SUBJECT
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AUTHORIZATION TO ACCEPT BEHAVIORAL HEALTH CONTINUUM INFRASTRUCTURE PROGRAM LAUNCH READY GRANT FUNDS AND MENTAL HEALTH STUDENT SERVICES ACT GRANT FUNDS, AND WAIVE BOARD POLICY B-29 (DISTRICTS: ALL)
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OVERVIEW
In an effort 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 this vulnerable population. In alignment with this commitment, County HHSA, Behavioral Health Services (BHS) continues to pursue new funding opportunities to enhance and expand access to critical mental health and substance use disorder prevention, engagement, and treatment services.
BHS has pursued the following grant opportunities for the projects noted below:
• Behavioral Health Continuum Infrastructure Program (BHCIP): Round 3 Launch Ready Grant for a new 12-bed acute psychiatric unit; and
• The Mental Health Services Oversight & Accountability Commission: Mental Health Student Services Act (MHSSA) grant to enhance the Creating Opportunities in Preventing and Eliminating Suicide program, which provides suicide prevention and mental health wellness education and information to school staff, students, and families.
In 2022, BHS was notified it was awarded approximately $12.4 million of one-time BHCIP funding and approximately $1.1 million in additional MHSSA grant funding. Today’s actions seek approval to authorize acceptance of BHCIP Launch Ready Grant and MHSSA grant funds and to waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires full-cost recovery for both grants.
Today's actions 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. This will be accomplished by providing inclusive services that yield better outcomes and opportunities for underrepresented communities.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Authorize the acceptance of approximately $12.4 million of one-time Behavioral Health Continuum Infrastructure Program Launch Ready Grant funding from the California Department of Health Care Services for Fiscal Year (FY) 2022-23 through FY 2026-27 for the construction of a new 12-bed Acute Psychiatric Unit within the existing Edgemoor Distinct Part Skilled Nursing Facility campus 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. Authorize the acceptance of approximately $1.1 million in additional Mental Health Student Services Act grant funding from the Mental Health Services Oversight & Accountability Commission for FY 2022-23 through FY 2025-26 to enhance the current Creating Opportunities in Preventing and Eliminating Suicide program, 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.
3. Waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires full cost recovery for grants.
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 pursuit of this goal, BHS is committed to pursuing funding sources that will support the provision of services to vulnerable and underserved populations.
The East Region, an area with high Medi-Cal client density and a large portion of the community falling within the lowest quartile of the Healthy Places Index, has limited behavioral health infrastructure which requires residents to travel to receive behavioral health services. Today's actions will improve regional access for seniors and medically frail adults residing within the Edgemoor facility, along with residents of the East Region who are in need of acute care by establishing new infrastructure and services within their community, though the new facility will serve residents countywide as needed. Establishing acute psychiatric services within the East Region supports regionally distributed access to specialty psychiatric care.
In the ten years preceding the pandemic, the rate of high school students who reported persistent feelings of sadness or hopelessness increased by 40%. The negative effects of the pandemic have exacerbated the deteriorating mental health of marginalized populations, furthering the health disparities that exist among underserved/underrepresented communities, and disproportionally impacting children and youth. To address the social, economic, cultural, geographic, and other barriers that often hinder the accessibility of behavioral health care, BHS has taken strides to address the gap by bringing services directly to communities of need.
Today’s action will enhance on-campus suicide prevention, mental health, and outreach to high-risk youth, including foster youth, youth who identify as LGBTQ+, and youth who have been expelled or suspended from school.
FISCAL IMPACT
Recommendation #1: Authorize the Acceptance of the Behavioral Health Continuum Infrastructure Program Launch Ready Grant
Funds tied to this request are not included in the Fiscal Year (FY) 2022-24 Operational Plan in the Health and Human Services Agency (HHSA). If approved, this request will result in estimated costs and revenue of approximately $13.4 million in FY 2022-23 through FY 2026-27 and will be used to support the Edgemoor Psychiatric Unit capital project appropriated in the County Health Complex Fund. The estimated revenue of $13.4 million is inclusive of $12.4 million associated with the Behavioral Health Continuum Infrastructure Program Launch Ready Grant allocation funded by State Fiscal Recovery Funds established by the American Rescue Plan Act, and a $1.0 million County match requirement funded by Realignment. Funds for this program will use existing appropriations and will be included in future Operational Plans, as needed. There will be no change in net General Fund cost and no additional staff years.
