $ 61.00 *Typhjm VI (Travel) 90691 $ 80.00 Varicella 90716 $ 150.00 $ 165.00 *yellow Fever (Travel) 90717 $ 175.00 Immunization Child Private DTAP 90700 $ 36.00 DTAP/HEP B/IPV 90726 $ 110.00 DTAP/IPV 90696 $ 60.00 $ 66.00 Flu 3-18 MVD Quad 90688 $ 25.00 Flu 3-18 yrs Prefilled Quad - 90686 $ 25.00 Flu 6-35 Months Prefilled Quad - 90685 $ 25.00 Flu Mist 3-18 yrs 90672 $ 25.00 Hepatitis A 90633 $ 37.00 $ 41.00 Hepatitis B - 90744 $ 27.50 HIB 90648 $ 35.00 HPV4 90649 $ 220.00 HPV 9 - 90651 $ 220.00 $ 242.00 IPV 90713 $ 45.00 Meningococcal Conjugate 90734 $ 175.00 MMR 90707 $ 90.00 PNU 13 90670 $ 175.00 $ 213.00

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COMMUNITY HEALTH SERVICES

CODE CHARGES p&'po'd in Rf 1)

PROPOSED Rotavirus (Rotarix)

TD TDAP

90681 90714

90715

$ 175.00

$ 35.00

S 55.00 Varicella 90716 $ 150.00 Immunization Child VFC DTAP (2) 90700 $ - DTAP/pB/IPV(4) DTAP/HIB/IPV (4) 90698

90723 $ -

DTAP/IPV (3) Flu 3-18 yrs MVD Quad

90696 90688

$ -

$ - Flu 3-18 yrs Prefihled Quad 90686 $ - Flu 6-35 months Prefihled Quad 90685 $ - Flu Mist 3-18yrs 90672 $ - Hepatitis A Hepatitis B

90633 $-

HIB 90648 $ - 1-WV 4 90649 $ - HPV9 90651 $ - IPV 90713 $ -

Meningococcal Conjugate__ 90734 $ - MMR PNU 13 Rotavirus (Rotarix)

90707 90670

90681

$ -

$ -

$ - TD 90714 $ - TDAP 90715 $ - Varicehla 90716 $ - Prenatal

-

Antepartum Management Care Coordination Maternit _________ EducationICounse!in30 min EducationlCounsehing 45 min

H1001 111 002 99402

-99403 $ 90.00

$ 20.00 $ 15.00

$ 105.00 Education/Counseling 60 mm 99404 Individual At-Risk Education Medical Nutrition Counseling_

1003 S9470

$ 20.00

$ 25.00 Postpartum 59430 $ 285.00 T Rhogarn _____ _____- J2790 [_$ 140.00

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COMMUNITY HEALTH SERVICES nrposed chanes in RFI)

CODE CHARGES PROPOSED Rhogam Administration 90384 $ 10.00 Risk Assessment Maternity H1000 $ 25.00 Sonogram 76815 $ 100.00 Reproductive Health and Wellness (RHW) Depo J1050 1 $ 73.00 $ 81.00 Depo Injection 96372 $ 20.00 $ 25.00 Destroy Vaginal Lesion (extensive) 57065 $ 291.00 Destroy Vaginal Lesion (simple) 57061 $ 171.00 Destroy Vulvar Lesion (extensive) 56515 $ 291.00 Destroy Vulvar Lesion (simple) 56501 $ 171.00 Destroy Anal Lesion 46900 $ 362.00 IUD Insertion 58300 $ 65.00 IUD Removal 58301 $ 145.00 IUD/Liletta J7302 $ 845.00 $ 930.00 IUD/Mirena Device J7302 $ 845.00 $ 930.00 IUD/Paragard J7300 $ 865.00 $ 952.00 IUD/Skyla J7301 $ 845.00 $ 930.00 Nexplanon Device J7307 $ 770.00 $ 931.00 Nexplanon Insertion 11981 $ 175.00 $ 202.00 NexplanonOut/In 11983 $ 250.00 $ 314.00 Nexplanon Removal 11982 $ 175.00 $ 228.00 PH, Body Fluids, NOS 83986 $ 6.00 Removal Penile Lesion 54050 $ 195.00 Urinalysis - 81002 $ 10.00 Wet Prep8 87210 $ 10.00 TB Clinic Chest X-ray 71020 $ 475.00 PPD-TB Skin Test (Mantoux) 86580 $ 7.00 $ 12.00 T-Spot (Blood Test) 86481 $ 175.00 Tobacco Cessation Group Counseling Per Participant S9453 1 $ 20.00 Tobacco Cessation 3-10 min 99406 $ 20.00 Tobacco Cessation 10+ min 99407 $ 40.00

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ENVIRONMENTAL HEALTH

Health District Portion Only PROGRAM 2017 Proposed Fees

Food License Operations <25,000 sq. ft. Level I $ 150.00 Level 2 $ 165.00 Level 3 Level

Level I Operations > 25,000 sq. ft.

