031417wsa Agenda Package9:00am
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11:00 am
Harnett County Board of Commissioners
Work Session
Tuesday, March 14, 2017
9:00 am
Harnett County Emergency Services:
1) M.O.U. for the E .M .T . curriculum for Harnett Central High School
2) Specialty Teams Contract
3) Hazardous Materials Cost Recovery Ordinance
Revision to the Clinical Patient Fees, Eligibility and Bad Debt-Write Off Policy
Commissioner's Compensation Discussion
County Manager's Report:
1) March 20, 2017 Regular Meeting Agenda Review
2) Letter of Support for Outpatient Imaging Center, Cape Fear Valley and
Harnett Health CON application
3) CCCC Board of Trustee Appointee
4) Harnett Health System Board of Trustee Appointees
5) Brunswick Co. visit with Sheriff Coats
6) Shawtown Headstart Update
Closed Session
Adjourn
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Board Meeting
Agenda Item
MEETING DATE: March 20, 2017
TO: HARNETT COUNTY BOARD OF COMMISSIONERS
SUBJECT: MOU between County of Harnett and Harnett County Public School System
(EMT Curriculum)
REQUESTED BY: Jimmy Riddle, Emergency Services Director
REQUEST:
We would like to request approval for a MOU (Memorandum of Understanding) between
County of Harnett (Harnett County Emergency Services/EMS) and Hamett County Public
School System for the EMT (Emergency Medical Technician) curriculum offered at Hamett
Central High School.
This memorandum of understanding is from the Harnett County Public School System that
allows our agency to sponsor this program in order for it to operate. We have previously
completed a MOU for the fire curriculum but have not for the EMT curriculum. The school
system is behind because this program has already begun.
The effective date for this MOU will be April 1, 2017. This is an auto-renewal MOU.
This MOU has already been reviewed by our Legal Department.
FINANCE OFFICER'S RECOMMENDATION:
COUNTY MANAGER'S RECOMMENDATION:
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STATE OF NORTH CAROLINA
MEMORANDUM OF UNDERSTANDING
COUNTY OF HARNETT .
This Memorandum of Understanding ("MOU") is made and entered into this the~ day of
April 2017, by and between County of Harnett, a body politic, organized and existing under the
laws of the State of North Carolina with its administrative offices located at 102 East Front
Street, Lillington, North Carolina (hereinafter referred to as "County"), and Harnett County
Public School System (hereinafter referred to as "School System").
I. Purpose
School System offers various courses at Harnett Central High School ("HCHS"),
including the Emergency Medical Technology Program ("Program") with the
assistance and support of Harnett County Emergency Services ("HCEMS"). The
purpose of the Program is to offer enhanced career and technical education
opportunities and provide training for careers in emergency medical services in
Harnett County. This MOU is to identify the roles of this collaborative relationship in
Emergency Medical Technician training.
II. Responsibilities
1. School System
a. Provide a certified Level I EMT instructor.
b. Provide the necessary instructional facilities.
c. Provide the necessary instructional materials, supplies and equipment.
d . Provide insurance that will cover the students and instructor(s) in case of
accident or civil liability.
e. Submit requests in a timely manner for the use of HCEMS equipment when
the ability to obtain such equipment is cost prohibitive for HCHS.
f . Return all HCEMS equipment in the same working order as it was delivered
to HCHS. If for any reason there is damage to any equipment, or the
equipment failed to operate properly, it is the responsibility of HCHS to
notify a representative of HCEMS so that any deficiencies can be repaired.
g. Monetary responsibility for any damaged equipment due to intentional or
negligent acts by HCHS students and/or staff will be appraised and a
reimbursement agreement worked out between HCEMS and HCHS .
h. Train students to ensure they have a working knowledge of HAZMAT, Blood
Borne Pathogens, and HIPAA regulations prior to allowing students to
participate in clinical settings with HCEMS.
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2 . County
a. Provide a contact person(s) to serve as liaison between HCHS and HCEMS to
provide consultation and assist as available in technical expertise of the
program.
b. Provide train i ng to the HCHS instructor that is responsible for the EMT
curriculum to ensure he/she is familiar with HCEMS equipment and all safety
issues associated with such equipment.
c. Ensure that all HCEMS personnel have passed a background check and that
each employee's record is continuously monitored for any changes .
d . Ensure that the equipment is del ivered at an agreed upon time when notified
by HCHS of the need of equipment for practical training.
e. Contact HCHS as soon as possible to arrange the retrieval of equipment if an
emergency should arise requiring the equipment be returned to HCEMS .
HCEMS will make all efforts to provide HCHS sufficient notice and avoid
unannounced arrivals to retrieve the equipment.
f . Notify the HCHS instructor of any practical application training opportunities
for the instructor or volunteer opportunities for HCHS students. Examples
include student participation in HCEMS disaster drills and HCHS in structor
participation in profe ssional training for certification renewal s.
g. Coordinate with the HCHS instructor to obtain any necessary permis sions or
documentation for students to participate in program activities.
Ill. Termination
This agreement may be cancelled o r term inated without cau se by either party upon
30 calendar days advance written notice to the other party. Such notification shall
state the effective date of termination or cancellation and include any final
performance and/or payment invoicing instructions/requirements.
IV. Indemnification
School Syst e m shall and hereby agrees to indemnify and hold harmless County, its
officers, agents, and emp loyees from and again st all loss, cost, damage, expense,
and liability caused by accident or other occurrence resulting in bodily injury,
including death and disease to any person, or damage or destruction to property,
real or personal caused by th e negligent or reckles s acts or omissions of Sch o ol
Sy st em , its volunteers, employees, stud ents, o r agents.
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V . Compliance With Applicable Law
School System and County, each at their sole expense, shall comply with all laws,
orders and regulations of Federal, State and municipal authorities, and with any
direction of any public officer, pursuant to the laws which impose any duty upon
School System or County.
VI. Declaration of Applicable Law
This MOU shall be governed by, construed , and enforced in accordance with the
laws of the State of North Carolina.
VII. Waiver
Failure of either party to insist upon strict performance of any covenant or condition
of this MOU in any one way or more instances shall not be construed as a waiver for
the future of such covenant, but the same shall be and remain in full force and
effect.
VIII. Entire Agreement; Modification; Severability
This MOU contains the entire agreement between the parties and shall not be
modified in any manner except by an instrument in writing executed by the parties.
If any term or provision of this MOU or the application thereof to any person or
circumstance shall, to any extent, be invalid or unenforceable, the remainder of this
MOU, or the application of such term or provision to persons or circumstances other
than those to which it is held invalid or unenforceable, shall not be affected thereby
and each term and provision of this MOU shall be valid and shall be enforced to the
fullest extent permitted by law.
IN WITNESS WHEREOF, County and the School System execute this Memorandum of
Understanding by subscribing their names and affixing their seals to this instrument on the day,
month, and year above written.
County of Harnett
By:-----------
Name: -----------
Title:
Date: ------------
3
Harnett County Public School System :
By : -------------
Name: ------------
Title: -------------
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Board Meeting
Agenda Item
MEETING DA TE: March 20, 2017
TO: HARNETT COUNTY BOARD OF COMMISSIONERS
SUBJECT: Specialty Team Agreement between Harnett County Chiefs Association and
the County of Harnett .
REQUESTED BY: Jimmy Riddle, Emergency Services Director
REQUEST:
We would like to request approval for the Specialty Team Agreement between Hamett
County Chiefs Association and the County of Harnett.
This agreement is to ensure supplemental funding provided by the County of Harnett to the
Harnett County Chiefs Association in support of training, equipping and maintaining the
Specialty Teams. This funding will offset some of the expenses that the Chief's Association
Specialty Teams incur each year. These teams consist of the following: Dive Team, Search &
Rescue Team and Trench/Confined Space Team. This agreement also ensures that these
teams are trained and meet all certifications/qualification requirements to operate/respond
within Hamett County and the State of North Carolina.
We are requesting for budget FYl 7-18 funds in the amount of $10,000.00 .
The effective date for this Agreement is July 1, 2017. This is an auto-renewal Agreement.
This Agreement has already been reviewed by our Legal Department.
FINANCE OFFICER'S RECOMMENDATION:
COUNTY MANAGER'S RECOMMENDATION:
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Specialty Team Agreement
This Specialty Team Agreement ("Agreement") is made and entered into on this the~ day of July 2017,
by and between the Hamett County Fire Chiefs Association (hereinafter referred to as "Association"), and
the County of Hamett (hereinafter referred to as "County").
