DATE: December 17, 2024
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Amendments to Agreements with Community Based Organizations to Implement Department of Public Health’s Health Disparities Program
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute Amendment No. 2 to Agreements with the following vendors to continue providing health intervention activities for Fresno County’s Community Health Worker Network, effective upon execution, to allow unspent fiscal year two funds, to be carried over to fiscal year three, to allow fiscal year three funds to be redirected to other line items, and to extend the base term of each agreement by seventeen (17) months from January 1, 2024 through May 31, 2026, with two optional one-year extension periods for a full term of March 28, 2023 through May 31, 2028 and no changes to the maximum compensation:
1) Reading and Beyond with a total not to exceed amount of $1,260,000,
2) Centro Binacional para el Desarrollo Indigena Oaxaqueño with a total not to exceed amount of $750,000,
3) West Fresno Health Care Coalition with a total not to exceed amount of $996,818,
4) Cultiva La Salud with a total not to exceed amount of $1,155,000.
2. Approve and authorize the Chairman to execute Amendment No. 1 to Agreement with Exceptional Parents Unlimited to allow unspent fiscal year two funds, to be carried over to fiscal year three, to allow fiscal year three funds to be redirected to other line items, to amend Article 7.1 of the agreement, and extend the base term of the agreement by seventeen (17) months from January 1, 2024 through May 31, 2026, with two optional one-year extension periods for a full term of March 28, 2023 through May 31, 2028 and no changes to the maximum compensation of $750,000.
REPORT
There is no additional Net County Cost associated with the recommended actions, which will increase the term of each Agreement by seventeen months, carryover unspent funds from year two to year three in each Agreement’s budget and reallocate funds to adjust for costs of the extended term. The second recommended action will also allow for the Agreement with Exceptional Parents Unlimited (EPU) to be updated to acknowledge the Center for Disease Control and Prevention’s (CDC) grant as one of the funding sources for this agreement by including the grant’s Catalog of Federal Domestic Assistance (CFDA) number. This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, these Agreements will terminate on December 31, 2024 and critical programs serving the needs of community members through health disparities interventions will cease services. Additionally, the full amount of funds initially agreed upon at the time of contract execution will not be maximized, causing the organizations and the County to have unspent funds at the end of the grant term.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The agreements will continue to be fully funded with federal grants. The total costs for each recommended action are outlined below:
Reading and Beyond
• Year One (3/28/2023 - 7/31/2023): $76,000
• Year Two (8/1/2023 - 7/31/2024): $522,987
• Year Three (8/1/2024 - 7/31/2025): $661,013
• Year Four (8/1/2025 - 5/31/2026): $0
• Term Maximum: $ 1,260,000
Centro Binacional para el Desarrollo Indigena Oaxaqueño
• Year One (3/28/2023 - 7/31/2023): $67,172
• Year Two (8/1/2023 - 7/31/2024): $328,652
• Year Three (8/1/2024 - 7/31/2025): $354,176
• Year Four (8/1/2025 - 5/31/2026): $0
• Term Maximum: $ 750,000
West Fresno Health Care Coalition
• Year One (3/28/2023 - 7/31/2023): $62,173
• Year Two (8/1/2023 - 7/31/2024): $416,710
• Year Three (8/1/2024 - 7/31/2025): $517,935
• Year Four (8/1/2025 - 5/31/2026): $0
• Term Maximum: $ 996,818
Cultiva La Salud
• Year One (3/28/2023 - 7/31/2023): $82,470
• Year Two (8/1/2023 - 7/31/2024): $527,540
• Year Three (8/1/2024 - 7/31/2025): $544,990
• Year Four (8/1/2025 - 5/31/2026): $0
• Term Maximum: $ 1,155,000
Exceptional Parents Unlimited
• Year One (3/28/2023 - 7/31/2023): $92,111
• Year Two (8/1/2023 - 7/31/2024): $406,694
• Year Three (8/1/2024 - 7/31/2025): $251,195
• Year Four (8/1/2025 - 5/31/2026): $0
• Term Maximum: $ 750,000
Sufficient appropriations and estimated revenues are included in the Department of Public Health’s Org 5620 FY 2024-25 Adopted Budget and will be included in subsequent budget requests.
