To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Amendment Agreement #77-469-2 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 Amendment Agreement #77-469-2 with Medical Review Institute of America, LLC, a limited liability company, effective June 1, 2024, to amend Contract #77-469-1, to increase the payment limit by $100,000, from $300,000 to a new payment limit of $400,000, to provide additional independent medical review (IMR) services for Contra Costa Health Plan’s (CCHP) Utilization Management Unit, with no change in the original term of November 1, 2023 through October 31, 2025.
FISCAL IMPACT:
Approval of this Amendment will result in additional contractual service expenditures of up to $100,000 and will be funded as budgeted 100% by CCHP Enterprise Fund II revenues. (No rate increase)
BACKGROUND:
CCHP has an obligation to provide certain IMR services 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. This contractor currently cooperates and participates in CCHP’s Quality Management Program which consists of quality improvement activities to improve the quality of care, 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.
On November 28, 2023, the Board of Supervisors approved Contract #77-469-1 with Medical Review Institute of America, LLC, in an amount of $300,000, for the provision of IMR services for CCHP’s Utilization Management Unit for the period November 1, 2023 through October 31, 2025.
Approval of Contract Amendment Agreement #77-469-2 will increase the payment limit and allow the contractor to provide additional IMR services including the addition of health specialty matched initial review services which will ensure timely assessments and an accurate overview of coverage for medical cases with no change in the original term of November 1, 2023 through October 31, 2025.
CONSEQUENCE OF NEGATIVE ACTION:
If this Amendment 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.