REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 14, 2022
FROM
GEORGINA YOSHIOKA, Interim Director, Department of Behavioral Health
SUBJECT
Title
Mental Health Services Act Annual Plan Update Fiscal Year 2022-23 and New Positions
End
RECOMMENDATION(S)
Recommendation
1. Approve the Mental Health Services Act Annual Plan Update Fiscal Year 2022-23, including an increase in Mental Health Services Act expenditures of $32,080,645, from $125,564,238 to $157,644,883, for the period of July 1, 2022 through June 30, 2023.
2. Authorize the Director of the Department of Behavioral Health, as the County Mental Health Director, to sign the Mental Health Services Act County Compliance Certification form, as required by the California Department of Health Care Services, for the Mental Health Services Act Annual Plan Update Fiscal Year 2022-23, on behalf of the County.
3. Authorize the Director of the Department of Behavioral Health, as the County Mental Health Director, and the Auditor-Controller/Treasurer/Tax Collector to sign the Mental Health Services Act County Fiscal Accountability Certification form, as required by the California Department of Health Care Services, for the Mental Health Services Act Annual Update Fiscal Year 2022-23, on behalf of the County, subject to review by County Counsel.
4. Authorize the Director of the Department of Behavioral Health, as the County Mental Health Director, to execute and submit the Mental Health Services Act Annual Plan Update Fiscal Year 2022-23 documents and any subsequent non-substantive amendments, as required by the California Department of Health Care Services, to the State of California Department of Health Care Services and Mental Health Services Oversight and Accountability Commission, on behalf of the County, subject to review by County Counsel.
5. Direct the Director of the Department of Behavioral Health, as the County Mental Health Director, to transmit all documents and amendments in relation to the Mental Health Services Act Annual Plan Update Fiscal Year 2022-23, to the Clerk of the Board of Supervisors within 30 days of execution.
6. Authorize the addition of 15 new regular positions for the Department of Behavioral Health, under the following classifications:
a. One Business Systems Analyst I, Administrative Services Unit, Range 57, ($62,525-$85,966).
b. Four Automated Systems Analyst II, Administrative Services Unit, Range 60, ($67,246-$92,664).
c. Two Business Systems Analyst II, Administrative Services Unit, Range 63, ($72,405-$99,653).
d. One Department Systems Engineer, Administrative Services Unit, Range 67, ($79,830-$109,928).
e. Four Fiscal Specialist, Clerical Unit, Range 35, ($36,556-$50,232).
f. One Administrative Manager, Management Unit, Range 70, ($86,008-$118,498).
g. One Supervising Fiscal Specialist, Supervisory Unit, Range 43, ($44,450-$61,173).
h. One Supervising Automated Systems Analyst II, Supervisory Unit, Range 61, ($68,910-$94,848).
(Presenter: Georgina Yoshioka, Interim Director, 388-0801)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Promote the Countywide Vision.
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
Recommendations No. 1 through 5
This item does not impact Discretionary General Funding (Net County Cost). The submission and approval of the Mental Health Services Act (MHSA) Annual Plan Update to the California Department of Health Care Services (DHCS), Mental Health Services Oversight and Accountability Commission (MHSOAC) is required by the State to enable the San Bernardino County Department of Behavioral Health (DBH) to expend State funds for the upcoming program year. Expenditures will not exceed $157,644,883 in 2022-23 for MHSA program services and will be funded by MHSA funding in the approximated annual amounts below.
|
MHSA Component |
Current 2022-23 Amount |
Recommended Increase/Decrease |
Recommended 2022-23 Amount |
|
Community Services and Supports (CSS) |
$81,397,864 |
$33,639,086 |
$115,036,950 |
|
Prevention and Early Intervention (PEI) |
$22,848,842 |
$1,631,190 |
$24,480,032 |
|
Innovation (INN) |
$8,335,824 |
($1,427,545) |
$6,908,279 |
|
Workforce Education and Training (WET) |
$3,767,608 |
$583,134 |
$4,350,742 |
|
Capital Facilities and Technological Needs (CFTN) |
$9,214,100 |
($2,345,220) |
$6,868,880 |
|
Total |
$125,564,238 |
$32,080,645 |
$157,644,883 |
Adequate appropriation and revenue will be included in DBH’s 2022-23 recommended budget.
Recommendation No. 6
This item does not impact Net County Cost. Included in the Fiscal Year 2022-23 MHSA Annual Plan Update, and will also be included in future Three Year Plans and Annual Plan Updates, is the estimated full year cost of the 15 requested regular positions of $1,715,751, which will be funded 100% by MHSA funding.
Adequate appropriation and revenue will be included in DBH 2022-23 recommended budget.
BACKGROUND INFORMATION
Recommendation No. 1 through 5
DBH developed the MHSA Annual Plan Update according to the guidelines provided by MHSOAC, including following the stakeholder process in California Welfare and Institutions Code (WIC) Section 5848 and California Code of Regulations Title 9, Division 1, Chapter 14, Sections 3300, 3315, and 3320, which included a 30-day public review and comment period from January 21, 2022 through February 28, 2022. A Public Hearing was held by the San Bernardino County Behavioral Health Commission on April 7, 2022.
