Time Item Presenter Action* Corresponding Document** 9:30am Call to Order and Introductions Albert Pacheco A

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1 Time Item Presenter Action* Corresponding Document** 9:30am Call to Order and Introductions Albert Pacheco A Policy Advisory Group AGENDA Monday, February 9, :30am-12:00pm CCALAC, 700 S. Flower Street, Suite 3150 (Conf. Room A) Los Angeles, CA Call-in: (888) Conference Room #: :35am Agenda and January 12th Minutes Albert Pacheco A January 12th Minutes 9:40am Federal Issues Tina Kim, Louise McCarthy, Joanne Preece A. Budget and Appropriations Update B NACHC P&I Planning I/D I/D Budget & Appropriations Memo** 2015 NACHC P&I Planning Memo 2015 P&I Schedule (Draft) ** 10:05am 11:00am County Issues Tina Kim, Louise McCarthy, Joanne Preece A. DHS/DPH/DMH Consolidation Update B. My Health LA (MHLA) 1. Pharmacy 2. Enrollment 3. Dental C. Health Neighborhoods Update State Issues Tina Kim, Louise McCarthy, Joanne Preece A. State Legislation B. Medi-Cal Program Update C. Covered California D. Remaining Uninsured Data Initiative (RUDI) E. CPCA State Policy Priorities D/A I/D I/D A I/D I/D D I DHS/DPH/DMH Consolidation Memo LABOS Statement of Proceedings on DHS/DPH/DMH Consolidation LADHS Consolidation Proposal Memo Consolidation DMH Principles Consolidation DPH Principles Consolidation ACHSA Position Consolidation MH Commission Statement Draft Consolidation Principles** MHLA Pharmacy Memo** MHLA Enrollment Memo MHLA Dental Survey Results** Health Neighborhoods Memo** State Legislation Memo Medi-Cal Program Update Memo Covered California Memo CPCA Policy Priorities Grid 11:45am Other Business A. March PAG Webinar/Teleconference B. Meeting Evaluation C. Board Leadership D I I/D Board Leadership Flyer 12:00pm Adjournment Albert Pacheco A Next Policy Advisory Group Meeting (WEBINAR/TELECONFERENCE) Monday, March 9, 2015 * A = Action D = Discussion I = Information ** handout provided under separate cover

2 Policy Advisory Group Meeting Minutes January 12th, :30am to 12:00pm CCALAC Conference Room A Attendees: Lisa Abdishoo, Sofia Burns, Alex Cotte, Chona de Leon, Jann Hamilton Lee, William Hobson, Tamra King, Jim Mangia, Margie Martinez, Elisa Nicholas, Albert Pacheco, Claudia Powell, Jackie Provost, Corinne Sanchez, Daniela Tena-Perez, Paula Wilson Teleconference: Dolores Bonilla Clay, Liz Forer, Franklin Gonzalez, Nik Gupta, Barbara Hines, Alicia Mardini, Kathy Nguyen, Rise Phillips, Sandra Rossato, Adel Syed, Kazue Shibata, Richard Veloz Guests: Alex Armstrong, Tatyana Klochko, Jina Lawler Staff: Lisa Fisher, Tina Kim, Louise McCarthy, Alex Medina, Joanne Preece, Erica Tarango, Rick Youngblood TOPIC / PERSON DISCUSSION ACTION Welcome and Margie Martinez, Co-Chair, called the meeting to order at 9:35 am. Introductions Approval of Agenda and Minutes Federal Issues Quorum reached. Margie Martinez asked for a motion to approve the agenda and past meeting minutes for December 8th. Louise McCarthy added additional topic to the County Issues, under MHLA, Section B: Supervisor Antonovich s consolidation motion. A. Budget & Appropriations Update: Joanne Preece updated members on health center appropriations (federal funding), the National Association of Community Health Center s (NACHC) Access if the Answer campaign, and congressional leadership appointments. Discussion ensued. Tina Kim elaborated on district meetings with newly elected Congressional representatives are currently being scheduled. She added that these visits will serve as an introduction for new congress members and provide them with more information about community clinics before NACHC P&I in March. Motion to approve minutes as amended made by Jackie Provost; seconded by Jann Hamilton Lee. Motion carried. 1

3 County Issues B NACHC Policy & Issues (P&I) Forum Tina discussed the attached memo and reminded members to register and book rooms for P&I as soon as possible. Members are advised to plan to fly in by Monday 3/16 so legislative visits may begin that following Tuesday. Tina requested members to look over the Congressional and Member listing in the memo to ensure its accuracy. She advised members to inform Alex Medina with appropriate information if not listed in a congressional district that they might reside in (as a constituent) or where members might have a personal relationship with that Congressmember by January 23. A. My Health LA (MHLA) Louise McCarthy and Tina discussed the outcomes of the leadership meeting between CCALAC and LADHS and key developments to date on pharmacy, community partner/ladhs engagement, enrollment and dental issues. Discussion ensued. B. Consolidation Motion - Louise informed members that a motion was made by Mayor Michael D. Antonovich for planning efforts to begin in order for the Departments of Health Services (DHS), Mental Health (DMH) and Public Health (DPH) to operate as a single unified health department that encompasses all aspects of population and personal health. Louise added that the intent is to break down barriers facing the County s patients, identify synergies between programs, streamline operations, optimize finances and align incentives. Discussion ensued. Motion to rescind the pharmacy amendment and get an extension on the due date time for submission of the complaint policy made by William Hobson; seconded by Corinne Sanchez. Motion carried. Motion to seek a reinstatement of the $1.9 million lost to community partners in the allocation of dental funding under MHLA by adding in new funding that would go to the 11 clinics, made by Chona de Leon; seconded by Jim Mangia. Motion carried. Motion to support integration of services and improved coordination of care for patients. To do so, clinics urge the County to: a) include a robust public stakeholder process, 2

4 including community mental health agencies, community clinics and health centers and other contracted community partners; and b) allow sufficient time to not only engage stakeholders, but to also investigate appropriate models of integration and to ensure that any legal and operational issues are sufficiently addressed prior to and throughout implementation. made by Jim Mangia; seconded by Corinne Sanchez. Motion carried. State Issues Other Business A Governor s Proposed Budget Tina reviewed attached document from the California Primary Care Association (CPCA) that discussed the Governor s proposed budget and as anticipated, it mainly implements and provides funding of programs and services required for the implementation of the Affordable Care Act. She also added that while he also does not propose additional cuts to vital health care safety net services, he also does not address the major issue of those who will remain uninsured even after the implementation of the ACA and Medi-Cal expansion. Discussion ensued. Joanne reviewed the State Legislature Leadership Update memo that included information on the 2015 leadership and CCALAC s state advocacy plan. Discussion ensued. Joanne reviewed attached memo informing members on Medi-Cal notices and terminations, 2015 renewals and reimbursement for care provided to patients with pending applications. Discussion ensued. Joanne briefly reviewed the attached information only memo regarding Covered California. A Policy Café Report Alex provided members with an update of the 2014 Policy Café and has informed that work is underway for the 2015 series. B. Advocacy Network Joanne announced Aaron Fox as the new co-chair. She also requested members take time to look at the Advocacy Network delegate list and send updated information to Erica 3

