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HomeMy WebLinkAbout8-2-2016 MinutesIREDELL COUNTY BOARD OF COMMISSIONERS PRE -AGENDA MINUTES Aueust 2, 2016 The Iredell County Board of Commissioners met in pre -agenda session on Tuesday, August 2, 2016 at 5:30 PM, in the Iredell County Government Center (South Wing Conference Room), 200 South Center Street, Statesville, NC. Board Members Present Chairman James B. Mallory III Vice Chairman Marvin Norman Tommy Bowles Steve Johnson Ken Robertson Staff present: County Manager Ron Smith, County Attorney Bill Pope, Deputy County Manager Beth Jones, Finance Director Susan G. Robertson, Attorney Lisa Valdez, Assistant to the Manager Ben Stikeleather, and Clerk to the Board Retha Gaither. CALL TO ORDER: Chairman James Mallory called the meeting to order. ADJUSTMENTS TO THE AGENDA: There were no adjustments to the agenda. ADMINISTRATIVE MATTERS Request from Tax Administration to Present the Annual Tax Settlement and Orders to Collect for the Tax Collector and Sheriff: Tax Administrator Bill Furches gave the following report: 2015 Taxes: Real & Personal Levy $105,193,505.89 MV — VTS 8,867,536.53 Add: Discoveries 542,283.53 Deduct: Releases (353,279.83) $114,250,046.12 Collections 112,587,273.70 2015 Outstanding Taxes $1,662,772.42 Collection Rates: All Property 98.54% Excluding Motor Vehicles 98.42% Motor Vehicles 100.00% Delinquent Taxes: Collections $1,673,976 Delinquent Taxes Outstanding $4,039,485 2016 Taxes Collected $ 217,750 The Numbers Collected Sl 1,153,306 more in current Iredell County taxes than previous year — up 11% Collected $1,606,295 more than was budgeted —101.42% of original budget Twelve year cumulative total $20.156 million over budgeted revenues Twelve year cumulative delinquent collections $25,128,440 Collected for all jurisdictions: 6-30-16 $172,008,829 August 2, 2016 Debt Setoff For the fiscal years 2002-2016, Iredelt ranked 28`s in the state out of 485 units of government participating with $2,861,873 collected. Iredell County did not participate in 2002 and 2003. For all years, we rank 16" among counties. Foreclosures As of this date, the collector's office has sent 732 properties to foreclosure. 416 of these cases have settled with 316 open. We have collected $4,080,096 in current and delinquent taxes. ar++� Chainnan Mallory stated this was a phenomenal job by the staff of Tax Administration. Commissioner Robertson said the lack of complaints prove that the process is effective and also that the department is in the top 20% of the State. Request from the Health Department for Approval of Revisions to the Fee Policy and Fee Schedules for Clinical, Dental, and Environment Health Divisions: Health Director Jane Murray presented the annual fee policy and fee schedules for review. The fee policy was approved on June 9 by the Board of Health. Some changes are due to language in the state contracts and federal dollars received through Title 10. There is a new item for engineer option permits which means a private engineer can design a system, work with a soil scientist, use a form developed by the State, and basically do all the work. It was written into legislation that they could only charge 30% of normal charges for the private engineer option permits. To date there haven't been any submissions. There were no changes in dental fees. There were a few changes in clinical services. August 2, 2016 Tax Collection Actions Vehicle Tags Blocked 0 Tax Statements 1,679 MV Third Notices 0 Debt Setoff 770 ($400,467) Garnishments 1,328 ($1,011,423) Credit Agency 288($136,678) Payment Arrangements 5 Lien Holder Letters 132 Bank Attachments 126 ($704,169) Tax Collection Problems Bankruptcies 172 for $215,448 (163 for $185,117 FY2015) 1,620 pieces bankruptcy mail with 2,198 researched Foreclosures filed 433 (Increase from 297) Collection Rates Last Nine Fiscal Years Fiscal Year Original Collection Rate Current Collection Rate 2015 98.58% 99.40% 2014 97.74% 99.45% 2013 97.06% 99.43% 2012 96.77% 99.45% 2011 96.81% 99.57% 2010 96.77% 99.62% 2009 96.89% 99.69% 2008 97.58% 99.68% 2007 96.80% 99.39% Average 97.22% 99.52% Debt Setoff For the fiscal years 2002-2016, Iredelt ranked 28`s in the state out of 485 units of government participating with $2,861,873 collected. Iredell County did not participate in 2002 and 2003. For all years, we rank 16" among counties. Foreclosures As of this date, the collector's office has sent 732 properties to foreclosure. 416 of these cases have settled with 316 open. We have collected $4,080,096 in current and delinquent taxes. ar++� Chainnan Mallory stated this was a phenomenal job by the staff of Tax Administration. Commissioner Robertson said the lack of complaints prove that the process is effective and also that the department is in the top 20% of the State. Request from the Health Department for Approval of Revisions to the Fee Policy and Fee Schedules for Clinical, Dental, and Environment Health Divisions: Health Director Jane Murray presented the annual fee policy and fee schedules for review. The fee policy was approved on June 9 by the Board of Health. Some changes are due to language in the state contracts and federal dollars received through Title 10. There is a new item for engineer option permits which means a private engineer can design a system, work with a soil scientist, use a form developed by the State, and basically do all the work. It was written into legislation that they could only charge 30% of normal charges for the private engineer option permits. To date there haven't been any submissions. There were no changes in dental fees. There were a few changes in clinical services. August 2, 2016 Increases were due to the cost of vaccines. Decreases are due to state recommendations to remain as close as possible to the actual cost. Commissioner Robertson asked if there were any potential concerns about Medicaid and/or Medicaid Max funds. Murray said there has been a lot of discussions. There was some legislation about changes but is yet to be seen how it will impact public health. The clinic numbers have declined because the private sector really wants those Medicaid dollars. Those with no insurance or Medicaid come to the Health Department for services. Commissioner Bowles asked if there had been any changes to the cap on food and lodging. Murray said the food code inspections could take four to five hours because it is so thorough. If there is a critical violation, then there is another inspection in ten days. If the problem is not resolved they will issue an intent to suspend the permit and the business is given 30 days. Chairman Mallory asked if the Health Department was seeing patients seeking pain management. Murray said if they did, it would be in the dental clinic but they do not use any narcotics, only Tylenol. The task force has a strategic planning retreat scheduled to continue to address the drug problems in