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: Participation Agreement with California Mental Health Services Authority (CalMHSA) for Psychiatric Inpatient Concurrent Review Program for Youth and Adults
RECOMMENDATION:
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Adopt a resolution authorizing a Participation Agreement with California Mental Health Services Authority (CalMHSA) to provide concurrent review services, for the term of July 1, 2026 through June 30, 2028, in an amount not to exceed $1,466,976.
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BACKGROUND:
Formed in 2009, the California Mental Health Services Authority (CalMHSA) is a joint powers authority created under California law, of 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 hospitals 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.
Pursuant to 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-hour, seven-day-a-week basis.
Concurrent review occurs while treatment is in progress, typically starting within 24 to 72 hours of admission to a hospital. The review process monitors utilization of resources and patient progress to ensure individuals receive medically necessary care in the appropriate setting and to reduce the likelihood of post-treatment denials of coverage.
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 entered 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, on May 7, 2024, this Board approved a Participation Agreement with CalMHSA for concurrent review services.
DISCUSSION:
BHRS recommends authorizing approval of this Participation Agreement with CalMHSA to continue providing concurrent review services, and support compliance with DHCS requirements. The technology-assisted concurrent review process supports compliance with DHCS BHINs by promoting a consistent, timely, and efficient review and authorization process.
CalMHSA contracts with Acentra Health to provide participating counties, like San Mateo County, a state-of-the-art, web-enabled utilization review platform. The platform enables participating hospitals to submit clinical information electronically and receive timely determinations regarding continued authorized stays. This “real-time” authorization capability supports timely access to medically necessary inpatient services for County clients.
Under the B-1 Administrative Memorandum, agreements with other public entities acting as governmental agencies are exempt from the Request for Proposals process. A waiver request was reviewed by County Procurement, which recommended for submission to this Board for approval.
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 2025-26 Estimated |
FY 2026-27 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 agreement with CalMHSA will strengthen the review and authorization process for psychiatric inpatient treatment services by supporting a more standardized, timely, and equitable system for approving care. The agreement will help ensure that individuals experiencing serious mental illness receive medically necessary treatment at the appropriate level of care while reducing delays and denials of coverage.
Individuals with serious mental illness often face systemic barriers to timely behavioral health treatment, including administrative complexity, provider shortages, and challenges navigating the healthcare system. This agreement supports improved access to care for all County residents, particularly those with the greatest behavioral health needs.
FISCAL IMPACT:
The term of the agreement is July 1, 2026 through June 30, 2028. The amount of the agreement is not to exceed $1,466,976 for the two-year term. Funds in the amount of $733,488 are included in the BHRS FY 2025-26 Adopted Budget. Of that amount, 50% will be funded by 2011 Realignment and 50% by Medi-Cal reimbursement. There is no Net County Cost.