Memorandum
Date: June 10, 2025
To: The Honorable Lake County Board of Supervisors
From: Elise Jones, Director of Behavioral Health Services
Subject: Approve Amendment No.1 to the Agreement Between County of Lake and Fremont Hospital, for Acute Inpatient Psychiatric Hospital Services and Professional Services Associated with Acute Inpatient Psychiatric Hospitalization for Fiscal Year 2024-25 to increase total compensation by $100,000 for a new contact maximum of $200,000 and authorize the Chair to sign
Executive Summary:
Background:
Lake County Behavioral Health Services (LCBHS), acting as the designated Mental Health Plan (MHP) under California’s Medi-Cal Specialty Mental Health Services (SMHS) program, is obligated to ensure access to medically necessary acute inpatient psychiatric hospital services for eligible Medi-Cal beneficiaries, in compliance with Title 42, Code of Federal Regulations (CFR) §438.206(c)(1), California Code of Regulations (CCR), Title 9, Section 1810.345, and Welfare and Institutions Code (W&I Code) §5600.4 and §5600.9. Due to the absence of an acute psychiatric hospital within Lake County, LCBHS must contract with out-of-county providers to meet its network adequacy standards (CCR, Title 9, §1810.435) and ensure timely care under federal and state Medicaid managed care requirements (42 CFR §438.68 and 42 CFR §438.207).
Original Agreement (March 31, 2025):
The Board of Supervisors approved an agreement (24.25.47) with BHC Fremont Hospital for the provision of acute inpatient psychiatric hospital services and associated professional services for Lake County Medi-Cal beneficiaries, with a not-to-exceed amount of $100,000 for FY 2024-2025. This agreement was structured to comply with federal and state regulations, including:
• Title 9, CCR, Sections 1810.380 and 1810.385, regarding oversight and audit requirements;
• 42 CFR Part 438, Subpart E, for program integrity and compliance;
• The Deficit Reduction Act of 2005, False Claims Act, and HIPAA (45 CFR Parts 160 and 164);
• W&I Code §5325 et seq. for patient rights;
• California Government Code §12920 et seq. and Section 504 of the Rehabilitation Act for non-discrimination.
Amendment No. 1 (May 2025):
Due to higher-than-anticipated utilization of services, the parties agreed to increase the contract maximum by an additional $100,000, resulting in a revised total not-to-exceed amount of $200,000 for FY 2024-2025. This amendment ensures continued access to critical inpatient psychiatric services for Lake County beneficiaries, aligning with network adequacy standards and the County’s contractual obligations under its MHP agreement with the California Department of Health Care Services (DHCS), as governed by W&I Code §14712(c)(3) and the Special Terms and Conditions (STCs) of the Medi-Cal 1915(b) Waiver.
Key Compliance Provisions:
• The Contractor must maintain all required licenses and certifications (CCR, Title 9, §1810.435).
• The Contractor must comply with federal and state confidentiality requirements, including 42 CFR Part 2, 45 CFR Part 164 (HIPAA), and W&I Code §5328.
• Services must meet the standards outlined in the Community Mental Health Services Act (MHSA) and the Medi-Cal Provider Manual for SMHS.
• Rates of reimbursement adhere to the Short-Doyle Medi-Cal claiming structure, with facility and professional fees clearly delineated.
Fiscal Impact:
The total revised agreement amount is $200,000, funded by Medi-Cal and realignment revenues, consistent with the County’s budgetary authority. Payments will follow the fiscal provisions outlined in the agreement, including rates for specific populations and services, and adherence to billing and documentation requirements.
Recommendation:
Staff recommends approval of the executive summary and the accompanying agreement and amendment documents for submission to the Board of Supervisors for final approval.
If not budgeted, fill in the blanks below only:
Estimated Cost: ________ Amount Budgeted: $100,000.00 Additional Requested: $100,000.00 Future Annual Cost: ________
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Recommended Action:
Approve Amendment No.1 to the Agreement Between County of Lake and Fremont
Hospital, for Acute Inpatient Psychiatric Hospital Services and Professional Services
Associated with Acute Inpatient Psychiatric Hospitalization for Fiscal Year 2024-25 to
increase total compensation by $100,000 for a new contact maximum of $200,000 and
authorize the Chair to sign.