ARTICLE 18

 

RELATING TO OFFICE OF HEALTH AND HUMAN SERVICES

 

     SECTION 1. Sections 42-7.2.1, 42-7.2-2, 42-7.2-4, 42-7.2-5, 42-7.2-6, 42-7.2-6.1, 42-

7.2-12 and 42-7.2-16 of the General Laws in Chapter 42-7.2 entitled ”Office of Health and

Human Services” are hereby amended to read as follows:

 

     42-7.2-1. Statement of intent.-- The purpose of this Chapter is to develop a consumer-

centered system of publicly-financed state administered health and human services that supports

access to high quality services, protects the safety of the state's most vulnerable citizens, and

ensures the efficient use of all available resources by the five (5) four (4) departments responsible

for the health and human services programs serving all Rhode Islanders and providing direct

assistance and support services to more than 250,000 individuals and families: the department of

children, youth, and families; the department of elderly affairs; the department of health; the

department of human services; and the department of mental health, retardation behavioral

healthcare, developmental disabilities and hospitals, collectively referred to within as

"departments". It is recognized that the executive office of health and human services and the

departments have undertaken a variety of initiatives to further this goal and that they share a

commitment to continue to work in concert to preserve and promote each other's unique missions

while striving to attain better outcomes for all the people and communities they serve. However,

recent and expected changes in federal and state policies and funding priorities that affect the

financing, organization, and delivery of health and human services programs pose new challenges

and opportunities that have created an even greater need for structured and formal

interdepartmental cooperation and collaboration. To meet this need while continuing to build on

the achievements that have already been made, the interests of all Rhode Islanders will best be

served by codifying in the state's general laws the purposes and responsibilities of the executive

office of health and human services and the position of secretary of health and human services.

 

     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, elderly affairs, health, human services, and mental

health, retardation behavioral healthcare, developmental disabilities and hospitals. In this

capacity, the office shall:

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

     (1) Improve the 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) Supervise the administrations of Administer the federal and state medical assistance

programs by acting as in the capacity of the single state agency authorized under title XIX of the

U.S. Social Security act, 42 U.S.C. § 1396a et seq., notwithstanding any general or public law or

regulation to the contrary, and exercising 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: (1) The the

powers, duties or functions conferred upon the departments by Rhode Island general laws for the

administration of the foregoing federal and state programs; or (2) The administrative

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

federal waiver applications, as may be approved from time to time by the secretary with respect

to the foregoing federal and state programs management and operations of programs or services

approved for federal financial participation under the authority of the Medicaid state agency.

 

     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 five 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 §§ 42-6-1 et seq. and 42-72-1(c).

 

     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

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 one (I) or 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

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

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 § 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 and to perform short and long-term policy planning and development.

     (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.

     (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) Hold the director of each health and human services department accountable for

their administrative, fiscal and program actions in the conduct of the respective powers and duties

of their agencies.

 

     42-7.2-6. Departments assigned to the executive office - Powers and duties. --(a) The

departments assigned to the secretary shall:

     (1) Exercise their respective powers and duties in accordance with their statutory

authority and the general policy established by the governor or by the secretary acting on behalf

of the governor or in accordance with the powers and authorities conferred upon the secretary by

this chapter;

     (2) Provide such assistance or resources as may be requested or required by the governor

and/or the secretary; and

     (3) Provide such records and information as may be requested or required by the

governor and/or the secretary to the extent allowed under the provisions of any applicable general

or public law, regulation, or agreement relating to the confidentiality, privacy or disclosure of

such records or information.

     (4) Forward to the secretary copies of all reports to the governor.

     (b) Except as provided herein, no provision of this chapter or application thereof shall be

construed to limit or otherwise restrict the department of children, youth and families, the

department of elderly affairs, the department of health, the department of human services, and the

department of mental health, retardation behavioral healthcare, developmental disabilities and

hospitals from fulfilling any statutory requirement or complying with any valid rule or regulation.

 

     42-7.2-6.1. Transfer of powers and functions.-- (a) There are hereby transferred to the

executive office of health and human services the powers and functions of the departments with

respect to the following:

     (1) By July 1, 2007, fiscal services including budget preparation and review, financial

management, purchasing and accounting and any related functions and duties deemed necessary

by the secretary;

     (2) By July 1, 2007, legal services including applying and interpreting the law, oversight

to the rule-making process, and administrative adjudication duties and any related functions and

duties deemed necessary by the secretary;

     (3) By September 1, 2007, communications including those functions and services related

to government relations, public education and outreach and media relations and any related

functions and duties deemed necessary by the secretary;

     (4) By March 1, 2008, policy analysis and planning including those functions and

services related to the policy development, planning and evaluation and any related functions and

duties deemed necessary by the secretary;

     (5) By June 30, 2008, information systems and data management including the financing,

development and maintenance of all data-bases and information systems and platforms as well as

any related operations deemed necessary by the secretary;

     (6) By October 1, 2009, assessment and coordination for long-term care including those

functions related to determining level of care or need for services, development of individual

service/care plans and planning, identification of service options, the pricing of service options

and choice counseling; and

     (7) By October 1, 2009, program integrity, quality control and collection and recovery

functions including any that detect fraud and abuse or assure that beneficiaries, providers, and

third-parties pay their fair share of the cost of services, as well as any that promote alternatives to

publicly financed services, such as the long-term care health insurance partnership.