5 Iuojhh m Tarango. C. March PAG Louise informed members that March PAG will be a teleconference/webinar. Adjournment There being no further business, the meeting was adjourned at 11:51 am. Motion to adjourn meeting made by Chona de Leon; Seconded by Elisa Nicholas. Motion carried. 4

6 Member Driven. Patient Focused. Date: February 9, 2015 To: Policy Advisory Group, CCALAC From: Tina Kim, Assistant Director of Policy Re: 2015 NACHC P&I Planning Memo (Information/Discussion) The National Association of Community Health Centers (NACHC) 2014 Policy & Issues (P&I) Forum will take place March 18-22, 2015, at the Marriott Wardman Park Hotel in Washington, D.C. Schedule CCALAC is actively working to schedule legislative visits with the U.S. House Representatives for LA County. CCALAC is also in the process of securing outside meetings with key policymakers and partners. For your review, CCALAC will provide the draft P&I meeting schedule to date as a handout at the PAG meeting. Members will receive updated versions of this meeting schedule as the trip nears. CCALAC Members should plan to fly in and arrive by Monday, March 16, with Hill visits starting Tuesday, March 17. Both the House and Senate are scheduled to be in Washington, D.C. during our trip. Registration CCALAC: In order to be included in the Hill visits and all important communications and s, you need to register with CCALAC. CPCA: Members need to register with CPCA to RSVP for the State Delegation Meeting dinner. Please note, when completing the CPCA registration form, you do NOT need to complete the sections My Consortium will schedule the following visits and Hill Visits to be scheduled by CPCA in the bottom half of CPCA s form. We will take care of that for you. NACHC: Registration for the NACHC P&I conference is open. Please note, you do NOT have to register for the P&I conference in order to attend CCALAC s Hill visits. Preparation In advance of the Hill visits, CCALAC Members will receive all materials, talking points, and guidance. To ensure that you receive all important communications and materials for P&I, register with CCALAC. At the next Policy Advisory Group meeting, NACHC policy staff will be calling in to provide the federal landscape as we prepare to head to the Hill. For questions about P&I scheduling or registration, please contact Erica Tarango at etarango@ccalac.org. You can also contact Tina Kim at tkim@ccalac.org with questions.

7 Member Driven. Patient Focused. Date: February 9, 2015 To: Policy Advisory Group, CCALAC From: Louise McCarthy, President & CEO Re: LA County Consolidation of Departments of Health, Mental Health & Public Health (Discussion/Action) On Tuesday, January 13 th, the LA County Board of Supervisors considered a motion presented by Mayor Mike Antonovich, to approve in concept the consolidation of the Departments of Health Services (DHS), Public Health (DPH) and Mental Health (DMH) into a single integrated department. Following is an update on the issue. Several attachments provide additional background. CCALAC Position At our last Policy Advisory Group (PAG) meeting, members discussed the consolidation motion, and took the following position on integration: LA s Community Clinics and Health Centers support integration of services and improved coordination of care for our County s most vulnerable patients. While the motion to consolidate the departments aims to improve integration, it does not guarantee it. Each department plays critical functions that impact the health and safety of the communities we serve, such as direct patient care or the timely inspection and licensing of community clinic facilities. Any consolidation must do no harm to the vulnerable communities that rely on Public Health, Mental Health and Health Services. If the Board of Supervisors chooses to move forward with consolidation, we urge that the County: Engage Stakeholders: each of the three Departments plays a critical role in the lives of countless LA residents and the many types of agencies that serve them. Stakeholders can provide vital input to ensure that integration is effective for all. Therefore, any consolidation must involve a robust public stakeholder process, including community mental health agencies, community clinics and health centers and other contracted community partners. Take the time to do it right: Integration holds great promise, but it isn t easy. Any plan to consolidate should not be rushed to meet an artificial deadline. Instead, LA County should allow sufficient time to not only engage stakeholders, but to also investigate appropriate models of integration and to ensure that any legal and operational issues are sufficiently addressed prior to implementation. Further, implementation itself should not be rushed. Thoughtful planning and rollout can save the County from avoidable problems further down the line. Board Passes Amended Consolidation Motion The January 13 th Board of Supervisors hearing was standing room only, with more than 100 people testifying before the Board. The majority of those testifying representing LADMH stakeholders. CCALAC provided comment reflecting the position described above. Following public comment, DHS Director Dr. Mitch Katz clarified that the intent of the motion is to have three independent departments working under one umbrella agency, not to consolidate all three into one department. Marvin Southard from DMH and Cynthia Harding from DPH made statements expressing gratitude for clarification on the intent of the motion.

8 The amended motion passed, with no objections, approving in concept the consolidation of the three departments into a single integrated agency and instructing the County CEO, Counsel and Department of Human Resources, in conjunction with DHS, DMH, and DPH to report back within 60 days with: a proposed structure to accomplish the consolidation; proposed implementation steps and time frame; and an analysis of the benefits and drawbacks to this action. The motion also instructs the CEO to establish a stakeholder/public participation process to ensure that their input is included in the report. The Board of Supervisors statement of proceedings is provided with this memo. Mitch Katz Released Consolidation Proposal LA Times Releases Confidential Katz Memo on Department Consolidation On January 22 nd, the LA Times made public a previously confidential memo from DHS Director Mitch Katz that described a proposal to consolidate Departments of Public Health and Mental Health under his department. In it, Katz laid out the rationale and a proposed structure for the merger. In an interview after the release of the memo, Katz states the BOS had asked him to come back with a proposed plan during a closed-session discussion in December, given there was no public discussion of the proposal when the memo was sent. According to Katz, the memo was marked confidential because of uncertainty as to whether the BOS would move forward with the proposal as initially described. A copy of the memo is included with this memo. Stakeholders Weigh In In addition to the testimony on the 13 th, stakeholders from all sides are developing and disseminating their positions and principles on the proposed consolidation. To date we have received a number of position documents from several groups, which are provided with this memo. LADMH: Principles aimed to result in the best possible client experience and culturally competent integrated care for clients and their families of all three systems. LADPH: Principles ranging from the planning process to the ultimate structure, whatever that may be. Association of Community Human Services Agencies (ACHSA): Letter from Bruce Saltzer urges LA County to develop a steering committee comprised of the three department heads along with client, family and provider representative of each department. At Mr. Saltzer s request, CCALAC supported this recommendation. Mental Health Commission: Letter supports the DMH Principles, and adds that a neutral party leads the planning process. Other key stakeholder groups, like the Community Health Councils and the Hospital Association of Southern California, are still developing their positions on the consolidation. We remain in contact with these organizations. CCALAC Position To further engage in the planning process, CCALAC will need to develop our own set of recommendations for both the planning as well as the implementation of any consolidation or integration of the three departments. Mitch s memo, along with the principles provided by our partner agencies offer a good framework from which we can develop a set of positions from the primary care perspective. We will provide a draft of principles for member consideration in advance of the PAG meeting. This is an action item. Once approved, we will continue to engage members to refine and further develop these principles as the process develops. 700 South Flower Street, Suite Los Angeles. C.A T (213) F (213)

