DATE: May 9, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Subrecipient Agreement with Buddhist Tzu Chi Medical Foundation for Mobile Vision Services
RECOMMENDED ACTION(S):
TITLE
1. Make a finding that it is in the best interest of the County to suspend the competitive bidding process consistent with Administrative Policy No. 34 for unusual or extraordinary circumstances as Buddhist Tzu Chi Medical Foundation’s Tzu Chi Mobile Clinic is the only mobile vision services provider in the Central Valley that provides a professional eye exam and prescription eyewear in the same visit for children and adults; and
2. Approve and authorize the Chairman to execute a Subrecipient Agreement for use of American Rescue Plan Act-State Local Fiscal Recovery Funds, with Buddhist Tzu Chi Medical Foundation to provide professional eye exams and prescription eyewear in the County’s rural areas, effective May 1, 2023, not to exceed three consecutive years, which includes a two-year base contract and one optional one-year extension, total not to exceed $600,000; and
3. Authorize the Director of Public Health, or designee, to approve and execute written changes to object levels in the Subrecipient Agreement budget that do not exceed ten percent (10%) of the total maximum compensation payable to Buddhist Tzu Chi Medical Foundation, as stipulated in Section 15 of the Subrecipient Agreement.
REPORT
There is no additional Net County Cost associated with the recommended actions. On August 9, 2022, your Board approved the Department’s allocation of ARPA-SLFRF for the Rural Mobile Health - Medical Services program which is intended to take healthcare services to rural areas, address health disparities, extend health education, and transition rural residents to a local clinic if they do not have a primary care provider. Approval of the recommended actions will allocate available Coronavirus State and Local Fiscal Recovery Funds (SLFRF) from the Department’s Rural Mobile Health - Medical Services program to Buddhist Tzu Chi Medical Foundation’s Tzu Chi Mobile Clinic (Tzu Chi Mobile Clinic) to provide professional eye exams and prescription eyewear for children and adults in the County’s rural areas at no cost to the patients. The third recommended action will delegate limited authority to the Director of Public Health, or designee, to make changes to object levels in the Agreement budget that do not exceed ten percent (10%) of the total maximum compensation payable to Buddhist Tzu Chi Medical Foundation under the terms of the Agreement. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board elect not to approve the recommended actions, Tzu Chi Mobile Clinic will not be included in the County’s Rural Mobile Health - Medical Services program to provide the expanded vision health services to the vulnerable population in the County’s rural areas. Rural communities would continue to have limited access to proper professional vision services until an additional funding source is made available to support the services.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
The Department’s request to suspend the competitive bidding process consistent with Administrative Policy No. 34 is due to Tzu Chi Mobile Clinic’s unique ability to provide same day mobile vision services in the county. Tzu Chi Mobile Clinic is the only mobile vision services provider that offers the professional eye exams and prescription eyeglasses in the same visit. Furthermore, Tzu Chi Mobile Clinic does not have restrictions to patient eligibility that other mobile vision providers have, including income and insurance limits, which could limit the number of patients that could be served at the rural mobile clinics.
RETROACTIVE AGREEMENT:
The recommended agreement is retroactive to May 1, 2023. Approval signatures from Tzu Chi Mobile Clinic for the final recommended agreement was received on April 12, 2023. The time required to prepare the recommended agreement did not allow presentation to your Board at an earlier date.
FISCAL IMPACT:
There is no Net County Cost associated with the recommended actions. The agreement will be funded by the Department’s allocation of the American Rescue Plan Act - State Local Fiscal Recovery Funds (ARPA-SLRF) funding for the Rural Mobile Health - Medical Services. The maximum amount payable under the agreement with Tzu Chi Mobile Clinic is $600,000. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2022-23 Adopted Budget and will be included in subsequent budget requests.
DISCUSSION:
On August 9, 2022, your Board approved the Department’s allocation of the ARPA-SLFRF for the Rural Mobile Health - Medical Services in the underserved agricultural and rural communities. This project is an enumerated Eligible Use of SLFRF as it responds to the COVID-19 public health emergency or its negative impacts within underserved agricultural and rural communities.
Rural Mobile Health Program - Medical Services
Project Expenditure Category: E.C. 1.14 Public Health, Other Public Health Services
Funding Amount: $6,000,000
Total Expenditures to Date: $0
Start Date: February 14, 2023
Estimated Completion Date: April 30, 2026
In the Interim Final Rule and Final Rule, the Treasury has determined several enumerated uses for the SLFRF including programs that address health disparities within impacted communities and increase access to health and social services, in order to promote and reach health equity. Given that many rural communities do not have access to high-quality healthcare services, including vision services at close proximity, this project will close the distance gap and increase access to healthcare services in an effort to address health disparities and increase access to health. In the Final Rule, the Treasury determined a program that is provided to a disproportionally impacted community including service to address health disparities, is an enumerated Eligible Use of SLFRF under Category A, as it responds to the COVID-19 public health emergency or its negative impacts.
On January 3, 2023, your Board approved two subrecipient agreements for the Rural Mobile Health program that have allowed the Department to begin providing targeted support to the vulnerable populations in Fresno County’s rural areas who remain affected by not only COVID-19, but other chronic health conditions. The Rural Mobile Health program is working towards identifying gaps in healthcare among residents living in Fresno County’s rural areas, connecting patients to community services and primary care doctors. The recommended subrecipient agreement with Tzu Chi Mobile Clinic will add another service to the Rural Mobile Health program that the targeted communities have historically experienced difficulty accessing. Tzu Chi Mobile Clinic will travel to multiple rural cities in Fresno County at least once a week as part of the Rural Mobile Health program and provide same day professional eye exams and prescription eyewear at no cost to patients. These mobile vision services will improve access for local disadvantaged communities to obtain routine eyecare that is essential to an individual’s overall health.
The recommended agreement allows modifications to object levels in the budget by written approval of the County’s DPH Director or designee that do not exceed 10% of the total maximum compensation payable to the contractor. Modifications shall not result in any change to the total maximum compensation payable nor shall it reduce the delivery of services or significantly alter the intent or scope of services originally approved under the recommended agreement, without returning to your Board for approval.
REFERENCE MATERIAL:
BAI #25, January 3, 2023
BAI #47, August 9, 2022
BAI #3, February 1, 2022
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition Acquisition Request
On file with Clerk - Agreement with Buddhist Tzu Chi Medical Foundation
CAO ANALYST:
George Uc