MACON COUNTY BOARD OF COMMISSIONERS JANUARY 8, 2013 AGENDA NOTE: Service awards for county employees will be presented

beginning at 5:30 p.m. 1. 6:00 p.m. Call to order and welcome by Chairman Corbin 2. Announcements 3. Moment of Silence 4. Pledge of Allegiance 5. Public Hearing(s) Installment Financing Contract for Improvements to Highlands School NOTE: Consideration of the contract and other related matters will immediately follow the public hearing 6. Public Comment Period 7. Adjustments to and approval of the agenda 8. Reports/Presentations A. School Resource Officers Sheriff Robert Holland B. Update on Parker Meadows Recreation Project Seth Adams and Mike Lovoy 9. Old Business A. Macon County Public Health FY 12-13 Billing and Collection Policies and Fee Schedules Jim Bruckner, Public Health Director B. QZAB Reimbursement Resolution 10.New Business A. Request from the Sky Valley/Scaly Mountain Volunteer Fire & Rescue Department for relief fund money David Key B. Resolution approving terms of loan modification Finance Director

11.Consent Agenda Attachment #11

All items below are considered routine and will be enacted by one motion. No separate discussion will be held except on request of a member of the Board of Commissioners.

A. B. C. D.

Minutes of the December 11, 2012 meeting Budget Amendments # 87-91 Tax Releases Monthly Ad Valorem Tax Collection Report (no action necessary)

12.Appointments 13.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, Sheraton RTP in Durham County

MACON COUNTY BOARD OF COMMISSIONERS 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__ Agenda Item 5

Yes

___

No

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

MEETING DATE: January 8, 2013 DEPARTMENT/AGENCY: Sheriff SUBJECT MATTER: School Resource Officers DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Commissioner Beale has asked Sheriff Robert Holland to address school safety issues as they relate to School Resource Officers (SROs) COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments _____ Agenda Item 8A

Yes

__X_

No

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

MEETING DATE: January 8, 2013 DEPARTMENT/AGENCY: Parks and Recreation SUBJECT MATTER: Parker Meadows Recreation Project DEPARTMENT HEAD COMMENTS/RECOMMENDATION: 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. COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments _____ Agenda Item 8B

Yes

__X_

No

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

MEETING DATE: January 8, 2013 DEPARTMENT/AGENCY: Health SUBJECT MATTER: FY 12-13 Billing and Collection Policies and Fee Schedules DEPARTMENT HEAD COMMENTS/RECOMMENDATION: 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. COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments ___X__ Agenda Item 9A

Yes

___

No

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 ____________

MCPH Billing Guide FY 13

Effective July 1, 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 an employee of the local health department is performing the services as an agent of the State.
Fees may be based on a plan recommended by the Health Director; The plan must be approved by the Board of Health and the Board of County Commissioners; And, fees collected under the authority of this subsection are to be deposited to the account

of the local health department so that they may be expended for public health purposes in accordance with the provisions of the Local Government Budget and Fiscal Control Act.
The State requires local health departments to provide certain services, and no one may be denied these services. It is in the best interest of our community for the Health Center to:

Assure that all residents can get all legally required public health services. Provide as many other recommended and needed health services as possible, within the resources we
still have available to use. The purpose of charging fees is to increase resources and use them to meet residents needs in a fair and balanced way. Fees are necessary to help identify and cover the full cost of providing public health services. As much as possible, fees are based on the true cost of providing a particular service (calculated as direct costs plus indirect costs). Throughout the year, ongoing cost analyses are performed and fee schedules shall be adjusted by the Health Director, in the amount of the increased cost for prevision of said services. A list of Health Center fees is available upon request. The information in the document below is the fee plan for FY 13, effective on July 1, 2010. This Billing Guide for FY13 replaces all earlier plans. COST OF SERVICE DETERMINATION Costs for services received through the Health Center are firstly based on the current Medicaid rate and then adjusted according to the actual cost of the service. If there is no Medicaid rate then fees are determined through cost analysis. Cost analysis takes into account all of the resources associated with providing a particular service and calculates the actual cost to provide that service. Cost analysis includes the calculation of direct and indirect costs for services and then adding these figures together to determine the actual cost of the service. Calculating direct cost: Direct costs are expenses that can be easily related to the provision of a specific service, i.e., physician and support staff salaries and benefits, medical supplies, lab tests, and other resources consumed at the time of the service. Calculating indirect costs: Indirect costs involve resources that are not directly consumed during the provision of a service, but without them the provision of that service would not be possible, i.e., administrative staff salaries and benefits, training costs, facility costs, insurance premiums, office equipment and supplies, and recruiting and marketing expenses.

