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HomeMy WebLinkAboutAgenda - 09-22-1980 Ali�' � -�6 AGENDA ITEM r 3 C7nANGE Cr UNTy COI ENnSSIUN3EFtS Room pia. 12 lob EAST IAxceuLIx IANE IIz,.,i.ss0l-L0TJG14.zv_c. 27278 Sttc.L,av W14rr=,ch drmr No""VALrxI N0%UN rUSTAV830N DOHA M WrLLHGrr A"B HAAU" September 19, 1980 Mr. Richard Whitted Chairman Orange County Board of Commissioners 106 E. Margaret Lane Hillsborough, NC 27278 Dear Mr. Whitted: I am writing on behalf of the Orange County Youth Services Needs Task Force to advise the Board of Commissioners of the recommendations of the Task Force'.regarding JJDP funds. At their June 23, 1980 meeting, the Board of Commissioners approved the county budget and an $8,400 JJDP draw down for the Phillips Project. This action deviated from the original Task Force recommendation. I subsequently requested that the Task Force be allowed to review our recommendations for the balance of the JJDP funds. This request was granted. I would 'mike to present the Task Force recommendation for the allocation of the balance of the' JJDP funds as follows. Janus House Liason Worker $4,000 Tree House Weekend Worker $1,320 I am requesting that the Commissioners consider these Task Force recommendations at the September 22, 1980 meeting. Representatives of the Task Force will be available to respond to these recommendations. Thank you for your continuing cooperation and concern_ Sincerely,. ♦ jl M. Harold Rogerson, Jr_ Chairman, Youth Services deeds Task Ford ml b i 300 l-J. Tryon ST_ �� 9ran 7 8i s h 7256 urha D LIHEALTH DEPARTMENT a line 227-2031 Barham line 688.7331 Carr Milt Mall.Suite 225 100 N.Greensboro Siteet Cartbaro,NZ 27510 942-4166 M E M 0 Jerry Anbinson,M.A P,A- y t TO: Commissioners FROM: Jerry Robinson DATE: September '19, 1980 RE- - Necessary Signing of Title XIX - Medicaid Participation Agreement At the Board of Health meeting last night (9--18•-80), the Board discussed signing of the Agreement and the operational changes regards expansion of fee-for- service this will involve. The motion was: "Rosetta Moore motioned to authorize the Director to sign the Title XIX Medicaid Participation Agreement between the Orange County Health Department and the Department of Human Resources, Division of Medical Assistance and to bring the Department into full compliance with this agreement by October 1, 19O0_ The w motion was seconded by Evelyn Lloyd and passed unanimously." The Board now refers the matter to the Commissioners as the Commissioner's representative must also be a signee in order to execute a legal contract. Attached is an explanation of the issue furnished the Board for their dis- cussion and a copy of the Agreement. The Board's chosen method of bringing us into compliance in this impossibly short time frame is to cease billing Medicaid for EPSDT. We will, however, con- tinue to provide EPSDT. When the Division of Health Services furnishes us more guideline and we have explored our capacity to change our fee-for-service practices, the Board will then deliberate this portion of the total situation. Therefore, the Commissioners can expect to receive a detailed recommendation from the Board regards expanded fees--for-service at a later date. JR 99 !� Attachments: 2 I s OF State of North Carolina Department of Human Resources Division of Medical Assistance 336 Fayetteville street Mall. Wake County Courthouse Annex Raleigh, North Carolina 27601 NORTH CAROLINA MEDICAL ASSISTANCE PROGRAM. (TITLE XIX - MEDICAID) LOCAL HEALTH DEPARTMENT or. DEVELOPMENTAL EVALUATION CENTER pARTICIPATION AGREEMENT Title XIX Provider Number Name O PrOv er Telephone i�um er ]. Street A ress C y � State Zxp By this. agreement the above-named provider and the North Carolina Division of Health Services (DAs) agree to participate: cooperatively in the provision of approved Medicaid services to eligible recipients of the north Carolina Medical. Assistance program" Title XIX approved services and reimbursement rates for this contract period are those lasted in Addenda A, B, C, and D. ' The pro'v'ider certifies that the clinic is operated to provide i s medical care in the form of physician supervised. clinical services i i 'which are diagnostic, therapeutic, rehabilitative and/or pallia- Live in nature. The provider certifies that patier& care is performed