Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health, and Recovery Services
Subject: Amendment to the Participation Agreement with California Mental Health Services Authority for Psychiatric Inpatient Concurrent Review Program for Youth and Adults
RECOMMENDATION:
title
Adopt a resolution authorizing an amendment to the Participation Agreement with California Mental Health Services Authority to provide Concurrent Review Services, extending the term through June 30, 2025, and increasing the amount by $96,078 to an amount not to exceed $672,542.
body
BACKGROUND:
Formed in 2009, the California Mental Health Services Authority (CalMHSA) is a public entity created under California Law, in which the County is a member, that provides administrative and fiscal services. 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. Per the California Department of Health Care Services Behavioral Health Information Notice (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.
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 utilization of resources and the patient's progress, to assure that the patient receives the right care, and to reduce denials of coverage after the treatment is complete.
In December 2023, a DHCS audit of BHRS found the County out of compliance for not having a concurrent review program in place, and the County enterted into an agreement through CalMHSA as part of the Corrective Action Plan for the audit finding.
As part of the Corrective Action Plan and specifically in response to the DHCS audit finding, BHRS sought approval from this Board for a Participation Agreement with CALMHSA for concurrent review services for the term of May 7, 2024 through December 31, 2024, in an amount not to exceed $576,464.
DISCUSSION:
BHRS recommends amending the Participation Agreement with CalMHSA to continue to provide concurrent review services, as BHRS has found the services provided by CalMHSA under the existing agreement to be satisfactory.
Additionally, CalMHSA entered into a services contract with Acentra Health (Acentra) to provide participating counties, like San Mateo County, a state of the art, web-enabled utilization review platform. Acentra’s platform allows participating hospitals to enter information as needed and obtain an answer timely on continued authorized stays. This approach allows BHRS to meet the inpatient needs of our clients efficiently because authorizations can occur in “real time”.
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.
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 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of client charts that have had concurrent review during an inpatient stay that pass chart audits |
95% 722 client charts |
95% 722 client charts |
COMMUNITY IMPACT:
This contract with CalMHSA will enhance the review and processing of treatment authorizations, ensuring a more standardized, fair, and efficient system for approving services. By supporting the authorization process, this partnership will ensure that adults with serious mental illness (SMI) receive the right care at the right time and reduce delays or denials of coverage after treatment is complete. Many individuals with SMI face systemic barriers to accessing timely and appropriate treatment due to administrative complexities, provider shortages, and disparities in healthcare navigation. Through this contract, we aim to create a more transparent and responsive approval system that attends to the needs of all County residents including the neediest.
FISCAL IMPACT:
The term of the amended agreement is May 7, 2024 through June 30, 2025. The amount of the agreement is not to exceed $672,542 for the term. The amendment increases the contract amount by $96,078. Funds in the amount of $96,078 are included in the BHRS FY 2024-25 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.