02/01/1984 BOH Minutes
Dag7e
The New Hanover County Board of Health met on Wednesday, February
1, 1984 at the New Hanover County Health Department.
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Membe rs Present:
Larry Neal, D.D.S., Chairman
Jean Credle, V. Chairman
Ted Bagley
Donald Blake
Carl Durham
Charles Hicks, M.D.
Harley Phillips, D.M.V.
Arnold SobOl, O.D.
James Strickland
Hobart Whaley
Members Absent:
William Grathwol
Others Present:
Robert S. Parker, Secretary to the Board
Ken Silliman, County Attorney
Mabel Price, Recording Secretary
Dr. Neal, Chairman, called
correct ions to the January
minutes be approved. Mr.
carried unanimOUSly.
the meeting to
4, 1984 Minutes.
Bag ley seconded
order and called
Mr. Whaley moved
the motion and
for
the
it
The following Board Members were given the Oath of Office:
1. Ted Bag ley
2. Charles Hicks, M.D.
3. Harley Phillips, D.M.V.
4. Arnold Sobol, O.D.
Jackie Loftis, Public Health Nurse, gave an informative
presentation on Our Triage Program and what it is accomplishing.
Fee Commi ttee Report: Mr. Parke r had prepared a revi sed schedule
of fees to be charged by the Department based on decisions made at
a Fee Committee Meeting. Copies of this schedule had been mailed
to the Committee and each member of the Committee felt that the
new Schedule was good. After much discussion, Mr. Blake moved
that the Fee Schedule be accepted as presented. Mr. Strickland
seconded the mot ion and it carried unanimously. A copy of the new
Schedule is attached as part of these minutes. The new Schedule
will be sent to the County Commissioners for approval. Target
date to begin using this Fee Schedule is July 1, 1984.
Long Range Planning Committee Report: The Long Range Planning
Commi tte had met and presented a draft of a long range plan for
the Board. Dr. Hicks moved that the Board adopt the draft as a
Long Range Policy for the Board. Mr. Durham seconded the motion
and it carried unanimoUSly. A copy of the Policy is attached as a
part of these minutes.
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00973
Emergency preparedness commi t tee Report: Mr. Whaley, Cha i rma n of ....
this Committee, gave a written report to the Board of a meeting
between this Committee, Col. Ben Washburn and other members of the ..
the Civil Preparedness Office. This Committee will meet again on
February 21, and Mr. Whaley invited any Board Member who wished,
to join them.
Proposed Satellite Clinic Changes: The follow-up communications
suggested by the Board at the January Board of Health meeting had
been completed. Notices had been posted in clinics that were to
be closed and input from the Department of social services had
been received. Therefore, Mr. Parker and Mrs. Marian Duggins,
Director of Nurses, presented a revised plan for closing various
cli nics. Mr. Blake moved the amended plan be adopted. Mr. Durham
seconded the motion and it carried unanimously. A copy of this
plan is attached as a part of these minutes.
Justification for Two New Sanitarian positions: Mr. Parker and
Michael Rhodes, Director of Environmental Health, presented
written justifications for the two new Sanitarian positions for
the Environmental Health Program. Mr. Parker will present this
justification along with the request for the two new Sanitarians
to the Commissioners.
Heal th Director's six Month Evaluation: Dr. Neal told the Board
that the Personnel Committee Would meet the middle of February to .....
do a six month's evaluation of Mr. Parker.
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Contract Signatures: Mr. Parker told the Board that according to
the requirements, all contracts will be presented to the Board of
Health for approval and signed by the Chairman of the Board. It
was suggested that the Board Agenda include a "Consent Agenda" for
items such as this.
Sewer Bond Referendum: Mr. Blake talked. about the Sewer Bond
Referendum which would be held on March 6, 1984 and encouraged the
Board to adopt a resolution supporting the Referendum. Mr. Blake
presented a resolut ion and moved that it be adopted. Mr. Durham
seconded the mot ion and it carried unanimously. A copy of the
Resolution is attached as a part of these minutes.
Animal control: As a matter of information, Mr. Blake told the
Board that Carolina Beach and Kure Beach are considering adopting
the County Animal Control Ordinance and asking the County Animal
Control Division to enforce it for them.
Health Director's Comments: Mr. Parker gave the Board Members
copies of the North Carolina Public Health Association Newsletter
and a Brochure on a Hazardous Waste Meeting designed for Board's
of Health and Health Professionals. The meeting will be held on ....
