REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
May 7, 2024
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Amendments to Contracts for Substance Use Disorder and Recovery Services Early Intervention, Outpatient Treatment, Intensive Outpatient Treatment and Recovery Services
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 2 to the following contracts, effective January 1, 2024, for the provision of Substance Use Disorder and Recovery Services Early Intervention, Outpatient Treatment, Intensive Outpatient Treatment and Recovery Services, expanding their service areas, updating standard contract language, and increasing the combined contract amount by $1,749,158 from $7,116,745 to $8,865,903, with no change to the contract period of July 1, 2022 through June 30, 2027:
1. High Desert Child, Adolescent and Family Services Center, Inc., Contract No. 22-471, increasing the total contract amount by $810,465 from $2,290,745 to $3,101,210.
2. Inland Valley Recovery Services, Contract No. 22-473, reflecting the legal name change to Inland Valley Drug and Alcohol Recovery Services dba Inland Valley Recovery Services, and increasing the total contract amount by $938,693 from $4,826,000 to $5,764,693.
(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.
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 recommended contract increases totaling $1,749,158 are funded by 2011 Realignment, Substance Use Prevention, Treatment and Recovery Services Block Grant, Federal Financial Participation Drug Medi-Cal, California Work Opportunity and Responsibility to Kids, Public Safety Realignment Assembly Bill 109 funds, and a Memorandum of Understanding with the Department of Children and Family Services (CFS). Adequate appropriation and revenue have been 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 substance use disorder (SUD) services to county residents experiencing severe mental illness and/or SUD. As a part of the DBH system of care, Substance Use Disorder and Recovery Services (SUDRS) provide a full range of SUDRS prevention, treatment services, and education for communities and residents in the county.
Early Intervention services are intended for county youth (ages 12 through 17) and adults (ages 18 through 20) to identify and address potential substance use before it develops into more serious conditions. These services often involve screening, assessment, brief counseling, and/or psychoeducation to help clients understand the risks of substance use and develop healthy coping skills.
Outpatient Treatment is designed for clients with SUDs and provides counseling, therapy, and supportive services without requiring clients to live at a treatment facility. Services typically include individual, group, and family therapy, as well as medication management and psychoeducation.
Intensive Outpatient Treatment is a more structured and time-intensive form of outpatient care, designed for clients with moderate to severe SUDs or co-occurring severe mental illness. Clients participate in multiple treatment sessions per week, which may include individual, group, and family therapy, as well as case management and other support services.
Recovery Services make support available to those who have completed treatment, allowing clients to informally reconnect with former treatment providers as they navigate their recovery journey in instances where a formal treatment episode is not warranted. These services may include peer support, self-help groups, case management, and ongoing counseling or therapy, with the goal of maintaining abstinence from substance use and preventing relapse.
Upon approval of these amendments, High Desert Child, Adolescent and Family Services Center, Inc. (HDCAFSC) will provide services to approximately 688 additional clients annually at an average estimated cost of $1,178 per client, and Inland Valley Drug and Alcohol and Recovery Services dba Inland Valley Recovery Services (IVRS) will provide services to approximately 796 additional clients annually at an average estimated cost of $1,178 per client.
These amendments are in response to a notification received by DBH on November 3, 2023, from Mental Health Systems, Inc. (MHS) that MHS would terminate its SUDRS contract with the County effective December 31, 2023. DBH program staff met with existing services providers, communicated the need for service expansion and directed providers to solicit interest through letters of intent. After the review of the letters of interest, DBH determined that HDCAFSC and IVRS would be best able to expand their service areas to include the High Desert, East Valley, West Valley, and Central Valley, for the remainder of the contract period. This commitment by HDCAFSC to expand its service area to include the Desert/Mountain region and IVRS to expand its service area to include East Valley/San Bernardino Metropolitan and West Valley region provided a seamless transition and continuity of a high standard of care for clients which had been served under the contract with MHS. This proactive approach ensures that essential services provided to the community will continue without interruption, in line with our commitment to delivering consistent and quality care.
For HDCAFSC and IVRS to rapidly prepare and ensure that the additional program services were fully operational by January 1, 2024, it was agreed that they may include up to $51,000 for HDACAFS and $30,401 for IVRS in startup costs to the standard invoicing from November 2023 through February 2024, submitted January 2024 through March 2024, which will be reconciled in the April 2024 invoice. The startup costs are included in the amended contract amounts indicated in the Recommendations.
These amendments will also update standard contract language, adding Executive Order N-6-22 - Russia Sanctions, Campaign Contribution Disclosure (Senate Bill 1439), update the legal name change for IVRS, and increase the combined contract amount by $1,749,158 from $7,116,745 to $8,865,903 with no change to the contract period of July 1, 2022 to June 30, 2027.
Upon approval, DBH will establish mechanisms to 1) regularly review client service data and progress, 2) conduct site visits and annual monitoring to ensure performance and compliance standards of the contracts are met, 3) review 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 4) review provider invoices to ensure client and bed counts are accurate prior to payment processing.
PROCUREMENT
On June 28, 2022 (Item No. 35), as a result of a formal procurement, the Board of Supervisors (Board) approved Contract No. 22-471 with HDCAFSC and Contract No. 22-473 with IVRS for the provision of SUDRS, in the total amount of $7,059,745, for the period of July 1, 2022 through June 30, 2027.
On May 23, 2023 (Item No. 25), the Board approved Amendment No. 1 to Contract No. 22-471 with HDCAFSC and Contract No. 22-473 with IVRS for the provision of SUDRS, in the amount of $57,000, increasing the contract amount from $7,059,745 to $7,116,745 with no change to the contract period of July 1, 2022 through June 30, 2027. The amendment also included adding an aggregate amount not to exceed $1,600,000 for clients referred by CFS for 2022-23 and 2023-24.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Manager, 388-0858) on April 5, 2024; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on April 19, 2024; Finance (Paul Garcia, Administrative Analyst, 386-8392) on April 26, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on April 26, 2024.