DATE: May 21, 2024
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, LMFT, Director, Department of Behavioral Health
SUBJECT: Amendment I to Agreement with BHC Sierra Vista Hospital for Inpatient Psychiatric Hospital Services.
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute Amendment I to Agreement with BHC Sierra Vista Hospital, to modify the rate sheet, effective upon execution with no change in term of July 1, 2023 to June 30, 2025, and no change to the maximum compensation of $15,300,000.
REPORT
There is no additional Net County Cost associated with the recommended action, which will modify the agreement scope of work and rates to align the service rates with the contractor’s regional rate as well as the most current Specialty Mental Health Services Medi-Cal Billing Manual Version 1.5, which aligns with California Advancing and Innovating Medi-Cal (CalAIM) payment reform. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. If your Board does not approve the recommended action, the Department will not be able set regional rates with the contractor or align professional service rates with CalAIM payment reform.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The maximum compensation of BHC Sierra Vista Hospital ($15,300,000) is funded with Mental Health Realignment. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2023-24 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 May 21, 2013, your Board approved Agreement No. 13-283 with DHCS, establishing the Department as the Mental Health Plan (MHP) for the County’s Medi-Cal persons served. The responsibilities include ensuring persons served have access to medically necessary mental health services provided within and/or outside of the County and reimbursement to mental health providers and psychiatric inpatient hospitals for services provided to persons served, in accordance with Welfare and Institutions Code (WIC) and Title 9 of California Code of Regulations (CCR).
On May 8, 2018, your Board approved Master Agreement No. 18-250 to contract with Inpatient Psychiatric Hospitals whose service costs may exceed the $200,000 maximum payable by the Internal Services Department - Purchasing Division Manager to non-contracted inpatient psychiatric hospitals rendering them unpayable under the expedited process approved on June 6, 2017.
The individuals served on the Master Agreement have high acuity needs and require immediate inpatient services that are volatile. The Master Agreement was intended to provide a mechanism for timely payment processing, minimizing of inpatient service wait times, and reliable availability of inpatient beds for county residents in need of inpatient psychiatric care.
On July 1, 2023, the Department superseded numerous agreements based on CalAIM requirements. The Inpatient Psychiatric Hospital Agreements were part of this sweep. BHC Sierra Vista Hospital was previously on the Master Agreement but requested to contract with the Department separately during this time.
This recommended amendment will revise Exhibit F Insurance Requirements to allow for the inclusion of Contractor self-insurance program as requested by County Risk Management and approved by the Department’s executive team.
The recommended amendment will also modify BHC Sierra Vista Hospital’s rate sheet in accordance with Medi-Cal requirements for claiming professional fees as defined in the Specialty Mental Health Services Billing Manual 1.5 based on CalAIM payment reform. Additionally, the Department’s executive team has approved increasing BHC Sierra Vista Hospital’s rates to align with the DHCS Regional Rates, which are set annually.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified in the April 2024 meeting.
REFERENCE MATERIAL:
BAI #48, June 20, 2023
BAI #33, May 8, 2018
BAI #40, June 6, 2017
BAI #46, May 21, 2013
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment I with BHC Sierra Vista Hospital
CAO ANALYST:
Ron Alexander