DATE: May 14, 2019
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Department of Behavioral Health
SUBJECT: Retroactive Amendment to Master Agreement for Inpatient Psychiatric Hospital Services
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute retroactive Amendment I to Master Agreement A-18-250 for out-of-county inpatient psychiatric services effective September 1, 2018 with no change in term to June 30, 2023 and increasing the maximum by $5,120,000 to a total of $9,000,000.
REPORT
Approval of the recommended action will increase the annual contract maximum in Master Agreement A-18-250 for Fiscal Year (FY) 2018-19 and each subsequent 12-month period through FY 2022-23 to cover the costs associated with the addition of providers and increased demands for inpatient psychiatric services.
ALTERNATIVE ACTION(S):
There is no viable alternative action. If your Board does not approve the recommended action to increase the annual contract maximum, the County would not have the ability to contract with additional contractors and pay for mandated services through this established agreement. In addition, the seriously and persistently mentally ill individuals would not receive the services they require in a timely manner, leaving mentally ill individuals without adequate services.
RETROACTIVE AGREEMENT:
The recommended Amendment is retroactive to September 1, 2018 due to the need for a mechanism to reimburse the out-of-county inpatient psychiatric hospitals that provided services to Medi-Cal and non-Medi-Cal recipients up to that point in the current fiscal year with then available funds in Master Agreement A-18-250.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The cost of the recommended Amendment will increase the maximum compensation amount to $9,000,000; a $5,120,000 increase over the existing maximum ($3,880,000) based on anticipated usage increases during FY 2018-19 and each subsequent 12-month period of the Master Agreement. Sufficient appropriations and estimated revenues are available in the Department’s Org 5630 FY 2018-19 Adopted Budget and will be included in future budget requests for the duration of the agreement. Total expenditures will be based on actual length of stay in the licensed facilities. The Amendment will be financed with Medi-Cal and Mental Health Realignment funds.
DISCUSSION:
On May 21, 2013, your Board approved agreement No. A-13-283 with the California Department of Health Care Services (DHCS), establishing the Department as the Mental Health Plan (MHP) for the County’s Medi-Cal Beneficiaries. The responsibilities include ensuring beneficiaries have access to medically necessary mental health services provided within or outside of the County and reimbursement to mental health providers and psychiatric inpatient hospitals for services provided to beneficiaries, 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. A-18-250 to contract with Inpatient Psychiatric Hospitals whose service costs may exceed the $100,000 maximum payable by ISD - Purchasing to non-contracted inpatient psychiatric hospitals rendering them unpayable under the expedited process approved on June 6, 2017. The Master Agreement No. 18-250 also allows the Department’s Director or Designee to add and/or delete providers as necessary.
The individuals served by the identified providers have high acuity needs and require immediate inpatient services. 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 Fresno County residents in need of inpatient psychiatric care. The recommended Amendment to Master Agreement A-18-250 will help the Department accomplish its intended goals with the Master Agreement by providing increased funding for the addition of additional inpatient psychiatric facilities as needed without returning to your Board. In addition, the funding increase provided by the recommended Amendment would provide funding to reimburse currently contracted inpatient psychiatric facilities for costs associated with services previously rendered to adults with severe and persistent mental health conditions as required by WIC and CCR.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of the recommended Amendment at the May 22, 2019 meeting.
REFERENCE MATERIAL:
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 to Master Agreement No. A-18-250
CAO ANALYST:
Ron Alexander