D.C. Code div. I, tit. 1, ch. 15, subch. III, pt. A
Prepared by the Mayor and transmitted to the Council of the District of Columbia on November 20, 1979, pursuant to the provisions of Section 422(12) of the District Charter.
D.C. DEPARTMENT OF HUMAN SERVICES
There is established, in the Executive Branch of the Government of the District of Columbia, the Department of Human Services headed by a Director of Human Services, who shall coordinate and direct the operations of the department through the Commissioners of Public Health and Social Services and subordinate organizational components established herein.
The Department of Human Services is established to assure that public health and social service policy is developed and implemented in response to the needs of individuals and families in the District of Columbia, and to promote the health, mental health and well-being of District residents through the delivery of high quality and equitably distributed services and income assistance programs.
There are hereby established in the Department of Human Services:
The functions of the major organizational components of the Department shall be as follows:
Oversees operations of a large, complex health and social services agency.
Provides policy leadership to evaluate and improve human services in the District of Columbia, coordinating public programs with private services to achieve equitable, high quality health care and social services for all citizens. Coordinates human services at the delivery and at the policy level, both within the Department and with other District agencies. Analyzes needs of District residents in health, social services, and related areas, and evaluates response of public programs to those needs.
Advises the Mayor and the City Administrator on all aspects of human resource programs, implementing Mayoral policy priorities and recommending specific actions to assure effective utilization of resources.
Assures effective management throughout the Department by means of supervision of key officials, and final approval of major policies and decisions (resource allocation, state plans and grant proposals, legislative or organizational recommendations, personnel actions, contracts and procurement). Assures compliance of health and social services facilities with federal and state regulations standards. Exercises quality control to minimize waste or abuse in large scale transfer payment programs. Assures the efficient and effective use of resources, including both dollars and personnel. Develops and makes operational policies, procedures and systems to assure coordination and integration at all levels within the Department, and with related programs.
Carries out responsibilities through delegation of major functions to a Commissioner of Public Health and a Commissioner of Social Services. Also supervises nine staff offices as follows:
Develops and administers state plans and programs for State Student Incentive Grants, postsecondary student loan programs, and programs authorized by the Higher Education Act of 1965.
Provides counseling, representation, technical assistance, and support services to veterans, their dependents and beneficiaries. Obtains for its clients the rights, benefits and privileges for which they are eligible.
Responsible for administrative support systems: procurement, contracting, property and supply management, forms management, operation of facilities, audio-visual services, printing, mail, messengers, transportation.
Coordinates the formulation, justification and presentation of DHS's annual budget submission. Exercises control over DHS expenditures; administers Financial Management System and cost analysis programs. Issues periodic reports to program officials. Maintains control over authorized personnel ceiling.
Consolidates legislative and administrative regulations for health and social services facilities and services. Establishes and implements licensing procedures. Certifies providers for Medicaid reimbursement. Provides nursing and nutrition consultation services.
Develops and assures the implementation of the comprehensive state health plan, the state mental health plan, and the medical facilities plan, performing the functions of the State Health Planning and Development Agency, as required by P.L. 93-641 and P.L. 93-64, within the overall framework of District of Columbia comprehensive planning. Assures compliance of District health facilities and providers with state planning goals by implementing the Certificate of Need and federal grant review functions defined by P.L. 93-641. Keeps the Director and the Commissioner of Public Health advised of laws, regulations and policies affecting health services planning. Provides technical and staff support to the State Health Coordinating Committee (SHCC). Reviews and provides for SHCC review of the state health and mental health plan, alcoholism prevention plan, substance abuse plan, and categorical grant requests in compliance with local, state and federal guidelines and District policy goals.
Develops and assures the implementation of the comprehensive state social services plan required by Title XX of the Social Security Act. Keeps the Director and the Commissioner of Social Services advised of laws, regulations and policies affecting social services planning and delivery. Reviews all state and categorical social service plans for compliance with local, state and federal guidelines and District policy goals.
Collects and publishes data and statistics in regard to health care and social services utilization, and selected health and social status indices.
Assures a hearing to an applicant for or recipient of any type of assistance or service provided by the Department of Human Services, to an applicant for or recipient of a license granted by the Department of Human Services, or to the provider of any service pursuant to a contract with the Department of Human Services, whose claim or application has been denied or who is aggrieved by any other action or inaction of the Department of Human Services which affects the receipt, suspension, reduction, or termination of his assistance.
Assures compliance with statutes and regulations governing the Department by clients, vendors and employees; conducts quality control audits and investigations; maintains security within the Department.
Develops, coordinates and operates all automatic data processing systems throughout the Department.
Oversees planning, financing and delivery of city-wide health care programs and services.
Provides policy leadership and advocacy for assuring equitable access to high quality health and mental health care services; for encouraging the development of high quality health care and hospital services; promoting restraint of health care costs; for assuring the participation of consumers and providers in health and mental health care policy making; and for the overall promotion of health advocacy in the District of Columbia.
Develops and implements management systems, organizational structures, and procedures to assure (1) cost-effective use of public resources to accomplish program goals; (2) full compliance with legislation and regulations affecting health care delivery which are delegated to the Department; and (3) coordination of programs with D.C. General Hospital, with the Office on Aging, and with private sector institutions and health professionals.
Provides policy and program guidance for special initiatives such as health promotion, deinstitutionalization, improved maternal and child health, and improved dental care.
Programs are carried out in four staff offices and five line administrations:
Has delegated responsibility to develop preparatory material for comprehensive state health and mental health plans. Assists appropriate administrations in program planning and the preparation of federally required state plans, categorical plans, and grant proposals in accordance with the provisions of applicable federal legislation and within the overall framework of District of Columbia comprehensive planning.
Provides technical guidance and assures compliance with federal and state regulations and guidelines governing the submission and implementation of state plans. Keeps the Commissioner advised of pending or proposed legislation and national programs affecting health policies and service delivery.
Administers technical programs and services for the medical investigation of all except clearly natural deaths in the District of Columbia, in accordance with the provisions of Section III of P.L. 91-358 and Commissioner's Order 71-16 as amended.
Administers the Medicaid program in respect to policy, scope of service, utilization and compliance with federal guidelines, delegating eligibility determination to the Payments Assistance Administration, and billing and payments to the Office of the Controller. Administers the Medical Charities programs, delegating eligibility determination and payments as above. Provides the Commissioner of Public Health with policy analysis of the impact of Medicare, Medicaid, and Medical Charities programs on the access of low-income and elderly citizens to equitable and high quality health care. Analyzes and recommends rate setting and other mechanisms for appropriate public actions to contain rising medical care costs.
Assures an effective level of emergency medical services for District residents, workers and visitors, through the establishment and enforcement of state regulations and the designation of cost-effective and well equipped trauma centers. In collaboration with the Fire Department maintains adequate ambulance and paramedic services.
Provides policy leadership to assure the promotion of District residents' health through the development of sound preventive and educational programs which focus on community-based environmental health. Implements state plans for tuberculosis and venereal disease control, lead poisoning control, and maternal and child nutrition programs. Directs programs for prevention and control of communicable and chronic diseases, childhood diseases and cancer. Manages community education programs to promote the health of District residents in relation to smoking, hypertension, accident prevention, and like problems. Operates the Central Laboratory. Analyzes data on morbidity and mortality rates and causes, and recommends program priorities to the Commissioner of Public Health.
Develops, recommends and implements a program of outpatient health care, including needs assessment, resource allocation, scope of services, work force needs, service priorities and strategies for cooperation with private providers. Administers a network of clinic-based services which are preventive, diagnostic, therapeutic and restorative for persons neither hospitalized nor institutionalized. Promotes a high-quality and cost-effective system which emphasizes coordinated and comprehensive care to the patient, while maintaining expertise in identifiable categorical units.
Develops, recommends and implements a program of long term health care, including needs assessment, resource allocation, scope of services, comparative analysis of direct operation and contractual services, work force needs, service priorities and strategies for cooperation with private providers and the Office on Aging. Administers facilities for patients in need of skilled or intermediate nursing care or long-term treatment and rehabilitation (D.C. Village, Glenn Dale Hospital and J.B. Johnson Extended Care Facility). Promotes deinstitutionalization of such patients and the development of sufficient nursing home capacity to accommodate the need. Administers home care, and nursing services to assist eligible aged and disabled patients who do not require inpatient care or supervision.
Assists in the development of a mental health care plan which meets the requirements of P.L. 93-64 and the needs of District residents, as well as making maximum use of cooperative services developed with Saint Elizabeths Hospital. Provides policy and program leadership for community support programs for patients on convalescent leave or discharged status from Saint Elizabeths Hospital. Emphasizes priority problems including the needs of alienated or disturbed youth. Administers a network of Community Mental Health Centers, consultation services, preventive education, suicide prevention and forensic psychiatry services. Works closely with Ambulatory Health Care Administration and Alcohol and Drug Abuse Administration to make maximum cost-effective use of clinical and preventive resources for related programs.