WITNESS ETH
WHEREAS, the parties understand that it is of vital importance and public good to ensure the
safety and well-being of all persons;
WHEREAS, the parties agree that it is a necessary public service for County to provide sufficient
funding to protect the Hamett County community in the case of an emergency situation;
NOW, THEREFORE, the parties have hereto mutually agreed to the terms of this agreement as
hereinafter set forth:
1. Purpose: This Agreement is established to ensure supplemental funding provided by County to
the Association in support of training, equipping and maintaining the Specialty Teams. This
Agreement assures that all Specialty Teams, which for the purposes of this agreement include
Special Tactics And Rescue ("ST AR"), Search and Rescue , and Dive Teams, are trained and meet
all certification/qualification requirements to operate/respond within Hamett County and the State
ofNorth Carolina.
2. Obligations of Parties to this Agreement:
a. The Association will provide County a quarterly report on current team certifications and a
proposed training calendar.
b. The Association will ensure that all Specialty Teams have completed, met, and/or
exceeded all necessary and /or required training, qualifications, and certifications required
by all laws, orders, and regulations of federal , state, and municipal authorities.
c. Supplemental funding may be utilized to employ a part-time Specialty Team Manager.
This individual will not be an employee of County and will be employed by the
Association . County will agree to provide office space for the Specialty Team Manager.
Association will provide County with a job description of the Specialty Team Manager's
position. The job description must be detailed to ensure all requirements are met.
3. General Specialty Team Requirements: In addition to the Specific Specialty Team
Requirements listed below in Paragraph 4, all Specialty Teams and their members must:
a. Meet or exceed all qualifications and certifications required by the State, and in some cases
Federal certifications, as well as orders and regulations of federal , state, and municipal
authorities ; .
b. Maintain a well-defined and multi-layered Chain of Command with key leadership
positions. The key leadership positions must be backed up with an alternate individual who
can operate in the absence of the Team Chief;
c. All Team Chiefs, including the alternates in the absence of the Team Chief, must ensure
the availability of a minimum level of staffing at all times to ensure prompt response to
any emergency, at any time , in any weather;
d. Employ or retain a Training Officer who understands all necessary qualifications and
certifications for their particular Specialty Team and will ensure that all team members
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meet or exceed those qualifications and certifications. The Training Officer must ensure all
training requirements, including continuing education, are met;
e. Ensure that all Specialty Team certification training is conducted by a certified instructor
and is relevant to the qualifications and certifications required. Other miscellaneous
training may be conducted by any Emergency Services personnel;
f. All training announcements must be published in a timely manner to ensure maximum
participation. Scheduled training will not be canceled unless there are extreme
circumstances that would preclude the class from being conducted. Team Leaders must
identify more than one instructor capable of conducting training. If team members are
identified as instructors and assume the responsibility of instructing a class, they must
identify an alternate instructor to ensure the class is conducted.
g. All team courses conducted must be relevant to team qualifications/certifications. Team
Chiefs, with the guidance of the team Training Officer, will develop a training plan for all
qualifications/certifications for that specific team position;
h. Team training schedules that detail the course and instructor must be published quarterly
and copies provided to the Association;
i. Notify County and Association when a Specialty Team is unable to operate for any reason;
j. Submit any and all equipment needs to the Association President to be brought before the
Association's Board of Directors prior to purchase or entry into a purchase agreement;
k. Utilize the Incident Command System and appoint a Safety Officer when active and
engaged in emergency response;
I. Comply with all Association policies and procedures, including, but not limited to,
Association's Joint Standard Operating Guidelines ("SOGs") developed by the various
fire/rescue departments of Hamett County ("Departments")Departments, and individual
host department SOGs;
m. Departments assuming the responsibility for a Specialty Team assume all responsibility for
the team , to include management, training, Standard Operating Guide development and
recruitment of team members. County and Association must be notified immediately when
a team can no longer function due to lack of personnel or certifications, or the Departments
can no longer maintain and manage the team ;
n. When Specialty Teams have been activated and are engaged in an operational response, all
operations will be conducted utilizing the Incident Command System, to include the
appointment of a Safety Officer. All team members will abide by County's Social Media
policy, to include no photography of active response scenes; and
o. Comply with all of the covenants, terms , conditions, provisions, and undertakings present
in this Agreement.
4. Specific Specialty Team Requirements: The following requirements are based on the individual
team and minimum training requirements to operate in County. The Team Chiefs and Training
Officers will be responsible for scheduling and tracking training and certifications.
a. Search & Rescue Team Requirements:
i. Planning Team Members: A minimum of 4 team members must have completed
the following courses and certifications provided by the North Carolina Division of
Emergency Management ("NCEM") or the National Association for Search &
Rescue ("NASAR") to be considered fully trained and prepared for any emergency,
at any time, in any weather:
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1. NCEM Entry Level Search & Rescue Course
2. NCEM Field Team Certification or NASAR SARTECH II Certification
3. NCEM Field Team Leader Training
4. Managing Land Search Operations Course
5. Lost Person Behavior Course
ii. Ground Search Personnel: A minimum of 12 team members must have completed
the following courses and certifications provided by NCEM or the NASAR to be
considered fully trained and prepared for any emergency, at any time, in any
weather:
1. NCEM Entry Level Search & Rescue Course
2. NCEM Field Team Certification or NASAR SAR TECH II Certification
3. NCEM Field Team Leader Training
b. Dive Team Requirements:
i. General Dive Team Member Requirements: In addition to any Dive Team Leader
being a certified Rescue Diver, all Dive Team Members, regardless of active or
inactive status, must:
1. Have obtained the Open Water and/or Scuba Diver level;
2. Attend quarterly, if not monthly, training sessions conducted by the Dive
Teams Training Officer which is to include an active dive component; and
3. Strive to attain, through the use of continuing education opportunities, the
Rescue Diver level
ii. Rescue/Recovery Dive Team Minimum Personnel Requirements: A minimum of
Six (6) individuals should comprise this team. These individuals are to include:
1. 2 Divers
2. 2 Shore Tenders
3. 1 Backup Safety Diver
4. 1 Dive Operator
iii. Evidence Recovery Dive Team Minimum Personnel Requirements: A minimum of
Four (4) individuals should comprise this team. These individuals are to include:
1. I Diver
2. 1 Shore Tender
3. 1 Backup Safety Diver
4. 1 Dive Operator
c. STAR Team Requirements: A minimum of 8 ST AR Team Members must be fully
trained and prepared for any emergency, at any time, in any weather. All STAR Team
Members must:
i. Meet all minimum training and equipment standards for trench, high angle, rope ,
and confined space operations;
ii. Attend monthly training and quarterly active drill sessions, which include skill set
scenarios for trench operations, high angle operations, and confined space
operations; and
iii. Complete an annual trench , confined space, and high angle training exercise.
5. Insurance: The Association covenants and agrees that it shall, at its sole expense, obtain and keep
in force the following minimum insurance coverage:
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a. Workers' Compensation: Coverage for all paid and volunteer workers meeting the
statutory requirements of The North Carolina Workers' Compensation Act, North Carolina
General Statutes§ 97.
b. Commercial General Liability: Bodily injury and property damage liability as will
protect the Provider from claims of bodily injury or property damages which arise from
operations of this Agreement. The amounts of such insurance coverage shall not be less
than $2,000,000.00 per occurrence and $3,000,000.00 aggregate coverage. This insurance
shall include coverage for completed operations/products liability, personal injury liability
and contractual liability.
c. Commercial Automobile Liability: Coverage shall be with limits no less than
$1,000,000.00 per occurrence for bodily injury and property damage for any vehicle used
during performance of contract services, including coverage for owned, hired, and non-
owned vehicles. Evidence of commercial automobile coverage is only necessary if vehicles
are used in the provision of services under this Agreement.
d. Proof of Insurance: Association shall furnish County all certificates of insurance
evidencing the above coverages.
e. Additional Insured: County and its employees shall be named as an additional insured on
all policies of insurance, except workers' compensation, specified above.
6. Indemnification: The Association shall and hereby agrees to indemnify and hold harmless
County, its officers, agents, and employees from and against all loss, cost, damage, expense, and
liability caused by accident or other occurrence resulting in bodily injury , including death and
disease to any person, or damage or destruction to property, real or personal , arising directly or
indirectly from operations, products, or services rendered or purchased under this Agreement. This
includes holding County harmless from any and all liability and expenses, including attorney's
fees, court costs, and other costs incurred by County caused by the negligent acts or omissions of
the Association, the Specialty Teams, its volunteers, employees, or clients.
7. Compliance With Applicable Law: County, at its sole expense, shall comply with all laws,
orders and regulations of federal , state, and municipal authorities, and with any direction of any
public officer, pursuant to the laws which impose any duty upon County.
8. Declaration of Governing Law: This Agreement shall be governed by, construed, and enforced
in accordance with the laws of the State of North Carolina.
9. Waiver: Failure of either party to insist upon strict performance of any covenant or condition of
this Agreement in any one or more instances shall not be construed as a waiver for the future of
any such covenant or condition, but the same shall be and remain in full force and effect.
