DATE: August 9, 2022
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: American Rescue Plan Act - Coronavirus State and Local Fiscal Recovery Funds - Public Health Initiatives
RECOMMENDED ACTION(S):
TITLE
1. Approve the allocation of American Rescue Plan Act State and Local Fiscal Recovery Funds in the total amount of $11,225,000 to the Department of Public Health Org 5620 for:
a. Rural Mobile Health - Medical Services, up to $6,000,000 in the underserved agricultural and rural communities;
b. Rural Mobile Health - Medical System Navigation and Linkage, up to $2,000,000 in the underserved agricultural and rural communities;
c. Public Health Building Roof Repair - up to $225,000;
d. Public Health Building Basement Rebuild to support community meetings, health education forums and trainings, and health supply storage capacity - up to $3,000,000
2. Adopt Budget Resolution increasing FY 2022-23 appropriations and estimated revenues for the Department of Public Health Org 5620 in the amount of $6,225,000 for facility project costs related to the Brix/Mercer building and contracted services (4/5 vote)
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first recommended action will authorize the Department of Public Health (DPH) to implement the described projects with funds provided through the American Rescue Plan Act (ARPA) - Coronavirus State and Local Fiscal Recovery Funds (SLFRF). Approval of the second recommended action will increase DPH Fiscal Year (FY) 2022-23 appropriations and estimated revenues to implement the projects. This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the SLFRF funds would not become available to the DPH to implement the various projects nor to fund necessary facility repairs and improvements. Implementation of the various projects and facility repairs and improvements will be delayed until another funding source is identified.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. Approval of the recommended actions will increase the Public Health Org. 5620 appropriations and estimated revenues in the amount of $6,225,000 to fund two programs and two facility repairs/improvement projects. Costs incurred by DPH to implement the programs and facility projects will be processed through claim reimbursement with the Auditor-Controller /Treasurer-Tax Collector. Costs will be funded through Auditor-Controller/Treasurer-Tax Collector Org 1033 - Disaster Claiming, Fund 0026, Subclass 91021.
Any unbudgeted cost associated with the implementation of each project that exceeds the DPH allocation of SLFRF will be assessed by DPH and accounted for in DPH’s future budgets.
DISCUSSION:
The ARPA established the SLFRF Program, which delivered $350 billion to state, local and Tribal governments across the country to support their response and recovery from the COVID-19 public health emergency.
The Department of the Treasury’s 31 CFR Par 35 Coronavirus State and Local Fiscal Recovery Funds Interim Final Rule (“Interim Final Rule”) and Final Rule (“Final Rule”) establish a framework to determining the type of programs and services that are eligible under ARPA.
SLFRF may be used for eligible activities under four general categories:
A. Respond to the COVID-19 public health emergency or its negative economic impacts;
B. Provide premium pay for essential workers;
C. Replace public sector revenue loss, subject to certain limitations; and,
D. Make necessary infrastructure investments in water, sewer, and broadband.
The Final Rule permits SLFRF to be used to cover costs for eligible activities within those four general categories for the period that begins March 3, 2021, and ends on December 31, 2024.
Recipients must return any funds to the U.S. Department of the Treasury which are not obligated by December 31, 2024, and any funds not expected to cover such obligations by December 31, 2026.
On February 1, 2022, your Board approved the Ad-Hoc Committee’s expenditure plan recommendations, indicating proposed use of the ARPA funds. The recommendations were presented by the County Administrative Office’s (CAO) establishing an ARPA - SLFRF expenditure plan to prioritize various internal and external partner requests for the County’s allocation of $194,063,657. The approved expenditure plan earmarked funds for the following five project to be undertaken by DPH.
These projects are enumerated Eligible Uses of SLFRF under Category A, as they respond to the COVID-19 public health emergency or its negative impacts, as follows:
Public Health (Eligible Use Category 1)
1a. Rural Mobile Health Program, Medical Services
Project Expenditure Category: E.C 1.14 Public Health, Other Public Health Services
Funding Amount: $6,000,000
Total Expenditures to Date: $0
Estimated Start Date: September 6, 2022
Estimated Completion Date: August 31, 2024
Funds allocated for Rural Mobile Health will assist the Department to set up a pilot program to increase access to health services in the underserved agricultural and rural communities in the County of Fresno. The goal of this project is to take healthcare services to rural areas, address health disparities, extend health education, and transition rural residents to a local clinic if they do not have a primary care provider.
Department staff met with several partners that participated in the COVID-19 Food and Ag Initiative, which included local farmers and several Community Based Organizations (CBOs). Some of these partners had also requested ARPA funding from the various sources for a rural mobile health program.
The Department’s preliminary design consists of two primary healthcare options that are planned to be delivered and provided through contracts with established mobile health clinics. The Department will prepare a full scope of services to be provided by the mobile clinics, an outreach program, and prepare the schedule of when and where the mobile clinic events will be held. The Department will oversee the implementation of the project.
