County officials say residential treatment providers need more flexibility to stop dangerous situations before someone is seriously hurt.
Marion County formally challenged Oregon health officials Wednesday over rules that local mental health workers say can leave them with too few options to stop dangerous situations before someone gets hurt.
The county filed a formal petition seeking changes to state rules governing residential treatment homes after staff at Horizon House described incidents involving threats, drugs and alcohol, and a resident repeatedly flicking a lighter beside a running oxygen tank.
The dispute centers largely on how quickly a treatment provider can act when a resident becomes a safety risk.
Under the current rules, providers generally must give a resident at least 30 days’ notice before an involuntary transfer or discharge. That timeline can be shortened when a resident’s behavior has already caused serious physical harm to another resident or staff member.
Marion County argues providers need more flexibility to intervene before a situation reaches that point.
Anna Maceira, a clinical supervisor at Marion County’s Horizon House, told commissioners about a resident who used oxygen and repeatedly flicked a lighter near his running oxygen tank. Staff feared a fire but, according to Maceira, were told they could not simply take the lighter away while developing an individualized safety plan.
After several weeks, the resident voluntarily agreed to let staff store it.
“We should not have to wait for a tragedy before we are allowed to prevent one,” Maceira said.
She also described challenges involving alcohol and drug use and another resident whose threatening and abusive behavior left other residents afraid in their own home.
The Oregon Health Authority has made temporary changes to residential treatment rules this year, including provisions allowing facilities to prohibit weapons and removing a requirement for state approval before certain involuntary discharge notices are issued. The state’s residential treatment rules also incorporate federal Medicaid requirements for home- and community-based services.
Commissioner Danielle Bethell said in a statement provided to Salem Business Journal that safety should apply equally to people receiving treatment and the employees caring for them.
“Oregonians experiencing vulnerabilities in their mental health state deserve to live in a safe environment,” Bethell said. “The same goes for any employee who chooses to work in an industry that is already very difficult.”
Bethell said the state has pointed to federal Medicaid requirements as a reason for some of the changes and argued Oregon should seek waivers or exemptions when federal requirements conflict with what providers consider reasonable safety policies.
States can ask the federal government for waivers from some Medicaid requirements, but it remains unclear whether a waiver could change the specific provisions Marion County is challenging.
County Counsel Steve Elzinga said the petition will require the state health agency to solicit public comment and formally consider the county’s proposed changes. Marion County also plans to encourage other counties with similar concerns to participate.
The temporary rules are scheduled to remain in effect through Nov. 25. If the state does not address Marion County’s concerns, Elzinga said the county will consider additional legal options.