Iredell County. This item was placed on the consent agenda L PURPOSE STATEMENT IREDELL COUNTY PUBLIC HEALTH DEPARTMENT 318 Turnersburg Highway, Statesville, NC 28625 Policy Title: Fee and Eligibility Policy Anticipated Annual June Review Period Division of Origin: Administration Non -intent change 5/16 revision date (s) Intent change revision 7/28/11, 11/18/11, 4/04/12, date (s): 6/04/12, 3/25/13, 7/23/13, 6/12/14, 10/15/14, 2/25/15, 3/18/15, 7/01/15 Prepared by: William S. Griffith Effective date for intent 7/28/11, 11/18/11, 4/04/12, change revision(s): 6/04/12, 3/25/13, 7/1/13, 8/1/13, 7/1/14, 11/1/14, 2/25/15, Managed by: CPT Billing Task Force 3/18/15, 7/1/15 Original Created Date: Affected Programs: Clinical Services & Env. Health Original Effective 12/14/07 ICBOH Approval: 6/09/16 Date: Location(s) of Policy: Administrative Division and ICBOCC Approval: 7/21/15 server Fees for public health department services are authorized under NC General Statute'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 County Commissioners, and (2) they are not otherwise prohibited by law. August 2, 2016 The demand for public health services is increasing, as are the costs of providing these services. Additionally, the resources to fund these services are diminishing. The public health department serves the public interest best by first assuring that all legally required public health services are furnished for all citizens, and then by providing as many recommended and requested public health services as possible. Fees are a means to help distribute services to the citizens of Iredell County in accordance with need, as well as to help finance and thus extend public health services. All payments from individuals and third party payers shall be used to support the services of the program in which revenues were earned. All fees collected shall be used in the current year or succeeding fiscal years. D. DEFINITIONS N/A III. POLICY A person must be a resident of the county to be eligible for services, except: I) as mandated by North Carolina Department of Health and Human Services, 2) if they are in the custody of Iredell County DSS, or 3) if they are a child attending school in Iredell County. Services that are mandated to be provided, regardless of County residence, are Family Planning, State Immunizations, STD, TB, and Communicable Disease Control. Family Planning clinic charges, billing, and collection procedures are in compliance with the most current Title X and code of federal regulations requirements, as referenced within this policy. Family Planning Services are provided without the imposition of any durational residency requirement or requirement that clients be referred by a physician. (42 CFR 59.5(b) (5); 9.9). Priority for services is to clients from low-income families and ability to pay is not a barrier to receipt of services (45 CFR 59.5 (a)(6-8). IV. PROCEDURE A. Fee Schedule A schedule of fee amounts shall be established for specified public health department services and updated on, at least, an annual basis. The board of health will be informed of data and the methodology used when approving fees. Internal cost analysis, reviewing cost settlement reports, service utilization numbers, and local market surveys are used to determine the most accurate and valid numbers for both cost and fees. Fees for services provided in clinical and dental programs are based on direct costs, current Medicaid rates, and/or the most current Medicaid Administrative cost information provided by NC DHHS DMA (42 CFR 59.5 (a) (8); 8.8.4). In addition, rates set by other agencies in the area and surrounding counties are considered when setting fees. Environmental Health Fees are set based on costs considering: work hours, supplies, mileage, training, equipment, overhead and other related costs. Fees charged by surrounding counties are also considered. B. Services Excluded Certain services, such as epidemiologic investigations, mandated immunizations, Communicable Disease Control, Tuberculosis and Sexually Transmitted Disease Control, and some Health Education services are excluded unless covered by Medicaid or other third party payers. For vaccinations that Iredell County department requires for employees, or as recommended by the CDC, the Iredell County Public Health Department only charges for the cost of the vaccine/supplies to give the vaccine. This is ONLY for vaccines that are a requirement for the person's job. Optional vaccines will be given in conformance with the Fee Policy. County employees will be charged for titer tests, but not a draw fee. July 1, 2016 C. Fee Charges Fees charged will be an established (flat) rate for certain services, including Environmental Health, General Clinic/, Miscellaneous Services, private pay vaccines, and community programs for Business and Industry. Fees for other services will be determined by applying a sliding scale based on family size and gross annual income to the fee schedule amount. August 2, 2016 Sliding scale fees will be charged on the basis of family income exceeding 100% of current Federal Poverty Guidelines (or other percent guidelines required by state or federal policy for applicable programs.) Family Planning requires the use of 101%-250% sliding scales (8.4.2). All other clinics use 10 L%-200% sliding scales. Family Planning clients whose income is at or below 100% of the FPL must not be charged, although third parties authorized or legally obligated to pay for services are billed (42 CFR 59.5(a)(7); 8.4.1). Minors requesting confidential services will be considered a family of one (42 CFR 59.2; 8.4.5). Minors accompanied by a parent or legal guardian must provide income for the family and will be charged appropriately. For an engineered option permit, a fee of thirty percent (30%) of the cumulative total of the fees to obtain an improvement permit, an authorization to construct, an operations permit, or an existing system for wastewater systems, will be assessed. The fee shall only be used in support of work to conduct site inspections; support the department's staff participation at post -construction conference meetings; and archive the engineered permit with the county register of deeds or other recordation of the wastewater system as required. (130A -336.1(n)) 340 B Guidelines 1. Family Planning: Clients with insurance, Health Choice, and Medicaid are given a prescription for birth control methods, to be filled at a pharmacy of their choice. Implantable and injectable birth control methods are administered. Clients receiving implantable or injectable birth control are given 34013 -purchased supply and insurance is billed according to Medicaid guidelines, to identify that 3406 -purchased birth control was used. Insurance clients are billed according to the established usual and customary fees. Private pay clients are charged according to the facility sliding fee for all birth control methods. 