DATE: April 25, 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
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 Immunization Local Assistance Grant, effective July 1, 2022 through June 30, 2027, total not to exceed $9,693,817.
2. Approve and authorize the Director of Public Health, or designee, to execute flu vaccine supplementary agreements for the sharing of flu vaccines that were provided to the Department by the State with interested medical providers that meet State and Department guidelines.
3. Approve and Authorize the Director of the Department of Public Health to submit any necessary forms for efficient administration of the grant through June 2027, without change to total award.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first recommended action will provide continued non-competitive California Department of Public Health (CDPH) grant funding to support immunizations, outreach, and educational services through the Department of Public Health’s Immunization Program. The funding provides staffing with related services and supplies. The agreement maximum for each fiscal year is $450,576, with an additional $7,440,937 in COVID-19 vaccine-related activities funding for FY 2022-23 that may roll over any unspent funds each year until June 30, 2025. The second recommended action will allow the Department’s Director, or designee, to execute flu vaccine supplementary agreements for the sharing of flu vaccines that were provided to the Department by the State with interested medical providers that meet State and Department guidelines. The third recommended action will allow the Director to submit any necessary and related forms to the California Department of Public Health for the efficient administration of the grant. This item is countywide.
ALTERNATIVE ACTION(S):
There is no alternative action. Should your Board not approve the recommended actions, the Department would be unable to fully fund immunization activities in the County, resulting in increased cost to the County to cover services and avoid being in violation of the California Health & Safety Code.
RETROACTIVE AGREEMENT:
The recommended retroactive revenue agreement was received from CDPH on January 26, 2023, is retroactive to July 1, 2022 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 annual allocation is $450,576 for FYs 2022-23 through 2026-27, with $7,440,936.74 in COVID-19 related activities funding for FY 2022-23, and that any unspent funds may be rolled over each year until June 30, 2025. 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.
The agreement includes full reimbursement of direct costs but does not allow for indirect cost recovery. Health Realignment will cover the current indirect rate of 18.816% percent ($78,607) of salaries and benefits per fiscal year.
DISCUSSION:
Pursuant to California Health and Safety Code, section 120350, County Health Officers are charged with the organization and maintenance of an immunization program to ensure availability to County residents and the investigation and outbreak mitigation of vaccine preventable diseases. The recommended agreement will provide funding to support mandated immunization programs, through health education, outreach, and direct immunization administration to County residents. Additionally, it will support case management for Hepatitis B positive mothers and their newborns, serves as a resource for immunization questions from providers throughout the County, and funds flu clinics during the fall and winter seasons. The annual funds will assist with vaccine awareness and immunization services, while the COVID-19 funding will help fund COVID-19 vaccine-related activities such as: staffing, vendor contracts to administer COVID-19 vaccine, pop-up COVID-19 vaccination clinics, community-based organization contracts, and the purchase and maintenance of vaccine storage equipment.
The Department has received immunization subvention funds for over 30 years and proposes to utilize these grant funds to fund program personnel costs as well as education and training materials. From February 11th, 2021 through March 1st, 2022, the Department’s Immunization program administered 132,880 doses of COVID-19 vaccines, redistributed 169,389 COVID-19 vaccine doses throughout Fresno County, and allowed the direct shipping of 553,832 doses to medical providers. To date, in FY 2022-23, over 10,233 vaccines were administered; 2,452 were flu vaccines, and 4,230 were COVID-19 vaccines. The program shared 5,948 flu vaccine doses with community medical partners, redistributed 91,709 doses of COVID-19 vaccines, and approved for direct shipping of 203,546 doses of COVID-19 vaccines to other providers.
The recommended Agreement deviates from the County’s standard indemnification language and requires the County (and the County’s contractors receiving this funding) to provide one-way indemnification to the State in the performance of the Agreement. This language is typically present in State grants therefore, the Department has determined that its acceptance of the indemnification language is advantageous as the State-grant is a critical funding source for Immunization related activities. Without this funding the continued provision of these services would be negatively impacted.
REFERENCE MATERIAL:
BAI #46, February 22, 2022
BAI #34, April 27, 2021
BAI #37, January 21, 2020
BAI #33, December 12, 2017
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with California Department of Public Health
CAO ANALYST:
Ron Alexander