Sonoma County health department’s tardy contracts continue to hinder providers


There are deadlines, too. Six months after any service is supplied, the state begins to penalize the entity submitting the declare and pays out at lower than 100%.

Rivera insisted DHS’s native well being companions haven’t been adversely affected by any backlogs in submitting claims, and he or she disputed the whistleblowers’ assertion that these delays resulted in misplaced cash for the county.

“Zero penalties,” she mentioned when requested.

However the contract difficulty, Rivera acknowledged, is actual. In some unspecified time in the future — the breakdown preceded not solely Rivera, but additionally her predecessor, Barbie Robinson, sources say — the county fell behind in getting signed contracts to its behavioral well being companions by July 1, the beginning of every fiscal yr.

This has created an annual cycle of hardship. Unwilling to easily cease providing help to the shoppers who desperately want it, the suppliers often simply function and not using a contract for a number of months. Which means cash going out for rental area, employees hours and provides, with little coming again in. And till they’ve a signed contract, organizations aren’t even certain of the speed they’ll be paid for companies.

“Most nonprofits run within the pink,” mentioned Hempl, the Petaluma Individuals Providers Heart director. “So what we find yourself doing is, both now we have to fundraise or we reduce companies in one other program. As a result of no matter {dollars} we earn, now we have to particularly parse them out to serve the wants of the group.”

Her group has by no means needed to depend on a line of credit score to cowl a late contract, however many do, Hempl added. And whereas fundraising comes with the territory, it may be exhausting to maintain up with momentary shortfalls.

“Finally, our donors turn out to be our financial institution,” Hempl mentioned. “And now we have a beneficiant group. However actually, if you happen to take the variety of folks dwelling in Petaluma, it comes out to $35 per particular person in Petaluma to fund what we do. Of 60,000 folks dwelling right here, now we have to get $35 from each.”

Although Rivera has spent most of her profession within the public sector, she did have a stint as government director at Compassion Heart, a nonprofit group in Shreveport, La. So she understands the challenges created by her division’s lengthy file of tardiness, she mentioned.

The largest obstacle to getting contracts out to nonprofits in time, based on Rivera, has been budget-driven staffing shortages. And the state of affairs solely received worse through the COVID-19 pandemic, Rivera mentioned, as employees took on new obligations and have been pressured to take care of their very own well being issues and, in lots of circumstances, little one care points.

“COVID actually daylighted how under-resourced the well being care system has been all through this nation,” she mentioned. “And it exacerbated the psychological well being disaster. Now we’re seeing the exacerbation of a staffing disaster.”

DHS responded by bringing in momentary assist, Rivera mentioned. And final Could, she tried to deal with the hole by directing some workers again to full-time, in-person work. That order led to rapid pushback from employees who claimed their work setting at DHS wasn’t protected.

Public well being staffing issues should not distinctive to this space.

“I’d like to say Sonoma is the one county the place it’s a difficulty, but it surely’s not,” mentioned Karen Larsen, CEO of the Steinberg Institute, a nonprofit group that advocates for stronger public coverage round psychological well being and substance use. “Workforce is a matter in every single place. I wouldn’t guess it’s a majority of California counties, but it surely’s greater than a handful the place this is a matter.”

Nonetheless, Rivera believes she will be able to construct her accounting employees to the place it must be and straighten out the continuing contract mess. Funding is beginning to arrive from each the state and federal governments for psychological well being and substance dysfunction companies. And, Rivera added, “If I would like additional momentary assist, I’ll ask for it.”

It’ll take some work. In October, Rivera mentioned 28 direct-service behavioral suppliers have been ready to execute their 2022-23 county contracts — greater than three months after 2021-22 contracts expired.

At the moment, the well being director mentioned the objective was to finish the remaining 28 contracts by the top of December.

On Wednesday, Rivera provided an replace: Solely 5 of the 28 have been nonetheless incomplete, she mentioned, and he or she anticipated 4 of these contracts to be executed by the top of the week.

“One supplier is out of compliance resulting from privateness audits and we don’t anticipate this contract to be accomplished by our goal date,” Rivera mentioned in an e-mail. “We’re hopeful that as we proceed to work diligently with this supplier we are going to resolve their compliance points by mid-February.”

She mentioned DHS is anticipating to barter 2023-24 contracts with behavioral well being companions “by the top of January to early February,” which might put the method on schedule.

“This has been a heavy elevate,” Rivera wrote. “I’m grateful for the endurance of our great suppliers who companion with us in offering high quality companies to our group. I’m additionally very grateful to our tireless employees who’ve labored lengthy hours to assist right these historic points which have plagued this contracting course of for a lot too lengthy.”

Native organizations are hopeful they’ll see enchancment.

“It’s refreshing that Tina took that decision from you and mentioned there are issues that have to get fastened,” Hempl mentioned. “There have been numerous errors previously, however how do we glance ahead? How will we not permit somebody to fall by way of the cracks when they’re battling psychological well being?”

You may attain Phil Barber at 707-521-5263 or On Twitter @Skinny_Post.


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