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NYSAC News NEW

YORK

STATE

ASSOCIATION

OF

COUNTIES

Healthy Counties

SPRING/SUMMER 2018


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President's Page NYSAC OFFICERS Hon. MaryEllen Odell Putnam County President Charles H. Nesbitt, Jr. Orleans County President-Elect Hon. Scott Samuelson Sullivan County First Vice President Hon. William E. Cherry Schoharie County Immediate Past President

MEMBERS Hon. Steven Bellone, Suffolk County www.suffolkcountyny.gov Philip R. Church, Oswego County www.oswegocounty.com Hon. Cheryl Dinolfo, Monroe County www.monroecounty.gov Hon. John LaPointe, Washington County www.co.washington.ny.us Hon. Jack Marren, Ontario County www.co.ontario.ny.us Hon. Daniel P. McCoy, Albany County www.albanycounty.com Hon. Marcus Molinaro, Dutchess County www.dutchessny.gov Hon. Mark C. Poloncarz, Erie County www2.erie.gov Hon. Martha Sauerbrey, Tioga County www.tiogacountyny.com Hon. Bill de Blasio, Mayor of New York City www.nyc.gov

PARLIAMENTARIANS Hon. Herman Geist, Esq., Westchester County www.westchestergov.com Hon. A. Douglas Berwanger, Wyoming County www.wyomingco.net

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elcome to the Spring/Summer issue of the NYSAC News magazine. This edition is devoted to role that counties play in the health of our communities. I am proud of our county governments that run public health departments, mental health departments, health insurance programs, employee wellness programs, water and sewer departments, restaurant inspections, inmate health programs, women and infant programs, all with an eye toward promoting health and preventing illnesses on an individual and social basis.

inform, educate and promote the role of women in our political system. In April, NYSAC hosted an international group of dynamic women from Algeria, Chile, Gambia, India, Jordan, Macedonia, and the Kyrgyz Republic to discuss the roles of education, representation, policy, and safe workplaces in encouraging women to run for political office. I thank my friend, colleague and NYSAC Past President Lucille McKnight for facilitating this great meeting. And a special thank you to NYSAC staff member Nicole Correia for her efforts to promote the work of the WLC.

Many articles in this issue take a look at these aspects of our work as local public servants. Other stories focus on timely legislative or policy issues that are impacting counties as State lawmakers complete their work in Albany and counties implement raising the age of criminal responsibility and prepare to develop budgets for the next fiscal year.

Our association staff members are continuing their work to represent county concerns as State lawmakers complete their work for this Legislative Session. They have made our collective presence known in the State Capitol through dozens and dozens of meetings with legislators and staff members on the issues that matter most to our governments, residents, and taxpayers. As always, we appreciate their hard work on our behalf.

I want to take this opportunity to recognize and thank the many county emergency managers, first responders, highway crews, and public safety employees who helped our residents weather the storms that battered our communities recently. In Putnam County, two major winter storms hit over two weeks that knocked out power for thousands of residents for a prolonged period of time. And in May, at least two tornadoes wreaked havoc in our county, leaving 90% of residents without power for three days. In both cases, our highway workers, police, fire, EMS, many volunteers and public servants, as well as the State and utility providers, responded quickly and professionally to ensure our residents were protected. I know that these storms and others ravaged counties across the state, and I want to acknowledge the thousands of local government workers who pull together during times of adversity. At our association, I am pleased to report that the NYSAC Women’s Leadership Council continues to

We are actively engaged with the National Association of Counties (NACo) as our congressional representatives consider major initiatives like a new federal infrastructure program and the farm bill. We have a growing number of counties who belong to NACo and are sending delegates to NACo meetings to actively engage in the national issues impacting New York's counties. If you would like to serve on a NACo committee, please contact the NYSAC offices. Don’t forget to mark your calendars for the next NYSAC conference, which will be held in Monroe County (Rochester) from September 24-26, 2018. I look forward to seeing you there.

Hon. MaryEllen Odell NYSAC President NYSAC News | www.nysac.org

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Director's Note NYSAC STAFF (partial listing) Stephen J. Acquario, Esq. Executive Director Karen Catalfamo Office/Financial Manager Nicole Correia Communication Manager Patrick Cummings, Esq. Counsel Jackie Dederick Records Manager Patricia Gettings Assistant to the Director Katie Hohman Legislative Director Alexandra LaMonte Research Analyst Mark LaVigne Deputy Director Dave Lucas Director of Finance & Intergovernmental Affairs Juanita Munguia Marketing Specialist Kate Pierce Multimedia Specialist Jeanette Stanziano Director of Education & Training

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YSAC’s mission is to represent, educate, advocate for, and serve member counties and their county officials. Organized in 1925, we are the only bipartisan statewide municipal association representing the interests of thousands of county leaders, including legislators, supervisors, county executives, administrators, commissioners and other of county officials who deliver essential services to New Yorkers. We maintain close ties with officials in Albany and Washington in an effort to ensure New York’s counties are adequately represented as state and federal policies and spending plans are determined. NYSAC consistently strives to provide cutting edge, timely training and educational opportunities through our conferences, webinars, reports, magazines, and electronic newsletters. Whenever we can, we are connecting and informing our members in new ways, through Twitter, Facebook, Instagram, and YouTube. We provide counties a variety of services and programs in the interest of better, more cost effective and efficient government. Our suite of partnership programs is designed to reduce the cost of county operations, provide added services to residents, and offer solutions to the biggest challenges counties face. These programs help underwrite the research, advocacy, services, and support provided by your association. This year marks the 25th anniversary of one our most successful programs, the New York Municipal Insurance Reciprocal (NYMIR). NYMIR today provides property and casualty insurance for nearly 900 local governments, including 34 counties. I would like to commend the foresight of Fulton County for being an initial subscriber. And thank you to Administrative Officer Jon Stead, who was there at

the beginning and remains a critical member of the Board of Governments. We continue to grow our purchasing card program, which is being used by counties to generate non-tax revenues through dividends on the purchases they were already making. US Communities is a national purchasing cooperative being used by counties, schools, cities and villages across the state, saving taxpayer dollars. This year, we are rolling out a new program, the Municipal Healthcare Financing Collective designed to lower the cost of stop loss insurance for selfinsured counties. It is only a slice of the overall cost of health insurance, but it is real savings for the county fisc and local taxpayers. Our other partnership programs continue to be strong partners with their participating counties. The Public Employer Risk Management Association (PERMA) provides workers compensation for county programs. The ProAct PBM provides county employees with top notch prescription benefits. The Municipal Electric and Gas Alliance (MEGA) is helping county-wide shared services panels log savings and state matching funds through is aggregated purchasing model. The Dental Network Card Program is a partnership that enables county leaders to provide their residents with access to lower cost dental services. Please know that we are always on the lookout for how we can better serve our member counties. If you have an idea for how we can help solve some of the problems you are facing, please let us know.

Stephen J. Acquario, Esq. NYSAC Executive Director

NYSAC News | www.nysac.org

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NYSAC News NEW

YORK

NYSAC News NEW

YORK

STATE

ASSOCIATION

OF

COUNTIES

NYSAC’s mission is to represent, educate, advocate for, and serve member counties at the federal and state levels. President Hon. MaryEllen Odell Publisher Stephen J. Acquario Managing Editor Mark F. LaVigne Editor Nicole M. Correia Advertising Staff Juanita Munguia

STATE

ASSOCIATION

OF

COUNTIES

Advertise with NYSAC Contact NYSAC Marketing Specialist Juanita Munguia at 518-465-1473 or jmunguia@nysac.org Published 3 times a year by the New York State Association of Counties (NYSAC), the NYSAC News is the official publication of NYSAC, a non-profit, municipal association serving the 57 counties of New York State and the City of New York with its five boroughs for over 90 years. NYSAC’s mission is to represent, educate and advocate for member counties at the federal and state levels.

NYSAC NEWS MAGAZINE 540 Broadway, 5th Floor, Albany, New York 12207 Phone • (518) 465-1473 Fax • (518) 465-0506 Send submissions to ncorreia@nysac.org. Submissions should be 750 to 1,000 words and include a high resolution photo of the author­. All submissions­are subject to editing for clarity, content and/or length. The advertisments and articles in NYSAC News in no way imply support or endorsement­by NYSAC for any of the products, services or messages conveyed herein. ©2018 New York State Association of Counties

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NYSAC News | Spring-Summer 2018


Table of Contents Volume 40, Issue 2 Spring-Summer 2018 Cover photo: Rochester, Monroe County

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NYSAC Hosts International Delegates for a Dialogue on Women in Government

12

County Leaders to Convene in Monroe County

14

State and Federal Medicaid Financing Reforms Benefit County Taxpayers

HEALTHY COUNTIES: WHAT IT MEANS

THE OPIOID CRISIS

29

America’s Opioid Epidemic Hits New York State Hard

30

Curbing the Opioid Epidemic: What's Your Plan?

32

$3.75M Secured for County Correctional Facilities Substance Use Treatment

PUBLIC HEALTH ISSUES

16

2018 County Health Rankings – Report Findings

33

Public Health Issues in Your Community

17

Rockland County – Healthiest County in NYS

35

Cayuga County’s Response to Harmful Algal Blooms in Public Drinking Water

19

The Healthy Neighborhood Program in Rockland County

36

Health Costs and Concerns for Local Jails

PROMOTING HEALTHY COMMUNITIES

38

Healthier Water for New York

40

Sheriffs’ Marine Patrols on the Waterways Of NYS

20

Walking Trails for Rural Health

21

Age Friendly Communities in Our Counties

41

Orange County Collaborative Governing Program Produces Healthy Communication

22

Tobacco Cessation, Stress Management, and Move More

42

The Erie County Commission on the Status of Women

24

Find Health Insurance Savings With New Financing Collective

44

Every Second Counts: Improving Active Shooter Response Times

25

Building a ‘Healthy Highway’ across Oswego County

26

Promoting Sustainable Local Food Systems Across New York State

NYSAC UPDATES

43

NYSAC Snapshots

46

Local Laws NYSAC News | www.nysac.org

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One organ donor can save an entire dance troupe.

YOU HAVE THE POWER TO SAVE LIVES. Thanks to the partnership with the New York State Association of Counties, it’s now easier than ever to join the New York State Donate Life Registry. Today we ask that you help us take another important step closer to achieving our goal of ensuring a transplant for every man, woman and child in need by accomplishing one simple task: Please include a link to the Donate Life Registry www.donatelife.ny.gov on your website so New Yorkers can easily educate themselves on the importance of donation and to learn how they can register as an organ and tissue donor. Together, we are saving and healing lives.

DonateLife.ny.gov facebook.com/DonateLifeNYS @DonateLifeNYS youtube.com/DonateLifeNYS


News from NYSAC NYSAC Hosts International Delegates for Dialogue on Women in Government In April, the New York State Association of Counties (NYSAC) Women's Leadership Council hosted a dialogue with an international group of women aimed at increasing women's participation in representative government. The women came to Albany County from Algeria, Chile, Gambia, India, Jordan, Macedonia, and the Kyrgyz Republic to learn about the role women play in American politics. The discussion, led by Albany County Legislator Lucille McKnight, focused on the roles of education, representation, policy, and safe workplaces in encouraging women to run for political office. Participating on behalf of NYSAC were Executive Director Stephen Acquario, Nicole Correia, Kathryn Hohman, Jeanette Stanziano, and Alexandra LaMonte. The NYSAC team answered questions about the Women's Leadership Council, political representation, and county government structure, education, and training in New York State. Melinda Mack, Executive Director of the New York Association of Training and Employment Professionals (NYATEP), joined the conversation to discuss training opportunities in New York and answer questions about the role of BOCES and vocational schools.

County Leaders to Convene in Monroe County New York county leaders will convene in Monroe County for NYSAC’s 2018 Fall Seminar, September 24 through 26. Comprehensive and cutting-edge workshops on a range of timely topics will be held at the Rochester Riverside Convention Center and the Hyatt Regency Rochester. As the third largest city in the state, Rochester is a shining example of downtown economic development and revitalization initiatives. Our host county of Monroe is also home to a wide variety of cultural and historic attractions that showcase the vibrancy of this unique region and the entire state of New York. County leaders will not want to miss this opportunity to network, attend professional key-note sessions, participate in policy discussions, and receive relevant information in support of the work that goes into serving counties each and every day. Education is the core of NYSAC’s mission, and at this event county officials can develop their leadership with excellence, integrity, and vision. Conference materials will be available on NYSAC’s website at www.nysac.org/fallseminar and will be mailed to members later this summer.

"Supporting women in government is a goal that reaches beyond our counties and New York State - it is a national and global goal as well. We are all better served when more women are represented in leadership positions," said NYSAC President MaryEllen Odell, Putnam County Executive. "A primary goal of the NYSAC Women's Leadership Council is to engage women in seeking leadership positions in their communities. We were thrilled to host today's forum to share how local government works in New York State, and to discuss barriers and opportunities for women to pursue elected office," said Nicole Correia, NYSAC Women's Leadership Council staff. NYSAC thanks the International Visitor Leadership Program for providing the opportunity for fruitful dialogue about women's representation within governments across the globe.

2018 Fall Seminar September 24-26 Hyatt Hotel, Rochester Monroe County

For more about the NYSAC Women's Leadership Council visit www.nysac.org/womensleadership.

NYSAC News | www.nysac.org

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State and Federal Medicaid Financing Reforms Benefit County Taxpayers By Dave Lucas, NYSAC Director of Finance & Intergovernmental Affairs

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ew York is somewhat unique in how it finances its Medicaid program, on many levels. This article focuses on how the state “partners” with counties today. What is different in New York is how reliant the state is on using locally-generated tax revenues to pay for the statewide Medicaid program. This model is not generally used in other states – especially to the degree it is in New York. Today, under New York State law, counties and New York City are required to provide $7.6 billion annually to support the state-designed and controlled Medicaid program. By NYSAC’s calculations, culled from data generated by the National Association of Counties (NACo) and the Government Accountability Office (GAO), New York counties spend more than all the other counties in the country combined to support state Medicaid program costs (not including voluntary payments counties make to support their publicly-owned nursing homes and hospitals). Counties have lobbied for decades regarding the extreme burden that paying for the state’s Medicaid program places on local budgets and property taxes – especially compared to other states. State lawmakers finally started to take these concerns to heart just over a decade ago when they took steps to stem the bleeding of county finances. This was achieved by the state imposing two separate county Medicaid growth caps in the last 13 years. At the core of this effort was a recognition by the state that they must take more fiscal responsibility for the programs they design and control. The change has been hugely positive. In the absence of these changes, county costs would be billions of dollars higher today and the most likely source of revenue would have been higher property taxes.

Three Percent Medicaid Growth Cap In 2005, state leaders enacted a cap on the annual growth of county Medicaid expenses to no more than 3.5 percent of the designated base year, which ratcheted down to no more than 3 percent of base year costs by 2008. 14

NYSAC News | Spring-Summer 2018

Prior to this time, the county share of Medicaid costs was a set percentage of each Medicaid service delivered. These rates varied from zero percent to 50 percent of the nonfederal share. County costs would generally rise each year based on state imposed provider rate increases, and recipient benefit or eligibility expansions. A large expansion of Medicaid benefits and eligibility in 2002 caused county costs to spike and the state enacted a growth cap on county Medicaid costs in 2005.

Zero Percent Medicaid Growth Cap In 2012, the enactment of a state-imposed local property tax cap led to a second growth cap on county Medicaid costs that lowered the three percent annual growth rate to zero percent by 2015. Since enactment of the zero percent Medicaid growth cap counties are spending about $1.05 billion less today on Medicaid then if the “hard” cap were not enacted. A key part of the success of this zero percent growth cap was Governor Cuomo’s creation of a Medicaid Redesign Team (MRT). The mission of the MRT, which included county participation, was to reform the state’s overall Medicaid program by increasing the quality of care, while reducing the annual growth rate in costs. The state estimates that if these two growth caps had not been enacted, county Medicaid costs would be $3.3 billion higher today.


Federal Affordable Care Act Reduces County Medicaid Costs In addition, counties also receive Medicaid cost reductions from the federal government through the Affordable Care Act (ACA), signed into law in 2010. Under the ACA, the federal government began phasing in enhanced federal Medicaid matching rates for certain enrollees that will grow from a 50 percent federal match to 90 percent by calendar year 2020. Under federal law these enhanced matching rates provide direct fiscal relief to the state of New York and its counties. These federal savings began flowing to counties in 2014. The state has passed the federal savings to counties by lowering each counties’ weekly Medicaid payments. While these federal savings vary, a typical county is spending about 6.6 percent less (ranging from 4.5 percent to 8.3 percent less) for Medicaid than the state’s zero percent statutory cap requires. In the 2018-19 state fiscal year counties statewide will spend about $547 million less than their respective state statutory caps because of the ACA.

It is important to note that the fiscal benefits from the ACA will begin to plateau for nearly all counties in the next year or two as the enhanced federal matching rates reach their maximum level. Future benefits will vary based on caseload changes in each county compared to the rest of the state, which could result in small fiscal increases or decreases from year to year.

Another key factor that remains unknown is the impact of federal changes to the ACA. Congress has tried to repeal the law and the President continues to maximize his administrative authority to dismantle as much of the law as possible. These actions could cause enrollment to decline (which can reduce fiscal benefits for New York), or even cause the law to eventually fail – if this occurs, the federal fiscal benefits currently provided would be reversed. The chart below highlights that in state fiscal year 2018-19, counties will spend $1.6 billion less due to the state zero percent growth cap and the ACA enhanced federal Medicaid match. This equals county cost avoidance of 18 percent since 2013, in the absence of these two changes alone. This success story highlights how important it is for county officials to continuously educate state elected officials on how state imposed mandates impact local costs and taxpayers, especially in comparison to other states. Additionally, it reminds state lawmakers that they must constantly review their actions to limit the fiscal impacts that unfunded mandates place on local homeowners and businesses, and that seemingly intractable problems can be resolved, or improved upon, with the proper focus and partnership.

NYSAC News | www.nysac.org

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HEALTHY COUNTIES: WHAT IT MEANS

County Health Rankings Reported by National Foundation Provided by

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magine a place where everyone has a fair and just chance to lead the healthiest life possible –this is the vision of health equity.

The County Health Rankings show that where we live matters to health. This year, we bring new analyses that show meaningful health gaps persist not only by place, but also among racial and ethnic groups. These gaps are largely the result of differences in opportunities in the places where we live. Discriminatory practices and structural and institutional policies, such as unfair bank lending practices and property tax-based school funding formulas contribute to the types of disparities illustrated in this report.

About County Health Rankings & Roadmaps The County Health Rankings & Roadmaps program is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. We have a vision of an America where we all strive together to build a national Culture of Health that enables all in our diverse society to lead healthy lives, now and for generations to come. The goals of the program are to: • Build awareness of the multiple factors that influence health, • Provide a reliable, sustainable source of local data and evidence to communities to help them identify opportunities to improve their health, • Engage and activate local leaders from many sectors in creating sustainable community change, and • Connect and empower community leaders working to improve health.

About the Report and Roadmaps The annual County Health Rankings measure vital health factors, including high school graduation rates, obesity, smoking, unemployment, access to healthy foods, the quality of air and water, income inequality, and teen births in nearly every county in America. The annual Rankings provide a snapshot of how health is influenced by where we live, learn, work and play. They provide a starting point for change in communities. The Roadmaps section of the report provides guidance and tools 16

NYSAC News | Spring-Summer 2018

to understand the data, and strategies that communities can use to move into action (view the Roadmaps at http://www. countyhealthrankings.org/take-action-to-improve-health/).

Summary of 2018 Findings • After nearly a decade of improvement, there are early signs that the percentage of babies born at low birthweight may be on the rise (8.2% in 2016, a 2% increase from 2014). Low birthweight is a key measure of health and quality of life. • Some places and groups of people have fewer social and economic opportunities, which also limit their ability to be healthy. More than 1 out of every 5 youth in the bottom performing counties do not graduate from high school in four years. For American Indian/Alaskan Native, Black, and Hispanic youth, it is 1 out of 4. In 2016, the unemployment rate for adults in the bottom performing counties was 7.5 %, more than twice that of adults in the top performing counties (3.2%). American Indian/Alaskan Native and Black adults experienced the highest unemployment rates (10.5% and 9.9%, respectively), while Whites and Asians experienced lower rates of unemployment (4.2% and 3.5%, respectively). • Child poverty rates remain at levels higher than those of the pre-recession era despite declines in recent years. Patterns of recovery vary by both race and place. Child poverty rates have been slow to rebound in rural counties and in those with a greater share of people of color. This is important because we also know that a healthy beginning is essential to a healthy future for our nation’s children. • Teen birth rates have been declining across community types and racial groups for more than a decade. Hispanic teens have seen the most improvement with rates falling from 77.7 to 31.9 per 1,000 females, ages 15-19. Black and American Indian/Alaskan Native teens have also seen notable improvements. Yet gaps by place and race persist. For example, teens in rural counties have seen the least improvement and continue to have the highest birth rates, nearly twice the rate of teens in suburban counties. American Indian/Alaskan Native, Hispanic, and Black teens have birth rates twice as high as White or Asian teens. To read the full report, learn about where your county ranks, explore the data, and search the database for public health strategies that have worked in other counties, visit countyhealthrankings.org


What makes Rockland the Healthiest County in NY?

By Patricia Schnabel Ruppert, DO, MPH, CPE, DABFM, FAAFP, Commissioner of Health and Commissioner of Hospitals, Rockland County, NY

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ith its mountains to hike, the Hudson River to enjoy, and small towns to explore, Rockland County, located about 30 miles north of New York City, is a wonderful place to live, work, and visit. It is also the Healthiest County in New York State for 2018. The Robert Wood Johnson Foundation collaborates with the University of Wisconsin Population Health Institute to rank nearly every county in the United States, using the framework as pictured below. This ranking helps determine what it takes to keep people healthy or makes them sick and is used to formulate policy changes and interventions to improve the health of a community. The County Health Rankings yield actionable data, evidence, and guidance to communities so that improvements can be made to affect the Health Outcomes of a County, which include length of life and quality of life.

The United States has come a long way regarding improvements to health in the past 100 years including reductions in smoking and infectious disease, progress in automotive safety, improved workplace standards, and access to medical care and educational opportunities. These improvements have been substantial in our community and are reflected in Rockland County’s ranking in the top three in New York State since 2010, first in 2015 and first again in 2018. The Rockland County Department of Health has many partners in this achievement: community and faith-based organizations, our physician and non-physician colleagues, our local hospitals, County Executive Ed Day, and our county legislature. Rockland’s robust economy, highperforming schools, quality health system, and healthy habits such as good nutrition, active lifestyles, and low smoking rates have contributed to our ranking as the healthiest county in New York State.

Health Equity: Improving Opportunity in All Communities We don’t rest on our laurels as we look for ways that we can continue to improve the health of our residents. On review of the data, we see that not everyone has benefited in the same way from the health improvements. The choices that are made regarding health are often related to the opportunities that are available, such as access to healthy food, safe and affordable housing, crimefree neighborhoods, and quality education. Higher than average scores in child poverty, housing problems, and lengthy commutes have prompted us to improve public health services for those who need it most. We see this inequality in our underserved and ethnically diverse populations. Differences in opportunity are the result of policies and practices at multiple levels, which need to be accurately addressed and changed. Our true progress for improved health for all will be measured by the outcomes of how health disparities change over the long term. At the Rockland County Department of Health, we are working with our community partners to achieve improved health equity as we jointly act on the data presented by the County Health Rankings report. We have ambitious programs NYSAC News | www.nysac.org

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in Community Health, including our most recent Influenza Outreach program, where we took our Influenza Immunization Program “on the road” around the county to vaccinate those, especially the underserved, who would benefit the most. We have an active Public Health Priorities Committee, which makes collective decisions and recommendations for policy change. We leverage collective power to put ideas into action. Our successful Rockland Codes Initiative (RCI) in our Housing Program has allowed for enforcement of violations of crowded and unsafe conditions, which have typically affected our minority and immigrant populations. Additionally, our Healthy Neighborhood program distributed hundreds of free Carbon Monoxide and Smoke Detectors to low to moderate income families and seniors. Through forward-thinking, public outreach programs like these we are working to improve everyone’s access to living a healthy lifestyle.

Focus on Prevention

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Our water, food, camp, and mosquito programs ensure the public health and safety of our community. Our Disease Prevention and Control Center investigates disease outbreaks and provides diagnoses, treatment and community control of tuberculosis. We continue to emphasize the prevention of chronic disease along with early and sustained treatment of this major negative influence on the health of our community. Prevention is a key indicator of quality. There is evidence that increasing the use of preventive services results in fewer people suffering from preventable diseases. Many are treated at earlier stages. It is also cost-effective. For every dollar spent on prevention, there is a $6.00 return on investment. Our paradigm at the Rockland County Department of Health includes highvalue, cost-effective preventive care with efficient resource utilization. This also leads to more effectual use of the dollars spent on health care. Along with our partners, we have accomplished a great deal, but we have even more to do as we pursue our mission to protect and promote optimal health for all residents of Rockland County. This snapshot of our community’s health provides us with an opportunity to further improve the health of our community. Our aim is to motivate our population, so they can be the healthiest, not only in New York State, but in the nation.

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NYSAC News | Spring-Summer 2018


HEALTHY COUNTIES: WHAT IT MEANS

Rockland’s Healthy Neighborhoods Program Brings County Services to the Community By Ed Day, Rockland County Executive

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s I have said time and again, the health and safety of all residents in Rockland County is the highest priority of my administration. Surveys have found that while citizens know public health is important to them, they aren't always exactly sure what it is or how it has affected their lives. Here in Rockland we are bringing county services to the community and making them more accessible for our residents. The Healthy Neighborhood program, created by our Department of Health, is designed to help families reduce health and safety risks at home. Best of all, it's free for low to moderate income families and seniors. During home visits, program staff review a wide variety of healthy homes issues; including carbon monoxide poisoning and prevention; smoke detector installation and use; radon testing; even asthma concerns and solutions. They go over the symptoms of carbon monoxide poisoning, check carbon monoxide levels in the home, and review the correct placement of carbon monoxide detectors. Last year the staff distributed 451 Carbon Monoxide Detectors and over 700 Smoke Detectors - making the lives of our residents significantly safer. You can

contact the Healthy Neighborhood Program for a no cost home visit to address any health or safety concerns you have at (845) 364-3292. Our Department of Health has also put in place a new way to deliver flu shots in the community, traveling to Spring Valley, Haverstraw, New City, Nyack and Suffern. All told they provided over 1,500 flu shots where they were needed most. While the nation faced a near flu pandemic, our Health Department's tireless work certainly is a big reason why we have been relatively unscathed, with Rockland having the 4th lowest rate of flu compared to the other 61 New York counties. This year we faced a more serious strain of flu than usual and the Health Department provided flu shots at our Pomona Campus. Thank you to our Rockland County Health Department professionals who work every day to ensure the safety and well-being of our communities. I want to recognize the important and crucial work performed by these men and women and raise awareness among the public of the importance of public health. It's truly impressive how you have not only maintained but improved our services despite difficult fiscal conditions. NYSAC News | www.nysac.org

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PROMOTING HEALTHY COMMUNITIES

Walking Trails for Rural Health By Sara Wall Bollinger, Director of Strategic Development, NYS Association of Rural Health Networks

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he life expectancy for people who live in rural areas is two years shorter than the life expectancy for urban residents. Causes of death contributing most to the increasing rural-urban disparity and lower life expectancy in rural areas include heart disease, lung cancer, unintentional injuries, COPD, stroke, suicide, and diabetes. These are all preventable conditions.

Rural areas experience higher rates of obesity than the national average. Obesity is a risk factor for a range of chronic diseases including heart disease and type two diabetes. As with other social determinants of health, those with fewer resources and less education are more likely to become overweight. Rural Health Networks are stepping in to help combat obesity in rural communities by developing and promoting walking trails. Research2 has shown that awareness of, and access to, walking trails increases their use. Herkimer HealthNet developed trail resources and printed a 20-page guide that highlights a sample of trails in Herkimer County including the name, location, length and type of trail. This project included signage and trail markers. Herkimer HealthNet has designed the Mohawk Valley Mile program to map out one-mile walking routes in local villages. www.facebook.com/herkimercountyhealthnet The Monday Mile came to the Rural Health Council of Madison County in the summer of 2016 in partnership with the Syracuse University Lerner Center. By creating easy onemile walks, Rural Health Networks are creating environments that support movement and being active in rural counties. Walking a mile for health supports people in setting goals to reach weekly physical activity recommendations. Setting intentions at the beginning of the week increases the likelihood these behaviors will continue the rest of the week. The Monday Mile is a fun way to get in daily exercise and helps to jump start the week. Walking has numerous health benefits; it can help maintain a healthy weight and lowers the risk for developing certain chronic diseases. Monday Mile locations are marked with signs that contain maps, directional arrows and distance markers. Walking the Monday Mile is also a great way to visit the many scenic areas in rural New York. www.mcruralhealthcouncil.org/monday-mileedit 20

NYSAC News | Spring-Summer 2018

GreeneWalks is a popular 8-week walking program created by the Greene County Rural Health Network in 2010 in which over 1,250 people have participated over the years. It was developed as a result of research showing the positive impact community walking programs can have on individuals who are overweight or obese. GreeneWalks is a free, 8-week contest that is open to all Greene County residents. Television and radio ads, billboards, and bank statement and utility bill inserts are used to promote the contest throughout the county. Online registration is required, after which each participant can download and print a walking log. The log provides space for participants to log their daily minutes or steps. In 2017, about 230 people enrolled in the program. Eight cash prizes were awarded through a random drawing of those participants who completed the program. Four-$250 prizes and four-$125 prizes were awarded. In 2010, only four $50 cash prizes were awarded to winners. The increase in the number of prizes as well as the amount of the prizes has increased participation. www.greenehealthnetwork.com/healthy-weight-initiative/ overview/ Seven Valleys Health Coalition (SVHC) in Cortland County has long seen the value of promoting and sponsoring opportunities for walking. Their partnership with Lime Hollow Nature Center has been ongoing for many years, including collaborating on multiple uses for walking trails which encourage physical activity, such as nature walks, disability access, moonlight snowshoeing and community trail work days. SVHC also started a Senior Walking Program in 2017 through a jointuse agreement with the Cortland City School District, City of Cortland and the Area Agency on Aging’s Retired Senior Volunteer Program and created a database of all free, indoor walking opportunities in Cortland County to ensure physical activity can continue during the cold, snowy months of our rural NY winters. www.sevenvalleyshealth.org/healthynow These Rural Health Network projects were funded in part via competitive grants through the NYS Department of Health’s: Rural Health Network Development program; Population Health Improvement Program; Local Initiatives for MultiSector Public Health Action (Local IMPACT); and Healthy Places to Live, Work and Play. 1: Singh, G.K., Siahpush, M. 2014. Widening Rural-Urban Disparities in Life Expectancy, U.S., 1969-2009. American Journal of Preventive Medicine, 46(2), 19-29 2: Brownson, RC et al. Promoting physical activity in rural communities: walking trail access, use and effects; Am J Prev Med 2000 Apr 18 :235-41


Age Friendly Communities in Our Counties By Greg Olsen, Acting Director, New York State Office for the Aging (NYSOFA)

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n his 2017 State of the State address, Governor Andrew M. Cuomo directed state agencies to employ a more proactive and interactive approach to improving New York’s overall population health to become the healthiest state in the country. Using the Prevention Agenda as the overarching framework, the Governor launched a Health Across All Policies approach, where health and non-health related state agencies work together to take into account how policies and programs can positively impact public health. This approach benefits New Yorkers of all ages in all geographic areas. As part of his approach, the Governor committed New York State to becoming the first age-friendly state in the nation as designated by the World Health Organization (WHO) and AARP—and through his efforts, New York received the designation in August 2017. WHO/AARP age-friendly communities address eight domains of livability. Municipalities throughout the country, including 16 in New York, have earned the age-friendly designation, but New York State is the first and only age-friendly state. Age friendly is not about old age—it is about the value of all ages. It is about designing communities for everyone that strengthen people’s connections to each other; improve health; increase physical activity; and support and advance the economic environment through proactive design and future-based planning. Since 2011, Governor Cuomo has been fighting to make New York State more equitable for people of all ages. Over the past seven years, New York has become a national leader in creating clean, livable, and sustainable communities by pioneering multi-faceted programs that support aging in place, coupled with an unparalleled suite of smart growth reforms that directly support AARP’s eight domains of livability: • Since signing the Complete Streets Act in 2011, 12 counties and more than 100 villages, towns, and cities have adopted Complete Streets policies to consider the safe, convenient access and mobility of all roadway users of all ages and abilities. • Through the Livable NY initiative, the state has been working with municipalities to provide technical assistance for planning decisions around livability. • More than 100,000 units of affordable housing will be created and preserved throughout the state by 2021. • As part of the 2017 Downtown Revitalization Initiative, New York State has awarded $100 million to 10 downtown areas, prioritizing awards to municipalities that have age-friendly policies in place. • In 2017, the New York State Office for the Aging created the nation’s first statewide aging services mobile app to connect older adults and caregivers with easily accessible material

about benefits, programs, and services, including information regarding health and wellness, housing, and transportation options. New York has had success in promoting high quality care for older New Yorkers, but the need for earlier interventions, modernized care, and additional assistance to support aging will continue as our population continues to age. Currently, New York has the fourth largest population of older adults in the nation: 3.7 million New Yorkers are 60 years of age or older, and 4.2 million are between the ages of 45 and 59. Within the next decade, 51 counties in New York will have a population that is made up of at least 25 percent of older adults. Governor Cuomo will continue to build on the state’s age-friendly strategies by advancing a series of policies to prepare for the emerging needs of our growing aging population, including: • Launching a Long Term Care Planning Council: The Council will examine New York’s long-term care system and will analyze, evaluate, and identify existing service gaps and prepare a strategic plan to meet the emerging needs of New York’s aging population over the next decade. • Continuing to Direct State Agencies Around Age Friendly Practices: The Governor will continue to direct agencies to consider the impact of their policies and procurements on health and healthy aging, aligned with the eight domains of an age-friendly community. The state will set aggressive goals, including establishing age-friendly emergency rooms that will be better equipped to provide care to aging New Yorkers with cognitive and physical disabilities. New York’s age-friendly agenda makes people and communities healthier, saves money, and boosts the economy. There is a myth that older adults contribute less and take more; however, the data do not support this—they instead show how vitally important older adults are to their communities and the economy. With their years of life, work, and family experience, almost 700,000 older New Yorkers contribute more than 119 million hours of community service at an economic value of more than $3 billion annually. Older New Yorkers and baby boomers make up 63 percent—or $379 billion—of all the household income generated in New York State. They support local businesses and schools through home ownership, contributing significantly to the local and state economy. And our older adults want to stay in New York. According to AARP, 90 percent of New York State residents surveyed say they want to retire in New York. And we want them to stay, as well. New York State exemplifies the motto “e pluribus unum”—out of many, one. Our state’s greatest asset are our people, and it is incumbent upon us to be at the forefront in promoting positive change to make sure New York remains a place where older adults can continue to live and thrive. NYSAC News | www.nysac.org

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PROMOTING HEALTHY COMMUNITIES

Tobacco Cessation, Stress Management, and Move More Oneida County Employee Wellness Program Yields Positive Results By Diane Tinelli Miller, Secretary to Director of Health, Oneida County Health Department

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n late 2016, Oneida County embarked on an Employee Wellness Program. With the support of County Executive Anthony J. Picente, Jr., a Wellness Steering Committee convened, chaired by the County Director of Health. The Committee launched a survey tool to gather employees’ thoughts and ideas on what wellness activities would meet their needs. Department heads selected Wellness Champions to represent and be wellness ambassadors for their staff. Quarterly meetings were scheduled for the Steering Committee, as well as for the Wellness Champions. Surveys were distributed in a variety of ways to engage as many employees as possible. Of the 38% of all employees who responded, 83% were interested in participating in worksite wellness, 62% would participate in a confidential risk assessment, 60% would like to participate in a screening at work (blood pressure and blood sugar/cholesterol were the top two), and 45% said the best way to communicate with them is through a weekly email. The Weekly Wellness Email was introduced in May 2017.

Based on survey results, these three focus areas for 2017 were established: Tobacco Cessation, Stress Management, and Move More. We knew investing in employee wellness efforts would result in saving money, less absenteeism, and a culture of encouraging others. The return on investment will be a healthy workforce, and a healthy public as well. This complements the mission of the Health Department, “Promoting and protecting the health of Oneida County.”

Tobacco Cessation A large focus of Oneida County’s Wellness Program this past year centered on tobacco cessation and creating tobacco-free zones on all Oneida County grounds. In November 2016, the Oneida County Board of Legislators unanimously approved a local law that would prohibit tobacco and e-device use on all Oneida County grounds beginning January 1, 2018. Oneida County Health Department recognized the importance of preparing employees and the public, and focused efforts on educating about the pending change. Employees and the public were notified of the pending local law through 22

NYSAC News | Spring-Summer 2018

signage, payroll stuffers, wellness emails, flyers posted in all departments, and information posted on the County website and Facebook page. Health Department staff also found it important to offer assistance to employees who were interested in quitting smoking. Health Department staff coordinated onsite smoking cessation, distributed information on the NYS Smokers’ Quitline, and provided employees with information on the Nicotine Replacement Therapy options that are covered by Oneida County’s health insurance plans.

The Weekly Wellness Email The Weekly Wellness Email (WWE) was created to communicate wellness information and happenings to employees. WWE has promoted materials for the NYS Smokers’ Quitline, free Lunchtime Workshops for employees, publicized campaigns such as the FDA’s Every Try Counts, and shared articles and infographics from the CDC and American Cancer Society. During the past year, three employees were highlighted in Weekly Wellness emails for their efforts to live healthier lifestyles: • Colleen Kwet, Finance - inspired by her daughter when they started to exercise last summer, Colleen was unhappy with her weight and breathing. Once she started to walk and exercise, she was ready to quit smoking and had the best fall season she has had in years. • Rod Wilson, IT- A few years after he quit smoking for good in 2009, his wife was diagnosed with breast cancer, requiring eight surgeries. Throughout this difficult time, Rod had workout injuries, making it difficult for him to stay active. Along with Rod, Before and after weightloss. this, stress eating and fast food contributed to his weight ballooning to 275 pounds. In September 2015 Rod began his journey to better health. He wanted to model good health for his two young sons at home, and be an active father. Rod subsequently lost 100 pounds through diet and exercise and hasn’t turned back since. To maintain


the weight loss, Rod works out six days a week. The Wellness Program nominated Rod for the American Heart Association (AHA) Mohawk Valley Lifestyle Change Award. On March 3, 2018, he was announced the winner at the closing ceremonies of the AHA Heart Run & Walk. • Sherri LaSalle, Personnel - After 33 years of smoking, Sherri quit cold turkey at the start of the year. She offered to share her story, and she is going strong!

Move More

Stress Management

In 2017, more than 100 Oneida County Wellness Walkers participated in three online Walking Challenges with Stridekick of varying timeframes (one month to three months), by syncing their step-counting devices or manually entering steps from pedometers: 1 Billion Steps Challenge of the American Public Health Association (APHA) - ranked 124th of 696 teams; 15 Million Steps to the Boilermaker – achieved steps goal; and Walk Oneida County NY Prepared Challenge – achieved steps goal, times nine! As of March 2018, we have participated in two new Walking Challenges this year, and will surpass last year.

The Wellness Email places an emphasis on wellness being multi-dimensional, encompassing all these facets: Emotional, Financial, Social, Spiritual, Occupational, Physical, Intellectual, and Environmental. These topics have been feature articles:

The Oneida County Boilermaker Corporate Cup Team had 11 employee runners who completed the 40th annual race on July 9, 2017. The 15k Boilermaker Road Race is a great source of pride for all in Oneida County. Four Lunch Hour Walks in 2017, with educational, communityminded or just-for-fun destinations, had a total of 55 employees participate. An Oneida County beach volleyball team had eight participants in after-work games at Utica College in the summer of 2017. We are very proud of our first year accomplishments. With an engaged Steering Committee and core group of Wellness Champions we are continuing efforts on all fronts to keep moving forward beginning with our workforce, to make a difference in the health of Oneida County.

• Stress Management • The Eight Dimensions of Wellness • National Employee Wellness Month – Mental Health • CFLR is Here to Help (Employee Assistance Program through Center for Family Life & Recovery) • Stress, Depression and the Holidays: Tips for Coping • Self-Care Tips for a Happy, Healthy Holiday Season (SelfCare Snowman infographic) • Links to MVP Chair Yoga and the Stretch Break Series for Work NYSAC News | www.nysac.org

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PROMOTING HEALTHY COMMUNITIES

Find Health Insurance Savings With New Financing Collective By Mark LaVigne, NYSAC Deputy Director

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s part of its mission, the New York State Association of Counties (NYSAC) is on the lookout for ways to help counties save money on non-mandated programs and services. One of the areas that we’ve been exploring is employee health insurance, the cost of which has been growing annually for decades, often without improving care or outcomes. As a result of these explorations, last year NYSAC started to create the Municipal Healthcare Financing Collective (MHFC), designed to lower and stabilize the cost of stoploss insurance for self-insured county health plans, and public employers with more than 100 covered employees. The program, developed in partnership with New York-based Relph Benefit Advisors (RBA), is created to help address the challenge of rising health insurance costs. The MHFC model enables multiple municipalities to join together and aggregate stop-loss plans as a way to lower the cost for participating employers. The MHFC program leverages enrollment and advanced data analytics to reduce stop-loss costs, claims volatility, as well as fixed costs. It does not diminish or change your existing benefit structure.

Based Upon Data Provided by 7 Upstate Municipalities Covered Employees

7 Municipalities

Annual Stop-Loss Premiums

$5,114,489

Ceded Premium (Green-Back Opportunity)

$3,407,855

Estimated Real Dollar Savings

$1,056,435!

For County-wide shared service panels, this program may qualify for shared service initiatives and matching funds for savings if multiple municipalities within one county participate in the collective. The target effective start date is 1/1/2019. For counties who may have an earlier renewal date, coverage is available as early as October 1, 2018.

Proof of Concept

• Reduced stop-loss cost through retention of Collective cost savings

Last year, we worked with Relph Benefit Advisors to collect and analyze county health care plan data so that we could prove the concept that counties can save money by aggregating the purchase of stop-loss insurance, which most self insured counties already do on their own. In this project, seven municipalities provided their plan data. Relph ran the data through the program structure and found a total of $1 million in savings for the seven municipalities. Of course, each of these municipalities will see different savings, based on their level of stop-loss and the numbers of covered lives in their program. But the data proved the concept, and the savings were significant, particularly as counties continue to operate in a property-tax cap environment in which every nickel and dime counts, and an annual $100,000 in savings can mean real property tax relief.

• Lower TPA (ASO) fees through combined group purchasing

What’s Next

• Prescription drug savings due to larger claims volume, plus greater negotiated discounts

As counties begin developing their 2019 Fiscal Year budgets, they are exploring all local discretionary programs, and nonmandated services for ways to save public funds. One place they are looking is health insurance. If your county is looking for savings in your health insurance plan, we encourage you to explore the savings opportunities with the Municipal Healthcare Financing Collective.

MHFC’s Value Propositions The Municipal Healthcare Financing Collective enables municipalities to pool their buying power with key healthcare solution providers, while remaining separate for insurance purposes. The more covered lives, the lower the cost of stoploss and greater savings for participating municipalities. • Decreased catastrophic claims volatility and risk

• Advanced data analytics for individual claim level review • Independent plan design and coverage rules for each municipality • Municipalities choose their own stop-loss attachment points based upon size and risk parameters

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Collective Opportunity

NYSAC News | Spring-Summer 2018

For more information you can call Relph Benefit Advisors directly by calling Eric Lintala at 800-836-0026, ext. 320, or call NYSAC Deputy Director Mark LaVigne at 518-465-1475.


Building a ‘Healthy Highway’ across Oswego County Getting school children on the road to a healthy lifestyle By Marion Ciciarelli, Public Relations Manager, Oswego Health Diane Oldenburg, Senior Public Health Educator, Oswego County Health Department

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oncerned about obesity rates among adults and students in Oswego County, members of the Oswego County Health Department (OCHD), Oswego Health (OH), and the county’s nine school districts have developed an amibitous program to improve the health status of local children. Thanks to funding provided by Oswego Health, the county’s leading healthcare provider, Oswego County, and the Shineman Foundation, an Oswego-based organization that supports programs that promote change, staff from Oswego Health and the Oswego County Health Department will roll out the Healthy Highway program in each of the county’s nine school districts this fall. The Healthy Highway program was developed by retired Rochester physical education teacher Wendy Cooper. The initiative combats childhood obesity by using traffic metaphors to teach students a common language regarding healthy choices in food and physical activity. Children quickly learn that it is important to “fuel” their bodies with “green light” foods and to limit the amount of “red light” food choices they make. It's all incorporated into a variety of activities to reinforce healthy choices and can be applied throughout the school. This program was piloted by the Oswego County Health Department several years ago in two elementary schools in the Oswego City School District. Evaluation of the program found that students were better able to identify “red light” and “green light” food choices and most importantly were using this information to make better choices in the cafeteria, when compared to their peers in the district that did not have the Healthy Highway Program implemented in their school. The Health Department also received positive feedback from parents who demonstrated that these important messages were being brought home to students’ families. The program will now be introduced in the elementary buildings in all nine school districts this fall and will be “driven” by school champions identified in each building. Oswego Health’s nurse educators and Oswego County Health Department public health educators, with assistance from two AmeriCorps members, will mentor school champions in each district to help implement the program across the county.

Key members of the Healthy Highway planning team receive training from program founder Wendy Cooper. They include Lori Greeney, OH; Cindy Walsh, CCE; Diane Oldenburg, OCHD; Lauren Whipple, CCE; Sonia Robinson, OCHD; Emily Boyle, OCHD; Sarah Wansink, OH; Frances DiFlippo, AmeriCorps, OH; Meghan Tice, AmeriCorps OCHD; and Wendy Cooper, founder of the Healthy Highway Program.

Additional community partners from Cornell Cooperative Extension (CCE), Oswego County Opportunities, Rural Health Network, Northern Oswego County Health Services, Inc, and the Oswego YMCA are being engaged to assist with implementing Healthy Highway projects in the schools as well as bringing Healthy Highway messages to families and into the community. The program’s success will be measured by Dr. Taejin Jung from SUNY Oswego, who helped evaluate the pilot project in 2015. Dr. Jung will continue to measure changes in knowledge and behavior around healthy eating, along with working to learn the students’ motivation for wanting healthier eating habits. In addition, the project will look to identify changes in Body Mass Index data among elementary school students. With Oswego Health driving this initiative, this project will move Oswego County’s children and families down the road to good health. The healthy habits this program develops at a young age will help guide and support students throughout their lifetime.

NYSAC News | www.nysac.org

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Promoting Sustainable Local Food Systems Across New York State By Alex LaMonte, NYSAC Research Analyst

The State of Spending on Local Food

2018-19 Enacted Budget

ew York is a leading agricultural producer in the United States, ranking in the top ten in the production of 30 commodities. In fact, we are the second largest producer of apples, snap beans, and maple syrup in the nation; the third largest producer of cabbage, grapes, and dairy; and the fourth largest producer of pears. With the abundance of local food at our fingertips, it may surprise you to learn that only 10% of the $957 million that publicly-funded institutions in New York State spend on food is used to purchase products grown, raised, or manufactured in the state. What would the health, environmental, and economic impact be if we made a stronger commitment to buying and promoting local food?

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The 2018-19 State Budget continues investment in New York State agriculture. Notably, the budget restores grant funding for local agriculture assistance programs, provides $1.1 million for Taste NY, and doubles the State’s investment in the Farm to School Program from $750,000 to $1.5 million. The budget also includes $10 million to increase the reimbursement schools receive for lunches from the current 5.9 cents per meal to 25 cents per meal for any district that purchases at least 30 percent of their ingredients from New York farmers, growers, producers, or processors. This investment in school lunches can expand market opportunities for farmers and help students to develop lifelong healthy eating habits.

State Action to Promote Local Food

USDA Farm to School Census

In recent years, the State has taken important steps to promote agricultural products grown in New York. In 2013, Governor Cuomo signed the Food Metrics Bill (S.4061/A.5102) into law to establish a framework for monitoring food spending by state agencies and track the origin of the food they procure. That same year, the Governor announced an initiative to promote New York’s food and beverage industries called Taste NY. This was followed by Buy NY in 2014, which aims to increase the purchase of local agriculture products in government-run institutions. In 2015, Governor announced the start of another new initiative: the NYS Farm to School Program. Farm to School was created to bring local, farm-fresh foods to students with the goal of strengthening local agriculture, improving student health, and promoting regional food systems awareness. Finally, in 2016, the State introduced NYS Grown & Certified to promote New York’s agricultural producers by labeling and marketing products grown and produced in the State. These actions have been accompanied by growing market demand for locally grown food in New York State and across the nation.

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Role of Counties in Promoting Local Food Counties can play an important role in improving the health of their communities and supporting New York State farms. The following are ideas to increase access to nutritious, local food within your county: • Adopt a healthy food resolution to commit your county to taking active steps to increase access to wholesome, local products. • Create a food council or task force that brings together community members and stakeholders to identify barriers to accessing healthy food. • Incorporate access to locally grown and processed food into a comprehensive land use plan. • Adopt a local purchasing preference policy to require food or agricultural products that are produced locally to receive some sort of preference. • Help all residents to purchase fresh, healthy food by encouraging local retailers to use EBT equipment. • Utilize land banks to convert vacant land into community gardens. • Provide economic development incentives to support local farmers and other food business in your county.

Program Snapshot New York State’s Farm to School Program connects schools with local farms and food producers to improve student health, strengthen local agriculture, and promote awareness of regional food systems. According to the USDA’s 2015 Farm to School Census, 61% of school districts in New York participated in farm to school activities in 2015, and an additional 16% intended to start farm to school activities in the future. As a result of the program, nearly $50 million has been invested in local food in New York State, with schools purchasing 88% of fruits, 77% of vegetables, 48% of milk, and 8% of meat/poultry locally. On average, school districts spend 11% of their budget on local products. Schools are also growing their own food in nearly 300 school gardens across the state.

Counties across the state have already implemented several of these initiatives. For example: • Suffolk County established a Food Policy Council tasked with promoting the production, distribution, and awareness of locally grown food; strengthening and prioritizing policies that will improve food access, health, and nutrition; and enhancing the regional food system by utilizing local agriculture, fishing, and shellfish aquaculture. • In 2015, The Albany County Land Bank acquired an overgrown vacant lot in a food desert and converted it into a large community garden to help increase access to nutritious foods for local residents. • Dutchess County adopted a Partnership for Management Growth Program in 1999 that focuses on protecting important agricultural and open space resources. To date, the Program has leveraged federal, state, municipal, and nonprofit partnerships to preserve 3,300 acres of farmland and 500 acres of open space. • Erie County established the Buffalo and Erie County Food Policy Council to build and strengthen a sustainable and just regional food system through policy recommendations, awareness, education, and advocacy. • Tompkins County created an Agriculinary Tourism Task Force that developed a Agriculinary Tourism Implementation Plan focused on enhancing the existing agritourism movement in the region, with renewed focus on developing local assets, products, events, and resources. These are just a few examples of how counties are taking advantage of local agriculture and businesses to create a healthier and more sustainable future for their residents.

