REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 25, 2024
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Amendments to Contracts for 0-5 Comprehensive Treatment Services
End
RECOMMENDATION(S)
Recommendation
Approve Amendments to the following Contracts, for the provision of 0-5 Comprehensive Treatment Services, updating standard contract language, increasing the combined contract amount by $6,072,278, from $128,789,043 to $134,861,321, and increasing the term by three months, for the total contract period of July 1, 2018, through September 30, 2024.
1. Citrus Counseling Services, Inc., Amendment No. 3 to Contract No. 18-344, increasing the total contract amount by $644,145, from $13,312,554 to $13,956,699.
2. Desert/Mountain Children’s Center, Amendment No. 3 to Contract No. 18-345, increasing the total contract amount by $2,589,369, from $56,807,677 to $59,397,046.
3. Hearts & Lives, Amendment No. 2 to Contract No. 18-346, increasing the total contract amount by $149,580, from $3,091,369 to $3,240,949.
4. Lutheran Social Services of Southern California, Amendment No. 3 to Contract No. 18-347, increasing the total contract amount by $249,299, from $5,152,278 to $5,401,577.
5. Victor Community Support Services, Inc., Amendment No. 2 to Contract No. 18-348, increasing the total contract amount by $1,499,711, from $30,994,564 to $32,494,275.
6. West End Family Counseling Services, Amendment No. 3 to Contract No. 18-349, increasing the total contract amount by $940,174, from $19,430,601 to $20,370,775.
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Promote the Countywide Vision.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The recommended increase of $6,072,278 for 0-5 Comprehensive Treatment Services is funded by the Children and Families Commission for San Bernardino County (First 5), Federal Financial Participation Medi-Cal, Mental Health Services Act Prevention and Early Intervention funds, and up to $117,448 in matching funds from Desert Mountain Special Education Local Planning Area (DMSELPA). Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2024-25 budget.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and substance use disorder (SUD) services to San Bernardino County (County) residents experiencing severe mental illness and/or SUD. An integral part of the service delivery system consists of County-operated clinics and contracted service providers delivering a variety of mental health treatment services, including 0-5 Comprehensive Treatment Services (0-5 CTS). 0-5 CTS is a Mental Health Services Act - Prevention and Early Intervention program administered through the DBH Children and Youth Collaborative Services unit. The 0-5 CTS program is comprised of two programs: Screening, Assessment, Referral, and Treatment (SART) and Early Identification and Intervention Services (EIIS). Services are provided countywide.
The SART program is designed to improve social, developmental, cognitive, emotional, and behavioral functioning of children ages 0-5. These children have been diagnosed with mental health disorders that require specialty mental health services (SMHS). Children referred to SART have experienced abuse (e.g., physical, sexual, or emotional), neo-natal issues (e.g., premature birth, poor maternal nutrition, and/or prenatal exposure to alcohol or other drugs), family issues (e.g., family violence, family substance use disorders, maternal mental illness), or been involved in the foster care system. For children who begin SART services before their fifth birthday, services may continue until their sixth birthday.
The EIIS program provides services to children ages 0-9 who struggle with social-emotional disturbances or display developmental concerns that require less intensive, short-term interventions. Services focus on children identified as unserved, underserved, or who have been referred from SART through the universal screening process - a process used to screen for children who may require a higher level of care.
DMSELPA, a support services agency that serves as a liaison to the desert and mountain local school districts, has a history of partnership with Desert/Mountain Children’s Center (DMCC) to provide Early & Periodic Screening, Diagnosis & Treatment (EPSDT) Medi-Cal SMHS to eligible children and youth in the school environment in the Low Desert, High Desert, and Mountain regions. EPSDT benefits provide comprehensive and preventive health care services for children under age 21. DMSELPA will provide a non-federal match for a portion of the costs for EPSDT Medi-Cal SMHS to eligible children and/or youth served through DBH contracts with DMCC, up to $117,448, which will allow for an additional $3,430,462 of Medi-Cal funded services to children and youth served by DMCC. This additional funding is included in the contract award to DMCC.
DBH estimates that in 2023-24 the recommended agencies will provide 0-5 CTS services to approximately 2,500 children through SART at an average cost of $6,280 per client, and to approximately 1,500 children through EIIS, at an average cost of $5,726 per client.
Approval of the amendments in the Recommendation will extend the term by an additional three months, increase the amount to fund the cost of additional services provided during the extended term, update standard contract language, and add Executive Order N-6-22 - Russia Sanctions, Campaign Contribution Disclosure (Senate Bill 1439).
DBH will also implement mechanisms to regularly 1) review client service data and progress, conduct site visits and annual monitoring to ensure performance and compliance standards of the contract(s) are met; 2) review applicable reimbursement claims and claims data to ensure fidelity and accuracy of service billing and optimization of Medi-Cal reimbursement in alignment with Contract terms and Department of Health Care Services billing requirements; and 3) review provider invoices administratively and programmatically to ensure client and bed counts are accurate prior to payment processing.
On June 12, 2018 (Item No. 35), as the result of a formal procurement, the Board of Supervisors (Board) approved Contract No. 18-344 with Citrus Counseling Services, Inc. (CCS), Contract No. 18-345 with DMCC, Contract No. 18-346 with Hearts & Lives, Contract No. 18-347 with Lutheran Social Services of Southern California (LSS), Contract No. 18-348 with Victor Community Support Services, Inc. (VCSS), and Contract No. 18-349 with West End Family Counseling Services (WEFCS) , for the provision of 0-5 CTS, in the total amount of $104,499,930, for the period of July 18, 2018 through June 30, 2023.
On June 8, 2021 (Item No. 33), the Board approved a standardized contract template to amend contracts with providers for the provision of SMHS to remove the County Contract Rate Provisions, effective March 1, 2020, and authorized the DBH Director to execute these amendments. On September 10, 2021, the DBH Director, as authorized by the Board, executed Amendment No. 1 to Contract No. 18-345 with DMCC and Contract No. 18-347 with LSS, removing the County Contract Rate provisions via the standardized contract template amendment. On September 20, 2021, the DBH Director, as authorized by the Board, executed Amendment No. 1 to Contract No. 18-344 with CCS, removing the County Contract Rate provisions via the standardized contract template amendment.
On June 27, 2023 (Item No. 43), the Board approved Amendment No. 2 to Contract No. 18-344 with CCS, Contract No. 18-345 with DMCC, and Contract No. 18-347 with LSS, and Amendment No. 1 to Contract No. 18-346 with Hearts & Lives, Contract No. 18-348 with VCSS, and Contract No. 18-349 with WEFCS, for the provision of 0-5 CTS, in the total amount of $128,789,043, for the period of July 1, 2018, through June 30, 2024.
On May 3, 2024, the DBH Director, as authorized by the Board, executed Amendment No. 2 to Contract No. 18-349 with WEFCS, removing the County Contract Rate provisions via the standardized contract template amendment.
PROCUREMENT
DBH is recommending extending the contracts with CCS, DMCC, Hearts & Lives, LSS, VCSS, and WEFCS for an additional three months due to the time necessary to review changes from the Department of Health Care Services, tasking DBH with developing new methods of increasing an existing service requirement through implementation of the Integrated Care Practice Model, including the provision of Intensive Care Coordination and Intensive Home-Based Services. A new procurement for the provision of 0-5 CTS is being conducted and will be concluded with contracts awarded effective October 1, 2024.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health (Ellayna Hoatson, Contract Supervisor, 388-0858) on June 17, 2024; County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on June 17, 2024; Finance (Paul Garcia, Administrative Analyst, 386-8392) on June 18, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on June 18, 2024.