SECTIONS 14087.5-14087.95 - California Statutes

WELFARE AND INSTITUTIONS CODE

SECTION 14087.5-14087.95

14087.5. (a) The California Medical Assistance Commission may
negotiate exclusive contracts with any county which seeks to provide,
or arrange for the provision of the health care services provided
under this chapter. The California Medical Assistance Commission
shall establish regulations concerning the time for submittal of
proposed plans for a contract by a county, and for the time by which
the California Medical Assistance Commission shall decide whether or
not to accept the county's proposal.
(b) The department shall seek all federal waivers necessary to
allow for federal financial participation in expenditures under this
article. This article shall not be implemented until all necessary
waivers have been approved by the federal government.
(c) (1) Notwithstanding subdivision (a) or any other provision of
law, on and after the effective date of the act adding this
subdivision, the department shall have exclusive authority to
negotiate the rates, terms, and conditions of county organized health
systems contracts and contract amendments under this article or
under Article 7 (commencing with Section 14490) of Chapter 8. As of
that date, all references in this article to the negotiator or the
California Medical Assistance Commission shall mean the department.
(2) For contracts executed pursuant to this article, the
department shall disclose, upon request, each negotiated contract or
contract amendment executed by both parties after July 1, 2007, which
shall be considered public records for the purposes of the
California Public Records Act (Chapter 3.5 (commencing with Section
6250) of Division 7 of Title 1 of the Government Code), including
contracts that reveal the department's rates of payment for health
care services, the rates themselves, and rate manuals.

14087.51. (a) It is necessary that a special commission be
established in San Mateo County and in any other county designated by
the California Medical Assistance Commission in order to meet the
problems of the delivery of publicly assisted medical care in the
counties and to demonstrate ways of promoting quality care and cost
efficiency.
(b) The Board of Supervisors of San Mateo County and of the
designated counties may, by ordinance, establish commissions to do
any or all of the following:
(1) Negotiate the exclusive contracts specified in Section 14087.5
and to arrange for the provision of health care services provided
pursuant to this chapter.
(2) Enter into contracts for the provision of health care services
to subscribers in the Healthy Families Program.
(3) Enter into agreements under Chapter 5 (commencing with Section
6500) of Division 7 of Title 1 of the Government Code.
(c) In addition to the authority specified in subdivision (b), the
Board of Supervisors of San Mateo County may, by ordinance,
authorize the commission established pursuant to this section to
provide health care delivery systems for any or all of the following
persons:
(1) Persons who are eligible to receive medical benefits under
this chapter in the county, including, but not limited to, persons
who are eligible through federal waiver or a pilot project.
(2) Persons who are eligible to receive medical benefits under
both Title 18 and Title 19 of the federal Social Security Act.
(3) Persons who are eligible to receive medical benefits under
Title 18 of the federal Social Security Act.
(4) Persons who are eligible to receive medical benefits under
publicly supported programs if the commission and participating
providers acting pursuant to subcontracts with the commission agree
to hold harmless the beneficiaries of the publicly supported programs
if the contract between the sponsoring government agency and the
commission does not ensure sufficient funding to cover program costs.
(5) Other individuals or groups in the service area, including,
but not limited to, public agencies, private businesses, and
uninsured or indigent persons. The commission shall not use any
payment or reserve from the Medi-Cal program for purposes of this
paragraph.
(d) Nothing in this section shall prohibit the commission
established pursuant to this section from providing services pursuant
to paragraph (5) of subdivision (c) in counties other than the
commission's county if the commission is approved by the Department
of Managed Health Care to provide services in those counties. The
commission shall not use any payment or reserve from the Medi-Cal
program for purposes of this subdivision.
(e) If the board of supervisors elects to enact an ordinance
pursuant to this section, all rights, powers, duties, privileges, and
immunities vested in a county by an article shall be vested in the
county commission. Any reference in this article to "county" shall
mean a commission established pursuant to this section.
(f) The enabling ordinance shall specify the membership of the
county commission, the qualifications for individual members, and any
other matters as the board of supervisors deems necessary or
convenient for the conduct of the county commission's activities. A
commission so established shall be considered a public entity for
purposes of Division 3.6 (commencing with Section 810) of Title 1 of
the Government Code. All commissioners shall be appointed by majority
vote of the board of supervisors and shall serve at the pleasure
thereof. The board of supervisors may appoint no more than two of its
own members to serve on the commission.
(g) As an alternative to establishing a separate commission, the
enabling ordinance may designate the board of supervisors itself as
the commission authorized by this article.
(h) Nothing in this section shall be construed to supersede
Section 14093.06 or 14094.3.

14087.52. (a) It is necessary that a special commission be
established in San Bernardino County in order to meet the problems of
the delivery of publicly assisted medical care in the county and to
demonstrate ways of promoting quality care and cost efficiency.
Because there is no general law under which such a commission could
be formed, the adoption of a special act and the formation of a
special commission is required.
(b) The Board of Supervisors of San Bernardino County may, by
ordinance, establish a commission to negotiate the exclusive contract
specified in Section 14087.5 and to arrange for the provision of
health care services provided pursuant to this chapter, and to enter
into contracts for the provision of health care services to
subscribers in the Healthy Families Program. If the board of
supervisors elects to enact this ordinance, all rights, powers,
duties, privileges, and immunities vested in a county by this article
shall be vested in the county commission. Any reference in this
article to "county" shall mean the commission established pursuant to
this section.
(c) It is the intent of the Legislature that if such a commission
is formed, the County of San Bernardino 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.
(d) The enabling ordinance shall specify the membership of the
county commission, the qualifications for individual members, the
manner of appointment, selection, or removal of commissioners, and
how long they shall serve, and any other matters as the board of
supervisors deems necessary or convenient for the conduct of the
county commission's activities. The commission so established shall
be considered an entity separate from the county, shall file the
statement required by Section 53051 of the Government Code, and shall
have, in addition to the rights, powers, duties, privileges, and
immunities previously conferred, the power to acquire, possess, and
dispose of real or personal property, as may be necessary for the
performance of its functions, to employ personnel and contract for
services required to meet its obligations, and to sue or be sued. Any
obligations of the commission, statutory, contractual, or otherwise,
shall be the obligations solely of the commission and shall not be
the obligations of the county or of the state unless expressly
provided for in a contract between the commission and the county or
state.
(e) Upon creation, the commission may borrow from the county, and
the county may lend the commission funds, or issue revenue
anticipation notes to obtain those funds necessary to commence
operations.
(f) In the event the commission may no longer function for the
purposes for which established, at such time as the commission's then
existing obligations have been satisfied or the commission's assets
have been exhausted, the board of supervisors may by ordinance
terminate the commission.
(g) Prior to the termination of the commission, the board of
supervisors shall notify the State Department of Health Services of
its intent to terminate the commission. The department shall conduct
an audit of the commission's records within 30 days of notification
to determine the liabilities and assets of the commission. The
department shall report its findings to the board within 10 days of
completion of the audit. The board 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 present the plan to the department within 30 days upon
receipt of these findings.
(h) Upon termination of the commission by the board, the County of
San Bernardino shall manage any remaining assets of the commission
until superseded by a department approved plan. Any liabilities of
the commission shall not become obligations of the county upon either
the termination of the commission or the liquidation or disposition
of the commission's remaining assets.
(i) Any assets of the commission shall be disposed of pursuant to
provisions contained in the contract entered into between the state
and the commission pursuant to this article.