Still comparing apples to oranges? U.S. Communities delivers cooperative purchasing solutions that can’t be matched.

Visit us at www.uscommunities.org NYSAC News | www.nysac.org

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THE OPIOID CRISIS

America’s Opioid Epidemic Hits New York State Hard By Thomas P. DiNapoli, New York State Comptroller

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he current epidemic of opioid overdose fatalities is being called the deadliest drug crisis in American history. It’s hard to imagine a community in our country that hasn’t felt the devastating effects. In addition to the toll the opioid epidemic has taken on families and communities, the financial costs – including health care spending, criminal justice costs and lost productivity due to addiction and incarceration – are estimated to exceed $500 billion a year nationally. While prescription opioids are effective at treating moderate to severe pain, they can lead to addiction. Overdoses from prescription opioids – including oxycodone, hydrocodone, morphine and methadone – are a major factor in the increase in opioid-related deaths. Research suggests that prescription opioid use is a risk factor for the use of heroin, with some individuals switching to it because heroin is cheaper and easier to obtain than prescription opioids. Use of illegally made and distributed fentanyl is also on the rise. Pharmaceutical fentanyl is a synthetic opioid that is approved for treating severe pain, although most fentanyl overdose deaths are linked to illegally made fentanyl sold through illegal drug markets for its heroin-like effect. While addiction to opioids goes back centuries, the current crisis started in the 1990s, when health care providers began prescribing opioids to treat chronic pain unrelated to cancer, according to the Centers for Disease Control and Prevention (CDC). Although the amount of opioids prescribed in the U.S. peaked in 2010, the CDC says prescribing remains high and varies widely from county to county.

New York State Numbers While other regions of the nation, notably Appalachia, the Rust Belt, and New England, have been hardest hit by this crisis, New York has not been spared. The rates of all opioid overdose deaths per 100,000 population in New York State nearly tripled between 2010 (5.4) and 2016 (15.1), according to CDC data. The rate of heroin deaths rose more than five-fold, from 1.0 in 2010 to 6.5 in 2016. For

prescription opioids, the death rate increased from 3.7 per 100,000 population in 2010 to 5.4 per 100,000 in 2016. In 2016, opioid overdose death rates were highest in Ulster (33 deaths per 100,000 population), Broome (32.3), Erie (31.1) and Onondaga (29) counties. Counties with the highest numbers of opioid overdose deaths in 2016 included Suffolk (340), Erie (272), Kings (270) and Bronx (263).

Treatment and Help If there is a silver lining to this dark epidemic, it's that New York residents are more likely to accept treatment compared to those in other states. Factors in these trends may include our higher-thanaverage rate of health insurance coverage and the State’s longstanding efforts to promote access to treatment. The State is helping communities throughout New York develop or expand treatment centers, provide housing or offer other types of programs including outpatient treatment. In February, the Governor’s Office announced the award of $10 million in capital funding to five treatment providers that will be adding 84 new beds. These facilities are located in underserved communities like Monroe, Greene and Chemung counties. Additional efforts to address the opioid epidemic will enhance the State’s ability to track opioid prescriptions, expand access to hospital detoxification services and train narcotic investigators to carry and administer naloxone, which can reverse an opioid overdose. Many first responders already carry naloxone. New York’s “naloxone access law” provides civil and criminal immunity to licensed healthcare providers or lay responders who administer this antidote. While drug abuse was once viewed as largely a matter for law enforcement, the increasing recognition that addiction is a public and mental health challenge may lead to more effective solutions. Continued research into addiction, and coordinated responses from government and the private sector, remain high priorities. With such ongoing efforts, we can make real progress in the fight against opioid addiction. NYSAC News | www.nysac.org

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THE OPIOID CRISIS

Curbing the Opioid Epidemic: What’s Your Plan? By Kayse Diamond, Marketing & Business Development Supervisor, ProAct

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harmaceutical companies once suggested that patients would not become addicted to prescription opioid pain relievers. As we know today, the reality is by far the opposite. More than 115 Americans die every day from an opioid overdose. With little sign that the opioid epidemic is slowing down, communities are coming together to educate themselves on the crisis and come up with ways to contribute to the efforts. To avoid risks associated with taking opioid medications, physicians can offer alternative options. Pain relief options come in many forms – most of which have fewer risks and side effects than opioids. These include: • Over-the-counter medications, such as ibuprofen (Motrin®), acetaminophen (Tylenol®), or naproxen (Aleve®) • Prescription strength anti-inflammatory drugs such as celecoxib (Celebrex®), diclofenac (Voltaren®), and etodolac (Lodine®) • Select prescription non-opioid medicines which target the nerves that produce pain, such as gabapentin (Neurontin®) and pregabalin (Lyrica®) • Injectable and topical non-opioid therapies • Chiropractic services, physical and massage therapy, exercise, and cognitive behavioral therapy

Solutions from a Pharmacy Benefit Perspective ProAct, Inc. is a Pharmacy Benefit Management Company used by many New York State counties. ProAct has partnered with

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NYSAC to offer county employees lower cost prescriptions through an employee benefit card. Many employers and plan sponsors are aware of the importance of having enhanced prevention and education options to minimize exposure to, and prevent overuse of, opioids. At ProAct, we are driving change across our plans to combat the progression of the opioid epidemic. ProAct’s clinical team is working both internally and with our clients to curb opioid misuse by implementing several programs.

Member Education Opioid medications are generally safe and useful for managing acute (short-term) pain when prescribed and used appropriately. Extended or inappropriate use can lead to dependence and/or addiction. Additionally, taking these medications differently than prescribed greatly increases the chances of severe side effects, including overdose and death. Many people are unaware of the risks associated with taking opioids. Therefore, ProAct provides resources to our clients to educate their members. These resources explain how to safely take an opioid medication, risks associated, and offer alternative drug options.


Treatment In addition to education for our clients, and additional provisions at the pharmacy, we have removed prior authorization requirements on products used to treat opioid dependence. Removal of prior authorization edits helps ensure access to medications, such as suboxone, used for addiction treatment. The goal is to remove barriers for those members seeking treatment for their addiction. At ProAct, our commitment is to our clients and their members. That is why we are committed to providing resources that will contribute in keeping our partners healthy. Contact ProAct today to learn more at proactbenefits.com/contact-us. ProAct, Inc. is a full-service Pharmacy Benefit Management Company combining industry-leading client service with the latest in PBM technology to produce innovative, affordable and flexible prescription drug benefit solutions. Visit us online at: www.proactbenefits.com.

Pharmacy Provisions Preventative actions start at the dispensing pharmacy. In hopes of minimizing early exposure and reducing inappropriate supply, we have added a quantity limit refill provision to all short-acting opioids. These include products such as: codeine (Tylenol w/Codeine®), hydrocodone (Lortab®, Norco®, Vicodin®), hydromorphone (Dilaudid®), morphine (MSIR®) and oxycodone (Oxy IR®, Percocet®). Often, these products are also combined with another ingredient, such as acetaminophen or ibuprofen, to provide additional analgesia. The program is intended to work in conjunction with federal and state programs that are already in place. This program places limits on both the amount of medication and number of fills a member can have over a set time-frame for shortacting opioids. While this program is not intended to prevent members from getting medications when they are appropriate, it will help ensure that these medications are used properly, both in quantity and duration. In addition, ProAct has added a prior authorization requirement on all long-acting opioids. Long-acting products are typically reserved for those in chronic pain due to illnesses, such as cancer. These include extended release versions of oxycodone (Oxycontin®), oxymorphone (Opana ER®), and morphine (Kadian®, MS Contin®) along with transdermal fentanyl (Duragesic®). This program requires that all long-acting products go through the prior authorization process to ensure the medications are being used prudently for the diagnosis.

NYSAC News | www.nysac.org

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THE OPIOID CRISIS

$3.75M Secured for County Correctional Facilities Substance Use Treatment By Kelly A. Hansen, Executive Director of the NYS Conference of Local Mental Hygiene Directors

NYS Conference of Local Mental Hygiene Directors, NY Sheriffs’ Association, and the NYS Association of Counties Secure $3.75 million for Substance Use Treatment and Transitions Services in County Correctional Facilities

could be most responsive to starting treatment, the jails have little to no resources to take advantage of the time limited opportunity.

n 2016, drug overdoses took the lives of 63,632 Americans with 42,252 (66%) of these deaths involving an opioid. Drug overdoses have become the leading cause of death for Americans under age 50.

Studies show that individuals who suffer from SUDs frequently come into contact with the criminal justice system. In fact, New York State’s jails report that approximately 68% of inmates with a SUD have been in their jails previously.

To give these staggering numbers context, drug overdose deaths in a single year have exceeded the number of US casualties in the Vietnam War (58,220) and motor vehicle deaths, which topped at 40,000 in 2017.

According to a December 2017 report commissioned by the Conference, more than half (51%) of New York State jails reported that they have no funding for Substance Use Disorder (SUD) treatment services, despite strong evidence that these services reduce crime, save money, and save lives.

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Now, think of these numbers not as statistics, but as what they really represent: mothers, fathers, siblings, children, neighbors, friends, and colleagues. Addiction eats at the core of our communities—it strains our health care resources, and reduces the economic vitality of families, businesses and governments. To address these far-reaching impacts, state, federal and local leaders continue to allocate billions of dollars for prevention, treatment and recovery services. In New York, they have launched Gubernatorial and Senatorial Task Forces, revamped the State’s prescribing and prescription monitoring practices, and enacted comprehensive laws to combat the heroin and opioid epidemic, including requiring insurance companies to cover and increase Substance Use Disorder (SUD) treatments. Still, there continues to be one critical gap in the treatment and support continuum of care: the local jails. Why provide SUD treatment inside the walls of the jail? Because there is evidence that it helps to ensure people remain in treatment after discharge, it reduces recidivism and it saves taxpayer dollars. Perhaps the most important reason to offer treatment during incarceration is because the person is clean and sober. Sobriety often produces clarity for the person and insight into their addiction. At a time when a person with SUD 32

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In order to address this gap in the treatment continuum, the NYS Conference of Local Mental Hygiene Directors (CLMHD) partnered with the NYS Sheriffs’ Association and the NYS Association of Counties (NYSAC), and led the charge to secure $3.75M in State funding in the final 2018-19 enacted State Budget for jail-based substance use disorder treatment and transitions services.

Localities participating in the needs assessment reported that a modest investment in treatment and transitional services would bring tremendous capacity to combat the opioid epidemic and other forms of addiction head-on with improved outcomes in recovery and reduced recidivism and victimizations. The study found that an annual State allocation of $12.8 million would allow every jail in the State to begin some level of programming. The period of jail incarceration offers a uniquely impactful opportunity to initiate the process of recovery, break the cycle of offending, and clear the pathway to successful community reintegration for those challenged by addiction. Communities that have implemented jail-based SUD services have reaped substantial benefits to public safety and public health. This year’s State allocation of $3.75M is a step in the right direction; however, there is still work to be done. It is imperative that a permanent program is established to ensure that the newly implemented jail based services remain in place, the end goal being that every county will have a fully funded statewide program to help expand access and have the necessary resources available to assist those suffering from addiction move along the pathway to recovery.


PUBLIC HEALTH ISSUES

Public Health in Your Community: Emerging Trends and the Value of Program Sustainability By Sarah Ravenhall, MHA, CHES, Executive Director, NYS Association of County Health Officials

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he American Public Health Association defines the role of public health as “promoting and protecting the health of communities where they live, learn, work, and play.” Does this definition give you an idea of how far the jurisdiction of public health spans? Professionals working within the 58 New York State local health departments serve on the front line, promoting health and protecting communities at the local level. Core public health services provided by local health departments include environmental health services, prevention of communicable disease, community health assessment, family health, emergency preparedness, and chronic disease prevention. As new threats to public health emerge, local health departments are the first responders. Today’s public health priorities are rapidly evolving. Public health leaders must remain nimble and triage public health issues daily. County Health Officials provide leadership for oversight of public health initiatives, spearheading community collaboration and demonstrating an overarching commitment to improving health outcomes. The efforts led by County Health Officials and their local health department staff culminate in empowered, healthy, and safe communities.

