To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Payments for Services Provided by BHC Sierra Vista Hospital, Inc.
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Auditor-Controller, or designee, to pay an amount not to exceed $11,728 to BHC Sierra Vista Hospital, Inc. for the provision of inpatient psychiatric treatment services including diagnostic and therapeutic services and mental health treatment, for the period June 14, 2023 through June 29, 2023, as recommended by the Health Services Director.
FISCAL IMPACT:
Payment of $11,728 is funded 100% by Mental Health Realignment funds.
BACKGROUND:
The Behavioral Health Services Department (BHSD) has been contracting with BHC Sierra Vista Hospital, Inc. since November 1, 2006. This Contract meets the social needs of County’s population by providing inpatient psychiatric hospital services to County-referred adults and adolescents. This Contract was entered into under and subject to the following legal authorities: 42 U.S.C. 1395, et seq.; 42 U.S.C. 300e; Welfare and Institutions Code §§ 14000, et seq.; Health and Safety Code, §§ 1340-1399.904; California Government Code §§ 25209.6, 26227 and 31000. The BHSD Quality Management, Utilization Management and Contract Monitor Staff meet on a regular basis to ensure monitoring and performance measures in the contract are upheld.
On September 13, 2022, the Board of Supervisors approved Novation Contract #24-794-9(17) with BHC Sierra Vista Hospital, Inc., in an amount not to exceed $75,000, for the provision of inpatient psychiatric hospital services to County-referred adults and adolescents for the period from July 1, 2022 through June 30, 2023, which included a six-month automatic extension through December 31, 2023, in an amount not to exceed $37,500.
On July 18, 2022, the Board of Supervisors approved a Payment for Services with BHC Sierra Vista Hospital, Inc., in an amount not to exceed $61,246, for additional inpatient psychiatric hospital services to County-referred adults and adolescents for the period March 3, 2023 to June 30, 2023.
On October 3, 2023, the Board of Supervisors approved a Payment for Services with BHC Sierra Vista Hospital, Inc., in an amount not to exceed $43,194, for additional inpatient psychiatric hospital services to County-referred adults and adolescents for the period April 17, 2023 to June 30, 2023.
This retroactive payment request is for a single inpatient admission. BHSD can receive these payment claims from acute-care facilities up to a year after the date of discharge due to timeframes for submitting claims, the Utilization Review authorization processes, and appeals process. Due to a successful appeal that was made within the allowed timeframe, the claim was not received for payment until after the end of the contract period of July 1, 2022 through June 30, 2023.
As requested by the County, BHC Sierra Vista Hospital, Inc. provided additional inpatient psychiatric treatment services in good faith. BHSD Administration has therefore determined that BHC Sierra Vista Hospital, Inc. is entitled to a payment in an amount not to exceed $11,728 for the reasonable value of their services under the equitable relief theory of quantum meruit. That theory provides that where a person has been asked to provide services without a valid contract, and the provider does so to the benefit of the recipient, the provider is entitled to recover reasonable value of those services.
CONSEQUENCE OF NEGATIVE ACTION:
BHC Sierra Vista Hospital, Inc. will not be paid for psychiatric treatment services rendered in good faith.