$

$

$

300.00 375.00

200.00 Level 2 - -- $ 220.00 Level - $ 720.00

Level $ 760.00 -

Mobile Operation S 126.00 VendingLocation 43.79+_CPI TemporaryOperationperEvent $ 75.00

FoodOperationTraining - LevelIperperson $ 30.00 FoodOperationTraining - LevelIIperperson $ 150,00 Food Operation Training - Level II per person - Proctor Test Only

$75.00

Plan Review - Commercial $ 350.00 PlanReview - Noncommercial $ 150.00 SamplingFee Swimming Pools, Spas and Special Use Pool License $

100.00 -F Lab Fee 450.00

EachadditionalLocation $ 200.00 Bathing Beach Permit $ 225.00

RVParksandCamps 50orfewerlots $ 400.00 More than 50lots(eachadd'l lot) - $ 400+4.00perlot Temporary Park Camp(per event) SOor fewer lots $ 250.00

TemporaryParkCamp(perevent)50lotsormore $ 250.00+0.50perlot ResidentDayCamp $ 400.00 TrashandTankTruckPermits $ 50.00 TattooParlorand BodyPiercing $ 550.00

£

Health 1. _District _Portion _Only PROGRAM 2017 Proposed Fees

Temporary Location-up to 5 days $ 200.00

Plan Review Fee $ 200.00

Hunger Task Force Home Inspections - $ 50.00

Private Water Systems New Well Permit - Residential $ 235.00

New Well Pen-nit - Commercial $ 245.00 Convert Well Permit - Residential -. $ 300.00

Convert Well Permit - Commercial 310.00

Alteration: Residential $ 235.00

Alteration: Commercial $ 245.00

Test Well Permit $ 125.00

Well Sealing Permit- Residential& Commercial S 150.00

Pond Permit $ 600.00

Variance Application Fee $ 160.00

Water Contractor Inspection $ 250.00

Water Hauling Vehicle Registration $ 200.00

Water Hauling w/unapproved H20 $ - 400.00

Water System Certification Water Sample - Bacteriological - w/perrnit

$

$

150.00 100.00

Water Sample - Bacteriological - w/o permit $ 100.00 Water Sample - All Others 100.00 -

Private Water Systems Water Sample - Lead $23.00 (When Taken with Bacteria) Water Sample - Nitrate $23.00 (When Taken with Bacteria) Water Sample - Nitrate-Nitrite $39.00 (When Taken with Bacteria) Water Sample Filing Fee - $ 100.00

Household Sewage Program, Small Flow Sewage Program Gray Water Recycling Program

Installer Registration $ 150.00 Service Provider Registration $ 150.00 Septage Hauler Registration $ 150.00 Repair Mound Design Fee $ 700.00 Repair Design Fee $ 600.00 Site Review Application - ( Preliminary) $ 150.00 Site Review Fee (Design) - $ 40000 Installation Permit Fee - New or Replacement 5 350.00

£

PROGRAM

Installation Permit Fee - Alteration

- - Health District Portion Only

2017 Proposed Fees________

S S

350.00 525.00 Mound Installation Permit Fee

Abandonment Application $ 100.00 Lot Split $ 300.00 Operation Permit & Periodic Inspection Fee Initial Operation Permit & Inspection Fee

with permit (1-Yr Permit) $ 100.00 Operation Permit Renewal Fee - Mechanical & Non-

Mechanical $ 50.00

Periodic Inspection Fee $ 150.00 Re-drawing Fee - $ 100.00 Re-inspection Fee

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-- 150.00 Sewage Certification $ 200.00 Collector Tile Fee S 200.00 Septage Hauler Vehicle $ 50.00 Domestic Land _Septage_ _Application Operation Permit & Periodic Inspection Fee

