REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 13, 2023
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Mental Health Services Act Three-Year Integrated Plan For Fiscal Years 2023-24 through 2025-26
End
RECOMMENDATION(S)
Recommendation
1. Approve the Mental Health Services Act Three-Year Integrated Plan for Fiscal Years 2023-24 through 2025-26, in the amount of $550,758,995, for the period of July 1, 2023 through June 30, 2026.
2. Approve Annual Prevention and Early Intervention Report, as required by Title 9 California Code of Regulations Section 3560.010 and incorporated into the Mental Health Service Act Three-Year Integrated Plan for Fiscal Years 2023-24 through 2025-26.
3. 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 Three-Year Integrated Plan for Fiscal Years 2023-24 through 2025-26, on behalf of the County.
4. 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 Three-Year Integrated Plan for Fiscal Years 2023-24 through 2025-26, on behalf of the County.
5. Authorize the Director of the Department of Behavioral Health, as the County Mental Health Director, to execute and submit the Mental Health Services Act Three-Year Integrated Plan for Fiscal Years 2023-24 through 2025-26 plan documents and any subsequent non-substantive amendments necessary, as required by the California Department of Health Care Services, to the State of California Department of Health Care Services, Mental Health Services Oversight and Accountability Commission, on behalf of the County, subject to review by County Counsel.
6. Direct the Director of the Department of Behavioral Health, as the County Mental Health Director, to transmit all Mental Health Services Act Three-Year Integrated Plan for Fiscal Years 2023-24 through 2025-26 plan documents and amendments, to the Clerk of the Board of Supervisors within 30 days of execution.
(Presenter: Georgina Yoshioka, Director, 252-5142)
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
This item does not impact Discretionary General Funding (Net County Cost). The submission and approval of the Mental Health Services Act (MHSA) Three-Year Integrated Plan (Plan) for Fiscal Years (FY) 2023-24 through 2025-26 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 MHSA funds for the upcoming program years. The Plan will not exceed $550,758,995 and will be funded by MHSA funding. The approximated annual amounts over the three-year period are provided below. The annual assignment of Prevention and Early Intervention (PEI) funds to the California Mental Health Services Authority (CalMHSA) is included in the aggregate total of PEI expenditures. Individual Program funding can be modified through the mandated stakeholder process. Any necessary updates will be reflected in a future required Annual Update to the Plan and presented to the Board of Supervisors (Board) for approval prior to submission to DHCS.
|
MHSA Component |
FY 2023-24 |
FY 2024-25 |
FY 2025-26 |
Total MHSA Expenditures |
|
Community Services and Supports (CSS) |
$119,178,540 |
$129,268,094 |
$136,162,886 |
$384,609,520 |
|
Prevention and Early Intervention (PEI) |
$30,409,776 |
$32,655,671 |
$34,152,475 |
$97,217,922 |
|
Innovation (INN) |
$7,531,869 |
$3,628,892 |
$848,028 |
$12,008,789 |
|
Workforce Education and Training (WET) |
$6,191,862 |
$6,271,789 |
$6,452,712 |
$18,916,363 |
|
Capital Facilities and Technological Needs (CFTN) |
$21,203,619 |
$8,538,469 |
$8,264,313 |
$38,006,401 |
|
Total |
$184,515,666 |
$180,362,915 |
$185,880,414 |
$550,758,995 |
Adequate appropriation and revenue will be included in DBH’s 2023-24 recommended budget and in DBH’s future recommended budgets.
BACKGROUND INFORMATION
DBH developed the MHSA Plan according to the guidelines provided by MHSOAC and by following the stakeholder process outlined in the California Welfare and Institutions Code (WIC) Section 5848 and Title 9 of California Code of Regulations (CCR) Sections 3300, 3315, and 3320, which includes a 30-day public review and comment period that took place Februrary 13, 2023 through March 15, 2023. A Public Hearing was held by the County Behavioral Health Commission (BHC) on April 6, 2023.
WIC Section 5847 subdivisions (a) and (b) directs the DBH Director, as the County Mental Health Director and responsible for the administration of the County’s mental health services, to execute and submit the MHSA Plan to the MHSOAC and DHCS within 30 days of adoption by the 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 Plan submission to the MHSOAC and DHCS, MHSA program services and operations will proceed with implementation.
The Plan highlights trends, program goals, and outcomes of DBH 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 $1,000,000. Since 2005, MHSA (also know as Proposition 63) has provided funding to the County for services and resources that promote wellness, recovery, and resiliency for adults ages 26 to 59 years old, and older adults ages 60 and over, 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 Plan and annual updates to include the Annual Prevention and Early Intervention Report.
The Annual Prevention and Early Intervention Report is required by MHSOAC as a separate Recommendation for Board approval per Title 9 CCR Section 3560.010. The report is included as a part of the PEI Component of the MHSA Plan.
The MHSA Plan 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 the ending of 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.
Over the three-year period, DBH anticipates that MHSA programs will serve approximately 440,000 clients across the continuum of care. The cost per client varies widely depending upon the specific MHSA program and the individual level of care provided, with estimated costs ranging from $322 to $2,686 per client.
The MHSA programs help to reduce symptoms of serious mental illness, improve functioning, reduce homelessness and justice involvement for consumers, use non-stigmatizing and culturally appropriate approaches to educate communities about behavioral health conditions, and increase access to necessary behavioral health services.
In accordance with WIC Section 5848, a public hearing was held on April 6, 2023. The public hearing was hosted by the BHC, and the BHC affirmed that DBH adhered to the MHSA CPP process and supported the submission of the MHSA Plan to the Board and the subsequent submission to the DHCS and MHSOAC. No substantive text edits were identified and updated during the stakeholder process. DHCS has the responsibility of releasing the full executed State Agreement to the County. 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. In addition, on today’s agenda, there is a companion item for the Board to approve the MHSA Innovation Plan.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on May 19, 2023; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on May 24, 2023; Finance (Christopher Lange, Administrative Analyst, 386-8393) on May 24, 2023; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on May 25, 2023.