HomeMy WebLinkAboutBOH agenda 082317ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: August 23, 2017
TIME: 7:00 P.M.
PLACE: Whitted Building, 3rd Floor Meeting Rooms
300 West Tryon Street
Hillsborough, NC 27278
TIME ITEM
7:00 p.m. I. Welcome New Employees
7:00 – 7:05 II. Public Comment for Items NOT on Printed Agenda
Public Comment for Items ON Printed Agenda will be
handled during that agenda item
(Please sign up for both on sheet near the entrance to room.)
Please limit your comments to 3 minutes.
7:05 – 7:10 III. Approval of August 23, 2017 Agenda
7:10 – 7:15 IV. Actions Items (Consent)
A. Minutes of June 28, 2017 Liska Lackey
7:15 – 8:00 V. Educational Sessions
A. Criminal Justice Resource Dept. Update Caitlin Fenhagen
B. 4th Quarter Financial Reports Rebecca Crawford
C. 4th Quarter Billing Dashboard Reports Rebecca Crawford
D. 2013 Medicaid Cost Settlement Program Reimbursement Rebecca Crawford/
Dorothy Cilenti
E. Senate Bill 16 Alan Clapp
F. NALBOH Update Beverly Scurry/Susan Elmore
8:00 – 8:45 VI. Action Items (Non Consent)
A. FY 16/17 Delinquent Accounts Rebecca Crawford
B. Mid-Year Fee Request Rebecca Crawford
C. FIT Program Pam McCall
D. Youth Tobacco Prevention Funding Donna King
E. BOH Policy Updates Beverly Scurry
8:45 – 8:55 VII. Reports and Discussion with Possible Action
A. Health Director Report Dorothy Cilenti
B. Update on Health Director Search Liska Lackey
C. Media Items Dorothy Cilenti
8:55 – 9:00 VIII. Board Comments
9:00 IX. Adjournment
BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to lstrange@orangecountync.gov advising her of
your attendance at this meeting OR CALL 919-245-2411.
Compliance with the “Americans with Disabilities Act” and Title VI - Interpreter services and/or special sound equipment
are available on request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter
or other accommodation.
Conforme a la “Ley sobre Estadounidenses con Discapacidades” (ADA) y el Título VI – los servicios de intérprete y/o
equipo de sonido especial están disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes
y Refugiados al 919-245-2387 para solicitar un intérprete u otros arreglos o adaptaciones.
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON June 28, 2017, at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey – Chair, Johanna Birchmayer,
Commissioner Mia Burroughs, Barbara Chavious, Paul Chelminski, Jennifer Deyo, Jessica
Frega, Sam Lasris and Timothy Smith
BOARD OF HEALTH MEMBERS ABSENT: Susan Elmore.
STAFF PRESENT: Dr. Dorothy Cilenti, Interim Health Director; Coby Jansen Austin, Programs
and Policy Director; Alan Clapp, Environmental Health Director; Rebecca Crawford, Financial
and Administrative Services Director; Robin Gasparini, Public Health Nursing Supervisor; Carla
Julian, Dental Clinic Practice Manager, HIPAA Privacy and Security Officer, Compliance/Risk
Manager; Donna King, Health Promotions and Education Services Director; Pam McCall,
Personal Health Services Director; Beverly Scurry, Board of Health Strategic Plan Manager; and
La Toya Strange, Administrative Assistant II.
GUESTS PRESENT: Brenda Bartholomew, Human Resources Director and Miguel Ozuna,
Vice-President, Springsted Waters.
I. Welcome New Employees
Liska Lackey, Chair, called the meeting to order. Dr. Cilenti welcomed, Lauren Kager, the new
employee in attendance.
II. Public Comment for Items NOT on Printed Agenda: None
III. Approval of the June 28, 2017 Agenda
Motion was made by to Jessica Frega approve the agenda, seconded by Sam Lasris and
carried without dissent.
IV. Action Items (Consent)
A. Minutes of May 24, 2017 Meeting
Motion was made by Mia Burroughs to approve the minutes of May 2017, seconded by
Jennifer Deyo and carried without dissent.
V. Educational Sessions
A. FSA Update
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Coby Jansen Austin, Programs and Policy Director, began by giving an overview of the Family
Success Alliance (FSA). The FSA is a collective impact initiative modeled on Harlem Children’s
Zone and other place-based cradle to college/career programs throughout the country. It’s a
partnership with community members, organizations, local government agencies, elected
officials and parents that works with families struggling with structual inequities so that all
Orange County families can succeed. The FSA is currently working in two zones. Zone 4 is in
Hillsborough and Zone 6 is in the Chapel Hill/Carrboro area.
Some of the data regarding these zones include:
• In Zone 6, there are four times as many non-economically disadvantaged students at a
“College Ready” level on End of Grade 3rd grade reading and 8th grade math as
economically disadvantaged students.
• The percentage of College Ready students by race/ethnicity in Zone 6 shows a much
higher (87%) rate among white versus hispanic (28%) and black students (30%).
Ms. Austin shared updates on some of the FSA’s successes and ongoing work.
• Hiring of new navigators has occurred. Zone 4 will have a total of 3 and Zone 6 will have
a total of 4 navigators.
• In Zone 4, a target area is Gateway Village, a project-based Section 8 apartment
complex with a contract with HUD in which rent for tenants at this property is based on
tenant income. In 2016, an action plan was created with the help of faith leaders, legal
aid and Alan Clapp to address the some concerns associated with Gateway Village
including backed up sewage on the land which affected tenants’ health. Under previous
management, there were a lot of evictions which caused a fear of retaliation amongst
tenants causing them not to report property issues; however, new management has
provided money in their budget to clean the backed up sewage on their property.
• In Zone 4, in Spring 2017, a social worker intern was on site to help build relationships
and assist families.
• Family Fun Days were held in the communities with a better turnout this year.
• This summer, the FSA partnered with grassroots organizations. A summer meal
program was launched with 45 families signing up.
• The FSA was able to assist Sisters on the Move in receiving a vehicle donation.
• Books on Break, a non-profit organization, raised $8,000 and was able to provide each
child with 10 books.
• End of the Year Celebration was held at Camp New Hope.
• Ready for K Camp, a kindergarten readiness program, was held.
• Strategic planning is underway to address housing, family planning, screening, mental
health, etc. OC Housing is launching a landlord program.
• The FSA is currently working on fundraising/development. The FSA wants to be additive
and not divert funds away from other community partners.
The BOH members had questions that were addressed by Ms. Austin.
B. Translation Boot Camp Update
Beverly Scurry, Board of Health Strategic Plan Manager, spoke on the action plan that was
addressed in the Strategic Plan regarding the Social Determinants of Health priority. The
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Strategic Plan states that “by February 2017, the OCHD will host at least two “translation boot
camps” with the Health Carolinians Access to Care committee, on specific health topics to
translate clinical language and recommendation about those health topics into culturally and
linguistically relevant and motivational messages”. A team, consisting of Donna King, Robin
Gasparini, Coby Jansen Austin, Margaret Campbell, Susan Clifford and Ms. Scurry was
created. The first medical topic chosen by the team was LARCs. Two meetings have been
held so far. Ms. Scurry stated that they would like to receive feedback from the BOH members.
She also stated that the team is being mindful and assessing the spreading of information into
the community and how it’s received.
C. BOH Policy and Procedures Upcoming Annual Review
Beverly Scurry, Board of Health Strategic Plan Manager, began by informing the BOH members
that the BOH is required to review their Policies and Procedures each year to meet accreditation
standards. She also mentioned that there was a very extensive review took place in 2015 and
this year has minor suggested changes. Ms. Scurry briefly summarized the recommended
updates/revisions that will be voted on at the August BOH meeting. They are:
Section 1: Board Adopted Policies
E. Fee and Eligibility Policy
Suggested Changes:
• Page 1: Section III A – Definitions
o Addition of Family Home Visiting Division
• Page 2: Section III B – Sources
o Change in verification from 10 days to 30 days
• Page 3: Section IV A – Residency Requirements
o Formatting
• Page 6: Section VI K, O, & P – Fees for Services
o Formatting
• Attachment B: Determination of Eligibility for Clinical Services
o Change in timeframe to provide income verification within 10 days to
30 days.
o Formatting
o (Changes already made)
Section III: Board Processes
Suggested Changes
• Formatting throughout
Policy III.B.c: Process for Recruitment and Reappointment for BOH Members
Fees
Suggested Changes
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• Board makes recommendation to Board of Commissioners who will
decide who to appoint.
The BOH members had comments/questions that were addressed by Ms. Lackey.
D. Budget Overview
Rebecca Crawford, Financial and Administrative Services Director, gave a summary of the FY
2017-2018 budget that was approved by the BOCC on June 20th. Staff has analyzed the
differences between the Requested budget, the County Manager’s Recommended budget, and
the Approved budget and found the Approved FY 2017-2018 budget for the Health Department
shows a $22,425 increase in revenue over the FY 2017-2018 Budget Request due to
anticipated additional Environmental Health fee revenue. The County Manager did not include a
requested $60,000 in County Capital funds in the Approved budget, which decreased the overall
impact of the anticipated Environmental Health fee revenue increase.
The Approved FY 17-18 budget experienced a $132,178 decrease in expenditures from the
request budget due to the following items that were not recommended by the County Manager:
• Data Systems Manager
• Senior Public Health Educator
• PH Program Manager – Behavioral Health (County Manager converted this request to
funding for a Behavioral Health consultant)
• Conversion of Communications Specialist from a temporary employee to permanent
employee (temporary funds remain in our budget to support this position)
• Operating costs related to new positions
• $15,000 increase in lab services for the medical clinics
• $13,365 for an FSA Development Consultant
The Health Department received notice from NC Department of Health and Human Services
(DHHS) earlier in June that we will receive an additional $1,020 in BCCCP funds, which were
added to the Approved budget.
The changes made from the department’s Requested budget will not have a detrimental effect
on operations, however, we will have to reallocate funds internally to cover the increased cost in
lab services and reallocate staff time from other projects to perform the duties required of the
disapproved Data Systems Manager and the disapproved FSA Development Consultant.
VI. Reports and Discussion with Possible Action
A. BOH Subcommittee Review
Beverly Scurry, Board of Health Strategic Plan Manager, discussed the subcommittees as they
relate to the BOH Strategic Plan Action Steps. There are four top priorities – Social
Determinants of Health, Physical Activity and Nutrition, Substance Abuse & Mental Health and
Engagement. There is a subcommittee for each priority except Engagement. After Ms. Scurry
reviewed the each priority’s subcommittee and its focus areas, BOH members signed up for
subcommittees.
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Social Determinants of Health Subcommittee
Liska Lackey, Johanna Birckmayer, Jennifer Deyo and Mia Burroughs
Physical Activity and Nutrition
Jessica Frega, Timothy Smith, Susan Elmore and Bruce Baldwin (Although he
wasn’t present, he was added to this subcommittee and will attend his first
meeting in August.)
Substance Abuse and Mental Health
Sam Lasris, Paul Chelminski, Barbara Chavious, Timothy Smith and Jessica
Frega
B. Health Director Report
In addition to her report, Dr. Cilenti stated that she will be participating in an upcoming meeting
that will include UNC, the county manager, Dr. Mike Steiner, past FSA chair, in which part of the
discussion involves the commitment to behavioral health services, particularly for those ages 0-
25. Dr. Cilenti also mentioned that she and Dr. Steiner will be meeting next week to explore
opportunities for our health department to work together with UNC to address the needs of
children in Orange County.
Dr. Cilenti will be a part of the search committee for a new Associate Vice Chancellor that will
oversee their student health and wellness program. UNC wants her to represent the OCHD to
get a community perspective.
