DATE: August 19, 2025
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Interim Director, Department of Public Health
SUBJECT: Retroactive Revenue Award from the California Department of Public Health for Tuberculosis Control Program
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive award from the California Department of Public Health for the Tuberculosis Control Local Assistance Base Award ($275,170) and includes Food, Shelter, Incentives and Enablers ($16,048) funds, effective July 1, 2025, through June 30, 2026; and
2. Approve and authorize the Director of the Department of Public Health to execute the State Contractor’s Release for the final invoices.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first recommended action will fund tuberculosis (TB) control activities in the Department of Public Health (Department), which includes screening, case management, treatment, contact investigation, and incentives to improve treatment compliance of TB patients. Approval of the second recommended action will allow the Director of the Department to execute the Contractor’s Release for the final invoice at the close of the grant term. The activities are funded with State and Federal funding and any additional costs will be covered with Health Realignment. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the recommended actions, the Department would be unable to fully fund TB control activities in the County, leading to a decrease in the TB related services that the Department would be able to provide to residents.
RETROACTIVE AGREEMENT:
The recommended agreement is retroactive to July 1, 2025. The TB Base Award and Food, Shelter, Incentives, Enablers (FSIE) Award agreement was received from CDPH on June 14, 2025 The agreement 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 sum of the awards will provide $275,170 in revenue in the current fiscal year. The Base Award is comprised of State ($136,974) and Federal ($138,196) funds. The State funds portion of the award includes the full FSIE amount ($16,048). The Department will cover any additional costs that may arise with Health Realignment. Sufficient appropriations and estimated revenues will be included in the Department’s Org 5620 FY 2025-26 Recommended Budget.
DISCUSSION:
In 2024, the Department’s TB Control Program provided treatment, case management, contact investigation, referral, and follow-up activities for 52 county residents newly diagnosed with active TB. Department staff also provided care for patients diagnosed prior to 2024 who had not yet completed treatment. The standard treatment regimens are six to twelve months; however, patients with drug-resistant TB may be treated as long as two years. Active TB patients receive Directly Observed Therapy (DOT) or video DOT (vDOT) in which program staff visit or view a daily video recording of patients to ensure ingestion of appropriate TB medications. TB Control Program staff provided 5,456 DOT visits and 5,152 vDOT viewings in 2024.
The Department also screened an additional 1,226 new patients with inactive TB or a disease other than TB. The Department’s Hospital Liaison and other TB Control Program staff closely monitored and managed 265 cases of the 1,610 additional cases as follow-up to immigration screening mandated by Federal law. Residents at high risk of developing TB include close contacts with active TB patients and people experiencing homelessness. Approximately 584 close contacts were evaluated for latent TB infections, and over 223 TB screenings were conducted on individuals who were identified as unhoused. In FY 2024-25, the County expended an average of $964.85 per TB patient for treatment, hospital case management, contact investigation, and/or screening.
The recommended Agreement deviates from the County’s standard indemnification language in that it requires the County agrees to indemnify, hold harmless and defend the State against any claims, losses, or legal costs that arise only from Fresno County’s own actions, such as negligence, willful misconduct, or failure to comply with the terms of the agreement. This is a one-way indemnification, meaning Fresno County is agreeing to protect the State from any liability resulting from the County’s actions, but the State does not provide the same protection to Fresno County. 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 TB control and prevention activities, without which the continued provision of these services would be negatively impacted.
REFERENCE MATERIAL:
BAI #48, September 10, 2024
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with CDPH
CAO ANALYST:
Ron Alexander