Note: Prior ordinance history: 1963, 1850
Pursuant to California Welfare and Institutions Code Section
14087.54, there is created the Santa Cruz-Monterey-Merced-San Benito-Mariposa
Managed Medical Care Commission. This commission is a multi-county
commission representing Santa Cruz, Monterey, Merced, San Benito,
and Mariposa Counties. The Santa Cruz-Monterey-Merced-San Benito-Mariposa
Managed Medical Care Commission shall be established effective on
that date that all five counties have in effect substantially similar
ordinances creating the commission and a quorum of said commission's
members have met to conduct its initial public meeting. Upon the establishment
of the commission, all of the rights, duties, privileges, and immunities
vested in Merced County by Welfare and Institutions Code Section 14087.5
et seq. (Division 9, Part 3, Chapter 7, Article 2.8) are instead transferred
to and vested in the commission, and shall continue to be so vested
until Merced County formally terminates its participation in the commission.
Any action to terminate participation must be preceded by a 90 day
notice to the other member counties and notice to the State Department
of Health Care Services as set forth in Welfare and Institutions Code
Section 14087.54(g).
(Ord. 2008, 2021)
A.
The
purpose of the commission is to negotiate exclusive contracts with
the California Department of Health Care Services and to arrange for
the provision of health care services to qualifying individuals in
Santa Cruz County, Monterey County, Merced County, San Benito County,
and Mariposa County who lack sufficient annual income to meet the
cost of health care, and whose other assets are so limited that their
application toward the cost of health care would jeopardize the person
or family's future minimum self-maintenance and security, pursuant
to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code.
B.
The
commission shall design and operate a program that:
1.
Delivers
primary care via a contracted provider network which significantly
improves access to primary care and related specialty and ancillary
services for enrolled Medi-Cal recipients;
2.
Includes
mechanisms for assuring that commission-financed medical care services
meet appropriate quality of care standards;
3.
Incorporates
a plan of service delivery and implements reimbursement mechanisms
which will promote the long-term viability of a locally operated Medi-Cal
managed care system and participating "safety net" providers herein
defined as Medi-Cal disproportionate share hospitals, county clinics
and licensed community clinics;
4.
Implements
a financial plan which includes the creation of a prudent reserve
within three years of commencing operations, and which provides that
if additional surplus funds accrue, they shall be used to expand access,
improve benefits and augment provider reimbursement;
5.
Gives
a high priority to increasing prevention, education, and early intervention
services for enrolled recipients;
6.
Ensures
that all program obligations, statutory, contractual or otherwise,
shall be the obligations of the program and shall not be the obligations
of Santa Cruz County, Monterey County, Merced County, San Benito County,
Mariposa County or the State;
7.
Implements
programs and procedures to ensure that a high level of member satisfaction
is maintained.
C.
The
commission shall also be authorized to contract with public insurers,
payors or plan sponsors to offer and/or administer their health care
programs and to contract with private insurers or plan sponsors to
administer their health care programs.
(Ord. 2008, 2021)
A.
The
commission shall consist of a maximum of 25 voting members whom, with
the exception of the director or designee of the health department
(or health services agency) who shall work in the respective county
and be appointed by the respective board of supervisors shall be legal
residents of the county of Santa Cruz appointed by the Board of Supervisors
of Santa Cruz County, legal residents of Monterey County appointed
by the Board of Supervisors of Monterey County, legal residents of
Merced County appointed by the Board of Supervisors of Merced County,
legal residents of San Benito County appointed by the Board of Supervisors
of San Benito County, and legal residents of Mariposa County appointed
by the Board of Supervisors of Mariposa County. The commission shall
be generally representative of the diverse skills, backgrounds, interests,
and demography of persons residing in each county.
B.
Each
member of the commission shall have a commitment to a health care
system which seeks to improve access to high quality health care for
all persons, regardless of their economic circumstances, and which
in fact delivers high quality care, and which in fact is financially
viable. Members of the commission shall likewise have an abiding commitment
to, and interest in, a quality publicly assisted health care delivery
system.
C.
The
number of voting members of the commission shall be based upon the
number of Medi-Cal beneficiaries within each county and includes a
maximum of five members within a county with the number of commissioners
within a county and commission representation categories determined
according to the following formula:
1.
Zero
to 15,000 Medi-Cal beneficiaries within the county equals one commission
seat to be filled by the director of the county health department
(or health services agency) or their designee;
2.
Fifteen
thousand to 30,000 Medi-Cal beneficiaries within the county equals
two commission seats to be filled as follows:
3.
Thirty
thousand to 45,000 Medi-Cal beneficiaries within the county equals
three commission seats to be filled as follows:
4.
Forty-five
thousand to 60,000 Medi-Cal beneficiaries within the county equals
four commission seats to be filled as follows:
5.
Sixty
thousand or more Medi-Cal beneficiaries within the county equals five
commission seats to be filled as follows:
a.
The director of the county health department (or health services
agency) or their designee,
b.
One member of the board of supervisors,
c.
One person representing health care providers,
d.
One person from the public representing the population of beneficiaries
to be served by the commission, and
e.
One at large representative of either the public representing the
population of beneficiaries to be served by the commission or one
person representing health care providers.
D.
Any
deletion of commissioners required based upon a change in the population
of Medi-Cal beneficiaries within a county will be achieved through
attrition, with a maximum of two years to come into compliance with
the membership provisions of this chapter.
E.
Commissioners
shall be appointed by majority vote of the board of supervisors of
the respective county. Any commission member may be removed from office
by a four-fifths vote of the board of supervisors of the county originally
appointing that member.
F.
Commissioners
appointed by the Merced County Board of Supervisors shall serve terms
of four years, with the exception of the initial selection of members.
The majority of the commission members initially appointed by the
Merced County Board of Supervisors shall serve terms commencing on
April 1 of the year in which the fourth district supervisor began
a full term. The remaining members initially appointed shall serve
terms commencing on April 1 of the year in which the fifth district
supervisor began a full term. The initial appointment terms shall
be drawn by lots. At the conclusion of a term, a member may be reappointed
to a subsequent four-year term or terms.
(Ord. 2008, 2021)
The board of supervisors declares that the individuals representing
the health care providers appointed to the commission are intended
to represent and further the interests of said providers, and that
such representation and furtherance will ultimately serve the public
interest. Accordingly, the board finds that for purposes of determining
whether any such commissioner has a "financial interest" within the
meaning of Government Code Section 87100, the industry, profession,
and providers are tantamount to and constitute the public generally
within the meaning of Section 87103 of the Government Code.
(Ord. 2008, 2021)
Procedures for the conduct of business not otherwise specified
in this chapter, including provisions for the creation of standing
committees, shall be contained in bylaws adopted by the commission
and submitted to the board of supervisors of each county for final
approval.
(Ord. 2008, 2021)
A majority of the appointed members of the commission (excluding
any positions that are vacant) shall constitute a quorum, and no act
of the commission shall be valid unless a majority of those members
appointed and not disqualified from voting due to a conflict of interest
concur therein. Any act of the commission shall be accomplished by
a roll call vote when such a vote is requested by any member in attendance.
A.
The
commission shall be considered an entity separate from the county
of Santa Cruz, the county of Monterey, the county of Merced, the county
of San Benito, and the county of Mariposa. The commission shall have
all of the powers made available generally to commissions under Welfare
and Institutions Code Section 14087.54. The commission shall have
the power to acquire, possess, and dispose of real or personal property,
as may be necessary for the performance of its functions, to employ
personnel and contract for services to meet its obligations, and to
sue or be sued. Any obligations of the commission, statutory, contractual,
or otherwise, shall be the obligations solely of the commission and
shall not be the obligations of the County of Santa Cruz, the county
of Monterey the county of Merced, the county of San Benito, or the
county of Mariposa.
(Ord. 2008, 2021)
A.
The
commission shall submit an annual report to each respective board
of supervisors and county administrative office on or before January
31 of each year. The report shall highlight the activities, accomplishments,
and future goals of the commission.
B.
Any
of the respective boards of supervisors may request that the commission
submit progress reports and recommendations at any time.
(Ord. 2008, 2021)
Vacancies occurring in the commission shall be filled by the
board of supervisors of the appointing county for the remainder of
the unexpired term only.
(Ord. 2008, 2021)
The provisions of this chapter are severable. If any section,
paragraph, sentence, phrase, or word of this chapter is declared invalid
for any reason, that decision shall not affect any other portion of
this chapter, which shall remain in full force and effect.
(Ord. 2008, 2021)
