To: Sonoma County Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Bill Carter, 565-5157
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
California Mental Health Services Authority Electronic Health Record Program Participation Agreement
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute a participation agreement with the California Mental Health Services Authority to facilitate the County’s participation in the Electronic Health Record Program in the amount of $100,000 through May 31, 2022.
B) Adopt a resolution authorizing budgetary adjustments to the fiscal year 2021-2022 adopted budget by increasing revenues and expenditures in the Department of Health Services by $100,000 to support participation in the California Mental Health Services Authority Electronic Health Record Program. (4/5th Vote Required)
end
Executive Summary:
The Sonoma County Department of Health Services (DHS), along with California’s other City/County Behavioral Health Plans (BHPs) operate in an increasingly complex health information, information technology and regulatory environment. As such, these systems rely upon electronic health records (EHR) to maintain health information safely, support care coordination, support provider treatment decision-making and bill for services. Unfortunately, EHRs available in California are limited because of the state certification requirements necessary to operate legitimately in the Medi-Cal system. DHS has invested in Avatar, one of the best EHRs available in California; however, as with all other currently available EHRs, its functionality is hampered by the State’s certification requirements.
The California Advancing and Innovating Medi-Cal (CalAIM) reform, currently underway and projected to be in place in 1-2 years, creates an opportunity to bring more EHRs to California, and to select or design systems tailored to meet our needs. California Mental Health Services Authority (CalMHSA), a county behavioral health Joint Powers Authority (JPA), has initiated a collaborative effort to partner interested counties to lead the development of an enterprise EHR, built with input from county behavioral health departments to take advantage of the opportunities for increased functionality and efficiencies offered by CalAIM.
DHS is requesting authorization to utilize $100,000 of one-time state funds allocated to Sonoma County DHS as a medium sized county determined by the participation agreement to support Behavioral Health Quality Improvement for CalAIM implementation to join this EHR project. This item also includes a request for approval of a resolution authorizing budgetary adjustments to the fiscal year 2021-2022 adopted budget by increasing revenues and expenditures in the Department by $100,000 to support participation in the CalMHSA Electronic Health Record Program.
Discussion:
California’s County Behavioral Health Plans (BHPs) operate in an increasingly complex environment. As Specialty Mental Health and Substance Use Providers, we are treating an expanded Medi-Cal population in an increasing amount of distress and are being asked to provide meaningful solutions for societal issues from homelessness to mental health impacts of COVID-19. Simultaneously, the requirements for administering our BHPs are rapidly evolving, with CalAIM’s documentation and payment reform on the horizon, requiring swift adoption of highly technical changes. Currently, the primary tool Behavioral Health Plans have to manage our business is our Electronic Health Record (EHR), which fall short in supporting our business needs. We cannot easily retrieve the data needed to make sound decisions, to highlight our successes locally, nor to respond to oversight and funding bodies.
Our current EHR, Avatar, represents one of the best currently available to county behavioral health divisions; however, the CalAIM reform, over the next 1-2 years, will simplify the administrative and regulatory systems governing Medi-Cal documentation and billing in a manner that makes it possible to create new EHRs that can maximize DHS functions.
Sonoma County is a member of CalMHSA, which proposes to use its unique position as a JPA for California counties to bring behavioral health divisions together into a semi-statewide collaborative to design, procure and implement a new enterprise EHR solution that will support our current and future business needs. By providing a collaborative solution, CalMHSA and counties will pool together intellectual and technical resources as well as purchasing power to create a solution during a time of potential risk and rapid change. This collaborative project will bring forward solutions to key business challenges such as:
• Master Client Index: shared repository of clients that begins prior to an assessment and allows complete timeliness tracking and identification of clients who may receive treatment across counties
• Master Consent: allows for compliant coordination among all relevant health, mental health, substance use and social service care providers
• Real Time Medi-Cal Eligibility: provides current eligibility status maximizing revenue capture
• Unified Solution for SMHS and SUD services: promotes coordination and administrative efficiency
• Flexible Billing Solution: spans current Short Doyle Phase II and future payment reform requirements
• Lean Clinical Record designed for documentation reform to reduce staff burden
• Structured Staffing/Program Hierarchy: allows easy access to position vacancy rate, productivity, and reporting relationships
• Embedded Quality Assurance Logic: reduces claiming errors and audit risk
• Natural Data Collection: meaningful reporting and evaluation by design
DHS proposes joining the CalMHSA and a coalition of county behavioral health divisions to collaboratively develop an enterprise EHR that will be available as CalAIM implements payment reform. Joining the project, Sonoma County will exercise leadership, have first-hand opportunities to impact project development and benefit from information created as California’s leading counties partner with EHR professionals, the state and each other to create a client and county-centric EHR.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 2: Identify gaps in the Safety Net system of services and identify areas where departments can address those gaps directly, and seek guidance from the Board when additional resources and/or policy direction is needed.
Prior Board Actions:
On May 7, 2013 the Board approved a second amended and restated Joint Exercise of Powers Agreement governing the operations of the California Mental Health Services Authority.
On November 9, 2010 the Board approved an amended and restated Joint Exercise of Powers Agreement (JPA) to join the California Mental Health Services Authority (CalMHSA).
On May 4, 2010 the Board approved a Joint Exercise of Powers Agreement (JPA) to join the California Mental Health Services Authority (CalMHSA) for the purpose of joint development and administration of MHSA programs.
Fiscal Summary
|
Expenditures |
FY 21-22 Adopted |
FY 22-23 Projected |
FY 23-24 Projected |
|
Budgeted Expenses |
|
|
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Additional Appropriation Requested |
100,000 |
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|
|
Total Expenditures |
100,000 |
0 |
0 |
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Funding Sources |
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|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
100,000 |
|
|
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Fees/Other |
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Use of Fund Balance |
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|
Contingencies |
|
|
|
|
Total Sources |
100,000 |
0 |
0 |
Narrative Explanation of Fiscal Impacts:
The Department is requesting appropriations of $100,000 for Fiscal Year 2021-2022 for contract services with the attached budget resolution. Revenue for this contract comes from California Advancing and Innovating Medi-Cal (CalAIM).
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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|
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|
|
|
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Participation Agreement with CalMHSA
Attachment 2 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None