BOARD OF SUPERVISORS

STATEMENT OF PROCEEDINGS COUNTY OF SAN DIEGO BOARD OF SUPERVISORS REGULAR MEETING TUESDAY, MAY 23, 2023, 9:00 AM COUNTY ADMINISTRATION CENTER, ROOM 310 1600 PACIFIC HIGHWAY, SAN DIEGO, CALIFORNIA Order Of Business A. REGULAR SESSION: Meeting was called to order at 9:02 a.m. PRESENT: Supervisors Nora Vargas, Chair; Terra Lawson-Remer, Vice-Chair; Joel Anderson; Jim Desmond; also, Andrew Potter, Clerk of the Board of Supervisors. ABSENT: (District 4 Seat Vacant) B. Statement (just cause) and/or Consideration of a Request to Participate Remotely (emergency circumstances) by a Supervisor, if applicable. C. Invocation was led by Pastor Benjamin Plata of the International Bible Baptist Church. D. Pledge of Allegiance was led by Mrs. Tanner’s 2nd Grade Class from the Monarch School. E. Presentations or Announcement of Proclamations and Awards: Chair Nora Vargas presented a proclamation declaring the Week of April 30 – May 6, 2023, to be Small Business Week throughout the County of San Diego. Chair Nora Vargas and Vice-Chair Terra Lawson-Remer presented a proclamation declaring the Month of May 2023, to be Foster Care Month throughout the County of San Diego. Vice-Chair Terra Lawson-Remer presented a proclamation declaring May 23, 2023, to be Third Avenue Charitable Organization Day throughout the County of San Diego. Supervisor Joel Anderson presented a proclamation declaring the Month of May 2023, to be Asian American Pacific Islander Month throughout the County of San Diego. Supervisor Joel Anderson presented a proclamation declaring June 30, 2023, to be Debra Rosen Day throughout the County of San Diego. Supervisor Jim Desmond presented a proclamation declaring May 23, 2023, to be San Marcos Prevention Coalition Day throughout the County of San Diego. F. Non-Agenda Public Communication: Opportunity for members of the public to speak to the Board on any subject matter within the Board’s jurisdiction but not an item on today’s agenda. G. Approval of the Statement of Proceedings/Minutes for the Regular meeting of May 2, 2023 and the Special meeting of May 11, 2023. 1TUESDAY, MAY 23, 2023

ACTION: ON MOTION of Supervisor Desmond, seconded by Supervisor Anderson, the Board of Supervisors approved the Statement of Proceedings/Minutes for the Regular Board of Supervisors meeting of May 2, 2023 and the Special meeting of May 11, 2023. Vargas, Anderson, Lawson-Remer, DesmondAYES: H. Consent Calendar I. Discussion Items J. Board Member Committee Updates. This is an opportunity for Members of the Board to provide informational updates on their committee assignments. No action may be taken. NOTICE: THE BOARD OF SUPERVISORS MAY TAKE ANY ACTION WITH RESPECT TO THE ITEMS INCLUDED ON THIS AGENDA. RECOMMENDATIONS MADE BY COUNTY STAFF DO NOT LIMIT ACTIONS THAT THE BOARD OF SUPERVISORS MAY TAKE. MEMBERS OF THE PUBLIC SHOULD NOT RELY UPON THE RECOMMENDATIONS IN THE BOARD LETTER AS DETERMINATIVE OF THE ACTION THE BOARD OF SUPERVISORS MAY TAKE ON A PARTICULAR MATTER. Board of Supervisors' Agenda Items Category # Subject Public Safety 1. SECOND CONSIDERATION AND ADOPTION OF ORDINANCE: NOTICED PUBLIC HEARING: FIRE MITIGATION FEE PROGRAM - ADOPTION OF NEXUS STUDY AND ORDINANCE REPEALING AND REENACTING THE SAN DIEGO COUNTY FIRE MITIGATION FEE ORDINANCE AND CEQA EXEMPTION (5/2/2023 - FIRST READING; 5/23/2023 - SECOND READING UNLESS ORDINANCE IS MODIFIED ON SECOND READING) 2. ADMINISTRATIVE ITEM: SECOND CONSIDERATION AND ADOPTION OF ORDINANCE: NOTICE OF PUBLIC HEARING: AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY CODE OF ADMINISTRATIVE ORDINANCES, RELATING TO SAN DIEGO COUNTY EMERGENCY MEDICAL SERVICES FEES (5/02/23 - FIRST READING; 5/23/23 - SECOND READING UNLESS ORDINANCE IS MODIFIED ON SECOND READING) [FUNDING SOURCE: FEES PAID BY CUSTOMERS] 2TUESDAY, MAY 23, 2023

3. ADMINISTRATIVE ITEM: SECOND CONSIDERATION AND ADOPTION OF ORDINANCE: NOTICED PUBLIC HEARING: COST RECOVERY PROPOSAL TO AMEND ARTICLE XX OF THE SAN DIEGO COUNTY CODE OF ADMINISTRATIVE ORDINANCES, SECTION 364.8 RELATING TO FEES CHARGED BY THE DEPARTMENT OF ANIMAL SERVICES EFFECTIVE FISCAL YEAR 2023-24 (5/2/2023 - FIRST READING; 5/23/2023 - SECOND READING UNLESS ORDINANCE IS MODIFIED ON SECOND READING) Health and Human Services 4. ADMINISTRATIVE ITEM: SECOND CONSIDERATION AND ADOPTION OF ORDINANCE: NOTICED PUBLIC HEARING: APPROVE AN ORDINANCE AMENDING ARTICLE XV-B OF THE SAN DIEGO COUNTY ADMINISTRATIVE CODE RELATING TO HEALTH AND HUMAN SERVICES CHARGES AND FEES 5. AUTHORIZE ACCEPTANCE OF INTEGRATED HIV SURVEILLANCE AND PREVENTION FUNDING FROM THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH [FUNDING SOURCE: CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, OFFICE OF AIDS INTEGRATED HIV SURVEILLANCE AND PREVENTION FUNDING FOR HEALTH DEPARTMENTS AND HEALTH REALIGNMENT; EXISTING HEALTH REALIGNMENT ALLOCATED FOR THIS PROGRAM] 6. RECEIVE THE SAN DIEGO ADVANCING AND INNOVATING MEDI-CAL ROADMAP AND AUTHORIZE AN INTERGOVERNMENTAL TRANSFER AGREEMENT FOR BEHAVIORAL HEALTH SERVICES [FUNDING SOURCE: LOCAL FUNDS, INCLUDING REALIGNMENT, MENTAL HEALTH SERVICES ACT AND EXISTING GENERAL PURPOSE REVENUE] Financial and General Government 7. COMMUNITY ENHANCEMENT GRANTS, NEIGHBORHOOD REINVESTMENT PROGRAM GRANTS AND CEQA EXEMPTION (DISTRICT: 5) [FUNDING SOURCE: TRANSIENT OCCUPANCY TAX REVENUES AND GENERAL PURPOSE REVENUE] 8. COMMUNITY ENHANCEMENT, NEIGHBORHOOD REINVESTMENT PROGRAM GRANTS AND CEQA EXEMPTIONS (DISTRICT: 1) [FUNDING SOURCE: AMERICAN RESCUE PLAN ACT, TRANSIENT OCCUPANCY TAX REVENUE, AND GENERAL PURPOSE REVENUE] 9. COMMUNITY ENHANCEMENT PROGRAM, NEIGHBORHOOD REINVESTMENT PROGRAM GRANTS AND CEQA EXEMPTIONS (DISTRICT: 2) [FUNDING SOURCE: TRANSIENT OCCUPANCY TAX AND GENERAL PURPOSE REVENUE] 3TUESDAY, MAY 23, 2023

