REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
July 23, 2024
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Revenue Provider Services Agreement with LaSalle Medical Associates for Outpatient Ancillary and Specialty Medical Services
End
RECOMMENDATION(S)
Recommendation
1. Approve Revenue Provider Services Agreement with LaSalle Medical Associates for the reimbursement of providing outpatient ancillary and specialty medical services to LaSalle Medical Associates members, retroactively, effective January 1, 2023, through December 31, 2025.
2. Direct the Clerk of the Board of Supervisors to maintain the confidentiality of the Provider Services Agreement pursuant to Health and Safety Code Section 1457(c)(1).
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 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 item will not result in the use of Discretionary General Funding (Net County Cost). This revenue agreement will be utilized to ensure reimbursement to Arrowhead Regional Medical Center (ARMC) from LaSalle Medical Associates (LaSalle) for providing outpatient care to managed care plan members who are assigned to LaSalle. Adequate appropriation and revenue are included in the ARMC 2024-25 budget and will be included in the 2025-26 recommended budget.
BACKGROUND INFORMATION
Health plans contract with Independent Practice Associations (IPA), such as LaSalle, for the provision of care for their managed care members. The recommended revenue agreement will provide reimbursement from LaSalle to ARMC for outpatient care services provided by ARMC to managed care plan members who are assigned to LaSalle. An IPA is an association of independent physicians that contract with health plans to provide services to the health plan’s members. Generally, under the contracts between the health plans and the IPAs, including LaSalle, the IPAs are required to directly provide healthcare services to their assigned members, or pay for the services when otherwise not available through the IPA. In cases where LaSalle is unable to provide the healthcare services to the assigned member, LaSalle must contract and pay other healthcare providers to provide such care to the member.
The agreement is presented to the Board of Supervisors at the earliest opportunity, following completion of all negotiations.
ARMC recommends approval of the agreement as it will ensure reimbursement to the County for outpatient care services provided at ARMC to LaSalle members, retroactively effective January 1, 2023 through December 31, 2025, and will allow ARMC to operate in a fiscally-responsible and business-like manner.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5455) on June 17, 2024; Risk Management (Gregory Ustaszewski, Staff Analyst II, 386-9008) on May 9, 2024; Finance (Chen Wu, Finance Budget Officer, 580-3165) on July 1, 2024; Finance (Jenny Yang, Administrative Analyst, 387-4884) on July 2, 2024; and County Finance and Administration (Paloma Hernandez-Barker, Deputy Executive, 387-5423) on July 3, 2024.