Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Agreement with Ernst & Young, LLP for Program Improvement for Valued Outpatient Treatment Mental Health Services Act Innovation Project
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Ernst & Young, LLP to provide and complete the Program Improvement for Valued Outpatient Treatment project for the term of September 1, 2025 through August 31, 2028, in an amount not to exceed $2,200,000, and authorizing and directing the President of the Board of Supervisors to execute the agreement on behalf of the County.
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BACKGROUND:
In 2004, California voters passed Proposition 63, known as the Mental Health Services Act (MHSA), which has provided dedicated state funds to expand and transform behavioral health services. This included funding for prevention and early intervention and innovation projects, in addition to community services and supports, workforce education and training, and capital facilities and technological needs.
In March 2024, California voters passed Proposition 1, Governor Newsom's effort to reimagine public mental health and substance use service delivery in California. Prop 1 reforms MHSA, changing the name to Behavioral Health Services Act (BHSA) and restructuring how MHSA allocates its funding. BSHA prioritizes treatment for the most vulnerable individuals living with serious mental illness and substance use disorders, housing interventions, and better integration of substance use and mental health treatment. Additionally, BHSA requires that counties and contracted service providers make a good faith effort to seek reimbursement from Medi-Cal and other funding sources for all eligible treatment services.
In August 2024, BHRS released a Request for Proposals (RFP) to support the department with these organizational and administrative changes and to meet other recent statewide initiatives and mandates such as CalAIM, Senate Bill (SB) 43, and Care Court. The RFP consisted of four service areas:
1) Project Management & Communication
2) Organizational Capacity Assessment
3) Implementation Technical Assistance
4) Community Planning & BHSA Three-Year Plan Development
Proposers were allowed to submit a proposal for one or up to all four service areas.
Eleven agencies submitted proposals in response to the RFP. Ernst & Young was recommended to provide organizational capacity assessment services (#2), and BHRS executed a department-level agreement for that work, which began in November 2024.
Ernst & Young was also recommended to provide Project Management & Communication (#1) and Implementation Technical Assistance (#3), due to their robust experience in project management and communication and with providing technical assistance to local, state, and federal agencies to implement complex reforms and organizational restructures.
On January 28, 2025, this Board approved an amendment to the San Mateo County MHSA Annual Update for FY 2024-25 and submission to the State Mental Health Services Oversight and Accountability Commission and the Department of Health Care Services. The amendment included four Innovation (INN) projects, one of which was the Progressive Improvements for Valued Outpatient Treatment (PIVOT) project. PIVOT is intended to support community-based organizations (CBOs) that are interested in becoming certified providers to bill Medi-Cal for allowable early intervention and peer-based services. The project has the potential to support the sustainability of critical Community-Defined Evidence Practices (CDEPs) by identifying Medi-Cal billable components of CDEPs. The budget for the PIVOT INN project was $5,650,000 over a five-year period for service delivery, administration, and program evaluation.
DISCUSSION:
As part of the Ernst & Young agreement for Project Management and Technical Assistance, Ernst & Young has prepared a scope of work for implementation and administration of PIVOT. Ernst & Young is also supporting Orange County with the implementation of their PIVOT project and brings their knowledge of Proposition 1/BHSA and the local impacts to San Mateo County to implement this project in coordination with contracted CBOs.
Ernst & Young will evaluate the capacity of existing contracted community-based providers of early intervention, peer services, and integrated behavioral health services to develop Medi-Cal billing infrastructure. Once the exploratory phase is completed, Ernst & Young will provide community-based providers with the technical assistance needed to obtain Medi-Cal certification, streamline Medi-Cal billing processes, and implement innovative approaches to care delivery. The final phase will include an assessment of operations to identify opportunities for ongoing improvement.
The proposed agreement with Ernst & Young includes a three-year term of September 1, 2025 through August 31, 2028 and a maximum fiscal obligation of $2,200,000 ("Agreement").
The resolution contains the County's standard provision allowing amendment of the County's fiscal obligations by a maximum of $25,000 (in aggregate).
The Agreement and resolution have been reviewed and approved by the County Attorney as to form.
It is anticipated that 100% of the participating CBOs will identify strategies to begin billing Medi-Cal.
PERFORMANCE MEASURE:
Measure
FY 2025-26
Estimated
FY 2026-27
Projected
Percentage of CBOs that will identify strategies to begin billing Medi-Cal.
100%
(14/14)
100%
(14/14)
COMMUNITY IMPACT:
MHSA-funded programs and services positively impact marginalized communities, especially cultural, racial, and ethnic communities struggling with severe mental health and substance use conditions. These funded programs (e.g., Full-Service Partnerships, Pathways Program, California Clubhouse, Lived Experience Academy) provide direct treatment and recovery supports and elevate the importance of providing culturally responsive services. Marginalized communities are engaged through services and programs that are culturally informed and specifically tailored to engaging marginalized cultural and racial communities.
The PIVOT project creates an opportunity to sustain effective and culturally informed early intervention and peer support services funded by San Mateo County MHSA (e.g., The Cari?o Project, Farmworker Equity Express, Kapwa Kultural Center, Recovery Connection, etc.) and enhance the volume and quality of culturally informed behavioral health services by assisting CBOs to become certified to bill Medi-Cal and helping them identify components of successful CDEPs that can be billable.
FISCAL IMPACT:
The total amount of the agreement is not to exceed $2,200,000. Funds in the amount of $957,500 are included in the BHRS FY 2025-26 Recommended Budget. Of that amount, 100% will be funded by MHSA, with no Net County Cost. Similar arrangements will be made for future years.