REPORT TO SHASTA COUNTY BOARD OF SUPERVISORS

BOARD MEETING DATE:  June  12, 2018
CATEGORY:  Consent - General Government-4.

SUBJECT:

Renewal Agreement with Exam Works Clinical Solutions, LLC, to provide Medicare Set Aside and State Children’s Health Insurance Program Reporting Services

Supervisorial District No. :  All

DEPARTMENT CONTACT:  Angela Davis, Director of Support Services, (530) 225-5515

STAFF REPORT APPROVED BY:  Angela Davis, Director of Support Services

RECOMMENDATION

Approve and authorize the Chairman to sign an agreement with Exam Works Clinical Solutions, LLC in an amount not to exceed $125,000 over the entire term of the agreement to provide Medicare Set Aside and State Children’s Health Insurance Program reporting services for the period June 16, 2018 through June 15, 2019, with two automatic one-year renewals.

SUMMARY

N/A

DISCUSSION

Medicare Set Aside Arrangements (MSAs) are future medical cost projections of Medicare covered services for treating the injury or condition that is the basis for a workers’ compensation claim when the injured person is, or may reasonably be expected to become a Medicare beneficiary within a specified time frame.  The formation of MSAs is a complex and challenging issue, and mishandling them can lead to increased settlement costs, inappropriate MSA allocation amounts, and significant time delays when seeking approval from Medicare. 

In addition to Medicare Set-Aside reporting, Exam Works Clinical Solutions, LLC (Exam Works) notifies Medicare of all County workers’ compensation claims and provides Medicare status of all claimants to the County in accordance with State Children's Health Insurance Program (SCHIP) requirements.

Legislation (Title 42 of the Code of Federal Regulations) has broadened the reporting requirements for determining potential Medicare costs associated with workers’ compensation claims, and requires that requests be submitted to Medicare for approval of the amount allocated for each determination.  This is a specialized field, and requires a high level of expertise.

Exam Works is experienced in the field, and has successfully provided their services to Shasta County since 2015, and previously provided their services to Shasta County as Gould & Lamb, LLC, from 2008-2015. Shasta County did not release a competitive procurement to establish this renewal contract as there are limited providers available, and interfaces into the SIMS Claims system were built specifically to support the partnership with Exam Works; however, as a member of the CSAC Excess Insurance Authority (CSAC EIA) Shasta County is able to take advantage of preferred pricing, which was established following a competitive process done by CSAC EIA.

ALTERNATIVES

The Board may choose not to approve this agreement. This is not recommended as Shasta County is able to take advantage of reduced rates offered by Exam Works to CSAC EIA members, and this is a specialized field with a limited amount of providers able to deliver the level of service provided by Exam Works. The Board may request additional information from staff.

OTHER AGENCY INVOLVEMENT

County Counsel has approved the agreement as to form. Risk Management has reviewed and approved the agreement. This recommendation has been reviewed by the County Administrative Office.

FINANCING

There is no additional General Fund impact from this agreement. The funds involved with this agreement are included in the FY 17-18 Risk Management budget and will be included in future proposed budgets. Risk Management’s Workers’ Compensation program is a County internal services fund, and costs are distributed to and included in the departments’ annual budgets.  Rates may increase or decrease depending on actual workers’ compensation claims filed and awarded annually.