| This policy establishes parameters for a cost-based payment structure for Los Angeles County Department of Mental Health (DMH) Legal Entities (LE) that operate Crisis Stabilization Units (CSUs), also referred to as psychiatric Urgent Care Centers (UCCs), in the Los Angeles County. Throughout this policy, the term UCC will be used to substitute for CSU.
Contracted agencies shall develop an internal policy and associated procedures that are consistent with their organizational practices and meet the requirements set forth in this policy.
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| Annual Expenditure Report (AER): A summary of actual expenses and payments of a cost-based UCC for a given fiscal year.
Cash Flow Advance: Disbursement amounts from County General Fund to a LE for purposes of providing cash flow pending the rendering, billing, and processing of claims for eligible services/activities. Such amounts are to be repaid by the LE, generally using amounts owed by the County or earned by contractor for services rendered.
Chair: Comfortable furniture authorized by DMH for use in the UCC for clients admitted for treatment. The chair is able to recline to allow clients to rest comfortably during their stay in the UCC.
Contractor: A DMH contracted agency responsible for services identified in the LE Contract.
Cost Report: A State of California required report for the Medi-Cal Program. The Annual Cost Report contains actual cost, revenue, and statistical information used to determine cost reimbursement for LE Mental Health Services Providers.
Crisis Stabilization: A service lasting less than 24 hours, to or on behalf of a client for a condition that requires more timely response than a regularly scheduled visit (9 CCR 1810.210). Service activities include, but are not limited to, one or more of the following: assessment, collateral, and therapy. Crisis stabilization is distinguished from crisis intervention in which services are delivered by providers who meet the crisis stabilization contact, site (9 CCR 1840.338), and staffing requirements (9 CCR 1840.348).
DMH Program Manager: A manager responsible for monitoring administrative, fiscal, and clinical operations of a DMH mental health program.
DMH Program Staff: A staff responsible for monitoring the day-to-day operations of a mental health program within DMH.
DMH Provider Reimbursement Section (PRS): A unit within DMH Financial Services Bureau responsible for reimbursement of rendered services.
Fiscal Year (FY): A 12-month budget and financial reporting period. The DMH FY begins on July 1 and ends on the following June 30.
Legal Entity (LE): A corporation, partnership, or agency providing specialty mental health services under contract with DMH, exclusive of individual or group providers, Fee-For-Service/Medi-Cal hospitals or psychiatric nursing facilities. (9 CCR 1840.100(c))
Maximum Capacity: The maximum number of clients each UCC can treat at any one time. This maximum client capacity is specified on the Medi-Cal certification issued to the UCC.
Mode of Service: A classification of service types used in DMH’s claims processing information system and for cost reporting. This allows any mental health service recognized by DMH to be grouped with similar services.
Program Budget: Schedule 4-A of the DMH LE Contract Service Delivery Plan (SDP) which is a set of anticipated costs and revenues for a particular funded program or a particular provider clinic/site for an entire FY.
Service Function Code (SFC): Numeric billing codes used to identify a service or service category within a Mode of Service.
Start-up Costs: A set of expenses allowed under a specific funding source(s) typically granted for a period of up to three (3) months and intended to assist a contractor in fully implementing a funded program.
Urgent Care Center (UCC): An outpatient program that provides for up to 24 hours of intensive crisis services composed of immediate care and linkage to community-based services and supports for individuals who would otherwise be brought to emergency rooms. UCCs must be Medi-Cal certified to provide crisis stabilization services, including integrated services for co-occurring substance abuse disorders, and Lanterman-Petris-Short designated to evaluate and treat individuals involuntarily detained (WIC 5150 and 5585).
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| To the extent that reimbursement for UCC services provided by a LE is cost-based and the services are provided under a contract without a maximum contract amount, DMH shall ensure the costs submitted for reimbursement are reasonable and allowable under applicable funding plans and monitored on a regular and ongoing basis.
The provisions regulating cost reimbursement procedures and cost report and settlement requirements shall be contained in the DMH LE Contract, Financial Exhibit A. This policy contains the guidelines for implementation of the contract provisions.
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