2. There is no charge to clients and insurance providers are not billed for medications given from STD or TB program 340B medication supply. Documentation of Discounts: Eligibility for discounts is documented in the agency's Clinic Management Software System on the patient's Financial Screen Exception in Familv Planning: Schedule of discounts is used for family incomes between 101-250% of FPL (42 CFR 59.5 (a) (8). Anyone, including minors, requesting confidential services will be considered a family of one, based on their individual income. Minors accompanied by a parent or a legal guardian, who do not want the spouse of the parent/legal guardian to know they are a patient in Family Planting must provide income based on the patient and the parent that is accompanying the patient (8.4.5). Where there is a legal obligation or authorization for third party reimbursement, including public or private sources, all reasonable efforts will be made to obtain third party payment without application of any discounts. Family income is assessed before determining if co -payments or additional fees charges. If insured, clients whose family income is at or below 250% FPL do not pay more (in co -payments or additional fees) than what they would otherwise pay when the schedule of discounts is applied. 42 CFR 59.5 (a) (9); 8.4.6 Repeated/Redone Services (No charge): Only on a limited basis, services may have to be repeated or redone, due to no fault of the patient. The attending clinician will determine when such a service will be repeated/redone and if it was due to public health department error. There will be no cost to the responsible party when public health department error is found. The clinician will refer to the patient history and assess the patient's current situation in making such a determination; such determination will not be based, in any way, on the reimbursement source of the responsible party. D. Income Eligibility: August 2, 2016 Income information and eligibility will not be obtained or determined for flat fee services. Income information will be obtained and documented from every Non -Medicaid and FP -W client. Income eligibility will be determined prior to service provision and shall be re-evaluated at each visit and at least annually. If there are changes, the new information will be obtained and the changes will be reviewed. Definition of a household unit: I_ The patient, AND: 2. All individuals, related or non -related, who live together and: • Contribute to the support of the patient; and/or • Have all or part of their support provided by the patient; and/or • Share with the patient a common source of support which is provided by a person who lives in same household as the patient. Exception in Maternal Health: A patient requesting Maternal Health services, who is less than 21 years of age, will not be required to show household income. if the father of the baby is living in the household, then his income will be taken into account, along with the patient's individual income. If the patient does not fall in this category, the patient must follow steps 1 & 2 above. L If countable income is greater than 185% of the Poverty Income Level, then the patient is ineligible for the MH program. 2. If patient is eligible for the MH Program, the discount to be given is determined at the initial eligibility visit and will remain the same throughout the pregnancy. A total estimated cost of maternal health services will be based on the gestational age at the time of the eligibility determination and will be provided to the patient along with the minimum payment amount expected to pay at each visit. Clients are informed via the payment contract that the cost specified is only an estimate and additional charges may be incurred with additional services. 3. If patient no longer qualifies for Emergency Medicaid at the time of delivery, the patient will be responsible for paying the physician's delivery flat fee to the public health department. The patient will also be responsible for hospital bill, which will be paid directly to hospital (arrangements made by patient). 4. Maternal Health patients that come from the jail system will not be required to go through the eligibility process. The jail will be responsible for patient's MH bill at the 100% rate. The public health department will bill the jail directly. (See Jail Inmate Fee policy for detailed information). Once the patient is released from the jail, the patient must go through the eligibility process as stated above to determine if the patient is eligible for the MH program. If the patient is ineligible, the public health department Maternal Care Coordinators will advise the patient of their options to obtain prenatal care elsewhere. E. Verification of Residency: When required, the patient or responsible party must submit verifiable documentation of residency. Acceptable documents include: Utility bills, cable TV bills, phone bills, or lease agreements. F. Verification of Income Responsible party will be required to submit verifiable documentation of income when sliding scale fees are applied. All patients must present their health insurance or Medicaid card at each visit and those who receive Medicaid are exempt from income eligibility determinations, with the exception of those with a FP waiver and non -covered Medicaid services. Acceptable Forms of Income Documentation 1. Paycheck stubs indicating most current pay period. 2. Copy of completed tax return from most recent calendar year (with attachments) for self- employed individuals, only. 3. Written statement (on official letterhead) from employer when no other documentation is available (incl. Phone number to verify) August 2, 2016 4. Income verification forms, for employers to complete, are available at the public health department upon request. 5. ESC Verification (internal use only). 6. Bank statements with reoccurring direct deposit Exception in Family Planning: To comply with Title X regulations, patients who do not present on the day of appointment with acceptable forms of income documentation will be given the option to be seen at 100% or reschedule their appointment. Reported income through other programs offered in the agency, rather than re -verifying income, may be used (8.4.1). Fees are waived for Family Planning patients, who for good cause, are unable to pay, but do not qualify for a discount (SOD), as determined by the Director of Nursing (42 CFR 59.2; 8.4.3). G. Gross Income -Defined Once documentation of income is viewed by the interviewer, a note should be made on the "NOTE" field of the FIH screen on the InSight system. Example: Notes: Pt. lives with husband, 1 child, mother, etc..... Gross income shall be used in fee determinations and shall be defined as the combined income received by the patients' family from the following sources: 1. Salaries and wages, including bonuses and prize winnings 2. Earnings from self-employment: Gross Income from tax documentation (i.e. lawn maintenance and housekeeping) 3. Investment income, stocks/bonds/savings interest, rentals, etc.... 4. Public assistance money 5. Unemployment compensation 6. Self -declared alimony and child support 7. Military allotments 8. Social Security Benefits 9. Veterans' Administration benefits 10. Retirement and pension payments 11. Worker's Compensation 12. Regular contributions from individuals not living in the household 13. Student Grants/stipends paid to student for living expense Gross Income shall not include 1. Irregular income that a minor earns from babysitting, lawn mowing, or other tasks. 