08/03/1983
.
00952
The New Hanover County BUdrd uf -Ie,ilth m~t "n ;'I'ednesc"L!\., Auqu .:;t~ ", ; )I~ ;
New Hanover County Health Department.
,
Members Present:
Larry Neal, D.D.S., Vice Chairman
Ted Bagley
Donald Blake
Jean Credle
J. William Eakins, M.D.
William Grathwol
James Strickland
Hobart \'/haley
Members ADsent:
Carl Durham, Chairman
Others Present:
Robert Pope, County Attorney
Mabel Price, Recording Secretary
Dr. Neal, Vice Chairman, edIled the meetinq to order at 8:00 A. M. and called
for corrections to the July G, 1983 minutes. Mr. Bagley moved the mi~utes be
approved. Mr. Whaley seconded the motion and it carried unanimously.
Search Committee ~enort: Dr. Eakins officially nominated Robert S. Parker ~s
Health Director. Mr. 3trickl~nd seconded the motion and it carried unanimously.
Dr. Neal announced that Mr. ?~rker would assume his duties on August 16, 1083.
-..
Seotic Tank Commit~ee Mr. ~rathwol reported for the sub-committee, aopointed
at the July meeting to check denial of septic tank permits on property owned
by Scott Rudisill. Mr. ~rathwol re~orted that the State Ordinance does ~rovide
that if certain enqineer~11g points are made this data can be referred to Raleigh,
if the Local Health DeDart~ent concurs, then if Raleiqh concurs with the data
submitted they can rec12ssify the soil. Locally we cannot reclasslfy the sOlI
once we have classified it as unsuitable. Thp sub-c~mmittee met with Ted ~2vi~;
County Attorney, and drew UD some tentative Procedural Guidelines which more
clearly define what the Ordi~ance already says. Mike Rhodes, Director of E~vi-
ronmental Health, stated that he went over these guidelines ''vith Mr. Rudisill
and that Mr. Rudisill had indicated he would be back in touch with him.
Mr. Blake questioned who should sign letters ..lE approval or disapproval and ;7~dde
a motion that letters be signed by the Director of the Health Department or the
Chief of that particular section. After much discussion about problems this
might cause, Mr. Blake withdrew his motion and asked that this be put on the
agenda for Sept~~er. Dr. Eakins will write a letter tQ Division Chiefs asking
for types of letters and reports that their Department sends out and who signs
and approves them. Mr. Blake and Dr. Eakins will review these and see what kind
of ramifications this might have.
Well Ordinance Fees: The Well Ordinance Committee has suggested a License
Fee of $25.00 for Well Workers, $25.00 for Well Drillers and S50.00 for a Com-
bination License. Mr Grathwol moved that these fees be adoDt~d. Dr. Eakins
seconded the motion and it carried unanimously.
.......
Family Planning Fee Policy:
at the July meetinq. (Copy
and it carried unanimously.
Dr. Neal moved the policy be aooroved ~s presented
attached to minutes). Dr. Eakins seconded the motion
00953
.
,-:t'ITlrnents tr-::n BOard :>1eml:+-'!rs:
Dr. Eakins asked Members of the Board to reVlew minutes for the ?ast year
and make a list of things that need to be corn~lp.ted, Dut priorities on the
list and either personally or by letter qet these to the new Director so that
he w;ll be able to begin work on them.
Mr. Blake mentioned River Fest and piney Woods Festivals - and requested that
we be very careful that we do not have health problew.s at these festivals
where food is concerned, but that we not put impossible restrictions on
the food providers. Mike Rhodes reported that he has already been worki~q
with the people who will be providing food for these events.
There being no further business, Dr. Eakins moved the meeting be adjourned.
Mr. Whaley seconded the motion and it was unanimously ~oproved and the meet-
ing was adjourned.
Respectfully submitted,
.
r:-~k~e-E3
vice Chairman, Bcare of Health
Approved: September 7, 1983
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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 indiscrim-
inately applied to all patients.
