1145-401308
Behavioral Health (BH) is an integrated Mental Health (MH) and Substance Use Disorder (SUD) service provider, primarily focusing on the delivery of assessment and treatment interventions. BH also does prevention and outreach for both MH and SUD, with prevention being done mostly through contracts with local entities. As the county’s’ Mental Health Plan (MHP), we provide inpatient treatment provisions, as well as specialty mental health services and SUD services to Medi-Cal beneficiaries and uninsured individuals with (severe) Serious Mental Illness (SMI), youth with Serious Emotional Disturbance (SED), and/or SUD meeting medical necessity criteria.
Services are primarily outpatient consisting of case management, rehabilitation, therapy, medications, triage & crisis, inpatient placement, and discharge coordination, monitoring clients placed in long term facilities, SMI supportive housing, prevention-outreach-engagement, peer specialist support, in custody & judicial services, and outpatient substance use disorder services. In addition to the service delivery system, BH also manages Quality Management and Compliance programs which ensure provisions of the various functional areas required by state contract and other associated federal standards to maintain program integrity.
* Each department is part of a "Fund". Many times, a department or even a fund may show greater expense then revenues for the current fiscal year. This does not account for money that was not spent in prior years, also known as "beginning fund balance". When creating the annual budget Counties are required by law to adopt a balanced budget, meaning the total expense cannot exceed the sum of revenue plus beginning fund balances.
Recent Departmental Accomplishments
Secured New Electronic Health Record Sofftware (EHR)
Behavioral Health is dedicated to ensuring compliance with state and federal EHR standards for securing the use, maintenance, and on-going functionality of an electronic health record and billing system that meets state data reporting and claiming requirements necessary to preserve the department’s eligibility to receive federal revenue and remain in compliance with contractual obligations set forth in the contract between Tuolumne County Behavioral Health (TCBH) and the Department of Health Care Services (DHCS).
Mental Health Diversion
In September 2021 TCBH began developing a local Mental Health Diversion Program. Half day trainings for the lead supervisors began on September 29, 2021. This initial training was followed by five additional half day trainings that were attended by TCBH, Law Enforcement and other community agencies that interact with Mental Health Diversion. Through these trainings each agency was able to identify their roles and responsibilities.
Dedicated Appointment Scheduling Phone Line
A dedicated telephone line was created to ensure beneficiaries are properly connected to appointment scheduling. This streamlined process improves access to care by preventing dropped calls, confusing automated menus, long wait times, and incorrect line transfers.
Grants
Throughout FY 21/22, securing grants became a focus to increase both services and network capacity for TCBH. Several grants were pursued to better prepare TCBH for upcoming requirements and to increase service availability to not only clients but Tuolumne County residence. BH received two grants, Crisis Care Mobile Unit (CCMU) Grant and State Hospitals Felony Incompetent to Stand Trial Grant.
Recent Departmental Accomplishments (Cont.)
External Quality Review Organization (EQRO)
The federally required EQRO conducted their annual review of the Behavioral Health Department Mental Health Plan (MHP) on March 23, 2022. The finding was that the Department demonstrated significant strengths in the following areas: integrated mental health and substance use disorder (SUD) programs; met the 10-day business standard for first offered appointment 81 percent of the time; member of a newly created multi agency Children System of Care (CSOC); and created a roll-out schedule for new electronic health record (EHR). Of the seven recommendations for improvement that resulted from the FY 2020-21 EQRO, the MHP addressed or partially addressed six recommendations.
The MHP has a robust claims verification and validation process. During the COVID-19 pandemic, it was able to maintain the claims volume without any significant change to its denial rates which remained below the statewide average. At the same time, the MHP acquired adequate equipment to expand its existing limited telehealth services to all clinical staff including more mobile and field-based capabilities.
Feedback in the stakeholder focus group reflect staff participation in committees, system planning, and Mental Health Plan initiative/policy development
Active partner in supporting mental health services for the homeless and Camp Hope.
TCBH Hosted events:
PIT Count, 1/21/22
Two Virtual Job Fairs, 4/14 & 4/15
Recent Departmental Accomplishments (Cont.)