10. AMENDMENTS TO THE COMPENSATION ORDINANCE RELATING TO THE RATIFIED TENTATIVE AGREEMENT FOR THE EMPLOYEE BARGAINING UNITS - DI AND DM REPRESENTED BY THE DISTRICT ATTORNEY INVESTIGATORS ASSOCIATION AND OTHER COMPENSATION ORDINANCE CHANGES (5/23/2023 - First Reading; 6/13/23 - Second Reading, unless the ordinance is modified on second reading) 11. AMENDMENTS TO THE COMPENSATION ORDINANCE RELATING TO A TENTATIVE AGREEMENT PENDING RATIFICATION FOR THE EMPLOYEE BARGAINING UNITS - DS AND SM REPRESENTED BY THE DEPUTY SHERIFFS’ ASSOCIATION OF SAN DIEGO COUNTY (5/23/2023 - First Reading; 6/13/23 - Second Reading, unless the ordinance is modified on second reading) 12. GENERAL SERVICES - CONTINUATION OF EMERGENCY REPAIRS AT THE COUNTY ADMINISTRATION CENTER [FUNDING SOURCE: CHARGES TO CLIENT DEPARTMENTS] (4 VOTES) 13. GENERAL SERVICES - APPROVAL OF NEW LEASE AGREEMENT FOR THE PUBLIC DEFENDER, 124 W. MAIN STREET, EL CAJON, AND NOTICE OF EXEMPTION [FUNDING SOURCE: EXISTING GENERAL PURPOSE REVENUE] 14. ADMINISTRATIVE ITEM: SECOND CONSIDERATION AND ADOPTION OF ORDINANCE: NOTICED PUBLIC HEARING: AN ORDINANCE TO AMEND SECTIONS 86.7, 86.8, 86.9, AND 86.10 OF THE SAN DIEGO COUNTY CODE OF ADMINISTRATIVE ORDINANCES RELATING TO FEES FOR SERVICES BY THE RECORDER AND COUNTY CLERK AND TO ADJUST RECORDER SHARE OF ADMINISTRATIVE COSTS FOR THE REAL ESTATE FRAUD FEE (05/02/2023 - first reading; 05/23/2023 - second reading, unless ordinance is modified on second reading) [FUNDING SOURCE: FEES PAID BY CUSTOMERS] 15. ADMINISTRATIVE ITEM: SECOND CONSIDERATION AND ADOPTION OF ORDINANCE: NOTICED PUBLIC HEARING: ORDINANCE AMENDING SECTION 439.2 OF THE COUNTY OF SAN DIEGO ADMINISTRATIVE CODE RELATING TO THE REGISTRAR OF VOTERS FEES FOR RECORDS AND SERVICES (5/02/2023 - first reading; 5/23/2023 - second reading unless ordinance is modified on second reading) [FUNDING SOURCE: FEES PAID BY CUSTOMERS; FEES PAID BY CANDIDATES RUNNING FOR OFFICE WHO WISH TO EXERCISE THE OPTION OF HAVING A CANDIDATE STATEMENT PRINTED IN THE VOTER INFORMATION GUIDE PER ELECTIONS CODE 13307] Appointments 16. APPOINTMENTS: VARIOUS Communications Received 17. COMMUNICATIONS RECEIVED 4TUESDAY, MAY 23, 2023

Public Safety 18. COMMUNITY PARAMEDICINE, COMMUNITY HEALTH AND INJURY PREVENTION, AND TRIAGE TO ALTERNATE DESTINATION PROGRAM UPDATE 19. REIMAGINING AMBULANCE TRANSPORTATION SERVICES IN THE COUNTY’S RURAL COMMUNITIES 20. FINAL REPORT AND RECOMMENDATIONS: DATA-DRIVEN APPROACH TO PROTECTING PUBLIC SAFETY, IMPROVING AND EXPANDING REHABILITATIVE TREATMENT AND SERVICES, AND ADVANCING EQUITY THROUGH ALTERNATIVES TO INCARCERATION [FUNDING SOURCES: LOCAL REVENUE FUND 2011, COMMUNITY CORRECTIONS SUBACCOUNT; STATE FUNDING THROUGH THE JUDICIAL COUNCIL OF CALIFORNIA FOR PRETRIAL SERVICES] Health and Human Services 21. RECEIVE UPDATE ON SUPPORTING CARE COORDINATION FOR JUSTICE-INVOLVED INDIVIDUALS: DATA GOVERNANCE AND INTEGRATION AND AMEND REPORT BACK SCHEDULE 22. PREVENTING SUICIDE IN SAN DIEGO COUNTY 23. RECEIVE AN UPDATE ON ESTABLISHING THE BEHAVIORAL HEALTH IMPACT FUND 2.0 24. APPROVE ACTIONS RELATED TO THE DEVELOPMENT OF A HOMELESSNESS PREVENTION PROGRAM 25. AUTHORIZE MEMORANDUM OF AGREEMENT BETWEEN THE COUNTY OF SAN DIEGO AND THE SAN DIEGO HOUSING COMMISSION FOR COLLABORATIVE EFFORTS TO ADDRESS THE HOUSING SHORTAGE - HOMEKEY ROUND 3 AND RESERVE FUNDS FOR UP TO FOUR PARTNERSHIP DEVELOPMENTS [FUNDING SOURCE: AMERICAN RESCUE PLAN ACT (ARPA) AND BEHAVIORAL HEALTH IMPACT FUND FUNDING; REALIGNMENT AND FEDERAL SHORT-DOYLE MEDI-CAL] 26. RECEIVE UPDATE ON OPIOID SETTLEMENT FRAMEWORK IMPLEMENTATION AND HARM REDUCTION MEDIA CAMPAIGNS INCLUDING ILLICIT FENTANYL AWARENESS FOR YOUTH; AUTHORIZE COMPETITIVE SOLICITATIONS FOR PUBLIC MESSAGING, OUTREACH, AND EDUCATION CAMPAIGNS; AND AUTHORIZE UPDATES TO THE OPIOID SETTLEMENT FRAMEWORK [FUNDING SOURCES: OPIOID SETTLEMENT FUNDS, MENTAL HEALTH SERVICES ACT, COMMUNITY ASSISTANCE, RECOVERY & EMPOWERMENT ACT START-UP/PLANNING FUNDS, AND CRISIS CARE MOBILE UNIT GRANT FUNDS] 5TUESDAY, MAY 23, 2023

