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Maricopa County Special Health Care District

Board of Directors Formal Meeting

May 24, 2017 1:00 p.m.

Agenda

Agendas are available within 24 hours of each meeting in the Office of the Board, Maricopa Medical Center, Administration Bldg, 2nd Floor 2601 E. Roosevelt, Phoenix, AZ 85008, Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m. and on the internet at http://www.mihs.org/about-mihs/district-board-of-directors. Accommodations for Individuals with Disabilities, alternative format materials, sign language interpretation, and assistive listening devices are available upon 72 hours advance notice through the Office of the Board, Maricopa Medical Center, Administration Bldg, 2nd Floor 2601 E. Roosevelt, Phoenix, Arizona 85008, (602) 344- 5177. To the extent possible, additional reasonable accommodations will be made available within the time constraints of the request. 5/18/2017 8:25 AM

Welcome We welcome your interest and hope you will often attend Maricopa County Special Health Care District Board of Directors meetings. Democracy cannot endure without an informed and involved electorate. The Board of Directors is the governing body for Maricopa Integrated Health System. Each member represents one of the five districts in Maricopa County. Members of the Board are public officials, elected by the voters of Maricopa County. The Board of Directors sets policy and the President & Chief Executive Officer, who is hired by the Board, directs staff to carry out the policies. Meetings The Board of Directors generally holds meetings at 1:00 p.m. on the fourth Wednesday of the month. Please visit http://www.mihs.org/about-mihs/district-board-of-directors or call the District Clerk at 602-344-5177 to confirm the date of the next regular meeting. The meeting may appear to proceed quickly, with important decisions reached with little discussion. However, the agenda and meeting material is available to the Board of Directors prior to the meeting, giving them the opportunity to study every item and to ask questions of District staff members. If no additional facts are presented at the meeting, action may be taken without further discussion. How Citizens Can Participate The Board of Directors values citizen comments and input. Citizens may appear before the Board of Directors to express their views. Any member of the public will be given three minutes to address the Board on issues of interest or concern to them. If you wish to address the Board, please complete a Speaker’s Slip and deliver it to the Clerk of the Board. If you have anything that you wish distributed to the Board and included in the official record, please hand it to the Clerk who will distribute the information to the Board Members and Maricopa Integrated Health System Senior Staff. Speakers will be called in the order in which requests to speak are received. Your name will be called when the Call to Public has been opened or when the Board reaches the agenda item which you wish to speak. As mandated by the Arizona Open Meeting Law, officials may not discuss items not on the agenda, but may direct staff to follow-up with the citizen.

AGENDA - Formal Meeting

Maricopa County Special Health Care District Board of Directors

Board Members Susan Gerard, Chair, District 3 Mary A. Harden, R.N., Vice Chair, District 1 Mark Dewane, Director, District 2 Elbert Bicknell, Director, District 4 Mary Rose Wilcox, Director, District 5 President & Chief Executive Officer Stephen A. Purves, FACHE Clerk of the Board Melanie Talbot Meeting Location Maricopa Medical Center Administration Building Auditoriums 1 and 2 2601 E. Roosevelt Street Phoenix, AZ 85008

Mission Statement The Maricopa Integrated Health System (MIHS) mission is to provide exceptional care, without exception, every patient, every time.

http://www.mihs.org/about-mihs/district-board-of-directors

http://www.mihs.org/about-mihs/district-board-of-directors

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When Speaking at the Podium Please state your name and the city in which you reside. If you reside in Maricopa County, please state the District you live in. If you have an individual concern involving the District, you are encouraged to contact your District Board member at 602-344-1241. We will do everything possible to be responsive to your individual requests. Public Rules of Conduct The Board Chair shall keep control of the meeting and require the speakers and audience to refrain from abusive or profane remarks, disruptive outbursts, applause, protests, or other conduct which disrupts or interferes with the orderly conduct of the business of the meeting. Personal attacks on Board members, staff, or members of the public are not allowed. It is inappropriate to utilize the Call to Public or other agenda item for purposes of making political speeches, including threats of political action. Engaging in such conduct, and failing to cease such conduct upon request of the Board Chair will be grounds for ending a speaker’s time at the podium or for removal of any disruptive person from the meeting room, at the direction of the Board Chair.

Mary Rose Wilcox 602-344-1241 [email protected]

Susan Gerard 602-344-1241 [email protected]

Mary A. Harden, R.N. 602-344-1241 [email protected]

Mark Dewane 602-344-1241 [email protected]

Elbert Bicknell 602-344-1241 [email protected]

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Maricopa Medical Center Administration Building Auditoriums 1 and 2

2601 E. Roosevelt Phoenix, AZ 85008

Wednesday, May 24, 2017 1:00 p.m.

One or more of the members of the Board of Directors of the Maricopa County Special Health Care District may attend telephonically. Board members attending telephonically will be announced at the meeting. Pursuant to A.R.S. § 38-431.03(A)(3), or any applicable and relevant state or federal law, the Board may vote to recess into an Executive Session for the purpose of obtaining legal advice from the Board’s attorney or attorneys on any matter listed on the agenda. The Board also may wish to discuss any items listed for Executive Session discussion in General Session, or the Board may wish to take action in General Session on any items listed for discussion in Executive Session. To do so, the Board will recess Executive Session on any particular item and reconvene General Session to discuss that item or to take action on such item.

Call to Order Roll Call Pledge of Allegiance Call to the Public This is the time for the public to comment. The Board of Directors may not discuss items that are not specifically identified on the agenda. Therefore, pursuant to A.R.S. § 38-431.01(H), action taken as a result of public comment will be limited to directing staff to study the matter, responding to any criticism or scheduling a matter for further consideration and decision at a later date.

ITEMS MAY BE DISCUSSED IN A DIFFERENT SEQUENCE General Session, Presentation, Discussion and Action: 1. Approval of Consent Agenda: 15 min

Note: Approval of contracts, minutes, IGA’s, proclamations, etc. Any matter on the Consent Agenda will be removed from the Consent Agenda and discussed as a regular agenda item upon the request of any Board member.

a. Minutes:

i. April 26, 2017 Melanie Talbot, MIHS, Executive Director, Board Operations

b. Contracts:

i. Approve a Memorandum of Understanding (90-17-178-1) with the Superior

Court of Arizona in Maricopa County for the construction and maintenance of space for a courtroom and judicial chambers within the MIHS Behavioral Health Annex located on the Main Hospital campus Gene Cavallo, MIHS, Vice President of Behavioral Health

1:00 1:05

1:10

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General Session, Presentation, Discussion and Action, cont.: 1. Approval of Consent Agenda, cont.:

b. Contracts, cont.: ii. Approve a new agreement (90-17-176-1) between the Maricopa County Special

Health Care District and Three Rivers Provider Network (TRPN) Ethel Hoffman, MIHS, Interim Managed Care Leader iii. Approve a new agreement (90-17-174-1) between the Maricopa County Special

Health Care District and Health Net Federal Services (TriCare/Centene) for Facility and Professional Services

Ethel Hoffman, MIHS, Interim Managed Care Leader iv. Approve a new Pharmacy Service Agreement Organization (PSAO) agreement

(90-17-168-1) between the Maricopa County Special Health Care District and the Leader Drug Stores, Inc.

Anna Sogard, MIHS, Director, Pharmacy v. Approve an Intergovernmental Agreement (IGA) (90-17-180-1) with the Arizona

Health Care Cost Containment System Administration (AHCCCS) to provide AHCCCS with the Non-Federal Match of funds in the amount of $463,603.49 in order to receive supplemental Medicaid payments for Disproportionate Share Hospital (DSH) hospitals.

Kathy Benaquista, MIHS, Chief Financial Officer

vi. Approve an Intergovernmental Agreement (IGA) (90-17-187-1) with the Arizona Health Care Cost Containment System Administration (AHCCCS) to provide AHCCCS with the Non-Federal Match of funds in the amount of $79,125.45 in order to receive supplemental Medicaid Disproportionate Share Hospital Funds payments for the benefit of Abrazo Hospitals.

Kathy Benaquista, MIHS, Chief Financial Officer vii. Approve amendment #21 to the Professional Services Agreement (90-12-084-1-

21) between the Maricopa County Special Health Care District and District Medical Group

John Hitt, M.D., MIHS, Chief Medical Officer

viii. Approve a new Sub-Operating Agreement (90-17-189-1) with Southwest Center for HIV/AIDS to add an additional 1,800 square feet of space for the purposes of expanding the dental practice to provide primary dental care for those infected with HIV/AIDS.

Kris Gaw, MIHS, Chief Operating Officer

c. Governance:

i. Approve The Travelers Indemnity Company (a Stock Company) property insurance policy and payment of the premium for period June 1, 2017 through June 1, 2018

Louis B. Gorman, MIHS, District Counsel

ii. Approve Arizona State Retirement System Supplemental Salary Deferral Plan 457(b) Plan Adoption Agreement of Participation Employers; Approve Arizona State Retirement System Supplemental Salary Deferral Plan Adoption Resolution

Kathy Benaquista, MIHS, Chief Financial Officer

1:10

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General Session, Presentation, Discussion and Action, cont.: 1. Approval of Consent Agenda, cont.: c. Governance, cont.:

iii. Approve Amendments to the Amended and Restated Maricopa County Special Health Care District Risk Management Insurance and Self-Insurance Plan


iv. Approve the submission of an application to the Texas Medicaid Healthcare Partnership to participate in the Texas Medicaid program as an out-of-state

provider of healthcare services. Nancy Kaminski, MIHS, Vice President Revenue Cycle v. Approve and Ratify filing of a Petition for Appointment of Permanent Guardian

and Temporary Conservator re: KW Louis B. Gorman, MIHS, District Counsel d. Medical Staff:

i. Approve Maricopa Integrated Health System Medical Staff Appointments,

FPPEs, Reappointments, Change of Privileges/Status, Waiver Requests, and Resignations for May 2017

Eric D. Katz, M.D., MIHS, Chief of Staff

ii. Approve Maricopa Integrated Health System Allied Health Professional Staff Appointments, FPPEs, Reappointments, and Resignations for May 2017

Eric D. Katz, M.D., MIHS, Chief of Staff

iii. Approve New Robotic Surgery Privileges for General Surgery, Obstetrics/Gynecology, and Urology and Robotic Surgery Proctor Form

Eric D. Katz, M.D., MIHS, Chief of Staff iv. Approve Proposed Revisions to the Operational Credentialing Policy (39026 T)

Eric D. Katz, M.D., MIHS, Chief of Staff e. Proposition 480 Capital:

i. Approve Amendment #3 to Contract 90-17-085-RFQ-CMAR with Kitchell

Contractors Inc. (KCI) for Construction Manager at Risk (CMAR) Guaranteed Maximum Price (GMP) for Phase Four (4) completion of the Employee Health building and of the Maricopa Medical Center southeast third floor area. Phase Four GMP cost is $288,872

Stephen Blaylock, MIHS, Project Executive

ii. Approve a new Cooperative Agreement (90-17-194-1) between Presidio Networked Solutions Group, LLC and Maricopa Integrated Health Systems (MIHS) for the Epic Test Management Services--Phase II. The project was included in the enterprise Strengthening the Foundation (eSTF) program budget approved by the Board of Directors. Cost of Phase II is $347,747.48, plus a 'not-to-exceed' travel expense of $53,046.23, for a total project amount of $400,793.71.

Kelly Summers, MIHS, Chief Information Officer

_________________________End of Consent Agenda____________________________

1:10

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General Session, Presentation, Discussion and Action, cont.: 2. Discussion and Possible Action on Maricopa Integrated Health System’s 2017 Legislative

Agenda and/or the District’s Position Regarding Current or Proposed State and Federal Legislative Items 20 min

Michael Fronske, MIHS, Legislative and Governmental Affairs Director 3. Quarterly Quality Dashboard Including but not Limited to Patient Satisfaction Survey Results/

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores 30 min Dan Hobohm, M.D., MIHS, Vice President of Quality Outcomes Denise White, MIHS, Interim Director of Quality

4. Discuss and Review Preliminary Operating Budget for Fiscal Year 2018 20 min Kathy Benaquista, MIHS, Chief Financial Officer

BREAK 5. Discuss the Implementation of Proposition 206 and Changes to the Maricopa Integrated Health

System Leave Plan 15 min Mica Goldfeder, MIHS, Vice President of Human Resources 6. Discuss, Review and Approve, Renew, Revise, or Rescind the Following Board Policy

Statements: 15 min Governance

a. Policy 99100 G Board Member Compensation for Meetings and Travel - Rescind b. Policy 99107 G Board Meeting Per Diem – New

c. Policy 99108 G Mileage Reimbursement – New d. Policy 99109 G Travel and Travel Expense Reimbursement – New Melanie Talbot, MIHS, Executive Director of Board Operations e. Policy 99105 G Insurance/Bonds for Board and District Employees - Revised


7. Consideration, Discussion, and Possible Action on the Position for Melanie Talbot 5 min

Board of Directors 8. Reports to the Board of Directors; Possible Action: 20 min

a. Monthly Proposition 480 Capital Purchases Update Kathy Benaquista, MIHS, Chief Financial Officer

b. April 2017 Maricopa Integrated Health System Key Indicator Dashboards; Financial Report Including but not Limited to Cost Accounting Report;

Kris Gaw, MIHS, Chief Operating Officer Kathy Benaquista, MIHS, Chief Financial Officer

c. Quarterly Compliance Officer’s Report, and MIHS Finance, Audit and

Compliance Committee Activities LT Slaughter, MIHS, Interim Chief Compliance Officer

d. Monthly Media Report Mike Robertson, MIHS, Vice President of Marketing and Public Affairs

1:25 1:45 2:15 2:35 2:45 3:00 3:15 3:20

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General Session, Presentation, Discussion and Action, cont.:

9. Concluding Items 15 min

a. Old Business: April 26, 2017 FY 18 Budget

• MIHS Emergency Department diversion rates and the diversion rates of other valley hospitals

• Schedule an additional budget Board meeting • How will the implementation of Prop 206 affect the budget

Board policy statements

• Please ask board counsel to weigh in on travel policy

b. Board Member Requests for Future Agenda Items or Reports c. Comments

i. Chairman and Member Closing Comment ii. President & Chief Executive Officer Summary of Current Events

Adjourn

3:55

3:40

Maricopa County

Special Health Care District


May 24, 2017

Item 1.a.i.

Minutes April 26, 2017

Present: Susan Gerard, Chairman, District 3

Mary A. Harden, R.N., Vice Chairman, District 1 Mark Dewane, Director, District 2

Elbert Bicknell, Director, District 4 Mary Rose Wilcox, Director, District 5 – telephonically

Others Present: Steve Purves, MIHS, President & Chief Executive Officer Kris Gaw, MIHS, Chief Operating Officer

Kathy Benaquista, MIHS, Chief Financial Officer John Hitt, M.D., MIHS, Chief Medical Officer

Sherry Stotler, R.N., M.S.N., MIHS, Chief Nursing Officer Erik Katz, M.D., MIHS, Chief of Staff – excused himself at 2:12 p.m.

Louis B. Gorman, MIHS, District Counsel Guest Presenters: Michael Fronske, MIHS, Legislative and Governmental Affairs Director Gene Cavallo, MIHS, Vice President Behavioral Health Services Sam Bowers, MIHS, Performance Excellence Administrator Keven Lopez, M.D., MIHS, Vice Chief of Staff Kathy Schmitz, MIHS, Sunnyslope Family Health Center Manager Elizabeth Ferguson, M.D., MIHS, Designated Institutional Official L.T. Slaughter, MIHS, Interim Chief Compliance Officer Recorded by: Melanie Talbot, MIHS, Executive Director of Board Operations

Cynthia Cornejo, MIHS, Deputy Clerk of the Board Call to Order Chairman Gerard called the meeting to order at 1:05 p.m. Roll Call Ms. Talbot called roll. Following roll call, it was noted that all five of the voting members of the Maricopa County Special Health Care District Board of Directors were present, which represented a quorum. Director Wilcox participated telephonically. Pledge of Allegiance Director Dewane led the Pledge of Allegiance. Call to the Public Chairman Gerard called for public comment. There were no comments from the public.

Minutes

Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center

Auditoriums 1 and 2 April 26, 2017

1:00 p.m.

Special Health Care District Board of Directors Meeting Minutes – General Session – April 26, 2017

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General Session, Presentation, Discussion and Action: 1. Approval of Consent Agenda:

a. Minutes:

i. March 22, 2017 b. Contracts:

i. Approve Amendment #5 to the contract (90-12-152-1-05) with Ernst & Young,

LLC for external auditing services ii. Approve a new Intergovernmental Agreement (90-17-151-1) with Maricopa

County and the Maricopa County Sheriff’s Office for the Establishment of the Health and Social Service Network (HSSN) in connection with the RE-LINK Program

iii. Approve Amendment #3 to the grant [90-15-186-1-03 (FTF-RC033-16-0524-01-

Y3)] with First Things First for Family Resource Centers services at the South Central, Maryvale, and Comprehensive Health Center Family Learning Centers.

iv. Approve Amendment #3 to the grant [90-15-185-1-03 (FTF-RC033-16-0552-02-

Y3)] with First Things First for the Care Coordination/Medical Home Services Program.

v. Ratify Arizona Care Network Participation Agreement (90-17-039-1) between the

Maricopa County Special Health Care District and Arizona Care Network, LLC.

vi. Approve Arizona Care Network Participating Physician Provider Agreement (90-17-039-1-01) between the Maricopa County Special Health Care District and Arizona Care Network NEXT, LLC.

vii. Approve an Intergovernmental Agreement (90-17-166-1) between MIHS and

AHCCCS. MIHS will provide the amount of $1,578,648, derived from local property tax assessments, to AHCCCS to satisfy the Non-Federal Share of SNCP (Safety Net Care Pool) payments in order to receive Federal matching funds for the benefit of Phoenix Children's Hospital. Total SNCP Payment to Phoenix Children's Hospital will be $5,132,145.

c. Governance: i. Approve and Waive Ogletree-Deakins Potential Conflict of Interest in CV 16-

4531-PHX-BSB d. Medical Staff:

i. Approve Maricopa Integrated Health System Medical Staff Appointments,

FPPEs, Reappointments, Change of Privileges/Status, Waiver Requests, and Resignations for April 2017

ii. Approve Maricopa Integrated Health System Allied Health Professional Staff

Appointments, FPPEs, Reappointments, and Resignations for April 2017


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General Session, Presentation, Discussion and Action, cont.: 1. Approval of Consent Agenda, cont.:

d. Medical Staff, cont.:

iii. Approve Proposed Revisions to the Nurse Practitioner Emergency Medicine Privileges

iv. Approve Proposed Revisions to the Physician Assistant Emergency Medicine

Privileges

v. Approve Proposed Revisions to the Nurse Practitioner Pediatric Emergency Medicine Privileges

vi. Approve New Nurse Practitioner (Adults) Critical Care Medicine Privileges vii. Approve Proposed Revisions to the Maricopa Integrated Health System Medical

Staff Professionalism Policy

e. Proposition 480 Capital:

i. Approve the purchase of 3,116 Maricopa Integrated Health System Personal

Computer monitors for a total of $457,910; and Approve the purchase of 1,558 Maricopa Integrated Health System workstations and services for a total of $1,377,677.44. This will complete Phase II of the Replacement Project

ii. Approve Amendment #2 to Contract 90-17-085-RFQ-CMAR with Kitchell

Contractors Inc. (KCI) for Construction Manager at Risk (CMAR) Guaranteed Maximum Price (GMP) for Phase Three (3) completion of the Employee Health building and conduct the demolition of the Maricopa Medical Center southeast third floor area. Phase Three GMP cost is $702,962

MOTION: Vice Chairman Harden moved to approve the consent agenda. Director Wilcox seconded. Motion passed by voice vote.

2. Discussion and Possible Action on the Maricopa County Special Health Care District Approval,

Authorization and Responsibility Matrix Vice Chairman Harden expressed her appreciation to senior administration for adjusting the Approval, Authorization and Responsibility Matrix (Matrix) and addressing the Board’s concerns. She noted that some omissions that needed correction, and suggested the following revisions; adding authority to the Chief Executive Officer for the following items, Section IV.A.4., Section IV.B., and Section XI.B. Mr. Purves concurred with those additions. MOTION: Vice Chairman Harden moved to approve the proposed revisions to the Maricopa County

Special Health Care District Approval, Authority and Responsibility Matrix with the following additions; adding authority to the Chief Executive Officer for the following Section IV.A.4., Section IV.B., and Section XI.B. Director Dewane seconded. Motion passed by voice vote.


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General Session, Presentation, Discussion and Action, cont.: 3. Discussion and Possible Action on Maricopa Integrated Health System’s 2017 Legislative Agenda

and/or the District’s Position Regarding Current or Proposed State and Federal Legislative Items Mr. Fronske reviewed the current statistics of the legislative session and noted that there continued to be contention with the state budget; however, it was expected to be addressed in the upcoming week. He reviewed the bills tracked by Maricopa Integrated Health System (MIHS) and highlighted the activity at a federal level, which included discussions surrounding the efforts to repeal and replace the Affordable Care Act (ACA). He stated that MIHS would continue to monitor the status and report back to the Board. 4. Discuss and Review Preliminary Budget Assumptions for Fiscal Year 2018; Review and Approve

Preliminary Volumes for Fiscal Year 2018 Ms. Benaquista reviewed the timeline for the 2018 fiscal year (FY18) budget planning process and noted that the preliminary volumes presented may change prior to the final approval of the budget; however, they would be used to establish revenue and expense assumptions for the upcoming fiscal year. She highlighted the organization’s margin improvement journey since fiscal year 2014, which included the continued improvement through fiscal year 2020. The major drivers for the FY18 budget included an increase in acute and behavioral health admissions, emergency room visits, surgical volumes, and ambulatory care visits. The increased surgical volumes were attributed to the additional services provided and the use of the da Vinci robot. The increase in emergency room visits was expected due to the addition of mid-level coverage, to reduce wait time and emergency room diversion. Vice Chairman Harden noted that acute admissions were currently missing the budgeted targets and questioned why the preliminary volumes projected an increase. Ms. Gaw explained that there were multiple factors; including but not limited the increased surgical volumes and improved emergency room throughput. Mr. Purves stated that the preliminary volumes were developed based on the projected volumes for the current year, not the budgeted targets. Vice Chairman Harden requested information on MIHS’s emergency room diversion rate, in particular, how often Maricopa Medical Center (MMC) closed to trauma due to emergency room saturation. Chairman Gerard suggested that staff also include information for surrounding hospitals. Ms. Benaquista stated that the budget assumptions did not contemplate any changes to the ACA; however, it anticipated a slight increase in commercial volumes due to the additional surgical services. The FY18 budget would result in a positive cash flow from operations, which would be used to increase cash revenues, make debt payments, and fund other strategic marketing and growth initiatives. There was also a potential to increase to the District property tax levy by $3 million. She highlighted the upcoming dates that the Board would have the opportunity to review the budget prior to final approval of the budget at June formal meeting. Chairman Gerard suggested scheduling an additional meeting, to allow the Board the opportunity to review prior to approval. Ms. Benaquista reviewed the proposed volumes and reiterated that they were based on the projected volumes for the current year and she did not anticipate those proposed volumes to change; minus any extraordinary circumstances. Chairman Gerard asked if the Regional Behavioral Health Authority (RBHA) had any plans to address or improve the behavioral health length of stay.


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General Session, Presentation, Discussion and Action, cont.: 4. Discuss and Review Preliminary Budget Assumptions for Fiscal Year 2018; Review and Approve

Preliminary Volumes for Fiscal Year 2018, cont. Mr. Cavallo stated that he was unaware of any plans that would impact the upcoming fiscal year. Ms. Benaquista referred to the payer mix, and noted the reduction in self-paying patients in the acute setting, which improved remarkably since FY15. The reduction of self-paying patients in outpatient setting was not as drastic; however, there was a reduction. She reviewed the revenue assumptions including the reduction to Medicare reimbursement by approximately $4.3 million, lack of Arizona Health Care Cost Containment System (AHCCCS) rate increases, nominal increases from any commercial payers, Federally Qualified Health Center rate increase, and the opportunity to increase in the property tax levy by $3 million. Many of the expense assumptions were unknown, as the budget workbooks were just returned. However, she noted that there was a slight reduction in the health insurance expense, a small increase in the Arizona State Retirement System (ASRS) contribution rate, and reviewed the projected inflation rates for other expenses. Ms. Talbot reiterated the budget review timeline and noted that all of the meetings were open to the public, and the information would be available on the District website. MOTION: Director Bicknell moved to approve the preliminary volumes for the 2018 fiscal year. Vice

Chairman Harden seconded. Motion passed by voice vote. 5. Discuss, Review and Approve, Renew, Revise, or Rescind the Following Board Policy

Statements: Governance

a. Policy 99100 G Board Member Compensation for Meetings and Travel - Rescind b. Policy 99107 G Board Meeting Per Diem – New

c. Policy 99108 G Mileage Reimbursement – New d. Policy 99109 G Travel and Travel Expense Reimbursement – New Ms. Talbot presented the policies to the Board and requested Policy 99100 G Board Member Compensation for Meetings and Travel be rescinded. That particular policy was implemented many years ago and was no longer adequate. She recommended the approval of the three remaining policies; which appropriately address each component of the outdated policy; per idem, mileage reimbursement, and travel and travel expense reimbursement. Mr. Purves, District Counsel, and Board Counsel reviewed all of the policies. Vice Chairman Harden referred to Policy 99109 G Travel and Travel Expense Reimbursement, and noted that the policy proposed a new procedure, in particular, item 3. Ms. Talbot concurred and noted that the new procedure would shift the financial responsibility to the Board member for any charges incurred for failure to utilized pre-arranged travel accommodations or attend pre-arranged conferences. However, the Board Office cost center may pay the charges in the event of accidents, serious illness, or death within the Board member’s immediate family or critical circumstances. Vice Chairman Harden proposed modifying the language to state, ‘however, in the event of accidents, serious illness, death within the Board member’s immediate family, or critical circumstances beyond the control of the Board member, the Board Office cost center will pay the charges. Payment will be determined by the Board of Directors.’ Ms. Talbot clarified that the proposed modification would require Board approval prior to the Board Office cost center paying any such charges.


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General Session, Presentation, Discussion and Action, cont.: 5. Discuss, Review and Approve, Renew, Revise, or Rescind the Following Board Policy

Statements, cont. Vice Chairman Harden agreed and noted that the Board should make the decision to pay the charges incurred for a fellow Board member failing to utilize the pre-arranged expenses. Chairman Gerard suggested any proposed revisions to any of the policies be submitted to Ms. Talbot. The discussion would continue next month, after legal counsel reviewed those modifications. 6. Consideration, Discussion, and Possible Action on the Performance Evaluation for Fiscal Year

2016 for Melanie Talbot, Executive Director of Board Operations/Clerk of the Board MOTION: Vice Chairman Harden moved that based on the Board’s review of Melanie Talbot’s

performance for the 2016 fiscal year, the Board has determined that she exceeds expectations. Director Dewane seconded.

Vice Chairman Harden expressed her appreciation for Ms. Talbot’s hard work. Chairman Gerard concurred and noted that Ms. Talbot’s vast knowledge of the organization was an asset to the Board. VOTE: Motion passed by voice vote. Director Wilcox agreed and expressed her gratitude to Ms. Talbot. Ms. Talbot thanked the Board for their kind words and appreciation. 7. Lean Six Sigma; Leadership Development and Process Improvement Initiatives Mr. Bowers provided an overview of the Lean Six Sigma process and stated that over the past five months, seventeen staff members participated in the classes. The classes consisted of fourteen days of classroom training, and were structured around the use of DMAIC (define, measure, analyze, improve, control) methodology. In order to obtain certification, staff was required to pass a written test and demonstrate their knowledge in a verbal presentation, displaying their understanding of the various tools, the operational changes, and lessons learned. Of the seventeen staff members participating, six were yellow-belt trainers. The following two presentations were examples of the work completed by green-belt recipients. Dr. Lopez presented his Lean Six Sigma project, The Benefits of Improved Patient Wait Time. He noted that 39% of the Avondale Family Health Center (FHC) patients’ wait time was longer than the desired cycle time, which affected the patient, provider, and staff satisfaction. The goal of the project was to improve the cycle time, which would in turn increase satisfaction, growth, and margin improvement. He noted that improving the wait time at each clinic, to allow one additional patient per day would result in close to $500,000 in additional revenue a year. He highlighted some of the tools used throughout the process, such as a high process flow map to outline the steps in a patient’s visit and detect steps in the process that add value and those that do not add value. Another tool utilized was the SIPOC (suppliers, inputs, process, output, customer) template, which identified the inputs and outputs of the process, and the impact to the suppliers and customers. The Pareto Chart uncovered potential factors contributing to the prolonged wait time, which allowed him to focus energy on those factors. He stated that he compiled the information gained from the various tools and focused on improving the pre-registration and scheduling processes. The implemented initiatives resulted in a higher percentage of patients experiencing a shorter cycle time. The utilization of the various tools also lead to additional ideas to improve throughput and patient and staff satisfaction.


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General Session, Presentation, Discussion and Action, cont.: 7. Lean Six Sigma; Leadership Development and Process Improvement Initiatives, cont. He expressed his gratitude for the opportunity to participate in the Lean Six Sigma training and certification. Ms. Schmitz presented her Lean Six Sigma project, 80 x 18 Colorectal Screenings. She noted that currently, only 37.1% of MIHS patients between the ages of 50-74 years were screened for colorectal cancer. The long-term goal was to screen 80% of patients in that age group for colorectal cancer by 2018; however, she aimed to increase the number of primary care patients at the Sunnyslope FHC to 50% by February 2017. She provided an overview of the project scope, which evolved as the project progressed, and the tools utilized throughout the process, such as a high-level process map and SIPOC. She also used the X’s and Y’s tool, which identified the goal and the possible variables in obtaining the goal. An imperative tool in this process was listening to the Voice of the Customer, to determine the reasons for not returning their specimens, which allowed her to discuss the results with the care team and determine potential improvements in educating the patients about the test. With the information obtained from the utilization of the various tools, and with the assistance of the entire clinic staff, the organization improved the number of patients being screened for colorectal cancer to from 37.1% to 51.4%, and Sunnyslope improved to 72% of patients being screened. Ms. Gaw commended both presenters and noted that the Lean Six Sigma process would bring better satisfaction, service, and patient experience. The process will also have an impact on the quality outcomes and financial stewardship. Chairman Gerard applauded the efforts of the participants of the Lean Six Sigma training process and appreciated the presentation. 8. Reports to the Board of Directors; Possible Action:

a. Monthly Proposition 480 Capital Purchases Update

b. March 2017 Maricopa Integrated Health System Key Indicator Dashboards; Financial Report Including but not Limited to Payor Mix Report, Investment of Funds Report;

c. Graduate Medical Education - Match Week Results

d. Annual District Wide Risk Management Program Report

e. Monthly Media Report

Chairman Gerard referred to item 8.c., the Graduate Medical Education – Match Week Results, and asked if the final position had been filled. Dr. Ferguson stated that there was no intention to fill the position outside of the match, due to qualified candidates. However, MIHS had a very successful match and the program directors were pleased with the results. The new medical residents begin orientation on June 15, 2017. Director Dewane referred to item 8.e., the Media Report, and highlighted an upcoming event, the Maricopa Health Foundation’s Inaugural Night of Heroes; which will feature retired Phoenix Police Officer and burn survivor, Jason Schechterle, and his medical and legal team. Mr. Murphy also reminded the Board of the upcoming Arizona Burn Center’s 13th Annual Chili and Salsa Showdown, which would feature chili and salsa tasking, live music, and a custom bike and car show. All of the proceeds from the event benefit the Arizona Burn Center.


8

General Session, Presentation, Discussion and Action, cont.: 9. Concluding Items

a. Old Business:

February 22, 2017 Legislative Update

• Provide a compare and contrast on proposed ACA changes that may affect MIHS

FY 18 Budget

• Frontend discussion about variables that could impact FY 18 budget March 22, 2017 Authorization Matrix

• Staff to bring specific examples as to how changes will impact operations, efficiencies, or effectiveness

b. Board Member Requests for Future Agenda Items or Reports c. Comments

i. Chairman and Member Closing Comment ii. President & Chief Executive Officer Summary of Current Events

Ms. Talbot reviewed old business and reiterated outstanding items. Mr. Purves noted that it was National Volunteer Week, and expressed his appreciation for the numerous volunteers at MIHS, which contributed approximately 21,000 work hours during the 2016 fiscal year. He also recognized Dr. Ferguson and the Academic Affairs staff for receiving the Accreditation Council for Graduate Medical Education (ACGME) accreditation. He announced Ms. Benaquista’s intent to retire in October. He thanked her for the years of service and the leadership she contributed to MIHS. He announced that Ms. Gaw was named one of the Top 25 Chief Operating Officers in the United States by Modern Healthcare, which was a tremendous honor for both Ms. Gaw and MIHS. Ms. Gaw stated that MIHS was one of five safety-net hospitals in the country to receive the opportunity to be loaned the da Vinci Surgical System, with no capital costs. This technology will train residents and fellows on the latest advances and techniques in robotic-assisted surgery. She expressed her appreciation to Drs. Goldberg and Hitt for their effort to bring this advancement to the system. Vice Chairman Harden requested a future discussion on how the implementation of Proposition 206 would affect the upcoming budget. She also requested an update on the completion rates for the mandatory compliance training, for the MIHS employees, medical residents, and District Medical Group (DMG) providers. Mr. Slaughter outlined the various methods that were being used to ensure that the mandatory compliance training would be completed by the June 30, 2017 deadline.


9

Adjourn MOTION: Director Dewane moved to adjourn the April 26, 2017 Special Health Care District Board

of Directors Formal Meeting. Vice Chairman Harden seconded. Motion passed by voice vote.

Meeting adjourned at 2:53 p.m. ______________________________ Susan Gerard, Chairman Special Health Care District Board of Directors

Maricopa County



May 24, 2017

Item 1.b.i.

Contracts 90-17-178-1

From: Compliance 360To: Melanie TalbotSubject: Contract Approval Request: Lease of Space in the Behavioral Health Annex Superior Court of Arizona in Maricopa

CountyDate: Thursday, May 04, 2017 8:25:00 PM

Message Information

From Purves, SteveTo Talbot, Melanie;

Subject Contract Approval Request: Lease of Space in the Behavioral Health Annex Superior Court of Arizona in Maricopa County

Additional Information Indicate whether you approve or reject by clicking the Approve or Reject button.

Add comments as necessary. Approve/Reject Contract

Click here to approve or reject the Contract. Contract Information

Status Pending ApprovalTitle Lease of Space in the Behavioral Health Annex

Contract Identifier Board - New ContractMIHS Contract

Number 90-17-178-1

Primary Responsible Party Maness, Brian D.

Departments Psych - AdministrationProduct/Service

Description Lease of space within the Behavioral Health Annex

Action/Background Approve a Memorandum of Understanding with The Superior Court of Arizona in Maricopa County ("Court") for the construction and maintenance of space for a courtroom and judicial chambers within the MIHS Behavioral Health Annex ("Annex") located on the Main Hospital campus. The purpose of the courtroom and judicial chambers at the Annex is to supplement the courtroom space that currently exists at the Desert Vista Behavioral Health Complex in Mesa. This second courtroom location will alleviate the need for MIHS to transfer its Annex patients to the Desert Vista facility in Mesa. The Court has an interest in holding court-ordered treatment hearings at an additional courtroom utilizing an additional judicial officer to relieve the increased caseload on the judicial officer and staff at the Desert Vista location. The Court shall pay MIHS an annual rental fee of $1 for the use of the Annex Courtroom. The agreement shall be effective upon signature for an initial term of five (5) years and renew automatically for one (1) additional five (5) years term (the "Subsequent

mailto:[email protected]




https://secure.compliance360.com/DMZ/DmzCustomViewLoader.aspx?CD=nbrakfEr8Je4Mf6zsrk0YhFnOfnbElLIR86SAz%252bMngNq9pghhviJVQ%253d%253d&PD=gewc47sikRhSw3aCHWoxcmVaFHN41d%2bVzzF1gxNKq6fCuV06dHU9tON28IdG4oNAOHqZj9T87toL%2f63sqzhAr4PlcIE3X43PBpyNCwXTqwTzFik9ztGNWldeEVeRuyYYT465HJYRoS%2biJso73bSin8ij%2fRW7uNCrQ7JOMH6hhHpEkRorwHdIgB0GJxjTWhtsxUm8q49sPN59SC0xNNUY6bR0iij5EwkH8e3yS%2bgcqi3YC5PVzlR1DbW3Tt902viVK80sVjn9CwSVtJfWdSjtYBOR3xNZswQg1a6ALqpXLdtJjqFjeEWZ0Q%3d%3d

Term"). Either party may terminate the agreement for any reason upon ninety (90) days written notice.

Evaluation ProcessNotes

CategoryEffective Date 5/24/2017

Expiration Date 5/23/2022Annual Value $1.00

Expense/Revenue RevenueBudgeted Travel Type YesProcurement Number

Primary Vendor Superior Court of Arizona in Maricopa County

Responses

Member Name Status CommentsGorman, Louis B. Approved

Cavallo, Gene A. Approved

Gaw, Kris D. Approved

Purves, Steve A. Approved

Talbot, Melanie L. Current

Maricopa County



May 24, 2017

Item 1.b.ii.


From: Compliance 360To: Melanie TalbotSubject: Contract Approval Request: Three Rivers Provider Network (TRPN) 1.1.2017 Base Agmt Three Rivers Provider

Network, Inc. (TRPN)Date: Monday, May 08, 2017 9:58:59 AM

Message Information


Subject Contract Approval Request: Three Rivers Provider Network (TRPN) 1.1.2017 Base Agmt Three Rivers Provider Network, Inc. (TRPN)




Status Pending ApprovalTitle Three Rivers Provider Network (TRPN) 1.1.2017 Base Agmt

Contract Identifier Article 5 - New ContractMIHS Contract

Number 90-17-176-1

Primary Responsible Party Hoffman, Ethel

Departments MANAGED CARE ADMINProduct/Service

DescriptionAction/Background Approve the agreement to effect the participation of MIHS in

the Three Rivers Provider Network (TRPN), a national provider network that contracts with hospitals, physicians and ancillary providers who render medical and health care services at pre-determined rates for the benefit of insurances companies, third party administrators, health plans and individuals (Clients) that directly or indirectly access TRPN for covered services. Participation in the network will enable MIHS to be listed as a TRPN participating provider and provide a mechanism for expedited payment by TRPN clients for services rendered. This agreement effective date is retroactive to 1/1/2017 to expedite payment of claims for services rendered but not yet submitted to TRHN. The reimbursement rates are very favorable at 90% of billed charges.

Evaluation ProcessNotes Three Rivers Provider Network (TRPN) contracts with hospitals,

physicians and ancillary providers who render medical and





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health care services at pre-determined rates for the benefit of insurances companies, third party administrators, health plans and individuals (Clients) that directly or indirectly access TRPN for covered services. Participation in the network enables contracted providers to be listed as a TRPN participating provider and provides a mechanism for expedited payment by TRPN clients for services rendered.



Expense/RevenueBudgeted Travel TypeProcurement Number

Primary Vendor Three Rivers Provider Network, Inc. (TRPN)

Responses

Member Name Status CommentsZenobi, Michael S. Approved Reimbursement rate is favorable

Gorman, Louis B. Approved

Benaquista, Kathleen F. Approved



Maricopa County



May 24, 2017

Item 1.b.iii.


From: Compliance 360To: Melanie TalbotSubject: Contract Approval Request: Health Net Federal Services (TriCare/Centene) for Facility and Professional Services

Health Net Federal Services (Tricare/Centene)Date: Monday, May 08, 2017 9:48:15 AM

Message Information


Subject Contract Approval Request: Health Net Federal Services (TriCare/Centene) for Facility and Professional Services Health Net Federal Services (Tricare/Centene)




Status Pending ApprovalTitle Health Net Federal Services (TriCare/Centene) for Facility and

Professional ServicesContract Identifier

MIHS Contract Number 90-17-174-1

Primary Responsible Party Hoffman, Ethel

DepartmentsProduct/Service

DescriptionAction/Background Approve this Agreement to enable MIHS to continue to provide

services to eligible veterans through the Tricare Program. This Agreement will replace the current Tricare agreement with United Healthcare as the Veteran's Administration awarded the Tricare contract to Health Net effective 10/1/2017. Volume that has historically come to MIHS through the United Healthcare Veteran's Services contract will now need to come through Health Net Federal Services. Current annual net revenue approximates $1,077,334 for facility and $276,101 for professional services. This contract will allow us to retain similar volume.

The negotiated rates for this book business is increased from 90% of the Tricare fee schedule to 95% for facility services and 92% for physician services. Consequently, we should expect an increase in annual net revenue, assuming a similar





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utilization pattern, of $59,389.Evaluation Process

NotesCategory

Effective Date 10/1/2017Expiration Date 5/3/2017

Annual Value $0.00Expense/Revenue

Budgeted Travel TypeProcurement Number

Primary Vendor Health Net Federal Services (Tricare/Centene)

Responses

Member Name Status CommentsZenobi, Michael S. ApprovedLooks good. Simple and to the point. It represents a replace contract

to United effective 10/1/17Gorman, Louis B. Approved

Benaquista, Kathleen F.Approved



Maricopa County



May 24, 2017

Item 1.b.iv.


From: Compliance 360To: Melanie TalbotSubject: Contract Approval Request: Leaders Drug Stores, Inc. PSAODate: Tuesday, May 09, 2017 7:45:49 AM

Message Information


Subject Contract Approval Request: Leaders Drug Stores, Inc. PSAOAdditional Information Indicate whether you approve or reject by clicking the Approve

or Reject button.



Status Pending ApprovalTitle Leaders Drug Stores, Inc. PSAO


Number 90-17-168-1

Primary Responsible Party Zenobi, Michael S.

Departments Hospital PharmacyProduct/Service

Description Leader Drug Stores, Inc. PSAO

Action/Background APPROVE the Leader Drug Stores, Inc. PSAO Agreement. The Leader Drug Store, Inc. PSAO agreement is a pharmacy group collaborative agreement that will consolidate MIHS’s non-AHCCCS PBM agreements under a single agreement. Additionally, this arrangement will expand MIHS’s Pharmacy participation to an expanded number of health insurer agreements we do not currently have contracted arrangements thus driving additional revenues through our pharmacies.

A side benefit of this agreement will be to create a level of administrative simplification by reducing the number of pharmaceutical payor contracts maintained by Managed Care Ops.

This PSAO PBM agreement that would consolidate nearly all of MIHS’s 25 existing PBM contracts under a single agreement and would provide or result in the following: • Increased net revenue ranging from $120,000 to $360,000 • Increased market and payor exposure / access





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• Administrative simplification gains in (a) future contract negotiations; (b) billing reconciliations

While reimbursement and financial performance of each contract held by a PSAO is proprietary and confidential, MIHS’ reimbursement performance of the top ten active commercial and Medicare Part D insurances were compared to a preferred PSAO vendor, finding that the annual performance opportunity was an increase in third-party reimbursement and dispensing fees totaling $120,121 (6.29%). The ability to service an additional 446 patients through contract expansion would yield an additional $136,240 to $222,257 in gross revenue from third-party reimbursement and dispensing fees, and an additional $16,623 in cash received from copays.

TABLE 5: ESTIMATED FINANCIAL PERFORMANCE UNDER PSAO PARTICIPATION - CY2016 Current Total 3rd Party reimbursement ($): $1,910,891 Dispensing Fees: 34,969 Ingredient Costs: 1,875,922 Cash copays received: 252,767

(Under LeaderNET) Total 3rd Party reimbursement ($): $2,031,012 Dispensing Fees: 43,036 Ingredient Costs: 1,987,976 Addt'l cash copays received: 16,624 Represents a 6.5% increase in cash copays collected.

Annual performance difference/opportunity ($): $120,121 Represents a 6.29% increase in gross revenue under PSAO participation.

Potential increase in volume: 3,302 Unique patients not currently serviced * average RX per commercial patient Non-weighted average $ per Rx $41.26 Weighted average $ per Rx: $67.31

Potential gross annual revenue growth ($): $136,240 - 222,258 Range using non-weighted and weighted averages with ability to service additional patients.

Total potential growth opportunity for CY2016 ($): $272,985 – 359,002 Combines active serviced patients and potential serviceable patients.

Effective upon execution.Evaluation Process

Notes The Leader Drug Stores, Inc. PSAO Agreement is a pharmacy group collaborative agreement that will consolidate MIHS’s non-AHCCCS PBM agreements under a single agreement. Additionally, this arrangement will expand MIHS’s Pharmacy participation to an expanded number of health insurer agreements we do not currently have contracted

arrangements thus driving additional revenues through our pharmacies.

A side benefit of this agreement will be to create a level of administrative simplification by reducing the number of pharmaceutical payor contracts maintained by Managed Care Ops.

CategoryEffective Date


Expense/RevenueBudgeted Travel TypeProcurement Number

Primary Vendor

Responses






Maricopa County



May 24, 2017

Item 1.b.v.


From: Compliance 360To: Melanie TalbotSubject: Contract Approval Request: Supplemental Payments to DSH Hospitals for svcs performed 10/01/2014 thru

09/30/2015 AHCCCSDate: Tuesday, May 09, 2017 7:44:23 AM

Message Information


Subject Contract Approval Request: Supplemental Payments to DSH Hospitals for svcs performed 10/01/2014 thru 09/30/2015 AHCCCS




Status Pending ApprovalTitle Supplemental Payments to DSH Hospitals for svcs performed

10/01/2014 thru 09/30/2015Contract Identifier Board - New Contract



Departments HOSPITAL ADMINISTRATIONProduct/Service

DescriptionSupplemental payments to DSH Hospitals for services performed between October 1, 2014 through September 30, 2015

Action/Background Approve an Intergovernmental Agreement ("IGA") with the Arizona Health Care Cost Containment System Administration ("AHCCCS") to provide AHCCCS with the Non-Federal Match of funds in the amount of $463,603.49 in order to receive supplemental Medicaid payments for DSH hospitals. Between the Federal Match of $1,006,287.10 and MIHS' Non-Federal Match contribution of $463,603.49, MIHS will receive a total allocation of $1,469,890.59 for services rendered from October 1, 2014 through September 30, 2015.


Category IGAEffective Date 5/24/2017

Expiration Date 5/23/2018





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Annual Value $1,469,890.59Expense/Revenue Revenue

Budgeted Travel Type YesProcurement Number

Primary Vendor AHCCCS

Responses





Maricopa County



May 24, 2017

Item 1.b.vi.


1

Melanie Talbot

From: Compliance 360 <[email protected]>Sent: Thursday, May 11, 2017 4:16 PMTo: Melanie TalbotSubject: Contract Approval Request: Supplemental Payments to DSH Hospitals for svcs

performed 10/01/2014 thru 09/30/2015 - For Benefit of Abrazo Hospitals AHCCCS

Message Information

From Purves, Steve To Talbot, Melanie;

Subject Contract Approval Request: Supplemental Payments to DSH Hospitals for svcs performed 10/01/2014 thru 09/30/2015 - For Benefit of Abrazo Hospitals AHCCCS

Additional Information

Indicate whether you approve or reject by clicking the Approve or Reject button. Add comments as necessary.

Approve/Reject Contract

Click here to approve or reject the Contract.

Contract Information

Status Pending Approval Title Supplemental Payments to DSH Hospitals for svcs performed 10/01/2014 thru

09/30/2015 - For Benefit of Abrazo Hospitals Contract Identifier Board - New Contract



Departments HOSPITAL ADMINISTRATION Product/Service

Description Supplemental payments to DSH Hospitals for services performed between October 1, 2014 through September 30, 2015. This agreement allows MIHS to provide the Non-Federal Share of funds for the benefit of Abrazo Hospitals.

Action/Background Approve an Intergovernmental Agreement ("IGA") with the Arizona Health Care Cost Containment System Administration ("AHCCCS") to provide AHCCCS with the Non-Federal Match of funds in the amount of $79,125.45 in order to receive supplemental Medicaid DSH payments for the benefit of Abrazo Hospitals. Between the Federal Match of $250,873.36 and MIHS' Non-Federal Match contribution of $79,125.45, the Abrazo Hospitals will receive a total allocation of $329,998.81 for services rendered from October 1, 2014 through September 30, 2015.

Evaluation Process Notes

Category IGA Effective Date 5/24/2017

Expiration Date 5/23/2018 Annual Value $79,125.45

2

Expense/Revenue Revenue Budgeted Travel

Type Yes

Procurement Number

Primary Vendor AHCCCS

Responses

Member Name Status Comments Gorman, Louis B. Approved Benaquista, Kathleen F. Approved Purves, Steve A. Approved Talbot, Melanie L. Current

Maricopa County



May 24, 2017

Item 1.b.vii.

Contracts 90-12-084-1-21

From: Compliance 360To: Melanie TalbotSubject: Contract Approval Request: Amendment #21 District Medical Group (DMG)Date: Wednesday, May 10, 2017 5:08:49 PM

Message Information


Subject Contract Approval Request: Amendment #21 District Medical Group (DMG)




Status Pending ApprovalTitle Amendment #21

Contract Identifier Board - AmendmentMIHS Contract

Number 90-12-084-1-21



Description Amendment #21

Action/Background Approve Amendment #21 to the contract between Maricopa County Special Health Care District ("MIHS") and District Medical Group ("DMG") to revise the Exhibit B, Sections II, VIII, Appendix A, and Appendix I of the agreement. This amendment revises Section II of the Agreement to accommodate necessary changes to add FTEs to the Surgery-Eye MD FTEs and Ortho-Spine Midlevels to the Surgery and Orthopedics Departments. This amendment revises Section VIII to accommodate necessary changes to add Internal Medicine MD FTEs and Psychiatrists for the previously approved additional 22 beds. This amendment revises Appendix A to accommodate necessary changes to the new Ortho-Spine Midlevel position. This amendment also revises Appendix I to accommodate necessary changes for an annual update per the agreement.

Total FTE Impact: +5.37 Total for all Amendment Items Including Pro-forma Information, is a Net Financial Impact of: $195,587.





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Expiration Date 6/30/2021Annual Value $195,587.00

Expense/Revenue ExpenseBudgeted Travel Type YesProcurement Number

Primary Vendor District Medical Group (DMG)

Responses


Williamson, Tera L. Approved


Hitt, John A. Approved




Maricopa County



May 24, 2017

Item 1.b.viii.


From: Compliance 360To: Melanie TalbotSubject: Contract Approval Request: Sub-Operating Agreement to Add Space for Dental Clinic and Storage Southwest

Center for HIV/AIDSDate: Thursday, May 11, 2017 4:15:29 PM

Message Information


Subject Contract Approval Request: Sub-Operating Agreement to Add Space for Dental Clinic and Storage Southwest Center for HIV/AIDS




Status Pending ApprovalTitle Sub-Operating Agreement to Add Space for Dental Clinic and

StorageContract Identifier Board - New Contract



Departments Hospital AdministrationProduct/Service

DescriptionSub-operating agreement to add additional space for dental clinic and basement storage

Action/Background Approve a new Sub-Operating Agreement with Southwest Center for HIV/AIDS to add an additional 1,800 square feet of space on the first floor for the purposes of expanding the dental practice to provide primary dental care for those infected with HIV/AIDS. An additional 182 square feet is also added in the basement for storage purposes.

For years 1-5, the annual basic use fee for the additional space will be $42,148. For years 6-10 the annual basic use fee will be $45,930. The initial term will be from 4/1/2017 through March 31, 2022 with the option to extend for one additional five year term from 4/1/2022 through 3/31/2027.


Category





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Annual Value $45,000.00Expense/Revenue Expense


Primary Vendor Southwest Center for HIV/AIDS

Responses


Whitney, Warren W. Approved approve







May 24, 2017

Item 1.c.i.

Governance Property Insurance Policy and Premium

Maricopa Integrated Health System | 2601 E. Roosevelt Street | Phoenix, Arizona 85008 | (602) 344-5011 | MIHS.org

Date: May 15, 2017 To: Susan Gerard, Chairman and Director, District 3

Mary A. Harden, R.N., Vice Chairman, District 1 Mark Dewane, Director, District 2 Elbert Bicknell, Director, District 4

Mary Rose Wilcox, Director, District 5 From: Trisha Farrell, Risk Management Operations Manager Cc: Steve Purves, President & Chief Executive Officer Louis Gorman, District Counsel Melanie Talbot, Executive Director of Board Operations Re: Property Insurance Renewal with The Travelers Indemnity Company (a Stock

Company) The District’s property insurance policy renews with effective dates of June 1, 2017 through June 1, 2018. Marsh, the District’s insurance broker, sought and received quotes from AIG, Zurich and Travelers Insurance companies. After a thorough review of the above three quotes from Marsh, it was felt that moving away from AIG and reestablishing a relationship with Travelers was the most appropriate. Travelers eagerness and lower quote bid than AIG’s expresses a commitment to regain MIHS’ business and sends a message that they are hopeful to establish a long ongoing relationship. The coverages submitted to the carriers included the District’s properties with the insurance value of $733,872,220, which is a 113% increase in property value. Due to the increased evaluation of properties and aggressiveness to move away from AIG, the new insurance premium for the Travelers policy renewal is $208,702, an increase of $95,140. AIG’s renewal quote was $221,393. Travelers is a strong partner for healthcare systems and has significant capacity to pay claims. They are also committed to building a relationship with the District on property coverage in providing a reduction in premiums from the expiring carrier, AIG, speaks to that commitment. Based on the foregoing reasons, we respectfully request that the Board approve the property renewal coverage for Travelers Indemnity Company and payment to Travelers Indemnity Company as soon as practical.

Maricopa County



May 24, 2017

Item 1.c.ii.

Governance Arizona State Retirement System Salary

Deferral Plan 457 (b) Plan

From: Compliance 360To: Melanie TalbotSubject: Contract Approval Request: ASRS Supplemental Salary Deferral Plan - 457(b) Arizona State Retirement System

(ASRS)Date: Thursday, May 11, 2017 7:34:59 PM

Message Information


Subject Contract Approval Request: ASRS Supplemental Salary Deferral Plan - 457(b) Arizona State Retirement System (ASRS)




Status Pending ApprovalTitle ASRS Supplemental Salary Deferral Plan - 457(b)


Number 90-17-186-1



DescriptionArizona State Retirement System Supplemental Salary Deferral Plan - 457(b)

Action/Background Approve Maricopa County Special Health Care District, dba, Maricopa Integrated Health System ("MIHS") joining and moving the employee assets of the MIHS 457(b) employee deferred compensation plan to the Arizona State Retirement System ("ASRS") sponsored 457(b) Supplemental Salary Deferral Plan ("ASRS Plan"). MIHS' participation will become effective upon execution of the 457 Plan Adoption Agreement and Adoption Resolution.


Category IGAEffective Date 6/1/2017


Expense/Revenue





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Budgeted Travel TypeProcurement Number

Primary Vendor Arizona State Retirement System (ASRS)

Responses


Goldfeder, Mica L.

Gaw, Kris D.




Approved

Approved

DC-4566 (01/2016) For help, please call 602-266-2733 azsrsp.com 1

Arizona State Retirement SystemSupplemental Salary Deferral Plan

Adoption Resolution

WHEREAS, the ,(Name of Political Subdivision)

hereinafter designated the Political Subdivision, through its governing body, desires to establish a supplemental defined contribution plan for all of its eligible officers and employees to be administered by the Arizona State Retirement System (hereinafter designated ASRS) under Article 2, Chapter 5, Title 38 of the Arizona Revised Statutes.

NOW, THEREFORE, BE IT RESOLVED, that the Political Subdivision hereby adopts a Supplemental Salary Deferral Plan (hereinafter designated SSDP) established by the ASRS pursuant to Section 38-781, Arizona Revised Statutes, for the officers and employees of the Political Subdivision who are eligible for participation in the SSDP.

BE IT FURTHER RESOLVED, that the (Position Title)

is designated as the Authorized Agent of the Political Subdivision and is authorized and directed as the representative of the Political Subdivision to conduct all negotiations, conclude all arrangements and sign all agreements and modifications of agreements which may be necessary to carry out the intent of the Agreement in conformity with all applicable federal and state laws, rules and regulations.

I, Clerk/Secretary of the ,(Political Subdivision)

State of Arizona, do hereby certify the foregoing to be a full, true and correct copy of the resolution adopted by the

of the ,(Name of Governing Body) (Political Subdivision)

at a regular/special meeting held on the day of , 20 , as the same appears on record in my office.

Clerk/Secretary


Chief Financial Officer

Maricopa County Special Health Care DistrictMelanie Talbot

Maricopa County Special Health Care DistrictMaricopa County Special Health Care District Board of Directors

24 May 17

NRM-13574AZ-AZ (01/2016) For help, please call 602-266-2733 azssdp.com 1

Preamble

Arizona State Retirement SystemSupplemental Salary Deferral Plan

457 Plan Adoption Agreement of Participation Employers

Employer Information

Employee Contributions (check box(es))

In-service Withdrawals (check box(es))

Loans (check box(es))

Other Information for the Participating Employers

Employer Signature

Acceptance by the Record Keeper and/or Third Party Administrator (if applicable)

Acceptance by ASRS

By this agreement, the Employer hereby adopts the ASRS Supplemental Salary Deferral Plan (SSDP) 457 Plan and permits Employees to begin contributing as of (date).

Employer Name:

Employer Address:

City, State, & ZIP: Employer Tax ID Number:

c Pre-tax per plan document c Roth after-tax contributions to also be enabled

c Roll-over contributions per plan document

c Shall not be allowed other than per plan document

c Plan to plan transfers to other active employer sponsored 457 plans allowed

c Shall be allowed per plan administrative agreement c Shall not be allowed

The ASRS is responsible for administration of this Plan. Inquiries regarding the adoption of the Plan or the meaning of its provisions should be directed to the ASRS or the acting record keeper. This adoption agreement may be used only in conjunction with the ASRS Supplemental Salary Deferral Plan (SSDP) 457 Plan

Name of Employer:

Signature: Date:

Title:

Name (please print):

Date Executed:

Signature:

Title:


Date Accepted:

The Arizona State Retirement System (ASRS) hereby accepts the adoption of the Plan by the Employer identified in the Employer Information section.

Arizona State Retirement System

Signature:

Title:


Date Executed:

Maricopa County Special Health Care District, dba, Maricopa Integrated Health System

2601 E. Roosevelt

Phoenix, AZ, 85008 86-0830701

Maricopa County Special Health Care District, dba, Maricopa Integrated Health System

Chair, Board of DirectorsSusan Gerard

X XX

X

X

X

June 1, 2017

Maricopa County



May 24, 2017

Item 1.c.iii.

Governance Risk Management Insurance and

Self-Insurance Plan

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Date: May 5, 2017 To: Susan Gerard, Chair, Director, District 3

Mary A. Harden, R.N., Vice Chair, Director, District 1 Mark Dewane, Director, District 2 Elbert Bicknell, Director, District 4 Mary Rose Wilcox, Director, District 5

From: Louis Gorman, District Counsel CC: Steve Purves, MIHS CEO Re: Board Questions: MIHS Risk Management Insurance and Self-Insurance Plan During the November 2012 Board meeting, questions were raised by Board members regarding the Amended and Restated Maricopa County Special Health Care District Risk Management Insurance and Self-Insurance Plan (Plan), to which Mr. Rocky Armfield, the former Director of Risk Management, responded. Chairman Gerard asked that staff review the issues raised by the Board in 2012 and the responses Mr. Armfield provided at that time and provide answers to the Board’s 2012 questions in light of the proposed revisions to the Plan. Set forth below are the Board’s questions taken from the Minutes of the 2012 meeting followed by responses that are reflect in the Plan that is before the Board for approval at its May 2017 meeting. (Words and phrases in red reflect proposed 2017 revisions in the 2017 Plan)

1. Why is the Board being asked to approve the Plan when the Plan states that the CEO has the power to dissolve it?

Response: Section 1.8.5 states that the Plan “…may be amended, or modified or dissolved only by the CEO and the Board of Directors”.

2. What delegated authority was given to the Chief Executive Officer, the Claims

Committee and the Plan Administrator, because the Board may want to retain authority instead?

Response: The Plan delegates to the Plan Administrator (the Director of Risk Management) a range of authority that is set forth in Section 1.9, such as adopting policies and procedures, purchasing insurance, retaining adjusters, etc. Section 1.9 also limits the authority of the Plan Administrator to those powers that are delegated by the Board or the CEO. The Board, having approved the Plan, has specifically delegated Claim Settlement and Recovery Authority to the Plan Administrator, the Claims Committee, and the Board of Directors that is set forth in Schedule “A” of the Plan.

More specifically, that delegated and retained settlement authority as modified by the Board at part of its approval of the Authority matrix, is as follows:

Plan Administrator: Up to $99,999. Claims Committee: From $100,000 up to $500,000 $250,000 Board of Directors: In excess of $501,000 $250,001

3. Mr. Armfield said the Plan was a self-insurance plan that has responsibilities directed to

the Risk Management Director, the Chief Compliance Officer, and the Chief Executive Officer.

Response: Since the 2012 Chief Compliance Officer and the 2012 Risk Management Director are no longer employed by the District, the Plan has been amended in 2014 and new reporting lines approved by the CEO reflect that the Plan Administrator reports to District Counsel with a dotted line to the Chief Medical Officer.

4. Mr. Armfield plans to bring specific claims and lawsuits to the Board on a routine basis

in order to get Board direction.

Response: Since the 2012 Compliance Officer and the 2012 Risk Management Director are no longer employed by the District, information regarding claims and lawsuits are taken to the Board in executive session on a regular basis. In addition, the Claims Committee, with two Board members, meets quarterly, and reviews new claims, potential claims, and lawsuits.

5. It was recommended that a Board Member join the Claims Committee during settlement

of claims and the Claims Committee would have authority to settle any claims covered by the plan in excess of $500,000 and up to and including $1 million.

Response: As noted in Response to #2 above, the settlement authority level of the Claims Committee and the Board has been revised. The redline draft of the 2017 Plan that will be presented to the Board at its May meeting will contain the following revised composition of the Claims Committee (additions are noted in red) and reflect that the Board has authority to select a Board Member(s) to sit on the Claims Committee and a three year term provision for the Board Member position on the Committee has been added. 1.7.4. "Claims Committee" means the District’s Claims Committee that meets at

least quarterly, and the District’s Claims Committee reviews potential or pending claims and approves claim and lawsuit settlements for money damages according to the attached Plan's Schedule A. The Claims Committee is comprised of reports to the CEO. The Claims Committee membership shall consist of the CEO, the District Director of Risk Management or its designee, District Counsel, Chief Medical Officer, Chief Compliance Officer, Chief Operating Officer, Chief Nursing Officer, V.P. of Human Resources and other staff (where appropriate) appointed to the Committee by the CEO. At least one member of the District Board of

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Directors selected by the Board shall serve on the Committee. The term of the Board Member(s) selected by the Board to serve on the Committee shall be for a three year term. The conduct of the Claims Committee is conducted under attorney-client privilege and attorney work product privilege. and such others as selected by the CEO.

6. Question is the Claims Committee a committee or a board.

Response: The Claims Committee is a committee.

7. Director Bicknell wanted to know which Board Member would serve, who would make

that appointment, and for how long? Response: See Response to #5 above that redefines the composition of the Claims Committee and answers these questions. In addition, a three year term has been inserted in Section 1.7.4 to reflect the term of the Committee’s Board Member(s).

8. Director Bicknell wanted to know when the Board Members would receive written

reports summarizing risk management activities, including claims, and claims by department including expenditures.

Response: Section 1.8.3. currently states that “The financial activities, management, trending information and business affairs of the Plan shall be managed effectively and efficiently with reports submitted annually or as otherwise requested by the CEO or the Board of Directors" (emphasis added).

9. Chairman Gerard wanted to know what section in the Plan states where, when and what

(information) the Board of Directors will receive and what senior administration would provide to the Board of Directors.

Response: Section 1.8.3 of the Plan addresses this point and emphasizes that any report or information that the Board requests will be provide anytime, i.e. “or as otherwise requested by the Board of Directors.” (Emphasis added).

10. A question was raised regarding what documents would be provided to the Board, when

the documents would be provided, and under what circumstances would senior administration ask for guidance from the Board.

Response: The Plan is the Board’s Plan. Thus, the Board has the right to ask for and receive from senior management any and all information, documents, records, and data, and there is no time limit placed on when the Board may make their request. Senior administration understands that the Plan is the Board’s Plan and therefore would consult with the Board with regard to any issue that would impact the application of the Plan.

11. It was recommended that any amendments to the Plan be reported to the Board of Directors.

Response: Section 1.8.5 of the Plan states that any amendment to the Plan will be brought to the Board for Board approval, as only the Board and the CEO may amend the Plan.

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Date: May 5, 2017 To: Susan Gerard, Chair, District 3

Mary A. Harden, R.N. Vice Chair, Director, District 1 Mark Dewane, Director, District 2

Elbert Bicknell, Director District 4 Mary Rose Wilcox, Director, District 5

From: Louis B. Gorman, District Counsel Cc: Steve Purves, President and Chief Executive Officer Melanie Talbot, Clerk of the Board of Directors Re: Proposed Revisions: Amended and Restated Maricopa County Special Health

Care District - Risk Management Insurance and Self Insurance Plan The proposed revisions to the Amended and Restated Maricopa County Special Health Care District Risk Management Insurance and Self Insurance Plan (“Plan”) are identified in the Plan with additions highlighted in yellow and deletions highlighted in yellow strikethroughs. Bill Sims has reviewed and contributed to the proposed revisions. Below are explanations, by Plan paragraph number, of the more noteworthy revisions in the 2017 Plan. The few revisions in the Plan that are minor or self-explanatory are not included in the discussion below.

1.4—The additional wording was added for clarification and to help those who work with the Plan, interpret it in a manner that effectuates the Plan’s intent, which is to afford maximum protection and coverage for the District, its Officers, Directors, and Employees.

1.7.4--The composition of the Claims Committee has been revised to include at least one Member

of the Board of Directors, who is selected by the Board. In addition, the Board Member(s) who are selected by the Board to serve on the Claims Committee will serve for a three year term. Section 1.7.4 has also been revised to permit additional members of MIHS’ senior management, who are selected by the CEO, to participate on an ad hoc basis in the Claims Committee.

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1.9.4—Paragraph 1.9.4 was inserted to reaffirm the authority of the Board of Directors to obtain

information, documents and data from senior management at any time, and that written reports to the Board are to be submitted annually or at any time the Board requests information.

2.2.1.11 and 2.2.1.12—These two sections relate to circumstances where the District would

consider paying for the defense costs associated with disciplinary or licensure proceedings brought by a licensing body (e.g. Arizona State Board of Nursing, Arizona State Board of Pharmacy, Arizona Medical Board) against a District employed licensed professional, particularly when that employee has already been terminated.

• 2.2.1.11 Under the proposed revisions, the District may provide coverage only in

cases where the licensing proceeding involving the District employee has the potential to adversely affect the liability of the District (i.e. where employee’s conduct is also at issue in a medical malpractice action and thus where MIHS may be held liable). In this situation, coverage under the Plan is discretionary.

• 2.2.1.12 Under the revision to this paragraph, the District will not defend or provide

coverage to a District employee in a licensing proceeding when the employee has been disciplined/dismissed from District employment under the Merit System process.

2.2.4.3--The previous language in this paragraph contained an exclusion from coverage where the

conduct of the employee constituted a violation of an Arizona criminal statutes (under Title 13) or an Arizona motor vehicle/traffic law (under Title 28). The previous wording was overly broad and could have created a potential coverage issues for the District itself. While the District may want to use the criminal conduct of the employee to deprive the employee of coverage, the District does not want to deprive itself of coverage for itself, due to the potential vicarious liability that would flow from that employee’s conduct. The revisions to this section now permit the District to be covered as an institution even when a District employee has been engaged in improper conduct.

2.2.4.7--This revision reflects the concern discussed in 2.2.4.3, above. While the District may

want the intentional and willful misconduct of an employee to permit denying coverage to the employee, the District does not want to deprive coverage for itself, based on the vicarious liability for that same employee’s conduct. For example, if the District faces a claim that an employee was abusing patients, the District may decide not to extend coverage to the employee, but will want to retain coverage for itself under the Plan and under any excess insurance plan.

Schedule “A” Settlement and Recovery Authority, has been revised to reflect the Board’s recent revisions in Article XI of the Authority Matrix.

AMENDED AND RESTATED

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

RISK MANAGEMENT

INSURANCE and SELF-INSURANCE PLAN

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TABLE OF CONTENTS

RECITALS 2

AGREEMENT 3

ARTICLE 1. GENERAL TERMS 3

1.1. Incorporation by Reference; Duration; Termination 3

1.2. Purposes 3

1.3. Manner of Financing 3

1.4. Conformity with Law 3

1.5. Authorizing Action 3

1.6 Reservation of Authority 3

1.7. Definitions 3

1.8. General Provisions 5

1.9. Power of Administrator 6

1.10. Disclaimer of Third Party Beneficiaries 6

ARTICLE 2. PROPERTY AND CASUALTY INSURANCE AND SELF-INSURANCE 6

2.1. Insurance 6

2.2. Powers and Duties of Administrator 7

2.3. Indemnification of Administrator 16

2.4. Designation of Administrator 16

2.5. Procurement Provisions 16

2.6. Counterparts 17

SCHEDULE A 18

2

h

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

RISK MANAGEMENT

INSURANCE and SELF-INSURANCE PLAN

This Maricopa County Special Health Care District (“District”) Risk Management Insurance and Self-Insurance Plan (“Plan”) dated and effective this ___ day of ____________ 20___, is established by the Maricopa County Special Health Care District and managed by the District’s Director of Risk Management or others as assigned by the District’s President and Chief Executive Officer.

RECITALS:

A. The insurance or self-insurance provided by the District (District) shall be extended to include its departments and employees, and volunteers and agents as authorized by the Plan Administrator, as further outlined in this Plan.

B. Insurance or bonds which may be procured includes, but is not limited to:

1. General, Vehicle, Environmental, and Directors and Officers Liability insurance;

2. Professional Liability (including medical malpractice) and Errors and Omissions Insurance;

3. Workers' Compensation and Employer's Liability Insurance; and

4. Property Insurance (including flood, crime, boiler and machinery, inland marine and builder's risk). C. This Plan shall cover District’s potential liability (including but not limited to vehicle liability, general

liability, medical malpractice, professional liability and errors and omissions, property damage, directors and officers liability, civil rights liability, and environmental liability).

D. The District’s Director Risk Management or designee is also authorized to do each of the following (collectively, the "Authorized Actions"):

1. In accordance with District contract and procurement rules, policies, and procedures, select risk management consultants or insurance brokers.

2. In accordance with District contracts and procurement rules, policies, and procedures, enter into contracts or agreements required for the management or administration of the Plan.

3. Establish terms and conditions of District' insurance, self-insurance or pooled coverage including limits and exclusions of coverage and the purchase of such policies.

4. Ensure that all claims adjusted and payable through the Plan are promptly resolved and paid.

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5. Take all necessary precautions to safeguard any Plan asset.

6. Establish Risk Management subsequent remedial measures or loss control and prevention programs to mitigate District claims or exposures, as more fully described herein.

E. District desires to establish this Plan to carry out the Authorized Actions.

F. Statutory references in this Plan shall refer to those statutes as they may have been or may be amended.

Accordingly, District agrees as follows:

AGREEMENT:

ARTICLE 1. GENERAL TERMS

1.1. Incorporation by Reference; Duration; Termination.

1.1.1. The foregoing Recitals are hereby incorporated by reference into this Plan as though fully set forth herein.

1.1.2. This Plan, as amended, shall continue until this Plan is terminated by District, which termination shall be effective by District President and Chief Executive Officer following approval by the Board of Directors. However, the termination of this Plan shall have no effect upon the existence, powers or other obligations of District.

1.2. Purposes. The purpose of this Plan is to carry out the Authorized Actions in furtherance of such purposes. District agrees to operate the Plan according to the terms and conditions set forth in this Plan.

1.3. Manner of Financing. The Plan may be funded by allocation of District funds and by monies recovered from litigation, statutory liens, recovery from insurers, subrogation and salvage value of damaged property, and interest earned on the funds held by the Plan. Additionally, the Plan may be funded through other available financial techniques and methods permissible under state or federal law.

1.4. Conformity with Law. If any term or provision of this Plan conflicts with or violates any state or federal law, as they now exist or are hereafter amended, this Plan shall be automatically deemed amended to conform to such laws and statutes. It is the intent of this Plan to afford the greatest possible protection to the District, its Officers, Directors, Employees and volunteers, and to the extent any provision is deemed to be unenforceable as a matter of law, it is to be construed in the broadest sense possible to effectuate that intent consistent with the laws of the State of Arizona or federal law, as may be applicable.

1.5. Authorizing Action. The Plan shall become effective May 25, 2017, 12:01 a.m.

1.6. Reservation of Authority. Nothing contained herein shall modify or restrict the legal or delegated obligations of District's President and Chief Executive Officer to administer and operate appropriate pooling, insurance or self-insurance programs for the District.

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1.7. Definitions.

1.7.1. "Administrator" means the District Director Risk Management or its designee.

1.7.2. "Board" or "Board of Directors" means the District’s Board of Directors.

1.7.3. “CEO" means District's President and Chief Executive Officer.

1.7.4. "Claims Committee" means the District’s Claims Committee that meets at least quarterly and District’s Claim’s Committee reviews potential or pending claims and approves claim and lawsuit settlements for money damages according to the attached Plan’s Schedule A. The Claims Committee is comprised of reports to the CEO. The Claims Committee membership shall consist of the CEO, the District Director of Risk Management or its designee, District Counsel, Chief Medical Officer, Chief Compliance Officer, Chief Operating Officer, Chief Nursing Officer, V.P. of Human Resources, and other staff (where appropriate) appointed to the Committee by the CEO. At least one member of the District Board of Directors selected by the Board shall serve on the Committee. The term of the Board Member(s) selected by the Board to serve on the Committee shall be for a three year term. The conduct of the Claims Committee is conducted under attorney-client privilege and attorney work product privilege. and such others as selected by the CEO.

