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SB-1029 Medi-Cal: County of Sacramento.(2019-2020)

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Date Published: 08/24/2020 09:00 PM
SB1029:v93#DOCUMENT

Amended  IN  Assembly  August 24, 2020
Amended  IN  Assembly  August 06, 2020
Amended  IN  Assembly  July 27, 2020
Amended  IN  Senate  May 14, 2020
Amended  IN  Senate  April 29, 2020
Amended  IN  Senate  March 19, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 1029


Introduced by Senator Pan
(Coauthors: Senators Dahle and Nielsen)
(Coauthors: Assembly Members Cooley, Cooper, Kiley, and McCarty)

February 14, 2020


An act to amend, repeal, and add Section 14089.07 of, and to add Section 14087.385 to, to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


SB 1029, as amended, Pan. Medi-Cal: County of Sacramento.
(1) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services are provided to qualified low-income persons under various health care delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law authorizes the department to enter into various types of contracts for the provision of services to beneficiaries, including contracts with Medi-Cal managed care plans.
Existing law provides that in counties selected by the Director of Health Care Services with the concurrence of the county, a special county health authority may be established, and in any county, by ordinance, a special commission may be established, in order to meet the problems of delivery of publicly assisted medical care in each county, and to demonstrate ways of promoting quality care and cost efficiency. Existing law authorizes several counties, including the County of Alameda, to establish, by ordinance, a health authority, and specified counties, such as the Counties of San Joaquin and Tulare, to establish, by ordinance, a special county health commission.
This bill would authorize the Board of Supervisors of the County of Sacramento to establish, by ordinance, a health authority to perform specified duties, including negotiating and entering into contracts with health plans, as prescribed. The bill would provide that any participating health plans shall be designated by the health authority for approval by the department, and that health plans approved by the department shall be eligible to contract with the department. require the health authority to meet with any health plans intending to contract with the department, and, subsequent to meeting with all interested health plans, to designate to the department at least 2 licensed health plans for the department’s approval based on specified criteria. The bill would require the health authority to be governed by a commission, would require the board to appoint commission members, and would require those members to include specified individuals, including representatives of nonprofit community health centers and hospital systems that operate in the County of Sacramento. The bill would specify the responsibilities and duties of each member of the commission, including serving the public interest of Medi-Cal beneficiaries served by the health authority and ensuring the fiscal solvency of the health authority. The bill would require the commission to establish advisory committees, including an executive committee, and would prohibit members of the commission and advisory committees from receiving compensation for activities relating to their duties, except as specified. The bill would provide that a member of the commission shall not be deemed to be interested in a contract entered into by the department if the member is a Medi-Cal recipient or if certain facts apply, including that the member was appointed to represent the interests of physicians, health care practitioners, hospitals, or other health care organizations. The bill would require the health authority to be considered a separate entity from the county, to be deemed a public agency for various purposes, including for purposes of grant programs, and to have specified authority as necessary to perform its functions, including the power to acquire real or personal property. The bill would authorize the board, by ordinance, to terminate the health authority under prescribed circumstances, and would require certain acts to be performed by the health authority, the County of Sacramento, the board, and the department, including requiring the department to conduct an audit of the health authority’s records, before the termination of the health authority.

(2)Existing law authorizes the Sacramento County Department of Health and Human Services to establish a stakeholder advisory committee to provide input on the delivery of health care services provided in the county. Existing law requires the advisory committee to include specified individuals, such as representatives of Medi-Cal managed care health plans, and authorizes the advisory committee to submit written input to the department on various policies, including those that improve coordination with traditional and safety net providers.

This bill would make these provisions inoperative upon the implementation of specified activities related to establishing a health authority in the County of Sacramento, and would repeal these provisions on the following January 1, except as specified. Upon the implementation of other prescribed activities relating to the health authority in the County of Sacramento, the bill would reenact these provisions.