2. Food Stamps 3. Supplemental Security Income (SSI) benefits Income during the twelve (12) months preceding the date of determination must be counted for all people in the family economic unit. Exception in Family Planning: Gross Income shall not include child support. H. Zero or Near Zero Income: If a patient reports zero income or very little income, the interviewer must include a written explanation of what the family is actually living on. In most cases, a statement of zero income would only be acceptable when the applicant lives on income from sources, such as food stamps, or lives in a homeless shelter, verified by a letter from the director of the shelter. The interviewer must include a written explanation of what the family is living on, based off of the Insufficient Income worksheet. Clients receiving family planning services that have a documented income at or below 100% of the FPL are not charged for services provided, although third parties authorized or legally obligated to pay for services are billed (8.4.1). Clients are not denied family planning services or subjected to any variation in quality of services due to inability to pay (42 CFR 59.5 (a) (7); 8.4.1). I. Walk-in Services: Any balance and /or payment plan payments must be paid up to current, prior to providing walk in services. If the balance and/or payment plan is not up to date, the patient is informed of what it will August 2, 2016 take to bring the account up to date. Once the account is current, walk in services may be provided. Payment is taken for the walk in services and is posted to that line. Exception- Immunization services: This does not apply to flat fee immunization services. J. Exceptions to computation of Income: 1. Exception: If any member of the family unit was unemployed during the previous 12 months, use the following formula to compute his/her income: (actual income from the last 6 months) plus (projected income for the next 6 months.) 2. Exception: If patient cannot prove previous 6 months' income, then current income will be taken into account using the 12 month projected formula. K. Verification of Income Statement: The patient is required to sign Terms and Conditions, at least annually or the next visit over 12 months from the previous visit, verifying that financial information supplied to the interviewer is true and accurate and consents that the public health department has the right to verify any and all information, consents for payment and assignment of benefits, and authorizes the release medical information, if necessary, for the processing of any claims. L. TPO: Permission to Use and Disclose Patient Health Information must be signed by the patient for treatment/payment/operations. M. Responsible Party -Defined: If a spouse comes into the public health department and indicates that they don't work, but the other spouse does, they may give the working spouse's social security number, income and insurance information. The non -working spouse would then sign the Terms and Conditions. The working spouse does not also have to sign the Terms and Conditions, but is considered the responsible party or guarantor. The responsible party will be billed for any unpaid balances for services rendered. N. Payment Collection Responsibility Clerical staff from Clinical Services and Environmental Health will be primarily responsible for informing clients/patients of expectations and responsibility to pay prior to or at the time service is rendered. Fee balances for Environmental Health services rendered should be paid, and completed septic system permits should be secured, promptly by the customer. Permits are held for fee payment, signature, and pickup in the branch office where the permit was generated. Clinical Services clerical staff will confirm a patient's ability to pay prior to service delivery. Reasonable efforts to collect charges without jeopardizing client confidentiality will be made (42 CFR 59.5(a) (9); 8.4.8) Verification of enrollment in Medicaid constitutes full payment for covered/billed services. Other third party insurance plans will be billed, unless the insurance company has previously notified the Iredell County Public Health Department that public health services are not eligible to be covered. Such patients will be informed that they will be considered as private pay patients. A patient, who has not brought the necessary income documentation and elects to be seen and classified at 100% of the sliding scale, must pay 50% of the amount due for the services received at the time of the visit and must agree to an extended payment plan. If a payment or denial notice is not received from a billed third party insurance plan within 120 days of service, the patient will be transferred to private pay. If an insurance payment is made directly to the patient and the full payment issued by the insurance company, with a copy of the FOB, is not received within 120 days of service, the patient will be transferred to private pay. Patients transferred to private pay will be transferred at 100% and patients will be informed of this at the time of service. August 2, 2016 Where payment collection is available from the Title XIX or Title XX of the Social Security Act for family planning services, a written agreement with the Title XIX or the Title XX state agency at either the grantee level or sub -recipient agency is required (42 CFR 59.5 (a) (9); 8.4.7). Failure to Pay/Failure to pick up permits: Once, at the beginning of each quarter, a certified, restricted delivery mailing will be sent to all customers with permits awaiting pickup in both Environmental Health division branch locations. The number of permits, the total fees owed (including the postage for the certified, restricted delivery letter), and a 30 -day pickup deadline will be clearly indicated in this mailing. One follow-up phone call will be attempted if the delivery receipt is not returned within 30 days. If there is no response to the phone call within 5 business days, the permit will be voided. Customers responding to the phone call will have 5 business days to pick up the permit. Atter that time, the permit will be voided. If both the mailing and phone contact are unsuccessful, the