Agenda - 03-05-2009 - Attachment 2

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S-25 * PHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The Department will continue to provide the mandatory Communicable Disease screening and provision of needed immunizations. Following this screening, refugees will be referred to community medical providers to establish a medical home and receive ongoing care. Because of their poor health status, they often require specialty services. Approximately 240 Refugees (children and adults) will be impacted by this change in service. Communicable Disease screening on all arriving refugees is a mandatory service, but refugee health assessments (comprehensive physical exams) are not. Nonetheless, a comprehensive physical exam is highly recommended. Many refugees arriving with complex health conditions that the Health Department staff is not trained to handle, are already being referred to medical providers who provide more comprehensive services for assessment, treatment and ongoing care. As we discontinue the health assessment service, we will need to work with our community partners to assure.a clear delineation of roles (Communicable Disease screening by Health Department, Refugee Health Assessments by community medical providers). Since the Refugee Health Assessment is a Medicaid-reimbursable service and refugees are eligible for Medicaid in the first 8 months after arrival, there is a funding stream available for community medical providers to be paid for this service. This will likely impact other community providers such as Carrboro Community Health Center who already provide services to a large number of refugees. The .5 Family Nurse Practitioner, currently assigned to refugee health assessments will be reassigned to provide an additional 720+ services in our traditional mandatory prevention/treatment programs. This includes mandatory clinical services such as Sexually transmitted diseases, Family Planning, Maternal, and Child Health care. As a safety net provider during difficult economic times, there is a greater request for these services. We anticipate that the Medicaid-revenue earned for Refugee Health Assessments ($15,608) will be replaced by Medicaid and fees generated providing the above traditional services. In addition, since Refugee Health Assessments (including the use of interpreters) take on average 1.5 hours to complete, we will be able to increase Family Nurse Practitioner productivity 3-fold with other services (averaging 20-30 minutes to provide). S-26 * PHS -- Proposal (Provide a brief description of the service change) Discontinue HIV Community Testing Program S-26 * PHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $5,652 Reduction in medical supplies S-26 * PHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This reduction will result in the loss of opportunity for higher-risk individuals to receive rapid HIV (Human Immunodeficiency Virus) testing results in a discreet community setting. 48