DATE: September 5, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Revenue Awards 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 ($333,597) and Food, Shelter, Incentives and Enablers Allotment ($19,907), effective July 1, 2023 through June 30, 2024;
2. Approve and authorize the Chairman to execute a retroactive award from the California Department of Public Health for Tuberculosis Control and Prevention as part of the Enhanced Prevention and Control Award ($10,000), effective July 1, 2023 through June 30, 2024; and
3. 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) activities in the Department of Public Health (Department), which include screening, case management, treatment, contact investigation, and incentives to improve treatment compliance of TB patients. Expenditures for enticements may include food, shelter, incentives, and enablers (FSIE) such as fast food, groceries, gift cards, bus transportation, equipment, and supplies. Approval of the second recommended action will provide additional funding to enhance the capability of TB prevention and control activities in the County. Approval of the third 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 action, 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 County residents.
RETROACTIVE AGREEMENT:
The recommended agreements are retroactive to July 1, 2023. The TB Base Award and FSIE Award agreement was received from CDPH on June 19, 2023, and the Enhanced Prevention and Control Award was received on July 28, 2023.These are 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 $363,504 in revenue in the current fiscal year. The Base Award ($333,597) is comprised of State ($142,867) and Federal ($190,730) funds. The additional FSIE allotment ($19,907) is comprised fully of State funds. The Enhanced Prevention and Control Award ($10,000) is fully Federal funds. The Department will cover any additional costs that may arise with Health Realignment. Sufficient revenues and estimated appropriations are included in the Department’s Org 5620 FY 2023-24 Recommended Budget.
DISCUSSION:
In 2022, the Department’s TB Control Program provided treatment, case management, contact investigation, referral, and follow-up activities for 31 county residents newly diagnosed with active TB. Department staff also provided care for patients diagnosed prior to 2022 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 4,453 DOT visits and 5,007 vDOT viewings in 2022.
The Department also screened an additional 1,671 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 225 cases of the 1,961 additional cases as follow-up to immigration screening mandated by federal law. Residents at high risk of developing TB include close contacts to active TB patients and people experiencing homelessness. Approximately 203 close contacts were evaluated for latent TB infections, and over 276 TB screenings were conducted on individuals who were identified as homeless. In FY 2022-23, the County expended an average of $1,362.71 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 to provide one-way indemnification to the State in the performance of the Agreement. This language is typically present in State grants. 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 #51, October 25, 2022
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Base and FSIE Agreement with CDPH
On file with Clerk - Enhanced Prevention and Control Agreement with CDPH
CAO ANALYST:
Ron Alexander