Board Of Supervisors — Tuesday, March 19, 2024

On February 27, 2024, your Board approved a Letter of Support for a regional request for California Coastal Conservancy LiDAR Derivatives Funding. The final application is now being prepared by the proponents. Humboldt County Public Works will serve as fiscal sponsor, on behalf of the North Coast Regional Partnership (NCRP). Staff Recommends your Board approve the revised Letter of Support and authorize the Chair to sign.

The United States Geological Survey (USGS) and California Department of Conservation recently funded collection of LiDAR data throughout Lake County. That initial collection is complete, and data is being refined over the course of 2024. In order for this data to be most usable for natural resource and fuels management and other purposes, LiDAR derivates additionally need to be developed. You will recall, the County has included LiDAR Derivatives in multiple recent grant applications approved by our Board, including CAL FIRE grant applications approved February 28, 2023, and January 9, 2024.

Approve Revised Letter of Support for California Coastal Conservancy LiDAR Derivatives Funding and Authorize the Chair to Sign.

This amendment includes Peer Support Services as a service. Peer Support Services are included in the State Mental Health Plan contract effective July 1, 2023. These services are reimbursable through Medi-Cal. We currently pay all contracted providers 65% of our rate/payment on the fee-for-service schedule as a passthrough.

Approve Amendment No. 2 to the Agreement Between County of Lake and Redwood Community Services, INC. For the Lake County WRAP Program, Foster Care Program, and Intensive Services Foster Care (ISFC) Program for Specialty Mental Health Services with no change to the contract maximum for Fiscal Years 2022-23, 2023-24, and 2024-25 and authorize the Board Chair to Sign.

The 2023/2024 Budget allowed for the Probation Department to purchases two new vehicles. The State Contract (cooperative purchases) was utilized, and Public Works Fleet Maintenance was able to secure one Ford Explorer for the Probation Department to add to the vehicles it uses. The quote for the proposed vehicle is attached for review. Probation is seeking approval of adding this vehicle to inventory and the authority to sign a Purchase Order for said vehicle.

Approve Purchase of one (1) Vehicle from Downtown Ford through the State Contract, in the amount of $57,374.76, and authorize the Probation Chief to issue Purchase Order

Annually, the State of California's Procurement Division, complying with legal competitive bidding requirements, solicits vehicle bids throughout the State of California. A State Contract is issued to the low bidders and the results are published and distributed to local agencies. Local agencies are given the opportunity to purchase these vehicles through the state at the same cost as the state. The quotes received for the vehicles are also attached. In an effort to purchase vehicles locally, vehicle make and models are identified in the State Contract and this detailed information is delivered to our local dealership to solicit their proposals on suggested or equivalent vehicles. Our local vendor advised us that they were unable to provide a price quotation for any of the vehicles.

Staff recommends that the Board of Supervisors approve the purchase of two (2) vehicles from Downtown Ford - Sacramento in the amount of $57,347.76 each for the Central Garage Fleet and authorize the Public Works Director/Assistant Purchasing Agent to issue the Purchase Orders

Attached for the Board's review and approval is Contract Change Order (CCO) No. 2 for the subject project. Contract Change Order No. 2 addresses the need to cover the cost of tax, shipping, and mobilization including excavation and installation of purchased concrete headwalls at Site 42 and Site 43, Harbin Springs Road. Headwalls to be installed on the inlet side of culverts at both locations to prevent erosion around the culverts and undermining of the road. This results in an increase of $17,524.28 to the contract amount of $246,737.30 for a revised contract amount of $264,261.58. This project is funded 75% from the State's CalOES funds and a 25% local match. Therefore, this project is 100% funded through construction.

Staff recommends approval by the Board of Supervisors of CCO No. 2 and that the Board authorize the Chair to execute said CCO for an increase of $17,524.28 and a revised contract amount of $264,261.58.

On August 17, 2021, the United States Department of Justice awarded a JAG Grant in the amount of $15,045 to the Lake County Sheriff's Office. Unfortunately, the extra-help position designated to be funded by this grant remains vacant and the Sheriff's Office did not accept the award and the funds were not expended. Sheriff Howe recommends declining the award and closing out this grant.

Approve Judicial Advocate General (JAG) Grant #15PBJA-21-GG- 01104-JAGX Decline Letter and Authorize Chair to Sign

Lake County Special Districts will be discussing proposed changes to our existing delinquent sewer and water Tax Roll schedule. The proposed adjustments aim to enhance efficiency for Special District staff and accommodate the customer's financial position. Special Districts staff will be discussing the specifics of these changes, highlighting the anticipated benefits and addressing any potential concerns from the board. Special Districts Administration will also be looking to establish staff direction from the Board of Supervisors.

