Buncombe County board adopts FY2027 billing guide, adds PrEP and environmental health fees

The Buncombe County Health & Human Services Board unanimously approved the department's FY2027 billing guide and fee schedule after a presentation and brief questions about access and cost.

Paul Watson, who presented the annual update required by accreditation and state rules, said the county annually adjusts its sliding-fee scale to match changes in federal poverty levels and proposed several specific additions for 2027. New items include fees for self-pay PrEP services (with the sliding-fee protections that can reduce cost to $0 for people with no income), a tattoo convention fee replacing the prior "temporary tattoo artist" definition, a shared-use kitchen fee to cover multiple operators using the same facility, an initial/late public swimming pool permit fee for applications filed within 30 days of expiration, and a public swimming pool night-visit inspection fee to cover additional staffing.

Watson said the clinic now bills some additional vaccine and family-planning methods at rates pegged to Blue Cross Blue Shield or Medicaid — whichever reimbursement is higher — to maximize reimbursables, and that the department has added a billing code for smoking-cessation services and codes to administer injectable PrEP medications.

Board members questioned whether new or adjusted fees could reduce access. Watson said the sliding fee scale allows clients with no income to pay $0, patient-assistance programs and third-party payers (including Blue Cross Blue Shield and Medicaid) frequently cover medication costs, and the department can waive fees or offer payment plans. He estimated clinic visit-and-lab out-of-pocket costs for some PrEP patients would typically run about $100–$200 when assistance is not available, and said patient-assistance programs and third-party billing make the medication broadly accessible; the clinic currently serves roughly 120 PrEP clients. Watson added the department pursues donated vaccine supplies and applies for assistance programs; he cited roughly $10,000 worth of vaccine donations obtained monthly for clients without means to pay.

After discussion the board voted to adopt the FY2027 billing guide as presented. The motion was moved by Greg and seconded by Linda; the chair called the voice vote and recorded unanimous approval.

The department will publish the adopted fee schedule and the supporting documentation; staff said sliding-fee provisions remain to ensure access for low-income clients and that the department has the authority to waive or arrange payment when needed.