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MINUTES ORANGE COUNTY BOARD OF HEALTH January 21, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 January 21, 2009 In November when new fees were approved by the Board, a new requirement to collect a $3 co-pay from all adult Medicaid service recipients was inadvertently left out. This is a requirement from the Medicaid program, however we must have a fee established to be able to collect it. Motion to accept items on the Consent Agenda was made by Tim Carey, seconded by Ernie Dodson, and carried without dissent. IV. Reports and Discussion with Possible Action A. Preliminary Budget for 09-10 Fiscal Year a. Budget Reductions: The County Manager has directed each department to prepare a budget with a 10% reduction in operating expenses. The desire is to cut operations rather than staff at this time. Each division has prepared a budget that represents a 10% cut. In all Divisions, except Personal Health Services, the cuts have been taken from various operational line items. For Personal Health Services, we are proposing savings through cutting programs and a currently vacant but recently authorized position. Dental Health has a reduction through holding the dental hygienist position approved in this current year budget open for the entire year. Central Administrative Services are proposing a 16% cut in order to restore some of the cuts proposed by Divisions providing direct services. In addition, staff will be sharing an estimate of revenue projections for next year which may further impact our budget. The Department will not receive revenue estimates from the State until February 15. The Board of Health will be reviewing the final budget at the February meeting and recommending any final adjustments that will be forwarded to the County. Tim Carey asked about the cost difference in percentage of personnel over operations in the overall budget for the department. Dr. Summers replied that roughly 80% of the cost is personnel and 20% operating expenses. It is anticipated that there will be no cost of living or salary increases for staff next year. b. Fees: Personal Health Services and Dental Health Services have examined all of their fees and prepared a chart for the Board’s consideration. The Board of Health adopted policy on setting fees is to increase the fees by the Consumer Price Index to ensure that fees keep pace with growth but remain affordable for patients. The policy also states that fees will be at a minimum aligned with Medicaid reimbursement levels since that is the lowest cost based reimbursement. It has been a number of years since a true cost study has been done to assess the appropriateness of our fees for services. The staff sought input from the Board Committee on setting fees and discussed that proposal (increasing fees 25% above the Medicaid rate) with the Health Director. By statute and by Medicaid policy, the Department should be considering setting fees based on the costs of actually delivering each service. A number of factors impact those costs, including the numbers of each service actually performed, staff salaries, how staff actually report their time, and the operational expenses associated with a particular procedure. Each year when the NC Division of Public Health prepares the documentation for the Medicaid cost settlement