2014 -- S 2972 SUBSTITUTE A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

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A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - OFFICE OF HEALTH AND

HUMAN SERVICES

     Introduced By: Senators DiPalma, Miller, DaPonte, Goldin, and Ottiano

     Date Introduced: May 01, 2014

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 42-7.2-2, 42-7.2-4 and 42-7.2-5 of the General Laws in Chapter

42-7.2 entitled "Office of Health and Human Services" are hereby amended to read as follows:

     42-7.2-2. Executive office of health and human services. -- There is hereby established

within the executive branch of state government an executive office of health and human services

to serve as the principal agency of the executive branch of state government for managing the

departments of children, youth and families, health, human services, and behavioral healthcare,

developmental disabilities and hospitals ("the departments"). In this capacity, the office shall:

      (a) Lead the state's four (4) health and human services departments in order to:

      (1) Improve the performance, economy, efficiency, coordination, and quality of health

and human services policy and planning, budgeting and financing.

      (2) Design strategies and implement best practices that foster service access, consumer

safety and positive outcomes.

      (3) Maximize and leverage funds from all available public and private sources, including

federal financial participation, grants and awards.

      (4) Increase public confidence by conducting independent reviews of health and human

services issues in order to promote accountability and coordination across departments.

      (5) Ensure that state health and human services policies and programs are responsive to

changing consumer needs and to the network of community providers that deliver assistive

services and supports on their behalf.

      (b) Administer the federal and state medical assistance programs in the capacity of the

single state agency authorized under title XIX of the U.S. Social Security act, 42 U.S.C. section

1396a et seq., and exercise such single state agency authority for such other federal and state

programs as may be designated by the governor. Except as provided for herein, nothing in this

chapter shall be construed as transferring to the secretary the powers, duties or functions

conferred upon the departments by Rhode Island general laws for the management and operations

of programs or services approved for federal financial participation under the authority of the

Medicaid state agency.

     (c) In cooperation with the health and human service system performance improvement

task force established pursuant to § 42-7.2-5.1, establish performance and outcome measures for

the departments and hold specific directors accountable for meeting said performance and

outcome measures and expectations.

     42-7.2-4. Responsibilities of the secretary. -- (a) The secretary shall be responsible to

the governor for supervising the executive office of health and human services and for managing

and providing strategic leadership and direction to the four (4) departments.

     (b) Notwithstanding the provisions set forth in this chapter, the governor shall appoint the

directors of the departments within the executive office of health and human services. Directors

appointed to those departments shall continue to be subject to the advice and consent of the senate

and shall continue to hold office as set forth in sections 42-6-1 et seq. and 42-72-1(c).

     (c) The secretary shall establish performance and outcome measures for the departments

and hold the directors accountable for meeting said performance and outcome measures and

expectations.

     42-7.2-5. Duties of the secretary. -- The secretary shall be subject to the direction and

supervision of the governor for the oversight, coordination and cohesive direction of state

administered health and human services and in ensuring the laws are faithfully executed, not

withstanding any law to the contrary. In this capacity, the Secretary of Health and Human

Services shall be authorized to:

      (1) Coordinate the administration and financing of health care benefits, human services

and programs including those authorized by the Global Consumer Choice Compact Waiver and,

as applicable, the Medicaid State Plan under Title XIX of the US Social Security Act. However,

nothing in this section shall be construed as transferring to the secretary the powers, duties or

functions conferred upon the departments by Rhode Island public and general laws for the

administration of federal/state programs financed in whole or in part with Medicaid funds or the

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administrative responsibility for the preparation and submission of any state plans, state plan

amendments, or authorized federal waiver applications, once approved by the secretary.

      (2) Serve as the governor's chief advisor and liaison to federal policymakers on Medicaid

reform issues as well as the principal point of contact in the state on any such related matters.

      (3) Review and ensure the coordination of any Global Consumer Choice Compact

Waiver requests and renewals as well as any initiatives and proposals requiring amendments to

the Medicaid state plan or category two (II) or three (III) changes, as described in the special

terms and conditions of the Global Consumer Choice Compact Waiver with the potential to affect

the scope, amount or duration of publicly-funded health care services, provider payments or

reimbursements, or access to or the availability of benefits and services as provided by Rhode

Island general and public laws. The secretary shall consider whether any such changes are legally

and fiscally sound and consistent with the state's policy and budget priorities. The secretary shall

also assess whether a proposed change is capable of obtaining the necessary approvals from

federal officials and achieving the expected positive consumer outcomes. Department directors

shall, within the timelines specified, provide any information and resources the secretary deems

necessary in order to perform the reviews authorized in this section;

      (4) Beginning in 2006, prepare and submit to the governor, the chairpersons of the house

and senate finance committees, the caseload estimating conference, and to the joint legislative

committee for health care oversight, by no later than March 15 of each year, a comprehensive

overview of all Medicaid expenditures outcomes, and utilization rates. The overview shall

include, but not be limited to, the following information:

      (i) Expenditures under Titles XIX and XXI of the Social Security Act, as amended;

      (ii) Expenditures, outcomes and utilization rates by population and sub-population

served (e.g. families with children, children with disabilities, children in foster care, children

receiving adoption assistance, adults with disabilities, and the elderly);

      (iii) Expenditures, outcomes and utilization rates by each state department or other

municipal or public entity receiving federal reimbursement under Titles XIX and XXI of the

Social Security Act, as amended; and

      (iv) Expenditures, outcomes and utilization rates by type of service and/or service

provider.

      The directors of the departments, as well as local governments and school departments,

shall assist and cooperate with the secretary in fulfilling this responsibility by providing whatever

resources, information and support shall be necessary.

      (5) Resolve administrative, jurisdictional, operational, program, or policy conflicts

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among departments and their executive staffs and make necessary recommendations to the

governor.

      (6) Assure continued progress toward improving the quality, the economy, the

accountability and the efficiency of state-administered health and human services. In this

capacity, the secretary shall:

      (i) Direct implementation of reforms in the human resources practices of the departments

that streamline and upgrade services, achieve greater economies of scale and establish the

coordinated system of the staff education, cross-training, and career development services

necessary to recruit and retain a highly-skilled, responsive, and engaged health and human

services workforce;

      (ii) Encourage the departments to utilize consumer-centered approaches to service design

and delivery that expand their capacity to respond efficiently and responsibly to the diverse and

changing needs of the people and communities they serve;

      (iii) Develop all opportunities to maximize resources by leveraging the state's purchasing

power, centralizing fiscal service functions related to budget, finance, and procurement,

centralizing communication, policy analysis and planning, and information systems and data

management, pursuing alternative funding sources through grants, awards and partnerships and

securing all available federal financial participation for programs and services provided through

the departments;

      (iv) Improve the coordination and efficiency of health and human services legal

functions by centralizing adjudicative and legal services and overseeing their timely and judicious

administration;

      (v) Facilitate the rebalancing of the long term system by creating an assessment and

coordination organization or unit for the expressed purpose of developing and implementing

procedures across departments that ensure that the appropriate publicly-funded health services are

provided at the right time and in the most appropriate and least restrictive setting; and

      (vi) Strengthen health and human services program integrity, quality control and

collections, and recovery activities by consolidating functions within the office in a single unit

that ensures all affected parties pay their fair share of the cost of services and are aware of

alternative financing.

      (vii) Broaden access to publicly funded food and nutrition services by consolidating

agency programs and initiatives to eliminate duplication and overlap and improve the availability

and quality of services; and

      (viii) Assure protective services are available to vulnerable elders and adults with

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developmental and other disabilities by reorganizing existing services, establishing new services

where gaps exist and centralizing administrative responsibility for oversight of all related

initiatives and programs.

      (7) Prepare and integrate comprehensive budgets for the health and human services

departments and any other functions and duties assigned to the office. The budgets shall be

submitted to the state budget office by the secretary, for consideration by the governor, on behalf

of the state's health and human services in accordance with the provisions set forth in section 35-

3-4 of the Rhode Island general laws.

      (8) Utilize objective data to evaluate health and human services policy goals, resource

use and outcome evaluation In cooperation with the health and human service system

performance improvement task force established pursuant to § 42-7.2-5.1, establish a

comprehensive data collection and performance evaluation system and to perform assist in short

and long-term policy planning and development, and increase department accountability. Said

performance evaluation system shall:

     (i) Engage department directors in the development of mutually-agreed upon goals,

measures, and desired outcomes;

     (ii) Provide guidance on what outcomes the department can reasonably be expected to

influence, how departments will use measures to manage programs and achieve desired

outcomes, and how directors will be held accountable in achieving desired outcomes;

     (iii) Develop and use timely and accurate performance data to set targets and inform

programmatic and budgetary decisions;

     (iv) Encourage and support candor in identifying and diagnosing barriers to achieving

desired outcomes, with a focus on removing and/or overcoming said barriers; and

     (v) Provide continuous follow-up and accountability for results.

      (9) Establishment of an integrated approach to interdepartmental information and data

management that complements and furthers the goals of the CHOICES initiative and that will

facilitate the transition to consumer-centered system of state administered health and human

services.

      (10) At the direction of the governor or the general assembly, conduct independent

reviews of state-administered health and human services programs, policies and related agency

actions and activities and assist the department directors in identifying strategies to address any

issues or areas of concern that may emerge thereof. The department directors shall provide any

information and assistance deemed necessary by the secretary when undertaking such

independent reviews.

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      (11) Provide regular and timely reports to the governor and make recommendations with

respect to the state's health and human services agenda.

      (12) Employ such personnel and contract for such consulting services as may be required

to perform the powers and duties lawfully conferred upon the secretary.

      (13) Implement the provisions of any general or public law or regulation related to the

disclosure, confidentiality and privacy of any information or records, in the possession or under

the control of the executive office or the departments assigned to the executive office, that may be

developed or acquired for purposes directly connected with the secretary's duties set forth herein.

     (14) Utilizing the performance evaluation system established pursuant to § 42-7.2-5(8),

Hold hold the director of each health and human services of the department departments

accountable for their administrative, fiscal and program actions in the conduct of the respective

powers and duties of their agencies.

     SECTION 2. Section 42-7.2-12.1 of the General Laws in Chapter 42-7.2 entitled "Office

of Health and Human Services" is hereby repealed.

     42-7.2-12.1. Human services call center study (211). -- (a) The secretary of the

executive office of health and human services shall conduct a feasibility and impact study of the

potential to implement a statewide 211 human services call center and hotline. As part of the

process, the study shall catalog existing human service information hotlines in Rhode Island,

including, but not limited to, state-operated call centers and private and not-for-profit information

hotlines within the state.

      (1) The study shall include analysis of whether consolidation of some or all call centers

into a centralized 211 human services information hotline would be economically and practically

advantageous for both the public users and agencies that currently operate separate systems.

      (2) The study shall include projected cost estimates for any recommended actions,

including estimates of cost additions or savings to private service providers.

      (b) The directors of all state departments and agencies shall cooperate with the secretary

in preparing this study and provide any information and/or resources the secretary deems

necessary to assess fully the short and long-term implications of the operations under review both

for the state and the people and the communities the departments serve.

      (c) The secretary shall submit a report and recommendations based on the findings of the

study to the general assembly, the governor, and the house and senate fiscal advisors no later than

February 1, 2007.

     SECTION 3. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human

Services" is hereby amended by adding thereto the following section:

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     42-7.2-5.1. Office of Health & Human Service's System Performance Improvement

Task Force. -- (a) There is hereby established a health and human service system performance

improvement task force which shall establish performance measures, expectations, and outcomes

for the department. The task force shall consist of the director of the department of

administration, the director of the office of management and budget, the secretary of health and

human services, and two (2) individuals who shall represent the staff of the general assembly, one

each appointed by the speaker of the house and the president of the senate.

     (b) The purpose of the task force shall be to establish performance measures,

expectations, and outcomes for the departments.

     (c) The task force shall submit a report on the measures and outcomes developed, and

recommendations concerning their use, to the governor, the speaker of the house of

representatives, and the president of the senate, no later than November 1, 2015.

     SECTION 4. This act shall take effect on January 1, 2015.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - OFFICE OF HEALTH AND

HUMAN SERVICES

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     This act would create a health and human service system performance improvement task

force which would establish performance measures, expectations and outcomes for all the

departments within the office of health and human services and improve coordination between

them.

     This act would take effect on January 1, 2015.

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