To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: ADOPT Position Adjustment Resolution No. 26293 to add three Health Service Accountant (represented) positions and cancel one Registered Nurse-Project, one Account Clerk-Advanced Level, and one Account Clerk-Experienced Level positions (represented) in the Health Services Department.
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
ADOPT Position Adjustment Resolution No. 26293 to add three (3) Health Services Accountant (VCTB) positions (represented) in salary plan and grade ZB5 1804 ($8,913.669 - $10834.642) and cancel one (1) Registered Nurse-Project (VWX5) (represented), one (1) Account Clerk-Advanced Level (JDTD) (represented), and one (1) Account Clerk-Experienced Level (JDVC) (represented) in the Health Services Department.
FISCAL IMPACT:
Upon approval, this action will result in an annual increase of $135,685.09 with $19,822.19 in pension cost inclusive. These positions will be funded by 50% Federal and 50% State funding.
BACKGROUND:
The California Advancing and Innovating Medi-Cal (CalAIM) program was created to transform and improve healthcare services to persons with Medi-Cal coverage through a complex set of initiatives to improve access, quality, and coordination of care. These initiatives will be implemented across CCH, and requires coordination between the Contra Costa Health Plan, Mental Health Services, Alcohol and Other Drugs Services, and Detention Health.
The FY24-25 Recommended Budget included 68 FTE for Detention Health to fulfill necessary West County augmentation per court order; 36.0 FTE to support CalAIM program expansion staffing requirements and opioid abuse reduction efforts; and increased staffing to implement the CalAIM billing requirements.
Over the next few years, county Behavioral Health Plans will be focusing on several areas including payment reform, policy and documentation redesign, quality and compliance, and data exchange. These changes are expected to improve system efficiencies, quality, and outcomes.
The increased level of regulatory oversight, grant management, audit requirements, system changes, and timeliness of the response to such requirements requires significant support from Health Services Finance. To address these requirements, the Finance Department is requesting three (3) additional Health Services Accountant positions.
Two (2) positions will be assigned to the Behavior Health Services Division to oversee the program obligations associated with the program expansion associated with Homeless Services, Alcohol and Other Drugs Services, and Detention Health as described below.
Health, Housing, and Homeless Services (H3):
The Homeless program has a stated goal of reducing unsheltered homelessness in the county by 1,100 persons within the next five years by expanding prevention services, expanding supply of interim housing, and expanding outreach and services to reduce homeless encampments across the County.
The Health Care for the Homeless program supports unhoused individuals through clinics at 15 field-based locations across the county. The funding sources for these programs requires significant Finance oversight to ensure continued funding and compliance with program guidelines, specifically including monitoring grant budget, submitting required reports to the grantor, and implementing procedures to monitor sub-recipient awards.
Alcohol and Other Drugs Services (AODS):
AODS has been tasked as the lead unit to coordinate and oversee implementation of activities supported through the California Opioid Abatement Accounts Fund, as well as supporting CalAIM expansion. The funding sources associated with these programs requires significant Finance oversight to comply with the associated program guidelines.
Detention Health:
The West County Reentry, Treatment, and Housing Facility (WRTH) will be constructed on a pad located within the secure perimeter of the already existing West County Detention Facility (WCDF) in the City of Richmond. This integrated housing, psychiatric, treatment, and reentry services facility will allow the transfer of approximately 400 people out of the county’s aging, outdated, and overcrowded Martinez Detention Facility. These inmates will be moved into the new facility, closing an entire housing unit at MDF. The proposed West County Reentry and Mental Health Treatment Facility addresses an immediate need to provide meaningful reentry programming and robust mental health treatment to many individuals now incarcerated at the Martinez Detention Facility. The proposed reentry and treatment facility would include approximately 25,000 square feet of program space for Mental Health and Substance Abuse Treatment Services; Adult Education Programs; Family Reunification Services, including Group and Individual Counseling; Implementation of Case Management and Needs Assessments that Allow for appropriate delivery of substance abuse treatment, job training, and placement. This program is anticipated to require additional Finance Department resources associated with the obligations of Health Services.
One (1) position will be added to the Contra Costa Health Plan Division to address the additional financial reporting created by CalAIM and the CCHP’s transition to a Single Plan Model on January 1, 2024. Approximately 30,000 members were added to CCHP under the Single Plan Model who were formerly managed by Anthem.
Additional Finance Department support is required to meet mandatory financial data submission requirements and deadlines, including quarterly financial reporting to the Department of Health Care Services (DHCS) State oversight agency, issuing various types of incentive payments to Health Plan providers, new State mandates that require Medi-Cal Managed Care Health Plans to report information related to plan members who have Other Health Care Coverage (OHC), and accounting for refunds due from providers for medical claim overpayments.
There are also increased state and federal reporting obligations for the Contra Costa Community Health Plan. This plan includes commercial coverage for County employees and retirees, and the State sponsored coverage available to in-home supportive service providers in Contra Costa County. Financial support is required for setting premium rates and monitoring Pharmacy costs.
CONSEQUENCE OF NEGATIVE ACTION:
If the action is not approved, Health Services will not have the appropriate staff to ensure compliance with increased level of fiscal regulatory oversight as the result of several program expansions.