BOARD OF GOVERNORS MEETING #241
December 4, 2014 ● 2:00 PM L.A. Care Health Plan 1055 W. 7th Street, Los Angeles, CA 90017
1 About L.A. Care Health Plan
Mission Statement L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Overview Committed to the promotion of accessible, affordable and high quality health care, L.A. Care Health Plan (Local Initiative Health Authority of Los Angeles County) is an independent local public agency created by the State of California to provide health coverage to low-income Los Angeles County residents. With more than 1.7 million members in seven product lines, L.A. Care is the nation’s largest publicly operated health plan.
L.A. Care Health Plan is governed by 13 board members representing specific stakeholder groups, including consumer members, physicians, federally qualified health centers, children’s health care providers, local hospitals and the Los Angeles County Department of Health Services.
L.A. Care advances individual and community health through a variety of targeted activities including a Community Health Investment Fund that has awarded more than $132 million throughout the years to support the health care safety net and expand health coverage. The patient-centered health plan has a robust system of consumer advisory groups, including eleven Regional Community Advisory Committees (governed by an Executive Community Advisory Committee), health promoters, and three Family Resource Centers that offer free health education and exercise classes to the community, and has made significant investments in Health Information Technology for the benefit of the more than 10,000 doctors and other health care professionals who serve L.A. Care members.
Programs Medi-Cal – In addition to offering a direct Medi-Cal line of business, L.A. Care works with three subcontracted health plans to provide coverage to Medi-Cal members. These partners are Anthem Blue Cross, Care 1st Health Plan, and Kaiser Permanente. Since 2012, L.A. Care has enrolled more than 170,000 Seniors and Persons with Disabilities as members, and as of January 1, an additional 164,000 Healthy Way LA members transitioned to L.A. Care’s Medi-Cal program. Medi-Cal beneficiaries represent a vast majority of L.A. Care members.
L.A. Care Covered™ – As a state selected Qualified Health Plan, L.A. Care provides the opportunity for all members of a family to receive health coverage under one heath plan in the Covered California state exchange. Currently, more than 20,000 Los Angeles County residents have enrolled in the L.A. Care Covered program. L.A. Care Cal MediConnect Plan– L.A. Care Cal MediConnect Plan provides coordinated care for Los Angeles County seniors and people with disabilities who are eligible for Medicare and Medi-Cal.
Healthy Families Program – Healthy Families, California’s Children’s Health Initiative Program, provides health coverage to children who do not qualify for Medi-Cal but whose families cannot afford private health insurance. L.A. Care’s Healthy Kids (0-5) – Sponsored by First 5 LA and the Children’s Health Initiative of Greater Los Angeles, Healthy Kids (0-5) provides health coverage for children who do not qualify for Medi-Cal and Healthy Families. L.A. Care Health Plan Medicare Advantage (HMO SNP) – The L.A. Care Medicare Advantage (HMO SNP) provides coordinated care for Los Angeles County seniors and people with disabilities who are eligible for Medicare and Medi-Cal. PASC-SEIU Homecare Workers Health Care Plan – L.A. Care provides health coverage to Los Angeles County’s In-Home Supportive Services (IHSS) workers, who enable our most vulnerable community members to remain safely in their homes by providing services such as meal preparation and personal care services.
2 www.lacare.org Facebook/lacarehealth LinkedIn/company/l.a.-care-health-plan Twitter: @lacarehealth AGENDA BOARD OF GOVERNORS MEETING No. 241 Thursday, December 4, 2014, 2:00 P.M. L.A. Care Health Plan, 10th Floor, 1055 W. 7th Street, Los Angeles, CA 90017
I. Welcome Thomas Horowitz, D.O., Chair II. Approve today’s meeting agenda Chair III. Public Comment Chair IV. Approve November 6, 2014 meeting minutes Chair V. Approve Consent Agenda Items Chair 1. Biennial Review of Conflict of Interest Code (BOG 100) 2. Ratify execution of Amendment 10 of Medi-Cal Contract 03-75799 (Hyde Amendment Family Planning Services) (BOG 101) 3. Ratify execution of Amendment 16 of Medi-Cal Contract 04-36069 (Coordinated Care Initiative Managed Long-Term Services and Supports into Medi-Cal Contract) (BOG 102) 4. Employee Recruitment Referral Raffle Incentive Program (BOG 103) 5. Wentworth Company Contract (BOG 104) 6. iColor Printing and Mailing Inc. Contract Amendment (FIN 100) 7. Epicor HRMS Contract Amendment (FIN 101) 8. Healthx Contract Amendment (FIN 102) 9. PCG Software Inc. Contract (FIN 103) 10. Beagle Parent Corp & Subs- DBA-Emdon Contract (FIN 104) 11. Ratify Verisk Contract (FIN 105) 12. Presidio Inc. Contract (FIN 106) 13. Encounter Modernization Project Contract (FIN 107) 14. RCAC Membership (ECA 100 ) 15. CHCAC Membership (CHC 100) 16. Ratify Re-election of CHCAC Chair and Vice Chair (CHC 101) VI. ADJOURN TO CLOSED SESSION (Est. time: 70 mins.) Chair A. CONTRACT RATES Pursuant to Welfare and Institutions Code Section 14087.38(m) Plan Partner Rates Provider Rates DHCS Rates B. REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Discussion Concerning New Product Lines Estimated date of public disclosure: December 2016 C. CONFERENCE WITH REAL PROPERTY NEGOTIATORS Pursuant to Section 54956.8 of the Ralph M. Brown Act Property: 1055 West 7th Street, Los Angeles Agency Negotiator: Howard A. Kahn Negotiating Parties: Jamison Properties, 1055 West Seventh, LLC Under Negotiation: Price and Terms of Payment D. CONFERENCE WITH LABOR NEGOTIATOR Pursuant to Section 54957 of the Ralph M. Brown Act Agency Negotiator: Howard A. Kahn Unrepresented Employee: All L.A. Care Employees 3 11/25/2014 12:03 PM Board of Governors Meeting Agenda December 4, 2014
E. CONFERENCE WITH LABOR NEGOTIATOR Pursuant to Section 54957 of the Ralph M. Brown Act Agency Negotiator: Thomas Horowitz, DO Unrepresented Employee: CEO
F. PUBLIC EMPLOYMENT Pursuant to Section 54957 Ralph M. Brown Act Title: Chief Executive Officer
VII. RECONVENE IN OPEN SESSION Chair
VIII. Chairperson’s Report Chair
IX. Chief Executive Officer Report Howard A. Kahn Chief Executive Officer X. Committee Reports
A. Executive Committee Thomas Horowitz, D.O., Chair
1. Government Affairs Update Cherie Fields 2015 Government Affairs Advocacy Activities Director, Government Affairs
Co-sponsorship FQHCs Alternative Payment Reform Legislation (BOG 105 )
State and Federal Legislative Policy Agenda (BOG 106)
Legislative Issues Review Process
2. Consideration of Employee Incentive Payout (EXE 100) Robert Turner Chief of Human Resources
3. Consideration of Current and Future Chief Executive Augustavia J. Haydel, Esq. Officer’s Compensation (Motion ) General Counsel
B. Finance & Budget Committee Michael Rembis, Chair
1. Financial Report (FIN 108) Tim Reilly Chief Financial Officer
2. October 2014 Investment Transactions Report Tim Reilly
C. Services Agreement Committee Ozzie Lopez, Chair XII. Advisory Committee Reports
A. Executive Community Advisory Committee Hilda Perez/Ozzie Lopez Board Consumer member and Advocate member
B. Children’s Health Consultant Advisory Committee Howard A. Kahn
XIII. Adjournment Chair The next meeting is scheduled on Thursday, February 5, 2015. The order of items appearing on the agenda may change during the meeting. Teleconference arrangements may change prior to the meeting. Those planning to participate by telephone should confirm with L.A. Care Board Services prior to the meeting. Please keep your comments to three minutes or less. THE PUBLIC MAY ADDRESS THE BOARD OF GOVERNORS ON ALL MATTERS LISTED ON THE AGENDA BY FILLING OUT A “REQUEST TO ADDRESS” FORM AND SUBMITTING THE FORM TO L.A. CARE STAFF PRESENT AT THE MEETING BEFORE THE AGENDA ITEM IS ANNOUNCED. YOUR NAME WILL BE CALLED WHEN THE ITEM YOU ARE ADDRESSING IS DISCUSSED. THE PUBLIC MAY ALSO ADDRESS THE BOARD ON L.A. CARE MATTERS DURING PUBLIC COMMENT. AN AUDIO RECORDING OF THE MEETING IS MADE TO ASSIST IN WRITING THE MINUTES AND IS RETAINED ONLY FOR 30 DAYS.
NOTE: THE BOARD OF GOVERNORS CURRENTLY MEETS ON THE FIRST THURSDAY OF MOST MONTHS AT 2:00 P.M. POSTED AGENDA and PRINTED MEETING MATERIALS ARE AVAILABLE FOR INSPECTION AT Board Services, 1055 W. 7th Street – 10th Floor, Los Angeles, California 90017.
Any documents distributed to a majority of the Board Members regarding any agenda item for an open session after the agenda has been posted will be available for public inspection at Board Services, L.A. Care Health Plan, 1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017, during regular business hours, 8:00 a.m. to 5:00 p.m., Monday – Friday.
Meetings are accessible to people with disabilities. Individuals who may require any accommodations (alternative formats – i.e., large print, audio, translation of meeting materials, interpretation, etc.) to participate in this meeting and wish to request an alternative format for the agenda, meeting notice, and meeting packet may contact L.A. Care’s Board Services Department at (213) 694-1250. Notification at least one week before the meeting will enable us to make reasonable arrangements to ensure accessibility to the meetings and to the related materials.
11/25/2014 1:14 PM
Board of Governors General Meeting # 240 Meeting Minutes – November 6, 2014 L.A. Care Health Plan Conference Room 1018-1019 1055 W. Seventh Street, Los Angeles, CA 90017 All votes during a teleconferenced portion of the meeting were by roll call Members Management/Staff Thomas Horowitz, DO, Chairperson Alexander K. Li, MD Howard A. Kahn, Chief Executive Officer Mark Gamble, Vice Chairperson Ozzie Lopez, MPA Gertrude Carter, MD, Chief Medical Officer Michael A. Rembis, FACHE, Treasurer** Supervisor Gloria Molina* Jonathan Freedman, Chief of Strategy, Regulatory & External Affairs Louise McCarthy, Secretary Hilda Perez Augustavia J. Haydel, Esq., General Counsel Hector De La Torre G. Michael Roybal, MD, MPH** Tim Reilly, Chief Financial Officer Thomas S. Klitzner, MD, PhD Sheryl Spiller* Tom Schwaninger, Chief Information Officer Jann Hamilton Lee *Absent ** Teleconference Robert Turner, Chief of Human Resources John Wallace, Chief Operating Officer AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN CALL TO ORDER Thomas Horowitz, DO, Chairperson, called the meeting to order at 2:07 p.m. Thomas Horowitz, DO, Chair Horowitz announced that the public may address the Board on the matters listed on the agenda before or during the Board’s consideration of the item, and on any other matters at the public comment section. Chair Horowitz welcomed Hector De La Torre to the Board of Governors. Member De La Torre thanked the Chair and expressed that with his experience representing the South Los Angeles area he hoped to add to L.A. Care’s work in improving health care services in the community.
APPROVAL OF The agenda was approved as submitted. Approved by roll call. MEETING AGENDA 10 AYES (Gamble, Horowitz, Klitzner, Lee, Thomas Horowitz, DO Li, Lopez, McCarthy, Perez, Rembis, and Roybal). 1 Abstention (De La Torre)
PUBLIC COMMENT There was no public comment. DRAFT 5 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ACCEPTANCE OF The minutes of the October 2, 2014 meeting were approved as submitted. Approved by roll call. MINUTES OF 10 AYES (Gamble, MEETING Horowitz, Klitzner, Lee, Li, Lopez, McCarthy, Thomas Horowitz, DO Perez, Rembis, and Roybal). 1 Abstention (De La Torre)
APPROVAL OF Member McCarthy may have a financial interest for which she might have a potential conflict of interest, and as Approved by roll call. CONSENT AGENDA such she refrained from participating in the discussion and vote on Motion FIN 104. 10 AYES (De La Torre, Gamble, Horowitz, Thomas Horowitz, DO 1. Quarterly Investment Report (FIN 100) Klitzner, Lee, Li, Lopez, 2. General Agent Payment Process (FIN 101 ) McCarthy, Perez, and 3. Healthx Contract Amendment (FIN 102) Roybal). 4. GHA Server Hardware Purchase (FIN 103) (Telephone communication with 5. Community Health Alliance of Pasadena (CHAP Care) Contract Amendment (FIN 104) Member Rembis was disrupted 6. Presidio Licenses and Maintenance Support (FIN 105) and he did not vote on this 7. Health eConnex Contract Amendment (FIN 106) motion.) 8. Ratify RCAC Membership (ECA 100)
ADJOURN TO Augustavia Haydel, Esq., General Counsel, announced the following items to be discussed in closed session. The Board CLOSED SESSION adjourned to a closed session at 2:12 p.m. Thomas Horowitz, DO (Members Rembis and Roybal joined the meeting by telephone.) A. CONTRACT RATES Pursuant to Welfare and Institutions Code Section 14087.38(m) Plan Partner Rates Provider Rates DHCS Rates B. REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Discussion Concerning New Product Lines Estimated date of public disclosure: November 2016
Board of Governors Meeting November 6, 2014
DRAFT 6 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN C. CONFERENCE WITH REAL PROPERTY NEGOTIATORS Pursuant to Section 54956.8 of the Ralph M. Brown Act Property: 1055 West 7th Street, Los Angeles Agency Negotiator: Howard A. Kahn Negotiating Parties: Jamison Properties, 1055 West Seventh, LLC Under Negotiation: Price and Terms of Payment D. PUBLIC EMPLOYMENT Pursuant to Section 54957 Ralph M. Brown Act Title: Chief Executive Officer E. CONFERENCE WITH LABOR NEGOTIATOR Agency Negotiator: Thomas Horowitz, DO Unrepresented Employee: CEO F. PUBLIC EMPLOYEE PERFORMANCE EVALUATION Section 54957 of the Ralph M. Brown Act Title: Chief Executive Officer
RECONVENE IN The Board reconvened in open session at 3:36 p.m. OPEN SESSION (Members Rembis and Roybal joined the meeting by telephone.) Thomas Horowitz, DO CHAIRPERSON’S There will be no Board Committee meetings in December, and no Board meeting in January. REPORT A reception honoring Howard Kahn, Chief Executive Officer, will be held after the December 4 Board meeting. Thomas Horowitz, DO Chair Horowitz welcomed L.A. Care Regional Community Advisory Committee (RCAC) Members Amanda Calzada (RCAC 1), Ana Rodriguez (RCAC 2), Esmeralda Cerezo (RCAC 3), Samla Diaz (RCAC 6), and Janner Gavidia (RCAC 10). He thanked the members for coming to the Board Meeting. Mr. Kahn added that ECAC has asked representatives to attend Board meetings and report back to their RCACs. Member McCarthy encouraged Board Members to attend ECAC meetings. Chair Horowitz reviewed accomplishments of Board Member Klitzner and his service to L.A. Care since he joined the Board in January 2004. He thanked Dr. Klitzner on behalf of the Board of Governors, and presented him with a resolution of the Board. Mr. Kahn noted that besides being the longest-standing Board Member, Dr. Klitzner was Board Chairperson for two
Board of Governors Meeting November 6, 2014
DRAFT 7 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN years, and he thanked Dr. Klitzner for his guidance and his service to L.A. Care. Dr. Klitzner thanked Dr. Horowitz and Mr. Kahn for their comments. He expressed his enjoyment in working as a member of the Board of Governors. He noted that the organizational structure and leadership is excellent at L.A. Care. The mission at L.A. Care, which is very near and dear to his beliefs, has carried L.A. Care to its current prominence and will continue to guide the Board and the organization in the future. Member De La Torre was appointed to the Services Agreement Committee.
CHIEF EXECUTIVE Mr. Kahn welcomed new Board Member Hector De La Torre. Mr. De La Torre is the OFFICER’S REPORT Executive Director of the Transamerica Center for Health Studies, which is a national nonprofit organization headquartered here in Los Angeles. Mr. De La Torre is the first Board Member to Howard A. Kahn be nominated by this Board of Governors. A copy of the L.A. Care Provider newsletter was provided to each Board Member. An invitation is also provided to the opening of the family resource center in Pacoima on Nov. 14. Introduced Mitra Madjdi, Executive Assistant to the Chief Executive Officer. Open enrollment for Covered California begins November 15 through February 15, 2015. Staff is preparing for community outreach efforts, trainings, and marketing plans for 2014- 15 enrollment. Working with California Primary Care Association and local community clinics on legislation for a pilot program for the Prospective Payment System and will report to the Board at the December meeting. Operations Report John Wallace, Chief Operating Officer, referred to the Operations Report included in the materials for this meeting: John Wallace Focus is on January 2015 increased membership expected through CalMedi-Connect transition. Improvements continue to be made in the Claims area. A joint request for proposals will be released in the next several of weeks by L.A. Care and Health Net, with involvement from the California Department of Health Care Services for a three-year pilot program for mobile vision services to be operated with schools in Los Angeles County.
Board of Governors Meeting November 6, 2014
DRAFT 8 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN 4th Quarter Jonathan Freedman, Chief of Strategy, Regulatory & External Affairs, reported: Organizational The Year End Organizational Performance Report was included in the materials for this Performance Report meeting. This was a tumultuous year: Transition of the members (165,000) of the Los Angeles County Low Income Health Jonathan Freedman Program (LIPH) into MediCal managed care Implementation of L.A. Care Covered Completion of the accreditation process by the National Committee on Quality Assurance (NCQA) and achieved accreditation Reversed the low performing icon (LPI) status in Medicare, thereby achieving passive enrollment for the duals demonstration pilot, CalMediConnect. Mr. Kahn added that the tumultuous nature of this past year was positive. He noted that the organization has seen membership growth of 60,000- 70,000 members per month. He commended the herculean effort by all departments to accomplish the organizational goals.
CHIEF MEDICAL Gertrude S. Carter, MD, Chief Medical Officer, referred to her written report included in the OFFICER’S REPORT materials provided for this meeting, and she reported: Jude I. Uwaezuoke, President of Speedycare Medical Distributors, Inc. spoke to this Board at its Gertrude S. Carter, MD October meeting. Staff has met with Mr. Uwaezuoke and is moving forward on actions to address his concerns. Chair Horowitz noted that a report is appreciated but the Board does not get involved in the details of L.A. Care operations, as the staff is very capable and competent in addressing any issues that arise. Mr. Kahn informed Board members that new Cal MediConnect/CCI program implementation has led to concern among service providers that they may be excluded from the program. Board Members who may be approached directly are encouraged to refer providers to staff. Member Lopez asked about a decline from 2013 to 2014 in the health plan customer service Medicare Star rating. Dr. Carter noted that the ratings are assessed and Stars are awarded for performance in comparison with the other plans each year. So even a small change (1%) in relative measure can affect the Stars awarded. Mr. Wallace added that the rating is based on consumer assessment of the services provided through the health plan network. If a consumer has a bad experience with a provider, the assessment can be negative. L.A. Care works closely with its providers to help them improve Board of Governors Meeting November 6, 2014
DRAFT 9 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN customer service. Mr. Kahn indicated that another important aspect of the Star rating system is that plans serving low income populations are not rated separately. Because there is a new understanding and recognition of the need for different assessment programs for health plans serving low income populations, CMS recently initiated a project to study those differences. Dr. Carter noted that staff considers consumer ratings to be a key strategic initiative. Member satisfaction is important and staff sees a lot of room for improvement.
MOTIONS FOR (Member Gamble left the meeting.) CONSIDERATION Ms. Haydel indicated that motions BOG 100, 101, 102 and 103 were to be presented directly to the Board today because of potential conflicts at the committee level. However, due to absences, the required four votes is not possible for these motions. She asked the Board to delegate authority to consider these motions to the Services Agreement Committee. There was no objection from Board Members to the proposal to delegate consideration of motions BOG 100.1114 (Health Integrated Contract Amendment), BOG 101.1114 (Rancho Los Amigos National Rehabilitation Center Grant), BOG 102.1114 (Safety Net Connect Contract), and BOG 103.1114 (Tides Center Grant), to the Services Agreement Committee due to potential conflicts of interest. Approved by roll call. Motion BOG 105.1114 10 AYES (De La Torre, To delegate consideration of Motion BOG 100.1114 (Health Integrated Contract Horowitz, Klitzner, Lee, Amendment), Motion BOG 101.1114 (Rancho Los Amigos National Rehabilitation Li, Lopez, McCarthy, Center Grant ), Motion BOG 102.1114 (Safety Net Connect Contract), and Motion BOG Perez, Rembis and 103.1114 (Tides Center Grant), to the Services Agreement Committee due to potential Roybal). conflicts of interest. Health Integrated Motion BOG 100.1114 Contract Amendment To authorize staff to amend a contract with Health Integrated for an amount not to exceed $1,400,000 from January 1, 2015 to June 30, 2015 for utilization management Gertrude S. Carter, MD administrative services to support Los Angeles County Department of Health Services. Rancho Los Amigos Motion BOG 101.1114 National Rehabilitation To approve redirection of $250,000 in previously allocated ad hoc grant funds to Rancho Center Grant Los Amigos National Rehabilitation Center to develop a peer mentor program that addresses the healthcare needs of spinal cord injury patients by lowering the risk of Board of Governors Meeting November 6, 2014
DRAFT 10 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Jonathan Freedman pressure ulcer sores and major depression.
Safety Net Connect Motion BOG 102.1114 Consideration of motions BoG Contract To authorize staff to execute a contract, subsequent to pilot evaluation, with SafetyNet 100, 101, 102 and 103 was Connect Inc., for software development and technical support for the eConnectLA delegated to the Services project from November 1, 2014 through October 31, 2017, for an amount not to exceed Agreement Committee. $945,000. Tides Center Motion BOG 103.1114 To authorize staff to execute a contract with Tides Center to provide train-the-trainer John Wallace programs for a total amount of $100,000 (total contract amount $100,050), for the period of September 1, 2014 to September 30, 2015. Consideration of Chief Augustavia Haydel, General Counsel, read a motion for delegation to Executive Committee on Executive Officer’s CEO performance evaluation. Compensation Motion BOG 104.1114 Approved by roll call. To delegate authority to the Executive Committee all powers necessary to complete the 10 AYES (De La Torre, following actions: Horowitz, Klitzner, Lee, A. With respect to L.A. Care’s current Chief Executive Officer, Howard A. Kahn, Li, Lopez, McCarthy, 1. to conduct a review of Mr. Kahn’s performance for the October 1, 2013 through Perez, Rembis and September 30, 2014 Performance Year, and Roybal). 2. to determine whether to award a performance-based incentive and the amount of the incentive. B. With respect to L.A. Care’s future Chief Executive Officer (Mr. Kahn’s successor), to conclude negotiations and make a final determination of the terms and conditions for employment, including but not limited to compensation. This authorization shall become effective only after the Board of Governors has affirmatively voted to determine the future Chief Executive Officer and the Chair of the Board has determined that a delegated actions need to be completed prior to the December 5, 2014 board meeting.
PUBLIC ADVISORY COMMITTEE REPORTS
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DRAFT 11 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN EXECUTIVE Member Lopez welcomed Ms. Dove Pinckney (RCAC 6) and he reported: COMMUNITY ECAC meeting was held on October 8. ADVISORY A motion was approved today on the Consent Agenda (ECA 100). COMMITTEE (ECAC) RCACs 3, 5, and 9 held a “Get Fit: Passport to Health” event in September. The event in RCAC 5 was held at Animo School, and was well attended with more than 100 participants Ozzie Lopez/ of all ages. The California University of Holistic Medicine provided basic body adjustments Hilda Perez and massages to participants. A member of L.A. Care’s internal Interdisciplinary Committee provided updates on issues that were previously submitted to ECAC. L.A. Care Health Promoters continue training and working with the RCACs and community, providing workshops on diabetes, health care grievances, access to care, Affordable Care Act, and other health related topics. Member Lopez complimented the work of the promotoras program. Cultural and Linguistic department staff provided information about L.A. Care’s language services. Member Gamble rejoined the meeting. Member Lopez invited Board members to attend ECAC meetings. Motion ECA 100.1114* Approved by roll call. To approve the following candidate(s) to the Regional Community Advisory 10 AYES (De La Torre, Committees (RCAC) as reviewed by the Executive Community Advisory Committee Gamble, Horowitz, (ECAC) during the October 8, 2014 ECAC meeting. Klitzner, Lee, Li, Lopez, McCarthy, Perez, and Name RCAC # Type of Member Roybal). (Agency, if applicable) (Telephone communication with Member Rembis was disrupted Northeast Valley Health Corporation/WIC RCAC 2 Community Partner and he did not vote on this Angela Bogarin RCAC 5 Consumer motion.) Sandra Verdugo RCAC 11 Consumer
STANDING COMMITTEE REPORTS
Board of Governors Meeting November 6, 2014
DRAFT 12 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN EXECUTIVE The Executive Committee met on October 22, 2014. (Minutes of the meeting can be obtained by COMMITTEE contacting Board Services.) Thomas Horowitz, DO Legislative Update / Cherie Fields, Director, Government Affairs, reported: Actions Federal Cherie Fields Results of some Congressional elections are still to be determined. Republican leadership has announced they will work to repeal Obamacare. It is unlikely the Republicans will be successful, but there will likely be some changes around the edges of the law. The resolution continuing spending under the federal budget will expire December 11. It is expected another continuing resolution will be passed. State Results of some state elections may not be known for several months. Also, due to some members leaving state office for other elected positions, there will be several special elections held in 2015. Democrats will not have a supermajority in California. Propositions 45 and 46 lost by wide margins, and two propositions promoted by Governor Brown passed. Local There will be two new members of the Los Angeles County Board of Supervisors on January 1, 2015 - Sheila Kuehl and Hilda Solis. Mr. Freedman noted that the dominant issue in Washington DC will be whether the Obama administration will be willing to adjust any of the Affordable Care Act. The fiscal climate of California is volatile due to its tax structure; there is new leadership in both houses and a lengthening of term limits. All these factors may affect the current structure of public health programs. California will have to address changes to the Medi-Cal managed care organization (MCO) tax due to concerns of the Centers for Medicare and Medicaid Services. (Member Rembis left the meeting.) Mr. Kahn opined that a big risk in Washington DC is that Medicare is considered to be off limits and Medicaid is more likely to be subject to cuts more than in the past. Potential cuts in funding are a great concern to safety net stakeholders. Board of Governors Meeting November 6, 2014
DRAFT 13 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Ms. Fields indicated that the supplemental primary care provider payment for Medicaid primary care providers (reimbursed at Medicare levels) may not be extended. Finally, the delay in implementation of rate cuts for Medicare will expire in 2015. Revisions to the L.A. Care Ms. Haydel referred to a motion included in the materials for this meeting to approve a Cash Balance Plan continuing allocation for Mr. Kahn’s retirement plan. She noted that the contributions by L.A. Approved by roll call. Care will continue to be paid only until Mr. Kahn’s separation from employment with L.A. Care. 10 AYES (De La Torre, Augustavia J. Haydel, Esq. Gamble, Horowitz, Motion EXE 100.1114 Klitzner, Lee, Li, Lopez, To approve revisions to the L.A. Care Cash Balance Plan to establish the annual McCarthy, Perez and allocation for the three year period December 4, 2014, to December 3, 2017, for Roybal). contributions on behalf of Howard A. Kahn, a qualified participant, as attached.
FINANCE & BUDGET Chair Horowitz reported that the Committee met on October 22, 2014. (Minutes of the meeting can COMMITTEE be obtained by contacting Board Services.) In addition to motions approved earlier on today’s consent Agenda, the Committee approved the purchase of computer hardware from Tiger Direct, a contract renewal with Curvature, contract amendments with 3Key Consulting, and contracts with Partners in Care Foundation and Integrated Behavioral Health Project which do not require Board approval. Motions approved under Motion FIN 100.1114* Consent Agenda To accept the Investment Report for the quarter ended September 30, 2014, as submitted. Approved by roll call. 10 AYES (De La Torre, Motion FIN 101.1114* Gamble, Horowitz, To approve revised procedures for timely payments to General Agents through Klitzner, Lee, Li, Lopez, September 30, 2015, for a total amount not to exceed $3,500,000. McCarthy, Perez, and Motion FIN 102.1114* Roybal). Authorize staff to amend the contract with Healthx for an additional amount of (Telephone communication with $126,175 (total contract not to exceed $713,395); for the member portal solution platform Member Rembis was disrupted and member mobile application module project through January 31, 2015. and he did not vote on this motion.) Motion FIN 103.1114* To authorize staff to purchase server hardware from GHA in the amount of $383,462 (total contract amount to not exceed $539,053.92).
Board of Governors Meeting November 6, 2014
DRAFT 14 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Motion FIN 104.1114* To authorize staff to amend the contract with the Community Health Alliance of Pasadena (CHAP) in the amount of $250,000 (total contract amount not to exceed $490,000); and to approve the technology incentive payment of the Stars Program in the amount of $10,000.
Motion FIN 105.1114* To approve funding for additional licenses and maintenance support services from Presidio, Inc. in an amount not to exceed $1,029,502, for a total contract amount of $1,749,539. Financial Update Tim Reilly, Chief Financial Officer, reported Tim Reilly The financial statements for the end of L.A. Care’s fiscal year ended September 30, 2014 have not been finalized. The audit firm is on site to assist with the year-end financial accounting. A formal written report (subject to audit) will be provided to the Board as soon as it is ready. It is expected that L.A. Care will end the fiscal year with a $40 million surplus. A deficit had been projected. The surplus is a result of negotiations with the Department of Health Care Services to improve the rates. Mr. Kahn noted that L.A. Care’s revenue increased from $2.7 billion at the end of 2013, to $4.1 billion as of September 2014, which is tremendous growth. The surplus for this year is only 1% but does represent improvement over the budgeted result. Monthly Investment Mr. Reilly referenced the Investment Transaction Report included in the meeting materials to Transaction Report fulfill the required monthly review by the Board of Governors. There were no questions from Board members about the transaction report. Tim Reilly Prequalified Consulting Mr. Freedman reported on the prequalified vendor contracts. L.A. Care used $2.1 million of and Staffing Vendor funds authorized by the Board to use for services of competitively selected contractors Program Fourth Quarter throughout the last fiscal year. The Board has received quarterly reports on the program. The Update and 2013-14 Fiscal use of these firms has greatly assisted in the implementation of new programs throughout the Year-End Summary organization. The program is intended to continue for two more years, at the end of the third year a request for proposals will be issued. Jonathan Freedman
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DRAFT 15 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN SERVICES Member Lopez reported that the Committee met immediately after the Board meeting on AGREEMENT October 2. (Minutes of the meeting can be obtained by contacting Board Services.) COMMITTEE Member Lopez thanked the Committee members for electing him Chair of the Committee. The Committee met in closed session to discuss Plan Partner Rates and Services Ozzie Lopez Agreements. There was no report from that closed session.
ADJOURNMENT The meeting was adjourned at 4:27 p.m. Ms. Perez thanked the RCAC members that attending the meeting.
Respectfully submitted by: Linda Merkens, Manager APPROVED BY: ______Malou Balones, Committee Liaison Louise McCarthy, Secretary Hilda Stuart, Committee Liaison Date Signed ______
Board of Governors Meeting November 6, 2014
DRAFT 16 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. BOG 100.1214
Committee: Chairperson: Thomas Horowitz, DO
Issue: Biennial Review of L.A. Care Health Plan’s (“L.A. Care”) Conflict of Interest Code.
Background: California state law requires local public agencies, such as L.A. Care, to review and update their Conflict of Interest Code biennially. Pursuant to the notice received from Los Angeles County – L.A. Care’s Conflict of Interest Code Reviewing Body - staff conducted a review of the Code and recommends updating the list of “Designated Positions” that are required to file a Form 700 as shown in the attached document on pages 3 and 4.
Pursuant to instructions from Los Angeles County, L.A. Care timely submitted its 2014 Biennial Review Certificate Form to the Board of Supervisors Executive Office. The next step in the process is to submit to the County the proposed revisions and supporting documentation by December 26, 2014.