14087.53. (a) It is necessary that a special commission be
established in Ventura County in order to meet the problems of the
delivery of publicly assisted medical care in the county and to
demonstrate ways of promoting quality care and cost efficiency.
Because there is no general law under which such a commission could
be formed, the adoption of a special act and the formation of a
special commission is required.
(b) The Board of Supervisors of Ventura County may, by ordinance,
establish a commission to negotiate the exclusive contract specified
in Section 14087.5 and to arrange for the provision of health care
services provided pursuant to this chapter, and to enter into
contracts for the provision of health care services to subscribers in
the Healthy Families Program. If the board of supervisors elects to
enact this ordinance, all rights, powers, duties, privileges, and
immunities vested in a county by this article shall be vested in the
county commission. Any reference in this article to "county" shall
mean the commission established pursuant to this section.
(c) The enabling ordinance shall specify the membership of the
county commission, the qualifications for individual members, the
manner of appointment, selection, or removal of commissioners, and
how long they shall serve, and any other matters as the board of
supervisors deems necessary or convenient for the conduct of the
county commission's activities. The commission so established shall
be considered an entity separate from the county, shall file the
statement required by Section 53051 of the Government Code, and shall
have, in addition to the rights, powers, duties, privileges, and
immunities previously conferred, the power to acquire, possess, and
dispose of real or personal property, as may be necessary for the
performance of its functions, to employ personnel and contract for
services required to meet its obligations, and to sue or be sued. Any
obligations of the commission, statutory, contractual, or otherwise,
shall be the obligations solely of the commission and shall not be
the obligations of the county or of the state.
(d) Upon creation, the commission may borrow from the county and
the county may lend the commission funds, or issue revenue
anticipation notes to obtain those funds necessary to commence
operations.
(e) In the event the commission may no longer function for the
purposes for which established, at such time as the commission's then
existing obligations have been satisfied or the commission's assets
have been exhausted, the board of supervisors may by ordinance
terminate the commission.
(f) Prior to the termination of the commission, the board of
supervisors shall notify the State Department of Health Services of
its intent to terminate the commission. The department shall conduct
an audit of the commission's records within 30 days of notification
to determine the liabilities and assets of the commission. The
department shall report its findings to the board within 10 days of
completion of the audit. The board 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 present the plan to the department within 30 days upon
receipt of these findings.
(g) Any assets of the commission shall be disposed of pursuant to
provisions contained in the contract entered into between the state
and the commission pursuant to this article.
(h) It is the intent of the Legislature that if such a commission
is formed, the County of Ventura 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.
(i) Upon termination of the commission by the board, the County of
Ventura shall manage any assets of the commission until superseded
by a department approved plan. Any liabilities of the commission
shall not become obligations of the county upon either the
termination of the commission or the liquidation or disposition of
the commission's remaining assets.

