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:

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

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

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

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

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

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

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

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

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

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and human services policy and planning, budgeting and financing.

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

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safety and positive outcomes.

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

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federal financial participation, grants and awards.

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

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

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

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

 

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services and supports on their behalf.

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

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

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

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

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

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

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

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Medicaid state agency.

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

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

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

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outcome measures and expectations.

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

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

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

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

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

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

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

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

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

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expectations.

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

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

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

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

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Services shall be authorized to:

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

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

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

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

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

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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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Social Security Act, as amended; and

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

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provider.

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

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

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resources, information and support shall be necessary.

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      (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

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governor.

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

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

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capacity, the secretary shall:

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

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

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

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

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services workforce;

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

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

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changing needs of the people and communities they serve;

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

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

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

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

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

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the departments;

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

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

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administration;

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

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

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

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

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

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

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

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alternative financing.

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

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

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and quality of services; and

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      (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

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

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initiatives and programs.

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

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

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

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

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3-4 of the Rhode Island general laws.

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

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

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

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

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

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performance evaluation system shall:

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

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measures, and desired outcomes;

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

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

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

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

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programmatic and budgetary decisions;

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

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

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

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

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

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

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services.

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

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

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

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

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information and assistance deemed necessary by the secretary when undertaking such

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independent reviews.

 

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

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

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

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

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

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

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

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

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

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

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

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powers and duties of their agencies.

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

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of Health and Human Services" is hereby repealed.

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

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

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

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

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

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hotlines within the state.

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

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

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

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

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

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

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

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

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

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

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

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February 1, 2007.

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

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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

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

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

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

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

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

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

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

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expectations, and outcomes for the departments.

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

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

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

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     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

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

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

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them.

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     This act would take effect on January 1, 2015.

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