Human Services Organization & Governance: A Changing Landscape Jill D. Moore & Aimee N. Wall Legal Basics for Human Services Administrators March 2018 Why are we talking about this? S.L. 2012- 126 (H 438) Consolidation law changes in counties S.L. 2017-41 (H 630) Social services regionalization & supervision working group What are we talking about? Agencies Organization Directors
Employees Local boards and Governance advisory committees Role of state General Framework Requirement: Counties must provide public health and social services Organizational options: Single-county separate PH & SS agencies Single-county consolidated human services agencies Multi-county agencies Other (authority models, interlocal agreements) Governance options for single-county agencies: Appointed governing board(s), or BOCC may assume powers and duties of board(s) 4
G.S. 153A-77 (S.L. 2012-146, H 438) CONSOLIDATION Consolidation Law Timeline 1973 Large counties may abolish boards (Mecklenburg) 1995 Large counties may establish CHSAs (Wake) 2012
All counties authorized to abolish boards and/or establish CHSAs 6 Options Stay the same Options in PH & SS laws Options in consolidation law Options in Consolidation Law 1
2 Board of County Commissioners Consolidated Human Services Board Department of Social Services and/or Public Health 3 Board of County Commissioners
Board of County Commissioners as a Consolidated Human Services Board Consolidated Human Services Agency Consolidated Human Services Agency PH and SS Organization and Governance June 2012 Not consolidated Consolidated human services agency (CHSA) with a consolidated human services board (Wake) CHSA with BOCC as governing board (Mecklenburg)
PH and SS Organization and Governance Resolutions as of February 1, 2018 SS & PH agencies with appointed governing boards Option 1 with both SS & PH agencies governed by BOCC (Graham, Stokes, Sampson [eff. April 1, 2018]) Option 1 with SS agency governed by BOCC, PH agency with appointed governing board (McDowell, Mitchell, Watauga, Wilkes, Surry, Columbus) Option 2 with consolidated HS agency including SS & PH, appointed CHS board (Jackson, Haywood, Buncombe, Gaston, Union, Stanly, Rockingham, Wake, Nash, Edgecombe, Carteret, Dare) Option 2 with consolidated HS agency include SS and other human services but not PH, governed by appointed CHS board (Polk) Option 3 with consolidated HS agency including SS & PH, governed by BOCC, health advisory committee (Clay, Swain, Yadkin, Mecklenburg [no advi. comm.], Guilford, Montgomery, Richmond, Bladen, Brunswick, Pender, Onslow) Option 3 with consolidated HS agency including SS & other human services but not PH, governed by BOCC (Cabarrus) Key Differences
Agency Board Hire Agency Director Personnel DSS Separate Appointed; 3-5 mem. Board hires SHRA PH
Separate Appointed; 11 mem. Board hires SHRA One Separate Elected* BOCC hires SHRA
Two Consolidated Appointed; (any combo of up to 25 human services) mem. Manager hires with advice & consent of CHS board SHRA Optional Manager hires with advice & consent of BOCC
SHRA optional Three Consolidated Elected* (any combo of human services) * If public health affected, must appoint health advisory committee (except in Mecklenburg) What goes in a CHSA? Law does not require any particular mix of human services May include: Public health Social services Other county human services departments
or programs Gaston County Public Health, Social Services, Transportation, Aging, Youth Services, Child Advocacy Center, Battered Womens Shelter Guilford County Public Health, Social Services, Transportation, County Veterans Affairs Cabarrus County Social Services, Aging, Transportation CHS Board Membership (if appointed)
County commissioner 4 consumers of human services Professionals: psychologist, pharmacist, engineer, dentist, optometrist, veterinarian, social worker, registered nurse, two physicians (one must be a psychiatrist) Up to 12 others Powers and duties Assume all powers and duties of PH/
SS boards, except hiring director Other powers and duties Advise and consent to hiring/firing of director Plan and recommend a budget Assure compliance with state/federal laws Recommend creation of human services programs Perform public relations and advocacy functions 13 Board of Social Services Membership (if appointed)
Two members appointed by BOCC Two members appointed by NC Social Services Commission One member appointed by the other members Powers and duties Consult with director in preparing agency budget Authority to inspect social services and public assistance records Authority to make some decisions related to Work First, Special Assistance, and services funded through the Social Services Block
Grant Review suspected cases of fraud for some public assistance programs 14 Board of Health Membership (if appointed) County commissioner
Physician Dentist Optometrist Veterinarian Registered nurse Pharmacist Professional engineer 3 general public members Powers and duties Make policy for local public health agency Adopt local public health rules Adjudicate disputes regarding local rules or locally imposed public health administrative penalties (fines) Impose local public health fees Satisfy state accreditation
requirements for local boards of health 15 Common threads Statutorily required Statutes and regulations grant authority Agency director not a member Role in advising the director Role with regard to agency employees Key differences
Appointment Size and composition Removal Vacancies Fees Budget Appointing agency director Rulemaking Adjudications
Accreditation-related duties Social services program related duties Access to records Assure compliance BOCC as governing board Process 30 days notice of public hearing Resolution adopted after public hearing Membership Conferred by election to board of commissioners Not required to meet statutory requirements for particular professions Powers & duties
Board of commissioners acquires; multiple sources of law Some may be delegated; some may not Advisory committee(s) Advisory committee on health required if BOH duties assumed Expanded committee or additional committees allowed Role of advisory committees No guidance or specific grant of authority in consolidation statute PH accreditation expressly allows certain duties to be delegated from the local board of health to an advisory committee, such as Review and report on community data Receive community input Foster partnerships with the community Advocate for public health Lessons Learned
Organizational structure Flexibility, but still must comply with state and federal mandates Employees Advance discussion about implications of change Update HR policies/ ordinance in advance to comply with federal merit personnel standards Open legal question about transitioning career status employees Advisory committees Define roles, including appropriate delegation
Information sharing Dont assume a components of a CHSA will be able to share information more freely than they could before consolidation Budget impact Dont assume creating a CHSA will save money SOCIAL SERVICES WORKING GROUP Overview S.L. 2017-41 (H 630) SSWGs Puzzle Piece Stage One
Stage Two Once reform is underway at the State level, how should a new and improved State system use regional offices to provide oversight and support for the county departments administering the social services program? In the countyadministered system, what change is needed to improve coordination and collaboration at the
county level? What would a regionally-administered system look like? SSWGs Focus Stage One The WHOLE enchilada Child welfare Adult services Public assistance, including Medicaid, Food and Nutrition, State-County Special Assistance, Work First, Energy programs, program integrity, etc. Child support enforcement Adult care home oversight Other programs
Not SSWGs Focus Organization of the state agencies overseeing local administration Services What services are being delivered Who is delivering services Who is receiving services Finance Who is paying for services How much do services cost Discussions Supervisory functions What is involved in supervising social services administration? Who does what? Central v. Regional v. County Staffing model What types of staff should be in the regional offices?
Maps What factors are important when designing regions? Relationship with Board of County Commissioners Should the BOCC have an expanded role in supervision of DSS when there are challenges facing the agency? Timelines Stage One Report 4/15/2018 Stage Two Report 2/1/2019 DHHS Plan 11/15/2018 NCGA and/or DHHS Acts? NCGA Acts? Regional Supervision? 3/1/2020
Information Social Services Microsite Meeting notices Materials Minutes Recordings https://www.sog.unc.edu/resources/microsites/social-services Questions? Jill Moore 919.966.4442 [email protected] Aimee Wall 919.843.4957 [email protected]
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