The first option will be made available upon request to rural communities or agricultural employers that would like to host the mobile clinic events at their location every 6 to 12 months. The first option has been designed to provide patients with the following basic screenings: glucose, blood pressure, COVID-19 testing/vaccination and routine immunizations, and counseling for chronic disease prevention and management.
The second option offers more extensive medical services, with an emphasis on preventive screenings and healthcare. The second option will be made available upon request to rural communities or agricultural employers that would like to host the mobile clinic events at their location every month for the duration of the contract term. The second option would provide the screenings included in option one and will also include additional laboratory services, medication management if indicated, and emergency prescription refills for certain medical diseases. Frequency and type of services will be evaluated throughout the project to address community needs and maximizing of funding resources.
The Department is evaluating potential medical partners that are attached to a university to deliver these medical services in order to train future healthcare providers on how to think beyond the clinic walls and care for Fresno County’s underserved populations. If action 1a. is approved by your Board, agreements with medical partners would be brought back to your Board for consideration.
The rural mobile health clinic locations will be finalized once subrecipient contracts with the medical provider(s) are in place. The Department will extend the invitation to local agriculture businesses that previously hosted COVID-19 vaccine clinics at their workplace to be a clinic site location for this program. Other agricultural and rural locations will be selected based on the following criteria: the absence of a nearby medical clinic, within Health Places Index (HPI) Quartile 1, and/or alignment with other organizations conducting similar work in the rural areas of the County. The Department may adjust the location criteria based on participation from partners to expand into other underserved areas.
The Department will document the number of services provided at each rural mobile health clinic and attempt to validate if patients receiving services followed up with scheduling and attending their medical appointments at nearby clinics during this project period, which is anticipated to run through December 31, 2026. The Department will utilize the recently approved health information exchange and assess whether these patients visited the local emergency rooms for non-emergency medical care. The additional goal is to provide these patients with knowledge on how to access medical services, and to reduce the amount of emergency room utilization and move the population towards a permanent medical home.
In the Interim Final Rule and Final Rule, the Treasury has determined several enumerated uses for SLFRF including programs that address health disparities within impacted communities and increase access to health and social services, in order to promote and reach health equity. Given that many rural communities do not have access to high-quality healthcare services at close proximity, this project will close the distance gap and increase access to healthcare services in an effort to address health disparities and increase access to health and social services. In the Final Rule, the Treasury determined a program that is provided to a disproportional impacted community including service to address health disparities is an enumerated Eligible Use of SLFRF under Category A, as it responds to the COVID-19 public health emergency or its negative impacts.
1b. Rural Mobile Health - Medical System Navigation and Linkage with CBOs
Project Expenditure Category: E.C 2.19 Public Health, Other COVID-19 Public Health Expenses
Funding Amount: $2,000,000
Total Expenditures to Date: $0
Estimated Start Date: September, 2022
Estimated Completion Date: June, 2024
Funds allocated for the Rural Mobile Health Linkages to Wellness will authorize the Department to provide funding support to CBOs, under contract, to conduct community outreach and technical support in tandem with the Rural Mobile Health Program.
Recognizing that CBOs can promote the County’s rural mobile health clinic at events, the goal of this program is to maximize community outreach through existing CBO networks, for the purpose of extending healthcare access in rural communities that experienced negative impacts due to the COVID-19 public health emergency. CBOs will provide outreach in rural areas of the County, provide ethnically sensitive health education materials to rural residents on common chronic and communicable diseases; assist patients in navigating the medical clinic enrollment and ongoing preventive care visits; and document any barriers that patients experience or encounter during navigation into the medical system. This information gathered by the CBOs will educate future communications with health partners to help address issues preventing patients from reaching positive health outcomes.
In the Final Rule, the Treasury determined a program that is provided to a disproportionally impacted community, including services to address health disparities, is an enumerated Eligible Use of SLFRF under Category A, as it responds to the COVID-19 public health emergency or its negative impacts. This program to provide community outreach and technical support in health-related issues will address health disparities and increase access to health and social services in disproportionately impacted rural areas, which do not have access to high-quality healthcare services at close proximity.
A request for proposal (RFP) would need to be issued for this program and therefore, it would have a later starting date than the medical component of Rural Mobile Health. Until new contracts are approved by your Board, the Department would utilize existing contracted CBOs when appropriate. This funding would also support an education campaign geared towards Fresno County residents helping them understand the importance of knowing their current health status, e.g., blood pressure, glucose, cholesterol, and seeking appropriate medical care through a primary care physician, in order to reduce the overwhelming use of emergency rooms at local hospitals for non-emergency concerns. Rural Mobile Health participants would receive the education materials first and then the Department would make the education materials available Countywide.
