REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
March 12, 2024
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Amendment to Contract with Vista Pacifica Enterprises dba Vista Pacifica Convalescent for Skilled Nursing Facilities Specializing in Dementia-Related Care
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 2 to Contract No. 20-369 with Vista Pacifica Enterprises dba Vista Pacifica Convalescent to provide skilled nursing for dementia-related care, updating contract language, with no change to the total aggregate amount of $2,605,735, or change to the contract period of June 9, 2020 through June 30, 2025.
(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 total amount of the Vista Pacifica Enterprises dba Vista Pacifica Convalescent (Vista Pacifica) contract will not exceed the aggregate amount of $2,605,735 and is 100% funded through 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 2024-25 recommended budget.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and substance use disorder services to county residents experiencing severe mental illness (SMI), and/or substance use disorders. An integral part of the service delivery system consists of providing specialized treatment services to the seriously mentally ill population. The highest level of care is the State Hospital psychiatric unit; the second highest level of treatment is provided through Institute of Mental Diseases and Skilled Nursing Facilities (SNF). Since 2020, DBH has contracted for SNFs specializing in dementia-related care.
SNFs offer a variety of specialized behavioral interventions for SMI consumers who require psychiatric monitoring in addition to treatment for their co-morbid medical condition (more than one condition such as autism spectrum disorders, medical conditions [high-blood pressure, insulin-dependent diabetics, and traumatic brain injury], etc.). SNFs are licensed by the State of California, Department of Health Care Services. Placement of consumers in specialized SNFs offers an appropriate level of care and is less costly than placement within an acute psychiatric or State Hospital. DBH continuously seeks local SNFs, or those in close proximity, willing to provide skilled nursing services. However, due to the level of care needed for consumers with co-morbid disorders, including the intensity of dementia-related care, few SNFs or other types of facilities are willing to accept them.
Contract No. 20-369 with Vista Pacifica provides the County with 10 beds. Due to the severity and complexity of behavioral and medical conditions experienced by these hard to serve consumers, Vista Pacifica is one of the SNFs available to meet the needs of this unique target population. Additionally, some consumers may have long criminal histories spending multiple years in a State Hospital as an Incompetent to Stand Trial or Mentally Disordered Offender. Their criminal background and behaviors are not compatible with a vulnerable population housed in many local SNFs and these local agencies have indicated they are not interested in working with challenging, disruptive or destructive behaviors.
Approval of this amendment will update standard contract language, which includes Funding and Budgetary Restrictions, Provisional Payment, Annual Cost Report Settlement, Personnel, and Campaign Contribution Disclosure (Senate Bill 1439) and update the Reimbursement Rate. The amendment will not change the aggregate amount of $2,605,735 or change the contract period of June 9, 2020 through June 30, 2025.
On June 9, 2020 (Item No.18), the Board of Supervisors (Board) approved Contract No. 20-369 with Vista Pacifica for SNF dementia-related services, in an aggregate amount not to exceed $1,551,250, for the period of June 9, 2020 through June 30, 2025.
On November 15, 2022 (Item No. 21), the Board approved Amendment No. 1 to Contract No. 20-369 with Vista Pacifica, updating contract language (Funding and Budgetary Restrictions, Provisional Payment, Aggregate Maximum Obligation, Reimbursement Rate, Bed Holds and Room Reserve Rates) and increasing the total aggregate amount by $1,054,485 from $1,551,250 to $2,605,735. The increase to the contract amount was due to the addition of five beds being provided to the County for SNF services, from five to 10 beds amongst four contracted providers, and increasing the County’s Authorized Rate for Bed Holds and Room Reservation. The amendment did not change the contract period of June 9, 2020 through June 30, 2025.
DBH will monitor contract performance on a regular basis to ensure performance and compliance standards are met by reviewing monthly reports, conducting site visits to review consumer progress, as well as performing an annual program review. Invoices will be reviewed and approved by DBH Program staff to ensure consumers and bed counts are accurate. DBH Fiscal will verify signatures, bed rate, and total cost prior to submitting for payment.
PROCUREMENT
DBH routinely performs a search of SNFs licensed throughout Southern California that will accept consumers with psychiatric needs and severe medical issues, including dementia-related disorders. DBH does not procure for these services as there are a limited number of state licensed SNF facilities with available beds willing to provide services to DBH consumers. The Purchasing Department continues to concur with the non-competitive justification of SNF services with the licensed SNF agency in the Recommendation as they specialize in providing services to SMI consumers with psychiatric and dementia-related disorders that other facilities will not accept.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on December 21, 2023; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on February 9, 2024; Purchasing (Jessica Barajas, Supervising Buyer, 387-2065) on February 15, 2024; Finance (Christopher Lange, Administrative Analyst, 386-8393) on February 12, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on February 26, 2024.