(3)

(2) This bill would make legislative findings and declarations as to the necessity of a special statute for the County of Sacramento.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 14087.385 is added to the Welfare and Institutions Code, immediately following Section 14087.38, to read:

14087.385.
 (a) The following definitions apply for purposes of this section:
(1) “Board” means the Board of Supervisors of the County of Sacramento.
(2) “Commission” means the governing body of the health authority.
(3) “County” means the County of Sacramento.
(4) “Department” means the State Department of Health Care Services.
(5) “Health authority” means a separate public entity established by the board that meets the requirements of state and federal law and criteria established by the department and engages in activities authorized by this section.
(b) The Legislature finds and declares that it is necessary that a health authority be established in the county to meet the problems of delivery of publicly assisted medical care in the county and to demonstrate ways of promoting timely access, quality care, and cost efficiency.
(c) By ordinance, the board may establish a health authority to do all of the following:

(1)Designate a number of Knox-Keene licensed health plans for purposes of health plan procurement under Section 14089 as the only Medi-Cal managed care health plans authorized to operate within the county, as specified under subdivision (f), until the health authority implements any activity described in paragraph (3).

(2)Conduct oversight on the quality, cost, and access of Medi-Cal services in the county, including health plans contracted by the department to provide Medi-Cal services in the county under Section 14089, until the health authority implements any activity described in paragraph (3).

