9:00 AM Board Report #311 Join by Webex

REGULAR MEETING OF THE GOVERNING BOARD OF THE INLAND EMPIRE HEALTH PLAN

December 14, 2020 - 9:00 AM

Board Report #311

Join by WebEx: https://iehp.webex.com/iehp/onstage/g.php?MTID=ed941e580a9bd8160987b21ad5e88234a Join by Phone: (866) 499-4146 Access code: 177 470 5813

The Inland Empire Health Plan is continuing to hold Governing Board meetings to conduct essential business. Pursuant to the Governor’s Executive Order, members of the Governing Board may attend the meeting via teleconference or video conference and will participate in the meeting to the same extent as if they were present. Members of the public may observe and participate electronically in the meetings. As a result of the Executive Order to stay home, in person participation at Governing Board meetings will not be allowed at this point in time.

If disability-related accommodations are needed to participate in this meeting, please contact Annette Taylor, Secretary to the IEHP Governing Board at (909) 296-3584 during regular business hours of IEHP (M-F 8:00 a.m. – 5:00 p.m.). PUBLIC COMMENT: Public Comment may be submitted via recorded voice message, email, or during the Public Comment section of the Agenda. Voice recorded public comment: To submit public comment via recorded message, please call 909-296- 3584 by 5pm on the Friday before the meeting. State your name and the item number(s) on which you wish to speak. The recordings will be limited to two minutes. These comments may be played at the appropriate time during the Board meeting. Email public comment: To submit an emailed public comment to the Governing Board please email [email protected] and provide your name, the agenda number(s) on which you wish to speak, and your comment. These comments will be distributed to all Board Members if received by 5pm on the Friday before the meeting.

AGENDA

I. Call to Order

II. Pledge of Allegiance

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III. Roll Call

IV. Changes to the Agenda

V. Public Comments on Matters on the Agenda

VI. Conflict of Interest Disclosure:

VII. Adopt and Approve of the Meeting Minutes from the November 9, 2020 Regular Meeting of the Governing Board of the Inland Empire Health Plan and IEHP Health Access

VIII. IEHP

CONSENT AGENDA ADMINISTRATION (Jarrod McNaughton)

1. 2020 Third Quarter Review of the IEHP Compliance Program

2. Approve Resolution 2020-004 for Authorizing the Designation of a Plan Administrator

FINANCE DEPARTMENT (Keenan Freeman) 3. Approve the Sixth Amendment to the Professional Services Agreement with Health Management Systems, Inc.

4. Monthly Financial Review

HEALTH SERVICES DEPARTMENT (Karen Hansberger, M.D.) 5. Approve the Fourth Amendment to the Professional Services Agreement with Brilliant Corners

6. Approve the First Amendment to the Statement of Work Document with Calibrated Healthcare Network, LLC

7. Approve the Fifth Amendment to the Professional Services Agreement with Guardian Angel Consulting, Inc.

8. Approve Request for Proposal 19-00824 Award to, and Ratify and Approve the Professional Services Agreement with, Pacific Interpreters, Inc.

9. Approve the Second Amendment to the Memorandum of Understanding with Riverside County Office on Aging

10. Approve the First Amendment to the Memorandum of Understanding with Riverside University Health System – Behavioral Health

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11. Approve the First Amendment to the Memorandum of Understanding with San Bernardino County Department of Aging and Adult Services

12. Approve the Fourth Amendment to the Memorandum of Understanding with San Bernardino County Department of Behavioral Health

13. Approve the Funding for The Pay for Performance Comprehensive Medication Management Program

INFORMATION TECHNOLOGY DEPARTMENT (Michael Deering) 14. Delegation of Authority to Approve an Amendment to the Professional Services Agreement with Conduent Business Services LLC.

15. Approve the Seventh Amendment to The Master License and Service Agreement with Edifecs, Inc.

16. Approve the Funding Increase to the Services Agreement with MCI Communications Services Inc. dba Verizon Business Services

17. Approve the Increase in Spending Authority with OpenText Corporation

18. Approve the Tenth Amendment and the Consulting Services Schedule to the Master Services and License Agreement with Optuminsight, Inc.

19. Ratify and Approve the Ordering Document to the Master License Services Agreement with Workfront, Inc.

MARKETING DEPARTMENT (Michelle Rai) 20. Approve the use of Selected Print and Digital Media Vendors for Advertising Services

21. Approve the use of Selected Broadcast Media for Advertising Services

22. Approve the use of Selected Outdoor Media Vendors for Advertising Services

OPERATIONS DEPARTMENT (Susie White) 23. Approve the Annual Update to the IEHP Provider Policies and Procedures Manuals and Encounter Data Interchange Manual

24. Approve the Sixth Amendment to the Professional Service Agreement with Netronix Integration Inc.

25. Approve the Third Amendment to the Management Agreement with Trigild Commercial Real Estate, Inc.

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26. Approve Request for Proposal #19-01443 Award to, and the Professional Services Agreement with, Shorett Printing, Inc. dba Crown Connect dba Crown Printers

PROVIDER NETWORK DEPARTMENT (Kurt Hubler)

27. Ratify and Approve the Third Amendment to the Hospital Per Diem Agreement with Loma Linda University Medical Center – City of Loma Linda 28. Approval of the Standard Templates The following standard templates are being presented to the Governing Board for approval: 1) Health Homes Amendment 2) Multidisciplinary Medication Assisted Treatment (MMAT) Amendment 3) Primary Care Provider Attachment A – Primary Care Services 4) Master Attachment A - Primary Care Physician Services and A-1 – Double Boarded (All LOBs_ NO MCR_MCR ONLY) 5) Master Attachment B and B-1 – Double Boarded Capitated Primary Care Physician (All LOBs_No MCR_MCR only) 29. Approval of the Evergreen Contracts Renewal under the Evergreen Clause of the following Agreements effective, January 1, 2021: Additional three (1) year term: 1) Fariborz Lalezarzadeh DO Inc - Participating Provider Agreement 2) Heritage Health Care Inc dba Heritage Gardens Health Care Center - Residential Care for the Elderly Provider Agreement Additional three (3) year term: 3) Chino Avenue Congregate Home Inc - Congregate Living Health Facility Provider Agreement 4) P & M Healthcare Holdings Inc dba Rancho Mesa Care Center - Skilled Nursing Facility Provider Agreement 5) Sela Healthcare Inc dba Villa Mesa Care Center - Skilled Nursing Facility Provider Agreement Additional five (5) year term: 6) 121 Rehab Physical Therapy Corporation - Participating Provider Agreement 7) Aeroflow Inc dba Aeroflow Healthcare- Ancillary Provider Agreement 8) BioHorizon Medical Inc - Ancillary Provider Agreement 9) Catherine Tuong dba Dr Catherine Tuong Optometrist - Participating Provider Agreement 10) Charles F Rose LMFT - Behavioral Health Provider Agreement 11) Coachella Valley Foot and Ankle Institute - Participating Provider Agreement 12) Healing Hand Family Care Clinics Corporation - Fee-For-Service Primary Care Provider Agreement 13) Mabel R Ribas - Behavioral Health Provider Agreement 14) Monzones Hospice Care LLC - Ancillary Provider Agreement 15) My Family Clinic Inc - Fee-For-Service Primary Care Provider Agreement 16) Pacific Perinatal Institute - Participating Provider Agreement

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17) Pomona Community Health Center dba Parktree Community Health Center - Participating Provider Agreement 18) Ramin Samadi MD Inc - Participating Provider Agreement 19) Southern California Bone and Joint Clinic Inc - Participating Provider Agreement 20) TrueCare Surgery Center - Ancillary Provider Agreement

POLICY AGENDA AND STATUS REPORT ON AGENCY OPERATIONS:

ADMINISTRATION (Jarrod McNaughton) 30. Chief Executive Officer Update

IEHP CALENDAR YEAR 2021 BUDGET (Keenan Freeman) 31. Adopt and Approve the Inland Empire Health Plan Calendar Year 2021 Budget

HEALTH SERVICES DEPARTMENT (Karen Hansberger, M.D.) 32. Value Based Payment Behavioral Health Integration Incentive Program Update

IX. IEHP HEALTH ACCESS

CONSENT AGENGA

PROVIDER NETWORK DEPARTMENT (Kurt Hubler)

33. Ratify and Approve the Third Amendment to the Hospital Per Diem Agreement with Loma Linda University Medical Center – City of Loma Linda 34. Approval of the Standard Templates The following standard templates are being presented to the Governing Board for approval: 1) Health Homes Amendment 2) Multidisciplinary Medication Assisted Treatment (MMAT) Amendment 3) Primary Care Provider Attachment A – Primary Care Services 4) Master Attachment A - Primary Care Physician Services and A-1 – Double Boarded (All LOBs_ NO MCR_MCR ONLY) 5) Master Attachment B and B-1 – Double Boarded Capitated Primary Care Physician (All LOBs_No MCR_MCR only) 35. Approval of the Evergreen Contracts Renewal under the Evergreen Clause of the following Agreements effective, January 1, 2021: Additional three (1) year term: 1) Fariborz Lalezarzadeh DO Inc - Participating Provider Agreement 2) Heritage Health Care Inc dba Heritage Gardens Health Care Center - Residential Care for the Elderly Provider Agreement Additional three (3) year term: 3) Chino Avenue Congregate Home Inc - Congregate Living Health Facility Provider

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Agreement 4) P & M Healthcare Holdings Inc dba Rancho Mesa Care Center - Skilled Nursing Facility Provider Agreement 5) Sela Healthcare Inc dba Villa Mesa Care Center - Skilled Nursing Facility Provider Agreement Additional five (5) year term: 6) 121 Rehab Physical Therapy Corporation - Participating Provider Agreement 7) Aeroflow Inc dba Aeroflow Healthcare- Ancillary Provider Agreement 8) BioHorizon Medical Inc - Ancillary Provider Agreement 9) Catherine Tuong dba Dr Catherine Tuong Optometrist - Participating Provider Agreement 10) Charles F Rose LMFT - Behavioral Health Provider Agreement 11) Coachella Valley Foot and Ankle Institute - Participating Provider Agreement 12) Healing Hand Family Care Clinics Corporation - Fee-For-Service Primary Care Provider Agreement 13) Mabel R Ribas - Behavioral Health Provider Agreement 14) Monzones Hospice Care LLC - Ancillary Provider Agreement 15) My Family Clinic Inc - Fee-For-Service Primary Care Provider Agreement 16) Pacific Perinatal Institute - Participating Provider Agreement 17) Pomona Community Health Center dba Parktree Community Health Center - Participating Provider Agreement 18) Ramin Samadi MD Inc - Participating Provider Agreement 19) Southern California Bone and Joint Clinic Inc - Participating Provider Agreement 20) TrueCare Surgery Center - Ancillary Provider Agreement

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

XI. ADJOURNMENT The next meeting of the IEHP Governing Board will be held on January 11, 2021 at the Inland Empire Health Plan

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ADMINISTRATION

1. 2020 THIRD QUARTER REVIEW OF THE IEHP COMPLIANCE PROGRAM

Recommended Action: Review and file Contact: Jarrod McNaughton, Chief Executive Officer Arif Shaikh, Director of Compliance and Regulatory Affairs/Compliance Officer Background: IEHP is required to implement an effective Compliance Program that meets the regulatory requirements set forth in 42 C.F.R. § 422.503(b)(4)(vi), 423.504(b)(4)(vi) and 438.608(a)(1)(iii). The principles outlined in the regulatory guidelines are applicable to all IEHP relevant decisions, situations, communications, and developments. The Governing Board is required to exercise reasonable oversight with respect to the implementation and effectiveness of the program.

This report provides an update on the IEHP Compliance Program and activities during the Third Quarter of 2020.

Discussion: 1. Compliance Program Compliance Training Program Updates New Hire Training For Q3 2020, there were 129 individuals due to complete New Hire Compliance Training. As of November 6, 2020, two remain outstanding. Compliance will continue to follow up with the Team Member’s Leadership Team and escalate to Executive Leadership in accordance with the department’s standard process if needed.

2020 Annual Compliance Training The Annual Compliance Training was launched on October 12, 2020. Team Members have been allotted five weeks to complete training. There is one Team Member who remains on leave since the 2019 Annual Compliance Training was launched.

Issues of Non-Compliance Issues of non-compliance are any instances/issues that cause IEHP to be out of compliance with operational, regulatory, and/or contractual requirements. These are outside of suspected Fraud, Waste, and Abuse (FWA), privacy incidents, and issues related to the Code of Conduct and Ethics. IEHP’s Compliance Audit & Oversight (A&O) Unit has implemented a centralized and formalized process for tracking, investigating, and correcting issues of non-compliance. The purpose of this process is to prevent, detect, and correct any issues of non-compliance.

For Q3 2020, Compliance experienced the following trends:

 During Q3, Compliance received an influx of Out of Area (OOA) cases from the Core Eligibility team. It was confirmed that the Core Eligibility team had implemented an Out of Area auditing process to ensure that Health Care Options (HCO) forms were faxed timely & that Exhibit 20/Notice for Disenrollment Due to Confirmation of Out of Area Status

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letters are being sent to members timely. Core Eligibility reported four (4) cases which were identified in their audit as potential issues of non‐compliance. Upon completion of the investigation, Compliance established a reporting threshold of three (3) cases or more, per month, pertaining to OOA issues before reporting to Compliance.  For Q3 2020, a total of eight incidents were received, and it was noted that the average duration an incident was open for investigation during the rolling year was 34.7 days and the longest time an investigation was open was 140 days. Of the eight incidents received, six were related to both the Medicare and the Medi-Cal lines of business, one was related to Medicare and one was related to the Medi-Cal line of business. Additionally, seven of the eight incidents received were deemed substantiated and one was deemed unsubstantiated.

2. Auditing & Monitoring Compliance Corrective Action Plan (CAP) Report and Dashboard A&O tracks and trends CAPs issued to internal IEHP Business Units through the course of investigations, auditing, and monitoring activities. Based on a rolling year, below are the CAPs by Status captured for Q3 2020:  52% of CAPs issued during the rolling calendar year are in a working progress status  13% of CAPs are in a CAP Validation status in which Compliance A&O conducts a validation process to ensure the CAP issue has been mitigated  22% of CAPs were accepted and did not require validation  4% CAPs have been validated  9% of CAPs were retracted.