L.A. Care’s legal staff recommends approving the revisions shown in the attached Conflict of Interests Code.
Budget Impact: None
Motion: To approve revisions to the Conflict of Interest Code of L.A. Care Health Plan, as attached, for submission to the L.A. County Board of Supervisors.
17
Conflict of Interest Code of the
LOCAL INITIATIVE HEALTH AUTHORITY FOR LOS ANGELES COUNTY
(L.A. CARE HEALTH PLAN)
Incorporation of FPPC Regulation 18730 (2 California Code of Regulations, Section 18730) by Reference
The Political Reform Act (Government Code Section 81000, et seq.) requires state and local government agencies to adopt and promulgate conflict of interest codes. The Fair Political Practices Commission has adopted a regulation (2 Cal. Code of Regs. 18730), which contains the terms of a standard conflict of interest code. After public notice and hearing, it may be amended by the Fair Political Practices Commission to conform to amendments in the Political Reform Act. Therefore, the terms of 2 California Code of Regulations Section 18730, and any amendments to it duly adopted by the Fair Political Practices Commission, are hereby incorporated into the conflict of interest code of this agency by reference. This regulation and the attached Appendices (or Exhibits) designating officials and employees and establishing economic disclosure categories shall constitute the conflict of interest code of this agency.
Place of Filing of Statements of Economic Interests
All officials and employees required to submit a statement of economic interests shall file their statements with the General Counsel of L.A. Care Health Plan, or his or her designee. L.A. Care Health Plan shall make and retain a copy of all statements filed by its Board Members and its Chief Executive Officer and forward the originals of such statements to the Executive Office of the Board of Supervisors of Los Angeles County.
L.A. Care Health Plan shall retain the originals of statements for all other Designated Positions named in the agency’s conflict of interest code. All retained statements, original or copied, shall be available for public inspection and reproduction (Gov. Code Section 81008).
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18
Conflict of Interest Code
LOCAL INITIATIVE HEALTH AUTHORITY FOR LOS ANGELES COUNTY (LA. CARE HEALTH PLAN)
EXHIBIT “A”
CATEGORY 1
Persons in this category shall disclose all interests in real property in Los Angeles County if the property or any part of it is located within or not more than two miles outside the boundaries of Los Angeles County or within two miles of any land owned or used by the Agency.
CATEGORY 2
Persons in this category shall disclose all investments, income (including loans, gifts, and travel payments) and business positions in:
a. Plan Partners (health plans under contract with the Agency), health care providers or other businesses under contract with or under consideration to contract with the Agency.
b. Businesses engaged in the delivery of health care services or supplies, or services or supplies ancillary thereto of a type to be provided or arranged for by the Agency;
c. Businesses that provide services, supplies, materials, machinery or equipment of a type purchased or leased by the Agency;
d. Businesses subject to the regulatory, permitting or licensing authority of the Agency;
e. Businesses that have contracts or otherwise conduct business with Plan Partners.
CATEGORY 3
Persons in this category shall disclose all business positions, investments in, or income (including loans, gifts, and travel payments) received from businesses that manufacture, provide or sell services and/or supplies of a type utilized by the agency and associated with the job assignment of designated positions assigned this disclosure category.
CATEGORY 4
Any consultant who performs the functions of a Designated Employee shall be required to file Statements of Economic Interests disclosing reportable interests in the categories assigned to that designated position.
In addition, disclosure of consultants shall be determined on a case-by-case basis by the Chief Executive Officer. The Chief Executive Officer may make a determination as to what disclosure, if any, is required by any particular consultant.
(*See footnote for clarification.)
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Conflict of Interest Code
LOCAL INITIATIVE HEALTH AUTHORITY FOR LOS ANGELES COUNTY (L.A. CARE HEALTH PLAN)
EXHIBIT “B”
Designated Positions Disclosure Categories Board Members 1, 2 Chief Executive Officer 1, 2 Chief of Staff 1, 2 General Counsel 1, 2 Chief Medical Officer 1, 2 Chief Operating Officer 1, 2 Chief Financial Officer 1, 2 Chief Information Officer 1, 2 Chief of Human and Community Resources 1, 2 Chief of Strategy, Regulatory and External Affairs 1, 2 Senior Executive Director, HITEC—LA 2 Executive Directors 2 Associate Counsels 2 Assistant Managing Counsel 2 Director of Outreach and Education, HITEC—LA 3 Director of EHR Technology — HITEC-LA 3 Program Director of Marketing and Communications — 3 HITEC-LA Senior Directors (including Assistant General Counsel, 2 Chief Actuary, and Medical Director) Directors 3 Compliance Officer, Privacy and Information Security 3 Officer and Controller 3 Senior Managers Administrative Manager, Family Resource Center 1, 2 Managers 3 Senior Project Manager to CEO 3
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Designated Positions Disclosure Categories Director, Services for Seniors and People with Disabilities 2 *Consultant /or New Position 4 *Consultant/ or New Position are included in the list of designated positions and shall disclose pursuant to the broadest disclosure category in the code, subject to the following limitations:
The Chief Executive Officer, or his or her designee, may determine in writing that a particular consultant or new position, although a “designated position,” is hired to perform a range of duties that is limited in scope and thus is not required to fully comply with disclosure requirements in this section. Such written determination shall include a description of the consultant’s or new position’s duties and, based upon that description, a statement of the extent of disclosure requirements. The Chief Executive Officer or his or her designee’s determination is a public record and shall be retained for public inspection in the same manner and location as this conflict-of-interest code. (Gov. Code Section 81008.)
EFFECTIVE: 10/30/2013
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21 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. BOG 101.1214
Committee: Chairperson: Thomas Horowitz, DO
Issue: Staff seeks ratification of its execution of Amendment No. 10 to L.A. Care’s Medi-Cal Contract No. 03-75799 (Hyde Amendment – Family Planning Services) with the California Department of Health Care Services (DHCS).
Background: In order for L.A. Care to continue its participation in the Medi-Cal Managed Care Program, it must continue its contractual relationship with DHCS. DHCS has prepared and submitted for L.A. Care’s execution Hyde Amendment No. 10 to the contract. The only revision contained in the Amendment provides for a one year extension from December 31, 2014 to December 31, 2015. Because DHCS provided Hyde Amendment No. 10 to L.A. Care on November 19, 2014 and requested that Hyde Amendment No. 10 be executed and returned in November, staff is seeking ratification of the execution of Amendment No. 10 by Howard A. Kahn, Chief Executive Officer.
Budget Impact: None
Motion: To ratify execution of Amendment No. 10 to Medi-Cal Contract 03- 75799 (pertaining to the Hyde Amendment Family Planning Services) between the California Department of Health Care Services and L.A. Care Health Plan, and to ratify any non- substantive changes to Amendment No. 10 which were made or negotiated by Howard A. Kahn, Chief Executive Officer and/or his designees.
22 STATE OF CALIFORNIA STANDARD AGREEMENT AMENDMENT STD. 213A_DHCS (Rev. 08/14) Agreement Number Amendment Number Check here if additional pages are added: Page(s) 03-75799 A10
Registration Number: 1. This Agreement is entered into between the State Agency and Contractor named below: State Agency’s Name (Also known as DHCS, CDHS, DHS or the State) Department of Health Care Services Contractor’s Name (Also referred to as Contractor) L.A. Care Health Plan 2. The term of this Agreement is: August 1, 2003 through December 31, 2015 3. The maximum amount of this Budget Act Line Items Agreement after this amendment is: 4260-601-0912 and 4260-601-0555 4. The parties mutually agree to this amendment as follows. All actions noted below are by this reference made a part of the Agreement and incorporated herein:
I. Amendment effective date: December 31, 2014, or until approved by DGS (if DGS approval is required).
II. Purpose of amendment: This amendment extends the contract term to December 31, 2015. DHCS is obtaining a continuation of the services identified in the original agreement.
III. Certain changes made in this amendment are shown as: Text additions are displayed in bold and underline. Text deletions are displayed as strike through text (i.e., Strike).
IV. Paragraph 2 (term) on the face of the original STD 213 is amended to read: August 1, 2003 through December 31, 2014December 31, 2015. All references to the former contract term of August 1, 2003 through December 31, 2014 in any exhibit incorporated into this agreement are hereinafter deemed to read August 1, 2003 through December 31, 2015.
(Continued on next page)
All other terms and conditions shall remain the same.
IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto. CONTRACTOR CALIFORNIA Department of General Services Contractor’s Name (If other than an individual, state whether a corporation, partnership, etc.) Use Only L.A Care Health Plan By(Authorized Signature) Date Signed (Do not type) Printed Name and Title of Person Signing Howard Kahn, Chief Executive Officer Address 1055 West 7th Street, 11th Floor Los Angeles, CA 90017 STATE OF CALIFORNIA Agency Name Department of Health Care Services By (Authorized Signature) Date Signed (Do not type) Printed Name and Title of Person Signing Exempt per: W&I Code Section Javier Portela, Acting Chief Operating Officer, Medi-Cal Managed Care Division 14087.55(c) Address 1501 Capitol Avenue, MS 4415, P.O. Box 997413 Sacramento, CA 95899-7413
23 Board of Governors MOTION SUMMARY Date: December 4, 2014 Motion No. BOG 102.1214 Committee: Chairperson: Thomas Horowitz, DO Issue: Staff seeks ratification of the execution of Amendment No. 16 (“Amendment No. 16”) (Contract No. 04-36069 A16) to L.A. Care’s Medi-Cal Contract with the California Department of Health Care Services (“DHCS”). Amendment No. 16 incorporates the Managed Long-Term Services and Supports (“MLTSS”) provisions of Coordinated Care Initiative into the Medi-Cal Contract for L.A. Care’s current Full Benefit Dual Eligible Members. Background: As part of the Coordinated Care Initiative, certain MLTSS have been incorporated into the terms and conditions of the Medi-Cal Contract. L.A. Care is to provide long term care, in-home supportive services, the multipurpose senior services program and community based adult services. DHCS will compensate L.A. Care for such services. Amendment No. 16 pertains to the current Full Benefit Dual Eligible Members for whose MLTSS L.A. Care became responsible beginning April 1, 2014. DHCS indicated it will be issuing a subsequent amendment to address MLTSS for L.A. Care members who are partial benefit dual eligible members. At its October 2, 2014 meeting, this Board Committee ratified the Chief Executive Officer’s execution of Amendment No. 16 due to the fact that DHCS had requested an expedited turnaround on the execution of Amendment No. 16. L.A. Care, subsequently, returned the executed Amendment No. 16 to DHCS with a reservation of rights to correct noted misstatements and errors. DHCS has not executed Amendment No. 16 and has, instead, made revisions to Amendment No. 16 regarding program obligations and rates and has, again, requested an expedited turnaround on the execution of Amendment No. 16. Staff is in the process of reviewing those revisions. Because DHCS is requesting an expedited turnaround on the execution of Amendment No. 16, staff, hereby, requests ratification of the Chief Executive Officer’s execution of Amendment No. 16. and L.A. Care’s return of Amendment No. 16 to DHCS with a reservation of rights. Budget Impact: Motion: To ratify the Chief Executive Officer’s execution of Amendment No. 16 to Contract 04-36069 (Medi-Cal Contract pertaining to the Coordinated Care Initiative Managed Long-Term Services and Supports into the Medi-Cal Program) between the California Department of Health Care Services and L.A. Care Health Plan, and to ratify any non-substantive changes to Amendment No. 16 which may be made or negotiated by the Chief Executive Officer and/or his designees.
24 L.A. Care Health Plan 04-36069 A16
IV. Exhibit A, Attachment 11, CASE MANAGEMENT AND COORDINATION OF CARE, is amended to read:
18. Excluded Services Requiring Member Disenrollment
Contractor shall continue to cover and ensure that all Medically Necessary services are provided to Members who must disenroll and receive the following services through the Medi-Cal FFS program until the date of disenrollment is effective.
A. Long Term Care (LTC)
Long term careTerm Care (LTC) is defined as care in a facility for longer than the month of admission plus one month. With the exception of Full Benefit Dual Eligible Members, LTC services are not covered under this Contract. Contractor shall cover Medically Necessary LTC services provided to Full Benefit Dual Eligible Members in accordance with the requirements in Exhibit A, Attachment 24, Managed Long Term Services and Supports. For all other Members, Contractor shall cover Medically Necessary nursing careLTC provided from the time of admission and up to one month after the month of admission.
Contractor shall ensure that Members, other than Members requesting hospice services, who are in need of nursing facilityLTC services, are placed in a health care facility that provides the level of care most appropriate to the Member's medical needs. These health care facilities include Skilled Nursing Facilities, subacute facilities, pediatric subacute facilities, and Intermediate Care Facilities. Contractor shall base decisions on the appropriate level of care on the definitions set forth in Title 22 CCR Sections 51118, 51120, 51120.5, 51121, 51124.5, and 51124.6 and the criteria for admission set forth in Title 22 CCR Sections 51335, 51335.5, 51335.6, and 51334 and related sections of the Manual of Criteria for Medi-Cal Authorization referenced in Title 22 CCR Section 51003(e).
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25 L.A. Care Health Plan 04-36069 A16
V. Exhibit A, Attachment 17, REPORTING REQUIREMENTS, is amended to read:
Contract Section Requirement Frequency Exhibit A - SCOPE OF WORK Attachment 1 ORGANIZATION AND ADMINISTRATION OF THE PLAN 2. A. Key Personnel (Disclosure Form) Key Personnel Annually (Disclosure Form) Attachment 2 FINANCIAL INFORMATION 2. Financial Audit Reports Annual certified Financial Annually B. 1) Statements and DMHC required or reporting forms B. 2) or Financial Statement 2. Financial Audit Reports Quarterly Financial Reports Quarterly B. 2) 4. Monthly Financial Statements Monthly Financial Statements Monthly (If applicable) Attachment 3 MANAGEMENT INFORMATION SYSTEM 2. Encounter Data Submittal Encounter Data Submittal Monthly C. Attachment 4 QUALITY IMPROVEMENT SYSTEM (QIS) 4. Quality Improvement Committee Quality Improvement Committee Quarterly C. meeting minutes 8. Quality Improvement Annual Report Quality Improvement Annual Annually Report 9. External Quality Review Requirements EAS Performance Measurement Annually A. External Accountability Set (EAS) Rates Performance Measures 2) b) 9. External Quality Review Requirements Reported rates Annually B. Under/Over-Utilization Monitoring 9. External Quality Review Requirements QIP Proposals or Status Reports Annually C. Quality Improvement Projects (QIPs)
10. Site Review Site Review Data Semi- E. Data Submission Annually Attachment 6 PROVIDER NETWORK 11. Provider Network Report Provider Network Report Quarterly 12. Plan Subcontractors Plan Subcontractors Report Quarterly
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26 L.A. Care Health Plan 04-36069 A16
Contract Section Requirement Frequency Attachment 9 ACCESS AND AVAILABILITY 13. Cultural and Linguistic Program Group Needs Assessment Every 5 C. Group Needs Assessment Summary Report years 4) Attachment 10 SCOPE OF SERVICES 5. Services for Members under Twenty- Confidential Screening/Billing Monthly One(21) Years of Age Report Form, PM 160-PHP B. Children's Preventive Services 5) 8. Services for All Members Report of Changes to Annually G. Pharmaceutical Services and Provision the Formulary of Prescribed Drugs 2) Attachment 12 LOCAL HEALTH DEPARTMENT COORDINATION 4. MOU Monthly Reports Local Health Department - Monthly MOU's Local Mental Health - MOU's (If deemed necessary) Attachment 13 MEMBER SERVICES 3. Call Center Reports Call Center Reports Quarterly
4. Written Member Member Services Guide Annually Information B. Attachment 14 MEMBER GRIEVANCE SYSTEM 3. Grievance Log and Quarterly Grievance Grievance Report Quarterly Report Attachment 15 MARKETING 3. Marketing Plan Marketing Plan Annually A. Attachment 16 ENROLLMENTS AND DISENROLLMENTS 1. Enrollment Program (Policy Letter 00-02) Provider Directory Semi- Annually Attachment 19 COMMUNITY BASED ADULT SERVICES (CBAS) 5. Required Reports for the CBAS Program Provision of ECM Report Quarterly A. 5. Required Reports for the CBAS Program CBAS Enrollment Report Quarterly B. 5. Required Reports for the CBAS Program Addition to Call Center Report Quarterly C. 5. Required Reports for the CBAS Program Addition to Grievance Report Quarterly D.
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27 L.A. Care Health Plan 04-36069 A16
Attachment 20 TRANSITION OF OPTIONAL TARGETED LOW-INCOME CHILD MEMBERS 1. Continuity of Care 2. Required Reports Continuity of Care Reports Monthly A. provided for Optional Targeted Low-Income Child Members 2. Required Reports Addition to Provider Network Quarterly B. Report 2.Required Reports Addition to Grievance Report Quarterly C. Attachment 21 MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS 3. Provider Network Reports Addition to the Provider Network Quarterly A. Report 3. Provider Network Reports Outpatient Mental Health Services Monthly B. Providers Report Attachment 22 LOW INCOME HEALTH PROGRAM (LIHP) MEMBERS 2. Required Reports Continuity of Care Reports Monthly A. 2. Required Reports Addition to the Provider Network Quarterly B. Report 2. Required Reports Addition to the Grievance Log and Quarterly C. Quarterly Grievance Report Attachment 23 CAL MEDICONNECT DUAL ELIGIBLE SPECIAL NEEDS PLANS 6. Provider Network Reports The full Medi-Cal provider network Initial A. Report 6. Provider Network Reports Provider Capacity Report Quarterly B. 6. Provider Network Reports Report of Provider Deletions and Quarterly C. Additions; Provider Not Accepting New Patients Attachment 24 MANAGED LONG-TERM SERVICES AND SUPPORTS (MLTSS) 10. Required Reports for Long Term Support and Retention of Quarterly Services and Supports Community Placement A. 10. Required Reports for Long Term Continuity Monthly Services and Supports of Care Requests B. 10. Required Reports for Long Term Addition to the Provider Network Quarterly Services and Supports Report C.
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Contract Section Requirement Frequency 10. Required Reports for Long Term Addition to Call Center Reports Quarterly Services and Supports D. 10. Required Reports for Long Term Addition to Grievances and Monthly Services and Supports Appeals Report E. Exhibit B – BUDGET DETAIL AND PAYMENT PROVISIONS 12. Payment of AIDS Beneficiary Rates AIDS Beneficiary Rate (ABR) Monthly A. Compensation at the AIDS Beneficiary Invoice Rate (ABR) 1) c)
VI. Exhibit A, Attachment 18, IMPLEMENTATION PLAN AND DELIVERABLES, is amended to read:
20. Managed Long-Term Services and Supports
Submit the following consistent with the requirements of Exhibit A, Attachment 24.
A. Submit executed Memoranda of Understanding, or documentation substantiating Contractor’s efforts to negotiate an agreement with the county In-Home Support Services (IHSS) office and IHSS Public Authority.
B. Submit policies and procedures for the provision of services at non-contracted Long Term Care (LTC) facilities.
C. Submit an addition to the policies and procedures related to provider training required in Provision 7 of this Attachment that includes key elements of operating a successful program for administering long term services and supports.
D. Submit policies and procedures for the provision of LTC and IHSS as Covered Services.
E. Submit policies and procedures for the provision of continuity of care through continued access to either a CBAS provider with whom there is an existing relationship for up to 12 months after Full Benefit Dual Eligible Member enrollment or an LTC provider with whom there is an existing relationship until December 31, 2016.
F. Submit policies and procedures for the risk stratification process conducted for Full Benefit Dual Eligible Members. Page 6 of 16
29 L.A. Care Health Plan 04-36069 A16
VII. Exhibit B, BUDGET DETAIL AND PAYMENT PROVISIONS, is amended to read:
4. Capitation Rates
A. DHCS shall remit to Contractor a capitation payment each month for each Medi-Cal Member that appears on the approved list of Members supplied to Contractor by DHCS. The capitation rate shall be the amount specified below. The payment period for health care services shall commence on the first day of operations, as determined by DHCS. Capitation payments shall be made in accordance with the following schedule of capitation payment rates at the end of the month. For aid codes see DEFINITION, Eligible Beneficiary:
For the period 01/01/11 – 05/31/11 Los Angeles Groups Aid Codes Rate Adult & Family 01, 0A, 02, 03, 04, 06, 08, 30, 32, 33, $122.63 34, 35, 38, 39, 40, 42, 45, 46, 47, 54, 59, 72, 82, 3A, 3C, 3E, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 4A, 4F, 4G, 4K, 4M, 5K, 7A, 7J, 7X, 8P, 8R, 86 Aged & Disabled 10, 14, 16, 20, 24, 26, 36, 60, 64, $525.72 Medi-Cal Only 66, 1E, 1H, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V, 2E, 2H Disabled/Dual 20, 24, 26, 36, 60, 64, 66, 6A, 6C, $130.87 Eligible 6E, 6G, 6H, 6J, 6N, 6P, 6V, 2E, 2H Aged/Dual Eligible 10, 14, 16, 1E, 1H $125.57 Breast and Cervical 0N, 0P $1,022.08 Cancer Treatment Program (BCCTP) AIDS/Dual Eligible $216.10
AIDS/Medi- $1,007.30 Cal Only Maternity $5,656.38
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For the period 06/01/11 – 06/30/11 Los Angeles Groups Aid Codes Rate Adult & Family 01, 0A, 02, 03, 04, 06, 08, 30, 32, 33, $122.63 34, 35, 38, 39, 40, 42, 45, 46, 47, 54, 59, 72, 82, 3A, 3C, 3E, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 4A, 4F, 4G, 4K, 4M, 5K, 7A, 7J, 7X, 8P, 8R, 86 Aged & Disabled 10, 14, 16, 20, 24, 26, 36, 60, 64, $546.91 Medi-Cal Only 66, 1E, 1H, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V, 2E, 2H Disabled/Dual 20, 24, 26, 36, 60, 64, 66, 6A, 6C, $130.87 Eligible 6E, 6G, 6H, 6J, 6N, 6P, 6V, 2E, 2H Aged/Dual Eligible 10, 14, 16, 1E, 1H $125.57 Breast and Cervical 0N, 0P $1,022.08 Cancer Treatment Program (BCCTP) AIDS/Dual Eligible $216.10 AIDS/Medi- $1,007.30 Cal Only Maternity $5,656.38
For the period 07/01/11 – 09/30/11 Los Angeles Groups Aid Codes Rate Adult & Family 01, 0A, 02, 03, 04, 06, 08 , 30, 32, $125.35 33, 34, 35, 38, 39, 40, 42, 45, 46, 47, 54, 59, 72, 82, 3A, 3C, 3E, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 4A, 4F, 4G, 4H, 4K,4L, 4M, 4T, 5K, 7A, 7J, 7X, 8P, 8R, 86 Aged & Disabled 10, 14, 16, 20, 24, 26, 36, 60, 64, $745.15 Medi-Cal Only 66, 1E, 1H, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V, 2E, 2H Disabled/Dual 20, 24, 26, 36, 60, 64, 66, 6A, 6C, $131.04 Eligible 6E, 6G, 6H, 6J, 6N, 6P, 6V, 2E, 2H Aged/Dual Eligible 10, 14, 16, 1E, 1H $125.54 Breast and Cervical 0N, 0P $1,042.51 Cancer Treatment Program (BCCTP) AIDS/Dual Eligible $216.06
AIDS/Medi- $1,036.02 Cal Only Maternity $5,656.38
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For the period 10/01/11-09/30/12 Los Angeles Aid Group Rates Adult & Family $124.92 Aged & Disabled/Medi-Cal Only $766.31 Disabled/Dual Eligible $139.88 Aged/Dual Eligible $129.85 Breast and Cervical Cancer Treatment Program (BCCTP) $853.95 AIDS/Dual Eligible $218.12 AIDS/Medi-Cal Only $978.20 Maternity $6,182.76
For the period 10/01/12-12/31/12 Los Angeles Aid Group Rates Adult & Family $118.15 Aged & Disabled/Medi-Cal Only $685.61 Disabled/Dual Eligible $134.82 Aged/Dual Eligible $122.03 Breast and Cervical Cancer $791.29 Treatment Program (BCCTP) AIDS/Dual Eligible $188.06 AIDS/Medi-Cal Only $866.88 Maternity $6,315.90
For the period 01/01/13-06/30/13 Los Angeles Aid Group Rates Adult & Family $136.21 Aged & Disabled/Medi-Cal Only $729.16 Disabled/Dual Eligible $140.88 Aged/Dual Eligible $127.27 Breast and Cervical Cancer Treatment $850.18 Program (BCCTP) AIDS/Dual Eligible $193.54 AIDS/Medi-Cal Only $896.99 Maternity $6,315.90
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For the period 07/01/13-09/30/13 Los Angeles Aid Group Rates Adult & Family $138.46 Aged & Disabled/Medi-Cal Only $741.21 Disabled/Dual Eligible $143.21 Aged/Dual Eligible $129.38 Breast and Cervical Cancer $864.22 Treatment Program (BCCTP) AIDS/Dual Eligible $196.74 AIDS/Medi-Cal Only $911.82 Maternity $6,420.28
For the period 10/01/13-12/31/13 Los Angeles Aid Group Rates Adult & Family $139.01 Aged & Disabled/Medi-Cal Only $791.47 Disabled/Dual Eligible $254.64 Aged/Dual Eligible $439.79 Breast and Cervical Cancer $857.28 Treatment Program (BCCTP) AIDS/Dual Eligible $191.87 AIDS/Medi-Cal Only $916.39 Maternity $6,463.34 CommencingFor the 01/01/14-3/31/14 period Los Angeles Aid Group Rates Adult & Family $125.24 Aged & Disabled/Medi-Cal Only $732.89 Disabled/Dual Eligible $252.78 Aged/Dual Eligible $438.68 Breast and Cervical Cancer Treatment $731.30 Program (BCCTP) Medi-Cal Only AIDS/Dual Eligible $190.68 AIDS/Medi-Cal Only $794.71 Maternity $6,463.34 Adult Expansion $556.41 Maternity Expansion $7,566.73
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Commencing 04/01/14 Los Angeles Aid Group Rates Adult & Family $125.24 Aged & Disabled/Medi-Cal Only $732.89 Family/Dual Eligible Disabled/Dual Eligible Aged/Dual Eligible Long Term Care/Dual Eligible______Breast and Cervical Cancer Treatment $731.30 Program (BCCTP) Medi-Cal Only AIDS/Dual Eligible AIDS/Medi-Cal Only $794.71 Maternity $6,463.34 Adult Expansion $556.41 Maternity Expansion $7,566.73
For the period 01/01/13-03/31/13 Los Angeles Groups Rate Optional Targeted Low-Income Child $77.17
For the period 04/01/13-06/30/13 Los Angeles Groups Rate Optional Targeted Low-Income Child $79.22
For the period 07/01/13-07/31/13 Los Angeles Groups Rate Optional Targeted Low-Income Child $80.53
For the period 08/01/13-12/31/13 Los Angeles Groups Rate Optional Targeted Low-Income Child $81.97
For the period 01/01/14-06/30/14 Los Angeles Groups Rate Optional Targeted Low-Income Child $84.28
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B. If DHCS creates a new aid code that is split or derived from an existing aid code covered under this Contract, and the aid code has a neutral revenue effect for the Contractor, then the split aid code will automatically be included in the same aid code rate group as the original aid code covered under this Contract. Contractor agrees to continue providing Covered Services to the Members at the monthly capitation rate specified for the original aid code. DHCS shall confirm all aid code splits, and the rates of payment for such new aid codes, in writing to Contractor as soon as practicable after such aid code splits occur.
C. Pursuant to 438.6(c)(2)(ii), the actuarial basis for the computation of the capitation payment rates shall be set forth in DHCS’ most recent version of the annually-published Rate Manual for the rate period that is identified above. Said Rate Manual is incorporated by reference in Exhibit E, Provision 1.
D. For Dual payment rates that are not identified in the schedule of capitation payment rates above, DHCS shall pay a capitated rate as stated in an M Letter sent to Contractor by DHCS. The M Letter shall serve as notification from DHCS to Contractor of the capitated rates for Dual payment rates not stated in this Contract, and the time period for which these rates will be applied. The M Letter shall not be considered exempt from any requirement of this Contract. The rates supplied in the M Letter will be adjusted within 30 days from the date of release.
E. By January 1, 2015, and annually thereafter, DHCS shall provide an amendment to this Contract to add Dual payment rates that have been sent to Contractor through the M Letter.
F. DHCS shall make an In-Home Support Service (IHSS) interim payment on behalf of Contractor for IHSS provider payroll as a portion of Covered Services. The IHSS interim payment shall be reconciled in accordance with the requirements in Exhibit A, Attachment 24, Managed Long Term Support Services, Provision 6, Provider Compensation Arrangements.
VIII. Exhibit E, ADDITIONAL PROVISIONS, is amended to read:
1. Additional Incorporated Attachments
The following Attachments 1 through 2324 are incorporated herein and made a part hereof by this reference:
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Attachment 1 - Organization and Administration of the Plan Attachment 2 - Financial Information Attachment 3 - Management Information System Attachment 4 - Quality Improvement System Attachment 5 - Utilization Management Attachment 6 - Provider Network Attachment 7 - Provider Relations Attachment 8 - Provider Compensation Arrangements Attachment 9 - Access and Availability Attachment 10 - Scope of Services Attachment 11 - Case Management and Coordination of Care Attachment 12 - Local Health Department Coordination Attachment 13 - Member Services Attachment 14 - Member Grievance System Attachment 15 - Marketing Attachment 16 - Enrollments and Disenrollments Attachment 17 - Reporting Requirements Attachment 18 - Implementation Plan and Deliverables Attachment 19 - Community Based Adult Services Attachment 20 – Transition of Optional Targeted Low-Income Child Attachment 21 – Mental Health and Substance Use Disorder Benefits Attachment 22 – Low-Income Health Program (LIHP) Members Attachment 23 - Cal MediConnect Dual Eligible Special Needs Plans Attachment 24 – Managed Long Term Services and Supports
IX. Exhibit E, Attachment 1, DEFINITIONS, is amended to read:
Actual Non-Service Expenditures means Contractor’s actual amounts incurred for non-service expenditures, including both administrative and care management costs, for Full Benefit Dual Eligible Members and excludes costs incurred by Contractor prior to the start of this Risk Corridor. Any reinsurance costs reflected will be net reinsurance costs.
Actual Service Expenditures means Contractor’s actual amount paid for providing services to Full Benefit Dual Eligible Members priced at Contractor fee level, and shall comprise of all provider payments for services to this population, including risk-sharing arrangements or sub- capitation payments.
Adjusted Non-Service Expenditures means Contractor’s Actual Non-Service Expenditures, adjusted to reflect the exclusion of costs greater than 125 percent of the non-medical cost per Member per month across all participating Contractors and including any consideration given to Contractor for any significant, non-typical membership mixes that may cause this exclusion to come into effect as well as the exclusion of
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36 L.A. Care Health Plan 04-36069 A16 reinsurance costs which is the net of reinsurance premiums; and adjustments resulting from DHCS’ review of Contractor’s non-service expenditures to address any inappropriate or excessive non-service expenditures, including executive compensation and stop loss expenditures.
Adjusted Service Expenditures means Contractor’s Actual Service Expenditures adjusted to reflect the following reductions from any recoveries of other payers outside of claims adjudication, including those pursuant to coordination of benefits, third party liability, rebates, supplemental payments, adjustments in claims paid, adjustments from providers including adjustments to claims paid, and Member contributions to care; and adjustments resulting from DHCS’ review of Contractor reimbursement methodologies and levels to address any excessive pricing.
Capitated Revenues means the amount of Medi-Cal managed care capitation payments/revenues paid to Contractor by DHCS for all services provided to Full Benefit Dual Eligible Members under this Contract.
Covered Services means Medical Case Management and those services set forth in Title 22 CCR, Division 3, Subdivision 1, Chapter 3, beginning with Section 51301, and Title 17 CCR, Chapter 4, Subchapter 13, Article 4, beginning with Section 6840. Covered Services do not include:
B. Long-term care services as specified in Exhibit A, Attachment 11, Provision 17, with the exception of services provided to Full Benefit Dual Eligible Members.
C. Home and Community Based Services (HCBS) Waiver Program Services as specified in Exhibit A, Attachment 11, provisions 14 and 21 regarding Waiver Programs, and Department of Developmental Services (DDS) Administered Medicaid Home and Community Based Services Waiver, with the exception of In-Home Support Services provided to Full Benefit Dual Eligible Members. HCBS do not include any service that is available as an EPSDT service, including EPSDT supplemental services, as described in Title 22 CCR Sections 51184, 51340 and 51340.1. EPSDT supplemental services are covered under this Contract, as specified in Exhibit A, Attachment 10 regarding Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Supplemental Services.
Eligible Beneficiary means any Medi-Cal beneficiary who is residing in the Contractor's Service Area with one of the following aid codes:
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Aid Group Mandatory Aid Codes Non-Mandatory Aid Codes Family 01, 02, 08, 0A, 30, 32, 33, 34, 03, 04, 06, 07, 40, 42, 43, 45, 35, 37, 38, 39, 3A, 3C, 3E, 3F, 46, 49, 4A, 4F, 4G, 4H, 4K, 4L, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 4M, 4N, 4S, 4T, 4W, 5K, 7J 3W, 47, 54, 59, 72, 7A, 7J, 7S, 7W, 7X, 82, 8P, 8R, E2, E5, K1, M3, M7, P5, P7, P9 Family/Dual Eligible 30, 32, 33, 34, 35, 37, 38, 39, 03, 04, 06, 07,40, 42, 43, 45, 3E, 3F, 3G, 3H, 3L, 3M, 3N, 3P, 46, 49, 4A, 4F, 4G, 4H, 4K, 3R, 3U, 3W, 47, 54, 59, 72, 7A, 4L, 4M, 4N, 4S, 4T, 4W, 5K 7J, 7W, 7X, 82, 8P, 8R, E2, E5, K1, M3, M7, P5, P7, P9 Disabled/Medi-Cal 20, 24, 26, 2E, 2H, 36, 60, 64, Only 66, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V Aged/Medi-Cal Only 10, 14, 16, 1E, 1H
Optional Targeted Low 5C, 5D, E7, H1, H2, H3, H4, H5, Income Child M5, T1, T2, T3, T4, T5 Adult 86 Adult Expansion L1, M1, 7U Breast and Cervical 0N,0P, 0W Cancer Treatment Program (BCCTP) Long Term Care/Dual 13, 23, 63 Eligible Disabled/Dual Eligible 20, 24, 26, 27, 2E, 2H, 36, 60, 20, 24, 26, 2E, 2H, 36, 60, 64 64, 66, 67, 6A, 6C, 6E, 6G, 6H, 66, 6A, 6C, 6E, 6G, 6H, 6J, 6J, 6N, 6P, 6V, 6W, 6X, 6Y 6N, 6P, 6V Aged/Dual Eligible 10, 14, 16, 17, 1E, 1H, 1X, 1Y 10, 14, 16, 1E, 1H, 2H
An Eligible Beneficiary may continue to be a Member following any redetermination of Medi-Cal eligibility that determines that the individual is eligible for, and the individual thereafter enrolls in, the BCCTP.
The following exclusions apply to all the above:
A. Individuals who have been approved by the Medi-Cal Field Office or the California Children Services Program for any major organ transplant that is a Medi-Cal FFS benefit except kidney transplants.
B. Individuals determined by the Medi-Cal Field Office to be in need of long term care and residing in a Skilled Nursing Facility for 30 calendar days past the month of admission.
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38 L.A. Care Health Plan 04-36069 A16
C. Individuals who have commercial or Medicare HMO coverage, unless the Medicare HMO is a provider under this Contract and DHCS has agreed, as a term of the HMO’s contract, that these individuals may be enrolled. Individuals with Medicare FFS coverage are not excluded from enrolling under this Contract.
Full Benefit Dual Eligible Member means a Member who is 21 years of age or older and is eligible for Medi-Cal, and who is also eligible for benefits under Medicare Part A (42 U.S.C. Sec. 1395c et seq.) and, Medicare Part B (42 U.S.C. Sec. 1395j et seq.).
In-Home Support Services (IHSS) means services provided for members in accordance with the requirements set forth in Welfare and Institutions Code Section 14186.1(c)(1).
Long-Term Care (LTC) means care provided in a skilled nursing facility and sub-acute care services.
X. All rights, duties, obligations and liabilities of the parties hereto otherwise remain unchanged.
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39 L.A. Care Health Plan 04-36069 A16 Exhibit A, Attachment 24 MANAGED LONG-TERM SERVICES AND SUPPORTS
1. Extent of Requirements
This Attachment and the requirements herein are hereby incorporated in full into the Contract. The requirements included in this Attachment are specific to Full Benefit Dual Eligible Members receiving Medi-Cal benefits under the terms of this Contract. Neither Contractor nor DHCS shall interpret any of the requirements in this Attachment to apply to any Member that is not defined as a Full Benefit Dual Eligible.
2. Quality Improvement System
In addition to Exhibit A, Attachment 4, Quality Improvement System, Provision 12. Credentialing and Recredentialing, Contractor also agrees to the following:
A. Contractor shall not be responsible for credentialing In-Home Support Services (IHSS) providers.
B. Credentialing IHSS providers is the responsibility of the county IHSS office or IHSS Public Authority.
3. Utilization Management
Notwithstanding Exhibit A, Attachment 5, Utilization Management, Provision 2. Pre-Authorizations and Review Procedures, Contractor shall not authorize IHSS hours. Contractor shall refer IHSS hours to the county for approval.
4. Provider Network
In addition to Exhibit A, Attachment 6, Provider Network, Contractor also agrees to the following:
A. Contractor shall ensure that every contracted Long Term Care (LTC) provider within the Service Area approved by the California Department of Public Health (CDPH) as a qualified provider is included in their network, to the extent that the provider remains licensed, certified, operating, and is willing to enter into a subcontract with Contractor on mutually agreeable terms and meets the Contractor’s credentialing and quality standards.
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40 L.A. Care Health Plan 04-36069 A16 Exhibit A, Attachment 24 MANAGED LONG-TERM SERVICES AND SUPPORTS
B. Contractor shall ensure that a Memorandum of Understanding (MOU) is in place with the county IHSS office and IHSS Public Authority.
C. If Contractor determines that additional LTC providers are necessary to meet the needs of its Members, Contractor may extend a contract or letter of agreement to any additional providers certified by CDPH.
D. If Contractor determines that Member needs for LTC services exceed Contractor’s network capacity, Contractor shall arrange for access to out-of-network providers in accordance with the requirements of this Contract as stated in Exhibit A, Attachment 9, Access and Availability, Provision 16. Out-of- Network Providers.
E. In addition to the subcontract termination requirements in Exhibit A, Attachment 6, Provision 14. Subcontracts, and the Member notification requirements in Exhibit A, Attachment 13, Member Services, Provision 5. Notification of Changes in Access to Covered Services, Contractor shall notify DHCS upon termination of an LTC provider contract:
1) If Contractor and an LTC provider cannot agree on mutually agreeable terms, Contractor must notify DHCS within five (5) working days of Contractor’s decision to exclude the LTC provider from its provider network. DHCS will attempt to resolve the contracting issue when appropriate.
2) Contractor shall provide DHCS with notice of its termination of a contract with an LTC provider at least 60 days prior to the contract termination effective date.
3) If termination of an LTC provider contract is for a cause related to quality of care or patient safety concerns, Contactor may expedite termination of the LTC provider contract and transfer Members to an appropriate, contracted LTC facility in an expeditious manner. DHCS shall be notified of the termination within 72 hours of said termination.
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41 L.A. Care Health Plan 04-36069 A16 Exhibit A, Attachment 24 MANAGED LONG-TERM SERVICES AND SUPPORTS
4) Contractor shall not continue to assign or refer Members to an LTC provider during the 60 days between notifying DHCS and the contract termination effective date.
F. Any MOU that Contractor enters into with the county IHSS office and IHSS Public Authority, for either the provision of health care service or to perform an administrative function, shall be submitted to DHCS for prior approval at least 60 calendar days prior to the effective date of the MOU. DHCS shall acknowledge in writing the receipt of any material sent to DHCS by Contractor for approval within five (5) working days of receipt. These MOUs shall not become effective until written approval is provided by DHCS and CDSS or by operation of law where DHCS has acknowledged receipt of the proposed MOU, and has neither approved nor rejected the proposed MOU within 60 calendar days of receipt.
1) Contractor shall submit an MOU for the county IHSS office and IHSS Public Authority to DHCS for approval.
2) Any new or updated MOU that makes a material change to the MOU must be re-submitted to DHCS. Previous MOU approval shall be valid only until such time as the new or amended MOU is approved by DHCS and CDSS.
G. Material changes to the IHSS MOU shall be submitted to DHCS for prior approval at least 30 calendar days before the effective date of any proposed changes governing compensation, services, or term. Proposed changes which are neither approved nor rejected by DHCS and CDSS shall become effective by operation of law 30 calendar days after DHCS has acknowledged receipt or upon the date specified in the MOU change, whichever is later.
5. Provider Relations
In addition to Exhibit A, Attachment 7, Provider Relations, Contractor shall:
A. Include in regular provider training key elements of operating a successful program for administering long term services and supports, including such topics as the applicable assessment
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42 L.A. Care Health Plan 04-36069 A16 Exhibit A, Attachment 24 MANAGED LONG-TERM SERVICES AND SUPPORTS
tools and processes, Person-Centered Planning, coordination with the IHSS program, population specific training and self-direction, information technology, billing, and systems operations.
B. Be excluded from any requirement to provide training to IHSS providers.
6. Provider Compensation Arrangements
In addition to Exhibit A, Attachment 8, Provider Compensation Arrangements, Contractor also agrees to the following:
A. Skilled Nursing Facilities and Nursing Facilities (SNF/NF) claims are to be paid in accordance with Welfare and Institutions Code Sections 14182.16 and 14186.3.
B. Claims processing for IHSS providers shall not be subject to this Contract’s provider compensation requirements.
C. Contractor assumes full risk for IHSS provider payments. On a quarterly basis, DHCS shall reconcile actual IHSS expenditures against the IHSS interim payment. If actual IHSS expenditures exceed or are lower than the interim payment amount, DHCS shall inform Contractor of the difference within 30 calendar days of completion of the reconciliation.
7. Covered Services
LTC and IHSS are covered services under this Contract for Full Benefit Dual Eligible Members. In addition to Exhibit A, Attachment 10, Scope of Services, Contractor shall also cover LTC and IHSS in accordance with the following requirements:
A. Contractor shall cover Medically Necessary LTC from the time of admission into an appropriate facility to either the Member’s release from the facility or to the Member electing to receive hospice services.
1) Contractor shall ensure that Members in need of LTC are placed in a facility that provides the level of care most appropriate to the Member's medical needs. These health care facilities include SNF/NF, subacute facilities, and Intermediate Care Facilities.
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43 L.A. Care Health Plan 04-36069 A16 Exhibit A, Attachment 24 MANAGED LONG-TERM SERVICES AND SUPPORTS
2) Contractor shall base decisions on the appropriate level of care on the definitions set forth in Title 22 CCR Sections 51118, 51120, 51120.5, 51121, 51124.5, and the criteria for admission set forth in Title 22 CCR Sections 51335, 51335.5, and 51334 and related sections of the Manual of Criteria for Medi-Cal Authorization referenced in Title 22 CCR Section 51003(e).
3) Upon admission to an appropriate facility, Contractor shall assess the Member’s health care needs and estimate the potential length of stay of the Member.
4) Contractor shall provide continuity of care for all Medically Necessary LTC services at non-contracting LTC facilities for those Full Benefit Dual Eligible Members residing in an LTC facility at the time of enrollment into Medi-Cal managed care. Contractor shall not require said Members residing in non-contracted facilities to relocate unless it is determined that relocation is Medically Necessary or if the non- contracted LTC facility does not meet the requirements set forth in Exhibit A, Attachment 24, Provision 8, Paragraph B.
B. Contractor shall cover IHSS in accordance with the eligibility determination as performed by the county’s IHSS office and ensure the provision of these services in accordance with the requirements set forth below in Provision 8. Coordination of Care.
1) Contractor shall not be required to determine Member eligibility to receive IHSS.
2) Contractor shall refer IHSS eligibility determination to the Member’s county of residence for approval.
8. Coordination of Care
In addition to Exhibit A, Attachment 11, Case Management and Coordination of Care, Contractor also agrees to the following:
A. Contractor shall maintain continuity of care for Members by recognizing any prior treatment authorization made by DHCS
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for not less than six (6) months following Member enrollment, in accordance with W&I Code Section 14186.3(c)(3).
B. Contractor shall provide continuity of care to Members through continued access to a CBAS provider with whom there is an existing relationship for up to 12 months after Member enrollment, or an LTC provider with whom there is an existing relationship through December 31, 2016. This requirement shall include out-of-network providers if there are no quality of care issues and the provider will accept Contractor or Medi-Cal FFS rates, whichever is higher, per the continuity of care requirements set forth in Exhibit A, Attachment 9, Access and Availability, Provision 16. Out-of- Network Providers.
C. Contractor shall assess risk level and needs for each new Full Benefit Dual Eligible Member, as well as current Full Benefit Dual Eligible Members upon request, by performing a risk stratification process in accordance with All Plan Letter APL 14-010 and, with a particular focus on identifying those Members who may need CBAS, LTC, and IHSS.
D. Contractor shall retain and compile a copy of each assessment conducted on the Full Benefit Dual Eligible Member’s behalf through IHSS, CBAS, and/or LTC. Contractor shall review these assessments and determine if any further care coordination of services for the Member is appropriate.
E. Contractor shall coordinate with Medicare providers as needed in the provision of CBAS, IHSS, or LTC, to the extent that Contractor is able.
9. Member Services
In addition to Exhibit A, Attachment 13, Member Services, Provision 4, Written Member Information, Contractor shall include in its Provider Directory the IHSS county office and Public Authority sites and all contracted LTC providers. The Provider Directory shall exclude individual IHSS workers.
10. Required Reports for Long Term Services and Supports
Contractor shall submit to DHCS the following reports:
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45 L.A. Care Health Plan 04-36069 A16 Exhibit A, Attachment 24 MANAGED LONG-TERM SERVICES AND SUPPORTS
A. Contractor shall provide to DHCS a quarterly report on support and retention of community placement. Contractor shall submit this report in a format specified by DHCS and shall include the following data elements:
1) Number of Members who are referred by Contractor to Health and Community Based Services (HCBS) waivers;
2) Number of Members who are referred by Contractor to IHSS, and are determined eligible by the county social services agency for IHSS;
3) The number of Members admitted in the prior quarter to a LTC facility and remained for less than 90 days, and who were afforded the choice of CBAS or IHSS after discharge. Contractor shall report these numbers to the extent that Contractor has been notified of Member admission and is covering part or all of the Member’s stay in a LTC facility;
4) The number of Members admitted in the prior quarter to, and remained in, an LTC facility for 90 days or more and who were afforded the choice of CBAS or IHSS after discharge;
5) The number of Members who transitioned to the community from an LTC facility, and which of those Members did not return to a facility during the subsequent 12 months period.
6) The number of Members receiving CBAS and/or IHSS in the community, along with number of Members receiving LTC in a facility.
B. Contractor shall report to DHCS, on a monthly basis and in a format specified by DHCS, the number of continuity of care requests, and the outcomes of those requests, for Full Benefit Dual Eligible Members.
C. In addition to the requirements in Exhibit A, Attachment 6, Provider Network, Provision 11. Provider Network Report, Contractor shall include LTC providers added to or deleted
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46 L.A. Care Health Plan 04-36069 A16 Exhibit A, Attachment 24 MANAGED LONG-TERM SERVICES AND SUPPORTS
from Contractor’s provider network, within the quarterly Provider Network Report submission.
D. In addition to the requirements set forth in Exhibit A, Attachment 13, Member Services, Provision 3. Call Center Reports, Contractor shall report to DHCS on calls related to Member satisfaction with LTC, CBAS, and IHSS within the quarterly Call Center Report submission. The quarterly Call Center Report shall also include calls related to IHSS grievances and whether Contractor has referred any grievances to the IHSS county office.
E. In addition to the requirements set forth in Exhibit A, Attachment 14, Member Grievance System, Provision 3. Grievance Log and Quarterly Grievance Report, Contractor shall also report to DHCS on a monthly basis the number and percentage of grievances or appeals that have been submitted in relation to a Member receiving LTC services. Contractor shall not be responsible for reporting grievances, appeals, or resolutions related to a Member receiving IHSS if they were reported to the county.
11. Risk Corridor
A. A Risk Corridor shall be established for a period of 24 months, effective April 1, 2014 and ending on March 31, 2016 for Full Benefit Dual Eligible Members as defined in Exhibit E, Definitions, of this Contract.
B. Gains and losses are defined as the Capitated Revenues minus the sum of Adjusted Service Expenditures and Adjusted Non-Service Expenditures, with positive figures defined as gains and negative figures defined as losses. The risk sharing of the gains and losses shall be constructed by DHCS so that it is symmetrical with respect to risk and profit, and so that all of the following apply:
1) Contractor is fully responsible for any losses up to 1 percent of Capitated Revenues.
2) Contractor shall fully retain any gains up to 1 percent of Capitated Revenues.
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47 L.A. Care Health Plan 04-36069 A16 Exhibit A, Attachment 24 MANAGED LONG-TERM SERVICES AND SUPPORTS
3) Contractor and DHCS shall equally share responsibility for any losses in excess of 1 percent, but less than 2.5 percent, of Capitated Revenues.
4) Contractor and DHCS shall equally share any gains greater than 1 percent, but less than 2.5 percent, of Capitated Revenues.
5) DHCS shall be fully responsible for all losses in excess of 2.5 percent of Contractor’s Capitated Revenues.
6) DHCS shall fully retain all gains in excess of 2.5 percent of Contractor’s Capitated Revenues.
C. The risk-sharing arrangement described in this Provision may result in payment by DHCS to Contractor or by Contractor to DHCS. All payments to be made by DHCS to Contractor or by Contractor to DHCS will be calculated and determined by DHCS. All calculations determined by DHCS will be based on Contractor’s capitation rate and enrollment data provided by DHCS for Full Benefit Dual Eligible Members, and Contractor’s Adjusted Services Expenditures and Adjusted Non-Service Expenditures for providing services to Full Benefit Dual Eligible Members.
1) All financial reporting will be subject to review and/or audit at DHCS’ discretion. As applicable, all calculations will sum Contractor’s capitation revenues, Adjusted Services Expenditures and Adjusted Non- Service Expenditures, across all counties in which Contractor operates under this Contract.
2) DHCS will determine Contractor’s Adjusted Service Expenditures and Adjusted Non-Service Expenditures, based on Contractor’s Actual Services Expenditures and Actual Non-Service Expenditures, Encounter Data, cost data, and financial reporting data, including DHCS’ rate development template, submitted by Contractor as required in this Contract.
3) DHCS and Contractor agree that, to the extent there are differences in Adjusted Services and Adjusted Non- Service Expenditures and Contractor’s Actual Service
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Expenditures and Actual Non-Service Expenditures across various sources, including the Encounter Data, cost, financial reporting, or other data submitted by Contractor, DHCS and Contractor will confer and make a good faith effort to reconcile those differences before the calculation of settlements.
4) Review procedures may include a review and/or audit of Contractor’s Encounter Data to be performed by DHCS, or either party’s authorized agents, to verify that all paid claims for Full Benefit Dual Eligible Members by Contractor are for providing services to this population and/or that provider reimbursement is not excessive. DHCS will have the final decision on the resolution of any differences in the expenditures.
5) DHCS reserves the right to adjust expenditures for services that are reimbursed at more than 10 percent above the median reimbursement rate of all other Contractors within a region.
a) For the purposes of this Contract, the region is defined as The Southern Counties Region, which includes Los Angeles, Orange, Riverside, San Bernardino, and San Diego counties.
b) If two or fewer counties are operational within a region, experience from other counties would be considered in the establishment of the median rate.
D. Payments by Contractor to related party providers shall not exceed the rate paid by Contractor for the same services to unrelated parties within the same county for the purpose of determining actual expenditures. Related parties are defined by Generally Accepted Accounting Principles.
12. Capitation Rate Structure for Full Benefit Dual Eligible Members
A. Underlying Rate Structure
The capitation rate will be paid as a single, blended capitation rate that accounts for the relative risk of Contractor’s Full Benefit Dual Eligible Members and is weighted accordingly.
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49 L.A. Care Health Plan 04-36069 A16 Exhibit A, Attachment 24 MANAGED LONG-TERM SERVICES AND SUPPORTS
These Members shall be segmented into three (3) separate and distinct population segments based on eligibility for rate setting purposes. These population segments are as follows:
1) Members eligible for Cal MediConnect, the State’s duals demonstration;
2) Members covered by Contractor and under Medicare managed care; and
3) Members ineligible for Cal MediConnect, such as SPD beneficiaries determined to be high-risk.
B. These Members shall also be grouped into four (4) Member mix categories representing differing levels of risk. These categories are defined as follows:
1) Institutionalized: Members in LTC aid codes and/or residing in an LTC facility for 90 days or more;
2) HCBS High: Members identified as high utilizers of HCBS. These Members meet one (1) or more of the following criteria:
a) Members who receive CBAS; b) Members who are clients of Multipurpose Senior Services Program (MSSP) sites; or c) Members who receive IHSS and are classified under the IHSS program as “severely impaired”;
3) HCBS Low: Members identified as low utilizers of HCBS. These Members are IHSS recipients and classified under the IHSS program as “not severely impaired”; and
4) Community Well: Members living in the community with no covered HCBS, are not residents in LTC facilities, and do not utilize CBAS, MSSP, or IHSS services.
C. The capitation rate will utilize the following payment methodology:
1) DHCS shall initially pay an estimated rate based on the assumed mix across the three (3) population segments and four (4) Member mix categories. This assumed mix
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is impacted by a DHCS assumption related to the percentage of Members who will opt out of Cal MediConnect.
2) DHCS shall recalculate the blended rate based on the actual Full Benefit Dual Eligible Member distribution beginning no later than January 1, 2015 when actual Full Benefit Dual Eligible Member enrollment is known. The final rate based on the actual enrollment distribution will incorporate the same base rates by population segment and Member mix category as the original estimated rate. DHCS shall always retain the ability to group Members into the three (3) population segments and four (4) Member mix categories.
3) The final Member mix calculations will be completed no later than nine (9) months after the recalculation time frames, either monthly, quarterly, or annually as referenced in each respective Phase identified in Section D of this Provision.
4) Once DHCS has recalculated the blended rate, there may be additional payments to Contractor or a recoupment of overpayment from Contractor to DHCS.
D. The payment process will vary over three (3) distinct phases to address the stability of enrollment and to establish appropriate financial incentives for Contractor.
1) Phase I: The recalculation of the final rate will be applied monthly and retroactively to match Contractor’s actual enrollment. This phase will continue through each county’s phase-in enrollment period for a minimum of one (1) year and will end at the start of the following fiscal quarter. For example, if Contractor operates in a county with a 12-month phase-in that began enrollment in April 2014, this phase would last through the end of March 2015.
2) Phase II: This phase will be for one (1) fiscal quarter. The recalculation of the final rate will be prospectively applied at the start of the quarter. Weighting of the three (3) population segments and four (4) Member mix categories will be based on the month preceding the
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quarter enrollment snapshot, which will be available after the quarter ends and will be retroactively applied to that period. For example, if Contractor operates in a county with a 12-month phase-in that begins enrollment in April 2014, this Phase II would be applicable for the
fiscal quarter of April 2015 through June 2015. Enrollment data from March 2015 would be utilized although the rate update would not occur until several months after the quarter to ensure data availability.
3) Phase III: Contractor’s capitation rates are based on a targeted, relative mix of Members and will not be adjusted during the year. The first year of this phase will be the remaining period in the calendar year.
a) Specific to Phase III, a targeted, relative mix will be projected by DHCS and its actuaries. This mix is designed to be achievable by Contractor, based on assumptions about Contractor’s ability to promote community services and prevent or delay institutional placement.
b) If the Member mix for Contractor for the year results in a greater than 2.5 percent impact to the Medi-Cal component of the capitation rate paid as compared to the capitation rate that would have been paid based on the actual mix, then Contractor and Medi-Cal would share equally in any cost increases or decreases beyond the 2.5 percent. Contractor’s actual gain or loss does not factor into this calculation.
E. With the structure as described above, DHCS and its actuaries will establish actuarially sound capitation rates for this Contract for Members eligible for long-term services and supports. These capitation rates will be consistent with 42 C.F.R. § 438.6(c) and reviewed by the Centers for Medicare and Medicaid (CMS). Capitation rates approved by CMS will serve as the baseline Medi-Cal costs.
F. DHCS and its actuaries will provide to CMS the underlying data for the capitation rate calculations associated with this Contract.
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G. As allowed under the capitation rates for this Contract, DHCS and its actuaries will calculate a range of actuarially sound capitation rates, including lower bound and upper capitation rates.
H. Limited risk corridors will be applied as described for Contractor and be reconciled after application of any risk adjustment methodologies and any other adjustments.
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53 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No.: BOG 103.1214
Committee: Chairperson: Thomas Horowitz, DO
Issue: L.A. Care Health Plan (“L.A. Care”) currently has 132 open employee positions and is launching a referral campaign to quickly gather qualified candidates to fill these critical positions.
Background: L.A. Care is committed to hiring qualified candidates who represent the culturally diverse population of Los Angeles County and the members we serve, at a reasonable cost with as much efficiency as possible.
Employee referrals are typically the best source of candidates. L.A. Care has a policy on incentives paid to employees for referring candidates (HR-106, Employee Recruitment Referral Bonus Program). L.A. Care has paid over $82,500 in employee referral incentives during the last fiscal year. Referral incentive payments to employees are subject to applicable payroll taxes.
Organizations periodically run special incentive campaigns to entice staff to make referrals when special needs arise or when there are many positions open. This year we are offering employees the opportunity to be entered into a onetime $5,000 recruitment referral “raffle” bonus. Because the proposed “raffle” program is not specifically addressed in the Employee Recruitment Referral Bonus Program policy, the program, which requires some level of Board review, would have usually been reviewed by the Executive Committee. There is no Executive Committee meeting scheduled until January 2015. This motion is presented for consideration by the Board of Governors.
The Employee Recruitment Referral Bonus Program is administered by the Human Resources Department, which maintains all related records.
Budget Impact: $5,000 recruitment referral raffle bonus.
Motion: To authorize a $5,000 recruitment referral raffle incentive program until December 19, 2014, to be administered by the Human Resources Department.
54 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No.: BOG 104.1214
Committee: Chairperson: Thomas Horowitz, DO
Issue: Request to authorize staff to execute a contract with Wentworth Company for staff recruitment assistance for the QNXT Task Force.
Background: To execute a contract with Wentworth Company for staff recruitment assistance for the QNXT Task Force from December 1, 2014 through November 30, 2015 in the amount of $162,500. Additional recruitment personnel are needed urgently to implement the planned cross- functional task force for the transition of Medi-Cal to the new Core Data System. Responsibilities will include recruiting candidates to backfill positions, creating job descriptions for new positions and acting as liaison between the QNXT Task Force and Human Resources.
As L.A. Care transitions the Medi-Cal program from the old data system to QNXT/CCA, all issues must be addressed expediently. A Task Force is being formed which will comprise of approximately 30 full time equivalent (FTE) staff members from various departments throughout the organization. In order to minimize impact on departments with staff moving to the Task Force and ensure that onboarding and training is completed timely, those positions will need to be filled within 45 days. Project Managers and Project Specialists also will be hired to support the Task Force. The Task Force will need to begin working on the high priority initiatives as soon as possible.
The Wentworth Company previously has been successful in quickly finding qualified candidates. Because the time frame for getting a firm to perform the recruitment is very short, there was no time to perform a competitive selection process for this project.
Budget Impact: $162,500 is within the amount budgeted included in the approved Fiscal Year 2014-15 IT budget under the Strategic Project: “Core System Project Operationalize”. Currently there is no 12 month history for this vendor.
Motion: To authorize staff to execute a contract with Wentworth Company for staff recruitment assistance for the QNXT Task Force in the amount of $162,500, from December 1, 2014 through November 30, 2015.
55 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. FIN 100.1214
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Amend the amount allocated for iColor Printing &Mailing Inc. contract, for printing services.
Background: A potential contract with iColor Printing &Mailing Inc. was approved by the Board of Governors on September 4, 2014 as an L.A. Care Preferred Vendor for Fiscal Year 2014-15. Staff would like to amend the allocated preferred vendor amount for iColor Printing &Mailing Inc. to add an additional $350,000 (total amount not to exceed $550,000) through September 30, 2015.
Printing has increased significantly due to membership growth and new product lines that require additional collateral for events and member materials. The vendor has exceeded all expectations in competitive pricing and quick turnaround. In the month of October; the Sales and Marketing department has spent the allotted amount in printing due to L.A. Care’s growth.
Budget Impact: Sufficient funds are allocated in the Sales & Marketing Department budget for FY 2014- 15.
Motion: To approve an additional amount of $350,000 (total amount not to exceed $550,000) to the preferred vendor, iColor Printing & Mailing Inc., through September 30, 2015.
56 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. FIN 101.1214
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Contract amendment with Epicor Human Resource Management Systems (HRMS) for software licenses and maintenance.
Background: The Epicor HRMS product was selected as the human resources information system following a competitive bid process in November/December 2010. Epicor HRMS integrates recruitment, applicant tracking and staff training functions, and improves access to performance and annual incentive goal program management tools. It has improved the on-boarding process, enabling progress toward full implementation of a paperless human resources system. In April 2011, the Board approved a contract with Epicor for HRMS, related services, and maintenance. The software license and the system were implemented in 2011. L.A. Care amended the contract in November 2012 to expand functionality of the system to include a self-service portal for candidates and a module to assist recruiting efforts. In May 2013 the number of perpetual user licenses was increased to 1,500. Epicor HRMS contracts total $494,095 to date. Staff requests authorization to amend the existing contract with Epicor HRMS through August 31, 2015 in the amount of $21,146 (total contract not to exceed $515,241) for the following: · 300 additional Epicor HRMS perpetual licenses for the employee self-service module and related support (1,800 total licenses). · 20 additional Epicor HRMS HR/Manager licenses. · Enhanced training, development, and candidate recruitment modules through August 31, 2015. · Annual software maintenance through August 31, 2015.
Budget Impact: The requested amount of $21,146 is budgeted in the Information Technology Department FY2014-15 budgets.
Motion: To authorize staff to execute a contract amendment with Epicor Human Resource Systems Corporation adding $21,146 (total contract not to exceed $515,241) for a human resource management system through August 31, 2015.
57 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. FIN 102.1214
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Contract amendment with Healthx for development and professional services to implement additional capabilities to member portal solution platform and member mobile application module.
Background: L.A. Care staff requests approval of a contract amendment of $120,000 with Healthx, obtain professional services and development services through December 31, 2015 to add capabilities to member portal solution platform and member mobile application module. Healthx was selected after an extensive selection process conducted in 2013, based on several measurements including years of experience working in healthcare, member portal platforms function, and integration with Trizetto’s as QNXT. L.A. Care has been pleased with Healthx products and services. New capabilities for the member portal solution platform and member mobile application modules are needed. L.A. Care staff is seeking approval to add funding to the existing contract with Healthx to fulfill those requirements. The expanded scope will be: · Design, implement and support “Pay Near Me”, to enhance L.A. Care member options for payment processing. · Design, implement and support Splash Screen and home page content item on the L.A. Care Covered (LACC) member portal to promote completion of the required Health Risk Assessment (HRA).
Budget Impact: The requested amount of $120,000 is budgeted in the Strategic Project Member Portal Redesign (phase I) for FY14-15.
Motion: To authorize staff to amend a contract with Healthx adding $120,000 (total contract not to exceed $933,395) for member portal solution platform and member mobile application module project through December 31, 2015.
58 Board of Governors MOTION SUMMARY Date: December 4, 2014 Motion No. FIN 103.1214
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Request to purchase software from PCG Software, Inc. to improve claims processing.