under F. Z 4 F t the direct supervision of a physician or other licensed practi� tioner of the healing arts within the scope of his practice as defined by state law or under the written orders, which are reviewed and updated annually, of such practitioners; that such practitioners are on the salaried or cont'sactual staff of -such i clinic or are voluntarily 'donating their service to said clinic; E that patient care provided.is not covered under separate Title XIX programs; that patients' services provided are under complete t control of the local department of health or developrnentaZ evalua- tion center; and that physicians or other licensed practitioners are not billing the Title XXX Program for their services. L The provider also certifies that fee schedules for such services are established and maintained. Health. care program services _refef'enced in this agreement are alternate or secondary sources of funding to Medicaid, which is the primary source. 7: Reasonable effort not inconsistent with other state or federal regulations, will be made by the local health department or DEC ;i to collect fees from other third party payars for covered services Local health departments will snake reasonable effort to collect fees from family planning patients, who are inelicjible for Title X1X or XX reimbursement, based on the recipient's ability to pay_ Sj sj The attached fee scale, recommended by the Division of Health services, may be used to charge for all services subject to the approval of appropriate governing bodies_ At the discretion of th i � • i 3 . 't i i 3 provider, fees may also be changed recipients of other service- Services will not be denied anyone because of an inability to pay- The Provider of Services Agrees: 1. To be responsible for remaining in compliance with the terms of the agreement and the provisions of Title XIX of the Social Security Act, and'regul.ati.ons issued thereunder_ 2. To accept Medicaid recipients for care and treatment. To provide approved services to eligible recipients under the North Carolina Medical. Assistance Program, Title XIX, without regard to race, color, national origin or haadicapping condition (Title VI of the Civil. Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973) . That if it has any restrictions on the type of services it will. make available and/or the type of health coriditions that it wi.l.l accept, or has any other criteria relating to the acceptance of persons for care and treatment, these restrictions or criteria must be applicable to all persons seeking its services and not just to Medicaid recipi.dnts. 3. To accept payment for Medicaid covered services in accordance with the rules and regulations for reimbursement, promulgated by the Secretary of Health and Human Services and by the State of North Carolina and established under the North. N� 3 3 4 Carolina Medicaid program. 4. To accept. as ' a ent in full.. the reimbursement rates as listed in Addenda A, B, C, and D- s. Not to charge a recipient or any other person, related or nonrel,ated, for covered items and services for which the recipient would be entitled to have payment made under Medicaid, and to make provision for the return or other disposition of funds incorrectly collected. To ' provide to a patient a statement of the amount for which the patient is actually liable in a spend down situation upon refunding collected money to a recipient: who is retroactively eligible for Medicaid services, to then bill. Medicaid for the reimbursable service_ Amounts in excess of authorized cost sharing paid to a:' provider by a recipient or other person for which the recipient is entitled to payment on his behalf under Medicaid con - �i stitute moneys- eys incorrectly collected_ A payment by an �I . individual to a provider which was proper' when made is 3j an incorrect payment when the individual. is ,;retroactive= i f ly entitled to Medicaid benefits~ the provider may r s charge the patient or another person for iteaes and �. -services not covered under the North Carolina Medicaid program. i s 5 - 6. To make reasonable effort, not inconsistent with other state or federal, regulations, to collect fees from third party payors for covered services_ When the recipient is covered by Medicare or any other third party, the provider will bill this source prior to billing Medicaid- The Medicaid, claim form must show-such payments by third parties_ 7. To keep any records necessary to disclose the extent of services the provider furnished to recipients under the State Medicaid plan. To keep such records for a mini- mum period of five (5) years from date of service_ 8. On request, furnish to the State Medicaid Agency, HHS, or the State Medicaid Fraud Control Unit, any informa- tion maintained under paragraph 7 above of this agree- ment and any information regarding payments claimed by the provider for furnishing services under the State Medicaid plan, 9. To participate in cost determination activities annually so that renegotiation of reimbursement rates may take` glace for each new contract period. Renegotiated rates are subject to r©ll-forward adjustments to costs. '10. The health department or developmental evaluation, center will reimburse the Division of<Health Services all monies incorrectly paid by Medicaid for services that would have been paid by Medicare. mm li. To maintain accounting records in accordance with gen-- erally accepted accounting principles and. medicaid recordkeeping requirement which will permit auditing in accordance with the North Carolina. reimbursement plan. To maintain such records for a minimum period of five (5) Years from close of fiscal gear.. That such records shall be subject to audit and review by Federal. and State representatives. Accounting records will be established and maintained for receipts from recip%erats of service in local health departments and developmental evaluation centers. These records will reflect which of the reimbursable service programs earned the receipts_ 12, To allow Federal and State officials, and their` contraat- ual agents, to make certification and compliance surveys, inspections, medical and professional reviews, and audits 'of data relating to services to Title XIM patients ads may be necessary under Federal and state statutes, rules and regulations_ To allow such visits at any time during hours of operation, including unannounced visits_ All such surveys, inspections, medical and professional. reviews, and audits will be in keeping with both Legal. • i and ethical practice governing patient confidentiality- r-+ M 'J 7 13. To submit billing for approved medical clinical serrr3.ci and DEC services on Form HNC©-01, EPSDT of :form number 372--109, Family` Planning Visit Record Form DHS 1458, Maternal Health Data Record 2771, Child Health Pzl=ary Care Patient Data Form. 2769, or H.S_T_S_ Terminal and mail, to Division of Health services, -Box 2091, Raleigh,, - North Carolina 27602_ T 14. The local,-providers Will comply with 42 CFR Part 455, utilization control, review, by participating in the assessment of Standards for Local Health Departments, and site reviews of Standards for Developmental Evalua- tion Centers. The Division of Health Services Agrees: — 1. To serve as intermediary between the 'North Carolina Medical Assistance Program and the Provider including assistance j with billing, payment, cost determination, cost settle- ment, and renegotiation of reimbursement rates. 2. To make vendor payments for service at the negotiated fee per visit rate in accordance with the applicable lawns or DHS policy and as promptly as is feasible after a proper claim is submitted and approved.. i 3. To withhold payments, if necessary, because of irregula-city from whatever cause until such irregularity or difference t i v:ti R can be resolved. 4. To give reasonable notice of any impending change in the provider status as a partici.patimg clinic service_ 5. To not-if y$the provides of,any substantive change in Y, Title XIX rules and regulations_ , The Division of Health Services and the Provider A ee,. 1. That in the event the Federal. and/or State laws should be amended or judicially interpreted so as to render r the fulfillment of this agreement on a part of either _ 1' party infeasible or impossible, or If the parties to this Agreement should be unable to agree upon Modify'- s ing amendments which would be needed to enable sub- : sta.ntial continuation of the Title X1X Program. as the_- ! result of amendments or judicial interpretations, then, and in that event, bath the provider and the `.i DHS .shall be discharged from further obligation created under the terms of this Agreement, except for ea_ui t-- able settlement of the respective accrued claims up a to the date of the termination. shall not be transferable or Z. That this Agreement assignable. Y. 3. That if any part of this Agreement is found to be in conflict with any Federal or State laws or r'egula- tions having equal weight of Zara, or if any part is 3 { • k R i placed in conflict by amendment of such laws, this Agreement is so amended. 