BOARD OF GOVERNORS MEETING
May 5, 2016 ● 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. Serving more than two million members in six 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 four 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. 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.
L.A. Care Covered Direct™ – L.A. Care’s first private health plan for all members of a family.
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.
L.A. Care Healthy Kids (0-5) – Sponsored by First 5 LA, Healthy Kids (0-5) provides comprehensive health care coverage for children who do not qualify for Medi-Cal or Covered California.
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.
www.lacare.org Facebook/lacarehealth LinkedIn/company/l.a.-care-health-plan Twitter: @lacarehealth2 Updated 4/15/2016 AGENDA BOARD OF GOVERNORS MEETING Thursday, May 5, 2016, 2:00 P.M. L.A. Care Health Plan, 10th Floor, 1055 W. 7th Street, Los Angeles, CA 90017
Teleconference Call In Information & Site Alexander K. Li, MD Call in number: (855) 846-1604 or (213) 438-5445 15 Princeton Road Participant Access code: 67163639 Livingston, NJ 07039 Welcome Mark Gamble, Chair
1. Approve today’s Agenda Chair 2. Public Comment Chair
3. Approve April 14, 2016 special meeting minutes Chair 4. Approve Consent Agenda Items Chair FIN 100 Quarterly Investment Report FIN 101 Pacific Health consulting Group Contract ECA 100 RCAC Membership ADJOURN TO CLOSED SESSION (Estimated time: 15 minutes) Chair 5. PUBLIC EMPLOYEE PERFORMANCE EVALUATION Section 54957 of the Ralph M. Brown Act Title: Chief Executive Officer 6. CONFERENCE WITH LABOR NEGOTIATOR Pursuant to Section 54957 of the Ralph M. Brown Act Agency Negotiator: Mark Gamble Unrepresented Employees: Chief Executive Officer RECONVENE IN OPEN SESSION Chair
7. Chairperson’s Report Chair Consideration Chief Executive Officer Compensation (Motion) 8. Chief Executive Officer Report John Baackes Second Quarter Strategic Vision Progress Report Chief Executive Officer Operations Report 9. Chief Medical Officer Report Gertrude S. Carter, MD Chief Medical Officer 10. Motions for Consideration John Baackes Approve JAR Insurance Services Contract Amendment (BOG 100) Approve contract with Echo Inc. for Nurse Advice Line Software (BOG 101) Strategic Discussions 11. Information Security Management Program John Baackes Tom Schwaninger Chief Information Officer
4/5/2016 2:36 PM 3 Board of Governors Meeting Agenda May 5, 2016 Page 2 of 2
12. California’s Waiver Proposal for Whole Person Care Jonathan Freedman Chief Strategy Officer Maria Calleros Director, Safety Net Initiatives Standing Committee Reports Executive Committee Chair 13. Government Affairs Update Cherie Fields Director, Government Affairs 14. Brilliant Corners Grant (EXE 100) John Baackes
Finance & Budget Committee Michael Rembis
15. Financial Report (FIN 102 ) Marie Montgomery Chief Financial Officer 16. Monthly Investment Transactions Report Marie Montgomery Advisory Committee Reports 17. Executive Community Advisory Committee Hilda Perez/Ozzie Lopez Consumer member and Advocate member RE-ADJOURN TO CLOSED SESSION (Estimated time: 15 minutes) Chair 18. CONFERENCE WITH LEGAL COUNSEL—ANTICIPATED LITIGATION Significant exposure to litigation pursuant to Section 54956.9(d)(2) of Ralph M. Brown Act 19. CONTRACT RATES Pursuant to Welfare and Institutions Code Section 14087.38(m) Plan Partner Rates Provider Rates DHCS Rates Medi-Cal Managed Care Supplemental Payment 20. REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Discussion Concerning New Product Lines Estimated date of public disclosure: May 2018 RECONVENE IN OPEN SESSION Chair Adjournment The next meeting will be on Thursday, June 2, 2016 at Antelope Valley Partners for Health, 44226 10th Street West, Lancaster, CA 93534 Please keep public comments to three minutes or less. The order of items appearing on the agenda may change during the meeting. If a teleconference location is listed at the top of this agenda, the public can participate in the meeting at that location. Teleconference arrangements listed at the top of this Agenda may change prior to the meeting. L.A. Care may make the teleconference number available to the public. If you wish to listen to the meeting by telephone, you can confirm details with L.A. Care Board Services staff prior to the meeting by calling (213) 694-1250, extension 4183 or 4184. 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 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. 4 4/5/2016 2:36 PM Schedule of Meetings May 2016
Monday Tuesday Wednesday Thursday Friday Saturday Sunday 1
2 3 4 5 6 7 8
Board of Governors 2 pm (for approx. 2-1/2 hours) 9 10 11 12 13 14 15
ECAC 10 am (for approx. 2 hours) 16 17 18 19 20 21 22 RCAC 16 CHCAC CCI 2 RCAC 11 RCAC 8 9 am 8:30 am 10 am 9 am 10:30 am (for approx. 2-1/2 (for approx. 2 hours) (for approx. 2-1/2 (for approx. 2-1/2 (for approx. 2-1/2 hours) RCAC 4 hours) hours) hours) 9 am Compliance & (for approx. 2-1/2 hours) Quality 2 pm (for approx. 2 hours) RCAC 7 4:30 am (for approx. 2-1/2 hours)
23 24 25 26 27 28 29 CCI 1 Finance & Budget CCI 4 10 am 1 pm 1 pm (for approx. 2-1/2 (for approx. 2 hours) (for approx. hours) 2-1/2 hours) Executive 2 pm (for approx.. 2 hours) 30 31
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]. 5 Prepared by mhbalones/printed on 04/29/16 Board of Governors & Public Advisory Committees 2016 Meeting Schedule / Member Listing 1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017 Tel. (213) 694-1250 / Fax (213) 438-5728
MEETING DAY, TIME, MEETING DATES & LOCATION MEMBERS Board of 1st Thursday May 5 Mark Gamble, Chairperson Governors 2:00 PM June 2 * Louise McCarthy, Vice Chairperson General Meeting (for approximately 3 hours) July 7 Michael Rembis, FACHE, Treasurer 1055 W. 7th Street, No meeting scheduled Alexander K. Li, MD, Secretary 10th Floor, in August Hector De La Torre Los Angeles, CA 90017 September 1 ** Jann Hamilton Lee October 6*** Thomas Horowitz, DO *June 2 Meeting starts at November 3 Ozzie Lopez 12 noon at Antelope Valley December 1 Hilda Perez Partners for Health G. Michael Roybal, MD, MPH 44226 10th Street West, Honorable Hilda L. Solis Lancaster, CA 93534 Sheryl Spiller Kimberly Uyeda, MD, MPH ** September 1 All Day Board of Governors Retreat starts at 8:30am at Staff Contact: California Endowment, John Baackes, Chief Executive Officer 1000 N. Alameda St, Los x4102 Angeles, CA 90012 Linda Merkens, Manager, Board Services, x4050 ***October 6 is a placeholder Board meeting and may be cancelled
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]. 6 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2016 MEETING SCHEDULE / MEMBER LISTING
Board of Governors - Standing Committees
MEETING DAY, MEETING TIME, DATES MEMBERS & LOCATION Executive 4th Wednesday of the May 25 Mark Gamble, Chairperson Committee month June 22 Louise McCarthy 2:00 PM July 27 Michael Rembis, FACHE No meetings in Alexander K. Li, MD (for approximately 2 hours) August Thomas Horowitz, DO 1055 W. 7th Street, September 28 G. Michael Roybal, MD, MPH 10th Floor, Los Angeles, October 26 CA 90017 November 16 Staff Contact: No meetings in Linda Merkens, Manager, Board Services, December x4050
Compliance & 3rd Thursday every 2 May 19 G. Michael Roybal, MD, MPH, Quality months July 21 Chairperson Committee 2:00 PM September 15 Jann Hamilton Lee (for approximately 2 hours) November 17 Alexander Li, MD 1055 W. 7th Street, Hilda Perez 10th Floor, Los Angeles, Kimberly Uyeda, MD CA 90017 Staff Contact: Jennifer Carabali Committee Liaison, Board Services, x 4184 Finance & 4th Wednesday of the May 25 Michael A. Rembis, FACHE, Chairperson Budget month June 22 Mark Gamble Committee 1:00 PM July 27 Jann Hamilton Lee No meetings in Ozzie Lopez (for approximately 2 hours) August Louise McCarthy 1055 W. 7th Street, September 28 Hilda Perez 10th Floor, Los Angeles, October 26 CA 90017 November 16 Staff Contact: No meetings in Malou Balones December Committee Liaison, Board Services/x 4183
Governance 1055 W. 7th Street, Thomas Horowitz, DO, Chairperson Committee 10th Floor Hector De La Torre Los Angeles, CA 90017 Ozzie Lopez Hilda Perez MEETS AS NEEDED 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]. 7 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2016 MEETING SCHEDULE / MEMBER LISTING
MEETING DAY, MEETING TIME, DATES MEMBERS & LOCATION Service 1055 W. 7th Street, Hector De La Torre, Chairperson Agreement 10th Floor Louise McCarthy Committee Los Angeles, CA 90017 Hilda Perez Honorable Hilda L. Solis MEETS AS NEEDED Sheryl Spiller
Staff Contact Malou Balones Committee Liaison, Board Services/x 4183
Audit Committee 1055 W. 7th Street, Alexander K. Li, MD, Chairperson 10th Floor Hector De La Torre Los Angeles, CA 90017 Jann Hamilton Lee
MEETS AS NEEDED 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]. 8 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2016 MEETING SCHEDULE / MEMBER LISTING
MEETING DAY, MEETING TIME, DATES MEMBERS & LOCATION L.A. Care Meets Annually or as Mark Gamble, Chairperson Community needed Louise McCarthy, Vice Chairperson Health 1055 W. 7th Street, Michael Rembis, FACHE, Treasurer 10th Floor, Los Angeles, Alexander K. Li, MD, Secretary CA 90017 Hector De La Torre Jann Hamilton Lee Thomas Horowitz, DO Ozzie Lopez Hilda Perez G. Michael Roybal, MD, MPH Honorable Hilda L. Solis Sheryl Spiller Kimberly Uyeda, MD, MPH
Staff Contact: John Baackes, Chief Executive Officer x4102 Linda Merkens, Manager, Board Services, x4050
L.A. Care Joint Meets Quarterly or as Mark Gamble, Chairperson Powers Authority needed Louise McCarthy, Vice Chairperson 1055 W. 7th Street, Michael Rembis, FACHE, Treasurer 10th Floor, Los Angeles, Alexander K. Li, MD, Secretary CA 90017 Hector De La Torre Jann Hamilton Lee Thomas Horowitz, DO Ozzie Lopez Hilda Perez G. Michael Roybal, MD, MPH Honorable Hilda L. Solis Sheryl Spiller Kimberly Uyeda, MD, MPH
Staff Contact: John Baackes, 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]. 9 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2016 MEETING SCHEDULE / MEMBER LISTING
Public Advisory Committees MEETING DAY, MEETING TIME, DATES STAFF CONTACT & LOCATION Children’s Health 3rd Tuesday of every other May 17 Lyndee Knox, PhD, Chairperson Consultant Advisory month July 19 Committee 8:30 AM September 20 General Meeting (for approximately 2 hours) November 15 Staff Contact: Jennifer Carabali 1055 W. 7th Street, Committee Liaison, Board Services/x 4184 10th Floor, Los Angeles, CA 90017
Executive 2nd Wednesday of the May 11 Elda Sevilla, Chairperson Community month June 8 Advisory Committee 10:00 AM July 13 (for approximately 2 hours) No meeting in August September 15 Staff Contact: 1055 W. 7th Street, October 12 Idalia Chitica, Community Outreach & 10th Floor, Los Angeles, November 9 Education, Ext. 4420 CA 90017 No meeting in December
Technical Advisory 4th Thursdays every other May 26 Chairperson to be elected Committee month July 28 9:00 AM September 22 (for approximately 2 hours) November 17 Staff Contact: Jennifer Carabali 1055 W. 7th Street, Committee Liaison, Board Services/x 4184 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]. 10 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2016 MEETING SCHEDULE / MEMBER LISTING
REGIONAL COMMUNITY ADVISORY COMMITTEES
MEETING DAY, REGION TIME, MEETING STAFF CONTACT & LOCATION DATE Region 1 3rd Friday of every other June 17 Adela Guadarrama, Chairperson Antelope Valley month August 19 10:00 AM October 21 (for approximately 2-1/2 hours) December 16 Chimbole Cultural Center Staff Contact: 38350 N. Sierra Highway Courtney Nicholas Palmdale, CA 93550 Community Outreach & Education, Ext. (661) 267-5656 6583
Region 2 3rd Wednesday of every June 20 Carlos Aguirre, Chairperson San Fernando other month August 15 Valley 10:00 AM October 17 (for approximately 2-1/2 hours) December 19 Family Resource Center- Pacoima Staff Contact: 10807 San Fernando Road Courtney Nicholas Pacoima, CA 91331 Community Outreach & Education, Ext. (844) 858-9942 6583
Region 3 3rd Tuesday of every other June 21 Lidia Parra, Chairperson Alhambra, month August 16 Pasadena and 9:30 AM October 18 Foothill (for approximately 2-1/2 hours) December 13* Rosemead Center Staff Contact: 3936 N. Muscatel Avenue, *Will meet the 2nd Kristina Chung Room 3 Tuesday of the month Community Outreach & Education, Ext. Rosemead, CA 91770 5139 (626) 569-2160
Region 4 3rd Tuesday of every other May 17 Hercilia Salvatierra, Chairperson Hollywood- month July 19 Wilshire, Central 9:00 AM September 20 and Glendale (for approximately 2-1/2 hours) November 15 Hope Street Family Center 1600 Hope Street, Rm 305 Los Angeles, CA 90015 Staff Contact: (213) 742-6385 Kristina Chung Community Outreach & Education, Ext. 5139
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]. 11 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2016 MEETING SCHEDULE / MEMBER LISTING
MEETING DAY, REGION TIME, MEETING STAFF CONTACT & LOCATION DATE Region 5 3rd Monday of every other June 20 Romalda Meza, Chairperson West month August 15 2:00 PM October 17 (for approximately 2-1/2 hours) December 19 Veterans Memorial Building Garden Room Staff Contact: 4117 Overland Avenue Martin Vicente Culver City, CA 90230 Community Outreach & Education, x 4423 (310) 253-6625
Region 6 3rd Thursday of every June 16 Dove Savage Pickney, Chairperson South, Compton, other month August 18 Inglewood 3:00 PM October 20 (for approximately 2-1/2 hours) December 15 Saint John’s Well Child & Family Center 808 W. 58th Street Staff Contact: Los Angeles, CA 90037 Frank Meza (323) 541-1600 Community Outreach & Education, x 4239
Region 7 3rd Thursday of every May 19 Dalia Cadena, Chairperson San Antonio and other month July 21 Bellflower 4:30 PM September 15 (for approximately 2-1/2 hours) November 17 Old Timers Foundation Family Center Staff Contact: 3355 E. Gage Avenue Frank Meza Huntington Park, CA 90255 Community Outreach & Education, x 4239 (323) 582-6090
Region 8 3rd Friday of every other May 20 Ana Romo – Chairperson Torrance and month July 15 Harbor 10:30 AM September 16 (for approximately 2-1/2 hours) November 18 Harbor Vista Housing Community Area Staff Contact: 430 N. Wilmington Blvd. Frank Meza Wilmington, CA 90744 Community Outreach & Education, x 4239 (310) 835-7660
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]. 12 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2016 MEETING SCHEDULE / MEMBER LISTING
MEETING DAY, REGION TIME, MEETING STAFF CONTACT & LOCATION DATE Region 9 3rd Monday of every other May 16 Christina Deh-Lee, Chairperson Long Beach month July 18 9:00 AM September 19 (for approximately 2-1/2 hours) November 21 Staff Contact: Miller Family Health Kristina Chung Education Center Community Outreach & Education, Ext. 3820 Cherry Avenue 5139 Long Beach, CA 90807 (562) 570-7987
Region 10 3rd Thursday of every June 16 Elsa Gervacio, Chairperson East Los Angeles, other month August 18 Whittier and North- 1:00 PM October 20 East (for approximately 2-1/2 hours) December 15 Staff Contact: Monsenor Oscar Romero Martin Vicente, Community Outreach & Clinic Education, Ext. 4423 2032 Marengo Street Los Angeles, CA 90033 (323) 780-6336
Region 11 3rd Thursday of every May 19 Elda Sevilla, Chairperson Pomona and El other Month July 21 Monte 9:00 AM September 15 Staff Contact: (for approximately 2-1/2 hours) November 17 Martin Vicente, Community Outreach & dA Center for the Arts Education, Ext. 4423 252 D South Main Street Pomona, CA 91766 (909) 397-9716
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]. 13 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2016 MEETING SCHEDULE / MEMBER LISTING
COORDINATED CARE INITIATIVE (CCI) CONSUMER COUNCIL
MEETING DAY, REGION TIME, MEETING STAFF CONTACT & LOCATION DATE Area 1 4th Tuesday of every other May 24 Marcia Ramos, Chairperson Antelope Valley month July 19* 10:00 AM September 27 (for approximately 2-1/2 hours) November 22 Staff Contact: Antelope Valley Partners for Dolly Tataje Health *Will meet the 3rd Community Outreach & Education, 44226 10th Street West Tuesday of the month Ext. 4585 Lancaster, CA 93534 (661) 267-5656
Area 2 4th Wednesday of every May 18* Elizabeth Lyons, Chairperson San Fernando other month July 27 Valley 10:00 AM September 28 (for approximately 2-1/2 hours) November 16* Family Resource Center- Staff Contact: Pacoima *Will meet the 2nd Susan Ma 10807 San Fernando Road Tuesday of the month Community Outreach & Education, Pacoima, CA 91331 Ext. 4586 (877) 287-6290
Area 3 4th Wednesday of every June 22 Brenda White, Chairperson South Los Angeles other month August 24 10:00 AM October 26 (for approximately 2-1/2 hours) December 21 Inglewood Family Resource Center Staff Contact: 3111 W. Century Boulevard, Dolly Tataje Suite 100 Community Outreach & Education, Inglewood, CA 90303 Ext. 4585 (310) 330-3130
Area 4 4th Tuesday of every other June 28 Neisma Istrefi, Chairperson Long Beach month August 23 1:00 PM October 25 (for approximately 2-1/2 hours) December 20* Mark Twain Branch Library Staff Contact: 1325 E. Anaheim Street *Will meet the 3rd Susan Ma Long Beach, CA 90813 Tuesday of the month Community Outreach & Education, (562) 570-1046 Ext. 4586
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]. 14 Board of Governors Special Meeting Minutes #253 – April 14, 2016 L.A. Care Health Plan Conference Room 1017-1018-1019 1055 W. Seventh Street, Los Angeles, CA 90017
Members Management/Staff Mark Gamble, Chair * John Baackes, Chief Executive Officer Louise McCarthy, Vice Chair Phinney Ahn, Chief of Staff Michael Rembis, Treasurer * Gertrude S. Carter, MD, Chief Medical Officer Alexander Li, MD, Secretary Henry Charoen, Executive Director, Medi-Cal Plan Partners Hector De La Torre Maribel Ferrer, Executive Director, Medicaid Coverage Expansion & TANF Jann Hamilton Lee Augustavia Haydel, General Counsel Thomas Horowitz, DO Dino Kasdagly, Chief Operating Officer Ozzie Lopez, MPA Noah Paley, Chief of Enterprise Integration Hilda Perez Marie Montgomery, Chief Financial Officer G. Michael Roybal, MD, MPH Bruce Pollack, Executive Director, Medi-Cal, SPD & CCI Honorable Hilda Solis Robert Turner, Chief Human Resources Officer Sheryl Spiller Kimberly Uyeda, MD, MPH *Absent AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN WELCOME Louise McCarthy, Vice Chair, called the meeting to order at 2:10 p.m. She announced that the public may address the Board on any matter at the Public Comment Louise McCarthy section at the beginning of this meeting, before or during the Board’s consideration of items listed on the Agenda. Guests are welcome to introduce themselves or can choose to remain anonymous. She welcomed the public and thanked them for coming to the meeting.
APPROVAL OF The meeting agenda was approved as submitted. Approved MEETING AGENDA unanimously. 10 AYES (Hamilton Louise McCarthy Lee, Horowitz, Li, Lopez, McCarthy, Perez, Roybal, Solis, Spiller, and Uyeda).
PUBLIC COMMENT Vivienne Grant-Peart, Manager of the Pico Women’s Medical Group, commented about continuity of care for pregnant patients. Continuity of care is a good policy, can save time and money, and
15 DRAFT greatly enhances the patient experience. Every month between five and eight prenatal patients whose enrollment defaults to groups that Pico Women’s Medical Groups is not a part of call for a prenatal visit. The providers explain how the system works and call the health plans to get the member switched so Pico will be able to provide prenatal care. It is rare to be able to get the enrollment updated for that patient on the same day. Often they are told it takes 45 days to make the transfer. Then there is an angry disgruntled person because they do not understand the default process. National Committee on Quality Assurance (NCQA) standards provide 45 days for timeliness of prenatal care once the patient is enrolled in a plan. Changes in patient enrollment can extend the wait for prenatal care beyond the 45-day timeliness. It appears that the policy is in conflict because it delays care beyond the NCQA standard and takes away from patient experience. She urged L.A. Care to revisit the policy and asked for comment. John Baackes, Chief Executive Officer, noted that her points are well taken and he will ask Gertrude S. Carter, MD, Chief Medical Officer, to review the issue. Member Thomas Horowitz, DO, indicated it is important to note that the early prenatal visits are important for early intervention to prevent a problem pregnancy. (Member De la Torre joined the meeting.) Vice Chairperson McCarthy read a statement from David Abber, who was not able to attend the meeting: Good afternoon Board Members and staff, I would like to thank you for hearing me and Linda Merkens for assisting me today. Although my single point of contact and I have worked diligently to work things out. I received a letter on January 29, 2016. It was established in this letter that for the past few months my health care had been delayed and not delivered in a timely and professional manner. This letter was vague and did not identify the issues caused by CFC and Ron Brandt. I was told that the police were called on me and I learned that this was not true from my single point of contact and that the Lancaster Police Department did not receive a call on me for that day for any wrong doing or misconduct. As a result, my PCP that was provided to me by CFC was never appropriate as he is a GI physician and not a PCP. My single point of contact brought to my attention that a GI physician could not be assigned as a PCP. And, could not support my health care because Dr. Mothry was not a part of my group. How could this be allowed to occur after I brought this to the attention of Steve Goby and John Baackes? Currently, I am assigned to a PCP which does not answer the phone. Grievance letters are sent in which I have attempted to contact the grievance staff at L.A. Care. However the staff will not return my calls or return the calls of my single point of contact. Also, on Monday, April 11, 2016, I went to the ER for chest pains. Also, I was assigned a PCP that is in violation of the L.A. Care Handbook for members. With good faith and transparency I am hopeful that I can receive the healthcare and allow my single point of contact to address my concerns. However, Mary Cifuentes cannot answer my questions due to others not assisting her and providing her with support. Board of Governors Special Meeting February 14, 2016, Page 2 of 18 DRAFT 16 Ms. Solis and her staff have sent correspondence dated April 8, 2016. This letter does not identify the real concerns I have and I would like to have a conversation with my single point of contact and Ms. Solis. Thank you, David Abber Vice Chairperson McCarthy noted that the concerns will be reflected in the Meeting Minutes, and Mr. Abber’s concerns will be referred to staff to protect his privacy.
ACCEPTANCE OF The minutes of the February 4, 2016 meeting were approved as submitted. Approved MINUTES OF unanimously. MEETING 11 AYES (De La Torre, Hamilton Lee, Louise McCarthy Horowitz, Li, Lopez, McCarthy, Perez, Roybal, Solis, Spiller and Uyeda).
APPROVAL OF Vice Chair McCarthy asked for any public comment on the Consent Agenda. There was no Approved CONSENT AGENDA public comment. unanimously. BOG 100 Bank authorization for Marie Montgomery, Chief Financial Officer 11 AYES Louise McCarthy EXE 100 Revised 2016 Board Meeting Schedule FIN 100 Authorization for Selection of Vendor for IT Performance Testing FIN 101 APS Healthcare Contract Amendment FIN 102 Cornerstone Data Strategies, Inc. Contract Amendment FIN 103 Golden Outlook Insurance Services Contract FIN 104 Health eConnex Contract Amendment COM 100 Revised Compliance & Quality Committee Charter SAC 100 Health eConnex Contract Amendment ECA 100 RCAC Membership
CHAIR’S REPORT There was no report from the Chair Louise McCarthy
CHIEF EXECUTIVE John Baackes, Chief Executive Officer, introduced new executive staff members Dino Kasdagly, OFFICER REPORT Chief Operations Officer, and Marie Montgomery, Chief Financial Officer. Mr. Kasdagly and Ms. Montgomery each described their qualifications for their respective positions and expressed John Baackes appreciation for the opportunity to join the staff at L.A. Care. Mr. Baackes informed the Board members that Geoff Vitrano will be the new Senior Director of Member Services, and Garrison Rios will be the new Executive Direcor, Cal MediConnect,
Board of Governors Special Meeting February 14, 2016, Page 3 of 18 DRAFT 17 CalMediConnect Operations; they were not able to attend today’s meeting. Operating Plan Mr. Baackes reviewed the four attributes of L.A. Care’s strategic plan, with 20 initiatives (a copy of his presentation can be obtained by contacting Board Services). Staff will report regularly on progress, with a report on three key initiatives: CSP Plus (core system conversion): Staff has made significant progress to move this project to satisfactory completion. A reorganization of the process was undertaken so it is led by business considerations rather than technology considerations. Interdisciplinary teams were developed which bring together system users and architects. By September 1 all business lines will operate on new QNXT platform. For three months this summer, June-July-Aug, L.A. Care will have no new IT department initiatives so the conversion can be completed without distraction. Mr. Kasdagly is managing the project. Mr. Kasdagly commented that the plans are locked, the focus is there, and other items are deprioritzed that might have gotten in the way of this implementation. Precision is necessary and staff will focus on achieving its plan. Accountability: L.A. Care is holding delegated entities responsible for their role in providing services through a Medi-Cal managed care plan. A scorecard has been drafted, Dr. Carter and Mr. Baackes will meet with the chief executive of each IPA to review the scorecard and discuss provider accountability. Comments from those meetings will be reported to this Board. The scorecards are based on current data. Quality survey results from HEDIS and CAHPS will be available by September, so the scorecards can be updated then. The encounter data and quality assessments are important. Direct contracts with providers: L.A. Care expanded its network in the Antelope Valley with direct contracting with physicians and a new contract with Heritage IPA. Mr. Baackes displayed print advertisements about the expansion of available providers that were published in the Antelope Valley Press. Claims Update Last year L.A. Care had an increasing claims inventory. Staff has worked to reduce the backlog of claims and examine the root cause. In about two months, it is expected that the claims will be paid within acceptable time frames. Corrections to this process will carry into the new core system project. Mr. Baackes has heard lately from hospital representatives that current claims are being paid, but older claims are still unpaid. Medi-Cal Enrollment Ms. Spiller alerted L.A. Care last September about the resumption of redeterminations for Medi- Cal eligibility. L.A. Care has been carefully monitoring the process. The impact is now
Board of Governors Special Meeting February 14, 2016, Page 4 of 18 DRAFT 18 becoming evident, but it is taking longer than originally expected. Since the Affordable Care Act was adopted there are more categories and large numbers of members who were sent the redetermination notices and have not returned the paperwork. Notices of Action have been sent advising members that they have a 90 day grace period. The bulk of terminations could occur in June, 2016. The delayed terminations due to eligibility has kept L.A. Care’s Medi-Cal enrollment growing, although there was a slight decrease in April, of about 2500 people in Medi-Cal. This will impact L.A. Care finances when the enrollment drops, because it will decrease revenue. Staff is carefully limiting administrative expenses. The working relationship with Los Angeles County Department of Public Social Services (DPSS) is appreciated. Member Spiller added that issues with the new system contributed to a delay in redeterminations, and only about 25,000 were terminated this month. That number will increase as the system issues were resolved. Mr. Baackes indicated that L.A. Care works to keep in touch with members to help them send in eligibility paperwork to avoid interruptions in coverage. Reinstatement will be retroactive to termination date due to insufficient eligibility documentation. Benefits are continued when there are issues with eligibility records. Benefits cannot be retroactively terminated. Member Solis expressed concern about contacting the communities that are hard to reach. She asked what other outreach efforts can be done to reinforce timely submission of documents to maintain eligibility for benefits. Mr. Baackes noted that L.A. Care does conduct outreach calls and the communications department could explore other ways to get information to people who might be affected. Mr. Baackes further commented that the California Department of Health Care Services (DHCS) is likely to reduce the Medi-Cal expansion rates again. Mr. Reilly has asked for as much advance notice as possible so L.A. Care can notify its delegated entities and Plan Partners. L.A. Care has begun a dialog with Health Net representatives to challenge a reduction. He noted that the rates are not sufficient for other programs, and L.A. Care is urging other plans to gather data so it can be shown clearly that program rates should be adjusted. L.A. Care Covered Enrollment This year L.A. Care operated the program for the third enrollment program. For the first two years, much of the enrollment has been in the Bronze tier of benefits, which includes a risk pool. Because utilization rates were very low, L.A. Care had to refund significant premium revenue. Going into the third year, L.A. Care arranged its pricing to encourage enrollment in the Silver Tier, where member premium subsidy is highest. By 2017, L.A. Care will have a better billing system, which has been a source of increased grievances for all health plans, because of the complexity of the member premium calculation. He also noted that an important enrollment consideration is that enrollees in California Covered health plans are screened for Medi-Cal eligibility. A second important consideration is that if they become
Board of Governors Special Meeting February 14, 2016, Page 5 of 18 DRAFT 19 ineligible for Medi-Cal, the member can reenroll with L.A. Care Covered to preserve continuity of care. Member Lopez asked if L.A. Care sends information about L.A. Care Covered if a member becomes ineligible for Medi-Cal. Mr. Baackes indicated that staff will follow up on that question. Member De La Torre noted that there must be a lot of people who become ineligible (earn out) of Medi-Cal. He asked if L.A. Care is told the reasons for ineligibility. Member Spiller reported that DPSS sends Covered California information to members that are terminated due to ineligibility. She noted that most terminations are due to a loss of contact or the member moves out of Los Angeles County. She indicated that there is a large population that is not enrolled in either program. Mr. Baackes noted that L.A. Care was informed that there were about 350,000 L.A. County residents who have not enrolled in health coverage plans. Member De La Torre informed Board members there are barriers to enrollment for the remaining uninsured. He also commented that because the most beneficial premium subsidies are at the Silver tier in California Covered, the value of enrolling the Silver tier should be emphasized. Mr. Baackes reported that L.A. Care’s Sales staff members make that point very strongly. It is the affordability. Member De La Torre noted that the national health care survey of millennial generation members will be available soon. Member Horowitz suggested looking for internal data to determine indicators for enrollment. Mr. Baackes noted that current enrollment is divided 40% Bronze and 60% Silver. Vice Chair McCarthy suggested that the enrollment numbers should be closely reviewed to track coverage of members by member months and to determine continued coverage for new immigrants who reach the five year limit in Medi-Cal. Member Horowitz noted that an increase in salary could lead to employer reductions in other benefits, which could also contribute to changes in enrollment in L.A. Care Covered. Cal MediConnect (CMC) Enrollment Mr. Baackes reported that the number of voluntary enrollees is growing. DHCS has proposed to reinstate passive enrollment for CMC. Beneficiaries who became eligible in 2014 and 2015 and did not get the passive enrollment mailing (about 60,500 in Los Angeles County), will receive a passive enrollment notice in June for passive enrollment in September and October 2016. Beneficiaries who became eligible for CMC in 2016 will be passively enrolled in January 2017.
