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ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: October 24, 2018
TIME: 7:00 P.M.
PLACE: Whitted Building, 3rd Floor Meeting Room
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 October 24, 2018 Agenda
7:10 – 7:15 IV. Actions Items (Consent)
A. Minutes of September 26, 2018 Susan Elmore
7:15 – 8:25 V. Educational Sessions
A. Customer Satisfaction Survey Victoria Hudson/Carla Julian/
(20 minutes) Pam McCall/Rebecca Crawford
B. 1st Quarter Financial Reports & Billing Dashboard Reports Rebecca Crawford
(15 minutes)
C. Advisory Board Update Beverly Scurry
(15 minutes) (relative to BOH Strategic Plan Priority: Engagement)
D. Healthy Carolinians of Orange County Ashley Rawlinson
(20 minutes) (relative to BOH Strategic Plan Priority: All Priorities)
8:25 – 8:30 VI. Action Items (Non-Consent)
A. BOH Policy (Fee & Eligibility Policy) Rebecca Crawford
8:30 – 8:55 VII. Reports and Discussion with Possible Action
A. Fluoride Ad Hoc Committee Update Liska Lackey
B. Presentation of 2019 Vice-Chair Susan Elmore
C. Health Director Report Quintana Stewart
D. Media Items Kristin Prelipp
8:55 – 9:00 VIII. Board Comments
9:00 XI. 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 September 26, 2018 at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Susan Elmore – Chair, Timothy Smith –Vice-
Chair, Keith Bagby, Commissioner Mia Burroughs, Jennifer Deyo, Jessica Frega, Liska Lackey
and Sam Lasris.
BOARD OF HEALTH MEMBERS ABSENT: Bruce Baldwin, Barbara Chavious and Paul
Chelminski.
STAFF PRESENT: Quintana Stewart, Health Director; Rebekah Moira Beck, Environmental
Health Specialist; Rebecca Crawford, Financial and Administrative Services Director; Jane
Grace, Advanced Practice Practitioner; Victoria Hudson, Interim Environmental Health Director;
Jennifer Jean-Baptiste, Office Assistant II-Nutrition; Renee Kemske, Nutrition Program
Manager; Anitra Kincy, Patient Accounting Technician; Lisa Lowe, Public Health Nursing
Supervisor II; Pam McCall, Public Health Nursing Director; Kristin Prelipp, Communications
Manager; Beverly Scurry, BOH Strategic Plan Manager;and La Toya Strange, Administrative
Assistant II.
GUESTS PRESENT: None.
I. Welcome New Employees
Susan Elmore, Chair, called the meeting to order. Quintana Stewart, Health Director, welcomed
new employees Jane Grace, Rebekah Moira Beck, Jennifer Jean-Baptiste and Anitra Kincy.
II. Public Comment for Items NOT on Printed Agenda: None.
III. Approval of the September 26, 2018 Agenda
Motion was made by Mia Burroughs to approve the agenda, seconded by Sam Lasris and
carried without dissent.
IV. Action Items (Consent)
A. Minutes of August 22, 2018 Meeting
Motion was made by Jessica Frega to approve the minutes of August 2018 with edits,
seconded by Sam Lasris and carried without dissent.
V. Educational Sessions
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A. Nutrition Update/Employee Heath and Wellness
Renee Kemske, Nutrition Services Manager, provided an overview of Nutrition Services and
discussed current/upcoming progress with the Community Health Grant.
Overview of Services: Ms. Kemske discussed current services offered: Medical Nutrition
Therapy, Diabetes Self-Management Education Services, Employee Wellness Services and
CDC Minority Diabetes Prevention Program. She provided data on types of MNT clients seen
and payer mix in FY18: 782 (53% OCHD referred, 47% non OCHD) and 42% Medicaid, 31%
Insurance, 27% Self-Pay.
History of Community Health Grant FY18: Ms. Kemske provided an overview of the
Community Health Grant: Awarded funding ($122,065) for 9/17-6/30/18 to increase access to
primary care and self-management support services for adult residents with chronic conditions
(obesity, pre-diabetes, diabetes, abnormal lipids, and hypertension). Through the grant, OCHD
piloted a voucher program covering the minimum fee for nutrition services ($20) and increased
the number of primary care clients seen by threefold. The grant also purchased diabetes testing
supplies, and funds for interpretation services to increase access for LEP clients. Staff held two
diabetes classes in Spanish and purchased simultaneous interpretation devices to aid in
interpretation. 100% of the participants had improved knowledge of diabetes self-care
behaviors and were satisfied with simultaneous interpretation devices.
Partners offered 5 Living Healthy Classes to 54 people and received 4.9 out of 5 for customer
satisfaction ratings. OCHD hired a Community Health Worker who maintained a provider
contact sheet (~500c contacts) to disseminate health/service information and conducted 58
outreach events. Grant partners convened a Community Health Collaborative to increase
awareness of local chronic disease services and to establish a formalized referral system to
better link residents to services. The partners held two focus groups (older adults and Spanish
LEP) in May 2018 and learned that there is decreased awareness of local services,
transportation, language and cost were identified barriers, and participants want more nutrition
services.
Overview of Community Health Grant FY18-19: OCHD was awarded $145,915 for FY19 with
potential of two additional years to expand FY18 pilot work with the following additional
components: Chatham County Public Health Department will replicate the voucher program for
Nutrition Services, partners will pilot a transportation assistance program for patients identifying
transportation as a barrier to care, OCHD will partner with the Department on Aging to provide
funding and support for cholesterol screenings and wellness events, and the Community Health
Worker will be trained in the Spanish Living Healthy curriculum and teach one class in Spanish.
The BOH had questions that were addressed by Ms. Kemske.
B. Medicaid Transformation Update
Quintana Stewart, Health Director, presented an outline of the requirements for PHPs and the
impact of this for the local health departments (LHDs) in NC. She began with the background
on the Medicaid Transformation. Below are highlights:
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• Medicaid will transition from a predominantly fee-for-service structure to managed care
where DHHS will remain responsible for all aspects of the Medicaid and NC Health
Choice programs.
• Regarding Prepaid Health Plans (PHPs), there will be 4 statewide MCOs and up to 12
Provider-Led Entities (PLEs) in 6 regions.
• Regional Rollout
Phase 1 involves the rollout of 2 regions in November 2019; while in phase 2, the
remaining 4 regions will do so in February 2020.
• Standard health plans will rollout first. They will cover physical health and mild to
moderate behavior health.
• Tailored health plans will rollout in 2020. They will cover physical health, complex
behavior health needs, serious mental illness, substance abuse, etc.
