Within the last month, the board of supervisors has committed more than $67 million to a host of psychological service providers, many of which did not engage in a competitive bid process to obtain the contracts. Some of the psychological service providers are working under single source arrangements. The board approved the contracts at the behest of San Bernardino County Department of Behavioral Health Services Director Veronica Kelley.
This week, the board signed off on contracts in aggregate worth more than $20 million with four separate companies to provide mental institution services. Those companies did not bid on those contracts. On May 23, the board approved a $12.5 million contract with Valley Star Behavioral Health, Inc. for the provision of what the Department of Behavioral Health Services calls transitional age youth crisis residential treatment program services. Valley Star submitted the only bid on the contract. Also on May 23, the board of supervisors approved a $17.6 million contract with six entities for the provision of what is deemed “comprehensive” mental health treatment for children under the age of five. No bidding on that contract was undertaken as a previous contract with the six companies was simply extended. And the board approved paying $12 million to six local hospitals for acute psychiatric inpatient services. Also on Tuesday, the board extended its contract with Children and Families Commission for San Bernardino County for the reimbursement of services provided through the 0–5 Comprehensive Treatment Services program, updating standard contract language, authorizing another year of services at a cost of $5,134,283.
On Tuesday of this week the board approved Kelley’s call to approve contracts with Braswell Enterprises, Inc. doing business as Sierra Vista; Shandin Hills Rehabilitation Center, Inc. doing business as Shandin Hills Behavioral Therapy Center; Vista Pacifica Enterprises, Inc.; and Golden State Health Centers, Inc. doing business as Sylmar Health and Rehabilitation Center “to provide institution for mental disease services, in an aggregate amount not to exceed $20,490,810, for the period of July 1, 2017 through June 30, 2022.
According to Kelley, “As the mental health plan [coordinator] for the county, the Department of Behavioral Health Services is required to provide adequate network of providers to county beneficiaries through an array of behavioral health services. The Department of Behavioral Health operates a continuum of care system that consists of county operated clinics and contracted service providers delivering a variety of mental health treatment services within each geographic region of the county. The highest level of care is a state hospital psychiatric unit; the next highest level of treatment is provided through an institution for
mental disease. Institution for mental disease facilities provide a program of organized therapeutic activities designed to promote daily living and social skills to severely and persistently mentally disabled county residents.”
Kelley continued, “The Department of Behavioral Health Services anticipates the institution for mental disease providers in the recommendation will provide on an annual basis an estimated 18,250 bed days for approximately 75 clients. Institution for mental diseases are state licensed, locked, skilled nursing facilities that provide specialized treatment services to the severely mentally ill population whose functioning level is too challenging to be maintained at a board and care facility or in the community. The Department of Behavioral Health contracted institution for mental disease facilities are responsible for maintaining state certification as a skilled nursing facility; providing bed days (room and board) at the California Department of Health Care Services’ specified rate(s); evaluating and accepting referrals from state hospitals, veterans hospitals, county/private facilities, and other facilities or sources deemed appropriate by the Department of Behavioral Health; providing psychiatric services, treatment, and support staff with specialized training; and providing medication management, crisis intervention, and discharge planning.”
The standard daily bed rate is determined by the California Department of Health Care Services and mandated by Assembly Bill 1054 to have annual increases, effective July 1st of each fiscal year, that varies by region and currently ranges from approximately $179.74 to $317.76.
According to Kelley, “The cost per client is difficult to determine as the bed type/bed rate varies based upon the individual psychiatric needs, the type of treatment required and the length of stay utilized to improve the client’s ability to transfer to the next least restrictive level – a board and care. Each contract has been written on a fee-for-service basis not to exceed the total annual aggregate amount. Preparing the contracts in this manner provides Department of Behavioral Health staff with the necessary flexibility to easily transfer clients to each of the institutions for mental disease based on availability. In addition, it permits Department of Behavioral Health staff to monitor the expenditures and make the necessary timely adjustments as needed.”