14087.54. (a) Any county or counties may establish a special
commission in order to meet the problems of the delivery of publicly
assisted medical care in the county or counties and to demonstrate
ways of promoting quality care and cost efficiency.
(b) (1) A county board of supervisors may, by ordinance, establish
a commission to negotiate the exclusive contract specified in
Section 14087.5 and to arrange for the provision of health care
services provided pursuant to this chapter. The boards of supervisors
of more than one county may also establish a single commission with
the authority to negotiate an exclusive contract and to arrange for
the provision of services in those counties. If a board of
supervisors elects to enact this ordinance, all rights, powers,
duties, privileges, and immunities vested in a county by this article
shall be vested in the county commission. Any reference in this
article to "county" shall mean a commission established pursuant to
this section.
(2) A commission operating pursuant to this section may also enter
into contracts for the provision of health care services to persons
who are eligible to receive medical benefits under any publicly
supported program, if the commission and participating providers
acting pursuant to subcontracts with the commission agree to hold
harmless the beneficiaries of the publicly supported programs if the
contract between the sponsoring government agency and the commission
does not ensure sufficient funding to cover program costs. The
commission shall not use any payments or reserves from the Medi-Cal
program for this purpose.
(3) In addition to the authority specified in paragraph (1), the
board of supervisors may, by ordinance, authorize the commission
established pursuant to this section to provide health care delivery
systems for any or all of the following persons:
(A) Persons who are eligible to receive medical benefits under
both Title 18 of the federal Social Security Act (42 U.S.C. Sec. 1395
et seq.) and Title 19 of the federal Social Security Act (42 U.S.C.
Sec. 1396 et seq.).
(B) Persons who are eligible to receive medical benefits under
Title 18 of the federal Social Security Act (42 U.S.C. Sec. 1395).
(C) Other individuals or groups in the service area, including,
but not limited to, public agencies, private businesses, and
uninsured or indigent persons. The commission shall not use any
payment or reserve from the Medi-Cal program for purposes of this
subparagraph.
(4) Nothing in this section shall prohibit a commission
established pursuant to this section from providing services pursuant
to subparagraph (C) of paragraph (3) in counties other than the
commission's county if the commission is approved by the Department
of Managed Health Care to provide services in those counties. The
commission shall not use any payment or reserve from the Medi-Cal
program for purposes of this paragraph.
(5) For purposes of providing services to persons described in
subparagraph (A) or (B) of paragraph (3), if the commission seeks a
contract with the federal Centers for Medicare and Medicaid Services
to provide Medicare services as a Medicare Advantage program, the
commission shall first obtain a license under the Knox-Keene Health
Care Service Plan Act (Chapter 2.2 (commencing with Section 1340) of
Division 2 of the Health and Safety Code).
(6) With respect to the provision of services for persons
described in subparagraph (A) or (B) of paragraph (3), the commission
shall conform to applicable state licensing and freedom of choice
requirements as directed by the federal Centers for Medicare and
Medicaid Services.
(7) Any material, provided to a person described in subparagraph
(A) or (B) of paragraph (3) who is dually eligible to receive medical
benefits under both the Medi-Cal program and the Medicare Program,
regarding the enrollment or availability of enrollment in Medicare
services established by the commission shall include notice of all of
the following information in the following format:
(A) Medi-Cal eligibility will not be lost or otherwise affected if
the person does not enroll in the plan for Medicare benefits.
(B) The person is not required to enroll in the Medicare plan to
be eligible for Medicare benefits.
(C) The person may have other choices for Medicare coverage and
for further assistance may contact the federal Centers for Medicare
and Medicaid Services (CMS) at 1-800-MEDICARE or www.Medicare.gov.
(D) The notice shall be in plain language, prominently displayed,
and translated into any language other than English that the
commission is required to use in communicating with Medi-Cal
beneficiaries.
(c) It is the intent of the Legislature that if a county forms a
commission pursuant to this section, 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.
(d) The enabling ordinance shall specify the membership of the
county commission, the qualifications for individual members, the
manner of appointment, selection, or removal of commissioners, and
how long they shall serve, and any other matters as a board of
supervisors deems necessary or convenient for the conduct of the
county commission's activities. A commission so established shall be
considered an entity separate from the county or counties, shall be
considered a public entity for purposes of Division 3.6 (commencing
with Section 810) of Title 1 of the Government Code, and shall file
the statement required by Section 53051 of the Government Code. The
commission shall have in addition to the rights, powers, duties,
privileges, and immunities previously conferred, the power to
acquire, possess, and dispose of real or personal property, as may be
necessary for the performance of its functions, to employ personnel
and contract for services required to meet its obligations, to sue or
be sued, and to enter into agreements under Chapter 5 (commencing
with Section 6500) of Division 7 of Title 1 of the Government Code.
Any obligations of a commission, statutory, contractual, or
otherwise, shall be the obligations solely of the commission and
shall not be the obligations of the county or of the state.
(e) Upon creation, a commission may borrow from the county or
counties, and the county or counties may lend the commission funds,
or issue revenue anticipation notes to obtain those funds necessary
to commence operations.
(f) In the event a commission may no longer function for the
purposes for which it was established, at the time that the
commission's then existing obligations have been satisfied or the
commission's assets have been exhausted, the board or boards of
supervisors may by ordinance terminate the commission.
(g) Prior to the termination of a commission, the board or boards
of supervisors shall notify the State Department of Health Care
Services of its intent to terminate the commission. The department
shall conduct an audit of the commission's records within 30 days of
the notification to determine the liabilities and assets of the
commission. The department shall report its findings to the board or
boards within 10 days of completion of the audit. The board or boards
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 present the plan to the
department within 30 days upon receipt of these findings.
(h) Upon termination of a commission by the board or boards, the
county or counties shall manage any remaining assets of the
commission until superseded by a department approved plan. Any
liabilities of the commission shall not become obligations of the
county or counties upon either the termination of the commission or
the liquidation or disposition of the commission's remaining assets.
(i) Any assets of a commission shall be disposed of pursuant to
provisions contained in the contract entered into between the state
and the commission pursuant to this article.
(j) Nothing in this section shall be construed to supersede
Section 14093.06 or 14094.3.

14087.55. (a) The department shall enter into contracts with
counties under this article, and shall be bound by the rates, terms,
and conditions negotiated by the negotiator.
(b) In implementing this article, the department may enter into
contracts for the provision of essential administrative and other
services.
(c) Contracts under this article may be on a nonbid basis and
shall be exempt from the provisions of Chapter 2 (commencing with
Section 10290) of Part 2 of the Public Contract Code.

14087.56. (a) The Health Facilities Financing Authority may,
pursuant to Chapter 7.2 (commencing with Section 15430) of Division 3
of Title 2 of the Government Code, grant up to four hundred thousand
dollars ($400,000) to each participating county to match other
moneys, including loans, received by the county if needed for the
costs of developmental activities approved by the department and the
California Medical Assistance Commission.
(b) Funds may be provided to the county agencies selected as
contractors under this article to assist in the design, development
and installation of necessary program components. The award of these
funds shall be based on criteria established by the department.

