DATE: November 28, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Revenue Agreement with the California Department of Public Health for Childhood Lead Poisoning Prevention Program
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive revenue Agreement with the California Department of Public Health for the Childhood Lead Poisoning Prevention Program, effective July 1, 2023 through June 30, 2026 ($4,719,083); and
2. Approve and authorize the Director of Public Health, or designee, to execute the State Contractor’s Release for the final invoice.
REPORT
There is no increase in Net County Cost associated with the recommended actions. Approval of the recommended actions will allow the Department of Public Health to continue to implement the Childhood Lead Poisoning Prevention Program (CLPPP) with funding provided by the California Department of Public Health (CDPH). The program provides case management, health education, and environmental assessment services to children who are diagnosed with or at high risk of developing lead poisoning. This item is Countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the recommended agreement, the Department would not be able to fund CLPPP and provide services for lead-poisoned children.
RETROACTIVE AGREEMENT:
The recommended agreement was received from CDPH on August 9, 2023 and is retroactive to July 1, 2023 and is being brought to your Board in accordance with the agenda item processing timelines.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The recommended agreement will provide $4,719,083 from July 1, 2023 through June 30, 2026. Annual maximum funding amounts are as follows:
• FY 2023-24: $1,538,916
• FY 2024-25: $1,577,130
• FY 2025-26: $1,603,037
The agreement allows full indirect cost recovery at the Department’s rate of 18.314% of salaries and benefits; however, the program will limit indirect cost recovery to 15% to allow for additional required direct expenses. The remainder ($40,720) will be covered with Health Realignment. There are no pending invoices related to this item. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2023-24 Adopted Budget and will be included in future budgets for the duration of the term.
DISCUSSION:
Since 1991, the Department has received funding from CDPH for childhood lead poisoning prevention and surveillance activities. Each year, CLPPP staff provide education and outreach to over 5,000 residents, community partners, healthcare providers, childcare centers and parents via health fairs, mailings, presentations and media campaigns. Staff also provide yearly monitoring to 600 new surveillance cases, case management services to over 30 children identified with very high blood lead levels (BLLs) and conduct over 20 environmental investigations. Staff focus on reaching areas at higher risk of lead exposure, which include older homes with lead-based paint that may be peeling.
The proposed agreement will provide continued funding to eliminate childhood lead poisoning for community outreach and education, healthcare provider education, surveillance, data analysis, and case management services for children with elevated BLLs. The neurological effects of lead poisoning are permanent; while treatment can reduce BLLs, it cannot reverse the harmful effects of the poisoning. In a young child, this can result in life-long learning and behavioral disabilities. Early intervention prevents further exposure to risk factors and reduces potential additional harm to lead-exposed children.
The recommended agreement contains non-standard termination language as it allows the State to terminate the agreement without cause, provided that written notice has been delivered at least 30 days prior to termination. The agreement also contains a termination clause that allows the County to submit a written request to terminate the agreement only in the event the State substantially fails to perform its responsibilities under the agreement. The Agreement also deviates from the County’s standard indemnification language in that it requires the County to provide one-way indemnification to the State in the performance of the Agreement. This language is typically present in State grants. The Department has determined that its acceptance of the indemnification language is advantageous to the County, as the State-grant is a funding source for Fresno County’s CLPPP, without which the continued provision of these services would be negatively impacted.
REFERENCE MATERIAL:
BAI #61, September 22, 2020
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with CDPH
CAO ANALYST:
Ron Alexander