Opioids The opioid crisis has posed a significant threat to the health and safety of New Yorkers and public health experts are working around the clock to reduce overdose and death. As prevention experts, local health departments focus on reducing supply and demand of opiate products and improving treatment and recovery outcomes. Activities led by local health departments include running naloxone trainings, leading local taskforces, hosting community educational forums, creating educational messaging, and organizing drug takeback events, among others. According to the New York State Department of Health’s Opioid Annual Report published October 2017, the rate of opioid related deaths has doubled between 2010 and 2015. As local health departments keep a careful eye on this threat to public health, we hope to see an increase in accessible community programs that will mitigate opioid related overdose and death.

Drinking Water Quality In 2017, the Governor established a 12-member Drinking Water Quality Council, making it clear that New York State is firmly invested in plans that will safeguard water sources. Local health departments play a key role in monitoring and maintaining water quality throughout the state. Threats to water quality cause concern to quality of drinking water, aquatic life and recreational use of water including boating and fishing. Chemical contaminants such as Perfluorooctanoic acid (PFOA), and Harmful Algal Blooms (HABs) caused by nutrient pollution, have become key public health considerations, particularly within the past decade. Drinking water contaminants can cause illness, so full-service local health departments conduct water sampling, testing and develop communication plans for water users. By working in coordination with New York State Department of Health and the Department of Environmental Conservation, threats to the more than 7,600 freshwater lakes, ponds, and reservoirs throughout New York State are mitigated and controlled. Local health departments recognize the importance of resident access to real time information about the safety and use of water, delivering guidance and information when appropriate.

Tobacco A 2014 U.S. Department of Health and Human Services report regarding tobacco use estimates that over 480,000 Americans die annually from tobaccocaused disease, making it the leading cause of preventable death. Although conventional cigarette use has declined in recent years, the emergence of electronic cigarettes and flavored tobacco products such as hookahs, cigars, and chewing tobacco have led to a climb in rates of noncigarette tobacco use. Marketing for these products often targets younger generations of users. A 2015 NIH FDA study found that 81% of youth who have ever used tobacco products started with a flavored product. Local health departments are steadfast in their commitment to eliminating exposure to secondhand NYSAC News | www.nysac.org

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smoke, preventing initiation of tobacco use by youth and young adults, increasing resident access to effective cessation services, and restriction of minors’ access to tobacco. Tobacco free communities lead to safe, healthy communities.

Health Concerns Unique to Each County These threats to public health only skim the surface when considering the full scope of public health issues that require local health department response. In addition to opioid misuse, drinking water quality, and tobacco concerns, public health directors also work to ensure core public health services are accessible and meet the individual needs of users. It is important to note that every local health department is unique, with services mirroring the needs of the communities being served. Core responsibilities include working to increase immunization rates, conducting lead testing and prevention of lead poisoning, developing emergency preparedness plans, monitoring and bending the curve on rates of chronic disease, addressing rural health issues, identifying health equity and disparities and beyond. Many local health departments also administer the Early Intervention and Preschool Special Education programs. The scope of public health can be tied to every aspect of your daily life, from home, school, work, the gym, restaurants, daycare, the park, airports, and beyond. Public health professionals are the unsung heroes protecting the health and safety of the community you live in. To sustain the level of work required to support our public health system, it is critical that the role of the public health infrastructure, and the professionals that support it, continue to be recognized as an essential service, supported and valued. Furthermore, ensuring the availability of funding to public health programs is continued will allow counties to mitigate threats to their communities and protect their citizens. For more information, or to contact the New York State Association of County Health Officials office please visit www. nysacho.org.

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PUBLIC HEALTH ISSUES

Cayuga County’s Response to Harmful Algal Blooms (HABs) By Deanna Ryan, M.S., Senior Public Health Educator and Public Information Officer, Cayuga County Health Department

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wasco Lake, located in the heart of Cayuga County, is the source of public drinking water for more than half of the county’s residents. The City of Auburn and Town of Owasco both draw water from separate intakes from Owasco Lake. Once drawn and treated, these two municipalities provide drinking water to their residents, and are the supplier of drinking water to many surrounding towns and villages. In 2016, the Cayuga County Health Department was the first health department in New York State to detect low levels of microcystin (a toxin produced by harmful algae blooms) in treated drinking water. Microcystin was detected in both supplies serving Auburn and Owasco. When these low-level detections occurred, the county worked with New York State Department of Health Bureau of Water Supply Protection and Wadsworth Lab to optimize treatment of the water at the water treatment plants; and also to collect routine water samples of the source water entering the treatment plant (raw water) and treated drinking water. While levels in treated water were below Environmental Protection Agency’s (EPA) Health Advisory of 0.3 micrograms per liter of microcystin, detection of toxins persisted in spite of efforts to optimize treatment to address the problem. Cayuga County and municipalities then worked with the Governor’s Office to secure funding to install a carbon activated treatment system that can be turned on when HABs are detected in the plant to remove any remaining microcystin. The County Health Department went into the 2017 HAB season with a proactive sampling plan. In July, water suppliers began weekly sampling of the water near their intakes, and after the water had been treated. The newly installed treatment systems began operating in September in response to a bloom detected in water that was entering the treatment plant. Once this detection occurred, water suppliers increased sampling to three times per week until blooms dissipated in November. The treatment

systems continued operating when blooms were no longer detected in the plant. Keeping pace with ongoing sampling, analysis, and notification during HAB events remains a significant challenge for the Owasco Lake drinking water response program. “In 2016, it was much easier to meet demand,” explained Eileen O’Connor, Cayuga County Director of Environmental Health. “With our increased sampling schedules, our program and the lab are both taxed by processing samples on an ongoing basis during HAB events. Logistics are extremely hectic to get same day samples and results for over the extended time periods of a bloom.” Timely notification about HABs in public drinking water is also a significant challenge. Acknowledging that there is a delay from the time a sample is taken to when it is analyzed at the lab and the results are reported is extremely important. It is important to be transparent about this timeline with the public. Another aspect to public information is trying to connect with everyone. While the Cayuga County Health Department has a robust and diverse communications plan, we realize that we may not be able to extend our messaging to everyone, especially those who might not have access to our website, social media, or do not read or watch the news. We are continually working to find alternative ways to disseminate our informational and educational messages. Having been the first local health department to experience toxins associated with HABs in the drinking water, we have since been able to share our experiences, message maps and lessons learned with other counties now facing similar situations. We know that this problem is not unique to Cayuga County, but as the first to experience this, we are happy to be a resource to others. NYSAC News | www.nysac.org

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PUBLIC HEALTH ISSUES

Health Costs and Concerns for Local Jails By Katie Hohman, NYSAC Legislative Director

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here are over 60 county operated local correctional facilities in New York State, and as of August 2017 there are more than 24,000 individuals housed in those facilities. Under New York State law, local correctional facilities are required to be maintained and operated by the county sheriff 's department.

Of the 24 counties that responded to that survey for 2016, jail health costs for hospitals totaled $3.2 million (40%) and jail health costs for pharmaceuticals totaled $3.7 million (43%).

The most important responsibility of local jails is to protect the health, safety, and well-being of each individual in the custody of that facility. Counties are also required by federal and state law to provide adequate health care for inmates. New York State Codes, Rules & Regulations, explain local correctional facilities health service policies and requirements. Specifically, each facility must provide adequate medical care for every individual. The chief administrative officer of each local correctional facility must develop and implement written policies and procedures, and each facility is obligated to have a registered physician for the facility.

In 2009, Governor Paterson signed into law the “Department of Health Oversight Law” Chapter 419 of the laws of 2009, that requires the New York Department of Health (DOH) to conduct annual reviews of HIV and Hepatitis C care in state and local correctional facilities. Since the enactment of this law, county

Upon entry and intake, each inmate is required to be examined by a physician or by medical personnel, within 14 days of admission. Inmates are screened to identify potential emergency situations among new arrivals and to ensure that patients with known illnesses and currently on medications are identified for further assessment and continued treatment. The facility forms include: inmate’s medical history (if available), inmate’s concerns, complaint of illness, diagnosis, and treatment prescribed.

Construction and Renovation

NYSAC recently surveyed counties, and jails identified addressing the health needs of the jail population as their most common concern. Inmate healthcare, medication and hospital stays are significant cost drivers for counties and many have seen a significant increase in jail health costs over the last five years for treating inmates. Specifically, hospital related costs, pharmaceuticals, treatment for HIV/Hepatitis C, dental and pregnancies are among the highest.

Hospital and Pharmaceuticals Our county jail facilities experience high turnover rates, including high recidivism rates. Our jails hold individuals that are serving sentences of a year or less and individuals who are there for pretrail holding and cannot afford bail. County jail inmates suffer from chronic health conditions at a higher rate than the general population and many have a mental illness, often accompanied by substance use disorders. In addition, counties are required to house and provide medical assistance to all New York State parole violators housed in our facilities. 36

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HIV/Hepatitis C Treatment

At a minimum, county jails are required to manage the following responsibilities:

Admissions Security and Supervision

Exercise Nondiscriminatory Treatment Legal Services

Correspondence

Access to Legal Counsel

Prisoner Hygiene

Grievance Programs

Disciplinary Action

Fire Prevention and Safety

Certain Civil Commitments Visitation

Maximum Facility Capacity Standards

Food Services

Staffing Requirements

Sanitation

Variances

Commissary

Funeral and Deathbed Visits

Personnel Standards Gifts and Gratuities Reportable Incident

InformationConfidentiality

Religion

Educational Services for Youth

Printed Material and Publications

Human Virus and AIDS-Related


jails have been required to provide more extensive testing to inmates for HIV and Hepatitis C, and more instances of these diseases have been discovered and subsequently required expensive treatment. The type of treatment inmates receive is up to the discretion of a medical professional. Within the last 10 years, new drugs for treating Hepatitis C have been approved by the Federal Drug Administration (FDA) with an estimated cost of $90,000 for the 12-week treatment. For many counties, the cost of providing such treatment to inmates causes great financial strain to jail medical budgets. Furthermore, once an individual begins treatment on this medication, he or she must continue the full course of treatment for it to be effective, which requires jail officials to monitor and maintain an inmate’s treatment record and required doses over a period of time which may precede or follow their incarceration. The State enacted this new law without providing financial support to counties to be able to provide this new level of care and treatment to individuals diagnosed with these diseases.

County Substance Use Disorder Programs As mental health and substance abuse problems have increased in local correctional facilities, counties have adapted. They have created programs that provide intensive exposure to recovery tools to aid in the long-term success of inmates with a history of

alcohol and drug abuse. Highly qualified credentialed counselors provide a tough regimen where inmates examine the problematic emotions and behaviors correlated with their chemical addiction. Many correctional facilities programs include: • Group counseling, • Chemical dependency/ Mental health psychoeducation, • Alcoholics Anonymous, Narcotics Anonymous, Gamblers Anonymous & other self-help meetings, • Individual counseling and evaluation sessions, and • Specialty groups including relapse prevention, anger management group, spirituality group, transition group, health awareness group, vocational development group, veteran’s group or mental health dual diagnosis group. The enacted 2018/19 State budget included $3,750,000 in funding for Substance Use Disorder programs for local correctional facilities, which will bolster the services provided in county jails, and help inmates better integrate into their communities once they’ve completed their sentence.

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NYSAC News | www.nysac.org

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PUBLIC HEALTH ISSUES

Healthier Water for New York By Robert Raczko, Senior Engineer, SUEZ North America

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rawing a glass of clean, healthy water is never as easy as it looks. Whether that water comes from a private well or one of New York State’s more than 9,500 public water systems, many things have to happen to ensure that water is abundant and safe. Contaminants, naturally occurring and manmade, need to be removed. Source water must be accessible—an increasingly unpredictable task, given the challenge of recent extreme weather. Treated water also must make it from Point A to Point B—despite aging water mains, leaky valves, and theft that can leave 30 percent or more of treated water unaccounted for. The entire systems of pipes, filters, pumps, testing facilities and storage tanks need to manned by a skilled workforce, and budgeted for in a financially viable manner. County legislators and departments of health work closely with private utilities to deliver clean, healthy water in many of the state’s 57 counties (outside New York City). Those utilities include SUEZ, which operates in Dutchess, Nassau, Orange, Putnam, Rockland and Westchester counties and provides drinking water services to 550,000 people and wastewater services to over 1 million people daily. Counties and their utility partners have a tall order: safeguard the health and safety of residents while updating aging infrastructure—all while keeping a sharp eye on costs. One of the best investments in time and money has been in pinpointing and fixing leaks in the thousands of miles in water distribution networks. In Westchester County, a system-wide district flow metering project—across 600 miles of water mains—achieved savings within the first year of full deployment of approximately $850,000. In Rockland County, non-revenue water was reduced to 17 percent, down from 22 percent four years ago. That’s huge considering the size of the operation there. In Rockland and a portion of Orange County, SUEZ alone delivers an average of

