Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings pursuant to Section 3.13.030 (E) of the El Dorado County Ordinance Chapter 3.13, Contracting Out, that the provision of Psychiatric Inpatient Concurrent Review is appropriate to be performed by California Mental Health Services Authority (CalMHSA) as they are another governmental entity or agency;
2) Approve and authorize the Chair to sign Participation Agreement 9677 with CalMHSA, in the amount of $75,600, and for the retroactive term of one year from July 1, 2025, through June 30, 2026;
3) Authorize the Purchasing Agent to execute amendments relating to Participation Agreement 9677, contingent upon approval by County Counsel and Risk Management, which do not exceed Purchasing Agent signature authority or increase the term of the Agreement beyond three years; and
4) Authorize the HHSA Director, or the Chief Assistant Director, to execute programmatic, administrative, and fiscal documents relating to Participation Agreement 9677.
FUNDING: 100% State Behavioral Health Realignment.
Body
DISCUSSION / BACKGROUND:
HHSA contracts with California Department of Health Care Services (DHCS) to serve as the Mental Health Plan (MHP) for El Dorado County (County). As the MHP, HHSA is responsible for conducting concurrent review and treatment authorization for all psychiatric inpatient hospital and psychiatric health facility services.
On May 31, 2019, DHCS issued Behavioral Health Information Notice (BHIN) 19-026, which requires county MHPs to ensure medical necessity and compliance with Title 9, California Code of Regulations, Section 1820.205, for Medi-Cal reimbursement of psychiatric inpatient services. MHPs must approve, modify, or deny authorization requests during inpatient care and provide written notification to both the treating providers and the beneficiary in the case of adverse decisions.
BHIN 22-017, issued on April 15, 2022, allows MHPs to either directly manage or delegate authorization responsibilities for psychiatric inpatient services, in accordance with federal law and specialty mental health services contract terms. To meet these requirements, concurrent review services are provided on behalf of HHSA’s Behavioral Health Division (BHD) for all admissions to the County Psychiatric Health Facility (PHF).
CalMHSA administers the PICR Program on behalf of participating MHPs. Through its subcontractor, CalMHSA offers a web-based platform and clinical support for conducting concurrent reviews and authorizations, ensuring consistency and efficiency in the process. The County has contracted with CalMHSA for PCIR services since 2022, with the most recent Participation Agreement 9161 signed by the Purchasing Agent, for a term effective January 6, 2025, through June 30, 2025.
On May 5, 2025, HHSA received the renewal PICR Agreement presented in this agenda item, with the term effective July 1, 2025. HHSA recommends the Board approve of this retroactive Participation Agreement 9677 to ensure continued provision of PICR services. The retroactive nature of the Agreement was necessary to facilitate contract processing and to prevent any lapse in essential services.
ALTERNATIVES:
Should the Board decline to approve this recommendation, HHSA BHD's internal Quality Management (QM) team would be required to conduct concurrent review and authorization for all psychiatric inpatient hospital services and PHF services, a significant administrative burden which threatens other critical QM staff’s functions. Additionally, not conducting the required concurrent reviews puts the County out of compliance with DHCS BHIN 19-026, BHIN 22-017, and the Parity in Mental Health and Substance Use Disorder Services Final Rule (Parity Rule; Title 42 of the California Code of Federal Regulations, part 438.910).
PRIOR BOARD ACTION:
09/13/22, 22-0363, HHSA CalMHSA Psych Inpatient Concurrent Review Agmt 6422
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel, Human Resources, and Risk Management.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this agenda item. Sufficient appropriations were included in the Fiscal Year 2025-26 Budget.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
Clerk of the Board to obtain signature of Chair on one original Participation Agreement 9677.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT:
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency