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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 Reviews by California Mental Health Services Authority (CalMHSA) will be performed by another governmental entity or agency;
2) Make findings in accordance with Procurement Policy C-17 Section 3.4 (3) exempting the competitive bidding process, with Purchasing Agent concurrence, because “competitive bidding would produce no economic benefit to the County”;
3) Approve and authorize the Chair to sign Participation Agreement 10153 with CalMHSA, in the amount of $148,176, and for the term of two years from July 1, 2026, through June 30, 2028;
4) Authorize the Purchasing Agent to execute amendments relating to Participation Agreement 10153, contingent upon approval by County Counsel and Risk Management, which does not increase the maximum dollar amount or increase the term of the Agreement beyond three years; and
5) Authorize the HHSA Director, or the Chief Assistant Director, to execute programmatic, administrative, and fiscal documents relating to Participation Agreement 10153.
FUNDING: 100% State Behavioral Health Realignment.
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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 required to conduct concurrent review of all treatment authorization requests (TARs) for the County Psychiatric Health Facility (PHF) services beginning on the first day of a client’s admission.
On May 31, 2019, DHCS issued Behavioral Health Information Notice (BHIN) 19-026, which mandated that county MHPs approve, modify, or deny TARs during inpatient stays and provide written notification to both the treating providers and the beneficiary when an adverse determination is made. BHIN 22-017, issued on April 15, 2022, allows MHPs to either directly manage or delegate concurrent reviews of TARs for psychiatric inpatient services. To meet these requirements, concurrent review is performed on all admissions to the County PHF.
Since 2022, the County has delegated this function to CalMHSA, which serves as the administrative entity responsible for conducting concurrent reviews on all County PHF admissions. Through its subcontractor Acentra, CalMHSA conducts concurrent reviews and provides a web-based utilization review platform and clinical support for TARs. Participation in CalMHSA's PICR program ensures a consistent and cost-efficient concurrent review process that meets all legal and regulatory requirements. This proposed Participation Agreement with CalMHSA is a renewal of Participation Agreement 9677, which was approved by the Board on September 16, 2025 (Legistar file 25-1072).
In accordance with Board Procurement Policy C-17, this Agreement with CalMHSA is exempt from competitive bidding, with Purchasing Agent concurrence, per Section 3.4, (3) which states "competitive bidding would produce no economic benefit to the county." CalMHSA has been providing county behavioral health jurisdictions throughout the State with immediate solutions to help counties address consistent and cost-efficient concurrent review process that meets all legal and regulatory requirements. Through HHSAs participation in this CalMHSA Program, the agency is able to ensure that concurrent reviews are conducted timely on all admissions to the County PHF.
ALTERNATIVES:
Should the Board decline to approve this recommendation, HHSA BHD's internal Quality Management (QM) team would be required to conduct concurrent review on all admissions to the County PHF, a significant administrative burden which threatens other critical QM functions. Additionally, not conducting the required concurrent reviews would put 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:
09/16/25, 25-1072, HHSA Agreement 9677 California Mental Health Services Authority
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel and Risk Management. The Auditor-Controller has been notified per Board Policy B-12.
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 2026-27 Budget request and will be included in future budgets for the term of the Agreement.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
Clerk of the Board to obtain signature of Chair on one original Participation Agreement 10153.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT:
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency