Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Agreement with Ankura Consulting Group, LLC to Provide Independent Review Organization Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Ankura Consulting Group, LLC to provide Independent Review Organization services for the term of October 25, 2021 through December 31, 2026, in an amount not to exceed $350,000.
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BACKGROUND:
In July 2021, the County of San Mateo and San Mateo Medical Center (SMMC) entered into a financial settlement with the Department of Justice on behalf of the Office of the Inspector General of the Department of Health and Human Services (OIG). As a result of the settlement, SMMC entered into a five-year Corporate Integrity Agreement (CIA) with the OIG. One requirement of the CIA is that SMMC must select an Independent Review Organization (IRO) to perform an annual medical necessity review of 100 paid claims, for each year of the CIA.
DISCUSSION:
SMMC must select and engage an IRO within 120 days of the CIA's effective date of July 29, 2021, which is November 26, 2021. Through referrals and inquiries, SMMC selected and interviewed five vendors for the IRO role. SMMC's Compliance Officer and County Counsel participated in the interview process. SMMC received proposals from four vendors which included a summary of experience, references and estimated quotes. SMMC's Compliance Officer contacted references for the top two vendors, which were selected based on experience in medical necessity clinical review.
SMMC is requesting that your Board waive the Request for Proposals process due to the nature of the IRO role and the time sensitivity regarding meeting the CIA's requirements. After thorough review of each vendor and review of experience, references...
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