To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Contract #77-469-1 with Medical Review Institute of America, LLC
☐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 #77-469-1 with Medical Review Institute of America, LLC, a limited liability company, in an amount not to exceed $300,000, to provide independent medical review (IMR) services for Contra Costa Health Plan’s (CCHP) Utilization Management Unit, for the period November 1, 2023 through October 31, 2025.
FISCAL IMPACT:
Approval of this contract will result in contractual service expenditures of up to $300,000 over a two-year period and will be funded 100% by CCHP Enterprise Fund II revenues. (No rate increase)
BACKGROUND:
CCHP has an obligation to provide certain IMR services, for its members under the terms of their Individual and Group Health Plan membership contracts with the county. This Contract is mandatory to help ensure CCHP is meeting the medical needs of the membership. Their established IMR history ensures adherence to industry regulations and increases the ability to improve the quality of care to CCHP members. This contractor has been providing these services and fostering a deep understanding of the CCHP organizations mission, values, and long-term objectives since November 1, 2022. 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 Department of Health Care Services (DHCS) regulation 42 CFR 432.10(a) Standards of Personnel Administration. Health Services Personnel approved this contract to ensure no conflicts with labor relations in October 2023.
This contractor currently cooperates with and participates in CCHP’s Quality Management Program which consists of quality improvement activities to improve the quality of care and services and member experience. Cooperation includes collection and evaluation of performance measurement data and participation in the organization’s clinical and service measure Quality Improvement Programs. The nature of the IMR services needed is complex and requires seamless coordination, integration and collaboration with existing programs and systems. There is a total of 2 IMR consulting service agencies in CCHP’s service area. CCHP is currently contracted with both. This contract renewal 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 California Department of Managed Health Care (DMHC) services. This contractor has been approved by the Public Works Department’s Purchasing Division on October 4, 2023.
In November 2022, the County Administrator approved, and the Purchasing Services Manager executed Contract #77-469 with Medical Review Institute of America, LLC, in an amount not to exceed $100,000, for the provision of IMR services for CCHP’s Utilization Management Unit for the period November 1, 2022 through October 31, 2023.
Approval of Contract #77-469-1 will allow the contractor to continue providing IMR services for CCHP through October 31, 2025.
CONSEQUENCE OF NEGATIVE ACTION:
If this contract is not approved, certain IMR services for CCHP will not be provided and state mandates will not be reached causing a delay in services to CCHP members.