BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: SB 893
S
AUTHOR: Wolk
B
VERSION: May 11, 2011
HEARING DATE: June 14, 2011
8
FISCAL: Governance and Finance; Appropriations;
2/3rds 9
3
CONSULTANT:
Hailey
SUBJECT
Health and Human Services System Improvement and
Accountability Act of 2011
SUMMARY
Directs the California Health and Human Services Agency to
establish a "review system" for programs administered by
state and local agencies, utilize a workgroup to draft an
implementing work plan, and establish an information
sharing plan in support of the review system.
ABSTRACT
Current law
1. Establishes the California Health and Human Services
Agency, with 10 departments, the Office of Statewide Health
Planning and Development, the Office of Systems
Integration, and the State Council on Developmental
Disabilities. (Government Code Section 12803)
2. Provides for a secretary of the agency, who is an
appointee of the governor, approved by the Senate, and is
Continued---
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responsible to the governor for the operations of each
department, office, and unit within the agency; the ten
departments are Health Care Services, Mental Health,
Developmental Services, Public Health, Social Services,
Alcohol and Drug Abuse, Aging, Rehabilitation, Community
Services and Development, and Child Support Services.
(Government Code Section 12850)
3. Assigns to the secretary responsibilities including
advising the governor on major policy and program
matters,
serving as the principal communication link between
the governor and each department within the agency,
ensuring sound fiscal management of each department
within the agency,
reviewing and evaluating systems within the agency
for the payment and computation of benefits (while
determining the adequacy and effectiveness of the
payment systems), and
reporting to the governor on legislative,
budgetary, and administrative programs to accomplish
comprehensive long-range, coordinated planning and
policy formulation. (Government Code Sections 12850
through 12852)
This bill
1. Makes findings and declarations including statements
that:
a. publicly-funded programs are not systematically
evaluated, performance and outcomes are not routinely
documented, and successful programs are not consistently
replicated; and,
b. this lack of information on performance, the
cost-effectiveness, and best practices undermines
opportunities to improve programs and ensure the best
use of limited resources.
2. Directs the agency to establish, by December 1, 2013,
the California Health and Human Services Review System in
order to review periodically the health and human service
programs administered by the state and local agencies.
3. Requires that these reviews include, but not be limited
to, mental health, substance abuse treatment,
rehabilitation, developmental programs, public health,
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child support, programs for the aging, health care, and
children's programs, and that the review extend to programs
provided by local agencies, joint powers agencies, regional
agencies, or nonprofit entities under contract with local
agencies.
4. Directs the agency, by June 1, 2012, to convene a
workgroup to draft a work plan to implement the system.
5. Prescribes membership of the workgroup to include
representatives of departments within the agency, outside
departments and commissions, local governments and regional
entities, various state associations, tribal entities,
advocacy organizations, including those working on equity
in access, and researchers conversant with public sector
accountability.
6. Directs the workgroup, in drafting a work plan, to
consider various aspects of planning and evaluation:
outcomes, performance measures, thresholds, geographic and
demographic indicators, timelines, technical assistance,
transparency, and statutory changes needed to implement the
bill's requirements.
7. Prescribes some of the outcomes that must be included
in the work plan: measures of employment, education,
housing and homelessness, health, safety, and criminal
justice involvement.
8. Requires the agency to report its progress to the
Legislature annually from 2013-14 through 2016-17.
9. Directs the agency to establish mechanisms to identify
and promote the replication of best practices in the
delivery of health and human services under its
jurisdiction, including: goals and objectives of promoting
best practices, a strategy to identify and promote the use
of best practices, a staffing plan, and identification of
those factors beyond the agency's control that could
significantly affect the achievement of the goals and
objectives.
10. Directs the agency secretary to establish an
information-sharing plan that: enables the exchange of
information among state and local agencies, provides
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information on the costs and effectiveness of publicly
supported health and human services programs in California,
permits the Legislature and the public to monitor outcomes,
establishes a memorandum of understanding to permit the
sharing of information among units of government, and
includes provisions to protect the privacy of individuals.
11. Directs the California Research Bureau to conduct
research on data held by the agency or the departments that
make up the agency.
12. Directs the agency secretary, in developing the
information-sharing plan, to consult with state and local
officials, clients and consumers who receive government
services, service providers, researchers, privacy experts,
the public, and others.
13. Requires the agency to transmit the
information-sharing plan to the Legislature by January 30,
2013.
14. Includes an urgency clause.
FISCAL IMPACT
Unknown.
BACKGROUND AND DISCUSSION
The author's purpose and intent
Under the governor's realignment proposal, counties are
encouraged to improve the integration of services, reduce
the cost of service delivery, and report information on
outcomes. However, county leaders report to the author
that state statutes prevent local agencies from sharing
information on clients receiving multiple services. The
bill will require the state to assess barriers to
information sharing and to develop a plan to facilitate
information sharing consistent with goals for realignment
and the need to report outcomes.
In addition, the bill requires an outcome-reporting system
for health and human services programs so that, after
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realignment, the state and counties will have a shared
understanding of the goals of health and human service
programs and how performance and outcomes will be measured
and monitored.
In designing this system of evaluation and review, the bill
requires the Health and Human Services Agency to consult
with representatives from local governments, tribal
entities, researchers, experts on outcome measures, clients
and families, and others. By requiring the agency to
design the system by December 1, 2013, the bill gives
enough time to develop a viable and robust strategy to
monitor the performance and outcomes achieved through
California's health and human service programs.
The bill also requires the agency to develop a strategy to
identify and promote best practices in the delivery of
services and then to use an information-sharing plan so
that counties can collect, share, and report the
information needed to meet the goals of realignment.
A new purpose for the agency
Earlier this year, the Governance and Finance Committee
held a hearing on realignment. Testimony from Daniel
Hancock, the chair of the Little Hoover Commission,
provided philosophical underpinnings to SB 893.
Among his remarks, Mr. Hancock said:
It is easier to integrate operations at the local
level and coordinate or consolidate programs that
focus on the same individuals or families.
The state must help counties set clear but flexible
goals for program outcomes.
Once services are realigned to counties, the
state's main responsibilities become developing
performance measures, monitoring quality, collecting
and analyzing data, cataloging best practices, and
holding counties accountable.
These new responsibilities give increased
importance to the state's information technology
systems.
Child welfare: an example of performance evaluations and
focus on outcomes
The author points to attention to outcomes in the child
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welfare system, the result of AB 636 (Steinberg, Chapter
678, Statutes of 2001), as a positive example of what SB
893 will lead to across all programs administered by
departments within the Health and Human Services Agency.
Analogy to the passage of the Mental Health Services Act
In 2004, voters passed the Mental Health Services Act,
which, in essence, realigned mental health services to
counties and left the state's Department of Mental Health
with the responsibility to design standards, provide
technical assistance, and assist with evaluation.
The experience of other states
The author points out that other states are focusing on
outcomes.
Virginia documents outcomes in a range of areas
important to quality of life.
Washington uses targeted outcomes, outcome reviews
and performance information as part on an initiative,
"Improving the Security of Washington's Vulnerable
Children and Adults."
Utah has an effort under way similar to
Washington's.
Maryland focuses on outcomes and performances in
its "StateStat" program.
COMMENT AND QUESTIONS
Significance
This bill would significantly shift the purpose and
resources of the California Health and Human Services
Agency. In concert with realignment, the agency and an
increasing number of its departments would shift from
program management to the provision of technical
assistance.
Suggested set of amendments
Given the extensive scope of SB 893, staff recommends that
the bill be amended to focus the agency and this new review
system on those programs and services that are realigned to
counties. Membership on workgroups would also be tailored
to those services included in realignment statutes.
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Technical changes
The Senate Office of Engrossing and Enrolling has
identified small changes and corrections to make the next
time the bill is amended.
POSITIONS
Support: None received
Oppose: None received
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