North Carolina General Statue 130A-39(g) Page 2 12/6/2012

MCPH Billing Guide FY 13

PAYMENT BY CONSUMER

Effective July 1, 2012

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 sliding fee scale. No consumer will be refused services solely on their inability to pay for said services. All fees may be paid by cash, check, or major credit card. Full payment is expected at the time of service. Consumers will be informed of their account status at each visit. An itemized receipt will be provided to individuals at time of payment. Fees for adult dental services will be collected before the service is rendered. Prepayment of co-pays for all services in which co-payments apply will be required and collected when services are rendered. Fees will be charged to individuals in families with annual gross incomes exceeding specified levels of a scale based on current Federal Poverty Income Guidelines. Verification of income and family size must be provided to determine a patients eligibility status. Verification (proof) of income may be provided for Family Planning services; however, if the patient has no proof of income, the patients declaration of income shall be accepted and any charge shall be based on what he/she declares. Falsification of this information will permanently disqualify 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. If income cannot be verified at the time of screening, the charge for all services except Family Planning will be at 100% pay. If verification of income is received within thirty days of a service, the charge will be retroactively adjusted to reflect percent pay based on verification received. Verification received after thirty days will be applied only to future services. Eligibility of Medicaid will be determined where applicable. Individuals will be required to provide all social security numbers and names used for employment purposes. If an individual refuses to provide information to verify income, they will not be eligible for the sliding fee scale and will be at 100% pay. Customary visit services for mandatory childhood immunizations, community outreach, tuberculosis, TB related X-rays, sexually transmitted disease control (STD), and other epidemiological investigations are provided at no cost to the consumer but may be billed to Medicaid or other third party agent. Separate fees may be charged for drugs, supplies, laboratory services, X-rays and other technological services, if appropriate. The costs of services performed by providers not affiliated with the Macon County Public Health Center are the responsibility of the patient/consumer. Fees may be charged or waived for educational services provided to individuals or groups, such as orientation, preceptorship, field training or classes. Charges not eligible for sliding scale discount include: a. Environmental Health services b. Non-mandated immunization services c. Miscellaneous/general services (see Miscellaneous/General section below) d. Out-of-county residents (see Out-of-County Service Restrictions section below) e. Specific insurance situations (see Insurance section below for details) Bills will be mailed monthly to individuals who have not paid charges in full for services rendered (exception Family Planning for those that request no mail be sent to their home). All bills will show total charges, as well as any discount that may have been provided. Arrangements may be made for payment plans when required for good cause. PAYMENT BY THIRD PARTY Verification of enrollment under Medicare, Medicaid, insurance or other third party payment plan is required by presentation of a valid card at the time of service. The Health Center is required to bill only participating third party payers for services rendered. Services that are billed to third parties are billed at 100% of the total charge with no discount applied. When the claim is returned from the third party payer all discounts are applied at that time. (i.e., any applicable sliding fee scale adjustment) For services rendered to
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consumers with insurance where the Health Center is not a participating provider, the consumer will be responsible for full payment of service when the service is delivered. The Health Center is currently participating with Medicaid, Medicare, Blue Cross Blue Shield, Crescent, Tri-care and NC Health Choice for medical services. The consumer is responsible for charges not covered by third party payers. Co-pay amounts must be paid at the time of services and are not subject to the sliding fee eligibility scale. Sliding fee scale discount does not apply in the following situations: a. 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 and are due. Consumers are expected to make payment at the time services are rendered. If a balance is carried forward consumers who have not made a payment on their account for any service(s) received from Macon County Public Health for 120 days shall be required to pay their past due balance before another service shall be rendered (see Service Denial for further information). The Health Center may use the following resources to pursue collection of patient accounts: billing statements, past due notices, collection agencies or credit bureaus, and the NC Local Government Debt Setoff Clearinghouse (ref: NCGS 105A-1 et seq.) as administered by the NC Department of Revenue

Accounts will be reviewed annually for bad debt status, and at that time with the approval of the BOH and the BOCCs the amounts may be written off for accounting purposes if no further collection is anticipated. Any payments received for write-off debts will be accepted and credited to appropriate accounts. At no time will a patient be notified that the account has been written off as a bad debt. Bad debts, which are determined uncollectible (i.e. bankruptcy, death), will be written off permanently upon notification. CONSUMER DONATION POLICY

A consumer may choose to make a donation to the agency. The consumer will never be asked to make a donation, but if offered the donation is accepted. Donations are not required, and are not a prerequisite for the provision of any service. Billing requirements set out above in the Payment by Consumer 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 not available, a written notification will be sent. All returned checks will be made good via cash, money order, and/or certified check. If a consumer has two returned checks within a one-year period, he/she will be required to pay for services in advance via cash, money order, or certified check for the period of one year. After the one-year period expires, if another returned check occurs, all future bills must be paid with cash, money order, or certified check prior to the provision of services. REFUNDS

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Effective July 1, 2012

In the event that a consumer or other third-party has overpaid their responsible charges, the credit balance is either: applied to future charges or refunded to the payer within thirty (30) days of discovery or request. Refunds for Environmental Health services are determined by attached policy and procedure. SERVICE DENIAL No individual may be denied Health Center mandated services e.g. communicable disease services (STD/TB). These services are provided at no charge to the consumer. Individuals who do not meet program guideline criteria may be denied specific services. Consumers covered by Medicaid who fail to make required co-payments will not be denied services. Individuals who have not paid proper charges for previous services (unless state and federal program rules prohibit services restriction or denial) may be required to pay fees beforehand, be denied access to services (see Account Collections and Bad Debts), or be denied subsequent services pending demonstration of a good faith effort to make payment within the past ninety (90) days. OUT OF COUNTY SERVICE RESTRICTIONS Macon County supports its low-income citizens by subsidizing the cost for certain health care services. To assure that Macon County citizens have maximum access to Health Center services only those services mandated by North Carolina General Statues or approved in this plan will be provided to nonMacon County residents. If an individual moves out of Macon County, they must obtain services from another provider. 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 requirements imposed by or pursuant to the regulations. Staff will not discriminate against any clients because of age, sex, race, creed, national origin, or disability. Staff will ensure consumers with LEP are provided adequate language assistance so they have meaningful access to the agencys services.

PROGRAM SPECIFIC INFORMATION ADULT HEALTH Provides limited health screening services for adults. Services provided through this program are not eligible for sliding fee scale payment or third party billing. Exception: Colposcopies may be billed to third parties. Eligibility:

Must be a resident of Macon County; Exception: Colposcopies. Must be 18 years and older. Adult Health Services are not eligible for sliding fee scale payment. Services will be paid for
prior to any service being rendered. Any additional fees associated with a visit will be added to the clients account and paid in full at checkout.

COMMUNICABLE DISEASE CONTROL Deals with the investigation and follow-up of all reportable communicable diseases. Testing, diagnosis, treatment, and referring as appropriate, of a variety of sexually transmitted diseases. Provides follow-up and treatment of TB cases and their contacts. No fees are charged directly to
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clients for these services as stated in Program Rules (exception Medicaid or other third party agent can be billed with the patients permission). Eligibility: No residency or financial requirements

BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCCP) Provides pap smears, breast exams and screening mammograms, assists women with abnormal breast examinations/mammograms, or abnormal cervical screenings to obtain additional diagnostic examinations. Eligibility: uninsured or underinsured; without Medicare Part B or Medicaid; between ages 40 - 64 for breast screening services and 18 - 64 for cervical screening services; have a household income at or below 250% of the federal poverty level. No charge for those who qualify for the program; family size shall be determined as follows: Client, spouse of client and all children under 18 years of age, including step-children who live in the home.

WOMENS HEALTH Provides limited health screening services (pap smears and/or breast exams) for women who do not meet the qualifications of the NC BCCCP Program. Grant funds may be available to cover the cost of repeat pap smears for women below 250% of federal poverty level when funding is available. Services provided are not eligible for sliding fee scale payment or third party billing. Eligibility:

Must be a resident of Macon County; 18 years and older. Womens Health Services are not eligible for sliding fee scale payment. Services will be paid for
prior to any service being rendered. Any additional fees associated with a visit will be added to the clients account and paid in full at checkout CHILD HEALTH Well child exams conducted by (appropriate provider); exam includes medical, social, development, nutritional history, lab work, and physical exam. MCPH accepts sliding fee scale; some Private Insurances; Health Choice; Medicaid
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Eligibility:

Effective July 1, 2012

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

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

Eligibility: No residency or financial requirements for immunizations. CARE COORDINATION FOR CHILDREN (CC4C) Case management assists families in identification of and access to services for children with special needs that will allow them the maximum opportunity to reach their development potential. MCPH accepts Medicaid Eligibility: Macon County children birth to age three who are at risk for developmental delay or disability, long term illness and/or social, emotional disorders and children ages birth to five who have been diagnosed with developmental delay or disability, long term illness and/or social, emotional disorder may be eligible for the program.

FAMILY PLANNING Clinic designed to assist women in planning their childbearing schedule; detailed history, lab work, physical exam, counseling and education given by (appropriate provider). MCPH accepts sliding fee scale; some Private Insurances; Medicaid or potentially Medicaid eligible. Eligibility: This can be a confidential service Women of childbearing age Residents of Macon and other surrounding North Carolina Counties Family Planning (Title X) patients who present for services without proof of income will be assigned to the sliding fee scale based on information shared verbally regarding income and sources. Unless the information warrants, they will never be charged at 100% as this would be considered a barrier to service. Proof of income may be requested, but cannot be required A Family Planning patient will never be refused a Family Planning service, be sent to collections or asked to meet with the Health Director due to a delinquent account. MISCELLANEOUS/GENERAL SERVICES
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Effective July 1, 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 to any service being rendered. Any additional fees associated with a visit will be added to the clients account and paid in full at checkout. MATERNAL HEALTH Prenatal care is medical care recommended for women during pregnancy. The aim of good prenatal care is to detect any potential problems early, to prevent them if possible (through recommendations on adequate nutrition, exercise, vitamin intake etc), and to direct the woman to appropriate specialists, hospitals, etc. if necessary. Visits are monthly during the first two trimesters (from week one to week 28 of pregnancy), every two weeks from 28 to week 36 of pregnancy and weekly after week 36 (until the day of delivery that could be between week 38 and 40 weeks). MCPH accepts sliding fee scale; some Private Insurances; Medicaid or potentially Medicaid eligible. Eligibility: Residents of Macon - eligibility policy and residency requirements attached Maternal Health clients will be required to have 2 proofs of residency

OB CARE COORDINATION MANAGEMENT (OBCM) Case manager assists pregnant women in receiving needed prenatal care and pregnancy related services. MCPH accepts Medicaid or potentially Medicaid eligible. Eligibility: Residents of Macon County

WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM (WIC) Supplemental nutrition and education program to provide specific nutritional foods and education services to improve health status of target groups. Eligibility: WIC is available to pregnant, breastfeeding, and postpartum women, infants, and children up to age 5 who meet the follow criteria: Be a resident of Macon County; Be at medical and/or nutritional risk; Have a family income less than 185% of the US Federal Poverty Level; Medicaid, AFDC, or food stamps automatically meet the income eligibility requirement

CHILDRENS DENTAL PROGRAM The Macon County Childrens Dental Clinic (Molar Roller) provides comprehensive general dental services to children from birth to 20 years of age.
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Eligibility: Resident of Macon County. Exception: Residents of other surrounding NC Counties if client has Medicaid or Health Choice. Services eligible for sliding fee scale with a maximum discount of 75%. Charges not eligible for sliding fee scale discount include: Services not covered by Medicaid or Health Choice and, those covered by insurances which MCPH is not a participating provider.

ADULT DENTAL PROGRAM The Macon County Adult Dental Clinic provides comprehensive general dental services to adults 21 years of age and above. Eligibility: Resident of Macon County. Exception: Residents of other surrounding NC Counties if client has Medicaid. Services eligible for sliding fee scale with a maximum discount of 50%. Charges not eligible for sliding fee scale discount include: Services not covered by Medicaid or Health Choice and, those covered by insurances which MCPH is not a participating provider. Fees for adult dental services will be collected before the service is rendered.

HEALTH EDUCATION/HEALTH PROMOTION Health education/health promotion services are provided to individuals and/or groups. The focus is to promote health and prevent disease, disability and premature death through education-driven voluntary behavior change activities; and is designed to enable people to increase control over, and to improve, their health. Details, policies and fees are specific to each program or activity offered. Fees for these programs and activities are subject to change and appropriately adjusted throughout the year. Eligibility: Residents of Macon and other North Carolina Counties Worksite Wellness Employee health services are available for all employers in Macon County. Employee health services are available on a per program basis or under and annual contract arrangement. Individual program fees will vary and are based on salary expense to prepare and deliver the program; current mileage rates if travel is required; as well as any materials, laboratory, or medical supplies costs. An administrative supplement of 10% is added for each individual program. Comprehensive worksite wellness programs are available under contract for organizations with at least 50 employees. This program, also known as the LIFE program, provides employee health screenings followed by customized programs and consultation services to address the health needs of the employees. Fees for the LIFE program range from $30 to $50 per employee per year depending upon the cost to provide the services, the number of programs provided, as well as the organizations ability to provide in-kind assistance. CPR/AED and First Aid Training:
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Various components of American Red Cross Standard First Aid and/or CPR/AED for lay responders are offered on-site at Macon County Public Healths location at Lakeside Drive in Franklin. Classes are offered for a fee approximately every month. The specific educational components offered may vary from month to month to best suit the current needs of the public. Pre-registration and pre-payment are required. A maximum of twelve individuals may be enrolled in a single instructor class. Fees for the specific educational components are based on current American Red Cross pricing and are subject to change. NUTRITION SERVICES: DSMT Services: Macon County Public Health offers Diabetes Self-Management Training services provided by a Registered Dietitian through American Diabetes Association approval/recognition. The registered dietitian is credentialed and a certified provider with Medicare, Medicaid and BCBS NC. For clients with these insurances, physician referral and medical diagnosis of diabetes the insurance will be billed and costs covered accordingly. For clients without these insurances a sliding fee scale based on annual gross income that is at or below 250% of poverty is used. The scale slides to a minimum discount of 20% in which the client is responsible for payment to the health center prior to service being rendered. MNT Services: Macon County Public Health offers Medical Nutrition Therapy services provided by a Registered Dietitian. The registered dietitian is credentialed and a certified providers with Medicare, Medicaid and BCBS NC. For clients with these insurances, physician referral and covered medical diagnosis the insurance will be billed and costs covered accordingly. For clients without these insurances a sliding fee scale based on annual gross income that is at or below 250% of poverty is used. The scale slides to a minimum discount of 20% in which the client is responsible for payment to the health center prior to service being rendered.

