PENDLETON - The organization that pays most of the bills for mental health treatment in Umatilla County doesn't think the county's Mental Health Department is performing satisfactorily.
Greater Oregon Behavioral Health Inc., a quasi-public health management organization in The Dalles, today published a request for proposals, seeking a new mental health provider for state clients in the county.
GOBHI notified the county earlier this month that it would not recertify the county to deliver mental health services "to GOBHI members living in Umatilla County." The county's contract with GOBHI expires Oct. 1. GOBHI officials hope to have a new provider in place before that date.
County CounselDouglas Olsen, in a letter Aug. 9, wrote, "It is unclear as to the legal basis of the action being taken by GOBHI. I was unable to find any provision in the contract between GOBHI and Umatilla County Mental Health requiring 'certification' by GOBHI for providing services.
"At the present time, Umatilla County Mental Health is certified by the State of Oregon," Olsen continued. "The State of Oregon, not GOBHI, is the entity to determine the certification of services by Umatilla County Mental Health."
Connie Caplinger, director of the county's Department of Health and Human Services, said after GOBHI conducted a site review in May the reviewers "indicated there were some things we needed to work on, but that things were drastically improved."
That's why GOBHI's notice of decertification, sent Aug. 4, caught county officials by surprise.
"They reported we were terminal and then handed us the death certificate," she said. "I was shocked. We had no indication between the site review and when we were handed the report that that was the intent of GOBHI."
Caplinger said she attended GOBHI executive board meetings in June and July, where she asked about the results of the May survey. Both times, she said, GOBHI officials told her they were "working on it."
"At no point in time did anybody tell me that it was their intent to decertify us," she said.
State officials also reviewed Umatilla County's Mental Health Department at the same time in May. The state issued the county a draft report, which has not been made public. The final public report is expected to be released this month.
Kevin Campbell, GOBHI's chief executive officer, said Umatilla County, with 6,500 state clients, is the largest of 12 counties the agency serves, but it has one of the lowest penetration rates. He explained that just 4.5 percent of 3,800 children and 5 percent of 2,700 adults were being served by the Mental Health Department. That means the department serves about 171 children and 135 adults, or a total of 306 state clients. For those services, it receives about $150,000 per month in Medicare and Medicaid funds through GOBHI, or an average of less than $500 per client.
State clients account for slightly more than half of the department's caseload, according to Charles Carnes, county mental health director.
Campbell said the county's penetration "should be over 7 percent for adults and for children about 6 percent." That means GOBHI expects the county to serve at least 189 adults and 228 children, or a total of about 417 state clients, about 36 percent more.
"Part of the issue that's underlying all of this is clinical capacity," Campbell said. "Caseloads have proven to be much higher than average over the years. Some case managers in the county have caseloads that are exceedingly high."
Consequently, GOBHI maintains the Mental Health Department needs more people, better management, or both.
The Mental Health Department, already the county's largest with about 80 employees, has been without a medical director (psychiatrist) for several months. The state, GOBHI and the county agree that's been a problem.
"I think Umatilla County can have one of the better programs in the state," Campbell said. "I just want to get there sooner than later."
Carnes agrees, and said the county has been negotiating with a candidate for the job and hopes to have someone on board soon.
"It's not about being right," Carnes said. "It's about doing what's right for the citizens of Umatilla County who need these services."
Umatilla County Mental Health
Umatilla County's Mental Health Department provides a variety of services to more than 500 clients on a regular basis. The bills for 60-65 percent of those clients are paid by Medicare or Medicaid. The remainder pay the bills themselves or have private insurance.
Charles Carnes, county mental health director, said services are provided by about 80 county employees with the help of 3-D Healthcare Services P.C. of Milton-Freewater, a five-member contracted team that includes two psychiatric nurse practitioners and three psychiatric nurses. Loss of state funding through Greater Oregon Behavioral Health Inc. could affect about 40 county jobs, Carnes said.
Among the round-the-clock services the county provides are:
Case management, which involves helping mentally ill clients with a range of activities to help them be as independent as possible
Therapeutic medical management
Assessment and referral services
Dual diagnosis services for people with a primary mental health diagnosis along with a substance abuse diagnosis.