Community Outreach and MH Education
BH Inflatables – first debuted in October 2021 and participated in the Sonora Christmas Parade 2021
Stanislaus State Virtual Field and Career Fair, 2/17/22
MHSA Community Stakeholder Virtual Meetings (five were held in February & March)
MHSA Prevention and Early Intervention Contractors Forum, 4/7/22; to be held quarterly
Blue Zones Community Discovery Fair, 4/9/22 (with Advisory Board members participating)
TCBH was featured in Tuolumne County Library’s display case during May in celebration of mental health awareness month
Board of Supervisors presentation on Mental Health Awareness Month, 5/3/22
Outreach partnership with TCSOS at local elementary and high schools during May – first school Columbia Elementary, 5/5/22
TCBH staff, volunteers and BH Inflatables participated in the Mother Lode Round-Up Parade featuring a “Garden of Hope” mental health awareness theme float, 5/7/22
Q&A Forum on the MHSA Annual Update, 5/9/22
Job Fair at Don Pedro High School, 5/18/22
Presentation focusing on Mental Health Awareness, 5/19/22
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Partnered with Tuolumne County Probation Department to help raise awareness of mental health during May 2022
ICES’ 36th Annual Children and Baby Fair, 6/4/22
LGBTQ Event June 2022
Top Departmental Concerns
Ongoing recruitment and retention challenges for Behavioral Health Clinicians and Program Supervisors that impact the department’s ability to provide services, meet State and Federal regulations (Medicaid Final Rule 2017), participate in state mandated partnerships with other departments, and fulfill grant obligations.
Lack of comparable wages for treatment providers which impacts the Departments ability to attract and to retain qualified and highly skilled practitioners of the Healing Arts.
Current and future state and federal monitoring, increased reporting, and audit requirements.
Pending significant system changes: new electronic health record and CalAIM related fiscal reform. California Advancing and Innovating Medi-Cal (CalAIM) is a multi-year initiative by DHCS to improve the quality of life and health outcomes of our population by implementing broad delivery system, program, and payment reform across the Medi-Cal program. For example, transition from a cost-based approach to one that is more streamlined and expeditious.
Low penetration rate for Foster Youth. The MHP’s Foster Care penetration rate was found to be lower than the statewide rate and appears to have gone down while the statewide and other small MHP average rates continue to improve. BH through the Children’s System of Care (CSOC) partnership with Child Welfare Services is working toward improving referral process developed to increase the penetration of the Foster Care population.
COVID continues to be the largest challenge for our Department.
Developing a compensation package to be more competitive in the labor market for TCBH workforce.
Implementation of Mobile Crisis Unit, and Felony Incompetent to Stand Trial grant, and MH Diversion services.
Partner with Superintendent of Schools to implement the Mental Health Student Services Act (MHSSA) grant.
Develop and implement certified Peer Specialists’ scope of practice guidelines to expand the BH workforce and service delivery base.
Monitor enhanced service delivery implemented within the Jail and Juvenile Detention Center in 2022 to assure the most effective programming for detained individuals.
To complete planning and implementation of the new electronic health record system, operationalize CalAIM initiatives and Drug Medi-Cal infrastructure.
Respond to EQRO opportunities for improvement identified during the EQRO 2022 review to improve beneficiary outcomes.
Continue partnership in the multiagency Children’s System of Care to leverage relationships with partnering agencies, especially CWS, to initiate quality improvement activities to increase MHP FC penetration rates.
Continue to explore and pursue other solutions to improve psychiatry wait times for children and Foster Care (FC) youth populations.
Collaborate with EHR vendor or psychiatric telehealth provider to track and trend Healthcare Effectiveness Data and Information Set (HEDIS) measures related to psychotropic medications; regularly track and trend FC prescribing practices.
Increase data analyze to identify needs system changes to increase timely system improvements.
CY 2022 will be a critical year for the MHP in terms of data management, claiming and security of protected health information as it transitions to the new EHR system. The new system will be critical to successfully adapting to changing needs under CalAIM, including payment reform, creating a beneficiary Patient Health Portal, and other new features.