To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Amendment #77-217-6 with Healthrisk Resource Group, 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 Amendment Agreement #77-217-6 with Healthrisk Resource Group, Inc., a corporation, effective November 1, 2024, to amend Contract #77-217-4 (as amended by Amendment Agreement #77-217-5), to provide additional claims processing and negotiation services with no change in the payment limit of $300,000 or the original term of March 1, 2024 through February 28, 2027.
FISCAL IMPACT:
Approval of this Amendment will not impact the payment limit of $300,000 and is funded 100% by Contra Costa Health Plan (CCHP) Enterprise Fund II revenues.
BACKGROUND:
CCHP has an obligation to provide certain specialized claims processing and negotiation services for its providers under the terms of the Individual and Group Health Plan membership contracts with the County. Contractor acts as a billing agent to negotiate discount rates, review documentation of medical claims and electronic claims from out of network medical providers services, which results in saving dollars for CCHP. The nature of claims processing and negotiation services needed is complex and requires seamless coordination, integration and collaboration with existing programs and systems. This Contractor has an established record of providing this expertise to the County since March 1, 2019. 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 Health and Safety Code § 1399.56. Health Services Personnel approved this Contract to ensure no conflicts with labor relations.
On March 19, 2024, the Board of Supervisors approved Contract #77-217-4 with Healthrisk Resource Group, Inc., in an amount not to exceed $300,000, to provide claims processing and negotiation services for the CCHP for the period March 1, 2024 through February 28, 2027.
On June 25, 2024, the Board of Supervisors approved Contract Amendment Agreement #77-217-5 with Healthrisk Resource Group, Inc., effective July 1, 2024, to modify the Contract provisions to conform to DMHC requirements with no change in the contract payment limit or the original term.
Approval of Contract Amendment Agreement #77-217-6 will allow the Contractor to provide additional claims processing and negotiation services through February 28, 2027.
CONSEQUENCE OF NEGATIVE ACTION:
If this Amendment is not approved, County will not be compliant with DMHC requirements.