May 21 and 22, 1984 and will begin at 6:00 P. M. Place is to be
announced later.
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00974
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There being no further business, Mr. Whaley moved
be adjourned. Mr. Durham seconded the motion and
carried unanimously. The Board adjourned at 9:25 A. M.
the
the
meeting
motion
Date Approved:
/j
C--'~ /l~ ~
Chairman, Board of Health
~~p~
Secretary to the Board
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DATE:
Narch 12, 1984
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Bob Parker
FRO;'1:
j'iarian Duggins
2E::
Consolidation of Martin Luther ~lng and
P.3nkin Teprace
Effective July 1, 1984
I. ':tatement:
Fo:lowing the Board of Yealth Action cn Febr~sry 1, 1984 concerning
:he above ~entioned activity, I have evalua:ej :he space 13yout at
~he t~o cl~nic=, and t18ve discussed ~cte~tial re~ovation to allow
r-'re [.:;:::,':e ,r urcr2,je ~;,'=',c:;er:~ space "v.':...:~ ';,. ::,;i?t:'s:;r. :i.'1''': ;'r. 2r.ell
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DA'l'L:
December 29, 1983
TO: Bob Parker
FROM: r,1ar ian Dugg ins
RE: pnCPOSED SATELLITE CLINIC CHANGES
I i-roblem
Current schedule of Satellite Clinics is expensive in terms
o~ !~( ~?ower, travel and ~hysician fees. The effectiveness
of s~rvices is questioned. Histor~ sJggests that clinics
~ave heen maintained and additional clinics have been es-
toblished without monitoring and id2I1tification of need.
1 I :::'(...::c.....:l"e:-l(1at::..on
;::2:~,,~..:~(; u',j::Lbl?r 'J:: cl:.r..:..cs ::'!-lro'..lgh c.~""".bi!~a.tiGn or eli:-;-,i~atiC:1
~s ~~Jicated by ~tiliz~t~cn, aGo~~a~nlC location and ser-
.:C~S I>:::::'~"'~l.Jcd~
3ee :-~:~oscd sC~0~u10.
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~~~;~ .)~ ___~lCS ~:~V8 s~a~l 3ttc~~a~-2, ~-8 p3~i8nts per
=li--'~ ~e ~nst is t~~ sa~e 3S l~~_:er :;~::ics, 15-~5 per
~1 2-:. "c::-c: '::":~r: ':.~G-~2l= :::..c: cl_:'~l':~:; :-:re 1~:;3tcc ....rithin
:: ~:,-':-:i':".~ ::-Ciii..1s 2.ess 7:.".3.:1 ::ive r:-,i~J~s .:""rom the ~-ie2.lth
2~2r~~e~t ~her~ ~any ~~ ~~le 3a~e ser;~2es are av~ilable.
-~~!~-por~~tic~ of
~~
.: "'.:C")c~~at':c.::1 ::~
~ecc~~:s, j~?lica~2 :-cccrds 1nd transfer
:~:?:s"t.~r :3:cJs ir1Cree:.s'2s :7i3.rgin 0:: e~ror
'.;!;; -:: ,~;:~~~'isio:1 to assure Y:Ja,li ty Sf=r-
.:': ::~cc.::a.l ;..it.3..
:i...~-' is ~_i::.:c'_l"': tD ""':".':-~~.~L::.l.:"l.
=T,' "~.''''':'C)':3i:''': -:-t.-,~;j,-:.2.::.>
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~ic~~n ~~~h~r ~~c ~lnj ~2~:~in ~0rr~ice :atellite Clinics
j;:e :'o,-"-::cl _~ ~~~~C'2~:1 C":-"'.I;",u:::.ty C::;'::ters. ~'lartin Luther
~t3. -:- -:0-.-j ..... ._~~ ~n ~"-? ~-~r;:l -1 C:(;;:c].-; ~,.J.nr:in has 2-n F~~P and
('.::n:-,i.l:i.it..~. ;t::31t!1 -",-i~.:i::'. ~~:~ -crk :--:3C is i'!ery similar, and
~o~~ _hJs~~~l ~~"a~3 ~r2 ~~~~ ). o~e site, ~t~llzlng all
~~~~ 3~~f~ ~e~~2r5. ~2.orj ~~3~~rl ~s ~rdependent ~rom
~ltl; j;f-:~'3!"+::-:'=~t ,:2r.t:-::l =-i.l.0..S :-::J.c: ~s i23l~:1L"'C by the
-'::::-."t.:.c+:i\"c ~'d"'S. Sill-'!:.:'=-..:....:::~ '~!ld c.c;:....i.pi7:C:1t 2l.:G housed dt the
~~L_ h De~~rt~c~t. ctnJ _3~c~atcry 2~j ~-r3Y stuJies a~e
(,,_'";;1.c: _.l,'_ t-.i:e ~~e-.:::.l-:'~l r'('::;)"":_'::::-or:t: ::-e,=:,~i~in: :rc::; :211:' trJ.vel.
