Section 2. The secretary of health and human services shall appoint, with the approval of the governor, a commissioner of mental health who shall serve at the pleasure of the secretary and may be removed by the secretary at any time, subject to the approval of the governor.

Such commissioner shall have such educational qualifications and such administrative and other experience, including education or experience in a field related to human services, as the secretary of health and human services determines are necessary for the performance of the duties of the commissioner.

The commissioner shall appoint and may remove such agents and subordinate officers as the commissioner may deem necessary, and may establish such divisions or regional management systems in the department as the commissioner deems appropriate from time to time. Except as otherwise provided by law all offices and positions shall be subject to the provisions of chapter thirty-one; provided, however, the provisions of chapter thirty-one shall not apply to physicians and psychiatrists with full medical-psychiatric responsibility as opposed to administrative responsibility, to community mental health area directors appointed under the provisions of section thirteen, to nurses employed as such by the department, or to attorneys acting as legal counsel; and provided further, however, and notwithstanding the preceding provision or any other provision of law, all offices and positions which as a condition of receiving federal grants for programs and activities to which the federal standards for a merit system of personnel administration relate and make necessary the application of the provisions of the civil service law, shall be subject to the provisions of chapter thirty-one if such federal standards are uniform in all states.

At the end of each fiscal year, the commissioner shall make an annual report of the activities of the department, and of each facility, clinic, or unit under its control, the cost of operating the same, the initiation of new programs, and the progress made in providing services and facilities for mental health in the commonwealth.

The position of commissioner shall be classified in accordance with section forty-five of chapter thirty and the salary shall be determined in accordance with section forty-six C of said chapter thirty.

Prior to undertaking any activity or implementing any policy which would affect expenditures for medical assistance under chapter one hundred and eighteen E, involving the delivery of services reimbursable under said chapter, certification and licensure of providers of services under said chapter, or identifying individuals eligible for such assistance under said chapter, the commissioner shall assure that such activity or policy is reviewed by the commissioner of medical assistance.