REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 15, 2022
FROM
GEORGINA YOSHIOKA, Interim Director, Department of Behavioral Health
SUBJECT
Title
Amendments to Contracts for Skilled Nursing Facilities in Dementia-Related Care Secondary to Behavioral Health Conditions
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 1 to the following contracts for the provision of Skilled Nursing Facilities for dementia-related care secondary to behavioral health and medical conditions, updating contract language and increasing the total aggregate amount by $1,054,485, from $1,551,250 to $2,605,735, with no change to the contract periods:
1. 1570 Fair Oaks Ave DBA Legacy Healthcare Center, Contract No. 21-286, for the contract period of April 20, 2021 through June 30, 2025.
2. Community Care on Palm, LLC, Contract No. 21-284, for the contract period of January 1, 2021 through June 30, 2025.
3. Foothill Heights Care Center, LLC, Contract No. 21-285, for the contract period of April 20, 2021 through June 30, 2025.
4. Vista Pacifica Enterprises dba Vista Pacifica Convalescent, Contract No. 20-369, for the contract period of June 9, 2020 through June 30, 2025.
(Presenter: Georgina Yoshioka, Interim Director, 388-0801)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The cost of the Skilled Nursing Facilities (SNFs) contracts will not exceed the aggregate amount of $2,605,735 and is 100% funded through 1991 Realignment. Adequate appropriation and revenue has been included in the Department of Behavioral Health’s (DBH) 2022-23 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and/or substance use disorder services to San Bernardino County residents who are experiencing major mental health issues and/or a substance use disorder. An integral part of the service delivery system consists of providing specialized treatment services to the seriously mentally ill population. The highest level of care is the State Hospital psychiatric unit; the second highest level of treatment is provided through Institution for Mental Diseases and SNFs. DBH appropriately places consumers in SNFs as they offer an appropriate higher level of care and are less costly than State Hospitals.
SNFs offer a variety of specialized behavioral interventions for Severely Persistently Mentally Ill (SPMI) consumers who require psychiatric monitoring in addition to treatment for their co-morbid medical condition. SNFs are licensed by the State of California, Department of Health Care Services. Placement of consumers in specialized SNFs offers an appropriate level of care and is less costly than placement within an acute psychiatric or State Hospital. DBH continuously seeks local SNFs, or those in close proximity, willing to provide skilled nursing services. However, due to the level of care needed for consumers with co-morbid disorders, including the intensity of dementia-related care, few SNFs or other types of facilities are willing to accept them.
Through the existing contracts, SNFs provide access to a total of ten beds for DBH consumers in need of these services. SNFs provide skilled nursing services to consumers whose needs require a locked setting for their psychiatric and medical care. The SNFs in the Recommendation have facilities located in close proximity to San Bernardino County and offer access to DBH consumers with dementia-related disorders secondary to their behavioral health and medical conditions. The amendments to increase the number of beds available are necessary due to an increase in consumers being released from State Hospitals and to facilitate a successful transition and reintegration of consumers to lower levels of care. DBH anticipates the SNF agencies in the Recommendation will provide approximately 3,650 annual bed days, at a cost not to exceed $186.30 per bed, per day.
PROCUREMENT
DBH routinely performs a search of SNFs licensed throughout Southern California that will accept consumers with psychiatric needs and severe medical issues, including dementia-related disorders. DBH does not procure for these services as there are a limited number of state licensed SNF facilities with available beds willing to provide services to DBH clients. Purchasing continues to concur with the non-competitive justification of SNF services with the licensed SNF agencies in the Recommendation as they specialize in providing services to SPMI consumers with psychiatric and dementia-related disorders whom other facilities will not accept.
On June 9, 2020 (Item No. 18), the Board of Supervisors (Board) approved the contract with Vista Pacifica, in an aggregate amount not to exceed $1,551,250, for the period of June 9, 2020 through June 30, 2025 for SNF specializing in dementia-related care secondary to behavioral health and medical conditions.
On April 20, 2021 (Item No. 20), the Board approved the contracts with Community Care on Palm, LLC for the period January 1, 2021 through June 30, 2025, and Foothill Heights Care Center, LLC, and 1570 Fair Oaks Ave DBA Legacy Healthcare Center for the period of April 20, 2021 through June 30, 2025, in an aggregate amount not to exceed $1,551,250 for SNF specializing in dementia-related care secondary to behavioral health and medical conditions.
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 clients and bed count are accurate prior to being forwarded to DBH Fiscal for payment processing. Fiscal will verify signatures, bed rate, and total cost prior to submitting for payment.
REVIEW BY OTHERS
This item has been reviewed by (Ellayna Hoatson, Contracts Supervisor, 388-0858) on October 3, 2022; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on October 25, 2022; Finance (Christopher Lange, Administrative Analyst, 386-8393) on October 26, 2022, and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) October 31, 2022.