Macon County Commissioners 09-11-2012 Agenda Packet

MACON COUNTY BOARD OF COMMISSIONERS SEPTEMBER 11, 2012 AGENDA 1. Call to order and welcome by Chairman Corbin 2.
Announcements 3. Moment of Silence 4. Pledge of Allegiance 5. Public Meeting North Carolina Department of Transportation Secondary Road Program NOTE: At the conclusion of the public meeting, the board will consider adoption of a resolution approving the proposed program. 6. Public Comment Period 7. Adjustments to and approval of the agenda 8. Reports/Presentations A. Gene Robinson Webster Enterprises Executive Director 9. Old Business 10.New Business A. Recommendation of Award for Swiss Colony Water System Improvements County Manager B. Change order Number 3 on the Iotla Valley Elementary School Project County Manager C. Consideration of ambulance bids David Key D. Consideration of Governors Highway Safety Program grant proposal Sheriff Holland E. Consideration of bids for sheriffs vehicles Sheriff Holland F. Subordination Agreement regarding Community Development Block Grant (CDBG) loan John Fay/County Attorney G. Refinancing resolutions with BB&T Finance Director
H. Cowee School/Macon County Heritage Center (1) Budget amendment (2) Memorandum of Understanding with the Land Trust for the Little Tennessee (LTLT) (3) Contract 11.Consent Agenda Attachment #11
All items below are considered routine and will be enacted by one motion. No separate discussion will be held except on request of a member of the Board of Commissioners.
A. B. C. D. E.
Minutes August 14th and August 21st meetings Budget amendments Tax releases Macon Public Health Center fees Resolution regarding Designation of Applicants Agent for the North Carolina Division of Emergency Management F. Monthly ad valorem tax collection report
12.Appointments A. Board of Health 13.Closed session (if necessary) 14.Recess until Monday, September 24, 2012 at 6 p.m. in the commission boardroom on the third floor of the Macon County Courthouse, 5 West Main Street, Franklin, NC
MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: Transportation (NCDOT) North Carolina Department of
SUBJECT MATTER: Secondary Road Program Public Meeting DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Representatives of NCDOT will be present to outline the Secondary Road Program for the county. Please see the attached letter and the accompanying maps and lists of planned expenditures for Fiscal Year 2013 and beyond. This meeting has been advertised by NCDOT and is scheduled for a 6 p.m. start. At the conclusion of the public meeting, the board will be asked to consider a resolution approving the proposed program. A copy of that resolution is attached.
COUNTY MANAGERS COMMENTS/RECOMMENDATION:
Attachments ___X__ Agenda Item 5
Yes
___
No

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: Webster Enterprises SUBJECT MATTER: Presentation DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Gene Robinson, the executive director of Webster Enterprises, has requested time on the agenda for a brief presentation regarding the impact that funding from the county has made on their efforts to provide job training skills and job placement to disabled and disadvantaged residents in Macon County.
Attachments _____ Agenda Item 8A
Yes
_X__
No

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: County Manager SUBJECT MATTER: Recommendation of award for Swiss Colony Water System Improvements DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Please see the attached letter from Mike Dowd with McGill Associates regarding the project referenced above. McGill is recommending award of the construction contract to Buchanan and Sons, Inc. in the amount of $682,535. A certified bid tabulation is attached with the letter. Also attached are documents pertaining to an updated project budget.
COUNTY MANAGERS COMMENTS/RECOMMENDATION: This is the final phase of the Highway 28/Riverbend water project. 100 percent grant funds. Recommend approval and budget adjustment.
Attachments ___X__ Agenda Item 10A
Yes
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No

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: County Manager SUBJECT MATTER: Change Order Number 3 on the Iotla Valley Elementary School Project DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Please see the attached change order, in the amount of $8,000, on the project referenced above. Also attached is a letter from Greg Borden, project manager for H&M Constructors, outlining the costs involved. COUNTY MANAGERS COMMENTS/RECOMMENDATION: Recommend approval.
Attachments ___X__ Agenda Item 10B
Yes
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No

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: Emergency Services SUBJECT MATTER: Ambulance bids DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Please see the attached bid tabulation for two ambulances. Per the County Manager, this item may have to be readvertised/rebid, and he can provide additional details at the meeting. COUNTY MANAGERS COMMENTS/RECOMMENDATION: Due to confusion and a possible contested bid award, and in the best interest of Macon County, the County Attorney and I recommend rebidding the ambulances, with a bid opening on September 20th and a continuation meeting on September 24th to award the contract.
Attachments ___X__ Agenda Item 10C
Yes
___
No

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: Sheriffs Department SUBJECT MATTER: Consideration of Governors Highway Safety Program grant proposal DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Please see the attached memo from Sheriff Robert Holland outlining an approved grant proposal for the upcoming federal fiscal year that would establish a new position (Traffic Safety Officer) within his department. He is requesting that the board adopt a resolution (also attached) authorizing him to enter into a contract for the grant and to appropriate funding for the local match. For your information, also attached are the Traffic Safety Project Contract and the Agreement of Conditions. COUNTY MANAGERS COMMENTS/RECOMMENDATION: Recommend approval. This helps restore the countys previous commitment for additional Nantahala coverage by the sheriffs office.
Attachments ___X__ Agenda Item 10D
Yes
___
No
Macon County Sheriffs Office 1820 Lakeside Drive Franklin, NC 28734 828-349-2104 Robert L. Holland, Sheriff
MEMO TO: FROM: DATE: RE: Members, Board of Commissioners Sheriff Holland September 5, 2012 GHSP Grant 2012-2013
______________________________________________________________________________________________________________________________
The Governors Highway Safety Program has approved a grant proposal for the Macon County Sheriffs Office for the Federal fiscal year, beginning October 1, 2012. The Governors Highway Safety Program administers Federal funding for the North Carolina Department of Transportation pursuant to Chapter 143B of the North Carolina General Statutes. To accept the Federal funds the Board of Commissioners must pass a resolution, by September 30, authorizing my Office to enter into a contract for the grant and also appropriate funds for the local match. The grant proposal is to establish a new position, a Traffic Safety Officer, which will include personnel, equipment and other expenses. This grant may be extended for two additional years and GHSP expects the project to continue after Federal funding is no longer available. The first year total is $121,215 including personnel expenses of $62,155 and equipment and other expenses of $59,060. Years two, three and four would only include personnel expenses. The following percentages and expenses apply and no increases were added to the personnel expenses in years 2, 3 and 4: Year 1 2 3 4 Federal 85% ($103,033) 70% ($74,005) 50% ($52,861) 0% Macon County 15% ($18,182) 30% ($31717) 50% ($52,861) 100% ($62,155)
Page 1 of 1
Resolution
North Carolina Governors Highway Safety Program
LOCAL GOVERNMENTAL RESOLUTION

WHEREAS, the Agency")
(The Applicant Agency)
(herein called the
has completed an application contract for traffic safety funding; and that
(The Governing Body of the Agency)
(herein called the "Governing Body) has thoroughly considered the problem identified and has reviewed the project as described in the contract; THEREFORE, NOW BE IT RESOLVED BY THE
(Governing Body)
IN OPEN , NORTH CAROLINA,
MEETING ASSEMBLED IN THE CITY OF THIS DAY OF , 20 , AS FOLLOWS:
1. That the project referenced above is in the best interest of the Governing Body and the general public; and 2. That
(Name and Title of Representative)
is authorized to file, on behalf of the Governing
Body, an application contract in the form prescribed by the Governors Highway Safety Program for federal funding in the amount of $ __________________ to be made to the Governing Body to assist in defraying
(Federal Dollar Request)
the cost of the project described in the contract application; and 3. That the Governing Body has formally appropriated the cash contribution of $
(Local Cash Appropriation)
as
required by the project contract; and 4. That the Project Director designated in the application contract shall furnish or make arrangement for other appropriate persons to furnish such information, data, documents and reports as required by the contract, if approved, or as may be required by the Governor's Highway Safety Program; and 5. That certified copies of this resolution be included as part of the contract referenced above; and 6. That this resolution shall take effect immediately upon its adoption.
DONE AND ORDERED in open meeting by

(Chairperson/Mayor)
ATTESTED BY
(Clerk)
SEAL
DATE
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North Carolina Governors Highway Safety Program Agreement of Conditions

This Agreement is made by and between the North Carolina Department of Transportation, hereinafter referred to as the Department, to include the Governors Highway Safety Program, hereinafter referred to as GHSP; and the applicant agency, for itself, its assignees and successors in interest, hereinafter referred to as the "Agency". During the performance of this contract, and by signing this contract, the Agency agrees as follows: A. Federal Provisions 1. Equal Opportunity/Nondiscrimination. The Agency will agree to comply with all Federal statutes and implementing regulations relating to nondiscrimination concerning race, color, sex, religion, national origin, handicaps, and age. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964; (b) Title IX of the Education Amendments of 1972, as amended; (c) 49 CFR Part 21, Non-Discrimination in Federally-assisted programs of the United States Department of Transportation, hereinafter referred to as "USDOT, as amended; (d) 49 CFR Part 27, Rehabilitation Act of 1973, as amended; and (e) The Age Discrimination Act of 1975, as amended. 2. Drug Free Workplace. The Agency agrees to comply with the provisions cited in the Drug-Free Workplace Act of 1988 (49 CFR Part 29 Sub-part F). 3. Federal Grant Requirements and Contracts. The Agency shall comply with the following statutes and implementing regulations as applicable: (a) 49 CFR Part 18, Uniform Administrative Requirements for Grants and Cooperative Contracts to State and Local Governments; (b) Office of Management and Budget, hereinafter referred to as OMB, Circular A-87, Cost Principles for State, Local, and Indian Tribal Governments; (c) OMB Circular A-21, Cost Principles for Institutions of Higher Education; (d) OMB Circular A-122 Cost Principles for Nonprofit Organizations; (e) 5 U.S.C. 1501-1508 and 5 CFR Part 151 "Political Activity of State and Local Offices, or Employees" (Hatch Act); and (f) NHTSA Grant Funding Policies, as revised, February 2002. 4. Lobbying. The Agency agrees to comply with the restrictions of lobbying members of Congress, 18 USC, Section 1913; Section 326 of the FY 2000 DOT Applications Act, prohibiting the use of USDOT Federal funds for grass roots lobbying campaigns to encourage third parties, members of special interest groups, or the general public to urge members of a State legislature to support or oppose a pending legislative or appropriations matter. 5. Audits. (a) Audit Required. Non-Federal entities that expend $500,000 or more in a year in Federal awards shall have a single or program-specific audit conducted for that year in accordance with the provisions of OMB Circular A-133, Subpart B, ___.200. Guidance on determining Federal awards expended is provided in OMB Circular A133, Subpart B, ___.205.
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(b) Single Audit. Non-Federal entities that expend $500,000 or more in a year in Federal awards shall have a single audit conducted in accordance with OMB Circular A-133, Subpart B, ___.500, except when they elect to have a programspecific audit conducted in accordance with OMB Circular A-133, Subpart B, ___.200, paragraph (c). (c) Non-Governmental Entities. Non-governmental entities (not-for-profit and for-profit entities) must adhere to North Carolina General Statute 143-6.1. 6. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -- Lower Tier Covered Transactions. (a) The prospective lower tier participant (the Agency) certifies, by submission of this contract proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal Department or Federal Agency. (b) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participants shall attach an explanation to this contract proposal. 7. Conditions for State, Local and Indian Tribal Governments. State, local and Indian tribal government Agencies shall adhere to the standards established by 49 CFR Part 18, Uniform Administrative Requirements for Grants and Cooperative Contracts to State and Local Governments, and additions or amendments thereto. Agencies shall also adhere to the standards established by the Office of Management and Budget, and in particular, OMB Circular A-87, Cost Principals for State, Local and Indian Tribal Governments and additions or amendments thereto, for principles for determining costs applicable to grants and contracts with state, local and Indian tribal governments. 8. Conditions for Institutions of Higher Education. If the Agency is an institution of higher education, it shall adhere to the standards established by 49 CFR Part 19, Uniform Administrative Requirements for Grants and Contracts with Institutions of Higher Education, Hospitals, and Other Non-profit Organizations and OMB Circular A21, Cost Principles for Institutions of Higher Education for determining costs applicable to grants and contracts with educational institutions. 9. Conditions for Non-Profit Organizations. If the Agency is a non-profit organization, it shall adhere to the standards established by 49 CFR Part 19, Uniform Administrative Requirements for Grants and Contracts with Institutions of Higher Education, Hospitals, and Other Non-profit Organizations and OMB Circular A-122, Cost Principles for Nonprofit Organizations for determining costs applicable to grants and contracts with nonprofit organizations. 10. Conditions for Hospitals. If the Agency is a hospital, it shall adhere to the standards established by 49 CFR Part 19, Uniform Administrative Requirements for Grants and Contracts with Institutions of Higher Education, Hospitals, and Other Non-profit Organizations and 45 CFR Subtitle A, Part 74, Appendix E, Principles for Determining Costs Applicable to Research and Development Under Grants and Contracts with Hospitals.
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B. General Provisions 1. Contract Changes. This document contains the entire agreement of the parties. No other contract, either oral or implied, shall supercede this Agreement. Any proposed changes in this contract that would result in any change in the nature, scope, character, or amount of funding provided for in this contract, shall require a written addendum to this contract on a form provided by the Department. 2. Subcontracts Under This Contract. The Agency shall not assign any portion of the work to be performed under this contract, or execute any contract, amendment or change order thereto, or obligate itself in any manner with any third party with respect to its rights and responsibilities under this contract without the prior written concurrence of the Department. Any subcontract under this contract must include all required and applicable clauses and provisions of this contract. The Agency must submit any proposed contracts for subcontracted services to the Governors Highway Safety Program for final approval no less than 30 days prior to acceptance. 3. Solicitation for Subcontracts, Including Procurements of Materials and Equipment. In all solicitations, either by competitive bidding or negotiation, made by the Agency for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Agency of the Agency's obligations under this contract. Additionally, Agencies making purchases or entering into contracts as provided for by this contract must adhere to the policies and procedures of 49 CFR 18.36 (Common Rule). Additionally, Agencies making purchases or entering into contracts as provided for by this contract must adhere to the policies and procedures of 49 CFR 18.36 (Common Rule) and Executive Order 150 as it pertains to Historically Underutilized Businesses. 4. Incorporation of Provisions in Subcontracts. The Agency shall include the provisions of section A-1 through A-6 of this Agreement in every subcontract, including procurements of materials and leases of equipment, unless exempted by the regulations, or directives issued pursuant thereto. The Agency shall take such action with respect to any subcontract or procurement as the Department, the State of North Carolina, hereinafter referred to as the State, the National Highway Traffic Safety Administration, hereinafter referred to as NHTSA, or the Federal Highway Administration, hereinafter referred to as FHWA, may direct as a means of enforcing such provisions including sanctions for noncompliance. Provided, however, that in the event the Agency becomes involved in, or is threatened with, litigation with a subcontractor or supplier as a result of such direction, the Agency may request the Department or the State to enter into such litigation to protect the interests of the Department or the State. In addition, the Agency may request the NHTSA or FHWA to enter into such litigation to protect the interests of the United States. 5. Outsourcing. All work shall be performed in the United States of America. No work will be allowed to be outsourced outside the United States of America.
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6. Property and Equipment. (a) Maintenance and Inventory. The Agency shall maintain and inventory all property and equipment purchased under this contract. (b) Utilization. The property and equipment purchased under this contract must be utilized by the Agency for the sole purpose of furthering the traffic safety efforts of the Agency for the entire useful life of the property or equipment. (c) Title Interest. The Department and NHTSA retain title interest in all property and equipment purchased under this contract. In the event that the Agency fails or refuses to comply with the provisions of this Agreement or terminates this contract, the Department, at its discretion, may take either of the following actions: (i) Require the Agency to purchase the property or equipment at fair market value or other mutually agreed to amount; or (ii) Require the Agency to transfer the property or equipment and title of said property or equipment, if any, to the Department or to another Agency, as directed by the Department. (d) Non-expendable Property. Non-expendable property is defined as property or equipment having a value of $5000 or more with a life expectancy of more than one year. Non-expendable property purchased under this contract cannot be sold, traded, or disposed of in any manner without the expressed written permission of the Department. 7. Promotional or Other Materials. Any promotional or other materials developed using funds from this contract must be reviewed and approved by the GHSP prior to their production. The cost of promotional materials is limited to a maximum of $5.00 per item. Items in excess of $5.00 may not be purchased without the expressed written approval of the GHSP. 8. Review of Reports and Publications. Any reports, papers, publications, or other items developed using funds from this contract must be reviewed and approved by the GHSP prior to their release. 9. Reimbursement. (a) General. Progress payments, based upon actual allowable costs for not less than one (1) month or more than three (3) months may be made upon receipt of an itemized invoice from the Agency on forms provided by the Department. The itemized invoice shall be supported by documentation of costs as prescribed by the Department. (b) Approval. The Governors Highway Safety Program and the Departments Fiscal Section shall approve the itemized invoice prior to payment. (c) Unapproved Costs. Any rejected or unaccepted costs shall be borne by the Agency. The Agency agrees that in the event the Department determines that, due to Federal or State regulations that grant funds must be refunded, the Agency will reimburse the Department a sum of money equal to the amount of Federal and State participation in the rejected costs. (d) Final Reimbursement Claims. Final reimbursement claims must be received by the GHSP within 30 days following the close of the approved contract period. Project funds not claimed by this date are subject to reversion. (e) Expending Funds Under This Contract. Under no circumstances will reimbursement be made for costs incurred prior to the contract effective date or after the contract ending date.
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10. Project Costs. It is understood and agreed that the work conducted pursuant to this contract shall be done on an actual cost basis by the Agency. The amount of reimbursement from the Department shall not exceed the estimated funds budgeted in the approved contract. The Agency shall initiate and prosecute to completion all actions necessary to enable the Agency to provide its share of the project costs at or prior to the conclusion of the project. 11. Program Income. The Agency shall account for program income related to projects financed in whole or in part with federal funds in accordance with 49 CFR Part 18. Program income earned during the contract period shall be retained by the Agency and added to the funds committed to the project by the GHSP and be used to further eligible program objectives. Program income must be accounted for separately and the records made available for audit purposes. 12. Project Directors. The Project Director, as specified on the signature page of this Agreement, must be an employee of the Agency or the Agency's governing body. Any exception to this provision must have the expressed written approval of GHSP. 13. Reports Required. (a) Quarterly Progress Reports. Unless otherwise directed, the Agency must submit Quarterly Progress Reports to the GHSP, on forms provided by the Department, which reflect the status of project implementation and attainment of stated goals. Each progress report shall describe the project status by quarter and shall be submitted to GHSP no later than fifteen (15) days after the end of each quarter. If the Agency fails to submit a Quarterly Progress Report or submits an incomplete Quarterly Progress Report, the Agency will be subject to having cost reimbursement requests withheld. Once a Quarterly Progress Report that substantiates adequate progress is received, cost reimbursement requests will be processed. (b) Final Accomplishments Report. A Final Accomplishments Report must be submitted to the GHSP within thirty (30) days of completion of the project, on forms provided by the Department, unless otherwise directed. If the Agency fails to submit a Final Accomplishments Report or submits an incomplete Final Accomplishments Report, the Agency will be subject to having cost reimbursement requests withheld. Once a Final Accomplishments Report that substantiates adequate progress is received, cost reimbursement requests will be processed. (c) Audit Reports. Audit reports required in Section A-5 above shall be provided to the Department within thirty (30) days of completion of the audit. 14. Out-of-State Travel. (a) General. All out-of-state travel funded under this contract must have prior written approval by the Governors Highway Safety Program. (b) Requests. Requests for approval must be submitted to the GHSP, on forms provided by the Department, no less than thirty (30) days prior to the intended departure date of travel. (c) Agency Travel Policy Required. For Agencies other than state agencies, out-ofstate travel requests must include a copy of the Agency's travel policy, to include allowances for lodging, meals, and other travel-related expenses. For state agencies, maximum allowable subsistence is limited to the prevailing per diem rates as established by the North Carolina General Assembly. (d) Agenda Required. Out-of-state travel requests must include a copy of the agenda for the travel requested.
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15. Conditions for Law Enforcement. In addition to the other conditions provided for in this Agreement, grants to law enforcement agencies are subject to the following: (a) Tasks Required. The following tasks must be included in Section D of this contract: (i) A minimum of one (1) safety belt checkpoint per month; (ii) A minimum of one (1) impaired driving checkpoint per month; (iii) A minimum of 50% of seat belt enforcement activities will be conducted at night between the hours of 10:00 p.m. and 4:00 a.m. (iv) Participation in all "Click It or Ticket" campaigns; (v) Participation in all "Booze It & Lose It" campaigns; (vi) Participation in any event or campaign as required by the GHSP. An effort must be made to utilize one of the Forensic Tests for Alcohol Branchs Mobile Breath Alcohol Testing (BATMobiles) units during at least one of the impaired driving checkpoints. (b) Certifications Required. (i) In-car Camera or Video System. For any in-car camera or video system purchased under this contract, it is required that the operator of that equipment has successfully completed Standardized Field Sobriety Testing training (SFST). A copy of this certificate must be filed with GHSP prior to reimbursement of in-car camera or video systems. (ii) Radar. For any radar equipment purchased under this contract, it is required that the operator of that equipment has successfully completed Radar Certification Training. A copy of this certificate must be filed with GHSP prior to reimbursement of radar equipment. (iii) Alcohol Screening Devices. For any preliminary alcohol screening devices purchased under this contract, it is required that the operator of that equipment has successfully completed the Alcohol Screening Test Device training offered by the Forensic Test for Alcohol Branch. (c) Report Required - Monthly Enforcement Data Report. In addition to the reports mentioned above, law enforcement agencies must submit a Monthly Enforcement Data Report on the form provided by the Department. If the Agency fails to submit a Monthly Enforcement Data Report or submits an incomplete Monthly Enforcement Data Report, the Agency will be subject to having cost reimbursement requests withheld. Once a Monthly Enforcement Data Report that substantiates adequate progress is received, cost reimbursement requests will be processed. The agency head must sign the form. However, the agency head may assign a designee to sign the form by providing written signature authority to the GHSP. 16. Conditions for Local Governmental Agencies. (a) Resolution Required. If the Agency is a local governmental entity, a resolution from the governing body of the Agency is required on a form provided by the Department. (b) Resolution Content. The resolution must contain a commitment from the governing body to provide the local funds as indicated in this contract. Additionally, the resolution is required even if the funding is one hundred percent from federal sources, as it serves as recognition by the governing body of federal funding for purposes of Section A-5 above. 17. Prohibited Interests. No member, officer, or employee of the Agency during his or her tenure, and for at least one (1) year thereafter, shall have any interest, direct or indirect, in this contract or the proceeds thereof or therefrom.
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18. Continued Federal and State Funding. (a) Federal Funding. The Agency agrees and understands that continuation of this project with Federal funds is contingent upon Federal funds being appropriated by the United States Congress specifically for that purpose. The Agency further agrees and understands that in the event funds originally appropriated by Congress for these grants are subsequently reduced by further acts of Congress, funding to the Agency may be proportionately reduced. (b) State Funding. The Agency agrees and understands that continuation of this project with funds from the State of North Carolina is contingent upon State funds being appropriated by the General Assembly specifically for that purpose. The Agency also agrees that any state funds received under this contract are subject to the same terms and conditions stated in this Agreement. 19. Performance. All grants provided by the Governor's Highway Safety Program are performance-based and, as such, require that continual progress be made toward the reduction of the number and severity of traffic crashes. Any agency, whose performance is deemed unsatisfactory by the GHSP, shall be subject to the sanctions as provided for in this contract. Additionally, unsatisfactory performance shall be cause for the Department to reduce or deny future funding. 20. Resolution of Disputes. Any dispute concerning a question of fact in connection with the work not disposed of by contract by and between the Agency and the Department, or otherwise arising between the parties to this contract, shall be referred to the Secretary of the North Carolina Department of Transportation and the authorized official of the Agency for a negotiated settlement. In any dispute concerning a question of fact in connection with the project where such negotiated settlement cannot be resolved in a timely fashion, the final decision regarding such dispute shall be made by the Secretary of the North Carolina Department of Transportation, with the concurrence of the Federal funding agency, and shall be final and conclusive for all parties. 21. Department Held Harmless. (a) For State Agencies. Subject to the limitations of the North Carolina Tort Claims Act, the Agency shall be responsible for its own negligence and holds harmless the Department, its officers, employees, or agents, from all claims and liability due to its negligent acts, or the negligent acts of its subcontractors, agents, or employees in connection with their services under this contract. (b) For Agencies Other Than State Agencies. The Agency shall be responsible for its own negligence and holds harmless the Department, its officers, employees, or agents, from all claims and liability due to its negligent acts, or the negligent acts of its subcontractors, agents, or employees in connection with their services under this contract.
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22. Records Access and Retention. The Agency shall provide all information and reports required by the regulations or directives issued pursuant thereto, and shall permit access to its books, records, accounts, other sources of information, and its facilities as may be determined by the Department, the State, NHTSA, or FHWA, as appropriate, to be pertinent to ascertain compliance with such regulations, orders and instructions. Furthermore, the Agency shall maintain such materials during the contract period, and for three (3) years from the date of final payment from the Department, for such inspection and audit. Where any information required of the Agency is in the exclusive possession of another who fails or refuses to furnish this information, the Agency shall so certify to the Department, State, NHTSA, or FHWA, as appropriate, and shall set forth what efforts it has made to obtain the information. 23. Sanctions for Non-Compliance. The applicant Agency agrees that if it fails or refuses to comply with any provisions and assurances in this contract, the Department may take any or all of the following actions: (a) Cancel, terminate, or suspend this contract in whole or in part; (b) Withhold reimbursement to the Agency until satisfactory compliance has been attained by the Agency; (c) Refrain from extending any further funding to the Agency under this contract with respect to which the failure or refusal occurred until satisfactory assurance of future compliance has been received from the Agency; (d) Refer the case to the United States Department of Justice for appropriate legal proceedings. 24. Cancellation, Termination, or Suspension of Contract. (a) By the Department. For noncompliance with any of the said rules, regulations, orders or conditions, this contract may be canceled, terminated, or suspended in whole or in part by the Department, by giving the Agency thirty (30) days advanced written notice. The Department, before issuing notice of cancellation, termination, or suspension of this contract, may allow the Agency a reasonable opportunity to correct for noncompliance. (b) By the Agency. The Agency may terminate this contract by providing thirty (30) days advanced written notice to the Department. 25. Completion Date. Unless otherwise authorized in writing by the Department, the Agency shall commence, carry on, and complete the project as described in the approved Highway Safety Project Contract by September 30 of the Federal fiscal year for which it was approved.
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26. Signature. By signing below, the Agency agrees to adhere to the terms and conditions of this Agreement. NAME SIGNATURE AGENCY PROJECT DIRECTOR TITLE ADDRESS DATE TELEPHONE NUMBER
NAME SIGNATURE
AGENCY AUTHORIZING OFFICIAL TITLE ADDRESS DATE TELEPHONE NUMBER
NAME SIGNATURE
AGENCY OFFICIAL AUTHORIZED TO RECEIVE FUNDS TITLE ADDRESS DATE TELEPHONE NUMBER
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MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: Sheriffs Department SUBJECT MATTER: Consideration of bids for vehicles DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Please see the attached bid tabulation for more information.
Attachments ___X__ Agenda Item 10E
Yes
___
No

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: Housing SUBJECT MATTER: Subordination Agreement regarding Community Development Block Grant (CDBG) loan DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Please see the attached e-mail from Macon County Housing Director John Fay, along with a proposed subordination agreement that has been forwarded to the County Attorney for his review and comments. Mr. Fay and the County Attorney can provide additional details at the meeting.
Attachments ___X__ Agenda Item 10F
Yes
___
No
Mike Decker
From: Sent: To: Subject: Attachments: John Fay <Jfay@maconnc.org> Monday, August 27, 2012 2:33 PM mdecker@maconnc.org item for 9/11/2012 Board of County Commissioners meeting DOC082712-08272012142440.pdf
HiMike,IhavearequestforsubordinationofacurrentCommunityDevelopmentBlockGrant(CDBG)rehabilitation forgivenloan.TheportionofCDBGfundssecuredtothecountyis$17,500.TheclienthadanexistingloanwithMacon BankandtheyarenowinterestedinrefinancingwithMaconBank.Itisdifficulttovalueapropertyinthesetimesbut accordingtoofficialrecordsthetotalofthecountysforgivenloanandtheamountrequestedfromMaconBankis withinthepropertysvalue. IhaveattachedacopyoftheSubordinationAgreementtothismailing.IspokewithJackandhesuggestedgivinga copyoftheagreementtoMr.ChesterJonesforhisevaluation. Thanks, John JohnFay HousingDirector (828)3692605 MaconCountyHousing 1419OldMurphyRd. Franklin,NC28734

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: Finance SUBJECT MATTER: Refinancing resolutions with BB&T DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Copies of the resolutions were not available as the agenda packet was being prepared for transmittal, but will be forwarded via separate e-mail once they are received. The Finance Director and County Manager can provide additional details at the meeting. COUNTY MANAGERS COMMENTS/RECOMMENDATION:
Attachments _____ Agenda Item 10G
Yes
__X_
No

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: SUBJECT MATTER: Cowee School DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Per the County Attorney, documents related to the transition of Cowee School into the Macon County Heritage Center will be e-mailed to you separately. The accompanying budget amendment will be provided at the meeting.
Attachments _____
Yes
__X_
No
Agenda Item 10H (1,2 and 3)

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: Governing Board SUBJECT MATTER: Consent Agenda DEPARTMENT HEAD COMMENTS/RECOMMENDATION:
A. Minutes Consideration of the minutes from the August 14th and August 21st meetings per attachment 11A. Finance Consideration of budget amendments #29 through #33 per attachment 11B. Tax releases Consideration of tax releases in the amount of $3,291.41 per attachment 11C. The supporting documentation is on file in the Deputy Clerks office. Macon Public Health Center fees Consideration of a fee schedule for Fiscal Year 2012-13 and the accompany billing and collection policy per attachment 11D. Resolution regarding Designation of Applicants Agent for the North Carolina Division of Emergency Management Consideration of the resolution per attachment 11E, which will designate David Key and Lori Hall as primary and secondary agents, respectively, to oversee the grant process for the Regionalization Hazard Mitigation Plan. The grant is for $70,000, with a 25 percent in-kind match. No county funding is required. The in-kind match can come from the combination of work by any county employees that work on the plan. The money is being used to hire an outside contractor to write a Regionalized Multi-Jurisdiction Hazard Mitigation Plan, with our region consisting of Macon and Clay counties. Memorandums of Agreement will soon follow. Monthly Tax Collection Report For the boards information, the monthly ad valorem tax collection report is attached as 11F. It does not require board action.
B.
C.
D.
E.
F.
Attachments ___X__ Agenda Item 11A-11F
Yes
___
No
MACON COUNTY BOARD OF COMMISSIONERS AUGUST 14, 2012 MINUTES Chairman Corbin convened the meeting at 6:00 p.m. All Board Members with the exception of Commissioner Beale, the Deputy Clerk, Finance Director, County Attorney, members of the news media and interested citizens were present. ANNOUNCEMENTS: There were no announcements.
MOMENT OF SILENCE: Chairman Corbin asked those in attendance to observe a moment of silence. PLEDGE TO THE FLAG: Led by Commissioner Tate, the pledge to the flag was recited. PUBLIC COMMENT: comment period. No one signed up to speak during the public
RESOLUTION APPROVING FINANCING TERMS: The Finance Director explained that requests for proposals for the financing of computer equipment in the amount of $1.5-million were sent to six financial institutions, with four responding. Their quotes are outlined in a memo from the Finance Director to the County Manager and board (Attachment 1), a copy of which is attached and is hereby made a part of these minutes. The Finance Director pointed out that PNC Equipment Finance had the lowest interest rate but had a prepayment penalty, and noted the County Manger wanted the option to pay off the loan early. The recommendation was to go with BB&T Governmental Finance at a rate of 1.44 percent with no bank fees and no prepayment penalty. The County Attorney noted the loan would be secured by the equipment and said that the phrase and Deed of Trust would need to be stricken from Item 2 in the resolution approving the financing terms. Commissioner Kuppers made a motion to approve the Resolution Approving Financing Terms, as amended, and it was seconded by Commissioner Tate. Chairman Corbin stated that the county had two large capital needs, one being computers for the schools and the second being improvements to the countys swimming pool. He added that neither project was in the current year budget because the board had decided not to raise taxes and to pay for these items out of fund balance. Commissioner Haven questioned the term of the loan, which is 54 months, and the total amount of interest that would be paid, which the Finance Director figured to be almost $49,000 over the full term of the loan. Chairman Minutes 08/14/12 Page 1 of 2
Corbin said the intent is to repay the loan in full over two budget years. The board voted 3-1, with Commissioner Haven opposing, to approve the Resolution Approving Financing Terms (Attachment 2), a copy of which is attached and is hereby made a part of these minutes. APPOINTMENT TO SCC BOARD OF TRUSTEES: Upon a motion by Commissioner Haven, seconded by Commissioner Tate, the board voted unanimously to forward a recommendation to the Jackson County Board of Commissioners that Gary Shields be reappointed to the Southwestern Community College (SCC) Board of Trustees for a term of three years. Commissioner Kuppers noted that Commissioner Beale had expressed his support for the reappointment. Chairman Corbin pointed out that no one signed up to speak during the public comment period, and noted that Commissioner Beale was in Raleigh preparing for the North Carolina Association of County Commissioners (NCACC) conference, at which the remaining members of the board and the County Manager would join him later in the week. RECESS: At 6:16 p.m. and upon a motion by Commissioner Kuppers, seconded by Commissioner Haven, the board voted unanimously to recess the meeting until 6 p.m. on Tuesday, August 21, 2012 in the commission boardroom on the third floor of the Macon County Courthouse at 5 West Main Street in Franklin, NC.
_____________________________ Jack Horton, County Manager Clerk to the Board
______________________________ Kevin Corbin Board Chairman
Minutes 08/14/12 Page 2 of 2
Macon County Public Health Fee Schedule

Modifier Code Description
1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
(Red = Increase Blue=Decrease)
FY 12/13
J1055 J2790 J3490 J7300 J7302 54050 54065 56501 56515 57170 57452 57454 57455 57456 58300 58301 59025 59425 59426 69210 86580 86580P G0008 G0009 G0010 Q2037 Q2038 Q2039 90471 90471 90472 90472 90474 90632 90633 90636 90646 90648 90649 90657 90658 90660 90662 90669 90675 90676 90680 90691 90700 90707 90713 90714 90716 90715 90717 90732 90733 90734 90736 90744
FP Medroxyprogester1 Acetate for Contraceptive use, 150mg, Injection (Depo-Provera) Rho(D) Immune Globulin (RhIg), full dose,300mcg 17P Injection FP Intrauterine copper contraceptive device, Paragard T380A FP Levonorgestrel-releasing intrauterine contraceptive system, 52 mg (Mirena) Destory Penis Lesion(s) - Simple Chemical Destruction Penis Lesion(s) - Extensive Cryosurgery TCA Vulva Destroy Vulva Lesion(s) - Complex Diaphragm fitting with instructions Colposcopy of the cervix including upper/adjacent vagina Colposcopy of the cervix including upper/adjacent vagina w/biopsy of cervix or endocervical curettage Colposcopy of cervix including upper/adjacent vagina w/biopsy of cervix Colposcopy of the cervix including upper/adjacent vagina w/endocervical curettage Insert intrauterine device Removal of IUD Fetal Non-Stress Test Prenatal visits: 4 to 6 visits Prenatal visits: 7 or more visits Remove impacted ear wax TB Test TB Test - Patient Pay Administration Fee - Flu Shot (Medicare) Administration Fee - Pneumonia Shot (Medicare) Administration Fee - Hep B (Medicare) Flu Virus Vaccine (Fluvirin) Medicare Flu Virus Vaccine (Fluzone) Medicare Flu Virus Vaccine (Unspecified) Medicare Vaccine Administration Fee EP Vaccine Administration Fee Vaccine Administration Fee-Each Additional EP Vaccine Administration Fee-Each Additional Intranasal Administration Fee Hep A - Adult Hep A - Pediatric Twinrix Vaccine Hib - Adult Hib - child Gardasil (HPV) Flu Shot (6-35 months) Flu Shot (3 yrs & >) Flumist - State Supplied Fluzone High Dose (65 & >) Prevnar Rabies Vaccine - Exposure Rabies Vaccine - Preventive Rotateq Typhoid Vaccine DTAP MMR IPV Td Varicella Vaccine Tdap Yellow Fever Vaccine Pneumonia Vaccine Meningococcal Menactra Zostavax (Shingles Vaccine) Hep B - Pediatric
50.00 134.00 21.00 428.00 528.00 228.00 387.00 229.00 394.00 91.00 191.00 269.00 253.00 239.00 132.00 169.00 62.00 1,000.00 1,300.00 86.00 10.00 10.00 19.00 19.00 19.00 6.00 6.00 6.00 19.00 14.00 19.00 14.00 20.00 45.00 30.00 90.00 26.00 26.00 137.00 6.00 6.00 26.00 116.00 211.00 211.00 76.00 56.00 29.00 56.00 31.00 26.00 87.00 39.00 96.00 51.00 113.00 111.00 161.00 27.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
90746 92552 92567 92587 96110 96372 97802 97803 99172 99173 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99381 99382 99383 99384 99384 99385 99385 99385 99386 99386 99387 99391 99392 99393 99394 99394 99395 99395 99395 99396 99396 99397 99406 99407 99408 99409 99420 99412
EP EP EP FP EP FP EP FP EP EP EP FP EP FP EP FP
Hep B - Adult Hearing test Tympanometry Evoked otoacoustic emissions; limited (single stimulus level, either transient Developmental Screening Therapeautic Injection Medical nutrition therapy; initial assessment and intervention, individual, Medical nutrition therapy; re-assessment and intervention, individual, Visual Acuity Screening Test - Color Visual Acuity Screening Test Office Visit (OV) new patient (pt) minor-phys time approx. 10 minutes OV new pt, moderate-phys time approx 20 minutes OV new pt, moderate-phys time approx 30 minutes OV new pt, complex-phys time approx 45 minutes OV new pt, severe-phys time approx 60 minutes OV established (estab) pt, minimal w/wo phys, time approx 5 min OV estab. pt, minor-phys time approx 10 min. OV estab. pt, moderate. phys time approx 15 min. OV estab. pt, severe. phys time approx 25 min. OV estab. pt, severe. phys time approx 40 min. New Patient (NP) physical exam: < 1 year NP physical exam: 1 to 4 Years NP physical exam: 5 to 11 years NP physical exam: 12 to 17 years NP physical exam: 12 to 17 years NP physical exam: 18 to 39 years NP physical exam: 18 to 39 years NP physical exam: 18 to 39 years NP physical exam: 40 to 64 years NP physical exam: 40 to 64 years NP physical exam: 65 years and over Established Patient (EP) physical exam: < 1 year EP physical exam: 1 to 4 years EP physical exam: 5 through 11 years EP physical exam: 12 to 17 years EP physical exam: 12 to 17 years EP physical exam: 18 to 39 years EP physical exam: 18 to 39 years EP physical exam: 18 to 39 years EP physical exam: 40 to 64 years EP physical exam: 40 to 64 years EP physical exam: 65 years and older Tobacco Education (3-10 min) Tobacco Education over 10 min Substance Abuse Substance Abuse over 30 min Additional Assessments Preventive medicine, group counseling, appx 60 minutes
55.00 39.00 18.00 63.00 13.00 20.00 45.00 22.00 5.00 5.00 83.00 124.00 180.00 280.00 326.00 43.00 72.00 121.00 209.00 262.00 211.00 227.00 226.00 249.00 242.00 242.00 242.00 242.00 287.00 287.00 310.00 200.00 200.00 200.00 216.00 216.00 217.00 217.00 217.00 242.00 242.00 250.00 12.00 23.62 31.00 63.00 9.00 91.00
DENTAL
D0120 D0140 D0145 D0150 D0160 D0170 D0210 D0220 D0230 D0240 D0250 Periodic oral evaluation Limited oral evaluation - problem focused Oral Evaluation, pt < 3yrs Comprehensive oral evaluation - new or established patient Detailed and extensive oral evaluation - problem focused, by report Re-evaluation - limited, problem focused (established patient; not post-operative visit) Intraoral - complete series (including bitewings) Intraoral -periapical first film Intraoral - periapical each additional film Intraoral - occlusal film Extraoral - first film 38.00 66.00 48.00 69.00 100.00 44.00 113.00 22.00 20.00 26.00 32.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
D0260 D0270 D0272 D0273 D0274 D1110 D1120 D1201 D1203 D1204 D1205 D1206 D1351 D1510 D1515 D1555 D2140 D2150 D2160 D2161 D2330 D2331 D2332 D2335 D2336 D2391 D2392 D2393 D2394 D2910 D2920 D2930 D2940 D2951 D3220 D3310 D3320 D3330 D4355 D5110 D5120 D5130 D5140 D5211 D5212 D5410 D5411 D5421 D5422 D5510 D5520 D5610 D5640 D5730 D5731 D5740 D5741 D7111 D7140 D7210 D7220
Extraoral - each additional film Bitewing - single film Bitewings - 2 films Bitewings - 3 films Bitewings - 4 films Prophylaxis - adult Prophylaxis - child Topical Fluoride w/ Prophylaxis Topical application of fluoride (prophylaxis not included) - child Topical application of fluoride (prophylaxis not included) - adult Topical Fluoride w/ Prophylaxis Topical fluoride varnish; therapeutic application for moderate to high caries risk patients Sealant - per tooth Space maintainer - fixed - unilateral Space maintainer - fixed - bilateral Remove Fix Space Maintainer Amalgam - 1 surface, primary or permanent Amalgam - 2 surfaces, primary or permanent Amalgam - 3 surfaces, primary or permanent Amalgam - 4 or more surfaces, primary or permanent Resin-based composite - 1 surface, anterior Resin-based composite - 2 surfaces, anterior Resin-based composite - 3 surfaces, anterior Resin-based composite - 4 or more surfaces or involving incisal angle (anterior) Resin based composite - 1 surface pstr perm Resin-based composite - 1 surface, posterior Resin-based composite - 2 surfaces, posterior Resin-based composite - 3 surfaces, posterior Resin-based composite - 4 or more surfaces, posterior Recement inlay/onlay or part Recement Crown Prefabricated stainless steel crown - primary tooth Sedative filling Pin retention - per tooth, in addition to restoration Therapeutic pulpotomy (excluding final restoration) Root canal therapy - anterior (excluding final restoration) Root canal therapy - bicuspid (excluding final restoration) Root canal therapy - molar (excluding final restoration) Full mouth debridement to enable comprehensive evaluation and diagnosis Complete Denture - Maxillary Complete Denture - Mandibular Immediate Denture - Maxillary Immediate Denture - Mandibular Maxillary Partial Denture - Resin Base Mandibular Partial Denture - Resin Base Adjust Complete Denture Maxillary Adjust Complete Denture Mandbular Adjust Partial Denture Maxillary Adjust Partial Denture Mandibular Repair Broken Complete Denture Replace Missing or Broken Tooth Repair Resin Denture Base Replace Broken Teeth Reline Complete Maxillary Denture Reline Complete Mandibular Denture Reline Maxillary Partial Denture Reline Mandibular Partial Denture Extraction, coronal remnants - deciduous tooth Extraction, erupted tooth or exposed root Surgical removal of erupted tooth Removal of impacted tooth - soft tissue
27.00 22.00 36.00 43.00 52.00 81.00 56.00 82.00 35.00 32.00 82.00 51.00 44.00 283.00 395.00 51.00 95.00 123.00 149.00 181.00 118.00 150.00 184.00 217.00 138.00 138.00 180.00 223.00 275.00 25.00 28.00 223.00 85.00 48.00 138.00 572.00 700.00 869.00 146.00 1138.00 1138.00 1234.00 1234.00 844.00 844.00 62.00 62.00 62.00 62.00 150.00 128.00 150.00 128.00 264.00 264.00 258.00 258.00 92.00 123.00 217.00 271.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
D7230 D7240 D7310 D7320 D7321 D7410 D7510 D9110
Removal of impacted tooth - partially bony Removal of impacted tooth - completely bony Alveoloplasty in conjunction with extractions - 4 or more tooth spaces, per quadrant Alveoloplasty not in conjunction with extractions - 4 or more tooth spaces, per quadrant Alveoloplasty not in conjunction with extractions - 1 to 3 tooth spaces, per quadrant Excision of benign lesion up to 1.25 cm Incision and drainage of abscess - intraoral soft tissue Palliative (emergency) treatment of dental pain - minor procedure
354.00 424.00 223.00 364.00 308.00 177.56 241.00 97.00
OTHER SERVICES
LU018 LU102 LU201 LU202 LU203 LU204 LU206 LU208 LU209 LU216 LU231 LU235 LU249 LU400 LU402 T1002 Copy of Medical Records TB Screening Form Repeat Pap (report only) International Travel Employment Physical; Limited ** DOT Physical; Limited ** Day Care Physical; Limited ** Sports Physical; Limited ** Foster Care Physical; Limited ** County Employee Physical; Limited ** Pap Smear and/or Clinical Breast Exam (Non-BCCCP Eligible) Replacement Pill pack Breast Exam Only Miscellaneous Services (ex. Medical records payment from Disability Determination) Medicaid Co-Payment RN Services fee based on service 10.00 25.00 70.00 90.00 35.00 35.00 35.00 50.00 83.00 10.00 40.00 15.00 3.00 19.00
** Limited Physical Exam Fees do not include Laboratory Testing Fees. Lab Testing Fees are charged seperatly.
HEALTH EDUCATION SERVICES

G0108 G0109 97802 97803 S9465 S9470 DSMT (Individual) 1/2 Hour Units DSMT (Group) 1/2 Hour Units MNT Individual/Initial (15 Min Units) MNT Re-Check/Individual (15 Min Units) Diabetic management program, dietician visit (BCBS) Nutritional counseling, dietician visit (BCBS) Baby Think It Over 4 Classes Body Fat Monitor & Calipers Body Fat Testing by Calipers Body Fat Testing by Monitor BTIO Keys Challenge Course CPR Breathing Barriers Adult 1st Aid / CPR / AED CPR w/AED (Adult & Child) - ELIMINATED Adult CPR/AED Adult & Pediatric CPR/AED Pediatric CPR/AED CPR w/AED (Child) + Infant CPR + FAB - ELIMINATED CPR w/AED (Adult & Child( + FAB - ELIMINATED Adult & Pediatric 1st Aid/CPR/AED First Aid-Basic Healthy Heart Screening Individual Health Education Life Worksite Wellness (A) Life Worksite Wellness (B) Life Worksite Wellness (C) Life Worksite Wellness (D) 53.23 18.18 24.51 21.44 34.50 34.50 350.00 10.00 7.00 5.00 6.00 10.00 6.00 60.00 60.00 45.00 60.00 45.00 55.00 75.00 75.00 30.00 35.50 20.00 40.00 37.50 35.00 32.50
90.00 70.00 90.00 70.00
110.00 70.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
Life Worksite Wellness (E) Locking Clips Face Shield LABORATORY 36415 36416 80048 80050 80051 80053 80055 80061 80069 80074 80076 80100 80101 80152 80156 80157 80158 80162 80164 80178 80182 80184 80185 80188 80195 80197 80198 80299 81001 81002 81003 81025 82024 82040 82043 82055 82075 82085 82088 82103 82104 82105 82131 82140 82150 82157 82164 82175 82232 82247 82248 82274 82306 82310 82330 82340
30.00 1.00 2.00
ROUTINE VENIPUNCTURE CAPILLARY BLOOD DRAW BMP- METABOLIC PANEL TOTAL CA GENERAL HEALTH PANEL ELECTROLYTE PANEL CMP - COMPREHEN METABOLIC PANEL PRENATAL - OBSTETRIC PANEL LIPID PANEL RENAL FUNCTION PANEL HEPATITIS PANEL- ACUTE (A,B,C) HEPATIC FUNCTION PANEL DRUG SCREEN, QUALITATE/MULTI w/ confirmation DRUG SCREEN SINGLE AMITRIPTYLINE CARBAMAZEPINE, TOTAL- TEGRETOL TEGRETOL, FREE CYCLOSPORINE - BLOOD DIGOXIN VALPROIC ACID (DIPROPYLACETIC ACID) LITHIUM NORTRIPTYLINE PHENOBARBITAL DILANTIN - PHENYTOIN, TOTAL PRIMIDONE- MYSOLINE (W/PHENOB) SIROLIMUS(RAPAMUNE) BLOOD TACROLIMUS THEOPHYLLINE QUANTITATIVE ASSAY DRUG URINALYSIS, AUTO W/SCOPE" URINALYSIS NONAUTO W/O SCOPE (P&G) URINALYSIS, AUTO, W/O SCOPE" URINE PREGNANCY TEST ACTH ALBUMIN MICROALBUMIN / CREAT RATION - RANDOM URINE ALCOHOL - BLOOD (ETHANOL) ALCOHOL- BREATH ETHANOL ALDOLASE ALDOSTERONE ALPHA-1-ANTITRYPSIN, TOTAL" ALPHA-1-ANTITRYPSIN, PHENOTYPE ALPHA-FETOPROTEIN, SERUM" AMINO ACIDS, SINGLE QUANT" AMMONIA AMYLASE ANDROSTENEDIONE ANGIOTENSIN I ENZYME TEST ARSENIC BETA-2 MICROGLOBULIN SERUM BILIRUBIN, TOTAL" BILIRUBIN, DIRECT" FECAL OCCULT BLOOD,IMMUNOASSAY VITAMIN D CALCIUM CALCIUM- ionized CALCIUM IN URINE
9.00 4.00 27.00 41.00 25.00 29.00 109.00 44.00 28.00 56.00 27.00 50.00 73.00 168.00 27.00 155.00 161.00 26.00 27.00 27.00 150.00 71.00 27.00 200.00 174.00 187.00 69.00 137.00 22.00 16.00 17.00 19.00 192.00 36.00 35.00 109.00 40.00 80.00 161.00 63.00 132.00 45.00 59.00 77.00 25.00 183.00 102.00 147.00 125.00 36.00 36.00 45.00 54.00 36.00 35.00 37.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
82374 82375 82378 82380 82384 82390 82435 82436 82465 82491 82542 82507 82523 82530 82533 82550 82552 82553 82565 82570 82575 82595 82607 82627 82668 82670 82672 82677 82705 82710 82728 82731 82746 82784 82785 82941 82947 82950 82951 82952 82952 82955 82977 82985 83001 83002 83010 83020 83021 83036 83090 83498 83516 83520 83525 83527 83540 83550 83615 83655 83690
CARBON DIOXIDE-BLOOD CARBON MONOXIDE-BLOOD CEA-CARCINOEMBRYONIC ANTIGEN CAROTENE, BETA THREE CATECHOLAMINES CERULOPLASMIN CHLORIDE-BLOOD CHLORIDE- URINE CHOLESTEROL-BLD/SERUM CHROMOTOGRAPHY, QUANT, SING" LAMOTRIGINE (LAMICTAL) SERUM CITRATE - urine 24 hour COLLAGEN CROSSLINKS CORTISOL, FREE - URINE 24 HOUR CORTISOL- TOTAL CPK TOTAL CPK ISOENZYMES CPK, MB FRACTION" CREATININE CREATININE- URINE 24 HOUR/RANDOM CREATININE CLEARANCE TEST CRYOGLOBULIN- semiquant, REFLEX VITAMIN B-12 DEHYDROEPIANDROSTERONE- DHEAS ERYTHROPOIETIN ESTRADIOL ESTROGEN ESTRIOL FATS/LIPIDS, FECES, QUAL" FECAL FATS, QUANTITATIVE FERRITIN FETAL FIBRONECTIN FOLIC ACID SERUM GAMMAGLOBULIN IgA, IgD, IgG, IgM, each GAMMAGLOBULIN IgE GASTRIN, SERUM GLUCOSE, BLOOD QUANT" O'SULLIVAN GLUCOSE TEST GLUCOSE TOLERANCE TEST (GTT) 2HR GLUCOSE TOLERANCE TEST -ADDITIONAL specimen GTT-ADDED SAMPLES G6PD ENZYME- QUANT GGT GLYCATED PROTEIN FSH- GONADOTROPIN (FSH) LH - GONADOTROPIN (LH) HAPTOGLOBIN, QUANT" SICKLE CELL TO STATE LAB HEMOGLOBIN CHROMOTOGRAPHY A1C Hgb - GLYCOSYLATED HEMOGLOBIN TEST HOMOCYSTINE HYDROXY-PROGESTERONE, 17-d alpha IMMUNOASSAY NONANTIBODY IMMUNOASSAY RIA INSULIN INSULIN-FREE IRON IRON BINDING TEST LACTATE (LD) (LDH) ENZYME LEAD (adult) LIPASE
36.00 109.00 43.00 108.00 172.00 53.00 37.00 36.00 25.00 154.00 154.00 188.00 255.00 106.00 100.00 25.00 94.00 158.00 25.00 41.00 39.00 50.00 31.00 48.00 132.00 104.00 48.00 125.00 101.00 146.00 26.00 188.00 29.00 65.00 68.00 99.00 18.00 28.00 31.50 10.50 10.50 107.00 25.00 44.00 36.00 31.00 69.00 0.00 86.00 29.00 59.00 148.00 119.00 181.00 37.00 55.00 25.00 10.00 37.00 38.00 42.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
83695 83704 83718 83721 83735 83825 83835 83874 83874 83880 83883 83891 83894 83898 83900 83901 83909 83912 83914 83921 83930 83935 83945 83970 83986 84066 84075 84100 84105 84132 84133 84134 84144 84146 84153 84154 84155 84156 84165 84166 84207 84244 84295 84300 84305 84402 84403 84425 84436 84439 84443 84445 84446 84450 84460 84466 84478 84479 84480 84481 84482
LIPOPROTEIN(A) LIPOPROTEIN PARTICLES-QUANTITATION HDL- DIRECT LIPOPROTEIN LDL DIRECT - LIPOPROTEIN MAGNESIUM MERCURY METANEPHRINES- TOTAL - 24 HOUR URINE MYOGLOBIN- SERUM QUANT MYOGLOBIN- URINE QUANT BNP- T-TYPE NATRIURETIC PEPTIDE NEPHELOMETRY NOT SPEC MOLECULE ISOLATE NUCLEIC MOLECULE GEL ELECTROPHOR MOLECULE NUCLEIC AMPLI, EACH" MOLECULE NUCLEIC AMPLI 2 SEQ MOLECULE NUCLEIC AMPLI ADDON SEPARATION+ID BY HIGH RESOLUTION GENETIC EXAMINATION MUTATION ID OLA/SBCE/ASPE ORGANIC ACID, SINGLE, QUANT" OSMOLALITY- BLOOD OSMOLALITY- URINE OXALATE -24 HR URINE PTH- PARATHYROID HORMONE-INTACT BODY FLUID ACIDITY Nitrazine paper PROSTATE ACID PHOSPHATASE ALKALINE PHOSPHATASE PHOSPHORUS- INORGANIC -SERUM PHOSPHORUS- INORGANIC - URINE POTASSIUM- SERUM POTASSIUM- URINE PREALBUMIN PROGESTERONE PROLACTIN PSA, TOTAL PSA, FREE PROTEIN - TOTAL/REFLECT SERUM PROTEIN, URINE RANDOM or 24 hour PROTEIN ELEC-PHORESIS, SERUM QUANT PROTEIN ELEC-PHORESIS/URINE/CSF VIT B6 - PLASMA RENIN SODIUM- SERUM SODIUM- URINE 24 HOUR SOMATOMEDIN TESTOSTERONE- FREE TESTOSTERONE- TOTAL VITAMIN B-1 THIAMINE T4- TOTAL THYROXINE T4- FREE THYROXINE TSH- THYROID STIM HORMONE TSI-THYROID STIMULATING IMMUNG VIT E - SERUM AST (SGOT) TRANSFERASE ALT (SGPT) ALANINE AMINO TRANSFERRIN TRIGLYCERIDES T3 or T4 UPTAKE or THBR T3- TRIIODOTHYRONINE (T3) T3-FREE ASSAY (FT-3) T3- REVERSE
120.00 124.00 25.00 29.00 25.00 137.00 200.00 130.00 130.00 204.00 133.00 55.00 32.00 32.00 15.00 1.50 15.00 41.00 1.00 222.00 52.00 52.00 94.00 100.00 9.00 28.00 36.00 37.00 37.00 25.00 37.00 67.00 85.00 49.00 30.00 116.00 36.00 60.00 51.00 100.00 179.00 135.00 36.00 37.00 71.00 186.00 37.00 119.00 23.00 27.00 28.00 253.00 103.00 25.00 25.00 59.00 25.00 23.00 75.00 112.00 217.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
84484 84520 84540 84550 84560 84585 84590 84591 84597 84630 84681 84702
TROPONIN, QUANT" BUN -UREA NITROGEN UREA NITROGEN -24 HR URINE URIC ACID- BLOOD URIC ACID- URINE VMA- URINE 24 HOUR VITAMIN A Vitamin B7 - Biotin VIT K - 1 ZINC C-PEPTIDE HCG- QUANT SERUM
153.00 25.00 38.00 25.00 37.00 96.00 112.00 227.00 204.00 94.00 115.00 40.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
84703 85002 85004 85007 85014 85018 85025 85041 85045 85048 85049 85060 85220 85240 85250 85300 85301 85302 85303 85305 85306 85307 85379 85384 85610 85613 85651 85660 85670 85705 85730 85732 86038 86060 86140 86141 86147 86160 86162 86200 86215 86225 86226 86235 86255 86256 86300 86300 86301 86304 86308 86334 86335 86340 86359 86360 86376 86382 86431 86580 86592
HCG-QUAL SERUM BLEEDING TIME TEST WBC DIFFERENTIAL -AUTOMATED WBC DIFFERENTIAL- MANUAL bld smear HEMATOCRIT HEMOGLOBIN CBC W/AUTO DIFF WBC RBC COUNT AUTOMATED RETICULOCYTE COUNT AUTOMATED WBC-COUNT - BLOOD (LEUKOCYTE ) AUTOMATED PLATELET COUNT AUTOMATED BLOOD SMEAR INTERPRETATION FACTOR V ACTIVITY FACTOR VIII ACTIVITY FACTOR IX ACTIVITY ANTITHROMBIN III TEST ANTITHROMBIN III ANTIGEN TEST PROTEIN C ANTIGEN PROTEIN C ACTIVITY PROTEIN S, TOTAL PROTEIN S FREE ACTIVATED PROTEIN C (ACP) RESISTANCE FIBRIN DEGRADATION, QUANT" FIBRINOGEN PT / INR PROTHROMBIN TIME RUSSELL VIPER VENOM, DILUTED" SED RATE, NONAUTOMATED" SICKLE CELL TEST-RBC REDUCTION-reflex fraction. THROMBIN TIME PLASMA THROMBOPLASTIN INHIBITION PTT- THROMBOPLASTIN TIME, PARTIAL" THROMBOPLASTIN TIME, SUBSTITUTION EA ANA- ANTINUCLEAR ANTIBODIES-DIRECT ANTISTREPTOLYSIN O, TITER" C-REACTIVE PROTEIN C-REACTIVE PROTEIN, HS - CARDIAC CARDIOLIPIN ANTIBOD, each class COMPLEMENT, ANTIGEN" COMPLEMENT, TOTAL (CH50)" CCP-CYCLIC CITRULPEPTIDE AB DNASE (DEOXYRIBONUCLEASE) ANTIBODY DNA ANTIBODY- NATIVE OR DOUBLE STRAND DNA ANTIBODY, SINGLE STRAND" NUCLEAR ANTIGEN ANTIBODY-EXTRACTABLE FLUORESCENT ANTIBODY, SCREEN" FLUORESCENT ANTIBODY, TITER" CA 15-3 -IMMUNOASSAY TUMOR, CA 27.29 -IMMUNOASSAY TUMOR, CA 19-9- MMUNOASSAY TUMOR, CA 125- MUNOASSAY TUMOR, MONO- HETEROPHILE ANTIBODIES-QUALITATIVE IMMUNOFIX E-PHORESIS, SERUM" IMMUNFIX E-PHORSIS/URINE/CSF INTRINSIC FACTOR ANTIBODY T CELLS; TOTAL COUNT CD4 / CD8, ABSOLUTE COUNT/RATIO" MICROSOMAL ANTIBODY NEUTRALIZATION TEST, VIRAL"(rabies titer) RA -RHEUMATOID FACTOR, QUANT" TB INTRADERMAL TEST RPR- BLOOD SEROLOGY, QUALITATIVE"
24.00 40.00 17.00 16.00 18.00 18.00 26.00 34.00 29.00 34.00 34.00 24.00 238.00 195.00 238.00 150.00 200.00 65.00 65.00 55.00 59.00 155.00 170.00 95.00 26.00 110.00 20.00 100.00 90.00 100.00 26.00 100.00 32.00 45.00 49.00 52.00 60.00 109.00 123.00 104.00 135.00 124.00 131.00 114.00 121.00 111.00 38.00 38.00 140.00 42.00 50.00 40.00 189.00 135.00 177.00 177.00 59.00 55.00 27.00 10.00 20.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
86593 86611 86617 86618 86632 86644 86645 86663 86664 86665 86677 86689
RPR-TITER BLOOD SEROLOGY, QUANT BARTONELLA ANTIBODY CAT SCRATCH LYME DISEASE ANTIBODY-CONFIRMATORY WB LYME DISEASE IGM ANTIBODY CHLAMYDIA IGM ANTIBODY CMV ANTIBODY- IGG CMV ANTIBODY, IGM" EPSTEIN-BARR ANTIBODY-EA EARLY ANTIGEN EPSTEIN-BARR ANTIBODY-EBNA NUCLEAR AG EPSTEIN-BARR ANTIBODY-VIRAL CAPSID(VCA) HELICOBACTER PYLORI - IGG QUANT HTLV/HIV WB CONFIRMATORY
20.00 236.00 300.00 133.00 125.00 112.00 112.00 108.00 108.00 108.00 51.00 103.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
86694 86695 86696 86701 86703 86704 86705 86706 86707 86708 86709 86735 86747 86757 86762 86765 86777 86780 86787 86790 86800 86803 86804 86850 86870 86880 86900 86901 87045 87070 87075 87077 87081 87086 87088 87168 87172 87177 87186 87205 87207 87209 87210 87230 87324 87338 87340 87350 87390 87425 87490 87491 87491 87517 87521 87522 87590 87591 87621 87880 87902
HERPES SIMPLEX TEST- TYPE 1 & 2 IGM HERPES SIMPLEX TYPE 1 IGG HERPES SIMPLEX TYPE 2 HIV-1 HIV-1/HIV-2, SCREENING HEP B CORE ANTIBODY, TOTAL" HEP B CORE ANTIBODY, IGM" HEP B SURFACE ANTIBODY- QUALITAtive HEP BE ANTIBODY HEP A ANTIBODY, TOTAL" HEP A ANTIBODY, IGM" MUMPS TITER - IGG ANTIBODY PARVOVIRUS ANTIBODY-B19 IGG-IGM RICKETTSIA AB-ROCKY MTN SPOTTED FEVER RUBELLA ANTIBODY TITER IGG RUBEOLA ANTIBODY TITER IGG TOXOPLASMA GONDII IGG ANTIBODY TP-PA SYPHILIS CONFIRM TEST VARICELLA-ZOSTER ANTIBODY TITER VIRUS ANTIBODY NOS THYROGLOBULIN ANTIBODY HEPATITIS C AB TEST HEP C AB TEST, CONFIRM" ANTIBODY SCREEN- RBC ANTIBODY IDENTIFICATION- RBC COOMBS TEST, DIRECT" BLOOD TYPING, ABO" BLOOD TYPING, RH (D)" STOOL (FECES) CULTURE to State Lab CULTURE, BACTERIA, OTHER" CULTURE ANAEROBIC BACTERIA, EXCEPT BLOOD" CULTURE AEROBIC ORGANISM IDENTIFICATION CULTURE SCREEN ONLY URINE CULTURE/COLONY COUNT URINE BACTERIA CULTURE MACROSCOPIC EXAM ARTHROPOD (nits-lice) PINWORM EXAM OVA AND PARASITES SMEARS-concentration SUSCEPTIBLE - MICROBE , MIC" GRAM STAIN- SMEAR, SMEAR, SPECIAL STAIN" SMEAR, COMPLEX STAIN- richrome, iron etc WET MOUNT, SALINE/INK" C.DIFFICILE B TOXIN - (QUAL) CLOSTRIDIUM difficile toxin A and B, EIA HELICOBACTER PYLORI, STOOL ANITGEN, EIA HEPATITIS B SURFACE AG, EIA" HEPATITIS BE AG, EIA" HIV-1 AG, EIA - STATE LAB ROTAVIRUS AG, EIA" CHLAMYDIA TRACH BY DNA PROBE CHLAMYDIA TRACH, DNA, TO State Lab CHLAMYDIA TRACH, DNA, LabCorp swab or ua HEPATITIS B, DNA, QUANT - PCR HEPATITIS C, RNA, AMP PROBE - QUAL HEPATITIS C, RNA, QUANTISURE (IU) N.GONORRHOEAE, DNA, DIR PROB" N.GONORRHOEAE, DNA, AMP PROB-STATE LAB HPV, DNA, AMP PROBE" STREP A ASSAY W/OPTIC HEPATITIS C GENOTYPE, DNA, "
100.00 94.00 127.00 33.00 33.00 28.00 67.00 28.00 81.00 29.00 29.00 36.00 207.00 141.00 30.00 38.00 94.00 67.00 51.00 143.00 105.00 38.00 406.00 28.00 107.00 56.00 25.00 38.00 0.00 25.00 88.00 25.00 25.00 18.00 22.00 17.00 15.00 25.00 23.00 18.00 119.00 50.00 15.00 140.00 127.00 204.00 27.00 83.00 0.00 137.00 32.00 0.00 129.00 541.00 368.00 406.00 84.00 0.00 105.00 32.00 582.00

1-Jul-11
26-Jun-12
Current FY 11/12
Proposed Changes
FY 12/13
88175-90 89055 89321 99000 99070 G0328 LU305 LU306
PAP COLLECTION FEE WBC - STOOL SEMEN ANAL, SPERM DETECTION"-AMC HANDLING FEE - Paps MATERIALS AND SUPPLIES-each container HEMOCCULTS X 3 (MEDICARE) COC DRUG COLLECTION FEE COC PATERNITY COLLECTION
16.75 69.00 30.00 15.00 7.50 18.00 15.00 15.00
MCPH Billing Guide FY 13
Effective July 1, 2012
MACON COUNTY PUBLIC HEALTH
FY 12-13
Billing and Collection Policies And Fee Schedules
Presented to and Approved by Board of Health on 06-26-2012 Presented to and Approved by Board of Commissioners on ____________

MACON COUNTY PUBLIC HEALTH BILLING AND COLLECTION POLICIES
RATIONALE North Carolina law1 allows a local board of health to impose a fee for services to be rendered by a
local health department, except where the imposition of a fee is prohibited by statute or where an employee of the local health department is performing the services as an agent of the State.
Fees may be based on a plan recommended by the Health Director; The plan must be approved by the Board of Health and the Board of County Commissioners; And, fees collected under the authority of this subsection are to be deposited to the account
of the local health department so that they may be expended for public health purposes in accordance with the provisions of the Local Government Budget and Fiscal Control Act.
The State requires local health departments to provide certain services, and no one may be denied these services. It is in the best interest of our community for the Health Center to:
Assure that all residents can get all legally required public health services. Provide as many other recommended and needed health services as possible, within the resources we
still have available to use. The purpose of charging fees is to increase resources and use them to meet residents needs in a fair and balanced way. Fees are necessary to help identify and cover the full cost of providing public health services. As much as possible, fees are based on the true cost of providing a particular service (calculated as direct costs plus indirect costs). Throughout the year, ongoing cost analyses are performed and fee schedules shall be adjusted by the Health Director, in the amount of the increased cost for prevision of said services. A list of Health Center fees is available upon request. The information in the document below is the fee plan for FY 13, effective on July 1, 2010. This Billing Guide for FY13 replaces all earlier plans. COST OF SERVICE DETERMINATION Costs for services received through the Health Center are firstly based on the current Medicaid rate and then adjusted according to the actual cost of the service. If there is no Medicaid rate then fees are determined through cost analysis. Cost analysis takes into account all of the resources associated with providing a particular service and calculates the actual cost to provide that service. Cost analysis includes the calculation of direct and indirect costs for services and then adding these figures together to determine the actual cost of the service. Calculating direct cost: Direct costs are expenses that can be easily related to the provision of a specific service, i.e., physician and support staff salaries and benefits, medical supplies, lab tests, and other resources consumed at the time of the service. Calculating indirect costs: Indirect costs involve resources that are not directly consumed during the provision of a service, but without them the provision of that service would not be possible, i.e., administrative staff salaries and benefits, training costs, facility costs, insurance premiums, office equipment and supplies, and recruiting and marketing expenses.
North Carolina General Statue 130A-39(g) Page 2 9/7/2012

PAYMENT BY CLIENT
Fees are charged for services and collected at the Health Center. See attachment for fee schedule. All fees are the responsibility of the patient, client or responsible party and may be subject to the sliding fee scale. No client will be refused services solely on their inability to pay for said services. All fees may be paid by cash, check, or major credit card. Full payment is expected at the time of service. Clients will be informed of their account status at each visit. An itemized receipt will be provided to individuals at time of payment. Fees for adult dental services will be collected before the service is rendered. Prepayment of copays for all services in which co-payments apply will be required and collected when services are rendered. Fees will be charged to individuals in families with annual gross incomes exceeding specified levels of a scale based on current Federal Poverty Income Guidelines. Verification of income and family size must be provided to determine a patients eligibility status. Verification (proof) of income may be provided for Family Planning services; however, if the patient has no proof of income, the patients declaration of income shall be accepted and any charge shall be based on what he/she declares. Falsification of this information will permanently disqualify clients from using sliding fee scale, except for Family Planning services. Eligibility will be reevaluated as patients income and household status changes or at least annually. If income cannot be verified at the time of screening, the charge for all services except Family Planning will be at 100% pay. If verification of income is received within thirty days of a service, the charge will be retroactively adjusted to reflect percent pay based on verification received. Verification received after thirty days will be applied only to future services. Eligibility of Medicaid will be determined where applicable. Individuals will be required to provide all social security numbers and names used for employment purposes. If an individual refuses to provide information to verify income, they will not be eligible for the sliding fee scale and will be at 100% pay. Customary visit services for mandatory childhood immunizations, community outreach, tuberculosis, TB related X-rays, sexually transmitted disease control (STD), and other epidemiological investigations are provided at no cost to the client but may be billed to Medicaid or other third party agent. Separate fees may be charged for drugs, supplies, laboratory services, X-rays and other technological services, if appropriate. The costs of services performed by providers not affiliated with the Macon County Public Health Center are the responsibility of the patient/client. Fees may be charged or waived for educational services provided to individuals or groups, such as orientation, preceptorship, field training or classes. Charges not eligible for sliding scale discount include: a. Environmental Health services b. Non-mandated immunization services c. Miscellaneous/general services (see Miscellaneous/General section below) d. Out-of-county residents (see Out-of-County Service Restrictions section below) e. Specific insurance situations (see Insurance section below for details) Bills will be mailed monthly to individuals who have not paid charges in full for services rendered (exception Family Planning for those that request no mail be sent to their home). Arrangements may be made for payment plans when required for good cause. PAYMENT BY THIRD PARTY Verification of enrollment under Medicare, Medicaid, insurance or other third party payment plan is required by presentation of a valid card at the time of service. The Health Center is required to bill only participating third party payers for services rendered. For services rendered to clients with insurance where the Health Center is not a participating provider, the client will be responsible for full payment of service when the service is delivered. The Health Center is currently participating with Medicaid, Medicare, Blue Cross Blue Shield, Crescent, Tri-care and NC Health Choice for medical services. The client is responsible
Page 3 9/7/2012
for charges not covered by third party payers. Co-pay amounts must be paid at the time of services and are not subject to the sliding fee eligibility scale. Sliding fee scale discount does not apply in the following situations: a. Clients with insurance in which MCPH is not participating provider. b. Clients with any insurance who choose not to use their coverage. c. Insurance co-payments (when MCPH is a participating provider) ACCOUNT COLLECTIONS AND BAD DEBT The Health Center will issue all clients a monthly statement of fees that have been incurred and are due. Clients are expected to make payment at the time services are rendered. If a balance is carried forward clients who have not made a payment on their account for any service(s) received from Macon County Public Health for 120 days shall be required to pay their past due balance before another service shall be rendered (see Service Denial for further information). The Health Center may use the following resources to pursue collection of patient accounts: billing statements, past due notices, collection agencies or credit bureaus, and the NC Local Government Debt Setoff Clearinghouse (ref: NCGS 105A-1 et seq.) as administered by the NC Department of Revenue Accounts will be reviewed annually for bad debt status, and at that time with the approval of the BOH and the BOCCs the amounts may be written off for accounting purposes if no further collection is anticipated. Any payments received for write-off debts will be accepted and credited to appropriate accounts. At no time will a patient be notified that the account has been written off as a bad debt. Bad debts, which are determined uncollectible (i.e. bankruptcy, death), will be written off permanently upon notification. RETURNED CHECK POLICY A $25.00 fee may be charged for a returned check written to Macon County Public Health (MCPH). The client will be notified via telephone, if possible, of the returned check. If a telephone number is not available, a written notification will be sent. All returned checks will be made good via cash, money order, and/or certified check. If a client has two returned checks within a one-year period, he/she will be required to pay for services in advance via cash, money order, or certified check for the period of one year. After the one-year period expires, if another returned check occurs, all future bills must be paid with cash, money order, or certified check prior to the provision of services. REFUNDS In the event that a client or other third-party has overpaid their responsible charges, the credit balance is either: applied to future charges or refunded to the payer within thirty (30) days of discovery or request. Refunds for Environmental Health services are determined by attached policy and procedure. SERVICE DENIAL No individual may be denied Health Center mandated services e.g. communicable disease services (STD/TB). These services are provided at no charge to the client. Individuals who do not meet program guideline criteria may be denied specific services. Clients covered by Medicaid who fail to make required co-payments will not be denied services. Individuals who have not paid proper charges for previous services (unless state and federal program rules prohibit services restriction or denial) may be required to pay fees beforehand, be denied access to services (see Account Collections and Bad Debts), or be denied subsequent services pending demonstration of a good faith effort to make payment within the past ninety (90) days.
Page 4 9/7/2012

OUT OF COUNTY SERVICE RESTRICTIONS
Macon County supports its low-income citizens by subsidizing the cost for certain health care services. To assure that Macon County citizens have maximum access to Health Center services only those services mandated by North Carolina General Statues or approved in this plan will be provided to nonMacon County residents. If an individual moves out of Macon County, they must obtain services from another provider. Clients are required to report any change of address at time of service. COMPLIANCE WITH TITLE VI AND VII, OF 42 US CODE CHAPTER 21 The MCPH complies with Title VI and Title VII of the Civil Rights Act of 1964 and all requirements imposed by or pursuant to the regulations. Staff will not discriminate against any clients because of age, sex, race, creed, national origin, or disability. Staff will ensure clients with LEP are provided adequate language assistance so they have meaningful access to the agencys services.
PROGRAM SPECIFIC INFORMATION ADULT HEALTH Provides limited health screening services for adults. Services provided through this program are not eligible for sliding fee scale payment or third party billing. Exception: Colposcopies may be billed to third parties. Eligibility:
Must be a resident of Macon County; Exception: Colposcopies. Must be 18 years and older. Adult Health Services are not eligible for sliding fee scale payment. Services will be paid for
prior to any service being rendered. Any additional fees associated with a visit will be added to the clients account and paid in full at checkout.
COMMUNICABLE DISEASE CONTROL Deals with the investigation and follow-up of all reportable communicable diseases. Testing, diagnosis, treatment, and referring as appropriate, of a variety of sexually transmitted diseases. Provides follow-up and treatment of TB cases and their contacts. No fees are charged directly to clients for these services as stated in Program Rules (exception Medicaid or other third party agent can be billed with the patients permission). Eligibility: No residency or financial requirements
Page 5
9/7/2012
BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCCP) Provides pap smears, breast exams and screening mammograms, assists women with abnormal breast examinations/mammograms, or abnormal cervical screenings to obtain additional diagnostic examinations. Eligibility: uninsured or underinsured; without Medicare Part B or Medicaid; between ages 40 - 64 for breast screening services and 18 - 64 for cervical screening services; have a household income at or below 250% of the federal poverty level. No charge for those who qualify for the program; family size shall be determined as follows: Client, spouse of client and all children under 18 years of age, including step-children who live in the home.
WOMENS HEALTH Provides limited health screening services (pap smears and/or breast exams) for women who do not meet the qualifications of the NC BCCCP Program. Grant funds may be available to cover the cost of repeat pap smears for women below 250% of federal poverty level when funding is available. Services provided are not eligible for sliding fee scale payment or third party billing. Eligibility:
Must be a resident of Macon County; 18 years and older. Womens Health Services are not eligible for sliding fee scale payment. Services will be paid for
prior to any service being rendered. Any additional fees associated with a visit will be added to the clients account and paid in full at checkout CHILD HEALTH Well child exams conducted by (appropriate provider); exam includes medical, social, development, nutritional history, lab work, and physical exam. MCPH accepts sliding fee scale; some Private Insurances; Health Choice; Medicaid Eligibility: Residents of Macon County; Birth to 20 years; Residents of other surrounding NC Counties if client has Medicaid or Health Choice
IMMUNIZATIONS Provide all required and recommended vaccines that are available for infants, school aged children and college bound individuals. Also provide a wide range of vaccines for adults to include foreign travel vaccinations. MCPH accepts some Private Insurances, Health Choice, Medicaid, and Medicare. In some instances charges do not apply (e.g. state supplied vaccine). Sliding fee scale does not apply to immunizations.
Page 6
9/7/2012

Eligibility:
No residency or financial requirements for immunizations. CARE COORDINATION FOR CHILDREN (CC4C) Case management assists families in identification of and access to services for children with special needs that will allow them the maximum opportunity to reach their development potential. MCPH accepts Medicaid Eligibility: Macon County children birth to age three who are at risk for developmental delay or disability, long term illness and/or social, emotional disorders and children ages birth to five who have been diagnosed with developmental delay or disability, long term illness and/or social, emotional disorder may be eligible for the program.
FAMILY PLANNING Clinic designed to assist women in planning their childbearing schedule; detailed history, lab work, physical exam, counseling and education given by (appropriate provider). MCPH accepts sliding fee scale; some Private Insurances; Medicaid or potentially Medicaid eligible. Eligibility: This can be a confidential service Women of childbearing age Residents of Macon and other surrounding North Carolina Counties Family Planning (Title X) patients who present for services without proof of income will be assigned to the sliding fee scale based on information shared verbally regarding income and sources. Unless the information warrants, they will never be charged at 100% as this would be considered a barrier to service. Proof of income may be requested, but cannot be required A Family Planning patient will never be refused a Family Planning service due to an outstanding balance MISCELLANEOUS/GENERAL SERVICES Include: daycare, DOT, foster care, employment or other specialty physical exams; laboratory services, etc. Eligibility: Residents of Macon County (exception, pregnancy tests) These services are not eligible for sliding fee scale payment. Services will be paid for prior to any service being rendered. Any additional fees associated with a visit will be added to the clients account and paid in full at checkout. MATERNAL HEALTH Prenatal care is medical care recommended for women during pregnancy. The aim of good prenatal care is to detect any potential problems early, to prevent them if possible (through recommendations on adequate nutrition, exercise, vitamin intake etc), and to direct the woman to appropriate specialists,
Page 7 9/7/2012
hospitals, etc. if necessary. Visits are monthly during the first two trimesters (from week one to week 28 of pregnancy), every two weeks from 28 to week 36 of pregnancy and weekly after week 36 (until the day of delivery that could be between week 38 and 40 weeks). MCPH accepts sliding fee scale; some Private Insurances; Medicaid or potentially Medicaid eligible. Eligibility: Residents of Macon - eligibility policy and residency requirements attached Maternal Health clients will be required to have 2 proofs of residency
OB CARE COORDINATION MANAGEMENT (OBCM) Case manager assists pregnant women in receiving needed prenatal care and pregnancy related services. MCPH accepts Medicaid or potentially Medicaid eligible. Eligibility: Residents of Macon County
WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM (WIC) Supplemental nutrition and education program to provide specific nutritional foods and education services to improve health status of target groups. Eligibility: WIC is available to pregnant, breastfeeding, and postpartum women, infants, and children up to age 5 who meet the follow criteria: Be a resident of Macon County; Be at medical and/or nutritional risk; Have a family income less than 185% of the US Federal Poverty Level; Medicaid, AFDC, or food stamps automatically meet the income eligibility requirement
CHILDRENS DENTAL PROGRAM The Macon County Childrens Dental Clinic (Molar Roller) provides comprehensive general dental services to children from birth to 20 years of age. Eligibility: Resident of Macon County. Exception: Residents of other surrounding NC Counties if client has Medicaid or Health Choice. Services eligible for sliding fee scale with a maximum discount of 75%. Charges not eligible for sliding fee scale discount include: Services not covered by Medicaid or Health Choice and, those covered by insurances which MCPH is not a participating provider.
ADULT DENTAL PROGRAM The Macon County Adult Dental Clinic provides comprehensive general dental services to adults 21 years of age and above.
Page 8 9/7/2012

Eligibility:
Resident of Macon County. Exception: Residents of other surrounding NC Counties if client has Medicaid. Services eligible for sliding fee scale with a maximum discount of 50%. Charges not eligible for sliding fee scale discount include: Services not covered by Medicaid or Health Choice and, those covered by insurances which MCPH is not a participating provider. Fees for adult dental services will be collected before the service is rendered.
HEALTH EDUCATION/HEALTH PROMOTION Health education/health promotion services are provided to individuals and/or groups. The focus is to promote health and prevent disease, disability and premature death through education-driven voluntary behavior change activities; and is designed to enable people to increase control over, and to improve, their health. Details, policies and fees are specific to each program or activity offered. Fees for these programs and activities are subject to change and appropriately adjusted throughout the year. Eligibility: Residents of Macon and other North Carolina Counties Worksite Wellness Employee health services are available for all employers in Macon County. Employee health services are available on a per program basis or under and annual contract arrangement. Individual program fees will vary and are based on salary expense to prepare and deliver the program; current mileage rates if travel is required; as well as any materials, laboratory, or medical supplies costs. An administrative supplement of 10% is added for each individual program. Comprehensive worksite wellness programs are available under contract for organizations with at least 50 employees. This program, also known as the LIFE program, provides employee health screenings followed by customized programs and consultation services to address the health needs of the employees. Fees for the LIFE program range from $30 to $50 per employee per year depending upon the cost to provide the services, the number of programs provided, as well as the organizations ability to provide in-kind assistance. CPR/AED and First Aid Training: Various components of American Red Cross Standard First Aid and/or CPR/AED for lay responders are offered on-site at Macon County Public Healths location at Lakeside Drive in Franklin. Classes are offered for a fee approximately every month. The specific educational components offered may vary from month to month to best suit the current needs of the public. Pre-registration and pre-payment are required. A maximum of twelve individuals may be enrolled in a single instructor class. Fees for the specific educational components are based on current American Red Cross pricing and are subject to change. NUTRITION SERVICES: DSMT Services: Macon County Public Health offers Diabetes Self-Management Training services provided by a Registered Dietitian through American Diabetes Association approval/recognition. The
Page 9 9/7/2012
registered dietitian is credentialed and a certified provider with Medicare, Medicaid and BCBS NC. For clients with these insurances, physician referral and medical diagnosis of diabetes the insurance will be billed and costs covered accordingly. For clients without these insurances a sliding fee scale based on annual gross income that is at or below 250% of poverty is used. The scale slides to a minimum discount of 20% in which the client is responsible for payment to the health center prior to service being rendered. MNT Services: Macon County Public Health offers Medical Nutrition Therapy services provided by a Registered Dietitian. The registered dietitian is credentialed and a certified providers with Medicare, Medicaid and BCBS NC. For clients with these insurances, physician referral and covered medical diagnosis the insurance will be billed and costs covered accordingly. For clients without these insurances a sliding fee scale based on annual gross income that is at or below 250% of poverty is used. The scale slides to a minimum discount of 20% in which the client is responsible for payment to the health center prior to service being rendered.
ENVIRONMENTAL HEALTH Fees for Environmental Health Services are collected at time of application by the Macon County Building Inspections Department. REFUND POLICY: Attached
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9/7/2012
N. C. Division of Public Health Women's and Children's Health Section Annual Gross Family Income Sliding Fee Scale --101% to 250% of Poverty Family Planning Waiver Eligibility Included
Effective 7/2011
FP Waiver Eligibility*
Partial-Pay Bracket Forty Percent From To 40% 59% $14,975 $20,227 $25,480 $30,732 $35,985 $41,237 $46,490 $51,742 $56,995 $62,247 $67,500 $72,752 $19,058 $25,743 $32,428 $39,113 $45,798 $52,483 $59,168 $65,853 $72,538 $79,223 $85,908 $92,593 Partial-Pay Bracket Sixty Percent From 60% $19,059 $25,744 $32,429 $39,114 $45,799 $52,484 $59,169 $65,854 $72,539 $79,224 $85,909 $92,594 $20,147 $27,214 $34,281 $41,348 $48,415 $55,482 $62,549 $69,616 $76,683 $83,750 $90,817 $97,884 To 79% $23,141 $31,259 $39,376 $47,494 $55,611 $63,729 $71,846 $79,964 $88,081 $96,199 $104,316 $112,434 Partial-Pay Bracket Eighty Percent From To 80% 99% $23,142 $31,260 $39,377 $47,495 $55,612 $63,730 $71,847 $79,965 $88,082 $96,200 $104,317 $112,435 $27,224 $36,774 $46,324 $55,874 $65,424 $74,974 $84,524 $94,074 $103,624 $113,174 $122,724 $132,274
Family Size 1 2 3 4 5 6 7 8 9 10 11 12
Federal Poverty $10,890 $14,710 $18,530 $22,350 $26,170 $29,990 $33,810 $37,630 $41,450 $45,270 $49,090 $52,910
Partial-Pay Bracket Twenty Percent From To 20% 39% $10,891 $14,711 $18,531 $22,351 $26,171 $29,991 $33,811 $37,631 $41,451 $45,271 $49,091 $52,911 $14,974 $20,226 $25,479 $30,731 $35,984 $41,236 $46,489 $51,741 $56,994 $62,246 $67,499 $72,751
Full Pay >100% $27,225 $36,775 $46,325 $55,875 $65,425 $74,975 $84,525 $94,075 $103,625 $113,175 $122,725 $132,275
* at or below 185% of federal poverty level
MCPH Billing Guide FY 13 FY12 Sliding Fee Scale
Guidelines for Determining Elements of the Sliding Fee Scale Eligibility screening is required on all new clients or when family size and/or income changes occur, or at 12 month intervals. Definition for Family Size and Countable Gross Income for the following clinics: Adult Health, Child Health, Prenatal, Family Planning and Dental A family is defined as a group of related or non-related individuals who are living together as one economic unit. Individuals are considered members of a single family or economic unit when their production of income and consumption of goods are related. An economic unit must have its own source of income. Example: client with no income must be considered part of a larger economic unit that provides support to the household. Groups of individuals living in the same house with other individuals may be considered a separate economic unit. For example, if two sisters and their children live in the same house and both work and support their own children, they would be considered a separate household. EXCEPTIONS TO ECONOMIC UNIT A. B. For Family Planning service only. Un-emancipated minors and others requesting confidential services will be considered a family unit of one, and fees will be assessed based on their own income. A foster child assigned by DSS shall always be considered a family of one.
C.
Determination of Gross Income: The dollar amounts represent gross annual income; they refer to total cash receipts before taxes from all sources. Household income sources include: Salaries and wages, earnings from self-employment (deduct business expenses, except depreciation); interest income, all investment and rental income; public assistance, unemployment benefits, workers compensation, alimony and child support, military allotments; Social Security benefits, VA benefits; retirement and pension pay; insurance or annuity plans; gaming proceeds and any other income not represented here that contributes to the household consumption of goods. This list is not all inclusive. Documents acceptable for income verifications: Current pay stub (noting the pay timeframe i.e.: weekly, bi-weekly etc.) Signed statement from employer indicating gross earnings for a specified pay period, statement must include the business name, address and phone number and must be legible. W-2 Forms Unemployment letter/notice Award letter from Social Security Office, VA or Railroad Retirement Board 1099s received from IRS For Self-employment: Accounting records or income tax return for the most recent calendar year, entire tax return must be provided in order allow deductions for business expenses.

MEETING DATE: September 11, 2012 DEPARTMENT/AGENCY: Governing Board SUBJECT MATTER: Board of Health Appointment DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Please see the attached letter of resignation from Dr. Egge. Per Jim Bruckner, the Board of Health is recommending that Dr. Fred Berger fill Dr. Egges unexpired term. This vacancy has not been advertised on the countys website. However, as a physician representative on the board, Dr. Egge must be replaced by a doctor. COUNTY MANAGERS COMMENTS/RECOMMENDATION:
Attachments ___X__ Agenda Item 12A
Yes
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No

Macon County Commissioners 09-11-2012 Agenda Packet

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MACON COUNTY BOARD OF COMMISSIONERS SEPTEMBER 11, 2012 AGENDA 1. Call to order and welcome by Chairman Corbin 2.

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments ___X__ Agenda Item 5

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments _____ Agenda Item 8A

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

Attachments ___X__ Agenda Item 10A

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

Attachments ___X__ Agenda Item 10B

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

Attachments ___X__ Agenda Item 10C

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

Attachments ___X__ Agenda Item 10D

North Carolina Governors Highway Safety Program

LOCAL GOVERNMENTAL RESOLUTION

(herein called the

IN OPEN , NORTH CAROLINA,

MEETING ASSEMBLED IN THE CITY OF THIS DAY OF , 20 , AS FOLLOWS:

is authorized to file, on behalf of the Governing

DONE AND ORDERED in open meeting by

North Carolina Governors Highway Safety Program Agreement of Conditions

Rev. 7/11 Page 2

Rev. 7/11 Page 3

Rev. 7/11 Page 6

Rev. 7/11 Page 7

Rev. 7/11 Page 8

AGENCY AUTHORIZING OFFICIAL TITLE ADDRESS DATE TELEPHONE NUMBER

Rev. 7/11 Page 9

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments ___X__ Agenda Item 10E

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments ___X__ Agenda Item 10F

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

Attachments _____ Agenda Item 10G

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Agenda Item 10H (1,2 and 3)

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments ___X__ Agenda Item 11A-11F

_____________________________ Jack Horton, County Manager Clerk to the Board

______________________________ Kevin Corbin Board Chairman

Minutes 08/14/12 Page 2 of 2

Macon County Public Health Fee Schedule

Macon County Public Health Fee Schedule

Macon County Public Health Fee Schedule

Macon County Public Health Fee Schedule

D7230 D7240 D7310 D7320 D7321 D7410 D7510 D9110

354.00 424.00 223.00 364.00 308.00 177.56 241.00 97.00

HEALTH EDUCATION SERVICES

90.00 70.00 90.00 70.00

Macon County Public Health Fee Schedule

30.00 1.00 2.00

Macon County Public Health Fee Schedule

Macon County Public Health Fee Schedule

Macon County Public Health Fee Schedule

Macon County Public Health Fee Schedule

Macon County Public Health Fee Schedule

Macon County Public Health Fee Schedule

Macon County Public Health Fee Schedule

Attachments _X Agenda Item 5

Attachments _X Agenda Item 10A

Attachments _X Agenda Item 10B

Attachments _X Agenda Item 10C

Attachments _X Agenda Item 10D

Attachments _X Agenda Item 10E

Attachments _X Agenda Item 10F

Attachments _X Agenda Item 11A-11F

Attachments _X Agenda Item 12A