The identified issues associated with the CAPs are in relation to:  44% related to monitoring activities  43% related to noncompliance  4% related to annual risk assessment  9% related to audit activities

Annual First Tier, Downstream and Related Entities (FDR)Vendor Assessment The Compliance Audit & Oversight Unit has concluded the 2020/2021 annual risk assessment of our First Tier, Downstream and Related Entities (FDRs) and/or subcontractors. The annual risk assessment of vendor FDRs/subcontractors is performed to determine the audit and monitoring strategy for our vendors. The assessment provides the organization a way to identify the line(s) of business that the vendor supports and provide information as to the scope of services related to that vendor/delegate’s responsibilities.

The Compliance Department used a pre-developed matrix to determine the risk stratification level of the FDR/subcontractor based on the Business Unit Contract Owner’s response to the Annual Vendor FDR Risk Assessment Questionnaire. The FDR is given an assigned risk rating (high, medium, low) to determine the level of oversight required for each vendor. The zones represent the risk level based on level of impact, auditing and monitoring oversight and/or performance concerns. The assessment resulted in two (2) high risk and two (2) deemed as medium risk and 23 low-risk. High risk areas include American Logistics Company (ALC) and

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DST (SS&C) Pharmacy Solutions. Medium risk areas include Licensed Psychologist, Paul Terrance McMahon and Imagenet LLC. It should be noted that those classified as low-risk FDRs have a monitoring or auditing system in place and no corrective actions plans (CAPs) have been issued within the last fiscal year. Those listed as High or Medium risk will be included in the First-Tier Entity Auditing & Monitoring’s (FTEAM) data collection. On October 22nd, 2020, the 2020/2021 annual FDR risk assessment was presented to the Compliance Committee.

Audit Plan Updates The 2020/2021 Audit Plan is in process. There has been a total of thirteen (13) audits completed thus far. During the course of Q3 2020, updates have been made to the Audit Plan. Multiple audits scheduled for Q3 and Q4 2020 are being rescheduled or removed to accommodate the Mock Joint State Programs Audit being conducted by Compliance A&O and to avoid duplication of efforts. The following updates have been made to the Audit Plan:  Four (4) audits are being removed to avoid duplication of efforts.  Ten (10) audits are being rescheduled to 2021.

Please see the attached 2020-2021 Audit Plan for the identified updates.

3. Special Investigations Unit (SIU): Privacy Incidents Federal and state laws/regulations require that IEHP ensures that Member health information is properly protected while allowing for the flow of information needed to provide and promote high quality health care. The IEHP Compliance SIU conducts intake and investigations involving privacy allegations and refers privacy breaches to appropriate regulatory agencies.

For the third quarter of 2020, 233 new privacy allegations were received; an increase of 14% compared to Q2. This quarter, 250 new or previously reported allegations were investigated and closed, including remediation, if needed. Of the 250 closed investigations, 95 incidents were substatiated with 82 remediated via internal measures and 13 referred to the appropriate regulatory agegncy as privacy breaches. Only privacy incidents which meet the breach1 criteria are reported to federal and state agencies. 51% of the substatiated investigations involved unauthorized access, use or disclosure via electronic means with most of these incidents involving a provider as the disclosing party relationship. We will monitor these incidents and continue to work with proper entities to help mitigate future occurrences.

The number of overdue investigations is impacted by the volume of reported allegations compared to available resources, as well as awaiting responses to address remediation measures. The number of overdue investigations decreased from Q2 to Q3 by 25%. The chart on the following page depicts the general privacy incident inventory as of June 30, 2020.

1 A breach is, generally, an impermissible use or disclosure that compromises the security or privacy of protected health information. An impermissible use or disclosure of protected health information is presumed to be a breach unless there is a low probability that the information has been compromised based on a risk assessment.

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45 39

1 6 1

PRIVACY NEW INTAKEINVESTIGATIONINVESTIGATION IN OVERDUEEXTENDED INVESTIGATIONPENDING CASE EXTENSIONCAP IN PROGRESS PROGRESS IN PROGRESS APPROVAL

Fraud, Waste, and Abuse Incidents To ensure compliance with federal and/or state laws and regulations, the SIU conducts intake and investigations of fraud, waste, and abuse allegations and refers suspected incidents to appropriate regulatory agencies.

For the third quarter of 2020, 164 new fraud, waste, and abuse allegations were received, a decrease of 8% compared to Q2. For this quarter, 194 new or previously reported allegations were investigated and closed, including remediation, if needed. Of the 194 closed investigations, 22 were substantiated with 12 remediated via internal measures and 10 referred to the appropritate regulatory agency as suspected fraud, waste or abse.

All suspected incidents were referred within the regulatory timeframes. Of the substantiated investigations remediated via internal measures, 50% involved billing isusues, and of the substantiated investigations which were referred to a regulatory agency, 60% involved forgery of prescriptions. IEHP continues to investigate and correct suspected activities, including recovery of funds, as appropriate.

The number of overdue investigations continue to be impacted by the volume of reported allegations compared to available resources. The number of overdue investigations decreased by 55% from Q2 to Q3. The chart below depicts the general fraud, waste, and abuse incident inventory as of September 30, 2020.

20 20

7 5 2 FWA NEW INTAKE INVESTIGATION ININVESTIGATION OVERDUEEXTENDED INVESTIGATIONREMEDIATION IN PROGRESS IN PROGRESS PROGRESS

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4. Regulatory Affairs: Performance Measure Validation (PMV) Audit On June 17, 2019, IEHP received notification of CMS’ intent to conduct a 2019 Performance Measure Validation (PMV) Audit to validate calendar year (CY) 2018 data used in reporting. The audit was conducted via WebEx on August 14, 2019.

As a result of the PMV audit, IEHP was issued a six (6)-month Performance Improvement Plan (PIP) for Core Measure 3.2: Members with an individual care plan completed within ninety (90) days of enrollment. IEHP submitted an updated PIP to CMS and DHCS contract managers on a monthly basis until deemed appropriate for closure. IEHP successfully closed out the Core 3.2 PIP on July 17, 2020.

On July 8, 2020, IEHP was once again selected to participate in the 2020 PMV Audit. On September 24, 2020, IEHP participated in the PMV Audit conducted by Health Services Advisory Group (HSAG). Following the audit, HSAG requested additional follow up items, which IEHP then submitted on October 2, 2020. IEHP is currently awaiting a final report.

2018 Joint Audit – DMHC Follow-Up Review On September 24, 2018, IEHP hosted the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC) for the 2018 Joint Audit. DHCS reviewed a lookback period of October 1, 2017 through September 30, 2018 for Medi-Cal, Seniors and Persons with Disabilities (SPDs) and Cal MediConnect (Medi-Cal portion only) line of business, while DMHC reviewed a lookback period of May 1, 2016 through April 30, 2018 and focused only on the Medi-Cal line of business.

DHCS found five (5) deficiencies and required IEHP complete a corrective action plan (CAP). IEHP closed the CAP with DHCS on July 11, 2019. On August 2, 2019, IEHP received the Final Report from DMHC. This report described five (5) deficiencies, similar to DHCS’ findings. The deficiencies identified by DMHC related to Grievance and Appeals and Access to Emergency Services and Payment.

On August 31, 2020, IEHP participated in a desk-level WebEx interview with the DMHC. Following the interview, IEHP has been asked to submit seven follow up items specific to declined grievances and 87 declined grievance case and audio files. IEHP is currently pending next steps.

Facility Site Review Medical Record (FSR MRR) Audit On April 29, 2019, IEHP received the DHCS Facility Site Review and Medical Record Review (FSR MRR) letter and report. Facility reviews occurred between March 25-28, 2019. IEHP received seven (7) Critical Element findings and fifteen (15) general findings. Critical element findings included: Office Management, Access and Safety, and Personnel. General findings included: Documentation, Preventative Care, and Continuity/Coordination.

IEHP remediated the critical elements and submitted the FSR MRR corrective action plan (CAP) on June 14, 2019. IEHP re-audited various facilities and submitted a follow-up response to DHCS on March 20, 2020. DHCS provided notification of formal CAP closure on August 6, 2020

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2020 DHCS Medical Audit On July 16, 2020, IEHP submitted a request for postponement of the 2020 DHCS Medical Audit. DHCS accepted the request for postponement on July 22, 2020 and agreed to resume with the regular audit schedule beginning with the 2021 Joint DHCS/DMHC Audit, which will be a full-scope medical audit. DHCS confirmed that, as customary, IEHP will receive a formal entrance letter three months prior to the scheduled audit.

In preparation for the scheduled audit, Compliance’s Audit & Oversight Unit has agreed to perform an internal mock audit. The mock audit will focus on areas where there were findings during the last two (2) audit cycles, or where IEHP has identified potential risk.

COVID-19 Reporting On March 9, 2020, IEHP received a request from DHCS to begin submitting daily reports reflecting the impact of COVID-19 on IEHP Members. The initial reporting request was limited to number of Members testing positive for COVID-19, and number of hospitalizations due to COVID-19. However, on March 28, 2020 DHCS revised its reporting request to include number of deaths from COVID-19, number of facility closures due to COVID-19, and additional information pertaining to facility closures.

As of October 5, 2020, IEHP has reported the following COVID-19 Totals to DHCS:  17,455 total positive COVID-19 tests among IEHP members  7,411 total hospital admissions associated with COVID-19 among IEHP members  294 total COVID-19 related deaths  42 total facility closures due to COVID-19 o Most closures occurred during the second quarter of 2020 and have since re-opened. o IEHP utilized telephonic support mechanisms such as the Nurse Advice Line (NAL) and MD Live systems to help triage members impacted by closures to appropriate points of care.

Fiscal Impact: None

Attachments: 2020-2021 Audit Plan.

Reviewed by Counsel: N/A

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ADMINISTRATION

2. APPROVE RESOLUTION 2020-004 FOR AUTHORIZING THE DESIGNATION OF A PLAN ADMINISTRATOR

Recommended Action: That the Governing Board of Inland Empire Health Plan (IEHP) adopt Resolution 2020-004 for the designation of a Plan Administrator to administer IEHP’s retirement benefit plans.

Contact: Jarrod McNaughton, Chief Executive Officer

Background: IEHP sponsors and maintains the following retirement benefit plans (each a Plan and collectively the Plans) for the benefit of its eligible employees:

Inland Empire Health Plan 457(b) Deferred Compensation Plan (457 Plan); and Inland Empire Health Plan Defined Contribution Plan (DC Plan); and, IEHP Retirement Plan (MP Plan)

The Plans require that IEHP, or a committee or another person or persons designated by IEHP, shall be the plan administrator responsible for the administration of the Plans and the investment of assets of the Plans.

Discussion: The following recommendations (Recommendations) are made by IEHP in consultation with counsel, who have evaluated the fiduciary and administrative structures of the Plan:

1. All duties and responsibilities with respect to the day-to-day administration and operation of the Plans, including the interpretation of plan documents, the determination of benefit payable, the investment management and oversight shall be the sole responsibility of IEHP’s Chief Organizational Development Officer who shall serve as the designated plan administrator of the Plans (Administrator) until removed or replaced in accordance with the Plan documents.

2. The Plan Administrator may appoint and retain representatives (such as recordkeepers, accountants, counsel, specialists, trustees) to assist in the administration of the Plans and the investment management and oversight without obtaining prior consent from the Board.

3. The Plan Administrator has the authority to adopt amendments to the Plans for any of the following purposes: (i) to conform the Plans’ terms to applicable law; (ii) to clarify the Plans’ intended operation; (iii) to implement any directive by the Board; or (iv) to make any other changes to the Plans that the Plan Administrator finds necessary or desirable, but only to the extent that any such change does not result in a material increase to the Plans’ cost.

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These Recommendations are presented to the Governing Board for consideration with a request to adopt Resolution 202-004 to empower the Plan Administrator to administer IEHP’s retirement plans.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: None

Financial Review: N/A

Reviewed by Counsel: Yes

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FINANCE DEPARTMENT

3. APPROVE THE SIXTH AMENDMENT TO THE PROFESSIONAL SERVICES AGREEMENT WITH HEALTH MANAGEMENT SYSTEMS, INC.

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Sixth Amendment to the Professional Services Agreement (Agreement) with Health Management Systems, Inc. (HMS) for the provision of the Coordination of Benefits Identification and Recovery Services effective February 15, 2021 through February 15, 2022.

Contact: Keenan Freeman, Chief Financial Officer

Background: HMS collects and processes information from many states and other insurance providers to identify when IEHP Members have other coverage. IEHP supplies HMS with paid claims data and HMS uses their other coverage data to identify claims IEHP paid when a Member had other healthcare coverage. HMS then works with the primary insurance carrier to recover the overpayment and IEHP pays HMS a commission on the recovery. This applies to Medi-Cal only.

In February 2011 under Resolution 11-41, the Governing Board approved a PSA with HMS for Coordination of Benefits Identification and Recovery Services to assist with third party liability recovery services. In November 2013 under Minute Order 13-354, the Governing Board approved the First Amendment which added the optional service of Medicaid Insurance Billing and Provider Recoupments. In February 2017 under Minute Order 17-17, a Second Amendment was approved extending the term through February 15, 2018. In February 2018 under Minute Order 16-64, a Third Amendment was approved extending the term through February 15, 2019. In March 2019, under Minute Order 19-43, a Fourth Amendment was approved extending the term through February 15, 2020. In March 2020 the Governing Board approved the Fifth Amendment extending the term through February 15, 2021.

Discussion: The Sixth Amendment extends the Agreement for one (1) additional year, effective February 15, 2021 through February 15, 2022. All other items and conditions of the Agreement remain in full force and effect. All costs for this Agreement are covered by recovered payments from the responsible health insurance carrier.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Will be included in the CY2021 Budget

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Fiscal Review: N/A

Reviewed by Counsel: Yes

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FINANCE DEPARTMENT

4. MONTHLY FINANCIAL REVIEW

Recommended Action: Review and File

Contact: Keenan Freeman, Chief Financial Officer

Discussion: Monthly Financials for PE October 31, 2020.