Board of Governors Special Meeting February 14, 2016, Page 6 of 18 DRAFT 20 Streamlined enrollment will allow health plans to assist members with enrollment. Mr. Baackes reported that L.A. Care will provide supportive comments on the proposal. L.A. Care will focus on encouraging the members of the Coordinated Care Initiative to enroll in the CMC program which provides access to greater coordination of benefits for the member. Member Solis suggested that L.A. Care work with the Promotoras in L.A. County. It would be great to have the navigators provide information and help reach those targeted populations so they can enroll in available programs. She suggested creating an initiate or other means to showcase the programs to help eligible people enroll. Vice Chair McCarthy noted that the L.A. County WERC program received funding from L.A. Care. She noted that the question is one of scale and alignment with L.A. Care priorities. Mr. Baackes reported that the L.A. Care promotoras program conducted three training sessions in the last few months. The Community Outreach and Education (COE) program was moved out of operations and into communications, and Mr. Baackes invited Mr. Oaxaca to provide additional information. Mr. Oaxaca informed Board Members that 30 health promoters in L.A. Care’s program receive training on a variety of health topics. Currently, staff is working to find ways to reach the difficult to reach populations and to more closely align with initiatives at L.A. Care and other initiatives outside of L.A. Care that can benefit the community. There are other organizations in this arena. He also noted that there are ways to build a career path for promotoras. Member Solis noted that promotoras can operate at different levels, and she has experienced some resistance from professionals because of the lack of credentials. Most recently, promotoras were used to work with residents in the area of the lead contamination in Vernon. The public health model was used to provide information to more than 100,000 people. There are many people who do not have health insurance. Promotoras can be a valuable tool. She would like L.A. County to increase the use of promotoras as has been done in other states to support public health programs. She encouraged L.A. Care to develop an initiative and report back to the Board. Member Lopez noted that the L.A. Care pomotora program has done wonderful work. There are lots of members in ECAC and RCAC program that L.A. Care can work with in developing a workforce opportunity. Member Perez recounted that former Board Member Maria Guerrero brought the pomotora program to L.A. Care. She is a health promoter and feels the program can make a difference for the community. She noted that in serving on the ad hoc CEO Selection Committee she noted in particular that Mr. Baackes included in his resume his experience in working with community health workers. The health promoter program is very unique because they do speak the Board of Governors Special Meeting February 14, 2016, Page 7 of 18 DRAFT 21 language of the community. She has been trying also to emphasize having pomotoras conduct home visits. She asked the board to consider asking promotors to attend a future Board meeting and make a presentation about the program. Member Horowitz suggested having a pomotora table at the Care Harbor clinic. Mr. Baackes and Mr. Oaxaca thanked the Board members for the suggestions, and Mr. Oaxaca will prepare a presentation for a future Board meeting. Healthy Kids Mr. Baackes reported that enrollment has been closed in the Healthy Kids program because those members will now be eligible for Medi-Cal. L.A. Care will ensure that all members are transitioned to a new health coverage program. Mr. Lopez suggested that L.A. Care’s Executive Community Advisory Committee members be invited to L.A. Care sponsored events. Community Health In 2014-15 the Community Health Investment Fund had a budget of $5 million which was used Investment Fund to fund 32 projects to support L.A. Care’s goals of strengthening the safety net and improving Summary for FY 2014-15 community and public health. Annual Sponsorship The 2014-15 Sponsorship Report lists 73 community events sponsored by L.A. Care for a total Report of $390,000. The requests for event sponsorships are increasing.
MOTIONS FOR CONSIDERATION Motion approved under Motion BOG 100.0416* Approved Consent Agenda Bank To designate Marie Montgomery, Chief Financial Officer, as signatory, with authority to unanimously on the authorization for Marie all bank accounts and investment accounts. Consent Agenda. Montgomery 11 AYES Westfall Commercial Mr. Baackes summarized a motion to purchase furniture for L.A. Care staff. This motion will Furniture Contract amend a contract with a firm that was hired after a competitive selection process conducted in Amendment 2011 and conducted again in 2015. Member Solis suggested that L.A. Care dontate its unused furniture for use by a non-profit organization. Motion BOG 101.0416 Approved To delegate authority to the Chief Executive Officer to amend the existing furniture unanimously. agreement with Westfall Commercial Furniture and to add funds not to exceed $450,000 11 AYES to purchase standard office furniture, equipment and installation labor. DST Systems, Inc. Mr. Baackes reported that L.A. Care selected a vendor to work on the claims and support L.A. Contract Amendment Care’s conversion to the QNXT system. Mr. Kasdagly noted that the specialized skills of the
Board of Governors Special Meeting February 14, 2016, Page 8 of 18 DRAFT 22 outside vendor are necessary to develop the workflows and operational processes to implement updated claims processes. Motion BOG 102.0416 Approved To authorize staff to amend a contract with DST Systems Inc., in the amount of unanimously. $1,850,000 (contract not to exceed $2,273,544) through December 31, 2016, to provide 11 AYES Professional Services for claims operational workflow system process development and improvements.
ADVISORY COMMITTEE REPORTS Executive Community Motion ECA 100.0416* Advisory Committee To approve the following candidate(s) to the Regional Community Advisory Approved Committees (RCAC) as reviewed by the Executive Community Advisory Committee unanimously on the Hilda Perez (ECAC) during the March 9, 2016 ECAC meeting. Consent Agenda. Ozzie Lopez 11 AYES Name RCAC/CCI Type of Member Channary Lim RCAC 2 Consumer Sophy Mom RCAC 2 Consumer Eng Nay Teang RCAC 2 Consumer Lluvia Salazar RCAC 11 Consumer Personal Assistance Services Council RCAC 11 Community Partner (PASC) / IHSS Member Perez welcomed the RCAC / CCI Members to the meeting: RCAC 1 Deena Des Voignes RCAC 2 Christine Provencio RCAC 3 Lidia Parra RCAC 4 Silvia Poz RCAC 5 Guadalupe Reynoso RCAC 6 Evangelina Cantero RCAC 7 Fatima Vasquez RCAC 8 Maria Isabel Tamayo RCAC 9 Rosa Santizo RCAC 10 Engracia Lopez RCAC 11 Maria Angel Refugio CCI Councils Area 1 Abelardo Menor Board of Governors Special Meeting February 14, 2016, Page 9 of 18 DRAFT 23 Area 2 Laura Rhone Member Perez reported that ECAC met on March 9 and April 13. Members welcomed Mr. Kasdagly at the April 13 meeting. ECAC approved two motions on April 13 to request assistance in resolving issues for members in the Antelope Valley. One issue is the long wait times for appointments at the Antelope Valley Clinic, and the other is a lack of equipment to enable providers to serve the needs of L.A. Care members who are Seniors and People with Disabilities. She reported that ECAC members discussed the vacancies at L.A. Care Regional Community Advisory Committees (RCAC). She reminded Board Members that Ms. Cooper commented at the last Board Meeting about the vacancies and about the status of the Ambassador program to recruit RCAC members. The Ambassador program was initiated by L.A. Care to address the RCAC vacancies, but the program was not successful. Consequently, ECAC formed a Member Recruitment ad hoc Committee which met on February 29, 2016 to develop a program to recruit more members, to raise the value of member feedback to L.A. Care. The Committee reviewed the L.A. Care Mission Statement and the purpose of the Advisory Committees. Committee members reviewed current RCAC membership, discussed the current membership recruitment process and provided feedback on what is working and what can be improved. Committee members will meet again to discuss member recruitment. Sales and Marketing staff presented an overview of L.A. Care product lines. Member Perez suggested having the presentation at each RCAC and CCI Council meeting. BEHAVIORAL Clayton Chau, MD, PhD, Medical Director for Care Management, Behavioral Health and Provider HEALTH SERVICES Continuing Education Health Services, presented information about the Behavioral Health services FOR L.A. CARE for L.A. Care Members. He noted that Behavioral Health (BH) includes mental health and MEMBERS substance use disorder services. Currently the Behavioral Health services delivery through Medi-Cal has three separate levels: Gertrude S. Carter, MD Services provided by the primary care provider (PCP) include routine screening, education and Clayton Chau, MD, PhD medication monitoring for common conditions. Mental health services outside the scope of the PCP services are provided by L.A. Care’s BH vendor, Beacon, and substance use disorder services provided by the Los Angeles County Department of Public Health. Separate “carved out” mental health services are provided by LA County Department of Mental Health and drug Medi-Cal “carved out” services provided by the Department of Public Health Division of Substance Abuse Prevention and Control.
Board of Governors Special Meeting February 14, 2016, Page 10 of 18 DRAFT 24 Member Horowitz noted that there are skill sets needed by PCPs that L.A. Care should nurture by providing training. He also asked if eConsult could be an effective tool for the PCP to provide BH services. Dr. Chau reported that L.A. Care provides continuing education for PCPs and other providers and has held training sessions that specifically about mental health and substance use disorder services for Medi-Cal beneficiaries. Member Li asked about data sharing relationship, and Dr. Chau responded that the information is shared to provide best level of care. Dr. Chau summarized the Medi-Cal programs available in Los Angeles County for adolescent mental health and substance use disorders. L.A. Care began eMangement of behavioral health services in January, which includes support of specialists on the eConsult system. Transition is taking place incrementally by the seven Regional Centers in Los Angeles County, helping to make the process as smooth as possible. L.A. Care’s Behavioral Health Department has contracted directly with L.A. County providers to ease the transition. L.A. Care is also working with providers and beneficiaries to provide the best possible BH care. Children’s Health Member Uyeda reported that the Children’s Health Consultant Advisory Committee (CHCAC) Consultant Advisory met on March 15. Committee Dr. Carter provided an update on the model of care for Cal Medi-Connect, which promotes greater interaction with members on an individual, personal/high-touch level through in- Kimberly Uyeda, MD home and peer-to-peer interaction. To support this new strategy, L.A. Care developed home interdisciplinary care teams, which include a case manager, behavioral health specialist, social worker, and community health worker. Jim Banks Senior Director, Quality Improvement and Health Assessment, presented an overview of member connection standards and provided information about L.A. Care’s online portal, My Health in Motion. Urged everyone to look at L.A. Care’s website which offers information for members and prospective members and providers. Plan Partners are interested in collaborating on an intervention to promote member satisfaction. Committee’s strategic vision for 2016 is to engender strategies for member engagement, prenatal and postpartum care, and comprehensive care for foster children (CCS).
STANDING COMMITTEE REPORTS Executive Committee The Executive Committee met on February 24 and March 23 (minutes are available by contacting Board Services). On February 24, the Committee approved employer sponsored long-term care Louise McCarthy insurance benefits for Officers (excluding the CEO), Senior Directors and Medical Directors (or equivalent level staff) beginning May 1, 2016, and for voluntary employee-sponsored benefits for all other staff, and to authorize expenditure of up to $50,000 for fiscal year 2015-16, and up Board of Governors Special Meeting February 14, 2016, Page 11 of 18 DRAFT 25 to $100,000 for each future fiscal year; and approved RCAC members reviewed by ECAC during the February 10, 2016 ECAC meeting. These motions do not need approval of the full Board.
Meeting Schedule Motion EXE 100.0416* approved on Consent To approve a revised 2016 Board of Governors regular meeting schedule to include: Approved Agenda 1. A meeting on June 2, 2016, starting at 12 Noon at the Conference Center, Antelope unanimously under Valley Partners for Health in Lancaster, California. the Consent Agenda. 2. An all-day Board Retreat on September 1, 2016 starting at 8:30 a.m. at the California 11 AYES Endowment Center for Healthy Communities. Government Affairs Cherie Fields, Director of Government Affairs, reported that two documents were provided in the Update meeting materials for this meeting (copies of the materials can be obtained by contacting Board Services).
Cherie Fields Medi Cal Funding and Accountability Act Initiative This initiative, sponsored by the California Hospital Association, has qualified for the November‐ 2016 state ballot, and it permanently extends the current hospital tax, or quality assurance fee, that is scheduled to end in 2017. Under current law the fee can be amended or repealed by a simple majority vote. This initiative requires a 2/3rd majority vote in both houses of the state legislature to make changes in how funds can be used. The initiative also removes the fee from the calculation for Proposition 98 funding for schools. It is estimated that in year two this initiative could bring $1 billion in children’s health coverage. Legislative Matrix The document summarized the 40 or 50- most relevant bills presented to the legislature. The matrix will be updated monthly. Ms. Fields highlighted the following: SB 1361 would restore the eyeglass benefit for adult Medi-Cal beneficiaries. Ms. Fields is reviewing any potential impact on L.A. Care’s rates for this benefit before declaring L.A. Care’s formal position of support on this legislation. SB 10 would formally require California to ask the federal government for permission to allow undocumented immigrants to purchase health coverage through Covered California without any government subsidies. This proposal was endorsed by Covered California at its recent Board meeting. Member Li asked how Medi-Cal coverage for undocumented residents could be proposed. Mr. Baackes noted that data about the current cost of health care provided to undocumented California residents could be used to explain the need for expansion of coverage to this beneficiary category. Member Perez noted that undocumented people contribute taxes but ironically they cannot use benefits for which they might qualify, but for their immigration
Board of Governors Special Meeting February 14, 2016, Page 12 of 18 DRAFT 26 status. Member Solis suggested that L.A. County may be able to provide data from the My Health L.A. program. Member McCarthy commented that SB 1335 is important legislation that is focused on the inclusion of community health centers in the direct contracting for substance use and specialty mental health services, particularly given Dr. Chau’s earlier presentation and many L.A. Care stakeholders are co-sponsoring the legislation. Ms. Fields noted she is communicating with California Primary Care Association on this legislation and anticipates L.A. Care will take a formal support position on this legislation. Finance & Budget The Committee met on February 24 and March 23 (meeting minutes are available from Board Services). Committee The Committee approved the following motions (that do not require Board approval): To execute a contract with a vendor to be selected, to implement an Identity Management Louise McCarthy Solution to enhance information technology security measures. To execute a contract with FireEye, Inc., to review computer systems and networks to seek out and identify active or dormant threats. To approve additional funding for a contract with Moore Wallace for printing the 2016 Medi- Cal Provider Directory. The monthly investment transactions report is included in the meeting materials. (Member Horowitz stepped out of the meeting room.) Motion Approved under Motion FIN 100.0416* Consent Agenda To authorize staff to execute a contract with a vendor not yet selected, in the amount of $500,000 to provide IT performance testing services from March 15, 2016 through September 30, 2016. Motion FIN 101.0416* To contract with APS Health Care for an amount not to exceed $2,500,000 from April 1, 2016 – June 30, 2016 for conducting Health Risk Assessment for Cal MediConnect and Seniors & People with Disabilities members. Motion FIN 102.0416* To authorize staff to amend the contract with Cornerstone Data Strategies, Inc., in the amount of $1,550,321 (total contract not to exceed $13,655,554) for consulting and staffing services through September 30, 2016. Approved Motion FIN 103.0416* unanimously on the Approval to amend the existing contract with Golden Outlook Insurance Services Consent Agenda. (AppleCare) in the amount of $332,000 (total contract not to exceed $2,890,430) for 11 AYES. Medicare Advantage Special Needs Plan retained Cal MediConnect members through December 31, 2016. Board of Governors Special Meeting February 14, 2016, Page 13 of 18 DRAFT 27 Motion FIN 104.0416* To approve a contract amendment with Health eConnex to provide imaging services to capture member data from PM160 paper forms in an amount not to exceed $200,000, with the total contract not to exceed $1,745,000, for the period of May 1, 2016 to April 30, 2017. Financial Report Mr. Reilly referred to the financial report included in the meeting materials and provided a summary of fiscal year financial performance for the period ending February 2016. (A copy of the Tim Reilly report and his presentation can be obtained by contacting Board Services.) Maria Montgomery Mr. Reilly reviewed the financial report included in the meeting materials. Overall, the combined membership is 9.6 million, favorable to the budget due to the growth in the Medi-Cal Plan Partners and the Adult Medi-Cal Expansion. Financial performance resulted in a surplus of $24 million or 0.8% on revenue, and is $24.5 million unfavorable to plan year to date. The unfavorable budget variance is driven by higher than expected healthcare expenses offset by higher revenue and administrative savings. He reviewed the operating margins for each line of business: Plan Partners 93.6%, Medi-Cal TANF/MCE, 84.7%, Medi-Cal SPD/CCI, 108.2., CMC, 94.7% and L.A. Care Covered, etc., 86.8%. The key financial ratios for the 5 months ending February 2016 are all positive, although the overall medical loss ratio is slightly higher than plan. The administrative ratio is lower than budgeted as L.A. Care has not hired staff as quickly as originally planned. Balance Sheet ratios for working capital, cash to claims and tangible net equity are positive. L.A. Care’s financial reserves have grown substantially, as have the requirements for reserves. At present, L.A. Care has a reserve slightly more than three times the minimum requirement and is making progress in reaching a reserve level of 530% of the minimum requirement. Member De La Torre indicated his concern with the 108% medical loss ratio in the CMC product. Mr. Reilly indicated that for several years staff has negotiated the CMC rates with the California Department of Health Care Services (DHCS), and DHCS introduced higher than required rates for the Medi-Cal expansion (MCE) program to alleviate the shortfall in the CMC rates. As Mr. Baackes indicated earlier, staff will continue discussions with DHCS about correcting rate algorithms for each program. Mr. Baackes noted that L.A. Care has reorganized the operational structure to focus executive leadership on individual product lines. The Approved Executive Director for the CMC product line has been tasked with identifying ways that L.A. unanimously. Care can address the high medical cost ratio. A report will be presented to the Board at a future 10 AYES. (De La meeting. Member De La Torre recommended that the lead health staff from the Department of Torre, Hamilton Lee, Finance be included in all conversations about how the individual program rates are developed. Li, Lopez, McCarthy, Motion FIN 105.0416 Perez, Roybal, Solis, To accept the Financial Report for the period ended February 29, 2016, as submitted. Spiller and Uyeda) Board of Governors Special Meeting February 14, 2016, Page 14 of 18 DRAFT 28 Monthly Investment Mr. Reilly referred to the September 2015 Investment Transaction Report included in the Transaction Report meeting materials. (A copy of the report can be obtained by contacting Board Services.) TriZetto Contract Mr. Baackes reported that an amendment to the contract with L.A. Care’s sole source vendor Amendment for the new QNXT system, TriZetto, to add $2.4 million to support features for the care management system. Member Rembis, Chairperson of the Finance & Budget Committee, asked staff to provide the Committee with a complete accounting of the costs for the core system project which can also be shared with the Board of Governors at a future meeting. Motion FIN 106.0416 To authorize staff to amend a contract with TriZetto in the amount of $2,400,000 (total Approved contract not to exceed $43,428,532) through September 30, 2016 to provide professional unanimously. services for L.A. Care’s Clinical Care Advance line of business Conversion Roll-out and 10 AYES. Medi-Cal conversion to QNXT projects. Authorization for Mr. Baackes presented a motion requesting authorization for additional funds for the Nurse additional funds for Advice Line (NAL). Currently, L.A. Care’s direct lines of business have approximately Nurse Advice Line 1,000,000 members with an average annual NAL utilization rate of 5%. Due to Medi-Cal expansion and the addition of new product lines, there has been a significant increase in L.A. Care’s membership and member utilization of NAL services, and staff was able to negotiate a reduction in the rate for these services. The contract for these services was originally awarded to Health Dialog through a competitive selection process. Member Solis asked about cultural and linguistic competency of the vendor. Dr. Carter assured the Board that L.A. Care staff works continually with the vendor to provide culturally appropriate services for all members. Member Solis asked about data on these services. Mr. Approved Baackes suggested that data on the NAL be provided in the next board meeting packet and Dr. unanimously. Carter could review the data at the meeting. Member Perez noted that at the Finance & Budget 10 AYES (De La Committee it was asked if there was a way to gather data that could indicate if these services Torre, Hamilton Lee, were helping members avoid emergency room use and/or hospitalization. Horowitz, Li, (Member Horowitz rejoined the meeting.) McCarthy, Perez, Roybal, Solis, Spiller Motion FIN 107.0416 and Uyeda). To approve additional funds in the amount of $3,591,390 for the Nurse Advice Line 1 ABSTENTION contract with Health Dialog. The total amount for the three year contract (February 1, (Lopez) 2016-January 31, 2019) shall not exceed $5,798,557. Compliance & Quality Dr. Roybal reported that the Committee met on March 17 and he summarized the meeting Committee activities: Board of Governors Special Meeting February 14, 2016, Page 15 of 18 DRAFT 29 Dr. Carter reported that L.A. Care completed the HEDIS onsite audit in early March. G. Michael Roybal, MD Encounter Data capture has improved. L.A. Care demonstrated significant improvement in 11 measures. At a recent exit conference for a DHCS audit that was completed last July and August, repeat findings were noted in utilization management for timeliness, grievance and appeals categorization and timeliness, and there were new findings on provider network and directory compliance. L.A. Care is working with providers to improve on issues such as access and timeliness for provider appointments. The Committee received an update on L.A. Care’s outreach to providers about preventing balance billing. L.A. Care received a notice of non-compliance from Department of Health Care Services in this area. Online provider education takes about 15 minutes, and L.A. Care is notified when a provider completes the education. Expecting all providers to have completed online education by the end of April, to make sure providers understand they cannot conduct balance billing. The Committee reviewed and approved 2015 evaluations and 2016 work plans for the Quality Improvement, Utilization Management and Case Management Programs. Based on the 2015 evaluation, regulatory requirements and needs of the populations served, the activities in the 2015 Work Plan will continue into 2016, and 2016 Work Plan will also include: Tracking and trending of HEDIS performance for measures that are at less than the Minimum Performance Level: Refine L.A. Care Covered Quality Rating System Continue improvements in encounter data reporting Continue to educate providers on quality improvement Achieve NCQA Readiness for all product lines. Consolidate requirements and reporting for all lines of business in one work plan Refine internal committee composition and responsibilities Consolidate intervention work among L.A. Care, Plan Partners, PPGs and individual providers. A motion to approve a minor revision to Compliance & Quality Committee Charter was approved earlier on the Consent Agenda. Services Agreement Hector De La Torre, Chairperson, reported that the Committee met on February 29, 2016. Committee (Minutes are available by contacting Board Services). The Committee approved two motions: a contract with Michael S. Kenny & Co. to support the Hector De La Torre Los Angeles County Department of Health Services (DHS) project to strengthen managed care infrastructure, and an amendment to the contract with Health eConnex for claims processing that was approved earlier in this meeting on the consent agenda. Board of Governors Special Meeting February 14, 2016, Page 16 of 18 DRAFT 30 The Committee met in closed session and discussed Plan Partner Services Agreement and Provider Rates. There was no report from that closed session. Motion approved under Motion SAC 100.0416* Approved the Consent Agenda To authorize staff to amend the contract with Health eConnex in the amount of $531,000 unanimously on the (not to exceed total contract amount of $2,076,000) to provide optical character Consent Agenda. recognition and electronic data interchange services for paper claims documents from 11 AYES. May 1, 2016 to September 30, 2016. PUBLIC COMMENTS Demetria Saffore, CCI Council Area 1, stated that she wanted to elaborate on the situation that Member Perez talked about regarding the Antelope Valley Community Clinic. Ms. Saffore really likes their set up, and they have a lot of services under one roof. They see patients up to 8 pm and she thinks that’s because they do not have enough doctors at the clinic. It is a long wait to get an appointment. She asked for a list of new providers in Antelope Valley. Mr. Baackes agreed to provider Ms. Saffore with a list. Wilma Ballew, CCI Council Area 2, asked that CCI Councils are included in references to RCACs and ECAC. She encouraged board members to come to CCI Council and RCAC meetings and invited Board members to the upcoming RCAC 2 meeting at the Family Resource Center in Pacoima. She is concerned about the RCAC Ambassador program. She feels that if that program had worked the RCACs would have full membership. Think need to move forward and try something new. Stephanie Booth, MD asked if L.A. Care can help gather signatures for a ballot initiative to increase cigarette tax, Save Lives California.com, sponsored by the California Medical Association. Lemmon McMillan, MD, asked about the practice transformation grant and would like to know how the process worked and what the intent was for those grant funds. He also commented that weaker organizations need more support than weaker ones. Dr. Carter offered to send information to Dr. McMillan. Board Member Perez announced that the RCAC member election of nominees for the two board seats is scheduled for July 29, 2016. ADJOURN TO There was no Public Comment on the closed session items. Augustavia J. Haydel, Esq., General CLOSED SESSION Counsel, announced the following items to be discussed in closed session. The Board adjourned to closed session at 4:30 p.m. Louise McCarthy CONFERENCE WITH REAL PROPERTY NEGOTIATORS Section 54956.8 of the Ralph M. Brown Act Property: 2140 E. Palmdale Blvd., Palmdale, California Board of Governors Special Meeting February 14, 2016, Page 17 of 18 DRAFT 31 Agency Negotiator: John Baackes, Chief Executive Officer Negotiating Parties: Eric Treibatch, Ophir Management Services Inc. Landlord: 2042 Town Square West LLC and 8454 Steller Blvd., LLC Under Negotiation: Price and Terms of Payment CONFERENCE WITH LEGAL COUNSEL—EXISTING LITIGATION Pursuant to Section 54956.9(d)(1) of Ralph M. Brown Act: Name of case: Dignity Health and Northridge Hospital Medical Center v. L.A Care et al. (BC583522) Haydel: Augustavia J. Haydel, Esq., General Counsel, presented a motion requesting approval to initiate legal action against the California Department of Health Care Services (DHCS) for indemnity, breach of contract, and related causes of action, arising out of a complaint filed by Dignity Health and Northridge Hospital Medical Center (Northridge) against L.A. Care. CONTRACT RATES Pursuant to Welfare and Institutions Code Section 14087.38(m) Plan Partner Rates Provider Rates DHCS Rates REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Discussion Concerning New Product Lines Estimated date of public disclosure: April 2018
RECONVENE IN The Board reconvened in open session at 4:55 p.m. There was no report on action taken during OPEN SESSION the closed session. Louise McCarthy
ADJOURNMENT The meeting was adjourned at 4:55 pm.
Respectfully submitted by: APPROVED BY: ______Linda Merkens, Manager, Board Services Alexander Li, MD, Secretary Malou Balones, Committee Liaison Jennifer Carabali, Committee Liaison Date Signed ______
Board of Governors Special Meeting February 14, 2016, Page 18 of 18 DRAFT 32
Board of Governors MOTION SUMMARY
Date: May 5, 2016 Motion No. FIN 100.0516
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Accept the Investment Report for the 2nd quarter ended March 31, 2016.
Background:
Budget Impact:
Motion: To accept the Quarterly Investment Report for the 2nd quarter ending March 31, 2016, as submitted.
33 DATE: April 15, 2016 TO: Finance & Budget Committee FROM: Marie Montgomery, Chief Financial Officer
SUBJECT: Quarterly Investment Report – March 2016
As of March 31, 2016, L.A. Care's combined investments market value was approximately $1.93 billion. Interest income, realized and unrealized gains and losses were around $3.7 million for the quarter. Based upon an independent compliance review performed at the end of the quarter LA Care is in compliance with its investment policy guidelines pursuant to the California Government Code and the California Insurance code.
At quarter end $1.84 billion (or 95% of total investments) were under the management of Payden and Rygel, an external professional asset management firm. The nature of these invested funds was as follows:
Holdings: U.S. Agency Securities 44% U.S. Treasury Securities 23% Corporate bonds 16% Asset Backed and Mortgage Backed Securities 12% Money Market 4% Other 1%
Average credit quality: AA+ Average duration: 0.3 years Average yield to maturity: 0.5%
These funds are managed as two separate portfolios by Payden & Rygel based on investment style – 1) the short-term portfolio and 2) the low duration portfolio. The short-term portfolio had approximately $1.76 billion invested as of 3/31/2016 and returned 0.18% for the quarter. The comparative short term money market index used as a benchmark returned 0.02% for the quarter. The extended term portfolio had approximately $84 million invested and returned a 0.35% for the quarter. The comparative 1-year Treasury note used as a benchmark had a return of 0.36%.
34 LA Care also invests with 2 government pooled investment funds, the Local Agency Investment Fund (LAIF) and the Los Angeles County Pooled Investment Fund (LACPIF). In March 2016, an additional $14.3 million was invested in LAIF and an additional $10 million was invested in LACPIF bringing their quarter end balances to $64 million and $20 million, respectively.
Based on most recent available data, the Local Agency Investment Fund (LAIF) yielded approximately 0.47% annualized for the quarter. Its total market value as of 3/31/16 was $67.7 billion with a weighted average maturity of around 146 days. LAIF is administered and overseen by the State Treasurer’s office. The fund’s investment holdings as of March 31, 2016 were as follows:
U.S. Treasury Securities 47% CD’s and bank notes 16% Agencies 12% Loans 9% Time deposits 9% Commercial paper 7%
The Los Angeles County Pooled Investment Fund (LACPIF) yielded approximately 0.81% and 0.92% annualized for the months of January and February, respectively. (March data has not been released yet by LACPIF.)
LACPIF’s total portfolio market value as of 2/29/2016 was around $25.7 billion, with an average maturity of 541 days. LACPIF is administered and overseen by the Los Angeles County Treasurer. The fund’s most recent investment holdings (2/29/2016) was as follows:
U.S. Govt. and Agency Securities 54% Commercial paper 30% Negotiable CD’s 16%
35 Sperry Capital Inc.
April 13, 2016
Mr. Timothy Reilly Chief Financial Officer L.A. Care Health Plan 1055 West 7th Street, 10th Floor Los Angeles, CA 90017
Re: L.A. Care Health Plan Quarterly Investment Report January 1, 2016 through March 31, 2016
OVERVIEW
The California Government Code requires the L.A. Care Treasurer to submit a quarterly report detailing its investment activity for the period. This investment report covers the three-month period from January 1, 2016 through March 31, 2016.
PAYDEN & RYGEL PORTFOLIO SUMMARY
As of March 31, 2016 the market values of the portfolios as managed by Payden & Rygel are as follows:
Portfolios Payden & Rygel
Cash Portfolio #2365 $1,758,906,429.28
Low Duration Portfolio #2367 $ 84,165,001.39
Total $1,843,071,430.67
COMPLIANCE WITH THE ANNUAL INVESTMENT POLICY
Based upon an independent compliance review performed by Sperry Capital Inc. of the monthly investment reports prepared by Payden & Rygel, L.A. Care is in compliance with L.A. Care’s investment guidelines pursuant to the California Government Code and the California Insurance Code. The Payden & Rygel investment reports include a monthly transaction summary along with the current market values of the investments as of each month end. The Payden & Rygel investment reports for L.A. Care are available upon request.
LA Care has invested funds California’s Local Agency Investment Fund (LAIF), the Los Angeles
Three Harbor Drive, Suite 101 Sausalito, CA 94965 Tel: 415.339.9201 Fax: 415.339.6030 [email protected] 36 Sperry Capital Inc.
April 13, 2016 Page 2 of 4
County Treasurer’s Pooled Investment Fund (LACPIF), and a Bank of America Merrill Lynch (BAML) sweep account money market fund. In a LAIF statement dated April 11, 2016, the statement shows a March 31, 2016 balance of $63,997,799.00. In the LACPIF statement dated April 8, 2016, the LACPIF March 31, 2016 balance was $20,049,177.57. The LACPIF balance does not reflect accrued interest. In the BAML report as of March 31, 2016 LA Care had a $0.00 balance in the BAML market sweep account.
Copies of the LAIF, LACPIF, and BAML monthly statements are available for review.
California Government Code Compliance Verification Detail as of March 31, 2016
California Government Code Compliance Payden & Rygel Verification Detail as of March 31, 2016
Maximum Permitted Maturity Actual Maximum Maturity
#2365 #2367 #2365 #2367 Enhanced Cash Low Duration Enhanced Cash Low Duration Compliance
US Treasuries 5 Years 5 Years 2.5 Years 2.5 Years Yes
US Agencies 5 Years 5 Years 2.6 Years 2.6 Years Yes
State of CA, Locals 5 Years 5 Years 1.3 Years 1.3 Years Yes
Commercial Paper 270 Days 270 Days 33 Days 33 Days Yes
Negotiable CDs 270 Days 270 Days 130 Days 47 Days Yes
Corporates (MTNs) 5 Years 5 Years 2.9 Years 2.9 Years Yes
MM & Mutual Funds NA NA 1 Day 1 Day Yes
Mortgage/Asset-Backed 5 Years 5 Years 4.1 Years 4.0 Years Yes
37 Sperry Capital Inc.
April 13, 2016 Page 3 of 4
California Insurance Code Compliance Verification Detail as of March 31, 2016
Compliance Verification Combined #2365 and #2367 Portfolios as of March 31, 2016 Insur. Code Govt. Code Sections Section 1170-1182 53601 1191-1202
US Treasuries Yes (1)(2)(3) Yes (4)(5) US Federal Agencies Yes (1)(2)(3) Yes (4)(5) State of California & Agencies Yes (1)(2)(3) Yes (4)(5) Commercial Paper Yes (1)(2)(3) Yes (4)(5) Negotiable CDs Yes (1)(2)(3) Yes (4)(6) Corporate Notes Yes (1)(2)(3) Yes (4)(6) Money Market Funds Yes (1)(2)(3) Yes (4)(6) Mortgage/Asset Backed Yes (1)(2)(3) Yes (4)(6)
(1) Approved security (2) Meets minimum rating (3) Meets diversification maximums (4) NAIC High Grade Obligations (5) Authorized by Insurance Code Sections 1174 and 1194.5 (6) Authorized by Insurance Code Section 1196.1
MARKET COMMENTARY
The first quarter of 2016 saw unexpected volatility in the commodities and equity markets. As a result, a “flight to quality” was experienced in the taxable fixed-income markets. There was a steady supply of new-issue investment-grade corporates and a moderate supply of taxable municipals, and in both sectors this new supply consisted largely of highly rated bonds. Also, Treasury auctions were for the most part strongly subscribed.
