DATE: January 24, 2023
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 - County Integrated Data Sharing System
RECOMMENDED ACTION(S):
TITLE
1. Approve the allocation of American Rescue Plan Act State and Local Fiscal Recovery Funds (ARPA-SLFRF) from Auditor-Controller/Treasurer-Tax Collector Disaster Claiming - Org 1033 to the Department of Public Health - Public Health Support Org 56201500 to authorize the acquisition and development of a Countywide Integrated Data Sharing System that would begin the initial phase of implementing the County Integrated Data Initiative, which will connect existing County information systems and improve coordination of data sharing within County systems and between the County and County partners which will improve the effective utilization of health resources to County residents ($5,000,000);
2. Adopt Budget Resolution increasing FY 2022-23 appropriations and estimated revenues for the Department of Public Health - Public Health Support Org 56201500 in the amount of $300,000 (4/5 vote).
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first recommended action will allocate $5,000,000 of ARPA-SLFRF to the Department of Public Health (Department) and authorize the acquisition and development of a Countywide Integrated Data Sharing System (IDSS) to connect existing County information systems to improve operational efficiency and potentially reduce duplication of services. The total cost of the IDSS project will exceed the amount recommended to your Board in this item. The Department plans to pursue other funding sources to bring a total project budget to at least $10 to $15 million, including plans to partner with the Fresno County Superintendent of Schools (FCSS). In the initial phase of the project, with your Boards approval of the first action, the Department anticipates that the IT framework will be developed, and some County databases will be able to exchange information among County departments, and possibly a County partner outside of the County IT Infrastructure. Approval of the second recommended action will increase appropriations to cover current year expected initial planning costs ; the remaining funds will be budgeted in subsequent years as the project progresses. This item is countywide.
ALTERNATIVE ACTION(S):
If your Board does not approve the recommended actions, the ARPA-SLFRF funds would not become available to the Department to begin to acquire and develop the IDSS which has been enumerated as an eligible response to the public health emergency or its negative impacts. The Department’s implementation of the recommended IDSS would be delayed until another funding source is identified.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The Department is requesting an allocation up to $5,000,000 to fund a portion of the IDSS project. Approval of the recommended Budget Resolution will increase the FY 2022-23 DPH - Public Health Org 56201500 appropriations and estimated revenues in the amount of $300,000 to fund initial planning expenses for the IDSS project. Costs will be offset through the Auditor-Controller/Treasurer-Tax Collector Org 1033 - Disaster Claiming, Fund 0026, Subclass 91021. The County Auditor will process claim reimbursements to the Department which will follow their established claim guidelines. The remaining $4,700,000 from the SLFRF allocation for this project will be included in the Department’s subsequent fiscal year budget requests.
DISCUSSION:
The ARPA-SLFRF Program 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 SLFRF Program ensures that governments have the resources needed to fight the pandemic and support families and businesses struggling with the public health and economic impacts, maintain vital public services, and build a strong, resilient, and equitable recovery by making investments that support long-term growth and opportunity.
In May 2021, the U.S. Department of the Treasury (Treasury) published 31 Code of Federal Regulations Part 35 Coronavirus State and Local Fiscal Recovery Funds Interim Final Rule (“Interim Final Rule”) for expenditure prior to April 1, 2022; and, the Final Rule (“Final Rule”), which established a framework to determining the type of programs and services that are eligible to receive SLFRF under the ARPA. The Final Rule became effective on April 1, 2022.
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 investments in 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, including the County and its subrecipients, must return any funds to the Treasury which are not obligated by December 31, 2024, and any funds not expended to cover such obligations by December 31, 2026.
