COUNTY OF SAN DIEGO - File #: 22-698

• File #: 22-698
• Version: 1
• Type: Health and Human Services
• Status: Agenda Ready
• File created: 11/6/2022
• In control: BOARD OF SUPERVISORS
• On agenda: 11/15/2022
• Title: AUTHORIZE AN AMENDMENT TO EXTEND EXISTING CONTRACT WITH UNITED HEALTH CARE FOR ADMINISTRATIVE SERVICES ORGANIZATION, EXTEND EXISTING CONTRACTS WITH PROVIDERS OF PRIMARY CARE SERVICES, AUTHORIZE PROCUREMENT FOR NEW SERVICES, AND AUTHORIZE APPLICATION FOR ADDITIONAL FUNDING OPPORTUNITY ANNOUNCEMENTS (DISTRICTS: ALL)

Date	Action By	Action	Result
11/15/2022	BOARD OF SUPERVISORS	took action as recommended, on Consent	Pass

DATE:
November 15, 2022
08

TO:
Board of Supervisors

SUBJECT
Title
AUTHORIZE AN AMENDMENT TO EXTEND EXISTING CONTRACT WITH UNITED HEALTH CARE FOR ADMINISTRATIVE SERVICES ORGANIZATION, EXTEND EXISTING CONTRACTS WITH PROVIDERS OF PRIMARY CARE SERVICES, AUTHORIZE PROCUREMENT FOR NEW SERVICES, AND AUTHORIZE APPLICATION FOR ADDITIONAL FUNDING OPPORTUNITY ANNOUNCEMENTS (DISTRICTS: ALL)

Body
OVERVIEW
The County of San Diego (County) Health and Human Services Agency (HHSA) has ongoing and evolving needs for administrative services organization (ASO) support for their healthcare services programs. Since 2005, the County has contracted for ASO services with United Health Care (dba AmeriChoice), which includes scopes of work that support HHSA Self-Sufficiency Services, Public Health Services, and Medical Care Services. Specific activities of the ASO include:
* Fund management and administration,
* Management information system design and maintenance,
* Enrollment and eligibility certification,
* Utilization management and care coordination,
* Claims adjudication, payment processing, and financial analysis and management,
* Provider network development, provider relations, and management and oversight,
* Complaints, grievances, and appeals processing, and
* Reconciliation of claims at fiscal year-end.

Approval of today's recommended actions authorizes an extension of the existing ASO contract for one year with one option year and up to six months if needed to allow HHSA to evaluate its current and future needs to better inform a new scope(s) of work for ASO services, and authorizes issuance of a competitive solicitation for those services and to award a new contract, subject to successful negotiations and determination of fair and reasonable pricing. Today's actions would also authorize the extensions of the existing primary care service contracts for one year with one option year and up to six months if needed to align with the ASO contract. Today's actions wo...