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
Meeting Agenda available at http://www.goldcoasthealthplan.org
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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2
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.
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RECOMMENDATION
Staff is recommending the Commission approve and authorize the CEO to execute DHCS
contract amendment A20.
CONCURRENCE
N/A
Attachments
None
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STATE OF CALIFORNIA
STANDARD AGREEMENT AMENDMENT
STD. 213A_DHCS (Rev. 08/14)
Agreement Number
Check here if additional pages are added: 7 Page(s)
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
2.
3.
4.
(Also referred to as Contractor)
Ventura County Medi-Cal Managed Care Commission dba Gold Coast Health Plan
The term of this Agreement is:
July 1, 2011 through December 31, 2016
$ Budget Act Line Items
The maximum amount of this
Agreement after this amendment is: 4260-601-0912 and 4260-601-0555
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
Contractor’s Name (If other than an individual, state whether a corporation, partnership, etc.)
CALIFORNIA
Department of General Services
Use Only
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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Ventura County Medi-Cal Managed Care Commission dba
Gold Coast Health Plan
10-87128 A20
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
Groups
Aid Codes
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
Aged/Dual Eligible 10,14,16,17,1E, 1H
Aged/Medi-Cal only 10, 14, 16, 17, 1E, 1H
Breast and Cervical
Cancer Treatment 0M, 0N, 0P, 0R, 0T, 0U
Program (BCCTP)
Disabled/Dual
20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A,
Eligible
6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y
Disabled/Medi-Cal 20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A,
Only
6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y
Long Term Care/
13, 23, 53, 63
Dual Eligible
Long Term
13, 23, 53, 63
Care/Medi-Cal only
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Ventura
Rate
$169.46
$254.30
$630.28
$1,483.78
$215.30
$1,010.61
$4,719.58
$7,461.40
Ventura County Medi-Cal Managed Care Commission dba
Gold Coast Health Plan
10-87128 A20
For the period 07/01/12 –12/31/12
Groups
Aid Codes
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
Aged/Dual Eligible 10,14,16,17,1E, 1H
Aged/Medi-Cal Only 10, 14, 16, 17, 1E, 1H
Breast and Cervical
Cancer Treatment 0M, 0N, 0P, 0R, 0T, 0U
Program (BCCTP)
Disabled/Dual
20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A,
Eligible
6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y
Disabled/Medi-Cal 20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A,
Only
6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y
Long Term Care/
13, 23, 53, 63
Dual Eligible
Long Term
13, 23, 53, 63
Care/Medi-Cal Only
Ventura
Rate
$175.86
For the period 01/01/13 – 06/30/13
Groups
Aid Codes
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
Aged/Dual Eligible 10,14,16,17,1E, 1H
Aged/Medi-Cal Only 10, 14, 16, 17, 1E, 1H
Breast and Cervical
Cancer Treatment 0M, 0N, 0P, 0R, 0T, 0U
Program (BCCTP)
Disabled/Dual
20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A,
Eligible
6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y
Disabled/Medi-Cal 20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A,
Only
6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y
Long Term Care/
13, 23, 53, 63
Dual Eligible
Long Term
13, 23, 53, 63
Care/Medi-Cal Only
Ventura
Rate
$183.28
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$262.18
$659.99
$1,555.28
$221.97
$1,034.28
$4,865.88
$7,854.82
$266.43
$726.00
$1,614.26
$226.12
$1,051.97
$4,871.79
$7,937.47
Ventura County Medi-Cal Managed Care Commission dba
Gold Coast Health Plan
10-87128 A20
For the period 07/01/13 – 12/31/13
Groups
Aid Codes
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,
Aged/Dual Eligible 10, 14, 16, 17, 1E, 1H
Aged/Medi-Cal only 10, 14, 16, 17, 1E, 1H
Breast and Cervical
Cancer Treatment 0M, 0N, 0P, 0R, 0T, 0U, 0W
Program (BCCTP)
Disabled/Dual
20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A,
Eligible
6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y
Disabled/Medi-Cal 20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A,
Only
6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y
Long Term Care/
13, 23, 53, 63
Dual Eligible
Long Term
13, 23, 53, 63
Care/Medi-Cal Only
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Ventura
Rate
$162.04
$244.15
$1,001.65
$1,529.33
$205.97
$1,001.65
$6,027.54
$10,265.77
Ventura County Medi-Cal Managed Care Commission dba
Gold Coast Health Plan
10-87128 A20
For the period 01/01/14-06/30/14
Groups
Aid Codes
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
Aged/Dual Eligible 10, 14, 16, 17, 1E, 1H
Ventura
Rate
$164.59
Aged/Medi-Cal only
Breast and Cervical
Cancer Treatment
Program (BCCTP)
Disabled/Dual
Eligible
Disabled/Medi-Cal
Only
Long Term Care/
Dual Eligible
Long Term
Care/Medi-Cal Only
Adult Expansion
$1,006.39
$1,538.05
10, 14, 16, 17, 1E, 1H
$242.70
0M, 0N, 0P, 0R, 0T, 0U, 0W
20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A,
6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y
20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 6A,
6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 6W, 6X, 6Y
13, 23, 53, 63
$1,006.39
13, 23, 53, 63
$10,265.82
L1, M1, 7U
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$204.54
$6,025.86
$832.85
$894.85
Ventura County Medi-Cal Managed Care Commission dba
Gold Coast Health Plan
10-87128 A20
For the period 07/01/14-12/31/14
Groups
Aid Codes
Adult & Family/
01, 02, 03, 04, 06, 07, 08, 30, 32, 33, 34,
Optional Targeted 35, 37, 38, 39, 40, 42, 43, 45, 46, 47, 49,
Low-Income Child 54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E, 3F,
(Under 19)
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
Adult & Family/
01, 02, 03, 04, 06, 07, 08, 30, 32, 33, 34,
Optional Targeted 35, 37, 38, 39, 40, 42, 43, 45, 46, 47, 49,
Low-Income Child 54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E, 3F,
(19 & Older)
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,
Aged/Medi-Cal Only 10, 14, 16, 17, 1E, 1H
Ventura
Rate
$88.56
Aged/Dual Eligible
10, 14, 16, 17, 1E, 1H
$189.87
Disabled/Medi-Cal
Only
20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 2H,
6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6R, 6V,
6W, 6X, 6Y
20, 24, 26, 27, 36, 60, 64, 66, 67, 2E, 2H,
6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6R, 6V,
6W, 6X, 6Y
13, 23, 53, 63
$920.60
Disabled/Dual
Eligible
Long Term
Care/Medi-Cal Only
Long Term
13, 23, 53, 63
Care/Dual Eligible
Breast and Cervical 0M, 0N, 0P, 0R, 0T, 0U, 0W
Cancer Treatment
Program (BCCTP)
Adult Expansion
L1, M1, 7U
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$297.22
$920.60
$184.19
$10,894.73
$6,319.75
$1,752.85
$813.02
Ventura County Medi-Cal Managed Care Commission dba
Gold Coast Health Plan
10-87128 A20
Commencing 01/01/15
Groups
Aid Codes
Adult & Family/
01, 02, 03, 04, 06, 07, 08, 30, 32, 33, 34,
Optional Targeted
35, 37, 38, 39, 40, 42, 43, 45, 46, 47, 49,
Low-Income Child
54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E,
(Under 19)
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
Adult & Family/
01, 02, 03, 04, 06, 07, 08, 30, 32, 33, 34,
Optional Targeted
35, 37, 38, 39, 40, 42, 43, 45, 46, 47, 49,
54, 59, 72, 82, 83, 0A, 3A, 3C, 3D, 3E,
Low-Income Child
3F, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W,
(19 & Older)
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,
Aged/Medi-Cal Only 10, 14, 16, 17, 1E, 1H
Ventura
Rate
$82.46
$288.57
$898.20
Aged/Dual Eligible
10, 14, 16, 17, 1E, 1H, 1X, 1Y
$187.01
Disabled/Medi-Cal
Only
20, 24, 26, 27, 36, 60, 64, 66, 67, 2E,
2H, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V,
6W, 6X, 6Y
20, 24, 26, 27, 36, 60, 64, 66, 67, 2E,
2H, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V,
6W, 6X, 6Y
13, 23, 63
$898.20
Disabled/Dual
Eligible
Long Term
Care/Medi-Cal Only
Long Term
13, 23, 63
Care/Dual Eligible
Breast and Cervical 0M, 0N, 0P, 0R, 0T, 0U, 0W
Cancer Treatment
Program (BCCTP)
Adult Expansion
L1, M1, 7U
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$181.40
$10,814.92
$6,315.14
$1,697.67
$802.57
Ventura County Medi-Cal Managed Care Commission dba
Gold Coast Health Plan
10-87128 A20
V.
For the period 01/01/13 – 03/31/13
Groups
Aid Codes
Optional Targeted 5C, 5D, H1, H2, H3, H4, H5
Low-Income Child E7, M5, T1, T2, T3, T4, T5
Ventura
Rate
$93.37
For the period 04/01/13 – 06/30/13
Groups
Aid Codes
Optional Targeted 5C, 5D, H1, H2, H3, H4, H5, E7, M5, T1, T2,
Low-Income Child T3, T4, T5
Ventura
Rate
$94.13
For the period 07/01/13 – 07/31/13
Groups
Aid Codes
Optional Targeted 5C, 5D, H1, H2, H3, H4, H5, E7, M5, T1, T2,
Low-Income Child T3, T4, T5
Ventura
Rate
$95.69
For the period 08/01/13 – 12/31/13
Groups
Aid Codes
Optional Targeted 5C, 5D, H1, H2, H3, H4, H5, E7, M5, T1, T2,
Low-Income Child T3, T4, T5
Ventura
Rate
$97.58
For the period 01/01/14 – 06/30/14
Groups
Aid Codes
Optional Targeted 5C, 5D, H1, H2, H3, H4, H5, E7, M5, T1, T2,
Low-Income Child T3, T4, T5
Ventura
Rate
$113.86
All rights, duties, obligations and liabilities of the parties hereto otherwise remain
unchanged.
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