Dr. Cilenti stated that, although the requested position was not granted, the OCHD will be
helping prepare the scope of work and providing leadership for the behavioral health position.
Interviews will most likely occur in September.
Dr. Cilent announced that Dr. Bruce Baldwin has been appointed by the BOCC to the BOH and
congratulated all of the reappointments that were approved by the BOCC. Lastly, she
mentioned that she, along with Alan Clapp, Rebecca Crawford, met with OWASA’s leadership,
took a tour and saw how raw water becomes drinking water. A letter of support to continue
fluoridation of water was also offered. OWASA will resume fluoridation of water as soon as their
equipment improvements are completed.
C. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
At 8:15pm, Sam Lasris motioned to move into closed session and Jessica Frega
seconded.
VIII. Closed Session to Discuss Health Director Recruitment
During the closed session, the Board of Health discussed the recruitment process with Mr.
Ozuna and Ms. Bartholomew.
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IX. Adjourn to Open Session
At 9:22 pm, Barbara Chavious motioned to move from closed to open session and Paul
Chelminski seconded.
X. Board Comments.
None.
XI. Adjournment
Jessica Frega moved to adjourn the meeting at 9:23pm and Paul Chelminski seconded.
The next Board of Health Meeting will be held August 23, 2017 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Dorothy Cilenti, MSW, MPH, DrPH
Orange County Interim Health Director
Secretary to the Board
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 2017
Agenda Item Subject: Criminal Justice Resource Department Update
Attachment(s): PowerPoint Presentation
Staff or Board Member Reporting: Caitlin Fenhagen, Criminal Justice Resource
Director
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information:
The director of the Criminal Justice Resource Department will discuss this fairly new
department including staff, history, and programs. The director will discuss community
collaborations they’ve built and how the health department plays a role. This
presentation relates directly to the BOH Strategic Plan under Substance Abuse &
Mental Health.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
Criminal Justice
Resource Department
Board of Health Presentation 8/23/17 Hillsborough
CJRD Staff
Criminal Justice Resource Director: Caitlin Fenhagen
Pretrial Release Case Manager: Ted Dorsi
Drug Treatment Coordinator: Paul Atherton
Criminal Case Assessment Specialist: Allison Zirkel, LCSW, LCAS
New Positions for FY 2017/2018:
MDP Coordinator
Mental Health Liaison for Court-Involved Youth
Administrative Assistant
CJRD History
9/1/15: Stepping Up Resolution Passed by Orange County BOCC. (link to Resolution)
11/2015: Criminal Justice Resource Office opened under the County Manager’s Office to oversee, support and enhance jail alternatives programming.
1/2016: Pretrial Release Case Manager, Drug Treatment Coordinator and Criminal Case Assessment Specialist hired.
4/15/16: Misdemeanor Diversion Program begins operation under CJRO.
5/2016: Justice Advisory Council charge, membership and structure approved by BOCC. (Link to JAC Membership)
7/1/17: BOCC approves Department status and three new positions.
CJRD Programs
Pretrial Release Services
Completes a daily intake and assessment of every person booked into the Orange County Detention Center scheduled for a First Appearance.
Seeks and verifies information regarding community ties, housing, family support, employment, school, medical concerns, mental health and substance use disorder treatment needs or engagement and prior or pending criminal history.
Initiates referrals to out-patient and in-patient treatment providers, contacts providers already in place, addresses medical needs with Jail medical staff and makes referrals to the Criminal Case Assessment Specialist for evaluation.
Provides information to court stakeholders for First Appearances and makes recommendations to facilitate release from custody.
Provides case management support, court date reminders and ensures adherence to pretrial release conditions for those under Pretrial Release supervision while cases pending.
Works with Clerk’s Office to conduct Strike Order hearings to preclude unnecessary incarceration for individuals that miss court dates.
CJRD Programs
Criminal Case Assessment Specialist
◦Clinical position created to screen and assess mental health and substance use treatment needs for individuals in the Orange County Detention Center and in diversionary programming.
◦Primary goal of the position is to increase opportunities for pretrial release by assessing needs and then advocating release by making referrals and recommendations for appropriate therapeutic services in the community.
◦For individuals who remain in custody, the CCAS provides counseling, referrals to the psychologist and psychiatrist, screens for peer support opportunities and diversionary courts, recommends medical attention and provides information to court stakeholders to assist in bond motions and sentencing decisions.
◦Provides discharge planning, ongoing case management support and care coordination with other treatment providers in order to ensure continuation of care and reduce recidivism.
CJRD Programs
Drug Treatment Courts
Recovery Court: Diversionary criminal court for high risk/high individuals
with a primary diagnosis of substance use disorder otherwise facing
incarceration of 120 days or more. Successful completion requires a
minimum of 1 year of compliance with recommended treatment, weekly
random drug screens and court conditions.
Family Treatment Court: This court is designed for parents or guardians
that have a significant substance use disorder and an abuse, neglect or
dependency petition has been filed by DSS. The goal of the court is to
reunify families by providing court-supervised treatment and intervention
to the parent or guardian for a minimum of one year.
CJRD Programs
Misdemeanor Diversion Program (MDP)
Pre-charge diversion program for 16 and 17 year old misdemeanor first offenders in Orange County.
2nd program of its kind in N.C. when started in April 2016.
Launched with the full support of all judicial stakeholders and all law enforcement agencies, who retain discretion on referrals.
Eligible youth are diverted entirely from the criminal justice system and placed on a diversion program for 90 days with 10-15 hours of directed (free) programming and an educational court session assigned.
If the youth is compliance with programming, court attendance and does not have any new criminal justice involvement, the original charges are never filed.
Goal is to address the inequity of N.C. being the last state in the country to treat 16 and 17 year olds as adults and not juveniles in the criminal justice system and to avoid a criminal charge for a youth that can have life-long collateral consequences.
Since Raise the Age legislation was passed this summer and will take effect in December 2019, the hope is to expand MDP to 18-21 year olds.
CJRD Collaborations
Orange County Sheriff’s Office
15B Racial Justice Task Force
Partnership to End Homelessness
Community Resource Court
Stepping Up Initiative
Cardinal Innovations
UNC Center for Excellence in Community Mental Health
Josh’s Hope
Jail Mental Health Work Group
Reentry Council Planning
Health Department
Health Department and CJRD
Current Collaborations
Health Department Director (or designee) is Appointed Position on the Justice Advisory Council
Beverly Scurry is new member of the Jail Mental Health Work Group and the Reentry Planning Sub-
Committee
Expansion of FIT Program – Duke Endowment Grant will allow Community Health Worker position to start in
January 2018 at the Health Department to provide case management care for formerly incarcerated
individuals reentering with chronic health issues
UNC Gillings School of Global Public Health referred to CJRD by Health Department:
Spring 2017 Project: Medical, Mental Health and Trauma-Informed Care Needs
Assessment and Recommendations for Drug Treatment Courts
2017/2018 Full Year Project: Recommending Evidence-Based Best Practices and Mapping
Resources for Health Care Provision in the Development of Orange County’s Coordinated Reentry
Council
Ongoing Collaboration Needs
Continuity of behavioral health care and case management needs after incarceration in Jail and Prison
Enhancement of health care and dental care referral process for criminal-justice involved individuals
Discussion of community crisis resource needs that will allow for increased law enforcement diversion of
minor offenses or those offenses committed by individuals experiencing homelessness, mental illness and
substance use disorders
Health Department role in Drug Treatment Courts
Questions/Comments?
Caitlin Fenhagen
Criminal Justice Resource Director
Orange County Courthouse
106 E. Margaret Lane
Hillsborough, NC 27278
919-245-2303
cfenhagen@orangecountync.gov
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 23, 2017
Agenda Item Subject: 4th Quarter Financial Report FY 16-17
Attachment(s): 4th Quarter Financial Report
4th Quarter Billing Dashboard
Staff or Board Member Reporting: Rebecca Crawford
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
Total Health Department Revenue: Average YTD monthly revenue in FY17 after the
fourth quarter is $247k/month or $2.97 million YTD, representing 95% of our overall
budgeted revenue for the year. This is an increase from an average of $225k/month in
FY16. Expenses were level with revenues at 95%.
Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14-
15, the average billing accuracy rate for medical at the end of FY 16-17 is 90% as
compared to 95% in FY 15-16 and the average rate for dental for FY 16-17 is 98% as
compared to 97% in FY 15-16.
Dental Earned Revenue by Source: The FY 16-17 average monthly revenue
($41k/month) ended the fiscal year below our budget projection ($47.5k/month) due to
decreased Medicaid and Commercial Insurance patients (Self-pay receipts exceeded
budget) and level with our FY 15-16 average of $40k/month. FY 16-17 dental revenue
totaled $497k at the end of the fourth quarter.