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28.6 million gallons of clean, safe water to more than 300,000 people each day. The water is drawn from more than 60 sources—70 percent from groundwater wells and 30 percent from surface reservoirs—treated in either our Lake DeForest Water Treatment Plant or our Letchworth Water Treatment Plant, and then distributed through 1,000 miles of water mains. Delivering this clean, safe drinking water—whether to large systems in Rockland and Orange counties, or to smaller systems, such as those in the Westchester County municipalities of Mount Kisco, Pleasantville, and New Castle— requires well-funded, peer-reviewed research and development, and deep and broad experience in operations and maintenance. In fact, New York counties see great benefit in working with private utilities whose experience includes working with thousands of industrial and municipal sites. In addition to reducing non-revenue water, county authorities and their utility partners often find that one of their biggest challenges is in adequately budgeting for system upgrades. As has been widely reported, public water and wastewater infrastructure across the country has been seriously underfunded and poorly maintained for decades. One solution is the deployment of asset-management systems. For example, in Oneida and Herkimer counties, Mohawk


Valley Water Authority (MVWA) recently deployed an assetmanagement system that will enable it to more efficiently operate, manage and maintain its water treatment and distribution system. Mohawk Valley’s system serves 126,500 residents of Utica and neighboring towns. The asset-management system tracks the age and suspected conditions of pipes, pumps and valves so that the MVWA can better predict their useful lifespan and prioritize capital improvements. That’s a huge advantage when you consider that many of the assets are buried out of sight. MVWA, through its utility partner, has been conducting an end-to-end assessment of the system—parts of which are more than 100 years old—for health and safety, regulatory compliance and engineering needs. Of course, when it comes to protecting New York State’s water, treating and distributing clean water is only half the battle. The other is in treating wastewater in an environmentally responsible way. In recent years, no wastewater treatment system has presented such challenges and achieved such success as the Nassau County system, which treats 115 million gallons of wastewater each day. Already hampered by under-investment and poor maintenance, the system was crippled in 2012 when Superstorm Sandy knocked the county’s main Bay Park treatment plant out of operation. Even before the storm, environmental groups had been fighting for years to reduce the amount of raw sewage and nitrogen flowing into the channels along the south side of Long Island. The facility had also received numerous noise and odor complaints. In fact, a coalition of environmental groups gave the facility just 12 points out of a possible 100, citing municipalities for not removing high levels of nitrogen from the effluent—

which had all but eliminated fish from nearby waters. In 2014, Nassau County officials, residents and environmental groups began working with SUEZ under a public-private partnership. Two years after SUEZ took over maintenance and operations, the group gave the system a score of 89. The group also gave work under the partnership high marks for eliminating major permit violations, removing 97 percent of total suspended solids and significantly reducing odors. That report card stated that SUEZ’ “international experience and expertise in wastewater has helped bring the plant into the millennium.” The project included implementing better management structures, upgrading equipment, providing significantly enhanced training, and cleaning the entire network of 3,000 miles of pipeline connected to the county’s Bay Park, Cedar Creek, and Glen Cove wastewater treatment facilities. While Nassau County’s wastewater system represents one of the biggest challenges and greatest successes in the country, it is in some ways not unique: Throughout New York State, counties have found that working in partnership with private utilities is the best way to ensure that drinking water is abundant and safe. SUEZ in North America operates across all 50 states and Canada with 7,000 employees dedicated to environmental sustainability and smart and sustainable resource management. The company provides drinking water, wastewater and waste collection service to 6.4 million people on a daily basis; treats over 600 million gallons of water and over 450 million gallons of wastewater each day; delivers water treatment and advanced network solutions to 16,000 industrial and municipal sites; processes 55,000 tons of waste for recycling; rehabilitates and maintains water assets for more than 4,000 municipal and industrial customers; and manages over $4 billion in total assets. Visit us at www.suez-na.com. NYSAC News | www.nysac.org

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PUBLIC SAFETY

Sheriffs’ Marine Patrols on the Waterways Of NYS By Sheriff Ron Spike, Yates County, NY

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heriffs in over forty counties outside of New York City operate Marine Patrol Units on navigable waterways. The NYS Office of Parks and Recreation & Historic Preservation relies on municipal and county law enforcement services - and for a majority of the state - the county Sheriffs' Office’s Marine Patrol Units. In most cases, Parks and Recreation departments make referrals to the county Sheriff for navigation and boating complaints, accident investigations, and enforcement of all related regulations. These generally involve the Navigation Law, Vehicle and Traffic Law (registrations), NYS OGS (lands under the water), and Lake George that have special regulations. Sheriffs send officers for the marine patrol officer basic course, patrol vessel operator, impaired boater recognition, PWC operator, and vessel noise enforcement. A portion of the money collected from vessel registration fees are provided for distribution to localities that operate marine patrols. While this money which may reach as much as $3 million per year - goes primarily to the county sheriffs and town and village police departments, a participating agency may receive aid equal to 50% of their total operating costs, capital, and personnel expenses, refunded up to a maximum of $200,000. Additionally, Parks and Recreation rely on the sheriff to also investigate and approve floating object and regatta permits before they issue them. Many Sheriffs' Offices have certified instructors that teach the “Make sure – Make shore” safe boating operator course. Parks and Recreation provided Sheriffs' Offices throughout the state patrol vessels on a “loaner” basis. The state sheriffs feel very fortunate to have a great working relationship and collaboration with this important state agency. Why is it important? Recreational boating in New York State is recognized as a 2-billion-dollar industry and New York ranks 7th in the nation for boat registrations. More and more sheriff marine patrols are taking a zero tolerance stand in three areas: (1) non-compliance in wearing personal floatation devices (PFD) or life jackets as commonly referred, (2) operating vessels while impaired by alcohol or drugs, (3) reckless operation. Between enforcement, increased education and prevention efforts fatalities on New York State waterways have declined 60% from what it was 35 years ago. Boating accident statistics have also shown that while accidents can happen anytime, most occur on Saturday and Sunday afternoons. This time frame has been addressed by sheriffs with increased patrol vessels, and even deputies patrolling on PWC’s. The state sheriffs take their mission seriously on our waterways and the patrol vessel is ever a public reminder of safety, and that the navigation related laws are important. Marine deputies answer 911 calls, citizen complaints, investigate in-water/ waterside crime and boating accidents, and do vessel inspections at launch sites and

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inspections on the water by displaying their emergency blue lights to cause the stop. They patrol regattas and other waterway events. They may make arrests and sometimes issue citations, but always have a lot of interaction with the recreational boaters through issuing warnings or counseling in an effort to promote safety for everyone. Often times the sheriff ’s patrol vessel is the “tow truck” on the lake, and can be seen towing stranded boaters to shore. Additionally, they may be the first to arrive when a boater, angler, skier, or tuber has been injured. Deputies are trained first responders and most patrol boats are equipped with AEDs, and often have saved lives, and have transported the injured to a nearby on shore ambulance. They frequently assist for many other emergencies including search and rescue or assist adjacent county sheriffs or other underwater dive teams in recovery operations. In some areas of the state, the patrols are very important to counter terrorism, counter drug efforts and border patrol. Many natural events such as flooding debris run off into lakes and rivers can cause special needs for sheriffs’ marine patrols such as marking hazards to navigation, and towing stumps, trees, and other floating hazards off the waterways. These are special circumstances, when no one takes responsibility for removal of these hazards, so sheriffs use salvage laws to make the waterway a safe place. Finally, a contemporary concern is for the prevention of invasive species into our lakes and waterways such as non-native plants and animals that degrade fishing and boating and may negatively affect tourism. Marine patrol officers are now educating boaters before and after boating to clean, drain, and dry their boats and motors, especially removing all visible plants. Preserving our natural resources - especially water - will secure our future for recreation, tourism, and their economic effect in our counties. Sheriffs’ marine patrols will continue their public safety promotion and preserving mission on our county waterways. Remember to be safe on the water and always wear your life jacket.


Orange County Collaborative Governing Program Produces Healthy Communication By Steven M. Neuhaus, Orange County Executive

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range County Government has established a model innovative Collaborative Governing Program aimed at fostering healthy communications amongst all interested parties with the goal of enhancing services and outcomes for those served by County Government. The first Collaborative Governing Program in New York State continues to be successful through a partnership with the New York State Association of Counties, The New York State Dispute Resolution Association, Inc. and the Dispute Resolution Center of Orange, Putnam, Sullivan and Ulster Counties (DRC). Now entering its fifth year, Orange County is proud to share with other governments some important points regarding its Collaborative Governing Program (CGP). The Orange County CGP is a comprehensive system for intragovernmental cooperation resulting in good public policy and cost-effective quality services. This is achieved through consultation, education and coaching of elected officials and government personnel in the skills of interest-based collaboration. CGP is rooted in proven Alternative Dispute Resolution communication skill practices and internationally acclaimed interest-based collaborative strategies. Orange County’s CGP started by focusing on the Legislative branch of government with the goal of bringing forward consensus on difficult issues. To facilitate that end, a training workshop was provided by CGP co-founders Dr. Bernadette Poole-Tracy and Niki Lee Rowe, as well as, other representatives from NYSDRA. The training showed that while agendas may differ, common goals and objectives could be reached. This initial training session provided the foundation upon which the program has grown. Taking the next step, specialty coaches were assigned as Legislative Committee Chairs to work one-on-one with DRC’s pool of trained mediators to assist with interest-based communication skills. This was accomplished by attending all legislative committee meetings and providing impartial feedback. This process resulted in exchanging ideas, improving communications, and creating positive working relationships aimed at a common goal of providing the best government for the people of Orange County. As a result, relationships were strengthened between both the Legislative and Executive branches of County Government which have helped to set the tone for inter-party collaborations.

With an increased level of healthy communication in the Legislative branch, the OCCGP expanded to the Executive branch where executive staff, commissioners, and department heads were trained in collaborative governing skills and interestbased negotiations. Through this process, an agreement was reached between both branches that would create a new Legislative Request Process; thereby saving time and increasing efficiency of county government. Regular “Leaders’ Meetings” were also an outcome of the OCCGP; whereby leaders from both Legislature and Executive were included in discussions and exchanges of information. As collaborative governing skills became embedded into the fabric of county government, the county’s commitment to the program continued. Several workshops were held for department heads, directors and middle management employees. Employees in the Department of Human Resources attended mediation training with the DRC. These employees are applying their collaborative skills in dealing with various dispute resolutions, employee relations and contract negotiations. The OCCGP encourages and fosters good communication between all branches of government and has produced significant accomplishments such as: 1. Healthy communication, 2. Increased productivity, including timely implementation of beneficial policies, 3. The establishment and testing of departmental mergers and consolidations, 4. Efficiencies of time and effort, 5. Increased budget efficiencies, 6. Increased cross governmental cooperation, 7. Certified mediators, and 8. Efforts to foster cooperation across local municipalities. Orange County has benefitted greatly from this partnership and is proud to be the first county in New York State to benefit from the many skills learned though the Collaborative Governing Program. NYSAC News | www.nysac.org

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The Erie County Commission on the Status of Women By Karen King, PhD, Executive Director, Erie County Commission on the Status of Women

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he Erie County Commission on the Status of Women (ECCSW) was established by a unanimous vote of the Erie County Legislature in 1987 to remove gender based inequities. In 1988, the Commission became a department of Erie County government. Being part of the county government has enabled the ECCSW to cultivate important partnerships within the government and the larger community. Forging collaborative relationships is at the heart of what we do. For 30 years, the ECCSW has connected women with the resources they need to reach their full potential. The Commission has served as legislative advocates, conducted policy studies, analyzed legislation, programs, and trends impacting women and girls, and developed collaborative programs with local and regional organizations and public officials. Our priorities include: ending gender-based discrimination, advocating for economic justice and empowerment; education, public awareness and engagement; health and well-being, and the development of business, civic and community leadership. As part of an ongoing effort to provide our community with valuable resources, the ECCSW key initiatives include the following:

Pay Equity The ECCSW is committed to promoting pay equity. In 2014, Erie County Executive Mark Poloncarz signed Executive Order #013, Pay Equity Certification on County Contracts, designed to ensure that any company which receives a county contract upholds equal pay for equal work. Most recently, the ECCSW 42

NYSAC News | Spring-Summer 2018

observed All Women’s Equal Pay Day with support for a State Ban on Wage-History Discrimination. County Executive Mark Poloncarz joined Erie County Legislature Majority Leader April Baskin, Legislator Barbara Miller-Williams and the ECCSW to mark All Women’s Equal Pay Day. Majority Leader Baskin submitted a resolution in support of legislation that overwhelmingly passed the State Assembly in 2017, but which is currently still under consideration by the New York State Senate. Assembly bill A2040C and Senate bill S6737A would prevent employers from using salary history to set wages for potential employees. Similar laws have been enacted in California, Massachusetts and Delaware.

The Tribute Garden The ECCSW works with the community to honor the lives of those affected by domestic violence through our Tribute Garden. Annually we join Cornell's Master Gardeners, local youth, and community members to maintain and expand the Tribute Garden while providing community education on the pervasive issue of domestic violence. Over the past several years, the ECCSW along with partner domestic violence service provider agencies organized the “Break the Cycle Bike-A-Thon and Walk” to bring awareness to the issue of domestic violence in our community. As a result of the success of these events, the ECCSW and our partners created the Tribute Garden - a permanent, public tribute honoring fallen victims and survivors, while also raising awareness. This year, we installed a kiosk at the Garden to educate visitors on the reasons for the Tribute Garden and the devastation domestic violence reeks on our community.


