To: Board of Supervisors of Sonoma County
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: Majority
Supervisorial District(s): 4/5th Vote Required
Title:
Title
California Mental Health Services Authority Semi-Statewide Enterprise Health Record
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 (CalMHSA) for the County to access the Semi-Statewide Enterprise Health Record Program through March 18, 2029 in an amount not-to-exceed $5,526,045.
B) Adopt a resolution authorizing budgetary adjustments to the fiscal year 2022-2023 adopted budget to program $1,789,664.60 of MHSA Innovation available fund balance to support Semi-Statewide Enterprise Health Record Program Year 1 participation. (4/5th Vote Required)
end
Executive Summary:
County Behavioral Health Plans operate with complex health information, information technology and regulatory environment. Unfortunately, electronic health record (EHR) systems available in California are limited because of the state certification requirements necessary to operate legitimately in the Medi-Cal system. Sonoma County’s Department of Health Services (“DHS” or “the Department”) has invested in myAvatar. A major change, California Advancing and Innovating Medi-Cal (CalAIM), is impacting the County, behavioral health providers, and health plans with goals to improve care through payment reform, reducing complexity and increasing flexibility. In order to comply with the changes as a result of CalAIM, County behavioral health will need to overhaul their existing electronic health record (EHR) systems or transition to a new, more modern EHR system with more modern capabilities built in to better meet the new standards. Many large payment reform requirements go into effect on July 1, 2023 and Sonoma County is preparing for these changes.
On December 7, 2021 the Board approved a participation agreement with CalMHSA that provided funding to CalMHSA to develop and manage a competitive procurement process to select a vendor to deliver a California-centric enterprise solution for electronic health records. Pursuant to the competitive procurement process, CalMHSA entered into a Master Services Agreement with Streamline Healthcare Solutions, LLC, to develop an EHR. DHS is now requesting authorization to enter into a participation agreement with CalMHSA for configuration, implementation, operation, and maintenance of a California-centric EHR to be used by all participating counties.
This item also includes a request for approval of $1,789,664.60 FY 2022-2023 budgetary adjustments to program available MHSA Innovation Fund balance to fund participation in the Semi-Statewide Enterprise 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 including homelessness and 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 falls 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.
Sonoma County is a member of CalMHSA, which is using its unique position as a JPA for California counties to bring behavioral health divisions together into a semi-statewide collaborative to configure, implement, operate, and maintain a new enterprise EHR solution that will support the Department’s current and future business needs. The new EHR will have the benefit of increased capabilities related to staff management, client outcomes, and state reporting. This endeavor is supported by California’s Department of Healthcare Services (DHCS) who is collaborating on the project, reducing audit risk to the county in the future related to the administration of the Mental Health Plan and the Drug Medi-Cal Organized Delivery System. 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.
On December 7, 2021 the Board approved a participation agreement with CalMHSA that provided funding to CalMHSA to develop and manage a competitive procurement process to select a vendor to deliver a California-centric enterprise solution for electronic health records. Pursuant to the competitive procurement process, CalMHSA entered into a Master Services Agreement with Streamline Healthcare Solutions, LLC, to develop an EHR. DHS is now requesting authorization to enter into a participation agreement with CalMHSA for configuration, implementation, operation, and maintenance of a California-centric EHR to be used by all participating cities and counties. As one of 19 Phase 1 participating counties in California, 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.
This item also includes a request for approval of a resolution authorizing budgetary adjustments to the fiscal year 2022-2023 adopted budget by increasing revenues and expenditures in the Department by $1,789,664.60 to support participation in the Semi-Statewide Enterprise Health Record Program. DHS plans to use Mental Health Services Act Innovation funding.
Mental Health Services Act (MHSA) as the Planned Funding Source
In November 2004, California voters approved Proposition 63, the Mental Health Services Act (MHSA). The Act imposes a one percent income tax on personal income in excess of $1 million. Much of the funding is provided to counties to fund mental health programs consistent with their local plans. The Act states that five percent of the total funding for each county shall be utilized for Innovative programs.
Innovative programs are defined as novel, creative, and/or ingenious mental health practices or approaches that are expected to contribute to learning, which are developed within communities through a process that is inclusive and representative of unserved and underserved individuals. The Innovation component allows counties the opportunity to try out new approaches that can inform current and future mental health practices. Innovation projects are subject to one-time funding with time limitations to assess and evaluate their efficacy.
To meet MHSA requirements for utilization of MHSA Innovation funding, the County’s proposed EHR plan was opened for a 30 day public comment period, beginning June 20, 2022 and ending July 19, 2022, a Mental Health Board MHSA Public Hearing was held on July 19, 2022, and this County Board of Supervisors board item was scheduled. CalMHSA presented the Semi-Statewide Enterprise Health Record Program project to the state Mental Health Services Oversight and Accountability Commission (MHSOAC) in August to receive formal approval for all participating counties to use MHSA Innovation funding for the project.
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 2: Establish equitable and data-driven distribution of services
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 December 7, 2021, the Board A) approved a participation agreement with CalMHSA to facilitate the County’s participation in the Electronic Health Record Program in the amount of $100,000 through May 31, 2022; and B) adopted 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 CalMHSA Electronic Health Record Program.
Fiscal Summary
|
Expenditures |
FY 22-23 Adopted |
FY 23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
|
$604,799.74 |
$543,740.58 |
|
Additional Appropriation Requested |
$1,789,664.60 |
|
|
|
Total Expenditures |
$1,789,664.60 |
$703,131.14 |
$642,051.98 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
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|
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State/Federal |
|
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Fees/Other |
|
|
|
|
Use of Fund Balance |
$1,789,664.60 |
$703,131.14 |
$642,051.98 |
|
Contingencies |
|
|
|
|
Total Sources |
$1,789,664.60 |
$703,131.14 |
$642,051.98 |
Narrative Explanation of Fiscal Impacts:
To implement the CalMHSA for fiscal year 2022-2023 additional appropriations and the use of MHSA Innovation Fund Balance in the amount of $1,789,664.60 is requested. $4,453,442 in projected 6/30/2023 year end MHSA Innovation fund balance is available.
The Department will include future year expenditure appropriations and use of fund balance through the budgetary process.
|
Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - CalMHSA Enterprise Health Record Participation Agreement
Attachment 2 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None