Calmhsa

Psychiatric Inpatient Concurrent Review and Authorization

Concurrent review and authorization for psychiatric inpatient hospital and psychiatric health facility services on behalf of multiple California county Mental Health Plans (MHPs) through the California Mental Health Services Authority (CalMHSA)

California Inpatient Psychiatric Hospital Concurrent Review

On May 13, 2019, the Department of Health Care Services (DHCS) released a Behavioral Health Information Notice (BHIN) to inform all County Mental Health Plans (MHPs) that they must develop a concurrent review and authorization process for all psychiatric inpatient hospital services, to be enforced on July 1, 2022. Effective April 1st, 2022, Kepro, in coordination with the California Mental Health Services Authority (CalMHSA), will be working with the county MHPs that have agreed to participate in this program.

Receives notification of admission and request for treatment authorization
Conducts concurrent clinical reviews to determine medical necessity
Facilitates care coordination and discharge planning
Provides notices of denials and adjudications appeal requests
Prepares reporting and analysis of relevant hospitalization variables
Conducts internal quality assurance and inter-rater reliability reviews
Arranges training and support to MHPs on provider portal and technology

CalMHSA-Kepro Introduction Presentation

Meet the CalMHSA-Kepro executive team, and learn about the processes and flow of the concurrent inpatient program. The county kick-off PowerPoint presentation can be accessed here: