Memorandum
Date: June 2, 2026
To: The Honorable Lake County Board of Supervisors
From: Elise Jones, Director of Behavioral Health Services
Subject: Approve Amendment No. 1 to the Agreement Between the County of Lake and SY Psychiatry LLC for Substance Use Disorder Treatment Medical Director Responsibilities on Behalf of Lake County Behavioral Health Services for Fiscal Year 2025-2026 for an Amount Not-to-Exceed $450,000 and Authorize the Chair of the Board to Sign.
Executive Summary:
Lake County Behavioral Health Services is requesting approval of Amendment No. 1 to the Agreement between the County of Lake and SY Psychiatry, LLC for Substance Use Disorder Treatment Medical Director responsibilities on behalf of Lake County Behavioral Health Services for Fiscal Year 2025-26. The original agreement was effective July 1, 2025, and was approved with a not-to-exceed amount of $350,000. Amendment No. 1 increases the agreement compensation by $100,000, for a new total not-to-exceed amount of $450,000.
SY Psychiatry, LLC provides required Substance Use Disorder Treatment Medical Director services that support the County’s Drug Medi-Cal Organized Delivery System (DMC-ODS) program. These services are necessary for regulatory compliance, clinical oversight, medical necessity determinations, treatment plan review and approval, continuing services justification, consultation with clinical staff, and overall program integrity. The Substance Use Disorder Treatment Medical Director role is a required component of DMC-ODS operations and supports the County’s ability to provide and claim allowable substance use disorder treatment services for Medi-Cal beneficiaries.
The requested increase is based on increased utilization of medical director services during Fiscal Year 2025-26. The amendment does not change the term of the agreement, the scope of services, or the operational structure of the contract. It is limited to increasing the contract’s not-to-exceed amount to allow continued payment for services already needed to maintain DMC-ODS compliance and continuity of care.
From a fiscal perspective, this agreement is funded through Behavioral Health program revenues, including applicable Medi-Cal reimbursement and allowable Substance Use Prevention, Treatment, and Recovery Services Block Grant funding, commonly referred to as SUBG. The Department’s State Fiscal Year 2025-26 SUBG budget includes $124,800 in Discretionary funding for SUD Medical Director consultant/contract costs for Hardeep Singh, MD, with an additional $5,000 budgeted for related training and certification costs. These funds offset a portion of the overall contract cost.
A portion of the services provided under this agreement may be Medi-Cal reimbursable when the services are allowable under DMC-ODS, medically necessary, properly documented, coded, and claimed in accordance with applicable Drug Medi-Cal billing requirements. Examples include covered clinical consultation services and medical team consultation activities that meet claiming requirements. However, not every medical director activity is automatically Medi-Cal reimbursable. Some administrative, compliance, policy development, program oversight, and quality assurance activities may be necessary for DMC-ODS operations but may not be directly claimable as Medi-Cal services.
To the extent services are claimed through Medi-Cal, the County is responsible for the non-federal share of those Medi-Cal expenditures through the applicable intergovernmental transfer/local match process. For the $100,000 increase included in this amendment, the estimated County share would be up to approximately $50,000 if the services are reimbursed at the standard 50% federal match rate. The actual County share may be lower depending on the applicable beneficiary aid-code mix, claiming category, and whether any services qualify for enhanced federal participation. Any non-claimable or non-Medi-Cal reimbursed costs will be funded through available Behavioral Health program revenues, including allowable SUBG funds where appropriate.
SUBG funds may support allowable substance use disorder treatment program costs, including a portion of the SUD Medical Director contract; however, SUBG funds may not be used as the County’s non-federal share or IGT match for Medi-Cal reimbursement. Accordingly, the Department will continue to distinguish between costs supported by SUBG, costs claimed to Medi-Cal, the required County share of Medi-Cal reimbursement, and any non-claimable program costs.
There is no requested increase to County General Fund support associated with this amendment. Costs associated with this agreement are included within the Behavioral Health budget and will be managed using available Behavioral Health program revenues, applicable Medi-Cal reimbursement, and allowable SUBG funding. Approval of this amendment will allow Lake County Behavioral Health Services to maintain required SUD Medical Director oversight, support continued DMC-ODS compliance, and preserve continuity of substance use disorder treatment services for Lake County residents.
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Estimated Cost: ________ Amount Budgeted: ________ Additional Requested: ________ Future Annual Cost: ________
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Recommended Action: Approve Amendment No. 1 to the Agreement Between the County of Lake and SY Psychiatry LLC for Substance Use Disorder Treatment Medical Director Responsibilities on Behalf of Lake County Behavioral Health Services for Fiscal Year 2025-2026 for an Amount Not-to-Exceed $450,000 and Authorize the Chair of the Board to Sign.