01.08.13 boc agenda packet for ipad final

7/30/2019 01.08.13 BOC Agenda Packet for iPad Final

1/40

MACON COUNTY BOARD OF COMMISSIONERS

JANUARY 8, 2013

AGENDA

NOTE: Service awards for county employeeswill be presented beginning at 5:30 p.m.

1. 6:00 p.m. Call to order and welcome by Chairman Corbin2. Announcements3. Moment of Silence4. Pledge of Allegiance5. Public Hearing(s) Installment Financing Contract for

Improvements to Highlands SchoolNOTE: Consideration of the contract and other related matters willimmediately follow the public hearing

6. Public Comment Period7. Adjustments to and approval of the agenda8. Reports/Presentations

A. School Resource Officers Sheriff Robert HollandB. Update on Parker Meadows Recreation Project Seth Adams

and Mike Lovoy

9. Old BusinessA. Macon County Public Health FY 12-13 Billing and Collection

Policies and Fee Schedules Jim Bruckner, Public Health

DirectorB. QZAB Reimbursement Resolution

10.New BusinessA. Request from the Sky Valley/Scaly Mountain Volunteer Fire &

Rescue Department for relief fund money David KeyB. Resolution approving terms of loan modification Finance

Director


2/40

11.Consent Agenda Attachment #11All items below are considered routine and will be enacted by one motion. Noseparate discussion will be held except on request of a member of the Board ofCommissioners.

A. Minutes of the December 11, 2012 meetingB. Budget Amendments # 87-91C.Tax ReleasesD.Monthly Ad Valorem Tax Collection Report (no action necessary)

12.Appointments13.Closed session (if necessary)14.Adjournment/Recess

Upcoming Meeting Schedule

Essentials of County Government January 9-10, Asheville, NC Mid-Year Update Meeting Saturday, January 19 at 9 a.m. at the

SCC Macon Campus Conference Room

NCACC Legislative Goals Conference January 24-25, SheratonRTP in Durham County


3/40


AGENDA ITEM

MEETING DATE: January 8, 2013

DEPARTMENT/AGENCY: Governing Board

SUBJECT MATTER: Public Hearing on Installment Financing

Contract for Improvements to Highlands School

DEPARTMENT HEAD COMMENTS/RECOMMENDATION:

Please see the attached Notice of Public Hearing for more details. The

Finance Director can provide additional information at the meeting.

Consideration of the contract and any other related matters is scheduled for

immediately after the close of the hearing.

COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments ___X__ Yes ___ No

Agenda Item 5


4/40


5/40


AGENDA ITEM


DEPARTMENT/AGENCY: Sheriff

SUBJECT MATTER: School Resource Officers


Commissioner Beale has asked Sheriff Robert Holland to address school

safety issues as they relate to School Resource Officers (SROs)


Attachments _____ Yes __X_ No

Agenda Item 8A


6/40


AGENDA ITEM


DEPARTMENT/AGENCY: Parks and Recreation

SUBJECT MATTER: Parker Meadows Recreation Project


Macon County Parks and Recreation Director Seth Adams and Mike Lovoy

of Alliance Consulting Engineers will update the board on developments

regarding the proposed recreation park site and the related Parks and

Recreation Trust Fund (PARTF) grant application.


Attachments _____ Yes __X_ No

Agenda Item 8B


7/40


AGENDA ITEM


DEPARTMENT/AGENCY: Health

SUBJECT MATTER: FY 12-13 Billing and Collection Policies and Fee

Schedules


Please see the attached documents for more details. Health Director Jim

Bruckner will be available to provide information or to answer questions.

As you may recall, this item was removed from the December 11, 2012

Consent Agenda and tabled until this meeting.



Agenda Item 9A


8/40

MCPH Billing Guide FY 13 Effective July 1, 2012

MACON COUNTY

PUBLIC HEALTH

FY 12-13

Billing and Collection Policies

And

Fee Schedules

Effective July 1, 2012

Presented to and Approved by Board of Health on 06-26-2012

Presented to and Approved by Board of Commissioners on ____________


9/40


Page 2 12/6/2012

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 anemployee 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 inaccordance 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 theseservices. 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 andbalanced 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 directcosts plus indirect costs). Throughout the year, ongoing cost analyses are performed and fee schedules shallbe 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 rateand then adjusted according to the actual cost of the service. If there is no Medicaid rate then fees aredetermined through cost analysis. Cost analysis takes into account all of the resources associated withproviding a particular service and calculates the actual cost to provide that service. Cost analysis includesthe calculation of direct and indirect costs for services and then adding these figures together to determine theactual 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 otherresources consumed at the time of the service.