Background: PCG Software, Inc. will provide virtual claims examiner/audit tool enabling L.A. Care to effectively process, monitor, review, analyze, and report on claims billing for senior, commercial and Medi- Cal claims; pre and post payment claims results; and improve claims processing and payment accuracy.
It is the only solution identified that contains Medi-Cal specific coding edits including fully populated X/Y code edits and ability to work with UPN code tables. The virtual examiner proposal includes monthly updates of all CMS and MediCal code edit updates; including x/y codes and UPN updates. Virtual Examiner automates posting of coding edits and error corrections identified by Virtual Examiner (VE) and Claims Audit Tool (CAT) into QXNT.
Using this combination of products will cut L.A. Care’s labor hours required for staff audits, quality audits and focused audits. The tool will provide significant savings in identifying code edit discrepancies pre- adjudication, and providing in-depth reporting capabilities to easily identify claims billed outside of normal billing patterns. The solution is cost effective and will help L.A. Care significantly reduce overpayment of claims. The integrated solution will serve as a compliance and educational tool for claims staff and network providers by presenting information that will help drive improvement in claims billing, processing, and payment accuracy.
Products include: · Virtual Examiner (VE) – sole vendor identified with claims editing software which includes Medi- Cal specific coding edits (over 2 million edits). · Claims Audit Tool (CAT) – software provides pre-and post-payment claims auditing, quality assurance and reporting functionality. It is the only software available that integrates with VE to facilitate review of VE edits. · Virtual AutoPost (VAP) – Co-developed by PCG Software and HCIM, VAP is the only software available that interfaces with host claims system to provide automated posting of VE and CAT edits. VAP is powered by SymKey, a business process automation tool provided and developed by HCIM.
59 · Virtual AuthTech (VA) – interactive claim analysis and coding rule research tool. · Virtual Reporter (VR) –fraud and abuse reporting and provider profiling software.
The above suite of products includes the following features: · Automated and comprehensive Medi-Cal code edits, including edits from X/Y codes · Full Suite of Medicare edits · Automatically posts edits and claim error corrections to core system data · Minimal Information Technology and Compliance staff required to maintain solution · Onsite solution, with no large transfer of data to interface/process back to system. · Expertise in integrating QNXT “attribute” fields into the product · Claims Audit Tool can be used by internal audit staff to: o Perform audits outside of vendor scope of services o Comprehensively track and report audit results o Automate routine audits o Automate correction of errors o Audit filters and auto audits can be configured by users
Year 1 Year 2 Year 3 Years 1-3 Total VE (Virtual Examiner) Option 1 Phase 1: 93,000 lives License $232,500 0 0 $232,500 Phase 1: 93,000 lives Annual Support $46,500 $48,360 $94,860 Phase 2: 700,000 lives License $560,000 0 0 $560,000 Phase 2: 700,000 lives Annual Support $112,000 $116,480 $228,480 Implementation Fee $30,000 0 0 $30,000 Total Virtual Examiner Option 1 $822,500 $158,500 $164,840 $1,145,840 CAT (Claims Auto Tool) $175,250 $20,050 $20,050 $215,350 VAP (Virtual Auth Post) $45,000 $45,000 $45,000 $135,000 VE-CAT-VAP Total $1,042,750 $223,550 $229,890 $1,496,190 w/CATNET Upgrade $70,000 $7,000 $7,000 $84,000 Total w/CATNET Upgrade $1,112,750 $230,550 $236,890 $1,580,190 L.A Care Costs – Hardware $60,000 Total amount $1,640,190
Budget Impact: Requested funds are budgeted in the Strategic Project - Claims Auditing Tool for FY 2014-15. Additional funds will be requested for FY2015-16 and FY 2016-17. Motion: Authorize staff to execute a three year contract with PCG Software, Inc. to procure software for the implementation of a virtual examiner/claims audit tool for a total amount of $1,640,190, from December 15, 2014 through December 31, 2017.
60 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. FIN 104.1214
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Three year contract with Beagle Parent Corp & Subs doing business as Emdeon to provide L.A. Care with electronic document capabilities.
Background: Emdeon provides healthcare electronic data interchange (EDI) solutions for health plans, and is the leading provider of clearinghouse services including electronic claims, enrollment and payment transactions. L.A. Care receives about 50% of its claims transactions in electronic format, but the current vendor is unable to accept and link attachments to claim files. This has created barriers to expanding electronic claims transmissions for greater accuracy and efficiency. Emdeon is the largest claims clearinghouse for hospitals and maintains relationships with many of L.A. Care’s major partners, and there is a potential to expand direct EDI services.
A competitive bid was conducted in May 2014 to evaluate clearinghouses; Office Ally and Emdeon were among the vendors that bidded. After evaluating the vendors, Emdeon was identified as the vendor of choice as it offered the lowest price per claim and the lowest real time transaction cost; additionally it is the vendor best able to increase direct EDI and add functionality, including attachments to claims. The receipt of claims through direct EDIT can save about half the cost of processing a paper claim.
Effective December 31, 2015, L.A. Care will be required by the Centers for Medicare and Medicaid Services (CMS) to certify compliance with the HIPPA TCI (Health Insurance Portability and Accountability Act Transactions, Code Sets, and Identifiers ) standards and the Affordable Care Act (ACA) operating rules for the following transactions: · 270/271 Real Time Eligibility inquiry/response · 276/277 Real Time Claim Status inquiry/response · 835 Electronic Remittance Advice
Emdeon Real Time Transaction Services will enable L.A. Care to comply with the HIPAA TCI standards, and Operating Rules. The Emdeon Real Time Services are CAQH (Council for Affordable Quality Healthcare) Core Certified. The CAQH Core certification is required for certification by CMS.
Emdeon services will include: · HIPAA compliant transaction sets from providers and facilities, including 837 professional and institutional claim transactions; 270/271 and 276/277 claim status and hosted eligibility/benefit transactions; and 835 electronic remittance advice (ERA) transactions. · Emdeon Advanced Claiming Services to include Pre-Adjudication Services (“PAS”) to assist with auto-adjudication process for electronically delivered claims data. The function of PAS is based upon logical validation and augmentation of data contained within each claim through
61 reference to externally supported tables such as eligibility, provider, group, etc. All vendor software will be resident on Emdeon systems and claim files shall be delivered to L.A. Care electronically via a secure file transfer protocol (FTP) connection.
The transaction volumes and costs over the three year term of the contract are projected to be: EMDEON One month of Invoices Service Type Volume Rate Cost Claim Count 0-120,000 120,000 0.24 $ 28,800.00 Claim Count 120001-170000 23,000 0.23 $ 5,290.00 Claim Count 170,001 – 420,000 0.22 $ - Claim Count: 420,00 – 835,000 0.21 $ - Claim County 835,000 and above 0.18 $- Advanced Claiming Transaction per claim 143,000 0.05 $ 7,150.00 Hosted Claim / Eligibility Transaction 100,000 0.25 $25,000.00 ERA Transaction Claims Count: 0-100,000 100,000 0.2 $ 20,000.00 Total of one month $ 86,240.00
Estimated cost for 1 year of invoices $ 1,034,880 Estimated cost for 3 years of invoices $ 3,104,640 Advances Claiming Implementation Fee One-time fee $ 10,000.00 ERA Transaction Fee One-time fee $ 5,000.00 Total of 3 years + additional fees $ 3,119,640
Budget Impact: Sufficient funds are budgeted in the Strategic Project – Claims Auditing Tool for FY2014-15. Additional funds will be requested for FY2015-16 and FY2016-17.
Motion: To authorize staff to execute a contract with Beagle Parent Corp & Subs doing business as Emdeon to provide electronic data interchange (EDI) services in the amount of $3,119,640, for the period of three years from December 1, 2014 through December 31, 2017.
Page 2 of 2 62 Board of Governors MOTION SUMMARY Date: December 4, 2014 Motion No. FIN 105.1214 Committee: Finance & Budget Chairperson: Michael Rembis Issue: Ratification of a contract with Verisk Health for Healthcare Effectiveness Data and Information Set (HEDIS) reporting. Background: Staff requests approval to ratify a contract with Verisk Health from November 1, 2014 to October 31, 2015, in the amount of $600,000. Verisk Health is a data management company that offers software licensed by the National Committee for Quality Assurance (NCQA) which is used for HEDIS reporting. Verisk has been L.A. Care’s HEDIS vendor for the past nine years. L.A. Care’s prior contract with Verisk through October 31, 2014, was in the amount of $520,500. Because the prior contract expired on October 31, the CEO sought approval from the Chairperson and the Treasurer of the Board of Governors to execute a new contract so that these important services would not be interrupted. L.A. Care Policy provides a means for execution of a contract when approved by the Chief Executive Officer with the approval of the Chairperson and Treasurer of the Board of Governors and subsequent ratification of the contract by the Board of Governors. This motion is for the Committee to ratify the authorization for the contract. Verisk provides L.A. Care with a suite of software and services that support HEDIS reporting, including generation of samples, a data entry toll, results for approximately 50 measures by product, plan partner, and provider group, a reporting tool and training. Verisk’s services are used by the Healthcare Outcomes and Analysis (HO&A) and Quality Improvement departments for in-depth data analysis, quality improvement projects, and reporting. A request for proposal process was conducted in January 2014, and Inovalon was selected as the new HEDIS vendor, replacing Verisk. The transition of vendors was anticipated to take place under a tight timeline. Unfortunately, a key milestone of contract completion was not met. To ensure that L.A. Care will pass the requirements of the HEDIS audit process and maintain its NCQA accreditation and comply with CMS and DHCS requirements, L.A. Care must run a parallel HEDIS process with both Verisk and Inovalon. The annual cost for the services is: Service Cost Annual Software License $558,000 Monthly Data Refreshes $18,000 Training $4,000 Variable support (billed as incurred) $20,000 Total $600,000 Budget Impact: This is a new and unanticipated expense, but there are sufficient funds in the Health Services FY 2014-15 budget allocation. Motion: To ratify a contract with Verisk Health to provide HEDIS reporting services in the amount of $600,000 from November 1, 2014 to October 31, 2015.
63 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No.: FIN 106.1214
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Contract with Presidio Inc. to provide telecommunications managed services, maintenance, support, and equipment.
Background: In June 2014, the board approved the amount of $720,036 for the Cisco Call Manager software upgrade and procurement of Presidio Inc.’s NICE call recording solution, a new call system that’s replacing our current CACTI system. The board also approved funding in the amount of $1,029,502 in November 2014, for 400 additional licenses, maintenance and support. The purchase of the new Cisco Call Manager and NICE hardware and software requires IT to seek a multi-disciplined vendor with the complex technical expertise and capability of supporting and maintaining this newly enhanced and critical telecommunications call center environment.
The call center is the primary communication among L.A. Care, its members and providers. All L.A. Care business units rely on telephone contact. Failure to maintain and support the system will seriously affect business operations and put L.A. Care at regulatory compliance risk. Additionally, with the rapid growth, it is necessary to maintain an updated telephone infrastructure and plan to meet the growth capacity levels to effectively meet the needs of our members.
L.A. Care completed a competitive bid process and request for proposal (RFP) in October, 2014. The RFP was sent to five vendors – CDW, Black Box, Presidio Inc., Integrated Systems Inc. and Technologent. The RFP evaluation team selected Presidio Inc., as the only vendor with the technological experience, expertise and certifications to provide support for both NICE and Cisco Call Manager. The Presidio Inc., contract will replace the contract with Integrated Systems Inc. expiring December, 31, 2014.
IT is requesting approval of $1,574,717.04 for a one year contract with Presidio Inc. to provide managed services and purchase equipment from 01/01/2015 – 12/31/2015.
Description of services Cost of Service Presidio Managed Services for 1 year $339,014.04
One time setup fee $110,703.00 Hardware Purchases $300,000.00 Software Purchases $200,000.00 Manufacture Support Purchases $580,000.00 Sales Tax $45,000.00 Total amount requested per quote $1,574,717.04
64 Budget Impact: The requested amount is budgeted in the Strategic Project – Cisco Call Manager Update budget for FY14-15.
Motion: To authorize staff to execute a contract for purchasing equipment, maintenance, support and managed services from Presidio Inc., in the amount of $1,574,717.04 through December 31, 2015.
65 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. FIN 107.1214 Committee: Finance & Budget Chairperson: Michael Rembis Issue: Contract with a key vendor to start the Encounter Modernization project to enhance L.A. Care’s enterprise systems.
Background: L.A. Care is launching phase I of the Encounter Modernization project to assess and improve encounter data infrastructure and determine the most efficient design to support a growing member population and expanded lines of business with increased complexity. The business need for encounter data is broad and the business functions impacted include revenue determination, quality of care measurement, and understanding cost of care trends. Encounter data processing and reporting are critical components of L.A. Care’s short and long-term performance.
Staff requests authorization to execute a contract up to $1,000,000 through September 2015 for the Encounter Modernization project for Fiscal Year 14-15. The vendor will assist with the development, design, implementation, integration and testing services. Vendors to be considered are: Cognizant, Trizetto, HCL and Infosys, all vendors with which L.A. Care has previously contracted. L.A. Care wants to ensure that all of the work is completed within the timeframe and allocated budget. The full scope of work is not yet determined. L.A. Care will continue to work with the selected vendor, to minimize disruption and additional training costs.
The vendor selected through L.A. Care’s competitive bid process will deliver the following scope of work:
1. Building and maintaining the project plan and deliverables 2. Business impact analysis of applications and systems 3. System integration and testing 4. Implementation of the deliverables 5. Manage defects, issues and system changes
Budget Impact: Sufficient funds are budgeted in the Strategic Project - Encounter Uplift (phase I), for FY14-15. Motion: To authorize staff to execute a contract with a vendor not yet selected, in an amount not to exceed $1,000,000 for phase 1 of the Encounter Modernization Project for FY14-15 through September 30, 2015.
66 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. ECA 100.1214
Committee: Executive Community Advisory Committee Chairperson: Aida Aguilar
Issue: Approval of additional member (s) to the Regional Community Advisory Committees (RCACs).
Background: Senate Bill 2092 requires that L.A. Care Health Plan ensure community involvement through a Community Advisory Committee. L.A. Care’s Regional Community Advisory Committee (RCAC) structure is composed of 5-35 members per RCAC. RCAC member recruitment is on-going to ensure the highest possible community involvement.
Budget Impact: None.
Motion: To approve the following candidate(s) to the Regional Community Advisory Committees (RCAC) as reviewed by the Executive Community Advisory Committee (ECAC) during the November 12, 2014 ECAC meeting. Name RCAC # Type of Member (Agency, if applicable)
Gloria Mejia 3 Consumer Rosa Pastrana 11 Consumer Maritza Zenteno 11 Consumer
67 Board of Governors MOTION SUMMARY Date: December 4, 2014 Motion No. CHC 100.1214
Committee: Children’s Consultant Advisory Chairperson: Lyndee Knox, PhD Committee (CHCAC)
Issue: Approval of CHCAC member.
Background:
Budget Impact: None
Motion: To approve the nomination of Demetria Malloy, M.D, MSHS, as Member of the Children’s Health Consultant Advisory Committee, for the Medical Director for Quality Management of L.A. Care Health Plan seat; for the first 4-year term from December 2014 to December 2018.
68 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. CHC 101.1214 Committee: Children’s Health Consultant Advisory Chairperson: Lyndee Knox, PhD Committee
Issue: Ratification of the election of Children’s Health Consultant Advisory Committee Chairperson and Vice Chairperson for 2015.
Background: At its November 18, 2014 meeting, the Children’s Health Consultant Advisory Committee re-elected Lyndee Knox, PhD as Chair and Kimberly Uyeda, MD, MPH as Vice Chair, respectively, for the 2015 calendar year.
Budget Impact: None
Motion: To ratify the re-election of Lyndee Knox, PhD as Chairperson and Kimberly Uyeda, MD, MPH as Vice Chairperson of the Children’s Health Consultant Advisory Committee for 2015.
69 November 24, 2014
TO: Board of Governors
FROM: Howard A. Kahn, Chief Executive Officer
SUBJECT: CEO Report – December 2014
As this is the last L.A. Care Board meeting of 2014, I wish you and your families a happy and healthy holiday season and a wonderful new year. There will be no Committee meetings in December and the next regularly scheduled Board meeting will be in February, 2015.
On a personal note, this will be my last Board meeting as the CEO of L.A. Care. It has been an honor and a privilege to work for L.A. Care for the past 13 years, and to work with this Board. While often challenging, the experience has far exceeded my expectations and has been completely rewarding and worthwhile. I am proud of all of the work, major milestones and multiple transformations L.A. Care has accomplished during my tenure: leadership of the Children’s Health Initiative, launch of a leading grant making program, development of L.A. Care’s directly contracted Medi-Cal network (MCLA), transition of seniors and people with disabilities into managed care, creation of the Family Resource Centers, launch of L.A. Care Covered, Medicaid expansion, Cal MediConnect, and enrollment of over 1.7 million members, to name a few. This was accomplished because of the unwavering support of the Board and our committed staff. Thank you for a great 13 years.
A Reflection
Changes? When I first arrived at L.A. Care I was astounded by the height and weight of the monthly Board Book. I proudly announced after one year that we had “lost a half-pound.” Well, 12 years later, our Board Book is not nearly as lengthy, and weighs nothing! While I won’t take credit for inventing the Internet or the iPad, we have taken advantage of the many technologic innovations that have occurred and have responded well to the many fundamental changes in financing and health services delivery, while instilling in our staff a sense of high ethics, respect for our Board governance process, and for our members.
The changes are not over (and never are), and the coming few years pose internal and external challenges. Due to Obamacare and other factors, Medi-Cal attracts far more attention than in the past and is an even greater driver of the healthcare market. Approximately 30% of L.A. County’s total population is Medi-Cal-eligible. The healthcare industry will continue to consolidate. The safety net will be challenged to compete, and most likely the entire health care system will try to respond to future changes while clinging to past values and infrastructures.
Ironically, because of our public status and service to the less fortunate, we are given less slack than other organizations – we have less capital, more regulatory constraints, and more public exposure. So, in many ways we have to be better and quicker to survive and thrive in a changing environment.
70 CEO Report – December 2014
Please find below an update on organizational activities that occurred in November 2014. Additional updates will be given during my CEO report at the December 4, 2014 Board meeting.
1. Coordinated Care Initiative (CCI) and Cal MediConnect (CMC) As previously mentioned, L.A. Care made the decision to not renew our 2015 Medicare Special Needs Plan (D-SNP) contract and allow our D-SNP product to terminate at the end of the year. As of January 1, 2015, D-SNP members who are eligible, will transition into our CMC product. Staff is working tirelessly to ensure that all affected members are aware of the January 1, 2015 transition date and to minimize continuity of care issues. Staff is confident that our CMC product will be ready for the D-SNP transition as well as the beginning of passive enrollment.
As previously reported, in May, the Department of Managed Health Care (DMHC) placed Alameda Alliance under the conservatorship of Mark Abernathy of Berkeley Research Group due to ongoing financial solvency issues. The Department of Health Care Services (DHCS) recently announced that in an effort to allow Alameda Alliance to remain focused on getting into a healthy financial and operational condition, the CCI will not move forward in Alameda County. DHCS also announced delays for Orange County; passive enrollment will begin no sooner than August 2015 and choice enrollment will begin no sooner than July 2015.
Echoing what we have long argued to CMS, a bipartisan group of 34 Congressmen has sent a letter to CMS stating that the current quality and risk factor rating system “perpetuates a downward funding and quality spiral” for dual eligibles by failing to recognize the challenges faced by these beneficiaries and the Plans that serve them.
2. Covered California (Health Benefit Exchange) November 15, 2014 marked the beginning of the 2015 Covered California open enrollment that runs through February 15, 2015. L.A. Care’s Sales Department has engaged with our community partners, safety net clinics and agents at more than 34 public events in November to facilitate and promote enrollment. This year, the L.A. Care Covered campaign includes custom photography that showcases L.A. Care’s deep understanding and commitment to the communities it has served for more than 17 years. It also includes numerous billboards, social media advertisements as well as English and Spanish radio advertisements. The statewide campaign includes the Covered California Bus Tour led by Peter Lee, Executive Director, Covered California. The tour made a stop at the L.A. Care-supported Community Health Alliance of Pasadena (CHAP Care) storefront enrollment site.
3. Family Resource Center Grand Opening in Pacoima L.A. Care is proud to announce the opening of our newest Family Resource Center in Pacoima. The ribbon cutting ceremony was held on November 14, where L.A. Care received proclamations from the San Fernando City Council as well as the Los Angeles City Council, and Board member Hilda Perez and I delivered remarks. The community grand opening was held the following day on November 15. It was a well-attended event with both Board Chair Thomas Horowitz and Board member Hilda Perez speaking. The Center will provide free health and wellness services for all residents of the San Fernando Valley area. Free and confidential one-on-one enrollment assistance for no-cost and low-cost health care coverage will also be available.
71 CEO Report – December 2014
4. Immigration Reform, Deferred Deportation On November 21, President Obama announced he was taking executive action on immigration reform. The new immigration program offers protection from deportation or allows immigrants to stay in the country longer if they meet certain conditions. This executive action could result in an increase of Latino enrollment under the Affordable Care Act by reducing the threat of deportation and making more immigrants comfortable signing up for coverage, especially in California. I was recently quoted in a Los Angeles Times article which outlines the impact of this new program for California, it is attached for your reference.
5. Medi-Cal Terminations by the Department of Health Care Services (DHCS) Pursuant to State law, DHCS began the annual renewal process for 2014 in June. From June through October 2014, approximately 5 million Medi-Cal beneficiaries were sent renewal packets. Beneficiaries who fail to respond are sent a discontinuance notice informing them that they have up to 90 days to submit the required information to continue their coverage. Advocates have noted the forms were not properly translated and many did not know how to fill out the form and or read any subsequent notices. For Los Angeles County, an estimated 200,000 face a loss of benefits before the end of the year. Neighborhood Legal Services and a coalition of legal groups have sued the state to stop the terminations, filing a petition in Alameda County Superior Court asking to declare DHCS’ policies unlawful. In addition, the groups filed a temporary restraining order to provide emergency relief to intervene, but a judge denied the order until he could hear more. A preliminary hearing is set for December 9.
6. New Appointments at the Department of Health Care Services (DHCS) On November 10, Governor Brown appointed Claudia Crist as the Deputy Director, Health Care Delivery Systems and Hannah Katch as the Assistant Deputy Director, Health Care Delivery Systems. Ms. Crist has over 20 years of experience in the health care field in a variety of positions. She has been working for Sutter Health for 14 years and has held several leadership positions there. Ms. Katch has over 6 years of experience in the health care field. Since January 2011 she has worked as the Senior Health Policy Advisor for Senator Al Franken of Minnesota. 7. Meetings and Events of Interest On November 6, 2014, I attended the retirement celebration of William Fujioka, Chief Executive Officer, Los Angeles County.
On November 17, 2014, I traveled to Sacramento to attend the Local Health Plans of California Board meeting. L.A. Care provided downtown meeting space for community activities and training this past month: November 7, 2014 – L.A. Care hosted a Health Promoters training on the Coordinated Care Initiative and access to care issues. November 17, 2014 – L.A. Care hosted a Local Health Plans of California meeting with marketing executives from the various Plans. November 20, 2014 - L.A. Care hosted a Joint Operations Committee meeting with the Department of Health Services.
Attachments: Los Angeles Times article. November sponsorship list.
72 CEO Report – December 2014
November 2014 Participation and Sponsorship List
Event Date Organization Event Location 11/7/2014 Southern California Public Annual Conference Los Angeles Health Association 11/9/2014 California Association of Convention and Expo Palm Springs Health Facilities 11/10/2014 Legal Aid Foundation Annual Access to Justice Beverly Hills Dinner 11/13/2014 Los Angeles County Medical L.A. Healthcare Awards Los Angeles Association 11/17/2014 California Association of Annual Meeting and Fall Long Beach Adult Day Services Conference 11/21/2014 California Dental Association California Dental Pomona Foundation and Western Association Cares University of Health Sciences
73 Immigration overhaul could boost Latino enrollment in Obamacare
Los Angeles Times November 22, 2014 By CHAD TERHUNE, ERYN BROWN President Obama's new immigration overhaul could increase Latino enrollment under his signature health law by reducing the threat of deportation and making more Californians comfortable signing up for coverage they already qualify to get. Over time, the initiative may also pave the way for more Californians to become eligible for state-funded Medi-Cal coverage. Friday, state officials were noncommittal about that idea, and said they would have to assess the effect of the president's immigration proposal. In the meantime, California healthcare leaders were optimistic about greater participation. "The president's decision could be a major boost to enrollment in California," said Howard Kahn, chief executive of L.A. Care Health Plan, which has 1.6 million Medi-Cal members and about 30,000 customers in the state insurance exchange. "It will open up both Covered California and Medi-Cal to people who feared exposure to deportation." Nationwide, the new immigration program applies to as many as 5 million people, offering them protection from deportation or allowing them to stay in the country longer if they meet certain conditions. The president's executive action won't make people newly eligible for Obamacare. The Affordable Care Act bars undocumented residents from getting subsidized health insurance in government-run exchanges or qualifying for Medicaid, a joint federal-state program for low-income people. Since the health-law rollout last fall, many Latinos who are eligible for Obamacare have been reluctant to apply out of worry that doing so could lead to deportation for family members who aren't citizens. As a result, the Covered California exchange has launched new TV ads aimed at easing those immigration concerns, and the president's announcement offers more protection against having a family torn apart. Even as enrollment enters year two, there are roughly 600,000 Latinos in California who remain uninsured despite qualifying for subsidized coverage under the health law. In a recent survey, 37% of those eligible said they were at least somewhat worried that signing up would draw attention to their family members' immigration status. It's estimated 3.2 million Californians will be uninsured by the end of open enrollment in mid-February, according to UC Berkeley projections. About half of those people, or 1.5 million, are not citizens or legal residents. Medi-Cal is California's healthcare safety-net program and it has already experienced enormous growth because of the health-law expansion. More than 2 million people have joined the program since January, pushing overall enrollment to 11.3 million. At this point, it's unclear how many more may ultimately qualify for Medi-Cal under the president's executive order.
74 Health-policy experts and consumer advocates say California has extended Medi-Cal coverage to similar groups in the past when they have secured legal protection. For instance, California is among a handful of states that offer Medicaid eligibility to people given legal status under the Deferred Action for Childhood Arrivals program. Obama created that 2012 program for young people who came to the country illegally as children. About 125,000 of these young California immigrants — sometimes called Dreamers — may qualify for Medi-Cal. "California has a long history of covering certain immigrant populations excluded from the federal program," said Anthony Wright, executive director of Health Access, a consumer advocacy group. "First, these people have to go through the process the president outlined and then they have to meet the income criteria for Medi-Cal." Medi-Cal costs are typically split between the state and federal government. But the state would have to pick up the full tab for immigrants covered by this latest overhaul. Some health-policy experts point out that undocumented residents already qualify for emergency Medi-Cal benefits if they land in the hospital, so the fiscal effect for comprehensive coverage is less than many predict. "The overall cost difference from emergency Medi-Cal to full-scope coverage is not that large," said Ken Jacobs, chairman of the UC Berkeley Center for Labor Research and Education. A spokesman for the California Department of Health Care Services, which runs the Medi-Cal program, said the agency "has not received any formal guidance from the Centers for Medicare & Medicaid Services regarding the president's immigration proposal. "Once any formal guidance is received, we will assess its potential impact on the Medi-Cal program." Obama's announcement came just as the second year of open enrollment got underway, and many people were already trying to sort through their insurance choices. Sonya Vasquez, healthcare policy director for Community Health Councils, an advocacy group in Los Angeles, said there's bound to be even more confusion now and enrollment counselors will need to have answers for how Obama's move affects people's healthcare options. The president's executive action could also spur more workers to sign up for health insurance through their jobs. Dr. J. Mario Molina, chief executive of Molina Healthcare Inc., said immigrants gaining work permits might feel more comfortable taking advantage of those benefits. The Long Beach insurer is a major Medicaid managed-care plan nationwide and sells policies on Covered California. More than anything, Molina said he worries that the public will misconstrue what's actually happening under the president's overhaul. "I don't want people to get the impression that 5 million people are suddenly going on Medicaid," he said. "This is not a way for illegal immigrants to get welfare benefits. That is not the case."
75 November 24, 2014
To: Board of Governors
Through: Jonathan Freedman, Chief of Strategy, Regulatory & External Affairs
From: Cherie Fields, Director of Government Affairs
Subject: 2015 Government Affairs Advocacy Activities
L.A. Care’s strategic priorities include the goal of raising awareness among legislators of value of the Local Initiative under the Two Plan Model. Government Affairs has identified the following activities for 2015 to help L.A. Care achieve this strategic priority. These identified activities are in addition to regular, day-to-day, activities accomplished by the Government Affairs.
Policy Briefing Convene a policy briefing in Sacramento for legislative offices and regulatory staff. This will be an opportunity to educate legislators, their staff, regulators (DMHC, Covered California, DHCS), and other key policy makers about L.A. Care’s value and our initiatives. Depending on the environment and issues at hand, L.A. Care may include other key organizations as additional presenters (Community Clinic Association of Los Angeles County, California Primary Care Clinic Association).
Legislative Day Hold a Legislative Day in Sacramento for L.A. Care’s Governing Board. This will provide an opportunity for Board members to engage with legislators and state officials, while being able to help advance our policy initiatives and communicate the importance and value that L.A. Care brings as a Local Initiative health plan.
Presentation of Distinguished Legislative Service Award Identify legislator(s) that have advanced and/or championed L.A. Care’s mission, vision, and values and present them with a Distinguished Legislative Service Award. This award will also serve as a way to cultivate a legislative champion(s) for L.A. Care.
76 Meet and Greet with Key Legislators Schedule small meet and greet events in district (e.g., dinner, coffee, lunch, etc.) for newly elected officials as well as key veteran elected officials. Depending on the district and issues at hand, the event may include Board Chair, key Board member/s, CEO, and key officer/s.
RCAC District Office Visits Schedule district office visits for Regional Advisory Committee members to meet with their respective legislators to share their unique perspective on important issues impacting L.A. Care.
District Level Policy Briefings Host two policy briefings at L.A. Care headquarters to educate and keep local elected offices informed of important developments in and health policy issues related to L.A Care and the community. The briefings would provide an opportunity for L.A. Care’s senior management staff to meet local staffers and discuss current issues facing our organization.
77 Board of Governors MOTION SUMMARY Date: December 4, 2014 Motion No. BOG 105.1214 Committee: Chairperson: Thomas Horowitz, DO Issue: Approval to Co-Sponsor Federally Qualified Health Center (FQHC) Alternative Payment Methodology (APM) Legislation. Background: This motion would authorize L.A. Care to co-sponsor legislation establishing a three-year pilot to implement an Alternative Payment Methodology (APM) for specific Federally Qualified Health Centers (FQHCs) in California, including five clinics in Los Angeles County. In addition to L.A. Care, California Primary Care Association (CPCA) and California Association of Public Hospitals and Health Systems (CAPH) would be co-sponsors. The pilot will allow greater flexibility in care delivery to ensure patients receive the right care, at the right place, at the right time. CPCA and CAPH requested that L.A. Care co-sponsor the legislation in the upcoming 2014-15 legislative session The pilot would be offered statewide. The five clinic sites in Los Angeles are: Alta Med (Boyle Heights and El Monte), Northeast Community Clinic, North East Valley Health and ChapCare (the two specific sites for ChapCare have not yet been identified) California’s Federally Qualified Health Centers (FQHCs) are operated by counties and non-profit community centers, and together are significant providers of health services to the Medi-Cal and uninsured populations. With full implementation of the Affordable Care Act (ACA), including the expansion of coverage to millions of new Medi-Cal enrollees, a shortage of primary care providers, and the increased use of team-based health care, the year pilot program’s goal is to transition the delivery of care at FQHCs from its current volume-based system to one that better aligns financing and delivery of health systems. Under the pilot, the health plan would be entirely responsible for the payment to the FQHCs, including the amount the clinic would have received under the visit-based Prospective Payment System (PPS). FQHCs would test a “wrap cap” which would convert the wraparound payment the FQHCs receive from the State into a per member per month (PMPM) payment. FQHCs will receive at least what they would have received under the per-visit PPS methodology – as well as the base payment currently received directly from the health plans. Prior Legislation In the 2013-2014 Legislative Session, CPCA and CAPH sponsored Senate Bill 1081 (Hernandez), which proposed a three-year PPS reform pilot using an APM. However, the bill failed to make it out of the Senate Appropriations Committee, and thus did not advance in the legislative process. CPCA and CAPH intend to introduce similar legislation in the upcoming legislative session. In the 2012-13 State Budget proposal, DHCS included language to revise the FQHC payment methodology to an APM. The proposal was rejected by the Legislature.
