To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Amendment/Extension #23-627-11 with Medvision, 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 Amendment No. 2 (#23-627-11) with Medvision, Inc., a corporation, effective April 17, 2024, to increase the payment limit by $150,000, from $108,216, to a new payment limit of $258,216, and extend the contract term for successive (1) year periods until terminated, for patient medical necessity review criteria and guidance software for the Contra Costa Health Plan (CCHP).
FISCAL IMPACT:
Approval of this Amendment will result in additional annual expenditures of up to $150,000 and will be funded as budgeted by the department in FY 2024-25, by 100% Contra Costa Health Plan Enterprise Fund II. (Rate increase)
BACKGROUND:
This Contract meets the needs of the County by allowing access to Apollo's Managed Care web portal, a clinical guideline application, and online resource that helps ensure appropriate patient care by providing medical review criteria and guidelines that assist in identifying case management and treatment options that are appropriate and medically necessary. CCHP has subscribed to Apollo's Managed Care Web Portal application since (at least) 2017 to aid in healthcare management regarding ambulatory, inpatient, behavioral health, rehabilitation, post-acute, primary care, and case management. Apollo's Managed Care online medical review criteria and guideline publications are evidence-based and operate with an advanced Microsoft .Net framework. Medical review criteria and guidelines are mandated by the Department of Health Care Services to ensure healthcare providers follow regulations and approve services that meet patient(s) medical necessity. CCHP will monitor its access to the portal using measurable service contract deliverables in compliance with Section III(B)(7) of the Purchasing Policy. This Contract was approved by Contra Costa Health Personnel to ensure there was no conflict with labor relations.
In May 2023, the County Administrator approved, and the Purchasing Services Manager executed Contract #23-627-9 with Medvision, Inc., in an amount not to exceed $105,716 for the provision of its web portal application, Apollo Managed Care, including technical support and services, for medical criteria and guidelines, for the departments Ambulatory Care, Inpatient, Behavioral Health, Rehabilitation, Post-Acute Care, Primary Care and Case Management, for the period April 18, 2023 through April 17, 2024.
In October 2023, the County Administrator approved, and the Purchasing Services Manager executed Amendment No. 1 (Contract #23-627-10) with Medvision, Inc., effective October 1, 2023, to increase the payment limit by $2,500 to a new payment limit of $108,216 for additional software licenses for to Apollo's Managed Care Web Portal application medical criteria and guidelines, for the departments Ambulatory Care, Inpatient, Behavioral Health, Rehabilitation, Post-Acute Care, Primary Care and Case Management with no change in the term.
Approval of Contract Amendment Agreement #23-627-11 (Amendment No. 2) will increase the payment limit (of the Contract) to allow the Contractor to provide services through April 17, 2025, and clarify that the Agreement is effective as of the Effective Date (April 18, 2023) and shall continue for successive one (1) year periods until terminated. The department is requesting a retroactive effective date for the term of this Contract due to delays caused by receipt of necessary documentation from the Contractor.
CONSEQUENCE OF NEGATIVE ACTION:
If this Amendment is not approved, CCHP will lose access to Apollo's Managed Care web portal application and the publications related to medical review criteria and guidelines that assist in identifying case management and treatment options that are appropriate and medically necessary, rendering non-compliance with state-mandated guidelines and policies.