REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
May 21, 2024
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Amendment to Contracts for Crisis Residential Treatment Program Services
End
RECOMMENDATION(S)
Recommendation
Approve amendments to the following contracts for the provision of Crisis Residential Treatment program services, increasing the combined contract amount by $4,000,000, from $70,000,000 to $74,000,000, with no change to the contract period of July 1, 2022 through June 30, 2027:
1. Amendment No. 2 to Contract No. 22-361 with Telecare Corporation, for services in the West Valley region, increasing the contract amount by $800,000, from $14,000,000 to $14,800,000.
2. Amendment No. 1 to Contract No. 22-362 with Valley Star Behavioral Health, Inc., for services in the East Valley region, increasing the contract amount by $800,000, from $14,000,000 to $14,800,000.
3. Amendment No. 1 to Contract No. 22-363 with Valley Star Behavioral Health, Inc., for services in the Eastern Desert region, increasing the contract by $800,000, from $14,000,000 to $14,800,000.
4. Amendment No. 1 to Contract No. 22-364 with Valley Star Behavioral Health, Inc., for services the High Desert region, increasing the contract by $800,000, from $14,000,000 to $14,800,000.
5. Amendment No. 2 to Contract No. 22-365 with Valley Star Behavioral Health, Inc., for services for transitional age youth in the East Valley region, increasing the contract by $800,000, from $14,000,000 to $14,800,000.
(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 and Stakeholders.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The recommended increase of $4,000,000 for Crisis Residential Treatment services (CRT) is funded by Federal Financial Participation Medi-Cal, and Mental Health Services Act funds. 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 mental health and substance use disorder (SUD) services to county residents experiencing severe mental illness and/or SUD. CRT is a bundled service for adults aged 18-59 or transitional age youth (TAY) aged 18-25 in crisis. This bundle includes, but is not limited to, assessments, treatment plan development, collateral services, crisis intervention, medication support services, and individual and group therapy. The length of stay in a CRT facility can be up to 30 days. If deemed medically necessary, up to two 30-day extensions are available, not to exceed a total of 90 days. Services are provided 24 hours a day, seven days a week.
DBH has been providing TAY CRT program services through Valley Star Behavioral Health, Inc. (Valley Star) since 2013. DBH anticipates that Valley Star will provide TAY CRT services to approximately 108 clients annually at an estimated cost of $27,777 per client.
Valley Star has been providing adult CRT program services in the East Valley region since 2017. Valley Star and Telecare Corporation (Telecare) have been providing adult CRT services in the High Desert, Eastern Desert and West Valley regions since 2018. Each regional adult CRT program will serve approximately 120 clients annually from fiscal year 2023-24 to 2026-27 at an estimated cost of $25,000 per client.
Based on extensive internal analysis, both Telecare and Valley Star have demonstrated sufficient evidence that an increase in the current allocation will enable them to increase available staff for CRT services. CRT providers face challenges in recruiting and retaining sufficient qualified staff to meet regulatory staffing requirements due to a competitive wage market. An increase to the current allocation will allow these providers to hire additional staff and offer competitive wages, ensuring that required staffing levels are consistently maintained.
DBH will also implement mechanisms to regularly: 1) review client service data and progress, conduct site visits and perform annual monitoring to ensure the performance and compliance standards of the contract(s) are met; 2) review applicable reimbursement claims and claims data to ensure fidelity and accuracy of service billing and optimization of Medi-Cal reimbursement in alignment with Contract terms and Department of Health Care Services billing requirements; and 3) review provider invoices administratively and programmatically to ensure client and/or bed counts are accurate prior to payment processing.
PROCUREMENT
On May 24, 2022 (Item No. 31), as the result of a formal procurement, the Board of Supervisors (Board) approved Contract No. 22-361 with Telecare in the amount of $14,000,000, Contract No. 22-362 with Valley Star in the amount of $14,000,000, Contract No. 22-363 with Valley Star in the amount of $14,000,000, Contract No. 22-364 with Valley Star in the amount of $14,000,000, to provide adult CRT program services, and Contract No. 22-365 with Valley Star to provide TAY CRT program services in the amount of $13,000,000, for a combined contract total of $69,000,000 for the period of July 1, 2022 through June 30, 2027.
On February 28, 2023 (Item No. 19), the Board approved Amendment No. 1 to Contract No. 22-365 with Valley Star to provide TAY CRT program services, increasing the contract amount by $1,000,000, from $13,000,000 to $14,000,000 with no change to the contract period of July 1, 2022 through June 30, 2027.
On September 26, 2023 (Item No. 19), the Board approved Amendment No. 1 to Contract No. 22-361 with Telecare, updating standard contract language, with no change to the total contract amount of $14,000,000, or the contract period of July 1, 2022 through June 30, 2027
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health (Ellayna Hoatson, Contract Supervisor, 388-0858) on April 25, 2024; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on April 29, 2024; Finance (Paul Garcia, Administrative Analyst, 386-8392) on May 6, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on May 6, 2024.