Title
Authorize the Chief Executive Officer of Natividad Medical Center ("NMC") until June 30, 2022 to execute agreements/amendments with commercial/private payers, including agreements/amendments containing non-standard risk provisions, for the purpose of adding NMC as an in-network provider of healthcare services for both hospital and professional services and for establishing reimbursement methodologies used in healthcare payments, subject to County Counsel and Auditor-Controller approval.
Report
RECOMMENDATION:
It is recommended the Board of Supervisors:
Authorize the Chief Executive Officer of Natividad Medical Center ("NMC") until June 30, 2022 to execute agreements/amendments with commercial/private payers, including agreements/amendments containing non-standard risk provisions, for the purpose of adding NMC as an in-network provider of healthcare services for both hospital and professional services and for establishing reimbursement methodologies used in healthcare payments, subject to County Counsel and Auditor-Controller approval.
SUMMARY/DISCUSSION:
The County of Monterey, on behalf of Natividad Medical Center ("NMC"), has contracts with over 20 commercial/private payers, such as Anthem Blue Cross, Blue Shield, Aetna, CIGNA and Central California Alliance for Health. Some of the payer agreements have been in place for over 20 years.
The purpose of a payer agreement is to permit NMC as an in-network provider to provide inpatient and outpatient services to the Plan's members. Insurance plans are also interested in establishing a new agreement with hospitals and providers if they lack one. As employers in the community change the insurance plans available to their employees, the plans in turn request modifications to their existing agreements with hospitals and providers.
In many situations, an employee health plan would want to have an agreement in place in a very short timeframe in order to provide the appropriate network of hospitals ...
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