Current FQHC Payment Methodology As mandated by federal law, FQHCs receive payments based on a Prospective Payment System (PPS). The
78 Board of Governors MOTION SUMMARY PPS is a bundled payment based on a set of services including core medical, behavioral health, oral health, transportation, and language translation. The current PPS payment structure has limitations, including: 1) in person visit requirement; 2) only certain types of health professionals may bill for a visit; 3) and the FQHC may only bill one PPS payment per day, regardless if the enrollee is seeing different health providers on the same day (such as behavioral health provider and medical provider). FQHC costs are not recognized when a provider has a telephone or email consult or communication exchange. These strict requirements do not provide the FQHCs with the financial means to provide services in a systematic way. FQHCs participating in Medi-Cal managed care receive PPS payment from both the health plan and the state. L.A. Care pays the FQHC a monthly capitated payment and the state makes up the remainder of the PPS payment through a “wrap around” payment. The “wrap around” payment comprises both state and federal funds and represents the majority of the PPS rate. An annual reconciliation is performed to ensure proper PPS payments were accomplished. Pilot Legislation For An Alternative Payment Methodology This pilot would test a “wrap cap” which would convert the “wrap around” payment FQHCs receive from the state into a per member per month (PMPM) payment. As allowed by federal law, FQHCs and states can agree to an APM where the floor of the payment is at least what the FQHCs would have received under the PPS. This pilot would delink capitation payments from the face-to-face visit requirement. The state would pay the health plan a monthly capitated rate per member assigned to the FQHC. The rate would be FQHC site-specific for three aid categories: child, adult, and SPD (and potentially could include the Medi-Cal optional expansion population – childless adults). The state would develop capitation rates by using utilization data for historical years for members assigned to the clinic in the impacted aid categories. Non-assigned members (those that are not in the pilot aid categories) would continue to be reimbursed with the current PPS payment provision. In order to mitigate the financial impact, the state has indicated it intends to include a risk corridor where the health plan would be responsible for costs/profits up to 0.5% of the capitated wrap payment and the state and health plan would share 50/50 in costs/profits for another small band and costs/profits beyond that second ban would be borne entirely by the state. Benefits of Pilot Legislation · Additional flexibilities for FHQCs in delivery of care – such as telephonic visits and email communication exchanges. · Ancillary providers, such as community health workers and nurses could be used to bundle services. · FQHCs could provide patients with different services on the same day. · Develop incentives for improving patient health outcomes. · If structured properly, the two-way risk corridor could minimize risk to health plan. · As a co-sponsor, L.A. Care can be actively involved in the development of legislative language as well as providing technical assistance on complex issues such as rate development, risk pool design, etc. · Managed care revenues will increase and thus the state would receive increased revenue from the managed care organization tax. Challenges/Issues of Pilot Legislation · Imperative that the state conducts a transparent rate setting process and includes health plans and FQHCs. · The risk corridor must be structured in such a way to prevent plan losses and to prevent utilization shift away from FQHCs to other providers. · It is likely that significant increased administrative responsibilities will be placed on health plan as well as those FQHCs who utilize IPAs. Health plans and IPAs should be recognized for additional responsibilities. Need to ensure the state provides for an administrative load that is outside the capitation calculation for the FQHC payment.
79 Board of Governors MOTION SUMMARY Motion: To approve L.A. Care to Co-Sponsor Federally Qualified Health Center Alternative Payment Methodology Legislation.
80 Board of Governors MOTION SUMMARY Date: December 4, 2014 Motion No. BOG 106.1214 Committee: Chairperson: Thomas Horowitz, DO Issue: Approval for L.A. Care’s 2015 State and Federal Policy Agenda Background: In accordance with the process approved by the L.A. Care Governing Board in March 2013, following is L.A. Care’s proposed 2015 State and Federal Policy Agenda for the Board’s consideration. This Agenda contains principles and policies that serve as the framework for the development and advocacy of positions on federal and state legislative, administrative, and budget issues. This Agenda provides guidance for L.A. Care’s Government Affairs Department to respond effectively to proposals that could significantly impact L.A. Care’s strategic and operational interests.
2015 State and Federal Policy Principles Coverage and Access · Support proposals strengthening government-sponsored programs and increasing health insurance coverage to the uninsured. · Support proposals protect patients while increasing California’s health care workforce and curb the shortage of health care providers. . Medi-Cal and Government-Sponsored Programs · Support proposals that strengthen and improve existing government-sponsored programs in ways that support the safety net, including expanding program eligibility and increasing reimbursement rates. · Support 1115 Waiver activities, which allows California the flexibility to design budget neutral demonstration projects that promote the objectives of the Medi-Cal program. · Support policies that support continued funding and authorization for the Children’s Health nsurance Program (CHIP). · Support policies that maintain or strengthen the Two-Plan Model. · Support a more equitable allocation of Federal Medicaid funds to reduce the current disparity whereas California receives significantly less Medicaid funds per Medicaid recipient than other states. · Support proposals simplifying government-sponsored program eligibility rules, application and the re- determination processes. · Support proposals addressing inequitable geographic variations in Medi-Cal reimbursement rates. · Support proposals that would increase transparency in the rate-setting process conducted by regulatory agencies (e.g., DMHC, DHCS, and Exchange). · Support use of health plan fees, provider fees, and intergovernmental transfers that maximize California’s share of Federal Medicaid funding. · Oppose proposals that would result in unfunded mandates or increase L.A. Care’s unreimbursed costs of administering health care services.
81 · Oppose proposals that weaken the Affordable Care Act, particularly the Medicaid Expansion and Exchange-based subsidies. · Oppose policies degrading the Two-Plan Model structure. Innovation, Competition, Quality · Support health care models that promote choice, drives competition on a level playing field, improves quality of care, and fosters innovation and cost containment. · Support proposals that align financial incentives among providers, patients, health plans, and payors. · Support the strengthening of anti-fraud measures and programs, and provide the ability of health plans and payors to recover lost funds. · Support proposals promoting home and community-based care for persons that would otherwise require institutionalization. · Support the use of health information technology that would result in cost-savings and patient care improvement.
Motion: To approve L.A. Care’s 2015 State and Federal Policy Agenda.
82 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. EXE 100.1214 Committee: Executive Chairperson: Thomas Horowitz, D.O. Issue: Approval of the payout of the Annual Incentive Plan, based on the results of individual performance goals and organizational targets for Fiscal Year 2013-2014. Background: At the beginning of Fiscal Year 2008-09 the Board of Governors approved the modification to Annual Incentive Program to base eligibility on the achievement of predetermined individual performance goals and targets. Previously, the Annual Incentive Program was based on overall organizational performance and was provided to all eligible employees without consideration for the level of each employee’s contribution to L.A. Care’s success. Based upon job classification, employees are eligible to participate in one of the three following components to its Annual Incentive Program: · Monthly Production Incentives Program based on pre-determined criteria; · Individual Annual Incentives Program based on pre-determined goals; and, · Administrative Support Incentive for support personal annually based on effective performance and overall organizational success. At the November 2014 Board of Governors meeting, a fiscal year-end Organizational Performance report was reviewed by the Board. The individual annual incentive goals completed by each eligible employee were instrumental in helping to achieve the 2013-14 Organizational Goals.
Employees are eligible to participate in the Individual Annual Incentive Program if they have successfully completed their individual annual incentive and have received an at least satisfactory performance rating. goals. Their performance is rated at threshold, target or maximum level and the incentive payments increase based upon the higher rating level and their employment classification.
Employee Participation in each program is as follows: · 38% (439) employees participate in the Production Incentive Program. · 49% (568) staff participates in the Individual Annual Incentive Program; 20% (112) of those are management employees. · 14% (162) of staff participates in the Administrative Bonus Program. The Production Incentive Program is included in the budget and was paid monthly according to policy. The Production Incentive Program payout was $1,686,362. This request is for authorization to payout two other incentive programs, for a total of $2,630,000. Budget Impact: The Annual Incentive Program budget previously approved by the Board of Governors for 2013 -14 was up to 5% of salaries and benefits ($5,845,000), which includes the three components described above and a projected amount for a potential incentive for the Chief Executive Officer. Approximately $1,528,638 of the budgeted amount will have been unspent due to staff vacancies and a potential incentive for the Chief Executive Officer yet to be determined by the Board.
83 Board of Governors MOTION SUMMARY Motion: To authorize payment not to exceed $2,630,000, for Individual Annual Incentive Program incentives based on completion of pre-determined individual goals and targets in support of L.A. Care’s 2013 – 14 Organizational Goals for eligible employees and the Administrative Support Incentive for all eligible employees as provided by the Annual Incentive Program. Distribution of the annual incentive payout shall be guided by Human Resource Policy # 602, Annual Organizational Incentive Program. The total amount of the incentives paid including those for the monthly Production Incentive Program, shall not exceed the budgeted amount approved by the Board of Governors.
84 85 86 87 88 89 Board of Governors MOTION SUMMARY
Date: December 4, 2014 Motion No. FIN 108 .1214
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Acceptance of the Financial Report for the twelve months ended September 30, 2014.
Background:
Budget Impact:
Motion: To accept the Financial Report for the twelve months ended September 30, 2014, as submitted.
90
Financial Performance September 2014
Unaudited
91 Financial Performance Results Highlights - unaudited September 2014
Overall
Total enrollment for September is 1,569,816 members. Fiscal year-to-date (twelve months) performance is a surplus of $40.6 million or 1.0% on revenue of $4.2 billion, and is $52.2 million favorable to plan. The favorable variance is driven primarily by savings in operating expenses which includes timing and capitalization of certain system related costs. Operating (Administrative) expenses are 4.3% of revenue and $59.6 million under budget.
Plan Partners Total enrollment for September is 817,468 members. Fiscal year-to-date performance is a surplus of $81.5 million, and is $44.4 million favorable to plan. The favorable variance is driven by higher revenue related to rate adjustments retroactive to October 2013 offset by higher healthcare expenses and savings in operating expenses.
Medi-Cal Direct (MCLA)
Total enrollment for September is 665,792 members. Fiscal year-to-date performance is a deficit of $1.5 million, and is $22.2 million favorable to plan. The favorable variance is driven by savings in operating expenses and higher revenue related to rate adjustments retroactive to October 2013 offset by higher inpatient claims and shared risk. Health care expenses are 94.9% of revenue (MCR) which is 0.7% unfavorable to budget.
Within MCLA, Seniors and Persons with Disabilities (SPD) enrollment is 75,516. Fiscal year-to-date performance is a deficit of $128.9 million, and is $99.0 million unfavorable to budget due to lower than expected capitation revenue and higher inpatient claims and pharmacy expenses. The MCR is 116.8% which is 19.3% unfavorable to budget.
Cal Medi-Connect (CMC) Cal Medi-Connect is operated as a separate line of business that launched in April 2014. Total enrollment for September is 4,803 compared to 14 initially in May. Fiscal year-to-date performance is a deficit of $16.4 million and is $14.1 million unfavorable to budget driven by lower than expected membership and start-up costs associated with this new product.
L.A. Care Covered (LACC) L.A. Care Covered began enrollment in October 2013. Total enrollment for September is 22,958 members. Fiscal year-to-date performance is a deficit of $2.7 million, and is $2.0 million favorable to plan, driven by lower operating expenses. Membership is significantly less than expected with 23,042 fewer members than budgeted; related to nationwide challenges associated with the launch of the program.
92 Financial Performance Results Highlights - unaudited September 2014
Medicare
Total enrollment for September is 8,907 members. Fiscal year-to-date performance is a deficit of $6.9 million, and is $6.6 million unfavorable to plan, driven by higher inpatient and outpatient expenses.
PASC-SEIU
Fiscal year-to-date performance is a deficit of $2.1 million, and is $1.2 million unfavorable to plan, driven by a federal shared risk assessment retroactive to January. Effective December 2013, L.A. Care Health Plan Joint Powers Authority (JPA) received its Knox-Keene license and became exempt from Managed Care Organization (MCO) taxes.
Healthy Kids
Total enrollment for September is 713 members. Fiscal year-to-date performance is a surplus of $574,000, and is $325,000 favorable to plan, driven by lower than expected inpatient and outpatient claims expenses.
Community Programs
Fiscal year-to-date performance is a deficit of $4.2 million, and is $6.9 million favorable to plan, driven by timing of grant activity.
HITEC-LA
The federal grant is drawn-down based upon expenses incurred. Fiscal year-to-date performance is a deficit of $231,000, and is $94,000 favorable to plan.
93 Combined Operations Financial Statement ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 1,569,816 1,512,480 57,336 Current Membership 1,569,816 1,593,883 (24,067) 1,590,437 1,530,298 60,139 Member Months 16,773,301 17,131,824 (358,523)
Revenue $526,454 331.01 $394,785 257.98 $131,669 73.03 Capitation $4,034,036 240.50 $4,089,654 238.72 ($55,618) 1.79 11,609 7.30 10,024 6.55 1,584 0.75 Maternity Kick 113,597 6.77 141,977 8.29 (28,379) (1.51) 28 0.02 37 0.02 (9) (0.01) Premiums 236 0.01 42 0.00 193 0.01 288 0.18 115 0.08 173 0.11 Grants/Others 3,182 0.19 2,926 0.17 256 0.02 538,378 338.51 404,961 264.63 133,417 73.88 Total Revenues 4,151,051 247.48 4,234,599 247.18 (83,548) 0.30
Healthcare Expenses 245,461 154.34 262,085 171.26 (16,624) (16.93) Capitation 2,443,456 145.68 2,485,749 145.10 42,293 (0.58) 6,938 4.36 6,597 4.31 341 0.05 Maternity Kick 78,345 4.67 94,038 5.49 15,693 0.82 14,687 9.23 5,226 3.42 9,461 5.82 CBAS Centers 73,499 4.38 89,684 5.23 16,185 0.85 1,315 0.83 2,180 1.42 (866) (0.60) Provider Incentives 38,437 2.29 44,305 2.59 5,867 0.29 1,292 0.81 8,146 5.32 (6,854) (4.51) Shared Risk 60,669 3.62 1,446 0.08 (59,223) (3.53) 94,215 59.24 36,511 23.86 57,704 35.38 Inpatient Claims 555,029 33.09 492,140 28.73 (62,888) (4.36) 123,572 77.70 25,196 16.46 98,376 61.23 Outpatient Claims 336,575 20.07 439,492 25.65 102,917 5.59 28,617 17.99 31,381 20.51 (2,764) (2.51) Pharmacy 283,888 16.93 294,045 17.16 10,157 0.24 3,977 2.50 8,001 5.23 (4,024) (2.73) Medical Administrative Expenses 58,521 3.49 63,443 3.70 4,923 0.21 520,075 327.00 385,324 251.80 134,751 75.20 Total Healthcare Expenses 3,928,420 234.21 4,004,342 233.74 75,922 (0.47) 96.6% 95.2% 1.4% MCR(%) 94.6% 94.6% -0.1%
18,303 11.51 19,637 12.83 (1,334) (1.32) Operating Margin 222,631 13.27 230,257 13.44 (7,626) (0.17)
19,815 12.46 17,084 11.16 2,731 1.29 Total Operating Expenses 176,825 10.54 236,391 13.80 59,565 3.26 3.7% 4.2% -0.5% Admin Ratio(%) 4.3% 5.6% 1.3%
(1,512) (0.95) 2,553 1.67 (4,064) (2.62) Income from Operations 45,806 2.73 (6,133) (0.36) 51,939 3.09
(606) (0.38) (1,496) (0.98) 890 0.60 Total Non-Operating Income (Expense) (5,252) (0.31) (5,469) (0.32) 217 (1.48)
($2,118) (1.33) $1,057 0.69 ($3,175) (2.02) Net Surplus(Deficit) $40,554 2.42 ($11,602) (0.68) $52,156 3.09 -0.4% 0.3% -0.7% Margin(%) 1.0% -0.3% 1.3%
94 MediCal Plan Partner Financial Statement ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 817,468 805,381 12,087 Current Membership 817,468 826,744 (9,276) 824,507 812,440 12,067 Member Months 9,471,248 9,639,522 (168,274)
Revenue $180,485 218.90 $156,978 193.22 $23,507 25.68 Capitation $1,666,161 175.92 $1,536,169 159.36 $129,992 16.56 6,268 7.60 6,379 7.85 (112) (0.25) Maternity Kick 73,156 7.72 87,896 9.12 (14,739) (1.39) 186,752 226.50 163,357 201.07 23,395 25.43 Total Revenues 1,739,317 183.64 1,624,065 168.48 115,252 15.16
Healthcare Expenses 153,853 186.60 144,427 177.77 9,426 8.83 Capitation 1,513,154 159.76 1,406,153 145.87 (107,001) (13.89) 5,771 7.00 5,876 7.23 (104) (0.23) Maternity Kick 68,371 7.22 80,555 8.36 12,184 1.14 9,479 11.50 1 0.00 9,479 11.50 CBAS Centers 10,118 1.07 14,084 1.46 3,966 0.39 521 0.63 1,603 1.97 (1,082) (1.34) Provider Incentives 25,323 2.67 30,094 3.12 4,771 0.45 00.00 (70) (0.09) 70 0.09 Inpatient Claims (61) (0.01) 0 - 61 0.01 00.00 (405) (0.50) 405 0.50 Outpatient Claims (131) (0.01) 0 - 131 0.01 1,654 2.01 1,693 2.08 (39) (0.08) Medical Administrative Expenses 12,052 1.27 8,958 0.93 (3,095) (0.34) 171,279 207.73 153,124 188.47 18,155 19.26 Total Healthcare Expenses 1,628,827 171.98 1,539,844 159.74 (88,983) (12.23) 91.7% 93.7% -2.0% MCR(%) 93.6% 94.8% 1.2%
15,474 18.77 10,233 12.60 5,240 6.17 Operating Margin 110,490 11.67 84,221 8.74 26,269 2.93
2,364 2.87 2,284 2.81 80 0.06 Total Operating Expenses 29,025 3.06 47,188 4.90 18,163 1.83 1.3% 1.4% -0.1% Admin Ratio(%) 1.7% 2.9% 1.2%
13,110 15.90 7,949 9.78 5,160 6.12 Income from Operations 81,465 8.60 37,033 3.84 44,432 4.76
$13,110 15.90 $7,949 9.78 $5,160 6.12 Net Surplus(Deficit) $81,465 8.60 $37,033 3.84 $44,432 4.76 7.0% 4.9% 2.2% Margin(%) 4.7% 2.3% 2.4%
95 MCLA Financial Statement ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 665,792 618,071 47,721 Current Membership 665,792 609,761 56,031 676,728 620,088 56,640 Member Months 6,429,768 6,325,631 104,137
Revenue $316,742 468.05 $196,590 317.04 $120,152 151.01 Capitation $2,040,662 317.38 $1,933,545 305.67 $107,117 11.71 5,341 7.89 3,645 5.88 1,696 2.01 Maternity Kick 40,441 6.29 54,081 8.55 (13,640) (2.26) 322,083 475.94 200,235 322.91 121,848 153.03 Total Revenues 2,081,103 323.67 1,987,626 314.22 93,477 9.45
Healthcare Expenses 75,347 111.34 91,159 147.01 (15,812) (35.67) Capitation 719,982 111.98 732,358 115.78 12,376 3.80 1,167 1.72 721 1.16 446 0.56 Maternity Kick 9,974 1.55 13,483 2.13 3,508 0.58 4,982 7.36 4,769 7.69 213 (0.33) CBAS Centers 62,565 9.73 75,600 11.95 13,035 2.22 646 0.95 405 0.65 242 0.30 Provider Incentives 11,274 1.75 10,175 1.61 (1,099) (0.14) 2,924 4.32 7,310 11.79 (4,385) (7.47) Shared Risk 58,580 9.11 0 - (58,580) (9.11) 88,766 131.17 31,059 50.09 57,707 81.08 Inpatient Claims 509,024 79.17 381,415 60.30 (127,609) (18.87) 117,463 173.58 23,754 38.31 93,709 135.27 Outpatient Claims 311,519 48.45 361,509 57.15 49,989 8.70 24,679 36.47 27,186 43.84 (2,507) (7.37) Pharmacy 258,301 40.17 260,608 41.20 2,307 1.03 2,338 3.45 2,953 4.76 (615) (1.31) Medical Administrative Expenses 33,908 5.27 38,029 6.01 4,121 0.74 318,312 470.37 189,315 305.30 128,997 165.07 Total Healthcare Expenses 1,975,128 307.18 1,873,176 296.12 (101,951) (11.06) 98.8% 94.5% 4.3% MCR(%) 94.9% 94.2% -0.7%
3,771 5.57 10,920 17.61 (7,149) (12.04) Operating Margin 105,976 16.48 114,450 18.09 (8,474) (1.61)
10,815 15.98 10,446 16.85 369 (0.86) Total Operating Expenses 107,475 16.72 138,108 21.83 30,633 5.12 3.4% 5.2% -1.9% Admin Ratio(%) 5.2% 6.9% 1.8%
(7,044) (10.41) 474 0.76 (7,518) (11.17) Income from Operations (1,499) (0.23) (23,658) (3.74) 22,159 3.51
($7,044) (10.41) $474 0.76 ($7,518) (11.17) Net Surplus(Deficit) ($1,499) (0.23) ($23,658) (3.74) $22,159 3.51 -2.2% 0.2% -2.4% Margin(%) -0.1% -1.2% 1.1%
96 Exhibit for information purposes only. Not a financial Statement MCLA SPD Exhibit ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 75,516 75,799 (283) Current Membership 75,516 99,179 (23,663) 74,960 75,922 (962) Member Months 898,906 985,338 (86,432)
Revenue 88,526 1,180.98 $45,356 597.40 $43,170 583.57 Capitation $586,570 652.54 $668,081 678.02 ($81,511) (25.48) 88,526 1,180.98 45,356 597.40 43,170 583.57 Total Revenues 586,570 652.54 668,081 678.02 (81,511) (25.48)
Healthcare Expenses 10,839 144.60 13,382 176.26 (2,543) (31.66) Capitation 151,894 168.98 170,124 172.66 18,230 3.68 978 13.04 1,000 13.18 (23) (0.13) CBAS Centers 10,734 11.94 11,340 11.51 606 (0.43) 132 1.76 202 2.66 (70) (0.89) Provider Incentives 3,356 3.73 1,805 1.83 (1,551) (1.90) 34,733 463.35 20,703 272.69 14,029 190.66 Inpatient Claims 228,112 253.77 184,842 187.59 (43,271) (66.17) 55,465 739.93 8,283 109.10 47,182 630.83 Outpatient Claims 137,509 152.97 151,669 153.93 14,159 0.95 11,765 156.95 13,216 174.07 (1,451) (17.13) Pharmacy 143,309 159.43 124,610 126.46 (18,699) (32.96) 484 6.45 979 12.89 (495) (6.44) Medical Administrative Expenses 10,276 11.43 7,203 7.31 (3,072) (4.12) 114,396 1,526.09 57,766 760.85 56,630 765.23 Total Healthcare Expenses 685,189 762.25 651,592 661.29 (33,598) (100.96) 129.2% 127.4% 1.9% MCR(%) 116.8% 97.5% -19.3%
(25,870) (345.11) (12,410) (163.45) (13,460) (181.66) Operating Margin (98,619) (109.71) 16,489 16.73 (115,108) (126.44)
2,973 39.66 2,366 31.17 606 8.49 Total Operating Expenses 30,292 33.70 46,421 47.11 16,128 13.41 3.4% 5.2% -1.9% Admin Ratio(%) 5.2% 6.9% 1.8%
(28,842) (384.77) (14,776) (194.62) (14,066) (190.15) Income from Operations (128,911) (143.41) (29,931) (30.38) (98,980) (113.03)
($28,842) (384.77) ($14,776) (194.62) ($14,066) (190.15) Net Surplus(Deficit) ($128,911) (143.41) ($29,931) (30.38) ($98,980) (113.03) -32.6% -32.6% 0.0% Margin(%) -22.0% -4.5% -17.5%
97
CMC Financial Statement ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 4,803 5,558 (755) Current Membership 4,803 36,105 (31,302) 4,684 5,027 (343) Member Months 17,095 107,918 (90,823)
Revenue $1,770 377.94 $9,686 1,926.82 ($7,916) (1,548.88) Capitation $25,139 1,470.54 $201,721 1,869.20 ($176,582) (398.66) 1,770 377.94 9,686 1,926.82 (7,916) (1,548.88) Total Revenues 25,139 1,470.54 201,721 1,869.20 (176,582) (398.66)
Healthcare Expenses (1,358) (289.86) 6,258 1,244.89 (7,616) (1,534.75) Capitation 10,657 623.43 102,713 951.77 92,056 328.34 226 48.28 456 90.81 (230) (42.52) CBAS Centers 817 47.77 0 - (817) (47.77) 30.58 0 - 3 0.58 Provider Incentives 3 0.16 0 - (3) (0.16) (1,841) (393.11) 630 125.25 (2,471) (518.36) Shared Risk 13 0.78 0 - (13) (0.78) 1,960 418.34 558 110.94 1,402 307.39 Inpatient Claims 7,239 423.43 49,729 460.80 42,490 37.37 4,050 864.54 1,317 261.95 2,733 602.59 Outpatient Claims 6,299 368.45 28,020 259.64 21,721 (108.81) 1,482 316.29 1,605 319.34 (124) (3.05) Pharmacy 5,599 327.51 7,397 68.54 1,798 (258.97) 1,470 313.77 535 106.44 935 207.33 Medical Administrative Expenses 5,180 303.00 6,519 60.40 1,339 (242.60) 5,990 1,278.83 11,359 2,259.62 (5,369) (980.78) Total Healthcare Expenses 35,806 2,094.53 194,377 1,801.16 158,572 (293.37) 338.4% 117.3% 221.1% MCR(%) 142.4% 96.4% -46.1%
(4,220) (900.90) (1,673) (332.80) (2,547) (568.09) Operating Margin (10,667) (623.99) 7,343 68.04 (18,010) (692.03)
693 148.05 4,347 864.72 (3,653) (716.67) Total Operating Expenses 6,668 390.07 9,639 89.32 2,971 (300.75) 39.2% 44.9% -5.7% Admin Ratio(%) 26.5% 4.8% -21.7%
(4,913) (1,048.94) (6,020) (1,197.52) 1,107 148.58 Income from Operations (17,335) (1,014.06) (2,296) (21.27) (15,039) (992.78)
890 190.05 0 0.00 890 190.05 Total Non-Operating Income (Expense) 890 52.07 0 0.00 890 52.07
($4,023) ($858.89) ($6,020) ($1,197.52) $1,997 $338.63 Net Surplus(Deficit) ($16,445) ($961.98) ($2,296) ($21.27) ($14,149) ($940.71) -227.3% -62.2% -165.1% Margin(%) -65.4% -1.1% -64.3%
98 L.A. Care Covered Financial Statement ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 22,958 25,428 (2,470) Current Membership 22,958 46,000 (23,042) 25,620 34,573 (8,953) Member Months 199,330 375,000 (175,670)
Revenue $2,370 92.52 $6,574 190.13 ($4,203) (97.62) Capitation $38,110 191.19 $106,389 283.70 ($68,279) (92.52) 26 1.00 35 1.00 (9) - Premiums 199 1.00 0 - 199 1.00 2,396 93.52 6,608 191.13 (4,212) (97.62) Total Revenues 38,309 192.19 106,389 283.70 (68,080) (91.52)
Healthcare Expenses 1,386 54.10 4,236 122.51 (2,850) (68.42) Capitation 21,112 105.91 38,756 103.35 17,644 (2.57) 58 2.27 87 2.53 (29) (0.26) Provider Incentives 357 1.79 2,000 5.33 1,643 3.54 13 0.51 19 0.56 (6) (0.05) Shared Risk 75 0.37 0 - (75) (0.37) (2,405) (93.89) 1,347 38.96 (3,752) (132.84) Inpatient Claims 1,254 6.29 15,778 42.08 14,524 35.78 (211) (8.25) (826) (23.90) 615 15.65 Outpatient Claims 2,994 15.02 27,665 73.77 24,671 58.75 354 13.81 343 9.92 11 3.89 Pharmacy 1,763 8.85 10,359 27.62 8,596 18.78 82 3.19 262 7.57 (180) (4.38) Medical Administrative Expenses 1,252 6.28 4,668 12.45 3,416 6.17 (724) (28.26) 5,468 158.14 (6,191) (186.40) Total Healthcare Expenses 28,808 144.52 99,227 264.60 70,419 120.08 -30.2% 82.7% -113.0% MCR(%) 75.2% 93.3% 18.1%
3,120 121.78 1,141 32.99 1,979 88.79 Operating Margin 9,501 47.66 7,162 19.10 2,338 28.56
1,690 65.96 1,458 42.18 232 23.78 Total Operating Expenses 10,506 52.70 11,853 31.61 1,347 (21.10) 70.5% 22.1% 48.5% Admin Ratio(%) 27.4% 11.1% -16.3%
1,430 55.81 (318) (9.19) 1,748 65.01 Income from Operations (1,005) (5.04) (4,690) (12.51) 3,686 7.47
(239) (9.34) (260) (7.53) 21 (1.82) Total Non-Operating Income (Expense) (1,653) (8.29) 0 - (1,653) (8.29)
$1,191 46.47 ($578) (16.72) $1,769 63.19 Net Surplus(Deficit) ($2,658) (13.34) ($4,690) (12.51) $2,032 (0.83) 49.7% -8.7% 58.4% Margin(%) -6.9% -4.4% -2.5%
99 Medicare Financial Statement ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 8,907 8,662 245 Current Membership 8,907 7,938 969 8,957 8,739 218 Member Months 90,557 83,706 6,851
Revenue $9,303 1,038.60 $8,835 1,010.98 $468 27.62 Medicare Part C $83,569 922.83 $86,077 1,028.32 ($2,508) (105.49) 537 59.99 1,039 118.87 (501) (58.88) Medicare Part D 8,233 90.92 0 - 8,233 90.92 9,840 1,098.59 9,874 1,129.84 (34) (31.25) Total Revenues 91,802 1,013.75 86,077 1,028.32 5,726 (14.57)
Healthcare Expenses 3,607 402.75 3,496 400.03 112 2.72 Capitation 33,043 364.89 31,895 381.04 (1,148) 16.15 84 9.33 85 9.68 (1) (0.34) Provider Incentives 1,467 16.20 2,009 23.99 542 7.80 196 21.85 187 21.38 9 0.47 Shared Risk 1,949 21.53 1,446 17.28 (503) (4.25) 5,612 626.58 3,200 366.23 2,412 260.35 Inpatient Claims 33,617 371.23 26,824 320.45 (6,794) (50.78) 2,025 226.09 1,093 125.02 933 101.07 Outpatient Claims 10,924 120.64 7,997 95.54 (2,927) (25.10) 1,378 153.82 1,285 146.99 93 6.83 Pharmacy 8,936 98.67 7,758 92.69 (1,177) (5.99) 210 23.42 410 46.86 (200) (23.44) Medical Administrative Expenses 4,069 44.93 2,511 29.99 (1,558) (14.94) 13,112 1,463.84 9,754 1,116.19 3,357 347.66 Total Healthcare Expenses 94,005 1,038.08 80,439 960.98 (13,566) (77.10) 133.2% 98.8% 34.5% MCR(%) 102.4% 93.5% -8.9%
(3,272) (365.26) 119 13.66 (3,391) (378.91) Operating Margin (2,203) (24.32) 5,637 67.34 (7,840) (91.67)
724 80.81 (2,862) (327.50) 3,586 408.31 Total Operating Expenses 4,695 51.85 5,890 70.37 1,195 18.52 7.4% -29.0% 36.3% Admin Ratio(%) 5.1% 6.8% 1.7%
(3,995) (446.07) 2,981 341.16 (6,977) (787.23) Income from Operations (6,898) (76.17) (253) (3.02) (6,645) (73.15)
($3,995) (446.07) $2,981 341.16 ($6,977) (787.23) Net Surplus(Deficit) ($6,898) (76.17) ($253) (3.02) ($6,645) (73.15) -40.6% 30.2% -70.8% Margin(%) -7.5% -0.3% -7.2%
100 PASC-SEIU Financial Statement ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 49,175 48,647 528 Current Membership 49,175 45,692 3,483 49,223 48,703 520 Member Months 554,677 535,104 19,573
Revenue $15,162 308.03 $14,999 307.96 $163 0.07 Capitation $170,907 308.12 $187,286 350.00 ($16,379) (41.88) 15,162 308.03 14,999 307.96 163 0.07 Total Revenues 170,907 308.12 187,286 350.00 (16,379) (41.88)
Healthcare Expenses 12,606 256.10 12,486 256.38 120 (0.28) Capitation 145,163 261.71 162,757 304.16 17,594 42.45 0- 0 - 0 - Provider Incentives 0 - 1 0.00 1 0.00 287 5.82 399 8.20 (113) (2.37) Inpatient Claims 3,854 6.95 4,399 8.22 545 1.27 245 4.98 242 4.96 3 0.01 Outpatient Claims 4,889 8.81 3,575 6.68 (1,314) (2.13) 719 14.60 958 19.67 (239) (5.07) Pharmacy 9,233 16.65 7,192 13.44 (2,041) (3.21) (1,778) (36.12) 2,147 44.09 (3,925) (80.21) Medical Administrative Expenses 2,047 3.69 1,745 3.26 (302) (0.43) 12,078 245.38 16,233 333.30 (4,154) (87.92) Total Healthcare Expenses 165,186 297.81 179,669 335.76 14,483 37.96 79.7% 108.2% -28.6% MCR(%) 96.7% 95.9% -0.7%
3,084 62.65 (1,234) (25.33) 4,318 87.98 Operating Margin 5,721 10.31 7,618 14.24 (1,897) (3.92)
2,686 54.57 442 9.07 2,245 45.51 Total Operating Expenses 6,768 12.20 6,697 12.51 (71) 0.31 17.7% 2.9% 14.8% Admin Ratio(%) 4.0% 3.6% -0.4%
398 8.08 (1,675) (34.40) 2,073 42.48 Income from Operations (1,047) (1.89) 921 1.72 (1,968) (3.61)
0- 0 - 0 - Total Non-Operating Income (Expense) (1,052) (1.90) (1,844) (3.45) 792 1.55
$398 8.08 ($1,675) (34.40) $2,073 42.48 Net Surplus(Deficit) ($2,099) (3.78) ($923) (1.73) ($1,176) (2.06) 2.6% -11.2% 13.8% Margin(%) -1.2% -0.5% -0.7%
101 Healthy Kids 0-5 Financial Statement ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 713 733 (20) Current Membership 713 1,141 (428) 718 728 (10) Member Months 10,607 13,692 (3,085)
Revenue $84 117.00 $85 116.98 ($1) 0.02 Capitation $1,241 116.96 $1,750 127.83 ($510) (10.87) 23.35 3 3.44 (0) (0.09) Premiums 36 3.42 42 3.09 (6) 0.33 86 120.35 88 120.42 (1) (0.07) Total Revenues 1,277 120.38 1,793 130.92 (516) (10.54)
Healthcare Expenses 24 33.03 24 32.79 (0) 0.24 Capitation 348 32.78 451 32.92 103 0.15 34.46 1 1.16 2 3.31 Provider Incentives 13 1.24 25 1.83 12 0.59 00.12 0 0.12 (0) (0.00) Shared Risk (1) (0.06) 0 - 1 0.06 34.34 (3) (3.47) 6 7.81 Inpatient Claims (14) (1.32) 346 25.24 360 26.56 22.66 8 10.42 (6) (7.75) Outpatient Claims 109 10.32 397 29.00 288 18.68 79.55 5 6.82 2 2.73 Pharmacy 66 6.25 101 7.36 34 1.11 22.47 2 2.64 (0) (0.17) Medical Administrative Expenses 33 3.13 27 1.94 (7) (1.19) 41 56.63 37 50.46 4 6.17 Total Healthcare Expenses 555 52.35 1,346 98.30 791 45.95 47.1% 41.9% 5.1% MCR(%) 43.5% 75.1% 31.6%
46 63.72 51 69.95 (5) (6.24) Operating Margin 722 68.03 447 32.62 275 35.41
13 17.48 11 15.60 1 1.88 Total Operating Expenses 148 13.93 197 14.42 50 0.50 14.5% 13.0% 1.6% Admin Ratio(%) 11.6% 11.0% -0.6%
33 46.24 40 54.35 (6) (8.11) Income from Operations 574 54.10 249 18.20 325 35.91
0- 0 - 0 - Total Non-Operating Income (Expense) 0 - 0 - - -
$33 46.24 $40 54.35 ($6) (8.11) Net Surplus(Deficit) $574 54.10 $249 18.20 $325 35.91 38.4% 45.1% -6.7% Margin(%) 44.9% 13.9% 31.0%
102 Community Programs Financial Statement ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 000 Current Membership 000 000 Member Months 000
Revenue $184 - $40 - $144 - Grants/Others $1,099 - $0 - $1,099 - 0- 0 - 0 - Capitation 0 - 0 - 0 - 184 - 40 - 144 - Total Revenues 1,099 - 0 - 1,099 -
Healthcare Expenses 0- 0 - 0 - Medical Administrative Expenses (9) - 0 - 9 - 0- 0 - 0 - Total Healthcare Expenses (9) - 0 - 9 - 0.0% 0.0% 0.0% MCR(%) 0.0% 0.0% 0.0%
184 - 40 - 144 - Operating Margin 1,108 - 0 - 1,108 -
292 - 434 - (142) - Total Operating Expenses 4,501 - 7,154 - 2,653 - 0.0% 0.0% 0.0% Admin Ratio(%) 0.0% 0.0% 0.0%
(108) - (394) - 286 - Income from Operations (3,392) - (7,154) - 3,761 -
0- (675) - 675 - Total Non-Operating Income (Expense) (846) - (4,000) - 3,154 -
($108) 0.00 ($1,069) 0.00 $961 0.00 Net Surplus(Deficit) ($4,238) 0.00 ($11,154) 0.00 $6,915 0.00 0.0% 0.0% 0.0% Margin(%) 0.0% 0.0% 0.0%
103 HITEC-LA Financial Statement ($ in thousands) September 2014 Current Prior Increase YTD YTD Fav
Membership 000 Current Membership 000 000 Member Months 000
Revenue $104 - $75 - $29 - Grants/Others $2,083 - $2,926 - ($843) - 0- 0 - 0 - Capitation 0 - 0 - 0 - 104 - 75 - 29 - Total Revenues 2,083 - 2,926 - (843) -
Healthcare Expenses 0- 0 - 0 - Medical Administrative Expenses 0 - 0 - 0 - 0- 0 - 0 - Total Healthcare Expenses 0 - 0 - 0 - 0.0% 0.0% 0.0% MCR(%) 0.0% 0.0% 0.0%
104 - 75 - 29 - Operating Margin 2,083 - 2,926 - (843) -
115 - 83 - 32 - Total Operating Expenses 2,314 - 3,251 - 938 - 0.0% 0.0% 0.0% Admin Ratio(%) 0.0% 0.0% 0.0%
(12) - (8) - (3) - Income from Operations (231) - (325) - 94 -
($12) 0.00 ($8) 0.00 ($3) 0.00 Net Surplus(Deficit) ($231) 0.00 ($325) 0.00 $94 0.00 0.0% 0.0% 0.0% Margin(%) 0.0% 0.0% 0.0%
104 Comparative Balance Sheet September 2014
(Dollars in thousands) Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 ASSETS
CURRENT ASSETS Total Current Assets 1,171,394 1,360,902 1,111,107 1,298,995 1,208,460 1,315,943 Capitalized Assets - net 22,675 25,002 26,169 26,751 27,427 28,654 NON-CURRENT ASSETS 11,291 11,330 10,338 10,325 10,487 10,151 TOTAL ASSETS 1,205,361 1,397,233 1,147,614 1,336,071 1,246,373 1,354,749
LIABILITIES AND FUND EQUITY
CURRENT LIABILITIES Total Current Liability 989,413 1,168,892 924,395 1,115,462 1,024,596 1,134,979 Long Term Liability 2,767 2,829 2,940 3,051 3,162 3,273 Total Liabilities 992,181 1,171,720 927,335 1,118,513 1,027,759 1,138,252
FUND EQUITY Invested in Capital Assets, net of related debt 22,675 25,002 26,169 26,751 27,427 28,654 Restricted Equity 302 302 302 300 300 300 Minimum Tangible Net Equity 53,090 53,090 61,935 61,935 61,935 80,462 Board Designated Funds 137,113 147,120 131,874 128,572 128,953 107,080 Retained Earnings (undesignated) 00000 0 Total Fund Equity 213,180 225,513 220,280 217,558 218,615 216,496
TOTAL LIABILITIES AND FUND EQUITY $1,205,361 $1,397,233 $1,147,614 $1,336,071 $1,246,373 $1,354,749
Solvency Ratios
Working Capital Ratio 1.18 1.16 1.20 1.16 1.18 1.16 Cash to Claims Ratio 0.71 0.76 0.59 1.01 0.63 0.94 Tangible Net Equity Ratio 4.02 4.25 3.56 3.51 3.53 2.69
105 November 19, 2014
TO: Finance & Budget Committee FROM: Timothy Reilly, Chief Financial Officer
SUBJECT: Monthly Investment Transaction Report – October 2014
In order to keep the Committee apprised of L.A. Care’s investment portfolios and to comply with California Government Code Section 53607, included are the investment transaction details for October 1, 2014 through October 31, 2014.
