Governance

 Standard

Each health plan’s governing entity shall incorporate a board, advisory committee, or policy making and influencing group which shall be proportionally representative of the APIA consumer populations to be served and the community at large, including age and ethnicity. In this manner, the community served shall guide policy formulation and decision making, including Request for Proposals development and vendor selection. The governing entity responsible for the Health Plan shall be accountable for its successful implementation, including its cultural competence provisions.

Implementation Guidelines

1. The Health Plan shall include formal procedures for decision-making related to policies, practices, and grievances, in accordance with state and federal law with APIA community and professional input, participation, and involvement at all levels, including fair hearings. APIA Consumers shall be informed of this procedure in their own language at intake at the time of any steps in the complaint and grievance process.

2.  The Health Plan shall make available an APIA culturally competent group of ombudspersons (minimally comprised of consumer, family member, and regional representatives) to be involved in all appeals and concerns from the community served. The group of ombudspersons shall have independence from the Health Plan, and there shall be formalized procedures for resolving differences of opinion between the ombudsperson and the Health Plan administration’s governance. Funding shall be set aside to support the process.

3. The governing entity shall determine for each Health Plan an equitable percentage of profit or savings to be reinvested in APIA community-based services and preventive programs on an ongoing basis. A financial penalty or termination of contracts is applicable when gross inequities to access and/or comparability of benefits exist.

4. The Health Plan shall develop interagency and cross-system agreements or pooled funding to coordinate services with other agencies (e.g., public health, social services, corrections and juvenile justice, youth services, education, substance abuse, developmentally disabled services).

5. Financial and liability risks for the Health Plan shall be distributed such that APIA culturally competent smaller scale providers and organizations shall be able to continue to deliver services.

6. Policies governing practitioner ethics and behavior (e.g., gift giving by consumers, interactions with consumers outside the service setting, confidentiality) shall provide for differences relevant to the context of APIA cultural values.

7. Contract continuation and renewal shall be contingent upon successful achievement of performance standards which demonstrate effective service, equitable access and comparability of benefits for APIA and other underserved populations.

Recommended Performance Indicators

1. Presence of a governing board, advisory committee, or other policy making and influencing group with a composition reflective of the demographics of the service area, and responsive to the APIA consumers’ needs.

2. APIA consumer awareness of, and participation in, Health Plan benefits, appeals procedures and ombudsperson, as demonstrated by the comparability of the rate of grievances and complaints.

3. Procedures in place to ensure that the percent of complaints and grievances made of individual practitioners in the treatment and care of APIA consumers, is tracked and factored into performance evaluations.

4. Presence of interagency and cross-system agreements to coordinate services for APIA consumers.

5. Procedures in place to ensure that financial liability for the Health plan shall be equitably distributed so that the smaller scale APIA culturally competent Mental Health Specialists are not overburdened.

6. Presence of APIA culturally-informed policies for practitioner behavior and performance based demonstrations of implementation.

Recommended Outcomes

1. Final disposition of grievances and appeals for APIA consumers.
   
   Benchmark: Comparable to overall service population.

2. Percent of APIA consumers receiving blended, coordinated, or wrap-around services.
   
   Benchmark: Comparable to overall service population and increasing over time.

3. Percent of reports of practitioner unethical behavior for practitioners serving populations.
   
   Benchmark: Comparable to overall service population.

4. Sanctions and incentives reinforce progress toward the delivery of APIA culturally competent services.
   
   Benchmark: Decreased rates of sanction over time.

5. Composition of the governing board and consumers served is reflective of APIA demographics of the service area.
   
   Benchmark: 90% of expected representation.

6. APIA Consumer awareness of plan.
   
   Benchmark: 80% of surveyed respondents aware of plan.

7. APIA Culturally-based policies shaping practitioner behaviors and measuring performance.
   Benchmark: Presence of Policies

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