Types of Local Public Health Agencies: Consolidated Human Services Agencies

This page includes questions and answers about consolidated human services agencies in North Carolina.

 

Please Note: These questions and answers have not been updated to reflect the changes from the 2012 legislative session. For more details, see the "legislative updates" page.

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FAQs

What is a consolidated human services agency (CHSA)?
Answer: 

A consolidated human services agency (CHSA) is a single-county agency that provides local public health services, social services, and mental health, developmental disabilities, and substance abuse services for the county residents. A county that creates a CHSA may also direct the agency to assume responsibility for other human servicesfunctions in the county.[1]

 


[1]G.S. 153A-77(b). 

Are there any consolidated human services agencies in North Carolina?
Answer: 

Two counties, Wake and Mecklenburg, have formed CHSAs. Wake County created a CHSA in 1996. Mecklenburg County adopted a resolution creating a consolidated human services agency in 2008 and recently began the process of consolidating some functions of the agencies. In the last quarter of 2011, the agency consolidated the finance operations of all three human services agencies.


How is a CHSA formed?
Answer: 

A CHSA may be created by the board of commissioners of a county that has a county-manager form of government[1] and a population that exceeds 425,000. There is not a clear procedure set out in the law for creating a CHSA, but commissioners would likely adopt a resolution.

 


[1]GS 153A-77(b) makes this option available to counties “having a county manager pursuant to GS 153A-81.” It appears that every county except Tyrrell has a county-manager form of government that would satisfy this definition. Personal communication with Carl Stenberg, February 2012, on file with author.  

May several counties join together to form a multi-county CHSA?
Answer: 

No. The law does not allow multi-county consolidated human services agencies. It states: “In the exercise of its jurisdiction over commissions, boards, and agencies, the board of county commissioners of a county having a county manager pursuant to G.S. 153A-81 may” create a consolidated human services agency.[1] Other portions of the statute give particular powers or duties to the county manager—a delegation of authority that would pose significant implementation difficulties if the statute were construed to permit multi-county agencies.

 


[1]GS 153A-77(b) (emphasis added). 

What happens to the local boards of health, social services, and mental health, developmental disabilities, and substance abuse services when a CHSA is formed?
Answer: 

Those boards are dissolved and a consolidated human services board is appointed. 

Who serves on a consolidated human services board?
Answer: 

A consolidated human services board may have up to 25 members, appointed by the county commissioners. State law specifies that the board must include

  • Certain professional occupations, including a psychologist, a pharmacist, an engineer, a dentist, an optometrist, a veterinarian, a social worker, a registered nurse, a psychiatrist, and at least one other licensed physician
  • Consumers of human services
  • Members of the general public

Of the consumers of human services, the following categories must be represented: a person with mental illness, a family member of a person with mental illness, a person with a developmental disability, a family member of a person with a developmental disability, a person in recovery from substance abuse, a family member of a person with a substance abuse problem, and at least two consumers of human services other than mental health, developmental disabilities and substance abuse.  One member may fill multiple roles on the board. For example, one member could have a family member who has a mental illness as well as a substance abuse problem.[1] A table comparing the membership of a consolidated human services board with other types of local boards of health is available in the attached document.

 


[1]G.S. 153A-77(c). 

Are there term limits for consolidated human services board members?
Answer: 

Consolidated human services board members are appointed to four-year terms and may serve a maximum of two consecutive four-year terms. Unlike with county boards of health, there is no exception for a situation in which a member is the only county resident who is a member of a licensed profession that must be represented on the board.[1] The county commissioner member of the board may serve only as long as he or she remains a county commissioner.

 


[1]G.S. 153A-77(c). At present, state law permits only counties with populations exceeding 425,000 to form a consolidated human services board. This could explain why there is no provision for a term to be extended if an individual is the only person in the county available to represent one of the professions that is required on the board, as it is less likely that a highly-populated county would encounter that circumstance. G.S. 153A-77(f).

