HomeMy WebLinkAboutSpecial Council Meeting February 18 1997WHATCOM COUNTY COUNCIL
Special Council Meeting
MENTAL HEALTH SYSTEM
February 18, 1997
The meeting was called to order at 10:05 a.m. by Council Chair Ward Nelson in the
Council Chambers, 311 Grand Avenue.
Also Present:
Marlene Dawson
Tom Brown
Alvin Starkenburg
Kathy Sutter
MENTAL HEALTH SYSTEM
Absent:
Barbara Brenner
Robert Imhof
Chair Nelson noted the purpose of today--s meeting is to discuss the past and future of the
mental health system. He gave background information on this issue. The Human Services
Committee (HSC) recommended the County withdraw from North Sound Regional Support
Network (NSRN) and use the Health and Human Services Department for mental health
services. Concerns were expressed by the HSC regarding the lack of citizen control; elected
officials review as Board members, which does not adequately protect citizens= interest; the
multi jurisdictional nature does not make individual county officials accountable to their citizens
for actions taken by the regional body as a whole; and the media does not cover the activities of
regional bodies affecting persons in Whatcom County. The public is, therefore, unaware of these
meetings and the impact of their decisions.
Chuck Benjamin, Director, Health Department, stated there have been many changes
since the HSC report. He introduced the speakers on the agenda.
Marcia Gunning, Health Department, Mental Health Division, gave background
information and an overview of the situation (handout on file). The legislature in 1989
established regional support networks to assure locally managed mental health systems. The
NSRSN is composed of five counties: Whatcom, San Juan, Skagit, Island and Snohomish, and
formed through an Interlocal Agreement. The RSN also has a contract with the State of
Washington, which states that the region continues to be responsible for all components of
outcome for the provision of mental health services to individuals regardless of their eligibility.
She then discussed the federal waiver.
Dave Dula, Chief, Washington State Office of Budget & Medicaid, reviewed the history
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of the RSN. He noted opposition to the mental health waiver, stating opponents thought it was
confusing. Decisions are being made for reasons other than treatment. A new waiver was
submitted in December 1996 which will incorporate inpatient services in community hospitals.
He also spoke to the make up of an RSN. Risks were discussed, stating the state was requested
to quantify the outpatient risk for a public mental health system, which they were able to do.
Much information is available regarding risks of providing inpatient services. He stated the
extent of risk must be defined. The smaller the population, the greater the risk. One of the goals
of the Mental Health Division is to ensure the RSNs are the providers of service throughout the
state.
Dula pointed out vision is a difficult subject because of all that has been happening
regarding this issue. He visions a consolidated and seamless system of care regardless of the
funding source. Implementation of this system would be through consolidation of services, both
in and outpatient, and capitation of the state hospitals.
A brief discussion followed. Topics included: creation of a regional RSN by Whatcom
County; the option of returning the system to the state; and capitation. Dula stated that under
Medicaid, charging for any Medicaid - covered service, no matter the circumstance, is not
allowed. The Medicaid capitation is for all medically necessary services needed by an
individual. Regarding choice, there are approximately 140 medical providers state -wide, which
are serving more people. The RSN is the provider, not the community mental health center,
which is a subcontractor with the provider. The RSN does provide choice, although it can direct
individuals to a given provider. A formal grievance process and an ombudsman program have
been instituted.
Another topic of discussion was dollars and service. Dula stated that size -wise, the
NSRN falls below the administrative staff of some of the other counties. The NSRN does not
have a high administrative cost. He commented on the NSRN plan in relation to other counties.
Eric Heacock, Director, North Sound Regional Support Network, addressed the topics of
vision, accomplishments, and responsibilities. He read the RSN vision statement (handout on
file), breaking this into various areas: functioning as a public managed care organization;
demonstrating the ability to manage costs and serve more people; discovering how to move from
fee for service to a capitated funding form; assuming risk; ensuring everyone receives the
appropriate level of care; and ensuring public oversight of the system remains with the elected
officials. He noted the second part of the vision is to meet the requirements of the Medicaid
waiver. He referred to his handout, page 17 -20 (Priority #4), regarding the integrated delivery
system, which states the consumer can receive services anywhere in this system at the same level
as anyone else in the region; the system is consumer oriented and responsive; and it guarantees
access to services regardless of where the individual is within the region.
Some of the accomplishments included: the Strategic Plan (handout above); adoption of
an equitable funding formula by the Board of Directors; request for proposals (RFP) placing
patient mental health services for the region into competitive procurement, which was important
Special Council Meeting, 2/18/97, Page 2
in order to create the integrated delivery system to ensure and guarantee access to care; and
adoption of the level of care manual, which is the criteria by which the region will admit,
discharge and approve utilization of services. He also stated his department has moved to a form
of subcapitation, hoping the service providers will assume risk and responsibility for utilization
management. A staffing plan has also been implemented, which reduces the budget by $60,000-
$80,000.
He spoke to the current functions of the RSNs: develop and implement quality assurance
programs; monitor contracts and service delivery; act as an agent of the state and local
government; assume risk; function as a capitated entity, as well as a regional public insurance
company; credential the service provider network; set regional clinical standards; and - -in the
state contract - -be responsible for the development and maintenance of a regional integrated crisis
delivery system.
Heacock requested comment for feedback by March 7. Discussion followed. Topics
discussed included: performance based contracts; the risk factor; ineligible service providers for
contract with his department; the County =s jail managed health care; his visioning for his
department =s meeting the various regional concerns; and tribal representation. Benjamin noted
the Board of Director =s decisions have not been by geographic boundaries but by region.
Nelson pointed out the County has not yet signed the contract with the state. He then
opened the meeting to the public.
Tom Richardson, member of the state Mental Health Advisory Committee as well as the
Human Services Task Force, spoke to the thrusts brought forward by the Task Force: looking for
an integrated service delivery that was consumer oriented; and looking for citizen participation
either directly or through elected representatives.
Benjamin addressed the subject of integration as an important aspect of the visioning
process on a local level. A Consolidation Committee has been formed to identify the areas
within substance abuse, mental health, developmental disabilities and public health that need to
be addressed in order to improve integrated services. Heacock responded by stating that the
counties are sharing much of the funding for mental health, and the RSN is contributing funds to
the counties to provide services. Thus, a significant amount of his department =s budget is going
to the counties to support their own important jurisdictional needs. There is not one specific
item that would bring this integration process to a head. Heacock shared some of the issues that
needed to be formalized: service providers need to maintain working agreements with agencies
outside mental health; some service providers have also become the substance abuse provider;
and meetings have been held with local coordinating councils. What needs to be done next is to
develop an implementation strategy in order to move beyond the vision and the plan. From his
perspective, he stated what the County is attempting to accomplish in terms of integration and
consolidation does not affect the relationship with the RSN, which has responsibilities to ensure
Special Council Meeting, 2/18/97, Page 3
that there is continuity of care and the provision of mental health services to those who need
these services, no matter which provider services are used.
Dula responded to the same question from the state perspective by stating his department
operates under federal programs, which are separate federally legislative mandated and
regulated, so it is very difficult to combine services. He pointed out their largest single
coordination issue is with medical assistants, who are going into managed care with the SSI
population for regular medical care. This is creating huge issues around that population, which
consists of people withholding various important and pertinent medical information. For a
minimal care system to be a seamless care system, it would be necessary to combine mental
health, aging, developmental disabilities, medical assistance, and DOSA under one program
because these programs affect almost all Medicaid eligibles. He thought this issue will never be
solved at the state level.
Rodney Lund: He has followed the Human Services Committee and expressed concerns
regarding the system being confusing, especially for a person with mental illness. He maintained
the system is driven by the needs of the bureaucracy and the providers. He also discussed the
RPF process being approved without public input. Lund would like consumers to have a solid
base with this issue.
Dawson noted that young children are the most unrepresented and unserved in the mental
health system. Heacock stated that North Sound has submitted a plan to better provide services
to children and adolescents. He also recognized it should also include the senior citizen, young
children and teens.
Josselyn Winslow, member of the Human Services Review Committee as well as the
state Mental Health and Aging Advisory Council and the Disability Initiative Advisory Council,
thought a system is needed which does not make the process difficult. Addressing the RSN
issue, she wanted to be sure the County does not lose its ability to respond to its needs at the
County level. She does agree with the consolidation of services, stating there is a need to use
service dollars better. She thought the option of consolidation with other RSNs so Whatcom
County can continue to manage its local County -based processes of having an integrated system
was a good idea.
John Rietz, Director, Behavioral Health, St. Joseph =s Hospital, commented regarding
integrated mental health services. Many steps have been made in this community over the years.
His department has consolidated these systems into one department. Although the system is not
perfect, work is constantly being done to improve an integrated system between mental health
and substance abuse.
Gary Williams, Regional Mental Health Coordinator for Whatcom and San Juan
Counties, stated that funding sources define how services are provided. One action on the local
level that can be done is collaborate. At the local level, regional county staff is trying to find
ways to avoid having people with multiple needs going to multiple providers because they rarely
Special Council Meeting, 2/18/97, Page 4
make it beyond the first provider. He thought his job was to continue to push the collaboration
so the services do become integrated.
Laura Witter asked if Whatcom County does not sign the contract, what local control
would change. Nelson replied this question would have to be asked again.
Nelson thought now would be the time for deliberation as to how to move forward into
the future. Sutter expressed interest in the review committee and asked if it would have an
update to its last report based on the changes with the RSN. Starkenburg felt there have been
strides forward and appreciated the leaders who have been working on this matter. He would
like further discussion with Nelson and Benjamin, although he would not like to rush any
decision at this point. Dawson asked how long can the County wait to sign the contract.
Gunning replied there is no interlocal now, but there is a clause to withdraw if necessary.
Benjamin asked to be invited to any Human Services Committee meeting.
ADJOURN
The meeting was adjourned at 12:05 p.m..
Elizabeth Bennett, Recording Secretary
NaDean Hanson, Recording Secretary
These minutes were approved by Council on 11997.
ATTEST:
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Dana Brown - Davis, Council Clerk L. Ward Nelson, Council Chair
Special Council Meeting, 2/18/97, Page 5