HomeMy WebLinkAboutMINUTES - 01142003 - C47 TO: BOARD OF SUPERVISORS ` = Contra
FROM: WILLIAM B. WALKER, M.D. CostaHealth Services Director
DATE: November 20, 2002 4 County
i�_C-vu -VSUBJECT: Managed Care Commission By-law revision
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Approve the attached document, reflecting proposed changes to the Managed Care
Commission's operating by-laws.
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 ten (10) 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.
In light of the current and continuing County budget situation, the MCC feels It is an
appropriate time to review the frequency and Structure of Commission meetings. Proposed
changes to the by-laws include both structural changes and changes to reflect compliance with
The Brown Act.
The MCC proposes to the Board the following changes to their by-laws:
- Change "at least nine (9) meetings a year" to "at least six (6) meetings a year„
- Change the names and functions of the three (3) standing committees to more accurately
reflect the concerns of the Commission and the community
- Reduce the number of Special committees from three (3) to one (1)
FISCAL IMPACT:
Reduction of staff time necessary to coordinate Commission and subcommittee meetings.
CONTINUED ON ATTACHMENT: XX YES SIGNATURE: /.,�.k 1.),��-
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4,RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
_.f,APPROVE OTHER
t ,
SIGNATURES} €
--_.—------------------------------------_-_ ------------
ACTION OF BO ON JANUARY 14, 2003 APPROVE AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE.
AND CORRECT COPY OF AN ACTION TAKEN
X UNANIMOUS(ABSENT NONE ) AND ENTERED ON THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES: NOES: SHOWN.
ABSENT: ABSTAIN:
ATTESTED_JANUARY 14 2003
CONTACT: Milt Camhi 313-6004 JOHN SWEETEN,CLERK OF THE
BOARD OF SUPERVISORS AND
CC: MiI�hI,CCH
COUNTY ADMINISTRATOR
�r
�x/
BY ,DEPUTY
Attachment 2
Draft
Revised November 20n0�t04��- ' cz
2002
PROPOSED
MANAGED CARE COMMISSION
BYLAWS
Bylaws for the 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 Iii Amendments
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CONTRA COSTA COUNTY
MANAGED CARE COMMISSION
BYLAWS
GOALS
The goals of the Contra Costa Health.Flan (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
BA. Consider the health care concerns for the Medi-Cal, Medicare,Healthy Families, Major
Risk Insurance Pro arrz (MRMIPI,,Access for Infants &Mothers AIM Commercial,
In-Home Sport Services(IHSS) Basic Health.Care, -Medically Indigent and other
persons served by the CCHP.
QB. 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.)
D.C. Do long-range planning and policy formulation and make recommendations to the Board
of Supervisors, County HSD Director, and Chief Executive Officer of CCHP/Local
Initiative including adotin an annual work plan and list of goals and priorities that will
aide the commissioners' work for the year and an annual rg ort that will describe major
activities accomplishments, attendance and re resentation and training of commission
members.
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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.
F-.E. Assure effectiveness, quality(including good outcomes), efficiency, access, acceptability
of CCHP services by ongoing as well as periodic formal reviews of information produced
by g anAT -date-Management Information System and other sources
GF. Regularly review the CCHP operational budget and amendments thereto.
H-.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.
-1 H. Encourage public understanding of CCHP and provide support throughout the county for
its development.
3:1. Prioritize and assign issues to appropriate committees.
J. MCC is charged with providing input, includinfrom traditional and safet -net
providers,,on CCHP's Cultural and Lin uistic Services Plan and such rc orts to the state
as required This shall include advisement on educational and Uerational issues
affecting ous who speak a rimar lan ua e other,than En fish 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.
4
Of Q11-erviSE3
fer-one year-
,
FSE. The Thenm& term of office is for three years.
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.
J-.H. A person appointed to fill a vacancy is to serve for the unexpired term of the member
replaced.
Pl. Resignations, in writing, are to be sent to the Board of Supervisors. The MCC will
initiate action to obtain a replacement.
K-.J. The MCC may appoint individuals as consultants to assist in the operations of the MCC
as deemed necessary.
&K. A third(3d)consecutive unexcused absence or four 4 fi -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 MCG Governance and MCC Operations
Committee.
M-.L. Members are required to comply with Fair Political Practice Commission reporting
requirements regarding financial disclosure and conflict of interest information,
N-.M, The Director of Health Services is an ex-officio,non-voting member.
