Approve first amendment to Agreement No. 24-326 with Sutter Valley Hospitals dba Sutter Center for Psychiatry to add funding in the amount of $156,000 for 2024-25 for a new contract maximum of $1,290,000 for the period of July 1, 2024 through June 30, 2027 for the provision of Acute Psychiatric Inpatient Hospital services. (No general fund impact) (Morales)

Approve first amendment to Agreement No. 24-326 with Sutter Valley Hospitals dba Sutter Center for Psychiatry to add funding in the amount of $156,000 for 2024-25 for a new contract maximum of $1,290,000 for the period of July 1, 2024 through June 30,2027 for the provision of Acute Psychiatric Inpatient Hospital services. 

As the Behavioral Health Plan, Yolo County is responsible for ensuring that all Yolo County Medi-Cal (California’s implementation of Medicaid) beneficiaries receive behavioral health services that meet their needs. Contractor provides inpatient psychiatric services, which can be partially funded for children and youth up to their 21st birthday and older adults over the age of 65 with Federal Financial Participation (FFP) funds (which require matching funds from a non-federal source).  There is a "federal lockout" for Medicaid billing for psychiatric hospitals for patients aged 21 through 64 that is known as the “Institutions for Mental Diseases (IMD) Exclusion.” It prevents the federal government from providing matching funds to states for services provided to these individuals in IMDs. The IMD exclusion was established when Medicaid was created in 1965 to ensure that states, not the federal government, bore the primary responsibility for funding inpatient mental health services. A facility is classified as an IMD if it has more than 16 beds and is primarily dedicated to the diagnosis and treatment of people with mental health conditions, including substance use disorders. The exclusion applies specifically to non-elderly adults, meaning those between the ages of 21 and 64. Federal Medicaid funding is available for inpatient psychiatric services for those under 21 and over 65. 

The County has responsibility for serving all Medi-Cal beneficiaries, regardless of age. Nevertheless, the contractor cannot bill Medi-Cal for services rendered to beneficiaries aged 21-64 due to the IMD Medicaid exclusion. Consequently, federal financial participation (FFP) is not available for such services. The stated contract amount is designated to fund services specifically for this age group.




For services provided to Yolo Medi-Cal beneficiaries who are either 20 years old or younger, or 65 years old or older, payment to the Contractor is not paid directly by the County.  Instead, the Contractor bills Medi-Cal directly to receive payment through FFP and the County’s mental health realignment funds.  The State then deducts the amount used for this purpose from the County’s monthly realignment apportionment. 

HHSA requests approval of this Agreement to allow the County to continue providing Acute Psychiatric Inpatient services to adults with serious mental illness (SMI). This additional funding is needed to cover the increasing client costs.

County Counsel has approved this Agreement as to form.
General Services Department, Procurement Division

On February 29, 2024, the Yolo County Deputy Director/Manager of Procurement or designee approved a sole/single source procurement for these services.

This vendor is able to provide the required acute psychiatric inpatient hospital services locally for adult consumers (age 21 to 64 years old), when no beds are available at our in-county Unit (at Woodland Memorial Hospital). Further, Sutter Center for Psychiatry also offers beds for the same services for children under 21 years old and seniors older than 64 years; a service that our local Inpatient unit does not provide.

If this sole source justification were not approved, Yolo County would have a reduced ability to care for residents in acute crisis who need of psychiatric inpatient services to stabilize. This would place these consumers, their loved ones, and the community as a whole at risk. Further, the County in some instances would be unable to meet state mandated standards regarding the provision of care for persons deemed a risk to themselves or to others, or too gravely disabled to function independently.

Performance Measures included in this Agreement are as follows:
The Performance Measures associated with this Agreement were included in the underlying Agreement and are not being revised at this time (see Att. B. Performance Measures).

In the prior Sutter Center for Psychiatry Agreement for 2023-24, the provider served 68 unduplicated Yolo County clients. There were 77 Yolo County inpatient admissions in 2023-24 with a total of 623 days of inpatient treatment. The average length of stay at this facility was 6 to 8 days. 93% of clients did not experience a psychiatric re-admission within 7 days of discharge. 84% of clients did not experience a psychiatric re-admission within 30 days of discharge.

In 2024-25, under this current Agreement, the provider served 68 unduplicated Yolo County clients with a total of 77 inpatient admissions. The average length of stay in the facility was 8 days. 93% of the Yolo County clients served were not readmitted to an inpatient hospital or psychiatric health facility within 7 days of discharge from the facility in the past year. 84% of the Yolo County clients were not readmitted to an inpatient hospital or psychiatric health facility within 30 days of discharge from the facility in the past year.