Title
Health and Human Services Agency recommending the Board:
1) Adopt El Dorado County’s Mental Health Services Act Annual Update for Fiscal Year (FY) 2022-2023; and
2) Authorize implementation of the FY 2022-2023 projects within the Annual Plan Update.
FUNDING: 81% Mental Health Services Act funds, 15% Federal Medi-Cal, 2% Federal Block Grants, 1% Realignment/State General Fund, and 1% Miscellaneous/Fee-for-Service.
Body
DISCUSSION / BACKGROUND:
In 2004, California voters passed Proposition 63, the Mental Health Services Act (MHSA). MHSA imposes a one (1) 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 (3) year program and expenditure plan, known as the MHSA Three-Year Program and Expenditure Plan. The plan has five (5) components intended to address specific goals for priority populations and other key community mental health needs, which are: Community Services and Supports (CSS), Prevention and Early Intervention (PEI), Innovation (INN), Workforce Education and Training (WET), and Capital Facilities and Technology Needs (CFTN).
Three-Year Plans and Updates are developed with input from community members and stakeholders through a public planning process, providing opportunities for community organizations and stakeholders to provide the framework for the plan's priorities by discussing mental health policy, program planning, implementation, monitoring, quality improvement, evaluation, and budget allocations. Each year, following the community stakeholder and public planning process, Counties are required to follow a formal process for providing the annual update to the Plan and presenting it to the Board of Supervisors for approval. The purpose of the Update is to review the Plan's existing projects and based upon their status or other identified needs, to make additions, modifications, or deletions to the Plan.
This year, the draft Fiscal Year (FY) 2022-23 Update was publicly posted for a 30-day review and public comment period on June 13, 2022. At the close of the 30-day period, the Behavioral Health Commission conducted a public hearing to receive any additional input from the community. Any substantive comments that were received about the draft Update during the 30-day comment period or the public hearing process were summarized and included in the final Update. Based upon community feedback, and at the recommendation of the Behavioral Health Director, 4 of the 5 Plan components of (PEI, CSS, INN, and CFTN) experienced some modifications to their respective areas. The INN component did not experience any updates.
Component 1: CSS, focuses on the development of recovery-oriented services for children, youth, adults, and older adults with serious mental illness.
New CSS Projects:
1. Services for a Crisis Residential Treatment (CRT) facility have been added for implementation after a facility is established using alternative funding. CRTs are a key 'level-of-care' that provide short-term treatment for adults with mental health needs who require 24-hour support in order to return to community living. Services routinely avert the need for hospitalization.
2. The Mental Health Student Services Act (MHSSA) is a grant-funded partnership between El Dorado County Office of Education (EDCOE) and El Dorado County Behavioral Health as a fiscal intermediary. Services are intended to screen the student population for mental health needs. Students that are identified for mental health needs will be served using a mental health skills curriculum and/or referred to mental health treatment providers in the community. Another key component is professional development for staff to create positive social-emotional school environments.
Modified CSS Projects:
1. All Children’s Full-Service Partnership contracts increased by 15% to more closely reflect anticipated expenditure increases due to CalAIM.
2. Transitions Treatment Program Project has had a change in provider.
Component 2: PEI projects are designed to prevent a mental illness from becoming severe and disabling, to the extent possible. The included PEI projects meet the PEI regulations as amended in 2018 and Senate Bill 1004 (2018).
Modified PEI Projects:
1. A Request for Proposal is anticipated for Senior Link Project and the budget has been increased from $75,000 to $100,000. Due to factors such as inflationary impacts, the budget is increasing to strengthen the RFP and attract qualified applicants.
2. Pioneer Unified School District has been added as an additional provider for the Primary Project to expand direct services to more children in the school setting. This south county school district will be in addition to Black Oak Mine USD in the divide, as well as Tahoe Youth and Family Services in the Tahoe basin.
3. The National Suicide Prevention Lifeline Project budget has been increased from $11,889 to $20,697. This increase is due to the increase in calls received recently, reflecting the corresponding increase in the County's share of the cost.
4. Prevention Wraparound Services: Juvenile Services Project budget has been decreased from $400,000 to $300,000. This budget decrease is based upon the performance of the contracted provider during two previous fiscal years in which the not-to-exceed amount was under-spent.
