Senate Bill No. 810 Chapter 2. Governance
CHAPTER 2. GOVERNANCE 140100.
(a) (1) The commissioner shall be appointed by the Governor on or before March 1, 2010 July 1 of the fiscal year following the date that this section becomes operative pursuant to Section 140700 , subject to confirmation by the Senate. If in session, the Senate shall act on the appointment within 30 days of the appointment date. If the Senate does not act on the appointment within that period, the nominee shall be deemed confirmed and may take office. If the Senate is not in session at the time of the appointment, the Senate shall act on the appointment within 30 days of the commencement of the next legislative session. If the Senate does not act on the appointment within that period, the appointee shall be deemed confirmed and may take office. (2) If the Senate by a vote fails to confirm the nominee for commissioner, the Governor shall make a new appointment within 30 days of the Senate’s vote. The appointment is subject to confirmation by the Senate, and the procedures described in paragraph (1) shall apply to the confirmation process.
(b) The commissioner is exempt from the State Civil Service Act (Part 2 (commencing with Section 18500) of Division 5 of Title 2 of the Government Code).
(c) The commissioner may not be a state legislator or a Member of the United States Congress while holding the position of commissioner.
(d) The commissioner shall not have been employed in any capacity by a for-profit insurance, pharmaceutical, or medical equipment company that sells products to the system for a period of two years prior to appointment as commissioner.
(e) For two years after completing service in the system, the commissioner may not receive payments of any kind from, or be employed in any capacity or act as a paid consultant to, a for-profit insurance, pharmaceutical, or medical equipment company that sells products to the system.
(f) The compensation and benefits of the commissioner shall be established by the California Citizens Compensation Commission in accordance with Section 8 of Article III of the California Constitution.
(g) The commissioner shall be subject to Title 9 (commencing with Section 81000) of the Government Code. 140101. (a) The commissioner shall be the chief officer of the agency and shall administer all aspects of the agency.
(b) The commissioner shall be responsible for the performance of all duties, the exercise of all power and jurisdiction, and the assumption and discharge of all responsibilities vested by law in the agency. The commissioner shall perform all duties imposed upon him or her by this division and other laws related to health care, and shall enforce the execution of those related to the system, and shall enforce the execution of those provisions and laws to promote their underlying aims and purposes. These broad powers shall include, but are not limited to, the power to establish the system’s budget and to set rates, to establish the system’s goals, standards, and priorities, to hire, fire, and fix the compensation of agency personnel, to make allocations and reallocations to the health planning regions, and to promulgate generally binding regulations concerning any and all matters related to the implementation of this division and its purposes.
(c) The commissioner shall appoint a deputy commissioner, the Director of the Healthcare Fund, the patient advocate of the Office of Patient Advocacy, the chief medical officer, the Director of the Payments Board, the Director of the Office of Health Planning, the Director of the Partnerships for Health, the regional health planning directors, the chief enforcement counsel, and legal counsel in any action brought by or against the commissioner under or pursuant to any provision of any law under the commissioner’s jurisdiction, or in which the commissioner joins or intervenes as to a matter within the commissioner’s jurisdiction, as a friend of the court or otherwise, and stenographic reporters to take and transcribe the testimony in any formal hearing or investigation before the commissioner or before a person authorized by the commissioner. (d) The commissioner, in accordance with the State Civil Service Act (Part 2 (commencing with Section 18500) of Division 5 of Title 2 of the Government Code), may appoint and fix the compensation of clerical, inspection, investigation, evaluation, and auditing personnel as may be necessary to implement this division. (e) The personnel of the agency shall perform duties as assigned to them by the commissioner. The commissioner shall designate certain employees by the rule or order that are to take and subscribe to the constitutional oath within 15 days after their appointments, and to file that oath with the Secretary of State. The commissioner shall also designate those employees that are to be subject to Title 9 (commencing with Section 81000) of the Government Code. (f) The commissioner shall adopt a seal bearing the inscription: “Commissioner, California Healthcare Agency, State of California.” The seal shall be affixed to or imprinted on all orders and certificates issued by him or her and other instruments as he or she directs. All courts shall take notice of this seal. (g) The administration of the agency shall be supported from the Healthcare Fund created pursuant to Section 140200. (h) The commissioner, as a general rule, shall publish or make available for public inspection any information filed with or obtained by the agency, unless the commissioner finds that this availability or publication is contrary to law. No provision of this division authorizes the commissioner or any of the commissioner’s assistants, clerks, or deputies to disclose any information withheld from public inspection except among themselves or when necessary or appropriate in a