Ventura County MediCal Managed Care Commission (VCMMCC ...€¦ · 09/03/2016 · Topa Topa Conference Room at Gold Coast Health Plan 711 E. Daily Drive Suite 106, Camarillo, CA

Meeting Agenda available at http://www.goldcoasthealthplan.org

Ventura County MediCal Managed Care Commission (VCMMCC)

dba Gold Coast Health Plan (GCHP) Commission Special Meeting Wednesday, March 9, 2016 5:00 PM Topa Topa Conference Room at Gold Coast Health Plan 711 E. Daily Drive Suite 106, Camarillo, CA 93010

AGENDA

CALL TO ORDER / ROLL CALL PUBLIC COMMENT The public has the opportunity to address Ventura County Medi-Cal Managed Care Commission (VCMMCC) doing business as Gold Coast Health Plan (GCHP) on the agenda. Persons wishing to address VCMMCC should complete and submit a Speaker Card. Persons wishing to address VCMMCC are limited to three minutes. Comments regarding items not on the agenda must be within the subject matter jurisdiction of the Commission. FORMAL ACTION ITEM 1. DEPARTMENT OF HEALTHCARE SERVICES (DHCS) CONTRACT AMENDMENT

A20

Staff: Brandy Armenta, Director of Compliance

RECOMMENDATION

Approve and authorize the Chief Executive Officer (CEO) to execute DHCS contract amendment A20.

CLOSED SESSION 2. CONFERENCE WITH LEGAL COUNSEL – ANTICIPATED LITIGATION

Significant exposure to litigation pursuant to paragraph (2) of subdivision (d) of Section 54956.9: Two Cases

2

COMMENTS FROM COMMISSIONERS ADJOURNMENT

Unless otherwise determined by the Commission, the next regular meeting will be held on March 28, 2016 in the County of Ventura Government Center, Hall of Justice – Lower Plaza Assembly Room, 800 South Victoria Avenue, Ventura, CA 93009.

Administrative Reports relating to this agenda are available at 711 East Daily Drive, Suite #106, Camarillo, California during normal business hours and on http://goldcoasthealthplan.org. Materials related to an agenda item submitted to the Commission after distribution of the agenda packet are available for public review during normal business hours at the office of the Clerk of the Board. In compliance with the Americans with Disabilities Act, if you need assistance to participate in this meeting, please contact (805) 437-5512. Notification for accommodation must be made by Monday, March 7, 2016 by 5 p.m. will enable the Clerk of the Board to make reasonable arrangements for accessibility to this meeting. This agenda was posted on Monday, March 7, 2016 at 5 p.m. at the Gold Coast Health Plan Notice Board, and on the internet.

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AGENDA ITEM NO. 1 To: Gold Coast Health Plan Commission From: Dale Villani, CEO Date: March 9, 2016 Re: State of California Contract Amendment A20 SUMMARY The State of California Department of Health Care Services (DHCS) establishes monthly capitation payments by major Medi-Cal population groups and updates them periodically to reflect policy changes and other adjustments. Amendment A20 reflects expected changes to Gold Coast Health Plan (GCHP or Plan) capitation rates for FY2013-14. BACKGROUND / DISCUSSION GCHP received a contract amendment from DHCS on March 2, 2016 which updates the Plan’s FY2013-14 capitation rates for a certain Medi-Cal aid code as follows:

· The amendment adjusts the FY2013-14 rates for the second half of the fiscal year (January 1, 2014 to June 30, 2014) to include the Hospital Quality Assurance Fee (HQAF) pursuant to Senate Bill (SB) 239 for the Adult Expansion population.

FISCAL IMPACT Amendment A20 increased capitation rates for the FY2013-14 SB239 funds, and will enable GCHP to receive approximately $5.2 million for distribution to various hospitals that serve Medi-Cal and uninsured patients. The allocations of distributions will be determined by the California Hospital Association. As a pass-through item, there is no impact to the Plan’s net assets.


