Types of Local Public Health Agencies: Consolidated Human Services Agencies

A consolidated human services agency (CHSA) is a single-county agency that provides local public health services and/or social services to county residents. A county that creates a CHSA may also consolidate other county human services functions into the CHSA.[1]

 

There are currently twenty-eight counties in North Carolina that have consolidated human services agencies (CHSAs).

Prior to 2012, only counties with a population of at least 425,000 could create a CHSA. Wake County created a CHSA in 1996. Mecklenburg County adopted a resolution creating a CHSA in 2008. In 2012, the North Carolina General Assembly passed Session Law (“S.L.”) 2012-126, which provided counties with new options regarding organization and governance of their human services functions. Specifically, S.L. 2012-126 allowed any board of county commissioners in a county with a county manager appointed pursuant to G.S. 153A-81 to combine two or more human services functions into a single CHSA.

A CHSA may be created by the board of commissioners of a county that has a county-manager form of government. To date, every county in North Carolina that has created a CHSA has done so through a resolution. The law does not explicitly require that counties create a CHSA through the use of a resolution, unless the board of county commissioners is also assuming the powers and duties of the CHSA’s governing board. However, the School of Government strongly recommends the use of a resolution to form a CHSA. Among other things, the language of the resolution establishes whether employees will be subject to the State Human Resources Act or subject to county personnel policies, as well as which departments or functions are being consolidated into the CHSA.
 

For more information on the process of creating a CHSA and the decisions involved, please see the attached document, "Considerations When Creating a CHSA." For more information on a county's decisions related to CHSA personnel, please see this bulletin. 

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.

 

If the county department of social services and the local health department have both been consolidated into a CHSA, then the governing boards for those agencies are dissolved when the CHSA is formed. The board of county commissioners (BOCC) then has two options for governance of the new CHSA. The BOCC may appoint a new consolidated human services board or may serve directly as the governing board for the CHSA.

If it decides to appoint a consolidated human services board, the BOCC must first create a nominating committee that includes members of the current (pre-consolidation) board of health and social services board, as well as the board responsible for managing mental health, developmental disabilities, and substance abuse services in the county. The nominating committee then recommends members for the new consolidated human services board and the BOCC makes appointments based upon those recommendations. After the initial board is in place, the BOCC will fill vacancies based upon nominees presented by the members of the consolidated human services board.

G.S. 153A-77(c).

A consolidated human services board may have up to 25 members, appointed by the board of county commissioners. All members of the CHS board must be residents of the county. The composition of the CHS board must “reasonably reflect the population makeup of the county” and must include:

• Four persons who are “consumers of human services.”
• Eight persons who are professionals, each with qualifications in one of these categories: one psychologist, one pharmacist, one engineer, one dentist, one optometrist, one veterinarian, one social worker, and one registered nurse.
• Two physicians licensed to practice medicine in North Carolina, one of whom must be a psychiatrist.
• One county commissioner.
• Other persons, including “members of the general public representing various occupations.”

The BOCC may elect to appoint a member of the CHS board to concurrently fill more than one category of membership (the categories described above) if the member has the qualifications or attributes of more than one category of membership.

 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.

Consolidated human services board members are appointed to four-year terms and may serve a maximum of two consecutive four-year terms. The county commissioner member of the board may serve only as long as he or she remains a county commissioner.
 

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 board of county commissioners
• 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]

The powers and duties of a consolidated human services board come from multiple sources. G.S. 153A-77(d) gives the board the following powers and duties:

• 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 county 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.
• 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.

Similarly, the board acquires many of the powers and duties of the county board of social services.[3] 

A consolidated human services board differs from other boards of health (and from the board of social services) in that it lacks the authority to appoint the agency director. Additionally, 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.[4] A table comparing the powers and duties of consolidated human services boards with other local boards of health is available here. 

Yes. If a board of county commissioners (BOCC) abolishes its consolidated human services board, the BOCC acquires the board’s powers and duties, described here. Prior to serving as the governing board for the new CHSA, the BOCC must hold a public hearing. The law requires “30 days’ notice of said public hearing given in a newspaper having general circulation in said county.” The hearing requirement is triggered by the BOCC assuming the powers and duties of another board – which could be a county board of health, a county board of social services, or a CHS board. [1]

If the CHSA includes public health and the BOCC assumes the powers and duties of the governing board, the BOCC must appoint an advisory committee for public health. [2]  The advisory committee membership must, at a minimum, meet the requirements for a county board of health found in G.S. 130A-35. The requirement for a health advisory committee applies only to counties that abolish their health or CHS boards after January 1, 2012. This amounts to an exception for Mecklenburg County, which abolished its boards (a county board of health, and subsequently a consolidated human services board) before that date.

If the CHSA will include a department of social services, the advisory committee could have a broader scope and include people with social services expertise or interests. The BOCC also has the option of appointing a separate advisory committee for social services or other issues, but that is not required by law.

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” in G.S. 130A-2 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 is one such duty. 

G.S. 153A-77(b)(3) authorizes a county to create a CHSA to “carry out the functions of any combination of commissions, boards, or agencies appointed by the board of county commissioners or acting under and pursuant to the authority of the board of county commissioners.” Counties can choose which functions to include in a CHSA. The term “human services” is undefined in the law. A CHSA may incorporate a local health department and/or department of social services, but other agencies, departments, or functions may also be involved. For example, some CHSAs in North Carolina provide services focused on veterans, aging populations, domestic violence services, or transportation. To date, all CHSAs formed in North Carolina have incorporated departments of social services, though not all CHSAs have incorporated public health (Cabarrus County’s CHSA does not include public health). There is, however, no requirement that a CHSA incorporate a county’s department of social services.

There are, however, some limitations. A CHSA may not include:

• A local management entity (“LME”) involved with mental health, developmental disabilities, and substance abuse services (with the exception of the CHSA serving Mecklenburg County);
• A public health authority assigned the power, duties, and responsibilities to provide public health services as outlined in G.S. 130A-1.1;
• A public hospital authority authorized to provide public health services under S.L. 1997-502; or
• A public hospital as defined in G.S. 159-39(a).

See G.S. 153A-76.

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 hiring of agency staff but the director’s hiring decisions must be approved by the county manager.[1]

A consolidated human services (CHS) director acquires most of the legal powers and duties of a local health director and a county director of social services, except that a CHS director may not hire agency employees without the county manager’s approval. State law also establishes that the CHS director is responsible for [1]:  

• Administering state human services programs.
• Administering human services programs of the local board of county commissioners.
• Acting as secretary and staff to the consolidated human services board under the direction of the county manager.
• Planning the budget of the consolidated human services agency.
• Advising the board of county commissioners through the county manager.
• Performing regulatory functions of investigation and enforcement of state and local health regulations, as required by state law.
• Acting as an agent of and liaison to the state, to the extent required by law.
• Appointing, with the county manager's approval, an individual that meets the statutory requirements to be a local health director (found in G.S. 130A-40(a)).

Many, though not all, of a local health director’s powers and duties are found in G.S. 130A-41. Similarly, many, though not all, of a director of social services’ powers and duties are found in G.S. 108A-14.

 

The law creating the position of consolidated human services director does not require any specific education or experience. The experience and education necessary to succeed in the consolidated human services director position may depend in part on how the county decides to structure the internal organization of the CHSA, as described below.  

Except as otherwise provided by law, the individual appointed as the CHSA director acquires all of the powers and duties as a social services director and a local health director (if both social services and public health are consolidated into the CHSA).  The CHSA director is permitted, but not required, to delegate most of these powers and duties to other staff members within the agency.  The county manager and the CHSA director have tremendous flexibility in deciding how to delegate these powers and duties and in how to structure the internal organization of the CHSA. For example, in some counties, the new CHSA director was formerly a DSS director or local health director prior to consolidation and retains that role after assuming leadership of the CHSA. In other counties, the CHSA director appoints both a DSS director and a public health director, who both report to the CHSA director and handle the day-to-day management of their respective divisions. In some counties, an assistant county manager is appointed to be the CHSA director and then appoints a social services and public health director (or a director and an assistant director in each division).

The only limitation on this flexible internal structuring authority comes from G.S. 153A-77(e), which requires that the CHSA director appoint (with the county manager’s approval) an individual who meets the statutory requirements of a local health director found in G.S. 130A-40(a). This appointment is only necessary if the CHSA director does not already personally meet those statutory local health director requirements. The law does not expressly require the CHSA director to delegate local health director powers and duties to the appointee who meets the G.S. 130A-40(a) requirements, but it may be prudent and logical to do so, since this individual would have the appropriate knowledge and experience to exercise such powers and  duties.  There is no equivalent requirement for the CHSA director to appoint someone with particular social services experience or qualifications, though many CHSA directors will find it necessary and pragmatic to do so.

More information about the appointment of the CHSA director and decisions regarding delegations of authority is available here.

Employees of a CHSA are subject to county personnel policies by default, unless the board of county commissioners elects to subject the employees to the State Human Resources Act (SHRA).  See G.S. 153A-77(d). If the BOCC wants to keep its social services and public health employees subject to the SHRA when creating a CHSA, it must explicitly elect to do so in the form of a resolution. Typically, counties that elect to keep employees covered under the SHRA do so as part of the same resolution that creates the CHSA, though this could be achieved through a separate (or later) resolution if desired. If the resolution creating a CHSA stays silent on the issue of personnel, the CHSA’s employees will automatically be covered under county personnel policies instead of the SHRA.

Additionally, G.S. 153A-77(d) mandates that all CHSAs comply with the federal requirements for merit personnel systems, which are found in Title 5, Section 900.603 of the Code of Federal Regulations. For counties that elect to keep their CHSA employees subject to the SHRA, the CHSA will generally be compliant with the federal merit personnel standards simply through abiding by the SHRA’s procedures. However, when a county wants to remove its CHSA employees from the SHRA, it should first instruct the county attorney (or outside counsel) to conduct a careful review of county personnel policies, procedures, and ordinances to ensure that they meet each of the federal standards. To the extent that they do not reflect the federal merit personnel system standards, these documents and practices will need to be modified specifically for CHSA employees. The county is not required to adhere to the federal merit personnel system standards for all county employees, though it may choose to do so.

More information regarding CHSA personnel policies and decisions for counties related to CHSA personnel is available here.

Unlike a district health department or public health authority, there are no statutory procedures for dissolving a consolidated human services 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 and social services. A county should also consider the potential impacts related to CHSA employees, who may be switching from an organizational model where they were subject to county personnel policies to an organizational model in which they will be subject to the State Human Resources Act.