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
Amendments to Contracts for Wraparound Mental Health Services
End
RECOMMENDATION(S)
Recommendation
1. Approve Amendment No. 1 to Contract No. 21-942, effective November 1, 2023, with South Coast Community Services for the provision of Wraparound Mental Health Services, updating contract language, expanding its service area to include the West Valley region effective January 1, 2024, and increasing the total contract amount by $16,236,696, from $48,533,435 to $64,770,131, with no change to the total contract period of January 1, 2022 through December 31, 2026.
2. Approve Amendments to the following contracts for the provision of Wraparound Mental Health Services, updating contract language, and increasing the combined total contract amount by $20,798,302, from $86,300,000 to $107,098,302, and with no change to the total contract period of January 1, 2022 through December 31, 2026:
a. Amendment No. 1 to Contract No. 21-939 with Lutheran Social Services of Southern California, increasing the total contract amount by $2,830,135, from $12,750,000 to $15,580,135.
b. Amendment No. 1 to Contract No. 21-941 with Mountain Counseling & Training, Inc., increasing the total contract amount by $62,627, from $2,550,000 to $2,612,627.
c. Amendment No. 2 to Contract No. 21-943 with Pacific Clinics, increasing the total contract amount by $8,762,436, from $27,750,000 to $36,512,436.
d. Amendment No. 1 to Contract No. 21-944 with Victor Community Support Services, Inc., increasing the total contract amount by $9,143,104, from $43,250,000 to $52,393,104.
(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 combined increase of $37,034,998 for Wraparound Mental Health Services (Wraparound) is funded by Federal Financial Participation Medi-Cal, Local Share, a Memorandum of Understanding with Children and Family Services (CFS), and Mental Health Services Act funds. 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 San Bernardino County (County) residents who are experiencing severe mental illness and/or SUD. An integral part of the service delivery system consists of County-operated clinics and contracted service providers delivering a variety of mental health treatment services, including specialized services for children and youth that are at risk of being placed in a group home.
In response to the passage of Senate Bill (SB) 163, the County implemented Wraparound in June 2002, consisting of two types of mental health services, Wraparound, and the Comprehensive Child and Family Support System (CCFSS), which are specialized services designed to allow children and youth to remain in their homes, rather than moving to a group home environment. Each provider has a specific responsibility and role within the County’s treatment delivery system. The availability of Wraparound helps to meet the needs of children and youth who have contact with the Probation Department and CFS, and are at-risk of out of home placement.
SB 163 identifies Wraparound as an intensive, community-based, family-centered process designed to allow children with serious behavior and/or emotional difficulties to remain in their community or be placed in the lowest level of care possible instead of being placed in a group home setting. Since 2003, CFS and DBH have been providing combined Wraparound for the County. DBH funds the mental health portion of Wraparound to children and youth enrolled in Wraparound by either Probation or CFS. CFS funds Foster Care Wraparound through Aid to Families with Dependent Children - Foster Care funding.
Since 2007, DBH has provided CCFSS, which are directed towards children, youth, and their families throughout the county who are not eligible for the more extensive SB 163 services. These services target children and youth who experience emotional disturbances, co-occurring disorders, and whose family’s yearly income is 200 percent or less of the Federal poverty level. Services are provided to children and youth from culturally diverse communities who are often identified as unserved or underserved. Specific efforts are made to reach Latino and African American children and youth who are over-represented in the justice system and in foster care, and do not have access to appropriate services.
An expansion to the existing contracts is needed to be in compliance with two legislative changes, the Family Urgent Response System (FURS) and Families First Prevention Services Act (FFPSA). FURS is a statewide system that was established by section 107 of SB 80 and amended by Assembly Bill 79 and required counties to develop and implement a 24/7 in person mobile response system by March 1, 2021. FURS provides in-person mobile response within one to three hours to current and former foster youth during situations of instability to preserve the relationship of the caregiver and the child or youth, prevent placement disruptions, and stabilize the living situation. In San Bernadino County, the Success First/Early Wrap program was identified to provide this mobile response and the providers have been sharing this responsibility on a rotating basis within each region. The increase to the existing contracts will help cover the cost of the additional services needed to meet the growing number of FURS calls annually.
