Loading...
HomeMy WebLinkAboutAgenda - 09-17-2024; 8-h - Fee Schedule Changes for Health Department 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: September 17, 2024 Action Agenda Item No. 8-h SUBJECT: Fee Schedule Changes for Health Department DEPARTMENT: Health ATTACHMENT(S): INFORMATION CONTACT: August 28, 2024 Board of Health Proposed Fee Changes Agenda Item Frederick Perschau, Finance and August 28, 2024 Board of Health Administrative Services Director, Proposed Fee Changes Agenda Item 919-245-2414 Addendum FY 2024-25 New Fees Requested Spreadsheet Environmental Health Fee Change Information PURPOSE: To establish and update fees as recommended by the Board of Health for certain personal health, dental health and environmental health services to assist in cost recovery. BACKGROUND: According to North Carolina General Statute (NCGS) 130A, the Board of Health is responsible for reviewing and recommending fees to the Board of County Commissioners in order to recover costs for those services for which fees may be charged. Establishment of fees also allows the Health Department to recover costs from third parties such as Medicaid, Medicare, and private insurance. A standard fee must be established that is charged to a patient or client regardless of their insurance status. The Health Department also has established a sliding fee scale to charge patients/clients based on income. At its August 28, 2024, meeting, the Board of Health reviewed and approved the proposed fees, recommending that the changes move forward to the Board of Commissioners for action. While the charge for the service is always the same, the amount collected by the Health Department varies according to the payor source. Twice a year, Medicaid reviews and makes rate adjustments based on the experience with various providers throughout the state. The department reviews and adjusts its fees based on this review to ensure that the maximum income allowed by Medicaid for a certain procedure can be recovered to defray the costs for providing a particular service. The Department reviews fees annually as part of budget process, however, sometimes changes in policy at the state level lead to a change in the fee structure, or a change in best practice for medical care dictates changes that fall outside of the budget cycle. The Medicaid Cost Settlement methodology requires that the Health Department examine its existing fees. In doing so, staff used the following methodology: 1. Increased fees to the regional cost average rather than the actual cost if it was significantly higher 2. Decreased fees if the actual cost was less than the current fee 2 3. Confirmed that all fees are equal to or exceed the Medicaid reimbursement rate This resulted in one (1) new proposed fee for the dental clinic (Dental Health), one (1) new proposed fee for the medical clinic (Personal Health), and one (1) new proposed fee for Environmental Health. Other additional proposed fee adjustments relate to Environmental Health fee increases for all re- inspection types as cost recovery for staff time. FINANCIAL IMPACT: Since most of these fees will only recover the direct costs of providing the services, the Department does not anticipate substantially increased revenues or expenditures. The Department continues to experience an increase in service to residents that qualify for reduced payment on the sliding fee scale. ALIGNMENT WITH STRATEGIC PLAN: This item supports: • GOAL 2: HEALTHY COMMUNITY OBJECTIVE 2. Expand access to quality, affordable healthcare services. • GOAL 1: ENVIRONMENTAL PROTECTION AND CLIMATE ACTION OBJECTIVE 6. Protect water supply/watersheds. RECOMMENDATION(S): The Manager recommends that the Board approve the proposed fee schedule changes, to become effective based on the dates on the attached FY 2024-25 New Fees Requested Spreadsheet, for Personal Health, Dental Health and Environmental Health Services as recommended by the Board of Health. 3 Agenda Item Number: VIII.A. ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 28, 2024 Agenda Item Subject: Proposed Fee Changes Attachment(s): New Fee Form Staff or Board Member Reporting: Dr. Stephanie George, Victoria Hudson, & Carla Julian Purpose: X Action Information only Information with possible action Summary Information: Fee Request 1 Dental Health Services would like to add a new fee which is a current fee reimbursed by Medicaid. The code is D1355 - Caries preventive medicament application - per tooth. Medicaid reimburses this procedure at $11.00 per tooth. There are very little restrictions in timing and quantity of this code. This procedure involves placing Silver Diamine Fluoride (SDF) to teeth that are at high risk of caries, such as partial erupted permanent teeth and teeth that are difficult to clean. Health Equity Impact We plan to use this medication in our current clinics, but also as we go into schools this year to provide preventive treatment. We can easily apply this medication to children and teeth that are at high risk for caries and help prevent future decay, even if we are unable to follow-up with routine care for these kids. This is a quick and affordable preventive measure we can take in our clinic and in schools. Fee Request 2 The Environmental Health Division requests fee increases for all re-inspection types as cost recovery for staff time. Health Equity Impact This fee has not increased for more than 3 years. The fees are assessed to contractors and management entities who require more than customary inspections due to failure to 4 comply with conditions of Permits or violations of Rules and North Carolina Administrative Codes. Fee Request 3 The Environmental Health Division requests a new fee which will be added to Building Permits requiring administrative review by Environmental Health. This fee is only assessed when the Building Inspections Office requests the review. It is collected by the Building Inspections Office as part of the Building Permit. This fee will not be assessed for any other Environmental Health/ Health Department function of the County. A decision will need to be made regarding the account where funds will be deposited. Health Equity Impact The Building Permit Review Fee is based on the total square footage of the building project. The fee is set at only 10 per square foot with a $25 minimum. Over the course of a fiscal year, these cents will add up. If possible in FY25-26, Environmental Health staff will deposit funds into an enterprise project account to fund environmental health equity assistance