10. Binding Effect: The covenants, terms, conditions, provisions and undertakings in this
Agreement, or in any renewals thereof, shall extend to and be binding upon the heirs , executors,
administrators, successors and assigns of the respective parties hereto as if they were in every case
named and expressed; and , wherever reference is made to either of the parties hereto , it shall be
held to include and apply also to the heirs, executors, administrators, successors and assigns of
such party, as if in each and every case so expressed.
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11. Entire Agreement; Modification; Severability: This Agreement contains the entire agreement
between the parties and shall not be modified in any manner except by an instrument in writing
executed by the parties. If any term or provision of this Agreement or the application thereof to
any person or circumstance shall, to any extent, be invalid or unenforceable, the remainder of this
Agreement, or the application of such term or provision to persons or circumstances other than
those to which it is held invalid or unenforceable, shall not be affected thereby and each term and
provision of this Agreement shall be valid and shall be enforced to the fullest extent permitted by
law.
12. Non-Appropriate Clause: Association acknowledges that County is a governmental entity and
the validity of this Agreement is based upon the availability of public funding under the authority
of its statutory mandate. In the event that public funds are not available and not appropriated for
the performance of County's obligations under this Agreement, then this Agreement shall
automatically expire without penalty to the County thirty (30) days after written notice to
Association of the non-appropriation of public funds.
13. Iran Divestment: Pursuant to § 14 7-86.59 of the North Carolina General Statutes, any person
identified as engaging in investment activities in Iran, as determined by appearing on the Final
Divestment List created by the State Treasurer pursuant to§ 147-86.58 of the North Carolina General
Statutes, is ineligible to contract with the State of North Carolina or any political subdivision of this
State. Pursuant to the requirements of the Iran Divestment Act of 2015 , Association does hereby
certify to the following:
a. That Association is not identified on the Final Divestment List of Entities that the State
Treasurer determined to be engaged in investment activities in Iran;
b. That Association shall not utilize on any contract with the State agency any subcontractor
that is identified on the Final Divestment List; and
c. That the undersigned is authorized by Association to make this Certification.
14. E-Verify Compliance: Association certifies that they and their subcontractors comply with the
requirements of Article 2 of Chapter 64 of the North Carolina General Statutes.
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IN WITNESS WHEREOF, the parties hereto, through their duly authorized representatives or
officers, have executed this Agreement as to the date and year first above written.
. . . ........ .
I I I I ..
COUNTY OF HARNETT
By:
Joseph Jeffries, County Manager
By:
Jimmy Riddle, Director
Harnett County Emergency Services
HARNETT COUNTY FIRE CHIEF'S ASSOCIATION
By:
Justin Riewestahl, President
THIS INS RUMENT HAS BEEN REVIEWED
Y E F NANCE OFFICER
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NORTH CAROLINA
COUNTY OF HARNETT
I, , a Notary Public , of the County and State afore~i~. ~ertify t t ~
Joseph Jeffries, who being by me duly sworn , says that he is the County Maria~ . '~ ~ ett if;jj
County, and that said instrument was signed by him as County Manager of saia Co~11ty ; a nd ...
the said Joseph Jeffries, County Manager of Harnett County, acknowledged said instrtuncnt~oe
the act and deed of Harnett County, North Carolina.
Witness my hand and Notarial Seal, that the _ day of ____ , 2017.
________ Nota,y Public
My Commission Expires: ________ _
NORTH CAROLINA
COUNTY OF HARNETT
I, , a Notary Public, of the County and State aforesaid, certify that Justin
Riewestahl, who being by me duly sworn, says that he is the President of the Harnett County Fire
Chiefs Association, and that by authority duly given and as the act of the Association, the
foregoing instrument was signed in its name by its P.resident.
Witness my hand and Notarial Seal, that the_ day of ____ , 2017.
________ Notary Public
My Commi ssion Expires: ________ _
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Board Meeting
Agenda Item
MEETING DATE: March 20, 2017
TO: HARNETT COUNTY BOARD OF COMMISSIONERS
SUBJECT: Hazardous Materials Response Cost Recovery Ordinance for Harnett
County
REQUESTED BY: Jimmy Riddle, Emergency Services Director
REQUEST:
We would like to request approval for the updated Hazardous Materials Response Cost
Recovery Ordinance for Harnett County.
Harnett County currently has a 1991 version of this ordinance that was very poorly written
and when any of our departments try to recoup expenses related to hazardous materials
incidents they are denied based on the incompleteness of this current ordinance. This updated
ordinance takes care of all the loop holes and has a cost recovery schedule outlined and it is
in accordance with current F.E.M.A. rates .
This updated ordinance provides the recovery of expenses incurred by Hamett County Fire
Departments including, but not limited to, departments contracted by County of Hamett, in
responding to an emergency substances or materials incident in accordance with N.C.G.S.
166A-27.
This updated Ordinance has already been reviewed by our Legal Department.
FINANCE OFFICER'S RECOMMENDATION:
COUNTY MANAGER'S RECOMMENDATION:
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HAZARDOUS MATERIALS RESPONSE COST RECOVERY ORDINANCE
HARNETT COUNTY
An ordinance to provide for recovery of expenses incurred by Harnett County Fire
Departments including, but not limited to, departments contracted by County of Harnett
("County"), in responding to an emergency hazardous substances or materials incident in
accordance with N.C.G .S. 166A-27.
THE COUNTY OF HARNETT HEREBY ORDAINS:
Section 1. Findings and Purpose.
County finds that a potential exists for responses to incidents involving the release or
threatened release of hazardous substances and/or materials. Such incidents create a great
likelihood of personal injury or property damage. The control and abatement of such incidents
places a significant financial and operational burden upon the fire departments, rescue and
emergency medical services, along with other department support resources . County finds that
it is necessary to adopt an ordinance to establish the liability for such incidents and to e stablish
a policy and methods which will allow the Fire Department to seek recovery of the
department's costs associated with emergency responses to hazardous substances and/or
materials incidents.
Section 2. Definitions.
Compressed Gas shall mean any material regulated as a compressed gas by the United States
Department of Transportation through regulations found in 49 CFR, Section 173.115.
Contract Agency shall mean any fire department that has an active contract with Harnett
County for fire or rescue protection.
Cost Recovery Schedule shall mean recovery of costs in accordance with F.E.M .A.
reimbursement schedule for 2015 .
County shall mean any and all Harnett County, North Carolina departments, agencies and
contract agencies of Harnett County including, but not limited to, local fire departments which
maintain a contract with Harnett County for emergency services.
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Emergency Response shall mean the providing, sending and/or utilizing of firefighting,
emergency medical and rescue services by a fire department or by a private industrial entity,
corporation or other assisting government agency operating at the request or direction of
County, for an incident resulting in a hazardous substances and/or materials release,
threatened release, or the clean up or abatement of same.
Expenses of an Emergency Response shall mean the d irect and reasonable costs incurred by
the fire department, or by a private person, corporation or other assisting government agency,
which is operating at the request or direction of County, when making an emergency response
to the hazardous substances and/or materials incident, including the costs of providing
firefighting, rescue services, emergency medical services, containment storage, cleanup and
abatement of all hazardous conditions at the scene of the incident. The costs further include all
salaries and wages of fire department personnel responding to the incident, salaries and wages
of County personnel engaged in the investigation, supervision and report preparation regarding
said incident, all salaries and wages of personnel of assisting government agencies operating at
the request or direction of County, and all costs connected with the administration of the
incident relating to any prosecution of the person(s) responsible, including those relating to the
production and .appearance of witnesses at any court proceedings in relation thereto. Costs
shall also include such items as disposable materials and supplies used during the response to
said incident, rental or leasing of equipment used for the specific response, replacement of
equipment which is contaminated beyond re-use or repair during the response to said incident,
special technical services and laboratory cost, and services and supplies purchased for any
specific evacuation relating to said incident.
Hazardous Substances and Materials shall include, but are not limited to, a chemical that is a
combustible liquid, a flammable gas, explosives, flammables, oxidizing material, pyrophoric,
unstable reactive or water reactive, radioactive, petroleum, petroleum products, gase s, or
poisons, and shall include all those materials and amounts that are designated to require a
Regional Response Hazmat Team ("RRT") response.
Owner shall mean any person having a vested or contingent interest in the premises, real
property, personal property, container or vehicle involved in the hazardous substances and/or
materials incident including, but not limited to, any duly authorized agent or attorney,
purchaser, devisee or fiduciary of said person having said vested or contingent interest.
Oxidizing Material shall mean any material regulated as an oxidizing material by the United
States Department of Transportation through regulations found in 49 CFR, Section 173 .127.
Person shall mean individuals, trusts, estates, groups, agencies, firms, joint ventures,
partnerships, corporations, clubs and all associations or organizations of natural person s, either
incorporated or unincorporated, howsoever operating or named , and whether acting by
themselves or by a servant, contractor, employee, agent or fiduciary, and includes all legal
representatives, heirs, successors and assignees thereof.
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Poison shall mean any liquid or gas that is life-threatening when mixed with air in small
amounts, and shall also include all those materials regulated as poison class A by the United
States Department of Transportation through regulations found in 49 CFR, Section 173 .132.
Premises shall mean any lot or parcel of land within Harnett County.
Radioactive Material shall mean any material required by the United States Department of
Transportation to have Type A packaging or other special protection or closed transport
vehicles under regulations found in 49 CFR, Section 173.403.
Release shall mean any spilling, leaking, pumping, pouring, emitting, emptying, discharging,
injecting, escaping, leaching, dumping or disposing of a hazardous substance or material into
the environment, or the abandonment or disposing of barrels, containers or other closed
receptacles containing a hazardous substance or material. "Release" does not include a
discharge permitted by State or Federal law.
Responsible Party shall mean the owner, operator, occupant or other person responsible for
the operation, maintenance and/or condition of any building, premises, property or vehicle
where an incident arises which involves the release or threatened release of hazardous
substances and or materials on or about said building, premises, property and/or vehicle .
Threatened Release shall mean any imminent or impending event potentially causing, but not
resulting in, a release which causes County to undertake an emergency response.
Vehicle shall mean any mode which is used as an instrument of conveyance including, but not
limited to, motor vehicles, railroads, boats, aircraft, etc.
Section 3. Hazardous Substances or Materials Incidents Policy
A. In the event that County employees or contracted agencies of County are dispatched to
a hazardous substances and/or materials incident, County employee and/or contract
agency in charge shall notify the responsible parties, including appropriate Federal,
State and local agencies, as soon as possible . County personnel shall make every effort
to limit County's action to those reasonably necessary to address dangers from fire, the
imminent threat of fire, or the imminent threat from any hazardous substances or
materials, and necessary evacuation of affected persons.
B. Except for procedures necessitated by fire or the imminent threat of fire resulting from
a hazardous substances or materials incident, County officials are not authorized to
incur any obligations, financial or otherwise, to County in regards to the mitigation of
impacts resulting from a hazardous substances and/or materials incident.
C. All County personnel shall take appropriate steps for a hazardous substances and/or
materials response that conform to their level of training, and as appropriate given the
3
031417wsa HC BOC Page 17
supplies and equipment available to them, in accordance with established protocols and
procedures.
Section 4 . Liability for Expense of an Emergency Response.
A. The responsible party shall be required to reimburse County or any contract agency for
County for all costs and expenses of an emergency response to said hazardous
substances and/or materials incident.
B. The expense of an emergency response shall be a charge imposed upon the responsible
party under this Ordinance . The charge constitutes a debt of that responsible party and
is collectable by County in the same manner as an obligation under contract, express or
implied.
C. The County Board of Commissioners may by resolution adopt a schedule of the costs
included within the expense of an emergency response. This schedule shall be available
at the office of the Clerk to the Harnett County Board of Commissioners for inspection
by the public during regular office hours.
D. County may within ten (10) days of receiving itemized costs, or any part thereof,
incurred for an emergency response, submit a bill for these costs by registered or
certified mail, return receipt requested, or personal service to the responsible party for
the expenses as enumerated under this ordinance. The bill(s) shall require full payment
within thirty days from the date of mailing or service of said bill upon the responsible
person .
E. Contract agencies shall conduct all of their billing and recovery actions under their
agencies financial and equipment procurement processes.
F. Any failure by the responsible party to pay said bill within thirty (30) days of mailing or
service of the bill shall constitute a default on said bill. In case of default, County shall
have the right and power to add all response costs to the tax roll of such property
involved in the hazardous substances and/or materials incident, and to l evy and collect
such costs in the same manner as provided for the levy and collection of real property
taxes against said property or premises. County shall also have the right to bring action
in the Superior Court of Harnett County to collect said costs if County deems such action
to be necessary.
Section 5. Conflict with State or Federal Law.
Nothing in this ordinance shall be construed to conflict with State or Federal laws requiring
persons responsible for or causing a release or threatened release from engaging in
remediation activities or paying the cost thereof, or both.
Section 6. Nonexclusive Remedy .
The remedies provided by this Ordinance shall be in addition to any other remedies available in
equity or at law and such penalties as provided by law or ordinance .
4
031417wsa HC BOC Page 18
Section 7. Repeal.
All pre-existing ordinances or parts of ordinances in conflict with this Ordinance are to the
extent of such conflict hereby repealed .
Section 8. Severability
If any section, subsection, clause, paragraph or provision of this Ordinance is held invalid by a
court of competent jurisdiction, such judgment shall only apply to the said portion thereof held
invalid, and the full remaining portions or parts of this Ordinance shall remain in full force and
effect.
Section 9. Effective Date.
This Ordinance shall become effective immediately upon adoption by the Harnett County Board
of Commissioners.
Hazardous Materials Cost Recovery Schedule
Description
Engine with personnel
Tanker with personnel
Heavy Rescue with personnel
Aerial Device with personnel
Support Vehicle (Service, Brush) with personnel
Ambulance
Emergency Management Vehicle with personnel
Materials Used
Equipment Damage
Footnotes:
1) Ambulance is based on standby for emergency responders.
2) Rates based on 2015 FEMA reimbursement schedule rates.
3) Personnel rates based on$ 20.00 per hour per responder.
4) Minimum of 1 hour but billed in 15 minute increments after the first hour.
5
Cost Rate
$160.00 per hour
$160.00 per hour
$160.00 per hour
$220.00 per hour
$120.00 per hour
$ 80.00 per hour
$100.00 per hour
Replacement cost + shipping costs
Based on Repair Costs
031417wsa HC BOC Page 19
A RESOLUTION OF THE COUNTY OF HARNETT, NORTH CAROLINA,
ADOPTING AN ORDINANCE ENTITLED
"HAZARDOUS MATERIALS AND SUBSTANCES ORDINANCE OF
HARNETT COUNTY, NORTH CAROLINA"
THAT WHEREAS, the North Carolina General Assembly, pursuant
to N.C.G.S. 143-215.82 and other relevant provisions of law, has
given counties local authority in the prevention and control of
oil and other hazardous substances discharged into sewers or
disposal systems; and
WHEREAS, pursuant to N.C.G.S. 153A-l40 and other relevant
provisions of law, counties have the authority to remove, abate
or remedy a condition dangerous or prejudicial to the public
health or public safety and enforce payment of the costs of so
doing; and
WHEREAS, at the present time the State of North Carolina
and its various departments do not have the ability to reimburse
the County of Harnett for certain costs involved in the abatement
and removal of hazardous materials which are emitted into the
environment:
THEREFORE, BE IT RESOLVED AND ORDAINED that an ordinance entitled
"Hazardous Material and Substance Abatement Ordinance of Harnett
County, North Carolina" is hereby adopted to read as follows:
HAZARDOUS MATERIAL AND SUBSTANCE ABATEMENT ORDINANCE OF
HARNETT COUNTY, NORTH CAROLINA
Sec. 1. Purpose and Authority. The District Fire Chief of
any fire department providing fire protection services
within any duly established fire protection district or
special service district within Harnett County, or his
designee, shall have the authority to summarily abate,
remedy or remove any threat from hazardous materials which
are emitted into the environment in such a manner as to
endanger the health or safety of the general public or the
environment. Any such District Fire Chief or his designee
shall have the authority to enter public or private
property, with or without the owner's consent, to respond
to such hazardous materials threats and emergencies. Such
District Fire Chief or his designee shall determine t h e
type, amount and quantity of equipment, materials and
personnel required to adequately abate and remedy any a nd
all threats from hazardous materials which are emitted into
the environment.
Sec. 2. Definitions.
031417wsa HC BOC Page 20
Ca) Hazardous Materials. Any substance which, when
discharged in any quantity, may present an eminent and
substantial danger to the public health or welfare or
to the environment.
(b) Having Control~-Shall mean, but not be
limited to, any person using, transferring, storing or
releasing hazardous materials on to lands or into the
air or waters within the County of Harnett.
Cc) Hazardous Material Response. The sending of
equipment, materials or personnel of or by any Fire
Department to abate or remove hazardous materials
which endanger the health or safety of persons or the
environment.
Cd> Person.
partnerships,
corporations,
agencies.
Includes individuals, firms,
associations, institutions,
local governments and governmental
Sec. 3. Responsibility;~ and Charges. Any property
owner and/or the person(s) exercising control over
hazardous materials that create a hazardous materials
threat or emergency shall be financially liable to the
District Fire Department and any other entity incurring
costs and expenses at the request or direction of or in aid
to such District Fire Department for any and all costs and
expenses incurred during or in connection with any such
threat or emergency. Said property owner and/or the
person(s) exercising control over such hazardous materials
shall assist such District Fire Department in abatement,
removal and remedial measures associated with any such
hazardous materials threat or emergency. Assistance shall
consist of but not be limited to any or all of the
following:
Ca) Compliance with the directions of the District
Fire Department.