1c. Repairing Brix/Mercer Roof
Project Expenditure Category: E.C 1.14 Health, Other COVID-19 Public Health Capital Investment to Public Facilities
Funding Amount: $225,000
Total Expenditures to Date: $0
Estimated Start Date: September, 2022
Estimated Completion Date: June, 2023
The funds allocated to this project will allow the Department to fund necessary facility repairs at the Department of Public Health’s headquarters, Brix / Mercer Facility. During the winter seasons, the facility requires routine roofing crack or hole repairs to stop water leaks from entering the building. Portions of the roof are estimated to be over 50 years old and are in dire need of replacement. Replacement of the roof will address capital investment need, will allow for the continued delivery of critical public services, and protect the facility from experiencing additional water damage during the wet seasons.
The Final Rule lists enumerated eligible uses to respond to the public health emergency, under the subcategory of COVID-19 mitigation and prevention. Applicable enumerated uses include improvements to emergency operations centers, improvements to COVID-19 testing sites and laboratories, and costs of establishing public health data systems (roofing repairs will protect the facility from experiencing further water damage).
The County’s Office of Emergency Services (OES) is located at the Department of Public Health Facility, and the Department of Public Health is integral to the County’s public health response to the COVID-19 pandemic. Like other eligible uses of SLFRF funds in this category, capital expenditures should be a related and a reasonably proportional response to a public health or negative economic impact of the pandemic. The COVID-19 pandemic has resulted in negative health impacts to the public; making investments to improve the Brix / Mercer Facility ensures that the Department of Public Health is able to provide a safe workspace for essential employees, remove any potential health hazards in the existing roof such as mold and mildew, improve the facility’s resiliency for future wet seasons, and continue to provide essential public health services to the public. By upgrading or replacing the roof at the Brix / Mercer Facility, the Department of Public Health will be able to continue to provide essential services as the pandemic continues and will not be hindered during the wet seasons.
1d. Rebuilding Brix/Mercer Basement
Project Expenditure Category: E.C 1.14 Health, Other COVID-19 Public Health Capital Investment to Public Facilities
Funding Amount: $3,000,000
Total Expenditures to Date: $0
Estimated Start Date: September 2022
Estimated Completion Date: December 2023
Funds allocated to this project will fund improvements to the Department’s main base of operations basement area. The Department experienced a flood in 2018 that completely destroyed the basement of the building. There was a previous flood in 2016 that destroyed 70% of the Public Health Laboratory. The County made the decision to relocate the public health laboratory to an offsite County-owned building after the second flood in 2018. The public health laboratory is now fully rebuilt, and the basement area is still pending construction until the settlement with the insurance company is finalized. Negotiations with the insurance company are moving forward and are not resulting in a full-cost reimbursement to the Department for rebuilding the laboratory and basement area. This funding request will assist the Department to ensure that funding is available to fully cover the costs for the basement, contingent upon the final settlement with the insurance company.
The newly redesigned basement will support the development of the County workforce in all service areas of the Department with training space and conference rooms. Basement design will include additional storage for Department programs, while still having the capacity for storing large assets, or larger inventory to respond accordingly during an epidemic or another pandemic. The basement has been utilized to store COVID testing kits for quick distribution to local medical providers, community-based organizations, and businesses. This has increased COVID testing capacity by having a test cache available to our local partners. The County’s COVID-19 response highlighted the importance of adequate space for both expanding safe space for the workforce as well as the need for adequate space for emergency response items received through the Department’s Office of Emergency Services (OES), and Medical Health Operational Area Coordinator (MHOAC). Additionally, these areas will be shared with County Departments, CBOs, and the community to conduct community meetings, health education forums, and health trainings.
Like other eligible uses of SLFRF funds in this category, capital expenditures should be a related and reasonably proportional response to a public health emergency or negative economic impact of the pandemic. The COVID-19 pandemic has resulted in negative health impacts to the public and making investments to improve the Brix / Mercer Facility ensures that the Department of Public Health is able to continue to provide essential services as the pandemic continues.
The Department would need to successfully complete and meet the substantive requirements of the Treasury’s Written Justification process for projects between $1 million and $10 million for this project, as part of the County’s demonstration that the project is a related and reasonably proportional response to the harm identified.
Each project is tentatively scheduled to begin, pending your Board’s approval of the funds. These Department projects recommended for funding total $11,225,000. The second recommended action will provide sufficient funding during FY 2022-23. Detailed scopes of work, project timelines, including project start and completion dates, and key performance indicators and programmatic data for the Department’s projects will be provided to the County Administrative Office on a quarterly and annual basis.
REFERENCE MATERIAL:
BAI # 3, February 1, 2022
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Resolution
CAO ANALYST:
George Uc