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Health and Human Services Agency (HHSA) recommending the Board adopt and authorize the Chair to sign Resolution 066-2024, authorizing the following allocation changes in HHSA, to support HHSA Behavioral Health and Public Health Divisions:
1) Deletion of 1.0 Full Time Equivalent (FTE) Limited Term Administrative Analyst I/II allocation;
2) Addition of 5.0 FTE Administrative Analyst I/II allocations;
3) Addition of 1.0 FTE Fiscal Technician allocation;
4) Addition of 5.0 FTE Mental Health Worker I/II allocations;
5) Addition of 3.0 FTE Mental Health Clinician IA/IB/II allocations;
6) Addition of 1.0 FTE Sr. Administrative Analyst allocation; and
7) Addition of 0.5 FTE Office Assistant I/II allocation.
FUNDING: State, Federal, and Realignment Funding, see the Financial Impact section for further detail.
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DISCUSSION / BACKGROUND:
The HHSA Personnel Allocations additions or deletion in this agenda request are being requested in order to meet new and emerging HHSA/County obligations, which include reporting, monitoring and data sharing measures, imposed by the Department of Health Care Services (DHCS) under the California Advancing and Innovating Medi-Cal (CalAIM) program, MHSA, and new State regulations. CalAIM and MHSA Reform are statewide initiatives implemented by the DHCS. The HHSA Behavioral Health Division (BHD) has a contractual obligation to meet the requirements of these initiatives.
Subsequently, DHCS, through the initiation of CalAIM, has placed new reporting requirements on County Mental Health Plans (MHP), which in the County, HHSA BHD serves as the MHP. Further, CalAIM has also increased Substance Use Disorder (SUD) program obligations on data tracking and reporting related to network adequacy, performance measures, and healthcare information exchange. Within the County, SUD programs/services are managed by the BHD. The SUD program provides substance use treatment services to eligible community members, which requires clerical support to be available to the SUDS staff. These obligations have been growing over the past two years, with an emphasis on unhoused populations, justice-involved individuals, and greatly expanded data requirements.
Consequently, HHSA is requesting the new personnel allocations in this agenda item to ensure that staff can meet new DHCS initiatives with the justification for these additions included below.
HHSA is requesting five FTE Administrative Analyst I/II allocations be added to support BHD MHP and SUD requirements, with the justification for these additions as follows:
• 2.0 FTE Administrative Analyst I/II allocations will support BHD, as the County MHP, in meeting new and expanded compliance and quality improvement requirements driven by CalAIM;
• 1.0 FTE Limited Term Administrative Analyst I/II allocation, currently included in the Fiscal Year (FY) 2023-24 Budget for BHD is being requested as a deletion. In its place, HHSA is requesting to add a permanent 1.0 FTE Administrative Analyst I/II, which will support the BHD SUD program in meeting new and expanded compliance and quality improvement requirements driven by CalAIM, including Network Adequacy tracking requirements, reporting on service delivery measures and monitoring and reporting on expanded requirements of the Drug Medi-Cal Organized Delivery System (DMC-ODS);
• 1.0 FTE Administrative Analyst I/II position will support the BHD’s MHSA program to assure programmatic performance, data tracking, and outcome performance measures under MHSA Reform will be met; and
• 1.0 FTE Administrative Analyst I/II will be placed in the HHSA Administration and Finance Division to assure that the BHD is meeting new and emerging CalAIM reporting and fiscal requirements, including addressing the ability to monitor and claim against new funding sources which come with significant administrative burdens such as Proposition 30 related claiming and increased federal block grant reporting requirements.