Cb) Supplying emergency response plan information for
the subject site.
Cc) Supplying emergency response equipment, personnel
and materials available on site.
Sec. 4. All charges for any hazardous materials emergency
response on behalf of the County of Harnett or by any
District Fire Department shall be based upon a schedule to
be approved by the County Manager which shall be kept on
file for public inspection in the office of the Chief of
each District Fire Department within the County of Harnett.
031417wsa HC BOC Page 21
sec. s. Payment of Charges. (a) Any charge assessed
pursuant to any provision of this ordinance which does not
exceed $300.00, shall be payable within thirty (30> days of
the assessment thereof by the Chief of the District Fire
Department in question, or his designee, which assessment
shall be in writing and delivered to the responsible party
as above set forth by personal delivery, or by certified
mail. Any charge in excess of $300.00 for a violation of
this ordinance, shall be payable within a period of time as
determined by the Chief of the District Fire Department in
question, subject to the approval of the Harnett County
Manager; provided that if the responsible party as above
determined is not agreeable to such time period, the
responsible party shall have ten days to appeal the
decision of said District Fire Chief to the Harnett County
Board of Commissioners in writing, whereupon the matter
will be placed on the agenda for the next regular meeting
of such Board for a decision, which decision by the Board
of Commissioners shall be final.
Cb) Any charge assessed under the terms of this ordinance
but not paid within the required time period shall be a
lien upon the lands or premises where abatement of the
subject hazardous materials threat or remedial action took
place, and shall be collected as unpaid taxes pursuant to
the authority of N.C.G.S. 153A-140, Chapter 105 of the
North Carolina General Statutes, and other applicable
provisions of law.
The provisions of this ordinance shall be effective upon
its adoption, and said ordinance shall become and be made part of
the Code of ordinances of Harnett County, North Carolina, and the
sections of this ordinance may be renumbered to accomplish such.
Duly adopted this lQ!!!_ day of ~M_ay ___ ~~' 1991.
HARNETT COUNTY BOARD OF COMMISSIONERS
2d ' 1 ' ~ By: ~ ):?. /,C 7 loG. Stewart, Chairman
Attest:
~eal of the County of Harnett
031417wsa HC BOC Page 22
Board Meeting
Agenda Item
MEETING DATE: March 20, 2017
TO: HARNETT COUNTY BOARD OF COMMISSIONERS
SUBJECT: Revised Clinical Patient Fees, Eligibility and Bad Debt -Write Off Policy
REQUESTED BY: John Rouse, Health Dir'i§/'
REQUEST:
At the March 2, 2017 meeting, the Board of Health approved the revisions to the Clinical
Patient Fees, Eligibility and Bad Debt-Write Off Policy. We have attached the pages and
sections that the veribage was changed.
Thank you for your consideration in this matter.
FINANCE OFFICER'S RECOMMENDl
COUNTY MANAGER'S RECOMMENDA _
\
I
\\hcfile2\hthsh are\admin\Fileshare\l-Excel\P ATIENT FEE INCREASE PROCESS-B OC Reque sts\agendaform2017.doc
Page I of I 031417wsa HC BOC Page 23
CLINICAL PATIENT FEES, ELIGIBILITY AND BAD DEBT WRITE OFF POLICY & PROCEDURE
Verbiage Changes:
Page 2.
I. Setting Charges for Services
b. No client will be denied services nor subject to any variation in service based solely on
the inability to pay or regardless of source of payment.
2. Service discounts : A schedule of discounts is to be used to adjust most service charges for
clients between 101 % and 250% of poverty. Family Planning clients with income < 100% of
the Federal Poverty Level are not charged for FP services.
II.
Page 4.
Page 5.
III.
Page 6.
Definition:
3.
a. No Medical Doctor referral is required for patients seeking FP services.
Billing clients for Care:
The Department of Public Health follows OMA guidelines when billing Family
Planning and other clinical services.
f. When billing 340B services through Family Planning, a UD modifier will be used
for Medicaid and HealthChoice clients.
VIII . Responsibility of Billing Staff-each visit:
Eligibility
Page 14.
3. Clients do not have to be a resident of the county to be eligible for services provided
by the Health Department.
031417wsa HC BOC Page 24
Page 15.
13. Patients w ill not be denied services nor subjected to any variation in services based solely
on the in ability to p ay.
16. The Health Director or hi s designee m ay make exceptions to the e li gibility
re quirem ents on a case-by-case bas is. The Health Director or his designee may waive
fees for Family Planning clients with incomes above 100% of the Federal Poverty Level
who, as determined by the Health Director or his designee, are unable, for good cause, to
pay for Family Planning services. Documentation of such decisions shall be maintained
in a log at the Billing Station.
Page 16.
Delete section:
Laboratory Billing -AFP -Prenatal Patients
Delete:
UNC LABORATORY
Change this section :
AF P la b s will be se nt t o UNC fo r testing on all prenatal patients:
Delete thi s section:
Medicaid eligible
Presumptive Medicaid
Insurance
0% pay patients/ until UNC meets quota for 0% pay patients
If patient is 20% or above and not eligible for Presum tive Medicaid this lab will be sent to
LabCo
LABCORPLABORATORY
AFP labs will be sent to LabCorp for testing after UNC meets uota. (The Lab can bill the
agency and the agency can bill the client per the agency's fee schedule, BUT the sliding fee scale
a:Qplies.) "For self-ay , Lab charges are paid by Harnett County Department of Public Health,
then the client is billed for lab on the Sliding Fee Scale."
The prenatal nurse will bring the form and patient to an intake management support staff
member to complete the form and at the time the determination will be made which reference lab
to send the test to. Also, the patient will be told at this time if there will be a charge for the labs.
031417wsa HC BOC Page 25
Policy and Procedure
HARNETT COUNTY HEALTH DEPARTMENT
I Title: CLINICAL PA TI ENT FEES, ELIGIBIL TY AND BAD DEBT -WRITE OFF
I APPROVED: 3-17-2005 DATES REVISED: 5-18-06 9-18-08 11-17-11 9-19-13 9-18-14
~ 9-17-15 3/2/17
I APPROVED B~(/fl,'l/vv~/Jl'l/ )ti~ idokL
John Rouse. Health Director Gail Hobbs, Interim Accounting Specialist
Board ofCommissioner·s Chairman
Purpose
Public health services are increasingly costly to provide. The Health Department serves the
public's interest best by assuring that all legally required public health services are furnished
for all citizens. The department provides recommended and requested public health services
based upon the priorities established by the Board of Health.
Fees are a means to help provide services to the citizens of Harnett County. Fees help
finance and extend public health services when government funding is not sufficient to
support the full cost of providing all required and requested services. Fees are considered
appropriate in the sense, that the entire population benefits from the availability of public
health services for those in need , it is the direct recipient of services who gains the greatest
direct benefit.
Fees for Health Department services are authorized under North Carolina I 30A-39 (g).
provided that 1) they are in accordance with a plan recommended by the Health Director and
approved by the Board of Health and Board of Count y Commissioners. and 2) they are not
otherwise prohibited by law. Fees are based on the cost of providing services.
Policy
The clinic is to operate a system of financial management to:
• meet the standard of grantor agencies
• safeguard all income and expenditures -fees collected (generated through
reimbursement) will be maintained in an identifiable line item in the Health
Department and County Finance Office.
• assure collection of revenues from all sources with financial obli gations of the
service
The policy will include procedures for (I) Setting Charges, (II) Definitions (III) Billing
Clients and (IV) Procedure for Aging of Accounts (Bad Debt Write-Off), (V) Patient
Demographic (VI) Determining Eligibility for Discounts.
031417wsa HC BOC Page 26
Page 2
Procedure
I. Setting Charges for Service
a. In accordance with G.S. l 30-A-39(g), the Board of Health has the authority and
duty to establish charges for services provided in clinics. Specific methods used
in seeking reimbursement will be through third-party coverage, including
Medicaid. Medicare (for massive immunizations), private insurance. and
individual patient pay. The Board of County Commissioners adopts fees
established by the Board of Health. The Board of Health and Board of
Commissioners adopt the fees along with the fiscal years budget process.
b. No client will be denied services nor subject to any variation in services based
solely on the inability to pay or regardless of the source of payment.
C. Eligibility:
Each client must cooperate in:
• an eligibility determination; and
• provision of documentation of third party eligibility (Medicaid, Medicare.
private insurance) for which they are eligible; and
• provision of declaration of income.
