To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Contract Amendment #23-627-12 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 Contract Amendment No. 3 (#23-627-12) with Medvision, Inc., a corporation, effective April 16, 2025, to amend Contract #23-627-9 (as amended by Contract Amendment #23-627-10 and #23-627-11), to increase the payment limit by $146,815, from $258,216 to a new payment limit of $405,031, for additional for patient medical necessity review criteria and guidance software for the Contra Costa Health Plan (CCHP).
FISCAL IMPACT:
This Contract Amendment will result in additional contractual service expenditures of up to $146,815 over a one-year period and will be funded 100% by Contra Costa Health Plan Enterprise Fund II. (Rate increase
BACKGROUND:
This Contract Amendment meets the needs of the County by allowing CCHP access to Contractor’s Apollo 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 the Apollo 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. Contractor’s Apollo Managed Care online medical review criteria and guideline publications are evidence-based and operate with 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.
A summary of service contract deliverables, including measurable outcomes required of the vendor to be monitored by the department in compliance with Section III(B)(7) of the Purchasing Policy (AB600.3), includes access to the web portal, maintenance and support services, and software updates. This Contract Amendment was approved by Contra Costa Health Personnel as a specialized services contract to ensure there is 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.
On October 22, 2024, the Board of Supervisors approved Contract Amendment #23-627-11 (Amendment No. 2) with Medvision, Inc., effective April 17, 2024, to increase the payment limit by $150,000 to a new payment limit of $258,216 and clarify that the contract will automatically renew for successive one (1) year periods until terminated for additional for patient medical necessity review criteria and guidance software for the Contra Costa Health Plan.
Approval of this Contract Amendment #23-627-12 (Amendment No. 3) will approve funds to allow the Contractor to provide services through April 17, 2026, 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 Contract Amendment is not approved, CCHP will lose access to the Apollo 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.