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MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 February 25, 2009 replied that staff felt that the longer the rule remained in the regulations the more potential would exist for a challenge. Commissioner Yuhasz asked if staff had communicated with planning prior to recommendation to remove this rule and was assured that staff had verified through the Planning Director to be sure there would be no conflicts with Planning and Development prior to making the recommendation. Rosemary Summers pointed out that the local rules for public health must be health related. This rule change is justified by that reason. Chris Harlan asked if a subdivision had been approved for 2-bedroom homes whether it would preclude an addition to the homes because of that restriction. Motion to accept the Rule Amendment as stated for On-Site Wastewater Rules was made by Matt Vizithum, seconded by Jessica Lee and carried without dissent. B. Fee Schedule Approval The approved Fee and Eligibility Policy states that: A. Fees are charged for health and dental services provided to individuals unless prohibited by law or regulation. Fees are established based upon cost analysis, Medicaid and Medicare rates, comparable provider rates and/or state or contractual agreements. B. The Health Director is authorized to adjust fees, rounded to the next highest dollar, on an annual basis: Fees will be adjusted annually by either a) the general rate of inflation calculated based on the current Consumer Price Index (CPI) or b) the percent increase in any new Medicaid/Medicare service rate adjustments, whichever is greater. C. Fee schedules will be reviewed annually during the budget process and adjusted as appropriate; a complete cost analysis for purposes of fee adjustments will be performed every five years. Wayne Sherman reported that a comprehensive Cost Analysis has not been completed since 2003 for Dental Health and since 2000 for Personal Health due to budget constraints. In 07-08 however, the County Budget office undertook a modest cost study of the most frequent CPT codes used by disciplines by comparing OCHD’s rate with regional and/or similar health departments and our costs were quite high. This comparison became the baseline cost used to determine 09-10 fees. The appropriate CPI rate was applied in 08-09 and 09-10 to the baseline fees to determine the recommended 09-10 fees. The 06-07 Medicaid Cost Study was under consideration as a baseline for fees but due to concerns about the accuracy of the data used to determine the OCHD Medicaid Costs, this was not pursued. New fees are to be determined based on the assessed cost of staffing, materials, supplies and/or equipment needed to deliver the service. Funding for another comprehensive Cost study is not anticipated in the near future so the department will be looking for opportunities to work with Financial or Business collegiate students to undertake a year-long, in-depth analysis of our fees. Rosemary Summers explained that these fees are based on 100% pay for services and are lower than private providers. On a sliding scale a 20% pay patient would pay 20%