SECTIONS 14165-14165.11 - California Statutes

WELFARE AND INSTITUTIONS CODE

SECTION 14165-14165.11

14165. There is hereby created in the Governor's Office the
California Medical Assistance Commission, for the purpose of
contracting with health care delivery systems for provision of health
care services to recipients under the California Medical Assistance
program.

14165.1. The commission shall be composed of seven voting members
and two ex officio members. The voting members shall be selected from
persons with experience in management of hospital services, risk
management insurance or prepaid health programs, the delivery of
health services, the management of county health systems, and a
representative of recipients of service. The Directors of the
Department of Health Services and the Department of Finance, or their
designees, shall serve as ex officio nonvoting members of the
commission.

14165.2. The Governor shall appoint three members of the
commission, one of which shall be designated chairperson. The Speaker
of the Assembly and the Senate Rules Committee shall each appoint
two members of the commission. Of the members first appointed by the
Governor, one shall serve for a term of three years, and two for a
term of two years. Of the members appointed by the Speaker of the
Assembly and the Senate Rules Committee, one appointed by the Speaker
of the Assembly and one appointed by the Senate Rules Committee
shall serve for a period of three years with the other appointees to
serve for a period of two years. Thereafter, all appointments shall
be for four-year terms.

14165.3. The commission shall hire an executive director, legal
counsel and such other staff as necessary consistent with funds
appropriated in the Budget Act. All professional staff employees of
the commission shall be exempt from civil service.

14165.4. It is the intent of the Legislature that beginning July 1,
1983, the functions, powers, and duties contained in Article 2.6
(commencing with Section 14081) become subject to the provisions
contained herein.

14165.5. The executive director shall act under the authority of
the commission and shall negotiate the terms, services, and costs
consistent with funds available. The commission shall serve as a
review body for all contracts negotiated by the executive director.
The commission may reject any proposed contract within 20 days after
approval by the executive director.

14165.6. The commission shall direct the planning, development and
negotiation of contract services which provide for:
(a) The provision of services through a capitation methodology,
including, but not limited to, health maintenance organizations,
organized county health systems, insurance companies, and independent
practice associations.
(b) Hospital inpatient or hospital outpatient services.
(c) Pilot projects meeting the provisions of Section 14491.5.
(d) Health care projects meeting the provisions of Article 2.91
(commencing with Section 14089).

14165.7. All decisions of the commission shall be by a majority of
four votes, including the hiring of the executive director. The
commission shall retain an independent office of legal counsel for
purposes of contract review. All contracts shall be reviewed by legal
counsel.

14165.8. The commission shall be reimbursed at the annual salary of
fifty thousand dollars ($50,000), beginning on January 1, 2006. The
commission shall set the salary of the executive director and other
staff consistent with funds appropriated. The annual compensation
provided by this section shall be increased in any fiscal year in
which a general salary increase is provided for state employees. The
amount of the increase provided by this section shall be comparable
to, but shall not exceed, the percentage of the general salary
increases provided for state employees during that fiscal year.

14165.9. The commission shall report to the Legislature on January
1 and May 1 of each year. The January report shall include all of the
following:
(a) The number and type of health service contracts.
(b) The persons served, cost per service, and other relevant and
statistical information.
(c) The projected contract services and estimated costs.
(d) The average per diem rate received by contract hospitals, as
of December 1 of the preceding year, shall be reported in the
following categories:
(1) Statewide.
(2) By standard consolidated statistical area, as defined by the
most recent United States Census.
(3) By that portion of the state not included within a standard
consolidated statistical area.
(4) Statewide by hospitals with 1-99 beds, 100-299 beds, and over
300 beds.
(e) The total number of hospitals receiving a net increase, a net
decrease, or having a contract rate tied to patient volume during the
preceding 12 months.
(f) A discussion of the effects of selective contracting on access
to, and quality of, services. In preparing this portion of the
report, the commission shall solicit comments from representatives of
beneficiaries and providers.
The May report shall serve as an update of information contained
in subdivisions (a) to (c), inclusive, of the January report.

14165.95. On or before February 1, 1984, the commission shall
submit to the Legislature an evaluation of its inpatient hospital
service procedure, including, but not limited to, the following:
(a) The recommended duration of contracts.
(b) The effect of the disclosure of executed contracts on the
price levels of subsequently negotiated contracts.
(c) The conditions under which contractors failing to secure a
contract on a first bid should be allowed to rebid.
(d) The effectiveness of contract provisions designed to ensure
access to hospital services and a high quality of care.
(e) The effect of flat per diem rates on the variety of cases
treated by contract hospitals.
The evaluation provided for by this section shall be accompanied
by a recommendation for any relevant legislation deemed necessary by
the commission.

14165.10. The commission or department may direct independent
studies, to include, but not be limited to, the following objectives:
(a) The development of a method of private medical insurance
coverage of the Medi-Cal program as to those Medi-Cal beneficiaries
whose medical costs reach a catastrophic level or who become
chronically ill.
(b) The potential for Medi-Cal payment of medical coverage
premiums for the various classifications of Medi-Cal beneficiaries.
(c) For each classification of Medi-Cal beneficiaries, the
provision of specified medical benefits on the basis of subsidization
by the beneficiaries through the payment of premiums.
(d) A comparison of Medi-Cal benefits with the medical coverage
available to most Californians not covered by Medi-Cal, along with
analysis and recommendations concerning alternative benefit packages
for Medi-Cal.
(e) The determination of whether health care plans providing
services to Medi-Cal beneficiaries should offer less than the full
range of Medi-Cal benefits.
(f) The development of alternative standards for beneficiary
eligibility and copayment under Medi-Cal.
(g) The development of a method of response to temporary deficits
in the Medi-Cal program that will both control expenditures and, to
the extent possible, preserve the availability to beneficiaries of
essential health services.

14165.11. (a) It is the intent of the Legislature that the
Department of Corrections operate in the most effective and efficient
manner possible when purchasing health care services for inmates. To
achieve this goal, it is desirable that the department have the
benefit of the experience of the California Medical Assistance
Commission in planning and negotiating for the purchase of health
care services.
(b) The commission may work with the Department of Corrections to
assist the department in planning and negotiating contracts for the
purchase of health care services. The commission may either consult
with the department or negotiate directly with providers on behalf of
the department, as mutually agreed upon by the commission and the
department.