Title
Authorize the Chief Executive Officer of Natividad Medical Center (NMC) to execute Addendum A (“Addendum”) to America’s Choice Provider Network Participating Hospital Agreement, adding reimbursement language for professional fees services billed by Natividad Medical Center, beginning September 1, 2016 and making no changes to the Agreement term of September 1, 2016 through August 31, 2017.
Report
RECOMMENDATION:
It is recommended the Board of Supervisors:
Authorize the Chief Executive Officer of Natividad Medical Center (NMC) to execute Addendum A (“Addendum”) to America’s Choice Provider Network Participating Hospital, adding reimbursement language for professional fees services billed by Natividad Medical Center, beginning September 1, 2016 and making no changes to the Agreement term of September 1, 2016 through August 31, 2017.
SUMMARY/DISCUSSION:
America’s Choice Provider Network (“ACPN”) is an independent network that offers an out-of network solution for over 1,400 payers, including insurance carriers, third party administrators, health and welfare funds, employer groups and self-insured health plans. More than 25 million members have access to ACPN’s national network. The Agreement renews annually with a 90 prior written notice of termination clause. The Board of Supervisors authorized execution of the ACPN agreement on August 30, 2016 designating NMC as an in network provider. The reimbursement rates for the professional fees billed by Natividad Medical Center were excluded from the original document. The Addendum lists the reimbursement rates retroactive to the agreement implementation date of September 1, 2016.
ACPN has requested that the County of Monterey approve and sign the agreement before ACPN signs the amendment.
Section 1457 of the Health and Safety Code provides that the records of a hospital or any other county medical facility that reveal the rates of payment for health care services rendered by, or purchased by, the hospital or other medical facility shall not be considered public records subject to disclosure pursuant to the California Public Records Act. Cal. Health & Safety Code § 1457(c)(1). Accordingly, the payment rates have been redacted from the attached copy of the Agreement.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved this Addendum as to legal form and risk provisions and the County Auditor-Controller has reviewed and approved as to payment provisions. The Agreement has also been reviewed and approved by NMC’s Finance Committee on December 2, 2016 and by the NMC Board of Trustees on December 2, 2016.
FINANCING:
There is no impact to the General Fund.
Prepared by: Nancy Majewski, Managed Care Operations Manager, 783-2385
Approved by: Gary R. Gray, DO, Chief Executive Officer, 783-2504
Attachments:
America’s Choice Provider Network Agreement (redacted rates)
America’s Choice Provider Network Addendum A (redacted rates)
All Attachments on file with the Clerk of the Board