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Presented December 14, 2020

18 of 111 FINANCE October 2020 Month-to-Date Year-to-Date Actual Budget Variance Actual Budget Variance Total Revenue $ 454,523,865 $ 419,182,781 $ 35,341,084 $ 1,828,708,160 $ 1,674,418,007 $ 154,290,153 Total Medical Costs $ 454,015,949 $ 418,068,708 $ (35,947,241) $ 1,768,250,734 $ 1,618,812,483 $ (149,438,251) Total Operating Expenses $ 20,471,590 $ 22,940,607 $ 2,469,017 $ 78,161,406 $ 91,675,426 $ 13,514,020 Total Non Operating Income (Expense) $ 2,105,192 $ 2,808,544 $ (703,352) $ 7,869,725 $ 11,246,766 $ (3,377,041) Board Designated Projects $ 2,679,000 $ - $ (2,679,000) $ 7,045,000 $ - $ (7,045,000) Net Surplus (Deficit) $ (20,537,483) $ (19,017,991) $ (1,519,492) $ (16,879,254) $ (24,823,137) $ 7,943,881 Highlights for the Month: • The favorable revenue variance compared to budget stems from higher-than-expected Medi-Cal membership volume and CY 2020 Part A/B risk adjustment for higher risk scores.

• The unfavorable medical costs variance is primarily due to higher-than-expected capitation and pharmacy claims.

• The favorable total operating expenses variance amount is driven by no additional expense estimates recorded for budgeted COVID-19 reserves, delays in Professional Services, Computer Equipment, and staffing for open positions, and reduction in Facility supplies and Security costs.

• The unfavorable non operating income (expense) variance is due to lower MCO Tax revenue compared to the expense of $0.6M.

• The unfavorable board designated projects variance is due to IEHP Healthcare Scholarship Fund distributions.

Please note a portion of the variance for revenue and medical costs are offsetting, driven primarily from Prop56. In October, $25.9M and $23.5 were recorded for Prop 56 revenue and medical costs, respectively. There is Other Income/Expenses that is not attributed to a specific line of business but included on a consolidated basis (i.e. Interest Income, Interest Expense, Rental Income, and Board Designated Projects).

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October 2020 Month-to-Date Year-to-Date Actual Budget Variance Actual Budget Variance Total Revenue $ 404,378,809 $ 372,416,556 $ 31,962,253 $ 1,626,050,766 $ 1,487,619,014 $ 138,431,752 Total Medical Costs $ 408,169,868 $ 370,550,320 $ (37,619,548) $ 1,596,836,307 $ 1,435,118,235 $ (161,718,072) Total Operating Expenses $ 18,067,852 $ 20,349,739 $ 2,281,887 $ 69,060,846 $ 81,229,182 $ 12,168,336 Total Non Operating Income (Expense) $ 1,736,855 $ 2,077,728 $ (340,873) $ 6,478,343 $ 8,323,503 $ (1,845,160) Net Surplus (Deficit) $ (20,122,057) $ (16,405,775) $ (3,716,282) $ (33,368,045) $ (20,404,899) $ (12,963,146) Highlights for the Month: • The favorable variance for Medi-Cal revenue compared to budget is primarily due to higher-than-budgeted membership.

• The unfavorable medical costs variance is primarily due to higher-than-expected capitation, and pharmacy claims.

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October 2020 Month-to-Date Year-to-Date Actual Budget Variance Actual Budget Variance Total Revenue $ 50,145,056 $ 46,766,225 $ 3,378,831 $ 202,657,395 $ 186,798,993 $ 15,858,402 Total Medical Costs $ 45,846,081 $ 47,518,388 $ 1,672,307 $ 171,414,427 $ 183,694,248 $ 12,279,821 Total Operating Expenses $ 2,403,738 $ 2,590,869 $ 187,131 $ 9,100,560 $ 10,446,245 $ 1,345,685 Total Non Operating Income (Expense) $ - $ - $ - $ - $ - $ - Net Surplus (Deficit) $ 1,895,238 $ (3,343,031) $ 5,238,269 $ 22,142,408 $ (7,341,500) $ 29,483,908 Highlights for the Month:

• The favorable revenue variance compared to budget is primarily due to the CY 2020 Part A/B risk adjustment for higher risk scores, CY 2020 Quality Withhold payment estimate, and Risk Sharing payment estimate.

• The favorable medical costs variance is primarily due to lower-than-expected facility services partially offset by higher-than- expected pharmacy claims.

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24 of 111 FINANCE Balance Sheet Oct-20 Sep-20 Variance Assets Current Assets $ 1,471,484,848 $ 1,715,559,700 $ (244,074,852) Fixed Assets $ 226,525,314 $ 227,471,146 $ (945,832) Deferred Outflows of Resources $ 48,501,292 $ 48,501,292 $ - Total Assets $ 1,746,511,454 $ 1,991,532,138 $ (245,020,684)

Liabilities and Net Assets

Current Liabilities $ 729,074,940 $ 998,020,131 $ (268,945,191) Long-Term Liabilities $ 10,210,780 $ 10,210,780 $ - Deferred Inflows of Resources $ 46,680,654 $ 2,218,665 $ 44,461,989 Equity $ 960,545,079 $ 981,082,562 $ (20,537,483) Total Liabilities and Net Assets$ 1,746,511,454 $ 1,991,532,138 $ (245,020,684)

Highlights for the Month: • Decrease in Current Assets and Current Liabilities is due primarily to directed payments received in the prior month and distributed in the current month for FY 18/19. • Increase in Deferred Inflows of Resources is due to CMS November 2020 payment received in October 2020.

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• Sept 2019 – Received $245M directed payments from DHCS • May 2020 – $203.3M IGT Rate Range payments were distributed • Feb 2020 – HQAF DHCS payment received for DOS July-18 to June-19 • Sept 2020 – Received $306M directed payments from DHCS • Mar 2020 – Payments to providers for HQAF July 2018-June 2019, no CMS • Oct 2020 – Payments to providers for directed payments partially offset by funding received and an increase in medical payment an increase in CMS funding received and lower paid claims in October. • April 2020 – Rate Range DHCS payment for DOS July 2018 to Jun 2019, DHCS payment for increased Medi-Cal rates and new FY 19/20 Prop 56 programs, and a decrease in medical payments 26 of 111 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #311 CONSENT AGENDA December 2020

HEALTH SERVICES DEPARTMENT

5. APPROVE THE FOURTH AMENDMENT TO THE PROFESSIONAL SERVICES AGREEMENT WITH BRILLIANT CORNERS

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Fourth Amendment to the Professional Services Agreement (Agreement) with Brilliant Corners for Community Living Solutions for additional amount not to exceed $3.1 million and extend the term for an additional one (1) year through December 31, 2021. The total amount payable under this Agreement shall not exceed $13.9 million through December 31, 2021.

Contact: Karen Hansberger, M.D., Chief Medical Officer

Background: IEHP recognizes that stable housing is a significant social determinant of health. In March 2018, IEHP launched an initiative to provide permanent supportive housing to qualifying high-cost, high- utilizing, homeless members (3H) as well as homeless Members transitioning from Skilled Nursing Facility Custodial Care (Custodial) to less restrictive community settings. IEHP has contracted with multiple Intensive Case Management Service (ICMS) providers, including Step Up on Second Street Inc., LightHouse Social Service Centers and Jewish Family Service of San Diego, to provide Members enrolled in this initiative with wraparound supportive services. IEHP partners with Brilliant Corners to provide Property Related Tenancy Services (PRTS) for Members enrolled in this initiative. Currently, Brilliant Corners provides the following services:

 Administration of the Flexible Housing Subsidy Pool (FHSP) for IEHP Members  Unit Identification Services  Securing housing and establishing site control  Administration of rental subsidies  Providing owner/participant liaison services  Managing unit repairs and modifications  Providing unit habitability and tenant wellness checks  Providing housing retention services  Participating in interdisciplinary care team conferences with ICMS providers and IEHP  Providing regular reports to IEHP on outcomes of interest and key performance indicators

As of October 2020, IEHP’s Housing Initiative has received over 2,170 referrals and housed a total of 203 Members. This figure includes 145 Members housed from the 3H Program and 58 from the Custodial Program.

In November 2017 under Minute Order 17-203, the Governing Board authorized contract initiation with Brilliant Corners. On February 16, 2018 the Agreement was fully executed for an amount not to exceed $6.3 million through January 1, 2020.

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In December 2018 the First Amendment was executed that revised the schedule of fees but did not otherwise change the original contract value or scope. On January 9, the Second Amendment was executed which extended the term of the Agreement through December 31, 2020 but did not otherwise change the original contract value or scope. In May 2020 under Minute Order 20-103 the Governing Board approved the Third Amendment that increased the total not to exceed amount payable to $10.8 million.

Discussion: This Fourth Amendment extends the contract term an additional (1) year through December 31, 2021 for an additional amount not to exceed $3.1 million. The total amount payable under this Agreement shall not exceed $13.9 million through December 31, 2021.

Financial Analysis:

Current Agreement Expiration 12/31/2020

Total Current Agreement Amount $ 10,800,000 Total Forecasted Spend for Current Agreement as of December 2020 $ 9,690,866 Forecasted Remaining Funds Available in Existing Agreement upon Expiration $ 1,109,134 Roll- over remaining funds for January 2021 - March 2021 $ 1,109,134 Requesting funding for nine (9) months of CY 2021 [April 2021 – December 2021] $ 3,100,000

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Will be included in the CY2021 budget

Fiscal Review: S. Ahmed – 10/19/2020

Reviewed by Counsel: Yes

28 of 111 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #311 CONSENT AGENDA December 14, 2020

HEALTH SERVICES DEPARTMENT

6. APPROVE THE FIRST AMENDMENT TO THE MASTER SERVICE AGREEMENT WITH CALIBRATED HEALTHCARE NETWORK

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve First Amendment to the Master Service Agreement (Agreement) with Calibrated Healthcare Network for the provision of Utilization Management (UM) Referral Processing to extend the Agreement term for an additional three (3) months through March 31, 2021, for an additional amount not to exceed $165,000. The total amount payable under this this Agreement shall not exceed $365,000 through March 31, 2021.

Contact: Karen Hansberger, M.D, Chief Medical Officer

Background: Calibrated Healthcare Network began providing UM Referral Processing services for IEHP as a pilot program on May 1, 2020. Previously, IEHP has used Transaction Applications Group but launched the pilot with Calibrated Healthcare while the Request for Proposal (RFP) for UM Services was underway. Calibrated Healthcare has been a cost-effective support for UM with a reduction in cost per auth in relation to our current vendor from $9/authorization to $1.50/authorization on average. Calibrated Healthcare will continue to provide the primary review of utilization management non-clinical referrals until the current active RFP is completed. These services enable IEHP to scale up to and address increased work volume when significant increases in membership or other operational challenges are experienced.

Discussion: Beginning 2018, IEHP has experienced an increase in IEHP Direct Membership and authorization requests due to some shifts and transitions in IEHP’s Independent Physician Association’s (IPA) network. In 2020, there was an increase in membership from 1.23M in January to 1.32M in September which resulted in an increase of daily authorization requests. IEHP is extending the Agreement for an additional three (3) months through March 2021 while the RFP for UM Services is completed. To ensure proper available funding and authorization capacity, IEHP is requesting an additional $165,000 to aide in absorption of IEHP’s UM non-clinical referral volume. The total amount payable under this this Agreement shall not exceed $365,000 through March 31, 2021.

The First Amendment will allow for an additional 5 non-clinical FTEs beginning September 2020, for a total of 15 FTEs, and reduce the rate from $2,700 to $2,500 per FTE per month for the entire term of SOW #1.

Rates per FTE Production Old Rates $2,700 (10 Total FTE) 90 per FTE per day New Rates $2,500 (15 Total FTE) 90 per FTE per day

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Approval of the budget increase will replenish the available funding to meet the financial obligations of this Agreement, as well as allow a strategic approach to seek options for the upcoming year.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY2021 Budget

Fiscal Review: V. Johnson, 11/23/20and

Reviewed by Counsel: Yes

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HEALTH SERVICES DEPARTMENT

7. APPROVE THE FIFTH AMENDMENT TO THE PROFESSIONAL SERVICES AGREEMENT WITH GUARDIAN ANGEL CONSULTING, INC.

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Fifth Amendment to the Professional Services Agreement with Guardian Angel Consulting for the provision of validating medical record compliance for an additional $500,000 for an additional two (2) years through December 31, 2022. The total cost of this Agreement shall not exceed $1,655,000 through December 31, 2022.

Contact: Karen Hansberger, M.D., Chief Medical Officer

Background: The IEHP Quality Informatics Team oversees the formal Healthcare Effectiveness Data and Information Set (HEDIS®) annual project and HEDIS® efforts throughout the year. This project utilizes Nurses to review medical records to capture additional HEDIS® data that may not have been identified through an administrative process. The goal of the project is to ensure preventative health screenings/tests/exams that Members may have completed during the appropriate measurement period are correctly captured and recorded. This data completeness assists IEHP with determination of resource allocation related to care gaps identified.

Guardian Angel Consulting, Inc. has been providing HEDIS medical record abstraction and training services since December 2015. On December 3, 2015 under Minute Order 15-238 the Chief Executive Officer signed an Agreement with Guardian Angel Consulting, Inc. for an amount not to exceed $199,000 for one-year through December 31, 2016. On December 16, 2016 under Minute Order 16-64 the First Amendment was signed extending the Agreement for one (1) year for an additional $199,000 for total amount not to exceed $398,000 through December 31, 2017. On December 21, 2017 under Minute Order 16-64, the Second Amendment was executed extending the agreement for one (1) year for an additional $199,000 for total amount not to exceed $597,000 through December 31, 2018. On July 9, 2018 under Minute Order 18-207 the Governing Board approved the Third Amendment for an additional $58,000 for total amount not to exceed $655,000 through December 31, 2018. On December 10, 2018 under Minute Order 18-332, the Governing Board approved the Fourth Amendment for an additional $500,000 for total amount not to exceed $1,155,000 through December 31, 2020.