Presentation considering Annual Delinquent Sewer and Water Tax Roll Schedule and established Staff Direction from Board of Supervisors

The Konocti Gardens project in Clearlake is a 102 unit multifamily apartment complex development off of Old Highway 53 near Highlands Way. Special Districts worked with the developer and initiated the capacity analysis for them in mid-December. Draft results were available at the end of January which indicated a mitigation project needed to be performed to upsize approximately 2,200' of sewer collection system due to the project impact. That impact was determined to cause a surcharge in the collection system resulting in sewer spills if the mitigation project was not completed prior to connection. Because of the modelling work already performed, JACOBS Engineering is well suited to complete the design and prepare the plans and specifications for the construction project. Construction is anticipated to occur this summer with completion in the fall of 2024.

Receive report to the Board on the current status of the Konocti Gardens project and the Special Districts sewer improvement project on Alvita Ave. in Clearlake to mitigate the development impacts

Staff is requesting that Article X of Chapter Two of the Lake County Code be amended to increase the purchasing limits, include additional definitions, modify a requirement for exemptions from competitive bidding and additional procedures for informal and formal bidding. Of the 35 counties we were able to obtain copies of their purchasing policies, all but 6 have significantly higher limits before requiring BOS approval. The distinction between RFP and formal bids is something that is currently missing as well as the procedures for RFP. The following sections have the proposed changes: Section 2-34. Definitions: (m) Purchase Order or Written Purchase Order, (n) Bid, (o) Request for Proposal (RFP), and (p) Request for Quotation (RFQ). Section 2-36. Powers and Duties: (a-c, m, n) $25,000 is increasing to $100,000. Section 2-37.4 Added language to prevent purchases from being split. Section 2-38. Exemptions from Competitive Bidding. 38.2(3) is being removed and replaced with "Service provided by another governmental agency". 38.3 $25,000 increased to $50,000 38.7 Added exemption pursuant to Election Code 13001 and 14100 Section 2-39. Solicitation Methods and Awarding Authority. (a) $3,000 increased to $5,000 (b) $3,000 increased to $5,000, and $25,000 increased to $50,000 (c) $25,000 increased to $50,000, and $50,000 increased to $100,000 (d) $50,000 increased to $100,000 Section 2-40. Informal Solicitation and Evaluation Procedures. 40.2 is being amended to include additional procedures for an RFQ. 40.3 $3,000 increased to $5,000, $25,000 increased to $50,000, and $50,000 increased to $100,000 40.4 $50,000 increased to $100,000 Section 2-41. Soliciting and Awarding Formal Bids. 41.1 is amended to clarify procedures for bidding. 41.2 is amended to include RFP procedures and is moving former 41.2 to 41.3. 41.2 to 41.5 is moving to 41.3 to 41.6. Section 2-42. Emergency Purchases. 42.1 $3,000 increased to $5,000 42.2 $25,000 increased to $100,000 These changes will improve efficiency and clarify informal and formal bidding for further transparency. Staff recommends your board approve the first reading of the purchasing ordinance update.

a) Waive the reading of the ordinance to have it read in title only. b) Advance the second reading of the ordinance to the next regular meeting.

Nielsen Merksamer, Lake County's advocates in Sacramento, are pleased to present a report on the first months of the 2024 Legislative Session. The presentation will give an overview of the state of politics in Sacramento, provide a summary of the Governor's budget proposals and the 2,000+ bills introduced since January, and highlight some of the budget proposals and bills of potentially specific interest to Lake County, based on their impact and the County's Legislative Priorities, adopted by your Board during your 2024 Governance Workshop. Geoff Neill, Senior Legislative Advocate, will provide the presentation and be available to answer any questions from the Board.

Informational update, only. Consider Direction to Staff, as appropriate.

Community Development Block Grant Mitigation (CDBG-MIT) is a unique and significant opportunity for eligible grantees to use this assistance in areas impacted by recent disasters to carry out strategic and high-impact activities to mitigate disaster risks and reduce future losses. The purpose of MIT-RIP is to assist local jurisdictions with mitigation-related infrastructure needs to support risk reduction from the three primary hazards (wildfire, flooding, and earthquake). MIT-RIP Projects must meet the HUD definition of mitigation, "activities that increase resilience to disasters and reduce or eliminate the long-term risk of loss of life, injury, damage to and loss of property, and suffering and hardship by lessening the impact of future disasters." The County of Lake has been allocated an amount not to exceed $2,346,659.90. Staff requests this item be continued to March 26, 2024.

