I'm sitting in the Oregon House Human Services Committee.  The committee is conducting an informational hearing about oversight of children's mental health programs.  Representatives Kennimer and Kotek have asked for the hearing. 

The programs are here to complain about redundant, burdensome and inefficient oversight.  Kim Thomas from Trillium is testifying right now.  He mentioned DRO as one of the ten or so agencies that oversee Trillium's activities.  He is now speaking directly to seclusion and restraint oversight.  Again, DRO is mentioned as one of the 4 agencies that Trillium must report to.

Janet Arenz from the Oregon Alliance of Children's Programs notes that Morrison Center has, in the past 6 months, spent 333 staff hours on audits and reviews.  Those reviews took 20.5 days.

Donna Keddy, Mike Morris and Janette Williams  from DHS are now speaking to the issue.  237 agencies are licensed by CAF.  After getting private health care agency license, AMH can certify psychiatric programs.  Oversight presently comes from CAF for health and safety, AMH for MH clinical services, SPD for seclusion and restraint, DD Services for health and safety and individual services plans, and OIT for protective services.

Psychiatric residential programs may have numerous contracts that have separate regulatory requirements.  Bruce Goldberg has asked for an efficiency review to eliminate duplication and redundancy.  An action plan is to be completed by July 31, 2009.  OYA and DHS consult with one another but it doesn't sound like duplication in oversight is addressed.  Rep. Kotek seems to be concerned about this.

Janette Williams notes that the state must fulfill requirements of multiple funding streams and multiple program requirements, e.g. DD does not allow restraint and OYA does not allow "hands on."  Mike Morris is testifying that he worked in hospitals for 20 years before coming to DHS.  He did not like the review processes when he was in that role.  Now, as a reviewer, he always seeks efficiencies.  He notes that very serious problems have come to AMH attention and they have had to close programs who had been certified by national accredidation organizations. 

Rep. Kotek asks if a waiver can be obtained from CMS to cut back on oversight requirements.  MIke Morris notes that some CHS requirements are not tied directly to funding.  He is not sure if CHS would allow streamlining of those requirments.  Rep. Kotek notes multiple reviews by state, county and MHO at Morrison Center.  She suggests that Medicaid funding structure should be reformed to cut down on duplication of required oversight.

Rep. Van Orman notes problem of staff turnover in these programs that can cause rule violations.  All agree.  Janet Arenz is now testifying again to push back a bit.  She says that her organizations' choice of business models is not as responsible for how oversight works as DHS might suggest.  Programs have just responded to what the state has sought to contract for.  Kim Thomas again testifies to the desire to have "a more consolidated approach" to review. 

My observation: Janet and Mike were the only ones to note the problems that have occurred in these programs despite the present oversight.  It would have been nice to discuss not only greater efficiency but also greater effectiveness.  I will make sure that this message is sent.