DATE: July 13, 2021
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Interim Director, Department of Public Health
SUBJECT: Amendments to COVID-19 Equity Project Agreements
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute First Amendment to Agreement No. D-20-297 with Fresno Economic Opportunities Commission for the COVID-19 Equity Project - African American Coalition to extend the term, add the provision of COVID vaccine services, influenza and/or other communicable diseases support services, add/adjust required Federal funding terms and conditions, and increase maximum compensation by $1,303,061, effective August 7, 2020 through December 31, 2021, total not to exceed $2,951,732.
2. Approve and authorize the Chairman to execute First Amendment to Agreement No. D-20-430 with Exceptional Parents Unlimited for the COVID-19 Equity Project- Disability Equity Project Coalition to extend the term, add the provision of COVID vaccine support, influenza and/or other communicable diseases support services, add/adjust required Federal funding terms and conditions, and increase maximum by $687,957, effective September 30, 2020 through December 31, 2021, total not to exceed $2,425,000.
3. Ratify Agreement No. D-20-524 with Building Healthy Communities for the COVID-19 Equity Project- Immigrant and Refugee Coalition previously executed by the County Administrative Office acting as the Emergency Services Director and approve and authorize the Chairman to execute First Amendment to Agreement No. D-20-524 to extend the term, add the provision of COVID vaccine support, influenza and/or other communicable diseases support services, revise terms and conditions, and increase maximum by $3,167,045, effective December 31, 2020 through December 31, 2021, total not to exceed $6,090,965.
REPORT
Approval of the first two recommended actions will execute the amendments with Fresno Economic Opportunities Commission (EOC) African American Coalition (AAC) and Exceptional Parents Unlimited (EPU) Disability Equity Project (DEP) Coalition for community health outreach and support services related to the COVID-19 pandemic, influenza and/or other communicable diseases support services through December 31, 2021. Approval of the third recommended action will ratify agreement and execute first amendment to agreement with Building Healthy Communities (BHC) Immigrant and Refugee (IR) Coalition for COVID-19 community health outreach and support services as well as the provision of influenza and/or other communicable diseases support services. There is no additional Net County Cost associated with the recommended actions. This item is Countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, the County would need to discontinue use of the COVID-19 Equity Project (CEP) Coalitions for the added provisions, significantly reduce the use of existing services to accommodate existing budgets with no change in term, and required federal funding terms and conditions would remain unchanged. In addition, State funding requires community-based organizations within the funding plan, thus partial State funding may be jeopardized.
FISCAL IMPACT:
There is no increase to Net County Cost associated with the recommended actions. These recommended actions are fully offset with a combination of funding from the CARES Act allocation ($6,309,634; 55%) for the total original contract amounts through June 2021 only and state funding ($5,158,063; 45%) for the total increased amounts for the remainder of the contract term. State grants require funds to be allocated to Community Based Organizations (CBO’s) to conduct community-based services. There are no outstanding invoices pending related to these agreements. Sufficient appropriations and estimated revenues will be included in the Department’s Org 5620 FY 2021-22 Recommended Budget.
DISCUSSION:
On March 15, 2020, the County Administrative Officer acting as the Emergency Services Director, proclaimed a local emergency to increase response capacity for the COVID-19 pandemic. On March 17, 2020, your Board proclaimed and ratified the local emergency due to the imminent and proximate threat of COVID-19. As of April 13, 2021, your Board terminated the proclamation of the local emergency and continues to function under the State proclaimed emergency.
The overwhelming increase of transmission and hospitalization rates created a great need for community health outreach and support services to enable and improve compliance with COVID 19 containment and mitigation measures especially among high risk residents and vulnerable populations. In response, the County deemed it necessary to mobilize and build upon the unique community ties the coalition partners have developed over years of working directly with vulnerable residents of the County. The CEP includes coalitions comprised of 18 community-based organizations focused on reaching and addressing the COVID-19 needs of diverse and vulnerable racial/ethnic populations including individuals with disabilities, people of color, immigrants and refugees, agricultural workers, and other essential workers.
Through May 26, 2021, the CEP coalitions have provided health education and outreach to nearly 9,052 individuals, reached 1,259 households for Isolation Quarantine Supports (IQS) support payments, and conducted and/or supported 127 total education/testing/vaccine events. Due to the significant work accomplished by the COVID Equity project to our vulnerable population the County was able to improve testing and vaccination in the health equity census tracts and zip codes tracked by the State in accordance with the State’s blueprint. This assisted the County to not be penalized and move up through the previous color-coded blueprint. The COVID Equity project assisted in moving the County from moving from 300 COVID tests per day to 6,000 tests per day by December 2020. Vaccination clinic support and outreach have been a significant investment from the COVID Equity Project and has assisted the County to be ranked 33 in the State when the County usually ranks on average 51 out of 58 CA counties in health outcomes. Additional County outcomes and COVID Equity Project metrics are included in a Board Briefing Report dated July 7, 2021. The recommended actions will allow for the expansion of scope of work to include COVID-19 vaccine outreach education and support to reduce stigma associated with vaccination and will allow implementation of vaccine clinics with a focus on serving the most vulnerable populations in a manner that advances racial health equity and access. Additionally, scope of work will be expanded to provide support services to influenza and/ or other communicable diseases throughout the end of term. The addition of influenza and/or communicable diseases is consistent with state funding requirements and will allow the County to be better prepared to manage any type of communicable disease outbreaks.
The agreements contain non-standard language allowing the contractors to request an advance payment of up to 25% of their maximum compensation to quickly onboard subcontractors. The agreements also contain a mutual without-cause termination clause upon 30 days advance written notice, a budget modification clause allowing the Director to approve line item changes of up to 10% of the maximum compensation, and a clause allowing the Director to approve subcontracts with additional community benefit organizations.
REFERENCE MATERIAL:
BBR, July 7, 2021
BAI #70, December 15, 2020
BAI #5.1, September 1, 2020
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment to Agreement No. D-20-297 with Fresno EOC
On file with Clerk - Amendment to Agreement No. D-20-430 with EPU
On file with Clerk - Agreement No. D-20-524 with BHC
On file with Clerk - Amendment to Agreement No. D-20-524 with BHC
CAO ANALYST:
Ron Alexander