MURIEL BOWSER
MAYOR
November 21, 2024
The Honorable Phil Mendelson
Chairman, Council of the District of Columbia
1350 Pennsylvania Avenue NW, Suite 504
Washington, DC 20004
Dear Chairman Mendelson:
Pursuant to section 451 of the District of Columbia Home Rule Act (D.C. Official Code § 1-
204.51) and section 202 of the Procurement Practices Reform Act of 2010 (D.C. Official Code §
2-352.02), enclosed for consideration and approval by the Council of the District of Columbia is
proposed Modification No. M004 to Contract No. CW113439 with Comagine Health to exercise
option year one in the estimated amount of $6,322,417.50. The period of performance is from
January 1, 2025, through December 31, 2025.
Under the proposed modification, Comagine Health will continue to conduct utilization reviews
and quality improvement activities for approximately 43,000 of the District’s Fee-For-Service
Medicaid program participants. The expected benefit of the utilization management and quality
improvement services includes improved safeguards against unnecessary or inappropriate use of
Medicaid services; ensuring the provisions of appropriate care through prospective, concurrent,
and retrospective reviews of services; medical record reviews; validation of the appropriateness of
requested services; improved data gathering and reporting; and the identification of fraud, waste,
abuse, and other violations.
My administration is available to discuss any questions you may have regarding the proposed
contract modification. In order to facilitate a response to any questions you may have, please have
your staff contact Marc Scott, Chief Operating Officer, Office of Contracting and Procurement, at
(202) 724-8759.
I look forward to the Council’s favorable consideration of this contract modification.
Sincerely,
Muriel Bowser
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of Contracting and Procurement
Pursuant to section 202(c-3) of the Procurement Practices Reform Act of 2010, as amended, D.C.
Official Code § 2-352.02(c-3), the following contract summary is provided:
COUNCIL CONTRACT SUMMARY
(Options)
(A) Contract Number: CW113439
Proposed Contractor: Comagine Health
Contract Amount (Option Period One): $6,322,417.50
Unit and Method of Compensation: Fixed Unit Price
Term of Contract: January 1, 2025 through December 31, 2025
Type of Contract: Requirements Contract
(B) Identifying number of the underlying contract, including the identifiers assigned to the
underlying contract by the Council for the base period and any subsequent option periods:
Base Period Amount: $5,276,971.01
(January 1, 2024, through December 31, 2024)
(Council Approval CA25-0656)
Option Period 1 Amount: $6,322,417.50
(January 1, 2025, through December 31, 2025)
Explanation of difference from base period (if applicable): The amount for option period one
exceeds the price for the base period due to inflationary factors related to the cost of operating a
business and because of consumer price index (CPI) inflation that measures the average change
over time in the prices paid by urban consumers for a market basket of consumer goods and
services. In addition, the District modified the contract to add the facilitation of Nursing Home
Continued Stay Review as mandated by the Center for Medicaid and Medicare Services (CMS).
Also, the District modified the contract to facilitate the Elderly and Persons with Disability (EPD)
waiver to incorporate the long-term care and support initiative.
Option Period 2 Amount: $6,333,423.57
(January 1, 2026, through December 31, 2026)
1
Explanation of difference from base period (if applicable): The amount for option period two
exceeds the price for the base period due to inflationary factors related to the cost of operating a
business and because of consumer price index (CPI) inflation that measures the average change
over time in the prices paid by urban consumers for a market basket of consumer goods and
services. In addition, the District modified the contract to add the facilitation of Nursing Home
Continued Stay Review as mandated by the Center for Medicaid and Medicare Services. Also, the
District modified the contract to facilitate the EPD waiver to incorporate the long-term care and
support initiatives.
Option Period 3 Amount: $6,522,586.60
(January 1, 2027, through December 31, 2027)
Explanation of difference from base period (if applicable): The amount for option period three
exceeds the price for the base period due to inflationary factors related to the cost of operating a
business and because of consumer price index (CPI) inflation that measures the average change
over time in the prices paid by urban consumers for a market basket of consumer goods and
services. In addition, the District modified the contract to add the facilitation of Nursing Home
Continued Stay Review as mandated by the Center for Medicaid and Medicare Services. Also, the
District modified the contract to facilitate the EPD waiver to incorporate the long-term care and
support initiatives.
