HomeMy WebLinkAboutMINUTES - 11091993 - 1.66 To k BOARD OF SUPERVISORS (tet
FROM: Mark Finucane, v`'I '`ra
Health Services Director Costa
DATE'. November 8, 1993 C0jqy
SUBJECT: Revised Letter of Intent
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION
APPROVE AND AUTHORIZE the Chairman to send a revised
Letter of Intent to the State Department of Health
Services clarifying certain issues and reaffirm the
Board of Supervisors' continued and unwavering
commitment to develop a Local Initiative under the
State's Medi-Cal Managed Care Expansion Plan.
II. FINANCIAL IMPACT
The Local Initiative will bring in an additional $10-
$13 million a year in Medi-Cal revenues. Also under
SB4561 State funds are available for Local Initiative
development.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND
On March 31, 1993, the State Department of Health
Services issued its plan for expanding Medi-Cal
managed care which calls for a two-plan model of Medi-
cal managed care in 13 target counties. Contra Costa
County is one of the 13 counties. The two-plan model
consists of a locally developed managed care system
called the Local Initiative and non-governmental HMO
to manage the care of the AFDC linked and Medically
Indigent Children Medi-Cal eligibles. Fee-for-service
Medi-Cal for these groups will be phased out when the
two-plan model is implemented. The State Plan contains
a two-year time frame for implementation.
On September 28, 1993 , the Board of Supervisors
submitted its Letter of Intent which expressed the
Board of Supervisors' commitment to developing the
Local Initiative.
On October 29, 1993, the State Department of Health
Services responded to the county's Letter of Intent.
CONTINUED ON ATTACHMENT: xYES SIGNATURE;
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE _OTHER
SIGNATURE S :
ACTION OF BOARD ON November 92 1993 APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERV19ORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES. AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
ATTESTED November 9 , 1993
Milt Camhi, CCHP PHIL BATCHELOR, CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
BY .C�< �/ DEPUTY
M382%7-83
III. REASONS FOR RECOMMENDATIONSIBACRGROUND, Continued
The State asked for clarification of the planning and
development process, intended governance structure,
evidence of community support, and the development
timetable.
In its communication, the State required Contra Costa
County to submit a revised Letter of Intent by
November 15, 1993 to be eligible for development
funding made available through SB456.
The revised Letter of Intent clarifies the positions
taken at the previous Board of Supervisors workshops.
Therefore, it is recommended that the Board of
Supervisors approve the attached revised Letter of
Intent and authorize the Chairman to forward it to the
State Department of Health Services within the
November 15, 1993 deadline.
The- Board of Supervisors Contra Ctrk'
eoff the Board
and
County Administration Building Costa
County
o(510)C 6-23 Administrator
V ll.t ts10)sas-z371
651 Pine 5t., Room 106 County
Martinez, California 94553
Tom Powers,1st District
Jeff Smith,2nd District e
t
Gayle Bishop,3rd District
Sunne Wright McPeak 4th District 'M'
Tom Tortakson,5th District �; z
Pr•`ii�a c•�.
COUNT
November 9, 1993
Lisa Tanaka, Chief
Local Initiative Development Unit
SDOHS
714/744 P Street
Sacramento CA 94234-7320
Dear Ms. Tanaka:
This is in response to your letter of October 29, 1993 requesting that you receive a revised
Letter of Intent from the Board of Supervisors by November 15, 1993. As we stated in our
September 28, 1993 Letter of Intent, "The Board of Supervisors is committed to Medi-Cal
managed care and reiterates its intent to develop the Local Initiative plan within the state's
timetable for implementation and will meet all applicable state and federal requirements." Below
are the amplifications to Contra Costa County's official Letter of Intent which addresses the
issues you raised in your recent communication.
1. Inclusive Planning and Development Process
Contra Costa County has previously authorized the pre-eminent planning body for the
Local Initiative in our county. This planning body, called the Medi-Cal Advisory
Planning Commission (MAPC), will have broad representation by affected stakeholders.
In addition to newspaper publicity about openings on MAPC, in October the Health
Services Director sent individual invitations to submit applications to the MAPC to all
the local hospitals, the Alameda/Contra Costa Medical Association, the Dental Society,
the Pharmacists Association and 24 community-based organizations representing grass
roots services and beneficiaries (see attached sample letters).
2
As of Friday, November 5, the county has received 31 applications. Applications
are due November 8, 1993. The Board of Supervisors Internal Operations Committee
will review the applications at its December 13, 1993 meeting and the Board of
Supervisors is expected to make the appointments at its December 14 meeting. The first
meeting of the MAPC is scheduled for Thursday, January 6, 1994.
2. Governance Structure
The Board of Supervisors, which has been the governing body for the publicly sponsored
managed care system in our community for over 20 years, intends to be the transitional
governing body for the Local Initiative. The Board of Supervisors will be advised by the
25 member MAPC. At the current time, the transitional governing body, the Board of
Supervisors, will retain the authority to provide overall policy direction to the Contra
Costa Health Plan as it expands to incorporate community safety net and traditional
providers. In order to carry out these legal responsibilities, the Board has created the
Medi-Cal Advisory Planning Commission as its pre-eminent agent directly accountable
for providing long-range planning direction to the Board of Supervisors respecting the
Local Initiative's: community and patient outcome goals; recommended access standards,
quality of care, scope of benefits and services offered by the Local Initiative; consumer
and provider satisfaction in the Local Initiative; ability to meet unmet community health
needs; and recommendations on long-term governance options. As noted, the Board of
Supervisors is currently the governing body for its county operated, state licensed,
federally qualified HMO, the Contra Costa Health Plan. An expanded CCHP (which will
include safety net and traditional providers) will be the vehicle through which the Board
of Supervisors will cavy out the Local Initiative activities. The Board of Supervisors
consists of five publicly elected members, one each from five distinct geographic areas
of the county.
The members of the Board of Supervisors are:
District 1 - Tom Powers
District 2 - Jeff Smith
District 3 - Gayle Bishop
District 4 - Sunne Wright McPeak
District 5 - Tom Torlakson
One of the first items of business for the MAPC will be a discussion of and making
recommendations on governance in relation to the two-plan model described in the State
Plan and the multi-plan model envisioned in national health care reform.
3
3. Evidence of Broad Based Community SupW
By December 14, 1993 the Board of Supervisors expects to appoint the members of the
Local Initiative public planning body, the MAPC, which is scheduled to hold its first
meeting Thursday, January 6, 1994. Attached are diagrams depicting the relationships
between MAPC and the community and between MAPC and the Board of Supervisors.
4. Development Timetable
Attached is the Local Initiative Timetable for Development which adheres to the timelines
set forth in the DHS plan.
We are pleased that the State Department of Health Services "will do everything it can to
expedite and assist with the development of the Local Initiative." We look forward to a
collaborative, cooperative working relationship with the state that will further our common goal
of providing accessible, affordable, high quality health care to our needy county residents.
The Contra Costa County Board of Supervisors offers to meet with appropriate State officials
to discuss and amplify any and all of the issues raised, especially those related to the planning
process, governance structure, community support, and development timetable.
Sincerely,
Tom Torlakson, Chair
Board of Supervisors
TT:BB/lmb
Attachments:
1. Sample Invitations Letters
2. Health First Community Participation
3. MAPC Organization Chart
4. Local Initiative Development Timetable
cc: Supervisor Gayle Bishop
Supervisor Tom Powers
Supervisor Sunne McPeak
Supervisor Jeff Smith
Phil Batchelor, County Administrator
Mark Finucane, Health Services Director L30:EP
AttaC'nment 1
Contra Costa County
The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR
Tom Powers,1st District
Jeff Smith,2nd District Mark Finucane, Director
Gayle Bishop,3rd District •. '--` L 20 Alien Street
Sunne Wright McPask,4th District Martinez,California 94553-3191
Tom Torlskson,5th District (510)370-5003
County Administrator _
FAX(510)370-5096
Phil Batchelor
County Administrator
October 8, 1993
Bill Guertin,
Executive Director
ACCMA
6230 Claremont Avenue
Oakland, CA 94618
Dear Mr. Guertin:
On June 21, 1993, the Contra Costa County Board of Supervisors informed the State of California that it would be
developing the Medi-Cal Local Initiative in Contra Costa County. On September 28, 1993,the Board filed a formal Letter
of Intent with the State specifying that the County was proceeding with the development of the Local Initiative and
committed to establishing the Medi-Cal Advisory Planning Commission (MAPA to assure provider, consumer, and
community input into the planning for the Local Initiative.
This special 25-member Commission will provide planning and policy direction and will make recommendations directly
to the Board of Supervisors,the County Health Services Director, and the Contra Costa Health Plan Advisory Board on
the development of the Local Initiative in our County.
The Board of Supervisors is now seeking to appoint representatives who are knowledgeable and experienced in meeting
the special needs of Medi-Cal and indigents. Your organization, the ACCMA, is being asked to nominate three
representatives to the Commission: one physician each from East and West County and one physician from any region
of the County.
Enclosed are three applications and an overview of the functions and membership. Please return the completed forms to
the address given on the form by November 8. 1993.
Thank you for your continuing commitment to health care for our community's most vulnerable populations.
Sincerii
Markucane,
Health Services Director
W:BBAmb
BecJaww: m Medi-Cal Advisory Pkm- Comms aim (MAM Appbasbans
(1)Comm Cash Canty Madi.Cal Advisory Planning Cammi.im overviav L70:AL
Mentthew Memorial Hmdal 6 CNnics Public Health Mental Health Substance Abuse • Environmental Heath
Contra Costa Heath Plan Emergency Medical services • Home Health Agency • Genatncs
A-345 (2/93)
Attachment 1
Camra Costa County
The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR
Tom Pourers,t st District
Jen Smith,2nd District Mark Finucane,Director
Gayle Bishop,3rd District �- 20 Allen Street
Sunne Wright McPeak,4th District Martinez,Cairfamia 94553-3191
Tom Tortakson,5th District
(510}370-5003
County Administrator y's ..,a= FAX(510)370-5098
Phil Batchelor `'r ►wry;.
County Administrator "*
October 11, 1993
Michael L. Wall, Chief Executive Officer
Mt. Diablo Medical Center
P.O. Box 4110
Concord CA 94524-4110
Dear Mr. Wall:
On June 21, 1993, the Contra Costa County Board of Supervisors informed the State of California that it would be
developing the Medi-Cal Local Initiative for managed care in Contra Costa County. On September 28, 1993, the Board
filed a formal Letter of Intent with the State specifying that the County was proceeding with the development of the Local
Initiative and committed to establishing the Mei-Cal Advisory Planning Commission (MAPA to assure provider,
consumer, and community input into the planning for the Local Initiative.
This special 25-member Commission will provide planning and policy direction and will make recommendations directly
to the Board of Supervisors, the County Health Services Director, and the Contra Costa Health Plan Advisory Board on
the development of the Local Initiative in our County.
The Board of Supervisors is now seeking to appoint representatives who are knowledgeable and experienced in meeting
the special needs of Medi-Cal and indigents. Community hospitals are now being asked to nominate three representatives
to the Commission. These hospitals must represent non-county facilities who have historically demonstrated a loyalty and
competence in serving the special needs of Medi-Cal beneficiaries,
Enclosed are applications and an overview of the functions and membership. Please return the completed applications to
the address given on the application by November 8. 1993.
Thank you for your continuing commitment to health care for our community's most vulnerable populations.
Sincerely,
Mark Finucane,
Health Services Director
ri�:taanar
cc: Barbara Goodhart, Hospital Council of Northern and Central California
flava =M: 0)ture&Cat Advitay Pau=&Cetnmision 04A,PC)AyP6cadoas
(3)C4ftm Cob County M;aaf.cst AAY wry 1`1001404 Camesiusica owsv M L30-ALS
Merrithew Memorial Hospital d CNnics Pudic Heaph • Mantel Heatth • Substance Abuse • Environmental Health
Contra Costa Heahh Plan • Emergency Medical.Seances • Horne Health Agency • Genstncs
Attachment 1
Contra Coosta County
The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR
Tom Powers,1st District
Jeff Smith,2nd District Mark Finucane,Director
Gayle Bishop,3rd District 20 Allen Street
Sunne Wright McPeak,4th District fN. i1il$Yttne2,Cw'domia 94553-3191
Tom Torlskson,5th District _
(510)370-5003
County Administrator FAX(510)370.5098
- No .:o
Phil Batchelor '``~
County Administrator >;_
October 12, 1993
Frances Green
Pittsburg Preschool Coordinating Council
1760 Chester Drive
Pittsburg CA 94565
Dear Ms. Green:
On June 21, 1993, the Contra Costa County Board of Supervisors informed the State of California that it would be
developing the Medi-Cal Local Initiative for managed care in Contra Costa County. On September 28, 1993, the Board
filed a formal Letter of Intent with the State specifying that the County was proceeding with the development of the Local
Initiative and committed to establishing the Medi-Cal Advisory Planning Commission (MAPA to assure provider,
consumer, and community input into the planning for the Local Initiative.
