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The Seward City Council approved the 2020 operating budget of the Seward Community Health Center at its Monday night meeting, but the resolution to do so included a condition that appeared to prohibit “direct hiring of staff related to behavioral health or substance use disorder services.”

The clause provoked public disagreement between city officials, who described it as merely a clarification of an existing policy, and health center Executive Director Craig Ambrosiani, who questioned its appropriateness.

It drew the support of Christine Sheehan, executive director of Seaview Community Services, whom the council asked to speak on the matter.

The measure passed 6–1, with Council Member Kelley Lane opposing. Lane had proposed an amendment to strike the restrictive language, but her motion died for lack of a second.

On Tuesday, Council Member Suzi Towsley filed a request for reconsideration, meaning that the item will come up at the next council meeting. Reconsideration requires a two-thirds vote of the council. 

Assistant City Manager Brennan Hickok said that the measure was included as an echo of language already in the so-called co-applicant agreement between the health center and the city, which requires that the health center collaborate rather than compete with other local providers.

Hickok said that the agreement “has a prohibition on competition,” adding that the health center directly hiring mental health professionals “is direct competition.”

The relevant portion of the agreement makes reference to the “public entity model” of community health centers, an uncommon form of health center organization in which a government entity acts as a sponsor for the health center, which is legally a separate entity.

It says only that that model “requires cooperation rather than competition among the community’s healthcare providers, creating partnerships to drive a more efficient healthcare delivery system and strengthen safety net programs.”

The health center program compliance manual actually requires all health centers, not only those sponsored by a public entity, to “make every reasonable effort to establish and maintain collaborative relationships” with other providers.

The provision surprised health center Executive Director Craig Ambrosiani, who disputed Hickok’s characterization of the agreement and argued that such language has no place in the resolution, the nominal purpose of which was to approve the center’s budget.

“I don’t know why in a resolution to approve our budget someone would have inserted a statement like this,” Ambrosiani said at the meeting. “I really don’t know what this has to do with our budget.

“We can work on this in our co-applicant agreement.”

The city and the health center have embarked on a re-negotiation of that agreement, following intervention by officials at the Health Resources and Services Administration, the federal agency that oversees the health center program.

The addition appears to be a response to a long-standing controversy about the authority of the health center to expand its scope without the city’s approval, a prospect which some other healthcare providers view as well.

The center two years ago applied for an expansion to its “scope of project” with HRSA, but did not seek the city’s agreement, according to statements at Monday night’s meeting and conversations with officials and board members at both organizations.

The move allowed the center to pursue federal grants in the areas of substance abuse treatment and mental health, areas within the specialty of other local providers such as Seaview Community Services.  

“This resolution is really addressing the FQHC’s move into behavioral health, which we understood in the beginning was prohibited,” said Seaview Executive Director Christine Sheehan, using the acronym for federally qualified health center.

Up to $107,000 of the funds unlocked by the new project scope goes to Seaview through a contract that the organization holds with the health center.

Judging by remarks made at the meeting by Sheehan and comments made to the Seward Journal by another local provider, some in Seward view the health center as a potential juggernaut fueled by grant funds to which others lack access.

“The FQHC has enormous advantages that the city has given it,” Sheehan said, referring to the health centers tenancy in the city-owned hospital building and to budgetary assistance that the health center has received for each year since its inception.

That assistance has declined by $100,000 each year. In 2020, the health center will receive $100,000 from the city. It would be the last year the health center would receive assistance under the existing arrangement.

Ambrosiani expressed concern that the resolution’s apparent limitation on the powers of the health center’s governing board would raise red flags with HRSA, which has already intervened once this year.

Ambrosiani appeared to be referring to requirements in the health center program compliance manual and the Code of Federal Regulations that the health center board have sole authority over “adopting health care policies including scope and availability of services, location and hours of services, and quality-of-care audit procedures.”

The city and the health center appear to disagree over the exact meaning of this requirement and another in the compliance manual forbidding arrangements in which non-board entities “have veto power over the health center board with regard to the required authorities and functions.”

The author’s spouse works part-time at the Seward Community Health Center.