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HomeMy WebLinkAboutMINUTES - 03172009 - C.73RECOMMENDATION(S): Approve the attached document, reflecting proposed changes to the Managed Care Commission’s operating bylaws. FISCAL IMPACT: None BACKGROUND: The Managed Care Commission, advisory board to the Contra Costa Health Plan (CCHP), is a 15-member Board-appointed body. The MCC currently meets six (6) times a year. Meetings are supported by CCHP staff who coordinate the agenda and meeting places, comply with posting requirements, distribute materials, and provide information and presentations of interest to the Commission. The MCC approved proposed changes to the bylaws at their November 2008 meeting. There are no substantive changes. Changes have been made for clarification, consistency, or to add the name of a new CCHP product. APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 03/17/2009 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS AYES 4 NOES ____ ABSENT ____ ABSTAIN ____ RECUSE ____ Contact: Patricia Tanquary, 313-6004 I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: March 17, 2009 David J. Twa, County Administrator and Clerk of the Board of Supervisors By: Katherine Sinclair, Deputy cc: Tasha Scott, Barbara Borbon, Jill Lorrekovich C.73 To:Board of Supervisors From:William Walker, M.D., Health Services Director Date:March 17, 2009 Contra Costa County Subject:Managed Care Commission By-law Revision Revised November 2008 BYLAWS MANAGED CARE COMMISSION 2 Bylaws Managed Care Commission Table of Contents Article I Name Article II Functions Article III Membership Article IV Conflict of Interest Article V Officers and Responsibilities Article VI Voting Article VII Meetings Article VIII Committees Article IX Amendments 3 CONTRA COSTA COUNTY MANAGED CARE COMMISSION BYLAWS GOALS The goals of the Contra Costa Health Plan (CCHP), a health maintenance organization, are to be responsive to the health care and health insurance needs of the people of Contra Costa County; and to encourage the promotion and awareness of CCHP to the general public, and in particular to the community's most vulnerable. The Managed Care Commission, the principal advisory board to CCHP, is to help assure the attainment of these goals. ARTICLE I: NAME The organization is to be known as the Managed Care Commission (MCC). ARTICLE II: FUNCTIONS A. Consider the health care concerns for the Medi-Cal, Medicare, Healthy Families, Major Risk Insurance Program (MRMIP), Access for Infants & Mothers (AIM), Commercial, In-Home Support Services (IHSS), Medically Indigent Programs such as Basic Health Care, and Health Care Coverage Initiative (HCCI), and other persons served by the CCHP. B. Assure provider, consumer, and community, as well as gender, ethnic, cultural, and geographically diverse population input to deliberations and decision-making. (The Board of Supervisors does this by its requirements for membership on the MCC and the MCC does likewise by its appointments to its committees.) C. Advise on long-range planning and policy formulation and make recommendations to the Board of Supervisors, County Health Services Department (HSD) Director, and Chief Executive Officer of CCHP/Local Initiative, adopt proposed annual work plan and list of goals and priorities that will guide the commissioners’ work for each year. Approve an annual report that will describe major activities, accomplishments, attendance and representation, and training of commission members. 4 D. Study and make recommendations to the Chief Executive Officer of CCHP on operational objectives, policies, and procedures and recommend changes as well as revised services, product development, marketing, and data gathering. E. Assure effectiveness, quality (including good outcomes), efficiency, access, and acceptability of CCHP services by ongoing as well as periodic formal reviews of information produced by a Management Information System and other sources. F. Regularly review the CCHP operational budget and amendments thereto. G. Review, analyze, and advise the Board of Supervisors, HSD Director, and Chief Executive Officer of CCHP of the overall progress, constraining or threatening needs, and special problems of CCHP. H. Encourage public understanding of CCHP and provide support throughout the county for its development. I. Prioritize and assign issues as necessary to appropriate committees. J. MCC is charged with providing input, including from traditional and safety-net providers, on CCHP’s Cultural and Linguistic Services Plan and such reports to the state as required. This shall include advisement on educational and operational issues affecting groups who speak a primary language other than English and cultural competency. ARTICLE III: MEMBERSHIP A. The Board of Supervisors as a whole shall make the appointments to the MCC. There will be 15 appointed members of the MCC: No less than one Medi-Cal subscriber of CCHP; one Medicare subscriber of CCHP or Medicare beneficiary; one commercial subscriber of CCHP; one person sensitive to medically indigent health care needs; one physician, non-contracting with CCHP; at least one other provider, non-contracting with CCHP; and no less than nine at-large members, non-contracting with CCHP. B. MCC members shall reside or work in Contra Costa County. C. The Board of Supervisors’ appointments reflect the County's ethnic, cultural, gender, and geographic diversity. D. Except for the Medi-Cal subscriber of CCHP, MCC members are voluntary, unpaid positions, but actual and necessary travel and related expenses are to be reimbursed as per County practice for Commission meetings. The Medi-Cal subscriber is to be given a $25 stipend plus expenses for each Commission meeting not to exceed 12 meetings per year. E. The term of office is for three years. 