HomeMy WebLinkAboutHIA_SanBernardino_Operational_Plan-c1HEALTHCARE IN ACTION
STREET MEDICINE SERVICES — OPERATIONAL PLAN
City of San Bernardino Professional Services Agreement
Service Commencement Date: September 1, 2026
Operational Plan Submission Date: August 14, 2026
Contractor Program Contact: Edward Menacho, General Manager, (909) 957-9921,
emenacho@healthcareinaction.org
1. PURPOSE AND RELATIONSHIP TO AGREEMENT
The purpose of this Operational Plan is to describe Healthcare in Action, Inc.'s ("HIA" or "Contractor")
operational approach for implementing and delivering Street Medicine Services in accordance with the executed
Professional Services Agreement ("Agreement") and Scope of Services (Exhibit A) between HIA and the City of
San Bernardino ("City").
This Operational Plan is intended to provide the City with information regarding HIA's staffing, service delivery,
field operations, coordination, safety, documentation, quality assurance, and medical record management
procedures.
This Operational Plan supplements the Agreement, Scope of Services, and Schedule of Charges and does not
modify, replace, or supersede any provision of the executed Agreement.
2. PROGRAM STAFFING AND ORGANIZATIONAL STRUCTURE
2.1 Organizational Structure
Healthcare in Action is a nonprofit medical and social services organization exclusively dedicated to providing
mobile medical care and supportive services to individuals experiencing homelessness. HIA currently operates
mobile street medicine teams across multiple service areas in Los Angeles, San Bernardino, and Riverside
Counties. The San Bernardino Street Medicine Program will be staffed and supervised through HIA's Inland
Empire Region under the oversight of the General Manager, Inland Empire Region, who reports to HIA's
executive and clinical leadership.
Field operations are carried out by an interdisciplinary street medicine team consisting of a Medical Provider,
Community Health Workers (Peer Navigators), and an HMIS Coordinator, supported by HIA's centralized clinical,
compliance, and administrative infrastructure. Team members are cross-trained and, where applicable, share
time across HIA's Inland Empire programs to ensure continuity and efficient use of resources, consistent with the
staffing allocations reflected in the Program Budget (Section 12).
2.2 Program Staffing
Position Title # of
Staff Primary Responsibilities Required License /
Certification
Medical Provider (Physician
Assistant or Nurse
Practitioner)
1 Provides full-scope primary medical care,
addiction treatment, and psychiatric care in the
Active California PA-C
or NP license; DEA
Position Title # of
Staff Primary Responsibilities Required License /
Certification
field; determines whether a client can be treated
by the field team or requires referral
registration, as
applicable
Community Health Worker
(Peer Navigator) 2
Conducts outreach and engagement, client
enrollment, care coordination, referrals to
housing and social services, and follow-up with
enrolled clients
HIA-provided
outreach/peer
navigator training
HMIS Coordinator 1
Enters and maintains client and program data in
the County's HMIS (Clarity) system; supports
monthly and quarterly performance reporting
HMIS/Clarity system
certification
Medical Assistant* As
needed
Provides clinical support, vitals, and point-of-care
testing support to the Medical Provider
CCMA/RMA
certification, as
applicable
Program Coordinator* As
needed
Provides scheduling, administrative, and logistics
support to the field team N/A
*Medical Assistant and Program Coordinator positions are budgeted for the Program but are not allocated
dedicated FTE in Year 1 (FY26-27). HIA will add staff capacity to these roles, consistent with the approved
Program Budget, as caseload or program needs require, and will notify the City of any resulting change in
staffing per Section 10.
2.3 Clinical Oversight
The Medical Provider operates under the clinical oversight and supervision of HIA's Medical Director /
supervising physician, consistent with California scope-of-practice requirements for Physician Assistants and
Nurse Practitioners. The supervising physician is responsible for review of clinical protocols and chart review, and
is available for consultation on complex cases and clinical decision-making support.
2.4 Staffing Coverage
HIA maintains service continuity through cross-training of field staff across its Inland Empire programs and a
shared pool of licensed Medical Providers who can provide coverage in the event of planned or unplanned staff
absences. An on-call clinician is available by phone twenty-four (24) hours a day, seven (7) days a week, to
address urgent clinical questions or coverage needs. In the event of an extended staffing disruption, HIA will
notify the City in accordance with Section 5.3 of this Plan and will implement a temporary coverage plan to
maintain continuity of services.