1.7.5. Special Health Care District or “District” means the Maricopa County Special Health Care District.

1.7.6. "Department(s)" means any department, budgetary unit, board or commission of the District.

1.7.7. "Employees" mean all persons who are paid a wage or salary in accordance with official entries on District payroll, officers, Board of Director Members of District, subject to the limitations set forth herein in Section 2.2.1.5. Additionally, agents of District shall be deemed to be employees for purposes of this Plan if and to the extent coverage under the Plan is expressly promised to an agent (including District contractors) by written agreement approved by the Board or following review by CEO or/and written approval from the Administrator.

Additionally, volunteers who provide services to or on behalf of District shall be entitled to the benefits of and coverage under this Plan (except for Employee benefits or unemployment benefits) when acting pursuant to direction and under the control of authorized District department directors and if:

1.7.7.1. Said volunteers are deemed employees as provided in A.R.S. § 23-901.06; or

1.7.7.2. Said volunteers are participating in programs authorized or created pursuant to state or federal law and which the CEO or Administrator has approved or the Board has approved; or

1.7.7.3. Said volunteers are participating in programs authorized or created pursuant to

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CEO or Board approval; or

1.7.7.4. Said volunteers are participating in a program designed and administered by any District department and which has been reviewed and pre-approved, in writing, by the CEO or the Administrator.

1.7.7.5. As a condition precedent to coverage under this Plan, all volunteers and agents, and/or the organizations, entities or corporations to which they belong, when requested by the Administrator, shall participate in and shall cooperate fully with the Administrator and the Risk Management Department in an underwriting process designed by the Administrator to ensure that said volunteers and agents are qualified by competence and moral character to serve District. This mandatory participation is further governed by the provisions of Section 2.2.5.3. In furtherance of the underwriting process, the Administrator is authorized to establish and enforce mandatory minimum reporting standards, indemnity and liability and other insurance coverage limits for all volunteers, contractors, agents, and/or the organizations, entities or corporations to which they belong.

1.7.8. "Expenditures" means all disbursements made through the Plan for the management and administration of District pooled, insurance or self-insured retention program.

1.7.9. “District” means the Maricopa County Special Health Care District and its Maricopa Integrated Health System. The terms “District” and “MIHS” are synonymous with the Maricopa County Special Health Care District.

1.7.10."Plan" means the Maricopa County Special Health Care District Risk Management Insurance or Self-Insurance Plan.

1.7.11."Release" means any spilling, leaking, discharging , emitting, escaping or leaching of one or more contaminants or pollutants groundwater, surface water, surface soils, subsurface soils, as well as any definition of "release" arising out of applicable federal or state statute or regulation.

1.7.12. "Plan Member" is any entity covered under the provisions of this Plan.

1.8 General Provisions

1.8.1. The Plan shall comply with all federal, state and local laws, rules, regulations, standards and executive orders, without limitation to those designated within this Plan. The laws and regulations of the State of Arizona shall govern the rights of the parties, the performance of this Plan and the resolution of any disputes thereunder. Any action relating to this Plan shall be brought in an Arizona court. Any changes in the governing laws, rules and regulations applicable to this Plan during the term of this Plan shall apply to this Plan but such changes shall not require an amendment to this Plan.

1.8.2. The Plan shall not discriminate against any individual in any way on account of such individual's race, color, religion, sex, age, disability, national origin, or ability to pay.

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1.8.3. The financial activities, management, trending information and business affairs of the Plan shall be managed effectively and efficiently with reports submitted annually or as otherwise requested by the CEO or the Board of Directors.

1.8.4. The Plan shall be subject to District budget, financial and audit rules.

1.8.5. This Plan, including schedules attached hereto, shall constitute the entire Plan and supersede all other understandings, oral or written. This Plan may be amended, or modified or dissolved only by the CEO and the Board of Directors.

1.8.6. The Administrator shall meet no less than quarterly with the District Counsel, Chief Medical Officer, Chief Nursing Officer, Chief Compliance Officer, V.P. for Human Resources, and the Chief Financial Officer to review all claims and lawsuits. All meetings shall be conducted under attorney-client privilege and attorney work product privilege.

1.9. Power of Administrator. The Administrator shall establish necessary policies, rules, and procedures to enable the Plan to do all such lawful acts and Authorized Actions which are permitted by statute, District Policies and by this Plan. Unless otherwise directed by the CEO or the Board of Directors, the Administrator may, do all of the following:

1.9.1. Adopt policies, rules and procedures for the administration of the Plan; provided, however, that such policies, rules and procedures may not be inconsistent with the provisions of this Plan, District Policies or applicable state and federal law and regulations.

1.9.2. Retain the services of adjusters and other claim related services, actuaries, auditors, engineers, private consultants, and advisors as the Administrator deems necessary in order to carry out the business and purposes of the Plan. The Administrator shall seek legal advice concerning the Plan and the administration of the Plan and its related policies and procedures from or through the District Counsel. In the event that the District Counsel cannot provide legal advice, due to conflict of interest District Counsel will retain outside counsel.

1.9.3. Authorize the payment of consultants; insurance premiums; costs of claim investigation, defense, and settlement (up to the limit established in Schedule attached hereto); and such other costs as are necessary to carry out the conditions of the Plan.

1.9.4 The financial activities, management, loss development factors, trending information, and business affairs of the Plan will be managed effectively and efficiently, with reports submitted to the Board annually, or as otherwise requested by the CEO or the Board of Directors.

1.10. Disclaimer of Third-Party Beneficiaries. Nothing in this Plan is intended to confer the status of third-party beneficiary on any person or entity.

ARTICLE 2. PROPERTY AND CASUALTY INSURANCE OR SELF-INSURANCE

2.1. Insurance. This Plan authorizes District to pool, self-insure or procure insurance, or all three, for any of the following types of insurance. The pool, insurance or self-insurance provided by District shall be

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extended to include its Directors, Officers, Departments and Employees, as further outlined in this Plan, which may include, but is not necessarily limited to, the following:

2.1.1. Property insurance (including flood, crime, boiler and machinery, inland marine and builder's risk),

2.1.2. Bonds,

2.1.3. Professional liability insurance (including medical malpractice) and Errors or Omissions,

2.1.4. Directors and Officers liability insurance,

2.1.5. Vehicle liability and vehicle physical insurance,

2.1.6. Workers' Compensation and employer's liability insurance, or

2.1.7 General Liability, including Privacy, Data Breach and Security (Information) liability insurance.

2.2. Powers and Duties of Administrator.

2.2.1. The Administrator shall establish, manage and administer a program to finance the risk of loss arising from (a) property, workers' compensation and liability losses, claims, costs and expenses, and (b) environmental impairment liability and associated losses, claims, costs and expenses. The Administrator shall exercise the Administrator's judgment to procure insurance from any insurer, pool, risk retention group, or captive to establish insurance, deductible or self-insured retention programs; to combine self-insured retention programs and procurement of insurance; or any combination of the foregoing. If a large deductible or self-insured retention is maintained, the Administrator shall establish adequate and appropriate reserves, which may include an allowance for claims incurred but not reported, for any claims made against District and which are covered by this Plan. Any program established by the Administrator shall conform to the provision of this Plan and applicable law to insure:

2.2.1.1. All appropriate District-owned or leased buildings or structures, or buildings in which District has an insurable interest, subject to the Plan per claim property deductible as established by the Administrator.

2.2.1.2. Contents or equipment in any buildings or structures owned, leased or rented, in whole or in part, by District, and reported to the Administrator, subject to the Plan per claim property deductible as established by the Administrator.

2.2.1.3. Expense incurred for restoration of operations, loss of revenue from interruption of District business due to direct physical loss or damage to real or personal property, loss of rental proceeds, or loss resulting from the inability of District to effect collection of revenue as a result of the direct loss or damage to records of revenue accounts receivable, subject to the Plan per claim property deductible as

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established by the Administrator.

2.2.1.4. District, and its Directors, Departments, and Employees thereof and such others as may be necessary to accomplish functions or business of District and its Departments, against liability for acts or omissions of any nature while acting in authorized District capacities and in the course and scope of employment or authorization except as otherwise prohibited by this Plan. For purposes of third-party liability claims only, an Employee shall be considered to be acting within the course and scope of his or her employment whenever operating a District-owned or rented vehicle in accordance with applicable District and departmental policies and procedures including the operation of District-owned vehicles while commuting between the Employee's work station and residence, or other location authorized under District policy and by the Employee's department director.

2.2.1.5. Professional medical liability insurance coverage shall extend as follows:

2.2.1.5.1. Physician employees, nurse employees, and other health care provider employees who provide health care services at any District owned or operated health care facility;

2.2.1.5.2. Any dental student, medical student, resident or individual enrolled and participating in an American Dental Association (ADA) Commission of Dental Accreditation, Accreditation Council for Graduate Medical Education (ACGME) approved District training program, or Graduate Medical Education Committee approved training or residency program, which is operating at a District-owned or operated facility or in an approved District residency or training program which as part of its curriculum conducts rotations to a non-District health care facility that has been approved by District. However, if such non-District health care facility maintains liability insurance, including but not limited to professional liability insurance coverage, the insurance maintained by the non-District health care facility shall be primary coverage, and the insurance or self- insurance provided by the terms of this Plan shall be excess and non-contributory liability coverage only;

2.2.1.5.3. Attending physicians, dentists and other health care providers who, by the terms of a contract with District or following review by and written pre-approval from the Administrator or the CEO, are to be provided general liability and/or professional liability insurance coverage for their professional health care services to patients in a District-owned or operated facility. However, if such attending physicians, dentists and other health care providers, maintain liability insurance, including general liability and/or professional liability insurance, such insurance shall be considered primary coverage, and the insurance or self-insurance provided by the terms of this Plan shall be considered excess

9

and non-contributory liability coverage only;

2.2.1.5.4. Attending physicians, dentists and other health care providers who, by the terms of a contract with District or following review by and written pre-approval from the Administrator or the CEO, provide direct supervision and training to a dental student, medical student, resident or individual enrolled in an approved District training program at a District- owned or operated, or at a non-District health care facility which has been approved by District. However, such contract must require District to provide the attending physicians, dentists and other healthcare providers general liability or professional liability insurance, and if such attending physicians, dentists and other health care providers maintain liability insurance, including general liability and/or professional liability insurance coverage, such insurance shall be considered primary, and the pool, insurance or self- insurance coverage provided by the terms of this Plan shall be considered excess and non-contributory coverage only;

2.2.1.5.5. Any contract, agreement, or provision that attempts to provide for or enlarge the scope of the property, workers' compensation, vehicle liability, general liability, or professional liability insurance coverage as set forth above, without the prior written pre-approval of the Board, CEO or Administrator, shall be null and void as respect to this Plan.

2.2.1.6. All personal property reported to the Administrator, including vehicles, owned by the District, and all non-owned personal property which is under the legal responsibility of District because of written leases or other written agreements, or policies and procedures adopted by District, subject to the Plan per claim property deductible as established by the Administrator.

2.2.1.7. Workers' compensation and employer's liability as prescribed by Title 23 of the Arizona Revised Statutes.

2.2.1.8. Other exposures to loss where insurance may be required to protect District, and its Departments, and Employees acting in the course and scope of employment or authorization except as otherwise prohibited by this Plan.

2.2.1.9. For purposes of Sections 2.2.1.4 and 2.2.1.7 above, the term “Employee” shall not include agents of District where the term of such agency precludes Plan coverage, and/or District liability for Employee benefits, unemployment benefits, workers' compensation benefits, or acts or omissions of such agents, or where such agents are deemed independent contractors.

2.2.1.10. For environmental impairment liabilities:

2.2.1.10.1. Any action necessary in the investigation, response, abatement,

10

removal, and other corrective activities, as legally required by applicable federal or state statutes, rules or regulations governing the release of contaminants or pollutants into groundwater, surface water, surface soils, subsurface soils or air;

2.2.1.10.2. The cleanup of contaminants or pollutants pursuant to a written order from a court of competent jurisdiction, or a federal or state agency having jurisdiction over rules, regulations or statutes requiring corrective action from District;

2.2.1.10.3. Payment of the costs incurred in the removal or remediation of contaminants or pollutants; and

2.2.1.10.4. Monetary awards or settlements of compensatory damages arising from claims District is legally obligated to pay as a result of the release of contaminants including the investigation and defense of any claim or lawsuit A claim or lawsuit includes a notice or lawsuit from a federal or state agency having jurisdiction over the release of contaminants or pollutants into groundwater, surface water, surface soils, subsurface soils or air.

2.2.1.11. When in the discretion of the Administrator, Upon consultation with the Chief Medical Officer, the Chief Nursing Officer or the Vice President for Human Resources, and District Counsel, a pending disciplinary or licensure procedure before a professional licensing or regulatory body that has been brought against any licensed District employee professional that has the potential to adversely affect the District’s potential liability, the Administrator may authorize the District’s expenditure for reasonable attorneys’ fees and reasonable costs, not to exceed an annual amount of $50,000 in the defense of a licensed District employed professional arising out of a disciplinary or licensure proceeding before a professional licensing or regulatory body.

If the Administrator, upon consultation with the Chief Medical Officer, the Chief Nursing Officer, the Vice President for Human Resources and District Counsel, subsequently determines that the licensed professional is not the prevailing party at the conclusion of the disciplinary or licensure proceeding, then the Administrator may seek reimbursement from the District employed licensed professional of all reasonable attorneys’ fees and reasonable costs paid by the Plan on behalf of the District employed licensed professional if the Administrator determines that to do so would be in the best interest of the District or the Plan.

11

2.2.1.12

In no event shall the District have an obligation to advance or reimburse such costs to a District employed professional where the employee has been disciplined or dismissed from District employment, regardless of the basis for the discipline or dismissal, pursuant to a documented review and disciplinary process.

The reasonable attorneys' fees and reasonable costs, not to exceed an annual amount of $50,000, of a licensed District employed professional arising out of a disciplinary or licensure proceeding before a professional licensing or regulatory body. If the Administrator, following approval by the Chief Medical Officer, the Chief Nursing Officer, and the Vice President for Human Resources determines that the licensed District employed professional is the prevailing party at the conclusion of the disciplinary or licensure proceeding, then the Administrator may reimburse the licensed District employed professional for reasonable attorneys' fees and reasonable costs in excess of the annual cumulative amount of $50,000 limit.

If the Administrator, in conjunction with the Chief Medical Officer, the Chief Nursing Officer, and the Vice President for Human Resources, subsequently determines that the licensed professional is not the prevailing party at the conclusion of the disciplinary or licensure proceeding, then the Administrator may seek reimbursement from the District employed licensed professional all reasonable attorneys' fees and reasonable costs paid by the Plan on behalf of the District employed licensed professional if the Administrator determines that to do so would be in the best interest of District or the Plan.

2.2.2. Disbursements to be made for and on behalf of the District for payment of any and all expenditures necessary to establish and to operate and administer the Plan including but not limited to the following:

2.2.2.1. To pay any and all valid claims and related expenses made against District for the risks of liability, property, professional or casualty loss, including workers' compensation loss, provided under the terms of this Plan;

2.2.2.2. To pay, subject to the Plan per claim property deductible as established by the Administrator, upon such terms and conditions as are deemed appropriate and proper, the cost arising from claims for the restoration or replacement of property, the removal of any debris resulting from the loss of property, and the loss of District income arising from the damage to property;

2.2.2.3. To pay, upon such terms and conditions as are deemed appropriate and proper, the legal claims, settlements or judgments, including pre-judgment and/or post-judgment interests, arising from lawful claims of liability that are the obligation of District;

12

2.2.2.4. To pay, upon such terms and conditions as are deemed appropriate and proper, the claims resulting from injuries to District workers or volunteers that would be covered under the terms of the Plan and Title 23 of the Arizona Revised Statutes.

2.2.2.5. To pay all costs and expenses of Plan administration;

2.2.2.6. To pay all legal fees, expenses and costs incurred in connection with the administration of the Plan including costs and fees necessary to pursue subrogation, defense, indemnity, and coverage as an ancillary matter to claims under the Plan;

2.2.2.7. Subject to 2.2.1.12, to pay all costs of investigations and legal defense of claims, including, but not limited to, the attorneys' fees and costs arising out of a disciplinary or licensure proceeding before a professional licensing or regulatory body;

2.2.2.8. To pay all actuary expenses and costs incurred in connection with the administration of the Plan;

2.2.2.9. To pay all consultant expenses and costs incurred in connection with the administration of the Plan;

2.2.2.10. To pay all audit expenses and costs incurred in connection with the administration of the Plan;

2.2.2.11. To pay all risk management consultant and insurance broker's fees and costs incurred in connection with the administration of the Plan;

2.2.2.12. To pay such other expenses including third-party administration bill review or database fees as may be necessary in connection with the administration of the Plan;

2.2.2.13. To settle claims of liability, when such claims are justly due and owing and are covered by this Plan, in an amount up to the limits established in Schedule A attached hereto;

2.2.2.14. To establish reserves for any and all valid claims for corrective action necessary in the response, abatement, investigation, remediation and removal activities resulting from the release of contaminants or pollutants that are the obligation of District;

2.2.2.15. To establish reserves for any and all valid claims for legal liability arising from the release of contaminants or pollutants that are the obligation of District;

2.2.2.16. To pay, upon such terms and conditions as deemed appropriate and proper, the costs arising from claims for corrective action necessary in the response, abatement, investigation, or remediation and removal activities resulting from release of contaminants or pollutants that are the obligation of District;

13

2.2.2.17. To pay proper claims, settlements or judgments, including pre- judgment and/or post-judgment interest, arising from the release of contaminants or pollutants that are the obligation of District;

2.2.2.18. To pay for taking corrective action and for compensating third- parties for bodily injury and property damage caused by accidental releases arising from the operation of petroleum underground storage tanks; and

2.2.2.19. To pay all insurance premiums and costs incurred as the result of the purchase of insurance, bonds, or other programs and plans which insures or bonds District, its Directors, Departments, and Employees against costs for lawful environmental impairment claims that are the obligation of District.

2.2.3. To pay for the defense of claims for workers' compensation, liability, or for environmental impairment liability against District.

2.2.3.1. District Counsel in collaboration with the Administrator shall appoint counsel to provide for the defense of District, the Board and its Directors, Departments, and Employees, and such others for whom this Plan may provide defense and/or indemnification on account of their acts or omissions.

2.2.3.2. To reject in whole or in part, or to settle or compromise (within the limits of authority set forth in Schedule A to this Plan), any claim made by any Employee or third party against District. The Administrator is authorized to -delegate all or any portion of said authority to District adjustors, claim analysts or District employees who report to the Administrator, and any such delegation of authority shall survive any vacancy of the Office of the Administrator.

2.2.3.3. To determine, in the exercise of the Administrator's best judgment, whether an offer to compromise and settle a claim has sufficient merit and/or to make a recommendation with regard to the proposed compromise and settlement.

2.2.3.4. The authority to issue a reservation of rights letter in conjunction with District Counsel whenever a claim or lawsuit is presented for which the issuance of such a letter is deemed appropriate. When issuing a reservation of rights letter, the Administrator is authorized to differentiate between the defense and the indemnification of a claim or lawsuit if, in the Administrator's sole discretion, such a differentiation would be in the best interest of District or the Plan. The authority to issue a denial of coverage letter whenever a claim or lawsuit is presented for which the issuance of such a letter is deemed appropriate. The Administrator may independently or collectively consult as the Administrator may deem appropriate in any given situation before the issuance of a reservation of rights or a denial of coverage.

2.2.4. EXCLUSIONS FROM COVERAGE: The coverage provided under the provisions of the Plan does not apply to loss, costs, claims, litigation expenses, or expenses listed below:

14

2.2.4.1. Arising from any expenditure for any purpose not specified in the Plan.

2.2.4.2. Arising from fines, assessments, penalties, punitive, exemplary, or treble damages, unless written approval has also obtained from the CEO or Administrator prior to payment. In determining whether to pay such losses, costs, claims, litigation expenses, damages or other expenses, the CEO and Administrator, in their sole discretion, may consider any or all of the following non-exclusive factors: (1) whether the statutory immunities afforded public entities and public employees under A.R.S. § 12-820 et seq. are applicable, (2) whether the adverse judgment or settlement is predicated upon an act or omission of any employee or former employee, agent or former agent, volunteer or former volunteer, acting within the course and scope of his or her employment as an Employee of District, or within the course and scope of his or her agent or volunteer duties and responsibilities while serving District ; (3) whether the employee or former employee, agent or former agent, volunteer or former volunteer, at the time of the act or omission giving rise to the liability, acted or failed to act in good faith and without actual malice and in the apparent best interest of District; (4) whether appointed counsel contributed in any way to the adverse judgment or settlement; (5) whether the jury or other fact finder contributed in any way to the adverse judgment or settlement; (6) whether any other factor suggests that payment of the adverse judgment or settlement would be in the best interest of District or the Plan. The CEO and Administrator's consideration of the foregoing factors is independent of whether or not a reservation of rights letter has been issued.

2.2.4.3. Arising from an act or omission determined by a court having jurisdiction to be a violation of Arizona Revised Statutes Titles 13 or Title 28. Notwithstanding the prior sentence, , as to the offending party if in the discretion of the CEO and Administrator, subject to Board approval, may provide indemnification of the offending party if to not do so would violate public policy and be inconsistent with the interests of the District. , provided however, Any exclusion under this provision shall not operate to preclude coverage for the District, its Officers, Directors or Employees for their vicarious liability, if any, or alleged negligence associated with supervision, retention or employment of the offending party. and 28, or a violation of any other federal, state or local law or ordinance which allows the imposition of criminal penalties. Any acts or omissions which may reasonably be characterized as a violation of the above-referenced laws are also excluded from coverage under the Plan, provided however, that the. The Plan may pay for the costs, including reasonable attorneys' fees, of investigating and defending against any such claims upon the following conditions: (1) upon approval of the Administrator; and (2) when incurred prior to entry of judgment of guilt or entry of a guilty plea or entry of a no contest plea to a violation of the above-referenced laws, whichever shall first occur; provided however that the Administrator shall have the right to recover all costs and fees expended upon

15

investigation and defense of any claims which result in a conviction or plea of guilty or no contest from the offending party.

2.2.4.4. Arising from a default of or breach of contract or agreement entered into with third-parties by District, its Directors, Department, or Employees, unless the default or breach is related to conduct or matters covered by the Plan.

2.2.4.5. Arising from any routine maintenance costs necessary for the reconstruction, repair, restoration, replacement, upgrading, or rebuilding of any District- owned (a) storage facility necessary for the storage of materials that may be considered as contaminants or pollutants; (b) buildings or structures or buildings or structures in which District has an insurable interest as determined by the Administrator, as set forth in Section 2.2.1.1; (c) contents in any buildings or structures owned, leased or rented, in whole or in part, by or to District, and reported to the Plan, as set forth in Section 2.2.1.2; (d) property, for which a claim has been for restoration or replacement thereof, as set forth in Section 2.2.2.2.

The intent of these exclusionary clauses is to exclude from Plan coverage the routine maintenance costs arising from (1) ordinary wear and tear or depletion; (2) rust, corrosion, erosion, mold, mildew, wet or dry rot; (3) settling, cracking, shrinking, bulging or expansion; (4) routine maintenance and upkeep; and (5) use of equipment or property specifically designed for hazardous operations and/or reasonably likely or foreseeable to incur damage or destruction.

2.2.4.6. Arising out of Maricopa County Special Health Care District Merit System. , except that non-coverage is limited to: 1) compensation of any hearing officer; 2) compensation of any court reporter(s) and costs of transcripts; 3) compensation of any persons who administer or provide administrative support service to the Merit System.

2.2.4.7. Arising from intentional and willful/wrongful act(s) of an Employee, provided, however that this shall not operate to exclude coverage for any Officer, Director, or Employee as to alleged independent negligence or vicarious liability (if any) for the conduct of the offending Employee.

2.2.4.8. Any costs of mandated or remedial programs, services and/or the alteration or construction of facilities necessary to comply with or fulfill the requirements of federal, state or local laws, regulations, or judgments/decrees arising out of any court of competent jurisdiction.

2.2.4.9. Arising from judicially or administratively imposed or mandated costs for wages, benefits or penalties arising out of employment or agency relationships with District.

2.2.4.10.For third-party liability claims arising from an Employee's use of a District- owned or rental vehicle contrary to District policy or procedure to the extent

16

consistent with Arizona’s mandatory financial responsibility law.

2.2.5. The coverage provided under the provisions of this Plan shall be subject to the following conditions:

2.2.5.1. In the event of a claim covered under the terms of this Plan, written notice containing particulars sufficient to identify the type of claim must be filed as required by A.R.S.§12-821.01 or shall be submitted in a manner otherwise allowed by law.

2.2.5.2. If a claim is made or suit is brought against the Board, a Director, Department, Employee, agent, volunteer or other person or entity covered by the terms of this Plan, the Director, Department, Employee, agent, volunteer or other person or entity shall promptly forward to the Administrator every demand, notice, summons, complaint, claim or other process received by the covered party or its representative. Failure to promptly forward to the Administrator every demand, notice, summons, complaint, claim or other process received may result in denial of coverage by the Plan, in the sole discretion of the Administrator. All claims of any kind made by or suits brought by a Director, Department, Employee, agent, volunteer or other person or entity covered by the terms of this Plan likewise shall be promptly forwarded to the Administrator. Failure to promptly forward to the Administrator every such demand, notice, summons, complaint, claim or other process may result in denial of coverage by the Plan, in the sole discretion of the Administrator.

2.2.5.3. The Administrator, in consultation with District Counsel, shall manage the investigation, settlement or defense of any claim made or suit brought or proceeding instituted against a party covered by the terms of this Plan, and any party covered by the terms of this Plan shall cooperate fully with the Administrator, Administrator's designee, and counsel appointed by the Administrator in the defense of claims or suits or other proceedings covered under the Plan; the appointed counsel also shall cooperate fully with the Administrator, Administrator's designee, and District Counsel; the failure of a covered party to fully cooperate in the administration, investigation and defense of any claim or suit or other proceeding, , may result in the loss of coverage under this Plan; the failure of appointed counsel to fully cooperate in the administration, investigation and defense of any claim or suit or other proceeding, or the failure of appointed counsel to honestly and competently represent the covered party, as determined by the Administrator after consultation with District Counsel, shall result in the termination of the appointment and reassignment of the defense of the claim or suit or other proceeding to new counsel.

2.2.5.4. In the case of a District Board Member, Employee or Director operating his or her private vehicle on District business, if valid and collectible personal or

17

commercial insurance is available to a party covered by the terms of this Plan that covers a loss also covered by this Plan, other than insurance that is written specifically for or in excess of coverage afforded by the Plan, the coverage afforded by this Plan shall be excess of and shall not contribute with such other insurance. Nothing contained in the terms of this Plan shall be construed to make the Plan subject to the terms, conditions and limitations of any other insurance.

2.2.5.5. No Director, Department, or Employee thereof may purchase insurance as a District charge or payment that is primary, contributing, or excess of coverage provided by this Plan without the express prior written approval of the Administrator.

2.2.5.6. Any loss payable for damage to property or contents of District will only be payable, subject to the Plan per claim property deductible established by the Administrator, upon the restoration or replacement of the property. The Plan shall not be obligated to compensate any Department, Employee, volunteer or agent of District if property covered by the terms of this Plan is damaged but is not restored or replaced.

2.2.5.7. The Administrator shall establish a policy and program for Subsequent Remedial Measures or loss control and prevention for non-clinical departments to reduce or eliminate the frequency and severity of loss and claims to District physical and financial assets and human resources. The loss control and prevention program may:

2.2.5.7.1. In collaboration with appropriate non-clinical departments conduct surveys of District facilities and operations to assist in hazard identification, analysis and mitigation;

2.2.5.7.2. Assist in formation of Environmental Safety or loss control and prevention committees as a deterrent to loss; severity and implement techniques to mitigate such losses; control and prevention.

2.2.5.7.3. Assist in identification of the causes of loos frequency and severity and implement techniques to mitigate such losses;

2.2.5.7.4. Implement any additional programs which will foster loss control and prevention.

2.2.5.7.5. Subsequent Remedial Measures Program (Non-Clinical Departments Only): all non-clinical Department(s), their Employees, and volunteers and other individuals whose conduct causes District to establish a claim indemnity reserve of $50,000 or more, or to pay $50,000 or more by settlement or judgment, shall participate in and shall cooperate fully in the Subsequent Remedial Measures Program implemented by the Administrator, which are authorized to conduct all reasonably

18

necessary audits for compliance and related loss control/risk management programs, and to seek compliance with the Subsequent Remedial Measures Program. The Administrator may include in the Subsequent Remedial Measures Program matters valued below the $50,000 threshold if, in the Administrator's discretion, such inclusion is in the best interests of District or the Plan.

2.3. Indemnification of Administrator. District shall indemnify, defend and hold harmless the Administrator from and against all claims and liabilities, to the same extent that any other District Employee is indemnified under the terms of this Plan and to the extent permitted by law.

2.4. Designation of Administrator. District Director of Risk Management is the Administrator of the Plan. The Administrator shall be responsible for the operation and management of the Plan as outlined herein.

2.5. Procurement Provisions. All purchases of the Plan, except for claim related medical and rehabilitative services, sub-rosa services, legal fees or services in defense of claims under the Plan, purchases of commercial or excess insurance, surety bonds, appeal or other types of bonds, single premium immediate or deferred annuities and structured settlement annuities, and any other insurance or self-insurance listed in Recitals A, B, C, and D of this Plan acquired by a broker of record or otherwise for District, shall comply with District’ Procurement Code. Bids and specifications shall be issued in sufficient time and detail to permit free competition. Any and all bids or proposals may be rejected by the Administrator with the concurrence of District Director of Procurement if it is determined that rejection is in the best interest of District or the Plan. Payment for materials and services contracted for by the Plan shall be the exclusive obligation of District.

2.6. Counterparts. This Plan may be executed in several counterparts, all of which together shall be considered an original.

Stephen A. Purves, FACHE Susan Gerard President & Chief Executive Officer Chairman, Board of Directors Maricopa Integrated Health System Maricopa County Special Health Care District

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SCHEDULE A

Settlement and Recovery Authority

For purposes of this Schedule A, a "claim" means the demand or demands for compensation or money damages made by any one individual claimant, person, corporation or other legal entity which (a) arise(s) from a single incident or related set of circumstances, and (b) is/are compensable under the provisions of this Plan. The provisions of A.R.S. § 12-612 notwithstanding, each claimant and statutory beneficiary in a wrongful death action shall be considered as having an individual "claim" for compensation for damages.

a. Director Risk Management/Administrator or their designee: (1) Any claim covered by this Plan up to and including $99,999.99 ; (2) any property damage and vehicle physical damage claims up to and including the amount of the deductible or in excess of any District-purchased property or vehicle insurance policy in effect when the loss occurs; (3) prosecution, compromise and recovery of all subrogation, restitution, salvage, workers' compensation and related medical lien claims up to and including $99,999.99 ; and (4) implementation and enforcement of loss of use policy for recovery of vehicle-related losses from third-parties up to and including $99,999.99.

b. Claims Committee: Any claim covered by this Plan in excess of $100,000 99,999.99 and up to and including $500,000 $250,000.

c. Board of Directors: Any claim covered by this Plan in excess of $500,001 $250,001.

Maricopa County



May 24, 2017

Item 1.c.iv.

Governance Texas Medicaid Healthcare Partnership

1

Melanie Talbot

From: Compliance 360 <[email protected]>Sent: Thursday, May 11, 2017 4:18 PMTo: Melanie TalbotSubject: Contract Approval Request: Provider Enrollment Application for Texas Medicaid

Healthcare Partnership Texas Medicaid Healthcare Partnership

Message Information

From Purves, Steve To Talbot, Melanie;

Subject Contract Approval Request: Provider Enrollment Application for Texas Medicaid Healthcare Partnership Texas Medicaid Healthcare Partnership

Additional Information

Indicate whether you approve or reject by clicking the Approve or Reject button. Add comments as necessary.




Status Pending Approval Title Provider Enrollment Application for Texas Medicaid Healthcare Partnership

Contract Identifier Board - New Contract MIHS Contract

Number 99004 G


Departments BUSINESS OFFICE Product/Service

Description Provider Enrollment Application for the Texas Medicaid Healthcare Partnership Program

Action/Background Approve the submission of an application to the Texas Medicaid Healthcare Partnership to participate in the Texas Medicaid program as an out-of-state provider of healthcare services. Pursuant to Board Policy 99004 G, Collection Efforts: "If services are provided to a patient that is covered by, or qualifies for, an out-of-state Medicaid program that MIHS does not contract with, MIHS staff will obtain an application to register as a qualified provider. The provider application will be forwarded to the Board of Directors. The Board of Directors will approve or deny the request for submission of the provider application on a case-by-case basis." MIHS currently has an outstanding balance of $13,762.06 for a Texas Medicaid recipient. Before MIHS can submit a claim for services rendered, the application to become an out-of-state provider must be submitted and approved by the Texas Health and Human Services Commission ("HHSC) and the claims contractor Texas Medicaid & Healthcare Partnership ("TMHP"). Upon Board

2

approval, staff will submit the application to HHSC and TMHP for their review and subsequent approval prior to submitting the claim for payment.

Evaluation Process Notes

Category Effective Date 5/24/2017

Expiration Date 5/24/2018 Annual Value $0.00

Expense/Revenue Revenue Budgeted Travel

Type Yes

Procurement Number

Primary Vendor Texas Medicaid Healthcare Partnership

Responses

Member Name Status Comments Gorman, Louis B. Approved Benaquista, Kathleen F. Approved Purves, Steve A. Approved Talbot, Melanie L. Current

Maricopa County



May 24, 2017

Item 1.c.v. No Handout

Governance

Petition for Appointment of Permanent Guardianship and Temporary

Conservator

Maricopa County



May 24, 2017

Item 1.d.i.

Medial Staff Medical Staff Appointments for

May 2017

Recommended by Credentials Committee: May 2, 2017 Recommended by Medical Executive Committee: May 9, 2017 Submitted to MSHCDB: May 24, 2017

1 of 3

MARICOPA INTEGRATED HEALTH SYSTEM

CREDENTIALS AND ACTION ITEMS REPORT MEDICAL STAFF

The credentials of the following individuals including, current licensure, relevant training and experience, malpractice insurance, current competence and the ability to perform the requested privileges have been verified.

INITIAL MEDICAL STAFF APPOINTMENT NAME CATEGORY DEPARTMENT/SPECIALTY APPOINTMENT DATES COMMENTS

Dirk S. Gesink, M.D. Active Orthopedic Surgery 6/01/2017 to 5/31/2019

Michael A. Sochacki, M.D. Active Orthopedic Surgery 6/01/2017 to 5/31/2019

INITIAL/FOCUSED PROFESSIONAL PRACTICE EVALUATION

NAME DEPARTMENT/SPECIALTY RECOMMENDATION EXTEND or PROPOSED STATUS

COMMENTS

Philip David Adelson, M.D. Surgery (Pediatric Neurosurgery) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Neurosurgery Core Privileges.

Ruth E. Bristol, M.D. Surgery (Pediatric Neurosurgery) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Neurosurgery Core Privileges.

Alexzandra K. Hollingworth, M.D. Surgery (Surgical Critical Care) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for General Surgery Core Privileges, Advanced Trauma Surgery Core Privileges.

Barry M. Krumholz, M.D. Surgery (Urology) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Urology Core Privileges.

Marisse Lardizabal, D.P.M. Surgery (Podiatric Surgery) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for ORIF, OR EX FIX, of Ankle Fractures And/Or Charcot Reconstruction Privileges and 1 of 2 cases submitted for Advanced Podiatric Medicine & Surgery and will maintain ongoing monitoring for 2nd case.

Ericka L. Scheller McLaughlin, D.O. Pediatrics (Cardiology) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Pediatric & Adolescent Cardiology Privileges.

David H. Shafron, M.D. Surgery (Pediatric Neurosurgery) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Neurosurgery Core Privileges.

Madhia Shahid, M.D. Pediatrics (Endocrinology) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Pediatric & Adolescent Endocrinology Privileges.

Zola N. Trotter, M.D. Pediatrics (Emergency Medicine) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Procedural Sedation.