Fixed-income markets held up to the pressures of the first quarter driven by the instability in oil, commodities, and equities. U.S. economic numbers, including rising housing starts, lower unemployment, and increased job participation, were moderately attractive. However, with global markets continuing to face severe challenges, the Federal Reserve pulled back to a dovish stance, so that now only two hikes are anticipated instead of four in 2016.
We expect the Federal Reserve to follow a slow and cautious path with regard to moving short-term rates, and we believe a low-rate environment will persist for some time.
38 Sperry Capital Inc.
April 13, 2016 Page 4 of 4
COMPLIANCE WITH THE ANNUAL INVESTMENT POLICY
Based on Sperry Capital’s review of Payden & Rygel’s month-end reports, L.A. Care’s Payden & Rygel’s portfolios were in compliance with its Annual Investment Guidelines and the California Government Code and the Insurance Code sections noted above. Based on Sperry Capital’s review of the LAIF and ACPIF March 2016 reports and their respective investment guidelines, the LAIF and LACPIF investments are in compliance with the Annual Investment Policy and the California Government Code and the California Insurance Code.
Sincerely,
James W. Martling Principal
Copy: Jason Chen, LA Care
39
QUARTERLY PORTFOLIO REVIEW
L.A. CARE HEALTH PLAN 1st Quarter 2016
PAYDEN.COM LOS ANGELES | BOSTON | LONDON | PARIS
40 LETTER FROM THE CEO
April 2016
Dear Client,
During the first quarter, investors weathered a squall in the credit and equity markets and awaited clues on the path of U.S. interest rates in 2016. Unfortunately, the Federal Reserve was not definitive about the timing of future rate increases, but focused on weaker global economic growth, deflation risk, and financial market volatility during the quarter. We would like to articulate our stance and how we have managed your portfolio in this environment.
First, in terms of US economic data, we remain upbeat. With 632,000 jobs added during the first quarter and the unemployment rate now at 5%, wage growth is finally picking up. As a result of the strong job market, people who left the workforce are returning and finding employment. As far as inflation is concerned, core measures, which exclude volatile energy prices, are in the area of 2% year-over-year. Low inflation, yes. Deflation, no.
Second, fears of a recession sparked by the decline in oil prices sent equity prices swooning and credit spreads wider in the first half of Q1. We think one of the most important roles of an investment manager is to stay calm when presented with market volatility – especially if the market moves contrary to our longer term views. We did not flinch, and given our fundamental view on the economy, we remain constructive on areas of the credit and equity markets unduly punished by fears of a recession.
In the bond market, the ¼ of a percent increase of the US federal funds rate in December had no impact on long term interest rates. While we anticipate one or two increases in short-term interest rates during the remainder of 2016, we do not foresee significant increases in longer term rates in the year ahead. Non-energy corporate balance sheets continue to be decently healthy and, in general, earnings expectations are favorable.
What can derail this outlook? The geo-political situation is unpredictable. However, it is not practical to make investment decisions based on unpredictable events. As the history of the firm has shown, our emphasis on liquidity, diversification, and taking action when necessary has served us well.
My very best wishes for the coming months.
Joan A. Payden
President & CEO
41 L.A. Care Health Plan Combined Portfolio Portfolio Review – 1st Quarter 2016
PORTFOLIO CHARACTERISTICS (As of 3/31/2016)
Market Value $1,843,071,430 Average Credit Quality AA+ Average Duration 0.3 years Average Yield to Maturity 0.5%
Sector Allocation MaturityAbsolute Return DistributionAbsolute Return
Market Value Percent Cash $25,476,686 1.4% Percent Market Value Money Market 72,487,120 3.9% <90 day 78.3% $1,442,903,989 Treasury 417,529,023 22.7% 90 days-1 year 10.7% 196,670,881 Agency 807,536,608 43.8% Credit 286,647,850 15.6% 1 - 2 years 9.4% 172,943,523 ABS/MBS 213,771,296 11.6% 2 - 5 years 1.7% 30,553,037 Municipal 19,622,847 1.1% 100.0% $1,843,071,430 $1,843,071,430 100.0%
PORTFOLIO RETURNS Periods over one year annualized
Periods ended 03/31/16 Trailing Trailing 1st Qtr 1 Yr 3 Yr Short Term Portfolio 0.18% 0.29% 0.26% Money Market Index* 0.02% 0.04% 0.02% Extended Term Portfolio 0.35% 0.54% 0.51% 1-year Treasury Note** 0.36% 0.40% 0.29% Combined Portfolio 0.19% 0.31% 0.30%
* iMoneyNet Institutional Money Market Yield Average ** Merrill Lynch 1-3 Yr Treasury Index from inception to 3/31/2010; Merrill Lynch 1-Yr Treasury Index thereafter.
42 Payden&Rygel l 333 S. Grand Avenue l Los Angeles, California 90071 l (213) 625-1900 l www.payden.com L.A. Care Health Plan Short Term Portfolio Portfolio Review – 1st Quarter 2016
PORTFOLIO CHARACTERISTICS (As of 3/31/2016)
Market Value $1,758,906,429 Average Credit Quality AA+ Average Duration 0.3 years Average Yield to Maturity 0.5%
Sector Allocation Maturity Distribution
Market Value Percent Percent Market Value Cash $25,071,826 1.4% Money Market 66,779,081 3.8% <90 day 79.6% $1,399,937,120 Treasury 396,764,262 22.6% 90 days-1 year 10.1% 177,083,987 Agency 791,487,103 45.0% 1 - 2 years 8.8% 154,541,820 Credit 259,290,011 14.7% 2 - 5 years 1.6% 27,343,502 ABS/MBS 200,995,537 11.4% Municipal 18,518,609 1.1% 100.0% $1,758,906,429 $1,758,906,429 100.0%
PORTFOLIO RETURNS Periods over one year annualized Periods ended 03/31/16 Trailing Trailing 1st Qtr 1 Yr 3 Yrs Short Term Portfolio 0.18% 0.29% 0.26% Money Market Index* 0.02% 0.04% 0.02%
* iMoneyNet Institutional Money Market Average
43 Payden&Rygel l 333 S. Grand Avenue l Los Angeles, California 90071 l (213) 625-1900 l www.payden.com Portfolio Review and Market Update – 1st Quarter 2016
MARKET THEMES
The first quarter of 2016 was extremely volatile, although the ending total return does not convey the turbulent ride. The first six weeks of the year highlighted worries over the fragile state of the global economy. Continued focus on a “hard landing” in China and falling commodity prices gave investors much to fret over. Government bonds rallied as investors sought protection from volatility, while credit spreads widened – a lot – and equities fell. In mid- February, however, stronger economic data out of the US and further action out of the European Central Bank and the Bank of Japan gave investors new hope. As oil prices stabilized and began to rise, earlier trends reversed. The quarter ended with government bonds selling off, credit spreads tightening, and equity markets rallying.
STRATEGY . The portfolio holds a diversified mix of credit sectors for income generation.
. Corporate bond yield premiums remain attractive, and we expect to maintain our exposure through the purchase of bonds in the new issue market.
. We maintain our allocation to high-quality asset-backed and mortgage-backed securities (ABS/MBS) with short duration profiles for their yield and diversification benefits.
INTEREST RATES
. Interest rates declined over the quarter, with the two year Treasury yield dropping 33 basis points from 1.05% to 0.72%. The US Treasury yield curve flattened, and the yield differential between two- and three-year maturities now stands at 13 basis points.
. Duration and curve positioning had a positive impact on performance.
. Longer-maturity corporate holdings contributed positively due to their higher income and price appreciation from a flattening of the yield curve.
SECTORS
. Credit yield premiums were volatile but ended the quarter unchanged. The overweight to credit added to performance as did individual security selection within corporates.
. High-quality ABS spreads held steady and contributed positively to performance, benefiting from higher income returns.
. There was minimal impact from MBS this quarter as spreads were volatile but ended the period only slightly wider, offsetting the return from yield.
44 Payden&Rygel l 333 S. Grand Avenue l Los Angeles, California 90071 l (213) 625-1900 l www.payden.com L.A. Care Health Plan Extended Term Portfolio Portfolio Review – 1st Quarter 2016
PORTFOLIO CHARACTERISTICS (As of 3/31/2016)
Market Value $84,165,001 Average Credit Quality AA Average Duration 0.6 years Average Yield to Maturity 0.8%
Sector Allocation Maturity Distribution
Market Value Percent Percent Market Value Cash $404,860 0.5% Money Market 5,708,039 6.8% <90 day 51.1% $42,966,869 Treasury 20,764,761 24.7% 90 days-1 year 23.3% 19,586,894 Agency 16,049,504 19.1% 1 - 2 years 21.9% 18,401,704 Credit 27,357,841 32.5% ABS/MBS 12,775,759 15.2% 2 - 5 years 3.8% 3,209,534 Municipal 1,104,237 1.3% 100.0% $84,165,001 $84,165,001 100.0%
PORTFOLIO RETURNS Periods over one year annualized
Periods ended 03/31/16 Trailing Trailing 1st Qtr 1 Yr 3 Yrs Extended Term Portfolio 0.35% 0.54% 0.51% 1-year Treasury Note* 0.36% 0.40% 0.29%
* Merrill Lynch 1-3 Yr Treasury Index from inception to 3/31/2010; Merrill Lynch 1-Yr Treasury Index thereafter.
45 Payden&Rygel l 333 S. Grand Avenue l Los Angeles, California 90071 l (213) 625-1900 l www.payden.com Portfolio Review and Market Update – 1st Quarter 2016
MARKET THEMES
The first quarter of 2016 was extremely volatile, although the ending total return does not convey the turbulent ride. The first six weeks of the year highlighted worries over the fragile state of the global economy. Continued focus on a “hard landing” in China and falling commodity prices gave investors much to fret over. Government bonds rallied as investors sought protection from volatility, while credit spreads widened – a lot – and equities fell. In mid- February, however, stronger economic data out of the US and further action out of the European Central Bank and the Bank of Japan gave investors new hope. As oil prices stabilized and began to rise, earlier trends reversed. The quarter ended with government bonds selling off, credit spreads tightening, and equity markets rallying.
STRATEGY
. The portfolio holds a diversified mix of credit sectors for income generation.
. Corporate bond yield premiums remain attractive, and we expect to maintain our exposure through the purchase of bonds in the new issue market.
. We maintain our allocation to high-quality asset-backed and mortgage-backed securities (ABS/MBS) with short duration profiles for their yield and diversification benefits.
INTEREST RATES
. Interest rates declined over the quarter, with the two year Treasury yield dropping 33 basis points from 1.05% to 0.72%. The US Treasury yield curve flattened, and the yield differential between two- and three-year maturities now stands at 13 basis points.
. The portfolio had positive returns from the rally in Treasury yields and performed inline with the index.
. Longer-maturity corporate holdings contributed positively due to their higher income and price appreciation from a flattening of the yield curve.
SECTORS
. Credit yield premiums were volatile but ended the quarter unchanged. The overweight to credit added to performance as did individual security selection within corporates.
. High-quality ABS spreads held steady and contributed positively to performance, benefiting from higher income returns.
. There was minimal impact from MBS this quarter as spreads were volatile but ended the period only slightly wider, offsetting the return from yield.
46 Payden&Rygel l 333 S. Grand Avenue l Los Angeles, California 90071 l (213) 625-1900 l www.payden.com MARKET PERSPECTIVE Negative Interest Rate Policy (NIRP): In Theory and In Practice In the first quarter of 2016, the Bank of Japan (BoJ) joined the Swiss National Bank, the Swedish Riksbank, the Danish Nationalbank, and the European Central Bank (ECB) as members of the NIRP brigade–the elite club of central banks with negative interest rate policies (see chart below). While NIRP grabbed headlines during the quarter, it remains to be seen whether such policy initiatives will boost economic activity.
NIRP in theory and NIRP in practice are two very different things. In theory, NIRP is supposed to boost aggregate spending in two ways–imposing a cost to save and weakening the domestic currency. First, negative interest rates impose a cost on those who wish not to spend money. In Japan and the euro area, banks with deposits at the central bank are “taxed” a negative interest rate for holding reserves. However, the impact of these negative rates has been limited as household depositors (i.e. the “real economy”) still receive positive yields.
The second way NIRP supposedly stimulates spending is by weakening the currency, thereby making exporters’ products cheaper versus global competitors. Just as traditional interest rate policy suggests lower interest rates weaken a domestic currency, negative interest rates theoretically have a more exaggerated effect on exchange rates. Unfortunately, for both the BofJ and the ECB, the yen and the euro have strengthened versus the dollar since their respective banks joined the NIRP brigade.
The jury is still out on NIRP’s effectiveness in practice, but the first quarter of 2016 left investors wondering: are central banks out of ammunition? Welcome to the NIRP Zone: Five Global Central Bank Policy Rates Are Below the Zero Lower Bound
4.0% Denmark: One-Week Certi icate o De osit 3.5%
3.0%
2.5%
2.0% Yield Yield 1.5% Sweden: One-week Debt Certi icates 1.0%
0.5% ECB: Overnight De osit Facility a an Swit erland: Overnight Sight De osit 0.0% -0.5% NIRP ZONE -1.0% 2009 2010 2011 2012 2013 2014 2015 2016 Source: Bank for International Settlements, Bloomberg *On January 29, 2016 the BoJ put in place a three tiered structure of rates,with one policy rate negative at -0.10%
47 OVER 30 YEARS OF INSPIRING CONFIDENCE WITH AN UNWAVERING COMMITMENT TO OUR CLIENTS’ NEEDS. LOS ANGELES | BOSTON | LONDON | PARIS PAYDEN.COM
US DOMICILED MUTUAL FUNDS CASH BALANCE US FIXED INCOME Payden/Kravitz Cash Balance Plan Fund Absolute Return Bond Fund EQUITY Cash Reserves Money Market Fund Equity Income Fund Core Bond Fund Corporate Bond Fund GLOBAL FIXED INCOME Floating Rate Fund Emerging Markets Bond Fund GNMA Fund Emerging Markets Corporate Bond Fund High Income Fund Emerging Markets Local Bond Fund Limited Maturity Fund Global Fixed Income Fund Low Duration Fund Global Low Duration Fund Strategic Income Fund TAX-EXEMPT FIXED INCOME US Government Fund California Municipal Income Fund
DUBLIN DOMICILED UCITS FUNDS EQUITY Global Bond Fund World Equity Fund Global Short Bond Fund FIXED INCOME Sterling Corporate Bond Fund – Investment Grade US Core Bond Fund Absolute Return Bond Fund USD Low Duration Credit Fund Global Emerging Markets Bond Fund Global Emerging Markets Corporate Bond Fund LIQUIDITY FUNDS Global Government Bond Index Fund Euro Liquidity Fund Global High Yield Bond Fund Sterling Reserve Fund Global Inflation-Linked Bond Fund US Dollar Liquidity Fund
For more information about Payden & Rygel’s, contact us at a location listed below.
LOS ANGELES BOSTON LONDON PARIS 333 South Grand Avenue 265 Franklin Street 1 Bartholmew Lane Representative Office Los Angeles, California 90071 Boston, Massachusetts 02110 London EC2N 2AX 54, 56 Avenue Hoche 213 625-1900 617 807-1990 United Kingdom 75008 Paris, France + 44 (0) 20-7621-3000 + 33-607-604-441
48
Board of Governors MOTION SUMMARY
Date: May 5, 2016 Motion No. FIN 101.0516
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Approve a contract amendment with Pacific Health Consulting Group to extend financial and strategic consulting services.
New Contract Amendment Sole Source
RFP/RFQ was conducted
Background: L.A. Care staff requests approval to extend a contract with Pacific Health Consulting Group (PHCG) from July 31, 2016 to May 31, 2017, in the amount of $440,000 (total contract not to exceed $1.215 million). L.A. Care has utilized the services of Bobbie Wunsch and Tim Reilly for several years for a range of projects including data analysis, executive-level strategic planning and advice, planning for strategic retreats, advising on federal, state, and local health policy issues, and for planning and implementation of the Cal-Medi Connect and Coordinated Care Initiative (CCI) programs.
Tim Reilly has most recently served as L.A. Care’s Chief (and Interim) Financial Officer. With this agreement he will provide consulting services related to state and federal rate issues, relations with Los Angeles County Department of Health Services, and executive support. Bobbie Wunsch will continue her work as a key contributor to the CCI programs. PHCG consulting services will be monitored by staff; and services can be discontinued prior to reaching the maximum terms of the agreement.
No request for proposal was conducted because the consultants are uniquely qualified to perform the services given their extensive knowledge of the industry and their familiarity with L.A. Care.
Budget Impact: Sufficient funds are budgeted in the Medicare Operations and Finance Services Departments for FY 2015-16.
Motion: To authorize staff to execute a contract extension in the amount of $440,000 (total contract not to exceed $1.215M) with Pacific Health Consulting Group to provide consulting services through May 31, 2017.
49
Board of Governors MOTION SUMMARY
Date: May 5, 2016 Motion No. ECA 100.0516
Committee: Executive Community Advisory Committee Chairperson: Elda Sevilla
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 April 13, 2016 ECAC meeting.
Name RCAC/CCI # Type of Member (Agency, if applicable) Maria Huerta RCAC 4 Consumer Nelly Martinez RCAC 4 Consumer Silvia Quezada RCAC 4 Consumer Belen Garcia RCAC 8 Consumer
50 April 27, 2016
TO: Board of Governors
FROM: John Baackes, Chief Executive Officer
SUBJECT: CEO Report – May 2016
Please find below an update on organizational activities that occurred in April 2016. Additional updates will be made at the May 5, 2016 Board meeting.
1. Update on Strategic Vision At the May 5, 2016 Board meeting, the second quarter progress update on execution of L.A. Care’s strategic vision (attached to this report) will be reviewed and discussed. Overall, L.A. Care is on track with the majority of activities designed to support execution of four overarching strategic priorities. They are listed below for your reference.
Clear lines of accountability that simplify processes and drive efficiency and excellence A network that aligns reimbursement with member risk and provider performance Tailored models of care for the specific needs of our member populations Recognized leader in improving health outcomes for low income and vulnerable populations
2. Value Initiative for IPA Performance L.A. Care is in the process of scheduling meetings with IPAs contracted directly with L.A. Care to review results of a newly developed performance “scorecard” and discuss ways to raise the bar on quality of care. The goal of this initiative is to create a network that consistently provides high quality care and excellent access to members. Metrics being evaluated include access and availability, HEDIS, member satisfaction, and utilization, among others.
In addition to the value initiative, L.A. Care continues to monitor the performance of the Community Access Network in the Antelope Valley in the areas of member access and network capacity.
3. Medi-Cal Enrollment and Redetermination Process Staff continue to work with the LA County Department of Public Social Services on monitoring the impact of the Medi-Cal redetermination (renewal) process on L.A. Care membership. As reported at the April 2016 Board of Governors meeting, due to system issues, the bulk of Medi-
51 Cal terminations due to beneficiaries no longer qualifying for Medi-Cal or not returning their paperwork could occur in June 1016. Staff is carefully monitoring enrollment and will continue with member outreach activities to help them avoid disruptions in coverage.
4. Care Navigator Apprenticeship Pilot Program for Community Clinics L.A. Care staff, in collaboration with external partner Worker Education & Resource Center (WERC), has completed the program design phase of our Community Clinic “Care Navigator Apprenticeship Pilot” (CNAP), approved by the Board of Governors on June 16, 2015. The purpose of CNAP is to train community health workers, using an apprenticeship model, and integrate them within a community clinic medical team, to assist patients in navigating and appropriately using the health care system, and connecting them to community resources to support their wellness and recovery. Upon completing the care navigator training modules, the apprentices shall be deployed to one of five clinics selected to participate in the pilot to work and continue their learning experience. On April 11, 2016, WERC released a CNAP request for applications inviting community clinics to apply to participate in the pilot. LA Care is scheduled to select five participating clinics in June 2016, select apprentices by July 2016, and launch the Apprenticeship Training Program in July of 2016. An advisory committee comprised of external partners including CCALAC, WERC, and clinic operations representatives have been instrumental in guiding L.A. Care’s program design process. The advisory committee will continue to stay involved throughout the launch of CNAP.
5. Events of Interest On April 7, 2016, L.A. Care participated in and staffed an outreach table at the North Hollywood Homeless Connect Day. The purpose of the event was to provide free, one-stop services for homeless or recently homeless people. Other agencies participating in the event included the LA County Departments of Public Social Services, Public Health, and Mental Health, the Department of Motor Vehicles, and many others. The event also offered free clothing, backpacks, showers, a mobile vision van, and pet supplies to visitors. L.A. Care staff passed out over 100 first aid kits and engaged nearly every visitor to our table. A certificate of appreciation was presented to staff from Councilmember Paul Krekorian’s office, who organized the event.
On April 16-17, 2016, L.A. Care partnered with High Desert Broadcasting to host a booth at the Poppy Festival at the Lancaster City Park. The L.A. Care booth received many visitors, and radio station 97.7 KTPI interviewed staff about L.A. Care’s new Community Access Network.
On April 18, 2016, I participated in a panel discussion at the Los Angeles Business Journal’s 2016 Healthcare Leadership Forum Awards. The purpose of the event was to discuss the state of health care, delivery of care, and impacts to businesses in Southern California. I was humbled to receive the Insurance CEO of the Year Award from LABJ.
On April 21, 2016, L.A. Care hosted a meeting and site visit for staff from the California Department of Managed Health Care (DMHC). The purpose of the meeting was informational and an opportunity for staff from both agencies to meet. L.A. Care has had a long standing, good working relationship with DMHC and looks forward to continued partnership.
Please find attached to my report a listing of events that L.A. Care sponsored in April.
52 Attachments: April 2016 sponsorship list Second quarter strategic vision progress update
53 April 2016 Participation and Sponsorship List
Event Date Organization Event Location Community Clinic 4/1/2016 Association of Los Angeles Health Care Symposium Hilton Orange County County
4/1/2016 ONEgeneration The Gala Skirball Cultural Center
Service Center for Mt. San Antonio 4/2/2016 Disabilities Athletics Faire Independent Life College, Walnut
4/2/2016 Rancho Los Amigos Amistad Gala Westin Long Beach
National Alliance on Bridging the Cultural Augustus F. Hawkins 4/9/2016 Mental Illness Divide High School
Hospital Association of 4/13/2016 Southern California Annual Meeting Santa Barbara (HASC)
Los Angeles Business Healthcare Leadership 4/18/2016 Los Angeles Journal Awards
Los Angeles 4/23/2016 KLJH - Taxi Production Women's Health Expo Convention Center
Mental Health Career 4/23/2016 The Wall Las Memorias USC Mark Taper Hall Conference
4/24/2016 All Access Entertainment Fiesta Broadway Broadway DTLA
St. John's Well Child and 4/24/2016 Movable Feast Park Plaza Family Center
Millennium Biltmore 4/28/2016 Familia Unida Salud to Love & Family Hotel
Latinas: Salud y Vida California Health 4/30/2016 Women's Health Lancaster Collaborative Conference
54 April 27, 2016
TO: Board of Governors
FROM : Jonathan Freedman, Chief Strategy Officer
SUBJECT: 2nd Quarter FY 2015-16 Organization Goals Progress Report
This progress report summarizes the status of organizational goals and tactics outlined in the Strategic Vision.
Among the notable activities for the second quarter are:
CSPplus Blueprint, which sets forth project work to improve Cal MediConnect in QNXT by July and move Medi-Cal claims processing by September 2016, was adopted.
Recruitment for Executive Directors for the remaining product lines (Cal MediConnect and Commercial Products) continued this quarter. The Executive Director for Cal MediConnect joined L.A. Care on April 19th. The infrastructure for product line accountability continues to be built through continued hiring of support staff and further definition of roles and responsibilities. Financial sustainability targets will be developed once all of the Executive Directors are in place.
The L.A. Care Community Access Network Antelope Valley (formerly Antelope Valley Community Access Network) was successfully launched for our members.
The PPG Performance Scorecard, now the “Value Initiative for IPA Performance” (VIIP) scoring tool, is being finalized by an interdisciplinary collaborative within L.A. Care. After multiple iterations, a final list of metrics has been selected and includes aggregated scores for HEDIS, Access to Care, Member Satisfaction with Clinical Groups, Utilization, and Encounter Timeliness. Meetings with the IPAs are being scheduled to initiate performance improvement discussions.
55 L.A. Care Strategic Vision (2015 – 2018) Quarterly Progress Report January – March 2016
Strategic Direction 1: Clear lines of accountability that simplify processes and drive efficiency and excellence Tactic Status Year 1 Milestones Updates 1.1 Ensure timely success of the core Medi-Cal design, build Q1, Oct-Dec 2015: Requirements development behind original schedule system conversion, to support and testing of October 31, 2015. Completion is now targeted for January 31, 2016. L.A. Care’s high-touch approach Remaining business requirement documents prioritized as highly critical. to serving members and Design and Build proceeding mainly in the Enrollment and Member providers. Conversion streams.
Lead: John Ounjian Q2, Jan-Mar 2016: CSPplus program refocused to address some operational and system issues for CMC for July and targeting an adjusted scope for Medi-Cal conversion, focused on Claims Payment, for September 1, 2016. 1.2 Identify and select competencies Define and select core Q1, Oct-Dec 2015: Internal and external resources and budget have been needed for the functions competencies including defined for the project. A vendor has been identified for competency performed at L.A. Care. leadership and key assessment and the project is in contract development. Key functional management roles for which to develop functional competencies have been defined Lead: Bob Turner competencies. and first group of trainers have been selected and scheduled to be certified by January 15, 2016.
Q2, Jan-Mar 2016: Planning sessions have been completed with the Leadership Team. Management and individual contributor focus groups were conducted to assist in identifying core, leadership, and management competencies that align with L.A. Care’s Strategic Priorities. 1.3 Conduct a talent assessment to N/A – this is primarily match employees’ skill sets with a year 2 tactic the competencies needed for the functions we perform and bridge the gaps through learning and development strategies.
1 Key: Green – all activities on track, Yellow – most activities on track, Red – most activities not on track
56 Tactic Status Year 1 Milestones Updates Lead: Bob Turner 1.4 Establish accountability for Design and implement Q1, Oct-Dec 2015: Executive Directors (EDs) for the following product product line performance, new org structure line population segments have been hired – Medi-Cal Plan Partners, including financial sustainability. Medi-Cal TANF/MCE, and Medi-Cal SPD/CCI. EDs are developing the infrastructure to support accountability for product line Lead: John Baackes performance. Recruitment is ongoing for the EDs for Cal MediConnect (CMC) and Commercial Products. Financial sustainability targets are being developed for budgeting purposes and will be formally established once all EDs are in place.
Q2, Jan-Mar 2016: Recruitment for Executive Directors for the remaining product lines (CMC and Commercial Products) continued this quarter. An ED for CMC was selected and will join L.A. Care on April 19, 2016. The infrastructure for product line accountability continues to be built with further definition of roles and responsibilities and continued hiring of support staff. Financial sustainability targets will be developed for budgeting purposes and will be formally established once all EDs are in place. 1.5 Improve our access to data by Enterprise Data Q1, Oct-Dec 2015: Successfully loaded five years of initial data for centralizing data management Warehouse (EDW) members, and providers for the Medi-Cal line of business into the and deploying the Enterprise framework and Enterprise Data Warehouse (EDW). Continuing to load additional Data Warehouse. infrastructure sources into the EDW, re-designing reports in Oracle Business implementation; initial Intelligence Enterprise Edition (OBIEE), and creating the necessary Lead: Tom Schwaninger data deployed Data Marts as required for the EDW.
Q2, Jan-Mar 2016: Progress from prior quarter continues. Operationalizing the nightly loading of data into the warehouse is a key priority including the raw enrollment and claims data files, which will enable better visibility of LAC data end to end. 1.6 Use data to drive decision- Create and staff Q1, Oct-Dec 2015: Outlined a structure for continuously assessing, making across product lines and Enterprise Integration improving and measuring core operations. This structure will involve functional areas by centralizing department the creation of: 1) a risk/planning management team to, with functional- enterprise data analytics and area and IT input, summarize “as-is” workflow and data integration, operationalizing data governance establish sensible operational measures, and prepare needs assessments; 2) a process improvement team to, with functional-area and IT input, Lead: Noah Paley develop process flows and functionality requirements that address assessed needs; and 3) a project management team to, with functional-
2 Key: Green – all activities on track, Yellow – most activities on track, Red – most activities not on track
57 Tactic Status Year 1 Milestones Updates area and IT input, develop budgets and execution timelines for implementing approved process improvement plans.
Q2, Jan-Mar 2016: Following the outlined structure provided in Q1, the three Enterprise Integration teams are currently being built. Planning Management has begun mapping the “as-is” workflow and data integration, with departmental and IT input, with the goal of achieving comprehensive, end-to-end “as-is” workflows for each health plan core function. Enterprise Integration has also guided the restructuring of the Data Governance Core Team and Council to focus on the Enterprise Data Warehouse; simultaneously, Enterprise Integration is establishing the foundation for the Portfolio Management Committee to collaborate, prioritize, and agree on Service Requests and Project Management Office projects in one enterprise-wide list.
3 Key: Green – all activities on track, Yellow – most activities on track, Red – most activities not on track
58 Strategic Direction 2: A network that aligns reimbursement with member risk and provider performance Tactic Status Year 1 Milestones Updates 2.1 Ensure an equitable distribution Execute contracts with Q1, Oct-Dec 2015: New five-year agreements with updated rates have of risk among MCLA and Plan Plan Partners, medical been executed with Anthem Blue Cross and Care 1st/Blue Partners. groups, and IPAs with Shield. Approximately 84% of MCLA lives are now assigned to PPG updated rates and contracts with updated rates and DOFRs. It is anticipated that 100% of Lead: Tim Reilly DOFRs MCLA lives will be assigned to contracts with updated rates and DOFRs by 3/1/2016. These figures exclude MCLA members assigned to DHS.
Q2, Jan-Mar 2016: Updated rates have been executed with all three Plan Partners (Anthem, Care 1st, and Kaiser). Approximately 97% of MCLA lives are now assigned to IPA contracts with updated rates and Division of Financial Responsibility (DOFRs) (excluding members assigned to DHS). New rates are anticipated by DHCS this year, which may require another analysis of member risk across providers and updated rate amendments. 2.2 Align high-risk members with Alignment of frail Q1, Oct-Dec 2015: We have collaborated with the Alzheimer’s providers most capable of elderly population with Association to bring training to our PPGs and internal Case serving their needs. appropriate providers Management staff in providing appropriate care coordination/case management for our members with cognitive disorders. We have also Lead: Trudi Carter provided a continuing medical education conference to Primary Care Providers (PCPs) where one of the topics is providing assessment and care for individuals with cognitive disorders.
Q2, Jan-Mar 2016: We continue to collaborate with the Alzheimer’s Association of Greater Los Angeles to educate internal Case Management and Behavioral Health staff in working with members and family of members with cognitive disorders. We have also formed an internal Frail Elderly Specialty workgroup to begin to identify this subpopulation and develop tactics to ensure proper alignment of members to providers. 2.3 Increase dual risk contracting Initiate discussions Q1, Oct-Dec 2015: (Metric: 150K Medi-Cal lives under dual risk arrangements for direct lines of with identified arrangement) Discussions with identified PPGs have been initiated. business. Participating Physician 3 PPG/Hospital completed, totaling 124,989 lives under dual risk Groups (PPGs) arrangements. Lead: Dino Kasdagly/Paul Van Duine
4 Key: Green – all activities on track, Yellow – most activities on track, Red – most activities not on track
59 Q2, Jan-Mar 2016: Initiative was temporarily put on hold due to concerns with internal oversight capabilities, and configuration/system issues. This strategic directive was re-launched in March 2016.
2.4 Reassess and enforce Development, Q1, Oct-Dec 2015: An interdisciplinary collaborative is drafting a 2016 performance standards for validation, and piloting version of a scoring tool. Much progress has been made for some providers in our networks. of PPG performance measures by translating separate scores and surveys into a normalized scoring tool merged score using the CMS recommended methodology of the Lead: Trudi Carter “Attainment Score.” Challenges persist in translating the various Compliance audit scores and comment-based feedback tools into an appropriately reflective numeric score. The tool will be finalized in February.
