State Codes and Statutes

Statutes > California > Wic > 14087.96-14087.9725

WELFARE AND INSTITUTIONS CODE
SECTION 14087.96-14087.9725



14087.96.  The following definitions shall apply for purposes of
this article:
   (a) "County" means the County of Los Angeles.
   (b) "Board of supervisors" means the Board of Supervisors of the
County of Los Angeles.
   (c) "Commission" means the separate public agency established by
the board of supervisors to operate a local initiative for health
care in the county.
   (d) "Local initiative" means the health plan or plans and other
health care programs owned or operated by the commission established
under this article, and operated pursuant to the strategic plan.
   (e) "Medi-Cal managed care programs" means all those components of
the Medi-Cal program that involve the restriction of access for
Medi-Cal patients to particular providers or health plans and that
involve managed care principles, including, but not limited to,
programs such as those described in Article 2.7 (commencing with
Section 14087.3), Article 2.8 (commencing with Section 14087.5),
Chapter 8 (commencing with Section 14200), including pilot programs
under Article 7 (commencing with Section 14490) thereof.
   (f) "Health care consumer" means a Medi-Cal beneficiary or any
other person eligible to receive health care services under the local
initiative, including parents, legal guardians, or conservators of
Medi-Cal beneficiaries and people who will receive health care
services under the local initiative.
   (g) "Health care consumer advocate" means an individual who,
whether in a paid or unpaid capacity, represents the interests of
Medi-Cal beneficiaries or people who will receive health care under
the local initiative.
   (h) "Strategic plan" means the report issued on March 31, 1993, by
the State Department of Health Services, entitled "The State
Department of Health Services' Plan for Expanding Medi-Cal Managed
Care: Protecting Vulnerable Populations" or the report, as
subsequently revised or amended.


14087.9605.  (a) The board of supervisors may, by ordinance,
resolution, or other action, establish a commission in order to meet
the problems of delivery of publicly assisted medical care in the
county and demonstrate ways of promoting quality care and cost
efficiency. The health care services provided by the commission shall
include, but are not limited to, services covered under this chapter
provided on a coordinated managed care basis. The commission shall
operate the local initiative that provides or arranges for the
delivery of health care services in all or part of the geographic
area of the county, in a manner that is consistent with managed care
principles, techniques, and practices directed at ensuring
cost-effective and adequate access to quality care, without
discrimination on the basis of medical condition, diagnosis, or
illness, in an amount, duration, and scope that is sufficient to
reasonably achieve its purpose for enrollees in the local initiative.
If the board of supervisors establishes a commission, all rights,
powers, duties, privileges, and immunities vested in the county
pursuant to the contract with the department under this article shall
be vested in the commission.
   (b) (1) The commission shall be considered a public entity that is
a local unit of government and that is separate from the county,
shall file the statement required by Section 53051 of the Government
Code, and shall be considered a public entity for purposes of
Division 3.6 (commencing with Section 810) of Title 1 of the
Government Code. The commission, members of the commission, and
employees of the commission shall be protected by the immunities
applicable to public entities and public employees governed by Part 2
(commencing with Section 814) of Division 3.6 of Title 1 of the
Government Code, except as provided by other statutes or regulations
that apply expressly to the commission.
   (2) The commission shall have all power necessary and appropriate
to do all of the following:
   (A) Operate programs involving health care services, including,
but not limited to, the power to own and operate one or more health
plans.
   (B) To enter into agreements with any public or private entity or
entities to provide or arrange for health care services on a
capitated or noncapitated basis.
   (C) To acquire, possess, and dispose of real or personal property.
   (D) To employ personnel and contract for services required to meet
its obligations.
   (E) To sue or be sued.
   (F) To enter into agreements under Chapter 5 (commencing with
Section 6500) of Division 7 of Title 1 of the Government Code.
   (3) The commission may enter into contracts with public and
private health care providers to provide health care and related
services to individuals enrolled in any health plan or health program
operated as part of the local initiative.
   (c) Nothing in this section shall be construed to authorize the
commission to operate any health care program other than the local
initiative described in the strategic plan as it currently exists or
as it may be amended by the department.



14087.961.  Governance of the commission shall be vested in a
governing body consisting of 13 members, each of whom shall have a
fiduciary duty to act in the best interest of the commission and the
local initiative, nominated by the following entities, and appointed
by the board of supervisors:
   (a) Four members shall be nominated by the board of supervisors to
represent the County of Los Angeles. No more than one member
nominated by the board of supervisors shall be a member of the board
of supervisors and each remaining member nominated by the board of
supervisors shall possess experience as a health care administrator
or as a health care provider.
   (b) One member shall be a representative of private hospitals that
have Medi-Cal disproportionate share status, or if that status no
longer exists, that serve an equivalent patient population, who shall
be nominated by the Hospital Association of Southern California.
   (c) One member shall be a representative of private hospitals that
do not have Medi-Cal disproportionate share status, who shall be
nominated by the Hospital Association of Southern California.
   (d) One member shall be a representative of free and community
clinics, who shall be nominated by the Community Clinics Association
of Los Angeles County.
   (e) One member shall be a representative of federally qualified
health centers, who shall be nominated by the Community Clinics
Association of Los Angeles County, or if that status no longer
exists, an equivalent group of health centers.
   (f) One member shall be a physician representative, who shall be
nominated by the Los Angeles County Medical Association, in
consultation with other physician associations within the county.
   (g) One member shall be a representative of Knox-Keene licensed
prepaid health plans, who shall be nominated by the California
Association of Health Plans.
   (h) One member shall represent health care consumers, and at the
time of being nominated, shall be a health care consumer. The initial
nominee shall be nominated by the working group on the role of the
consumer for the first nominee, and thereafter, by a process
determined by the community advisory committee under which only
health care consumers may nominate and vote for appointees.
   (i) One member shall be a health care consumer advocate, who shall
represent health care consumers. The initial nominee shall be
nominated by the working group on the role of the consumer for the
first nominee, and thereafter, by a process determined by the
community advisory committee under which only health care consumers
may nominate and vote for appointees.
   (j) One member shall be a children's health care provider
representative, who shall be nominated by the Children's Planning
Council as the coordinating entity for organizations and agencies
providing direct services to, or advocacy for, children and families
within the county.



14087.9615.  (a) The composition of the 13-member governing body of
the commission, as prescribed in Section 14087.961, shall be subject
to alteration upon a two-thirds vote of the full membership of the
governing body, if the action is also concurred in by an affirmative
vote of at least four members of the board of supervisors; provided,
however, no change in the composition of the governing board shall
result in the elimination of representation by the county, private
physicians, hospitals, and other providers, clinics, or consumers and
consumer advocates.
   (b) Notwithstanding subdivision (a), no governing body member
shall be removed except as provided in Section 14087.964.



14087.962.  Members of the governing body shall either reside, be
employed, or provide services in the geographic area served by the
local initiative. Nominees shall be appointed to the governing body
by the board of supervisors. The board of supervisors shall not deny
appointment to a nominee described in subdivisions (b) to (j),
inclusive, of Section 14087.961 without specific cause as set forth
in Section 14087.964.



14087.9625.  (a) Members of the governing body of the commission
shall serve four-year terms.
   (b) Individuals shall be limited to serving on the governing body
for two consecutive four-year terms or a maximum of 10 years.



14087.963.  (a) The governing body of the commission shall establish
rules for its proceedings. There shall be at least six meetings per
year.
   (b) (1) Each governing body member shall be entitled to one
hundred dollars ($100) remuneration from commission funds for each
governing body meeting attended, and may receive similar remuneration
for attending meetings of committees of the governing body, except
that the total remuneration for each governing body member for all
meetings shall not exceed the sum of four hundred dollars ($400) per
month, plus actual expenses incurred in attending these meetings at
rates payable to county officers and employees.
   (2) The per meeting rate and monthly limit of one hundred dollars
($100) and four hundred dollars ($400), respectively, may be
increased by the governing body, subject to approval by the board of
supervisors.


14087.9635.  (a) A majority of the members of the governing body
shall constitute a quorum for the transaction of business, and all
official acts of the governing body shall require the affirmative
vote of a majority of the members present and voting.
   (b) No official act shall be approved with less than the
affirmative vote of four members of the governing body, unless the
number of members prohibited from voting because of conflicts of
interest precludes adequate participation in the vote.



14087.964.  A member of the governing body shall be removed from
office if a majority of the members present and voting find that one
or more of the following causes for removal exists:
   (a) The member neither lives in, nor is employed in, the
geographic area served by the local initiative.
   (b) The member has been convicted of a crime involving corruption
or any felony.
   (c) The member has failed to attend three consecutive governing
body meetings or a majority of the meetings in the most recent
calendar year.
   (d) The member has failed to discharge legal obligations as a
member of a public agency.
   (e) A request for removal has been submitted by the appropriate
nominating entity in accordance with Section 14087.9645.



14087.9645.  A member of the governing body may be removed at the
request of the entity that nominated the member. The entity that
nominated a member may request removal of that member for any of the
following reasons:
   (a) Any of the causes listed in Section 14087.964.
   (b) The member no longer meets the qualifications for office or
the criteria applied by the nominating entity in selecting the member
as its nominee.



14087.965.  (a) A request for removal under Section 14087.9645 shall
be adopted by the nominating entity in the same manner as the
nomination was adopted and shall be confirmed by a written request
for removal delivered to the governing body, setting forth the
grounds for removal.
   (b) A removal under subdivision (a) shall be effective upon action
by the governing body, that shall be taken at the first meeting
following receipt of the written request.
   (c) The nominating entity shall be legally responsible for
improper removals.
   (d) A nominating entity that requests removal of a governing body
member shall nominate a successor within 60 days after the effective
date of the removal.


14087.9655.  (a) The governing body shall establish a technical
advisory committee to provide technical expertise to the governing
body.
   (b) Members of the committee shall include a medical school
representative, an epidemiologist, a pharmacist, a representative of
a nursing association, a home health care representative, a long-term
care provider, a mental health care provider, a medical
rehabilitation provider, and an expert on health care quality, or, in
the alternative, other persons with health care expertise.
   (c) The technical advisory committee shall meet on a regular
basis, and shall make recommendations and reports to the governing
body.



