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HomeMy WebLinkAboutMINUTES - 12202005 - C132 �7/ TO: BOARD OF SUPERVISORS Contra FROM: WILLIAM B. WALKER, M.D. •�` — + _ ';• Health Services Director ot, �- °a� = `.�'�`94 Costa DATE: December 9 2005Cou nty SUBJECT: Approval of Official Charter for the Joint Conference Committee SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: Approve the attached Charter for the Joint Conference Committee. BACKGROUND: The Joint Conference Committee (JCC) was started in 1997 via a Board Order to ensure adequate oversight of Contra Costa Health Plan per regulatory requirements. The description of the Joint Conference Committee and its responsibilities was previously contained only in the Quality Management Program Description in the Governing & Advisory Body Descriptions. This Board Order would provide a stand-alone document that describes the JCC, its membership and scope of responsibilities, and how it interacts with the other advisory bodies and governing agencies of the Contra Costa Health Plan. The only change to this document from its description in the 2005 Quality Management Program Description (approved by this Board in September 2005) is the addition of a physician voting alternate. In recognition of the Board's strict adherence to the Brown Act requirements, it is necessary to have one voting alternate to the two voting. physician members of the JCC in the case of a medical emergency calling away one or more of those members, in order to still reach a quorum. This alternate would also be approved by the Board of Supervisors should this amendment be accepted. FISCAL IMPACT: None ATTACHMENTS,: Joint Conference Committee proposed charter. CONTINUED ON ATTACHMENT: X YES SIGNATURE: --------------------------------------------------------------------------------------------------------- ---------------------------------------------------- Loo,"RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER l SIGNATURE(S): 11101 V 0000 ACTION OF BOA N APPROVE AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN UNANIMOUS(ABSENT An ) AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE AYES: NOES: SHOWN. ABSENT: ABSTAIN: ATTESTED � CONTACT: Teresa O'Riva,CCHP 313-6967 JOHN-SWOETEN, OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR CC: Jill Lorrekovich,CCHP R Teresa O'Riva,CCHP BY ,DEPUTY ACOS . 0 �T q Health Services Division of Contra Costa ference Joint I:on Committee Conil"Ittee Chaffer page 1 of 8 jCC Charter PIP Joint Conference Committee Charter INTRODUCTION TO Contra Costa Health Plan (CGRP) is the Contra Costa County operated CCHP Health Maintenance Organization (HMO), the first Federally-qualified HMO in the country operated by local government. CCHP contracts with individual providers, Contra Costa Regional Medical Center and Health Centers (CCRMC&HC) and Kaiser Permanente to arrange comprehensive health care services. CCHP provides health care for public and private employee groups, private individuals, Medi-Cal and Medicare beneficiaries, and low- income county residents. CCHP's overall commitment is serving the County's most vulnerable populations. MISSION CCHP's organizational mission is to provide affordable, high quality, accessible health care with integrity and compassion to all that use our programs. THE JOINT CONFERENCE COMMITTEE PURPOSE The Joint Conference Committee of the Board of Supervisors and CCHP is the mechanism by which the Board of Supervisors exercises oversight of CCHP. All meetings of the Joint Conference Committee are open to the public because of the public nature of the Board of Supervisors. RESPONSIBILITIES • Promotes communication between the Board of Supervisors, the CCHP Quality Council, and CCHP administration. • Assesses and monitors the overall performance of CCHP and its contracted providers including, but not limited to, the quality of care and service provided to members. • Receives, evaluates, and makes recommendations to the Board regarding the reports and recommendations of the Quality Council. Such reports include reports regarding the current and on-going activities of the QM Department and are made on a quarterly basis or more frequently as may be required. • Reviews, evaluates, and makes recommendations to the Board, � annually or more frequently as required, regarding modification of the QMP and work plan, and implementation of the QMP and work plan. • Receives, evaluates, and takes action with regard to reports from CCHP's QM Director and Medical Director regarding the current and JCC Charter Page 2 of 8 on-going activities of the QM Department on a quarterly basis or more frequently as may be required. Any action taken by the Joint Conference Committee is subject to approval by the Board of Supervisors. • Modifies, approves, and implements provider sanctions and contract terminations. Any action taken by the Joint Conference Committee is subject to approval by the Board of Supervisors. • Reviews, evaluates, and acts upon Medical Policy Guidelines, subject to the Board of Supervisors' approval. • Receives and reviews quarterly reports regarding Appeals Committee activity. • Receives and reviews reports on adherence to Privacy and Confidentiality regulations. MEMBERSHIP The Joint Conference Committee shall not exceed nine (9) members. Voting Privileges Two (2) members of the Board of Supervisors, appointed by the Board. Two (2) physician members appointed by the Board from all CCHP provider networks. To fill these positions, nominations will be solicited by announcing the vacancy to all providers. The CCHP Medical Director will select the candidates and one alternate and present them to the Board for approval. Terms are two years with unlimited reappointments. A quorum requires 3 of 4 voting members in attendance. The physician alternate may vote in place of a physician member for the purposes of reaching a quorum. Non- Voting Members CCHP Medical Director. Director of Health Services of Contra Costa County. CCHP CEO Executive Director. Health Services Chief Financial Officer. Chair, Managed Care Commission JCC Charter Page 3 of 8 CHAIR The Chair is a member of the Board of Supervisors, elected annually. 11 FREQUENCY At least quarterly and are open to the public, except for confidential matters that may be discussed and acted upon in executive session. CONFLICT OF Any individual who has been professionally involved in an issue or case INTEREST may not participate in the review, evaluation, or final disposition of the case. PURPOSE Contra Costa County Board of Supervisors, which is elected through general elections, is the governing body of the CCHP. The Board of Supervisors is ultimately responsible for the governance and oversight of CCHP activities, including the Quality Management Program (QMP), administration, and strategic planning activities. RESPONSIBILITIES • Develops policy in consultation and with the recommendation of the Joint Conference Committee. • Reviews, evaluates, and acts upon the annual QMP and Work Plan. • Reviews, evaluates, and acts upon Quality reports that are submitted at least quarterly. • Receives, evaluates and acts upon recommendations of the CCHP Credentialing Committee. • Appoints Joint Conference Committee membership. • Reviews, evaluates, and acts upon findings of the Joint Conference Committee. MEMBERSHIP Five (5) elected members through general elections in one of the five districts of Contra Costa County for a term of four (4) y CHAIR Rotates among the five board members annual) FREQUENCY Weekly public meetings in accordance with the Brown Act. To preserve the confidentiality of some discussion and reports, the Board of Supervisors has the authority to meet in executive session (without any members of the public present). t � � PURPOSE The Quality Council (QC) is the principal committee for coordinating and directing Quality Management activities for CCHP, including but not limited to: quality management, member and provider grievances, peer review and credentialin , and utilization management RESPONSIBILITIES • Receives, evaluates, and acts upon the reports of subcommittees. • Reviews, evaluates, and makes recommendations to the Board of Supervisors or the Joint Conference Committee, annually, regarding the status of contracted providers to whom quality management, utilization management, credentialin , medical records and member JCC Charter Page 4 of 8 Leg— rights and responsibilities activities have been delegated. • Receives recommendations from the Credentialing Committee and evaluates the recommendations by integrating provider-specific quality of care, utilization management, and other data made available by the CCHP Credentialing Committee. The Quality Council makes recommendations to the Board of Supervisors or the Joint Conference Committee regarding the credentialing status of providers. • Receives QM occurrence and grievance reports, quarterly or more frequently as required, regarding potential member or provider quality issues. The Quality Council investigates such occurrence and grievances reports and makes recommendations to the Board of Supervisors and the Joint Conference Committee regarding resolution or implementation of any corrective action that may be required. • Receives and reviews, at least quarterly and more frequently as required, reports from the Director of QM regarding unit activities including, but not limited to: Quality Improvement projects, Disease Management program status, Health Education, Cultural and Linguistics issues, Facility Site Review status or issues, occurrence and grievance volume and trends, delegation audit scores and recommendations. The Quality Council evaluates these reports and makes recommendations to the Board of Supervisors and the Joint Conference Committee regarding implementation of any corrective action that may be required. • Receives UM reports quarterly or more frequently as required. The Quality Council evaluates such reports and makes recommendations to the Board of Supervisors and the Joint Conference Committee regarding implementation of corrective action that may be required. • Receives Grievance Committee activity reports monthly and more frequently as required. The Quality Council evaluates such reports and makes recommendations to