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During the formal HEDIS 2018 season (2017 Measurement Year) IEHP utilized Guardian Angel Consulting, Inc. for 100% primary chart abstraction. The partnership has allowed IEHP to maximize the impact of medical record review for the following key measures:

Discussion: Every year, following the formal HEDIS season medical record review process, the Quality Informatics Team continues on-going medical record review efforts which supports Global Quality P4P and the current HEDIS measurement period (example: HEDIS 2021/Measurement Year 2020). IEHP is requesting continued HEDIS medical record abstraction and training services to assist with the validation of medical record compliance for identified measures.

Services Cost HEDIS 2021 (Measurement Year 2020) Medical Record Abstraction, Training $250,000 and Consulting fees for related HEDIS 2021 activities HEDIS 2022 (Measurement Year 2021) Medical Record Abstraction, Training $250,000 and Consulting fees for related HEDIS 2022 activities

The total cost of the Fifth Amendment is not to exceed $500,000 through December 31, 2022. The total compensation payable under this Agreement shall not exceed $1,655,000 through December 31, 2022.

Strategy Focus Areas: (Make selection) Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in 20/21 Budget

Fiscal Review: V. Johnson, 11/12/20

Reviewed by Counsel: Yes

32 of 111 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #311 CONSENT AGENDA December 14, 2020

HEALTH SERVICES DEPARTMENT

8. APPROVE REQUEST FOR PROPOSAL 19-00824 AWARD TO, AND RATIFY AND APPROVCE THE PROFESSIONAL SERVICES AGREEMENT WITH, PACIFIC INTERPRETERS, INC.

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) 1) approve Request for Proposal 19-00824 (RFP 19-00824) award to, and 2) ratify and approve the Professional Services Agreement (Agreement) with, Pacific Interpreters for the provision of Telephonic Interpreter Services and Video Remote Interpreting (VRI) Services for an amount not to exceed $3,000,000 for five (5) years effective November 1, 2020 through October 31, 2025.

Contact: Karen Hansberger, M.D., Chief Medical Officer

Background: IEHP requires qualified and trained interpreters for Telephonic Interpretation Services between IEHP Member Services Representatives, other IEHP departments, and/or contractors and Members or prospective Members. This service is mandated by the California Department of Health Care Services under the Medi-Cal contract.

VRI is a video telecommunication service that provides American Sign Language (ASL) to individuals who are deaf or hard of hearing. IEHP requires ASL interpretation for Members between IEHP, Urgent Care Facilities, and other business associates. IEHP has contracted with Pacific Interpreters to provide telephonic and interpretation services for over ten (10) years.

IEHP released a telephonic and video interpretation services Request for Proposals (RFP) in March 2020. The goal was to find a single vendor with the skills and material required to provide telephonic and video interpretation services to IEHP Members. The following five (5) bidders responded with completed proposals:

 Pacific Interpreters, Inc.  Telelanguage  Interpreters Unlimited, Inc.  LionBridge  Focus Interpreting, Inc.

The vendors were scored by three (3) reviewers on four (4) criteria with a possible total score of 110 points. Points were distributed according to the following categories:

1. Checklist/Acknowledgement 2. Company Profile/Experience 3. Scope of Service 4. Live Demonstration

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Scores for proposal and demonstrations are outlined below:

Vendor Scores Proposal Pacific Interpreters, Inc. 56.82 Telelanguage 49.8 Interpreters Unlimited, Inc. 52.32 LionBridge 47.36 Focus Interpreting, Inc. 42.13 Demonstration Pacific Interpreters, Inc. 9 Telelanguage 9 Interpreters Unlimited, Inc. 8 LionBridge 9 Focus Interpreting, Inc. 6 Final Total Score Pacific Interpreters, Inc. 89.64 Telelanguage 88.8 Interpreters Unlimited, Inc. 87.53 LionBridge 80.79 Focus Interpreting, Inc. 65.64

Based on the total combined score of 89.64, IEHP selected incumbent Pacific Interpreter as the most qualified and responsive vendor for telephonic and video remote interpreting (VRI) services.

Pacific Interpreters is IEHP’s current incumbent and has handled approximately 40 million interactions nationally in 2019 which connected to their team of 11,000 professionals, on demand interpreters via audio or video in 30 seconds or less. Language services are provided in more than 240 languages, 24 hours a day, seven days a week, 365 days a year.

Discussion: The new Agreement with Pacific Interpreters will continue to include pricing based on usage per minute. Pacific interpreters will be reimbursed seventy-nine cents ($0.79) per minute for all languages for telephonic interpreting services. VRI pricing will be based on usage per minute that includes American Sign Language (ASL) at one dollar and seventy-five cents per minute ($1.75) and one dollar and fifty cents ($1.50) for all other languages. Pacific Interpreters will continue to provide interpretation services between IEHP Member Services Representatives, other IEHP departments, and/or contractors and Members or prospective Members.

The following tables represent all costs incurred by Pacific interpreters from 2016 until present, the number of calls received by Pacific Interpreters per month, and the estimated utilization for the year of 2021.

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Pacific Interpreter Services Annual Expenditure 2016 2017 2018 2019 2020 Total Cost Invoice Total $335,021.05 $321,178.63 $213,268.30 $351,060.97 $397,899.75 $1,618,428.70

Pacific Interpreter Services Calls- Utilization Volume 2020 Calendar Year Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 July-20 Aug-20 Total Calls 2,863 2,498 3,316 3,628 3,294 3,802 3,758 3,802 26,691

Pacific Interpreter Services- Utilization Volume 2021 Calendar Year (Average) Jan-21 Feb-21 March-21 April-21 May-21 June-21 Calls 3,500 3,500 3,500 3,500 3,500 3,500 Jul-21 Aug-21 Sept-21 Oct-21 Nov-21 Dec-21 Total Calls Calls 3,500 3,500 3,500 3,500 3,500 3,500 42,000 In response to the utilization trend and the anticipation of future expenditures, it is recommended that an annual not-to-exceed amount of $540,000 be budgeted for this Agreement, for a total not- to-exceed amount of $2,700,000 for a five (5) year term effective November 1, 2020 through October 31, 2025. Prior to the Effective Date of this Agreement, Pacific Interpreters has been providing Telephonic Interpreting Services under a prior Agreement which expires February 28, 2021 with IEHP. Due to the impact of COVID-19, there has been an unforeseen increase of appointment requests for Telephonic Interpreting Services. As a result, Pacific Interpreters has been rendering additional Telephonic Interpreting Services for the benefit of IEHP and its Members. Additional funds are needed to cover the costs for the increase of services (“COVID-19 Overages”). IEHP anticipates the total cost of the COVID-19 Overages to be an amount not-to-exceed $300,000.00, which will be payable under the new Agreement.

The total not-to-exceed amount for the new Agreement is $3,000,000, as calculated below:

Contract Year Compensation Amount 1 $540,000 2 $540,000 3 $540,000 4 $540,000 5 $540,000 Total: $2,700,000 COVID-19 Overages: $300,000 Total Contract Amount: $3,000,000

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Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY2021 Budget

Fiscal Review: V. Johnson

Reviewed by Counsel: Yes

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MEDICAL SERVICES DEPARTMENT

9. APPROVE THE SECOND AMENDMENT TO THE MEMORANDUM OF UNDERSTANDING WITH RIVERSIDE COUNTY OFFICE ON AGING

Recommended Action: That the Governing Board of the Inland Empire Health Plan approve the Second Amendment to the Memorandum of Understanding (“MOU”) with Riverside County Office on Aging for the Multipurpose Senior Service Program (MSSP) to extend the term one (1) year through December 31, 2021.

Contact: Karen Hansberger, M.D., Chief Medical Officer

Background: The Coordinated Care Initiative requires that MSSP be a Medi-Cal benefit available through the managed care health plan in specified counties. Riverside and San Bernardino counties are included in the initiative. MSSP provides social and health care coordination services for eligible seniors enabling them to remain in their homes. IEHP is responsible for providing MSSP as a managed care benefit through a contract with the California Department of Health Care Services (DHCS). Riverside County Office on Aging has been performing MSSP related administration and coordination tasks since 2012.

In January 2018, the MOU gave Riverside County Office on Aging the authority to continue performing these functions under a managed care system. In March 2020, a First Amendment was executed extended the period of performance for one (1) additional year through December 31, 2020.

Discussion: This Second Amendment extends the period of performance for one (1) additional year through December 31, 2021.

Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable

Fiscal Impact: None

Reviewed by Counsel: Yes

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MEDICAL SERVICES DEPARTMENT

10. APPROVE THE FIRST AMENDMENT TO THE MEMORANDUM OF UNDERSTANDING WITH THE RIVERSIDE UNIVERSITY HEALTH SYSTEM – BEHAVIORAL HEALTH

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the First Amendment to the Memorandum of Understanding (MOU) with Riverside University Health System- Behavioral Health (RUHS-BH) for the provision of coordinating the delivery of health care services to Riverside County beneficiaries.

Contact: Karen Hansberger, M.D., Chief Medical Officer

Background: Since 1998, IEHP has worked with the RUHS-BH to develop a County specific, all-inclusive MOU that appropriately establishes physical and specialty mental health care services for Medi- Cal and Medicare Dual Choice recipients. Periodically, the MOU is reviewed and updated to incorporate changes to State regulations. The previous update to the MOU added new responsibilities for IEHP and RUHS-BH related to Eating Disorder Services. The update specified quarterly submission of claims packets to RUHS by IEHP.

Discussion: Certain treatment services for severe Eating Disorders are not generally covered by Medi-Cal, such as specialized inpatient Eating Disorders units or residential treatment centers. Moreover, a severe Eating Disorder is one that may require a higher level of care to manage than either RUHS-BH or IEHP can reasonably provide via their respective outpatient provider networks. As such, when members/clients are identified as having an Eating Disorder, IEHP and RUHS-BH work together, to the best of their respectively abilities, to provide these members with appropriate services.

The First Amendment to the current RUHS MOU clarifies the reimbursement arrangement related to the provision of these services. Specifically, it requires that IEHP submit claims packets to RUHS requesting reimbursement at 50% of facility and professional fees for Eating Disorder- related services on a monthly basis and that RUHS in turn remit payment within 30 business days from the receipt of the claims package. The First Amendment moved from quarterly submissions and payments, to a monthly cadence.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable

Fiscal Impact: None

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Financial Review: V. Johnson, 12/2/20

Reviewed by Counsel: Yes

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MEDICAL SERVICES DEPARTMENT

11. APPROVE THE SECOND AMENDMENT TO THE MEMORANDUM OF UNDERSTANDING WITH RIVERSIDE COUNTY OFFICE ON AGING

Contact: Karen Hansberger, M.D., Chief Medical Officer

Discussion: This Second Amendment extends the period of performance for one (1) additional year through December 31, 2021.

Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable

Fiscal Impact: None

Reviewed by Counsel: Yes

40 of 111 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #311 CONSENT AGENDA December 14, 2020

MEDICAL SERVICES DEPARTMENT

12. APPROVE THE FOURTH AMENDMENT TO THE MEMORANDUM OF UNDERSTANDING WITH SAN BERNARDINO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Fourth Amendment (Amendment) to the Memorandum of Understanding (MOU) with San Bernardino County Department of Behavioral Health (SBDBH) for the provision of coordinating the delivery of health care services to San Bernardino County beneficiaries.

Contact: Karen Hansberger, M.D. Chief Medical Officer

Background: Since 1998, IEHP has worked with the San Bernardino Department of Behavioral Health (SBDBH) to develop a County specific, all-inclusive MOU that appropriately establishes physical and specialty mental health care services for Medi-Cal and Medicare Dual Choice recipients. Periodically, the MOU undergoes a review and update process to incorporate new changes to State regulations. This ensures that the responsibility is current, and that Medi-Cal and Medicare Dual Choice recipients do not experience a lapse in service. The MOU expiring on December 31, 2020 focused on changes related to improving collaboration between IEHP and San Bernardino Department of Behavioral Health in terms of interdisciplinary meetings and transitioning Members to the appropriate care. In November 2020, IEHP and SBDBH approved a retro board amendment (III) effective February 13, 2018 through December 31, 2020 specific to Eating Disorder treatment and mutual associated responsibilities.

The Medicaid Health Home State Plan Option is afforded to states under the Patient Protection and Affordable Care Act (Pub. L. 111-148), enacted on March 23, 2010, as revised by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), enacted on March 30, 2010, together known as the Affordable Care Act (ACA). Section 2703 of the ACA allows states to create Medicaid health homes to coordinate the full range of physical health, behavioral health, and community-based long-term services and supports (LTSS) needed by members with chronic conditions.

Discussion: IEHP has worked with SBDBH to amend the MOU to include the following: 1. The MOU shall be extended and continue in effect through December 31, 2022. 2. The term may be extended for up to one (1) additional one (1) year period, at the mutual consent of the parties. 3. Updated responsibilities for IEHP and SBDBH to include the following a. IEHP will refer Members in need of SUD treatment to the Screening Assessment and Referral Center b. Both parties will develop a manual to address various procedures outlined in the MOU c. IEHP will reimburse SBDBH at 100% of Medicare allowable and SBDBH will submit claims for reimbursement in accordance with IEHP’s procedures

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d. Increased collaboration between SBDBH and Member’s medical providers e. Improved clarification related to IEHP and SBDBH collaboration in terms of Members requiring Eating Disorder treatment 4. All other terms and conditions of the MOU remain the same.

IEHP requests approval to extend the Health Homes Program (HHP) related sections of the SBDBH MOU through December 31, 2021. The Department of Health Care Services (DHCS) has guaranteed HHP funding through December 31, 2021. SBDBH would continue to serve as a Community-Based Care Management Entity (CBCME), in conjunction with IEHP, with responsibility for ensuring that assigned HHP Members receive access to HHP services. This includes employing and maintaining a multi-disciplinary care team that provides the following six (6) core HHP services to eligible Members as per the DHCS HHP Program Guide: 1. Comprehensive and individualized care management; 2. Care coordination; 3. Health promotion (including connection to medical, mental health, and substance use disorder care); 4. Comprehensive transitional care from inpatient to other setting (including appropriate follow- up); 5. Individual and family support, including authorized representatives; and 6. Referral to relevant community and social support services (including connection to housing, transportation, healthy lifestyle supports, childcare, and peer recovery support).

