RFP-DBH-12-16-25-Inpatient Concurrent Review.pdf

Request for Proposal for

Inpatient Concurrent Review

Georgina Yoshioka, Director Department of Behavioral Health

San Bernardino County Department of Behavioral Health

Contracts Administration 303 East Vanderbilt Way

San Bernardino, CA 92415-0026

RFP DBH 25-61

ePro Document ID # DBHE26-ADMN-6093

Request for Proposals San Bernardino County Department of Behavioral Health Title: Inpatient Concurrent Review RFP DBH 25-61 / ePro Bid # DBHE26-ADMN-6093 i

TABLE OF CONTENTS

I. INTRODUCTION

A. Purpose B. Period of Contract C. Proposal Conference D. Questions E. Correspondence F. Admonition to Proposers G. Proposal Submission Deadline H. Assistance to Proposers with a Disability

II. PROPOSAL TIMELINE

III. PROPOSAL CONDITIONS

A. All Proposers must:

B. Authorized Signatures C. Contingencies D. Term of Offer E. Required Review F. Right of Rejection G. Best Value Evaluation Process H. Amendments/Addendums to RFP I. Proposal Submission J. Local Preference Policy K. Incurred Costs L. Public Records Act M. Clarification of Offers N. Formal Agreement O. Independent Contractor Status P. Pre-Award On-Site Visits Q. Level of Service R. Termination of Awarded Contract S. Iran Contracting Act of 2010 T. Executive Order N-6-22 – Russia Sanctions U. California Consumer Privacy Act V. Final Authority

IV. PROGRAM REQUIREMENTS (SCOPE OF WORK)

A. Definitions B. Background C. Program Description

V. CONTRACT REQUIREMENTS

A. General B. Indemnification and Insurance Requirements C. Right to Monitor and Audit Performance and Records

VI. EQUAL EMPLOYMENT OPPORTUNITY/CIVIL RIGHTS

A. Equal Employment Opportunity Program B. Civil Rights Compliance C. Policy Prohibiting Discrimination, Harassment, and Retaliation

VII. EMPLOYMENT OF FORMER COUNTY OFFICIALS

VIII. IMPROPER CONSIDERATION

IX. DISCLOSURE OF CRIMINAL AND CIVIL PROCEEDINGS

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X. SUBCONTRACTOR STATUS

XI. PROPOSAL SUBMISSION

A. General B. Proposal Presentation C. Proposal Format

XII. PROPOSAL EVALUATION AND SELECTION

A. Evaluation Process B. Evaluation Criteria C. Negotiations and Notice of Intent to Award D. Appeal and Award E. Final Authority

ATTACHMENTS:

A. Proposal Submission Checklist B. Table of Contents C. Statements of Certification D. Reportable Conditions E. Disclosures, Exceptions, and California Public Records Act Exemptions to RFP F. Subcontractor Information G. Financial Capability H. Indemnification and Insurance Requirements Affidavit I. Rate Sheet Sample J. Rate Sheet Cover Page K. References Form L. Attestation Regarding Ineligible/Excluded Persons M. Data Security Requirements N. Local Vendor Preference Self-Certification O. Certification Regarding Debarment or Suspension; California Secretary of State Business Entity

Registration P. Business Associate Agreement

I. INTRODUCTION

A. Purpose

San Bernardino County (County), through Department of Behavioral Health (DBH) is seeking proposals from interested and qualified organizations and agencies, hereinafter referred to as “Proposers” or “Contractors,” to provide Inpatient Concurrent Review (ICR) services to evaluate real-time authorizations that are conducted for every Medi-Cal psychiatric inpatient stay to ensure that each day of care remains medically necessary, is delivered at the appropriate level, and is aligned with an established discharge and aftercare plan. DBH is seeking to award one (1) contract to an eligible proposer within the United States.

B. Period of Contract

Specific services to be provided under this Request for Proposals (RFP) are outlined under Section IV, Program Requirements. The contract period will be for a five (5) year period beginning on July 1, 2026 through June 30, 2031. Currently, the projected allocation for this service is approximately $11,983,620. The estimated yearly allocations are indicated on the table below:

Fiscal Year (July 1 through June 30)

Amount

26-27 $1,764,543

27-28 $1,982,704

28-29 $2,664,704

29-30 $2,744,685

30-31 $2,826,984

C. Proposal Conference

1. A proposal conference will be held via Microsoft Teams on: Tuesday, January 13, 2026 beginning at 9:00 A.M. (PST) at:

https://teams.microsoft.com

Meeting ID: 248 843 578 278 3 Meeting password: HN6ez9zX

Join by phone:

+1 661-568-6806, United States Phone Conference ID: 102 074 852#

2. Attendance at the proposal conference is strongly recommended, as important information regarding this RFP will be discussed and questions will be addressed.

D. Questions

All questions relating to this RFP must be submitted in writing via e-mail, fax, or mail to the contact listed in Paragraph E of this Section. Questions should be clear and concise and include references to sections of the RFP when applicable. The deadline to submit questions is 12:00 https://teams.microsoft.com/ noon (PST), on Tuesday, January 20, 2026. The subject line of the facsimile (fax) or e-mail must read: RFP DBH 25-61.

Answers to written questions will be compiled into one (1) or more documents and posted as an Addendum on the following County website within two (2) weeks following the deadline to submit questions:

https://epro.sbcounty.gov/bso/

E. Correspondence

All correspondence, including proposals and questions, are to be submitted through ePro or to the RFP contact:

San Bernardino County Department of Behavioral Health

ATTN: Contracts Development Unit

RE: RFP DBH 25-61

303 East Vanderbilt Way, 1st Floor Reception San Bernardino, CA 92415-0026

RFP Contact Person: Shane Hibbard-Miller Phone: (909) 386-8264 E-mail: Shane.Hibbard-Miller@dbh.sbcounty.gov Fax: (909) 890-0470

Fax number and e-mail address may be used to submit questions only. Proposals will not be accepted by fax or e-mail.

F. Admonition to Proposers

Once the RFP has been issued, the individual identified above is the sole contact point for any inquiries or information relating to this RFP. Failure to adhere to this policy may result in disqualification of the Proposer and rejection of proposal.

G. Proposal Submission Deadline

1. All proposals or bids must be received no later than 4:00 P.M. (PST) on Tuesday, February 10, 2026. Late or incomplete proposals or bids will not be accepted.

2. An electronic proposal or bid can be submitted through ePro:

https://epro.sbcounty.gov/bso/. Submittals in ePro will be opened from the system’s “encrypted lock box” after the deadline and evaluated as stated in this solicitation. If the proposal or bid is submitted through ePro, the proposal or bid may also be withdrawn OR retrieved, adjusted, and re-submitted by the Vendor at any time prior to the scheduled deadline for submission of the proposal or bid. If the proposal or bid is submitted through ePro, the proposer/bidder acknowledges that its electronic signature is legally binding. OR

3. Hard copies of the proposal or bid containing original signatures will also be accepted at the location identified in this solicitation in Paragraph E above. Postmarks will not be https://epro.sbcounty.gov/bso/ accepted in lieu of actual receipt. The proposal or bid can be withdrawn at any time prior to the scheduled deadline for submission of the proposal or bid.

4. Proposals must be received by the designated date and time. All Proposers must register with the ePro system prior to the date and time to receive the proposal or they will be disqualified. Late or incomplete proposals will not be accepted.

Electronic response must be submitted through the San Bernardino County Electronic Procurement Network (ePro) https://epro.sbcounty.gov/bso/. System-related issues in ePro shall be directed to the Purchasing Department at (909) 387-2060. For procurement questions involving ePro, please contact the RFP Contact identified in Section I, Paragraph E - Correspondence.

H. Assistance to Proposers with a Disability

Proposers with a disability may request accommodation regarding the means of communicating this RFP or participating in the procurement process. For more information, contact the RFP Contact no later than ten (10) days prior to the Deadline for Submission of Proposals.

II. PROPOSAL TIMELINE

RFP Release Date Tuesday, December 16, 2025

Proposal Conference Tuesday, January 13, 2026 at 9:00 A.M. (PST)

Deadline for Submission of Questions

Tuesday, January 20, 2026 by 12 noon (PST)

**Questions may be submitted in writing prior to the Proposal Conference

Deadline for Submission of Proposals Tuesday, February 10, 2026 by 4:00 P.M. (PST)

Tentative Start Date for Contract(s) July 1, 2026

The above dates are subject to change as deemed necessary by San Bernardino County.

III. PROPOSAL CONDITIONS

A. All Proposers must:

1. Be a non-profit, for-profit organization or other legally constituted business entity.

2. Have no record of unsatisfactory performance with any government agency or County Department including DBH in the twenty-four (24) month period immediately preceding the date of issuance of this RFP. Proposers who are or have been seriously deficient in contract performance during this period, in the absence of circumstances properly beyond the control of the Proposer, shall be presumed to be unable to meet this requirement.

3. Register in the County’s Electronic Procurement Network (ePro) system.

4. Meet other presentation and participation requirements listed in this RFP.

B. Authorized Signatures

All proposals must be signed by an individual authorized to bind the Proposer to the provisions of the RFP.

C. Contingencies

Funding for this program is contingent on funding from the appropriate office of the State of California (State) and is subject to reimbursement under Federal and State laws. This RFP does not commit the County to award a contract. Cost, while not necessarily the primary factor used in the selection process, is an important factor. The County will award a contract based on the proposal that best meets the needs of the County.

D. Term of Offer

Proposals shall remain open, valid, and subject to acceptance anytime within nine (9) months after the proposal opening.

E. Required Review

Proposers should carefully review this RFP for defects and questionable or objectionable material.

Comments from Proposers concerning defects and objectionable material in this RFP must be made in writing and received by the RFP contact prior to the deadline for submission of questions identified in Section II or at least ten (10) calendar days before the Deadline for Submission of Proposals (whichever occurs last). This will allow issuance of any necessary amendments or addendums to the RFP. It will also help prevent the opening of a defective proposal and exposure of proposals upon which an award could not be made. Protests based on any omission or error, or on the content of this RFP, may be disallowed if not submitted in writing to the attention of the RFP Contact, prior to the deadline for submission of questions identified in Section II or at least ten (10) calendar days before the Deadline for Submission of Proposals (whichever occurs last).

