Dmh

In this case of first impression, we address administrative regulations implemented in 1995 to govern reimbursement of private hospitals that provide acute psychiatric care to Medi-Cal beneficiaries. Plaintiffs Glendale Memorial Hospital & Health Center, Long Beach Community Hospital, Northridge Hospital Medical Center, and Presbyterian Intercommunity Hospital (Hospitals) sought a writ of mandate in superior court challenging decisions made by defendant state Department of Mental Health (DMH) that Hospitals were not entitled to reimbursement for certain days of psychiatric care provided to a number of patients. The trial court found that many of DMH’s decisions were not supported by substantial evidence and entered judgment ordering DMH to reimburse Hospitals. Real party in interest County of Los Angeles (County), which under the 1995 regulations is immediately liable for the reimbursement payments, appealed.

DMH’s decisions denying reimbursement were set forth in terse statements that, based on a clinical review of information submitted, DMH had decided that medical necessity for the requested charges had not been established. We conclude that these decisions fail to…