14087.9657.  (a) The governing body shall establish a children's
health consultant advisory committee to provide to the governing body
expertise on child, adolescent, and maternal health issues.
   (b) Members of the committee shall include representatives of
government health departments and school districts in the geographic
area served by the local initiative, as well as medical professionals
with background in pediatrics and obstetric care, or, in the
alternative, other persons with health care expertise.
   (c) The children's health consultant advisory committee shall meet
on a regular basis, and shall make recommendations and reports to
the governing body.



14087.966.  (a) The governing body for each geographic region served
by the local initiative shall establish a regional community
advisory committee to ensure community involvement.
   (b) Each regional community advisory committee shall have no more
than 35 members, a majority of whom shall be consumers and consumer
advocates, but may also include providers.
   (c) (1) The chairpersons of the regional community advisory
committees shall comprise an executive community advisory committee.
   (2) It is the intent of the Legislature that a majority of the
executive community advisory committee shall be consumers and
consumer advocates, plus two at-large members.
   (d) The executive community advisory committee shall make
recommendations, and shall report on its activities, to the governing
body and shall be able to place matters of the governing body's
agenda for consideration.



14087.9665.  (a) The commission may borrow or receive funds from any
person or entity as necessary to cover development costs and other
actual or projected obligations of the local initiative.
   (b) The county may lend funds to the commission upon such terms as
the board of supervisors may establish.
   (c) Notwithstanding any other provision of law, both the county
and the commission shall be eligible to receive funding under
subdivision (p) of Section 14163, and the local initiative shall be
considered for all purposes to satisfy the requirements of
subdivision (p) of Section 14163.



14087.967.  To the full extent permitted by federal law, the
department and the commission may enter into contracts to provide or
arrange for health care services for any or all persons who are
eligible to receive benefits under the Medi-Cal program. The
contracts may be on an exclusive or nonexclusive basis, and shall
include payment provisions on any basis negotiated between the
department and the commission. In addition, health plans or programs
operated by the commission as part of the local initiative may also
include, but are not limited to, individuals covered under Title 18
of the Social Security Act (Subchapter 18 (commencing with Section
1395) of Chapter 7 of Title 42 of the United States Code),
individuals employed by public agencies and private businesses, and
uninsured or indigent patients.



14087.9675.  (a) The auditor-controller of the county, at those
intervals the auditor-controller deems appropriate, but no less
frequently than annually, shall conduct a review of the fiscal
condition of the commission, report the findings to the commission
and the board of supervisors, and provide a copy of the findings to
any public agency upon request.
   (b) At the county auditor-controller's discretion, other
operational or financial audits of the commission may be conducted.
   (c) Upon the written request of the county auditor-controller, the
commission shall provide full access to all commission records and
documents as necessary to allow the county auditor-controller to
perform the activities authorized by this section.



14087.968.  Notwithstanding any other provision of law, the county
shall not be liable for any damages or losses, whether financial or
in any other form, that may result from the reliance of any person,
entity, or agency on the actions or omissions of, or the findings
made by, the auditor-controller under this section.




14087.9685.  (a) Notwithstanding any other provision of law, any
obligation of the commission and its local initiative, statutory,
contractual, or otherwise, shall be an obligation solely of the
commission and shall not be an obligation of the county or of the
state. Except as otherwise provided in this article, neither the
county nor the state shall be liable for any act or omission of the
commission.
   (b) Except as agreed to by contract with the county, no liability
of the commission shall become an obligation of the county upon
either termination of the commission and its local initiative or the
liquidation or disposition of the commission's remaining assets.
   (c) All claims for money damages against the commission shall be
governed by Part 3 (commencing with Section 900) and Part 4
(commencing with Section 940) of Division 3.6 of Title 1 of the
Government Code, except as otherwise provided by other statutes or
regulations that expressly apply to the commission.



14087.969.  (a) Notwithstanding any other provision of law, neither
a member of the governing body of the commission nor a member of any
advisory panel to the governing body shall be deemed to be interested
in a contract or amendment to a contract entered into by the
commission within the meaning of Article 4 (commencing with Section
1090) of Chapter 1 of Division 4 of Title 1 of the Government Code if
all of the following conditions are satisfied:
   (1) The board of supervisors or the governing body appointed the
member to represent the interests of the county, physicians, health
care practitioners, hospitals, pharmacies, other health care
organizations, consumers, or consumer advocates. For purposes of this
section, each group whose interests are described in this paragraph
shall be referred to as a stakeholder.
   (2) The contract or the contract as amended authorizes individuals
or organizations in the same stakeholder group that the member was
appointed to represent to provide services under the local
initiative.
   (3) The contract or the contract as amended contains substantially
the same terms and conditions as contracts entered into with other
individuals or organizations in the same stakeholder group that the
member was appointed to represent.
   (4) The contract or the contract as amended does not specifically
authorize the member or the member's organization, as defined in
paragraph (1) of subdivision (e), to provide services under the local
initiative.
   (b) If paragraphs (1) to (3), inclusive, of subdivision (a) are
satisfied but the contract or the contract as amended would
specifically authorize the member or the member's organization to
provide services under the local initiative, the contract approved by
the governing body of the commission shall be deemed to comply with
Section 1090 of the Government Code if the member abstains from
voting on the contract or amendment to the contract, the member
discloses the interest to the governing body or the advisory panel,
whichever is applicable, the governing body or advisory panel notes
the disclosure and the abstention in its official records, the member
does not influence or attempt to influence the governing body, the
advisory panel, or any member of the governing body or advisory panel
to enter into the particular contract or the contract as amended,
and the governing body or advisory panel authorizes the contract or
amendment to the contract in good faith only by a vote of its
membership sufficient for the purpose without counting the vote of
the member.
   (c) Notwithstanding any other provision of law, income from a
contractor under the local initiative to a member or to a member's
organization, as defined in paragraph (1) of subdivision (e), which
is unrelated income, as defined in paragraph (2) of subdivision (e),
shall not cause the member of the governing body of the commission or
the member of the advisory panel to the governing body to be deemed
to be interested in the contract or amendment to the contract for
purposes of Article 4 (commencing with Section 1090) of Chapter 1 of
Division 4 of Title 1 of the Government Code, if the contract or the
contract as amended contains substantially the same terms and
conditions as contracts entered into with other contractors in the
same stakeholder group that is the source of the unrelated income.
   (d) If the particular contract or the contract as amended does not
contain substantially the same terms and conditions as contracts
entered into with other contractors in the same stakeholder group
that is the source of the unrelated income, the contract approved by
the governing body of the commission shall be deemed to comply with
Section 1090 of the Government Code if the member abstains from
voting on the contract or amendment to the contract, the member
discloses the interest to the governing body or the advisory panel,
whichever is applicable, the governing body or advisory panel notes
the disclosure and abstention in its official records, the member
does not influence or attempt to influence the governing body to
enter into the particular contract or the contract as amended, and
the governing body or advisory panel authorizes the contract or
amendment to the contract in good faith only by a vote of its
membership sufficient for that purpose without counting the vote of
the member.
   (e) For purposes of this section, the following definitions shall
apply:
   (1) "Member's organization" means an entity for which the member
serves as an employee, officer, board member, or consultant, or in
which the member has any other financial interest for purposes of
Article 4 (commencing with Section 1090) of Chapter 1 of Division 4
of Title 1 of the Government Code.
   (2) "Unrelated income" means income that is not related to, or is
not for providing services under, the local initiative.




14087.9695.  The department, if at no state General Fund expense,
may take all appropriate steps, in cooperation with the county and
the commission, to obtain approval for a demonstration or pilot
project under applicable federal laws, including, but not limited to,
Section 1315 of Title 42 of the United States Code, in connection
with the local initiative in the county. The project may include
Medi-Cal coverage for enrollees in the local initiative who otherwise
would not be covered under the Medi-Cal program. The project shall
not be used to curtail existing rights with respect to eligibility
and services for the Medi-Cal population, nor to obtain federal
waivers of the payment provisions applicable to federally qualified
health centers or noninstitutional providers under paragraphs (10),
(13), (30), and (37) of subsection (a) of Section 1396a of Title 42
of the United States Code.



14087.9697.  In any transfer of functions from county employees to
the commission, the commission shall continue to recognize the
employee organization that represented the employees performing those
functions at the time of the transfer of duties. The commission
shall also be bound by the terms of any memorandum of understanding
that is in effect as of the date of the transfer of functions for the
duration thereof, or until replaced by a subsequent memorandum of
understanding.



14087.97.  The commission shall be deemed to be a public agency that
is a local unit of government for purposes of all grant programs and
other funding and loan guarantee programs.



14087.9705.  (a) The commission shall obtain licensure as a health
care service plan under Chapter 2.2 (commencing with Section 1340) of
Division 3 of the Health and Safety Code.
   (b) Commencing on the date that the commission first receives
Medi-Cal capitated payments for the provision of health care services
to Medi-Cal beneficiaries and the commission is in full compliance
with all of the requirements regarding tangible net equity applicable
to a health care service plan licensed under Chapter 2.2 (commencing
with Section 1340) of Division 3 of the Health and Safety Code, all
of the following provisions shall apply:
   (1) The commission is authorized to select and design its
automated management information system, subject to the requirement
that the department, in cooperation with the commission, prior to
making capitated payments, approve the system. The department shall
test the system to ensure that the system is capable of producing
detailed, accurate, and timely financial information on the financial
condition of the commission, and any other information that is
generally required by the department in its contracts with other
local initiatives and with health care service plans.
   (2) In addition to the reports required by the Department of
Managed Health Care under Chapter 2.2 (commencing with Section 1340)
of Division 3 of the Health and Safety Code and the rules of the
Director of the Department of Managed Health Care adopted and
promulgated thereunder, the commission shall provide, on a monthly
basis, to the department, the Department of Managed Health Care, and
the members of the commission a copy of the automated report
described in subdivision (a) and a projection of assets and
liabilities, including those that have been incurred but not
reported, with an explanation of material increases or decreases in
current or projected assets and liabilities. The explanation of
increases and decreases in assets or liabilities shall be provided,
upon request, to a hospital, independent physicians' practice
association, or community clinic that has contracted with the
commission to provide health care services.
   (3) In addition to the reporting and notification requirements to
which the commission is subject under Chapter 2.2 (commencing with
Section 1340) of Division 3 of the Health and Safety Code, the chief
executive officer or director of the commission shall immediately
notify the department, the Department of Managed Health Care, and the
members of the commission, in writing, of any fact or facts that, in
the chief executive officer's or director's reasonable and prudent
judgment, is likely to result in the commission being unable to meet
its financial obligations. The written notice shall describe the fact
or facts, the anticipated financial consequences, and the actions
that will be taken to address the anticipated consequences.
   (4) In no event shall the Department of Managed Health Care waive
or vary, nor shall the department request the Department of Managed
Health Care to waive or vary, the tangible net equity requirements
for a commission under Chapter 2.2 (commencing with Section 1340) of
Division 3 of the Health and Safety Code after three years after the
date of the commencement of capitated payments to the commission.
Until the commission is in compliance with all of the tangible net
equity requirements under Chapter 2.2 (commencing with Section 1340)
of Division 3 of the Health and Safety Code and the rules of the
Director of the Department of Managed Health Care adopted and
promulgated thereunder, the commission shall develop a stop-loss
program that is appropriate to the risks of the commission. The
stop-loss program shall be subject to the approval of the department
and the Department of Managed Health Care.
   (5) In the event the commission votes to file a petition of
bankruptcy, or the board of supervisors notifies the department that
it intends to terminate the commission, the department shall
immediately transfer the commission's Medi-Cal beneficiaries to other
managed care contractors, when the contractors are available, and
the contractors are able to demonstrate that they can absorb the
increased enrollment without detriment to the provision of health
care services to their existing enrollees. To the extent that other
managed care providers are unavailable or the department determines
that the transfer to the other contractors to a fee-for-service
reimbursement system is in the best interest of any particular
beneficiary, the department shall make that transfer to the
fee-for-service system, pending the availability of managed care
contractors that can demonstrate that they can absorb the increased
enrollment without detriment to the provision of health care services
to their existing enrollees, or until the department determines that
providing care to any particular beneficiary pursuant to a
fee-for-service reimbursement system is no longer necessary to
protect the continuity of care or other interests of the beneficiary.
Beneficiaries who have been or who are scheduled to be transferred
to a fee-for-service reimbursement system or managed care contractor
may make a choice to be enrolled in another managed care system, if
one is available, in full compliance with federal freedom-of-choice
requirements.
   (6) The commission shall submit to a review of financial records
when the department determines, based on data reported by the
commission or other data received by the department, that the
commission will not be able to meet its financial obligations to
health care providers contracting with the commission. If the
department, pursuant to a review of financial records under this
paragraph, determines that the commission will not be able to meet
its financial obligation to contracting health care providers for the
provision of health care services, the Director of Health Services
shall immediately terminate the contract between the commission and
the department and shall immediately transfer the commission's
Medi-Cal beneficiaries in accordance with paragraph (5) in order to
ensure uninterrupted provision of health care services to
beneficiaries and to minimize financial disruption. Beneficiary
eligibility for Medi-Cal shall not be affected by this action.
Beneficiaries who have been or who are scheduled to be transferred
under paragraph (5) may make a choice to be enrolled in another
managed care plan, if one is available, in full compliance with
federal freedom-of-choice requirements.
   (7) It is the intent of the Legislature that the department shall
implement Medi-Cal capitated enrollments in a manner that ensures
that appropriate levels of health care services will be provided to
Medi-Cal beneficiaries and that appropriate levels of administrative
services will be furnished to health care providers. The contract
between the department and the commission shall authorize the
department to administer the number of covered Medi-Cal enrollments
in a manner that ensures that the commission's provider network and
administrative structure are able to provide appropriate and timely
services to beneficiaries and to participating providers.
   (8) In the event a commission is terminated, files for bankruptcy,
or otherwise no longer functions for the purposes for which it was
established, the county shall, with respect to compensation for
provision of health care services to beneficiaries, occupy no greater
or lesser status than any other health care provider in the
disbursement of assets of the commission.
   (9) Nothing in this section shall be construed to impair or
diminish the authority of the Director of the Department of Managed
Health Care under Chapter 2.2 (commencing with Section 1340) of
Division 3 of the Health and Safety Code, nor shall any thing in this
section be construed to reduce or otherwise limit the obligation of
a commission licensed as a health care plan under Chapter 2.2
(commencing with Section 1340) of Division 3 of the Health and Safety
Code to comply with the requirements of that chapter, and the rules
of the Director of the Department of Managed Health Care adopted
thereunder.



14087.971.  (a) Contracts under this article between the department
and the commission shall be on a nonbid basis and shall be exempt
from Chapter 2 (commencing with Section 10290) of Part 2 of Division
2 of the Public Contract Code.
   (b) It is the intent of the Legislature that the county shall,
with respect to its medical facilities and programs, occupy no
greater or lesser status than any other health care provider in
negotiating with the commission for contracts to provide health care
services.



14087.9715.  The Legislature intends that implementation of this
article shall involve consultation and cooperative activities among
various agencies of the state and county, and the commission. The
Legislature finds and declares that those activities are in
furtherance of the state's goals and efforts. The activities of the
commission and its local initiative shall be recognized as state
action for purposes of all statutes and regulations relating to
business competition.


14087.972.  Neither the commission nor its local initiative shall be
considered to be an agency, division, department, or instrumentality
of the county, and neither the commission nor its local initiative
shall be subject to the personnel, procurement, or other operational
rules of the county.


14087.9722.  (a) If the commission established pursuant to this
article no longer functions for the purposes for which it was
established, when the commission's existing obligations have been
satisfied or the commission's assets have been exhausted, the board
of supervisors may, by ordinance, resolution, or other action,
terminate the commission.
   (b) Prior to the termination of the commission, the board of
supervisors shall notify the department of its intent to terminate
the commission. Within 30 days of the notification, the department
shall conduct an audit of the records of the commission to determine
the liabilities and assets of the commission. The department shall
report its findings to the board of supervisors within 10 days of the
completion of the audit. The board of supervisors shall prepare a
plan to liquidate or otherwise dispose of the assets of the
commission and to pay the liabilities of the commission to the extent
of the commission's assets, and shall present the plan to the
department within 30 days after receiving the department's audit
findings.
   (c) Upon termination of the commission by the board of
supervisors, the county shall manage any remaining assets of the
commission until superseded by a plan approved by the department.
   (d) All assets of the commission remaining after the payment of
the liabilities of the commission pursuant to subdivision (b) shall
be disposed of pursuant to the contract entered into between the
state and the commission pursuant to Section 14087.




14087.9725.  (a) Nothing in this article shall be construed as
amending the requirements of Section 17000.
   (b) Nothing in this article shall be construed to preclude the
department from expanding Medi-Cal managed care in ways other than
those expressly provided in this article.


State Codes and Statutes

Statutes > California > Wic > 14087.96-14087.9725

WELFARE AND INSTITUTIONS CODE
SECTION 14087.96-14087.9725



14087.96.  The following definitions shall apply for purposes of
this article:
   (a) "County" means the County of Los Angeles.
   (b) "Board of supervisors" means the Board of Supervisors of the
County of Los Angeles.
   (c) "Commission" means the separate public agency established by
the board of supervisors to operate a local initiative for health
care in the county.
   (d) "Local initiative" means the health plan or plans and other
health care programs owned or operated by the commission established
under this article, and operated pursuant to the strategic plan.
   (e) "Medi-Cal managed care programs" means all those components of
the Medi-Cal program that involve the restriction of access for
Medi-Cal patients to particular providers or health plans and that
involve managed care principles, including, but not limited to,
programs such as those described in Article 2.7 (commencing with
Section 14087.3), Article 2.8 (commencing with Section 14087.5),
Chapter 8 (commencing with Section 14200), including pilot programs
under Article 7 (commencing with Section 14490) thereof.
   (f) "Health care consumer" means a Medi-Cal beneficiary or any
other person eligible to receive health care services under the local
initiative, including parents, legal guardians, or conservators of
Medi-Cal beneficiaries and people who will receive health care
services under the local initiative.
   (g) "Health care consumer advocate" means an individual who,
whether in a paid or unpaid capacity, represents the interests of
Medi-Cal beneficiaries or people who will receive health care under
the local initiative.
   (h) "Strategic plan" means the report issued on March 31, 1993, by
the State Department of Health Services, entitled "The State
Department of Health Services' Plan for Expanding Medi-Cal Managed
Care: Protecting Vulnerable Populations" or the report, as
subsequently revised or amended.


14087.9605.  (a) The board of supervisors may, by ordinance,
resolution, or other action, establish a commission in order to meet
the problems of delivery of publicly assisted medical care in the
county and demonstrate ways of promoting quality care and cost
efficiency. The health care services provided by the commission shall
include, but are not limited to, services covered under this chapter
provided on a coordinated managed care basis. The commission shall
operate the local initiative that provides or arranges for the
delivery of health care services in all or part of the geographic
area of the county, in a manner that is consistent with managed care
principles, techniques, and practices directed at ensuring
cost-effective and adequate access to quality care, without
discrimination on the basis of medical condition, diagnosis, or
illness, in an amount, duration, and scope that is sufficient to
reasonably achieve its purpose for enrollees in the local initiative.
If the board of supervisors establishes a commission, all rights,
powers, duties, privileges, and immunities vested in the county
pursuant to the contract with the department under this article shall
be vested in the commission.
   (b) (1) The commission shall be considered a public entity that is
a local unit of government and that is separate from the county,
shall file the statement required by Section 53051 of the Government
Code, and shall be considered a public entity for purposes of
Division 3.6 (commencing with Section 810) of Title 1 of the
Government Code. The commission, members of the commission, and
employees of the commission shall be protected by the immunities
applicable to public entities and public employees governed by Part 2
(commencing with Section 814) of Division 3.6 of Title 1 of the
Government Code, except as provided by other statutes or regulations
that apply expressly to the commission.
   (2) The commission shall have all power necessary and appropriate
to do all of the following:
   (A) Operate programs involving health care services, including,
but not limited to, the power to own and operate one or more health
plans.
   (B) To enter into agreements with any public or private entity or
entities to provide or arrange for health care services on a
capitated or noncapitated basis.
   (C) To acquire, possess, and dispose of real or personal property.
   (D) To employ personnel and contract for services required to meet
its obligations.
   (E) To sue or be sued.
   (F) To enter into agreements under Chapter 5 (commencing with
Section 6500) of Division 7 of Title 1 of the Government Code.
   (3) The commission may enter into contracts with public and
private health care providers to provide health care and related
services to individuals enrolled in any health plan or health program
operated as part of the local initiative.
   (c) Nothing in this section shall be construed to authorize the
commission to operate any health care program other than the local
initiative described in the strategic plan as it currently exists or
as it may be amended by the department.



14087.961.  Governance of the commission shall be vested in a
governing body consisting of 13 members, each of whom shall have a
fiduciary duty to act in the best interest of the commission and the
local initiative, nominated by the following entities, and appointed
by the board of supervisors:
   (a) Four members shall be nominated by the board of supervisors to
represent the County of Los Angeles. No more than one member
nominated by the board of supervisors shall be a member of the board
of supervisors and each remaining member nominated by the board of
supervisors shall possess experience as a health care administrator
or as a health care provider.
   (b) One member shall be a representative of private hospitals that
have Medi-Cal disproportionate share status, or if that status no
longer exists, that serve an equivalent patient population, who shall
be nominated by the Hospital Association of Southern California.
   (c) One member shall be a representative of private hospitals that
do not have Medi-Cal disproportionate share status, who shall be
nominated by the Hospital Association of Southern California.
   (d) One member shall be a representative of free and community
clinics, who shall be nominated by the Community Clinics Association
of Los Angeles County.
   (e) One member shall be a representative of federally qualified
health centers, who shall be nominated by the Community Clinics
Association of Los Angeles County, or if that status no longer
exists, an equivalent group of health centers.
   (f) One member shall be a physician representative, who shall be
nominated by the Los Angeles County Medical Association, in
consultation with other physician associations within the county.
   (g) One member shall be a representative of Knox-Keene licensed
prepaid health plans, who shall be nominated by the California
Association of Health Plans.
   (h) One member shall represent health care consumers, and at the
time of being nominated, shall be a health care consumer. The initial
nominee shall be nominated by the working group on the role of the
consumer for the first nominee, and thereafter, by a process
determined by the community advisory committee under which only
health care consumers may nominate and vote for appointees.
   (i) One member shall be a health care consumer advocate, who shall
represent health care consumers. The initial nominee shall be
nominated by the working group on the role of the consumer for the
first nominee, and thereafter, by a process determined by the
community advisory committee under which only health care consumers
may nominate and vote for appointees.
   (j) One member shall be a children's health care provider
representative, who shall be nominated by the Children's Planning
Council as the coordinating entity for organizations and agencies
providing direct services to, or advocacy for, children and families
within the county.



14087.9615.  (a) The composition of the 13-member governing body of
the commission, as prescribed in Section 14087.961, shall be subject
to alteration upon a two-thirds vote of the full membership of the
governing body, if the action is also concurred in by an affirmative
vote of at least four members of the board of supervisors; provided,
however, no change in the composition of the governing board shall
result in the elimination of representation by the county, private
physicians, hospitals, and other providers, clinics, or consumers and
consumer advocates.
   (b) Notwithstanding subdivision (a), no governing body member
shall be removed except as provided in Section 14087.964.



14087.962.  Members of the governing body shall either reside, be
employed, or provide services in the geographic area served by the
local initiative. Nominees shall be appointed to the governing body
by the board of supervisors. The board of supervisors shall not deny
appointment to a nominee described in subdivisions (b) to (j),
inclusive, of Section 14087.961 without specific cause as set forth
in Section 14087.964.



14087.9625.  (a) Members of the governing body of the commission
shall serve four-year terms.
   (b) Individuals shall be limited to serving on the governing body
for two consecutive four-year terms or a maximum of 10 years.



14087.963.  (a) The governing body of the commission shall establish
rules for its proceedings. There shall be at least six meetings per
year.
   (b) (1) Each governing body member shall be entitled to one
hundred dollars ($100) remuneration from commission funds for each
governing body meeting attended, and may receive similar remuneration
for attending meetings of committees of the governing body, except
that the total remuneration for each governing body member for all
meetings shall not exceed the sum of four hundred dollars ($400) per
month, plus actual expenses incurred in attending these meetings at
rates payable to county officers and employees.
   (2) The per meeting rate and monthly limit of one hundred dollars
($100) and four hundred dollars ($400), respectively, may be
increased by the governing body, subject to approval by the board of
supervisors.


14087.9635.  (a) A majority of the members of the governing body
shall constitute a quorum for the transaction of business, and all
official acts of the governing body shall require the affirmative
vote of a majority of the members present and voting.
   (b) No official act shall be approved with less than the
affirmative vote of four members of the governing body, unless the
number of members prohibited from voting because of conflicts of
interest precludes adequate participation in the vote.



14087.964.  A member of the governing body shall be removed from
office if a majority of the members present and voting find that one
or more of the following causes for removal exists:
   (a) The member neither lives in, nor is employed in, the
geographic area served by the local initiative.
   (b) The member has been convicted of a crime involving corruption
or any felony.
   (c) The member has failed to attend three consecutive governing
body meetings or a majority of the meetings in the most recent
calendar year.
   (d) The member has failed to discharge legal obligations as a
member of a public agency.
   (e) A request for removal has been submitted by the appropriate
nominating entity in accordance with Section 14087.9645.



14087.9645.  A member of the governing body may be removed at the
request of the entity that nominated the member. The entity that
nominated a member may request removal of that member for any of the
following reasons:
   (a) Any of the causes listed in Section 14087.964.
   (b) The member no longer meets the qualifications for office or
the criteria applied by the nominating entity in selecting the member
as its nominee.



14087.965.  (a) A request for removal under Section 14087.9645 shall
be adopted by the nominating entity in the same manner as the
nomination was adopted and shall be confirmed by a written request
for removal delivered to the governing body, setting forth the
grounds for removal.
   (b) A removal under subdivision (a) shall be effective upon action
by the governing body, that shall be taken at the first meeting
following receipt of the written request.
   (c) The nominating entity shall be legally responsible for
improper removals.
   (d) A nominating entity that requests removal of a governing body
member shall nominate a successor within 60 days after the effective
date of the removal.


14087.9655.  (a) The governing body shall establish a technical
advisory committee to provide technical expertise to the governing
body.
   (b) Members of the committee shall include a medical school
representative, an epidemiologist, a pharmacist, a representative of
a nursing association, a home health care representative, a long-term
care provider, a mental health care provider, a medical
rehabilitation provider, and an expert on health care quality, or, in
the alternative, other persons with health care expertise.
   (c) The technical advisory committee shall meet on a regular
basis, and shall make recommendations and reports to the governing
body.



14087.9657.  (a) The governing body shall establish a children's
health consultant advisory committee to provide to the governing body
expertise on child, adolescent, and maternal health issues.
   (b) Members of the committee shall include representatives of
government health departments and school districts in the geographic
area served by the local initiative, as well as medical professionals
with background in pediatrics and obstetric care, or, in the
alternative, other persons with health care expertise.
   (c) The children's health consultant advisory committee shall meet
on a regular basis, and shall make recommendations and reports to
the governing body.



14087.966.  (a) The governing body for each geographic region served
by the local initiative shall establish a regional community
advisory committee to ensure community involvement.
   (b) Each regional community advisory committee shall have no more
than 35 members, a majority of whom shall be consumers and consumer
advocates, but may also include providers.
   (c) (1) The chairpersons of the regional community advisory
committees shall comprise an executive community advisory committee.
   (2) It is the intent of the Legislature that a majority of the
executive community advisory committee shall be consumers and
consumer advocates, plus two at-large members.
   (d) The executive community advisory committee shall make
recommendations, and shall report on its activities, to the governing
body and shall be able to place matters of the governing body's
agenda for consideration.



14087.9665.  (a) The commission may borrow or receive funds from any
person or entity as necessary to cover development costs and other
actual or projected obligations of the local initiative.
   (b) The county may lend funds to the commission upon such terms as
the board of supervisors may establish.
   (c) Notwithstanding any other provision of law, both the county
and the commission shall be eligible to receive funding under
subdivision (p) of Section 14163, and the local initiative shall be
considered for all purposes to satisfy the requirements of
subdivision (p) of Section 14163.



14087.967.  To the full extent permitted by federal law, the
department and the commission may enter into contracts to provide or
arrange for health care services for any or all persons who are
eligible to receive benefits under the Medi-Cal program. The
contracts may be on an exclusive or nonexclusive basis, and shall
include payment provisions on any basis negotiated between the
department and the commission. In addition, health plans or programs
operated by the commission as part of the local initiative may also
include, but are not limited to, individuals covered under Title 18
of the Social Security Act (Subchapter 18 (commencing with Section
1395) of Chapter 7 of Title 42 of the United States Code),
individuals employed by public agencies and private businesses, and
uninsured or indigent patients.



14087.9675.  (a) The auditor-controller of the county, at those
intervals the auditor-controller deems appropriate, but no less
frequently than annually, shall conduct a review of the fiscal
condition of the commission, report the findings to the commission
and the board of supervisors, and provide a copy of the findings to
any public agency upon request.
   (b) At the county auditor-controller's discretion, other
operational or financial audits of the commission may be conducted.
   (c) Upon the written request of the county auditor-controller, the
commission shall provide full access to all commission records and
documents as necessary to allow the county auditor-controller to
perform the activities authorized by this section.



14087.968.  Notwithstanding any other provision of law, the county
shall not be liable for any damages or losses, whether financial or
in any other form, that may result from the reliance of any person,
entity, or agency on the actions or omissions of, or the findings
made by, the auditor-controller under this section.




14087.9685.  (a) Notwithstanding any other provision of law, any
obligation of the commission and its local initiative, statutory,
contractual, or otherwise, shall be an obligation solely of the
commission and shall not be an obligation of the county or of the
state. Except as otherwise provided in this article, neither the
county nor the state shall be liable for any act or omission of the
commission.
   (b) Except as agreed to by contract with the county, no liability
of the commission shall become an obligation of the county upon
either termination of the commission and its local initiative or the
liquidation or disposition of the commission's remaining assets.
   (c) All claims for money damages against the commission shall be
governed by Part 3 (commencing with Section 900) and Part 4
(commencing with Section 940) of Division 3.6 of Title 1 of the
Government Code, except as otherwise provided by other statutes or
regulations that expressly apply to the commission.



14087.969.  (a) Notwithstanding any other provision of law, neither
a member of the governing body of the commission nor a member of any
advisory panel to the governing body shall be deemed to be interested
in a contract or amendment to a contract entered into by the
commission within the meaning of Article 4 (commencing with Section
1090) of Chapter 1 of Division 4 of Title 1 of the Government Code if
all of the following conditions are satisfied:
   (1) The board of supervisors or the governing body appointed the
member to represent the interests of the county, physicians, health
care practitioners, hospitals, pharmacies, other health care
organizations, consumers, or consumer advocates. For purposes of this
section, each group whose interests are described in this paragraph
shall be referred to as a stakeholder.
   (2) The contract or the contract as amended authorizes individuals
or organizations in the same stakeholder group that the member was
appointed to represent to provide services under the local
initiative.
   (3) The contract or the contract as amended contains substantially
the same terms and conditions as contracts entered into with other
individuals or organizations in the same stakeholder group that the
member was appointed to represent.
   (4) The contract or the contract as amended does not specifically
authorize the member or the member's organization, as defined in
paragraph (1) of subdivision (e), to provide services under the local
initiative.
   (b) If paragraphs (1) to (3), inclusive, of subdivision (a) are
satisfied but the contract or the contract as amended would
specifically authorize the member or the member's organization to
provide services under the local initiative, the contract approved by
the governing body of the commission shall be deemed to comply with
Section 1090 of the Government Code if the member abstains from
voting on the contract or amendment to the contract, the member
discloses the interest to the governing body or the advisory panel,
whichever is applicable, the governing body or advisory panel notes
the disclosure and the abstention in its official records, the member
does not influence or attempt to influence the governing body, the
advisory panel, or any member of the governing body or advisory panel
to enter into the particular contract or the contract as amended,
and the governing body or advisory panel authorizes the contract or
amendment to the contract in good faith only by a vote of its
membership sufficient for the purpose without counting the vote of
the member.
   (c) Notwithstanding any other provision of law, income from a
contractor under the local initiative to a member or to a member's
organization, as defined in paragraph (1) of subdivision (e), which
is unrelated income, as defined in paragraph (2) of subdivision (e),
shall not cause the member of the governing body of the commission or
the member of the advisory panel to the governing body to be deemed
to be interested in the contract or amendment to the contract for
purposes of Article 4 (commencing with Section 1090) of Chapter 1 of
Division 4 of Title 1 of the Government Code, if the contract or the
contract as amended contains substantially the same terms and
conditions as contracts entered into with other contractors in the
same stakeholder group that is the source of the unrelated income.
   (d) If the particular contract or the contract as amended does not
contain substantially the same terms and conditions as contracts
entered into with other contractors in the same stakeholder group
that is the source of the unrelated income, the contract approved by
the governing body of the commission shall be deemed to comply with
Section 1090 of the Government Code if the member abstains from
voting on the contract or amendment to the contract, the member
discloses the interest to the governing body or the advisory panel,
whichever is applicable, the governing body or advisory panel notes
the disclosure and abstention in its official records, the member
does not influence or attempt to influence the governing body to
enter into the particular contract or the contract as amended, and
the governing body or advisory panel authorizes the contract or
amendment to the contract in good faith only by a vote of its
membership sufficient for that purpose without counting the vote of
the member.
   (e) For purposes of this section, the following definitions shall
apply:
   (1) "Member's organization" means an entity for which the member
serves as an employee, officer, board member, or consultant, or in
which the member has any other financial interest for purposes of
Article 4 (commencing with Section 1090) of Chapter 1 of Division 4
of Title 1 of the Government Code.
   (2) "Unrelated income" means income that is not related to, or is
not for providing services under, the local initiative.




14087.9695.  The department, if at no state General Fund expense,
may take all appropriate steps, in cooperation with the county and
the commission, to obtain approval for a demonstration or pilot
project under applicable federal laws, including, but not limited to,
Section 1315 of Title 42 of the United States Code, in connection
with the local initiative in the county. The project may include
Medi-Cal coverage for enrollees in the local initiative who otherwise
would not be covered under the Medi-Cal program. The project shall
not be used to curtail existing rights with respect to eligibility
and services for the Medi-Cal population, nor to obtain federal
waivers of the payment provisions applicable to federally qualified
health centers or noninstitutional providers under paragraphs (10),
(13), (30), and (37) of subsection (a) of Section 1396a of Title 42
of the United States Code.



14087.9697.  In any transfer of functions from county employees to
the commission, the commission shall continue to recognize the
employee organization that represented the employees performing those
functions at the time of the transfer of duties. The commission
shall also be bound by the terms of any memorandum of understanding
that is in effect as of the date of the transfer of functions for the
duration thereof, or until replaced by a subsequent memorandum of
understanding.



14087.97.  The commission shall be deemed to be a public agency that
is a local unit of government for purposes of all grant programs and
other funding and loan guarantee programs.



14087.9705.  (a) The commission shall obtain licensure as a health
care service plan under Chapter 2.2 (commencing with Section 1340) of
Division 3 of the Health and Safety Code.
   (b) Commencing on the date that the commission first receives
Medi-Cal capitated payments for the provision of health care services
to Medi-Cal beneficiaries and the commission is in full compliance
with all of the requirements regarding tangible net equity applicable
to a health care service plan licensed under Chapter 2.2 (commencing
with Section 1340) of Division 3 of the Health and Safety Code, all
of the following provisions shall apply:
   (1) The commission is authorized to select and design its
automated management information system, subject to the requirement
that the department, in cooperation with the commission, prior to
making capitated payments, approve the system. The department shall
test the system to ensure that the system is capable of producing
detailed, accurate, and timely financial information on the financial
condition of the commission, and any other information that is
generally required by the department in its contracts with other
local initiatives and with health care service plans.
   (2) In addition to the reports required by the Department of
Managed Health Care under Chapter 2.2 (commencing with Section 1340)
of Division 3 of the Health and Safety Code and the rules of the
Director of the Department of Managed Health Care adopted and
promulgated thereunder, the commission shall provide, on a monthly
basis, to the department, the Department of Managed Health Care, and
the members of the commission a copy of the automated report
described in subdivision (a) and a projection of assets and
liabilities, including those that have been incurred but not
reported, with an explanation of material increases or decreases in
current or projected assets and liabilities. The explanation of
increases and decreases in assets or liabilities shall be provided,
upon request, to a hospital, independent physicians' practice
association, or community clinic that has contracted with the
commission to provide health care services.
   (3) In addition to the reporting and notification requirements to
which the commission is subject under Chapter 2.2 (commencing with
Section 1340) of Division 3 of the Health and Safety Code, the chief
executive officer or director of the commission shall immediately
notify the department, the Department of Managed Health Care, and the
members of the commission, in writing, of any fact or facts that, in
the chief executive officer's or director's reasonable and prudent
judgment, is likely to result in the commission being unable to meet
its financial obligations. The written notice shall describe the fact
or facts, the anticipated financial consequences, and the actions
that will be taken to address the anticipated consequences.
   (4) In no event shall the Department of Managed Health Care waive
or vary, nor shall the department request the Department of Managed
Health Care to waive or vary, the tangible net equity requirements
for a commission under Chapter 2.2 (commencing with Section 1340) of
Division 3 of the Health and Safety Code after three years after the
date of the commencement of capitated payments to the commission.
Until the commission is in compliance with all of the tangible net
equity requirements under Chapter 2.2 (commencing with Section 1340)
of Division 3 of the Health and Safety Code and the rules of the
Director of the Department of Managed Health Care adopted and
promulgated thereunder, the commission shall develop a stop-loss
program that is appropriate to the risks of the commission. The
stop-loss program shall be subject to the approval of the department
and the Department of Managed Health Care.
   (5) In the event the commission votes to file a petition of
bankruptcy, or the board of supervisors notifies the department that
it intends to terminate the commission, the department shall
immediately transfer the commission's Medi-Cal beneficiaries to other
managed care contractors, when the contractors are available, and
the contractors are able to demonstrate that they can absorb the
increased enrollment without detriment to the provision of health
care services to their existing enrollees. To the extent that other
managed care providers are unavailable or the department determines
that the transfer to the other contractors to a fee-for-service
reimbursement system is in the best interest of any particular
beneficiary, the department shall make that transfer to the
fee-for-service system, pending the availability of managed care
contractors that can demonstrate that they can absorb the increased
enrollment without detriment to the provision of health care services
to their existing enrollees, or until the department determines that
providing care to any particular beneficiary pursuant to a
fee-for-service reimbursement system is no longer necessary to
protect the continuity of care or other interests of the beneficiary.
Beneficiaries who have been or who are scheduled to be transferred
to a fee-for-service reimbursement system or managed care contractor
may make a choice to be enrolled in another managed care system, if
one is available, in full compliance with federal freedom-of-choice
requirements.
   (6) The commission shall submit to a review of financial records
when the department determines, based on data reported by the
commission or other data received by the department, that the
commission will not be able to meet its financial obligations to
health care providers contracting with the commission. If the
department, pursuant to a review of financial records under this
paragraph, determines that the commission will not be able to meet
its financial obligation to contracting health care providers for the
provision of health care services, the Director of Health Services
shall immediately terminate the contract between the commission and
the department and shall immediately transfer the commission's
Medi-Cal beneficiaries in accordance with paragraph (5) in order to
ensure uninterrupted provision of health care services to
beneficiaries and to minimize financial disruption. Beneficiary
eligibility for Medi-Cal shall not be affected by this action.
Beneficiaries who have been or who are scheduled to be transferred
under paragraph (5) may make a choice to be enrolled in another
managed care plan, if one is available, in full compliance with
federal freedom-of-choice requirements.
   (7) It is the intent of the Legislature that the department shall
implement Medi-Cal capitated enrollments in a manner that ensures
that appropriate levels of health care services will be provided to
Medi-Cal beneficiaries and that appropriate levels of administrative
services will be furnished to health care providers. The contract
between the department and the commission shall authorize the
department to administer the number of covered Medi-Cal enrollments
in a manner that ensures that the commission's provider network and
administrative structure are able to provide appropriate and timely
services to beneficiaries and to participating providers.
   (8) In the event a commission is terminated, files for bankruptcy,
or otherwise no longer functions for the purposes for which it was
established, the county shall, with respect to compensation for
provision of health care services to beneficiaries, occupy no greater
or lesser status than any other health care provider in the
disbursement of assets of the commission.
   (9) Nothing in this section shall be construed to impair or
diminish the authority of the Director of the Department of Managed
Health Care under Chapter 2.2 (commencing with Section 1340) of
Division 3 of the Health and Safety Code, nor shall any thing in this
section be construed to reduce or otherwise limit the obligation of
a commission licensed as a health care plan under Chapter 2.2
(commencing with Section 1340) of Division 3 of the Health and Safety
Code to comply with the requirements of that chapter, and the rules
of the Director of the Department of Managed Health Care adopted
thereunder.



14087.971.  (a) Contracts under this article between the department
and the commission shall be on a nonbid basis and shall be exempt
from Chapter 2 (commencing with Section 10290) of Part 2 of Division
2 of the Public Contract Code.
   (b) It is the intent of the Legislature that the county shall,
with respect to its medical facilities and programs, occupy no
greater or lesser status than any other health care provider in
negotiating with the commission for contracts to provide health care
services.



14087.9715.  The Legislature intends that implementation of this
article shall involve consultation and cooperative activities among
various agencies of the state and county, and the commission. The
Legislature finds and declares that those activities are in
furtherance of the state's goals and efforts. The activities of the
commission and its local initiative shall be recognized as state
action for purposes of all statutes and regulations relating to
business competition.


14087.972.  Neither the commission nor its local initiative shall be
considered to be an agency, division, department, or instrumentality
of the county, and neither the commission nor its local initiative
shall be subject to the personnel, procurement, or other operational
rules of the county.


14087.9722.  (a) If the commission established pursuant to this
article no longer functions for the purposes for which it was
established, when the commission's existing obligations have been
satisfied or the commission's assets have been exhausted, the board
of supervisors may, by ordinance, resolution, or other action,
terminate the commission.
   (b) Prior to the termination of the commission, the board of
supervisors shall notify the department of its intent to terminate
the commission. Within 30 days of the notification, the department
shall conduct an audit of the records of the commission to determine
the liabilities and assets of the commission. The department shall
report its findings to the board of supervisors within 10 days of the
completion of the audit. The board of supervisors shall prepare a
plan to liquidate or otherwise dispose of the assets of the
commission and to pay the liabilities of the commission to the extent
of the commission's assets, and shall present the plan to the
department within 30 days after receiving the department's audit
findings.
   (c) Upon termination of the commission by the board of
supervisors, the county shall manage any remaining assets of the
commission until superseded by a plan approved by the department.
   (d) All assets of the commission remaining after the payment of
the liabilities of the commission pursuant to subdivision (b) shall
be disposed of pursuant to the contract entered into between the
state and the commission pursuant to Section 14087.




14087.9725.  (a) Nothing in this article shall be construed as
amending the requirements of Section 17000.
   (b) Nothing in this article shall be construed to preclude the
department from expanding Medi-Cal managed care in ways other than
those expressly provided in this article.



State Codes and Statutes

State Codes and Statutes

Statutes > California > Wic > 14087.96-14087.9725

WELFARE AND INSTITUTIONS CODE
SECTION 14087.96-14087.9725



14087.96.  The following definitions shall apply for purposes of
this article:
   (a) "County" means the County of Los Angeles.
   (b) "Board of supervisors" means the Board of Supervisors of the
County of Los Angeles.
   (c) "Commission" means the separate public agency established by
the board of supervisors to operate a local initiative for health
care in the county.
   (d) "Local initiative" means the health plan or plans and other
health care programs owned or operated by the commission established
under this article, and operated pursuant to the strategic plan.
   (e) "Medi-Cal managed care programs" means all those components of
the Medi-Cal program that involve the restriction of access for
Medi-Cal patients to particular providers or health plans and that
involve managed care principles, including, but not limited to,
programs such as those described in Article 2.7 (commencing with
Section 14087.3), Article 2.8 (commencing with Section 14087.5),
Chapter 8 (commencing with Section 14200), including pilot programs
under Article 7 (commencing with Section 14490) thereof.
   (f) "Health care consumer" means a Medi-Cal beneficiary or any
other person eligible to receive health care services under the local
initiative, including parents, legal guardians, or conservators of
Medi-Cal beneficiaries and people who will receive health care
services under the local initiative.
   (g) "Health care consumer advocate" means an individual who,
whether in a paid or unpaid capacity, represents the interests of
Medi-Cal beneficiaries or people who will receive health care under
the local initiative.
   (h) "Strategic plan" means the report issued on March 31, 1993, by
the State Department of Health Services, entitled "The State
Department of Health Services' Plan for Expanding Medi-Cal Managed
Care: Protecting Vulnerable Populations" or the report, as
subsequently revised or amended.


14087.9605.  (a) The board of supervisors may, by ordinance,
resolution, or other action, establish a commission in order to meet
the problems of delivery of publicly assisted medical care in the
county and demonstrate ways of promoting quality care and cost
efficiency. The health care services provided by the commission shall
include, but are not limited to, services covered under this chapter
provided on a coordinated managed care basis. The commission shall
operate the local initiative that provides or arranges for the
delivery of health care services in all or part of the geographic
area of the county, in a manner that is consistent with managed care
principles, techniques, and practices directed at ensuring
cost-effective and adequate access to quality care, without
discrimination on the basis of medical condition, diagnosis, or
illness, in an amount, duration, and scope that is sufficient to
reasonably achieve its purpose for enrollees in the local initiative.
If the board of supervisors establishes a commission, all rights,
powers, duties, privileges, and immunities vested in the county
pursuant to the contract with the department under this article shall
be vested in the commission.
   (b) (1) The commission shall be considered a public entity that is
a local unit of government and that is separate from the county,
shall file the statement required by Section 53051 of the Government
Code, and shall be considered a public entity for purposes of
Division 3.6 (commencing with Section 810) of Title 1 of the
Government Code. The commission, members of the commission, and
employees of the commission shall be protected by the immunities
applicable to public entities and public employees governed by Part 2
(commencing with Section 814) of Division 3.6 of Title 1 of the
Government Code, except as provided by other statutes or regulations
that apply expressly to the commission.
   (2) The commission shall have all power necessary and appropriate
to do all of the following:
   (A) Operate programs involving health care services, including,
but not limited to, the power to own and operate one or more health
plans.
   (B) To enter into agreements with any public or private entity or
entities to provide or arrange for health care services on a
capitated or noncapitated basis.
   (C) To acquire, possess, and dispose of real or personal property.
   (D) To employ personnel and contract for services required to meet
its obligations.
   (E) To sue or be sued.
   (F) To enter into agreements under Chapter 5 (commencing with
Section 6500) of Division 7 of Title 1 of the Government Code.
   (3) The commission may enter into contracts with public and
private health care providers to provide health care and related
services to individuals enrolled in any health plan or health program
operated as part of the local initiative.
   (c) Nothing in this section shall be construed to authorize the
commission to operate any health care program other than the local
initiative described in the strategic plan as it currently exists or
as it may be amended by the department.



14087.961.  Governance of the commission shall be vested in a
governing body consisting of 13 members, each of whom shall have a
fiduciary duty to act in the best interest of the commission and the
local initiative, nominated by the following entities, and appointed
by the board of supervisors:
   (a) Four members shall be nominated by the board of supervisors to
represent the County of Los Angeles. No more than one member
nominated by the board of supervisors shall be a member of the board
of supervisors and each remaining member nominated by the board of
supervisors shall possess experience as a health care administrator
or as a health care provider.
   (b) One member shall be a representative of private hospitals that
have Medi-Cal disproportionate share status, or if that status no
longer exists, that serve an equivalent patient population, who shall
be nominated by the Hospital Association of Southern California.
   (c) One member shall be a representative of private hospitals that
do not have Medi-Cal disproportionate share status, who shall be
nominated by the Hospital Association of Southern California.
   (d) One member shall be a representative of free and community
clinics, who shall be nominated by the Community Clinics Association
of Los Angeles County.
   (e) One member shall be a representative of federally qualified
health centers, who shall be nominated by the Community Clinics
Association of Los Angeles County, or if that status no longer
exists, an equivalent group of health centers.
   (f) One member shall be a physician representative, who shall be
nominated by the Los Angeles County Medical Association, in
consultation with other physician associations within the county.
   (g) One member shall be a representative of Knox-Keene licensed
prepaid health plans, who shall be nominated by the California
Association of Health Plans.
   (h) One member shall represent health care consumers, and at the
time of being nominated, shall be a health care consumer. The initial
nominee shall be nominated by the working group on the role of the
consumer for the first nominee, and thereafter, by a process
determined by the community advisory committee under which only
health care consumers may nominate and vote for appointees.
   (i) One member shall be a health care consumer advocate, who shall
represent health care consumers. The initial nominee shall be
nominated by the working group on the role of the consumer for the
first nominee, and thereafter, by a process determined by the
community advisory committee under which only health care consumers
may nominate and vote for appointees.
   (j) One member shall be a children's health care provider
representative, who shall be nominated by the Children's Planning
Council as the coordinating entity for organizations and agencies
providing direct services to, or advocacy for, children and families
within the county.



14087.9615.  (a) The composition of the 13-member governing body of
the commission, as prescribed in Section 14087.961, shall be subject
to alteration upon a two-thirds vote of the full membership of the
governing body, if the action is also concurred in by an affirmative
vote of at least four members of the board of supervisors; provided,
however, no change in the composition of the governing board shall
result in the elimination of representation by the county, private
physicians, hospitals, and other providers, clinics, or consumers and
consumer advocates.
   (b) Notwithstanding subdivision (a), no governing body member
shall be removed except as provided in Section 14087.964.



14087.962.  Members of the governing body shall either reside, be
employed, or provide services in the geographic area served by the
local initiative. Nominees shall be appointed to the governing body
by the board of supervisors. The board of supervisors shall not deny
appointment to a nominee described in subdivisions (b) to (j),
inclusive, of Section 14087.961 without specific cause as set forth
in Section 14087.964.



14087.9625.  (a) Members of the governing body of the commission
shall serve four-year terms.
   (b) Individuals shall be limited to serving on the governing body
for two consecutive four-year terms or a maximum of 10 years.



14087.963.  (a) The governing body of the commission shall establish
rules for its proceedings. There shall be at least six meetings per
year.
   (b) (1) Each governing body member shall be entitled to one
hundred dollars ($100) remuneration from commission funds for each
governing body meeting attended, and may receive similar remuneration
for attending meetings of committees of the governing body, except
that the total remuneration for each governing body member for all
meetings shall not exceed the sum of four hundred dollars ($400) per
month, plus actual expenses incurred in attending these meetings at
rates payable to county officers and employees.
   (2) The per meeting rate and monthly limit of one hundred dollars
($100) and four hundred dollars ($400), respectively, may be
increased by the governing body, subject to approval by the board of
supervisors.


14087.9635.  (a) A majority of the members of the governing body
shall constitute a quorum for the transaction of business, and all
official acts of the governing body shall require the affirmative
vote of a majority of the members present and voting.
   (b) No official act shall be approved with less than the
affirmative vote of four members of the governing body, unless the
number of members prohibited from voting because of conflicts of
interest precludes adequate participation in the vote.



14087.964.  A member of the governing body shall be removed from
office if a majority of the members present and voting find that one
or more of the following causes for removal exists:
   (a) The member neither lives in, nor is employed in, the
geographic area served by the local initiative.
   (b) The member has been convicted of a crime involving corruption
or any felony.
   (c) The member has failed to attend three consecutive governing
body meetings or a majority of the meetings in the most recent
calendar year.
   (d) The member has failed to discharge legal obligations as a
member of a public agency.
   (e) A request for removal has been submitted by the appropriate
nominating entity in accordance with Section 14087.9645.



14087.9645.  A member of the governing body may be removed at the
request of the entity that nominated the member. The entity that
nominated a member may request removal of that member for any of the
following reasons:
   (a) Any of the causes listed in Section 14087.964.
   (b) The member no longer meets the qualifications for office or
the criteria applied by the nominating entity in selecting the member
as its nominee.



14087.965.  (a) A request for removal under Section 14087.9645 shall
be adopted by the nominating entity in the same manner as the
nomination was adopted and shall be confirmed by a written request
for removal delivered to the governing body, setting forth the
grounds for removal.
   (b) A removal under subdivision (a) shall be effective upon action
by the governing body, that shall be taken at the first meeting
following receipt of the written request.
   (c) The nominating entity shall be legally responsible for
improper removals.
   (d) A nominating entity that requests removal of a governing body
member shall nominate a successor within 60 days after the effective
date of the removal.


14087.9655.  (a) The governing body shall establish a technical
advisory committee to provide technical expertise to the governing
body.
   (b) Members of the committee shall include a medical school
representative, an epidemiologist, a pharmacist, a representative of
a nursing association, a home health care representative, a long-term
care provider, a mental health care provider, a medical
rehabilitation provider, and an expert on health care quality, or, in
the alternative, other persons with health care expertise.
   (c) The technical advisory committee shall meet on a regular
basis, and shall make recommendations and reports to the governing
body.



14087.9657.  (a) The governing body shall establish a children's
health consultant advisory committee to provide to the governing body
expertise on child, adolescent, and maternal health issues.
   (b) Members of the committee shall include representatives of
government health departments and school districts in the geographic
area served by the local initiative, as well as medical professionals
with background in pediatrics and obstetric care, or, in the
alternative, other persons with health care expertise.
   (c) The children's health consultant advisory committee shall meet
on a regular basis, and shall make recommendations and reports to
the governing body.



14087.966.  (a) The governing body for each geographic region served
by the local initiative shall establish a regional community
advisory committee to ensure community involvement.
   (b) Each regional community advisory committee shall have no more
than 35 members, a majority of whom shall be consumers and consumer
advocates, but may also include providers.
   (c) (1) The chairpersons of the regional community advisory
committees shall comprise an executive community advisory committee.
   (2) It is the intent of the Legislature that a majority of the
executive community advisory committee shall be consumers and
consumer advocates, plus two at-large members.
   (d) The executive community advisory committee shall make
recommendations, and shall report on its activities, to the governing
body and shall be able to place matters of the governing body's
agenda for consideration.



14087.9665.  (a) The commission may borrow or receive funds from any
person or entity as necessary to cover development costs and other
actual or projected obligations of the local initiative.
   (b) The county may lend funds to the commission upon such terms as
the board of supervisors may establish.
   (c) Notwithstanding any other provision of law, both the county
and the commission shall be eligible to receive funding under
subdivision (p) of Section 14163, and the local initiative shall be
considered for all purposes to satisfy the requirements of
subdivision (p) of Section 14163.



14087.967.  To the full extent permitted by federal law, the
department and the commission may enter into contracts to provide or
arrange for health care services for any or all persons who are
eligible to receive benefits under the Medi-Cal program. The
contracts may be on an exclusive or nonexclusive basis, and shall
include payment provisions on any basis negotiated between the
department and the commission. In addition, health plans or programs
operated by the commission as part of the local initiative may also
include, but are not limited to, individuals covered under Title 18
of the Social Security Act (Subchapter 18 (commencing with Section
1395) of Chapter 7 of Title 42 of the United States Code),
individuals employed by public agencies and private businesses, and
uninsured or indigent patients.



14087.9675.  (a) The auditor-controller of the county, at those
intervals the auditor-controller deems appropriate, but no less
frequently than annually, shall conduct a review of the fiscal
condition of the commission, report the findings to the commission
and the board of supervisors, and provide a copy of the findings to
any public agency upon request.
   (b) At the county auditor-controller's discretion, other
operational or financial audits of the commission may be conducted.
   (c) Upon the written request of the county auditor-controller, the
commission shall provide full access to all commission records and
documents as necessary to allow the county auditor-controller to
perform the activities authorized by this section.



14087.968.  Notwithstanding any other provision of law, the county
shall not be liable for any damages or losses, whether financial or
in any other form, that may result from the reliance of any person,
entity, or agency on the actions or omissions of, or the findings
made by, the auditor-controller under this section.




14087.9685.  (a) Notwithstanding any other provision of law, any
obligation of the commission and its local initiative, statutory,
contractual, or otherwise, shall be an obligation solely of the
commission and shall not be an obligation of the county or of the
state. Except as otherwise provided in this article, neither the
county nor the state shall be liable for any act or omission of the
commission.
   (b) Except as agreed to by contract with the county, no liability
of the commission shall become an obligation of the county upon
either termination of the commission and its local initiative or the
liquidation or disposition of the commission's remaining assets.
   (c) All claims for money damages against the commission shall be
governed by Part 3 (commencing with Section 900) and Part 4
(commencing with Section 940) of Division 3.6 of Title 1 of the
Government Code, except as otherwise provided by other statutes or
regulations that expressly apply to the commission.



14087.969.  (a) Notwithstanding any other provision of law, neither
a member of the governing body of the commission nor a member of any
advisory panel to the governing body shall be deemed to be interested
in a contract or amendment to a contract entered into by the
commission within the meaning of Article 4 (commencing with Section
1090) of Chapter 1 of Division 4 of Title 1 of the Government Code if
all of the following conditions are satisfied:
   (1) The board of supervisors or the governing body appointed the
member to represent the interests of the county, physicians, health
care practitioners, hospitals, pharmacies, other health care
organizations, consumers, or consumer advocates. For purposes of this
section, each group whose interests are described in this paragraph
shall be referred to as a stakeholder.
   (2) The contract or the contract as amended authorizes individuals
or organizations in the same stakeholder group that the member was
appointed to represent to provide services under the local
initiative.
   (3) The contract or the contract as amended contains substantially
the same terms and conditions as contracts entered into with other
individuals or organizations in the same stakeholder group that the
member was appointed to represent.
   (4) The contract or the contract as amended does not specifically
authorize the member or the member's organization, as defined in
paragraph (1) of subdivision (e), to provide services under the local
initiative.
   (b) If paragraphs (1) to (3), inclusive, of subdivision (a) are
satisfied but the contract or the contract as amended would
specifically authorize the member or the member's organization to
provide services under the local initiative, the contract approved by
the governing body of the commission shall be deemed to comply with
Section 1090 of the Government Code if the member abstains from
voting on the contract or amendment to the contract, the member
discloses the interest to the governing body or the advisory panel,
whichever is applicable, the governing body or advisory panel notes
the disclosure and the abstention in its official records, the member
does not influence or attempt to influence the governing body, the
advisory panel, or any member of the governing body or advisory panel
to enter into the particular contract or the contract as amended,
and the governing body or advisory panel authorizes the contract or
amendment to the contract in good faith only by a vote of its
membership sufficient for the purpose without counting the vote of
the member.
   (c) Notwithstanding any other provision of law, income from a
contractor under the local initiative to a member or to a member's
organization, as defined in paragraph (1) of subdivision (e), which
is unrelated income, as defined in paragraph (2) of subdivision (e),
shall not cause the member of the governing body of the commission or
the member of the advisory panel to the governing body to be deemed
to be interested in the contract or amendment to the contract for
purposes of Article 4 (commencing with Section 1090) of Chapter 1 of
Division 4 of Title 1 of the Government Code, if the contract or the
contract as amended contains substantially the same terms and
conditions as contracts entered into with other contractors in the
same stakeholder group that is the source of the unrelated income.
   (d) If the particular contract or the contract as amended does not
contain substantially the same terms and conditions as contracts
entered into with other contractors in the same stakeholder group
that is the source of the unrelated income, the contract approved by
the governing body of the commission shall be deemed to comply with
Section 1090 of the Government Code if the member abstains from
voting on the contract or amendment to the contract, the member
discloses the interest to the governing body or the advisory panel,
whichever is applicable, the governing body or advisory panel notes
the disclosure and abstention in its official records, the member
does not influence or attempt to influence the governing body to
enter into the particular contract or the contract as amended, and
the governing body or advisory panel authorizes the contract or
amendment to the contract in good faith only by a vote of its
membership sufficient for that purpose without counting the vote of
the member.
   (e) For purposes of this section, the following definitions shall
apply:
   (1) "Member's organization" means an entity for which the member
serves as an employee, officer, board member, or consultant, or in
which the member has any other financial interest for purposes of
Article 4 (commencing with Section 1090) of Chapter 1 of Division 4
of Title 1 of the Government Code.
   (2) "Unrelated income" means income that is not related to, or is
not for providing services under, the local initiative.




