Be prepared. In early September, the U.S. Secretary of Labor, Thomas Perez, sent a letter to governors warning them about the the Home Care Final Rule, which mandates most home health-care workers to be paid the minimum wage and given overtime. It’s likely to affect nearly two million employees nationwide -- although the date when it goes into effect is still uncertain.
Under pressure from the federal government, states now have to figure out how to enforce this new rule. The first step is an inventory of all their home care programs. Then, ideally before the complaints start pouring in, states will have to have develop plans for oversight. For example, since there’s now a mandate to cover travel time to and from a job, states have to find a way to monitor the now-reimbursable expenses associated with transportation.
For years, we’ve been suspicious about the quality of citizen surveys used to gauge the quality of government services. That's because people are more likely to respond to surveys when they’re particularly outraged and are looking for someplace to vent. The surveys are also often used to judge the work of one particular service provider when the experience of the person completing the survey may have involved lots of different people and institutions that day.
This was borne out recently by an article by psychiatrist Reba Peoples. According to the author, patient satisfaction surveys are often inadvertently anti-provider, particularly when patients are asked to measure a provider’s skills. As she writes, “any number of things from expensive parking, to snarky front desk staff, to not being prescribed desired medications and/or interventions that are clearly not indicated for the condition at hand can lead to low satisfaction scores.”
Sometimes citizen surveys are the only way to get close to a measure of the results of certain programs, for sure. It’s just that putting too much faith in them can lead an analyst astray.
We’re always interested when we run across particularly good government websites. The Center for Digital Government recently named Arkansas.gov the best government website in the country. Arkansas has been at or near the top of this particular evaluation several times in recent years. Perhaps the most impressive element of the site is a feature called Gov2Go, which allows the state to reach out directly to citizens to remind them when it’s time to do things like pay property taxes or renew their licenses.
Many of the state's individual agencies also have impressive websites. Its Department of Finance and Administration, for example, has set up iPad kiosks in state revenue offices “which have reduced the wait times for drivers renewing their vehicle registrations,” according to a state release. It now has such kiosks at a dozen individual sites and plans on expanding their use.
“Mayors could never get away with the kind of nonsense that goes on in Washington. In our world, you either picked up the trash or you didn't. ... You either filled a pothole or you didn't.” - Philadelphia Mayor Michael Nutter
The world is full of courses about government management, ranging from budgeting to forecasting to human resources. But when it comes to training students to make sure elections are not only efficient and fair but also consistent, there’s been nothing of substance out there -- until now. The Humphrey School of Public Policy at the University of Minnesota is forging into this territory with a brand new online course that could wind up being a model for the country.
The first course, under way now, covers substantive issues like questions of voter eligibility and voting by mail and also gives students a solid comprehension of tensions in elections like central versus local control. People who complete the online curriculum receive a certificate in election administration, which might help them advance their careers. Moreover, if such certificates become widely used in the future, they have the potential to help ensure that election management becomes professionalized.
“More and more, since the 2000 election, people are appreciating how election administration can have outcomes,” says Doug Chapin, director of the Program for Excellence in Election Administration at Humphrey. He emphasizes the need for heightened professionalism in the field, saying that, “we’re trying to take the same rigor and conceptual clarity that are applied to other levels of government and bring it to election administration.”
How can the states cut down on Medicaid fraud? There are lots of possibilities, including financially rewarding people who turn in doctors or other providers who have overcharged Medicaid on claims for services they haven't provided. These are known as False Claims Acts and they allow whistleblowers to get a portion of the dollars collected when someone alerts the government about a problem. Ten states have a False Claims Act specifically for Medicaid. Another 20 have similar laws in place that go more broadly to include programs like food stamps.
Understandably, many provider representatives don't like this and argue that the laws lead to frivolous lawsuits. That's why when Washington state passed its law in 2012, legislators wrote it so the law would sunset in 2016 if it wasn't working. The legislative auditor won’t release its report until December, but it told legislators last month that the results were positive. Whistleblowing in Washington has helped to increase fraud collections by 28 percent between June 2012 and May 2015. What's more, legislative audit staff indicated that there was no evidence of frivolous cases. Provider representatives couldn't provide any examples of costs incurred from cases filed under Washington’s Medicaid False Claims Act.
It’s clear that measuring public services can have great value. Just a few weeks ago, California Attorney General (AG) Kamala Harris, took state databases on killings by police officers and made them public online. She believes that providing access to those numbers -- instead of keeping them locked up in police department computers -- will help restore the faith in the police that has been lost due to recent police-related killings.
Among the things a citizen can discover is that although about 14 percent of deaths of people in custody were at the hands of law officers, “most deaths in custody from 2005 to 2014 resulted from natural causes such as illnesses,” according to the website. There may be more information coming, as the AG pushes for legislation to require the police to report data on every case in which people are seriously injured -- not just killed -- by officers.
Cybersecurity is on the top of the list of tasks confronting America’s cities and states. According to the National Association of State Chief Information Officers, “the most pressing policy concern for CIOs in 2015 is securing our IT networks against outside threats.”
Thus far, governments have been trying to develop all kinds of schemes for preventing hackers from stealing private information or disabling their systems. But in early August, at a conference in Las Vegas devoted to security, another tactic emerged, according to Richard Bejtlich in a paper for the Brookings Institution. The idea? “If you can’t protect it, don’t collect it.” For example, if a state or city is providing a service that requires a credit card number, it may be wise to only retain that number for the moments it’s needed and then expunge it from the system entirely.
Similarly, there was discussion at the conference around how to avoid using social security numbers (SSNs) when they’re not necessary. If someone is trying to obtain something from a state or city that requires him to provide his SSN, a government could translate it into another number that the citizen can use to get what he needs. As Bejtlich wrote, “the next stage of the information revolution requires rethinking the businesses processes surrounding sensitive data. Data minimization must be a key theme in cybersecurity going forward.”
The economic vitality of states and cities depends on having skilled workers. Governments are anxious to avoid so-called “skill gaps,” areas in which there are jobs available but not enough trained personnel to fill them. One of the biggest such problem areas is in rural mental health, according to a September article in Kaiser Health News.
This is a nationwide issue. It focuses on the problem in Texas, stating that, some 185 of the state’s 254 counties have no psychiatrists at all. That’s an area representing more than 3 million people. Apparently there are fewer and fewer residents interested in this specialty -- and many of those who do so aren’t interested in working in remote regions of states. What’s to do?
Sita Diehl, director of state policy and advocacy with the National Alliance on Mental Illness, believes economic incentives aren’t enough. Instead, she argues, “the most successful strategies are to find young people within the rural community. They know the community; they have an investment in the community.” By finding young people interested in helping improve the mental health of their own communities, Diehl hopes to groom a solid corps of new rural psychiatrists.