REGULAR MEETING OF THE GOVERNING BOARD OF THE IEHP HEALTH ACCESS. May 9, :15 a.m. Board Report #117

Transcription

1 REGULAR MEETING OF THE GOVERNING BOARD OF THE IEHP HEALTH ACCESS May 9, :15 a.m. Board Report #117 Riverside County Administrative Building Board Chambers - First Floor 4080 Lemon Street Riverside, CA If special accommodations are needed to participate in this meeting, please contact Annette Taylor, Secretary to the IEHP Governing Board at (909) during regular business hours of IEHP (M-F 8:00 a.m. 5:00 p.m.) PUBLIC INPUT AT INLAND EMPIRE HEALTH PLAN GOVERNING BOARD MEETINGS The meeting of the Inland Empire Health Plan Governing Board is open to the public. A member of the public may address the Board on any agenda item. Requests to address the Board must be submitted in person to the Secretary of the Governing Board prior to the start of the meeting. 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 the agenda are available for inspection at the meeting listed in this agenda, and at the following location beginning three (3) working days prior to the meeting date: Sixth Street, Suite 120 Rancho Cucamonga, CA 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 A. Board Chair advises persons wishing to address the Governing Board that they must first complete a Request To Speak Form B. Forms are located next to the agendas at the entrance of this room or from the Board Secretary C. Completed Form should be given to the Board Secretary prior to speaking D. The Chairperson may call the person wishing to speak during the discussion on any particular agenda item. E. Conflict of Interest Disclosure: Any person present at this board meeting who wishes to speak on a matter must state: 1. Their name and the organization they represent 2. Any contributions in excess of $ made by them or their organization in the past twelve (12) months to any IEHP Governing Board member 3. The name of the Governing Board member receiving the contribution 4. The agenda item or matter of consideration with which they are involved

2 AGENDA May 9, 2016 IV. Adoption and approval of the minutes from the April 13, 2016 Regular Meeting of the Governing Board of IEHP Health Access. V. CONSENT AGENDA (Items listed on the Consent Agenda are expected to be routine and non-controversial and, unless the Board directs that an item be held for further discussion, the entire Consent Agenda will be acted upon for block approval. If the Board directs that an item listed on the Consent Agenda be held for further discussion, the item will be addressed under Deferred Items, following the Policy Agenda.) ADMINISTRATION (Bradley P. Gilbert, M.D.) FINANCE DEPARTMENT (Laurie Holden) INFORMATION TECHNOLOGY DEPARTMENT (Michael Deering) MARKETING DEPARTMENT (Susan Arcidiacono) MEDICAL SERVICES DEPARTMENT Clinical MEDICAL SERVICES DEPARTMENT Operational - (Marcia Anderson) OPERATIONS DEPARTMENT (Rohan Reid) No Items for the above Departments PROVIDER NETWORK DEPARTMENT (Kurt Hubler) 1. Inland Empire Health Plan Hospital Per Diem Agreement with Loma Linda University Medical Center 3 rd Amendment Eff. June 1, Participating Provider Agreement with San Bernardino Medical Orthopedic Group dba Arrowhead Orthopaedics - 6th Amendment Eff. May 1, Approve the Standard Templates to the following Master Agreements and Attachments, and Authorization to sign the Agreements and Attachments: (a) Master Transportation Template (b) Attachment B CAP PCP 4. Evergreen Contract Approval: (a) Admitter Agreement with Martin Lewis Rocha dba Martin Roch, M.D. Inc Effective June 1, 2016, additional five (5) year term. (b) Ancillary Provider Agreement (All Lines of Business) with Alere Women s and Children s Health, LLC Effective June 1, 2016, additional five (5) year term. (c) Ancillary Provider Agreement (All Lines of Business) with Brandi Paris dba Vital Medical Effective June1, 2016, additional five (5) year term. (d) Ancillary Provider Agreement (All Lines of Business) with Casa Colina Surgery Center LLC dba Casa Colina Surgery Center Effective June 1, 2016, additional two (2) year term. (e) Ancillary Provider Agreement (All Lines of Business) with Delta Hospice of CA, Inc Effective June 1, 2016, additional five (5) year term. (f) Ancillary Provider Agreement (All Lines of Business) with Glenwood Surgery Services Effective June 1, 2016, additional two (2) year term. 2