3.0 FTE Administrative Analyst I/II positions (noted above) will be placed in the MHP and SUDS Quality Assurance (QA), Quality Improvement (QI), Utilization Review (UR) unit, to assign with the reporting obligations. These 3.0 FTE Administrative Analyst I/II positions will support the BHD in meeting the increased obligations, ensuring contractual compliance, and minimizing the risk of DHCS issuing fines. Further, 1.0 FTE Administrative Analyst I/II (noted above) will be placed in the BHD MHSA program to assure all programmatic performance, data tracking, and outcome performance measures under MHSA Reform will be met. This position will work closely with clinical staff and BH Division QI/QA/UR staff in order to accurately report data from all MHSA funded projects. The 5.0 FTE Administrative Analyst I/II will address CalAIM and MHSA Reform driven obligations, both for the BHD programs and the administrative and finance operations. This includes data tracking & reporting, outcome measures development and reporting, financial and statistical data reporting, and claiming to Medi-Cal and other insurance companies.
Further, HHSA is requesting the following personnel allocations be added to support the BHD and Public Health Division (PHD) with CalAIM reporting, with the justification for these additions as follows:
• 1.0 FTE Fiscal Technician will be placed in the HHSA Administration and Finance Department to assure that BHD new CalAIM financial data, reporting requirements and CalAIM claimable services are claimed in a timely manner, and to improve HHSA BHD’s ability to monitor contract claiming.
• 1.0 FTE Sr. Administrative Analyst I/II will assist HHSA BHD, PHD, and the Administration and Finance Department by addressing programmatic and reporting requirements under CalAIM.
Lastly, HHSA is requesting the additions of 5.0 FTE Mental Health Worker I/II and 3.0 FTE Mental Health Clinician IA/IB/II to meet new BHD program requirements, with the justification for these additions as follows:
• 1.0 FTE Mental Health Worker I/II will be assisting BHD with Community Assistance Recovery and Empowerment (CARE) Court (referred to as CARE Court) with the provision of case management, care coordination, and rehabilitative services to CARE Court participants, which are required to begin no later than December 1, 2024. Senate Bill (SB) 1338 was signed into law September 2022, establishing a new CARE Court in California, addressing treatment needs of individuals suffering from untreated schizophrenia and other psychotic disorders. El Dorado County is mandated to implement CARE Court on December 1, 2024. CARE Court and mobile crisis services will improve overall health outcomes for community members experiencing a mental health crisis and/or SUD.
• 2.0 FTE Mental Health Worker I/II will be added to meet the new BHD Medi-Cal mobile crisis benefit service requirements, which are mandated for delivery by all County Behavioral Health Plans as a new benefit. Behavioral Health Information Notice BHIN 23-025 establishes the Medi-Cal Mobile Crisis Services Benefit Implementation requirements. All California County BH Divisions have a mandate to provide 24/7 mobile crisis services beginning on 1/1/24. The 2.0 FTE mobile crisis Mental Health Worker I/II will provide intervention and follow-up services to community members experiencing a mental health and/or substance use crisis in the community. One of the FTE Mental Health Clinicians IA/IB/II will provide clinical assessment and intervention mobile crisis services to community members experiencing a mental health and/or substance use crisis in the community. The 1.0 FTE Mental Health Clinician IA/IB/II and 2.0 FTE Mental Health Worker I/II will combine services to provide 24/7 mobile crisis services together with existing crisis services staff within the BHD, and contracted service support currently being pursued through competitive procurement, allowing HHSA to meet the new state obligation for this benefit.
• 1.0 FTE Mental Health Clinician IA/IB/II and 2.0 FTE Mental Health Worker I/II positions will implement Behavioral Health Bridge Housing (BHBH) and provide integrated services to the unhoused populations. The BHD has received BHBH funds from DHCS to provide care coordination, case management, treatment services and housing supports to the BHD adult clients. These additional staff will implement BHBH and provide integrated services to the unhoused populations.
• 1.0 FTE Mental Health Clinician IA/IB/II will assist BHD with addressing the needs of 0-5-year-old Medi-Cal members in the community, and will provide mental health assessment, treatment, case management, and early intervention services. This age group has historically received few services from HHSA, however, BHD is contractually obligated to address the mental health needs of County Medi-Cal members, regardless of age and services delivered at this age can prevent significant future needs; and
• 0.5 FTE Office Assistant I/II addition will be placed in the BHD SUD program and will be added to a current 0.5 FTE position in SUD to result in a 1.0 FTE Office Assistant I/II position in BHD. This Office Assistant I/II will provide clerical support, including receptionist duties, to the BHD SUDS staff.