Kelly acknowledged the Department of Behavioral Health does not procure these services as there are a limited number of state licensed institutions for mental disease facilities willing to provide services to the Department of Behavioral Health clients. “Of the willing agencies listed in the recommendation, two reflect the only licensed institutions for mental disease in San Bernardino County and the other two specialize in providing services to persistently mentally ill clients with psychiatric needs, severe medical issues, and a criminal history that other facilities reject,” she said.
Kelly said the county’s purchasing department supported the non-competitive contracts with the four institutions for mental disease services with the justification they provide specialized services. She said the Department of Behavioral Health will monitor contractor performance on a regular basis to ensure compliance standards are met.
On May 23, the board of supervisors similarly acceded to Kelley’s recommendation that the county enter into a $12.5 million contract with Valley Star Behavioral Health, Inc. for the provision of transitional age youth crisis residential treatment program services for the period of July 1, 2017 through June 30, 2022.
Transitional age youth crisis residential treatment consists of crisis intervention services for transitional age youth, ages 18 to 25, diagnosed with mental health and co-occurring disorders. Valley Star Behavioral Health, Inc. has operated a 14-bed transitional age youth crisis residential treatment program facility, located in San Bernardino, since March of 2013. Under the contract, Kelley said Valley Star Behavioral Health will provide assessments, treatment plan development, collateral services, crisis intervention, medication support services, and individual and group therapy for individuals diagnosed with mental health and co-occurring disorders. “The Department of Behavioral Health anticipates Valley Star will provide transitional age youth crisis residential treatment program services to approximately 158 individuals annually, at an estimated cost of $15,822 per individual,” Kelley said. “As the mental health plan [coordinator] for the county, the Department of Behavioral Health provides an array of behavioral health and mental health treatment services, including crisis intervention services.”
Transitional age youth crisis residential treatment provides an alternative to hospitalization and assists clients in stabilizing and transitioning to lower levels of care and community reintegration.
“The transitional age youth population has specific needs that are addressed by the program,” said Kelley. “Services are voluntary and available for admission 24 hours a day, seven days a week. The program operates on the principal of choice, wellness, recovery, and resilience as defined by the participant. Even when in crisis, transitional age youth are entitled and capable of making their own informed choices about healing and crisis stabilization.”
The transitional age youth crisis residential treatment program is intended to provide a peer-based environment that nurtures informed decision making, provides links to community resources, reinforces the responsibility each person has for themselves, and provides skills for managing crisis and will provide culturally and linguistically competent services.
“Valley Star will provide services at the transitional age youth crisis residential treatment 14-bed facility to eligible transitional age youth who are experiencing an acute psychiatric episode or crisis who will benefit from short-term crisis residential treatment services as an alternative to hospitalization,” said Kelley. “Referrals for transitional age youth crisis residential treatment services will be generated from Department of Behavioral Health clinics and programs, law enforcement, hospital emergency rooms, and mental health assessment teams and may include referrals of individuals who do not meet hospital admission criteria, but will benefit from this level of care. The average length of stay at the crisis residential treatment facility can be up to 30 days with two 30-day extensions, if deemed necessary.”
On October 4, 2016, the county administrative office approved solicited vendors to provide transitional age youth behavioral health services to severely mentally ill individuals in need of immediate access to short-term crisis residential mental health services through the transitional age youth crisis residential treatment program. The bid invitation was publicly advertised through direct mailing to more than 500 organizations, published in eight local newspapers, and listed on the county’s electronic procurement website. A total of four agencies attended the mandatory proposal conference and technical assistance on January 10, 2017. Valley Star submitted the only proposal in response to the bid invitation.
Kelley insisted that Valley Star’s proposal was reviewed and evaluated by Department of Behavioral Health contracts, fiscal, and program staff to ensure it met the requirements as stated in the bid request. The Department of Behavioral Health reviewed and evaluated the proposal based on set criteria, including, but not limited to demonstrated ability to serve the target population, ability to provide required services, demonstrated ability to serve the number of unduplicated participants, readiness to provide services, experience, staffing levels and qualifications, and ability to obtain state license s and certifications.
Also on May 23, the board of supervisors complied with Kelley’s recommendation to sign off on what is termed “0-5 Comprehensive Treatment Services” contract extensions, increasing the total contract amount by $17,683,281, from $53,794,243 to $71,477,524 for the total period of July 1, 2013 through June 30, 2018. The action increased the total contract amount with Christian Counseling Services by $2,147,195, from $6,309,561 to $8,456,756; increased the total contract amount with Desert/Mountain Children’s Center by $5,923,335, from $19,848,132 to $25,771,467; increased the total contract amount with Hearts and Lives by $498,610 from $888,330 to $1,386,940; increased the total contract amount Lutheran Social Services of Southern California by $831,016 from $1,480,548 to $2,311,564; increased the total contract amount with Victor Community Support Services, Inc. by $5,149,144, from $16,323,229 to $21,472,373; and increased the total contract amount with West End Family Counseling Services by $3,133,981 from $8,944,443 to $12,078,424.
On May 23, the board also approved a memorandum of understanding with the Desert/Mountain Special Education Local Plan Area to receive reimbursement of up to $1,621,113 in matching funds for early and periodic screening diagnosis and treatment Medi-Cal Specialty Mental Health Services provided by Desert Mountain Children’s Center, for the period of July 1, 2017 through June 30, 2018.
According to Kelley, “The 0-5 Comprehensive Treatment Services program, consisting of the screening, assessment, referral, and treatment (SART) is designed to improve the social, developmental, cognitive, emotional and behavioral functioning of children ages 0-5. The early identification and intervention services (EIIS) enable young children ages 0 through 8 years of age easy access to needed mental health services which are more appropriately served through early identification and intervention services.”
Kelley said that in 2017-18, she anticipates services will be provided to an estimated 2,269 SART clients at a cost of $4,800 per client, and 2,264 EIIS clients at the cost of $3,000 per client.
The SART program provides services to children, from birth to their seventh birthday who are determined to need assessment and treatment related to severe mental health disorders that require specialty mental health services. The EIIS program provides services directed toward children, from birth to their ninth birthday, throughout the county who are not eligible for services through SART and struggle with social-emotional disturbances or display developmental concerns that require less intensive, short-term interventions.
On June 25, 2013 as the result of a formal procurement, the board of supervisors approved previous contracts with Christian Counseling Services, Desert/Mountain Children’s Center, Hearts and Lives, Lutheran Social Services of Southern California, Victor Community Support Services, Inc., and West End Family Counseling Services for the provision of 0-5 Comprehensive Treatment Services, in the total contracted amount of $35,083,200, for the period of July 1, 2013 through June 30, 2016. The contracts included the option of two one-year extensions based on availability of funds and contractor performance. Since that time, the board has approved amendments to the contracts, with the most recent on June 14, 2016 updating standard contract language, increasing the total contract amount to $53,794,243, and exercising the first option to extend the contracts through June 30, 2017.
This week the board also approved a second amendment to a contract with the Children and Families Commission for San Bernardino County for the reimbursement of services provided through the 0–5 Comprehensive Treatment Services program, updating standard contract language, extending the contract an additional year, and increasing the total contract amount by $5,134,283, from $20,590,517 to $25,724,800, for the period of July 1, 2013 through June 30, 2018.
Again upon Kelley’s recommendation, the board approved contracts with Aurora Charter Oak Hospital, Canyon Ridge Hospital, Inc. dba Canyon Ridge Hospital, Community Hospital of San Bernardino, Loma Linda University Behavioral Medicine Center, Vista Behavioral Hospital, LLC dba Pacific Grove Hospital and Redlands Community Hospital for the provision of acute psychiatric inpatient services to eligible county residents that are Medi-Cal eligible as well as for individuals served by the indigent care program, in an aggregate amount not to exceed $12,000,000, for the period of July 1, 2017 through June 30, 2020.
“Procurement is not conducted for the provision of acute psychiatric inpatient services as the State of California determines the area fee-for-service hospital(s) the county is required to contract with for these services,” Kelley said. -Mark Gutglueck