9 STATEMENT OF PROCEEDINGS FOR THE REGULAR MEETING OF THE BOARD OF SUPERVISORS OF THE COUNTY OF LOS ANGELES HELD IN ROOM 381B OF THE KENNETH HAHN HALL OF ADMINISTRATION 500 WEST TEMPLE STREET, LOS ANGELES, CALIFORNIA Tuesday, January 13, :30 AM 2. Recommendation as submitted by Supervisor Antonovich: Approve in concept the consolidation of the Departments of Health Services, Public Health and Mental Health into a single integrated Department, including the assumption of the environmental toxicology bureau functions currently performed by the Agricultural Commissioner; and instruct the Interim Chief Executive Officer, County Counsel and the Director of Personnel in conjunction with the Department of Health Services, to report back within 60 days with a proposed structure to accomplish the consolidation as well as proposed implementation steps and a time frame for achievement of the consolidation. Dr. Jonathan Fielding, Bruce Saltzer, Susan Mandel, Herman Debose, Herb Hatanaka, Grace Santillano, Jaime Garcia, Bob Schoonover, Oscar Valladares, Keenan Sheedy, Lilian Cabral, Shoreh Rostami-Tehrani, Herman Herman, Matthew Roychoudhary, Leonard Rose and other interested persons addressed the Board. Dr. Mitchell Katz, Director of Health Services, Dr. Marvin Southard, Director of Mental Health, and Cynthia Harding, Interim Director of Public Health, addressed the Board and responded to questions. Supervisor Antonovich amended recommendation No. 2 of his motion to instruct the Interim Chief Executive Officer, County Counsel and the Director of Personnel, in conjunction with the Departments of Health Services, Mental Health, Public Health and Agricultural Commission/ Weights and Measures to report back within 60 days with a proposed structure to accomplish such a consolidation, as well as proposed implementation steps, time frame for achievement of a consolidation, and the benefits as well as any drawbacks to the consolidation. In addition, instruct the Interim Chief Executive Officer to establish a stakeholder/public participation process to ensure that their input is considered in the report.

10 Board of Supervisors Statement Of Proceedings January 13, 2015 Supervisor Ridley-Thomas made a motion to amend Supervisor Antonovich's motion to include the Sheriff's Department in the working group discussions on the Health Department consolidation and instruct the Departments to include in the 60-day report back, a recommendation on whether the Sheriff's Department Medical Services Bureau should be included in the consolidation, and if so, how it should be structured and accomplished. Supervisor Antonovich accepted Supervisor Ridley-Thomas' amendment. Supervisor Knabe made a motion to also include the Los Angeles County Mental Health and Public Health Commissions input. Supervisor Antonovich accepted Supervisor Knabe's amendment. Supervisors Kuehl and Solis made a motion to amend Supervisor Antonovich's motion as follows: Recommendation No. 1 - Approve in concept the consolidation of the Departments of Health Services, Public Health and Mental Health into a single integrated department agency, ; and Recommendation No. 2 - as well as proposed implementation steps, time frame for achievement of a consolidation an agency, Supervisor Antonovich accepted Supervisors Kuehl and Solis amendments. After discussion, on motion of Supervisor Ridley-Thomas, seconded by Supervisor Antonovich, this item was approved as amended to: 1. Approve in concept the consolidation of the Departments of Health Services, Public Health and Mental Health into a single integrated agency, including the assumption of the environmental toxicology bureau functions currently performed by the Agricultural Commissioner; 2. Request the Interim Chief Executive Officer, County Counsel, the Director of Personnel and the Sheriff, in conjunction with the Departments of Health Services, Mental Health, Public Health and Agricultural Commissioner/Weights and Measures to report back within 60 days with a proposed structure to accomplish such a consolidation, proposed implementation steps, time frame for County of Los Angeles Page 2

11 Board of Supervisors Statement Of Proceedings achievement of an agency, the benefits as well as any drawbacks, and whether the Sheriff s Department Medical Services Bureau should be included in the consolidation, and if so, how it should be structured and accomplished. In addition, the Interim Chief Executive Officer was instructed to establish a stakeholder/public participation process, including the Los Angeles County Mental Health and Public Health Commissions, to ensure that their input is considered in the report. ( ) Ayes: 5 - Supervisor Solis, Supervisor Ridley-Thomas, Supervisor Kuehl, Supervisor Knabe and Supervisor Antonovich January 13, 2015 Attachments: Motion by Supervisor Antonovich Motion by Supervisor Antonovich Motion by Supervisor Ridley-Thomas Report Video I Audio I Video II Audio II The foregoing is a fair statement of the proceedings of the regular meeting held January 13, 2015, by the Board of Supervisors of the County of Los Angeles and ex officio the governing body of all other special assessment and taxing districts, agencies and authorities for which said Board so acts. Patrick Ogawa, Acting Executive Officer Executive Officer-Clerk of the Board of Supervisors By County of Los Angeles Page 3

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18 Principles to Guide Discussions around the Integration of DHS, DMH and DPH Services The Los Angeles County Board of Supervisors approved in concept the integration of DHS, DMH, and DPH services under a single health agency. The planning and implementation of this action requires the use of core principles to guide a thoughtful discussion leading to decisions that will best serve the needs of the people of Los Angeles County. DELIVERABLES TO THE BOARD OF SUPERVISORS: 1. A structure for the approved in concept health agency model, uniting the Departments of Health Services (DHS), Mental Health (DMH), and Public Health (DPH) under a single combined LA County health agency, 2. Possible steps for implementing a health agency, 3. A timeframe for transition to the agency model, 4. The expected benefits and disadvantages of the agency model. CORE PRINCIPLES 1. Clarity of Purpose. Clearly define objectives that will be achieved by changes in organizational structure or processes. Develop a plan and evaluate it to measure benefits and impacts to each department. 2. Transparent Decision-Making. Act with integrity and transparency in decision-making to build trust with employees and community stakeholders. Use a consensus-based approach whenever possible. 3. Autonomy. Each Department must be empowered to carry out its mission with appropriate authority to manage key matters, including priority setting, budget, operational planning, resource allocation, and equal access to the Board of Supervisors. 4. Mutual Respect. During the process of planning integrated services, act in ways that demonstrate respect for each Department s unique contributions to achieving shared goals. 5. Synergistic Opportunities. Identify synergistic opportunities for integration that will protect population, personal, and mental health, prevent disease and injury, and promote overall health and well-being for everyone in Los Angeles County. 6. Safe and Open Communication. Promote an environment to fully discuss the advantages and drawbacks to the proposed agency structure and commit to clearly articulating the process by which key decision are being made. 7. Essential and Legally Mandated Services. Preserve and expand the programs and services that have the greatest impact on population health and elimination of health disparities, and promote health care access. Ensure that levels of resources, including dedicated funding streams, which are providing essential and/or legally mandated public health services, are continued in at least current levels in order to maintain access and quality. 8. Sustained Leadership. Ensure each Department retains a strong leadership team and the ongoing ability to attract and retain high-quality leaders who are capable of leading challenging initiatives in personal, mental and public health. Preserve a broad set of classifications and positions designated to assess, plan, implement and evaluate essential public health functions at multiple levels throughout each Department. 9. Partnership and Collaboration. Maintain and nurture existing key partnerships, both with internal County partners and external stakeholders and service providers, to pursue shared goals and outcomes. Each department has carefully cultivated community relationships that are unique and integration should not interrupt those partnerships but seek to leverage them for improved service delivery for everyone in Los Angeles County. 10. Commitment to Efficiency. Consider consolidating key planning, business, and administrative services only when such consolidation adds clear value and leads to meaningful savings and improvement in services, while assuring that access to these services is guaranteed for each Department at a level that is at least equal to what was available before the integration. 11. Empowered Workforce. Empower staff through approaches that support learning and growth, encourage innovations that facilitate change, and reward success. Promote cross-department team-building. January 27, 2015

