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Supervisors pressed on behavioral-health contractor rates and crisis-response models as county seeks sustainable, countywide coverage
Summary
The Board heard multiple public comments and department testimony about proposed changes to contracted behavioral-health rates and about the planned transition from PERT to a countywide Mobile Crisis Response Team (MCRT) model; supervisors requested more analysis and a transition plan.
The Board of Supervisors heard extended public comment and staff responses Monday about proposed FY2025-26 changes to behavioral-health contract rates and county crisis response.
Behavioral Health staff told the board the county is moving from a cost-based reimbursement approach to a fee-for-service model and has proposed new FY2025-26 rates that reflect state cost-of-living adjustments and a high blended pass-through proportion. Staff said the county's proposed dollar rates are higher than other Bay Area counties and that, after analysis, eliminating a separate 10% "intensive services" differential is fiscally defensible because the base hourly rates already exceed peer counties.
Community-based providers and advocacy organizations urged the supervisors to preserve differential payments and warned that abrupt cuts could destabilize providers that deliver the majority of county-contracted behavioral services. Providers said the differential supported outreach-heavy, high-acuity programs and cited investments in electronic health records, clinical supervision and expanded service capacity tied to prior rate increases.
Separately, supervisors and members of the public debated the future of the Psychiatric Emergency Response Team (PERT) model, which embeds clinicians with law-enforcement officers for some high-acuity responses. Administration and Behavioral Health leaders said PERT is not widely reimbursable under Medi-Cal and is not scalable countywide; they propose bolstering MCRT to provide 24/7 countywide coverage and improving operational integration with law enforcement (dispatch protocols, radio access, law enforcement liaisons) to handle the infrequent but critical incidents that require police presence.
Supervisors asked for detailed implementation plans and requested an off-agenda memo explaining the three-year rate transition, the safeguards offered to providers (advance cash, reconciliation), and monitoring metrics the county will use to detect provider instability. Behavioral Health staff said they will provide additional written analysis and continue stakeholder engagement.