proceeding or investigation under this division or to other federal or state regulatory agencies. No provision of this division either creates or derogates from any privilege that exists at common law or otherwise when documentary or other evidence is sought under a subpoena directed to the commissioner or any of his or her assistants, clerks, and deputies. (i) It is unlawful for the commissioner or any of his or her assistants, clerks, or deputies to use for personal benefit any information that is filed with, or obtained by, the commissioner and that is not then generally available to the public. (j) The commissioner shall avoid political activity that may create the appearance of political bias or impropriety. Prohibited activities shall include, but not be limited to, leadership of, or employment by, a political party or a political organization; public endorsement of a political candidate; contribution of more than five hundred dollars ($500) to any one candidate in a calendar year or a contribution in excess of an aggregate of one thousand dollars ($1,000) in a calendar year for all political parties or organizations; and attempting to avoid compliance with this prohibition by making contributions through a spouse or other family member. (k) The commissioner shall not participate in making or in any way attempt to use his or her official position to influence a governmental decision in which he or she knows or has reason to know that he or she or a family or a business partner or colleague has a financial interest. (l) The commissioner, in pursuit of his or her duties, shall have unlimited access to all nonconfidential and all nonprivileged documents in the custody and control of the agency. (m) The Attorney General shall render to the commissioner opinions upon all questions of law, relating to the construction or interpretation of any law under the commissioner’s jurisdiction or arising in the administration thereof, that may be submitted to the Attorney General by the commissioner and upon the commissioner’s request shall act as the attorney for the commissioner in actions and proceedings brought by or against the commissioner or under or pursuant to any provision of any law under the commissioner’s jurisdiction. 140102. The commissioner shall do all of the following: (a) Oversee the establishment, as part of the administration of the agency, of all of the following: (1) The Healthcare Policy Board, pursuant to Section 140103. (2) The Office of Patient Advocacy, pursuant to Section 140105. (3) The Office of Health Planning, pursuant to Section 140602. (4) The Office of Healthcare Quality, pursuant to Section 140605. (5) The Healthcare Fund, pursuant to Section 140200. (6) The Public Advisory Committee, pursuant to Section 140104. (7) The Payments Board, pursuant to Section 140208. (8) Partnerships for Health. (b) Determine goals, standards, guidelines, and priorities for the system. (c) Establish health planning regions, pursuant to Section 140112. (d) Oversee the establishment of locally based integrated service networks, including those that provide services through medical technologies such as telemedicine, that include physicians in fee-for-service, solo and group practice, essential community, and ancillary care providers and facilities in order to pool and align resources and form interdisciplinary teams that share responsibility and accountability for patient care and provide a continuum of coordinated high quality primary to tertiary care to all California residents while preserving patient choice. This shall be accomplished in collaboration with the chief medical officer, the Director of the Office of Health Planning, the regional medical officers, the regional planning boards, and the patient advocate. (e) Annually assess projected revenues and expenditures and assure financial solvency of the system pursuant to Section 140203. (f) Develop the system’s budget pursuant to Section 140206 to ensure adequate funding to meet the health care needs of the population. Review all budgets and locations annually to ensure they address disparities in service availability and health care outcomes and for sufficiency of rates, fees, and prices. (g) Establish a capital management framework for the system pursuant to Section 140216, including, but not limited to, a standardized process and format for the development and submission of regional operating and regional capital budget requests and ensure a smooth transition to system oversight. (h) Establish standards and criteria for the development and submission of provider operating and capital budget requests. (i) Establish standards and criteria for the allocation of funds from the Healthcare Fund as described in Chapter 3 (commencing with Section 140200). (j) During transition and annually thereafter, determine the appropriate level for a reserve fund for the system and implement policies needed to establish the appropriate reserve. (k) Establish an enrollment system that ensures all eligible California residents, including those who travel out of state; those who have disabilities that limit their mobility, hearing, or vision or their mental or cognitive capacity; those who cannot read; and those who do not speak or write English are aware of their right to health care and are formally enrolled in the system. The commissioner may contract with a third party for eligibility and enrollment services if the comm
