Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Agreement with Ernst & Young, LLP for Behavioral Health Services Act Project Management and Implementation Technical Assistance Services
RECOMMENDATION:
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Adopt a resolution to execute an agreement with Ernst & Young, LLP to provide Behavioral Health Services Act (BHSA) project management and implementation technical assistance services for the term of January 1, 2025 through June 30, 2026, in an amount not to exceed $1,600,000.
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BACKGROUND:
California Proposition 1 (Prop 1) intends to expand supportive housing and treatment facilities, improve accountability, and increase transparency of behavioral health care systems across California. The statewide initiative will impose new funding allocations to the Mental Health Services Act (MHSA) “millionaire’s tax”, increasing the amount available for housing interventions and reducing the amount available for behavioral health services and supports. In addition, Prop 1 expands the community engagement, program and expenditure planning, monitoring, and outcome and fiscal reporting requirements associated with the MHSA millionaire’s tax to all Behavioral Health and Recovery Services (BHRS) revenue sources. Implementation of Prop 1 requires BHRS to make considerable administrative and organizational changes. Finally, Prop 1 includes new funding for both BHSA transition planning and ongoing administrative costs.
DISCUSSION:
In August 2024, BHRS released a Request for Proposals (RFP) to support the division with these organizational and administrative changes, as well as meet other recent statewide initiatives and mandates such as CalAIM, Senate Bill 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 its robust experience in both project management and communication and provision of technical assistance to local, state, and federal agencies to implement complex reforms and organizational restructures. Ernst & Young’s proposal included a plan to support and guide BHRS, contractors and key stakeholders through the next 18 months as the division conducts a community planning process, develops a three-year plan for all BHRS programs and services, and implements the recommendations of its organizational capacity assessment. In addition, the Ernst & Young team demonstrated technical expertise in several areas needed to support the above-mentioned implementation recommendations, including expertise in information technology, innovation, electronic healthcare records management, fiscal planning, program restructuring, performance outcomes, contracting, substance use services integration, staff training and workforce development. Ernst & Young will support BHRS with the transition to BHSA through 1) evaluating the impact of Proposition 1 and other State initiatives on existing and planned BHRS programs and services, 2) supporting transition planning and innovation efforts, and 3) identifying recommendations for continuous improvement.
The not-to-exceed aggregate amount for this contract is $1,600,000.
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 the contractor will provide deliverables on-time and within budget for the contract period 100% of the time.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of time contractor will provide deliverables on-time and within budget for the contract period. |
100% |
100% |
EQUITY IMPACT:
Prop 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 racial demographics of the MHSA Steering Committee meeting participants that helped guide the most recent three-year community planning process in FY 22-23 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 the agreement is January 1, 2025 through June 30, 2026. The amount of the agreement is not to exceed $1,600,000 for the 18-month term. Funds in the amount of $842,383 are included in the BHRS FY 2024-25 Recommended Budget. Of that amount, 100% will be funded through the MHSA. There is no Net County Cost. Similar arrangements will be made for future years.