REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
September 26, 2023
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
JOSHUA DUGAS, Director, Department of Public Health
SUBJECT
Title
Master Employment Agreement for the California Advancing and Innovating Medi-Cal Program
End
RECOMMENDATION(S)
Recommendation
1. Approve a Master Employment Agreement template to hire and retain program staff for the California Advancing and Innovating Medi-Cal program.
2. Authorize the Chief Executive Officer, or the designated Department Director, to approve and execute individual Employment Agreements for the California Advancing and Innovating Medi-Cal Program and Amendments to the individual agreements, to extend the term for successive one-year periods not to extend beyond June 30, 2026, subject to County Counsel review.
(Presenter: William L. Gilbert, Director, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The expenses for the California Advancing and Innovating Medi-Cal (CalAIM) Program are funded by the California Department of Health Care Services and reimbursed to the County on behalf of Arrowhead Regional Medical Center (ARMC), the Department of Behavioral Health (DBH), and the Department of Public Health (DPH) through the Inland Empire Health Plan (IEHP). Based on financial modeling, revenues from IEHP are expected to cover the majority of the program expenses, including staffing costs. The revenues include incentive funding under Enhanced Care Management (ECM) Provider Agreement No. 21-983 approved by the Board of Supervisors (Board) on December 14, 2021 (Item No. 17).
Program expenses exceeding the funding allocation from IEHP will be met through the State’s Cal AIM grant: Providing Access and Transforming Health (PATH), as detailed in the Background Information section. There are two PATH grants - one for infrastructure transition, expansion and development and another for justice-involved capacity building. Budget adjustments are not requested at this time but will be included in a future item or in the 2023-24 Mid-Year Report presented to the Board for approval. Adequate appropriation and revenue will be included in future recommended budgets.
BACKGROUND INFORMATION
Effective January 1, 2022, San Bernardino County (County) has implemented the state-mandated ECM Program. ECM utilizes a whole-person care approach to meet the medical and non-medical circumstances of high-need Medi-Cal beneficiaries (including individuals who are homeless and/or have serious mental illness), and adults and children with complex medical conditions. Through the ECM Program, these beneficiaries receive care at the County medical location of their preference, thereby reducing the need to transfer these individuals between providers or County departments.
On January 11, 2022 (Item No. 12), the Board approved Master Employment Agreements for ECM and Community Supports (as provided by the Office of Homeless Services) programs to hire staff. Recommendation No. 1 approves the Master Employment Agreement template for new and revised job classifications for the CalAIM Program. The positions include ECM/Justice-Involved Office Assistant, ECM/Justice-Involved Community Health Workers, ECM LVN Care Manager, Justice-Involved Medi-Cal Specialist, Justice-Involved Medi-Cal Specialist Supervisor, ECM Behavioral Health Care Manager, ECM Community Health Worker Supervisor/Trainer, and ECM Program Manager.
On April 11, 2023 (Item No. 16), the Board authorized the acceptance of the PATH Capacity and Infrastructure Transition, Expansion and Development Round 1B grant in an amount up to $2,781,853. Funds are allocated from this grant as follows: $908,685 for DPH, $1,410,556 for DBH, and $462,612 for ARMC.
On August 8, 2023 (Item No. 15), the Board authorized the acceptance of the PATH - Justice Involved Capacity Building Grant, Round 2, in the amount of $1,050,000, for ARMC’s implementation of Justice-Involved Medi-Cal application support.
Recommendation No. 2 authorizes the Chief Executive Officer, or the designated department director, to execute the Master Employment Agreements and Amendments with contracted staff.
The details regarding the contract positions for CalAIM are included in Attachment A. As an overview, the County anticipates hiring an additional 28 positions, increasing the total number of CalAIM contract positions from 133 to 161 for County departments as indicated:
|
|
Positions |
|
Department |
Existing |
New |
|
Arrowhead Regional Medical Center |
78 |
17 |
|
Behavioral Health |
34 |
8 |
|
Office of Homeless Services |
13 |
0 |
|
Public Health |
8 |
3 |
|
Total |
133 |
28 |
ARMC, DBH, and DPH recommend approval of this item to provide for the health, safety and social service needs of County residents through the expanded implementation of the CalAIM Program.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Cynthia O’Neill, Principal Assistant County Counsel, Bonnie Uphold, Supervising Deputy County Counsel, Adam Ebright, Deputy County Counsel, and Dawn Martin, Deputy County Counsel, 387-5455) on September 1, 2023; Human Resources (Gina King, Assistant Director, 387-5560) on August 31, 2023; Behavioral Health (Georgina Yoshioka, Director, 252-5142) on September 5, 2023; Public Health (Joshua Dugas, Director, 387-9146) on September 5, 2023; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on September 5, 2023; Finance (Christopher Lange, Administrative Analyst, 386-8393, Paul Garcia, Administrative Analyst, 386-8392, and Jenny Yang, Administrative Analyst, 387-4884) on September 8, 2023; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238, Valerie Clay, Deputy Executive Officer, 387-5423, and Diane Rundles, Assistant Executive Officer, 387-5570) on September 11, 2023.