Board approves behavioral-health placement and services contract amendments amid concerns about rising inpatient costs

The Lassen County Board of Supervisors voted to continue a contract with Crestwood Behavioral Health Inc. for subacute placements and approved two related contract amendments on a series of voice votes during its meeting. The board authorized the county chief administrative officer to execute the Crestwood agreement and amendments for Kingsview Professional Services and ResPad/ResMed placements.

A county presenter (speaker 7) told the board the Crestwood agreement covers subacute placements for residents who require secure but not maximum-security hospitalization; the county currently has one person placed in a Crestwood facility in Redding. The presenter said the county is seeking authorization “not to exceed $400,000” for the Crestwood agreement to ensure capacity if an additional placement is needed. The presenter described the per-patient cost as high—“still $890 a day” for care—and said placement decisions are constrained by state-set rates and capacity at regional facilities.

Separately, the board approved an amendment to Kingsview Professional Services to add funding to complete the county’s annual review and expenditure report (ARER). The presenter said the amendment would add $6,500 to cover ARER work currently outsourced because Lassen County has been without a fiscal officer; board members and staff discussed a correction to the memo’s arithmetic and agreed the revised contract total should fall into the “29‑thousand” range as presented in the meeting materials.

The board also approved a second amendment to the county’s agreement with ResPad (used for higher‑level inpatient psychiatric placements, primarily in Redding and Red Bluff). The presenter asked the board to increase the ResPad contingency to a not‑to‑exceed amount discussed during the meeting to ensure the county can pay large, unpredictable bills when residents are hospitalized outside the county. The presenter said the county had previously increased the contract as placements rose year over year and noted one recent month’s bill for a single patient was nearly $96,000.

Board members pressed staff on how these placements are paid. The presenter said the county has historically used Mental Health Services Act (MHSA) funds and, going forward, will use funds under the Behavioral Health Services Act (BHSA); she also said the county had already used some realignment dollars to cover placement bills and voiced concern that the county’s allocated funds could be exhausted in a large incident. The presenter explained that in some cases a Lassen County resident hospitalized elsewhere retains Lassen County Medi‑Cal until eligibility is changed, which can delay billing transfers and leave the county responsible for charges that arrive after the hospitalization.

Several supervisors emphasized the practical difficulty of recruiting experienced fiscal officers and described the county’s interim reliance on outside consultants. The presenter said the county is attempting to “grow our own” fiscal and clinical staff through local partnerships with universities, but that the specialized budgeting skills needed for these reports and contract negotiations are hard to recruit immediately.

All three items were approved by voice vote with no roll-call tallies recorded in the transcript. The board then took a short break.