4. period of Agreement: The terms of this Agreement; shall, remain in farce until modifications identified by either party is deemed necessary and changes mutually acceptable are negotiated. 5. 'Termination: Either party may terminate this agree- ment on sixty days advance notice by certified maiL to the other party. Authorized Local. Official. date Director, Div_ of Health da':. Services (:aunty Fiscal. Officer date bFiS Budget Officer cis.: R � -�~~ � � 30D W.Tryon Street Hillsborough.m�u727B County ��o "* m�chapL`Hill line o68-450t Mebane m`" zu'eouc 0�K"��� ������8����������^�' nw^anv"e emmn� oxw^*nu°m nm =,"�° ~ ^.~ ~ ~~---'- - o",,Mill Mall—Suite ao `oomm.m"rt>omStreet � Canbory mC_os,u 942-416B M E M 0l jerry no*;riscri.MAp& ' Director ^ TO Board of Health _ / FxoH: Jerry Robinson _ DATE: 'September 11, 1980 _ RE- Expanding the Departmental Fen System BACKGROUND On August 26' 1980 , I attended a workshop held by the Office =f' Ad miniot r a - ti«u procedures, Division of Health Services (DH5)' The subject was w `nemuranomx of Understanding for Title XlX' between the Division opMedical Aaalotunoe (DMA) .,and DHS' The schedule of future workshops will cover "....clinic flow to maximize earned income, and the process for billing Medicare/private carriers for covered services." From Title XIX (Medicaid) we obtain $2/000 in family planning funds and ' i Diagnosis and Treatment srrvIuuo {CPSDT}~ ' $o62 in Early and p�r�»dio Sn��e"�ng'n��agn o a badly developed program for eligible The small [P5pT co��e��z�no a�� uymy� " os�' � ~ig�blo D5S case load children participate in this program. Our o���dzen, State figures'show'le than � t and�thv eligible pg5 n=ods to develop ' department this effort, We are. entitled to bill for ,approved mc6loel clinical services" but ^t budget �ur this �� - are not doing �o yp�' However, our aool year (July �, 1�a� 3unr 30` 1981) contains an item. to collect $12°716 in fona f or 'other clinical services'. Lastly Title XzX ploys an unknown factor in our d*nra l fees which 1"o, and can are u»ugec=d at $22`a43 (we started charging dental fnnn on July 1, not yet predict the extent to which Medicaid will contribute to thefer need). d that the effective date of the Memorandum of Understanding � I� was announced is J 198V0 The nHS representative stated that DMS would not ewwh to l i ti - p lz=nQu based on our agreement to sign the Memorandum October 1. gate ournon comne"do �o h~ ~^g`~d by -'-el� (and in order to do =o I need th e Th e Memorandum and by Neal E»ono` Orange County Finance Director Board's action on September 1n) mmiaa1nnezo` approval on (and in order For him to sign he needs the County Cc September 22)' Should we fail to sign, it is possible that the Medicaid program uI6 seek restitution of funds to some unknown point in our past history. Should cc a h ve �n �no� boen out we sign we could still be subject to lit �gn�ion because we ha to,t tell ^�n no *o� of compliance. our ignorance or the low and the DHS feilvre b�us in �� excuses us. The implication at the meeting was that Medicaid will pleased a=e us get into complianon with the October 1 signing as the first step. not The agreement clearly states we will agree to make "reasonable effort, �� inconsistent onn1mtent wlth other state �l rugulotiona'- to collect ���s from n� r or Feder i 3 services". This relatively third-party payors for moc n ' zy innocent clause throws us into a patient accounts, billing system, clerical shortage and patient health u records difficulty of significant size. The problem is further complicated by� ' federal law which makes it illegal to charge Medicaid or Medicare unless everyone � � is charged for that service. | ` ` . c ' - � � / ` _ •..