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable

Fiscal Impact: None

Financial Review: V. Johnson, 12/2/20

Reviewed by Counsel: Yes

42 of 111 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #311 CONSENT AGENDA December 14, 2020

HEALTH SERVICES DEPARTMENT

13. APPROVE THE FUNDING FOR THE PAY FOR PERFORMANCE COMPREHENSIVE MEDICATION MANAGEMENT PROGRAM

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the funding for the Pay for Performance (P4P) Comprehensive Medication Management (CMM) Program for a cost not to exceed $2,000,000 for one (1) additional year effective January 1, 2021 through December 31, 2021.

Contact: Karen Hansberger, M.D., Chief Medical Officer

Background: Comprehensive Medication Management (CMM) is a program that was developed in collaboration with USC to provide the highest level of care to all its members and improve health outcomes. CMM services are provided by pharmacists with an extended scope of practice which includes collaborative practice agreements with physicians. It is the standard of care that ensures each patient’s medications (i.e., prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the co-morbidities and other medications being taken, and ability to be taken by the patient as intended. This streamlined process between the member, pharmacist, and provider, will help prevent further progression of complex diseases and help bridge the gap in health care.

It will decrease the total cost of care, ER visits, readmission rates while improving HEDIS/CAHPS scores, quality of care, access to care, and provider/member satisfaction. Diabetes, Asthma/COPD, Hypertension, Opioid Use, Heart Failure, Mental Health, Hyperlipidemia are some of the core disease states this program will address.

CMM’s positive impact on economic and clinical outcomes has been proven by multiple organizations in different settings. One such success story was from El Rio Community Health Center, which serves over 75,000 people in Pima County, Arizona. In 2011, 20% of El Rio’s adult patients (8,954 of 44,952) had diagnosed hypertension, but only 67% of those diagnosed had the condition under control. Pharmacists at El Rio were encouraged to establish CPAs with the center’s medical providers. These agreements enable pharmacists to work directly with patients to help them manage their hypertension and other chronic conditions, such as diabetes and hyperlipidemia. Within the scope of the CPA, pharmacists have the discretion to change patient medications. After CMM was implemented, El Rio reported improved clinical outcomes (e.g., lower cholesterol and blood pressure levels), increased use of recommended screenings, and reduced ER visits.

Another case study for CMM outcome is the Missouri’s State Program for Pharmacy-Assisted CMM program.

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Missouri’s State Program Pharmacy-Assisted CMM program  Total cost of $518.10 PMPM care ROI 2.5:1  ER Visits 25% Hospitalization  Rates 12%

https://www.cdc.gov/dhdsp/pubs/docs/Best_Practice_Guide_CDTM_508.pdf

Discussion: IEHP will be transitioning from Phase III of the current P4P program to Phase IV which will be known as the CMM program. During 2021 the CMM Program will focus on Asthma and Diabetes.

CMM program will enroll up to 65 additional pharmacy providers sites. With this network, IEHP will be able to enroll up to 3,250 high risk and rising risk members. Outcome measures will be focused on a decrease of hospitalizations, ER visits, total cost of care, overall care outcomes, and patient adherence. CMM services will provide patient and provider satisfaction, increase in CAHPS scores, and improved HEDIS measures.

Program cost consists of payment for pharmacy providers, training, program resources and tools as detailed below. 1. Payment for Pharmacy Providers: $1,875,000 2. Payment for Program Tools/Resource: $125,000  Training/coaching for CMM staff  EHR data sharing platform  Provider relation strategy

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY2021 Budget

Financial Review: V. Johnson, 11/23/20

Reviewed by Counsel: Yes

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INFORMATION TECHNOLOGY DEPARTMENT

14. DELEGATION OF AUTHORITY TO APPROVE AN AMENDMENT TO THE PROFESSIONAL SERVICES AGREEMENT WITH CONDUENT BUSINESS SERVICES LLC.

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) delegate the authority for the Chief Executive Officer (CEO) to, after legal review and approval, sign an Amendment to the Professional Services Agreement (Agreement) with Conduent Business Services, LLC. (Conduent) for the continued provision of software services at an additional amount not to exceed $3,000,000 through June 30, 2022.

Contact: Michael Deering, Chief Information Officer

Background: In August 2013 IEHP released a Request for Proposal (RFP) for Core System Replacement Consulting Services in order to select the best Core System Replacement. HTMS was chosen as IEHP’s third party consultant based upon a combination of the reviews of their submitted proposal, scoring evaluation, and required onsite presentation.

In September 2014, IEHP publicly released the RFP for the Core System replacement solution. Out of the 28 vendors that expressed an interest to respond, six (6) of those vendors completed their response submissions.

In June 2015 under Minute Order 15-143, the Governing Board approved the Delegation of Authority for IEHP to sign an agreement with HSP for the on-site Core Replacement System solution. The General Terms of the resultant contract were signed and executed on September 9, 2015 for an amount not to exceed $34.265 million through September 2020.

In June 2017 under Minute Order 17-88, the Governing Board approved the 2017/2018 Fiscal Year Budget Presentation and HSP was provisioned with additional funding of $4.5 million due to an increase in enhancement costs and an increase to the associated implementation costs of an extended go-live.

In October 2018, Conduent announced intentions to acquire HSP in alignment with the company's strategy to enhance its core portfolio and further define the company as a technology-led, digital interactions company. The acquisition of HSP was finalized on January 3, 2019.

In February 2019, under Minute Order 19-34, the Governing Board approved an Amendment to the Agreement with Conduent for a no-cost term extension through August 31, 2019. This extension allowed for the utilization of Professional Services hours which were credited and still available to IEHP.

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In August 2019, under Minute Order 19-150, the Governing Board approved an Amendment to the Agreement with Conduent for a funding increase and term extension not for an additional amount not to exceed $2.75 million through December 31, 2021 for the provision of post-go live support services.

In July 2020, under Minute Order 20-183, the Governing Board approved the Tenth Change Order and Funding Increase to the Agreement with Conduent for an amount not to exceed $1.5 million through December 31, 2021.

In November 2020, under Minute Order 20-317, the Governing Board approved the funding increase to the Agreement with Conduent for an additional amount not to exceed $600,000 through December 31, 2021 to continue the provision of software service funding within the fiscal year to calendar year budget cycle conversion period.

Discussion: IEHP is requesting that the Governing Board delegate authority for the CEO to approve an Amendment to IEHPs existing Agreement with Conduent for the continued provision of software licensing and professional support services. These licenses and associated services support central components of IEHP’s internal IT infrastructure. The requested amount for approval is inclusive of new maintenance fees associated with recent system enhancements and is also inclusive of a five (5) percent contingency. The total additional amount requested is not to exceed $3,000,000 through June 30, 2022.

Strategy Focus Areas: Member Experience Network Team Members

Operational Excellence Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY2021 Budget

Financial Review: J. Haines 11/11/20

Reviewed by Counsel: Yes

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INFORMATION TECHNOLOGY DEPARTMENT

15. APPROVE THE SEVENTH AMENDMENT TO THE MASTER LICENSE AND SERVICE AGREEMENT WITH EDIFECS, INC.

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Seventh Amendment (Amendment) to the Master License and Service Agreement (MLSA) with Edifecs, Inc. (Edifecs) for an amount not to exceed $402,303 through December 15, 2023 for the continued provision of a hosted Operating Rule Solution.

Contact: Michael Deering, Chief Information Officer

Background: On June 22, 2018 under Minute order 18-198, the Governing Board approved the Encounter and EDI Solution Project. The project implementation cost was approved for an amount not to exceed $5.8 million under the capital budget; though a more conservative value of $5 million was ultimately requested of board for the initial scope requirements.

On August 13, 2018 under Minute Order 18-236, the Governing Board approved the award of Request for Proposal #18-002 (RFP) to Edifecs for the provision of an Encounter and EDI Solution, and on November 21, 2018 IEHP entered into the Fourth Amendment to the MLSA with Edifecs for the provision of the RFP awarded Encounter and EDI solution Project.

On December 10, 2018 the Governing Board approved the Fifth Amendment to the MLSA with Edifecs for a term extension through December 16, 2019. The term extension was required due to the MLSA term originally timing in conjunction with a December 2015 Edifecs provisioned compliance solution for CAQH CORE operating rule sets. The EDI and Encounter Solution was drafted as an Amendment to the existing MLSA with Edifecs.

On June 10, 2019 under Minute order 18-198, the Governing Board approved the funding increase of $3.1 million for the Edifecs provisioned EDI and Encounter Solution that was included in the FY19/20 Budget Presentation. This approval also granted the Chief Executive Officer authority to negotiate and, after legal review and approval, sign appropriate agreements and amendments.

On September 9, 2019 under Minute Order 19-174, the Governing Board approved the funding increase and term extension to the MLSA with Edifecs for an amount not to exceed $168,000 through December 31, 2020, bringing the new total amount under the agreement to $8.268 million.

On May 11, 2020 under Minute Order 20-109, the Governing Board approved the Change Order to the MLSA for an amount not to exceed $525,000 through December 31, 2021 for an additional 3,563 professional service hours for further refinement of system workflows and post go-live stabilization.

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On September 14, 2020, under Minute Order 20-272, the Governing Board approved the funding increase and Change Order #1990 to the MLSA with Edifecs for an amount not to exceed $1.6 million through December 31, 2021.

Discussion: Since IEHP first entered into an Agreement with Edifecs for the provision of a hosted CAQH CORE Operating Rule Solution, IEHP’s Information Technology team has made significant developments and improvements to IEHP’s underlying transaction infrastructure. With these more robust capabilities in-hand, the Plan has now been able to pursue a reduced-scale and reduced-cost term extension for the continuation of these hosted services.

The Seventh Amendment will reduce IEHP’s annual cost-commitment for the receipt of Operating Rule solution services by more than $600,000. In total, IEHP is requesting that the Governing Board approve a three (3) year term extension to this Agreement for an additional amount not to exceed $402,303 through December 15, 2023.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY2021 Budget

Financial Review: J. Haines

Reviewed by Counsel: Yes

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INFORMATION TECHNOLOGY DEPARTMENT

16. APPROVE THE FUNDING INCREASE TO THE SERVICES AGREEMENT WITH MCI COMMUNICATIONS SERVICES INC. DBA VERIZON BUSINESS SERVICES

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the funding increase to the Services Agreement (Agreement) with MCI Communications Services Inc. DBA Verizon Business Services (Verizon) for the continued provision of WAN, VOIP, and Internet Telecommunication Services for an additional amount not to exceed $525,000 through March 13, 2022.

Contact: Michael Deering, Chief Information Officer

Background: In October 2012 under Minute Order 12-285, the Governing Board approved the Master Services Agreement (MSA) with Verizon Corporation for toll free telephone services for a period of three (3) years. Prior to this MSA, IEHP was being charged $0.024/min and $0.035/min for non-switched and switched services. Following the MSA, IEHP committed to a 0.016/min rate and a $120,000 Annual Volume Commitment.

In July 2013, under Minute Order 13-230, the Governing Board approved an Amendment to the MSA, entitled Amendment: 02. This Amendment expanded IEHPs telecommunication capacities through utilization of the Plan's new Unified Cisco Phone System which allowed IEHP to install Multi-Protocol Label Switch (MPLS) lines. This configuration upgrade provided a higher performing network that was capable of supporting Verizon SIP trunking services, Voice over Internet Protocol (VOIP) at the Atrium, and extended Enterprise Local Area Network (LAN) and Wide Area Network (WAN) solutions. The new total amount under this Agreement was not to exceed $174,720 annually through July 2016; after which the contract automatically entered into a month to month term structure.

In March 2018, under Minute Order 16-64, the Governing Board approved the Amendment to the MSA, entitled Amendment: 03. This Agreement continued IEHP's Annual Volume Commitment of $120,000 and extended the Agreement for an additional two (2) years through March 19, 2020.

In March 2019, under Minute Order 19-46, the Governing Board approved the Fourth Amendment to the MSA with Verizon for the continued provision of WAN, VOIP, and Internet services as well as the upgrade and migration to a new VOIP platform that will allow IEHP to participate in next generation 5G environments for an amount not to exceed $1.1 million for a period of three (3) years.

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Discussion: IEHP began a planned migration to the use of a next-generation VOIP platform model in mid-2019. This new platform provisions IEHP with the ability to utilize 5G technology for Plan operations and communication. With the introduction of 5G technology, it is anticipated that connected services will be able to experience:

 Lessened device energy use  Raised cost savings  Higher system capacities  Higher data exchange rates,  Vast improvements in device connectivity  Lowered latencies

As an example of the expected capacities, 5G Networks have exhibited data transference rates at speeds up to 100 times faster than the preceding 4G LTE cellular technology. These capabilities provide new opportunities in the utilization of wearable devices and remote care delivery. Due to the impact that Covid-19 has had on accelerating the Inland Empire’s need for remote care delivery options, upgrades such as these have become increasingly more important to pursue.

IEHP's upgrades in telecommunication infrastructure have allowed for the improved operation, stability, reliability, and versatility of the Plan's phone and internet lines as well as their associated services. This funding increase will support the standard provision of existing services as well as a temporary duplication of SIP trunk lines that is required for successful migration to the new platform. IEHP is requesting the funding increase to support the continued provision of WAN, VOIP and Internet Telecommunication services for an amount not to exceed $525,000 through March 13, 2022.

Strategy Focus Areas: Member Experience Network Team Members

Operational Excellence Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in the CY2021 Budget

Financial Review: J. Haines 11/20/2020

Reviewed by Counsel: N/A

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INFORMATION TECHNOLOGY DEPARTMENT

17. APPROVE THE INCREASE IN SPENDING AUTHORITY WITH OPENTEXT CORPORATION

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the increase in spending authority with OpenText Corporation for cloud-based faxing services. The additional cost shall not exceed $250,000. The new total cost under this Agreement shall not exceed $2.75 million through December 31, 2021.