5 F. There are no term limits for reappointment of MCC members. G. Persons who are involved as contractors with CCHP cannot be members of the MCC nor can Health Services Department employees. H. A person appointed to fill a vacancy is to serve for the unexpired term of the member replaced. I. Resignations, in writing, are to be sent to the Board of Supervisors. The MCC will initiate action to obtain a replacement. J. The MCC may appoint individuals as consultants to assist in the operations of the MCC as deemed necessary. K. A third (3rd) consecutive unexcused absence or four (4) unexcused absences in a rolling twelve (12) months from a regular MCC meeting will be considered a resignation from the MCC, and a replacement will be recommended to the Board of Supervisors. Exception to this policy requires approval by the Governance and MCC Executive Committees L. Members are required to comply with Fair Political Practice Commission reporting requirements regarding financial disclosure and conflict of interest information. M. The Director of Health Services is an ex-officio, non-voting member. N. The Chief Executive Officer of CCHP is an ex-officio, non-voting member. O. The Board of Supervisors function as ex-officio, non-voting members. ARTICLE IV: CONFLICT OF INTEREST A. Even though persons who are involved as contractors with CCHP cannot be members of the MCC, in the course of MCC business, issues or events may arise that could possibly constitute a conflict of interest for members. Therefore, MCC members must file a conflict of interest statement with the Fair Political Practices Commission (FPPC) initially when appointed, annually thereafter, and at the time of resignation. Failure to file such a statement may result in the member's removal. B. Members may participate on issues in all discussions including those having a direct financial impact on the members and/or their institutions. However, no member may vote on an issue in which the member and/or the member's organization or his/her immediate family member(s) (i.e., husband, wife, child, mother, father, sister, brother) has a direct financial conflict of interest. 6 C. The Board of Supervisors, in establishing the new Managed Care Commission, has established that "persons who are involved as contractors with CCHP cannot be members of the MCC, nor can Health Services Department employees." This means individuals (or members of their immediate family) or their employee(s) who contract with Contra Costa Health Plan or work for CCHP contractors MAY NOT be an MCC member. This prohibition includes the following (and members of their immediate families). 1. Contra Costa County employees with policy-making responsibilities (e.g., department heads, division head). 2. Any Contra Costa County Health Services Department employee (includes all Contra Costa Health Plan employees). 3. Physicians who: a. currently contract directly with CCHP or b. receive a substantial portion of their income from CCHP or from their relationship with an Independent Practice Association (IPA) or other medical group as a result of that IPA's or medical group's contract with CCHP or c. are in policy-making positions of the IPA or medical group which contracts with CCHP. 4. Other providers (e.g., dentists, pharmacists, etc.) who: a. currently contract directly with CCHP or b. receive a substantial portion of their income from CCHP or from their relationship with an organization as a result of that organization's contract with CCHP or c. are in policy-making positions of the IPA or medical group which contracts with CCHP. 5. Other employees or consultants who are in policy-making positions or report directly to those who are in policy-making positions of any business, professional corporation, organization, clinic, or hospital that contracts with CCHP. 6. Individuals who do not live or work or serve a significant number of patients who reside within the Contra Costa County borders. 7. Any individual who would receive a significant direct financial benefit from their position as a member of the MCC. 7 ARTICLE V: OFFICERS AND RESPONSIBILITIES OF OFFICERS A. The MCC will elect its chair and vice-chair. B. Officers to be elected by the MCC members at the last meeting of the year and take office at the regular first meeting of the calendar year. C. Upon the vacancy of the MCC Chair, the MCC will elect a new Chair at the following meeting. D. Officers to serve in same office for no more than two successive one-year terms. E. The Chair presides at all MCC meetings and represents the MCC at all CCHP Joint Conference Committee (JCC) meetings. The Chair may appoint a designee to attend JCC meetings. F. The Vice-Chair shall assume all obligations and authority of the Chair in his/her absence. G. In his/her absence, the Chair of a standing committee shall preside at MCC meetings. ARTICLE VI: VOTING A. Each member to have the authority to speak and participate in discussions on all matters presented before or pertaining to the activities of the MCC including those having a direct financial impact on the members and/or their institutions. Each member to have the authority to cast one vote on all matters presented before or pertaining to the activities of the MCC except in a situation in which the member and/or the member's organization or his/her immediate family member(s) (e.g., husband, wife, child, mother, father, sister, brother) has a direct financial conflict of interest. B. A quorum is 50 percent plus one of the fifteen-member commission (8). A quorum is continued until challenged. C. A majority vote is necessary to pass motions. When a decision is made in an MCC standing committee, subcommittee, ad hoc committee, or task force, it may be done by: 1. A demonstration of consensus or 2. A vote taken where a majority rules. 3. When a vote is taken and a majority rules, there may be a minority report submitted as part of the record if this represents a substantial number (i.e., 1/3 of those voting), and those in the minority agree to submit a report. Of course, individual(s) may at any time 8 express their oral or written opinions as such outside of the MCC record but should not represent themselves as representatives of the MCC. D. When a formal decision is made by the full MCC, it should generally be done by: 1. A vote taken where a majority rules with an established quorum. If the decision is unanimous, it is recorded as such. If there is opposition, the opposing votes may be recorded by name at the discretion of the chair or request of the MCC. If there are abstentions, they are recorded by name as such. Any commissioner who indicates a conflict of interest and refrains from voting should be recorded accordingly. 