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5150 Survey July 15, 2016 |
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AGENCY |
QUESTIONS |
NOTES |
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1. Does your county transfer 5150 patients from the ED to a psych facility? |
2. How are they transferred (ALS, BLS, Cage Car, LE)? |
3. Who is responsible for transferring the patient from the ED (County, Contractor, Hospital, LE, Local provider)? |
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Alameda County EMS Agency |
Yes |
Non-emergency ambulance at the BLS level |
The hospital is ultimately responsible but utilizes a non-emergency ambulance provider. |
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CCEMSA |
Yes |
BLS Ambulance (or ALS if BLS not available) |
The hospital is ultimately responsible but calls an ambulance to transport the patient. |
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Contra Costa County EMS Agency |
No |
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ICEMA |
Yes |
Depends upon the transfer order however; BLS Ambulance is one level and type of transportation often used |
Depends on the circumstance, and how the word responsible is being defined. If responsible means “financially responsible”, the financial responsibility is becoming increasingly the patient’s and/or their insurance coverage. In some instances it’s the County’s through indigent/social services/etc. In some areas, law enforcement becomes the financially responsible party due to their department’s assumption that the patient due to incarnation is their responsibility. |
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Imperial County EMS Agency |
Yes |
BLS |
Ambulance contractor through separate agreement with County Behavioral Health. |
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Merced County EMS Agency |
Yes |
ALs Ambulance |
The hospital is initially responsible for the patient then calls an ambulance to make the transfer out of the ED |
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Monterey County EMS Agency |
Yes, via ALS ambulance (all calls in Monterey County are ALS-staffed ambulances), even long distance our of county transfers. |
Same as question #1. |
911 Ambulance Contractor |
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Mountain Valley EMS Agency |
Yes |
ALS or BLS Ambulance |
The hospital is ultimately responsible but calls an ambulance to transport the patient. |
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Napa County EMS Agency |
Yes |
BLS |
Hospital |
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North Coast EMS Agency |
Yes |
* See Below. |
The hospital is ultimately responsible but calls an ambulance to transport the patient. |
* See Below. |
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Orange County EMS Agency |
Yes |
BLS Ambulance |
Sending ED is responsible for arranging transfer; Which BLS Ambulance Company to choose is determined by patients’ insurance or county contract (unfunded patients). |
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Sacramento County EMS Agency |
Yes. None of our hospitals have licensed psychiatric services so all 5150 patients are eventually moved to a psych facility. |
Mostly they are transported by BLS ambulance. There are times where a cage car is used when the patient is being transferred and admitted to Sac County Mental Health Treatment Center, if the van is available. |
It is the responsibility of the hospital to find placement, via several options (Social Worker, County mental health etc.), for the patient and schedule the transportation. Each hospital has their contracted providers to provide transport. |
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San Benito County EMS Agency |
Yes |
Normally BLS |
Behavioral Health has a contract with a local provider. The hospital also has a contract with a local provider. |
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San Diego County EMS Agency |
Yes |
Determined by the sending physician. |
Determined by the sending physician and hospital’s contract provider or alternate means depending on the patient condition. |
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San Joaquin County |
Yes |
All levels depending on patient need. |
Transferring hospital or SJC Behavioral Health Services depending on status of patient. |
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San Mateo County EMS Agency |
Yes |
BLS Ambulance (or ALS if BLS not available) |
The hospital is ultimately responsible but calls an ambulance to transport the patient. |
San Mateo has two SMART transport units dedicated to behavioral health Emerg if law calls for an assist, they can place in 5150 or take to alternative location. We use special trained paramedics in a non- ambulance. |
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Santa Barbara County EMS Agency |
Yes |
ALS, OCCASIONAL CAGED CAR BY AMBULANCE PROVIDER. |
CONTRACTOR AS PART OF THIER AGREEMENT, PLUS THEY HAVE TO MOVE THE PATIENT WITHIN 1 HOUR 90% OF THE TIME. |
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Santa Cruz County EMS Agency |
Yes |
BLS |
The ED is here, and they arrange with a BLS provider or whomever they can to get it done. |
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Sonoma County EMS Agency |
Yes |
Determined by the sending physician. |
Determined by the sending physician and hospital’s contract provider or alternate means depending on the patient condition. |
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Tuolumne County EMS Agency |
Yes |
Safety Car (Cage car) if restraints are not required. |
We bill the patient (don’t collect very much), the hospital arranges the transfers, transport by local provider. |
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North Coast EMS Agency Question #2: Inter-facility transfers (IFTs) & AMBULANCE REIMBURSEMENT of the Mental Health Consumer, Humboldt ambulance companies: – *Arcata Ambulance* is reimbursed for mental health transfers in the same manner as they are for other types of calls. *Medi-Cal* does not recognize a different reimbursement rate for ALS vs. BLS, so running a full cardiac arrest or transferring an individual to mental health reimburses the same *(this reimbursement was cut 10% September 15, 2013 and is significantly below the cost of providing the service)*.*Medicare* will reimburse based on the level of service the individual requires which would be *BLS-2 for transfers to mental health*. – Whether an individual is on a 5150 hold, or is a voluntary admit, does not seem to affect reimbursement. It is rare however for Arcata Ambulance to transfer an individual from an acute care facility to a psychiatric facility that is not on a 5150 hold. – Bad debt write-off is significantly higher for transfers to mental health than for other calls. This is due to the higher percentage of these individuals having no form of insurance and who are often unable or unwilling to complete the paperwork to get coverage. Direct subsidy for transporting these individuals is not received. – *City Ambulance* is reimbursed for Mental Health transports/transfers to definitive care in the same way they are for medical transports. *Medi-Cal and Medicare* pay for the service. Private insurance depends on the member benefits. – *The medical justification is care not available at the sending facility*. The billing guidelines are complicated and are different for each carrier. *Medicare inpatients transferred to St Joseph* and back to the psychiatric facility *MUST* be charged to the facility under CMS guidelines. From our perspective, there is no difference regarding EMTALA laws interpreted relative to IFTs of mental health patient from other patients who require specialty care not available at receiving hospital. |
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ALSO SEE: http://www.northcoastems.com/plansspecialty-care/5150-holds/section-2-summary-of-laws/ |
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For more information visit NORTH COAST EMS’s FAQ about 5150’s web guide at: http://www.northcoastems.com/plansspecialty-care/5150-holds/section-3-faqs/
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Survey conducted by: Richard W. Todd, EMS Agency Administrator – MHOAC El Dorado County, Health and Human Services Agency 2900 Fair Lane Court Placerville, CA 95667 Wk: (530) 621-6505Fax: (530) 621-2758 |
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