3/11/2009
Global Waiver Taskforce: Department Solicits Requests for Stakeholder Participation
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The EOHHS will provide oversight of budgetary priorities across the five departments from a broader administrative perspective. A coordinated budget will allow the office and Secretary Jane Hayward to look beyond specific funding streams with a view toward the overall policy picture and the integration and improvement of services.
The EOHHS has submitted a coordinated budget for the five departments for fiscal year 2006 and 2007, and will submit an integrated budget for FY2008.
The cost of children's mental health and substance abuse services is one of the fastest growing costs in the state budget and sufficient management tools are currently not in place that can help assure improved client outcomes and overall service system quality. EOHHS is leading an effort to review children's behavioral health services and recently completed a report to the Governor and General Assembly on the subject (see "Reports" on this website for complete report) that includes an action plan to improve service delivery and outcomes.
This report, mandated by the General Assembly in 2005, is the result of nearly a dozen lengthy working meetings of the Children's Behavioral Health Workgroup, the majority of which occurred between October and December of 2005. Formed under the direction of the EOHHS, the Workgroup consisted of more than fifty individuals including representatives of the RI General Assembly, the EOHHS, DCYF, DHS, HEALTH, MHRH, DOE, KIDSCOUNT, the Rhode Island Community Mental Health Centers Association, health insurers, health care providers and advocacy groups.
It is expected that the report and all of its recommendations will be reviewed and discussed during the current legislative session.
The Executive Office of Health and Human Services is coordinating the procurement process with each of the five health and human service agencies. A workgroup has been formed and is charged with reviewing current practices in the areas of contracting, legislative grants and procurement. The workgroup has reviewed current contract boilerplates to standardize the format across departments and is working with the Department of Administration by providing feedback on the new Oracle financial accounting system.
Currently, over 200 legislative grants totaling over $13 million are awarded to the five EOHHS agencies. The process for applying and receiving funds varies widely among the agencies. Through the efforts of the EOHHS, the five departments agreed on a best practice for managing these legislative grants and has created a more uniform, standardized procedure for awarding and reimbursing these grants.
The five departments also apply for and receive a number of federal grants each year. The EOHHS has begun reviewing federal grant applications requiring support letters from other departments in an effort to look at this process from a more global perspective. The EOHHS' goal is to view all grant applications in relationship to one another and in consideration of their impact on other departments and existing resources. Understanding each department's ability to commit resources and determining whether a grant advances or supports the state's overall health and human services policy goals are important considerations in the grant application process.
The EOHHS Policy workgroup is being reconstituted to update a draft interagency agreement defining the respective and shared responsibilities of health and human services agencies in protecting the safety of Rhode Islanders residing in state regulated and/or financed long term care settings. The workgroup decided last year to postpone completion of the agreement until final action was taken on a series of legislative proposals reforming the nursing facility complaint investigation and survey process. The workgroup will be revising the interagency agreement to reflect changes in policy as a result of the reforms that were enacted.
Staff from the EOHHS has worked with a number of EOHHS departments to develop streamlined human resources policies and efficient services in the payroll and policy areas.
The administrative workgroup was designed to examine key support functions within the five health and human service departments with an eye towards reducing redundancy, increasing efficiency and to the extent reasonable and appropriate establish consistent standards across the departments. The approach has been for the workgroup to function as a standing oversight committee with flexible or standing subcommittees formed as appropriate. A primary focus of the administrative workgroup has been the coordination of human resources, which necessitated the establishment of subcommittees. One committee has been working on the consolidating of the four (4) payroll offices at the Department of Mental Health, Retardation and Hospitals into one office. Additionally this group was to examine the various payroll practices and make recommendations for continuity of practice. The new office has also assigned the responsibility to one staff member to be the contact with the personnel office and payroll office at the Department of Administration to enhance the quality of communication to more quickly resolve issues.
