09/08/1982
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The New Hanover County Board of Health met on Wednesday, September 8, 1982 at
the New Hanover County Health Department.
Members Present:
Carl Durham, Chairman
Roma Lee Hall, Vice Chairman
J. William Eakins, M.D.
William Grathwol
Larry Neal, D.D.S.
James Strickland
Hobart Whaley
Members Absent:
Donald Blake
One Vacant Membership
Others Present:
James M. Brown, Health Director
Robert Pope, Attorney
Mabel Price, Recording Secretary
Mr. Durham, Chairman, called the meeting to order at 8:00 A. M. and called for
corrections to the August 11, 1982 minutes. Mrs. Hall moved the minutes be
approved. Mr. Whaley seconded the motion and it carried unanimously.
Consultants Report: Jim McMahan and Nancy Lane of Planning and Design Associates
were present for the meeting and gave their final report for the August 16 - Sep-
tember 10, 1982 contract. Mr. McMahan gave an update on recommended fee schedule
and policy, the revised position description for the Administrative Officer, the
Cost Report and the Home Health Bookkeeping System. Ms. Lane gave recommendations
for a Long Range Planning Policy. Both consultants expressed their thanks to the
Board and Staff for the opportunity of working with them and their appreciation for
all the cooperation they had received.
Fee Policy Committee Report: Dr. Neal presented a proposed Fee Policy and Schedule
which had been prepared by his Committee and Nancy Lane of Planning and Design
Associates. Dr. Neal moved the policy and schedule be adopted by the Board. Mrs.
Hall seconded the motion. After some discussion and clarification the motion was
unanimously approved. The policy and schedule will be presented to the County
Commissioners for their approval on September 20, 1982. Copy of the policy and
schedule is attached as a part of these minutes.
Septic Tank Committee: Dr. Eakins gave a report on the meeting with the Drainage
Committee and the Sub-Division Committee. Both committees have proposals that are
being considered by the County Commissioners.
Shellfish and Seafood Ordinance: Dr. Neal reported that he is working to bring
the proposed ordinance more in line with the wording in the State ordinance before
presenting it for adoption. He will also have one more public hearing.
Water Sampling: There was no report from this committee.
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Priorities Progress: Mr. Strickland reported that number one on the priorities
list - the hiring of an Environmental Health Chief - had been given much thought
and that there is a possibility of reclassification of this position from Environ-
mental Health Supervisor to Environmental Health Director, upgrading the position
r~r 9 , 5
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from Grade 72 to Grade 76. He also reported that Mr. Brown had been to Raleigh to talk
with Dr. Ronald Levine, State Health Director and Stacey Covil, Chief of Environmental
Health bget recommendations of qualified applicants. Mr. Strickland suggested that
a committee be set up to screen applicants for the position - possibly someone from
the Board, County Personnel, someone from State and Mr. Brown. Mr. Grathwol moved
that Mr. Brown proceed with having this position reclassified according to State and
County Policies. Mrs. Hall seconded the motion and it carried unanimously. Mr. Dur-
ham asked that a letter accompany the request explaining the reasons the reclassifica-
tion is being requested. Mr. Strickland reported briefly on the other priority list
items: Cost Report, Fee Collection Policy, Renovation of Building, Study of telephone
system, Long Range Planning, Internal Monthly Report for Home Health.
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Mr. Brown presented his plan for reorganizing the Administrative'Di~ision of the Health
Department. Under this plan the Administrative Officer II would work at the same level
of other Division Chiefs. The Personnel Technician and Finance Technician would work
independently but the Administrative Officer would work with policy and procedure in
relationship to these two positions. Mr. Brown also proposed hiring an Administrative
Secretary to take over the secretarial duties of his office and for the Board of Health.
Mrs. Hall moved that the Board of Health approve the position for Administrative Officer
and approve the plan as presented. Mr. Strickland seconded the motion and it carried
unanimously.
Resignation from Board: Mr. Durham announced that Dr. Franklin had resigned from the
Board of Health. Dr. Franklin is moving out of the State.