2 of 3

REAPPOINTMENTS NAME CATEGORY DEPARTMENT/SPECIALTY APPOINTMENT DATES COMMENTS

Gretchen B. Alexander, M.D. Active Psychiatry 6/01/2017 to 5/31/2019

Erum N. Ali, M.D. Active Psychiatry 6/01/2017 to 5/31/2019

Georgetta C. Bidwell, M.D. Courtesy Internal Medicine (Nephrology) 6/01/2017 to 5/31/2019

Timothy Scott Davie, M.D. Active Emergency Medicine 6/01/2017 to 5/31/2019

Patrick H. David, M.D. Active Anesthesiology 6/01/2017 to 5/31/2019

Celsius-Kit Jara Gesmundo, M.D. Active Psychiatry 6/01/2017 to 5/31/2019

Maryam Helen Hazeghazam, M.D. Active Psychiatry 6/01/2017 to 5/31/2019

Kaveh Homayoon, M.D. Active Surgery (Urology) 6/01/2017 to 5/31/2019

William T. Johnson, M.D. Active Anesthesiology 6/01/2017 to 5/31/2019

John S. Kingsley, M.D. Active Psychiatry 6/01/2017 to 5/31/2019

Barry M. Krumholz, M.D. Courtesy Surgery (Urology) 6/01/2017 to 5/31/2019

Maher Mousa, M.D. Active Internal Medicine (Nephrology) 6/01/2017 to 5/31/2019

Randy W. Oppenheimer, M.D. Active Surgery (Otolaryngology) 6/01/2017 to 5/31/2019

Yvonne L. Patterson, M.D. Courtesy Internal Medicine 6/01/2017 to 5/31/2019

Kamala Premkumar, M.D. Active Psychiatry 6/01/2017 to 5/31/2019

Matthew Donald Skinner, M.D. Courtesy Internal Medicine 6/01/2017 to 5/31/2019

Christina Marie Smarik, M.D. Active Family & Community Medicine 6/01/2017 to 5/31/2019

Shabnam Sood, M.D. Active Psychiatry 6/01/2017 to 5/31/2019

Jeffrey Randal Stowell, M.D. Active Emergency Medicine 6/01/2017 to 5/31/2019

Tina L. Younger, M.D. Active Internal Medicine/Pediatrics 6/01/2017 to 5/31/2019

CHANGE IN PRIVILEGES

NAME DEPARTMENT/SPECIALTY ADDITION / REVISION/ REDUCTION / WITHDRAWAL COMMENTS Timothy Scott Davie, M.D. Emergency Medicine Addition: Procedural Sedation Privileges Unsupervised

Pedro Jose Roque, M.D. Emergency Medicine Addition: Procedural Sedation Privileges Unsupervised

Lara Nicole Ulm, M.D. Pediatrics Withdrawal:Procedural Sedation Privileges Voluntary Relinquishment of Privilege due to non-utilization of privilege.

STAFF STATUS CHANGE NAME DEPARTMENT CHANGE FROM/TO COMMENTS*

Sheetal Shah, D.O. Internal Medicine Courtesy to Active Increase in hours


3 of 3

RESIGNATIONS Information Only

NAME DEPARTMENT/SPECIALTY STATUS REASON

Peter J. Baron, M.D. Pediatrics (Cardiology) Courtesy to Inactive Resigned (Effective 05/24/2017)

David Christian Chapman, M.D. Pediatrics Courtesy to Inactive Resigned (Effective 05/24/2017)

Kathryn Therese Donesa-Zuzak, M.D. Family & Community Medicine Active to Inactive Resigned (Effective 05/24/2017)

Vinodh Narayanan, M.D. Pediatrics Courtesy to Inactive Resigned (Effective 05/24/2017)

Leslie Touger, M.D. Pediatrics Courtesy to Inactive Resigned (Effective 05/24/2017)

Babak Bakhtiari Yekta, M.D. Emergency Courtesy to Inactive Resigned (Effective 05/24/2017) Definitions: Active > 1,000 hours/year – Active members of the medical staff have voting rights and can serve on medical staff committees Courtesy < 1,000 hours/year – Courtesy members do not have voting rights and do not serve on medical staff committees Reappointments Renewal of appointment and privileges is for a period of two years unless otherwise specified for a shorter period of time. FPPE Focused professional practice evaluation is a process by which the organization validates current clinical competence. This process may also be used when a question arises in practice patterns.

Maricopa County



May 24, 2017

Item 1.d.ii.

Medial Staff Allied Health Professional Staff

Appointments for May 2017


1 of 2

MARICOPA INTEGRATED HEALTH SYSTEM CREDENTIALS AND ACTION ITEMS REPORT

ALLIED HEALTH PROFESSIONAL STAFF

The credentials of the following individuals including, current licensure, relevant training and experience, malpractice insurance, current competence and the ability to perform the requested privileges have been verified.

ALLIED HEALTH PROFESSIONALS - INITIAL APPOINTMENTS NAME DEPARTMENT PRACTICE PRIVILEGES/

SCOPE OF SERVICE APPOINTMENT DATES COMMENTS/SPONSORING PHYSICIAN

(if applicable)

Thomas Edison Leary, Jr., F.N.P. Family and Community Medicine Practice Prerogatives on file 6/01/2017 to 5/31/2019 Temporary Privileges granted as of 4/17/2017

Daniel Jared McArthur, C.R.N.A. Anesthesiology Practice Prerogatives on file 6/01/2017 to 5/31/2019 Temporary Privileges request for 5/22/2017

Stacy Jean Sanchez, F.N.P. Family and Community Medicine Practice Prerogatives on file 6/01/2017 to 5/31/2019 Temporary Privileges granted as of 4/17/2017

Kyle Sutherland, P.A.-C Surgery (Trauma/Burn) Practice Prerogatives on file 6/01/2017 to 5/31/2019 Temporary Privileges requested for 5/03/2017

INITIAL/FOCUSED PROFESSIONAL PRACTICE EVALUATION

NAME DEPARTMENT RECOMMENDATION EXTEND or PROPOSED STATUS

COMMENTS

James Ferguson, C.C.P. Surgery (Perfusionist) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Cardiovascular Perfusionist Privileges.

Melissa Ostaszewski, C.C.P. Surgery (Perfusionist) Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Cardiovascular Perfusionist Privileges.

ALLIED HEALTH PROFESSIONALS – REAPPOINTMENTS

NAME DEPARTMENT PRACTICE PRIVILEGES/ SCOPE OF SERVICE

APPOINTMENT DATES

COMMENTS/SPONSORING PHYSICIAN (if applicable)

Mary Cost, Psy.D Psychiatry Practice Prerogatives on file 6/01/2017 to 5/31/2019

Michael Joseph Klemens, Ph.D. Psychiatry Practice Prerogatives on file 6/01/2017 to 5/31/2019

ALLIED HEALTH PROFESSIONALS – CONDITIONAL REAPPOINTMENTS

NAME DEPARTMENT PRACTICE PRIVILEGES/ SCOPE OF SERVICE

APPOINTMENT DATES

COMMENTS/SPONSORING PHYSICIAN (if applicable)

Sylvia Pena Hayashi, D.N.P., W.H.N.P. Obstetrics/Gynecology Practice Prerogatives on file 6/01/2017 to 12/31/2017 Granted Temporary Waiver with the condition of achieving national certification by 12/31/2017.

CHANGE IN PRIVILEGES

NAME DEPARTMENT/SPECIALTY ADDITION / REVISION/ REDUCTION / WITHDRAWAL COMMENTS

Sylvia Pena Hayashi, D.N.P., W.H.N.P. Obstetrics/Gynecology Addition: Endometrial Biopsy General Supervision


2 of 2

RESIGNATIONS

Information Only NAME DEPARTMENT/SPECIALTY STATUS REASON

Whitney Erin Howe, P.A.-C Surgery AHP to Inactive Resigned (Effective 05/24/2017)

Jonathan Dale Peckham, P.A.-C Surgery AHP to Inactive Resigned (Effective 05/24/2017) General Definitions: Allied Health Professional Staff

An Allied Health Professional (AHP) means a health care practitioner other than a Medical Staff member who is authorized by the Governing Body to provide patient care services at a MIHS facility, and who is permitted to initiate, modify, or terminate therapy according to their scope of practice or other applicable law or regulation. Governing Body authorized AHPs are: Certified Registered Nurse Anesthetists; Certified Registered Nurse Midwife; Naturopathic Physician; Optometrists; Physician Assistant; Psychologists (Clinical Doctorate Degree Level); Registered Nurse Practitioners.

Practice Prerogatives Scopes of practice summarizing qualifications for the respective category, developed with input from the physician director of the clinical service and the observer/sponsor/responsible party of the AHP, Department Chair, and other representatives of the Medical Staff, Hospital management, and other professionals.

Supervision Definitions: (1) General Supervision The procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure or provision of the services.

(2) Direct Supervision The physician must be present in the office suite or on the premises of the location and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.

(3) Personal Supervision A physician must be in the room during the performance of the procedure.

Maricopa County



May 24, 2017

Item 1.d.iii.

Medial Staff Robotic Surgery Privileges for

General Surgery, OB/GYN, and Urology

ROBOTIC SURGERY PRIVILEGES FOR GENERAL SURGERY, OB/GYN, AND UROLOGY

Pending MIHS Board Approval: 5/2017

Requested ROBOTIC SURGERY

Criteria to apply for privileges: Must have unsupervised Basic laparoscopy and/or Advance Laparoscopy Privileges Pathway #1 Applicants must have documentation of completion of training in robotically assisted laparoscopic surgery during residency or fellowship with provision of a case log detailing number and type of procedures performed, a letter of attestation from training program director affirming competence in performance of requested privileges and that residency or fellowship was completed within the last 24 months prior to applying for privileges; AND three (3) concurrently proctored cases that are:

Low complexity

Non-obese (BMI <40)

No previous intra-abdominal surgeries

With Port placement and docking time documented

With Console start and end times documented

Pathway #2 If more than two years out of training and did not receive formal didactic and “hands on” training in robotically assisted laparoscopic surgery, applicant must show documentation of the completion of the Intuitive da Vinci Surgical System Off Site Training Program; AND

Provide documentation showing completion of dV Si System Modules davincisurgerycommunity.com; AND o dV Si Systems Overview o dV Si System Draping o dV Si System Docking o dV Si System Safety Features o First Assist Essentials o Basics of Electrosurgery o dV OR Setup and Systems Connection o dV Si Visions System o dV Si Surgeon Console o dV Si System Trouble Shooting o dV Si System Trouble Shooting o Sterile Field Trouble Shooting o dV Si System Comprehensive Assessment (Print Certificate after completion)

Observation of another surgeon performing at least two (2) cases within the relevant specialty or subspecialty; AND

Three (3) concurrently proctored cases that are: o Low complexity o Non-obese (BMI <40) o No previous intra-abdominal surgeries o With Port placement and docking time documented o With Console start and end times documented

Pathway #3 For applicants who maintain current unsupervised robotically assisted laparoscopic surgery privilegesin another institution, only a case log demonstrating at least 30 completed cases within the last two (2) years of practice is required and letter from the Chair/Chief documenting successful performance of Robotic Surgery Privileges

Focus Professional Practice Evaluation: Retrospective review by the Robotic Peer Review Committee of a minimum of five (5) video recorded robotically assisted laparoscopic surgery procedures. . Reappointment Criteria: Successful performance of ten (10) robotically assisted laparoscopic surgery procedures reflective of the scope of privileges requested, for the past twenty-four (24) months based on results of ongoing professional practice evaluation and outcomes.

http://davincisurgerycommunity.com/

MARICOPA INTEGRATED HEALTH SYSTEM Robotic Surgery Proctor Form

Applicant Name

Facility

Case Performed

Date of Case Proctored Case #___ of 3

Rate each of the following categories on a 1 (Inadequate) to 5 (Most appropriate) scale:

Category 1 2 3 4 5

Room set-up and patient positioning

Port placement

Docking

Camera and clutching

Operative approach

Ability to guide the operative team from the console

“Fire Drill” What is the plan for bleeding, equipment malfunction, etc?

Readiness for independent robotic operating

Additional Comments:

Overall Pass or Fail (circle one option)

Proctor Name and Signature

Maricopa County



May 24, 2017

Item 1.d.iv.

Medial Staff Revisions to the Operational

Credentialing Policy (39026 T)

Once Printed This Document May No Longer Be Current

Policy #39026 T Title: Clinical Services/Medical Affairs: Operational Credentialing Policy Page 1 of 8

02/175/17 Supersedes 03/162/17


Maricopa Integrated Health System Administrative Policy & Procedure Effective Date: 04/10

Reviewed Dates: 02/15, 03/16, 02/2017, 5/2017

Revision Dates: 09/11, 04/12, 04/13, 04/14, 02/15, 03/16, 02/17, 5/2017

Policy #: 39026 T

Policy Title: Clinical Services/Medical Affairs: Operational Credentialing Policy and Procedure

Scope: [ ] District Governance (G)

[ ] System-Wide (S)

[ ] Division (D)

[ ] Multi-Division (MD)

[x] Department (T) Medical Staff Services

[ ] Multi-Department (MT)

Purpose: In accordance with Medical Staff Bylaws and Medical Staff and Allied

Health Professional Credentials Policies, to further define the process for

credentialing members of the Medical Staff and Allied Health Professional staff in

compliance with NCQA standards, DNV, CMS, and health plan delegation

agreements. Definitions:

Allied Health Professional: A health care practitioner other than a Medical Staff member who is authorized to provide patient care services in the Hospital who has

been granted clinical privileges. AMA: American Medical Association

AOA: American Osteopathic Association

Certifacts: An official Display Agent for the American Board of Medical Specialties

(ABMS) to serve as one of the providers of primary source equivalent ABMS

CMS: Centers for Medicare and Medicaid Services

Delegation Agreement – An agreement between MIHS and a health plan that

allows the health plan to accept the credentialing process of MIHS, provided MIHS

meets the health plan’s credentialing standards and successfully demonstrates

compliance upon audit by the respective health plan.

DNV: Det Norske Veritas – A hospital accreditation program approved by the US

Centers for Medicare and Medicaid Services (CMS). DNV performs annual deemed

status surveys.

Medical Staff: All physicians, dentists, oral surgeons and podiatrists who have been appointed to the Medical Staff by the Board.



02/175/17 Supersedes 03/162/17


NCQA: National Committee for Quality Assurance

Participating Practitioners: Medical Staff and Allied Health Professional Staff as

defined in the Credentialing Policy.

Virtual Meeting: A meeting conducted by way of either video or web based

conferencing with audio.

Clinical Privileges or Privileges: The authorization granted by the Board to render specific patient care services, for which the Medical Staff leaders and Board have developed eligibility and other privileging criteria and focused and ongoing

professional practice evaluation standards.

Policy:

The credentialing process is performed in accordance with the Medical Staff and Allied Health Professional Staff Credentials Policy and is operationalized as set forth in this policy. A health care plan may delegate its credentialing function for practitioners who provide services at Maricopa Integrated Health System (MIHS). Health care plans, through a contractual agreement, may delegate the credentialing, re-credentialing and monitoring for adverse actions of all participating practitioners. The Delegation Agreement shall detail the delegated activities, responsibilities of the health plan and of MIHS, and the process by which evaluation of the process shall occur. MIHS may sub-delegate primary source verification and, if applicable, shall conduct regular audits of all such delegated activities. The applications for initial appointment and reappointment existing now and as may be revised are incorporated by reference and made a part of the Medical Staff and Allied Health Professional Credentials Policies. Procedure:

SECTION 1 – INITIAL APPOINTMENT PROCEDURES

1.1 Verification of Information

The information that shall be collected and verified by representatives of the

Medical Staff Services (MSS) Department working with the Credentials

Committee shall include, but not be limited to:

1.1.1 Education and training are verified through the AMA/AOA profile or

directly with the training program by written letter. The Educational Commission for Foreign Medical Graduates (ECFMG) may be used for verification of a physician’s graduation from a foreign medical school.

1.1.2 All currently unrestricted professional licensures or certifications verified directly with the appropriate state agencies, by a letter,

telephone verification, licensing board website, or secure electronic communication obtained from the appropriate state licensing board. Telephone and electronic communication shall be appropriately

documented with the date, time, and initials of the individual performing the verification. A current copy of the Drug Enforcement



02/175/17 Supersedes 03/162/17


Administration (DEA) registration when applicable, with the date and

number of each shall also be obtained. 1.1.3 Specialty or sub-specialty board certification, recertification, or active

candidate status verified by Certifacts, AMA/AOA profile, or directly with the Specialty Board.

1.1.4 Continuous professional liability insurance coverage as required in the

Credentialing Policy. The applicant must include names of present and past insurance carriers and complete information on malpractice

claims history and experience including past and pending claims, final judgments, or settlements. The National Practitioners Data Bank

(NPDB) is queried for verification of any professional liability claims. 1.1.5 Any pending or completed action involving the withdrawal of an

application for or the denial, revocation, suspension, reduction,

limitation, probation, non-renewal, or voluntary relinquishment (by expiration or resignation while under investigation or to avoid

investigation) of: license or certificate to practice in any state or country; DEA or other controlled substances registration; specialty or sub-specialty board certification or eligibility; staff membership status,

prerogatives, or clinical privileges at any hospital, clinic or health care institution; professional liability insurance coverage. The entities that

shall verify this information shall include, but not be limited to: the applicable state agency; health care affiliations; NPDB; and professional peer references.

1.1.6 Health status information provided in response to pertinent questions about practitioner’s physical and mental health status or

chemical/substance dependency/abuse that may impair his/her ability to provide professional services.

1.1.7 Charge, indictment, conviction, or a plea of guilty or no contest

pertaining to any felony, or to any misdemeanor involving (i) controlled substances; (ii) illegal drugs; (iii) Medicare, Medicaid, or

insurance or health care fraud or abuse; or (iv) violence against another shall be elicited on the application.

1.1.8 All hospitals or health care organizations where the applicant had or

has any association, employment, privileges or practice to include start and end dates of each affiliation. All time gaps in practice greater than

three (3) months since graduation must be accounted for and shall be verified by an individual who can attest to the validity of the activity as specified by the applicant, or re-applicant.

1.1.9 Medicare sanctions are verified directly with the OIG and SAM (Office of the Inspector General and the System for Awards Management)

websites or the NPDB. 1.1.10 The Medicare Opt-Out Report will be reviewed on at initial

appointment. If a practitioner is identified they shall be deemed to not

meet the qualifications for appointment as outlined in the credentialing policies.

1.1.11 The NPDB is queried at the time of initial appointment/reappointment and for new privilege requests



02/175/17 Supersedes 03/162/17


SECTION TWO - REAPPOINTMENT PROCEDURES

2.1 All terms, conditions, requirements, and procedures relating to initial

appointment shall apply to continued appointment and reappointment. Each staff member shall be sent an application for reappointment and notice of the date on which the appointment will expire (not to exceed two years from the

last appointment/reappointment) in accordance with Medical Staff and Allied Health Professional Staff Credentialing Policies.

2.2 The MSS Department shall verify information since the time of the member’s last appointment regarding professional and collegial activities, performance, clinical or technical skills and conduct. Such information will include but not

be limited to: 2.2.1 At least two peer references

2.2.2 Within the last two years, any pending or completed professional action as specified in Section 1.1.5 of this policy.

2.2.3 Medical malpractice history over the past two years is required on the

application and verified though NPDB. 2.2.4 All currently unrestricted professional licensures or certifications

verified directly with the appropriate state agencies, and a current copy of the Drug Enforcement Administration (DEA) registration when applicable, with the date and number of each.

2.2.5 Specialty or sub-specialty board certification, or recertification 2.2.6 All hospitals or health care organizations where the applicant had or

has any association, employment, privileges or practice with the dates of each affiliation.

2.2.7 Medicare/Medicaid Sanctions (i.e., OIG and SAM) and Medicare Opt

Out Report 2.3 The sources used for verification will be the same as in the initial

credentialing process

SECTION THREE - NOTIFICATION AND STATUS OF APPLICATION

3.1 During the initial credentialing or recredentialing process, the practitioner

will be given notice by the MIHS credentialing staff of any conflicting information and be given an opportunity to reconcile such information in

accordance with the Medical Staff and Allied Health Professional Credentials Policies.

3.2 Practitioners receive a copy of the Medical Staff Bylaws, Medical Staff

Credentialing Policy, or Allied Health Professional Credentialing Policy (if applicable) outlining their rights.

3.3 Practitioners have the right to review information submitted to support their credentialing application in accordance with the Practitioner Access to Credentialing Files Policy.



02/175/17 Supersedes 03/162/17


SECTION FOUR - ONGOING VERIFICATION OF INFORMATION

4.1 Medicare/Medicaid Exclusions shall be verified on a monthly basis. Verification shall be accomplished through a sweep of the credentialing database matched against the OIG (Office of Inspector General) and SAM

(System for Awards Management) websites. 4.2 Medicare/Medicaid Opt-Out Report - The Medicare Opt-Out Report will be

reviewed on a quarterly basis; if a practitioner is identified the health plan will be notified immediately.

4.3 Licensure - The applicant’s current professional licensure shall also be verified at the time of license renewal and revision of privileges. During the interim period between reappointment cycles, the Credentials Committee

shall review disciplinary actions identified, or other issues deemed to be significant. The Credentials Committee shall make recommendations on

these matters, when deemed necessary. Any licensure revocation, suspension, restriction, or probation shall result in a like limitation of clinical privileges, as of the date such action becomes effective and throughout its

term. Contracted health plans shall be notified immediately of any such actions.

4.4 Patient Complaints, Adverse Events, and Medical Record Review- The collection of and review of information obtained from complaints, adverse events, and medical record review is performed on a concurrent basis. Appropriate interventions are identified from adverse events through the confidential peer review mechanism.

SECTION FIVE - REPORTING TO THE NATIONAL PRACTITIONER DATA BANK

(NPDB) AND STATE LICENSING BOARD

5.1 It is the policy of MIHS to comply with the required reporting of adverse actions taken against a Participating Practitioner to all regulatory agencies, including the National Practitioner Data Bank (NPDB) and the appropriate

State of Arizona Licensing Board. 5.2 Following a formal peer review process, and at the time that MIHS denies,

reduces, revokes, terminates, or suspends the privileges of a practitioner for a period of longer than thirty (30) calendar days, or accepts the Participating Practitioner’s surrender of privileges while under investigation by MIHS, MIHS

will notify the NPDB and the appropriate State of Arizona Licensing Board. 5.3 NPDB Reporting:

5.3.1 MIHS will submit a report to the NPDB of the adverse action consistent

with the NPDB timeliness requirements.

5.3.2 The NPDB report will be submitted electronically, in accordance with

NPDB requirements via the NPDB website at www.npdb-hipdb.com

5.4 State of Arizona Licensing Board Reporting: The Report Verification

Document that MIHS received from the NPDB will be submitted to the

appropriate State licensing board.

http://www.npdb-hipdb.com/



02/175/17 Supersedes 03/162/17


SECTION SIX – PROTECTION AGAINST DISCRIMINATION

6.1 In accordance with the Medical Staff and Allied Health Professional

Credentials Policies, No individual shall be denied appointment or

reappointment at the Hospital on the basis of gender, race, creed, sexual

orientation, or national origin. Means used to prevent discrimination in the

decision making process includes:

6.1.1 The Credentials Committee will be comprised of a multi-disciplinary,

heterogeneous group of practitioners to the degree feasible. 6.1.2 All members of the medical staff and allied health professional staff are

required to attest to their willingness to abide by the Medical Staff

Bylaws and associated documents. Discrimination is prohibited in the

Medical Staff Credentialing Policy (section 2.A.5) and Allied Health

Professional Credentialing Policy (Section 3.A.5).

6.1.3 Adverse recommendations must be supported by qualitative and

quantitative data that is presented to the Credentials Committee blindly

(i.e., using a numeric identifier in lieu of name, discipline, specialty,

etc.).

6.2.4 All denial decisions will be handled in accordance with the Medical Staff

Credentials Policy (Article 3.A.6-3.A.7) and Allied Health Professional Policy (Article 4.A.5-4.5.6) and potentials for discrimination shall be assessed through the respective (medical staff or allied health

professional staff) Hearing and Appeal Process. 6.2 The Credentials Committee will conduct an annual review of credentialing

decisions to ensure that practitioners are not discriminated against.

SECTION SEVEN – GENERAL PROVISIONS

7.1 MIHS shall seek to verify all the data elements as set forth in this policy and the Medical Staff and Allied Health Professional Staff Credentialing Policies.

7.2 MIHS will conduct timely verification of information, as evidenced by approval

(or denial) of a provider for initial credentialing/appointment within ninety (90) days of receipt of a complete application.verify all information provided

on the physician’s application deemed completed within ninety (90) days of the Credentials Committee decision. Each applicant is required to sign and attest to the accuracy of the information provided in the application. and

reapplication. If the signature attestation exceeds ninety (90) calendar days before the credentialing decision, MSS shall update it with an attestation that

the information on the application remains correct and complete. 7.27.3 MIHS will conduct timely verification of information, as evidenced by

approval (or denial) of a provider for re-credentilaing/reappointment within

one hundred eighty (180) days of receipt of a complete application. Each applicant is required to sign and attest to the accuracy of the information

provided in the re-credentialing/reappointment application. If the signature attestation exceeds one hundred eighty (180) days before the credentialing decision, MSS shall update it with an attestation that the information on the

application remains correct and complete.



02/175/17 Supersedes 03/162/17


7.37.4 All members of the Medical Staff and Allied Health Professional Staff

acknowledge that they agree to respect and maintain the confidentiality of all discussions, deliberations, proceedings, and activities of Medical Staff

Committees and Departments which have the responsibility of evaluating and improving the quality of care in the Hospital. Members of the Credentials Committee and other Peer Review Committees may be required to sign a

confidentiality statement. 7.47.5 Provisionally credentialed (clean file review) and approval is permitted

in accordance with the criteria and process set forth in the Medical Staff Credentialing Policy (Section 4.B) and Allied Health Professional Staff

Credentialing Policy (Section 4.C). 7.57.6 The health care plan and MIHS will identify the providers who will

participate in this agreement in a written list updated monthly. Any published

directories are based on the information provided from the Credentials Office. 7.67.7 MIHS will conform to the current requirements established by the

NCQA. 7.77.8 For purpose of the “Federal Quality Health Care (FQHC) Look Alike”

delegated credentialing arrangements, a completed application is defined as

the fully verified application that has been acted on favorably by the MIHS Credentials Committee.

7.87.9 Any meeting of the Credentials Committee by way of a virtual meeting may only be conducted by either video or web based conferencing with audio.

References: MIHS Medical Staff Bylaws, Medical Staff Credentialing Policy,

Allied Health Professional Staff Manual, Practitioner Access to Credential Files,

NCQA Standards CR 1- 12, Health Care Quality Improvement Act of 1986.

MIHS Policy & Procedure - Approval Sheet

(Before submitting, fill out COMPLETELY.)

POLICY RESPONSIBLE PARTY: Stephanie Davee

DEVELOPMENT TEAM(S): Credentialing Committee

Policy #:39026 T

Policy Title: Operational Credentialing Policy and Procedure

e-Signers: John Hitt, M.D., M.B.A

Executive Vice President and Chief Medical Officer

Eric D. Katz, M.D.

Chief of Staff



02/175/17 Supersedes 03/162/17


Place an X on the right side of applicable description:

New -

Retire - Reviewed -

Revised with Minor Changes -X

Revised with Major Changes -

Please list revisions made below: (Other than grammatical changes or name

and date changes) Revised the 180 day rule to 90 day rule as required in the

AHCCCS Policy 950 for initial appointment/credentialing: Added the 180 day rule for

recredentialing/reappointment (per NCQA rules) Processes.

Reviewed and Approved by in Addition to Responsible Party and E-

Signer(s): Included AMA/AOA profile as primary verification source for board

certification specialty and subspecialty verification.

Committee: Credentials Committee 05/2017

Committee: Medical Executive Committee 05/2017

Reviewed for EPIC: 00/00

Other: Maricopa Special Health Care District Board 05/2017

Other: 00/00

Maricopa County



May 24, 2017

Item 1.e.i.

Proposition 480 Capital 90-17-085-RFQ-CMAR

From: Compliance 360To: Melanie TalbotSubject: Contract Approval Request: 3rd Floor, Maricopa Medical Center, Behavioral Health/Medical Unit Remodel GMP4

Kitchell Contractors of ArizonaDate: Thursday, May 11, 2017 7:34:12 PM

Message Information


Subject Contract Approval Request: 3rd Floor, Maricopa Medical Center, Behavioral Health/Medical Unit Remodel GMP4 Kitchell Contractors of Arizona


Add comments as necessary.




Status Pending ApprovalTitle 3rd Floor, Maricopa Medical Center, Behavioral Health/Medical

Unit Remodel GMP4Contract Identifier

MIHS ContractNumber 90-17-085-4

Primary ResponsibleParty Ellis, Deb L.

Departments Integrated Program Management OfficeProduct/Service

DescriptionThis Board action is to approve GMP four (4) for renovation work within the 3rd Floor, Maricopa Medical Center, Behavioral Health/Medical Unit Remodel for Kitchell Contractors, Inc. (KCI).

KCI has committed to a 6-day work week in order to make our aggressive August opening date possible for the Behavioral Health/Medical Unit Remodel. Additionally, to ensure this exceptionally fast timeline is met, MIHS and KCI have agreed to approach the work in multiple phases, allowing the team to manage component parts of the project simultaneously rather than sequentially where possible.

This phased approach has allowed KCI to order materials and complete work as soon as it has been identified through the design process, rather than waiting for all construction costs to be finalized.





https://secure.compliance360.com/DMZ/DmzCustomViewLoader.aspx?CD=nbrakfEr8Jfby%252fRxiyxhPgPOs%252bSvW%252fsAJ5qpM%252f6f8l%252fxanC4EjYtlA%253d%253d&PD=gewc47sikRgWWZir5gyCsUjWsDGsicX0MmPZpE5Hq4SA%2b4Kc9WC%2fTjSQfnV0Q4oA0tRcNI%2fSWlzGnTWG2noqIjiqBFVw5MSdA4paTet7Z%2fk0LsGv%2fIB7yl%2fjImp2JmsrsezONc3d%2fnZ%2f7UTCN6gKzieLlr7PFHwUE1PobSZTe48767QhIoPLOqnRvzdE0CLKPrxpWhJSq7Xzi9bLA9uPKMZavVgCg7MgFDC0OGeswgF2rIee0RWsidXBRKVCCQfGgHxzsSa%2fHaTipPA264i7T1vIeI5%2bxPh43phWDrxG9ei%2bW4ry5P0Eow%3d%3d

GMP four (4) is the final GMP for the project. The Phase four (4) GMP cost will be $288,872.

Action/Background Approve Contract 90-17-085-RFQ-CMAR with Kitchell Contractors for Construction Manager at Risk (CMAR) Guaranteed Maximum Price (GMP) for Phase Four (4) renovation work within the 3rd Floor, Maricopa Medical Center, Behavioral Health/Medical Unit Remodel.




Expense/Revenue ExpenseBudgeted Travel Type YesProcurement Number 90-17-085-RFQ-CMAR

Primary Vendor Kitchell Contractors of Arizona

Responses

Member Name Status CommentsBlaylock, Stephen D. Approved

Doria, Susan S. Approved



Benaquista, Kathleen F.Approved



Maricopa County



May 24, 2017

Item 1.e.ii.

Proposition 480 Capital 90-17-194-1

Maricopa Integrated Health System Information Technology 2601 E. Roosevelt Phoenix, AZ 85008

DATE:

05/12/17

TO: Cc:

MIHS Board of Directors Steve Purves, President and CEO Kathy Benaquista, EVP and CFO Melanie Talbot, Executive Director Board Operations

FROM: Kelly Summers, Senior Vice President and Chief Information Officer

SUBJECT: EPIC Testing for Rehost and Upgrade

Members of the MIHS Board of Directors, In March 2017, MIHS IT brought in the services of OST Healthcare to assess and prioritize the process development needs, develop scope and recommendations for aligning with best practices for test management, specifically to support the EPIC re-host/re-platform/upgrade project. This discovery created a detailed scope for this engagement. The intent of this engagement is to develop processes and plans for functional testing of planned EPIC upgrades, and its associated key applications, as identified in the discovery phase. A well-defined, structured testing process and framework will ensure successful execution of multiple concurrent data center transformations planned between May 2017 and September 2017. The total cost is $347,747.48, including a not to exceed amount of $53,046.23 for travel and incidental expenses. This budget is included in the $23M bond approved by MIHS Board of Directors for eSTF Program. Thank you for your consideration and please let me know if you have any additional questions.

From: Compliance 360To: Melanie TalbotSubject: Contract Approval Request: Epic Test Management Services--Phase II Presidio Networked Solutions Group, LLCDate: Monday, May 15, 2017 4:23:15 PM

Message Information


Subject Contract Approval Request: Epic Test Management Services--Phase II Presidio Networked Solutions Group, LLC




Status Pending ApprovalTitle Epic Test Management Services--Phase II

Contract IdentifierMIHS Contract

Number 90-17-194-1

Primary Responsible Party Pardo, Laela N.

Departments OFFICE OF THE CIOProduct/Service

Description Epic Test Management Services--Phase II

Action/Background Approve a new Cooperative Agreement between Presidio Networked Solutions Group, LLC and Maricopa Integrated Health Systems (MIHS) for the Epic Test Management Services--Phase II.

In March 2017 Presidio performed the Phase I of the Epic test management services that assessed MIHS' needs in aligning enterprise best practices for test management in support of MIHS' eSTF program. This request for Phase II defines the efforts required for Presidio to develop processes (playbooks) and maintenance plans (runbooks) for functional testing the results of planned Epic upgrades, and key ecosystem applications deemed necessary to ensure the successful execution of multiple concurrent data center transformations planned.

The Presidio services will be accessed through the Maricopa County SAVE contract 16076-RFP. The project was included in the eSTF program budget. Cost of Phase II is $347,747.48,





https://secure.compliance360.com/DMZ/DmzCustomViewLoader.aspx?CD=nbrakfEr8JfX6M%252byAFMOeOKpmT%252btLLp08VGuVeDRxDqmYIuV5RhrWg%253d%253d&PD=gewc47sikRjgG9an9AXmoMe7d5teF%2bX9hWpP%2bGJed7K%2fZI2s5AW7tpPhJXBIWQ1ZJgbEzKvnzLKNoG7zJqVZHA%2fjRJmY9JVXTt4uqVbqZQrPdma2%2fPd5g8NgKeSw1QEOSAByDuvE0SvinJVh7j80757XSa8L91utUoJLlOCgYaxLGtPaUiVvxZ7Zm9G13zy8DtYarsvl7%2fYrC7NAcNS953eawNw49KaR5kQ6hdNWq1m8DnV4HCrcAlc0k%2fnmBqaP6gY4JX4KF0PoFSRcXvQAb0nJ9vzHsgNRTqCraWc7Q%2forSkBMt1rqVQ%3d%3d

plus a 'not-to-exceed' travel expense of $53,046.23, for a total project amount of $400,793.71.

Evaluation Process Procurement has been satisfied pursuant to HS-102(B)(1) of the Procurement Code in that contracts between MIHS and other political subdivisions, cooperative purchasing agreements with governmental entities or other governments are exempt from the solicitation requirements of the Procurement Code.

NotesCategory Co-op


Annual Value $400,793.71Expense/Revenue Expense


Primary Vendor Presidio Networked Solutions Group, LLC

Responses

Member Name Status CommentsManess, Brian D. Approved Ok to route for approvals.

Summers, Kelly R. Approved





Maricopa County



May 24, 2017

Item 2. Presented at the Meeting

2017 Legislative Agenda

Legislative & Governmental Relations

Presentation

24, May 2017

Michael Fronske Director of Legislative and Government

Affairs

1

Sine die May 10, 7pm Day 122 Bills posted 1079 Bills passed 353 Bills vetoed 5 Bills signed 315 Resolutions passed 42

Current Statistics of Session

2

Status of State Budget • The legislature passed and the Governor signed a $9.8 billion

dollar budget. Included funding for AHCCCS adult emergency dental coverage up to $1,000.00 per year, per member.

Status of Key Bills • HB 2452 BONDING; AMORTIZED PREMIUM; SEGREGATED

FUND (Signed by Gov. Ducey, 3/29) • SB 1479 MENTAL HEALTH TREATMENT; PATIENT TRANSPORT

(DEAD) • SB 1005 Striker - Now HOSPITAL HOLDS (DEAD) • HB 2317 PARTISAN OFFICES; DISTRICTS; CITIES; SCHOOLS

(DEAD)

State Legislation and Issues

3

Status of Other Bills of Interest • HB 2043 STATE HOSPITAL; PROPERTY LEASES (Signed by

Gov. Ducey, 5/10) • SB 1031 DANGEROUS; INCOMPETENT DEFENDANTS; STUDY

CMTE (Signed by Gov. Ducey, 3/29) • HB 2239 INCOMPETENT; NONRESTORABLE DEFENDANTS;

INVOLUNTARY COMMITMENT (Signed by Gov. Ducey, 3/24) • Numerous ASRS Bills

State Legislation and Issues

4

Recent ACA Related Actions: • House Republicans passed the AHCA 217-213 • ACA elements in the AHCA:

– At risk include: pre-existing conditions, individual mandate, subsidies, essential health benefits, Medicaid expansion, age rating, employer mandate, taxes

– In play include: exchanges, lifetime limits – Safe include: young adult coverage, preventive care, Medicare "doughnut

hole" closing, Medicare payment cuts

• The Senate has established a 13 member work group to

develop a Senate version of an ACA repeal and replace with action expected in July

Federal Issues

5

Maricopa County



May 24, 2017

Item 3.

Quarterly Quality Dashboard

Patient Safety/ Quality/ Patient Experience

Dan Hobohm, MD – VP of Quality Outcomes

Denise White – Interim Quality Management Director

Safe Care

2

Safe Care

1. Patient Safety Indicator (PSI - 90) Clinical Documentation Improvement (CDI) = 85% inpatient

admissions are concurrently reviewed try to identify potential PSI in this process

Smart Solutions = identifies PSIs after coding complete • There were problems with software- which was fixed late

February • Stop bill when identified if Medicare patient • CDI reviews each identified PSI chart and queries provider

Action Items

3

Safe Care

1. The name was changed from “Patient Safety of Selected Indicators Composite” to “Patient Safety and Adverse Events Composite” to capture the concept of patient harm resulting from a patient safety event.

