Tobacco Settlement Advisory Group Work Plan

1. Background
   In November 2000, the Orange County voters approved Measure H that created the Orange County Tobacco Settlement Fund for the County's share of all funds received from the Tobacco Litigation Master Settlement Agreement of 1998. The measure specifies that moneys shall be allocated and appropriated for health programs from the Orange County Tobacco Settlement Funds as follows:
   1. 19% to provide health care services for seniors and persons with disabilities including but not limited to, community based long term care, transportation services and in-home support services.
   2. 12% to tobacco prevention and control, including cessation services, for youth and adults to reduce smoking and the consumption of tobacco, other addiction programs, and community mental health programs and facilities.
   3. 20% to non-profit community clinics, mobile health clinics, university and hospital-affiliated clinics, so that children and families receive immunizations, primary, specialty and dental health care services.
   4. 23% to fund emergency medical services provided by emergency room physicians and emergency room on-call physician specialists to pay for non-paying patients, so that emergency rooms and trauma centers are not closed.
   5. 6% to hospitals within Orange County maintaining basic or comprehensive emergency services or trauma centers to cover the costs of providing charity care, proportionate to each hospital's charity care and bad debts as reported to the California Office of Statewide Health Planning and Development.
   6. 20% to the Sheriff's Department for public safety program and services, which may include, expansion of existing facilities and programs that provide mental, alcohol, and drug abuse treatment programs under the direction or supervision of the Sheriff.
2. General Guidelines
   1. MISSION
      The Health Care Tobacco Settlement Revenue Advisory Group will provide community recommendations on the distribution of Tobacco Settlement Revenue to the Health Care Agency in a manner that conforms to the requirements of Measure H.
   2. GUIDING PRINCIPLES
      1. Support for a Tobacco Control Strategy that will significantly reduce tobacco use among youth and adults, should be reflected in each proposal for funding as appropriate.
      2. Support for programs that promote known health care needs of the county that promote access and less barriers to quality health care and improve health and well being of all residents.
      3. Use of Tobacco Settlement Revenue to the known health care needs of the county, but having the flexibility to respond to new and changing threats to the health of the community.
      4. Promote healthy life styles through prevention, education and treatment.
      5. Support for programs that demonstrate effectiveness through evaluation of outcomes, and that incorporate "best practices" which have proven to be cost effective and efficient.
      6. Use of Tobacco Settlement Revenue funds to leverage funding, thereby maximizing new dollars to meet health care needs.
      7. Use of Tobacco Settlement Revenue to supplement, not supplant, existing health care revenue and programs.
      8. Collaboration with the entire county health community, and encouragement of public/private partnerships.
   3. Local Tobacco Settlement Revenues (TSR) will be used to reduce tobacco related illness and death, and to improve the health and well being of all people countywide-children, adolescents, adults and older adults.
3. Definitions
   1. The purpose of the Health Care Tobacco Settlement Advisory group is to provide community recommendations to the Health Care Agency Director on annual tobacco settlement funded program planning and oversight to verify that expenditures conform to the requirements of Measure H. The Tobacco Settlement Advisory Group is comprised of the following members:
      1. Physicians Community Representative—Michele Revelle
      2. Hospital Community Representative—Julie Puentes
      3. Children & Families Representative—Mike Ruane
      4. Orange County Community Clinic Representative—Isabel Becerra
      5. Mental Health Community Representative—Mary-Evelyn Bryden
      6. Senior Community Representatives—Ray Kaldenbach
      7. Alcohol & Drug Community Representative —Phil Falcetti
      8. Community Health Representative—John Stratman
      9. Disabled Community Representative
      10. Health Care Agency—Dave Riley
   2. The Tobacco Settlement Subcommittees shall include representation from community representatives, issue area experts and the Health Care Agency. The subcommittees can be expanded or reduced as needed to address specific issues. The suggested composition of the subcommittees includes but is not limited to the following:
      1. At least one Tobacco Settlement Advisory Group member
      2. At least one County representative with experience in the issue area
      3. Representation from the healthcare community at large in Orange County
      4. Health Care Agency Tobacco Settlement Coordinator
   3. The "Annual Tobacco Settlement Spending Plan" shall include descriptions of the proposed Tobacco Settlement Revenue programs and expenditures for a fiscal year.
   4. The "Quarterly TSR Fiscal Report" is a report of the expenditures by TSR funded programs and actual revenue.
   5. The "Annual Tobacco Settlement Program Report" is a report to the Board of Supervisors that includes summaries of accomplishments and outcome evaluations of TSR funded programs in the preceding fiscal year.

TSR Advisory group members shall meet regularly and observe the HCA Code of Conduct. Members that miss three or more meetings in a twelve-month period may be replaced upon the recommendations of the Advisory Group.

Subcommittee members are expected to regularly attend scheduled meetings, accurately represent community needs, and adhere to the Health Care Agency's Code of Conduct.

4. Procedure
   1. Program Planning
      1. Continuing Programs
         1. The Tobacco Settlement Advisory Group shall make recommendations by majority vote on continuing programs based on program outcomes and the guiding principles.
         2. Spending Plan funding recommendations shall require a majority (6 or more) vote to determine the position of the TSR Advisory Group.
         3. The target date for completing evaluations and recommendations is April.
      2. Annual Tobacco Settlement Spending Plan
         1. The Tobacco Settlement Advisory Group shall make recommendations for the Annual Tobacco Settlement Spending Plan based on the guiding principles and community need by majority vote.
         2. HCA will draft the Annual Tobacco Settlement Spending Plan. The plan will be developed with the input from the Advisory Group and shall address the healthcare needs in Orange County. The target date for the Annual Tobacco Settlement Spending Plan is June.
      3. Needs Assessment
         1. Tobacco Settlement Subcommittees shall assist in identifying service gaps and community needs within the funding categories of Measure 'H.".
   2. Program Implementation and Monitoring
      1. The Tobacco Settlement Subcommittees and Advisory Group shall assist the Health Care Agency in the implementation of the approved programs. The assistance may include but is not limited to participating on evaluation panels, attending meetings, coordinating community events, publicizing program services and other functions as needed.
      2. The Health Care Agency is responsible for contract administration related to the Annual Tobacco Settlement Spending Plan.
      3. The Health Care Agency shall share program updates with the Tobacco Settlement Advisory Group on a regular basis. Updates shall include program milestones and the Quarterly TSR Fiscal Report.
      4. The Tobacco Settlement Advisory Group shall review adjustments to the Tobacco Settlement Spending Plan if necessary in response to fluctuations in the actual TSR received.
   3. Program Evaluation
      1. The Health Care Agency shall share TSR program outcome reports with the Tobacco Settlement Advisory Group.
      2. The Tobacco Settlement Advisory Group will review the program outcomes for effectiveness, efficiency, consistency with Measure 'H' and the guiding principles. This information will be used in program planning for subsequent years as described above.
      3. The Tobacco Settlement Advisory Group shall provide input on the Annual Tobacco Settlement Program Report to the Board of Supervisors.
      4. The target date for the Annual Tobacco Settlement Program Report is Fall.