REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 23, 2026
FROM
Joshua Dugas, Acting Director, Department of Behavioral Health
SUBJECT
Title
Participation Agreement with the California Mental Health Services Authority for Psychiatric Inpatient Concurrent Review
End
RECOMMENDATION(S)
Recommendation
1. Approve Participation Agreement with the California Mental Health Services Authority (Agreement No. 14634-SBR-PICR-26_27), including non-standard terms, for Psychiatric Inpatient Concurrent Review, in an amount not to exceed $4,802,784 for the contract period of July 1, 2026 through June 30, 2028.
2. Authorize the Director of the Department of Behavioral Health to electronically sign and submit the Participation Agreement, including any subsequent non-substantive amendments, as required by the California Mental Health Services Authority, on behalf of the County, subject to review by County Counsel.
3. Direct the Director of the Department of Behavioral Health to transmit the executed Participation Agreement, including any subsequent non-substantive amendments, to the Clerk of the Board of Supervisors within 30 days of execution.
(Presenter: Joshua Dugas, Acting Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
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 Participation Agreement (PA), in an amount not to exceed $4,802,784 for the full two-year term, will be funded by existing ongoing 1991 and 2011 Realignment, Behavioral Health Services Act, and Federal Financial Participation Medi-Cal funds. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2026-27 budget and will be included in the 2027-28 recommended budget.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and substance use disorder (SUD) services to San Bernardino County (County) residents experiencing severe mental illness and/or SUD. The California Mental Health Services Authority (CalMHSA) is a Joint Powers Authority (JPA), comprised of the City of San Bernardino and County mental health plans, that provides administrative and fiscal services for member cities and counties to maximize resources for the most efficient use of purchasing products, develop requests for proposals, and coordinate implementation of statewide or multi-county projects. DBH has been a member of the JPA since November 2008.
CalMHSA offers member counties the ability to enter into a PA for a technology assisted Inpatient Concurrent Review (ICR) process, a web-enabled review platform to carry out psychiatric ICR and authorization services. ICR allows hospitals to receive timely feedback and update subsequent documentation to meet Medi-Cal standards while patients are receiving inpatient care. This increases the likelihood of approval for services reimbursed to hospitals. Additionally, inpatient authorization regulations allow hospitals to be retroactively reimbursed for bed days provided in prior budget years in circumstances including hospitalizations that cross budget years, appealed bed days, and resubmitted documentation to correct administrative errors.
DBH is required to manage authorizations for inpatient acute psychiatric hospital services. Following the previous PA for ICR services, CalMHSA entered into a service contract with Acentra Health (Acentra) to provide a technology assisted ICR process and clinical services that allow for a consistent and efficient review process across participating counties, including DBH. The PA with CalMHSA for the continued utilization of Acentra will allow DBH to meet ICR timeframes for completing initial and additional authorization requests within 24 hours for extended hospital stays. The ICR approach supports mental health plan compliance with the California Department of Health Care Services (DHCS) Behavioral Health Information Notice (BHIN) 19-026, or any subsequent BHIN, and the Parity in Mental Health and Substance Use Disorder Services Final Rule (Title 42 CFR, part 438.910) and BHIN 22-017, Concurrent Review Standards for Psychiatric Inpatient Hospital and Psychiatric Health Facility Services.
The PA with CalMHSA includes terms that differ from the standard County contract. These non-standard terms include the following:
1. The County must provide 90 days’ notice to terminate the PA for convenience.
• County Policy 11-05 requires that the County have the right to terminate the contract, for any reason, with a 30-day written notice of termination without any obligation other than to pay amounts for services rendered and expenses reasonably incurred prior to the effective date of termination.
• Potential Impact: The County can terminate the PA but may still be obligated to the terms of the PA without any recourse.
2. There is a mutual indemnification whereby each party is required to defend, indemnify, and hold the other party harmless from and against any and all liability, loss, expense, attorneys' fees, or claims for injury or damages from the negligent or intentional acts or omissions of the other party.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify CalMHSA, the County could be contractually waiving the protection of sovereign immunity.
3. There is no stated venue in the PA.
• County Policy 11-05 requires venue for disputes in Superior Court of California, County of San Bernardino, San Bernardino District.
• Potential Impact: Having no express venue in the PA means that venue in any other County within California could be applied to disputes arising under this PA, which may result in additional expenses that exceed the amount of the PA.
4. The PA does not require DHCS and/or CalMHSA to meet the County’s insurance standards as required pursuant to County Policy 11-07.
• The County Policy requires contractors to carry appropriate insurance at limits and under conditions determined by the County’s Risk Management Department and set forth in the County standard contract.
• Potential Impact: The PA does not include County standard insurance requirements. This means that the County has no assurance that DHCS and/or CalMHSA will be financially responsible for claims that may arise under the PA, which could result in expenses to the County that exceed the amount of the PA.
On May 19, 2026 (Item No. 22), through a competitive procurement, the Board of Supervisors approved Contract No. 26-370 with Telligen, Inc. (Telligen) for the provision of ICR services in the amount not to exceed $9,475,830 for the period of July 1, 2026 through June 30, 2031. Although the contracts with Telligen and CalMHSA are for the same services under different operating names, the contract with CalMHSA will be terminated once Telligen is fully operational and able to assume all ICR process services for DBH.
This temporary overlap with CalMHSA and Telligen was planned to ensure continuity of ICR services during the transition to Telligen; however, was inadvertently omitted from the Telligen item. The CalMHSA PA is needed to ensure a seamless transition during the Telligen implementation. Telligen may not be fully operational until September 1, 2026, DBH anticipates the need for concurrent contracted services to extend approximately 120 days into the new contract term to ensure provisions of a seamless transition for Medi-Cal members. DBH continues to meet ICR timeframes for completing initial and additional authorization requests for extended hospital stays within 24 hours as mandated by DHCS.
The contract termination notice shall be provided to CalMHSA in accordance with Exhibit B, Section IV. (A) Withdrawal, Cancellation and Termination procedures of the PA, which specifies 90 days’ written notice to CalMHSA, with the understanding that if Telligen does not become fully operational, or there are a large number of overlapping cases, the termination period may be extended, as needed.
DBH recommends the approval of the PA, including non-standard terms, to continue to utilize the ICR process for quality control measures, ensuring psychiatric inpatient stays meet the DHCS requirements of a 24-hour turnaround. The ICR process is essential for authorizing the necessity of the services provided to increase the likelihood of the reimbursement of services rendered.
Approval of Recommendation No. 2 authorizes the Director of DBH to execute and submit the PA and any non-substantive amendments through the delegated authority process per County Counsel directive, eliminating the need to return to the Board for approval thereby easing the administrative burden for the CalMHSA PA.
DBH will also implement mechanisms to regularly review 1) the concurrent review platform used to authorize inpatient acute psychiatric hospitalizations, including site visits and annual monitoring, ensuring performance and compliance standards of the PA are met; 2) documentation pertaining to approval/denial of psychiatric inpatient hospital services are transmitted to the appropriate entities for authorization and reimbursement; 3) provider invoices administratively and programmatically to ensure accuracy prior to payment processing.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by Department of Behavioral Health (Diana Barajas, Administrative Supervisor I, 388-0862) on May 29, 2026; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on May 29, 2026; Risk Management (Stephanie Pacheco, Staff Analyst II, 386-9039) on June 2, 2026; and County Finance and Administration (Iliana Rodriguez, Administrative Analyst, 386-8392) on June 4, 2026.