Contact: Michael Deering, Chief Information Officer

Background: In May 2014 under Minute Order 14-124, the Governing Board approved the Professional Services Agreement (Agreement) with EasyLink Services, formerly known as Open Text, for cloud-based faxing services at a cost not to exceed $360,000 for a period of three (3) years, effective January 31, 2014.

In October 2014 under Minute Order 14-248, the Governing Board approved the First Amendment to the Agreement, which replaced the Corporate Vendor, EasyLink Services, with its subsidiary, Xpedite Systems, LLC, and changed the Agreement type with Xpedite Systems, LLC from a Professional Services Agreement to a Customer Services Agreement. The additional cost, which included tax and other fees, was not to exceed $500,000. The total costs under this Agreement increased to an amount not to exceed $860,000 for three (3) years, effective October 1, 2014.

In January 9, 2017 under Minute Order 17-00, the Governing Board approved an increase in spending authority with Xpedite System, LLC for cloud-based faxing services for an amount not to exceed $300,000 through October 1, 2017. The total costs under this Agreement increased to an amount not to exceed $1.16 million.

In September 2017 under Minute Order 17-156, the Governing Board approved an increase in spending authority and the renewed Agreement. The renewal was altered in structure from the Agreement's initial composition by transitioning from year-based terms to month-to-month auto- renewals. The total requested amount was $414,000 which included a 15% contingency for a period of one (1) year. The new total cost under this Agreement increased to an amount not to exceed $1.574 million.

In October 2018 under Minute Order 18-297, the Governing Board approved an increase in spending authority for $230,000. Since 2018, IEHP has been exploring new vendor options and possible in-house based solutions. As such, the $230,000 was to account for six (6) months of funding.

In July 2019 under Minute Order 19-125, the Governing Board approved an increase in spending authority for $196,000. This resulted in a new total cost not to exceed of $2.0 million.

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In October 2019 under Minute Order 19-193, the Governing Board approved an increase in spending authority for $250,00. This requested amount was to cover a period of four (4) to six (6) months, during which time IEHP would be fine-tuning the parameters of an API build that would allow for the direct migration of faxed information into IEHP’s MedHOK system. This resulted in a new total cost not to exceed of $2.25 million.

In April 2020 under Minute Order 20-83, the Governing Board approved an increase in spending authority for $250,000 through September 31, 2020. The new total cost under the agreement was not to exceed $2.5 million.

Discussion: In 2018, IEHP pursued a system-wide upgrade to its faxing system infrastructure. The first step in this upgrade required migration of all faxing communications to a RightFax system. As of December 2018, IEHP completed the RightFax migration upgrade.

To expand on this upgrade, IEHP planned the construction of a bridge between the RightFax virtualized servers and components of IEHP’s CORE system. In particular, IEHP intends to construct an application programming interface (API) that will link existing fax connections with MedHOK repositories, effectively populating the faxed data into MedHOK’s available pool of data. As the API build requires contribution from multiple vendor sources, the timing of the Fax- MedHOK API completion is contingent upon the timelines of concurrent MedHOK project work. As of 2020, IEHP is positioned to evaluate qualified bidders for the new carrier connection upgrade.

Due the IEHP IT Team’s critical role in maintaining a fully remote workforce, the IT team has re- prioritized projects as needed to support IEHP’s successful navigation through the Covid-19 National Health Emergency. To allow for the continuation of uninterrupted faxing services until a qualified bidder is selected, and to allow for the provision of services until bidder solicitation is re- initiated, IEHP is requesting approval for an additional $250,000 through December 31, 2021. The new total cost under the agreement is not to exceed $2.75 million.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY 2021 Budget

Financial Review: J. Haines

Reviewed by Counsel: N/A

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INFORMATION TECHNOLOGY DEPARTMENT

18. APPROVE THE TENTH AMENDMENT AND THE CONSULTING SERVICES SCHEDULE TO THE MASTER SERVICES AND LICENSE AGREEMENT WITH OPTUMINSIGHT, INC.

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve 1) the Tenth Amendment and 2) the Consulting Services Schedule to the Master Service and License Agreement (MSLA) with OptumInsight, Inc. (Optum) for an additional cumulative amount not to exceed $44,122.

Contact: Michael Deering, Chief Information Officer

Background: IEHP has been using Optumlnsight (formerly lngenix Consulting, Inc.) since 2009. lngenix Consulting, Inc. (now Optumlnsight) was selected after a thorough Request for Proposal (RFP) process as the most responsive/responsible vendor.

Between 2009 and 2015, IEHP executed multiple Amendments to the MSLA with OptumInsight for the provision of myriad claims-pricing related consulting and software services, including Web.StratTM and APC AssistantTM

In February 2016 under Minute Order 16-26, the Governing Board approved the Seventh Amendment to the MSLA with Optum for Web.StratTM and APC AssistantTM software for an additional amount not to exceed $581,011 for a period of three (3) years.

In December 2018 under Minute Order 18-336, the Governing Board approved the Eight Amendment to the MSLA with Optum for Web.StratTM and APC AssistantTM claims related software for an additional cost not to exceed $98,280 for twelve (12) months, effective December 11, 2018 through December 10, 2019.

In November 2019 under Minute Order 19-210, the Governing Board approved the funding increase to the MLSA for an additional amount not to exceed $100,000 through July 31, 2020.

In May 2020 under Minute Order 20-108, the Governing Board approved the Ninth Amendment to the MLSA with Optum for the no-cost term extension to the Web.StratTM and APC AssistantTM Product Schedule.

Discussion: IEHP currently uses Optum's Web.StratTM and APC AssistantTM software to support claims processed within IEHP’s legacy Diamond 725 claim processing system (Diamond 725). In February 2015, IEHP selected the Health Solutions Plus (HSP) claim processing system. This Tenth Amendment will extend the term of the existing WebStrat and APC Assistant services to allow for continued maintenance and support of claims processed throughout the Diamond 725

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lifecycle until all required data may be accessed within the HSP system. This service extension will be for an additional amount not to exceed $34,752 through June 30, 2021.

Secondly, IEHP utilizes Optum-provisioned services to assist in the evaluation and analysis of inpatient claim pricing accuracies. IEHP’s Network Team uses these services on an ad hoc basis. This particular Consulting Services Schedule is for an additional amount not to exceed $9,370 through October 31, 2021 and will provision services for over 33,000 inpatient hospital claims.

Combined, IEHP is requesting an additional amount not to exceed $44,122.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY2021 Budget

Financial Review: J. Haines 11/05/20

Reviewed by Counsel: Yes

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INFORMATION TECHNOLOGY DEPARTMENT

19. RATIFY AND APPROVE THE ORDERING DOCUMENT TO THE MASTER LICENSE SERVICES AGREEMENT A WITH WORKFRONT, INC.

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the ordering document to the Master Software License and Services Agreement (MLSA) with Workfront, Inc. for the continued provision of work management software at a cost that shall not exceed $3,700,538 for a period of three (3) years, effective December 6, 2020 through December 6, 2023.

Contact: Michael Deering, Chief Information Officer

Background: In 2011, IEHP issued an RFP for task management software for their Information Technology (IT) and Operations departments. IEHP selected AtTask, Inc. as the most responsive/responsible vendor.

In December 2011 Resolution 09-98 was approved by the Governing Board for the capital expenditure with AtTask, Inc. for the provision of task management software.

In December 2012, under Minute Order 12-349, the Governing Board approved the annual renewal of existing licenses and approved the further addition of licenses to support an increase in users from the IT and Operations departments.

In December 2013, under Minute Order 13-49, the Governing Board approved the annual renewal of existing licenses and approved the further addition of licenses to support an increase in Team Members from additional utilizing departments.

In December 2014, under Minute Order 14-318, the Governing Board approved the annual renewal of existing licenses, the addition of further licenses to support multiple departments, and the upgrade of these licenses to an improved level of security standard.

In early 2015 AtTask, Inc. became known as Workfront, Inc. (Workfront). In February 2016 Minute Order 16-28 was approved by the Governing Board for additional licenses.

In December 2016, under Minute Order 16-198, the Governing Board approved the annual renewal of existing licenses, the provision of additional licenses, and the provision of Digital Asset Management (DAM) software, a ProofHQ plugin, and corresponding licenses.

In December 2017, under Minute Order 17-243, the Governing Board approved the Ordering Document for the three (3) year renewal of the MLSA with Workfront for an additional amount not to exceed $3, 035,500; effective December 6, 2017 through December 6, 2020.

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Discussion: Since 2011, IEHP has been utilizing Workfront to facilitate and improve work-task management, workflow intake processes and project execution efficacies. IEHP has also expanded the use of Workfront from an IT and Operations-dominant project management tool to an Enterprise-wide work management application spanning multiple IEHP departments. Currently, Workfront serves as IEHP's primary work management and collaboration tool and is used to support all IEHP departments.

IEHP is requesting that the Governing board approve the renewal of the Workfront provisioned work management software for an additional three (3) years at amount not to exceed $3,700,538 through December 6, 2023.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY 2021 Budget

Financial Review: J. Haines

Reviewed by Counsel: Yes

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MARKETING DEPARTMENT

20. APPROVE THE USE OF SELECTED PRINT AND DIGITAL MEDIA VENDORS FOR ADVERTISING SERVICES

Recommended Action: That the Governing Board of Inland Empire Health Plan (IEHP) approve the use of selected print and digital media vendors for advertising services, for a total compensation payable of $362,400 for Calendar Year 2021 (CY 2021).

Contact: Michelle Rai, Chief Communications and Marketing Officer

Background: Print and digital advertising is generally used for branding and direct response purposes. For example, IEHP distributes print and digital flyers to promote Medi-Cal, Cal MediConnect program and Community Resource Centers. IEHP also runs print advertisements in the Riverside and San Bernardino Medical Society Associations’ publications to promote our partnership with Providers, organizational achievements, high Physician Satisfaction scores, etc.

Discussion: IEHP has been using print and digital channels as direct response vehicles to promote Medi-Cal and the Cal MediConnect program. These advertising channels have proven very effective for many years. In addition, IEHP promotes their brand and services to the provider community in selected publications such as the Riverside Medical Society Association, San Bernardino Medical Society Association, and the CAHP Annual Report.

IEHP requests approval to purchase advertising from all print and digital publications owned and/or affiliated with the following entities for CY 2021:

a. California Association of Health Plans (CAHP) b. CA Senior Guide c. Inland Empire Magazine d. Riverside Medical Society Association e. San Bernardino Medical Society Association f. Valassis Direct and Valassis Digital

The total compensation payable for print and digital media advertising services are $362,400 for CY 2021.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

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Fiscal Impact: Included in CY 2021

Financial Review: (S. Ahmed, 11/19/2020)

Reviewed by Counsel: N/A

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MARKETING DEPARTMENT

21. APPROVE THE USE OF SELECTED BROADCAST MEDIA FOR ADVERTISING SERVICES

Recommended Action: That the Governing Board of Inland Empire Health Plan (IEHP) authorize IEHP to use selected broadcast media advertisers including radio and cable TV in the total compensation payable of $2,092,600 for Calendar Year 2021 (CY 2021).

Contact: Michelle Rai, Chief Communications and Marketing Officer

Background: Broadcast advertising is generally used for branding and direct response to support key company objectives and initiatives. For example, IEHP uses radio and cable TV as advertising channels to promote Medi-Cal coverage to the uninsured population or key HEDIS/CAHPS measures to IEHP Members, such as preventive care, flu shots, and customer satisfaction. Broadcast advertising is also one of the critical media channels that has contributed to our current 90 percent Medi-Cal plan choice rate (highest among local public plans in California) and our 97 percent brand awareness rate in the Inland Empire.

Broadcast advertising will also help support the Strategic Focus Areas for a top employer brand within the Inland Empire and California.

Discussion: IEHP uses data from media ratings company, Nielsen, and our Member’s survey and focus groups to evaluate and select high performance radio stations and cable TV shows that will effectively reach their target audiences.

IEHP requests the approval to purchase radio and cable TV advertising from all stations owned and/or affiliated with the following companies for CY 2021:

RADIO AND TELEVISION  Gulf California Broadcast (KUNA,  Alpha Media, LLC (KKUU/KPSI) KUNA TV Telemundo 15 Palm Springs, KDFX TV)  Charter Communications Holding  Hulu, LLC LLC dba Spectrum Reach  El Dorado Broadcasting  Inland Empire Broadcasting Corp. (KATJ/KZXY) (KOLA)  Entercom Communications Corp.  Liberman Broadcasting, Inc. (KRQB) (KFRG)  Pandora Media, LLC  Entravision Communications

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RADIO AND TELEVISION (KLYY, KLOB, NBC Palm Springs KPSE-TV, Univision Palm Springs KVER-TV)  FKA Clear Channel  RM Broadcasting, LLC (KPLM) Communications dba iHeart Media and Entertainment Inc.

IEHP will purchase advertising directly with the radio stations and cable providers instead of through a media placement agency. With this approach, IEHP will receive a discount rate that is only given to not-for-profit organizations, as well as some credits for their direct purchase. The total compensation payable for broadcast media services are $2,092,600 for CY 2021.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY 2021 Budget

Financial Review: (S. Ahmed, 11/19/2020)

Reviewed by Counsel: N/A

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MARKETING DEPARTMENT

22. APPROVE THE USE OF SELECTED OUTDOOR MEDIA VENDORS FOR ADVERTISING SERVICES

Recommended Action: That the Governing Board of Inland Empire Health Plan (IEHP) approve the use of selected outdoor media vendors for advertising services, for a total compensation payable of $1,096,500 for Calendar Year 2021(CY 2021).

Contact: Michelle Rai, Chief Communications and Marketing Officer

Background: Outdoor advertising is generally used for branding and direct response to support key company objectives and initiatives. For example, IEHP uses outdoor advertising channels to promote Medi- Cal coverage to the uninsured population and key HEDIS/CAHPS measures to IEHP Members such as preventive care, flu shots, customer satisfaction, and the Community Resource Centers (CRC). We support the CRC’s with freeway and interior billboards. The goal is to impact Members’ behavior to help them be healthier and to help improve HEDIS/CAHPS scores.