the Board of Supervisors and the Joint Conference Committee regarding implementation of corrective action that may be required • Reviews and makes recommendations to the Board of Supervisors and the Joint Conference Committee, annually or more frequently as required, regarding modifications to be made to the QM Work Plan, and other Quality Management reports. • Reviews and evaluates QM reports pertaining to medical, Pharmacy and Therapeutics, and benefit interpretation policy issues. The Quality Council makes recommendations to the Board of Supervisors and the Joint Conference Committee regarding trends and modifications to be implemented. • Distributes QM and other CCHP information to individually contracted providers via the Medical Director through letters, newsletters, policies and procedures, provider manuals, and other appropriate JCC Charter Page 5 of 8 OF methods. • Reports to CCHP senior administration for the purpose of planning and designing services for and administering CCHP operations. • Provides additional medical review of appeals/reconsiderations by physician committee members as required. • Reviews and approves clinical practice guidelines periodically. MEMBERSHIP Full Voting Privileges • The CCHP Medical Director • A licensed physician consultant designated by the CCHP Medical Director • The Quality Chair or designee from each of CCHP's delegated provider networks • Director of CCRMC & HC QM Department • The CCHP QM Director • A minimum of two (2) independent physicians from any of the CCHP contracted provider networks, with at least one representing the individually contracted physician network. To fill these positions, nominations are solicited by announcing the vacancy to all providers. The physician members will be appointed and annually re-appointed by the CCHP Medical Director. These members serve one-year terms. • The CCHP Authorizations/Utilization Manager • The CCHP Member Services Manager Note: For peer review issues, onmedical providers may vote. CHAIR CCHP Medical Director or des!gnee FREQUENCY Monthly, a minimum of nine (9)times yearly PUBLIC ADVISORY OTHER COORDINATING COMMITTEES grilt"RIX W Oki=16- I I cm uIxg a Ur PURPOSE The Managed Care Commission (MCC) is the principal public advisory board to CCHP. The goal of the MCC is to help assure the attainment of CCHP's strategic goals and objectives. The MCC reports directly to the Board of Supervisors annual) and more frequently as required. RESPONSIBILITIES • Consider the health care concerns for all members served by CCHP. • Assure provider, consumer, and community, as well as gender, ethnic, cultural, and geographically diverse population input to deliberations and decision-making. • Conduct long-range planning and policy formulation, and make recommendations to the Board of Supervisors, County HSD Director and CCHP Chief Executive Officer (CEO). This includes adopting an annual work plan and list of goals and priorities as well as an annual JCC Charter Page 6 of 8 3- c�y report describing major activities and accomplishments. • Study and make recommendations to the CCHP CEO regarding operational objectives, policies and procedures, and recommend changes. • Assure effectiveness of quality programs by ongoing and periodic review. • Regularly review the CCHP operational budget and amendments thereto. • Advise the Board of Supervisors, HSD Director, and CCHP CEO of the overall progress, constraining or threatening needs, and special problems of CCHP. • Encourage public understanding of CCHP and provide support throughout the county for its development. • Prioritize and assign issues to appropriate committees. • Provide input, including from traditional and safety-net providers, regarding 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 rima language other than English, as well as cultural competency MEMBERSHIP There are fifteen (15) commissioners, appointed by the Board of Supervisors, all with voting privileges; • At least one Medi-Cal subscriber • A Medicare subscriber or beneficiary • A Commercial subscriber • An individual sensitive to medically indigent needs • Anon-contracting physician • At least one other non-contracting provider • The remaining nine (9) seats are at large members non-contracting with CCHP. Non-voting Members • The Health Services Director • CCHP CEO The Board of Supervisors serve as ex-officio members without voting privileges. CHAIR Elected by Commission members The Chair presides at all MCC meetings and represents the MCC at all CCHP Joint Conference Committee meetings. FREQUENCY A minimum of six (6) times yearly JCC Charter Page 7 of 8 Contra Costa Health Plan Organizational Chart Cmef Ekmwve Officer Ckubu&nm MmaWdQ" &pw"m C &Juint Crof Com�ittee Director of �W�YVe �dicnl Artzta/flssislrmts Urmtor SeMm&Retention Qirura[Qoffdiau offlcff Provider Affairs GredaWding Akmber AdviceNursePro�ido•iicasanServices &P"Cadom &0ufiwch Bminm Services Quality Mmnenmt acdrm QUdity LEMS VajiacWon&SqpaY Disease Mmaganed hkrn6ershipMtinterea�ce Health Elccdion Mminishation A�dtdUNY(1�IIJ Fina" AWhmtaUom, Wl&dion Goi���Maims &CareMvugemeM C"&ads Phart��ac}' JCC Charter Page 8 of 8