issioner finds that doing so would meet the system’s goals and standards, and result in greater efficiency and cost savings to the system. (l) Establish an electronic claims and payments system for the system where all claims under the system shall be filed and paid, and implement, to the extent permitted by federal law, standardized claims and reporting methods. The commissioner may contract with a third party for claims and payment services if the commissioner finds that doing so would meet the system’s goals and standards, and result in greater efficiency and cost savings to the system. (m) Establish a system of secure electronic medical records that comply with state and federal privacy laws and that are compatible across the system. (n) Establish an electronic referral system that is accessible to providers and to patients. (o) Establish standards based on clinical efficacy to guide delivery of care and a process to identify areas where no such standards exist, set priorities and a timetable for their development, and ensure a smooth transition to clinical decisionmaking under statewide standards. (p) Implement policies to ensure that all Californians receive culturally and linguistically sensitive care, pursuant to Section 140604, and that all disabled Californians receive care in accordance with the federal Americans with Disabilities Act (42 U.S.C. Sec. 12101 et seq.) and Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sec. 794) and develop mechanisms and incentives to achieve these purposes and a means to monitor the effectiveness of efforts to achieve these purposes. (q) Create a systematic approach to the measurement, management, and accountability for care quality and access, including a system of performance contracts that contain measurable goals and outcomes and appropriate statewide and regional health care databases to assure the delivery of quality care to all patients. (r) Establish standards for mandatory reporting by health care providers and penalties for failure to report. (s) Develop methods and a framework to measure the performance of health care coverage and health delivery system upper level managers, including a system of performance contracts that contain measurable goals and outcomes. (t) Implement policies to ensure that all residents of this state have access to medically appropriate, coordinated mental health services. (u) Ensure the establishment of policies that support the public health. (v) Meet regularly with the chief medical officer, the patient advocate for the Office of Patient Advocacy, the Public Advisory Committee, the Director of the Office of Health Planning, the Director of the Payments Board, the Director of the Partnerships for Health, regional planning directors, and regional medical officers to review the impact of the agency and its policies on the health of the population and on satisfaction with the system. (w) Negotiate for or set rates, fees, and prices involving any aspect of the system and establish procedures thereto. (x) Establish a formulary based on clinical efficacy for all prescription drugs and durable and nondurable medical equipment for use by the system. (y) Establish guidelines for prescribing medications and durable medical equipment that are not included in the system’s formularies. (z) Utilize the purchasing power of the state to negotiate price discounts for prescription drugs and durable and nondurable medical equipment for use by the system. (aa) Ensure that use of state purchasing power achieves the lowest possible prices for the system without adversely affecting needed pharmaceutical research. (ab) Create incentives and guidelines for research needed to meet the goals of the system and disincentives for research that does not achieve the system goals. (ac) Implement eligibility standards for the system, including guidelines to prevent an influx of persons to the state for the purpose of obtaining medical care. (ad) Determine an appropriate level of, and provide support during the transition for, training and job placement for persons who are displaced from employment as a result of the initiation of the system. (ae) Oversee the establishment of a system for resolution of disputes pursuant to Sections 140608 and 140610. (af) Investigate the costs and benefits to the health of the population of advances in information technology, including those that support data collection, analysis, and distribution. (ag) Ensure that consumers of health care have access to information needed to support their choice of a physician. (ah) Collaborate with the licensing entities of health facilities to ensure that facility performance is monitored and that deficient practices are recognized and corrected in a timely fashion and that consumers and providers of health care have access to information needed to support their choice of facility. (ai) Establish an Internet Web site that provides information to the public about the system that includes, but is not limited to, information that supports choice of providers and facilities, informs the public about meetings of state and regional health planning boards and activities of the Partnerships for Health. (aj) Procure funds, including loans, for the system, enter into leases, and obtain insurance for the system and its employees and agents. (ak) Collaborate with state and local authorities, including regional planning directors, to plan for needed earthquake retrofits in a manner that does not disrupt patient care. (a l ) Establish a process that is accessible to all Californians for the system to receive the concerns, opinions, ideas, and recommendation of the public regarding all aspects of the system. (am) Annually report to the Legislature and the Governor, on or before October of each year and at other times pursuant to this division, on the performance of the system, its fiscal condition and need for rate adjustments, consumer copayments or consumer deductible payments, recommendations for statutory changes, receipt of payments from the federal government and other sources, whether current year goals and priorities are met, future goals, and priorities, and major new technology or prescription drugs or other circumstances that may affect the cost of health care. 140103. (a) The commissioner shall establish a Healthcare Policy Board and shall serve as the president of the board. (b) The board shall do all of the following: (1) Establish goals and priorities for the system, including research and capital investment priorities. (2) Establish the scope of services to be provided to the population in accordance with Chapter 5 (commencing with Section 140500). (3) Establish guidelines for evaluating the performance of the system, its officers, health planning regions, and health care providers. (4) Establish guidelines for ensuring public input on the system’s policy, standards, and goals. (c) The board shall consist of the following members: (1) The commissioner. (2) The deputy commissioner. (3) The Director of the Healthcare Fund. (4) The patient advocate of the Office of Patient Advocacy. (5) The chief medical officer. (6) The Director of the Office of Health Planning. (7) The Director of the Partnerships for Health. (8) The Director of the Payments Board. (9) The State Public Health Officer. (10) One member of the Public Advisory Committee who shall serve on a rotating basis to be determined by the Public Advisory Committee. (11) Two representatives from regional planning boards. (A) A regional representative shall serve a term of one year and terms shall be rotated in order to allow every region to be represented within a five-year period. (B) A regional planning director shall appoint the regional representative to
serve on the board. (d) It is unlawful for the board members or any of their assistants, clerks, or deputies to use for personal benefit any information that is filed with or obtained by the board and that is not then generally available to the public. 140104. (a) The commissioner shall establish the Public Advisory Committee to advise the Healthcare Policy Board on all matters of policy for the system. (b) Members of the Public Advisory Committee shall include all of the following: (1) Four physicians all of whom shall be board certified in their field and at least one of whom shall be a psychiatrist. The Senate Committee on Rules and the Governor shall each appoint one member. The Speaker of the Assembly shall appoint two of these members, both of whom shall be primary care providers. (2) One registered nurse, to be appointed by the Senate Committee on Rules. (3) One licensed vocational nurse, to be appointed by the Senate Committee on Rules. (4) One licensed allied health practitioner, to be appointed by the Speaker of the Assembly. (5) One mental health care provider, to be appointed by the Senate Committee on Rules. (6) One dentist, to be appointed by the Governor. (7) One representative of private hospitals, to be appointed by the Governor. (8) One representative of public hospitals, to be appointed by the Governor. (9) One representative of an integrated health care delivery system, to be appointed by the Governor. (10) Four consumers of health care. The Governor shall appoint two of these members, one of whom shall be a member of the disability community. The Senate Committee on Rules shall appoint a member who is 65 years of age or older. The Speaker of the Assembly shall appoint the fourth member. (11) One representative of organized labor, to be appointed by the Speaker of the Assembly. (12) One representative of essential community providers, to be appointed by the Senate Committee on Rules. (13) One union member, to be appointed by the Senate Committee on Rules. (14) One representative of small business, to be appointed by the Governor. (15) One representative of large business, to be appointed by the Speaker of the Assembly. (16) One pharmacist, to be appointed by the Speaker of the Assembly. (c) In making appointments pursuant to this section, the Governor, the Senate Committee on Rules, and the Speaker of the Assembly shall make good faith efforts to assure that their appointments, as a whole, reflect, to the greatest extent feasible, the social and geographic diversity of the state. (d) Any member appointed by the Governor, the Senate Committee on Rules, or the Speaker of the Assembly shall serve a four-year term. These members may be reappointed for succeeding four-year terms. (e) Vacancies that occur shall be filled within 30 days after the occurrence of the vacancy, and shall be filled in the same manner in which the vacating member was initially selected or appointed. The commissioner shall notify the appropriate appointing authority of any expected vacancies on the board. (f) Members of the Public Advisory Committee shall serve without compensation, but shall be reimbursed for actual and necessary expenses incurred in the performance of their duties to the extent that reimbursement for those expenses is not otherwise provided or payable by another public agency or agencies, and shall receive one hundred dollars ($100) for each full day of attending meetings of the committee. For purposes of this section, “full day of attending a meeting” means presence at, and participation in, not less than 75 percent of the total meeting time of the committee during any particular 24-hour period. (g) The Public Advisory Committee shall meet at least six times a year in a place convenient to the public. All meetings of the board shall be open to the public, pursuant to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code). (h) The Public Advisory Committee shall elect a chair who shall serve for two years and who may be reelected for an additional two years. (i) Appointed committee members shall have worked in the field they represent on the committee for a period of at least two years prior to being appointed to the committee. (j) The Public Advisory Committee shall elect a member to serve on the Healthcare Policy Board. The elected member shall serve for one year, and may be recalled by the Public Advisory Committee for cause. In that case, a new member shall be elected to serve on that board. The Public Advisory Committee representative shall represent to the board the views of the committee members. (k) It is unlawful for the committee members or any of their assistants, clerks, or deputies to use for personal benefit any information that is filed with or obtained by the committee and that is not generally available to the public. 