3. HOURS OF OPERATION
The Program will operate Monday through Thursday or Tuesday through Friday, 8:00 a.m. to 5:00 p.m., providing
direct field-based patient services including allocated time for documentation during standard business hours. In
addition, an on-call clinician is available by telephone twenty-four (24) hours a day, seven (7) days a week, to
address urgent clinical needs.
4. SERVICE DELIVERY PROTOCOLS
4.1 Service Delivery Model
HIA will operationalize the Scope of Services through a mobile, street-based care delivery model in which the
Medical Provider and Community Health Workers travel directly to street encampments, shelters, and interim
housing facilities located within the City of San Bernardino. This approach removes common barriers to care by
eliminating the need for clients to travel to a fixed clinic location. The Program prioritizes high-acuity individuals
and is designed to serve at least seventy-five (75) unique unhoused individuals annually, with a maximum active
caseload of forty-five (45) patients per Medical Provider at any given time; as clients stabilize and transition
("graduate") to a stable environment that no longer requires street medicine, new patients are enrolled to
maintain caseload capacity.
4.2 Outreach and Engagement
Community Health Workers (Peer Navigators) conduct systematic outreach to known and newly identified
encampment sites, shelters, and interim housing facilities within the City to locate individuals experiencing
unsheltered homelessness. Outreach staff build trust and rapport over repeated contacts using a low-barrier,
harm-reduction approach that does not condition engagement or enrollment on medication compliance for
mental illness, participation in religious services or drug treatment services, possession of identification, or
ability to pay.
4.3 Client Intake and Consent
Prior to the initiation of services, HIA staff complete a client intake process that includes informed consent, a
brief health and psychosocial assessment, and enrollment in HIA's electronic health record and, where
applicable, the County's HMIS (Clarity) system. Participation is voluntary, and clients may decline any component
of services without losing access to future outreach and engagement.
4.4 Medical Services
In the field, the Medical Provider delivers full-scope primary medical care, addiction counseling and
medication-assisted treatment, psychiatric care including medication management, laboratory testing, and
point-of-care ultrasonography, and coordinates the dispensing and delivery of medications from pharmacies. The
Medical Provider, operating under physician supervision as described in Section 2.3, determines in real time
whether a client's needs can be safely addressed by the field team or require referral to a higher level of care, a
specialist, or an emergency department.
4.5 Referrals and Care Coordination
The team coordinates referrals, and transportation where needed, to medical specialists, hospitals, primary care,
behavioral health, and substance use treatment providers, as well as County, State, and federal programs and
nonprofit and social service agencies. Clients are enrolled in the Coordinated Entry System and connected to
available housing and shelter resources, and staff assist clients with applications for food stamps (CalFresh),
disability benefits, and other social service programs.
4.6 Follow-Up and Continuity of Care
Peer Navigators conduct follow-up contacts with enrolled clients at regular intervals to monitor stability and
sustain engagement, and HIA's care management function tracks each client's status against the Program's
caseload limits. Clients who stabilize in permanent or interim housing "graduate" from active street medicine
caseloads, and their outcomes are documented to support the Program's Quality of Life and performance targets
described in Exhibit A of the Agreement.
4.7 Scope of Practice
The Contractor will ensure that medical services are provided by appropriately licensed or credentialed
personnel acting within their applicable scope of practice and in accordance with applicable laws, regulations,
and professional standards.
5. COORDINATION WITH THE CITY AND COMMUNITY PARTNERS
5.1 City Coordination
The Contractor's primary contact for coordination with the City's Housing & Homelessness Division:
Name: Gabriela Leon, Homeless Solutions Manager
Phone: (909) 998-2280
Email: Leon_ga@sbcity.org
5.2 Community Partnerships
HIA coordinates with the City's Housing & Homelessness Division, the San Bernardino County Continuum of Care
and Regional Task Force on Homelessness (RTFH), County behavioral health and substance use treatment
providers, area shelters and interim housing operators, and other County, State, and federal programs and
nonprofit agencies to support referrals and successful transitions out of homelessness for enrolled clients.
