REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
January 14, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
School Site Agreement Template for the Breathmobile® Program
End
RECOMMENDATION(S)
Recommendation
1. Approve a revised School Site Agreement template for the Breathmobile® Program, which removes language that indicates the services are at no cost to the student.
2. Authorize the ARMC Chief Executive Officer to execute individual School Site Agreement Templates with schools and/or school districts for the Breathmobile® Program, for the period of January 14, 2025 through June 30, 2027, which include non-substantive changes, subject to review by County Counsel.
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
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) as a grant award from the Children and Families Commission’s First 5 Program for San Bernardino County (First 5) provides funding for Breathmobile® Program (Breathmobile®) services to children ages five and under. Expenses for services provided to children over five years of age are funded by State Medi-Cal, Federal Medicare, private insurance, co-payments, private pay, and other department revenue. Adequate appropriation and revenue have been included in the Arrowhead Regional Medical Center (ARMC) 2024-25 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
The Breathmobile® was developed and implemented in early 2000 to bridge the healthcare accessibility gap by meeting the patient in their respective communities to reduce barriers to care. The Breathmobile®, team in collaboration with school nurses and health aides, facilitates initial identification of patients. Ongoing communication with the school nurses and health aides help the patients remain compliant with their asthma management program.
The Breathmobile® travels to 40 different school sites throughout San Bernardino County, rotating to each site every six weeks. During the school hours, the Breathmobile® staff sees patients that attend the school site, as well as any child referred from the surrounding area. A complete evaluation, examination, care plan and extensive patient family education are completed at the time of the visit. The Breathmobile® provides coordinated case identification, structured mobile office visits, diagnostic testing, physical exam, pharmacological therapy and patient/family education in asthma management.
This revised School Site Agreement template removes language indicating that services are at no cost to the patient and adds language indicating that the patient/guarantor will be responsible for any applicable copayments and deductibles. This change will align Breathmobile® services with other ARMC services and enable ARMC to be reimbursed for any copayments and deductibles that are required based on the patient’s insurance coverage.
On August 25, 2020 (Item No. 11), the Board of Supervisors (Board) accepted a grant award from First 5 in the amount of $1,086,537, and approved funding Agreement No. 20-679 with First 5 for the Breathmobile® for the period of August 25, 2020 through June 30, 2023. ARMC’s Breathmobile® has received grant funding support from Children and Families Commission’s First 5 Program since August of 2010. ARMC’s use of other funds, such as Medi-Cal, Medicare, private pay, co-payments, or private insurance, covers the cost of service provided to any child that does not qualify for First 5 funding. Through the establishment of school site agreements, ARMC’s Breathmobile® will continue to provide services to children of all ages, with or without funding from First 5.
On June 28, 2022 (Item No. 18), the Board approved the non-financial Breathmobile® Program School Site Agreement template for the provision of the Arrowhead Regional Medical Center Breathmobile® at school and/or district sites, for a term of five years from the date of execution. The item also authorized the Director of Arrowhead Regional Medical Center to execute the template with schools and/or school districts, for the period July 1, 2022 through June 30, 2027, on behalf of the County, with non-substantive changes, subject to review by County Counsel.
Approval of Recommendation No. 2 will enable the ARMC Chief Executive Officer to execute individual agreements with schools and/or school districts based on the approved revised template, as well as any non-substantive amendments to the template (e.g., change in leadership, addresses, etc.). The agreements will be effective for a period of five years after execution, unless earlier terminated by the parties.
ARMC recommends approval of the revised agreement template to ensure ARMC maintains fiscal responsibility while continuing the management of asthma care and education for children and families.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan Supervising Deputy County Counsel, 387-5455) on November 22, 2024; Purchasing (Veronica Pedace, Buyer III, 387-2464) on December 4, 2024; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on December 17, 2024; Finance (Jenny Yang, Administrative Analyst, 387-4884) on December 20, 2024; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on December 23, 2024.