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nCO:1 daily.
,-..:r." n :2rr.:i...:'C 1.3 Y'~~~:-l
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Reco~~endation to co~~ine these two clinics will:
Provide opportunity to design record system
compatible with Health Department Master Card
and Central File.
Provide a staff compliment that appropriately
serves the patient, e.g., FNP, CHA and Clerk.
Provide sufficient man hours to operate the clinic
~rom 8 a.m. to 5 p.m., and after regular hours
Nithout interruption in services.
~educe cost of nedical equipment.
B. 'Jell 3ab" Clinics - Phvsician Attendina
~
C~rrc~tly ~ave 9 clinics per month at 8 co~munity sites.
There are C2':-1':rZiC~S 'n,ith 7 pediat.ricians and 1 family
~r2ct~L2 ~hysician.
P~r:'S,~32 :::';3.-:' ;l:,::-cbr-::'r c~ clinics be reduced to 4 and
c:~:-_~r....:::i..~:, sites ~c red:.Jced to 4.
:::!":;-csed =:~,;-,::_l'~ (s'2:c !13.p, loca-=ior.s)
C:-e:::L 'cs:J. "cr<>:h .'.. ._'c~l;:h 1 :-: ~Gnt:--~
~C':..:J2.=-;e ~'or:.h a;-:s' South
,~e~~.~! 1 x ~onth
~~c.".b:_;-e :;e::"ay, 2oustO:l ~'1oore, :'Jt?sbi tt Courts
LO:1C:: =-~?.3: ~:l::::-}:
1 x mor.th
-....::::-'.8:"::2 !.-)o::g Lea.f and Masor;boro
C3.rcl_I1.J. :.;-=:.3.C......1
1
;non~h
c. ::~al.~~ ~:3.i:1~e:1ance Cli:1ic:s - ?~urse :;ttcnding
!::'..:.rre:-:tl_' ~i:::~'e ~4 clinics at 12 sites, excluc..:.ng Martin
:.llther" :':l~:G (~r:c. .'~,C:.:1k.ln 7err3ce. Clinics arc located in
~Gtl;;'::--~~ :-L"O] ?,:'t: ~>J,-:"l~~i:1~s 3nd CO::-::-iunity Centers, except
:01:' .=-:t-::s _:'1 \ .~;~~c:iist Church) a:1d Sil....er Lake
(_..2Pt:.:~:. C'1.1,::,'C~l~.. l:.t~eridance is ~ess than If) patients
rf~= ;:_~ic l:: =cot~s ElIJ., Silver L3Ke, flillcrcst and
C.J.l-ol..;.,:J3 ::-:-c~.;:-;..
I'r.....):~,.)~': _';:',::'J:~r:'J !"i'..2r.ber of c1ini::-s rer :ont!1
13, -,; ~ ~."~.3j20 :Jltc:5 -:::-om 12 to I.
::-om 24
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Ronald H. levine, MD., M PH.
STATE HEALTH DI~ECOR
DIVISION OF HEALTH SERVICES
POBox 2091
Raleigh, N.C 27602-2091
',\
11M I 9 1984
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March 8, 1984
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1,..__.-,,_,. I
TO:
Local Health Directors
V ("OJ
'i""O~
ME!-!ORMDt'l1
FR0/1:
Dr. Ronald H. Levine, State Health
SUBJECT: Charges Prohibited by North Carolina State Statute
It has come to my attention that some health departments may be charging
patients for services where charges are prohibited by law. I remind you that:
G.S. 130A-153(a) prohibits charging patients for administration of vaccines
required by law:
G.S. 13U.\-162
prohibits ch,Jrgin~ patients for examination and treatmEilt
of V.D. patients; and
G.S. 130A-!7~(a) prohibits cllargin~ pati~nts for Examir:ation and tre3tme~t of
tuberculosis patients, suspects and cor-tacts.
