Executive Order

Executive Order  No. 49: Designating certain agencies to administer federal programs

Date: 01/31/1966
Issuer: John A. Volpe
Amended by: Executive Order 51

Table of Contents

WHEREAS, the enactment of Title XIX of the Social Security Act has created new opportunities to assure that good health and medical care is available to individuals and families who could not otherwise afford it; and

WHEREAS, Title XIX is concerned not only with the purchase of available health and medical services for those who need them but with the quality and accessibility of such services; and

WHEREAS, despite the requirement of Title XIX, fulfillment of the full potential of the program cannot be achieved by any single Massachusetts agency working alone; and

WHEREAS, there is necessary to this end a close working partnership between the Department of Public Welfare and the Department of Public Health, these being the two agencies most closely concerned; and

WHEREAS, such a partnership must rest on a firm definition of the separate roles of each department and the specific allocation between them of those responsibilities not clearly belonging to either;

NOW, THEREFORE, in order to lay a foundation for the delineation of such roles and responsibilities, I hereby order as follows:

1. Pursuant to Section 1902(a) (5) of Title XIX of the Social Security Act, as added by Section 121(a) of Public Law 89-97 of the 89th Congress, the Department of Public Welfare shall be the State agency to administer the State plan for medical assistance called for by Section 1901 and 1902 of said Title and shall comply with Federal requirements governing the designated State agency.

2. Pursuant to Section 1902(a) (9) of said Title, the Department of Public Health shall be the State authority responsible for establishing and maintaining standards for public and private institutions in which recipients of medical assistance under the State plan may receive care or services.

3. The Commissioner of Public Welfare and the Commissioner of Public Health shall (a) develop by mutual agreement a definition of the primary roles of their respective departments under Title XIX, (b) develop methods of cooperating in the fulfillment of joint functions, and (c) provide for the allocation between them of functions incidental to the fulfillment of these roles, adopting for this purpose such rules, regulations and/or contractual arrangements as may be appropriate to the purpose.

4. In the working out of such understandings, agreements, rules, regulations, and contracts the Commissioner of Public Welfare and the Commissioner of Public Health shall be governed by the following guidelines:

(a) It shall be the primary responsibility of the Department of Public Welfare to: (i) perform those functions, including the determination of eligibility, the conduct of hearings, and the making of reports, required of the "State agency" under the State plan; (ii) carry out the administrative steps incidental to the processing, recording, and auditing of vendor payments; and (iii) pursue the qualitative improvement, through educational leave, in-service training and otherwise, of social services involving the identification of health problems, the referral of clients to needed health and medical services, and assistance to clients in obtaining such services.

(b) It shall be the primary responsibility of the Department of Public Health to: (i) set standards for purchased services, including the content of such services, and establish requirements for the use of consultant services and bases for payment for services; (ii) plan for the development of the facilities and services required to assure the availability and accessibility of high quality medical care for all those entitled thereto; and (iii) assist the providers of service (hospitals, extended care services, home health services, physicians, etc.) in strengthening their resources for preventive, diagnostic, and rehabilitative care or treatment.

(c) It shall be the joint responsibility of both departments to cooperate in (i) developing methods of assuring that eligible persons will be referred to the appropriate providers of service; (ii) providing information to such persons about available health and medical services; (iii) identifying gaps in the availability and shortcomings in the quality of such services and opportunities for improving programs of health education; and (iv) working out cooperative arrangements with the Department of Mental Health, the Massachusetts Rehabilitation Commission, and the Commonwealth Service Corps designed to assure maximum utilization of and coordination of the provision of medical assistance with the services administered or supervised by those agencies.

(d) Other functions incidental to the implementation of Title XIX shall be allocated to one or the other department on the basis of its respective mission and capabilities.

5. To assure the benefits of the understanding, advice, cooperation, and support of the health professions in the development and administration of the Commonwealth's Title XIX program, the Governor, with the advice of the Commissioner of Public Welfare and the Commissioner of Public Health, shall appoint an unpaid Medical Assistance Advisory Council consisting of physicians, dentists, nurses, hospital and nursing home administrators and representatives of other health professions in such numbers and proportions and for such terms as he shall deem appropriate. The Medical Assistance Advisory Council shall elect its own chairman and meet from time to time either on its own motion or on call of the chairman.

Given at the Executive Chamber in Boston this thirty-first day of January in the year of our Lord one thousand nine hundred and sixty-six and of the Independence of the United States of America, the one hundred and ninetieth.

Commonwealth of Massachusetts

Secretary of the Commonwealth

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