I. Cost-based services: Charges are to be based on an accounting analysis of all services
provided. The Board of Health accepts the Medical Fees in the United States 501
h percentile
times geographic adjustment factors for North Carolina. unless the approved Medicaid rates
are greater. If the Medicaid rate is greater then that will be the acceptable charge. A
comparison of the Medicaid cost study is considered. The Fee Setting Committee reviews
and makes recommendations to Board of Health.
2. Service discounts: A schedule of discounts is to be used to adjust most service charges for
clients between I 01 % and 250% of poverty. Family Planning clients with income <100% of
the Federal Poverty Level are not charged for Family Planning services.
3. The discounts will be based on:
1. household members (economic unit), family and
11. income.
4. Financial Agreements/Assignment of Benefits Authorization is to be scanned in Patagonia
Electronic Health Record to acknowledge responsibility for services not covered by third
party carriers. Patients at 0% do not have to sign Financial Agreement.
031417wsa HC BOC Page 27
Page 3
II. Definition:
1. Adults and Emancipated minors : 164.502(g)(2)
a. Emancipated minors: In North Carolina. there are only two ways for a minor to be
emancipated (see G.S. 7B-3500 et seq):
• By marriage. or
• By an o rd er of emancipation granted by a court.
b. Adults: In North Carolina, a person age 18 or older is an ad ult for purposes of making
health care decisions.
2. Minor's consent sufficient for certain medical health services (G.S. 90-2 1.5)
a. Any minor may give effecti ve consent to a physician lic ensed to practice medicine in
North Carolina for medical health services for the prevention. diagnosis and treatment
of (i) venereal disease and o ther diseases reportable und G.S . 130A-l 35 , (ii)
pregnancy, (iii) abuse of controlled substances or alco h ol. and (iv) emotional
dist urb ance. This section does not authorize the inducing, of an abortion,
performance of a sterili zati on operation. or commitment to a mental institution or
hospital for confinement or treatment of a mental condit ion. This section does not
prohibi t th e admission of a minor to a treatment faci lity upon his own written
application in an emer gency situation as authorized by G.S. 122C-222.
b. Any minor who is emancipated may consent to any medical treatment, dental and
health services for himself or for his child . (197 1. c. 35: 1977. c.582. s.2; 1983. c.302,
S 2: 1985. C. 5899 , S. 3 1.)
3. Services to minors :
• Family planning services s hall be available to all who vol untaril y request such
services without regard to age or parental consent. (I SA NCAC 2 lA.0503)
a. Family Planning -clinic designed to assist women in planning their
chi ldbearing schedule: detailed history , lab work, physical exam, counseling
and educati on given by appropriate provider. Women of childbearing age
regardless of residency; s liding fee scale, Medicaid and third party insurance.
Clients must be charged based on household members and income and
discounts may be established for persons between IO I %-250% of poverty
based on sl iding fee scale. If client loses birth control pills a $10.00 per pack
031417wsa HC BOC Page 28
Page 4
will be accessed to the client and sliding fee scale will apply. Depo-Provera is
to be billed separately from physical fee. If during the course of a Family
Planning or Maternal Health visit the clinician needs to rule out STDs to meet
standards of care, the patient cannot be charged for STD testing and treatment.
[The STD services must be provided at no cost to the client. Medicaid can be
bi lied and if permission is given by client then third party insurance can be
billed; but co-pays, co-insurance/deductibles for STD are adjusted off.] The
billing staff must determine, as accurately as possible, the client's ability to
pay based upon family income. This determination and notice of any
applicable waiver should be made prior to the delivery of services and must be
conducted each time a client requests services. When considering charges to
minors for family planning, several conditions must be taken into account. If
the minor is unemancipated and confidentiality of services is not a concern,
the family's income must be considered in determining the charge for the
services. When a minor requests confidential services, without the
involvement of a principal family member, charges for services must be based
on the minor's income. Income actually available to the minor. such as wages
from part-time employment, stipends and allowances paid directly to the
minor, should be considered in determining the minor's ability to pay for
services. Those services normally provided by parents/guardians, e.g., food ,
shelter, transportat ion, tuition, etc., should not be included in determining a
minor's income. Under certain circumstances where confidentiality is
restricted to limited members of the family, e.g., one parent is aware of the
minor seeking services but the other is not because of disagreement regarding
the minor's right to receive family planning services. the charges shall be
based on the minor's income if the minor's confidentially would be breached
in seeking the full charge. Billing staff must seek payment from third parties
who are authorized or legally obligated to pay for services unless , in doing so,
patient confidentiality would be compromised. Third parties should be billed
at full charge and not discounted. unless there is a contracted reimbursement
rate that must be billed per the third party agreement. Family Planning
patients will have fees assessed based on declaration of income if no proof of
income is provided. The use of NC Debt Set-Off is acceptable for collecting
past due amounts for Family Planning. Bills/receipts given to clients at the
time of service show total charges, as well as any allowable discounts. Where
a third party is responsible, bills are submitted to that party. Bills to third
party show total charges, without discounts, unless there is a contracted
reimbursement rate that must be bill per the third party agreement. Famil y
Planning Services will not be denied because the patient has a delinquent
account balance. No Medical Doctor referral is required for patients seeking
Family Planning services.
031417wsa HC BOC Page 29
Page 5
4. Child Health clients must be charged based on household members and income and
discounts established for clients between IO 1-250% of poverty based on sliding fee
sca le .
5. Maternal Health clients must be charged based on household members and income
and discounts established for clients between 101-250% of poverty based on sliding
fee scale.
6. Adult Health clients must be charged based on household members and income and
discounts established for clients between 101-250% of poverty based on sliding fee
scale. If Adult Health services falls under flat fee service follow the Flat Fee Policy.
7. Communicable Disease Control-this program deals with the investigation and
follow-up of all reportable communicable and/or sexually transmitted diseases, to
include: testing, diagnosis , treatment and referring as appropriate. It also provides
follow-up and treatment of Tuberculosis cases and their contacts. The services must
be provided at no cost to the client. Medicaid can be billed and if permission is given
by client then third paity insurance can be billed ; but copays. co-insurance /
deductibles are adjusted off.
8. Flat Fee Service: thi s is clinical service not on a sliding fee scale; vaccine is
purchased by this agency or services provided by agency and is not mandated by the
state.
III. Billing clients for Care:
a. See section IX. Flat Fee Services for non-discounted services.
b. The Department of Public Health follows DMA guidelines when billing Family
Planning and other clinical services.
c. Patagonia Electronic Health Record (accounting system): Bills are to be given
directly to the client at the time of their clinic vis it and/or claim sent to another
payment source, i.e. Medicaid, Medicare or private insurance. If payment is not
made in full at time of visit then a payment schedule (dollar amount, daily,
weekly, and monthly payment) will be discussed with client and put on file .
d. Emancipated minors (by legal emancipation, or married) fees are to be based on
household members and income. Fees for clients requesting confidentiality or no
contact must be based on the client ·s income alone and a family size <~f one.
e. Bills to clients are to show full charge Jess the appropriate slid ing fee discount.
031417wsa HC BOC Page 30
Page 6
f. Bills to third party payer sources are to reflect the full charge and without any
discount/no sliding fee discount. Unless there is a contracted reimbursement rate
that must be billed per the third pa11y agreement.
g. When billing 340B services through Family Planning. a UD modifier wil l be used
for Medicaid and HealthChoice clients.
h. All denied claims will be reviewed for re-submission to Medicaid or third party
msurance.
1. Patagonia's Aging Report is reviewed on a monthly basis and necessary
con-ections are made.
J. When a bill is not paid in full during the clinic visit. a bill is to be mailed to the
client"s address sixty (60) days after the visit and monthly thereafter until written
off. After three consecutive bills with .. no'· response then a letter will be sent with
bill (see form letter attached). Bills are not to be mailed to adolescents when it
may undermine their confidentiality or when a client requests no contact or no
mail . When confidentially or no mail is requested by client see if alternate billing
address can be used. Also, see Debt Set-Off Policy for further collection options.
k. Clients are to receive a receipt for any payment. (Printed from Patagonia EHR
unless after closeout for daily depos it then hand written numbered receipt will be
issued).
I. Voluntary donations may be accepted and a receipt issued. Clients are not
pressured to make voluntary donations. Voluntary donations are not a
prerequisite for provision of any service or supply. Billing requirements set out
are not waived because of client donations. If the donation is from a client with
an account balance, it is considered a payment. not a donation.
m. No mail is sent to confidential clients, or if requested by a client to receive no
mail or no contac t .. no snai l mail .. is checked in Patagonia.
IV. Process for billing clients and aging accounts follows :
Billing
a. Explain to client charges for that day"s services and request payment during clinic
visit; inform client of balance due and have client sign .. Financial
Agreement/Assignment of Benefits Authorization , if deemed necessary.
b. Bills to patients show total charges . as well as any allowable charges.