Additional expansion of services under these contracts is needed to comply with FFPSA, Section 672(k)(4)(F) of Title 42 of the United States Code, which requires six months of aftercare services to be provided to youth exiting Qualified Residential Treatment Programs, known as Short-Term Residential Therapeutic Programs (STRTPs) in California. California operationalized FFPSA’s mandate in Welfare and Institutions Code 4096.6, which states that each county child welfare agency, probation department, and mental health plan will jointly provide, arrange for, or ensure the provision of the six months of High Fidelity wraparound. The costs associated with this expansion consists of providing High Fidelity Wraparound services for the requisite six months to an estimated 640 youth leaving STRTPs annually (about 20% leaving STRTPs are already receiving Wraparound services).
Approval of the recommended amendments with Lutheran Social Services of Southern California; Mountain Counseling & Training, Inc.; South Coast Community Services (SCCS); Pacific Clinics; and Victor Community Support Services, Inc., will update standard contract language, adding Executive Order N-6-ww - Russia Sanctions, Campaign Contribution Disclosure (SB 1439), revising Addendum I “Children’s SB 163 Mental Health Services Program Service Description” and Addendum II “Children’s Success First/Early Wrap Mental Health Services Program Service Description” to account for the expansion of services, and increasing the total combined contract amount by $37,034,998, from $134,833,435 to $171,868,433, with no change to the contract period of January 1, 2022 through December 31, 2026.
In addition, the amendment to Contract No. 23-942 with SCCS will expand its service area to include the West Valley region. Mental Health Systems, Inc. (MHS), notified DBH on November 3, 2023, that they would be terminating its contract with DBH for Wraparound, effective December 31, 2023. SCCS, which is the only current provider of Wraparound to propose for the West Valley region as well, expressed willingness and ability to expand its current contract to include the area previously covered by MHS. This commitment by SCCS to expand its current operations has provided a seamless transition and maintains a high standard of continuity in care for the youth and broader community currently being served. This proactive approach ensures that the essential services provided to the community will continue without interruption, aligning with DBH’s commitment to delivering consistent and quality treatment to the children and youth in the Children’s System of Care.
In order for SCCS to rapidly prepare and ensure that the additional program services were fully operational by January 1, 2024, it was agreed that SCCS may include up to $125,000 in additional costs to the standard invoicing from November 2023 through February 2024, submitted December 2023 through March 2024, which will be reconciled in the April 2024 invoice.
DBH is requesting retroactive approval of the recommended amendment with SCCS. DBH received notification from MHS on November 3, 2023, terminating its contract for Wraparound with the County, effective as of December 31, 2023. Subsequently, this item is being presented at this time because it is the first available Board of Supervisors (Board) date following the necessary time to identify an eligible and appropriate provider and negotiate and complete the required DBH program, fiscal, administrative, and legal reviews. Delaying the item to a future Board date would impact services as the new provider has been financing the additional staff with current funding while negotiations were ongoing.
DBH program staff will continue to monitor contract performance on a regular basis to ensure performance and compliance standards are met by reviewing monthly reports at regularly scheduled program review meetings. Electronic Health Record data and Claim for Reimbursement forms are reviewed regularly to ensure fidelity and accuracy of service billing and maximization of Medi-Cal reimbursement in alignment with contract terms. Provider invoices are 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 verify signatures and service costs prior to issuing payment.
PROCUREMENT
On December 14, 2021 (Item No. 23), as a result of a formal procurement, the Board approved the contracts with Lutheran Social Services of Southern California (Contract No. 21-939), MHS (Contract No. 21-940), Mountain Counseling & Training (Contract No. 21-941), South Coast Community Services (Contract No. 21-942), Uplift Family Services (Contract No. 21-943), and Victor Community Support Services (Contract No. 21-944), to provide Wraparound, in the total combined contract amount of $145,983,435 for the period of January 1, 2022 through December 31, 2026.
On November 14, 2023 (Item No. 23), the Board approved Amendment No. 1 to Contract No. 21-943, reflecting the legal name change from Uplift Family Services to Pacific Clinics and updating standard contract language, with no change to the contract amount or the contract period.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on March 8, 2024; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on March 13, 2024; Finance (Christopher Lange, Administrative Analyst, 386-8393) on March 20, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on March 20, 2024.