County Makes Final Pitch for U.S. Approval of Superagency

With $15 million of medical reimbursement money at stake, Ventura County officials submitted to a federal agency this week their third and final restructuring plan for the county’s massive Human Services Agency.

The restructuring would merge mental health and social services to create one superagency. If its revised plan fails to meet legal requirements, however, the county stands to lose millions of dollars a year in Medicare and Medi-Cal payments for treating the mentally ill.

“This is the final round from our standpoint,” said Wayne Moon, the Federal Health Care Financing Administration’s director of Medicare certification, based in San Francisco.

The previous plans were rejected primarily because they did not show that a direct line of authority still exists between Ventura County Medical Center and the mental health unit, Moon said.

“We’ve got to get a clear understanding that the hospital is in charge of the services for mental health clients,” Moon said. “If they’re not, they can’t bill for the services and we’re going to say the merger is unacceptable.”

In April, Ventura County supervisors voted 3 to 2 to merge mental health and welfare services into a new Human Services Agency. Supervisors Susan Lacey, Kathy Long and John Flynn supported the merger, while Chairwoman Judy Mikels and Supervisor Frank Schillo voted against it.

Proponents say the new agency would promote teamwork among county doctors and social workers and place an emphasis on helping the mentally ill live independently. Opponents contend that the team approach will erode the authority of doctors to make medical decisions about their patients.

Although federal officials gave the county until next week to submit the revised plan, county officials mailed the final draft Wednesday, said Chief Administrative Officer Lin Koester.

“I’m anxious for them to get back to us,” Koester said. “And this draft I personally believe conforms to all of the concerns they have identified. We would like to get this resolved; it’s been hanging around way too long.”

If this draft is not approved, Koester said, he will request that the matter return to the board for reconsideration. Federal officials said they may take up to 30 days to review the revised contract and make a decision.

Mikels said federal approval should have come before a vote on the merger took place. If federal officials reject this version, she said, she would vote to dismantle the program until the legal issue is settled.

“We should undo this mess for now and take the next year, or whatever it takes, to do it properly,” Mikels said. “So the funding is not in jeopardy.”

Flynn said “no member of the board would agree to jeopardize funding.”

“We’re not going to let that happen,” Flynn said. “If they say we are way off base, then the mental health inpatient unit will be back in direct line of authority with the hospital. But it just means cutting out that one part, not doing away with the whole Human Services Agency.”

Koester, who before the vote in April had recommended keeping the agencies separate but fostering increased partnerships to help the mentally ill, has additional concerns. When signing the county’s annual Medicare billing documents earlier this week, he added a “disclosure statement,” acknowledging to federal authorities that the merger may have violated federal regulations.

Under federal laws, individuals who sign cost reports may be subject to criminal prosecution as well as civil liability, Koester stated in the memo.

“Specifically, I have concerns over the county’s compliance with Medicare’s regulations, especially regarding the requirement of a single line of administrative authority for the time period following the Board’s decision of April 7, 1998,” Koester explained to supervisors in a Nov. 30 memo.

“This has to be disclosed with Medicare filing so that the protection clause is there,” Koester said in an interview Thursday. “I’m being cautious. Telling the truth, that’s the name of the game.”

Koester is not the only one anxious to get the matter resolved. Advocates for the mentally ill, who have closely monitored the merger, voiced concern over the many hours the county staff has spent to resolve the legal issue.

Last month, Koester flew to San Francisco with four other county officials to speak directly to federal authorities about the merger.

Richard Clemence, a consultant for the county Alliance for the Mentally Ill, called the merger a “catastrophe.”

“Here we have the county holding on for dear life at almost any cost to keep the mentally ill under the social services administration, instead of the hospital where they belong,” Clemence said. “The bottom line is that [the Federal Health Care Financing Administration] does not want social workers treating the mentally ill.”

Mikels stopped short of arguing against a team approach to treating mentally ill patients.

“I’m not bitter one way or the other,” Mikels said. “It’s just that we didn’t give it due process and $15 million--even a half a million--is too much to lose.”