State of Alaska Division of Legislative Audit

Organizational and Administrative Structure Improving Administrative Functions Recommendations Table

Recommendation NumberRecommendation
2.3.1Increase the level of detail in the Budget Alignment and Core Services Alignment documents.
2.3.2Use the Budget Overview Presentations to make a case.
2.3.3Refine individual elements of the Budget Overview Presentations.
2.3.4Improve readability and usefulness.
2.3.5Illustrate interconnectivity at fiscal analysis stage.
2.3.6Consider phasing in a zero-based budget process.
3.1.B.1Evaluate positions that have been vacant for more than six months to determine need.
3.1.B.2Repurpose vacant positions that have never been filled.
3.2.B.1Establish an internal audit section for the entire department.
3.2.C.2Foster care home licensing should remain a separate function because it is so closely integrated with the fieldwork performed by child welfare workers.
3.2.D.1Expand cross-training opportunities so staff can conduct multi-purpose site visits.
3.2.D.2Consider creating a formal process for coordinating site visits.
3.2.D.3While maintaining needed subject matter expertise, explore opportunities for interdivisional DHSS site visit compliance teams that can evaluate multiple department grantees during limited visits to remote areas of the state.
3.2.D.4Expand collaboration with other local and state agencies that perform site visits (such as the Fire Marshal) to alert the department to any potential issues.
3.2.I.2Separate foster care licensing statutes and regulations from other residential care facilities.
3.2.I.3Clarify the waiver and variance process for kinship placements in department regulations.
3.2.I.4Develop a template or checklist for OCS workers and/or eligibility technicians to assist in correctly documenting the components of Title IV-E eligibility within the appropriate timeframes.
3.2.I.5Prioritize technology purchases and implementation to assist OCS workers.
3.2.J.1Prioritize and accelerate plans to shift OCS intake from a regional intake system to a centralized intake system comprised of a distinct unit of trained CPS workers who receive reports of child abuse and neglect 24 hours a day, 7 days a week.
3.3.A.1Further integrate Medicaid functions across the department to achieve cost savings and create a more streamlined authority for Medicaid policy, programming, budget, and oversight.
3.3.A.2Increase the pace at which coordinated care for Medicaid enrollees and cost saving opportunities are identified within the Medicaid program through a focused and concerted efforts across all divisions.
3.3.C.2Create a Quality Committee whose membership includes the DHSS Chief Medical Officer and external stakeholders, such as providers.
4.1The efforts of the Alaska Council on Emergency Medical Services should be refocused from professional advocacy to providing more formalized policy and budget advice to the DHSS commissioner and governor.
4.4To maintain and augment the effectiveness and efficiency of all DHSS advisory bodies, policymakers should:
1. Review periodically, beyond traditional sunset audits, whether each membership body is better equipped to determine policies/oversee programs than other available alternatives such as internal agency workgroups or subject matter experts from academia or the public/private sectors.

2. Establish and enforce expectations regarding the use of performance management tools by agency councils, boards and commissions.

3. Use the criteria developed in this analysis when considering the creation of any new advisory bodies.
6.1.1Alaska should maintain a single state agency for health and social services.
6.3.2Move forward with the transfer of the ILP program to DEED.
7.1.1Revise the prioritization scoring system to address the concerns, weaknesses and unintended consequences identified in this review.
7.1.2Revise the ITG process to limit the number of projects that must be vetted by the ITG Committee.
7.1.3Require the completion of all information on the Application Development Project Status Report.
7.1.4Identify and correct inconsistencies in IT policy, procedures, terminology, and titles throughout the department noted in the discussion.
7.3.1Implement mandatory project management training and mentoring for IT and division staff, including Division Business Alignment Liaisons and project managers, who are tasked with responsibilities concerning development, integration and implementation of technology systems.
7.4.A.1Allocate resources to IT security systems and other tools to ensure critical concerns cited in the OCR Audit and the Risk Mitigation Plan are addressed.
7.4.A.2Educate division leaders and system users on the risks of mobile computing and social media, and obtain agreement on policies concerning need for restrictions and why waivers from security requirements should be more closely monitored and restricted.
7.4.A.3Develop and offer on-line security awareness training programs.
7.4.A.4Restrict and closely scrutinize requests for IT security waivers that may facilitate security breaches.
7.4.A.5Implement strict enforcement policies and procedures regarding the use of USB drives, external hard drives, social media, and other possible points of entry for cyberattacks.
7.4.B.1Develop a plan to address the significant shortcomings and productivity issues identified by operational staff using DSM.
7.4.B.2Expedite the execution of this plan.
7.4.B.3Communicate progress on the plan and how problems are being addressed to all DHSS staff at regular intervals.
7.5.1Continue to expand the use and availability of technology in SOPHN to improve patient communications, improve services and maximize efficiency.
7.5.2Prioritize migration to electronic health records (EHRs) for all divisions – particularly SOPHN – to reduce medical errors, maximize operational efficiency, and minimize redundant training.
8.1.B.2Update current charges to reflect the true cost of testing for ASPHL’s contractual work with other health entities.
8.1.B.4Maintain services for state agencies currently receiving laboratory work from ASPHL when instituting a fee-for-service system.