5.3 Communication and Escalation
● HIA's Inland Empire Region leadership will promptly notify the City's designated contact identified in
Section 5.1 of any significant operational issues, service disruptions, safety concerns, or other matters
requiring the City's attention.
● Significant incidents involving clients, staff, or Program operations are documented using HIA's internal
incident report process and reviewed by clinical and program leadership; the City is notified consistent
with the Agreement and applicable reporting requirements.
● In the event of an emergency, staffing disruption, or vehicle/equipment failure, HIA will implement its
internal continuity procedures — including reallocating staff or equipment from other Inland Empire
programs — to restore services as quickly as possible, and will keep the City informed of status and
expected resolution timelines.
6. SAFETY AND EMERGENCY RESPONSE PROCEDURES
6.1 Client Safety
Field staff are trained to identify and respond to unsafe field conditions, including environmental hazards and
situations requiring de-escalation, and travel in teams to encampments and other field sites whenever feasible.
Staff are equipped with mobile phones and, where applicable, GPS-enabled devices to support real-time
communication with program leadership and to allow staff location to be monitored for safety purposes.
6.2 Medical Emergencies
In the event of a medical emergency in the field, HIA staff activate Emergency Medical Services (911) and provide
first aid or stabilization within their scope of practice while awaiting EMS arrival. The Medical Provider consults
with the supervising physician or on-call clinician as needed, and the incident is documented in the client's
medical record and reported internally consistent with HIA's incident reporting procedures.
7. DOCUMENTATION AND DATA REPORTING PROCEDURES
7.1 Service Documentation
HIA maintains a contemporaneous record of each client encounter — including services provided, clinical
findings, and referrals — in HIA's electronic health record system to substantiate services provided under the
Agreement.
7.2 HMIS/Data Systems
HIA records client information and program outcomes in the San Bernardino County regional HMIS system
(Clarity), in accordance with RTFH's HMIS Policies and Procedures, including standards for data entry, data
quality, and timeliness. The City will be listed as a program administrator once the Program is enrolled in HMIS
and registered with RTFH. HIA will submit monthly performance reports to the City — including total contacts
and encounters, unduplicated individuals served, types of medical and behavioral health services provided, and
housing referrals and outcomes — and will participate in quarterly performance reviews. Any performance
reports provided to the City shall not be individualized to ensure protection of private personal information.
7.3 Record Retention
HIA maintains service records, medical records, and financial and accounting records related to the Agreement
for a minimum of four (4) years from the date of final payment, consistent with the Agreement, and will make
such records available to the City for inspection or audit at mutually convenient times, subject to applicable
confidentiality protections.
8. QUALITY ASSURANCE AND MONITORING
8.1 Quality Assurance
HIA's Inland Empire Region leadership conducts regular case review and team meetings to monitor service
delivery, caseload management, and progress toward Program performance targets, using monthly and quarterly
reporting data to identify trends and areas for improvement.
8.2 Clinical Quality Oversight
The supervising physician / Medical Director reviews clinical documentation and provides ongoing oversight of
the quality and appropriateness of medical services delivered by the Medical Provider, including periodic chart
review and case consultation.
8.3 Staff Training
All Program staff complete HIA onboarding training — including HIPAA and confidentiality training, cultural
competency and trauma-informed care training, CPR/first aid, and field safety training — prior to assignment to
the Program, with ongoing training provided throughout the Term as required by HIA policy, licensure, or
applicable law.
9. HIPAA COMPLIANCE AND MEDICAL RECORD MANAGEMENT
9.1 HIPAA Compliance
The Contractor shall maintain policies and procedures to ensure compliance with applicable provisions of the
Health Insurance Portability and Accountability Act (HIPAA), its implementing regulations, and other applicable
federal and state privacy and confidentiality requirements.
9.2 Medical Records
HIA creates and maintains client medical records in its electronic health record system, with access limited to
authorized clinical and administrative staff on a need-to-know basis. Records are retained in accordance with
Section 7.3 of this Plan and applicable HIPAA and California requirements.
9.3 Protected Health Information
HIA safeguards Protected Health Information through role-based access controls, secure and encrypted
transmission and storage, and limitations on disclosure to those authorized under HIPAA and applicable law. PHI
is disposed of using secure destruction methods consistent with HIA policy.
9.4 Staff Confidentiality and Training
All staff complete HIPAA and confidentiality training as part of onboarding and on a recurring basis thereafter,
and sign confidentiality agreements as a condition of employment.
