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Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings that the provision of Behavioral Health Workforce Program services provided by California Mental Health Services Authority (CalMHSA) are in the public's best interest and that the work is with or among any other governmental entities or agencies in accordance with El Dorado County Ordinance Code, Chapter 3.13.030(B);
2) Make findings in accordance with Procurement Policy C-17 Section 3.4 (3) exempting the competitive bidding process, with Purchasing Agent concurrence, because “competitive bidding would produce no economic benefit to the county”;
3) Approve and authorize the Chair to sign Participation Agreement 8245 with CalMHSA, to participate in the Behavioral Health Workforce Program, in the amount of $305,000, effective upon execution through December 31, 2027;
4) Authorize the Purchasing Agent to execute amendments relating to Agreement 8245, contingent upon approval by County Counsel and Risk Management, which do not increase the maximum dollar amount or term of the Agreement; and
5) Authorize the HHSA Director, Chief Assistant Director, or Director of Behavioral Health, to execute programmatic, administrative, and fiscal documents relating to Agreement 8245.
FUNDING: 100% State Mental Health Services Act (MHSA).
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DISCUSSION / BACKGROUND:
The CalMHSA Joint Powers Authority (JPA) was formed by counties in 2009 through the State of California (CA) to work on collaborative, multi-county projects that improve behavioral health care for all residents. The CalMHSA JPA provides administrative and fiscal services in support of member counties for statewide training, technical assistance and capacity building. On February 15, 2011, the Board authorized the County to become a participating member in the CalMHSA JPA via Resolution 024-2011 (File ID: 10-1324). Thereafter, the County has continued to be a participating member of CalMHSA JPA.
In an effort to combat the nationwide behavioral health workforce shortages impacting CA county behavioral health agencies, CalMHSA created a new Behavioral Health Workforce Program that will act as the umbrella program for a variety of behavioral health workforce, staffing, and training programs. Subsequently, CalMHSA provided the County HHSA Behavioral Health Division (BHD) with a Behavioral Health Workforce Program Master Participation Agreement (referred to as the Participation Agreement in this agenda item) which included separate programs that HHSA BHD could elect to participate in.
HHSA BHD is experiencing staffing shortages with a current division wide vacancy rate of 39% and a vacancy rate of 65% for the Mental Health Clinician classification. Vacancy rates have consistently been above 40% for the Mental Health Clinician classification since 2022. The HHSA BHD is exploring all options to decrease vacancy rates with the CalMHSA Behavioral Health Workforce Program as one way to improve staffing for the BHD.
HHSA BHD selected the following CalMHSA programs for engagement through the Participation Agreement: Remote Supervision Program; Training and Certification Courses; and the Medi-Cal Peer Support Specialist Offerings Program. These programs are summarized as follows:
CalMHSA’s Remote Supervision Program
Within CA, in order to obtain mental health/medical practice licensure, pre-licensed professionals (also called Associates) are required to work under a licensed supervisor in their field of study in order to gain the appropriate number of clinical experience hours and clinical supervision hours, pass the appropriate licensing exam(s), and register with the State licensing board. Under CalMHSA’s Remote Supervision Program, clinical supervision for pre-licensed HHSA BHD staff (such as Mental Health Clinicians, Clinical Social Workers, Marriage and Family Therapists, Psychologists, and Clinical Counselors, who are working towards licensure in CA) will be provided remotely by CalMHSA, via a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform. Through this program, CalMHSA will match licensed supervisors with HHSA BHD pre-licensed staff in their practicum. This Remote Supervision Program will help HHSA BHD pre-licensed behavioral health staff meet the licensed supervision requirements to qualify for state licensure in their field(s) of practice.