14087.9695.  The department, if at no state General Fund expense,
may take all appropriate steps, in cooperation with the county and
the commission, to obtain approval for a demonstration or pilot
project under applicable federal laws, including, but not limited to,
Section 1315 of Title 42 of the United States Code, in connection
with the local initiative in the county. The project may include
Medi-Cal coverage for enrollees in the local initiative who otherwise
would not be covered under the Medi-Cal program. The project shall
not be used to curtail existing rights with respect to eligibility
and services for the Medi-Cal population, nor to obtain federal
waivers of the payment provisions applicable to federally qualified
health centers or noninstitutional providers under paragraphs (10),
(13), (30), and (37) of subsection (a) of Section 1396a of Title 42
of the United States Code.



14087.9697.  In any transfer of functions from county employees to
the commission, the commission shall continue to recognize the
employee organization that represented the employees performing those
functions at the time of the transfer of duties. The commission
shall also be bound by the terms of any memorandum of understanding
that is in effect as of the date of the transfer of functions for the
duration thereof, or until replaced by a subsequent memorandum of
understanding.



14087.97.  The commission shall be deemed to be a public agency that
is a local unit of government for purposes of all grant programs and
other funding and loan guarantee programs.



14087.9705.  (a) The commission shall obtain licensure as a health
care service plan under Chapter 2.2 (commencing with Section 1340) of
Division 3 of the Health and Safety Code.
   (b) Commencing on the date that the commission first receives
Medi-Cal capitated payments for the provision of health care services
to Medi-Cal beneficiaries and the commission is in full compliance
with all of the requirements regarding tangible net equity applicable
to a health care service plan licensed under Chapter 2.2 (commencing
with Section 1340) of Division 3 of the Health and Safety Code, all
of the following provisions shall apply:
   (1) The commission is authorized to select and design its
automated management information system, subject to the requirement
that the department, in cooperation with the commission, prior to
making capitated payments, approve the system. The department shall
test the system to ensure that the system is capable of producing
detailed, accurate, and timely financial information on the financial
condition of the commission, and any other information that is
generally required by the department in its contracts with other
local initiatives and with health care service plans.
   (2) In addition to the reports required by the Department of
Managed Health Care under Chapter 2.2 (commencing with Section 1340)
of Division 3 of the Health and Safety Code and the rules of the
Director of the Department of Managed Health Care adopted and
promulgated thereunder, the commission shall provide, on a monthly
basis, to the department, the Department of Managed Health Care, and
the members of the commission a copy of the automated report
described in subdivision (a) and a projection of assets and
liabilities, including those that have been incurred but not
reported, with an explanation of material increases or decreases in
current or projected assets and liabilities. The explanation of
increases and decreases in assets or liabilities shall be provided,
upon request, to a hospital, independent physicians' practice
association, or community clinic that has contracted with the
commission to provide health care services.
   (3) In addition to the reporting and notification requirements to
which the commission is subject under Chapter 2.2 (commencing with
Section 1340) of Division 3 of the Health and Safety Code, the chief
executive officer or director of the commission shall immediately
notify the department, the Department of Managed Health Care, and the
members of the commission, in writing, of any fact or facts that, in
the chief executive officer's or director's reasonable and prudent
judgment, is likely to result in the commission being unable to meet
its financial obligations. The written notice shall describe the fact
or facts, the anticipated financial consequences, and the actions
that will be taken to address the anticipated consequences.
   (4) In no event shall the Department of Managed Health Care waive
or vary, nor shall the department request the Department of Managed
Health Care to waive or vary, the tangible net equity requirements
for a commission under Chapter 2.2 (commencing with Section 1340) of
Division 3 of the Health and Safety Code after three years after the
date of the commencement of capitated payments to the commission.
Until the commission is in compliance with all of the tangible net
equity requirements under Chapter 2.2 (commencing with Section 1340)
of Division 3 of the Health and Safety Code and the rules of the
Director of the Department of Managed Health Care adopted and
promulgated thereunder, the commission shall develop a stop-loss
program that is appropriate to the risks of the commission. The
stop-loss program shall be subject to the approval of the department
and the Department of Managed Health Care.
   (5) In the event the commission votes to file a petition of
bankruptcy, or the board of supervisors notifies the department that
it intends to terminate the commission, the department shall
immediately transfer the commission's Medi-Cal beneficiaries to other
managed care contractors, when the contractors are available, and
the contractors are able to demonstrate that they can absorb the
increased enrollment without detriment to the provision of health
care services to their existing enrollees. To the extent that other
managed care providers are unavailable or the department determines
that the transfer to the other contractors to a fee-for-service
reimbursement system is in the best interest of any particular
beneficiary, the department shall make that transfer to the
fee-for-service system, pending the availability of managed care
contractors that can demonstrate that they can absorb the increased
enrollment without detriment to the provision of health care services
to their existing enrollees, or until the department determines that
providing care to any particular beneficiary pursuant to a
fee-for-service reimbursement system is no longer necessary to
protect the continuity of care or other interests of the beneficiary.
Beneficiaries who have been or who are scheduled to be transferred
to a fee-for-service reimbursement system or managed care contractor
may make a choice to be enrolled in another managed care system, if
one is available, in full compliance with federal freedom-of-choice
requirements.
   (6) The commission shall submit to a review of financial records
when the department determines, based on data reported by the
commission or other data received by the department, that the
commission will not be able to meet its financial obligations to
health care providers contracting with the commission. If the
department, pursuant to a review of financial records under this
paragraph, determines that the commission will not be able to meet
its financial obligation to contracting health care providers for the
provision of health care services, the Director of Health Services
shall immediately terminate the contract between the commission and
the department and shall immediately transfer the commission's
Medi-Cal beneficiaries in accordance with paragraph (5) in order to
ensure uninterrupted provision of health care services to
beneficiaries and to minimize financial disruption. Beneficiary
eligibility for Medi-Cal shall not be affected by this action.
Beneficiaries who have been or who are scheduled to be transferred
under paragraph (5) may make a choice to be enrolled in another
managed care plan, if one is available, in full compliance with
federal freedom-of-choice requirements.
   (7) It is the intent of the Legislature that the department shall
implement Medi-Cal capitated enrollments in a manner that ensures
that appropriate levels of health care services will be provided to
Medi-Cal beneficiaries and that appropriate levels of administrative
services will be furnished to health care providers. The contract
between the department and the commission shall authorize the
department to administer the number of covered Medi-Cal enrollments
in a manner that ensures that the commission's provider network and
administrative structure are able to provide appropriate and timely
services to beneficiaries and to participating providers.
   (8) In the event a commission is terminated, files for bankruptcy,
or otherwise no longer functions for the purposes for which it was
established, the county shall, with respect to compensation for
provision of health care services to beneficiaries, occupy no greater
or lesser status than any other health care provider in the
disbursement of assets of the commission.
   (9) Nothing in this section shall be construed to impair or
diminish the authority of the Director of the Department of Managed
Health Care under Chapter 2.2 (commencing with Section 1340) of
Division 3 of the Health and Safety Code, nor shall any thing in this
section be construed to reduce or otherwise limit the obligation of
a commission licensed as a health care plan under Chapter 2.2
(commencing with Section 1340) of Division 3 of the Health and Safety
Code to comply with the requirements of that chapter, and the rules
of the Director of the Department of Managed Health Care adopted
thereunder.



14087.971.  (a) Contracts under this article between the department
and the commission shall be on a nonbid basis and shall be exempt
from Chapter 2 (commencing with Section 10290) of Part 2 of Division
2 of the Public Contract Code.
   (b) It is the intent of the Legislature that the county shall,
with respect to its medical facilities and programs, occupy no
greater or lesser status than any other health care provider in
negotiating with the commission for contracts to provide health care
services.



14087.9715.  The Legislature intends that implementation of this
article shall involve consultation and cooperative activities among
various agencies of the state and county, and the commission. The
Legislature finds and declares that those activities are in
furtherance of the state's goals and efforts. The activities of the
commission and its local initiative shall be recognized as state
action for purposes of all statutes and regulations relating to
business competition.


14087.972.  Neither the commission nor its local initiative shall be
considered to be an agency, division, department, or instrumentality
of the county, and neither the commission nor its local initiative
shall be subject to the personnel, procurement, or other operational
rules of the county.


14087.9722.  (a) If the commission established pursuant to this
article no longer functions for the purposes for which it was
established, when the commission's existing obligations have been
satisfied or the commission's assets have been exhausted, the board
of supervisors may, by ordinance, resolution, or other action,
terminate the commission.
   (b) Prior to the termination of the commission, the board of
supervisors shall notify the department of its intent to terminate
the commission. Within 30 days of the notification, the department
shall conduct an audit of the records of the commission to determine
the liabilities and assets of the commission. The department shall
report its findings to the board of supervisors within 10 days of the
completion of the audit. The board of supervisors shall prepare a
plan to liquidate or otherwise dispose of the assets of the
commission and to pay the liabilities of the commission to the extent
of the commission's assets, and shall present the plan to the
department within 30 days after receiving the department's audit
findings.
   (c) Upon termination of the commission by the board of
supervisors, the county shall manage any remaining assets of the
commission until superseded by a plan approved by the department.
   (d) All assets of the commission remaining after the payment of
the liabilities of the commission pursuant to subdivision (b) shall
be disposed of pursuant to the contract entered into between the
state and the commission pursuant to Section 14087.




14087.9725.  (a) Nothing in this article shall be construed as
amending the requirements of Section 17000.
   (b) Nothing in this article shall be construed to preclude the
department from expanding Medi-Cal managed care in ways other than
those expressly provided in this article.