Date: October 20, 2026
To: The Honorable Lake County Board of Supervisors
From: Elise Jones, Director of Behavioral Health Services
Subject: Approve Agreement No. 26.27.3 between the County of Lake and SY Psychiatry, LLC for Substance Use Disorder Medical Director and clinical consultation services for the term of July 1, 2026 through June 30, 2027, in an amount not to exceed $425,000, and authorize the Chair of the Board of Supervisors to sign the Agreement.
Executive Summary:
Lake County Behavioral Health Services (LCBHS) is responsible for providing or arranging substance use disorder services through the Drug Medi-Cal Organized Delivery System (DMC-ODS). As part of these responsibilities, the County requires qualified physician oversight to support clinical care, utilization management, quality assurance, regulatory compliance, and other medical-director functions.
The proposed Agreement with SY Psychiatry, LLC designates Hardeep Singh, MD as the County’s Substance Use Disorder Medical Director for Fiscal Year 2026-27. Services include physician-level medical oversight, development and implementation of DMC-ODS medical policies and standards, clinical consultation, review of medical necessity and ASAM level-of-care issues, medication and Medications for Addiction Treatment consultation, utilization management and service authorization review, quality assurance and quality improvement activities, credentialing and compliance support, and other authorized physician services.
The Agreement also authorizes Dr. Singh to provide clinical review and consultation for complex substance use disorder cases and County-contracted DMC-ODS providers when specifically authorized by the County. Unless expressly delegated in writing, utilization-management recommendations remain advisory and the County retains final authority for authorization, coverage, and member-notice decisions.
SY Psychiatry, LLC will be compensated at a rate of $200 per hour for authorized services, with total compensation not to exceed $425,000 during the Agreement term. The $200 hourly rate applies to authorized SUD Medical Director and professional services, including clinical consultation, utilization management, service authorization, quality assurance/quality improvement activities, and other services performed pursuant to the Agreement.
When Dr. Singh personally renders a covered DMC-ODS service that is eligible for Medi-Cal claiming, the service is entered into the County’s SmartCare electronic health record and billing system using the applicable CPT or HCPCS code, service duration or unit, diagnosis, rendering provider information, and other required billing information. Payment to the Contractor remains based on the $200 hourly contract rate unless a different rate is specifically established in the Agreement.
Dr. Singh has historically provided Medi-Cal-billable clinical services in addition to his Medical Director responsibilities. During Fiscal Year 2024-25, he provided 234 Medi-Cal billable services, which generated $471,028 in Medi-Cal charges, with $349,621 in Medi-Cal reimbursement received. During Fiscal Year 2025-26, he provided 254 Medi-Cal billable services, which generated $601,848 in Medi-Cal charges, with $495,886 in Medi-Cal reimbursement received. The charge amounts reflect services billed through the County’s Medi-Cal claiming system, while the reimbursement amounts reflect actual Medi-Cal payments received by the County. The Agreement also includes required Medical Director and administrative activities that may not be separately claimable to Medi-Cal, including policy development, clinical consultation, meetings, quality review, chart review, training, and other physician oversight functions. These activities are invoiced based on actual time worked at the same $200 hourly rate.
The Agreement is effective July 1, 2026 through June 30, 2027. Total compensation under the Agreement shall not exceed $425,000.
The Agreement is exempt from the formal competitive procurement process pursuant to applicable County purchasing and consultant-selection requirements because the services require specialized professional medical expertise and continuity of qualified physician oversight for the County’s DMC-ODS program.
Fiscal Impact:
Total compensation under the Agreement shall not exceed $425,000 for Fiscal Year 2026-27. The Agreement includes both Medi-Cal-reimbursable clinical services and Medical Director, administrative, quality assurance, utilization review, and related activities that may not be separately reimbursable through Medi-Cal.
Eligible clinical services personally rendered by Dr. Singh are documented in SmartCare and billed through the County’s DMC-ODS Medi-Cal claiming process. Payment to SY Psychiatry LLC remains based on the contracted rate of $200 per hour. Medical Director and other authorized activities that are not separately claimable to Medi-Cal are also compensated at the $200 hourly rate.
Procurement Exemption: This Agreement is exempt from the standard solicitation process pursuant to exemption code 38.2(2) of the County’s Consultant Selection Policy. The services require specialized professional medical expertise and continuity of qualified physician oversight for the County’s DMC-ODS program. SY Psychiatry, LLC, through Hardeep Singh, MD, has provided these specialized Medical Director and clinical consultation services to the County, and continuation of the Agreement supports uninterrupted physician oversight, regulatory compliance, utilization management, quality assurance, and clinical consultation functions.