Agenda Item 6A
December 9, 2014
Action
MEMORANDUM
December 5, 2014
TO:
FROM:
SUBJECT:
County Council
rf'\
Advisory Board -
Robert H. Drummer, Senior Legislative
Attorne~
Action:
Expedited Bill 57-14, Health - Montgomery Cares
Continuation
Expedited Bill 57-14, Health - Montgomery Cares - Advisory Board - Continuation,
sponsored by Council Vice President Leventhal, was introduced on November 25, 2014. A
public hearing was held on December 2.
Background
Montgomery Cares Program is a public/private partnership between the County
Department of Health and Human Services and a network of nonprofit clinics and hospitals that
provides primary medical care and prescription medications to low-income, uninsured adults
who reside in the County. The Advisory Board for the Montgomery Cares Program was
established to guide the development of the Program and to ensure steady and measurable
growth in the number of uninsured County residents accessing high quality and efficient health
care services.
Under current law, the Advisory Board must recommend to the Council and the
Executive whether the County should continue the Board or establish an alternative governance
structure for the Montgomery Cares Program on or before January 1,2015. Bill 57-14 would
extend the time for the Board to make this recommendation to March 31,2015. The Bill would
also extend the sunset date for the Board from June 30, 2015 to October 31, 2015. Vice
President Leventhal, the lead sponsor, explained the reason for the extension at ©4-S.
Public Hearing
The only witness at the public hearing, Steve Gammarino, speaking on behalf of the
Montgomery Cares Advisory Board, supported the BilL (©9)
Mr.
Gammarino stated that the
Board needs more time to evaluate the governance structure for Montgomery Cares because the
healthcare landscape has recently changed significantly due
to
the implementation of the Patient
Protection and Affordable Care Act.
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Discussion
The Patient Protection and Affordable Care Act (ACA) increased the availability of
health insurance to County residents, but it has not eliminated the need for Montgomery Cares to
fill the gap for uninsured residents. The Advisory Board is requesting a modest extension of
time to evaluate the effect of the ACA on its mission
in
order to determine how best to leverage
the ACA to increase the availability of medical services for County residents.
Council staff
recommendation:
enact the Bill as introduced.
This packet contains:
Expedited Bill 57-14
Legislative Request Report
Leventhal Memorandum - November 18,2014
Testimony of Steve Gammarino
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Expedited Bill No.
57-14
Concerning: Health - Montgomery Cares
- Advisory Board - Continuation
Revised: November 13.2014 Draft No.
L
Introduced:
November 25. 2014
Expires:
May 25.2016
Enacted: _ _ _ _ _ _ _ _ __
Executive: _ _ _ _ _ _ _ __
Effective: _ _ _ _ _ _ _ _ __
Sunset Date: _---:-_ _:---_ _ __
ChI _ _, Laws of Mont. Co. _ __
COUNTY COUNCIL
FOR MONTGOMERY COUNTY, MARYLAND
By: Council Vice President Leventhal
AN EXPEDITED ACT
to:
(1)
extend the life of the Advisory Board for the Montgomery Cares Program; and
(2)
generally amend the law creating the Advisory Board for the Montgomery Cares
Program.
By amending
Montgomery County Code
Chapter 24, Health and Sanitation
Section 24-53
Boldface
Underlining
[Single boldface brackets]
Double underlining
[[Double boldface brackets]]
* * *
Heading or defined term.
Added to existing law by original bill.
Deletedfrom existing law by original bill.
Added by amendment.
Deletedfrom existing law or the bill by amendment.
Existing law unaffected by bill
The County Council for Montgomery County, Maryland approves the following Act:
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EXPEDITED BILL
No.
57-14
1
Sec.
1.
Section 24-53 is amended as follows:
24-53. Termination.
2
3
4
5
6
(a)
(b)
Date.
The Board tenninates on [June 30,2015] October 31,2015.
Continuance of Board.
By [January 1, 2015] March
.lL
2015, the
Board must recommend to the County Executive and County Council
whether the County should continue the Board or establish an
alternative governance structure for the Program.
Sec. 2.
Expedited Effective Date.
7
8
9
10
11
The Council declares that this legislation is necessary for the immediate
protection of the public interest. This Act takes effect on the date on which it
becomes law.
Approved:
12
13
Craig
L.
Rice, President, County Council
14
Approved:
Date
15
Isiah Leggett, County Executive
16
17
Date
This is a correct copy o/Council action.
Linda M. Lauer, Clerk ofthe Council
Date
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board •
continu
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LEGISLATIVE REQUEST REPORT
Health
DESCRIPTION:
Expedited Bill 57-14
Montgomery Cares Advisory Board
-
Continuation
Under current law, the Advisory Board for Montgomery Cares must
recommend to the Council and the Executive whether the County
should continue the Board or establish an alternative governance
structure for the Montgomery Cares Program on or before January 1,
2015. Expedited Bill 57-14 would extend the time for the Board to
make this recommendation to March 31,2015. The Bill would also
extend the sunset date for the Board from June 30, 2015 to October
31,2015.
