Memorandum
Date: January 14, 2025
To: The Honorable Lake County Board of Supervisors
From: Elise Jones, Director of Behavioral Health Services
Subject: Approve Amendment No. 1 of Agreement Between County of Lake and Sacramento Behavioral Health Care Hospital LLC for Acute Inpatient Psychiatric Hospital Services and Professional Services Associated with Acute Inpatient Psychiatric Hospitalizations for FY 2024-25 in the Amount of $250,000.00
Executive Summary:
The County Mental Health Plan (MHP) in California is obligated to ensure access to a full continuum of mental health services, including acute inpatient psychiatric care, as part of its responsibilities to Medi-Cal beneficiaries. The California Welfare and Institutions Code (WIC) and Department of Health Care Services (DHCS) guidelines outline these obligations.
Here are some key points about the MHP's obligations regarding acute inpatient psychiatric hospitals:
1. Obligation to Ensure Access to Acute Inpatient Care
• California Welfare and Institutions Code (WIC) Section 5775 mandates that the County MHP ensure that individuals under its care have access to necessary mental health services, including inpatient psychiatric services when required. Specifically, MHPs are expected to ensure that clients who need acute psychiatric care can be referred to appropriate facilities, including hospitals.
• The WIC Section 5776 further reinforces that MHPs must work to ensure access to inpatient psychiatric care and other services that contribute to the recovery of individuals with serious mental health conditions. MHPs often do this through contracts with hospitals and other providers to provide services such as inpatient care, crisis stabilization, and detoxification services.
2. Contracts with Acute Inpatient Psychiatric Hospitals
• MHPs are required to contract with acute inpatient psychiatric hospitals or other designated inpatient facilities to ensure that individuals needing inpatient care have access to these services. This is particularly important for individuals experiencing psychiatric crises who need short-term intensive treatment in a hospital setting.
• In cases where a local MHP does not have adequate inpatient psychiatric beds, they must ensure that their contracted providers offer access to facilities in neighboring counties, or utilize the State Hospital system when necessary (such as when individuals are deemed incompetent to stand trial or require state-funded psychiatric care under other provisions of the law).
3. Medi-Cal Payment and Authorization Process
• The California Department of Health Care Services (DHCS) regulates the Medi-Cal reimbursement for acute inpatient psychiatric care. DHCS has specific Behavioral Health Information Notices (BHINs) that guide how MHPs should manage contracting, billing, and quality assurance for inpatient care. These notices provide clarity on what services are reimbursable under Medi-Cal and how to manage authorizations for inpatient admissions, treatment duration, and discharge planning.
• BHINs also specify the requirements for network adequacy, ensuring that MHPs have an adequate number of contracted psychiatric hospitals to meet the needs of their beneficiaries.
4. Network Adequacy Requirements
• Network adequacy is a critical component of an MHP’s obligations under Medi-Cal. According to Welfare and Institutions Code Section 14184 and California Code of Regulations Title 9, MHPs must maintain a network of providers that offer a range of psychiatric services, including acute inpatient care. The DHCS issues guidance to MHPs on network adequacy requirements, outlining expectations for contracting with inpatient facilities and other providers to meet the needs of the local population.
• DHCS also monitors these contracts through annual reports and audits, ensuring that MHPs meet both state and federal standards for providing timely access to care, including inpatient psychiatric services.
5. Crisis Services and Continuity of Care
• MHPs are also responsible for ensuring continuity of care, which includes facilitating the smooth transition of individuals from acute inpatient care to outpatient services or community-based care. This may involve collaborating with acute inpatient psychiatric hospitals to ensure that discharge planning and follow-up care are in place.
6. Involuntary Treatment and Acute Care:
• Welfare and Institutions Code Section 5150 et seq. establishes procedures for the involuntary detention of individuals in psychiatric crisis and the subsequent provision of acute care, including inpatient hospitalization. MHPs must ensure access to facilities that can accommodate 5150 holds, 5151 evaluations, and 5152 certifications for those requiring emergency psychiatric care.
In summary, the County Mental Health Plan is required to:
• Contract with acute inpatient psychiatric hospitals or similar providers to ensure access to inpatient psychiatric care.
• Work within the framework of Medi-Cal and ensure adequate provider networks for psychiatric services, including emergency and short-term care.
• Ensure continuity of care from inpatient services to community-based services, especially through case management and discharge planning.
An amendment is being requested due to the contractor's (Sacramento Behavioral Health Care Hospital) service utilization exceeding projections, resulting in an increase to the total compensation, with a maximum limit of $250,000.00.
If not budgeted, fill in the blanks below only:
Estimated Cost: $250,000.00 Amount Budgeted: $250,000.00 Additional Requested: ________ Future Annual Cost: ________
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Recommended Action: Approve Amendment No. 1 of Agreement Between County of Lake
and Sacramento Behavioral Health Care Hospital LLC for Acute Inpatient Psychiatric
Hospital Services and Professional Services Associated with Acute Inpatient Psychiatric
Hospitalizations for FY 2024-25 in the Amount of $250,000.00.