SINN. The Chief Executive Officer of CCHP is an ex-officio,non-voting member.
;?NO. 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 an
conflict of interest statement with the:Fair Political Practices Commission(FPPCI
initially when appointed, annually thereafter, and at the time ofresi nab tion.-ini#ial-and
Failure to file such a statement may result in the member's removal.
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B. Members may participate on issues in all discussions including those having a direct
financial impact on the members anchor their institutions. However,nig 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.
C. The Beard 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 employees)who contract with Contra
Costa Health Plan or work for CCHP contractors MAY NOT bean 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 IPA
or other medical group as a result of that IPA's or medical group's contract with
CCHP or
c. are in policy-matting 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 CCI ' 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.
6
7. Any individual who would receive a significant direct financial benefit from their
position as a member of the MCC.
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 3y first meeting of the calendar ve....-
thereaft .
,
C. meetn the vacancy ofthe 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 megfiW.
F. The Vice-Chair shall assume all obligations and authority of the Chair in his/her absence.
G. In his/her absence, the Chair or Vice Ch 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 currently appointed membership. 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:
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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
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 a quorum present. 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 sic 6 e49)-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 tt ee (3;�_�-prior to the day named
for such meeting. Notice and agenda i.s 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 111 23 and allows for the conduct of meetings by teleconference
F:There shall be a period of time set aside at the beginning and during of each MCC meeting to
receive public comment.
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ARTICLE "III. COMNUTTEES
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
present and voting in order to take action. Special meetings of the Executive Committee
shall coMply complywith the Brown Act's advance written notice r uirements.'
C. There will be three(3) standing and one l thfee+3)-special committeesof the MCC with
names and functions as follows:
STANDING COMMITTEES
1. Quality Assurance Health Care
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. member-and AW6
Review
disease management plans and results of interventions. Remi Aux avai ability,
U.
and fftember-
Analyze all legislative and regulatory chanes that may impact Quality. Make
recommendations to MCC.
2. Resource Management; agree
Study plan budgets, expenditures, and cost and utilization trends. Review resource
management efforts including advice Nurse services, care management,pharmacy
pro rg am,utilization management. and authorization. Review financial liability of
services benefits and pricing of current and new pro-grams. Anal ze all legislative and
regulatory chanes with financial iMpact. Make recommendations to MCC.
3. Customer Relations Alar-keting and Health Wometion
Analyze member and consumer issues including eo a hie, ender, ethnic cultural
accessibility, availabilit and-accegtability, and other facets of consumer concerns.
Study needs of current and potential subscribers reap ,tin&fer scope of services, scope
9
of benefits, and price issues. Examine satisfaction resorts and surveys.and patterns of
enrollments and disenrollments and retention of CCHP members and of competitors.
Review outreach, enrollment camnaigm, advertising and media promotionsheakh
. Analyze all legislative—and regulatory
chanes that may impact customers. Make recommendations to MCC.
SPECIAL COMMITTEES
El
fn-44e for-the Leeal Initia4iVe oil-
F-e-e-o-1--eBA-fiefis to Nice.
-2.Goveraaftee
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
:MCC. Assist in MCC member recruitment, orientation, and retention efforts. Make
recommendations to MCC.
state,
and F-ag-U14or-Y faa#eFs. Make F-eeeffifnendatiefis to NIC-G.
D. There may be Ad Hoc Committees of the MCC. These will be created by the MCC for
special issues or concerns 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.
E. Committee chairs must be members of the MCC.
F. MCC committee chairs and vieer ehe are appointed by the MCC chair(initially soehei )
at the first meeting after each election of MCC officers
G. MCC committee members are appointed by their respective committee chair as soon as
possible
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H. Committee positions are voluntary,unpaid positions, and travel expenses are not subject to
reimbursement.
I. MCC committee chairs shall determine the number of appointed members of their respective
committees between 3 a ' ',with at least 2 of the members being MCC members. The
remaining number of committee members with voting privileges may be cion-MCC members.
J. 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.
K. All members of the public are welcome at committee meetings and time shall be set aside for
public comment.
L. Only appointed members of the committees may vote, although any individual or
organization may attend and participate in committee discussion.
M. A majority of committee members resent at a committee meetin shall ccinstitute a u�
at
N. Committee decisions are advisory only and subject to full MCC approval.
1.l