27. APPROVE AN ORDINANCE AMENDING AND REPEALING PROVISIONS IN THE SAN DIEGO COUNTY ADMINISTRATIVE CODE RELATED TO THE CHILD AND FAMILY STRENGTHENING ADVISORY BOARD OF SAN DIEGO COUNTY, THE POLINSKY CHILDREN’S CENTER ADVISORY BOARD, AND THE SAN DIEGO COUNTY FOSTER CARE SERVICES COMMITTEE (MAY 23, 2023 - FIRST READING; JUNE 13, 2023 - SECOND READING UNLESS ORDINANCE IS MODIFIED ON SECOND READING) Land Use and Environment 28. AMEND AT&T WIFI SERVICES AND ACCEPT AND APPROPRIATE GRANT FUNDS FOR EMERGENCY CONNECTIVITY FUND [FUNDING SOURCE: A GRANT FROM THE FCC'S EMERGENCY CONNECTIVITY FUN] (4 VOTES) Financial and General Government 29. CONTINUED ITEM FROM MAY 2, 2023 (20): RESOLUTION TO CALL A SPECIAL ELECTION TO FILL THE VACANCY OF THE FOURTH DISTRICT COUNTY OF SAN DIEGO BOARD OF SUPERVISORS [FUNDING SOURCE: REDIRECTION OF GENERAL PURPOSE REVENUE INCLUDED IN THE RECOMMENDED OPERATIONAL PLAN FOR BOARD SECURITY AND UNANTICIPATED EXPENDITURES] 30. ENDORSE THE CALIFORNIA STATE ASSOCIATION OF COUNTIES (CSAC), AT HOME PLAN TO REDUCE HOMELESSNESS 31. PROTECTING CHILDREN FROM CANNABIS POISONING 32. ADOPTING A RESOLUTION SUPPORTING THE ADDITION OF UNINCORPORATED AREA REPRESENTATION TO THE SAN DIEGO ASSOCIATION OF GOVERNMENTS BOARD OF DIRECTORS 33. ENHANCING THE EFFICIENCY OF THE NEIGHBORHOOD REINVESTMENT PROGRAM (NRP) AND COMMUNITY ENHANCEMENT PROGRAM (CE) GRANT APPROVAL PROCESS 34. ADOPT AN ORDINANCE TO ADD SECTION 125.25 TO ARTICLE VIII OF THE SAN DIEGO COUNTY ADMINISTRATIVE CODE TO ESTABLISH THE CREATION OF A WORKPLACE JUSTICE FUND (5/23/23 - First Reading; 6/13/23- Second Reading unless ordinance is modified on second reading) [FUNDING SOURCE: AVAILABLE GENERAL PURPOSE REVENUE CURRENTLY BUDGETED IN THE CHIEF ADMINISTRATIVE OFFICE] 6TUESDAY, MAY 23, 2023

35. FISCAL YEAR 2022-23 THIRD QUARTER OPERATIONAL PLAN STATUS REPORT AND BUDGET ADJUSTMENTS [FUNDING SOURCE: OPERATING TRANSFERS IN FROM SAN DIEGO COUNTY FIRE PROTECTION DISTRICT; OPERATING TRANSFERS IN FROM THE GENERAL FUND, AVAILABLE PUBLIC LIABILITY INTERNAL SERVICE FUND (ISF) FUND BALANCE, EPIDEMIOLOGY AND LABORATORY CAPACITY ENHANCING DETECTION EXPANSION GRANT, STATE WATER RESOURCES CONTROL BOARD, REVENUE FROM CLIENT DEPARTMENTS, AVAILABLE PRIOR YEAR PARK LAND DEDICATION ORDINANCE FUND BALANCE, OPERATING TRANSFERS IN FROM PARKLAND DEDICATION FUND, FEDERAL AVIATION ADMINISTRATION,ADVANCED MOLECULAR DETENTION PROGRAM GRANT, OPERATING TRANSFERS IN FROM VARIOUS NON-GENERAL FUND, MISCELLANEOUS REVENUES AND AVAILABLE PRIOR YEAR AIRPORT ENTERPRISE FUND FUND BALANCE (4 VOTES) 36. APPROVAL OF THE CONFLICT OF INTEREST CODES FOR GROSSMONT UNION HIGH SCHOOL DISTRICT, HELIX CHARTER HIGH SCHOOL, SAN DIEGO METROPOLITAN TRANSIT DISTRICT (MTS) AND UPPER SAN LUIS REY GROUNDWATER MANAGEMENT AUTHORITY Closed Session 37. CLOSED SESSION Public Communication 38. PUBLIC COMMUNICATION 7TUESDAY, MAY 23, 2023

1. NOTICED PUBLIC HEARING: FIRE MITIGATION FEE PROGRAM - ADOPTION OF NEXUS STUDY AND ORDINANCE REPEALING AND REENACTING THE SAN DIEGO COUNTY FIRE MITIGATION FEE ORDINANCE AND CEQA EXEMPTION (5/2/2023 - FIRST READING; 5/23/2023 - SECOND READING UNLESS ORDINANCE IS MODIFIED ON SECOND READING) (DISTRICTS: ALL) SUBJECT: OVERVIEW On May 2, 2023 (21), the Board of Supervisors took action to further consider and adopt the Ordinance on May 23, 2023. The unincorporated areas of San Diego County experienced significant growth in recent decades, increasing the demand on fire services for the residents of new developments. As a result, the Board of Supervisors of San Diego County (Board) adopted Ordinance No. 7066 (N.S.) on December 11, 1985, to establish the Fire Mitigation Fee (FMF) Program as a mechanism for collecting and allocating funds to fire agencies in unincorporated areas of San Diego. Through the FMF Program, the County of San Diego (County) collects a fee from applicants when building permits are issued and distributes the funds to the 13 participating fire agencies on a quarterly basis. These funds allow fire agencies, lacking legal authority to directly impose and collect mitigation fees, to provide capital facilities and equipment for fire suppression or emergency medical services, including station construction, station expansion or improvements, and fire or emergency medical apparatus to serve new developments in their districts. Since the FMF program was initially approved, there have been changes to State law, County strategic initiatives, industry standards, and community needs that impact the provision of fire protection and emergency medical services throughout the unincorporated area. Over the past year, staff have coordinated with a consultant, participating agencies, and the public to determine the appropriate level of fees for the program. This coordination culminated in a “Nexus Study” which informed the recommendations for the Fire Mitigation Fee. The actions in today’s request will adopt the findings of the study and replace the existing County FMF Ordinance with an updated version. The ordinance will be introduced on May 2, 2023 and, if approved, will be scheduled for adoption on May 23, 2023. If the proposed ordinance is altered on May 23, 2023, then a subsequent meeting date will be selected for the ordinance's adoption. These actions will allow for the continued use of mitigation fees to fund fire service expenditures related to new development within the boundaries of participating fire agencies in the unincorporated areas of San Diego County. Lastly, a waiver of Board Policy B-29 is requested because County Fire staff and consultant costs to administer the Fire Mitigation Fee Program will not be recovered by program fees. RECOMMENDATION(S) CHIEF ADMINISTRATIVE OFFICER 1. Find that the adoption of the proposed ordinance is exempt from the California Environmental Quality Act (CEQA), as specified under Section 15273(a) of the CEQA Guidelines. 1TUESDAY, MAY 23, 2023

