Creating a Bureaucracy to Manage Health Care and Infectious Disease at the State Level- Department of Aging
Is it possible to create an organization and its "Manager" that can do this without corruption? A case study, using Lessons Learned from the Covid-19 era
Part XXVIX: The Department of Aging 43-21-10 to 43-21-130
Introduction
This is the last post and last department I will discuss in detail that is contained in S.915. It is a revision of the existing department, but the revisions are significant with respect to The Deep State Conundrum.
Sections 43-21-10 and 20 The Advisory Council on Aging
Section 43-21-10. There is created the Department on Aging. The department must be supported by an Advisory Council on Aging consisting of one member from each of the ten planning and service areas and five members from the State at large. The director of the department shall provide statewide notice that nominations may be submitted to the director from which the
GovernorSecretary of Health and Policy shall appoint the members of the council. The members must be citizens of the State who have an interest in and a knowledge of the problems of an aging population. In making appointments to the council, consideration must be given to assure that the council is composed of appointees who are diverse in age, who are able and disabled, and who are active leaders in organizations and institutions that represent different concerns of older citizens and their families. The chair must be elected by the members of the advisory council from its members for a term of two years and until a successor is elected. Members of the council shall serve without compensation but shall receive mileage and subsistence authorized by law for members of boards, commissions, and committees. The advisory council shall meet at least once each quarter and special meetings may be called at the discretion of the director of the department. Rules and procedures must be adopted by the council for the governance of its operations and activities.
The Governor no longer appoints the members; the Secretary of Health and Policy does, which is a Deep State Conundrum. The Council defines its responsibilities.
Section 43-21-20. (A) The members of the advisory council shall serve for terms of four years and until their successors are appointed and qualify. The terms of the members expire on June thirtieth and all vacancies must be filled in the manner of the original appointment for the unexpired portion of the term only. No member may serve more than two consecutive terms.
(B) The
GovernorSecretary of Health and Policy may terminate a member of the council for any reason pursuant to the provisions of Section1-3-24044-12-50(B)(1), and the reason for the termination must be communicated to each member of the council.
Section 43-21-40 Department Responsibilities
Section 43-21-30. Reserved
Section 43-21-40. (A) The department shall be the designated state agency to implement and administer all programs of the federal government relating to the aging, requiring acts within the State which are not the specific responsibility of another state agency under the provisions of federal or state law. The department may accept and disburse any funds available or which might become available pursuant to the purposes of this chapter, upon the prior approval of the Secretary of Health and Policy.
(B) The department shall study, investigate, plan, promote, and execute a program to meet the present and future needs of aging citizens of the State, pursuant to the State Health Services Plan, and it shall receive the cooperation of other state departments and agencies in carrying out a coordinated program.
(C) It shall also be the duty of the department to encourage and assist in the development of programs for the aging in the counties and municipalities of this State. It shall consult and cooperate with the Secretary of Health and Policy, public and voluntary groups, with county and municipal officers and agencies, and with any federal or state agency or officer for the purpose of promoting cooperation between state and local plans and programs, and between state and interstate plans and programs for the aging.
(D) Without limiting the foregoing, the department is specifically authorized to:
(a)(1) initiate requests for the investigation of potential resources and problems of the aging people of the State, encourage research programs, initiate pilot projects to demonstrate new services, and promote the training of personnel for work in the field of aging;
(b)(2) promote community education in the problems of older people through institutes, publications, radio, television, and the press;
(c)(3) cooperate with, encourage, and assist local groups, both public and voluntary, which are concerned with the problems of the aging;
(d)(4) encourage the cooperation of agencies in dealing with problems of the aging and offer assistance to voluntary groups in the fulfillment of their responsibility for the aging;
(e)(5) serve as a clearinghouse for information in the field of aging;
(f)(6) appoint such committees as it deems necessary for carrying out the purposes of this chapter, such committee members to serve without compensation;
(g)(7) engage in any other activity deemed necessary by the department to promote the health and well-being of the aging citizens of this State, not inconsistent with the purposes of this chapter or the public policies of the State, including the State Health Services Plan;
(h)(8) certify homemakers and home health aides pursuant to the Federal Omnibus Budget Reconciliation Act of 1987 and subsequent amendments to that act and through regulations promulgated in accordance with the Administrative Procedures Act establish and collect fees for the administration of this certification program. Fees collected must be placed on deposit with the State Treasurer. Accounting records must be maintained in accordance with the Comptroller General's policies and procedures. Unused fees may be carried forward to the next fiscal year for the same purpose;
(i)(9) award grants and contracts to public and private organizations for the purpose of planning, coordinating, administering, developing, and delivering aging programs and services;
(j)(10) designate area agencies on aging as required by the Older Americans Act; and
(k)(11) administer the Senior Citizens Center Permanent Improvement Fund established pursuant to Section 12-21-3441 and community services programs in accordance with Section 12-21-3590.Section 43-21-45. The Department on Aging shall designate area agencies on aging, and area agencies on aging shall designate focal points. Focal points shall provide leadership on aging issues in their respective communities and shall carry out a comprehensive service system for older adults or shall coordinate with a comprehensive service system in providing services for older adults. The area agencies on aging represent the regional level of the state aging network and the focal points represent the local level of the state aging network.
"Area agencies” is a vague term, as is the rest of the wording in the section. This needs some more thought. Are these committees? Are they NGOs? How large a region? By the way, how old is “old”?
Section 43-21-50. The department may receive on behalf of the State any grant or grant-in-aid from government sources, or any grant, gift, bequest, or devise from any other source. Title to all funds and other property received pursuant to this section shall vest in the State unless otherwise specified by the grantor.
Section 43-21-60. The Department on Aging shall submit an annual report to the
GovernorGovernor, the Secretary of Health and Policy, and to the General Assembly on or before January first of each year. The report shall deal with the present and future needs of the elderly and with the work of the department during the year.
My impression is that this last section is not quite specific enough. It should at least say “The Director of the Department on Aging”. And what about providing performance objectives set for the year and whether or not those objectives where met. What about Lessons Learned and Corrective Actions taken? Let’s make this a real business report.
Section 43-21-70 The Department of Aging Director
Section 43-21-70. The
GovernorSecretary of Health and Policy shall appoint with the advice and consent of the Senate a director to be the administrative officer of the Department on Aging who shall serve at theGovernor'ssecretary's pleasureand who is subject to removal pursuant to the provisions of Section1-3-240.Section 43-21-80.
The director shall appoint any other personnel and consultants considered necessary for the efficient performance of the duties prescribed by this chapter and shall fix the compensation therefore in accordance with the Human Resource Management Division of the State Department of Administration and Merit System requirements.The director shall administer the policies and regulations of the department. Department employees shall have such general duties and receive such compensation as determined by the director, within the authority given by the Secretary. The director shall be responsible for the administration of state personnel policies and general personnel policies of the Executive Office of Health and Policy. The director shall have sole authority to employ and discharge employees subject to such personnel policies and funding available for that purpose.
Sections 43-21-100 to 120 Deleted Sections
Section43-21-100. The Department on Aging shall prepare the budget for its operation which must be submitted to the Governor and to the General Assembly for approval.
Section43-21-110. The General Assembly shall provide an annual appropriation to carry out the
work of the commission.
Section43-21-120. There is created the Coordinating Council to the Department on Aging to work with the department on the coordination of programs related to the field of aging, and to advise and make pertinent recommendations, composed of the following: the Director of the Department of Health and Environmental Control, the State Director of Social Services, the Director of the Department of Mental Health, the Superintendent of Education, the Director of the State Department of Labor, Licensing and Regulation, the Executive Director of the South Carolina State Department of Employment and Workforce, the Secretary of Commerce, the Commissioner of the State Department of Vocational Rehabilitation, the Director of the Clemson University Extension Service, the Director of the South Carolina Department of Parks, Recreation and Tourism, the Director of the South Carolina Retirement System, the Executive Director of the South Carolina Municipal Association, the Executive Director of the State Office of Economic Opportunity, the Executive Director of the South Carolina Association of Counties, the Commissioner of the Commission for the Blind, the Director of the Department of Health and Human Services, the Director of the Department of Alcohol and Other Drug Abuse Services, and the Chairperson of the Commission on Women.
The council shall meet at least once each six months and special meetings may be called at the discretion of the chairman or upon request of a majority of the members.
The chairman of the advisory commission and the director of the Department on Aging, who shall serve as secretary to the council, shall attend the meetings of the council.
The director of each agency or department making up the council shall serve as chairman of the council for a term of one year. The office of chairman is held in the order in which the membership of the council is listed in this section.
Sections 43-21-130 The Long Term Care Council
Section 43-21-130. (A) There is created the Long Term Care Council
(council)composed of the following voting members:(1) the
Governor or his designeeLong Term Care Ombudsman;(2) the Director of the Department of Social Services;
(3) the Director of the Department of Public Health
and Environmental Control;(4) the Director of the Department of
MentalBehavioral Health;(5) the Director of the Department of Intellectual and Related Disabilities
and Special Needs;(6) the Director of the
DivisionDepartment on Aging;(7) the Director of the Department of Health Financing
and Human Services;
(8) the Chairman of the Joint Legislative Health Care Planning and Oversight Committee, or his designee;
(9) the Chairman of the Joint Legislative Committee on Aging, or his designee;
(10)(8) one representative of each of the following groups appointed by theLieutenant GovernorSecretary of Health and Policy annually:(a) long term care providers;
(b) long term care consumers;
(c) persons in the insurance industry developing or marketing a long term care product.
So this Council is comprised of the Directors of the various Departments under the Secretary of Health Policy. It looks like Chairmen from two legislative committees will no longer be members. There is only one consumer representative. There are two other appointed members, both of which have a financial interest in terms of lobbying. All three are appointed by the Secretary of Health and Policy. The term of the three is 1 year.
(B) Each director serving as a council member may authorize in writing a designee to vote on his behalf
at two meetings a year. Members appointed by theLieutenant GovernorSecretary of Health and Policy to represent private groups serve without compensation.(C) The council shall meet at least quarterly, provide for its own officers, and make an annual report to the Secretary of Health and Policy, the General Assembly, and the Governor before January second each year. This report must include new council recommendations.
Section 43-21-140. (A) The council has no authority to direct or require any implementing action from any member agency. The council shall identify future policy issues in long term care and may conduct research and demonstration activities related to these issues. Through close coordination of each member agency's planning efforts, the council shall develop recommendations for a statewide service delivery system for all health-impaired elderly or disabled persons, regardless of the persons' resources or source of payment in furtherance of the State Health Services Plan. These recommendations must be updated annually as needed. The service delivery system must provide for:
(1) charges based on ability to pay for persons not eligible for Medicaid;
(2) coordination of community services;
(3) access to and receipt of an appropriate mix of long term care services for all health-impaired elderly or disabled persons;
(4) case management; and
(5) discharge planning and services.
(B) The council, through its member agencies, shall study and make recommendations concerning the costs and benefits of: adult day care centers, in-home and institutional respite care, adult foster homes, incentives for families to provide in-home care, such as cash assistance, tax credits or deductions, and home-delivered services to aid families caring for chronically impaired elderly relatives.
Link back to Part I: Act 60- The Reorganization Directive Bill
---- Begin Discussion of existing law on Natural and Health Disaster Management: Act 44
Link back to Part II: Title 44, Chapter 1
Link back to Part III: Title 44, Sections 4-100-120 Legislative Findings and Intent
-----Definition of Deep State Conundrum and Solution Outline
Link back to Part IV: The Deep State Conundrum and Solution
---- Continuing Discussion of existing law on Natural and Health Disaster Management: Act 44
Link back to Part V: Title 44, Section 4 130 Definitions
Link back to Part VI: Title 44 Section 4 300, 310 Natural Disasters
Link back to Part VII: Title 44 Section 4 320 Disposal of Human Remains
Link back to Part VIII: Title 44 Section 4 330 Supply Purchase and Logistics
Link back to Part IX: Title 44 Section 4 340 Destruction of Property in a Public Health Emergency
Link back to Part X. Title 44 Section 4 500 and 520 Control and Treatment of Infectious Disease
Link back to Part XI: Title 44 Section 4 530 and 540 Quarantine and Isolation
Link back to Part XII: Title 44 Section 4 550 Specimen Collecting
Link back to Part XIII: Title 44 Section 4-560 Access to protected health information
Link back to Part XIV: Title 44 Section 4-570 Emergency Powers Regarding Human Resources
-----Primary Solution to Deep State Conundrum
Link back to SCHIAS: One part of the solution to the Deep State Conundrum: An Independent State-wide Open Source Medical Data and Analytics System
------ Begin Discussion of Bill S.915, which implements Act 60 and has yet to pass
Link back to Part XV: Bill S.915 Revision of Title 44 Adding Chapter 12
------ What was the methodology for selecting the consultant?
Link back to: The problem of reorganizing government agencies: the fox in the henhouse
------ Continuing Discussion of Bill S.915, which implements Act 60 and has yet to pass
Link back to Part XVI: Bill S.915 Revisions to Title 44, Ch 12 50, 60, Organization of the Executive Office of Health and Policy
Link back to Part XVII. Bill S.915 Revisions to Title 44, Ch. 1 50-100 Powers.
Link back to Part XVIII: Bill S.915 Ch 6 Dept of Health Financing Ch 6-5 to 115
Link back to Part XIX: Bill S.915 Ch 6 Dept of Health Financing Ch 6- 132 to 910 Medicaid
Link back to Part XX: Bill S.915 Ch 6 The Medical Pharmacy and Therapeutics Committee Ch 6- 30 to 40
Link back to Part XXI: Bill S.915 Ch 6 Data Oversight Council Ch 6- 170-180
Link back to Part XXII: Bill S.915 Ch 7 Residential Care
Link back to Part XXIII: Bill S.915 Ch 7 Hospital Infections Disclosure Ch 7 2410-2440
Link back to Part XXIV: Bill S.915 Ch 9 Dept of Behavioral Health Ch 9 10-90
Link back to Part XXV: Bill S.915 Ch 9 Dept of Behavioral Health Ch 9 90-160
Link back to Part XXVI: Bill S.915 Ch 20 Dept of Intellectual and Related Disabilities
Link back to Part XXVII: Bill S.915 Ch 20 Dept of Intellectual and Related Disabilities (contd) 20-210 to 330 Organization and Responsibilities
Link back to Part XXVIII: Bill S.915 Ch 20 Dept of Intellectual and Related Disabilities 20-375-1170 Organization and Responsibilities (even more)