Develops, recommends and implements state alcoholism and drug abuse plans which meet the requirements of P.L. 92-225 and the needs of District residents. Works closely with Ambulatory Health Care Administration and Mental Health Services Administration as well as the courts and the Corrections Department to make maximum cost-effective use of clinical and preventive resources for related programs. Provides policy leadership for community-based prevention, education and treatment programs. Administers detoxification and rehabilitation centers, residential treatment centers and outpatient clinics for the treatment of alcoholics and substance abusers.
Oversees planning, financing and delivery of city-wide social services programs.
Provides policy leadership and advocacy for assuring equitable access to high quality day care, child welfare, rehabilitation and family services; developing and implementing strategies to promote cooperation with voluntary associations and private providers; assuring the participation of consumers and providers in policy making; and the promotion of family stability and economic independence for District residents.
Develops and implements management systems, organizational structures, and procedures to assure (1) accurate assessment of economic and social status and needs of District residents; (2) cost-effective use of public resources to accomplish program goals; (3) full compliance with legislation and regulations affecting social services delivery which are delegated to the Department; (4) coordination of programs with the Office on Aging, the Departments of Corrections, Recreation, Housing and Community Development and Labor, the Court system and Corporation Counsel [now Attorney General for the District of Columbia], and with private sector institutions and professionals; and (5) prevention of fraud and abuse in payments assistance programs.
Provides policy and program guidance for special initiatives such as the deinstitutionalization of mentally retarded and developmentally disabled persons from Forest Haven; response to the growing need for help for abused and neglected children and their families; coordination of city-wide programs to serve youth; and the development of high quality day care services.
Programs are carried out in one office and five line administrations:
Has delegated responsibility to develop preparatory material for comprehensive social services planning. Assists appropriate program administrations in the development of the annual and long range state plans for Food Stamps, cash assistance, child welfare, and the Mentally Retarded and Developmentally Disabled, categorical plans and grant proposals in accordance with the provisions of applicable federal legislation and within the overall framework of District of Columbia comprehensive planning. Provides technical guidance on compliance with federal and state regulations and guidelines governing the submission and implementation of state plans. Keeps the Commissioner advised of pending or proposed legislation and national programs affecting social services policies and service delivery.
Develops, recommends and implements a program of services to the mentally retarded and developmentally disabled, including needs assessment, resource allocation, and program priorities. Implements the Constitutional Rights of the Mentally Retarded Act of 1979. Operates Forest Haven facility, and assures appropriate outplacement of residents. Administers diagnostic, educational, therapeutic, and home-based services. Coordinates programs with Vocational Rehabilitation Administration.
In cooperation with the Office of Social Services Planning and Development, provides for needs assessment, and develops state plan for resource allocation, program priorities and rehabilitation services to physically, mentally and emotionally disabled residents. Determines eligibility for federal social security disability programs. Administers state plan and individual rehabilitation plans for District residents eligible under provisions of the Vocational Rehabilitation Act.
Provides institutional and after care services to youth who are adjudicated delinquents, or are in pre-hearing and pre-trial status. Operates the Receiving Home for pre-hearing detention, and the Cedar Knoll School and the Oak Hill Youth Center for adjudicated detention. Administers alternative group homes for status offenders and pre-trial detention. Works closely with the public schools, the Department of Labor, the Department of Recreation and the juvenile justice system to assure city-wide education, training, employment and recreation opportunities for youth.
Assists in the development of needs assessment and state plan priorities for Title XX services. Develops cooperative and contractual arrangements for Title XX services administered in other organizational units. Develops, recommends and implements a program of child welfare services. Implements the Prevention of Child Abuse and Neglect Act of 1977 ( P.L. 2-22 ). Administers adult protective and emergency shelter services.
Provides financial, medical and food stamp assistance to eligible residents of the District. Determines eligibility for programs. Maintains case files and performs regular recertifications to prevent fraud and abuse. Works closely with the Child and Family Services Administration to integrate client intake at service sites. Issues manuals and trains workers for eligibility determinations. Assures compliance with federal regulations and guidelines governing transfer payment programs.
There is hereby transferred to the Director of Human Services all powers, duties, and functions assigned or delegated to the Director of the Department of Human Resources as of the date immediately prior to the effective date of this Reorganization Plan. All positions, property, allocations, and other funds, available or to be made available relating to the powers, duties and functions assigned herein are hereby transferred to the Department of Human Services.
The Director of Human Services, in the performance of assigned duties and functions, is authorized to complete the realignment of the organizational components of the Department herein established by means of redelegations of functions among organizational units and reassignment of departmental positions among control and responsibility centers, or by the elimination or establishment of alternative responsibility centers, in order to accomplish the following specific objectives:
The District of Columbia Department of Human Resources is hereby abolished.
This Reorganization Plan No. 2 of 1979 shall become effective in accordance with Section 422(12) of P.L. 93-198.
MAYOR'S STATEMENT
The Department of Human Resources was created in 1970 by the merger of the Departments of Vocational Rehabilitation, Public Health, Public Welfare, and Veterans Affairs. Its resources now include approximately 8,000 employees and a budget of over $ 440 million.
The purpose of this consolidation was to assure that public health and social services programs responded to the needs of individuals and families in an integrated and holistic fashion. The structure was intended to enable citizens to obtain in unified centers the information, forms, and counseling they required to participate in programs to which they were entitled. It would also enable managers to coordinate and take account of all the factors that should go into policies and decisions about resources and priorities.
However, this valid and important promise has never been fully realized. Nor has the quality of health care, rehabilitation services, income maintenance programs, and child, youth and family services over this decade been as high as the citizens of the District expect and deserve.
One of the chief goals of this Administration is to improve and coordinate those services. The heart of any government lies in the quality of its response to people in need. Citizens of the District have the right to expect prompt access to public services when they need them and are eligible to receive them, in a straightforward and courteous setting. Guidelines for services should be clear and available to everyone. Moreover, the quality of public services should be as high as the quality of private services. It is our responsibility to use the planning, regulating and priority setting powers of government to achieve uniform high standards of health care and social services, so that those who need financial help are not relegated to separate and low quality systems. Equally important, it is the job of government to encourage private provision of human services wherever possible, and to be sure that those private professionals who share in public services benefit from an efficient and responsive partnership with government.
I have therefore examined our deficiencies in respect to these goals of accessibility, quality and cost-effectiveness. I have particularly questioned the extent to which the organizational size and structure of the Department of Human Resources accounts for the difficulties which clients and service providers encounter, and what structural changes would cure these deficiencies.
It was my initial judgment that the most effective way to proceed would be to reduce the size of the departmental bureaucracy and to assure clear focus for independent advocacy of health needs in the District by creating an independent health authority. My transition policy team cautioned me, however, that the issues related to such a separation were complex, and that an immediate organizational decision of this kind would not necessarily accomplish my purpose.
Therefore, early this year I created a special task force under the leadership of Dr. Arthur Hoyte to draw up the functional components of an independent health department, and to assess the impact of such a change on health care in the District. Concurrently we have explored other alternatives, carrying out with leadership in the Department of Human Resources, with members of the executive staff, and with community and professional leadership an intensive examination of policy and management issues. We have reviewed the two recent major analyses of the Department, one carried out in 1977 by a Mayor's Panel on the Organization and Management of Human Resources Programs, and the other in 1978 by a City Council Task Force on the Reorganization of the Department of Human Resources.
My conclusion is that in order to overcome the deficiencies which now exist in human services programs we must proceed through several stages. The Department of Human Resources is large and complex; it accounts for over one-third of our operating department budget. It carries out many state responsibilities that have dramatically changed and increased over the last decade; its internal administrative structure is not well suited to these changing requirements for state planning and accountability for federal funds. Internal management procedures are weak; the department lacks mechanisms to produce integration of policy, planning and operational decisions at the appropriate level.
I am therefore proposing at this time a reorganization which addresses these immediate problems. I believe that we must concentrate on internal administrative and management reorganization before fundamental program and public policy decisions can be effectively staffed and appropriately debated.
I am aware that the organized medical community would prefer to move forward at once to an independent health department. Many agree with me, however, that such a separation would not in itself guarantee an improvement in services, and have expressed their willingness to support these internal management improvements as a first step. We are agreed that my proposal does not preclude the alternative of a separate department in the future, if implementation of this Reorganization Plan does not produce the improvement in health care policy formulation and services which is our common goal.
This Reorganization Plan therefore contains the first two steps in what I expect to be a continuing evaluation and improvement in health and social services in the District.
PHASE ONE
The first step, which will take place immediately upon Council approval, thoroughly restructures senior management responsibility and accountability within the Department. It brings together under the authority of those managers the staff and budget resources which will enable them to meet newly defined responsibility to coordinate planning, policy formulation, and implementation of programs.
I propose to reemphasize the ultimate goal of the agency by renaming it the Department of Human Services. The Director of the Department will have fewer direct administrative responsibilities, and a stronger mandate to shape overall public policy and service coordination, as well as to set and impose a far higher standard of management performance throughout the agency.
At the most senior level of the Department the Reorganization Plan creates two new key positions:
In order to achieve a consolidated point of accountability for health care policy and service delivery, and a focus for a more productive engagement of the private sector in public policy decisions, the Plan calls for a Commissioner of Public Health. The responsibilities of that Commissioner will include the grouping of programs now found in three of the Department's administrations and in parts of Executive Direction and Support. I have chosen to include authority for health, mental health, and drug and alcohol abuse services under a single Commissioner in order to emphasize my belief that the health of the body and of the mind are closely related. I expect the planning and implementation of each program area to be improved, and all of them properly coordinated to meet the health and mental health needs of District citizens.
The Reorganization Plan proposes a corresponding position of Commissioner of Social Services, with a unified responsibility at the most senior level for rehabilitation programs, income assistance programs, and the services provided to children, youth and families. In consolidating new leadership for social services, I will require a more productive partnership with the federal government and the private sector, and more efficient use of District resources.
The creation of these two key positions is accompanied by the dismantling of the Office of State Agency Affairs and the Office of Planning and Evaluation. The offices of the five line administrators (Community Health and Hospitals, Mental Health, Substance Abuse, Social Rehabilitation, and Payments Assistance) are also converted to a different configuration of responsibilities. As a result, the total number of executive level positions in the Department will not be increased.
This initial realignment of senior executive staff and program offices will produce several immediate benefits:
It will put the necessary staff and budget resources in the hands of senior program managers who have responsibility for shaping policy recommendations and administrative services.
It will allow the Director of Commissioners to focus on long-range planning, policy and management concerns.
It will provide a clear focus for discussion and development of health care and social services policy issues.
It will allow for increased emphasis on policy initiatives such as health promotion, promotion of dental care, reduction of infant mortality rates, and consolidation of programs for youth.
It will allow more effective involvement of officials at the program level with those at the planning and evaluation level, to the advantage of both.
It will assure better integration of federal and District resources in the achievement of program objectives, and hold program managers accountable for compliance with local, state, and federal policies and procedures.
PHASE TWO
The remainder of FY 1980 will be devoted to completing and refining this Reorganization Plan. In the process each major administration, bureau, and office will be reviewed and restructured to achieve clearer and more accountable job definitions for middle management personnel, and to implement important policy objectives detailed in the plan. Additional benefits will flow from this phase of the plan:
Improved relationships between program administrators and federal officials.
Timely compliance in carrying out state and local planning functions.
Better linkage of budget preparation to the planning process, and to policy priorities.
Increased program accountability to the public, the Mayor and legislators.
Improved administrative procedures for data collection, needs assessment, facilities management, contracting and procurement.
Implementation of performance standards for personnel.
Assurance of compliance with federal and local legislation and regulations governing the Department.
Improved standard setting and regulation of facilities.
Coordination of services to avoid duplication and encourage the most cost-effective programs.
Improved response to legal challenges in respect to services, and implementation of relevant court orders.
FUTURE STEPS
This Reorganization Plan does not alter the overall functions and responsibilities of the Department, nor does it represent any change in present budget allocations for programs or policy priorities already established in the FY 1980 budget. It does alter the distribution of management resources and responsibilities, and thus provides the basis on which better policy and resource allocation recommendations can rationally and publicly be made in the coming months.
Because policy focus and advocacy will be more visibly located, citizens and Council members can have more effective access to decision makers within the Department. Because operational accountability is more specific, the City Administrator will be able to apply the management performance standards which we are generating throughout the government.
The effective delivery of health care and social services, in a time of budget constraints and increasing urban needs, is a challenge to every major city in the United States. I submit that this Reorganization Plan is the necessary next step in my continuing commitment to achieving accessible, high quality and cost-effective human services in the District of Columbia.
D.C. Code div. I, tit. 1, ch. 15, subch. III, pt. A