Article 6 — County Organized Health System

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Editor's note— Ord. No. 4613, §§ 1, 2, adopted Jan. 10, 2023, repealed the former Art. 6, §§ 1380—1382, and enacted a new Art. 6 as set out herein. The former Art. 6 pertained to similar subject matter and derived from Ord. No. 4593, §§ 1, 2, adopted January 25, 2022.

1380 - General provisions. 1380-1 - Pursuant to Welfare and Institutions Code section 14087.54, there is hereby formed a commission, referred to in this Article as the Ventura County Medi-Cal Managed Care Commission. 1380-2 - The Ventura County Medi-Cal Managed Care Commission is empowered to negotiate and enter into exclusive contracts with the State of California Department of Health Care Services pursuant to Welfare and Institutions Code section 14087.5, and to arrange for the provision of health care services under division 9, part 3, chapter 7 of the Welfare and Institutions Code. The Ventura County Medi-Cal Managed Care Commission is also authorized to:

(a)

Enter into contracts for the provision of health care services to persons who are eligible to receive medical benefits, subject to the limitations of Welfare and Institutions Code section 14087.54, subdivision (b)(2);

(b)

Provide health care delivery systems for:

(1)

Persons who are eligible to receive medical benefits under both the Medicare program as defined in title 18 of the Federal Social Security Act (42 U.S.C. § 1395 et seq.) and under the Medicaid program as defined in title 19 of the Federal Social Security Act (42 U.S.C. § 1396 et seq.), and/or

(2)

Persons who are eligible to receive medical benefits under the Medicaid program as defined in title 19 of the Federal Social Security Act (42 U.S.C. § 1396 et seq.);

(c)

File the statement required by Government Code section 53051;

(d)

Acquire, possess, and dispose of real or personal property, as may be necessary for the performance of its functions;

(e)

Employ personnel and contract for services required to meet its obligations;

(f)

Sue and be sued; and

(g)

Enter into agreements under chapter 5 (commencing with section 6500) of division 7 of title 1 of the Government Code.

1380-3 - The Ventura County Medi-Cal Managed Care Commission shall for all purposes be an entity separate from the County of Ventura, and shall be deemed a public entity for purposes of division 3.6 (commencing with section 810) of title 1 of the Government Code. Any obligations of the Ventura County Medi-Cal Managed Care Commission (statutory, contractual, or otherwise) shall be the obligations solely of the Ventura County Medi-Cal Managed Care Commission and shall not be obligations of the County of Ventura or the State of California. 1380-4 - The Ventura County Medi-Cal Managed Care Commission shall design and operate a program or programs, whose mission is to improve the health of its members through the provision of the best possible quality care and services. This will be accomplished by:

(a)

Delivering medical care via a contracted provider network that will improve access to primary, specialty and ancillary services;

(b)

Establishment of mechanisms to assure that medical care services meet appropriate quality of care standards;

(c)

Incorporating a plan of service delivery and implementing reimbursement mechanisms which promote the long-term viability of a locally operated Medi-Cal managed care system and the existing participating provider networks inclusive of "Safety Net" providers herein defined as Medi-Cal disproportionate share hospitals, county clinics, federally qualified health centers, and licensed rural health clinics;

(d)

Implementing a financial plan which includes the creation of a prudent reserve and which provides that if additional surplus funds accrue, they shall be used to expand access, improve benefits and augment provider reimbursement in Ventura County;

(e)

Placing a high priority on prevention, education, early intervention services and case management for enrolled recipients;

(f)

Ensuring that all obligations, statutory, contractual or otherwise, shall be the obligations of the Ventura County Medi-Cal Managed Care Commission and shall not be the obligations of the County of Ventura or the State of California; and

(g)

Implementing programs and procedures to ensure a high level of member satisfaction.

(Ord. No. 4613, §§ 1, 2, 1-10-2023)

1381. • Board of Directors (Commission). 1381-1 - The governing board of the Ventura County Medi-Cal Managed Care Commission shall consist of thirteen (13) voting members. It is desirable that members of the Ventura County Medi-Cal Managed Care Commission possess skills and knowledge in the design and operation of a publicly managed health care delivery system. 1381-2 - Members of the Ventura County Medi-Cal Managed Care Commission shall be appointed by a majority vote of the Board of Supervisors and shall consist of the following:

(a)

Two (2) members shall be practicing physicians who serve a significant number of Medi-Cal beneficiaries in Ventura County. One (1) shall be nominated by the Ventura County Medical Association and one (1) shall be nominated by the Ventura County Medical Center Executive Committee. (Physician Representatives)

(b)

Two (2) members shall be representatives of private hospitals and healthcare systems operating within Ventura County and shall be nominated by the Hospital Association of Southern California. Nominees shall be from different hospitals and healthcare systems. The two (2) appointed members shall not be affiliated with the same hospital or healthcare system. (Private Hospital/Healthcare System Representatives)

(c)

One (1) member shall be a representative of the Ventura County Medical Center Health System and shall be nominated by the Ventura County Medical Center System Administration. (Ventura County Medical Center System Representative)

(d)

One (1) member shall be a member of the Board of Supervisors, nominated and selected by the Board of Supervisors. (Public Representative)

(e)

Two (2) members shall be representatives of Clinicas del Camino Real nominated by the Clinicas del Camino Real Chief Executive Officer. (Clinicas Del Camino Real Representatives)

(f)

One (1) member shall be the Ventura County Health Care Agency Director or designee nominated by the Health Care Agency Director. (Ventura County Health Care Agency Representative)

(g)

One (1) member shall be a Medi-Cal beneficiary and/or a representative of an advocacy organization that serves the Medi-Cal population and is not otherwise represented on the Ventura County Medi-Cal Managed Care Commission. This member shall be appointed from applications submitted to the Ventura County Executive Office after a posting of public notice for the open position. (Consumer Representative—Beneficiary and/or Advocate)

(h)

One (1) member shall be a Medi-Cal beneficiary. This member shall be appointed from applications submitted to the Ventura County Executive Office after a posting of public notice for the open position. (Consumer Representative—Beneficiary)

(i)

One (1) member shall be a representative of the County of Ventura nominated by the Ventura County Executive Officer. (County of Ventura Representative)

(j)

One (1) member shall be the Ventura County Human Services Agency Director or designee nominated by the Human Services Agency Director. (Ventura County Human Services Agency Representative)

1381-3 - In order to stagger terms with the intent of maintaining experienced members, in the initial cycle of appointments, the following appointees shall serve two-year terms: One of the Ventura County Medical Center Health System Representatives, the Physician Representative nominated by the Ventura County Medical Association, the Public Representative, and one (1) Private Hospital/Healthcare System Representative. All other initial appointments and all subsequent appointments to the Ventura County Medi-Cal Managed Care Commission shall be for four-year terms. No member may serve more than two (2) consecutive four-year terms. Any vacancy will be filled by appointment by the Board of Supervisors for the remainder of the unexpired term and shall maintain the balance of representation on the Ventura County Medi-Cal Managed Care Commission.

A member may be removed from the Ventura County Medi-Cal Managed Care Commission by a four-fifths (⅘) vote of the Board of Supervisors.

Nominations to the Ventura County Medi-Cal Managed Care Commission shall be submitted to the Ventura County Executive Office, which shall be responsible for screening nominees and presenting candidates to the Ventura County Board of Supervisors. Appointments will be based on the individuals' knowledge of the healthcare needs of women, children, seniors, and/or the disabled, and business, finance and/or political experience.

1381-4 - Procedures for the conduct of business not otherwise specified in this Article shall be contained in bylaws adopted by the Ventura County Medi-Cal Managed Care Commission. 1381-5 - The Ventura County Medi-Cal Managed Care Commission may establish a committee(s) or advisory board(s) for any purpose that will be beneficial in accomplishing the work of the Ventura County Medi-Cal Managed Care Commission. At a minimum, two (2) committees/advisory boards shall be established, one (1) member/consumer based and one (1) provider based.

unty Medi-Cal Managed Care Commission. 1381-5 - The Ventura County Medi-Cal Managed Care Commission may establish a committee(s) or advisory board(s) for any purpose that will be beneficial in accomplishing the work of the Ventura County Medi-Cal Managed Care Commission. At a minimum, two (2) committees/advisory boards shall be established, one (1) member/consumer based and one (1) provider based.

(Ord. No. 4613, §§ 1, 2, 1-10-2023)

1382. • Cultural Diversity Program.

The Ventura County Medi-Cal Managed Care Commission shall establish a Cultural Diversity Program to ensure that employees, contractors and recipients of health care services are treated with respect and without discrimination. The governing board of the Ventura County Medi-Cal Managed Care Commission shall appoint a Chief Diversity Officer, who shall be responsible for implementation of the Cultural Diversity Program, and shall provide staff and resources for the Chief Diversity Officer as necessary and appropriate. The Chief Diversity Officer shall report directly to the governing board of the Ventura County Medi-Cal Managed Care Commission, and shall have the authority, independent of any other executive officer, to take disciplinary action against any employee, except the chief executive officer, for failure to comply with the Cultural Diversity Program. The Chief Diversity Officer shall also provide reports to the Ventura County Board of Supervisors, through the County's Chief Executive Officer, on a quarterly or more frequent basis.

(Ord. No. 4613, §§ 1, 2, 1-10-2023)