Medical Earned Revenue by Source: Medical earned revenue is currently below the
budgeted projection for FY 16-17. The monthly average after the fourth quarter
($55k/month) exceeded FY16 ($50k/month) but lower than our budget projection
($59.6k/month). Medical revenue totaled $663k for FY 16-17.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ____________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
Orange County Health Department
Fourth Quarter Financial Report
FY 2016-2017
TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Revenue
Donations
Finance and Admin Services 0 (15)0 0.00%
Dental Health 0 (338)0 0.00%
Health Promotion & Edu (1,885)(19,515)(18,882)103.35%
Environmental Health (600)(1,200)0 0.00%
Personal Health 913 (8,670)(18,000)48.17%
Donations Total (1,573)(29,737)(36,882)80.63%
Internal Allocations
Finance and Admin Services (23,500)(23,500)(23,500)100.00%
Dental Health (18,000)(18,000)(18,000)100.00%
Health Promotion & Edu (56,072)(56,072)(56,072)100.00%
Environmental Health (60,000)(60,000)(60,000)100.00%
Personal Health (30,000)(30,000)(30,000)100.00%
Internal Allocations Total (187,572)(187,572)(187,572)100.00%
Service Revenue
Finance and Admin Services 0 (107,646)0.00%
Dental Health (126,680)(497,880)(570,183)87.32%
Environmental Health (171,539)(571,406)(542,124)105.40%
Personal Health (188,529)(663,693)(715,822)92.72%
Service Revenue Total (486,748)(1,732,980)(1,935,775)89.52%
State Allocations
Finance and Admin Services (7,935)(43,640)(42,885)101.76%
Health Promotion & Edu (22,203)(112,323)(121,953)92.10%
Environmental Health (35,687)(41,738)(34,000)122.76%
Personal Health (66,870)(430,491)(405,835)106.08%
State Allocations Total (132,695)(628,192)(604,673)103.89%
Grants Project Revenues
NACCHO Grant 0 (15,000)(15,000)100.00%
Piedmont Hlth Srv - Nutr (30,598)(66,763)(40,925)163.13%
CC4C Accesscare (38,071)(150,790)(149,624)100.78%
PCM Accesscare (39,730)(158,834)(147,651)107.57%
Dental Health 0 (2,000)(2,000)100.00%
Grants Project Revenues Total (108,400)(393,386)(355,200)110.75%
Revenue Total (916,987)(2,971,867)(3,120,102)95.25%
Orange County Health Department
Fourth Quarter Financial Report
FY 2016-2017
TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL BUDGET
Expenditures
Salaries 1,563,091 5,421,841 5,497,579 98.62%
Benefits 545,693 1,953,232 1,972,009 99.05%
Travel 4,815 9,818 8,887 110.47%
Training 6,350 44,142 48,990 90.10%
Certifications & Licensing 2,012 8,107 13,089 61.93%
Mileage 9,138 25,794 34,768 74.19%
Telephone 23,568 91,501 79,878 114.55%
Postage 5,019 14,746 14,602 100.99%
Motor Pool 10,521 44,625 48,807 91.43%
Equip Repairs 1,068 6,667 7,358 90.61%
Equip Rent 218 1,503 1,570 95.73%
Duplicating 2,787 13,919 14,911 93.35%
Printing 1,472 9,752 11,807 82.59%
Advertising 7,871 17,114 24,655 69.41%
Dues 729 3,203 4,270 75.00%
Subscriptions 249 800 1,500 53.32%
Dept Supplies 28,052 42,151 43,224 97.52%
Edu Supplies 2,036 5,881 9,978 58.94%
Office Supplies 7,420 28,171 28,522 98.77%
Medical Supplies 30,153 128,907 145,686 88.48%
Bloodborn Path Supplies 276 (7,727)(5,551)139.20%
Pharmacy Supplies 56,684 176,583 192,540 91.71%
Comp Supp/Software 2,274 4,152 6,954 59.70%
Contracted Srv 295,789 847,583 1,057,015 80.19%
X-Ray 2,072 9,944 23,625 42.09%
Lab Srv 38,350 124,544 131,906 94.42%
Bonds & Insurance 10,347 10,347 10,347 100.00%
Uniforms 1,138 6,836 8,333 82.04%
Community Proj 17,544 32,078 64,241 49.93%
Innovations Project 4,024 14,831 15,800 93.87%
Accreditation Project 0 2,750 2,750 100.00%
Family Success Alliance 0 0 0
Credit Card Exp 2,045 6,520 6,000 108.66%
Capital Exp Under $500 1,447 13,275 13,018 101.98%
Nicotine Replacement Therapy 4,671 12,765 12,797 99.75%
NACCHO Grant 986 228 1,058 21.58%
Grant Project Expenditures
Dental Grant 2,000 2,000 2,000 100.00%
Health Disparities 0 (0)(658)0.07%
Susan G. Komen Grant 911 12,782 46,140 27.70%
NACCHO Grant 7,017 13,429 15,000 89.53%
Capital Expenditures
Equipment 9,860 13,518 13,594 99.44%
IT Equipment 0 3,600 3,601 99.98%
Furnishings 0 969 1,101 87.97%
Expenditures Total 2,709,698 9,172,880 9,633,700 95.22%
Grand Total 2,709,698 9,172,880 9,633,700 95.22%
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 23, 2017
Agenda Item Subject: 2013 Medicaid Cost Settlement Program
Reimbursement
Attachment(s): LHD Desk Review NPR Letter
Staff or Board Member Reporting: Rebecca Crawford
Purpose: _ _Action
_X_ Information only
___ Information with possible action
Summary Information:
The Health Department received official notification of a Notice of Program
Reimbursement on August 3rd from the NC DHHS Department of Medical Assistance
(DMA). This notice referenced the 2013 Medicaid Cost Settlement report (period ending
June 30, 2013.) As you may remember, the Medicaid cost settlement process has been
contested since DMA required a new cost report methodology beginning in State Fiscal
Year (SFY) 2011. The main point of contention is the calculation of the Medicaid
population statistic. After a long debate, the primary issue of the Medicaid population
statistic has been clarified by a recent ruling in a lawsuit between DMA and Cabarrus
County. DMA prevailed and will retroactively settle all Local Health Department (LHD)
cost settlements beginning with SFY 2013. SFY 2013 will be the only year where an
overpayment (by DMA) is applied since DMA started using the new statistic prior to
payments made in SFY 2014.
Orange County is in a payback situation and owes a total of $200,524 to DMA. We
received funds in 2015 from the state legislature to offset the loss incurred by the SFY
2013 overpayment in the amount of $219,043.90, which when combined with the
payback amount referenced above, leaves us with a net gain of $18,519.90.
DMA has offered LHD’s the option to either accept the payback amount and remit
payment or appeal the proposed payback by “scrubbing” our data according to the
agreed upon process listed in the Cabarrus County court ruling. We’ve learned this
made a significant reduction in the payback amount for Cabarrus County. Our staff have
determined it is in our best interest to work with the NC Public Health Association (who
historically has prepared our annual cost settlement report) to “scrub” our 2013 data.
We will update you with more information regarding this process after we submit our
appeal and scrubbed data.
Recommended Action: __Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ____________________
_X__Accept as information
___Revise & schedule for future action
___Other (detail):
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 2017
Agenda Item Subject: Board of Health Policy Review
Attachment(s): Proposed Revisions Section I.E. & Section I.E. Attachment B
Staff or Board Member Reporting: Beverly Scurry
Purpose: __X_ Action
_ _ Information only
____ Information with possible action
Summary Information:
The Board of Health reviews its policy manual annually. Updates to the Fee and
Eligibility Policy are recommended below:
I.E. Fee and Eligibility Policy
• Addtion of Family Home Visiting under income eligibility
• Change from 10 days to 30 days or less in which patients must provide verification of
income and/or residency
• Residency requirements specify residents or non-resident ‘may’ be eligible instead of
‘is’ eligible. Also excludes Family Home Visiting programs.
• Fee for service statement added - Fees for 340b drugs dispensed to Medicaid
patients will be reviewed and set annually based on the average, annual cost to
the County to purchase the drugs.
Section I.E. Attachment B
• Refects the change from 10 business days to 30 business days or less
Recommended Action: _X_Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Board of Health P & P Manual, Section I
Policy E, Attachment B
Updated 11/2014, 4/2017
S:\MANAGERS WORKING FILES\BOH\AGENDAS & ABSTRACTS\2017 Agenda & Abstracts\August 2017\VI.E. I.E.
Attachment B - Eligibility Finan Resp (7-2017).docx
DETERMINATION OF ELIGIBILITY FOR CLINICAL SERVICES
The Orange County Health Department, following approved policy and procedures, has determined that
_____________________ (Client Name) is eligible for [circle] Medical / Dental services and will be
charged _______ percent (%) of the total fees, based on the number of people living in the home and the
total amount of gross income in the home.
STATEMENT OF FINANCIAL RESPONSIBILITY
_______ I understand that I am responsible for all fees involved in receiving services at the Orange
County Health Department (as stated above)
_______ I understand that I am required to provide income verification to be eligible for the
sliding fee scale. If I do not provide income verification in the next 3010 business days
or less(by _______________), any services I receive that are not covered by insurance,
with the exception of Family Planning services, will be billed at 100% on the sliding fee
scale.
_______ I understand that if I report that I am pending Medicaid eligibility, but I do not follow-
through with the Medicaid application or do not receive coverage, I will be responsible
for all charges based on the sliding fee scale determination.
_______ I understand that payment is due at the time services are provided. I further understand
that, if circumstances do not allow full payment on the day of service, a payment plan
will be established.
_______ I understand I will receive a statement and an overdue notice for balances older than 30
days that are equal to or greater than $50.00. I also understand that if I do not submit
payment in full or honor a monthly payment plan within 30 days of that statement date;
my account will be sent to the Orange County attorney for debt setoff.
_______ I understand that if I do not make a “good faith” effort to pay on any past bills due, future
services may be limited or denied. However, emergency services will not be denied.
I understand I must notify the clinic as soon as possible if I cannot keep my appointment.
Medical Clinics: 919-245-2400 Dental Clinic: 919-245-2435
__________________________________________________ ________________________
Signature of Client/Responsible Party Date
__________________________________________________ ________________________
Signature of Interpreter Date
__________________________________________________ ________________________
Signature of OCHD Employee Date
Initial
Initial
Initial
Initial
Initial
Initial
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 1 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
I. Purpose
A. Public health services are increasingly costly to provide. The Health Department serves
the public’s interest best by assuring that all legally required public health services are
furnished to all citizens. The department provides recommended and requested public
health services based upon the priorities established by the Board of Health.
B. Fees are a means to help provide services to the residents of Orange County. Fees help
finance and extend public health services when government funding is not sufficient to
support the full cost of providing all required and requested services.
C. Fees for Orange County Health Department services are authorized under North Carolina
G.S. 130A-39, provided that:
1. They are in accordance with a plan recommended by the Health Director and
approved by the Board of Health and the Orange County Board of Commissioners.
2. They are not otherwise prohibited by law.
3. They are deposited to the account of the local Health Department for public health
purposes in accordance with the provisions of the Local Government Budget and
Fiscal Control Act.
D. Fees for services must also be in compliance with N.C. Administrative Code, Title X
Regulations, and Women’s and Children’s Health Program Rules.
E. There will be no charge for Title X Services provided for individuals with income less
than 100% of the Federal Poverty Level (FPL.)
II. Policy Implementation
The implementation of this policy is delegated to appropriate financial or support staff in
each division of the health department.
III. Income Eligibility
A. Definitions
1. Definition: A family is defined as a group of individuals who are living together as
one economic unit. Individuals are considered members of a single family or
economic unit when their production of income and consumption of goods are
related. A pregnant woman is counted as a family of two in determining family size.
2. Income eligibility requirements apply to: Dental Health, Family Planning, Child
Health, Maternal Health, Adult Health, Nutrition Services, Family Home Visiting,
and Primary Care Services.
3. The Health Department utilizes a sliding fee scale based on Federal Poverty
Guidelines in accordance with the Fee Schedule approved annually during the
County Budget process. NC DPH updates and issues the scale yearly. Specifically,
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 2 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
the health department uses the 101% - 250% Federal Poverty Level sliding scale.
Determination of Sliding Fee percentage is based on gross income and family size.
4. Verification of income is required at time of enrollment for services, at the annual
financial interview, or if there is a change in the work status in the family unit for
clients to be eligible for the sliding fee scale.
a. An annual gross income statement is preferred for evaluation.
i. Gross income is defined as the total of all cash income before deductions for
income taxes, employee social security taxes, insurance premiums, bonds,
etc. For self-employed applicants, net income after business expenses. Gross
income does NOT include money earned by children for babysitting, lawn
mowing and other tasks.
ii. In general gross income includes: salary, wages, commissions, fees, tips,
overtime pay, unemployment compensation, public assistance money,
alimony and child support payments, Social Security benefits, VA benefits,
Supplemental Security Income (SSI) benefits, retirement & pension
payments, worker’s compensation, bonuses, prize winnings and other sources
of cash income except those specifically excluded.
B. Sources
1. Sources of income verification may include, but are not limited to:
a. Current pay stub
b. Self-employment accounting records
c. Letter documenting current employment and wages from employer
d. Recent income tax return
e. Unemployment or workers compensation receipt
f. Public assistance letter
g. Prior income verification through enrollment in other Health Department
programs
2. If an individual claims “no income” (except for minors consenting to specific
services under G.S. 90-21.5), a signed “Verification of Income and/or Residency”
form (Attachment A) indicating financial support from another party must be
submitted.
3. Failure to provide verification within 3010 business days or less of date of service
will result in charges being assessed at 100% of sliding fee scale. The client will
receive notification of required income verification at the time the initial appointment
is made.
4. The client must read, sign and understand the “Determination of Eligibility Payment
Plan for Clinical Services” and “Statement of Financial Responsibility Payment
Plan” form (Attachment B) at their initial visit and annual financial reviews.
C. Environmental Health
Persons seeking Environmental Health services must obtain and properly complete an
application for service and pay the corresponding fee for service (all applicants pay at the
100% pay status) before an appointment for a field visit will be scheduled. Sometimes
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 3 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
additional fees may be necessary if during service delivery it is determined that the
correct fees were not initially paid, or services requested are more than applied for.
Wastewater Treatment Management Program (WTMP) and Mobile Home Park fees are
the only Environmental Health services invoiced after the inspection. These inspections
are not application based but occur on a regulated, recurring schedule.