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24 Member Driven. Patient Focused. Date: February 9, 2015 To: Policy Advisory Group, CCALAC From: Joanne Preece, Policy Analyst Re: My Health LA Enrollment (Information/Discussion) This memo provides the latest information regarding My Health LA (MHLA) enrollment issues. As of the end of December, 68,390 people were enrolled in the MHLA program. LA County Department of Health Services (LADHS) reports more recently that enrollment now tops 76,000. The MHLA enrollment report through December 31 is available online. Following are the policy and programmatic enrollment issues CCALAC continues to monitor and engage with LADHS on. Policy Issues: End of Month vs. 30-Day Timeframe for Application Completion Issue: Adhering to the end of the month deadline for application completion/submission in order for visits during that month to be billable is difficult when patient visit/application initiation is close to the end of the month. End of the month deadline also makes it impossible for CPs to implement consistent policies regarding how long a patient should be given to return documentation to the clinic in order to complete their enrollment. Proposed Solution: Impose a 30-day window for application completion/submission. Patient visits would be billable from month of initial visit/application initiation date. Per County Counsel, this would require a Board of Supervisors approval of a contract amendment. Enrollment Outside of the Medical Home Issue: Contract reads that enrollment must be done at medical homes. CCALAC raised this issue during contract negotiations and LADHS explained reasons why the department preferred to limit enrollment to medical home sites, but expressed that it could possibly be revisited at a later date. CPs now report that not being able to enroll at mobile units and at off-site health fairs and events is limiting their ability to successfully enroll all of their eligible patient population and to serve all members of mixed status families at these events. Proposed Solution: Change contract language to permit enrollment outside the medical home. Per County Counsel, this would require a Board of Supervisors approval of a contract amendment. Grace Period or Cost Sharing for Disenrolled Patients: Issue: DHS has disenrolled over 2500 patients due to missing documents. It is clear that among enrollers, between August and December, there was significant misunderstanding of the policy and process for pending, completing and submitting applications in OEA. Proposed Solution: Allow a cost sharing or a grace period for payment of October, November and December MHLA claims for services provided to beneficiaries who were disenrolled due to missing documents and who are able to be re-enrolled by CPs. It is unclear at this time what type of vehicle would be required to achieve this solution. Number of OEA User Accounts: Issue: LADHS is contracted with SIS for a maximum of 1500 OEA User Accounts (~500 concurrent). CPs cannot be limited in the number of staff who are able to access OEA. In addition to enrollers, in the usual course of business,

25 many clinic staff need to have real time access to a patient s coverage status billers, front desk, patient registration, call center, etc. As evidenced by call center data shared by LADHS in December, if staff cannot access OEA, they will call MHLA Member Services to inquire as to patients coverage status. This is not efficient for the CPs, nor a good use of Member Services. Proposed Solution: LADHS to continue to closely monitor remaining available OEA User Account slots and project future need. LADHS continues to provide this information to CCALAC at monthly check in meetings. CCALAC and LADHS to monitor whether CPs report that their number of users is being limited to the point where it impedes staff s ability to efficiently perform their job duties. LADHS may need to increase the number of User Accounts in their contract with SIS. This would require an amendment to the contract LADHS has with SIS. Programmatic Issues: Appeals Process for Disputed Disenrollments: Issue: There is no clear appeals process for disputing MHLA disenrollments. Proposed Solution: Implement an appeals process. LADHS should provide clear guidance on what is acceptable as proof that documents were uploaded into OEA and should include retro coverage to the month of original application for patients whose application is under appeal or has an active trouble ticket open with SIS (retro coverage only for those patients whose appeal results in a positive enrollment determination). Communication to Appropriate CP Staff: Issue: CPs report that their Eligibility Leads and OEA Training Leads are sometimes treated as decision-makers and information is sent to them that by-passes CEOs/COOs, and/or they are asked to provide information or make decisions that are not appropriate given their position in their organizations. In other cases information is sent by LADHS only to CEOs/COOs and doesn t trickle down to eligibility staff and enrollers. Proposed Solution: LADHS to engage with CCALAC to ensure that distribution lists and MHLA groups contain the appropriate CP staff and are used for the correct purposes. Process for Disenrollment of DHS Patients from MHLA: Issue: CP patients are being terminated from MHLA due to their being DHS patients. Process by which patients are determined to be DHS patients and are asked whether they prefer to stay with their CP or DHS is not transparent. Clinics are concerned their patients are being disenrolled from MHLA, yet they will continue to obtain (non-billable) services from the CP. Proposed Solution: LADHS to provide clinics with details of the process used to determine which MHLA patients are also DHS patients and also the script used when contacting these patients to ask about their provider preference. LADHS should solicit input from CPs into the content of that script to ensure patients are making an informed decision. OEA Reports: Issue: CPs still report that they cannot get accurate site- and organization-level MHLA patient counts off the reports that they generate in OEA. CPs report that the site-specific report totals do not match the cumulative totals. CPs would also like the report to contain a field reason for disenrollment so that they do not have to go into each application one by one to see the reason (eg. incomplete application ) for each disenrollment; also incomplete application does not specify which document was missing. Proposed Solution: LADHS to provide additional training to CPs beyond just how to generate the reports in OEA CPs need training on how to accurately read the reports. Possible formation of a workgroup to look at the reports and identify issues (LADHS, CCALAC, CP representatives). LADHS to ask SIS to make requested fixes/changes to the OEA reports. Receipt and Retention of Faxed Documents in OEA: Issue: Members continue to report that faxed documents do not always successfully attach to the application in One-e-App (OEA). LADHS states that since they are not seeing many trouble tickets opened for this reason, it is not clear there is really an issue. CPs, CCALAC and LADHS all acknowledge this is a difficult issue to prove. Proposed Solution: LADHS and CCALAC will encourage enrollers to report all issues with documents to the OEA help desk. LADHS has advised the help desk to open a trouble ticket on every case involving issues with document receipt or retention in OEA. CCALAC, LADHS and CPs will continue to monitor this issue. 700 South Flower Street, Suite Los Angeles. C.A T (213) F (213)