F. Right of Rejection

Proposals must comply with all of the terms of the RFP, and all applicable local, State, and Federal laws, codes, and regulations. County may reject as nonresponsive any proposal that does not comply with all of the material and substantial terms, conditions, and performance requirements of the RFP. Further, the County may reject a proposal from any entity that is a parent, affiliate, or subsidiary, or that is under common ownership, control, or management with any other entity submitting a Proposal in response to this RFP.

Proposer may not qualify the proposal nor restrict the rights of the County. If Proposer does so, the proposal may be determined to be a nonresponsive counteroffer and the proposal may be rejected.

No proposal shall be rejected, however, if it contains a minor irregularity, defect or variation and if the irregularity, defect or variation is considered by the County to be immaterial or inconsequential, the County may choose to accept the proposal.

Minor informalities may be waived by the County when they:

• Do not affect responsiveness;

• Are merely a matter of form or format;

• Do not change the relative standing or otherwise prejudice other offers;

• Do not change the meaning or scope of the RFP;

• Are trivial, negligible, or immaterial in nature;

• Do not reflect a material change in the work; or

• Do not constitute a substantial reservation against a requirement or provision.

In such cases the Proposer will be notified of the deficiency in the proposal and given an opportunity to correct the irregularity, defect or variation or the County may elect to waive the deficiency and accept the proposal. The decision to provide a waiver shall in no way modify or compromise the overall purpose of the submittal, nor excuse the Proposer from compliance with all requirements if awarded a contract.

This RFP does not commit the County to award a contract. County reserves the right to reject any or all proposals if it is in the best interest of the County to do so. County also reserves the right to terminate this RFP process at any time.

G. Best Value Evaluation Process

As established in this RFP, the County realizes that criteria other than price are important and will award contract(s) based on the proposal that best meets the needs of the County. The County seeks the optimal combination of quality, price, and various qualitative elements of the required services that will provide the County the greatest or best value for its money.

H. Amendments/Addendums to RFP

The County reserves the right to issue amendments or addendums to this RFP if the County considers that changes are necessary or additional information is needed.

Changes to a proposal or withdrawal of a proposal will only be allowed if a request is received prior to the Deadline for Submission of Proposals. No amendments or withdrawals will be accepted after the Deadline for Submission of Proposals.

I. Proposal Submission

To be considered, all proposals must be submitted in the manner set forth in this RFP. Submission of a proposal indicates that the Proposer has read and understands the entire RFP, including all appendixes, attachments, exhibits, schedules, and addenda (as applicable) and that all concerns regarding the RFP have been resolved. It is the Proposer’s responsibility to ensure that its proposal arrives on or before the specified deadline. All proposals and materials submitted become the property of the County.

J. Local Preference Policy

San Bernardino County has adopted a Local Preference Policy. A local preference of five percent (5%) shall be applied in the cost evaluation of proposals or bids for goods, services, equipment, or a minor public work project, unless an exemption applies. In a price-based bid, five percent (5%) will be deducted from the local vendor’s proposed cost for the purpose of comparison when the local vendor’s proposed cost is not the lowest. If the local vendor’s bid is equal to or lower than the price of an otherwise successful non-local vendor after the 5% preference is applied, the local vendor will be given the opportunity to match the lowest quoted price. In a best value evaluation, five percent (5%) of the awardable points for cost will be added to the local vendor’s score. If the local vendor’s overall score is equal to or lower than that of an otherwise successful nonlocal vendor, the local vendor will be recommended for award.

Local Preference per County Policy 11-10: “Due to the evaluation of qualitative elements along with cost in a best value evaluation, application of local preference for cost proposals may not result in award to a local vendor with the lowest cost after applying local preference.”

Local Vendor - A local vendor is any vendor, contractor or consultant (hereafter “vendor”) that meets all of the following requirements:

1. Vendor’s main office (headquarters) or a major regional office is located within the County.

2. Vendor employs a minimum of twenty-five percent (25%) of the vendor’s full-time management employees and twenty-five percent (25%) of its full-time regular employees working from the San Bernardino County location(s).

3. Vendor employs one (1) full-time or two (2) part-time employees with primary residence in the County.

4. Vendor’s “point of sale” for purposes of reporting sales tax to the State Board of Equalization is within the boundaries of the County. The payment of any local share of sales tax must go to the County or a city within the County. If the local business has more than one sales office in the State of California, the office located in the County shall be the point of sale for sales tax calculation.

5. Vendor is not delinquent in any taxes or other payments to the County.

6. Vendor possesses a valid and verifiable business license (if required).

7. Vendor has been open and established for at least six (6) months prior to the issuance of the solicitation;

8. Vendor can demonstrate on-going business activity in the field of endeavor on which they are proposing from that office during the preceding six (6) months.

9. Vendor has not within five (5) years prior to the solicitation admitted guilt or been found guilty by any court or state or federal regulatory enforcement agency of violation of any criminal law or any law or regulation regarding fraud.