2. When a vote is taken and a majority rules, there may be a minority report submitted as part of the record if this represents a substantial number (i.e., 1/3 of those voting), and those in the minority agree to submit a report. Of course individual(s) may at any time express their oral or written opinions as such outside of the MCC record but should not represent themselves as representatives of the MCC. ARTICLE VII: MEETINGS A. There shall be at least six (6) meetings a year at a time and place agreed upon. B. Notice and agenda of all regular meetings, the minutes of past meetings, and committee reports to be mailed to each member at least 96 hours prior to the day named for such meeting. Notice and agenda is posted per requirements. C. Meetings of the MCC to be open to the public in accordance with the Ralph M. Brown Act and Better Government Ordinance and meetings to be governed by Roberts Rules of Order. D. If it is necessary, the MCC or any of its committees may meet by teleconference and shall adhere to the regulations set forth in Murray, Stats. 1994, Chapter 1153 that Government Code section 11123 and allows for the conduct of meetings by teleconference. There shall be a period of time set aside at the beginning and during each MCC meeting to receive public comment. ARTICLE VIII: COMMITTEES A. There will be a five-member Executive Committee of the MCC made up of the MCC Chair, Vice-Chair, immediate past Chair, and two (2) members elected from the membership as a whole. If the Vice-Chair is immediate past Chair, then three (3) members shall be elected from the membership as a whole. At least one member must be a member of CCHP. B. The Executive Committee shall meet on an "as needed" basis. It shall have authority to make decisions for the MCC when time is of the essence or when the MCC is unable to assemble a quorum. The Executive Committee must have at least three (3) members 9 present and voting in order to take action. Special meetings of the Executive Committee shall comply with the Brown Act’s advance written notice requirements. C. There will be three (3) standing, one (1) special, and a provision for Ad Hoc committees of the MCC with names and functions as follows: STANDING COMMITTEES 1. Quality Assurance Study health care delivery issues, and new, alternative, or improved modes of diagnosis and treatment. Review quality assurance studies and reports such as HEDIS. Analyze health education services and wellness promotion programs. Review disease management plans and results of interventions. Analyze all legislative and regulatory changes that may impact Quality. Make recommendations to MCC. 2. Resource Management Study plan budgets, expenditures, and cost and utilization trends. Review resource management efforts including advice nurse services, care management, pharmacy program, utilization management, and authorization. Review financial liability of services, benefits, and pricing of current and new programs. Analyze all legislative and regulatory changes with financial impact. Make recommendations to MCC. 3. Customer Relations Analyze member and consumer issues including geographic, gender, ethnic, cultural, accessibility, availability, and acceptability, and other facets of consumer concerns. Study needs of current and potential subscribers respecting scope of services, scope of benefits, and price issues. Examine satisfaction reports and surveys and patterns of enrollments and disenrollments and retention of CCHP members and of competitors. Review outreach, enrollment campaigns, advertising and media promotions. Analyze all legislative and regulatory changes that may impact customers. Make recommendations to MCC. The reports of standing committees—Quality Assurance, Resource Management and Community Relations—are heard by the full MCC at each meeting. However, any of these committees can convene outside of the full MCC meeting to focus on a particular subject. SPECIAL COMMITTEES 1. Governance and MCC Operations Committee Recommend structural and governance changes of the Managed Care Commission and its standing and special committees and annually recommend a slate of officers for the 10 MCC. Assist in MCC member recruitment, orientation, and retention efforts. Make recommendations to MCC. 2. Ad Hoc Committees There may be Ad Hoc Committees of the MCC. These will be created by the MCC for special issues, concerns, or projects that do not fit into the work of the standing committees or that may involve several of them. The assignment, membership, and duration will be set by the MCC. D. COMMITTEE MEMBERSHIP 1. Committee chairs must be members of the MCC. 2. MCC committee chairs are appointed by the MCC chair at the first meeting after each election of MCC officers. 3. MCC committee members are appointed by their respective committee chair as soon as possible. 4. Committee positions are voluntary, unpaid positions, and travel expenses are not subject to reimbursement. 5. MCC committee chairs shall determine the number of appointed members of their respective committees with at least two (2) of the members being MCC members. The remaining number of committee members with voting privileges may be non-MCC members. 6. The committee chairs shall notify the MCC upon selection of the number of members and appointments to their respective committees by providing the MCC with a committee roster to include names and addresses of its members. Changes may be made to the committee membership as appropriate for its scope of work. The MCC shall be notified in a timely manner of any committee changes. 7. All members of the public are welcome at committee meetings and time shall be set aside for public comment. 8. Only appointed members of the committees may vote, although any individual or organization may attend and participate in committee discussion. 9. A majority of committee members present at a committee meeting shall constitute a quorum. 10. Committee decisions are advisory only and subject to full MCC approval.