REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
March 14, 2023
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Participation Agreement with California Mental Health Services Authority for Psychiatric Inpatient Concurrent Review
End
RECOMMENDATION(S)
Recommendation
1. Approve Participation Agreement (State Agreement No. 1121-PICR-2022-SJC) with the California Mental Health Services Authority for Psychiatric Inpatient Concurrent Review, in the amount of $2,313,184, effective from the date of execution through December 31, 2024.
2. Designate the Director of the Department of Behavioral Health, as the County Mental Health Plan Director, to sign and submit the Participation Agreement, including any subsequent non-substantive amendments, as required by the California Mental Health Services Authority, on behalf of the County, subject to review by County Counsel.
3. Direct the Director of the Department of Behavioral Health, as the County Mental Health Plan Director, to transmit the Participation Agreement and any subsequent non-substantive amendments to the Clerk of the Board of Supervisors within 30 days of execution.
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
This item will not result in the use of Discretionary General Funding (Net County Cost). The Participation Agreement with the California Mental Health Services Authority (CalMHSA), for the provision of the psychiatric inpatient concurrent review and authorization process through a web-enabled utilization review platform, in the amount of $2,313,184 will be funded by 1991 Realignment. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2022-23 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
CalMHSA is a Joint Powers Authority (JPA), comprised of City and County Mental Health Plans, that provide administrative and fiscal services for member cities and counties to maximize resources for the most efficient use of purchasing products, develop requests for proposals, and coordinate implementation of statewide or multi-county projects, such as the statewide Suicide Prevention and Stigma and Discrimination Reduction campaigns. The California Behavioral Health Directors Association (CBHDA) sponsored the formation of the JPA to jointly develop and fund mental health services and education programs. DBH has been a member of the JPA since November 2008.
On November 18, 2008 (Item No. 90), the Board of Supervisors (Board) approved non-financial Agreement No. 08-1173 with CalMHSA to create and participate in the California Counties’ Mental Health Services Authority to jointly develop and fund mental health services and education programs as determined on a regional, statewide, or other basis.
On August 24, 2010 (Item No. 20), the Board approved Amendment No. 1 to non-financial Agreement No. 08-1173, updating membership voting and funding language.
On May 7, 2013 (Item No. 25), the Board approved Amendment No. 2 to non-financial Agreement No. 08-1173, to broaden the breadth of programs to include all mental and/or behavioral health programs, as requested by the CalMHSA member counties and CBHDA.
CalMHSA is offering member cities and counties the ability to enter into the Participation Agreement (PA) for a technology-assisted concurrent review process, which is a web-enabled utilization review platform with clinical services to carry out psychiatric inpatient concurrent review and authorization services. DBH currently reviews psychiatric inpatient hospital charts for authorization of services provided to a patient through a retrospective review. The hospital sends DBH the chart within 14 days after the patient has been discharged, resulting in review of services for authorization that have already occurred. The new concurrent review process occurs while the patient is still in the hospital, so DBH is reviewing for authorization of mental health services to the patient concurrently with the inpatient hospital stay.
In Recommendation No. 1, DBH is requesting approval of the PA, which will allow DBH to utilize the technology-assisted concurrent review process to ensure a consistent and efficient method for its concurrent reviews and authorization requirements for inpatient acute psychiatric hospitalization. The PA, if approved, will be an addendum to Agreement No. 08-1173. As of April 15, 2022, DBH must respond to inpatient psychiatric hospital authorizations within 24 hours of the request instead of the previous 14-day requirement. Utilizing the PA will assist participating cities and counties in meeting the 24-hour requirement for concurrent review and authorization for inpatient acute psychiatric hospitalization and will support compliance with the California Department of Health Care Services requirements.
In Recommendation Nos. 2 and 3, DBH is requesting authorization for the DBH Director, as the County Mental Health Plan Director, as required by CalMHSA, to execute and submit the PA along with any subsequent non-substantive amendments to CalMHSA on behalf of the County, subject to review by County Counsel. If approved, DBH will also transmit the related agreement documents and any amendments to the Clerk of the Board within 30 days of execution.
DBH will regularly monitor the review process to ensure the contractual requirements and quality of the documentation review are being met as it pertains to authorization approval/denial of psychiatric inpatient hospital services.
PROCUREMENT
N/A
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on February 9, 2023; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on February 16, 2023; Finance (Christopher Lange, Administrative Analyst, 386-8393) on February 17, 2023; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on February 27, 2023.