10. Vendor is not federally debarred.

11. Vendor is not suspended or debarred from participation in doing business with the County, in the scope of work that is the subject of the solicitation.

12. Local Vendor Self-certification – Documentation provided.

Local Vendor self-certification form is required for any bid or proposal when a local preference is claimed affirming that it meets each of the above stated criteria and signed by a vendor representative with the authority to obligate the company under penalty of perjury. (See Attachment N).

K. Incurred Costs

The County is not obligated to pay any costs incurred by Proposer in the preparation of a proposal in response to this RFP. Proposer agrees that all costs incurred in developing this proposal are the Proposer’s responsibility.

L. Public Records Act

All proposals and other material submitted become the property of the County and are subject to release according to the California Public Records Act (Government Code § 6250). All proposal information, including cost information, will be held in confidence during the evaluation and negotiation process. Thereafter, proposals are subject to becoming a non-exempt public record.

If a Proposer believes that any portion of its proposal is exempt from public disclosure, it must indicate the specific portions believed to be confidential and not subject to disclosure on Attachment E. The Proposer also must include a brief description that sets out the reasons for exemption from disclosure. Each stated exemption must include a citation to supporting legal authority, including statutory authority or case law, to support exemption from the Public Records Act. Requested exemptions that do not meet the requirements of this section will not be considered.

The County will use reasonable means to ensure that such information is safeguarded but will not be held liable for inadvertent disclosure of the information. Proposals marked “Confidential” in their entirety will not be honored, and the County might not deny public disclosure of any portion of proposals so marked.

By submitting a proposal with portions identified in Attachment E as “Confidential,” Proposer represents that it has a good faith belief that such portions are exempt from disclosure under the California Public Records Act. Proposer may be requested to obtain legal protection from disclosure should a Public Records Act request be received. In the event the County does not disclose the information marked “Confidential,” Proposer agrees to reimburse the County for, and to indemnify, defend (with counsel approved by County) and hold harmless the County, its officers, employees, agents, and volunteers from and against any and all claims, damages, losses, liabilities, suits, judgments, fines, penalties, costs and expenses, including without limitation, attorneys’ fees, expenses and court costs of any nature arising from or relating to the County’s non-disclosure of any such designated portions of a proposal.

M. Clarification of Offers

1. The County may require the potential Proposer(s)/Contractor(s) selected to provide additional information or clarification on any area contained in this RFP or which might be used to evaluate vendors. This may include cost, technical, or other clarifications needed to make a decision.

2. In order to determine if a proposal is reasonably susceptible for award, communications by the Facilitator for the evaluation panel are permitted with a Proposer to clarify uncertainties or eliminate confusion concerning the contents of a proposal. Clarifications may not result in a material or substantive change to the proposal. The evaluation by the panel may be adjusted as a result of such clarification under this section.

N. Formal Agreement

Proposer will be required to enter into a formal contract with the County. This RFP sets forth some of the general provisions which will be included in the final contract. In submitting a response to this RFP, the proposer will be deemed to have agreed to each clause unless the proposal identifies an objection and County agrees to a change of language in writing. All objections to any provisions of the final contract should be listed on Attachment E – Disclosures, Exceptions, and Public Records Act Exemptions to RFP, or any exception thereto shall be waived.

O. Independent Contractor Status

Any Proposer that is awarded a contract will be considered an independent Contractor(s), wholly responsible for the manner in which it performs, and will assume exclusively the responsibility for the acts of its employees who will not be entitled to any rights and privileges of County employees nor be considered in any manner to be County employees.

P. Pre-Award On-Site Visits

Site visits may be conducted to verify information submitted in the RFP and to determine if the proposed facilities are appropriate for the proposed services to be provided.

Q. Level of Service

For any contract awarded as a result of the RFP, no minimum or maximum number of ICR requests can be guaranteed by the County.

R. Termination of Awarded Contract

The contract between the County and selected Proposer(s) will contain specific language which addresses the option of both the selected Proposer(s) or County to terminate the contract without cause, termination for the convenience of the County, and termination for cause.

S. Iran Contracting Act of 2010

In accordance with Public Contract Code Section 2204(a), the Proposer certifies that at the time the proposal is submitted, the Proposer signing the proposal is not identified on a list created pursuant to subdivision (b) of Public Contract Code Section 2203 (https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List- Folder/List-of-Ineligible-Businesses) as a person [as defined in Public Contract Code Section 2202(e)] engaging in investment activities in Iran described in subdivision (a) of Public Contract Code Section 2202.5, or as a person described in subdivision (b) of Public Contract Code Section 2202.5, as applicable.

Proposers are cautioned that making a false certification may subject the Proposer to civil penalties, termination of existing contract, and ineligibility to bid on a contract for a period of three

(3) years in accordance with Public Contract Code Section 2205. Proposer agrees that signing the proposal shall constitute signature of this Certification.

