CHAPTER 2.91 - FRESNO—KINGS—MADERA REGIONAL HEALTH AUTHORITY
Sections:
2.91.010 - Establish.
2.91.020 - Purpose.
2.91.030 - Governing body, membership and terms of office.
2.91.040 - Bylaws.
2.91.050 - Quorum.
2.91.060 - Status and powers of the health authority.
2.91.070 - Minutes.
2.91.080 - County financial assistance to health authority.
2.91.090 - Reports.
2.91.100 - Vacancies.
2.91.110 - Validity.
2.91.120 - Implementation.
2.91.010 - Establish.
Pursuant to the Joint Powers Agreement into which the counties of Fresno, Kings, and Madera have entered under the provisions
of the California Joint Exercise of Powers Act (Government Code section 6500 et seq.) and to California Welfare and Institutions
Code Section 14087.38, there is created the Fresno—Kings—Madera Regional Health Authority. This Health Authority is a three-county
regional health authority representing the counties of Fresno, Kings, and Madera. The health authority shall be established
effective on that date that all three counties have in effect substantially similar ordinances creating the Health Authority
and a quorum of the Health Authority's members have met to conduct its initial public meeting. Upon the establishment of the
health authority, all of the rights, duties, privileges, and immunities vested in the county of Madera by Welfare and Institutions
Code Sections 14087.38 et seq. (Part 3, Division 9, Chapter 7, Article 2.7) are instead transferred to and vested in the health
authority, and shall continue to be so vested until the county of Madera formally terminates its participation in the health
authority. The health authority shall continue to represent the county of Madera until the county of Madera formally terminates
the representation. Any action to terminate representation shall be pursuant to the joint powers agreement. In the event of
termination, the county of Madera and the health authority shall give notice to the California Department of Health Care Services
as set forth in Section 14087.38(v)(1).
(Ord. No. 637, § 1, 4-14-09)
2.91.020 - Purpose.
A. The purpose of the health authority is to negotiate a contract with the California Department of Health Care Services and
to arrange for the provision of health care services to qualifying individuals in Fresno County, Kings County, and Madera
County, pursuant to Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code.
B. The health authority shall design and operate a program or programs that:
1. Delivers primary care via a contracted provider network which significantly improves access to primary care and related specialty
and ancillary services for enrolled Medi-Cal recipients;
2. Includes mechanisms for assuring that health authority-financed medical care services meet appropriate quality of care standards;
3. Incorporates a plan of service delivery and implements reimbursement mechanisms which will promote the long-term viability
of a locally operated Medi-Cal managed care system and participating "safety net" providers, herein defined as Medi-Cal Disproportionate
Share Hospitals, county clinics and licensed community and rural clinics;
4. Implements a financial plan which includes the creation of a prudent reserve within three years of commencing operations,
and which provides that if additional surplus funds accrue, they shall be used to expand access, improve benefits and augment
provider reimbursement;
5. Gives a high priority to increasing prevention, education and early intervention services for enrolled recipients;
6. Ensures that all program obligations, statutory, contractual or otherwise, shall be the obligations of the program and shall
not be the obligations of the participating counties or the state of California;
7. Implements programs and procedures to ensure that a high level of member satisfaction is maintained.
C. The health authority shall also be authorized to contract with public insurers, payors or plan sponsors to offer and/or administer
their health care programs and to contract with private insurers or plan sponsors to administer their health care programs.
(Ord. No. 637, § 1, 4-14-09)
2.91.030 - Governing body, membership and terms of office.
A. The health authority shall be governed by the health authority commission ("commission") which shall consist of seventeen
voting members, six of whom shall be appointed by the board of supervisors of the county of Fresno, three of whom shall be
appointed by the board of supervisors of the county of Kings, three shall be appointed by the board of supervisors of the
county of Madera, and five of whom shall be appointed as described below. The commission shall be generally representative
of the diverse skills, backgrounds, interests, and demography of persons residing in the three counties.
