Scan Health Plan

“The sole member of the organization is SCAN Group, a California nonprofit public benefit corporation.”

“The sole member has the power to appoint the members of the board of directors.”

“The Form 990 is prepared by BDO USA, LLP working in conjunction with SCANs Finance department. SCAN Health Plans Director of Accounting- has direct responsibility for this effort, subject to supervision by the Vice President and Controller of SCAN Health Plan. After an initial draft of the Form 990 is prepared, it is circulated for review and comment by relevant members of the executive team who have responsibility for and/or knowledge regarding the various matters disclosed and/or described in the form. The General Counsel, in particular, reviews the Form 990 and ensures accuracy of descriptions and that disclosure is complete. The draft Form 990 is reviewed in pertinent part by the Compensation Committee of the Board; the Form 990 is reviewed in its entirety by the Audit and Compliance Committee of the Board of Directors of SCAN Group and all members of the Board of Directors after it is prepared for filing, but prior to filing.”

“SCAN Health Plan regularly and consistently monitors and enforces compliance with its Conflict of Interest policy through annual circulation of a Conflict of Interest questionnaire which all members of the Board of Directors, officers and members of executive management must complete and sign. In addition, there is annual mandatory compliance education and training. SCANs Compliance Department is responsible for enforcement of SCANs robust compliance program and SCANs Policies and Procedures. Members of the Executive Team also have responsibility for enforcement. The legal department of SCAN Group reviews all contractual relationships entered into by the organization and SCANs General Counsel is responsible for monitoring the Conflicts of Interest questionnaire. The legal department of SCAN Group monitors and enforces adherence to these policies on an ongoing basis.”

“15a: The process for determining the compensation of the Chief Executive Officer (CEO) of SCAN Health Plan is conducted by the Compensation Committee of the Board of Directors of SCAN Group, all the voting members of which are independent persons. In determining the compensation of the CEO, the Compensation Committee works with and relies upon the counsel and expertise of Ernst & Young, a consultant with well- established experience and expertise in the area of nonprofit organization executive compensation and compliance with the intermediate sanctions requirements applicable to such compensation. Ernst & Young provides an Executive Compensation Report to the Compensation Committee each year which furnishes the basis for determining the CEOs compensation package during the following year. The Ernst & Young Executive Compensation Report is based on a review of the executive compensation practices of a variety of organizations considered comparable to SCAN Health Plan based upon certain industry standard metrics. The Compensation Committee deliberates on the issue of the CEOs compensation package in consideration of the Ernst & Young Executive Compensation Report. Questions are asked of, and answered by, Ernst & Young, regarding such report and other matters relevant to such package. Based on such deliberations, the Compensation Committee makes a recommendation to the Board of Directors of SCAN Group regarding the compensation package for the following year. The full Board of Directors of SCAN Group deliberates on and then votes on such recommendation; the Chief Executive Officer is recused for the entirety of such deliberations and vote. The minutes of the Compensation Committee and the Board of Directors for these meetings are prepared substantially contemporaneously and substantiate such deliberations and decisions. 15b: The process for determining the compensation of officers and key employees of SCAN Health Plan is conducted by the Human Resources Department and Chief Executive Officer (CEO) of SCAN Health Plan, with the approval of the Compensation Committee of the Board of Directors of SCAN Group; all of the voting members of the Committee are independent persons. In determining each employee's compensation, the Human Resources Department and Compensation Committee work with and rely upon the counsel and expertise of Ernst & Young, a consultant with well-established experience and expertise in the area of nonprofit organization executive compensation and compliance with the intermediate sanctions requirements applicable to such compensation. Ernst & Young provides an "Executive Compensation Report" to the Human Resources Department each year which furnishes the basis for the establishment of such employees' compensation package during the following year. The Ernst & Young Executive Compensation Report is based on a review of the executive compensation practices of a variety of organizations considered comparable to SCAN Health Plan and SCAN Group based on various metrics. The Chief Executive Officer (CEO) makes a recommendation to the Compensation Committee with respect to each employees compensation package in light of the Ernst & Young Executive Compensation Report. At the Compensation Committee meeting addressing such matters, questions are asked of, and answered by Ernst & Young, regarding their report and other matters relevant to the package; pursuant to their deliberations, the Compensation Committee makes a decision regarding the compensation package for such employees for the following year. The minutes of the Compensation Committee for this meeting are prepared substantially contemporaneously and substantiate such deliberations and decisions.”

“SCAN Health Plans governing documents and conflict of interest policy are not made available to the public. SCAN Health Plans audited financial statements are publicly available through the Department of managed health cares website and tax returns are available on request.”

“SCAN Health Care Services: SCAN Health Plan has a culture of quality and a long history of fulfilling our mission: Keeping seniors healthy and independent. As a Medicare Advantage and Prescription Drug Plan (MAPD) in California, SCAN collaborates with a network of delegated providers to offer Medicare and Medi-Cal covered health and behavioral healthcare and additional supplemental benefits. Our member-centric model of care ensures quality, individualized care for all members, including members with special needs such as members eligible for both Medicare and Medicaid, members with chronic conditions and frail members with functional deficits. The Health Care Services programs at SCAN are evidence-based and aligned with geriatric best practices. They include complex care management, advanced illness management, memory program, disease management and care navigation and coordination. The programs are aligned with the Institute for Healthcare Improvements Triple Aim and seek to ensure: - A safe and satisfying health care experience - Improved health outcomes for individuals and populations - Access and affordability for our members In general, population based quality activities are performed by SCANs Health Care Services department which includes a dedicated and highly qualified team of Registered Nurses and Masters prepared social workers, supported by an interdisciplinary team of nurses, social workers, gerontologists, a Board Certified Geriatrician, a Behavioral Health Specialist, and a Clinical Pharmacist. SCAN Health Plan supported the formation of The SCAN Foundation in 2007 with a contribution of $205 million; for calendar year 2015 the Foundation awarded grants in the amount of $5,951,203 and incurred program expenses in the amount of $11,670,129. In addition, SCAN Health Plan participates in numerous activities related to the care of seniors which provide significant community benefits including but not limited to the following: 1. Change a Life Foundation (Grant): One time grants to members and Independence At Home (IAH) clients for needed services not available otherwise (ramps, refrigerators, extensive dental work, bathroom modifications, wheelchair ramps, chair lifts). 2. Connecting Provider to Home: SCAN staff work with 4 medical groups to provide in home support through social worker and community health worker TEAMS TO ENCHANCE integration between the home and the physician. Serves members of other health plans as well as SCAN. Tests model that can be disseminated to multiple medical groups/health plans. 3. Council on Aging; Adopt-a-Senior: Provides holiday gifts for older and/or disabled residents of care facilities in Orange County. 4. Special Needs Plans Training: Conducted 2 hour webinar for providers on CMS Services for Special Needs Plan requirements, best practices, and how to be audit ready. 5. Provider education on compliance requirements to protect members from inappropriate denials. Annually, SCAN offers four 1-hour training sessions for medical groups to assist them in better practices around service denials. 6. Presentation: American Health Insurance Plans (AHIP) Conference on Medicare: Presentation to AHIP Medicare Conference about SCAN Health Risk Assessment (HRA) process. 7. Industry Collaboration Effort (ICE) Committee Participation: Approximately 27 staff members serve on 11 different Industry Collaboration Effort committees. These committees share best practices across health plans, including topics of Maximum Out of Pocket, Grievances and Appeals Improvement, Claims Standardization. Participation is on a volunteer basis. 8. Joint Presentation at ICE Conference-ICE Maximum Out of Pocket team: Presentation at 2015 ICE Conference: SCAN, along with the Centers for Medicare Services, Humana and Sharp Healthcare participated in a CMS panel session on the Organization, Determinations, Appeals and Grievances (ODAG) universe tables. Provided reminders and best practices for all delegates and other hea”