2. Consider and adopt AN ORDINANCE REPEALING AND REENACTING SECTIONS 810.301 THROUGH 810.315 OF THE SAN DIEGO COUNTY CODE OF REGULATORY ORDINANCES RELATED TO THE SAN DIEGO COUNTY FIRE MITIGATION FEE PROGRAM (second reading, unless ordinance is modified on second reading). EQUITY IMPACT STATEMENT The County of San Diego’s Fire Mitigation Fee (FMF) Program was established as a mechanism for collecting and allocating funds to the thirteen local fire agencies in unincorporated areas of San Diego County. These funds allow fire agencies, who lack legal authority to directly impose and collect development impact fees, to provide capital facilities and equipment to serve new developments in their districts. The County’s ongoing administration of the development impact fee program requires compliance with the updates in AB 602 and the Mitigation Fee Act, including the adoption of a Nexus Study and Ordinance. These actions will ensure the continuation of the program and support the availability of emergency medical services and fire response, supporting safety for unincorporated communities. SUSTAINABILITY IMPACT STATEMENT The proposed actions in today’s request support the County of San Diego’s (County) Sustainability goals to provide just and equitable access to services by helping to ensure fire protection agencies in the unincorporated areas of the County can maintain the level of fire protection and emergency medical services to their communities and have the capability to respond and recover to immediate needs for individuals, families, and the region. FISCAL IMPACT There is no fiscal impact associated with these recommendations. Today’s recommendations support the continuation of the County’s Fire Mitigation Fee (FMF) Program for the collection of a developmental impact fee on behalf of local fire agencies in unincorporated areas of San Diego County. There will be no change in net General Fund cost and no additional staff years. The FMF Program does not recover costs associated with the administrative support provided by consultants and San Diego County Fire (County Fire) estimated at $219,268 and will be funded with property tax and existing General Purpose revenue. BUSINESS IMPACT STATEMENT Adoption of the updated Fire Mitigation Fee (FMF) Program Ordinance will continue to provide collect and allocate funds to fire agencies in unincorporated areas of San Diego County for the provision of capital facilities and equipment to serve new development. ACTION: ON MOTION of Supervisor Desmond, seconded by Supervisor Lawson-Remer, the Board of Supervisors closed the Hearing and took action as recommended, on Consent, adopting Ordinance No. 10841(N.S.), entitled: AN ORDINANCE REPEALING AND REENACTING SECTIONS 810.301 THROUGH 810.315 OF THE SAN DIEGO COUNTY CODE OF REGULATORY ORDINANCES RELATED TO THE SAN DIEGO COUNTY FIRE MITIGATION FEE PROGRAM. Vargas, Anderson, Lawson-Remer, DesmondAYES: 2TUESDAY, MAY 23, 2023

2. ADMINISTRATIVE ITEM: SECOND CONSIDERATION AND ADOPTION OF ORDINANCE: NOTICE OF PUBLIC HEARING: AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY CODE OF ADMINISTRATIVE ORDINANCES, RELATING TO SAN DIEGO COUNTY EMERGENCY MEDICAL SERVICES FEES (5/02/23 - FIRST READING; 5/23/23 - SECOND READING UNLESS ORDINANCE IS MODIFIED ON SECOND READING) (DISTRICTS: ALL) SUBJECT: OVERVIEW On May 2, 2023 (22), the Board of Supervisors took action to further consider and adopt the Ordinance on May 23, 2023. Today’s action requests that the San Diego County Board of Supervisors (Board) approve amendments to Article XX of the San Diego County Administrative Code and waive Board Policy B-29, Fees, Grants, and Revenue Contracts - Department responsibility for full cost recovery, related to fees charged for services by the County of San Diego (County) Emergency Medical Services Office (EMS). The Board last approved revisions to EMS’s fees on April 5, 2022 (15). By regularly reviewing costs and fees, departments can recuperate costs in a systematic manner, ensure all fees are fair and equitable, and enable stakeholders to plan for fee increases. In accordance with Board Policy B-29, County EMS recently reviewed eight fees and associated costs, and proposes adjustments to three of those fees during Fiscal Year 2023-24, including three fee increases. Five fees remain unchanged. Attachment A is a summary comparison of current and proposed fees. The Auditor and Controller has reviewed and approved the supporting documentation and methodology for the proposed fee adjustments. Today’s request includes two steps. The ordinance will be introduced on May 2, 2023, and, if approved, it will be scheduled for adoption on May 23, 2023. If the proposed ordinance is altered on May 23, 2023, then on that date a subsequent meeting date will be selected for the ordinance’s adoption. In addition, today’s recommendations request the waiving of Board Policy B-29, due to recent labor negotiations and the timing of the current fee package as Year 3 out of three years of a phased fee increase. RECOMMENDATION(S) CHIEF ADMINISTRATIVE OFFICER Consider and adopt (unless ordinance is modified on second reading): AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY CODE OF ADMINISTRATIVE ORDINANCES, RELATING TO SAN DIEGO COUNTY EMERGENCY MEDICAL SERVICES FEES. EQUITY IMPACT STATEMENT Services and oversight provided by the San Diego County Emergency Medical Services Office (EMS) is supported through a fee for individuals and agencies for the credentialing of prehospital personnel (Emergency Medical Technicians, Paramedics and Mobile Intensive Care Nurses), ambulance permitting, and inspections for private agencies, approval for continuing education 3TUESDAY, MAY 23, 2023

providers, and the hospital specialty care designations for base station hospitals and trauma centers. The EMS office provides this detailed level of oversight ensuring the San Diego community receives medical care by appropriately licensed and verified personnel, properly permitted transport vehicles, and appropriately designated hospital facilities. SUSTAINABILITY IMPACT STATEMENT Today’s actions are supportive of the County of San Diego’s (County) Sustainability goals to provide just and equitable access to County services by ensuring all EMS responders are appropriately credentialed in a comprehensive and timely manner. This allows for general purpose revenue to be available for other programs, ensuring the long-term solvency and fiscal stability of these and other County services. The proposed actions further ensure just and equitable access to goods and services through reasonable fee amounts that are levied only on those services necessary to ensure such cost recovery. FISCAL IMPACT There is no fiscal impact in the current fiscal year. If approved, the three revised EMS fees will be effective July 1, 2023. Funds will be included in the Fiscal Year 2023-25 CAO Recommended Operational Plan for County Fire. The funding source is fees paid by customers. Fees do not cover all the operating costs. These costs will be supported by County Fire’s existing General Purpose Revenue. There is no change in net General Fund cost and no additional staff years. BUSINESS IMPACT STATEMENT N/A ACTION: ON MOTION of Supervisor Desmond, seconded by Supervisor Lawson-Remer, the Board of Supervisors closed the Hearing and took action as recommended, on Consent, adopting Ordinance No. 10842(N.S.), entitled: AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY CODE OF ADMINISTRATIVE ORDINANCES, RELATING TO EMERGENCY MEDICAL SERVICES FEES. Vargas, Anderson, Lawson-Remer, DesmondAYES: 3. ADMINISTRATIVE ITEM: SECOND CONSIDERATION AND ADOPTION OF ORDINANCE: NOTICED PUBLIC HEARING: COST RECOVERY PROPOSAL TO AMEND ARTICLE XX OF THE SAN DIEGO COUNTY CODE OF ADMINISTRATIVE ORDINANCES, SECTION 364.8 RELATING TO FEES CHARGED BY THE DEPARTMENT OF ANIMAL SERVICES EFFECTIVE FISCAL YEAR 2023-24 (5/2/2023 - FIRST READING; 5/23/2023 - SECOND READING UNLESS ORDINANCE IS MODIFIED ON SECOND READING) (DISTRICTS: ALL) SUBJECT: OVERVIEW On May 2, 2023 (23), the Board of Supervisors took action to further consider and adopt the Ordinance on May 23, 2023. 4TUESDAY, MAY 23, 2023

The Department of Animal Services (DAS) protects the public from dangerous animals, protects animals from abuse and neglect, and saves the lives of thousands of unwanted, abandoned or lost pets each year. Historically, approximately 6,500 animals from the unincorporated area of the county enter DAS’ two shelters annually. DAS provides animal-related law enforcement, sheltering, medical and pet adoption services to the unincorporated area of the county. For some of the services it provides, DAS charges fees. Today’s action requests that the San Diego County Board of Supervisors (Board) approve amendments to Article XX Fees and Charges. The Board of Supervisors’ (Board) Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, directs departments to recover the full cost of services provided to agencies or individuals. The Board has historically waived Policy B-29 as it applies to dog license and animal services fees, based on the recognition that increasing fees to full cost recovery would deter some residents from licensing their dogs and from adoption or claiming animals. This would likely contribute to unnecessary euthanasia of sheltered animals and impair DAS’ ability to maintain the County goal of zero euthanasia of healthy and treatable animals. To determine the proposed changes, DAS calculated the costs of staff salary and benefits and services and supplies carrying out the services tied to each of the department’s fees, to determine the full cost recovery fee amount. The resulting full cost recovery fees are then compared to fees charged by other regional animal services agencies to ensure that DAS’ proposed fees are comparable to the regional average. DAS also analyzed local economic and animal services needs data to ensure that the proposed fees are attainable to residents of the department’s service area. The last DAS cost recovery package approved by the Board was June 4, 2019 (12). Since that time, fees charged by DAS have not kept pace with the steady increase in operational costs for shelter services and medical care, consequently, the County has experienced net cost increases. Today’s request increases 39 of 56 existing fees, decreases one, and adds seven fees to DAS’s fees schedule for a total of 63 fees, to recover a greater share of the operational costs for the services provided to the residents of the County’s unincorporated area. According to surveys completed by DAS, the proposed fees are comparable to fees charged by other regional jurisdictions. If the proposed fees are approved, DAS does not anticipate a decrease in the number of dogs licensed or the number of animals claimed from County shelters, nor any adverse impact to adoption rates. If approved, DAS will begin collecting fee increases and new fees on July 1, 2023. Today’s request includes two steps. The ordinance is being introduced today, May 2, 2023, and if approved, will be scheduled for adoption on May 23, 2023. If the proposed ordinance is altered on May 23, 2023, then on that date a subsequent meeting date will be selected for the ordinance’s adoption. RECOMMENDATION(S) CHIEF ADMINISTRATIVE OFFICER Consider and adopt (unless ordinance is modified on second reading): AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY CODE OF ADMINISTRATIVE ORDINANCES, SECTION 364.8 RELATING TO FEES CHARGED BY THE DEPARTMENT OF ANIMAL SERVICES EQUITY IMPACT STATEMENT The proposed actions would amend some of the Department of Animal Services (DAS) fees for 5TUESDAY, MAY 23, 2023

services that are provided to cover more of the full cost of those services in alignment with current San Diego County Board of Supervisors’ standards and to reflect applicable laws and regulations. By recovering more of the cost of services through small adjustments in its fee schedule, the DAS ensures that sufficient resources remain to provide services to individuals experiencing financial hardship and those in historically underserved and underrepresented communities that require animal services. To develop the fees, an analysis was conducted to examine the tasks and functions performed, including direct and indirect costs of performing those tasks, as well as a regional comparison with similar agencies. The calculation for the fee increases were reviewed to ensure that the services are not cost prohibitive for customers. SUSTAINABILITY IMPACT STATEMENT The proposed adjustments to the Department of Animal Services (DAS) fee structure are based on available expenditure and revenue data, live time studies, and regional comparisons. The fee changes are a result of the cumulative increase of cost drivers, such as salaries and benefits, services and supplies, and associated indirect costs of DAS. The proposed adjustments are appropriate as they support the County of San Diego’s Strategic Initiative of Sustainability to align the County’s available resources with services while maintaining fiscal stability and ensuring long-term solvency. FISCAL IMPACT There is no fiscal impact in the current fiscal year. If approved, additional funds from the revised fees, estimated at approximately $352,000, will be included in the Fiscal Years 2023-25 CAO Recommended Operational Plan for the Department of Animal Services (DAS). The proposed fees will not achieve full cost recovery for the services provided. If approved, the estimated amount of the requested B-29 waiver is approximately $1,084,000 in Fiscal Year 2023-24 and will be absorbed with existing General Purpose Revenue budgeted in DAS. Future years costs not covered by the revised fees will be absorbed with existing General Purposed Revenue and included in future Operational Plans. There will be no change in net General Fund costs and no additional staff years. BUSINESS IMPACT STATEMENT N/A ACTION: ON MOTION of Supervisor Desmond, seconded by Supervisor Lawson-Remer, the Board of Supervisors closed the Hearing and took action as recommended, on Consent, adopting Ordinance No. 10843(N.S.), entitled: AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY ADMINISTRATIVE ORDINANCE CODE, SECTION 364.8 RELATING TO FEES CHARGED BY THE DEPARTMENT OF ANIMAL SERVICES. Vargas, Anderson, Lawson-Remer, DesmondAYES: 4. ADMINISTRATIVE ITEM: SECOND CONSIDERATION AND ADOPTION OF ORDINANCE: NOTICED PUBLIC HEARING: APPROVE AN ORDINANCE AMENDING ARTICLE XV-B OF THE SAN DIEGO COUNTY ADMINISTRATIVE CODE RELATING TO HEALTH AND HUMAN SUBJECT: 6TUESDAY, MAY 23, 2023

SERVICES CHARGES AND FEES (DISTRICTS: ALL) OVERVIEW On May 2, 2023 (24), the Board of Supervisors took action to further consider and adopt the Ordinance on May 23, 2023. Today’s action requests that the San Diego County Board of Supervisors (Board) approve amendments to Article XV-B of the San Diego County Administrative Code related to fees charged for services by the County of San Diego (County) Health and Human Services Agency (HHSA), Public Health Services and Behavioral Health Services. The Board last approved revisions to HHSA’s fees and rates on May 24, 2022 (23). The proposed Ordinance represents a comprehensive package that seeks to support the cost of providing HHSA services, while maintaining fees that are fair and equitable for customers and the public. In accordance with Board Policy B-29 (Fees, Grants, and Revenue Contracts-Department Responsibility for Cost Recovery), HHSA recently conducted a review of their fees and rates, in order to ensure costs are fully recovered for services provided to agencies or individuals. A total of 85 HHSA fees and their associated costs were reviewed, resulting in proposed additions, adjustments, and determinations to maintain existing fees. The Auditor and Controller has reviewed and approved the supporting documentation and the methodology for establishing the fees in this proposal for Fiscal Year 2023-24. Today's request requires two steps: on May 2, 2023, it is requested that the Board consider an Ordinance amending sections of the San Diego County Administrative Code related to HHSA fees. If the Board takes the action as recommended, then on May 23, 2023, the proposed Ordinance will be brought back to the Board for consideration and adoption. If the proposed Ordinance is amended on May 23, 2023, then on that date a subsequent meeting will be selected for the ordinance’s adoption. This item supports the County’s vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by ensuring that the County has optimized its health and social services delivery system to ensure efficiency, integration and innovation while maintaining fiscal stability. RECOMMENDATION(S) CHIEF ADMINISTRATIVE OFFICER Consider and adopt (second reading): AN ORDINANCE AMENDING ARTICLE XV-B OF THE SAN DIEGO COUNTY ADMINISTRATIVE CODE RELATING TO HEALTH AND HUMAN SERVICES CHARGES AND FEES EQUITY IMPACT STATEMENT As part of standard practice, the County of San Diego (County) Health and Human Services Agency (HHSA) performs an annual review of fees and rates charged in order to ensure that charges do not exceed the County’s actual cost for the service provided. Additionally, HHSA reviews fees annually to ensure that costs are fully recovered for services provided to agencies or individuals, in alignment with current San Diego County Board of Supervisors standards and that 7TUESDAY, MAY 23, 2023

