BILL NUMBER: SB 810	AMENDED	BILL TEXT	AMENDED IN SENATE  APRIL 23, 2009INTRODUCED BY   Senator Leno   (Principal coauthor: Senator Alquist)   (Principal coauthors: Assembly Members Ammiano, Huffman, andYamada)   (Coauthors: Senators Cedillo, Corbett, DeSaulnier, Florez,Hancock, Lowenthal, Padilla, Pavley, Romero, Steinberg, Wiggins, andYee)   (Coauthors: Assembly Members Bass, Beall, Block, Blumenfield,Brownley, Chesbro, Coto, Davis, De La Torre, Eng, Evans, Feuer, Fong,  Hayashi, Jones,  Lieu,  Bonnie Lowenthal, Ma,Mendoza,  Monning,  Nava, Price, Ruskin,  Salas, Skinner, Solorio, Swanson, Torlakson, and Torrico)                        FEBRUARY 27, 2009   An act to add Division 114 (commencing with Section 140000) to theHealth and Safety Code, relating to health care coverage.	LEGISLATIVE COUNSEL'S DIGEST   SB 810, as amended, Leno. Single-payer health care coverage.   Existing law does not provide a system of universal health carecoverage for California residents. Existing law provides for thecreation of various programs to provide health care services topersons who have limited incomes and meet various eligibilityrequirements. These programs include the Healthy Families Programadministered by the Managed Risk Medical Insurance Board, and theMedi-Cal program administered by the State Department of Health CareServices. Existing law provides for the regulation of health careservice plans by the Department of Managed Health Care and healthinsurers by the Department of Insurance.   This bill would establish the California Healthcare System to beadministered by the newly created California Healthcare Agency underthe control of a Healthcare Commissioner appointed by the Governorand subject to confirmation by the Senate. The bill would make allCalifornia residents eligible for specified health care benefitsunder the California Healthcare System, which would, on asingle-payer basis, negotiate for or set fees for health careservices provided through the system and pay claims for thoseservices. The bill would provide that a resident of the state with ahousehold income, as specified, at or below 200% of the federalpoverty level would be eligible for the type of benefits providedunder the Medi-Cal program. The bill would require the commissionerto seek all necessary waivers, exemptions, agreements, or legislationto allow various existing federal, state, and local health carepayments to be paid to the California Healthcare System, which wouldthen assume responsibility for all benefits and services previouslypaid for with those funds.   The bill would create the Healthcare Policy Board to establishpolicy on medical issues and various other matters relating to thesystem. The bill would create the Office of Patient Advocacy withinthe agency to represent the interests of health care consumersrelative to the system. The bill would create within the agency theOffice of Health Planning to plan for the health care needs of thepopulation, and the Office of Health Care Quality, headed by a chiefmedical officer, to support the delivery of high quality care andpromote provider and patient satisfaction. The bill would create theOffice of Inspector General for the California Healthcare Systemwithin the Attorney General's office, which would have variousoversight powers. The bill would prohibit health care service plancontracts or health insurance policies from being issued for servicescovered by the California Healthcare System. The bill would createthe Healthcare Fund and the Payments Board to administer the financesof the California Healthcare System. The bill would create theCalifornia Healthcare Premium Commission (Premium Commission) todetermine the cost of the California Healthcare System and to developa premium structure for the system that complies with specifiedstandards. The bill would require the Premium Commission to recommenda premium structure to the Governor and the Legislature on or beforeJanuary 1,  2011   2012  , and to make adraft recommendation to the Governor, the Legislature, and the public90 days before submitting its final premium structurerecommendation. The bill would specify that only its provisionsrelating to the Premium Commission would become operative on January1, 2010, with its remaining provisions becoming operative on the datethe Secretary of California Health and Human Services notifies theLegislature, as specified, that sufficient funding exists toimplement the California Healthcare System. The bill would requirethat system to be operative within 2 years of that date and wouldprovide for various transition processes for that period.   The bill would extend the application of certain insurance fraudlaws to providers of services and products under the system, therebyimposing a state-mandated local program by revising the definition ofa crime. The bill would enact other related provisions relative tobudgeting, regional entities, federal preemption, subrogation,collective bargaining agreements, compensation of health careproviders, conflict of interest, patient grievances, independentmedical review, and associated matters.   The California Constitution requires the state to reimburse localagencies and school districts for certain costs mandated by thestate. Statutory provisions establish procedures for making thatreimbursement.   This bill would provide that no reimbursement is required by thisact for a specified reason.   Vote: majority. Appropriation: no. Fiscal committee: yes.State-mandated local program: yes.THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:  SECTION 1.  Division 114 (commencing with Section 140000) is addedto the Health and Safety Code, to read:      DIVISION 114.  CALIFORNIA UNIVERSAL HEALTHCARE ACT      CHAPTER 1.  GENERAL PROVISIONS   140000.  There is hereby established in state government theCalifornia Healthcare System, which shall be administered by theCalifornia Healthcare Agency, an independent agency under the controlof the Healthcare Commissioner.   140000.6.  No health care service plan contract or healthinsurance policy, except for the California Healthcare System plan,may be sold in California for services provided by the system.   140001.  This division shall be known and may be cited as theCalifornia Universal Healthcare Act.   140002.  This division shall be liberally construed to accomplishits purposes.   140003.  The California Healthcare Agency is hereby created anddesignated as the single state agency with full power to superviseevery phase of the administration of the California Healthcare Systemand to receive grants-in-aid made by the United States government,by the state, or by other sources in order to secure full compliancewith the applicable provisions of state and federal law.   140004.  The California Healthcare Agency shall be comprised ofthe following entities:   (a) The Healthcare Policy Board.   (b) The Office of Patient Advocacy.   (c) The Office of Health Planning.   (d) The Office of Health Care Quality.   (e) The Healthcare Fund.   (f) The Public Advisory Committee.   (g) The Payments Board.   (h.) Partnerships for Health.   140005.  The Legislature finds and declares all of the following:   (a) An estimated 6.6 million Californians were uninsured in 2006,representing over 20 percent of the nonelderly population.   (b) In California, 763,000 children are currently uninsured, andan additional 300,000 are significantly at risk for losing theircoverage.   (c) Health care spending has continuously grown two to three timesfaster than California's economy, while health insurance premiumshave grown significantly faster than overall health care spending.   (d) Since 2000, health care costs have outpaced increases in wagesby a ratio of four to one.   (e) One-third of California's State Budget is devoted to healthcare, including direct public programs as well as employee healthbenefits. The imbalanced growth in health spending relative toeconomic growth which drives public revenues greatly hindersCalifornia's ability to maintain a balanced budget.   (f) On average, the United States spends more than twice as muchas all other industrial nations on health care, both per person andas a percentage of its gross domestic product. Additionally, the rateof health care inflation significantly outpaces other industrialnations.   (g) Despite this high spending, United States healthcare outcomesconsistently rank at the bottom of all industrial nations and theUnited States Institute of Medicine has declared an epidemic ofsubstandard health-care throughout the nation.   (h) Instead of effectively containing costs, costs have beenincreasingly shifted to working Californians in the form of acontinual decline in employer-offered coverage, dramatic increases inpremiums, copayments, and deductibles, declining clinical quality,overall reductions in benefits, and inappropriate utilization reviewprocedures that deny patients access to needed care.   (i) As a result, one-half of all bankruptcies in the United Statesnow relate to medical costs, though three-fourths of bankruptedfamilies had health care coverage at the time of sustaining theinjury or illness.   (j) More than one-half of all Americans report forgoingrecommended health care because of the cost, and Americans are morelikely to report difficulty seeing a doctor on the day they sought.   (k) Health plans and insurers compete to construct patient poolsconsisting of the healthiest segments of the population, leavinghigher risk patients to public programs or uninsured.   (l) Segregating patients into groups based on actuarialassessments of their medical risk guarantees the continuation ofentrenched health care disparities in access and quality, and driveshealth care resources toward healthier populations who least need itfor whom more care often does more harm than good.   (m) The Institute of Medicine estimates that 18,000 people dieannually in the United States because of lack of access to care andthat 30,000 die from overtreatment.   (n) The RAND Institute estimates that one-third of clinicalprocedures performed are of questionable clinical benefit.   (o) Quantitative analyses performed by the Congressional BudgetOffice, the General Accounting Office, the Lewin Group, and theLegislative Analyst's Office indicate that under a single payerhealth care coverage system, the amount currently spent for healthcare is adequate to finance comprehensive high quality health carecoverage for every resident of the state.   (p) According to these reports and numerous other studies, bysimplifying administration, achieving bulk purchase discounts onpharmaceuticals, reducing the use of emergency facilities for primarycare, and better managing health care resources, California coulddivert billions of dollars toward direct health care.   (q) Enactment of a single payer universal health care system wouldcreate 2.6 million jobs in the United States, while infusing threehundred seventeen billion dollars ($317,000,000,000) in new businessand public revenues and one hundred billion dollars($100,000,000,000) in wages into the United States economy accordingto a recent study by the Institute for Health and SocioeconomicPolicy.   (r) Single payer health care, exhibited by Medicare and theVeterans Administration, along with virtually every other industrialnation in the world, is a well tested model that has been proven tocontain the growth in health care spending while promoting qualityimprovements and maintaining comprehensive coverage.   140005.1.  (a) It is the intent of the Legislature to establish asystem of universal health care coverage in this state that providesall residents with comprehensive health care benefits, guarantees asingle standard of care for all residents, stabilizes the growth inhealth care spending, and improves the quality of health care for allresidents.   (b) It is the intent of the Legislature that, in order to ensurean adequate supply and distribution of direct care providers in thestate, a just and fair return for providers electing to becompensated by the health care system, and a uniform system ofpayments, the state shall actively supervise and regulate a system ofpayments whereby groups of fee-for-service physicians are authorizedto select representatives of their specialties to negotiate with thehealth care system, pursuant to Section 140209. Nothing in thisdivision shall be construed to allow collective action against thehealth care system.   140006.  This division shall have all of the following purposes:   (a) To provide affordable and comprehensive health care coveragewith a single standard of care for all California residents.   (b) To control health care costs and the growth of health carespending, subject to the obligation described in subdivision (a).   (c) To achieve measurable improvement in the quality of care andthe efficiency of care delivery.   (d) To prevent disease and disability and to improve or maintainhealth and functionality.   (e) To increase health care provider, consumer, employee, andemployer satisfaction with the health care system.   (f) To implement policies that strengthen and improve culturallyand linguistically sensitive care and sensitive care provided todisabled persons.   (g) To develop an integrated population-based health care databaseto support health care planning.   (h) To provide information and care in an appropriate andaccessible format.   140007.  As used in this division, the following terms have thefollowing meanings:   (a) "Agency" means the California Healthcare Agency.   (b) "Clinic" means an organized outpatient health facility thatprovides direct medical, surgical, dental, optometric, or podiatricadvice, services, or treatment to patients who remain less than 24hours, and that may also provide diagnostic or therapeutic servicesto patients in the home as an alternative to care provided at theclinic facility, and includes those facilities defined under Sections1200 and 1200.1.   (c) "Commissioner" means the Healthcare Commissioner.   (d) "Direct care provider" means any licensed health careprofessional that provides health care services through directcontact with the patient, either in person or using approvedtelemedicine modalities as identified in Section 2290.5 of theBusiness and Professions Code.   (e) "Essential community provider" means a health facility thathas served as part of the state's health care safety net forlow-income and traditionally underserved populations in Californiaand that is one of the following:   (1) A "community clinic" as defined under subparagraph (A) ofparagraph (1) of subdivision (a) of Section 1204.   (2) A "free clinic" as defined under subparagraph (B) of paragraph(1) of subdivision (a) of Section 1204.   (3) A "federally qualified health center" as defined under Section1395x (aa)(4) or 1396d (l)(2) of Title 42 of the United States Code.   (4) A "rural health clinic" as defined under Section 1395x (aa)(2)or 1396d (l)(1) of Title 42 of the United States Code.   (5) Any clinic conducted, maintained, or operated by a federallyrecognized Indian tribe or tribal organization, as defined in Section1603 of Title 25 of the United States Code.   (6) Any clinic exempt from licensure under subdivision (h) ofSection 1206.   (f) "Health care provider" means any professional person, medicalgroup, independent practice association, organization, healthfacility, or other person or institution licensed or authorized bythe state to deliver or furnish health care services.   (g) "Health facility" means any facility, place, or building thatis organized, maintained, and operated for the diagnosis, care,prevention, and treatment of human illness, physical or mental,including convalescence and rehabilitation and including care duringand after pregnancy, or for any one or more of these purposes, forone or more persons, and includes those facilities defined undersubdivision (b) of Section 15432 of the Government Code.   (h) "Hospital" means all health facilities to which persons may beadmitted for a 24-hour stay or longer, as defined in Section 1250,with the exception of nursing, skilled nursing, intermediate care,and congregate living health facilities.   (i) "Integrated health care delivery system" means a providerorganization that meets both of the following criteria:   (1) Is fully integrated operationally and clinically to provide abroad range of health care services, including preventative care,prenatal and well-baby care, immunizations, screening diagnostics,emergency services, hospital and medical services, surgical services,and ancillary services.   (2) Is compensated using capitation or facility budgets, exceptfor copayments, for the provision of health care services.   (j) "Large employer" means a person, firm, proprietary ornonprofit corporation, partnership, public agency, or associationthat is actively engaged in business or service, that, on at least 50percent of its working days during the preceding calendar yearemployed at least 50 employees, or, if the employer was not inbusiness during any part of the preceding calendar year, employed atleast 50 employees on at least 50 percent of its working days duringthe preceding calendar quarter.   (k) "Premium Commission" means the California Healthcare PremiumCommission.   (l) "Primary care provider" means a direct care provider that is afamily physician, internist, general practitioner, pediatrician, anobstetrician-gynecologist, or a family nurse practitioner orphysician assistant practicing under supervision as defined inCalifornia codes or essential community providers who employ primarycare providers.   (m) "Small employer" means a person, firm, proprietary ornonprofit corporation, partnership, public agency, or associationthat is actively engaged in business or service and that, on at least50 percent of its working days during the preceding calendar yearemployed at least two but no more than 49 employees, or, if theemployer was not in business during any part of the precedingcalendar year, employed at least two but no more than 49 eligibleemployees on at least 50 percent of its working days during thepreceding calendar quarter.   (n) "System" means the California Healthcare System.   140008.  The definitions contained in Section 140007 shall governthe construction of this division, unless the context requiresotherwise.      CHAPTER 2.  GOVERNANCE   140100.  (a) (1) The commissioner shall be appointed by theGovernor on or before March 1, 2010, subject to confirmation by theSenate. If in session, the Senate shall act on the appointment within30 days of the appointment date. If the Senate does not act on theappointment within that period, the nominee shall be deemed confirmedand may take office. If the Senate is not in session at the time ofthe appointment, the Senate shall act on the appointment within 30days of the commencement of the next legislative session. If theSenate does not act on the appointment within that period, theappointee shall be deemed confirmed and may take office.   (2) If the Senate by a vote fails to confirm the nominee forcommissioner, the Governor shall make a new appointment within 30days of the Senate's vote. The appointment is subject to confirmationby the Senate, and the procedures described in paragraph (1) shallapply to the confirmation process.   (b) The commissioner is exempt from the State Civil Service Act(Part 2 (commencing with Section 18500) of Division 5 of Title 2 ofthe Government Code).   (c) The commissioner may not be a state legislator or a Member ofthe United States Congress while holding the position ofcommissioner.   (d) The commissioner shall not have been employed in any capacityby a for-profit insurance, pharmaceutical, or medical equipmentcompany that sells products to the system for a period of two yearsprior to appointment as commissioner.   (e) For two years after completing service in the system, thecommissioner may not receive payments of any kind from, or beemployed in any capacity or act as a paid consultant to, a for-profitinsurance, pharmaceutical, or medical equipment company that sellsproducts to the system.   (f) The compensation and benefits of the commissioner shall beestablished by the California Citizens Compensation Commission inaccordance with Section 8 of Article III of the CaliforniaConstitution.   (g) The commissioner shall be subject to Title 9 (commencing withSection 81000) of the Government Code.   140101.  (a) The commissioner shall be the chief officer of theagency and shall administer all aspects of the agency.   (b) The commissioner shall be responsible for the performance ofall duties, the exercise of all power and jurisdiction, and theassumption and discharge of all responsibilities vested by law in theagency. The commissioner shall perform all duties imposed upon himor her by this division and other laws related to health care, andshall enforce the execution of those related to the system, and shallenforce the execution of those provisions and laws to promote theirunderlying aims and purposes. These broad powers shall include, butare not limited to, the power to establish the system's budget and toset rates, to establish the system's goals, standards, andpriorities, to hire, fire, and fix the compensation of agencypersonnel, to make allocations and reallocations to the healthplanning regions, and to promulgate generally binding regulationsconcerning any and all matters related to the implementation of thisdivision and its purposes.   (c) The commissioner shall appoint a deputy commissioner, theDirector of the Healthcare Fund, the patient advocate of the Officeof Patient Advocacy, the chief medical officer, the Director of thePayments Board, the Director of the Office of Health Planning, theDirector of the Partnerships for Health, the regional health planningdirectors, the chief enforcement counsel, and legal counsel in anyaction brought by or against the commissioner under or pursuant toany provision of any law under the commissioner's jurisdiction, or inwhich the commissioner joins or intervenes as to a matter within thecommissioner's jurisdiction, as a friend of the court or otherwise,and stenographic reporters to take and transcribe the testimony inany formal hearing or investigation before the commissioner or beforea person authorized by the commissioner.   (d) The commissioner, in accordance with the State Civil ServiceAct (Part 2 (commencing with Section 18500) of Division 5 of Title 2of the Government Code), may appoint and fix the compensation ofclerical, inspection, investigation, evaluation, and auditingpersonnel as may be necessary to implement this division.   (e) The personnel of the agency shall perform duties as assignedto them by the commissioner. The commissioner shall designate certainemployees by the rule or order that are to take and subscribe to theconstitutional oath within 15 days after their appointments, and tofile that oath with the Secretary of State. The commissioner shallalso designate those employees that are to be subject to Title 9(commencing with Section 81000) of the Government Code.   (f) The commissioner shall adopt a seal bearing the inscription:"Commissioner, California Healthcare Agency, State of California."The seal shall be affixed to or imprinted on all orders andcertificates issued by him or her and other instruments as he or shedirects. All courts shall take notice of this seal.   (g) The administration of the agency shall be supported from theHealthcare Fund created pursuant to Section 140200.   (h) The commissioner, as a general rule, shall publish or makeavailable for public inspection any information filed with orobtained by the agency, unless the commissioner finds that thisavailability or publication is contrary to law. No provision of thisdivision authorizes the commissioner or any of the commissioner'sassistants, clerks, or deputies to disclose any information withheldfrom public inspection except among themselves or when necessary orappropriate in a proceeding or investigation under this division orto other federal or state regulatory agencies. No provision of thisdivision either creates or derogates from any privilege that existsat common law or otherwise when documentary or other evidence issought under a subpoena directed to the commissioner or any of his orher assistants, clerks, and deputies.   (i) It is unlawful for the commissioner or any of his or herassistants, clerks, or deputies to use for personal benefit anyinformation that is filed with, or obtained by, the commissioner andthat is not then generally available to the public.   (j) The commissioner shall avoid political activity that maycreate the appearance of political bias or impropriety. Prohibitedactivities shall include, but not be limited to, leadership of, oremployment by, a political party or a political organization; publicendorsement of a political candidate; contribution of more than fivehundred dollars ($500) to any one candidate in a calendar year or acontribution in excess of an aggregate of one thousand dollars($1,000) in a calendar year for all political parties ororganizations; and attempting to avoid compliance with thisprohibition by making contributions through a spouse or other familymember.   (k) The commissioner shall not participate in making or in any wayattempt to use his or her official position to influence agovernmental decision in which he or she knows or has reason to knowthat he or she or a family or a business partner or colleague has afinancial interest.   (l) The commissioner, in pursuit of his or her duties, shall haveunlimited access to all nonconfidential and all nonprivilegeddocuments in the custody and control of the agency.   (m) The Attorney General shall render to the commissioner opinionsupon all questions of law, relating to the construction orinterpretation of any law under the commissioner's jurisdiction orarising in the administration thereof, that may be submitted to theAttorney General by the commissioner and upon the commissioner'srequest shall act as the attorney for the commissioner in actions andproceedings brought by or against the commissioner or under orpursuant to any provision of any law under the commissioner'sjurisdiction.   140102.  The commissioner shall do all of the following:   (a) Oversee the establishment, as part of the administration ofthe agency, of all of the following:   (1) The Healthcare Policy Board, pursuant to Section 140103.   (2) The Office of Patient Advocacy, pursuant to Section 140105.   (3) The Office of Health Planning, pursuant to Section 140602.   (4) The Office of Healthcare Quality, pursuant to Section 140605.   (5) The Healthcare Fund, pursuant to Section 140200.   (6) The Public Advisory Committee, pursuant to Section 140104.   (7) The Payments Board, pursuant to Section 140208.   (8) Partnerships for Health.   (b) Determine goals, standards, guidelines, and priorities for thesystem.   (c) Establish health planning regions, pursuant to Section 140112.   (d) Oversee the establishment of locally based integrated servicenetworks, including those that provide services through medicaltechnologies such as telemedicine, that include physicians infee-for-service, solo and group practice, essential community, andancillary care providers and facilities in order to pool and alignresources and form interdisciplinary teams that share responsibilityand accountability for patient care and provide a continuum ofcoordinated high quality primary to tertiary care to all Californiaresidents while preserving patient choice. This shall be accomplishedin collaboration with the chief medical officer, the Director of theOffice of Health Planning, the regional medical officers, theregional planning boards, and the patient advocate.   (e) Annually assess projected revenues and expenditures and assurefinancial solvency of the system pursuant to Section 140203.   (f) Develop the system's budget pursuant to Section 140206 toensure adequate funding to meet the health care needs of thepopulation. Review all budgets and locations annually to ensure theyaddress disparities in service availability and health care outcomesand for sufficiency of rates, fees, and prices.   (g) Establish a capital management framework for the systempursuant to Section 140216, including, but not limited to, astandardized process and format for the development and submission ofregional operating and regional capital budget requests and ensure asmooth transition to system oversight.   (h) Establish standards and criteria for the development andsubmission of provider operating and capital budget requests.   (i) Establish standards and criteria for the allocation of fundsfrom the Healthcare Fund as described in Chapter 3 (commencing withSection 140200).   (j) During transition and annually thereafter, determine theappropriate level for a reserve fund for the system and implementpolicies needed to establish the appropriate reserve.   (k) Establish an enrollment system that ensures all eligibleCalifornia residents, including those who travel out of state; thosewho have disabilities that limit their mobility, hearing, or visionor their mental or cognitive capacity; those who cannot read; andthose who do not speak or write English are aware of their right tohealth care and are formally enrolled in the system. The commissionermay contract with a third party for eligibility and enrollmentservices if the commissioner finds that doing so would meet thesystem's goals and standards, and result in greater efficiency andcost savings to the system.   (l) Establish an electronic claims and payments system for thesystem where all claims under the system shall be filed and paid, andimplement, to the extent permitted by federal law, standardizedclaims and reporting methods. The commissioner may contract with athird party for claims and payment services if the commissioner findsthat doing so would meet the system's goals and standards, andresult in greater efficiency and cost savings to the system.   (m) Establish a system of secure electronic medical records thatcomply with state and federal privacy laws and that are compatibleacross the system.   (n) Establish an electronic referral system that is accessible toproviders and to patients.   (o) Establish standards based on clinical efficacy to guidedelivery of care and a process to identify areas where no suchstandards exist, set priorities and a timetable for theirdevelopment, and ensure a smooth transition to clinicaldecisionmaking under statewide standards.   (p) Implement policies to ensure that all Californians receiveculturally and linguistically sensitive care, pursuant to Section140604, and that all disabled Californians receive care in accordancewith the federal Americans with Disabilities Act (42 U.S.C. Sec.12101 et seq.) and Section 504 of the Rehabilitation Act of 1973 (29U.S.C. Sec. 794) and develop mechanisms and incentives to achievethese purposes and a means to monitor the effectiveness of efforts toachieve these purposes.   (q) Create a systematic approach to the measurement, management,and accountability for care quality and access, including a system ofperformance contracts that contain measurable goals and outcomes andappropriate statewide and regional health care databases to assurethe delivery of quality care to all patients.   (r) Establish standards for mandatory reporting by health careproviders and penalties for failure to report.   (s) Develop methods and a framework to measure the performance ofhealth care coverage and health delivery system upper level managers,including a system of performance contracts that contain measurablegoals and outcomes.   (t) Implement policies to ensure that all residents of this statehave access to medically appropriate, coordinated mental healthservices.                                                 (u) Ensure theestablishment of policies that support the public health.   (v) Meet regularly with the chief medical officer, the patientadvocate for the Office of Patient Advocacy, the Public AdvisoryCommittee, the Director of the Office of Health Planning, theDirector of the Payments Board, the Director of the Partnerships forHealth, regional planning directors, and regional medical officers toreview the impact of the agency and its policies on the health ofthe population and on satisfaction with the system.   (w) Negotiate for or set rates, fees, and prices involving anyaspect of the system and establish procedures thereto.   (x) Establish a formulary based on clinical efficacy for allprescription drugs and durable and nondurable medical equipment foruse by the system.   (y) Establish guidelines for prescribing medications and durablemedical equipment that are not included in the system's formularies.   (z) Utilize the purchasing power of the state to negotiate pricediscounts for prescription drugs and durable and nondurable medicalequipment for use by the system.   (aa) Ensure that use of state purchasing power achieves the lowestpossible prices for the system without adversely affecting neededpharmaceutical research.   (ab) Create incentives and guidelines for research needed to meetthe goals of the system and disincentives for research that does notachieve the system goals.   (ac) Implement eligibility standards for the system, includingguidelines to prevent an influx of persons to the state for thepurpose of obtaining medical care.   (ad) Determine an appropriate level of, and provide support duringthe transition for, training and job placement for persons who aredisplaced from employment as a result of the initiation of thesystem.   (ae) Oversee the establishment of a system for resolution ofdisputes pursuant to Sections 140608 and 140610.   (af) Investigate the costs and benefits to the health of thepopulation of advances in information technology, including thosethat support data collection, analysis, and distribution.   (ag) Ensure that consumers of health care have access toinformation needed to support their choice of a physician.   (ah) Collaborate with the licensing entities of health facilitiesto ensure that facility performance is monitored and that deficientpractices are recognized and corrected in a timely fashion and thatconsumers and providers of health care have access to informationneeded to support their choice of facility.   (ai) Establish an Internet Web site that provides information tothe public about the system that includes, but is not limited to,information that supports choice of providers and facilities, informsthe public about meetings of state and regional health planningboards and activities of the Partnerships for Health.   (aj) Procure funds, including loans, for the system, enter intoleases, and obtain insurance for the system and its employees andagents.   (ak) Collaborate with state and local authorities, includingregional planning directors, to plan for needed earthquake retrofitsin a manner that does not disrupt patient care.   (a) Establish a process that is accessible to all Californians forthe system to receive the concerns, opinions, ideas, andrecommendation of the public regarding all aspects of the system.   (am) Annually report to the Legislature and the Governor, on orbefore October of each year and at other times pursuant to thisdivision, on the performance of the system, its fiscal condition andneed for rate adjustments, consumer copayments or consumer deductiblepayments, recommendations for statutory changes, receipt of paymentsfrom the federal government and other sources, whether current yeargoals and priorities are met, future goals, and priorities, and majornew technology or prescription drugs or other circumstances that mayaffect the cost of health care.   140103.  (a) The commissioner shall establish a Healthcare PolicyBoard and shall serve as the president of the board.   (b) The board shall do all of the following:   (1) Establish goals and priorities for the system, includingresearch and capital investment priorities.   (2) Establish the scope of services to be provided to thepopulation in accordance with Chapter 5 (commencing with Section140500).   (3) Establish guidelines for evaluating the performance of thesystem, its officers, health planning regions, and health careproviders.   (4) Establish guidelines for ensuring public input on the system'spolicy, standards, and goals.   (c) The board shall consist of the following members:   (1) The commissioner.   (2) The deputy commissioner.   (3) The Director of the Healthcare Fund.   (4) The patient advocate of the Office of Patient Advocacy.   (5) The chief medical officer.   (6) The Director of the Office of Health Planning.   (7) The Director of the Partnerships for Health.   (8) The Director of the Payments Board.   (9) The State Public Health Officer.   (10) One member of the Public Advisory Committee who shall serveon a rotating basis to be determined by the Public AdvisoryCommittee.   (11) Two representatives from regional planning boards.   (A) A regional representative shall serve a term of one year andterms shall be rotated in order to allow every region to berepresented within a five-year period.   (B) A regional planning director shall appoint the regionalrepresentative to serve on the board.   (d) It is unlawful for the board members or any of theirassistants, clerks, or deputies to use for personal benefit anyinformation that is filed with or obtained by the board and that isnot then generally available to the public.   140104.  (a) The commissioner shall establish the Public AdvisoryCommittee to advise the Healthcare Policy Board on all matters ofpolicy for the system.   (b) Members of the Public Advisory Committee shall include all ofthe following:   (1) Four physicians all of whom shall be board certified in theirfield and at least one of whom shall be a psychiatrist. The SenateCommittee on Rules and the Governor shall each appoint one member.The Speaker of the Assembly shall appoint two of these members, bothof whom shall be primary care providers.   (2) One registered nurse, to be appointed by the Senate Committeeon Rules.   (3) One licensed vocational nurse, to be appointed by the SenateCommittee on Rules.   (4) One licensed allied health practitioner, to be appointed bythe Speaker of the Assembly.   (5) One mental health care provider, to be appointed by the SenateCommittee on Rules.   (6) One dentist, to be appointed by the Governor.   (7) One representative of private hospitals, to be appointed bythe Governor.   (8) One representative of public hospitals, to be appointed by theGovernor.   (9) One representative of an integrated health care deliverysystem, to be appointed by the Governor.   (10) Four consumers of health care. The Governor shall appoint twoof these members, one of whom shall be a member of the disabilitycommunity. The Senate Committee on Rules shall appoint a member whois 65 years of age or older. The Speaker of the Assembly shallappoint the fourth member.   (11) One representative of organized labor, to be appointed by theSpeaker of the Assembly.   (12) One representative of essential community providers, to beappointed by the Senate Committee on Rules.   (13) One union member, to be appointed by the Senate Committee onRules.   (14) One representative of small business, to be appointed by theGovernor.   (15) One representative of large business, to be appointed by theSpeaker of the Assembly.   (16) One pharmacist, to be appointed by the Speaker of theAssembly.   (c) In making appointments pursuant to this section, the Governor,the Senate Committee on Rules, and the Speaker of the Assembly shallmake good faith efforts to assure that their appointments, as awhole, reflect, to the greatest extent feasible, the social andgeographic diversity of the state.   (d) Any member appointed by the Governor, the Senate Committee onRules, or the Speaker of the Assembly shall serve a four-year term.These members may be reappointed for succeeding four-year terms.   (e) Vacancies that occur shall be filled within 30 days after theoccurrence of the vacancy, and shall be filled in the same manner inwhich the vacating member was initially selected or appointed. Thecommissioner shall notify the appropriate appointing authority of anyexpected vacancies on the board.   (f) Members of the Public Advisory Committee shall serve withoutcompensation, but shall be reimbursed for actual and necessaryexpenses incurred in the performance of their duties to the extentthat reimbursement for those expenses is not otherwise provided orpayable by another public agency or agencies, and shall receive onehundred dollars ($100) for each full day of attending meetings of thecommittee. For purposes of this section, "full day of attending ameeting" means presence at, and participation in, not less than 75percent of the total meeting time of the committee during anyparticular 24-hour period.   (g) The Public Advisory Committee shall meet at least six times ayear in a place convenient to the public. All meetings of the boardshall be open to the public, pursuant to the Bagley-Keene OpenMeeting Act (Article 9 (commencing with Section 11120) of Chapter 1of Part 1 of Division 3 of Title 2 of the Government Code).   (h) The Public Advisory Committee shall elect a chair who shallserve for two years and who may be reelected for an additional twoyears.   (i) Appointed committee members shall have worked in the fieldthey represent on the committee for a period of at least two yearsprior to being appointed to the committee.   (j) The Public Advisory Committee shall elect a member to serve onthe Healthcare Policy Board. The elected member shall serve for oneyear, and may be recalled by the Public Advisory Committee for cause.In that case, a new member shall be elected to serve on that board.The Public Advisory Committee representative shall represent to theboard the views of the committee members.   (k) It is unlawful for the committee members or any of theirassistants, clerks, or deputies to use for personal benefit anyinformation that is filed with or obtained by the committee and thatis not generally available to the public.   140105.  (a) (1) There is within the agency an Office of PatientAdvocacy to represent the interests of the consumers of health care.The goal of the office shall be to help residents of the state securethe health care services and benefits to which they are entitledunder the laws administered by the agency and to advocate on behalfof and represent the interests of consumers in governance bodiescreated by this division and in other forums.   (2) The office shall be headed by a patient advocate appointed bythe commissioner.   (3) The patient advocate shall establish an office in the City ofSacramento and other offices throughout the state that shall provideconvenient access to residents.   (b) The patient advocate shall do all the following:   (1) Administer all aspects of the Office of Patient Advocacy.   (2) Assure that services of the Office of Patient Advocacy areavailable to all California residents.   (3) Serve on the Healthcare Policy Board and participate in theregional Partnerships for Health.   (4) Oversee the establishment and maintenance of the grievanceprocess pursuant to Sections 140608 and 140610.   (5) Participate in the grievance process and independent medicalreview system on behalf of consumers pursuant to Section 140610.   (6) Receive, evaluate, and respond to consumer complaints aboutthe system.   (7) Provide a means to receive recommendations from the publicabout ways to improve the system and hold public hearings at leastonce annually to discuss problems and receive recommendations fromthe public.   (8) Develop educational and informational guides for consumersdescribing their rights and responsibilities and informing them abouteffective ways to exercise their rights to secure health careservices and to participate in the system. The guides shall be easyto read and understand, available in English and other languages,including Braille and formats suitable for those with hearinglimitations, and shall be made available to the public by the agency,including access on the agency's Internet Web site and throughpublic outreach and educational programs, and displayed in provideroffices and health care facilities.   (9) Establish a toll-free telephone number, including a TDDnumber, to receive complaints regarding the agency and its services.Those with hearing and speech limitations may use the CaliforniaRelay Service's toll-free telephone numbers to contact the Office ofPatient Advocacy. The agency's Internet Web site shall have complaintforms and instructions on their use.   (10) Report annually to the public, the commissioner, and theLegislature about the consumer perspective on the performance of thesystem, including recommendations for needed improvements.   (c) Nothing in this division shall prohibit a consumer or class ofconsumers or the patient advocate from seeking relief through thejudicial system.   (d) The patient advocate in pursuit of his or her duties shallhave unlimited access to all nonconfidential and all nonprivilegeddocuments in the custody and control of the agency.   (e) It is unlawful for the patient advocate or any of his or herassistants, clerks, or deputies to use for personal benefit anyinformation that is filed with, or obtained by, the agency and thatis not then generally available to the public.   140106.  (a) There is within the Office of the Attorney General anOffice of the Inspector General for the California HealthcareSystem. The Inspector General shall be appointed by the Governor andsubject to Senate confirmation.   (b) The Inspector General shall have broad powers to investigate,audit, and review the financial and business records of individuals,public and private agencies and institutions, and privatecorporations that provide services or products to the system, thecosts of which are reimbursed by the system.   (c) The Inspector General shall investigate allegations ofmisconduct on the part of an employee or appointee of the agency andon the part of any health care provider of services that arereimbursed by the system and shall report any findings of misconductto the Attorney General.   (d) The Inspector General shall investigate patterns of medicalpractice that may indicate fraud and abuse related to over or underutilization or other inappropriate utilization of medical productsand services.   (e) The Inspector General shall arrange for the collection andanalysis of data needed to investigate the inappropriate utilizationof these products and services.   (f) The Inspector General shall conduct additional reviews orinvestigations of financial and business records when requested bythe Governor or by any Member of the Legislature and shall reportfindings of the review or investigation to the Governor and theLegislature.   (g) The Inspector General shall establish a telephone hotline foranonymous reporting of allegations of failure to make healthinsurance premium payments established by this division. TheInspector General shall investigate information provided to thehotline and shall report any findings of misconduct to the AttorneyGeneral.   (h) The Inspector General shall annually report recommendationsfor improvements to the system or the agency to the Governor, theLegislature, and the commissioner.   140107.  The provisions of the Insurance Frauds Prevention Act(Chapter 12 (commencing with Section 1871) of Part 2 of Division 1 ofthe Insurance Code), and the provisions of Article 6 (commencingwith Section 650) of Chapter 1 of Division 2 of the Business andProfessions Code shall be applicable to health care providers whoreceive payments for services through the system under this division.   140108.  (a) Nothing contained in this division is intended torepeal any legislation or regulation governing the professionalconduct of any person licensed by the State of California or anylegislation governing the licensure of any facility licensed by theState of California.   (b) All federal legislation and regulations governing referralfees and fee-splitting, including, but not limited to, Sections1320a-7b and 1395nn of Title 42 of the United States Code, shall beapplicable to all health care providers of services reimbursed underthis division, whether or not the health care provider is paid withfunds coming from the federal government.   140110.  (a) The system shall be operational no later than twoyears after the date this division, other than Article 2 (commencingwith Section 140230) of Chapter 3, becomes operative, as described inSection 140700.   (b) The commissioner shall assess health plans and insurers forcare provided by the system in those cases in which a person's healthcare coverage extends into the time period in which the new systemis operative.   (c) The commissioner shall implement means to assist persons whoare displaced from employment as a result of the initiation of thesystem, including determination of the period of time during whichassistance shall be provided and possible sources of funds, includingfunds from the system, to support retraining and job placement. Thatsupport shall be provided for a period of five years from the datethat this division becomes operative.   140111.  (a) The commissioner shall appoint a transition advisorygroup, which shall include, but not be limited to, the followingmembers:   (1) The commissioner.   (2) The patient advocate of the Office of Patient Advocacy.   (3) The chief medical officer.   (4) The Director of the Office of Health Planning.   (5) The Director of the Healthcare Fund.   (6) The State Public Health Officer.   (7) Experts in health care financing and health careadministration.   (8) Direct care providers.   (9) Representatives of retirement boards.   (10) Employer and employee representatives.   (11) Hospital, integrated health care delivery system, essentialcommunity provider, and long-term care facility representatives.   (12) Representatives from state departments and regulatory bodiesthat shall or may relinquish some or all parts of their delivery ofhealth care services to the system.   (13) Representatives of counties.   (14) Consumers of health care services.   (b)  The transition advisory group shall advise the commissioneron all aspects of the implementation of this division.   (c) The transition advisory group shall make recommendations tothe commissioner, the Governor, and the Legislature on how tointegrate health care delivery services and responsibilities relatingto the delivery of the services of the following departments andagencies into the system:   (1) The State Department of Health Care Services.   (2) The Department of Managed Health Care.   (3) The Department of Aging.   (4) The Department of Developmental Services.   (5) The Health and Welfare Data Center.   (6) The State Department of Mental Health.   (7) The State Department of Alcohol and Drug Programs.   (8) The Department of Rehabilitation.   (9) The Emergency Medical Services Authority.   (10) The Managed Risk Medical Insurance Board.   (11) The Office of Statewide Health Planning and Development.   (12) The Department of Insurance.   (13) The State Department of Public Health.   (d) The transition advisory group shall make recommendations tothe Governor, the Legislature, and the commissioner regardingresearch needed to support transition to the system.   140112.  (a)  The transition advisory group shall makerecommendations to the commissioner relative to how the system shallbe regionalized for the purposes of local and community-basedplanning for the delivery of high quality cost-effective care andefficient service delivery.   (b) The commissioner, in consultation with the Director of theOffice of Health Planning, shall establish up to 10 health planningregions composed of geographically contiguous counties grouped on thebasis of the following considerations:   (1) Patterns of utilization of health care services.   (2) Health care resources, including workforce resources.   (3) Health needs of the population, including public health needs.   (4) Geography.   (5) Population and demographic characteristics.   (6) Other considerations as determined by the commissioner, theDirector of the Office of Health Planning, or the chief medicalofficer.   (c) The commissioner shall appoint a director for each region.Regional planning directors shall serve at the will of thecommissioner and may serve up to two eight-year terms to coincidewith the terms of the commissioner.   (d) Each regional planning director shall appoint a regionalmedical officer.   (e) Compensation for officers of the system and appointees who areexempt from the civil service shall be established by the CaliforniaCitizens Commission in accordance with Section 8 of Article III ofthe California Constitution, and shall take into considerationregional differences in the cost of living.   (f) The regional planning director and the regional medicalofficer shall be subject to Title 9 (commencing with Section 81000)of the Government Code and shall comply with the qualifications foroffice described in subdivisions (c), (d), and (e) of Section 140100and subdivisions (j) and (k) of Section 140101.   140113.  (a) Regional planning directors shall administer thehealth planning region. The regional planning director shall beresponsible for all duties, the exercise of all powers andjurisdiction, and the assumptions and discharge of allresponsibilities vested by law in the regional agency. The regionalplanning director shall perform all duties imposed upon him or her bythis division and by other laws related to health care, and shallenforce execution of those provisions and laws to promote theirunderlying aims and purposes.   (b) The regional planning director shall reside in the region inwhich he or she serves.   (c) The regional planning director shall do all of the following:   (1) Establish and administer a regional office of the stateagency. Each regional office shall include, at minimum, an office ofeach of the following: Patient Advocacy, Health Care Quality, HealthPlanning, and Partnerships for Health.   (2) Appoint regional planning board members and serve as presidentof the board.   (3) Identify and prioritize regional health care needs and goals,in collaboration with the regional medical officer, regional healthcare providers, the regional planning board, and regional director ofPartnerships for Health pursuant to the priorities and goals of thesystem established by the commissioner.   (4) Regularly assess projected revenues and expenditures to ensurefiscal solvency of the regional planning system and advise thecommissioner of potential revenue shortfalls and the possible needfor cost controls.   (5) Assure that regional administrative costs meet standardsestablished by the division and seek innovative means to lower thecosts of administration of the regional planning office and those ofregional providers.   (6) Plan for the delivery of, and equal access to, high qualityand culturally and linguistically sensitive care and such care fordisabled persons that meets the needs of all regional residentspursuant to standards established by the commissioner.   (7) Seek innovative and systemic means to improve care quality andefficiency of care delivery and to achieve access to programs forall state residents.   (8)  Recommend means to and implement policies established by thecommissioner to provide support to persons displaced from employmentas a result of the initiation of the new system.   (9) Make needed revenue sharing arrangements so thatregionalization does not limit a patient's choice of provider.   (10) Implement procedures established by the commissioner for theresolution of disputes.   (11) Implement processes established by the commissioner andrecommend needed changes to permit the public to share concerns,provide ideas, opinions, and recommendations regarding all aspects ofthe system's policies.   (12) Report regularly to the public and, at intervals determinedby the commissioner and pursuant to this division, to thecommissioner on the status of the regional planning system, includingevaluating access to care, quality of care delivered, and providerperformance, and other issues related to regional health care needs,and recommending needed improvements.   (13) Identify or establish guidelines for providers to identify,maintain, and provide to the regional planning director inventoriesof regional health care assets.   (14) Establish and maintain regional health care databases thatare coordinated with other regional and statewide databases.   (15) In collaboration with the regional medical officer, enforcereporting requirements established by the system and makerecommendations to the commissioner, the Director of the Office ofHealth Planning, and the chief medical officer for needed changes inreporting requirements.   (16) Establish and implement a regional capital management planpursuant to the capital management plan established by thecommissioner for the system.   (17) Implement standards and formats established by thecommissioner for the development and submission of operating andcapital budget requests and make recommendations to the commissionerand the Director of the Office of Health Planning for needed changes.   (18) Support regional providers in developing operating andcapital budget requests.   (19) Receive, evaluate, and prioritize provider operating andcapital budget requests pursuant to standards and criteriaestablished by the commissioner.   (20) Prepare a three-year regional operating and capital budgetrequest that meets the health care needs of the region pursuant tothis division, for submission to the commissioner.   (21) Establish a comprehensive three-year regional planning budgetusing funds allocated to the region by the commissioner.   140114.  The regional medical officers shall do all of thefollowing:   (a) Administer all aspects of the regional office of health carequality.                                                              (b)Serve as a member of the regional planning board.   (c) In collaboration with the commissioner, the chief medicalofficer, the regional medical officer, regional planning boards, thepatient advocate of the Office of Patient Advocacy, regionalproviders, and patients, oversee the establishment of integratedservice networks, including those that provide services throughmedical technologies such as telemedicine, that include physicians infee-for-service, solo and group practice, essential community, andancillary care providers and facilities that pool and align resourcesand form interdisciplinary teams that share responsibility andaccountability for patient care and provide a continuum ofcoordinated high quality primary to tertiary care to all residents ofthe region.   (d) Assure the evaluation and measurement of the quality of caredelivered in the region, including assessment of the performance ofindividual providers, pursuant to standards and methods establishedby the chief medical officer to ensure a single standard of highquality care is delivered to all state residents.   (e) In collaboration with the chief medical officer and regionalproviders, evaluate standards of care in use at the time the systembecomes operative.   (f) Ensure a smooth transition toward use of standards based onclinical efficacy that guide clinical decisionmaking. Identify areasof medical practice where standards have not been established andcollaborated with the chief medical officer and health careproviders, to establish priorities in developing needed standards.   (g) Support the development and distribution of user-friendlysoftware for use by providers in order to support the delivery ofhigh quality care.   (h) Provide feedback to, and support and supervision of, healthcare providers to ensure the delivery of high quality care pursuantto standards established by the system.   (i) Collaborate with the regional Partnerships for Health todevelop patient education to assist consumers in evaluating andappropriately utilizing health care providers and facilities.   (j) Collaborate with regional public health officers to establishregional health policies that support the public health.   (k) Establish a regional program to monitor and decrease medicalerrors and their causes pursuant to standards and methods establishedby the chief medical officer.   (l) Support the development and implementation of innovative meansto provide high quality care and assist providers in securing fundsfor innovative demonstration projects that seek to improve carequality.   (m) Establish means to assess the impact of the system's policiesintended to assure the delivery of high quality care.   (n) Collaborate with the chief medical officer, the Director ofthe Office of Health Planning, the regional planning director, andhealth care providers in the development and maintenance of regionalhealth care databases.   (o) Ensure the enforcement of, and recommend needed changes in,the system's reporting requirements.   (p) Support providers in developing regional budget requests.   (q) Annually report to the commissioner, the public, the regionalplanning board, and the chief medical officer on the status ofregional health care programs, needed improvements, and plans toimplement and evaluate delivery of care improvements.   140115.  (a) Each region shall have a regional planning boardconsisting of 13 members who shall be appointed by the regionalplanning director. Members shall serve eight-year terms that coincidewith the term of the regional planning director and may bereappointed for a second term.   (b) Regional planning board members shall have resided for aminimum of two years in the region in which they serve prior toappointment to the board.   (c) Regional planning board members shall reside in the regionthey serve while on the board.   (d) The board shall consist of the following members:   (1) The regional planning director, the regional medical officer,the regional director of the Partnerships for Health, and a publichealth officer from one of the counties in the region.   (2) When there is more than one county in a region, the publichealth officer board position shall rotate among the public healthcounty officers on a timetable to be established by each regionalplanning board.   (3) A representative from the Office of Patient Advocacy.   (4) One expert in health care financing.   (5) One expert in health care planning.   (6) Two members who are direct care providers in the region, oneof whom shall be a registered nurse.   (7) One member who represents ancillary health care workers in theregion.   (8) One member representing hospitals in the region.   (9) One member representing essential community providers in theregion.   (10) One member representing the public.   (e) The regional planning director shall serve as chair of theboard.   (f) The purpose of the regional planning boards is to advise andmake recommendations to the regional planning director on all aspectsof regional health policy.   (g) Meetings of the board shall be open to the public pursuant tothe Bagley-Keene Open Meeting Act (Article 9 (commencing with Section11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of theGovernment Code).   140116.  The following conflict-of-interest prohibitions shallapply to all appointees of the commissioner or transition advisorygroup, including, but not limited to, the patient advocate, theDirector of the Healthcare Fund, the purchasing director, theDirector of the Office of Health Planning, the Director of thePayments Board, the chief medical officer, the Director ofPartnerships for Health, regional planning directors, and theInspector General:   (a) The appointee shall not have been employed in any capacity bya for-profit insurance, pharmaceutical, or medical equipment companythat sells products to the system for a period of two years prior toappointment.   (b) For two years after completing service in the system, theappointee may not receive payments of any kind from, or be employedin any capacity or act as a paid consultant to, a for-profitinsurance, pharmaceutical, or medical equipment company that sellsproducts to the system.   (c) The appointee shall avoid political activity that may createthe appearance of political bias or impropriety. Prohibitedactivities shall include, but not be limited to, leadership of, oremployment by, a political party or a political organization; publicendorsement of a political candidate; contribution of more than fivehundred dollars ($500) to any one candidate in a calendar year or acontribution in excess of an aggregate of one thousand dollars($1,000) in a calendar year for all political parties ororganizations; and attempting to avoid compliance with thisprohibition by making contributions through a spouse or other familymember.   (d) The appointee shall not participate in making or in any wayattempt to use his or her official position to influence agovernmental decision in which he or she or a