To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Nolan Sullivan, 707-565-4774; Jan Cobaleda-Kegler, 707-565-5157
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Inpatient Concurrent Review Services Contract
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute an agreement with HippVinci, Inc., doing business as Telligen, Inc., for inpatient concurrent review services for the period of October 1, 2026 through June 30, 2029, in an amount not to exceed $675,000, subject to review and approval as to form by County Counsel with authorization to execute amendments extending the agreement for up to two additional one-year periods, through June 30, 2031, and increasing the agreement amount by no more than $156,000 for each extension year, for an aggregate agreement amount not to exceed $987,000, subject to available appropriations and review and approval as to form by County Counsel.
B) Authorize the Director of Health Services, or designee, to execute modifications to the agreements in this Board Item which do not significantly change the scopes of service in order to address increased service needs, payment or reimbursement methodologies, subject to available funding and approval by County Counsel.
C) Adopt a Budget Resolution adjusting the Department of Health Services FY 2026-2027 Adopted Budget to increase revenue and expenditures appropriations by $174,600 to support the execution of the agreement with Telligen. (4/5th Vote Required)
end
Executive Summary:
The Sonoma County Department of Health Services, Behavioral Health Division, is responsible for authorizing and managing acute psychiatric inpatient hospital and psychiatric health facility services for eligible Medi-Cal beneficiaries in accordance with federal and state requirements.
Inpatient concurrent review consists of real-time clinical review and authorization during a psychiatric inpatient stay. The process determines whether continued inpatient services remain medically necessary, are being delivered at the appropriate level of care, and are supported by appropriate treatment, discharge, and aftercare planning.
The Department is seeking authorization to enter into an agreement with HippVinci, Inc., doing business as Telligen, Inc., for the period of October 1, 2026 through June 30, 2029, in an amount not-to-exceed $675,000. The agreement includes options to extend the term for up to two additional one-year periods. Telligen will complete initial and continued-stay reviews, apply medical-necessity criteria, communicate authorization determinations to inpatient providers, support timely discharge planning, maintain required documentation and performance reporting required for regulatory compliance and reimbursement.
Discussion:
Background
The Sonoma County Department of Health Services (“Department”), Behavioral Health Division, administers the County’s Medi-Cal Specialty Mental Health Services program. As part of this responsibility, the Department manages authorization and utilization-review activities for Medi-Cal beneficiaries receiving acute psychiatric inpatient hospital and psychiatric health facility services.
Inpatient concurrent review involves conducting real-time authorization reviews during each psychiatric inpatient stay. These reviews help ensure that:
• Inpatient services remain medically necessary;
• Services are provided at the appropriate level of care;
• Treatment is consistent with the beneficiary’s clinical needs;
• Discharge and aftercare planning begin promptly;
• Continued-stay decisions are completed within required timeframes;
• Authorization decisions are supported by adequate clinical documentation; and
• Services meet applicable Medi-Cal, state, and federal requirements.
The concurrent review process gives inpatient providers timely feedback and an opportunity to correct or supplement documentation while the beneficiary is still receiving care. Timely review improves compliance with Medi-Cal requirements and supports reimbursement for authorized inpatient services.
Certain inpatient services may also be eligible for retroactive reimbursement in limited circumstances, including hospitalizations spanning fiscal years, appealed inpatient days, and resubmitted documentation intended to correct administrative errors.
The Department has been in contract with California Mental Health Service Authority (CalMHSA) for these services, which are provided through CalMHSA’s subcontractor, Accentra Health. As the existing agreement was due for procurement, DHS is transitioning to a new contracting arrangement using a procurement conducted by another California county. These services are required across county behavioral health systems, and it is common for counties to contract with external entities to perform this function.
The current CalMHSA agreement remains in effect through December 31, 2026. Staff recommends the HippVinci, Inc. contract commence on October 1, 2026 in order to provide for a transition period necessary to ensure continuity of services and to secure transfer of patient information and active concurrent review activities from the current provider to the new provider. Cases will decline with CalMHSA as they transfer to Telligen, and by the end of the calendar year should all have transitioned.
This item also includes related appropriation adjustments to transfer available funding from the existing CalMHSA agreement to the new contract as services transition.
Telligen
Telligen will be required to perform concurrent review services in accordance with applicable federal and state requirements, including Department of Health Care Services guidance, Medi-Cal Specialty Mental Health Services requirements, and County policies and procedures. Contracting for these services is intended to improve the timeliness and consistency of authorization decisions, strengthen communication with inpatient providers, support discharge and aftercare planning, improve documentation and utilization reporting, and allow County clinical staff to focus additional resources on care coordination and other behavioral health functions.
