lela human services combined 2015 v3 -asheville · 9/21/2015 10 medicaid managed care all lmes must...
TRANSCRIPT
9/21/2015
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Essentials of Human Services:What Every County Commissioner Should Know
Mark Botts, Jill Moore, and Aimee Wall
September 2015
Agenda
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Human Services
• Mental Health
• Public Health
• Social Services
Consolidated Human Services
Three Questions
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1. What do the agencies do?
2. How are the agencies organized?
3. What are the county commissioners’ roles?
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WHAT ARE HUMAN SERVICES?
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5
Mission is to enhance and
protect the health and well-being of
all Americans.
Meeting human needs through an interdisciplinary
knowledge base
Maintaining a commitment to
improving the overall quality of life of
service populations
Focusing on prevention as
well as remediation of
problems
“Human services”
Social services
Public health
Aging
Veterans
Trans-portation
Other?
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General Government
4%
Public Safety19%
Economic and Physical
Development7%
Solid Waste3%
Water/Sewer3%
Libraries/Culture1%Envt’al Quality
.3%
Education32%
Other6%
Human Services25%
Catawba County Projected
ExpendituresFY 2014-15
Total: $207.3 million
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Social Services77%
Public Health22%
Partners BHM1%
Other0.2%
Catawba County Projected Human Services Expenditures – FY 2014-15
Total: $51.8 million
Other Counties?
37%
6%
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Based on FY 2010-11 Data Available from
NCACC
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• Congress, DHHS, Other Agencies
Federal
• General Assembly, DHHS, Rulemaking Bodies
State
• Boards of county commissioners• Agency governing boards• Agencies
Local
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Intergovernmental: Who does what?
• Federal funding with strings attached
• Drives policy development– Who is served?
– What services?
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Federal Role
• Establish policy via legislation• Appropriate state and federal funding
General Assembly
• Implement policy via rule (laws)
Rulemaking Bodies
• Distribute funds• Supervise county administration• Audit, quality assurance, technical assistance, appeals
NC DHHS
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State Role
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• County role varies across the three areas
• Boards of County Commissioners have common roles
Establish the agency
Establish the governing body
Appropriate funds
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County Role
MH/DD/SA:
Less direct involvement for
BOCC
Other HS (including PH/SS):
More direct involvement for
BOCC
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Recent Legislative Trend: Role of BOCC
Questions?
?
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MENTAL HEALTH, DEVELOPMENTAL DISABILITIES, AND SUBSTANCE ABUSE SERVICES
Mark Botts
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Terminology
Area Authority
Local Management Entity (LME)
Managed Care Organization
(MCO)
Three Questions
1. What do LMEs do?
Statutory law
DMH contract
DMA contract
2. How are LMEs organized?
Statutory law
3. What is the role of the board of commissioners?
Statutory law
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WHAT DOES AN LME DO?
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What Does an LME Do?
Local management entities are responsible for the management and oversight of the public system of MH/DD/SA services at the community level.
An LME shall plan, develop, implement, and monitor services… to ensure expected outcomes for consumers within available resources. G.S. 122C-115.4
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Who Pays for Services?
Medicaid 81%
State/Federal Block Grant
17%
County2% $428 million
Cardinal Innovations FY 2013-14 Revenue By Source
LME Revenue Trends
Who Pays for Services?
Medicaid 80%
State and Federal
Block Grant17%
County 1%
Other 2%
$369 million
Smoky Mountain Center FY 2015-16 Budgeted Revenues By Source
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Where Does the State and Federal Money Go?
Services88%
Admin.11%
Risk Reserve
1%
$360.5million
Smoky Mountain Center FY 2015-16 Budgeted Medicaid/State/Federal Revenues
LME Service-Related Functions
AccessProvider Relations capacity enrollment monitoring
Service Management authorization utilization care coordination
Quality Management Community Collaboration
Service Management
Approve specific services to individual consumers—“service authorization”
Evaluate the medical necessity, clinical appropriateness, and effectiveness of services according to state criteria—“utilization management”
Monitor individual care decisions at critical treatment junctures to assure effective care is received when needed—“care coordination”
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Medicaid Managed Care
All LMEs must implement the “1915(b)/(c) Managed Care Waiver” by July 2013
S.L. 2011-264 (H 916) Federal government waives certain Medicaid rules
to permit the state to implement Medicaid in a different way From fee for service to capitated funding From freedom of choice to mandatory enrollment
The state promises to implement a “managed care” system that contains costs while improving the quality of services
Managing Care
• Managing the quality of care
• Managing the cost of care
Doctor Patient LME
Managing Care—Cost and Quality
Eligible individual?