3 AGENDA May 9, 2016 (g) Ancillary Provider Agreement (All Lines of Business) with MYT Home Health Care Inc dba South Bay Home Health Care Effective June 1, 2016, additional five (5) year term. (h) Ancillary Provider Agreement (All Lines of Business) with Nu-Era Home Health Agency Inc Effective June 1, 2016, additional five (5) year term. (i) Ancillary Provider Agreement (All Lines of Business) with Omni Motion, Inc Effective July 1, 2016, additional five (5) year term. (j) Ancillary Provider Agreement (All Lines of Business) with Premier Healthcare Services LLC Effective June 1, 2016, additional five (5) year term. (k) Ancillary Provider Agreement (All Lines of Business) with RMC Surgery Center (l) Inc Effective June 1, 2016, additional two (2) year term. Ancillary Provider Agreement (All Lines of Business) with THC Orange County Inc Southern California Specialty Care Inc KND Development 52 LLC KND Development 53 LLC KND Development 54 LLC and KND Development 55 LLC Effective June 1, 2016, additional two (2) year term. (m) Admitter/Hospitalist Agreement with Hospitalists Medicine Physicians of California Inc Effective June 1, 2016, additional three (3) year term. (n) Open Access Provider Agreement (Excluding Medicare) with Cyrus Damirchi Effective June 1, 2016, additional five (5) year term. (o) Open Access Provider Agreement (Excluding Medicare) with Daksha A. Jain, M.D. Effective June 1, 2016, additional five (5) year term. (p) Open Access Provider Agreement (Excluding Medicare) with Elliot Weinstein Effective June 1, 2016, additional five (5) year term. (q) Open Access Provider Agreement (Excluding Medicare) with George Villanueva, D.O., Inc. dba Perris Valley Medical Group Effective June 1, 2016, additional five (5) year term. (r) (s) (t) Open Access Provider Agreement (Excluding Medicare) with Hampton Gaskins MD Inc dba Hampton Medical Clinic Effective June 1, 2016, additional five (5) year term. Open Access Provider Agreement (Excluding Medicare) with Raincross Medical Group, Inc. Effective June 1, 2016, additional five (5) year term. Open Access Provider Agreement (Excluding Medicare) with Rosemarie Tweed, D.O., APC Effective June 1, 2016, additional five (5) year term. (u) Open Access Provider Agreement (Excluding Medicare) with Subhi G. Sharif Effective July 1, 2016, additional one (1) year term. (v) Open Access Provider Agreement (Excluding Medicare) with Webster Wong dba Arrowhead Pediatric Medical Group Inc Effective June 1, 2016, additional five (5) year term. (w) Open Access Provider Agreement (Excluding Medicare) with Western University of Health Sciences dba Western University Medical Center Effective June 1, 2016, additional five (5) year term. (x) Capitated Primary Care Provider Agreement (All Lines of Business) with Rogelio Drenning-Manriquez, M.D. Effective June 1, 2016, additional five (5) year term. (y) Fee-For-Service Primary Care Provider Agreement (All Lines of Business) with Family Medical Clinic and Urgent Care, Inc Effective June 1, 2016, additional five (5) year term. 3

4 AGENDA May 9, 2016 (z) Participating Provider Agreement (All Lines of Business) with Anil Rastogi, M.D., Inc. dba Hemet Heart Medical Center Effective June 1, 2016, additional five (5) year term. (aa) Participating Provider Agreement (All Lines of Business) with Bryan X Lee MD A Professional Medical Corporation dba Bryan X Lee MD A Professional Medical Corporation Effective June 1, 2016, additional five (5) year term. (bb) Participating Provider Agreement (All Lines of Business) with Children s Hospital of Orange County dba CHOC Children s Specialists Effective June 1, 2016, additional five (5) year term. (cc) Participating Provider Agreement (All Lines of Business) with Hemet Radiology Medical Group, Inc. Effective June 1, 2016, additional five (5) year term. (dd) Participating Provider Agreement (All Lines of Business) with Kazem Seyed MD Effective June 1, 2016, additional five (5) year term. (ee) Participating Provider Agreement (All Lines of Business) with Rancho Physical Therapy Inc Effective June 1, 2016, additional five (5) year term. (ff) Participating Provider Agreement (All Lines of Business) with Valley OB/GYN Medical Group Effective June 1, 2016, additional five (5) year term. VI. POLICY AGENDA AND STATUS REPORT ON AGENCY OPERATIONS: (A motion to approve the items listed on the Policy Agenda will be taken following each department s presentation. IEHP Governing Board Members have the option of excluding an item from a master motion for further discussion or for separate motion) ADMINISTRATION (Bradley P. Gilbert, M.D.) FINANCE DEPARTMENT (Laurie Holden) OPERATIONS DEPARTMENT (Rohan Reid) INFORMATION TECHNOLOGY DEPARTMENT (Michael Deering) MEDICAL SERVICES DEPARTMENT Clinical MEDICAL SERVICES DEPARTMENT Operational - (Marcia Anderson) PROVIDER NETWORK DEPARTMENT (Kurt Hubler) MARKETING DEPARTMENT (Susan Arcidiacono) No Items for the above departments VII. COMMENTS FROM THE PUBLIC ON MATTERS NOT ON THE AGENDA A. Board Chair advises persons wishing to address the Governing Board that they must first complete a Request To Speak Form B. Forms are located next to the agendas at the entrance of this room or from the Board Secretary C. Completed Form should be given to the Board Secretary prior to speaking 4

