DATE: January 23, 2024
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director of Behavioral Health
SUBJECT: Amendments to Kings View Crisis Intervention Team Contracts to Add Medi-Cal Mobile Crisis Services
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute Amendment I to Agreement with Kings View for Fresno Metropolitan Crisis Intervention Team Services to add mandated Medi-Cal Mobile Crisis Benefit Services, effective upon execution with no change to the term of July 1, 2023 through June 30, 2025 and increasing the maximum by $1,489,985 to a total of $6,383,391;
2. Approve and authorize the Chairman to execute Amendment I to Agreement with Kings View for Fresno Rural Crisis Intervention Team Services to add mandated Medi-Cal Mobile Crisis Benefit Services, effective upon execution with no change to the term of July 1, 2023 through June 30, 2025 and increasing the maximum by $1,437,238 to a total of $7,267,787; and,
3. Approve and authorize the Chairman to execute Amendment II to Agreement with Kings View to expand use of the County’s Health and Wellness Center to 24 hours a day, 7 days a week, 365 days a year, effective upon execution with no change to the term of January 1, 2022 through June 30, 2025 ($0).
REPORT
Approval of the recommended actions will allow the Department to adhere to new Department of Health Care Services (DHCS) mandated Medi-Cal Mobile Crisis Benefit Services inclusive of a dedicated mobile crisis hotline and two-member team response to non-law enforcement related mental health and substance use disorder crisis calls 24 hours a day, 7 days a week (24/7). The first and second recommended actions will allow for necessary updates to agreements for existing co-response Crisis Intervention Team (CIT) contracts to align with DHCS service requirements. The increase in funding will allow Kings View to add positions, both personnel and sub-contracted. The recommended actions will be 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, with no increase in Net County Cost. This item is countywide, with the Fresno Metro CIT and Medi-Cal Mobile Crisis services pertaining to Districts that overlap with the Fresno metropolitan area and the Rural CIT and Medi-Cal Mobile Crisis services pertaining to the remaining Districts. The Health and Wellness Center is located in District 3.
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 DHCS guidelines. Kings View will not be able to operate Metro crisis services out of the Health and Wellness Center on a 24/7 basis, and will need to lease additional facility space from midnight to 6 AM.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The recommended Amendment for the Fresno Metro program will increase the FY 2023-24 maximum compensation by 22.4% or $537,618. The full contract maximum will increase from $4,893,406 to $6,383,391. The recommended Amendment for the Fresno Rural program will increase the FY 2023-24 maximum compensation by 16% or $458,651. The full contract maximum will increase from $5,830,549 to $7,267,787. The increases are fully funded by Mental Health Realignment, CCMU grant funding, MHSA-PEI, Medi-Cal and Drug Medi-Cal revenues. The recommended Amendment for the County-owned Health and Wellness Center does not include an exchange of funds. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2023-24 Adopted Budget and in future budget requests for the term’s duration.
DISCUSSION:
The American Rescue Plan Act (ARPA) of 2021 section 9813 allows states to add qualifying community-based mobile crisis intervention services as a covered Medicaid benefit for a five-year period, beginning April 1, 2022, and ending March 31, 2027. On June 19, 2023, DHCS released Behavioral Health Information Notice (BHIN) No. 23-025 that established mobile crisis services as a new benefit in the Medi-Cal program. No sooner than January 1, 2023, and upon receiving approval from DHCS, the Department shall provide, or arrange for the provision of, qualifying mobile crisis services in accordance with the requirements set forth in BHIN 23-025.
On December 11, 2018, the Board approved Agreement No. 18-688 with Kings View to provide CIT services in the Fresno Metropolitan area. Services include, but are not limited to assessment, crisis intervention, community referrals and linkages, and short-term/brief case management. On September 20, 2022, the Board approved a Supersede Agreement No. 22-241 that retroactively changed the contractor’s name from Kings View Behavioral Health to Kings View and add Crisis Care Mobile Units grant funding for case manager positions. On June 20, 2023, the Board approved Supersede Agreement No. 23-303 to add DHCS California Advancing and Innovating Medi-Cal (CalAIM) language and Amendment I to Agreement No. D-21-560 to extend the term of the license agreement for Kings View to operate out of the Health and Wellness Center. The service agreement has been funded with MHSA-PEI, CCMU and Medi-Cal FFP revenue.
On June 21, 2022, the Board approved Agreement No. 22-266 with Kings View for Rural CIT services. On September 20, 2022, the Board approved Amendment I to add CCMU grant funding to add case manager positions. On June 20, 2023, the Board approved Supersede Agreement No. 23-308 to add DHCS CalAIM language. This service agreement has been funded with MHSA-PEI, CCMU and Medi-Cal FFP revenue.
To be in compliance with DHCS guidelines outlined in BHIN 23-025, the Department plans to expand the services currently provided by the existing contracted CIT programs, to include a 24/7 hotline for dispatch of the mobile crisis response teams and Medi-Cal mobile crisis intervention teams consisting of one (1) clinician and one (1) licensed or associate-level practitioner of the healing arts (LPHA) or other qualified provider. The response teams are to establish a rapid response, individual assessment and community-based stabilization to persons served who are experiencing behavioral health crisis. These services shall be designed to provide relief to persons served experiencing a behavioral health crisis, including through de-escalation and stabilization techniques; reduce the immediate risk of danger and subsequent harm; and avoid unnecessary emergency department care, psychiatric inpatient hospitalizations, and law enforcement involvement. While mobile crisis services are intended to support an integrated approach to responding to both mental and substance use related crises, and mobile crisis teams will be carrying, trained, and able to administer naloxone, this team is not intended to replace emergency medical services for medical emergencies.
Approval of the recommended actions will allow the Department to amend the current CIT contracts to include the mandated services outlined in BHIN 23-025. The existing Metro program operates out of the Health and Wellness Center seven days a week 6am-12am. With the recommended amendment to license Agreement No. 23-304 the Metro program will be able to operate out of the Health and Wellness Center 24 hours a day, 7 days a week, 365 days a year.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of the recommended agreements at its December 2023 meeting.
REFERENCE MATERIAL:
BAI #46, June 20, 2023
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 - Amendment I to Agreement No. 23-303 with Kings View
On file with Clerk - Amendment I to Agreement No. 23-308 with Kings View
On file with Clerk - Amendment II to Agreement No. D-21-560 with Kings View
CAO ANALYST:
Ronald W. Alexander, Jr.