REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
February 24, 2026
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Non-Financial Federally Qualified Health Center Referral Agreement with Community Health Systems, Inc.
End
RECOMMENDATION(S)
Recommendation
Approve non-financial Federally Qualified Health Center Referral Agreement with Community Health Systems, Inc., including non-standard terms, for inpatient and outpatient specialized services for the term of February 24, 2026 through February 23, 2031.
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost) as this non-financial Referral Agreement (Agreement) with Community Health Systems, Inc. (CHSI) does not include any associated costs. Each facility will be responsible for billing the applicable third-party payors for the costs associated with patient care provided at the respective facilities.
BACKGROUND INFORMATION
CHSI operates a Federally Qualified Health Center (FQHC) providing outpatient medical services to uninsured, economically disadvantaged, and medically vulnerable populations. As a condition of operating as an FQHC, CHSI is required to maintain referral arrangements with hospitals and other healthcare facilities to ensure patients can receive medically necessary services not available within the FQHC setting.
Arrowhead Regional Medical Center (ARMC) is a 456-bed general acute care hospital serving the residents of San Bernardino County, including operation of a Level I Trauma Center, Comprehensive Stroke Center, Burn Center, and multiple specialty outpatient clinics.
This Agreement establishes a formal referral relationship under which ARMC will accept patients referred by CHSI for medically necessary inpatient hospital services and specialized outpatient care, subject to ARMC capacity and applicable admission criteria. These services are utilized when CHSI patients require hospital-based treatment or specialty care beyond the scope of services available at the FQHC. ARMC will accept referred patients regardless of insurance status or ability to pay, consistent with applicable federal requirements, including Emergency Medical Treatment and Active Labor Act.
The Agreement with CHSI was negotiated and include the following non-standard contract terms:
1. The County is required to indemnify CHSI for claims that result solely from or attributable solely to the acts or omissions of the County or its agents in the performance of the Agreement.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify CHSI, the County could be contractually waiving the protection of sovereign immunity. Claims that may otherwise be barred against the County, time-limited, or expense-limited could be brought against CHSI without such limitations and the County could be responsible to defend and reimburse CHSI for costs, expenses, and damages.
2. CHSI’s general indemnity obligation is limited to claims that result solely from or attributable solely to the acts or omissions of CHSI or its agents in the performance of the Agreement.
• The County standard contract general indemnity provision requires the contractor to indemnify, defend, and hold County harmless from third-party claims arising out of the acts, errors or omissions of any person.
• Potential Impact: CHSI's indemnity obligation is more limited compared to the standard County general indemnity obligation. In the event a claim arises that falls outside the scope of CHSI's limited indemnity obligation, the County could be financially responsible for the defense of the claim and any resulting judgment/settlement.
ARMC recommends approval of this Agreement, including the non-standard terms, which will expand access to medically necessary hospital and specialty services for underserved and vulnerable populations in the County.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5455) on February 20, 2026; Finance (Chen Wu, Finance Budget Officer, 580-3165) on January 30, 2026; and County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on February 2, 2026.