REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF THE COUNTY OF SAN BERNARDINO
AND RECORD OF ACTION
May 19, 2020
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Amendment to Agreement with Inland Empire Health Plan
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 4 to Agreement No. 17-846 with Inland Empire Health Plan to add billing codes for reimbursement for Multidisciplinary Medication Assisted Treatment (MMAT) services for selected IEHP network providers effective May 19, 2020 through December 31, 2022, which will allow ARMC to provide primary health care services to IEHP members; and direct the Clerk of the Board to continue to maintain confidentiality of Agreement 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 Agreement with Inland Empire Health Plan and IEHP Health Access (collectively referred to as “IEHP”) will not result in the use of Discretionary General Funding (Net County Cost). Expenditures for this service are funded through reimbursements by IEHP on a capitation system based on the number of Medi-Cal patients per month assigned to Arrowhead Regional Medical Center (ARMC) for primary care. Funding sources may change in the future pending any legislative activity related to the repeal and/or replacement of the Affordable Care Act. Sufficient appropriation and revenue are included in the Arrowhead Regional Medical Center (ARMC) 2019-20 budget and will be included in future recommended budgets
BACKGROUND INFORMATION
Approval of this Amendment clarifies the billing codes used for the reimbursement of Multidisciplinary Medication Access Treatment (MMAT) services for selected IEHP network providers. When the MMAT program began, a billing code was assigned to account for the time a provider saw a patient. IEHP has since reviewed and recommended the addition of billing codes to differentiate between pharmacist and physician provided services. This will allow for greater clarity for regulatory purposes.
On November 14, 2017, (Item 6) the Board of Supervisors (Board) approved Agreement No. 17-846 with IEHP to allow ARMC to provide primary health care services to IEHP members and to be reimbursed on a capitation rate based on the number of Medi-Cal patients per month assigned to ARMC’s primary care clinics by IEHP, along with other reimbursable items outlined in the agreement.
On August, 2, 2018, (Item 6) to the Board approved Amendment No. 1 to provide primary health care services to IEHP members and direct the Clerk of the Board to maintain confidentiality of the Agreement pursuant to Health and Safety Code Section 1457(c)(1) effective January 1, 2018 through December 31, 2022. <http://cob-sire.sbcounty.gov/sirepub/agdocs.aspx?doctype=agenda&itemid=273205>
December 18, 2018, (Item 13), the Board of Supervisors approved Amendment No. 2 to update capitalization rates and maintain confidentiality of the agreement pursuant to Health and Safety Code Section 1457(c)(1).
On May 21, 2019, (Item 13) the Board of Supervisors approved Amendment No. 3 to add Behavior Health Integration (BHI) and Multidisciplinary Medication Assisted Treatment (MMAT) Pilot programs participation through the use of medications in combination with counseling and behavioral therapies for the treatment and sustained recovery for people with substance use disorders. Approval also maintains confidentiality pursuant to Health and Safety Code Section 1457(c)(1).
ARMC provides for the safety, health and social service needs of County residents by providing healthcare services to IEHP members. The recommended Agreement contributes to the fiscally-responsible and business-like operation of ARMC by allowing reimbursement for services provided to IEHP members not assigned to ARMC for their primary care.
Pursuant to Health and Safety Codes 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 this agreement.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Mike Markel, County Counsel, 387-5455) on April 07, 2020; Finance (Yael Verduzco, Administrative Analyst, 387-5285) on April 30, 2020; and County Finance and Administration (Matthew Erickson, Chief Financial Officer, 387-5423) on May 4, 2020.