T. Executive Order N-6-22 – Russia Sanctions

On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (the EO) regarding Economic Sanctions against Russia and Russian entities and individuals. “Economic Sanctions” refers to sanctions imposed by the U.S. government in response to Russia’s actions in Ukraine https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/List-of-Ineligible-Businesses https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/List-of-Ineligible-Businesses

(https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information/ukraine-russia-related-sanctions), as well as any sanctions imposed under state law (https://www.dgs.ca.gov/OLS/Ukraine-Russia). By submitting a bid or proposal, Proposer represents that it is not a target of Economic Sanctions. Should it be determined Proposer is a target of Economic Sanctions or is conducting prohibited transactions with sanctioned individuals or entities, that shall be grounds for rejection of the Proposer’s bid/proposal any time prior to contract execution, or, if determined after contract execution, shall be grounds for termination by the County.

U. California Consumer Privacy Act

To the extent applicable, if Contractor is a business that collects the personal information of a consumer(s) in performing services pursuant to this contract, Contractor must comply with the provisions of the California Consumer Privacy Act (CCPA). (Cal. Civil Code §§1798.100, et seq.).

For purposes of this provision, “business,” “consumer,” and “personal information” shall have the same meanings as set forth at Civil Code section 1798.140. Contractor must contact the County immediately upon receipt of any request by a consumer submitted pursuant to the CCPA that requires any action on the part of the County, including but not limited to, providing a list of disclosures or deleting personal information. Contractor must not sell, market or otherwise disclose personal information of a consumer provided by the County unless specifically authorized pursuant to terms of this contract. Contractor must immediately provide to the County any notice provided by a consumer to Contractor pursuant to Civil Code section 1798.150(b) alleging a violation of the CCPA, that involves personal information received or maintained pursuant to this contract. Contractor must immediately notify the County if it receives a notice of violation from the California Attorney General pursuant to Civil Code section 1798.155(b).

V. Final Authority

The final authority to award a contract as a result of this RFP rests solely with San Bernardino County Board of Supervisors, or as delegated by the Board of Supervisors.

IV. PROGRAM REQUIREMENTS (SCOPE OF WORK)

A. Definitions

1. The terms Proposer, Contractor, Provider, or Vendor/Applicant are used interchangeably throughout this document referring to the entity submitting a response and may subsequently become a Contractor.

2. The terms beneficiary, client, customer, participant, or patient are used interchangeably throughout this document and refers to the individual(s) receiving services.

3. Definition of May, Shall, and Should. Whenever in this document the words “may”, “shall”, and “should” are used, the following definitions shall apply: “may” is permissive; “shall” is mandatory; and “should” means desirable.

4. Wherever in this document and in any attachments hereto, the terms "Contract" and/or "Agreement" are used to describe the conditions and covenants incumbent upon the parties hereto, these terms are interchangeable.

5. Definition of May, Shall and Should. Whenever in this document the words "may," "shall" and "should" are used, the following definitions shall apply: "may" is permissive; "shall" is mandatory; and "should" means desirable.

6. The term “Director,” unless otherwise stated, refers to the Director of the Department of Behavioral Health for San Bernardino County.

7. Acute Day: A day during which the beneficiary meets medical necessity criteria for inpatient psychiatric services, requiring twenty-four (24) hour medical and psychiatric care.

8. Acute Psychiatric Hospital: A facility licensed by the California Department of Health Care Access and Information (HCAI) as a hospital providing acute psychiatric inpatient services and certified by DHCS to provide Medi-Cal psychiatric inpatient hospital services.

9. Administrative Day: A day in which the beneficiary no longer meets criteria for acute care but remains hospitalized due to lack of appropriate discharge placement (e.g., waiting for a residential facility).

10. Authorization: The process by which a MHP determines whether a requested specialty mental health service is medically necessary for a Medi-Cal beneficiary and authorizes the provision of those services.

11. Concurrent Review: The utilization management process conducted during an inpatient stay to determine whether continued services are medically necessary. The review ensures that care remains appropriate and that the patient still meets criteria for acute inpatient services.

12. County of Responsibility: The California county mental health plan (MHP) that is financially responsible for providing or arranging Medi-Cal specialty mental health services for a Medi- Cal beneficiary.

13. Department of Behavioral Health (DBH): San Bernardino County Department of Behavioral Health, under state law, provides mental health, substance use disorder treatment and services to County residents. In order to maintain a continuum of care, DBH operates or contracts for the provision of prevention and early intervention services, twenty-four (24) hour care, outpatient services, case management, crisis and referral services and emergency shelter beds services. Community services are provided in county metropolitan and rural areas and are readily accessible to County residents.

14. Fee-for-Service/Medi-Cal Hospital: A psychiatric hospital that provides Medi-Cal covered psychiatric inpatient hospital services and is reimbursed directly by the State of California rather than through county MHPs.

15. General Acute Care Hospital: A hospital licensed under Health & Safety Code §1250(a) that provides a wide range of medical, surgical, and emergency care, and may include psychiatric units licensed for inpatient psychiatric care.

16. Inpatient Psychiatric Hospital Services: Provided in a hospital that has been certified as a provider of psychiatric services under the California Medi-Cal program. These services are provided to eligible beneficiaries who, due to a mental disorder, require twenty-four (24) hour inpatient care for diagnosis or treatment of a mental disorder.