�raj;� 2 September' 11, '198cY, Board of Health E4emo re Fee System ., By separate contracts and regulations we shall continue to charge family forfeit our $72,000/year in family planning grants. BY agree_ planning fees or forf with the Robert eit J ohnson Foundation and all local parties, we shall. pent continue dental fees. Therefore, technically the compliance problem lies with EPSDT and other clinical services. One quick and simple solution would be to provide EPSDT services to anyone free and not bill EPSDT and to not start any other clinical service fees. This could lead to our budget expenditures exceed- ing our income by $-13,000. The only way I know to balance such a projected defi- cit involves staff and program reductions. I Via received on August 13, a Department of Human Resources (DHR) p ublica- tion from its Division of Plans and Operations (OPO). This publication is entitled 'Minimum Administrative Standards for Local Human Service Programs, and applies equally to local DSS, Health and Mental Health. Apparently, there is a trio, year grace period to get into compliance with a large number of operational, standards. Regards (Board) policy development for our department, relevant to our immediate problem, the 'Standards' state: "Client services services--eligibility dequirementsDfor Depart- each service.....fee-for-service plan"; "• ment [DHR1 for reimbursement purposes (by us) shall be net of all applicable credits, refunds, and fees/income generated as a result of program activities/ services.."; and, "Each local human service agency....that provide first and third party reimbursable services should: (�) establish for each patient/client at the time of initial. visit, an accounts receivable ledger card....which shall indicate:... (a) The ability to pay for services, (b) The amounts billed for services, and .-(c) All money received on behalf of the patient/client from first or third party sources; E4y^personal interpretation of this is that DHR intends to push for fee systems in local health departments during the next several years, wherever possible. I have called staff together (two meetings on September 5) arid discussed this significant issue and solicited their ideas and suggestions.. The following outline as modified was used for the staff discussions-- PROPOSED EXPANSION OF FEES-FOR-5ERVICE SYSTEM AT THE HEALTH DEPARTMENT GOAL: SERVICES AT THROUGH SCOPE ASYPRESEN E Tg PROVIDE CONSTRAINTS: LA . (PASTJDHSOGUIDANDCEEREGARDSTIIOT CHARGINGFFOR OTB,SVD, - ETC., WAS SAID TO BE INCORRECT.) OBJECTIVE: 1. CHARGE 14EDICAID AND OTHER THIRD-PARTY PAYORS VHEE1 POSSIBLE. CONSTRAINTS: 1) CANNOT CHARGE THIRD--PARTY PAYORS FOR A SERVICE WITHOUT CHARGING EVERYONE. ?) EXCEPT CHARGE E THAN ANYONE ELSE ADJUSTMENTS. EI 3) E-JUST MAKE REASONABLE EFFORT TO COLLECT FROM PATIENTS WITHOUT THIRD-PARTY COVERAGE. OBJECTIVE: 2. CHARGE SERVICES RECEIVED, IF THIRD-PARTY Board of Health Herno re Fee System 3 September' '11, 1980 CONSTRAINTS: 1) CHARGES MUST NOT DISCOURAGE UTILIZATION OF SERVICES. 2) NO ONE CAN BE REFUSED SERVICE BECAUSE. OF INABILITY TO PAY. TASKS: 1. Board establish appropriate policy, and A. Determine for which services fees should be charged_ B. Establish recommended charges for these services. C. Recommend a sliding scale based on household income level.. D. Board recommendations to Commissioners 2. Establish accounts system and billing clerk capacity. 3. Establish a modified or strict appointment systemr per clinic as appropriate to facilitate the billing process_ 4. Set implementation date and notify public and all responsible officials. 5. Determine income of household for service recipients and identify patty responsible for payment as patients/clients arrive. 6. Record service's which were received in medical records and documents. 7. Charge patients. € a. Collect fees or bill. 9. Provide reports on fee collection. Thirteen staff submitted recommendations, as follows: 1. Pediatrics examinations--7 persons suggested charging for sick or well child exams, or both.. 2. Multiphasic clinic---6 persons suggested charging for this service. 4 3. Blood pressure screening and monitoring-•-4 were in favor, and 3 opposed to charging for this service. 4. TB screening and treatment--2 felt sve should charge for screening when it was required for the patient's work; 3 felt we should not charge for TB treatment. 5. VD screening and treatment--2 people thought we should change for these services, and 6 felt we should not. 6. Immunization-4 persons suggested we charge for adult and foreign travel immunizations. 