Title
Consider a preliminary analysis report in response to Board Referral No. 2023.12 seeking collaboration between County of Monterey and City of Salinas on a pilot crisis response program. (Alejo)
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive a preliminary analysis report in response to Board Referral No. 2023.12;
b. Provide direction on a preferred referral processing option:
i. Proceed with completion of referral as outlined in preliminary report;
ii. Proceed with completion of referral based on modifications by Board;
iii. Return to Board with a more comprehensive analysis of referral and anticipated effort for completion; or
iv. Rescind referral.
c. Provide further direction, as appropriate.
SUMMARY:
Behavioral Health (BH) has been participating in meetings and discussions with the City of Salinas regarding Mobile Crisis Services over the past year. BH presented on this topic at the May 23, 2022 Salinas Valley City Managers and Mayors meeting held in Greenfield where City of Salinas representative was in attendance. Following that presentation, City Manager outreached to BH and a follow-up discussion occurred on June 21, 2022. On July 5, 2022, BH presented on Mobile Crisis Services to additional representatives of the City of Salinas to initiate further discussion and exploration of possible opportunities for City / County collaboration. This was followed by additional discussion on August 18, 2022, and BH provided a presentation to the Salinas City Council on September 6, 2022 at the request of the City Manager. BH has also presented on Mobile Crisis Services to the Health, Housing and Human Services Committee of the Board of Supervisors on May 6, 2022, and the Board of Supervisors on September 13, 2022. BH joined follow-up discussion on exploration of a mobile crisis unit at the City’s Ad Hoc MOU Committee meeting on March 2, 2023. Upon receipt of the referral from the Board of Supervisors, BH outreached to the City of Salinas and a meeting is scheduled for June 5, 2023 to further explore a potential pilot crisis response program.
Under the American Rescue Plan Act (ARPA), states are eligible for an 85% enhanced Federal Medical Assistance Percentage (FMAP) for qualifying mobile crisis services for twelve (12) quarters between April 2022 and April 2027. Department of Health Care Services (DHCS) submitted a State Plan Amendment (SPA) to Centers for Medicare and Medicaid Services (CMS) that established a new Medi-Cal mobile crisis benefit. On December 19, 2022, DHCS issued a Behavioral Health Information Notice (BHIN 22-064) on the new Medi-Cal Mobile Crisis Services Benefit Implementation to provide guidance regarding implementation of the Medi-Cal Community-Based Mobile Crisis Intervention Services benefit by county mental health plans (MHPs), Drug Medi-Cal (DMC) counties and Drug Medi-Cal Organized Delivery System (DMC-ODS) counties. This guidance states, “No sooner than January 1, 2023 and upon receiving approval from DHCS, county MHPs, DMC counties, and DMC-ODS counties (collectively, “Medi-Cal behavioral health delivery systems”) shall provide, or arrange for the provision of, qualifying mobile crisis services in accordance with the requirements set forth in this BHIN. Medi-Cal behavioral health delivery systems shall have the benefit fully implemented by December 31, 2023. Mobile crisis services are an integral part of California’s efforts to strengthen the continuum of community-based care for individuals who experience behavioral health crises, including through implementation of the 988 Suicide and Crisis Lifeline and the Crisis Care Mobile Units Program Grant.” BHIN 22-064 outlines the specific requirements and service components that need to be met to ensure all Medi-Cal members have access to coordinated crisis care 24 hours a day, 7 days a week, 365 days per year. Attached is a presentation given by DHCS in partnership with Cal OES and CalHHS at the Forensic Mental Health Association of California (FMHAC) in April 2023 that outlines the specific Medi-Cal Mobile Crisis Services Benefit requirements and timeline (please refer to DHCS slides 17-25 in the attachment). County behavioral health plans are required to submit implementations plans to DHCS by October 31, 2023 and have full implementation of this new benefit by December 31, 2023.
Developing a pilot program with the City of Salinas that would meet the DHCS requirements is essential to not only develop but help sustain the program over time. Given workforce shortage challenges and the specific requirements outlined by DHCS requiring at least a two-person team comprised of “Qualified Mobile Crisis Team Members” as defined by DHCS (please refer to pages 8-9 of the attached BHIN), consideration should be given to exploring the viability of partnering BH clinicians with City of Salinas paramedic units given the DHCS restrictions regarding law enforcement involvement in mobile crisis response (please refer to pages 19-20 of the attached BHIN and slide 21 of the attached PowerPoint). As crisis services are provided irrespective of ability to pay or payor source, BH would request that the City of Salinas share some of the cost associated with services provided to the uninsured and privately insured to go towards offsetting staffing cost for the program as Medi-Cal reimbursement would not be received for these groups.
BH continues to explore all viable solutions to meet DHCS requirements and implementation deadlines despite current workforce shortage and hiring challenges to include contracting out for additional resources as Community Based Organizations (CBO) have greater flexibility in staffing and scheduling than do county entities and may be able to work alongside and augment the services being provided by our county staff and county contracted provider Seneca who operates the Children and Youth Mobile Response Team and Family Urgent Response System (FURS) in Monterey County.
PRELIMINARY ANALYSIS:
Background: Behavioral Health is in receipt of Referral no. 2023.12, assigned by the Board on 5/23/2023, requesting the Behavioral Health Bureau collaborate with City of Salinas and explore launching a joint model crisis response pilot program.
Project Description: BH understands the collaborative effort required for this project and is committed to that, and the specifics of this project have yet to be determined and will need to be determined in partnership with the City of Salinas. BH and City of Salinas are already in communication and follow-up meetings have been scheduled to continue discussions.
Estimated Project Cost: Project costs are unknown at this time. BH intends to identify potential costs and include as part of our Response.
Staffing Level Estimate: The specifics of this project have yet to be identified and will be fully determined in collaboration with the City of Salinas. We are unable to estimate staffing at this time. Proposed Response date is 90 days from this preliminary referral response: September 2023.
Departmental Challenges: BH has been historically successful in collaborating with the City of Salinas. Challenges in this project will be a.) finding and hiring qualified personnel to fill Mobile Crisis positions; b.) securing sustainable funding for these positions; and c.) complete planning and locate resources needed to meet the new Mobile Crisis response requirements as outlined in this report.
Proposed Response Date: BH intends to continue communication and collaboration with the City of Salinas in this effort. Proposed Response date is 90 days from this preliminary referral response: September 2023.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Mark a check to 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: Melanie Rhodes, Deputy Director Behavioral Health, 796-1742
Jon Drake, Assistant Bureau Chief, 755-4357
Katy Eckert, Behavioral Health Bureau Chief, 755-4580
Approved by:
______________________________Date ____________________________
Elsa Mendoza Jimenez, Director of Health, 755-4526
Attachments:
Preliminary Analysis Report
Board Referral No. # 2023.12
Behavioral Health Information Notice # 22-064
PowerPoint Presentation