CalMHSA’s Training and Certification Program
Through participation in this program, HHSA BHD staff can receive training in the California Welfare and Institutions Code (WIC) §5150; a law that regulates involuntary custody holds for individuals if there is probable cause to believe that as a result of a mental health disorder, the individual is a danger to self, or a danger to others, or is gravely disabled. Under WIC §5150, individuals may undergo placement for evaluation, crisis intervention, and treatment in a facility designated by the jurisdictional county for evaluation and treatment, which in El Dorado County, is the Psychiatric Health Facility (PHF). Admitting PHF residents presenting for crisis evaluation in the County, who are detained pursuant to WIC §5150, are assessed by HHSA BHD Psychiatric Emergency Services staff.
CalMHSA Medi-Cal Peer Support Specialist Offerings Program
In 2020, Senate Bill (SB) 803 was passed which made it possible for certified Peer Support Specialists to be eligible for Medi-Cal reimbursement through county mental health plans and substance use disorder plans (behavioral health plans). Pursuant to SB 803, The Department of Health Care Services (DHCS) established CalMHSA as the certifying agency for Peer Support Specialists, responsible for the certification, examination, and enforcement of professional standards for Medi-Cal Peer Support Specialists in CA. On April 28, 2023, the Board approved and executed the CalMHSA Participation Agreement 3467-PSSC-2023-EDC (FENIX 7410), authorizing HHSA BHD to utilize CalMHSA to certify Peer Support Specialists in the County (File ID: 23-0400). HHSA’s ongoing participation in this program will allow HHSA BHD to ensure Medi-Cal Peer Support Specialists meet certification standards established by the DHCS.
In accordance with Board of Supervisors Procurement Policy C-17, CalMHSA is exempt from competitive bidding, with Purchasing Agent concurrence, per Section 3.4, (3) which states "competitive bidding would produce no economic benefit to the county." CalMHSA is providing county behavioral health jurisdictions throughout the State with immediate workforce solutions to help counties address shortages in clinical supervision. This program through CalMHSA has expanded to 11 counties since its inception less than one year ago. Currently, 61 county pre-clinician staff are using the program. Further, CalMHSA’s partnership with Motivo Health, the staffing firm that CalMHSA is utilizing to provide staffing services, to give counties access to the only provider offering to-scale remote supervision in California. Many counties that have pre-licensed staff but do not have access to enough clinical supervisors are participating so they can receive virtual clinical supervision through CalMHSA’s contracted Motivo’s HIPAA-compliant platform.
HHSA BHD recommends the Board approve and execute this CalMHSA Participation Agreement 8245, thereby authorizing the County’s participation in the State’s Behavioral Health Workforce Program to help remedy chronic behavioral health shortages with staffing and training and to keep HHSA BHD staff in compliance with the standards for the WIC §5150 and Medi-Cal Peer Support Specialist Certification.
ALTERNATIVES:
Should the Board decline to approve the Behavioral Health Workforce Program Master Participation Agreement, the County will continue to provide required pre-licensed supervision and address staffing shortages as it has prior to the Agreement. However, if the County chooses not to participate in the CalMHSA Medi-Cal Peer Support Specialist Certification program, it will be responsible for establishing its own certification program that meets standards established by DHCS. If the County fails to participate in the CalMHSA Medi-Cal Peer Support Specialist Certification Program, or establish its own certification program, it will be out of compliance with SB 803.
PRIOR BOARD ACTION:
1) 02/15/11, 10-1324, HHSA CalMHSA JPA Agreement
2) 04/18/23, 23-0400, HHSA CalMHSA Agreement 7410
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel, Human Resources Risk Management, Information Technologies. The Auditor-Controller was notified of this Agreement in accordance with Policy B-12.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this Agenda item. The Behavioral Health Workforce Program Master Participation Agreement will be funded with MHSA funding. Sufficient appropriations are included in the Fiscal Year 2023-24 Budget and will be included in future budgets for the term of the Agreement.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Clerk of the Board to obtain signature of Chair on one (1) original Participation Agreement 8245; and
2) Clerk of the Board to return one (1) fully executed Agreement to HHSA Contracts hhsa-contracts@edcgov.us.
STRATEGIC PLAN COMPONENT:
Safe and Healthy Communities
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency