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Approve a participation agreement with California Mental Health Services Authority for $217,392 to conduct required concurrent review of psychiatric inpatient hospital services for the period July 1, 2025 through June 30, 2026; Delegate authority to the County Administrator to execute the agreement and any subsequent amendments, with County Counsel concurrence, up to an aggregate of $74,999; and Approve a $110,432 Appropriation Transfer Request to increase appropriations and recognize revenue to fund the agreement for FY2025/26 (4/5 vote required)
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Published Notice Required? Yes ___ No _X _
Public Hearing Required? Yes ___ No _X _
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends that the Board of Supervisors approve a participation agreement with California Mental Health Services Authority for $217,392 to conduct required concurrent review of psychiatric inpatient hospital services for the period of July 1, 2025 through June 30, 2026; delegate authority to the County Administrator to execute the agreement and any subsequent amendments, with County Counsel concurrence, up to an aggregate of $74,999; and approve an $110,432 Appropriation Transfer Request (ATR) to increase appropriations and recognize revenue to the fund the agreement for FY2025/26.
SUMMARY:
Solano County Behavioral Health, as a contracted Mental Health Plan (MHP) with the State of California, is required to conduct concurrent review and authorization for all psychiatric inpatient hospital services and psychiatric health facility services. The State made policy changes to ensure an MHPs’ compliance with the federal Parity in Mental Health and Substance Use Disorder Services Final Rule. To implement these changes, CalMHSA entered into a services agreement with Acentra Health (formerly known as Kepro/Keystone Peer Review Organization) to conduct concurrent review and authorization of inpatient psychiatric hospital services on behalf of multiple California County MHPs.
FINANCIAL IMPACT:
The agreement will be funded with federal Medi-Cal Quality Assurance revenue, State General Fund, and 2011 Realignment. An ATR for $110,432 is needed to increase appropriations for this agreement and recognize revenue in the Department’s FY2025/26 Working Budget. There is no impact to the County General Fund.
DISCUSSION:
Per the Department of Health Care Services’ (DHCS) Behavioral Health Information Notices (BHIN) 19-026 and BHIN 22-017, Mental Health Plans (MHPs) are required to conduct concurrent review and authorization for all psychiatric inpatient hospital services and psychiatric health facility services. The BHINs outline policy changes implemented to ensure a MHPs’ compliance with the federal Parity in Mental Health and Substance Use Disorder Services Final Rule (Parity Rule; Title 42 of the CFR, part 438.910). The process of concurrent review includes the review of clinical information to determine if medical necessity is met for continued stay, in which the clinical team continues to review the care and verifies medical necessity at appropriate intervals, typically no less than every three (3) days.
Given these policy changes, CalMHSA has entered a services contract with Acentra Health to conduct the concurrent review and authorization of inpatient psychiatric hospital services on behalf of Solano County, and on behalf of multiple California County MHPs. Acentra Health provides a web-enabled utilization review platform and clinical services to carry out psychiatric inpatient concurrent review, authorization services, and to provide other related services. It is anticipated this contract will provide concurrent review services to approximately 955 children, adolescent, and adult clients served per year representing the County’s average annual utilization of inpatient psychiatric hospital services.
ALTERNATIVES:
The Board could choose not to approve this agreement. This is not recommended as MHPs are required to conduct concurrent review and authorization for all psychiatric inpatient hospital services and psychiatric health facility services to ensure compliance with federal and State mandates.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved the contract for legal sufficiency.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION