Title
Adopt a Resolution amending Article I.d. of the Monterey County Master Fee Resolution effective July 1, 2019, to adjust certain fees related to the Health Department’s Clinic Services Bureau pursuant to the attached Fee Schedule.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
Adopt a Resolution amending Article I.d. of the Monterey County Master Fee Resolution effective July 1, 2019, to adjust certain fees related to the Health Department’s Clinic Services Bureau pursuant to the attached Fee Schedule.
SUMMARY/DISCUSSION:
The Health Department’s Clinic Services Bureau (Clinic Services) operates Federally Qualified Health Center Look-Alike (FQHC-LA) clinics that are required, by the Health Resources and Services Administration (HRSA), to periodically review its fee schedule to ensure that it accurately reflects the costs of services provided and that fees are consistent with local prevailing rates or charges. In compliance with the requirements, Clinic Services has been reviewing and adjusting its fee schedules annually. Proposed fees for FY2019-20 increase an average of 8.13% from FY2018-19.
Additionally, Clinic Services is mandated by HRSA to offer Sliding Fee Discount Program (SFDP) for patients whose income is at or below 200% of the Federal Poverty Level (FPL). Effective 8/1/2018, Clinic Services increased SFDP fees to $0, $40, $70, $105 and $130, respectively for those who were eligible if a patient's income is at 100% or below, under 120%, under 133%, under 185% and at 200% or below of the FPL. Since the increase, data reflects average number of visits per year per patient decreased from 1.48 to 1.38 for patients with FPL between 101% and 200%. Although there might be many factors contributing to this trend, in order to keep services affordable and accessible, Clinic Services will not increase SFDP fees in FY 2019-2020 and keep the current patient responsibility amounts.
Calculations and documents in support of all fee adjustments recommended herein are attached and are on file with the Clerk of the Board along with a SFDP chart reflecting calendar year 2019 FPL. In all cases, the proposed fees reflect no more than the actual, reasonable, fully loaded costs of the services provided to the payor/applicant. By definition, these service charges are not a ‘tax’ and are exempt from voter approval pursuant to Article XIII C section 1(e)(1)-(2) of the California Constitution (‘Prop. 26’: charge imposed for specific benefit conferred/ privilege/ service or product provided or granted to the payor).
The work supports the Monterey County Health Department’s 2018-2022 Strategic Plan Initiatives: 1.) Empower the community to improve health; and 3.) Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services. It also supports the following of the ten essential public health services, specifically: 5.) Develop policies and plans that support individual and community health efforts; and 7.) Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed as to legal form.
FINANCING:
The recommended fee adjustments are intended to recapture service costs with considerations of operational cost, relative value units, payor reimbursements and prevailing local charges, without generating additional revenue. The proposed fee levels assure that the programs remain revenue neutral with no additional impact on the County’s General Fund Contribution. The fee increase is also intended to stay compliant with HRSA’s requirements.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related Board of Supervisors Strategic Initiatives:
☐Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☐Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
☒Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services; promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☐Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Nan Kyung Kim, Finance Manager, x1308
Approved by: Elsa Jimenez, Director of Health, x4526
Attachments:
Proposed Resolution is on file with the Clerk of the Board
Proposed Article I.d. Fee Schedule is on file with the Clerk of the Board
Fee Schedule comparing current and proposed fees is on file with the Clerk of the Board
Sliding Scale Discount Chart, Effective July 1, 2019, is on file with the Clerk of the Board