Calculating indirect costs: Indirect costs involve resources that are not directly consumed duringthe 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 equipmentand supplies, and recruiting and marketing expenses.

1 North Carolina General Statue 130A-39(g)


10/40


Page 3 12/6/2012

PAYMENT BY CONSUMER

Fees are charged for services and collected at the Health Center. See attachment for fee schedule.All fees are the responsibility of the patient, consumer or responsible party and may be subject to the slidingfee scale. No consumer will be refused services solely on their inability to pay for said services.All feesmay be paid by cash, check, or major credit card. Full payment is expected at the time of service.

Consumers will be informed of their account status at each visit. An itemized receipt will be provided toindividuals at time of payment. Fees for adult dental services will be collected before the service is rendered.Prepayment of co-pays for all services in which co-payments apply will be required and collected whenservices are rendered.

Fees will be charged to individuals in families with annual gross incomes exceeding specified levelsof a scale based on current Federal Poverty Income Guidelines. Verification of incomeand family size mustbe provided to determine a patients eligibility status. Verification (proof) of income may be provided forFamily Planning services; however, if the patient has no proof of income, the patients declaration of incomeshall be accepted and any charge shall be based on what he/she declares. Falsification of this informationwill permanently disqualify consumers 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. Ifincome cannot be verified at the time of screening, the charge for allservices except FamilyPlanningwill beat 100% pay. If verification of income is received within thirty days of a service, the charge will beretroactively adjusted to reflect percent pay based on verification received. Verification received after thirtydays 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 individualrefuses to provide information to verify income, they will not be eligible for the sliding feescale 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 areprovided at no cost to the consumer but may be billed to Medicaid or other third party agent. Separate feesmay be charged for drugs, supplies, laboratory services, X-rays and other technological services, ifappropriate. The costs of services performed by providers not affiliated with the Macon County PublicHealth Center are the responsibility of the patient/consumer. Fees may be charged or waived for educationalservices provided to individuals or groups, such as orientation, preceptorship, field training or classes.

Charges not eligible for sliding scale discount include:a. Environmental Health servicesb. Non-mandated immunization servicesc. 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). All bills will show totalcharges, as well as any discount that may have been provided. Arrangements may be made for payment planswhen required for good cause.

PAYMENT BY THIRD PARTY

Verification of enrollment under Medicare, Medicaid, insurance or other third party payment plan isrequired by presentation of a valid card at the time of service. The Health Center is required to bill onlyparticipating third party payers for services rendered. Services that are billed to third parties are billed at100% of the total charge with no discount applied. When the claim is returned from the third party payer alldiscounts are applied at that time. (i.e., any applicable sliding fee scale adjustment) For services rendered to


11/40


Page 4 12/6/2012

consumers with insurance where the Health Center is not a participating provider, the consumer will beresponsible for full payment of service when the service is delivered. The Health Center is currentlyparticipating with Medicaid, Medicare, Blue Cross Blue Shield, Crescent, Tri-care and NC Health Choice formedical services. The consumer is responsible for charges not covered by third party payers. Co-payamounts 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. Consumers with insurance in which MCPH is not participating provider.b. Consumers 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 consumers a monthly statement of fees that have been incurred andare due. Consumers are expected to make payment at the time services are rendered. If a balance is carriedforward consumers who have not made a payment on their account for any service(s) received from MaconCounty Public Health for 120 days shall be required to pay their past due balance before another service shallbe rendered (see Service Denial for further information).

The Health Center may use the following resources to pursue collection of patient accounts: billingstatements, past due notices, collection agencies or credit bureaus, and the NC Local Government DebtSetoff 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 theBOH and the BOCCs the amounts may be written off for accounting purposes if no further collection isanticipated. 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 aredetermined uncollectible (i.e. bankruptcy, death), will be written off permanently upon notification.

CONSUMER DONATION POLICY

A consumer may choose to make a donation to the agency. The consumer will never be asked tomake a donation, but if offered the donation is accepted. Donations are not required, and are not aprerequisite for the provision of any service. Billing requirements set out above in the Payment byConsumer section are not waived because of consumer donations. (ref: Donation Policy 101.9)

RETURNED CHECK POLICY

A $25.00 fee may be charged for a returned check written to Macon County Public Health (MCPH).The consumer will be notified via telephone, if possible, of the returned check. If a telephone number is notavailable, a written notification will be sent. All returned checks will be made good via cash, money order,and/or certified check. If a consumer has two returned checks within a one-year period, he/she will berequired 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


12/40


Page 5 12/6/2012

In the event that a consumer or other third-party has overpaid their responsible charges, the creditbalance is either: applied to future charges or refunded to the payer within thirty (30) days of discovery orrequest. 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 consumer. Individuals who do not meet programguideline criteria may be denied specific services. Consumers covered by Medicaid who fail to makerequired co-payments will not be denied services. Individuals who have not paid proper charges for previousservices (unless state and federal program rules prohibit services restriction or denial) may be required to payfees beforehand, be denied access to services (see Account Collections and Bad Debts), or be deniedsubsequent services pending demonstration of a good faith effort to make payment within the past ninety(90) days.

