REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF THE COUNTY OF SAN BERNARDINO
AND RECORD OF ACTION
October 27, 2020
FROM
VERONICA KELLEY, Director, Department of Behavioral Health
SUBJECT
Title v
Amendment to Contracts for Institution for Mental Disease Services
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 1, effective October 27, 2020, to the following contracts for the provision of Institution for Mental Disease services, updating standard contract language and fiscal provisions, and increasing the aggregate total contract amount by $2,380,592, from $20,490,810 to $22,871,402, with no change to the total contract period of July 1, 2017 through June 30, 2022:
1. Sunbridge Braswell Enterprises, LLC dba Sierra Vista, Contact No. 17-413
2. Shandin Hills Rehabilitation Center, Inc. dba Shandin Hills Behavioral Therapy Center, Contact No. 17-414
3. Golden State Health Centers, Inc. dba Sylmar Health and Rehabilitation Center, Contact No. 17-416
(Presenter: Veronica Kelley, Director, 388-0801)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Health and Social Services Needs of County Residents.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The increase of $22,871,402 to the contracts for Institution for Mental Disease (IMD) services is funded by 1991 Realignment. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2020-21 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
As the Mental Health Plan for the 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 a State Hospital psychiatric unit; the next highest level of treatment is provided through an IMD. IMD facilities provide a program of organized therapeutic activities designed to promote daily living and social skills to County residents experiencing a severe and persistent behavioral health disorder.
The standard daily bed rate for IMD services is determined by the Department of Health Care Services (DHCS) and mandated by Assembly Bill 1054 to be, posted annually, which may include increases effective July 1st of each fiscal year. In 2018 and 2019, DBH consumer needs for IMD services were 7- 9% higher than originally estimated and IMD services incurred a daily bed rate increase of $6.74 posted by DHCS effective July 1, 2019. Due to this increase in rates and the need for additional beds, DBH is recommending amending the contracts to update contract language and fiscal provisions, and to increase the aggregate amount for the provision of IMD services in order to maintain required service levels.
DBH anticipates the IMD providers in the Recommendation will provide on an annual basis an estimated 18,250 bed days for approximately 75 consumers. The cost per consumer, ranging from $187.98 to $367.76 per bed day, is difficult to predetermine. Each consumer placement must consider the individual, psychiatric needs, the type of treatment required, the facility available, the bed type/bed rate assigned, and the length of stay utilized to improve consumer’s ability to transition to the next least restrictive and most appropriate level of care.
IMDs are state licensed, locked, skilled nursing facilities that provide specialized treatment services to consumers experiencing a severe behavior health disorders whose functioning level is too challenging to be maintained at a Board and Care facility, including Augmented Board and Care. DBH contracted IMD facilities are responsible for:
• Maintaining state certification as a Skilled Nursing Facility;
• Providing bed days (room and board) at the California Department of Health Care Services’ (DHCS) specified rate(s);
• Evaluating and accepting referrals from State Hospitals, Veterans 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.
Each contract has been written on a fee-for-service basis not to exceed the total aggregate amount which provides DBH staff with the necessary flexibility to easily transfer consumers to each of the IMDs based on availability. In addition, it permits DBH staff to monitor the expenditures and make the necessary timely adjustments as needed.
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. Of the willing agencies listed in the Recommendation, two reflect the only licensed IMDs in San Bernardino County and the other one specializes in providing services to persistently mentally ill consumers with psychiatric needs, severe medical issues, and a criminal history that other facilities decline to admit.
On June 13, 2017 (Item No. 22), the Board of Supervisors approved the contracts in the Recommendation for the provision of IMD services, in the aggregate amount of $20,490,810, for the period of July 1, 2017 through June 30, 2022.
DBH will continue to monitor contractor performance on a regular basis to ensure compliance standards are met.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Natalie Kessee, Contracts Manager, 388-0869) on October 7, 2020; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on October 8, 2020; Finance (Christopher Lange, Administrative Analyst, 386-8393) October 8, 2020; and County Finance and Administration (Tanya Bratton, Deputy Executive Officer, 388-0332) on October 8, 2020.