(1) Commencing January 1, 2024, designate a number of Knox-Keene licensed health plans for purposes of the department’s Medi-Cal managed care plan procurement under Section 14089 for the County of Sacramento as specified under subdivision (f), until the health authority implements a county-sponsored local initiative health plan as authorized by Section 14087.38 as described in paragraph (3).
(2) Meet with health plans that operate as Medi-Cal managed care plans in the county pursuant to Section 14089 to review and discuss strategies for improving quality, cost, and access of Medi-Cal services in the county, until the health authority implements any activity described in paragraph (3).
(3) (A) Consistent with Section 14087.38, and upon approval of the health authority and the board, pursue either of the following activities:
(i) Seek and obtain Knox-Keene health plan licensure in order to serve as the county-sponsored local initiative contracted to contract with the department to arrange for the provision of health care services to qualifying individuals. individuals, as authorized by Section 14087.3.
(ii) Negotiate and enter into a contract with a Knox-Keene licensed health plan to be the designated county-sponsored local initiative health plan to contract with the department. for the purpose of contracting with the department for the provision of health care services to qualifying individuals as authorized by Section 14087.3.
(B) Upon the implementation of any activity described in subparagraph (A), the county may continue to administer its stakeholder advisory committee, as described under Section 14089.07.
(4) Establish advisory committees to the commission, as specified under paragraph (4) of subdivision (e).
(d) The enabling ordinance shall specify the membership of the governing commission of the health authority, the qualifications for commission members, and the manner of appointment and selection consistent with subdivision (e). The enabling ordinance shall also specify all of the following:
(1) Any requirements for the bylaws adopted by the commission to conduct business, including quorum, minutes, and reports.
(2) The terms of offices for commission members.
(3) The process and conditions for removing commission members, which shall be consistent with paragraph (3) of subdivision (e), and appointments to fill vacancies.
(4) Any other matters the board deems necessary or convenient for the conduct of the health authority’s activities.
(e) (1) The health authority shall be governed by a commission appointed by the board to reflect the diversity of the community. Each member of the commission has the responsibility and duty to comply with applicable federal and state laws and regulations, to serve the public interest of Medi-Cal beneficiaries served by the health authority, and to ensure the operational well-being and fiscal solvency of the health authority. Members of the commission shall further strive to improve health care quality, to better integrate the services of Medi-Cal managed care plans and behavioral health and oral health services, to promote prevention and wellness, to ensure the provision of cost-effective health and mental health care services, and to reduce health disparities. Notwithstanding this chapter, the commission shall be compromised of 20 voting members, and at least 2 nonvoting members. The voting members shall consist of all of the following:
(A) Five members shall be individuals who advocate on behalf or represent the interests of Medi-Cal beneficiaries in the county. Of the five members, at least one individual shall advocate on behalf of Medi-Cal beneficiaries for behavioral health services. The initial individuals shall be nominated by the board. Subsequent members shall be nominated by the consumer protection advisory committee established by the health authority.
(B) Two members shall be individuals who are Medi-Cal beneficiaries in the county at the time they are nominated. The initial individuals shall be nominated by the board, and subsequent members shall be nominated by the consumer protection advisory committee established by the health authority.
(C) Three members shall be representatives of nonprofit community health centers that operate in the county and serve Medi-Cal beneficiaries, and these members shall be nominated by the Central Valley Health Network, or its successor organization.
(D) Four members shall be individuals who are nominated by the Hospital Council of Northern and Cental California, or any successor organization, and represent hospital systems operating in the county. The board shall appoint no more than one individual representing each hospital system.
(E) Two members shall be physicians, nominated by the Sierra Sacramento Valley Medical Society, or any successor organization, who serve Medi-Cal beneficiaries in the county.
(F) One member shall be a behavioral health services provider who serves Medi-Cal beneficiaries in the county.
(G) One member shall be an individual nominated by the stakeholder advisory committee on oral health and dental services, established pursuant to Section 14089.08, who resides or is employed in the county.
(H) A member of the board, or their designee.
(I) The director of the County Department of Health Services, or their designee.
(2) (A) Until the health authority implements any activity described in paragraph (3) of subdivision (c), nonvoting members shall include at least two members who represent Medi-Cal managed care plans operating in the county and two individuals who represent independent physician practice associations operating in the county.
(B) Upon the implementation of any activity described in paragraph (3) of subdivision (c), the nonvoting members shall include at least two individuals who represent independent physician practice associations operating in the county.
(3) The composition and nominating process of the governing commission shall be subject to alteration, upon two-thirds vote of the full voting membership of the commission and concurred in by resolution or ordinance of the county, provided that any change in the composition of the commission does not result in the elimination of voting representation by the county, physicians, hospitals, community health centers, beneficiaries, or beneficiary advocates.
(4) The commission shall establish advisory committees, which shall include an executive committee, a consumer protection committee, and any other committee determined to be advisable by the health authority.
(5) The commission shall consult with, and receive input from, the stakeholder advisory committee established pursuant to Section 14089.08 on matters that may impact the oral health of Medi-Cal beneficiaries.
(6) Members of the commission and its committees shall not be paid compensation for activities relating to their duties as members, but commission members who are Medi-Cal recipients shall be reimbursed an appropriate amount by the county for travel and childcare expenses incurred in performing their duties related to the commission and those committees.
(7) Notwithstanding any other law, a member of the commission shall not be deemed to be interested in a contract entered into by the department within the meaning of Article 4 (commencing with Section 1090) of Chapter 1 of Division 4 of Title 1 of the Government Code if the member is a Medi-Cal recipient or if all of the following apply:
(A) The member was appointed to represent the interests of physicians, health care practitioners, hospitals, or other health care organizations.
(B) The contract authorizes the member or the organization the member represents to provide Medi-Cal services in the county.
(C) The contract contains substantially the same terms and conditions as contracts entered into with other individuals or organizations the member was appointed to represent.
(D) The member does not influence nor attempt to influence the commission or another member of the commission to recommend that the department enter into the contract in which the member is interested.
(E) The member discloses the interest to the commission and abstains from voting on any recommendation on the contract.
(F) The commission notes the member’s disclosure and abstention in its official records.

(f)(1)Participating health plans shall first be designated by the health authority for approval by the department. Health plans approved by the department shall be eligible to contract with the department. Designation by the health authority and approval by the department provides the health plan only with the opportunity to compete for a contract and does not guarantee a contract with the state.

(2)Designation requirements imposed by the health authority shall not conflict with the requirements imposed by the department, the federal Medicaid program, and the Medi-Cal program, and may not impose stricter requirements, without the department’s approval, than those imposed by the department, the federal Medicaid program, and the Medi-Cal program.

