GOLD BEACH After a debate that spanned both sides of the lunch hour Monday, the Curry County Commissioners approved changes to a mental health job description to bring the county into compliance with federal regulations.
Having made the big decision to add new duties to one position, the commissioners refused to approve the companion request to remove those duties from the old position.
The confusion began when Human Services Director Deb Wilson asked that the position currently filled by Marty Litchfield be changed from MED Program coordinator at $2,908 a month, to Mental Health Program manager at $3,451 a month.
Wilson said the change did not have anything to do with Litchfield, who was on hand to help explain the situation.
Litchfield is leaving the county on May 11 to accept a job with the Texas Department of Human Resources.
Wilson said she learned her department is out of compliance with federal laws because Jean Hale, the person who currently authorizes mental health benefits, is also a person who provides those benefits.
Wilson said the federal government requires a firewall between authority responsibilities and provider responsibilities to protect from the appearance of impropriety under federal self-referral laws.
She provided the commissioners with a list of the applicable federal laws and the agencies that could enforce them.
She said the penalties include stiff fines and even jail time for people who know about the crossover between authorizing and providing benefits.
To solve the problem, Wilson asked the commissioners to change Litchfields job description so that his replacement would be the person authorizing mental health benefits.
Wilsons companion request would have removed that duty from Hales job description, at no reduction to her $3,287 a month salary.
Hale would have been reclassified from clinical care manager to mental health clinical supervisor, but Commissioner Lucie La Bont failed to get a second when she made that motion.
In spite of La Bonts argument that the county must comply with federal law, the other commissioners were reluctant to approve reclassifying the position for Litchfields replacement.
Commissioner Cheryl Thorp said at budget time, she wanted to look closely at any new job description. She said Wilson already had the most employees of any county department.
Wilson said it wasnt really a new position. She said Litchfield is already doing everything in the description except authorizing benefits.
Commissioner Marlyn Schafer said the county is planning to do a salary study. She didnt know how job descriptions were connected with that and feared some employees could get huge raises because of new descriptions.
Wilson said the Mental Health Program uses no money out of the countys general fund. She said the funding is available from the Oregon Health Plan and state and federal sources to pay for her request.
Schafer asked Wilson if she could authorize the benefits herself.
Wilson said her duties take her away from the office too much. She said the person who authorizes benefits cannot be someone who provides clinical treatment, but should be someone with a clinical background.
Thorp said, Im concerned about building a top-heavy agency. She said the state has not yet guaranteed funding for the year.
Im not trying to be lean and mean, said Thorp. Im trying to be reality-oriented.
She also said Wilson was not appropriate to supervise the mental health program and the psychiatrist scheduled to arrive this summer.
I cannot be an expert in all areas, said Wilson. Thats one reason for this position.
Wilson said if the reclassifications were not approved, she would have to write to Medicare and Medicaid and explain the county knows it is out of compliance with federal law.
Thorp asked her if she could combine positions.
Wilson said that is what she was doing by combining Litchfields position with the position to authorize benefits.
Litchfield said, Were looking at managing mental health in compliance with state and federal regulations.
Were not just willy-nilly making changes. Were not just reinventing the wheel. The changes are well thought-out. Were bringing the program into compliance.
Thorp said, The county has great need. Human Services has functioned with much less people over the past 12 years. If your funding goes away, were in trouble.
Litchfield said his department is running more like private businesses now, more efficiently, and that rewriting some job descriptions is part of that.
La Bont said the state was unlikely to cut funding to Human Services.
She said she spoke with Sen. Ken Messerle in Salem last week and was impressed with his support for Human Services.
He definitely intends to fully fund Human Services, she said. He understands the necessity and how it fits with public safety.
But what is the county doing in that kind of business? said Schafer.
Wilson said with state funding going to the counties belonging to Jefferson Behavioral Health, the money goes into services, not to pay stockholders of private companies.
Litchfield said those services are needed to provide community safety. He said the changes Wilson requested would increase the performance of the Mental Health Program.
Wilson said oversight of the program would be improved.
Thorp was still worried about state funding. She said she would support the request if the department could consolidate somewhere else.
Litchfield said her concerns about state funding were a good reason for the department to be more efficient now. He said with the reclassification, his replacement would be a monitoring agent.
Why not have this management person manage more? said Schafer.
We do, said Wilson. This person will oversee systems in mental health, developmental disabilities and others. This person will take staff productivity data and work with program coordinators.
She said the new psychiatrist would not be the person to do clinical supervision because the psychiatrist needs to be seeing people to generate revenue.
La Bonts first motion was for the reclassification of Hale. It receive no second. Her next motion to reclassify Litchfields position was approved unanimously.
Wilson said the request for Hale was simply to remove the part of her job description about authorizing benefits.
Schafer said she would be willing to do that later if she was provided with a copy of Hales original job description.