The Montgomery Cares Advisory Board needs more time to evaluate
the usefulness of the current governance structure for the
Montgomery Cares Program.
The goal of the Bill is to provide more time for the evaluation of the
governance structure of the Program.
HHS Director
To
be
requested.
To be requested.
To be requested.
To be researched.
Robert H. Drummer, Senior Legislative Attorney
Not applicable.
PROBLEM:
GOALS AND
OBJECTIVES:
COORDINATION:
FISCAL IMPACT:
ECONOMIC
IMPACT:
EVALUATION:
EXPERIENCE
ELSEWHERE:
SOURCE OF
INFORMATION:
APPLICATION
WITHIN
MUNICIPALITIES:
PENALTIES:
None.
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MONTGOMERY COUNTY COUNCIL
ROCKVILLE, MARYLAND
GEORGE LEVENTHAL
COUNCILMEMBER
AT-LARGE
MEMORANDUM
November 18,2014
TO:
FROM:
SUBJECT:
Councilmembers
George Leventhal, Council Vice President
gL
Introduction of Expedited Bill to Extend the Sunset Date for the
Montgomery Cares Advisory Board
I am asking the Council to introduce on November 25
th
an expedited bill to extend
the sunset date for the Montgomery Cares Advisory Board from June 30, 2015 to
October 31,2015 to allow the Board to have until March 31, 2015 to provide the
Executive and the Council with a recommendation on whether to continue the Board or
establish an alternative structure.
When the Montgomery Cares Advisory Board was established, Montgomery
Cares was focused on primary care for uninsured low-income adults. With the Council's
ongoing support, Montgomery Cares served almost 28,000 patients in FY14 and
increased access to behavioral health services, specialty care, and preventive care, such as
maminograms. The Affordable Care Act is changing access to health care. Patient­
centered medical homes and family-centered health care are changing how health care is
delivered, and we are now looking to achieve the "Triple
Aim"
of improving population
health, improving the patient experience, and reducing the per capital cost of health care.
I have attached a copy of the law establishing the Montgomery Cares Advisory
Board. The current law requires the Board to provide the Executive and the Council with
a recommendation on whether it should continue by January 1,2015. The Board needs
additional time to discuss how it might be structured given changes to programs serving
low income residents (possibly adults and children) and develop its recommendation.
The bill I am proposing would give the Board until March 31, 2015 to forward its
recommendation. The Council would then have until October 31, 2015 to consider the
recommendation and amend the law as needed.
Attachment: Montgomery County Code, Section 24-47 through 24-53
STELLA
B. WERNER OFFICE BUILDING
100 MARYLAND AVENUE, 6TH FLOOR, ROCKVILLE, MARYLAND 20850
240n77-7811
OR
240n77-7900,
TTY
240n77-7914,
FAX
240n77-7989
WWW.MONTGOMERYCOUNTYMD.GOV/COUNCIL
~
PRINTED ON RECYCLED PAPER
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MONTGOMERY COUNTY CODE
Sec. 24-47. Defmitions.
(a)
In
this article the following words have the meanings indicated.
(b)
(c)
"Board" means the Advisory Board for the Montgomery Cares Program.
"Department" means the Department of Health and Human Services.
(d)
"Program" means the Montgomery Cares Program, a public/private partnership
between the Department and a network of nonprofit clinics and hospitals that provides primary
medical care and prescription medications to low-income, uninsured adults who reside
in
the
County. (2006 L.M.C., ch. 2, §
I.)
Sec. 24-48. Established.
There is an Advisory Board for the Montgomery Cares Program. (2006 L.M.C., ch. 2,
§
1.)
*Editor's note-For history on previous
Art. VI,
see the editor's note to
Art.
V of this
chapter.
Sec. 24-49. Mission
The Board's mission is
to
guide the development of the Program
to
ensure steady and
measurable growth
in
the number ofuninsured County residents accessing high quality and
efficient health care services, including primary, specialty, dental, and behavioral health care
services. (2006 L.M.C., ch. 2,
§
1.)
Sec. 24-50. Members; appointments; terms.
(a)
Total members.
The Board
has
17 members.
(b)
Ex
officio members.
Subject
to
confirmation by the County Council, the County
Executive should appoint the following individuals to serve as ex officio members of the Board:
1
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(1)
(2)
Chief s designee.
The County Health Officer or Officer's designee; and
The Chief of the Department's BehavioriU Health and Crisis Service or the
(c)
Other members.
Subject to confinnation by the County Council, the County
Executive should appoint the following individuals to serve on the Board:
(1)
Program;
(2)
1 representative of hospitals that participate in the Program;
2 representatives of community health care providers that participate in the
(3)
The chair of the Board of Directors ofthe entity that contracts with the
Department to administer the distribution of
funds
for the delivery of Program services or the
chair's designee;
(4)
3 members ofthe public;
(5)
4 individuals who have knowledge of and experience with issues relating
to health care for uninsured individuals such as primary care, specialty care, dental care,
behavioral health care, or fiscal matters relating to any of these types of care;
(6)
(7)
1 representative of the Commission on Health; and
1 representative ofthe County Medical Society; and
2 current or former recipients of services under the Program.
(8)
(d)
Terms.
A member appointed under subsection (c) serves a 3-year term.
Appointments; removal.
Section 2-148 does not apply to members appointed
(e)
under subsection
(b).
(f)
(c).
Conflicts ofInterest.
(1)
(2)
Section 19A-l1(a) does not apply to a member appointed Under subsection
A member appointed under subsection (c) must:
(A)
file a limited public financial disclosure statement that complies
with Section 19A-17(a)(6); and
publicly disclose
to
the Board the nature and circumstances of any
conflict before voting on any Board recommendation. (2006 L.M.C., ch. 2,
§
1; 2006 L.M.C.,
ch. 38,
§
1; 2008 L.M.C., ch. 33, § 1; 2011 L.M.C., ch. 4, §
1.)
(B)
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Editor's note--2008 L.M.C., ch. 33,
§
2, states: Transition. The term of each member of
the Advisory Board for the Montgomery Cares Program in office when this Act takes effect is
extended to June 30,2009. Beginning on July 1,2009, the terms ofeach member appointed on
or
after
that date must be staggered so that one-third. are appointed for a one-year term, one-third
are appointed for a two-year term, and one-third are appointed for a three-year term.
Sec. 24-51. Voting; chair; meetings; compensation.
(a)
(b)
1-year term.
Voting.
All members of the Board are voting members.
Chair.
The members of the Board must elect a chair by majority vote to serve a
Meetings.
The Board must meet
at
least 10 times each year.
(c)
(d)
Compensation.
Except as provided in subsection (e), a member must serve
without compensation.
(e)
Expenses.
A member may request reimbursement for mileage and dependent care
costs at rates established by the County. (2006 L.M.C., ch. 2,
§
1; 2006 L.M.C., ch. 3,
§
1.)
Sec. 24-52. Duties and staff.
Duties.
The Board may advise the County Executive, County Council, and
(a)
Department on any matter relating to the goal of ensuring a steady and measurable
growth
in the
number of uninsured County residents accessing high quality health care services, including:
(1)
Eligibility criteria for participating health care providers;
Eligibility criteria for individuals served by the Program;
The method for allocating Program funds;
The method ofdistributing funds to participating health care providers;
The Program budget;
Growth targets and resources needed to meet those targets;
Assistance to eligible individuals to obtain State and federal health care
(2)
(3)
(4)
(5)
(6)
(7)
coverage;
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(8)
services to clients;
(9)
(10)
Policies and practices to maximize the use of County funds for direct
Evaluation of the Program, including quality of care assessment; and
Strategic planning.
(b)
Report.
The Board must submit a quarterly report to the County Executive,
County Council, and Department on its activities, findings, and recommendations.
(c)
Consideration offindings and recommendations.
The County Executive, County
Council, and Department must give serious consideration to the findings and recommendations
ofthe Board.
Staff.
The Department must provide appropriate staff for the Board. (2006
(d)
L.M.C., ch. 2,
§
1; 2008 L.M.C., ch. 33,
§
1.)
Sec. 24-53. Termination.
(a)
Date.
The Board terminates on June 30, 2015.
(b)
Continuance ofBoard
By January 1,2015, the Board must recommend to the
County Executive and County Council whether the County should continue the Board or
establish an alternative governance structure for the Program. (2006 L.M.C., ch. 2,
§
1; 2008
L.M.C., ch. 33,
§
1.)
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II
cares
for your health
Montgomery Cares Advisory Board
December 2, 2014
Testimony to the Montgomery County Council
Expedited Bill 56-14, Health - Montgomery Cares - Advisory Board - Continuation
On behalf of the Montgomery Cares Advisory Board (MCAB), we strongly recommend to the County
Council that the advisory board be granted additional time to re-establish our governance structure.
This would change the recommendation for continuation date from January 1,2015 to March 31,2015
and extend the sunset date from June 30, 2015 to October 31, 2015.
The Board makes this recommendation because the healthcare landscape has vastly changed since
MCAB's inception in 2006. We are putting concerted effort into ensuring our mission, duties and
structure align with the Montgomery Cares program and possibly other county health care delivery
programs that serve the uninsured.
The implementation of the ACA expanded access to care for many Montgomery County residents but
there is an estimated 60,000 residents who remain uninsured. Currently, the Montgomery Cares
program serves around 30,000 uninsured residents. Based on these numbers, there will continue to be
a need for a primary care delivery system that serves this population.
At this time, the MCAB is obtaining input from key stakeholders including leadership for the Clinics,
Hospitals, DHHS, PCC, and the County Council HHS Committee. One option MCAB is conSidering will
expand its mission to include other county safety-net programs. This would. include all county
programs that provide healthcare for the uninsured such as Maternity Partnership and Care for Kids.
Expanding the MCAB mission would provide a more comprehensive review of critical county safety-net
programs by the MCAB and align its oversight with the DHHS structure of these programs.
We appreCiate the county's commitment to the Montgomery Cares program and continue to work on
improving efficiency and effectiveness. Thank you for considering MCAB's continuation request.
Steve Gammarino,
Vice-Chair, Montgomery Cares Advisory Board