To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Amendment to Chapter 34 of the Sonoma County Code - County Organized Health System - Second Reading
End
Recommended Action:
Recommended action
Adopt an ordinance titled “An Ordinance of the Board of Supervisors of the County of Sonoma, State of California, Amending Chapter 34 of the Sonoma County Code to Revise the Formula Used to Determine the Number of Partnership HealthPlan of California Commission Seats per County and to Align the Sonoma County Code with the Revised Partnership HealthPlan of California Commission Bylaws.”
end
Executive Summary:
On December 12, 2023, at a regular meeting, the Board of Supervisors introduced a proposed ordinance to revise Chapter 34 of the Sonoma County Code, County Organized Health System, to align with the expansion of Partnership HealthPlan of California Commission (hereinafter, “Commission” or “the Commission”) into additional member counties, revise the formula used to determine the number of Partnership HealthPlan of California Commission seats per County, and remain consistent with the Commission bylaws. The Commission is a multi-county commission that provides for a managed healthcare plan for Medi-Cal recipients. The expansion to additional member counties was scheduled to occur on or about January 1, 2024.
Discussion:
On August 23, 2023, the Partnership HealthPlan of California Board of Commissioners approved revised bylaws to align with the California Department of Health Care Services 2024 contract and National Committee for Quality Assurance standards. On December 12, 2023, at a regular meeting, the Board of Supervisors introduced a proposed ordinance (“First Reading”) to revise Chapter 34 of the Sonoma County Code, County Organized Health System, to align with the expansion of the Commission into additional member counties, revise the formula used to determine the number of Partnership HealthPlan of California Commission seats per County, and remain consistent with the Commission bylaws.
The Department is recommending adoption of an ordinance amending Chapter 34 to remain consistent with Commission bylaws and their formula granting Commission member seats. Adoption of the ordinance confirms the Board’s approval for the continued participation of the County of Sonoma in the Commission with updated terms as set forth in the ordinance. The Commission’s expansion to additional member counties was scheduled to occur on or about January 1, 2024.
The Commission is a multi-county commission that provides for a managed healthcare plan for Medi-Cal recipients. Implementation of a county organized health system is authorized by Welfare and Institutions Code Section 14087.54. In September 2009, the Board of Supervisors of Sonoma County approved an ordinance adding Chapter 34 to the Sonoma County Code, authorizing the County to join the Commission.
The Commission is comprised of representatives from Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Modoc, Marin, Mendocino, Napa, Nevada, Placer, Plumas, Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity, Yolo, and Yuba counties and provides coverage to over 650,000 Medi-Cal enrollees, including over 100,000 current Medi-Cal enrollees in Sonoma County.
This ordinance revision includes the following changes:
• Clarifying the Commission negotiated a contract with the California Department of Health Care Services, as specified in Welfare and Institutions Code Section 14087.5, to arrange for the provision of health care services provided under Welfare and Institutions Code Chapter 7, Part 3, Division 9, as well as clarifying that the Commission is authorized to negotiate a contract with the California Department of Health Care Services to expand the Commission into additional member counties. The expansion is expected to occur on or about January 1, 2024.
• Revising the formula for membership in the Commission to those appointed by the Board of Supervisors of each member county, unless and until the Commission, by formal action, establishes a different formula or system of membership, and updating the composition of the Commission as follows:
1. 0-45,000 Medi-Cal beneficiaries within a county equals one Commission seat.
2. 45,001-60,000 Medi-Cal beneficiaries within a county equals two Commission seats.
3. 60,001+ Medi-Cal beneficiaries within a county equals three Commission seats.
|
Commission Seats |
Existing Formula (# of Medi-Cal Beneficiaries) |
Revised Formula (# of Medi-Cal Beneficiaries) |
|
1 |
0 - 25,000 |
0 - 45,000 |
|
2 |
25,001 - 40,000 |
45,001 - 60,000 |
|
3 |
40,001 - 55,000 |
60,001+ |
|
4 |
55,001 or more |
N/A |
• Defining the Commissioner selection criteria and encouraging the County to consider selecting Commissioners from the following settings:
1. Safety net providers (including providers at federally qualified health centers).
2. Behavioral health providers.
3. Regional center providers.
4. Local education authorities.
5. Dental providers.
6. Indian Health Service facility providers.
7. Hospital providers with special efforts to select candidates as opportunity allows, who reflect the diversity of the community and regions (including, but not limited to race, ethnicity, language, and disability status).
• Adjusting the term of office to add language stating that at the conclusion of a member’s term, the Commission member shall remain in office until a successor member has been selected and installed into office.
• Adjusting the term of office to add language stating that an office shall become vacant if a Commissioner ceases to function in the area from which appointed or fails to attend three (3) Commission meetings in a row.
• Clarifying the obligation of the Commission is to conduct business as Partnership HealthPlan of California.
• Adding new termination of membership language to read the Commission shall continue to represent the County of Sonoma until such time as the Sonoma County Board of Supervisors terminates the representation and clarifying the means of terminating the representation by providing ninety (90)-days’ notice to other member counties and the California Department of Health Care Services, as specified in Welfare and Institutions Code § 14087.54(g).
The current ordinance formula equates to four (4) seats for the County of Sonoma, with current commissioner appointment selection criteria as follows:
(1) One (1) member shall be a community clinic representative identified by the Redwood Community Health Coalition (clinic representative).
(2) One (1) member shall be a hospital representative from a Sonoma County hospital identified by the hospitals in Sonoma County (hospital representative).
(3) One (1) member shall be the Director of the Sonoma County Department of Health Services or designee (county official).
(4) One (1) member from the community (public representative).
Future projections, utilizing the revised formula, would equate to three (3) seats for the County of Sonoma. Updated Commission bylaws include language to allow for seats lost due to the implementation of the updated representation formula to be eliminated using the process of attrition, which allows a lost seat to be vacated one year after the adoption of the updated formula or on the seat’s natural expiration date, whichever occurs first.
|
Current Commission Seats |
Commissioner |
Term |
On Commission Since |
|
1 - Clinic Representative |
Kathryn Powell |
5/22/2020 - 5/21/2024 |
5/22/2012 |
|
2 - Hospital Representative |
Vacant |
N/A |
N/A |
|
3 - County Official |
Tina Rivera |
5/21/2021 - 5/20/2024 |
5/21/2021 |
|
4 - Public Representative |
Cathryn Couch |
1/1/2021 - 12/31/2024 |
1/1/2021 |
The hospital representative seat was last occupied by Mary Kay Brooks, whose term ended on May 21, 2022. The seat has remained vacant since the end of Ms. Brooks’ term.
In order to bring Sonoma County into alignment with the new formula for membership in the Commission, the Department recommends the hospital representative seat be eliminated, as the seat is currently vacant, and the commissioner appointment selection criteria be updated as follows to reflect the three (3) seats the revised formula allows:
(1) One (1) member shall be a community clinic representative identified by the Redwood Community Health Coalition (clinic representative).
(2) One (1) member shall be the Director of the Sonoma County Department of Health Services or designee (county official).
(3) One (1) member from the community (public representative).
|
Updated Commission Seats |
Commissioner |
Term |
On Commission Since |
|
1 - Clinic Representative |
Kathryn Powell |
5/22/2020 - 5/21/2024 |
5/22/2012 |
|
2 - County Official |
Tina Rivera |
5/21/2021 - 5/20/2024 |
5/21/2021 |
|
3 - Public Representative |
Cathryn Couch |
1/1/2021 - 12/31/2024 |
1/1/2021 |
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 2: Better integrate services and handoffs within the Safety Net departments.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
On December 12, 2023, the Board adopted a resolution introducing, reading the title of, and waiving further reading of a proposed ordinance revision to Chapter 34 of the Sonoma County Code to revise the formula used to determine the number of Partnership HealthPlan of California Commission seats per county and to align the Sonoma County Code with the revised Partnership HealthPlan of California Commission Bylaws.
On November 10, 2015, the Board of Supervisors adopted an ordinance amending Chapter 34 of the Sonoma County Code to revise the formula used to determine the number of Partnership HealthPlan of California Commission seats per county and to align the Sonoma County Code with the revised Partnership HealthPlan of California Commission Bylaws.
In September 2009, the Board of Supervisors approved an ordinance adding Chapter 34 of the Sonoma County Code to authorize the County to join an existing commission entitled Partnership HealthPlan of California, comprised of Napa, Solano, and Yolo counties, that arranges for the provision of health care services for Medi-Cal enrollees.
Fiscal Summary
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Expenditures |
FY23-24 Adopted |
FY24-25 Projected |
FY25-26 Projected |
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Budgeted Expenses |
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Additional Appropriation Requested |
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Total Expenditures |
0 |
0 |
0 |
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General Fund/WA GF |
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State/Federal |
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Fees/Other |
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Use of Fund Balance |
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General Fund Contingencies |
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Total Sources |
0 |
0 |
0 |
Narrative Explanation of Fiscal Impacts:
There are no fiscal impacts associated with this item.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Ordinance
Attachment 2 - Partnership HealthPlan of California Commission Bylaws
Related Items “On File” with the Clerk of the Board:
None