140105. (a) (1) There is within the agency an Office of Patient Advocacy to represent the interests of the consumers of health care. The goal of the office shall be to help residents of the state secure the health care services and benefits to which they are entitled under the laws administered by the agency and to advocate on behalf of and represent the interests of consumers in governance bodies created by this division and in other forums. (2) The office shall be headed by a patient advocate appointed by the commissioner. (3) The patient advocate shall establish an office in the City of Sacramento and other offices throughout the state that shall provide convenient access to residents. (b) The patient advocate shall do all the following: (1) Administer all aspects of the Office of Patient Advocacy. (2) Assure that services of the Office of Patient Advocacy are available to all California residents. (3) Serve on the Healthcare Policy Board and participate in the regional Partnerships for Health. (4) Oversee the establishment and maintenance of the grievance process pursuant to Sections 140608 and 140610. (5) Participate in the grievance process and independent medical review system on behalf of consumers pursuant to Section 140610. (6) Receive, evaluate, and respond to consumer complaints about the system. (7) Provide a means to receive recommendations from the public about ways to improve the system and hold public hearings at least once annually to discuss problems and receive recommendations from the public. (8) Develop educational and informational guides for consumers describing their rights and responsibilities and informing them about effective ways to exercise their rights to secure health care services and to participate in the system. The guides shall be easy to read and understand, available in English and other languages, including Braille and formats suitable for those with hearing limitations, and shall be made available to the public by the agency, including access on the agency’s Internet Web site and through public outreach and educational programs, and displayed in provider offices and health care facilities. (9) Establish a toll-free telephone number, including a TDD number, to receive complaints regarding the agency and its services. Those with hearing and speech limitations may use the California Relay Service’s toll-free telephone numbers to contact the Office of Patient Advocacy. The agency’s Internet Web site shall have complaint forms and instructions on their use. (10) Report annually to the public, the commissioner, and the Legislature about the consumer perspective on the performance of the system, including recommendations for needed improvements. (c) Nothing in this division shall prohibit a consumer or class of consumers or the patient advocate from seeking relief through the judicial system. (d) The patient advocate in pursuit of his or her duties shall have unlimited access to all nonconfidential and all non
privileged documents in the custody and control of the agency. (e) It is unlawful for the patient advocate or any of his or her assistants, clerks, or deputies to use for personal benefit any information that is filed with, or obtained by, the agency and that is not then generally available to the public. 140106. (a) There is within the Office of the Attorney General an Office of the Inspector General for the California Healthcare System. The Inspector General shall be appointed by the Governor and subject to Senate confirmation. (b) The Inspector General shall have broad powers to investigate, audit, and review the financial and business records of individuals, public and private agencies and institutions, and private corporations that provide services or products to the system, the costs of which are reimbursed by the system. (c) The Inspector General shall investigate allegations of misconduct on the part of an employee or appointee of the agency and on the part of any health care provider of services that are reimbursed by the system and shall report any findings of misconduct to the Attorney General. (d) The Inspector General shall investigate patterns of medical practice that may indicate fraud and abuse related to over or under utilization or other inappropriate utilization of medical products and services. (e) The Inspector General shall arrange for the collection and analysis of data needed to investigate the inappropriate utilization of these products and services. (f) The Inspector General shall conduct additional reviews or investigations of financial and business records when requested by the Governor or by any Member of the Legislature and shall report findings of the review or investigation to the Governor and the Legislature. (g) The Inspector General shall establish a telephone hotline for anonymous reporting of allegations of failure to make health insurance premium payments established by this division. The Inspector General shall investigate information provided to the hotline and shall report any findings of misconduct to the Attorney General. (h) The Inspector General shall annually report recommendations for improvements to the system or the agency to the Governor, the Legislature, and the commissioner. 140107. The provisions of the Insurance Frauds Prevention Act (Chapter 12 (commencing with Section 1871) of Part 2 of Division 1 of the Insurance Code), and the provisions of Article 6 (commencing with Section 650) of Chapter 1 of Division 2 of the Business and Professions Code shall be applicable to health care providers who receive payments for services through the system under this division. 140108. (a) Nothing contained in this division is intended to repeal any legislation or regulation governing the professional conduct of any person licensed by the State of California or any legislation governing the licensure of any facility licensed by the State of California. (b) All federal legislation and regulations governing referral fees and fee-splitting, including, but not limited to, Sections 1320a-7b and 1395nn of Title 42 of the United States Code, shall be applicable to all health care providers of services reimbursed under this division, whether or not the health care provider is paid with funds coming from the federal government. 140110. (a) The system shall be operational no later than two years after the date this division, other than Article 2 (commencing with Section 140230) of Chapter 3, becomes operative, as described in Section 140700. (b) The commissioner shall assess health plans and insurers for care provided by the system in those cases in which a person’s health care coverage extends into the time period in which the new system is operative. (c) The commissioner shall implement means to assist persons who are displaced from employment as a result of the initiation of the system, including determination of the period of time during which assistance shall be provided and possible sources of funds, including funds from the system, to support retraining and job placement. That support shall be provided for a period of five years from the date that this division becomes operative. 140111. (a) The commissioner shall appoint a transition advisory group, which shall include, but not be limited to, the following members: (1) The commissioner. (2) The patient advocate of the Office of Patient Advocacy. (3) The chief medical officer. (4) The Director of the Office of Health Planning. (5) The Director of the Healthcare Fund. (6) The State Public Health Officer. (7) Experts in health care financing and health care administration. (8) Direct care providers. (9) Representatives of retirement boards. (10) Employer and employee representatives. (11) Hospital, integrated health care delivery system, essential community provider, and long-term care facility representatives. (12) Representatives from state departments and regulatory bodies that shall or may relinquish some or all parts of their delivery of health care services to the system. (13) Representatives of counties. (14) Consumers of health care services. (b) The transition advisory group shall advise the commissioner on all aspects of the implementation of this division. (c) The transition advisory group shall make recommendations to the commissioner, the Governor, and the Legislature on how to integrate health care delivery services and responsibilities relating to the delivery of the services of the following departments and agencies into the system: (1) The State Department of Health Care Services. (2) The Department of Managed Health Care. (3) The Department of Aging. (4) The Department of Developmental Services. (5) The Health and Welfare Data Center. (6) The State Department of Mental Health. (7) The State Department of Alcohol and Drug Programs. (8) The Department of Rehabilitation. (9) The Emergency Medical Services Authority. (10) The Managed Risk Medical Insurance Board. (11) The Office of Statewide Health Planning and Development. (12) The Department of Insurance. (13) The State Department of Public Health. (d) The transition advisory group shall make recommendations to the Governor, the Legislature, and the commissioner regarding research needed to support transition to the system. 140112. (a) The transition advisory group shall make recommendations to the commissioner relative to how the system shall be regionalized for the purposes of local and community-based planning for the delivery of high quality cost-effective care and efficient service delivery. (b) The commissioner, in consultation with the Director of the Office of Health Planning, shall establish up to 10 health planning regions composed of geographically contiguous counties grouped on the basis of the following considerations: (1) Patterns of utilization of health care services. (2) Health care resources, including workforce resources. (3) Health needs of the population, including public health needs. (4) Geography. (5) Population and demographic characteristics. (6) Other considerations as determined by the commissioner, the Director of the Office of Health Planning, or the chief medical officer. (c) The commissioner shall appoint a director for each region. Regional planning directors shall serve at the will of the commissioner and may serve up to two eight-year terms to coincide with the terms of the commissioner. (d) Each regional planning director shall appoint a regional medical officer. (e) Compensation for officers of the system and appointees who are exempt from the civil service shall be established by the California Citizens Commission in accordance with Section 8 of Article III of the California Constitution, and shall take into consideration regional differences in the cost of living. (f) The regional planni
