REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
December 17, 2024
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Amendments to Contracts for Comprehensive Treatment Services Student Assistance Program and School-Aged Treatment Services
End
RECOMMENDATION(S)
Recommendation
Approve the following contract amendments for the provision of the Comprehensive Treatment Services Student Assistance Program, and School-Aged Treatment Services, increasing the total contract amounts by $10,040,161, from $199,600,140 to $209,640,301, and extending the contract term for three months, for a total contract period of July 1, 2018, through March 31, 2025:
1. Desert/Mountain Children’s Center, Amendment No. 6 to Contract No. 18-382, increasing the total contract amount by $3,624,819, from $85,683,756 to $89,308,575.
2. Lutheran Social Services of Southern California, Amendment No. 3 to Contract No. 18-383, increasing the total contract amount by $89,910, from $2,326,686 to $2,416,596.
3. Mountain Counseling and Training, Amendment No. 5 to Contract No. 18-384, increasing the total contract amount by $277,917, from $5,544,999 to $5,822,916.
4. South Coast Children's Society, Inc., dba South Coast Community Services, Amendment No. 7 to Contract No. 18-385, increasing the total contract amount by $3,150,382, from $55,379,724 to $58,530,106.
5. Victor Community Support Services, Inc., Amendment No. 5 to Contract No. 18-386, increasing the total contract amount by $2,036,129, from $35,765,772 to $37,801,901.
6. West End Family Counseling Services, Amendment No. 5 to Contract No. 18-387, increasing the total contract amount by $861,004, from $14,899,203 to $15,760,207.
(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 contract increases totaling $10,040,161 are funded by Mental Health Services Act funds, Federal Financial Participation Medi-Cal, 2011 Realignment, and matching funds from the Desert Mountain Special Education Local Planning Area (DMSELPA) up to $279,893. 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 and contracted service providers delivering a variety of mental health treatment services. Comprehensive Treatment Services (CTS) is comprised of the Student Assistance Program (SAP) and School-Aged Treatment Services (SATS) programs. SAP and SATS are two distinctive programs, that collectively represent a large portion of the children’s continuum of care for mental health services and each program is expected to collaborate cohesively with the other. These programs are located in the cities of Barstow, Apple Valley, Redlands, Crestline, Blue Jay, Big Bear Lake Yucca Valley, Ontario, and San Bernardino, and also provide countywide services to additional areas such as Fontana, Rancho Cucamonga, Mt. Baldy, San Antonio Heights, and North Upland.
SAP is a school-based approach to providing focused services to students in need of interventions for SUD, mental health, academic, emotional, and/or social issues. The program serves children/youth (grades K-12) and their families. It services families who have been exposed to trauma, are experiencing the first onset of serious psychiatric illness, are in stressed families, are at-risk for school failure, and/or at-risk of or are experiencing juvenile justice involvement (JJI).
SATS provides services to Medi-Cal beneficiaries who are at-risk of school failure due to SUD, JJI, mental health, emotional, and/or social issues. The program serves school-age Medi-Cal eligible children/youth (up to age 21) who experience significant distress and resulting dysfunction due to a mental health condition and thus meet Medi-Cal medical necessity criteria.
DMSELPA, a support services office that serves as a liaison to desert and mountain local school districts, has a history of partnership with the Desert/Mountain Children’s Center (DMCC) to provide Early & Periodic Screening, Diagnosis & Treatment (EPSDT) Medi-Cal specialty mental health services (SMHS) to eligible children and youth in the school, 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/youth through DBH contracts with DMCC, up to $279,893 which will allow for an additional $1,999,236 of Medi-Cal funded services to children and youth served by DMCC through the SATS program. This additional funding is included in the contract award to DMCC.
On June 26, 2018 (Item No.21), as the result of a formal procurement, the Board of Supervisors (Board) approved the contracts in the Recommendation for the provision of CTS, in the amount of $124,376,615 for the period of July 1, 2018, through June 30, 2023. These contracts included the SAP, SATS, and Children’s Intensive Services (CIS) program service components.
On September 10, 2019 (Item No. 24), the Board approved Amendment No. 1 to the following: Contract No. 18-384 with Mountain Counseling & Training (MCT), increasing the total contract amount by $700,000, from $3,700,000 to $4,400,000; Contract No. 18-385 with South Coast Children's Society, Inc., dba South Coast Community Services (SCCS), increasing the total contract amount by $9,981,324, from $28,595,745 to $38,577,069; Contract No. 18-386 with Victor Community Support Services, Inc. (VCSS), increasing the total contract amount by $8,518,676, from $16,497,040 to $25,015,716; and Contract No. 18-387 with West End Family Counseling Services (WEFCS), increasing the total contract amount by $4,800,000, from $5,586,865 to $10,386,865, and updating standard contract language. Amendment No. 1 to the contracts increased the contract amounts by $24,000,000, changing the total aggregate amount for all six contracts from $124,376,615 to $148,376,615, with no change to the contract period of July 1, 2018, through June 30, 2023. With the implementation of the Medicaid Managed Care Final Rule, the California Department of Health Care Services mandated that DBH ensured eligible beneficiaries were adequately served. This mandate, combined with the increased number of children/youth who qualify for SATS, resulted in the need to increase the contract amounts due to the doubling of previously projected referral numbers.