permit and all associated paperwork will be immediately voided, and all tees paid toward the work done will be non-refundable. Failure to pay charges, for rendered services, in full, at the time of service, constitutes a debt for reasonable collection, unless the department is billing other third party insurance. Any outstanding balances, after the collection of other third party insurance, will also constitute a debt for reasonable collection. Extended payments: Arrangements may be made for extended payments when good cause is indicated, using a Payment Agreement form. Patients will be informed of their account status at each visit and at other encounters. Private pay payments received will always be posted to the oldest public health department services ledger balance. Exception- Flat fee services: Flat fee charges are due at the time of service delivery and will be posted to that service, unless the service is billed to the patient's medical insurance carrier. O. Ability to pay -defined: For programs requiring financial eligibility, the process establishes the patient's ability to pay. Those patients who fall within 20%-100% on the sliding scale have been determined to have an "ability to pay" at that particular level. Those patients sliding to 0% are to be provided services at no charge to the patient. Unwillingness to pay -defined: During the financial eligibility process, the expectations of payment, by the client, arc discussed. The client signs a Terms and Conditions form, agreeing to pay for the cost of the services. "Unwillingness to pay" is defined as follows: the patient makes no effort to satisfy their financial contract after their "ability to pay" has been determined. Service limitations/denials may be applied when patients do not make a good -faith effort to reduce the outstanding balance. Consideration shall be given to necessity of services, program guidelines, and any statutorily required services. Q. Delinquent status- defined: When a patient's account balance is not current with the established financial contract, their account is considered in delinquent status. R. Services denial: A patient having an established financial contract which is not current AND does not make payments to bring their contract up to date will be denied services at the public health department. Exception- Dental/Family Plannintr/Walk-in services: To receive dental, child health, July 20, 2016 family planning, or walk-in services, patients with a financial contract must be current AND their outstanding balance cannot be in excess of $75.00. July I, 2016 Exception -Family Planning: Fees are waived for Family Planning patients, who for good cause, are unable to pay, but do not qualify for a discount (SOD), as determined by the Director of Nursing (8.4.1). Exception- Emergency Services: Emergency services may never be denied, unless the department is not equipped to provide a specialized emergency service. If necessary, a referral will be generated. Emergency dental patients and dental patients undergoing an emergency August 2, 2016 treatment plan, current Maternal Health patients, and Maternal Health patients returning for their six-week check-up will not be denied services. S. Statement Billing Patients with an active account in our patient care management software will be billed monthly at 30-60-90 day intervals. Statements will not be generated on balances below $3.00. Confidential patients will be informed that they will not receive a mailed statement, but that they will still be expected to follow the terms of their Patient Agreement. Exception- FP statements: Family Planning Clients will receive a billing statement, at the time of service, showing the total amount of the charges for their services that day, any discounts allowed and the remaining balance. T. Attorney Letter: Once annually, if a patient's account has been delinquent for 120 days, an Attorney letter will be mailed to the patient. Letters will not be generated on balances below $3.00 or sent to confidential patients. U. Notice of debt owed: If there is no payment activity on a patient's account following the mailing of the Attorney letter, a Notice of Debt Owed will be mailed to the patient. This Notice will not be generated on balances below $3.00 or sent to confidential patients. V. NC debt set-off program: Accounts, with balances in excess of 550.00, that are delinquent and that have received the Notice of Debt Owed letter, will be submitted to the North Carolina Debt Set-off program in accordance with the rules and regulations, thereof. W. Bad debt write-off: Accounts will be written off no earlier than one year or more after the last date of any payment on the account. Bad debts, which are determined uncollectible, (i.e. death, bankruptcy) will be written off upon notification. X. Service reinstatement: An itemized list of uncollectible, outstanding patient balances will be prepared before the end of the fiscal year for the Health Director's review. Those approved by the Health Director and the Board of Health will be written off and reported to the Board of County Commissioners. The accounts receivable system shall indicate the recording of the debt as uncollectible and evidence shall be on file to document required billings Y. Bad Debt Reclamations: Clients that have had a bad debt write-off within the last 2 years must comply with the reinstatement policy. (Exceptions: minor/non-emancipated Child Health, Immunizations, and dental patients). Reinstatement: customers must bring contract up-to-date. Those without a contract must pay 50% of their outstanding balance. A new contract will be negotiated. Z. Administration of Policy: The Public Health Director shall establish procedures to implement the Fee Policy. The Public Health Director presents the Fee Policy to the Board of Health and the Board of County Commissions for approval. The Public Health Director presents the Fee Schedule to the Board of Health and the Board of County Commissions for approval, annually and as needed during the fiscal year. The Public Health Director is authorized to adjust the fee policy and fees for Medicaid, Medicare, and usual/customary third party insurance, as well as for private pay. The Board of Health and Board of County Commissioners shall be informed of these fee/fee policy adjustments at their next meeting. AA. Donations: Voluntary donations can be accepted from any person regardless of insurance status. There must be no schedule of donations, no pressure on anyone to make donations, and donations must not be a prerequisite to the provision of services or supplies (8.4.9). August 2, 2016 10 Donations can be accepted for any program or service of the health department, including Family Planning. All donations must be accepted in accordance to the departments Solicitations for Donations Policy. New staff are required to review all agency policies and existing