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Section 1399.86 Of Article 11.1. Consumer Operated And Oriented Plans From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 11.1.
1399.86
. (a) A CO-OP shall be subject at all times to the
prohibitions in PPACA against converting or selling to a for-profit
or nonconsumer-operated entity at any time after receiving a solvency
loan.
(b) A CO-OP shall do all of the following, in addition to any other requirements imposed under Section 156.515 of Title 45 of the Code of Federal Regulations:
(1) Implement policies and procedures to foster and ensure member control of the organization. For purposes of this paragraph, a CO-OP shall meet the following requirements:
(A) The CO-OP shall have governing documents that incorporate governing rules that ensure that the directors of the operational board are elected by a majority vote of a quorum of the CO-OP members.
(B) All members of the CO-OP shall be eligible to vote for each director on the CO-OP's operational board.
(C) Each member of the CO-OP shall have one vote in the election of each director of the CO-OP's operational board.
(D) The first elected directors of the CO-OP's operational board shall be elected no later than one year after the effective date on which the CO-OP provides coverage to its first member; the entire operational board shall be elected no later than two years after the same date.
(E) Elections of the directors on the CO-OP's operational board shall be contested so that the total number of candidates for vacant positions on the operational board exceeds the number of vacant positions, except in cases where a seat is vacated midterm due to death, resignation, or removal.
(F) A majority of the voting directors on the operational board shall be members of the CO-OP.
(2) Have an operational board of directors that meets the following requirements:
(A) Each director shall have one vote unless he or she is a nonvoting director.
(B) Positions on the board of directors may be designated for individuals with specialized expertise, experience, or affiliation (for example, providers, employers, including small business consortia, and unions); however, those positions shall not constitute a majority of the operational board even if the individuals in those positions are also members of the CO-OP.
(C) (i) No representative of any federal, state, or local government, or of any political subdivision or instrumentality thereof, and no representative of any organization described in Section 156.510(b)(1)(i) of Title 45 of the Code of Federal Regulations may serve as staff of the CO-OP or on the CO-OP's formation board or operational board.
(ii) No board member or staff of the CO-OP shall enter into an agreement or transaction that would jeopardize member control as required by Section 156.515 of Title 45 of the Code of Federal Regulations. A board member or staff of the CO-OP shall only enter into arm's length transactions as described in Section 156.510(b)(2) (ii) of Title 45 of the Code of Federal Regulations.
(3) Have governing documents that incorporate ethics, conflict of interest, and disclosure standards. These standards shall protect against health care coverage industry involvement and interference. In addition, these standards shall ensure that each director acts in the sole interest of the CO-OP, its members, and its local geographic community, as appropriate, and acts consistently with the terms of the CO-OP's governance documents and applicable state and federal law. At a minimum, these standards shall include the following:
(A) A mechanism to identify potential ethical or other conflicts of interest.
(B) A duty on the CO-OP's executive officers and directors to publicly disclose all potential conflicts of interest pursuant to the same standards required for state boards or commissions.
(C) A process to determine the extent to which a conflict exists.
(D) A process to address any conflict of interest.
(E) A process to be followed in the event a director or executive officer of the CO-OP violates the standards described in this paragraph.
(b) A CO-OP shall do all of the following, in addition to any other requirements imposed under Section 156.515 of Title 45 of the Code of Federal Regulations:
(1) Implement policies and procedures to foster and ensure member control of the organization. For purposes of this paragraph, a CO-OP shall meet the following requirements:
(A) The CO-OP shall have governing documents that incorporate governing rules that ensure that the directors of the operational board are elected by a majority vote of a quorum of the CO-OP members.
(B) All members of the CO-OP shall be eligible to vote for each director on the CO-OP's operational board.
(C) Each member of the CO-OP shall have one vote in the election of each director of the CO-OP's operational board.
(D) The first elected directors of the CO-OP's operational board shall be elected no later than one year after the effective date on which the CO-OP provides coverage to its first member; the entire operational board shall be elected no later than two years after the same date.
(E) Elections of the directors on the CO-OP's operational board shall be contested so that the total number of candidates for vacant positions on the operational board exceeds the number of vacant positions, except in cases where a seat is vacated midterm due to death, resignation, or removal.
(F) A majority of the voting directors on the operational board shall be members of the CO-OP.
(2) Have an operational board of directors that meets the following requirements:
(A) Each director shall have one vote unless he or she is a nonvoting director.
(B) Positions on the board of directors may be designated for individuals with specialized expertise, experience, or affiliation (for example, providers, employers, including small business consortia, and unions); however, those positions shall not constitute a majority of the operational board even if the individuals in those positions are also members of the CO-OP.
(C) (i) No representative of any federal, state, or local government, or of any political subdivision or instrumentality thereof, and no representative of any organization described in Section 156.510(b)(1)(i) of Title 45 of the Code of Federal Regulations may serve as staff of the CO-OP or on the CO-OP's formation board or operational board.
(ii) No board member or staff of the CO-OP shall enter into an agreement or transaction that would jeopardize member control as required by Section 156.515 of Title 45 of the Code of Federal Regulations. A board member or staff of the CO-OP shall only enter into arm's length transactions as described in Section 156.510(b)(2) (ii) of Title 45 of the Code of Federal Regulations.
(3) Have governing documents that incorporate ethics, conflict of interest, and disclosure standards. These standards shall protect against health care coverage industry involvement and interference. In addition, these standards shall ensure that each director acts in the sole interest of the CO-OP, its members, and its local geographic community, as appropriate, and acts consistently with the terms of the CO-OP's governance documents and applicable state and federal law. At a minimum, these standards shall include the following:
(A) A mechanism to identify potential ethical or other conflicts of interest.
(B) A duty on the CO-OP's executive officers and directors to publicly disclose all potential conflicts of interest pursuant to the same standards required for state boards or commissions.
(C) A process to determine the extent to which a conflict exists.
(D) A process to address any conflict of interest.
(E) A process to be followed in the event a director or executive officer of the CO-OP violates the standards described in this paragraph.
