Agenda Item   

AGENDA STAFF REPORT

 

                                                                                                                        ASR Control  24-000145

 

MEETING DATE:

03/26/24

legal entity taking action:

Board of Supervisors

board of supervisors district(s):

All Districts

SUBMITTING Agency/Department:

Health Care Agency   (Approved)

Department contact person(s):

Mindy Winterswyk (714) 347-0366 

 

 

Debra Baetz (714) 834-2830

 

 

Subject:  Contract for Fiscal Intermediary Services

 

      ceo CONCUR

County Counsel Review

Clerk of the Board

          Concur

Approved Agreement to Form

Consent Calendar

 

 

3 Votes Board Majority

 

 

 

    Budgeted: N/A

Current Year Cost:   N/A

Annual Cost: FY 2024-25 $250,000
FY 2025-26 $250,000
FY 2026-27 $250,000

 

 

 

    Staffing Impact:

No

# of Positions:            

Sole Source:   No

    Current Fiscal Year Revenue: N/A

   Funding Source:     State: 56% (Tobacco Settlement), Fees/Other: 44% (EMS Fund)

County Audit in last 3 years: No

   Levine Act Review Completed: Yes

 

    Prior Board Action:         5/21/2019 #32

 

RECOMMENDED ACTION(S):

 

 

1.

Approve the selection of and Contract with Advanced Medical Management, Inc., for provision of Fiscal Intermediary Services for the Emergency Medical Services Fund Program, for an amount not to exceed $750,000, for the term July 1, 2024, through June 30, 2027, renewable for one additional two-year term.

 

2.

Pursuant to Contract Policy Manual Section 3.4.114, authorize the Health Care Agency Director or Deputized designee to exercise a contingency contract cost increase, not to exceed a total of 10 percent of the Contract amounts for the first year of the Contract, for the entire term of the Contract, including renewal, and within the scope of work set forth in the Contract. The use of this contingency contract cost increase is subject to approval requirements established by the County Procurement Officer.

 

3.

Authorize the County Procurement Officer or Deputized designee to execute the Contract with Advanced Medical Management, Inc., as referenced in the Recommended Action above.

 

 

 

 

 

SUMMARY:

 

Approval of the selection of and Contract with Advanced Medical Management, Inc., for provision of Fiscal Intermediary Services for the Emergency Medical Services Fund Program will fund services to the Health Care Agency’s various providers for the provision of health care services and administrative support to meet the County’s mandate under Health and Safety Code 1797.98a.

 

 

 

BACKGROUND INFORMATION:

 

The Emergency Medical Services Fund (EMSF) is a State mandated program that collects and distributes payments to physicians to offset the cost of charity care provided to unfunded patients in an emergency room. The Health Care Agency (HCA) receives annual funding from various sources, to reimburse emergency room physicians for services provided. Funding sources include: 1) a portion of Tobacco Settlement Revenues (TSR), as specified in Measure H; and 2) a portion of SB 12/612 (Maddy) and SB 1773 funds, which come from penalty assessments on certain traffic fines. See Attachment C for Measure H, Attachment D for SB 12/612, and Attachment E for SB 1773.

 

On May 21, 2019, following a Request for Proposal (RFP), your Honorable Board (Board) approved the current Agreement for provision of Fiscal Intermediary Services for the EMSF Program with Advanced Medical Management, Inc. (AMM), for a five (5) year term, July 1, 2019, through June 30, 2024.

 

AMM has provided satisfactory services as the current fiscal intermediary, processing and paying claims in accordance with EMSF program rules. This includes monitoring to ensure physicians attempt to bill the patient or other responsible parties prior to billing the EMSF program. Continual monitoring of claims volume and EMSF funds for each Fiscal Year (FY) is required to make any adjustments to interim payment rates and thereby ensure all providers are paid. Once all claims have been paid, if funds remain at the close of the FY, a final reconciliation is completed where providers receive an additional payment proportional to their claims volume and all claims paid for the FY. In FY 2022-23, the reimbursement to physicians was $11,142,755 and AMM processed an estimated 41,040 EMSF claims.

 

On November 29, 2023, HCA released an RFP in the County’s online bidding system to solicit proposals from qualified providers for the provision of Fiscal Intermediary Services. The RFP included the County’s intent to award one contract to the qualified provider whose proposal was determined to be the most responsive to the requirements of the RFP. Notification of the RFP posting was sent to all online bidding system registered users with 105 of them viewing the notice. HCA received only one proposal from AMM by the deadline of December 29, 2023. February 7, 2024, is the date of the Notice to Award, and no protests were received.  HCA evaluated the proposal submitted by AMM for Fiscal Intermediary Services and recommends to award the Contract to AMM.

 

Performance Outcomes

Fiscal intermediary services will provide a mechanism for claims processing to meet the regulatory requirements for EMSF fund administration under Health and Safety Code 1797.98a and will secure reimbursement rates given unpredictability of claims volume.

 

The following metrics are monitored for this contract: 90 percent of claims processed within the required 65 calendar days, and completion of 100 percent of required fund reporting within specified deadlines.

 

HCA staff have conducted due diligence on the Contractor. Reference checks were satisfactory and completed with County of Fresno Department of Public Health, River City Medical Group, and Seoul Medical Group.

 

The Contractor’s performance has been confirmed as at least satisfactory. HCA has verified there are no concerns that must be addressed with respect to Contractor’s ownership/name, litigation status or conflicts with County interests.

 

HCA requests that the Board authorize, pursuant to Contract Policy Manual Section 3.4-114, the County Procurement Officer or Deputized designee, to exercise a contingency contract cost increase in an amount not to exceed 10 percent of the contract amount for the first year of the contract, for the entire term of the Contract, including renewal, and within the scope of work set forth in the contract. The contingency provision would be exercised in the event there is an increase in the projected number of claims to be processed. The use of this contingency contract cost increase is subject to approval requirements established by the County Procurement Officer.

 

This Contract does not currently include subcontractors or pass through to other providers. See Attachment B for Contract Summary Form.

 

Orange County Preference Policy is not applicable to this Contract.

 

HCA requests that the Board approve the selection of and Contract for Fiscal Intermediary Services for the Emergency Medical Services Fund Program with AMM as referenced in the Recommended Actions.

 

 

 

FINANCIAL IMPACT:

 

Appropriations for this Contract will be included in Budget Control 042 FY 2024-25 Budget and will be included in the budgeting process for future years.

 

The proposed Contract includes provisions allowing HCA to terminate the Contract, reduce the level of services, an/or renegotiate the levels of services provided, as necessary.

 

 

 

STAFFING IMPACT:

 

N/A

 

ATTACHMENT(S):

 

Attachment A - Contract MA-042-24010971 for Fiscal Intermediary Services with Advanced Medical Management, Inc.
Attachment B - Contract Summary Form
Attachment C - Health and Safety Code 1797.98a
Attachment D - Senate Bill 12/612
Attachment E - Senate Bill 1773