Approve agreement with California Mental Health Services Authority (CalMHSA) in the amount of $70,896 for the period of July 1, 2025 through December 31, 2025 for the provision of Psychiatric Inpatient Concurrent Review (PICR). (No general fund impact) (Morales)

Approve agreement with California Mental Health Services Authority (CalMHSA) in the amount of $70,896 for the period of July 1, 2025 through December 31, 2025 for the provision of Psychiatric Inpatient Concurrent Review (PICR).

Per the Department of Health Care Services (DHCS) Behavioral Health Information Notices (BHIN) 19-026 and BHIN 22-017, the County Mental Health Plan (MHP) is required to conduct concurrent review and authorization for all psychiatric inpatient hospital services and psychiatric health facility services. These BHINs outline policy changes implemented to ensure a MHPs’ compliance with the Parity in Mental Health and Substance Use Disorder Services Final Rule (Parity Rule; Title 42 of the CFR, part 438.910). This agreement is a renewal of a prior agreement with CalMHSA effective November 1, 2024 through June 30, 2025. Prior to contracting with CalMHSA, the Quality Management (QM) unit had historically been responsible for meeting this requirement. Due to the high cost of inpatient hospitalization there was a need to conduct reviews of hospital stays more frequently (every 3 days instead of the previous practice of every 10 days). The previous contract has allowed us to maintain this more frequent review timeline. Based on current staffing, the QM unit does not have the capacity to complete the reviews to this frequency. CalMHSA has a services contract with Acentra Health to provide counties a web-enabled utilization review platform and clinical services to carry out psychiatric inpatient concurrent review and authorization services on behalf of multiple California County MHPs.

Renewing this agreement with CalMHSA, will allow the County to continue meeting authorization requirements, as well as have increased oversight over hospitalizations. The authorization process for these services is mandated by the state and audited during triennial reviews. Non-compliance with these requirements can result in fines and sanctions. Additionally, more frequent reviews of medical necessity help prevent clients from staying in a higher level of care for longer than necessary. As the cost of inpatient care is high, this can help reduce the overall cost of hospitalization.

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

On October 8, 2024, County’s Deputy Director of GSD/Manager of Procurement/County Purchasing Agent (Purchasing Agent) approved a sole/single source procurement for these services, based on satisfactory service/reasonable prices and to avoid the interruption of County business. Without sole/single source approval for these services, the County would be negatively impacted due to not being able to provide the community with mandatory services. Factors considered, included but were not limited to: CalMHSA is the only organization in California that offer these services.

Vendor Performance
The contract does not have performance measures as it does not involve direct care to clients.