Recommendation #2: Authorize the Acceptance of the Mental Health Student Services Act (MHSSA) Grant
Funds for this request are not included in the Fiscal Year 2022-24 Operational Plan in the HHSA. If approved, this request will result in an estimated total cost and revenue of $1.1 million in FY 2022-23 through FY 2025-26. The funding source is the Mental Health Services Oversight & Accountability Commission. Funding for this program will use existing appropriations and be included in future Operational Plans. There will be no change in net General Fund costs and no additional staff years.
Recommendation #3: Waive Board Policy B-29, Fees, Grants, Revenue Contracts
For the Behavioral Health Continuum Infrastructure Program Launch Ready Grant a waiver of Board Policy B-29 is requested because the funding does not offset costs associated with the Behavioral Health Continuum Infrastructure Program Launch Ready Grant local match requirement of approximately $1.0 million in FY 2022-23 through FY 2026-27. The public benefit of this project far outweighs the B-29 unrecoverable costs.
For the Mental Health Student Services Act Grant a waiver of Board Policy B-29 is requested because the funding does not offset all costs associated with the implementation of the Mental Health Student Services Act grant of approximately $15,000 annually. The public benefit of providing these services far outweighs the unrecoverable costs and maximizes grant funds used to implement the project.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
At their meeting on August 4, 2022, the Behavioral Health Advisory Board 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 this vulnerable population. In alignment with this commitment, County HHSA, Behavioral Health Services (BHS) continues to pursue new funding opportunities to enhance and expand access to critical mental health and substance use disorder prevention, engagement, and treatment services. BHS recently pursued grant opportunities for the projects noted below which were both conditionally awarded.
Recommendation #1: Authorize the Acceptance of the Behavioral Health Continuum Infrastructure Program (BHCIP) Launch Ready Grant
In 2021, the California Department of Health Care Services (DHCS) was authorized through legislation to establish the BHCIP and award approximately $2.1 billion to construct, acquire, and expand properties and invest in mobile crisis infrastructure related to behavioral health. DHCS is releasing these funds through six grant rounds targeting various gaps in the State's behavioral health facility infrastructure.
On January 31, 2022, BHCIP released a Request for Application for the round 3 funding cycle, BHCIP Launch Ready Grant, which provides funding to construct, acquire, and rehabilitate real estate assets to expand the behavioral health continuum of treatment and service resources in settings serving Medi-Cal beneficiaries. Proposed behavioral health infrastructure projects must demonstrate they have been through a planning process and are ready for implementation.
BHCIP funding opportunities are designed to address the following State priorities:
• Invest in behavioral health and community care options that advance racial equity;
• Seek geographic equity of behavioral health and community care options;
• Address urgent gaps in the care continuum for people with behavioral health conditions, including seniors, adults with disabilities, and children and youth;
• Increase options across the life span that serve as an alternative to incarceration, hospitalization, homelessness, and institutionalization;
• Meet the needs of vulnerable populations with the greatest barriers to access, including people experiencing homelessness and justice involvement;
• Ensure care can be provided in the least restrictive settings to support community integration, choice, and autonomy;
• Leverage county and Medi-Cal investments to support ongoing sustainability; and
• Leverage the historic State investments in housing and homelessness.
In March 2022, BHS submitted three BHCIP Launch Ready Grant applications totaling $46.7 million for planned capital projects to support the expansion of the behavioral health continuum of care infrastructure within San Diego County, including the Tri-City Psychiatric Health Facility in the North Coastal Region, the new Crisis Stabilization Unit with co-located sobering services in the East Region, and the Edgemoor Acute Psychiatric Unit within the East Region.
On June 21, 2022, BHS received a notice of conditional award of approximately $12.4 million for the Edgemoor Acute Psychiatric Unit capital project, which will add a new 12-bed acute psychiatric unit within the existing Edgemoor Distinct Part Skilled Nursing Facility (DPSNF) campus. Construction of this new acute psychiatric unit will allow residents to continue to receive the appropriate specialty psychiatric care without requiring them to transfer out of their residence. The new facility will serve residents countywide as needed but will increase accessibility to vulnerable individuals within the East Region, which currently has limited behavioral health infrastructure. The acute psychiatric unit may also be able to serve other area skilled nursing facilities (SNFs) with patients in need of stabilization, thus reducing the need to transport these patients to hospital emergency rooms. The acute psychiatric unit will also provide local connections to inpatient services for those requiring higher levels of care.