ENVIRONMENTAL HEALTH Fees for Environmental Health Services are collected at time of application by the Macon County Building Inspections Department. REFUND POLICY: Attached

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N. C. Division of Public Health Women's and Children's Health Section Annual Gross Family Income Sliding Fee Scale --101% to 250% of Poverty Family Planning Waiver Eligibility Included

Effective 7/2011

FP Waiver Eligibility*
Partial-Pay Bracket Forty Percent From To 40% 59% $14,975 $20,227 $25,480 $30,732 $35,985 $41,237 $46,490 $51,742 $56,995 $62,247 $67,500 $72,752 $19,058 $25,743 $32,428 $39,113 $45,798 $52,483 $59,168 $65,853 $72,538 $79,223 $85,908 $92,593 Partial-Pay Bracket Sixty Percent From 60% $19,059 $25,744 $32,429 $39,114 $45,799 $52,484 $59,169 $65,854 $72,539 $79,224 $85,909 $92,594 $20,147 $27,214 $34,281 $41,348 $48,415 $55,482 $62,549 $69,616 $76,683 $83,750 $90,817 $97,884 To 79% $23,141 $31,259 $39,376 $47,494 $55,611 $63,729 $71,846 $79,964 $88,081 $96,199 $104,316 $112,434 Partial-Pay Bracket Eighty Percent From To 80% 99% $23,142 $31,260 $39,377 $47,495 $55,612 $63,730 $71,847 $79,965 $88,082 $96,200 $104,317 $112,435 $27,224 $36,774 $46,324 $55,874 $65,424 $74,974 $84,524 $94,074 $103,624 $113,174 $122,724 $132,274

Family Size 1 2 3 4 5 6 7 8 9 10 11 12

Federal Poverty $10,890 $14,710 $18,530 $22,350 $26,170 $29,990 $33,810 $37,630 $41,450 $45,270 $49,090 $52,910

Partial-Pay Bracket Twenty Percent From To 20% 39% $10,891 $14,711 $18,531 $22,351 $26,171 $29,991 $33,811 $37,631 $41,451 $45,271 $49,091 $52,911 $14,974 $20,226 $25,479 $30,731 $35,984 $41,236 $46,489 $51,741 $56,994 $62,246 $67,499 $72,751

Full Pay >100% $27,225 $36,775 $46,325 $55,875 $65,425 $74,975 $84,525 $94,075 $103,625 $113,175 $122,725 $132,275

* at or below 185% of federal poverty level

MCPH Billing Guide FY 13 FY12 Sliding Fee Scale

Effective July 1, 2012

Guidelines for Determining Elements of the Sliding Fee Scale Eligibility screening is required on all new clients or when family size and/or income changes occur, or at 12 month intervals. 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 one economic unit. Individuals are considered members of a single family or economic unit when their production of income and consumption of goods are related. An economic unit must have its own source of income. Example: 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 be considered a separate economic unit. For example, if two sisters and their children live in the same house and both work and support their own children, they would be considered a separate household. EXCEPTIONS TO ECONOMIC UNIT A. B. For Family Planning service only. Un-emancipated minors and others requesting confidential services will be considered a family unit of one, and fees will be assessed based on their own income. A foster child assigned by DSS shall always be considered a family of one.

C.

Determination of Gross Income: The dollar amounts represent gross annual income; they refer to total cash receipts before taxes from all sources. Household income sources include: Salaries and wages, earnings from self-employment (deduct business expenses, except depreciation); interest income, all investment and rental income; public assistance, unemployment benefits, workers compensation, alimony and child support, military allotments; Social Security benefits, VA benefits; retirement and pension pay; insurance or annuity plans; gaming proceeds and any other income not represented here that contributes to the household consumption of goods. This list is not all inclusive. Documents acceptable for income verifications: Current pay stub (noting the pay timeframe i.e.: weekly, bi-weekly etc.) Signed statement from employer indicating gross earnings for a specified pay period, statement must include the business name, address and phone number and must be legible. W-2 Forms Unemployment letter/notice Award letter from Social Security Office, VA or Railroad Retirement Board 1099s received from IRS For Self-employment: Accounting records or income tax return for the most recent calendar year, entire tax return must be provided in order allow deductions for business expenses.

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

MEETING DATE: January 8, 2013 DEPARTMENT/AGENCY: Finance SUBJECT MATTER: QZAB Reimbursement Resolution DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Per the Finance Officer, the County Attorney is preparing this resolution and will have it available at the meeting on Tuesday. COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments _____ Agenda Item 9B

Yes

_X_

No

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

MEETING DATE: January 8, 2013 DEPARTMENT/AGENCY: Emergency Services SUBJECT MATTER: Request from the Sky Valley/Scaly Mountain Volunteer Fire & Rescue for relief fund money DEPARTMENT HEAD COMMENTS/RECOMMENDATION: 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. COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments ___X__ Agenda Item 10A

Yes

___

No

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

MEETING DATE: January 8, 2013 DEPARTMENT/AGENCY: Finance SUBJECT MATTER: modification Resolution approving terms of loan

DEPARTMENT HEAD COMMENTS/RECOMMENDATION: Please see the attached resolution regarding the second part of the refinancing of the BB&T loan, which will lower the interest rate from 4.59 percent to 2.61 percent on an amount not to exceed $7.5-million. The Finance Director can provide additional details at the meeting. COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments ___X__ Agenda Item 10B

Yes

___

No

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 the terms 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 Trust Company (BB&T) dated as of July 18, 2008 (the Original Agreement) ; and WHEREAS, the changes to the terms of the Payment Schedule include revising the interest rate from 4.59% to 2.61% on an amount not to exceed $7,500,000 of the outstanding principal 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 Agreement set forth herinabove are hereby approved and the Chairman of the Macon County Board of County Commissioners is authorized and directed to take such action as may be necessary to effectuate such changes and the Clerk to the Macon County Board of County Commissioners is authorized to attest to any signatures. The prepayment clause in Article III, section 3.03 of the Financing Agreement and Deed of Trust is hereby waived as it relates to the modification. All other terms and conditions of the Original Agreement and the Payment Schedule thereof remain in full force and effect. Adopted this 8th day of January, 2013. Attestation: SEAL

_______________________________ Clerk to the Board of County Commissioners Macon County, North Carolina

______________________________
Chairman of the Board of County Commissioners

Macon County, North Carolina

MACON COUNTY BOARD OF COMMISSIONERS AGENDA ITEM

MEETING DATE: January 8, 2013 DEPARTMENT/AGENCY: Governing Board SUBJECT MATTER: Consent Agenda DEPARTMENT HEAD COMMENTS/RECOMMENDATION:
A. Minutes Consideration of the minutes from the December 11th, 2012 meeting per attachment 11A. Finance Consideration of budget amendments #87 through #91 per attachment 11B. Tax releases Consideration of tax releases in the amount of $1,336.14 per attachment 11C. The supporting documentation is on file in the Deputy Clerks office. Monthly Tax Collection Report For the boards information, the monthly ad valorem tax collection report is attached as 11D. It does not require board action.

B.

C.

D.

COUNTY MANAGERS COMMENTS/RECOMMENDATION:

Attachments ___X__ Agenda Item 11A-11D

Yes

___

No

MACON COUNTY BOARD OF COMMISSIONERS DECEMBER 11, 2012 MINUTES Chairman Corbin convened the meeting at 6:03 p.m. All Board Members, the County Manager, Deputy Clerk, Finance Director, County Attorney, members of the news media and interested citizens were present. 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 arrangements to hold the meeting at the Macon Bank Corporate Center. MOMENT OF SILENCE: Chairman Corbin asked those in attendance to observe a moment of silence. PLEDGE TO THE FLAG: the flag was recited. Led by Commissioner Higdon, the pledge to

PUBLIC HEARINGS: Chairman Corbin called the public hearing on the Elderly Individuals and Individuals with Disabilities Program Grant Application to order at 6:07 p.m., and recognized Macon County Transit Director Kim Angel, who provided a brief overview of the so-called Section 5310 program. She said that this would be a two-year grant totaling $355,500, with the county to provide a 50 percent match of $177,750. No one from the public signed up to speak, and Chairman Corbin closed the public hearing at 6:13 p.m. He then opened the public hearing on the Macon County Community Transportation Program Application at 6:13 p.m. and again recognized Mrs. Angel, who gave a brief description of the so-called Section 5311 program, pointing out its human 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 County Manager, Chairman Corbin closed the public hearing at 6:26 p.m. Upon a motion by Commissioner Beale, seconded by Commissioner Tate, the board voted unanimously to adopt the Public Transportation Program Minutes 12/11/12 Page 1 of 7

Resolution as presented (Attachment 1), a copy of which is attached and is hereby made a part of these minutes. Upon a motion by Commissioner Tate, seconded by Commissioner Beale, the board voted unanimously to adopt the Community Transportation Program Resolution as presented (Attachment 2), a copy of which is attached and is hereby made a part of these minutes. PUBLIC COMMENT: comment period. No one signed up to speak during the public

ADJUSTMENTS TO AND APPROVAL OF THE AGENDA: Upon a motion by Commissioner Beale, seconded by Commissioner Haven, the board voted unanimously to approve the agenda as adjusted, as follows: To modify Item 10A under New Business as a Qualified Zone Academy Bond (QZAB) resolution, per the County Attorney. To add consideration of authorizing the County Manager to enter into an agreement with the North Carolina Department of Transportation regarding McCoy Bridge as Item 10C under New Business, per the County Manager. To add consideration of authorizing the County Manager to enter into a contract with Alliance Consulting Engineers to perform a Phase I environmental study and other related matters regarding the proposed recreational park site located off Maxwell Home Road as 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 the County Manager. To hold a closed session for the purpose of preserving the attorneyclient privilege under Item 13, per the County Manager. To remove Item 11F, Macon County Public Health FY 12-13 Billing and Collection Policies and Fee Schedules, from the Consent Agenda and to table that item until the January 8, 2013 regular meeting. To add discussion of a Georgia-based water study as item 10G under New Business, per Commissioner Haven. To add Budget Amendment #78 to the Consent Agenda under Item 11B, per the Finance Director.

PRESENTATION OF THE COMPREHENSIVE ANNUAL FINANCIAL REPORT Erica Brown with Martin Starnes & Associates presented a Minutes 12/11/12 Page 2 of 7

PowerPoint presentation on the highlights of the countys Comprehensive Annual Financial Report (CAFR) for the fiscal year ending June 30, 2012. She explained that the county had received an unqualified or clean opinion from the firm, and she expressed her appreciation to the Finance Director and her staff. A copy of the CAFR and the accompanying Compliance Letters are on file in the Deputy Clerks office. No action was necessary. BOARD MEMBER COMMITTEE APPOINTMENTS: Chairman Corbin distributed a list of committee assignments for the board for 2013 (Attachment 3), a copy of which is attached and is hereby made a part of these minutes. He also noted that Commissioner Haven would be added as a liaison to the planning board. NCDOT TRAFFIC LIGHT CONTROLLER PROJECT: Emergency Services Director David Key explained that he was seeking approval of a professional services agreement with J.M. Teague Engineering involving the installation of a traffic signal upgrade at the intersection of the US 441 bypass and Hyatt Road, as that upgrade would provide for emergency vehicle preemption of the signal light for ambulances leaving the EMS base. He said that the county had already invested $17,595 in the project and that approximately $13,000 was needed to complete it. The County Manager noted it had taken more to approve and design the project than to install it, but it would be an advantage for EMS personnel to have control of the signal light. Mr. Key took the board through a scenario involving how the preemption would work and recommended completing the project. The County Manager said that the North Carolina Department of Transportation (NCDOT) had been asked to pay for the signal upgrade but would not do so, adding that the additional funds could come from contingency. Upon a motion by Commissioner Beale, seconded by Commissioner Tate, the board voted unanimously to approve an allocation of $13,148 from contingency to complete the upgrade, with Commissioner Beale specifically asking for documentation of a warranty. RESOLUTION AND LEASE WITH FOREX CURRENCY TRADE ADVISORS: Economic Development Director Tommy Jenkins recommended that the board renew a one-year lease with Forex Currency Trade Advisors for space in the Small Business Center at the current rate of $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 had prepared a revised resolution and lease in regard to this, and upon a motion by Commissioner Haven, seconded by Commissioner Tate, the board voted unanimously to approve a resolution declaring property to Minutes 12/11/12 Page 3 of 7

be surplus and approving a one year lease of the same by Macon County to Forex Currency Trade Advisors, LLC. A copy of the resolution (Attachment 4) and lease (Attachment 5) are attached and are hereby made a part of these minutes. RESOLUTION AUTHORIZING NEGOTIATION OF INSTALLMENT FINANCING CONTRACTS: The Finance Director explained that the county had been looking to go to the bond market to refinance some $16 million in debt incurred in renovating East Franklin School and building the MountainView Intermediate School. After contacting BB&T, she said the bank got creative and found a way to refinance the loan by dividing it into two parts. As the county can borrow up to $10 million per year under a qualified (tax-exempt) rate, she pointed out that Macon currently has $8.5 million in loan capacity, and that BB&T was willing to modify the rate on that amount from 4.59 percent to 2.61 percent this month, 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 the county saving more than $2.1-million. Following further discussion, and upon a motion by Commissioner Haven, seconded by Commissioner Beale, the board voted unanimously to adopt a Resolution Approving Terms of Modification (Attachment 6) as presented, securing the 2.61 percent interest rate on $8.5 million of the outstanding principal balance of the loan. A copy of the resolution is attached and is hereby made a part of these minutes. QZAB RESOLUTION: Following discussion and upon a motion by Commissioner Beale, seconded by Commissioner Tate, the board voted unanimously to approve a resolution authorizing the negotiation of an installment financing contract for $1.5 million for renovations to Highlands School using Qualified Zone Academy Bonds (QZAB) funding and to hold a public hearing on this matter at the boards January 8, 2013 regular meeting. A copy of the resolution (Attachment 7) is attached and is hereby made a part of these minutes. SATISFACTION OF SECURITY INSTRUMENT: The County Manager explained that the county was a secured creditor in a security instrument (a deed of trust) covering Community Development Block Grant (CDBG) expenditures for rehabilitation repairs and modifications to the residence of Marvin D. and Lillie R. Bryant, and that the note was now satisfied. He recommended release of the instrument by the county, and that recommendation was approved upon a motion by Commissioner Beale, seconded by Commissioner Higdon, and all favored. A copy of the Satisfaction of Security Instrument (Attachment 8) is attached and is hereby made a part of these minutes. Minutes 12/11/12 Page 4 of 7

NCDOT AGREEMENT REGARDING MCCOY BRIDGE: The North Carolina Department of Transportation (NCDOT) had supplied the county with a proposed agreement as to transfer of ownership and maintenance for Bridge #172, known locally as the McCoy Bridge. Following some background information from Commissioner Beale, and an outline of the specifics of the agreement by the County Manager, Commissioner Beale made a motion, seconded by Commissioner Tate, to accept the terms of the agreement and to transfer ownership and maintenance of the bridge to the county, with the caveat of NCDOT providing signage for the bridge. A lengthy discussion regarding the actual amount of the maintenance cost ensued. The County Manager pointed out that NCDOTs first choice was to tear down the bridge and replace it with a new one, but that residents of the Cowee Community wanted to save it and have a new bridge constructed nearby. Following continued discussion regarding possible options, Commissioner Beale said the board needed to preserve a piece of history, and called for a vote on the matter. The board voted 4-1, with Commissioner Higdon opposing, to approve the agreement with NCDOT as presented (Attachment 9), a copy of which is attached and is hereby made a part of these minutes. PHASE I ENVIRONMENTAL STUDY FOR RECREATION SITE: The County Manager stated that Mike Lavoy, an engineer with Alliance Consulting Engineers, had provided the county with a preliminary layout of a proposed recreation park at the former Parker Meadows Golf Course, and had submitted a proposal to perform the necessary due diligence and grant administration for the project. For a total of $27,900 the county would get a Phase I environmental site assessment, coordination and administration of the Parks and Recreation Trust Fund (PARTF) grant, plus an environmental assessment and wetland survey. The County Manager recommended that the county contract with Alliance for these services, with the funds to come from contingency, with the County Attorney noting that the board could waive the requirement to advertise for these services as the total was less than $30,000. Commissioner Higdon questioned the portions of the proposal that called for certain information to be provided by the owner, and said that municipal sewer would be a must for the project, and that there were considerable drainage issues at the site. There were also questions as to which county ordinances, such as the high impact ordinance, applied to the project. Upon a motion by Commissioner Beale, seconded by Commissioner Haven, the board voted unanimously to waive the requirement to seek proposals, authorize the county manager to enter into a contract with Alliance Consulting Engineers in the amount of $27,900, and to move money from contingency to cover the cost. The Minutes 12/11/12 Page 5 of 7

County Manager requested that the record reflect that the county would proceed with the PARTF application, and the board agreed. FURNISHINGS FOR SHERIFFS OFFICE: The County Manager explained 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 a motion by Commissioner Tate, seconded by Commissioner Beale, the board voted unanimously to move no more than $64,000 from contingency for the furniture. The County Manager noted that the upcoming move by the North Carolina Drivers License office to this location would free up space in the countys Small Business Center. At 8:10 p.m., Commissioner Beale was excused from the meeting, as he had to travel to Raleigh. WATER STUDY: Commissioner Haven expressed his concerns over information that he had received from the University of Georgia School of Forestry regarding a study of water resources in the county, saying that some of the studys suggestions were overbearing. He gave a packet of information to Chairman Corbin for his review and Commissioner Haven said that he had wanted to bring the matter up for discussion. No action was taken. CONSENT AGENDA: Upon a motion by Commissioner Tate, seconded by Commissioner Haven, the following items on the consent agenda were unanimously approved: Minutes Approved the minutes from the November 13th, November 20th and December 3rd meetings. Budget amendments Approved the following budget amendments: #74 for Cooperative Extension to appropriate revenues and expenditures in the amount of $4,200 for Serve Safe classes; #75 for the Airport Capital Project Fund to move $7,530 from contingency as a transfer to the fund, as the airport authority had received additional money for the apron improvements project and this amount reflects the 10 percent match for those funds; #78 for the Health Department to appropriate $4,167 in additional 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 Managers office.) Monthly ad valorem tax collection report No action necessary. Change Order No. 1 on Swiss Colony Project Approved a time extension of 21 days on the project.

Minutes 12/11/12 Page 6 of 7

VOTING DELEGATE FOR LEGISLATIVE GOALS CONFERENCE: Upon a motion by Commissioner Haven, seconded by Commissioner Higdon, the board voted unanimously to designate Chairman Corbin as the boards voting delegate for the upcoming Legislative Goals Conference. CLOSED SESSION: At 8:26 p.m., and upon a motion by Commissioner Haven, seconded by Commissioner Tate, the board voted unanimously to go into closed session for the purpose of consulting with the attorney under G.S. 143-318-11(a)(3). At 9:44 p.m., and upon a motion by Commissioner Haven, seconded by Commissioner Higdon, the board voted unanimously to come out of closed session. RECREATION SITE DUE DILIGENCE: Chairman Corbin explained that the county would be asking to extend the due diligence period on the proposed 48-acre recreation site by 30 days, and to ask for 15 days beyond the end of that period to close on the property, with the understanding that the County Manager is authorized to terminate the agreement if the time is not granted or to sign an amendment if it is. Upon a motion by Commissioner Haven, seconded by Commissioner Higdon, the board voted unanimously to approve the request as stated by the chairman. CLOSE OUT OF IOTLA VALLEY ELEMENTARY SCHOOL PROJECT: The County Manager recommended that the board formally close out the Iotla Valley Elementary School Project by authorizing a final payment of $55,781 to the architectural firm of Bowers, Ellis and Watson, and upon a motion by Commissioner Tate, seconded by Commissioner Haven, the board voted unanimously to do so by moving $55,781 from the projects contingency fund. Chairman Corbin noted that the additional money was necessary due to additional time spent on the project as well as redesign work due to changes in the state building code. ADJOURN: The County Manager reminded the board members of various meetings that were scheduled to take place in January 2013, and he also distributed information on the Community Service Block Grant program for their review. At 9:53 p.m., upon a motion by Commissioner Higdon, seconded by Commissioner Haven, the board voted unanimously to adjourn. _____________________________ Jack Horton, County Manager Clerk to the Board Minutes 12/11/12 Page 7 of 7 ______________________________ Kevin Corbin Board Chairman