REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
July 27, 2021
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Amendment to Capitated Primary Care Provider Agreement with Inland Empire Health Plan and IEHP Health Access
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 7 to Agreement No. 17-846 with Inland Empire Health Plan and IEHP Health Access, to add billing codes for reimbursement for Behavioral Health Integration and Multidisciplinary Medication Assisted Treatment, retroactively effective June 1, 2021 through December 31, 2022; and Direct the Clerk of the Board to maintain confidentiality of Amendment No. 7 pursuant to Health and Safety Code Section 1457(c)(1).
(Presenter: William L. Gilbert, Director, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this recommended agreement amendment will not result in the use of Discretionary General Funding (Net County Cost). These billing codes allow for reimbursement and thus result in revenue for Arrowhead Regional Medical Center (ARMC) based on a capitation system that uses a value-based methodology for the Health Homes Program participation. Sufficient appropriation and revenue have been included in ARMC’s 2021-22 budget and will be included in the 2022-23 recommended budget.
BACKGROUND INFORMATION
This recommended agreement amendment adds billing codes for reimbursement of Behavioral Health Integration (BHI) and Multidisciplinary Medication Assisted Treatment (MMAT) services. BHI and MMAT are designed to support whole person care by incorporating the treatment of behavior health conditions and opioid use disorders into a primary care setting. Billing codes have been added to allow for the billing and reimbursement of qualified behavioral health services provided to patients. Approval of this item provides for the safety, health, and social service needs of County residents by offering healthcare services to Inland Empire Health Plan and IEHP Access (collectively referred to as “IEHP”) members.
On November 14, 2017 (Item No. 6), the Board of Supervisors (Board) approved Agreement 17-846 with IEHP to provide primary healthcare services to IEHP members and to be reimbursed on a capitation system. Capitation is a fixed amount of money per patient per unit of time paid for health care services. In the Agreement, the capitation system is based on the number of IEHP Medi-Cal patients assigned to ARMC primary care clinics.
On August 7, 2018 (Item No. 6), the Board approved Amendment No. 1 to Agreement 17-846 to modify the compensation rates to be reimbursed to the County for healthcare services to IEHP members.
On December 18, 2018 (Item No. 13), the Board approved Amendment No. 2 to Agreement 17-846 to update the capitation rates and to add Health Homes Program participation, effective January 1, 2019 through December 31, 2020.
On May 21, 2019 (Item No. 13), the Board approved Amendment No. 3 to Agreement 17-846 to add Behavior Health Integration and Multidisciplinary Medical Assisted Treatment pilot programs participation, effective July 1, 2019, with no change to the contract term of January 1, 2018 through December 31, 2022.
On May 19, 2020 (Item No. 13), the Board approved Amendment No. 4 to Agreement 17-846 to add billing codes for reimbursement for Multidisciplinary Medical Assisted Treatment for selected IEHP network providers, effective May 19, 2020 through December 31, 2022.
On December 15, 2020 (Item No. 16), the Board approved Amendment No. 5 to Agreement 17-846, to extend ARMC’s participation in the Health Homes Program through December 30, 2021.
On January 26, 2021, (Item No. 14), the Board approved Amendment No. 6 to Agreement 17-846 to modify compensation rates to be reimbursed to ARMC under the Health Homes Program.
IEHP presented the new billing codes and amendment to ARMC in May 2021. This is the first date available for presentation following the required administrative, operational, and legal reviews. Board approval at this time will not impact services provided to ARMC or IEHP patients.
Pursuant to Health and Safety Code section 1457(c)(1) specific terms related to the rates of payment for health care services are not immediately subject to laws related to public records; therefore, the Clerk of the Board is directed to maintain confidentiality of Amendment No. 7.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387- 5455) on June 8, 2021; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-6150) on June 9, 2021; Finance (Yael Verduzco, Administrative Analyst, 387-5285) on June 16, 2021; and County Finance and Administration (Matthew Erickson, County Chief Financial Officer, 387-5423) on June 28, 2021.