they are updated to reflect applicable laws and regulations. To develop the cost recovery proposal, HHSA performed an analysis of all services provided to customers to examine the tasks and functions performed, including the direct and indirect costs of performing those tasks in relation to the specific services. Criteria were established to determine a fair and equitable fee for direct services provided. The proposed Ordinance represents a comprehensive package that seeks to support the cost of providing HHSA services, while maintaining fees that are fair and equitable for customers and the public. Updates include County HHSA, Public Health Services, Public Health Laboratory (PHL) fees that are either tied to environmental testing, such as testing of drinking water or foodborne illness investigations, or clinical fees such as tests for communicable disease outbreaks, among others. Additionally, five existing fees for the Non-Diagnostic General Health Assessments are being added to the County Administrative Code Article XV-B, Section 244 to consolidate all PHL fees in the same Admin Code. Lastly, the proposed Ordinance includes a revision to a fee for the Edgemoor Skilled Nursing Facility to align with updated full cost recovery information. Today’s action would update fees for services provided by the County that help to promote health and safety and have an impact on the lives of Black, Indigenous, People of Color, women, people with disabilities, immigrants, youth, the LGBTQ+ community, and other underserved groups. SUSTAINABILITY IMPACT STATEMENT Today’s proposed actions support the County of San Diego’s (County) Sustainability Goal #2 to provide just and equitable access by aligning the County’s available resources with services to maintain fiscal stability and ensure long term solvency. FISCAL IMPACT Funds for this request are not included in the Fiscal Year 2023-24 CAO Recommended Operational Plan in the Health and Human Services Agency. If approved, this request will result in an estimated increase in revenue of $97,192 in Fiscal Year 2023-24. There is no change in net General Fund cost and no additional staff years. BUSINESS IMPACT STATEMENT N/A ACTION: ON MOTION of Supervisor Desmond, seconded by Supervisor Lawson-Remer, the Board of Supervisors closed the Hearing and took action as recommended, on Consent, adopting Ordinance No. 10844(N.S.), entitled: AN ORDINANCE AMENDING ARTICLE XV-B OF THE SAN DIEGO COUNTY ADMINISTRATIVE CODE, RELATING TO HEALTH AND HUMAN SERVICES CHARGES AND FEES. Vargas, Anderson, Lawson-Remer, DesmondAYES: 5. AUTHORIZE ACCEPTANCE OF INTEGRATED HIV SURVEILLANCESUBJECT: 8TUESDAY, MAY 23, 2023

AND PREVENTION FUNDING FROM THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH (DISTRICTS: ALL) OVERVIEW For over 25 years, the San Diego County Board of Supervisors (Board) has authorized grants and agreements with the California Department of Public Health (CDPH), Office of AIDS to provide a variety of HIV prevention services to reduce the transmission of HIV in San Diego County. As of December 31, 2022, there were approximately 15,000 people living with HIV in the county and an estimated 1,300 persons living with HIV who are unaware of their HIV status. In 2022, there were 469 new HIV diagnoses indicating that HIV continues to be a major public health concern in San Diego County. Today’s action requests the Board to waive Board Policy B-29, approve the acceptance of $1,685,980 in Integrated HIV Surveillance and Prevention funding for Health Departments from the CDPH, Office of AIDS for the period of January 1, 2023 to December 31, 2023. Authorization is further requested to apply for additional funding opportunities that would support testing, prevention, and care and treatment needs of individuals and families in San Diego County who are impacted by HIV. This item supports the County of San Diego’s (County) vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as the ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished through education, prevention, and intervention to interrupt transmission of disease in the region. This item also supports the County’s Getting to Zero initiative by planning and allocating resources dedicated to services for residents who are living with or vulnerable to HIV. RECOMMENDATION(S) CHIEF ADMINISTRATIVE OFFICER 1. Waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of revenue agreement applications and full-cost recovery of grants. 2. Authorize the acceptance of $1,685,980 in Integrated HIV Surveillance and Prevention funding for Health Departments grant funds from the California Department of Public Health, Office of AIDS for the period of January 1, 2023 to December 31, 2023, for HIV services related to prevention, and authorize the Clerk of the Board to execute all required grant documents, upon receipt, including any annual extensions, amendments or revisions that do not materially impact or alter the services or funding level. 3. Authorize the Agency Director, Health and Human Services Agency to apply for any additional funding opportunity announcements, if available, to address the prevention, testing, care and treatment needs of those impacted by HIV. EQUITY IMPACT STATEMENT Since the beginning of the epidemic, HIV has disproportionately impacted the most vulnerable 9TUESDAY, MAY 23, 2023

residents. Gay, bisexual, and other men who have sex with men, for instance, are currently estimated to comprise less than 2% (LGBTQ+ Identification Rises to 5.6% in Latest U.S. Estimate, gallup.com) of the adult population, and yet they comprise 62% of recent HIV diagnoses and 71% of persons living with HIV. Moreover, in San Diego County, like much of the rest of the United States, HIV has disproportionately impacted Black and Hispanic communities. Blacks comprise less than 5% of the county’s population but comprise 12% of recent HIV diagnoses. Hispanics comprise 34% of the population of the county yet comprise 48% of recent HIV diagnoses. Since HIV prevention services funding began in the mid-1990s, efforts have largely been focused on what are now the main strategies of the County of San Diego’s Getting to Zero initiative: test, treat, prevent, engage, and improve. In Fiscal Year 2021-22, 487 people enrolled in pre-exposure prophylaxis (PrEP) navigation, 398 completed a visit with a PrEP prescriber within 30 days, and 33 newly diagnosed and five previously diagnosed persons living with HIV were linked to or re-engaged in HIV medical care. Additionally, approximately 20,000 people are tested for HIV through these resources. Efforts are directed at populations disproportionately impacted by HIV, including Black and Hispanic gay and bisexual men and other men who have sex with men. Data of new diagnoses during the years 2017-2021 demonstrated that Blacks were diagnosed at a rate of 34.9 per 100,000 and Hispanics were diagnosed at a rate of 19.9 per 100,000. Comparatively, Whites had a rate of 8.2 per 100,000 and Asian/Pacific Islanders had a rate of 5.3 per 100,000. The success in reaching residents and communities most disproportionately impacted by HIV is due in large part to the HIV Planning Group, an official advisory board to the San Diego County Board of Supervisors that also has the legislative authority to allocate Ryan White Part A funding to respond to local needs as determined by review of epidemiologic data and extensive engagement to communities. SUSTAINABILITY IMPACT STATEMENT The proposed actions align with the County of San Diego’s Sustainability Goal #2 to provide just and equitable access and Sustainability Goal #4 to protect health and wellbeing. This will be done by increasing capacity and services aimed to prevent, identify, and treat HIV. Testing, identification, and treatment of HIV will improve the overall health of communities, reduce the demand of associated care services, while increasing effectiveness of care providers and lowering operating costs. FISCAL IMPACT Funds for this request are included in the Fiscal Year (FY) 2022-24 Operational Plan and in the FY 2023-24 CAO Recommended Operational Plan Change Letter in the Health and Human Services Agency. If approved, this request will result in estimated costs of $876,094 and revenue of $842,990 in FY 2022-23 and estimated costs of $876,094 and revenue of $842,990 in FY 2023-24. The funding source is the California Department of Public Health, Office of AIDS Integrated HIV Surveillance and Prevention funding for Health Departments and Health Realignment. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These costs are estimated at $66,208 for the term of this grant. The funding source for these costs will be existing Health Realignment allocated for this program. The public benefit for 10TUESDAY, MAY 23, 2023

