SUBJECT
Title
AUTHORIZE ACCEPTANCE OF BEHAVIORAL HEALTH BRIDGE HOUSING GRANT FUNDS; AUTHORIZE A REQUEST FOR STATEMENT OF QUALIFICATIONS; AUTHORIZE AMENDMENTS FOR LICENSED ADULT AND SENIOR RESIDENTIAL CARE FACILITY SLOTS; AND AUTHORIZE COMPETITIVE PROCUREMENTS FOR GRANT ADMINISTRATION SERVICES (DISTRICTS: ALL)
Body
OVERVIEW
On September 27, 2022 (23), the San Diego County Board of Supervisors adopted the Behavioral Health Optimal Care Pathways (OCP) model, which outlined the optimal future capacity necessary across key services in the Behavioral Health Continuum of Care to support people with critically limited opportunities for placement due to complex needs, lack of existing services in the continuum, inadequate capacity, and/or other specialty care needs that present barriers to care. Within community-based care services, the County of San Diego (County) Health and Human Services Agency, Behavioral Health Services (BHS) identified the need to increase capacity for licensed adult and senior residential care facility (board and care) bed days by nearly 150%, which roughly translates to 450 additional beds, to care for individuals within our system.
Through the Behavioral Health Bridge Housing (BHBH) Program, the California Department of Health Care Services (DHCS) will provide a total of $1.5 billion in funding to county behavioral health agencies and Tribal entities to operate bridge housing settings to address the immediate and sustainable housing needs of people experiencing homelessness who have serious behavioral health conditions. This includes individuals with serious mental illness and/or substance use disorder with a primary focus on serving historically underserved client populations that are most in need of care and individuals with a Community Assistance, Recovery & Empowerment plan.
On June 23, 2023, DHCS notified BHS of a conditional award of $44,300,211 of non-competitive BHBH grant funding through the initial funding round to increase bridge housing capacity for individuals with serious behavioral health conditions, who are experiencing homelessness. The BHBH grant funds will be utilized through June 30, 2027, to increase payment for board and care within adult and senior residential care facilities licensed by the Community Care Licensing Division of the California Department of Social Services for people enrolled in Medi-Cal. This payment is structured as a patch that is added to funds from Supplemental Security Income that is routinely used to pay for board and care. A portion of the BHBH funding will also be utilized to support infrastructure start-up costs in the first year to expedite the ability for the new board and care slots to be operationalized and would shift to additional board and care capacity, if unspent.
Approval of today’s recommended actions will authorize the acceptance of the one-time non-competitive BHBH Program funding allocation and authorize a Request for Statement of Qualifications for licensed residential adult and senior care facility slots (board and care patches) that provide enhanced rates to support people with behavioral health conditions and amendments to existing licensed residential adult and senior care facilities (board and care patches) that support people with behavioral health conditions. Historically, payment patches for enhanced board and care have been referred to as augmented services program payments.
Today’s recommendation also authorizes competitive procurements for administration, oversight, and consultation services to support implementation of grant programs within BHS, which may include the BHBH Program, Community Care Expansion Preservation Program, Behavioral Health Continuum Infrastructure Program, Mental Health Services Act Public Behavioral Health Workforce Development and Retention Innovation Program, and others, if awarded.
These items support the County’s vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities by supporting housing stability for adults and seniors with behavioral health conditions, including those who are experiencing or at risk of homelessness.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Authorize the acceptance of $44,300,211 of one-time Behavioral Health Bridge Housing (BHBH) grant funding and authorize the Agency Director, Health and Human Services Agency, or designee to execute all required documents, upon receipt, including any annual extensions, amendments, or revisions that do not materially impact or alter the services or funding level.
2. In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting, to issue a Request for Statement of Qualifications (RFSQ) for licensed residential adult and senior care facility slots (board and care patches) or augmented services programs (ASPs) for people with behavioral health conditions, and re-release the RFSQ, as needed, and upon successful negotiations and determination of a fair and reasonable price, award contracts for an Initial Term of up to one year, with up to four 1-year Options, and an additional six months, if needed, and to amend the contracts, as needed, to reflect changes in program, funding or service requirements, subject to the availability of funds and approval of the Agency Director, Health and Human Services Agency.
3. In accordance with Board Policy A-87, Competitive Procurement, and Administrative Code Section 401, authorize the Director, Department of Purchasing and Contracting, subject to successful negotiations and a determination of a fair and reasonable price, to amend existing licensed residential adult and senior care facility (board and care patches or ASPs) contracts that serve individuals with behavioral health conditions, if needed, to reflect changes in program, funding or service requirements, subject to the availability of funds and approval of the Agency Director, Health and Human Services Agency.
4. In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting, to issue competitive solicitations for management, administration, and consultation services to support grant implementation within Behavioral Health Services, which may include the BHBH Program, Community Care Expansion Preservation Program, Behavioral Health Continuum Infrastructure Program, Mental Health Services Act Public Behavioral Health Workforce Development and Retention Innovation Program, and others, and upon successful negotiations, and determination of a fair and reasonable price, award contracts for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed; and to amend contracts as required to reflect changes to services and funding, subject to the approval of the Agency Director, Health and Human Services Agency.
EQUITY IMPACT STATEMENT
The vision of the County of San Diego Health and Human Services Agency, Behavioral Health Services (BHS) is to build a system in which mental health and substance use services are equitably and regionally distributed and accessible to all individuals and families within the region who are in need. In alignment with this goal, BHS is committed to pursuing funding sources that will support the provision of services to vulnerable and underserved populations. Today's actions will allow BHS to accept new Behavioral Health Bridge Housing (BHBH) Program grant funding to increase the capacity of board and care within licensed residential adult and senior care facilities that support individuals with behavioral health conditions who are experiencing homelessness.
According to the San Diego Regional Task Force on Homelessness 2022 Point-in-Time Count (PITC), at least 8,427 individuals were experiencing homelessness across San Diego County. Additionally, 13% of the individuals experiencing homelessness were identified as having a serious mental illness (SMI) and 9% reported a substance use disorder (SUD). Individuals with SMI and/or SUD have a higher difficulty exiting homelessness and establishing housing stability. The BHBH funding will bolster support to enhance bridge housing that meets the unique needs of low-income seniors and individuals experiencing homelessness with behavioral health needs, ensuring that an already vulnerable population receives the care and support they need, further contributing to reductions in local health disparities. To provide a more comprehensive view of the data, 2022 PITC figures were used.
SUSTAINABILITY IMPACT STATEMENT
Today’s item supports the County of San Diego (County) Sustainability Goal #2 to provide just and equitable access to County services by pursuing available funding focused on serving historically underserved client populations that are most in need of care. As noted in the Equity Impact Statement, today’s actions will support the unique needs of low-income seniors and individuals experiencing homelessness with serious behavioral health needs. Furthermore, in alignment with the Behavioral Health Optimal Care Pathways model, today’s actions support optimal future capacity across the entire behavioral health system ensuring that services at all levels of care are available and accessible.
This item also supports Sustainability Goal #4 to protect the health and wellbeing of everyone in the region by preserving existing board and care facilities for people experiencing homelessness who have serious behavioral health conditions. The majority of the funding outlined in today’s item is dedicated to supporting new board and care slots in existing facilities. This will allow the County to meet the regional need for immediate and sustainable housing, while leveraging established board and cares.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year (FY) 2023-25 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs and revenue of $8.4 million in FY 2023-24 and estimated annual costs and revenue of $14.3 million in FY 2024-25 through FY 2026-27. The funding sources are State General Fund through the Behavioral Health Bridge Housing (BHBH) grant, Mental Health Services Act, Realignment, and other grant funding as awarded. Today’s recommendations address the total project cost of $51.3 million, which includes $44.3 million in BHBH grant funds and $7.0 million funded by the remaining sources previously mentioned. Funding for this request in future years will be included in future Operational Plans. There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
On April 6, 2023, the Behavioral Health Advisory Board (BHAB) received an informational update on the Behavioral Health Bridge Housing (BHBH) program as Behavioral Health Services was developing the BHBH Program submission proposal. At their meeting on July 6, 2023, BHAB voted to approve these recommendations.
BACKGROUND
To support the well-being of those with behavioral health conditions, the San Diego County Board of Supervisors (Board) and the County of San Diego (County) Health and Human Services Agency (HHSA) remain committed to investing in services to meet the needs of individuals. In alignment with this commitment, County HHSA, Behavioral Health Services (BHS) continues to pursue funding opportunities to enhance and expand access to critical mental health and substance use disorder prevention, engagement, housing, and treatment services.
In September 2022, Assembly Bill 179 legislation authorized $1.5 billion in funding for the Behavioral Health Bridge Housing (BHBH) Program. The BHBH Program provides funding for bridge housing expansion, which offers short and midterm housing options to people experiencing homelessness who have serious behavioral health conditions, with the goal of connecting them to long-term housing.
On September 27, 2022 (23), the Board adopted the Behavioral Health Optimal Care Pathways (OCP) model, which outlined the optimal future capacity necessary across key services in the Behavioral Health Continuum of Care to support people with critically limited opportunities for placement due to complex needs, lack of existing services in the continuum, inadequate capacity, and/or other specialty care needs that present barriers to care. Within community-based care services, BHS identified the need to increase capacity for licensed residential adult and senior care facility (board and care) bed days by nearly 150%, which roughly translates to 450 additional beds, to care for individuals within our system.
To advance implementation of the OCP model, the BHBH Program will offer one-time funding to increase payment for board and care to establish additional capacity dedicated to supporting Medi-Cal enrolled individuals with behavioral health conditions who are experiencing homelessness, including individuals with a Community Assistance, Recovery & Empowerment (CARE) plan, to ensure they receive effective care in the least restrictive setting, based on their unique needs.
On April 27, 2023, BHS applied for funding through the California Department of Health Care Services (DHCS) to support the BHBH Program.
BHBH funds are being released through four rounds, as follows:
• February 2023: $907 million non-competitive allocation to counties;
• Spring 2023: $50 million competitive allocation to Tribal entities;
• Summer 2023: $250 million competitive allocation to counties and Tribal entities; and
• Fiscal Year 2024-25: $250 million competitive allocation to counties and Tribal entities.
Staff will return to the Board at a future date to seek further authority to accept additional BHBH funding if awarded through future funding rounds.
BHBH funds will be utilized to address the following priorities:
• Complement ongoing State, county, and Tribal efforts, to address homelessness;
• Provide supportive services and housing navigation to assist people who have serious behavioral health conditions and are experiencing homelessness;
• Serve individuals with serious behavioral health conditions, including serious mental illness (SMI) and/or substance use disorder (SUD), who are experiencing homelessness; and
• Provide bridge housing and supportive services throughout the county, including in rural areas, to enable people to remain in their communities.
BHBH funds primarily provide operational and supportive services funding to expand bridge housing capacity within existing settings or new settings, and can be utilized across four domains, including:
• County program implementation;
• Bridge housing outreach and engagement;
• Bridge housing, including shelter/interim housing, rental assistance, auxiliary (patch) funds for assisted living settings (board and cares), and housing navigation; and
• Bridge housing start-up infrastructure.
On June 23, 2023, BHS was notified by the DHCS that San Diego County was conditionally awarded $44,300,211 of non-competitive BHBH grant funding through the initial funding round to increase bridge housing capacity to expand board and care payments within facilities licensed by the Community Care Licensing Division (CCLD) of the California Department of Social Services to support people enrolled in Medi-Cal with serious behavioral health conditions who are experiencing homelessness, including individuals with a CARE plan. This payment is structured as a patch that is added to funds from Supplemental Security Income that is routinely used to pay for board and care. Funding must be utilized through June 30, 2027.
In alignment with the findings outlined in the Behavioral Health OCP model, a total of approximately $41.5 million of the BHBH grant funds will be utilized to establish new licensed adult and senior residential care facility slots (board and care patches) for people who are enrolled in Medi-Cal, also known as augmented services programs (ASPs), that will be operational through June 30, 2027. The remaining BHBH funds totaling $2.8 million will be utilized for first year infrastructure start-up costs that will expedite the ability for the new board and care capacity to be operationalized. Start-up costs may be used for but not limited to start-up costs for furniture, equipment, and minor renovations. Start-up funds would be utilized in the first year and would be shifted to additional board and care slots, if unspent.
Approval of today’s recommended actions will:
• Authorize acceptance of one-time BHBH Project funding totaling $44.3 million;
• Authorize a Request for Statement of Qualifications (RFSQ) and award contracts to expand capacity within adult and senior residential care facilities licensed by CCLD that serve individuals with behavioral health conditions who are enrolled in Medi-Cal (board and care patches), also known as augmented services programs (ASPs);
• Authorize amendments to existing licensed residential adult and senior care facility (board and care or ASP) contracts that serve individuals with behavioral health conditions who are enrolled in Medi-Cal; and
• Authorize competitive solicitations for grant management, administration, and consultation services within BHS, to support grant implementation, which may include the BHBH Program, Community Care Expansion Preservation Program, Behavioral Health Continuum Infrastructure Program, Mental Health Services Act Public Behavioral Health Workforce Development and Retention Innovation Program, and others, if awarded.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the County of San Diego’s 2023-2028 Strategic Plan initiatives of Equity (Health) and Community (Quality of Life) as well as the regional Live Well San Diego vision, by reducing disparities and disproportionality of individuals by pursuing housing stability for adults and seniors with behavioral health conditions, including those who are experiencing or at risk of homelessness.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Interim Chief Administrative Officer
ATTACHMENT(S)
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