regular meeting of the governing board …/media/marketing/files/about-us/...regular meeting of the...

REGULAR MEETING OF THE GOVERNING BOARDOF THE

IEHP HEALTH ACCESS

August 08, 2016

Board Report #120

San Bernardino County Government Center 385 N. Arrowhead Ave.

Board Chambers - First Floor San Bernardino CA 92415

If disability-related accommodations are needed to participate in this meeting, please contact Annette Taylor, Secretary to the IEHP Health Access Governing Board at (909) 296-3584 during regular business hours of IEHP (M-F 8:00 a.m. – 5:00 p.m.)

PUBLIC COMMENT AT IEHP HEALTH ACCESS GOVERNING BOARD MEETINGS:The meeting of the IEHP Health Access Governing Board is open to the public. A member of the public may address the Board on any item on the agenda and on any matter that is within the Board’s jurisdiction. Requests to address the Board

must be submitted in person to the Secretary of the Governing Board prior to the start of the meeting and indicate any contributions in excess of $250.00 made by them or their organization in the past twelve (12) months to any IEHP Health Access Governing Board member as well as the name of the Governing Board member who received contribution. The Board may limit the public input on any item, based on the number of people requesting to speak and the business of the

Board.

All public record documents for matters on the open session of this agenda can be viewed at the meeting location listed above, IEHP main offices at 10801 6th Street, Suite 120, Rancho Cucamonga, CA 91730 and online at http://www.iehp.org.

AGENDA

I. Call to Order

II. Board Secretary: Any changes to the agenda packet including the “Information Relative To The Possible Conflict of Interest” Form

III. COMMENTS FROM THE PUBLIC ON MATTERS ON THE AGENDA

IV. Conflict of Interest Disclosure:

V. Adopt and Approve of the Meeting Minutes from the July 11, 2016 Regular Meeting of the Governing Board of IEHP Health Access

VI. CONSENT AGENDA

ADMINISTRATION (Bradley P. Gilbert, M.D.)

No Items

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http://www.iehp.org/

Submittals to IEHP Health Access Governing BoardStaff Reports and Recommendations #110

August 08, 2016

FINANCE DEPARTMENT

No Items

INFORMATION TECHNOLOGY DEPARTMENT (Michael Deering)

No Items

MARKETING DEPARTMENT (Susan Arcidiacono)

No Items

MEDICAL SERVICES DEPARTMENT (Jennifer N. Sayles, M.D/Marcia Anderson)

No Items

OPERATIONS DEPARTMENT (Rohan Reid)

No Items

PROVIDER NETWORK DEPARTMENT (Kurt Hubler)

1. Ratify and Approve the Second Amendment to the Per Diem Hospital Agreement with Prime Healthcare Services III, LLC DBA Montclair Hospital Medical Center

2. Ratify and Approve the Third Amendment to the Hospitalists Agreement with HNI Medical Services of California, P.C.

3. Ratify and Approve the Second Amendment to the Health-Plan Provider Agreement with San Bernardino County Fire Protection District

4. Ratify and Approve the New Participating Privider Agreenment with IE Health and Wellness Management, Inc., A Texas Corporation

5. Approval of the Standard Templates to the Following Master Agreements and Attachments, and Authorization for the Chief Executive Officer of IEHP to Sign the Agreements and Attachments

1. Autism – Master Agreement2. Behavioral Health Master Agreement (Excluding Medicare)3. Behavioral Health Master Agreement (All Lines of Business)4. Community Based Adult Services Provider Agreement (All Lines of Business)5. Exhibit K-1 Autism – Master Agreement 6. Master Admitter Hospitalist Agreement (No Medicare)7. Master Admitter Hospitalist Agreement (All Lines of Business)8. Master Agreement (Excluding Medicare)9. Master Agreement (Medicare Only)10. Master Agreement (All Lines of Business)11. Master Capitated Hospital Agreement12. Master Per Diem Hospital Agreement13. Master Per Diem Hospital Agreement for Behavioral Health Services14. Master Hospitalist Template15. Master IPA Agreement (All Lines of Business)16. Master IPA Agreement (Excluding Medicare)

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17. Master IPA Agreement (Medicare Only)18. Master Letter of Agreement Appeal Reviewer – Blanket Evergreen19. Master Letter of Agreement – Autism Blanket – Evergreen20. Master Letter of Agreement – Blanket – PCP – SPD21. Master Letter of Agreement – Long Term Sub Acute SNF – Evergreen22. Master Letter of Agreement – Member Specific23. Master Letter of Agreement – Member Specific - Out of Network Autism