5 AGENDA May 9, 2016 VIII. ADJOURNMENT (The next meeting of the IEHP Health Access Governing Board will be held on June 11, 2016) 5

6 V. CONSENT AGENDA May 9, 2016 PROVIDER NETWORK 1. APPROVE THE THIRD AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH LOMA LINDA UNIVERSITY MEDICAL CENTER Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Third Amendment to the Hospital Per Diem Agreement with Loma Linda University Medical Center effective June 1, Contact: Kurt Hubler, Chief Network Officer Background: Loma Linda University Medical Center is currently a contracted Hospital Provider in the IEHP Provider Network. Discussion: This Amendment includes the Center of Excellence (COE) for the treatment of Hepatitis B and C in Attachment C1. All other items and conditions of the Agreement remain in full force and effect. Fiscal Impact: Included in FY15/16 Budget Attachments: Copy of the Inland Empire Health Plan Hospital Per Diem Amendment is attached to the Minute Order. Reviewed by Counsel: Yes 6

7 V. CONSENT AGENDA May 9, 2016 PROVIDER NETWORK 2. APPROVE THE SIXTH AMENDMENT TO THE PARTICIPATING PROVIDER AGREEMENT WITH SAN BERNARDINO MEDICAL ORTHOPEDIC GROUP DBA ARROWHEAD ORTHOPAEDICS Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Sixth Amendment to the Participating Provider Agreement with San Bernardino Medical Orthopedic Group dba Arrowhead Orthopaedics effective May 1, Contact: Kurt Hubler, Chief Network Officer Background: San Bernardino Medical Orthopedic Group dba Arrowhead Orthopaedics is currently a contracted participating Provider in the IEHP Provider Network. Discussion: This Amendment is tailored to reflect the services offered by San Bernardino Medical Orthopedic Group dba Arrowhead Orthopaedics. Fiscal Impact: Included in FY15/16 Budget Attachments: Copy of the new Amendment to the Participating Provider Agreement is attached to the Minute Order. Reviewed by Counsel: Yes 7

8 V. CONSENT AGENDA May 9, 2016 PROVIDER NETWORK 3. APPROVE THE STANDARD TEMPLATES TO THE MASTER AGREEMENTS AND ATTACHMENTS, AND AUTHORIZATION FOR THE CHIEF EXECUTIVE OFFICER TO SIGN THE AGREEMENTS AND ATTACHMENTS Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the 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. Contact: Kurt Hubler, Chief Network Officer Background: IEHP contracts with physicians and other providers using Governing Board approved Standard Template Agreements. On a periodic basis IEHP reviews the IEHP & IEHP Health Access Templates and updates are made to them as necessary. The Governing Board has authorized the Chief Executive Officer to sign the Agreements. Discussion: The following standard templates are being presented to the Governing Board for the approval: a) Master Transportation Template b) Attachment B PCP CAP (All LOBs) Fiscal Impact: Included in FY15/16 Budget Attachments: Copies of the above referenced Standard Templates are attached to the Minute Order. Reviewed by Counsel: Yes 8

9 V. CONSENT AGENDA May 9, 2016 PROVIDER NETWORK 4. APPROVAL OF THE EVERGREEN CONTRACTS Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the listed Evergreen Contract(s) for an additional one (1) to five (5) year term. Contact: Kurt Hubler, Chief Network Officer 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: Renew under the Evergreen Clause of the following Agreements: 1. Admitter Agreement with Martin Lewis Rocha dba Martin Roch, M.D. Inc Effective June 1, 2016, additional five (5) year term. 2. Ancillary Provider Agreement (All Lines of Business) with Alere Women s and Children s Health, LLC Effective June 1, 2016, additional five (5) year term. 3. Ancillary Provider Agreement (All Lines of Business) with Brandi Paris dba Vital Medical Effective June1, 2016, additional five (5) year term. 4. Ancillary Provider Agreement (All Lines of Business) with Casa Colina Surgery Center LLC dba Casa Colina Surgery Center Effective June 1, 2016, additional two (2) year term. 5. Ancillary Provider Agreement (All Lines of Business) with Delta Hospice of CA, Inc Effective June 1, 2016, additional five (5) year term. 6. Ancillary Provider Agreement (All Lines of Business) with Glenwood Surgery Services Effective June 1, 2016, additional two (2) year term. 7. Ancillary Provider Agreement (All Lines of Business) with MYT Home Health Care Inc dba South Bay Home Health Care Effective June 1, 2016, additional five (5) year term. 8. Ancillary Provider Agreement (All Lines of Business) with Nu-Era Home Health Agency Inc Effective June 1, 2016, additional five (5) year term. 9. Ancillary Provider Agreement (All Lines of Business) with Omni Motion, Inc Effective July 1, 2016, additional five (5) year term. 10. Ancillary Provider Agreement (All Lines of Business) with Premier Healthcare Services LLC Effective June 1, 2016, additional five (5) year term. 11. Ancillary Provider Agreement (All Lines of Business) with RMC Surgery Center Inc Effective June 1, 2016, additional two (2) year term. 9

