To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Amendment #27-799-15 with Health Management Systems, 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 Agreement #27-799-15 with Health Management Systems, Inc., a corporation, effective January 1, 2025, to amend Contract #27-799-13 (as amended by Amendment Agreement #27-799-14), to provide additional professional auditing services for the Contra Costa Health Plan (CCHP) Claims Unit with no change in the payment limit of $2,000,000 or the original term of January 1, 2024 through December 31, 2025.
FISCAL IMPACT:
Approval of this Amendment will not impact the payment limit of $2,000,000 and is funded 100% by CCHP Enterprise Fund II revenues. (No additional rates)
BACKGROUND:
CCHP is mandated by State and Federal law to have professional auditing services which includes measures that prevent, detect, and correct noncompliance, insurance billing, provider recoupment, insurance verifications and coordination of benefits with the Centers for Medicare and Medicaid Services (CMS) program requirements. This Contract is mandatory to provide the needed Managed Care Audit Services of Insurance Billing and Provider Recoupment to maintain mandated requirements by the State of California Department of Managed Health Care (DMHC) and Department of Health Care Service (DHCS). Contractor has been fostering a deep understanding of the CCHP organizations mission, values, and long-term objectives since May 2010. This Contract is entered into under and subject to the following legal authorities: California Government Code ?? 26227 and 31000; Health and Safety Code ? 1451. Health Services Personnel approved this Contract to ensure no conflicts with labor relations.
On February 6, 2024, the Board of Supervisors approved Contract #27-79...
Click here for full text