Title
a. Amend the Fiscal Year (FY) 2019-20 Health Department Adopted Budget 023-4000-8410-HEA012 to delete 2.0 FTE vacant Contract Physician and 1.0 FTE vacant Sr. Clinic Nurse, and add 3.0 FTE Public Health LVN, 8.0 FTE Medical Assistant, 1.0 FTE Chronic Disease Prevention Coordinator, and 1.0 FTE Accountant III, resulting in estimated increased costs of $52,142 in FY 2019-20 and $156,427 in FY 2020-21, financed by a corresponding increase in revenues generated by these positions (4/5ths vote required); and
b. Direct the Auditor-Controller and County Administrative Office to incorporate the position changes in the FY 2019-20 Health Department Adopted Budget 023-4000-8410-HEA012.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Amend the Fiscal Year (FY) 2019-20 Health Department Adopted Budget 023-4000-8410-HEA012 to delete 2.0 FTE vacant Contract Physician and 1.0 FTE vacant Sr. Clinic Nurse, and add 3.0 FTE Public Health LVN, 8.0 FTE Medical Assistant, 1.0 FTE Chronic Disease Prevention Coordinator, and 1.0 FTE Accountant III, , resulting in estimated increased costs of $52,142 in FY 2019-20 and $156,427 in FY 2020-21, financed by a corresponding increase in revenues generated by these positions; and
b. Direct the Auditor-Controller and County Administrative Office to incorporate the position changes in the FY 2019-20 Health Department Adopted Budget 023-4000-8410-HEA012.
SUMMARY/DISCUSSION:
The Health Department requests the Board’s approval to amend the FY 2019-20 adopted positions in the Behavioral Health Bureau (BHB), 023-4000-8410-HEA012, to delete 2.0 FTE vacant Contract Physician positions and 1.0 FTE vacant Sr. Clinic Nurse position, and add 3.0 FTE Public Health LVN, 8.0 FTE Medical Assistant, 1.0 FTE Chronic Disease Prevention Coordinator, and 1.0 FTE Accountant III.
Overall, these position changes will result in estimated increased costs of $52,142 in FY 2019-20 and $156,427 in FY 2020-21, which will be financed by a corresponding increase in revenues generated by the positions. The requested changes in clinical positions will aid in the reorganization of the Medical Team to implement a staffing model designed to maximize scarce medical resources, psychiatrists, and optimize efficiencies with the addition of support staff who will perform routine but essential functions to support client care.
Nurse Practitioners will provide diagnoses, medication support, follow up on serious mentally ill patients, and provide consultation to other nursing staff and case managers to manage clients’ psychiatric conditions at the lowest level of care possible to avoid or minimize emergency hospitalizations. The Public Health LVNs in consultation with psychiatrists and other nurses will administer medications and other treatments necessary to prevent the acute deterioration of clients’ psychotic disorders which can lead to hospitalization. Medical Assistants will be paired with psychiatrists whom they will support by preparing clients for their appointments, scheduling appointments, arranging for ancillary services, instructing clients about medications and special diets, etc. This staffing and work distribution will provide more efficient clinical coverage and improved client care at a lower cost.
The Chronic Disease Prevention Coordinator (CDPC) position is needed to perform required State reporting regarding cultural competency and efforts to promote and develop appropriate mental health services that meet the diverse needs of the County’s racial, ethnic, cultural, and linguistic populations. Currently, a CDPC within Health Department Administration (HD Admin) provides support with this function to the BHB. However, the expanding reporting requirements exceed the available capacity in HD Admin to meet the BHB’s needs.
The Accountant III position will provide needed resources to meet increasing requirements for fiscal oversight over contracted providers and fiscal reporting. The Accountant III will ensure protocols and policies and procedures are in place to comply with State requirements and will be responsible for oversight and maintenance of the same. In addition, the Accountant III will perform fiscal analysis and projections, assist with budget development and reporting, and will handle the most complex accounting and finance projects.
This work supports the Monterey County Health Department 2018-2022 Strategic Plan Initiative Number 2, to enhance community health and safety through prevention and Number 4, to engage MCHD workforce and improve operational functions to meet current and developing population health needs. It also supports one or more of the ten essential public health services, specifically, Number 6, to enforce laws and regulations that protect health and ensure safety and Number 8, to assure a competent public and personal health care workforce.
OTHER AGENCY INVOLVEMENT:
The County Administrative Office Budget Office, Auditor-Controller, County Counsel and Human Resources have reviewed the recommendations. This item was presented to the Budget Committee on November 22, 2019.
FINANCING:
The financial impact of these changes is estimated at $52,142 in FY 2019-20 and $156,427 in FY 2020-21, which will be financed by a corresponding increase in revenues generated by these positions. The increased costs for FY 2019-20 will be managed within the Adopted Budget. The positions will be funded with a mixture of Federal Financial Participation (FFP), Sales Tax Realignment (Realignment), Mental Health Services Act (MHSA), or other State grant funds. FFP depends upon client eligibility and is typically estimated between 50%-65%, with Realignment, MHSA, or grant funds making up the 50%-35% difference.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related Board of Supervisors Strategic Initiatives:
☐Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☒Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
☒Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services; promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☐Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Miriam Y. Mendoza-Hernández, Finance Manager, Ext. 4578
Approved by: Elsa M. Jimenez, Director of Health, Ext. 4526
Attachments:
Attachment A is on file with the Clerk of the Board
Resolution is on file with the Clerk of the Board