Covered service?
Based on clinical assessment?
Medically necessary?
Qualified provider?
Evidence that treatment helps?
Other needed services?
Outcomes over time?
ProviderLME
LME
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Analyze data on access, service authorization, and claims payment for:
1. high cost/high need consumers
2. utilization of various services in the service array
3. gaps in the service array
4. consumer access, initiation, engagement and retention
The foregoing list is only a sample of the many QM activities that LMEs must engage in.
Quality Management
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Heightened Responsibility—MCO functions require area authorities to meet
– more rigorous financial accountability standards – more intensive information management,
analysis, and reporting
State Must Document Promise Is Kept
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• Adequate provision against risk of insolvency
• Timely provider payments• Adequate exchange of information
(billing, payment, other transaction data) with DHHS and providers
HOW ARE LMES ORGANIZED?
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Establishing the Agency
A county must provide MH/DD/SA services through an area authority
The catchment area of an area authority must contain at least 500,000 people
Two or more BOCCs shall jointly establish an area authority with approval of DHHS Sec’y
Changing LMEs requires approval of the Sec’y
Sec’y can dissolve an LME that doesn’t perform
G.S. 122C-115.34
Appointing the Governing Board
The boards of county commissioners within the area shall appoint members and approve a plan for their LME that describes the board composition, appointments, and selection process.
– 11-21 voting members
– 11 prescribed categories of representation
– 2 prescribed non-voting members
G.S. 122C-118.1, 122C-115.2
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• Personnel• Budget and finance• Consumer affairs• Information management
• Services – Access– Provider relations– Service management – Quality management – Community collaboration
LME Governing Responsibility
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To efficiently provide necessary
and effective services to eligible
people within available resources
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Area Authority Personnel
G.S. 122C-121 and -111
Director•Planning•Implementing•Monitoring
WHAT ARE THE COUNTY COMMISSIONERS’ ROLES?
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The County Role
Establish the agency Appoint the governing body Appoint commissioner to advisory board Appropriate funds Participate in annual review of LME director Review and monitor service capacity financial health community collaborationThrough the approval of business plan and review of reports
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Counties Shall Appropriate Funds
And shall not reduce county appropriations and expenditures for current operations and ongoing programs because of the availability of State allocated funds, fees, capitation amounts, or fund balance to the area authority.
G.S. 122C-115.
Recommendation—Ask your LME to talk about the programs that wouldn’t be available without county dollars. crisis services? jail services? forensic evaluations? multidisciplinary evaluations?
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Annual Performance Review
LME board must annually evaluate its appointed LME director for performance in specified areas, including• Developing and maintaining effective
relationships with the community served and with state and local officials
The LME board must consider comments from the boards of county commissioners
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LME Reporting to Counties
• Quarterly financial reports
• Quarterly service delivery reports that assess the quality and availability of services
• Annual progress report assessing the LME’s ability to meet the service needs of its catchment area.
• Approved budget and annual audit
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LME Business Plan
Each county through its area authority must develop, review, and approve a business plan for the management and delivery of services that addresses
Planning that identifies service gaps and ways to fill those gaps
Collaboration with other local service systems to ensure access to and coordination of services
G.S. 122C-115.2
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LME-MCO
Social Services
Juvenile Justice
Schools
Hospitals
Criminal Courts
Civil Courts
Collaborative Context
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LME Duty—Community Collaboration
Must establish and maintain effective collaborative working relationships with other public agencies, health care providers, and human services agencies within their catchment area
Recommendation—Ask your LME how they are collaborating with other agencies, including social services, juvenile justice, community hospitals, and the courts.
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LME Duty—Community Collaboration
Must build a community collaborative of crisis/emergency stakeholders that engage in and support crisis prevention, crisis stabilization, and engagement of individuals into services after a crisis event
Recommendation—Ask your LME to describe its collaborative efforts with community hospitals, law enforcement, the courts, and their contracted providers to prevent, stabilize, and engage.
Questions?
?
PUBLIC HEALTHJill Moore
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Three Questions
1. What do local public health agencies do?
2. How are local public health agencies organized?
3. What is the role of the board of county commissioners?
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WHAT DOES PUBLIC HEALTH DO?
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London 1854: The Broad Street Pump
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Video credits
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• John Snow: Pioneer of Epidemiologydownloaded from PBS LearningMedia, http://www.pbslearningmedia.org.
• Copyright © 2010, 2005 WGBH Educational Foundation. All Rights Reserved.
• Adapted from Rx for Survival -- A Global Health Challenge: How Safe Are We?
• Rx for Survival -- A Global Health Challenge is a Co-Production of the WGBH/NOVA Science Unit and Vulcan Productions, Inc. Dramatic sequences produced by Dangerous Films, Ltd
• Project funded by the National Institute of Environmental Health Sciences
NC 2013: Community Festival
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Cases/ Suspected
Cases
Isolate & Confirm
Diagnosis
Contacts
Persons receiving PEP within 72 hrs.
Symptomatic Asymptomatic
Susceptible
Persons unable to
receive PEP
High-risk persons
receiving IG
Monitor for symptoms
Quarantine
Immune
What does public health do?
Population
Environment
Individuals
• Assessment• Policy• Preparation & response
• Food, lodging, & institutional sanitation
• Water & wastewater• Lead, pests, other risks
• Disease detection, prevention and control
• Clinical care• Service coordination
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Sources of required services/activities
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Federal laws(e.g., HIPAA)
Mandated services rule
Provide• On-site water supply
• Sanitary sewage collection, treatment, & disposal
• Food, lodging, & institutional sanitation
• Communicable disease control
• Vital records registration (public health-specific responsibilities)
Provide or assure• Child health
• Maternal health
• Family planning
• Dental public health
• Home health
• Adult health
• Public health laboratory
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Who pays for local public health?
County appropriations
• Revenues from public health must be returned to public health
• Maintenance of effort requirement in effect 2014-2016 (repealed by HB 44)
Medicaid• Reimbursement for services• Cost settlement
State & federal funds
• Federal funds allocated by state• State aid-to-county funds
Other• Medicare reimbursements• Other fees for services• Grants received locally
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Catawba County Public Health Projected Revenue, FY 2014-15
Total: $11.1 million
Federal.05%
State11%
Federal and state
15%
Local8%
Charges and fees44.5%
Miscellaneous1%
Contingency2.5%
General fund17%
HOW ARE PUBLIC HEALTH AGENCIES ORGANIZED?
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County responsibility (G.S. 130A-34)
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• County health department• Consolidated human services
agency (CHSA)• District health department• Public health authority
Agency
• Appointed board• Commissioners assume board
powers & duties; appoint advisory committee
Governance
Cabarrus only: Public hospital authority w/public hospital authority board
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Types of Local PH Agencies and BoardsJune 1 2015
County health department with county BOH (56)
County health department governed by BOCC (health advisory committee) (1)
District health department with district BOH (6 districts delineated by different shades of purple, 21 counties)
Consolidated HS agency with CHS board (10)
Consolidated HS agency governed by BOCC (health advisory committee) (10)
Public health authority with PHA board (1)
Public hospital authority with hospital board authorized to act as BOH (1)
STOKES
SWAINBUNCOMBE
GASTON
UNION
YADKIN
MONT-GOMERY
RICH-MOND
ROCK-INGHAM
WAKE
EDGE-COMBE DARE
BLADEN
BRUNSWICK
PENDER
ONSLOW
GUILFORD
CARTERET
NASH
Board of Health
Role: “protect and promote the public health”
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Powers and duties:
• Appoint local health director
• Make policy for local public health agency
• Adopt local public health rules
• Adjudicate disputes regarding local rules or locally imposed public health administrative penalties (fines)
• Impose local public health fees
• Satisfy state accreditation requirements for BOHs
Local Health Director Powers & Duties
G.S. 130A-41• Administer PH programs• Hire/dismiss employees*• Enforce local PH rules• Investigate & control
communicable diseases• Isolation & quarantine authority• Enforce immunization laws• Investigate & control rabies• Abate public health nuisances
& imminent hazards• Disseminate PH information
and promote health• Advise local officials• Enter contracts**
Elsewhere in GS 130A• Rabies vaccination clinic• Embargo authority• Access to records• Etc.
Elsewhere in GS• Approve jail medical plan• Relocation of graves• Etc.
Other• Compliance, budget, etc.