26 Pend vs. Submit : Issue: There is no pend button or option in OEA. To pend an application the enroller must select not received in OEA when asked if they have received the documents from the client. Per LADHS, received at this stage of the application should be interpreted by the enroller to mean received by OEA, not just received as in provided by the patient to the enroller; however, the documents would not actually be uploaded at this stage in the application process because the links and instructions for printing the Rights and Declarations and fax cover sheet, and the screen that walks the enroller through uploading documents, don t come until several screens later in OEA. It also remains unclear whether enrollers are able to go back in the application and change their response from received to not received (to pend the application) if they encounter an issue with being able to fax or upload the same day. Proposed Solution: LADHS will continue to provide training and improved communication of the policy and OEA procedures. In late January, LADHS provided enrollers with a two-page tip-sheet that will be developed jointly by LADHS, CCALAC and CP volunteers (1/21: document is in development, expected to be released by DHS anytime). Long-term, explore possible OEA modifications to make process more intuitive and clear to enrollers. Eligibility Leads January Meeting Recap LADHS held the monthly MHLA Eligibility Leads meeting via conference call on January 27. Eligibility Leads (ELs) had an opportunity to check in with their program advocate on the joint auditing exercise. LADHS reviewed the Tip-Sheet provided this week to help enrollers better understand the process for uploading documents, pending and submitting an application in One-e-App. LADHS also shared information on an upcoming OEA training webinar and We ve Got You Covered trainings. CCALAC flagged several issues raised on the call for additional follow-up: Reconciling MHLA denied claims with patients enrollment status on OEA reports; Communication and education for both enrollers and patients around medical home assignment, particularly the issue of when whole families are assigned to the same medical home, but one or more members actually uses a different clinic as their medical home, the time frame and procedure for getting patients assigned correctly; Understanding eligible immigration statuses, distinguishing which types of work permits and visas are eligible for full scope Medi-Cal, and how to assist patients who are incorrectly denied full-scope Medi-Cal by DPSS workers; and How to re-enroll a disenrolled patient there was confusion on the part of LADHS staff as to whether enrollers should be modifying the existing application, or creating a new one with the same person ID. We ve Got You Covered Training CPs should by now have received an from LADHS with dates and registration information for We've Got You Covered (WGYC) trainings. If MHLA enrollers are not Certified Enrollment Counselors (CECs) or Certified Application Assisters (CAAs), they must take this training, or become a certified CEC, by April 1, Enrollers who are not certified or trained by April 1 will lose OEA access. WGYC training is conducted by Maternal Child and Health Access (MCHA) and Neighborhood Legal Services (NLS), with all trainings and materials generously funded through a grant from Health Net. Trainings will be held from 8:30am 4:30pm at either MCHA or NLS. Please note, the February and March WGYC training dates are only available to enrollers who have never been certified as a CEC or CAA. During the month of April, as space permits, WGYC trainings may be opened for other enrollers who would like a "refresher" course. Enrollment and Communications Strategy Through a grant CCALAC was recently awarded, CCALAC staff will be working on two initiatives related to MHLA enrollment in 2015, one component will be around communications and messaging and the other will be development of an enrollment plan for the rest of the year and holding a series of best practices convenings. Joanne Preece and Alex Medina are reaching out to a small group of clinic enrollment supervisors and ELs to participate in informal workgroups to guide this work. CCALAC is also engaging a consultant, Fenton Communications, to assist on the communications side. In late January, CCALAC and LADHS staff participated in a site visit with UniHealth Foundation. If funding is awarded, it will support, on CCALAC s side, the development of an Outreach and Enrollment Peer Network. Please contact Joanne Preece at jpreece@ccalac.org with any questions. 700 South Flower Street, Suite Los Angeles. C.A T (213) F (213)

27 Member Driven. Patient Focused. Date: February 9, 2015 To: Policy Advisory Group, CCALAC From: Tina Kim & Joanne Preece, Government & External Affairs Division Re: State Legislation Memo (Action) This memo includes information on 2015 bills that may be of interest to CCALAC Members. The first weeks of the legislative session included the initial introduction of bills for the legislative session. Many are the re introduction of bills that failed passage in the last session including SB 1005(Lara), which is now SB 4(Lara) and SB 1081 (Hernandez), which is now SB 147 (Hernandez). CCALAC recommends that the Membership take a support position on the following bills: SB 4 (Lara) Health care coverage: immigration status Current law creates the California Health Benefit Exchange for the purpose of facilitating the enrollment of qualified individuals and small employers in qualified health care plans. Current law also provides for the Medi Cal program, under which qualified low income individuals receive health care services. This bill would declare the intent of the Legislature all Californians, regardless of immigration status, have access to affordable health coverage and care. SB 22 (Roth) Medical residency training program grants Would create the Graduate Medical Education Trust Fund in the State Treasury, to consist of funds from publicprivate partnerships created to fund grants to graduate medical residency training programs and any interest that accrues on those moneys, and would require that moneys in the fund be used, upon appropriation by the Legislature, for those purposes, as specified. The bill would require the Office of Statewide Health Planning and Development, in consultation with the California Healthcare Workforce Policy Commission, to develop criteria, upon receipt of private donations of sufficient money to develop the criteria, for distribution of available funds. SB 26 (Hernandez) California Health Care Cost and Quality Database Would state the intent of the Legislature to establish a system to provide valid, timely, and comprehensive health care performance information that is publicly available and can be used to improve the safety, appropriateness, and medical effectiveness of health care, and to provide care that is safe, medically effective, patient centered, timely, affordable, and equitable. The bill would require the Secretary of California Health and Human Services to, no later than January 1, 2017, enter into a contract with one or more independent, nonprofit organizations to administer the California Health Care Cost and Quality Database. SB 33 (Hernandez) Medi Cal: estate recovery Would require the State Department of Health Care Services to make claims only in specified circumstances for those health care services that the state is required to recover under federal law, and would define health care services for these purposes. The bill would delete the proportionate share provision and would delete the requirement that the department make a claim upon the death of the surviving spouse. The bill would also require the department to provide a current or former beneficiary, or his or her authorized representative, upon request

