Santa Clara County Municipal Code Ch. XX Special Health Authority

The purposes of the Health Authority are to meet the problems of delivery of publicly assisted medical care in Santa Clara County, to demonstrate ways of promoting quality care and cost efficiency, and to further such other purposes as are contemplated by Welfare and Institutions Code section 14087.38 and as are set forth herein. In addition, to better facilitate these ends, the Health Authority shall expeditiously pursue a transition to a "Single Plan" model and shall coordinate with the County on a joint Medi-Cal managed care strategy to the greatest extent possible.

(Ord. No. NS-300.576, § 1, 8-1-95; NS-300.997, § 1, 6-3-25)

The purposes of the Health Authority are to meet the problems of delivery of publicly assisted medical care in Santa Clara County, to demonstrate ways of promoting quality care and cost efficiency, and to further such other purposes as are contemplated by Welfare and Institutions Code Section 14087.38 and as are set forth herein. In addition, to better facilitate these ends, the Health Authority shall expeditiously pursue a transition to a "Single Plan" model and shall coordinate with the County on a joint Medi-Cal managed care strategy to the greatest extent possible.

(Ord. No. NS-300.576, § 1, 8-1-95; NS-300.997, § 2, 6-3-25)

(a) The Health Authority shall be an entity separate from the County of Santa Clara ("County"). Obligations of the Health Authority shall be obligations solely of the Health Authority, and shall not, directly or indirectly, be obligations of the County or any officials, employees or agents of the County. The County (including all officials, employees and agents) shall not be liable for any act or omission of the Health Authority.

(b) The Health Authority shall have the power to negotiate and enter into contracts with the State Department of Health Services and to arrange for the provision of health care services for Medi-Cal beneficiaries as authorized by Section 14087.38.

(c) To the extent authorized by Section 14087.38, the Health Authority may also enter into contracts to arrange for the provision of health care services to individuals including, but not limited to, those covered under Subchapter XVIII (commencing with Section 1395) of Chapter 7 of Title 42 of the United States Code, those entitled to coverage under other publicly supported programs, those employed by public agencies or private businesses, and uninsured or indigent individuals.

(d) The Health Authority shall have all rights, powers, duties, privileges and immunities expressed, either directly or implicitly, in Section 14087.38.

(e) Chapter 1 of Division A6 of the Ordinance Code of the County, containing general rules and procedural requirements applicable to boards and commissions of the County, shall not apply to the Health Authority.

(Ord. No. NS-300.576, § 1, 8-1-95)

(a) Governance. Responsibility for governing and managing the affairs of the Health Authority shall be vested in a Governing Board ("Governing Board").

(b) Number. The Governing Board shall consist of seven members ("Board members"), each of whom shall have a fiduciary duty to act in the best interest of the Health Authority consistent with the purposes of the Health Authority set forth in Section A18-331.

(c) Qualifications. Board members shall be chosen for their willingness and ability to effectively contribute to and support the objectives of the Health Authority, shall have a commitment to a health care system that seeks to improve access to quality health care for persons served by the Health Authority, and shall have a commitment to maintaining and preserving a health care safety net for the medically indigent and uninsured populations of Santa Clara County. Board members shall either reside, be employed, or provide services in Santa Clara County, and shall be generally representative of the diverse backgrounds, interests and demography of persons residing in Santa Clara County.

(d) Appointments. All Board members shall be appointed by the County Board of Supervisors. Appointments shall be made upon a majority vote by the County Board of Supervisors. Any processes otherwise utilized by the members of the County Board of Supervisors regarding rotation of appointments among their offices shall not apply to appointments to the Health Authority. One seat shall be reserved for the Public Health Officer or designee.

(e) Nominations. Board members shall be nominated by the County Executive, and shall represent the interests of the County, the general public, beneficiaries, physicians, hospitals, clinics, and other nonphysician health care providers, and may include individuals with expertise in business, finance, managed care, hospital administration, information technology, medicine, health care policy, or law.

(f) Terms of office. The terms for all Board members shall be two years. No Board member may serve more than four consecutive terms.

(g) Resignation, removal and vacancies.

(1) Any Board member may resign at any time by giving written notice of such resignation to the chairperson of the Governing Board. Such resignation shall take effect at the time specified in the notice; provided, however, that if the resignation is not to be effective immediately upon receipt of the notice by the chairperson, the Governing Board must affirmatively vote to accept the effective date specified, and if the Governing Board does not approve such later date, the resignation shall be effective immediately.

(2) The Board of Supervisors may, by an affirmative vote of no less than three members, remove a member of the Governing Board with or without cause.

(h) Quorum. A majority of the Governing Board shall constitute a quorum to initiate the transaction of business at any regular or special meeting of the Governing Board. No act of the Governing Board shall be valid unless a majority of those Board members constituting a quorum concur therein.

(Ord. No. NS-300.576, § 1, 8-1-95; Ord. No. NS-300.634, § 1, 3-28-00; Ord. No. NS-300.738, § 1, 8-9-05; Ord. No. NS-300.823, §§ 1—3, 6-22-10; Ord. No. NS-300.852, § 1, 4-3-12; NS-300.997, § 3, 6-3-25)

The Governing Board may establish such committees or subcommittees for any purpose that will be beneficial in accomplishing the work of the Health Authority. At a minimum three types of advisory committees shall be established: (1) one or more Provider Advisory Councils; (2) a Consumer Advisory Committee; and (3) a Transitional Advisory Committee. The membership, duties and responsibilities of committees and subcommittees, including the Provider Advisory Council, the Consumer Advisory Committee, and the Transitional Advisory Committee shall be delineated in the bylaws of the Health Authority.

(Ord. No. NS-300.576, § 1, 8-1-95; Ord. No. NS-300.634, § 2, 3-28-00; NS-300.997, § 4, 6-3-25)

In accordance with the Ordinance Code of the County and under state law, the Public Health Officer of the County may present or propose recommendations directly to the Governing Board.

(Ord. No. NS-300.576, § 1, 8-1-95)

(a) Procedures for the conduct of business not otherwise specified herein shall be contained in the bylaws of the Health Authority.

(b) The bylaws shall contain:

(1) A provision recognizing that the obligations, acts, omissions or liabilities of the Health Authority are not obligations of the County or any officials, employees or agents of the County;

(2) A provision requiring that each and every contract, indenture, mortgage, loan or credit document, lease, or other instrument or obligation of the Health Authority shall contain a statement to the effect that the Health Authority is a separate legal entity from the County, that the County, and its officials, employees and agents, are not responsible for the obligations of the Health Authority, and that (except if the County is a direct party to the particular document or instrument) the parties to the particular document or instrument do not intend to, and do not have the power to, confer on any person or entity any rights or remedies against the County or any officials, employees or agents of the County.

(3) A provision requiring the Governing Board to prepare and deliver to the County Board of Supervisors an annual written report describing the activities of the Health Authority during the preceding year, and outlining, in general terms, the anticipated nature of the Health Authority's activities for the forthcoming year.

(c) The bylaws shall contain a provision requiring the Health Authority, in connection with the conduct of its business and the discharge of its responsibilities, to meet the standards set forth in this subsection and such standards shall be set forth in the bylaws.

(1) In negotiating and renegotiating contracts, the Health Authority shall give preference to providers in the following categories, which preference shall be weighted based on (i) the number of categories a provider is within, and (ii) the factors referred to in each category:

(A) Disproportionate share hospitals. For this category, substantial preference shall be given to those hospitals that have regularly and repeatedly qualified for this status under the Medi-Cal program. Further, preference shall increase based on the levels of disproportionality of each hospital, with the most preference given to those that have the highest levels of disproportionality. These factors shall be applied in a fashion to ensure that the disproportionate share hospitals have sufficient participation so as to ensure the receipt of all available federal funding for the geographic area of Santa Clara County;

(B) Safety net providers. For this category, preference shall be given to federally qualified health centers and any other providers recognized as safety net providers.

(C) Traditional Medi-Cal providers. For this category, preference shall be given to community-based clinics and private providers with a history of serving a substantial proportion of Medi-Cal and uninsured patients.

(D) Providers that are responsible for providing health care to the medically indigent and uninsured. For this category, substantial preference shall be given to those providers that have regularly and repeatedly provided the highest levels or ratios of care to the medically indigent and uninsured. This shall be done in a fashion to preserve the health care safety net, including public health services.

(2) In establishing and maintaining the provider network, the Health Authority shall foster and maintain the clinical relationships between Medi-Cal, medically indigent and uninsured patients and their health care providers;

(3) In establishing and maintaining the provider network, the Health Authority shall recognize and accommodate cultural and linguistic diversity of Medi-Cal, medically indigent and uninsured patients; and

(4) In establishing and maintaining the provider network, the Health Authority shall recognize, accommodate and support those special programs and activities of providers that have been regularly and repeatedly successful in addressing the medical and social needs of Medi-Cal, medically indigent and uninsured individuals.

(d) The Governing Board shall appoint a three-member Bylaws Committee, all of whom shall be Board members. The initial bylaws, and any modifications to the bylaws, must be approved by a majority vote of the Bylaws Committee following approval as to form and legality by County Counsel, and by the affirmative vote of no less than a majority of Board members.

(Ord. No. NS-300.576, § 1, 8-1-95; Ord. No. NS-300.634, § 3, 3-28-00; Ord. No. NS-300.852, § 2, 4-3-12; NS-300.997, § 5, 6-3-25)

The Health Authority shall continue until the County Board of Supervisors takes action to terminate the Health Authority. Any termination shall comply with applicable provisions of Section 14087.38.

(Ord. No. NS-300.576, § 1, 8-1-95)