5. The Student Wellness Center - Middle School Project budget has been increased from $150,000 to $300,000 to provide additional and enhanced services.
6. Statewide PEI Project budget has been increased from $60,000 to $65,000.
7. The Community-based Outreach and Linkage Project description has been adapted to allow for alternative staffing options. This would allow the Psychiatric Emergency Response Team (PERT) to be any of 1) clinician and law enforcement; 2) two clinicians; or 3) clinician and Substance Use Disorder (SUD) staff member. This will enhance the availability and appropriateness of the response.
8. The Suicide Prevention and Stigma Reduction Project budget was increased to $231,000 to support the initiatives in the Suicide Prevention Strategic Plan approve July 19, 2022, and increases in currently operating initiatives.
Discontinued PEI Projects:
1. The Friendly Visitors Project was eliminated due to lack of a provider and will be re-evaluated for the FY 2023-24 through FY 2025-26 MHSA Three Year Program and Expenditure Plan.
Component 3: INN consists of projects that are designed to contribute to learning, rather than a primary focus on providing a service. In addition to the Board of Supervisor adoption of MHSA Plans and Annual Updates that include INN projects, the Mental Health Services Oversight and Accountability Commission (MHSOAC) also must approve INN projects. INN projects cannot exceed five (5) years in duration.
Modified INN Projects:
1. “Partnership between Senior Nutrition and Behavioral Health to Reach Home-bound Older Adults in Need of Mental Health Services” project - The MHSOAC approved this Innovation project on January 23, 2020. This project has not been implemented due to impacts from the nationwide mental health staffing shortage crisis. This project is scheduled to end on September 30, 2023. There is no change in funding.
Components 4 and 5: WET and CFTN serve to support the development of a well-trained, qualified, and diverse workforce and strengthen the foundation of the mental health system. Since these components are no longer funded by the MHSA, counties transfer funds from the CSS component to fund these projects.
Modified WET projects:
1. The Workforce Development Project budget has been increased from $150,000 to $165,000 to support retention initiatives.
Modified CFTN projects:
1. There are several modifications to the CFTN projects which require an increase in budget from $550,000 to $950,000. This increase will cover additional staff to manage and implement modifications to the Electronic Health Record and help to upgrade technology to meet mandatory federal and state mandates due to CalAIM.
2. CFTN Administrative Costs have been updated to reflect the option to utilize housing consultant services. The budget has been increased from $25,000 to $125,000.
ALTERNATIVES:
Failure to adopt the Update will not only result in an inability to provide continuity of care for clients currently receiving MHSA-funded services from contracted vendors but it will also result in El Dorado County being out of compliance with the requirements of the MHSA, which includes adoption of an annual Update. Consequently, the FY 2020-21 - 2022-23 MHSA Three-Year Program and Expenditure Plan would continue as the foundation for MHSA services in the County, without the recommended updates that were framed by community members and stakeholders through the required public planning process.
PRIOR BOARD ACTION:
07/19/22, 22-1046, HHSA Suicide Prevention Strategic Plan
06/22/21, 21-0713, HHSA MHSA Plan Update 2021-22
06/09/20, 20-0446, HHSA Mental Health Services Act FY 2020-21 - FY 2022-23 Plan Approval
06/25/19, 19-0936, HHSA MHSA Plan Update FY 2019-20
06/26/18, 18-0874, HHSA MHSA FY 2018-19 Annual Update
06/20/17, 17-0551, HHSA MHSA FY 2017-18 - FY 2019-20 Three-Year Program and Expenditure Plan
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
N/A
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
The changes identified in the MHSA Plan update for FY 2022-23 are included in the HHSA FY 2022-23 Adopted Budget submission. The HHSA MHSA budget has sufficient appropriations to support the MHSA Plan programs and is updated annually with MHSA Plan changes. Should revenues received fall short of projections and insufficient fund balance is available, expenditures will be adjusted as needed. There is no County general fund impact within the MHSA Plan update.
CLERK OF THE BOARD FOLLOW UP ACTIONS
N/A
STRATEGIC PLAN COMPONENT:
County of El Dorado Strategic Plan Project - Healthy Communities; Improved health, well-being, and self-sufficiency of El Dorado County communities, residents, and visitors.
CONTACT
Daniel Del Monte, Interim Director, Health and Human Services Agency