5. Patients who are certified for family planning services under Title
XX will not be charged for family planning visits1 Claims will
be submitted to Title XX for reimbursable visits. No patient charges
will be assessed for New Hanover County residents when income falls
below 125% of poverty.
6. Title XX certification will be done on New tianover County residents.
Out of county residents will be referred to their own health depar~~ent
for family planning services. Out of county residents desiring
family planning services in New tianover County Health Department
will be charged a fee based on the sliding scale. Out of county
residents whose income falls below 125% of the poverty level will
be charged at 15% of the full charge.
7. Patients who are receiving Medicaid 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 ~atient for contraceptive services.
8. Full charges will be assessed if patient income falls at or above
200% of the federal non-farm poverty level.
9. 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,) should be billed if elibibility criteria are met. Charges
to emancipated minors will be based on the local fee schedule.
Reimbursable visits include initial/an~ual, six ~anth visits, medical
evaluations/problEms based on saI:l€ r:;_::ir.:!l.r'T.; r'e'::;:Ji!"'e~en:s for claiming
tn,rd party payment for visit types.
NHCHD 5/83
-2-
10. Charges may be made for supplies not required by the plan of contraceDtive
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.
11. No one will be denied services based solely on the inability to
pay.
12. 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 donatio!1s, or implied. or oVe!"'~
coercion.
13. Every effort will be made to provide services to patients at or
below 150% of poverty.
14. Declaration of income information will be obtained verbally fro~
the patient. Documentation of income will be requested or income
verification conducted at the discretion of the Family Pl~~ning
Staff.
15. 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. A!1Y income inf'ormatior: th2t.
is obtained within 5 working days wi:l be entered in the patie;.~'3
record and reported through the patient aata system. If warra~te:,
the earlier charges may be adjusted as long as the income stat~.::
was the same at the earlier visit ~~8~ to exceed S days).
16. The fee policy will be explained to each patient wi th explanaLor;s
of purpose and details of procedure when the patient receives thei~
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.
17. Provided that patient confidentiality is not jeopardized, bills
showing total charges less sliding scale discount will be mailed
to patients within 30 days after their clinic visit. Future bills
can be mailed at the discretion of the Fa~ily Planning Staff not
to exceed three notices.
18. 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 bac~-up person. (See Attacrii"iient II-(irJe ~'ritc Systei'i'
NHCHD S/B3
,
-3-
19. 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
Receivable Report to be submitted to Raleigh.
20. Patients must be given a receipt each time that a payment is collected.
21. On each encounter thereafter, when there is an outstanding balance,
the patient will be reminded of the balance and an effort for collection
will be made.
22. Patients whose accounts have had no paymenc 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-cont~asep:ive
related visits. Services may De denied :.:... no payment is received
during or after the second visit. Contrac~ptive related pmergency
services may not be denied.
23. Bad debt write-off policies have been established. (See Attachment -:
24. It is illegal for fees collected in family planning to be put in
any fund other than a separate family?planning account for use
in the loca~ family plar.ni.ng ~rograrn.-
25. These fee polici~s are doc~entej and a~e a component o~ our F~i~y
Flannir.g M2~Ua~ and avai1atle ~2~ ir.spectic~.
~-~4~
~3
~~ \-P~L_
Date
Heal th Director
a~7:#L~~'
Chaiman Board of Heal th
2Grant Policy Statef!lent, Re: V.S. Dept. of Health & Human Services,
Public Hea:tn Service, DHHS Publica:io~ (OASH\ e~-5C.O~ Pg. 25, Four.d
in Codified Fed. re~. for FP # L2CfF:q.: 1~1 _
NH:HD ~/83
.
NEW HANOVER COUNTY HEALTH DEPARTMENT
FAMILY PLANNING BAD DEBT WRITE OFF POLICY
After all procedures have been followed as previously described
in the fee policy, the bad debt write offs will be handled as follows:
The patients 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. lEx. 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 no effort for payment is made.
