REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
January 24, 2023
FROM
JOSHUA DUGAS, Director, Department of Public Health
SUBJECT
Title
Amendment to Revenue Agreement with Inland Empire Health Plan and IEHP Health Access for Primary Care Services
End
RECOMMENDATION(S)
Recommendation
1. Approve Amendment No. 1 to Revenue Agreement No. 20-265 with Inland Empire Health Plan and IEHP Health Access for the Department of Public Health, updating Addendum A to expand Primary Care Services to include Covered California line of business, with no change in the contract period of June 1, 2020 through May 31, 2025.
2. Direct the Clerk of the Board of Supervisors to maintain confidentiality of the Agreement 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 does not impact Discretionary General Funding (Net County Cost). The Inland Empire Health Plan (IEHP) has a capitation agreement with the Department of Public Health (DPH) where it will pay a fixed rate for each enrolled IEHP member for the provision of primary care services. The actual amount to be generated is based on an actual fee for service utilization. The capitation agreement applies only to certain services; other services are billed to IEHP on a fee-for-service basis. The total revenue earned under this agreement will vary with the number of enrollees and the medical services those enrollees receive. The DPH budget includes estimates of the additional revenue to be generated and additional expenditures to be incurred as a result of making health care services available to Covered California members. In 2021-22, DPH received $2,542,663 in revenue for IEHP Managed Care. Appropriation and revenue of $2,850,000 are included in the DPH recommended 2022-23 budget and will be included in future budgets.
BACKGROUND INFORMATION
This Amendment will allow DPH to continue as an IEHP network provider for primary care services. DPH is currently a participating Medi-Cal provider in the IEHP Medi-Cal network. Therefore, IEHP has invited DPH to participate in the healthcare service product expansion of the Covered California network. It is IEHP’s expectation that Medi-Cal will shift to the Covered California program as the State conducts annual reviews to determine whether applicants continue to meet Medi-Cal eligibility requirements.
IEHP is one of two entities that have been chosen as a preferred County managed care plan for San Bernardino and Riverside Counties. DPH currently provides Primary Care services for IEHP members. Health promotion, disease prevention, health maintenance, patient education, and diagnosis and treatment of acute and chronic illnesses are some of the primary care services provided.
Either party may terminate the Revenue Agreement without cause upon providing the other party with 90 days’ written notice.
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 of Supervisors is directed to maintain confidentiality of this Agreement.
On May 19, 2020 (Item No. 68), the Board of Supervisors approved Agreement No. 20-265 with IEHP and IEHP Health Access for DPH to provide Primary Care Services, for the period of June 1, 2020 through May 31, 2025. The Agreement directs the Clerk of the Board to maintain confidentiality of the Agreement pursuant to California Health and Safety Code section 1457(c)(1).
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by Human Services Contracts (Patty Steven, Contracts Manager, 388-0241) on January 3, 2023; County Counsel (Adam Ebright, Deputy County Counsel, 387-5455) on January 3, 2023; Finance (Paul Garcia, Administrative Analyst, 386-8392) on January 3, 2023; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on January 4, 2023.