     (8) By January 1, 2011, client protective services including any such services provided to

children, elders and adults with developmental and other disabilities;

     (9) [Deleted by P.L. 2010, ch. 23, art. 7, § 1].

     (10) By July 1, 2012, the HIV/AIDS care and treatment programs.

     (b) The secretary shall determine in collaboration with the department directors whether

the officers, employees, agencies, advisory councils, committees, commissions, and task forces of

the departments who were performing such functions shall be transferred to the office.

     (c) In the transference of such functions, the secretary shall be responsible for ensuring:

     (1) Minimal disruption of services to consumers;

     (2) Elimination of duplication of functions and operations;

     (3) Services are coordinated and functions are consolidated where appropriate;

     (4) Clear lines of authority are delineated and followed;

     (5) Cost-savings are achieved whenever feasible;

     (6) Program application and eligibility determination processes are coordinated and,

where feasible, integrated; and

     (7) State and federal funds available to the office and the entities therein are allocated and

utilized for service delivery to the fullest extent possible.

     (d) Except as provided herein, no provision of this chapter or application thereof shall be

construed to limit or otherwise restrict the departments of children, youth and families, human

services, elderly affairs, health, and mental health, retardation behavioral healthcare,

developmental disabilities, and hospitals from fulfilling any statutory requirement or complying

with any regulation deemed otherwise valid.

     (e) The secretary shall prepare and submit to the leadership of the house and senate

finance committees, by no later than January 1, 2010, a plan for restructuring functional

responsibilities across the departments to establish a consumer centered integrated system of

health and human services that provides high quality and cost-effective services at the right time

and in the right setting across the life-cycle.

 

     42-7.2-12. Medicaid program study.-- (a) The secretary of the executive office of health

and human services shall conduct a study of the Medicaid programs administered by the state to

review and analyze the options available for reducing or stabilizing the level of uninsured Rhode

Islanders and containing Medicaid spending.

     (1) As part of this process, the study shall consider the flexibility afforded the state under

the federal Deficit Reduction Act of 2006 and any other changes in federal Medicaid policy or

program requirements occurring on or before December 31, 2006, as well as the various

approaches proposed and/or adopted by other states through federal waivers, state plan

amendments, public-private partnerships, and other initiatives.

     (2) In exploring these options, the study shall examine fully the overall administrative

efficiency of each program for children and families, elders and adults with disabilities and any

such factors that may affect access and/or cost including, but not limited to, coverage groups,

benefits, delivery systems, and applicable cost-sharing requirements.

     (b) The secretary shall ensure that the study focuses broadly on the Medicaid programs

administered by the executive office of health and human services and all five (5) of the state's

five (5) four (4) health and human services departments, irrespective of the source or manner in

which funds are budgeted or allocated. The directors of the departments 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 options under review

both for the state and the people and the communities the departments serve. The secretary shall

submit a report and recommendations based on the findings of the study to the general assembly

and the governor no later than March 1, 2007.

 

     42-7.2-16. Medicaid System Reform 2008. -- (a) The executive office of health and

human services, in conjunction with the department of human services, the department of elderly

affairs, the department of children youth and families, the department of health and the

department of mental health, retardation behavioral healthcare, developmental disabilities, and

hospitals, is authorized to design options that reform the Medicaid program so that it is a person-

centered, financially sustainable, cost-effective, and opportunity driven program that: utilizes

competitive and value based purchasing to maximize the available service options, promote

accountability and transparency, and encourage and reward healthy outcomes, independence, and

responsible choices; promotes efficiencies and the coordination of services across all health and

human services agencies; and ensures the state will have a fiscally sound source of publicly-

financed health care for Rhode Islanders in need.

     (b) Principles and Goals. In developing and implementing this system of reform, the

executive office of health and human services and the five (5) four (4) health and human services

departments shall pursue the following principles and goals:

     (1) Empower consumers to make reasoned and cost-effective choices about their health

by providing them with the information and array of service options they need and offering

rewards for healthy decisions;

     (2) Encourage personal responsibility by assuring the information available to

beneficiaries is easy to understand and accurate, provide that a fiscal intermediary is provided

when necessary, and adequate access to needed services;

     (3) When appropriate, promote community-based care solutions by transitioning

beneficiaries from institutional settings back into the community and by providing the needed

assistance and supports to beneficiaries requiring long-term care or residential services who wish

to remain, or are better served in the community;

     (4) Enable consumers to receive individualized health care that is outcome-oriented,

focused on prevention, disease management, recovery and maintaining independence;

     (5) Promote competition between health care providers to ensure best value purchasing,

to leverage resources and to create opportunities for improving service quality and performance;

     (6) Redesign purchasing and payment methods to assure fiscal accountability and

encourage and to reward service quality and cost-effectiveness by tying reimbursements to

evidence-based performance measures and standards, including those related to patient

satisfaction; and

     (7) Continually improve technology to take advantage of recent innovations and advances

that help decision makers, consumers and providers to make informed and cost-effective

decisions regarding health care.