As of October 31, 2014, L.A. Care's investment portfolio total was $612 million. These funds are managed by Payden & Rygel, an external professional asset management firm, and are managed as separate portfolios based on investment style in a Short-term Portfolio and Extended Portfolio.
106 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 10/01/2014 Account Number: through 10/31/2014
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 10/01/14 10/01/14 Buy 25,000,000.000 U.S. TREASURY BILL 10/09/14 912796DZ9 (24,999,972.22) (24,999,972.22)
10/01/14 10/01/14 Buy 50,000,000.000 U.S. TREASURY BILL 10/16/14 912796CF4 (49,999,979.17) (49,999,979.17)
10/01/14 10/01/14 Buy 25,000,000.000 U.S. TREASURY BILL 10/16/14 912796CF4 (24,999,989.58) (24,999,989.58)
10/01/14 10/01/14 Buy 50,000,000.000 U.S. TREASURY BILL 10/23/14 912796EA3 (49,999,969.44) (49,999,969.44)
10/01/14 10/02/14 Buy 25,000,000.000 U.S. TREASURY BILL 10/23/14 912796EA3 (24,999,912.50) (24,999,912.50)
10/03/14 10/08/14 Buy 465,699.880 FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 (465,699.88) (43.28) (465,743.16)
10/21/14 10/24/14 Buy 975,000.000 GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.56 36159LCF1 (976,180.66) (60.34) (976,241.00)
10/31/14 10/31/14 Buy 50,000,000.000 U.S. TREASURY BILL 11/13/14 912796CL1 (49,999,837.50) (49,999,837.50)
10/31/14 10/31/14 Buy 25,000,000.000 U.S. TREASURY BILL 11/13/14 912796CL1 (24,999,918.75) (24,999,918.75)
10/31/14 10/31/14 Buy 50,000,000.000 U.S. TREASURY BILL 11/06/14 912796ED7 (49,999,987.50) (49,999,987.50)
10/31/14 10/31/14 Buy 25,000,000.000 U.S. TREASURY BILL 11/06/14 912796ED7 (24,999,993.75) (24,999,993.75)
10/31/14 10/31/14 Buy 50,000,000.000 U.S. TREASURY BILL 11/06/14 912796ED7 (49,999,841.67) (49,999,841.67)
10/30/14 10/31/14 Buy 50,000,000.000 U.S. TREASURY BILL 12/04/14 912796EG0 (49,999,976.39) (49,999,976.39) 10/31/14 10/31/14 Buy 50 ,000 , 000 . 000 U.S. TREASURY NOTE 11/15/14 0.38 912828RQ5 (50 ,006 , 026 . 88) (86 , 107 . 34) (50 ,092 , 134 . 22) 476,440,699.880 (476,447,285.89) (86,210.96) (476,533,496.85)
10/01/14 10/01/14 Coupon SO CAL EDISON FRN 10/01/14 842400FX6 727.31 727.31
10/01/14 10/01/14 Coupon CA GOLDEN EMPIRE SFA LEASE 05/01/15 0.25 381008AR2 216.09 216.09
10/03/14 10/03/14 Coupon FFCB FRN 10/03/16 0.17 3133ED3B6 735.42 735.42
10/07/14 10/07/14 Coupon NATL RURAL UTILITIES FRN 05/01/15 0.28 63743HEJ7 684.88 684.88
10/07/14 10/07/14 Coupon ORACLE FRN 07/07/17 0.43 68389XAT2 875.82 875.82
Payden & Rygel 107 Page 1 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 10/01/2014 Account Number: through 10/31/2014
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 10/08/14 10/08/14 Coupon JOHN DEERE CAPITAL FRN 10/08/14 24422ERX9 408.60 408.60
10/08/14 10/08/14 Coupon FFCB FRN 07/08/16 0.17 3133ED4K5 733.75 733.75
10/10/14 10/10/14 Coupon METLIFE GLOBAL FRN 144A 04/10/17 0.61 59217GBE8 2,352.13 2,352.13
10/11/14 10/11/14 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.58 263901AE0 462.74 462.74
10/11/14 10/11/14 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.58 263901AE0 656.79 656.79
10/11/14 10/11/14 Coupon WAL-MART STORES 04/11/16 0.60 931142DE0 1,500.00 1,500.00
10/13/14 10/13/14 Coupon FFCB FRN 02/13/17 0.19 3133EDFB3 806.67 806.67
10/14/14 10/14/14 Coupon JOHN DEERE CAPITAL FRN 10/11/16 0.52 24422ESE0 304.27 304.27
10/15/14 10/15/14 Coupon JPMORGAN CHASE 10/15/15 1.10 46623EJR1 2,750.00 2,750.00
10/15/14 10/15/14 Coupon USAA 2012-1 A3 CAR 08/15/16 0.43 90327BAC6 28.05 28.05
10/15/14 10/15/14 Coupon USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 139.33 139.33
10/15/14 10/15/14 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 512.33 512.33
10/17/14 10/17/14 Coupon FFCB FRN 04/17/17 0.20 3133EDJX1 509.00 509.00
10/20/14 10/20/14 Coupon WELLS FARGO FRN 07/20/16 0.76 94974BFM7 579.06 579.06
10/20/14 10/20/14 Coupon WELLS FARGO FRN 07/20/16 0.76 94974BFM7 2,316.25 2,316.25
10/22/14 10/22/14 Coupon GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 560.00 560.00
10/23/14 10/23/14 Coupon BNY MELLON 10/23/15 0.70 06406HCD 1,750.00 1,750.00
10/23/14 10/23/14 Coupon BNY MELLON FRN 10/23/15 0.46 06406HCF4 1,183.48 1,183.48
10/23/14 10/23/14 Coupon NEW YORK LIFE GLOBAL FRN 14 05/23/16 0.58 64952WBP 745.07 745.07
10/24/14 10/24/14 Coupon GEET 2013-2 A2 EQP 06/24/16 0.61 36163GAB7 675.01 675.01
Payden & Rygel 108 Page 2 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH 10/01/2014 PLAN Account Number: through 10/31/2014
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 10/01/14 10/25/14 Coupon FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 482.10 482.10
10/01/14 10/25/14 Coupon FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.51 3136AJ2A3 315.01 315.01
10/01/14 10/25/14 Coupon FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.41 3136AKQJ5 565.72 565.72
10/28/14 10/28/14 Coupon BRANCH BANKING & TRUST FR 10/28/15 0.57 07330NAE5 722.07 722.07
10/28/14 10/28/14 Coupon BRANCH BANKING & TRUST FR 10/28/15 0.57 07330NAE5 1,444.14 1,444.14
10/28/14 10/28/14 Coupon PNC BANK FRN 01/28/16 0.54 69349LAJ7 1,393.03 1,393.03
10/29/14 10/29/14 Coupon AMERICAN EXPRESS FRN 07/29/16 0.74 0258M0DH 1,045.87 1,045.87
10/30/14 10/30/14 Coupon MANUFACTURERS & TRADERS T 01/30/17 0.61 55279HAC4 780.85 780.85
10/30/14 10/30/14 Coupon US BANK CINCINNATI FRN 01/30/17 0.46 90331HMD 595.57 595.57
10/31/14 10/31/14 Coupon U.S. TREASURY FRN 01/31/16 0.07 912828WK 176.88 176.88 10/31/14 10/31/14 Coupon U.S. TREASURY FRN 01/31/16 0.07 912828WK 312 . 10 312 . 10 30,045.39 30,045.39
10/01/14 10/01/14 Income 196.890 ADJ NET INT USD 196.89 196.89
10/01/14 10/01/14 Income 24.520 CLASS ACTION PROCEEDS - CO USD 24.52 24.52 10/01/14 10/01/14 Income 81 . 610 STIF INT USD 81 . 61 81 . 61 303.020 303.02 303.02
10/01/14 10/01/14 Contributn 150,000,000.000 NM USD 150,000,000.00 150,000,000.00
10/30/14 10/30/14 Contributn 11,000,000.000 NM USD 11,000,000.00 11,000,000.00
Payden & Rygel Page 3 109 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH 10/01/2014 PLAN Account Number: through 10/31/2014
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount
Cash - cont. 10/31/14 10/31/14 Contributn 289 ,000 , 000 . 000 NM USD 289 ,000 , 000 . 00 289 ,000 , 000 . 00 450,000,000.000 450,000,000.00 450,000,000.00
10/27/14 10/28/14 Call 500,000.000 BRANCH BANKING & TRUST FR 10/28/15 0.57 07330NAE5 500,000.00 500,000.00
10/27/14 10/28/14 Call 1,000,000.000 BRANCH BANKING & TRUST FR 10/28/15 0.57 07330NAE5 1,000,000.00 1,000,000.00
10/29/14 10/30/14 Sell Long 20,000,000.000 FHLB DISCOUNT NOTE 11/26/14 313385Q82 19,996,712.22 2,417.78 19,999,130.00
10/29/14 10/30/14 Sell Long 3,000,000.000 FHLMC DISCOUNT NOTE 01/26/15 313396BB8 2,998,831.67 728.33 2,999,560.00 10/29/14 10/30/14 Sell Long 20 ,000 , 000 . 000 FHLMC DISCOUNT NOTE 11/20/14 313397Q20 19 ,996 , 878 . 33 2 , 491 . 67 19 ,999 , 370 . 00 44,500,000.000 44,492,422.22 5,637.78 44,498,060.00
10/15/14 10/15/14 Pay Princpl 11,860.704 USAA 2012-1 A3 CAR 08/15/16 0.43 90327BAC6 11,860.70 11,860.70
10/15/14 10/15/14 Pay Princpl 18,280.910 USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 18,280.91 18,280.91
10/24/14 10/24/14 Pay Princpl 119,184.253 GEET 2013-2 A2 EQP 06/24/16 0.61 36163GAB7 119,184.25 119,184.25
10/01/14 10/25/14 Pay Princpl 46,047.010 FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 46,047.01 46,047.01
10/01/14 10/25/14 Pay Princpl 22,309.160 FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.51 3136AJ2A3 22,309.16 22,309.16 10/01/14 10/25/14 Pay Princpl 1 , 496 . 750 FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.41 3136AKQJ5 1 , 496 . 75 1 , 496 . 75 219,178.787 219,178.78 219,178.78
10/01/14 10/01/14 Mature Long 1,000,000.000 SO CAL EDISON FRN 10/01/14 842400FX6 1,000,000.00 1,000,000.00
10/02/14 10/02/14 Mature Long 30,000,000.000 U.S. TREASURY BILL 10/02/14 912796DX4 29,999,980.83 19.17 30,000,000.00
10/08/14 10/08/14 Mature Long 480,000.000 JOHN DEERE CAPITAL FRN 10/08/14 24422ERX9 480,000.00 480,000.00
Payden & Rygel 110 Page 4 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH 10/01/2014 PLAN Account Number: through 10/31/2014
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 10/09/14 10/09/14 Mature Long 25,000,000.000 U.S. TREASURY BILL 10/09/14 912796DZ9 24,999,972.22 27.78 25,000,000.00
10/09/14 10/09/14 Mature Long 49,500,000.000 FHLB DISCOUNT NOTE 10/09/14 313385J80 49,498,246.88 1,753.12 49,500,000.00
10/16/14 10/16/14 Mature Long 50,000,000.000 U.S. TREASURY BILL 10/16/14 912796CF4 49,999,979.17 20.83 50,000,000.00
10/16/14 10/16/14 Mature Long 25,000,000.000 U.S. TREASURY BILL 10/16/14 912796CF4 24,999,989.58 10.42 25,000,000.00
10/23/14 10/23/14 Mature Long 50,000,000.000 U.S. TREASURY BILL 10/23/14 912796EA3 49,999,969.44 30.56 50,000,000.00 10/23/14 10/23/14 Mature Long 25 ,000 , 000 . 000 U.S. TREASURY BILL 10/23/14 912796EA3 24 ,999 , 912 . 50 87 . 50 25 ,000 , 000 . 00 255,980,000.000 255,978,050.62 1,949.38 255,980,000.00
10/09/14 10/09/14 Withdrawal (75,000,000.000) WD USD (75,000,000.00) (75,000,000.00)
10/16/14 10/16/14 Withdrawal (75,000,000.000) WD USD (75,000,000.00) (75,000,000.00) 10/23/14 10/23/14 Withdrawal (75 ,000 , 000 . 000) WD USD (75 ,000 , 000 . 00) (75 ,000 , 000 . 00) 225,000,000.000) (225,000,000.00) (225,000,000.00)
Payden & Rygel 111 Page 5 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 10/01/2014 Account Number: through 10/31/2014
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 10/03/14 10/08/14 Buy 256,134.940 FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 (256,134.94) (23.81) (256,158.75)
10/23/14 10/28/14 Buy 900,000.000 BMW 2013-A A3 CAR 11/27/17 0.67 05578XAC2 (900,527.34) (50.25) (900,577.59)
10/23/14 10/28/14 Buy 1,000,000.000 HONDA 2013-4 A3 CAR 09/18/17 0.69 43814FAC6 (1,000,312.50) (191.67) (1,000,504.17)
10/23/14 10/28/14 Buy 1,000,000.000 TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 (1,003,476.56) (321.39) (1,003,797.95)
10/29/14 10/30/14 Buy 3,500,000.000 U.S. TREASURY NOTE 03/31/16 0.38 912828C40 (3,506,425.78) (1,081.73) (3,507,507.51) 10/30/14 10/31/14 Buy 500 , 000 . 000 U.S. TREASURY NOTE 03/31/16 0.38 912828C40 (500 , 782 . 93) (159 . 68) (500 , 942 . 61) 7,156,134.940 (7,167,660.05) (1,828.53) (7,169,488.58)
10/01/14 10/01/14 Coupon SO CAL EDISON FRN 10/01/14 842400FX6 581.85 581.85
10/01/14 10/01/14 Coupon CA GOLDEN EMPIRE SFA LEASE 05/01/15 0.25 381008AR2 118.56 118.56
10/07/14 10/07/14 Coupon NATL RURAL UTILITIES FRN 05/01/15 0.28 63743HEJ7 338.83 338.83
10/07/14 10/07/14 Coupon ORACLE FRN 07/07/17 0.43 68389XAT2 437.91 437.91
10/10/14 10/10/14 Coupon METLIFE GLOBAL FRN 144A 04/10/17 0.61 59217GBE8 987.90 987.90
10/11/14 10/11/14 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.58 263901AE0 388.10 388.10
10/11/14 10/11/14 Coupon WAL-MART STORES 04/11/16 0.60 931142DE0 270.00 270.00
10/13/14 10/13/14 Coupon FFCB FRN 02/13/17 0.19 3133EDFB3 645.33 645.33
10/14/14 10/14/14 Coupon GE CAPITAL CORP FRN 07/12/16 0.88 36962G7A6 1,061.30 1,061.30
10/01/14 10/15/14 Coupon FHR 3612 AE 12/15/14 1.40 31398LKJ6 61.22 61.22
10/15/14 10/15/14 Coupon U.S. TREASURY NOTE 10/15/15 0.25 912828TT7 1,625.00 1,625.00
10/15/14 10/15/14 Coupon U.S. TREASURY NOTE 10/15/15 0.25 912828TT7 2,750.00 2,750.00
10/15/14 10/15/14 Coupon USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 104.50 104.50
Payden & Rygel 112 Page 1 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 10/01/2014 Account Number: through 10/31/2014
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 10/15/14 10/15/14 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 273.08 273.08
10/17/14 10/17/14 Coupon JOHN DEERE CAPITAL 04/17/15 0.88 24422ERQ4 1,793.75 1,793.75
10/17/14 10/17/14 Coupon FFCB FRN 04/17/17 0.20 3133EDJX1 254.50 254.50
10/20/14 10/20/14 Coupon WELLS FARGO FRN 07/20/15 0.51 94985H5G5 1,038.61 1,038.61
10/22/14 10/22/14 Coupon GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 311.11 311.11
10/23/14 10/23/14 Coupon BNY MELLON 10/23/15 0.70 06406HCD 2,625.00 2,625.00
10/23/14 10/23/14 Coupon JPMORGAN CHASE FRN 04/23/15 0.68 46623EJX8 1,448.93 1,448.93
10/23/14 10/23/14 Coupon NEW YORK LIFE GLOBAL FRN 14 05/23/16 0.58 64952WBP 596.06 596.06
10/01/14 10/25/14 Coupon FHMS K501 A1 CMBS 06/25/16 1.34 3137ANLN3 244.05 244.05
10/01/14 10/25/14 Coupon FHMS K502 A1 CMBS 12/25/16 0.73 3137B03V4 459.30 459.30
10/01/14 10/25/14 Coupon FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 266.76 266.76
10/01/14 10/25/14 Coupon FNA 2014-M4 ASQ2 CMBS 01/25/17 1.27 3136AJB21 715.66 715.66
10/01/14 10/25/14 Coupon FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.51 3136AJ2A3 157.50 157.50
10/01/14 10/25/14 Coupon FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.51 3136AJ2A3 157.50 157.50
10/01/14 10/25/14 Coupon FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.41 3136AKQJ5 314.29 314.29
10/01/14 10/27/14 Coupon FSPC T-50 A6X (FHLMC) 02/27/15 3.61 31392VXP2 307.37 307.37
10/27/14 10/27/14 Coupon JPMORGAN CHASE FRN 01/25/18 1.13 46625HJF8 621.86 621.86
10/28/14 10/28/14 Coupon BRANCH BANKING & TRUST FR 10/28/15 0.57 07330NAE5 722.07 722.07
10/29/14 10/29/14 Coupon FFCB FRN 08/29/17 0.19 3133EDTT9 255.33 255.33
10/30/14 10/30/14 Coupon US BANK CINCINNATI FRN 01/30/17 0.46 90331HMD 476.46 476.46
Payden & Rygel 113 Page 2 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 10/01/2014 Account Number: through 10/31/2014
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 10/31/14 10/31/14 Coupon IBM 10/31/14 0.88 459200GZ8 2,231.25 2,231.25
10/31/14 10/31/14 Coupon U.S. TREASURY NOTE 04/30/15 0.13 912828UY4 1,562.50 1,562.50
10/31/14 10/31/14 Coupon U.S. TREASURY FRN 01/31/16 0.07 912828WK 73.18 73.18 10/31/14 10/31/14 Coupon U.S. TREASURY FRN 01/31/16 0.07 912828WK 129 . 16 129 . 16 26,405.78 26,405.78
10/01/14 10/01/14 Income 9.600 STIF INT USD 9.60 9.60
10/27/14 10/28/14 Call 500,000.000 BRANCH BANKING & TRUST FR 10/28/15 0.57 07330NAE5 500,000.00 500,000.00
10/27/14 10/28/14 Sell Long 1,500,000.000 U.S. TREASURY NOTE 01/15/15 0.25 912828RZ5 1,500,756.69 1,069.97 1,501,826.66
10/29/14 10/30/14 Sell Long 1,300,000.000 U.S. TREASURY NOTE 10/15/15 0.25 912828TT7 1,301,573.13 133.93 1,301,707.06 10/29/14 10/30/14 Sell Long 2 ,200 , 000 . 000 U.S. TREASURY NOTE 10/15/15 0.25 912828TT7 2 ,202 , 662 . 22 226 . 65 2 ,202 , 888 . 87 5,500,000.000 5,504,992.04 1,430.55 5,506,422.59
10/01/14 10/15/14 Pay Princpl 13,911.680 FHR 3612 AE 12/15/14 1.40 31398LKJ6 13,911.68 13,911.68
10/15/14 10/15/14 Pay Princpl 13,710.683 USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 13,710.68 13,710.68
10/01/14 10/25/14 Pay Princpl 55,287.120 FHMS K501 A1 CMBS 06/25/16 1.34 3137ANLN3 55,287.12 55,287.12
10/01/14 10/25/14 Pay Princpl 5,378.380 FHMS K502 A1 CMBS 12/25/16 0.73 3137B03V4 5,378.38 5,378.38
10/01/14 10/25/14 Pay Princpl 25,479.350 FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 25,479.35 25,479.35
10/01/14 10/25/14 Pay Princpl 11,154.580 FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.51 3136AJ2A3 11,154.58 11,154.58
10/01/14 10/25/14 Pay Princpl 11,154.580 FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.51 3136AJ2A3 11,154.58 11,154.58
10/01/14 10/25/14 Pay Princpl 831.528 FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.41 3136AKQJ5 831.53 831.53
Payden & Rygel 114 Page 3 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 10/01/2014 Account Number: through 10/31/2014
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 10/01/14 10/27/14 Pay Princpl 41 , 674 . 690 FSPC T-50 A6X (FHLMC) 02/27/15 3.61 31392VXP2 41 , 674 . 69 41 , 674 . 69 178,582.591 178,582.59 178,582.59
10/01/14 10/01/14 Mature Long 800,000.000 SO CAL EDISON FRN 10/01/14 842400FX6 800,000.00 800,000.00 10/31/14 10/31/14 Mature Long 510 , 000 . 000 IBM 10/31/14 0.88 459200GZ8 510 , 000 . 00 510 , 000 . 00 1,310,000.000 1,310,000.00 1,310,000.00
Payden & Rygel 115 Page 4 116 117 118 119 120 121 122 BOARD OF GOVERNORS Services Agreement Committee Meeting Minutes – October 2, 2014 Conference Room 1025, 1055 W. Seventh Street, Los Angeles, CA 90017 Members Management/Staff Public Ozzie Lopez Howard A. Kahn, Chief Executive Officer Alan Bloom, Care 1st Louise McCarthy Augustavia J. Haydel, General Counsel Supervisor Gloria Molina* Tim Reilly, Chief Financial Officer Hilda Perez John Wallace, Chief Operating Officer Sheryl Spiller * Absent ** Teleconference
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER
CALL TO ORDER Augustavia Haydel, General Counsel, called the meeting to order at 4:25 pm She announced that members of the public may address the Committee on the matters listed on the agenda before or during the Committee’s consideration of the item, and on any other matters at the Public Comment section at the end of the agenda.
APPROVAL OF MEETING The agenda for today’s meeting was unanimously approved as submitted. Approved unanimously. AGENDA 4 AYES. (Lopez, McCarthy, Perez and Spiller) Augustavia J. Haydel
ELECTION OF 2014 Ms. Haydel called for nominations for Committee Chair. COMMITTEE CHAIR Approved unanimously. Ozzie Lopez was nominated by Member McCarthy, seconded by Member 4 AYES Perez, and was unanimously elected the 2014 Committee Chair. Augustavia J. Haydel, Esq.
APPROVAL OF MEETING The minutes of December 16, 2013 and September 4, 2014 meetings were Approved unanimously. MINUTES approved as presented. 4 AYES Ozzie Lopez
PLAN PARTNER Ms. Haydel invited comments from Plan Partners. COMMENTS There was no comment. 123 APPROVED AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER
Augustavia J. Haydel, Esq.
