REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 27, 2023
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Amendment to Contracts for Comprehensive Treatment Services Student Assistance Program and School-Aged Treatment Services
End
RECOMMENDATION(S)
Recommendation
Approve amendments to the following contracts for the provision of Comprehensive Treatment Services Student Assistance Program, and School-Aged Treatment Services, increasing the total contract amounts by $40,160,604 from $139,359,232 to $179,519,836, and extending the contract term for one year for a total contract period of July 1, 2018 through June 30, 2024:
1. Desert/Mountain Children’s Center, Amendment No. 4 to Contract No. 18-382, increasing the total contract amount by $14,499,272, from $63,934,847 to $78,434,119.
2. Lutheran Social Services of Southern California, Amendment No. 1 to Contract No. 18-383, increasing the total contract amount by $359,634, from $1,787,235 to $2,146,869.
3. Mountain Counseling and Training, Amendment No. 3 to Contract No. 18-384, increasing the total contract amount by $1,111,666, from $3,877,500 to $4,989,166.
4. South Coast Community Services, Amendment No 5 to Contract No. 18-385, increasing the total contract amount by $12,601,535, from $36,477,421 to $49,078,956.
5. Victor Community Support Services, Inc., Amendment No. 3 to Contract No. 18-386, increasing the total contract amount by $8,144,481, from $23,549,050 to $31,693,531.
6. West End Family Counseling Services, Amendment No. 3 to Contract No. 18-387, increasing the total contract amount by $3,444,016, from $9,733,179 to $13,177,195.
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Promote Countywide Vision.
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The increase of $40,160,604 for Comprehensive Treatment Services (CTS) Student Assistance Program (SAP) and School-Aged Treatment Services (SATS) is funded by Children and Families Commission for San Bernardino County (First 5), Mental Health Services Act Prevention and Early Intervention, Federal Financial Participation Medi-Cal, 2011 Realignment, and matching funds from the Desert Mountain Special Education Local Planning Area (DMSELPA), up to $1,119,595. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2022-23 and 2023-24 budgets.
BACKGROUND INFORMATION
DBH is responsible for providing behavioral health and substance use disorder services to San Bernardino County (County) residents experiencing severe and persistent mental illness, substance use, and other additions. An integral part of the service delivery system consists of County-operated and contracted service providers delivering a variety of mental health treatment services. CTS is comprised of the SAP and the SATS programs. SAP and SATS are two distinctive programs, that collectively represent a large portion of the children’s continuum of care for mental health services and each program is expected to collaborate cohesively with the other. These programs are located in the cities of Barstow, Apple Valley, Redlands, Crestline, Blue Jay, Big Bear Lake Yucca Valley, Ontario and San Bernardino, but provide countywide services that include additional areas such as Fontana, Rancho Cucamonga, Mt. Baldy, San Antonio Heights, and North Upland.
SAP is a school-based approach to providing focused services to students in need of interventions for substance use disorders, mental health, academic, emotional, and/or social issues. The program serves children/youth (grades K-12) and their families, who have been exposed to trauma, are experiencing the first onset of serious psychiatric illness, are in stressed families, are at risk for school failure and/or at risk of, or are experiencing, juvenile justice involvement.
SATS provides services to Medi-Cal beneficiaries who are at risk of school failure due to substance use disorder, juvenile justice involvement, mental health, emotional, and social issues. The program serves school-age Medi-Cal eligible children/youth (up to the age of 21) that experience significant distress and resulting dysfunction due to a mental health condition, and thus meet Medi-Cal medical necessity criteria.
DMSELPA, a support services office that serves as a liaison to the desert and mountain local school district, has a history of partnership with Desert/Mountain Children’s Center (DMCC) to provide Early & Periodic Screening, Diagnosis & Treatment (EPSDT) Medi-Cal specialty mental health services (SMHS) to eligible children and youth in the school, and preventive health care services for children under age 21. DMSELPA will provide a non-federal match for a portion of the costs for EPSDT Medi-Cal SMHS to eligible children and/or youth through DBH contracts with DMCC, up to $1,119,595, which will allow for an additional $8,014,281 of Medi-Cal funded services to children and youth served by DMCC through SATS program. This additional funding is included in the contract award to DMCC.
DBH is requesting approval of amendments to the contracts listed in the Recommendation to continue to provide CTS for the SAP and SATS programs. DBH anticipates an estimated 14,232 clients to be served at an estimated cost of $2,822 per client.
PROCUREMENT
On June 26, 2018 (Item No.21), as the result of a formal procurement, the Board of Supervisors (Board) approved the contracts in the Recommendation for the provision of CTS, in the amount of $124,376,615 for the period of July 1, 2018 through June 30, 2023. These contracts included the SAP, SATS, and Children’s Intensive Services (CIS) program service components.
On September 10, 2019 (Item No. 24), the Board approved Amendment No. 1 to the following: Contract No. 18-384 with Mountain Counseling & Training (MCT) (MCT Contract), increasing the total contract amount by $700,000, from $3,700,000 to $4,400,000; Contract No. 18-385 with South Coast Community Services (SCCS) (SCCS Contract), increasing the total contract amount by $9,981,324, from $28,595,745 to $38,577,069; Contract No. 18-386 with Victor Community Support Services, Inc. (VCSS) (VCSS Contract), increasing the total contract amount by $8,518,676, from $16,497,040 to $25,015,716; and Contract No. 18-387 with West End Family Counseling Services (WEFC) (WEFC Contract), increasing the total contract amount by $4,800,000, from $5,586,865 to $10,386,865, and updating standard contract language. Amendment No. 1 to the contracts increased the contract amounts by $24,000,000, changing the total aggregate amount for all six contracts from $124,376,615 to $148,376,615, with no change to the contract period of July 1, 2018 through June 30, 2023.
On September 29, 2020 (Item No. 20), the Board approved Amendment No. 1 to Contract No. 18-382 with DMCC (DMCC Contract), decreasing the total contract amount by $5,225,000, from $68,209,730 to $62,984,730. The Board also approve Amendment No. 2 to the following: MCT Contract, decreasing the total contract amount by $522,500, from $4,400,000 to $3,877,500; SCCS Contract, decreasing the total contract amount by $4,950,000, from $38,577,069 to $33,627,069; VCSS Contract, decreasing the total contract amount by $1,466,666, from $25,015,716 to $23,549,050; and WEFC Contract, decreasing the total contract amount by $653,686, from $10,386,865 to $9,733,179. These amendments decreased the contract amounts by $12,817,852, changing the total aggregate amount for all six contracts from $148,376,615 to $135,558,763, with no change to the contract period of July 1, 2018 through June 30, 2023.
The decreases to the contracts approved on September 29,2020 were done in response to the economic impact of the COVID-19 pandemic. DBH recommended the contracts providing CIS be amended to decrease the total contract amount by $12,817,852 to eliminate the CIS component as of October 1, 2020. The $12,817,852 funding for the discontinued CIS program was released and became available for other Realignment programs within DBH as needed, which included over 70 programs providing Specialty Mental Health and Substance Use Disorder Services. All funds were expended.
On June 8, 2021 (Item No. 33), the Board approved a standardized contract template amendment to amend contracts with providers for the provision of Specialty Mental Health Services in order to remove the County Contract Rate Provisions, effective March 1, 2020, and authorized the DBH Director to execute these amendments. As a result, on September 5, 2021, the DBH Director, as authorized by the Board, executed Amendment No. 2 to the DMCC Contract, removing the County Contract Rate provisions via the standardized contract template Amendment. Also, on September 13, 2021, the DBH Director, as authorized by the Board, executed Amendment No. 3 to the SCCS Contract, removing the County Contract Rate provisions via the standardized contract template amendment.
On April 26, 2022 (Item No. 20), the Board approved Amendment No. 3 to the DMCC Contract, increasing the total contract amount by $950,117, from $62,984,730 to $63,934,847 and Amendment No. 4 to the SCCS Contract, increasing the total contract amount by $2,850,352, from $33,627,069 to $36,477,421. These amendments decreased the contract amounts by $3,800,469, changing the total aggregate amount for all six contracts from $148,376,615 to $139,359,232, with no change to the contract period of July 1, 2018 through June 30, 2023.
DBH is recommending extending the contracts with DMCC, Lutheran Social Services of Southern California, MCT, SCCS, VCSS and WEFC for an additional year. An additional year is being requested due to the changes from the Department of Health Care Services, tasking DBH with developing new methods of increasing an existing service requirement through implementation of the Integrated Care Practice Model, including the provision of Intensive Care Coordination and Intensive Home-Based Services. A new procurement for the provision of CTS SAP SATS will be conducted and concluded in 2023-24, for service effective July 1, 2024.
DBH will continue to monitor contract performance on a regular basis to ensure performance and compliance standards are met by reviewing monthly reports, ongoing site visits to review consumer progress, as well as an annual program review. The provider invoices will be reviewed and approved by DBH Programs to ensure client counts are accurate prior to being forwarded to Fiscal staff for payment. Fiscal staff will verify signatures and service costs prior to issuing payment.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on May 30, 2023; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on June 5, 2023; Finance (Christopher Lange, Administrative Analyst, 386-8393) on June 5, 2023; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on June 8, 2023.