From the Klamath Falls Herald Tribune, June 26, 2013

Klamath County commissioners approved executing a contract Tuesday with the Oregon Health Authority as a bridge toward ousting itself from providing mental health care and putting that task in the hands of a nonprofit.

On June 14, the commissioners sent a letter to the state saying the county could no longer financially afford to run its mental health department, called Klamath Behavioral Health and Wellness, under the state’s fee-for-service model going into effect Monday. In the letter, the commissioners asked the Oregon Health Authority to help transition its services to a nonprofit.

On Monday the commissioners, along with Klamath Behavioral Health and Wellness director Amanda Bunger and county treasurer and chief financial officer Jason Link, held a work session where they spoke with OHA representatives over the phone. Amy Boivin, deputy director of Klamath Youth Development Center, also sat at the table.

At the end of a nearly two-hour discussion, executing the contract, called an intergovernmental agreement, was the only concrete decision made. Commissioners made executing the agreement official at their regular weekly meeting on Tuesday.

Commissioners had previously signed the two-year intergovernmental agreement with the OHA but had not executed it. Justin Hopkins, with the addictions and mental health department of the Oregon Health Authority, ensured the commissioners the contract would be amended to reflect the likely shorter-term duration of the transition period (90 days versus two years).

Though hesitant about signing a contract before the amendments were made, commissioners agreed because the contract includes a three-month opt out clause and a 45-day termination clause if funding is insufficient.

The county and the state are under a time crunch in planning the transition.

The county gave the 81 employees of Klamath Behavioral Health and Wellness 30-day termination notices June 4 (see story below).

Also, Jefferson Behavioral Health, which formerly served Klamath and other southern Oregon counties’ mental health programs, will close June 30.

Other steps in the transition process are still being worked out to make sure they meet Oregon law and at the same time provide some kind of a smooth road for county employees and clients of Klamath Behavioral Health and Wellness.

“Our goal for today’s meeting is to make sure there is a plan in place so that come Monday, clients continue to receive services and doors stay open,” said Hopkins, with the addictions and mental health department of the Oregon Health Authority. “We want to make sure everyone is able to get the services they need effective July 1.”

“Nobody’s willing to close the door on July 1. Everybody wants to continue the service to clients that are participating,” said Commission Chairman Dennis Linthicum.

Extending the contract should help to ensure funding for the county department during the transition. How that funding would pencil out is still unknown.

The county also will be getting money back from Jefferson Behavioral Health after it closes.

Even then, the county is concerned about running its department at a loss for the next three months.

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A smooth transition?

Klamath Behavioral Health and Wellness oversees 1,200 outpatients, about 700 of which are on medications. As the county works to transition its mental health care to a nonprofit, those are the people who need the transition to be smooth.

Despite impending deadlines only a week away while working on a 90-day timescale, those at the work session with the Klamath County commissioners and the Oregon Health Authority on Monday were determined to make sure the 1,200 clients would get care, and that care would be disturbed as little as possible.

Justin Hopkins, with the addictions and mental health department of the Oregon Health Authority, said in an ideal situation clients may not even notice the change. That is what they’re striving for.

“This idea of transitioning clients out and into another program may be moot,” he said during the work session. “Really the only change in a client’s experience may be the name on the building or something to that effect. But really, they could ultimately be seeing the same clinician in the same building at the end of the day.”

Nonprofit status

In asking the state for help transitioning out of the mental health care arena, Klamath County has said the services will likely go to a nonprofit.

Officially no nonprofit has been named.

But Klamath Youth Development Center is willing to step up. On the same day the commissioners sent their letter to the state asking for help with the transition, KYDC CEO Stan Gilbert sent a letter to the Oregon Health Authority saying his company would like to be the designated mental health care provider for Klamath County.

The nonprofit already provides mental health care to children and teens, and requested the county approve it to care for adults, too.

Commissioners didn’t do that during Monday’s work session only because they were unsure if the county still has the authority to grant approval during the transition. Such approval may need to come from the state.

Representatives from the Oregon Health Authority said they would need to find out if a formal request for proposal process would need to be completed to find a nonprofit to take over services, or if this could be called an emergency situation and allow the OHA to name a specific entity.

Amy Boivin, deputy director at KYDC, said during the work session her organization would like to begin building capacity to serve adults.

Klamath Behavioral Health and Wellness unsure of the status of its employees

Come Monday morning, Klamath Behavioral Health and Wellness director Amanda Bunger does not know who in her office will show up for work.

At the beginning of June the county gave 30-day layoff notices to all 81 employees in the mental health department, otherwise known as Klamath Behavioral Health and Wellness.

Bunger said “many” members of her team have already left, either to retire or move out of the area. She doesn’t know the plans of some of her employees because, as she put it, they don’t have to tell her.

During a work session on Monday, Bunger told Klamath County commissioners and representatives from the Oregon Health Authority she needs more clarity in who will and won’t be staying on next week.

“If I were able to say we’re going to extend, for example all the therapists,” Bunger said, throwing out a hypothetical situation, “I don’t know if three of them are going to say, ‘I already found something I just didn’t tell you.’ Or they could say, ‘Cool. I’m into it. I’m glad someone else will pick me up.’ I just can’t tell you that. I don’t know that. If I can at least know who we’re going to extend, who we’re going to lay off, I think that will give us more clarity of who is actually physically left to do this.”

Whether the county will rescind layoff notices, extend them another 30 days, or let employees go, is still undetermined. Bunger said those were the three possible options for employees.

Commission Chairman Dennis Linthicum was against only giving employees repeated 30-day layoff notices, a possibility discussed during the work session.

“I’m afraid of giving everybody these little two-week or 30-day notices and you wear them out and they say ‘forget it,’” Linthicum said. “Instead of saying we’ve got a job to do it’s a transition job. It is only a 90-day or 120-day job, but you get them focused on achieving that goal of getting people to transition to the other service providers.”

“Whatever entity takes over mental health care in Klamath County will need those employees,” said Hopkins, with the addictions and mental health department of the Oregon Health Authority.

“For a new community mental health program to stand up, they’ll have to hire — and the law would probably require them to hire — the current county employees if they’re going to provide the same services.”