DATE: September 25, 2018
TO: Board of Supervisors
SUBMITTED BY: David Pomaville, Director, Department of Public Health
SUBJECT: Retroactive Revenue Award with the California Department of Public Health
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive Base Award with the California Department of Public Health, for Tuberculosis Control Local Assistance Funds ($290,998) and Award Allotment ($16,987), effective July 1, 2018 through June 30, 2019.
2. Approve and authorize the Director of the Department of Public Health to execute the Contractor’s Release Form for submission with the final invoice.
REPORT
Approval of the recommended actions will fund tuberculosis (TB) activities in the Department of Public Health, which include contact investigation, screening, treatment and incentives to improve treatment compliance of TB patients. Incentives may include food, shelter, incentives and enablers (FSIE) expenditures such as fast food, groceries, bus transportation, equipment, supplies, and shelter. The activities are funded with State and Federal funding and the indirect costs will be covered with Health Realignment, with no Net County Cost. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, the Department would be unable to fully fund TB control activities in the County.
RETROACTIVE AGREEMENT:
The Base Award was received from the California Department of Public Health on June 29, 2018 and is retroactive to July 1, 2018. The award was not brought to your Board on an earlier date due to a delay in receiving data regarding the number of County residents served by the TB Control Program. The Department has implemented procedures to ensure the data is available through the Department’s epidemiology team, thereby preventing delays in the future.
FISCAL IMPACT:
There is no increase in net County cost associated with the recommended actions. The total Base Award of $290,998 consists of $121,877 State and $169,121 Federal funding, plus $16,987 for FSIE expenditures comprised of State funding. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2018-19 Recommended Budget. The award includes full reimbursement for direct costs and the Department will cover indirect cost of 26.5% ($63,337) with Health Realignment.
DISCUSSION:
In 2017, the Department’s TB Control Program provided treatment, contact investigation, referral and follow-up activity for 62 county residents newly diagnosed with active TB. Department staff provided care for patients diagnosed prior to 2017 who had not yet completed treatment. The standard treatment regimens are six to twelve months; however, drug resistant TB patients may be treated as long as two years. Additionally, 2,057 new TB patients were evaluated and determined to have inactive TB disease, a disease other than TB, or were still in the process of final diagnosis at the end of 2017. Of the 2,057 new patients 247 of them are case managed by the Department’s Hospital Liaison and closely monitored by the Department’s TB Control Program. Pulmonary TB patients receive Directly Observed Therapy (DOT) in which DOT staff visit patients daily or bi-weekly to observe ingestion of the TB medication to ensure it is taken correctly. Over 11,006 DOT visits were made in 2017.
County residents at high risk of developing TB include persons in close contact to active TB patients and persons who were identified as homeless. Approximately 1,009 close contacts were evaluated for latent TB infections, and over 801 TB screenings were conducted on persons who were identified as homeless. In FY 2017-18 the County, on average, expended $845 per TB patient for treatment, hospital case management, contact investigation, or screening.
Approval of the recommended actions will provide funding to continue the control activities. The State funding allocation to the County is recalculated every two years using five years of surveillance data. Data from the years 2012 to 2016 was used to calculate the allocations for the FY 2018-19 awards; the first of a two-year funding cycle.
The recommended award between the State and County contains non-standard termination language as it allows the State to terminate for cause, cancel immediately for cause, or upon 30 days written notice, the State may terminate with or without cause. The recommended award includes a termination clause that allows the County to submit a written request to the State to terminate the contract only in the event the State substantially fails to perform its duties under the contract.
REFERENCE MATERIAL:
BAI #37, August 22, 2017
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk -Acceptance of Award with CDPH
CAO ANALYST:
Sonia M. De La Rosa