Welfare and Institutions Code (WIC) Section 5847 (a) and (b), directs the DBH Director, as the County Mental Health Director responsible for the administration of the County’s mental health services, to execute and submit the MHSA Annual Plan Update to the MHSOAC and DHCS within 30 days of adoption by the Board of Supervisors (Board). The MHSOAC maintains evaluation responsibilities over all MHSA components and maintains approval authority over the INN component only. After approval by the Board and MHSA Annual Plan Update submission to the MHSOAC and DHCS, MHSA program services and operations will proceed with implementation. A MHSA Three Year Plan or an annual update to the Three Year Plan is submitted each year to report evaluation outcomes and any required changes.
The MHSA Plan highlights trends, program goals, and outcomes of DBH MHSA programs and provides a roadmap to a unified system of care. The emphasis of the Plan is to link MHSA components, programs, and funding with Medi-Cal and other behavioral health programs to create an integrated service experience for County residents.
In 2004, California voters passed Proposition 63, which established a state personal income tax surcharge of one percent on the portion of taxpayers' annual taxable income that exceeds $1 million. Since 2005, MHSA (also known as Proposition 63) has provided funding to the County for services and resources that promote wellness, recovery, and resiliency for adults and older adults with serious mental illness and for children and youth with serious emotional disturbances and their family members. Per WIC Section 5847, DBH must submit a Board approved MHSA Plan and Annual Plan Updates.
The MHSA Annual Plan Update consists of six MHSA components including: Community Program Planning (CPP), PEI, CSS, INN, WET, and CFTN.
• The CPP is not a specific “programmatic component,” but rather includes countywide stakeholder input and involvement in the planning, implementation, evaluation, and improvement of all MHSA component programs.
• The PEI component is intended to reduce risk factors, increase protective factors, and intervene early in the progression of a behavioral health illness.
• The CSS component contributes to the ongoing transformation of the public mental health system by: augmenting existing services; establishing a system of care for crisis services; developing programming to address the needs of transitional age youth; developing supportive housing and maximizing MHSA funds for housing opportunities; and enhancing and expanding wraparound services to children, youth, adults, and older adults.
• INN projects are unique, as they are intended to contribute to learning and test the implementation of novel, creative, ingenious mental health approaches expected to contribute to learning for integration into the mental health system. All INN projects are time-limited and part of a rigorous evaluation process, which can include transitioning INN strategies into other funded programs or ending strategies depending on lessons learned.
• The purpose of the WET component is to recruit, develop, and maintain an appropriately educated and culturally competent workforce.
• The CFTN component provides funding to purchase or rehabilitate County-owned buildings that will be utilized in the provision of MHSA funded behavioral health services, such as the construction of Crisis Residential Treatment centers, and to support the implementation of new electronic and technological enhancements such as the Electronic Health Record and billing systems.
On June, 9, 2020 (Item No. 13), the Board approved DBH’s MHSA Three-Year Integrated Plan for Fiscal Years 2020-21 through 2022-23 in the amount of $370,388,948, for the period of July 1, 2020 through June 30, 2023.
On June 8, 2021 (Item No. 30), the Board approved DBH’s MHSA Annual Plan Update for Fiscal Year 2021-22 in the amount of $116,401,434, which included a decrease in MHSA expenditures of $7,019,414, from $123,420,848 to $116,401,434. The recommended decrease in MHSA expenditures for 2021-22 was based on state funding projections, anticipated expenditures based on previous year’s utilization, and maximizing opportunities to leverage other funding sources to support programming.
Program changes identified through stakeholder input include increased behavioral health and housing supports for homeless individuals, expanded mental health crisis services, increased access to services for individuals experiencing first symptoms of the onset of a serious mental illness, and increased access to mental health treatment for individuals transitioning from the adult criminal justice system.
In accordance with WIC Section 5848, a public hearing was held on April 7, 2022 by the San Bernardino County Behavioral Health Commission, and no substantive recommendations or changes to the Plan Update were suggested. Non-substantive text edits were identified and updated during the stakeholder process. DHCS has the responsibility of releasing the fully executed State Agreement to the County, and MHSOAC continues to provide DBH with direction on the preparation and submission of the MHSA Plan and annual updates. Items requiring Board approval, such as acceptance of funding, or requests for changes in departmental appropriation or staffing, will continue to be presented to the Board for approval.
Recommendation No. 6
The MHSA CFTN component supports implementation of technological enhancements to meet the needs of DBH and its clients. DHCS is currently implementing several initiatives to transform the public behavioral health delivery system to a population health approach, prioritizing person-centered care and further advancing the development and implementation of an integrated, comprehensive, and seamless system. DBH has three main goals affiliated with these transformative changes: implementation of payment reform designed to incentivize client outcomes and quality of care over volume and cost; program and documentation redesign to improve access to behavioral health services and strengthen the continuum of care; and to significantly increase requirements for data sharing and integration between behavioral health plans and managed care plans.
DBH, with approval from the County Innovation and Technology Department (ITD), has requested new positions that will utlize MHSA funding, which will aid in the implementation of all DHCS initiatives, including integrated MHSA programming. The approval of these positions will support DBH by improving tracking of client level outcomes, claims submissions, reducing late claim denials, and improving cash flow.
PROCUREMENT
N/A
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on May 18, 2022; County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on May 19, 2022; Human Resources (Gina King, Deputy Director, 387-5570) on May 26, 2022; Finance (Christopher Lange, Administrative Analyst, 386-8393) on May 20, 2022; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on May 31, 2022.