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
Contract with Alamo Health Management, LLC for Enhanced Board and Care Services
End
RECOMMENDATION(S)
Recommendation
Approve Contract with Alamo Health Management, LLC, for the provision of Enhanced Board and Care services, in the total amount of $68,512,500, for the contract period of July 1, 2023 through June 30, 2028.
(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.
Pursue County Goals and Objectives by Working with Other Agencies.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The amount of $68,512,500 for Enhanced Board and Care (EBC) services will be funded by the Mental Health Services Act. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2023-24 budget and will be included in future recommended 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 addictions. Since 2003, DBH has utilized EBC services to meet the specialized needs of hard-to-place adults experiencing medical and behavioral health conditions.
This contract with Alamo Health Management, LLC (Alamo) will increase the County’s capacity of Adult Residential Facility (ARF) beds by providing 150 beds (to the already existing 55 beds) with EBC services which include, but are not limited to medication management, diabetic services, transportation to and from medical and psychiatric appointments, life skills education, Activities of Daily Living (ADL), daily on-site treatment groups and educational classes, substance use disorder education, behavioral health treatment, socialization and recreational activities, and offer services for the hearing impaired. ADL refers to activities such as bathing, dressing, transferring (e.g., transitioning from a bed to a wheelchair), using the toilet room, eating, and walking that reflect the consumer’s capacity for self-care.
These EBC services are provided 24 hours a day, seven days per week to consumers experiencing serious medical and behavioral health conditions, whose behavior continues to negatively impact the ability to find placement for them in a lower level of care. This includes adults which require care and supervision, as well as assistance with performing their ADL. These EBC services are provided by ARFs which are licensed and governed by the State of California, Community Care Licensing Division.
Alamo will accept referrals from DBH’s Centralized Hospital Aftercare Services, as well as Adult Forensics Programs. Alamo EBC’s uniqueness allows them to accept consumers with forensic backgrounds, such as those consumers with mental health and/or substance use needs who are involved with the criminal justice system, consumers who have been or are being released from detention centers and diverted from the State hospitals.
Additionally, Alamo accepts consumers currently committed to State hospitals being transitioned back into the community, with many of them having spent decades in the State hospital; experiencing a mental health condition with complex co-occurring diagnoses (e.g., autism spectrum disorders, medical conditions [insulin-dependent diabetics and traumatic brain injury]); requiring mobility assistance such as canes, walkers, and wheelchairs; and having a visual or hearing impairment.
Alamo also provides on-site medical and behavioral health care, such as nursing, psychiatry, and labs for blood draws. Alamo offers special considerations with room availability for couples and small dogs.
A goal of the EBC program is to reduce the consumers' length of stay in acute psychiatric hospitals and long-term locked psychiatric residential facilities by transitioning consumers to a lower level of care. DBH anticipates that Alamo will provide services for up to 200 consumers annually at an estimated rate of $68,437 per consumer.
PROCUREMENT
DBH does not procure for these services as there are a limited number of State licensed EBC facilities with available beds willing to provide services to DBH consumers. The Purchasing Department concurs with the non-competitive justification of EBC services from Alamo as they specialize in providing services to consumers who experience behavioral health conditions that other facilities will not accept.
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 count are accurate. DBH Fiscal will verify signatures, bed rate, and total cost prior to submitting for payment.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on May 18, 2023; Purchasing (Michelle Churchill, Supervising Buyer, 387- 2070) on June 8, 2023; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on June 1, 2023; Finance (Christopher Lange, Administrative Analyst, 386-8393) on June 5, 2023; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0332) June 8, 2023.