REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
September 26, 2023
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Contracts for Institution for Mental Disease Services
End
RECOMMENDATION(S)
Recommendation
1. Approve Amendment No. 1, effective September 26, 2023, to the following contracts for the provision of Institution for Mental Disease services, updating contract language that includes incident notification instructions, and increasing the aggregate contract amount by $4,745,000, from $36,159,090 to $40,904,090, with no change to the total contract period of July 1, 2022 through June 30, 2027:
a. Braswell Enterprises, Inc. dba Sierra Vista, Contract No. 22-291.
b. Golden State Health Centers, Inc. dba Sylmar Health and Rehabilitation Center, Contract No. 22-292.
c. Shandin Hills Rehabilitation Center, Inc. dba Shandin Hills Behavioral Therapy Center, Contract No. 22-293.
d. View Heights Convalescent Hospital, Contract No. 22-294.
2. Approve contracts with the following agencies for the provision of Institution for Mental Disease services, in the aggregate amount of $40,904,090 referenced in Recommendation No. 1, effective September 26, 2023 through June 30, 2027:
a. Generations Healthcare
b. Vista Pacifica
(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.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The increase of $4,745,000 for a total aggregate amount of $40,904,090 for Institution for Mental Disease (IMD) services is funded by 1991 Mental Health Realignment. 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
As the Mental Health Plan for San Bernardino County (County), DBH is required to provide an adequate network of treatment providers to County beneficiaries through an array of behavioral health services. DBH operates a continuum of care system that consists of County operated clinics and contracted service providers delivering a variety of mental health treatment services within each geographic region of the county. The highest level of care is state hospitals and acute psychiatric units; the next highest level of care is provided through an IMD facility. IMD facilities provide a program consisting of organized therapeutic activities which promote daily living and social skills to County residents experiencing a severe and persistent behavioral health disorder.
IMD facilities are state licensed, locked, skilled nursing facilities that provide specialized treatment services to consumers experiencing a severe behavioral health disorder whose functioning level is too challenging to be maintained at a licensed board and care facility, including augmented board and care, or in the community. DBH contracted IMD facilities are responsible for:
• Maintaining state certification as a skilled nursing facility;
• Providing bed days (room and board) at the Department of Health Care Services specified rate(s);
• Evaluating and accepting referrals from state hospitals, veteran hospitals, county/private facilities, and other facilities or sources deemed appropriate by DBH;
• Providing psychiatric services, treatment, and support staff with specialized training; and
• Providing medication management, crisis intervention, and discharge planning.
Amendment No. 1 with current contractors, Braswell Enterprises, Inc. dba Sierra Vista (Braswell) (Contract No. 22-291), Golden State Health Centers, Inc. dba Sylmar Health and Rehabilitation Center (Sylmar) (Contract No. 22-292), Shandin Hills Rehabilitation Center, Inc. dba Shandin Hills Behavioral Therapy Center (Shandin) (Contract No. 22-293), and View Heights Convalescent Hospital (VHC) (Contract No. 22-294), contains specific contract language changes that update incident notification instructions, and increases the total aggregate amount by $4,745,000, from $36,159,090 to $40,904,090, with no change to the contract period of July 1, 2022 through June 30, 2027.
The increase of the total aggregate amount in this item is due to the addition of the agencies in Recommendation No. 2. The recommended contracts with Generations Healthcare and Vista Pacifica will allow DBH to increase the availability of IMD treatment services for county residents, increasing the total available IMD beds from 70 to 75.
DBH anticipates that the six IMD providers will provide an estimated 27,375 bed days annually for approximately 100 consumers, at an average cost of $81,808 per consumer.
PROCUREMENT
DBH does not procure for these services as there are a limited number of state licensed IMD facilities willing to provide services to DBH consumers. The IMD providers specialize in providing services to persistently mentally ill consumers with psychiatric needs, severe medical issues, and a criminal history that other facilities decline to admit. The Purchasing Department continues to support the non-competitive contracts for IMD services with the justification of specialized services.
On April 26, 2022 (Item No. 19), the Board of Supervisors approved the contracts with Braswell (Contract No. 22-291), Sylmar (Contract No. 22-292), Shandin (Contract No. 22-293), and VHC (Contract No. 22-294) in an aggregate amount not to exceed $36,159,090, for the period of July 1, 2022 through June 30, 2027.
DBH will monitor contract performance on a regular basis to ensure performance and compliance standards are met by reviewing monthly reports, completing ongoing site visits to review consumer progress, as well as completing an annual program review. Provider invoices will be reviewed and approved by DBH Program to ensure consumer and bed counts are accurate prior to being forwarded to DBH fiscal staff for payment processing. Fiscal staff will verify signatures, bed rate, and total cost prior to submitting for payments.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on August 23, 2023; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on August 28, 2023; Purchasing (Michelle Churchill, Supervising Buyer, 387- 2070) on July 7, 2023; Finance (Christopher Lange, Administrative Analyst, 386-8393) on August 29, 2023; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on August 29, 2023.