This means that no charge may be made to the patient for administrative,
diagnostic, or treatment procedures associated with delivery of the above
services. The health department is required to administer required immlniza-
tions a~d provide examination and treatment of venereal disease and tuberculosis
at no cost to the patient. However, this does not preclude billing Medicaid
for eligible patients or billing other potential third party payors. Please
contact the appropriate progrdm office or the office of third party reimburs~-
mcnt if you have questions.
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Jame\ B Hunl Jr/ Sarah T Morro....... M D M P H
DEPARTMENT Of HUMAN RESOURCES
GOVERNOR SECIlET AllY
..
\'...:"t-..ST~TE Of NORTH CAROLINA
fA:;~. .
Attachment #4
STATEMENT OF INABILITY TO PAY
This is to verify that I am medically indigent and cannot
afford to pay for Health Department services.
DATE
REVIEW OF CONSENT FORM
PATIENT SIGNATURE
WITNESS SIGNATURE
7-1-84
Attachment #5
SATELLITE CLINIC
STATEMENT OF INABILITY TO PAY
This is to verify that I am medically indigent and cannot
afford to pay for private medical care.
REVIEW OF CONSENT FORM
DATE
PATIENT SIGNATURE
WITNESS SIGNATURE
~
7-1-84
Attachment 116
NEW HANOVER COUNTY HEALTH DEPARTMENT FAMILY PLANNING FEE POLICY
1. The family planning program has established a method of
directly assessing patient charges and collecting payments
for clinical services in accordance with Title X regulations
and the fee policy as established by New Hanover County Board
of Health.
2. The model fee scale developed by the Family Planning Branch
will be the method of determining patient charges.
3. Patient fee system charges are:
a. based on a cost analysis of services provided; and,
b. discounted (adjusted according to the current sliding fee
scale based on patient's income and family size.
4. There will be no minimum fee requirement or surcharge that is
indiscriminately applied to all patients.
5. Patients who are certified for family planning services under
Title XX will not be charged for reimbursable family planning
visits. Claims will be submitted to Title XX for
reimbursable visits. *No patient charges will be assessed
when income falls below 125% of poverty.
6. Patients who are receiving Merlicaid Labels (Title XIX) will
submit their Medicaid number for third party payment.
Reimbursable visits will be claimed to Title XIX for payment
and no further charges will be made to the patient for
contraceptive services.
7. Full charges will be assessed if patient income falls at or
above 200% of the federal non-farm poverty level.
8. Unemancipated minors seeking confidential services are "a
family of one" and are to be considered on the basis of their
own resources. In such cases, the minor's income must still
be reported through the patient data system. Third-party
sources (e.g., Title XIX, Title XX,) shoulrl be billed if
eligibili ty criteria are met. Charges to emancipated minors
will be based on the local fee schedule.
9. Charges may be made for supplies not required by the plan of
contraceptive care based on cost of supplies. Charges for
extra cycles of pills may also be made. Non-family planning
services will be charged according to locally established fee
schedule and will apply to all patients.
10. No one will be denied services based solely on the inability
to pay.
*Reimbursable visits include initial/annual, six month visits,
medical evaluations/problems based on same minimum requirements
for claiming third party payment for visit types.
-2-
11. Donations may be accepted from any patient regardless of
income status as long as they are truly voluntary. There
should be no "schedule of donations", bills for donations, or
implied or overt coercion.
12. Every effort will be made to provide services to patients at
or below 150% of poverty.
13.
Declaration of income information will be
from the patient. Documentation of income
or income verification conducted at the
Family Planning Staff.
obtained verbally
will be requested
discretion of the
14. Patients unable to provide any income information will be
placed in the full pay category until their eligibility for a
sliding scale discount can be established. Any income
information that is obtained within 5 working days will be
entered in the patient's record and reported through the
patient data system. If warranted, the earlier charges may
be adjusted as long as the income status was the same at the
earlier visit (not to exceed 5 days).
15. The fee policy will be explained to each patient with
explanations of purpose and details of procedure when the
patient receives their initial contraceptive services and as
indicated on subsequent visits. Each patient is given an
opportunity to pay and every effort will be made by the
Family Planning Staff to collect total or partial payments on
the day of the visits.
16. Provided that patient confidentiality is not jeopardized,
bills showing total charges less sliding scale discololnt will
be mailed to patients within 30 days after their clinic
visit. Future bills can be mailed at the discretion of the
Family Planning Staff not to exceed three notices.
