LAFCO & HEALTHCARE DISTRICTS PREPARING FOR THE SILVER TSUNAMI CALAFCO Annual Conference – San Diego October 26, 2017
LAFCOS & HEALTHCARE DISTRICTS • Topics to be covered in the session: • The relationship between LAFCOs and Healthcare Districts • Healthcare District preparation for the anticipated increase in the older population (65-85+) and their associated needs for healthcare services (The Silver Tsunami) • Case studies of local LAFCOs and Healthcare Districts (Alameda/Sonoma) • Ongoing and future State Legislative efforts to address Healthcare Districts and LAFCOs (CALAFCO/ACHD)
LAFCOS & HEALTHCARE DISTRICTS • LAFCO-HDs Michael Colantuono • Grossmont HD Barry Jantz • LAFCO-HD case studies Sblend Sblendorio / Mark Bramfitt • CALAFCO-HD legislation Amber King / Martha Poyatos
LAFCO & HEALTHCARE DISTRICTS PREPARING FOR THE SILVER TSUNAMI CALAFCO Annual Conference – San Diego October 26, 2017
CALAFCO Annual Conference San Diego, CA October 26, 2017 Michael G. Colantuono Colantuono, Highsmith & Whatley, PC 420 Sierra College Drive, Ste. 140 Grass Valley, CA 95945-5091 (530) 432-7357 MColantuono@chwlaw.us Twitter @MColantuono (C) 2012 Colantuono & Levin, PC 8
Express power to act outside District (HSC 32121): Operate a health plan (r) Provide health care facilities & services (j) Own or lease property (c) Ambulance service (l) Other powers impliedly limited to District territory, but how significant are these? This is a contested issue. (C) 2012 Colantuono & Levin, PC 9
Need not be contiguous (HSC 32001) Must exclude territory not benefited ( i.e., uninhabited) Annexing territory excluded during formation process due to lack of benefit requires findings (GC 58106) May be multi-county (HSC 32001) No overlapping districts w/o consent of the first district unless principal act says otherwise (GC 56119) (C) 2012 Colantuono & Levin, PC 10
Subject to zoning power of city or county ◦ 55 Ops. CA AG 375 (1972) Medical operations subject to regulation by a variety of state health care agencies, such as OSHPD, Department of Insurance, etc. (C) 2012 Colantuono & Levin, PC 11
HSC 32137 allows a Health Care District to change its name by a resolution filed with the County Clerk Other laws require all government agencies to register with the Secretary of State Continued receipt of property taxes requires submission of BOE Form 400-TA (C) 2012 Colantuono & Levin, PC 12
Property taxes (HSC 32200 ff.) Special taxes: 2/3-voter approval (HSC 32240; GC 53730.5 ff) Bonded debt ◦ Capital facilities & coinsurance plans (HSC 32300) ◦ Revenue bonds (HSC 32315) ◦ State bonds (HSC 32350) Appear to lack assessment authority Substantial revenues from fees for service, health plans, third- party payments, etc. (C) 2012 Colantuono & Levin, PC 13
Governed by principal act (HSC 32200) ◦ In re Valley Health System , 429 B.R. 692 (Bkcy CD Cal. 2010) But CKH can fill gaps in the principal act ( id .) If LAFCo receives application to form or reorganize a HCD, it must give notice to state health agencies (GC 56131.5) Dissolution requires voter approval (GC 57103) as does transfer of > ½ an HCD’s assets (HSC 32121(p)) (C) 2012 Colantuono & Levin, PC 14
Principal Act refers to the District Organization Law ◦ HSC 32002 & GC 58030 ff. Formation process ◦ Petition (GC 58030) ◦ Bd of Sups of largest county (by district territory) is “supervising authority” (GC 58004(d) ◦ Election (GC 58130 ff.) ◦ Uniform District Election Law applies (HSC 32002) ◦ LAFCo provides impartial analysis (HSC 32002.31) (C) 2012 Colantuono & Levin, PC 15
Is a HCD subject to LAFCo’s power to approve out -of-district service under GC 56133? ◦ Broad express powers to act outside district may make this a rare question ◦ Where principal act impliedly limits power to within district, the power may be entirely lacking, with or without LAFCo’s approval ◦ SD LAFCo took the position that it does have this power and affected HCD acquiesced in its position This is a hotly contested issue. Clearly HCDs were intended to compete with private actors, but with each other? (C) 2012 Colantuono & Levin, PC 16
Are HCDs subject to LAFCO’s power to activate and deactivate latent powers under GC 56824.10 et seq.? Technically, yes. Practically, it may be difficult to show that what an HCD proposes constitutes a “new or different function of class of service” (C) 2012 Colantuono & Levin, PC 17