Providers24. Master Letter of Agreement – Mental Health Provider (LCSW – MFT –

Psychologist – Psychiatrist)25. Master Letter of Agreement – Mental Health Provider (LCSW – MFT)26. Master Letter of Agreement – Mental Health Provider (Psychiatrist)27. Master Letter of Agreement – Mental Health Provider (Psychologist)28. Master Participating Provider Agreement – Vision29. Master Participating Provider Agreement – Vision (Exam Only)30. Master Skilled Nursing Facility Provider Agreement (Excluding Medicare) 31. Master Skilled Nursing Facility Provider Agreement (All Lines of Business)32. Master SNFist Agreement Template 33. Master Transportation Template34. Home Health – Attachment B35. Home Health – Hospice – Attachment B

6. Approval of Evergreen Contracts:a) Ancillary Provider Agreement with Ajeet R. Singhvi, M.D. – Effective

September 1, 2016, additional five (5) year term.b) Ancillary Provider Agreement with Cindy Wiemann dba Omni Medical –

Effective October 1, 2016, additional five (5) year term.c) Ancillary Provider Agreement with Golden Valley Medical & Oxygen Service –

Effective September 1, 2016, additional five (5) year term.d) Ancillary Provider Agreement with Inland Valley Hospice Care, Inc. – Effective

September 1, 2016, additional five (5) year term.e) Ancillary Provider Agreement with Neogenomics Laboratories Inc. – Effective

October 1, 2016, additional five (5) year term.f) Ancillary Provider Agreement with Option Care Enterprises Inc dba Walgreens

Infusion Services – Effective September 1, 2016, additional five (5) year term.g) Ancillary Provider Agreement with Serenity Hospice LLC – Effective

September 1, 2016, additional five (5) year term.h) Capitated Agreement with Heritage Provider Network – Effective September 1,

2016, additional one (1) year term. i) Open Access Provider Agreement (Excluding Medicare) with Corona Pediatrics,

Inc. dba Corona Pediatrics – Effective September 1, 2016, additional five (5) year term.

j) Open Access Provider Agreement (Excluding Medicare) with Juan M Acosta dba Clinica Medica Del Valle – Effective September 1, 2016, additional five (5) year term.

k) Fee-For-Service Primary Care Provider Agreement (All Lines of Business) with Neelam Gupta MD dba Ramona Medical Clinic – Effective September 1, 2016, additional five (5) year term.

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August 08, 2016

l) Fee-For-Service Primary Care Provider Agreement with Rene Salhab M.D. – Effective September 1, 2016, additional five (5) year term.

m) Fee-For-Service Primary Care Provider Agreement (Excluding Medicare) with Loma View Pediatric Medical Clinic Inc – Effective September 1, 2016, additional five (5) year term.

n) Participating Provider Agreement with Comprehensive Primary Medical Associates – Effective September 1, 2016, additional five (5) year term.

o) Participating Provider Agreement with Desert Heart Rhythm Consultants – Effective September 1, 2016, additional five (5) year term.

p) Participating Provider Agreement with Ifeanyi Ugochuku dba Inland Surgical Group, Inc. – Effective September 1, 2016, additional five (5) year term.

q) Participating Provider Agreement with Indermohan S Luthra MD – Effective September 1, 2016, additional five (5) year term.

r) Participating Provider Agreement with Micha Rettenmaier Brown Lacey Partnership dba Gynecologic Oncology Associates – Effective September 1, 2016, additional five (5) year term.

s) Participating Provider Agreement with Radiation Oncology Physicians Inc – Effective September 1, 2016, additional five (5) year term.

t) Participating Provider Agreement with Riverside Medical Clinic Inc. – Effective September 1, 2016, additional two (2) year term.

u) Participating Provider Agreement with Rodolfo R Batarse dba Rodolfo R Batarse MD – Effective September 1, 2016, additional five (5) year term.

v) Participating Provider Agreement with Serendipity Hearing Inc dba Sonus SF0010 – Effective September 1, 2016, additional one (1) year term.

w) Participating Provider Agreement with Shadi A Qasqas MD Inc – Effective September 1, 2016, additional five (5) year term.

x) Participating Provider Agreement with William D Suval MD Inc – Effective September 1, 2016, additional five (5) year term.

y) Participating Provider Agreement (Medicare Only) with San Bernardino Medical Group, Inc. – Effective September 1, 2016, additional five (5) year term.