17. The clerk logs the patient on the day sheet and on the
patient ledger card according to type of visit. Based on the
Sliding Fee Scale for North Carolina the charge is made,
collection recorded, and receipt given to the patient. The
numbered charge slip is retained and submitted with the day
sheet and collections to a designated back-up person. (See
Attachment II - One Write System)
18. The clerk is responsible for daily balancing and submission
of day sheet, receipts, and deposit. A monthly report is
completed and retained in her file for completion of the
Quarterly Accounts Rece i vable Report to be submi t ted to
Rale igh.
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19. Patients must be given a receipt each time that a payment is
collected.
20.
On each encounter thereafter, when there is
balance, the patient will be reminded of the
effort for collection will be made.
an outstanding
balance and an
21. Patients whose accounts have had no payment in 2 clinic
visits and have demonstrated no "good faith" effort to pay
will be subject to service restrictions. Family planning
service restrictions will be at the discretion of the Family
Planning Staff and may include prioritizing appointments, or
refusal to serve for non-contraceptive related visits.
Services may be denied if no payment is received during or
after the second vi sit. Contracept ive related emergency
services may not be denied.
22. Bad debt write-off policies have been established (See
Attachment I).
23. It is illegal for fees collected in family planning to be put
in any fund other than a separate family palnning account for
use in the local family planning program.**
24. These fee policies are documented and are a component of our
Family Planning Manual and available for inspection.
Date
Health Director
Chairman, Board of Health
**Grant POlicy Statement, Re: US Department of Human & Health
Services, Public Health Service, DHHS Publication (DASH) 82-50,00
pg 25, Found in Codified Fed. reg. for FP #420FR59.5 (a) (8)
NHCHD 10/83
NEW HANOVER COUNTY HEALTH DEPARTMENT
FAMILY PLANNING BAD DEBT WRITE OFF POLICY
After all procedures have been followed
the fee pOlicy, the bad debt write
follows:
as previously described
offs will be handled
in
as
The patient's ledger card will be coded with a red "R" each
time the patient is reminded of the outstanding balance.
.Bad debts will be written off as uncollectable, 1 year
following the date of the visit except when:
1. There has been no intervening visit within that year and
the patient wishes to remain an active patient. (Ex:
Diaphragm patient that requires only one visit per year.)
At the time of the next visit the patient will be seen,
but future services may be denied if effort for payment
is not made.
2. Small amounts are being paid toward the bill.
List of patients and amounts owed will be submitted to the Health
Director with the date list is submitted. Health Director must
approve with signature and date before proceeding further. Write
offs will be done by adjusting patients balance to "0" and ledger
card placed as inactive. Any future visits would reactivate the
ledger card and charges begin again. Patients returning who wish
to pay on previous balance (even though it may have been wri tten
off) will be allowed to do so.
Clerk will make an
reflect the amount
Fees Report.
adjustment in the Accounts Receivable Column to
of write offs and submit this in the QUarterly
Date
Health Director
Chairman, Board of Health
NHCHD 5/84
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Attachment #7
BILLING POLICY - HOME HEALTH
GOAL: Maintain an orderly billing procedure compliant with
Federal, State and local policies.
PROCEDURE:
1. Each patient shall be billed three (3) times on a monthly
basis.
2. A waiting period of thirty (30) days after final billing shall
be observed, then bill is to be submitted to State Grant if
applicable or written off as bad debt.
3. For ongoing accounts, portion of bill that has been billed
three (3) times and waiting period of thirty (30) days has
been observed shall be submitted to State Grant if applicable
or written off as bad debt.
Attachment #10
.
Laboratory Services Check List
LABORATORY SERVICES CHECK LIST
NAME:
DATE:
DOCTOR:
TEST:
Blood Glucose
Cholesterol
Coulter Hematology
(WBC,RBC,HGB,HCT,MCV)
Differential Count
Platelet Count
Sedimentation Rate
Urinalysis, Complete
Urinalysis, Dipstick
Hemoccult
Ova and Parasites
pinworm Prep
Throat Culture
Stool Culture
VDRL, Non VD
Mail Off Fee
Glucose (Diabetic Screen)
Pregnancy Test
There is a $2.00 charge for each test
checked, except for Pregnancy Test
wh i ch is S 5 . 00.
Please take this check list to the
General Reception Window to pay for
services. Then return to the Labora-
tory for service.
TOTAL BILL:
To be in duplicate, one copy for the laboratory files and one copy
for the patient.
7-1-84