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Nevada County adopts BHSA transition; behavioral health director warns of billing lag and contract adjustments
Summary
Nevada County leaders unanimously approved authorizations tied to the transition from the Mental Health Services Act (MHSA) to the Behavioral Health Services Act (BHSA). Behavioral Health Director Phoebe Bell told supervisors the department billed roughly $34 million in Medi‑Cal services year‑to‑date but had received about $8.9 million in payments so far amid payment‑reform and EHR changes.
The Nevada County Board of Supervisors on a unanimous roll call adopted resolutions authorizing county certifications tied to the state’s transition from MHSA to the Behavioral Health Services Act (BHSA).
Phoebe Bell, Nevada County Behavioral Health Director, told the board the department has undergone a major payment‑reform shift tied to CalAIM, moving on 07/01/2023 from a largely cost‑based system to fee‑for‑service. “Year to date, we generated about $34,000,000 worth of Medi‑Cal revenue,” Bell said, and added that “on the far right, you see what we’ve been paid, which is $8,900,000,” a gap she described as evidence of a difficult ramp‑up and delayed state reimbursements.
Bell described the department’s reliance on a broad provider network and contract portfolio. She said the county contracts out roughly 70% of its behavioral‑health costs and that changes in state policy and a new electronic health‑record rollout have slowed billing and created timing mismatches between services billed and dollars received. “There’s a lot of potential upsides to payment reform,” she said, “but there’s a lot of risk as well.”
Supervisors pressed for clarity on how contract renewals and out‑of‑county vendors fit the new funding structure; Bell said most current items on the consent calendar were renewals and that some adjustments reflect inflation, added service demand and occasional state program changes. The board’s adopted actions included authorizing the Behavioral Health Director to sign county compliance certificates and approving related fiscal certifications required by the state.
What happens next: Bell said the county will begin the BHSA 3‑year planning process next January, with a first BHSA plan expected by 06/30/2026. The board also directed staff to keep supervisors informed about contract renewals and state reporting requirements as the new law and funding streams take effect.
