REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 25, 2024
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
JOSHUA DUGAS, Director, Department of Public Health
SUBJECT
Title
Amendment to Enhanced Care Management Provider Agreement with Inland Empire Health Plan
End
RECOMMENDATION(S)
Recommendation
1. Approve Amendment No. 3 to Enhanced Care Management Provider Agreement No. 21-983 with Inland Empire Health Plan, to increase the reimbursement rates to San Bernardino County for the provision of Enhanced Care Management services, and extend the agreement by an additional year, for the total agreement period of January 1, 2022 through June 30, 2025.
2. Direct the Clerk of the Board of Supervisors to maintain confidentiality of Amendment No. 3 to Agreement No. 21-983 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
Improve County Government Operations.
Operate in a Fiscally-Responsible and Business-Like Manner.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
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 item will result in additional revenue paid by the Inland Empire Health Plan (IEHP) to Arrowhead Regional Medical Center (ARMC), the Department of Behavioral Health (DBH), and Department of Public Health (DPH) to offset the cost of providing Enhanced Care Management (ECM) services. Approval of any necessary budget adjustments are not being requested at this time, but, if necessary, will be recommended to the Board of Supervisors (Board) for review and approval.
BACKGROUND INFORMATION
Amendment No. 3 (Amendment) to Agreement No. 21-983 (Agreement) increases the IEHP per member per month reimbursement rates for San Bernardino County (County) residents enrolled in the ECM program and extends the Agreement for an additional year. This Amendment will enable the County to optimize a whole-person care approach through continuation of the ECM program. and address a County goal to provide for the safety, health, and social service needs of County residents.
Beginning January 1, 2022, the County implemented the ECM program as established by the California Department of Health Care Services. The purpose of the ECM program is to provide a holistic care approach to address the medical and non-medical circumstances of high-need Medi-Cal beneficiaries at their County medical location of preference. High-need Medi-Cal beneficiaries include individuals who are homeless and/or have serious mental illnesses, children with complex medical conditions, justice-involved populations with significant clinical needs, and the growing aging population. Based on the needs and medical location of preference of the IEHP member, an ECM team is assigned from DBH, ARMC, and/or DPH to provide multi-disciplinary services to improve the patient’s overall health outcomes and address various social determinants of health.
On December 14, 2021 (Item No. 17), the Board approved the Agreement with IEHP that established capitation payment rates and set the parameters for the County departments, including ARMC, DBH, DPH, and the Office of Homeless Services (OHS), to receive incentive funding for providing ECM and community supports services to high-need IEHP members.
On March 29, 2022 (Item No. 13), the Board approved Amendment No. 1 to the Agreement with IEHP to increase reimbursement rates, with no change to the term of January 1, 2022, through June 30, 2024.
On February 28, 2023 (Item No. 7), the Board approved Amendment No. 2 to the Agreement with IEHP to increase reimbursement rates, with no change to the term of January 1, 2022, through June 30, 2024.
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 of Supervisors is directed to maintain confidentiality of the Amendment.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Adam Ebright, and Dawn Martin, Deputies County Counsel, 387-5455) on June 11, 2024; Behavioral Health (Georgina Yoshioka, Director, 252-5142) on June 10, 2024; Public Health (Joshua Dugas, Director, 387-9146) on June 11, 2024; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on June 11, 2024; Finance (Paul Garcia, Administrative Analyst, 386-8393, Carl Lofton, Administrative Analyst, 387-5404, and Jenny Yang, Administrative Analyst, 387-4884) on June 13, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238, Robert Saldana and Valerie Clay, Deputies Executive Officer, 387-5423) on June 13, 2024.