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Local public health employees
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Minimum staff ruleLocal health director, PH nurse,
EH specialist, secretary
Accreditation standardsMedical director, nursing director, EH director, communicable disease director, expertise in
epidemiology, data management, other areas
Other considerationsWho is needed to carry out functions/activities?
Medical record specialists, health educators, nutritionists, social workers, administrative and operations support, …
WHAT ARE THE COUNTY COMMISSIONERS’ ROLES?
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Refresher: County Role
• Common duties: In the three primary human services fields, BOCC must:
Establish the agency
Establish the governing body
Appropriate funds
• BOCC may have other duties as well
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What are the county commissioners’ roles?
Establish local PH agency
• County or district health department, public health authority, part of consolidated agency
Establish board• Local board of health (county, district, PHA)• Consolidated human services board• BOCC serves as board (county or CHS only)
Appropriate funds
• Revenues from public health must be returned to public health
• Maintenance of effort requirement repealed
Other duties
• Approve fees imposed by BOH or CHS board• If acting as BOH:
• Assume all BOH powers & duties• Appoint advisory committee on health
• If CHSA, decide if employees under SHRA
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Questions?
?
SOCIAL SERVICESAimee Wall
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1. What do local departments of social services do?
2. How are local departments of social services organized?
3. What is the role of the board of county commissioners?
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Three Questions
WHAT DOES DSS DO?
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• More than 50 distinct programs– Established, administered, & funded
– Federal, state, & local government
• “Safety net” – Families, elderly,
children, poor
– Economic, nutrition, health, social
• Mandated v. optional?
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What Does DSS Do?
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Social Services Programs
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• Public Assistance– Work First
– Supplemental nutrition (i.e., “food stamps”)
– Medicaid
– Health Choice
– Energy assistance
– Day care subsidy
– Special assistance
• Children– Child protective
– Foster care
– Adoption
– Child support
• Adults– Adult protective
– Guardianship
• Adult care homes
Who Pays for Social Services?
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• Federal-state programs• Grants to states
Federal
• Accepts federal grants• Appropriates state and federal funding
State
• Levy property tax sufficient to pay county share of mandated programs
• Non-mandated programs
County
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Federal33%
State7%
Federal and state23%
Local 8%Charges and
Fees1%
Miscellaneous0%
Contingency2%
General Fund26%
Catawba County DSS Projected Revenue FY 2014-15
Total: $40 million
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“State-Supervised andCounty-Administered System”
County • Administering programs
• County agencies & employees
• Funding part of cost
State
• Supervising county administration
• Policy & training
• Paying benefits
• Funding part of cost
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HOW IS DSS ORGANIZED?
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Types of DSS Agencies
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Organization
Governance
DSS Agency
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DSS with DSS Board
Consolidated human services agency with a consolidated human services board (Wake)
Consolidated human services agency with BOCC as governing board (Mecklenburg)
Types of DSS AgenciesJune 2012
DSS with DSS Board (74)
DSS with BOCC as governing board (6) (McDowell, Watauga, Wilkes, Surry, Stokes, Columbus)
CHSA with CHS Board (10) (Haywood, Buncombe, Gaston, Nash, Union, Rockingham, Wake, Edgecombe, Carteret, Dare)
CHSA with BOCC as governing board (11)(Swain, Yadkin, Mecklenburg, Cabarrus, Guilford, Montgomery, Richmond, Bladen, Brunswick, Pender, Onslow)
Types of DSS AgenciesSeptember 2015
Organization
81
• Single county DSS
• Consolidated human services agency
• Other options– Share director
– Interlocal agreement for regional departments or shared services
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Governance
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• County Board of Social Services
• Consolidated Human Services Board
• BOCC as Governing Board
Board of County Commissioners
County DSS Board
Department of Social Services
Social Services Commission
Governing Board
Agency
Appointing authority
DSS Board
DSS Board
• Powers and duties – Appoint social services director
– Consult with director in preparing agency budget
– Authority to inspect confidential social services and public assistance records
– Review suspected cases of fraud for some public assistance programs*
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WHAT ARE THE COMMISSIONERS’ ROLES?
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Refresher: County Role
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• Common duties: In the three primary human services fields, BOCC must:
Establish the agency
Establish the governing body
Appropriate funds
• BOCC may have other duties as well
What are the county commissioners’ roles?
Establish agency
• County DSS • CHSA • Multi-county with interlocal agreement
Establish board
• DSS board • Consolidated human services board• BOCC serves as board
Appropriate funds • Approve; appropriate
Other duties• If acting as DSS board, assume all
powers and duties of DSS board• If CHSA, decide if employees under SPA
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Questions?
?
CONSOLIDATED HUMAN SERVICES
Jill Moore
89
Three Questions
1. What do consolidated human services agencies do?
2. How are consolidated human services agencies organized?
3. What is the role of the board of county commissioners?
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Bonus question
What are county commissioners’ options under the 2012 consolidation law?
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Options under 2012 Law (H 438)
Option 1• BOCC assumes powers and duties
of one or more local board(s). • No change to agency(ies).
Option 2• BOCC creates a consolidated
human services agency (CHSA).• BOCC appoints a CHS board.
Option 3• BOCC creates a CHSA.• BOCC assumes powers and duties
of the CHS board.
WHAT DO CONSOLIDATED HUMAN SERVICES AGENCIES DO?
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What is a CHSA?
Description
G.S. 153A-77(b)
• County agency with authority to carry out the functions of any combination of county human services programs or agencies
• May include public health and social services, but does not have to include both and is not limited to those two
Exclusions
G.S. 153A-76
• A CHSA may not include:– Public health authority
– Public hospital authority
– District health department
– MH/DD/SA agency
“Human services”
Social services
Public health
Aging
Veterans
Trans-portation
Other?
95
Examples
CabarrusSocial services
AgingTransportation
OnslowPublic health
Social servicesSenior services
HaywoodPublic health
Social services
RockinghamPublic health
Social servicesVeterans
Youth
BladenPublic health
Social servicesAging
Transportation
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HOW ARE CONSOLIDATED HUMAN SERVICES AGENCIES ORGANIZED?
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Options under 2012 Law (H 438)
Option 1• BOCC assumes powers and
duties of local boards. • Agencies stay the same.
Option 2• BOCC creates a consolidated
human services agency (CHSA).• BOCC appoints a CHS board.
Option 3• BOCC creates a CHSA.• BOCC assumes powers and
duties of the CHS board.
Board of County
Commissioners
Department of Social Services
Local Health Department
Board of County Commissioners
Consolidated Human Services
Board
Consolidated Human Services
Agency
Board of County Commissioners as
a CHS Board
Consolidated Human Services
Agency
12
3
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Not consolidated
Consolidated human services agency with a consolidated human services board (Wake)
Consolidated human services agency with BOCC as governing board (Mecklenburg)
CHS Organization and GovernanceJune 2012
SS & PH agencies with appointed governing boards
Option 1 with both SS & PH agencies governed by BOCC (Stokes)
Option 1 with SS agency governed by BOCC, PH agency with appointed
governing board (McDowell, Watauga, Wilkes, Surry, Columbus)
Option 2 with consolidated HS agency including SS & PH, appointed CHS board (Haywood, Buncombe, Gaston, Union,
Rockingham, Wake, Nash, Edgecombe, Carteret, Dare)
Option 3 with consolidated HS agency including SS & PH, governed by BOCC, health advisory committee (Swain,
Yadkin, Mecklenburg, Guilford, Montgomery, Richmond, Bladen, Brunswick, Pender, Onslow)
Option 3 with consolidated HS agency including SS & other human services but not PH, governed by BOCC (Cabarrus)
HS Organization and GovernanceSeptember 2015
Options Option 2: CHS board appointed by BOCC from slate of nominees; prescribed membership
Option 3: BOCC assumes powers and duties of CHS board & appoints advisory committee
Board Assumes powers & duties of boards included in agency (e.g., PH and SS), except appointing director
Other powers & duties set out in CHSA law
Advisory committee
Required for Option 3
Must include same membership as county board of health, may include other members as well
CHSA Board & Advisory Committee
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Consolidated Human Services Board
Membership (BOCC appoints from slate of nominees)• Four consumers of human services• Psychologist• Pharmacist• Engineer• Dentist• Optometrist• Veterinarian• Social Worker• Registered Nurse• Two physicians (one must be a
psychiatrist)• County commissioner• Up to 12 others
Powers and Duties• Acquires powers & duties of
other boards (except hiring director)
• Other powers and duties– Plan and recommend a
budget – Assure compliance with
state/federal laws– Recommend creation of
human services programs– Perform public relations
and advocacy functions
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• County manager hires with advice and consent of governing board
• Director must meet statutory requirements for a local health director or appoint someone who does
• Decisions regarding CHSA leadership:– Hire new CHS director or assign
responsibilities to current employee? – Delegate authority from CHS director to
agency staff?– Whom to designate as person with local
health director qualifications?