     (c) The executive office of health and human services shall annually submit a report to

the governor and the general assembly commencing on a date no later than July 1, 2009

describing the status of the administration and implementation of the Global Waiver Compact.

 

     SECTION 2. Chapter 42-7.2 of the General Laws entitled ”Office of Health and Human

Service” is hereby amended by adding thereto the following section:

 

     42-7.2-17. Statutory reference to the office of health and human services.--

Notwithstanding other statutory references to the department of human services, wherever in the

general or public laws, or any rule or regulation, any reference shall appear to the "department of

human services" or to "department" as it relates to any responsibilities for and/or to Medicaid,

unless the context otherwise requires, it shall be deemed to mean "the office of health and human

services."

 

     SECTION 3. Section 42-18-5 of the General Laws in Chapter 42-18 entitled "Department

of Health" is hereby amended to read as follows:

 

     42-18-5. Transfer of powers and functions from department of health. -- (a) There

are hereby transferred to the department of administration:

      (1) Those functions of the department of health which were administered through or with

respect to departmental programs in the performance of strategic planning as defined in section

42-11-10(c);

      (2) All officers, employees, agencies, advisory councils, committees, commissions, and

task forces of the department of health who were performing strategic planning functions as

defined in section 42-11-10(c); and

      (3) So much of other functions or parts of functions and employees and resources,

physical and funded, related thereto of the director of health as are incidental to and necessary for

the performance of the functions transferred by subdivisions (1) and (2).

      (b) There is hereby transferred to the department of human services the administration

and management of the special supplemental nutrition program for women, infants, and children

(WIC) and all functions and resources associated therewith.

      (c) There is hereby transferred to the department of human services executive office of

health and human services the HIV/AIDS direct services programs care and treatment programs

and all functions and resources associated therewith. The department of health shall retain the

HIV surveillance and prevention programs and all functions and resources associated therewith.

 

     SECTION 4. Section 35-17-1 of the General Laws in Chapter 35-17 entitled "Medical

Assistance and Public Assistance Caseload Estimating Conferences" is hereby amended to read

as follows:

 

     35-17-1. Purpose and membership. -- (a) In order to provide for a more stable and

accurate method of financial planning and budgeting, it is hereby declared the intention of the

legislature that there be a procedure for the determination of official estimates of anticipated

medical assistance expenditures and public assistance caseloads, upon which the executive budget

shall be based and for which appropriations by the general assembly shall be made.

      (b) The state budget officer, the house fiscal advisor, and the senate fiscal advisor shall

meet in regularly scheduled caseload estimating conferences (C.E.C.). These conferences shall be

open public meetings.

      (c) The chairpersonship of each regularly scheduled C.E.C. will rotate among the state

budget officer, the house fiscal advisor, and the senate fiscal advisor, hereinafter referred to as

principals. The schedule shall be arranged so that no chairperson shall preside over two (2)

successive regularly scheduled conferences on the same subject.

      (d) Representatives of all state agencies are to participate in all conferences for which

their input is germane.

      (e) The department of human services shall provide monthly data to the members of the

caseload estimating conference by the fifteenth day of the following month. Monthly data shall

include, but is not limited to, actual caseloads and expenditures for the following case assistance

programs: temporary assistance to needy families, SSI federal program Rhode Island Works, and

SSI state program, general public assistance, and child care, state food stamp program, and

weatherization. The executive office of health and human services report shall include report

relevant caseload information and expenditures for the following medical assistance categories:

hospitals, long-term care, nursing homes, managed care, pharmacy, special education, and all

other medical services. In the category of managed care, caseload information and expenditures

for the following populations shall be separately identified and reported: children with

disabilities, children in foster care, and children receiving adoption assistance. The information

shall include the number of Medicaid recipients whose estate may be subject to a recovery, the

anticipated recoveries from the estate and the total recoveries collected each month.

 

     SECTION 5. Chapter 40-6 of the General Laws entitled "Public Assistance Act" is

hereby amended by adding thereto the following section:

 

     40-6-27.2. Supplementary cash assistance payment for certain supplemental security

income recipients. -- There is hereby established a $206 monthly payment for disabled and

elderly individuals who, on or after July 1, 2012, receive the state supplementary assistance

payment for an individual in state licensed assisted living residence under section 40-6-27 and

further reside in an assisted living facility that is not eligible to receive funding under Title XIX

of the Social Security Act, 42 U.S.C. section 1381 et seq.

 

     SECTION 6. This article shall take effect on July 1, 2012.