• NC goals for Medicaid managed care are to 1)measurably improve health, 2)maximize
value to ensure program sustainability and 3)increase access to care.
• For the most part, OCHD services will remain the same. As a primary care provider, the
OCHD will concurrently launch the Advanced Medical Home (AMH) model with the
Managed Care Model. There will be one standardized contract across the state in which
DHHS will be responsible for developing and requiring PHPs to use. The PHPs will be
responsible for frontline oversight and have the right to terminate with the LHDs.
• There are 4 tiers in the AMH model. OCHD is currently a level 2 Carolina Access
program meaning we will be grandfathered into tier 2 but are able to attest to tier 3.
Before doing so, the OCHD must make sure that it’s a good fit for us. The biggest
difference between the two tiers is the reimbursement rates.
• DHHS will require PHPs to monitor the performance of AMHs in all tiers and calculate
performance-based measures based on a set of quality measures.
• AMH implications for LHDs include the LHDs having options to choose which tier they
want to participate in depending on eligibility and readiness.
• The safety net and current access to care for Medicaid patients should not decrease, but
be enhanced.
• There will be no changes to our Managed Care payments for the first 2 years. Cost
Settlement will continue for Medicaid services provided that are not in the Medicaid
Transformation plan. OCHD will bill and receive payment from the PHPs for services
provided to their patients.
• Some of the participating PHPs include Aetna, United Healthcare and UNC.
The BOH had questions that were addressed by Ms. Stewart.
VI. Action Items (Non-Consent)
A. BOH Policy
Quintana Stewart, Health Director, led the Board in a discussion of the proposed revisions to the
Standard Operating Procedures. The proposed revisions went sent to the Board for their review
prior to the BOH meeting. Proposed revisions included:
III. Composition
A. The composition of the Board of Health is governed by NCGS 130A-35(b)-(d) which states
the composition of the board shall reasonably reflect the population and makeup of the county.
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B. For purposes of Board composition, diversity includes, but is not limited to, professional
experience, cultural and educational background, geography, age, gender, race and ethnicity.
When assessing Board composition or identifying suitable candidates for appointment/re-
appointment, the Board will consider candidates on merit and statutory requirement with
consideration to the benefits of diversity.
C. The Orange County Board of Health is committed to ensuring diversity among members and
values the benefits that diversity brings. Diversity promotes the inclusion of different
perspectives and ideas, mitigates against group think and ensures that the Board has the
opportunity to benefit from a variety of skills, backgrounds and experiences.
D. The Board’s commitment to diversity shows internal and external stakeholders that the
organization emphasizes diverse constituencies and does not discriminate against minorities,
thereby enhancing the Board’s reputation with county government and residents.
C. Committees
3. Physical Activity & Nutrition to replace Access to Care
5. Social Determinants of Health to replace Childhood and Family Obesity
Prevention
The BOH members had questions that were addressed by Ms. Stewart.
Motion to forward to the County Attorney with the added change of “citizens” to
“residents” and approve contingent upon the County Attorney’s approval was made by
Jessica Frega, seconded by Jennifer Deyo and carried without dissent.
Rebecca Crawford, Financial and Administrative Services Director, began by informing the BOH
members that the BOH is required to review its policy manual annually. Updates to two sections
of the Fee and Eligibility section of the policy are recommended below:
I.E. Fee and Eligibility Policy
Staff recommends making the following revisions to the Fee and Eligibility Policy for the
purposes of clarification, to be in compliance with state requirements, and to update
according to system changes:
- Service Limitation/Denial (Section V.C.): Expanded the section stating that Family
Planning patients will never be refused service due to an outstanding balance or
inability to provide proof of income to include Maternal Health and Child Health
patients at the recommendation of the DHHS Administrative Consultant.
- Fees Collection (Section VII.E.): Clarified that clients are given a statement
showing the cost of services after charges are processed upon request rather than
at the time services are received since the Epic Electronic Medical Record (EMR)
system is unable to produce a statement until after charges are processed, which
may not occur until after the patient has left the clinic.
- Fees Collection (Section VII.I.): Updated the Billing Cycle section to specify the
billing statement process for the Epic Electronic Medical Record (EMR) system since
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it differs from both the Patagonia EMR and Eaglesoft EMR that was detailed in the
previous version.
The BOH will vote on the Fee and Eligibility Policy updates at the next meeting.
The BOH members had questions that were addressed by Ms. Crawford.
VII. Reports and Discussion with Possible Action
A. Health Director Annual Evaluation
Susan Elmore, Chair, reviewed this year’s process for the annual review. She will meet with the
County Manager. A survey will be sent to Ms. Stewart’s direct reports and a random sampling
of approximately 10 staff at the OCHD. The annual review will occur during a closed session at
the November 2018 meeting where the results will be discussed as well as her performance.
B. Committee for 2019 Vice-Chair Selection
As it is customary for the current Vice-Chair to occupy the Chair position because of the
experience gained as Vice-Chair, there will be a committee formed for Vice-Chair selection.
Susan Elmore, Chair, stated that Timothy Smith and Liska Lackey (Vice-Chair and past Chair,
respectively) will be on that committee and suggested that any BOH members interested in
serving on the committee contact Mr. Smith and/or Ms. Lackey. She also gave a brief overview
of the Vice-Chair duties.
The BOH members had questions that were addressed by Ms. Elmore.
C. Health Director Report
Highlights of Ms. Stewart’s report are below:
• She thanked all of the BOH members that met with her for their timeto have the 1-on-1
meetings and mentioned that she’ll meet with Sam Lasris once his meeting time has
been rescheduled.
• As of September 11th, the County had gone into full blown Hurricane Florence mode.
She gave a big Kudos and thanks to OCHD staff as they all stepped up during this time
assisting with shelters, Environmental Health going above and beyond with their
inspections of the shelters, Kristin for all of her assistance, etc. The OCHD received
compliments from various agencies for their help.
• On yesterday, the first Strategic Planning training occurred with Deitre Epps which was
centered around Results Based Accountability. There are various Strategic Plans
(Ashley Rawlinson – Healthy Carolinians; Beverly Scurry – Racial Equity Commission;
Coby Jansen Austin – FSA) within the OCHD and the goal is to have them fall under
one big comprehensive plan.
• Ed Kerwin will send the BOH letter to his board at OWASA. He stated that they were
appreciative that we’re assisting them with the fluoridation issue.
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• Beverly Scurry attended a conference on fluoridation and public health in Concord.
There were a lot of opponents of fluoridation that were also in attendance. Some of
them caused disruptions to some of the speakers.
• Last Friday, the Suicide Prevention Walk took place. Ms. Stewart thanked Timothy
Smith for attending.
D. Media Items
Kristin Prelipp, Communications Manager, briefly mentioned the article in which
LaTosha Scott was featured which was included in the Media Items packet.
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
VIII. Board Comments
Keith Bagby attended Orange County Schools Health, Safety and Wellness Resource Fair
that was held this past Saturday at the Hillsborough Walmart. He stated that it was a
great event with a good turnout.
IX. Adjournment
Liska Lackey moved to adjourn the meeting at 8:26pm and Keith Bagby seconded.
The next Board of Health Meeting will be held October 24, 2018 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Quintana Stewart, MPA
Orange County Health Director
Secretary to the Board
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: October 24, 2018
Agenda Item Subject: Customer Satisfaction Survey 2018
Attachment(s): Personal Health Client Input Surveys 2018
Staff or Board Member Reporting: Pam McCall, PHSD Director; Victoria Hudson,
Interim EH Director; Carla Julian, Dental Clinic Manager
Purpose: ____ Action
_ X_ Information only
____ Information with possible action
Summary Information:
Per Board of Health Policy and Accreditation standards, annually staff will present to the
Board of Health results of patient and client input on services received, including any
corrective actions deemed necessary to improve services.
Personal Health:
The majority of the measures show satisfaction rates of greater than 90% for both clinic
sites. Areas of improvement include increasing the sample size and assessing our
survey to assure we are capturing helpful information.
Dental Health:
The patient satisfaction surveys continue to reflect high satisfaction rates for services
provided, clinic wait time, and courteousness of staff and providers. Areas on which to
obtain new data include satisfaction with hours of operation, likelihood of seeking
services at a Chapel Hill Clinic, and delineating wait times for different types of
appointments.
Environmental Health:
The Customer Satisfaction Survey was analyzed for September 2017- September 2018.
There were 178 responses. There was a marked increase in the number of FLI service
respondents which is attributed to the increase number of FLI emails being sent. Open
comments are often very complementary and about helpfulness of OCEH. Comments
are used in performance reviews and in opportunities for quality improvement when a
comment may be critical of professionalism or wait times. The customers and
community are generally very satisfied with OCEH but there may be measures that are
missing. Open comments give more information which is not as measurable. There is
a proposal to add an optional return contact when the comment requires clarification.
There is a need for clarification on which surveys are community input versus customer
input. The survey collection filter needs to be adjusted to match FY.
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):
Environmental Health
Customer Satisfaction 2017-2018
Victoria Hudson
Interim Environmental Health Director
Purpose
•Customer satisfaction is a
priority of Orange County
•The local health
department must have in
place a process for
assessing consumer and
community satisfaction
with its services
•These are frontline
measures of quality and
performance improvement
processes for the agency
History – EH Surveys
•Originally a paper survey tool used to collect
responses from customers and community during a
scheduled period, once annually, and questions are
relatively unchanged
•Survey have been an electronic survey link on every
outgoing signature line from EH staff since September
2009
•Survey is aso a link on EH pages of County website
•To date, over 1300 survey results have been collected
Summary of this year’s data
•September 2017- September 2018
•N=178
•Survey consisted of 18 total questions
•Average time taken 2.25 minutes
•Allowed free form comment on services
•Allowed free form for
staff recognition
Survey Respondents
Improvement in FLI Respondents
•In July 2017 paperless initiatives so that FLI
staff sending more reports by email
•In 2017-2018 survey, a setting was
discontinued that prevented the same
computer from opening a new survey
•Increasing good rapport with establishment
operators and no fear of reprisal
Results- Response Time
Office Staff Field Staff
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
How would you rate staff promptness and response time?
Excellent
Good
Fair
Poor
N/A
Results- Knowledge
Office Staff Field Staff
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
How would you rate the knowledge of our staff?
Excellent
Good
Fair
Poor
N/A
Results- Overall Satisfaction
Excellent Good Fair Poor N/A
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
My overall satisfaction with the Health Department services
ONSITE
FLI
Results- Open Comments
•Comments are often very complementary
•Comments are often about helpfulness and
getting extra attention
•Comments are used in performance reviews
•Comments are used in opportunities for
quality improvement when a comment may
be critical of professionalism or wait times
Limitations
•The customers and community measure as
generally satisfied with OCEH
•Open comments give us a bit more
information but not measurable
•Proposing adding a way for return contact
when the comment requires clarification
•Clarify surveys that are community versus
customer
Conclusions and Improvements
•The customers and community are generally very
satisfied with OCEH but there may be measures
that are missing
•Open comments give us a bit more information
but not measurable
•Proposal to add an optional return contact when
the comment requires clarification
•Clarification on which surveys are community
input versus customer input
•The survey collection filter needs to be adjusted
to match FY
Questions?
Visit us at Orange County Environmental Health
131 W. Margaret Ln
Hillsborough, NC 27278
919-245-2360
www.OrangeCountyNC.gov/641/Environmental-Health
Dental Health Services Patient Satisfaction Surveys October 2018
Dental Health Satisfaction Surveys
Since July 2017 Patient Satisfaction Surveys Administered through Solutionreach Patient Management Software
Surveys built into program and sent automatically after patient’s appointment
Surveys not available in Spanish in Solutionreach
Paper Survey conducted October 2017
English/Spanish results combined
October 2017 English and Spanish Survey Results
Satisfaction with Overall Experience
October 2017 English and Spanish Survey Results (cont.)
The location of the clinic is convenient
October 2017 English and Spanish Survey Results (cont.)
Front Desk Staff Courteous and Responsive to My Needs
October 2017 English and Spanish Survey Results (cont.)
The Dental Hygienist or Assistant was Courteous and
Responsive to My Needs
October 2017 English and Spanish Survey Results (cont.)