MHRH has taken the lead on this effort after consensus was reached on certain operating principles. Payroll functions of the four (4) payroll offices have been centralized with consistent payroll practices being applied. The merging of the payroll functions with personnel has taken place through the creation of a centralized "pay-personnel" office which now permits effective cross training of staff for a more efficient office. A significant effort underway is the consolidation of time sheets and how best to implement change in this area including use of electronic methods for submission and a redesign of the time sheets.
Another committee worked at the Department of Elderly Affairs focused on developing rules of work in the areas of: a department-wide, off-site work log to improve consistency and to record offsite work; establishing standards and practices for management to better manage sick leave; and, establishing standards and practices to manage non-regular work schedules such as flex time, LWOP and part-time schedules. These changes have been implemented.
The EOHHS Policy workgroup reviewed the administrative rule-making process across the five departments and has developed a plan for coordinating that process and other legal administrative procedures across the departments. As all state departments are required by law to review and re-file all of their administrative rules in January 2007, the workgroup is reconvening to begin implementation of a plan to meet that mandate. The focus of the plan is to incorporate existing best practices across the departments and create a coordinated and streamlined rule-making process that is easy for consumers to navigate and understand.
The EOHHS has facilitated an effort to coordinate and enhance training opportunities across the five departments. By analyzing training needs and resources available in the departments and at RI College (RIC) it was recommended by the EOHHS Policy workgroup that the Child Welfare Institute at RIC be expanded to become the Institute of Professional Development and Training in Human Services encompassing training for all of the health and human service departments. The goal of the Institute would be to maximize existing resources to coordinate and improve pre-service and in-service training opportunities for all five health and human service departments. An agreement has been reach outlining the vision, mission and objectives with the School of social work to change the name from the Child Welfare Institute to the Institute for Professional Development and Training in Human Services.
Meanwhile, the EOHHS has facilitated an effort to coordinate and enhance existing training opportunities across the five departments.
Presently the EOHHS is reviewing training concepts that cut across the five (5) departments that will enhance the service delivery in the departments and facilitate interaction at the professional level.
As part of the Coordinated Service Plans initiative joint training will be taking place between DCYF and DHS. To enhance this training the Child Welfare Institute will be providing on-going pre-service training for appropriate DHS on coordinated service plans and family centered practice.
The EOHHS is leading the Department of Human Services and the Department of Children, Youth and Families to work in full partnership with families that are clients of both departments at the same time. These families are commonly known as dual families. These families have both a family independence service plan from the DHS and a service plan with the child welfare department. The family independence service plan’s emphasis is on economic stability and the Department of Children, Youth and Families’ service plan’s emphasis is on emotional stability. The service plans of each department are structured to move towards success for the family in their respective sphere. Client requirements from both departments have often been at odds with one another, making it sometimes difficult or impossible to fulfill them simultaneously without ramifications or penalty. For dual families to be successful both of these goals must be worked on at the same time and this requires an active partnership among the two (2) agencies and the family.
This project has been many months in planning with the first staff trainings taking place on February 27, 2006 and March 6, 2006.
In August of 2004, Governor Carcieri tapped the EOHHS to conduct an internal review of Hillside Health Center and the Department of Health’s regulatory oversight and response relative to the quality of care received by residents at Hillside. The managing director of the EOHHS was charged with overseeing this review as well as providing recommendations to the Governor on improving the DOH’s oversight of licensed health care facilities to improve the quality of care received in nursing homes. A detailed 40-page report was completed and submitted to the Governor by the EOHHS on September 20, 2004. The report is available on this website under “Reports.”
The EOHHS conducted two Medicare Part D summits to bring together all of the parties affected by and/or have an interest in the implementation of the federal government’s new Medicare Prescription Drug program (Medicare Part D) that began on January 1, 2006. The majority of the over 170,000 Rhode Islanders enrolled in Medicare could be enrolled in this new plan, intended to bring Medicare participants more choices in health coverage and better health care benefits. Medicare Part D will have a tremendous effect on pharmacy providers, doctors, insurers, advocates, and consumers. And, because it also impacts a number of health and human service departments, the EOHHS has taken on the role of reviewing the major issues, researching and gathering information on current efforts and resources available to help frame the implementation of this significant new program. In addition, the EOHHS is coordinating the efforts of the five health and human services departments around Medicare Part D by assisting in the sharing of information between departments and the Centers for Medicare and Medicaid Services (CMS) and setting up bi-weekly teleconferences with the Medicare Part D prescription drug plans.
