SD27 - Study of Health Care-Related Boards in the Commonwealth of Virginia with Recommendations for Action Pursuant to SJR 317 of 1997


Executive Summary:
Senate Joint Resolution (SJR) 317 of the 1997 Session of the General Assembly directed the Secretary of Health and Human Resources, in cooperation with the Joint Commission on Health Care (JCHC), to review the various boards, advisory boards, commissions, committees, and councils (hereafter referred to as “boards”) identified by the Joint Commission on Health Care and recommend any appropriate revisions, consolidations or restructuring of these boards. The Virginia Department of Medical Assistance Services, which was designated as the lead agency, contracted with the Center for Public Policy Research of the Thomas Jefferson Program in Public Policy at the College of William and Mary to conduct this study. In completing this study and at the request of the Secretary, the goals of the study are as follows:

Update the inventory resulting from a previous legislative study conducted by the Joint Commission on Health Care pursuant to SJR 104 of 1996 and make recommendations as to appropriate revision, consolidation, or elimination of the health care-related boards;

Create a comprehensive inventory of all health policy-related entities that are composed of legislators or are appointed by the legislature; and,

Investigate and report on the key issues related to the development of health care policy in Georgia, Maryland, North Carolina, and Ohio.

Findings and Recommendations

A. Update the Inventory Resulting From the Previous JCHC Study and Make Recommendations as to Appropriate Revision, Consolidation, or Elimination of Health Care-Related Boards

Our update includes 79 boards, including 16 additional boards not included in the prior JCHC study. Not surprisingly, the number of boards for each state agency varies widely, with the Department of Health and the Department of Health Professions having approximately 50 percent of the 79 boards responsible for health care-related issues in the Commonwealth. Below are the general findings and recommendations related to the boards. For the most part, this study concurs with the general conclusions reached by the previous JCHC study.

1. There is a Large Number of Boards.

In its study of the health care-related boards, the JCHC found that there is a large number of boards, and most, if not all, have specific constituencies, which support their mission and existence. The inventory update supports this conclusion. As before, nearly all the boards focus on specific health issues as opposed to broad health policy.

2. Representation of Citizens and Intra-Agency Representatives on Existing Boards Should Be Increased.

Of the 719 identifiable board members, 76 percent are professionals, consumers, or citizens. Our analysis demonstrates that while professional involvement on the boards is high, the representation of citizens and intra-agency representatives on the boards is fairly low. Of the 719 members on the existing boards, for example, only 49 members, seven percent of all members that can be identified, are citizens.

3. The Interaction Among Boards is Minimal and Informal.

This study concurs with the prior JCHC study finding that there is minimal formal interaction and networking among the boards. However, there is some indication from agency contacts that informal interaction may be taking place. This interaction occurs through three avenues: individuals may serve on several boards, agency employees staff more than one board, and board membership may include representatives from several agencies.

To encourage more interaction among Virginia’s boards, the following actions are recommended:

Create opportunities for formal networking of existing boards.

Revise the Code of Virginia to require boards to collaborate, where appropriate.

Direct the Secretary of Health and Human Resources to design a mechanism and appropriate incentives that lead to the sharing of information across boards.

4. Most Boards Should Remain Unchanged.

Of the 79 boards identified in this study, we recommend that 62, or 78 percent, of the Commonwealth’s boards remain unchanged. In short, these boards are functioning as intended. Although the boards may not be interacting with each other nearly enough, they have clear missions, are working to perform their missions as identified in the Code of Virginia, and meet regularly as directed by their enabling legislation. There are several other boards that are not meeting regularly that we recommend keeping, including those boards that are new and have not yet had an initial meeting.

5. Two Boards Under the Department of Professional and Occupational Regulation Should be Reassigned to the Department of Health Professions.

The Board for Opticians and the Board for Hearing Aid Specialists under the Department of Professional and Occupational Regulation should be moved to the Department of Health Professions given their functions.

