DATE: April 22, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Amendment l to Agreement with UHS Madera, Inc. dba River Vista Behavioral Health for Inpatient Psychiatric Hospital Services
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute Amendment I to Agreement No. 23-312 with UHS Madera, Inc. dba River Vista Behavioral Health, to modify the Contractor Scope of Work and Rates Exhibit, with no change in term of July 1, 2023 to June 30, 2025, or compensation maximum of $23,800,000.
REPORT
There are no additional Net County Cost associated with the recommended action. The recommended amendment will modify the Contractor Scope of Work and Rates Exhibit of the Agreement to align with the Administrative Day Rates set by California Department of Health Care Services (DHCS). This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. If your Board does not approve the recommended action, the Agreement will continue to exclude the administrative day services rate that Contractor is to be paid. The Department is required by DHCS to provide and reimburse inpatient psychiatric services, including administrative day services.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The maximum compensation of the agreement will remain at $23,800,000, which will be fully funded by Mental Health Realignment Funds. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2024-25 Adopted Budget and will be included in future budget requests for the duration of the term. Actual costs will be determined by actual services provided.
DISCUSSION:
On October 11, 2022, the Board approved the California Department of Health Care Services (DHCS) Agreement 22-452 (State agreement#22-20101) to continue to operate the Fresno County Mental Health Plan (FCMHP) in accordance with all applicable Federal and State laws. The responsibilities include ensuring persons served have access to medically necessary mental health services within and/or outside of the County including psychiatric inpatient hospital services in accordance with Welfare and Institutions Code (WIC) Division 5, Title 42 Code of Federal Regulations, and Title 9 of California Code of Regulations (CCR) Chapter 11 commencing with Section 1810.100.
On January 7, 2025, the Board approved Agreement No. 25-008 (State agreement#24-40134) with DHCS, establishing DBH as the Behavioral Health Plan (BHP) for the County’s Medi-Cal and Drug Medi-Cal Organized Delivery System persons served. This agreement continues the responsibilities discussed above for psychiatric inpatient hospital services.
Psychiatric inpatient hospital services include both acute psychiatric inpatient hospital services and administrative day services. All services are approved through a third party to ensure the services meet medical necessity, per 42 C.F.R., § 438.210(b)(1). BHPs are required to reimburse for these services for individuals between the ages of 21-65 in Institutions for Mental Disease (IMD) which includes UHS of Madera. These required services are not reimbursable from Medi-Cal/Medicaid for the persons in the age group of 21-64 due to the Medicaid IMD exclusion. The IMD exclusion is a long-standing policy under Medicaid that prohibits the federal government from providing federal Medicaid funds to states for services rendered to certain Medicaid-eligible individuals who are receiving services in IMDs (§1905(a)(30)(B) of the Social Security Act [SSA]).
On June 20, 2023, the Board approved Agreement No. 23-312 with UHS of Madera for the provision of inpatient psychiatric hospital services to Fresno County persons served eligible for such services under the Medi-Cal program. Administrative day services were included in the scope of work and are part of inpatient psychiatric services. Administrative days refer to time spent in a psychiatric hospital for persons served who no longer require acute hospital care, but are awaiting placement into a lower-level facility. These days might still involve necessary care, such as supervision, monitoring, and administrative processes, but do not involve direct psychiatric care. They may still need to stay in the hospital under supervision until a suitable outpatient or residential care facility becomes available.
The recommended amendment will modify the Contractor Scope of Work and Rates Exhibit to align with the rates set by DHCS in accordance with Behavioral Health Information Notice 23-019. The Administrative Day Rate was described in the agreement, but the rate was not provided in the Contractor Scope of Work and Rates Exhibit of the Agreement. The agreement is being amended to include the rate on the Exhibit for clarification. The amendment will also update the contractor’s information on the same exhibit to reflect most recent contacts of the Business Office Director and the Chief Financial Officer.
REFERENCE MATERIAL:
BAI #18, January 7, 2025
BAI #48, June 20, 2023
BAI #23, October 11, 2022
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment l to Agreement with UHS Madera
CAO ANALYST:
Ron Alexander