Mammoth’s hospital invited to provide orthopedic services in Bishop when Bishop lost its local bone docs Years later, a new CEO at Bishop hospital ordered Mammoth to leave town and persuaded LAFCO to order it, too Mammoth refused and litigation ensued (C) 2012 Colantuono & Levin, PC 18
Sacramento Superior Court concluded that extra-territorial service required LAFCO approval notwithstanding principal act Also concluded that LAFCO and No. Inyo waited too long to sue and that new facilities for the Mammoth Hospital’s orthopedists did not amount to a further expansion of service No. Inyo appealed and the appeal will take 18-24 months to resolve (C) 2012 Colantuono & Levin, PC 19
Certainly has power and duty to approve MSR, SOI & reorganizations. Does not control formation, but may be able to do so in reorganization context. Dissolution or sale of most assets requires voter approval. Difficult role in refereeing disputes between HCDs as to extra- territorial activity (C) 2012 Colantuono & Levin, PC 20
LAFCo has a bully pulpit via MSR & SOIs Some HCDs are attracting attention due to competition for scare property tax dollars and are therefore vulnerable to criticism if LAFCo, grand jury or others conclude they are not serving the public interest. Like all CA governments, HCDs have a need to engage the public they serve and LAFCo can help them do so. (C) 2012 Colantuono & Levin, PC 21
New Report on Special Districts has chapter focused on HCDs which no longer operate hospitals (37 of 79) Three recommendations ◦ Legislature should update the HCD law ◦ Legislature should not do end-runs around LAFCO as to HCDs or otherwise ◦ Association of California Healthcare Districts should share and promote best practices Assembly Local Government Committee had a March 2017 hearing on HCDs (C) 2012 Colantuono & Levin, PC 22
(C) 2012 Colantuono & Levin, PC 23
LAFCO & HEALTHCARE DISTRICTS PREPARING FOR THE SILVER TSUNAMI CALAFCO Annual Conference – San Diego October 26, 2017
Grossmont Healthcare District CALAFCO Annual Meeting San Diego – October 26, 2017 Barry Jantz, CEO – bjantz@grossmonthealthcare.org
As stewards of the public trust, your Grossmont Healthcare District will preserve and protect those resources entrusted to its care. To maintain and improve the physical and behavioral health of its constituents, we will: Partner with our hospital operator, Sharp HealthCare, to ensure access to state-of-the-art medical services at Grossmont Hospital for all of the residents of Grossmont Healthcare District and beyond. Anticipate and recognize the unmet health care needs of the communities we serve and support suitable services to the greatest extent possible consistent with available resources. 26
1952 – Public Vote to form Grossmont Hospital District 1955 – Opening of Grossmont Hospital 1970/80s – Major Expansions Completed 1980s – Change in CA Law to Allow Hospital Leases 1991 – Lease of Hospital to Grossmont Hospital Corporation 1995 – Hospital District becomes a Healthcare District 2006 – Prop G passes with over 77% of the vote ($247 million) 2014 – Prop H Lease Extension passes – over 86% 2016-18 – Prop G Projects completed 27
“A district that leases or transfers its assets to a corporation…shall act as an advocate for the community to the operating corporation…and report to the community on the progress made in meeting the community’s health needs.” (Health and Safety Code) Lease, Transfer, Affiliation Governance Structure: Hospital Operating Board and Designees Limits for incurring debt and changes to hospital core services Monthly/Annual Reports from the Hospital to the HCD Board Annual Sharp Grossmont Community Benefits Report Quarterly Facilities Inspections / State of the Facilities Benefits of a Public/Private partnership 28
Existing Reality: Highest proportion of seniors in San Diego County Higher level of cardio cases, re-admissions, etc Symbiotic relationship between lone hospital and nearby nursing homes Busiest Emergency Department in the County Ongoing Efforts: Public/Private Partnership on new facilities, including Heart & Vascular Grants program focused on direct patient care New Care Center to “decant” non -emergent ED visits “Seniors in Crisis” pilot project 29
Recommend
More recommend