Another benefit of establishing new acute psychiatric services within the campus is that Edgemoor will maintain its Distinct Part (DP) status. Per Medi-Cal, part of the criteria for a patient to be admitted to a DPSNF is an alternate placement that cannot be found at a lower level of care, which may include a free-standing SNF. The DP designation allows for these patients to be transferred to the least restrictive setting, generally from an acute hospital to a DPSNF, when other facilities will not accept the patient. This supports seamless access to specialty psychiatric care for older and medically frail adults by removing barriers to care and supporting residents of the facility with equitable access to services in their own community.
Currently, Edgemoor provides 24-hour, long-term skilled nursing care for adults with complex medical needs who require specialized interventions from highly trained staff. The 192-bed facility operates as a DPSNF and is licensed by the California Department of Public Health. Construction of the new acute psychiatric unit will require the permanent closure of 20 SNF beds with the subsequent addition of 12 acute psychiatric beds. Once completed, Edgemoor will have total capacity of 12-bed acute psychiatric unit and a 172-bed DPSNF. Patients receiving services within each of the two units will remain distinct and separate. The total estimated cost to construct the new 12-bed acute psychiatric unit within Edgemoor is approximately $13.4 million, inclusive of $12.4 million funded by BHCIP Launch Ready Grant and $1.0 million County match requirement funded by Realignment.
Today’s action requests the Board to authorize the acceptance of one-time BHCIP Launch Ready Grant funding of approximately $12.4 million for the construction of the new 12-bed Acute Psychiatric Unit within the existing Edgemoor DPSNF campus. Additionally, today's action requests the Board to authorize the department to waive the Board Policy B-29 requirement for full cost recovery associated with the BHCIP Launch Ready Grant local match requirement of approximately $1.0 million in Fiscal Year (FY) 2022-23 through FY 2026-27. The public benefit of this project far outweighs the B-29 unrecoverable costs because it expands behavioral health services for residents in East Region in need of acute care.
Recommendation #2: Authorize the Acceptance of the Mental Health Student Services Act (MHSSA) Grant
The MHSSA grant is a competitive grant through the Mental Health Services Oversight & Accountability Commission (MHSOAC) that was established to fund partnerships between county behavioral health departments and local educational entities for the purpose of increasing access to behavioral health services at school sites. On average, a young person dies by suicide every hour and 25 minutes in the U.S. (Centers for Disease Control and Prevention, 2015). For every young person who dies by suicide, an estimated 100-200 youth make suicide attempts (Centers for Disease Control and Prevention, 2016). Youth suicide is preventable, and educators and schools are key to prevention. The MHSSA grant funding is designed to bolster coordination and infrastructure development to support on-campus mental health services, suicide prevention, drop-out prevention, placement assistance, service plans for students in need of ongoing services, and outreach to high-risk youth, including foster youth, youth who identify as LGBTQ+, and youth who have been expelled or suspended from school.
On February 25, 2020 (13), the Board approved BHS to apply for and accept MHSSA grant funds of approximately $6 million for FY 2021-22 through FY 2023-24; however, the County was not initially selected for an award. Due to the COVID-19 pandemic, the MHSOAC extended the grant opportunity to counties that were not originally funded, and on June 15, 2021, the County received notification of tentative award and opportunity to submit a revised application to MHSOAC. On September 21, 2021, BHS was notified by the MHSOAC that the MHSSA grant application and funding of approximately $6 million was approved.
On April 18, 2022, the MHSOAC released a Request for Applications for current grantees to apply for additional funding. The additional grant funding will enhance the current Creating Opportunities in Preventing and Eliminating Suicide (COPES) program and will be used to enhance hiring of qualified mental health personnel in schools throughout the county, professional development for school staff, or to support other strategies that respond to the mental health needs of children and youth.
Today's action requests the Board to authorize the acceptance of an estimated $1.1 million of additional MHSSA grant funding for the COPES contract. Additionally, today's action requests the Board to authorize the department to waive the Board Policy B-29 requirement for full cost recovery associated with the additional MHSSA grant for administrative overhead costs of approximately $15,000 per fiscal year. The public benefit of providing these services far outweighs the B-29 unrecoverable costs and allows for the maximization of grant funds used to implement the project. Without the revenues, the ability of children and youth to enhance access to behavioral health services at school sites will be impacted.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today's proposed actions support the County of San Diego's 2022-2027 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 with mental illness and substance use disorders and ensuring access to a comprehensive continuum of behavioral health services administered through accessible behavioral health programs.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Chief Administrative Officer
ATTACHMENT(S)
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