Initial Fee $ 300.00 Renewal Fee $ 150.00

Sampling Fee S 100.00+lab fee Variance Application Fee $ 150.00 Consultation Fee per hour $ 200.00 Fees charged by GSWCD COST FIB _110 - 0_&_M_fees

Mechanical (1-Yr Permit) 5 200.00 Non-Mechanical (3-Yr Permit) 150.00

Plumbing Program Unchanged from 2016 Plumber Registration Unchanged from 2016 Plumbing Permit Unchanged from 2016 Additional for each fixture Unchanged from 2016 Water Service Permit: Residential Unchanged from 2016

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- per foot additional over 100 feet Unchanged from 2016 Water Service Permit: Commercial

Unchanged from 2016

per foot additional over 100 feet Unchanged from 2016 Sewer Permit: Residential Unchanged from 2016 -

per foot additional over 100 feet Sewer Permit: Commercial

per foot additiona! over 100 feet

Unchanged from 2016 Unchanged from 2016 Unchanged from 2016 -

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PROGRAM Water Heater Permit

Health _District _Portion _Only 2017 Proposed Fees

Unchanged from 2016 Water Softener Permit Unchanged from 2016 Irrigation System Permits Re-inspection Fee

Unchanged from 2016 Unchanged from 2016

Plan Review Fee - Commercial Unchanged from 2016 1-10 Fixtures Unchanged from 2016 11-30 Fixtures Unchanged from 2016 31-51 Fixtures Unchanged from 2016 51 + Fixtures Unchanged from 2016

HEALTH COMMISSIONER' S REPORT Mrs. Branum highlighted items from the Health Commissioner's Report and answered board questions satisfactorily.

Mrs. Branum also provided the following additional information: • an update on the new building project. • new environmental health director, Jeff Webb, has been hired and is expected to start

January 4, 2017,

COMMITTEE REPORTS Administrative Evaluation Committee - No Report. Finance/Audit Committee - No Report, Personnel Committee - No Report. Planning and Evaluation Committee - No Report, Nominating Committee - Mr. Selden reported on behalf of the Nominating Committee. The committee submitted a written request to the board to amend the bylaws. The requested amendment is to change section two so that each term will be for one year with not more than three (3) consecutive terms. The committee felt that the flexibility is important during this time. If the board approves the amendment to the bylaws at the December board meeting, the committee will be prepared to offer a slate of officers for 2017. Ms. Terwoord asked if the committee considered longer terms instead of the one year term. Mr. Selden stated the committee did not consider a longer term of office. Mr. Selden suggested it may be time to take another look at the bylaws. The board discussed options.

EXECUTIVE SS51ON No Executive Session.

PERSONNEL Mrs. Branum noted that Tiffany Rich has accepted a public health nurse position previously vacated by Karen Hatcher-McGuire. The position had originally been put on hold but after the departure of the medical assistant the need for an additional nurse became a priority.

* -

OLD BUSINESS No Old Business.

NEW BUSINESS #16-11-03 -4. Mr. Root moved to approve the release of claim of delinquent and current taxes for the following foreclosed and/or abandoned residential property:

M40000200080026600 East Market Street, Xenia, Ohio 45385 M40000200050022000 392 East Market Street, Xenia, Ohio 45385

The waiver of taxes applies to foreclosed or abandoned properties; once the properties are purchased or ownership is assumed, the full taxes will be reinstated, If the properties are sold, the total maximum amount of taxes waived minus the cost of upkeep, should then be reimbursed from the proceeds of the sale on a prorated basis with all other Greene County taxing entities who have waived taxes. Ms. Terwoord seconded the motion.

The motion carried by acclamation.

ADDITIONAL BUSINESS Ms. Montague asked about the transition of Help Me Grow to the Department of Developmental Disabilities. Mrs. Branum stated that the program at the state level is moving to Department of Developmental Disabilities but the program will remain with the health district locally. Mrs. Branum also reported that the Help Me Grow program will now be two programs in one, early intervention and home visiting.

Mr. Filson noted the handout on the Opiate Overdose Epidemic. Mrs. Branum stated that health district staff are participating in a community forum this evening regarding the opiate and overdose epidemic in Greene County and noted that the health district tis the distributor of Naloxone.

#16-11-03-5. Dr. Johnson moved to adjourn the November 3, 2016, meeting. Ms. Montague seconded the motion.

The November 3, 2016, Greene County Board of Health meeting adjourned at 7:30 p.m.

jLJy Scott Filson, President

Me ssa A. Branum, Secretary

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