IV. Residency Requirements
A. Any individual, Orange County resident or non-resident, is may be eligible for services
provided by the Health Department. Exceptions include non-STD Communicable Disease
cases, designated Family Home Visiting programs (Orange County residents only), and
when prohibited by law or regulation.
B. Proof of Residency may be determined by using the US Postal and/or Orange County
GIS website and one of the following: Driver’s License, Government-issued
identification, Pay Stub (Within the last 30 days), Utility bill (Within the last 45 days);
Current rental or lease agreement; Personal or property tax bill; Student identification,
and Matrícula Consular (Mexican ID Card 1). Clients without one of the above
identifying information sources but reportedly living within the county will be required to
produce a written statement or letter from the head of household, verifying that the
person resides in their home. Special cases will be referred to the Clinic Manager or
Supervisor. Failure to provide proof of residency may result in referral to another
resource.
C. Proof of Residency in Orange County is required for self-pay patients to be eligible for
the sliding fee scale when requesting Maternal Health, Child Health, Primary Care,
Nutrition Services, and Dental Health Services. Out-of-county residents will be assessed
at 100% of charges not covered by a third party payer source.
V. Service Limitation/Denial
A. Services will not be denied based solely on the inability to pay, with the exception of
those services that require a flat or minimum fee. Emergency dental services and urgent
primary care services will be provided to clients regardless of any outstanding balance
due.
B. Otherwise, services may be denied if the department does not have the resources needed
to provide a quality non-mandated service or the individual does not meet the residency
or financial requirement.
1 The Matrícula Consular de Alta Seguridad (MCAS) (Consular Identification Card) is an identification card issued by
the Government of Mexico through its consulate offices to Mexican nationals residing outside of Mexico. Retrieved from
http://en.wikipedia.org/wiki/Matr%C3%ADcula_Consular on October 14, 2012.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 4 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
C. Family Planning clients will never be refused service due to an outstanding balance or
inability to provide proof of income.
D. Maternal and Child Health clients who are at 60% to 100% pay status may have services
limited or denied for failure to make payments based on designated Payment Plans
(“good faith” effort).
E. Falsification of eligibility by the client may result in denial or limitation of services.
F. The Health Department shall not deny a service due to religion, race, national origin,
creed, sex, marital status, familial status, sexual orientation, veteran status or age.
G. The Health Department shall assure that no otherwise qualified handicapped individual,
solely by reason of his/her handicap, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under any program or activity covered by
this agreement.
H. The Health Director can override any decision to deny or limit services to a client in
accordance with the existing fee waiver process.
VI. Fees for Services
A. In order to facilitate early entry into prenatal care or family planning services, pregnancy
tests will be provided free of charge unless they are required as part of another service.
B. In order to facilitate early identification of and referral for hypertension, two blood
pressure screenings will be provided in the clinic free of charge. Borderline readings will
be checked free until determined to be normal or the client is referred for further
evaluation. Follow-up of clients with a diagnosis of hypertension will be charged
according to the fee policy.
C. Fees are not charged for diagnosis and treatment of sexually transmitted diseases, or
investigation and control of communicable diseases. There is also no charge to clients for
any State-provided vaccine.
D. Fees are charged for health and dental services provided to individuals unless prohibited
by law or regulation. Fees are established based upon cost analysis, Medicaid and
Medicare rates, comparable provider rates and/or state or contractual agreements. The
Health Director shall inform the Board of Health and the Orange County Board of
Commissioners of these adjustments in a timely manner.
E. Fees may be charged to clients for “non-program” specific services without being
adjusted on a sliding fee scale (flat fees).
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 5 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
F. Fees may be charged for education, community-based limited clinical services (such as
influenza shots) and screening services provided to individuals or groups. The following
applies to these services:
1. They include orientation, field training, dental screening and education, and/or other
health promotion activities such as infant and toddler car seats, bike helmets, or
equipment rental.
2. The Health Director will negotiate fees for services where fees have not been
previously determined.
3. Income eligibility requirements do not apply to these services.
G. Per NC General Statute Chapter 7B, Subchapter 4, Article 35, and confidentiality
regulations, emancipated minors and other individuals requesting confidential services
will be considered a family of one for determination of charges. Private insurance will
also not be billed for minors receiving services for which they can consent unless
permission is received from the minor.
H. Persons requesting any program services may be encouraged to apply for Medicaid, as
applicable.
I. The Personal Health Services Division clinical and nutrition services will use the
appropriate sliding fee schedule for services when adjustable fees are allowed; all other
fees will be charged at 100%.
1. Clients, who require services provided on the sliding fee schedule, are expected to
pay the appropriate fee in full based on sliding fee guidelines.
2. This schedule will require assessment of the client’s financial status on an annual
basis or when a financial status change occurs, as specified in section III.
J. Dental Health Services, Primary Care Services, and Nutrition Services will use a sliding
fee schedule for all services, with a minimum charge to be established at the annual fee
review during the budget preparation process.
1. The minimum charge for dental, primary care, and nutrition services will apply
regardless of the determination of the client’s financial status.
2. If a client is determined to fall at the 0% pay level, the minimum charge will be the
only charge levied and collected.
3. Minimum charge is due at time of service.
K. Fee schedules will be reviewed annually during the budget process and adjusted as
appropriate; a complete cost analysis for purposes of fee adjustments will be performed
every five years. The process for this cost analysis includes a review of the following
elements:
a. Most recent vaccine and drug purchase costs
b. Most recent lab pricing lists
c. Most recent Medicaid Cost Settlement data for procedure costs
d. Environmental Health equipment, labor, and staff costs
e. Review of fee schedules of surrounding jurisdictions
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 6 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
f. Analysis of existing self-pay client base and how increased costs would affect
their ability to get necessary care
f.
L. Based on G.S. 130A-41, the Health Director is authorized to enter into contracts, which
may include negotiated reimbursement rates.
M. The Health Director may not make exceptions to the Fee Policy except to accommodate
specific situations through the fee waiver process (Attachment C).
N. Any minimum administrative fee or flat fees shall be applied without discrimination to all
patients.
O. There will be no “schedule of donations”, bills for donations, or any other implied
coercion for donations from clients as a condition for being seen at the Health
Department. Donations to the health department can be made through the Orange County
Community Giving Fund. Fees for services will not be waived because of client
donations.
O.P. Fees for 340b drugs dispensed to Medicaid patients will be reviewed and set annually
based on the average, annual cost to the County to purchase the drugs.
VII. Fee Collection
A. Environmental Health service fees are paid before an appointment is scheduled. Field
staff cannot accept fees in the field.
B. Fees collected from Medicaid and Medicare and other third party insurance for a covered
service, combined with payment of any applicable co-pays and co-insurance, constitutes
full payment for that service.
C. A co-payment, deductible, or balance of charge can be collected at the time of service
from individuals covered by other third party insurance plans when OCHD is a member
of their provider panel (exception family planning). For Family Planning clients, family
income should be assessed before determining whether co-payments or additional fees
are charged; if their family income is verified to be at or below 250% FPL, they should
not pay more (in copayments or additional fees) than what they would otherwise pay
when the schedule of discounts is applied. With regard to other insured clients, payments
towards a deductible for clients whose family income is verified to be at or below 250%
FPL should have the appropriate sliding fee schedule applied.
D. If OCHD is not on the insurance provider panel, the client will be charged for the
service(s) based on the Health Department’s fee schedule. The client will be provided
with documentation of services for submission of a claim to their insurance company.
Formatted: Indent: Left: 1.25", No bullets or
numbering
Formatted: List Paragraph, No bullets or
numbering
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 7 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
E. At the time services are received, the client will be given a statement showing the cost of
services for that visit as well as their total account balance.
F. Payment is due at the time services are rendered.
G. When the client is unable to pay in full at the time services are rendered, a payment plan
is established, and the client must sign a “Payment Agreement Form” (Attachment D)
except for minimum-fee or flat-fee charges. Client must then make a payment in any
amount in order to activate the payment plan.
H. When a client requests “no mail”, discussion of payment of outstanding debt shall occur
at the time the service is rendered. A remark regarding “no mail” is entered into the
medical data system. No letters or other correspondence concerning insurance or past
due accounts will be sent to any client that requests “no mail”. Reasonable efforts will be
made to collect charges without jeopardizing client confidentiality.
I. The Billing Cycle for the Health Department (by Division) is as follows:
1. Personal Health & Dental Health Divisions
a. Bills will be sent monthly by the tenth of the month for two months after services
have been rendered indicating a statement of balance due. Every quarter, all
accounts with a balance $50 or more that are more than 60 days past due will be
forwarded to the County Attorney Office and pursued through debt set-off in
accordance with the county policy. Accounts with a balance of less than $50 will
remain delinquent until paid or written-off.
b. If a debt is not paid, when the client attempts to make another appointment, the
client will be told they have a previous balance, and they must have an active
payment plan or make a payment at time of next service except for Family
Planning clients.
2. Environmental Health Division
a. An initial invoice for additional or miscellaneous Wastewater Treatment
Management Program (WTMP) charges is mailed with the inspection form.
b. If no payment is received within 90 days, a second notice is mailed.
c. If no payment is received after an additional 30 days and the debt is $50 or
greater, the account is forwarded to the County Attorney’s Office, which will
pursue it through the county’s debt set-off procedure.
d. Debt owed by a corporation or non-individual is dissolved upon sale of property.
e. The county attorney’s office has deemed debt that becomes part of an estate will
become dissolved.
f. If the client presents and voluntarily wishes to pay on the account, any amount
the client offers will be accepted, documented in the client file, and a receipt will
be provided.
g. Mobile Home Parks are billed annually on the calendar year. The procedure is
the same as noted above.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 8 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
J. Insurance and Third Party Billing
1. Where a third party is responsible, bills are to be submitted to that party;
2. Third parties authorized or legally obligated to pay for clients at or below 100% FPL
are properly billed
3. Third party bills (including Medicaid) show total charges without any discounts
unless there is a contracted reimbursement rate that must be billed per the third party
agreement.
4. The health department will bill insurance and managed care organizations for which
provider approval has been established. The patient will be responsible for all
deductibles, coinsurance and non-covered charges.
5. Patient or parent/guardian signature is required to give authorization to file claims
and provide necessary information to the insurance company (Attachment E).
6. Patients, or the accompanying parent/guardian of an un-emancipated minor with
appropriate insurance benefits, who receive public health services will be given the
opportunity to choose whether to have insurance filed in order to avoid breach of
confidentiality or pay the associated fee according to where the patient falls on the
sliding fee scale.
VIII. Review and Approval
A. This Policy shall be reviewed annually by members of the Financial Review Committee.
The committee shall have representatives from each division, and must also include the
Health Department’s Finance and Administrative Services Director
B. Any policy revisions must be approved by the Health Director and the Board of Health.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: 8/23/17
Agenda Item Subject:
Senate Bill 16 Section 19 Wastewater System Permit Extension
Attachment(s): Powerpoint
Staff or Board Member Reporting: Alan Clapp, EH Director
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information:
The legislature recently ratified Senate Bill 16. This Act is a regulatory reform bill that
among other things extends the expiration of wastewater permits. The Bill was vetoed
by the Governor on Monday August 14th. However it is anticipated the Bill will be
approved by veto override when the Legislature goes back in session in September.
This Act differs from previous extension legislation in that the extension affects long
expired wastewater permits. The three previous extension acts only extended the life of
currently valid permits. A synopsis of this bill will be discussed at this time.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_ Accept as information
___Revise & schedule for future action
___Other (detail):
SENATE BILL 16
SECTION 19
Impacts to Environmental Health
Alan Clapp
Environmental Health Director
Business Regulatory Reform Act of 2017
Senate Bill 16
•Formerly H374 (Business Freedom Act)
•Improvement Permit is the soil/site approval for a septic
system. Permit is valid 5 years from the date of issuance.