(3)Designation of health plans by the health authority shall continue for the term of the Medi-Cal contract.

(4)Designation requirements imposed by the health authority shall further the goals of increased quality, access, network adequacy, reducing health disparities, and integration of behavioral and oral health within the delivery of health care services in the Medi-Cal program.

(f) (1) For purposes of the designation of health plans pursuant to paragraph (1) of subdivision (c), prior to procurement under Section 14089, the health authority shall meet with any health plans intending to contract with the department as Medi-Cal managed care plans in the county. Any health plan intending to contract with the department as a Medi-Cal managed care plan in the county, and intending to submit a proposal to the department in a procurement process, shall first be required to meet with the health authority.
(2) Subsequent to meeting with all interested health plans, the health authority shall designate to the department at least two Knox-Keene licensed health plans for the department’s approval based on the criteria described in paragraph (3).
(3) Any criteria used by the health authority to determine the designation of health plans pursuant to paragraph (1) of subdivision (c) shall not conflict with requirements for Medi-Cal managed care plans established by the department, the Department of Managed Health Care, the federal Medicaid program, or state law, and shall conform with any guidance issued by the department pursuant to paragraph (7). Designation requirements imposed by the health authority shall further the department’s goals and requirements for procurement under Section 14089 including, but not limited to, increased quality, access, network adequacy, reduction of health disparities, and integration of behavioral and oral health within the delivery of health care services in the Medi-Cal program.
(4) Notwithstanding any designation by the health authority, only health plans approved by the department as meeting plan procurement requirements determined by the department shall be eligible to contract with the department as Medi-Cal managed care plans in the county. Designation by the health authority provides the health plan only with the opportunity to compete in the procurement process under Section 14089 and does not guarantee the award of a Medi-Cal managed care plan contract with the department.
(5) If the health authority does not designate at least two health plans that receive approval from the department, the department shall determine other health plans to contract with as Medi-Cal managed care plans to ensure there are at least two Medi-Cal managed care plans in Sacramento County.
(6) Designation of health plans by the health authority shall continue for the term of the Medi-Cal contract, unless the department determines that the criteria for designation specified in paragraph (3) is no longer met.
(7) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this subdivision by means of letters or other similar instructions, without taking any further regulatory action. This may include, but need not be limited to, guidance to the health authority with respect to the requisite criteria and timing for the designation of health plans pursuant to this subdivision.
(g) The health authority established under this section shall be considered a separate entity from the county and shall file a statement as required by Section 53051 of the Government Code. The health authority shall have the power to acquire, possess, and dispose of real or personal property, as necessary for the performance of its functions, to employ personnel and contract for services required to meet its obligations, to sue or be sued, and to enter into agreements under Chapter 5 (commencing with Section 6500) of Division 7 of Title 1 of the Government Code. Any obligations of a health authority, including those that are statutory, contractual, or otherwise, shall be obligations solely of the health authority and shall not be the obligations of the county or the state.
(h) Upon its creation, the health authority may borrow from the county, and the county may lend the health authority funds or issue revenue anticipation notes to obtain any necessary funds to commence operations.
(i) The health authority shall be deemed a public agency that is a unit of local government for purposes of all grant programs and other funding and loan guarantee programs.
(j) (1) The health authority shall be considered a public entity for purposes of Division 3.6 (commencing with Section 810) of Title 1 of the Government Code.
(2) The health authority, members of its governing board, and its employees, shall be protected by the immunities applicable to public entities and public employees governed by Part 1 (commencing with Section 810) and Part 2 (commencing with Section 814) of Division 3.6 of Title 1 of the Government Code, except as provided by any other statute or regulation that expressly applies to the health authority.
(k) If a health authority no longer functions for the purposes for which it is established, and at the time the health authority’s existing obligations have been satisfied or the health authority’s assets have been exhausted, the board, by ordinance, may terminate the health authority.
(l) (1) Before the termination of the health authority, the board shall notify the department of its intent to terminate the health authority. If the health authority implemented any activity described under paragraph (2) of subdivision (c), the department shall conduct an audit of the health authority’s records within 30 days of the notification to determine the liabilities and assets of the health authority.
(2) The department shall report its findings to the board within 10 days of completion of that audit. The board shall prepare a plan to liquidate or otherwise dispose of the assets of the health authority and to pay the liabilities of the health authority to the extent of the health authority’s assets, and present the plan to the department within 30 days upon receipt of these findings.
(m) Any assets of the health authority shall be disposed of pursuant to any contract entered into between the state and the health authority in accordance with this section.
(n) Upon termination of a health authority by the board, the county shall manage any remaining assets of the health authority until the implementation of a department-approved plan. Any liabilities of the health authority shall not become obligations of the county upon the termination of the health authority or the liquidation or disposition of the health authority’s remaining assets.
(o) Notwithstanding this section, the health authority, as established by ordinance by the board, may pursue any other activities set forth under Section 14087.38.

SEC. 2.Section 14089.07 of the Welfare and Institutions Code is amended to read:
14089.07.

(a) The Sacramento County Department of Health and Human Services may establish a stakeholder advisory committee to provide input on the delivery of health care services provided in the county pursuant to this article and Section 14182. The advisory committee shall include, but not be limited to, Medi-Cal beneficiaries, patient representatives, health care providers, and representatives of Medi-Cal managed care health plans.

(b) The advisory committee may submit written input to the department on policies that improve coordination with traditional and safety net providers, enhance the capacity of the county’s health care delivery system, and improve health care services and health outcomes.

(c) The advisory committee may request, in writing, and receive final reports submitted to the department by any managed care health plan operating in the County of Sacramento as long as the report is not exempt from disclosure pursuant to Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code, or any other contractual, statutory, or legal exemption, or privilege. The advisory committee may review and provide written comments to the department on these reports, and these reports may include issues such as evaluation of access, quality, and consumer protections.

(d) State General Fund moneys shall not be used to fund advisory committee costs, nor to fund any related administrative costs incurred by the county.

(e)(1)Upon the establishment of a health authority in the County of Sacramento, and the implementation of paragraphs (1) and (2) of subdivision (c) of Section 14087.385, this section shall become inoperative.

(2)If this section becomes inoperative pursuant to paragraph (1), this section shall be repealed on January 1 of the following year.

SEC. 3.Section 14089.07 is added to the Welfare and Institutions Code, to read:
14089.07.

(a)The Sacramento County Department of Health and Human Services may establish a stakeholder advisory committee to provide input on the delivery of health care services provided in the county pursuant to this article and Section 14182. The advisory committee shall include, but not be limited to, Medi-Cal beneficiaries, patient representatives, health care providers, and representatives of Medi-Cal managed care health plans.

(b) The advisory committee may submit written input to the department on policies that improve coordination with traditional and safety net providers, enhance the capacity of the county’s health care delivery system, and improve health care services and health outcomes.

(c) The advisory committee may request, in writing, and receive final reports submitted to the department by any managed care health plan operating in the County of Sacramento as long as the report is not exempt from disclosure pursuant to Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code, or any other contractual, statutory, or legal exemption, or privilege. The advisory committee may review and provide written comments to the department on these reports, and these reports may include issues such as evaluation of access, quality, and consumer protections.

(d) State General Fund moneys shall not be used to fund advisory committee costs, nor to fund any related administrative costs incurred by the county.

(e)This section shall become operative only upon the implementation of paragraph (3) of subdivision (c) of Section 14087.385 at a date subsequent to the implementation of paragraphs (1) and (2) of subdivision (c) of Section 14087.385.

SEC. 4.SEC. 2.

 The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique circumstances in the County of Sacramento with respect to the operation and governance of the publicly assisted medical care program in the county.