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 thoseservices mandated by North Carolina General Statues or approved in this plan will be provided to non-Macon County residents. If an individual moves out of Macon County, they must obtain services fromanother provider. Consumers 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 requirementsimposed 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 consumers with LEP are provided adequatelanguage 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 noteligible for sliding fee scale payment or third party billing. Exception: Colposcopies may be billed tothird 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 tothe 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


13/40


Page 6 12/6/2012

clients for these services as stated in Program Rules (exception Medicaid or other third party agentcan be billed with the patients permission).

Eligibility:

No residency or financial requirements

BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCCP)

Provides pap smears, breast exams and screening mammograms, assists women with abnormal breastexaminations/mammograms, or abnormal cervical screenings to obtain additional diagnosticexaminations.

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 livein the home.

WOMENS HEALTH

Provides limited health screening services (pap smears and/or breast exams) for women who do notmeet the qualifications of the NC BCCCP Program. Grant funds may be available to cover the cost ofrepeat 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 tothe 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 PrivateInsurances; Health Choice; Medicaid


14/40


Page 7 12/6/2012

Eligibility:

Residents of Macon County; Birth to 20 years; Residents of other surrounding NC Counties ifclient has Medicaid or Health Choice

IMMUNIZATIONS

Provide all required and recommended vaccines that are available for infants, school aged children andcollege bound individuals. Also provide a wide range of vaccines for adults to include foreign travelvaccinations. MCPH accepts some Private Insurances, Health Choice, Medicaid, and Medicare. Insome instances charges do not apply (e.g. state supplied vaccine). Sliding fee scale does not apply toimmunizations.

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 specialneeds that will allow them the maximum opportunity to reach their development potential. MCPHaccepts 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 beendiagnosed with developmental delay or disability, long term illness and/or social, emotionaldisorder 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 feescale; 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 andsources. Unless the information warrants, they will never be charged at 100% as this would beconsidered 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, be sent to collectionsor asked to meet with the Health Director due to a delinquent account.

MISCELLANEOUS/GENERAL SERVICES


15/40


Page 8 12/6/2012

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 toany service being rendered. Any additional fees associated with a visit will be added to theclients account and paid in full at checkout.

MATERNAL HEALTH

Prenatal care is medical care recommended for women during pregnancy. The aim of good prenatalcare is to detect any potential problems early, to prevent them if possible (through recommendations onadequate nutrition, exercise, vitamin intake etc), and to direct the woman to appropriate specialists,hospitals, etc. if necessary. Visits are monthly during the first two trimesters (from week one to week28 of pregnancy), every two weeks from 28 to week 36 of pregnancy and weekly after week 36 (untilthe 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 relatedservices. 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 educationservices to improve health status of target groups.

Eligibility: WIC is available to pregnant, breastfeeding, and postpartum women, infants, and childrenup 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 dentalservices to children from birth to 20 years of age.


16/40


Page 9 12/6/2012

Eligibility:

Resident of Macon County. Exception: Residents of other surrounding NC Counties if clienthas 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 orHealth 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 21years of age and above.

Eligibility:

Resident of Macon County. Exception: Residents of other surrounding NC Counties if clienthas 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 topromote health and prevent disease, disability and premature death through education-driven voluntarybehavior 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 theseprograms 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. Employeehealth services are available on a per program basis or under and annual contractarrangement. Individual program fees will vary and are based on salary expense to prepareand 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 foreach individual program. Comprehensive worksite wellness programs are available undercontract for organizations with at least 50 employees. This program, also known as the LIFEprogram, provides employee health screenings followed by customized programs andconsultation services to address the health needs of the employees. Fees for the LIFEprogram range from $30 to $50 per employee per year depending upon the cost to providethe services, the number of programs provided, as well as the organizations ability toprovide in-kind assistance.

CPR/AED and First Aid Training:


17/40


Page 10 12/6/2012

Various components of American Red Cross Standard First Aid and/or CPR/AED for layresponders are offered on-site at Macon County Public Healths location at Lakeside Drivein Franklin. Classes are offered for a fee approximately every month. The specificeducational components offered may vary from month to month to best suit the currentneeds 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 educationalcomponents 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 providedby a Registered Dietitian through American Diabetes Association approval/recognition. Theregistered dietitian is credentialed and a certified provider with Medicare, Medicaid andBCBS NC. For clients with these insurances, physician referral and medical diagnosis ofdiabetes the insurance will be billed and costs covered accordingly. For clients without theseinsurances a sliding fee scale based on annual gross income that is at or below 250% ofpoverty is used. The scale slides to a minimum discount of 20% in which the client isresponsible for payment to the health center prior to service being rendered.

MNT Services:

Macon County Public Health offers Medical Nutrition Therapy services provided by aRegistered Dietitian. The registered dietitian is credentialed and a certified providers withMedicare, Medicaid and BCBS NC. For clients with these insurances, physician referral andcovered medical diagnosis the insurance will be billed and costs covered accordingly. Forclients without these insurances a sliding fee scale based on annual gross income that is at orbelow 250% of poverty is used. The scale slides to a minimum discount of 20% in which theclient 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 CountyBuilding Inspections Department.

REFUND POLICY: Attached


18/40


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 FP Waiver Eligibility*

Partial-Pay Bracket Partial-Pay Bracket Partial-Pay Bracket

Family Federal Twenty Percent Forty Percent Sixty Percent

Size PovertyFrom20%

To39%

From40%

To59%

From60%

To79%

1 $10,890 $10,891 $14,974 $14,975 $19,058 $19,059 $20,147 $23,141

2 $14,710 $14,711 $20,226 $20,227 $25,743 $25,744 $27,214 $31,259

3 $18,530 $18,531 $25,479 $25,480 $32,428 $32,429 $34,281 $39,376

4 $22,350 $22,351 $30,731 $30,732 $39,113 $39,114 $41,348 $47,494

5 $26,170 $26,171 $35,984 $35,985 $45,798 $45,799 $48,415 $55,611

6 $29,990 $29,991 $41,236 $41,237 $52,483 $52,484 $55,482 $63,729

7 $33,810 $33,811 $46,489 $46,490 $59,168 $59,169 $62,549 $71,846

8 $37,630 $37,631 $51,741 $51,742 $65,853 $65,854 $69,616 $79,964

9 $41,450 $41,451 $56,994 $56,995 $72,538 $72,539 $76,683 $88,081

10 $45,270 $45,271 $62,246 $62,247 $79,223 $79,224 $83,750 $96,199

11 $49,090 $49,091 $67,499 $67,500 $85,908 $85,909 $90,817 $104,316

12 $52,910 $52,911 $72,751 $72,752 $92,593 $92,594 $97,884 $112,434

* at or below

185% of federal

poverty level


19/40


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 at12 month intervals. A clients percentage of pay is documented on the Financial Eligibility Application in

the clients medical record and in HIS.

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 oneeconomic unit. Individuals are considered members of a single family or economic unit when theirproduction of income and consumption of goods are related.An economic unit must have its own source of income.

Example: consumer 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 beconsidered a separate economic unit. For example, if two sisters and their children live in the same houseand both work and support their own children, they would be considered a separate household.

EXCEPTIONS TO ECONOMIC UNIT

A. For Family Planning service only.

B. Un-emancipated minors and others requesting confidential services will be considered afamily unit of one, and fees will be assessed based on their own income.

C. A foster child assigned by DSS shall always be considered a family of one.

Determination of Gross Income:

The dollar amounts represent gross annual income; they refer to total cash receipts before taxes from allsources.

Household income sources include: Salaries and wages, earnings from self-employment (deduct businessexpenses, except depreciation); interest income, all investment and rental income; public assistance,unemployment benefits, workers compensation, alimony and child support, military allotments; SocialSecurity benefits, VA benefits; retirement and pension pay; insurance or annuity plans; gaming proceedsand any other income not represented here that contributes to the household consumption of goods. Thislist 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 mustinclude the business name, address and phone number and must be legible.W-2 FormsUnemployment letter/noticeAward letter from Social Security Office, VA or Railroad Retirement Board1099s received from IRSFor Self-employment: Accounting records or income tax return for the most recent calendar year, entiretax return must be provided in order allow deductions for business expenses.


20/40


21/40


AGENDA ITEM


DEPARTMENT/AGENCY: Finance

SUBJECT MATTER: QZAB Reimbursement Resolution


Per the Finance Officer, the County Attorney is preparing this resolution and

will have it available at the meeting on Tuesday.


Attachments _____ Yes _X_ No

Agenda Item 9B


22/40


AGENDA ITEM


DEPARTMENT/AGENCY: Emergency Services

SUBJECT MATTER: Request from the Sky Valley/Scaly Mountain

Volunteer Fire & Rescue for relief fund money


Please see the attached reimbursement request from the Sky Valley-Scaly

Mountain Volunteer Fire and Rescue Department. Commissioner Tate has

asked Emergency Services Director David Key to attend the meeting to

explain and to answer questions.



Agenda Item 10A


23/40


24/40


AGENDA ITEM


DEPARTMENT/AGENCY: Finance

SUBJECT MATTER: Resolution approving terms of loan

modification


Please see the attached resolution regarding the second part of therefinancing of the BB&T loan, which will lower the interest rate from 4.59percent to 2.61 percent on an amount not to exceed $7.5-million. TheFinance Director can provide additional details at the meeting.



Agenda Item 10B


25/40

Resolution Approving Terms of Modification - Contract 9933002354-00003

formerly known as contract 003-1301030-012

WHEREAS, Macon County, North Carolina ("County") has determined to change theterms of the Payment Schedule to the Financing Agreement and Deed of Trust granted to F.Louis Loyd, III (the Deed of Trust Trustee) for the benefit of Branch Banking and TrustCompany (BB&T) dated as of July 18, 2008 (the Original Agreement) ; and

WHEREAS, the changes to the terms of the Payment Schedule include revising theinterest rate from 4.59% to 2.61% on an amount not to exceed $7,500,000 of the outstandingprincipal balance and BB&T waiving any application of the prepayment clause in Article III,Section 3.03 of the Financing Agreement and Deed of Trust;

NOW, THEREFORE BE IT RESOLVED by the governing body of Macon County,North Carolina that the proposed changes to the Payment Schedule of the Original Agreementset forth herinabove are hereby approved and the Chairman of the Macon County Board ofCounty Commissioners is authorized and directed to take such action as may be necessary toeffectuate such changes and the Clerk to the Macon County Board of County Commissioners isauthorized to attest to any signatures. The prepayment clause in Article III, section 3.03 of theFinancing Agreement and Deed of Trust is hereby waived as it relates to the modification. Allother terms and conditions of the Original Agreement and the Payment Schedule thereof remainin full force and effect.

Adopted this 8th day of January, 2013.

Attestation:

SEAL

_______________________________ ______________________________Clerk to the Board of County Commissioners Chairman of the Board of County CommissionersMacon County, North Carolina Macon County, North Carolina


26/40


AGENDA ITEM


DEPARTMENT/AGENCY: Governing Board

SUBJECT MATTER: Consent Agenda


A. Minutes Consideration of the minutes from the December 11th, 2012 meeting

per attachment 11A.

B. Finance Consideration of budget amendments #87 through #91 per attachment11B.

C. Tax releases Consideration of tax releases in the amount of $1,336.14 perattachment 11C. The supporting documentation is on file in the Deputy Clerksoffice.

D. Monthly Tax Collection Report For the boards information, the monthly advalorem tax collection report is attached as 11D. It does not require board action.



Agenda Item 11A-11D


27/40

Minutes12/11/12Page 1 of 7

MACON COUNTY BOARD OF COMMISSIONERSDECEMBER 11, 2012

MINUTES

Chairman Corbin convened the meeting at 6:03 p.m. All BoardMembers, the County Manager, Deputy Clerk, Finance Director, CountyAttorney, members of the news media and interested citizens werepresent.

ANNOUNCEMENTS: Commissioner Tate announced that the planning

board retreat with the county commissioners was set for Tuesday,February 21, 2013, beginning at 6 p.m., with staff to make arrangementsto hold the meeting at the Macon Bank Corporate Center.

MOMENT OF SILENCE: Chairman Corbin asked those in attendance toobserve a moment of silence.

PLEDGE TO THE FLAG: Led by Commissioner Higdon, the pledge tothe flag was recited.

PUBLIC HEARINGS: Chairman Corbin called the public hearing on the

Elderly Individuals and Individuals with Disabilities Program GrantApplication to order at 6:07 p.m., and recognized Macon County TransitDirector Kim Angel, who provided a brief overview of the so-calledSection 5310 program. She said that this would be a two-year granttotaling $355,500, with the county to provide a 50 percent match of$177,750. No one from the public signed up to speak, and ChairmanCorbin closed the public hearing at 6:13 p.m. He then opened the publichearing on the Macon County Community Transportation ProgramApplication at 6:13 p.m. and again recognized Mrs. Angel, who gave abrief description of the so-called Section 5311 program, pointing out itshuman service and public transportation aspects. She stated that this

one-year program calls for a total funding request of $307,431, of which$40,220 is the local match. No one from the public signed up to speak,and following questions from the board and comments from the CountyManager, Chairman Corbin closed the public hearing at 6:26 p.m. Upona motion by Commissioner Beale, seconded by Commissioner Tate, theboard voted unanimously to adopt the Public Transportation Program


28/40


Resolution as presented (Attachment 1), a copy of which is attached andis hereby made a part of these minutes. Upon a motion byCommissioner Tate, seconded by Commissioner Beale, the board votedunanimously to adopt the Community Transportation ProgramResolution as presented (Attachment 2), a copy of which is attached and

is hereby made a part of these minutes.

PUBLIC COMMENT: No one signed up to speak during the publiccomment period.

ADJUSTMENTS TO AND APPROVAL OF THE AGENDA: Upon a motionby Commissioner Beale, seconded by Commissioner Haven, the boardvoted unanimously to approve the agenda as adjusted, as follows:

To modify Item 10A under New Business as a Qualified ZoneAcademy Bond (QZAB) resolution, per the County Attorney.

To add consideration of authorizing the County Manager to enterinto an agreement with the North Carolina Department ofTransportation regarding McCoy Bridge as Item 10C under NewBusiness, per the County Manager.

To add consideration of authorizing the County Manager to enterinto a contract with Alliance Consulting Engineers to perform aPhase I environmental study and other related matters regardingthe proposed recreational park site located off Maxwell Home Roadas Item 10D under New Business, per the County Manager.

To authorize the submission of a Parks and Recreation Trust Fund(PARTF) grant application with regard to the proposed recreation

site as Item 10E under New Business, per the County Manager. To authorize the purchase of furniture for the new offices of the

Sheriffs Department as Item 10F under New Business, per theCounty Manager.

To hold a closed session for the purpose of preserving the attorney-client privilege under Item 13, per the County Manager.

To remove Item 11F, Macon County Public Health FY 12-13 Billingand Collection Policies and Fee Schedules, from the ConsentAgenda and to table that item until the January 8, 2013 regularmeeting.

To add discussion of a Georgia-based water study as item 10Gunder New Business, per Commissioner Haven.

To add Budget Amendment #78 to the Consent Agenda under Item11B, per the Finance Director.

PRESENTATION OF THE COMPREHENSIVE ANNUAL FINANCIALREPORT Erica Brown with Martin Starnes & Associates presented a


29/40


PowerPoint presentation on the highlights of the countys ComprehensiveAnnual Financial Report (CAFR) for the fiscal year ending June 30, 2012.She explained that the county had received an unqualified or cleanopinion from the firm, and she expressed her appreciation to the FinanceDirector and her staff. A copy of the CAFR and the accompanying

Compliance Letters are on file in the Deputy Clerks office. No action wasnecessary.

BOARD MEMBER COMMITTEE APPOINTMENTS: Chairman Corbindistributed a list of committee assignments for the board for 2013(Attachment 3), a copy of which is attached and is hereby made a part ofthese minutes. He also noted that Commissioner Haven would be addedas a liaison to the planning board.

NCDOT TRAFFIC LIGHT CONTROLLER PROJECT: EmergencyServices Director David Key explained that he was seeking approval of a

professional services agreement with J.M. Teague Engineering involvingthe installation of a traffic signal upgrade at the intersection of the US441 bypass and Hyatt Road, as that upgrade would provide foremergency vehicle preemption of the signal light for ambulances leavingthe EMS base. He said that the county had already invested $17,595 inthe project and that approximately $13,000 was needed to complete it.The County Manager noted it had taken more to approve and design theproject than to install it, but it would be an advantage for EMS personnelto have control of the signal light. Mr. Key took the board through ascenario involving how the preemption would work and recommendedcompleting the project. The County Manager said that the North

Carolina Department of Transportation (NCDOT) had been asked to payfor the signal upgrade but would not do so, adding that the additionalfunds could come from contingency. Upon a motion by CommissionerBeale, seconded by Commissioner Tate, the board voted unanimously toapprove an allocation of $13,148 from contingency to complete theupgrade, with Commissioner Beale specifically asking for documentationof a warranty.

RESOLUTION AND LEASE WITH FOREX CURRENCY TRADEADVISORS: Economic Development Director Tommy Jenkinsrecommended that the board renew a one-year lease with Forex Currency

Trade Advisors for space in the Small Business Center at the current rateof $333.33 per month. He noted that the lease will run from August 1,2012 through July 31, 2013. The County Attorney explained that he hadprepared a revised resolution and lease in regard to this, and upon amotion by Commissioner Haven, seconded by Commissioner Tate, theboard voted unanimously to approve a resolution declaring property to


30/40


be surplus and approving a one year lease of the same by Macon Countyto Forex Currency Trade Advisors, LLC. A copy of the resolution(Attachment 4) and lease (Attachment 5) are attached and are herebymade a part of these minutes.

RESOLUTION AUTHORIZING NEGOTIATION OF INSTALLMENTFINANCING CONTRACTS: The Finance Director explained that thecounty had been looking to go to the bond market to refinance some $16million in debt incurred in renovating East Franklin School and buildingthe MountainView Intermediate School. After contacting BB&T, she saidthe bank got creative and found a way to refinance the loan by dividingit into two parts. As the county can borrow up to $10 million per yearunder a qualified (tax-exempt) rate, she pointed out that Maconcurrently has $8.5 million in loan capacity, and that BB&T was willingto modify the rate on that amount from 4.59 percent to 2.61 percent thismonth, and then do the remainder in January of 2013. Over the life of

the 15-year loan, she said that the combined actions would result in thecounty saving more than $2.1-million. Following further discussion, andupon a motion by Commissioner Haven, seconded by CommissionerBeale, the board voted unanimously to adopt a Resolution ApprovingTerms of Modification (Attachment 6) as presented, securing the 2.61percent interest rate on $8.5 million of the outstanding principal balanceof the loan. A copy of the resolution is attached and is hereby made apart of these minutes.

QZAB RESOLUTION: Following discussion and upon a motion byCommissioner Beale, seconded by Commissioner Tate, the board voted

unanimously to approve a resolution authorizing the negotiation of aninstallment financing contract for $1.5 million for renovations toHighlands School using Qualified Zone Academy Bonds (QZAB) fundingand to hold a public hearing on this matter at the boards January 8,2013 regular meeting. A copy of the resolution (Attachment 7) isattached and is hereby made a part of these minutes.

SATISFACTION OF SECURITY INSTRUMENT: The County Managerexplained that the county was a secured creditor in a securityinstrument (a deed of trust) covering Community Development BlockGrant (CDBG) expenditures for rehabilitation repairs and modifications

to the residence of Marvin D. and Lillie R. Bryant, and that the note wasnow satisfied. He recommended release of the instrument by the county,and that recommendation was approved upon a motion by CommissionerBeale, seconded by Commissioner Higdon, and all favored. A copy of theSatisfaction of Security Instrument (Attachment 8) is attached and ishereby made a part of these minutes.


31/40


NCDOT AGREEMENT REGARDING MCCOY BRIDGE: The NorthCarolina Department of Transportation (NCDOT) had supplied the countywith a proposed agreement as to transfer of ownership and maintenancefor Bridge #172, known locally as the McCoy Bridge. Following some

background information from Commissioner Beale, and an outline of thespecifics of the agreement by the County Manager, Commissioner Bealemade a motion, seconded by Commissioner Tate, to accept the terms ofthe agreement and to transfer ownership and maintenance of the bridgeto the county, with the caveat of NCDOT providing signage for the bridge.A lengthy discussion regarding the actual amount of the maintenancecost ensued. The County Manager pointed out that NCDOTs first choicewas to tear down the bridge and replace it with a new one, but thatresidents of the Cowee Community wanted to save it and have a newbridge constructed nearby. Following continued discussion regardingpossible options, Commissioner Beale said the board needed to preserve

a piece of history, and called for a vote on the matter. The board voted4-1, with Commissioner Higdon opposing, to approve the agreement withNCDOT as presented (Attachment 9), a copy of which is attached and ishereby made a part of these minutes.

PHASE I ENVIRONMENTAL STUDY FOR RECREATION SITE: TheCounty Manager stated that Mike Lavoy, an engineer with AllianceConsulting Engineers, had provided the county with a preliminary layoutof a proposed recreation park at the former Parker Meadows Golf Course,and had submitted a proposal to perform the necessary due diligenceand grant administration for the project. For a total of $27,900 the

county would get a Phase I environmental site assessment, coordinationand administration of the Parks and Recreation Trust Fund (PARTF)grant, plus an environmental assessment and wetland survey. TheCounty Manager recommended that the county contract with Alliance forthese services, with the funds to come from contingency, with the CountyAttorney noting that the board could waive the requirement to advertisefor these services as the total was less than $30,000. CommissionerHigdon questioned the portions of the proposal that called for certaininformation to be provided by the owner, and said that municipal sewerwould be a must for the project, and that there were considerabledrainage issues at the site. There were also questions as to which

county ordinances, such as the high impact ordinance, applied to theproject. Upon a motion by Commissioner Beale, seconded byCommissioner Haven, the board voted unanimously to waive therequirement to seek proposals, authorize the county manager to enterinto a contract with Alliance Consulting Engineers in the amount of$27,900, and to move money from contingency to cover the cost. The


32/40


County Manager requested that the record reflect that the county wouldproceed with the PARTF application, and the board agreed.

