Item L1
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: December 17, 2008
Division: County Administration
Bulk Item: Yes No ~
Department: County Administration
Staff Contact Person/Phone #: Cher McGuirk 305-293-7539
AGENDA ITEM WORDING:
Approval of current client fees for public health services provided by Monroe County Health
Department.
ITEM BACKGROUND:
Item seeks to approval by Board of county Commissioners to increase certain fees (noted in document)
maintain other fees that remain unchanged.
PREVIOUS RELEVANT BOCC ACTION:
Previous Fee Schedule put before the BOCC February 21,2007 in resolution no. 093-2007 increased
clinical fees.
CONTRACT/AGREEMENT CHANGES:
STAFF RECOMMENDATIONS:
$0
BUDGETED: Yes ~ No
TOTAL COST:
COST TO COUNTY:
SOURCE OF FUNDS:
REVENUE PRODUCING: Yes
No
AMOUNT PER MONTH Year
APPROVED BY: County Atty 11/24/08
OMB/Purchasing _ Risk Management _
DOCUMENT A TION:
Included
Not Required__
DISPOSITION:
AGENDA ITEM #
Revised 8/06
RESOLUTION NO.
- 2008
A RESOLUTION OF THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA
AUTHORIZING THE MONROE COUNTY HEALTH
DEPARTMENT TO ESTABLISH FEES SPECIFICALLY
FOR PRIMARY CARE SERVICES, COMMUNITY PUBLIC
HEALTH SERVICES, VITAL STATISTICS, MEDICAL
RECORDS, PUBLIC RECORDS AND
RETURNED/DISHONORED CHECKS OFFERED AT THE
MONROE COUNTY HEALTH DEPARTMENT AS SET
FORTH IN EXHIBIT "A" ATTACHED HERETO AND
MADE A PART OF THIS RESOLUTION.
WHEREAS, F. S. 154.01(2) requires counties to establish and maintain full-time county
health departments to provide environmental health, communicable disease control and primary
care services; and
WHEREAS, F.S. 154.01(3) requires the Department of Health to enter into contracts
with counties for this purpose; and
WHEREAS, on January 17, 2007, the Board approved the annual core contract between
the Monroe County and the Florida Department of Health for public health services; and
WHEREAS, F. S. 154.06(1) authorizes each county and each county health department
to collect fees for primary care services rendered through the county health departments provided
that a schedule of such fees is established by resolution of the Board of County Commissioners
or by rule of the department; and
WHEREAS, F.S. 154.06(2) requires all funds collected under this section to be
expended solely for the purpose of providing health services and facilities within the county
served by the county health department and pursuant to the rules and regulations cited therein
and pursuant to all other applicable rules and regulations; and
WHEREAS, on September 21, 2005, the Board approved a resolution authorizing the
Monroe County Health Department to increase the fees charged for birth and death certificates
(Resolution No. 358-2005); and
WHEREAS, on February 21, 2007, the Board approved a resolution authorizing the
Monroe County Health Department to increase the fees charged for primary care services offered
at the Monroe County Health Department (Resolution No. 093-2007); and
WHEREAS, the Monroe County Health Department has indicated the need to re-define
and re-establish fees for public health services offered at the Monroe County Health Department
as set forth in Exhibit ''A'' attached hereto and made a part of this Resolution; and
WHEREAS, pursuant to F. S. 154.01(a) and 154.06(1), this fee resolution does not
include fees for environmental health services offered at the Monroe County Health Department
which are regulated by a uniform statewide fee schedule and are specifically outside of the
jurisdiction of the Board of County Commissioners of Monroe County, Florida; and
WHEREAS, the Board is satisfied with the justification provided by the Monroe County
Health Department;
NOW THEREFORE; BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA;
1. That the Monroe County Health Department shall collect fees for primary care
services, community public health services, vital statistics, medical records,
public records, returned/dishonored checks as specified in Exhibit ''A'' attached
hereto and made a part of this Resolution.
2. The Monroe County Health Department is solely responsible for ensuring
effective notice is provided to the general public and other impacted agencies and
organizations of the specific service fee increases.
3. The Monroe County Health Department is solely responsible for ensuring the
County's compliance with all financial and transitional rules and regulations, and
any other factors that may be impacted by the service fee increases at all levels;
local, state and federal.
4. Any prior resolution, ordinance or contract inconsistent herewith is hereby
repealed.
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida at a regular meeting held on the _ day of December, AD., 2008.
Mayor Neugent
Mayor Pro Tem Murphy
Commissioner DiGennaro
Commissioner Wigington
Commissioner Carruthers
(Seal)
A TTEST: DANNY L. KOLHAGE, CLERK
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By:
BY:
Deputy Clerk
Mayor
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FEE RESOLUTIONS
A. PURPOSE. To establish public health service fees in order to expand
existing public health services to the community at large.
B. PRIMARY CARE SERVICES.
(1) Primary care services include well and sick adult and child health services
and family planning services. These services will be charged at not more than
150% of the prevailing Medicare rate. Where there is no Medicare fee, the fee
will be the Medicaid rate. Service levels will be determined utilizing current
Medicare guidelines for coding and billing services provided. Discounting
adjustments will be made to client fees based upon the current contract for
services with Medicare and other 3rd party payers. In addition, sliding scale
adjustments to fees for primary care services will be based upon Federal OMB
guidelines and in accordance with State of Florida Department of Health Policy
56-66-08. Medicaid is billed at the current Medicaid Cost-based rate and
reimbursement for these services is considered payment in full.
(2) Pharmacy - Medications issued will be provided at the most recent cost.
Medicaid is accepted as payment in full.
(3) Injection fee for parenteral medications per injection
$35.00
(4) Lab fees - All laboratory and pathology fees are subject to sliding scale fee
adjustment based upon OMB Federal Guidelines.
a. Bloods Specimens sent to outside laboratory- cost plus a $25.00
venipuncture fee per visit.
b. Specimens tested in c1inic- $10.00
(hemoglobin, urine, blood sugar, mono, wet mount, strep)
c. Pregnancy test
No charge
d. Non-blood specimens sent to outside laboratory, processing fee $10.00
per visit.
C. COMMUNITY PUBLIC HEALTH SERVICES
(1) Tuberculosis X-ray for suspected, confirmed or
Symptomatic contact or case
No Charge
(2) Tuberculosis Skin Test for suspected, confirmed or
Symptomatic contact or case
No Charge
(3) Tuberculosis (TB) Sputum Culture for suspected,
confirmed, or symptomatic contact of case
No Charge
(4) Tuberculin (TB) Skin Test, with reading, any other than
EXHIBIT
--A-
$35.00
10/30/2008
listed above in C. (1).
(5) Sexually Transmitted Diseases - The fee will be derived by considering the
client sliding fee group which is calculated at eligibility determination, based
on Federal OMB Guidelines. Medicaid identification will be accepted as full
payment in lieu of charges. $70.00
(6) Adult Immunizations: Per vaccine- cost + $35.00 injection fee per vaccine.
(7) Required Immunizations for children up to age 18 and eligible for
the Vaccine for Children program No Charge
(8) Class/Seminar attendance registration
Per person charge for health care, social work
and counseling employees.
AIDS 101
AIDS 500
AIDS 501
$ 5.00
$10.00
$50.00
VITAL STATISTICS:
(1) Birth Certificates:
Additional Copies
$ 16.00
$ 16.00
(3) Death Certificates - Certified Copy
Additional Copies
$ 4.00
$ 13.00
$ 13.00
$ 10.00
(2) Protective Covers
(4) Express Fee
E. MEDICAL RECORDS:
(1) Copying of Medical Record (per page)
50 cents
F. PUBLIC RECORDS:
(1) Copying of Public Record (per page)
25 cents
G. RETURNED/DISHONORED CHECKS: (S. 215.34(2), F.S.)
A service fee of $15.00 or 5% of the face amount of the check, draft, or money
order whichever is greater, not to exceed $150.00
2
10/30/2008
154~JH C~0tiUEty h~~~Wrn depM1wtliiJl([;l1ltt ddhre~Oj sy~f...:hlk-
()) The several counties of the state may cooperate with the Department of Health in the establishment
and malritenance of full-tiule county health departments in such counties for the promotion of the
public's health, the control and eradication of preventable diseases, and the provision of primary health
care for specIal populations.
