HomeMy WebLinkAbout2007-136RESOLUTION NO. 2007- 136
A RESOLUTION OF INDIAN RIVER COUNTY, FLORIDA,
TO ADOPT A 2007/2008 FEE SCHEDULE FOR THE
INDIAN RIVER COUNTY HEALTH DEPARTMENT.
WHEREAS, the Indian River County Health Department has proposed a fee
schedule for October 1, 2007, through September 30, 2008, as more specifically set
forth in Exhibit "A" attached hereto and made a part hereof; and
WHEREAS, Florida Statutes section 154.06(1) provides that the Indian River
County Board of County Commissioners must approve the fee schedule by resolution,
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF INDIAN RIVER COUNTY, FLORIDA, that:
1. Effective October 1, 2007, all of the fees set forth on Exhibit "A" are hereby
approved for use by the Indian River County Health Department, pursuant to
Florida law.
2. The fees set forth on Exhibit "A" are in effect from October 1, 2007, through
and including September 30, 2008, and, thereafter, shall continue to be in full
force and effect from October 1, 2007, and continuing until such time as the
Indian River County Health Department requests that the Indian River County
Board of County Commissioners adopt a new resolution that supersedes this
Resolution in whole or in part.
This Resolution was moved for adoption by Commissioner Bowden
and the motion was seconded by Commissioner Davi s and, upon being put
to a vote, the vote was as follows:
Chairman Gary C. Wheeler Aye
Vice Chairman Sandra L. Bowden Aye
Commissioner Wesley S. Davis Aye
Commissioner Joseph E. Flescher Aye
Commissioner Peter D. O'Bryan Aye
The Chairman thereupon declared the resolution duly passed and adopted this
9th day of October , 2007.
Attest: J. K. Barton, Clerk
By
INDIAN RIVER COUNTY, FLORIDA
BOARD OF COUNTY COMMISSIONERS
Gary,
. Wheeler, Chairman
Deputy Clerk
Attachment: Exhibit "A"
Effective Date: October 9, 2007, nunc pro tunc to October 1, 2007.
APPROVED AS TO FORM
AN ' I_ . ' L SUFFICIENCY
MARIAN E. FEL
ASS; TANT OOUNT`! ATTORNEY
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Laboratory Services 0% - A 17% - B 33% - C 50% - D 67% - E 83% - F 100% - G FEE
IN-HOUSE LAB
LAB $0.00 $2.55 $4.95 $7.50 $10.05 $12.45 $15.00 $15.00
Contracted Laboratory Services
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LAB $0.00 $4.25 $8.25 $12.50 $16.75 $20.75 $25.00- $25.00
NOTE: Tests which exceed a charge of $100.00 will be billed individually on a sliding fee scale percentage based on IRCHD cost of lab service
IN-HOUSE and CONTRACTED LAB Fee is for all labs performed at the time of service.
All Lab fees will be charged in addition to office visits on a sliding fee scale as above.
Records Fees
Copy of Medical Record/per page $0.15 per page and an additional $.05 for double sided copies plus cost of postage if mailed.
Large scale copying requets requiring extensive clerical assistance will be subject to an $10.00 administration fee in addition to the above statad farm
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D5214 Mandibular Partial Denture (Cast Metal)
D5281 Removable Unilateral Partial Denture
D5520 Replace Teeth Complete Denture + LAB
D5640 Replace Teeth - Partial Denture + LAB
D5650 Add Tooth to Existing Denture + LAB
D5660 Add Clasp to Partial Denture + LAB
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D5410 Adjust Complete Denture - Max
05411 Adjust Complete Denture - Mand
D5421 Adjust Partial Denture - Max
D5422 Adjust Partial Denture - Mand
D5510 Repair Complete Denture - Base
05731 Reline Complete Mand - Chairsid(
05750 Reline Complete Max + LAB
D5751 Reline Complete Mand + LAB
D5810 Interim Prosthetic Visit - N/C (INTI
D5820 Interim Partial Denture (Upper FIiF
D5821 Interim Partial Denture (Lower FIiF
D7111 N Coron Remnants -Deciduous
D7140 Ext. Erupted Tooth or
D7160 Sched Surg Post Op
07210 Surgical Erupted
D7220 Surg Ext -Soft Tissue Impact
D7230 Surg Ext -Part. Bony Impact
D7240 Surg Ext -Part. Bony Impact
D7241 Surg Ext -Comp Bony Unusual
D7250 Root Recovery -Surgery
07270 Tooth Reimplant/Stabilization
D7280 Surg Exposure to Aid Eruption
D7285 Biopsy - Hard Tissue + LAB
D7286 Biopsy - Soft Tissue + LAB
D7288 Brush Biopsy + LAB
D7310 Alveoloplasty w/Extraction
D7320 Alveoloplasty No Extraction
D7410 Surgical Excision<1.25cm + LAB 1
D7420 Surgical Excision>1.25cm + LAB I
D7510 I & D - Intraoral (Drainage Abcess)
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D9110 Palliative Services
D9230 Analgesia (Nitrous)
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D0270 Bitewings -Single L or R
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D1351 Sealant - Per Tooth 3, 14,
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For the purpose of family planning, sexually transmitted disease, or HIV/AIDS services only, minors seeking those services shall be
considered a separate family for income eligibility determination purposes and shall be assessed fees for those services based upon their
own personal gross income.
Any client who elects to waive the eligibility determination process shall be assigned to the full fee category. If there is no fee for a service,
income eligibility does not need to be determined, except for WIC.
The self -declaration statement shall include a signed acknowledgment that the statement is true at the time it is made, and that the person
making the statement understands that the provider shall attempt to verify the statement. Verification can be secured by telephone, in
written form, or by face-to-face contact, verification does not require a written document to confirm an applicant's or client's statement.
If th d I 1
e prove er is unable to verify wages pato or an employer will not verify wages paid, the self -declaratory statement provided by the
I nnnGn aria .......a
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.G.,.� y ..y %.nu aria mew suocontractors shall not be denied services for tuberculosis, sexually transmitted disease. or HIWAInS
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JChentsInterviewedexaminedortestedat , , IRCHD's initiative because they are a contact to a case of communicable disease or hem'
IL.e
y are a member of a group at risk mat is being investigated by the IRCHD shall not be charged a fee for the interview examination nr
to f • th
s mg, ese clients may be charged on a sliding tee scale for any treatment indicated, but they cannot be denied services based
Inn in�Lili{.. ►........ _
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• ardl fh"
d female sterilization, shall be limited
ien s may request d review of their fee charge on the basis that they have severe, unusual, and unavoidable expenses or obliaatinns that
subt f II
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munica dlsedsC control because of tenure or inability to pay a prescribed fee, regardless of their income.
eg ess o t eir income, however, the family planning services of inserting Norplant, and male an
depending on the availability of funds to pay for these services.
CI' t � I
s an is y reduce their ability to pay and which warrant special consideration.
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IRCHD POLICIES
School Year Policy Regarding Physicals: If a patient is already established at IRCHD as a primary care patient, physicals will be given
based on sliding fee scale; however, if they are new to the clinic for medical care, they must pay the advance fee of $40.00 unless they
register as a primary care patient and transfer all current medical records to the health department.
County of Residence: (Primary Care) If a patient has Medicaid, other confirmed medical coverage, or prepays out of county charge, we will
see them in the clinic and bill for service. However, all sliding fee or zero pay patients must be seen at the health department in the county of
their residence. Failure to show confirmation of county residence will result in payment of 100% until such confirmation is obtained.
(Exception to this rule will be for treatment of communicable diseases and family planning services.)
Insurance will not be billed for family planning services.
Employee medical care will be provided based on approved policy and procedure.
Hepatitis A & B vaccines are provided free of charge to ages 0-18 per CDC Vaccine for Children guidelines. If a patient has Medicaid
Covera a Med' 'd 11
9 , icai wl cover Hep A & b to age zi. Vaccines will not be provided on a sliding fee scale for non -established patients over
thea a of 18 EXCEP
I9 TION. Vaccine will be provided free of charge or on reduced fee if vaccine is treatment for communicable dicaaca —
to all patients who request HIV test. However, test will be given regrdless of ability to pay.
ses.
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ents who are Dreanant and
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