Outdoor advertising is one of the critical media channels, which has contributed to IEHP’s 90 percent Medi-Cal plan choice rate (highest among local public plans in California) and our 97 percent brand awareness rate in the Inland Empire.

Discussion: For many years IEHP has used only high-performance billboards, bus sides and bus shelters in strategic marketing locations throughout the Inland Empire. IEHP uses the Traffic Impression report from Caltrans to determine which billboard locations will reach current and potential Members effectively.

Currently, IEHP advertises at the following billboard locations:

LOCATION SIZE ILLUMINATION 91 Freeway in Riverside 14’ x 48’ Yes Interstate 10 in Rialto 14’ x 48’ Yes Interstate 10 in Palms 10’6” x 36’ Yes Spring/Indio/Coachella Interstate 10 in Yucaipa 12’ x 40’ Yes Interstate 215 in Perris/Hemet 12’ x 40’ Yes Interstate 15 in Hesperia (1) 12’ x 40’ Yes Interstate 15 in Victorville (2 for CRC) 12’ x 30’ & 14’ x 48’ Yes

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IEHP requests approval to purchase advertising from the following companies that own the outdoor media channels listed above for CY 2021:

1) Clear Channel Outdoor 2) The Lamar Companies

For the printing of the vinyl billboards (i.e. fabrication), IEHP solicits quotes from the following vendors.

1) Independent’s Service Company 2) Metromedia Technologies

The total compensation payable for outdoor media advertising services are $1,096,500 for CY 2021.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY 2021

Financial Review: (S. Ahmed, 11/19/2020)

Reviewed by Counsel: N/A

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OPERATIONS DEPARTMENT

23. APPROVE THE ANNUAL UPDATE TO THE IEHP PROVIDER POLICIES AND PROCEDURES MANUALS AND ENCOUNTER DATA INTERCHANGE MANUAL

Recommended Action: The Inland Empire Health Plan (IEHP) Governing Board approve the annual update to the Provider Policies and Procedures Manuals and the Encounter Data Interchange (EDI) Manual.

Contact: Susie White, Chief Operating Officer

Background: These Manuals are designed to help IEHP Providers, Hospitals and IPAs understand the rules and regulations IEHP must comply with, as required by DHCS, DMHC, NCQA, and CMS. This year, with the intent to streamline and modernize the distribution process, the distribution of CD copies of the Provider Manuals has been discontinued. Instead, a dedicated webpage on IEHP’s Provider Portal is now available for the 2021 Provider and EDI Manuals at www.iehp.org>For Providers>Provider Manuals.

IEHP is required by State and Federal regulators to maintain an Acknowledgment of Receipt (AOR) of the Provider manual on file for all our contracted Providers, Hospitals and IPAs. A letter and/or e-mail was sent to all Provider offices, Hospitals and IPAs with a unique access code and link to an electronic Attestation Form so Providers can attest that they have access to and have reviewed the 2021 Provider and EDI Manuals.

Discussion: IEHP reviews and updates as necessary the policies in the Manuals at a minimum once annually. This Annual Update to the Provider Manual consists of any new policies as well as revisions made to policies that were sent out in the Annual Update from the previous year in order to comply with NCQA standards, legislative changes, regulatory requirements, clarifications imposed by DMHC, DHCS, CMS; and operational changes as reflected in contract renewals. Interim policy updates are made throughout the year as needed, due to requirement changes.

IEHP continues to post State and Federal benefit links on IEHP’s Provider Portal.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: None

Fiscal Review N/A

Reviewed by Counsel: N/A

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OPERATIONS DEPARTMENT

24. APPROVE THE SIXTH AMENDMENT TO THE PROFESSIONAL SERVICE AGREEMENT WITH NETRONIX INTEGRATION INC.

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Sixth Amendment to the Professional Service Agreement (Agreement) with Netronix Integration Inc. (Netronix) for Security Services, effective December 31, 2020 through December 31, 2021. The total cost of this sixth amendment shall not exceed $408,959. The total amount payable under this Agreement shall not exceed $2,025,198.

Contact: Susie White, Chief Operations Officer

Background: After a thorough and comprehensive Request for Proposal (RFP) process in February 2013, Netronix was selected as the most qualified vendor for the implementation and installation of security cameras, alarm system, software, and access control systems for the relocation of IEHP from San Bernardino to Rancho Cucamonga. In April 2013 under Minute Order 13-75, the Governing Board approved the Netronix Agreement for an amount not to exceed $256,000 through July 1, 2014.

IEHP has been using Netronix since 2013 with the most recent Amendment approved by the Governing Board in December 2018 under Minute Order 18-310 for security services for IEHP’s Expansion Space Project, the IEHP warehouse, the High Desert Community Resource Center, and general maintenance for an additional $582,821. Total amount payable amount under this agreement not to exceed $1,616,239.

Discussion: Netronix’s services are required for IEHP’s Empire Lakes and Atrium Enhancements, as well as for the possible addition of future Community Resource Centers. Netronix has initiated such services for the above projects and will ensure implementation and completion of all access controls, security cameras, and building alarm systems.

The total cost of this Sixth Amendment shall not exceed $408,959. The total amount payable under this Agreement shall not exceed $2,025,198.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY2021 Budget

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Financial Review: Yes

Reviewed by Counsel: Yes

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OPERATIONS DEPARTMENT

25. APPROVE THE THIRD AMENDMENT TO THE MANAGEMENT AGREEMENT WITH TRIGILD COMMERCIAL REAL ESTATE, INC.

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Third Amendment to the Management Agreement with Trigild Commercial Real Estate, INC. for Property Management services for an additional three (3) months through March 31, 2021 for an additional cost not to exceed $9,000. The total amount payable under this Agreement shall not exceed $968,000.

Contact: Susie White, Chief Operating Officer

Background: In April 2013 under Minute Order 14-308, the Governing Board approved the Management Agreement with Trigild Commercial Real Estate for Property Management services. As IEHP became new building owners of the Atrium building, IEHP absorbed preexisting tenants.

In September 2016 under Minute Order 16-137, the Governing Board approved the First Amendment to the Management Agreement with Trigild Commercial Real Estate for Property Management services. In September 2016, IEHP procured the adjacent building from the Atrium, Empire Lakes located at 9500 Cleveland Ave. Trigild’s property management services were expanded because of preexisting tenants within the Empire Lakes building. Trigild’s Property.

In June 2020 under Minute Order 20-140, the Governing Board approved the Second Amendment to the Management Agreement with Trigild Commercial Real Estate for Property Management services. For an additional six (6) months, Trigild will continue to maintain all property management services for both the Atrium and Empire Lakes building, such services include:  Tenant Relations  Tenant Financials  Building Vendor Relations Services and Equipment Procurement  Budgetary Review and Development  Building Maintenance and Project Oversight During these last six (6) months IEHP was evaluating property management services to transition and manage support internally.

Discussion: IEHP continues to require temporary property management services at both the Atrium and Empire Lakes buildings. Trigild Commercial Real Estate, INC will maintain all property management services for both the Atrium and Empire Lakes building for an additional three (3) months. IEHP is

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currently collaborating with Trigild Commercial Real Estate, INC to transition property management support services to manage internally.

The total additional cost shall not exceed $9,000 through March 31, 2021. The total amount payable under this Agreement shall not exceed $968,000.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Will be Included in CY2021 Budget

Financial Review: Yes

Reviewed by Counsel:

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OPERATIONS DEPARTMENT

26. APPROVE REQUEST FOR PROPOSAL #19-01443 AWARD TO, AND THE PROFESSIONAL SERVICES AGREEMENT WITH, SHORETT PRINTING, INC. DBA CROWN CONNECT DBA CROWN PRINTERS

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve Request For Proposal (RFP) #19-01443 Award to, and the Professional Services Agreement (Agreement) with, Shorett Printing, Inc dba Crown Connect dba Crown Printers for PHI Printing, Fulfilment, and Mailing Services for one (1) year effective January 1, 2021 for an amount not to exceed $1.7 million through December 31, 2021.

Contact: Susie White, Chief Operations Officer

Background: On March 17, 2020 IEHP advertised an RFP for PHI Printing, Fulfilment, and Mailing Services on IEHP’s third party Public Purchase website. All final proposals were due April 7, 2020. IEHP received bids from the following five (5) vendors:

 Crown Printers  Deluxe Branded Marketing  InfoSend  KP LLC  Sepire

The initial responses were reviewed and scored. RFP scoring was based on scale of weighted points on the following categories:

 Acknowledgment of RFP;  Company profile and experience;  Understanding of scope of service;  Overall cost  Local preference

Seven (7) IEHP evaluators conducted scoring on the categories listed above. All awarded points were combined for each bidder for a grand total with the following results:

Bidders Proposal Scores Crown Printers* 85 InfoSend* 81 KP LLC* 78 Deluxe Branded Marketing 74 Sepire 48

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Based on the initial RFP evaluations, IEHP selected the top three (3) bidders* for virtual demonstration. Scoring for the demonstrations were based on the following categories, with 10 points being the best possible score:

 Printing and Mailing  Security  Services and Emergency  Overall Presentation

The results of the demonstration are as follows:

Bidders Demo Scores Crown Printers* 8.2 InfoSend 7.9 KP LLC 7.4

From each demonstration score, IEHP took the accumulation of the RFP proposal evaluations and the demonstration evaluations. IEHP awarded the PHI Printing, Fulfilment, and Mailing Services RFP based on responsiveness to the RFP and the ability to meet IEHP’s specific scope of services. Below are the final results:

Combing Scores Crown Printers InfoSend KP LLC RFP Proposal Evaluations 85 81 78 Demonstrations 8.2 7.9 7.4 Total Score 93.2 88.9 85.4 Overall Ranking 1 2 3

IEHP selected Crown Connect based on responsiveness, demonstration interaction, understanding of IEHP’s specific scope of service, and experience.

Discussion: IEHP is required to perform hourly sweeps of the MedHOK system for correspondence that is ready to be sent to IEHP members. This must be performed daily to ensure that correspondence is processed and sent within the timeframe that has been established through regulatory agencies that oversee both Medicare and Medi-Cal lines of business. The business units are responsible for ensuring the correspondence is completed within those regulatory timeframes and routed through MedHOK for processing and mailing. That correspondence is then processed out of MedHOK on the same day that it was submitted by the business units and finalized within the timeframe established by the regulatory body that has oversight for the particular line of business.

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The following detailed scope of services are outlined within the agreement with Crown Printers Services:  Crown automation systems will perform hourly sweeps of MHK for Utilization Management and Care Management business units primarily and aggregate correspondence in preparation for processing and sending to members.  At predetermined times, Crown will process correspondence. This includes verifying address integrity, adding quality control barcoding to the correspondence to ensure the highest accuracy and mitigate any risk of PHI breech, add pre-sort barcoding to each mail piece to allow for the lowest possible postage rate to be utilized.  Correspondence is delivered to the USPS Bulk Mail Entry Unit in San Bernardino to be delivered to intended recipient.  Crown will provide quality control documents and USPS receipt documentation daily to the IEHP Fulfillment Specialist so that verification of quantity expected to quantity mailed can be completed.  Crown returns digital information back to MHK to provide completion data on the correspondence to ensure availability of the information in the historical files for the member to satisfy regulatory requirements.  Crown will provide this service, on behalf of IEHP, due to the high volume of correspondence and the regulatory timelines required for timely mailing.

The total compensation under this agreement shall not exceed $1.7M through December 31, 2021.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence

Technology Financial Stewardship Not Applicable

Fiscal Impact: Included in CY2021 Budget

Financial Review:

Reviewed by Counsel: Yes

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PROVIDER NETWORK DEPARTMENT

27. RATIFY AND APPROVE THE THIRD AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH LOMA LINDA UNIVERSITY MEDICAL CENTER – CITY OF LOMA LINDA

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) and IEHP Health Access ratify and approve the Third Amendment to the Hospital Per Diem Agreement with Loma Linda University Medical Center, effective November 1, 2020.

Contact: Kurt Hubler, Chief Network Officer

Background: Loma Linda University Medical Center is currently a contracted Hospital in the IEHP Network.

Discussion: The Amendment is to term the Attachment B7 – Center of Excellence (COE) for the Treatment of Hepatitis B and C with an effective date of December 31, 2020.

In addition, effective November 1, 2020, the Amendment replaces the Attachments B- Compensation Rates, B1-Compensation Rates-Medicare Advantage Program, B2-Compensation Rates-Home Health Services, B3-Compensation Rates-Diabetes Education Services, B4- Community-Based Adult Services and B5-Notes to Compensation Rates.

Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable

Fiscal Impact: Included in FY19/20 Bridge Period Budget

Financial Review: N/A

Reviewed by Counsel: Yes

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PROVIDER NETWORK DEPARTMENT

28. APPROVAL OF THE STANDARD TEMPLATES

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the IEHP Standard Template Agreements, referenced below in section (d), and authorize the Chief Executive Officer or his designee to execute the templates, 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 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 approval:

1) Health Homes Amendment 2) Multidisciplinary Medication Assisted Treatment (MMAT) Amendment 3) Primary Care Provider Attachment A – Primary Care Services 4) Master Attachment A - Primary Care Physician Services and A-1 – Double Boarded (All LOBs_ NO MCR_MCR ONLY) 5) Master Attachment B and B-1 – Double Boarded Capitated Primary Care Physician (All LOBs_No MCR_MCR only)

Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable

Fiscal Impact: None

Financial Review: N/A

Reviewed by Counsel: Yes

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PROVIDER NETWORK DEPARTMENT

29. APPROVAL OF THE EVERGREEN CONTRACTS

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

Contact: Kurt Hubler, Chief Network Officer

Background: An Evergreen Contract is a contract that automatically renews on the same terms and subject to the same conditions as the original agreement, unless sooner terminated in accordance with the terms and conditions.

