To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Amendment Agreement #77-469-3 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 #77-469-3 with Medical Review Institute of America, LLC, a limited liability company, effective December 1, 2024, to amend Contract #77-469-1 (as amended by #77-469-2), to provide additional Independent Medical Review (IMR) services for Contra Costa Health Plan's (CCHP) Utilization Management Unit and to modify 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 November 1, 2023 through October 31, 2025.
FISCAL IMPACT:
Approval of this Amendment will not impact the payment limit of $400,000 and is funded 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. 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. 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 I...
Click here for full text