2. Small amounts are ~eing paid tow~rd the bill.
Bad debt write offs will he done by adjusting patients balance
to "0" and ledger card placed as inactive. Any future visi ts would
reactivate the ledger card and charges begin again. Patients returr.ing
who wish to pay on previous balance (even though it may have been written
off) will be allowed to do so.
Clerk will make an adjustment in the Accounts Receivable Col~~n
to reflect the amount of write offs and submit this in the Quarterly
Fees Report.
<g , ~4 ~ g?
~~p~
Date
Heal th Director
Ch8irman Soard
NHCHD 5/83
Family Planning Patient Fees
1. Why do we ~ to chaRge patient fees if We receive Title X funds?
. . . projects supported under health services delivery pro-
grams are expected to develop, to the extent possible,
independence from PHS grant support . Each project
is to establish a plan to (1) recover to the maximum extent
feasible third-party revenues to which it is entitled for
services provided, (2) garner all other available Federal,
State, local, and private funds, and (3) charge benefi-
ciaries according to their ability to pay for services
without creating a barrier to those services.
Source: U.s. Department of Health and Human Services,
Public Health Service, Grants Policy Statement.
DHHS Publication (OASH) 82-50,000, page 25.
2. Why must there be a Sliding fee scale and how are the end points determiL~d?
Each project (receiving Title X funds) must provide that
charges will be made for services to persons other than
those from low-income families in accordance with a
schedule of discounts based on the ability to pay . . .
(emphasis added)
Source: 42 CFR 59.5 (7)
(Title X regulations)
J. When must the full cost of service be charged?
Substantial justification is expected for a schedule of d1S-
counts for which the upper limit 1S above 200\ of poverty.
Source: Proqram Guidelines for Project Grants for Family
Planning Services.
.
4. Who are these "low-income families"?
Title X defines "low-income family" as
total income does not exceed 100 percent
recent. . . Poverty Guidelines. . . ."
lIa family whose
of the most
Source: 42 CFR 59.2
(Title X regulations)
5. What about Charging teens?
Title X regulations specifically exclude "low-income families"
from fee requirements. [42 CFR 59.5(7)J It also says that
"low-income f~milies" may include fa."!:ilv 17lembers whcse famil)
income ex:::eeds 10811. ;::;.= ;:;,::.:e=t.y b',,;.:. ....~..;:., c:i."::(: ...Hi~:t tv itvai.i
themselves or the farrlily's resources. Teens seek~ng
confidential services must be considered on the basis of
their own resources. (a family of one)
"'"
Source: DHHS Region IV interpretation of 42 CFR 59.2
.....1
Family Planning Branch
3/2/83
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S
200% of Poverty
150% of Poverty
125% of Poverty
No Income
Suggested Patient Fee Procedures for
Title X Grantees Participating in Title XX
Using Statewide Fee Schedule
Higher
Incomes
Full Patient Pay
_ Zero Patient Pay
~o direct patient
charges. Cost of
v~si t, plus lab
and administrative >-
,-charges, fully
rreimburSable by
T~tle XX (to the
extent of local
allocation) .
Some services are
also reimbursed by
Medicaid.
Family Income
as measured by
Federal Poverty
Guidelines
Family Planning Branch
3/1/83
Services may be
denied after the
first visit.
Service restriction~
>- may be applied.
No serVlce
limitations. hl:
efforts should be
made to serve the
patients without
regard to fee
account status.
This is our target
populat~on .
Suggestions for Using the "Family of One" Designation
Is the patient an unemancipated minor* (age 17 or less)?
Does the patient desire .confidential
services" (i.e., without parent's
knowledge)?
Is there an extenuating circumstance
that prevents the service recipient
from fully utilizing the family's
resources to pay for health care?
For example, is the patient financially
dependent upon an abusive spouse who
does not approve of family planning?
Can the family's
resources, including
those of the parents,
be used to pay for
the services?
Use family of
one designation
to determine
charge.
Determine fee status
using family size
and income.
Use family of
one designation
to determine
charge.
*
*Emancipated minors have many of the rights of an adult. Emancipated minors may be
treated as adults for fee purposes, too. Emancipation is made possible by, 1) court
petition, 2) marriage, and/or 3) enlistment in the military.
(Note: The Title X definition of family is not the same as the Purchase of Care
d~nition. For Title X purposes, a family is "a social unit composed of one
person, or two or more persons living together, as a household." (42 CFR 59.2)
The same definition is used to determine eligibility for Title XX as well.
Family Planning Branch
3/7/83
New Hanover County Health Department
Fa~ily Planning Program
;"::~ach.'nent I
THE ONE-WRITE SYSrH:
1.
The charge slip is the patient's receipt of amount paid as well
as services received. It also serves as an appointment slip reminder
for the patient. The right section of the charge slip is the clinic's
verification of services and charges and is maintained in the patient
folder.
2.
The ledger card is the record of all financial transactions for
each patient and is maintained in the patient folder.
The day sheet is a daily record of all financial transactions during
clinic hours (including mail-in-payments). It is also a record
o~ bank deposits, covering :or a certain period of tL~e.
~. All entries on all three forms will be made simulta~ecusly. The
only exceptio~ is the adjustment of entries for bad debt write-offs
which involves only the ledger card and day sheet.
o.
The sequence of entry is adaptable to each clinic setting. But
to assure uniformity of record keeping and audit acceptability,
the entry should reflect amounts as indicated by the instructions
below.
~~en the patie~~ arrives at clinic anc is intervie~ed :cr income
i~formatior., identifying information is er.terec O~ ::r.e ~harge sli~1
~edger card/and daj.' sneet. ~he info~atior cons:s: cf':
s. Date: d3te o~ visit
b.
Fatient Number: the :linic assignee nu~ber
Previous Balance: this is obtai~ed from the pa:ie~t's ledger
card
d. Name: the patient's first and last name
e. On the day sheet (far right after folding for duplicate deposit
record) the preprinted number from the charge slip should be
entered in the column headed "receipt number."
I. Toe ledger card anc charge slip are placed in the patient's folder.
A~ter the patient receives services, supplies, anc/or their next
appointment date, this information is enterec on the charge slip
by the appropriate rr,edica: service sta:f ~ember.
,_,_.-,n_
....~i-..... J __-'
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One-Write System (Continued I
Page _
8. The charge slip and ledger card are returned to the person responsible
for collection of fees. The full fee (gross charges) is entered
on the charge slip as well as the percentage range (based on income
and family size). The amount of patinet charges (net charges) or
minimum fee is then written on the charge slip. The ledger card
and charge slip will then be placed in line on the day sheet, matching
the pre-printed number on the charge slip with the number entered
on the deposit record at the right side of the day sheet. The following
information is entered:
a. Gross Charges: This information is obtained from the right
side of the charge slip as a total of full fee for services
and supplies. This information is necessary for state program
reporting to H.E.W.
b. Net Charges: the total of all charges after application of
percentage rate.
c. Credits:
1. Payments: the total amount of cash received from the patient.
This amount is also entered on the deposit record to the
right on the day sheet. The total of this column is entered
on the monthly report (MCH-FP-6).
2. Adjustments: this column is for the entry of "bad debt"
write-offs. The a~ounts entered here will be shown only
on the ledger card and day sheet, not on the patient's
receipt. The total of this column is entered on the (MCH-FP-61.
d. Current Balance: This is the amount due on the account after
new charges are added to the old balance, and credits are deducted.
NOTE: The patient's receipt may show a balance due.
In the event the old balance is dropped after adjustment
for bad debts is made and the patient wished to pay on
that old balance, accept the patient's payment, give the
patient a receipt and credit this to her account in the
payments ~olumn.
9. The tear-off carbon of the deposit slip is to be attached to the
monthly reports which are mailed on a monthly basis for ledger entry
at the District Office.
10.
All entries are to be completed
are to be completed in red ink.
person.
in ink. All corrections and voids
Errors can be verified by a second
11. Entries in the spaces across the bottom of the day sheet are optional,
except for totals of column entries.
NHCHD 6/83