Discussion: Renewal under the Evergreen Clause of the following Agreements effective, January 1, 2021:

Additional three (1) year term: 1) Fariborz Lalezarzadeh DO Inc - Participating Provider Agreement 2) Heritage Health Care Inc dba Heritage Gardens Health Care Center - Residential Care for the Elderly Provider Agreement

Additional three (3) year term: 3) Chino Avenue Congregate Home Inc - Congregate Living Health Facility Provider Agreement 4) P & M Healthcare Holdings Inc dba Rancho Mesa Care Center - Skilled Nursing Facility Provider Agreement 5) Sela Healthcare Inc dba Villa Mesa Care Center - Skilled Nursing Facility Provider Agreement

Additional five (5) year term: 6) 121 Rehab Physical Therapy Corporation - Participating Provider Agreement 7) Aeroflow Inc dba Aeroflow Healthcare- Ancillary Provider Agreement 8) BioHorizon Medical Inc - Ancillary Provider Agreement 9) Catherine Tuong dba Dr Catherine Tuong Optometrist - Participating Provider Agreement 10) Charles F Rose LMFT - Behavioral Health Provider Agreement 11) Coachella Valley Foot and Ankle Institute - Participating Provider Agreement 12) Healing Hand Family Care Clinics Corporation - Fee-For-Service Primary Care Provider Agreement 13) Mabel R Ribas - Behavioral Health Provider Agreement 14) Monzones Hospice Care LLC - Ancillary Provider Agreement 15) My Family Clinic Inc - Fee-For-Service Primary Care Provider Agreement 16) Pacific Perinatal Institute - Participating Provider Agreement 17) Pomona Community Health Center dba Parktree Community Health Center - Participating Provider Agreement 18) Ramin Samadi MD Inc - Participating Provider Agreement

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19) Southern California Bone and Joint Clinic Inc - Participating Provider Agreement 20) TrueCare Surgery Center - Ancillary Provider Agreement

Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable

Fiscal Impact: Included in FY19/20 Bridge Period Budget

Financial Review: N/A

Reviewed by Counsel: N/A

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ADMINISTRATION

30. CHIEF EXECUTIVE OFFICER UPDATE

Recommended Action: Review and File

Contact: Jarrod McNaughton, Chief Executive Officer

Discussion: Chief Executive Officer update for December 14, 2020 Governing Board Meeting.

75 of 111 76 of 111 77 of 111 https://vimeo.com/486597553/3626669334

78 of 111 79 of 111 80 of 111 How IEHP responded: • UM staff began working holidays starting Thanksgiving • We are auto-approving DME for Direct and IPA Members. and extended on weekends making the team available every day of the week. • Nurses are on standby every day including weekends and holidays for the Cal MediConnect/ Medicare Members, Medi- • Weekend staffing is circulated to hospitals and Cal and housing to assist hospitals with any additional needs. voicemails reflect teams working every day to assist our hospital partners with Member needs. • BH is also staffed and will assist with BH needs every day including holidays. • Post-acute teams are working with all partners for placements. • Recuperative care – modified the referral process to allow direct admit to recup from the IEHP inpatient nurses. Our • An email was sent to all hospital partners to ensure county recups have been updated on the new process they know we are available to assist. for this emergency.

• Our DME partners are aware to provide oxygen • Telephone list with assignments were sent out by our UM concentrators to stable patients in ED Team informing them of who’s on call and available for each of who can go home for both Direct and IPA Members. these areas.

81 of 111 COVID-19 IEHP December Board Update

December 14, 2020

7 82 of 111 COVID-19 Member Impact Dashboard

83 of 111 8 COVID-19 Member Impact Dashboard Cont.

84 of 111 9 10 85 of 111 COVID-19 Vaccine Distribution Strategy

• IEHP is represented on the COVID vaccine distribution committees of both San Bernardino and Riverside Counties.

• IEHP internal multidisciplinary workgroup established.

• Goal: Establish a vaccine management plan to provide IEHP Members and Providers with accurate and timely information on the COVID vaccine and to ensure that eligible Members who want the vaccine are able to receive it as soon as possible.

11 86 of 111 COVID Vaccine Distribution: IEHP’s Role

• Data / Information Management o IEHP will support efforts by identifying high risk IEHP Members eligible to receive the vaccine in Priority Phase 1B o IEHP will assist in tracking Members who receive their first dose of vaccine • Communications / Messaging o IEHP will perform outreach to Members as they are eligible to receive the vaccine o Public information campaign, PSAs, alignment of messaging with counties o Provide accurate and timely vaccine information to Members and Providers o IEHP is participating in a UC Riverside / NIH research effort to understand attitudes around COVID vaccination in Medi-Cal recipients in order to improve outreach messaging • Vaccine Distribution o IEHP will coordinate vaccine distribution and administration efforts for IEHP Members with the counties. 87 of 111 12 Questions?

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IEHP CY 2021 BUDGET

31. ADOPT AND APPROVE THE IEHP CALENDAR YEAR 2021 OPERATIONS AND CAPITAL BUDGET

Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) adopt and approve the IEHP Calendar Year 2021 (CY 2021) Operations and Capital Budget as presented.

Contact: Keenan Freeman, Chief Financial Officer

Background: IEHP prepares and presents its annual budget to the Governing Board for approval for the upcoming calendar year. IEHP’s new calendar year is January 1 through December 31. The budget consists of an Operating Budget for the upcoming twelve (12) month period. The Operating Budget is presented on a Consolidated Basis, as well as individually for the specific product lines.

The Operating Budget consists of the following major categories: 1. Enrollment 2. Operating Revenues (Premiums) 3. Medical Expenses 4. General & Administrative Expenses 5. Net Surplus/(Deficit)

Enrollment, which is the primary driver for revenues (premiums) and medical expenses, is forecasted using current and potential market share. Operating Revenues are projected based on forecasted enrollment and Per-Member-Per-Month (PMPM) premiums. Medical Expenditures are based on forecasted enrollment, projected utilization, cost trends, and any known changes in provider contracting rates. General and Administrative Expenditures are forecasted based on actual costs together with any known cost increases or decreases in this category.

The Capital Budget consists of projected expenditures for fixed or long-term assets, such as building renovations, computers, and equipment for the whole organization.

Discussion: The budget process starts with forecasting enrollment for the upcoming calendar year. Enrollment drives two (2) major components of the budget; revenues and medical expenses as these are forecasted on a PMPM basis. Current enrollment and growth trends during the calendar year are reviewed and factored-in to forecast enrollment. Consideration is given to the overall market. Projections are done for Medical and General and Administrative (G&A) expenses. A Net Surplus or Deficit is calculated by offsetting all expenses against revenues. The budget also illustrates PMPM calculations and cost ratios as applicable.

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The Capital Budget process provides a three (3) year plan. Due to many of the projects crossing multiple calendar years, this approach allows financial visibility and strategic planning for a longer period. An organizational priority level is included in the plan, along with estimated start dates to provide additional flexibility.

The detail of the CY 2021 Operating and Capital Budget will be discussed further in the attached presentation.

Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable

Fiscal Impact: As stated above.

Reviewed by Counsel N/A

90 of 111 IEHP CY 2021 Operating & Capital Budget December 14, 2020

91 of 111 CY 2021 Income Statement

92 of 111 Main Drivers of Medi-Cal Experience

• For Medi-Cal Classic and Expansion combined, it is expected to run at a $40 million net loss for CY 2021. • The Medi-Cal rate increase (excluding CCI) is 3.8%. Negative adjustments for countywide averaging / risk adjustment (-0.75%) and population acuity (-2%) are included and pending finalization by DHCS. • The projected PMPM trend for Medi-Cal FFS medical claims is 4.9% based on historical trends and actuarial assumptions. Considerations for COVID impact on claim costs are accounted for, yet the impact is still largely uncertain. • Membership is assumed to be at 5.6% loss from December 2020 to December 2021, with a conservative assumption of 65% of members gained in 2020 due to COVID disenrollment suspension will be disenrolled. • Overall, the Medi-Cal expansion net surplus is large but not enough to offset the net loss in the Medi-Cal Classic line of business.

93 of 111 Main Drivers of CMC Experience

• For CMC line of business, it is expected to run at a $16.8 million loss for CY2021. • Part A/B county rates (at 1.0 risk score) for RVC/SBC are increased by 2.8% and 2.3% respectively from CY2020 to CY2021; however the increase is largely offset by the change in normalization factors (-1.9% for CY2021) built in the risk adjustment model year over year. • CMS calculates risk score by blending EDPS and RAPS data. For CY2021, the blend is 75/25%, changed from 50/50% in CY2020. The EDPS/RAPS gap is conservatively assumed to be within 1% in CY2021. • CMS continues to include a minimum savings of 5.1% and 5.5% for RVC/SBC respectively in Medicare Part A/B rate development. • For Part D, after risk sharing subsidy, Part D net premium does not fully fund Part D eligible expense.

94 of 111 Membership Assumptions

95 of 111 Projected 3 Year Capital Budget and Other Developments

96 of 111 CY 2021 Budget Summary

• Adjusted Net Surplus for Calendar Year 2021 is expected to be a loss of $59.4 million.

• Our reserves will be used to fund capital purchases for CY 2021.

• Staff will continue to work with DHCS to receive adequate rate increases for recent costs trends in Medi-Cal and MLTSS rates.

• Outstanding items to be up-dated in January 2021 include the following: - Final base rates with 1.) population acuity adjustment, 2.) LANE services efficiency adjustment, and 3.) risk adjustments. - Rx revenue/expense for 3 months due to the delay in the Pharmacy carve out. - Impact on costs related to more recent COVID development.

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HEALTH SERVICES DEPARTMENT

32. VALUE BASED PAYMENT BEHAVIORAL HEALTH INTEGRATION INCENTIVE PROGRAM UPDATE

Recommended Action: Review and File

Contact: Karen Hansberger, M.D., Chief Medical Officer

Discussion: Presentation update on the Value Based Payment – Behavioral Health Integration Incentive Program presented by Dr. Takisha Wada, Vice President, Population Health.

98 of 111 The California Department of Health Care Services (DHCS) Value Based Payment – Behavioral Health Integration (VBP BHI) Incentive Program

Takashi Wada, MD, MPH IEHP Executive Director of Population Health

99 of 111 Value Based Payment – Behavioral Health Integration Incentive Program: • Need: 4.4 million Californians need mental health treatment with nearly 2 million suffering from serious mental illness. Current system is fragmented and poorly coordinated.

• Objective: incentivize clinical Providers to improve physical and behavioral health outcomes, care delivery, and patient experience by developing or expanding integrated care practice models. • Funding: supported by Proposition 56 funds at $180+ million over 2 years for entire state

100 of 111 Eligibility • Primary care, specialty care, perinatal care, hospitals, behavioral health Providers

Project Focus Areas • Basic Behavioral Health (BH) Integration • Maternal Access to Mental Health and Substance Use Disorder Screening and Treatment • Medication Management for Members with Co-occurring diagnoses • Diabetes screening for Members with Serious Mental Illness • Follow up after Hospitalization for Mental Illness • Follow up after Emergency Dept. visit for BH Diagnoses

101 of 111 Timeline • DHCS release of application: 11/12/19 • BH Integration Program applications due to IEHP: 1/21/20 • IEHP received 82 project proposals • Program put on hold due to COVID • DHCS Notified Health Plans that BHI was going forward: 7/20 • Preliminary awards announced: 11/2/20 • Program new start date: 1/1/21 (previously 4/1/20) • Program duration: 1/1/21 – 12/31/22

102 of 111 IEHP Total Award for IE • $32,376,142 funding over 2 years • 20 applicant organizations/ 30 project funded (possibly more)

Basic BH Integration • Community Health Systems Inc. (Riv) • Desert AIDS Project (Riv) • Dignity Health Medical Foundation (Riv) • Health Service Alliance (SB) • Illumination Foundation (SB) • Loma Linda University Health (SB) • St. Mary High Desert Medical Group (SB) 103 of 111 Maternal Access to BH/SUD • Loma Linda University Health (Riv/ SB) • Mommy & Me Medical Group (Riv) • ARMC (SB) • SAC Health System (SB)

Medication Management for Members with Co-Occurring Diagnoses • MFI Recovery Center (Riv) • Loma Linda University Health (SB)

104 of 111 Diabetes Screening for Members with Serious Mental Illness • Loma Linda University Health (Riv/SB) • MFI Recovery Center (Riv) • Neighborhood Health Care (Riv) • Redlands Community Hospital (Riv/SB)

Follow up after Hospitalization for Mental Illness • M. Nieves Gutierrez-Go MD, Inc (Riv) • Riverside University Health System (Riv) • ARMC (SB) • Loma Linda University Health (SB)

105 of 111 Follow up after Emergency Dept. visit for BH Diagnoses • Loma Linda University Health (Riv/SB) • Pomona Valley Hospital Medical Center (Riv/SB) • San Gorgonio Hospital (Riv) • ARMC (SB)

106 of 111 Questions?

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PROVIDER NETWORK DEPARTMENT

33. RATIFY AND APPROVE THE THIRD AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH LOMA LINDA UNIVERSITY MEDICAL CENTER – CITY OF LOMA LINDA

Contact: Kurt Hubler, Chief Network Officer

Background: Loma Linda University Medical Center is currently a contracted Hospital in the IEHP Network.

Discussion: The Amendment is to term the Attachment B7 – Center of Excellence (COE) for the Treatment of Hepatitis B and C with an effective date of December 31, 2020.

Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable

Fiscal Impact: Included in FY19/20 Bridge Period Budget

Financial Review: N/A

Reviewed by Counsel: Yes

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PROVIDER NETWORK DEPARTMENT

34. APPROVAL OF THE STANDARD TEMPLATES

Contact: Kurt Hubler, Chief Network Officer

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

Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable

Fiscal Impact: None

Financial Review: N/A

Reviewed by Counsel: Yes

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PROVIDER NETWORK DEPARTMENT

35. APPROVAL OF THE EVERGREEN CONTRACTS

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

Contact: Kurt Hubler, Chief Network Officer

Discussion: Renewal under the Evergreen Clause of the following Agreements effective, January 1, 2021:

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19) Southern California Bone and Joint Clinic Inc - Participating Provider Agreement 20) TrueCare Surgery Center - Ancillary Provider Agreement

Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable

Fiscal Impact: Included in FY19/20 Bridge Period Budget

Financial Review: N/A

Reviewed by Counsel: N/A

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