The Dentist was Courteous and Responsive to My Needs
Survey Results (60 Respondents)
What Did You Like Most
Punctuality
Kindness
Attention
Making me feel comfortable
Trust everyone
Friendliness
Great attitudes
The people
What Can We Improve
Dentists explain problems better
Wait time for next appointment
Hire more hygienists
Get my teeth cleaned more often
Survey Results: June to Oct 2018
73 Respondents to Solutionreach survey
88% - total wait time less than 15 min
97% responded good to excellent for:
Dentist explanations
How well provider listened
Spent appropriate amount of time with patient
5 respondents (7%) said ease of scheduling urgent appointments was poor to fair
Dental Health Improvement Plan
2017 Follow Up
Wait time for hygiene appointment
Hired 3rd hygienist in July 2018
UNC Dental Hygiene students continue on Tuesdays and Thursdays through fall semester
Rescheduling patients with appointments greater than 6 months out
Able to schedule current patients for 3, 4 and 6 month recall appointments
Dental Health Improvement Plan - 2018
Investigate possibility of one late clinic per week and include question about hours of operation in survey
Include question about likelihood of going to Chapel Hill clinic location if offered
Include question about wait time for different types of appointments
Upload Spanish-language survey to Solutionreach
Customer Satisfaction Survey Results October 24, 2018
Personal Health Services
Surveys
•Paper surveys distributed one week in August
•Surveys available in English and Spanish
•29 surveys collected at SHSC
•32 surveys collected at WHSC
•Not all respondents answered all questions
Results
% AGREE WHSC
N=32
SHSC
N=29
Convenient Location 100% 100%
Convenient Hours 97%
1 no response
96%
1 no response
Easy to Contact Clinic 94%
1 disagree
86%
4 disagree
Easy to Make Appointment 94%
1 disagree
93%
2 disagree
Waited more than 15 minutes past
appointment time 34%
14 disagree
7 no response
31%
16 disagree
4 no response
Results
% Agree WHSC
N=32
SHSC
N=29
Staff Explained My Care 98%
2 no response
97%
1 no response
Staff treated me with respect 94%
2 no response
97%
1 no response
Staff listened to me 91%
3 no response
97%
1 no response
Understood staff explanations 94%
2 no response
97%
1 no response
Overall satisfaction 78%
7 no response
97%
1 no response
Would recommend to family and
friends 94%
2 no response
97%
1 no response
Results
% Agree WHSC
N=10
SHSC
N=8
Interpreter was professional 90%
1 no response
100%
Interpreter clearly interpreted for staff 100%
88%
1 no response
Interpreter clearly interpreted for me 100% 88%
1 no response
“How can we improve?”
•Very good, thank you for your help
•Nothing at all – I’m very pleased with the services.
•Nothing 10/10
•The phlebotomist was lovely
•Not that I can think of other than there should be a clinic in
Carrboro.
•I have found this office to be extremely professional at all
visits! Well done and kudos to the staff!
•Nothing for me, it’s really good.
Plan
•Continue to assess customer satisfaction
•Investigate approaches for continuous patient feedback
data (text surveys)
•Incorporate continuous quality improvement to provide
efficient, effective, patient centered care.
Questions?
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: October 24, 2018
Agenda Item Subject: 1st Quarter Financial Report FY 18-19
Attachment(s): 1st Quarter Financial Report
1st 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 FY19 after the
first quarter is $157k/month or $471k YTD, representing 13.6% of our overall budgeted
revenue for the year. Multiple factors contribute to the lower than normal revenue:
Electronic Medical Record (EMR) change to Epic, provider on maternity leave in Dental,
and departmental closures due to hurricane Florence. As usual though, the total first
quarter revenue is also skewed down due to the majority of state funds not eligible to be
drawn in July (this is typical) and allocations of Medicaid Max funds will not be
transferred into our budget until the end of the fiscal year. Expenses are higher than
revenues, but on trend, at 20.5% of the total, overall budget.
Total Billing Accuracy: Billing Accuracy is under construction due to the change in
EMR. The Informatics team is working diligently to have this measure for both medical
and dental back by the second quarter financial report.
Dental Earned Revenue by Source: The FY 18-19 average monthly revenue
($39.5k/month) for the first quarter is below our budget projection ($45k/month) and our
FY 17-18 average of $42.6k/month due to having a dentist on maternity leave. Also, we
projected and budgeted to receive a higher level of revenue for FY 18-19 than in FY 17-
18 because of the additional Dental Hygienist we received for this fiscal year. Our new
Hygienist was hired mid-quarter so we will not begin seeing increased revenues until
second quarter. FY 18-19 dental earned revenue totaled $118k at the end of the first
quarter.
Medical Earned Revenue by Source: Medical earned revenue is currently below the
budgeted projection for FY 18-19 ($55.6k/month) at $16.3k/month due to provider
turnover (2 new providers started seeing patients in late July and August) and as clinic
staff continue to work through issues with the new EMR, improved customer service
during the EMR transition with longer appointment times (meaning we saw fewer
patients), and have dealt with clinic closures due to hurricane Florence. We anticipated
these issues as they arise in all new automation projects and have staff dedicated to
fixes by increased training for providers, weekly workflow meetings, a Quality
Improvement team called the “Epic Optimization Team”, and teams devoted to building
algorithms with UNC IT to decrease errors in the billing system build (our state
requirements make our billing very different from a typical UNC outpatient clinic and
require much more specificity). Medical clinic revenue totals $49k for first quarter FY 18-
19.
Environmental Health Earned Revenue by Source: Environmental Health earned
revenue is currently below the budgeted projection for FY 18-19 ($53k/month) at
$44.3k/month) although this is a seasonal trend. We typically see an increase in
revenue during the spring with public pool and septic inspections.
Grants Fund Revenue:
FSA has drawn $100k of the multi-year Kenan grant. Expenditures are low at this time
but we anticipate these will increase once the new Social Work Supervisor II position is
filled in the second quarter.
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):
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Orange County Health Department
First Quarter Financial Report
FY 2018-2019
General Fund
TOTAL HEALTH Q1 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Revenue
Donations
Finance and Admin Services (6,000)(6,000)(6,000)100.00%
Health Promotion & Edu (16,000)(16,000)(26,450)60.49%
Personal Health 0 0 (18,000)0.00%
Donations Total (22,000)(22,000)(50,450)43.61%
Internal Allocations
Finance and Admin Services 0 0 (37,144)0.00%
Dental Health 0 0 (18,000)0.00%
Health Promotion & Edu 0 0 (244,756)0.00%
Personal Health 0 0 (30,000)0.00%
Internal Allocations Total 0 0 (329,900)0.00%
Service Revenue
Dental Health (118,337)(118,337)(542,217)21.82%
Environmental Health (132,505)(132,505)(637,494)20.79%
Personal Health (48,837)(48,837)(667,625)7.32%
Service Revenue Total (299,680)(299,680)(1,847,336)16.22%
State Allocations
Finance and Admin Services (42,249)(42,249)(42,921)98.44%
Health Promotion & Edu (5,002)(5,002)(86,446)5.79%
Environmental Health (364)(364)(41,324)0.88%
Personal Health (45,316)(45,316)(522,334)8.68%
State Allocations Total (92,932)(92,932)(693,025)13.41%
Grants Project Revenues
Piedmont Hlth Srv - Nutr 0 0 (33,800)0.00%
CC4C Accesscare (23,999)(23,999)(147,686)16.25%
PCM Accesscare (26,372)(26,372)(167,334)15.76%
Personal Health 0 0 (47,593)0.00%
MDPP (320)(320)(11,134)2.87%
Community Health Grant (6,151)(6,151)(145,914)4.22%
Grants Project Revenues Total (56,842)(56,842)(553,461)10.27%
Revenue Total (471,454)(471,454)(3,474,172)13.57%
Orange County Health Department
First Quarter Financial Report
FY 2018-2019
General Fund
TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Expenditures
Salaries 1,200,717 1,200,717 5,889,752 20.39%
Benefits 485,189 485,189 2,143,394 22.64%
Travel 3,172 3,172 19,371 16.37%
Training 16,170 16,170 73,444 22.02%
Certifications & Licensing 1,614 1,614 10,022 16.10%
Mileage 8,319 8,319 36,529 22.77%
Telephone 22,948 22,948 104,825 21.89%
Postage 3,587 3,587 13,475 26.62%
Equip Repairs 1,681 1,681 6,425 26.16%
Equip Rent 603 603 1,200 50.25%
Duplicating 1,867 1,867 14,350 13.01%
Printing 1,850 1,850 17,509 10.56%
Advertising 0 0 23,985 0.00%
Dues 2,388 2,388 5,150 46.36%
Subscriptions 60 60 1,700 3.53%
Dept Supplies 2,596 2,596 44,013 5.90%
Edu Supplies 60 60 21,105 0.28%
Office Supplies 5,338 5,338 29,185 18.29%
Medical Supplies 32,781 32,781 151,774 21.60%
Bloodborn Path Supplies 326 326 1,200 27.13%
Pharmacy Supplies 43,648 43,648 163,200 26.75%
Comp Supp/Software 1,143 1,143 5,933 19.26%
Contracted Srv 245,404 245,404 1,313,561 18.68%
X-Ray 2,729 2,729 24,625 11.08%
Lab Srv 21,126 21,126 151,810 13.92%
Bonds & Insurance 0 0 10,815 0.00%
Uniforms 3,502 3,502 8,700 40.25%
Community Proj 5,848 5,848 45,263 12.92%
Innovations Project 2,710 2,710 20,000 13.55%
Accreditation Project 2,750 2,750 2,750 100.00%
Credit Card Exp 2,599 2,599 11,800 22.02%
Capital Exp Under $500 2,959 2,959 4,134 71.58%
Nicotine Replacement Therapy 0 0 9,111 0.00%
Hurricane Florence 130 130 0 100.00%
Capital Expenditures
Equipment 923.95 924 889 103.93%
Expenditures Total 2126734.5 2,126,734 10,380,999 20.49%
Grand Total 2126734.5 2,126,734 10,380,999 20.49%
Orange County Health Department
First Quarter Financial Report
FY 2018-2019
Grants Fund
TOTAL HEALTH Q1 YTD ACTUAL
ANNUAL
BUDGET
% OF ANNUAL
BUDGET
Revenue
Kenan Grant 0 (100,000)(300,000)33.33%
Revenue Total 0 (100,000)(300,000)33.33%
Expenditures
Kenan Grant 9,010 9,010 300,000 3.00%
Expenditures Total 9,010 9,010 300,000 3.00%
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: October 24, 2018
Agenda Item Subject: Orange County Advisory Board Update
Attachment(s): Advisory Board Report
Staff or Board Member Reporting: Beverly Scurry
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
The Board of Health identified action steps related to engagement in the 2018-2020
Strategic Plan. One of these action steps is to receive biannual updates on actions of
other Orange County advisory boards that relate to the BOH strategic plan priorities.
The summary provided contains BOH top priorities related information from various
Orange County advisory boards from April 2018 to September 2018, as available from
the boards.
Some boards being tracked do not have updates included because they do not pertain
to the BOH’s priorities or they were not available at the time of the report.
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):
Submitted October 23, 2018
O RANGE C OUNTY
A DVISORY B OARD
S UMMARY
A PRIL 2018 - S EPTEMBER 2018
Board of Health Engagement
10/23/18
1
Biannual Report
Board of Health Engagement
B OARD BOH
P RIORITY
S UMMARY
Orange County
Schools Board
of Education
Social
Determinants of
Health, Physical
Activity and
Nutrition, Mental
Health and
Substance Abuse
• Approved agreement for FSA to conduct a Kindergarten
Readiness Program at New Hope Elementary for academic and
social support for students entering Kindergarten who did not
have access to Pre-K.
• Approved several MOAs including partnerships with
o Orange County Rape Crisis Center – Safe Touch
Program
o OCHD – Youth Tobacco Use Prevention Program
(TRU)
o Insight Human Services – Drug screening for students
and Substance Abuse Family Education
o Orange Partnership for Alcohol & Drug Free Youth
• Effort between Orange County Schools and Chapel Hill
Carrboro City Schools for mental health awareness – Children’s
Mental Health Awareness Week May 7 – 11, 2018
• Long-range planning and topics of interest for future board
agendas include:
o Community Engagement
o Racial Equity – discipline
o Equity Task Force
o Nutrition
o Minority Recruitment/Diverse Hiring Practices
o Full Landscape of community partnerships (gap analysis)
• Child Nutrition – Summer Food Service Program 2018
o 5,719 breakfasts served
o 8,429 lunches serves
Chapel
Hill/Carrboro
City Schools
Board of
Education
Social
Determinants of
Health; Substance
Abuse & Mental
Health
• Board received an update by the superintendent on their Equity
Plan which includes specific objectives and action steps
• Estes Hill Elementary is implementing the Conscious Discipline
Curriculum. This program uses neuroscience and developmental
psychology and applies it to teaching adults and children how to
manage their behaviors and emotions.
• Culbreath Middle School has AA Male WIN class that is a
semester long and addresses ways to help AA students create
lasting counter-narratives that combat pervasive implicit and
explicit racial bias.
• Equity End of Year Updated included program on specific
action steps that focus on instruction, discipline, and family and
community engagement.
10/23/18
2
• In efforts to update their Strategic Plan, CHCCS began collecting
data in November 2017. That data analysis led to four main areas
of focus including Student Success, Employee Experience,
Family and Community Engagement, and Organizational
Effectiveness.
DEAPR Physical Activity
and Nutrition • Members of this Board are county resident appointed by the
BOCC and represent each county townships plus municipalities.
They consult with and advise DEAPR and BOCC on:
o Parks planning
o Development & operation
o Recreation facilities
o Policies & programs
o Public trails & open spaces
• No meeting minutes available from April – September
Board of County
Commissioners
Social
Determinants of
Health, Physical
Activity,
Substance Abuse
& Mental Health
• Proclamations:
o Sexual Assault Awareness Month - April
o Fair Housing Month – April
• BOCC approved agreement for increased hours of FSA
Navigators
• EMS Initiatives and activities to promote community well-
being:
o Freedom House Alternative Destination Transport
o Naloxone Distribution Clean Needle Exchange
o Coordinated Opioid Overdose Reduction Effort
(COORE)
o Do Not Resuscitate (DNR) Bracelet Project
Chapel Hill
Town Council
N/A
Minutes are not available online
Carrboro Board
of Aldermen
Physical Activity
and Nutrition;
SAMH
• Resolution Passed for May to be National Bike Month; May 9th is
International Bike to School Day; May 15th is National Bike to
Work Day; and May 14 – 18th is National Bike to Work Week
• Proclamation that June is Pride Month as well as Gun Violence
Awareness Month
• Town of Carrboro award a NC DOT Bicycle and Pedestrian
Planning Grant to update the town’s Comprehensive Bicycle
Transportation Plan
Hillsborough
Board of
Commissioners
Substance Abuse
& Mental Health • The Board discussed very little related to the BOH top
priorities. They have passed a Resolution for Domestic
Violence Awareness Month for September.
Orange Unified
Transportation
Board
(OUTBoard)
Physical Activity
& Nutrition • The Bicycle Safety Subcommittee created a bicycle safety
video PSA as well as will post “Drive Safely Ride Safely’
safety signs within the county’s Rural Buffer signs.
• OC is piloting a Go Pass program for county employees.
Currently they are getting prices and working out the kinks.
10/23/18
3
This program will include shared bicycles and possibly
electronic scooters.
Healthy
Carolinians of
Orange County
All • Conducted the Poverty Simulation Exercise for Person County
on April 11, 2018. Approximately 30 people participated,
including the Person County Health Director
• Spoke with AL Stanback Counselors to propose implementing
“Sources of Strength” peer education model among students to
assist with mental health and suicide prevention efforts, a priority
of the Mental Health and Substance Abuse committee, to go
along with the “Be the 1 To” campaign that was adopted in 2017
• The Access committee sponsored a 211-a-thon, on June 26,
2018, in partnership with Cardinal Innovations and NC 211 to
bring awareness and education regarding 211, which is an online
portal for community resources.
• Conducted the Poverty Simulation Exercise for Chapel Hill
Carrboro City School Pre-K Staff on August 27, 2018.
Approximately 60 people participated including CHCCS
Superintendent
• HCOC’s Coordinator (Ashley), has a seat on the Orange County
Food Council and was asked to participate in the racial equity
work that will undergo and began in August. The Food Council
contracted with Tina Vasquez and had their first facilitation
session on September 19, 2018
• HCOC’s Mental Health & Substance Abuse committee hosted
its 2nd annual “Be the Light” suicide prevention walk on Friday
September 21, 2018. It was held at Gold Park, in Hillsborough
and had approximately 100 individuals present.
o The speaker was Phillip J Roundtree, who flew in
from Philadelphia, Pennsylvania
o Community Agencies/Organizations were present
that had something to do with mental health, safety
and suicide prevention. Those present were:
NAMI Orange
Moms Demand Action
Cardinal Innovations – Present and
sponsored $1000 to assist with the event
El Futuro
Orange County Strong – Donated bottled
water
WHIT’s – Provided kid scoop ice cream in
vanilla and chocolate
Safe Kids OC – Provided gun locks
o We had great community involvement
Quintana
Hillsborough Chief Hampton and Police
Officers
10/23/18
4
Commissioner Renee Price
Mayor Tom Stevens
Hillsborough Town Commissioner Matt
Hughes
Rick Bruton (Cardinal Innovations)
Board of Health Member Tim Smith
Organizations Present
NAMI Orange
Cardinal Innovations
Moms Demand Action for Gun Sense
OCHD Counseling Services
El Futuro
Orange County Strong
WHIT’s
Safe Kids OC
• The Access committee, last year, sponsored the County’s first
Try Transit Week, and recommended the county taking that
process over once they hired a Transportation Demand Manager.
That position was hired and that activity was consumed by the
County! The committee continues to support and the Demand
Manager sits on the Access committee. Try Transit Week was
held the week of September 17th and the Transit Academy was
held October 5, 2018 (rescheduled due to Hurricane Florence)
• The Physical Activity & Nutrition committee has members who
are volunteering with Orange County Schools to implement the
CATCH Program within the afterschool program for 3
elementary schools. The director of the afterschool program is a
member of the Physical Activity & Nutrition Committee, where
the request was asked.
• The CATCH Program was something funded through the BOH.
• The 3 schools participating in the CATCH program are
o Central Elementary
o Efland Cheeks Global Elementary
o New Hope Elementary
o Committee volunteers are volunteering the 3rd
Tuesday of every month and that will continue
through 2018. New schools will be selected next
semester
o The first date was October 16, 2018
10/23/18
5
Family Success
Alliance
Access • The Council adopted a new strategic plan for 2019-2021, which
maps out four main priority areas: Family Empowerment
(evolving the current navigator program into a tiered approach),
Partnerships (cultivating a more inclusive partnership model),
Systems Change (prioritizing racial equity and systems change),
and Foundational strategies (expanding reach and impact,
optimizing infrastructure, securing resources).
• FSA completed innovation grants to four schools that furthered
restorative justice practices, supported art therapy for students,
and enhanced mindfulness practices (FY17-18). FSA sponsored
summer camps at New Hope Elementary and Frank Porter
Graham Bilingue, and evaluation results showed improved
academic outcomes for students in both camps. The navigator
team has expanded to include two additional navigators, bringing
the total to 9 navigators. A grant from Kenan Charitable Trust is
supporting the hiring of a new Manager of Family Engagement
for a three-year term.
Justice Advisory
Council
Substance Abuse
& Mental Health • North Carolina Reentry Week was celebrated in Orange County
on Friday, April 27th in Hillsborough by having the first
gathering of the Orange County Local Reentry Council. The
event was hosted by the Criminal Justice Resource Department
and the Health Department.
• Criminal Justice Resource Department was awarded a grant to
serve as the Intermediary Agency for our Local Reentry Council
(LRC). This funding will provide critical support to the work of
the LRC and is renewable for a total of three years. The grant
also allows CJRC to hire two full-time positions: a LRC
Coordinator and a Reentry Case Manager.
S:\MANAGERS WORKING FILES\BOH\AGENDAS & ABSTRACTS \2018 Agenda & Abstracts\October 2018\V.D. Abstract October 2018
HCOC Update.doc
Agenda Item Number: ____
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: October 24, 2018
Agenda Item Subject: 2018 Healthy Carolinians Update
Attachment(s): Healthy Carolinians of Orange County 2017 Update
Staff or Board Member Reporting: Ashley Rawlinson, Healthy Carolinians
Coordinator
Purpose/Recommended Action: ___ Approve
___ Approve & forward to Board of Commissioners
___ Information with possible action
_X_ Accept as information
___ Revise & schedule for future action
Summary Information:
Since the last HCOC presentation, in March 2018, HCOC committees have been working hard
planning and implementing the goals that were identified in the 2016-2019 Community Action
Plans. This presentation will share some of the successes that came with implementation and
the plans of what is in store for the rest of 2018, as well as the upcoming plans for the 2019
Community Health Assessment.
Financial Considerations: None
Recommended Motion (if any):
Ashley Rawlinson, MPH
BOH Meeting
October 24, 2018
Social Determinants of Health
Poverty Simulation Exercise
Person County
May 11th
Approximately 30 participants
CHCCS Pre-K Head Start Staff
August 27th
Approximately 60 participants
Social Determinants of Health
211-a-Thon
June 26th
15 Agencies Represented
211 Day
Try Transit Week
Week of September 17th
Transit Academy
October 5th
Mental Health & Substance Abuse
Hosted 2nd “Be the Light” Suicide Prevention Walk
September 22nd
Guest: Phillip J Roundtree
Approximately 100 people present
Organizations Present
NAMI Orange
Cardinal Innovations
Moms Demand Action for Gun Sense
OCHD Counseling Services
El Futuro
Orange County Strong
WHIT’s
Safe Kids OC
Physical Activity & Nutrition
CATCH Program
A program for Elementary (K-5) and Middle School students that
encourages physical activity and nutrition among adolescents.
Addresses childhood obesity that is a priority and interest of
HCOC, the Board of Health, and SHAC (School Health Advisory
Council).
Schools involved this semester:
Central Elementary
Efland Cheeks Global
New Hope Elementary
The Remaining of 2018
Groundwater Presentation
December 4th
Whitted Human Services
5:30p – 8:30p
Partnerships with
OCHD Tobacco Prevention Program
Family Success Alliance
Organizing Against Racism
Plans for 2019
Community Health Assessment Process
Development of Leadership Team
Deciding who to involve in the process
Determine the process to collect primary and secondary data
from the community
Prioritize health issues for the county
Review and write the final report
Develop action plans to address those priorities.
2020-2023 Action Planning
Based on identified priorities, 2-3 action plans will be
developed around each priority
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: October 24, 2018
Agenda Item Subject: Fee and Eligibility Policy Approval
Attachment(s): Draft Fee and Eligibility Policy
Staff or Board Member Reporting: Rebecca Crawford
Purpose: _X_ Action
___ Information only
___ Information with possible action
Summary Information:
The Board of Health reviews its policy manual annually. Updates to two sections of the
Fee and Eligibility section of the policy are recommended below:
I.E. Fee and Eligibility Policy
Staff recommends making the following revisions to the Fee and Eligibility Policy
for the purposes of clarification, to be in compliance with state requirements, and
to update according to system changes:
- Service Limitation/Denial (Section V.C.): Expanded the section stating that
Family Planning patients will never be refused service due to an outstanding
balance or inability to provide proof of income to include Maternal Health and
Child Health patients at the recommendation of the DHHS Administrative
Consultant.
- Fees Collection (Section VII.E.): Clarified that clients are given a statement
showing the cost of services after charges are processed upon request
rather than at the time services are received since the Epic Electronic Medical
Record (EMR) system is unable to produce a statement until after charges
are processed, which may not occur until after the patient has left the clinic.
- Fees Collection (Section VII.I.): Updated the Billing Cycle section to specify
the billing statement process for the Epic Electronic Medical Record (EMR)
system since it differs from both the Patagonia EMR and Eaglesoft EMR that
was detailed in the previous version.
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):
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:, 10/2014, 9/2015, 4/2016, 9/2018
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:, 10/2014, 9/2015, 4/2016, 9/2018
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 30 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:, 10/2014, 9/2015, 4/2016, 9/2018
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, 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:, 10/2014, 9/2015, 4/2016, 9/2018
C. Family Planning, Maternal Health, and Child Health clients will never be refused service
due to an outstanding balance or inability to provide proof of income. Health Department
clients are eligible to receive these services regardless of their participation in other
programs. Family Planning, Maternal Health, and Child Health services are voluntary to
all clients.
D. Falsification of eligibility by the client may result in denial or limitation of services.
E. 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.
F. 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.
G. 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:, 10/2014, 9/2015, 4/2016, 9/2018
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 unless the client is deemed homeless.
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:, 10/2014, 9/2015, 4/2016, 9/2018
f. Analysis of existing self-pay client base and how increased costs would affect
their ability to get necessary care
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.
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.
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:, 10/2014, 9/2015, 4/2016, 9/2018
E. After charges are processed, the client will be given a statement showing the cost of
services for that visit as well as their total account balance upon request.
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 Division
a. Billing statements will be sent no more than three days after charges post to client ledger.
Statements will be sent to clients for the next two consecutive months for balances due.
After three consecutive months with a past due balance, accounts 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.
2. Dental Health Divisions
a. Bill statements 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.
3. 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.
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:, 10/2014, 9/2015, 4/2016, 9/2018
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.
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.
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, 10/22/2014, 9/22/2015, 4/26/2016, 9/2018
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, 10/22/2014, 9/22/2015, 4/26/2016, 9/2018
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 30 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, 10/22/2014, 9/22/2015, 4/26/2016, 9/2018
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, 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, 10/22/2014, 9/22/2015, 4/26/2016, 9/2018
C. Family Planning, Maternal Health, and Child Health clients will never be refused service
due to an outstanding balance or inability to provide proof of income. Health Department
clients are eligible to receive Family Planningthese services regardless of their
participation in other programs. Family Planning, Maternal Health, and Child Health
services are voluntary to all clients.
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.D. Falsification of eligibility by the client may result in denial or limitation of services.
F.E. 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.F. 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.G. 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.
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, 10/22/2014, 9/22/2015, 4/26/2016, 9/2018
E. Fees may be charged to clients for “non-program” specific services without being
adjusted on a sliding fee scale (flat fees).
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 unless the client is deemed homeless.