Q2, Jan-Mar 2016: The interdisciplinary collaborative continues refining the newly titled, “Value Initiative for IPA Performance” (VIIP) scoring tool. After various iterations, the final list of metrics has been selected and include aggregated scores for HEDIS, Access to Care, Member Satisfaction with Clinical Groups, Utilization and soon, Encounter Timeliness. These materials will be used in discussion with IPAs for performance improvement.
5 Key: Green – all activities on track, Yellow – most activities on track, Red – most activities not on track
60 Strategic Direction 3: Tailored models of care for the specific needs of our member populations Tactic Status Year 1 Milestones Updates 3.1 Improve our capability to Implement direct Q1, Oct-Dec 2015: The Antelope Valley Community Access Network develop and support direct network for Antelope (AV-CAN) became effective January 1, 2016 for Medi-Cal. networks for subpopulations Valley within our membership. Q2, Jan-Mar 2016: Renamed L.A. Care Community Access Network Antelope Valley (CAN AV), L.A. Care CAN AV was successfully Lead: Trudi Carter launched Additionally, L.A. Care is establishing a direct network of chiropractic and acupuncture practitioners in LA County in order to reduce our reliance on vendor networks. L.A. Care recently completed its analysis of CMC direct network contracting opportunities with the goal of reducing CMC opt-out rates. 3.2 Develop tailored population Develop and Q1, Oct-Dec 2015: The Cal MediConnect (CMC) model of care has health management programs for implement a new been updated to reflect current processes. A scope of work has been the unique needs of our model of care for the developed to outline activities necessary for tailoring the model of care vulnerable, high-risk, and other frail elderly (CMC only) to the CMC population and for improving the health management subpopulations. program. The SOW will be initiated in January 2016 with leadership from a consultant and key internal departments. Lead: Trudi Carter Q2, Jan-Mar 2016: Our engagement with a Model of Care consultant is fully underway and a project team structure, including an executive steering committee and multiple cross-functional work groups, has been implemented. The team’s key focus is to better engage frail dual members in Care Management through an in-home assessment process, re-aligned care management staffing, improved Delegated Support Team structure, and consistent messaging across clinical, member services, provider, and marketing outreach. 3.3 Pilot direct networks for certain Implement Antelope Q1, Oct-Dec 2015: The Antelope Valley Community Access Network member subpopulations. Valley Direct Network, (AV-CAN) became effective January 1, 2016 for Medi-Cal. Currently IMD Direct Network, evaluating other areas in L.A. County for direct network development. Lead: Dino Kasdagly/Paul Van and Transgender Direct Work on transgender network continuing. Duine Network (surgical component only) Q2, Jan-Mar 2016: The L.A. Care CAN AV was successfully launched. Provider Network Operations is currently evaluating CCI utilization data to identify direct network contracting opportunities. Development and deployment of a network strategy will occur in Q3.
6 Key: Green – all activities on track, Yellow – most activities on track, Red – most activities not on track
61 Strategic Direction 4: Recognized leader in improving health outcomes for low income and vulnerable populations Tactic Status Year 1 Milestones Updates 4.1 Develop an L.A. Care brand that Complete Q1, Oct-Dec 2015: Completed, aggregated and reviewed all L.A. Care articulates our value proposition. environmental scan internal consumer research for integration into the “Parent Brand” and develop planning. This includes Awareness and Image surveys for L.A. Care Lead: R. Lightner/F. Oaxaca workplan for Covered and Medi-Cal and focus groups for L.A. Care Covered and CMC. rebranding Milestone completion delayed due to other priorities.
Q2, Jan-Mar 2016: Conducted meeting with selected Leadership Team and management team members on the creative direction for the Parent Brand Refresh initiative. Feedback to be incorporated into the plan and presented in Q3.
4.2 Actively support safety net Optimize alternative Q1, Oct-Dec 2015: Safety Net Initiatives (SNI) and Quality Improvement providers’ ability to perform their data submission continue to support safety net providers (DHS) to improve their HEDIS delegated functions and succeed processes for DHS scores by working through data submission processes such as timelines, in managed care environment. HEDIS-related data sources, and format. This collaboration has increased transparency and health services communication channels between L.A. Care and DHS, resulting in a better Lead: Maria Calleros understanding of data gaps and strategies to remedy any potential data barriers. DHS will build on significant improvements for 20 measures from HEDIS Reporting Year 2015 for Reporting Year 2016. SNI also partnered with PNO and Facility Site Review (FSR) to implement a policy to reflect provider capacity of DHS attending physicians practicing fewer than 8 hours per week, and collaborated with IT, PMO, and PNO to document requirements for direct member assignment to DHS and Community Clinic providers.
Q2, Jan-Mar 2016: SNI continues to maintain a strong operational relationship with safety net providers via the Joint Operations Meetings with DHS and Managed Care Operations & Policy Roundtable meetings with CCALAC & HCLA IPA. Recent progress includes the completion of Phase I of the DHS Claims Backlog, through development, implementation, and maintenance of system changes, as well as reporting metrics to avoid future claims being misdirected to DHS in error. With the recent change in the CSPplus timeline for clinic assignment implementation from September 2016 to Q2 of CY2017, SNI is currently collaborating with
7 Key: Green – all activities on track, Yellow – most activities on track, Red – most activities not on track
62 IT, PMO, and PNO to explore alternative solutions to current DHS empanelment challenges. 4.3 Capitalize on our community ECAC/RCAC Q1, Oct-Dec 2015: Launched workplan project survey for all 15 advisory resources such as our public budget process areas, analyzed results, and results are in process of being vetted. advisory committees to ensure improved; CHIF CHIF grants broadened to include community wellness and prevention and that we are a responsive, grants broadened healthcare reform. Government Affairs is continuing work with legislature accountable and responsible (MCO tax models and legislative briefings) to advocate for organization partner in support of the L.A. and members. Care brand. Q2, Jan-Mar 2016: Lead: Jon Freedman Hosted the first Saturday Conference for 2016 on Behavioral Health Treatments in the Primary Care Setting on February 27, 2016 with 260 attendees. The Family Resource Centers are currently focused on expansion efforts. A 7,000 sq. ft. facility has been selected in the city of Palmdale. A motion for approval will be presented to the Board of Directors in April. Working with LA County and author’s office on SB 997 to ensure that children enrolled in Healthy Kids (0–5 yrs) and My Health LA (administered by LA County) have a seamless transition into Medi-Cal program. 4.4 Optimize the financially Determine Q1, Oct-Dec 2015: The FY 2015-2016 budget, which was approved by the responsible growth potential of membership and Board in September 2015, includes financial and membership targets for Cal MediConnect and L.A. Care financial targets for CMC and LACC product lines. The targets are being revised/updated in Covered. CMC and LACC January 2016 for approval by the Board.
Lead: John Baackes Q2, Jan-Mar 2016: The Board approved the revised FY 2015-2016 budget with updated financial and membership targets for CMC and LACC on February 4, 2016. Additional critical analyses of CMC and LACC growth potential will be conducted once Product Executive Directors are identified and established. 4.5 Foster innovative approaches to Begin LANES Q1, Oct-Dec 2015: HITEC-LA is on track to reach its meaningful use goal improving health status of our implementation, of 3,000 providers in 1Q 2016. LANES launch for DHS expected in 1Q members and the quality of care Community Health 2016. CMS awarded L.A. Care a Transforming Clinical Practice Initiative provided by our safety net. Worker program grant of up to $15.8M over four years to help 3,100 L.A. County clinicians piloted, CHIF grants improve care for patients with diabetes and/or depression. Los Angeles Lead: Jon Freedman broadened Practice Transformation Networks launched this quarter with Network Partner. Community Health Workers Advisory Committee formed.
8 Key: Green – all activities on track, Yellow – most activities on track, Red – most activities not on track
63 Q2, Jan-Mar 2016: HITEC-LA was awarded $10.8M over three years from DHCS to continue the program, which is expected to reach its meaningful use goal of 3,000 providers. The Advisory Committee selected Care Navigators as the Community Health Worker model best suited for local clinics. The Pilot has been renamed the Care Navigator Apprentice Pilot. In Q2, the Advisory Committee finalized: (1) standardize clinic readiness assessment (2) selection criteria for participating clinics (3) recruitment process and screening of Care Navigators (4) care Navigator job description & core competencies roles (5) Clinic participation Request for Application. Released the Community Health Investment Fund (CHIF) “Cross Sector Partnership” RFA, which addresses social determinants of health as well as preventive strategies that can be replicated in clinical and non-clinical settings.
9 Key: Green – all activities on track, Yellow – most activities on track, Red – most activities not on track
64 April 28, 2016
To: Board of Governors
From: Gertrude S. Carter, MD, Chief Medical Officer Subject: CMO Report for May 2016
Behavioral Health
The Behavioral Health Department has developed a Los Angeles county wide Universal Release Form to authorize member’s release of information concerning physical health, mental health, drug and alcohol diagnosis, HIV/AIDS information and genetic testing. This form was developed during workgroups over the last two years and included the participation of DMH, DHS, DPH and all five L.A. County Medi-Cal providers (L.A. Care, Kaiser, Care 1st, Anthem, Health Net and Molina). We are currently in the last stages of finalizing an operational processes for member revocation. Each entity’s subject matter experts and legal departments have reviewed and approved the Universal Release Form. The form is scheduled to “go-live” next month. The transition of the Behavioral Health Therapy benefit for members with Autism Spectrum Disorder has continued to be a successful and smooth process. Beginning in February 2016, the transition started with South Central Regional Center (30 members) and continued into March with Frank D. Lanterman Regional Center (51 members). We will transition the remaining five regional centers over the next five months. L.A. Care has continued to build an ASD Provider Network to encompass nearly 20 providers and will likely reach approximately 50-60 providers. We have continued to hold a monthly ASD stakeholders meeting with all seven regional centers as well as all five Los Angeles Medi-Cal Health Care Plan. We have attributed much of the success to the open communication and continuous forums for discussion created during these monthly meetings. Provider Continue Education Program
L.A. Care hosted or co-hosted a total of 60 Continuing Medical Education (CME) and Continuing Education (CE) trainings in 2015, of which 41 were CME trainings. The program continues to host daytime or evening trainings and weekend conferences in 2016. We have hosted a total of three Saturday conferences this year on Behavioral Health Treatments, Trauma Informed Care, and Pain Management in the Primary Care Setting. Additionally, we have hosted 16 CME/CE trainings in 2016.
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65 Case Management
Case Management is currently restructuring the Cal MediConnect Case Management program, structure, and operations. The restructure will support the new high-touch in the home Model of Care (MOC) currently being designed. The department also restructured Complex Case Management team for all lines of business team and reporting structure to strengthen the position for compliance under two management teams: Medicare & Non-Medicare. The department goal is to increase participation in the Interdisciplinary Care Team (ICT) meetings for members, PPGs, IHSS social workers, and PCPs. There has been an increase in participation from less than 10% to 20% for members and PCPs.
Healthcare Outcomes & Analysis
HO&A has led the programming and documentation for Strategic Goal 2, Tactic 4 for a view on PPG clinical and operational excellence incorporating HEDIS rates, access to care, member satisfaction, and utilization akin to other publically reported ratings. Multiple departments have participated in the process. We are also collaborating with Plan Partners in joint efforts in disseminating information and goal development with shared PPGs. L.A. Care’s contract with the current HRA vendor, APS Healthcare, will end June 30, 2016. The decision has been made to bring the entire HRA process internally in order to align with our long-term strategic goals. The HRA questionnaires will be built into CCA (QNXT). This coincides with Case Management being implemented in CCA in June of 2106. The HRA process is being redesigned to leverage our Member Services Welcome Call. For the CMC HRA, a major goal will be to improve the face-to-face completion rate. Performing the in-home HRA will allow the plan to gain insight on ways to improve patient safety, home and community service needs, and improve overall coordination of services.
Utilization Management
Two key management directors have been added to the UM leadership team. Dr. Joseph Spooner, Medical Director of Clinical Provider Services and Michele Gibony, RN, Senior Director of Clinical Provider Services.
In December 2015, L.A. Care responded to DHCS request for Plan’s to submit materials addressing the administration of the MediCal transportation benefit. L.A. Care worked Health Services and UM staff worked with Plan Partners to identify how the benefit is currently administered and developed a common set of criteria and services for transportation services consistent with the new DHCS requirements. In April 2016, DHCS approved the revisions made to L.A. Care member materials and the L.A. Care UM policy addressing the administration of the transportation benefit. L.A. Care will be working with member advocates and our transportation vendor to develop a seamless member centric process to facilitate provisions of transportation services.
Grievance and Appeals
The Grievances and Appeals department continues to address key areas identified during the CMS quarterly submissions in the 2015 DHCS audit. The areas addressed include: standard definitions relevant to grievances and appeals, timeliness of processing grievances and appeals, member and provider correspondence, and tracking & trending for improvement in A&G. Significant work on these items have
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66 resulted in completion of definitions and sharing of these definitions across the organization including member services, utilization management, and quality. Continued process re-design to improve timeliness by eliminating bottlenecks. Finally, improvements to the G&A system PCT that features automatic correspondence as well as tracking & trending.
Managed Long Term Services and Supports (MLTSS)
MLTSS partnered with Alzheimer’s Greater Los Angeles to create professional training webinars aimed at a better dementia-capable system of care. Three webinars have trained multidisciplinary staff at L.A. Care Health Plan and provider groups. The first training reached 18 Community Based Adult Services (CBAS) and Long Term Care (LTC) Nursing Facility providers in March 2016. In this training, Dr. Rafael Amezcua focused on incorporating cognitive screening into routine practice; best practices in medication and non- medication treatments for people with dementia; prioritizing key post-diagnostic disease management items; and connecting caregivers to community-based resources and services. A two-part series engaged 95 L.A. Care MLTSS, Case Management and Behavioral Health staff in April 2016. Jennifer Schlesinger, Director of Professional Training and Healthcare Services at Alzheimer’s Greater Los Angeles, delivered both parts: (1) Fundamentals of Alzheimer’s Disease for Care Managers; and (2) Effectively Managing the Behavioral Symptoms of Alzheimer’s Disease.
MLTSS and the L.A. Care communications Department surveyed 475 L.A. Care members’ caregivers (43% of whom are In-Home Support Services [IHSS] workers) on their needs. Two-thirds said they had had no training; more than half reported feeling overwhelmed; less than 5% had received support from community service providers. Following the survey, two caregiver focus groups took place in April 2016. We will launch a MLTSS caregiver support initiative later in 2016 based on the survey and focus group data.
Quality Improvement
Childhood Immunization: The department is continuing our Rapid Cycle Process Improvement Project in collaboration with Watts Health. We are moving into the Plan-Do-Study-Act phase with an initial focus on appointment scheduling to help children stay on track with respect to the recommended childhood immunization schedule. Separately, LAC met with the LA County Immunization Program to explore opportunities to improve childhood immunization. In collaboration with Anthem, we have identified high volume/low performing PCP practices and will be following up with the County Immunization Program to map out a strategy to prioritize the list and set up site visits. Results of recent survey of PCPs have been tabulated both at the PPG and individual provider level. Although we did not attain our overall health plan target we have made incremental improvements. We will continue the ongoing monitoring, corrective action plans. The PPG results will have been shared with the groups and will be discussed in upcoming telephonic meetings. Health Information Technology (HIT) HITEC-LA achieved its goal of 3,000 providers at meaningful use under the Health IT Regional Extension Center program, which is winding down to end June 2016. HITEC-LA will continue meaningful use support under the California Technical Assistance Program to assist 2,165 Medi-Cal providers. Contracts with California Department of Health Care Services and vendors were finalized; provider enrollment started, program infrastructure was established, and budgets were developed.
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67 TCPI reached its enrollment goal of 3,100 clinicians. Practice assessments for 18 organizations covering 1,410 clinicians were completed. Collection of baseline quality and cost data started. Coaching and technical assistance to clinicians is expected to begin 3Q 2016. We are well on our way to a successful grant implementation.
Los Angeles Network for Enhanced Services (LANES) completed technical launch and is preparing to populate L.A. County Department of Health Services data to go live 3Q 2016. LANES finalized its data exchange participation agreement (DEPA), received certification, finished privacy and security reviews, developed its pricing schedule, and has ten significant prospective participants including hospitals, payers, and clinics. L.A. Care is reviewing the DEPA and is expected to contract with LANES in 2016.
Pharmacy
The Medicating Therapy Management (MTM) 2015 results show a much improved Comprehensive Medication Review rate of 52% up from 21% in 2014. We continue to work to reach more members and providers to complete more CMRs. The department negotiated an agreement with JWCH Pharmacy to provide direct observation therapy (DOT) of Hepatitis C medications to our members on skid row starting 4-1-16. We anticipate that this will result in an improvement in adherence and completion of the Hepatitis C treatment regiments in this population in addition to the avoidance of waste of these very expensive drugs. We are continuing internal program to improve adherence to chronic disease medications while analyzing the results of the same from 2015.
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Board of Governors MOTION SUMMARY
Date: May 5, 2016 Motion No. BOG 100.0516
Committee: Chairperson: Mark Gamble
Issue: Staff is requesting approval to amend and extend the current contract with JAR Insurance Services (JAR) in the amount of $696,000 (not to exceed $5,035,894).
New Contract Amendment Sole Source RFP/RFQ was conducted
Background: L.A. Care staff requests approval to amend the contract with JAR Insurance Services (JAR) in the amount of $696,000 (not to exceed $5,035,894) through May 31, 2017. The funds will be utilized to pay agent commissions for the Medicare Advantage Special Needs Plan (DSNP) retained members that transitioned to Cal MediConnect (CMC).
JAR is an agency specializing in Medicare Advantage and DSNP plans that L.A. Care contracted with to enroll dual eligible beneficiaries in the DSNP line of business. The closure of the DSNP plan generated a transition of DSNP members enrolled by the agency into the CMC product. JAR currently has retained 1,249 original DSNP members in CMC, and receives residual commission payments for those member enrollments.
A competitive selection process among four agencies resulted in the selection of JAR Insurance Services. Evaluation criteria included the ability to provide licensed and Medicare certified agents fluent in the preferred languages of prospective beneficiaries. The vendor’s multi-lingual capabilities included Spanish, Chinese, Farsi, Korean and Tagalog.
The Centers for Medicare and Medicaid Services (CMS) establishes the commission paid to agents. Agents are compensated only for retained DSNP members enrolled in the CMC product. Funding for agency contracts is reviewed after the Medicare Open Enrollment period to evaluate the amount required for their purchase orders. The funding requested will fulfill the term of JAR’s current contract and will extend the contract through May 31, 2017. L.A. Care anticipated this contract extension to support the retention of DSNP converted CMC members.
Budget Impact: Sufficient funds are budgeted in Sales and Marketing for FY2015-16 and will be forecasted for FY2016-17.
Motion: Approval to amend the existing contract with JAR Insurance Services in the amount of $696,000 (total contract not to exceed $5,035,894) for Medicare Advantage Special Needs Plan (DSNP)Cal MediConnect member retention through May 31, 2017.
69
Board of Governors MOTION SUMMARY
Date: May 5, 2016 Motion No. BOG 101.0516
Committee: Chairperson: Mark Gamble
Issue: Execute a contract with Echo, Inc. to provide nurse advice line software.
New Contract Amendment Sole Source RFP/RFQ was conducted
Background: L.A. Care staff requests approval to execute a two-year contract with Echo, Inc. from September 1, 2016 to August 31, 2018 in an amount not to exceed $250,000. The vendor will provide software to assist the Los Angeles County Department of Health Services (DHS) with implementation of an in-house nurse advice line which will be staffed by DHS nurses.
With the Safety Net Transition & Support Agreement, L.A. Care established the DHS Quality Improvement Program (QIP) to support DHS quality improvement and transformation efforts in connection with providing patient services. In accordance with QIP policies and procedures, DHS submitted a request in February 2016 for L.A. Care to procure nurse advice line software using available QIP funds. Implementation of the software will improve patient experience and promote appropriate utilization of health services. Additionally, the software will enable DHS to assist patients with health questions by phone, and DHS nurses will be able to use the software to centralize all patient health inquiries in ORCHID, the DHS patient data system.
DHS intends to launch the system, which will be housed at LAC+USC, by September 1, 2016. The nurse advice line will be available to all DHS patients for after-hour inquiries from 4 p.m. to 8 a.m. in the initial 3-6 months after launch. Thereafter, the nurse advice line will be available 24 hours, seven days a week.
Echo, Inc. was chosen through a competitive request for proposal process in March 2016. Three vendors responded to the request, and a review committee of DHS staff selected Echo, Inc. because of their competitive price and superior customer support.
Budget Impact: There is no budget impact on L.A. Care. The DHS Quality Improvement Program will cover all expenditures stemming from the contract with Echo, Inc.
Motion: To authorize L.A. Care to execute a two-year contract with Echo, Inc. in an amount not to exceed $250,000 from September 1, 2016 to August 31, 2018, for nurse advice line software to support the Los Angeles County Department of Health Services.
70 Information Security Management Program
L.A. Care Board of Governors May 5, 2016
71 Introduction
Last year, for the first time, healthcare led all industry sectors in cyber attacks . IBM called 2015 the “Year of the Healthcare Security Breach” . More than 100 million (34% of) healthcare records were compromised last year among health plans and hospitals, compared to just 0.63% records compromised 2011-2014
Hacking and malware (including ransomware) breaches have risen dramatically, as healthcare organizations are considered softer, “prime” targets due to: • Historically lower investment in IT (compared to financial and other institutions) • Variety in types/ages of healthcare data sources/stores • Ever-increasing volume, sensitivity and velocity across networks of Protected Health Information (PHI) – its growing electronic capture and dissemination adds vulnerabilities • PHI has higher value on the black market than credit card data
Security preparedness has elevated in priority not only internally within healthcare organizations, but also among their partners and regulators
72 Strengthening Our Defenses
L.A. Care is launching a formal Information Security Management Program to further mitigate potential threats, building on our current activities and expanding our use of industry standard tools including:
. Data loss prevention for PHI scanning and control . Intrusion prevention at the network level . Multi-factor authentication for all remote access & mobile device encryption . Data at rest encryption to protect member information . Annual security penetration testing & risk assessments to identify and address vulnerabilities
In addition to technology measures, the entire organization must be familiar with and comply with security policies and procedures to successfully mitigate risks, maintain appropriate levels of vigilance and improve resiliency
73 Goals of Our Formalized Information Security Program
Members’ information PROTECT LA Care’s assets, resources and intellectual properties
Disruption of business operations and loss of productivity PREVENT Subsequent financial losses MINIMIZE Loss of organization’s reputation Violation of laws, regulations and non-compliance
MONITOR Identify and investigate potential security incidents RESPOND Limit the damage of the incident and find the root cause RECOVER Expedite incident resolution and recovery to normalcy Provide appropriate notifications
74 Summary Approach (Formalized program to be rolled out over the next 24 months)
Information Security Officer (Louis Anumudu) hired 11/15 2 Sr. Security Analysts being recruited; planned to be hired by 7/16 Efforts guided by ISO 27001 (international standard)
Phase 1 Phase 2 Phase 3 Phase 4
Information Security Maturity Assessment
Security Strategy and Planning
Execution, including Information Security Policy Review and Documentation
Measure (Metrics)
Ongoing Operational /Tactical Information Security Activities
12/16 6/16 9/16 6/17 12/1775 ISO 27001 Roll-Out Methodology
Information Security Management Program Milestones - Based on staffing by 7/01/2016:
7/16 9/16 12/16 6/17 9/17 12/17
76 Our Continuing Focus on Information Security
Experts agree perfect security is impossible
Thus far, no major incidents at L.A. Care Recent PenetrationTest results were favorable We remain vigilant and diligent; however the bar is ever-rising with evolving threats; as such,
Further enhancements & investments are ongoing in order to detect, deter and respond to incidents
77 L.A. Care State Legislative Matrix Updated as of April 25, 2016
The following matrix contains key state legislation being tracked by L.A. Care’s Government Affairs Department. This list does not include all legislation currently being monitored; instead, this is a shortened list Government Affairs for your information. If there are any questions, please contact Cherie Fields, Director of Government Affairs, at [email protected] or by telephone at (916) 930-0043.
AB 73 AUTHOR: Waldron[R] TITLE: Patient Access to Prescribed Antiretroviral Drugs SUMMARY: Provides, to the extent permitted by federal law, that if medically necessary antiretroviral drugs used in the treatment of HIV/AIDS is prescribed by a Medi-Cal beneficiary's treating provider for that purpose, and coverage for that drug is denied by a Medi-Cal managed care plan in which the beneficiary is enrolled, that denial shall be reviewed in accordance with these provisions. Provides the conditions under which that patient would be entitled to an automatic urgent appeal. POSITION: Watch; CAHP – Watch SPONSOR: Author DISPOSITION: Senate Health Committee
AB 211 AUTHOR: Gomez[D] TITLE: In-Home Supportive Services SUMMARY: Modifies the definition of the Coordinate Care Initiative for the purposes of determining which provisions become inoperative if the condition is not met, and excludes, among others, those provisions that establish the In-Home Supportive Services Employer-Employee Relations Act. Establishes the Statewide Authority and determines the duties of, and when those duties are assumed by, the Authority. Establishes the IHSS Fund. Requires counties to pay the County IHSS Maintenance of Effort. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate Inactive File
AB 533 AUTHOR: Bonta [D] TITLE: Health Care Coverage: Out-of-Network Coverage SUMMARY: Requires a health care service plan contract or insurance policy to provide that if an enrollee or insured receives covered services from a contracting health facility, at which, or as a result of which, the enrollee receives covered services provided by a nonparticipating provider, the enrollee or insured would be required to pay the professional only the same cost-sharing required if the services were provided by a contracting professional. Provides for dispute resolution process and related contracts. POSITION: Watch; CAHP – Watch SPONSOR: Health Access DISPOSITION: Assembly
78 Government Affairs AB 635 AUTHOR: Atkins [D] TITLE: Medical Interpretation Services SUMMARY: Requires the State Department of Health Care Services to seek federal funding to establish a program to provide and reimburse for certified medical interpretation services except sign language interpretation services, to Medi-Cal beneficiaries who are limited English proficient. Offers medical interpreter services to Medi-Cal providers serving beneficiaries on either a fee-for-service or managed care basis. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate Inactive File
AB 796 AUTHOR: Nazarian[D] TITLE: Health Care Coverage: Autism: Pervasive Disorders SUMMARY: Extends the operation of existing law which requires insurance coverage for behavioral health treatment for pervasive developmental disorder or autism. Requires the Board of Psychology to convene a committee to create a list of evidence-based treatment modalities for purposes of behavioral health treatment for pervasive development disorder or autism, and to post the list on the Board's Internet Web site. POSITION: Watch; CAHP – Watch SPONSOR: DIR Floor Time Coalition DISPOSITION: Senate Health Committee
AB 1568 AUTHOR: Bonta [D] TITLE: Medi-Cal: Demonstration Project SUMMARY: Establishes the Medi-Cal 2020 Demonstration Project Act. Retains the continuously appropriated Demonstration Disproportionate Share Hospital Fund for safety net care pool payments. Provides for the Global Payment Program, the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program and the Dental Transformation Initiative. Amends the contract with the external quality review organization regarding assessment of primary, core specialty, and facility access to care for managed care beneficiaries. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Health Committee
AB 1696 AUTHOR: Holden [D] TITLE: Medi-Cal Tobacco Cessation Services SUMMARY: Provides that tobacco cessation services are covered benefits, subject to utilization controls, under the Medi-Cal program. Requires such services to include all intervention recommendations, as periodically updated, assigned a specified grade by the U.S. Preventive Services Task Force, and a specified number of quit attempts per year. Includes approved medication. Requires guidelines and agreements to allow a smoker's hotline to furnish nicotine replacement therapy, and guidelines to managed care programs. POSITION: Watch; CAHP – Oppose SPONSOR: Cancer Society DISPOSITION: Assembly Appropriations Committee
79 Government Affairs AB 1715 AUTHOR: Holden [D] TITLE: Healing Arts: Behavioral Analysis: Licensing SUMMARY: Increases the number of members that constitute a quorum of the Board of Psychology. Enacts the Behavior Analyst Act. Invests the enforcement of the Act with the Board. Requires the Board to post licensure information for behavior analysts and interns. Requires a license prior to engaging in related activities. Provides the details for the obtaining of a license including education, background checks, and the payment of related fees. POSITION: Watch; CAHP – Support if Amended SPONSOR: California Association for Behavioral Analysis DISPOSITION: Assembly Appropriations Committee
AB 1739 AUTHOR: Waldron [R] TITLE: Medi-Cal Allergy Testing SUMMARY: Requires the State Department of Health Care Services to treat specified allergy tests as equivalent in their sensitivity and accuracy for confirming the existence of an allergy in a patient, and to provide the same standard of coverage for either test for those individuals with a medical history consistent with specified conditions. Requires the Department to update its provider bulletins to reference the most current professional literature and guidance relating to allergy testing. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 1763 AUTHOR: Gipson [D] TITLE: Health Care Coverage: Colorectal Cancer: Screening SUMMARY: Requires a health care service plan contract or a health insurance policy to provide coverage for colorectal cancer screening examinations and laboratory tests, require the coverage to include additional colorectal cancer screening examinations and laboratory tests recommended by the treating physician if the individual is at high risk for colorectal cancer. POSITION: Watch; CAHP – Oppose SPONSOR: American Cancer Society; California Colorectal Cancer Coalition DISPOSITION: Assembly Appropriations Committee
AB 1808 AUTHOR: Wood [D] TITLE: Minors: Mental Health Services SUMMARY: Authorizes a marriage and family therapist trainee and a clinical counselor trainee to provide certain services to a minor, including mental health treatment or counseling services on an outpatient basis or residential shelter services. Requires such trainees to consult with their supervisor when assessing the maturity of a minor to participate in related services. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate
80 Government Affairs AB 1831 AUTHOR: Low [D] TITLE: Health Care Coverage: Prescription Drug: Refills SUMMARY: Requires a health care service plan contract or health insurance policy that provides coverage for prescription drug benefits to allow for early refills of covered topical ophthalmic products at a specified percentage of the predicted days of use. POSITION: Watch; CAHP – Watch SPONSOR: CA Academy of Eye Physicians & Surgeons; CA Optometry Association DISPOSITION: Assembly Appropriations Committee
AB 1839 AUTHOR: Patterson [R] TITLE: Health Benefit Exchange: Enrollment Options SUMMARY: Requires the State Health Benefit Exchange's enrollment system to be upgraded so an enrollee whose family income qualifies him or her for subsidized coverage, but only qualifies children in the household 19 years of age or younger for Medi-Cal, would be presented with the option of either enrolling in a plan with subsidized coverage for himself or herself and enrolling their eligible child or children in Medi- Cal, or enrolling in a single plan for the family. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Health Committee
AB 1863 AUTHOR: Wood [D] TITLE: Medi-Cal: Federally Qualified Health Centers SUMMARY: Includes a marriage and family therapist within those health care professionals cover under a specified definition. Requires a federal qualified health center or rural health clinic that currently includes the cost of services for such therapists for the purpose of establishing its rate to apply for an adjustment to its per-visit rate, and to bill these services as a separate visit. Requires such entities that elect to add these services, to process these services as a change in scope of service. POSITION: L.A. Care - Support; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 1915 AUTHOR: Santiago [D] TITLE: Alcohol and Drug Programs: Facility Expansion SUMMARY: Authorizes a program for making grants or loans to residential treatment centers that are expanding services or to substance use disorder treatment service facilities that are expanding to provide residential treatment services. Establishes a related fund. Transfers funds from the General Fund to that fund to implement the program. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Health Committee
AB 1954 AUTHOR: Burke [D] TITLE: Health Care Coverage: Reproductive Health Care Services SUMMARY: Prohibits every health care service plan contract or health insurance policy, with exceptions, from requiring an enrollee or insured to receive a referral in order to receive productive or sexual health care services. POSITION: Watch; CAHP – Oppose SPONSOR: CA Family Health Council; CA Latinas for Reproductive Justice; NARAL Pro- Choice CA DISPOSITION: Assembly Appropriations Committee 81 Government Affairs AB 1977 AUTHOR: Wood [D] TITLE: Opioid Abuse Task Force SUMMARY: Requires health care service plans and health insurers to convene an Opioid Abuse Task Force for the purpose of developing recommendations regarding the abuse and misuse of opioids. Requires the task force to submit a report detailing its findings and recommendations to specified government entities. POSITION: L.A. Care - Support; CAHP – Oppose SPONSOR: N/A DISPOSITION: Assembly Health Committee
AB 2004 AUTHOR: Bloom [D] TITLE: Hearing Aids: Minors SUMMARY: Requires a health care service plan contract or health insurance policy to include coverage for hearing aids for an enrollee or insured under a specified age. POSITION: Watch; CAHP – Oppose SPONSOR: Author DISPOSITION: Assembly Appropriations Committee
AB 2050 AUTHOR: Steinorth [R] TITLE: Health Care Coverage: Prescription Drugs: Refills SUMMARY: Requires a health care service plan or health insurance policy that provides coverage for prescription drug benefits to implement a medication synchronization policy for the dispensing of prescription drugs so that prescriptions that are refilled at the same frequency may be filled concurrently. POSITION: Watch; CAHP – Watch SPONSOR: Pharmacists DISPOSITION: Assembly Appropriations Committee
AB 2077 AUTHOR: Burke [D] TITLE: Health Care Eligibility, Enrollment, and Retention Act SUMMARY: Relates to the Health Care Reform Eligibility, Enrollment, and Retention Planning Act. Establishes procedures to ensure eligible recipients of insurance affordability programs move between the Medi-Cal program and other insurance affordability programs without any breaks in coverage as required in existing law. Requires an individual's case to be run through a specified system that deals with individuals whose circumstances change or is reevaluated for eligibility for insurance. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 2084 AUTHOR: Wood [D] TITLE: Medi-Cal SUMMARY: Provides that comprehensive medication management (CMM) services are a covered benefit under the Medi-Cal program. Includes, a written medication treatment plan designed to resolve documented medication therapy problems and to prevent future medication therapy problems. Requires the evaluation of the effectiveness of CMM on quality of care, patient outcomes and, total program costs. POSITION: Watch; CAHP – Concern; LHPC – Concern SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
82 Government Affairs AB 2095 AUTHOR: Allen [R] TITLE: Medi-Cal: Prescriptions SUMMARY: Requires the Legislative Analyst's Office to conduct or cause to be conducted a study comparing the purchase or administration of brand name prescription medications through the Medi-Cal program to the purchase or administration of biosimilars through the Medi-Cal program. Requires the study to cover specified fiscal years. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Health Committee
AB 2108 AUTHOR: Waldron [R] TITLE: Medi-Cal: Adult Dental Services SUMMARY: Requires the State Department of Health Care Services to report to the Legislature on the cost and feasibility of restoring full adult dental services as a covered benefit under the Medi-Cal program. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Health Committee
AB 2115 AUTHOR: Wood [D] TITLE: Health Care Coverage: Disclosures SUMMARY: Relates to health care coverage disclosures. Requires every disclosure form issued by a health care service plan or insurer for group benefit plan to include a statement that the person may be eligible for reduced-cost coverage through the State Health Benefit Exchange, no-cost coverage through Medi-Cal, coverage through an insured spouse or parent, or free or discounted prescription medicines through a manufacturer's patient assistance program. Requires a statement regarding patient assistance programs. POSITION: Watch; CAHP – Oppose SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 2207 AUTHOR: Wood [D] TITLE: Medi-Cal: Dental Program SUMMARY: Requires the Department of Health Care Services to undertake specified activities for the purpose of improving the Medi-Cal Dental Program, such as expediting provider enrollment and monitoring dental service access and utilization. Requires a Medi-Cal managed care health plan to provide dental health screenings for eligible beneficiaries and refer them to the appropriate Medi-Cal dental providers. Relates to data regarding the dental fee-for-service dental program. POSITION: Watch; CAHP – Watch SPONSOR: DHCS (unofficially) DISPOSITION: Assembly Appropriations Committee
83 Government Affairs AB 2209 AUTHOR: Bonilla [D] TITLE: Health Care Coverage: Clinical Care Pathways SUMMARY: Requires a health care service plan or health insurer that adopts the use of a clinical pathway to comply with certain requirements, including that the plan or insurer ensures each such pathway is developed in accordance with specified procedures. Prohibits a plan or insurer from adopting a pathway that hinders education, research, patient screening, or patient access to clinical trials. Requires public notification about the pathway adopted. POSITION: Watch; CAHP – Oppose SPONSOR: Association of Northern CA Oncologists; Medical Oncology Association of Southern CA DISPOSITION: Assembly Appropriations Committee
AB 2372 AUTHOR: Burke [D] TITLE: Health Care Coverage: HIV Specialists SUMMARY: Defines for specified purposes specialty physicians and professional providers, respectively, to include a physician who meets the criteria for an HIV specialist. Requires a health care service plan contract or health insurance policy to include an HIV specialist as an eligible primary care provider, if the provider requests the primary provider status and meets the plan's or health insurer's eligibility criteria for all specialists seeking primary care physician status. POSITION: Watch; CAHP – Oppose SPONSOR: AIDS Healthcare Foundation DISPOSITION: Assembly Appropriations Committee
AB 2394 AUTHOR: Garcia [D] TITLE: Medi-Cal: Nonmedical Transport SUMMARY: Adds to the schedule of benefits nonmedical transportation subject to utilization controls and permissible time and distance standards for a beneficiary to obtain covered Medi-Cal services. These provisions shall not be interpreted to add a new benefit to the Medi-Cal program. Requires the department to adopt regulations by July 1, 2018. Commencing July 1, 2017, the bill would require the department to provide a status report to the Legislature on a semiannual basis until regulations have been adopted. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 2400 AUTHOR: Nazarian [D] TITLE: Prescription Drug Coverage: Prior Authorization SUMMARY: Specifies that an external exception request may be file in lieu of a grievance with a health care service plan or health insurer regarding nonformulary drugs, following an adverse benefit determination. Requires any plan or insurer grievance system process or a plan or insurer internal process to require the resolution of grievances or complaints that involve the disapproval of a request for a formulary drug within a specified time period for both nonurgent and exigent circumstances. POSITION: Watch; CAHP – Oppose SPONSOR: Arthritis Foundation DISPOSITION: Assembly Appropriations Committee
84 Government Affairs AB 2436 AUTHOR: Hernandez [D] TITLE: Health Care Coverage and Disclosures SUMMARY: Requires a health care service plan contract or a policy of health insurance that provides coverage for prescription drug benefits to notify the enrollee or insured of information related to the cost of a prescription drug at the time that the drug is purchased or delivered. Requires a health care service plan or health insurer, in contracting, to require the manufacturer to disclose to the plan or insurer the cost of the prescription drug in United States dollars in Canada, Germany, and Mexico. POSITION: Watch; CAHP – Oppose SPONSOR: Health Access DISPOSITION: Assembly Appropriations Committee
AB 2507 AUTHOR: Gordon [D] TITLE: Telehealth: Access SUMMARY: Adds video, telephone, and email communications, as well as text or chat conferencing, to the definition of telehealth. Prohibits a health care provider from requiring the use of telehealth when a patient prefers in-person services and requires health care service plans and insurers to include coverage for services provided to a patient through telehealth. Prohibits an insurer from interfering with the physician- patient relationship based on telehealth services. POSITION: Watch; CAHP – Oppose SPONSOR: Stanford Hospital DISPOSITION: Assembly Appropriations Committee
AB 2670 AUTHOR: Hernandez [D] TITLE: Medi-Cal: Managed Care Health Plans SUMMARY: Relates to Medi-Cal program and managed care health plans. Requires the State Department of Health Care Services to annually administer the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys for all Medi-Cal managed care plan populations. Requires the CAHPS survey to include county organized health systems and geographic managed care. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 2703 AUTHOR: Linder [R] TITLE: Medical Confidentiality: Authorizations SUMMARY: Amends existing law that governs the obtaining of a valid authorization of medical information that provides a requirement that if the authorization is handwritten by a person who signs it or is in a specified typeface. Allows the authorization to be an electronic equivalent of the required type face. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Health Committee
85 Government Affairs AB 2712 AUTHOR: Chiu [D] TITLE: Pharmacies: Medi-Cal Program Participation SUMMARY: Relates to pharmacies and Medi-Cal program participation. Relates to any patient upon presentation of a valid prescription for the patient and evidence of residency in California. Provide that the term covered by insurance does not apply to a prescription for a specific medication prescribed for a patient that is not included on the drug formulary maintained by that patient's health care service plan or health insurer, and for which the patient is prepared to pay cash. POSITION: Watch; CAHP – Oppose SPONSOR: N/A DISPOSITION: Assembly Health Committee
AB 2752 AUTHOR: Nazarian [D] TITLE: Health Care Coverage: Continuity of Care SUMMARY: Requires a health care service plan or a health insurer to notify an enrollee or insured in annual renewal materials that the enrollee's or insured's prescription drug is no longer covered by the plan or policy or has changed tiers in the plan's or insurer's drug formulary. Exempts a specialized plan that covers dental or vision services. Requires a plan or policy annual renewal materials include information on the plan's provider directory or directories. POSITION: Watch; CAHP – Oppose SPONSOR: Chronic Care Coalition DISPOSITION: Assembly Appropriations Committee
AB 2764 AUTHOR: Bonilla [D] TITLE: Health Care Coverage: Mammography SUMMARY: Requires that mammography coverage under health care service plans and health care insurance policies to include, but not be limited to, digital mammography and breast tomosynthesis. POSITION: Watch; CAHP – Watch SPONSOR: CA Radiological Society DISPOSITION: Assembly Appropriations Committee
SB 10 AUTHOR: Hernandez [D] TITLE: Health Care Coverage: Immigration Status SUMMARY: Requires and application for a waiver for coverage under the Health Benefit Exchange for individual with a certain immigration status. Requires, after the waiver has been granted, the Exchange to offer qualified health benefit plans in the State, to these individuals. Requires that individuals eligible to purchase State qualified health plans pay the cost of coverage without federal assistance. POSITION: L.A. Care - Support; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Health Committee
86 Government Affairs SB 586 AUTHOR: Hernandez [D] TITLE: Children’s Services SUMMARY: Relates to the Children's Services program, which provides medically necessary services required by physically handicapped children whose parents are unable to pay for those services. Exempts certain contracts from existing law which prohibits services covered by CCA from being incorporated into a Medi-Cal managed care contract. Requires the State Department of Health Care Services to contract with one or more Kids Integrated Delivery System networks. Establishes selection criteria. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Health Committee
SB 818 AUTHOR: Nielsen [R] TITLE: Developmental Services: Medi-Cal: Rate Increases SUMMARY: Appropriates certain sums to the Department of Developmental Services to provide a 10% rate increase for certain developmental service providers and regional center operating budgets, and appropriates certain sums to the Department of Health Care Services to restore rates paid to Medi-Cal providers to those levels in effect prior to the implementation of the provider rate reductions. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate Health Committee
SB 908 AUTHOR: Hernandez [D] TITLE: Premium Rate Change: Notice: Other Health Coverage SUMMARY: Requires that if the Department of Managed Health Care or the Department of Insurance determines that a group rate is unreasonable or not justified, the contractholder or policyholder would be notified in writing of the determination, and be given a specified time period to obtain health coverage. Requires the prior rate to be in place during that period. Relates to small group plans through the Exchange. Revises obsolete references and makes other technical, nonsubstantive changes. POSITION: Watch; CAHP – Oppose SPONSOR: Health Access DISPOSITION: Senate Appropriations Committee
SB 923 AUTHOR: Hernandez [D] TITLE: Health Care Coverage: Cost Sharing Changes SUMMARY: Prohibits, for grandfathered plan contracts and policies and nongrandfathered plan contracts and policies in the individual and small group markets, a health care service plan contract or health insurance policy that is issued, amended, or renewed from changing any cost sharing requirements during the plan year or policy year, except when required by a change in state or federal law. POSITION: Watch; CAHP – Watch SPONSOR: Author DISPOSITION: Senate
87 Government Affairs SB 932 AUTHOR: Hernandez [D] TITLE: Health Plan Mergers SUMMARY: Requires a person that intends to merge with, consolidate, acquire, purchase, or control, directly or indirectly, any health care service plan or risk-bearing organization to give notice, and secure the prior approval from, the Director of the Department of Managed Health Care. Provides the time period for the Department to approve, disapprove, suspend, or postpone the effectiveness of the change. Provides procedural actions regarding the approval of the transaction. Relates to provider contracts. POSITION: Watch; CAHP – Watch SPONSOR: Author DISPOSITION: Senate Appropriations Committee
SB 960 AUTHOR: Hernandez [D] TITLE: Medi-Cal: Telehealth: Reproductive Health Care SUMMARY: Enacts provisions relating to the use of reproductive health care under the Medi-Cal Program. Provides that face-to-face contact between a health care provider and a patient shall not be required under the program for reproductive health care provided by store and forward. POSITION: Watch; CAHP – Watch SPONSOR: Planned Parenthood DISPOSITION: Senate
SB 997 AUTHOR: Lara [D] TITLE: Health Care Coverage: Immigration Status SUMMARY: Authorizes the enrollment of eligible children who were enrolled in comprehensive low-cost coverage provided by a health care service plan with a specified total enrollment, in full-scope Medi-Cal with the same health care service plan. Provides county applicability. Requires a plan to provide specified information regarding the child's transition into the Medi-Cal program. Requires the determination of whether an eligible child was enrolled with plan coverage. Requires regulations. POSITION: Watch; CAHP – Oppose SPONSOR: Health Access DISPOSITION: Senate Appropriations Committee
SB 999 AUTHOR: Pavley [D] TITLE: Health Insurance: Contraceptives: Annual Supply SUMMARY: Requires a health care service plan or health insurance policy to cover a specified supply of FDA approved, self administered hormonal contraceptives dispensed at one time by a prescriber, pharmacy, or onsite at a licensed or authorized location. Authorizes a pharmacist to dispense those same contraceptives, including a specified supply or when dispensing pursuant to protocols developed by the Board of Pharmacy, up to a specified supply at one time. Relates to covering out-of-network provider prescriptions. POSITION: Watch; CAHP – Oppose SPONSOR: N/A DISPOSITION: Senate Appropriations Committee \
88 Government Affairs SB 1002 AUTHOR: Monning [D] TITLE: End of Life Option Act: Telephone Number SUMMARY: Requires the State Department of Public Health to post a toll-free number on its Internet Web site for the purpose of receiving and responding to inquiries in multiple languages regarding the End of Life Option. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 1010 AUTHOR: Hernandez[D] TITLE: Health Care: Prescription Drug Costs SUMMARY: Requires health care service plans or health insurers that file rate information to report to the Department of Managed Health Care or the Department of Insurance specified cost information regarding covered prescription drugs. Requires a manufacturer to inform State purchasers, health care service plans, health insurers and chairs of specified legislative committees about specified increases in the wholesale acquisition cost of drugs. Relates to submission of rate increases for all large group benefit. POSITION: Watch; CAHP – Support SPONSOR: CA Labor Federation DISPOSITION: Senate Appropriations Committee
SB 1034 AUTHOR: Mitchell [D] TITLE: Health Care Coverage: Autism SUMMARY: Modifies requirements to be a qualified autism service professional to include providing behavioral health treatment, such as clinical management and case supervision. Requires that a treatment plan be reviewed no more than once every 6 months, unless a shorter period is recommended. POSITION: Watch; CAHP – Watch SPONSOR: Autism Speaks DISPOSITION: Senate Appropriations Committee
SB 1113 AUTHOR: Beall [D] TITLE: Pupil Health: Mental Health SUMMARY: Authorizes a county and local educational agency to enter into a partnership that includes an agreement between the county mental health plan and the local entity establish a Medi-Cal mental health provider that is county-operated or county- contracted, for the provision of mental health services to students of the local agency and in which there are provisions for the delivery of campus-based mental health services through qualified clinicians to provide support. Requires a HMO plan to reimburse providers. To read the current text of the bill, click here. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
89 Government Affairs SB 1135 AUTHOR: Monning [D] TITLE: Health Care Coverage: Notice of Timely Access SUMMARY: Requires a health care service plan contract or a health insurance policy issued, renewed, or amended to provide information to enrollees and insureds regarding the standards for timely access to health care services and other specified health care access information, including interpreter services. Requires providing the enrollee or insured information regarding consumer assistance. Requires a plan or insurer to provide a contracting provider with information relating to referrals or health care services. POSITION: Watch; CAHP – Oppose SPONSOR: Health Access DISPOSITION: Senate Appropriations Committee
SB 1159 AUTHOR: Hernandez [D] TITLE: Health Care Cost and Quality Database SUMMARY: Requires certain health care entities, including health care service plans, to provide specified information to the Secretary of Health and Human Services. Authorizes reporting a health care entity failing to comply with that requirement to the health care entity's regulating agency, and the agency to enforce that requirement. Provides for data security. Relates to individually identifiable proprietary contract information. Convenes an advisory committee to develop a health care cost and quality database. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 1252 AUTHOR: Stone [R] TITLE: Health Care Costs: Patient Notification SUMMARY: Requires, when a medical procedure is scheduled to be performed on a patient, the general acute care hospital, surgical clinic, and the attending physician to notify the patient, in writing, of the net costs to the patient for the medical procedure being done. POSITION: Watch; CAHP – Watch SPONSOR: Author DISPOSITION: Senate Health Committee
SB 1300 AUTHOR: Hernandez [D] TITLE: Medi-Cal: Emergency Medical Transport SUMMARY: Imposes a quality assurance fee for each transport provided by an emergency medical transport provider, subject to the fee in accordance with prescribed methodology. Authorizes an exemption for categories of such providers from the fee if necessary to obtain federal approval. Creates a related fund. Provides purposes for that fund. Requires provider reports, and a fine for not reporting. Increases the Medi-Cal reimbursement to private providers, including managed care health plans. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
90 Government Affairs SB 1335 AUTHOR: Mitchell [D] TITLE: Medi-Cal Benefits: Medi-Cal and Mental Health SUMMARY: Authorizes federally qualified health center rural health clinics and rural health clinics to provide Drug Medi-Cal and to receive reimbursement for services pursuant to a contract or contracts mutually agreed upon by the clinics and the county or the Department of Health Care Services. Authorizes such clinics to elect to provide specialty mental health services and to receive reimbursement for those services pursuant to a related contract or contracts. Authorizes contracting for these services. POSITION: L.A. Care - Support; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 1361 AUTHOR: Nielsen [R] TITLE: Medi-Cal and Eyeglasses SUMMARY: Restores Medi-Cal coverage of eyeglasses provided every to an individual of a specified age or older who has a specified visual acuity. Authorizes the State Department of Health Care Services to implement those provisions by means of all- county letters, plan letters, plan or provider bulletins, or similar instructions. POSITION: L.A. Care - Support; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 1401 AUTHOR: McGuire [D] TITLE: Pediatric and Home Care Expansion Act SUMMARY: Requires the Department of Health Care Services to develop regional pilot projects targeted to increase access to in-home, private duty nursing care for children receiving Medi-Cal benefits who are eligible for in-home, shift nursing care services and participate in specified programs. Requires a increased reimbursement rate. Authorizes reasonable provider eligibility standards and participation requirements. Requires the Department or its contractor to report an evaluation of the projects effectiveness. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
91 Government Affairs Special Session Legislation
ABX2 1 AUTHOR: Bonta [D] TITLE: Medi-Cal: Developmental Services Funding SUMMARY: Appropriates a specified sum to the State Department of Developmental Services to, commencing July 1, 2016, among other things, increase rates and wages for certain developmental services providers and fund incentive payments for competitive integrated employment opportunities and internships for individuals with developmental disabilities. DISPOSITION: Chaptered
SBX2 2 AUTHOR: Hernandez [D] TITLE: Medi-Cal: Managed Care: Organization Tax SUMMARY: Establishes a new managed care organization provider tax on licensed health care service plans, managed care plans contracted to provide Medi-Cal services, and alternate health care service plans. Establishes applicable taxing tiers and per enrollee amounts. Establishes a related fund for tax moneys to pay the nonfederal share of Medi-Cal rates for health care services. Provides for a graduation elimination of the gross premiums tax for health care service plans subject to the provider tax. DISPOSITION: Chaptered
92 Government Affairs
Board of Governors MOTION SUMMARY
Date: May 5, 2016 Motion No. EXE 100.0516
Committee: Executive Committee Chairperson: Mark Gamble
Issue: Award up to $200,000 to Brilliant Corners, a non-profit agency, to help transition homeless individuals with complex physical and behavioral health conditions into permanent supportive housing.
Background: L.A. Care funds will support the transition of 100 homeless individuals, including L.A. Care members, with complex physical and behavioral health conditions into permanent supportive housing. Homeless individuals have a higher risk of acute, chronic illness and mortality, report worse health outcomes, and are at higher risk for mental health disorders than the general population. Supportive housing improves the physical, social, and economic well-being of homeless individuals and families while reducing overall public resource expenditures. This initiative is a collaboration with the Housing for Health division of Los Angeles County Department of Health Services, which is also a funder of this program.
Alignment with L.A. Care Organizational Goals: This project aligns with L.A. Care’s strategic vision of being a recognized leader in improving health outcomes, improving access and supporting high quality and coordinated care for low income and vulnerable populations in underserved areas of Los Angeles County. It also aligns with the Triple Aim goals of improving population health and patient experience in a cost effective manner.
CHIF Grant Program Impact: The Community Health Investment Fund (CHIF) allocation for fiscal year 2015-2016 is $5 million and $100,000 has been spent. If this request for up to $200,000 is approved, the available remaining CHIF amount will be $4,700,000.
Motion: To approve an award of up to $200,000 to Brilliant Corners, a non- profit agency, to transition up to 100 homeless individuals with complex physical and behavioral health conditions into permanent supportive housing.
93 April 11, 2016
TO: Executive Committee
FROM : Jonathan Freedman, Chief Strategy Officer Roland Palencia, Director, Community Benefit Programs
SUBJECT: Approval to award up to $200,000 to Brilliant Corners to help transition homeless individuals with complex physical and behavioral health conditions into permanent supportive housing.
Introduction L.A. Care’s Community Benefits Department seeks approval to award up to $200,000 to Brilliant Corners, a non-profit agency, to provide move-in assistance to transition homeless individuals with complex physical and behavioral health conditions into permanent supportive housing. This initiative is in collaboration with the Housing for Health (HFH) division of Los Angeles County Department of Health Services (DHS).
With the goal of creating 10,000 supportive housing units, DHS has launched the largest supportive housing program that is linked to a health care system in the country. L.A. Care funds will leverage those efforts by up to $2,000 per person. Brilliant Corners has already secured over $1.3 million in funding from a variety of sources, including the Weingart Foundation and DHS.
Issue Background From 2013 to 2015, Los Angeles County saw a 12% increase in the number of persons experiencing homelessness, with the most current estimate at 44,359 individuals experiencing homelessness on any given night (LAHSA Point in Time Count). Individuals experiencing, or who have experienced, homelessness have a higher risk of mortality and acute and chronic illness, report worse health outcomes, and have higher risk for mental health disorders than the general population (National Health Care for the Homeless Council, Morrison, 2009; 2011). Homeless individuals experience significant gaps in accessing health care services, and as a result of delayed treatment, they rely heavily on emergency department visits and experience high rates of hospitalizations for preventable illnesses best addressed in the primary care environment. Furthermore, the small group of “high utilizers,” who account for a majority of acute care usage, are more likely to be chronically homeless and tend to suffer from mental health, substance abuse, and physical health co-morbidities. Studies have demonstrated that supportive housing improves the physical, social, and economic well-being of homeless individuals and families while reducing public resource expenditures.
Organizational Background Brilliant Corners is a 501(c) 3 nonprofit public benefit corporation with a mission to provide affordable, community-based supportive housing that meets the unique needs of each served
94 April 11, 2016 Brilliant Corners – LAC DHS Housing for Health Program Page 2 of 2 individual, including adults with developmental disabilities, those transitioning from homelessness, and homeless Veterans. Founded in 2004, Brilliant Corners develops, owns and manages affordable, supportive, community-based housing, and provides housing-related services and clinical case management to over 1,000 individuals, including those transitioning from institutionalization or from the street. Brilliant Corners operates DHS’ Flexible Housing Subsidy Pool (FHSP), a locally funded rental subsidy program that provides resources to quickly and effectively house homeless individuals with complex physical and behavioral health conditions.
Project Deliverables Move-in assistance funds are key to significantly reduce or end homelessness. Moving into a home with furniture and household goods supports a healthier transition from homelessness to housing as it improves housing stability and retention rates. The move-in assistance funds would allow DHS and Brilliant Corners to provide critical one-time expenses that are highly leveraged by other funding sources. Security deposits will be made directly to the landlord and goods will be directly purchased from vendors.
1. By June 2017, up to 100 homeless individuals, including L.A. Care members, will receive support for move-in assistance that includes housing application fees, security deposit, utilities, household goods, durable medical equipment, adaptive devices, and purchase of documents (birth certificate, California ID, passport) needed to secure benefits and housing.
2. Upon admission to the program, all 100 housed individuals will be connected to a system of care that includes intense case management services for physical, behavioral health and substance abuse disorder services.
3. A year after completion of the program, over 90% of participants will maintain permanent housing for 12 months or more.
Evaluation RAND Corporation will be contracted to evaluate the impact and effectiveness of HFH’s permanent supportive housing program. The evaluation will culminate in a final report by mid-2017.
Key evaluation measures will include: housing retention, health and wellness indicators, utilization of DHS health services and links to health care, a medical home and other Los Angeles County services, including mental health services, substance abuse disorder services and benefits establishment. It will also feature cost savings analysis using public expenditures information from DHS and other Los Angeles County agencies including Mental Health, Public Health, Public Social Services, Adult Probation, and Sheriff’s Departments.
The evaluation will monitor outcomes associated with individual permanent supportive housing projects to identify best practices to inform future efforts. Findings will provide lessons learned for similar efforts and for public-private partnerships across the country. The report will be shared with the L.A. County Board of Supervisors, non-profit partners, funders such as L.A. Care, and local, state and national audiences through conferences and publications.
95 96 97 98 99 100 101 102
Board of Governors MOTION SUMMARY
Date: May 5, 2016 Motion No. FIN 102.0516
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Acceptance of the Financial Report for the period ended March 31, 2016.
Background:
Budget Impact:
Motion: To accept the Financial Report for the period ended March 31, 2016, as submitted.
103
Financial Performance March 2016
3/31/2016
104 Financial Performance Results Highlights March 2016
Overall
The combined member months is 11.6 million, which is 275,278 favorable to the budget driven by the growth in the MediCal Plan Partners and the Adult Expansion. The performance is a surplus of $33.7 million or 0.9% on revenue, and is $23.3 million unfavorable to plan. The unfavorable budget variance is driven by higher than expected healthcare expenses offset by higher revenue and administrative savings.
MediCal Plan Partners The member months is 5.6 million, which is 120,210 member months favorable to the budget. The performance is a surplus of $73.0 million, and is $27.7 million favorable to plan. The favorable budget variance is driven by higher revenue, timing of the provider incentives, and the administrative savings offset by higher than expected subcapitation expense.
MediCal Direct SPD-CCI
The member months is 1.2 million, which is slightly favorable to the budget. The performance is a deficit of $135.8 million, and is $12.9 million unfavorable to plan. The unfavorable budget variance is driven by higher than expected healthcare expenses offset by higher revenue and the administrative savings. The unfavorable healthcare expenses is driven by outpatient, inpatient, and skilled nursing claims.
MediCal Direct TANF-MCE The member months is 4.4 million, which is 179,023 member months favorable to the budget. The performance is a surplus of $107.8 million, and is $44.0 million unfavorable to plan. The unfavorable budget variance is driven by higher than expected healthcare expenses offset by higher revenue.
Cal MediConnect (CMC) The member months is 80,531, which is slightly unfavorable to the budget. The performance is a deficit of $11.9 million, and is $3.6 million unfavorable to plan. The unfavorable budget variance is driven by lower than expected revenue offset by lower than expected healthcare and administrative expenses.
Commercial
L.A. Care Commercial consists of Covered California, PASC-SEIU and Healthy Kids. The member months is 356,186, which is 26,067 unfavorable to the budget. The performance is a surplus of $5.8 million compared to the budget. The favorable budget variance is driven by higher revenue and lower healthcare expenses offset by higher operating expenses.