This special 25-member Commission will provide planning and policy direction and will make recommendations directly
to the Board of Supervisors,the County Health Services Director, and the Contra Costa Health Plan Advisory Board on
the development of the Local Initiative in our County.
The Board of Supervisors is now seeking to appoint representatives who are knowledgeable and experienced in meeting
the special needs of Medi-Cal and indigents. Three community-based organizations will be representatives on the
Commission. In addition, three current or past Medi-Cal beneficiaries will be seated. We ask that your organization
submit nominations for either or both categories.
Enclosed are two applications and overviews of the functions and membership. Please return the completed applications
to the address given on the form by November 8. 1993.
Thank you for your continuing commitment to health care for our community's most vulnerable populations.
Sincerely,
�Gyt.c.(-
lakinjuch—e,
Health Services Director
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Contra Costa Heahh Plan + Emergency M"cal Services • Homs Heath Agency Geniaincs
A-345 (2193)
Attachment 2
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Attachment 3
Medi-Cal Advisory Planning Commission
Organization Chart
Contra Costa County
Board of Supervisors
/
Health Services
Department
DirectorF — Medi-Cal Advisory
Planning
Contra Costa Commission
Health PIan (MAPC)Planning Body
(CCHP) f
Advisory Board or All Phases
Reviews All of County
CCHP Programs: Sponsored
Medi-Cal Managed
ow Medi-Cal
ow Medicare Care Program
ow Basic Adult Care
aw Commercial
(individual,
small group,
large group)
aw MajorRisk
Medical Insurance
Program
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[PM4TM 11/8/93
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TEL Oct 29,93 14 : 17 No .004 F.02
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ct W.OF
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6EP'ARTMENT OF HEALTH SERVICES
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(416)657-OM5
OCT 2 q,Wj .
Mr. Tom Torlalcsat, Chairman
County Board of Supervim
Contra Costa County
651 tae Strad, Room 106
Martinez, CA 34553
Dear Mr. Tortnksvw
Tho purpose of this lefter is to address concem the Depamnent of Health Services (DHS)
identified upon review of Contra Costa Coy's Leiter of Intent to develop a Media-Cal 1=0
Initiative, as dawfibed In OP Dqm m►e es letter dated August 6. 1993.
With the recent passage of SA456, Chapter 573,Statutes of 1993,finding has b000me available
to mimbum Local Initiative plamuas for a portion of the costa of fanning the Local Init#ative
entity and for a portion of the casts of developing the Local Wiadve health daUvmy systm in
acwnfanee with the DHS pian to expand Mel-tel manged care. Pauding allocations will be
dependent upon the development of a Local Initiative which is in co1'rlgli=with the rent and ti
sti%jubvAnenrts of the Depastmeat's Ilan.
It is hnporu*that Local Initiative planning efforts continue at an aggrasim pace, Madl-Cal
caseload c ontinm to gmw at a rapid pace resulting in a coDntimrittg and critical mod,for acxess
to gca dity health can. The Department gill do evory(hing it can to expedite ami audd with the
development of the Local InLtiafiw, however, it is important for you to know that the
Deparhnewt intends to develop mainstream plan oonbuft camurrent with the development of
the LoW Initiative contracts. DHS intends to begin coobudug with mainstream plans
ao;ording to our original timetable. This means that on April 1, 1995 a rugnstraami plan could
become gWadoW while a Local InWxdve is still in development.
Ml a Dqmtment expecu County Boards of Sui avisoms to sit mb a mvise d Inter of Intent which
addresses the components identified below as missing or incoampld o, At a mia h=m,the revised
Letter of latent most provide a firm timetable which identifies the target dabs by which dw
County inters to menet the I oar of Iowa mpeircments. In order to decnoaaaatc Cera Costa
Cmmty's commitment to faet'litate the development of ft Local initiatim, DHS roust raeive
a letter from the County Board of Supetvitum by 1'Icrvember 15, 1993 Whig addresses the LetEear
of Let mt ripclrrirr.rncata dumbed below.
Your Letter, of liabW MIA to docament, and staff have not obsem W ciomkp net of the
ful]avvluaig;
TEL Oct29.93 1.4:17 N0 .004 P.03
3 -
Mr. Tom Todakadtt
PAP 2
OCT 2 g 149k3 ,
• INCLUSIVE MANNING AND 3'2ITI WPNEENT PROMS
The bdwtw of safety na provUers, traadidmd providers, and other interested
sta'lcelttol lm wa the pbmft of the lA cd Itdtiativts has jw been demonshatod by
Contra Com County's Letter of Intent. To date,your wanly baa been dmeloi W the '
Laval Inidafto inclepeaderady. Aaaor+dia S to do DHS Flaw,these dal &*Adm am to be
included in tine planning process of 00 Local Illative,so that the resulting managed care
platy is broadly niat+emartative of loved needs and wishes. Allfiough Contra Cosa County
has bd d some meetiop upda ft the public and provider on dw progmsan of Lwd
Initiative planning and develops aat,this approach does not demonstrate a pubUclprivate
witabomtive effort. Conft Coma County needs to devdap a Lord Imola dve planning
body wilt broad ropt+eseatation by affected saalmholdars.
•
GOVERNANCESTRUCTURE
The intended govotnamoa sonic wm-for the Local Initiative was not Identified by
Contra Costa Caarnty's Fetter of Feat.. This is a vhd coanponeat of tbri Uncal Initiative
developmeant. As previously descr[W, Senate SM 4,56 aapproprist+ed funding for Local
Iniidadvc dcvelopnumL The availability of funding adds more sigrnifioanoe to this
rev nh=nent than was indicated in our August 6, 1993 letter. This is bec m, a DHS
intods to elevate a portion of the developmeatt foods. cooaistout with tib Unguage in
SS 456, to cmaty Boards of Supervisors througb aont:acu, to offset a portion of the
ovate of famlimg the Local Initiative entity.
At a minimum, tine dewdpdan of Contra caste county goweming stractaue should
Include., identification of the legal. entity (e.g., nonprofit oorporstion, forVoM
cosgoradw, public bear dh coporKdon, etc.); the number of seats on the governing
board: the o mpositton of tW board (e.g., providers, consumers, county supervisors,
etc.),and how board members will be selected.
• XVUWNCR OF BROAD BASED COIVRMMNiTY SUPPORT
Evidence of community aWpoet.for tate devslapment of the Local initiative was-not
demonstrated by Coarse Costa County in the Letter of iwM. Althaugb statements ware
maw da*Ming thee is community support for Local Yuitia Ve development, the
devdopsmW prrooess identified by the County docs not supl M this claim. Aaccptable
o vjdea= of commaaity suppW can be letters from c movmtwity and piuvider gwgps,
e�ttablisttmum# of a public pig body with booa+d ;mpcesentation, opt mimutes frons .
puM meetings your county has hard to dimin the•drwdepment of the Local Initiative.
TEL= Oct 29,93 14 : 18 No .004 P.04
r _
Mir- Tam Town
VIVT 2 9 1993
•
DEVELOPMENT ENT TBMrA,BLE
A tin=ble for the develo9mert of the Local bdUa ivo was=1 included with the Letter
of Intent. The development of the Local Initiative must, at a nimimum, adhem to the
timelines set forth in dw DHS Plan. The operational date for the tw"lan model is set
for April.1, 1995. Contra Costa County must submit a timetable that demona mtes the
County intends to adhere to the milestatcs dasc k od in the DIETS Plan. On an individuate
basis, counties may propose deviations from the development scbedulc pditd in the
DHS Plan, but it is the intent.of DHS that the start date of both the Local initiative and
the mainstream plans remains at April 1, 1995.
Department staff intend to meet with the Lned Initiative planners in each county in the aper
future to discuss the progress of local planning efforts and to addresms concerns that Local
Initiative planims may have.
If you have questions eoneearing this letter, please comsat your project analyst,
mr. Larry Lucero, I=9 Initiative Development Unit, 714 P Sau t, Roam 1340, Sacramento,
CA 95814 or call Mr. Lucery at (916) 657-1014. r
Sincerely,
Lisa Tanaka. Chief
Isocal Initiative Development Unit
cc: Mr. Mark Finucane, Director
Headh Services Dg arVu ml
Contra Costa County
20 Allen Street
Martinez, CA 94553