REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 17, 2026
FROM
JOSHUA DUGAS, Director, Department of Behavioral Health
SUBJECT
Title
Amendment to Contract with Netsmart Technologies, Inc. for Behavioral Health Management Information Systems
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 2 to Contract No. 25-26 with Netsmart Technologies, Inc., for the provision of Behavioral Health Management Information Systems, updating standard contract language, and increasing the total contract amount by $139,038, from $22,479,308 to $22,618,346, with no change to the contract period of July 1, 2024 through June 30, 2029.
(Presenter: Joshua Dugas, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Foster Sustainable Development Through Strategic Partnerships.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The recommended increase of $139,038 with Netsmart Technologies, Inc. (Netsmart) is funded by Behavioral Health Services Act funds. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2026-27 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. DBH implemented a Behavioral Health Management Information System (BHMIS) in partnership with Netsmart to comply with state and federal requirements to provide mental health and SUD services to county residents.
Netsmart provides hosting services, including hardware, servers, technical support, and disaster recovery, eliminating the need for additional County infrastructure and associated technical resources. Disaster recovery services support the timely restoration of client data and system functionality following an outage or emergency, helping ensure continued access to critical health information and minimizing disruptions to behavioral health services.
Netsmart is responsible for the ongoing enhancement, customization, configuration, and maintenance of the BHMIS. The BHMIS provides a fully integrated, web-enabled platform supporting critical clinical, administrative, and financial functions, with secure data-sharing capabilities. The BHMIS platform meets the requirements of the State Department of Health Care Services’ Medi-Cal, Federal Medicare, and California Advancing and Innovating Medi-Cal programs by facilitating essential billing, reporting, interoperability, and data-sharing initiatives.
Since going live in July 2020, the BHMIS has:
• Supported over 141,183 clients
• Processed more than 10.6 million services
These services include assessments, targeted case management, therapy, and other related services. As DBH’s Electronic Health Record (EHR), the BHMIS supports billing automation, service tracking, and continuity of care through improved access to medical records.
In 2025-26, the BHMIS observed the following outcomes:
• Supported approximately 46,182 unduplicated clients annually
• Processed 1,717,006 services
The BHMIS anticipates the following outcomes for the remainder of the contract term:
• Support approximately 46,182 unduplicated clients annually
• Increased service volume driven by new state-mandated service and reporting requirements
On January 14, 2025 (Item No. 27), the Board of Supervisors (Board) approved Contract No. 25-26 with Netsmart, for the provision of the BHMIS, in the amount not to exceed $22,479,308, for the period of July 1, 2024 through June 30, 2029. The Board also authorized the Director of DBH (Director) to execute Change Orders, subject to review by County Counsel, provided such acceptance does not increase the total not-to-exceed amount of $22,479,308 or change the duration of the contract.
On October 6, 2025, the Director executed Amendment No. 1 to Contract No. 25-26, adding an audit function of the BHMIS platform at no cost and allowing DBH to enhance the investigation of configuration changes, proactive monitoring, and reliable compliance reporting. In addition, this function allows DBH to detect reporting and monitoring changes that can impact multiple months of service, resulting in millions of dollars of unpaid claims.
On March 16, 2026, the California Department of Health Care Services issued Behavioral Health Information Notice (BHIN) 26-013, requiring counties to bidirectionally exchange minimum necessary member information in real time with Medi-Cal Managed Care Plans, contracted providers, community-based organizations, and other Medi-Cal Partners. This initiative supports service delivery, care coordination, referrals, and transitions of care, consistent with applicable privacy laws and specified Data Exchange Framework requirements. It also requires processes for the real-time sharing and receipt of Admission, Discharge, and Transfer (ADT) event notifications, including through Qualified Health Information Organization (QHIO), health information exchanges, or other technology platforms, and requires these obligations to be communicated to and enforced with subcontractors and network providers.
The recommended amendment updates standard contract language and adds requirements for real-time data sharing and ADT event notifications to support timely care coordination, referrals, transitions of care, and continuity of care for Medi-Cal members, consistent with BHIN 26-013 and applicable California Data Exchange Framework requirements. The amendment requires Netsmart to securely exchange member information, cooperate with the County and contributing agencies identified in BHIN 26-013, and maintain appropriate privacy, consent, and data-security safeguards.
DBH currently utilizes Netsmart’s applications, myAvatar, and CareConnect solutions to support the exchange of health information and is implementing connectivity with partnered QHIOs as part of DBH’s interoperability efforts. This implementation includes measures to address data exchange interruptions and necessary workflow and technology updates to maintain compliance with applicable state and federal health information exchange requirements. The recommended increase of $139,038 will support the configuration of CareConnect’s interoperability between the EHR and QHIOs, with implementation beginning January 1, 2027. This implementation will enable the secure electronic exchange of client demographic and ADT information between the EHR and QHIOs, effectively supporting more timely access to relevant health information and improved continuity and coordination of care.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health (Vanessa Esparza, Administrative Supervisor I, 388-0858) on October 21, 2026; County Counsel (Bonnie Uphold, Supervising Deputy County Counsel, 387-5455) on November 3, 2026; and County Finance and Administration (Lizveth Varela, Administrative Analyst, 387-4883) on October 30, 2026.