2. PSI 08, 12 and 15 had definition changes. 3. The number of indicators for composite went from 8 to 10. 4. The reference population was updated and only includes data

with complete present on admission (POA) data. 5. Component weighing now incorporates harm.

Changes to PSI in 2017

4

Safe Care

PSI 03 Pressure Ulcer Rate* PSI 06 Iatrogenic Pneumothorax Rate PSI 08 In-Hospital Fall With Hip Fracture Rate* PSI 09 Perioperative Hemorrhage or Hematoma Rate PSI 10 Postoperative Acute Kidney Injury Rate PSI 11 Postoperative Respiratory Failure Rate PSI 12 Perioperative Pulmonary Embolism (PE) or Deep Vein

Thrombosis (DVT) Rate PSI 13 Postoperative Sepsis Rate* PSI 14 Postoperative Wound Dehiscence Rate PSI 15 Unrecognized Abdominopelvic Accidental

Puncture/Laceration Rate3


5

* The weighted score for these are significantly higher than 2016

Safe Care

1. PSI 08, 12 and 15 had definition changes. 2. PSI 08 In hospital Fall with hip fracture rate- previously was only

post-operative fall with hip fracture. 3. PSI 12 Perioperative pulmonary embolism and deep vein

thrombosis (DVT) rate- definition was narrowed and now excludes patients with isolated calf vein DVT and patients with diagnosis of acute brain or spinal injury.

4. Unrecognized abdominal or pelvic accidental puncture or laceration rate – definition narrowed to only those patients with abdominal or pelvic injury requiring a return to the operating room at least one day after the original case.


6

Quality Healthcare

7

Action Items Quality Healthcare

1. Severe Sepsis & Septic Shock Nurse-Driven Care

• SCC approved to trial in SICU & MICU Provider Order Set Update

• Repeat Lactate pre-checked to redraw if > 1.9 • Sequential Organ Failure Assessment (SOFA) – request to

build a SOFA early warning BPA

2. HBIPS Provider Education Awareness – late November 2016 1:1 face-to-face meetings with outliers April data still being abstracted – improvement being made

8

Patient Experience

Two Overall Questions • RATE – All Areas Using any number from 0-10, where 0 is the worst possible and 10 is the best possible, what number would you use to rate this hospital?

• RECOMMEND - MMC Would you recommend this Maricopa Integrated Health System to your

friends or family?

Our plan is to focus on two overall questions:

9

10

1 Inpatient: Actions plans center around nursing communication and patients’ perception of pain.

2 Ambulatory: Respecting the patients’ preferences in all things – communication and coordination of care.

3 Ancillary: Ensuring patients are seen within 15 minutes of their appointment.

4 BH: Helpfulness of therapy sessions and noise level.

Action Items Patient Experience

Patient Experience Inpatient – HCAHPS scores

11

Action Items

12

• LEAP Team - Workout Session 6 focused on ( 3 ) initiatives: *HCAHPS Cleanliness Scores - 1. A Gold Cart for EVS is seen as a functional trophy for the inpatient unit with the ‘most improved’ cleanliness score over a month. The housekeeper will use the roving trophy during the month and have the operations’ manager stock it for them each day. *HCAHPS Quietness Scores – 1. The LEAP Team surveyed several of the night shift staff from floors 2-7 to identify what is contributing to the noise at night and what can be done to improve it? The number 1 item identified was floor cleaning during the overnight hours. The team worked closely with EVS management, who has agreed to clean the floors on the inpatient units before 10pm. 2. Signage for floors 2-7 was created to notify visitors and remind staff that quiet hours should be observed during the hours of 10p-6a and to turn lights down/TVs off when not being watched after the 10pm *HCAHPS Pain Management Scores - 1. Initiated consistent scripting to improve patients perception of how well the nurse manages their pain. 2. Rolled-out pain scripting in November for all nursing, clinical and many non-clinical areas. • The efforts of the multidisciplinary team has shown improvement in the patient experience scores. • Leaders are continuing to make staff aware of the surveys and to engage patients.

• LEAP Team - Workout Session 8 will continue to focus on Patient Experience - a new set of initiatives will be developed around

May 18th. Meeting to be scheduled.

Patient Experience

Patient Experience Ambulatory – CG-CAHPS

13

Connect Experience

14

• Clinic Compare – 3rd quarter FY 2017 score for “Would recommend provider’s office” = 85.9% (this is 1.6% higher than the previous quarter of 84.3%)

• Provider Scorecard – providers received individual scorecards on the 15th of every month. • Current Action plan focus: 1. Returning patient phone calls same day received. (CGCAHPS survey) 2. Returning phone calls for normal lab results. (CGCAHPS survey) 3. Improve “Would recommend score” for clinics with FTYD score below the organizational target of 88.9%. (CONNECT Survey)

Patient Experience

Response Rates

15

Ambulatory Response Rates: • Ambulatory Services implemented Connect Experience on February 1st, 2016. • MIHS is surveying patients using email and automated calls. Survey consists of

8 questions. • Overall response rate for 3rd quarter FY2017 is 28%, up from 25.4% prev. qtr

Patient Experience

Patient Experience Behavioral Health - Tonic

16

Behavioral Health • Continue to utilize the Tonic tool. • The responses for Behavioral Health are averaging over 500

completed surveys a quarter. • Patients will continue to be surveyed prior to leaving the

facility. • Patients are provided a quiet and confidential space to

complete the survey online.

Maricopa County



May 24, 2017

Item 4.

Preliminary Operating Budget for Fiscal Year 2018

Proposed Budget Fiscal Year 2018

May 24th, 2017 Kathleen Benaquista

Chief Financial Officer

2

FY 2018 Budget Calendar

3

Executive Summary - Volumes

• Volumes for acute services were budgeted to increase 3%-6% when compared to the FY2017 projection.

• Admissions + 5.4% • Patient Days + 3.2% • Observation Days - 2.1% • Emergency Departments + 6.0% • Surgeries + 10.8%

• Surgery volume is budgeted to increase due to addition of hand, spine and

eye surgeries. • Admissions from the EDs continue to be the primary driver for acute

services volume and are budgeted for a modest 3% increase from the FY2017 projection.

4


• Behavioral Health admissions for FY2018 are budgeted to increase more than 10.0% primarily due to the addition of Med-Psych Unit 11. This unit will be located on the third floor of the acute hospital and its 22 beds are budgeted to accept patients starting August 2017.

• Delivery volume was budgeted to increase slightly from the February 2017 projection.

• Most clinic volumes were calculated at the provider level for FY2018. A

‘target’ number of patient visits per provider session was set for each FQHC clinic.

5


• The FY2018 budget for the 7th Avenue Walk-In Clinic assumes a 4.8% decrease over the FY2017 projection due to the loss of Southwest Keys volume

• The FHC/WHH Clinics budgets are 10.4% over the FY2017 projection

though two WHH locations are budgeted to close. This will leave MIHS with three remaining WHHs.

• The CHC Clinics are budgeting for an 11.7% increase in visits compared to

the February FY2017 projection. This increase is driven by an expected increase in provider productivity, new hand, spine, eye and urology services.

• The Dental Clinics budgeted a 4.4% increase in visits compared to the February FY2017 projection. This increase is primarily due to the newly awarded McDowell Dental Ryan White grant.

6

Executive Summary - Revenue

• In FY 2018 payer mix is expected to remain stable. At this time it is assumed that Ambetter, a Health Net of Arizona, Inc. insurance plan, will continue to offer its product through the Health Insurance Marketplace in Arizona. It is also not known if another insurance company plans on entering this market in calendar year 2018.

• This budget does not include any changes that may occur if the American Health Care Act is passed by Congress.

• The Revenue Cycle Team has achieved significant operational improvements over the last two years and will continue to focus on sustaining them and begin to work on new projects. This year some areas of focus will be centralizing scheduling, investment in and restructuring of inpatient and ambulatory care management, focus on clinical documentation for observation admissions, workers compensation payment practices etc. The budget includes $3.2M from these initiatives.

7

Executive Summary - Revenue

• MIHS budgeted to receive a rate increase of approximately $2.2M from

AHCCCS for an adjustment in the APRDRG weights and a rate increase of $1.3M in professional fees for teaching hospital support.

• The payment adjustments authorized by the Affordable Care Act (ACA) of 2010 is expected to result in a reduction in net Medicare payments of $3.9M in FY 2018 .

• The increase in adjusted patients days of 7.1%, which includes increases in ambulatory volumes, added inpatient bed capacity to behavioral health and new surgical volume (hand, spine, eye) accounts for the majority of the $24.1M increase in net patient revenue.

8

Executive Summary - Expenses

• Salaries and benefits include $4.5M for FY 2018 merit and market adjustments. $800K has been budgeted for Prop 206, which results in additional cost to give people time off. Health insurance and other benefit costs are stable as a percent of salaries.

• Additional FTE resources totaling 153.0 have been budgeted for volume

increases and to support new services. e.g. - behavioral health, surgical, and emergency. Additionally, some clinical staffing targets have been increased due to MIHS’s purchase of Action OI productivity benchmark information.

• Supplies are expected to increase by $11.5M due to volume/inflation and the new 340b program, $2.0M and $9.5M respectively.

9


• Medical Service Fees are expected to increase by $4.5M. $3.0M of the increase is for additional services to be implemented in FY2018 such as Behavioral Health Unit 11, hand, spine, and ophthalmology; as well as already approved new services such as OP Behavioral Health. $1.5M is related to an increase in salary dollars paid to DMG due to rate adjustments.

• Purchased Services expenses are expected to increase by $2.5M compared to FY2017 projection. $1M increase in advertising, $216K increase for HIM auditing, $157K for recruitment expenses, $307K for collection fees, and $766K for eSTF post implementation work.

10


• Other Expenses are expected to increase by $6.3M.

• Rental expenses are expected to increase by $1.1M. $420K is for the new Data Center, $400K is for the new centralized scheduling space, $318K for additional rentals for the lab, operating room, and MRI depts.

• Repairs and Maintenance expenses are expected to increase by $4.3M. HTM increased by $274K for maintenance on additional items, e.g. the da Vinci machine, $600K increase in Microsoft Enterprise agreement, $1.0M for the pharmacies Pyxis machines, $1.2M for HP maintenance including UPS services for DC00 and Key Government maintenance and $1.1M is for various systems including; Avaya, Citrix, Altura, 3M, and Kronos.

• Utilities are expected to increase by $800K due to inflation and costs associated with the new data center, $250K and $550K respectively.

11

Executive Summary – Ad Valorem Tax

• The property tax levy for the health system’s operations is budgeted at the maximum amount of $73.8M contingent upon the Board’s approval.

• The budget also includes the property tax revenue for the third year payments towards the Prop 480 bond.

12

Other Funding Sources

FY 2016 FY 2018Actual Budget Forecast Budget

Funding ( amounts expressed in millions )AHCCCS Medical Education 39.61$ 36.57$ 33.67$ 33.67$ Disproportionate Share (DSH) 4.20 4.20 4.20 4.20 Meaningful Use (0.76) 2.63 1.35 1.35 PCMH - Capitation Payment 1.82 0.90 1.08 1.09 Psych Teaching subsidy 3.55 3.55 3.55 3.55 Trauma subsidy 2.83 2.83 2.44 2.44

Total ( amounts expressed in millions ) 51.25$ 50.68$ 46.29$ 46.30$

** FY17 forecast & FY18 budget calculated at a 15% reduction based on FY16 Actual - no current information from AHCCCS regarding FY17 GME

FY 2017

13

Other Funding Sources

• AHCCCS Medical Education is forecasted and budgeted to have a 15% reduction of the FY2016 amount. AHCCCS has informed MIHS that there will be a reduction of the FY2017 amount per CMS, however at this time MIHS has not been informed of the amount.

• We are not anticipating any significant changes in other funding sources and are budgeting status quo.

14

Projected Volume Comparisons to Budget

FY 2015 FY 2016 FY 2017 FY 2017 FY 2018 % ChangeVolume Actual Actual Budget Projected* Budget FY17/FY18

AcuteAdmissions 13,234 12,160 12,302 10,863 11,447 5.4%Length of Stay 4.9 5.0 4.9 4.9 4.8 -2.1%Patient Days 64,571 60,339 60,486 53,018 54,716 3.2%Average Daily Census - IP 176.9 164.9 165.7 145.3 149.9 3.2%

Observation Days 4,994 4,803 4,569 6,185 6,057 -2.1%Average Daily Census w/ Obs 190.6 178.0 178.2 162.2 166.5 2.7%

Adjusted Patient Days** 241,075 242,693 253,249 241,168 258,250 7.1%

Behavioral healthAdmissions 3,277 3,253 3,439 3,275 3,605 10.1%Length of Stay 19.7 21.5 21.4 22.8 22.4 -1.6%Patient Days 64,419 69,985 73,487 74,508 80,688 8.3%Average Daily Census 176.5 191.2 201.3 204.1 221.1 8.3%

* Projection is Actual YTD as of February 2017 annualized** Adjusted patient days is calculated using 1.91 as the APD Factor.

15



ED Visits Adult 48,924 49,015 48,213 47,304 49,015 3.6%Peds 22,756 22,945 23,139 20,144 22,945 13.9%L&D 904 4,595 4,706 4,623 4,693 1.5%Burn 1,959 2,364 2,324 2,420 2,338 -3.4%Total 74,543 78,919 78,382 74,490 78,991 6.0%

ED AdmissionsNon-Trauma 8,169 9,207 9,366 8,267 8,572 3.7%Trauma 940 944 962 972 957 -1.5%Total 9,109 10,151 10,328 9,239 9,529 3.1%

ED Admissions as % of Total Acute Admissions 68.8% 83.5% 84.0% 85.0% 83.2% -2.1%

ED Admissions as % of Total 12.2% 12.9% 13.2% 12.4% 12.1% -2.7% ED Visits

Adult 14% 14% 14% 12% 12%Peds 6% 5% 5% 4% 4%L&D 40% 42% 43% 44% 44%Burn 24% 19% 18% 22% 22%

* Projection is Actual YTD as of February 2017 annualized

16



Deliveries 2,848 2,422 2,543 2,499 2,543 1.8%

SurgeriesInpatient 4,168 4,144 4,058 3,636 4,058 11.6%Outpatient 3,629 3,567 3,444 3,239 3,557 9.8%Total 7,797 7,711 7,502 6,875 7,615 10.8%

7th Ave Walk In Clinic Visits 25,865 24,444 25,924 22,883 21,785 -4.8%

Ambulatory VisitsFHC & WHH 214,657 211,288 219,977 184,641 203,815 10.4%CHC 163,910 163,831 163,656 152,420 170,177 11.7%Dental 26,799 25,007 21,736 22,628 23,624 4.4%Total 405,366 400,126 405,369 359,689 397,616 10.5%

* Projection is Actual YTD as of February 2017 annualized

17

Payor Mix – Inpatient Acute

0%

10%

20%

30%

40%

50%

60%

Commercial Medicaid Medicare Other Other Govt Self pay

FY 15

FY 16

FYTD 17

18

Payor Mix – Inpatient Behavioral Health

0%

10%

20%

30%

40%

50%

60%

70%


FY 15

FY 16

FYTD 17

19

0%

10%

20%

30%

40%

50%

60%


FY 15

FY 16

FYTD 17

Payor Mix – Outpatient Hospital Outpatient + CHC + FHC + Dental + 7AWIC + Dialysis

Property Tax History

20

Fiscal Year Amt Levied Tax Rate Rate Change2006 $40.0M 0.1206 2007 $42.9M 0.1184 -0.00222008 $46.3M 0.0935 -0.02492009 $49.9M 0.0856 -0.00792010 $53.0M 0.0914 0.00582011 $55.7M 0.1122 0.02082012 $57.9M 0.1494 0.03722013 $57.9M* 0.1683 0.01892014 $62.5M 0.1939 0.02562015 $65.1M 0.1856 -0.00832016 $67.3M ** 0.1943 0.00872017 $70.8M 0.1959 0.00162018 $73.8M 0.1930 -0.0029

* 2013 is the only year that the full amount was not levied.

** Arizona taxpayers approved Proposition 117 on the November 6, 2012 which became effective in tax year 2015. This resulted in a change in valuation methodology beginning in fiscal year 2016.

Tax rate is per $100 in levied property value.

Property Tax Comparisons

21

Based on Primary Assessed Value FY17 No rate change

from FY17 Same $ as FY17 FY18 Max $

Tax levy $70.8M $74.9M $70.8M $73.8MRate per $100 0.1959 0.1959 0.1850 0.1930Rate change year over year 0.0016 (0.0000) (0.0556) (0.0029)% Rate change from inception 62.4% 62.4% 53.4% 60.0%

FTE Dashboard

22

Paid FTE Related InformationFY 2017 Variance Variance %

FY 2016 thru March FY 2018 YTD to YTD toActual YTD Actual Budget Budget Budget

FTE/AOB WO Residents 4.7 4.7 4.6 0.1 1.3%

FTE/AOB 5.1 4.9 4.9 0.1 1.4%

Payroll FTEs 3,276 3,042 3,210 (168) (5.5%)Contract FTEs 74 255 240 15 5.9%Total FTEs 3,350 3,297 3,450 (153) (4.6%)

OT Hours as a % of Worked Hours 2.5% 2.0% 2.1% (0.0%) (2.2%)

Benefits as a % of Salary 25.6% 28.9% 29.7% (0.8%) (2.8%)

Annual Cost per Payroll FTE Salaries 66,040 66,546 68,401 (1,855) (2.8%) Benefits 16,915 19,223 20,312 (1,089) (5.7%) Total 82,955 85,769 88,712 (2,943) (3.4%)

Cost per Contract FTE 79,350 40,832 45,572 (4,740) (11.6%)

23

Income Statement – Maricopa Medical Center FY 2016 FY 2017 FY 2018

Actual Projected Budget Variance Variance %

OPERATING REVENUE Gross patient revenue 2,058,681,208 2,021,628,583 2,127,177,303 105,548,720 5% Total deductions (1,443,718,730) (1,472,744,411) (1,544,576,904) (71,832,493) (5%) Patient service revenue 614,962,479 548,884,172 582,600,399 33,716,227 6%

Self-pay and bad debt deductions (246,618,727) (181,641,120) (191,218,864) (9,577,744) (5%)

Net patient service revenue 368,343,752 367,243,052 391,381,535 24,138,484 7%

Other revenue 56,145,561 51,259,955 66,489,880 15,229,925 30%

Total operating revenues 424,489,313 418,503,007 457,871,415 39,368,408 9%

OPERATING EXPENSES Salaries and wages 216,324,713 202,434,232 219,572,396 (17,138,164) (8%) Contract labor 5,881,676 13,586,296 10,925,889 2,660,407 20% Employee benefits 55,407,012 58,476,582 65,202,054 (6,725,471) (12%) Medical service fees 68,108,039 61,824,912 66,272,842 (4,447,930) (7%) Supplies 62,510,554 59,263,074 70,730,570 (11,467,496) (19%) Purchased services 25,438,596 22,054,948 24,544,318 (2,489,370) (11%) Other expenses 35,261,832 38,174,718 44,247,416 (6,072,698) (16%) Premium taxes 7,128,740 7,531,224 8,291,912 (760,688) (10%) Depreciation 26,894,751 25,463,369 27,180,995 (1,717,626) (7%)

Total operating expenses 502,955,912 488,809,355 536,968,391 (48,159,036) (10%)

Operating Income (78,466,599) (70,306,348) (79,096,976) (8,790,628) (13%)

24

Income Statement – Maricopa Medical Center FY 2016 FY 2017 FY 2018

Actual Projected Budget Variance Variance %

NONOPERATING REVENUES Noncapital grants 8,200,503 8,819,930 11,510,665 2,690,736 31% Noncapital transfers from County/State 3,547,896 3,547,896 3,547,896 0 0% Investment income 400,762 615,235 720,000 104,765 17% Other nonoperating revenue (expenses) (5,745,940) 25,181,447 (10,550,263) (35,731,711) (142%) Interest expense (2,726,608) (1,977,520) (976,741) 1,000,779 51% Tax levy 102,773,760 110,423,298 113,702,828 3,279,530 3%

Total nonoperating revenues 106,450,373 146,610,285 117,954,385 (28,655,900) (20%)

Excess of revenues over expenses 27,983,774 76,303,938 38,857,410 (37,446,528) (49%)

ASRS Pension Timing Normalization (10,300,582) 0 0 0Bond Related Normalization (33,009,499) (37,771,067) (38,857,149) (1,086,082) (3%)Sale Proceeds Normalization 0 (31,825,423) 0 31,825,423 100%

Normalized excess revenue over expenses (15,326,308) 6,707,447 260 (6,707,187) (100%)

25

Dashboard – Maricopa Medical Center

FY 2016 FY 2017 FY 2018Actual Projected Budget Variance Variance %

Net Patient Revenue/APD 1,518 1,515 1,516 0 0.0%

Operating Revenue/APD (incl. other rev) 1,749 1,727 1,773 46 2.7% Operating Expense/APD 2,072 2,017 2,079 (62) (3.1%)

Labor/APD 916 891 893 (1) (0.1%) Supply/APD 258 245 274 (29) (12.0%)

Operating Income (Loss)/APD (323) (290) (306) (16) (5.6%)

Net Income (Loss) With Bond/APD 115 315 150 (164) (52.2%)

Net Income (Loss) Without Bond/APD (63) 28 0 (28) (100.0%)

Maricopa County



May 24, 2017

Item 5.

Implementation of Proposition 206

Arizona Prop 206 Paid Sick Leave

05.24.17 Mica Goldfeder, Vice President Human Resources

Basic Provisions of Prop 206 Effective July 1, 2017

• Paid Sick Leave applies to all employees, even non-benefitted employees who do not currently accrue paid leave;

• Paid sick leave is accrued at the rate of 1 hour of paid sick leave for every 30 hours worked – up to 40 hours per year;

• Broad definition of “sick leave” that can be used in increments as small as 15 minutes;

• Attendance policies must be revised so that absences related to paid sick leave are not counted against an employee’s attendance record;

• Presumption of retaliation if employee receives discipline within 90 days of taking paid sick leave.

2

Benefit Eligible Employees will use current PTO Bank

• Employers do not need to create a new Sick Leave bank if provide a PTO bank that can be used for broad reasons listed in Prop 206;

• Our current PTO bank meets all of the requirements of the new law;

• There is no additional cost to comply with Prop 206 for Benefit Eligible Employees.

3

Impact on MIHS Attendance Policy

• Employees will not accrue attendance points for PTO used for Paid Sick Leave;

• Employees will be able to use up to 40 hours of “PTO – Sick Leave” each year without attendance points;

• To prevent abuse, MIHS will implement a PTO policy requiring a minimum of 2 hours advanced noticed for use of “PTO – Sick Leave”;

• Employees who fail to give appropriate notice will be subject to progressive disciplinary action.

4

Non-Benefit Eligible Employees will require new Sick Leave Bank

• Pool/PRN employees do not accrue PTO; • To comply with Prop 206, MIHS will provide

a new “Sick Leave” bank for non-benefitted employees;

• Employees will accrue 1 hour of “sick leave” for every 30 hours worked, up to a maximum of 40 hours per year;

• Sick leave is not paid out upon separation from employment at MIHS;

• Projected cost: $800,000 annually.

5

Maricopa County



May 24, 2017

Item 6.a.

Board Policy Statement 99100 G

Policy #99100 G – Board Policy: Governance/Board Member Compensation for Meetings and Travel Page 1 of 2 Date: 04/09 Supersedes: 01/09

Maricopa Integrated Health System: District Governance - Board Policy Statement Effective Date: 12/04 Frequency of Review: Annual Reviewed Dates: Revision Dates: 09/06; 08/07; 01/09; 04/09 Policy #: 99100 G Policy Title: Board Policy – Governance

• Board Member Compensation for Meetings and Travel Scope: [X] District Governance(G) [ ] System-Wide(S) [ ] Multi-divisions(MD) [ ] Division(D) [ ] Multi-departments(MT) [ ] Department(T) Signature: ____________________________________________________________ [William Bruno, Chair - Board of Directors, Maricopa County Special Health Care District] [Date] Purpose: To establish Board member compensation for meetings and travel as specified below. Policy: Approvals In accordance with A.R.S. § 48-5505 (1) the Board shall approve all necessary travel and incidental expenses for which reimbursement is sought by a Board member. This includes authorization of all conference, seminar or meeting registration fees, and all related lodging, air and ground transportation, mileage and meal expenses. Meeting Fees It is the policy of the Board of Directors to compensate Directors for attendance at official Board meetings and to reimburse them for travel expenses as determined by District policies for allowable expenditures incurred while on appropriate Board business. Board members may be compensated for attendance at the following meetings at the maximum allowed by law, $200.00 per day: 1. Full Board Meetings 2. Standing and special committees of the Board 3. Attendance at approved conferences, seminars, or meetings as representatives of the District Board Travel Reimbursement Out-of-town travel expenses by Board members will be reimbursed in accordance with District budget based upon the following guidelines:

Policy #99100 G – Board Policy: Governance/Board Member Compensation for Meetings and Travel Page 2 of 2 Date: 04/09 Supersedes: 01/09

• Designated point of departure for mileage purposes is the Director’s home (This applies to in- town travel also.) • Reimbursement for use of personal vehicle is at the Federal rate for Income Tax purposes. Mileage records should be maintained. (This applies to in-town travel also.) • Use of personal vehicle on trips is reimbursed at the lesser of the approved mileage rate or coach airfare to the same destination. • The Board authorizes in advance, reimbursement of any member’s mileage to and from meetings of

the Board of Directors, to and from meetings of any committees of the Board of Directors, to and from meetings between a board member and an MIHS staff member.

• Receipts are required for lodging, train, airplane, rental car, and any other item over $25.00. • Reimbursement for travel away from the District is to be based on the regulations set out in Title 38,

Chapter 4, Article 2 of the Arizona Revised Statutes. • Requests for reimbursement must be on forms and in a manner prescribed by the District.

Maricopa County



May 24, 2017

Item 6.b.


Policy #99107 G – Board Policy: Governance/ Board Meeting Per Diem Page 1 of 1 Date: 04/17 Supersedes: 00/00

Maricopa Integrated Health System: District Governance - Board Policy Statement Effective Date: 04/17 Reviewed Dates: Revision Dates: Policy #: 99107 G Policy Title: Board Policy – Governance

• Board Meeting Per Diem

Scope: [X] District Governance(G) [ ] System-Wide(S) [ ] Multi-divisions(MD) [ ] Division(D) [ ] Multi-departments(MT) [ ] Department(T) Signature: ____________________________________________________________ [Susan Gerard, Chair - Board of Directors, Maricopa County Special Health Care District] [Date] Policy: Members of the Board of Directors shall serve without compensation; however, in accordance with A.R.S. § 48-5505, each Board member may receive a per diem for attending Board of Directors meetings. This per diem will not exceed, $200 per meeting, as prescribed by A.R.S. § 32-1604. Procedure: 1. On an annual basis, Board members will need to complete a Payment Authorization Form,

selecting the option(s) to receive a per diem. Per diems will be paid on the first pay period of the following month.

2. Per diems will be charged against the Board Office cost center. 3. Board members are eligible for a per diem for all regular, executive session, special and

emergency meetings of the Board of Directors. References: Payment Authorization Form

Maricopa County



May 24, 2017

Item 6.c.


Policy #99108 G – Board Policy: Governance/ Mileage Reimbursement Page 1 of 2 Date: 04/17 Supersedes: 00/00


• Mileage Reimbursement

Scope: [X] District Governance(G) [ ] System-Wide(S) [ ] Multi-divisions(MD) [ ] Division(D) [ ] Multi-departments(MT) [ ] Department(T) Signature: ____________________________________________________________ [Susan Gerard, Chair - Board of Directors, Maricopa County Special Health Care District] [Date] Policy: Members of the Board of Directors shall serve without compensation; however, in accordance with A.R.S. § 48-5505, each Board member is allowed necessary incidental expenses actually incurred in performing official District business. This includes reimbursement of any Board members’ mileage. Procedure: 1. On an annual basis, Board members will need to complete a Payment Authorization Form,

selecting the option(s) to receive mileage reimbursement. Reimbursement will be paid on the first pay period of the following month.

2. Mileage reimbursements will be charged against the Board Office cost center.

3. Mileage will be reimbursed at the prevailing Internal Revenue Service standard mileage rate for business.

4. The designated point of departure and return for mileage purposes is the Board member’s home. 5. Board members will need to provide the following details to the Board Office within 30 days of the

date of travel: the date of travel, the purpose of the meeting, the destination, and total round trip miles. The Board Office will compile the information and submit for reimbursement.

6. Board members are responsible for maintaining their personal vehicle insurance as required by

Arizona law. 7. If a Board member is involved in a motor vehicle accident while using their personal vehicle on

District business, damage to a Board member’s vehicle is not covered by the District’s auto insurance. The District does not pay any out of pocket expenses for physical damage or any portion of a Board member’s deductible.

Policy #99108 G – Board Policy: Governance/ Mileage Reimbursement Page 2 of 2 Date: 04/17 Supersedes: 00/00

8. Repairs made to personal vehicles will not be reimbursed by the District. References: Payment Authorization Form

Maricopa County



May 24, 2017

Item 6.d.


Policy #99109 G – Board Policy: Governance/ Travel and Travel Expense Reimbursement Page 1 of 3 Date: 05/17 Supersedes: 00/00


• Travel and Travel Expense Reimbursement

Scope: [X] District Governance(G) [ ] System-Wide(S) [ ] Multi-divisions(MD) [ ] Division(D) [ ] Multi-departments(MT) [ ] Department(T) Signature: ____________________________________________________________ [Susan Gerard, Chair - Board of Directors, Maricopa County Special Health Care District] [Date] Policy: Members of the Board of Directors shall serve without compensation; however, in accordance with A.R.S. § 48-5505, each is allowed necessary travel and incidental expenses actually incurred in performing official District business. This includes reimbursement to and from Board pre-approved educational conferences and seminars. Procedure: 1. Travel expenses will be charged against the Board Office cost center.

2. Travel expenses for educational conferences or seminars need Board approval prior to travel.

Travel expenses include commercial transportation, mileage, lodging, conference registration fees, and meals and incidentals.

3. The Board Office should be notified immediately of any cancellations. Failure to timely notify the Board Office to cancel, or transfer any and all arrangements that result in charges, or failure to attend, could result, at the Board’s discretion, in a Board member being obligated to pay those charges. However, in the event of accidents, serious illness, or death within the Board member’s immediate family or critical circumstances beyond the control of the Board member, as deemed by the Board, the Board member will not have to pay charges incurred.

4. All air transportation, lodging accommodation, and conference registration must be made through

the Board Office. The Board Office will reserve and pre-pay air transportation, lodging accommodations, and any conference or seminar fees after the Board approved the travel expense.


Procedure, cont.: 5. Air travel is limited to locations outside of Arizona. Airline tickets will be booked as early as

possible to obtain lower pricing and using the lowest available coach class airfare while attempting to meet reasonable needs such as avoidance of multiple connecting flights and lengthy layovers. No more than two (2) Board members will be booked on the same flight.

6. Rental car reservation may be made by the Board Office in advance when out of state, however,

rental cars are not paid for in advance and are considered a reimbursable expense. The use of a rented car must only be used when other means of transportation are unavailable and not as a matter of personal convenience. Car rentals will be intermediate-size cars or smaller. Rental cars should be refueled prior to return to avoid refueling surcharges. Gas purchased when using a rental car is reimbursable with receipts.

7. Travel by personal vehicle is permitted for out of state travel in lieu of air travel. Mileage will be

reimbursed at the current IRS standard mileage rate up to the amount of the lowest priced roundtrip commercial air option available at the time of travel. When more than one Board member is traveling by the same personal vehicle to a board approved conference or seminar, only one mileage reimbursement may be allowed.

8. If a Board member is involved in a motor vehicle accident while using their personal vehicle on

District business, damage to a Board member’s vehicle is not covered by the District’s auto insurance. The District does not pay any out of pocket expenses for physical damage or any portion of a Board member’s deductible.

9. Repairs made to personal vehicles will not be reimbursed by the District. 10. When a conference is held at a hotel, such hotel shall be used for lodging when possible. Travel

discounts for conference attendees may have been negotiated by the sponsoring organization. The Board Office will take advantage of these when possible.

11. Meals and incidental expenses shall not exceed the amounts published by the GSA and will

follow the GSA guidelines for travel days; which will be reimbursed at 75% of the determined rate. Meals and incidentals reimbursements will not be made when an overnight stay is not needed or when the location is less than 50 miles from the departure point (Board member’s residence).

12. Baggage fees, airport parking and taxi cab fare are considered a reimbursable expense. 13. Reimbursement requests shall be made within 30 days of travel. 14. Any expenses incurred over the Board approved amount are the personal responsibility of the

respective Board Member. 15. The District will not reimburse expenses incurred by a spouse and/or guest in connection with

travel of Board member. 16. Non-reimbursable expenses include:

Tips (that is included in meals and incidentals rates) In room movies, spa or resort services or fees, laundry or dry cleaning costs Alcoholic beverages (both in-flight and during travel) In flight movies Traffic or parking fines Trip and auto insurance

Theft, loss or damage to personal property Child care expenses Air, hotel, and auto upgrade fees


References: Payment Authorization Form

Maricopa County



May 24, 2017

Item 6.e.


Policy #99105 G – Board Policy: Governance/Insurance/Bonds for Board and District Employees Page 1 of 1 Date: 05/1701/15 Supersedes: 01/1503/13

Maricopa Integrated Health System: District Governance - Board Policy Statement Effective Date: 08/06 Reviewed Dates: 02/10, 02/11, 5/17 Revision Dates: 03/09, 03/13, 01/15, 5/17 Policy #: 99105 G Policy Title: Board Policy - Governance

• –Insurance/Bonds for Board and District Employees Scope: [X] District Governance(G) [ ] System-Wide(S) [ ] Multi-divisions(MD) [ ] Division(D) [ ] Multi-departments(MT) [ ] Department(T) Signature: ____________________________________________________________ [Susan GerardTerence M. McMahon, Chair - Board of Directors, Maricopa County Special Health Care District] [Date] Policy: All members of the Board of Directors and other Maricopa County Special Health Care District employees authorized to receive or disburse funds of the District will be provided either insurance or bonds, in an amount required by law or, if none, in an amount determined by the Board or Director of Risk Management for the faithful performance of their duties. The District, through its Director of Risk Management or its designee, shall pay for such insurance or bonds for its Board and District employees. In lieu of bonds, the Director of Risk Management is authorized under the Amended and Restated Maricopa County Special Health Care District Risk Management Insurance and Self-Insurance Plan, to procure and maintain comparable insurance coverage, including crime, employee dishonesty, fidelity and Board of Directors and District Officers liability insurance, to protect the interests of the District, its Board of Directors and District employees that would otherwise be protected by either insurance or bonds to insure faithful performance of duties.

Maricopa County



May 24, 2017

Item 7. No Handout

M. Talbot Position

Maricopa County



May 24, 2017

Item 8.a.

Reports to the Board Monthly Proposition 480 Capital

Purchases Update


PROPOSITION 480 - 1st offering

Note: Current month activity highlighted in 'YELLOW' - prior months amount paid are also hidden

Department Grouping Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid

Feb 2017 Mar 2017 Apr 2017 Cumulative Total

IT eSTF - Enterprise Strengthening the Foundation (see attached for detail) 14,000,000$ 17-900 14,000,000$ 2,517,148$ 4,019,851$ 862,034$ 12,776,663$

108213 IT Client & Mobility (Phase 1) 4,340,400$ 16-934 1,356,068$ 3,201$ 3,033$ 372,308$ 995,653$

Client & Mobility (Phase 2) 17-906 1,377,677$ -$

108212 IT IPT (PBX Replacement) 3,000,000$ 16-909 3,000,000$ -$

108212 IT Legacy Storage (DP-007) 2,500,000$ 16-910 2,500,000$ 68,550$ 1,740,683$

108220 IT Single Sign on 500,000$ -$

108216 IT Fluency Enterprise 450,000$ -$

108220 IT Perimeter, Internal security 700,000$ 16-900 67,176$ 67,188$

108213 IT Epic 2014 Monitors (Phase 1) 1,050,000$ 16-933 421,500$ 7,500$ 72,500$ 218,000$

Epic 2014 Monitors (Phase 2) 17-905 457,910$ -$

108216 IT LCM 200,000$ 16-937 125,000$ 12,600$ 126,936$

108216 IT Epic Modules 150,000$ -$

105411 IT PeriCalm or GEConnect smart tracing software 115,269$ -$

108216 IT EPCS 75,000$ -$

108250 IT new software for Contract approval routing 35,000$ -$

108216 IT Integration 10,000$ -$

108216 IT VNA & Universal PACS Viewer 1,200,000$ -$

108220 IT SEIMS 250,000$ -$

108213 IT MyChart Bedside Tablets 240,000$ -$

108216 IT Integration SOA Architecture 2,400,000$ -$

108216 IT Software Quality Assurance 600,000$ -$

ITPWIM Global Monitor Software - additional funding required to support

implementation of CER15-075, Cloverleaf Availability33,200$ 16-924 35,400$ 35,400$

Total Budgeted Amount 31,848,869$ 23,340,731$ 2,588,899$ 4,030,383$ 1,319,442$ 15,960,521$

Allocated Bond Funding 33,000,000$ 33,000,000$ 33,000,000$

(Over) / Under 1,151,131$ 9,659,269$ 17,039,479$



108212 IT EPIC replatform and upgrade to 2016 9,000,000$ -$

Total Budgeted Amount 9,000,000$ -$ -$ -$ -$ -$

Allocated Bond Funding -$ -$ -$

(Over) / Under (9,000,000)$ -$ -$




107701 Clinical Patient monitors - High Acuity 6,979,132$ 16-908 6,979,132$ 7,583$ 6,441,536$

107701 Clinical Pyxsis upgrade 2017 1,175,211$ -$

Responsible owner - Kelly Summers (CIO)

Responsible owner - Sherry Stotler (CNO)

Responsible owner - Kelly Summers (CIO)



208100 Clinical Unit 10 Phase II 450,000$ -$

107701 Clinical Stretcher replacement 403,200$ 16-912 398,013$ 48,225$ 395,538$

105546 Clinical IVUS - intravascular ultrasound for placement of stents 160,000$ 16-922 132,500$ 128,048$

107701 Clinical Vigileo Monitors (8) 112,000$ 16-928 111,930$ 96,016$

105460 Clinical Balloon Pumps 110,000$ 16-920 142,151$ 146,300$

208100 Clinical Convert Unit 2 at DV to an Adolescent Unit 100,000$ -$

106430 Clinical Endo Tower 80,000$ -$

476205 Clinical Zeiss - Cirrus HD opthal camera 60,655$ 16-919 60,655$ 60,654$

107701 Clinical Vivid Q BT12 Ultrasound 55,750$ 16-931 55,750$ 55,000$

106430 Clinical Colonoscopes 50,000$ -$

107701 Clinical Zoll Thermoguard XP (formerly Alsius) 33,230$ 16-906 33,230$ 33,230$

107701 Clinical Replacement of tray line for room service project 33,000$ -$

105431 Clinical Flexible Ureteroscope (2) 13,390$ -$

105431 Clinical 3:1 Mesher 13,300$ 16-927 13,300$ 12,870$

105431 Clinical 1:1 Mesher 26,600$ 16-927 26,600$ 26,190$

105431 Clinical 2:1 Mesher 26,600$ 16-927 26,911$ 26,190$

496204 Clinical Urodynamics machine (for surgery clinic) 22,835$ 16-929 17,935$ 17,935$

104201, 104202 Clinical UltraMist System 20,120$ 16-925 24,670$ 20,195$

104582 Clinical Replace Chair in Eye Room 20,000$ -$

107452 Clinical EVS UV floor equipment 18,500$ -$

105482 Clinical Fluid Warmers 6,494$ -$

105482 Clinical Puffer Tenometer 5,200$ -$

105431 Clinical Doppler 3,950$ 16-935 3,950$ 3,950$

107701 Clinical Autostainer (Histology) 47,000$ -$

496201 Clinical Ultrasound (for breast clinic) 27,821$ 16-931 27,821$ 22,685$

105431 Clinical Biom 5 10,513$ 16-930 10,513$ 8,051$

105431 Clinical HINNI Laryngoscope 8,645$ -$

105431 Clinical wilson frame 5,253$ -$

208100 Clinical medical beds for psych units 209,968$ 16-932 207,429$ 208,879$

105431 Clinical King Tong Pelvic fx reducer 8,600$ 16-926 9,500$ 9,500$

105431 Clinical Stryker Core Power Equipment --Contract 369,113$ 16-904 369,113$ 369,113$

107701 Clinical Patient Monitoring (Low Acuity) - Formerly named Alarm Management 350,010$ 16-907 350,010$ 336,319$

107701 Clinical AIMS Upgrade 176,382$ 16-901 52,482$ 51,232$

107701 Clinical AIMS Upgrade 16-902 12,000$ 12,000$

107701 Clinical AIMS Upgrade 16-903 101,500$ 112,850$

107701 Clinical Temperature Monitoring - Non FQHC Depts 150,000$ 17-908 119,219$ -$

105420 Clinical Blood Culture Instrument Lease 88,650$ -$

Clinical 2 Pillcams for Endo 13,950$ -$

Clinical Replace 11 ultrasounds 1,307,000$ 16-931 1,307,000$ 1,139,331$

Clinical POC Ultrasounds (10) 450,000$ 16-931 455,128$ 640,327$

Total Budgeted Amount 13,202,072$ 11,048,441$ 48,225$ -$ 7,583$ 10,373,939$


(Over) / Under (202,072)$ 1,951,559$ 2,626,061$






107702 Facilities Plant upkeep and repair 2,420,000$ -$

Ice Machine Replacement 16-911 23,801$ 23,000$

Steam Condensate Return Piping Replacement 16-914 62,569$ 62,529$

107702 Facilities Minor renovations 1,080,000$ -$

105411 Facilities Replace OR Cabinets 30,000$ -$

107751 Facilities Batteries 12,000$ -$

107702 Facilities Roof Repair/Replacement 1,500,000$ -$

Facilities MMC 7th Floor Roof 16-905 276,425$ 274,582$

-$

Total Budgeted Amount 5,042,000$ 362,795$ -$ -$ -$ 360,112$


(Over) / Under (42,000)$ 4,637,205$ 4,639,888$




107702 Ambulatory Facility upkeep 600,000$ 17-910 3,655$ -$

496205 Ambulatory Cannon CR2 Fundus Camera 33,292$ 16-936 33,292$ -$

476101 Ambulatory Colposcopes 21,000$ -$

416608 Ambulatory Chandler-Modular work stations 19,000$ -$

476101 Ambulatory Construction -Refugee Interpreter Resource Room 12,000$ -$

456503 Ambulatory Chandler ADA Doors 15,000$ -$

456407 Ambulatory Glendale Digital X-Ray unit and Sensors (Panoramic Digital AND Nomad digital) 53,789$ 16-917 68,202$ 63,217$

Ambulatory Avondale Digital X-Ray unit and Sensors -$

456503 Ambulatory Chandler Dental Digital Radiology - Panoramic x-ray 65,264$ 16-915 65,264$ 63,564$

456401 Ambulatory CHC - Digital Panoramic x-ray 63,819$ 16-916 63,819$ 60,419$

Ambulatory CHC Dental Replace Chairs Lights, Compressor and Deliverey Units 127,642$ -$

Ambulatory CHC Cost for new equipment and cost of moving existing to Avondale X-Ray 50,000$ 16-921 70,276$ 83,327$

Ambulatory Avondale- Replace all flooring. 65,593$ 17-904 70,435$ -$

Ambulatory Temperature Monitoring - FQHC Depts 100,000$ 17-909 52,936$ -$

Ambulatory McDowell Dental 19,390$ 16-918 15,990$ 15,990$

476106 Ambulatory

CHC Internal Medicine Clinic Renovation - Increase the number of exam rooms to

accommodate 1st, 2nd & 3rd yr residents as of July 1, 2017 plus the attendings and

midlevel providers, improve operations, clnic flow and space allocation.

212,741$ -$

456404 Ambulatory CHC Dental Autoclave Replacement including printer & Cassette rack 30,930$ -$

456403 Ambulatory Chandler Dental Autoclave Replacement including printer and Cassette rack 6,186$ -$

456404 Ambulatory South Central Dental Autoclave Replacement including printer and Cassette rack 6,186$ -$

456405 Ambulatory Avondale Dental Autoclave Replacement including printer and Cassette rack 12,372$ -$

456406 Ambulatory Mea Dental Autoclave Replacement including printer and Cassette rack 6,186$ -$

456407 Ambulatory Glendale Dental Autoclave Replacement including printer and Cassette rack 12,372$ -$

Responsible owner - Kris Gaw (COO)

Responsible owner - Wyatt Howell (CAO) - updated listing per MHCGC



456407 Ambulatory Glendale Dental Facility Suction Pump 2,253$ -$

456407 Ambulatory Glendale Dental Compressor 4,191$ -$

Ambulatory FQHC Contingency 1,460,794$

Ambulatory FHC Helmer Medical Refrigerators 17-714 11,110$ 11,110$

Ambulatory FHC Helmer Medical Refrigerators 17-901 156,625$ -$

Ambulatory FQHC Contingency - addtl camera -$ 16-936 42,587$ -$

Total Budgeted Amount 3,000,000$ 654,191$ -$ -$ -$ 297,627$


(Over) / Under -$ 2,345,809$ 2,702,373$




908100 Contingency Bond related expenses (legal fees, etc.) 325,646$ N/A 325,646$ 325,646$

107701 Contingency Audiology - Astera Audiometer 11,326$ 16-913 11,326$ 11,326$

908103 Contingency 3rd Floor Behavioral Health/Medical Unit Remodel 2,532,000$ 17-903 2,532,000$ 143,264$ 143,264$

Contingency 22 Behavioral Health Beds for 3rd Floor MMC 181,773.24$ 17-907 181,773.24$ -$

-$

Total Budgeted Amount 3,050,745$ 3,050,745$ -$ -$ 143,264$ 480,236$


(Over) / Under 2,949,255$ 2,949,255$ 5,519,764$




108100 Strategic Navigant - Proposition 480 planning 994,000$ 16-923 994,000$ 994,000$

Kaufmann Hall - Prop 480 pllanning 170,000$ 16-923 170,000$ 170,000$

IPv4Xchange (ARIN Based Transfer Escrow Payment) 7,040$ 16-923 7,040$ 7,040$ 7,040$

Vanir Construction Management 749,971$ 16-923 749,971$ 330,932$ 646,820$ 977,752$

IMPO Modular Building 240,948$ 17-902 240,948$ -$

Dickerson Wright PLLC 53,751$ 16-923 53,751$ 29,901$ 23,850$ 53,751$

Sims Murrary LD 6,145$ 16-923 6,145$ 6,145$ 6,145$

Payroll 150,607$ 16-923 150,607$ 27,440$ 37,879$ 39,932$ 150,607$

-$

Total Budgeted Amount 2,372,462$ 2,372,462$ 27,440$ 411,896$ 710,602$ 2,359,295$


Responsible owner - Kathy Benaquista (CFO)

Responsible owner - Susan Doria (SVP-Strategic Planning)



(Over) / Under 7,627,538$ 7,627,538$ 7,640,705$




Reimbursement for Capital Expenditures 36,000,000$ N/A 36,000,000$ 36,000,000$

Total Budgeted Amount 36,000,000$ 36,000,000$ -$ -$ -$ 36,000,000.00$

Allocated Bond Funding 36,000,000$ 36,000,000$ 36,000,000.00$

(Over) / Under -$ -$ -$


Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid


GRAND TOTALS 106,000,000$ 76,829,366$ 2,664,563$ 4,442,280$ 2,180,891$ 65,831,729$

VARIANCE: Budgeted amount vs CER amount issued 29,170,634$

Remaining cash in the bank 40,168,271$

Interest income earned -

ACTUAL cash in the bank 40,168,270.57$

Responsible owner - Kathy Benaquista (CFO)


PROPOSITION 480

Enterprise Strenghtening the Foundation Project (eSTF)

Approved by District Board on October 26, 2016

Total Budgeted Amount - CER #17-900 23,000,000$

Vendor Description Budgeted Amount Amount Paid Amount Paid Amount Paid Amount Paid

Cumulative Total

Feb 2017 Mar 2017 Apr 2017

Guidesoft 63286 LAN Design Services 145,900$ 145,900$ 145,900$

Guidesoft 57850 Network Design Services 385,597$ 192,799$ 385,597$

WWT 63741 Design Validation 29,461$ -$

Guidesoft 41230/57249 Compute and Network Consultant Services 42,840$ 57,973$

Bluetree 59858 EPIC Technical Architect - Consultant Services 722,375$ 26,626$ 65,077$ 35,739$ 236,713$

WWT 63662 Purchase of Palo Alto equipment 820,740$ 707,592$ 820,740$

WWT 63663 Purchase of F5 equipment 497,950$ 159,839$ 428,346$

WWT 64111 Purchase of Infoblox equipment 349,005$ 2,660$ 55,828$ 286,601$

WWT 63285 Purchase of Cisco Equipment 6,669,041$ 1,783,538$ 3,213,826$ 6,434,334$

WWT 63661 Purchase of EMC equipment 2,970,852$ 2,970,852$

WWT TBD Integration Services 116,100$ -$

HyeTech 69042 Hyetech Implementation Services 4,461,339$ 345,500$ 345,500$

Guidesoft 69175 vCore Implementation Services 621,620$ 117,905$ 117,905$

Epic 70514 Epic Gap Analysis and Upgrade professional services 573,300$ 1,618$ 1,618$

IPV4 Xchange PCARD Domain and IP address Registration 7,715$ -$

WWT 64112 Purchase of APC equipment 332,893$ 3,347$ 3,347$

CDW 66876 Software Licenses and Subscription (Microsoft) 376,291$ 368,286$ 368,286$

WWT 66878 Purchase of Racks and Cables 105,325$ 14,480$ 56,173$ 70,653$

SHI 66613 Software Licenses and Subscription (Linux, Security) 58,531$ 14,596$ 24,144$ 38,741$

CTS 66877 Cabling and Fiber 102,340$ 46,447$ 46,447$

Lanmor 66875 Badge Readers 209,036$ -$

CenturyLink 66874 Racks and Structured Cabling 284,948$ -$

RMJ Electric 66873 Power Remediation 60,550$ 17,110$ 17,110$

Graybar 70926 Fiber Optics 32,681$ -$

OST 72655 EPIC replatform, rehost, testing 400,910$ -$

20,377,340$ 2,517,148$ 4,019,851$ 862,034$ 12,776,663$

Remaining Budgeted Amount 2,622,660$

Maricopa Integrated Health System

Bond Proceeds account

10-901000-102140

Beginning balance - 02/01/17 49,477,035.91$

Less:Interest income (Transfered) (21,031.30)$

Less:Stryker Sales Corp 16-912 Patient Monitoring (48,224.61) Payroll 16-923 SVP-Strategic Planning (27,439.57) Carahsoft Technology Corp 16-934 Client & Mobility (3,201.20) Guidesoft 17-900 eSTF (Network Design Project) (72,950.00) Guidesoft 17-900 eSTF (Network Design Project) (72,950.00) Guidesoft 17-900 eSTF (Network Design Project) (68,550.00) Guidesoft 17-900 eSTF (Network Design Project) (96,399.25) Guidesoft 17-900 eSTF (Network Design Project) (96,399.25) World Wide Technology 17-900 eSTF (Network Design Project) (70,200.00) World Wide Technology 17-900 eSTF (Network Design Project) (81,665.92) World Wide Technology 17-900 eSTF (Network Design Project) (645,669.68) World Wide Technology 17-900 eSTF (Network Design Project) (691,891.92) World Wide Technology 17-900 eSTF (Network Design Project) (2,042.06) World Wide Technology 17-900 eSTF (Network Design Project) (92,629.36) World Wide Technology 17-900 eSTF (Network Design Project) (61,541.57) World Wide Technology 17-900 eSTF (Network Design Project) (137,897.68) Bluetree Network 17-900 eSTF (Network Design Project) (1,231.16) Bluetree Network 17-900 eSTF (Network Design Project) (16,160.00) Bluetree Network 17-900 eSTF (Network Design Project) (1,554.54) Bluetree Network 17-900 eSTF (Network Design Project) (7,680.00) CDW Government 17-900 eSTF (Network Design Project) (284.40) CDW Government 17-900 eSTF (Network Design Project) (5,730.95) CDW Government 17-900 eSTF (Network Design Project) (313.12) CDW Government 17-900 eSTF (Network Design Project) (153,460.01) CDW Government 17-900 eSTF (Network Design Project) (208,497.17)

(2,664,563.42)$

Ending balance - 02/28/17 46,791,441.19$


Less:Payroll 16-923 SVP-Strategic Planning (37,878.71) IPv4Xchange (ARIN Based Transfer Escrow Payment) 16-923 SVP-Strategic Planning (7,040.00) Vanir Construction Management 16-923 SVP-Strategic Planning (330,931.90) DICKINSON WRIGHT PLLC 16-923 SVP-Strategic Planning (29,901.00) SIMS MURRAY LTD 16-923 SVP-Strategic Planning (6,144.60) HP INC 16-933 Epic Monitors (7,500.00) Carahsoft Technology Corporation 16-934 Client & Mobility (3,032.66) Bluetree Network 17-900 eSTF (Network Design Project) (4,455.00) Bluetree Network 17-900 eSTF (Network Design Project) (19,040.00) Bluetree Network 17-900 eSTF (Network Design Project) (18,200.00) Bluetree Network 17-900 eSTF (Network Design Project) (1,554.46) World Wide Technology 17-900 eSTF (Network Design Project) (2,660.08) World Wide Technology 17-900 eSTF (Network Design Project) (707,592.00) World Wide Technology 17-900 eSTF (Network Design Project) (21,150.00) World Wide Technology 17-900 eSTF (Network Design Project) (19,596.64) World Wide Technology 17-900 eSTF (Network Design Project) (133,943.71) World Wide Technology 17-900 eSTF (Network Design Project) (317,040.60) World Wide Technology 17-900 eSTF (Network Design Project) (25,477.74) World Wide Technology 17-900 eSTF (Network Design Project) (51,201.36) World Wide Technology 17-900 eSTF (Network Design Project) (2,639,106.64) World Wide Technology 17-900 eSTF (Network Design Project) (6,309.56) World Wide Technology 17-900 eSTF (Network Design Project) (214.00) SHI International Corp 17-900 eSTF (Network Design Project) (13,486.03) SHI International Corp 17-900 eSTF (Network Design Project) (1,110.45) Bluetree Network 17-900 eSTF (Network Design Project) (18,120.00) Bluetree Network 17-900 eSTF (Network Design Project) (3,707.99) World Wide Technology 17-900 eSTF (Network Design Project) (790.08) World Wide Technology 17-900 eSTF (Network Design Project) (13,476.38) Epic System Corporation 17-900 eSTF (Network Design Project) (1,618.00)

(4,442,279.59)$

Ending balance - 03/31/17 42,349,161.60$


Less:DATEX OHMEDA 16-908 Patient Monitoring (3,563.45) DATEX OHMEDA 16-908 Patient Monitoring (335.35) DATEX OHMEDA 16-908 Patient Monitoring (3,556.80) DATEX OHMEDA 16-908 Patient Monitoring (292.60) DATEX OHMEDA 16-908 Patient Monitoring (138.60) DATEX OHMEDA 16-908 Patient Monitoring (95.68) DATEX OHMEDA 16-908 Patient Monitoring 399.12 Payroll 16-923 SVP-Strategic Planning (39,932.00) Dickinson Wright 16-923 SVP-Strategic Planning (23,850.00) VANIR CONSTRUCTION MANAGEMENT INC 16-923 SVP-Strategic Planning (367,867.70) VANIR CONSTRUCTION MANAGEMENT INC 16-923 SVP-Strategic Planning (51,171.00) VANIR CONSTRUCTION MANAGEMENT INC 16-923 SVP-Strategic Planning (227,781.00) HP INC 16-933 Epic Monitors (67,500.00) HP INC 16-933 Epic Monitors (5,000.00) HP INC 16-934 Client & Mobility (92,880.00) HP INC 16-934 Client & Mobility (858.00) HP INC 16-934 Client & Mobility (5,090.00) HP INC 16-934 Client & Mobility (585.00) HP INC 16-934 Client & Mobility (95.00) HP INC 16-934 Client & Mobility (155.00) HP INC 16-934 Client & Mobility (254,560.00) HP INC 16-934 Client & Mobility (6,108.00) HP INC 16-934 Client & Mobility (702.00) HP INC 16-934 Client & Mobility (8,985.00) HP INC 16-934 Client & Mobility (745.00) HP INC 16-934 Client & Mobility (209.00) HP INC 16-934 Client & Mobility (341.00) CARAHSOFT TECHNOLOGY CORPORATION 16-934 Client & Mobility (994.96) Forsythe Technology 16-937 LCM (1,800.00) Forsythe Technology 16-937 LCM (10,800.00) CORPORATE TECHNOLOGY SOLUTIONS LLC 17-900 eSTF (Network Design Project) (13,618.47) CORPORATE TECHNOLOGY SOLUTIONS LLC 17-900 eSTF (Network Design Project) (32,828.78) HP INC 17-900 eSTF (Network Design Project) (17,970.00) HP INC 17-900 eSTF (Network Design Project) (1,490.00) HP INC 17-900 eSTF (Network Design Project) (190.00) HP INC 17-900 eSTF (Network Design Project) (310.00) Bluetree Network 17-900 eSTF (Network Design Project) (18,659.24) Guidesoft 17-900 eSTF (Network Design Project) (117,905.00) WORLD WIDE TECHNOLOGY INC 17-900 eSTF (Network Design Project) (3,990.00) HYE TECH NETWORK AND SECURITY SOLUTIONS 17-900 eSTF (Network Design Project) (345,500.00) SHI INTERNATIONAL CORP 17-900 eSTF (Network Design Project) (24,144.48) WORLD WIDE TECHNOLOGY INC 17-900 eSTF (Network Design Project) (22,828.44) WORLD WIDE TECHNOLOGY INC 17-900 eSTF (Network Design Project) (2,233.00) WORLD WIDE TECHNOLOGY INC 17-900 eSTF (Network Design Project) (29,990.00) WORLD WIDE TECHNOLOGY INC 17-900 eSTF (Network Design Project) (132,104.17) WORLD WIDE TECHNOLOGY INC 17-900 eSTF (Network Design Project) (3,347.36) WORLD WIDE TECHNOLOGY INC 17-900 eSTF (Network Design Project) (33,000.00) RMJ ELECTRICAL CONTRACTORS INC 17-900 eSTF (Network Design Project) (2,850.00) RMJ ELECTRICAL CONTRACTORS INC 17-900 eSTF (Network Design Project) (8,995.00) BLUETREE NETWORK INC 17-900 eSTF (Network Design Project) (17,080.00) WORLD WIDE TECHNOLOGY INC 17-900 eSTF (Network Design Project) (27,735.07) RMJ ELECTRICAL CONTRACTORS INC 17-900 eSTF (Network Design Project) (5,265.00) KITCHELL CONTRACTORS INC OF ARIZONA 17-903 3rd Floor Remodel (143,264.00)

(2,180,891.03)$

Ending balance - 04/30/17 40,168,270.57$


Bond Interest & Redemption account

10-901000-102150


Add:Maricopa County collection (Bond levy) 703,162.98 Interest income 21,031.30 Less:Principal & Interest payment - JP Morgan Ending balance - 02/28/17 24,999,315.21$


Add:Maricopa County collection (Bond levy) 1,147,350.26 Interest income Less:Principal & Interest payment - JP Morgan Ending balance - 03/31/17 26,146,665.47$


Add:Maricopa County collection (Bond levy) 1,954,146.48 Interest income Less:Principal & Interest payment - JP Morgan Ending balance - 04/30/17 28,100,811.95$

Maricopa County



May 24, 2017

Item 8.b.

Reports to the Board Key Indicator Dashboard and

Financial Report

Maricopa Integrated Health SystemKey Indicator Dashboard April 30, 2017

Maricopa Integrated Health SystemKey Indicator Dashboard - OperationalApril 30, 2017

Actual Budget Variance Var % Actual Budget Variance Var % Actual Variance Var %

Labor

FTE/AOB WO Residents 4.72 4.62 (0.11) (2.3%) 4.68 4.61 (0.07) (1.5%) 4.66 (0.02) (0.4%)Turnover Rate - Voluntary 1.19% 14.23%Turnover Rate - Involuntary 0.31% 3.97%Turnover Rate - Uncontrollable 0.03% 1.60%Turnover Rate - Total 1.54% 19.81%

Acute

Admissions 951 983 (32) (3.3%) 9,113 10,400 (1,287) (12.4%) 10,357 (1,244) (12.0%)

Length of Stay (LOS) 4.6 5.1 0.5 9.6% 4.9 4.9 0.0 0.4% 4.9 0.1 1.1%

Patient Days 4,370 4,996 (626) (12.5%) 44,409 50,886 (6,477) (12.7%) 51,022 (6,613) (13.0%)

Acute - Observation Days and Admits

Observation Days 468 381 86 22.6% 5,115 3,796 1,319 34.7% 3,882 1,233 31.8%

Observation Admission - Transfer to Inpatient 126 81 45 55.6% 1,203 898 305 34.0% 982 221 22.5%

Observation Admission Only 340 286 54 18.7% 3,736 2,825 911 32.3% 3,074 662 21.5%

Total Admissions - Acute plus Observation Only 1,291 1,269 22 1.7% 12,849 13,225 (376) (2.8%) 13,431 (582) (4.3%)

Behavioral Health

Admissions 285 276 9 3.3% 2,784 2,870 (86) (3.0%) 2,730 54 2.0%

Length of Stay (LOS) 21.5 21.0 (0.5) (2.4%) 22.3 21.4 (0.9) (4.3%) 21.2 (1.1) (5.1%)

Patient Days 6,123 5,791 332 5.7% 62,047 61,340 707 1.2% 57,893 4,154 7.2%

Case Mix Index

Total Hospital 1.48 1.38 0.10 7.2% 1.46 1.38 0.08 5.8% 1.40 0.06 4.3%

Acute (Excluding Newborns) 1.66 1.59 0.07 4.4% 1.66 1.59 0.07 4.4% 1.61 0.05 3.1%

Behavioral Health 1.06 1.02 0.04 3.9% 1.05 1.02 0.03 2.9% 1.02 0.03 2.9%

Medicare 1.86 2.09 (0.23) (11.0%) 2.21 2.09 0.12 5.7% 2.13 0.08 3.8%

AHCCCS 1.79 1.65 0.14 8.5% 1.71 1.65 0.06 3.6% 1.65 0.06 3.6%

Current Month CY Year to Date PY Year to Date

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Maricopa Integrated Health SystemKey Indicator Dashboard - OperationalApril 30, 2017

Actual Budget Variance Var % Actual Budget Variance Var % Actual Variance Var %Current Month CY Year to Date PY Year to Date

Ambulatory

Family Health Centers (FHC) Visits 14,850 17,911 (3,061) (17.1%) 149,355 174,687 (25,332) (14.5%) 170,521 (21,166) (12.4%)Whole Health Home (WHH) Visits 665 868 (203) (23.4%) 7,254 8,103 (849) (10.5%) 9,098 (1,844) (20.3%)Comprehensive Health Center (CHC) Visits 12,983 14,842 (1,859) (12.5%) 129,851 135,906 (6,055) (4.5%) 136,390 (6,539) (4.8%)

Subtotal : 28,498 33,621 (5,123) (15.2%) 286,460 318,696 (32,236) (10.1%) 316,009 (29,549) (9.4%)

Dental Clinics Visits 1,858 1,809 49 2.7% 19,160 18,290 870 4.8% 21,156 (1,996) (9.4%)7th Ave Walk-In Clinic Visits 1,692 2,293 (601) (26.2%) 18,593 21,866 (3,273) (15.0%) 21,292 (2,699) (12.7%)

Total Ambulatory Visits : 32,048 37,723 (5,675) (15.0%) 324,213 358,852 (34,639) (9.7%) 358,457 (34,244) (9.6%)

Hospital

Surgical Center (SURG) - Total IP & OP Surgeries 557 647 (90) (13.9%) 5,873 6,182 (309) (5.0%) 6,353 (480) (7.6%)Surgical Center (SURG) - Total Surgical Minutes 64,890 73,848 (8,958) (12.1%) 671,535 712,256 (40,721) (5.7%) 728,160 (56,625) (7.8%)Surgical Center (SURG) - Minutes per Case 116 114 (2.4) (2.1%) 114 115 0.9 0.8% 115 0.3 0.2%

Operating Room Utilization 61% 70% (9.3%) (13.3%) 61% 70% (9.3%) (13.3%) 67% (5.9%) (8.8%)

Deliveries 150 186 (36) (19.4%) 1,991 2,144 (153) (7.1%) 2,067 (76) (3.7%)

Trauma Visits (subset of ED Visits) 183 168 15 8.9% 1,918 1,689 229 13.6% 1,744 174 10.0%

Emergency Department (ED) 6,543 6,889 (346) (5.0%) 62,817 65,981 (3,164) (4.8%) 66,317 (3,500) (5.3%)

Adult ED 4,000 4,109 (109) (2.7%) 39,702 40,113 (411) (1.0%) 40,729 (1,027) (2.5%) Peds ED 2,078 2,238 (160) (7.1%) 17,457 19,993 (2,536) (12.7%) 19,779 (2,322) (11.7%) L&D ED 280 394 (114) (28.9%) 3,678 3,950 (272) (6.9%) 3,880 (202) (5.2%) Burn ED 185 148 37 25.0% 1,980 1,925 55 2.9% 1,929 51 2.6%

% of Total ED Visits Resulting in Admission Adult 15.0% 14.3% 0.7% 4.8% 12.7% 14.1% (1.4%) (9.9%) 14.0% (1.3%) (9.2%) % of Total ED Visits Resulting in Admission Peds 3.5% 5.3% (1.8%) (33.9%) 4.0% 4.6% (0.6%) (13.7%) 4.8% (0.8%) (16.8%) Left Without Treatment (LWOT) ADULT 2.9% <3% 0.1% 2.8% 2.4% <3% 0.6% 19.0% 3.2% 0.8% 24.1% Left Without Treatment (LWOT) PEDIATRICS 0.8% <3% 2.2% 74.3% 0.3% <3% 2.8% 91.7% 0.8% 0.5% 68.4%

Overall ED Median Length of Stay (minutes) ADULT 240 <240 - 0.0% 241 <240 (1) (0.4%) 258 17 6.6% Overall ED Median Length of Stay (minutes) PEDS 133 <220 87 39.5% 121 <220 99 45.0% 148 27 18.2% PSYCH ED Median LOS (minutes) ADULT 549 <0 (549) (100.0%) 594 <0 (594) (100.0%) 747 153 20.4% PSYCH ED Median LOS (minutes) PEDS 1,968 <0 (1,968) (100.0%) 1,306 <0 (1,306) (100.0%) 2,091 785 37.5%

Median Time to Treatment (MTT) (minutes) ADULT 26 <30 4 13.3% 24 <30 6 20.0% 24 0 0.0% Median Time to Treatment (MTT) (minutes) PEDS 23 <30 7 23.3% 20 <30 10 33.3% 33 13 39.4% % of Acute Patients Admitted Through the ED 63.0% 59.7% 3.3% 5.5% 55.4% 54.5% 1.0% 1.8% 55.1% 0.3% 0.6%

Cath Lab Utilization - Room 1 35% 45% (10.3%) (23.0%) 35% 45% (9.9%) (22.1%) 38% (2.5%) (6.6%)Cath Lab Utilization - Room 2 31% 45% (13.6%) (30.3%) 34% 45% (11.5%) (25.5%) 42% (8.5%) (20.2%)Cath Lab Utilization - IR 62% 65% (3.1%) (4.7%) 61% 65% (3.8%) (5.9%) 48% 13.5% 28.3%CCTA/Calcium Score 17 15 2 13.3% 127 150 (23) (15.3%) 145 (18) (12.4%)

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Maricopa Integrated Health SystemKey Indicator Dashboard - FinancialApril 30, 2017

Actual Budget Variance Var % Actual Budget Variance Var % Actual Variance Var %

Operating Income / (Loss) in 000s

Maricopa Medical Center (5,300)$ (5,428)$ 128$ 2.4% (59,716)$ (78,345)$ 18,628$ 23.8% (78,356)$ 18,640$ 23.8%Maricopa Health Plan 1,912 1,912 - 0.0% (592) 5,805 (6,397) (110.2%) 5,736 (6,328) (110.3%)Maricopa Care Advantage (92) (92) - 0.0% (1,977) (227) (1,750) (771.5%) (1,035) (942) (91.0%)Total Operating Income (000s) (3,480)$ (3,608)$ 128$ 3.5% (62,285)$ (72,766)$ 10,481$ 14.4% (73,655)$ 11,370$ 15.4%

Net Income / (Loss) in 000s

Maricopa Medical Center 4,428$ 4,064$ 365$ 9.0% 68,139$ 16,601$ 51,538$ 310.4% 14,238$ 53,901$ 378.6%Maricopa Health Plan 1,912 1,912 - 0.0% (574) 5,805 (6,379) (109.9%) 5,866 (6,441) (109.8%)Maricopa Care Advantage (92) (92) - 0.0% (1,975) (227) (1,749) (770.8%) (1,035) (941) (90.9%)Total Net Income (000s) 6,248$ 5,884$ 365$ 6.2% 65,589$ 22,180$ 43,410$ 195.7% 19,069$ 46,520$ 244.0%

Net Income / (Loss) in 000s

without Bond or Sale related Rev & Exp

Maricopa Medical Center 1,275$ 912$ 363$ 39.7% 4,806$ (14,911)$ 19,717$ 132.2% (13,466)$ 18,273$ 135.7%Maricopa Health Plan 1,912 1,912 - 0.0% (574) 5,805 (6,379) (109.9%) 5,866 (6,441) (109.8%)Maricopa Care Advantage (92) (92) - 0.0% (1,975) (227) (1,749) (770.8%) (1,035) (941) (90.9%)Total Net Income (000s) 3,095$ 2,732$ 363$ 13.3% 2,256$ (9,333)$ 11,589$ 124.2% (8,635)$ 10,891$ 126.1%

Liquidity

Total Cash and Investments (000s) 109.6$ 149.3$ (39.7)$ (26.6%) 128.1$ (18.5)$ (14.4%)

Total Days Cash on Hand 60.3 78.6 (18.3) (23.3%) 57.8 2.5 4.3%

Cushion Ratio 12.4 16.4 (4.0) (24.6%) 26.6 (14.2) (53.5%)

Capital Structure

EBITDA Debt Service Coverage 10.0 5.3 4.7 88.4% 8.5 1.5 17.6%

Profitability

Operating Margin (12.13%) (13.70%) 1.58% 11.5% (13.21%) 1.09% 8.2%

Greater than or equal to 100% of BudgetWithin 95% to 100% of BudgetLess than 95% of Budget

Legend

Current Month CY Year to Date PY Year to Date

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Indicator Definition Trend Median

Cash + Short-Term Investments

(Operating Expenses Less - Depreciation) / YTD Days

Cash + Short-Term Investments

Principal + Interest Expenses

EBITDA

Principal + Interest Expenses

Operating Income (Loss)

Operating Revenues

All discharged accounts.

Includes normal newborns (DRG 795).

Includes discharges with a Behavioral Health patient type.

Discharged accounts.

Excludes normal newborns (DRG 795).

Excludes discharges with a Behavioral Health patient type.

Discharged accounts with a financial class of Medicare or

Medicare Managed Care. Excludes normal newborns (DRG 795).


Discharged accounts with a financial class of AHCCCS or

Maricopa Health Plan. Excludes normal newborns (DRG 795).


For ALL Case Mix values -- only Patient Types of Inpatient, Behavioral Health and Newborn are counted (as appropriate).

Patient Types of Observation, Outpatient and Emergency are excluded from all CMI calculations at all times.

New individual MS-DRG weights are issued by CMS each year, with an effective date of October 1st.

Up Above

Up Above

Case Mix Index - AHCCCS =

Case Mix Index - Medicare =

AboveUp

Up Above

Up Above

Discharges with a Behavioral Health patient type.

Case Mix Index - Acute

(Excluding Newborns)=

Case Mix Index -

Total Hospital=

Case Mix Index -

Behavioral Health=

AboveCushion Ratio

AboveOperating Margin = X 100 Up

Above

Up=

EBITDA Debt Service

Coverage = Up

Appendix A

Definition of Financial Indicators

Desired Position

Relative to

AboveTotal Days Cash on Hand = Up

4 of 24

Acute - Patient Days and Admissions

Current Budget VariancePatient Days 4,370 4,996 (626)Admissions 951 983 (32)

ALOS 4.6 5.1 0.5ADC (Average Daily Census) 146 167 (21)

Psych - Patient Days and Admissions

Current Budget VariancePatient Days 6,123 5,791 332Admissions 285 276 9

ALOS 21.5 21.0 (0.5)ADC (Average Daily Census) 204 193 11

Adjusted Patient Days (APD)

Current Budget Variance %Variance19,937 20,990 (1,053) -5.0%

Net Patient Service Revenue

Current Budget Variance %Variance$31,081,090 $32,471,849 ($1,390,759) -4.3%

Other Operating Revenue

Current Budget Variance %Variance$4,433,000 $4,796,997 ($363,997) -7.6%

MARICOPA MEDICAL CENTERFINANCIAL STATEMENT HIGHLIGHTSFor the month ending April 30, 2017

OPERATING REVENUE

For the month of April, variances in patient days are in Burn services (179), Medical/Surgical/APCU (134), Critical care (179), Peds Acute (65) and Post Partum/L&D (69).

