FROM: Barbara Hannah, Chief Counsel
SUBJECT: MMRO Medical Advisors
RECOMMENDATION:
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Recommend that the Board approve a contract with MMRO to provide medical advisor services and authorize the Chief Executive Officer to execute the agreement.
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BACKGROUND:
SBCERA utilizes medical advisors to provide independent medical assessments of disability retirement applications under the County Employees’ Retirement Law of 1937 (CERL). These reviews include Independent Medical Examination (IME) reports recommending denial of benefits, nonservice-connected disability applications, and cases where medical evidence supports granting service-connected disability retirement without an IME.
Recently, SBCERA expanded its medical review process to evaluate whether applications filed beyond the statutory filing period satisfy Government Code section 31722, which requires evidence of continuous incapacity from discontinuance of service through the application date. Over the past year, two medical advisors retired, leaving only one available medical advisor. This reduction, combined with increased review demands, has created processing delays, particularly for applications preliminarily identified as untimely.
Proposed Engagement Of Mmro
Managed Medical Review Organization, Inc., (MMRO) provides medical advisory services, medical record reviews, and independent medical examinations to public retirement systems, including those governed by CERL. SBCERA previously contracted with MMRO, and following a recent meeting, staff determined that MMRO has expanded its capabilities and developed a stronger understanding of CERL disability retirement requirements.
Staff proposes engaging MMRO as SBCERA’s primary medical advisor to review IME reports, nonservice-connected disability applications, service-connected disability applications where an IME may be unnecessary, and medical records involving statutory timeliness determinations. MMRO would provide independent medical opinions, while eligibility determinations would remain with SBCERA and the Board of Retirement.
The proposed engagement would expand medical review capacity, reduce processing delays, and provide access to a broader network of medical specialists. MMRO’s proposed fee structure would also result in cost savings compared to SBCERA’s existing medical advisor arrangements, while preserving the flexibility to utilize individual medical advisors as needed.
Conclusion
Engaging MMRO would address SBCERA’s current medical advisor staffing limitations, improve processing efficiency, and provide cost savings. Given MMRO’s experience with CERL retirement systems and its prior relationship with SBCERA, staff recommends that the Board approve the proposed engagement.
BUDGET IMPACT:
Costs for this item are included in the current year administrative and/or non-administrative budget.
STRATEGIC PLANNING GOAL/OBJECTIVE:
Operational Excellence & Efficiency
STAFF CONTACT:
Barbara Hannah
ATTACHMENTS:
Exhibit A: MMRO Proposal
Exhibit B: Confidential