17. Institution for Mental Diseases (IMD): A facility with more than sixteen (16) beds primarily engaged in the treatment of mental illness. IMDs are not eligible for federal Medicaid reimbursement for beneficiaries aged twenty-one (21) through sixty-four (64), unless part of a waiver (e.g., California Advancing and Innovating Medi-Cal (CalAIM)).

18. Medical Necessity: The standard per Title 9 of the California Code of Regulations (CCR) used to determine whether a mental health service is appropriate and required for diagnosing or treating a mental disorder, based on clinical criteria and functional impairment. This includes the presence of a covered behavioral health diagnosis manifested by acute symptoms of sufficient severity that the absence of immediate behavioral health services could reasonably be expected to result in a patient’s health being placed in jeopardy and/or the patient being a danger to self and/or others.

19. Mental Health Plan (MHP): A county or group of counties responsible for administering Medi- Cal specialty mental health services to beneficiaries within that jurisdiction under a contract with the California Department of Health Care Services (DHCS).

20. Short-Doyle/Medi-Cal Hospital: A psychiatric hospital or psychiatric health facility that is part of the SD/MC program, a funding and reimbursement structure used by California counties to pay for specialty mental health services provided to Medi-Cal beneficiaries.

21. Subcontractor: An individual, company, firm, corporation, partnership or other organization, not in the employment of or owned by Contractor who is performing services on behalf of Contractor under the contract or under a separate contract with or on behalf of Contractor.

22. Treatment Authorization Log (TAR): A formal request for approval to provide specific treatments or services to members, particularly in the Medi-Cal system of care.

23. Utilization Review Platform (UR): a software used to automate, standardize, and manage the process of determining the medical necessity and appropriateness of specific care for patients.

B. Background

DBH is required to manage authorizations directly for inpatient acute psychiatric hospital services or delegate those functions to an administrative entity. Implementing concurrent review for inpatient acute psychiatric hospitalizations enables a consistent and efficient review process across participating counties and supports DBH's compliance with DHCS Behavioral Health Information Notice (BHIN) 19-026, BHIN 22-017, and the federal Parity in Mental Health and Substance Use Disorder Services Final Rule (Final Rule) (42 CFR §438.910).

The purpose of a concurrent review process is to evaluate real time authorizations that are conducted for every Medi-Cal psychiatric inpatient stay to ensure that each day of care remains medically necessary, is delivered at the appropriate level, and is aligned with an established discharge and aftercare plan.

Concurrent review allows hospitals to receive timely feedback and update subsequent documentation to meet Medi-Cal standards while patients are receiving inpatient care. This increases a higher likelihood of approval for services reimbursed to contractors. Additionally, inpatient authorization regulations allow hospitals to be retroactively reimbursed for bed days provided in prior fiscal years in circumstances including hospitalizations that cross fiscal years, appealed bed days, and resubmitted documentation to correct administrative errors.

C. Program Description

1. Program Objective

DBH is seeking a qualified contractor within the United States to provide comprehensive psychiatric inpatient concurrent review and authorization services through a UR with integrated clinical services. The concurrent review process must occur in real time while the patient is still hospitalized, ensuring authorization decisions for Medi-Cal covered inpatient psychiatric services are made concurrently with the hospital stay and prior to the patient’s discharge. This model supports timely and medically appropriate treatment while facilitating effective care coordination and discharge planning while aligning with compliance of the BHINs and Final Rule as stated above.

Concurrent review services enhance the efficiency, consistency, and clinical appropriateness of inpatient utilization management by applying medical necessity criteria uniformly, reducing authorization delays, and promoting timely transitions to lower levels of care. This approach also allows DBH to reallocate time and resources toward care coordination, strengthens data reporting and accountability, and aligns with CalAIM goals.

These goals include but are not limited to streamlining access, reduce unnecessary inpatient stays, and improving integration between behavioral and physical health systems.

2. Program Requirements

As part of DBH’s expectations for service delivery, the County is seeking the following service commitments:

a. Concurrent review and authorization of psychiatric inpatient services provided to the following populations:

i. Medi-Cal members receiving psychiatric inpatient hospital services in any hospital within San Bernardino County.

ii. Indigent persons receiving psychiatric inpatient hospital services in a hospital within San Bernardino County.

iii. Medi-Cal members with a County of Responsibility other than San Bernardino County receiving psychiatric inpatient hospital services at the County Short- Doyle/Medi-Cal hospital.

b. Response to hospital inquiries within two (2) calendar days to support real time decision-making and reduce unnecessary inpatient days.

c. Establishment of a mechanism for identifying and documenting administrative days to ensure DBH can properly process payments when medically necessary services are no longer required but the patient remains hospitalized due to placement barriers.

d. Timely submission of completed TARs to DBH within five (5) business days of completion.

e. Strict adherence to all applicable federal, state, and local regulatory requirements, including relevant DHCS BHINs and compliance with the Parity in Mental Health and Substance Use Disorder Services Final Rule (42 CFR §438.910).