(2) A functional system of county health department services shan be established which shan include
the following three levels of service and be funded as follows:
(a) "EIlvirQD1l1eDJalhejl.1thseryices" are those services which are organized and operated lQJll'Q~cj:the
bealth_nof J:11e -Ze!lemLQ.ublkbYJDOJilioring and regulating activiti~jn th~~envirol1IIlentwhich_:may
contributeJ9.the occurrence o[Jransmissi1)n_Qf disease. Environmental health services shall be supported
by available federal, state, and local funds and shall include those services mandated on a state or federal
level. EXjl.lllpJes of environmental health se~ices include, but arJ;iJJ.ot limited to, food hygiene. safe
drinking _water supply._s~wage and .solid waste disposal, swimming pools, group care facilities, migrant
labor camp~.Joxic material control, radiological health, occupational health~and_ entomology.
3) The Department of Health shall enter into contracts with the several counties for the purposes of this
part. All contracts shall be negotiated and approved by the appropriate local governing bodies on behalf
of the department. In accordance with federal guidelines, the state may utilize federal funds for county
health department services. A standard contract format shall be developed and used by the department in
contract negotiations. The contract shall include the three levels of county health department services
outlined in subsection (2) above and shall contain a section which stipulates, for the contract year:
(a) All revenue sources, including federal, state, and local general revenue, fees, and other cash
contributions, which shall be used by the county health department for county health department
serVIces;
154.06 Fees and services rendered; authority.--
(1) The Department of Health may establish by rule fee schedules for public health services rendered
through the county health departments. Such rules may include provisions for fee assessments,
copayments, sliding fee scales, fee waivers, and fee exemptions. In addition, the department shall adopt
bY- rule a uniform statewide fee schedule for all regulatory activities performed through the
environmental health program. Each county may establish, and each county health department may
collect. fees for primary care services. provided that a schedule of such fees is established by resolution
of the board of county commissioners or by rule of the department, respectively. Fees for primary care
services and communicable disease control services may not be less than Medicaid reimbursement rates
unless otherwise required by federal or state law or regulation.
r.~~Q!..JlTl..QN NO. ,093 - 26&7
A :RESOLUTION OF TIlE BOAR}) OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA
A1Tl'HORIZING THE MONROE COUNTY HEALTH
DEPARTMENT TO ESTABIJSH CLINICfJ. FEES FOR
PRIMAR.Y CARE SERVICES OF'FERED AT THE
MONROE COUNTY HEALTH DEPARTMENT AS SET
FORTH IN EXHIBIT "A" ATTACHED HERETO AND
MADE A PART OF THIS RESOLUTION.
WHEREAS, F. S. 154.01(2) requires counties to establish and maintain full-time county
health departments to provide environmental health, communicable disease control and primary
care servicel~; and
WHEREAS. F.S. 154.01(3) requires the Department of Health to enter into contracts
with countiels for this purpose; and
WHEREAS. on January 17, 2007, the Board apprpved the annual core contract between
the Monroe County and the Florida Department of Health for public health services; and
WHEREAS. F. S. 154.06(1) authorizes each county and each county health department
to collect fees for primary care services rendered through the county health departments provided
that a schedule of such :fees is established by resolution of the Board of County Commissioners
or by rule of'the department; and
WHEREAS, F.S. 154.06(2) requires all funds collected under this section to be
expended sctlely fur the purpose of providing health services and facilities within the county
served by the county health department and pursuant to the rules and regulations cited therein
and pursuant to all other applicable rules and regulations; and
WHER.l:AS. on September 21, 2005. the Board previously approved a resolution
authorizing the Monroe County Health Department to inc.rease the fees charged for birth and
death certifi(:ate5 (Resolution No. 358-2005). which wjJl remain in effect; and
WHEREAS, the Monroe County Healtlt Department has indicated the need to establish
clinical fees for primary care services offered at the Monroe County Health Department.a.s set
forth in Exhibit '~ II attached hereto and made a part of this Resolution; and
WHEREAS. the Board is satisfied with the justification provided by the Momoe County
Health Department;
NOW THEREFORE; BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUW"fV. FLORIDA;
1. That the Monroe County Health Department shall collect fees for primary care
services as specified in Exhibit ''A'' attached hereto and made a part of this
Resolution.
2. The Momoe County Health Department is solely responsible for ensuring
effective notice is provided to the general public and other impacted agencies and
organizations of the specific service:fee increases.
3. The Monroe County Health Department is solely responsible for ensuring the
County's compliance with all financial and transitional rules and regulations, and
any other factors that may be impacted by the service fee increases at all levels;
local, state and federal.
4. Any prior resolution, ordinance or contract inconsistent herewith is hereby
repealed,
5. This resolution shan become effective on M,u-ch 1.2007.
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida at a regular meeting held on the 21st day of February, AD., 2007.
