DATE: April 9, 2024
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director of Behavioral Health
SUBJECT: Agreement with Kings View for Mobile Crisis Services to Add Grant-Funded School-Based Pilot
RECOMMENDED ACTION(S):
TITLE
1. Accept First Amendment to Resolution No. CY 2022-06 with California Health Facilities Financing Authority for Investment in Mental Health Wellness Grant Program for Children and Youth to extend the term through April 30, 2025, with no change to total of $1,371,806; and
2. Approve and authorize the Chairman to execute Agreement with Kings View for Crisis Intervention Team and Medi-Cal Mobile Crisis Benefit Services, and to add grant-funded School-based Mobile Crisis Services Pilot, effective upon execution through June 30, 2025, which includes one optional one-year extension, total not to exceed $10,503,399.
REPORT
There is no additional Net County Cost associated with the recommended actions, which will allow the Department of Behavioral Health (Department) to provide services consistent with California Health Facilities Financing Authority (CHFFA) grant guidelines for mobile crisis support teams to non-law enforcement related behavioral health crisis calls at Fresno County schools. The first recommended action will extend the term of the existing CHFFA funding agreement by nine months through April 30, 2025. The second recommended action will allow the County to replace, restate and supersede current Metropolitan (Metro) and Rural agreements for Crisis Intervention Team (CIT) and mandated Medi-Cal Mobile Crisis Response Team (MCRT) services based on cost efficiencies in combining similar services under one vendor, Kings View, and add CHFFA funding for additional positions and vehicles to respond to school-based behavioral health crisis. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, the Department will be out of compliance with CHFFA grant guidelines and forfeit the grant funding.
FISCAL IMPACT:
There is no increase to Net County Cost associated with the recommended actions. Kings View is the County’s current vendor for CIT and MCRT services in Fresno metropolitan and rural areas. The current agreements with Kings View are $6,383,391 for the Metro program and $7,267,787 for Rural program, both with termination dates of June 30, 2025. The agreements are funded with Mental Health Realignment, Crisis Care Mobile Unit (CCMU) grant funding, Mental Health Services Act Prevention and Early Intervention (MHSA-PEI), Medi-Cal Federal Financial Participation (FFP) revenue and Drug Medi-Cal FFP revenue. The recommended Supersede Agreement combines the current agreements and sets a new total maximum compensation to $10,503,399 effective upon execution. Increases in prior funding levels is fully funded by the CHFFA grant. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2023-24 Adopted Budget and will be included in future budget requests for the term’s duration.
DISCUSSION:
In 2016, Senate Bill 833 (Section 20) expanded the Investment in Mental Health Wellness Act to specifically address a continuum of crisis services for children and youth, 21 years of age and under. Funding was to be allocated to develop crisis residential treatment, crisis stabilization, mobile crisis support teams, and family respite care programs for this specific population. Grants from CHFFA were disbursed to California counties or to their nonprofit or public agency designees to support capital improvement, expansion and limited start-up costs.
On October 25, 2022, the Board retroactively approved the submittal of a grant application to the CHFFA Investment in Mental Health Wellness Grant Program for Children and Youth, Round 4. On August 22, 2023, the Board approved revenue Agreement No. 23-416 with CHFFA to expand mental health intervention services with dedicated school-based mobile crisis services. Through this grant, the Department plans to expand the services currently provided by existing contracted mobile crisis programs with a pilot project of trauma-informed mobile crisis support teams dedicated to children and youth who experience a behavioral health crisis while in attendance at a Fresno County school. While the current mobile crisis teams respond to calls for children and youth, and provide services at area schools, the school-based teams will be dedicated to respond to calls only from this population and will provide follow-up with the children and youth served for at least 30 days after the initial call response, as well as their parents/caregivers and the schools.
On December 11, 2018 the Board approved Agreement No. 18-688 with Kings View to provide CIT services in the Fresno metropolitan areas (Metro). Services include, but are not limited to assessment, crisis intervention, community referrals and linkages, and short-term/brief case management. CIT clinicians are dispatched in response to behavioral health crisis calls in the community with law enforcement. On June 21, 2022, the Board approved Agreement No. 22-266 with Kings View for CIT services in the Fresno rural areas. On September 20, 2022, the Board approved a Supersede Agreement No. 22-241 to the Metro agreement that retroactively changed the contractor’s name from Kings View Behavioral Health to Kings View and Amendment I to the Rural agreement, both adding CCMU grant funding for case manager positions. On June 20, 2023, the Board approved Supersede Agreement No.s 23-303 and 23-308 of the Metro and Rural agreements to implement new Department of Health Care Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) regulations. On January 23, 2024, the Board approved amendments the Metro and Rural agreements to add MCRT services as mandated by DHCS Medi-Cal Mobile Crisis Benefit Services. MCRT services include a dedicated 24/7 mobile crisis hotline and two-member team response to non-law enforcement related behavioral health crisis calls in the community.
Approval of the recommended Supersede Agreement will allow the Department to combine the current agreements and include the CHFFA funded services for a better coordinated mobile crisis intervention system of care, leverage more flexible staffing strategies between the three response models, and reduce additional administrative burden. As a condition of CHFFA funding, there is agreement language for the vehicle compensation where Kings View will be the registered owner of the vehicles and list the County as the first lienholder.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of the recommended items at its March 2024 meeting.
REFERENCE MATERIAL:
BAI #29, January 23, 2024
BAI #28, August 22, 2023
BAI #46, June 20, 2023
BAI #33, October 25, 2022
BAI #26, September 20, 2022
BAI #46, June 21, 2022
BAI #32, December 11, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - First Amendment to Resolution with CHFFA
On file with Clerk - Supersede Agreement with Kings View
CAO ANALYST:
Ronald W. Alexander, Jr.