To: Board of Supervisors
From: Dr. Ori Tzvieli, Interim Health Services Director
Report Title: Contract #23-867 with Inovalon Provider, Inc.
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Interim Health Services Director, or designee, to execute on behalf of the County (1) a Software and Service Agreement and (2) an Order Form with Inovalon Provider, Inc., a corporation, in an amount not to exceed $52,000, for Medicare eligibility data management software and services for Contra Costa Health (CCH) for the period from June 10, 2025 through June 09, 2028 through March 31, 2027, and for successive twelve (12) month terms thereafter until terminated.
FISCAL IMPACT:
This Contract will result in contractual service expenditures of up to $52,000 over a three-year period and will be funded 100% by Hospital Enterprise Fund I.
BACKGROUND:
This Contract meets the needs of CCH by providing a data management platform and (related) services regarding Medicare eligibility verification. Inovalon One® Platform, Inovalon’s Direct Data Entry (DDE) Verification allows access via a secure online connection for Medicare Part A providers to manage Medicare Part A claims. Inovalon One® Platform, a data-driven, cloud-based Software as a Service (SaaS) solution that enables healthcare organizations to improve clinical outcomes and economics by bringing together national-scale connectivity, real-time primary source data access, and advanced analytics, is utilized by CCH for Medicare eligibility verification, including claim status lookup, and online claim correction and enables enterprise usage throughout CCH registration sites, Health Information Management, Utilization Review, Contra Costa Health Plan, Financial Counseling, and Patient Billing.
Since 2016, these services have been procured via Purchase Order (prior PO #029209 FY2023-2024) in compliance with County Administrative Bulletin AB600.3. Section III (B) (7), the department is transitioning the documenting of these services from PO to Contract. This Contractor was approved as the sole source supplier of this platform by the Public Works Department's Purchasing Division on October 22, 2024; a summary of service contract deliverables includes configuration, implementation, ongoing monitoring, management of the SaaS, and telephone support. This Contract was approved by Health Services Personnel to ensure there is no conflict with labor relations.
Under Contract #23-867, the parties will execute a Software and Service Agreement (including mutual indemnification), the County's Health Insurance Probability and Accountability (HIPPA) Business Associate Addendum (BAA) and an Order Form. Under the Software and Service Agreement, Inovalon’s liability for a breach of Protected Health Information is limited to $2,000,000. The Software and Service Agreement will automatically renew for additional twelve (12) month periods unless terminated as provided under the terms of the contract, or when no active Order Forms are in effect (per term specified in each Order Form). Under the Contract, the County is obligated to indemnify Inovalon for third-party claims arising out of the County’s negligent performance of the agreement. The division is requesting a retroactive effective date of April 1, 2024, for the Order Form caused by delays in negotiating renewal terms between the parties.
Approval of this new Contract #23-867 allows (approves funds) for the Contractor to provide services through June 09, 2028 through March 31, 2027. Thereafter, the Contract renews for successive twelve (12) month periods until terminated under the agreement.
CONSEQUENCE OF NEGATIVE ACTION:
If this Contract is not approved, CCH will lose access to this Medicare eligibility data management platform and (related) services regarding Medicare eligibility verification, risking regulatory non-compliance.