B. Each member of the commission shall have a commitment to a health care system which seeks to improve access to high quality
health care for all persons, regardless of their economic circumstances, and which in fact delivers high quality care, and
which in fact is financially viable. Members of the commission shall likewise have an abiding commitment to, and interest
in, a quality publicly assisted health care delivery system.
C. The seventeen voting members shall include:
1. Three persons who shall be one member of the Fresno County board of supervisors, one member of the Kings County board of supervisors,
and one member of the Madera County board of supervisors.
2. Three persons who shall be the director of the department of public health or director of the department of social services
of the county of Fresno, the director of the department of public health or director of the department of social services
of the county of Kings, and the director of the department of public health or director of the department of social services
of the county of Madera.
3. Four persons appointed by the Fresno County board of supervisors who are representative of the interests of physician providers
of Medi-Cal covered health care services, health care consumers, community representatives, or community clinics; one person
appointed by the Kings County board of supervisors who is representative of the interests of physician providers of Medi-Cal
covered health care services, health care consumers, community representatives, or community clinics; and one person appointed
by the Madera County board of supervisors who is representative of the interests of physician providers of Medi-Cal covered
health care services, health care consumers, community representatives, or community clinics.
4. Three persons appointed by the commission who are representative of the interests of health care consumers, providers of pharmacy
services or other health care services, or other person with the commitment as stated in subsection B, above.
5. One person shall be a representative of the Children's Hospital of Central California, and one person shall be a representative
of the Community Regional Medical Center. The designation of these two members shall be made by their respective facilities,
subject to confirmation by the commission. The commission may, in its discretion, reject any person designated by the hospital
or medical center and request additional designations.
D. Commission members designated for appointment by a county board of supervisors shall be appointed by majority vote of the
board of supervisors of the respective county. Any commission member so appointed may be removed from office by a majority
vote of the board of supervisors of the county originally appointing that member.
E. Appointments to be made by the health authority shall be nominated, selected, replaced or removed, as may be necessary, in
accordance with the JPA and the bylaws adopted by a majority of the voting members of the health authority.
F. Except as provided in subsection 2.91.030(G) herein, all Health Authority members except members appointed pursuant to subsections
2.91.030(C)(1) and 2.91.030(C)(2) shall serve terms of three years. Terms for Health Authority members appointed pursuant
to subsections 2.91.030(C)(1) and 2.90.030(C)(2) shall be coterminous with their position unless the appointing board of supervisors
replaces such member on its own motion.
G. Initial selections of health authority members other than members appointed pursuant to subsections 2.91.030(C)(1) and 2.91.030(C)(2)
will be for one-, two- or three-year terms in order to establish a rotation of member appointments. Once the initial term
is fulfilled, the appointing party shall make succeeding appointments for a full three-year term. At the conclusion of a term,
a member may be reappointed to a subsequent three-year term or terms. Initial selection terms will be as follows:
1. One regional representative from Children's Hospital of Central California; and one regional representative from Community
Regional Medical Center, pursuant to subsection 2.91.030(C)(5) above, will be appointed to three-year terms.
2. Two members to be appointed by the Fresno County board of supervisors and one member to be appointed by the authority, pursuant
to subsections 2.91.030(C)(3) and 2.91.030(C)(4) above, shall be appointed for an initial term of one year each. Such one-year
term shall be identified in the appointment.
3. One member to be appointed by the Fresno County board of supervisors, one member to be appointed by the Madera County board
of supervisors and one member to be appointed by the Authority, pursuant to subsections 2.91.030(C)(3) and 2.91.030(C)(4)
above, shall be appointed for an initial term of two years each. Such two-year term shall be identified in the appointment.
4. One member to be appointed by the Fresno County board of supervisors, one member to be appointed by the Kings County board
of supervisors and one member to be appointed by the Authority, pursuant to subsections 2.91.030(C)(3) and 2.91.030(C)(4)
above, shall be appointed for an initial term of three years each. Such three-year term shall be identified in the appointment.