NACW National Conference The ECCSW is a member of the National Association of Commissions for Women (NACW) and in July of 2017 hosted the 47th Annual NACW Conference and Empowerment Summit in Erie County. 2017 marked the 100th anniversary of Women’s Suffrage in New York State and the conference theme, Embracing Our Past, Empowering Our Future commemorated this historic event. The conference featured over 60 speakers, including Lieutenant Governor Kathy Hochul, Senator Kirsten Gillibrand, State Assemblymember Crystal Peoples-Stokes, Erie County Legislators Barbara Miller-Williams and Lynne Dixon as well as representation from the business community, not-for -profits, and advocacy organizations.

Healthy Relationships/ Partner Abuse Awareness The ECCSW in partnership with several community partners is implementing an initiative which targets interpersonal partner violence within the adolescent population in Erie County. This initiative started with a kick-off summit during teen dating violence awareness month, in February 2018, which brought over 100 high school students from across Erie County together for an interactive and informative workshop which fostered opportunities for leadership, peer mentorship, and advocacy skills building. The next phase will include student participants to serve as their school’s relationship violence awareness ambassadors.

More recently the ECCSW has embarked on several exciting new initiatives including:

Middle Skills and Building Trades Workforce Development

First Amendment, First Vote!

The ECCSW is convening a collaborative of community partners to provide educational programs and apprenticeship opportunities to women and girls. One of the most effective ways to narrow the gender wage gap and address systemic poverty in Erie County is to promote a trained inclusive workforce that prepares women to fill the demand for middle skills jobs - those jobs that require more than a high school diploma, but less than a bachelor’s degree – in the occupational areas of advanced manufacturing, energy, transportation, distribution, logistics and the building and construction trades.

The ECCSW is partnering with Friends of Women’s Rights National Park and Women March in Seneca Falls on a new program entitled First Amendment, First Vote! This is an inclusive, non-partisan civic engagement program designed to encourage high school girls to actively participate in the political process and begin to imagine themselves as candidates for elected office sometime in their future. The program includes educational workshops and fieldtrips. Students from across Erie County participated in the inaugural session at the Buffalo History Museum on March 10 and will partake in a field trip to Seneca Falls in May.

NYSAC SNAPSHOTS

County Executives gathered in Albany prior to the Governor's State of the State address.

Exhibitors met with county leaders at the NYSAC Legislative Conference.

NYSAC President Odell and Exec. Dir. Acquario in Washington, DC.

County delegates attended dozens of educational workshops at the NYSAC Legislative Conference.

Stephen Acquario spoke about New York's opioid crisis at the NACo Legislative Conference.

County Treasurers and Comptrollers joined NYSAC at a press conference on internet sales tax reform. NYSAC News | www.nysac.org

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PUBLIC HEALTH ISSUES

EVERY SECOND COUNTS: Improving Active Shooter Response Times By Laura Curran, Nassau County Executive

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he Parkland Florida tragedy was a grim reminder that no community is immune from the threat of an active shooter. As Nassau County Executive, it’s my duty to address this reality, and to ensure we do all we possibly can to prepare for an incident we hope to never face. The typical campus shooter is a student known to others in the school community. A little more than half of the 270 school shootings since Columbine in 1999 happened on college campuses – with high school incidents a close second. Sixtyeight percent of school shooters got their guns from relatives or at home.

who are being equipped with ballistic vests and helmets, have been trained in mass casualty response. Designated police-officer liaisons work with each school district to coordinate active shooter response plans, and every Nassau police officer on patrol will visit a school at least once each school day. Officers are learning the layout of every school, coordinating active shooter plans with school leadership, and

Active Shooter School Resource Program • Introduced on March 20, 2018 • Added Officers to our Homeland Security Unit to work with school officials, both public and private, to ensure that all entities are trained with regard to active shooter and general safety

But here is perhaps the most crucial statistic to consider if the goal is to save as many lives as possible: since Columbine, 75 percent of school shootings are over in less than five minutes. “Every second counts,” Nassau County Police Commissioner Patrick Ryder said. “We’ve got to cut down response time to save lives.” And our Active Shooter Response Plan shaves off precious seconds by honing tactical measures, launching educational initiatives, and closely collaborating with our 56 school districts. In Nassau County, we’ve instituted Rave, a smart-phone app, which allows a teacher or administrator to covertly alert a dedicated terminal in our 911 call center. That alert will immediately send out patrol cars to a scene. The Rave app is in more than 130 of the 450 public school buildings in Nassau County, with more slated to come on line each week. All sworn police officers, including village and city officers, receive uniform active-shooter-response training at the Nassau County Police Academy. And Nassau County Police Medics, 44

NYSAC News | Spring-Summer 2018

• Active Shooter Awareness, Situational Awareness Training, Lockdown Drills and Public Outreach • Continuing to expand RAVE to other school districts • 177 post cars patrolling every day. POP Officers and School Resource officers to visit schools on an daily basis to check in with schools and to encourage and promote communication serving as the designated representative to assist if school officials have concerns about a particular student. Our cops are also planning training for school officials, students, and parents on how to spot a potential threat. This is how we protect our kids – by working together to ensure lightning-fast response, properly equipping our first responders with training and tools, and maximizing our intelligence.


NYSAC Thanks the Sponsors & Exhibitors of the 52nd Annual County Finance School CORPORATE SPONSOR Solix, Inc.

SPECIAL EVENT SPONSORS

Bank of America Merrill Lynch Good Energy, LP KeyBanc Capital Markets New York Municipal Insurance Reciprocal PERMA PKF O'Connor Davies, LLP three+one

GOLD SPONSORS

Bank of America Merrill Lynch Drescher & Malecki LLP Insero & Co CPAs KeyBanc Capital Markets

EXHIBITORS

Aetna Auctions International, Inc. Barclay Damon, LLP Collar City Auctions Realty & Mgmt, Inc. Enterprise Fleet Management Humana, Inc. InStream, LLC Janney Montgomery Scott New York Municipal Insurance Reciprocal New York Power Authority NYS & Local Retirement System NYS Department of Public Service PERMA PKF O'Connor Davies, LLP Relph Benefit Advisors Systems East, Inc.

SILVER SPONSORS

Auctions International, Inc. Bonadio Group CPA's & More Collar City Auctions Realty & Mgmt, Inc. Evans Bank, N.A. & The Evans Agency FTN Financial Capital Markets Harris Beach PLLC JPMorgan Lumsden & McCormick, LLP NBT Bank Raymond F. Wager, CPA, P.C. S&P Global Ratings Siemens Industry, Inc. TD Bank, N.A. Trespasz & Marquardt, LLP UHY LLP Venesky & Company Webster Bank, N.A.

THURSDAY DINNER SPONSORS

Fiscal Advisors & Marketing, Inc. M&T Bank NYSAuctions.com Orrick, Herrington & Sutcliffe, LLP Roosevelt & Cross, Incorporated

Thank You to Our 2018 NYSAC Partners ECONOMIC DEVELOPMENT PARTNER Saratoga County Capital Resource Corporation

EXCELSIOR PARTNERS Airbnb AT&T KeyBanc Capital Markets New York Municipal Insurance Reciprocal NYSTEC NYS Auctions.com SecureWatch 24 SUEZ TNT Fireworks

ASSOCIATE PARTNERS M.J. Engineering & AHI Land Surveying, P.C. Auctions International, Inc. Maser Consulting P.A. Barclay Damon, LLP MVP Healthcare, Inc. Barton & Loguidice, D.P.C. BST & Co. CPA's, LLP CanaRx Group Inc. CSRA, Inc. Discover eGov Enterprise Fleet Management Envision Strategy, LLC Health Economics Group, Inc. Lyft

Municipal Electric and Gas Alliance, Inc. (MEGA) Nationwide Retirement Solutions NYSERDA PERMA

Relph Benefit Advisors Roemer Wallens Gold & Mineaux, LLP The Bonadio Group The Cicala Law Firm PLLC Transmission Developers, Inc. U.S. Communities Venesky & Company

PFM Financial Services, LLC PKF O'Connor Davies, LLP ProAct, Inc.

NYSAC News | www.nysac.org

45


LOCAL LAWS

Tobacco, Allergy Awareness, ATVs and More By Patrick Cummings, NYSAC Counsel

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YSAC tracks local laws that have been passed by our member counties. Understanding what other counties are doing to address their local issues and needs can provide ideas for you, our local leaders, to help determine what is best for your county. Below are brief descriptions of unique and recently passed local laws by our members as well as a web address link to find the entirety of the local law.

Onondaga County Passes Local Law Prohibiting the Sale of Tobacco, Herbal Cigarettes, Electronic Smoking Devices, and Tobacco Related Products to Anyone Under Age 21

electronic smoking devices, pipes, and similar articles posed a threat to youth within Onondaga County and that increasing the minimum age of legal access to tobacco products to (21) will help prevent or delay initiation of tobacco use by their youthful residents. The county definition of "Tobacco Products" includes cigarettes, cigars, chewing tobacco, powdered tobacco, nicotine water, and electronic smoking (e-cigarettes). Link to local law: www.bit.ly/OnondagaTobaccoLaw

Erie County Enacts Local Law Banning Conversion Therapy On March 6, 2018 Erie County adopted a local law banning the practice of conversion therapy on minors (less than 18 years of age). The local law defines conversion therapy as “any formal treatment that aims to change sexual orientation and gender identity of a minor.” The local law makes clear this practice restriction does not include “psychotherapies that provide acceptance, support, and understanding for clients. And in addition, do(es) not prohibit clergy fix pastoral counseling, teaching, or relaying of their religion's doctrine.” Any person who knowingly violates the provisions of this local law shall be guilty of a misdemeanor punishable by a fine of up to $1000 and/or up to one year in prison.

On January 1, 2018 an Onondaga County local law went into effect that raises the legal age for purchasing tobacco and tobacco related products to 21. The County Legislature based their need for this law, in part, from the Bureau of Tobacco Control and the New York State Department of Health reports, which concluded the majority of smokers report having their first cigarette in their early teens, with over ninety percent (90%) starting by age 21. NY County Legislatures have the power to pass that protect and ensure the health, safety, and of their residents. Onondaga County found that of tobacco generated by the smoking of cigars, 46

NYSAC News | Spring-Summer 2018

local laws well-being the effects cigarettes,

Link to local law: www.bit.ly/ErieConversionLaw


Suffolk County Adopts Local Law to Raise Allergy Awareness at Restaurants

Suffolk County Amends Local Law to Revise Sewer Use Regulations

On January 18, 2018 Suffolk County adopted a local law which will require companies that provide food services to provide notification to customers of potential allergy risks. The Legislature determined that food allergies are a growing public health concern that impacts an estimated 15 million Americans. To help improve food allergy safety the county will require food service establishments to place on their menus and menu boards the following customer notification: “When placing your order, please inform your server if a person in your party has a food allergy.” The law further requires the Commissioner of the County Department of Health Services to establish a program for food service establishments to be designated as "Food Allergy Friendly" and shall maintain a listing of food service establishments receiving such designations on the department’s website. Any food service establishment operator who is noncompliant with this local law shall be subject to a civil penalty of not less than $50 nor more than $500 for each such violation. This law goes into effect 180 days after January 18, 2018. Link to local law: www.bit.ly/SuffolkAllergyLaw

St. Lawrence County Passes Local Law to Increase Permittable Areas for All-Terrain Vehicle Operation

On January 15, 2018, the Suffolk County Legislature passed a local law that amended sewer use regulations in the county. Suffolk County Legislature found these amendments were in keeping with their mission to protect county sewer infrastructure and the environment. This local law clarifies fees, discharge conditions, requires permits of municipal leachate and non-municipal leachate, further defines what is objectional waste, and places a moratorium on applications and discharge of certain new sources. Municipal leachate and non-municipal leachate will require approval and permits from the county. Leachate is defined under the law as: the liquid resulting from contact with or passage through a landfill that is operated pursuant to applicable regulations and which does not contain hazardous waste or other materials which would characterize the liquid as objectionable. Objectional, prohibited and limited waste now includes: Discharge of wastes directly to the sewers of the County POTW from temporary facilities, such as portable toilets, recreational vehicles, marine toilets and the like. Link to local law: www.bit.ly/SuffolkSewerLaw

On February 8, 2018, and for the second year in a row, St. Lawrence County passed a local law increasing the number of roads and bridges allowing for all-terrain vehicle (ATV) operation. All roads and bridges in this expansion are countyowned and controlled. This law allows for an additional six roads and nine additional bridges. Local authorization such as this local law are needed to permit resident ATV operation on county owned and controlled roads and bridges. Link to local law: www.bit.ly/StLawrenceATVLaw NYSAC News | www.nysac.org

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