County long-term care leadership raised concerns that multiple managed-care contracts for skilled patients are outdated and reimbursements no longer reflect current market rates. The director said some contracts have not been renegotiated for nine years and that daily reimbursement rates are insufficient to cover care costs.

Staff proposed issuing an RFP to hire consultants to evaluate contracts and negotiate improved rates. One firm quoted an approximate cost of about $9,000 per contract to perform negotiations or consulting work; staff suggested a project-rate approach rather than hourly billing where possible to estimate total costs and potential financial return.

"When you take the whole of how many contracts that we have, though, it would go over that threshold," the director said, explaining the administrative work required and the rationale for an RFP to establish leverage and clearer scope. Commissioners agreed the RFP could provide useful leverage and moved to proceed with procurement planning.

The board gave direction to develop an RFP and return with scope and cost estimates rather than approving immediate consultant spending. The director said the goal is to increase contracted rates over time toward market levels so insurers bear appropriate costs and county subsidy burden is reduced.