PUBLIC COMMENTS There was no public comment.
ADJOURN TO CLOSED Ms. Haydel announced the Committee would discuss the following item and the SESSION meeting was adjourned to closed session at 4:27 p.m.: CONTRACT RATES Ozzie Lopez Pursuant to Welfare and Institutions Code Section 14087.38(m) Plan Partner Services Agreement Plan Partner Rates
RECONVENE IN OPEN The Chair reconvened the meeting in open session at 4:35 pm. SESSION There was no report from the closed session Ozzie Lopez
ADJOURNMENT The meeting was adjourned at 4:36 p.m.
APPROVED BY: Respectfully submitted by: Malou Balones, Committee Liaison ______Linda Merkens, Manager, Board Services Ozzie Lopez, Committee Chairperson
Services Agreement Committee Meeting Minutes Page 2 of 2 October 2, 2014 APPROVED 124 Board of Governors Executive Community Advisory Committee
Meeting Minutes – October 8, 2014 L.A. Care Health Plan, 1055 West 7th Street, Los Angeles, CA 90017 ECAC Members RCAC Members/Public L.A. Care Board of Governors/Staff María Adela Guadarrama, RCAC 1 Chair, María T Caballero, RCAC 1 Hilda Pérez, Consumer Member, Board of Governors Carlos Aguirre, RCAC 2 Chair Russel Mohler, RCAC 1 Ozzie López, Member Advocate, Board of Governors Cynthia Conteas-Wood, Outgoing RCAC 3 Chair Virginia Mártinez, RCAC 2 John Wallace, Chief Operating Officer Lidia Parra, RCAC 3 Chair Lidia Luna, RCAC 3 Gertrude S. Carter, Chief Medical Officer Hercilia Salvatierra, RCAC 4 Chair Araceli Aragón, RCAC 4 Maribel Ferrer, Senior Director Member and Medi-Cal Operations María Guadalupe Méndez, Outgoing RCAC 5 Chair Ana Santiago, RCAC 4 Idalia Chitica, Community Outreach Field Specialist Supervisor Romalda Meza, RCAC 5 Chair Angélica Albarrán, RCAC 7 CO&E Mary Romero, Outgoing RCAC 6 Chair María Galván, RCAC 8 Susan Choi, Interpreting Services Specialist Dove Savage Pinkney, RCAC 6 Chair Kristina Chung, Community Outreach Field Specialist, CO&E Dalia Cadena, RCAC 7 Chair Jena Diwan Pomeroy, Incentive Program Manager, QI Ana Romo, RCAC 8 Chair Auleria Eakins, Community Outreach Manager CO&E Cristina Deh- Lee, RCAC 9 Chair Oliver Fauria, Temp, CO&E Aida Aguilar, RCAC 10 Chair , ECAC Chair Laura Garcia, Health Promoter Liaison CO&E Elda Sevilla, RCAC 11 Chair Felicia Gray, Community Outreach Liaison CO&E Silvia Poz, At Large Member, ECAC Vice Chair Hilda Herrera, Community Outreach Liaison CO&E Demetria Saffore, At Large Member Judy Hsieh Bigman, Resource Specialist, CO&E Devina Kuo, Health Promoter Program Manager CO&E * Excused Absent ** Absent Susan Ma, CCI Field Specialist, CO&E *** Via teleconference Linda Merkens, Manager, Board Services Frank Meza, Community Outreach Field Specialist, CO&E Peter Prampetch, Analyst, CO&E Jose Ricardo Rivas, Community Outreach Liaison CO&E Laura Rodriguez, CCI Liaison, CO&E Hilda Stuart, Committee Liaison, Board Services Eduardo Kogan, Interpreter Prity Thanki, Local Government Advisor, Government Affairs Paula Alvira, Interpreter Paola Valdivia, Special Projects Manager Kenia Valle, Member Retention Unit, Member Services Department Martin Vicente, Community Outreach Field Specialist CO&E María Weaver, Member Retention Unit, Member Services Department
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER CALL TO ORDER Aida Aguilar, ECAC Chair, called the meeting to order at 10:10 a.m.
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AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER ACKNOWLEDGEMENT On behalf of L.A. Care, its leadership and CO&E staff, Auleria Eakins, Manager, CO&E, OF OUTGOING ECAC acknowledged outgoing ECAC Chairs (Cynthia Conteas-Wood, María Méndez, and Mary MEMBERS Romero), and those who will continue to serve on ECAC for another term (Aida Aguilar, Carlos Aguirre, Dalia Cadena, Cristina Deh Lee, Maria Adela Guadarrama, Ana Romo, Hercilia Salvatierra, and Elda Sevilla) for their support to L.A. Care and its consumers in each RCAC region. Ms. Eakins noted many changes occurred in the last year. Ms. Eakins also noted that the ECAC members demonstrated advocacy in partnership with L.A. Care and the community
Ozzie López, Board Member Advocate, acknowledged the outgoing ECAC Chairs on behalf of the Board of Governors for their advocacy efforts, and for keeping members of their RCACs and local communities informed about health care in Los Angeles County. Board Member López asked that they continue advocating in their communities. He stressed the need for people to be engaged in their communities. Board Member López thanked them for their years of service.
APPROVE Carlos Aguirre, RCAC 2 Chair, asked if meeting materials will continue to be mailed prior Approved MEETING AGENDA to the meetings. Idalia Chitica, Field Specialist Supervisor, noted delays with the translation of unanimously as the meeting minutes. She informed the Committee that the materials were sent out on amended. 13 AYES Friday via U.S mail and email. (Aguilar, Aguirre, Cadena, Conteas- Cynthia Conteas Wood, Outgoing RCAC 3 Chair, noted that today’s meeting Agenda did not Wood, Deh-Lee, include an item for the transition of ECAC Chairs, and requested that the item be posted Guadarrama, on future ECAC meeting Agendas. Ms. Conteas-Wood also noted that the plaques she has Méndez, Poz, received for prior terms show different ending months for her years of service, and Romero, Romo, requested staff to determine a specific month for the transition of ECAC’s leadership. Ms. Saffore, Salvatierra, Chitica acknowledged the requests made by Ms. Conteas-Wood. and Sevilla.) The Agenda for today’s meeting was approved as presented.
APPROVE Ms. Conteas-Wood noted typographical errors on pages 5, 6, and 18 of the English version Approved MEETING MINUTES of the meeting minutes. The September 10, 2014 meeting minutes were approved as unanimously as amended. amended.
13 AYES Ms. Chitica asked newly-elected ECAC Chairs to join the meeting (Lidia Parra, RCAC 3, Romalda Meza, RCAC 5, and Dove Savage Pinkney, RCAC 6).
Ms. Chitica thanked outgoing chairs Conteas-Wood, Méndez and Romero for their service, and they withdrew from the meeting.
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AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER STANDING ITEMS ECAC CHAIRPERSON Chairperson Aguilar presented the following motion: Approved REPORT unanimously. Motion ECA 100: To approve the following candidate(s) to the Regional 13 AYES (Aguilar, Aida Aguilar, Chair Community Advisory Committees (RCAC) as reviewed by the Executive Aguirre, Cadena, Community Advisory Committee (ECAC) during the October 8, 2014 ECAC Deh-Lee, meeting. Guadarrama, Meza,
Parra, Poz, Romo, Name RCAC # Type of Member Saffore, Salvatierra, Northeast Valley Health RCAC 2 Community Partner Savage Pinkney, Corporation/WIC and Sevilla.) This Angela Bogarin RCAC 5 Consumer motion will be Sandra Verdugo RCAC 11 Consumer forwarded to the Chairperson Aguilar noted that the order of some Agenda items for today’s meeting will change. November 6 Board of Governors meeting. L.A. CARE SENIOR John Wallace, Chief Operating Officer, acknowledged the outgoing Chairs, welcomed the STAFF REPORT incoming Chairs, and reported:
Membership L.A. Care membership increased by 71,685 since September. L.A. Care total membership is 1.556 million. Increased enrollment is due to the Affordable Care Act (ACA), which allows people that were previously uninsured to enroll in health care plans. Much of the increased membership went to L.A. Care directly contracted Medi-Cal line of business (MCLA) which increased by 55,786, for a total of 722,764 members. Member focused departments at L.A. Care are rapidly growing to keep up with the pace and increased membership.
Dual Eligible Special Needs Plan (D-SNP) The D-SNP program serves those who are eligible for Medicare and Medi-Cal (dually eligible.) L.A. Care has participated in the D-SNP program for four years, and there are approximately 9,000 members enrolled in the program. As of January 1, 2015, L.A. Care will participate in Cal MediConnect (CMC), which is a similar program for dually eligible members. About 7,000 current D-SNP members will transition to CMC on January 1. Executive Community Advisory Committee October 8, 2014 Page 1273 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER The rest of the D-SNP members will be informed about how to choose a new plan. A small portion of the current D-SNP membership will not qualify to join CMC, and L.A. Care is working with independent organizations such as Neighborhood Legal Services to reach out to those members and offer resources to ensure continuity of care. Members under 18 years old who are developmentally disabled and use the L.A. County Regional Centers are not eligible for CMC at this time.
Mr. Wallace informed the Committee that citizenship or legal immigrant status is required to qualify for Medicare and Medi-Cal benefits.
In response to question from Chairperson Aguilar, Mr. Wallace informed the Committee that letters were mailed out this week to notify D-SNP members who will be affected by the changes. Members must make a decision before January 1, 2015. If a health plan is not selected by then, members will not be automatically assigned to a Medicare managed care plan but will be transferred to the Medicare Fee For Service (FFS) program.
PUBLIC COMMENT Russell Mahler, RCAC 1 member, identified himself as a Regional Center client and asked how members will be affected if they do not receive the letter on time. Mr. Wallace noted that L.A. Care is working with the regional centers to ensure that staff is aware of the change and will inform their clients.
Silvia Poz, At- Large Member, shared her mother’s personal experience and asked for reasons why her mother is being directed to call Medicare and not L.A. Care, if L.A. Care is her Medi-Cal plan. Mr. Wallace informed the Committee that Medicare is the primary insurance payer and covers most of the patient’s medical care and Medicare makes the decisions about payment. Mr. Wallace noted that dual eligible members have an option to join the CMC program to coordinate Medicare and Medi-Cal benefits with one health plan. He noted that the CMC program provides added benefits over Medicare FFS, and members will gain benefits when they join CMC. In response to Ms. Poz’s concern, he noted that if a provider informs a member that a procedure is not available, it may be because the provider is not in the CMC provider network. Mr. Wallace stressed the CMC program is designed to make it easier for dually eligible members to have one health plan that will manage both Medicare and Medi-Cal benefits, and provide additional services. Mr. Wallace informed the Committee that prior authorization from the health plan may be required for some services.
Dove Savage Pinkney, RCAC 6 Chair, noted a lot of confusion in the community about the different programs. She asked if a person can get a second opinion from a provider. Mr. Executive Community Advisory Committee October 8, 2014 Page 1284 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER Wallace informed the Committee about Health Insurance Counseling and Advocacy Program (HICAP), a free service sponsored by the federal government to provide guidance and unbiased information. HICAP works with Medicare beneficiaries to explain the different programs available under Medicare and how these programs may affect each beneficiary in a particular circumstance. Mr. Wallace will provide HICAPs’ telephone number at a future meeting (A flyer which included HICAP’s telephone number was provided at the end of the meeting during the CCI presentation, and is available by contracting COE staff.)
HEALTH SERVICES Gertrude S. Carter, MD, Chief Medical Officer, reported: REPORT L.A. Care improved the Star rating and cured the low performing icon (LPI). Dr. Carter acknowledged hard work throughout the organization. Although the D-SNP program will be ending, L.A. Care will continue to work on Star performance since the CMC program has the same Medicare requirements and most of the current D-SNP members will transition to CMC. Healthcare Effectiveness Data and Information Set (HEDIS), Stars and other similar programs will continue to assess L.A. Care programs. HEDIS and Star ratings are conducted annually. L.A. Care offers educational sessions for providers to discuss issues that can help improve HEDIS scores. This week a session was offered to discuss women’s health. An education session on pediatric care was held last week with good attendance. L.A. Care is discussing quality improvement programs for Medi-Cal with Plan Partners (Kaiser, Care 1st and Anthem Blue Cross). Although each plan is responsible for their own quality improvement program, there is overlap in contracts with providers. L.A. Care is collaborating and combining resources with Plan Partners in working with providers. The Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS) require providers to have phone access for members outside of their regular office hours. Seventy five percent of the contracted providers are compliant with the requirements. L.A. Care is working on an improvement program to help the rest of the providers with the requirements. A health behavior services for autism was added as a Medi-Cal benefit on September 15. Dr. Clayton Chau will come to an ECAC meeting to explain how L.A. Care will be providing the new benefit for its members. L.A. Care is working closely with the LA County regional centers to put a strong program in place and to ensure continuity of care for beneficiaries. ECAC members previously asked about regulations and oversight of nurse practitioners.
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AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER Nurse practitioners (NP) are considered providers and credentialing checks and monitoring by health plans are required. NPs have a wide scope of practice, particularly in California where their scope of practice is similar to a family care practice provider, and includes prescribing medication (with some exceptions for certain narcotic medications).
In response to question from Chairperson Aguilar, Dr. Carter informed the Committee that the Stars program is for Medicare and L.A. Care contracts with Plan Partners only for the Medi-Cal program. Poor Plan Partner performance can affect overall HEDIS scores for Medi-Cal. Dr. Carter indicated that Kaiser’s scores usually help bring up the overall HEDIS scores and scores from Anthem Blue Cross and Care 1st are usually better than that of MCLA.
Chairperson Aguilar noted that she was not aware that a patient has the ability to request a call a provider. Dr. Carter informed the Committee that a patient be able to directly communicate with a provider, and if the provider is not available, there should be a substitute provider available. Dr. Carter referred members to the member handbook for more information. Maribel Ferrer, Senior Director Member and Medi-Cal Operations, informed the Committee that the Member Services Department is developing a quick start guide for the CMC program. Ms. Ferrer noted that the member handbook and evidence of coverage are lengthy and the quick start guide will highlight important information including tips on how to contact providers and access services after regular business hours. Ms. Deh-Lee asked that information on how to get a second opinion be added to the quick start guide.
PUBLIC COMMENT: Ms. Conteas Wood noted that some health plans have e-mail that allow the member to connect directly with the provider.
In response to question from Ms. Eakins, Dr. Carter informed the Committee that the health behavior services for autism benefit is not to test for autism, it is a behavior therapy currently used to treat autism. She noted that this is one of several treatments for autism and not all people with autism qualify for it.
In response to question from Chairperson Aguilar, Dr. Carter informed the Committee that the health plan has an obligation to inform members of the new added benefit, and noted that Medi-Cal has sent out notices to beneficiaries using FFS for their Medi-Cal benefits.
In response to question from Chairperson Aguilar, Dr. Carter indicated that a NP can do a significant amount of patient care without direct supervision by a physician. Dr. Carter noted that in some parts of California NPs have their own practice. The health plan has to Executive Community Advisory Committee October 8, 2014 Page 1306 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER provide oversight and credentialing to ensure that NPs stay within those guidelines.
PUBLIC COMMENT: Ms. Conteas-Wood noted that NPs can prescribe medication with the exception of narcotics, which requires a physician signature.
BOARD MEMBER Board Member López reported that the Board met on October 2. REPORT The list of board approved motions is available in English and Spanish. o The Board approved a $300,000 grant to the Northeast Valley Health Corporation to support the start-up of the new San Fernando Health Center Adult Wellness Center. o The Board approved the execution of a contract with APS Healthcare Inc. (APS), in the amount of $1,993,104 and to extend the terms of the contract for Seniors and People with Disabilities (SPD), Dual Eligible Special Needs Plan (D-SNP) and L.A. Care Covered lines of business to run concurrently through December 31, 2015. Walter Zelman, PhD was honored for almost 12 years of distinguished service to L.A. Care. During his tenure he served three years as Vice Chair, and two years as Chair of the Board. Dr. Zelman has vast institutional knowledge and will be missed by all. Hector De La Torre was appointed yesterday by the Board of Supervisors and will join the Board at its next meeting.
GOVERNMENT Prity Thanki, Local Government Advisor, reported (a copy of the report can be requested through AFFAIRS UPDATE CO&E): September 30, 2014, was the last day for Governor Brown to sign or veto bills passed by the 2014 Legislature. Most bills signed into law will take effect on January 1, 2015. There are two bills relevant to the Medi-Cal program. o SB 964(Hernandez) requires the California Department of Managed Health Care (DMHC) to conduct annual assessments of managed care health plans for timely access to doctors and adequacy of the provider network. This bill was created in response to complaints received specifically from people in Covered California regarding the narrow provider network offered by some health plans. o SB 18(Leno/Hernandez) requires the California Department of Health Care Services (DHCS) to accept $6 million from the California Endowment (and $6 million in matching federal funds) for Medi-Cal eligibility assistance from community groups. On October 1, 2014, Los Angeles County launched a program called “My Health LA”. This program is for low income, uninsured people who don’t qualify for government sponsored programs, and is limited to 150,000 low income uninsured residents in L.A. Executive Community Advisory Committee October 8, 2014 Page 1317 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER County. The L.A. County Board of Supervisors allocated $61 million for this program, to replace coverage previously offered under the Healthy Way L.A. unmatched program. My Health LA is free for L.A County residents six years of age or older, not eligible for Medi-Cal and with household income of 138% or less of the federal poverty level. My Health LA includes primary and preventive care, pharmacy, and may also include dental care. Services are provided by non-profit clinics also known as “Community Partners”. There are 164 Community Partner Clinics in My Health L.A. Specialty, urgent and emergency care is also covered at DHS county facilities. More information can be found at http://dhs.lacounty.gov/wps/portal/dhs/mhla, or by calling 1-844-744-6452. Ms. Chitica informed the Committee that a County Representative will provide additional information about this program at the November ECAC meeting.
In 2012, President Obama developed the Deferred Action for Childhood Arrivals (DACA) program. To qualify for this program a person must have arrived in the U.S. before the age of 16, be under 31 years of age as of June 2012, and have continually lived in the U.S. since 2007. DACA beneficiaries are not considered to be “lawfully present” under the ACA are not eligible to receive financial assistance through Covered Califonia, but may qualify for Medi-Cal benefits at low or no cost. County offices were not informed that DACA recipients are Medi-Cal eligible, and the eligibility determination systems were not programmed to identify them so they were previously declined when applying for Medi-Cal benefits. DHCS is working to improve the technical issues and has provided guidance to county offices. DACA recipients can request immediate Medi-Cal coverage if they have urgent medical needs.
Dalia Cadena, RCAC 7 Chair, asked if employed DACA recipients can apply for Medi-Cal or My Health L.A. Ms. Thanki noted that DACA recipients are eligible for Medi-Cal benefits but My Health L.A. is for people without legal status that don’t qualify for any other federal program or public assistance.
HEALTH PROMOTER Devina Kuo, Manager, Health Promoter Program, informed the Committee the month of PROGRAM UPDATE October is community health worker and health promoter’s month, and she reported:
Health Promoters (HPs) monthly continuing education meetings-Group A (2012 graduates) HPs in group A met on October 3, 2014, and received an update on the Coordinated Care Initiative (CCI) and ACA programs; information about My Health L.A., and discussed HP programming and work plans for fiscal year 2014-15. They also discussed feedback, pilot evaluation surveys, and grievances review.
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AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER HPs will meet again on November 7, 2014 for training on communication and stress management, they will review types of care to teach group B. Group B (2014 graduates) HPs in group B met on September 17, 2014, and received training on grievances which they will teach RCAC members during the October and November RCAC meetings. They will meet again on October 22 for a Health Care Reform (HCR) presentation.
HPs in the RCACs HPs attending August and September RCAC meetings, to teach pre-diabetes part II, focusing on physical activity. This topic was requested at previous RCAC meetings. At the request of RCAC members, HPs from group B will teach RCAC members about grievances during October and November RCAC meetings.
HPs in Active Steps Program (ASP) All ASP for 2014 have ended and staff is completing data entry and analysis. L.A. Care staff will share the findings during a roundtable session at the 142nd Annual American Public Health Association (APHA) Conference in November, and will provide an opportunity to explain the benefits of partnerships between community and academic in public health research, programs and interventions. The findings and a brief presentation of the outcome at APHA will be shared with ECAC in December.
HPs in group A Provided workshops on health topics and participated in community events. Assisted with the resource booth at Care Harbor September 11-14. Assisted RCACs 3, 5, and 9 with their Get Fit Passport to Health events in September.
HPs in Group B Weekly presentations on access to health care Collaborated with Latinos for a Healthy CA on a Diabetes Outreach and Education Initiative to train HPs in L.A. County. On October 4, 2014, L.A. Care’s HP groups A and B received six hours of training on Diabetes management. On October 23, 2014, L.A. Care HPs and Vision y Compromiso will host a celebration for Health Promoters at St. Vincent Medical Center. HPs will participate in a theater event on October 25, 2014, which is co–sponsored by CA Latinas for Reproductive Justice and continues last year’s ACA y QUE? Forum in East Los Angeles. (Flyers were available at the meeting). HPs will perform skits about the importance of preventive health.
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AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER Ms. Kuo informed the Committee that L.A. Care has a three year grant with an outside consulting firm called Harder and Company Community Research. This firm will analyze the HP program, and provide recommendations for improvement.
Ms. Kuo shared preliminary findings from the last fiscal year’s HP activities. Significant increase in participants’ knowledge on access to care and HCR. Pre- and Post- test scores show increased knowledge from 36% to 88%. Surveys are collected at each of the HP workshops, with results showing that more than 90% of the participants indicated that they enjoyed the workshops, handouts and visuals were helpful, location and time for the classes were convenient, materials were easy to understand, speakers were organized and expectations were met. More information will be shared at a future ECAC meeting.
The firm conducted a focus group with HPs and the highlights of a report on the focus group included: HPs are able to clarify HCR and access to health care issues, they felt as a welcome and trusted resource in the community. They are learning and implementing changes in their own lives, learning about rights in to health care access and are able to help others. HPs confidence level and ability for public speaking and reaching out to community members have all increased. HPs requested more practice sessions during training, and additional time for practice sessions will be incorporated in training sessions in 2015.
Hilda Pérez, Consumer Board Member, and Health Promoter, acknowledged the positive impact of the HP program in the community and among HPs. She noted that HPs have discussed the HPP budget and have questions about stipends provided to HPs, which are considered to be low because they include mileage, childcare reimbursement and other possible expenses when traveling. Board Member Pérez further noted that L.A. Care has invested time and resources to prepare HPs but there is disappointment and lack of motivation and engagement because of the stipend amount. Board Member Pérez noted that the HPP is a strong grass roots program and HPs are well trusted in the community. She asked other HPs to provide input on this issue. Board Member Pérez informed the Committee that she is unable to discuss or vote on any item related to the HPP at the Board of Governors due to conflicts of interest.
Ana Romo, RCAC 8 Chair, asked if a motion could be made to request that Laura Garcia exclusively assist the HPP. Ms. Romo noted that Ms. Garcia is currently assisting 15 HPs in group A and 23 HPs in group B and is assisting RCACs. Ms. Romo further noted that
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AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER additional help is needed for the HPP and asked how to submit a formal request for L.A. Care to consider. Ms. Ferrer informed the Committee that staffing and assignments are an administrative decision that does not require a motion. She indicated that management will review the request.
Board Member López asked about the amount of time spent and stipend a HP receives. Ms. Kuo informed the Committee that HPs receive $30.00 for a presentation without mileage reimbursement. For a health fair that lasts all day, HPs are provided with $60.00 stipend. If the HP travels outside of the RCAC region, they are provided with a $25.00 stipend and mileage is reimbursed.
OVERVIEW OF ECAC Peter Prampetch, Analyst, CO&E, reported (a copy of the report can be obtained by contacting REPORTS CO&E):
RCAC Membership Total membership in all 11 RCACs is 231 including consumers and community partners.
Fiscal Year 2013-14 Budget Report on Third Quarter (April -June). Total budget for FY 2013-14 is $600,000 of which approximately $100,000 or 43% of the budget was spent in the third quarter. Approximately $343,000 or 57% of the budget is left. Mr. Prampetch informed the Committee that the budget for FY 2014-15 starts on October 1, 2014. Any amount left from the FY 2013-14 budget is not transferred to the new FY budget.
Committee members reviewed expenses incurred in the third quarter and the total actual and remaining amount for promotional items, rent, supplies and services, transportation services, meetings-conferences-catering, ECAC/RCAC reimbursements and stipends, ECAC/RCAC work plans, and interpretation and translation.
Board Member López noted that this Committee has demonstrated itself to be fiscally conservative and the funds going to the community are investments. He suggested that a process be developed to tightly manage the budget on a quarterly basis to ensure that ECAC goals are maximized. Ms. Ferrer suggested that the upcoming strategic planning session will be a good opportunity to discuss programs and activities to ensure appropriate investment in the community while being fiscally responsible. Board Member López asked if Board Member Pérez and he could participate in the strategic planning sessions. Ms. Ferrer answered affirmatively, and noted that their feedback would be appreciated. Board Member López asked ECAC to review the budget report, and think about ways to invest funds in their communities, and to be prepared to provide feedback and recommendations at the upcoming strategic planning session. Executive Community Advisory Committee October 8, 2014 Page 13511 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER
Board Member Pérez asked that RCAC membership and budget reports be sent in advance of the meeting along with meeting Agenda and other materials to allow Committee members additional time to review the reports. Ms. Chitica acknowledged the request and noted that the reports will be included in the packet that is mailed to members prior to the meetings where the budget reports will be discussed.
Ms. Meza asked if more funds could be allocated to the HP program. She noted that HPs are not happy with the stipends that are currently provided and the HPs work hard, and leave their family behind to do their work in the community. Ms. Meza also asked if L.A. Care can provide water, fruit or snacks for people attending community workshops facilitated by HPs. Mr. Prampetch informed the Committee that the HP budget is separate from the ECAC/RCAC budget. He also noted that not all RCACs have full membership. He added that the ECAC/RCAC budget includes budget for full membership in the RCACs. Mr. Prampetch noted that this year there were no conferences held, and next year more funds will be spent if conferences are held.
AT-LARGE MEMBER Demetria Saffore, and Silvia Poz, At-Large Members, reported (copies of the report can be requested UPDATE by contacting CO&E): (MEMBER RCAC Membership: RECRUITMENT/CCI) RCAC member candidates from RCACs 2, 5 and 11 are proposed for approval in Motion ECA100. The CO&E Department received five member interest cards from RCACs 4 and 8. A total of 204 interest cards have been received to date. Interest cards are processed based on eligibility for RCAC membership. L.A. Care has welcomed 43 new members into the RCACs during this fiscal year.
Ms. Poz reminded ECAC members to continue to encourage RCAC members to submit interest cards and work with RCAC Ambassadors.
Mr. Aguirre asked if a recruited individual is notified if their membership is rejected. Ms. Chitica informed the Committee that staff verifies eligibility for each interest card received, and asks interested individuals to attend the next RCAC meeting. She noted that some that have been invited do not attend the RCAC meeting. Ms. Chitica also noted that staff follows up on each interest card received with a courtesy call to inform individuals if they are not eligible and the reasons for the ineligibility. Ms. Chitica reminded Committee members that staff is looking for consumers enrolled in various product lines not just Medi-Cal, and the majority of the interest cards that have been received are from
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AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER individuals enrolled in Medi-Cal.
Ms. Poz asked L.A. Care to keep RCAC Ambassadors up to date, and noted her concern about the Ambassador in RCAC 4. Ms. Chitica informed Ms. Poz that the Field Specialist assigned to RCAC 4 will contact the RCAC Ambassador to address Ms. Poz’s concerns.
L.A. Care CCI and Cal MediConnect community meetings: September 11 – Consumer meeting at the Chimbole Cultural Center in area 1 Antelope Valley. September 25 – Consumer meeting at L.A. Sports Activity Center in area 3, South Los Angeles.
Susan Ma, CCI, Field Specialist, reported on future CCI/Cal MediConnect meetings (information in English and Spanish was available at the end of the meeting ) October 9- Community Leader meeting will be held in area 4 (Long Beach) from 1:00 p.m. to 3:30 p.m. at the Mark Twain Library, located at 1401 E. Anaheim St., Long Beach, CA 90813. November 6 – Consumer meeting will be held from 1:00 p.m. to 3:30 p.m. at the Mark Twain Library in Long Beach.
MEMBER ISSUES Ms.Savage Pinkney, RCAC 6 Chair, reported a recurring issue submitted by Mary Romero, RCAC 6 former RCAC 6 Chair. Ms. Romero observed at St. Francis Medical Center’s urgent care Interdisciplinary department, where an elderly person waited a long time to be seated while she waited to be Committee seen by the doctor. This is an ongoing issue at this center. Other RCAC 6 members shared similar experiences and concerns. RCAC 6 members unanimously decided that the issue be ( forwarded to ECAC to request assistance from the Interdisciplinary Committee (IC) for review.
Ms. Savage Pinkney also reported an isolated issue reported by a RCAC 6 member. Member reported that her daughter’s pediatrician found child to be underweight and instructed mother to add olive oil to the child’s food and give her vitamins. Member noted that her daughter’s condition did not improve and was upset that the pediatrician neglected to refer child to a specialist. Member noted that her daughter’s appointments changed from every two to three months to monthly because the child’s weight was not improving. Member scheduled an appointment with a specialist on June 4, 2014 but her daughter suffered a heart attack on June 1, was taken to St. Francis Medical Center and transferred to Long Beach Children’s Hospital. Child was discharged on July 17. According to Member, attending physician stated that child suffered certain levels of brain damage and also had kidney problems as a result of the heart attack, and child is not expected to have a full Executive Community Advisory Committee October 8, 2014 Page 13713 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER recovery. Member is requesting L.A. Care to investigate this issue.
For the newly elected ECAC members, Ms. Chitica informed the Committee of the responsibility to present issues reported by RCAC memberss, which are then forwarded to Interdisciplinary Committee for review and resolution.
Jena Diwan Pomeroy, Incentives Program Manager and member of the IC, will provide an update regarding the status of the member issues that were forwarded to the IC at prior meetings. IC received information earlier this week about the issues that were reported today. The issues will be reviewed and addressed; the second issue will be addressed immediately. A member issue from RCAC 11 stating that members were being billed for using the emergency room at Alhambra Hospital and Foothill Presbyterian Hospital had been received previously and was forwarded to L.A. Care’s Provider Network Operations department (PNO) for an investigation. PNO conducted research to find existing policies that would address this issue. Policies are in place and PNO is working on enforcement.
PUBLIC COMMENT: Ms. Conteas-Wood asked for an update on the issue submitted by RCAC 3 in regards to a dental clinic providing services to Medi-Cal patients only on certain days of the week. Ms. Diwan Pomeroy informed the Committee that a status on this issue was not forwarded to her and an update will be provided at the next meeting.
COMMUNITY Ms. Poz informed the Committee that RCAC 4 members participated in a community ENGAGEMENT event on September 27. Ms. Poz asked if L.A. Care can provide a table cloth when
ECAC members members participate in health fairs and community events. Ms. Chitica acknowledged the request and noted that requests can be made to the Field Specialist or the HPP staff in advance. Ms. Eakins added that all of the L.A. Care branding and materials, including table cloths and tents come through the L.A. Care’s Marketing department. Ms. Eakins noted that currently there are not enough table cloths available to cover multiple events happening at the same time, but informed the Committee that extra ones will be ordered. Cristina Deh Lee, RCAC 9 Chair, reported that RCAC 9 hosted a Get Fit: Passport to Health event on September 13 in collaboration with Light and Life Christian Fellowship. Ms. Deh Lee noted low attendance despite the great set up, partnership, workshops and resources available at the event. Ms. Deh Lee further noted that the Executive Community Advisory Committee October 8, 2014 Page 13814 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER weather was hot and there was another big community event happening in the area. She informed the Committee that 5,000 flyers were distributed for this event. Ms. Meza reported that RCAC 5 hosted, in collaboration with Green Dot, a successful Get Fit: Passport to Health event on September 27 at Animo School, which was well attended with more than 100 participants including youth. Ms. Meza noted that the California University of Holistic Medicine provided basic body adjustments and massage to participants. Ms. Parra reported that RCAC 3 hosted a Get Fit: Passport to Health event in collaboration with Madison Elementary School. Cooking workshops, zumba classes and childcare was available. Parent/child interactive activities and raffles were also available.
NEW BUSINESS C&L SERVICES- Susan Choi, Interpreting Services Specialist, Cultural and Linguistic department, presented a PRESENTATION summary of L.A. Care’s language services and program evaluation for review and comment. (a copy of the presentation can be requested from CO&E): Health plans are required by law to provide interpreting services to its members. There are approximately 200 languages available for telephonic interpreting, and services are available within seconds. Face-to-face interpretation can be requested for medical and outpatient appointments, and for lab work and tests. The interpreter will meet the member at the service location at the time of the appointment. Hospitals, pharmacies and plan partners are required to provide these services to members. Interpreting services are free for L.A. Care members. When an interpreter is not available for face-to-face interpreting, the doctor can request an interpreter participate by telephone. Simultaneous interpreting is done at meetings and conferences. L.A. Care does not pay for interpreting services while a member is in the emergency room or if the member is enrolled with a plan partner. Ms. Ferrer clarified that L.A. Care will provide and pay for services for members enrolled in the direct lines of business, but if the member is enrolled in L.A. Care through one the plan partners, the plan partner is responsible for providing and paying the services. Members can call the Member Services department to request interpreting. It is recommended that the member calls the Member Services department as soon as they know the date of their doctor appointment. L.A. Care produced a video to showcase the importance of interpreting services when Executive Community Advisory Committee October 8, 2014 Page 13915 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER trying to improve the health outcome for the patient. Committee members were asked to provide feedback on how to improve services.
Chairperson Aguilar asked about responsibility for providing translation services for Medi Medi (dually eligible) members. Ms. Ferrer the Committee that if the member is not enrolled with L.A. Care, services are requested either from Medicare (FFS program) or the Medicare plan through which they are enrolled.
Ms. Choi informed the Committee that the video is available in the Asian threshold languages (Mandarin, Cantonese, Korean, Khmer, Vietnamese, Tagalog and Thai). She noted that versions of the video are also available in Spanish and American Sign Language; Farsi, Armenian and Arabic will be available in the future. Ms. Choi noted that the video can be found on the L.A. Care website under language or Cultural & Linguistic services.
In response to question from Ms. Deh Lee, Ms. Choi responded that the video is not yet available in Japanese language.
Board Member Pérez asked if feedback should be submitted by calling Member Services. Ms. Choi responded affirmatively.
ECAC STRATEGIC Ms. Chitica reported: PLANNING A strategic planning meeting will be held on December 9, one day prior to the ECAC meeting, and is tentatively scheduled from 9:00 a.m. to 2:00 p.m. It will include the first ECAC leadership training, designed to gather feedback on the types of training that ECAC members need in order to fulfill their responsibilities as Chairs. At Large members will be invited to participate in the strategic planning meeting.
In response to question from Ms. Poz, Ms. Chitica informed the Committee Chairs, Vice Chairs and At Large members will be invited to the strategic meeting. Ms. Chitica asked ECAC members to inform RCAC Vice Chairs about the meeting.
Ms. Deh Lee asked if this meeting will cover outreach activities and budgeting. Ms. Chitica noted that the meeting will be to discuss the types of training that ECAC members need to fulfill their responsibilities in the next two years. She noted that facilitators have been hired to guide the discussion. ECAC AT-LARGE Ms. Chitica reported: MEMBER ELECTIONS At-Large elections are planned for the November ECAC meeting. Applications, roles and responsibilities, qualifications and other pertinent information
Executive Community Advisory Committee October 8, 2014 Page 14016 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER will be mailed out soon to the RCACs that don’t meet in October. RCACs meeting this month will receive the information at their RCAC meeting. Deadline to submit applications, is on November 5, 2014, one week prior to the November ECAC meeting. Anyone interested in the At Large position needs to submit an application by Nov. 5. Ms. Poz and Ms. Saffore are eligible to run again for the positions, and will be required to submit an application and be present at the Nov. 12 ECAC meeting. Candidates will be invited to speak at the November 12 ECAC meeting about their reasons for running and their qualifications. ECAC members will select two At-Large members at the November meeting.
Ms. Chitica asked ECAC members to encourage members to apply if they have previously shown interest in leadership opportunities.
Board Member Pérez asked if Chairs of RCACs that are not meeting in October can call their members to inform them that materials will arrive in the mail and to remind them of the deadline to submit the application. Ms. Chitica encouraged RCAC Chairs to communicate with their members and to contact their Field Specialist if a current RCAC member roster is needed to contact members.
In response to question from Ms. Poz, Ms. Chitica informed the Committee that the current At Large member term ends in November. The At Large members elected at the November meeting will begin a term in December.
OLD BUSINESS
COORDINATED CARE Susan Ma, Coordinated Care Initiative Field Specialist, presented (a copy of the presentation can be INITIATIVE requested through CO&E): PRESENTATION The Coordinated Care Initiative (CCI) has two key parts; mandatory enrollment in health plans for Medi-Cal benefits including Managed Long Term Services and Supports (MLTSS), and transition of Medi-Cal and Medicare (dually eligible) members in health plans for coordination of all the Medicare and Medi-Cal services. This is a three year project to promote coordinated health care delivery to seniors and people with disabilities who are dually eligible. CCI is being implemented in eight counties including L.A. County A goal is to improve communication between providers including physicians, specialists and other providers, to improve access to care and coordinate all services, to encourage promoter person-centered planning, promote independence in the
Executive Community Advisory Committee October 8, 2014 Page 14117 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER community, provide the right care, in the right place, and at the right time/ Cost savings are anticipated. Dually eligible members have the option to enroll in a Cal MediConnect (CMC) health plan or to opt out of CMC for Medicare but must enroll in a Medi-Cal managed care plan to receive Medi-Cal benefits including MLTSS. Medi-Cal only members need to enroll in a Medi-Cal managed care plan to receive Medi-Cal benefits including MLTSS. CMC is a comprehensive program that covers medical, prescription drugs, and LTSS for dual eligible members. Passive enrollment for CMC started in April 1, 2014. Eligible members receive a “blue envelope” containing a 90 day notice about CMC and choice for enrollment, a 60 day notice with a selection form, and a 30 day notice which includes a reminder to complete and return the form and notifies member that they will be passively enrolled if they do not select a health plan. The new CMC choice form is easy to understand, and provides two options: o Option A, to select a CMC plan (L.A. Care, Care 1st, Caremore, Health Net and Molina are the health plan choices for option A). o Option B, to keep Medicare the same and select a mandatory Medi-Cal managed care plan (L.A. Care and Health Net are the health plan choices available for option B). o If a health plan is not selected, the member will be automatically enrolled in a health plan. Any questions about CMC can be answered by calling the L.A. Care Member Services department at 1-888-839-9909 or visiting the CMC website www.calmediconnectla.org.
Ms. Ma will provide this presentation to the RCACs starting in November.
Chairperson Aguilar asked if a patient can ask their doctor for assistance to complete the CMC choice enrollment form. Ms. Ma noted that for independent assistance with the form, members should call Health Care Options (HCO), which will not influence the choice for the member but will explain the programs available. A provider may guide a member to select an Option or plan. Members should make an informed choice that is best for themselves.
Chairperson Aguilar asked if a member can request assistance if they want to keep the same provider or health plan. Ms. Ferrer informed the Committee that the best option is for the member to contact an agency that has familiarity and will provide objective information.
Executive Community Advisory Committee October 8, 2014 Page 14218 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER Members can ask the provider for help, but a provider may not be fully informed about the program. Ms. Ferrer noted that HICAP and HCO can provide detailed information about the CMC program. It is recommended to refer people to them if they have questions. Ms. Ma noted that the contact numbers for these agencies are included in the handout.
Chairperson Aguilar asked if a non-L.A. Care member can call the L.A. Care Member Services department with questions. Ms. Ferrer answered affirmatively but encouraged everyone to contact and refer to HICAP and HCO, as HCO can assist people with enrollment, and L.A. Care is not authorized to enroll members.
ECAC E-MAIL Board Member López asked at the last meeting that staff explore an e-mail process for ADDRESSES distributing ECAC materials and information. L.A. Care’s Information and Technology department staff confirmed that the request is possible and will provide recommendations. Ms. Ferrer noted that the new Chairs and At Large members should be in place first, and she noted that some e-mail address may be tentatively created in December. L.A. Care will provide training. More information on the status of the project will be provided at the next ECAC meeting.
RCAC/ECAC Ms. Chitica reported: UPCOMING EVENTS Orientation is tentatively scheduled on November 7, 2014 for new consumer members only. The members will be informed of the training by telephone or mail. Committee members were asked to encourage new members to participate in the training. Orientation will be held in January for new community partners that have joined the RCACs. More information will be provided at future meetings. Members who receive stipends and reimbursements from government funded programs or entities must attend AB1234 ethics training every two years. Training is mandatory for members who wish to continue receiving stipends or reimbursements. RCAC membership will not be affected if they don’t attend this training, however Members will not be able to receive stipend or reimbursement from L.A. Care until the training is completed. The tentative date and location for this training is December 5, 2014 at Holman United Methodist Church. L.A. Care will provide transportation for RCAC members outside the area.
Chairperson Aguilar expressed her concern about the capacity at Holman United Methodist Church and asked staff to consider another location that can accommodate all RCAC members.
PUBLIC COMMENT Ms. Conteas-Wood also noted concerns with the cleanliness and maintenance of the Executive Community Advisory Committee October 8, 2014 Page 14319 of 20 APPROVED
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER restrooms at the location.
PUBLIC COMMENTS Ms. Kuo announced that Choose Health LA Moms would like to interview English speaking women who have children. Between 10 and 20 women will participate in a focus group and receive a $40 gift card for participating. Ms. Kuo noted that focus groups in Spanish and other languages will probably be conducted next year. Flyers with additional information were available at the meeting. ADJOURNMENT Chairperson Aguilar adjourned the meeting at 1:02 p.m.
RESPECTFULLY SUBMITTED BY: APPROVED BY:
Hilda Stuart, Committee Liaison, Board Services ______Linda Merkens, Manager, Board Services Aida Aguilar, ECAC Chair Date ______
Executive Community Advisory Committee October 8, 2014 Page 14420 of 20 APPROVED 145 146 147 148 Schedule of Meetings December 2014
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
1 2 3 4 5 6 7
Board of Governors Meeting 2 pm (for approximately 2 hours)
8 9 10 11 12 13 14 ECAC 10 am (for approximately 2 hours)
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31
THERE ARE NO BOARD COMMITTEE MEETINGS IN DECEMBER 2014 AND, NO BOARD OF GOVERNORS MEETING IN JANUARY 2015.
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 149 Prepared by mhbalones/printed on 11/25/14 Board of Governors & Public Advisory Committees 2014 Meeting Schedule / Member Listing 1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017 Tel. (213) 694-1250 / Fax (213) 438-5728
MEETINGDAY,TIME, MEETING &LOCATION DATES MEMBERS Board of 1st Thursday December 4 Thomas Horowitz, DO, Chairperson 2:00 PM Mark Gamble, Vice Chairperson Governors (for approximately 3 hours) Michael Rembis, FACHE, Treasurer General Meeting 1055 W. 7th Street, Louise McCarthy, Secretary 10th Floor, Los Angeles, Hector De La Torre CA 90017 Jann Hamilton Lee Thomas S. Klitzner, MD, PhD, Alexander K. Li, MD Ozzie Lopez Honorable Gloria Molina Hilda Perez G. Michael Roybal, MD, MPH Sheryl Spiller Staff Contact: Howard A. Kahn, Chief Executive Officer, x4102 Linda Merkens, Manager, Board Services, x4050
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 150 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
Board of Governors - Standing Committees
MEETINGDAY,TIME, MEETING &LOCATION DATES 2014 MEMBERS Executive Committee 4th Wednesday of the month No meeting in Thomas Horowitz, DO, Chairperson 2:30 PM December Mark Gamble (for approximately 2 hours) Michael Rembis 1055 W. 7th Street, Louise McCarthy 10th Floor, Los Angeles, G. Michael Roybal, MD, MPH CA 90017 Alexander K. Li, MD Staff Contact: Linda Merkens, Manager, Board Services,x4050 Compliance & 3rd Thursday every 2 months No meeting in G. Michael Roybal, MD, MPH, Chairperson Quality Committee 2:30 PM December Jann Hamilton Lee (for approximately 2 hours) Alexander Li, MD Honorable Gloria Molina 1055 W. 7th Street, Hilda Perez 10th Floor, Los Angeles, Staff Contact: CA 90017 Malou Balones Committee Liaison, Board Services, x 4183 Finance & Budget 4th Wednesday of the month No meeting in Michael A. Rembis, FACHE, Chairperson Committee 1:00 PM December Jann Hamilton Lee (for approximately 2 hours) Thomas Horowitz, DO Ozzie Lopez 1055 W. 7th Street, Louise McCarthy 10th Floor, Los Angeles, Staff Contact: CA 90017 Hilda Stuart Committee Liaison, Board Services, x 4184 Governance MEETS AS NEEDED Alexander K. Li, MD, Chairperson Committee 1055 W. 7th Street, Mark Gamble 10th Floor, Los Angeles, Ozzie Lopez CA 90017 Hilda Perez Sheryl Spiller Hector De La Torre Staff Contact: Malou Balones Committee Liaison, Board Services/x 4183 Service Agreement MEETS AS NEEDED Ozzie Lopez, Chairperson Committee 1055 W. 7th Street, Hector De La Torre 10th Floor, Los Angeles, Louise McCarthy CA 90017 Honorable Gloria Molina Hilda Perez Sheryl Spiller Staff Contact Malou Balones Committee Liaison, Board Services/x 4183 For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 151 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY,TIME, MEETING &LOCATION DATES 2014 MEMBERS Audit Committee MEETS AS NEEDED G. Michael Roybal, MD, MPH, Chairperson 1055 W. 7th Street, Jann Hamilton Lee 10th Floor, Los Angeles, Alexander K. Li, MD CA 90017 Staff Contact Hilda Stuart Committee Liaison, Board Services, x 4184
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 152 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY,TIME, MEETING &LOCATION DATES MEMBERS L.A. Care Meets Annually or as needed Thomas Horowitz, DO, Chairperson 1055 W. 7th Street, Mark Gamble, Vice Chairperson Community 10th Floor, Los Angeles, Michael Rembis, FACHE, Treasurer Health CA 90017 Louise McCarthy, Secretary Hector De La Torre Jann Hamilton Lee Thomas S. Klitzner, MD, PhD, Alexander K. Li, MD Ozzie Lopez Honorable Gloria Molina Hilda Perez G. Michael Roybal, MD, MPH Sheryl Spiller Staff Contact: Howard A. Kahn, Chief Executive Officer, x4102 Linda Merkens, Manager, Board Services, x4050
L.A. Care Joint Meets Quarterly or as Thomas Horowitz, DO, Chairperson needed Mark Gamble, Vice Chairperson Powers Authority 1055 W. 7th Street, Michael Rembis, FACHE, Treasurer 10th Floor, Los Angeles, Louise McCarthy, Secretary CA 90017 Hector De La Torre Jann Hamilton Lee Thomas S. Klitzner, MD, PhD, Alexander K. Li, MD Ozzie Lopez Honorable Gloria Molina Hilda Perez G. Michael Roybal, MD, MPH Sheryl Spiller Staff Contact: Howard A. Kahn, Chief Executive Officer, x4102 Linda Merkens, Manager, Board Services, x4050
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 153 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
Public Advisory Committees MEETINGDAY,TIME, MEETING &LOCATION DATES STAFFCONTACT Children’s Health 3rd Tuesday of every other Lyndee Knox, PhD, Chairperson Consultant Advisory month Committee 8:30 AM General Meeting (for approximately 2 hours) Staff Contact: Hilda Stuart 1055 W. 7th Street, Committee Liaison, Board Services, x 4184 10th Floor, Los Angeles, CA 90017 Executive 2nd Wednesday of the month December 10 Aida Aguilar, Chairperson Community Advisory 10:00 AM Committee (for approximately 2 hours)
1055 W. 7th Street, Staff Contact: 10th Floor, Los Angeles, Idalia Chitica, Community Outreach & CA 90017 Education, Ext. 4420
Technical Advisory 4th Thursdays every other Chairperson to be elected Committee month 9:00 AM (for approximately 2 hours) Staff Contact: Malou Balones 1055 W. 7th Street, Committee Liaison, Board Services/x 4183 10th Floor, Los Angeles, CA 90017
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 154 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
REGIONALCOMMUNITYADVISORYCOMMITTEES
MEETINGDAY,TIME, REGION &LOCATION MEETINGDATE STAFFCONTACT Region 1 3rd Friday of every other December 19 Adela Guadarrama, Chairperson Antelope Valley month 10:00 AM (for approximately 2-1/2 hours) Staff Contact: Chimbole Cultural Center Kristina Chung 38350 N. Sierra Highway Community Outreach & Education, Ext. 5139 Palmdale, CA 93550 Tel (661) 267-5656 Region 2 3rd Monday of every other December 15 Carlos Aguirre, Chairperson San Fernando Valley month 10:00 AM (for approximately 2-1/2 hours) Francis Polytechnic Senior High Staff Contact: School Kristina Chung 12431 Roscoe Blvd. Community Outreach & Education, Ext. 5139 Sun Valley, CA 91352
Region 3 3rd Tuesday of every other December 16 Lidia Parra, Chairperson Alhambra, Pasadena month and Foothill 9:30 AM (for approximately 2-1/2 hours) Staff Contact: Jackie Robinson Community Liliana Arevalo Center Community Outreach & Education, Ext. 4586 1020 N. Fair Oaks Blvd. Pasadena, CA 91103 Tel (626) 744-7300 Region 4 3rd Tuesday of every other Hercilia Salvatierra, Chairperson Hollywood-Wilshire, month Central and Glendale 9:00 AM (for approximately 2-1/2 hours) St. Vincent Medical Center Staff Contact: Mark Taper Building Board Rm Liliana Arevalo 2200 W. Third St. Community Outreach & Education, Ext. 4586 Los Angeles, CA 90057 Tel. (213) 484-7766
Region 5 3rd Monday of every other December 15 Romalda Meza, Chairperson West month 2:00 PM (for approximately 2-1/2 hours) Mar Vista Housing Dev. Staff Contact: Multipurpose Room Martin Vicente 4909 Marionwood Street Culver Community Outreach & Education, x 4423 City, CA 90230 Tel. (310) 915-9006
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 155 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY,TIME, REGION &LOCATION MEETINGDATE STAFFCONTACT Region 6 3rd Thursday of every other December 18 Dove Pinkney, Chairperson South, Compton, month Inglewood 3:00 PM (for approximately 2-1/2 hours) Staff Contact: Saint John’s Well Child & Family Center Auleria Eakins th 808 W. 58 Street Community Outreach & Education, x 4280 Los Angeles, CA 90037 Tel. (323) 541-1600 Region 7 3rd Thursday of every other Dalia Cadena, Chairperson San Antonio and month Bellflower 4:30 PM (for approximately 2-1/2 hours) Staff Contact: Old Timers Foundation Family Liliana Arevalo Center Community Outreach & Education, Ext. 4586 3355 E. Gage Avenue Huntington Park, CA 90255 Tel (323) 582-6090 Region 8 3rd Friday of every other Ana Romo – Chairperson Torrance and Harbor month 10:30 AM (for approximately 2-1/2 hours) Staff Contact: John Mendez Community Center Idalia Chitica 707 W. C Street Community Outreach & Education, x 4420 Wilmington, CA 90748 Tel. (310) 549-0052 Region 9 3rd Monday of every other Christina Deh-Lee, Chairperson Long Beach month 9:00 AM (for approximately 2-1/2 hours) Staff Contact: Miller Family Health Education Center Kristina Chung 3820 Cherry Avenue Community Outreach & Education, Ext. 5139 Long Beach, CA 90807 Tel. (562) 570-7987
Region 10 3rd Thursday of every other December 18 Aida Aguilar, Chairperson East Los Angeles, month Whittier and North- 4:00 PM East (for approximately 2-1/2 hours) Staff Contact: Boyle Heights Technology Youth Center Martin Vicente, Community Outreach & th 1600 East 4 Street Education, Ext. 4423 Los Angeles, CA 90033 Tel. (323) 526-0145 Region 11 3rd Wednesday of every Elda Sevilla, Chairperson Pomona and El other Month Monte 9:00 AM Staff Contact: (for approximately 2-1/2 hours) Martin Vicente, Community Outreach & First Christian Church Education, Ext. 4423 1751 North Park Avenue Pomona, CA 91768 Tel. (909) 622-1144
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 156 Board of Governors & Public Advisory Committees 2015 Meeting Schedule / Member Listing 1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017 Tel. (213) 694-1250 / Fax (213) 438-5728
MEETINGDAY,TIME, MEETINGDATES &LOCATION MEMBERS Board of 1st Thursday No meeting in Thomas Horowitz, DO, Chairperson Governors 2:00 PM January Mark Gamble, Vice Chairperson General Meeting (for approximately 3 hours) February 5 Michael Rembis, FACHE, Treasurer 1055 W. 7th Street, March 5* Louise McCarthy, Secretary 10th Floor, April 2 Hector De La Torre Los Angeles, CA 90017 May 7-(All Day Jann Hamilton Lee Retreat) Thomas S. Klitzner, MD, PhD, June 4 Alexander K. Li, MD July 2* Ozzie Lopez No meeting in August Honorable Gloria Molina September 3 Hilda Perez October 1* G. Michael Roybal, MD, MPH November 5 Sheryl Spiller December 3*
*Strategic Focus from Staff Contact: 12:00-2:00 p.m. in Howard A. Kahn, Chief Executive addition to regular Officer, x4102 Board meeting from Linda Merkens, Manager, Board Services, 2:00-5:00 p.m. x4050
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 157 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
Board of Governors - Standing Committees
MEETINGDAY, 2015 TIME, MEETING MEMBERS &LOCATION DATES Executive 4th Wednesday of the January 28 Thomas Horowitz, DO, Chairperson Committee month February 25 Mark Gamble 2:30 PM March 25 Michael Rembis (for approximately 2 hours) April 22 Louise McCarthy 1055 W. 7th Street, May 27 G. Michael Roybal, MD, MPH 10th Floor, Los Angeles, June 24 Alexander K Li, MD CA 90017 July 15* No meeting in *moved due to summer / August Staff Contact: holidays September 23 Linda Merkens, Manager, Board Services, October 28 x4050 November 18* No meeting in December
Compliance & 3rd Thursday every 2 January 15 G. Michael Roybal, MD, MPH, Quality months March 19 Chairperson Committee 2:30 PM May 21 Jann Hamilton Lee (for approximately 2 hours) July 16 Alexander Li, MD No meeting in Hilda Perez 1055 W. 7th Street, August 10th Floor, Los Angeles, September 17 Staff Contact: CA 90017 November 19 Malou Balones No meeting in Committee Liaison, Board Services, x 4183 December
Finance & 4th Wednesday of the January 28 Michael A. Rembis, FACHE, Chairperson Budget month February 25 Jann Hamilton Lee Committee 1:00 PM March 25 Thomas Horowitz, DO (for approximately 2 hours) April 22 Ozzie Lopez May 27 Louise McCarthy 1055 W. 7th Street, June 24 10th Floor, Los Angeles, July 15* CA 90017 No meeting in Staff Contact: August Hilda Stuart *moved due to summer / September 23 Committee Liaison, Board Services, x 4184 holidays October 28 November 18* No meeting in December
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 158 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY, 2015 TIME, MEETING MEMBERS &LOCATION DATES Governance MEETS AS Alexander K Li, MD Chairperson Committee NEEDED Mark Gamble 1055 W. 7th Street, Ozzie Lopez 10th Floor, Los Hilda Perez Angeles, Sheryl Spiller CA 90017 Walter Zelman, PhD
Staff Contact: Malou Balones Committee Liaison, Board Services/x 4183
Service MEETS AS Ozzie Lopez, Chairperson Agreement NEEDED Louise McCarthy Committee 1055 W. 7th Street, Hector De La Torre 10th Floor, Los Hilda Perez Angeles, Sheryl Spiller CA 90017 Staff Contact Malou Balones Committee Liaison, Board Services/x 4183
Audit Committee MEETS AS G. Michael Roybal, MD, MPH, NEEDED Chairperson 1055 W. 7th Street, Jann Hamilton Lee 10th Floor, Los Alexander K. Li, MD Angeles, CA 90017 Staff Contact Hilda Stuart Committee Liaison, Board Services, x 4184
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 159 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY, MEETING TIME, DATES MEMBERS &LOCATION L.A. Care Meets Annually or as Thomas Horowitz, DO, Chairperson Community needed Mark Gamble, Vice Chairperson Health 1055 W. 7th Street, Michael Rembis, FACHE, Treasurer 10th Floor, Los Angeles, Louise McCarthy, Secretary CA 90017 Hector De La Torre Jann Hamilton Lee Thomas S. Klitzner, MD, PhD, Alexander K. Li, MD Ozzie Lopez Honorable Gloria Molina Hilda Perez G. Michael Roybal, MD, MPH Sheryl Spiller
Staff Contact: Howard A. Kahn, Chief Executive Officer, x4102 Linda Merkens, Manager, Board Services, x4050 L.A. Care Joint Meets Quarterly or as Thomas Horowitz, DO, Chairperson Powers Authority needed Mark Gamble, Vice Chairperson 1055 W. 7th Street, Michael Rembis, FACHE, Treasurer 10th Floor, Los Angeles, Louise McCarthy, Secretary CA 90017 Hector De La Torre Jann Hamilton Lee Thomas S. Klitzner, MD, PhD, Alexander K. Li, MD Ozzie Lopez Honorable Gloria Molina Hilda Perez G. Michael Roybal, MD, MPH Sheryl Spiller
Staff Contact: Howard A. Kahn, Chief Executive Officer, x4102 Linda Merkens, Manager, Board Services, x4050
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 160 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
Public Advisory Committees MEETINGDAY, MEETING TIME, DATES STAFFCONTACT &LOCATION Children’s Health 3rd Tuesday of every other January 20 Lyndee Knox, PhD, Chairperson Consultant Advisory month March 17 Committee 8:30 AM May 19 General Meeting (for approximately 2 hours) July 21 Staff Contact: September 15 Hilda Stuart 1055 W. 7th Street, November 17 Committee Liaison, Board Services, x 4184 10th Floor, Los Angeles, CA 90017
Executive 2nd Wednesday of the January 14 Aida Aguilar, Chairperson Community month February 11 Advisory Committee 10:00 AM March 11 (for approximately 2 hours) April 8 May 13 Staff Contact: 1055 W. 7th Street, June 10 Idalia Chitica, Community Outreach & 10th Floor, Los Angeles, July 8 Education, Ext. 4420 CA 90017 No meeting in August September 9 October 14 November 11 December 9
Technical Advisory 4th Thursdays every other January 29 Chairperson to be elected Committee month March 26 9:00 AM May 28 (for approximately 2 hours) July 23 Staff Contact: September 24 Malou Balones 1055 W. 7th Street, November 19 Committee Liaison, Board Services/x 4183 10th Floor, Los Angeles, CA 90017
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 161 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
REGIONALCOMMUNITYADVISORYCOMMITTEES
MEETINGDAY, REGION TIME, MEETING STAFFCONTACT &LOCATION DATE Region 1 3rd Friday of every other February 20 Adela Guadarrama, Chairperson Antelope Valley month April 17 10:00 AM June 19 (for approximately 2-1/2 hours) August 21 Staff Contact: Chimbole Cultural Center October 16 Judy Hsieh Bigman 38350 N. Sierra Highway December 18 Community Outreach & Education, Ext. Palmdale, CA 93550 4199 Tel (661) 267-5656
Region 2 3rd Monday of every other February 23* Carlos Aguirre, Chairperson San Fernando month April 20 Valley 10:00 AM June 15 (for approximately 2-1/2 hours) August 17 Family Resource Center- October 19 Staff Contact: Pacoima December 21 Judy Hsieh Bigman 10807 San Fernando Road Community Outreach & Education, Ext. Pacoima, CA 91331 4199 Tel. (844) 858-9942 *will meet the 4th Monday of the month
Region 3 3rd Tuesday of every other February 17 Lidia Parra, Chairperson Alhambra, month April 21 Pasadena and 9:30 AM June 16 Foothill (for approximately 2-1/2 hours) August 18 Staff Contact: Jackie Robinson October 20 Kristina Chung Community Center December 15 Community Outreach & Education, Ext. 1020 N. Fair Oaks Blvd. 5139 Pasadena, CA 91103 Tel (626) 744-7300
Region 4 3rd Tuesday of every other January 20 Hercilia Salvatierra, Chairperson Hollywood- month March 17 Wilshire, Central 9:00 AM May 19 and Glendale (for approximately 2-1/2 hours) July 21 St. Vincent Medical Center September 15 Staff Contact: Mark Taper Building Board November 17 Kristina Chung Rm Community Outreach & Education, Ext. 2200 W. Third St. 5139 Los Angeles, CA 90057 Tel. (213) 484-7766
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 162 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY, REGION TIME, MEETING STAFFCONTACT &LOCATION DATE Region 5 3rd Monday of every other February 23* Romalda Meza, Chairperson West month April 20 2:00 PM June 15 (for approximately 2-1/2 hours) August 17 Mar Vista Housing Dev. October 19 Staff Contact: Multipurpose Room December 21 Martin Vicente 4909 Marionwood Street Community Outreach & Education, x 4423 Culver City, CA 90230 Tel. (310) 915-9006 *will meet the 4th Monday of the month
Region 6 3rd Thursday of every February 19 Dove Savage Pickney, Chairperson South, Compton, other month April 16 Inglewood 3:00 PM June 18 (for approximately 2-1/2 hours) August 20 Staff Contact: Saint John’s Well Child & October 15 Frank Meza Family Center December 17 Community Outreach & Education, x 4239 808 W. 58th Street Los Angeles, CA 90037 Tel. (323) 541-1600
Region 7 3rd Thursday of every January 21 Dalia Cadena, Chairperson San Antonio and other month March 19 Bellflower 4:30 PM May 21 (for approximately 2-1/2 hours) July 16 Staff Contact: Old Timers Foundation September 17 Frank Meza Family Center November 19 Community Outreach & Education, x 4239 3355 E. Gage Avenue Huntington Park, CA 90255 Tel (323) 582-6090
Region 8 3rd Friday of every other January 16 Ana Romo – Chairperson Torrance and month March 20 Harbor 10:30 AM May 15 (for approximately 2-1/2 hours) July 17 Staff Contact: John Mendez Community September 18 Frank Meza Center November 20 Community Outreach & Education, x 4239 707 W. C Street Wilmington, CA 90748 Tel. (310) 549-0052
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 163 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY, REGION TIME, MEETING STAFFCONTACT &LOCATION DATE Region 9 3rd Monday of every other January 17* Christina Deh-Lee, Chairperson Long Beach month March 16 9:00 AM May 18 (for approximately 2-1/2 hours) July 20 Staff Contact: Miller Family Health September 21 Kristina Chung Education Center November 16 Community Outreach & Education, Ext. 3820 Cherry Avenue 5139 Long Beach, CA 90807 Tel. (562) 570-7987 *will meet the 4th Monday of the month
Region 10 3rd Thursday of every February 19 Aida Aguilar, Chairperson East Los Angeles, other month April 16 Whittier and North- 4:00 PM June 18 East (for approximately 2-1/2 hours) August 20 Staff Contact: Boyle Heights Technology October 15 Martin Vicente, Community Outreach & Youth Center December 17 Education, Ext. 4423 1600 East 4th Street Los Angeles, CA 90033 Tel. (323) 526-0145
Region 11 3rd Wednesday of every January 21 Elda Sevilla, Chairperson Pomona and El other Month March 19 Monte 9:00 AM May 21 Staff Contact: (for approximately 2-1/2 hours) July 16 Martin Vicente, Community Outreach & First Christian Church September 17 Education, Ext. 4423 1751 North Park Avenue November 19 Pomona, CA 91768 Tel. (909) 622-1144
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 164