The Collin County Observer™

Tuesday's Commissioners Court meeting never seemed like it would end.

The meeting began at 1:30 PM, with a full house but it was after 6:00 PM before they finally adjourned before an empty gallery.

Most of the attendees were county employees there to see the debate over longevity pay. (See "Collin County workers' longevity pay cut back")

But many were there to hear how the court would deal with the growing discontent with the county's indigent health care grants. Last week, I reported on the McKinney Children's Clinic's refusal to accept the county's grant reporting requirements.

The McKinney clinic objected to the county changing the rules after the grants were awarded - specifically the requirements that the clinics report the full name, address, diagnosis code and last 4 digits of the social security number for each patient served. The clinic also protested the new policy of reimbursing for illness, not for "well-patient" visits.

In a surprising development, Candy Blair, the county health care administrator, told the commissioners that she had received a legal opinion that cast doubt on whether the grant program was legal.

After a protracted debate on immigrants, social security numbers, diagnosis codes and HIPPA, the commissioners seemed to agree that they wanted to insure that none of the grant funds were spent on illegal aliens. The court then agreed to go into executive session with their lawyer to discuss the legal aspects of the grant process.

At 6 PM, the court reconvened and the court voted on revising the grants -

1. Require only the 2007 documentation for the period from October 1 to December 31, 2007

2. Void and rewrite all grants for calendar year 2008, changing them from a "fee for performance" grant to a provider agreement contract. The contracts would redefine the grants to be more like an insurance system type "fee for service" arrangement. The contracts, called "Business Associates Agreements" would include the reporting requirements, and a HIPPA disclosure form be submitted for for each patient visit.

Left unanswered was the suggestion of a committee made up of clinic leaders and county officials that would try to resolve the clinic's concerns.

In one long meeting, the county commissioners managed to screw up their employee benefit package, without addressing the underlying morale issues, and screw up the indigent grant program, again without addressing the underlying dissatisfaction with the program.

The employees came out losers.
The charitable clinics and their volunteers were losers.
The poor and sick children were big losers.

Bill