Option Period 4 Amount: $6,719,223.98
(January 1, 2028, through December 31, 2028)
Explanation of difference from base period (if applicable): The amount for option period four
exceeds the price for the base period due to inflationary factors related to the cost of operating a
business and because of consumer price index (CPI) inflation that measures the average change
over time in the prices paid by urban consumers for a market basket of consumer goods and
services. In addition, the District modified the contract to add the facilitation of Nursing Home
Continued Stay Review as mandated by the Center for Medicaid and Medicare Services. Also, the
District modified the contract to facilitate the EPD waiver to incorporate the long-term care and
support initiatives.
(C) A statement that Citywide Clean Hands database indicates that the proposed contractor is
current with its District taxes. If the Citywide Clean Hands Database indicates that the
proposed contractor is not current with its District taxes, either: (1) a certification that the
contractor has worked out and is current with a payment schedule approved by the District;
or (2) a certification that the contractor will be current with its District taxes after the
District recovers any outstanding debt as provided under D.C. Official Code § 2-353.01(b):
On October 28, 2024, the Citywide Clean Hands database certified that Comagine Health is
current with its District tax laws.
(D) A statement that the proposed contract is within the appropriated budget authority for the
agency for the fiscal year and is consistent with the financial plan and budget adopted in
accordance with D.C. Official Code §§ 47-392.01 and 47-392.02:
2
The Department of Health Care Finance Agency Fiscal Officer certified that funding in the amount
of $6,322,417.50 is available to support option period one of the contract.
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GOVERNMENT OF THE DISTRICT OF COLUMBIA
Department of Health Care Finance
Office of the Chief Financial Officer
MEMORANDUM
TO: Nancy Hapeman
Acting Chief Procurement Officer
Office of Contracting and Procurement
THRU: Delicia V. Moore
Associate Chief Financial Officer
Human Support Services Cluster
FROM: Darrin Shaffer
Agency Fiscal Officer
Department of Health Care Finance
DATE: November 13, 2024
SUBJECT: Certification of Funding for the Utilization Management & Quality Improvement Contract
The Office of the Chief Financial Officer hereby certifies that the sum of 6,322,417.50 is included in the District’s
Local Budget and Financial Plan for Fiscal Year 2025 to fund the costs associated with the Department of Health
Care Finance’s (DHCF) contract with Comagine Health. This certification supports the Utilization Management &
Quality Improvement (UMQI) contract for the Base Year Option beginning January 1, 2025 through December 31,
2025. The fund allocation is as follows:
Vendor: Comagine Health DHCF Contract #: CW113439
Fiscal Year 2025 Funding: 01/01/2025 - 9/30/2025
Agency Fund Account Program Cost Center Project Award Amount
HT0 1010001 7132001 100190 70161 Blank Blank $1,185,453.28
HT0 4025002 7132001 100190 70161 200881 2001984 $3,556,359.84
FY25 Contract Total $4,741,813.12
Fiscal Year 2026 Funding: 10/1/2025 - 12/31/2025
Agency Fund Account Program Cost Center Project Award Amount
HT0 1010001 7132001 100190 70161 Blank Blank $395,151.10
HT0 4025002 7132001 100190 70161 200881 2001984 $1,185,453.28
FY26 Contract Total $1,580,604.38
Upon approval of the District’s Local Budget and Financial Plan by the Council and the Mayor and completion of
the thirty-day Congressional layover, funds will be sufficient to pay for fees and costs associated with the contract.
There is no fiscal impact associated with the contract.
Should you have any questions, please contact me at (202) 442-9079.
441 4th Street, N.W., Suite 960N, Washington, D.C. 20001 (202) 442-5988 FAX (202) 478-1373
1. Contract Number Page of Pages
AMENDMENT OF SOLICITATION / MODIFICATION OF CONTRACT
CW113439 1 1
2. Amendment/Modification Number 3. Effective Date 4. Requisition/Purchase Request 5. Solicitation Caption
No.