staff are required to review policies when intent change revisions are made. Information about the donation procedure is posted in the multi -service clinic waiting area and on the health department website. A printable donation form is also available on the Health Department website. if. INTERNAL & EXTERNAL RESEARCH /RESOURCES A. South Central Incubator -Finance & Billing Best Practices B. NC State Administrative Consultants/Finance 101 Handbook C. NC Consolidated Agreement and Program Addenda D. OPA Program Requirements for Title X Funded Family Planning Projects (section 8.4: Charges, Billing, and Collections) HE RESOURCES NEEDED: A. PERSONNEL: N/A B. EQUIPMENT/SUPPLIES: N/A C. OTHER RESOURCES (FUNDING): N/A IV. COST/BENEFIT IMPACT, IF APPLICABLE Proper procedures will provide financial integrity with avoidance of litigation and fines/penalties V. LEGAL AUTHORITY: Title X of the Public Health Service Act, State of NC Consolidated Agreement, NCGS 130A —45.13, NCGS 159, Article 3, Health Insurance Portability and Accountability Act of 1996, Public Law 104-91, HIPAA Administration Simplification Provisions Sections 261-264, 45 CFR 164.512, Administrative Procedures Manual for Federal Block Grant Funds, 1 NCAC 33, Sections .0100 - .1502, OMB Circular A87 and A-133, 45 CFR 4, 10A NCAC 45, 45A and 46, and all applicable program rules contained in the North Carolina Administrative Code, as well as all applicable State & Federal laws and regulations. Vl. RELATED POLICIES & PROCEDURES WITH SIMILAR CONTENT: Clinical Services Eligibility Procedures Policy, Refund Policy, Voucher PROCEDURES, Payment Policy, Medicaid Processing Policy, Third Party Insurance Policy, and Solicitations for Donations Policy VII. APPROVAL/SUPPORT: Name of Person/Group Approving/Supporting Policy Date Name of Person/Group Approving/Supporting Policy Date Jane Murray, Health Director Martha Price, Computer Consultant Susan Johnson, Director of Nursing Angela Gill, Patient Relations Rep. Bill Griffith, Director of Finance Rose Torres, Patient Accts. Supervisor Norma Rife, Director of PHDP Leslie Hatfield, Dental Pgm. Supervisor Brady Freeman, Director of Env. Health Marsha Branch, Proc. Asst. IV Maria Call, Mgmt. Support Supervisor Caroline Taylor, Admin. Officer Kim Mecimore, Env. Health Supervisor I Adrian Pruett, Env. Health Supervisor [ Request from the Public Library to Approve Budget Amendment #1 for the Scholarship to Attend the 2016 Conference: Library Director Steve Messick said this budget amendment is to receive $1,400 from the State Library for a scholarship for Michelle Kennedy to attend the Association of Urban and Small Libraries Conference in Fargo, ND at the end of August 2, 2016 11 October. Several staff members have received this scholarship and brought back many great ideas. The scholarship covers all expenses and there are no matching funds from the County. This item was placed on the consent agenda. Request from the Public Library to Approve an Agreement with ISS to Provide Student ID Accounts and Exceptions for Late Fees: Library Director Steve Messick stated they are working on a project in cooperation with Iredell-Statesville Schools. This project would provide access to all students in ISS using their student ID number. This is based on a project the Charlotte -Mecklenburg Library successfully conducted in 2015 and won the 2015 National Association of Counties Award. ISS would provide the Library with data files of all student records which would be loaded into the Library's computer system. Students would be able to use the Library with just their student ID number. There would be an opportunity for parents to opt out if they choose. The purpose is for students to have access to books and on-line resources. Julie Moore said students would have access to research data basis, NC Live, Pronunciator, Atomic Training and Learning Express. They would be able to borrow and have access to digital materials, such as eBooks, eAudios, and magazines like Overdrive and Zinio. With the student account they would be able to check out ten print or audio books from the Public Library collection. There would be no overdue fines associated with the accounts but the users would be responsible for any fees associated with lost or damaged items. There would be no fees associated with on- line resources. Messick said they learned about this project in the spring and was contacted by Iredell- Statesville Schools who had also heard about the program. This is a pilot project and if successful it could potentially expand to charter, private, and home schools. This request is for approval to pursue an agreement with ISS to provide these accounts and to waive late fees. Currently there are 7,700 library users with library cards in the 5-17 age group. In 2015 the Library collected $5,800 in late fees from those accounts. It is unknown how much money may be lost with this program. It would depend upon whether they would use the student account or the regular library account. They would still be responsible for any lost or damaged items. Commissioner Bowles asked the timeframe before an item is considered lost. Messick said the great majority of books do come back. There is a special Library Collection Service that helps to clear accounts. Chairman Mallory asked if the Mooresville Graded School District had been contacted. Messick said someone from the Mooresville Library is researching the same program with MGSD. Chairman Mallory asked if the majority would use it remotely. Messick said remote access will be the emphasis and to focus on middle and high schools students who have lap tops. The Library has many informational resources that are available through the Library that are not available through the schools or the general public. However, in order to use those students must have a library account. Chairman Mallory encouraged contact with the Mooresville Graded School District and suggested the approval from the Board should include MGDS. August 2, 2016 12 Commissioner Bowles asked about Mitchell Community College students. Messick said they had not thought about MCC but will look into the possibility. This item was placed on the consent agenda. Request from the Iredell County Executive Committee to Appoint a Replacement for the Office of Iredell County Register of Deeds: County Manager Ron Smith said the recommendation from the Executive Committee is Ron Wyatt. Mr. Wyatt has requested the appointment to be effective August 21, 2016 Commissioner Bowles asked about the salary. Smith said that could be discussed in Closed Session. Chairman Mallory asked if there were any questions concerning the General Statutes and the responsibility and limitations of the Board of Commissioners. County Attorney Bill Pope said the following G.S. was included in the agenda packet. § 161-5. Vacancy in office. (a) Repealed by Session Laws 1991, c. 60, s. 1. (al) When a vacancy