Agenda - 10-17-2000-8e - Laserfiche WebLink

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t ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: October 17, 2000 Action Agenda Item No. $~ SUBJECT: Dental Clinical Fee Increases DEPARTMENT: Health PUBLIC HEARING: (YIN) No ATTACHMENT(S): INFORMATION CONTACT: Draft Fee Schedule Rosemary Summers, ext 2411 TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 9fi8-4501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To consider approving dental clinical fee increases for some procedures. BACKGROUND: The North Carolina Division of Medical Assistance, the division that administers the Medicaid program, is requiring all health department dental clinical programs to "unbundle" their services and bill Medicaid for each individual service provided. The unbundling was originally to take effect October 1, however due to delays in providing reimbursement rates to health departments, the implementation has been delayed until November 1, 2000. Currently, health departments receive a lump sum payment for each Medicaid visit, regardless of the work performed. The draft fee schedule reflects the unbundled rate of Medicaid reimbursement and adjusts the full pay fee accordingly. The full pay fee must be equivalent to Medicaid reimbursement and to the extent possible reflects the full cost of providing the service. The full pay fees have been compared with area practices and are consistent with charges by private practitioners and the UNC Dental School. The health department operates on a sliding fee scale, charging clients on a 0/20/40/80/100 percent pay scale. 100% pay is based on 200% of the federal poverty level ($32,900 for a family of four). Atypical six month cleaning visit (with no fillings or extractions) for a patient under the age of 14 prior to this change would have been $70.00 and with the new fee schedule will be $75. Approximately 3% of total patient visits are at the 100% pay level. The department also bills private insurance and North Carolina Health Choice for services. In order to capture the full amount of Medicaid reimbursement under this new policy, the Department must begin implementing the new fees on November 1, 2000. FINANCIAL IMPACT: Total Medicaid revenue collected in fiscal year 1999-2000 was $102,200 based on $100 per visit. At the current unbundled Medicaid rate that would have yielded $99,568 or $2,632 less at the unbundled rate of reimbursement. The current year's projection for Medicaid revenue was $108,200. The current anticipated loss under the unbundled scheme