14087.57. Notwithstanding any provision of law, a member of a
commission authorized by Section 14087.51 or 14087.54, or a member of
any advisory committee to the commission, shall not be deemed to be
interested in 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
apply:
(a) The member was appointed to represent the interests of
physicians, health care practitioners, hospitals, pharmacies, or
other health care organizations.
(b) The contract authorizes the member or the organization the
member represents to provide services under the commission's program.
(c) (1) The contract contains substantially the same terms and
conditions as contracts entered into with other individuals or
organizations that the member was appointed to represent.
(2) If the contract does not contain substantially the same terms
and conditions, the member shall recuse himself or herself from
making, participating in making, or in any way attempting to use his
or her official position to influence the making of, a decision on
the contract.
(d) The member does not influence or attempt to influence the
commission or another member of the commission to enter into the
contract in which the member is interested.
(e) The member discloses the interest to the commission and
abstains from voting on the contract.
(f) The commission notes the member's disclosure and abstention in
its official records and authorizes the contract in good faith by a
vote of its membership sufficient for the purpose without counting
the vote of the interested member.

14087.58. (a) Notwithstanding any other provision of law, those
records of a special commission formed pursuant to this article that
reveal the commission's rates of payment for health care services or
the commission's deliberative processes, discussions, communications,
or any other portion of the negotiations with providers of health
care services for rates of payment, shall not be required to be
disclosed pursuant to the California Public Records Act, Chapter 5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code, or any similar local law requiring the disclosure of
public records. However, three years after a contract or contract
amendment has been executed, the portion of the contract or contract
amendment relating to the rates of payment shall be open to
inspection under Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title I of the Government Code.
(b) Notwithstanding the California Public Records Act, or Article
9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division
3 of Title 2 of, and Chapter 9 (commencing with Section 54950) of
Part 1 of Division 2 of Title 5 of, the Government Code, or any other
provision of state or local law requiring disclosure of public
records, those health care peer review and quality assessment records
of a special commission authorized by this article, or a committee
thereof, shall not be subject to disclosure. These records and
proceedings of any such commission or committee and individual
members of the commission or committee thereof shall be afforded all
immunities, privileges, and protections available to "peer review
bodies" as defined under Section 805 of the Business and Professions
Code, including the protections of Section 1157 of the Evidence Code.

14087.6. A county that has contracted for the provision of services
pursuant to this article may provide the services directly to
recipients, or arrange for any or all of the services to be provided
by subcontracting with primary care providers, health maintenance
organizations, insurance carriers, or other entities or individuals.
The subcontracts may utilize a prospectively negotiated reimbursement
rate, fee-for-service, retainer, capitation, or other basis for
payment. The rate of payment established under the contract shall not
exceed the total per capita amount that the department estimates
would be payable for all services and requirements covered under the
contract if all these services and requirements were to be furnished
to Medi-Cal beneficiaries under the Medi-Cal fee-for-service program.
Counties that are responsible for providing health care under this
chapter shall make efforts to utilize existing health service
resources if these resources can be estimated by the county to result
in lower total long-term costs and accessible quality care to
persons served under this chapter. The granting of a certificate of
need pursuant to the criteria set forth in Section 127200 of the
Health and Safety Code or a certificate of exemption pursuant to the
criteria set forth in Section 127175 of the Health and Safety Code
shall satisfy the intent of this provision.

14087.61. (a) The counties contracting pursuant to subdivision (a)
of Section 14087.5 may arrange for the delivery of Medi-Cal services
to Medi-Cal beneficiaries, except that the counties may exclude all
of the following:
(1) Long-term care services rendered by nursing facilities or all
categories of intermediate care facilities for the developmentally
disabled.
(2) Dental services.
(3) Services in any federal or state hospital.
(4) Home- or community-based care waivered services.
(b) Exclusion of these services shall be subject to the approval
of the department and the California Medical Assistance Commission.

14087.7. To the extent that a county chooses to contract with
primary care providers pursuant to this article, the county shall
ensure that designation forms and appropriate information concerning
primary care providers are given to beneficiaries.

14087.8. When the department has entered into a contract with a
county pursuant to this article, the department shall, at a minimum,
through a method independent of any agency of the county, monitor the
level and quality of services provided in a county, as well as a
county's expenditures pursuant to the contract, and shall ensure
conformity with federal law.

14087.9. A combination of counties may contract with the department
pursuant to this article for the provision of services.

14087.95. Counties contracting with the department pursuant to this
article shall be exempt from the provisions of Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code for purposes of carrying out the contracts.