occurs from any cause in the office of register of deeds, the board of county commissioners shall fill such vacancy by the appointment of a successor for the unexpired term, who shall qualify and give bond as required by law. If the register of deeds was elected as the nominee of a political party, the board of county commissioners shall consult the county executive committee of that political party before tilling the vacancy and shall appoint the person recommended by that committee, if the party makes a recommendation within 30 days of the occurrence of the vacancy. (b) In the interim between a vacancy in the office of register of deeds and the appointment and qualification of a successor register of deeds, under the provisions of subsection (a), any incumbent assistant or deputy register of deeds appointed under G.S. 161-6 prior to the vacancy shall continue to hold office as assistant or deputy registers of deeds until discharged or otherwise lawfully relieved of office by the lawful successor to the office of register of deeds. (1868, c. 35, s. 4; Code, s. 3649; Rev., s. 2651; C.S., s. 3546; 1965, c. 900; 1975, c. 868, ss. 1, 2; 1977, c. 180; 1981, c. 763, ss. 8, 9, 14; c. 830; 1987, c. 196, s. 2; 1989, c. 497, s. 4; 1989 (Reg. Sess., 1990), c. 1056; 1991, c. 14, s. 1, c. 60, ss. 1, 4.) Commissioner Johnson expressed appreciation to all the members of the Executive Committee for their hard work and for the fair process. He also congratulated Mr. Wyatt for his appointment. This item was placed on the consent agenda. Request from the County Attorney to Approve the Lease Amendment with Iredell Statesville Schools to Add 153 Acres Adjacent to SIHS: Attorney Lisa Valdez said the Board accepted, at the last meeting, the conveyance of 153 acres from the ISS School Board in order to combine with the existing site for construction and water shed regulations. The current South Iredell High School site is under a lease agreement pursuant to the 2008 COPs funding. This adds 152 acres to the lease agreement to be under the same terms that when paid it will be returned. This item was placed on the consent agenda. Request from Administration for Approval to Negotiate and Execute a Contract with Bordeaux Construction Company to Construct the Jail: Project Manager David Saleeby said the agenda packet contained the RFQ process and a summary of the project. The team includes David Saleeby, Bert Connolly, David Montgomery, Robert Woody, Dean Lail, and Ben August 2, 2016 13 Stikeleather. An RFQ was sent out for a CMAR (Construction Manager at Risk) which is a construction company that would work on behalf of the County to help design the project. Five responses were returned and the team interviewed all five. The team met, evaluated the candidates and selected the top two. After some site visits a second round of interviews was conducted with the top two companies. For each company they visited one completed site and a site just beginning with only footings. The team unanimously selected Bordeaux Construction of Raleigh. The request is for approval to move forward with a contract with Bordeaux Construction Company. Commissioner Robertson asked if all local companies were given the same opportunities. Saleeby said yes. Smith said one of the pre -requisites was jail experience. With CMAR there is an opportunity to use local sub -contractors. Commissioner Johnson asked how many projects this company has been involved in. Bert Connolly said Chatham, Yadkin, Alexander, Montgomery, Harnett, Brunswick, Columbus, and Sampson. Commissioner Johnson asked if the company traditional completed the projects on time and under budget. Saleeby said yes. Smith added the company has worked well with Mosely Architects in the past. Saleeby said the CMAR needs to be on board to work with the Architect on the County's behalf to help design to get the most for the bucks. Smith said the Architect has actually been put on hold until the CMAR was on board and to ensure a GMP (Guaranteed Maximum Price) at the end of every phase. The CMAR will be working for the County to get the smallest GMP. Commissioner Johnson asked about the durability of Bordeaux's product. Connolly said Sampson's was started in 2005 and Brunswick was in 2006. There have been no complaints. Chairman Mallory asked about the original approved cost of $18-$21 million. This report states $21.9 million. Saleeby said the construction will be $18.3 million but there are many other items to go with it. Smith said the idea is to fine-tune the GMP to bring it in under budget. An urban site is always difficult. Commissioner Bowles asked if the team that voted on Bordeaux will continue to stay with the project or if their job is complete. Saleeby said parts of the team will continue. Chairman Mallory asked about the capabilities for video interviews to minimize movement of prisoners. August 2, 2016 14 Connolly said that will be included in the discussion with the contractors. Smith said the team will work with Bordeaux to stay within budget but if issues arise for any reason they will move on to the next contractor. This item was placed on the consent agenda. Request Approval of the July 19, 2016 Minutes: There were no corrections to the minutes. This item was placed on the consent agenda. The Board recessed at 6:30 PM until the regular session at 7:00 PM IREDELL COUNTY BOARD OF COMMISSIONERS REGULAR MINUTES August 2, 2016 The Iredell County Board of Commissioners met in regular session on Tuesday, August 2, 2016 at 7:00 PM, in the Iredell County Government Center (Commissioners' Meeting Room), 200 South Center Street, Statesville, NC. Board Members Present Chairman James B. Mallory III Vice Chairman Marvin Norman Tommy Bowles Steve Johnson Ken Robertson Staff present: County Manager Ron Smith, County Attorney Bill Pope, Deputy County Manager Beth Jones, Finance Director Susan G. Robertson, Attorney Lisa Valdez, Assistant to the Manager Ben Stikeleather, and Clerk to the Board Retha Gaither. CALL TO ORDER by Chairman Mallory. INVOCATION: Chairman James Mallory asked everyone to bow their heads for a moment of silence. PLEDGE OF ALLEGIANCE led by Emily Holland. PRESENTATION OF SPECIAL RECOGNITIONS & AWARDS (None) ADJUSTMENTS TO THE AGENDA (None) APPOINTMENTS BEFORE THE BOARD Shawn Eckles of Troutman, Presenting a Status Report for ICTV: Shawn Eckles, founder of ICTV presented a brief history and future plans for non-profit ICTV. Currently it is only available on-line with plans to raise funds for live streaming by 2017. Mr. Eckles was not seeking financing from the County, but asked the Board to publicly endorse ICTV and its future business activities. August 2, 2016 15 Chairman Mallory expressed appreciation to Mr. Eckles for the initiative and insight into the technical processes to get such a project off the ground. However, as for the endorsement, Mallory asked the County Attorney to research/evaluate the proprieties and potential issues that might arise from such an endorsement. Emily Holland, 4-H Youth Delegate to NCACC Annual Conference: Cooperative Extension Agent Nancy Keith introduced Emily Holland as the 4-H Youth Representative. Emily has been in 4-H for four years and very involved in many different club activities. She is a member of the State 4-H dairy judging team. She is the representative for the NC Youth Voice, where members of the 4-H and Boys/Girls Club meet in conjunction with the representatives of the North Carolina Association of County Commissioners during the annual conference. Holland thanked the Board for allowing her the opportunity to appear before the Board. She spoke briefly on problems that teens face today. There are many issues for teens with the major problem being drug abuse. Drugs are readily available everywhere, in school, from peers and even from their own family members. She encouraged the Board and all citizens in Iredell County to take time out of their busy schedules to talk to teens, to show them love and attention. She would like to see more programs that involve teens in activities such as agriculture to learn to grow their own food. Commissioner Bowles commented that if students are engaged in particular activities they are less likely to experiment with drugs. Commissioner Robertson stated the key is to get young people engaged in something they find fulfilling as opposed to abusing drugs. He asked how she was selected to represent Iredell County. Holland said she was chosen from the 4-H group. Commissioner Johnson congratulated Holland and said it takes a degree of courage to stand before a public body. He volunteered to make himself available to be a speaker anytime needed. Vice Chairman Norman asked Holland to stay in touch. Chairman Mallory commented that Holland is an extraordinary teenager which gives hope toward the next generation knowing that she will continue to be a leader in the community and state. The subject of drug abuse is very serious and there is an epidemic of opioid abuse. There is a task force working to integrate many different organizations to effectively deal with drug abuse. Holland said she had been invited to sit in on the task force meeting. Keith added that the Iredell County Fair would be open for nine days this year. It will open on Friday, September 2 and close Saturday, September 10. Chairman Mallory introduced a Boy Scout Michael Knight, who attended the meeting to fulfill badge requirements. PUBLIC HEARINGS (None) August 2, 2016 16 ADMINISTRATIVE MATTERS County Manager Ron Smith summarized the consent agenda as follows: • Request from Tax Administration to present the Annual Tax Settlement and Orders to Collect for the Tax Collector and Sheriff. • Request from the Health Department for approval of revisions to the Fee Policy and fee schedules for clinical, dental, and environmental health divisions. • Request from the Public Library to approve budget amendment #1 for the scholarship to attend the 2016 Small Libraries' Conference. • Request from the Public Library to approve an agreement with Iredell-Statesville Schools to provide student ID accounts and exceptions for late fees. • Request from the Iredell County Republican Executive Committee to appoint Ron Wyatt for the Office of Iredell County Register of Deeds effective August 21, 2016 • Request from the County Attorney to approve a lease amendment with Iredell Statesville Schools to add 153 acres adjacent to South Iredell High School. • Request from Administration for approval to negotiate and execute a contract with Bordeaux Construction Company to construct the jail expansion. • Request approval of the July 19 minutes. MOT10N by Commissioner Johnson to approve the consent agenda. VOTING: Ayes — 5; Nays — 0 Chairman Mallory congratulated Ron Wyatt on the appointment as Register of Deeds and on the next opportunity to serve the citizens of Iredell County. Also, a shout out to former Register of Deeds Matt McCall and his accomplishments in terms of customer focus, new technologies, and expanding services with a satellite office in Mooresville. Chairman Mallory also recognized Representative John Fraley who attended the meeting and for his close working relationship with Iredell County. ANNOUNCEMENT OF VACANCIES OCCURING ON BOARDS & COMMISSIONS Troutman Planning Board ETJ (I Announcement) Industrial Facilities & Pollution Control Financing Authority (1 Announcement) APPOINTMENTS TO BOARD AND COMMISSIONS Iredell-Alexander-Catawba County Farm Service Agency County Committee (1 Appointment/Nomination) — The Board actually makes a nomination and submits for the Farm Service Agency Committee Election. MOTION by Commissioner Robertson to nominate Doug Carrigan. VOTING: Ayes — 5; Nays — 0 Partners Behavioral Health Board of Directors (l Appointment) OTIO by Commissioner Bowles to appoint Jane Murray. VOTING: Ayes — 5; Nays — 0 August 2, 2016 17 UNFINISHED BUSINESS (None) NEW BUSINESS (None) COUNTY MANAGER'S REPORT County Manager Ron Smith shared the following information: • The Employee/Retiree Recognition and Awards Breakfast is scheduled for Friday, August 6, 8:00 AM at the Iredell County Agricultural Center. • Beginning Thursday, August 11, Ben Stikeleather will have office hours one day a week at Government Center South. • Letters went out to the VFD chiefs and their board chairpersons which explained the status of the funding process. CLOSED SESSIONS MOTION by Vice Chairman Norman to enter into Closed Session at 7:45 PM for Economic Development (G.S. 143-318.11 (a) (4)); Personnel (G.S. 143-318.11 (a) (6)); and Property Acquisition (G.S. 143-318.11 (a) (5)) VOTING: Ayes — 5; Nays — 0 Chairman Mallory resumed open session at 9:05 PM. OTION by Commissioner Robertson to call for a public hearing on August 16, at 7:00 PM, regarding an economic development incentive of $63,300 over a five year period for Project Stewie, based on a $3 million investment in Iredell County. VOTING: Ayes — 5; Nays — 0 MOTION by Commissioner Bowles to call for a public hearing on August 16, at 7:00 PM, regarding an economic development incentive of $854,000 over a six year period for Project Ryan, based on a $38.1 million investment in Iredell County. VOTING: Ayes — 5; Nays — 0 MOT10N by Commissioner Johnson to call for a public hearing on August 16, 2016, at 7:00 PM, regarding an economic development incentive of $74,905 over a five year period for Project Lightning, based on a $3.55 million investment in Iredell County. VOTING: Ayes — 5; Nays — 0 ADJOURNMENT OTION by Commissioner Johnson to adjourn at 9:15 PM. (The next meeting will be Tuesday, August 16, 2016, 7:00 PM, in the Commissioners' Meeting Room, Pre -Agenda Discussion at 5:30 PM in the South Wing Conference Room, Government Center, 200 South Center Street, Statesville, NC) August 2, 2016 18 Date Approved Retha C. Gaither, Clerk August 2, 2016 19