7. Pregnancy tests---7 persons suggested a fee be assessed and 2 were opposed. B. Maternal clinic---4 were in favor of charging for this service and 3 were opposed. a 1 A Hoard of Health Memo re Fee System 4 September ' 9. other--5 persons felt the sliding scale should go down to _ zero; 1 person felt we should only charge neW patients in the maternal clinic; 2 persons were opposed to charging for certain services to some age groups, such as children under 7, teens, or the elderly. One person dial not think we should charge for a health edu- cation service (Teen Parenting). This department and the number of its different activities is overly complex_ I believe that computerization is the proper course to take to handle the data flow_ A fee-for-service system expansion could cause our manual System to collapse. Therefore, I and Lisa Beralzheimer met with Sam Gattis, heal Evans, Johnny Horner, Keith Brooks, et. al., on September 3.. It was concluded that from the stand- points of finance, programer time and our having accomplished the preliminary work, that we should be the next task for the computer center. BOARD DECISION OPTIONS 1. Signing of Medicaid Contract: A. If no--forfeit all Title XIX revenues, EPSDT and Family Planning Grants; B. If yes-- a) Continue Dental and Family Planning fees and not bill. EPSDT or other clinical services to anyone including Medicaid; h) Continue Dental and Family Planning fees as at present, charge: a slld- ing fee scale for all child health services like EPSDT; c) Continue Dental and Family Planning fees, develop a fee scale for EPSDT type child health services, and develop a fee scale for all clinical services that are third-party reimbursable (must have prey, ssnting symptom, be physician supervised acid diagnostic, therapeutic, rehabilitative and/or palliative in nature): d) Continue Dental and Family Planning fees and develop a fee scale for all clinical services. e) Develop, as in Mental Health, a comprehensive fee system for all depart- mental services. DIRECTOR'S RECOMMENDATIONS A. Charge fees for all clinic personal health services except childhood immuni- zations. This excludes community, home based and school personal health services and Health educational services. B. Base the 10090'' fee charge an cost analysis and use of the Medicaid/Medicare reimbursement rates which would constitute the lowest 100% charge. Our costs would be calculated to exclude State furnished materials, Biologics and services. A few procedure charges should be a flat fee. C. Use.our existing fee scale to reduce the 1001 fee by family size and income.. As in Family Planning and Dental, to keep the lower limit at 150' or one dollar, whichever is greater (unless the patient/service is exempted as for teens in Family Planning). The one dollar minimum is also the Medicaid co-payment. --See attached fe- scale and charges examples-- The fees thus generated would constitute about. 2-3% of our budget, (perhapu $15,090). 1 base this prediction on what happened in Dental and Family Planning. 1)cnt.al is a particularly good case study. The fees did not. decrease patient dentanr. fees did document our dental case load in the lowest, income segment; because up to t3oard of Health Memo re Fee System 5 September 11, '19BG 7MG'+ of the patients are in the lowest income category we know ere are serving the greatest need (also by dental need standards); because of the low incomes we charge very small fees; our collection rate is well below 50% our income may not even meet our budget. lam as concerned about impact of this recommendation on certain services, i.e.,, hypertension screening, V.D. and TB, as anyone else. Therefore, if adverse effects are noted, I would immediately recommend limited/selected fee waivers. The value of an internally consistept policy for administration of that policy can not be overstressed. We can not communicate among staff, much Jess the public, a policy that is overly specific per service. We simply have too many services. This logic applies to use of one sliding scale also. ► I am convinced that it's only a matter of time before local health will be like mental health, with acxross-the•-board fees for all services. I view this recommendation to you as my obligation. It was difficult to formulate. I will be happy to discuss the total logic behind it in detail at the meeting. However, the-Board must formulate its own collective policy. Please feel free to ask me to individually or collectively furnish you with necessary data_ JR 99 1 Attachments: 2 E I� 1 . I 1 0 H F 3 yS L E l i r R£ COHMEii01: D FEE SCALE FAMILY SIZE j PERCENT 5 6 i OF CHARGE $ 2 3 4 1'5 o Monthly Rangd $. 