105 Consolidated Operations Income Statement ($ in thousands) March 2016 Current Prior Increase YTD YTD Fav
Membership 2,025,080 1,973,926 51,154 Member Months 11,631,161 11,355,883 275,278
Revenue $716,764 353.94 $604,906 306.45 $111,858 47.50 Capitation $3,600,273 309.54 $3,298,850 290.50 $301,423 19.04 $126 0.06 $233 0.12 ($106) (0.06) Pay for Performance $897 0.08 $393 0.03 $504 0.04 716,890 354.01 605,139 306.57 111,751 47.44 Total Revenues 3,601,170 309.61 3,299,243 290.53 301,927 19.08
Healthcare Expenses 326,914 161.43 302,607 153.30 24,307 8.13 Capitation 1,748,074 150.29 1,720,826 151.54 (27,248) 1.24 (58,148) (28.71) 879 0.45 (59,026) (29.16) Provider Incentives and Shared Risk (91,675) (7.88) (13,636) (1.20) 78,039 6.68 80,147 39.58 87,627 44.39 (7,480) (4.82) Inpatient Claims 453,382 38.98 404,870 35.65 (48,511) (3.33) 241,931 119.47 106,495 53.95 135,436 65.52 Outpatient Claims 774,838 66.62 566,750 49.91 (208,088) (16.71) 37,719 18.63 35,083 17.77 2,636 0.85 Skilled Nursing Facility 254,686 21.90 153,141 13.49 (101,544) (8.41) 50,447 24.91 40,539 20.54 9,908 4.37 Pharmacy 255,710 21.98 213,270 18.78 (42,440) (3.20) 4,112 2.03 3,876 1.96 236 0.07 Medical Administrative Expenses 24,363 2.09 31,466 2.77 7,103 0.68 683,123 337.33 577,107 292.36 106,016 44.97 Total Healthcare Expenses 3,419,377 293.98 3,076,687 270.93 (342,689) (23.05) 95.3% 95.4% 0.1% MCR(%) 95.0% 93.3% -1.7%
33,767 16.67 28,032 14.20 5,735 2.47 Operating Margin 181,793 15.63 222,556 19.60 (40,763) (3.97)
25,338 12.51 23,334 11.82 2,004 0.69 Total Operating Expenses 146,757 12.62 160,068 14.10 13,310 1.48 3.5% 3.9% 0.3% Admin Ratio(%) 4.1% 4.9% 0.8%
8,429 4.16 4,698 2.38 3,731 1.78 Income from Operations 35,036 3.01 62,488 5.50 (27,452) (2.49)
1,308 0.65 94 0.05 1,214 0.60 Total Non-Operating Income (Expense) (1,324) (0.11) (5,448) (0.48) 4,124 (0.37)
$9,736 4.81 $4,792 2.43 $4,945 2.38 Net Surplus(Deficit) $33,712 2.90 $57,040 5.02 ($23,328) (2.12) 1.4% 0.8% 0.6% Margin(%) 0.9% 1.7% -0.8%
106 MediCal Plan Partners Income Statement ($ in thousands) March 2016 Current Prior Increase YTD YTD Fav
Membership 973,138 952,184 20,954 Member Months 5,628,322 5,508,112 120,210
Revenue $258,783 265.93 $227,849 239.29 $30,935 26.64 Capitation $1,323,159 235.09 $1,260,226 228.79 $62,933 6.29 258,783 265.93 227,849 239.29 30,935 26.64 Total Revenues 1,323,159 235.09 1,260,226 228.79 62,933 6.29
Healthcare Expenses 231,969 238.37 213,438 224.16 18,531 14.22 Capitation 1,220,670 216.88 1,169,156 212.26 (51,513) (4.62) 0 - (3) (0.00) 3 0.00 Provider Incentives and Shared Risk 3,836 0.68 13,375 2.43 9,540 1.75 215 0.22 256 0.27 (41) (0.05) Outpatient Claims 1,398 0.25 0 - (1,398) (0.25) 555 0.57 525 0.55 29 0.02 Medical Administrative Expenses 3,190 0.57 4,835 0.88 1,645 0.31 232,739 239.16 214,217 224.97 18,522 14.19 Total Healthcare Expenses 1,229,094 218.38 1,187,367 215.57 (41,727) (2.81) 89.9% 94.0% 4.1% MCR(%) 92.9% 94.2% -1.3%
26,044 26.76 13,632 14.32 12,412 12.45 Operating Margin 94,065 16.71 72,859 13.23 21,206 3.49
3,717 3.82 3,562 3.74 155 0.08 Total Operating Expenses 22,098 3.93 27,646 5.02 5,549 1.09 1.4% 1.6% 0.1% Admin Ratio(%) 1.7% 2.2% 0.5%
22,327 22.94 10,070 10.58 12,257 12.37 Income from Operations 71,967 12.79 45,213 8.21 26,754 4.58
576 0.59 123 0.13 453 0.46 Total Non-Operating Income (Expense) 1,005 0.18 24 0.00 981 (0.17)
$22,903 23.54 $10,193 10.71 $12,710 12.83 Net Surplus(Deficit) $72,972 12.97 $45,237 8.21 $27,735 4.75 8.9% 4.5% 4.4% Margin(%) 5.5% 3.6% 1.9%
107 MediCal Direct SPD-CCI Income Statement ($ in thousands) March 2016 Current Prior Increase YTD YTD Fav
Membership 193,744 188,854 4,890 Member Months 1,151,241 1,144,785 6,456
Revenue $228,422 1,178.99 $159,368 843.87 $69,054 335.12 Capitation $1,027,007 892.09 $862,381 753.31 $164,626 138.77 228,422 1,178.99 159,368 843.87 69,054 335.12 Total Revenues 1,027,007 892.09 862,381 753.31 164,626 138.77
Healthcare Expenses 12,187 62.90 12,857 68.08 (670) (5.18) Capitation 72,700 63.15 70,159 61.29 (2,541) (1.86) (69,755) (360.04) (16,745) (88.67) (53,010) (271.37) Provider Incentives and Shared Risk (167,794) (145.75) (26,779) (23.39) 141,015 122.36 40,464 208.85 44,032 233.15 (3,568) (24.30) Inpatient Claims 234,150 203.39 203,306 177.59 (30,844) (25.80) 215,249 1,111.00 85,079 450.50 130,170 660.49 Outpatient Claims 649,849 564.48 438,007 382.61 (211,842) (181.87) 32,299 166.71 30,965 163.96 1,334 2.75 Skilled Nursing Facility 228,763 198.71 143,410 125.27 (85,353) (73.44) 17,862 92.19 13,401 70.96 4,461 21.24 Pharmacy 89,988 78.17 93,214 81.42 3,226 3.26 1,130 5.83 1,070 5.67 60 0.17 Medical Administrative Expenses 6,038 5.24 7,695 6.72 1,657 1.48 249,437 1,287.45 170,659 903.66 78,777 383.80 Total Healthcare Expenses 1,113,695 967.39 929,013 811.52 (184,682) (155.87) 109.2% 107.1% 2.1% MCR(%) 108.4% 107.7% -0.7%
(21,014) (108.46) (11,291) (59.79) (9,723) (48.68) Operating Margin (86,688) (75.30) (66,632) (58.20) (20,056) (17.09)
8,693 44.87 8,024 42.49 669 2.38 Total Operating Expenses 49,905 43.35 56,292 49.17 6,387 5.82 3.8% 5.0% 1.2% Admin Ratio(%) 4.9% 6.5% 1.7%
(29,707) (153.33) (19,315) (102.27) (10,392) (51.06) Income from Operations (136,593) (118.65) (122,924) (107.38) (13,668) (11.27)
457 2.36 84 0.44 373 1.92 Total Non-Operating Income (Expense) 791 0.69 15 0.01 776 (0.67)
($29,250) (150.97) ($19,231) (101.83) ($10,019) (49.14) Net Surplus(Deficit) ($135,802) (117.96) ($122,910) (107.37) ($12,892) (10.60) -12.8% -12.1% -0.7% Margin(%) -13.2% -14.3% -1.0%
108 MediCal Direct TANF-MCE Income Statement ($ in thousands) March 2016 Current Prior Increase YTD YTD Fav
Membership 787,816 763,590 24,226 Member Months 4,414,882 4,235,859 179,023
Revenue $188,682 239.50 $182,660 239.21 $6,022 0.29 Capitation $1,033,889 234.18 $950,881 224.48 $83,008 9.70 188,682 239.50 182,660 239.21 6,022 0.29 Total Revenues 1,033,889 234.18 950,881 224.48 83,008 9.70
Healthcare Expenses 60,403 76.67 57,550 75.37 2,852 1.30 Capitation 331,050 74.98 344,770 81.39 13,720 6.41 9,258 11.75 14,005 18.34 (4,747) (6.59) Provider Incentives and Shared Risk 65,826 14.91 (2,325) (0.55) (68,151) (15.46) 38,400 48.74 41,956 54.95 (3,556) (6.20) Inpatient Claims 202,741 45.92 180,867 42.70 (21,873) (3.22) 19,447 24.68 18,164 23.79 1,283 0.90 Outpatient Claims 101,567 23.01 107,596 25.40 6,029 2.40 2,722 3.45 1,952 2.56 770 0.90 Skilled Nursing Facility 16,483 3.73 2,234 0.53 (14,249) (3.21) 29,003 36.81 24,030 31.47 4,973 5.34 Pharmacy 150,180 34.02 104,537 24.68 (45,644) (9.34) 1,307 1.66 1,249 1.64 58 0.02 Medical Administrative Expenses 8,314 1.88 10,755 2.54 2,441 0.66 160,540 203.78 158,907 208.10 1,633 (4.33) Total Healthcare Expenses 876,161 198.46 748,434 176.69 (127,727) (21.77) 85.1% 87.0% 1.9% MCR(%) 84.7% 78.7% -6.0%
28,142 35.72 23,753 31.11 4,389 4.61 Operating Margin 157,728 35.73 202,447 47.79 (44,719) (12.07)
8,925 11.33 8,195 10.73 730 0.60 Total Operating Expenses 50,776 11.50 50,744 11.98 (32) 0.48 4.7% 4.5% 0.2% Admin Ratio(%) 4.9% 5.3% -0.4%
19,217 24.39 15,558 20.38 3,659 4.02 Income from Operations 106,953 24.23 151,703 35.81 (44,751) (11.59)
411 0.52 39 0.05 372 0.47 Total Non-Operating Income (Expense) 861 0.20 101 0.02 761 (0.17)
$19,628 24.91 $15,597 20.43 $4,031 4.49 Net Surplus(Deficit) $107,814 24.42 $151,804 35.84 ($43,990) (11.42) 10.4% 8.5% 1.9% Margin(%) 10.4% 16.0% -5.5%
109 CMC Income Statement ($ in thousands) March 2016 Current Prior Increase YTD YTD Fav
Membership 12,907 13,015 (108) Member Months 80,531 84,874 (4,343)
Revenue $19,778 1,532.33 $15,881 1,220.23 $3,897 312.10 Capitation $110,630 1,373.76 $120,512 1,419.89 ($9,882) (46.14) 19,778 1,532.33 15,881 1,220.23 3,897 312.10 Total Revenues 110,630 1,373.76 120,512 1,419.89 (9,882) (46.14)
Healthcare Expenses 9,281 719.07 6,150 472.54 3,131 246.52 Capitation 46,736 580.34 52,745 621.45 6,009 41.11 781 60.49 1,106 85.00 (326) (24.51) Provider Incentives and Shared Risk 6,070 75.37 2,468 29.08 (3,602) (46.29) 851 65.90 417 32.01 434 33.89 Inpatient Claims 13,477 167.36 17,066 201.07 3,588 33.72 6,628 513.53 2,569 197.41 4,059 316.12 Outpatient Claims 20,139 250.08 18,467 217.58 (1,673) (32.51) 2,648 205.16 2,114 162.45 534 42.71 Skilled Nursing Facility 9,152 113.64 7,472 88.04 (1,680) (25.61) 1,851 143.40 1,841 141.43 10 1.97 Pharmacy 7,031 87.31 8,244 97.13 1,213 9.82 1,073 83.14 986 75.76 87 7.37 Medical Administrative Expenses 6,540 81.21 7,051 83.07 511 1.87 23,112 1,790.69 15,184 1,166.62 7,929 624.07 Total Healthcare Expenses 109,145 1,355.31 113,512 1,337.42 4,367 (17.90) 116.9% 95.6% 21.3% MCR(%) 98.7% 94.2% 4.5%
(3,335) (258.36) 698 53.62 (4,032) (311.97) Operating Margin 1,485 18.44 7,000 82.47 (5,515) (64.03)
2,165 167.70 2,233 171.55 (68) (3.85) Total Operating Expenses 13,359 165.89 15,311 180.40 1,952 14.51 10.9% 14.1% -3.1% Admin Ratio(%) 12.1% 12.7% 0.6%
(5,499) (426.06) (1,535) (117.93) (3,964) (308.13) Income from Operations (11,874) (147.45) (8,311) (97.93) (3,563) (49.52)
0 - 0 - 0 - Total Non-Operating Income (Expense) 1 0.02 3 0.04 (2) 0.02
($5,499) (426.06) ($1,535) (117.93) ($3,964) (308.13) Net Surplus(Deficit) ($11,873) (147.43) ($8,308) (97.89) ($3,565) (49.54) -27.8% -9.7% -18.1% Margin(%) -10.7% -6.9% -3.8%
110 Commercial Income Statement ($ in thousands) March 2016 Current Prior Increase YTD YTD Fav
Membership 57,475 56,283 1,192 Member Months 356,186 382,253 (26,067)
Revenue $21,129 367.61 $19,148 340.21 $1,981 27.41 Capitation $105,574 296.40 $104,806 274.18 $769 22.22 21,129 367.61 19,148 340.21 1,981 27.41 Total Revenues 105,574 296.40 104,806 274.18 769 22.22
Healthcare Expenses 13,085 227.67 12,611 224.07 474 3.60 Capitation 76,931 215.98 83,996 219.74 7,065 3.75 1,568 27.28 2,515 44.68 (947) (17.40) Provider Incentives and Shared Risk 388 1.09 (375) (0.98) (763) (2.07) 548 9.54 1,307 23.23 (759) (13.69) Inpatient Claims 3,324 9.33 3,710 9.71 386 0.37 413 7.18 434 7.71 (21) (0.52) Outpatient Claims 2,050 5.75 2,794 7.31 744 1.55 51 0.88 42 0.75 9 0.13 Skilled Nursing Facility 248 0.70 24 0.06 (224) (0.63) 1,732 30.13 1,269 22.54 463 7.59 Pharmacy 8,508 23.89 7,274 19.03 (1,234) (4.86) 47 0.82 45 0.81 2 0.01 Medical Administrative Expenses 281 0.79 1,130 2.96 849 2.17 17,444 303.51 18,224 323.79 (780) (20.28) Total Healthcare Expenses 91,729 257.53 98,553 257.82 6,824 0.29 82.6% 95.2% -12.6% MCR(%) 86.9% 94.0% 7.1%
3,685 64.11 924 16.42 2,761 47.69 Operating Margin 13,845 38.87 6,253 16.36 7,592 22.51
1,169 20.33 1,029 18.28 140 2.05 Total Operating Expenses 7,171 20.13 5,349 13.99 (1,822) (6.14) 5.5% 5.4% 0.2% Admin Ratio(%) 6.8% 5.1% -1.7%
2,516 43.78 (105) (1.86) 2,621 45.64 Income from Operations 6,673 18.74 903 2.36 5,770 16.37
(136) (2.37) (153) (2.72) 17 0.35 Total Non-Operating Income (Expense) (853) (2.40) (895) (2.34) 41 0.05
$2,380 41.40 ($258) (4.59) $2,638 45.99 Net Surplus(Deficit) $5,820 16.34 $9 0.02 $5,812 16.32 11.3% -1.3% 12.6% Margin(%) 5.5% 0.0% 5.5%
111 Comparative Balance Sheet March 2016
(Dollars in thousands) Jun-15 Sep-15 Dec-15 Jan-16 Feb-16 Mar-16 ASSETS
CURRENT ASSETS Total Current Assets 2,394,226 2,788,549 3,138,238 3,520,530 3,082,767 3,419,346 Capitalized Assets - net 39,420 46,591 51,300 53,839 53,355 53,612 NON-CURRENT ASSETS $583 $22,527 23,382 27,051 26,378 24,989 TOTAL ASSETS $2,434,230 $2,857,668 3,212,921 3,601,420 3,162,500 3,497,947
LIABILITIES AND FUND EQUITY
CURRENT LIABILITIES Total Current Liability $2,065,720 $2,361,096 2,703,797 3,085,616 2,641,878 2,967,587 Long Term Liability $3,648 $3,632 3,653 3,680 3,707 3,708 Total Liabilities $2,069,368 $2,364,728 2,707,450 3,089,296 2,645,584 2,971,295
FUND EQUITY Invested in Capital Assets, net of related debt $39,420 $46,591 51,301 53,839 53,355 53,612 Restricted Equity $300 $300 300 300 300 300 Minimum Tangible Net Equity $125,167 $137,057 150,181 154,575 159,371 165,193 Board Designated Funds $199,974 $310,692 303,689 303,409 303,405 307,548 Total Fund Equity $364,862 $492,940 $505,471 $512,124 $516,916 $526,652
TOTAL LIABILITIES AND FUND EQUITY $2,434,230 $2,857,668 $3,212,921 $3,601,420 $3,162,500 $3,497,947
Solvency Ratios
Working Capital Ratio 1.16 1.18 1.16 1.14 1.17 1.15 Cash to Claims Ratio 0.80 0.88 0.88 0.85 1.02 0.97 Tangible Net Equity Ratio 2.91 3.60 3.37 3.31 3.24 3.19
112
Cash Flows Statement ($ in thousands) Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 YTD Cash Flows from Operating Activities: Capitation Revenue $ 1,063,113 $ (28,764) $ 499,756 $ 479,996 $ 1,170,609 $ 619,710 $3,804,418 Other Income (Expense), net (157) 2,260 (140) 584 910 769 4,227 Healthcare Expenses (396,986) (486,194) (516,652) (204,202) (878,755) (390,320) (2,873,109) Operating Expenses (20,857) (19,555) (33,144) (24,554) (17,783) (21,133) (137,027) Net Cash Provided By Operating Activities 645,113 (532,255) (50,180) 251,824 274,981 209,026 798,509
Cash Flows from Investing Activities Net Proceeds from Sale of Investments 25,804 100,324 54,168 109,770 25,091 67,375 382,532 Purchase of Capital Assets (2,342) (2,221) (2,115) (3,216) (212) (952) (11,058) Net Cash Provided By Investing Activities 23,462 98,103 52,053 106,554 24,879 66,423 371,474
Cash Flows from Financing Activities: Gross Premium Tax (MCO Sales Tax) - Net 33,977 (29,931) (602) 14,937 8,936 (483) 26,835 Pass through transactions (AB 85, IGT, etc.) 33,977 (3,121) 168,273 (15,982) (146,046) 28,987 44,551 Net Cash Provided By Financing Activities 12,440 (33,051) 167,671 (1,045) (137,110) 28,504 71,386
Net Increase in Cash and Cash Equivalents 681,015 (467,203) 169,544 357,333 162,751 303,953 1,241,369
Cash and Cash Equivalents, Beginning 182,755 897,747 430,544 600,087 957,420 1,120,171 182,755 Cash and Cash Equivalents, Ending $ 863,770 $ 430,544 $ 600,088 $ 957,420 $ 1,120,171 $ 1,424,124 $ 1,424,124
Reconciliation of Income from Operations to Net Cash Provided By (Used In) Operating Activities:
Excess of Revenues over Expenses $ 5,475 $ (4,803) $ 11,860 $ 6,652 $ 4,792 $ 9,736 $ 33,712
Adjustments to Excess of Revenues Over Expenses: Depreciation 647 661 660 678 696 695 4,037 Realized and Unrealized (Gain)/Loss on Investments 364 707 764 (711) 346 (859) 612 Deferred Rent 31 18 (28) 27 27 2 76 Gross Premium Tax provision 282 (132) 196 188 178 281 993 Total Adjustments to Excess of Revenues over Expenses 1,324 1,254 1,592 182 1,247 119 5,718 - Changes in Operating Assets and Liabilities: Capitation Receivable 532,630 (594,600) (65,701) (132,511) 563,100 (98,262) 204,656 Interest and Non-Operating Receivables (193) 2,197 (105) (129) 159 63 1,993 Prepaids and Other Current Assets 2,009 (1,448) 1,473 (5,862) 54 2,756 (1,019) Accounts Payable and Accrued Liabilities (1,438) 3,197 (11,948) 2,329 2,467 (1,636) (7,029) Subcapitation Payable 9,846 (55,005) (52,069) 228,160 (127,475) 210,937 214,394 MediCal Adult Expansion Payable 136,960 97,484 74,636 100,828 (191,402) 132,131 350,637 Deferred Capitation Revenue 5,986 (12,414) 1,493 373 1,828 1,772 (962) Accrued Medical Expenses (41,523) 17,933 (35,138) 33,543 (351) (55,627) (81,163) Reserve for Claims 24,947 21,061 21,784 18,304 20,663 7,187 113,946 Reserve for Provider Incentives (31,486) (8,527) 2,583 1 - - (37,429) Grants Payable 575 1,415 (640) (45) (100) (150) 1,055 Net Changes in Operating Assets and Liabilities 638,313 (528,707) (63,632) 244,990 268,943 199,171 759,079
Net Cash Provided By Operating Activities $ 645,113 $ (532,255) $ (50,180) $ 251,824 $ 274,981 $ 209,026 $ 798,509 ------
113 DATE: April 15, 2016 TO: Finance & Budget Committee FROM: Marie Montgomery, Chief Financial Officer
SUBJECT: Monthly Investment Transaction Report for March 2016
To keep the Committee apprised of L.A. Care’s investment portfolios and to comply with California Government Code Section 53607, attached are the investment transaction details from March 1 to March 31, 2016.
L.A. Care's total investment market value as of March 31, 2016 was $1.93 billion. This includes approximately $64 million invested with the Los Angeles County Pooled Investment Fund (LACPIF) and $20 million invested with the statewide Local Agency Investment Fund (LAIF). The government pooled funds are overseen by the county treasurer (LACPIF) and state treasurer (LAIF). An additional $14 million was invested in LACPIF in March and an additional $10 million was invested in LAIF in March, 2016.
The remainder, $1.84 billion, is managed by Payden & Rygel, an external professional asset management firm, and is divided to two separate portfolios based on investment style: 1. The Short-term Portfolio, and, 2. The Extended Portfolio
Transactions within those two portfolios are included in the attached report.
114 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 03/01/2016 Account Number: through 03/31/2016
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 02/25/16 03/01/16 Buy 150,000.000 JOHNSON & JOHNSON 03/01/19 1.13 478160BR4 (149,982.00) (149,982.00)
03/01/16 03/03/16 Buy 800,000.000 U.S. TREASURY BILL 03/02/17 912796JE0 (794,661.33) (794,661.33)
02/29/16 03/03/16 Buy 180,000.000 EXXON MOBIL 03/01/18 1.44 30231GAU (180,000.00) (180,000.00)
03/04/16 03/07/16 Buy 1,400,000.000 U.S. TREASURY NOTE 10/31/16 0.38 912828F88 (1,398,304.69) (1,846.15) (1,400,150.84)
03/03/16 03/10/16 Buy 90,000.000 STRYKER 03/08/19 2.00 863667AK7 (89,895.60) (89,895.60)
03/09/16 03/10/16 Buy 1,200,000.000 U.S. TREASURY NOTE 01/31/17 0.50 912828H78 (1,198,218.75) (642.86) (1,198,861.61)
03/08/16 03/15/16 Buy 240,000.000 BERKSHIRE HATHAWAY 03/07/18 1.45 084664CE9 (239,906.40) (239,906.40)
03/17/16 03/18/16 Buy 2,000,000.000 U.S. TREASURY BILL 03/24/16 912796HH5 (1,999,916.67) (1,999,916.67)
03/17/16 03/21/16 Buy 930,000.000 FHLMC C 6/16/16 Q 03/16/18 1.13 3134G8NT (929,953.50) (145.31) (930,098.81)
03/18/16 03/23/16 Buy 198,000.000 CATERPILLAR FINANCIAL 06/01/17 1.63 14912L5E7 (199,403.82) (1,001.00) (200,404.82)
03/23/16 03/24/16 Buy 1,500,000.000 U.S. TREASURY BILL 04/07/16 912796HK8 (1,499,877.50) (1,499,877.50)
03/22/16 03/28/16 Buy 600,000.000 CA DEPT WATER RESOURCES-W 12/01/16 0.99 13066KW2 (600,846.00) (1,932.45) (602,778.45) 03/24/16 03/29/16 Buy 500 , 000 . 000 U.S. TREASURY NOTE 10/31/17 0.75 912828TW (499 , 355 . 47) (1 , 545 . 33) (500 , 900 . 80) 9,788,000.000 (9,780,321.73) (7,113.10) (9,787,434.83)
03/01/16 03/01/16 Coupon CISCO SYSTEMS FRN 03/01/19 1.14 17275RAQ 462.18 462.18
03/01/16 03/01/16 Coupon ILLINOIS TOOL WORKS 02/25/17 0.90 452308AS8 1,800.00 1,800.00
03/01/16 03/01/16 Coupon ELI LILLY & CO 03/01/18 1.25 532457BK3 625.00 625.00
03/01/16 03/01/16 Coupon PNC BANK FRN 06/01/18 1.06 69353REN4 1,054.34 1,054.34
03/01/16 03/01/16 Coupon SKANDINAVISKA ENSKILDA BAN 03/01/16 0.40 83051H6Y7 1,258.33 1,258.33
03/02/16 03/02/16 Coupon CHEVRON FRN 03/02/18 0.80 166764AW 622.35 622.35
Payden & Rygel 115 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 03/01/2016 Account Number: through 03/31/2016
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 03/02/16 03/02/16 Coupon CHEVRON 03/02/18 1.37 166764AV2 1,365.00 1,365.00
03/03/16 03/03/16 Coupon CATERPILLAR FINANCIAL FRN 03/03/17 0.86 14912L5Y3 642.96 642.96
03/03/16 03/03/16 Coupon CISCO SYSTEMS 03/03/17 1.10 17275RAT9 1,595.00 1,595.00
03/06/16 03/06/16 Coupon EXXON MOBIL 03/06/18 1.31 30231GAL6 4,273.88 4,273.88
03/07/16 03/07/16 Coupon BANK OF AMERICA FRN 12/07/18 1.40 06050TMF6 1,225.47 1,225.47
03/07/16 03/07/16 Coupon MANUFACTURERS & TRADERS F 03/07/16 55279HAB6 1,577.74 1,577.74
03/07/16 03/07/16 Coupon PACCAR FINANCIAL FRN 06/06/17 0.83 69371RL95 146.06 146.06
03/09/16 03/09/16 Coupon PACCAR FINANCIAL 03/09/18 1.45 69371RM4 1,160.00 1,160.00
03/10/16 03/10/16 Coupon CHARLES SCHWAB 03/10/18 1.50 808513AK1 1,500.00 1,500.00
03/11/16 03/11/16 Coupon US BANK OHIO FRN 09/11/17 0.83 90331HMJ9 734.67 734.67
03/12/16 03/12/16 Coupon TEXAS INSTRUMENTS 03/12/17 0.88 882508AX2 875.00 875.00
03/13/16 03/13/16 Coupon FFCB 1ML FRN 02/13/17 0.48 3133EDFB3 1,504.78 1,504.78
03/14/16 03/14/16 Coupon JPMORGAN CHASE FRN 06/13/16 0.96 48121CJM9 946.40 946.40
03/14/16 03/14/16 Coupon WELLS FARGO FRN 09/14/18 1.03 94974BGD 957.62 957.62
03/15/16 03/15/16 Coupon CHASE 2014-A1 A1 CDT 01/15/19 1.15 161571GJ7 479.17 479.17
03/15/16 03/15/16 Coupon CHASE 2015-A3 A CDT 1MOFRN 04/15/19 0.69 161571GW 421.24 421.24
03/15/16 03/15/16 Coupon CISCO SYSTEMS FRN 06/15/18 0.94 17275RAY8 831.13 831.13
03/15/16 03/15/16 Coupon DRYROCK 2014-2 A 1MOFRN CD 03/16/20 0.78 06742LAC7 599.28 599.28
03/15/16 03/15/16 Coupon DRYROCK 2014-2 A 1MOFRN CD 03/16/20 0.78 06742LAC7 599.28 599.28
03/15/16 03/15/16 Coupon HONDA 2014-4 A2 CAR 01/17/17 0.58 43814JAB0 84.24 84.24
Payden & Rygel 116 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 03/01/2016 Account Number: through 03/31/2016
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 03/15/16 03/15/16 Coupon HOME DEPOT FRN 09/15/17 1.00 437076BJ0 379.02 379.02
03/15/16 03/15/16 Coupon JOHN DEERE 2014-A A3 EQP 04/16/18 0.92 47787VAC5 882.67 882.67
03/15/16 03/15/16 Coupon JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 431.07 431.07
03/15/16 03/15/16 Coupon GEORGIA POWER FRN 03/15/16 373334KB6 483.72 483.72
03/15/16 03/15/16 Coupon TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 232.95 232.95
03/15/16 03/15/16 Coupon TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 48.92 48.92
03/15/16 03/15/16 Coupon TOYOTA 2015-A A2 CAR 07/17/17 0.71 89236WAB 172.63 172.63
03/15/16 03/15/16 Coupon TOYOTA 2015-B A2A GREEN CA 11/15/17 0.77 89237CAB7 359.97 359.97
03/15/16 03/15/16 Coupon U.S. TREASURY NOTE 09/15/18 1.00 912828L40 575.00 575.00
03/15/16 03/15/16 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 123.70 123.70
03/17/16 03/17/16 Coupon FFCB 1ML FRN 04/17/17 0.49 3133EDJX1 579.09 579.09
03/18/16 03/18/16 Coupon HONDA 2013-4 A3 CAR 09/18/17 0.69 43814FAC6 257.72 257.72
03/18/16 03/18/16 Coupon HONDA 2016-1 A2 CAR 06/18/18 1.34 43814NAB1 256.83 256.83
03/19/16 03/19/16 Coupon FHLB 03/19/18 0.88 3130A7CX1 655.52 655.52
03/20/16 03/20/16 Coupon FHLMC 1ML FRN 04/20/17 0.44 3134G72G5 369.63 369.63
03/20/16 03/20/16 Coupon VOLKSWAGEN 2013-2 A3 CAR 04/20/18 0.70 92867PAC7 264.55 264.55
03/21/16 03/21/16 Coupon BMW 2016-1 A2A LEASE 01/22/18 1.17 05581RAB2 773.50 773.50
03/21/16 03/21/16 Coupon GEDFT 2014-2 A 1MOFRN FLOO 10/20/19 0.88 36159LCN4 686.00 686.00
03/21/16 03/21/16 Coupon HONDA 2015-2 A3 CAR 02/21/19 1.04 43813NAC0 216.67 216.67
03/22/16 03/22/16 Coupon AMERICAN EXPRESS FRN 09/22/17 0.92 0258M0DS 671.50 671.50
Payden & Rygel 117 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 03/01/2016 Account Number: through 03/31/2016
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 03/22/16 03/22/16 Coupon GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 64.53 64.53
03/24/16 03/24/16 Coupon TORONTO DOMINION NY YCD 03/24/16 0.39 89113E3N4 242.67 242.67
03/25/16 03/25/16 Coupon BMW 2013-A A3 CAR 11/27/17 0.67 05578XAC2 161.42 161.42
03/25/16 03/25/16 Coupon FHMS KF01 A 1MOFRN CMBS 04/25/19 0.79 3137AUP52 2.78 2.78
03/01/16 03/25/16 Coupon FNA 2014-M4 ASQ2 CMBS 01/25/17 1.27 3136AJB21 434.14 434.14
03/01/16 03/25/16 Coupon FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.75 3136AJ2A3 32.40 32.40
03/01/16 03/25/16 Coupon FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.75 3136AJ2A3 32.40 32.40
03/01/16 03/25/16 Coupon FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.65 3136AKQJ5 444.49 444.49
03/01/16 03/25/16 Coupon FNA 2015-M13 ASQ2 CMBS 09/25/19 1.65 3136AQDQ 548.67 548.67
03/01/16 03/25/16 Coupon FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.61 3136AMTM 578.60 578.60
03/01/16 03/25/16 Coupon FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.61 3136AMTM 201.04 201.04
03/26/16 03/26/16 Coupon BANK OF AMERICA 03/26/18 1.65 06050TLY6 4,125.00 4,125.00
03/29/16 03/29/16 Coupon FFCB 1ML FRN 08/29/17 0.47 3133EDTT9 616.73 616.73 03/31/16 03/31/16 Coupon U.S. TREASURY NOTE 09/30/17 0.63 912828TS9 3 , 281 . 25 3 , 281 . 25 46,527.90 46,527.90
03/01/16 03/01/16 Income 55.310 STIF INT USD 55.31 55.31
03/11/16 03/14/16 Sell Long 800,000.000 U.S. TREASURY BILL 12/08/16 912796HU6 796,327.30 1,296.53 797,623.83
03/18/16 03/21/16 Sell Long 500,000.000 U.S. TREASURY BILL 03/24/16 912796HH5 499,978.62 10.42 499,989.04
03/17/16 03/22/16 Sell Long 300,000.000 VISA 12/14/17 1.20 92826CAA0 301,224.00 980.00 302,204.00
Payden & Rygel 118 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 03/01/2016 Account Number: through 03/31/2016
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 03/23/16 03/29/16 Sell Long 30 , 000 . 000 COCA-COLA 10/27/17 0.88 191216BR0 29 , 999 . 40 110 . 83 30 , 110 . 23 1,630,000.000 1,627,529.32 2,397.78 1,629,927.10
03/15/16 03/15/16 Pay Princpl 76,528.715 HONDA 2014-4 A2 CAR 01/17/17 0.58 43814JAB0 76,528.72 76,528.72
03/15/16 03/15/16 Pay Princpl 82,281.906 JOHN DEERE 2014-A A3 EQP 04/16/18 0.92 47787VAC5 82,281.91 82,281.91
03/15/16 03/15/16 Pay Princpl 42,352.248 JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 42,352.25 42,352.25
03/15/16 03/15/16 Pay Princpl 52,510.734 TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 52,510.73 52,510.73
03/15/16 03/15/16 Pay Princpl 11,027.254 TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 11,027.25 11,027.25
03/15/16 03/15/16 Pay Princpl 43,363.449 TOYOTA 2015-A A2 CAR 07/17/17 0.71 89236WAB 43,363.45 43,363.45
03/15/16 03/15/16 Pay Princpl 55,264.787 TOYOTA 2015-B A2A GREEN CA 11/15/17 0.77 89237CAB7 55,264.79 55,264.79
03/15/16 03/15/16 Pay Princpl 42,498.345 USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 42,498.35 42,498.35
03/18/16 03/18/16 Pay Princpl 63,637.866 HONDA 2013-4 A3 CAR 09/18/17 0.69 43814FAC6 63,637.87 63,637.87
03/20/16 03/20/16 Pay Princpl 38,320.437 VOLKSWAGEN 2013-2 A3 CAR 04/20/18 0.70 92867PAC7 38,320.44 38,320.44
03/22/16 03/22/16 Pay Princpl 121,002.884 GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 121,002.88 121,002.88
03/25/16 03/25/16 Pay Princpl 38,087.035 BMW 2013-A A3 CAR 11/27/17 0.67 05578XAC2 38,087.04 38,087.04
03/25/16 03/25/16 Pay Princpl 181.830 FHMS KF01 A 1MOFRN CMBS 04/25/19 0.79 3137AUP52 181.83 181.83
03/01/16 03/25/16 Pay Princpl 5,872.300 FNA 2014-M4 ASQ2 CMBS 01/25/17 1.27 3136AJB21 5,872.30 5,872.30
03/01/16 03/25/16 Pay Princpl 10,139.180 FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.75 3136AJ2A3 10,139.18 10,139.18
03/01/16 03/25/16 Pay Princpl 10,139.180 FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.75 3136AJ2A3 10,139.18 10,139.18
03/01/16 03/25/16 Pay Princpl 3,375.198 FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.65 3136AKQJ5 3,375.20 3,375.20
03/01/16 03/25/16 Pay Princpl 1,268.200 FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.61 3136AMTM 1,268.20 1,268.20
Payden & Rygel 119 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 03/01/2016 Account Number: through 03/31/2016
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 03/01/16 03/25/16 Pay Princpl 440 . 650 FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.61 3136AMTM 440 . 65 440 . 65 698,292.198 698,292.22 698,292.22
03/01/16 03/01/16 Mature Long 750,000.000 SKANDINAVISKA ENSKILDA BAN 03/01/16 0.40 83051H6Y7 750,000.00 750,000.00
03/03/16 03/03/16 Mature Long 2,000,000.000 U.S. TREASURY BILL 03/03/16 912796FZ7 1,999,595.56 404.44 2,000,000.00
03/03/16 03/03/16 Mature Long 1,000,000.000 U.S. TREASURY BILL 03/03/16 912796FZ7 999,866.67 133.33 1,000,000.00
03/07/16 03/07/16 Mature Long 830,000.000 MANUFACTURERS & TRADERS F 03/07/16 55279HAB6 830,000.00 830,000.00
03/15/16 03/15/16 Mature Long 230,000.000 GEORGIA POWER FRN 03/15/16 373334KB6 230,000.00 230,000.00
03/24/16 03/24/16 Mature Long 1,500,000.000 U.S. TREASURY BILL 03/24/16 912796HH5 1,499,937.50 62.50 1,500,000.00 03/24/16 03/24/16 Mature Long 800 , 000 . 000 TORONTO DOMINION NY YCD 03/24/16 0.39 89113E3N4 800 , 000 . 00 800 , 000 . 00 7,110,000.000 7,109,399.73 600.27 7,110,000.00
Payden & Rygel 120 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/01/16 03/01/16 Buy 10,900,000.000 FHLB DISCOUNT NOTE 03/16/16 313384UJ6 (10,899,182.50) (10,899,182.50)
