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Lassen County tables Paperless Knowledge renewal; approves Community Medical Specialists contracts for crisis and clinic coverage
Summary
Public Health Director Natalie Ruger asked to renew the county's Paperless Knowledge timekeeping contract but supervisors asked for clarification of a clause that could allow $100,000 per year and tabled the item; the Board approved two agreements with Community Medical Specialists for after‑hours crisis coverage (cap $200,000) and daytime clinic therapists (max cited $750,000).
The Board reviewed multiple public‑health contract items. Natalie Ruger, Director of Public Health, requested approval of a renewal with Paperless Knowledge — software the department uses for staff time documentation and grant invoicing. Supervisors questioned contract language (section 5.3.0.6) that, as read aloud, could be interpreted to allow charges up to $100,000 per year; Ruger said she would gather clarifying language and asked for approval before the fiscal year. The Board voted to table the item to the next meeting to allow staff to clarify payment language and confirm the contract term.
Separately, Tiffany Armstrong, director of Behavioral Health, presented two agreements with Community Medical Specialists. The first covers after‑hours crisis coverage (weekends and holidays) and was described as having a maximum contract amount of $200,000. The second expands in‑person weekday clinical services (two therapists regularly on site, plus psychiatric services as needed) and was described in the meeting transcript with a maximum of $750,000 to cover varied rates and possible provider changes.
Armstrong explained triage and call routing: an Alameda switchboard performs first‑line triage for 988 calls and the county’s crisis line, then transfers appropriate calls to clinicians to avoid frivolous callbacks. She said the provider documents encounters in the county’s electronic health record and staff follow up on Monday mornings. Hourly rates discussed in the presentation included $166 per hour for licensed clinicians, $200 for psychologists, $210 for nurse practitioners/physician assistants and $275 for psychiatrists; Armstrong said much of the daytime clinical cost is reimbursed through Medi‑Cal (reimbursement rates vary by service type; speakers cited about 75% for some children’s services and roughly 50% for some adult services, not dollar‑for‑dollar).
The Board authorized the county CAO to execute the Community Medical Specialists agreements; the after‑hours contract was described as a critical stopgap to avoid staff working nights and holidays and to ensure crisis assessments are covered.
Next steps: Public Health will provide clarified contract language for the Paperless Knowledge renewal at the next meeting and will continue to monitor contractor usage and reimbursement metrics for the Community Medical Specialists agreements.
