Interfacility Transfer Policies – Humboldt County

Emergency Room staff conclude the transfer of the individual, including completion and distribution of the transfer paperwork; accompanying the individual to the ambulance; and notifying the accepting hospital of the individual‘s estimated time of arrival.

MINORS who cannot be stabilized are transferred by ambulance to an age appropriate facility, out-of–county.

OUT-of-COUNTY: A 5150 transfer from Emergency Departments to out-of-County hospital requires a psychiatric evaluation prior to transfer. This Psychiatric Evaluation is required prior to transfer to determine the need for inpatient hospitalization, as well as, evaluate if the individual is fit for transfer, how to safely transfer, and verifies the individual continues to meet 5150 criteria. These evaluations are NOT performed by Humboldt County Behavioral Health. County Behavioral Health does NOT come to Emergency Rooms to do a Psychiatric Evaluation and are not responsible for the bill for this Psychiatric Evaluation, or individuals transferred out-of-County. It is the treating Hospital’s responsibility. A Psychiatric Evaluation can be done by any psychiatrist.

2023: Dr. Soper does the psychiatric evaluations at St. Joseph’s and Dr. Tessler does them for Mad River Community Hospital.

Out-of-County Medi-Cal patients: Humboldt County Behavioral Health is the Medi-Cal facility for Humboldt County. Sempervirens must contact the out-of-county facility directly. The facilities will not accept a patient just based on a hospital request. When individuals are on the CSU, the BH staff are seeking out-of-county placements, and then sending packets to facilities.  When an individual is at the ED, the ED will send packets to CSU and out-of-county facilities.  Humboldt Behavioral Health will be notified of admission and need for concurrent review.

Inter-facility transfers (IFTs) & AMBULANCE REIMBURSEMENT of the Mental Health Consumer, Humboldt ambulance companies:

• Arcata Ambulance is reimbursed for behavioral 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 Behavioral 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 the initial receiving hospital.