Agenda Items 8
&
10
September 29,2015
Public Hearing/Action
MEMORANDUM
September 25,2015
TO:
FROM:
County Council
Robert H. Drummer, Senior Legislative
Attomey~
SUBJECT:
Public Hearing/Action: Expedited Bill 36-15, Health - Montgomery Cares
Advisory Board - Continuation Amendments
Health and Human Services recommendation: the Committee agreed to sponsor legislation
implementing the MCAB recommendations. The Committee did not meet to discuss the Bill after
its introduction.
Expedited Bill 36-15, Health - Montgomery Cares Advisory Board - Continuation ­
Amendments, sponsored by Lead Sponsor, the Health and Human Services Committee, was
introduced on September 15, 2015. Action is tentatively scheduled immediately following the
hearing.
Bi1l36-15 would extend the life ofthe Advisory Board for the Montgomery Cares Program
and modify its mission, duties, and membership.
Background
The County law governing the Advisory Board for Montgomery Cares Program
(Montgomery Cares Advisory Board or MCAB) sunsets on October 31, 2015.
The Health
and
Human Services Committee held a worksession on June 11, 2015 to discuss the recommendations
of the MCAB. The MCAB proposed that it be continued through December 31, 2021 with an
expanded mission due to the Affordable Care Act, the expansion of Medicaid, and consumer­
centered medical care. See the March 27,2015 memo from the MCAB at ©7-9. The MCAB
proposed the following changes:
1.
Dermition of Montgomery Cares Program:
Current:
"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.
MCAB Proposed:
 PDF to HTML - Convert PDF files to HTML files
"Program" means the Department's health care delivery system that provides primary medical care
and other essential health care and related services, through public/private partnerships, to low­
income and uninsured residents of Montgomery County.
2. Mission of the Board:
Current:
The Board's mission is to guide the development ofthe Program to ensure steady and measureable
growth in the number of uninsured County residents accessing high quality and efficient health
care services, including primary, specialty, dental, and behavioral health care services.
MCAB Proposed:
The Board's mission is to advise and recommend policies that assure access to high quality,
efficient health care and related services for low-income and uninsured County residents.
3. Membership:
The MCAB is recommending the addition of one individual from a Managed Care
Organization who
is
familiar with Medicaid and insurance issues affecting low-income
populations.
In
order to retain an odd number ofmembers (and the current total of 17), the MCAB would reduce
from four to three the number of individuals who have knowledge of and experience with issues
relating to health care for low-income individuals, such as primary care, specialty care, behavioral
health, or fiscal matters relating to any of these types of care.
4. Duties:
The MCAB is recommending changes to two duties and the addition of one more.
Current
#9:
Evaluation of the Program, including quality of care assessment;
MCAB Proposed
#9:
Evaluation ofpolicies and programs to improve access to health care and related services for low­
income and uninsured residents;
Current #10:
Strategic Planning.
MCAB Proposed #10:
Strategic Planning in support ofthe health care for the uninsured programs administered by DHHS
which currently include Montgomery Cares, Care for Kids, Maternity Partnership, DHHS Dental
Services, and Health Care for the Homeless.
MCAB Proposed
#11
(new):
2
 PDF to HTML - Convert PDF files to HTML files
Provide recommendations on health care services provided to low-income and uninsured residents,
including primary care, specialty care, dental care, behavioral health, and ancillary services.
5. Reporting:
Current:
The Board must submit a quarterly report to the County Executive, County Council, and
Department on its activities, findings, and recommendations.
MCAB Proposed:
The Board must submit an annual Report to the County Executive, County Council and
Department on its activities, findings, and recommendations.
The HHS Committee recommended approval of the MCAB proposed changes and the
extension of the Board until December 31, 2021. Bill 36-15 would implement these changes to
the law.
This packet contains:
Expedited Bill 36-15
Legislative Request Report
MCAB March 27, 2015 Memorandum
F:\LAW\BILLS\1536 Montgomery Cares - Continuation\PH-Action Memo.Docx
Circle #
1
6
7
3
 PDF to HTML - Convert PDF files to HTML files
Expedited Bill No.
36 -15
Concerning: Health - Montgomery Cares
Advisory Board - Continuation
Amendments
Revised: August 3,2015 Draft No. _1_
Introduced:
September 15. 2015
Expires:
March 15, 2017
Enacted: _ _ _ _ _ _ _ __
Executive: _ _ _ _ _ _ _ __
Effective: _ _ _ _ _
~
__- ­
Sunset Date: October 31, 2015
Ch. _ _, Laws of Mont. Co. _ __
COUNTY COUNCIL
FOR MONTGOMERY COUNTY, MARYLAND
Lead Sponsor: Health and Human Services Committee
AN EXPEDITED ACT
to:
(1 ).
extend the life of the Advisory Board for the Montgomery Cares Program;
(2)
modify its mission and duties;
(3)
modify its membership; and
(4)
generally amend the law creating the Advisory Board for the Montgomery Cares
Program.
By amending
Montgomery County Code
Chapter 24, Health and Sanitation
Sections 24-47, 24-49, 24-50, 24-52 and 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 wu:iffected by bill.
The County Council for Montgomery County, Maryland approves thefollowing Act:
 PDF to HTML - Convert PDF files to HTML files
ExPEDITED BILL
No.
36-15
1
2
3
Sec. 1.
Sections 24-47, 24-49, 24-50, 24-52 and 24-53 are amended as
follows:
24-47. Definitions.
4
[(a)]
In
this article the following words have the meanings indicated[.];
[(b)"]Board["]
means the Advisory Board for the Montgomery Cares
5
6
7
Program.
[(
c
)"]Department["]
means the Department ofHealth and Human Services.
8
[(
d),,]Programr']
means the [Montgomery Cares Program, a public/private
9
10
11
12
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] Department's health
care delivery system that provides primary medical care and other essential
health care and related services, through pUblic/private partnerships, to low-
income and uninsured residents ofthe County.
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] advise and recommend policies that ensure
access to high quality, efficient health care and related services for low-income and
uninsured County residents.
24-50. Members; appointments; terms.
(a)
Total members. The Board has 17 members.
13
14
15
16
17
18
19
20
21
22
23
24
(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 ofthe Board:
(1)
25
26
27
The County Health 0g)er or Officer's designee; and
F:\LAW\BILLS\1536 Montgomery Cares - Continuation\BiIIl.Doc
 PDF to HTML - Convert PDF files to HTML files
ExPEDITED BILL
No. 36-15
1
(2) The Chief of the Department's Behavioral Health and Crisis
Service or the Chiefs designee.
(c)
Other members. Subject to confinnation by the County Council, the
County Executive should appoint the following individuals to serve on
the Board:
(1) 2 representatives of community health care providers that
participate in the Program;
(2)
1 representative ofhospitals that participate in the Program;
2
3
4
5
6
7
8
9
(3) The chair of the Board of Directors of the 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 of the public;
(5)
[4)
10
11
12
13
14
15
16
J
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 ofthese types ofcare;
(6)
(7)
(8)
{2}
17
18
19
1 representative ofthe Commission on Health; and
1 representative of the County Medical Society;
[and)
2 current or fonner recipients of services under the Program; and
20
21
22
1
representative from
income populations.
~
Managed Care Organization who is
familiar with Medicaid and insurance issues affecting low­
23
24
*
24-52. Duties and staff.
*
*
25
26
(a)
Duties.
The Board may advise the County Executive, County Council,
and Department on any matter relating to the goal of ensuring a steady
F:\LAW\BlLLS\1536 Montgomery Cares - Continuation\Bill1.Doc
 PDF to HTML - Convert PDF files to HTML files
ExPEDITED BILL
No.
36-15
1
and measurable growth in the number of uninsured County residents
accessing high quality health care services, including:
(1 )
(2)
(3)
(4)
Eligibility criteria for participating health care providers;
Eligibility criteria for individuals served by the Program;
The method for allocating Program funds;
The method of distributing funds to participating health care
providers;
(5)
(6)
(7)
The Program budget;
Growth targets and resources needed
to
meet those targets;
Assistance to eligible individuals to obtain State and federal
health care coverage;
(8)
Policies and practices to maximize the use of County funds for
direct services to clients;
(9)
Evaluation of [the Program, including quality of care assessment]
policies and programs to improve access to health care and
related services for low-income and uninsured County residents;
[and]
(10) Strategic planning in support of the Health Care for the
Uninsured programs administered
Qy
the Department, including:
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
CA)
(ill
{Q
Montgomery Cares;
Care for
Kids;
Maternity Partnership;
the Department Dental Services; and
Health Care for the Homeless; and
22
23
24
25
26
27
@
tID
illJ
Health care services provided to low income and uninsured
County residents, including primary care, specialty care, dental
care, behavioral
healed
-4­
ancillary services,
F:\LAW\Bll..LS\] 536 Montgomery Cares - Continuation\BiIIl.Doc
 PDF to HTML - Convert PDF files to HTML files
ExPEDITED BILL
No.
36-15
1
2
(b)
Report.
The Board must submit [a quarterly] an annual report to the
County Executive, County Council, and Department on its activities,
fmdings, and recommendations.
3
4
5
*
24-53. Termination.
(a)
(b)
*
*
6
7
Date.
The Board terminates on [October 31,2015] December 31, 2021.
Continuance of Board.
By March 31, [2015] 2021, the Board must
8
9
10
recommend to the County Executive and County Council whether the
County should continue the Board or establish an alternative
governance structure for the Program.
11
12
Sec. 2.
Expedited Effective Date.
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:
13
14
15
16
George Leventhal, President, County Council
17
18
Date
Approved:
Isiah Leggett, County Executive
19
This is a correct copy ofCouncil action.
Date
20
Linda M. Lauer, Clerk of the Council
Date
F:\LAW\BILLS\l536 Montgomery Cares - Continuation\BilI l.00c
 PDF to HTML - Convert PDF files to HTML files
LEGISLATIVE REQUEST REPORT
Expedited Bil136-15
Montgomery Cares Advisory Board
-
Extension
DESCRIPTION:
The Bill would extend the life of the Montgomery Cares Advisory
Board (MCAB) until December 31, 2021.
It
would also modify the
Board's mission and duties due to the changing environment in the
health care industry.
The law creating the MCAB sunsets on October 31, 2015. The MCAB
is still necessary.
Extend the MCAB and modify its mission due to the changing
environment in the health care industry.
HHS Department
To be determined.
To be determined.
To be requested.
To be requested.
Linda McMillan, Senior Legislative Analyst, and 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.
F:\LAw\BILLS\1536 Montgomery Cares Continuation\LRR.Docx
 PDF to HTML - Convert PDF files to HTML files
MONTGOMERY CARES ADVISORY BOARD
MEMORANDUM
March 27, 2015
TO:
George Leventhal, President, Montgomery County Council
Isiah
Leggett, Montgomery County Executive
Steve Gammarino, Chair, Montgomery Cares Advisory Board
FROM:
SUBJECf:
Extension of the Montgomery Cares Advisory Board and related recommendations
The enabling legislation for the Montgomery Cares Advisory Board (Board) specifies
that
authorization will sunset on October 31, 2015, unless reauthorization
is
can:ied
out The Board, as
required,
is submitting our recommendations about the
future
of the Board following
the
end of
the
authorization.
As
chair
of the board, I am writing
to
communicate our recommmdation
that
the Board
be
continued and that its
scope
be
expanded.
This recommendation
took into
consideration
the
changing environment
in
healthcare today.
Some ofthese changes included the implementation of the ACA, expansion of Medicaid and the drive
for consumer-centered medical care. The Board's recommendation is
also
based on feedback and
advice from key Montgomery Care stakeholders, which include leadership from the Montgomery
Cares
Clinics, DHHS, The
Primary
Care
Coalition, and
the
County Council HIlS Committee. The
stakeholders unifonnly thought that
the
Board
plays a valuable role
in
providing policy advice
to
the
County and serving as a forum for stakeholder input for
the
Program.
It
was
also
recognized that the
Board was well positioned
to
provide an advisory role on medical care delivery and access for all low
income and
uninsured
Montgomery County residents
to
include the County's other health care safety­
net
programs.