The Department anticipates approximately 1,200 concurrent review encounters annually. The average cost is estimated at approximately $140 per review in FY 2026-27 and FY 2027-28 and $130 per review in FY 2028-29. Performance standards will be incorporated into the agreement and monitored throughout the contract term. Additional information regarding regulatory requirements, anticipated benefits, service outcomes, and estimated utilization and costs is included in Attachment 2.
Scope of Services
Under the proposed agreement, Telligen will provide inpatient concurrent review and related utilization-management services for eligible Sonoma County Medi-Cal beneficiaries. Services will include reviewing and processing initial and continued-stay authorization requests for psychiatric inpatient and psychiatric health facility services; assessing medical necessity, level of care, treatment and discharge planning; communicating and documenting authorization, modification, denial, and appeal decisions; issuing required notices; maintaining complete review records; and providing utilization and performance reporting.
The contractor will also participate in audits, quality-improvement and utilization-management activities, maintain appropriately qualified clinical staff and secure information systems, and cooperate with County monitoring and corrective-action requirements.
Procurement
San Bernardino County conducted a competitive procurement for substantially similar inpatient concurrent review services through Request for Proposals No. RFP DBH 25-61/ePro Bid #DBHE26-ADMN-6093. San Bernardino County publicly advertised the solicitation, conducted a bidder conference, and received four proposals. The solicitation required proposers to demonstrate their service capacity, implementation readiness, relevant experience, staffing qualifications, ability to measure outcomes, and proposed cost. San Bernardino County subsequently selected Telligen through that procurement for a five-year agreement for the period of July 1, 2026 through June 30, 2031.
The Sonoma County Department of Health Services reviewed San Bernardino County’s solicitation, evaluation and selection documentation , scope of services, contractor qualifications, pricing, and resulting agreement. Based on that review, the Department determined that the scope substantially aligns with Sonoma County’s service needs, and that Telligen has the experience, clinical capacity, staffing, technology, and organizational qualifications necessary to the services for Sonoma County. Telligen has agreed to provide Sonoma County with pricing that is the same or more favorable than the comparable pricing established through San Bernadino’s procurement.
The Department is seeking to enter into an agreement with Telligen, Inc. from effective date through June 30, 2029, with two one-year options to extend in an amount not-to-exceed $675,000 to provide inpatient concurrent review services. Each extension year would increase the agreement amount by no more than $156,000 per year, for an aggregate agreement amount not to exceed $987,000.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 3: Create a “no wrong door” approach where clients who need services across multiple departments and programs are able to access the array of services needed regardless of where they enter the system.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
None
Fiscal Summary
|
Expenditures |
FY 26-27 Adopted |
FY 27-28 Projected |
FY 28-29 Projected |
|
Budgeted Expenses |
$325,920 |
$168,000 |
$156,000 |
|
Additional Appropriation Requested |
$174,600 |
|
|
|
Total Expenditures |
$500,520 |
$168,000 |
$156,000 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$500,520 |
$168,000 |
$156,000 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
General Fund Contingencies |
|
|
|
|
Total Sources |
$500,520 |
$168,000 |
$156,000 |
Narrative Explanation of Fiscal Impacts:
The FY 2026-2027 Adopted Budget includes $325,920 for concurrent review services. This amount includes $149,520 for services provided through the California Mental Health Services Authority (CalMHSA) through December 31, 2026, and $176,400 available for the proposed Telligen agreement.
The proposed Telligen agreement has an initial maximum obligation of $675,000. The proposed Telligen agreement includes a one-time implementation fee of $225,000 and estimated year-one service costs of $126,000, for a total FY 2026-2027 cost of $351,000. The existing $176,400 appropriation, together with the requested $174,600 appropriation increase for FY 2026-2027, will fund these costs. When combined with $149,520 budgeted for the existing CalMHSA agreement, total FY 2026-2027 cost are projected to be $500,520. Approval of this item will increase FY 2026-2027 appropriations by $174,600.
The proposed three-year agreement with Telligen includes the $225,000 one-time implementation fee and year-one services cost of $126,000 that were mentioned above, as well as the estimated costs of $168,000 in FY 2027-2028 and $156,000 in FY 2028-2029. Funding for future fiscal years will be requested through the annual budget process, subject to available funding and Board approval.
These services are funded with 1991 Mental Health Realignment and are eligible for reimbursement through Federal Financial Participation and Proposition 30 Quality Assurance and Utilization Review (QAUR) claiming.
Narrative Explanation of Staffing Impacts (If Required):
None
Attachments:
Attachment 1 - Budget Resolution
Attachment 2 - Additional Information
Attachment 3 - Request for Proposals
Attachment 4 - Draft Agreement
Related Items “On File” with the Clerk of the Board:
None