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AN ORDINANCE relating to the Public Health Department; amendingSMC 10.03.130 to change Departmental fees for personal health services.

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BE IT ORDAINED BY THE ICITY OF SEATTLE AS FOLLOWS:

S CTIONE 1. Effective January 1, 1985, Section 10.03.130 of the Seattle

Municipal Code (Ordinance 110272 as.amended by Ordinance 110446) is amended as

f ol I ows:

10.03.130 Fees for personal health care and dental services

A. General fees established: Fees for health care services authorized in

SMC 10.60.010 are hereby fixed and established as the indicated maximum

allowable reimbursement levels under Title XIX of the Social Security Act, as

amended, for the indicated units of service, as specified in-the Schedule of

Maximum Allowances and Program Descriptions published July, 1981, by the State

of Washington, Department of Social and Health Services, Division of Medical

Assistance, as amended by memorandum 83-66 issued June 13, 1983, by such

Division, three copies of each of which documents have been filed with the

City Clerk as C.F. 292751 which schedule, as amended, is hereby adopted and,

by this reference, made a part of this section; provided, that fees for denta

services authorized in SMC 10.60.010, are hereby fixed and established as the

Division of Medical Assistance, three copies of which have been filed with the

City Clerk as C.F. 291001, which schedule is hereby adopted and, by this

reference, made a part of this section; provided, further, that in the event

the State Department of Social and Health Services, or its successor,

publishes any new or revised Schedule of Maximum Allowances and no different

fee has been established pursuant to subsection B, hereof, then the Director

of Public Health, after making and filing a finding by said Director that such

new or revised Schedule is consistent with State guidelines for the establish-

ment of such schedules and filing~three copies of such new or revised Schedule

with the City Clerk, which copies are adopted and made a part of this section

indicated maximum allowable reimbursement levels under Title XIX of the Social

Security Act, as amended, for the indicated units of service, as specified in

.the Schedule of Maximum Allowances and Program Descriptions published May,

1981,,by the State of Washington, Department of Social and Health Services,

I by this reference, shall charge and collect, as the Department's fee, the

2 maximum allowable reimbursement set forth in such new or revised Schedule.

3 1. Special fees established:

4 Notwithstanding the provisions of subsection A, hereof, fees for the

5 health care services specified below are hereby established at the following

6 amounts:

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C.

SERVICE FEE

NEW PATIENTS

CPT 90000 Brief Visit $24.00

CPT 90010 Limited Visit $28.00

CPT 90015 Intermediate Visit $36.00

CPT 90017 Extended Visit $53.00

ESTABLISHED PATIENTS

CPT 90030 Minimal Visit, $12.00

CPT 90040 Brief Visit $18.00

CPT 90050 Limited Visit $21.00

CPT 90060 Intermediate Visit $28.00

CPT 90070 Extended Visit $36.00-

PRE-NATAL AND POST-PARTUM CARE

CPT 59440 First Trimester

CPT 59441 Second Trimester

CPT 59442 Third Trimester

CPT 59430 Post Partum Care

$60.00

(44GI94) T7711-_00

$36.00

SPECIALTy rLINICS/PROGRAMSv

Dental Care - Partial Prop~ylaxis- Partial Scal.in_g

(($24.QQ))

$10.00

$16.63

Fee adjustments: Except as is provided in SMC 10.03.130 F, the

Director of Public Health is authorized to charge and collect reduced fees for

the personal health care and dental services authorized to be performed under

SMC 10.60.010, according to the following schedule:

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Gross Income Level ofHealth Care Services Fee

Recipient Category

From more than 100% through150% of the CSA PovertyGuidelines

From more than 150% through200% of the CSA PovertyGuidelines

Over 200% of the CSA PovertyGuidelines

B

C

Fee

(Expressed as a percentageof Departmental fee as

established in

SMC 10.03.130 A or B)

No charge

33% PLUS full Departmentalcost of pharmaceutical

supplies

66% PLUS full Departmentalcost of pharmaceutical

supplies

100% PLUS full Departmentalcost of pharmaceutical

supplies

Provided, that in the event the sum of the percentage of the Departmental fee

specified in Fee Category B, C, or D and the Departmental cost of phar-

uiaceutical supplies is not evenly divisible by 25t, the Director shall add to

such sum whatever amount, up to 24t, will make such adjusted sum so divisible,

and shall charge and collect such adjusted sum as the applicable fee;

Provided, further, that the Director of Public Health is authorized to waive

the fees established by this section, for care provided to any recipient who

demonstrates, or on whose behalf a demonstration is given, to the reasonable

satisfaction of the Director, that such recipient is unable to pay such fees,

or when the Director determines that such services are necessary to avert or

control a current public health problem.

D. The term "CSA Poverty Guidelines," as used in subsection C, hereof,

means the "poverty income guidelines" applicable to the State of Washington,

as published in the Federal Register, Vol. ((44)) 49, No. ((44)) 39, pg.

7151, effective February ((17, 1983)) 262 1984, three copies of

which, together with related information, have been filed with the City Clerk

as C.F.,((242W49)) 293252, and which guidelines are hereby adopted and, by

this reference, made a part hereof; provided, that in the event the Federal

Government.publishes any new or revised poverty guidelines and no different

poverty guidelines have been established by the City Council, then the term

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(To be used for all Ordinances except Emergency.)

"CSA Poverty Guidelines" shall mean such new or revised poverty income guide-

lines, upon the filing of three copies of the same with the City Clerk.