Long Range Planning Policy: Mr. Durham presented the following Long Range Planning
Policy for consideration of the Board: "The New Hanover County Board of Health affirms
that long range planning should be an intergral part of the operation of the New Hanover
County Health Department. A ten year plan shall be established which will define the
growth needs and directions of the Health Department such that the Health Department
can best serve the public health requirements of New Hanover County. There shall be
a yearly review and update of the plan submitted to the Board of Health. The Board
of Health instructs the Health Department administration to establish such a long
range plan at the earliest possible time." Mr. Whaley moved the above policy be adopted.
Mr. Grathwol seconded the motion and it carried unanimously.
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PDA Consultants: Mr. Durham expressed thanks on behalf of the Board to Jim McMahan
and Nancy Lane of Planning and Design Associates for all the help and assistance they
have given to the Board of Health and the Department. The Board was in agreement that
a letter of thanks be given to them from the Board.
Grievance Review: Mr. Durham told the Board that a Health Department Staff Member
had filed a grievance through the employee's attorney and asked that the grievance
be heard by the Board, bypassing the regular route of the grievance procedure. Mr.
Durham appointed a committee to work with the persons involved in the grievance. The
committee will be as follows: Bill Grathwol, Chairman, Mrs. Hall and Mr. strickland.
The committee will bring their recommendations to the entire Board for action. Mr.
Pope advised that these meetings will be an exception to the established grievance
policy, may set a precedence and must be accomplished through executive sessions. Mr.
Gillespie, Attorney for the employee, was present for the meeting.
Health Director's Report:
1. Tom Stich, Sanitarian, reported that the Environmental Health Section had
participated in Environmental Health week and showed the Board snapshots
of the display the Environmental Health Section had made and placed at
Independence Mall during that week.
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2. Hilda White, Personnel, gave a brief report on the status of vacancies,
new hires and resignations for the month of August. She also gave goals
and objectives of the personnel position.
3. Marian Duggins, Nursing Director, reported on the reorganizational plans
for the Personal Health Division and gave a follow-up report on the Perinatal
Program.
Executive Session: Mr. Brown requested that the Board adjourn to Executive Session.
Dr. Eakins moved that the Board go to executive session. Mr. Grathwol seconded the
motion and it carried unanimously.
Mr. Durham moved the Board return to regular session. Dr. Eakins seconded the
motion and it carried unanimously and the Board returned to regular session at
10:20 A. M.
There being no further business Mr. Grathwol moved the meeting be adjourned. Dr.
Eakins seconded the motion and it carried unanimously and the meeting was adjourned
at 10:21 A. M.
Respectfully submitted,
~ÞI2.
Chairman, Board of Health
I ecretary to the~~
Approved: October 6, 1982
I
STA TE OF NORTH CAROLINA,
COUNTY OF NEW HANOVER.
AFFIDAVIT OF PUBLICATION
I Befort! m~, a Notary Public in and fOE afore~aid State and County, came this -.~;!..day of.___.~~g_~____..uI9_Jt?_
I __:____..J.:.ª-Q.Q1LBrJ.,ns_0lL_____________m_u_' who being duly sworn, deposes and says that he isÇlª§§_·_A<J.Y..!__Mgr
the STAR-NEWS NEWSPAPERS, Inc. and that the advertising of N9t,tÇ_E?__9X.J?YÞJj-_Ç__JJßfu'Jng
appeared in said publication on the date (or dates) and in the space as specified below:
DATE
_'?dZJL__:1Qiß_2_______________
("- A 'P'I'Tn'tJ n'li' A 1'\
Notice of Public Hearing
Shellfish Seafood Ordinance
SIZE
----...--------1
------...-.-----
_______ m.h_ cols. x____n___m___Jines
... - ---- -------------...------------------------
The New Hanover County
Board of Health will hold a public
heanng re proposed ordinance at
----------- 730 P-.M, Tuesday, August 31,
1982 In the County CommiSSion-
er's Meeting room, County Ad-
------------ ::::;"~F'on building, 320 Chast-
Copies of the ordinance can
be seen at the office of the clerk
------------ to the Board of County Commls-
~~r;:rswa;:e~t :m~:: ~~ab';
Sub3cribed and sworn to before ~ at the Health Depart-
me this_____~_~___day oÍ-___~.!!~_~________~____n____19__ª~
_2.~____.~~_L!J_~^_:_____________
Notary Public.