with the Orange County Housing Department to meet goals of the Division Strategic Plan. Fee Request 4 Personal Health Services requests a new fee be added for a Stand-Alone School Health Assessment. Proof of a health assessment for a child entering NC public schools for the first time is required according to NC General Statue 130A-440. The health assessment must have been completed within 12 months prior to the date of entry to public school. If the school hasn't received the health assessment form and a record of completed immunizations by the 30th calendar day from the first day of a child's attendance, the principal is required by law to exclude the child from school on the 31st day until such evidence has been presented by the parent or guardian. Many children come to the health department for their school health assessment and immunizations during that 30-calendar day period before school exclusion. If an age- appropriate child health preventive health visit cannot be performed during time allotted for the School Health Assessment, the NC Division of Child and Family Well-Being, Whole Child Health Section allows for a Stand-Alone School Health Assessment at a fixed rate to improve access for children and adolescents to avoid exclusion from school. The Personal Health Services Division would like to add the following fee to their fee schedule in order to bill for the allowable stand-alone fee: 2024 ICD-10-CM Diagnosis Code Z02.0 - Encounter for examination for admission to educational institution - $40.00 Health Equity Impact Preventive examinations on OCHD's fee schedule range from $205.00 to $275.00. The average fee for Z02.0 at walk-in clinics is $60.00 to $200.00. We believe a flat fee of $40.00 will allow our lower income community members the opportunity to pay less than what they would pay at a private sector walk-in clinics when a complete preventive 5 examination is not possible due to the number of visits we need to accommodate during the 30-calendar day exclusion period. Recommended Action: Approve X Approve & forward to Board of Commissioners for action Approve & forward to Accept as information Revise & schedule for future action Other (detail): 6 Agenda Item Number: VIII.A. ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 28, 2024 Agenda Item Subject: Proposed Fee Changes, Personal Health Services Addendum Attachment(s): New Fee Form Staff or Board Member Reporting: Carla Julian Purpose: X Action Information only Information with possible action Summary Information: Personal Health Services Fee Request Proof of a health assessment for a child entering NC public schools for the first time is required according to NC General Statue 130A-440. The health assessment must have been completed within 12 months prior to the date of entry to public school. If the school hasn't received the health assessment form and a record of completed immunizations by the 30th calendar day from the first day of a child's attendance, the principal is required by law to exclude the child from school on the 31 st day until such evidence has been presented by the parent or guardian. Many children come to the health department for their school health assessment and immunizations during that 30-calendar day period before school exclusion. If an age- appropriate child health preventive health visit cannot be performed during time allotted for the School Health Assessment, the NC Division of Child and Family Well-Being, Whole Child Health Section allows for a Stand-Alone School Health Assessment at a fixed rate to improve access for children and adolescents to avoid exclusion from school. The Personal Health Services Division would like to add the following fee to their fee schedule in order to bill for the allowable stand-alone fee. 2024 ICD-10-CM Diagnosis Code Z02.0 - Encounter for examination for admission to educational institution - $40.00 7 Health Equity Impact Preventive examinations on OCHD's fee schedule range from $205.00 to $275.00. The average fee for Z02.0 at walk-in clinics is $60.00 to $200.00. We believe a flat fee of $40.00 will allow our lower income community members the opportunity to pay less than what they would pay at a private sector walk-in clinics when a complete preventive examination is not possible due to the number of visits we need to accommodate during the 30-calendar day exclusion period. Recommended Action: Approve X Approve & forward to Board of Commissioners for action Approve & forward to Accept as information Revise & schedule for future action Other (detail): 8 FY 2024-25 Annual Operating Budget Proposed Fee Change Department Health 1.Review FY24-25 Commissioner Approved Fee Schedule linked here 2.List any proposed new fees or fee changes below Anticipated Reason for Increase 2024-25 Revenue (Describe,in detail,why the increase is needed and what 2023-24 Proposed from Fee Division Name of Fee impact the increase will have.) Rate Rate Change Effective Date To cover the cost of shipping printed materials to residents Example- who request information.Recent postage increase has Finance Example-Shipping Fees caused a funding gap of$1,000 since November 2021. $ 1.00 $ 1.10 $ 4,000.00 July 1,2024 Dental Health D1355-Caries preventive New Fee $ - $59.00 $4,000.00 October 1,2024 Environmental Denial of a Operation Health Permit/Reinspection fee Cost recovery of staffing $ 50.00 $ 100.00 $1,000 November 1,2024 Environmental New fee:To cover the cost of staffing unfunded CB project- Health Review of Building Permit requirement of Planning and Inspections Department $ - $25 min $26,475 November 1,2024 Denial of a Well Environmental Construction/Reinspection Health fee Cost recovery of staffing $ 50.00 $ 100.00 $500 November 1,2024 Environmental Total Suspended/Dissolved Health Solids Analyses Cost increase of lab kit $ 75.00 $ 100.00 $ 100.00 November 1,2024 Environmental Swimming Pool Permit Health Denial/Reinspecition fee Cost recovery of staffing $ 150.00 $ 200.00 $ 750.00 November 1,2024 Z02.0-Encounter for Personal Health examination for admission Services to educational institution New Fee $ - $ 40.00 October 1,2024 Page 1 of 1 Proposed Fee Change i New Fee : Building Permit EH Review • The business rules of the Orange County Building Permits require Environmental Health ( EH ) to review each Permit where there is onsite wastewater and/or water supply. Multiple reviews are included when changes are made during construction . • FY 23/24 there were N1, 059 reviews without compensation . These reviews require 3-5 workhours each week.