To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Amendment #77-655-1 with Abdul W. Wali, M.D.
☒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 #77-655-1 with Abdul W. Wali, M.D., an individual, effective November 1, 2024, to amend Contract #77-655, to provide additional medical consultation services and modify the Contract provisions to conform to Department of Managed Healthcare (DMHC) requirements with no change in the payment limit of $400,000 or the original term of April 1, 2024 through March 31, 2025.
FISCAL IMPACT:
Approval of this Amendment will not impact the payment limit of $400,000 and is funded 100% by Contra Costa Health Plan (CCHP) Enterprise Fund II revenues.
BACKGROUND:
The Health Services Department and CCHP are required by state and federal regulations to provide various certified medical consultation services in order to maintain its authorization to provide health care services to its members and recipients. Medical consulting is essential to our Utilization Management to ensure that CCHP is meeting and following the Medi-Cal Managed Care Plan from the State of California Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS). This new Contractor has been providing medical consultation services to the CCHP Medical Management Team, with regard to CCHP’s policies and procedures since April 1, 2024. 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 42 CFR 432.10(a) Standards of Personnel Administration. Health Services Personnel approved this Contract to ensure no conflicts with labor relations.
On March 19, 2024, the Board of Supervisors approved Contract #77-655 with Abdul W. Wali, M.D., in an amount not to exceed $400,000, to provide medical consultation services for the CCHP Medical Management Team for the period April 1, 2024 through March 31, 2025.
Approval of Contract Amendment #77-655-1 will allow CCHP to modify the Contract service plan provisions to conform with the DMHC requirements and allow the Contractor to provide additional medical consultation services through March 31, 2025.
CONSEQUENCE OF NEGATIVE ACTION:
If this Amendment is not approved, County will not be compliant with DMHC requirements.