HHSA is requesting the deletion of 1.0 FTE LT Administrative Analyst I/II and the addition of 5.0 FTE Administrative Analyst I/II, 1.0 FTE Fiscal Technician, 5.0 FTE Mental Health Worker I/II, 3.0 FTE Mental Health Clinician IA/IB/II, 1.0 Sr. Administrative Analyst, and 0.5 FTE Office Assistant I/II to support the increased workload resulting from the implementation and expansion of new programs within Behavioral Health, primarily as a result of CalAIM regulations and requirements. Additionally, working directly with the Human Resources Department, HHSA has developed the attached County Counsel approved Personnel Allocation Resolution.
ALTERNATIVES:
Should the Board decline to approve this recommendation, HHSA would not be able to implement the activities and services described, many of which are mandated by the State through contracts and regulatory requirements (DMC-ODS, MHP, MHSA) which will result in fines, sanctions, and penalties from the State Department of Health Care Services.
PRIOR BOARD ACTION:
1) 06/13/23, 23-1120, CAO - Budget Hearing
2) 06/20/23, 23-1154, CAO - FY 2023-24 Personnel Allocation, Reso 088-2023
3) 09/19/23, 23-1725, CAO - Adopted Budget Direction
4) 09/26/23, 23-1771, CAO - Budget Resolution
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Human Resources, Chief Administrative Office, County Counsel, & El Dorado County Employees' Association, Local 1, AFSCME Council 57
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
The total cost increase for these added positions is estimated at $2.1 million, with approximately $1.9 million being funded by state and federal revenue sources, and about $200,000 being funded by Realignment. 2.0 FTE Administrative Analyst I/II positions will be funded through 48% Federal Medi-Cal QA/UR and 52% Realignment funding. 1.0 FTE Administrative Analyst I/II position will be funded through 48% Federal Medi-Cal Admin and 52% Realignment funding. 1.0 FTE Administrative Analyst I/II will be funded through 100% Mental Health Services Act (MHSA) funding. 1.0 FTE Administrative Analyst I/II will be funded through 48% Federal Drug Medi-Cal QA/UR and 52% Realignment funding. 1.0 FTE Fiscal Technician will be funded through 48% Federal Medi-Cal Admin and 52% Realignment funding. 5.0 FTE Mental Health Worker I/II will be funded through 73% Medi-Cal and 27% MHSA funding. 3.0 Mental Health Clinician IA/IB/II will be funded through 68% Medi-Cal and 32% MHSA funding. The 0.5 FTE Office Assistant I/II will be funded through 50% Drug Medi-Cal Admin and 50% Realignment funding. The 1.0 Sr. Administrative Analyst will be funded through Future of Public Health (FoPH) State funding.
The addition of these allocations has no Net County Cost. The impact to Behavioral Health Realignment is estimated at $200,000 in increase appropriations. There is sufficient Realignment revenue to cover these additional positions. These positions will reduce the probability of fines, sanctions, and penalties from the State Department of Health Care Services that would impact Realignment funding, if the BHD cannot meet State mandates. There are sufficient appropriations in the Fiscal Year 2023-24 Budget to cover these additional positions and have been included in the FY 2024-25 Budget request.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
1) Obtain signature of Chair on Resolution, if approved; and
2) Provide one certified Resolution to HHSA-Contracts at 3057 Briw Rd and 1 certified Resolution to Heather Andersen in Human Resources at 330 Fair Lane.
STRATEGIC PLAN COMPONENT:
This agenda item contributes to the workforce excellence and safe and healthy communities goals of the strategic plan.
CONTACT
Olivia Byron-Cooper, MPH, Director