FURNISHINGS FOR SHERIFFS OFFICE: The County Managerexplained that approximately $64,000 worth of mid-grade furniture was

needed to furnish the new sheriffs department offices on Patton Avenue,and he suggested that the funds be taken from contingency. Upon amotion by Commissioner Tate, seconded by Commissioner Beale, theboard voted unanimously to move no more than $64,000 fromcontingency for the furniture. The County Manager noted that theupcoming move by the North Carolina Drivers License office to thislocation would free up space in the countys Small Business Center.

At 8:10 p.m., Commissioner Beale was excused from the meeting, as hehad to travel to Raleigh.

WATER STUDY: Commissioner Haven expressed his concerns overinformation that he had received from the University of Georgia School ofForestry regarding a study of water resources in the county, saying thatsome of the studys suggestions were overbearing. He gave a packet ofinformation to Chairman Corbin for his review and Commissioner Havensaid that he had wanted to bring the matter up for discussion. No actionwas taken.

CONSENT AGENDA: Upon a motion by Commissioner Tate, secondedby Commissioner Haven, the following items on the consent agenda wereunanimously approved: Minutes Approved the minutes from the

November 13th, November 20th and December 3rd meetings. Budgetamendments Approved the following budget amendments: #74 forCooperative Extension to appropriate revenues and expenditures in theamount of $4,200 for Serve Safe classes; #75 for the Airport CapitalProject Fund to move $7,530 from contingency as a transfer to the fund,as the airport authority had received additional money for the apronimprovements project and this amount reflects the 10 percent match forthose funds; #78 for the Health Department to appropriate $4,167 inadditional money awarded by the state for the Immunization Action Plan.(Revisions with corresponding numbers attached.) Tax releases Approved tax releases in the amount of $192.75. (A computer printout of

releases is on file in the Tax Department and the County Managersoffice.) Monthly ad valorem tax collection report No actionnecessary. Change Order No. 1 on Swiss Colony Project Approved atime extension of 21 days on the project.


33/40


VOTING DELEGATE FOR LEGISLATIVE GOALS CONFERENCE: Upona motion by Commissioner Haven, seconded by Commissioner Higdon,the board voted unanimously to designate Chairman Corbin as theboards voting delegate for the upcoming Legislative Goals Conference.

CLOSED SESSION: At 8:26 p.m., and upon a motion by CommissionerHaven, seconded by Commissioner Tate, the board voted unanimously togo into closed session for the purpose of consulting with the attorneyunder G.S. 143-318-11(a)(3). At 9:44 p.m., and upon a motion byCommissioner Haven, seconded by Commissioner Higdon, the boardvoted unanimously to come out of closed session.

RECREATION SITE DUE DILIGENCE: Chairman Corbin explained thatthe county would be asking to extend the due diligence period on theproposed 48-acre recreation site by 30 days, and to ask for 15 daysbeyond the end of that period to close on the property, with the

understanding that the County Manager is authorized to terminate theagreement if the time is not granted or to sign an amendment if it is.Upon a motion by Commissioner Haven, seconded by CommissionerHigdon, the board voted unanimously to approve the request as stated bythe chairman.

CLOSE OUT OF IOTLA VALLEY ELEMENTARY SCHOOL PROJECT:The County Manager recommended that the board formally close out theIotla Valley Elementary School Project by authorizing a final payment of$55,781 to the architectural firm of Bowers, Ellis and Watson, and upona motion by Commissioner Tate, seconded by Commissioner Haven, the

board voted unanimously to do so by moving $55,781 from the projectscontingency fund. Chairman Corbin noted that the additional moneywas necessary due to additional time spent on the project as well asredesign work due to changes in the state building code.

ADJOURN: The County Manager reminded the board members ofvarious meetings that were scheduled to take place in January 2013, andhe also distributed information on the Community Service Block Grantprogram for their review. At 9:53 p.m., upon a motion by CommissionerHigdon, seconded by Commissioner Haven, the board voted unanimouslyto adjourn.

_____________________________ ______________________________

Jack Horton, County Manager Kevin CorbinClerk to the Board Board Chairman


34/40


35/40


36/40


37/40


38/40


39/40


40/40