Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health, and Recovery Services
Subject: Participation Agreement with California Mental Health Services Authority for Psychiatric Inpatient Concurrent Review Program for Youth and Adults
RECOMMENDATION:
title
Adopt a resolution to enter into a Participation Agreement with California Mental Health Services Authority to provide Concurrent Review Services, for the term of January 1, 2024 through December 31, 2024, in an amount not to exceed $576,464.
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BACKGROUND:
The California Mental Health Services Authority (CalMHSA) administers the Psychiatric Inpatient Concurrent Review program with the primary purpose of conducting concurrent review and authorization for all psychiatric inpatient hospital and psychiatric health facility services on behalf of participating California County Mental Health Plans (MHP). Behavioral Health and Recovery Services (BHRS) is the MHP for San Mateo County.
A concurrent review occurs while treatment is in progress and usually starts within 24-72 hours of admission to a hospital. The main focuses of the review are to track the utilization of resources and the patient's progress, to ensure the patient receives the proper care, and to reduce denials of coverage after the treatment is complete.
By utilizing a technology-assisted concurrent review process, the CalMHSA will ensure a consistent and efficient review process across participating counties and will support MHP compliance with California Department of Health Care Services (DHCS) Behavioral Health Information Notice (BHIN) 19-026 (or any BHIN released by DHCS that supersedes BHIN 19- 026), and the Parity in Mental Health and Substance Use Disorder Services Final Rule (Parity Rule; Title 42 of the CFR, part 438.910).
A DHCS audit of BHRS found the County out of compliance for not having a concurrent review program in place, and entering into an agreement through CalMHSA for this service is part of the Corrective Action Plan for the audit finding.
DISCUSSION:
Per the DHCS BHIN 19-026, MHPs are required to conduct concurrent review and authorization for all psychiatric inpatient hospital services and psychiatric health facility services on a 24/7/365 basis. BHRS recommends entering a Participation Agreement with CalMHSA to provide concurrent review services.
CalMHSA entered into a services contract with Acentra Health (formerly known as Kepro/Keystone Peer Review Organization, Inc.) to provide participating counties a web-enabled utilization review platform and clinical services to carry out psychiatric inpatient concurrent review and authorization services on behalf of multiple California County MHPs. Formed in 2009, CalMHSA is a public entity created under authority of Joint Powers of Authority (JPA), in which the County is a member, that provides administrative and fiscal services.
The resolution contains the County’s standard provision allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
The Participation Agreement and resolution have been reviewed and approved by the County Attorney as to form.
This Participation Agreement is coming to this Board late due to extended negotiations with CalMHSA, to partner with the County for concurrent review services.
It is anticipated that 95% of the client charts that have had concurrent review during an inpatient stay will pass chart audits.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Estimated |
FY 2024-25 Projected |
|
Percentage of client charts that have had concurrent review during an inpatient stay that pass chart audits |
95% 185 client charts |
95% 722 client charts |
FISCAL IMPACT:
The term of the agreement is January 1, 2024, through December 31, 2024. The amount of the agreement is not to exceed $576,464 for the one-year term. Of the agreement amount, $288,232 is included in the BHRS FY 2023-24 Adopted Budget. Of that amount, 25% will be funded by 2011 Realignment and 75% by Medi-Cal reimbursement. There is no Net County Cost. Similar arrangements will be in place for subsequent years.