REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
December 16, 2025
FROM
JOSHUA DUGAS, Director, Department of Public Health
SUBJECT
Title
Amendments to Revenue Agreements with Inland Empire Health Plan for Specialty and Primary Care Services
End
RECOMMENDATION(S)
Recommendation
1. Approve Amendment No. 2 to Revenue Agreement No. 16-714, with the Inland Empire Health Plan for Specialty Care Services, amending the agreement language to reflect a new incentive payment program for obstetrics providers who meet certain thresholds regarding select health measures, updating regulatory language, and increasing provider reimbursement rates, with no change to the contract term, which began November 1, 2016, and automatically renews until the contract is terminated by either party.
2. Approve Amendment No. 3 to Revenue Agreement No. 20-265, with Inland Empire Health Plan for Primary Care Services, amending the agreement language to reflect a new incentive payment program for primary care providers who meet certain thresholds regarding select health measures, updating regulatory language, and increasing provider reimbursement rates, with no change to the total contract period of June 1, 2020 through May 31, 2026.
3. Direct the Clerk of the Board of Supervisors to maintain confidentiality of the agreements pursuant to California Health and Safety Code section 1457(c)(1).
(Presenter: Joshua Dugas, Director, 387-9146)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
This item will not result in the use of Discretionary General Funding (Net County Cost). Inland Empire Health Plan (IEHP) will reimburse the Department of Public Health (DPH) for Specialty and Primary Care Services provided to IEHP members at a capitated rate. Actual amounts to be generated are on a fee-for-service basis per patient for services rendered. Adequate appropriation and revenue have been included in the DPH 2025-26 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
DPH is currently a participating Medi-Cal provider in the IEHP Medi-Cal network. IEHP is one of two entities that have been chosen as a County managed care plan for San Bernardino and Riverside Counties. DPH is required to enter into Provider Agreements with IEHP to outline services provided under the Medi-Cal program and establish reimbursement rates. The recommended amendments each establish new incentive payment programs, requiring providers to meet certain health measures (such as postpartum depression, screenings for diabetes, breast, cervical, and colorectal cancers, high blood pressure, flu and Tdap vaccines, among others) to maximize funding reimbursements. Measures include a variety of preventative health screenings, tests, and vaccines which promote long-term positive health outcomes.
On April 19, 2016 (Item No. 41), the Board of Supervisors (Board) approved Revenue Letter of Agreement No. 16-168 with IEHP to provide and bill for specialty care services including obstetrics and HIV services for the period of April 20, 2016 through December 31, 2016, pending approval of a formal contract.
On September 13, 2016 (Item No. 55), the Board approved Revenue Contract No. 16-714 with IEHP for DPH to provide specialty care services, for the period of November 1, 2016 through October 31, 2021, with automatic annual renewals thereafter.
On May 19, 2020 (Item No. 68), the Board approved Revenue Agreement No 20-265 with IEHP for DPH to provide Primary Care Services, for the period of June 1, 2020 through May 31, 2025.
On January 24, 2023 (Item No. 40), the Board approved Amendment No. 1 to Revenue Agreement No. 20-265 updating Addendum A to expand Primary Care Services to include individuals who select health plans through Covered California, with no change to the contract period of June 1, 2020 through May 31, 2025.
On September 26, 2023 (Item No. 50), the Board approved Amendment No. 1 to Revenue Contract No. 16-714 with IEHP and IEHP Health Access, updating Addendum A to expand specialty care services to include the Covered California line of business, with no change to the contract period of November 1, 2016 through October 31, 2021, with automatic renewals until the contract is terminated by either party.
On May 20, 2025 (Item No. 60), the Board approved Amendment No. 2 to Revenue Agreement 20-265 with IEHP for primary care services, extending the contract term for an additional year, for a total contract period of June 1, 2020 through May 31, 2026.
The specialty care services agreement allows DPH to deliver specialty care to DPH assigned IEHP members, including obstetrics/gynecology and HIV/AIDS. Additionally, services provided under the primary care agreement include health promotion, disease prevention, health maintenance, patient education, and diagnosis and treatment of acute and chronic illnesses.
Approval of these amendments will allow DPH to continue as an IEHP network provider for specialty and primary care services and access additional payments under the incentive programs. The amended agreements are necessary to align with recent regulatory changes associated with regulations for provider incentives and targeted rate increases under Chapter 42, Statutes of 2023 (Assembly Bill 118).
Pursuant to California Health and Safety Code section 1457(c)(1), specific terms related to the rates of payment for health care services in a county medical facility are not immediately subject to laws related to public records; therefore, the Clerk of the Board is directed to maintain the confidentiality of these agreements.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Adam Ebright, Deputy County Counsel, 387-5455) on October 31, 2025; and County Finance and Administration (Iliana Rodriguez, Administrative Analyst, 387-4205) on October 31, 2025.