The state's eight health and human service agencies should be merged under the authority of a single Cabinet member, according to a Legislative Audit Council report released Tuesday.

Together, the agencies control $5.7 billion, or about 38 percent of the state budget. Three agencies have Cabinet members the governor appoints, but five do not.

The agencies include the departments of Alcohol and Other Drug Abuse Services (DAODAS), Disabilities and Special Needs, Health and Environmental Control, Health and Human Services, Mental Health, Social Services, Vocational Rehabilitation, and the Commission for the Blind.

Consolidating the agencies would make it easier to get help from state government, the report said. It also could reduce administrative costs.

State Rep. Rex Rice, R-Easley, has introduced a bill to implement much of the recommendations, and he tied it to a cigarette tax increase to fund Medicaid.

"We've got to fix health care," Rice said. "We've got to put some limits on the growth and figure out how to streamline agencies and coordinate agencies. It's going to take some change."

It was the audit council's second report in a week dealing with health care. Last week, auditors recommended ways the state could save Medicaid dollars. This week, the report focused on non-Medicaid health and human service issues.

In addition to combining agencies, the report recommended consolidating four areas where similar services are provided by more than one agency: addiction treatment, rehabilitation, programs for emotionally disturbed children, and senior and long-term care.

For instance, Health and Human Services funds various senior and long-term care services. Social Services has a unit that investigates senior abuse and neglect. Mental Health owns two nursing homes that provide institutional long-term care. DHEC provides home health services.

The report recommends consolidating these services - except for home health - under a single, freestanding agency, or under either Social Services or Health and Human Services.

Mental Health Director George P. Gintoli, whose department has its 5,100 employees, 9,500 volunteers and 24 mental health centers and inpatient facilities, praised the council's report, which he called "conscientious and thoughtful."

Gintoli said he would help implement its recommendations, some of which the department already has been working toward, such as developing performance measures.

Roy Mathis, speaker of the Silver Haired Legislature, a senior advo-cacy group, said centralizing senior care services could improve security and quality of care in long-term care facilities around the state.

Duplicating services increases costs and can make it tough to know where to get help, the report said. Planning is fragmented, and agencies spend extra resources on interagency referrals and service coordination.

The report had a handful of other recommendations. Two of them dealt with agency billing at Mental Health and DHEC.

Mental Health collects an average of 10 percent of the amount billed to clients and 15 percent of what's billed to insurance companies. By being more aggressive, the department could collect more from people without insurance. Every 10-percent increase in that group would bring in an additional $840,000.

John Hutto, spokesman for the department, agreed that collections can be increased, but the high number of uninsured patients would make it difficult.

DHEC, meanwhile, should be more aggressive in collecting money owed from its health service clients, the report said. Doing so could allow the agency to provide more services.

Jan Easterling, DHEC spokeswoman, said the department has known about the need for a centralized billing system for some time and is working on it.

Gov. Mark Sanford said the report advances the notion of fiscal responsibility and accountability in government.

"We don't accept waste and duplication in the business world, and we shouldn't accept it from state government, either," he said in a statement. "We're in a situation with the budget where we can't afford inefficiency and a lack of accountability."

Jonathan Maze covers health care and technology. Reach him at 937-5719.