Commonly called “perc test”
•Wastewater Construction Authorization is the permit used
to install the system. This permit is required to get a
Building permit. Permit is valid as long as the associated
Improvement Permit is valid. Commonly called “Septic
permit”
•Operation Permit is the “Approval” of the septic system
installation
Is This the first Permit Extension Act?
•No
•However the 3 previous acts only extended valid permits
•This Bill resurrects permits that issued between 1/1/2000
and 1/1/2015
Previous Permit Extension Acts
Opponent Talking Points
•Contradicts SL 2014-120 which says that the Health
Department can advise owner of new systems and
technologies available.
•Rule changes and new septic system technologies that
have been developed since the original permit were
issued cannot be used since the original permit must be
honored.
•No provisions for changes in site plan or altered site
conditions from man made or natural causes.
Opponent Talking Points cont.
Opponent Talking Points cont.
•Altered site conditions would not result in letter of
revocation and appeal rights.
•Greater chance that conditions on the site have changed
resulting in increased potential for tort claims.
•Permits issued in error would now be valid again.
•The public would benefit from a new evaluation that may
allow a gravity system where the old permit required a
pump system.
•Sites may have been permitted multiple times since 2000
due to normal course of expiration.
•Well permits issued on valid permit site plans may now be
invalid by resurrecting expired wastewater permits.
Opponent Talking Points cont.
•Reduced revenues for LHD
•Potential RIF’s due to reduced number of new
applications
•Manufacturers of new trench products would not be able
to have the product used since the resurrected permit
would not allow a change to new technology
•Only changes in design flow or characteristics is required
to make these older permits invalid
•Will counties with computer permitting software be able to
reactivate expired permits?
•Some counties may have purged expired permits under
their normal disposition schedule
Proponent Talking Points
•Helps constituents in areas still in recession
•Site Conditions cannot have changed since the permit
was issued so what does it matter if the permit expired
•The Health Department has the ability to review the site at
the Operation Permit stage
•Permit fees are not a good thing
•The extension encourages the local economy
Local Effects of the Bill
•Improvement Permits in “Expired” status: 1985
•Construction Authorizations in “Expired” status: 520
•At current fee structure: $1.15 million dollar revenue loss
if all of the expired permits were acted upon before
1/1/2020.
Bill Status
•Ratified by the Legislature 8/3/17
•Vetoed by the Governor 8/14/17
•Legislature back in Session in September
•Override of veto is quite possible
•All House and Senate Republicans voted in favor of the Bill
•Some Democrat House members voted in favor of the Bill
•What can you do?
•Contact your representatives in House and Senate
•Encourage them to support the Governor’s veto
•Or remove Section 19 from the Bill
•Section 19 was added during committee
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 23, 2017
Agenda Item Subject: Bad Debt Write-Off: Transfer of Uncollectible
Debt from Active to Inactive
Attachment(s): Delinquent and Uncollectible Accounts Policy
Staff or Board Member Reporting: Rebecca Crawford
Purpose: _X_Action
___ Information only
___ Information with possible action
Summary Information:
Per the department’s Delinquent and Uncollectable Accounts policy (15.0), uncollectible
accounts are to be administratively written off the books. The purpose of this accounting
function is to precisely account for and pursue funds which are truly unrecoverable. The
last administrative write-offs were performed by the Board of Health in August 2016
(Personal Health, Dental Health, and Environmental Health) for FY 2015-2016.
Personal Health, Dental Health, and Environmental Health continue to participate in the
NC Debt Set-Off Program, which allows the county to collect debts on delinquent
accounts with a balance between $50 and $4,000 through the customer’s tax refund.
The Health Department anticipates collecting payments on delinquent accounts being
pursued through the NC Debt Set-Off program; therefore, those accounts are not
included in this write-off request.
Based on the definitions of uncollectible accounts in the department’s policy, the
following table represents all uncollectible debt from clients for FY 2016-2017.
Division
Number of
Uncollectable
Accounts
Write-Off
Amount
Personal Health 80 $1,401.15
Dental Health 89 $2,348.10
Environmental
Health 6 $780.00
Total 175 $4,529.25
We request to administratively move a total of $4,529.25 in uncollectible debt from
‘active’ to ‘inactive’ status for the reasons indicted in the table above.
The customer will never be informed that a debt has been written off. If a customer
whose account had been determined uncollectible returns to clinic within three years,
the delinquent write-off amount will be reactivated and the billing process resumed.
Likewise, if a customer requests a non-required service from Environmental Health, the
delinquent write-off amount will be reactivated and the billing process resumed.
Recommended Action: _X_Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ____________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Agenda Item Number
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 23, 2017
Agenda Item Subject: FY 2017-18 Fee Schedule & Requested Changes
Attachment(s): Fee Schedule & Requested Changes
Staff/Board Member Reporting: Rebecca Crawford, Finance and Administrative
Services Director
Purpose/Recommended Action: ___ Action/Approve
_x_ Action/Approve & forward to Board of Commissioners
___ Information with possible action
___ Accept as information
___ Revise & schedule for future action
Summary Information:
The Health Department reviews fee schedules on an annual basis through the budget approval
process; however, the Nutrition Program was awarded funding from a regional Minority
Disease Prevention Program (led by Alamance County) through NCDHHS for FY 17-18 after
the FY 17-18 budget was approved. The Agreement Addendum associated with this funding
requires that all funding recipients charge program participants a one-time fee of $25 unless a
scholarship (i.e. fee waiver) is provided (see Section III.7 of the attached Addendum). As this is
a newly identified fee, it is necessary to add it to our fee schedule in an effort to remain in
compliance with our Agreement Addendum. The proposed change is detailed below:
Name of Fee 2017-18
Current Fee
2017-18 Proposed
Fee
2017-18 Budget
Impact
MDPP Flat Fee $0 $25 $1,875
Recommended Motion:
To approve the proposed fee changes for 2017-2018 as presented and forward to the Board of
County Commissioners for action.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 23, 2017
Agenda Item Subject: FIT Program
Attachment(s): FIT Program Overview
Staff or Board Member Reporting: Pam McCall, PHS Director
Purpose: _X_ Action
_ __Information only
___ Information with possible action
Summary Information:
The Formerly Incarcerated Transitions Program (FIT Program) is a project funded by
the Duke Endowment to provide people released from NC prisons assistance in
accessing medical services and other community reentry services. For year one, the
funding amount will be $35,594.
OCHD is partnering with UNC Family Medicine to implement the program by hiring and
supervising a Community Health Worker to provide case management services to
people being released from prison in Orange County.
Recommended Action: ___Approve
_X_Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Formerly Incarcerated
Transitions (FIT)
Program Overview
Pam McCall
Public Health Nursing Director
NEED
•Over 36,000 incarcerated in NC State Prisons
•18,618 people released from state prisons in
2015
•Chronic disease burden high (80%)
Chronic medical problems
Mental illness
Substance use disorders
NEED
•No system in place to transition into health care
Only 15%-25% see a medical provider in first
year post-release
•Death rate is 12 times normal in the first 2 weeks
post-release.
TRANSITION SITES
•NC Department of Public Safety in process of
improving the reentry process.
•Transition Sites-existing prisons will facilitate
coordination of services with local reentry
service providers.
•Prisoners will be relocated to a Transition Site
near their county of residence prior to release.
INTERVENTION
Collaboration between NC state prison system,
local reentry community and local safety net
providers.
Community Health Worker will engage those
with chronic disease prior to release and with
local reentry community, develop a
comprehensive reentry plan.
GOALS
•Increase utilization of Primary Care and
Behavioral Health Services
•Decrease rates of ED visits and hospitalization
•Increase adherence with use of medications
and treatment plans
•Decrease recidivism
•Improve health outcomes and satisfaction
with health care services
OCHD ROLE
•Hire, supervise and support Community
Health Worker to start January 2018.
•Model position at Durham County Health
Department.
•Recruit CHW with a history of involvement in
the criminal justice system.
OCHD COST
Annual Costs
Year 1
( beginning 1/1/18) Year 2 Year 3
Grant
County
General
Funds
Total Grant
County
General
Funds
Total Grant
County
General
Funds
Total
FTE 1.00 0.00 1.00 0.50 0.50 1.00 0.25 0.75 1.00
Salaries, Benefits, and
Fringe $27,993 $0 $27,993 $27,993 $27,993 $55,986 $13,997 $41,990 $55,986
Travel $1,000 $0 $1,000 $1,000 $0 $1,000 $1,000 $0 $1,000
Training $300 $0 $300 $300 $0 $300 $300 $0 $300
Computer $2,500 $0 $2,500 $0 $0 $0 $0 $0 $0
Departmental Supplies $3,800 $0 $3,800 $1,300 $0 $1,300 $1,300 $0 $1,300
Total $35,593 $0 $35,593 $30,593 $27,993 $58,586 $16,597 $41,990 $58,586
OCHD IN KIND
Role # of Hours per
Month
Hourly Rate
(Salary and
Benefits)
Year 1
Annual Cost
Year 2
Annual Cost
Year 3
Annual Cost
Primary Supervision 6 $42.70 $1,537 $3,074 $3,074
Program Oversight 1 $55.70 $334 $668 $668
Hiring and Onboarding 6 $33.69 $1,213
Financial Grants Management 4 $32.24 $774 $1,548 $1,548
Total $3,858 $5,290 $5,290
REQUEST
•Approve acceptance of Duke Endowment
grant funds to employ community health
worker.
•Forward to BOCC for approval.
Questions?
Pam McCall
pmccall@orangecountync.gov
919-245-2402
www.OrangeCountyNC.gov/Health
Agenda Item Number: VI E
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 23, 2017
Agenda Item Subject: Youth Tobacco Funding
Attachment(s): Division of Public Health Agreement Addenda FY17-18 : 451 Tobacco
Prevent-CDC Core Grant $45,500
Staff or Board Member Reporting: Donna King
Purpose: _X__ Action
__ Information only
____ Information with possible action
Summary Information: The North Carolina General Assembly appropriated $500,000
per year in non-recurring funds in FY17-18 and FY18-19 for youth tobacco use
prevention. The budget provides funding to develop strategies to prevent the use of all
tobacco products, with a focus on new and emerging tobacco products, including
electronic cigarettes by youth and people of childbearing age.
Orange County Health Department was recognized as a leader in youth tobacco use
prevention by the Region 5 Health Directors and will receive $45,500 to support and
enhance current youth tobacco use prevention programming. April Richard, Tobacco
Prevention and Control, is currently collaborating with all five local high schools;
engaging youth in peer prevention work through TRU Clubs.
Recommended Action: ___Approve
_X Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Division of Public Health
Agreement Addendum
FY 17-18
Page 1 of 5
_____________________________________________ ____________________________________
Health Director Signature (use blue ink) Date
Local Health Department to complete:
(If follow-up information is needed by DPH) LHD program contact name:
Phone number with area code:
Email address:
Signature on this page signifies you have read and accepted all pages of this document. Revised June 2016
Orange County Health Department
Chronic Disease and Injury /
Tobacco Prevention and Control
Local Health Department Legal Name DPH Section / Branch Name
451--Tobacco Prevention and Cessation
Jim Martin 919-707-5404.
Jim.Martin@dhhs.nc.gov
Activity Number and Description DPH Program Contact
(name, phone number, and email)
06/01/2017 – 05/31/2018
Service Period DPH Program Signature Date
(only required for a negotiable agreement addendum)
07/01/2017 – 06/30/2018
Payment Period
Original Agreement Addendum
Agreement Addendum Revision #
I. Background:
The North Carolina General Assembly appropriated non-recurring funds in FY17-18 and FY18-19 for
youth tobacco use prevention. The budget provides funding to develop strategies to prevent the use of
new and emerging tobacco products, including electronic cigarettes by youth and people of childbearing
age.