6. Six Boards Should Be Eliminated, Because They Are No Longer Necessary--They Are No Longer Functional and/or Their Missions Are Currently Carried Out By Other Boards in the Commonwealth.

We recommend eliminating six of the Commonwealth’s existing boards while recognizing that their elimination may take away important opportunities for citizen input into government decision making. None of these boards are currently functioning -- they do not meet and their functions have been taken over, or are duplicated by other boards. These boards include the following:

Department of Health: Home Care Services Advisory Committee and AIDS Advisory Board

Department for the Aging: Specialized Transportation Council and Specialized Transportation Technical Advisory Committee

Department of Medical Assistance Services: Advisory Committee on Medicare and Medicaid

Interagency: Interagency Coordinating Council on Housing for the Disabled

7. The Virginia Council on Coordinating Prevention and the State Executive Council for At-Risk Youth and Families Should Be Consolidated.

Given the need for prevention to deal with at-risk youth and families, many state contacts recommended that rather than breathing new life into the Virginia Council on Prevention, its functions should be consolidated into the State Executive Council. This will likely require new legislation that would expand the mission and duties of the State Executive Council.

8. Further Study Must Be Done to Determine Whether Seven Boards Are Necessary.

There are seven boards where further study is needed before any recommendation as to no action, elimination, or consolidation can be made. In these cases, study as to either, the boards’ appropriateness, use, interaction with the State or other boards, and effectiveness, is necessary. With regard to the Regional Health Planning Agencies/Boards, we recommend that further study be conducted with the goal of ascertaining the mechanisms in place by which the Regional Boards have the capacity to impact State level planning. It is our assessment that the five Regional Boards are functioning productively, and that there is effective communication among them.

The boards recommended for further study include the following:

Department of Health: Virginia Health Planning Board

Department of Health: Regional Emergency Medical Services Councils

Department of Health: Regional Health Planning Agencies/Boards

Department of Health Professions: Psychiatric Advisory Board

Department of Mental Health, Mental Retardation, and Substance Abuse Services: Governor’s Council on Alcohol and Drug Abuse Problems

Department of Mental Health, Mental Retardation, and Substance Abuse Services: Alzheimer’s Disease and Related Disorders Commission

Department of Medical Assistance Services: Medicaid Prior Authorization Advisory Committee

9. Consideration Should Be Given to Linking Local School Health Boards to an Existing State Board.

Discussions indicate that the local School Health Boards report directly to the Departments of Health and Education. There is currently no state board to which the local boards report. Interviewees indicated their support for establishing a new state school health board. Rather, we recommend investigating the possibility of linking the local boards to an existing board, such as the Board of Health or the Board of Education.

B. Create a Comprehensive Inventory of All Health Policy-Related Entities That Are Composed of Legislators or Are Appointed By the Legislature

There are 21 legislative entities that involve some aspect of health care policy. Their missions range from overseeing the administrative procedures for the various local driver alcohol rehabilitation programs to making recommendations on the delivery of mental health services and studying the health problems of African-American males. The membership on these boards consists primarily of legislators (62 percent) and professionals (25 percent).

C. Investigate and Report on the Ways in Which Georgia, Maryland, North Carolina, and Ohio Develop Health Care Policy

All states interviewed utilized boards and councils to form health care policy and to monitor and advise government on health care issues. Most of these were established through code, and most have no sunset provisions. Several were formed as a result of federal requirements, but many are established to give a particular constituency (e.g., persons with disabilities) a voice in government or to address a specific issue (e.g., transportation and housing). As in Virginia, the Governor and legislature of these states have attempted to reduce the number of the boards. However, even though they are narrowly defined, the boards and councils do represent an opportunity for citizen participation, as well as an opportunity for political patronage. Furthermore, relatively few resources are required to operate the boards, given the opportunity for public involvement. As such, the reductions have been minimal.

Most states reported that there were few regulatory or policy making boards, usually one per agency. The majority of the boards are advisory.