Senate commission recommends separating hospitals from BHDDH

STATE HOUSE – A Senate commission studying the administrative structure of Rhode Island’s health and human service programs is recommending reshaping the Department of Behavioral Health, Developmental Disabilities and Hospitals by considering bringing responsibility for children’s behavioral health and developmental disabilities into its fold and creating a separate Department of Hospitals.

In a report issued yesterday, the commission is also recommending the creation of a separate sub-agency to concentrate on Medicaid administration, giving the Health and Human Services Secretary more say in the hiring and firing of the directors of agencies that report to him or her while holding the secretary more accountable for legislatively determined outcomes, as well as several other changes to help the state’s health and human services agencies respond nimbly to challenges and fluctuations in the populations they serve.

“This is the first time since the Executive Office of Health and Human Services was created in 2005 that there has been an evaluation of whether the current structure is the most effective use of our resources to help Rhode Islanders. Our commission has listened carefully to those who manage and work in these agencies, those they serve and those who partner with them, and looked at best practices from other states. Our recommendations are designed to build on the strengths that we see, and make adjustments in areas where we have challenges to meet. Our proposals are meant to sharpen the focuses of our health care and human services agencies, some of which are currently tasked with a very broad scope. This isn’t any criticism of our state’s hardworking health and human services agencies or employees – it’s an effort to hone in on administrative structures that better support their efforts,” said Sen. Joshua Miller (D-Dist. 28, Cranston, Providence), who is chairman of the Special Legislative Commission to Review and Make Recommendations Regarding the Efficient and Effective Administration of Health and Human Services Programs, as well as chairman of the Senate Health and Human Services Committee.

“Some of our proposals will require legislation to implement, and the Department of Administration will play a central role in any departmental restructuring. I look forward to continuing the discussions we’ve started in our commission hearings with additional stakeholders, and with legislative leaders, department heads, the governor and their staffs,” Chairman Miller continued.

The report states that “[h]ospital management is a distinct skillset from other types of departmental management,” and separating the administration of hospitals from behavioral healthcare and developmental disabilities services would allow the two separate agencies to better focus on their responsibilities. Additionally, the commission recommends the state explore the possibility of making that department a quasi-public agency, which might allow it to respond to issues and opportunities more quickly and efficiently than a state agency while also maintaining public oversight.

Similarly, moving responsibility for children’s behavioral health and developmental disabilities programs from the Department of Children, Youth and Families to what is currently the Department of Behavioral Health, Developmental Disabilities and Hospitals would allow DCYF to better focus on youth safety and stability, while improving the continuum of care throughout life for Rhode Islanders with behavioral health needs or developmental disabilities. The report suggests the state consider the move, with a timeframe as recommended by EOHHS and other stakeholders, contingent upon the transfer of hospitals to a separate department.

The commission’s recommendation to create a Medicaid Department is a model used in many other states, and would increase accountability in Medicaid, which represents about one-third of the state budget. Doing so would elevate the role of the state Medicaid director, making that director directly accountable to the governor and the General Assembly.

Additional recommendations include creating a stakeholder group to provide input for the new rate review of all state licensed and contracted social service providers, which was enacted through this year’s state budget bill; creating a Health and Human Services Cabinet convened by the Health and Human Services Secretary; including DCYF in the biannual Caseload Estimating Conference that helps legislators set department budgets, and reviewing compensation structures within EOHHS and its sub-agencies to support talent acquisition and retention. There are numerous vacancies in the agencies that report to EOHHS, and recruitment and retention of leaders and staff in those departments has been a challenge for the state in recent years.

In addition to Chairman Miller, the 11-member commission that studied the state health and human services agencies and issued the report included Sen. Louis P. DiPalma (D-Dist. 12, Middletown, Newport, Little Compton, Tiverton); Sen. Jessica de la Cruz (R-Dist. 23, North Smithfield, Burrillville, Glocester); Rhode Island Public Expenditure Council President and CEO Michael DiBiase; former Rhode Island Health Insurance commissioner Marie Ganim; Matthew Gunnip, president of Local 580, SEIU, AFL-CIO, RI Alliance of Social Service Employees; Tanja Kubas-Meyer, executive director of the Rhode Island Coalition for Children and Families; Elena Nicolella, president & CEO of the Rhode Island Health Center Association; Elizabeth Winangun, police director, Office of Gov. Daniel McKee; Tina Spears, executive director of Community Provider Network of Rhode Island; and Susan A. Storti, President and CEO of the Substance Use and Mental Health Leadership Council of Rhode Island.