ng director and the regional medical officer shall be subject to Title 9 (commencing with Section 81000) of the Government Code and shall comply with the qualifications for office described in subdivisions (c), (d), and (e) of Section 140100 and subdivisions (j) and (k) of Section 140101. 140113. (a) Regional planning directors shall administer the health planning region. The regional planning director shall be responsible for all duties, the exercise of all powers and jurisdiction, and the assumptions and discharge of all responsibilities vested by law in the regional agency. The regional planning director shall perform all duties imposed upon him or her by this division and by other laws related to health care, and shall enforce execution of those provisions and laws to promote their underlying aims and purposes. (b) The regional planning director shall reside in the region in which he or she serves. (c) The regional planning director shall do all of the following: (1) Establish and administer a regional office of the state agency. Each regional office shall include, at minimum, an office of each of the following: Patient Advocacy, Health Care Quality, Health Planning, and Partnerships for Health. (2) Appoint regional planning board members and serve as president of the board. (3) Identify and prioritize regional health care needs and goals, in collaboration with the regional medical officer, regional health care providers, the regional planning board, and regional director of Partnerships for Health pursuant to the priorities and goals of the system established by the commissioner. (4) Regularly assess projected revenues and expenditures to ensure fiscal solvency of the regional planning system and advise the commissioner of potential revenue shortfalls and the possible need for cost controls. (5) Assure that regional administrative costs meet standards established by the division and seek innovative means to lower the costs of administration of the regional planning office and those of regional providers. (6) Plan for the delivery of, and equal access to, high quality and culturally and linguistically sensitive care and such care for disabled persons that meets the needs of all regional residents pursuant to standards established by the commissioner. (7) Seek innovative and systemic means to improve care quality and efficiency of care delivery and to achieve access to programs for all state residents. (8) Recommend means to and implement policies established by the commissioner to provide support to persons displaced from employment as a result of the initiation of the new system. (9) Make needed revenue sharing arrangements so that regionalization does not limit a patient’s choice of provider. (10) Implement procedures established by the commissioner for the resolution of disputes. (11) Implement processes established by the commissioner and recommend needed changes to permit the public to share concerns, provide ideas, opinions, and recommendations regarding all aspects of the system’s policies. (12) Report regularly to the public and, at intervals determined by the commissioner and pursuant to this division, to the commissioner on the status of the regional planning system, including evaluating access to care, quality of care delivered, and provider performance, and other issues related to regional health care needs, and recommending needed improvements. (13) Identify or establish guidelines for providers to identify, maintain, and provide to the regional planning director inventories of regional health care assets. (14) Establish and maintain regional health care databases that are coordinated with other regional and statewide databases. (15) In collaboration with the regional medical officer, enforce reporting requirements established by the system and make recommendations to the commissioner, the Director of the Office of Health Planning, and the chief medical officer for needed changes in reporting requirements. (16) Establish and implement a regional capital management plan pursuant to the capital management plan established by the commissioner for the system. (17) Implement standards and formats established by the commissioner for the development and submission of operating and capital budget requests and make recommendations to the commissioner and the Director of the Office of Health Planning for needed changes. (18) Support regional providers in developing operating and capital budget requests. (19) Receive, evaluate, and prioritize provider operating and capital budget requests pursuant to standards and criteria established by the commissioner. (20) Prepare a three-year regional operating and capital budget request that meets the health care needs of the region pursuant to this division, for submission to the commissioner. (21) Establish a comprehensive three-year regional planning budget using funds allocated to the region by the commissioner. 140114. The regional medical officers shall do all of the following: (a) Administer all aspects of the regional office of health care quality. (b) Serve as a member of the regional planning board. (c) In collaboration with the commissioner, the chief medical officer, the regional medical officer, regional planning boards, the patient advocate of the Office of Patient Advocacy, regional providers, and patients, oversee the establishment of integrated service networks, including those that provide services through medical technologies such as telemedicine, that include physicians in fee-for-service, solo and group practice, essential community, and ancillary care providers and facilities that pool and align resources and form interdisciplinary teams that share responsibility and accountability for patient care and provide a continuum of coordinated high quality primary to tertiary care to all residents of the region. (d) Assure the evaluation and measurement of the quality of care delivered in the region, including assessment of the performance of individual providers, pursuant to standards and methods established by the chief medical officer to ensure a single standard of high quality care is delivered to all state residents. (e) In collaboration with the chief medical