Rhode Island Attorney General Peter Neronha is proposing two cabinet-level agencies to replace the Executive Office of Health and Human Services, separating health-care regulation and financing from other human services.
The 71-page proposal, released Oct. 29, also calls for an independent Office of Health Policy and Planning governed by a seven-member board. It would have authority to set cost-growth and rate caps, enforce spending targets for insurers and health systems, and approve or deny major regulatory decisions. The changes would require legislation and funding.
Under the plan, a Health Administration and Financing Agency would oversee the Department of Health, a standalone Medicaid agency and the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. The health insurance commissioner's office and HealthSource RI, the state's insurance marketplace, would move under the new agency's administration.
A separate Human Services Agency would oversee the Department of Human Services, child-welfare agency, Office of Healthy Aging and veterans' services. The Department of Human Services would continue handling individual Medicaid eligibility, while the new Medicaid agency would manage the program.
Neronha argues that the current structure leaves health oversight fragmented. The proposed policy office would collect and analyze health-system data and take over certain hospital-review functions from the health department. The Health Services Council, which advises on some of those reviews, would be eliminated.
The proposal acknowledges one-time costs for the transition and computer systems, plus ongoing funding needs and additional staffing for the new policy office. Its fiscal section does not supply an itemized dollar budget. Suggested funding options include assessments on insurers or health systems, health-related taxes and state appropriations.
Implementation would begin with legislation and appointments, followed by staff transfers and agreements assigning responsibilities. Full operation would come in a later phase. The proposal sets out that sequence without a calendar date for completion.
Neronha separately proposed a state-managed health insurance option. His office said it would be available through HealthSource RI and outside the marketplace to individuals and employers. That proposal also requires further state action.
Neronha, who is leaving office, urged state leaders to act on the proposals after his term ends.
The attorney general's office is accepting written comments on the proposals at healthcare@riag.ri.gov through Nov. 30. Commenters are asked to use Public Comment in the subject line.