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: Amendment to the Agreement with Ernst & Young, LLP for Proposition 1 - Behavioral Health Services Act Project Management and Implementation Technical Assistance Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Ernst & Young, LLP to add Proposition 1 - Behavioral Health Services Act (BHSA) project management and implementation technical assistance services, increasing the agreement by $1,826,000, to an amount not to exceed $3,426,000, with no change to the term.
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BACKGROUND:
California Proposition 1 (Prop 1), passed by voters in March 2024, re-envisions how county public mental health and substance services are delivered in California. Prop 1 prioritizes the most vulnerable individuals living with serious mental illness and/or substance use disorders who are at risk or experiencing homelessness and/or justice involved; expands supportive housing and treatment facilities; and increases accountability and transparency in planning and reporting fiscal and client outcomes.
A component of Prop 1 is the Behavioral Health Services Act (BHSA), which modernizes the Mental Health Services Act (MHSA) and changes the funding allocations for counties. In addition, BHSA introduces the three-year Integrated Plan and Behavioral Health Outcomes, Accountability, and Transparency Report (BHOATR), which require counties to develop and report on an integrated plan for all county behavioral health services, revenue, expenditures, and performance on statewide behavioral health goals and measures.
In August 2024, BHRS released a Request for Proposals (RFP) to support the department with implementation of Proposition 1 and the intersection with other statewide mandates. Ernst & Young was selected to administer three of the four components of the RFP - organizational capacity assessment, project management and subject matter technical assistance. Technical Assistance projects were to-be-determined as we waited for DHCS to finalize Prop.1 policy guidelines and conducted our internal assessment process to determine what infrastructure would be necessary for compliance with Prop. 1.
On January 28, 2025, this Board executed an agreement with Ernst & Young (EY) to deliver project management and communication and technical assistance to support transition planning and prepare Behavioral Health and Recovery Services (BHRS) to implement Prop 1 when it goes live on July 1, 2026.
It is now necessary to amend this agreement for additional technical assistance projects included in the RFP released in 2024, that will ensure that the department is in compliance to implement Prop 1 by July 1, 2026. Implementation of these activities is required by the State, and the State has dedicated one-time funding to counties for Prop 1 start-up activities.
DISCUSSION:
In addition to ongoing Project Management and Communication, EY has been providing technical assistance to support the implementation of Prop 1. To-date EY has supported an MHSA program assessment and restructuring process to guide new funding allocation requirements and facilitated a strategic alignment and visioning process with BHRS to align current efforts and new priorities with the shifting behavioral health landscape. EY has demonstrated technical expertise in several areas needed to support the ongoing Prop. 1 infrastructure work, including but not limited to expertise in innovation, fiscal planning, program restructuring, performance outcomes, contracting, staff training and workforce development.
This agreement is being amended to increase the contract budget by $1,826,000 for the following additional technical assistance projects that will ensure that BHRS is in compliance to implement Prop 1 by July 1, 2026.
Subject matter Technical Assistance projects added include but are not limited to:
- Staff Capacity - Leadership Training program to upskill staff capabilities to be able to meet the requirements of Prop 1.
- Evidence-Based Practices - Support the department with the implementation of BH-Connect evidence-based practices to fidelity and development of Full Service Partnership programs with different tiers to address various levels of need.
- Organizational Restructuring - Build upon the findings of the Organizational Capacity Assessment conducted by EY in 2024, specifically related to BHRS organizational restructuring.
- Fiscal Infrastructure - Support the department in implementing fiscal tracking and reporting processes that align with the Integrated Plan and BHOATR requirements.
- Communications - campaign to help communicate the current transformation efforts at BHRS to staff, contracted providers and the community.
The California Department of Health Care Services (DHCS) continues to update policy guidance for Prop 1. This amendment includes funding for other to-be-determined implementation projects that may be needed to support implementation of Prop 1 prior to July 1, 2026.
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 agreements and resolution have been reviewed and approved by the County Attorney as to form.
It is anticipated that 100% of technical assistance and infrastructure projects will be completed to prepare BHRS for compliance with Proposition 1 by July 1, 2026.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Actual |
FY 2025-26 Estimated |
|
Percentage of technical assistance and infrastructure projects that will be completed to prepare BHRS for compliance with Proposition 1 by July 1, 2026 |
100% (3 out of 3) |
100% (5 out of 5) |
COMMUNITY IMPACT:
Proposition 1 requires that BHRS be ready to implement the type of inclusive community planning and evaluation of behavioral health services that were previously limited to programs funded by the MHSA millionaire’s tax to include all BHRS revenue sources by July 1, 2026. The demographics of the MHSA Steering Committee meeting participants that helped guide the most recent three-year community planning process in FY 2022-23 were comparable to the general San Mateo County population, except for Asian communities which were underrepresented by 10% compared to the general population.
Prop 1 also expands outcome reporting requirements associated with MHSA to all programs and services delivered by BHRS. This will allow BHRS to monitor and address disparities for underserved communities, including individuals who are incarcerated, experiencing homelessness or institutionalized.
FISCAL IMPACT:
The term of this agreement is January 1, 2025 through June 30, 2026. The total amount of the agreement is not to exceed $3,426,000. Funds in the amount of $2,689,789 are included in the BHRS FY2025-26 Budget. Of that amount, 100% will be funded by the MHSA via dedicated funds from the State to support counties with the implementation of Prop 1. There is no Net County Cost.