DISCUSSION:
On March 28, 2023, your Board approved Agreements A-23-129, A-23-130, A-23-131, A-23-132, and A-23-133 which allowed the County to partner with multiple organizations to promote community health support and to provide health intervention activities for implementation of Fresno County’s Initiative to Address COVID-19 Related Health Disparities. On March 19, 2024, your Board approved First Amendments A-24-127, A-24-129, A-24-130, and A-24-131, which allowed subcontracted agencies to carryover unspent fiscal year one funds to fiscal year two and corrected language in Article 7.1 of each Agreement in accordance with federal funding.
On March 28, 2023, your Board approved Agreement A-23-136 which allowed the Department to accept a 12-month no cost extension of the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities grant (CDC-RFA-OT21-2103) through the United States Department of Health and Human Services, Centers for Disease Control and Prevention, which is a primary funding source of these Agreements. On November 9, 2023 the Department received a no cost extension of COVID-19 Epidemiology and Laboratory Capacity (ELC) Enhancing Detection and ELC Enhancing Detection Expansion grants through the California Department of Public Health, which are additional funding sources of these Agreements.
Approval of the recommended actions will allow the Department to extend the offer of no cost extensions to contracted partners which will allow organizations the ability to continue providing critical interventions to County residents through May 31, 2026. The recommended actions would also allow changes to each organization’s budget to reflect actuals in fiscal years one and two and carryover unspent funds into fiscal year three. A carryover of unused funds will allow each organization to fully utilize the resources provided in the original Agreements and maximize the impacts of the program in the community. The second recommended action would also allow for a correction in the wording of Article 7.1 of the Agreement with EPU to include the correct CFDA Number to acknowledge the CDC as one of the Federal funding sources of this Agreement. No changes were made to the total compensation of each Agreement.
During the initial year of implementation, contracted agencies completed over 2,100 social determinants of health (SDoH) screenings and enrolled over 1,800 community members into the Health Disparities Program. Screenings and enrollment allow community health workers (CHW) to assess client needs and provide community linkages and referrals to assist clients in achieving maximum health outcomes. Social service and medical referrals are common CHW interventions, which include connecting patients to a primary health care provider. Other mitigation efforts include addressing emerging health trends within Fresno County, guided by disease surveillance indicators, and dissemination of linguistically and culturally appropriate health education materials within targeted communities. Attachment A is the Health Disparities Program annual impact summary for the period of June 1, 2023 through June 30, 2024. Contracted agencies will continue to collaborate with the Department’s Rural Mobile Health Program and offer clients an opportunity to enroll into the CHW network through initial SDoH screeners used to assess the client’s unique needs and develop an individualized approach to address barriers to health, while providing wrap around services to enrolled clients.
While assessing spending trends, it was determined that most agencies will expend the maximum agreement amount prior to May 31, 2026. The Department is exploring supplemental funding options to sustain contracted partners through full term of their agreements. Should extensions or additional funding be available, it will be brought to your Board for approval at a later time.
REFERENCE MATERIAL:
BAI #45, March 19, 2024
BAI #49, March 28, 2023
BAI #48, March 28, 2023
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment 2 to Agreement with Reading and Beyond
On file with Clerk - Amendment 2 to Agreement with Centro Binacional para el Desarrollo Indigena Oaxaqueño
On file with Clerk - Amendment 2 to Agreement with West Fresno Health Care Coalition
On file with Clerk - Amendment 2 to Agreement with Cultiva La Salud
On file with Clerk - Amendment 1 to Agreement with Exceptional Parents Unlimited
On file with Clerk - Attachment A Health Disparities Annual Impact Summary
CAO ANALYST:
Ron Alexander