To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Nolan Sullivan, 707-565-4774; Jan Cobaleda-Kegler, 707-565-5157
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Behavioral Health Memorandum of Understanding with County of Mendocino
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Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute a Memorandum of Understanding with County of Mendocino, Behavioral Health and Recovery Services for access to available beds at the Sonoma County Crisis Stabilization Unit, for contract maximum of $25,000 in revenue to the County of Sonoma, and a term from the effective date through June 30, 2028, subject to review and approval as to form by County Counsel.
B) Authorize the Director of Health Services, or designee, to execute modifications to the agreement associated with this Item in order to address changes in service needs, payment or reimbursement methodologies, subject to available funding as well as review and approval by County Counsel.
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Executive Summary:
The Department of Health Services is seeking authority to enter into a Memorandum of Understanding (MOU) with the County of Mendocino, Behavioral Health and Recovery Services to grant the County of Mendocino access to available beds at the Sonoma County Crisis Stabilization Unit, for a term of effective date through June 30, 2028. The purpose of this MOU is to assist Mendocino County or designee who may refer individuals to access available beds at the Sonoma County Crisis Stabilization Unit (CSU) by establishing the roles and responsibilities of the parties in the provision of short-term Crisis Stabilization services for Medi-Cal beneficiaries who reside within the County of Mendocino. The Department of Health Services shall make CSU beds available to Mendocino County on a space-available basis for individuals requiring crisis stabilization services consistent with CSU admission criteria, applicable laws, and Sonoma County policies and procedures.
Discussion:
The County of Sonoma Department of Health Services (DHS) is committed to ensuring timely access to high-quality, clinically appropriate behavioral health services for individuals experiencing psychiatric crises. As part of this commitment, DHS operates a CSU designed to provide short-term, intensive intervention aimed at stabilizing individuals in crisis, reducing unnecessary hospitalizations, and supporting safe transitions back to community-based care. The CSU serves as a critical component of the local crisis continuum, aligning with State requirements and advancing system goals related to access, diversion, and continuity of care.
Recognizing that individuals in crisis may require services beyond the capacity or immediate availability of their county of residence, DHS collaborates with neighboring jurisdictions to promote regional coordination and maximize existing system resources. This Memorandum of Understanding with the County of Mendocino reflects a shared commitment between DHS and a partnering county to ensure that Medi-Cal beneficiaries have access to appropriate levels of care regardless of geographic boundaries, while maintaining clear expectations related to clinical decision-making, operational responsibilities, and fiscal accountability. Through this agreement, DHS seeks to support a coordinated, efficient, and compliant approach to crisis stabilization services that prioritizes patient safety, system sustainability, and equitable access to care.
As outlined in the agreement, Mendocino County Behavioral Health and Recovery Services seeks to refer eligible Medi-Cal beneficiaries to Sonoma County’s CSU. Because these services involve two separate county systems, distinct funding responsibilities, and regulated clinical operations, the MOU ensures that both parties have a shared understanding of roles, expectations, and limitations.
This MOU also clarifies that Sonoma County retains clinical authority over admissions and service delivery, while Mendocino County remains responsible for authorizations, transportation, and post-discharge care. Sonoma County will bill the California Department of Health Care Services for Medi-Cal eligible services upon receipt of an approved Treatment Authorization Request. In the event that the California Department of Health Care Services denies a claim, Mendocino County agrees to reimburse Sonoma County for the cost of services provided, based on the California Department of Health Care Services established rates, up to a defined cap of $25,000 for the term of the MOU unless amended.
Beds will be made available on an “as available” basis and are not set aside or guaranteed for Mendocino County clients. When a need arises, Mendocino County will contact DHS to request placement, and admission will be contingent upon current capacity and clinical appropriateness at the time of the request. Based on projected utilization, this arrangement is expected to equate to approximately 2-3 clients annually, assuming an average length of stay exceeding one hour. Mendocino County anticipates referring only a limited number of clients each year under this agreement.
Sonoma County DHS is expected to receive reimbursement from the State for most, if not all, services provided to these clients, consistent with applicable Medi-Cal and state funding mechanisms. This MOU enables coordinated regional crisis response capacity while maintaining clear governance, defined financial responsibility, and compliance with State and federal requirements.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 3: Create a “no wrong door” approach where clients who need services across multiple departments and programs are able to access the array of services needed regardless of where they enter the system.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
None
Fiscal Summary
Narrative Explanation of Fiscal Impacts:
Approval of the proposed revenue agreement will result in $25,000 of revenue subject to actual services rendered. Agreement term is from the effective date through June 30, 2028. The contract maximum is $25,000.
Narrative Explanation of Staffing Impacts (If Required):
None
Attachments:
Attachment 1 - Draft Agreement
Related Items “On File” with the Clerk of the Board:
None