The Tobacco Prevention and Control Branch (TPCB) collaborates with and builds capacity of partners,
including state and local agencies, local health departments and community organizations, to plan and
implement culturally appropriate evidence-based strategies to reduce deaths and health problems due to
tobacco use and secondhand smoke (SHS). TPCB’s four major goal areas are to: (1) Prevent initiation of
tobacco use among youth and young adults; (2) Eliminate exposure to SHS; (3) Promote tobacco use
cessation among adults and youth; and (4) Identify and eliminate tobacco-related disparities
While cigarette smoking has declined among North Carolina’s young people from 15.5% of high school
students in 2011 to 9.3% in 2015, use of any tobacco products increased from 25.8% of high school
students in 2011 to 27.6% in 2015. This increase was due to the rising use of emerging tobacco
products, including electronic cigarettes (North Carolina Youth Tobacco Survey, 2015).
II. Purpose:
This Agreement Addendum provides funds for the Local Health Department to develop strategies to
prevent the use of all tobacco products, with a focus on new and emerging tobacco products, including
electronic cigarettes, by youth and people of childbearing age and to provide tobacco cessation services
Page 2 of 5
Revised June 2016
including nicotine replacement therapy. The Local Health Department will work in Region 5 in
coordination with the Tobacco Control Manager and the Regions 5 Tobacco-Free Leadership Teams.
III. Scope of Work and Deliverables:
1. Assist in the Maintenance of a Regional Tobacco-Free Leadership Team:
On behalf of its Region, the Local Health Department will help enhance the Regional Tobacco Free
Leadership Team which is comprised of Local Health Directors from each county in the region, two
to three identified community partner advisors, and is facilitated by the full-time Regional Tobacco
Control Manager. The Regional Leadership Team will communicate monthly via in-person
meetings, conference calls and/or email correspondence in order to guide the process of
accomplishing the tobacco use prevention and cessation program goals of the region.
2. Continue to develop and foster a Regional Tobacco-Free Collaborative including membership
representing vulnerable populations:
The Local Health Department must develop a plan to engage priority populations (e.g., racial/ethnic
populations, those living in under-resourced and low-income communities) in the planning,
implementation and/or evaluation of at least one strategy within the Regional Collaborative to build
support for evidence-based program and policy implementation in the communities served.
3. Implement the Tobacco Prevention and Control Annual Action Plan for current fiscal year:
The Local Health Department will submit their final version of the Fiscal Year 2017–2018 annual
action plan in collaboration with the Regional Tobacco Control Manager by September 30, 2017.
TPCB staff will review the annual action plan and provide recommendations so that a final version
can be submitted by September 30, 2017. Annual action plans are subject to change based on
legislative decisions and can be modified by the Regional Manager during quarterly reviews with
approval from TPCB staff.
4. Ensure that activities described in the Fiscal Year 2017- 2018 annual action plan address
evidence-based policy, systems and environmental changes supporting tobacco free norms.
Activities include:
a. Provide consistent and evidence-based messages about the health risks of all tobacco product
use, including new and emerging tobacco products, such as e-cigarettes, cigars, little cigars, and
hookah and exposure to secondhand smoke and aerosol from e-cigarettes and other tobacco
products.
b. Educate parents, teachers, coaches, college-aged young people, civic and community leaders,
dental and health care professionals, public health, mental health and substance abuse prevention
professionals, and other influencers of youth about the risks of all tobacco product use, including
e-cigarettes, among youth and young adults.
c. Expand Regional and Local coalitions to include diverse adult influencers of youth and youth
leaders, such as parents, teachers, coaches, college-aged young people, civic and community
Page 3 of 5
Revised June 2016
leaders, dental and health care professionals, public health, mental health and substance abuse
prevention professionals, and other influencers of youth, including but not limited to those
recruited by Youth Empowered Solutions (YES!) who is a contractor providing training and
technical assistance.
d. Work with the TPCB, YES! and research partners to test messages with the purpose of building
knowledge about and support for high-impact media campaigns to educate adult influencers,
young people, the public, and civic and community leaders about the consequences of emerging
tobacco product use, such as e-cigarette, cigar and hookah use, among youth and young adults.
e. Implement a policy strategy to reduce the use of e-cigarettes by including e-cigarettes in policies
and programs related to smoking and tobacco product use at the local levels.
f. Promote comprehensive tobacco-free environments, including e-cigarettes and other emerging
tobacco products, for:
a. childcare centers
b. schools
c. community colleges and universities
g. Ensure that tobacco-free schools policies are being implemented effectively to prohibit all tobacco
product use, including e-cigarettes and other emerging tobacco products.
h. Work with community partners in substance use prevention on educational efforts to reduce youth
access to all tobacco products, including e-cigarettes, cigars, little cigars, and hookah in retail
settings.
i. Ensure that youth and young adults who use tobacco products receive tailored tobacco use
cessation messages and utilize QuitlineNC services.
j. Work with schools to promote available best practice interventions and curriculum for tobacco use
prevention and the risks of e-cigarette use.
k. Provide tobacco cessation services including nicotine replacement therapy.
IV. Performance Measures/Reporting Requirements:
Performance Measure #1: Evidence that staff provided consistent and evidence-based messages
about the health risks for all tobacco product use. This includes new and emerging tobacco products,
such as e-cigarettes, cigars, little cigars, and hookah, and exposure to secondhand smoke and aerosol
from e-cigarettes and other tobacco products.
Performance Measure #2: Number and names of organizations of influencers of youth and young
adults educated about the health risks of all tobacco product use. This includes organizations that
represent parents, teachers, coaches, civic & community leaders, dental and health care
professionals, public health, mental health and substance abuse prevention professionals.
Performance Measure #3: Number and names of organizations of influencers of youth and young
adults that become actively engaged in the Regional/Local coalitions. This includes organizations
that represent parents, teachers, coaches, civic & community leaders, dental and health care
professionals, public health, mental health and substance abuse prevention professionals.
Performance Measure #4: Report new regulations or policies adopted and implemented that
eliminate exposure to secondhand smoke, e-cigarette use, and all tobacco use in government
buildings, grounds, and public places; colleges and community colleges; multiunit housing; and
workplaces.
Page 4 of 5
Revised June 2016
Performance Measure #5: Evidence of promotion of compliance with tobacco-free schools law;
tobacco-free child care center rules; tobacco free campuses. Evidence of promotion of tobacco-free
environments 24 hours a day, 7 days a week, for home-based childcare centers, and community
colleges, colleges and universities that have not yet gone tobacco-free to the full extent allowed by
law.
Performance Measure #6: Evidence of educational efforts to reduce youth access to all tobacco
products, including e-cigarettes, cigars, little cigars, and hookah in retail settings. Evidence that this
is done in coordination with substance abuse prevention coalitions.
Performance Measure #7: Evidence of work with schools and school systems to promote
emerging best practice interventions (including but not limited to curricula) for tobacco prevention
and the risks of emerging tobacco products, including e-cigarettes.
Performance Measure #8: Evidence of increased support for cessation, including nicotine
replacement therapy.
Regional Tobacco Control Managers are required to submit quarterly progress and outcome reports to
the Tobacco Prevention and Control Branch.
V. Performance Monitoring and Quality Assurance:
The Regional Tobacco-Free Collaborative’s progress is evaluated on a regular basis by the Tobacco
Prevention and Control Branch to denote progress on their annual action plan. This feedback is to ensure
adequate performance. The evaluations are discussed at site visits scheduled as needed. A site visit will
be scheduled once per year of the Agreement Addendum’s service period with the Local Health
Department and Regional Leadership Team. Future meetings and site visits will be planned
collaboratively.
The Local Health Department is provided with written feedback at least twice per year and
recommendations by the TPCB. TPCB monitors the Local Health Department by identifying major
strengths, weaknesses, areas to be addressed, and success story ideas in the Interim Reports compiled by
the TPCB Director of Surveillance and Evaluation.
TPCB monitors the Local Health Department’s monthly reimbursement requests through the Aid-to-
Counties database, conducts two “100% spending budget” meetings, and conducts monthly conference
calls to ensure budgets are spent appropriately and programmatic activity is on track.
Certain situations outlined below may result in inadequate performance and require corrective actions:
a. Non-completion of activities in the annual action plan will require documentation of barriers
preventing implementation of activities and require an amended annual action plan within the
quarter that the change took place, which must be approved by the TPCB.
b. In the event of a gap in staffing or another major change in annual action plan delivery, the Local
Health Department should identify staff internally to continue progress and recruit and orient a
replacement rapidly. In the event that there is delay, and the Local Health Department cannot show
a plan to spend the unspent program dollars, those funds are reverted and redistributed through the
100% spending plan.
c. If the Local Health Department does not implement activities in the annual action plan and has not
documented barriers explaining why the activities were not completed, the funding for those
Page 5 of 5
Revised June 2016
activities must be returned to the TPCB or will be re-negotiated with TPCB-approved replacement
activities and budget.
VI. Funding Guidelines or Restrictions:
a. The state funds added by this Agreement Addendum Revision #2 may be used by the Local Health
Department to furnish "coffee breaks" refreshments provided there are twenty or more participants and
costs do not exceed four dollars and fifty cents ($4.50) per participant per day.
b. Funds may be used to provide QuitlineNC services, including to purchase nicotine replacement therapy.
c. Funds may not be used for lobbying.
d. Recipients may not use funds to conduct research.
e. Recipients may only expend funds for reasonable program purposes, including personnel, travel, supplies,
and services, such as contractual.
f. Awardees may not generally use funding for the purchase of furniture or equipment. Any such proposed
spending must be identified in the budget and receive prior approval by TPCB.
g. The Local Health Department must perform a substantial role in carrying out project objectives and not
merely serve as a conduit to another party or provider who is ineligible.
h. The Local Health Department must have on-site the Potential Conflict of Interest and Disclosure Form
regarding acceptance of funds from tobacco-related entities and the Health Department Tobacco Use
Policy. Any changes in these policies must be reported to the TPCB.
i. Budget for the Local Health Department is based on availability of funds.
j. Funds may not be used to supplant existing state or federal funds.
k. Recipients may not use funds to provide direct cessation services or other direct services other than those
through evidence-based QuitlineNC services.
l. Indirect costs are not applicable to this grant.
m. Recipients are restricted from dealings with corporations with recent felonies or unpaid federal tax liability.
n. Funds may not be used for fundraising.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 23, 2017
Agenda Item Subject: NALBOH Update
Attachment(s):
Staff or Board Member Reporting: Susan Elmore/Beverly Scurry
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information: Susan Elmore and Beverly will give an update on the NALBOH 2017 Annual
Conference held in Cleveland, OH on August 2-4, 2017.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
Board of Health P & P Manual, Section I
Policy E, Attachment B
Updated 11/2014, 4/2017
S:\MANAGERS WORKING FILES\BOH\AGENDAS & ABSTRACTS\2017 Agenda & Abstracts\August 2017\VI.E. I.E.
Attachment B - Eligibility Finan Resp (7-2017).docx
DETERMINATION OF ELIGIBILITY FOR CLINICAL SERVICES
The Orange County Health Department, following approved policy and procedures, has determined that
_____________________ (Client Name) is eligible for [circle] Medical / Dental services and will be
charged _______ percent (%) of the total fees, based on the number of people living in the home and the
total amount of gross income in the home.
STATEMENT OF FINANCIAL RESPONSIBILITY
_______ I understand that I am responsible for all fees involved in receiving services at the Orange
County Health Department (as stated above)
_______ I understand that I am required to provide income verification to be eligible for the
sliding fee scale. If I do not provide income verification in the next 3010 business days
or less(by _______________), any services I receive that are not covered by insurance,
with the exception of Family Planning services, will be billed at 100% on the sliding fee
scale.
_______ I understand that if I report that I am pending Medicaid eligibility, but I do not follow-
through with the Medicaid application or do not receive coverage, I will be responsible
for all charges based on the sliding fee scale determination.
_______ I understand that payment is due at the time services are provided. I further understand
that, if circumstances do not allow full payment on the day of service, a payment plan
will be established.
_______ I understand I will receive a statement and an overdue notice for balances older than 30
days that are equal to or greater than $50.00. I also understand that if I do not submit
payment in full or honor a monthly payment plan within 30 days of that statement date;
my account will be sent to the Orange County attorney for debt setoff.
_______ I understand that if I do not make a “good faith” effort to pay on any past bills due, future
services may be limited or denied. However, emergency services will not be denied.
I understand I must notify the clinic as soon as possible if I cannot keep my appointment.
Medical Clinics: 919-245-2400 Dental Clinic: 919-245-2435
__________________________________________________ ________________________
Signature of Client/Responsible Party Date
__________________________________________________ ________________________
Signature of Interpreter Date
__________________________________________________ ________________________
Signature of OCHD Employee Date
Initial
Initial
Initial
Initial
Initial
Initial
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 1 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
I. Purpose
A. Public health services are increasingly costly to provide. The Health Department serves
the public’s interest best by assuring that all legally required public health services are
furnished to all citizens. The department provides recommended and requested public
health services based upon the priorities established by the Board of Health.
B. Fees are a means to help provide services to the residents of Orange County. Fees help
finance and extend public health services when government funding is not sufficient to
support the full cost of providing all required and requested services.
C. Fees for Orange County Health Department services are authorized under North Carolina
G.S. 130A-39, provided that:
1. They are in accordance with a plan recommended by the Health Director and
approved by the Board of Health and the Orange County Board of Commissioners.
2. They are not otherwise prohibited by law.
3. They are deposited to the account of the local Health Department for public health
purposes in accordance with the provisions of the Local Government Budget and
Fiscal Control Act.
D. Fees for services must also be in compliance with N.C. Administrative Code, Title X
Regulations, and Women’s and Children’s Health Program Rules.
E. There will be no charge for Title X Services provided for individuals with income less
than 100% of the Federal Poverty Level (FPL.)
II. Policy Implementation
The implementation of this policy is delegated to appropriate financial or support staff in
each division of the health department.
III. Income Eligibility
A. Definitions
1. Definition: A family is defined as a group of individuals who are living together as
one economic unit. Individuals are considered members of a single family or
economic unit when their production of income and consumption of goods are
related. A pregnant woman is counted as a family of two in determining family size.
2. Income eligibility requirements apply to: Dental Health, Family Planning, Child
Health, Maternal Health, Adult Health, Nutrition Services, Family Home Visiting,
and Primary Care Services.
3. The Health Department utilizes a sliding fee scale based on Federal Poverty
Guidelines in accordance with the Fee Schedule approved annually during the
County Budget process. NC DPH updates and issues the scale yearly. Specifically,
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 2 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
the health department uses the 101% - 250% Federal Poverty Level sliding scale.
Determination of Sliding Fee percentage is based on gross income and family size.
4. Verification of income is required at time of enrollment for services, at the annual
financial interview, or if there is a change in the work status in the family unit for
clients to be eligible for the sliding fee scale.
a. An annual gross income statement is preferred for evaluation.
i. Gross income is defined as the total of all cash income before deductions for
income taxes, employee social security taxes, insurance premiums, bonds,
etc. For self-employed applicants, net income after business expenses. Gross
income does NOT include money earned by children for babysitting, lawn
mowing and other tasks.
ii. In general gross income includes: salary, wages, commissions, fees, tips,
overtime pay, unemployment compensation, public assistance money,
alimony and child support payments, Social Security benefits, VA benefits,
Supplemental Security Income (SSI) benefits, retirement & pension
payments, worker’s compensation, bonuses, prize winnings and other sources
of cash income except those specifically excluded.
B. Sources
1. Sources of income verification may include, but are not limited to:
a. Current pay stub
b. Self-employment accounting records
c. Letter documenting current employment and wages from employer
d. Recent income tax return
e. Unemployment or workers compensation receipt
f. Public assistance letter
g. Prior income verification through enrollment in other Health Department
programs
2. If an individual claims “no income” (except for minors consenting to specific
services under G.S. 90-21.5), a signed “Verification of Income and/or Residency”
form (Attachment A) indicating financial support from another party must be
submitted.
3. Failure to provide verification within 3010 business days or less of date of service
will result in charges being assessed at 100% of sliding fee scale. The client will
receive notification of required income verification at the time the initial appointment
is made.
4. The client must read, sign and understand the “Determination of Eligibility Payment
Plan for Clinical Services” and “Statement of Financial Responsibility Payment
Plan” form (Attachment B) at their initial visit and annual financial reviews.
C. Environmental Health
Persons seeking Environmental Health services must obtain and properly complete an
application for service and pay the corresponding fee for service (all applicants pay at the
100% pay status) before an appointment for a field visit will be scheduled. Sometimes
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 3 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
additional fees may be necessary if during service delivery it is determined that the
correct fees were not initially paid, or services requested are more than applied for.
Wastewater Treatment Management Program (WTMP) and Mobile Home Park fees are
the only Environmental Health services invoiced after the inspection. These inspections
are not application based but occur on a regulated, recurring schedule.
IV. Residency Requirements
A. Any individual, Orange County resident or non-resident, is may be eligible for services
provided by the Health Department. Exceptions include non-STD Communicable Disease
cases, designated Family Home Visiting programs (Orange County residents only), and
when prohibited by law or regulation.
B. Proof of Residency may be determined by using the US Postal and/or Orange County
GIS website and one of the following: Driver’s License, Government-issued
identification, Pay Stub (Within the last 30 days), Utility bill (Within the last 45 days);
Current rental or lease agreement; Personal or property tax bill; Student identification,
and Matrícula Consular (Mexican ID Card 1). Clients without one of the above
identifying information sources but reportedly living within the county will be required to
produce a written statement or letter from the head of household, verifying that the
person resides in their home. Special cases will be referred to the Clinic Manager or
Supervisor. Failure to provide proof of residency may result in referral to another
resource.
C. Proof of Residency in Orange County is required for self-pay patients to be eligible for
the sliding fee scale when requesting Maternal Health, Child Health, Primary Care,
Nutrition Services, and Dental Health Services. Out-of-county residents will be assessed
at 100% of charges not covered by a third party payer source.
V. Service Limitation/Denial
A. Services will not be denied based solely on the inability to pay, with the exception of
those services that require a flat or minimum fee. Emergency dental services and urgent
primary care services will be provided to clients regardless of any outstanding balance
due.
B. Otherwise, services may be denied if the department does not have the resources needed
to provide a quality non-mandated service or the individual does not meet the residency
or financial requirement.
1 The Matrícula Consular de Alta Seguridad (MCAS) (Consular Identification Card) is an identification card issued by
the Government of Mexico through its consulate offices to Mexican nationals residing outside of Mexico. Retrieved from
http://en.wikipedia.org/wiki/Matr%C3%ADcula_Consular on October 14, 2012.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 4 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
C. Family Planning clients will never be refused service due to an outstanding balance or
inability to provide proof of income.
D. Maternal and Child Health clients who are at 60% to 100% pay status may have services
limited or denied for failure to make payments based on designated Payment Plans
(“good faith” effort).
E. Falsification of eligibility by the client may result in denial or limitation of services.
F. The Health Department shall not deny a service due to religion, race, national origin,
creed, sex, marital status, familial status, sexual orientation, veteran status or age.
G. The Health Department shall assure that no otherwise qualified handicapped individual,
solely by reason of his/her handicap, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under any program or activity covered by
this agreement.
H. The Health Director can override any decision to deny or limit services to a client in
accordance with the existing fee waiver process.
VI. Fees for Services
A. In order to facilitate early entry into prenatal care or family planning services, pregnancy
tests will be provided free of charge unless they are required as part of another service.
B. In order to facilitate early identification of and referral for hypertension, two blood
pressure screenings will be provided in the clinic free of charge. Borderline readings will
be checked free until determined to be normal or the client is referred for further
evaluation. Follow-up of clients with a diagnosis of hypertension will be charged
according to the fee policy.
C. Fees are not charged for diagnosis and treatment of sexually transmitted diseases, or
investigation and control of communicable diseases. There is also no charge to clients for
any State-provided vaccine.
D. Fees are charged for health and dental services provided to individuals unless prohibited
by law or regulation. Fees are established based upon cost analysis, Medicaid and
Medicare rates, comparable provider rates and/or state or contractual agreements. The
Health Director shall inform the Board of Health and the Orange County Board of
Commissioners of these adjustments in a timely manner.
E. Fees may be charged to clients for “non-program” specific services without being
adjusted on a sliding fee scale (flat fees).
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 5 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
F. Fees may be charged for education, community-based limited clinical services (such as
influenza shots) and screening services provided to individuals or groups. The following
applies to these services:
1. They include orientation, field training, dental screening and education, and/or other
health promotion activities such as infant and toddler car seats, bike helmets, or
equipment rental.
2. The Health Director will negotiate fees for services where fees have not been
previously determined.
3. Income eligibility requirements do not apply to these services.
G. Per NC General Statute Chapter 7B, Subchapter 4, Article 35, and confidentiality
regulations, emancipated minors and other individuals requesting confidential services
will be considered a family of one for determination of charges. Private insurance will
also not be billed for minors receiving services for which they can consent unless
permission is received from the minor.
H. Persons requesting any program services may be encouraged to apply for Medicaid, as
applicable.
I. The Personal Health Services Division clinical and nutrition services will use the
appropriate sliding fee schedule for services when adjustable fees are allowed; all other
fees will be charged at 100%.
1. Clients, who require services provided on the sliding fee schedule, are expected to
pay the appropriate fee in full based on sliding fee guidelines.
2. This schedule will require assessment of the client’s financial status on an annual
basis or when a financial status change occurs, as specified in section III.
J. Dental Health Services, Primary Care Services, and Nutrition Services will use a sliding
fee schedule for all services, with a minimum charge to be established at the annual fee
review during the budget preparation process.
1. The minimum charge for dental, primary care, and nutrition services will apply
regardless of the determination of the client’s financial status.
2. If a client is determined to fall at the 0% pay level, the minimum charge will be the
only charge levied and collected.
3. Minimum charge is due at time of service.
K. Fee schedules will be reviewed annually during the budget process and adjusted as
appropriate; a complete cost analysis for purposes of fee adjustments will be performed
every five years. The process for this cost analysis includes a review of the following
elements:
a. Most recent vaccine and drug purchase costs
b. Most recent lab pricing lists
c. Most recent Medicaid Cost Settlement data for procedure costs
d. Environmental Health equipment, labor, and staff costs
e. Review of fee schedules of surrounding jurisdictions
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 6 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
f. Analysis of existing self-pay client base and how increased costs would affect
their ability to get necessary care
f.
L. Based on G.S. 130A-41, the Health Director is authorized to enter into contracts, which
may include negotiated reimbursement rates.
M. The Health Director may not make exceptions to the Fee Policy except to accommodate
specific situations through the fee waiver process (Attachment C).
N. Any minimum administrative fee or flat fees shall be applied without discrimination to all
patients.