03/01/16 03/01/16 Buy 50,000,000.000 FHLB DISCOUNT NOTE 04/06/16 313384VF3 (49,985,000.00) (49,985,000.00)
03/01/16 03/01/16 Buy 12,000,000.000 FHLB DISCOUNT NOTE 04/06/16 313384VF3 (11,996,400.00) (11,996,400.00)
02/25/16 03/01/16 Buy 1,640,000.000 JOHNSON & JOHNSON 03/01/19 1.13 478160BR4 (1,639,803.20) (1,639,803.20)
03/02/16 03/02/16 Buy 50,000,000.000 FAMC DISCOUNT NOTE 03/10/16 31315KUC2 (49,997,444.44) (49,997,444.44)
03/02/16 03/02/16 Buy 25,000,000.000 FAMC DISCOUNT NOTE 03/10/16 31315KUC2 (24,998,722.22) (24,998,722.22)
03/02/16 03/02/16 Buy 50,000,000.000 FHLB DISCOUNT NOTE 04/13/16 313384VN6 (49,982,500.00) (49,982,500.00)
03/02/16 03/02/16 Buy 33,174,000.000 FHLB DISCOUNT NOTE 04/13/16 313384VN6 (33,162,389.10) (33,162,389.10)
03/01/16 03/03/16 Buy 17,000,000.000 U.S. TREASURY BILL 03/02/17 912796JE0 (16,886,553.33) (16,886,553.33)
03/03/16 03/04/16 Buy 50,000,000.000 FAMC DISCOUNT NOTE 03/16/16 31315KUJ7 (49,996,166.67) (49,996,166.67)
03/03/16 03/04/16 Buy 25,000,000.000 FAMC DISCOUNT NOTE 03/16/16 31315KUJ7 (24,998,083.33) (24,998,083.33)
03/01/16 03/04/16 Buy 510,000.000 PNC BANK 03/04/19 1.95 69353REV6 (509,484.90) (509,484.90)
03/02/16 03/07/16 Buy 180,000.000 NATL RURAL UTILITIES 01/27/17 1.10 637432MW (180,293.40) (220.00) (180,513.40)
03/04/16 03/07/16 Buy 50,000,000.000 U.S. TREASURY BILL 04/07/16 912796HK8 (49,990,743.06) (49,990,743.06)
03/09/16 03/10/16 Buy 50,000,000.000 FHLB DISCOUNT NOTE 04/06/16 313384VF3 (49,989,875.00) (49,989,875.00)
03/09/16 03/10/16 Buy 48,000,000.000 FHLMC DISCOUNT NOTE 03/18/16 313396UL5 (47,997,653.33) (47,997,653.33)
03/09/16 03/10/16 Buy 9,000,000.000 RABOBANK NEDERLAND YCD 08/08/16 0.71 21685VML0 (8,999,991.00) (177.50) (9,000,168.50)
03/03/16 03/10/16 Buy 990,000.000 STRYKER 03/08/19 2.00 863667AK7 (988,851.60) (988,851.60)
03/09/16 03/10/16 Buy 50,000,000.000 U.S. TREASURY BILL 04/07/16 912796HK8 (49,989,850.00) (49,989,850.00)
03/10/16 03/11/16 Buy 50,000,000.000 U.S. TREASURY BILL 04/14/16 912796HL6 (49,989,091.67) (49,989,091.67)
Payden & Rygel 121 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/08/16 03/15/16 Buy 2,160,000.000 BERKSHIRE HATHAWAY FRN 03/07/18 1.18 084664CF6 (2,160,000.00) (2,160,000.00)
03/16/16 03/17/16 Buy 25,000,000.000 FHLB DISCOUNT NOTE 03/23/16 313384UR8 (24,999,000.00) (24,999,000.00)
03/17/16 03/21/16 Buy 3,500,000.000 FHLMC C 6/16/16 Q 03/16/18 1.13 3134G8NT (3,499,825.00) (546.88) (3,500,371.88)
03/21/16 03/22/16 Buy 50,000,000.000 FFCB DISCOUNT NOTE 04/27/16 313312WC (49,987,500.00) (49,987,500.00)
03/21/16 03/22/16 Buy 23,000,000.000 FFCB DISCOUNT NOTE 04/27/16 313312WC (22,994,250.00) (22,994,250.00)
03/23/16 03/24/16 Buy 20,000,000.000 FHLB DISCOUNT NOTE 04/15/16 313384VQ9 (19,996,944.44) (19,996,944.44)
03/23/16 03/24/16 Buy 10,000,000.000 FHLMC DISCOUNT NOTE 04/15/16 313396VQ3 (9,998,533.33) (9,998,533.33)
03/23/16 03/24/16 Buy 50,000,000.000 FNMA DISCOUNT NOTE 05/18/16 313588WZ (49,979,298.61) (49,979,298.61)
03/23/16 03/28/16 Buy 35,000,000.000 FAMC DISCOUNT NOTE 05/04/16 31315KWK (34,989,568.06) (34,989,568.06)
03/29/16 03/29/16 Buy 50,000,000.000 FHLB DISCOUNT NOTE 04/20/16 313384VV8 (49,993,583.33) (49,993,583.33)
03/29/16 03/30/16 Buy 25,000,000.000 FHLB DISCOUNT NOTE 05/25/16 313384XG9 (24,988,722.22) (24,988,722.22)
03/29/16 03/30/16 Buy 50,000,000.000 TVA DISCOUNT NOTE 04/26/16 880592WB (49,991,000.00) (49,991,000.00)
03/30/16 03/31/16 Buy 25,000,000.000 U.S. TREASURY BILL 09/29/16 912796JM2 (24,948,812.50) (24,948,812.50) 03/30/16 03/31/16 Buy 35 ,000 , 000 . 000 FHLB DISCOUNT NOTE 04/13/16 313384VN6 (34 ,997 , 472 . 22) (34 ,997 , 472 . 22) 987,054,000.000 (986,702,588.46) (944.38) (986,703,532.84)
03/01/16 03/01/16 Coupon BRANCH BANKING & TRUST FR 12/01/16 1.07 07330NAF2 533.49 533.49
03/01/16 03/01/16 Coupon BRANCH BANKING & TRUST FR 12/01/16 1.07 07330NAF2 3,200.93 3,200.93
03/01/16 03/01/16 Coupon BRANCH BANKING & TRUST FR 12/01/16 1.07 07330NAF2 1,066.98 1,066.98
03/01/16 03/01/16 Coupon BRANCH BANKING & TRUST FR 12/01/16 1.07 07330NAF2 1,237.69 1,237.69
03/01/16 03/01/16 Coupon CISCO SYSTEMS FRN 03/01/19 1.14 17275RAQ 924.36 924.36
Payden & Rygel 122 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/01/16 03/01/16 Coupon CISCO SYSTEMS FRN 03/01/19 1.14 17275RAQ 496.84 496.84
03/01/16 03/01/16 Coupon CISCO SYSTEMS FRN 03/01/19 1.14 17275RAQ 838.85 838.85
03/01/16 03/01/16 Coupon CISCO SYSTEMS FRN 03/01/19 1.14 17275RAQ 3,004.16 3,004.16
03/01/16 03/01/16 Coupon CA GOLDEN EMPIRE SCH FRN 05/01/16 0.60 381008AS0 1,497.54 1,497.54
03/01/16 03/01/16 Coupon COCA-COLA 09/01/16 1.80 191216AU4 48,339.00 48,339.00
03/01/16 03/01/16 Coupon COCA-COLA 09/01/16 1.80 191216AU4 4,383.00 4,383.00
03/01/16 03/01/16 Coupon ELI LILLY & CO 03/01/18 1.25 532457BK3 5,000.00 5,000.00
03/01/16 03/01/16 Coupon PNC BANK FRN 06/01/18 1.06 69353REN4 8,434.69 8,434.69
03/01/16 03/01/16 Coupon SKANDINAVISKA ENSKILDA BAN 03/01/16 0.40 83051H6Y7 12,583.33 12,583.33
03/02/16 03/02/16 Coupon CHEVRON FRN 03/02/18 0.80 166764AW 3,704.46 3,704.46
03/02/16 03/02/16 Coupon CHEVRON FRN 03/02/18 0.80 166764AW 1,852.23 1,852.23
03/02/16 03/02/16 Coupon CHEVRON 03/02/18 1.37 166764AV2 8,190.00 8,190.00
03/02/16 03/02/16 Coupon FFCB 1ML FRN 01/02/18 0.48 3133EEWS 4,082.96 4,082.96
03/02/16 03/02/16 Coupon FFCB 3ML FRN 03/02/18 0.60 3133EEDP2 1,952.46 1,952.46
03/03/16 03/03/16 Coupon CATERPILLAR FINANCIAL FRN 03/03/17 0.86 14912L5Y3 4,945.85 4,945.85
03/03/16 03/03/16 Coupon CATERPILLAR FINANCIAL FRN 03/03/17 0.86 14912L5Y3 824.31 824.31
03/03/16 03/03/16 Coupon CATERPILLAR FINANCIAL FRN 03/03/17 0.86 14912L5Y3 3,297.23 3,297.23
03/03/16 03/03/16 Coupon CATERPILLAR FINANCIAL FRN 03/03/17 0.86 14912L5Y3 471.50 471.50
03/03/16 03/03/16 Coupon CISCO SYSTEMS 03/03/17 1.10 17275RAT9 2,915.00 2,915.00
03/03/16 03/03/16 Coupon CISCO SYSTEMS 03/03/17 1.10 17275RAT9 5,527.50 5,527.50
Payden & Rygel 123 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/03/16 03/03/16 Coupon FFCB 1ML FRN 10/03/16 0.46 3133ED3B6 1,800.42 1,800.42
03/04/16 03/04/16 Coupon FFCB 1ML FRN 08/04/17 0.48 3133EDUD 3,774.03 3,774.03
03/06/16 03/06/16 Coupon EXXON MOBIL 03/06/18 1.31 30231GAL6 17,421.75 17,421.75
03/07/16 03/07/16 Coupon AMERICAN EXPRESS FRN 06/05/17 0.91 0258M0DN 4,836.40 4,836.40
03/07/16 03/07/16 Coupon BANK OF AMERICA FRN 12/07/18 1.40 06050TMF6 13,633.32 13,633.32
03/07/16 03/07/16 Coupon BNY MELLON FRN 03/06/18 1.08 06406HCK3 563.69 563.69
03/07/16 03/07/16 Coupon BNY MELLON FRN 03/06/18 1.08 06406HCK3 1,127.39 1,127.39
03/07/16 03/07/16 Coupon MANUFACTURERS & TRADERS F 03/07/16 55279HAB6 4,077.41 4,077.41
03/07/16 03/07/16 Coupon MANUFACTURERS & TRADERS F 03/07/16 55279HAB6 2,851.33 2,851.33
03/07/16 03/07/16 Coupon PACCAR FINANCIAL FRN 06/06/17 0.83 69371RL95 243.43 243.43
03/07/16 03/07/16 Coupon PACCAR FINANCIAL FRN 06/06/17 0.83 69371RL95 4,625.08 4,625.08
03/07/16 03/07/16 Coupon PACCAR FINANCIAL FRN 06/06/17 0.83 69371RL95 373.25 373.25
03/07/16 03/07/16 Coupon PACCAR FINANCIAL FRN 06/06/17 0.83 69371RL95 5,111.93 5,111.93
03/08/16 03/08/16 Coupon NGN 2010-R2 1A 1MOFRN NCUA 11/06/17 0.81 62888UAA8 1,557.48 1,557.48
03/08/16 03/08/16 Coupon NGN 2010-R2 1A 1MOFRN NCUA 11/06/17 0.81 62888UAA8 1,618.43 1,618.43
03/08/16 03/08/16 Coupon NGN 2011-R1 1A 1MOFRN NCUA 01/08/20 0.89 62888YAA0 7,960.75 7,960.75
03/08/16 03/08/16 Coupon NGN 2011-R1 1A 1MOFRN NCUA 01/08/20 0.89 62888YAA0 1,356.77 1,356.77
03/08/16 03/08/16 Coupon NGN 2011-R2 1A 1MOFRN NCUA 02/06/20 0.84 62889CAA7 944.76 944.76
03/08/16 03/08/16 Coupon NGN 2011-R4 1A 1MOFRN NCUA 03/06/20 0.82 62889FAA0 5,780.93 5,780.93
03/08/16 03/08/16 Coupon NGN 2011-R4 1A 1MOFRN NCUA 03/06/20 0.82 62889FAA0 689.85 689.85
Payden & Rygel 124 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/09/16 03/09/16 Coupon PACCAR FINANCIAL 03/09/18 1.45 69371RM4 7,032.50 7,032.50
03/10/16 03/10/16 Coupon BNP PARIBAS YCD 03/10/16 0.55 05574RP90 10,427.08 10,427.08
03/10/16 03/10/16 Coupon CHARLES SCHWAB 03/10/18 1.50 808513AK1 9,000.00 9,000.00
03/11/16 03/11/16 Coupon NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.84 62889EAA3 3,882.43 3,882.43
03/11/16 03/11/16 Coupon NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.84 62889EAA3 440.01 440.01
03/11/16 03/11/16 Coupon NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.84 62889EAA3 503.28 503.28
03/11/16 03/11/16 Coupon US BANK OHIO FRN 09/11/17 0.83 90331HMJ9 1,311.92 1,311.92
03/11/16 03/11/16 Coupon US BANK OHIO FRN 09/11/17 0.83 90331HMJ9 5,247.67 5,247.67
03/12/16 03/12/16 Coupon TEXAS INSTRUMENTS 03/12/17 0.88 882508AX2 2,187.50 2,187.50
03/13/16 03/13/16 Coupon FFCB 1ML FRN 02/13/17 0.48 3133EDFB3 1,880.97 1,880.97
03/14/16 03/14/16 Coupon FFCB 3ML FRN 09/12/17 0.56 3133EETJ9 11,160.00 11,160.00
03/14/16 03/14/16 Coupon JPMORGAN CHASE FRN 06/13/16 0.96 48121CJM9 2,103.11 2,103.11
03/14/16 03/14/16 Coupon JPMORGAN CHASE FRN 06/13/16 0.96 48121CJM9 3,049.51 3,049.51
03/14/16 03/14/16 Coupon JPMORGAN CHASE FRN 06/13/16 0.96 48121CJM9 2,734.04 2,734.04
03/15/16 03/15/16 Coupon BB&T CORPORATION FRN 06/15/18 1.49 05531FAP8 5,202.17 5,202.17
03/15/16 03/15/16 Coupon BB&T CORPORATION FRN 06/15/18 1.49 05531FAP8 1,040.43 1,040.43
03/15/16 03/15/16 Coupon CHASE 2014-A1 A1 CDT 01/15/19 1.15 161571GJ7 3,354.17 3,354.17
03/15/16 03/15/16 Coupon CHASE 2014-A1 A1 CDT 01/15/19 1.15 161571GJ7 1,916.67 1,916.67
03/15/16 03/15/16 Coupon CHASE 2014-A1 A1 CDT 01/15/19 1.15 161571GJ7 2,875.00 2,875.00
03/15/16 03/15/16 Coupon CHASE 2015-A3 A CDT 1MOFRN 04/15/19 0.69 161571GW 3,791.20 3,791.20
Payden & Rygel 125 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/15/16 03/15/16 Coupon CISCO SYSTEMS FRN 06/15/18 0.94 17275RAY8 15,791.53 15,791.53
03/15/16 03/15/16 Coupon DRYROCK 2014-2 A 1MOFRN CD 03/16/20 0.78 06742LAC7 5,992.78 5,992.78
03/15/16 03/15/16 Coupon DRYROCK 2014-2 A 1MOFRN CD 03/16/20 0.78 06742LAC7 2,996.39 2,996.39
03/15/16 03/15/16 Coupon HONDA 2014-4 A2 CAR 01/17/17 0.58 43814JAB0 158.83 158.83
03/15/16 03/15/16 Coupon HONDA 2015-1 A2 CAR 06/15/17 0.70 43814KAB7 568.42 568.42
03/15/16 03/15/16 Coupon HONDA 2015-1 A2 CAR 06/15/17 0.70 43814KAB7 936.22 936.22
03/15/16 03/15/16 Coupon HOME DEPOT FRN 09/15/17 1.00 437076BJ0 3,344.25 3,344.25
03/15/16 03/15/16 Coupon JOHN DEERE 2013-B A3 EQP 08/15/17 0.87 477879AC4 754.98 754.98
03/15/16 03/15/16 Coupon JOHN DEERE 2014-A A3 EQP 04/16/18 0.92 47787VAC5 1,780.05 1,780.05
03/15/16 03/15/16 Coupon JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 2,696.25 2,696.25
03/15/16 03/15/16 Coupon JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 71.39 71.39
03/15/16 03/15/16 Coupon JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 466.76 466.76
03/15/16 03/15/16 Coupon GEORGIA POWER FRN 03/15/16 373334KB6 546.81 546.81
03/15/16 03/15/16 Coupon GEORGIA POWER FRN 03/15/16 373334KB6 1,556.30 1,556.30
03/15/16 03/15/16 Coupon TOYOTA 2014-B A3 CAR 03/15/18 0.76 89231RAC8 2,399.48 2,399.48
03/15/16 03/15/16 Coupon TOYOTA 2015-A A2 CAR 07/17/17 0.71 89236WAB 1,080.84 1,080.84
03/15/16 03/15/16 Coupon TOYOTA 2015-A A2 CAR 07/17/17 0.71 89236WAB 487.88 487.88
03/15/16 03/15/16 Coupon TOYOTA 2015-B A2A GREEN CA 11/15/17 0.77 89237CAB7 3,371.70 3,371.70
03/15/16 03/15/16 Coupon TOYOTA 2015-C A2A CAR 02/15/18 0.92 89231TAB6 5,750.00 5,750.00
03/15/16 03/15/16 Coupon U.S. TREASURY NOTE 09/15/18 1.00 912828L40 9,800.00 9,800.00
Payden & Rygel 126 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/15/16 03/15/16 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 232.08 232.08
03/15/16 03/15/16 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 836.36 836.36
03/15/16 03/15/16 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 1,059.68 1,059.68
03/15/16 03/15/16 Coupon WACHOVIA FRN 06/15/17 0.90 929903DU3 4,941.81 4,941.81
03/15/16 03/15/16 Coupon WACHOVIA FRN 06/15/17 0.90 929903DU3 2,965.08 2,965.08
03/16/16 03/16/16 Coupon FFCB 1ML FRN 04/16/18 0.49 3133EEZC7 2,680.46 2,680.46
03/17/16 03/17/16 Coupon FFCB 1ML FRN 01/17/18 0.47 3133EEZM5 3,699.51 3,699.51
03/17/16 03/17/16 Coupon FFCB 1ML FRN 04/17/17 0.49 3133EDJX1 1,158.19 1,158.19
03/18/16 03/18/16 Coupon HONDA 2016-1 A2 CAR 06/18/18 1.34 43814NAB1 2,653.94 2,653.94
03/19/16 03/19/16 Coupon FHLB 03/19/18 0.88 3130A7CX1 7,022.36 7,022.36
03/20/16 03/20/16 Coupon FHLMC 1ML FRN 04/20/17 0.44 3134G72G5 2,261.78 2,261.78
03/20/16 03/20/16 Coupon VOLKSWAGEN 2013-2 A3 CAR 04/20/18 0.70 92867PAC7 3,968.26 3,968.26
03/20/16 03/20/16 Coupon VOLKSWAGEN 2013-2 A3 CAR 04/20/18 0.70 92867PAC7 661.38 661.38
03/21/16 03/21/16 Coupon BMW 2016-1 A2A LEASE 01/22/18 1.17 05581RAB2 8,729.50 8,729.50
03/21/16 03/21/16 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.83 36159LCF1 630.93 630.93
03/21/16 03/21/16 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.83 36159LCF1 317.08 317.08
03/21/16 03/21/16 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.83 36159LCF1 776.53 776.53
03/21/16 03/21/16 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.83 36159LCF1 2,416.96 2,416.96
03/21/16 03/21/16 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.83 36159LCF1 287.96 287.96
03/21/16 03/21/16 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.83 36159LCF1 1,061.26 1,061.26
Payden & Rygel 127 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/21/16 03/21/16 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.83 36159LCF1 129.42 129.42
03/21/16 03/21/16 Coupon GEDFT 2014-2 A 1MOFRN FLOO 10/20/19 0.88 36159LCN4 2,606.80 2,606.80
03/21/16 03/21/16 Coupon HONDA 2015-2 A3 CAR 02/21/19 1.04 43813NAC0 4,285.67 4,285.67
03/21/16 03/21/16 Coupon INTL FINANCE CORP FRN 01/20/17 0.60 45950VHJ8 2,341.11 2,341.11
03/22/16 03/22/16 Coupon AMERICAN EXPRESS FRN 09/22/17 0.92 0258M0DS 1,208.71 1,208.71
03/22/16 03/22/16 Coupon AMERICAN EXPRESS FRN 09/22/17 0.92 0258M0DS 4,387.16 4,387.16
03/22/16 03/22/16 Coupon AMERICAN EXPRESS FRN 09/22/17 0.92 0258M0DS 3,357.52 3,357.52
03/22/16 03/22/16 Coupon BB&T CORPORATION 03/22/17 2.15 05531FAK9 24,187.50 24,187.50
03/22/16 03/22/16 Coupon BB&T CORPORATION 03/22/17 2.15 05531FAK9 1,612.50 1,612.50
03/22/16 03/22/16 Coupon GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 116.16 116.16
03/22/16 03/22/16 Coupon GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 348.49 348.49
03/24/16 03/24/16 Coupon TORONTO DOMINION NY YCD 03/24/16 0.39 89113E3N4 2,730.00 2,730.00
03/25/16 03/25/16 Coupon BMW 2014-A A3 CAR 11/26/18 0.97 09658UAC3 1,705.58 1,705.58
03/01/16 03/25/16 Coupon FHMS K708 A2 CMBS 01/25/19 2.13 3137AQT24 2,378.50 2,378.50
03/01/16 03/25/16 Coupon FHMS K708 A2 CMBS 01/25/19 2.13 3137AQT24 1,775.00 1,775.00
03/01/16 03/25/16 Coupon FHMS K710 A2 CMBS 05/25/19 1.88 3137ARPY6 2,997.11 2,997.11
03/25/16 03/25/16 Coupon FHMS KF01 A 1MOFRN CMBS 04/25/19 0.79 3137AUP52 12.50 12.50
03/01/16 03/25/16 Coupon FNA 2012-M9 ASQ2 CMBS 12/25/17 1.51 3136A7L26 2,054.08 2,054.08
03/01/16 03/25/16 Coupon FNA 2013-M1 ASQ2 CMBS 11/25/16 1.07 3136ABPT4 923.90 923.90
03/01/16 03/25/16 Coupon FNA 2013-M7 ASQ2 CMBS 03/26/18 1.23 3136AEGM 1,710.12 1,710.12
Payden & Rygel 128 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/01/16 03/25/16 Coupon FNA 14-M1 ASQ2 CMBS 11/25/18 2.32 3136AHUV 3,573.24 3,573.24
03/01/16 03/25/16 Coupon FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.75 3136AJ2A3 64.80 64.80
03/01/16 03/25/16 Coupon FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.65 3136AKQJ5 800.09 800.09
03/01/16 03/25/16 Coupon FNA 2014-M6 FA 1MOFRN CMBS 12/25/17 0.69 3136AJ7D2 610.65 610.65
03/01/16 03/25/16 Coupon FNA 2015-M10 FA 1MOFRN CMB 03/25/19 0.65 3136ANA98 4,947.64 4,947.64
03/01/16 03/25/16 Coupon FNA 2015-M12 FA 1MOFRN CMB 04/25/20 0.76 3136AP3Z3 6,082.87 6,082.87
03/01/16 03/25/16 Coupon FNA 2015-M13 ASQ2 CMBS 09/25/19 1.65 3136AQDQ 5,761.00 5,761.00
03/01/16 03/25/16 Coupon FNA 2015-M3 FA 1MOFRN CMBS 06/25/18 0.62 3136AMMC 682.35 682.35
03/01/16 03/25/16 Coupon FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.61 3136AMTM 6,864.73 6,864.73
03/01/16 03/25/16 Coupon FNA 2015-M7 ASQ2 CMBS 04/25/18 1.55 3136ANJY4 4,843.75 4,843.75
03/01/16 03/25/16 Coupon FNA 2015-M8 FA 1MOFRN CMBS 11/25/18 0.58 3136ANMF 6,033.24 6,033.24
03/01/16 03/25/16 Coupon FNA 2015-M8 FA 1MOFRN CMBS 11/25/18 0.58 3136ANMF 810.43 810.43
03/01/16 03/25/16 Coupon FNA 2015-M8 FA 1MOFRN CMBS 11/25/18 0.58 3136ANMF 877.97 877.97
03/26/16 03/26/16 Coupon BANK OF AMERICA 03/26/18 1.65 06050TLY6 21,862.50 21,862.50
03/31/16 03/31/16 Coupon U.S. TREASURY NOTE 03/31/16 0.38 912828C40 88,125.00 88,125.00
03/31/16 03/31/16 Coupon U.S. TREASURY NOTE 03/31/17 0.50 912828J92 37,500.00 37,500.00 03/31/16 03/31/16 Coupon U.S. TREASURY NOTE 09/30/17 0.63 912828TS9 20 , 078 . 13 20 , 078 . 13 668,090.61 668,090.61
Payden & Rygel 129 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/01/16 03/01/16 Income 2,757.470 STIF INT USD 2,757.47 2,757.47 03/01/16 03/01/16 Income 5 , 792 . 280 ADJ NET P&I USD 5 , 792 . 28 5 , 792 . 28 8,549.750 8,549.75 8,549.75
03/01/16 03/01/16 Contributn 200,000,000.000 NM USD 200,000,000.00 200,000,000.00
03/04/16 03/07/16 Sell Long 3,000,000.000 U.S. TREASURY NOTE 03/31/16 0.38 912828C40 3,000,117.19 4,887.30 3,005,004.49
03/17/16 03/22/16 Sell Long 3,270,000.000 VISA 12/14/17 1.20 92826CAA0 3,283,341.60 10,682.00 3,294,023.60
03/23/16 03/29/16 Sell Long 370,000.000 COCA-COLA 10/27/17 0.88 191216BR0 369,992.60 1,366.94 371,359.54 03/30/16 03/31/16 Sell Long 25 ,000 , 000 . 000 U.S. TREASURY BILL 10/13/16 912796HJ1 24 ,927 , 272 . 92 30 , 532 . 64 24 ,957 , 805 . 56 31,640,000.000 31,580,724.31 47,468.88 31,628,193.19
03/08/16 03/08/16 Pay Princpl 35,804.967 NGN 2010-R2 1A 1MOFRN NCUA 11/06/17 0.81 62888UAA8 35,804.97 35,804.97
03/08/16 03/08/16 Pay Princpl 37,206.241 NGN 2010-R2 1A 1MOFRN NCUA 11/06/17 0.81 62888UAA8 37,206.24 37,206.24
03/08/16 03/08/16 Pay Princpl 139,237.070 NGN 2011-R1 1A 1MOFRN NCUA 01/08/20 0.89 62888YAA0 139,237.07 139,237.07
03/08/16 03/08/16 Pay Princpl 23,730.549 NGN 2011-R1 1A 1MOFRN NCUA 01/08/20 0.89 62888YAA0 23,730.55 23,730.55
03/08/16 03/08/16 Pay Princpl 18,675.358 NGN 2011-R2 1A 1MOFRN NCUA 02/06/20 0.84 62889CAA7 18,675.36 18,675.36
03/08/16 03/08/16 Pay Princpl 314,385.936 NGN 2011-R4 1A 1MOFRN NCUA 03/06/20 0.82 62889FAA0 314,385.94 314,385.94
03/08/16 03/08/16 Pay Princpl 37,516.222 NGN 2011-R4 1A 1MOFRN NCUA 03/06/20 0.82 62889FAA0 37,516.22 37,516.22
03/11/16 03/11/16 Pay Princpl 85,208.462 NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.84 62889EAA3 85,208.46 85,208.46
03/11/16 03/11/16 Pay Princpl 9,656.959 NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.84 62889EAA3 9,656.96 9,656.96
03/11/16 03/11/16 Pay Princpl 11,045.541 NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.84 62889EAA3 11,045.54 11,045.54
Payden & Rygel 130 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/15/16 03/15/16 Pay Princpl 144,294.599 HONDA 2014-4 A2 CAR 01/17/17 0.58 43814JAB0 144,294.60 144,294.60
03/15/16 03/15/16 Pay Princpl 165,215.805 HONDA 2015-1 A2 CAR 06/15/17 0.70 43814KAB7 165,215.81 165,215.81
03/15/16 03/15/16 Pay Princpl 272,120.149 HONDA 2015-1 A2 CAR 06/15/17 0.70 43814KAB7 272,120.15 272,120.15
03/15/16 03/15/16 Pay Princpl 187,876.144 JOHN DEERE 2013-B A3 EQP 08/15/17 0.87 477879AC4 187,876.14 187,876.14
03/15/16 03/15/16 Pay Princpl 165,935.176 JOHN DEERE 2014-A A3 EQP 04/16/18 0.92 47787VAC5 165,935.18 165,935.18
03/15/16 03/15/16 Pay Princpl 264,903.870 JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 264,903.87 264,903.87
03/15/16 03/15/16 Pay Princpl 7,013.748 JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 7,013.75 7,013.75
03/15/16 03/15/16 Pay Princpl 45,859.122 JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 45,859.12 45,859.12
03/15/16 03/15/16 Pay Princpl 321,786.691 TOYOTA 2014-B A3 CAR 03/15/18 0.76 89231RAC8 321,786.69 321,786.69
03/15/16 03/15/16 Pay Princpl 271,492.896 TOYOTA 2015-A A2 CAR 07/17/17 0.71 89236WAB 271,492.90 271,492.90
03/15/16 03/15/16 Pay Princpl 122,548.876 TOYOTA 2015-A A2 CAR 07/17/17 0.71 89236WAB 122,548.88 122,548.88
03/15/16 03/15/16 Pay Princpl 517,646.834 TOYOTA 2015-B A2A GREEN CA 11/15/17 0.77 89237CAB7 517,646.83 517,646.83
03/15/16 03/15/16 Pay Princpl 79,731.408 USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 79,731.41 79,731.41
03/15/16 03/15/16 Pay Princpl 287,333.944 USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 287,333.94 287,333.94
03/15/16 03/15/16 Pay Princpl 364,056.620 USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 364,056.62 364,056.62
03/20/16 03/20/16 Pay Princpl 574,806.562 VOLKSWAGEN 2013-2 A3 CAR 04/20/18 0.70 92867PAC7 574,806.56 574,806.56
03/20/16 03/20/16 Pay Princpl 95,801.094 VOLKSWAGEN 2013-2 A3 CAR 04/20/18 0.70 92867PAC7 95,801.09 95,801.09
03/22/16 03/22/16 Pay Princpl 217,805.195 GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 217,805.20 217,805.20
03/22/16 03/22/16 Pay Princpl 653,415.582 GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 653,415.58 653,415.58
03/25/16 03/25/16 Pay Princpl 818.235 FHMS KF01 A 1MOFRN CMBS 04/25/19 0.79 3137AUP52 818.24 818.24
Payden & Rygel 131 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/01/16 03/25/16 Pay Princpl 105,394.212 FNA 2012-M9 ASQ2 CMBS 12/25/17 1.51 3136A7L26 105,394.21 105,394.21
03/01/16 03/25/16 Pay Princpl 211,579.480 FNA 2013-M1 ASQ2 CMBS 11/25/16 1.07 3136ABPT4 211,579.48 211,579.48
03/01/16 03/25/16 Pay Princpl 26,913.084 FNA 2013-M7 ASQ2 CMBS 03/26/18 1.23 3136AEGM 26,913.08 26,913.08
03/01/16 03/25/16 Pay Princpl 2,008.520 FNA 14-M1 ASQ2 CMBS 11/25/18 2.32 3136AHUV 2,008.52 2,008.52
03/01/16 03/25/16 Pay Princpl 20,278.360 FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.75 3136AJ2A3 20,278.36 20,278.36
03/01/16 03/25/16 Pay Princpl 6,075.356 FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.65 3136AKQJ5 6,075.36 6,075.36
03/01/16 03/25/16 Pay Princpl 26,014.350 FNA 2014-M6 FA 1MOFRN CMBS 12/25/17 0.69 3136AJ7D2 26,014.35 26,014.35
03/01/16 03/25/16 Pay Princpl 13,096.600 FNA 2015-M10 FA 1MOFRN CMB 03/25/19 0.65 3136ANA98 13,096.60 13,096.60
03/01/16 03/25/16 Pay Princpl 13,760.500 FNA 2015-M12 FA 1MOFRN CMB 04/25/20 0.76 3136AP3Z3 13,760.50 13,760.50
03/01/16 03/25/16 Pay Princpl 6,014.274 FNA 2015-M3 FA 1MOFRN CMBS 06/25/18 0.62 3136AMMC 6,014.27 6,014.27
03/01/16 03/25/16 Pay Princpl 15,046.500 FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.61 3136AMTM 15,046.50 15,046.50
03/01/16 03/25/16 Pay Princpl 24,781.160 FNA 2015-M8 FA 1MOFRN CMBS 11/25/18 0.58 3136ANMF 24,781.16 24,781.16
03/01/16 03/25/16 Pay Princpl 3,328.810 FNA 2015-M8 FA 1MOFRN CMBS 11/25/18 0.58 3136ANMF 3,328.81 3,328.81 03/01/16 03/25/16 Pay Princpl 3 , 606 . 210 FNA 2015-M8 FA 1MOFRN CMBS 11/25/18 0.58 3136ANMF 3 , 606 . 21 3 , 606 . 21 5,950,827.272 5,950,827.28 5,950,827.28
03/01/16 03/01/16 Mature Long 7,500,000.000 SKANDINAVISKA ENSKILDA BAN 03/01/16 0.40 83051H6Y7 7,500,000.00 7,500,000.00
03/02/16 03/02/16 Mature Long 15,000,000.000 FHLB DISCOUNT NOTE 03/02/16 313384TU3 14,995,792.50 4,207.50 15,000,000.00
03/02/16 03/02/16 Mature Long 50,000,000.000 FHLB DISCOUNT NOTE 03/02/16 313384TU3 49,992,500.00 7,500.00 50,000,000.00
03/02/16 03/02/16 Mature Long 10,000,000.000 FHLB DISCOUNT NOTE 03/02/16 313384TU3 9,998,500.00 1,500.00 10,000,000.00
03/03/16 03/03/16 Mature Long 50,000,000.000 FFCB DISCOUNT NOTE 03/03/16 313312TV2 49,969,583.33 30,416.67 50,000,000.00
Payden & Rygel 132 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/03/16 03/03/16 Mature Long 50,000,000.000 U.S. TREASURY BILL 03/03/16 912796FZ7 49,995,416.67 4,583.33 50,000,000.00
03/07/16 03/07/16 Mature Long 25,000,000.000 FHLMC DISCOUNT NOTE 03/07/16 313396TZ6 24,998,687.50 1,312.50 25,000,000.00
03/07/16 03/07/16 Mature Long 2,145,000.000 MANUFACTURERS & TRADERS F 03/07/16 55279HAB6 2,145,000.00 2,145,000.00
03/07/16 03/07/16 Mature Long 1,500,000.000 MANUFACTURERS & TRADERS F 03/07/16 55279HAB6 1,500,000.00 1,500,000.00
03/09/16 03/09/16 Mature Long 50,000,000.000 FHLB DISCOUNT NOTE 03/09/16 313384UB3 49,989,888.89 10,111.11 50,000,000.00
03/09/16 03/09/16 Mature Long 25,000,000.000 FHLB DISCOUNT NOTE 03/09/16 313384UB3 24,995,916.67 4,083.33 25,000,000.00
03/09/16 03/09/16 Mature Long 20,900,000.000 FHLMC DISCOUNT NOTE 03/09/16 313396UB7 20,897,306.22 2,693.78 20,900,000.00
03/10/16 03/10/16 Mature Long 7,500,000.000 BNP PARIBAS YCD 03/10/16 0.55 05574RP90 7,500,000.00 7,500,000.00
03/10/16 03/10/16 Mature Long 50,000,000.000 FAMC DISCOUNT NOTE 03/10/16 31315KUC2 49,997,444.44 2,555.56 50,000,000.00
03/10/16 03/10/16 Mature Long 25,000,000.000 FAMC DISCOUNT NOTE 03/10/16 31315KUC2 24,998,722.22 1,277.78 25,000,000.00
03/10/16 03/10/16 Mature Long 50,000,000.000 U.S. TREASURY BILL 03/10/16 912796HF9 49,994,073.61 5,926.39 50,000,000.00
03/10/16 03/10/16 Mature Long 50,000,000.000 U.S. TREASURY BILL 03/10/16 912796HF9 49,994,444.44 5,555.56 50,000,000.00
03/15/16 03/15/16 Mature Long 260,000.000 GEORGIA POWER FRN 03/15/16 373334KB6 260,000.00 260,000.00
03/15/16 03/15/16 Mature Long 740,000.000 GEORGIA POWER FRN 03/15/16 373334KB6 740,000.00 740,000.00
03/16/16 03/16/16 Mature Long 50,000,000.000 FAMC DISCOUNT NOTE 03/16/16 31315KUJ7 49,996,166.67 3,833.33 50,000,000.00
03/16/16 03/16/16 Mature Long 25,000,000.000 FAMC DISCOUNT NOTE 03/16/16 31315KUJ7 24,998,083.33 1,916.67 25,000,000.00
03/16/16 03/16/16 Mature Long 10,900,000.000 FHLB DISCOUNT NOTE 03/16/16 313384UJ6 10,899,182.50 817.50 10,900,000.00
03/17/16 03/17/16 Mature Long 50,000,000.000 U.S. TREASURY BILL 03/17/16 912796HG7 49,991,678.47 8,321.53 50,000,000.00
03/17/16 03/17/16 Mature Long 50,000,000.000 U.S. TREASURY BILL 03/17/16 912796HG7 49,992,708.33 7,291.67 50,000,000.00
03/18/16 03/18/16 Mature Long 48,000,000.000 FHLMC DISCOUNT NOTE 03/18/16 313396UL5 47,997,653.33 2,346.67 48,000,000.00
Payden & Rygel 133 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 03/01/2016 Account Number: through 03/31/2016
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 03/23/16 03/23/16 Mature Long 44,000,000.000 FHLB DISCOUNT NOTE 03/23/16 313384UR8 43,989,183.33 10,816.67 44,000,000.00
03/23/16 03/23/16 Mature Long 39,999,000.000 FHLB DISCOUNT NOTE 03/23/16 313384UR8 39,990,150.22 8,849.78 39,999,000.00
03/23/16 03/23/16 Mature Long 25,000,000.000 FHLB DISCOUNT NOTE 03/23/16 313384UR8 24,999,000.00 1,000.00 25,000,000.00
03/24/16 03/24/16 Mature Long 50,000,000.000 U.S. TREASURY BILL 03/24/16 912796HH5 49,990,250.00 9,750.00 50,000,000.00
03/24/16 03/24/16 Mature Long 50,000,000.000 U.S. TREASURY BILL 03/24/16 912796HH5 49,990,250.00 9,750.00 50,000,000.00
03/24/16 03/24/16 Mature Long 9,000,000.000 TORONTO DOMINION NY YCD 03/24/16 0.39 89113E3N4 9,000,000.00 9,000,000.00
03/30/16 03/30/16 Mature Long 50,000,000.000 FHLB DISCOUNT NOTE 03/30/16 313384UY3 49,987,500.00 12,500.00 50,000,000.00
03/30/16 03/30/16 Mature Long 20,000,000.000 FHLB DISCOUNT NOTE 03/30/16 313384UY3 19,995,000.00 5,000.00 20,000,000.00 03/31/16 03/31/16 Mature Long 47 ,000 , 000 . 000 U.S. TREASURY NOTE 03/31/16 0.38 912828C40 47 ,000 , 000 . 00 47 ,000 , 000 . 00 ,059,444,000.000 1,059,280,082.67 163,917.34 1,059,444,000.00
03/09/16 03/09/16 Withdrawal (75,000,000.000) WD USD (75,000,000.00) (75,000,000.00)
03/16/16 03/16/16 Withdrawal (125,000,000.000) WD USD (125,000,000.00) (125,000,000.00) 03/23/16 03/23/16 Withdrawal (100 , 000 , 000 . 000) WD USD (100 ,000 , 000 . 00) (100 ,000 , 000 . 00) 300,000,000.000) (300,000,000.00) (300,000,000.00)
Payden & Rygel 134 Nurse Advice Line (NAL) Finance & Budget Committee April 27, 2016
Gertrude S. Carter, M.D. Chief Medical Officer L.A. Care Health Plan
135 Regulatory Requirements for NAL
• DHCS-Title 22 • California Health & Safety Code, §1348.8 • Cal MediConnect (CMC) 3 Way Contract • Title 28, California Code of Regulations, §1300.67.2.2(c)(8)(A) • NCQA Requirement for all lines of business
136 NCQA Requirements for NAL
– The NAL’s requirements are listed in the Standards for Member Connections (MEM) 7- Health Information Line.
NCQA MEM-7 requirements are as follows: • Access to Health Information Line -Available 24 hours per day -Provides secure transmission of electronic communication with a 24 hour turn-around -Provides interpreter services for members by telephone • Capabilities -Follow-up on specified cases and contact members -Link member contacts to a contact history • Monitoring -Tracks telephone and web statistics at least monthly -Track member use of health information line at least quarterly -Evaluate member satisfaction with line at least annually -Monitor call periodically -Analyze data at least annually, identify and prioritize opportunities for improvement
137 Nurse Advice Line Calls by Product Line Rolling 12 Months
138 Redirection Rates Member’s Initial Intended Treatment Plan or Setting: Emergency Room
42% Not Redirected 43%
Redirected to a Higher Level of Care 17% 911 14%
41% Redirected to a Lower Level of Care 43% Urgent Care
361 Number of Symptom Check Calls 415
0 50 100 150 200 250 300 350 400 450 Number of Symptom Redirected to a Lower Redirected to a Not Redirected Check Calls Level of Care Higher Level of Care March 361 148 60 153 February 415 177 58 180
March February 139 Redirection Rates Member’s Initial Intended Treatment Plan or Setting: Urgent Care
71% Not Redirected 77%
6% Redirected to a Higher Level of Care 6% Emergency Room
23% Redirected to a Lower Level of Care Provider/Office 17% Visit 184 Number of Symptom Check Calls 241
0 50 100 150 200 250 300 Number of Symptom Redirected to a Lower Redirected to a Higher Not Redirected Check Calls Level of Care Level of Care March 184 42 11 131 February 241 42 14 185
March February 140 Redirection Rates Member’s Initial Intended Treatment Plan or Setting: Call Provider/Office Visit
48% Not Redirected 50%
36% Redirected to a Higher Level of Care 32% Urgent Care
16% Redirected to a Lower Level of Care 17% Home Treatment
292 Number of Symptom Check Calls 317
0 50 100 150 200 250 300 350 Number of Symptom Redirected to a Lower Redirected to a Not Redirected Check Calls Level of Care Higher Level of Care March 292 46 105 141 February 317 54 103 160
March February 141 Redirection Rates Member’s Initial Intended Treatment Plan or Setting: Home Treatment
20% Not Redirected 29%
80% Redirected to a Higher Level of Care 71% Call Provider/Office Visit
Redirected to a Lower Level of Care N/A
313 Number of Symptom Check Calls 414
0 50 100 150 200 250 300 350 400 450 Number of Symptom Redirected to a Lower Redirected to a Not Redirected Check Calls Level of Care Higher Level of Care March 343 0 274 69 February 414 0 296 118
March February 142 Top Referral Activity Referral Activities Referral Activities February 2016 March 2016 0% 2% 0% 3% 5% 5% 7% 11%
N=1,703 N=2,007 calls calls
81% 86% General Information- 86% General Information- 81% Other-7% Other-11% Chronic Condition & Case Management- 5% Chronic Condition & Case Management-5% Web Tools- 2% Web Tools- 3% Wellness Support- NA Wellness Support-NA
• Wellness Support= Question related to a lifestyle change such as tobacco cessation and weight loss • Web Tools= Question related to website, such as health plan website or nurse chat website
• Chronic Condition & CM= Support with a chronic condition 143 • Other= Calls that do not fit into any category above Questions?
144 145 146 147 148 149 Board of Governors Executive Community Advisory Committee Meeting Minutes – March 9, 2016 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 * Maria Teresa Caballero RCAC 1 Hilda Pérez, Member, Board of Governors Alicia Flores, RCAC 1 Vice-Chair Ana Maria Barroso, RCAC 2 Maribel Ferrer, Executive Director, Medicaid Coverage Carlos Aguirre, RCAC 2 Chair Estela Lara, RCAC 2 Expansion & TANF Lidia Parra, RCAC 3 Chair Elizabeth Cooper, RCAC 2/CCI Malou Balones, Committee Liaison, Board Services Hercilia Salvatierra, RCAC 4 Chair Area 2 Jennifer Carabali, Committee Liaison, Board Services Romalda Meza, RCAC 5 Chair Roberto Santos, RCAC 3 Idalia Chitica, Field Specialist Supervisor, CO&E Dove Savage Pinkney, RCAC 6 Chair Irma Torres, RCAC 6 Kristina Chung, Community Outreach Field Specialist, CO&E Dalia Cadena, RCAC 7 Chair Fátima Vásquez, RCAC 7 Auleria Eakins, Community Outreach Manager, CO&E Ana Romo, RCAC 8 Chair Maria Isabel Tamayo, RCAC 8 Felicia Gray, Community Outreach Liaison, CO&E Cristina Deh- Lee, RCAC 9 Chair, ECAC Samnieng Rous, RCAC 9 Laura Garcia, Health Promoter Liaison CO&E Vice Chair Janner Gavidia, RCAC 10 Hilda Herrera, Community Outreach Liaison CO&E Elsa Gervacio, RCAC 10 Chair Reina Orellana, RCAC 11 Judy Hsieh Bigman, Community Resource Specialist, CO&E Elda Sevilla, RCAC 11 Chair, ECAC Chair Abelardo Menor, CCI Area 1 Devina Kuo Fan, Health Promoter Program Manager, CO&E Silvia Poz, At Large Member Marilen Menor, CCI Area 1 Susan Ma, CCI Field Specialist, CO&E Demetria Saffore, At Large Member Wilma Ballew, CCI Area 2 Linda Merkens, Manager, Board Services Marcia Ramos, CCI Area 1 Chair Deaka McClain, CCI Area 4 Frank Meza, Community Outreach Field Specialist, CO&E Elizabeth Lyons, CCI Area 2 Chair Johnathan Cooper, Public Nancy Molina, CCI Liaison, CO&E Brenda White, CCI Area 3 Chair Courtney Nicholas, Community Outreach Field Specialist, CO&E Nesima Istrefi, CCI Area 4 Chair Eduardo Kogan, Interpreter Francisco Oaxaca, Director of Communication, Communications Paula Alvira, Interpreter Department * Excused Absent ** Absent Sina New, Interpreter Peter Prampetch, Analyst, CO&E *** Via teleconference Bo Uce, Interpreter Gina Ramirez, Management Associate Cynthia Rios, Community Outreach Liaison CO&E Jose Ricardo Rivas, Community Outreach Liaison CO&E Dolly Tataje, CCI Field Specialist, CO&E Prity Thanki, Local Government Advisor, Government Affairs Christina Vane-Perez, Special Projects Manager Christian Vega, Member Retention Unit, Member Services Department Martin Vicente, Community Outreach Field Specialist, CO&E Diane Weber, Strategic Planning Specialist, Strategy, Regulatory and External Affairs
APPROVED 150 AGENDA ACTION TAKEN ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS CALL TO ORDER Elda Sevilla, ECAC Chair, called the meeting to order at 10:04 a.m. She asked those wishing to address the Committee to complete a public comment form available at the registration table. Staff members are available to help people complete the form and get it to the Chairperson. ECAC members and members of the public are recognized by the Chair before commenting. Each person has three minutes to speak. APPROVE Dalia Cadena, RCAC 7 Chair, stated that the Health Promoter Update lists Prity Thanki, when Approved MEETING AGENDA it should be Devina Kou. Idalia Chitica, Field Specialist Supervisor, CO&E, that the new agendas unanimously. found in the folder have been updated with the correct information. 17 AYES, (Aguirre, Cadena, Deh-Lee, Flores, Gervacio, Istrefi, Lyons, Meza, Parra, Pinkney, Poz, Ramos, Romo, Salvatierra, Sevilla, The Agenda for today’s meeting was approved as amended. Saffore, and White). APPROVE A committee member noted that on the February meeting minutes, attendance was not Approved MEETING MINUTES properly documented. Idalia Chitica, Field Specialist Supervisor, CO&E, stated that corrections to unanimously. will be made to reflect members who attended the February 10, 2016 meeting. 17 AYES
Hilda Pérez, Member, Board of Governors, noted that pages three and four in the Spanish version did not indicate that public attendees to the Children’s Health Advocacy Consultant Committee will not get traveling expenses covered as there are no consumer members assigned to that committee.
The February 10, 2016 meeting minutes were approved as amended. STANDING ITEMS ECAC CHAIR PERSON Elda Sevilla, ECAC Chair, presented the following motion: REPORT (Ana Romo, RCAC 8 Chair left the meeting) Motion ECA 100.0316 Approved To approve the following candidate(s) to the Regional Community Advisory unanimously. Committees (RCAC), and Coordinated Care Initiative Councils (CCI) as reviewed by 16 AYES (Aguirre, Cadena, Deh-Lee,
Executive Community Advisory Committee March 9, 2016 / Page 2 of 10 APPROVED 151 the Executive Community Advisory Committee (ECAC) during the February 10, 2016 Flores, Gervacio, ECAC meeting. Istrefi, Lyons, Meza, Parra, Pinkney, Poz, Ramos, Salvatierra, Sevilla, Saffore, and Name RCAC/CCI # Type of Member White). (Agency, if applicable) Channary Lim RCAC 2 Consumer Sophy Mom RCAC 2 Consumer Eng Nay Teang RCAC 2 Consumer Lluvia Salazar RCAC 11 Personal Assistance Services RCAC 11 Community Partner Council (PASC)/ Public Authority for IHSS GOVERNMENT Prity Thanki, Local Government Advisor, reported that on February 29, 2016, the Legislature AFFAIRS UPDATE approved a new restructured Managed Care Organization (MCO) tax on health plans in order to continue to provide $1.3 billion annually for the Medi-Cal program. California currently taxes health plans that participate in Medi-Cal. In 2014, federal officials said that California’s current MCO tax did not meet federal requirements. It had to be changed by July 2016 or California would lose the matching funds from the federal government. Rather than funding the program from the state budget surplus, Governor Brown called a special session last summer to come up with a different plan that would also help fund programs for those with developmental disabilities. On February 29th, the MCO tax structure drew unanimous support from Democrats and even won some Republican votes to reach the required two-thirds needed for the tax to pass. The new MCO tax structure still needs to be approved by the federal government. As part of this deal, the Legislature approved $300 million for programs that help Californians with developmental disabilities, including higher wages for staff at regional centers and increased money to support independent-living programs. On March 1, 2016, Governor Brown signed the bills into law, effective July 1, 2016.
A California Medi-Cal Hospital Reimbursement Initiative is on the November ballot this year.
The federal government helps pay for the Medi-Cal program, however in order for California to get the federal funds, it needs to contribute a matching amount of its own money. Since 2009, hospitals have paid the state a fee to help California get federal funds for Medi-Cal. Once the hospitals’ funds are matched with federal dollars, the money is re-distributed to hospitals in the form of supplemental Medi-Cal payments. As part of the agreement, hospitals have allowed California to take a small portion of the fee money to pay for health care for children.
Executive Community Advisory Committee March 9, 2016 / Page 3 of 10 APPROVED 152 The current hospital fee program is set to expire in 2017. The ballot measure, if passed by California voters, will make the fee program permanent. It will also add language to California’s Constitution to require voter approval of changes to the hospital fee program to make sure that the State does not divert the money for non-health care purposes but instead uses these funds for supporting health care services for children, seniors and low-income Californians.
(Ana Romo, RCAC 8 Chair joined the meeting) HEALTH PROMOTOR Devina Kuo Fan, Health Promoter Program Manager, CO&E (A copy of the written report can be PROGRAM UPDATE requested by contacting the CO&E Department) reported: In FY 2014-2015, Health Promoters conducted over 220 outreach efforts They collected a total of 3,758 surveys on the following topics: o Access to Health Care o Asthma: No More Attacks o Healthcare Reform o How to Communicate With Your Doctor o Types of Care o My Plate Results showed that community members who attended had an increased knowledge change based on the workshop pre- and post- test surveys. Also, there was a high level of satisfaction for these workshops among the community members that attended. Health promoters are reaching 85% women, majority (91%) are over 30 years old, 90% Latino, 4% Asian, 2% African American, 1% White. Previous monthly trainings: o January 28, 2016 Rethink Your Drink o February 5 & 25, 2016: Caring for a Loved One with Dementia part 1 & 2. Learning objectives: Define dementia, identify ways to lower caregiver stress, and how to communicate effectively with a person with dementia; understand importance of advanced planning, home safety, and driving safety. o February 18, 2016 Alzheimer’s Community Forum Upcoming meetings: o Mar 11, 2016: Colorectal Cancer by the American Cancer Society o Mar 24, 2016: Colorectal Cancer practice presentations o Apr 1, 2016: Advanced Care Planning by Behavioral Health Department and Caring for a Loved One with Dementia part 1 revised. o Apr 8, 2016: Caring for a Loved One with Dementia part 1 & 2 practice presentations RESPECTFULLY SUBMITTED BY: APPROVED BY:
Executive Community Advisory Committee March 9, 2016 / Page 4 of 10 APPROVED 153 Some community workshop topics that Health Promoters taught were: the “A Little Sugar in the Blood: Pre-Diabetes” with stretch bands exercise activities, access to care: “Health in Your Hands” and “Types of Care.” Previous events: o Health Promoters and staff attended Alzheimer’s Community Forum, February 18, 2016 o A Health Promoter volunteered performing BP screenings and BMI screenings at the Family Resource Center Inglewood – Blood pressure screenings, February 26 & 29, 2016 Upcoming Events: o Family Resource Center Boyle Heights – The Wellness Center 2nd Anniversary Celebration, March 19, 2016, Health Promoters will help with registration, set-up, a My Plate demonstration, and clean-up.
Ms. Romo asked if the Health Promoters could provide ECAC members a written report. AT-LARGE MEMBER Silvia Poz, At Large Member, reported that there were five members approved. UPDATE RCAC 2 had three new members: Channary Lim, Sophy Mom and Eng Nay Teang (RCAC MEMBER RCAC 11 had two new members Lluvia Salazar and Personal Assistance Services Council RECRUITMENT/CCI) (PASC)/Public Authority for IHSS
Eight interest cards were submitted in February from RCACs 4, 6, 7, and 9. For FY 2015-2016, a total of 17 interest cards were received. Not all interest cards are processed due to eligibility and specific product lines are needed to reflect overall L.A. Care Membership. For Fiscal Year 2015-2016 there have been 18 new members in the RCACs. Demetria Saffore, At Large Member, reported there are 36 members in the CCI Consumer Council. There were two CCI Council meetings in February 2016: Area 3 South Los Angeles and Area 4 Long Beach. Members enjoyed a presentation on “The ABCs of Cal MediConnect”, presented by L.A. Care’s Medicare Operations Department.
Susan Ma, CCI Field Specialist, CO&E, reported Community participation in the following events: o Martin Luther King Breakfast at San Fernando o Lunar New Year Event in Monterey Park Advocacy training for Legislative day to Sacramento will be held on May 25, 2016 Overall member concerns/feedback are: o Balancing billing, doctor charging a fee when filling out medical forms
Executive Community Advisory Committee March 9, 2016 / Page 5 of 10 APPROVED 154 o Members not able to continue to receive their medications after being assigned to a new doctor Future plans: o Continue discussion on the work plan for 2016 o Continue to participate in community events/Healthcare Fairs o Continue to receive health education training at the CCI Council meetings o On-going member recruitment COMMUNITY Ms. Poz shared a program called “Find out who is your Legislator in your area” by calling ENGAGEMENT 1-888-868-3762. ECAC Members Cristina Deh- Lee, RCAC 9 Chair, ECAC Vice Chair, shared that on March 12, 2016 the City of Long Beach will have a health event, “Kids in the Kitchen,” at Martin Luther King Park.
Maribel Ferrer, Executive Director, Medicaid Coverage Expansion & TANF, announced that she was no longer going to be attending the ECAC meetings as she has started a new position. She thanked Ms. Chitica and Ms. Eakins for their support. She introduced Francisco Oaxaca, Director of Communications, who will replace her at the ECAC table. Mr. Oaxaca thanked Maribel and shared that he is looking forward to working with ECAC members and attending the RCAC/CCI meetings.
ECAC members thanked Ms. Ferrer for all she has done for ECAC and wished her the best in her new endeavors. MEMBER ISSUES Chair Sevilla stated that ECAC needs to discuss this section of the agenda. She asked that ECAC members come to the next meeting prepared to present to ECAC any health access issues that were discussed in the RCAC or CCI Council meetings. Health Navigators from the Member Services Department will be available at the end of the meeting to address individual member issues.
Ms. Saffore stated that there is a global issue in her community and recommends someone from L.A. Care reach out to a primary care physician who treats a large number of CCI members but is no longer contracted with L.A. Care. Ms. Chitica stated she will get the information and forward it to the correct department.
Brenda White, CCI Area 3 Chair, asked if there are updates on the expansion of the Inglewood Family Resource Center (FRC). Ms. Eakins informed Committee members that there are no updates but she will invite the FRC manger to the next ECAC meeting to provide an update.
Jennifer Carabali, Committee Liaison, Board Services
Executive Community Advisory Committee March 9, 2016 / Page 6 of 10 APPROVED 155 Ms. Deh- Lee shared that she has information from a St. Mary event as they are looking for partners. Mr. Oaxaca responded that L.A. Care does partner with different associates for events. NEW BUSINESS 1099 FORM Auleria Eakins, Community Outreach Manager, CO&E reminded ECAC members that the 1099 Forms were mailed at the end of January from the Finance Department. If a member received $599 or more in checks and gift cards for attending meetings L.A. Care is required to send the 1099 form. Members can contact the Finance Department with questions. Members can keep their stipend under $599 if they wish. NEW ECAC Idalia Chitica, Field Specialist Supervisor, CO&E, reported that a written report will be provided to REPORTING AT CCI Councils and RCACs to conserve the time spent at the meetings. Chairs will meet 30 RCAC/CCI MEETINGS minutes with their field specialists before the meeting to review the report. RCAC/CCI Council chairs will give a verbal report of all high priority items at the meeting. The new reporting process will start this month and all feedback will be valuable.
Elizabeth Cooper, CCI Area 2/RCAC 2, was concerned that issues discussed at ECAC may never be shared with RCAC members. Ms. Chitica responded that there will be time to read the written report and ask questions.
Member Perez reminded members that they were all elected as chairs and it is their responsibility to take their own notes based on important topics discussed during the ECAC meetings.
Ms. White shared that at CCI Area 3 has reporting process like that already in place and it has been successful.
Ms. Eakins stated that all members will be able to discuss whatever they want about what was reported from the ECAC meeting. MEETING GROUND Auleria Eakins, Community Outreach Manager, CO&E, stated that all RCACs should have RULES implemented ground rules. This will assure everyone can participate in the meeting. The ground rules will be posted at the meeting location. All meetings should be a safe environment for all participants. All RCACs can add to the ground rules based on the need of each advisory committee. OLD BUSINESS RESPONSE TO Auleria Eakins, Community Outreach Manager, CO&E reported that a written response to the MOTION ECA-A.0216- motion presented during the February ECAC meeting was included in the meeting packet. REMOVAL PROCESS FOR THE ELECTED Ms. Chitica noted that all RCAC and CCI members will have to hold an event to vote for the removal of the board member.
Executive Community Advisory Committee March 9, 2016 / Page 7 of 10 APPROVED 156 BOARD OF GOVERNORS SEATS Ms. Eakins noted that currently there is no need to create rules to remove because there are no plans to remove a member, and she recommended that ECAC members focus on the upcoming elections.
Ms. Poz stated that she would like ECAC to create the rules for removal.
Ms. Chitica stated that ECAC could create an ad hoc committee to discuss rules for removal. She added that all RCAC and CCI members will get a copy of L.A. Care’s bylaws. The following members volunteered to be members of the ad hoc committee: Christina Deh-Lee, Elda Sevilla, Dalia Cadena, Ana Romo, Brenda White and Silvia Poz. Alternate Members are Nesima Istrefi, Demetria Saffore and Elizabeth Lyons. REVIEW AND Auleria Eakins, Community Outreach Manager, CO&E, reported that L.A. Care is moving forward APPROVAL OF with the election. Every four years ECAC reviews the application for candidates. L.A. Care has APPLICATION FOR updated the application with recommendations from ECAC. By consensus, ECAC BOARD SEAT members agreed to Member Perez noted that the Spanish version of the application was not clear in regard to the use the proposed board members having to attend all RCAC and CCI meetings at least once during the four year application in the term. Ms. Chitica stated that edits to the Spanish version would be made. election process. TRANSPORTATION Auleria Eakins, Community Outreach Manager, CO&E, thanked all members who helped find UPDATE other transportation. A transportation application has been drafted and is currently under review by the legal department.
Ms. Cooper suggested that members who may be impacted by changes to transportation process give their feedback. She also shared that some doctors might charge patients for a doctor’s note.
Ms. Chitica noted that April 4, 2016, is a print dead line to include candidate information in the election booklet. Candidates can apply up to 60 days prior to the election event on July 29, 2016. ECAC AD-HOC Elizabeth Lyons, CCI Area 2 Chair, reported that the ECAC Member Recruitment Ad Hoc COMMITTEE- Committee met on February 29, 2016. Ad-Hoc Committee members present were Adela MEMBER Guadarrama, Demetria Saffore, Nesima Istrefi and Elizabeth Lyons. Members of the public in RECRUITMENT attendance were Russell Mahler (RCAC 1), Estela Lara (RCAC 2) and Wilma Ballew (CCI Area 2). The Committee reviewed the L.A. Care Mission Statement and the purpose of the Advisory Committees. Committee members reviewed the current membership, discussed the current membership recruitment process and provided feedback on what is working and what can be improved. Committee members will meet again to continue discussing membership recruitment Malou Balones, Committee Liaison, Board Services ______Executive Community Advisory Committee March 9, 2016 / Page 8 of 10 APPROVED 157 before presenting a recommendation to ECAC. The next ECAC Member Recruitment ad hoc Committee meeting is scheduled for April 4, 2016 from 10:00 a.m. to 12:00 p.m.
Member Perez asked about the eligibility of the members for RCACs/CCI and if there is an appeal process if a prospective member is denied. PUBLIC COMMENTS Ms. Chitica stated that public attendees can get parking validation when attending ECAC meetings.
Ms. Deh- Lee shared a pamphlet about negative effects of sleep deprivation.
Ms. Eakins reminded members who attend the Board meetings to provide CO&E staff their names for acknowledgment.
Ms. Cooper recommended that all members to speak up and listen to others as well. She spoke for her son, Jonathan Copper, who thanked L.A. Care for transportation and giving his mother a chance to participate.
Wilma Ballew, CCI Area 2, shared that she is happy to see the committee moving in the right direction, and that it is important which members are part of the committee.
Deaka McClain thanked the Committee for an opportunity to speak, and recommended that the next work plan for RCACs and CCIs include domestic violence as a topic for education.
Estela Lara, RCAC 2 stated that she voices the concerns that all RCAC 2 members. She encouraged all members to empower the members. The organization is here to serve the members.
Marcia Ramos, CCI Area 1 Chair, stated that members in her community are receiving bills after the medical insurance has paid. Ms. Chitica responded that those members should contact Member Services.
Dove Savage Pinkney, RCAC 6 Chair, asked what is being done by L.A. Care about the homeless population. Ms. Chitica responded that currently the city and county are implementing an initiative to serve the homeless. ADJOURNMENT Chairperson Sevilla adjourned the meeting at 1:10 p.m. Linda Merkens, Manager, Board Services Elda Sevilla, ECAC Chair
Executive Community Advisory Committee March 9, 2016 / Page 9 of 10 APPROVED 158 Date ______
Executive Community Advisory Committee March 9, 2016 / Page 10 of 10 APPROVED 159