My commission expires__!~_~_:.__~_?.__________, 19___~§
- - ---- -------------..----------------- -------
--------------
n_____________ cols. x__u___________lines
-------------------...--------------------
-----------~--
u_uu________ cols. x_______________Jines
-------------
___m_________ cols. x___m_________Jines
STAR-NEWS NEWSPAPERS, Inc.
By
Upon reading the foregoing affidavit with the advertisement thereto annexed it is adjudged by the Court
ìa '"hat the said publication was duly and properly made, and that the summons has been duly and legally eerved
,n the defendant(s).
(
This_________________day of
_________________,19--------.
\
/
--------------------------------------------
Clerk of Superior Court
J &6 L -9784
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NEW HANOVER COUNTY HEALTH DEPARTMENT FEE PLAN
Wilmington, N.C.
I.
Rationale
In response to continued inflation and reductions in federal and state subsidies,
New Hanover County Health Dep~rtment has been forced to seek ways to assure that
its limited resources are focussed on those activities that provide the maximum
public benefit. Public interest is best served by assuring that all legally
mandated services are available to all County residents. Some non-voluntary
services , such as communicable disease control, must be available without
any barriers such as charges that would deter use of the service. Other
voluntary services, such as animal licenses , benefit a limited number of
people, who should share in the cost to provide the service.
In recent years, the health department has been requested to provide additional
personal and environmental health services for public benefit. The Department
can best serve the community by continuing to mãke these services available to
citizens with the greatest need and the least access to alternatives.
User fees provide a means to distribute services to County citizens on the
basis of demand. Combined with a sliding fee scale, these fees can also
distribute the burden of payment on the basis of ability to pay. Selectively
applied, they distribute the cost of services to those who gain unique and
particular benefits for themselves.
Fees for public health department services are authorized under North Carolina
General Statute 130-17, provided that: 1) the fees are in accordance with a
plan recommended by the Health Director and approved by the Board of Health and
the County Commissioners; and 2) the fees are not otherwise prohibited by law.
Fees have been charged and collected by New Hanover County Health Department
for several years. This revision of those formal and informal fee plans superceeds
all preceding plans.
II. Goals and Philosophy
It is the intent of the New Hanov~r County Board of Health and the County
Commissioners to insure that the New Hanover County Health Department :
1. Provides its medical care services free of charge to indigent people.
2. Charges people and their third-party payors, who can afford to pay,
competitive private rates for comparable medical services.
3. Charges uniform fees for voluntarily procured non-medical services,
such as animal control and environmental services, where permitted
by state law.
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Fees
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4. Sets fees that will insure that certain services in the health
department can become as nearly financially self-sufficient as
possible.
III. Affected Services
Fees will be charged for specified services provided by the New Hanover County
Health Department, in the Personal Health, Environmental Health, Animal
Control, Family Planning, Home Health, Nutrition, Laboratory, and Pharmacy Division.
Mandated public health services, community health, epidemiologic investigation
and control, health education, tuberculosis control, venereal disease control,
and immunization and sanitation inspections may be excluded, Vaccines provided
to the health department ðt no cost will be provided without charge. Fees pro-
hibited by law will not be imposed.
Separate fees may be charged for la~oratory, x-ray, and other technological
services when these are not included as part of another comprehensive service.
Fees may be charged for educational services provided to individuals or groups,
such as orientation, preceptorship, or field training.
IV. Fee Schedule
Insofar as possible, fees for certain medical añd laboratory services may be
based upon reasonable prevailing rates. Fees for other services will be
based upon budgetary costs to the health department, plus a county overhead
fee.
Where budgetary costs cannot be allocated with preC1S1on, nominal fees may be
established in amounts related to known costs. Where Medicaid, other third
party or program contract fee amounts are established on the basis of statewide
average or other costs, the health department fee may be set equal to that amount.
Fees will be adjusted at least annually by the Board of Health upon recommendation
from the Health Director, to reflect budgetary and third party constraints.