RECOMMENDATION Staff is recommending the Commission approve and authorize the CEO to execute DHCS contract amendment A20. CONCURRENCE N/A Attachments None


STATE OF CALIFORNIA

STANDARD AGREEMENT AMENDMENT STD. 213A_DHCS (Rev. 08/14)

Check here if additional pages are added: 7 Page(s)

Agreement Number Amendment Number

10-87128 A20 Registration Number:

1. This Agreement is entered into between the State Agency and Contractor named below: State Agency’s Name (Also known as DHCS, CDHS, DHS or the State)

Department of Health Care Services Contractor’s Name (Also referred to as Contractor)

Ventura County Medi-Cal Managed Care Commission dba Gold Coast Health Plan 2. The term of this Agreement is: July 1, 2011 through December 31, 2016 3. The maximum amount of this $ Budget Act Line Items Agreement after this amendment is: 4260-601-0912 and 4260-601-0555

4. The parties mutually agree to this amendment as follows. All actions noted below are by this reference made a part of the Agreement and incorporated herein:

I. Amendment effective date: January 1, 2014 or until approved by DGS (if DGS approval is required).

II. Purpose of amendment: It adjusts the 2013-2014 capitation rates for the Optional Expansion and

Senate Bill (SB) 239 by changing Exhibit B, Budget Detail and Payment Provisions, Provision 3. Capitation Rates, Paragraph A.2).

III. Certain changes made in this amendment are shown as: Text additions are displayed in bold and underline.

Text deletions are displayed as strike through text (i.e., Strike)

(Continued on next page)

All other terms and conditions shall remain the same. IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto.

CONTRACTOR CALIFORNIA Department of General Services

Use Only Contractor’s Name (If other than an individual, state whether a corporation, partnership, etc.)

Ventura County Medi-Cal Managed Care Commission dba Gold Coast Health Plan

By(Authorized Signature) Date Signed (Do not type)

Printed Name and Title of Person Signing

Dale Villani, CEO

Address

711 E. Daily Dr., Suite 106 Camarillo, CA 93010

STATE OF CALIFORNIA Agency Name

Department of Health Care Services By (Authorized Signature) Date Signed (Do not type)

Printed Name and Title of Person Signing Exempt per: Welfare and Institutions Code Section 14087.55(c)

Javier Portela, Chief Managed Care Operations Division

Address

1501 Capitol Avenue, MS 4415, P.O. Box 997413 Sacramento, CA 95899-7413

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Back to Agenda


10-87128 A20

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IV. Exhibit B, Budget Detail and Payment Provisions, Provision 3. Capitation Rates,

Paragraph A.2), is amended to read:

3. Capitation Rates

For the period 07/01/11 -- 06/30/12 Ventura Groups Aid Codes Rate

Family/Adult 01, 02, 03, 04, 06, 08, 30, 32, 33, 34, 35, 37, 38, 39, 40, 42, 45, 46, 47, 54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 4A, 4F, 4G, 4K, 4L, 4M, 5K, 7A, 7J, 7X, 8P, 8R

$169.46

Aged/Dual Eligible 10,14,16,17,1E, 1H $254.30 Aged/Medi-Cal only 10, 14, 16, 17, 1E, 1H $630.28 Breast and Cervical Cancer Treatment Program (BCCTP)

0M, 0N, 0P, 0R, 0T, 0U $1,483.78

Disabled/Dual Eligible

20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$215.30

Disabled/Medi-Cal Only

20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$1,010.61

Long Term Care/ Dual Eligible

13, 23, 53, 63 $4,719.58

Long Term Care/Medi-Cal only

13, 23, 53, 63 $7,461.40



10-87128 A20

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For the period 07/01/12 –12/31/12 Ventura Groups Aid Codes Rate


$175.86

Aged/Dual Eligible 10,14,16,17,1E, 1H $262.18 Aged/Medi-Cal Only 10, 14, 16, 17, 1E, 1H $659.99 Breast and Cervical Cancer Treatment Program (BCCTP)

0M, 0N, 0P, 0R, 0T, 0U $1,555.28


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$221.97


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$1,034.28


13, 23, 53, 63 $4,865.88

Long Term Care/Medi-Cal Only

13, 23, 53, 63 $7,854.82

For the period 01/01/13 – 06/30/13 Ventura Groups Aid Codes Rate


$183.28

Aged/Dual Eligible 10,14,16,17,1E, 1H $266.43 Aged/Medi-Cal Only 10, 14, 16, 17, 1E, 1H $726.00 Breast and Cervical Cancer Treatment Program (BCCTP)

0M, 0N, 0P, 0R, 0T, 0U

$1,614.26


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$226.12


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$1,051.97


13, 23, 53, 63 $4,871.79


13, 23, 53, 63 $7,937.47



10-87128 A20

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For the period 07/01/13 – 12/31/13 Ventura Groups Aid Codes Rate

Family/Adult 01, 02, 03, 04, 06, 07, 08, 30, 32, 33, 34, 35, 37, 38, 39, 40, 42, 43, 45, 46, 47, 49, 54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E, 3F, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 4A, 4F, 4G, 4K, 4L, 4M, 4N, 4S, 4T, 4W, 5K, 7A, 7J, 7W, 7X, 8P, 8R, 81, 86, 87, E2, E5, K1, M3, M7, P5, P7, P9,

$162.04

Aged/Dual Eligible 10, 14, 16, 17, 1E, 1H $244.15 Aged/Medi-Cal only 10, 14, 16, 17, 1E, 1H $1,001.65 Breast and Cervical Cancer Treatment Program (BCCTP)

0M, 0N, 0P, 0R, 0T, 0U, 0W

$1,529.33


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$205.97


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$1,001.65


13, 23, 53, 63 $6,027.54


13, 23, 53, 63 $10,265.77



10-87128 A20

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For the period 01/01/14-06/30/14 Ventura Groups Aid Codes Rate

Family/Adult 01, 02, 03, 04, 06, 07, 08, 30, 32, 33, 34, 35, 37, 38, 39, 40, 42, 43, 45, 46, 47, 49, 54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E, 3F, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 4A, 4F, 4G, 4K, 4L, 4M, 4N, 4S, 4T, 4W, 5K, 7A, 7J, 7S, 7W, 7X, 8P, 8R, 81, 86, 87, E2, E5, K1, M3, M7, P5, P7, P9

$164.59

Aged/Dual Eligible 10, 14, 16, 17, 1E, 1H $242.70

Aged/Medi-Cal only 10, 14, 16, 17, 1E, 1H $1,006.39 Breast and Cervical Cancer Treatment Program (BCCTP)

0M, 0N, 0P, 0R, 0T, 0U, 0W $1,538.05


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$204.54


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$1,006.39


13, 23, 53, 63 $6,025.86


13, 23, 53, 63 $10,265.82

Adult Expansion L1, M1, 7U $832.85 $894.85



10-87128 A20

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For the period 07/01/14-12/31/14 Ventura Groups Aid Codes Rate

Adult & Family/ Optional Targeted Low-Income Child (Under 19)

01, 02, 03, 04, 06, 07, 08, 30, 32, 33, 34, 35, 37, 38, 39, 40, 42, 43, 45, 46, 47, 49, 54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E, 3F, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 4A, 4F, 4G, 4K, 4L, 4M, 4N, 4S, 4T, 4W, 5K, 7A, 7J, 7S, 7W, 7X, 8P, 8R, 81, 86, 87, E2, E5, K1, M3, M7, P5, P7, P9, 5C, 5D, H1, H2, H3, H4, H5, E6, E7, M5, T1, T2, T3, T4, T5

$88.56

Adult & Family/ Optional Targeted Low-Income Child (19 & Older)

01, 02, 03, 04, 06, 07, 08, 30, 32, 33, 34, 35, 37, 38, 39, 40, 42, 43, 45, 46, 47, 49, 54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E, 3F, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 4A, 4F, 4G, 4K, 4L, 4M, 4N, 4S, 4T, 4W, 5K, 7A, 7J, 7S, 7W, 7X, 8P, 8R, 81, 86, 87, E2, E5, K1, M3, M7, P5, P7, P9,

$297.22

Aged/Medi-Cal Only 10, 14, 16, 17, 1E, 1H $920.60

Aged/Dual Eligible 10, 14, 16, 17, 1E, 1H $189.87


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 2H, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$920.60


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 2H, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y

$184.19


13, 23, 53, 63 $10,894.73

Long Term Care/Dual Eligible

13, 23, 53, 63 $6,319.75

Breast and Cervical Cancer Treatment Program (BCCTP)

0M, 0N, 0P, 0R, 0T, 0U, 0W $1,752.85

Adult Expansion L1, M1, 7U $813.02



10-87128 A20

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Commencing 01/01/15 Ventura Groups Aid Codes Rate

Adult & Family/ Optional Targeted Low-Income Child (Under 19)

01, 02, 03, 04, 06, 07, 08, 30, 32, 33, 34, 35, 37, 38, 39, 40, 42, 43, 45, 46, 47, 49, 54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E, 3F, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 4A, 4F, 4G, 4K, 4L, 4M, 4N, 4S, 4T, 4W, 5K, 7A, 7J, 7S, 7W, 7X, 8P, 8R, 81, 86, 87, E2, E5, K1, M3, M7, P5, P7, P9, 5C, 5D, H1, H2, H3, H4, H5, E6, E7, M5, T1, T2, T3, T4, T5

$82.46

Adult & Family/ Optional Targeted Low-Income Child (19 & Older)

01, 02, 03, 04, 06, 07, 08, 30, 32, 33, 34, 35, 37, 38, 39, 40, 42, 43, 45, 46, 47, 49, 54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E, 3F, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 4A, 4F, 4G, 4K, 4L, 4M, 4N, 4S, 4T, 4W, 5K, 7A, 7J, 7S, 7W, 7X, 8P, 8R, 81, 86, 87, E2, E5, K1, M3, M7, P5, P7, P9,

$288.57

Aged/Medi-Cal Only 10, 14, 16, 17, 1E, 1H $898.20

Aged/Dual Eligible 10, 14, 16, 17, 1E, 1H, 1X, 1Y $187.01


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 2H, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V, 6W, 6X, 6Y

$898.20


20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 2H, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V, 6W, 6X, 6Y

$181.40


13, 23, 63 $10,814.92

Long Term Care/Dual Eligible

13, 23, 63 $6,315.14

Breast and Cervical Cancer Treatment Program (BCCTP)

0M, 0N, 0P, 0R, 0T, 0U, 0W $1,697.67

Adult Expansion L1, M1, 7U $802.57



10-87128 A20

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For the period 01/01/13 – 03/31/13 Ventura Groups Aid Codes Rate Optional Targeted Low-Income Child

5C, 5D, H1, H2, H3, H4, H5 E7, M5, T1, T2, T3, T4, T5

$93.37


5C, 5D, H1, H2, H3, H4, H5, E7, M5, T1, T2, T3, T4, T5

$94.13


5C, 5D, H1, H2, H3, H4, H5, E7, M5, T1, T2, T3, T4, T5

$95.69


5C, 5D, H1, H2, H3, H4, H5, E7, M5, T1, T2, T3, T4, T5

$97.58


5C, 5D, H1, H2, H3, H4, H5, E7, M5, T1, T2, T3, T4, T5

$113.86

V. All rights, duties, obligations and liabilities of the parties hereto otherwise remain unchanged.


Documents

Ventura County MediCal Managed Care Commission (VCMMCC ...€¦ · 09/03/2016 · Topa Topa Conference Room at Gold Coast Health Plan 711 E. Daily Drive Suite 106, Camarillo, CA