For the month, negative variances are in Pharmacy admin rev ($355K), Interns & residents program ($147K), meaningful use revenue ($135K) and Cafeteria sales ($80K). Positive variances are in GME revenue $254K, Grants/Research $64K and Medical students

5 of 24


Salaries and Wages

Current Budget Variance %Variance$16,913,752 $17,616,661 $702,909 4.0%

Paid FTE's - Payroll Current Budget Variance %Variance3,051 3,184 133 4.2%

Paid FTE's - Payroll (without Residents )

Current Budget Variance %Variance2,865 2,994 129 4.3%

Salaries per Paid FTE's Current Budget Variance %Variance$5,543 $5,533 ($10) -0.2%

Contract Labor

Current Budget Variance %Variance$1,371,605 $890,785 ($480,820) -54.0%

Dollars FTE'sClinical applications ($70K) (2.5) FTE's

Health Info Mgmt (HIM) ($92K) (7.1) FTE's

N/S 51 APCU ($41K) (3.8) FTE's

Physical Therapy ($34K) (2.5) FTE's

Operating Room ($31K) (2.3) FTE's

Compliance Dept ($27K) (1.0) FTEs

IT security ($26K) (1.9) FTE's

FTE's - Contract Labor Current Budget Variance %Variance

274 237 (37) -15.6%

FTE's - Outsource Departments (included in total Contract Labor count)Current Budget Variance %Variance

228 228 (0) -0.2%

OPERATING EXPENSES

Below are the departments contributing to majority of the negative variance to budget for contract labor:

6 of 24


Adjusted Occupied Beds (AOB)Current Budget Variance %Variance

665 700 (35) -5.0%

FTE's per AOBCurrent Budget Variance %Variance

5.00 4.89 (0.11) -2.2%

FTE's per AOB (without Residents )

Current Budget Variance %Variance4.72 4.62 (0.10) -2.2%

Employee Benefits


Benefits as a % of Salaries

Current Budget Variance %Variance31.6% 30.9% -0.6% -2.0%

Medical Service Fees


Supplies


For the month of April, DMG expenses related to staffing are $58K below budget and DMG collections are also better than budget by $81K.

For the month of April, positive variances are in self insured trust related expenses (net) 165K, taxes and ASRS $128K and other benefits, $44K. Negative variances are mostly in paid leave accrual, ($237K).

For the month of April, positive variances are in pharmaceuticals $248K, other supplies prior month correction) $236K, GPO rebates $170K, OR and burn supplies $54K, food & nourishments $43K, various medical supplies $90K, R&M supplies $30K and implants $42K. Negative variances are in lab supplies ($119K) based on increased volume from FHC's and CHC which are now done in-house .

7 of 24


Purchased Services


Other Expenses

Current Budget Variance %Variance$3,149,760 $3,093,655 ($56,105) -1.8%

Premium taxes

Current Budget Variance %Variance$628,175 $628,175 $0 0.0%

Depreciation



For the month April, non-operating grant related revenue for capital items $191K, Investment income $20K and other Research/Grant related $25K.

For the month of April, positive variances are in repairs/maintenance software related and equipment $36K, mechanical and other $21K, utilities $50K, web-based subscriptions $40K. Negative variances are in building rent ($81K), equipment rental ($40K) bank related charges ($26K) offset by corresponding revenue, and overhead cost ($39K) offset by corresponding revenue in Research.

For the month of April, positive variances are in advertising $117K, consulting & mgmt $126K, collection fees $26K, ambulatory coding $60K, other services - IHMS $68K, research study related $28K (with offsetting revenue), linen mgmt and various other services $58K and accounting/auditing $9K. Negative variances are in laboratory services ($114K), other professional services for clinical applications/informatics ($99K).

NON-OPERATING REVENUES (EXPENSES)

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Cash & cash equivalents

Apr-17 Jun-16 Change % change$70,298,728 $65,757,062 $4,541,666 6.9%

Restricted cash - Bond

Apr-17 Jun-16 Change % change$68,269,083 $97,249,748 ($28,980,665) -29.8%

Paid $34.0M to JP Morgan Chase on July 1st 2016 for Principal and interest.

Patient A/R, net of allowance


Other receivable and prepaid items

Apr-17 Jun-16 Change % change$21,865,237 $21,466,341 $398,896 1.9%

FY17 other receivables / prepaids includes: $2.0M due from Home Assist Health $9.5M in prepaids/deposits$1.5M in receivables from grants & research sponsors $7.1M in inventory$270K in other misc receivables $584K in retail pharmacy receivable $874K due from DMG for pro-fees collections

Estimated amounts due from third party payors


FY17 due from third party payors includes:$ 3.5M due from AHCCCS for DSH $118K due from Ryan White Part C & D programs$90.5M due from AHCCCS for GME ($57.6M to be received in April)

Due from related parties

Apr-17 Jun-16 Change % change$14,444,843 $718,863 $13,725,980 1909.4%

FY17 due from related parties includes:$226K due from Ryan White Part A programs $13.7M due from Maricopa County - tax levy$490K due from First Things First programs


ASSETS

9 of 24


Capital assets, net


Other assets

Apr-17 Jun-16 Change % change$19,800,000 $19,800,000 $0 0.0%

$ 9.8M in investments to Maricopa Care Advantage$10.0M in investments to Mercy Maricopa Integrated Care

Deferred outflows


Current maturities of long-term debt


$36M Principal payment #2 related to the bond offering $599K in Bond Interest payable$216K in deferred rent $1.2M capital leases payable

Accounts payable


FY17 accounts payable includes:$ 2.4M due to DMG for annual recon and pass thru payments $14.3M in vendor related expense accruals/estimates$ 6.1M in vendor approved payments

Accrued payroll and expenses


LIABILITIES & NET POSITION

10 of 24


Medical claims payable

Apr-17 Jun-16 Change % change

$14,193,658 $19,281,904 ($5,088,246) -26.4%

Due to related parties

Apr-17 Jun-16 Change % change$0 $3,039,310 ($3,039,310) -100.0%

Other current liabilities


FY17 other current liabilties includes: $3.8M in settlement reserved for Medicare $118K in settlement reserved for FQHC for FFY13$1.3M in settlement reserved for SNCP $3.7M in settlement reserved for FQHC for FFY15$3.0M in deferred income for grants, research, & study residuals $1.8M in settlement reserved for EMR $856K in unclaimed/stale dated checks $8.6M in patient credit balances

Long term debt


FY17 long term debt includes:$154K in capital leases obligations $87K in long term loan for McDowell clinic$8.4M loan due to Maricopa County $37.0M Bonds payable

Long term liabilities

Apr-17 Jun-16 Change % change($24,227,841) ($24,227,841) $0 0.0%

Deferred inflows


Net position


11 of 24

Member Months

Current Budget Variance %Variance-29 -29 0 0.0%

Revenue

Current Budget Variance %Variance$2,486,886 $2,486,886 $0

Revenue PMPM

Current Budget Variance %VarianceN/A $0 N/A

Investment income

Current Budget Variance %Variance$0 $0 $0

Purchased Services

Current Budget Variance %Variance$526,042 $526,042 $0

Medical Claims


Premium taxes

Current Budget Variance %Variance($1,527) ($1,527) $0

Run out activity on claims and IBNR true up.

OPERATING EXPENSES

MARICOPA HEALTH PLANFINANCIAL STATEMENT HIGHLIGHTS

For the month of April 30, 2017

OPERATING REVENUE

Revenue is due to updated reconcilaitions with the State due to claims run out processed in April. Reconciliations will continue to be updated as claims run out completes and IBNR estimates are adjusted.

12 of 24



Other current assets

Apr-17 Jun-16 Change % change$8,199,112 $8,618,856 ($419,744) -4.9%

Accounts payable


Vendor related expense accruals/estimates & admin fee



Amounts payable to hospitals, physicians and other medical expenses related providers.


Apr-17 Jun-16 Change % change$14,562,757 $14,875,847 ($313,090) -2.1%

Net assets


MARICOPA HEALTH PLANFINANCIAL STATEMENT HIGHLIGHTS


LIABILITIES & NET ASSETS

ASSETS

13 of 24

Member Months

Current Budget Variance %Variance0 0 0

Revenue


Revenue PMPM


Purchased Services


Medical Claims


OPERATING EXPENSES

MARICOPA CARE ADVANTAGEFINANCIAL STATEMENT HIGHLIGHTS


OPERATING REVENUE

April revenue related to Part D reconciliaiton monies with CMS.

Continued claims run out and IBNR true up.

14 of 24



Other current assets

Apr-17 Jun-16 Change % change$945,284 $3,210,174 ($2,264,890) -70.6%

Accounts payable

Apr-17 Jun-16 Change % change$75,416 $398,390 ($322,974) -81.1%

Vendor related expense accruals/estimates and admin fees



Amounts payable to hospitals, physicians and other medical expenses related providers.


Apr-17 Jun-16 Change % change$2,903,477 $2,472,113 $431,364 17.4%

Net assets


MARICOPA CARE ADVANTAGEFINANCIAL STATEMENT HIGHLIGHTS


LIABILITIES & NET ASSETS

ASSETS

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MARICOPA COUNTY SPECIAL HEALTH DISTRICTCONSOLIDATED

Statement of Net PositionApril 30, 2017

4/30/2017 6/30/2016

ASSETS Current Assets Cash and cash equivalents General funds Delivery system $70,298,728 $65,757,061 Health Plans 39,349,756 62,373,744 Total cash and cash equivalents - general funds 109,648,484 128,130,805

Restricted cash - Bond 68,269,083 97,249,748 Patient A/R, net of allowances 56,153,085 72,285,150 Other receivables and prepaid items 21,865,237 21,466,341 Estimated amounts due from third-party payors 94,201,103 43,908,331 Due from related parties 14,444,843 718,863 Other current assets 4,950,410 9,646,308 Total current assets 369,532,244 373,405,547

Capital Assets, Net 214,938,666 211,250,614

Other Assets 23,993,986 23,993,986 Total assets 608,464,896 608,650,147

Deferred outflows 31,497,747 31,497,747

LIABILITIES AND NET POSITION Current Liabilities Current maturities of long-term debt 38,017,168 41,678,099 Accounts payable 28,435,033 23,426,409 Accrued payroll and expenses 20,854,318 22,139,939 Medical claims payable 20,748,958 53,005,229 Due to related parties 0 3,039,310 Other current liabilities 31,123,365 25,865,877 Total current liabilities 139,178,841 169,154,864

Long-term debt Bonds payable 37,000,000 73,000,000 Other long-term debt 18,087,282 17,885,840 Total long-term debt 55,087,282 90,885,840

Long term liabilities (24,227,841) (24,227,841) Total liabilities 170,038,282 235,812,862

Deferred inflows 42,450,839 42,450,839

Net position Invested in capital assets, net of related debt 158,834,216 151,686,675 Unrestricted 268,639,306 210,197,517Total net position 427,473,522 361,884,193

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MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICTCONSOLIDATED

Statement of Revenues and ExpensesFor the Ten Periods Ending April 30, 2017

APR2017 APR2017 APR2017 APR2017 Prior Year Prior Year Prior Year YTD YTD YTD YTD YTD Prior Year Prior YearActual Operating Budget % Change Same Month Same month Same Month APR2017 APR2017 Budget % Change Prior Year Same Month Same Month

Budget Variance APR2016 Variance % Change Actual Operating Budget Variance Same Month Variance % Change

Net patient service revenue $31,081,090 $32,471,849 ($1,390,759) (4.3%) $32,389,821 ($1,308,731) (4.0%) $306,810,046 $307,409,509 ($599,463) (0.2%) $305,520,188 $1,289,858 0.4%

Other revenue 6,936,494 7,300,491 (363,997) (5.0%) 29,700,663 (22,764,168) (76.6%) 206,766,243 223,587,835 (16,821,592) (7.5%) 320,310,287 (113,544,044) (35.4%) Total operating revenues 38,017,584 39,772,340 (1,754,756) (4.4%) 62,090,484 (24,072,899) (38.8%) 513,576,289 530,997,344 (17,421,055) (3.3%) 625,830,475 (112,254,186) (17.9%)

OPERATING EXPENSES

Salaries and wages 16,913,752 17,616,661 702,909 4.0% 17,516,066 602,314 3.4% 171,977,381 177,280,080 5,302,699 3.0% 180,437,738 8,460,357 4.7% Contract labor 1,371,605 890,785 (480,821) (54.0%) 485,740 (885,866) (182.4%) 11,778,642 9,402,233 (2,376,409) (25.3%) 4,545,453 (7,233,189) (159.1%) Employee benefits 5,337,741 5,451,771 114,029 2.1% 6,619,797 1,282,056 19.4% 50,130,517 53,983,679 3,853,162 7.1% 54,466,587 4,336,070 8.0% Medical service fees 5,316,353 5,454,788 138,435 2.5% 6,297,821 981,468 15.6% 51,727,383 56,828,831 5,101,448 9.0% 59,427,822 7,700,439 13.0% Supplies 4,353,073 5,183,860 830,788 16.0% 4,704,631 351,559 7.5% 49,748,296 52,533,777 2,785,481 5.3% 50,434,814 686,518 1.4% Purchased services 2,283,127 2,578,270 295,143 11.4% 4,715,981 2,432,854 51.6% 33,706,072 37,658,630 3,952,558 10.5% 43,359,905 9,653,833 22.3% Medical claims 158,605 158,605 0 0 23,894,536 23,735,931 99.3% 144,570,981 151,045,069 6,474,088 4.3% 243,487,678 98,916,697 40.6% Other expenses 3,149,760 3,093,655 (56,106) (1.8%) 2,712,395 (437,365) (16.1%) 31,806,946 31,127,613 (679,333) (2.2%) 30,044,309 (1,762,636) (5.9%) Premium taxes 626,648 626,648 () 0 1,100,234 473,585 43.0% 9,313,254 9,684,258 371,005 3.8% 11,173,294 1,860,041 16.6% Depreciation 1,987,145 2,325,522 338,377 14.6% 2,212,766 225,621 10.2% 21,102,112 24,219,424 3,117,312 12.9% 22,108,086 1,005,974 4.6%

Total operating expenses 41,497,810 43,380,565 1,882,755 4.3% 70,259,966 28,762,156 40.9% 575,861,584 603,763,593 27,902,010 4.6% 699,485,686 123,624,103 17.7%

Operating income (3,480,225) (3,608,224) 127,999 3.5% (8,169,483) 4,689,257 57.4% (62,285,295) (72,766,250) 10,480,954 14.4% (73,655,211) 11,369,916 15.4%

Nonoperating revenues (expenses)

Noncapital grants 590,954 676,193 (85,239) (12.6%) 687,541 (96,586) (14.0%) 7,211,943 6,730,659 481,283 7.2% 6,447,763 764,180 11.9% Noncapital transfers from County/State 295,658 295,658 0 0 295,658 0 0 2,956,580 2,956,580 0 0 2,956,580 0 0 Investment income 61,791 40,840 20,951 51.3% 27,672 34,119 123.3% 543,016 408,401 134,614 33.0% 487,669 55,347 11.3% Other nonoperating revenue (expenses) (267,725) (558,031) 290,306 52.0% (77,070) (190,655) (247.4%) 26,706,691 (5,525,949) 32,232,640 583.3% (564,461) 27,271,152 4,831.4% Interest expense (162,558) (173,165) 10,607 6.1% (456,327) 293,768 64.4% (1,647,053) (1,727,116) 80,063 4.6% (2,247,824) 600,772 26.7% Tax levy 9,210,345 9,210,345 0 0 8,564,480 645,865 7.5% 92,103,451 92,103,451 0 0 85,644,803 6,458,648 7.5%

Total nonoperating revenues (expenses) 9,728,466 9,491,840 236,626 2.5% 9,041,954 686,512 7.6% 127,874,628 94,946,027 32,928,601 34.7% 92,724,530 35,150,098 37.9%

Excess of revenues over expenses $6,248,240 $5,883,616 $364,624 6.2% $872,472 $5,375,769 616.2% $65,589,333 $22,179,777 $43,409,556 195.7% $19,069,319 $46,520,014 244.0%

Bond related revenues and expenses (3,153,335) (3,151,265) (2,070) (0.1%) (2,516,981) (636,354) (25.3%) (31,507,506) (31,512,646) 5,140 0 (27,541,263) (3,966,243) (14.4%)Sale Proceeds related revenues and expenses 0 0 0 0 (5,975) 5,975 100.0% (31,825,424) 0 (31,825,424) 0 (163,031) (31,662,392) (19,421.1%)

Increase in net assets $3,094,906 $2,732,351 $362,554 13.3% ($1,650,484) $4,745,390 287.5% $2,256,403 ($9,332,869) $11,589,272 124.2% ($8,634,976) $10,891,379 126.1%

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MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICTMARICOPA MEDICAL CENTER




Net patient service revenue $31,081,090 $32,471,849 ($1,390,759) (4.3%) $32,389,821 ($1,308,731) (4.0%) $306,810,046 $307,409,509 ($599,463) (0.2%) $305,520,188 $1,289,858 0.4%

Other revenue 4,433,000 4,796,997 (363,997) (7.6%) 3,173,060 1,259,941 39.7% 46,339,714 47,249,656 (909,942) (1.9%) 43,872,716 2,466,998 5.6% Total operating revenues 35,514,090 37,268,846 (1,754,756) (4.7%) 35,562,881 (48,790) (0.1%) 353,149,760 354,659,165 (1,509,405) (0.4%) 349,392,904 3,756,856 1.1%

OPERATING EXPENSES

Salaries and wages 16,913,752 17,616,661 702,909 4.0% 17,516,066 602,314 3.4% 171,977,381 177,280,080 5,302,699 3.0% 180,437,738 8,460,357 4.7% Contract labor 1,371,605 890,785 (480,821) (54.0%) 485,740 (885,866) (182.4%) 11,778,642 9,402,233 (2,376,409) (25.3%) 4,545,453 (7,233,189) (159.1%) Employee benefits 5,337,741 5,451,771 114,029 2.1% 6,619,797 1,282,056 19.4% 50,130,517 53,983,679 3,853,162 7.1% 54,466,587 4,336,070 8.0% Medical service fees 5,316,353 5,454,788 138,435 2.5% 6,297,821 981,468 15.6% 51,727,383 56,828,831 5,101,448 9.0% 59,427,822 7,700,439 13.0% Supplies 4,353,073 5,183,860 830,788 16.0% 4,704,631 351,559 7.5% 49,748,296 52,533,777 2,785,481 5.3% 50,434,814 686,518 1.4% Purchased services 1,756,654 2,051,797 295,143 14.4% 2,517,101 760,447 30.2% 18,312,971 21,346,370 3,033,399 14.2% 20,343,839 2,030,868 10.0% Medical claims 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Other expenses 3,149,760 3,093,655 (56,106) (1.8%) 2,712,395 (437,365) (16.1%) 31,806,946 31,127,613 (679,333) (2.2%) 30,044,309 (1,762,636) (5.9%) Premium taxes 628,175 628,175 () 0 594,062 (34,114) (5.7%) 6,281,752 6,281,751 () 0 5,940,616 (341,135) (5.7%) Depreciation 1,987,145 2,325,522 338,377 14.6% 2,212,766 225,621 10.2% 21,102,112 24,219,424 3,117,312 12.9% 22,108,086 1,005,974 4.6%

Total operating expenses 40,814,259 42,697,014 1,882,755 4.4% 43,660,378 2,846,119 6.5% 412,866,000 433,003,757 20,137,758 4.7% 427,749,264 14,883,265 3.5%

Operating income (5,300,168) (5,428,167) 127,999 2.4% (8,097,498) 2,797,329 34.5% (59,716,240) (78,344,593) 18,628,352 23.8% (78,356,360) 18,640,120 23.8%


Noncapital grants 590,954 676,193 (85,239) (12.6%) 687,541 (96,586) (14.0%) 7,211,943 6,730,659 481,283 7.2% 6,447,763 764,180 11.9% Noncapital transfers from County/State 295,658 295,658 0 0 295,658 0 0 2,956,580 2,956,580 0 0 2,956,580 0 0 Investment income 61,791 40,840 20,951 51.3% 20,918 40,873 195.4% 523,639 408,401 115,237 28.2% 357,295 166,344 46.6% Other nonoperating revenue (expenses) (267,725) (558,031) 290,306 52.0% (77,070) (190,655) (247.4%) 26,706,691 (5,525,949) 32,232,640 583.3% (564,461) 27,271,152 4,831.4% Interest expense (162,558) (173,165) 10,607 6.1% (456,327) 293,768 64.4% (1,647,053) (1,727,116) 80,063 4.6% (2,247,824) 600,772 26.7% Tax levy 9,210,345 9,210,345 0 0 8,564,480 645,865 7.5% 92,103,451 92,103,451 0 0 85,644,803 6,458,648 7.5%

Total nonoperating revenues (expenses) 9,728,466 9,491,840 236,626 2.5% 9,035,200 693,266 7.7% 127,855,251 94,946,027 32,909,224 34.7% 92,594,156 35,261,095 38.1%

Excess of revenues over expenses $4,428,297 $4,063,673 $364,624 9.0% $937,703 $3,490,595 372.2% $68,139,011 $16,601,434 $51,537,577 310.4% $14,237,796 $53,901,215 378.6%

Bond related revenues and expenses (3,153,335) (3,151,265) (2,070) (0.1%) (2,516,981) (636,354) (25.3%) (31,507,506) (31,512,646) 5,140 0 (27,541,263) (3,966,243) (14.4%)Sale Proceeds related revenues and expenses 0 0 0 0 (5,975) 5,975 100.0% (31,825,424) 0 (31,825,424) 0 (163,031) (31,662,392) (19,421.1%)

Increase in net assets $1,274,963 $912,408 $362,554 39.7% ($1,585,253) $2,860,216 180.4% $4,806,081 ($14,911,212) $19,717,293 132.2% ($13,466,499) $18,272,580 135.7%

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Net Patient Service Revenue per APD $1,559 $1,547 $12 0.8% $1,652 ($93) (5.6%) $1,520 $1,454 $66 4.5% $1,498 $21 1.4%

Salaries $16,913,752 $17,616,661 $702,909 4.0% $17,516,066 $602,314 3.4% $171,977,381 $177,280,080 $5,302,699 3.0% $180,437,738 $8,460,357 4.7%Benefits 5,337,741 5,451,771 114,029 2.1% 6,619,797 1,282,056 19.4% 50,130,517 53,983,679 3,853,162 7.1% 54,466,587 4,336,070 8.0%Contract Labor 1,371,605 890,785 (480,821) (54.0%) 485,740 (885,866) (182.4%) 11,778,642 9,402,233 (2,376,409) (25.3%) 4,545,453 (7,233,189) (159.1%)Total Labor Costs $23,623,099 $23,959,217 $336,118 1.4% $24,621,603 $998,504 4.1% $233,886,539 $240,665,991 $6,779,452 2.8% $239,449,778 $5,563,239 2.3%

Supplies $4,353,073 $5,183,860 $830,788 16.0% $4,704,631 $351,559 7.5% $49,748,296 $52,533,777 $2,785,481 5.3% $50,434,814 $686,518 1.4%Medical Service Fees 5,316,353 5,454,788 138,435 2.5% 6,297,821 981,468 15.6% 51,727,383 56,828,831 5,101,448 9.0% 59,427,822 7,700,439 13.0%All Other 5,964,873 6,504,824 539,951 8.3% 6,356,955 392,082 6.2% 31,342,030 66,008,799 34,666,769 52.5% 59,141,050 27,799,019 47.0%Total $15,634,298 $17,143,471 $1,509,173 8.8% $17,359,406 $1,725,108 9.9% $132,817,710 $175,371,407 $42,553,697 24.3% $169,003,686 $36,185,976 21.4%

Total Operating and Non Operating Expenses $39,257,397 $41,102,688 $1,845,291 4.5% $41,981,009 $2,723,612 6.5% $366,704,249 $416,037,398 $49,333,149 11.9% $408,453,464 $41,749,215 10.2%*Excludes Depreciation

Tax Levy Property Tax $5,898,095 $5,898,095 0 0 $5,606,100 $291,995 5.2% $58,980,951 $58,980,951 0 0 $56,061,003 $2,919,948 5.2% Bonds 3,312,250 3,312,250 0 0 2,958,380 353,870 12.0% 33,122,500 33,122,500 0 0 29,583,800 3,538,700 12.0%Total Tax Levy $9,210,345 $9,210,345 0 0 $8,564,480 $645,865 7.5% $92,103,451 $92,103,451 0 0 $85,644,803 $6,458,648 7.5%

Patient Days - Acute 4,370 4,996 (626) (12.5%) 4,858 (488) (10.0%) 44,409 50,886 (6,477) (12.7%) 51,022 (6,613) (13.0%)Patient Days - Psych 6,123 5,791 332 5.7% 5,744 379 6.6% 62,047 61,340 707 1.2% 57,893 4,154 7.2%Patient Days - Total 10,493 10,787 (294) (2.7%) 10,602 (109) (1.0%) 106,456 112,226 (5,770) (5.1%) 108,915 (2,459) (2.3%)

Adjusted Patient Days 19,937 20,990 (1,053) (5.0%) 19,611 326 1.7% 201,911 211,482 (9,571) (4.5%) 203,895 (1,984) (1.0%)APD Ratio 1.90 1.95 (.05) (2.4%) 1.85 .05 2.7% 1.90 1.88 .01 0.6% 1.87 .02 1.3%

Total Admissions 1,236 1,259 (23) (1.8%) 1,244 (8) (0.6%) 11,897 13,270 (1,373) (10.3%) 13,087 (1,190) (9.1%)Adjusted Admissions 2,348 2,450 (101) (4.1%) 2,301 47 2.1% 22,565 25,006 (2,442) (9.8%) 24,500 (1,935) (7.9%)

Average Daily Census - Acute 146 167 (21) (12.5%) 162 (16) (10.0%) 146 167 (21) (12.7%) 167 (21) (12.7%)Average Daily Census - Psych 204 193 11 5.7% 191 13 6.6% 204 202 2 1.2% 190 14 7.5%Average Daily Census - Total 350 360 (10) (2.7%) 353 (4) (1.0%) 350 369 (19) (5.1%) 357 (7) (1.9%)

Adjusted Occupied Beds 665 700 (35) (5.0%) 654 11 1.7% 664 696 (31) (4.5%) 669 (4) (0.6%)

Paid FTEs - Payroll 3,051 3,184 133 4.2% 3,260 208 6.4% 3,043 3,158 115 3.6% 3,274 232 7.1%Paid FTEs - Contract Labor 274 237 (37) (15.6%) 79 (195) (246.7%) 257 240 (17) (7.0%) 68 (189) (278.8%)Paid FTEs - Total 3,325 3,421 96 2.8% 3,339 14 0.4% 3,300 3,398 98 2.9% 3,342 43 1.3%

FTEs per AOB 5.00 4.89 (.11) (2.3%) 5.11 .10 2.0% 4.97 4.88 (.08) (.02) 5.00 .03 .01Salaries per FTE - Payroll $5,543 $5,532 ($10) (0.2%) $5,373 ($169) (3.2%) $56,517 $56,139 ($378) (0.7%) $55,104 ($1,413) (2.6%)Salaries per FTE - Contract Labor $5,015 $3,765 ($1,249) (33.2%) $6,156 $1,141 18.5% $45,882 $39,187 ($6,695) (17.1%) $67,079 $21,196 31.6%

Benefits as a % of Salaries 31.6% 30.9% (0.6%) (2.0%) 37.8% 6.2% 16.5% 29.1% 30.5% 1.3% 4.3% 30.2% 1.0% 3.4%

Labor Costs as a % of Net Patient Revenue 76.0% 73.8% (2.2%) (3.0%) 76.0% 0 0 76.2% 78.3% 2.1% 2.6% 78.4% 2.1% 2.7%

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Salaries & Contract Labor per APD $917 $882 ($35) (4.0%) $918 $1 0.1% $910 $883 ($27) (3.1%) $907 ($3) (0.3%)Benefits per APD 268 260 (8) (3.1%) 338 70 20.7% 248 255 7 2.7% 267 19 7.1%Supplies per APD 218 247 29 11.6% 240 22 9.0% 246 248 2 0.8% 247 1 0.4%Medical Service Fees per APD 267 260 (7) (2.6%) 321 54 17.0% 256 269 13 4.7% 291 35 12.1%All Other Expenses per APD 299 310 11 3.5% 324 25 7.7% 155 312 157 50.3% 290 135 46.5%Total Expenses per APD $1,969 $1,958 ($11) (0.6%) $2,141 $172 8.0% $1,816 $1,967 $151 7.7% $2,003 $187 9.3%*Excludes Depreciation

Salaries & Contract Labor per Adj. Admissions $7,786 $7,555 ($231) (3.1%) $7,823 $37 0.5% $8,144 $7,465 ($678) (9.1%) $7,550 ($593) (7.9%)Benefits per Adj. Admissions 2,273 2,225 (47) (2.1%) 2,877 604 21.0% 2,222 2,159 (63) (2.9%) 2,223 2 0.1%Supplies per Adj. Admissions 1,854 2,116 262 12.4% 2,045 191 9.3% 2,205 2,101 (104) (4.9%) 2,059 (146) (7.1%)Medical Service Fees per Adj. Admissions 2,264 2,227 (37) (1.7%) 2,737 473 17.3% 2,292 2,273 (20) (0.9%) 2,426 133 5.5%All Other Expenses per Adj. Admissions 2,540 2,655 115 4.3% 2,763 223 8.1% 1,389 2,640 1,251 47.4% 2,414 1,025 42.5%Total Expenses per Adj. Admissions $16,717 $16,778 $62 0.4% $18,244 $1,527 8.4% $16,251 $16,637 $386 2.3% $16,672 $421 2.5%*Excludes Depreciation

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MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICTMARICOPA HEALTH PLAN




Net patient service revenue 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Other revenue 2,486,887 2,486,887 0 0 24,329,675 (21,842,788) (89.8%) 150,650,301 164,126,328 (13,476,027) (8.2%) 249,973,053 (99,322,752) (39.7%) Total operating revenues 2,486,887 2,486,887 0 0 24,329,675 (21,842,788) (89.8%) 150,650,301 164,126,328 (13,476,027) (8.2%) 249,973,053 (99,322,752) (39.7%)

OPERATING EXPENSES

Salaries and wages 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Contract labor 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Employee benefits 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Medical service fees 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Supplies 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Purchased services 526,042 526,042 0 0 1,923,190 1,397,148 72.6% 14,147,425 14,774,682 627,257 4.2% 19,690,751 5,543,326 28.2% Medical claims 50,074 50,074 0 0 22,167,711 22,117,637 99.8% 134,063,392 140,143,935 6,080,543 4.3% 219,313,559 85,250,167 38.9% Other expenses 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Premium taxes (1,527) (1,527) 0 0 506,172 507,699 100.3% 3,031,502 3,402,507 371,005 10.9% 5,232,678 2,201,176 42.1% Depreciation 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total operating expenses 574,589 574,589 0 0 24,597,073 24,022,484 97.7% 151,242,319 158,321,124 7,078,805 4.5% 244,236,988 92,994,669 38.1%

Operating income 1,912,298 1,912,298 0 0 (267,398) 2,179,696 815.2% (592,018) 5,805,204 (6,397,222) 110.2% 5,736,065 (6,328,083) 110.3%


Noncapital grants 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Noncapital transfers from County/State 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Investment income 0 0 0 0 6,754 (6,754) (100.0%) 17,807 0 17,807 0 130,374 (112,567) (86.3%) Other nonoperating revenue (expenses) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Interest expense 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Tax levy 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total nonoperating revenues (expenses) 0 0 0 0 6,754 (6,754) (100.0%) 17,807 0 17,807 0 130,374 (112,567) (86.3%)

Excess of revenues over expenses $1,912,298 $1,912,298 0 0 ($260,644) $2,172,942 (833.7%) ($574,211) $5,805,204 ($6,379,415) (109.9%) $5,866,439 ($6,440,650) (109.8%)

Bond related revenues and expenses 0 0 0 0 0 0 0 0 0 0 0 0 0 0Sale Proceeds related revenues and expenses 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Increase in net assets $1,912,298 $1,912,298 0 0 ($260,644) $2,172,942 833.7% ($574,211) $5,805,204 ($6,379,415) 109.9% $5,866,439 ($6,440,650) 109.8%

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MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICTMARICOPA CARE ADVANTAGE




Net patient service revenue 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Other revenue 16,607 16,607 0 0 2,197,928 (2,181,321) (99.2%) 9,776,228 12,211,851 (2,435,623) (19.9%) 26,464,518 (16,688,290) (63.1%) Total operating revenues 16,607 16,607 0 0 2,197,928 (2,181,321) (99.2%) 9,776,228 12,211,851 (2,435,623) (19.9%) 26,464,518 (16,688,290) (63.1%)

OPERATING EXPENSES

Salaries and wages 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Contract labor 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Employee benefits 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Medical service fees 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Supplies 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Purchased services 431 431 0 0 275,690 275,259 99.8% 1,245,676 1,537,578 291,902 19.0% 3,325,315 2,079,639 62.5% Medical claims 108,531 108,531 0 0 1,726,825 1,618,294 93.7% 10,507,589 10,901,134 393,545 3.6% 24,174,119 13,666,530 56.5% Other expenses 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Premium taxes 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Depreciation 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total operating expenses 108,962 108,962 0 0 2,002,515 1,893,553 94.6% 11,753,265 12,438,712 685,447 5.5% 27,499,434 15,746,169 57.3%

Operating income (92,355) (92,355) 0 0 195,413 (287,768) 147.3% (1,977,037) (226,861) (1,750,176) (771.5%) (1,034,916) (942,121) (91.0%)


Noncapital grants 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Noncapital transfers from County/State 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Investment income 0 0 0 0 0 0 0 1,570 0 1,570 0 0 1,570 0 Other nonoperating revenue (expenses) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Interest expense 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Tax levy 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total nonoperating revenues (expenses) 0 0 0 0 0 0 0 1,570 0 1,570 0 0 1,570 0

Excess of revenues over expenses ($92,355) ($92,355) 0 0 $195,413 ($287,768) (147.3%) ($1,975,467) ($226,861) ($1,748,606) 770.8% ($1,034,916) ($940,551) 90.9%

Bond related revenues and expenses 0 0 0 0 0 0 0 0 0 0 0 0 0 0Sale Proceeds related revenues and expenses 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Increase in net assets ($92,355) ($92,355) 0 0 $195,413 ($287,768) 147.3% ($1,975,467) ($226,861) ($1,748,606) (770.8%) ($1,034,916) ($940,551) (90.9%)

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MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICTd/b/a MARICOPA MEDICAL CENTER

VolumesFor the Ten Periods Ending April 30, 2017

Current Period Year to Date

Actual Operating Budget Variance % Change Last Year % Change Actual Operating Budget Variance % Change Last Year % Change

Admissions

Acute 951 983 (32) (3.3%) 971 (2.1%) 9,113 10,400 (1,287) (12.4%) 10,357 (12.0%) Psych 285 276 9 3.3% 273 4.4% 2,784 2,870 (86) (3.0%) 2,730 2.0% Total 1,236 1,259 (23) (1.8%) 1,244 (0.6%) 11,897 13,270 (1,373) (10.3%) 13,087 (9.1%)

Observation Admissions

Transferred to Inpatient * 126 81 45 55.6% 97 29.9% 1,203 898 305 34.0% 982 22.5% Observation Admission Only 340 286 54 18.7% 341 (0.3%) 3,736 2,825 911 32.3% 3,074 21.5% Total Observation Admissions 466 367 99 26.8% 438 6.4% 4,939 3,723 1,216 32.7% 4,056 21.8%

Total Admissions and

Observation Only

Total 1,576 1,545 31 2.0% 1,585 (0.6%) 15,633 16,095 (462) (2.9%) 16,161 (3.3%)

Adjusted Admissions

Total 2,348 2,450 (101) (4.1%) 2,301 2.1% 22,565 25,006 (2,442) (9.8%) 24,500 (7.9%)

Length of Stay

Acute 4.6 5.1 0.5 9.6% 5.0 8.2% 4.9 4.9 (0.0) 0.4% 4.9 1.1% Psych 21.5 21.0 (0.5) (2.4%) 21.0 (2.1%) 22.3 21.4 (0.9) (4.3%) 21.2 (5.1%) Total 8.5 8.6 0.1 0.9% 8.5 0.4% 8.9 8.5 (0.5) (5.8%) 8.3 (7.5%)

Patient Days

Acute 4,370 4,996 (626) (12.5%) 4,858 (10.0%) 44,409 50,886 (6,477) (12.7%) 51,022 (13.0%) Psych 6,123 5,791 332 5.7% 5,744 6.6% 62,047 61,340 707 1.2% 57,893 7.2% Total 10,493 10,787 (294) (2.7%) 10,602 (1.0%) 106,456 112,226 (5,770) (5.1%) 108,915 (2.3%)

Average Daily Census

Acute 146 167 (21) (12.5%) 162 (10.0%) 146 167 (21) (12.7%) 167 (12.7%) Psych 204 193 11 5.7% 191 6.6% 204 202 2 1.2% 190 7.5% Total 350 360 (10) (2.7%) 353 (1.0%) 350 369 (19) (5.1%) 357 (1.9%)

Adjusted Patient Days

Total 19,937 20,990 (1,053) (5.0%) 19,611 1.7% 201,911 211,482 (9,571) (4.5%) 203,895 (1.0%)

* Already Included in 'Acute Admissions'

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MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICTd/b/a MARICOPA MEDICAL CENTER

VolumesFor the Ten Periods Ending April 30, 2017

Current Period Year to Date

Actual Operating Budget Variance % Change Last Year % Change Actual Operating Budget Variance % Change Last Year % Change

Surgeries

Inpatient 296 334 (38) (11.4%) 333 (11.1%) 3,126 3,363 (237) (7.0%) 3,416 (8.5%) Outpatient 261 313 (52) (16.6%) 324 (19.4%) 2,747 2,819 (72) (2.6%) 2,937 (6.5%) Total 557 647 (90) (13.9%) 657 (15.2%) 5,873 6,182 (309) (5.0%) 6,353 (7.6%)

Inpatient Minutes 42,240 44,382 (2,142) (4.8%) 46,965 (10.1%) 413,850 446,875 (33,025) (7.4%) 454,560 (9.0%) Outpatient Minutes 22,650 29,466 (6,816) (23.1%) 29,625 (23.5%) 257,685 265,381 (7,696) (2.9%) 273,600 (5.8%) Total 64,890 73,848 (8,958) (12.1%) 76,590 (15.3%) 671,535 712,256 (40,721) (5.7%) 728,160 (7.8%)

Deliveries

Total 150 186 (36) (19.4%) 159 (5.7%) 1,991 2,144 (153) (7.1%) 2,067 (3.7%)

ED Visits

Adult 4,000 4,109 (109) (2.7%) 4,162 (3.9%) 39,702 40,113 (411) (1.0%) 40,729 (2.5%) Peds 2,078 2,238 (160) (7.1%) 1,970 5.5% 17,457 19,993 (2,536) (12.7%) 19,779 (11.7%) L&D 280 394 (114) (28.9%) 317 (11.7%) 3,678 3,950 (272) (6.9%) 3,880 (5.2%) Burn 185 148 37 25.0% 162 14.2% 1,980 1,925 55 2.9% 1,929 2.6% Total 6,543 6,889 (346) (5.0%) 6,611 (1.0%) 62,817 65,981 (3,164) (4.8%) 66,317 (5.3%)

7th Ave Walk-In Clinic

Total 1,692 2,293 (601) (26.2%) 1,841 (8.1%) 18,593 21,866 (3,273) (15.0%) 21,292 (12.7%)

OP Visits

FHC 15,515 18,779 (3,264) (17.4%) 16,534 (6.2%) 156,609 182,790 (26,181) (14.3%) 179,619 (12.8%) CHC 12,983 14,842 (1,859) (12.5%) 13,566 (4.3%) 129,851 135,906 (6,055) (4.5%) 136,390 (4.8%) Dental 1,858 1,809 49 2.7% 1,870 (0.6%) 19,160 18,290 870 4.8% 21,156 (9.4%) Total 30,356 35,429 (5,073) (14.3%) 31,970 (5.0%) 305,620 336,986 (31,366) (9.3%) 337,165 (9.4%)

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Maricopa County



May 24, 2017

Item 8.b.

Reports to the Board Health Plan Sale Proceeds

Maricopa Integrated Health SystemHealth Plan Sale Proceeds10-101000-102160

Beginning balance - 02/01/17 -$ Add:Interim Payment for Member Transfer 30,607,983.33 Bank Interest 4,039.92 Less:Consulting Services (497,092.00)Bank Fees (50.00) Ending balance - 02/28/2017 30,114,881.25$

Beginning balance - 03/01/17 30,114,881.25$ Add:Final Reconciliation Payment 2,086,850.00 Bank Interest 4,894.84Less:Consulting Services (50,509.00) Ending balance - 03/31/17 32,156,117.09$

Beginning balance - 03/01/17 32,156,117.09$ Add:Bank Interest 4,755.89Less: Ending balance - 04/30/17 32,160,872.98$

Maricopa County



May 24, 2017

Item 8.b.

Reports to the Board Cost Accounting Report

MARICOPA INTEGRATED HEALTH SYSTEMSERVICE LINE PROFITABILITYDISCHARGE DATE 10/1/2015 to 9/30/2016DEFINITIONSSOURCE McKesson Performance AnalyticsSCOPE All encounters with a discharge date between 10/1/2015 and 9/30/2016

Total encounter charges > $0.00MAJOR DIVISIONS:

ACUTE CARE Patient Type = Inpatient, Emergency, Newborn, ObservationMENTAL HEALTH Patient Type = Behavioral HealthOUTPATIENT Patient Type = Outpatient

SERVICE LINE GROUPINGS:Inpatient Grouped based on coded discharge DRGOutpatient Grouped based on coded ICD-9 principal diagnosis

PROFITABILITY COLUMN DEFINITIONS:Est Net Revenue Modeled expected payments based on patient type and insurance plan historical collectionsDirect Costs Cost directly associated with a departmentFQHC and Other Revenue Offsets FQHC, catering, rental, and other misc operating revenueContribution Margin Estimated net revenue less direct costs plus FQHC and other revenue offsetsIndirect Costs Overhead (administration, teaching, etc)Net Margin w_o Subsidies Contribution margin less indirect costs less subsidiesSubsidies DSH, meaningful use, psych teaching subsidy, and other non operating revenuesNet Margin w_Subsidies Contribution margin less indirect costs

MAJOR CHANGES FROM PRIOR REPORTINGIndirect Costs include an additional $15M of GME revenue offsetting expenses

DOES NOT INCLUDERetail pharmacyGrants and ResearchTax levy / BondsMaricopa Health Plan/Maricopa Care Advantage

PENDING ITEMSDMG Medical Service Fee Allocations before DMG review

ESTIMATED NET REVENUESelf pay accounts older than 90 days are considered closed and total payments equal net revenueNon self pay accounts older than 270 days are considered closed and total payments equals net revenue

DEFINITIONS 1

MARICOPA INTEGRATED HEALTH SYSTEMSERVICE LINE PROFITABILITYDISCHARGE DATE 10/1/2015 to 9/30/2016SUMMARY ANALYSIS

SUMMARY BY MAJOR DIVISION

Group MIHS Major Divisions Est Net Revenue Direct Costs FQHC and Other Revenue Offsets

Contribution Margin Indirect Costs Net Margin w_o

Subsidies Subsidies Net Margin w_Subsidies

Acute 197,523,820 158,037,136 3,286,039 42,772,744 66,971,970 -24,199,235 2,983,124 -21,216,157Mental Health 57,639,751 49,457,565 55,050 8,237,235 24,032,952 -15,795,715 4,407,802 -11,387,914Outpatient 110,005,245 90,298,299 248,287 19,955,508 34,597,356 -14,641,938 2,615,154 -12,026,695Report Total 365,168,815 297,793,000 3,589,376 70,965,487 125,602,278 -54,636,888 10,006,080 -44,630,766

SUMMARY BY FINANCIAL CLASS

Primary Financial Class Name Est Net Revenue Direct Costs FQHC and Other Revenue Offsets



AHCCCS 103,088,974 88,902,785 1,340,979 15,527,282 36,147,917 -20,620,669 2,031,634 -18,589,040COMMERCIAL 14,722,051 6,354,760 50,535 8,417,827 2,866,936 5,550,891 359,094 5,909,985GRANTS 1,932,521 1,757,380 4,969 180,110 672,253 -492,146 48,262 -443,881LAW ENFORCEMENT 5,588,099 3,557,654 123,257 2,153,703 1,521,422 632,282 83,791 716,075MANAGED CARE 53,142,869 29,094,833 258,711 24,306,772 11,968,413 12,338,342 726,901 13,065,250MARICOPA HEALTH PLAN 29,933,636 23,050,165 288,689 7,172,208 9,333,713 -2,161,521 545,040 -1,616,480MEDICARE 40,217,550 28,388,128 192,751 12,022,181 12,588,709 -566,531 1,346,009 779,485MEDICARE HMO 35,267,994 22,353,902 220,961 13,135,071 9,620,112 3,514,952 908,511 4,423,467OTHER GOVERNMENT 28,117,679 31,638,493 438,058 -3,082,724 13,341,301 -16,424,026 726,214 -15,697,813MMIC/RBHA 32,401,926 26,410,126 38,376 6,030,177 12,834,306 -6,804,129 2,324,289 -4,479,842SELF PAY 7,401,945 32,754,439 602,652 -24,749,795 13,254,486 -38,004,299 845,928 -37,158,346WORKERS COMP 13,353,570 3,530,334 29,439 9,852,675 1,452,709 8,399,966 60,406 8,460,374Report Total 365,168,815 297,793,000 3,589,376 70,965,487 125,602,278 -54,636,888 10,006,080 -44,630,766

MAJOR DIVISION 2

MARICOPA INTEGRATED HEALTH SYSTEMSERVICE LINE PROFITABILITYDISCHARGE DATE 10/1/2015 to 9/30/2016ACUTE CARE DIVISION

ACUTE CARE DIVISION BY PATIENT TYPE

Patient Type Est Net Revenue Direct Costs FQHC and Other Revenue Offsets



Emergency 26,589,726 18,369,010 1,900,222 10,120,961 8,156,898 1,964,055 391,168 2,355,177Inpatient 147,343,285 115,750,839 808,199 32,400,645 48,440,922 -16,040,277 2,143,566 -13,896,712Newborn 12,944,024 11,020,585 300,178 2,223,615 4,606,229 -2,382,615 167,046 -2,215,568Observation 10,646,786 12,896,703 277,440 -1,972,477 5,767,920 -7,740,397 281,343 -7,459,054Total 197,523,820 158,037,136 3,286,039 42,772,744 66,971,970 -24,199,235 2,983,124 -21,216,157

ACUTE CARE DIVISION BY FINANCIAL CLASS




AHCCCS 56,826,219 61,558,615 1,251,897 -3,480,488 25,897,669 -29,378,163 1,158,524 -28,219,667COMMERCIAL 9,712,791 2,557,184 47,226 7,202,833 1,046,075 6,156,759 44,398 6,201,156GRANTS 12,830 33,349 17 -20,502 14,827 -35,329 448 -34,882LAW ENFORCEMENT 3,521,800 2,267,769 121,876 1,375,906 1,019,857 356,049 49,456 405,505MANAGED CARE 37,285,847 15,702,020 231,433 21,815,262 6,604,941 15,210,320 240,591 15,450,910MARICOPA HEALTH PLAN 10,541,588 10,827,140 257,581 -27,968 4,577,046 -4,605,015 190,521 -4,414,502MEDICARE 21,825,516 12,234,668 165,824 9,756,672 5,298,397 4,458,275 244,237 4,702,511MEDICARE HMO 21,055,283 10,502,951 199,337 10,751,669 4,520,365 6,231,304 201,378 6,432,682OTHER GOVERNMENT 22,781,071 27,453,922 424,206 -4,248,642 11,620,995 -15,869,638 581,301 -15,288,338MMIC/RBHA 183,201 345,626 10,653 -151,772 170,259 -322,031 6,766 -315,265SELF PAY 1,630,437 11,482,960 547,287 -9,305,232 4,918,978 -14,224,211 214,774 -14,009,443WORKERS COMP 12,147,235 3,070,933 28,704 9,105,006 1,282,562 7,822,444 50,731 7,873,175Total 197,523,820 158,037,136 3,286,039 42,772,744 66,971,970 -24,199,235 2,983,124 -21,216,157

ACUTE CARE DIVISION 3

MARICOPA INTEGRATED HEALTH SYSTEMSERVICE LINE PROFITABILITYDISCHARGE DATE 10/1/2015 to 9/30/2016MENTAL HEALTH DIVISION

MENTAL HEALTH DIVISION BY PATIENT TYPE




Behavioral Health 57,639,751 49,457,565 55,050 8,237,235 24,032,952 -15,795,715 4,407,802 -11,387,914Total 57,639,751 49,457,565 55,050 8,237,235 24,032,952 -15,795,715 4,407,802 -11,387,914

MENTAL HEALTH DIVISION BY FINANCIAL CLASS




AHCCCS 266,155 302,359 262 -35,941 142,074 -178,016 26,018 -151,997COMMERCIAL 4,546,475 3,509,724 2,732 1,039,482 1,719,564 -680,081 307,223 -372,858LAW ENFORCEMENT 135,084 80,592 44 54,535 41,410 13,126 7,058 20,184MANAGED CARE 2,616,482 2,266,638 2,400 352,244 1,094,513 -742,268 197,697 -544,571MEDICARE 11,858,836 10,811,105 13,650 1,061,381 5,234,094 -4,172,713 956,283 -3,216,431MEDICARE HMO 5,696,759 5,949,845 7,755 -245,332 2,890,648 -3,135,980 538,600 -2,597,380OTHER GOVERNMENT 466,390 558,287 919 -90,978 275,837 -366,815 60,657 -306,158MMIC/RBHA 32,053,569 25,973,223 27,288 6,107,634 12,631,959 -6,524,324 2,313,779 -4,210,545SELF PAY 0 5,792 1 -5,791 2,853 -8,645 487 -8,158Total 57,639,751 49,457,565 55,050 8,237,235 24,032,952 -15,795,715 4,407,802 -11,387,914

MENTAL HEALTH DIVISION 4

MARICOPA INTEGRATED HEALTH SYSTEMSERVICE LINE PROFITABILITYDISCHARGE DATE 10/1/2015 to 9/30/2016OUTPATIENT DIVISION

OUTPATIENT DIVISION BY PATIENT TYPE




Dialysis Series 4,902,193 3,917,949 14,838 999,082 1,610,590 -611,508 77,202 -534,305CHC 26,176,756 22,031,106 98,126 4,243,813 8,367,652 -4,123,818 638,810 -3,484,903Dental 3,671,364 4,583,251 23,926 -887,969 1,661,009 -2,548,974 92,027 -2,456,938FHC 46,226,010 35,800,038 83,822 10,510,001 13,887,451 -3,377,539 1,324,654 -2,052,928All Other * 29,028,922 23,965,955 27,575 5,090,581 9,070,654 -3,980,099 482,461 -3,497,621Total 110,005,245 90,298,299 248,287 19,955,508 34,597,356 -14,641,938 2,615,154 -12,026,695

OUTPATIENT DIVISION BY FINANCIAL CLASS




AHCCCS 45,996,599 27,041,811 88,819 19,043,711 10,108,174 8,935,509 847,092 9,782,624COMMERCIAL 462,785 287,852 578 175,511 101,298 74,213 7,473 81,687GRANTS 1,919,691 1,724,031 4,952 200,612 657,426 -456,816 47,814 -408,999LAW ENFORCEMENT 1,931,216 1,209,293 1,338 723,262 460,155 263,107 27,278 290,387MANAGED CARE 13,240,540 11,126,175 24,878 2,139,266 4,268,959 -2,129,709 288,613 -1,841,088MARICOPA HEALTH PLAN 19,392,048 12,223,025 31,108 7,200,176 4,756,668 2,443,494 354,519 2,798,022MEDICARE 6,533,197 5,342,355 13,278 1,204,128 2,056,217 -852,093 145,490 -706,596MEDICARE HMO 8,515,952 5,901,105 13,869 2,628,733 2,209,099 419,627 168,533 588,165OTHER GOVERNMENT 4,870,218 3,626,284 12,933 1,256,896 1,444,469 -187,574 84,256 -103,318MMIC/RBHA 165,156 91,277 435 74,314 32,089 42,225 3,744 45,968SELF PAY 5,771,508 21,265,687 55,364 -15,438,771 8,332,655 -23,771,443 630,667 -23,140,745WORKERS COMP 1,206,335 459,401 735 747,669 170,147 577,522 9,675 587,198Total 110,005,245 90,298,299 248,287 19,955,508 34,597,356 -14,641,938 2,615,154 -12,026,695

OUTPATIENT DIVISION 5

MARICOPA INTEGRATED HEALTH SYSTEMSERVICE LINE PROFITABILITYDISCHARGE DATE 10/1/2015 to 9/30/2016OUTPATIENT DIVISIONOUTPATIENT DIVISION, DIALYSIS SERIES PATIENT TYPE, BY FINANCIAL CLASS




AHCCCS 317,831 263,487 925 55,269 104,715 -49,446 5,045 -44,400MANAGED CARE 4,132 2,762 0 1370 1,215 155 31 186MARICOPA HEALTH PLAN 433,290 316,122 1659 118,827 128,409 -9,582 5,741 -3,841MEDICARE 435,356 505,018 1772 -67,891 208,220 -276,110 9,958 -266,153MEDICARE HMO 129,193 141,836 628 -12,015 59,137 -71,152 3,199 -67,953OTHER GOVERNMENT 3,582,391 2,569,949 9451 1,021,893 1,061,774 -39,881 50,369 10,489SELF PAY 0 118,774 402 -118,372 47,120 -165,492 2,859 -162,633Total 4,902,193 3,917,949 14,838 999,082 1,610,590 -611,508 77,202 -534,305OUTPATIENT DIVISION, CHC PATIENT TYPE, BY FINANCIAL CLASS




AHCCCS 10,662,060 6,239,728 27,402 4,449,752 2,275,593 2,174,167 189,630 2,363,828COMMERCIAL 47,005 39,131 155 8,028 15,890 -7,860 1,074 -6,786GRANTS 315,071 323,220 1,796 -6,352 149,725 -156,077 10,326 -145,748LAW ENFORCEMENT 578,997 362,665 888 217,220 132,155 85,066 7,786 92,854MANAGED CARE 3,295,969 2,273,503 8,873 1,031,340 872,521 158,812 55,858 214,687MARICOPA HEALTH PLAN 5,196,397 3,179,285 14,736 2,031,859 1,204,041 827,823 92,855 920,688MEDICARE 1,594,170 1,231,512 4,911 367,572 444,018 -76,442 33,228 -43,209MEDICARE HMO 2,303,534 1,654,549 5,278 654,267 599,278 54,993 39,885 94,887OTHER GOVERNMENT 296,290 197,620 1,915 100,587 73,131 27,456 6,254 33,711MMIC/RBHA 7,641 3,414 20 4,247 1,364 2,883 143 3,026SELF PAY 1,772,453 6,467,605 31,947 -4,663,207 2,574,480 -7,237,680 200,498 -7,037,153WORKERS COMP 107,169 58,874 205 48,500 25,457 23,042 1,271 24,314Total 26,176,756 22,031,106 98,126 4,243,813 8,367,652 -4,123,818 638,810 -3,484,903


MARICOPA INTEGRATED HEALTH SYSTEMSERVICE LINE PROFITABILITYDISCHARGE DATE 10/1/2015 to 9/30/2016OUTPATIENT DIVISIONOUTPATIENT DIVISION, DENTAL PATIENT TYPE, BY FINANCIAL CLASS


Contribution Margin Indirect Costs Net Margin wo

Subsidies Subsidies Net Margin w Subsidies

AHCCCS 1,328,099 1,291,039 14,998 52,056 465,616 -413,561 26,654 -386,904GRANTS 220,677 207,155 248 13,770 71,314 -57,543 3,926 -53,617LAW ENFORCEMENT 24,453 27,327 129 -2,745 10,244 -12,989 678 -12,311MANAGED CARE 453,171 516,590 737 -62,683 179,641 -242,322 10,383 -231,939MARICOPA HEALTH PLAN 958,161 840,126 3,055 121,090 311,597 -190,509 16,842 -173,666MEDICARE HMO 45,618 75,402 196 -29,589 27,803 -57,392 1,362 -56,030OTHER GOVERNMENT 52,344 47,658 168 4,855 17,635 -12,780 1,134 -11,646SELF PAY 588,841 1,577,954 4395 -984,721 577,159 -1,561,878 31,047 -1,530,824Total 3,671,364 4,583,251 23,926 -887,969 1,661,009 -2,548,974 92,027 -2,456,938OUTPATIENT DIVISION, FHC PATIENT TYPE, BY FINANCIAL CLASS




AHCCCS 24,310,027 12,927,178 28,548 11,411,471 4,912,221 6,499,220 493,856 6,993,066COMMERCIAL 79,488 85,259 94 -5,676 29,596 -35,272 3,111 -32,161GRANTS 671,682 730,073 2,873 -55,519 254,082 -309,603 24,535 -285,068LAW ENFORCEMENT 569 636 3 -65 248 -312 17 -295MANAGED CARE 3,541,278 4,222,801 12,558 -668,949 1,634,227 -2,303,185 150,113 -2,153,080MARICOPA HEALTH PLAN 8,754,317 5,033,045 10,674 3,731,976 1,991,447 1,740,516 184,147 1,924,657MEDICARE 2,634,782 1,893,691 5,100 746,195 733,824 12,366 68,569 80,932MEDICARE HMO 4,262,057 2,385,890 6,582 1,882,759 920,456 962,293 90,812 1,053,100OTHER GOVERNMENT 652,299 554,364 560 98,522 194,943 -96,422 21,902 -74,520RBHA 140,551 84,086 336 56,801 30,050 26,750 3,097 29,846SELF PAY 1,166,963 7,874,147 16,466 -6,690,677 3,182,663 -9,873,357 284,171 -9,589,198WORKERS COMP 11,998 8,866 30 3,162 3,695 -532 325 -207Total 46,226,010 35,800,038 83,822 10,510,001 13,887,451 -3,377,539 1,324,654 -2,052,928

OUTPATIENT DIVISION, ALL OTHER PATIENT TYPE, BY FINANCIAL CLASS




AHCCCS 9,378,582 6,320,379 16,946 3,075,163 2,350,029 725,129 131,907 857,034COMMERCIAL 336,292 163,462 329 173,159 55,812 117,345 3,288 120,634GRANTS 712,261 463,583 35 248,713 182,305 66,407 9,027 75,434LAW ENFORCEMENT 1,327,197 818,665 318 508,852 317,508 191,342 18,797 210,139MANAGED CARE 5,945,990 4,110,519 2,710 1,838,188 1,581,355 256,831 72,228 329,058MARICOPA HEALTH PLAN 4,049,883 2,854,447 984 1,196,424 1,121,174 75,246 54,934 130,184MEDICARE 1,868,889 1,712,134 1,495 158,252 670,155 -511,907 33,735 -478,166MEDICARE HMO 1,775,550 1,643,428 1,185 133,311 602,425 -469,115 33,275 -435,839OTHER GOVERNMENT 286,894 256,693 839 31,039 96,986 -65,947 4,597 -61,352MMIC/RBHA 16,964 3,777 79 13,266 675 12,592 504 13,096SELF PAY 2,243,251 5,227,207 2,154 -2,981,794 1,951,233 -4,933,036 112,092 -4,820,937WORKERS COMP 1,087,168 391,661 500 696,007 140,995 555,012 8,079 563,091Total 29,028,922 23,965,955 27,575 5,090,581 9,070,654 -3,980,099 482,461 -3,497,621* All Other include: OP Angio, OP Burn clinic,OP Cardiology, OP Cath lab, OP Endoscopy, OP Lab, OP surgery, ED burn


MARICOPA INTEGRATED HEALTH SYSTEMSERVICE LINE PROFITABILITYDISCHARGE DATE 10/1/2015 to 9/30/2016CHARITY CARE: Financial Class = Self-Pay

CHARITY CARE BY MAJOR DIVISION

Group MIHS Major Divisions Est Net Revenue Direct Costs FQHC and Other Revenue Offsets



Acute Care 1,630,437 11,482,960 547,287 -9,305,232 4,918,978 -14,224,211 214,774 -14,009,443Mental Health - 5,792 1 -5,791 2,853 -8,645 487 -8,158Outpatient 5,771,508 21,265,687 55,364 -15,438,771 8,332,655 -23,771,443 630,667 -23,140,745Total 7,401,945 32,754,439 602,652 -24,749,795 13,254,486 -38,004,299 845,928 -37,158,346

CHARITY CARE BY PATIENT TYPE




Emergency 645,597 3,749,095 473,262 -2,630,233 1,687,470 -4,317,703 79,898 -4,237,811Inpatient 818,008 6,362,854 46,914 -5,497,932 2,632,834 -8,130,767 107,194 -8,023,572Newborn 3,990 105,373 4,029 -97,354 46,192 -143,546 1,857 -141,689Observation 162,843 1,265,639 23,083 -1,079,713 552,483 -1,632,196 25,825 -1,606,371Behavioral Health 0 5,792 1 -5,791 2,853 -8,645 487 -8,158Dialysis Series 0 118,774 402 -118,372 47,120 -165,492 2,859 -162,633CHC 1,772,453 6,467,605 31,947 -4,663,207 2,574,480 -7,237,680 200,498 -7,037,153Dental 588,841 1,577,954 4,395 -984,721 577,159 -1,561,878 31,047 -1,530,824FHC 1,166,963 7,874,147 16,466 -6,690,677 3,182,663 -9,873,357 284,171 -9,589,198All Other 2,243,250 5,227,206 2,153 -2,981,795 1,951,232 -4,933,035 112,092 -4,820,937Total 7,401,945 32,754,439 602,652 -24,749,795 13,254,486 -38,004,299 845,928 -37,158,346

CHARITY CARE 8

Maricopa County



May 24, 2017

Item 8.c.

Reports to the Board Quarterly Compliance Officer’s Report

Board of Directors - FY 2017 Internal Audit and Compliance Work

Plans (Q4 Update -

As of May 15, 2017)

1

I. FY2017 Compliance and Internal Audit Work Plan

2

Project Name Audit Timing Est. Audit Hours

Risk Assessment and Selection Q1 (Current State Assessment)

CQ1.1 Compliance Department Evaluation and Clean-Up of Outstanding Items Q1 250 (Completed)

CQ1.2 Privacy and Security Policy and Procedure Review (R4, R13,R24) Q1 200 (Completed) CQ1.3 Compliance Policy and Procedure Review (and review of Compliance IT Systems) (R16) (R15) Q1 150 (Completed)

CQ1.4 Research Department Report – Process Improvement (Phase I) (R6), (R7), (R25) Q1 200 (Completed)

Risk Re-assessment and Selection Q2

CQ2.1 340b Pharmacy Compliance (R5), (R16), (R19) Q2 200 (Completed) CQ2.2 Research Department Report – Process Improvement (Phase II) (R6), (R7), (R25) Q2 250 (Completed)

CQ2.3 Site visits of all external sites (DNV and HIPAA)(R1), (R2), (R3), (R5), (R9), (R13) Q2 200 (Completed)

CQ2.4 Behavioral Health Billing (R1), (R2), (R3), (R5), (R6), (R7) Q2 100 (Completed)

CQ2.5 Creation of Training Materials for Employees, Physicians and Residents (R13), (R23), (R24) Q2 150 (Completed)

The 2017 compliance projects are listed below with proposed timing and estimated hours (for Q1 through Q4). Each project will, at a minimum, include a focus on the adequacy of compliance with regulations, as well as the identification of value added recommendations. The 2017 compliance work plan represents compliance activities based on the results of the risk assessment and may be subject to change based on changes in risk, priorities and MIHS initiatives throughout the fiscal year.

2017 Compliance Work Plan

3



CQ3.1 Health Plan Sale and Reconciliation (R16) Q3 50 (Completed)

CQ3.2 IT Disaster Recover and Business Continuity (R8), (R13), (R16), (R17) Q3 200 (On-Going)

CQ3.3 Charge Description Master – PWC’s Pathway to Excellence Program (Moved from FY 2016) (R3) Q3 100 (In-Process)

CQ3.4 Trauma Revenue Cycle - Phase I ($2.6 million in recovered Revenue) Q3 250 (Re-bill Completed)

CQ.3.5 ED/Burn to OBS/Admit (Working with Case Management and PAs) Phase I Q3 250 (On-going)

CQ3.6 (Added) – Co-Applicant Arrangement Negotiations Q3/Q4 300 (In-Process)

(Old CQ3.4)MedAssets Contract Manager Accuracy (Moved from FY 2016) (R11) Q3 TBD (Move)

(Old CQ3.5) Patient Eligibility and Billing (Moved from FY 2016) (R2) Q3 TBD (Move)


CQ3.4 Trauma Revenue Cycle - Phase II Q4 In-Process

CQ.3.5 ED/Burn to OBS/Admit - Phase II Q4 In-Process

CQ4.1 (Move to 2018) Physicians at Teaching Hospital (Moved from FY 2016) Q4 TBD CQ4.2 (Move to FY2018) Provider Based Clinic Reviews (Moved from FY 2016) (R1), (R2), (R6), (R9) Q4 TBD

CQ4.3 (Move to FY 2018) Cardiac Interventional Lab (Moved from FY 2016) Q4 TBD

Risk Assessment and 2018 Compliance Plan Development Q4 120

Special Projects and Other Compliance Requests On-going TBD

Compliance Planning, Administration and Meetings Quarterly TBD

2017 Compliance Plan (continued)

4


Risk Assessment and Selection Q1 (Current State Assessment)

IQ1.1 Internal Audit Department Evaluation and Clean-Up of Outstanding Items Q1 250 (Completed)

IQ1.2 Contracts involved in Patient Care (Prior Year DNV Exception) (Updated Contract System) (R21) Q1 100 (Completed)

IQ1.3 Meaningful Use Audit (Phase I) (R13), (R15, (R16), (R24) Q1 100 (Completed) IQ1.4 Business Associate Agreement Review (Updated Contract System) (R13), (R21) Q1 200 (Completed)


IQ2.1 Meaningful Use Audit (Phase II) (R13), (R15, (R16), (R24) Q2 200 (Final Negotiations May 2017))

IQ2.2 Application Identification and Security Review (R8), (R13) Q2 350 (Completed)

IQ2.3 P-Card Audit and Travel Expenses (R14), (R20) Q2 150 (Completed)

IQ2.4 IT Security and PCI Compliance (R13), (R24) Q2 200 (On-going)

The 2017 internal audit projects are listed below with proposed timing and estimated hours (for Q1 through Q4). Each project will, at a minimum, include a focus on the adequacy of internal controls as well as the identification of value added recommendations. The 2017 audit plan represents audits based on the results of the risk assessment and may be subject to change based on changes in risk, priorities and MIHS initiatives throughout the fiscal year.

2017 Internal Audit Plan

5



IQ3.1 Prop 480 Allocated Funds (R22) Q3 150 (In-Process)

IQ3.2 Grants Compliance (R25) Q3 200 (In-Process)

IQ3.3 DMG Contract Compliance Review (R12) (Phase I) Q3 350 (In-Process)


IQ4.1 Prop 480 Structure Analysis and Internal Controls Q4 250 (Planned)

IQ4.2 DMG Contract Compliance Review (Phase II) Q4 350 (Planned)

IQ4.1(Moved to FY2018) Hospital Cost Report – Salaries and DME Payments (Moved from FY 2016) (R10), (R14), (R18) Moved TBD

IQ4.2 (Moved to FY2018) Self Pay Collections (Moved from FY 2016) (R9) Moved TBD

IQ4.3 (Moved to FY 2018) Inpatient Outlier Cases and Mechanical Ventilation (R7), (R16) Moved TBD

IQ4.4 (Moved to FY2018) Conflict of Interest (Moved from FY 2016) (R16) Moved TBD Risk Assessment and 2018 Internal Audit Plan Development Q4 120

Special Projects and Other Internal Audit Requests On-going TBD

Internal Audit Planning, Administration and Meetings Quarterly TBD

2017 Internal Audit Plan (continued)

6

II. Ethics Point Hotline Report

7

ISSUES REPORTED FY17 to Date

7

9

8

7

6 5

4

3

3

3

2 2

9

Inappropriate Behavior

Patient Care

Other

Harassment - Workplace

Environment, Health and Safety

Health Insurance Portability andAccountability Act (HIPAA)

Disclosure of Confidential Information

Patient Abuse/Verbal

Unfair Employment Practices

Misconduct Behavior

Unauthorized/Fraudulent Use ofCompany Facilities and Equipment

Other

8

III. (In-Process) FY 2018 Enterprise Risk Assessment

9

Executive Summary

One of the key foundational activities for the Internal Audit and Compliance Department (Audit and Compliance) is to perform a risk assessment to form the basis for the annual compliance and internal audit work plans. During the assessment, a number of factors are considered including the current business environment, risks common to the healthcare industry, and the feedback received from the individuals interviewed.

A high-level risk assessment, including interviews of key members of MIHS management, is being performed in May and June 2017 and in the proposed FY2018 internal audit and compliance work plans will be developed.

Understand the Business 1

• Conducted interviews with various members of MIHS Management and Healthcare Industry leaders; • Considered whether any key initiatives or changes to MIHS’ strategic plan may impact the risk profile of the organization; • Reviewed the audit and compliance work plans and priorities of other health systems to determine current areas of

focus by others in the industry.

Risk Assessment 2

• Prioritized risks and areas of concern based on the importance to business performance, impact to the organization and the likelihood of control /process issues;

• Considered the prior year risk assessments and work completed in FY16 & FY17 and the findings from previous internal audit and compliance activities.

Prioritized Internal Audit and Compliance Plan 3

• Propose a list of compliance and internal audit projects focused on the risks identified and areas of concern to be completed in FY2018. These will be reassessed quarterly.

10

Understand the Business As part of our process in understanding MIHS’s current environment, key business processes, and concerns, we seeking input from each of the following members of MIHS Management:

Steve Purves President and Chief Executive Officer

Kris Gaw Chief Operations Officer Kathy Benaquista Chief Financial Officer Dr. Wisinger/Dr. Hitt Chief Medical Officer Sherry Stotler Chief Nursing Officer/VP Patient Care Services Kelly Summers Chief Information Officer Nancy Kaminski Vice President of Revenue Cycle Lito Landas Controller, General Finance Services

Brian Maness Director of Contracts and Procurement

Anna Sogard Director of Pharmacy Services Manny Soto Director of Health Information Management Louis Gorman District General Counsel Warren Whitney SVP, Government Affairs Mike Robertson SVP, Marketing and Public Affairs Susan Doria SVP. Strategic Planning Mike Zenobi VP, Managed Care Operations Gene Cavallo VP, Behavior Health Services Wyatt Howell SVP, Ambulatory Care Services Cheri Tomlinson VP. Grants and Research Mica Goldfeder VP, Human Resources And many more!

11

Understand the Business – MIHS’s Main Business Units


A - Acute Care

B – Graduate Medical

Education (Residency Program)

C - FQHC D - CHC

E - Behavioral

Health

F - DMG

(District Medical Group)

G - Health Plans

12

IV. Compliance Training Report 5/4/2017

13

FY 2017 - Compliance Training Report (as of 5/4/2017)

Maricopa County



May 24, 2017

Item 8.d.

Reports to the Board Monthly Media Report

Marketing and Public Relations

4/14/17 – 5/14/17

1


4/14/17 – 5/14/17

2

Media Coverage

Media Outlet Date Reach Headline Local TV news 5/13 801K Woman still hospitalized

from e-cigarette explosion AZ Republic/azcentral.com

5/12 4 M Dr. Alicia Cowdrey / MIHS First Episode Center

Local TV news 4/27 332K Mesa PD officer hospitalized after hard landing

Local TV news 4/26 504K Teen shot in chest Phoenix New Times

4/26 642K Why HIV is increasing in Arizona

Modern Healthcare

5/8 75K Kris Gaw is one of 25 top healthcare COO in the country

Total exposure: 6.4 Million

Proposition 480 Exposure MIHS “Building Our Future” Web Site We are keeping various audiences updated through the MIHS website. A tab entitled “Building Our Future” on the homepage of the website, www.MIHS.org, allows interested visitors to receive updated information regarding various subject areas of Proposition 480. These areas include News, Implementation Planning, Bond Advisory Committee and Vendors and Contractors. Between April 15 – May 10, we have had:

• 655 page views on “Building Our Future” section of MIHS.org • 471 unique page views (from new users)

The “Building Our Future” web page will continue to be updated with tactical elements such as news stories, photos, video, PDF files and links to desired entities.

http://www.mihs.org/


4/14/17 – 5/14/17

3

General MIHS.org Web Site Exposure (April 15 – May 10) MIHS.org

Total Visits 27,886 Total Page Views 69,334 Pages Per Visit 2.31 Average Length of Visit 1:24 New Visitors 18,409 E-News Outreach Each month MIHS delivers a community E-News email to our list of community subscribers. Community E-News

Sent (successful delivery) 300,932 Opens 3,302 (1.1%) Click Thru 111 (3.3%) Social Media Facebook March

2017 April 2017

Total

Impressions 690,725 546,909 1,237,634 Reach 188,107 341,818 529,925 Video Views 51,954 46,739 98,693 New Likes 237 201 438 YouTube March

2017 April 2017

Total

Minutes Watched 5,237 2,063 7,300 Video Views 1,884 1,091 2,975


4/14/17 – 5/14/17

4

Community Outreach (April 15 – May 10)

Community Events

Date Attendance

GAIN Free Community Party at Villa De Paz Elementary School

4/28/17 110

I CAN WELLNESS Fair, Chandler 4/28/17 300 AZ Burn Center Chili/Salsa Event 4/29/17 750

Calendar of Events for MIHS President and CEO, Steve Purves

4/28 – Tour of Chicanos Por La Causa in Maryvale

4/27 – Attended MHF Arizona Legacy Circle “Night of Heroes” event

4/27 – Opening remarks, Volunteer Week receptions

4/26 – Targeted investment meeting at AHCCCS

4/19 – Prop 480 Update Meeting w/Scottsdale Mayor Jim Lane

4/19 – AZ Chamber “Update from the Capitol” luncheons w/Senators Flake and McCain 4/17 – Tour of Mayo Clinic School of Medicine

Maricopa County



May 24, 2017

Item 9. No Handout

Concluding Items

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