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HomeMy WebLinkAboutORD-2014-048 Approval of Budget Amendment #4-B Related to Position Changes and Receipt of Additional Medicaid Revenue within the Health Department1610A DE91149a ORANGE COUNTY BOARD of COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: December 9, 2014 Action Agenda Item No. 6 -i SUBJECT: Approval of Budget Amendment #4 -B Related to Position Changes and Receipt of Additional Medicaid Revenue within the Health Department DEPARTMENT: Health PUBLIC HEARING: (Y /N) I No ATTACHMENT(S): INFORMATION CONTACT: Pam McCall 245 -2402 Coby Austin 245 -2414 Dr. Colleen Bridger 245 -2410 Clarence Grier 245 -2453 PURPOSE: To approve Budget Amendment #4 -B related to position changes and receipt of additional Medicaid revenue within the Health Department, specifically to: 1) approve changing a currently budgeted 1.0 FTE Public Health Nurse I position to two .50 FTE Public Health Nurse I positions; 2) increase a currently budgeted .50 FTE Public Health Nurse II Preparedness Coordinator position to a .60 FTE position; 3) approve changing a currently budgeted temporary grant funded Medical Office Assistant position to a permanent .50 FTE position; and 4) approve receipt of additional Medicaid revenue. BACKGROUND: orange County faces increasing competition from UNC Hospital and Duke Medicine to attract and retain well- qualified nursing staff. In addition, over half of the current nursing staff is eligible to retire within the next five years. The County has a vested interest in retaining current staff as well as attracting the best candidates to fill future vacancies. On the recommendation of the previous County Manager, the Health Department and Human Resources worked together to create a Nurse Retention Plan. This plan was approved by the County Manager for the purpose of recruiting and retaining a high quality public health nurse workforce for orange County. one component of the plan is job sharing. This was identified by the nursing staff as an attractive workplace option. Because the incumbent in the Public Health Nurse I position has expressed the desire to work part -time, staff proposes to move forward with implementing this part of the plan by changing a currently budgeted 1.0 FTE Public Health Nurse I position to two .60 FTE Public Health Nurse I positions. The Public Health Preparedness Coordinator is responsible for developing and implementing mutual aid agreements to support National Incident Management System (NIMS) compliant public health response, working in conjunction with Emergency Services to use and maintain incident management systems for local events and response activities, updating county Strategic National Stockpile plans in accordance with the most current Centers for Disease Control and Prevention guidance, and working with Emergency Services to update and maintain the Emergency Operations Framework plan. This position is responsible for completing the new NC Public Health Preparedness Capabilities Rubric which was released on November 4, 2014. After moving through the Preparedness Capabilities Rubric, health departments will be required to revise all of their existing preparedness plans to an All Hazards Plan. For eight years the Preparedness Coordinator position had been a shared Public Health Nurse 11 position with Person County. In October 2013 the position was redesigned as a shared Public Health Preparedness Coordinator with Emergency Services. The position was filled in March 2014 and the incumbent resigned on November 14, 2014. Emergency Services and Health have mutually determined that a shared position was not the most effective method of managing employee performance and associated work tasks. Consequently, Emergency Services will maintain the .64 FTE preparedness position and the Health Department will return to the previous model of a part -time Public Health Nurse filling this Public Health Preparedness position. In the current climate with Ebola virus and other emerging infectious diseases threatening the health and safety of U.S. residents, a nurse with public health or communicable disease training can be a valuable asset and adds nursing capacity to the Health Department. The person in this position would continue to work closely with Emergency Services to revise and implement new All-Hazards Public Health preparedness plans to ensure that the County is prepared to respond to public health threats. Given the increasing duties associated with the change to the All Hazards Plan and the current workload associated with Ebola, staff requests that the P H N 11 Preparedness Coordinator position be established as a 4.64 FTE Public Health Nurse II position within the Health Department. The salary for the current Nutrition Office Assistant position has been grant funded since 2449. The current grant is funded by the Office of Minority Health and Health Disparities; subcontractor with UNC Family Medicine and AccessCare. The grant period ends in May 2015. Additional funding is still pending. The funds are allocated but no RFA has been released. Nutrition Services has identified a new source of revenue to support the cost of adding benefits to this position. Recently the Division of Medical Assistance has made changes to Medicaid billing requirements to allow a Medical Nutrition Therapy appointment on the same day as an office visit. The details of the financial impact are outlined below. This allows patients to see the registered dietitian on the same day as their office visit. This is a tremendous benefit to the patient as it is more convenient than having to make a return visit to see the dietitian. Additionally, most of these patients have chosen not to see the dietitian on a different day than the office visit and therefore have not received the benefit of this service. Essentially, all of the prenatal clients meet nutritional risk criteria and can benefit from Medical Nutrition Therapy. The majority of these patients have Medicaid and this additional source of revenue will provide the funds to support benefits for this position. This position ensures that clients are scheduled for Nutrition Service Appointments, which includes verifying insurance benefits, scheduling appointments, making reminder calls, and K demonstrating excellent customer service skills. Without this position, the registered dietitians use time to call and verify benefits taking them away from direct client care. This position is essential for sustaining and growing nutrition services programs. The goal of making this position a permanent .64 FTE position is to reduce turnover and sustain and grow the nutrition services program. FINANCIAL IMPACT: The Health Department budgeted for afull -time (1 FTE) PHN I this year, but so far this position has only been filled by a 0.50 FTE. The salary portion of creating a complementary 0.50 FTE PHN I position is therefore covered in the current budget. The additional cost for benefits will be covered with available department vacant position salary savings. The total anticipated cost (January —June 2015) is $12,796 in salary and $6,223 in benefits. The PHN II position is fully funded by a grant. The .64 FTE PHN II position is expected to cost $13,500 in salary and $6,967 in benefits for February through June 2015, totaling $24,467. The Health Department received a $38,836 grant to cover the expenses associated with this position. Only $13,087 was spent in the first five months of this 12-month grant, and the remaining $26,749 is more than sufficient to cover this expense. The additional expense associated with making the Nutrition Office Assistant position a permanent .50 FTE position with benefits will be covered by additional revenue. Salary costs for June 2015 (after the grant expires) were already included in the original budget and anticipated revenue for this fiscal year. The expense increase is estimated at $5,468, which will cover 6 months of benefits. Staff anticipates additional Medicaid revenue to cover the full amount of this increase. RECOMMENDATION(S): The Manager recommends that the Board approve Budget Amendment #4 -B to: 1) approve the shared Public Health Nurse I position splitting the current 1.0 FTE position into two 0.50 FTE benefitted positions; 2) approve reclassifying the Public Health Preparedness position previously shared with Emergency Services into a 0.60 FTE Public Health Nurse II position within the Health Department; 3) approve making the Nutrition Office Assistant position into a .50 FTE Permanent Position; and 4) approve the receipt of $5,468 in additional Medicaid revenue.