HomeMy WebLinkAboutAgenda - 01-22-2009 - 4j ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: January 22, 2009
Action Agenda
Item No.
SUBJECT: New Health Department Fees for Personal Health Services
DEPARTMENT: Health PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): INFORMATION CONTACT:
New Fees Proposal Rosemary Summers, 245-2411
PURPOSE: To establish Health Department fees for certain personal health services to assist
in cost recovery.
BACKGROUND: According to NCGS 130A, the Board of Health is responsible for reviewing
and recommending fees to the Board of County Commissioners in order to recover costs for
those services for which fees may be charged by the Health Department. Establishment of fees
also allows the Health Department to recover costs from third parties such as Medicaid,
Medicare, and private insurance. A standard fee must be established that is charged to a
patient or client regardless of insurance status. The Health Department also has established a
sliding fee scale to charge patients/clients based on income. At the November 2008 meeting,
the Board of Health reviewed and approved this proposal, recommending that it move forward to
Commissioners for action.
While the charge for the service is always the same, the amount collected by the Health
Department varies according to the payor source. Twice a year, Medicaid reviews and makes
rate adjustments based on the experience with various providers throughout the state. The
Health Department reviews and adjusts its fees based on this review to ensure that the
maximum income allowed by Medicaid for a certain procedure can be recovered to defray the
costs for providing a particular service. The Department reviews fees annually as part of budget
process, however, sometimes changes in policy at the state level means a change in the fee
structure or a change in best practice for medical care dictates changes that fall outside of the
budget cycle.
The first four fees noted on the attachment are related to a birth control method that provides 3
years of protection for a woman wishing to prevent pregnancy. The Department has received
additional family planning funds to be able to purchase this method and offer it to clients. The
next fee is related to a change in state policy that allows the Department to begin charging for
oral contraceptives. The proposed fee for oral contraceptive pills will cover the direct costs of
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the average contraceptives used yet still be affordable for clients. There are four fees
associated with required testing for Health Department employees, volunteers, and contractors
such as interpreters. These are flat fees paid by the prospective employee, volunteer or
contractor. Direct service providers must show immunity to Varicella, Measles, Mumps and
Rubella but often cannot provide documented vaccination. This would allow a titer (a blood test
that shows immunity levels) to be drawn to establish immunity and prevents unnecessary re-
vaccination. These fees allow the Department to pay the direct costs of UNC Labs that
performs these tests. The Bile Acid Test is a best practice lab test for the most common form of
liver disease for prenatal patients. This is also a direct cost of the test performed by UNC Labs.
Reimbursement for administration of vaccines must be consistent across payors and at the
present time there is a differential fee of $5.00 for Medicare and $11.00 for Medicaid for the
administration of one vaccine. The new proposed fee brings the Medicare charge to the same
level as the Medicaid administration fee. Finally, as part of a new federal policy, the Health
Department is required to collect a $3.00 co-pay from all adult Medicaid recipients and that
needs to be added to the fee schedule.
FINANCIAL IMPACT: in
S ce most of the fees will only recover the direct costs of providing the
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services, the Department does not anticipate substantially increased revenues or expenditures.
The Department continues to experience a rise in service to residents that qualify for reduced
payment on the sliding fee scale.
RECOMMENDATION(S): The Manager recommends the Board approve the additions and
changes to the fee schedule for Personal Health Services in the Health Department.
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Personal Health Services Division
New Fees Proposal
November 2008
Final December 2008
Implanon—small, thin, implantable hormonal contraceptive that is effective for up to 3
years (J7307 CPT Code)
> Cost: $446.51/unit
> Medicaid reimbursement: $637.97
➢ Proposed fee: $765.00/unit*
Insertion, non-biodegradable drug delivery(11981 CPT Code)
> Medicaid reimbursement: $109.90
> Proposed fee: $132.00*
Removal,non-biodegradable drug delivery(11982 CPT Code)
> Medicaid reimbursement: $126.82
> Proposed fee: $152.00*
Removal with re-insertion, non-biodegradable drug delivery(11983 CPT Code)
> Medicaid reimbursement: $192.71
> Proposed fee: $231.00*
Oral Contraceptive Pills(S4493 CPT Code)
> Average Cost of all: $5.98/pack
Average Cost of most used: $5.56/pack
> Medicaid reimbursement: $3.35/pack
> Proposed fee: $7.00
> (WalMart Pharmacy provides at $9/pack)
Employee Varicella Titer(LU214 CPT Code)—Flat Fee for new employees, volunteers,
contractors
➢ UNC Lab Cost: $78.00
> Proposed fee: $78.00
Employee Measles (Rubeola) Titer(86765 CPT Code)
> UNC Lab Cost: $48.00
> Proposed fee: $48.00
Employee Mumps Titer(86735 CPT Code)
➢ UNC Lab Cost: $50.00
➢ Proposed fee: $50.00
Employee Rubella Titer(86762 CPT Code)
> UNC Lab Cost: $75.00
➢ Proposed fee: $75.00
Bile Acid Test-UNC Lab (82239 CPT Code)
➢ UNC Lab Cost: $93.00
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> Proposed fee: $93.00
Administration of Influenza Vaccine - Medicare (G0008 CPT Code)
➢ Current fee: $5.00
➢ Proposed fee: $11.00**
Administration of Pneumococcal Vaccine - Medicare (G0009 CPT Code)
➢ Current fee: $5.00
> Proposed fee: $11.00**
Adult Medicaid Co-pay
➢ Proposed fee: $3.00***
* Fee based on 1.2% of Medicaid reimbursement
** Needs to be consistent with fee for Administration of 1 vaccine (90471 CPT Code=
$11.00)per Public Health Consultant
***Mandated by federal Medicaid rule