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
Contract with Loma Linda University Children’s Hospital for Crisis Stabilization Unit Services
End
RECOMMENDATION(S)
Recommendation
Approve Contract with Loma Linda University Children’s Hospital, including non-standard terms, for the provision of Crisis Stabilization Unit services, in the amount of $16,519,974, effective upon execution through June 30, 2029.
(Presenter: Joshua Dugas, 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
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The amount of $16,519,974 for Crisis Stabilization Unit (CSU) Services is funded by Medi-Cal Federal Financial Participation, and the Department of Behavioral Health (DBH) will act as a pass-through entity for all Medi-Cal reimbursement received, minus a five percent administrative fee retained by DBH.
The administrative fee will be reviewed annually and may be adjusted accordingly but not to exceed 25.99%. The initial 5% is a preliminary estimate based on projected administrative costs. DBH will reassess the fee annually using actual contract administration costs, reimbursement activity, and operational experience. Any adjustment will be based on this analysis and will not exceed the state-agreed administrative fee cap of 25.99%. DBH will not incur any direct cost. Adequate appropriation and revenue have been included in DBH’s 2026-27 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
As San Bernardino County’s (County) Mental Health Plan (MHP), DBH provides behavioral health treatment services throughout the county to individuals with severe and persistent mental illness. CSU services are available 24 hours a day, seven days a week, to individuals experiencing an acute psychiatric episode or mental health crisis who may benefit from short-term stabilization as an alternative to unnecessary psychiatric hospitalization. CSU provides a bundled array of services, including assessments, treatment plan development, collateral services, crisis intervention, medication support, and individual and group therapy. The program is designed to stabilize immediate mental health crises and connect clients with appropriate community-based outpatient services that support long-term stabilization and recovery.
Loma Linda University Children’s Hospital (LLUCH) has constructed a 24-space Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) unit on its hospital campus to provide CSU services to individuals presenting to the Emergency Department (ED) with behavioral health crises requiring stabilization. The EmPATH unit will be designated under the Lanterman-Petris-Short Act and will provide CSU services to eligible patients transferred from the ED. Locating these services on the hospital campus will facilitate the timely transition of patients from the ED to specialized behavioral health care for assessment and stabilization. This integrated model is intended to reduce ED wait times, improve timely access to appropriate behavioral health services, and connect patients to higher levels of care when clinically necessary.
The recommended contract with LLUCH includes the following non-standard terms that deviate from the standard County contract:
1. The contract does not require LLUCH to fully indemnify the County, as required by Policies 11-05 and 11-07.
• The County standard contract indemnity provision requires the contractor to indemnify, defend, and hold the County harmless from all claims for any cause arising out of the acts, errors or omissions of any person.
• Potential Impact: LLUCH is not required to defend, indemnify or hold the County harmless from all claims. If the County is sued for a claim outside the scope of the indemnification provision, then the County may be solely liable for the costs of defense and damages.
2. The County is required to indemnify LLUCH from and against any and all liability and expense incurred in connection with any claims or demands for damages of any nature whatsoever resulting from the negligent acts or failures to act of the County.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify LLUCH, the County could be contractually waiving the protection of sovereign immunity. Claims that may otherwise be barred against the County, time limited or expense limited could be brought against LLUCH without such limitations and the County could be responsible to defend and reimburse LLUCH for costs, expenses, and damages, which could exceed the total contract amount.
3. The contract does not require LLUCH to meet the County’s insurance standards as required pursuant to County Policies 11-5, 11-07, and 11-07 SP.
• County policy requires contractors to carry appropriate insurance at limits and under conditions determined by the County’s Risk Management Department and as set forth in County policy and in the standard County contract.
• Potential Impact: The County has no assurance that LLUCH will be financially responsible for claims that may arise under the contract, which could result in expenses to the County that exceed the total contract amount.
The contract with LLUCH will function as a pass-through arrangement, allowing Medi-Cal reimbursement for eligible CSU services provided to the County beneficiaries to be reimbursed through DBH, as the County’s MHP. Approximately 8,850 Medi-Cal behavioral health encounters are anticipated during the three-year contract term, based on LLUMC’s estimate of approximately 2,950 qualifying encounters annually.
PROCUREMENT
California’s Medi-Cal Specialty Mental Health Services (SMHS) structure requires eligible SMHS to be administered through the County’s MHP. Welfare and Institutions Code section 5775 establishes the County’s responsibility for SMHS, and DHCS guidance recognizes Crisis Stabilization as a reimbursable SMHS when provided through an eligible CSU. Accordingly, LLUCH requires a contractual relationship with DBH so that eligible CSU claims can be routed through the County’s MHP.
The Purchasing Department supports this non-competitive procurement with LLUCH based on the Government Mandated/Legal Requirement, in accordance with County Policy 11-04, Procurement of Goods, Supplies, Equipment and Services. The contract establishes the contractual and reimbursement mechanism necessary for DBH, as the County’s MHP, to administer Medi-Cal reimbursement for eligible Crisis Stabilization Services provided through LLUCH hospital-based EmPATH CSU.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Diana Barajas, Administrative Supervisor II, 388-0862) on October 16, 2026; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on October 19, 2026; Risk Management (Noel Cantrell, Administrative Supervisor, 386-8890) on October 19, 2026; Purchasing (Jessica Barajas, Supervising Buyer, 387-2065) on October 1, 2026; and County Finance and Administration (Lizveth Varela, Administrative Analyst, 387-4883) on October 27, 2026.