REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 14, 2022
FROM
JOSHUA DUGAS, Director, Department of Public Health
SUBJECT
Title
Amendment to Contract with California University of Science and Medicine for Primary Care Services
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 1 to Contract No. 19-398 with California University of Science and Medicine, including non-standard terms, to continue to provide primary care services, the expansion of services to include the Refugee Health Assessment Program and Psychiatric services, exercising the first option to extend for one year, and increasing the contract amount by $3,368,343, from $7,667,464 to $11,035,807, for the total contract period of July 1, 2019 through June 30, 2023.
(Presenter: Joshua Dugas, 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
This item will not impact Discretionary General Funding (Net County Cost). The increase of $3,368,343 for primary care and the expansion of services is funded by fee-for-service, Medi-Cal, Managed Care Medi-Cal, private insurance, private pay clients, and 1991 Realignment funds. Adequate appropriation and revenue have been included in the Department of Public Health’s (DPH) 2021-22 budget and will be included in the 2022-23 recommended budget.
BACKGROUND INFORMATION
DPH currently operates Federally Qualified Health Centers (FQHCs) in the cities of San Bernardino, Ontario, Hesperia, and Adelanto. Section 330 of the Public Health Services Act requires that FQHCs serve an underserved area or population, provide comprehensive primary care services and coverage for medical emergencies during and after business hours, ensure continuity of care and hospital admitting privileges, and have an ongoing quality assurance program. FQHCs qualify for enhanced reimbursement from Medicare and Medicaid.
Under the terms of the recommended amendment, California University of Science and Medicine (CUSM) will continue to provide comprehensive primary care services through licensed physicians and mid-level practitioner support at the designated FQHCs, Monday through Friday. CUSM acts as the lead agency and subcontract a portion of the services through an agreement with CEP-America AUC, dba Vituity, Inc. (Vituity). Vituity will provide licensed physicians for the primary care services.
In addition to primary care services, the amendment adds provider hours to enhance the existing Refugee Health Assessment program within the health centers. This program provides newly admitted refugees, asylees, victims of trafficking, and other eligible entrants with culturally and linguistically appropriate comprehensive health assessments under the agreement with the California Department of Public Health, Office of Refugee Health. Data shows more than 76,000 Afghans have been brought to the United States through Operation Allies Welcome since January 2022. DPH currently has a fee-for-service reimbursement agreement with the California Department of Public Health, Office of Refugee Health for the Refugee Health Assessment Program (approved November 16, 2021, Item No. 44), which increased DPH’s capacity to support the safe transition and resettlement of these individuals within San Bernardino County and other adjacent counties by, screening and identifying health-related conditions, and/or communicable diseases of public significance. The funding for refugee healthcare provider time will allow services for an estimated 500 refugees, asylees, and other eligible individuals annually.
The recommended amendment to the contract with CUSM will add psychiatry services to supplement the growing need for access to behavioral health services. With the growing mental health shortage in San Bernardino County, the demand for this service can generate up to 1,040 health center visits annually. Untreated and/or undertreated mental health disorders are a continually rising public health burden. Compounding this issue is a lack of available mental health providers and services to meet this burden, thus this disparity continues to grow. The FQHCs will continue to utilize the Collaborative Care model, which focuses on primary care providers and embedded behavioral health professionals providing evidence-based interventions, such as medication and/or psychosocial treatments, to defined patient populations.
Approval of this item allows DPH to meet its mandate of providing health services, including the expansion of Refugee Health Assessment Program and psychiatry services to DPH referred clients and San Bernardino County residents, and assist clinic operations at the FQHCs with meeting compliance requirements for an additional year. The amendment to CUSM’s contract also extends the non-standard County contract terms, which state:
The County shall provide Professional Liability Indemnity to the Contractor while providing such services. The contract includes language to indemnify, defend, and hold harmless the Contractor for services rendered at the County-sponsored facility.
• The County requires Professional Liability Insurance with limits of not less than $1,000,000 per claim or occurrence and $2,000,000 aggregate limits.
• Potential Impact: By agreeing to indemnify the Contractor, the County is assuming the risk of liability and waiving the protection of sovereign immunity.
DPH recommends approval of the amendment, including the non-standard provisions, as the specialized service is needed for clinical operations and to remain in compliance with mandated Federal requirements.
CUSM’s performance is monitored by review of monthly reports to ensure compliance with the administrative, program, and fiscal terms and conditions of the contract. CUSM will cooperate with the County in the implementation, monitoring, and evaluation of this contract and will comply with all reporting requirements established by the contract. CUSM’s charges must be for services provided to eligible beneficiaries under applicable Federal, State, and locally funded programs. DPH Budget and Administrative Services will review invoices and attachments remitted by CUSM prior to payment. The County reserves the right to request additional program and/or fiscal reports to facilitate this monthly review.
PROCUREMENT
On June 11, 2019 (Item No. 42), as a result of a formal procurement, the Board of Supervisors approved Contract No. 19-398 with CUSM to provide Primary Care Services, in the amount of $7,667,464, for the period of July 1, 2019 through June 30, 2022.
REVIEW BY OTHERS
This item has been reviewed by Human Services Contracts (Patty Steven, Contracts Manager, 388-0241) on April 13, 2022; County Counsel (Adam Ebright, Deputy County Counsel, 387-5455) on April 26, 2022; Finance (Paul Garcia, Administrative Analyst, 386-8392) on May 4, 2022; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on May 16, 2022.