3. Staffing Requirements

All staff shall be employed, or contracted for, by the Contractor. Staff work the designated number of hours per week in full time equivalents (FTE's), perform the job functions specified for Inpatient Concurrent Review and shall meet the CCR requirements.

a. Contractor shall hire and train qualified staff in compliance with all applicable State regulations.

b. Contractor shall maintain ongoing compliance with Medi-Cal Utilization Review requirements and record keeping requirements, per BHIN 22-017 to include subsequent notices published in regard to concurrent review. The Contractor will participate in on-going contract related Medi-Cal audits by the State. A copy of the plan of correction regarding deficiencies will be forwarded to DBH.

c. Contractor shall participate in DBH’s annual evaluation of the program and shall make required changes in areas of deficiency.

d. Contractor shall make available to the DBH Program Manager copies of all administrative policies and procedures utilized and developed for service location(s) and shall maintain ongoing communication with the Program Manager regarding those policies and procedures.

e. Contractor must submit a report to the DBH Program Manager by the fifth (5th) of each month. As a minimum, the monthly report must include an overview of the total caseload, number of Medi-Cal cases and non-Medi-Cal cases. The report is to cover changes and status of staffing, program and services that impact service delivery under the contract.

f. Contractor shall submit additional reports as required by DBH.

g. Contractor shall designate a licensed Medical Doctor (MD) to be available for consultation, respond to complex hospital inquiries, and participate in peer-to-peer discussions when needed to support medical necessity determinations and resolve care disputes in a clinically appropriate and timely manner. Contractor’s MD or designee must attend ad hoc and prescheduled meetings as determined by the County.

h. Contractor understands that compliance with all standards listed is required by the State and the San Bernardino County. Failure to comply with any of the above requirements or special provisions below may result in reimbursement being withheld until Contractor is in full compliance.

i. Contractor shall be required to maintain adequate staffing levels and appropriate licensure for all personnel performing concurrent review and authorization functions.

Contractor shall be in accordance with applicable state and federal regulations, including BHIN’s and any subsequent guidance issued DHCS. Staffing must be sufficient to ensure that all clinical and administrative requirements of the concurrent review process are met in a timely and compliant manner.

j. To support strong operational alignment and accountability, DBH requires direct access to contractor leadership to ensure swift resolution of issues and maintain open lines of communication. The contractor must assign a dedicated team or staff member solely responsible for servicing DBH, in order to promote consistency, responsiveness, and a working familiarity with the County’s unique systems, workflows, and community needs.

4. Administrative Requirements

a. The contractor must have the ability to maintain acceptable electronic files and records which preserve the original record’s integrity and meet statistical reporting requirements.

b. The contractor must have the administrative and fiscal capability to provide and manage the proposed services and to ensure an adequate audit trail.

c. The contractor will be responsible for holding hospitals accountable to the established timeliness standards as outlined in Title 9 of the California Code of Regulations and all applicable BHIN’s, including but not limited to the following key deadlines:

i. Admission Notification – Hospitals must submit notification of admission within twenty-four (24) hours of the patient’s admission.

ii. Treatment Authorization Request (TAR) Submission – TARs must be submitted within fourteen (14) calendar days following discharge or after ninety-nine (99) consecutive inpatient days, whichever occurs first.

iii. Retroactive TAR Submission – Retroactive TARs must be submitted within sixty (60) days of the identification of the need for such a request.

d. The contractor is expected to maintain ongoing collaborative meetings with DBH on a monthly basis throughout the term of the contract to facilitate communication, problem-solving, and continuous quality improvement.

e. Any changes to concurrent review criteria or enforcement thereof must be communicated in writing to the DBH Deputy Director of Program Support Services (PSS) and/or designee in advance, no later than thirty (30) days prior to implementation by the contractor.

5. Information Technology Requirements

1. The contractor shall maintain a secure, web-based provider portal that offers real-time access to accurate records for DBH and contracted hospitals.

2. The contractor shall offer “read-only” access to DBH on the web-based provider portal to ensure transparency and open communication.

3. The contractor shall have the appropriate amount of electronic storage capacity to maintain all accurate and acceptable records for a minimum of ten (10) years from the final date of the contract period or from the date of completion of any audit, whichever is later.

4. The contractor must provide the ability to generate customizable reports that support DBH’s administrative, clinical, and quality assurance functions. These reports must include, but not be limited to:

a. Number of approved and denied inpatient days.

b. Reasons for denial.

c. Correspondence details between the contractor and hospital regarding pending and/or potential denials.

d. Inpatient hospitalization counts, categorized by hospital and time period.

e. Individual member hospitalization histories.

f. High utilizer reports identifying members with frequent hospitalizations.

g. Reports that can be exported and integrate with DBH’s existing TAR Log to allow for a centralized and comprehensive historical tracking system.

5. The contractor must provide DBH with direct access to data and reporting tools through the provider portal, allowing the department to run queries independently and on demand as needed for planning, monitoring, and compliance purposes.

6. The contractor shall provide training and technical assistance for all DBH personnel utilizing the secure, web-based provider portal, including:

a. Training on accessing and navigating the portal.

b. Guidance and support with documentation standards.

c. Ongoing technical and documentation support as needed.

