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060120June 1, 2020 The Randolph County Board of Commissioners met in regular session at 6:00 p.m. in the 1909 Randolph County Historic Courthouse Meeting Room, 145 Worth Street, Asheboro, NC. Chairman Darrell Frye, Vice -Chairman David Allen, Commissioner Kenny Kidd, Commissioner Maxton McDowell, and Commissioner Hope Haywood were present. Also present were County Manager Hal Johnson, Finance Officer Will Massie, County Attorney Ben Morgan, and Clerk to the Board Dana Crisco. Chairman Frye gave the invocation and everyone recited the Pledge of Allegiance. Required social distancing was maintained throughout the meeting due to the COVID- 19 pandemic. The meeting was livestreamed on Facebook. The public could attend the meeting but the meeting room capacity was limited to 50 people. Public Comment Period Pursuant to N.C.G.S. § 153A-52.1, Chairman Frye opened the floor for public comment and closed it after no one wished to speak. Consent Agenda On motion of Allen, seconded by Haywood, the Board voted unanimously to approve the Consent Agenda, as presented, as follows: • approve Board of Commissioners regular meeting minutes of 514120 and special meeting minutes of 5111120; • reappoint Lisa Canoy, Mark Hensley, Ann Hoover, Betty Hunt, Duffy Johnson, Hal Johnson, Tyler Keziah, Bob Lawler, Elizabeth Mitchell, Carolyn Vickrey, Emma Washington, and Toni Welch and appoint Tara Aker and Randall Russell to the Randolph County Aging Services Planning Committee; • accept Randolph Senior Adults Center (RSAA) as the Lead Agency for the HCCBG and approve FY20-21 HCCBG Funding Plan (Form DAAS-731) and authorize Chairman to sign; • approve new clinic fees for COVID-19-Public Health. as follows: 99441 99442 99443 PHONE E/M PHYS/QHP- 5-10 MIN $51 PHONE E/M PHYS/QHP-11-20 MIN ...................................................................................................................................................... PHONE E/M PHYS/QHP-21-30 MIN • approve Budget Amendment Social Services -Energy Assistance, as follows: 2019-2020 Budget Ordinance General Fund—Budget Amendment # 52 Revenues Increase Decrease Restricted Intergovernmental $20,828 Appropriations Increase Decrease Social Services $20,828 6/1/20 • elect Chairman Frye as Voting Delegate for NA Co Annual Conference in July; • approve Budget Amendment Public Health Dental, as follows: 2019-2020 Budget Ordinance General Fund—Budget Amendment # 53 Revenues Increase Decrease Miscellaneous $2,400 Appropriations Increase Decrease Public Health $2,400 • approve Budget Amendment Administration Nexsen Pruet, as follows: 2019-2020 Budget Ordinance General Fund—Budget Amendment # 54 Revenues Increase Decrease Appropriated Fund Balance $25,000 Appropriations Increase Decrease Administration $25,000 • approve Budget Amendment JDRC-Boys and Girls Club, as follows: 2019-2020 Budget Ordinance General Fund—Budget Amendment # 55 Revenues Increase Decrease Restricted Intergovernmental $11,249 Appropriations Increase Decrease Juvenile Day Reporting Center $11,249 • approve Budget Amendment Library-LSTA Grant, as follows: 2019-2020 Budget Ordinance General Fund—Budget Amendment # 56 Revenues Increase Decrease Restricted Intergovernmental $3,000 Appropriations Increase Decrease Public Library $3,000 • approve Budget Amendment Soil and Water ADFP Grant, as follows: 2019-2020 Budget Ordinance General Fund—Budget Amendment # 57 Revenues Increase Decrease Restricted Intergovernmental $29,600 Appropriations Increase Decrease Soil and Water $29,600 6/1/20 • approve Budget Amendment JDRC-COVID-19, as follows: 2019-2020 Budget Ordinance General Fund—Budget Amendment # 58 Revenues Increase Decrease Restricted Intergovernmental $2,326 Decrease Appropriations Increase Decrease Juvenile Day Reporting $2,326 • approve Budget Amendment 2020 Timber Receipts, as follows: 2019-2020 Budget Ordinance General Fund—Budget Amendment # 59 Revenues Increase Decrease Restricted Intergovernmental $12,300 Appropriations Increase Decrease Education $12,300 • approve Bud,�,,et Amendment Sandhills Grant to Randolph Countv Schools, as follows: 2019-2020 Budget Ordinance General Fund—Budget Amendment # 60 Revenues Increase Decrease Restricted Intergovernmental $115,000 Appropriations Increase Decrease Other Human Services $115,000 Mediko Healthcare Contract for Inmates Sheriff Seabolt gave an annual cost and monthly cost for the bids they had received for Inmate Healthcare Services. Mediko bid their annual cost to be $753,840 with an approximate monthly cost of $62,820. Quality Correctional Health Care (QCHC) bid their annual cost to be $525,171 with an approximate monthly cost of $43,764. Wellpath did not bid. He said Mediko costs $228,670 more annually than QCHC with the cost pool the same. However, for the first time ever, the inmate medical health care provider has taken the initiative to obtain Medicaid benefits for inmates. In January, an inmate incurred substantial medical costs totally more than $100,000. Mediko was able to get almost $90,000 covered by Medicaid. Mediko has also implemented Medication Assisted Therapy for pregnant inmates who would otherwise be hospitalized. This is also a significant cost savings to the County. In addition, Mediko has provided emergency medical care in the jail to inmates injured during incarceration in lieu of sending them to the Emergency Department. This practice has most certainly saved the County the cost of multiple hospital bills and has reduced transportation costs. Sheriff Seabolt presented a comparison of medical costs during the same time period of medical expenses from the previous provider to the current provider. The comparison indicated that the Sheriff's Office has already incurred savings with Mediko. It is believed that Mediko is capable 6/1/20 of providing care for inmates who would have previously been sent to a Department of Corrections hospital for safekeeping and Mediko has sought out Medicaid for inmates who are eligible. He listed some of the differences between Mediko and the previous care provider. Mediko has provided a comprehensive 200 page Protocol/Policy to nurses versus the 20 page manual used by the previous provider. This ensures each inmate receives appropriate, individualized care. Mediko has implemented medical screening of every inmate at the time of admission. With the previous supplier, screening was only done on those inmates identified by detention staff with an immediate need. Mediko has provided 100% staffing since the beginning of the contract never leaving the facility without medical staff. In making the decision to use Mediko, the following factors were addressed: • Mediko has provided outstanding service to the Randolph County Detention Center and makes great strides to implement cost saving measures for Randolph County. • Mediko stepped -in to provide health care with very little notice after the previous provider abruptly ended their contract. • Mediko has strived to meet every contractual obligation. • Mediko has been an excellent partner in the fight to keep COVID-19 out of the Detention Center. • Mediko responds promptly to inmate medical needs and conducts evaluations and treatments to meet the individual needs of the inmates (not generalized health care). • Mediko has offered triage and medical treatments at the jail instead of sending inmates to the Emergency Department. • Mediko has worked collaboratively with Daymark to provide on-site mental health and substance abuse services for inmates such as Tele -psyche and Medication Assisted Treatment. • Mediko has taken the initiative to get Medicaid benefits for inmates who need costly outside medical services. • Mediko liaisons are currently working with County Information Technology to implement paperless systems to ensure medical records are accurate and safely stored. • Three Mediko nurses and a doctor who worked for the previous provider now feel much more empowered and capable of providing for the inmate health care needs due to the leadership, guidance, and protocols established by Mediko. Sheriff Seabolt said, in his opinion, keeping Mediko as the inmate health care provider would be the most prudent decision in light of the current pandemic. Successful protocols are in place that have proven effective in keeping the virus out of the Detention Center. Based on the level of service received, the cost difference in keeping Mediko versus contracting with another provider will actually be a cost savings when comparing the medical bills paid outside of the cost pool with another provider. Mediko has already saved Randolph County almost $90,000 in inmate health care costs since January 2020. He stated that the additional cost in contracting with Mediko is a worthy investment to protect the County from liability and asked the Board to approve the contract for Mediko, Inc. in the amount of $753,841 for FY2020-2021. 6/1/20 Commissioner Haywood said Mediko had invited Public Health to join their training when they started treatment at the Detention Center. Public Health had commented on the comprehensive training they received. Mediko and Randolph County have a good partnership and they have helped keep COVID-19 out of the Detention Center. Chairman Frye agreed that Mediko is doing the right things in regards to the pandemic. He asked Public Health Director Susan Hayes to talk about her experience with Mediko. Ms. Hayes said that it has been a great partnership. They never had that with the previous provider. Commissioner Haywood stated that the collaboration with Daymark was also a benefit. Many inmates will benefit from their services while incarcerated. Chairman Frye said the price for their contract is more than the other bidder. He asked for an explanation of the benefits with Mediko. Justin Brubaker, Business Manager, said the previous provider charged the Detention Center fees when the population went over a certain threshold. Mediko raised the threshold for the inmate population so no additional costs have been incurred. Safekeeping at a Department of Corrections hospital is not used as often with Mediko which leads to a cost savings. Mediko files for inmate Medicaid. That never happened with the previous provider. Chairman Frye asked about the financial comparison between the previous vendor and Mediko. Mr. Brubaker said he was showing the eight months with Mediko versus the same calendar time frame for the previous vendor. Commissioner Allen stated that the Detention Center staff know the quality of care given by Mediko but not of QCHC. Mr. Brubaker said he was not familiar with the quality of care from QCHC. Commissioner Allen agreed that Mediko has done a good job keeping COVID-19 out of the Detention Center. He liked the partnership with Daymark. Colonel Aundrea Azelton said Daymark uses a telemedicine approach so inmates do not have to be taken out of the facility. More inmates are seen and there is no additional transportation cost. Daymark also has a dedicated nurse for the Detention Center. Chairman Frye asked about a rapid testing machine for COVID-19 at the Detention Center. Major Phillip Cheek said he had spoken to Mediko and their nurses could provide tests on-site. Sheriff Seabolt stated if inmates are tested in-house and have a positive diagnosis, they can be kept away from the general population. Currently, they stay at the hospital. Commissioner McDowell asked how the County saves money with Medicaid funds. Mr. Brubaker said by applying for Medicaid for inmates upon entry, the County does not have to pay out of their funds. On motion of Haywood, seconded by Allen, the Board voted unanimously to approve the renewal of the contract with Mediko, Inc. in the amount of $753,841 for the FY2020-2021. 6/1/20 Randolph County Tourism Development Authority (RCTDA) Request to Waive Administrative Fees David Caughron, Chairman of the RCTDA Board, said revenue for RCTDA has been lost due to COVID-19. He praised both Amber Scarlett and Amber Renee Skeen. They had cut costs where they could. They had the burden to furlough some employees. They continued to mail out collateral materials and answer phones. They even created some videos to showcase some of Randolph County's offerings. He then introduced Amber Scarlett, Interim RCTDA CEO. Ms. Scarlett said that the Board of Directors of the Tourism Development Authority was asking to have the administrative fee for FY 19-20 of 2 �/z % be waived due to the Coronavirus Crisis. She gave the following presentation: I come to you this evening on behalf of the Randolph County Tourism Development Authority Board of Directors with a request to waive the annual administrative fee of 2 112 percent of our projected 201912020 budget year as defined in our contract with Randolph County. Our projected expenditures for the 201912020 budget year were set at $1.lmillion. However, our collections have fallen quite short of this projection. Recently, the tourism industry has directly been affected by COVID-19 and has experienced a drastic downturn in revenues. Randolph County has seen significant declines of lodging tax collections following Governor Cooper's Executive Order 135, an extension of Executive Order 121 issuing a stay-at-home order. This Executive Order resulted in travel across the state of North Carolina coming to a halt. Our attractions and museums in the Heart of North Carolina closed. Our dining establishments shifted their business models to takeout services only. Our shops were supported solely by online sales. Our events were postponed or, sadly, cancelled. Our destination marketing and promotion efforts have continued with a different tone and message; one of virtual support with weekly social media marketing with minimal cost to our organization. Revenues March -Jun *Revenues for March 2020 were reported as $36,106 in comparison to March 2019 $69,452. ($33,346 d Terence from 2019 to 2020) *Revenues for April 2020 were reported to date as $17, 697. April 2019 revenues were $98,100. ($80,403 d Terence from 2019 to 2020) The entire month of April fell into the stay-at-home order and we also saw the cancellation of the High Point Furniture Market - a strong revenue collection for our Archdale area hotels. We found one property in Archdale completely closed on April 3, 2020, and to date has not reopened for business. *Collections are still in process for May 2020. However, May 2019 revenues were reported as $127,877. The stay-at-home order was extended into the first week of May and travelers are slowly finding their comfort level as we make every effort to create safe environments for them to experience. *Our June 2019 revenues were reported as $94,088. Savinzs 6/1/20 Our organization has been successful in the reduction of expenditures since mid- March, with plans to continue into 2021. We have received deferments and forgiveness for some of our operational and advertising costs through this budget year. Our Personnel savings have been $6,500 per month through the elimination of one part- time employee and placing two of our full- time employees on furlough leave in 30 -day increments. Our Operational savings have been $5, 000 per month by reducing costs of office supplies, postage, printing, utilities, and travel expenses. Our Marketing savings have been an estimated $5, 000 per month by reducing advertising buys and renegotiating contracts, halting sponsorships for events, halting assistance with print publications such as maps and brochures and placing special municipality project assistance on hold. Despite these savings, we have still needed to utilize our fund balance monthly to sustain our expenses. We have taken slow steps into Phase II of the recovery strategy and are seeing an uptick in occupancy from our area hotels in Archdale and Asheboro. However, we will not meet the $1.1 million budget as previously anticipated. To date, our anchor attraction, the North Carolina Zoo remains closed. Several of our Seagrove Pottery community partners will remain closed until Phase III and restrictions are still in place for gathering in large numbers preventing special events to occur. We appreciate the consideration of our request to waive the 2y-, % administrative fee from our projected 201912020 budget allowing our fund balance to sustain our organization into the future for the anticipated return of revenues. Commissioner Kidd works with RCTDA. He said he was impressed by the work of the Board, Amber Scarlett, and Amber Skeen. He explained that the only revenue for RCTDA is occupancy tax which has been reduced dramatically due to COVID-19. He clarified that the administrative fee comes from the Board contracting with the County Finance Office. Commissioner Allen asked what the amount of the 21/2% is for FY2019-2020. Ms. Scarlett replied it is $27,688. Chairman Frye wanted to be sure that was for the year that ends in June 2020. Ms. Scarlett said it was. The FY 2020-2021 budget of $700,000 will be presented on June 15Ih. Chairman Frye asked about the DOT Visitors' Centers and staffing. Ms. Scarlett said that is a separate State Budget Contract. The FY2020-2021 contract has been issued. For staffing, there are two teams; one for each center. They work a two/three shift to eliminate contact with each other. People are not coming into the Center so staff members are handing out information on the sidewalk. Some workers did not come back because they were not comfortable with the ongoing pandemic. Commissioner Kidd reiterated how much hard work had gone into the new budget request. It is difficult to cut $400,000 while keeping everyone safe and still giving out materials. 6/1/20 On motion of Kidd, seconded by McDowell, the Board voted unanimously to approve waiving the financial and administrative service fee of 2Y-,% of RCTDA's budgeted expenditures for FY2019-2020. Public Health Request for Positions Susan Hayes, Public Health Director, asked for a new position of Public Health Educator I. This is a full-time position. This position will primarily provide health education to the Hispanic population in Randolph County. Our current crisis has heightened disparities among the minority populations living here. It is critical to be able to provide health education and disease prevention recommendations with respect to the beliefs, customs, values, language, and traditions of the minority population to improve outcomes in the county now and in the future. She also asked for a new position of Accounting Specialist L This is a full-time position. Public Health has a complex budget. She has wanted to make this request for some time, but had not felt it was the right year to ask previously. She asked the internal auditor to look at the current processes and it was recommended that this position be added. Due to the current crisis, this need has become accelerated and necessary to adequately manage the budget. Chairman Frye asked if this would require experience or would have on the job training. Ms. Hayes said she would like to find someone with a finance background. It is a complex job. Chairman Frye inquired if Public Health was still needing a Physician's Assistant (PA). Ms. Hayes replied that it was included in the upcoming budget. There is a need for that position because there is no physician on staff. Nurses in Public Health with the recommendation of a physician can do more than nurses in a private practice. Currently men must be sent to Merce Clinic. If there was a PA, men could be seen at Public Health and things could be done more quickly. Chairman Frye asked if the requests for both positions were in the budget. Mr. Massie said the funding will come in the FY2020-2021 budget. Approving it now allows Ms. Hayes to start advertising. Commissioner Allen inquired if Medicaid expansion and privatization occur, will the Accounting Assistant I position be made more complex. Ms. Hayes said it would. The expansion would create four or five more entities that will need to be billed individually. Commissioner Kidd asked if the Public Health Educator position would be permanent. Ms. Hayes agreed it would. Commissioner Allen noted that two-thirds of the COVID-19 population in Randolph County have been in the Latino community. Ms. Hayes said, historically, Public Health had interpreters not educators. Chairman Frye commented that the COVID-19 videos in Spanish were well received. 6/1/20 On motion of Haywood, seconded by Allen, the Board voted unanimously to approve the addition of Accounting Specialist I and Public Health Educator I positions to the Public Health department. Chairman Frye stated that having Sam Varner as the business liaison has been a benefit to the Health team. Commissioner Haywood said that a new Health Educator will help the Hispanic population take better care of themselves. Commissioner McDowell has been attending the Crisis Management Team meetings twice a week. He has been pleased with the collaboration of all departments during this pandemic. Chairman Frye noted that County employees have continued to provide the services that citizens need. Situation Report on COVID-19 Susan Hayes, Public Health Director, said to date that 515 patients have been released from isolation, 13 deaths have occurred, 10 patients are currently hospitalized, and there have been two nursing home outbreaks; one at Universal Healthcare and the other at Clapp's Nursing Home. Nursing homes have worked extremely hard to keep their residents and employees safe. Public Health has a dedicated nurse that works with them. Testing is being increased and providers can opt -in to be a test site. They are able to request testing supplies and Personal Protective Equipment (PPE). All of the Urgent Cares, First Health, and Horizon Internal Medicine are sites for testing. CVS on Dixie Dr. started drive-thru testing. Chairman Frye asked how accessible the rapid test was and if the machines were available. Ms. Hayes replied that there was not a large supply of the rapid tests. Public Health can send patients to Horizon Internal Medicine and the hospital. White Oak Physicians is trying to become a test site. Machines are not readily available. Most are being sent to places where there are high numbers of cases. She hoped that a machine could be obtained. Ms. Hayes said contact tracing is starting to be done through a State partnership called Carolina Community Tracing Collaborative. This collaborative gives each county the Contact Tracers they need. Randolph County has been promised 26 tracers. Public Health had thought about doing it internally but found it to be too labor intensive and expensive. Using the Collaborative, there is no expense to the County. Commissioner McDowell asked what kind of background Contact Tracers needed to have. Ms. Hayes said the applicant must have a high school diploma. Once picked, the applicant must go to a three day training. Until Public Health gets the Contact Tracers, they will continue to do the tracing. 6/1/20 Commissioner Haywood asked when the Tracers will be available and if they would go through Public Health. Ms. Hayes said she was not sure when the Tracers would be available and that some of her staff is trained on the database used by the Collaborative. Establishment of the Coronavirus Relief Fund Will Massie, Finance Officer, said the Federal response to the COVID-19 crisis was the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act"). He outlined the CARES Act as follows: • COVID-19 related costs after March 1 and before December 30, 2020 are eligible. • Specifically prohibits its use for local government revenue replacement. Role of the State • HB 1043 2020 COVID-19 Recovery Act 5/4/20 • Created the Coronavirus Relief Fund • $150,000,000 current allocation to Counties • Randolph County received $2,587,509 • Reporting requirements, including CRF Plan • State placed another $150,000,000 in reserve for possible revenue replacement, if Congress allows it through future legislation. Medical Expenses Covered • Costs of providing COVID-19 testing, including serological testing. • Emergency medical response expenses, including emergency medical transportation, related to COVID-19. Public Health Expenses Covered • Expenses for communication and enforcement by State, territorial, local, and Tribal governments