031417wsa HC BOC Page 31
Page 7
c. If client is unable to pay full amount of bill for that day"s service. prepare
.. Payment Agreement Form" for clients to sign. Scan agreements into Patagonia
under .. Billing Bin'·.
d. Label will be kept on each client in a notebook and the encounter forms shall be
matched back to the label sheet to ensure all encounter forms are accounted for.
e. If encounter forms are not accounted for follow-up with s upervi sor of that clinic.
(A duplicate encounter fom1 may need to be created if original is not found).
f. Mail statement of account to client sixty (60) days after visit and monthly
thereafter until written off or collected through Debt Set-off.
g. After 3 months; mail .. payment agreement form'' to client to select payment
option(s), if client has not signed ··payment agreement form'· or if client has
already made a selection send a copy of .. payment agreement fom1·· on file to the
client along with statement of balance from accounting system.
h. Mail past due notice to client sixty (60) days after the ··payment agreement form"'
has been mailed.
1. Inform patient of balance due at time of service and
a. Next telephone call, (if appli cable or time allows)
V. Aging Patient Accounts (Bad Debt Write-Offs)
a. Aging of account is an accounting procedure to periodically provide an update
and realistic value for accounts receivable. Accounts will be aged every 2 years
or annually, if deemed by Health Director or Designee and written off as
.. uncollectible'· on ly after two (2) years following the date of last service and no
effort to pay has been made by patient. Unless. approval by Board of Health
and/or Board of Commissioners to delay write-offs.
b. Two years after the initial visit balance and payment has not been rendered. and
client has been sent to Debt Set-off program and has not been in for service any
balance remaining under $50 after two years will be written-off. Balance will be
reinstated once client returns for service. Balances over $50 follow Debt-Set Off
Policy. unless unable to collect from Debt-Set Off.
c. As long as a balance remains, the client is to be info1med of the current balance.
031417wsa HC BOC Page 32
Page 8
d. In the event a client should offer payment on an amount previously written-off.
the charge will be reinstated and payment accepted. Reinstatement will reflect
the amount written-off in the accounting system . If client returns to Health
Department for services write-off will be reinstated and the client will be
infonned of the amount owed.
e. The electronic client ledger card (accounting system) will indicate the write-off.
f. The Hamett County Board of Health authorizes the Health Director to write-off
debts deemed uncollectible under this policy; the Health Director will report to
the Board of Health the total amount to be written off. The Health Director will
then request approval of the write-off debts from the Board of Commissioners.
After approval by the Board of Commissioners then the debts will be written off.
g. Reasonable efforts to collect charges/bills without jeopardizing patient
confidentiality are made.
The Harnett County Health Department utilizes an Electronic Accounting System for
receivables (Patagonia EHR).
Electronic version to be used, unless Patagonia EHR (accounting system) is down then
paper version will be done and then scanned into system when it is back up.
VI. Patient Demographics and Insurance Information
a. A Patient Demographics will be initiated and completed for each client.
b. Personal data required includes:
• Last name, First name, Middle Initial (MN if one)
• Social Security number, as needed for billing and debt set-off
• Date of Birth
• Race and Ethnicity
• Sex
• County of Residence Code
• Country of Origin
• Address and phone number
• Preferred Language
• If minor, Parent Details: Father Name, Father DOB, Father Phone. Father
SSN, Emergency Contac Name, Emergency Contact Number; Mother Name,
Mother DOB, Mother Phone, Mother SSN.
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c. Insurance infonnation: (Patagonia EHR)
Primarv & Secondarv
• Self-Pay
o Insurance Type (Type Self-Pay)
o Insurance Type (Type Self-Pay)
o Relationship with In sured (S pou se, se lf, child. other )
o Full Name of Insured
o Insured number
o Date of Birth of Insured
o Gender of Insured
o Address of Insured
o Home Phone of Insured. if available
o Work Phone oflnsured , if available
o Cell Phone of Insured. if available
o Subscriber Assignment of Benefits (clients will sign)
o Subscriber Release of Info (cl ient s will sign
o Has Coordination of Benefits
• Medicaid / Medicare / or Private Insurance
o In surance Type (
o Insurance (Type Medicaid)
o Relationship with Insured (Spouse, self. child . other)
o Full Name of In sured
o Insured number
o Date of Birth of Insured
o Gender of Insured
o Address of In sured
o Home Phone of In sured, if available
o Work Phone of Insured. if available
o Cell Phone , if available
o Subscriber Assignment of Benefits (clients will sig n)
o Subscriber Release of Info (clients will sign
o Has Coordination of Benefits
VII. Instructions for Determining Eligibility for Sliding Scale Fee Discount:
Definition :
1. Economic Unit: The Ec onomic Unit will consist of people li ving in the home
related to the client and those living in the home pro vidin g direct or indirect
financial support for the client.
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1. 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 mush have its own source of income. Also,
groups of individuals living in the same house with other individuals may be
considered a separate economic unit if each group support only their unit. A
pregnant woman is counted as two (including the unborn child) in determining the
family size. (Related to client by blood, marriage, or adoption , father of unborn
child or client's boyfriend , and/or live in the same household as the client and
contribute to the client's support; rent , utilities , grocies, clothes, etc.). Those who
are financially responsible for the client or those who dependent on the client for
financial assistance are included in economic unit.
1. A foster child assigned by Department of Social Services is a family of
one with income considered to be paid to the foster parent for support of
the child.
2. A student maintaining a separate residence and receiving most of her/his
support from her/his parents or guardians may be counted as a dependent
of the family. Self-supporting students maintaining a separate residence
would be a separate economic unit. Family Planning considers this group
extremely high-risk for unintended pregnancy. Any student in this
category is considered as a family of one and is to be billed based on the
income of the client.
3. An individual or family in an institution is considered a separate economic
unit.
4. If a patient requests .. confidential services". regardless of age, the agency
shall consider them a family unit of one based on their income.
5. Family Planning patient is marked as .. confidential'' in Patagonia E H R
when Encounter is created; ESB is created and .. no snail mail is checked'·.
6. If a Family Planning patient presents for a service and is considered to be
a minor, interview questions may include the following: I) Ask the patient
if their parents are aware of their visit? 2) Ask if .. both'" parents are aware
of their visit, since sometimes the mother may be present with the patient,
however, the father may not be aware of the visit. 3) Ask if yo u can send a
bi II to the home, to both parents. 4) If the patient states both parents are
aware and it is not a confidential visit, you should treat as such.
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7. lncome information reported for Family Planning financial eli gibility
screening can be used through other programs offered in the agency, rather
than re-verifying income or solely on the client 's self-rep ort in g.
3. Sources of Income:
• Employer Wages
• W-2
• SSI / Public Assistance payments
• Retirement
• Social Security
• Alimony payments
• Unemployment compensation
• Regular contributions from sources outside the home
• Financial payment/other source s of income that may exist include but not
limited to cash , or that can be readily converted to cash , etc ...
Some items not included as income:
• Housing a llowance for military personnel is not counted. The e li gibility specia li st
will have to identify the proper amount of the housing allowance and subtract it
from the tota l gross income shown on the check.
• Non-cash benefits such as WIC vouchers , food stamps, food , rent or fuel received
in lieu of wages.
• In-kind housing assistance
• School lunches, etc ...
4. Client Household/Contact Electronic: (information needed to enter into Patagonia)
a. Complete Client Household on each client every 12 months: unless client has a
change then it will be updated and resigned earlier. The client will be asked at each
visit if there has been a change in their financial status. Income will always be based
on the .. actual date '· of service. If there has been a change or it is time for their
annual review the income determination process shall take place. If flat fee service
or no charge client household is not necessary.
• Enter the following information:
I. Last name , First name , Middle Initial (MN, if one)
2. Relation
3. Employer
4 . Annual Income
031417wsa HC BOC Page 36
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5. Proof of Income (proof is not required -type declaration of income or if they
bring proof provide type of proof: example pay stub. etc.
a. If minor -type not specified
6. Date Verified
5. Computation of income
Regular Income Formula:
The patient's income will be determined by the following:
Income will be based on a twelve (12) month period . If the patient is working
the day they present for a service, income will be calculated weekly. bi -
weekly, monthly or annually, depending on the documentation obtained. rf
the patient is unemployed the day they present for their service. their
.. employment only'· income will be calculated at zero (0), however the patient
shall be asked to provide '·their mechanism··, in regards to their paying for
food. clothing, shelter. utility bills. etc. Refer to .. sources of income'' counted
and apply all sources, as appropriate ... Regular contributions received from
other sources outside of the home·· is considered one of these sources. If the
patient is receiving unemployment or other .. sources'' of income, as designated
above, all of these sources shall be counted.