10 V. CONSENT AGENDA May 9, Ancillary Provider Agreement (All Lines of Business) with THC Orange County Inc Southern California Specialty Care Inc KND Development 52 LLC KND Development 53 LLC KND Development 54 LLC and KND Development 55 LLC Effective June 1, 2016, additional two (2) year term. 13. Admitter/Hospitalist Agreement with Hospitalists Medicine Physicians of California Inc Effective June 1, 2016, additional three (3) year term. 14. Open Access Provider Agreement (Excluding Medicare) with Cyrus Damirchi Effective June 1, 2016, additional five (5) year term. 15. Open Access Provider Agreement (Excluding Medicare) with Daksha A. Jain, M.D. Effective June 1, 2016, additional five (5) year term. 16. Open Access Provider Agreement (Excluding Medicare) with Elliot Weinstein Effective June 1, 2016, additional five (5) year term. 17. Open Access Provider Agreement (Excluding Medicare) with George Villanueva, D.O., Inc. dba Perris Valley Medical Group Effective June 1, 2016, additional five (5) year term. 18. Open Access Provider Agreement (Excluding Medicare) with Hampton Gaskins MD Inc dba Hampton Medical Clinic Effective June 1, 2016, additional five (5) year term. 19. Open Access Provider Agreement (Excluding Medicare) with Raincross Medical Group, Inc. Effective June 1, 2016, additional five (5) year term. 20. Open Access Provider Agreement (Excluding Medicare) with Rosemarie Tweed, D.O., APC Effective June 1, 2016, additional five (5) year term. 21. Open Access Provider Agreement (Excluding Medicare) with Subhi G. Sharif Effective July 1, 2016, additional one (1) year term. 22. Open Access Provider Agreement (Excluding Medicare) with Webster Wong dba Arrowhead Pediatric Medical Group Inc Effective June 1, 2016, additional five (5) year term. 23. Open Access Provider Agreement (Excluding Medicare) with Western University of Health Sciences dba Western University Medical Center Effective June 1, 2016, additional five (5) year term. 24. Capitated Primary Care Provider Agreement (All Lines of Business) with Rogelio Drenning-Manriquez, M.D. Effective June 1, 2016, additional five (5) year term. 25. Fee-For-Service Primary Care Provider Agreement (All Lines of Business) with Family Medical Clinic and Urgent Care, Inc Effective June 1, 2016, additional five (5) year term. 26. Participating Provider Agreement (All Lines of Business) with Anil Rastogi, M.D., Inc. dba Hemet Heart Medical Center Effective June 1, 2016, additional five (5) year term. 27. Participating Provider Agreement (All Lines of Business) with Bryan X Lee MD A Professional Medical Corporation dba Bryan X Lee MD A Professional Medical Corporation Effective June 1, 2016, additional five (5) year term. 28. Participating Provider Agreement (All Lines of Business) with Children s Hospital of Orange County dba CHOC Children s Specialists Effective June 1, 2016, additional five (5) year term. 29. Participating Provider Agreement (All Lines of Business) with Hemet Radiology Medical Group, Inc. Effective June 1, 2016, additional five (5) year term. 10

11 V. CONSENT AGENDA May 9, Participating Provider Agreement (All Lines of Business) with Kazem Seyed MD Effective June 1, 2016, additional five (5) year term. 31. Participating Provider Agreement (All Lines of Business) with Rancho Physical Therapy Inc Effective June 1, 2016, additional five (5) year term. 32. Participating Provider Agreement (All Lines of Business) with Valley OB/GYN Medical Group Effective June 1, 2016, additional five (5) year term. Fiscal Impact: Included in FY15/16 Budget 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 11

12 VI. POLICY AGENDA AND STATUS REPORT ON AGENCY OPERATIONS May 9, 2016 No items on the Policy Agenda 12

13 VII. COMMENTS FROM THE PUBLIC May 9,, 2016 COMMENTS FROM THE PUBLIC 1. Board Chair advises persons wishing to address the Governing Board that they must first complete a Request To Speak Form 2. Forms are located next to the agendas at the entrance of this room or from the Board Secretary 3. Completed Form should be given to the Board Secretary prior to speaking 13

14 VIII. ADJOURNMENT May 9, 2016 ADJOURNMENT: The next meeting of the IEHP Health Access Governing Board will be held on Monday, June 13,