REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 19, 2024
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Budget Adjustment for the Providing Access and Transforming Health - Capacity and Infrastructure Transition, Expansion and Development
End
RECOMMENDATION(S)
Recommendation
1. Authorize the Auditor-Controller/Treasurer/Tax Collector to post the necessary budget adjustments to the Department of Behavioral Health’s 2024-25 budget, as detailed in the Financial Impact section (Four votes required).
2. Authorize the addition of two contract Enhanced Care Management Supervisor/Trainer positions for the Department of Behavioral Health Enhanced Care Management Program.
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
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
This item does not impact Discretionary General Funding (Net County Cost). The estimated cost of $282,118 for the recommended positions will be funded 64% ($179,845) by a grant received from the California Department of Health Care Services (DHCS) under the Providing Access and Transforming Health (PATH) - Capacity and Infrastructure Transition, Expansion and Development (CITED) Program (Round 3) and 36% ($102,273) by the Enhanced Care Management (ECM) Managed Care Provider Agreement No. 21-983 (Agreement) with Inland Empire Health Plan (IEHP).
The Department of Behavioral Health (DBH) requests the Auditor-Controller/Treasurer/Tax Collector (ATC) to post the following adjustments to their budget:
|
DBH Fund |
Commitment Item |
Description |
Action |
Amount |
|
9200542200 |
51001010 |
Regular Salary |
Increase |
$282,118 |
|
9200542200 |
40408955 |
State Grant |
Increase |
$282,118 |
BACKGROUND INFORMATION
California State Assembly Bill 133 (Chapter 143, Statutes 2021) authorized the PATH CITED grant funding to support the implementation of California Advancing and Innovating Medi-Cal (CalAIM) initiatives, which includes the ECM program. PATH CITED (Round 3) provides funding to build capacity and infrastructure for the delivery of Medi-Cal ECM program benefits and community support services. This funding will allow Arrowhead Regional Medical Center (ARMC), DBH, and the Department of Public Health (DPH) to continue to develop the ECM program, expanding enhanced healthcare access to communities that have historically been underserved.
On September 30, 2022, the Chief Executive Officer (CEO) approved the submission of the grant application for PATH CITED, Round 1. As a result, on March 24, 2023, the County was awarded up to $2,781,853 in grant funding. On May 31, 2023, the CEO approved the submission of the grant application for PATH CITED, Round 2. The County was not awarded.
Effective January 1, 2022, DHCS, through CalAIM, established new statewide programs: ECM and Community Supports (CS). This initiative emphasizes a whole-person care approach, the medical and non-medical circumstances of high-need Medi-Cal beneficiaries will be met at their county medical location of preference, thereby reducing the need to transfer these individuals between providers or county departments. High-need Medi-Cal beneficiaries include individuals who are homeless and/or have serious mental illnesses, adults and children with complex medical conditions, justice-involved populations with significant clinical needs, and the growing aging population. ARMC and DPH are working in collaboration to provide ECM services to Medi-Cal beneficiaries at DPH clinics.
Beyond medical services, the inclusion of CS is led by Office of Homeless Services (OHS), a division of Community Revitalization, which is focusing on sustaining services such as housing transition navigation services, housing deposits, and housing tenancy. San Bernardino County (County) may consider other types of services in the future.
PATH CITED (Round 3) funding addresses the gaps in local organizational capacity and infrastructure that exist statewide, enabling local partners to scale up the services they provide to Medi-Cal beneficiaries, such as additional staff billing systems and data exchange capabilities. The CITED initiative provides direct funding to support ECM and CS services. Entities that are contracted or plan to contract with a managed care plan can apply to receive funding for specific capacity needs to support the transition, expansion, and development of these specific services.
On December 14, 2021 (Item No. 17), the Board of Supervisors (Board) approved the ECM Agreement with IEHP that established capitation payment rates and set the parameters for County departments, including ARMC, DBH, DPH, and OHS, to receive incentive funding for providing ECM and CS services to high-need IEHP members, for the term of January 1, 2022 through June 30, 2024.
On March 29, 2022 (Item No. 13), the Board approved Amendment No. 1 to the Agreement with IEHP, increasing reimbursement rates to the County, with no change to the term of January 1, 2022, through June 30, 2024.
On February 28, 2023 (Item No. 7), the Board approved Amendment No. 2 to the Agreement with IEHP, increasing reimbursement rates to the County, with no change to the term of January 1, 2022, through June 30, 2024.
On February 15, 2024, the CEO approved the submission of a grant application for PATH CITED (Round 3) in the amount of $1,439,364. On July 10, 2024, the County was awarded PATH CITED (Round 3) funding in the amount of $352,638, for the period of August 20, 2024, through August 19, 2026; $179,845 of this grant was allocated to DBH. On August 20, 2024 (Item No. 26), the Board formally accepted this grant award (Contract No. 24-772).
On June 25, 2024 (Item No. 24), the Board approved Amendment No. 3 to the Agreement with IEHP, increasing reimbursement rates to the County and extending the Agreement by an additional year, for a revised term of January 1, 2022, through June 30, 2025.
The County will utilize the PATH CITED (Round 3) grant funding to support a whole-person care approach to address the medical and non-medical circumstances of high-need Medi-Cal beneficiaries enrolled in the ECM Program. This includes adding two ECM Supervisor/Trainer contract positions through June 30, 2026,to develop and train ARMC, DPH, and DBH Community Health Worker staff on the new child/youth and justice-involved populations.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on October 23, 2024; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on October 28, 2024; Auditor-Controller/Treasurer/Tax Collector (Charlene Huang, Auditor-Controller Manager, 382-7022) on October 30, 2024; Human Resources (Gina King, Assistant Director, 387-5560) on November 4, 2024; Finance (Paul Garcia, Administrative Analyst, 386-8392) on November 7, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on November 7, 2024.