VII. POLICY AGENDA AND STATUS REPORT ON AGENCY OPERATIONS:

ADMINISTRATION (Bradley P. Gilbert, M.D.)

No Items

FINANCE DEPARTMENT

No Items

INFORMATION TECHNOLOGY DEPARTMENT (Michael Deering)

No Items

MARKETING DEPARTMENT (Susan Arcidiacono)

No Items

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August 08, 2016

MEDICAL SERVICES DEPARTMENT (Jennifer N. Sayles, M.D/Marcia Anderson)

No Items

OPERATIONS DEPARTMENT (Rohan Reid)

No Items

PROVIDER NETWORK DEPARTMENT (Kurt Hubler)

No Items

VIII. COMMENTS FROM THE PUBLIC ON MATTERS NOT ON THE AGENDA

IX. ADJOURNMENT

The next meeting of the IEHP Health Access Governing Board will be held on Monday, September 12, 2016 at the Riverside County Administrative Center.

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Submittals to the IEHP Health Access Governing BoardStaff Reports and Reports and Recommendations #120

CONSENT CALENDAR August 8, 2016

PROVIDER NETWORK DEPARTMENT

1. RATIFY AND APPROVE THE SECOND AMENDMENT TO THE PER DIEM HOSPITAL AGREEMENT WITH PRIME HEALTHCARE SERVICES III, LLC DBA MONTCLAIR HOSPITAL MEDICAL CENTER

Recommended Action:That the Governing Board of the IEHP Health Access (IEHP) ratify and approve the Inland Empire Health Plan Per Diem Hospital Agreement with Prime Healthcare Services III, LLC dba Montclair Hospital Medical Center

Contact:Kurt Hubler, Chief Network Officer

Background:Prime Healthcare Services III, LLC dba Montclair Hospital Medical Center is currently a contracted Provider in the IEHP Provider Network.

Discussion:This Amendment extends the Agreement term for three years, beginning July 1, 2016 through June 30, 2019 and the Attachment C1, Compensation Rates reflects Inpatient Hospital Services APR-DRG rates.

All other items and conditions of the Agreement remain in full force and effect.

Strategic Priorities:Quality of Care Access to Care Practice Transformation

Human Development Technology Not Applicable

Fiscal Impact:Included in FY 16/17 Budget

Attachments:Copy of the Inland Empire Health Plan Per Diem Agreement is attached to the Minute Orders.

Reviewed by Counsel:Yes

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2. RATIFY AND APPROVE THE THIRD AMENDMENT TO THE HOSPITALISTS AGREEMENT WITH HNI MEDICAL SERVICES OF CALIFORNIA, P.C.

Recommended Action:That the Governing Board of the IEHP Health Access (IEHP) ratify and approve the Hospitalists Agreement with HNI Medical Services of California, P.C. as assignee and delegee of the Hospitalist Agreement by and between Inland Empire Health Plan and Srinivas Vuthoori MD A Professional Corporation dba Cambridge Hospitalists, effective June 15, 2016.


Background:HNI Medical Services of California, P.C. as assignee and delegee of the Hospitalist Agreement by and between Inland Empire Health Plan and Srinivas Vuthoori MD A Professional Corporation dba Cambridge Hospitalists is currently a contracted Provider in the IEHP Provider Network.

Discussion:This Amendment includes a monthly stipend for the period of three (3) months from the date of this amendment, ending on September 15, 2016.

All other items and conditions of the Agreement remain in full force and effect.




Attachments:Copy of the Hospitalists Agreement is attached is attached to the Minute Orders.


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3. RATIFY AND APPROVE THE SECOND AMENDMENT TO THE HEALTH-PLAN PROVIDER AGREEMENT WITH SAN BERNARDINO COUNTY FIRE PROTECTION DISTRICT

Recommended Action:That the Governing Board of the IEHP Health Access (IEHP) ratify and approve the Health Plan-Provider Agreement with San Bernardino County Fire Protection District effective July 1, 2014.


Background:Health Plan-Provider Agreement is currently a contracted Provider in the IEHP Provider Network.