E. No fee for treatment of certain sexually-transmitted diseases:

Notwithstanding any provision in subsection A or B, hereof, to the contrary,

the Director of Public Health shall not charge or collect a fee for health

care services provided for the treatment of syphilis, gonorrhea or chancroid.

F. Fees chargeable to third-party payors: Whenever a chargeable personal

health care service or treatment is provided to a recipient for whom third-

party financial assistance is available, including but not limited to that

from private insurance carriers, and Medicare, the Department shall charge the

third-party payor the Fee Category "Y fee, except for patients covered by

Title XIX of the Social Security Act, as amended, the fees for whom shall be

those specified in SMC 10.03.130 A.

Secflon__~.Z Thii ordin*ince, shall take efrect and be In force thirty days from and after its passage and

Approval, if npproyed by the Xfayor; otherwise it shall take effect at the time It sball become a law undc.r the

provisions of the city chvAer.I ~

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Passed by the City Council........ day of

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and signed by me In open session in authentication of its pass

......... _._ .............

14v.

Approved by me

Filed by me ..... __day oi

(SEAL)

Published... ..... ......... .............. ............. ...........

Attest... ...... ..................

ler and bty Cle&

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Seattle-King County/DEPARTMENT OF PUBLIc HEALTH400 Yesler Way Seattle, Washington 98104 (2 0 6) 5 8 7 - 4 6 0 0

JESSE W. TAPP, M.D., M.P.H.

Director of Public Health

August 10, 1984

Gary Zarker, Director

Off';;-,e of Management and Budget

300~ Municipal BuildingSeattle, Washington 98104

Attention: Germaine Covington

Dear Mr. Zarker:

Re: Personal Health Fees

R E`C

The attached ordinance establishes two new dental fees separate from the sche-

dule of maximum allowances in order to tailor Health Department fees to our den-

tal practices. Obstetric fees have also been increased to reflect the increase

in the Medicaid reimbursement schedule. The specialty visit at Harborview

Medical Center has been omitted. The STD clinic will use the visit fees

established for the rest of the Department. The same changes are being proposed

for adoption by the King County Board of Health.

This request is consistent with the Health Department's 1985 budget proposal.

If you have any questions regarding this ordinance, please contact Elise Chayet

at 587-4615.

Sincerely,

_Jes0' W. Tapp

JWT: EC: nr

Attachment

cc: Judy Clegg

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District Sefvice Centers:

I

CENTRAL NORTH COLUMBIA HEALTH CENTER SOUTHWEST EAST SOUTHEAST

1500 Public Safety Bldg. 10501 Meridian Ave. N. 3722 S. Hudson ! 0820 8th Ave. S.W. 2424 156th Ave. N.E. Renton

Seattle 98104 Seattle 98133 Seattle 98116 Seattle 98146 Bellevue 98007 3001 N.E. 4th St.

587-2755 363-4765 587-4650 244-6400 885-1278 Renton 98056228-2620

Environmental Health Services Auburn172 20th Ave. 20 Auburn Ave.Seattle 98122 Auburn 98002587-4632

852-B400

SOP - 100 - 014

Section 1. Personal Health Services Fees

Section 2. The proposed ordinance will allow the Health Department to

establish two new dental fees, increase obstetric fees to reflect

Medicaid changes, and incorporate Health Department visit fees into

the STD program.

Section 3. The Seattle Division expects to obtain $35,521 in patient

generated revenue for maternity services and $27,000 in dental

fees and donations.

Section 4. N/A

Section 5. N/A

Section 6. On an annual basis, the Health Department will evaluate the effect

of its fee policies on patient generated revenue and access to

care.

Section 7. 'The Department could maintain the status quo. It would result in

a loss of revenue from third party payors for maternity services

and would affect the Department's ability to charge for dental

services.

A "I,ATTIdavit of Publication

STATE OF WASHINGTONKING COUNTY-SS.

The undersigned, on oath states that he is an

authorized representative of The Daily Journal of Commerce,

a daily newspaper, which newspapet, Js a legal newspaper

th, -n r moreon ~-;znd -A is now andI

-1-as bec.-'reulad.

ile-c,-nafterthxn, shn-- r-'- -~jnor to ;A t-U-"

refered to" ij;A% e, n the Eng`slo langvagc, ~-,or tin-- ~ously

a's a da"lly jj~. Sea~ve,-,"

rig C Wasbi.,~grton,

alld -5t is no-~&? ar.d~ d1uring al~ Faid was pi;inted in an~, ortA., cr-owee medi-tta-ned ai t~-lc~ a p ace of y'

+'ki- -'~ws~ aner The -1~3.ailv Jol~n7n.al of Cor-117nerCe 1K,:),S OR tl'~-'

12th day of 'ur a lepal ne,,vspaper K)y1~ -te, 1941, approved as - ,

ti~je superior Court of King U"Llrlly-

v,~ a s -pne notice ii" exact form annexed-,, ub' !shed in

regl,;Iar issues of 'n-ie 1:1w.ly Journal of Cor-nmerce, was

regularly o:, ing f. e belowto its subscribers dur

stated period. The an-rtexed notice, a ------------------------------------------

OrO;-n.ance No. 112026................. . . .......... - -- -------- ............... -------------- - ..................

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cenber L-Mk....... ........was published on --------------

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Sub~cribed and sworn. to before me on

De c~n~~r ---------------------

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.............. 141ey..

otary Publie for the State of Washington,restaing In SOMMe.