V. CONTRACT REQUIREMENTS

A. General

The selected Proposer(s) may be required to agree to the terms contained below. If the Proposer has any objections, these objections must be addressed in the RFP response to the County or the objections will be deemed to have been waived.

Please note that the final contract may contain additional terms and conditions not listed herein.

1. Representation of the County

In the performance of the contract, Contractor, its agents and employees, shall act in an independent capacity and not as officers, employees, or agents of the County.

2. Contractor Primary Contact

a. Contractor will designate an individual to serve as the primary point of contact for the contract. Contractor shall not change the primary contact without written notification and acceptance of the County. Contractor shall notify DBH when the primary contact will be unavailable/out of the office for one (1) or more workdays and will also designate a back-up point of contact in the event the primary contact is not available.

Contractor or designee must respond to DBH inquiries within two (2) business days.

b. Contractor shall provide DBH with contact information, specifically, name, phone number and e-mail address of Contractor’s staff member who is responsible for the following processes: Business regarding administrative issues, Technical regarding data issues, Clinical regarding program issues; and Facility.

3. Background Checks for Contractor Personnel

Contractor shall ensure that its personnel (a) are authorized to work in the jurisdiction in which they are assigned to perform services; (b) do not use legal or illegal substances in any manner which will impact their ability to provide services to the County; and (c) are not otherwise disqualified from performing the services under applicable law. If requested by the County and not in violation of applicable law, Contractor shall conduct a background check, at Contractor’s sole expense, on all its personnel providing. If requested by the County, Contractor shall provide the results of the background check of each individual to verify that the individual meets Contractor’s standards for employment. Such background check shall be in the form generally used by Contractor in its initial hiring of employees or contracting for contractors or, as applicable, during the employment screening process but must, at a minimum, have been performed within the preceding twelve (12) month period. Contractor personnel who do not meet the County’s hiring criteria, in County’s sole discretion, shall not be assigned to work on County property or services, and County shall have the right, at its sole option, to refuse access to any contract personnel to any County facility.

4. Change of Address

Contractor shall notify the County in writing, of any change in mailing address within ten

(10) business days of the change.

5. Choice of Law

This contract shall be governed by and construed according to the laws of the State of California.

6. Compliance with County Policy

In performing the services and while at any County facilities, Contractor personnel (including subcontractors) shall (a) conduct themselves in a businesslike manner; (b) comply with the policies, procedures, and rules of the County regarding health and safety, and personal, professional and ethical conduct; (c) comply with the finance, accounting, banking, Internet, security, and/or other applicable standards, policies, practices, processes, procedures, and controls of the County; and (d) abide by all laws applicable to the County facilities and the provision of the services, and all additions and modifications to each of subsections (b), (c), and (d) (collectively, “County Policies”). County Policies, and additions or modifications thereto, may be communicated orally or in writing to Contractor or Contractor personnel or may be made available to Contractor or Contractor personnel by conspicuous posting at a county facility, electronic posting, or other means generally used by County to disseminate such information to its employees or contractors.

Contractor shall be responsible for the promulgation and distribution of County Policies to Contractor personnel to the extent necessary and appropriate.

County shall have the right to require Contractor’s employees, agents, representatives and subcontractors to exhibit identification credentials issued by County in order to exercise any right of access under this Contract.

7. Contract Assignability

Without the prior written consent of the County, the contract is not assignable by Contractor either in whole or in part.

8. Contract Amendments

Contractor agrees any alterations, variations, modifications, or waivers of the provisions of the contract, shall be valid only when reduced to writing, executed and attached to the original contract and approved by the person(s) authorized to do so on behalf of Contractor and County.

9. Contract Exclusivity

This is not an exclusive contract. The County reserves the right to enter into a contract with other Contractors for the same or similar services. The County does not guarantee or represent that the Contractor will be permitted to perform any minimum amount of work, or receive compensation other than on a per order basis, under the terms of this Contract.

10. Copyright

County shall have a royalty-free, non-exclusive and irrevocable license to publish, disclose, copy, translate, and otherwise use, copyright or patent, now and hereafter, all reports, studies, information, data, statistics, forms, designs, plans, procedures, systems, and any other materials or properties developed under this contract including those covered by copyright, and reserves the right to authorize others to use or reproduce such material. All such materials developed under the terms of this contract shall acknowledge San Bernardino County Department of Behavioral Health as the funding agency and Contractor as the creator of the publication. No such materials or properties produced in whole or in part under this contract shall be subject to private use, copyright or patent right by Contractor in the United States or in any other country without the express written consent of County. Copies of all educational and training materials, curricula, audio/visual aids, printed material, and periodicals, assembled pursuant to this contract must be filed with and approved by the County prior to publication. Contractor shall receive written permission from DBH prior to publication of said training materials.

11. Ownership of Documents

All documents, data, products, graphics, computer programs and reports prepared by Contractor or subcontractor pursuant to the Agreement shall be considered property of the County upon payment for services. All such items shall be delivered to DBH at the completion of work under the Agreement.