Unemplovment or Irre2:ular In come Formula:
• Six months formula
• Wage earners unemployed at time of application
• Unemployed any time during previous 12 months
• Example: Unemployed today
• Income detem1ined six months back
• Income determined six months forward
• Total = 12 months of income
An electronic version of the Financial Eligibility Determination shall be
maintained in Patagonia EHR for future reference. The number in the household.
annual gross income and percentage of pay should be reflected on the financial
documentation. The documentation should be signed and dated by the interviewer
and patient. Use of electronic signatures is acceptable.
Income is re-assessed annually unless there has been a change in financial status.
Following the initial financial eligibility determination , the client will be asked at
each visit if there has been a change in their financial s tatus. Income will always
be based on the .. actual date .. of service. If there has been a change or it is time for
their annual review the income detem1ination process should take place.
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Patient fees are assessed according to the rules and regulations of each program
and for clients based on sliding fee between 101-250% of poverty level will be
used to detennine fees. All third-party providers are billed where applicable.
Clients presenting with third party health insurance coverage where copayments
are required shall be subject to collection of the required copayment at the time of
service. For Family Planning (Title X) clients the copay may not exceed the
amount they would have paid for services based on sliding fee scale.
Income information reported during the financial eligibility screening for one
program can be used through other programs offered in the agency, rather than to
re-verify income or rely so lel y on the client 's self-report.
Individuals and emancipated minors seeking confidential or individuals requesting no
contact service are to be considered a family unit of one (family planning, etc)
• Client documentation when refused: Client/guardian may be requested
to declare income annually or as changes occur, but proof of income for
documentation is not required. rf client refuses income information he/she
will be accessed at I 00%. except Family Planning will not be accessed
(0%).
• Documentation is required: Acceptable sources of income verification .
Proof of income is not required.
I . Check/Pay stubs
2. W-2 forms
3. Letter from employer, etc.
4. Self-employed clients can provide the latest tax return
5. Self-Declaration
•!• Check all Eligible Programs in Patagonia EHR:
• Eligibility specialist will ensure that all eligible programs are checked that
apply to the clients visit in Patagonia EHR.
• Eligibil it y specialist will create declaration of income and have client sign
and date declaration of income list
• Eligibility specialist wi ll sign and date declaration of income list
VIII. Responsibility of Billing Staff -each visit
I. Clients are screened to determine financial eligibility at the time of visit
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2. Explain to the client the reason for charging fees for services received and sliding fee
scale 101-250%
3. Discuss with client acceptable forms of income verification.
4. Complete financial eligibility in Patagonia
-if no income. can be referred to Department of Social Services with ·'Third Party
Confirmation Letter" (attached to policy) or accept declaration of income.
5. There is no minimum fee requirement or surcharge that is indiscriminately applied to
all patients.
6. Explain that the expectation of the Health Department is that reimbursement is
expected same day as service. If unable to pay same day have the client sign a
contract agreeing to pay for the cost of the services. If, on subsequent visits, the
client has not made payment, remind client of signed agreement. (see attached
.. Financial Agreement/Assignment of Benefits Authorization·· Form)
7. Billing staff shall copy insurance card and a fom1 of identification to ensure the
correct insured client is using the insurance card. (May be scanned into Patagonia
under .. billing bin'')
8. Billing staff should collect insurance co-insurance/deductibles and will be accessed
according to the sliding fee scale. Co-pays are not subject to sliding fee scale and
will be collected at 100%, with the exception to Family Planning which wi ll be
applied to the sliding fee scale.
Eligibilitv
1. Clients will not be denied statutorily required services based solely on the inability to
pay. Services may be denied if the department does not have the resources needed to
provide a quality non-mandated service. Family Planning clients will not be denied
because the patient has a delinquent account balance.
2. The Health Department shall not deny a service due to religion, race, national origin.
creed , sex, marital status or age.
3. Clients do not have to be a resident of the county to be eligible for services provided
by the Health Department.
4. Clinical services provided by the Health Department are targeted to individual with
income between 101 %-250% or below of the federal poverty level.
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5. Cost of foam and condoms, and other non-prescription contraceptives are included in
the reimbursement rate established for preventive medicine codes. Medicaid and
third party insurance clients will be provided a prescription unless, confidential or no
contact requested. These clients will be provided pills. One exception is if a client
loses her birth control pills there will be a $10.00 per pack or currently established fee
accessed to the client and sliding fee scale will apply .
6. Clients will be informed to bring Medicaid card. Insurance card. Health Choice Card
and /or household income or declare income at the time of visit.
7. Clients will be asked if their income has changed at each visit to the health
department.
8. There shall be no minimum fee requirement or surcharge that is indiscriminately
applied to all patients.
9. Patients are not required to apply for Medicaid to receive services.
10. Medicaid recipients are eligible to receive program services.
11. Patient shall be given a receipt each time a payment is collected. showing charge and
discounted fee for services.
12. Patient schedule of charges are on county website and a sign is posted that states
--patient fee information is available upon request".
I 3. Patients will not be denied services nor subjected to any variation in services based
solely on inability to pay.
14. Patients, including Family Planning patients are not required to meet with the Health
Director in an attempt to collect a delinquent account.
15. Patients will not be denied services because the patient has a delinquent account
balance.
16. The Health Director or his designee may make exceptions to the eligibility
requirements on a case-by-case basis. The Health Director or his designee may waive
fees for Family Planning clients with incomes above 100% of the Federal Poverty
Level who, as detennined by the Health Director or his designee, are unable, for good
cause, to pay for Family Planning services. Documentation of such decisions shall be
maintained in a log at the Billing Station.
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Laboratory Billing -AFP -Prenatal Patients
AFP labs will be sent to UNC for testing on all prenatal patients.
IX. FLAT FEE SERVICES
Flat Fee Service This is clinical services not on a sliding fee scale , vaccine is purchased by
this agency and is not mandated by the State nor is the vaccine provided by the state; and
providers see adult women for services (pap smear, labs-such as cholesterol. urinalysis).
• Flat fee service will be collected at the billing before the client is seen in clinic.
• If the client does not receive the service then a refund will be issued.
• Medicaid does not pay for PPD/Tuberculin Skin Test if related to work or school, so in
this instance the client is responsible for the charge.
This policy shall be reviewed by the Health Director annually. If there is a
revision/amendment to this policy then it shall be brought back to the Board of Health
for approval at the next meeting date and the Board and Board of Commissioners at
their next meeting date.
031417wsa HC BOC Page 41
March 20, 2017
Ms. Martha Frisone, Assistant Chief
Health Planning and Certificate of Need Section
North Carolina Division of Facilities Services
809 Ruggles Drive
Raleigh, NC 27603
Re: Cape Fear Valley Health System
CON Application for Hamett County Imaging Center
April 1, 2017 Review Period
Dear Ms. Frisone:
I am writing on behalf of the Harnett County Board of Commissioners. Harnett
County enjoys a positive relationship with both Harnett Health System and Cape Fear
Valley Health and share a mutual desire to provide quality healthcare services to the
residents of Harnett County.
Cape Fear Valley Health System is seeking CON approval to develop a
freestanding outpatient-imaging center in Harnett County. This project will promote
cost-effective approaches , expand health care services to the medically underserved, and
encourage quality health care services by providing more efficient health care services to
the patient population served by Harnett Health.
Please convey to the Certificate of Need Section at the North Carolina Division of
Health Services Regulation the Harnett County Board of Commissioner's support for the
approval and this project.
Sincerely,
Gordon Springle, Chairman
Hamett County Board of Commissioners
031417wsa HC BOC Page 42
® P.O. Box l 706
Dunn, NC 28335
(91 0) 892-1000
Harnett Health from the Office of the President and CEO
March 3, 2017
Joe Jeffries, County Manager
Harnett County Commissioner
P.O. Box 759
Lillington, NC 27546
Dear Mr. Jeffries:
This letter is to inform you that the Harnett Health System Board of Trustees made the
following nominations at the February 27, 2017 board meeting to fill seats on the Harnett
Health Systems Board of Trustees that will expire April 1, 2017.
Nominees to be approved by the Harnett County Board of Commissioners (These are County
Commissioner Appointments):
Dr. J. Bradley Creed District 3
Appointed to serve a three year term
Term of Appointment-April 1, 2017 through March 31, 2020
Susan Chriscoe District4
Appointed to serve a three year term
Term of Appointment-April 1, 2017 through March 31, 2020
We appreciate your consideration for approval of the Board's nominees. Should you have
any questions, please feel free to contact me.
Sincerely,
. e Jackson
President
Harnett Health System
Board Chair
Ji~rn_e~ _Healt!1 ~ys_~em_
Betsy Johnson H ospitol (Dunn) · Central Harnett H ospital (Lillington) · Harnett Health Foundation
Angier M edical Services · Dunn Medical Services · Li llington Medical Services · Harnett OB/GYN · Premiere Pediatrics
Benson Rehab & Wellness · Breast Care Center · Wound Care Center
031417wsa HC BOC Page 43