Health and Mental Health Services
Government Programs, Health Plans, Insurance Companies and
Healthcare Providers Payer Agreements
33.
Revised recommendation: Authorize the Director of Health Services to
negotiate, execute, and terminate new agreements for a duration of one year or
more, with government, commercial, and private payers, or their subcontracted
healthcare (Payer Contracts), to compensate the County for the provision of
inpatient, outpatient, and other healthcare services provided by the Department
of Health Services (DHS) hospitals and health centers (County Healthcare
Services). This delegation shall include, without limitation, the ability to specify
methods and rates of payment that are appropriate for the services rendered
thereunder, including capitated payments, as well as the authority to exclude or
revise certain County standard contractual terms while remaining in compliance
with applicable laws and regulations. Such authority shall remain in effect for a
period of five years through June 30, 2031. Payer Contracts shall be subject to
submission to the Chief Executive Office (CEO) and Board in its then-current
draft form with feedback provided to DHS within five calendar days thereafter,
and subsequent notification to the CEO and the Board. Authorize the Director to
take the following actions: (Department of Health Services) APPROVE
(Continued from the meeting of 6-16-26)
Negotiate, execute and terminate amendments to existing or future Payer
Contracts, including to adjust rates or modes of payment, including
service/capitation rates and incentive payments, add or remove lines of
business or service lines into or out of such Payer Contracts, improve or
update clinical and/or administrative operations within the Payer
Contract’s scope of services, extend or terminate the term of the Payer
Contract in accordance with contract terms, adjust division of financial
responsibility under relevant Payer Contracts, update or incorporate new
State/Federal law and regulations, County policies, accreditation
requirements, and other authorities, and take any additional actions
required by contracts, rules, and guidelines. Amendments to Payer
Contracts shall be subject to submission to the CEO and the Board in its
then-current draft form with feedback provided to DHS within five
calendar days thereafter, and subsequent notification to the CEO and the
Board.
Negotiate, prepare, and accept Medi-Cal related incentives, awards, and
other payments whether deriving from Federal or State governments or
health plans, with notice to the Board and the CEO.
Negotiate, execute and terminate letters of agreement for a duration of
six months or less with Healthcare Payers (Payer LOAs), to compensate