Inpatient Concurrent Review

The San Bernardino County Department of Behavioral Health is soliciting proposals through Request for Proposals DBH 25-61 for Inpatient Concurrent Review services to serve Medi-Cal members and indigent persons receiving psychiatric inpatient hospital care. The contractor will conduct real-time concurrent and retrospective utilization review to ensure medical necessity of inpatient stays, appropriate service levels, and alignment with discharge planning, serving an estimated 11,000 to 16,000 unduplicated clients annually with 100 to 200 out-of-county cases monthly across San Bernardino County. Key deliverables include establishing a secure, web-based provider portal offering real-time access to records with read-only access for the County and hospitals, maintaining 24/7/365 clinical coverage with a dedicated team of licensed clinicians and Medical Doctors, responding to hospital inquiries within two business days, and submitting Treatment Authorization Request determinations within five business days of completion. The contractor must employ Utilization Review reviewers holding active California licenses as Registered Nurses, Licensed Clinical Therapists, Licensed Marriage and Family Therapists, Licensed Professional Clinical Counselors, Licensed Psychologists, or Licensed Social Workers, with a Medical Doctor maintaining an active California medical license available for consultation and peer-to-peer discussions. Evaluation criteria allocate 65 percent to program components including service delivery capability, experience, staffing qualifications, and outcomes measurement, and 35 percent to financial components including cost per participant and various financial ratios. A mandatory Proposer's Conference was held on January 13, 2026, via Microsoft Teams; written questions must be submitted by noon on January 20, 2026; and proposals are due by 4:00 P.M. Pacific Standard Time on February 10, 2026, submitted either electronically through ePro or in hard copy to 303 East Vanderbilt Way, San Bernardino, CA 92415, with contract award anticipated for presentation to the Board of Supervisors on May 19, 2026, and a tentative contract start date of July 1, 2026.

Proposers must be non-profit or for-profit organizations with no record of unsatisfactory performance with any government agency in the preceding twenty-four months and must register in the County's ePro system prior to submission; no specific set-asides or disadvantaged enterprise restrictions are identified in the available documentation. Proposers must submit complete rate proposals for each fiscal year, three years of audited financial statements or unaudited statements if audited statements are unavailable, and proof of required insurance coverage including Worker's Compensation ($250,000), General Liability ($1,000,000 per occurrence/$2,000,000 aggregate), Professional Liability/Errors & Omissions ($1,000,000 per occurrence/$2,000,000 aggregate), and Cyber Liability ($1,000,000 per occurrence/$2,000,000 aggregate). The contractor must obtain a California business license prior to contract start, though it is not required at proposal submission, and indirect administrative costs cannot exceed 15 percent of modified direct costs. The five-year contract period runs from July 1, 2026, through June 30, 2031, with a total projected allocation of approximately $11,983,620, including $1,764,543 for fiscal year 2026-27, $1,982,704 for 2027-28, $2,664,704 for 2028-29, $2,744,685 for 2029-30, and $2,826,984 for 2030-31, with funding derived from 10 percent 1991 Realignment, 35 percent 2011 Realignment, and 55 percent Medi-Cal Quality Assurance sources. Contractors expending $1,000,000 or more in federal funds annually must undergo a single audit, and the proposal offer remains firm and binding for nine months from the date the proposal is opened and recorded.