O. There will be no “schedule of donations”, bills for donations, or any other implied
coercion for donations from clients as a condition for being seen at the Health
Department. Donations to the health department can be made through the Orange County
Community Giving Fund. Fees for services will not be waived because of client
donations.
O.P. Fees for 340b drugs dispensed to Medicaid patients will be reviewed and set annually
based on the average, annual cost to the County to purchase the drugs.
VII. Fee Collection
A. Environmental Health service fees are paid before an appointment is scheduled. Field
staff cannot accept fees in the field.
B. Fees collected from Medicaid and Medicare and other third party insurance for a covered
service, combined with payment of any applicable co-pays and co-insurance, constitutes
full payment for that service.
C. A co-payment, deductible, or balance of charge can be collected at the time of service
from individuals covered by other third party insurance plans when OCHD is a member
of their provider panel (exception family planning). For Family Planning clients, family
income should be assessed before determining whether co-payments or additional fees
are charged; if their family income is verified to be at or below 250% FPL, they should
not pay more (in copayments or additional fees) than what they would otherwise pay
when the schedule of discounts is applied. With regard to other insured clients, payments
towards a deductible for clients whose family income is verified to be at or below 250%
FPL should have the appropriate sliding fee schedule applied.
D. If OCHD is not on the insurance provider panel, the client will be charged for the
service(s) based on the Health Department’s fee schedule. The client will be provided
with documentation of services for submission of a claim to their insurance company.
Formatted: Indent: Left: 1.25", No bullets or
numbering
Formatted: List Paragraph, No bullets or
numbering
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 7 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
E. At the time services are received, the client will be given a statement showing the cost of
services for that visit as well as their total account balance.
F. Payment is due at the time services are rendered.
G. When the client is unable to pay in full at the time services are rendered, a payment plan
is established, and the client must sign a “Payment Agreement Form” (Attachment D)
except for minimum-fee or flat-fee charges. Client must then make a payment in any
amount in order to activate the payment plan.
H. When a client requests “no mail”, discussion of payment of outstanding debt shall occur
at the time the service is rendered. A remark regarding “no mail” is entered into the
medical data system. No letters or other correspondence concerning insurance or past
due accounts will be sent to any client that requests “no mail”. Reasonable efforts will be
made to collect charges without jeopardizing client confidentiality.
I. The Billing Cycle for the Health Department (by Division) is as follows:
1. Personal Health & Dental Health Divisions
a. Bills will be sent monthly by the tenth of the month for two months after services
have been rendered indicating a statement of balance due. Every quarter, all
accounts with a balance $50 or more that are more than 60 days past due will be
forwarded to the County Attorney Office and pursued through debt set-off in
accordance with the county policy. Accounts with a balance of less than $50 will
remain delinquent until paid or written-off.
b. If a debt is not paid, when the client attempts to make another appointment, the
client will be told they have a previous balance, and they must have an active
payment plan or make a payment at time of next service except for Family
Planning clients.
2. Environmental Health Division
a. An initial invoice for additional or miscellaneous Wastewater Treatment
Management Program (WTMP) charges is mailed with the inspection form.
b. If no payment is received within 90 days, a second notice is mailed.
c. If no payment is received after an additional 30 days and the debt is $50 or
greater, the account is forwarded to the County Attorney’s Office, which will
pursue it through the county’s debt set-off procedure.
d. Debt owed by a corporation or non-individual is dissolved upon sale of property.
e. The county attorney’s office has deemed debt that becomes part of an estate will
become dissolved.
f. If the client presents and voluntarily wishes to pay on the account, any amount
the client offers will be accepted, documented in the client file, and a receipt will
be provided.
g. Mobile Home Parks are billed annually on the calendar year. The procedure is
the same as noted above.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 8 of 8
Original Effective Date: January 25, 2001
Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15, 7/17
J. Insurance and Third Party Billing
1. Where a third party is responsible, bills are to be submitted to that party;
2. Third parties authorized or legally obligated to pay for clients at or below 100% FPL
are properly billed
3. Third party bills (including Medicaid) show total charges without any discounts
unless there is a contracted reimbursement rate that must be billed per the third party
agreement.
4. The health department will bill insurance and managed care organizations for which
provider approval has been established. The patient will be responsible for all
deductibles, coinsurance and non-covered charges.
5. Patient or parent/guardian signature is required to give authorization to file claims
and provide necessary information to the insurance company (Attachment E).
6. Patients, or the accompanying parent/guardian of an un-emancipated minor with
appropriate insurance benefits, who receive public health services will be given the
opportunity to choose whether to have insurance filed in order to avoid breach of
confidentiality or pay the associated fee according to where the patient falls on the
sliding fee scale.
VIII. Review and Approval
A. This Policy shall be reviewed annually by members of the Financial Review Committee.
The committee shall have representatives from each division, and must also include the
Health Department’s Finance and Administrative Services Director
B. Any policy revisions must be approved by the Health Director and the Board of Health.
Health Director’s Report
August 23, 2017
• Community Health Grant Summary
OCHD was awarded $122,065 for a Community Health Grant from the Office of Rural Health for
the time period of September 1, 2017 to June 30, 2018, with potential for additional funding for
a second year, FY18-19. The goal of this funding is to increase access to primary and preventive
care as well as self-management support services for vulnerable patient populations living with
chronic disease in Orange County. The target population will be uninsured, Medicaid, and
Medicare patients who are obese, and/or living with pre-diabetes/diabetes, abnormal lipids
and/or hypertension. OCHD will use part of this funding to supplement staffing and operational
costs for Medical Nutrition Therapy and Diabetes Self-Management Education services as well
as to create a voucher program covering the costs of the minimum fee for nutrition services.
These vouchers will reduce barriers to care with the goal of improving health outcomes. We
plan to hire a community health worker who will establish relationships with patients in
identified zip codes of Orange County and offer them support to better manage their disease as
well as strengthen our community partnerships. UNC Family Medicine will be a partner on this
grant with the goal of increasing the number of Chronic Disease Management classes (Stanford
Curriculum) as part of the partnership.
• Minority Diabetes Prevention Program Funds
We were awarded $10,125 as part of a Nine-County Regional Collaborative (Alamance County
Health Department is the lead agency) through the NC Department of Public Health to offer the
CDC minority diabetes prevention program. This is a year-long program to help people who
have prediabetes or who are at high risk for type 2 diabetes make realistic and achievable
lifestyle changes that can cut their risk of developing type 2 diabetes by half. This program will
start August 25th and will have 16 weekly sessions with incentives to aid in behavior change.
After the 16 weeks, there will be follow-up sessions to help participants continue the positive
lifestyle changes learned during the program.
• Behavioral Health Consultant
The BOCC allocated funds for a behavioral health consultant to move forward with assessing the
existing system and making recommendations to bridge gaps identified in the needs assessment
performed last fall. We are in the process of having community partners such as UNC
Healthcare, UNC Department of Pediatrics, Cardinal Innovations, and the school systems review
the RFP and hope to have it issued at the end of August with a goal of awarding a contract in
mid-November.
• Innovation Grants Update
Eight ideas were submitted to the Health Director for Innovation Grant funding in June. Five of
the ideas were selected to go through the full application process by the Health Director and
Leadership Team. In July, the Division Directors reviewed the applications and determined two
could be funded immediately and one needed more information. The “Be the 1 to” grant will
give the health department an opportunity to start an important public health intervention.
This grant will bring awareness to OC and equip residents with the tools and education needed
to become a county where having conversation about suicide is normal and non-judgmental,
while also helping residents become familiar with whom to refer individuals to if/when they are
in a crisis in a place where this kind of initiative does not currently exist. The Front of the
House Food Safety Education grant would provide the local health department with an
education intervention that does not currently exist. Environmental Health has assessed this
violation and determined there is a definite gap in training resources focused on front of the
house staff and servers. The OSWP Calendar grant would provide an educational resource as a
guide to homeowners in ways to maintain their wells and help keep their well water safe to
drink. It will also offer to decrease the number of non-compliant and malfunctioning septic
systems, thus reducing expenses to the Health Department and re-inspection and repair costs to
the client. Long term goals include a reduction in the amount of malfunctions, the amount of
time until a septic system or well is serviced, and a reduction in Notice of Violations issued due
to the self-policing of homeowners. All applicants were notified of the grant decisions. More
information on graphic design and a line-item budget for the OSWP Calendars is pending
consultation with the health department’s communications specialist. Grant recipients were
oriented on purchasing procedures for 2017-2018. The mid-term report is due on December
31st.
• Funding for Racial Equity Training for Clinical Staff
We received the BCBSNC Training and Equipment Grant. This grant funds $9,500 and allows us
to engage an Equity Leadership Team (Open Source Leadership) to guide medical clinic staff
through an assessment of current culture and readiness to engage in racial equity work
designed to analyze structural racism and tailor interventions to impact social determinants
affecting our community.
This will be done through a one-day introductory "Leading for Racial Equity" Workshop. The
workshop is designed to understand the historical and contemporary construction of race and
structural racism and to develop a shared framework and language for racial equity. A brief
survey prior to the session assesses knowledge and skill that will tailor content.
Then, the team will provide a half-day follow-up "From Theory to Practice": This follow-up is
done 1-3 months after initial session to review and revisit the framework and reflect on usage
and barriers to implementation.
After the sessions, the leadership team will receive on-going coaching on integrating the equity
work into practice, policies and culture of the medical clinic. This includes four, two-hour
meetings over a determined timeframe to consult and strategize on this integration.
Outcomes include:
1. Staff will disaggregate current Orange County population health data via a racial equity lens
and track and trend data over next three years.
2. Leadership and staff will examine how existing policies and programs, including fee and
eligibility policy, primary care program, and family planning programs positively or
negatively impact population heath using a racial equity lens.
3. Staff will develop potential interventions to disrupt existing inequities and impact the ways
in which race operates in the clinic, including possible changes in resource allocation,
policies, communications, and roles.
• Youth Tobacco Prevention Funding
The Health Department has received state funding for the next two years to expand Youth
Tobacco Prevention efforts in the county and assist with a regional approach to prevention of
initiation of tobacco use by young people. Some examples of how funds may be used include
providing training on emerging tobacco products to youth role models and paying for
registration and travel for students to youth empowerment and advocacy trainings and
conferences.
• Mobile Home Parks Survey
For many years, there has been interest in addressing the vulnerability of residents living in
mobile home parks in Orange County. The Board of Commissioners allocated funds in the
FY2015-16 and FY16-17 budgets to address land banking of mobile homes parks and/or to assist
in the acquisition of property for future residential development as an affordable housing
alternative. An ad hoc committee of local housing partners and the Planning Department began
meeting last fiscal year to discuss and evaluate the opportunities and obstacles. The voices of
mobile home residents have not yet been a part of this process, and the committee recognized
the need for their input. Navigators with the Family Success Alliance, who have personal and
programmatic connections to mobile home park residents, are partnering with the county
manager’s office to visit various mobile home parks in the coming weeks to conduct a survey
and will share the results of this survey with the County to help inform what actions can be
taken. We anticipate that results will be available in late September.
• Adolescent Health Services
Dr. Mike Steiner, Chair of the Department of Pediatric and Adolescent Medicine at UNC, is
interested in collaborating with the health department to expand comprehensive health and
wellness services for underserved adolescents and young adults in the county. An initial meeting
was held to discuss unmet needs particularly in the areas of substance abuse and mental health
services. A follow-up meeting is being scheduled to include other partners, such as Piedmont
Health Services, to see if there is interest and demand for a program similar to the JustTeens
initiative in Guilford County.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 23, 2017
Agenda Item Subject: Health Director Recruitment Update
Attachment(s):
Staff or Board Member Reporting: Liska Lackey
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information: To provide an update on the health director search.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):