511 - under 68 - under #15552 - under 668 - under 825 • under S 482 - under. $ 1'5 , Annual Range S 6,132 - under # $,015 - under $ 9,400 - under $11,784 - under $13, 28% Monthly Range $ 512 - $ 613 S .669 - $ 801 $ 826 - $ 990 $ 983 - $ 1,178 S 1:140 - $ 1,367 5 1,297 - S 1,555 i Annual Range $ 6,133 - $ 7,356 $ 8,017 - $ 9,612 # 9,901 - $11,880 $11,785 - $14;136 113,669 * ;16,404 $15,553 - $18,660 40% Annual Range $ 7,357 - $ 8,380 $ 9$613--5$11,208 $11,881 - 513.860 $14,137 - $16,488 #16,405 - $19,140 18,661 - $21,868 s 60% Monthly Range $ 716 -.5 . 817 $ 935 - $ 1,067 5 1,156 - $ 1.320 $ 1,375 - $ 1.578 $ 1.596 - S 1,823 $ 1,815 - $ 2,873. jj Annual Range E'8,581 - 9,804 $11,209 - $12,804 13,861 - $15,840 $16,489 - $18,840 $19,141 - $21,876 $21,769 • $24,876 SOS Monthly Range $ 818 - $ 919 $ 1,068 - $ 1,200 $ 1,321 - $ 1,485 $ 1,571 - S 1,766 $ 1,824 - $ 2,051 $ 2,074 - $ 2,332 i Annual Range # 9,685 #11,028 $12,809 - $14,4ob 515,841 - $17,820 $18,941 - $21,192 $21,877 - $24,612 $24,877 - $27,984 ' i 100% Monthly Range $ 920 - over $ 1,201 - over $ 1,486 - aver $ 1,767 - over $ 2,852 - aver S 2,333 - over it $24,613 - over $27,985 - over Annual Range $11,029 - over $14,401 - over $17,821 - over $21,1.93 - over ' 4 PERCENT SIZE PERCE OF CHARGE 1 g g l8 11 12 15ao Monthly Range S 3,326 - under S 1,355 - under, 5 1,385 - under 5 1,414 - under S 1,444 - under $ 1,473 - under Annual Range 1,327$$15,912 - under $16,260 - under $16,620 - under $16,968 - under $17,328- under $17,676 - under } 28% AnnualyRangeRange $15,912 - $19,892- 516,261 - $19,512 $16,621 - $19,944 $16 969 - $20,364 #17,329 - $20,796 $17,677 - $21,216 4D% Mdnthly Range $ 1,592 - 5 1,856 $ 1,627 - $ 1,897 S 1,663 - $ 1,939 $ 1,698 - S 1,980 $ 1,734 - $ 2:022 $ 1,769 - $ 2,063 Annual Range $79.593 - #22,272 $13,513 - $22,764 $19,945 - $23,268 $20,365 - $23,768 $28,197 - $24,264 $21,217 - $24,756 60% Monthly Range $ 1,85] - $ 2,121 $ 1,898 - $ 2,168 5 1,940 - S 2,216 S 1,981 - $ 2,263 $ 2.023 - $ 2,311 S 2,864 - $ 2,358 Annual Range $22,273 - $25.452 $22,765 - $26,016 $23,269 - $26,592 $23,761 - $27,156 $24,265 - $27,732 $24,757 $28,296 8O% Monthly Range $ 2:122 - S 2,386 $ 2,169 - $ 2,439 $ 2,217 - $ 2.493 $ 2,264 - S 2.546 $ 2,312 - $ 2,600 $ 2,359 - i 2,653 Annual Range $25.453 - $28,632 $26.817 - $29,268 $26,593 - $29 916 $27,156 - $30,552 $27,733 - $31,200 $28,297 - $31,836 108% Monthly $28,633 - over 529.269 - over $29.917 - over $30,553 - over $31.281 - aver $31.837 - aver 1.. •Persons whose income falls below 50% of the median income (56,132) receive services at no charge. 2. The dollar figures in the above sliding fee scale represent monthly and annual gross income. 3. �amsily size refers to the total number of persons supported by or dependent an that income. 4. Service charges for patients certified for Title XIX or 'title XX will be reimbursed upon submission a€ claims to the Division of Health Services, 5. Patients whose income falls below Title XX income eligibility, but are not certified through Title XX for reimbursement, ' will be assessed a nominal fee (15%) of full charges, (Family Planning only) 6. A waiver of all Family Planning fees is applied to teenagers. N. C. Department of Human Resources Division of Health Services Family Planning Branch 113179 SAMPLE DENTAL FEES CHARGED pR0}wEDURE EXAM X-RAY FLU0IRIDE EXTRACTTQN T-1-CLING 100 $15.00 $23.00 $3.00 $13.00 $13-00 80 12.00 18.40 6.40 10.40 10.140 60 9.00. 1,3.80 4.80 7.80 7.80 40 6.00 9.20 3.20 5.20 5.20 20 3.00 4.60 1.6D ! 2.60 2.60 15 2.25 3.45 1.20 ± 1.95 1.95 Under Medicaid, patients pay a $1.00 fee no matter what service is rendered. NORTjj CAROLINA STATEIRIDE FAMILY PLANNING PROGRAM PATIENT FEES (REVISED AS OF JULY 11 1980) °n CNRp INITIAL OR ANNUAL VISIT E�4EDICAL �r1ITH PELVIC VISIT MEDICAL tlTTci�Ji7T PE 15 $9.00 $3.00 2.00 � 20 I2.DO 4.00 9.00 5.00 40 25.00 60 37.00 13.00 7.00 $0 50.00 18.00 10.00) 100 6z.00 23.00 12.00 1 s i i