Mayor Mario DiGennaro
Mayor Pro Tem Dixie M. Spehar
Commissioner Charles "Sonny. McCoy
Commissioner George Neugent
Commissioner Sylvia Mwphy
Yes
Yes
Yes
Yes
Yes
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BOARD OF COUN1YCO~
OF MONROE COUNTY, FLO~Ar~ :.n
~/(Lr2 . ~
BY: Y&'/'~
Mayor Mario DiGennaro
MONROE COUNTY ATTORNEY
A PROVED AS TO FORM:
Date
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H~E RESOLUTIONS
tl. PURPOSF,. To establi!i1h public health s.ervice fees In order to expand existing
publtc health services to the communit)' at large.
fl. PRiMARY CARE SEftVlCES.
("1) Acute Episodic 'IIIness ~ Primary care services wlll be charged on a fee-for-
service basis not less than the prevailing Medicaid rate, nor more than the
. prevailing Medicare rate. The fee win be derived by considering the type of visit,
the client sliding fee group bas8d on federal OMS Guidelines. and the State
Medicaid rate. Medicaid Identlflea1lon will be accepted as full payment In lieu of
charges.
(~O Family Planning - The fee will ~ derived by con&ldering tns type of visit, th.e
client srlding fee group based on Federal OMS Guidelines, and the State
Medicaid rate. MedIcaId identification will be accepted as fuU payment in lieu of
charges.
(~~) Well Child Services - The fee will be derived by conSidering the client sliding
f99 group, which 1$ calcuklted at eligl:>llfty (tetermlnation based on Federal OMS
Guidelines. The fee group wUl be applied to the rate not less than the prevailing
Medicaid rate. nor more than the prewtllng Medicaid rate. Medicaid
identification wjll be accepted lie full payment In lieu of the fee.
(4) SchooVDay Care Physicals - A one-time serVice, $30.00 per physical. (A
RmJted visit which fulfills the baste requirement of the School System or II Day
Care Center. lab tests and/or services perfonned beyond the basic .
requirement will be charged for separately.)
(5) Pharmacy - Fees are assessed per cost of DrescriDtion Dlus disp@nsina fee. .
The fee will be derived by adding $5 dispensing fee plus the cost of presaiptlon.
Cost of prescription is the C08t of medicatfon plus 0% to 20% to be determined
on a sliding fee scafe category. The payment will be assessed by considering
the crient sliding fee group, which is calculated at eliglbfUty determination. based
on Federal OMS Guidelines. Medicaid ldentltlcatlon will be aocepted as full
payment In lieu of charges.
(6) Women's Health Care - Non F$deral/y funded program for
uninsuredlunderinsured women. A one time fee of $125 to cover complete
worn.n's physical, PAP smear, Gonon11ea, Syphilis, HIV, Chlamydia and
Human Papilloma Virus, if Indicated. A complimentary follow up visit if required.
Lab services and/or other services cherged separately. No income verification
needed.
IA
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(i') lead Screening - Tho fee will be derIved by consldering th.:' OOent sliding fee
group which Is calculated at englbllity determination, based on Fedeml OMS
Guidelines. The f'Se group will b& applied to the rate estabUshed by the State
f\11edicaid program. Medicaid identffi:;auon wil! be 8C""..epted F;S fun payment in
lieu of charge$.
(€I) Blood Chemi;:.tries Only - Actual Cost plus per visit
specimen drawing and handlfng fee of
(E~) Herpes Culture Test
(10) Pregnancy Test - Nurse Consultation
Official docume~ion of positive test
(11) Pregnancy Test - Teenage Clients
(12) Chest XwRay
(t3) Hypertension. series of up to fIVe tests
paid at first visit
(1.4) Thin-Prep PAP laboratory test
(1!5) HPV Test
$20.00
$30.00
No Charge
$10.00
No Charge
Medicaid Rate
$10.00
$25.00
$25.00
C. COMMUNITY PUBLIC HEALTH SERVICES
(1) Tuberculosis X-ray for suspected. confirmed or
Symptomatic contact or case
(2) Tuberculoel8 Skin Teat for 8U8p8Cted, confinned or
Symptomatic contact or case
(3) TubercuJosI6 (TB) Sputum Culture for suspected,
conflnned, or symptomatic oontact of case
(4) Chest Xwray for he811h care employees or for
vocational or college student program requirements, with
Physician fnterpretation
(5) Tuberculin (TB) Skin Test, with reading
No Charge
No Charge
No Charge
$50.00
$35.00
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(5) Sexually Yr2nsmitted Dl8easee - The f~'& will be denved by oomMerlng thp,
client sliding fee group which is calculated at eligibility determination. based on
Federal OMS Guidefines. The fee group will be applied to the rate establfshed
by the state Medicaid Program. Medtcajd identtfication will be accepted as: full
payment in lieu of charges.. Pat.i&n1s re1elTed by the Disease Intervention
Specialist for inm~l testing may be charged.
(()) Tasting for HIV I Antibodies
(a) For Health Department Clients With eligibility card:
For test resul1s within the normal time period
(State Lab per 81idlng fee scale) No Charge to $20.00 .
For Faster test rftults (WIthin 48 hours)
Private Lab
$40.00
(b) For people who are not alreedy Health
Department Clients:
For test results within the normal time
Period (State Lab)
For faater test results (withIn 48 hours)
Private Lab
$20.00
$40.00
(7) 'mmunizatlons for adults (such as intemational travel vaccinations, hepatitis
prevention, etc.):
Flat Fee: Prevailing vaccine oosts plus dispensing fee.
Dispensing Fee:
(8) Required Immunizations for chldren up to age 18 .
$35.00
No Charge
(9:) Labol1ltory Services
Blood Drawlng Fee:
Prevailing lab cost plus blood drawklg
$15.00
(10) Class/Seminar attendance registration
Per person charge for hearth care, soc{al work
and counseling employees, per BCC resolution
AIDS 101
AIDS 500
AIDS 501
$ 5.00
$10.00
$50.00
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VITAL STATIS'nCS:
(1) Birth Certificates:
Fee Pursuant to Bee Resolution
State Fee Pursuant to Section 382.025.
F$ (Surcharge for Certificates Issued by
Loc.al ReQistrars)
StMe Surcherge, Child Welfare Training
Trust Fund
Toea' Fee for Birth CertfftOate8
4> 12.00
$ 2.50
(:~) Additional Copies
(:~) Protective Covers
(-<~) Death CerUficatea - Certified Copy
$ 1.50
$16.00
$ 7.00
$ 4.00
$13.00
$ 10.00
(fi) Express Fee
E. MEDICAL RECORDS:
(1) Copying MedIcal Reeord (per page for first ,25 pages)
Per page thereafter
F. PUBLIC RECORDS:
(1) Copying of Public Record (per page)
$1.00
25 cents
25 cents
1.'i ayor Spehar
m:SOLlJTICI"1 NO. 358 .~2005
h. RESOLUTION OF THE BOARD OF COUNTY COMhUSSIONERS
OF MONROE COUNIT, FLorIDA, TO INCREASE CHARGES FOR
BIRTH AND DEATH CERTIFICATES.
WHE.Rr~AS, Section 154.01(2)(b) F.S. requires county health departments to maintain vital statistics;
alt0
WHEREAS, this service may be funded by federal, state or local funds; and
WHEREAS, the Monroe County Health Department currently charges $8.00 and $9.00, respectively,
for birth and death certificates, while other Florida counties are charging averages of $10.00 and $14.00 each;
and
WHEREAS, the BOCC finds that an increase in the fees charged is warranted and that the increase will
be used to defray the cost to the CoWlty of services provided by the Monroe County Health Department;
NOW, TIlEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY;
I. That the Monroe County Health Department shall collect fees for the following services as specified:
CERTIFICAlE
Birth
Death
~
$12.00
$13.00
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This resolution shall become effective on October 1,2005. "';::It-< -f
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PASSED AND ADOPTED by the Board of County Commissioners of Monroe CounIji~da, at a
regular meeting of the Board held on the 2101 day of September, 2005. ::<-i C'",) r- ~
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2.
Any prior resolution inconsistent herewith is hereby repealed.
3.
Mayor Dixie M. Spehar
Mayor Pro Tern Charles "Sonny" McCoy
Commissioner Murray Nelson
Commissioner George Neugent
CQmmissioner David Rice
Yes
Yes
Yes
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Attest:I>~~.~~GE, CLERK
. By: l1Jtlule,,~~
Dc:puty GIed;'
BOARD OF COUNTY COMMISSIONERS
OFM~~.FLORlDA
By: ~~~ 7J?, ~
YOR
( S1lAL)
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