May a consolidated human services board member be removed from office before his or her term is up?
Answer: 

A member of a consolidated human services board may be removed from office by the board of county commissioners for any of the following reasons: 

  • Commission of a felony or other crime involving moral turpitude
  • Violation of a state law governing conflict of interest
  • Violation of a written policy adopted by the boards of county commissioners of each county in the district
  • Habitual failure to attend meetings
  • Conduct that tends to bring the office into disrepute
  • Failure to maintain qualifications for appointment (e.g., maintaining licensure in a profession, being a county resident, etc.)

Before it acts to remove a member, the board of county commissioners must give the member written notice of the basis for removal and provide an opportunity for the member to respond.[1]

 


[1]G.S. 153A-77(c). 

What are the powers and duties of a consolidated human services board?
Answer: 

The powers and duties of a consolidated human services board come from multiple sources. The state law that allows eligible counties to create a CHSA gives the board the following powers and duties:[1]

  • Set fees for services based on recommendations of the human services director. Any fees related to public health services are subject to restrictions on the amount and scope that would apply if the fees were set by a local board of health.
  • Assure compliance with laws related to state and federal programs administered by the CHSA.
  • Recommend creation of local human services programs.
  • Adopt local health rules and participate in appeals related to enforcement of those rules.
  • Perform regulatory health functions required by state law.
  • Act as coordinator or agent of the state when required by state or federal law.
  • Plan and recommend a consolidated human services budget.
  • Conduct audits and reviews of human services programs.
  • Advise local officials through the county manager.
  • Perform public relations and advocacy functions.
  • Protect the public health to the extent required by law.
  • Perform comprehensive mental health services planning.
  • Develop certain dispute resolution procedures for contractors, clients and public advocates. 

In addition, the consolidated human services board has most of the powers and duties of a local board of health.[2] Specifically, it is charged with protecting and promoting public health in the county and may:

  • Adopt local public health rules
  • Impose fees for local public health services with the approval of the county commissioners (except when state law prohibits local fees)
  • Adjudicate disputes about local health rules or the local imposition of administrative penalties (fines) for violations of public health laws

The board must also meet the benchmarks for boards of health in North Carolina’s local health department accreditation program (see question 11).

A consolidated human services board differs from other boards of health in that it lacks the authority to appoint the agency director. Also, while a consolidated human services board plans and recommends the agency budget, it is prohibited from transmitting or presenting the budget for local health programs.[3] A table comparing the powers and duties of consolidated human services boards with other local boards of health is available here

 


[1]GS 153A-77(d).

[2]G.S. 130A-43(b).

[3]G.S. 130A-43. 

May a board of county commissioners abolish the consolidated human services board and assume its powers and duties?
Answer: 

Under present law, counties with populations exceeding 425,000 may abolish any or all of their local human services boards and permit the board of county commissioners to exercise the powers and duties of the abolished boards. The law that permits this applies to boards that are either (1) appointed by the commissioners, or (2) acting under the commissioners’ authority.[1] This clearly includes a consolidated human services board.  If a board of county commissioners abolishes its consolidated human services board, the county commissioners acquire the board’s powers and duties, described here.

 


[1]G.S. 153A-77(a). 

Must a CHSA be accredited by the North Carolina Local Health Department Accreditation Board?
Answer: 

A state law requires each local public health agency to obtain and maintain accreditation.[1] State regulations set the standards that must be met for an agency to be accredited.[2] This requirement applies to any agency functioning as a “local health department” under North Carolina law. The statutory definition of “local health department” includes a county health department, a district health department, or a public health authority. Although the definition does not mention consolidated human services agencies, a separate law states that such agencies “shall have the responsibility to carry out the duties of a local health department.”[3] Obtaining and maintaining accreditation appears to be one such duty. More information about local health department accreditation is available here.

 


[1]G.S. 130A-34.1.

[2]N.C. Admin. Code, Title 10A, Chapter 48.

[3]G.S. 130A-43(a).

Must a CHSA take on all three functions specified in the law (public health, social services, and mental health, developmental disabilities, and substance abuse services), or is it possible to create a CHSA that consolidates only two of the functions?
Answer: 

While the law doesn’t directly answer this question, the law as a whole strongly suggests that that a CHSA must include all three human services functions: public health, social services, and mental health, developmental disabilities and substance abuse services (MHDDSAS).

  • The law authorizes the creation of “a consolidated human services agency with the authority to carry out the functions of the local health department, the county department of social services, and the area mental health, developmental disabilities, and substance abuse services authority.”[1] In interpreting statutes, the use of the word “and” rather than “or” is significant and suggests that all three functions must be part of the CHSA.
  • A separate provision in the law allows a county to add other county human services functions to the CHSA’s duties.[2] Because it creates this option, it appears that public health, social services, and MHDDSAS are the “core” human services programs that must be included and others are optional.
  • The law specifies who must be included on the consolidated human services board. The board must include people who are served by each of the three agencies, with a heavy emphasis on clients, families, and providers involved with the MHDDSAS services. It would be incongruous to have a board so heavily weighted towards the MHDDSAS arena to govern the activities of an agency focused on public health and social services.

Thus, the law appears clearly to contemplate that a CHSA will assume the functions of all three agencies—public health, social services, and MHDDSAS—and it provides for a board that represents the interests of all three agencies.


[1]G.S. 153A-77(b)(3) (emphasis added).

[2]G.S. 153A-77(b)(4). 

Who hires and fires the employees of a CHSA?
Answer: 

The county manager appoints a consolidated human services director with the advice and consent of the consolidated human services board. The consolidated human services director may initiate the appointment of agency staff but hiring decisions must be approved by the county manager.[1]


[1]G.S. 153A-77(e). 

What are the powers and duties of a consolidated human services director?
Answer: 

A consolidated human services director has most of the legal powers and duties of a local health director, except he or she may not hire agency employees without the county manager’s approval. A consolidated human services director also has duties that go beyond those of a traditional local health director, largely reflecting his or her role as the chief administrator for human services programs other than public health.[1] More information about the powers and duties of a local health director is available here

 


[1]G.S. 153A-77(e).

Must a consolidated human services director have the same training, education, or experience as other local health directors?
Answer: 

The law creating the position of consolidated human services director does not require any specific education or experience, but North Carolina’s standards for local public health agency accreditation specify that the agency’s governing board must appoint a local health director who meets the requirements of the law that applies to county and district health directors.[1] (More information about those qualifications is available here.) However, the accreditation program does not require local agencies to satisfy every provision in the standards—agencies may skip a small proportion of the standards and still be accredited.[2]  Therefore, it is possible that a consolidated agency could satisfy accreditation standards without meeting the specific standard that addresses the director’s qualifications.

 


[1]See 10A NCAC 48B .1304; see also 10A NCAC 48B .0901(b)(1) (requiring the agency to have, or be recruiting, a local health director who meets legal requirements for the position).

[2]The accreditation rules establish benchmarks and specify how many benchmarks must be met in each of three areas: agency core functions and essential services, facilities and administrative services, and board of health. 10A NCAC 48B. 0103. For example, a local public health agency must satisfy at least six of eight benchmarks pertaining to the board of health. 

Which personnel policies apply to a CHSA?
Answer: 

Employees of consolidated human services agencies are subject to county personnel ordinances and policies.[1] Because the consolidated agency administers certain federal social services programs, the policies must meet federal requirements for a merit personnel system.[2]


[1]G.S. 153A-77(d); see also G.S. 126-5(a)(2) (specifying that an employee of a CHSA created pursuant to G.S. 153A-77(b) is not a local employee who is subject to the State Personnel Act).

[2]5 CFR § 900.601 to .605 (requiring state and local agencies who receive certain federal grants to have merit personnel systems in place that comply with minimum federal requirement); 5 CFR Subpart F, Appendix A (specifying the grant programs subject to that requirement and including several programs for which a CHSA would likely receive federal grant funding, such as foster care and adoption assistance grants, Medicaid, and the program commonly referred to as food stamps).  

May a county dissolve a consolidated human services agency and create or join a different form of local public health agency?
Answer: 

Unlike a district health department or public health authority, there are no statutory procedures for dissolving a consolidated agency, but there is no doubt that a county may do so. There would be a number of administrative tasks associated with dissolving the agency, including dissolving the consolidated human services board and appointing new boards and directors for public health, social services, and mental health services.

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