This
expanded role would allow for the development of comprehensive strategies and
policies
to
improve continuity of care for
this
population.
Based on
this
evaluation the Board recommends:
1.
The
Board continue
to
provide an advisory role for the Montgomery
Cares
Program.
2. The Board's mission be revised
';0
advise and recommend policies that assure access
to
high quality, efficient healthcare and related services for low income and
uninsured
County residents".
3.
The
Board expand
its
oversight
to
programs
under the authority of
the
Health Care for
the Uninsured programs administered by DHHS. This includes
Care
for Kids,
Maternity Partnership, Dental
Services, and
Health Care for the Homeless.
4.
The
Board's membership
be
mOOified
to
add
an individual from a Managed
Care
Organization
to
complement the expertise ofthe Board
in
this expanded role.
 PDF to HTML - Convert PDF files to HTML files
The
Board
appreciates
the opportunity
to
provide
this
recommendation and we are committed
to
continuing
to
work
in
close collaboration with you
to
achieve the principles of the Triple
Aim
(improving population hemth, patient experience and reducing
costs)
for our community.
We welcome the opportunity
to
meet with you
to
address
any questions you may have on
these recommendations.
Attachment
cc: Uma Ahluwalia,
Director.
DHHS
Dr.
Inder
1.
Tillman, Public Health Officer, DHHS
 PDF to HTML - Convert PDF files to HTML files
Recommendations to Continue the
Montgomery Cares Advisory Board
The Board recommends the following
to
the Montgomery County Executive and Montgomery
County Council:
1.
That
the
Montgomery Cares Advisory Board
be
reauthorized
2.
That
the
name ''Montgomery Cares Advisory Board"
be
retained
3. That the Montgomery County Council amend Section
24-47
of the Montgomay County Code to
change the definition of "Program"
to
the
following,
''means the
Department's
health care
delivery
system
that provides primary medical
care
and
other
essential
health
care
and
related
services,
through
publiclprivate
partnerships,
to
low-income
and
uninsured
residents of Montgomery County."
4.
That
the Montgomery County Council amend Section
24-49
of
the
Montgomay County Code
to
change
the
mission of the Board
to
read,
"The
Board's
mission
is
to
advise
and
recommend
policies that
assure access
to
high.
quality, efficient health
care
and
related
services
for
low­
income and
uninsured
County residents,"
5.
That
the Montgomery County Council amend Section 24-52(a)
of
the Montgomery County
Code
to
reflect
the
following duties:
• Change
item
#9
to read: Evaluation of
policies and programs
to
improve
access
to
health
care
and related
services
for low-income and
uninsured
residents;
• Change
item #10 to
read:
Strategic Planning
in
support
of
the
Health
Care
for
the
Uninsured programs
administered
by DHHS which currently include
Montgomery
Cares, Care
for
Kids,
Maternity Partnership,
DHHS
Dental
Services,
and Health
Care
for
the
Homeless;
and
• Add
#11
to
read:
Provide recommendations on health
care services
provided
to
low Income and
uninsured
residents,
including
primary
care,
specialty
care,
dental
care,
behavioral health, and ancilJary
services.
6.
That
the
Montgomery County Council amend Section 24-52(b) of
the
Montgomery County Code
to
read,
'''The Board must submit
an annual
ReJX)rt
to
the
County Executive, County Council and
Department on its activities, findings
and
recommendations.
7.
That the Montgomay County Council amend Section 24-50 of
the
Montgomay County Code to
change the membership of
the
board as follows:
• Item
#5:
Change
from
4
to
3 individuals who have knowledge ofand experience with
issues relating to health care for low-income individuals such as
primary
care,
specialty care, dental care, behavioral health, or fiscal matters relating to any of
these
types
of
care
• .Item #10: Add 1
individual
from a
Managed
Care
Organization
who is
familiar
with Medicaid
and
insurance issues affecting low-income populations.
8.
That
the
Montgomay County Council amend Section 24-53
of
the Montgomery County Code to
reauthorize the Board
through
December 31, 2021.