28 and free of charge, with the total amount of Medi Cal expenses that have been paid on his or her behalf that would be recoverable under these provisions, as specified. SB 36 (Hernandez) Medi Cal: demonstration project Current law provides for a demonstration project under the Medi Cal program until October 31, 2015, to implement specified objectives, including better care coordination for seniors and persons with disabilities and maximization of opportunities to reduce the number of uninsured individuals. This bill would require the State Department of Health Care Services to submit an application to the federal Centers for Medicare and Medicaid Services for a waiver to implement a demonstration project that, among other things, continues the state's momentum and successes in innovation achieved under the demonstration project described above. SB 147 (Hernandez) Federally Qualified Health Centers This bill would require the department to authorize a 3-year APM pilot project for FQHCs that would be implemented in any county and FQHC willing to participate. Under the APM pilot project, participating FQHCs would receive capitated monthly payments for each Medi-Cal managed care enrollee assigned to the FQHC in place of the wrap-around, fee-for-service per-visit payments from the department. The bill would require, except as specified, that an evaluation of the APM pilot project be conducted by an independent entity within 6 months after the APM pilot project is completed, and that the independent entity report the findings to the department and the Legislature. CCALAC State Advocacy Plan As a reminder, CCALAC is working to schedule district meetings in February 2015 with the following state elected officials: State Senate District 18: Bob Hertzberg DEM District 30: Holly Mitchell DEM District 20: Connie Leyva DEM District 32: Tony Mendoza DEM District 22: Ed Hernandez (Incumbent) DEM District 33: Ricardo Lara DEM District 24: Kevin de Leon (Incumbent) DEM District 34: Janet Nguyen REP District 26: Ben Allen DEM District 35: Isadore Hall DEM State Assembly District 39: Patty Lopez DEM District 58: Cristina Garcia (Incumbent) DEM District 41: Chris Holden (Incumbent) DEM District 62: Autumn Burke DEM District 44: Jacqui Irwin DEM District 64: Mike Gipson DEM District 51: Jimmy Gomez DEM District 66: David Hadley REP District 53: Miguel Santiago DEM District 70: Patrick O Donnell DEM District 55: Ling-Ling Chang REP CCALAC staff will equip Members with the tools, templates, talking points, and other resources necessary to successfully engage in this advocacy plan. Please contact Tina Kim at tkim@ccalac.org or Joanne Preece at jpreece@ccalac.org with questions. 700 South Flower Street, Suite Los Angeles. C.A T (213) F (213)

29 Member Driven. Patient Focused. Date: February 9, 2014 To: Policy Advisory Group, CCALAC From: Joanne Preece, Policy Analyst Re: Medi-Cal Program Updates (Information/Discussion) This memo includes important information on submitting Medi-Cal claims for patients whose applications were pending at the time services were provided and other Medi-Cal updates. DHCS Provides Guidance on Medi-Cal Claims for Patients with Pending Applications In late January, the Department of Health Care Services (DHCS) issued guidance for providers around submitting Medi- Cal claims for services provided to beneficiaries while their application was pending. In 2014, many Medi-Cal providers provided care to patients who had submitted an application for health insurance, but had not yet received a response, and many providers are currently still seeing patients with pending Medi-Cal applications. DHCS recognizes that delays in billing may have occurred due to the delays in Medi-Cal application processing. Therefore, DHCS will accept untimely claims for services that are provided to Medi-Cal recipients while their applications are pending and will not deny claims solely based upon a delayed submission. In order for claims to be paid, recipients must have eligibility in the Medi-Cal Eligibility Database System (MEDS) for the month in which services were rendered. Though timeliness may be overridden, all claims are subject to the appropriate edits and audits of the Medi-Cal program requirements to qualify for full reimbursement. Timeliness overrides will apply for late claims submitted on or after January 1, 2014, to December 31, 2015, for dates of service on or after January 1, 2014, to December 31, The timeliness override is limited to claims where eligibility determinations were delayed due to the implementation of the Medi-Cal expansion per the Affordable Care Act (ACA). Providers are required to insert an attestation statement reason for late eligibility determination by notating the delay reason code 10 with a description of Delay in determination of Medi-Cal eligibility in the comment section on the applicable claim. This policy applies to paper and electronic claims for all provider types (except FamilyPACT), but also includes appeals or Claims Inquiry Forms for an adjustment of a claim reduced for timeliness. Detailed claim completion instructions are located in the Medi-Cal Provider Manuals. Official changes to the provider bulletin are expected in February. Judge Rules on Backlog Lawsuit, Orders Timely Eligibility Determinations A state Superior Court judge ruled in January in favor of health advocates and legal services groups in a lawsuit filed in September 2014 in Alameda County Superior Court alleging that the large backlog of applications to Medi-Cal program left hundreds of thousands of people unable to access health care. The ruling orders the state Department of Health Care Services (DHCS) to make timely determinations on the Medi-Cal applications, allows that applicants who are likely to be eligible for benefits but whose cases have not been decided within 45 days can receive provisional benefits, and also orders the state to notify applicants that they have a right to an administrative hearing on their eligibility. The ruling is absolutely vital in ensuring benefits for everyone who is entitled to them, said Cori Racela, an attorney with Neighborhood Legal Services of LA County (NLS). State officials argued that the backlog has been reduced by 95

30 percent, that 80 percent of new applicants found eligible for Medi-Cal are being enrolled immediately, and that patients all along could get their medical bills covered for care received while their applications were pending. But Racela says the ruling is critical in ensuring that the practice of giving applicants temporary coverage is cemented in policy. CCALAC will continue to engage with NLS, CPCA and the LA County Department of Public and Social Services to determine the impact of this ruling on clinic patients with pending applications and will provide additional updates and guidance as information becomes available. Medi-Cal Accelerated Enrollment Accelerated Enrollment (AE) is DHCS mitigation strategy to avoid the buildup of an application backlog during the current open enrollment period. If counties cannot determine eligibility within the 45 days required by law, applicants are granted temporary coverage under a fee-for-service aid code until the county makes the final eligibility determination. AE is available for all Medi-Cal applications during open enrollment, regardless of application channel. Covered CA to Medi-Cal Transition: During the 2014 renewal period, some consumers were transitioned from Covered CA to Medi-Cal due to income or other changes found during their annual renewal. Covered CA coverage ended for these cases on December 31, 2014; their Medi-Cal coverage was effective as of January 1, These beneficiaries are assigned an Express Lane aid code which enables selection of a Medi-Cal managed care plan and allows for a more seamless transition while the county works the cases to assign a permanent aid code. Please contact Joanne Preece at jpreece@ccalac.org with any questions. 700 South Flower Street, Suite Los Angeles. C.A T (213) F (213)