V. Medically Indigent Sliding Fee Scale
Individuals will be charged for clinical services on the basis of ability to pay.
Families with annual incomes that exceed current federal Poverty Income guidelines
or other income guidelines which must be employed for other federal or state
funded programs will be charged full rates. Others will be offered reduced
rates based upon family income.
The reduced rate, sliding fee scale, will be maintained as uniformly as possible
among health department programs.
Eligibility for reduced rates will be determined by clerical personnel prior to
service. Verbal statements of patients, their parents or guardians, may be ac-
cepted. Signed statements may also be required for certain programs. Enrollment
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Fees
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under Social Security Titles XVIII. XIX. XX. or other third party coverage will
be determined where applicable. Individuals who are identified as possibly eli-
gible will be referred to appropriate agencies for eligibility determination.
Once eligibility for reduced rates is determined. it will be continued for a
period of one year. unless ·otherwise requested by a patient. Third party
coverage will be verified on each visit.
Fees for environmental health and animal control services will not be adjusted
by the sliding scale.
VI. Collection
Fees will be collected at the time service is rendered. by trained clerical per-
sonnel at central bookkeeping stations. In certain cases. fees will be collected
at the point of service by the professional rendering services. Responsible audit
trails will be maintained for all fee collections.
Individuals who pay at the time of service will be provided with itemized receipts.
Itemized bills will be sent to others,monthly. Enrollment in a third party pay-
ment plan may be presumed to constitute full payment for that service.
Failure to pay a proper charge for services rendered will constitute a debt for
reasonable collection. Unpaid accounts will be billed monthly. Balance due
of less than five dollars ($5.00) will be billed again. Balances of $5.00
to $25.00 will be billed three times. Balances in excess of $25.00 will be
billed four times. Third and fourth bills will be stamped "Account Past Due.
Service May be Withheld Pending Payment." Balances less than $2.00 will
not be billed.
Arrangements may be made for deferred or extended payment, when necessary for good
causes.
Once a year. the Health Director. or his designated representative. will review
bad debts outstanding six months after the last bill has been rendered as described.
At that time he or she will authorize write off of such amounts for accounting pur-
poses. Payments received later for bad debts will be accepted and credited to
appropriate accounts. However, no further collection efforts will be applied to
these accounts.
VII. Delinquent Accounts
No individual will be denied services at the New Hanover County Health Department
because of inability to pay, as determined by the Sliding Fee Scale.
With the exception of Family Planning. patients. individuals with unpaid balances
may be denied subsequent optional services. pending demonstration of a good faith
effort to make payment.
Attachments: Eligibility Scale
Fee Schedule
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NEW HANOVER COUNTY HEALTH DEPARTMENT FEE SCHEDULE
FISCAL YEAR 1983
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SERVICE
FULL CHARGE
Animal Control
3.00 per year
17.00/ 25 dogs
25.00 (1st two times/yr.)
+3.00/day lodging
Pending will include
Spay Neuter Charges
'$25.00 for each law
violated up to County
maximum (subject to County
ceiling)
3.00 per animal per day
County Dog Tag
Impounded Dog Redemption
Adoption
Citations
Shelter Fee
Adult Health Screening
CPT-4 Initial & Annual Visit, consists of:
54.00
Chest X-Ray
Visual acuity exam
Glaucoma exam
Height, Weight, Blood pressure check
Cancer screen - oral exam, neck and axillary
nodes, thyroid nodule palpation, breast
exam, teaching self breast examination, vagina
and cervix visual exam, nutritional assessment,
pap smear
Diptheria - Tetanus shot
Follow-up personal record review and call-back
Laboratory tests:
Hemocult
Routine blood sugar
Coulter hematology (WBC, RBC, Hgb. Hct., MCV)
Routine Urinalysis
71010
98592
98600
98609
98588
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88150
90720
90000
82270
82947
85021
81000
following:
5.00
9.00
8.00
4.00
5.00
3.75
4.00
20.00
17.75
10.00
5.00
Follow up Visit may consist of one or more of
98609 Weigþt and blood pressure
Nutritional Counseling
Nursing Counseling, intermediate visit (15.30 min.)
Hemocult
Routine blood sugar monitoring
Wet Smear for Trichinosis and Yeast
Nurse Counseling, brief, [15 min.
71010 Chest X-Ray
98588 Cancer Screen
98592 Visual Acuity Exam
88150 Pap Smear
EPSDT 1
Child Health Screen
82270
82947
87205
,
21.96
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N. H. Fee Schedule
Environmental Health
Septic Tank Permit
Soil Evaluation
Unrestricted Septic Tank Installer License Fee
Restricted Septic Tank Installer Licnese Fee
Well Permit, including sample analysis
Rat Bait
Ship Inspections - Wilmington
Ship Inspections - Sunny Point
Water Samples:
Coliform bacteria analysis
Sample Collection and filing fee
Repeat Water Samples (includes analysis)
Non-Community Water Samples
Environmental Health
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5.00
20.00
100.00 per calendar year
50.00 per last 6 mos.
10.00 per job
15.00
1. 50 per lb.
35.00
70.00 (overtime)
42.50
,85.00 (overtime)
10.00
5.00
8.00
Pending charge;
Proposed changes pending approval of septic tank ~rdinance
Septic tank permit
Septic tank approval
Soil evaluation - Residential
soil evaluation - Non-Residential
15.00
35.00 to 3 bedrooms
5.00 per additional bedroom
35.00 first 1,000 gallons
per day
5.00 each additional 500
gallons per day
1. Charge may be determined by established program policy, medicaid
or other program policy, e.g. State family planning grant, EPSDT.
2. Pending approval of County Septic Tank Ordinance.
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99000
'9072
82947
85021
82270
87177
85031
82996
88150
87060
87086
181002
1000
6592
87205
87086
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page 3
SERVICE
Epidemiology
Supplies
1
Family Planning
Limited Service / Pregnancy Test
Intermediate Service wo pelvic
Extended Service w pelvic
Comprehensive Service, Initial or Annual
Visual Exam, speculum evaluation
Condeloma painting
Collect Specimen in Office
1
Home Health Agency
Public Health Nu~se Visit
Physical Therapy Service
Home Health Aide Visit
Speech Therapy Service
Immunization 1
Innoculation
Ingredients
Flu
Yellow Fever
Pneumonia
Laboratory
Acid fast culture and smear,
Blood glucose
Cholesterol test
Choliform bact. in water
Coulter hematology (WBC,RBC,Hgb,Hct,MCV)
Feces for occult blood ( hemocult)
M~lk Analysis - routine
Milk analysis- buttermilk, sr. cream, yougurt
Ova and parasite test
Pinworm prep
Platelet count
Pregnancy test
Pap Smear
Sedimentation rate
Throat culture
Urine culture and sensitivity
Urinalysis, complete
Urinalysis, routine
VDRL for employment physical
Wet smear for trich and yeast
Wound culture
Mail-off fee
Differential count
FULL CHARGE
cost + 10%
5.00
12.55
23.30
62.74
4.00
5.00
3.00
Self pay
7.00
8.00/hr
6.00
NA
3.00
cost
3.00
7.50
6.00
10.00
5.00
5.00
10.00
7.00
4.00
5.00
4.00
7.00
4.00
5.00
5.00
5~00
3.75
10.00
10.00
4.00
3.00
5.00
3.75
10.00
5.00
3.50
Medicare
19.60
22.40
16.80
Medicaid
19.11
21.84
16.38
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Fee Policy NH
page 4
I
SERVICE
FULL CHARGE
Laboratory cont.
Stool culture
7.00
Nutrition
Nutritional Counseling
( includes materials )
8.00 per session
Pharmacy
Dispensing
Ingredients
Unc1assified1
2.00
cost
Authorized record copies
Education/ training per student day
Group education per staff hour
2.00
10.00
10.00
X-ray
I
With physician interpretation
Without physician interpretation
20 .00
9.00
,
1. Charge may be determined by established program policy, e.g. Medicaid
or other state grant such as family planning.
Vaccines received by the department without cost will be provided without
charge
9/82