M004 January 1, 2025 Utilization Management and
Quality Improvement
6. Issued by: Code 7. Administered by (If other than line 6)
Office of Contracting and Procurement Department of Health Care Finance
Health Services Cluster Division of Clinician, Pharmacy & Acute Provider Services
441 4th Street NW, Suite 300S 441 4th Street, NW, Suite 900S
Washington, DC 20001 Washington, DC 20001
8. Name and Address of Contractor (No. street, city, county, state, and zip code) 9A. Amendment of Solicitation No.
Comagine Health
9B. Dated (See Item 11)
10700 Meridian Ave. N., Suite 300
Seattle, WA 98133 10A. Modification of Contractor/Order No.
POC: Foster C. “Bud” Beall Jr., Vice President, Care Management X CW113439
Office: 800-949-7536 x2041 10B. Dated (See Item 13)
Email: bbeall@comagine.org January 1, 2024
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
The above numbered solicitation is amended as set forth in item 14. The hour and date specified for receipt of Offers is extended. is not extended.
Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By
completing Items 8 and 15, and returning one (1) copy of the amendment: (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or
(c) BY separate letter or fax which includes a reference to the solicitation and amendment number. FAILURE OF YOUR ACKNOWLEDGMENT TO BE
RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF
YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such may be made by letter or fax, provided each letter or
telegram makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.
12. Accounting and Appropriation Data (If Required)
13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTORS/ORDERS,
IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14
A. This change order is issued pursuant to (Specify Authority): 27 DCMR, Chapter 36, Contract Modifications
The changes set forth in Item 14 are made in the contract/order no. in item 10A.
B. The above numbered contract/order is modified to reflect the administrative changes (such as changes in paying office, appropriation
data etc.) set forth in item 14, pursuant to the authority of: 27 DCMR § 3601.3 (a)
C. This supplemental agreement is entered into pursuant to authority of: 27 DCMR § 3601.2
X D. Other: Exercise of Option, pursuant to the authority of: 27 DCMR § 3601.3 (c)
E. IMPORTANT: Contractor is not required is required to sign this document and return one (1) copy to the issuing office.
14. Description of Amendment/Modification (Organized by UCF Section headings, including solicitation/contract subject matter where feasible.)
Contract CW113439 is hereby modified as follows:
1. In accordance with Section F.2 titled “Option to Extend the Term of the Contract,” the District of
Columbia Government, Office of Contracting and Procurement, on behalf of the Department of Health
Care Finance, hereby exercises option period one to extend the term of the contract from January 1,
2025, through December 31, 2025, in the amount of $6,322,417.50.
2. Attachment A: Price Schedule
All Other Terms and Conditions Remains Unchanged
Except as provided herein, all terms and conditions of the document is referenced in Item 9A or 10A remain unchanged and in full force and effect.
15A. Name and Title of Signer (Type or print) 16A. Name of Contracting Officer
Tracy Williams
15B. Name of Contractor 15C. Date Signed 16B. District of Columbia 16C. Date Signed
(Signature of person authorized to sign) (Signature of Contracting Officer)
ATTACHMENT A: PRICE SCHEDULE
B.3.2 OPTION PERIOD ONE
January 1, 2025, through December 31, 2025
Est. Unit Total Estimated
CLIN Item Description Unit
Qty. Price Amount
1001 PRIOR AUTHORIZATION REVIEWS AS DESCRIBED IN C.5.1
Each
1001A Acute Care Hospitals 1,000 $72.10 $72,100.00
Admission
Retrospective Acute Care Each
1001B 500 $92.70 $46,350.00
Hospitals Admission
Each
1001C Specialty Hospital 1,000 $72.10 $72,100.00
Admission
1001D Continued Stay Review Each Review 1,500 $72.10 $108,150.00
Outpatient Medical Services &
1001E Each Service 750 $72.10 $54,075.00
Surgical Procedures
1001F DME/POS Each Service 2,000 $72.10 $144,200.00
1001G Eyewear and Contact Lenses Each Service 3,000 $72.10 $216,300.00
1001H Dental & Orthodontic Service Each Service 2,000 $72.10 $144,200.00
Each
1001I SUD RTF 700 $257.50 $180,250.00
Admission
SUD Residential Treatment
1001J Each Review 1,500 $257.50 $386,250.00
Concurrent Review
Total for 1001 Prior Authorization Reviews $1,423,975.00
1002 LONG TERM CARE REVIEWS AS DESCRIBED IN C.5.2
1002A Home H