REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 10, 2025
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
Master Employment Agreement for the Enhanced Care Management Program
End
RECOMMENDATION(S)
Recommendation
1. Approve Master Employment Agreement for the following positions, to support the Enhanced Care Management program to hire new and retain existing program staff, as detailed in Attachment A, under the California Advancing and Innovating Medi-Cal program, effective upon execution through June 30, 2028, with the option to extend the term for a maximum of three successive one-year periods:
a. Enhanced Care Management Care Coordinator
b. Justice Involved Medi-Cal Specialist
c. Enhanced Care Management Secretary
d. Enhanced Care Management/Justice Involved Community Health Worker
e. Enhanced Care Management Licensed Vocational Nurse Care Manager
f. Enhanced Care Management Alcohol and Drug Counselor
g. Enhanced Care Management Automated Systems Technician
h. Enhanced Care Management Informatics Analyst
i. Enhanced Care Management Clinical Therapist
j. Enhanced Care Management Community Health Worker Supervisor/Trainer
k. Justice Involved Medi-Cal Specialist Supervisor
l. Enhanced Care Management Automated Systems Analyst
m. Enhanced Care Management Program Manager
n. Enhanced Care Management Nursing Program Coordinator
o. Enhanced Care Management Nurse Informatics Coordinator
p. Enhanced Care Management Healthcare Program Administrator
q. Enhanced Care Management Program Manager II
r. Enhanced Care Management Community Health Worker II/Lead
s. Enhanced Care Management Behavioral Health Care Manager
t. Enhanced Care Management Registered Nurse Care Manager
u. Enhanced Care Management Business Systems Analyst
v. Enhanced Care Management Program Analyst
w. Enhanced Care Management/Justice Involved Office Assistant
2. Authorize the ARMC Chief Executive Officer, Director of the Department of Behavioral Health, or the Director of the Department of Public Health to execute individual Employment Agreements, effective upon execution through June 30, 2028, amendments to the individual Employment Agreements for the Enhanced Care Management program, under the California Advancing and Innovating Medi-Cal program, to exercise the option to extend the term for a maximum of three successive one-year periods, and to make non-substantive changes to the individual employment agreements, on behalf of the County, subject to review by County Counsel.
(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 impact Discretionary General Funding (Net County Cost). The California Department of Health Care Services (DHCS) provides funding to Medi-Cal Managed Care Plans (MCPs), such as Inland Empire Health Plan (IEHP), for the provision of the California Advancing and Innovating Medi-Cal (CalAIM) program, which includes the Enhanced Care Management (ECM) program. ECM expenses are funded by IEHP under an agreement with Arrowhead Regional Medical Center (ARMC), the Department of Behavioral Health (DBH), and the Department of Public Health (DPH) for provision of services to eligible IEHP members. Should ECM program expenses exceed funding provided under the IEHP agreement, ARMC, DBH, or DPH will utilize department funding to offset the remaining costs. In the event that IEHP ceases provision of funding, the ECM program will be discontinued by the affected departments.
Adequate appropriation and revenue will be included in the ARMC 2025-26 and future recommended budgets. Adjustments to the DPH and DBH budgets are not requested at this time, but may be included in a future Countywide budget report presented to the Board of Supervisors (Board) for approval, if necessary.
BACKGROUND INFORMATION
Beginning January 1, 2022, DHCS established the new statewide CalAIM program, under which ECM program services are provided. The purpose of the ECM program is to provide a holistic, whole-person approach to address the medical and non-medical circumstances of high-need Medi-Cal beneficiaries at their County medical location of preference, through the assigned Medi-Cal MCP. It provides a wider range of services designed to stabilize and support the lives of eligible clients. High-need Medi-Cal beneficiaries eligible for ECM include individuals who are unhoused or have serious mental illnesses and/or substance use disorders, children with complex medical conditions, justice-involved populations with significant clinical needs, and the aging population.
Based on the needs and medical location of preference of the IEHP member, the member is assigned to an ECM care team from DBH, ARMC, or DPH. The assigned team will provide multi-disciplinary services to improve the client’s overall health outcomes and address various social determinants of health. The care teams will consist of program staff, qualified based on life, social, and/or medical experience and education, individually contracted under the recommended ECM program master employment agreement. The recommended agreement includes revisions to position descriptions based on the services provided by the individual departments, adds positions not identified in the existing template, and identifies the salary grade for these positions.
On December 14, 2021 (Item No. 17), the Board approved revenue Agreement No. 21-983 with IEHP for the provision of ECM program services by ARMC, DBH, and DPH, for the term of January 1, 2022, through June 30, 2024, with subsequent amendments to increase the annual reimbursement rates and extend through June 30, 2025. Under this agreement, ARMC and DPH collaborated to provide limited ECM program services to DPH ECM clients as this program was not yet established within the DPH clinics.
A companion item is being presented to the Board on June 10, 2025, for approval of a new revenue agreement with IEHP for continued provision of ECM program services by ARMC, DBH and DPH, effective July 1, 2025, through June 30, 2028. This new IEHP ECM agreement includes infrastructure funding for DPH to establish its ECM program, specifically supporting necessary contract ECM administrative positions, and development of DPH’s ECM care teams consisting of the contract staff. These contract staff will support the transition of DPH assigned ECM clients from ARMC, allowing for implementation of DPH’s ECM program and expansion of service provision throughout DPH clinics.
On January 11, 2022 (Item No. 12), the Board approved Master Employment Agreement No. 22-1082 for the ECM program to hire staff for the period of January 1, 2022 through June 30, 2024. On September 26, 2023 (Item No. 17), the Board approved Master Employment Agreement No. 23-1028, replacing Agreement No. 22-1082, for new and revised job classifications to hire and retain program staff under the ECM and CalAIM program, for the period of October 1, 2023 through June 30, 2026.
Recommendation No. 1 approves a new Master Employment Agreement for the ECM and CalAIM program that will replace Master Employment Agreement No. 23-1028. The new Master Employment Agreement is effective upon execution through June 30, 2028, with the option to extend the term for a maximum of three successive one-year periods. New individual employment agreements will be executed with affected staff and all new incoming staff. The County and the contract employee may terminate the individual employment agreement at any time without cause upon 14 days prior written notice to the other party. The County may terminate the individual employment agreement immediately for just cause.
Recommendation No. 2 delegates authority to the ARMC Chief Executive Officer, Director of DBH, or the Director of DPH to execute individual employment agreements, effective upon execution through June 30, 2028, execute any amendments to extend the individual employment agreements on behalf of the County, as well as to make non-substantive changes to the individual employment agreements, subject to County Counsel review. Non-substantive changes include filling in blanks in the individual employment agreements, updating names, and making any non-substantive clerical changes.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Scott Runyan, Principal Assistant County Counsel, and Charles Phan, Supervising Deputy County Counsel, 387-5455) on May 30, 2025; DBH (Georgina Yoshioka, Director, 252-5142) on May 29, 2025; DPH (Joshua Dugas, Director, 387-9146) on May 29, 2025; Human Resources (Gina King, Assistant Director, 387-5560) on May 29, 2025; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on June 2, 2025; Finance (Paul Garcia, Administrative Analyst, 386-8393, Iliana Rodriguez, Administrative Analyst, 387-5404, and Jenny Yang, Administrative Analyst, 387-4884) on June 2, 2025; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238, Robert Saldana and Valerie Clay, Deputy Executive Officers, 387-5423) on June 2, 2025.