REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
December 19, 2023
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Agreements for Substance Use Disorder and Recovery Services Withdrawal Management and Residential Treatment Services
End
RECOMMENDATION(S)
Recommendation
1. Approve a standard agreement template for Substance Use Disorder and Recovery Services Withdrawal Management and Residential Treatment services, in an aggregate amount not to exceed $89,730,320, for the period of January 1, 2024 through December 31, 2028.
2. Authorize the Assistant Executive Officer or the Director of the Department of Behavioral Health to execute the standard agreement template with the individual Substance Use Disorder and Recovery Services Withdrawal Management and Residential Treatment services providers, including any non-substantive changes to the standard agreement template in relation to the provision of Substance Use Disorder and Recovery Services Withdrawal Management and Residential Treatment services, on behalf of the County, subject to review by County Counsel.
3. Approve agreement with Tarzana Treatment Centers, Inc. for the provision of Substance Use Disorder and Recovery Services Withdrawal Management and Residential Treatment services, in the same aggregate amount of $89,730,320 as referenced in Recommendation No. 1, for the period of January 1, 2024 through December 31, 2028.
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The total aggregate amount of $89,730,320 is funded by Substance Use Prevention, Treatment, and Recovery Services Block Grant, Federal Financial Participation Drug Medi-Cal, California Work Opportunity and Responsibility to Kids, Memorandum of Understanding with Children and Family Services, Mental Health Services Administration Community Services Mental Health Block Grant, Assembly Bill 109 Public Safety Realignment, and the Mental Health Services Act. Adequate appropriation and revenue are included in the Department of Behavioral Health’s (DBH) 2023-24 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and/or substance use disorder services to San Bernardino County (County) residents who are experiencing severe mental illness and/or substance use disorder. An integral part of the service delivery system consists of County operated and contracted service providers delivering an array of treatment and supportive services. DBH provides a full range of substance use disorder prevention, treatment, education, and recovery support services for families and residents of the County with the goal of promoting prevention, recovery, and resiliency.
Substance Use Disorder and Recovery Services (SUDRS) Withdrawal Management and Residential Treatment (WM and RT) services provide a 24-hour living support and structure with available trained personnel ranging from high intensity to low intensity services, which include clinical services to address addiction in a therapeutic setting for adults (ages 18 and over), adolescents (ages 12-17), and perinatal patients. In the 2024 calendar year, DBH anticipates that qualified providers for SUDRS WM and RT services will provide these services to approximately 3,455 clients at an estimated cost of $5,194 per client.
Recommendation No. 1 will allow DBH to utilize a standard agreement template for SUDRS WM and RT services, in an aggregate amount not to exceed $89,730,320. DBH utilizes a standard agreement template for this service in order to maintain a pool of qualified contract providers for these necessary services. Through this action, five of the agencies recommended for contract award will be able to provide SUDRS WM and RT services through the use of a standard agreement template from January 1, 2024 through December 31, 2028.
In Recommendation No. 2., DBH is requesting authorization for the Assistant Executive Officer or DBH Director to execute the standard agreement templates and make any non-substantive changes, on behalf of the County, subject to review by County Counsel.
Recommendation No. 3 will allow DBH to have an individual agreement with Tarzana Treatment Centers, Inc. (Tarzana), in the same aggregate amount of $89,730,320 as referenced in Recommendation No. 1. The individual agreement with Tarzana differs from the standard agreement template as it contains a payment structure based on a fee-for-service model. The fee-for-service payment structure is required due to the specialized population of adolescents and the limited number of clients to be served. Adolescents require a different approach to treatment and additional requirements which include but are not limited to, the need for the provider to coordinate with educational institutions to reintegrate the adolescent into school while in treatment, provide support to assist with schoolwork, and work with the adolescent’s family to build a support system and promote continued recovery. The number of adolescent clients treated at the residential level is less than adult clients, therefore, the adolescent population receiving treatment is considered limited.
DBH will monitor contractor performance on a regular basis to ensure compliance standards are met. Contract monitoring is inclusive of, but not limited to, site visits and assessments of policy, procedures, process implementation, and service delivery components to ensure compliance with contract and applicable laws and regulations. The fiscal review ensures costs claimed are reasonable, allowable and in compliance with related financial records and procedures. Additionally, as needed and appropriate, a review of Medi-Cal certification, related standards, and chart documentation may be completed.
The standard agreement template with the individual SUDRS WM and RT providers, including the agreement with Tarzana, may be terminated with or without cause upon 30 days written notice.
PROCUREMENT
On September 18, 2023, the County Administrative Office approved and authorized the release of a Request for Proposals (RFP) No. DBHE24-ADS-5108 through the Electronic Procurement Network (ePro), to solicit interested and qualified organizations and agencies to provide SUDRS WM and RT services. The RFP was publicly advertised in local newspapers and through direct mailings to more than 600 community-based organizations, service providers, and other interested parties.
A bidder’s conference was held on October 11, 2023. Seven proposals, listed below, were received in response to the RFP by the established deadline. The seven proposals met the minimum requirements and were reviewed during the evaluation process.
|
Proposing Agency |
Proposed Regions |
Proposed Age Range |
|
Citadel Community Care Facilities |
Desert/Mountain |
Adult |
|
G and C Swan, Inc. |
East Valley/San Bernardino Metropolitan, West Valley, Central Valley, and Desert/Mountain |
Adult |
|
Inland Valley Drug and Alcohol Recovery Services, Inc. |
West Valley |
Adult |
|
Phoenix House Orange County Inc. |
West Valley |
Adult |
|
Social Science Services, Inc. |
East Valley/San Bernardino Metropolitan, West Valley, Central Valley, and Desert/Mountain |
Adult |
|
Tarzana Treatment Centers, Inc. |
East Valley/San Bernardino Metropolitan |
Adolescent |
|
Veteran’s Alcohol Rehabilitation Program, Inc. |
East Valley/San Bernardino Metropolitan |
Adult |
The evaluation committee, comprised of four individuals with representation from Inland Empire Health Plan and DBH, reviewed and evaluated the proposals based on the criteria referenced in the RFP, including but not limited to: demonstrated ability to serve the target population, ability to provide required services as specified in the RFP, demonstrated ability to serve the number of unduplicated participants indicated, appropriate staffing levels and requirements and ability to provide required services in the specified geographic areas. Based on the program and fiscal evaluations and resulting contract negotiations, six of the seven proposing agencies are recommended for contract award to provide SUDRS WM and RT services through December 31, 2028. Per negotiations with Phoenix House Orange County Inc., they will serve the Desert/Mountain region in addition to the initial proposed region of the West Valley.
The agency not recommended for contract award, Citadel Community Care Facilities, was notified by letter via electronic mail, including the ability to submit a formal written protest to the Purchasing Director based on the criteria in the RFP. A written protest was not received.
SUDRS WM and RT services is an ongoing procurement, which allows DBH to continuously accept proposals from new providers. This is necessary to meet changes in laws, regulations and program requirements. The agreement template requested in Recommendation No. 1 will be executed with five of the six agencies recommended for contract award and will be utilized due to the ongoing need to expedite adding newly accredited facilities to the existing qualified provider pool. The agreement for the other awarded agency, Tarzana, is being presented to the Board for approval as it differs from the template agreement in payment structure based on a fee-for-service model.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0869) on December 11, 2023; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on December 13, 2023; Purchasing (Jessica Barajas, Supervising Buyer, 387-2065) on December 13, 2023; Finance (Christopher Lange, Administrative Analyst, 386-8393) on December 12, 2023; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on December 14, 2023.