31 Member Driven. Patient Focused. Date: February 9, 2015 To: Policy Advisory Group, CCALAC From: Joanne Preece, Policy Analyst Re: Covered California (Information/Discussion) This memo includes information and updates pertaining to Covered California (Covered CA). Open Enrollment Covered CA s second open enrollment period ends on February 15. Covered CA officials report that the exchange is on track to meet its enrollment goal of signing up at least 500,000 new consumers during open enrollment. Covered CA officials are encouraging Certified Enrollment Counselors (CECs) to prepare for the possible extension of the application completion deadline until February 20th; however (as of this writing), that deadline has not yet been extended. In January, CCALAC attended Covered CA s board meeting in person and participated in a teleconference with CPCA, Covered CA staff and representatives from other regional consortia. Board Meeting Recap CCALAC attended Covered CA s January board meeting in person. Agenda items included changes to the Navigator Program payment structure and discussion of Certified Application Counselor (CAC) Program regulations. With regard to Board composition, Diana Dooley was re-elected and will continue in her role as Board Chair. No replacement has been announced for Dr. Robert Ross, who resigned from the board at the end of December Governor Brown has not yet indicated whether he will reappoint or replace board members Kim Belshe and Susan Kennedy, both of whose terms officially ended at the end of December 2014, but agreed to stay on until Dr. Ross replacement is announced. Navigator Program In recognition that not all enrollment assistance activities result in a CEC delegation and plan effectuation, as well as to account for the lag time in receiving effectuation data from the health plans, the Covered CA board in January approved a change to the Navigator Program payment policy. To be eligible for the next 25% payment, Covered CA will count assisted applications that result in plan selection toward enrollment goals instead of those that result in effectuation. Covered CA staff emphasize that this does not change the enrollment goals, merely changes how they count enrollment. This change is only for the purpose of meeting the next 25% payment, not for additional benchmarks beyond that. For organizations that do not meet their goal, Covered CA may process the next payment upon satisfactory demonstration of their efforts to implement their enrollment plan. Navigator Grantees will need to sign an amendment implementing these changes. Certified Application Counselor (CAC) Program The CAC Program is the uncompensated in-person assistance model required by the Affordable Care Act. Following the current open enrollment period, current Certified Enrollment Entities (CEEs) that do not receive funding under the 700 South Flower Street, Suite Los Angeles. C.A T (213) F (213)

32 Navigator Program will have to convert to the CAC model. Regulations are very similar to those for the CEE program. CCALAC and CPCA, along with numerous consumer and advocacy groups, commented at the board meeting on the proposed regulations, calling for Covered CA staff to continue stakeholder engagement, to minimize the administrative burden on CEEs through the transition, to be mindful of when current CEE agreements expire and ensure the transition is completed ahead of that date, and to ensure a seamless transition for CEEs, CECs and consumers. CEE Amendment CEEs should have received an amendment to their CEE Agreement. The amendment changes the end term of the contract to June 30, 2015; incorporates new requirements to comply with recent with federal regulations; makes updates and replacements to the Scope of Work, Budget and Payment Provisions, and Privacy and Security Requirements; and adds Marketing and Branding Guidelines. Of note, the amendment revises payment provisions for application assistance payments that result in Medi-Cal applications; compensation for Medi-Cal renewals is removed and payment for mixed eligibility households is specified. CEEs must return their signed amendments to Covered CA, the terms and changes in the amendment are not negotiable. Reimbursement for Medi-Cal Enrollment Another $1.3 million in payments will be made to CEEs in early-february for Medi-Cal applications processed through September 30, Covered CA will be sending a 1099 to CEEs for application assistance payments made to entities in Covered CA is working with DHCS to provide a current update on how much funding is left in the AB 82 bucket (this is the $14 million from TCE plus federal matching dollars that funds the $58 reimbursements for Medi-Cal enrollments). As of October, about $16 million remained, meaning that heading into the current open enrollment period, there was still funding available to support Medi-Cal enrollments. The $58 reimbursements will continue to be paid out until the funding is exhausted or the CEE agreements terminate at the end of June. DHCS and Covered CA have not yet provided a clear answer on what will happen to any remaining funding after the expiration of the CEE agreements. CPCA and CCALAC will continue to monitor this item. IRS Form 1095-A Covered CA consumers are now receiving the new IRS Form 1095-A. This form contains information consumers will need in order to reconcile the Advanced Premium Tax Credit (APTC) they received for the 2014 benefit year with the amount they were eligible for based on their actual 2014 Modified Adjusted Gross Income (MAGI). Covered CA s 1095-A Toolkit will help educate CECs ahead of the tax season about the form and how consumers will use it. The toolkit includes Talking Points, FAQs, the 1095-A Dispute Form, Medi-Cal Tax Filing FAQs, a Job Aid, a training webinar, and copies of the consumer notice in multiple languages. CECs are strongly encouraged to familiarize themselves with the toolkit materials as the 1095-A tax form is brand new and is anticipated to create significant confusion among consumers in February. Covered CA stresses that CECs are not tax preparers and should not be answering tax preparation questions from consumers. Recent updates around the 1095-A form include: If consumers received Advanced Premium Tax Credit (APTC) in 2014, but when they reconcile and file their 2014 taxes it indicates they should have been Medi-Cal eligible, the consumer will not have to re-pay the APTC that was paid to their Covered CA plan. The IRS issued Notice , which waives certain penalties for one year for some individuals who received excess advance premium tax credits (APTC) but are unable to pay them back in full by April 15. The relief applies to taxpayers who are otherwise current with their tax filing and payment obligation, have a balance due to the IRS resulting from excess APTC, and who report the amount of excess APTC on their 2014 tax return. 700 South Flower Street, Suite Los Angeles. C.A T (213) F (213)

33 Medi-Cal Advanced Study Course for CECs Now Available The Medi-Cal Advanced Study course for CECs is available now in the Learning Management System (LMS). This is an optional training course that is separate from the required courses for CEC Certification and recertification with Covered CA. CECs will find step-by-step instructions on how to access this course here. CEC Help Desk Expanded Hours The CEC Help Desk ( ) is offering expanded hours through February 15, the end of open enrollment. Hours are Monday through Friday, 8:00am to 8:00pm; Saturday and Sunday, 8:00am to 6:00pm. No Family Dental Plans in 2015 Last year, Covered CA reported that family dental plans would be available on the exchange at some point in Covered CA shared this week that family dental plans will not be available in Children will still get dental coverage through their health plan; that does not change as a result of this announcement Renewals Covered CA recently released data on 2014 renewals. Of the just over a million people who were eligible to renew their coverage for 2015 through Covered CA, 92 percent of eligible consumers have been renewed, and 94 percent of those stayed in the same plan that they were in last year. About a third of eligible consumers shopped for other plans available on the exchange, but few ended up making a change. The other two-thirds took no action and were automatically reenrolled in their plan from Not everyone who did not renew their private coverage lost coverage; an estimated 85,000 consumers were determined eligible for Medi-Cal during the renewal process due to income or other changes, and others gained job-based coverage or for other reasons no longer needed health insurance through Covered CA. On a call with reporters, Executive Director Peter Lee attributed the lack of plan changes to consistent premium prices. Some of the inertia could also be due to general satisfaction with plans and prices while some may be related to confusion surrounding the renewal notices and process. Please Joanne Preece at jpreece@ccalac.org with any Covered CA questions. 700 South Flower Street, Suite Los Angeles. C.A T (213) F (213)