On September 29, 2020 (Item No. 20), the Board approved Amendment No. 1 to Contract No. 18-382 with DMCC, decreasing the total contract amount by $5,225,000, from $68,209,730 to $62,984,730. The Board also approve Amendment No. 2 to the following: MCT Contract, decreasing the total contract amount by $522,500, from $4,400,000 to $3,877,500; SCCS Contract, decreasing the total contract amount by $4,950,000, from $38,577,069 to $33,627,069; VCSS Contract, decreasing the total contract amount by $1,466,666, from $25,015,716 to $23,549,050; and WEFCS Contract, decreasing the total contract amount by $653,686, from $10,386,865 to $9,733,179. These amendments decreased the contract amounts by $12,817,852, from $148,376,615 to $135,558,763, with no change to the contract period of July 1, 2018, through June 30, 2023.
The contract decreases, approved on September 29, 2020, were in response to the economic impact of the COVID-19 pandemic. DBH recommended the contracts providing CIS be amended to eliminate the CIS component as of October 1, 2020. The $12,817,852 funding for the discontinued CIS program was released and made available for other Realignment-funded programs within DBH as needed, which included over 70 programs providing SMHS and SUD Services. All funds were expended.
On June 8, 2021 (Item No. 33), the Board approved a standardized contract template to amend contracts with providers for the provision of SMHS in order to remove the County Contract Rate Provisions, effective March 1, 2020, and authorized the DBH Director to execute these amendments. As a result, the DBH Director executed Amendment No. 2 to the DMCC Contract on September 5, 2021, and Amendment No. 3 to the SCCS Contract on September 13, 2021, removing the County Contract Rate provisions via the standardized contract template amendment.
On April 26, 2022 (Item No. 20), the Board approved Amendment No. 3 to the DMCC Contract, increasing the total contract amount by $950,117, from $62,984,730 to $63,934,847 and Amendment No. 4 to the SCCS Contract, increasing the total contract amount by $2,850,352, from $33,627,069 to $36,477,421. These amendments increased the contract amounts by $3,800,469, changing the aggregate amount for all six contracts from $148,376,615 to $139,359,232, to add Mental Health Student Services Act services, with no change to the contract period of July 1, 2018, through June 30, 2023.
On June 27, 2023 (Item No. 46), the Board approved Amendment No. 4 to DMCC Contract No. 18-382, increasing the total contract amount by $14,499,272, from $63,934,847 to $78,434,119; and Amendment No. 1 to Lutheran Social Services of Southeran California (LSSSC) Contract No. 18-383, increasing the total contract amount by $359,634, from $1,787,235 to $2,146,869; and Amendment No. 3 to MCT Contract No. 18-384, increasing the total contract amount by $1,111,666, from $3,877,500 to $4,989,166; Amendment No. 5 to SCCS Contract No. 18-385, increasing the total contract amount by $12,601,535, from $36,477,421 to $49,078,956; Amendment No. 3 to VCSS Contract No.18-386, increasing the total contract amount by $8,144,481, from $23,549,050 to $31,693,531; and Amendment No. 3 to WEFCS Contract No. 18-387, increasing the total contract amount by $3,444,016, from $9,733,179 to $13,177,195. These amendments were due to 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.
On June 25, 2024 (Item No. 41), the Board approved Amendment No. 5 to DMCC Contract No. 18-382, increasing the total contract amount by $7,249,637 from $78,434,119 to $85,683,756; Amendment No. 2 to LSSSC Contract No. 18-383, increasing the total contract amount by $179,817, from $2,146,869 to $2,326,686; Amendment No. 4 to MCT Contract No. 18-384, increasing the total contract amount by $555,833, from $4,989,166 to $5,544,999; Amendment No. 6 to SCCS Contract No. 18-385, increasing the total contract amount by $6,300,768, from $49,078,956 to $55,379,724; Amendment No. 4 to VCSS Contract No. 18-386, increasing the total contract amount by $4,072,241, from $31,693,531 to $35,765,772; and Amendment No. 4 to WEFCS Contract No. 18-387, increasing the total contract amount by $1,722,008, from $13,177,195 to $14,899,203, and extending the contract term by six months, for a total period of July 1, 2018 through December 31, 2024.
Approval of amendments to the contracts listed in the Recommendation will allow CTS services to continue to be provided for the SAP and SATS programs. DBH anticipates an estimated 3,558 clients will be served at an estimated cost of $2,822 per client for the three-month contract extension.
DBH recommends extending the contracts with DMCC, LSSSC, MCT, SCCS, VCSS, and WEFCS for an additional three months to allow sufficient time to complete the ongoing solicitation process that is currently underway for contracts expected to be effective April 1, 2025.
DBH will also implement mechanisms to regularly review 1) client service data and progress, conduct site visits and annual monitoring to ensure performance and compliance standards of the contract(s) are met; 2) applicable claims data and claims for reimbursement 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) provider invoices administratively and programmatically to ensure client and/or bed counts are accurate prior to payment processing.
PROCUREMENT
N/A
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Michael Shin, Contracts Supervisor, 388-0899) on December 9, 2024; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on December 11, 2024; Finance (Paul Garica, Administrative Analyst, 386-8392) on December 11, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on December 11, 2024.