To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Add four (4) full-time positions and cancel one (1) full-time position in various classifications for the Behavioral Health Division in the Health Services Department
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
ADOPT Position Adjustment Resolution No. 26239 to add the following four (4) full-time positions:
• Two (2) Registered Nurse (VWXG) positions at salary plan and grade L32-1880 ($12,004 - 14,991)
• One (1) Clerk-Senior Level (JWXC) position at salary plan and grade 3RX-1033 ($4,434 - $5,662)
• One (1) Nursing Program Manager (VWHF) position at salary plan and grade ZZX-1002 ($16,567 - $18,265)
and cancel the following one (1) position:
• One (1) Utilization Review Manager (VWHG) position #16502
for various programs in the Behavioral Health Division in the Contra Costa Health Department as specified in Attachment A. (represented)
Behavioral Health (0467): APPROVE Budget Amendment No. BDA-23-00311 authorizing FY 23-24 Miscellaneous State Aid (9435) appropriations in the amount of $686,926 for salaries, benefits, and expenses in the Behavioral Health Department.
FISCAL IMPACT:
The action has an annual salary and benefit cost of approximately $686,926. There is no Net County Cost as these positions will be fully funded through CalAIM dollars.
The Budget Amendment will result in increasing the appropriations to Miscellaneous State Aid (9435) appropriations in the amount of $686,926: Permanent Salaries (1011) by $427,725, F.I.C.A (1042) $19,829, Retirement Expense (1044) by $96,967, Employee Group Insurance (1060) by $83,592, Retiree Health Insurance (1061) by $53,059, Unemployment Insurance (1063) by $518, and Workers Compensation Insurance (1070) by $5,236 in the Behavioral Health Department.
BACKGROUND:
The Health Services Department is requesting these actions to support operational needs in various units:
1. The Enhanced Care Management (ECM) Program provides person-centered care management to the highest-need Medi-Cal enrollees primarily through in-person engagement where enrollees live, seek care, and choose to access services. ECM teams focus on assisting persons with diagnoses of serious mental illness and/or substance misuse. On October 17, 2023, the Board of Supervisors approved the transfer of twenty-one (21) ECM positions from the Public Health Division to the Behavioral Health Division. The transferred team consists of Mental Health Clinical Specialists, Substance Abuse Counselors, and Mental Health Community Support Workers, but no medical practitioners or administrative support. The two Registered Nurses will be responsible for assisting ECM enrollees diagnosed with serious behavioral health conditions with co-occurring physical health conditions access necessary medical care for their untreated or under-treated health conditions. Their role will be to provide consultation to the Mental Health Clinical Specialists and Substance Abuse Counselors to ensure a comprehensive and whole person care approach to the identification of client needs and referral to appropriate medical services required under the ECM interdisciplinary approach. The Clerk-Senior Level being requested will provide administrative support to the ECM team.
2. The Behavioral Health Administration Unit provides support to the Behavioral Health Division which provides integrated services for mental health, substance abuse, and other needs that promote wellness and recovery of all residents of Contra Costa County. The Nursing Program Manager position being requested will be responsible for developing and implementing new and expanded divisional clinical quality assurance programs. The Department of Health Care Services (DHCS) has added, and continues to add, many new quality-focused mandates emphasizing the quality of clinical care and adherence to compliance functions. Each new state mandate introduces additional quality measures and reporting requirements of clinical outcomes. The Behavioral Health Division has also been implementing many new grant-funded clinical initiatives that include quality measures in addition to the existing quality assurance requirements of Medi-Cal. The cost of the new position will be offset by the cancellation of one vacant Utilization Review Manager position, which has been vacant since June 1, 2023, and determined to no longer be needed, due to changes in utilization review and authorization process resulting from the implementation of the CalAIM system redesign.
CONSEQUENCE OF NEGATIVE ACTION:
If this action is not approved, the Enhanced Care Management teams will have insufficient staff to provide clinical expertise as part of the whole-person, interdisciplinary care management approach required for Enhanced Care Management. The ECM teams will also not have sufficient administrative support to effectively provide coordination of services and comprehensive care management to ECM enrollees. The Behavioral Health Division will also have insufficient staff to implement quality assurance programs ensuring quality of care and compliance to mandates from the State’s Department of Health Care Services.