34 California Primary Care Association Policy Platform 2015 "Healthy You, Healthy Communities" The health of our patients and our communities is the mission and driving passion for Health Centers. This passion drives our health centers, our association, and is at the heart of our 2015 policy platform: (1) Ensuring that all Californians have health care coverage and access to care, (2) Transforming the infrastructure of care to deliver culturally competent, whole person, quality health care and support services to anyone who walks through our doors, and (3) Strengthening the core business infrastructure of our network of health centers statewide. ACTION IMPLEMENTATION Objective Legislative Administrative Educational Coverage and Access for All Protect Californians right to comprehensive health care coverage. Continue to work closely with Health for All coalition. Support and strongly engage in Senator Lara s bill (SB 04, formerly SB 1005). Under NACHC guidance continue to advocate aggressively for solutions to the health center funding cliff. Continue to advocate for administrative fixes to outreach, enrollment and renewal systems to guarantee that health center patients can enroll in, and stay in, a program of coverage. Partner with consortia and consumer stakeholder groups to provide health centers with the training, technical assistance, and best practice solutions they need to be successful in outreach, enrollment and retention. Ensure Californians have access to vital health care services that meet the comprehensive healthcare needs of individual patients and communities. Advocate for restoration of EAPC in the 1115 Waiver. Advocate for policies that incentivize default assignment of Medi Cal lives to health centers. Work to ensure that Medi Cal and Covered California enrollees have timely access to quality, comprehensive care and push for increased oversight of network adequacy standards with particular attention to specialty access needs. Eliminate unnecessary barriers to care, including licensing and building code rules that prevent the creation and operation of safe new health centers. Sponsor legislation on Intermittent Clinic Licensing (Extension of clinic hours from 20 to 30). Analyze clinic licensing regulations to identify regulatory mechanisms for streamlining and expediting clinic licensing. Empower health centers to meet the needs of their patients and local community by advancing state and federal policies that promote flexibility in the delivery of health care. Work with HRSA to address issues that relate to change in scope and specialty care issues with FTCA. 330 Delivery of Culturally Competent, Whole Person, Quality Health Care and Support Services Empower patients to access and utilize healthcare services appropriately by seamlessly integrating primary, oral, and behavioral health care services. Explore legislative solutions for securing PPS for MFTs and PPS for same day behavioral health visits (with possible sunset). Participate in Behavioral Health DSRIP conversations to ensure health centers can take full advantage of coordination and service expansion opportunities. Participate in Drug Medi Cal 1115 Waiver WG to advocate for increased incentives for provider participation and access to substance use disorder services for patients. Help communities rebuild their behavioral health delivery system by strengthening the coordination and delivery of mental health and substance use disorder services in the primary care setting. Explore options for expanding services through elective contracting arrangements with county specialty mental health. Share behavioral health billing process once confirmed by State to ensure that health centers are billing correctly. Support patients with complex chronic conditions by strengthening case management and care coordination support services through traditional, culturally competent means, and also through the use of community health workers with deep roots and experience in the community. Continue to advocate and inform both CalSIM TA program around PCHH and the Section 2703 opportunity to ensure as many health centers as possible can participate in a PCHH supplemental payment initiative. Share TA and training as made available through CalSIM and educate Continue work with RAMP and other partners on CA adoption of Preventive members on 2703 participation as it is designed and implemented. Services Rule to allow for greater use and integration of Community Health Workers and expand culturally competent care. Legislative / Page 10 of 25 Page 1

35 To meet the health care needs of the communities they serve, provide skilled and trained health care professionals with the flexibility to practice at the top of their license, and align their scope with their training and skills. Work closely with Senator Hernandez and coalition of organizations committed to moving forward a Nurse Practitioner Scope Bill that can help advance care transformation. Strong Core Business Infrastructure Improve the health of patients and communities by developing and implementing an innovative financial model that leverages the unique ability of health centers to provide comprehensive care to everyone, especially in hard to serve and underserved communities. Continue to work with health centers, the state, plans and health system partner on payment reform alternative payment methodology. Advocate for equitable and transparent reimbursement policies that are applied in a standardized and timely fashion. Timely Payment of PPS Reconciliation Form Fix: Reconciliation timing delays (shorten time allowed to pay back health centers); Potential Solution File within 5 months of FY end, DHCS pays 80% of filing within 60 days. Another 90 days to audit. No later by 10 months clinic fully paid. Proposed state policy that if managed care plans deny a claim the state is obligated to pay the wrap around. Shorten time to finalize new rate. Work with the state to resolve issues relating to reconciliation. In particular, reconciliation issues that result from costs a clinic decides carve out of their PPS rate, including P4P payments. Change Medicare certification to be retroactive to date of application. Work with health centers to get their code 18 payments correct so they don t have so much sitting with the state. Improve the quality and delivery of care to patients by promoting healthcare innovation and quality improvement through systemic Pay for Performance and shared savings programs in Medi Cal Managed Care programs. Participate on the 1115 Waiver Provider Incentives WG to inform and influence a statewide Medi Cal P4P program. Analyze impact of CPCA sponsored 2002 Chu bill regarding managed care member assignment on FQHC P4P programs. Continue to research P4P options and share with all members so that health centers without P4P opportunities can talk to their plans about starting them. Further California s managed care implementation strategy by supporting regulations and policies that improve transparency, collaboration, and investment in primary care. Support policies that increase standardized data sharing and the communication of data between managed care plans, the state, and contracted providers. Pursue policies that ensure transparency and accuracy in managed care network directories and contracting practices. Educate health centers to leverage their position within safety net networks in managed care contracting through a comprehensive Managed Care+ program. Invest in the future of healthcare by establishing a solid foundation of health information technology and data analytics. Working closely with OHIT to capture the 90/10 match resources for the delivery of meaningful use technical assistance to providers. Support efforts to expand health information exchange. Counter the nation s shortage of healthcare providers, especially in underserved communities, by expanding the federal Teaching Health Center program, protecting the National Health Service Corps, and securing additional matching funds for physician loan repayment program. At the Federal Level, Work with NACHC, AATHC, and Clinicians for the Underserved to promote Federal policies that strengthen investments in Teaching Health Centers and National Health Service Corp. Participate on the 1115 Waiver Workforce WG to inform and influence a statewide health workforce agenda that centers on the needs of health center patients. Included, but not limited to, expanded funding of SLRP, reintroduction of state GME funding, and creation of a California Teaching Health Center program. Work with health centers to maximize their utilization of state and federal opportunities related to healthcare workforce (this includes increasing use of OSHPD programs like SLRP). Better integrate the workforce programming and priorities across California s AHECs. Legislative / Page 11 of 25 Page 2

36 Member Driven. Patient Focused. BOARD LEADERSHIP+ Friday, March 6, 2015 Hilton Orange County/Costa Mesa 3050 Bristol Street, Costa Mesa, CA Consortia Members* Until January 31st - $200 After January 31st - $250 After March 4th - $300 Non-Members Until January 31st - $250 After January 31st - $300 After March 4th - $350 *Member pricing has been extended to all members of CCALAC, COCCC, CCC, & CCASBC. The Board Leadership+ Training is a full day training held in concert with the Annual Health Care Symposium. This program will provide the basics for new board members and act as an effective refresher for more seasoned board members. Topics include: Board Roles and Responsibilities Compliance Responsibilities for Board Members Business Operations & Finance for the Board Critical Thinking & Communicating for Impact We had a board member attend the Board Leadership+ Training last year and found it very valuable... it is a great overview of board governance and responsibility. Dee Clay, CEO, Wilmington Community Clinic REGISTER Founded in 1994, CCALAC represents the interests of community clinics and health centers that operate over 200 primary care sites throughout the county. Our members serve as the medical home for over 1 million patients per year.