Since January 1, 2006 the EOHHS has coordinated a mailing to pharmacies and has facilitated communications with the CMS which have resulted in several Executive Orders being signed by Governor Carcieri in response to a number of problems implementing the new federal program. These problems have made it difficult for a significant number of beneficiaries to fill prescriptions.
The Governor, on January 11, 2006, temporarily reinstated the previously run state Medicaid pharmaceutical coverage for dual eligible beneficiaries as a “stop-gap” measure to ensure coverage until the federal government makes the changes necessary to move forward with Part D. The EOHHS will remain the point agency in coordinating the state’s activities relative to the implementation of Part D.
Governor Carcieri directed Jane Hayward and the Executive Office of Health and Human Services to conduct a thorough review of the state’s assisted living system in June of 2005. The review, which included matters of regulations and oversight, was completed and released publicly in January, 2006. It included 23 recommendations for improving assisting living quality, safety and oversight in Rhode Island.
Following the release of the report, which can be found on this website under “reports,” a number of measures have been implemented. Still others are being introduced legislatively or are being tracked for implementation. “When fully implemented, the reforms will significantly improve the way Rhode Island regulates assisted living facilities and protects their residents,” said the Governor in his statement upon releasing the report.
To implement the recommendations in the report, the Secretary established an interagency Assisted Living Task Force in February of 2006. The Task Force is overseeing several workgroups, each of which is charged with leading the efforts ensure key recommendations are implemented in a timely and successful manner.
The EOHHS is responding to concerns about the need to establish an after hours emergency line for the Department of Elderly Affairs. The establishment of a twenty-four (24) hour emergency response system for elders in crisis would significantly improve the State’s ability to ensure the care and safety of some of its most vulnerable citizens. To this end, the EOHHS is bringing together representatives from the departments of Health; Children, Youth and Families; and, Elderly Affairs to review current practices, analyze options and determine the best after hours system to serve the needs of RI's elderly population.
In October of 2004, the Executive Office of Health and Human Services was selected to administer this five-year, $11.75 million cooperative agreement between the federal Center for Substance Abuse Prevention and the Governor. The overarching goals of the SPF SIG are:
The SPF SIG is based upon the public health model and emphasizes the use of data driven decision-making at each step of its five step strategic planning framework.
Recent Progress
The Center for Hispanic Policy and Advocacy, John Hope Settlement House, Progreso Latino, Socio-Economic Development Center for Southeast Asians and Urban League of RI have each received awards of $100,000 annually, over five years, to assist in state systems development. It is anticipated that, as result of these awards, the state will significantly improve its capacity to plan for and provide culturally appropriate/culturally relevant prevention interventions to diverse populations. In addition, the number of culturally competent agencies and individuals who deliver substance abuse prevention programming will be increased. The awards will support:
- More active engagement and meaningful participation of minority CBOs in the state and community strategic planning processes.
- Development of a strategic plan to comprehensively address substance abuse prevention needs of racial and ethnic minorities in RI.
- Improvements in organizational effectiveness that will enhance the ability of the CBO to identify prevention needs within their interest community and identify culturally appropriate, evidence-based strategies to address those needs.
After the Center for Substance Abuse Prevention approves a required State Strategic Plan, approximately $1.3 million dollars will be available to fund eligible communities to develop and implement a data driven, comprehensive strategic plan for substance abuse prevention within their community. The strategic plan requires identification of consequences of substance abuse and the consumption patterns that contribute to the consequences. The eligibility of communities to apply for SPF SIG funds will based on their rankings relative to the consequences and consumption patterns selected by state leaders as priorities for intervention. It is projected that RI will submit its Strategic Plan sometime early this summer (2006).
