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
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
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
(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.