To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Contract #77-637 with The Prospera Group
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Health Services Director, or designee, to execute on behalf of the County Contract #77-637 with The Prospera Group, a corporation, in an amount not to exceed $250,000, to provide managed care regulatory consultation services to Contra Costa Health Plan (CCHP) Compliance Unit with regard to expanding the CCHP Provider Network for the period from December 1, 2023 through November 30, 2024.
FISCAL IMPACT:
Approval of this contract will result in annual expenditures of up to $250,000 and will be funded 100% by CCHP Enterprise Fund II revenues.
BACKGROUND:
CCHP has an obligation to provide certain specialized health care services for its members under the terms of their Individual and Group Health Plan membership contracts with the County. This is a new contractor who will provide managed care regulatory consultation services to the CCHP Compliance Unit, in regard to the CCHP Provider Network expansion of hard to contract specialties. CCHP is transitioning to a Single Plan Model for Medi-Cal Managed Care Members in the service area of Contra Costa County. This transition will increase CCHP’s Member base by over 30,000 Members, requiring expansion of the CCHP Provider Network to meet their medical needs and meet Department of Health Care Services (DHCS) and Department of Managed Health Care (DMHC) continuity of care requirements. This new contract will maintain comprehensive area coverage for the entire CCHP membership and meet the Knox-Keene Act, time and distance mandate required by the State of DMHC services.
This contract is entered into under and subject to the following legal authorities: California Government Code §§ 26227 and 31000; Health and Safety Code § 1451; and 42 CFR 432.10(a) Standards of Personnel Administration. Health Services Personnel approved this contract to ensure no conflicts with labor relations in September 2023. This contractor will participate in CCHP’s contracts recruitment and development program which consists of providing additional Managed Care Medi-Cal resources for CCHP members to ensure the medical needs of the membership are being met.
The nature of the managed care regulatory consulting services needed is complex and requires seamless coordination, integration and collaboration with existing programs and systems. There are a total of 3 managed care regulatory consultants in CCHP’s service area. The Prospera Group is familiar with CCHP’s specific requirements to help ensure a smoother implementation and delivery process. This contractor has been approved by the Public Works Department’s Purchasing Division on October 3, 2023.
Under new Contract #77-637, contractor will provide managed care regulatory consultation services for CCHP compliance unit for the period December 1, 2023 through November 30, 2024. This contract action is to temporarily support the compliance function for 2 years while the division works to staff permanently with County employees.
CONSEQUENCE OF NEGATIVE ACTION:
If this contract is not approved, the CCHP compliance unit will not receive the benefits of compliance consultation from the contractor and state mandated requirements will not be met.