Discussion:This Second Amendment allows San Bernardino County Fire Protection District to participate in the intergovernmental transfer revenues allowed by the California Department of Health Care Services to maintain the availability of Medi-Cal health services to Medi-Cal beneficiaries.

The term of this Agreement is July 1, 2014, and shall terminate on September 30, 2017.




Attachments:Copy of the Health Plan-Provider Agreement is attached to the Minute Order.

Reviewed by Counsel:N/A

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4. RATIFY AND APPROVE THE NEW PARTICIPATING PROVIDER AGREEMENT WITH IE HEALTH AND WELLNESS MANAGEMENT, INC., A TEXAS CORPORATION

Recommended Action:That the Governing Board of the IEHP Health Access (IEHP) ratify and approve the Participating Provider Agreement with IE Health and Wellness Management, Inc., A Texas Corporation (“IEHWM”), effective July 12, 2016.


Background:IE Health and Wellness Management, Inc., A Texas Corporation (“IEHWM”) has agreed to participate in the IEHP network.

Discussion:This Agreement was tailored to reflect the Annual Health Assessments services offered by IE Health and Wellness Management, Inc., A Texas Corporation (“IEHWM”).




Attachments:Copy of the Participating Provider Agreement is attached to the Minute Order.


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5. APPROVE THE STANDARD TEMPLATES TO THE FOLLOWING MASTER AGREEMENTS AND ATTACHMENTS, AND AUTHORIZATION FOR THE CHIEF EXECUTIVE OFFICER OF IEHP TO SIGN THE AGREEMENTS AND ATTACHMENTS

Recommended Action:That the Governing Board of the IEHP Health Access (IEHP) approve the IEHP Standard Template Agreements, referenced below in section (d), and authorize the Chief Executive Officer or his designee to execute the template, wherein the body of the document remains unchanged except for the identifying information of the individual provider and non-material changes per individual provider requirements.


Background:IEHP contracts with physicians and other providers using Governing Board approved Standard Template Agreements. On a periodic basis IEHP reviews the IEHP & IEHP Direct Standard Templates and updates are made to the templates, as necessary. The Governing Board has authorized the Chief Executive Officer to sign the Agreement in lieu of having the Chair of the Governing Board execute the documents.

Discussion:The following standard templates are being presented to the Governing Board for the approval:

1. Autism – Master Agreement2. Behavioral Health Master Agreement (Excluding Medicare)3. Behavioral Health Master Agreement (All Lines of Business)4. Community Based Adult Services Provider Agreement (All Lines of Business)5. Exhibit K-1 Autism – Master Agreement 6. Master Admitter Hospitalist Agreement (No Medicare)7. Master Admitter Hospitalist Agreement (All Lines of Business)8. Master Agreement (Excluding Medicare)9. Master Agreement (Medicare Only)10. Master Agreement (All Lines of Business)11. Master Capitated Hospital Agreement12. Master Per Diem Hospital Agreement13. Master Per Diem Hospital Agreement for Behavioral Health Services14. Master Hospitalist Template15. Master IPA Agreement (All Lines of Business)16. Master IPA Agreement (Excluding Medicare)17. Master IPA Agreement (Medicare Only)18. Master Letter of Agreement Appeal Reviewer – Blanket Evergreen19. Master Letter of Agreement – Autism Blanket – Evergreen20. Master Letter of Agreement – Blanket – PCP – SPD21. Master Letter of Agreement – Long Term Sub Acute SNF – Evergreen

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22. Master Letter of Agreement – Member Specific23. Master Letter of Agreement – Member Specific - Out of Network Autism Providers24. Master Letter of Agreement – Mental Health Provider (LCSW – MFT – Psychologist –

Psychiatrist)25. Master Letter of Agreement – Mental Health Provider (LCSW – MFT)26. Master Letter of Agreement – Mental Health Provider (Psychiatrist)27. Master Letter of Agreement – Mental Health Provider (Psychologist)28. Master Participating Provider Agreement – Vision29. Master Participating Provider Agreement – Vision (Exam Only)30. Master Skilled Nursing Facility Provider Agreement (Excluding Medicare) 31. Master Skilled Nursing Facility Provider Agreement (All Lines of Business)32. Master SNFist Agreement Template 33. Master Transportation Template34. Home Health – Attachment B35. Home Health – Hospice – Attachment B




Attachments:Copies of the above referenced Standard Templates are attached to the Minute Order.


