REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
March 26, 2024
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Amendment to Contracts for Skilled Nursing Facility Neurobehavioral Services
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 2 to the following contracts for the provision of Skilled Nursing Facility Neurobehavioral Services, updating standard contract language, increasing the combined contract amount by $1,784,750, from $6,794,565 to $8,579,315, and extending the contract term for an additional 15 months for a total contract period from July 1, 2019 through June 30, 2025:
1. Contract No. 19-419 with Crestwood Behavioral Health, Inc, increasing the total amount by $1,128,504, from $4,296,232 to $5,424,736.
2. Contract No.19-420 with Helios Healthcare, LLC, increasing the total amount by $656,246, from $2,498,333 to $3,154,579.
(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 recommended increase of $1,784,750 for the contracts for Skilled Nursing Facility Neurobehavioral Services (SNF NS) is funded by Local Share. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2023-24 budget and will be included in the 2024-25 recommended budget.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and/or substance use disorder (SUD) services to San Bernardino County residents who are experiencing severe mental illness (SMI) and/or SUD. An integral part of the service delivery system consists of providing specialized treatment services to individuals with behavioral health conditions requiring the highest level of locked care provided by the State Hospital psychiatric unit. The next level of care is available at the Institute of Mental Diseases (IMDs) and Skilled Nursing Facilities (SNF). DBH appropriately places clients with SMI in SNFs when an opening becomes available as these facilities offer an appropriate level of care and are less costly than the acute psychiatric hospitals or State Hospitals.
Crestwood Behavioral Health, Inc. (Crestwood) and Helios Healthcare, LLC (Helios) have successfully provided SNF NS to DBH clients since 2005. The severity and complexity of behavioral and medical conditions experienced by these clients can make this population difficult to serve. These SNFs are available to meet the needs of this unique population, including clients that may have long criminal histories spending multiple years in a State Hospital as incompetent to stand trial or an offender with a mental disorder. Due to the co-occurrence of serious medical issues and severe behavioral health conditions, there are no SNFs in the county and surrounding areas that will accept and admit this difficult population. DBH anticipates that Crestwood and Helios will provide SNF NS to approximately 20 clients annually at an estimated cost of $71,390 per client.
Amendment No. 2 to Contract No. 19-419 with Crestwood and Contract No. 19-420 with Helios will update standard contract language, adding Executive Order N-6-22-Russia Sanction, Campaign Contribution Disclosure (Senate Bill 1439), increasing the combined total contract amount by $1,784,750, from $6,794,565 to $8,579,315, and extending the contract periods 15 months for a total period from July 1, 2019 through June 30, 2025.
DBH program staff will monitor contract performance on a regular basis to ensure performance and compliance standards are met by reviewing monthly reports, conducting ongoing site visits to review consumer progress, and completing an annual program review. Provider invoices will be reviewed and approved by DBH program staff to ensure client counts are accurate prior to being forwarded to DBH fiscal staff for payment. DBH fiscal staff will verify signatures and service costs prior to issuing payment.
PROCUREMENT
In February 2019, DBH performed a search of SNFs throughout Southern California that would accept clients with psychiatric needs and severe medical issues. Crestwood and Helios are recommended to provide the required SNF services as they are the only two providers in California who specialize in SMI clients with psychiatric and severe medical issues that other facilities do not accept. The Purchasing Department continues to support these non-competitive contracts with a specialized credentials justification.
DBH does not procure for these services as there are a limited number of facilities with available beds willing to provide services to these clients.
On June 25, 2019 (Item No. 22), the Board of Supervisors (Board) approved non-competitive Contract No. 19-419 with Crestwood, in the amount of $4,296,232 and Contract No. 19-420 with Helios, in the amount of $2,498,333, for the provision of SNF NS, for the period of July 1, 2019 through March 31, 2024.
On May 10, 2022 (Item No. 15), the Board approved Amendment No. 1 to non-competitive Contract No. 19-419 with Crestwood and Contract No. 19-420 with Helios, updating contract language pertaining to bed rates with no change to the combined contract amount of $6,794,565 or the contract period of July 1, 2019 through March 31, 2024.
The recommended amendments will allow Crestwood and Helios to continue to provide services to DBH clients requiring SNF NS, with a total six-year contract term. DBH will be conducting a formal procurement for all SNF services in 2024-25 to be effective July 1, 2025. This extension aims to align the current contract with existing SNF contracts, and allows time for a new competitive process to be completed for these services.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on March 4, 2024; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on March 7, 2024; Purchasing (Jessica Barajas, Supervising Buyer, 387-2065) on March 14, 2024; Finance (Christopher Lange, Administrative Analyst, 386-8393) on March 19, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on March 19, 2024.