DATE: August 20, 2024
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director of Behavioral Health
SUBJECT: Amendments to Mobile Crisis Care Mobile Units Grant and Associated Agreements
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to accept Amendment II to Resolution No. CY 2022-06 with California Health Facilities Financing Authority to extend the term of the Investment in Mental Health Wellness Grant Program for Children and Youth by two months through June 30, 2025, with no change to total of $1,371,806;
2. Retroactively approve and authorize Department of Behavioral Health Director’s previous submittal of a grant application to the California Department of Health Care Services for additional Crisis Care Mobile Units grant funds to expand mobile crisis teams ($750,000);
3. Approve and authorize the Chairman to execute a retroactive Amendment I to Agreement with Advocates for Human Potential, Inc. for the Crisis Care Mobile Units Grant effective January 31, 2024 with no change to the term of September 1, 2021 through June 30, 2025, and increasing the maximum by $750,000 to a total of $1,503,437; and
4. Approve and authorize the Chairman to execute a retroactive Amendment I to Agreement with Kings View for Crisis Intervention Team and Medi-Cal Mobile Crisis Benefit Services to expand use of dedicated school-based staff, effective April 9, 2024, with no change to the term of April 9, 2024 through June 30, 2025, and no change to the maximum compensation of $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 Crisis Care Mobile Units (CCMU) grant guidelines; and 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, and in the community for children and youth, 21 and under. Approval of the first recommended action will extend the term of the existing CHFFA funding agreement by two months through June 30, 2025. The second recommended action will authorize the retroactive submission and will allow the Department to submit and accept additional CCMU grants funds. It should be noted that Advocates for Human Potential, Inc. (AHP) published the Additional Grant Funding application on January 31, 2024. To meet the grant application deadline of February 7, 2024, the Department submitted the application on February 7, 2024 contingent upon your Board’s approval. AHP approved the funding on March 20, 2024 and the final recommended agreement on July 19, 2024. The third recommended action will provide the County additional Crisis Care Mobile Units (CCMU) funding for direct service staff for mobile crisis response. The fourth recommended action will allow the County to update the Scope of Services to expand the use of the school-based dedicated staff beyond Fresno County schools to the community. 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; and not receive additional CCMU grant funding to support the mobile crisis services program.
RETROACTIVE AGREEMENT:
The retroactive Amendment with Advocates for Human Potential, Inc. (AHP) is retroactive to January 31, 2024 to align with the funding term set by AHP. The Department received the final agreement from AHP via electronic mail on July 19, 2024 due to need corrections requested by the Department that did not allow the Department to present the item to the Board at an earlier date.
With regards to the fourth recommended action, the Amendment with Kings View is retroactive to add the additional CCMU grant funds to the Agreement and allow the County to expand mobile crisis response services.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The additional CCMU funding will offset Mental Health Realignment funding. The total maximum compensation of $10,503,399 for the Agreement with Kings View is unchanged. The Agreement is funded with Mental Health Realignment, Mental Health Services Act Prevention and Early Intervention (MHSA-PEI), CCMU grant funding, CHFFA grant funding, Medi-Cal Federal Financial Participation (FFP) revenue and Drug Medi-Cal FFP. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2024-25 Recommended 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 and 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.
The Department of Health Care Services (DHCS) utilized $150 million in funding received from the Behavioral Health Continuum Infrastructure Program and $55 million in funding received from the Substance Abuse and Mental Health Services Administration through the Coronavirus Response and Relief Appropriations Act to solicit applications from county or city behavioral health agencies to support and expand behavioral health mobile crisis and non-crisis services. After learning of the grant opportunity and holding internal planning meetings, the Department submitted the application to DHCS on the due date of August 23, 2021. On October 19, 2021, the Board retroactively approved the Department’s request to apply for CCMU grant funding through DHCS in the amount of $753,500. The grant application included funding for case management staff and Crisis Intervention Team (CIT) for Youth training through the National Center for Youth Opportunity and Justice (NCYOJ). On September 20, 2022, the Board retroactively approved the Agreement 22-420 with AHP for the CCMU Grant.
On January 25, 2024, AHP notified the Department that additional CCMU funding was approved by DHCS. After holding internal discussions and receiving clarification from AHP on eligibility, the Department submitted an application to AHP on the due of February 7, 2024. On March 20, 2024, the Department received a notice of award from AHP for additional CCMU funding. On April 8, 2024, the Department received the Amendment to Agreement 22-420. However, the name of the Chairman was incorrectly listed and the Department requested that AHP submit a corrected Amendment. AHP notified the Department of the correction May 31, 2024 but did not submit a corrected Amendment until July 19, 2024.
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.
On April 9, 2024 the Board approved Superseding Agreement 24-148, to combine agreements and included 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.
Approval of the recommended items will allow the County to remain in compliance with CHFFA grant guidelines and expand the use of mobile crisis support teams dedicated to Fresno County schools. The updated Scope of Services for the school-based mobile crisis services will allow the school-based teams to support children and youth experiencing a behavioral health crisis out in the community during periods where schools are not in session.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board will be notified of the recommended items at its August 2024 meeting.
REFERENCE MATERIAL:
BAI #38, April 9, 2024
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 #25, October 19, 2021
BAI #32, December 11, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment II to Resolution with CHFFA
On file with Clerk - AHP Additional Grant Funding Application
On file with Clerk - Amendment I to Agreement with AHP
On file with Clerk - Amendment I to Agreement with Kings View
CAO ANALYST:
Ronald W. Alexander, Jr.