California § 100500 - There is in state government the California Health Benefit Exchange, an independe

§ 100500. There is in state government the California Health Benefit Exchange, an independe

(a) There is in state government the California Health Benefit Exchange, an independent public entity not affiliated with an agency or department, which shall also be known as Covered California. Covered California shall be governed by an executive board consisting of five members who are residents of California. Of the members of the board, two shall be appointed by the Governor, one shall be appointed by the Senate Committee on Rules, and one shall be appointed by the Speaker of the Assembly. The Secretary of California Health and Human Services or the secretary’s designee shall serve as a voting, ex officio member of the board. (b) Members of the board, other than an ex officio member, shall be appointed for a term of four years, except that the initial appointment by the Senate Committee on Rules shall be for a term of five years, and the initial appointment by the Speaker of the Assembly shall be for a term of two years. Appointments by the Governor shall be subject to confirmation by the Senate. A member of the board may continue to serve until the appointment and qualification of the member’s successor. A vacancy shall be filled by appointment for the unexpired term. The board shall elect a chairperson on an annual basis. (c) (1) A person appointed to the board shall have demonstrated and acknowledged expertise in at least two of the following areas: (A) Individual health care coverage. (B) Small employer health care coverage. (C) Health benefits plan administration. (D) Health care finance. (E) Administering a public or private health care delivery system. (F) Purchasing health plan coverage. (G) Marketing of health insurance products. (H) Information technology system management. (I) Management information systems. (J) Enrollment counseling assistance, with priority to cultural and linguistic competency. (2) Appointing authorities shall consider the expertise of the other members of the board and attempt to make appointments so that the board’s composition reflects a diversity of expertise. (d) A member of the board shall have the responsibility and duty to meet the requirements of this title, the federal act, and all applicable state and federal laws and regulations, to serve the public interest of the individuals and small businesses seeking health care coverage through the Exchange, and to ensure the operational well-being and fiscal solvency of the Exchange. (e) In making appointments to the board, the appointing authorities shall take into consideration the cultural, ethnic, and geographical diversity of the state so that the board’s composition reflects the communities of California. (f) (1) A member of the board or of the staff of the Exchange shall not be employed by, a consultant to, a member of the board of directors of, affiliated with, or otherwise a representative of, a carrier or other insurer, an agent or broker, a health care professional, or a health care facility or health clinic while serving on the board or on the staff of the Exchange. A member of the board or of the staff of the Exchange shall not be a member, a board member, or an employee of a trade association of carriers, health facilities, health clinics, or health care professionals while serving on the board or on the staff of the Exchange. A member of the board or of the staff of the Exchange shall not be a health care professional unless the member or staff does not receive compensation for rendering services as a health care professional and does not have an ownership interest in a professional health care practice. (2) A board member shall not receive compensation for service on the board, but may receive a per diem and reimbursement for travel and other necessary expenses, as provided in Section 103 of the Business and Professions Code, while engaged in the performance of official duties of the board. (3) For purposes of this subdivision, “health care professional” means a person licensed or certified pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or licensed pursuant to the Osteopathic Act or the Chiropractic Act. (4) (A) It is the intent of the Legislature that clinical volunteer services be performed in settings that predominantly serve populations that are high need, underserved, or otherwise vulnerable, including the homeless and those who receive health care coverage through the Medi-Cal program. Notwithstanding paragraph (1), a member of the board or of the staff of the Exchange may perform volunteer services if all of the following conditions are met: (i) The member of the board or staff is a health care professional who was actively participating in that profession prior to appointment to the Exchange. (ii) The member of the board or staff does not receive compensation for performing volunteer services and does not have an ownership interest or other financial interest in the entity, facility, clinic, or provider group. (iii) The volunteer services are performed at the University of California or a nonprofit educational institution; a facility, clinic, or provider group operated by, or affiliated with, an academic medical center of either the University of California or a nonprofit educational institution; or a facility, clinic, or provider group operated by a state agency or county health system that does not directly contract with the Exchange. (B) For purposes of this paragraph, compensation and financial interest for a health care professional who performs volunteer services does not include either of the following: (i) A contribution to a professional liability insurance program made by the entity, facility, clinic, or provider group for the member or staff. (ii) The provision of physical space, equipment, support staff, or other supports made by the entity, facility, clinic, or provider group for the member or staff necessary for the performance of volunteer services described in subparagraph (A). (g) A member of the board shall not make, participate in making, or in any way attempt to use the member’s official position to influence the making of a decision that the member knows or has reason to know will have a reasonably foreseeable material financial effect, distinguishable from its effect on the public generally, on the board member or a member of the board member’s immediate family, or on either of the following: (1) A source of income, other than gifts and other than loans by a commercial lending institution in the regular course of business on terms available to the public without regard to official status aggregating two hundred fifty dollars ($250) or more in value provided to, received by, or promised to the member within 12 months prior to the time when the decision is made. (2) A business entity in which the member is a director, officer, partner, trustee, employee, or holds any position of management. (h) The board or a member of the board, or an officer or employee of the board, is not liable in a private capacity for or on account of an act performed or obligation entered into in an official capacity, when done in good faith, without intent to defraud, and in connection with the administration, management, or conduct of this title or affairs related to this title. (i) The board shall hire an executive director to organize, administer, and manage the operations of the Exchange. The executive director shall be exempt from civil service and shall serve at the pleasure of the board. (j) The board is subject to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2), except that the board may hold closed sessions when considering matters related to litigation, personnel, contracting, and rates. (k) (1) The board shall apply for planning and establishment grants made available to the Exchange pursuant to Section 1311 of the federal act. If an executive director has not been hired under subdivision (i) when the United States Secretary of Health and Human Services makes the planning and establishment grants available, the California Health and Human Services Agency shall, upon request of the board, submit the initial application for planning and establishment grants to the United States Secretary of Health and Human Services. (2) If a majority of the board has not been appointed when the United States Secretary of Health and Human Services makes the planning and establishment grants available, the California Health and Human Services Agency shall submit the initial application for planning and establishment grants to the United States Secretary of Health and Human Services. Any subsequent applications shall be made as described in paragraph (1) once a majority of the members have been appointed to the board. (3) The board is responsible for using the funds awarded by the United States Secretary of Health and Human Services for the planning and establishment of the Exchange, consistent with subdivision (b) of Section 1311 of the federal act. ( l ) A reference to the California Health Benefit Exchange or the Exchange is deemed to refer to Covered California.