Continue to a date and time certain Board of Supervisors meeting on Tuesday, March 26, 2024 at 1:00 p.m.

2 Vacancies Applicant: Maria Kann

Appoint Maria Kann to the East Region Town Hall

Lake Behavioral Health Services Department is currently in a budget deficit due to issues processing Medi-Cal reimbursement. The cause of this deficit is a lack of timely reimbursement for Medi-Cal eligible services due to billing code error issues in our new Electronic Health Record (E.H.R.), SmartCare. These billing code error issues were outside of County staff control. The E.H.R. is contracted directly with the California Mental Health Services Authority (CalMHSA) who was the entity responsible for the migration of data into SmartCare. Unfortunately, migration and set-up errors have precluded effective billing. As the Board is aware, LCBHS migrated to a new E.H.R. in March 2023 as a Pilot County. Our previous E.H.R, Anasazi, had been scheduled to sunset at the end of 2023. Thus, a transition to a new E.H.R. vendor was unavoidable. After a thorough review of available options, we joined the Semi-Statewide Electronic Health Record Enterprise called SmartCare through CalMHSA. To date, there are 23 other California counties using this system. There have been challenges processing claims for Behavioral Health services out of the new E.H.R. since it went live in March 2023. As stated above, these were the result of billing code error issues that were outside of County staff control. We have continued to work diligently with CalMHSA to resolve these billing error issues. We are not the only County experiencing these issues. As of March 12, 2024 CalMHSA reported $1.5B approved claims in SmartCare, but only $451.9M of those claims, or 30.1%, have been paid to Counties. There is also a total of $150.5M denied claims. A request for disaggregated County-specific claims data, including data on the age of claims and claims error rates was requested of CalMHSA on March 11, 2024. Due to the challenges with the new E.H.R. processing claims and resultant dearth of Medicaid funding LCBHS brought forth Resolution 2023-90 to remove reserve designations on June 27, 2023. This Resolution authorized removal of reserve designations to provide sufficient cash flow. At that time, we anticipated resolution of billing issues with the new E.H.R. within a couple of months. It should be noted that there has been a recent forward momentum in the resolution of the billing error issues and we were issued a payment of $498,058.40 last week. The Board is also aware that California Mental Health Plans went through payment reform transition as part of California Advancing and Innovating Medi-Cal (Cal-AIM). This reform changed the way Mental Health Plans are reimbursed for services away from reimbursement of Certified Public Expenditures to a Cost-Based reimbursement methodology. On the technical side, it changed all of the billing codes in the system, further complicating matters. CalMHSA was responsible for completing the transition of billing codes in SmartCare. To date, we continue to have inaccurate information in the billing code and entry side despite our continued advocacy for these issues to be resolved. County Mental Health Plans have always been required to contribute local funding, typically through our Mental Health Services Act (MHSA) and 2011 Realignment, to match Federal Medicaid dollars in billing claims. In order to receive the Federal Financial Participation (FFP) we must contribute this local share to receive the Medicaid payments for which we are eligible. Effective July 1st 2023 Counties must participate in an Intergovernmental Transfer (IGT) process instead of a cost reconciliation process through cost reports. The IGT is intended to support County Mental Health and Drug Medi-Cal Plans with ensuring availability of funding, instead of waiting for a cost report process to be completed. Presently, the Department of Health Care Services (DHCS) is only caught up in reconciliating cost reports for all Counties through FY 2014-2015. As you can see in the table below, LCBHS has processed several IGT transfers since the first manual transfer in January, when we were able to submit our first batch of Medicaid billing. The Department of Health Care Services had failed to get the automatic IGT withdrawal process in place and functional until February 2024. There was no notification that automatic withdrawals would commence to maintain our target IGT balance. Thus, we did a manual transfer in the beginning of February and then two weeks later DHCS took out an automatic transfer. We must maintain the target balance of $503,376 at all times to facilitate the reimbursement process, effectively tying up half a million dollars at any one time. Presently, LCBHS has the following in IGT: January 2024 - Manual Transfer $172,536.45 February 2024 - Manual Transfer $224,018.00 February 2024 - Automatic Withhold $259,787.24 Current IGT Balance $502,621.37 Target IGT Balance $503,376 LCBHS was not able to submit claims in the new E.H.R. system until December of 2023 due to issues on the E.H.R. vendor side over which LCBHS had no control. Again, we were not the only County in this position. Unfortunately, there continued to be challenges with submitting claims successfully in the system to DHCS since. Presently, LCBHS has: SMHS Claims Approved $2,300,000.00 SMHS Claims Paid to Lake County $487,700.00 SMHS Claims Denied (Due to State System Issues) $66,700.00 Amount paid to Medi-Cal billable providers (July 1, 2023 - Feb. 29, 2024) $8,078,708.17 Total amount currently owed to us by DHCS for Medicaid payments $1,812,300 Due to the multifaceted impacts of implementing a new E.H.R. and CalAIM payment reform LCBHS has not received timely reimbursement for Mental Health or Substance Use Disorder services rendered. The biggest impact has been on our mental health program. Despite this pause in Medi-Cal revenue we continued to pay our contracted providers. There are other counties who defaulted on payments to their contracted providers due to issues with revenue this fiscal year due to issues with CalAIM payment reform. We are requesting two loans to remedy this budgetary shortfall while we continue to process Medi-Cal payments due to us. One loan from the General Fund of $3,000,000 and one loan from the Department of Social Services' realignment Fund of $1,000,000 for a total of $4,000,000. As the table above demonstrates, we are expecting $1,812,300 in payments for services spanning back to the start of the Fiscal Year. We are also projecting revenue of $10,295,967.67 through the remainder of the fiscal year which includes Medi-Cal reimbursements, grant funds, Realignment, and MHSA funding. We are working diligently, every day, to remedy this matter. To reiterate, unlike other counties that suspended payments to contracted providers we have continued to ensure continuity of payment and services to our community partners. In addition to this request, LCBHS plans to complete the following tasks immediately: * File a complaint with the California Mental Health Services Authority. * Report this situation and resultant fiscal hardship to the California Behavioral Health Director's Association * Explore support available from our State Legislative Delegation in resolving this matter.

Approve General Fund Loan Request of $3,000,000 and Loan of $1,000,000 from Department of Social Services Realignment Fund.

Section 29125, 29126, 29126.1, and 29130 of the Government Code provides authority for the Board of Supervisors to transfer and revise appropriations, cancel unused appropriations, transfer unused appropriations to contingencies, reduce estimate and cancel appropriate designations and reserves. The Behavioral Health Services Department joined the California Mental Health Services Authority's Semi-Statewide Enterprise Health Record as one of three pilot Counties and went live in the new system March 1, 2023, and were not able to successfully submit claims for services to the Department of Healthcare Services until December 2023. Behavioral Health now has a deficit fund balance due to lack of reimbursement for Medicaid claims from March 2023 forward, that must be resolved to continue to pay their vendors and staff. They have requested a short-term loan from General Fund in the amount of $3,000,000 to be paid back within 12 months and returned to its original Reserve, Fund 154. 1991 Realignment does allow for up to 10% to be transferred between The Department of Social Services, Public Health, and Behavioral Health. Social Services has agreed to loan $1,000,000 and Public Health has agreed to loan $130,000. These amounts fall under the 10% of their 1991 Sales Tax Realignment.

Staff recommends that your Board adopt the Short-Term Loan Resolution between the General Fund and Behavioral Health in the amount of $3,000,000 to be repaid within 12 months.

This is the second amendment of the agreement between Lake County Behavioral Health Services, as Lead Agency for the Lake County Continuum of Care, and Adventist Health Clear Lake for Fiscal Years 2021-2022, 2022-2023, and 2023-24 entered into on September 1, 2021 to provide Emergency Shelter and Rapid Re-Housing to those experiencing homelessness in Lake County. This agreement utilizes the special Emergency Solutions Grant - COVID (ESG-CV) that was part of the CARES Act. This agreement modifies the original budget, shifting funds from Rapid Re-Housing to Emergency Shelter. The reason is there is a lack of available and affordable permanent housing to assist people to obtain, therefore, the funding would not have been spent in time to meet the spending deadlines imposed by requirements of the ESG-CV grant. However, funding could be utilized for Emergency Shelter for those experiencing homelessness. The budget is also increased by $100,000. This funding was originally meant to be utilized by the City of Clearlake to address Emergency Shelter. The City of Clearlake has opted to have the funding utilized by the Hope Center, which operates as part of Adventist Health Clear Lake, to address the need. This brings the total of the agreement to $443,000.00. This amendment also extends the termination date from September 30, 2023 to December 31, 2023 to allow for the updated invoicing to reflect the budget changes.

Approve Amendment Number 2 to the Agreement Between the County of Lake - Lake County Behavioral Health Services as Lead Administrative Entity for the Lake County Continuum of Care and Adventist Health Clear Lake Hospital, Inc. in the Amount of $443,000 for Fiscal Years 2021-2024 and Authorize the Board Chair to Sign.