9.5 Medical Record Access
HIA responds to authorized requests for medical records or information in accordance with HIPAA, applicable
California privacy law, and client authorization requirements, while maintaining applicable privacy protections.
9.6 Privacy or Security Incidents
HIA follows its internal policies for identifying, responding to, documenting, and reporting suspected privacy or
security incidents, including potential breaches of PHI, consistent with HIPAA breach notification requirements
and applicable law.
9.7 Information Provided to the City
The Contractor shall provide the City with programmatic and performance information necessary to monitor
compliance with the Agreement while maintaining the confidentiality of protected medical information.
Unless otherwise authorized or required by law, the Contractor will utilize aggregate, de-identified, or otherwise
legally permissible information when reporting program performance to the City.
10. OPERATIONAL PLAN UPDATES
The Contractor shall notify the City of material changes to the operational procedures described in this Plan.
Updates may include changes to staffing structure, service locations, hours of operation, safety procedures, data
systems, or other operational components that materially affect the delivery of contracted services.
Operational Plan updates shall not modify or supersede the requirements of the executed Agreement, Scope of
Services, or Schedule of Charges.
11. CONTRACTOR CERTIFICATION
The Contractor certifies that this Operational Plan accurately describes the Contractor's operational approach for
implementing the Street Medicine Services required under the Agreement.
CONTRACTOR: HEALTHCARE IN ACTION, INC.
Name: Edward Menacho
Title: General Manager, Inland Empire Region
Signature: _________________________________________
Date: August 14, 2026
12. PROGRAM BUDGET
The following Program Budget corresponds to the Schedule of Charges referenced in Exhibit B of the Agreement
and reflects the total not-to-exceed compensation of $600,000.00 over the 24-month Term.
Project Period Contract execution to 2 years
Proposed Budget Amount $600,000.00 (total over 2 years)
Total Grant Awarded (Year 1, FY26-27) $300,000.00
Budget Total (Year 2, FY27-28) $300,000.00
12.1 Year 1 Budget (FY 2026–27)
Position Title Monthly Salary % Time on
Project # Months Cost
Medical Provider (Physician Assistant or
Nurse Practitioner) $13,955 15% 12 $25,119
Medical Assistant $4,532 0% 12 $0
Community Health Worker (Peer
Navigator) $5,858 10% 12 $7,030
Community Health Worker (Peer
Navigator) $5,858 10% 12 $7,030
Coordinator $4,532 0% 12 $0
HMIS Coordinator $5,858 10% 12 $7,030
Total Salaries $46,209
Position Title Monthly Salary % Time on
Project # Months Cost
Benefits (30%) $13,863
Total Salary & Benefits $60,071
Operating Expense / Overhead Item Cost
Medical Supplies and Equipment $5,012
Patient Problem-Solving Funds $5,000
Staff Mileage $0
Mobile Van & Related Expenses $180,000
Total Operating Expenses $190,012
Operating Expense / Overhead Item Cost
Indirect Cost @ 20% $49,917
Total Overhead $49,917
Year 1 Budget Total: $300,000
12.2 Year 2 Budget (FY 2027–28)
Position Title Monthly Salary % Time on
Project # Months Cost
Medical Provider (Physician Assistant or
Nurse Practitioner) $14,374 25% 12 $43,121
Medical Assistant $ - 0% 12 $0
Community Health Worker (Peer
Navigator) $6,034 75% 12 $54,306
Community Health Worker (Peer
Navigator) $6,034 75% 12 $54,306
Coordinator $4,668 23% 12 $12,884
HMIS Coordinator $6,034 25% 12 $18,102
Total Salaries $182,719
Benefits (30%) $54,816
Total Salary & Benefits $237,534
Operating Expense / Overhead Item Cost
Medical Supplies and Equipment $5,000
Patient Problem-Solving Funds $5,000
Staff Mileage $0
Operating Expense / Overhead Item Cost
Van Related Expenses (fuel, registration, etc.) $3,000
Total Operating Expenses $13,000
Operating Expense / Overhead Item Cost
Indirect Cost @ 20% $49,466
Total Overhead $49,466
Year 2 Budget Total: $300,000
Total Grant Awarded (Years 1–2): $600,000.00