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MINUTES ORANGE COUNTY BOARD OF HEALTH January 21, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 January 21, 2009 funds, a comparison of costs across the state is prepared for each clinical procedure code (CPT). The State believes that this is the best cost representation for a health department to utilize in determining fees. The Board may elect to set fees lower than costs but must provide a rationale for doing so and must apply that rationale to like services. If fees are set below Medicaid rates then Medicaid will only pay the set fee level. If the Board wishes to set fees on a basis other than the Consumer Price Index increase, then the policy for setting fees will also need to be changed. Tim Carey asked if the budget must be balanced for each division. Rosemary Summers replied that revenues as well as expenses will be looked at therefore each division will have to submit a balanced budget. Dr. Carey also stated that elimination of a resident position in dental health did not make sense because a resident generally brings in more revenue than the cost of the position. Chris Harlan commented that the chart provided with the dental services was a good illustration of safety net provider services and the impact that curtailing services or availability would have on the community. Carla Julian reported that cuts were being made in Risk Management/Quality Assurance in travel expenses, training and other expenditures. Rosemary Summers stated that proposed state legislative action will ask that preparedness be added to local health department as a mandated service. Jessica Lee stated that there has to be a limit to cutting expenses to the point where the department would not be able to provide the mandated services. Sharon Freeland asked for clarification of the fee system for low income or zero- pay patients. Angela Cooke explained that the patients in that category would pay $25 per visit. Chris Harlan asked if there is a protocol for doing cost studies and how frequently they should be done. Rosemary Summers explained that and accepted best practice is to repeat a cost study every 3-5 years to ensure that personnel costs are captured as well as changes in service delivery. It is more difficult to establish a “new fee” cost since there is no actual experience in delivering the new service. In the past those fees have been established by comparing fees from other public agencies providing the same or a similar service. Staff will re-work the fee calculation methods and place this on the agenda for February. Environmental Health has not proposed fee changes for this coming year, but may examine the fees more closely before the February meeting. Tom Konsler reported that environmental health staff has been moving to digitalizing files and email of scanned documents to help defer postage and copy costs. Due to the economic slow down, there has been a decline in onsite and well permit program applications and therefore in revenue. Sharon Freeland commented that she realized that all areas had to make budget cuts, but programs such as HIV and other community services that are so needed are being impacted. Dr. Summers stated that due to budget cuts all