“Independence at Home: SCAN'S MISSION OF KEEPING SENIORS HEALTHY AND INDEPENDENT IS NOT LIMITED TO SCAN MEMBERS. SCAN RECOGNIZES ITS RESPONSIBILITY TO ENHANCE THE QUALITY OF LIFE FOR ALL THOSE IN THE COMMUNITES WE SERVE. TO THAT END, SCAN SPONSORS AND PROMOTES INNOVATIVE GERIATRIC RESEARCH, INVESTS IN SIGNIFICANT COMMUNITY EDUATION AND OUTREACH EFFORTS, AND SUPPORTS LIKE-MINDED COMMUNITY ORGANIZATIONS THROUGH GRANTS. THE CORNERSTONE OF SCAN'S COMMUNITY ENGAGEMENT COMES THROUGH INDEPENDENCE AT HOME (IAH). THROUGH THE PROGRAMS RUN BY IAH, SCAN HAS CONNECTED WITH THOUSANDS OF SENIORS AND CAREGIVERS ACROSS ITS SERVICE AREAS. TODAY'S INDEPENDENCE AT HOME PROGRAMS ARE SUPPORTED BY FUNDING THROUGH THE STATE AND FROM SCAN HEALTH PLAN. THE PROGRAMS ARE GEARED TO SUPPORTING THE UNDERSERVED, FRAIL AND DISABLED SENIORS IN OUR COMMUNITY. IAH'S HALLMARK PROGRAMS ARE: -MULTIPURPOSE SENIOR SERVICES PROGRAM (MSSP): THIS PROGRAM PROVIDES LONG-TERM IN-HOME CARE MANAGEMENT FOR ADULTS 65 PLUS WHO QUALIFY FOR MEDI-CAL. THIS PROGRAM WAS FIRST STARTED IN 1977. -SUPPORTIVE SERVICES PROGRAM (SSP): THIS PROGRAM INCLUDES CARE MANAGEMENT, PLANNING, AND DAILY LIVING ASSISTANCE SERVICES FOR FUNCTIONALLY IMPAIRED OLDER ADULTS. -LOS ANGELES COUNTY'S LINKAGE PROGRAM: THIS PROGRAM PROVIDES CARE MANAGEMENT, CARE PLANNING, COMPREHENSIVE INFORMATION, AND SERVICE ARRANGEMENTS FOR FRAIL, AT-RISK ADULTS. -INNERLINKS ADVANTAGE (IA): THIS PROGRAM PROVIDES IN-HOME MENTAL HEALTH SUPPORT. -CALIFORNIA COMMUNITY TRANSITIONS (CTT): THIS PROGRAM ASSISTS WITH THE SAFE TRANSITION FROM HEALTHCARE FACILITIES BACK TO COMMUNITY LIVING. -FAMILY CAREGIVER SUPPORT PROGRAM (FCSP): THROUGH THIS PROGRAM, FAMILY CAREGIVERS RECEIVE INFORMATION, TRAINING, COUNSELING, CARE MANAGEMENT, RESPITE AND COMMUNITY RESOURCE REFERRALS. IN 2015, SCAN COMBINED ITS COMMUNITY GIVING PROGRAM AND COMMUNITY OUTREACH PROGRAM WITH INDEPENDENCE AT HOME. SCAN COMMUNITY GIVING PROGRAM: SCAN'S COMMUNITY GIVING (CG) PROGRAM IS FOCUSED ON MEETING AN INDIVIDUAL'S BASIC NEEDS INCLUDING NUTRITION, SHELTER, HEALTH AND SOCIALIZATION, AND ON ENHANCING AN INDIVIDUAL'S ABILITY TO REMAIN INDEPENDENT IN THEIR OWN COMMUNITY. THIS IS ACCOMPLISHED THROUGH ONE-TIME OPERATING GRANTS. THE SCAN COMMUNITY GIVING COMMITTEE IDENTIFIES ORGANIZATIONS WHOSE MISSION ALIGNS WITH THE PROGRAM PRIORITIES. AS A RESULT OF THIS APPROACH, THE MAJORITY OF GRANTEES ARE IDENTIFIED AND CONTACTED BY OUR STAFF. POLICIES AND PROCEDURES: A. IDENTIFICATION AND VETTING OF POTENTIAL PROGRAM GRANTEES - DIRECTOR, COMMUNITY OUTREACH, COLLABORATES WITH VARIOUS SCAN HEALTH PLAN DEPARTMENTS (I.E., HEALTH CARE SERVICES, AND INDEPENDENCE AT HOME) AND REPUTABLE AGENCIES TO IDENTIFY PROSPECTIVE GRANTEE ORGANIZATIONS. THE PROSPECTIVE GRANTEES UNDERGO THE CG VETTING PROCESS AND ARE MEASURED AGAINST THE FOLLOWING CRITERIA: 1) ALIGNMENT WITH THE SCAN HEALTH PLAN MISSION; 2) MUST BE A VERIFIED NONPROFIT OR GOVERNMENTAL AGENCY WITH TAX-EXEMPT STATUS; AND, 3) THE ORGANIZATION MUST BE AT LEAST TWO YEARS OLD. SUCCESSFUL CANDIDATES ARE ADDED TO THE LARGER SCAN HEALTH PLAN GRANTEE POOL. B. SHORT LISTING POTENTIAL GRANTEE - DIRECTOR, COMMUNITY OUTREACH AND MANAGER, COMMUNITY OUTREACH AND GIVING, USE VARIOUS METHODS, INCLUDING OUTBOUND CALLS, INTERNET RESEARCH, AND INDUSTRY RATINGS TO REVIEW THE POTENTIAL GRANTEE POOL AND GENERATE A SHORTLIST. C. EVALUATION AND SELECTING OF GRANTEES BY THE COMMUNITY GIVING COMMITTEE (CGC) - THE CGC IS A NINE-MEMBER COMMITTEE REPRESENTATIVE OF ALL LEVELS OF MANAGEMENT AND CHAIRED BY THE VICE-PRESIDENT OF INDEPENDENCE AT HOME (IAH). THE CGC MEETS ON A QUARTERLY BASIS AND ITS ROLE IS TWOFOLD: 1) EVALUATE, SELECT, AND DECIDE THE AMOUNT TO BE AWARDED TO THE GRANTEE ORGANIZATIONS, AND, 2) STEER THE CG PROGRAM. THE CGC BASES ITS DECISION TO MAKE AWARDS ON THE INFRASTRUCTURE OF THE GRANTEE ORGANIZATION, AND ITS PERCEIVED ABILITY TO EFFECTIVELY AND EFFICIENTLY IMPACT THE LIVES OF SENIORS AND CONTINUE A SUSTAINABLE RELATIONSHIP. D. GRANTEE OUTREACH - SUBSEQU”

“Provider Integration Program: SCAN has long recognized the importance of the provider network in supporting our mission to keep seniors healthy and independent and that our members highly value their relationship with their physicians. This appreciation led SCAN to charter the SCAN Provider Integration Steering Committee, with membership coming from the clinical and operational leaders of our key physician groups and health systems. A main area of focus for this effort has been quality improvement, supporting 5 Star performance metrics. SCAN and the provider organization leaders recognize that if we are to succeed in the CMS Medicare Advantage 5 Star program we must do so as a collective system. We share 5 Star metrics data that highlights individual physician group performance on HEDIS and Part D quality measures, supporting identification of best practices within the SCAN provider network. We invite the providers to share their best quality improvement practices with their colleagues from other provider organizations, hosting a webinar series several times a year with a best practice organization leading the webinar, sharing their approaches and lessons learned. We have also worked with UCLA Geriatric Medicine researchers to promote best practice identification and implementation in the areas of end of life care and chronic disease management. This effort culminated in a process within which the Provider Integration physician groups were supported in implementing an identified best practice. UCLA presented the results of this research at the Gerontological Society of America and the American Association Public Health Association annual national meetings. SCAN supports advances in care for seniors by working closely with our provider networks to support their efforts, knowing that the work they do to improve systems and processes of care will benefit their entire patient population. For the year ending December 31, 2015 the Provider Integration Program incurred $400,397 in program expenses.”

“On November 30, 2015, SCAN Health Plan transferred $75 million to SCAN Group to FUND STRATEGIC PROJECTS RELATED TO SCAN'S MISSION, INCLUDING CHARITABLE PROGRAMS. SCAN Health Plan is not obligated to make future transfers.”

“Description:medical services total fees:1921369886”

“Description:other fees total fees:26446899”