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Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings pursuant to Section 3.13.030 (B) of the El Dorado County Ordinance Chapter 3.13, Contracting Out, that Mobile Crisis services provided by Sierra Mental Wellness Group (SMWG) requires specialty skills and qualifications not expressly identified in County classifications are involved in the performance of the work;
2) Approve and authorize the Chair to sign competitively procured Agreement for Services 9019 with SMWG, in the amount of $4,129,000 for the initial 19-month term from December 10, 2024, through June 30, 2026, with the option to extend the Agreement for one additional year through June 30, 2027, for a maximum compensation amount of $7,055,000 if the extension is granted;
3) Authorize the Purchasing Agent to execute amendments relating to Agreement 9019, contingent upon approval by County Counsel and Risk Management, which do not increase the maximum dollar amount or term of the Agreement; and
4) Authorize the HHSA Director, or the Chief Assistant Director, to execute programmatic, administrative, and fiscal documents relating to Agreement 9019.
FUNDING: Federal and State Funding: 75% Mental Health Services Act and 25% Federal Medi-Cal.
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DISCUSSION / BACKGROUND:
In 2004, California voters passed Proposition 63, the MHSA, which imposes a one percent tax on personal income in excess of $1,000,000. The funds from the tax are distributed to California counties and are intended to transform the Mental Health System into one that is consumer and family driven, recovery-oriented, accessible, culturally competent, and a system that offers services appropriate for the population that is served.
MHSA requires counties to prepare a three-year program and expenditure plan, known as the MHSA Three-Year Program and Expenditure Plan (or the “MHSA Plan”), and perform subsequent Annual Updates to the Plan. On June 20, 2023, the County’s most recent MHSA Plan, covering Fiscal Year (FY) 2023-24 through FY 2025-26, was adopted by the Board (Legistar file 23-0933), with an amendment to said Plan adopted by the Board on February 27, 2024 (Legistar file 24-0084).
Pursuant to Behavioral Health Information Notice (BHIN) No. 23-025 published by the California Department of Health Care Services (DHCS), the County as the Mental Health Plan (MHP) in El Dorado County is mandated to deliver 24/7 Mobile Crisis Services to include on-site Mobile Crisis Response (de-escalation and stabilization services) for behavioral health emergencies in the community. As outlined in the BHIN, MHP counties shall provide, or contract with providers to establish qualifying mobile crisis services or teams to serve its jurisdiction.
On June 18, 2024, the Board adopted the County’s MHSA Plan’s Annual Update for FY 2024-25, which included the updated project titled the “MHSA Community-based Outreach and Linkage Project” that addressed the 24/7 Mobile Crisis Services mandates set forth by the DHCS (Legistar file 24-0832).
To formally solicit for these services, HHSA worked in partnership with County Procurements and Contracts Division to solicit qualified providers for the Behavioral Health Crisis Intervention Services via Request for Qualifications (RFQ) No. 24-0037, which was posted on April 18, 2024, and closed on May 25, 2024. Following the RFQ evaluation process, SMWG was selected by HHSA to provide these services for the County and was added to the RFQ's resulting Qualified List on June 27, 2024.
SMWG, a mental health provider in Northern California, extends crisis response services to several neighboring counties. SMWG will provide Mobile Crisis Services, following the DHCS guidance outlined in BHIN 23-025 for Mobile Crisis Team operations also referred to as Crisis Care Mobile Unit's (CCMU). Through proposed Agreement 9019 presented in this agenda item, SMWG will provide a Mobile Crisis Team, consisting of trained counselors and peer support specialists, to respond to behavioral health emergencies in El Dorado County and will connect individuals to essential resources and ongoing support, thereby enhancing engagement in behavioral health services.
SMWG’s CCMU will deliver rapid response, individual assessments, and community-based stabilization for El Dorado County residents and Medi-Cal beneficiaries facing mental health and substance use disorder crises. The CCMU team will deliver interventions to provide relief to individuals through de-escalation and stabilization techniques; minimize risk of danger and subsequent harm; and reduce reliance on emergency departments, psychiatric inpatient hospitals, and law enforcement.
SMWG will manage the CCMU team during contracted hours in South Lake Tahoe and the Western Slope, ensuring a prompt response to crisis calls and coordination with local law enforcement and other partner agencies when necessary. SMWG will also provide follow-up support to assist individuals and families access essential services. Mobile Crisis services outside of these contracted hours will be administered through the existing Psychiatric Emergency Response Team (PERT) as outlined in County Memorandum of Understanding (MOU) 8008 with the El Dorado County Sheriff's Office (EDSO) (Legistar file 23-1677).
HHSA recommends the Board approve this Agreement with SMWG to ensure that the County will meet its obligations as the County MCP to deliver the 24/7 Mobile Crisis Services.
ALTERNATIVES:
Should the Board decline to approve this recommendation, HHSA would be unable to meet the mandated 24/7 Mobile Crisis services as outlined in BHIN 23-025 to eligible Medi-Cal beneficiaries experiencing a mental health and/or substance use disorder (SUD) crisis. HHSA would continue to provide services through coordination with EDSO through the PERT MOU, and with other law enforcement agencies as applicable, and will also independently provide services through its Behavioral Health Division but would be unable to meet the 24/7 requirements, resulting in state sanctioned fines and penalties. Additionally, counties are unable to draw down Medi-Cal Mobile Crisis funding in the absence of 24/7 services, leading to diminished funding for this project.
PRIOR BOARD ACTION:
1) 06/20/23, 23-0933, HHSA Adoption of FY 2023-24 - FY 2025-26 MHSA 3-Year Program and Expenditure Plan
2) 12/12/23, 23-1677, HHSA EDSO PERT MOU 8008
3) 02/27/24, 24-0084, HHSA MHSA Plan Amendment
4) 06/18/24, 24-0832, HHSA MHSA FY 2024-25 Annual Update
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel, Human Resources, Risk Management, and Procurement and Contracts.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this agenda item as funding is provided through state-funded Mental Health Services Act and Federal/State funded Medi-Cal. Sufficient appropriations have been included in HHSA’s Fiscal Year 2024-25 Budget and will be included in future budgets for the term of the Agreement, as well as Medi-Cal reimbursement as appropriate.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to obtain signature of Chair on one original Agreement for Services 9019.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency