Health Services Fee Determination Policy

To provide a uniform and systematic process for determining appropriate fees, the Mercer County Board of Health approved three readings of the following policy on September 14, 2022, October 19, 2022, and November 9, 2022. The policy will take effect ten days after the first publication date.

OBJECTIVE:

The objective is to create a standard guideline for Mercer County Health District (MCHD) staff who determine appropriate fees to charge clients for purchased vaccine, administration fees, and miscellaneous health services fees.

PURPOSE:

The purpose is to ensure periodic review of costs to determine appropriate fees.

DEFINITIONS:

Cost: the amount MCHD pays for vaccine, administration, or other expenses

Fee: the amount MCHD charges the client to recover costs

M Lots: are vaccine lots with the added prefix M designated for vaccine that MCHD received through the 317 Adult Vaccine Fund and Vaccines for Children (VFC) funds.

P Lots: are vaccine lots with the added prefix P designated for vaccine purchased by MCHD, also called private or purchased vaccine.

VFC: is Vaccine for Children, which is a federally funded program for children under the age of 19 who meet criteria established by the Centers for Disease Control.  The client pays nothing for this vaccine. The provider can charge an administration fee to provide the vaccine.

317 Adult Vaccine Fund: is provided through the Ohio Department of Health. Certain vaccines are available for adults without insurance, ages 19 and older, who meet the criteria in the agreement with ODH. The client pays nothing for this vaccine. The provider can charge an administration fee to provide the vaccine.

PROCEDURE:

• The director of nursing or designee will determine purchased vaccines to be ordered. Cost per dose including excise tax will be calculated. The cost will not include prompt payment discounts from vendors.
• The cost per dose will be updated on the Actual Pricing Guide and the billing specialist will be notified that document has been updated.
• The fee schedule for private vaccines and administration codes will be determined based on the highest payor’s reimbursement rate, rounded up to the nearest dollar. A 20% discount will be applied when all fees are paid in full at the time of service.
• Lead and HgB fees are determined by calculating 140% of the current invoiced lab fees and rounding up to the nearest five-dollar increment.
• Tuberculin Skin Testing fees are based on current VFC/317 administration fees.
• Lice shampoo and oil fees are determined by adding the current invoiced fees + shipping and rounding up to the nearest five-dollar increment.
• The director of nursing and billing specialist will review the fee schedule at least once per year. More frequent adjustments may be necessary if vaccine cost or reimbursement rates change.