Medi-Cal, Privider Rates, Confidentiality
Q: Can a Medi-Cal fiscal intermediary which is a public agency [created by a County BOS], maintain that its provider rates are proprietary, confidential? The rates in question are not to be confused with CMAC hospital rates.
A: Although I am not familiar with the type of Medi-Cal fiscal intermediary you reference below, the first step is to determine if it is a local agency for the purposes of the Public Records Act. The term “local agency” is defined at Government Code section 6252 and includes such entities as cities, counties, school districts, and any other “local public agency.” It also includes any entities that qualify as “legislative bodies” under subdivisions c and d of section 54952 of the Government Code. Those sections define a “legislative body” as follows:
“(c) (1) A board, commission, committee, or other multimember body that governs a private corporation, limited liability company, or other entity that either:
(A) Is created by the elected legislative body in order to exercise authority that may lawfully be delegated by the elected governing body to a private corporation, limited liability company, or other entity.
(B) Receives funds from a local agency and the membership of whose governing body includes a member of the legislative body of the local agency appointed to that governing body as a full voting member by the legislative body of the local agency.”
(d) The lessee of any hospital the whole or part of which is first leased pursuant to subdivision (p) of Section 32121 of the Health and Safety Code after January 1, 1994, where the lessee exercises any material authority of a legislative body of a local agency delegated to it by that legislative body whether the lessee is organized and operated by the local agency or by a delegated authority.
If the Medi-Cal fiscal intermediary is a local agency for the purposes of the Public Records Act, the law provides that records created, owned or maintained by that entity are public records, unless one of the Act’s many exemptions to disclosure apply. As a first step, I would suggest that you send the entity a written request for records reflecting the information you seek. A sample Public Records Act request can be found on CFAC’s web site. If your request is in writing and the entity decides it is going to withhold the requested records, the entity is required to respond to you within 10 days, citing the exemptions upon which it is relying. Once you know which exemptions they’re relying on, you can better evaluate your claim to the records. This all assumes, of course, that the intermediary is a local agency under the PRA.