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6. APPROVAL OF EVERGREEN CONTRACTS

Recommended Action:That the Governing Board of the IEHP Health Access (IEHP) approve the listed Evergreen Contract for an additional one (1) to five (5) year term.


Background:Evergreen Contract – A Contract that automatically renews on the same terms and subject to the same conditions as the original agreement, upon the approval of Governing Boards of Inland Empire Health Plan and IEHP Health Access, unless sooner terminated in accordance with the terms and conditions.

Discussion:Renewal Under The Evergreen Clause Of The Following Agreements:

a) Ancillary Provider Agreement with Ajeet R. Singhvi, M.D. – Effective September 1, 2016, additional five (5) year term.

b) Ancillary Provider Agreement with Cindy Wiemann dba Omni Medical – Effective October 1, 2016, additional five (5) year term.

c) Ancillary Provider Agreement with Golden Valley Medical & Oxygen Service – Effective September 1, 2016, additional five (5) year term.

d) Ancillary Provider Agreement with Inland Valley Hospice Care, Inc. – Effective September 1, 2016, additional five (5) year term.

e) Ancillary Provider Agreement with Neogenomics Laboratories Inc. – Effective October 1, 2016, additional five (5) year term.

f) Ancillary Provider Agreement with Option Care Enterprises Inc dba Walgreens Infusion Services – Effective September 1, 2016, additional five (5) year term.

g) Ancillary Provider Agreement with Serenity Hospice LLC – Effective September 1, 2016, additional five (5) year term.

h) Capitated Agreement with Heritage Provider Network – Effective September 1, 2016, additional one (1) year term.

i) Open Access Provider Agreement (Excluding Medicare) with Corona Pediatrics, Inc. dba Corona Pediatrics – Effective September 1, 2016, additional five (5) year term.

j) Open Access Provider Agreement (Excluding Medicare) with Juan M Acosta dba Clinica Medica Del Valle – Effective September 1, 2016, additional five (5) year term.

k) Fee-For-Service Primary Care Provider Agreement (All Lines of Business) with Neelam Gupta MD dba Ramona Medical Clinic – Effective September 1, 2016, additional five (5) year term.

l) Fee-For-Service Primary Care Provider Agreement with Rene Salhab M.D. – Effective September 1, 2016, additional five (5) year term.

m) Fee-For-Service Primary Care Provider Agreement (Excluding Medicare) with Loma View Pediatric Medical Clinic Inc – Effective September 1, 2016, additional five (5) year term.

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n) Participating Provider Agreement with Comprehensive Primary Medical Associates – Effective September 1, 2016, additional five (5) year term.

o) Participating Provider Agreement with Desert Heart Rhythm Consultants – Effective September 1, 2016, additional five (5) year term.

p) Participating Provider Agreement with Ifeanyi Ugochuku dba Inalnd Surgical Group, Inc. – Effective September 1, 2016, additional five (5) year term.

q) Participating Provider Agreement with Indermohan S Luthra MD – Effective September 1, 2016, additional five (5) year term.

r) Participating Provider Agreement with Micha Rettenmaier Brown Lacey Partnership dba Gynecologic Oncology Associates – Effective September 1, 2016, additional five (5) year term.

s) Participating Provider Agreement with Radiation Oncology Physicians Inc – Effective September 1, 2016, additional five (5) year term.

t) Participating Provider Agreement with Riverside Medical Clinic Inc. – Effective September 1, 2016, additional two (2) year term.

u) Participating Provider Agreement with Rodolfo R Batarse dba Rodolfo R Batarse MD – Effective September 1, 2016, additional five (5) year term.

v) Participating Provider Agreement with Serendipity Hearing Inc dba Sonus SF0010 – Effective September 1, 2016, additional one (1) year term.

w) Participating Provider Agreement with Shadi A Qasqas MD Inc – Effective September 1, 2016, additional five (5) year term.

x) Participating Provider Agreement with William D Suval MD Inc – Effective September 1, 2016, additional five (5) year term.

y) Participating Provider Agreement (Medicare Only) with San Bernardino Medical Group, Inc. Effective September 1, 2016, additional five (5) year term.




Attachments:A copy of the original Agreements are attached to the Minute Order and are maintained in IEHP’s permanent file cabinets.

Reviewed by Counsel:N/A

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