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State budget cuts, service requests force new health department fees

Fredericktown, MO. January 26, 2011 — A new ordinance passed by the Madison County Commissioners took effect on January 1, 2011.

The ordinance provides fees for services provided by the Madison County Health Department. Discussions and decisions regarding the ordinance were made during open session meetings of the Madison County Commissioners and the Madison County Health Department Board of Trustees between August and December 2010. The ordinance was approved at the December 20, 2010 meeting of the commissioners and published in the Democrat News for three weeks prior to its implementation.  The following information has been compiled from the health department administration in order to help the general public gain an understanding of how and why this ordinance came about.

The Madison County Health Department (MCHD) was established by vote of the people in 1949 with the support of 10 cents per $100 assessed valuation. This has not been increased since its inception. The purpose of the MCHD is to provide core service of public health such as immunizations, communicable disease prevention, identification and control, assess the health of the community and educate the public on health issues.

The MCHD receives funding through the Missouri Department of Health and Senior Service for (*) Core Public Health Services.

Over the past several years, funding from this general revenue has been reduced. In 2008 the MCHD received $56,028.02 for core health services. In 2010 the department received $43,745.65. The $12,282.37 reduction in funding has been made up by local tax dollars. As the economy and health insurance coverage continues to change, the department is being accessed by a greater number of citizens. In 2009, the department averaged 1,700 client services a month. In 2010, request for services climbed to an average of 2,450 per month; due in part to insurance coverage changes or loss of coverage.

In 2009, the significant funding cut from the state prompted the MCHD Board of Trustees to review the programs provided by the health department; the cost to provide the programs and the reimbursement to fund those programs. Two programs were cut as the services were available through MMC Rural Health and the Beyer Medical Group which could receive reimbursement, while the MCHD could not. With continuing cuts in funding in 2010, and more expected in the future, the board looked at two possible options; a request to place a tax increase on the ballot, or a fee for service. The board felt a fee for service was the best option. The fee for service ordinance was designed under Missouri State Revised Statutes 192.300 with a sliding fee scale based upon the federal poverty level schedules of the U.S. Health and Human Services agency.

The cost for each program is calculated monthly and the annual program costs to clients served are the basis of the maximum fee for each service. E.G.; a family of three with an annual income between $22,888 and $23,802 is at the 20 percent fee rate. Which means the fee for service for this family is at 20 percent of the actual cost of the service. The fees for service will change on February 1 each year. The fees for 2011 have decreased for all services.

In regards to projected revenues from the fee for service plan:

The total estimated cost to provide the services on the fee schedule is $213,569.98. Based on the average household income of Madison County, which places the average of 40 percent pay for services and the number of services to each program; we (MCHD) are estimating additional revenue of $63,974.75. Anticipated revenues from insurance billing are $40,364.78. (*) The State of Missouri Core Functions funding is $44,398. The remainder of the estimated cost to provide service being from our local Mill tax support of $64,832.45.

Another provision of the ordinance is the authority of the health department to bill for services (as the ordinance provides for) in response to a communicable disease outbreak, when laboratory tests identify the source; a single unit, identifiable group or business.

Federal funded programs are not subject to the Fee for Services Schedule:

WIC (Women, Infants and Children nutrition program) Lead Poisoning Prevention Programs.

Child care Health Consultation and Maternal Child Health Injury Prevention program.

Also, such local programs such as blood pressure screening, diet education, community health education programs and presentations.

In light of the continued budget cuts from the state, and an increased demand for services, the MCHD has explored many options to obtain reimbursement for services.

In 2004, the department began contracting with insurance companies to be reimbursed for billable services such as immunizations and basic heath care services.

By 2010, many insurance companies have contracted with the MCHD with the exception of Blue Cross and Blue Shield and Medicare. Medicare will only provide reimbursement for influenza and Pneumonia vaccinations. Medicare requires a physician to be on staff in the office in order to provide for more reimbursements. 

The department will contact an insurance company to make application as a provider when citizens seek services through the department and have insurance with a company the department doesn’t have a contract with according to administration. Current insurance companies the department has contracts with are: Care Improvement Plus (Flu and Pneumonia only), Coventry, Harmony Health Care, Healthlink HMO and PPO, Humana (Flu and Pneumonia only), Medicaid (Medicaid insured are in the income bracket of no fee), Medicare (Flu and Pneumonia only), Mercy Health Plan, Meritian Health, Molina Healthcare, Missouri Health Care Plan, Secure Horizons (Flu and Pneumonia only), Tricare, UMR.

The health department administration said the client will be aware of the cost of the service they are requesting before hand. Services will be provided even if the client has no form of payment at the time of service according to MCHD administration.  (Cash, checks or money orders only at this time No debit or credit cards). These services will be reviewed by the MCHD Board of Trustees at the next meeting. At that time, the board will determine if the client will be billed or the service cost will be noted as erroneous. Any appeals would go before the Board of Trustees.

Madison County Health Department Administrator Becky Hunt said, “The MCHD Board of Trustees and administration work very hard to be cost effective in service provisions, supplies and staffing needs. We are doing our best to be good stewards of the public monies we receive.”

If anyone has any questions or concerns, the Madison County Health Department Board of Trustees or Administrator Becky Hunt welcomes your comments, ideas and suggestions.

Health Department Board meetings are held at 3:30 p.m. on the fourth Tuesday of each month. The next scheduled meeting is February 22, 2011 at the health department, 806 W. College Ave.

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