providing these services far outweighs these costs. There will be no change in net General Fund costs and no additional staff years. BUSINESS IMPACT STATEMENT N/A ACTION: ON MOTION of Supervisor Desmond, seconded by Supervisor Lawson-Remer, the Board of Supervisors took action as recommended, on Consent. Vargas, Anderson, Lawson-Remer, DesmondAYES: 6. RECEIVE THE SAN DIEGO ADVANCING AND INNOVATING M E D I - C A L R O A D M A P A N D A U T H O R I Z E A N INTERGOVERNMENTAL TRANSFER AGREEMENT FOR BEHAVIORAL HEALTH SERVICES (DISTRICTS: ALL) SUBJECT: OVERVIEW On July 13, 2021 (14) the San Diego County Board of Supervisors (Board) committed to provide opportunities to achieve better health outcomes and reduce health disparities for vulnerable populations by supporting the County of San Diego’s (County) Wellness Delivery System. In alignment with this Board priority, the County mobilized planning and coordination to support implementation of California Advancing and Innovating Medi-Cal (CalAIM). CalAIM is the California Department of Health Care Services’ (DHCS) long-term commitment to improve the quality of life and health outcomes of Medi-Cal beneficiaries by implementing broad delivery system transformation including program and payment reforms across the Medi-Cal Program. Active participation in the CalAIM Medi-Cal delivery system transformation allows the County to facilitate the integration of primary health, behavioral health, and social services and to streamline service coordination for vulnerable San Diegans enrolled in Medi-Cal. The County Health and Human Services Agency, Medical Care Services San Diego Advancing and Innovating Medi-Cal (SDAIM) Unit was established in July 2022 to support local CalAIM implementation. The SDAIM Unit has developed an initial workplan (roadmap) to align County priorities with the CalAIM initiative and guide future planning and coordination of implementation activities. Specific to behavioral health, CalAIM will allow for consistent and seamless administration of Medi-Cal services by reducing complexity, increasing flexibility, improving outcomes, reducing health disparities, and driving behavioral delivery system transformation through policy improvements and payment reform that will shift from the existing cost-reimbursement system to a fee-based reimbursement system. This will involve transitioning existing and new County-operated and contracted behavioral health and Medi-Cal services from the current certified public expenditure-based reimbursement methodology to an Intergovernmental Transfer (IGT)-based reimbursement methodology for certain services. Today’s action requests the Board to receive the SDAIM Roadmap, authorize agreements and all necessary documents for submission and regulatory processing for CalAIM implementation, authorize the IGT agreement with DHCS for the CalAIM Behavioral Health Payment Reform implementation and transfer local funds to DHCS, amend behavioral health contracts funded by Medi-Cal Federal Financial Participation to reflect changes associated with CalAIM Behavioral 11TUESDAY, MAY 23, 2023

Health Payment Reform implementation, and authorize application for future funding opportunities to build capacity and infrastructure to ensure successful local implementation. This item supports the County’s vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the Live Well San Diego vision of healthy, safe, and thriving communities. This approach will ensure higher quality care and more equitable health outcomes by improving and integrating care for people with complex health and social needs. RECOMMENDATION(S) CHIEF ADMINISTRATIVE OFFICER 1. Receive the San Diego Advancing and Innovating Medi-Cal Roadmap. 2. Authorize the Agency Director, Health and Human Services Agency, or designee to execute agreements, certification forms, and all necessary documents for submittal and regulatory processing as required for California Advancing and Innovating Medi-Cal (CalAIM) implementation. 3. Authorize the Agency Director, Health and Human Services Agency (HHSA), or designee, to execute, upon receipt, the Intergovernmental Transfer (IGT) agreement with the Department of Health Care Services (DHCS) for CalAIM Behavioral Health Payment Reform implementation, and transfer local eligible funds to DHCS, as specified in the agreement, and authorize the Agency Director, HHSA, or designee, to execute, upon receipt, future updates or amendments to the agreement, as required, that do not materially impact or alter the services. 4. In accordance with Board Policy A-87, Competitive Procurement, and Administrative Code Section 401, authorize the Director, Department of Purchasing and Contracting, subject to successful negotiations and a determination of a fair and reasonable price, to amend behavioral health contracts funded by Medi-Cal Federal Financial Participation to reflect changes associated with CalAIM Behavioral Health Payment Reform implementation, subject to the availability of funds, and amend the contracts as required in order to reflect changes to services and funding allocations as a result of CalAIM, subject to the approval of the Agency Director, HHSA. 5. Authorize the Chief Administrative Officer or designee to apply for any additional funding opportunities to ensure successful CalAIM implementation in San Diego County. EQUITY IMPACT STATEMENT Historic inequities within the healthcare system and across broader social and economic factors have resulted in worse health outcomes among Black, indigenous, and people of color, including reduced life expectancy and increased risk for some chronic diseases and other morbidities. The COVID-19 pandemic further exacerbated disparities in health and healthcare, particularly for Black, Hispanic/Latino, and American Indian/Alaska Native and Pacific Islander populations. As a major source of healthcare coverage, Medi-Cal can help advance equity goals and reduce disparities by increasing access to health care, identifying new and innovative approaches to service delivery, and implementing changes to managed care, provider payments, and benefits. Medi-Cal is the main source of health insurance coverage for California’s low-income children, adults, and seniors and people with disabilities. Over one million people in San Diego County meet income eligibility requirements for Medi-Cal. People of all ages are enrolled in Medi-Cal for health care coverage: as of March 2023, those age 19 to 44 years old represent the largest 12TUESDAY, MAY 23, 2023

Medi-Cal population in San Diego County (38.3%), followed by children age 0 to 18 years old (32.3%), adults age 45 to 64 (20.4%), and adults age 65 and older (9.0%). Among individuals with a reported race/ethnicity, 37.5% were Hispanic, 17.3% were White, 6.9% were Asian and Pacific Islander, 5.0% were Black, and 0.4% were American Indian and Alaska Native; race/ethnicity was not reported for 33.0% of enrollees. As of March 2023, 1,062,906 individuals were enrolled in Medi-Cal in San Diego County, representing one-third of the county’s population and the second largest Medi-Cal population in the state. California Advancing and Innovating Medi-Cal (CalAIM) is the Department of Health Care Services’ framework to improve health equity by addressing social drivers of health and prioritizing prevention and whole person care beyond healthcare settings. To guide local CalAIM implementation efforts, community partners including County of San Diego (County) departments, managed care plans, health and social care providers, community organizations, consumer and community advocates were engaged in the development of the County’s San Diego Advancing and Innovating Medi-Cal (SDAIM) Roadmap. Community and stakeholder engagement took place between November 2022 and February 2023 and included focused input sessions, community listening sessions, and a presentation at a local conference. Input gathered from these efforts informed the development of the SDAIM Roadmap. SUSTAINABILITY IMPACT STATEMENT The proposed action supports several County of San Diego (County) sustainability goals and commitments that strengthen the resilience of the community, including community participation, ensuring equitable access to services, and affirming services meet health and social care needs which align, respectively, with the County’s Sustainability Goal #1 to engage the community in a meaningful way, Sustainability Goal #2 to provide just and equitable access to services, and Sustainability Goal #4 to protect the health and wellbeing of everyone in the region. This will be accomplished by funding a more efficient system that will improve care coordination and serve as an essential first step toward implementing added enhancements with long-lasting benefits. FISCAL IMPACT Recommendations 1, 2, and 5 There is no fiscal impact associated with today’s actions for Fiscal Year (FY) 2023-24. There may be future impacts based on recommendations. Any such recommendations would be brought to the San Diego County Board of Supervisors for consideration and approval. There is no change in net General Fund costs and no additional staff years. Recommendations 3-4 Funds for this request are included in the FY 2023-25 CAO Recommended Operational Plan Change Letter for the Health and Human Services Agency. If approved, the current behavioral health system impacted by the Intergovernmental Transfer (IGT) process will be approximately $500 million across existing Medi-Cal eligible services annually. The funding sources for the IGT are local funds, including Realignment, Mental Health Services Act and existing General Purpose Revenue. There will be no change in net General Fund costs and no additional staff years. 13TUESDAY, MAY 23, 2023

BUSINESS IMPACT STATEMENT N/A ACTION: ON MOTION of Supervisor Vargas, seconded by Supervisor Anderson, the Board of Supervisors took action as recommended. Vargas, Anderson, DesmondAYES: Lawson-RemerNOT PRESENT: 7. COMMUNITY ENHANCEMENT GRANTS, NEIGHBORHOOD REINVESTMENT PROGRAM GRANTS AND CEQA EXEMPTION (DISTRICT: 5) SUBJECT: OVERVIEW Community Enhancement and Neighborhood Reinvestment Program funding assists nonprofit organizations in providing essential services to citizens of San Diego County. Reinvesting taxpayer money in worthwhile organizations is a benefit to the citizens and communities of North County. RECOMMENDATION(S) SUPERVISOR JIM DESMOND 1. Allocate $44,955 from Community Enhancement budget (Org 12900) to the YMCA of San Diego County to promote safe recreation by providing funds for facility, instructor and lessons cost for swim safety lessons for children. 2. Allocate $18,000 from the Neighborhood Reinvestment Program budget (Org 15670) to the Department of Parks and Recreation (Org 52806) to aid in the purchase of swim starter platforms for the community of Valley Center. 3. Transfer appropriations of $18,000 from the Neighborhood Reinvestment Program budget (Org 15670) to the Department of Parks and Recreation (Org 52806) to aid in the purchase of swim starter platforms for the community of Valley Center. 4. Allocate $20,000 from Neighborhood Reinvestment Program budget (Org 15670) to Oceanside’s Finest Basketball Club to purchase shoot away basketball machines to support the free basketball program that teaches kids the fundamentals of the sport. 5. Allocate $4,641 from the Neighborhood Reinvestment Program budget (Org 15670) to The Rock Rose School for Creative Learning to help with renovation cost in converting the bathroom to meet ADA requirements located at 2135 Gum Tree Lane, Fallbrook, CA 92028. 6. Amend the grant agreement date of the 9/27/2022 (14) allocation of $35,000 from the 14TUESDAY, MAY 23, 2023

Neighborhood Reinvestment Program budget (Org 15670) to the Escondido Sunrise Rotary to begin on 5/18/22 and Authorize the Director, Office of Economic Develop and Government Affairs to amend the grant agreement accordingly. 7. Find that the grants serve a public purpose. 8. Authorize the Director, Office of Economic Development and Government Affairs to execute grant agreements with the organizations awarded grants establishing terms for receipt of the funds described above and to make minor amendments to the agreements that are consistent with the general purpose of the grants but do not increase the grants. 9. Find that the allocation to The Rock Rose School for Creative Leaning is exempt from review under the California Environmental Quality Act (CEQA) pursuant to Section 15301 of the CEQA Guidelines. EQUITY IMPACT STATEMENT These proposed allocations of funds are intended to improve the quality of life throughout the County by providing funds for nonprofits whose work addresses inequities by providing services to all with an emphasis on underserved communities. The organizations that were chosen work to promote a sense of belonging and utilize equity in their operations, outreach, and programs. SUSTAINABILITY IMPACT STATEMENT The proposed allocation of funds will contribute to the overall sustainability of the region by providing funding to organizations that align with the County of San Diego Sustainability Goals by engaging the community, provide just and equitable access, transition to a green and carbon-free economy, protect the health and wellbeing of the community members, protect water, ecosystems, habitats, biodiversity and/or reduce pollution and waste. FISCAL IMPACT Funds for this request are included in the Fiscal Year 2022-2023 Operational Plan for the Community Enhancement Program budget (Org 12900) and the Neighborhood Reinvestment Program (Org 15670). The fiscal impact of these recommendations is $44,955 from the Community Enhancement Program budget (Org 12900) and $42,641 from the Neighborhood Reinvestment Program budget (Org 15670) totaling $87,596. The funding sources are Transient Occupancy Tax Revenues and General Purpose Revenue. There will be no change in net General Fund cost and no additional staff years. BUSINESS IMPACT STATEMENT N/A ACTION: ON MOTION of Supervisor Desmond, seconded by Supervisor Lawson-Remer, the Board of Supervisors took action as recommended, on Consent. 15TUESDAY, MAY 23, 2023

Vargas, Anderson, Lawson-Remer, DesmondAYES: 8. COMMUNITY ENHANCEMENT, NEIGHBORHOOD REINVESTMENT PROGRAM GRANTS AND CEQA EXEMPTIONS (DISTRICT: 1) SUBJECT: OVERVIEW The County of San Diego is fortunate to have an opportunity to reinvest taxpayer money into our communities for the benefit of the public. This action will assist the County in meeting the needs of the community. RECOMMENDATION(S) CHAIR NORA VARGAS 1. Allocate $30,000 from the Community Enhancement American Rescue Plan Act (ARPA) budget (Org 12905) to Business for Good San Diego to support staff salaries and towards a conference event to celebrate change makers and businesses that make a difference in the community. Expenses for the conference include venue costs, emcee with DJ, tables and chairs, tablecloths, utensils, cups, photo booth, videographer, photographer, stage rental costs, audio visual rental costs, including marketing and advertising. Funding is necessary to address revenue shortfalls that occurred due to the closures of public spaces and attendance maximums caused by the COVID-19 pandemic. 2. Allocate $15,000 from the Community Enhancement American Rescue Plan Act (ARPA) budget (Org 12905) to Empowering Latino Futures to support with staff salaries to benefit the 25th Annual International Latino Book Awards and the Latino Book & Family Festival, both events which were financially impacted by the ongoing effects of the COVID-19 pandemic due to loss of participants and revenue. 3. Allocate $50,000 from the Community Enhancement American Rescue Plan Act (ARPA) budget (Org 12905) to Jacobs Center for Neighborhood Innovation to support with staff salaries for their economic development, marketing, and event staff. Funds will also support hosting a Community Health Resource Fair in Summer 2023. Due to ongoing issues associated with the COVID-19 pandemic, staff salaries and the ability to host larger-scale community events were impacted. Funding is necessary to address these impacts. 4. Allocate $15,000 from the Community Enhancement American Rescue Plan Act (ARPA) budget (Org 12905) to Sharia’s Closet to support employee salaries and development trainings for staff. Funding also includes costs towards rent and support towards their Bag of Hope program including purchasing emergency clothing and hygiene kits for those experiencing clothing insecurity. As a result of event cancellations and the curtailment of social gatherings during the COVID-19 pandemic, the organization experienced reduced revenue. This funding is necessary to address these impacts of the pandemic on the 16TUESDAY, MAY 23, 2023

organization. 5. Allocate $35,000 from the Community Enhancement American Rescue Plan Act (ARPA) budget (Org 12905) to Vanguard Culture to support the cost of hiring a consultant to develop and create a post-pandemic marketing plan to support the ENVZN23 art festival in Logan Heights. Funding will also include rental costs toward sound and lighting equipment,