(Ord. No. 637, § 1, 4-14-09)
2.91.040 - Bylaws.
Procedures for the conduct of business not otherwise specified in this chapter, including provisions for the creation of standing
committees, shall be contained in the JPA and in bylaws adopted by the health authority.
(Ord. No. 637, § 1, 4-14-09)
2.91.050 - Quorum.
A majority of the appointed members of the health authority shall constitute a quorum, and no act of the health authority
shall be valid unless a majority of those members appointed and not disqualified from voting due to a conflict of interest
concur therein. Any act of the health authority shall be accomplished by a roll call vote when such a vote is requested by
any member in attendance.
(Ord. No. 637, § 1, 4-14-09)
2.91.060 - Status and powers of the health authority.
The health authority shall be considered an entity separate from the county of Fresno, the county of Kings, and the county
of Madera. The health authority shall have the power to acquire, possess, and dispose of real or personal property, as may
be necessary for the performance of its functions, to employ personnel and contract for services to meet its obligations,
and to sue or be sued. Any obligations of the health authority, contractual, or otherwise, shall be the obligations solely
of the health authority and shall not be the obligations of either the county of Fresno, the county of Kings, or the county
of Madera.
(Ord. No. 637, § 1, 4-14-09)
2.91.070 - Minutes.
Official minutes recording motions entertained and actions taken at each meeting of the health authority shall be prepared
and submitted to each respective board of supervisors and county administrative office in each county.
(Ord. No. 637, § 1, 4-14-09)
2.91.080 - County financial assistance to health authority.
The counties of Fresno, Kings, and Madera may advance to the health authority limited financial and/or in-kind support for
reasonable costs associated with planning, development, and health Authority administration provided that the health authority
agrees to reimburse each county for that funding according to a mutually agreed schedule of repayment once operations begin.
(Ord. No. 637, § 1, 4-14-09)
2.91.090 - Reports.
A. The commission shall submit an annual report to each respective board of supervisors and county administrative office on or
before January 31st of each year and subsequently filed with the clerk of each respective board of supervisors. The report
shall highlight the activities, accomplishments and future goals of the health authority.
B. Any of the respective boards of supervisors may request the commission to submit progress reports and recommendations at any
time. The commission shall respond to such requests within a reasonable period of time.
(Ord. No. 637, § 1, 4-14-09)
2.91.100 - Vacancies.
A. Vacancies occurring on the commission, for appointments pursuant to subsection 2.91.030(C)(3), shall be filled by the board
of supervisors of the appointing county for the remainder of the unexpired term only. Vacancies occurring on the commission,
for appointments pursuant to subsection 2.91.030(c)(1) or 2.91.030(c)(2), shall be filled by the board of supervisors of the
appointing county and for a term pursuant to subsection 2.91.030(F).
B. Vacancies occurring on the commission, for appointments subject to commission approval, shall be filled by the health authority
in accordance with its bylaws and applicable provisions of state law.
(Ord. No. 637, § 1, 4-14-09)
2.91.110 - Validity.
If any section, subsection, paragraph, sentence, clause, phrase, or portion of this chapter is for any reason held to be invalid
or unconstitutional by any court of law with proper jurisdiction, such decision shall not affect the validity of the remaining
portions of this chapter. The board of supervisors hereby declares that it would have adopted the ordinance codified in this
chapter, and each section, subsection, paragraph, sentence, clause, phrase, or portion thereof, irrespective of the fact that
any one or more sections, subsections, paragraph, sentences, clauses, phrases, or portion thereof be declared invalid or unconstitutional.
(Ord. No. 637, § 1, 4-14-09)
2.91.120 - Implementation.
This chapter shall be implemented only when and if each of the counties duly approve and execute a joint powers agreement
creating the health authority as a separate entity.
(Ord. No. 637, § 1, 4-14-09)