REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
August 4, 2026
FROM
JANKI PATEL, Acting Director, Department of Public Health
SUBJECT
Title
Amendment to Contract with California University of Science and Medicine for Primary Care, Pediatric, Psychiatric, and Refugee Health Assessment Program Services
End
RECOMMENDATION(S)
Recommendation
1. Approve Amendment No. 1 to Contract No. 25-931 with California University of Science and Medicine, for primary care, pediatric, psychiatric, and Refugee Health Assessment Program services in the Department of Public Health’s Federally Qualified Health Centers and School-based Service Sites, updating indemnification and insurance provisions, with no change to the not-to-exceed amount of $16,258,096, or the contract period of January 1, 2026 through December 31, 2028.
2. Direct the Clerk of the Board of Supervisors to maintain the confidentiality of Amendment No. 1 to Contract No. 25-931, pursuant to Health and Safety Code Section 1457(c)(1).
(Presenter: Janki Patel, Acting Director, 387-9146)
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 cost for services provided by California University of Science and Medicine (CUSM) is funded by Medi-Cal reimbursement, private insurance, existing ongoing 1991 Realignment funds, and fee revenue. Payments to CUSM are made on a fee-for-service basis. Adequate appropriation and revenue have been included in the Department of Public Health’s (DPH) 2026-27 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
Section 330 of the Public Health Services Act requires that Federally Qualified Health Centers (FQHCs) serve an underserved area or population, offer a sliding fee scale to patients, provide comprehensive health services, and have an ongoing quality assurance program. FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. DPH operates four FQHCs in San Bernardino, Ontario, Hesperia, and Adelanto. The services provided include primary care, maternal health, human immunodeficiency virus (HIV) care and treatment, reproductive health, dental and nutrition care, and diagnostic radiology. In 2014, DPH added comprehensive pediatric services through its FQHCs. In 2023, DPH expanded pediatric services to two School-based Service Sites (SBSSs) in Apple Valley and Ontario.
Through its licensed physicians, mid-level practitioners, and psychiatrists, CUSM provides primary care, psychiatric, and Refugee Health Assessment Program services at all four of DPH's FQHCs, as well as pediatric services at the FQHCs in Hesperia and Adelanto and the SBSS in Apple Valley. In 2025, CUSM provided these services through approximately 20,882 appointments at these locations.
On November 18, 2025, (Item No. 51), as a result of Requests for Proposals Nos. DPHE25-CO-5725 and DPHE25-CO-5726, the Board of Supervisors approved Contract No. 25-931 with California University of Science and Medicine, to provide primary care, pediatric, psychiatric, and Refugee Health Assessment Program services in DPHs FQHCs and School-based Service Sites, in an amount not-to-exceed $16,258,096, for the contract period of January 1, 2026 through December 31, 2028.
The recommended Amendment No. 1 to Contract No. 25-931 with CUSM includes terms which deviate from the County standard contract as follows:
1. The County is required to defend and indemnify CUSM, its physicians, mid-level practitioners, and psychiatrists (PROVIDERS) for medical malpractice and professional negligence.
• The County's standard contract does not contractually require the County to indemnify its contractor under any circumstance.
• Potential Impact: By agreeing to indemnify the PROVIDERS, 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 the PROVIDERS without such limitations and the County would be responsible to defend and reimburse the PROVIDERS for costs, expenses, and damages, which could exceed the total contract amount.
2. The Agreement does not require CUSM to meet all of the County insurance standards.
• The County’s standard contract requires contractors to carry appropriate insurance at limits and under conditions determined by County’s Risk Management Department.
• Potential Impact: The Agreement does not include all of County standard insurance requirements. This means that the County has limited assurance that CUSM will be financially responsible for claims that may arise from the Agreement, which could result in expenses to the County that exceed the total amount in the Agreement.
Pursuant to Health and Safety Code section 1457(c)(1), specific terms related to the rates of payment for health care services are not immediately subject to laws related to public records. Therefore, the Clerk of the Board is directed to maintain confidentiality of the contract.
DPH recommends approval of Amendment No. 1 to Contract No. 25-931 with CUSM, including the non-standard terms, to continue providing for the safety, health, and social service needs of county residents by ensuring the availability of primary care, pediatric, psychiatric, and Refugee Health Assessment Program services at DPH’s FQHCs and SBSSs.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Adam Ebright, Deputy County Counsel, 387-4229) on July 15, 2026; Risk Management (Stephanie Pacheco, Staff Analyst II, 386-9039) on July 15, 2026; and County Finance and Administration (Iliana Rodriguez, Administrative Analyst, 386-8392) on July 17, 2026.