To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Contract #23-864 with Health Management Associates, Inc.
☒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 #23-864 with Health Management Associates, Inc., a corporation, in an amount not to exceed $1,470,000 for consultation and technical assistance with regard to technology implementation of the Medicaid Dual Eligible Special Needs Plan (D-SNP), for the period from January 1, 2025 through June 30, 2026.
FISCAL IMPACT:
Approval of this agreement will result in expenditures of up to $1,470,000 for eighteen (18) months and will be funded as budgeted by the department in FY 2024-25, by 100% Contra Costa Health Plan Enterprise Fund II.
BACKGROUND:
This contract is entered into under and subject to the following legal authorities: California Government Code §§ 26227 and 31000. Health Services Personnel approved this Contract to ensure no conflicts with labor relations.
Contra Costa Health Plan (CCHP) is mandated by Department of Health Care Services (DHCS) to implement D-SNP program by January 1, 2026. CCHP members enrolled in the D-SNP program will have both Medi-Cal and Medicare coverages. CCHP is required to manage and coordinate all of their benefits across the two coverage and meet all the regulatory requirements from DHCS and Center for Medicare and Medicaid Services (CMS).
This Contractor was selected as they are uniquely suited to assist the County in meeting the technological and regulatory demands of the D-SNP program. Contractor has supported other California Health Plan Information Technology (IT) teams in implementing D-SNP program. Contractor is currently supporting IT departments of San Francisco Health Plan (SFHP) and CenCal Health Plan in similar role. Contractor’s knowledge of D-SNP requirements and actual expertise in implementing IT systems will be beneficial to CCHP to learn quickly and avoid mistakes given the small implementation window. In addition, the Contractor's previous engagement with CCHP has given them an understanding of existing IT system and processes so they can hit the ground running. Additionally, this Contractor successfully managed CCHP's compliance, member services and claims units and that knowledge will be beneficial as new IT systems to support DSNP are implemented in those and other units. This Contractor was approved by the Public Works Purchasing on October 16, 2024.
Approval of Contract #23-864 will allow the Contractor to provide consultation and technical assistance regarding technology implementation of D-SNP through June 30, 2026.
CONSEQUENCE OF NEGATIVE ACTION:
If this amendment is not approved, the CCHP will not be in compliance with DHCS requirements.