CHSA Director
• Employees of county health and social services departments are subject to State Human Resources Act (SHRA)*
• BOCC may elect to keep employees under SHRA or put completely under county policies
• County policies for CHSAemployees must comply with Federal Merit Personnel Standards
*Formerly the State Personnel Act (SPA)
CHSA Personnel
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Federal Merit Personnel Standards
• Recruiting, selecting, and advancing employees based on merit
• Equitable and adequate compensation
• Training employees
• Retaining/separating employees on the basis of performance
• Correcting inadequate performance
• Assuring fair treatment of applicants and employees
• Assuring employees are protected against coercion for partisan political purposes
5 CFR § 900.603
SHRA Policy Areas
1. Position classification
2. Recruitment & selection, including minimum qualifications
3. Pay relationships (does not prescribe salary administration policies)
4. Reduction in force
5. Discipline and dismissal procedures
6. Grievance – contested case hearing at OAH
Board Hire Agency Director HRDSS Appointed;
3-5 membersBoard hires SHRA
PH Appointed;11 members
Board hires SHRA
One Elected (BOCC)*
BOCC hires SHRA
Two Appointed;up to 25 members
County manager hires with advice & consent of CHS board
SHRA optional
Three Elected (BOCC)*
County manager hires with advice & consent of BOCC
SHRA optional
Key Differences
* If public health affected, must appoint health advisory committee
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WHAT ARE THE COUNTY COMMISSIONERS’ ROLES?
109
BOCC Role: Creating a CHSA
Deliberate & decide• Is consolidation right for
your county?• Which agencies will you
include?• Will you appoint a board or
assume its powers and duties?
• Will employees be under SHRA or county personnel policies?
Prepare• If changes to personnel
policies needed, make them• Discussions with existing
agency leadership and staff• Plan for new board:
• Appointed board: Identify members of nominating committee
• BOCC as board: Consider advisory committee(s)—types, members, roles
Public notice & resolution• 30 days’ notice of public
hearing• Public hearing• Adopt resolution
BOCC Role: Ongoing
Board & Advisory
Committee(s)
• Option 2: Periodically appoint new board members from nominees
• Option 3: Carry out CHSA board powers and duties; determine role of advisory committee(s) & maintain membership
Appropriate funds
• Approve budget and appropriate funds• Satisfy any duties associated with
particular services/programs in agency
Other duties • Vary depending on services/programs included in agency
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Defining Goals
• What are the county’s goals and what route will get you there? – Improve service delivery– Create a new vision for human
services programs – Create a unified personnel system
for all county personnel– Change the relationship between
board of county commissioners and the departments
– Identify efficiencies and reduce human services spending
– Others?
Budget Impact
• How might a county save money in human services programs when creating a CHSA?– Not filling vacancies, including agency director
position– Cross-training staff to work in multiple programs– Combining back office functions such as finance,
HR, or IT– Moving operations into shared space– Realizing efficiencies through operational changes– Reducing or eliminating optional services– Entering into interlocal agreements with
neighboring counties for select services
Budget Impact
• How might a county save money in human services programs without creating a CHSA?– Not filling vacancies, including agency director position– Cross-training staff to work in multiple programs– Combining back office functions such as finance, HR,
or IT– Moving operations into shared space– Realizing efficiencies through operational changes– Reducing or eliminating optional services– Entering into interlocal agreements with neighboring
counties for select services
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Hot Topics
Personnel
• If employees are removed from SHRA, what should be done before that happens? After that happens?
• Must county personnel policies to comply with federal regulations?
Information sharing
• In a CHSA, can information be shared within the agency more freely?
• If the BOCC is the governing board (option 3), may the commissioners have access to confidential client information?
Delegation
• Which responsibilities assumed by the CHSA director may be delegated to others?
• How should delegation be accomplished?
Role of BOCC in Option 3
• When BOCC is CHSA governing board:• What is the role of the advisory
committee(s)?• What kind of training should the board
receive?• How should CHSA business be
conducted and documented in BOCC meetings?
Hot Topics
Questions?
?