Agenda

Return

C. 36

To:	Board of Supervisors
From:	William Walker, M.D., Health Services Director
Date:	March 8, 2016

Contra

Costa

County

Subject:

Contract Amendment Agreement #27-799-5 with Health Management Systems, Inc.

APPROVE	OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR	RECOMMENDATION OF BOARD COMMITTEE

Action of Board On: 03/08/2016

APPROVED AS RECOMMENDED

OTHER

Clerks Notes:

VOTE OF SUPERVISORS

AYE:

John Gioia, District I Supervisor
Candace Andersen, District II Supervisor
Mary N. Piepho, District III Supervisor
Karen Mitchoff, District IV Supervisor
Federal D. Glover, District V Supervisor

Contact:	Patricia Tanquary, 313-6004
cc:	A Floyd M Wilhelm

I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown.
ATTESTED: March 8, 2016
David Twa,

BY:	, Deputy

RECOMMENDATION(S):

Approve and authorize the Health Services Director, or his designee, to execute, on behalf of the County, Contract Amendment Agreement #27-799-5 with Health Management Systems, Inc., a corporation, effective February 1, 2016, to amend Contract #27-799-4, to increase the payment limit by $200,000, from $650,000 to a new payment limit of $850,000, with no change in the original term of February 1, 2015 through January 31, 2017.

FISCAL IMPACT:

This amendment is funded 100% by Contra Costa Health Plan Enterprise Fund II. (No rate increase)

BACKGROUND:

Contra Costa Health Plan is mandated by State and Federal law to have a comprehensive fraud, waste, and abuse prevention and detection program which must include measures that prevent, detect, and correct noncompliance with the Centers for Medicare and Medicaid Services (CMS) program requirements. On April 21, 2015, the Board of Supervisors approved Contract #27-799-4 with Health Management Systems, Inc. for the provision of auditing services, for the period from February 1, 2015 through January 31, 2017. At the time of negotiations, the payment limit was based on target levels of utilization. However, based on revised projections, actual usage will exceed the target levels by the end of the Contract term. Approval of Contract Amendment Agreement #27-799-5 will allow the Contractor to continue providing services through January 31, 2017.

CONSEQUENCE OF NEGATIVE ACTION:

If this amendment is not approved, the Health Plan will be out of compliance with CMS services program requirements.

CHILDREN'S IMPACT STATEMENT:

Not Applicable