officer and regional providers, evaluate standards of care in use at the time the system becomes operative. (f) Ensure a smooth transition toward use of standards based on clinical efficacy that guide clinical decisionmaking. Identify areas of medical practice where standards have not been established and collaborated with the chief medical officer and health care providers, to establish priorities in developing needed standards. (g) Support the development and distribution of user-friendly software for use by providers in order to support the delivery of high quality care. (h) Provide feedback to, and support and supervision of, health care providers to ensure the delivery of high quality care pursuant to standards established by the system. (i) Collaborate with the regional Partnerships for Health to develop patient education to assist consumers in evaluating and appropriately utilizing health care providers and facilities. (j) Collaborate with regional public health officers to establish regional health policies that support the public health. (k) Establish a regional program to monitor and decrease medical errors and their causes pursuant to standards and methods established by the chief medical officer. (l) Support the development and implementation of innovative means to provide high quality care and assist providers in securing funds for innovative demonstration projects that seek to improve care quality. (m) Establish means to assess the impact of the system’s policies intended to assure the delivery of high quality care. (n) Collaborate with the chief medical officer, the Director of the Office of Health Planning, the regional planning director, and health care providers
in the development and maintenance of regional health care databases. (o) Ensure the enforcement of, and recommend needed changes in, the system’s reporting requirements. (p) Support providers in developing regional budget requests. (q) Annually report to the commissioner, the public, the regional planning board, and the chief medical officer on the status of regional health care programs, needed improvements, and plans to implement and evaluate delivery of care improvements. 140115. (a) Each region shall have a regional planning board consisting of 13 members who shall be appointed by the regional planning director. Members shall serve eight-year terms that coincide with the term of the regional planning director and may be reappointed for a second term. (b) Regional planning board members shall have resided for a minimum of two years in the region in which they serve prior to appointment to the board. (c) Regional planning board members shall reside in the region they serve while on the board. (d) The board shall consist of the following members: (1) The regional planning director, the regional medical officer, the regional director of the Partnerships for Health, and a public health officer from one of the counties in the region. (2) When there is more than one county in a region, the public health officer board position shall rotate among the public health county officers on a timetable to be established by each regional planning board. (3) A representative from the Office of Patient Advocacy. (4) One expert in health care financing. (5) One expert in health care planning. (6) Two members who are direct care providers in the region, one of whom shall be a registered nurse. (7) One member who represents ancillary health care workers in the region. (8) One member representing hospitals in the region. (9) One member representing essential community providers in the region. (10) One member representing the public. (e) The regional planning director shall serve as chair of the board. (f) The purpose of the regional planning boards is to advise and make recommendations to the regional planning director on all aspects of regional health policy. (g) Meetings of the board shall be open to the public pursuant to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code). 140116. The following conflict-of-interest prohibitions shall apply to all appointees of the commissioner or transition advisory group, including, but not limited to, the patient advocate, the Director of the Healthcare Fund, the purchasing director, the Director of the Office of Health Planning, the Director of the Payments Board, the chief medical officer, the Director of Partnerships for Health, regional planning directors, and the Inspector General: (a) The appointee shall not have been employed in any capacity by a for-profit insurance, pharmaceutical, or medical equipment company that sells products to the system for a period of two years prior to appointment. (b) For two years after completing service in the system, the appointee may not receive payments of any kind from, or be employed in any capacity or act as a paid consultant to, a for-profit insurance, pharmaceutical, or medical equipment company that sells products to the system. (c) The appointee shall avoid political activity that may create the appearance of political bias or impropriety. Prohibited activities shall include, but not be limited to, leadership of, or employment by, a political party or a political organization; public endorsement of a political candidate; contribution of more than five hundred dollars ($500) to any one candidate in a calendar year or a contribution in excess of an aggregate of one thousand dollars ($1,000) in a calendar year for all political parties or organizations; and attempting to avoid compliance with this prohibition by making contributions through a spouse or other family member. (d) The appointee shall not participate in making or in any way attempt to use his or her official position to influence a governmental decision in which he or she or a family or a business partner or colleague has a financial interest.