To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Contract #77-469-4 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 County Contract #77-469-4 with Medical Review Institute of America, LLC, a limited liability company, in an amount not to exceed $400,000, to provide independent medical review (IMR) services for Contra Costa Health Plan’s (CCHP) Utilization Management Unit for the period November 1, 2025 through October 31, 2027.
FISCAL IMPACT:
Approval of this Contract will result in contractual service expenditures of up to $400,000 over a two-year period and will be funded 100% by CCHP Enterprise Fund II revenues.
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 CCHP members. Contractor’s established IMR history ensures adherence to industry regulations and increases the ability to improve the quality of care to CCHP members. Contractor has been providing these services and fostering a deep understanding of the CCHP organization’s 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. 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. This Contractor was approved by the Public Works Department’s Purchasing Division on December 10, 2025.
On November 28, 2023, the Board of Supervisors approved Contract #77-469-1 with Medical Review Institute of America, LLC, in an amount not to exceed $300,000, for the provision of IMR services for CCHP’s Utilization Management Unit for the period November 1, 2023 through October 31, 2025.
On May 21, 2024, the Board of Supervisors approved Contract Amendment #77-469-2 with Medical Review Institute of America, LLC, effective June 1, 2024, to increase the payment limit by $100,000, to a new payment limit of $400,000, for additional IMR services for CCHP’s Utilization Management Unit, including the addition of health specialty matched initial review services to ensure timely assessments and an accurate overview of coverage for medical cases with no change in the original term ending October 31, 2025.
On December 17, 2024, the Board of Supervisors approved Contract Amendment #77-469-3 with Medical Review Institute of America, LLC, effective December 1, 2024, to provide additional IMR services for CCHP’s Utilization Management Unit and to modify Contract provisions to conform to Department of Managed Healthcare (DMHC) requirements with no change in the payment limit of $400,000 or term ending October 31, 2025.
Approval of Contract #77-469-4, will allow the Contractor to continue to provide IMR services for the CCHP Utilization Management Unit through October 31, 2027. Contract delay was due to Division not receiving required Contract forms from the Contractor in a timely manner.
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 met, causing a delay in services to CCHP members.