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
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, 10/22/2014, 9/22/2015, 4/26/2016, 9/2018
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
f. Analysis of existing self-pay client base and how increased costs would affect
their ability to get necessary care
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.
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.
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, 10/22/2014, 9/22/2015, 4/26/2016, 9/2018
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.
E. At the time services are receivedAfter charges are processed, the client will be given a
statement showing the cost of services for that visit as well as their total account balance
upon request.
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 Division
a. Billing statements will be sent no more than three days after charges post to client ledger.
Statements will be sent to clients for the next two consecutive months for balances due.
After three consecutive months with a past due balance, accounts 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.
1.2. & Dental Health Divisions
a. Bill statementss 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.
2.3. 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.
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, 10/22/2014, 9/22/2015, 4/26/2016, 9/2018
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.
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: October 26, 2018
Agenda Item Subject: Fluoride Ad Hoc Committee Update
Attachment(s):
Staff or Board Member Reporting: Liska Lackey
Purpose: ____ Action
_ _ Information only
__X Information with possible action
Summary Information: Ms. Lackey will provide an update on the recruitment of subject
matter experts.
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: October 24, 2018
Agenda Item Subject: Elections (Chair and Vice-Chair)
Attachment(s):
Staff or Board Member Reporting: Susan Elmore
Purpose: ____ Action
____ Information only
_X__ Information with possible action
Summary Information:
Per the Board of Health Policies and Procedures, the Board shall elect a Chair and
Vice-Chair by majority vote each year at the last meeting of the calendar year. This
discussion’s purpose will include getting nominations for each position for a vote that
will take place at next month’s meeting. We will be presenting the slate of officers.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Health Director’s Report
October 2018
• September 28, 2018 - Meeting with Christian Lawson, UNC Director of Emergency
Services; discussion around how to support a UNC Collaborative with Orange County to
support mental health work, coordinate local resources and improve efficiencies with
patient response activities.
• September 24th & October 1st, 2018 – OCHD Leadership completed two days of strategic
planning work with Consultant, Deitre Epps, Race for Equity, LLC. The departmental
strategic plan will use the Results Based Accountability (RBA) framework to link our
population health goals (population accountability) and PH programs/services
performance measures (performance accountability). The overall departmental plan will
also pull the Board of Health Strategic Plan, Family Success Alliance Strategic Plan,
Community Health Assessment/Improvement Plan and Racial Equity Council Strategic
Plan into alignment with the overall Health Department Plan.
• October 3, 2018 – OCHD Management Team Meeting; I completed Part 2 of the
Disciplinary Action Guidance Series; reviewed policy and procedures as outlined in the
NC Human Resources Manual; the manual was revised October 1, 2017.
• October 4, 2018 – Attended Orange County Department Director’s meeting; County HR
will move to a new performance evaluation system beginning January 2019. The new
system has 3 main content sections: Core Competencies (33.3%), Position Specific
Competencies (33.3%) and Employee Goals (33.4%). There is also a mandatory Mid-
Year Review with the new system.
• October 5, 2018 – Hurricane Florence Debriefing meeting with Deputy County Manager,
Emergency Services, Asset Management, Communications and Department of Social
Services; preparation for Board of County Commissioners Hurricane Response report
out.
• October 9th -10th, 2018 – Completed half of Week 1 of Municipal & County
Administration Course at UNC SOG; classes interrupted due to Hurricane Michael.
• October 12, 2018 – Annual OCHD Staff Picnic – great food and fellowship; some
employees were unable to attend this year due to effects of Hurricane Michael. Looking
forward to next year!
• October 16, 2018 – Dr. Day and I presented a mobile dental clinic proposal to Board of
County Commissioners as an option for fulfilling their commitment to reinstate county
dental services in the southern part of the county. This option would replace the original
plans to build a dental clinic in the upcoming Southern Human Service Campus
renovations. The Commissioners unanimously agreed with the mobile clinic option and
communicated their support.
Legislative Updates
• NC Association of Local Health Directors (NCALHD) provided comment on proposed
federal legislation entitled the “Pandemic and All-Hazards Preparedness Reauthorization
Act of 2018.” The association supports this legislation and notes that NC’s
accomplishments and successes, from mitigating Ebola outbreaks in 2014 to responding
to Hurricane Matthew in 2016 and currently responding to the opioid epidemic can be
directly attributed to the Pandemic and All Hazards Preparedness Act. NCALHD’s
specific comment on this legislation is related to Improving efficiency and strategic
planning for the use of PHEP and HPP funds. NCALHD feels this legislation would
further the work of local public health if it included the allowance of pre-preparedness
training for all staff, regardless of salary funding source, for emergency purposes. In
alignment with recommendation from ASTHO, we offer for consideration the following
amendment to the proposed legislation:
Notwithstanding any existing provisions to the contrary, formally allow state, local, and
territorial public health staff funded through federal categorical cooperative agreements
and grants to allocate up to 5 percent of their time to participate in pre-incident
preparedness-oriented training and exercises as well as be assigned to response activities.
This will help promote an agency-wide culture of preparedness and would enable state,
local, and territorial public health departments to more easily and quickly redirect, on a
temporary and limited basis, existing, skilled staff to serve as a force multiplier without
the impediment of funding source restrictions (e.g. General Funds vs. federal categorical
grant funding), when needed and would serve an important purpose, especially during
those smaller scale events when additional personnel are needed but the threshold for
formal temporary redirection of personnel is not met.
• NCALHD’s voted to support the NC Association of ABC Boards’ position to oppose
privatization of our State control system for the sale of liquor. The decision was made
based on the public health concern that access to minor’s could increase with no real
enforcement.
• During a press conference on October 15, 2018, Attorney General Josh Stein announced
that he has launched an investigation into Juul, the e-cigarette company. He sent the
company a civil investigative demand to ask for more information about Juul’s marketing
practices, retailers, and contact with resellers, efforts to verify age before purchase, and
any youth education and awareness programs. He also asked for information about the
number of North Carolinians using Juul.
Upcoming Events
• October 25, 2018 – “Vision 2020: Together, We Can Vaccinate Our State Against
Tobacco Use”; American Cancer Society Tobacco Partners Meeting in Raleigh, NC.
• October 29, 2018 – NC Public Health Leadership Institute full day in-person session in
Chapel Hill, NC.
• November 2, 2018 - *Original Date Cancelled due to Hurricane Florence*Annual
UNC PHield Trip – a way of introducing incoming public health students from UNC to
local governmental public health; approximately 40-50 students will come to
Hillsborough to learn from staff what local public health looks like in practice. Donna
King serves as lead on this and has an afternoon of fun and engaging activities planned.