of public health orders related to COVID-19. • Expenses for acquisition and distribution of medical and protective supplies, including sanitizing products and personal protective equipment, for medical personnel, police officers, social workers, child protection services, and child welfare officers, and other public health or safety workers in connection with the COVID-19 public health emergency. • Expenses for disinfection of public areas and other facilities, e.g., nursing homes, in response to the COVID-19 public health emergency. Payroll Expenses Covered • Payroll expenses for public safety, public health, health care, human services, and similar employees whose services are substantially dedicated to mitigating or responding to the COVID-19 public health emergency. Compliance with Public Health Measures Covered • Expenses to improve telework capabilities for public employees to enable compliance with COVID-19 public health precautions. • Expenses of providing paid sick and paid family and medical leave to public employees to enable compliance with COVID-19 public health precautions. 6/1/20 • COVID-19-related expenses of maintaining state prisons and county jails, including as relates to sanitation and improvement of social distancing measures, to enable compliance with COVID-19 public health precautions. Other COVID-19 Related Costs • Any other COVID-19-related expenses reasonably necessary to the function of government that satisfy the Fund's eligibility criteria. Planned Allocation Medical Expenses $200,000 Public Health Expenses 400,000 Payroll Expenses 1,250,000 Compliance 637,509 Municipal Reimbursement 100,000 Total Allocation $2,587,509 • County is fully responsible for all dollars spent. • The CRF plan can be amended later. Mr. Massie said a Resolution to Commit Resources for the Coronavirus Relief Fund for the County of Randolph was in the packet. Creating a Coronavirus Relief Fund for this restricted funding source will keep the money from blending with the General Fund. Chairman Frye explained in more detail how the allocations for each county were determined. He said that three large counties received their funding directly from the Federal government. The State received $3.5 billion from the Federal government and has spent approximately $1.6 billion. This was the source of the $2.5 million for Randolph County. The State still has approximately $2 billion in reserve. Senator Berger would like to hold the money until unemployment runs out in July. Commissioner Allen commented that none of this funding can be used for revenue replacement. Mr. Massie said he was not sure how much of this funding will be used this fiscal year versus next fiscal year. Commissioner McDowell said having the funding separate from the General Fund was the proper way to handle these monies. Chairman Frye commented that each department and municipality will have different expenses. On motion of McDowell, seconded by Allen, the Board voted unanimously to approve the Resolution to Commit Resources for the Coronavirus ReliefFund for the County of Randolph, as follows: 6/1/20 RESOLUTION TO COMMIT RESOURCES FOR THE CORONAVIRUS RELIEF FUND FOR THE COUNTY OF RANDOLPH WHEREAS; the world is responding to the global COVID-19 pandemic; and WHEREAS; the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act') was passed by the U.S. Congress and signed by the President; and WHEREAS; the CARES Act provided emergency funding to allow state and local governments to better respond to this public health emergency; and WHEREAS; the U.S. Treasury Department has issued Guidance for the use of these emergency funds; and WHEREAS; the State ofNorth Carolina received an allocation offunding that in part was passed on to 97 counties in the state; and WHEREAS; Randolph County has received an initial allocation of $2,587,509 subject to the Treasury guidance; and WHEREAS; this allocation must be spent on direct COVID-19 response costs after March 1, 2020, or be returned to the federal government by December 30, 2020; and WHEREAS; Randolph County does not consider these revenues to be General Fund resources and desires to account for the current and future federal and state allocations and the interest earnings thereon in the Coronavirus Relief Fund. NOW, THEREFORE, BE IT RESOLVED, that the Randolph County Board of Commissioners does hereby commit both special revenues deposited into the Coronavirus ReliefFund and interest earnings thereoffor eligible COVID-19 response costs. County Manager's Update County Manager Hal Johnson did not have any updates. Commissioner Updates The Commissioners did not have any updates. Adiournment At 7:33 p.m. on motion of Allen, seconded by Kidd, the Board voted unanimously to adjourn. Darrell Frye, Chairman David Allen 6/1/20 Kenny Kidd Hope Haywood Maxton McDowell Dana Crisco, Clerk to the Board 6/1/20