Agenda Item 4B
September 15,2015
Introduction
MEMORANDUM
September 11, 2015
TO:
FROM:
£\
Robert H. Drummer, Senior Legislative Attorney
fffO
County Council
Introduction:
Expedited Bill 36-15, Health - Montgomery Cares Advisory Board
SUBJECT:
- Continuation - Amendments
Expedited Bill 36-15, Health - Montgomery Cares Advisory Board - Continuation ­
Amendments, sponsored by Lead Sponsor, the Health and Human Services Committee, is
scheduled to be introduced on September 15, 2015. A public hearing is tentatively scheduled for
September 29,2015 at 1:30 p.m.
Bill 36-15 would extend the life ofthe Advisory Board for the Montgomery Cares Program.
The Bill would also modifY its mission and duties as well as modifY its 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. Definition 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:
"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.
 PDF to HTML - Convert PDF files to HTML files
2. Mission of the Board:
Current:
The Board's mission is to guide the development of the 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 ofthese 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 of policies 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):
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.
2
 PDF to HTML - Convert PDF files to HTML files
5. Reporting:
Current:
The Board must submit a quarterly report to the County Executive, County Council, and
Department on its activities, [mdings, 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
Circle
#
1
6
7
F:\LAw\BILLS\1536 Montgomery Cares - Continuation\lntro Memo.Docx
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 Htunan Services Committee
AN EXPEDITED ACT
to:
(l)
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]
Qouble 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 unqffected 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
Sec.
1.
Sections 24-47, 24-49, 24-50, 24-52 and 24-53 are amended as
follows:
24-47. Definitions.
[(a)]
In
this article the following words have the meanings indicated[.]
~
2
3
4
5
[(b
)"]Board["]
means the Advisory Board for the Montgomery Cares
Program.
[(c)"]Departmentr']
means the Department ofHealth and Human Services.
[(d)"]Program["]
means the [Montgomery Cares Program, a public/private
6
7
8
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 of uninsured 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
13
14
15
16
17
18
19
20
21
22
access to high quality, efficient health care and related services for low-income and
uninsured County residents.
24-50. Members; appointments; terms.
(a)
(b)
Total members. The Board has 17 members.
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)
The
County
Health
o~rr
or Officer's
designee; and
F:\LAW\BILLS\1536 Montgomery Cares - Continuation\BiII1.Doc
23
24
25
26
27
 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 confirmation 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 of hospitals that participate in the Program;
2
3
4
5
6
7
8
9
10
11
(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]
12
13
J
individuals who have knowledge of and experience with
14
15
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 of care;
(6)
(7)
(8)
(2}
16
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
1
representative from
income populations.
~
Managed Care Organization who is
familiar with Medicaid and insurance issues affecting low­
22
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\BILLS\1536 Montgomery Cares - Continuation\BiII I.Doc
 PDF to HTML - Convert PDF files to HTML files
ExPEDITED BILL
No.
36-15
1
2
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;
(2) Eligibility criteria for individuals served by the Program;
(3)
The method for allocating Program fimds;
3
4
5
6
7
(4) The method of distributing fimds 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 fimds 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:
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
CA)
Montgomery Cares;
Care for Kids;
Maternity Partnership;
the Department Dental Services; and
Health Care for the Homeless; and
lID
(g
CD)
23
24
25
@
!l1.)
Health care services provided to low income and uninsured
County residents, including primary care, specialty care, dental
26
27
care, behavioral
healed
-4­
ancillmy services.
«
F:\LAW\BILLS\1536 Montgomery Cares Continuation\BiIIl.Doc
 PDF to HTML - Convert PDF files to HTML files
EXPEDITED BILL
No. 36-15
1
(b)
Report.
The Board must submit [a quarterly] an annual report to the
2
County Executive, County Council, and Department on its activities,
fmdings, and recommendations.
3
4
*
24-53. Termination.
(a)
(b)
*
*
5
6
7
Date.
The Board tenninates on [October 31,2015] December 21,2021.
Continuance of Board
By March 31, [2015] 2021, the Board must
8
9
10
11
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.
12
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
Date
17
Approved:
18
Isiah Leggett, County Executive
Date
19
This is a correct copy ofCouncil action.
20
Linda M. Lauer, Clerk ofthe Council
Date
F:\LAW\BILLS\1536 Montgomery Cares - Continuation\BiIll.Doc
 PDF to HTML - Convert PDF files to HTML files
LEGISLATIVE REQUEST REPORT
Expedited Bill 36-15
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 detennined.
To be detennined.
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
Extension ofthe Montgomery Cares Advisory Board and related recommendations
FROM:
SUBJECT:
The enabling legislation for the Montgomery Cares Advisory Board (Board) specifies that
authorization
will
sunset
on October 31, 2015, unless reauthorization
is
carried
oul
The
Board, as
required, is submitting our recommendations about the
future
of the Bow following the end of the
authorization.
As
chair of the boaId, I am writing to communicate our recommendation
that
the
Board
be
continued and that its scope
be
expanded.
This recommendation took into consideration
the
changing environment in healthcare today.
Some of these changes included the implementation of the ACA, expansion ofMedicaid 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, DIffiS, The
Primary
Care Coalition, and
the
County Council IffiS 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 ofcomprehensive strategies and
policies
to
improve continuity ofcare 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
''to
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 DEllIS. This includes
Care
for Kids,
Maternity Partnership,
Dental
Services,
and
Health Care for
the
Homeless.
4.
The
Board's membership
be
modified
to
add an individual from a
Managed
Care
Organization to complement the expertise of the Board in this expanded role.
7
 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
health.
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, DImS
Dr.
Index 1. Tillman, Public Health Officer, DHHS
8
 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
ofthe Montgomery 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
publidprivate
partnerships,
to
low-income
and
uninsured
residents of Montgomery County."
4.
That
the Montgomery County Council amend Section
24-49
ofthe Montgomery County Code
to
change the mission of the Board
to
read,
'The Board's mission
is
to
advise
and
recommend
poUcies that
assure access
to
high
quality,
efticient health
eare
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,
DBBS
Dental
Services,
and Health
Care
for the Homeless;
and
• Add
#11
to
read: Provide recommendations on health
care services
provided
to
low
income and un.im1Ired 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
Report
to
the County Executive, County Council and
Department on its activities, findings and recommendations.
7.
That the Montgomery County Council amend Section 24-50 of
the
Montgomery County
Code
to
change the membership of the board
as
follows:
• Item
#5:
Change from
4
to
3 individuals who have knowledge of and 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 insumnce issues affecting low-income populations.
8.
That
the Montgomery County Council amend Section 24-53
of
the Montgomery County Code to
reauthorize the Board through
December
31,
2021.