MACON COUNTY BOARD OF COMMISSIONERS  September 10, 2019 AGENDA  1. Call to order and welcome by Chairman Tate  2. Announcements  A. Update on Space Needs Analysis Project- Derek Roland, Macon  County Manager 3. Moment of Silence 4. Pledge of Allegiance  5. Public Hearing(s) - 6:00 pm. Section 5311 (ADTAP), 5310, 5339, 5307 and applicable State funding, or combination thereof. NOTE: Immediately following the close of the public hearing, the  board may consider taking action. 6. Public Comment Period 7. Additions to agenda  8. Adjustments to and approval of the agenda  9. eports/Prcsentatons  A. Town of Highlands fiber project update. - Town of Highlands B. Broadband for Scaly Mountain Area presentation. - Little T A. Decision regarding telecommunication tower application for 175 ft. monopole tower at 575 CR Cabe Road. Macon County B. Consideration of Macon County Involuntary Commitment Transportation Agreement.- Chester. Jones, County Attorney A. Detention Center Medical Services Contract- Chester Jones, B. Consideration of VAYA resolution in support of funding to meet the mental health, intelectua/deveopment. disabilities, and  Broadband Services  10.Old Business  Board of Commissioners.  11.New Business  County Attorney    substance use disorder service needs of the citizens of Macon County.- Shelly Foreman, Community Relations Regional C. Rejection of bid No. 4310-08 due to change in specifications.- D. Community Care Clinic funding request. Cathy Stiles, Executive  Director, VAYA Health Derek Roland, County Manager  Director  12.Consent Agenda - Attachment  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. August 13, 2019 Board meeting minutes B. Budget Amendments #60-61 C. Tax Releases for August in the amount of $6,807.7 D. Tax Office Monthly Report E. Relief of the taxing unit for collection of real estate taxes that are ten years past due. F. Macon County Public Health billing guide and fee changes FY  19-20' 13.Appointments  A. Southwestern Community College Board of Trustees (1 seat)  B. Recreation Commission (2 seats) 14.Closed session (if necessary) 15. Adjourn/Recess    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  MEETING DATE: September 10, 2019 DEPARTMENT/AGENCY: Transit SUBJECT MATTER: Public Hearing COMMENTSRECOMMENDATION:  Macon County Transit, as part of their annual grant application process, is applying for federal transit funding which is passed through NCDOT to assist with capital, operating and administrative needs during fiscal year  2021.  Attachments X Agenda Item 5  Yes  No    PUBLICTRANSPORTATION PROGRAM: RESOLUTION  FY 2021 RESOLUTION  Section 5311 (including ADTAP), 5310, 5339, 5307 and applicable State funding, or combination thereof. Applicant seeking permission to apply for PublicTransportation Program funding, enter into agreement with the North Carolina Department of Transportation, provide thei necessary assurances and the required local  match. required)  A motion was made by (Board Member's Name).  and seconded by (Board. Member's Name or N/A, if not  for the adoption of the following resolution, and upon being put to a vote was duly adopted. WHEREAS, Article 2B of Chapter 136 of the North Carolina General Statutes and the Governor of North Carolina have designated the North Carolina Department of Transportation (NCDOT) as the agency responsible for administering federal and state public transportation funds; and WHEREAS, the North Carolina Department of Transportation will apply for a grant from the US DeparmemtofTamptation. Federal Transit. Administration and receives funds from the North Carolina General Assembly toj provide assistance for rural public transportation projects; and WHEREAS, thej purpose of these transportation funds isi to provide grant monies to local agencies for the provision of rural, small urban, and urban public transportation services consistent with the policy requirements of each funding source for planning, community and agency involvement, service design, service alternatives, training and conference participation, reporting and other requirements (drug and alcohol testing policy and program, disadvantaged business enterprise program, and fully allocated WHEREAS, the funds applied for may be. Administrative, Operating, Planning, or Capital funds and WAER:ASmom.Communiy Transportation applicants may apply for funding for purchase-of-  costs analysis); and  will have different percentages of federal, state, and local funds. service" projects under the Capital budget Section 5310 program.  WHEREAS, Macon County hereby assures and certifies that it will provide the required local matching funds; that its staff] has the technical capacity to implement and manage the project(s), prepare required reports, obtain required training, attend meetings and conferences; and agrees to comply with the federal and state statutes, regulations, executive orders, Section 5333 (b) Warranty, and all administrative requirements related to the applications made to and grants received from thel Federal Transit Administration, as well as the provisions of Section 1001 of Title 18, U.S.C.  1  Revised 04-03-19    WHEREAS, the applicant has or will provide all annual certifications and assurances to the  State of North Carolina required for the project;  NOW, THEREFORE, bei it resolved that the County Manager of Macon County is hereby authorized to submit grant application (s) for federal and state funding ini response to NCDOT's calls for projects, make the necessary assurances and certifications and be empowered to enter into an agreement with thel NCDOT  toj provide rural, small urban, and urban public transportation services.  7 Michael A. Decker, HR Director/Depuly Clerk to the Board dol hereby certify that the above is a true and correct copy of an excerpt from the minutes of ai meeting of the (Name of Applicant's Governing Board) Macon  County Board of Commissioners duly held on the 10th day of September, 2019.  Signature of Certifying Official  *Note that the authorized official, certifying official, and notary public should be three separate individuals.  Seal Subscribed and sworn to me  Affix Notary Seal Here  (date)  Notary Public*  Printed. Name and. Address My commission expires  (date)  2  Revised 04-03-19    LOCAL SHARE CERTIICATION FOR FUNDING  MACONICOUNTY (Legal Name of Applicant)  Requested Funding Amounts  Project Administrative 5311 Operating (No State Match) 5310Operating (No State Match) 5307 Operating 5307 Planning Combined Capital Mobility Management 5310C Capital Purchase of Service  Total Amount $199,522 $. $165,000 $. $. $98,395 $. $. $ $. $  Local Share $29,928( (15%) $. (50%) $82,500 (50%) $ (50%) $. (20%) $9,840(10%) $. (50%) $ (10%) $ (%) $. (_%) $. (_%)  Funding programs covered are 5311, 5310, 5339 Bus and Bus Facilities, 5307 (Small fixed  route, regional, and consolidated urban-rural systems)  TOTAL  $462,917 Total Funding Requests  $122,268 Total Local Share  The Local Share is available from the following sources:  Source of Funds  Grant Applied To Administrative (5311) Capital 5310 5310  Amount $29,928 $9,840 $19,500 $63,000 $  County General Funds County General Funds County General Funds EDTAP(state)  TOTAL  $122,268  ** Fare box revenue is not an applicable source for local share funding    FY 2021 Local Share Certificate (page 2)  I,t the undersigned representing MACONCOUNTY dol hereby certify toi the North Carolina Department of Transportation, that the required local funds for the FY2021 Community Transportation Program and 5307 Governors Apportionment willl be available as of July1,2020,  which has aj period of performanceof) July 1, 2020 - June 30, 2021.  Signature of Authorized Official Derek C. Roland, County Manager Type Name and' Title of. Authorized Official  Date    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  MEETING DATE: September 10, 2019 DEPARTMENT/AGENCY:NIA  SUBJECT MATTER: Reports and Presentations COMMENIS/RECOMMENDATION:  9A. Representatives from the Town of Highlands will provide an update to the Board of Commissioners on their fiber project, which upon its completion will provide broadband internet service to 9B. Representatives from Little T Broadband Services will provide an update to the Board of Commissioners on their efforts to provide broadband internet service to Macon County Residents  residents and businesses within the town limits.  Attachments Agenda Item 9A-9B  Yes X No    MACON COUNTY BOARD OF COMMISSISSIONERS  AGENDA ITEM  MEETING DATE: September 10, 2019  DEPARTMENT/AGENCY: Board of Commissioners  SUBJECIMATTER: Decision regarding telecommunication tower application for 175 ft. monopole tower at 575 C.R. Cabe Road, Franklin  NC,28734.  COMMENTS/ECOMMENDATION:  Following a public hearing on July 9, 2019 and a continuation on August 13, 2019, the Board of Commissioners will render a decision on the application for a 175 ft. monopole tower at 575 C.R. Cabe Road, Franklin NC, 28734. The applicant for this telecommunication tower is Verizon Wireless.  Attachments Agenda Item 10A  Yes  X No    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  MEETING DATE: September 10, 2019 DEPARTMENT/AGENCY: Legal Transportation Agreement  SUBJECT MATTER: Consideration of Involuntary Commitment  COMMENTS/RECOMMENDATION:  County Attorney Chester Jones will present to the board for consideration the Macon County Involuntary Commitment Transportation Agreement. As you will recall, the requirement for this agreement comes following changes  toinvoluntary commitment laws brought about by SB 630.  Attachments Agenda Item 10B  X Yes  No    STATE OF NORTH CAROLINA MACON COUNTY  MEMORANDUM OF TRANSPORTATION AGREEMENT  THIS MEMORANDUM OF TRANSPORTATION AGREEMENT ("Transportation Agreement") is made and entered as ofthe 3rd day of August, 2019 ("Effective Date"), among the law enforcement agencies listed below and the Macon County Sheriff's Office  Saenfsome7Claetive)x "the Parties',individualy "Party"). Commitments, was amended and is effective October 1,2019; and  WHEREAS, N.C.G.S.9122C-251, Custody and Transportation for Involuntary WHEREAS, N.C.G.S. $122C-251(g) requires the governing body of a city or county adopt a plan known as an "involuntary commitment transportation agreement" or "transportation agreement" for the custody and transportation of respondents in involuntary  commitment proceedings; and  WHEREAS, once adopted, the Transportation Agreement must be submitted to: the Magistrates in Macon County; the Macon County Clerk of Court; the Division of Mental Health Development Disabilities, and Substance Abuses Services; and the Local Management Entity-  Managed Care Organization ("LME/MCO") that serves Macon County. hereinafter set: forth, the Parties mutually agree as follows;  NOW THEREFORE, for and in consideration of mutual promises to each other as 1. After a Macon County Magistrate issues an involuntary commitment order ("IVC Order") and the Magistrate contacts the local law enforcement agency in the jurisdiction where the respondent resides or is physically located, an officer or deputy with the a. Ifthe respondent is a resident of the municipality or is physically taken into custody in the municipal limits, the municipality is responsible for transportation of the respondent in accordance with North Carolina General Statutes Chapter b. If the respondent is a resident of the county outside any municipal limit or is physically taken into custody outside municipal limits, the county is responsible for transportation of the respondent in accordance with North Carolina General  jurisdiction shall retrieve the IVC Order from the Magistrate.  122C.  Statutes Chapter 122C.  2. The officer or deputy shall attempt to locate the respondent at the address provided on the IVC Order or where the magistrate believes the subject is physically located.  (CS:0063866.DOCX)  Page 1of5    3. Upon location, the officer or deputy shall take respondent into custody and transport respondent to Angel Medical Center in Franklin, NC, or other approved facility. After the facility has completed its examination of respondent, and if further care is required, 4. The Sheriff's Office shall respond to the facility for respondent's transport to any facility in North Carolina, identified by the initial facility (who conducted the initial evaluation), 5. Upon completion of the initial evaluation, if the facility determines respondent is not in need of further treatment, an officer or deputy with the agency that took respondent into custody shall return respondent to the address in the IVC Order or allow for other 6. Each party to this Transportation Agreement agrees it is responsible for its own acts and/or omissions and those of its officials, employees, representative and agents in carrying out the terms of this Transportation Agreement and the results thereof to the extent authorization by law and shall not be responsible for the acts and/or omissions of 7. It is understood and agreed that each Party's liability may be limited by the provisions or other immunity law applicable to each law enforcement agency. Parties understand and agree that each Party has not waived its rights, immunities and protections provided by law. Nothing contained in this Transportation Agreement shall waive or amend, nor shall be construed to waive or amend any defense or immunity that either Party, their 8. This Transportation Agreement is not intended to and will not constitute, create, give rise to, or otherwise recognize a joint venture, partnership, corporation or other formal business association or organization of any kind among the Parties. Moreover, the rights and the obligations of the Parties under this Transportation Agreement will be only those  the facility will locate ai facility for respondent's future care.  for respondent's: future care.  transportation arrangements ofr respondent be made.  any other Party and the results thereof.  respective officials and employees, has or may have.  expressly set forth in this Transportation Agreement.  9. This Agreement may be amended by written agreement oft the Parties.  10. Each term, condition, or covenant herein is subject to and shall be construed in accordance with the North Carolina law and anyapplicable federal law. 11.This Agreement may be executed in two (2) or more counterparts each of which will be IN WITNESS WHEREOF, the law enforcement agencies and the Sheriff's Office, acting under authority of their respective governing bodies as evidenced by the authorized signatures of such governing bodies set forth below, have caused this Memorandum of Transportation  deemed to be an original.  Agreement to be duly executed as set forth below.  (G:00686.DOCK)  Page 20 of5    COUNTY OF MACON  By: (SEAL)  James Tate, Chair of the Macon County Board of Commissioners  ATTEST: Date:  Derek Roland, Macon County Clerk  COUNTY OF MACON  By:  Robert Holland, Sheriff of Macon County  (SEAL)  ATTEST:  Derek Roland, Macon County Clerk  Date:  (CS:0063866.DOCK)  Page 3 of5    TOWN OF FRANKLIN  By:  Bob Scott, Mayor of] Franklin  (SEAL) ATTEST: Date:  Travis Tallent, Franklin, Town Clerk  TOWN OF FRANKLIN  By:  David Adams, Chief of Franklin Police  (SEAL)  ATTEST:  Travis Tallent, Franklin Town Clerk  Date:  (CS:00063866.DOCK)  Page 4 of5    TOWN OF HIGHLANDS  By:  Patrick Taylor, Mayor of Highlands  (SEAL) ATTEST: Date:  Gibby Shaheen, Highlands, Town Clerk  TOWN OF HIGHLANDS  By:  Bill Harrell, Chief of Highlands Police  (SEAL)  ATTEST:  Gibby Shaheen, Highlands Town Clerk  Date:  (CS:0006386.DOCX)  Page 5 of5    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  MEETING DATE: September 10, 2019 DEPARTMENT/AGENCY: Legal  SUBJECT MATTER: Detention Center Medical Services Contract  COMMENTS/RECOMMENDATION:  County Attorney Chester Jones will present to the Board, a Contract for Medical Services at the Macon County Detention Center. ** Contract to be presentedfor consideration at meeting**  Attachments Agenda Item 11A  Yes X No    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  MEETING DATE: September 10, 2019 DEPARTMENT/AGENCY: VAYA Health  SUBJECT MATTER: Resolution in support of funding to meet the mental health, intelectualdevelopmenta. disabilities and substance use  disorder service needs of the citizens of Macon County.  COMMENIS/RECOMMENDATION:  Shelly Foreman, Community Relations Director with VAYA Health will be requesting for the Board of Commissioners to consider a resolution in support of funding to meet the mental health, imelecmualdcvecPmena disabilities and substance use disorder service needs of the citizens ofMacon  County.  Attachments XYes Agenda Item 11B  No    MACON COUNTY BOARD OF COUNTY COMMISSIONERS  RESOLUTION IN SUPPORT OF FUNDING TOI MEET THE MENTAL HEALTH, INTELLECTUAL/DEVELOPMENTAL DISABILITIES, AND SUBSTANCE USE: DISORDER WHEREAS, MACON County recognizes that, with appropriate services and supports, individuals WHEREAS, MACON County further recognizes that individuals with intellectual developmental  SERVICE NEEDS OF THE CITIZENS OF. MACONCOUNTY with mental health and substance use disorders can achieve recovery; and  disabilities ("IDD") can live productive lives in the homes and communities oft their  choice; and  WHEREAS, the amount of resources needed for mental health, substance use disorder and IDD WHEREAS, MACON County is a member of Vaya Health, a public Local Management Entity/  services and supports is increasing due tol North Carolina'si increasing population; and Managed Care Organization ("LME/MCO") responsible for management and oversight ofp publicly-funded mental health, substance use disorder and IDD services for over 270,000 Medicaid-covered and uninsured individuals across twenty-two (22) western  North Carolina counties (the "Catchment Area"); and  WHEREAS, consistent with the goals oft the 1915(b)/(c) Medicaid Waiver expansion, the Vaya Health  Board ofl Directors developed a comprehensive reinvestment plan beginning in SFY 2015-16 as part ofai focused effort toi reduce unnecessary emergency department admissions, divert people from incarceration and institutionalization, combat the opioid epidemic, and support county Departments of Social Services; and  WHEREAS, Vaya has already reinvested $18.5 million of its Medicaid savings in al broad array of  initiatives designed to directly address the needs oft the citizens of MACON County, including but not limited to expanding Facility Based Crisis and Behavioral Health Urgent Care services, implementing an innovative evidenced-based service to support children aging out oft the foster care system, distributing opioid overdose reversal kits, increasing provider rates and expanding Medication Assisted' Treatment; and  WHEREAS, State funding for North Carolina's behavioral healthcare system has been inconsistent and  inadequate for more. than 17 years since mental health reform legislation was passed by  the North Carolina General Assembly in 2001; and  WHEREAS, the North Carolina General Assembly has reduced State funding for behavioral health  services (known as single-stream funding) by more than $458 million statewide over the past four years, including more than $48 million in cuts to single-stream funding to Vaya    alone, while requiring Vaya and other LME/MCOs to continue offering the same level of  State-funded services as before such reductions; and  WHEREAS, ifthej proposed $9 million single-stream reduction int the pending State budget is passed  into law, the General Assembly will have cut $57 million in single-stream funding from  Vaya; and  WHEREAS, despite these significant single-stream funding reductions, Vaya has continued serving  the uninsured and underinsured using remaining State funds and Medicaid savings that were: intended tol be used for implementing its reinvestment plan; and  WHEREAS, such continued reductions have forced Vaya to eliminate, or halt work on, items from its WHEREAS, MACON County has continued to: fund Vaya with County dollars to supplement services  reinvestment plan; and  to our residents, but we are concerned that additional reductions in behavioral health funding by the State may increase the need for the local allocation and place additional strain on local hospitals, Emergency Medical Services, jails, housing, and other social  service resources.  NOW, THEREFORE, BEI ITI RESOLVED, that we, thel MACON COUNTY Board of Commissioners,  dol hereby request that the North Carolina General. Assembly:  Stop cutting Vayal Health's State single-stream funding sO that such funds can be utilized to strengthen access to healthcare services fort the mental health, intellectual/ developmental disabilities, and substance use disorder needs ofuninsured and underinsured MACON County Allow Vaya Health to build up its Medicaid savings sO that Vaya can reinvest in services and supports for our communities rather than mandating that such funds be used to: replace reduced  citizens; and State funding.  This the 10th day of September 2019.  By: (SEAL)  James Tate, Chair oft the Macon County Board of Commissioners  ATTEST:  Derek Roland, Macon County Clerk  Date:    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  MEETING DATE: September 10, 2019 DEPARTMENT/AGENCY: Administration SUBJECT MATTER: Rejection of bid No. 4310-08 COMMENTSRECOMMENDATION:  Administration will be requesting that the Board ofCommissioners reject bid No. 4310-08. Specifications on this bid, for 4 patrol vehicles were changed following release ofthe bid, which in turn, invalidated all responding bids. Changes to the vehicle specifications were made by the Sheriff's department following a change in the department's vehicle needs.  Attachments Agenda Item 11C  X Yes  No    Macon County Sheriff's Office Bid No. 4310-08 - Four (4) Patrol Vehicles opened Friday, August 9, 2019 @ 3:00 p.m.  Make Model Price Per Vehicle Options Per Vehicle Total Bid  Ilderton Dodge Chrysler. Jeep Ram Jacky. Jones Ford Ken Wilson Ford  Dodge Durango $ 30,755.00 $ Ford Explorer $ 36,349-70 $ Ford Explorer $ 37,644.00 $  2,305.00 $ 132,240.00 145,398.80 150,576.00 550.00 $ 134,200.00  Smoky Mountain Chrysler Dodge. Jeep RAM Dodge Durango $ 33,000.00 $    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  MEETING DATE: September 10, 2019  DEPARTMENT/AGENCY: Community Care Clinic SUBJECT MATTER: Funding Request COMMENTS/RECOMMENDATION:  The Community Care Clinic has received $145,000 annually in grant funding, for the past three years from the Office of] Rural Health. This grant however, expired on July 1,2 2019. The Office of Rural Health recently notified the Community Care Clinic that their request for a continuation of this grant was not accepted due to limited funds available. Asaresult, the Community Care Clinic will be requesting funding to cover basic operating expenses over the next six months, in which they will continue to look for an ongoing and sustainable funding source. Additional information will be  provided at the meeting.  Attachments Agenda Item 11D  Yes  X No    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  MEETING DATE: September 10, 2019 DEPARTMENT/AGENCY: N/A SUBJECT MATTER: Consent Agenda COMMENTS/RECOMMENDATION:  12A. Minutes oft the August 13, 2019 Regular meeting  12B. Budget Amendment #60-61  12C. Tax Releases in the Amount of $6,807.70 for the month of  August  12D. Tax Office Monthly Report  12E. Release of the taxing unit for collection of real estate taxes that 12F. Macon County Public Health billing guide and fee changes FY  are ten years past due  19-20'  Attachments Agenda Item 12A-12F  X Yes  No    MACON COUNTY: BUDGET AMENDMENT AMENDMENT# FROM: Lindsay Leopard DEPARTMENT: Sheriff's Office  4p0  EXPLANATION: Donations and Caléndar Sales Appropriation: for Shop witha Cop, MCSO Christmas  Dinner, Operation Think Twice, Prime for Life, and Calendars.  ACCOUNT 113840-417900 114310-556024 113344-435015 114310-556024  DESCRIPTION Fund Balance. Appropriated Special Fund Expenses Calendar Sales Special Fund Expenses  INCREASE $25,000.00 $25,000.00 $15,000.00 $15,000.00  DECREASE  REQUESTED! BY  RECOMMENDED BY FINANCEOFFICER APPROVED BY COUNTYMANAGER  A  Barudbel  ACTION BY OABDOICOMMIONENS 9ho/19 meebing  APPROVED ANDENTEREDONLMINUTESDATED.  CLERK    MACON COUNTY BUDGET AMENDMENT  AMENDMENT# DEPARTMENT: HEALTH EXPLANATION: expenditures and revenue.  Ll  Receivedinew grant monies (GusNIP Grant). Need to increase budget in  ACCOUNT 115128- 113511-  DESCRIPTION GusNIP-Federal GusNIP- Federal  INCREASE  DECREASE  377,252 377,252  REQUESTED BY DEPARTMENTHEAD Carmine Rocco RECOMMENDBD BY FINANCE OFFICER Kuandhael  APPROVED BY COUNTY MANAGER ACTION) BY BOARDOF COMMISSIONERS APPROVED. AND ENTERED ON MINUTES DATED  glio/19 mekny  CLERK    heleases 8/19  Tax Collections 09/03/19 Group Number REL*19*08 Seq Date Account Taxbill Nbr Number Number 10 08/14/19 7125 19A6596376558 ALLEN, GRADY T 08/08/19 56419 19A6573966129 BLEVINS, WILLARD H JR 20 08/28/19 64069 19A7459172502 BRAMBLETT, BLEANOR ARCHER 15 08/20/19 113147 19A7429961421 BREGAR LLC 17 08/21/19 108752 19A108752.07 C'EST LA VIE LLC 18 08/21/19 17782 19A17782.07 CEST LA VIE, LLC 08/05/19 139317 19A139317,12 CIT BANK N.A. 7 08/13/19 143878 19A143878.01 FLANAGAN, MICHAEL F 08/13/19 140461 19A6531158848 HARRISON, ROBERT BLAIR 21 08/29/19 139384 19A6584991593  Detail Transactions by Group Tax Transaction Code Amount GO1 97.42- F08 29.69- LO1 95.00- GO1 229.24- 229.24- 0.00 F01 33.34- GOI 104.47- 104.47- 0.00 F10 8.36- G01 732.24- 732.24- 0.00 P10 58.63- G01 14.33- F03 2.62- LO1 95.00- 111.95- G01 62.43- F03 11.40- 73.83- G01 108.48- 108.48- 0,00 F01 15.78- G01 194.84- 194.84- 0.00 F01 28.34- G01 248.43- 248.43- 0,00 F05 48.00- GO1 296.13- 296.13- 0.00 F01 43.07-  RTC020303 Page Descripen  Effective Date 08/05/19  Levy Penalty Addl Interest Discnt Trn Check Trans Rev Amount Amount Chgs Amount Amount Cde 0.00 95.00- 0.00  97.42- 0.00 29.69- 0.00 33.34- 0.00 8.36- 0.00 58.63- 0.00 14.33- 0.00 2.62- 0.00 56.75- 5.68- 10.36- 1.04- 15.78- 0.00 28.34- 0.00 48.00- 0.00 43.07- 0.00  0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00  222.11- 127.11- 0.00 95.00- 0.00 0.00 R CLERICA 262.58- 262.58- 0.00 0.00 0.00 0.00 R CLERICA 112.83- 112.83- 0.00 0.00 0.00 0.00 R CLERICA 790.87- 790.87- 0.00 0.00 0.00 0.00 R CLERICA  ***  0.00 95.00- 0.00  16.95- 0.00 95.00- 0.00 0.00 R CLERICA 67.11- 6.72- 0.00 0.00 0.00 R CLERICA  124.26- 124.26- 0.00 0.00 0.00 0.00 R CLERICA 223.18- 223.18- 0.00 0.00 0.00 0.00 R CLERICA 296.43- 296.43- 0.00 0.00 0.00 0.00 R CLERICA    Tax Collections 09/03/19 Group Number REL*19*08 Soq Date Account Taxbill Nbr Number Number HENSON, JO ELIZABETH 13 08/20/19 137432 19A137432.14 LARD, LAWSON A III 08/06/19 139666 MCTYEIRE, ROBERT A, 08/14/19 113411 19A7550158392 MOSBY, JOHN D III CO-TRUSTEE 08/06/19 11684 19A7459257948 PADGETT, GLORIA B 08/09/19 53311 19A53311.08 PASSMORE, GENE SILER 23 08/30/19 38372 19A38372.11 PEAVY, MERRELL o 16 08/21/19 132325 19A7540894100 SMITH, JAMES EUGENE CO-TRUST 12 08/19/19 19885 19A19885.14 SNEAD-SMITH DUO INC 22 08/30/19 56418 19A56418.12  Detail Transactions by Group Abatement Tax Transaction Code Amount G01 58.94- F10 4.72- HO1 24.62- 86.28- G01 187.35- 187.35- 0.00 F10 15.00- HO1 78.25- G01 402.10- 402.10- 0.00 F10 34.76- G01 485.50- 485.50- 0.00 F10 38.87- G01 3.75- F05 0.72- LO1 95.00- 99.47- G01 8.62- FO8 2.63- 11.25- G01 530.16- 530.16- 0.00 F10 42.45- G01 1195.23- 948.52- 246.71- P10 95.69- KO1 499.21- 396.17- 103.04- G01 F01  RTC020303 Page  Effective. Date 08/05/19  Levy Penalty Addl Interest Discnt Trn Check Amount Amount Chgs Amount Amount Cde Number Trans Descriptn Rev  339.20- 339.20- 0.00 0.00 0.00 0.00 R CLERICA  58.94- 0.00 4.72- 0.00 24.62- 0.00 15.00- 0.00 78.25- 0.00 34.76- 0.00 38.87- 0.00 3.75- 0.00 0.72- 0.00 8.62- 0.00 2.63- 0.00 42.45- 0.00 75.94- 19.75- 9.75- 0.00 1.42- 0.00  0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00  88.28- 0.00 0.00 0.00 0.00 R CLERICA  280.60- 280.60- 0.00 0.00 0.00 0.00 R CLERICA 436.86- 436.86- 0.00 0.00 0.00 0.00 R CLERICA 524.37- 524.37- 0.00 0.00 0.00 0.00 R CLERICA  0.00 95.00- 0.00 4.47- 0.00 95.00- 0.00 0.00 R CKERICA 11.25- 0.00 0.00 0.00 0.00 R CLERICA  572.61- 572.61- 0.00 0.00 0.00 0.00 R CLERICA 1790.13- 1420.63- 369.50- 0.00 0.00 0.00 R CLERICA  9.75- 1.42-    Tax Collections 09/03/19 Group Number REL*19*08 Seg Date Account Taxbill Nbr Number Number STATE FARM MUTUAL AUTO INS co. 11 08/15/19 137689 19A6578269176 THOMAS, WILLIAM F. 08/13/19 49760 19A49760.01 US BANCORP NATIONAL 19 08/22/19 93406 19A7530950152 14 08/20/19 57536 19A57536.01  Detail Trancacti ions by Group Abatement Tax Transaction Code Amount 11.17- G01 64.44- FOB 19.64- 84.08- G01 24.02- FO1 3.49- 27.51- F10 10.08- HO1 52.60- G01 31.61- F07 8.91- L01 95.00- 135.52- 14.02- 48.72- 8.91- 51.96- 380.00-  RTC020303 Page  Effective Date 08/05/19  Levy Penalty Addi Interest Disent Trn Check Trans Rev Amount Chgs Amount Amount Cde Number Descriptn 11.17- 0.00 0.00 0.00 0.00 R CLERICA 84.08- 0.00 0.00 0.00 0.00 R CLERICA 27.51- 0.00 0.00 0.00 0,00 R CLERICA  64.44- 0.00 19.64- 0.00 24.02- 0.00 3.49- 0.00 10.08- 0.00 52.60- 0.00 31.61- 0.00 8.91- 0.00  0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00  G01 125.93- 125.93- 0.00  HOWARD R  188.61- 188.61- 0.00 0.00 0.00 0.00 R CLERICA  0.00 95.00- 0.00  WIGGS, INGRID LUCILLE  40.52- 0.00 95.00- 0.00 0.00 R CLERICA 12.98- 1.04- 0.00 0.00 0.00 48.72- 0.00 0.00 0.00 0.00 8.91- 0.00 0.00 0.00 0.00 51.96- 0.00 0.00 0.00 0.00 0.00 0.00 380.00- 0.00 0.00  Tax Code Totals F01*19- FR FIRB F03*19- OTTO FR FOS*19- WM FIRE F07*19- BT FIRE F08*19- COWEE FR F10*19- HLDS FR H01*19- HLD CITY L01*19- RES FEE Total for Group REL*19*08 Cycle  125.44- 125.44- 0.00 0.00 0.00 0.00 308.56- 288.81- 19.75- 0.00 0.00 0.00 654.68- 551.64- 103.04- 0.00 0.00 0.00 6807.70- 6051.48- 376.22-380.00- 0.00 0.00  G01*19- GEN TAX 5215.41- 4963.02- 252.39- 0.00 0.00 0.00  Totals By Tax Cycle Current Delinquent 6807.70-  0.00    ADV VALOREMT REPORT Aug-19  Beginning Levy Less Less  Equals Gross Less  Outstanding -777831.66 2629432.39 456705.11 1803669.61  Montht tol Date Balance Added Releases Write- Offs Adlevy Payments Refunds MiscDr/Cr NetPayments Balance  Generalt Tax Firec Districts LandfilUser Fee Totals Veart toDate GeneralTax FireD Districts landfi UserFee Totals COMPAREDT TO3 33.95%0  24783507.51 3495.34 5799.16 -16.7 24781186.99 6201439.29 3652.77 8773.83 -6189012.69 18592174.3 30452079.82 4152.33 -7385.79 -20.6 30448825.76 -7437419.04 3652.77 10216.81 -7423549.46 23025276.3 Balance Added Releases Write-Offs Adjlewy Payments Refunds Misc Dr/Cr NetF Payments Balance Percentage 28347776.57 -5799.16 -1133.76 28340843.65 -9772094.19 8947.44 14477.4 -9748669.35 18592174.3 34779533.52 -7385.79 1308.59 34770839.14 -11771150.62 8947.44 16640.34 -11745562.84 23025276.3 33.78  3407626.45 656.99 -1016.63 -2.76 3407264.05 -778641.31  0 809.65 0 633.33  2260945.86 Beginning Levy Less  0  -570 -1.14 2260374.72 -457338.44  Less  Equals Gross Less.  Outstanding Callection 1244.61 -1246780.54 2629432.39 32.16 -750112.95 1803669.61 29.37  34.4  3877396.95 -1016.63 167.39 3876212.93 -1248025.15  2554360 2018T TAXES ASOF 8/31/2018  -570 -7.44 2553782.56 -751031.28  918.33  34.4%0 COLLECTEDON:2 20190 COUNTYG GENERAL TAXES, LATELISTING PENALTIES, DISCOVERIES ANDDEFERED1 TAXESASO OF 8/31/2019AS    TO: FROM: RE:  Macon County Commissioners Macon County Tax Collector's Office Teresa McDowell, Tax Collections Supervisor  Relief of the Taxing Unit for Collection of Real Estate Taxes that are Ten Years Past Due  Dear Commissioners:  Itist the practice in North Carolina that the tax collections staff be relieved of collecting any tax accounts that are a minimum of ten (10) years old. Under North Carolina General Statute $105-378, "no county or municipality may maintain an action or procedure to enforce any remedy provided byl lawi for the collection of taxes or the enforcement of any taxl liens unless the action or procedure isi instituted within ten (10) years from the date the taxes became due". There is some confusion in connection to utilizing this statute, in thati it affects only utilizing enforced collection remedies, and does not automatically relieve the. tax collector of the obligation to collect taxes that are more than ten (10) years past due. The only formal method for relieving at tax collector of the collection responsibilityi is through thei insolvents process, which states that after a tax has been declared insolvent, the governing board is permitted to relieve the tax collector of responsibility for collecting the tax. This decision does not release the taxpayer from responsibility for the tax, however the tax collector responsible for the taxes Chris McLaughlin, Associate Professor of Public Law and Government for the UNC School of Government states in his! book "Fundamentals of Property Tax Collection Law in North Carolina" that the practice in "manyi if not mostj jurisdictions (in North Carolina) is for the taxing unit to write off taxes that are more than ten (10) years old and relieve the collector from collecting these taxes by' "re- charging" the tax collector with only the ten (10) most recent years oft taxes each year when the new property taxes are levied." Using this process, any taxes more than ten (10) years old may be collected ifoffered, cannot be collected using enforced remedies, and will no longer affect the tax collector's collection percentage from priort tax years. This office is requesting that this practice be utilized in Macon County, and that the Tax Collector only be charged with the last ten (10) years taxes to collect. Ihave attached the outstanding tax bills fort the 2008 year as ofJ June 30", 2019, and ask that this  need no longer include them on subsequent annual settlements.  office be relieved from collecting these taxes.  2008: Respectfully,  $27,349.48  Thank you and please contact my office if yous should have any questions.  Tuus memu  Teresa McDowel!    TAX COLLECTIONS ALL BILLS 2008 CODE/DESCRIPTION AO ADV COST F01FR FIRE F02 CLCH PR F03OTTO FR F04 CULL FR FO5WM FIRE F06_SCALY FR F07BT PIRE F08 COWEE FR Fo9 NANT FR F10 HLDS FR F11 MTVAL FR G01 GEN TAX HO1 HLD CITY L01 LANDFILL 210 BILLS  MACON co. TAX COLLECTOR STANDING TAX BILLS BY YEAR AS OF 07/01/19  RTC0804 PAGE 1  ORIGINAL TAX INFORMATION LEVY PENALTY 516.00 0.00 712.65 16.29 245.79 0.00 308.41 0.00 210.13 0.00 217.21 0.00 4.69 0.00 158.23 6.00 756.65 2.61 190.45 0.00 165.96 1.07 159.16 0.00 22,581,74 232.65 22,614.39 1,689.12 6.41 4,B00.00 0.00 32,716.19 265.03 32,981.22  TAX DUE INFORMATION LEVY PENALTY TOTAL DUE 508.42 0.00 622.03 16.29 243.22 0.00 308.41 0.00 210.13 0.00 135.45 0.00 4.69 0.00 148.20 6.00 756.65 2.61 190.45 0.00 86.87 1.07 159.16 0.00 18,758.31 232.65 18,990.96 380.21 6.41 4,572.25 0.00 27,084.45 265.03 27,349.48  TOTAL 516.00 72B.94 245.79 308.41 210.13 217.21 4.69 164.23 759.26 190.45 167.03 159.16 1,695.53 4,800.00  508.42 638.32 243.22 308.41 210.13 135.45 4.69 154.20 759.26 190.45 87.94 159.16 386.62 4,572.25    Requested changes to the Billing and Collection Policy  Page Number Section  Change  4  Payment by Consumer  1. Addition of phrase "nor subject to variation" as recommended by state consultant. 2. Changed wording to indicate we will provide itemized receipt upon request - per state 3. Added statement that charges incurred during a visit but not paidi for on date of visit will be billed. Program. These: services will not be billed to an insurance and include CDL Physicals, College Entrance Physicals, etc. current Consolidated and Agreement and all program Agreement Addenda's that are issued by the state. Removal of the requirement of participation in the Health Risk Assessment - Insurance no longer requires this 1. Addition to clarify that we accept all consumers to 2. Removed "this can be a confidential service" per 3. Added verbiage for confidential service consumers' protection from collection process  consultant.  5 6 7 8  Payment By Third Party Addition of Specialty exams under the Adult Health Compliance With Title Addition ofa a statement that says we also comply with the  VlandVII Employee Health Family Planning  process.  the program notj just women. state consultant  9  Miscelaneous/Seneral Removed Miscelaneous/Seneral Services and clarified Services/Adult Health Adult as previously: stated that no insurance willl be billed Adult Dental Program Changed Sliding Fee Scale to 250% of Federal Poverty and  for these services. Removed "womens health colposcopy" the maximum discount to 75% which will match the Child  Added "Other Services" section  10 11 12 12 12 12  Dental Program. Spelled out DSME Spelled out MNT  Nutrition Services Animal Services Guidelines for Determining Elements oft the Sliding Fee Scale  Environmental Health Removed at the will of and replaced with by the Boards  Removed at the will of and replaced with by the Boards Removed HIS and replaced with dental record.    Fee Changes  New clinical charges for the Integrated Care: services  99492 99493 99494  hitial psychjatrio collabroative care management first 70iminutes Subsequent psychiatrio collaborative gare-management 60mnutes Collaborative care management,each additional 30mins in amonth  131.00 105,00 55.00  New Lab feel based on outside physician order  82679  ESTRONE, SERUM  44.00  New Labi fee based on negotiated rate  86003  ALLERGEN SPECIFIC IgE QUANTITATIVEOR SEMIQUANTITATIVE (24  126.00  units)  Thisi is a decrease in price due to a negotiated rate for the 24 unit panel fora allergy testing for LabCorp charge. The price is for all 24 units. The previous charge was a per unit charge which added up to $800.  We willl be bringing this document to you throughout the year as price changes are passed on to. us. This willi include increases and decreases in price, especially immunization rates. We also plan to evaluate the dental fees soon based on thei fact that we are now getting a higher reimbursement from Medicaid.    Formatted: Differentf first page header  MACON COUNTY PUBLIC  HEALTH  FY18-19 19-20  Billing and Collection Policies  And Fee Schedules Effective  Presented to and Approved by Board ofHealth on Presented to and Approved by Board of Commissioners on  April24,2018 May-8,2018    Macon County Public! Health Billing Guide FY19-20  Effective  MACON COUNTYI PUBLICHEALTH BILLING. ANDCOLLECTIONPOLICIES  RATIONALE  North Carolinal law' allows al local board of! health toi impose af fee for serviçes tol be rendered by al local health department, except where thei imposition ofai fee is prohibited by statute or where an employee oft the local health department is performing the services as an agent oft the State. Fees may bel based on aj plan recommended! by thel Health] Director; Thep plani must be: approved by thel Board ofHealth and thel Boardo of County Commissioners; And, fees collected undert thea authority ofthis subsection aret tol bec deposited tot thes account oft the locall health department sot that theyr may bec expended for public! healthp purposes ina accordance witht thep provisions oft the Local Government! Budget andl Fiscal Control. Act. The State requires locall health departments top provide certain services, and no one may bec denied these services. Itis int thel besti interest of our community for thel Health Centert to: Provide ast many other recommended: andi needed! health services as possible, withint ther resources wes still Thel HealthI Director has the rightt to waivei fees fori individuals who forag good cause aret unablet toj pay.? Thej purpose of charging feesi ist toi increaser resources: and uset them tor meet: residents' needsi inaf fair and balanced way. Fees arer necessary tol helpi identify and cover the full cost ofp providing public! healths services. As mucha as possible, fees arel based ont the true cost ofp providing ap particular service (calculated as direct costs] plusi indirect costs). Throughout the year, ongoing costa analyses are performed andi fees schedules shall be adjusted! by thel HealthI Director, with approval from the! Boàrd ofHealth and thel Board ofCommissioners ini the's amount oftl thei increased cost for Thei information int the document belowi is.t thef feel planf for FY 19-20, effective on. July 1,2019. This Billing Guide for  Assuret that all residents can get alll legally required! public! healths services.  have availablet tou use.  prevision ofs saids serviçes. AI list of Health Center fees is available upon request.  FY119-201 replaces all earlier plans. COST OF SERVICEI DETERMINATION  Costs fors services received through thel Health Center aret based on the: actual cost oft thes service Cost analysis takes into account all oft thei resources associated with providing aj particular service and calculates the actual çost to provide that service. Cost analysisi includes the calculation of direct andi indirect costs for serviçes and then adding Calculating direct cost: Direct costs are expensest that can be easily relatedt tot thej provision ofas specific service, i.e., physician ands supports staff salaries andl benefits, medical supplies, labt tests, and other resources Calculating indirect costs: Indirect costsi involver resourcest that arer not directly consumed duringt the provision ofas service, but withoutt them thej provision oft that service wouldr not bej possible, i.e., administrative: staff salaries andl benefits, training costs, façility costs,i insurancej premiums, office equipment ands supplies, andi recruiting  these figures together toc determinei the: actual cost oft the service.  consumed: att thet time oft thes service. andi marketinge expenses.  'North Carolina General Statue 130A-39(g) 2IAW1 Tite.X8.4.3(42 CFR59.2)  Page3    Macon County Public Health Billing Guide FY19-20  Effective  PAYMENT: BY CONSUMER ORI RESPONSIBLETHIRD, PARTY (SELFPAY)  Fees are charged fors services and collected att the! Health Center. See attachment: for fees schedule. All fees are thet responsibility oft the consumer, consumer or responsiblet third party andr mayb bes subjectt tot thes sliding fee scale. Noo consumer willl ber refused services solely ont their inability top payf fors said: services. All fees may bep paidb by cash, check, orr major credit card. Fullj payment is expecteda att thet time ofs service. Consumers willl bei informedo oft their account status ate each visit. Ani itemizedt receipts showingt total charges, as well as any discounts willl bep providedt to individuals at timé of payment. Thirdp parties authorized orl legally responsiblet top payi for consumers at or below 100% ofthe Federall Povertyl Lèvel are properly billed. Fees for adult dentals services willl bec collected beforet thes servicei is rendered. Prepayment ofc co-pays for alls servicesi inv which co-payments apply willl ber required: and collected when Fees willl bec charged toi individualsi in families with annual grossi incomes exceeding specified1 levels ofas scale based on current Federal) Poverty Income Guidelines. Verification ofi income and family size must bep providedto determineac consumer'se eligibility: status. Falsification oft thisi information willp permanently disqualify consumers from using sliding fees scale. Eligibility willl ber reevaluated: as consumer'si income and household: status changes or at least annually. Ifincome cannot be verified att thet time of screening, the chargef for all services willl be at 100% pay anda al Payment Agreement will bep presented tot the consumer for signature until verification: is provided. If verification ofi incomei is received within thirty days ofas servicé, the chargey willl ber retroactively adjustedt tor reflect percent pay based on verificationi received. Verificationi received after thirty days willl be applied only to future services. Eligibility of! Medicaid will be determined where applicable. Individuals willl bei requestedi top provide ali socials securityr numbers and names used for employment; purposes. Ifani individual refusest top providei informationt to verify income, they willr not be eligible fort thes sliding fees scale and will be at 100% pay. Customary visit services fori mandatory childhoodi immunizations, community outreach, Tuberculosis (TB), TBI related X-rays, Sexually" Transmitted! Disease control (STD), and other epidemiological investigations are provided atr no cost tot the consumer but may be! billedt tol Medicaid or other third party agent. Separate feest may be charged for drugs, supplies, laboratory services, X-rays and other technological services, ifa appropriate. The costs of services performed by providers not affiliated withl Macon County Publicl Health: are ther responsibility ofthe consumer. Fees may be charged or waivedi for educational: services providedt toi individuals or groups, such as  services arei rendered.  orientation, preceptorship, field training or classes. Charges not eligible for slidings scale discount include: Environmental. Healths seryices Non-mandatedi immunization: services  Misellancouslgencrals services (seel Misellaneous/eneral: sectionb below) Out-of-county residents (see Out-of-County Servicel Restrictions: sectiont below) Specifici insurances situations (seel Insurance section belowi for details)  Bills willl be mailed monthly toi individuals whol have not paid charges in full for services rendered (exception Family Planning for those that request noi maill bes sent tot their home).. All bills will show total charges, as well as any discount that may haveb been provided. Arrangements mayb bet madef forj payment plansy when requiredi for good cause.  PAYMENTBY THIRDI PARTY  Verification ofe enrollment under) Medicare, Medicaid, insurance or other third party payment plani isr required by presentation ofay valido card at the time ofs service. Thel Health Centeri isr requiredt tol bill only participatingt third party payers fors services rendered. Services that arel billedt tot third parties areb billeds at 100% oft thet total charge with no discount applied unlesst there isac contractedi eimbursement: rate thati must bel billedp per thet third party agreement. When the claimi is returned from thet third party payer all discounts are applied att that time. (ie, any applicables sliding fee scale adjustment)] For services rendered to consumers withi insurance where thel Health Center is not ap participating provider, the consumer willl ber responsiblef for flpayment ofs service when the servicei is delivered. The consumer    Macon County Public! Health Blling Guide FY19-20 arer nots subject tot thes sliding fee eligibility scale. Sliding fee scale discount does nota applyi int the followings situations: Consumers withi insurancei iny which MCPH ist not! participating provider. servicesi i.e. Family Plannings serviçes and Communicablel Disease Services). Insurance co-payments (when) MCPHi isa ap participating provider). Servicest that are offered as specialty exams undert the Adult Health Program.  Effective.  is responsible for charges not covered1 byt third party payers. Co-pay amounts must bep paid att thet time ofs services and  Consumers with any insurance who chooser nott tou uset their coverage (exception thosei reguestingconfidemntial  ACCOUNTCOLLECTIONSANDI BADI DEBT  The Health Center willi issue all consumers ai monthly statement off fees that have beeni incurred: and are due. Consumers are expectedt toI make payment att thet time services arei rendered. Ifab balancei is carried forwardo consumers whol have not made aj payment on their account for any service(s)received: from Macon County Publicl Healthf for 120 days shalll ber requiredt top pay their past due balancel before another services shall ber rendered (see Servicel Denial for The Health Center may uset the following resourcest to pursue collection of consumer accounts: billing statements, past duei notices, collection agencies or credit bureaus, and the NCI Local Government: Debt Setoff Clearinghouse (ref: NCGS 105A-1 ets seq.) as administered! by thel NCI Department of Revenue Accounts willl be reviewed annually for bad debt status, and att that time with the approval oft thel BOH and the BOCC'sthe amounts may be written offf for accounting purposesi ifn nof further collection is anticipated.. Any payments received for write-off debts willl be: accepted: and credited to appropriate: accounts. Atnot time will a consumer be notified that the account has been written offass al bad debt. Bado debti may ber reinstated att time of service unless itis determined uncollectible (i.e. bankruptcy, death), aty which time it will bes written offp permanently.  furtheri information).  CONSUMERI DONATION. POLICY  A consumer may chooset tor make a donation tot the agency. The consumer willi never bes asked1 tor makea donation, buti ifofferèd the: donation: is accepted. Donations: are notr required, and arei not ap prerequisite fort the provision of anys seryice. Billingr requirements: set outa abovei int thel Payment by Consumer: section arer noty waived  because of consumer donations. (ref. Donationl Policy 101.9) RETURNEDCHECKPOLICY  AS $25.001 feey willl be chargedi for al returned check writtent tol Macon County Public) Health (MCPH). The consumer willl be notified viat telephone orl letter. Allr returned checks willl ber made good via cash, money order, and/or certified check. Ifac consumer has two returned checks withina a one-year period, he/shey willl ber requiredt toj payf for servicesi in advance via cash, money order, or certified check fort thep period ofone year. After the one-year period expires, ifanother returned check occurs, allf futureb billsi must! be paidy with cash, money order, or certified check prior tot the provision ofs services. (Exception: Family) Planning, Childl Healths and! Maternal Healths services for families with income ato or below 250% ofFederal Poverty shouldr not pay morei inc co-payments or additional fees than what they otheryise! pay whena a Schedule ofl Discountsi is applied. 421 U.S.C.300e ets e/42CFR3959).  REFUNDS  Int the event that a consumer or other third-party has overpaid their responsible charges, the credit balancei is either: applied to future charges or1 refundedt tot thej payer within thirty (30) days of discovery or request. Refunds for  Environmentall Health services are determined! by attached policy and procedure.  Page 5    SERVICEDENIAL  Noi individual may be denied Health Center mandated: services e.g. communicable disease: services (STD/TB) andi immunizations. Theses services are provided at no charge tot the consumer. Individuals who dor not meet program, guideline criteria may be denieds specifics services. Consumers coveredb by Medicaid who. fail tor make required co-1 payments will not bed denied serviçes but may bes subject toc collections and/or bad debts set-off.. Individuals whol have not! paidp proper charges for previous services (unlesss states and federal program rules prohibit serviçes restriction or denial) mayl ber requiredt toj payf fees beforehand, be denied access tos services (see Account Debts), or bec denieds subsequent services] pending demonstration ofag good faith effortt tor make payment withint the  Collections andl Bad past ninety (90) days.  OUTOFG COUNTY: SERVICEI RESTRICTIONS  Macon County supports itsl low-income citizens by subsidizingt the cost for certain! health care services. To assuret that Macon County citizens! have maximum access tol Health Centers services only thoses services mandatedb by Federal Law, North Carolina General Statues or approvedi int this plan willl bep providedt tor non-Macon County residents. Ifani individual moves out ofMacon County, they are encouragedto obtains serviçes from another provider. Consumers arer requiredt tor report any change ofaddress att time ofs service. COMPLIANCEWITHTITLEVIAND VII,OF 421 US CODE CHAPTER21 language assistance sot they have meaningful access to.t the: agency'ss services.  Thel MCPH complies with' Title Vi and" Title' VII oft the Civill Rights Act of 1964 and all requirements imposed by or pursuant tot the regulations. Staff will not discriminate against any consumers because of age, sex, race, creed, national origin, or disability. Staff will ensure consumers withl LEP are provided adequate Services will be provided. reported and billedi in compliance with the most current Consolidated. Agreement and  Formatted: Indent: Left: 0", Firstl line: 0"  allp program Agreement. Addendas. PROGRAM: SPECIFICINFORMATION  COMMUNICABLEDISEASECONTROL  Deals with thei investigation and follow-up of alli reportable communicable diseases. Testing, diagnosis, treatment, and referring as appropriate, ofay variety ofSTD's. Provides follow-up andi treatment ofTB cases and their contacts. Noi fees are charged directly to consumers: for these services as statedi inl Program Rules (exception. Medicaid or other third party agent canl bel billed with the consumer'spemision),  Eligibility:  Noresidency or financial requirements  BREAST ANDCERVICALCANCIRCONTROLPROGRAMCECCCP)  Provides paps smears, breast exams and screening mammograms, assists women with abnormal breast cramnarosmammogrm, or abnormal cervical screenings to obtain additional diagnostic examinations.  Eligibility:  Page6    Must bea a resident of Macon County; uninsured or underinsured; without! Mediçarel Part B orl Medicaid;  between ages 40-6 641 for breasts screenings services and 18- 641 for ceryicals screening services; have al householdi income ato or below 250% oft thei federalp poverty level. No charge for those who qualify: for thep program; familys size shall bec determined: as follows: Consumer, spouse of consumer and all children under 18 years of age, including step-children whol live  int thel home. Proof ofi income must be provided. CHILDI HEALTH Choice; Medicaid Eligibility:  Well child exams conducted' by (appropriate provider); exami includes medical, social, development, nutritional history, lab work, andj physical exam. MCPH: accepts self-pay; most] Private: Insurances; Health  Residents ofN Macon County; Birtht thru 20 years;  >Discounts are used fori incomes between 101 -25096ofFederal Poverty. Consumers whose income exceeds 250% ofFederal Poverty are charged usingt the departments Schedule of Fees. Consumers whosei income isa at orb below1 100%0 ofFederall Poverty are not charged for Child Health services. Provides acute episodicr mediçal care and chronice disease management services. This] programi is not  EMPLOYEEI HEALTH Eligibility:  intended tor replace ani individual'sp primary care provider.  APymppe the-e eounty's-"Health Risk-A6seSSHeNE Newe employees int the waiting period fort their healthi insurancet tos start Employees and retirees andi their dependents ont the county healthi insurancej plan Select part-time employees as determinedbyt the county manager.  WORKSITE WELLNESS  Employeel healths services are available for all employersi in Macon County. Employeel health services are available on aj per program basis or under and annual contract arrangement. Individual program fees will vary and areb based ons salary expense top prepare and deliver thep program; current mileage ratesi iftraveli is required; as well as any materials, laboratory, ori medical supplies costs. An administrative: supplement of 10% is addedf fore eachi individual program. Comprehensive worksite wellness programs are available under contracti for organizations and companies with at least 506 employees. This program, alsol known: ast theLIFE provides employeel healths screenings followedb by customized programs and consultation: services toa address thel healthr needs oft the employees. Fees for thel LIFE program rangef from $30to $50 per employee per year depending upon the cost top providet thes services, thei number of programs provided, as well ast the  program,  organization's 's abilityt toj providei in-kinda assistance.  IMMUNIZATIONS  Page7    Provide all required andr recommended vaccinest that are available: fori infants, school aged children and college boundi individuals. Also] provideav wide range of vaccines for adultst toi include foreignt travel vaccinations. MCPH: accepts most Privatel Insurances, Health Choice, Medicaid, andl Medicare. Ins somei instances charges dor nota apply (e.g. states supplied vaccine). Sliding fees scale does not apply toi immunizations.  Eligibility;  Noresidency or financial requirements fori immunizations. CARECOORDINATION. FOR CHILDREN(CC4O  Caser management assists families ini identification ofa ands access tos services for children with special needst that  will allow them thei maximum opportunity to1 reach their development potential.  Eligibility:  Macon County children birtht toa aget three who are atr risk for developmental delay or disability, longt term illness and/ors social, emotional disorders and children ages birth tof fivey whol have been diagnosed with developmental delay or disability, longt termi illness and/or social, emotional disorder may be eligible for  thej program. FAMILYPLANNING  Services Clinie designed to assist çonsumers wemeni inp planningt their childbearings schedule; detailed history, lab work, physical exam, counseling and education given by (appropriate provider). MCPH accepts self-pay; most Private Insurances; Medicaid or potentially Medicaid eligible.  Eligibility:  This can bea a "confidential service"  Schedule ofI Discounts: isl used fori incomes between 101 -250% ofFederal! Poverty. Consumers whose inçome exceeds 250% ofFederall Poverty are charged usingt the departments Schedule ofFees. Consumers whose incomei is. at or below 100% of Federall Poverty arei not charged for Family) Planning Services are providedy without regardt tor residençe requirements andy withouta ai referral by aj physician (42 Proofo ofi income must be' provided. (Exception: fort those requesting" "Confidential Services" that dor not have proof ofi income orb by producing proof ofi income may put their confidentiality ati risk, they may writea a statement of declaration ofi income., )Wherel legally obligated or authorizedi tor receivet thirdp party reimbursement: includingi public orp privates sources alli reasonablet effortst must bei made to obtains said payment without application ofa any discounts. Family) Incomes should! bes accessed1 before determining whether co-payments or additional fees are charged. Families withi inçome at or below 250% ofFederal Poverty shouldr not pay morei inc co-payments or additional feest than what they otherwisej pay whena Schedule ofI Discounts is applied. (42U.S.C.3 300 ets seq.42 CFR5 59.5 (a)(9)). AFamily Planning consumer willi never ber refused al Family) Planning service, or askedt tor meet with the Health] Director due toa delinquent account; howevert they may! be referredt tol Debts set-off. Incomei information: reported ont thel Familyl Planning financiale eligibility screening can beu used through  services.  U.S.C. 3006 et seq. 42CFR: 59.5(b)(5).  Pages 8    other programs rathert than re-verification ofincome or relying on the consumer declaration. Pregnancy tests will bec charged! basedo on the qualifying Schedule ofDiscounts. MASCHHMANEOUSIGEERALSERHCEALTH Include: daycare, DOT, foster care, employment or others specialty physical exams.-laboratory- services, oekalm.CApospil Fort these services noi insurances will bel billed.  Formatted: Indent: Left: 0.44", Right: 0.53", Line spacing: Exactly1 12.6pt  Eligibility:  18y years and older Phaysmiss,  Residents ofN Macon County (exception, colposcopies, pregnancy tests, laberateryservies) Theses services arei not eligible for sliding fee scale payment. Services will be paid for priort tos any service beingr rendered. Any additional fees associated witha a visit willl be addedt tot the consumers: account and  paidi inf full ato checkout, LaboratoryServices Eligibility: None Exceptions: None MATERMALHEALTE  OTHER SERVICES  Third partyi insurançe can be billed. these services are not eligible for Sliding Fee Discount. Prenatal carei isi medical care recommendedi for women during pregnancy. The: aim of good prenatal carei ist to detect any potential problems early, to preventt them ifp possible (through recommendations ona adequate nutrition, exercise; vitamini intakee etc), andt to directt they woman tos appropriates specialists, hospitals, etc. if necessary. Visits arei monthly duringt the firstt twot trimesters (from week onet tov week 28 ofp pregnancy), every two weeks from 28t to week3 36 ofp pregnancy and weekly after week: 36 (until the day ofdeliveryt that couldb be between week 38 and 40 weeks). MCPH: accepts self-pay; most Privatel Insurances; Medicaid or potentially  Medicaid eligible. Eligibility:  Residents of Macon- eligibility policy andi residency requirements attached Matemal Health consumers willl bei requiredt tol have proofofresidency  Proofo ofi income isi required.. services.  Schedule ofDiscountsi is used fori incomes between 101 250% ofFederal Poverty. Consumers whose income exceeds 250% of Fedéral Poverty are charged using the departments Schedule of] Fees. Consumers whosei incomei is ato orb below 100%0 ofFederal Poverty arei not charged forl Maternal Health  OB CARECOORDINATIONMANAGEMENT(OBCM)  Case manager assists pregnant women ini receiving needed prenatal care andj pregnancy relateds services.  Eligibility:  Residents of Macon County  Page9    Primary Care  Provides primary, cares services for Macon County residents between.t the ages of21-6 64. Consumers are. requiredt to complete an application to determine eligibility priort tor receivings services. Third partyi insurance willl beb billeda appropriately. Self-pay consumers: may qualify for sliding fees scale discount based ont their family size and householdi income with the maximum discount of 60%. Sliding fee discount ist based on  Formatted: Font: NotE Bold  250% off federal poverty. Eligibility:  Resident ofMacon County between thes ages of21-64  WOMEN, INFANTS, ANDO CHILDRENI NUTRTIONPROGKAMCIO  Supplemental nutrition ande education programt toj provide specific nutritional foodsa and education servicest to Eligibility: WICi isa availablei top pregnant, breastfeeding, and postpartum women, infants, and children up to: age  improve! health status oftarget groups. 5 who meet the follow criteria: Bear resident ofl Macon County; Be atr medical and/or nutritionali risk; CHILDRENS! DENTALPROGRAM  Haveaf familyi incomel less than 185% oft the US Federall Poverty] Level; Medicaid, AFDC, or food: stamps automatically: meét the income eligibilityrequirement  Thel Macon County Children's] Dental Clinic (Molar Roller) provides comprehensive general dentals services to children from birth to 20 years of age. Self-pay consumers may qualify for sliding fees scalel based ont their familys size and householdi income. Sliding fee discount is based on 250% of Federall Poverty with ai maximum  discount of75%. Eligibility:  Resident ofN Macon County. ADULTDENTALPROGRAM  Thel Macon County Adultl Dental Clinic provides comprehensive general dental servicest to adults 21 years of age and above. Self-pay consumersi may qualify foras sliding fee discount based oni family size and! household income. Slidingf fee discounti is based on2 2509ofFederall Poverty with amaximum discount of7 75%. Skimglee-disgeantisdseminadem2eAywithemMimeBH diseeuntof50%er  Eligibility:  Residents ofN Macon County.  Charges note eligible for sliding fee scale discount include: Services not covered by Medicaidor  Page 10    Health Choice andt those covered byi insurances whichl MCPHi is not aj participatingprovider., Fees for adult dental services will be collected beforet thes servicei isr rendered. Health education/healtht traimngprogamservices are provided toi individuals and/org groups.  (i.e. Fluoride treatments for adults)  COMMUNITY EDUCATION. ANDTRAINING  Eligibility:  NoReasridiomyRepiremat: EXAMPLE  Cardiopulmonary resuscitation (CPR) Automated external defibrilators(AED) First Aid' Training: EXPLANATION  Various components of American] Red Cross Standard] First Aida and/or CPR/AED1 forl lay responders are offered on-site at! Macon County] Public Health Classes are offered foraf fee- -Pre- registration andj pre-payment: are required. Fees for thes specific educational components are  based on current American. Red Cross! pricing.  NUTRITION! SERVICES:  Formatted: Right: 0.9" Formatted: Indent: Hanging: 0.08",Right: 0.9"  Diabetes Selr-Management) Eduçation (DSME) DSME-Services:  Macon County] Public Health offers Diabetes Self-Management. Education/Training: services accredited by the American! Diabetès. Association The registered dietitians are credentialed: and cértified providers withs somet third party payors.-For consumers with third partyi insurance,, a physician referral and medical diagnosis ofd diabetesi isi requiredi in order for thei insurance to be billeda and costs coyered accordingly. Self-pay consumersi may qualify fora a slidingf fee discount based oni familys size and household: income, Sliding fee discount is determined on 250% ofi federal poverty with ar maximum discount of2 20%in which the consumer: ist responsible for paymentt tot the Macon County Public Health offersI Diabetes Prevention. Program accredited by" The Center for Disease Control and Prevention, Because there: ist no establishedi billing code fort thisp program accepted by third party payors and to encourage participation, asmallp program fee willb be established for each] participant. Consumers may qualify for sliding fee scale discount based ont their familys size andl household: income with the sliding fee discounti ist based on 250% of federal poverty. Medicaid or Medicaid eligible consumers may be eligible for a Center: for Disease Control and Prevention (CDC)s sponsored: scholarship andt therefore arer not chargeda a feei for thep program, but  health center priort tos service beingr rendered. Diabetes] Prevention. Program (DPP)  are eligible for thei inçentives. Eligibility > Declaration ofI Income  Page 11    Medical Nutrtion Therapy (MNT) Services:  Formatted: Right: 0.9"  Macon County Public Health offers Medical Nutrition" Therapy services. The registered dietitians are credentialed: and certified providers with somet third party payers. For consumers witht thirdp party insurance, aj physician referral anda a coveredr medical diagnosisi is requiredi in order for thei insurance to bel billeda and costs covered: accordingly. Self-pay consumersi may qualify fora sliding fee discount based on family size and! householdi income. Slidingf fee discount is determined on 250% off federal poverty with a maximum discount of20%i iny whicht the consumer: is responsible for paymentt tot thel health center prior tos service being rendered: to consumer.  ENVIRONMENTALHEALTH  Unlike other health department fees, Environmental Health fees are determined bya att the-willoft thel Boards of Health and County Commissioners. Environmental. Health fees from other counties are.t takeni into consideration. Exception, water testing fees are determined based on actual costs for supplies/test. kits. Fees  for Environmentall Health Services are collecteda att time ofa application,  REFUNDPOLICY: Attached  ANIMALSERVICES  Unlike other health department fees, Animal Service fees are determined] by at-the-willeft thel Boards of Health and County Commissioners. Animal Service fees from other counties are takeni into consideration.  Fees for Animal Services are due: att time ofs Service.  Guidelines for Determining) Elements oft the Sliding) Fee Scale  Eligibilitys screening isi requiredi on all new consumers or when family size and/ori income changes occur, or at 12 monthi intervals. A consumer' s! percentage of payi is documented ont the! Financiall Eligibility Applicationi in the consumer'si medical: record and dentalrecord-HS. Consumer: incomei informationi reported canl bet usedto determine eligibility for other sliding fèe based programs (i.e. Adult! Health, Child] Health, Prenatal, Family Definitioni for Family Size and CountableGross Income for the following clinics: Primary Care, Nutrition Services,: Child Health, Maternal Health, Family Planning andl Dental Af family is defined as as group ofr related ori non-relatedi individuals who arel living together as one economic unit. Individuals are consideredr members ofa as single family or economict unit when their production ofi income and Example: consumer with noi inçome: must be considered part ofal larger economici unit thatp provides supportt tot the household. Groups ofi individuals livingi in thes samel housev with other individuals may! be consideredas separate economict unit. For example, iftwos sisters andt their children livei int thes same house and both work and support their  Planning andl Dental).  consumption ofg goods arer related. An economici unit must havei its owns source ofi income.  own children, they would! be considereda a separatel household.  Page 12    EXCEPTIONSTOECONOMICUNI  A. Un-emancipatedi minors and others requesting confidential: services willl bec considered: ai family unit of  one, and fees willl bes assessed based ont their owni income. B. Af foster child assigned! by DSSs shall always be consideredaf family of one.  Determination: of Gross Income:  Thed dollar amounts represent gross annuali income; theyr refer tot total cash receipts beforet taxes from all sources. Householdi income sources include: Salaries and wages, earnings from self-employment (deduct business expenses, except depreciation); interesti income, alli investment: andr rental income; public assistance, unemployment benefits, worker'so compensation, alimony, military allotments; Social Security benefits, VAT 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 listi is not alli inclusive.: Documents: acceptable fori incomes verifications: Current pay stub (notingt the pay timeframe i.e.: weekly, bi-wéekly etc.) business name, address and phonei number and must bel legible. Award letter from Social Security Office, VA or Railroad) Retirement: Board must be! providedi in ordert to allow deductions: for business expenses.  Signeds statement from employer indicating gross earnings: foras specified pay. period, statement must includei the  W-2) Forms Unemployment letter/notice 1099'sr received from IRS  Fors Self-employment. Accounting records ori income taxi return fort the most recent calendar year, entire tax return  Page 13    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  MEETING DATE: September 10, 2019 DEPARTMENT/AGENCY: N/A SUBJECT MATTER: Appointments COMMENTSRECOMMENDATION:  A. Southwestern Community College Board ofTrustees. (1 seat)  B. Recreation Commission (2 Seats)  Attachments X Yes Agenda Item 13A-B  No    Printform  Application for Appointment to Macon County Authorities, Boards, Commissions and Committees Thel Macon County Board of Commissioners believes all citizens should have the opportunity to Participate in governmental decisions. The Board wants to appoint qualified, knowledgeable and dedicated people to serve on authorities, boards and committees. Ifyou have an interest in being considered for an appointment to any advertised vacancy, please thoroughly complete the form below before the advertised deadline and choose from the following options.  Mail to: County Manager's Office 5West Main Street Franklin, North Carolina 28734  or FAX to: 828-349-2400  Any Questions, please call the County Manager's Office at (828)349-2025 Name of Authority, Board or Committee applying for: Recreation Commission  Name Timothy Crabtree Address'g1 Hoffman Lane Telephone: Home 828-371-2665 Occupation Self Employed  City Franklin  NCZip 28734  Work  Business Address 2119Lakesidel Dr. Suite B, Franklin, NC, 28734 Email. Address immycrabehotmallcom  Briefly explain any anticipated conflict ofi interest you may have ifa appointed:  N/A  Educational Background Minor Business Administration Business and Civic Experiences/Sklls: Crabtree Family Building & Inv. Areas of] Expertise and Interest/Skills: Business. Outdoor Recreation. Organized Sports  BSR Recreation Management- Commercial Recreation &T Tourism Management Appalachian State University- 2007 Own and Operate Motor Co. Grill, Crabtree Generals Store & Coffee, Main St. &Lake Emory! Storage, Papa Prints,  Franklin High School Graduate: 2003  Served 3yr Term Franklin Area Chamber of Commerce Board  List any Authorities, Boards, Commissions or Committees presently serving on: Tourism Development Committee (Macon County-Frankin &! Nantahala)  Tourism Development. Authority (Town of Franklin) Speclal Olympics ofMacon County SIGNATURE:   StreetsofFranklin  DATE: AWG. 13 2019