On February 1, 2022, your Board approved the Ad-Hoc Committee’s expenditure plan, which earmarked funds for proposals that may be funded either in whole or in part by the County’s $194,063,657 allocation of SLFRF. The Board-approved expenditure plan earmarked funding and committed departments to further vet and return to your Board to formally request approval of the allocation for their earmarked projects. The Department’s recommended project is an enumerated Eligible Use of SLFRF under Category A, as the IDSS project would respond to the COVID-19 public health emergency or its negative impacts by enhancing a public health data system, under the subcategory of COVID-19 mitigation and prevention. The Department’s recommended project that will be funded by SLFRF is described as follows:
Public Health (Eligible Use Category A)
County Integrated Data Sharing System
Project Expenditure Category: E.C. 1.7 Public Health, Other COVID-19 Public Health Expenses
Funding Amount: $5,000,000
Total Expenditures to Date: $0
Estimated Start Date: February 2023
Estimated Completion Date: January 2025
In recognition of the importance of capital expenditures in the COVID-19 public health response,
the Final Rule specified that recipients may make various eligible capital expenditures, including establishing or enhancing public health data systems that support responses to the COVID-19 public health emergency, that may also provide benefits for other use cases and long-term capacity of public health departments and systems. Under the Final Rule, COVID-19 mitigation and prevention consistent with recommendations and guidance from the Centers for Disease Control and Prevention, which includes the establishment or enhancement of public health data systems, is an enumerated eligible use of SLFRF.
The Department’s IDSS project will assist County departments who are contributing data to coordinate more efficiently the County’s allocation of resources. Specifically, departments will be able to coordinate medical, mental health, and social services to avoid redundancies and duplication of services by County staff or County contracted services (e.g., community-based organizations). Further development of the County’s public health data system will assist with coordination between appropriate County departments during a pandemic, epidemic, or high-risk event . For example, during the COVID-19 response, it was imperative to ensure first responders were well informed before providing aid to COVID-19 positive patients or individuals believed to be infected by COVID-19, to reduce the spread of COVID-19 and ensure appropriate protocols were followed in custody, during temporary detainment, and to determine if there was a possible exposure to COVID-19. This process was initially managed through spreadsheets and by phone calls, which were inefficient when communicating in situations that required real-time access to data for first responders to serve clients, while also protecting public health and mitigating the spread of COVID-19.
The cost of the IDSS project will exceed the amount recommended to your Board in this Item. The Department plans to pursue other funding sources to bring a total project budget to at least $10 to $15 million. In addition, the Department plans to partner with FCSS to assist with funding, initial costs and ongoing maintenance costs of the information technology (IT) backbone . FCSS would take the lead in supporting the Community Information Exchange component of the County IDSS that would support schools and contracted community-based organizations (CBOs). With this shared IT backbone, County departments will be able to determine more easily which common clients are being provided service by not just County staff, but also by County-contracted CBOs. This streamlining of information would allow effective and efficient utilization of County resources that hasn’t been accessible to the County thus far and will result in improved coordination of care for County residents and improved public health data systems to meet new demands, as well as provide for scaling needs in the event of future public health emergencies.
County IDSS will require significant contractual commitments from FCSS, the County, and other agencies interested in supporting development and/or access to information. The Department will coordinate with the County Administrative Office (CAO), County Counsel, FCSS, and interested County departments to draft, negotiate, and review the appropriate Master Agreement(s), which will be brought to your Board for your Board’s consideration. On a parallel track, the Department will work with FCSS to draft a Request for Proposal (RFP) that meets both the County’s and FCSS’s requirements, and which will solidify the backbone IT costs of the project in a phased implementation approach. The Department would move forward with each phase described below, contingent upon funding availability.
Participating County departments will determine which data would be allowed to be shared with other County departments and outside agencies, and who may view County data. Each County department’s decision to share data will extend not only to fellow County department staff, but also to contracted County vendors, CBO’s, and certain school districts. As participating department’s develop a proposed framework leading to a proposed agreement or intra-department arrangement the proposed agreement or intra-department arrangement will undergo County Counsel’s review as to legal form in the manner that is typical of its review of proposed County agreements.
The County implementation team will consist of representatives from CAO to assist in the coordination efforts, Department of Public Health, Department of Behavioral Health, Department of Social Services, Probation, Internal Services, and other County departments interested in contributing data. The County implementation team will consult with County Counsel, as needed.
The County team will solicit a consultant to assist with the IT infrastructure development, RFP development, implementation, and operational maintenance of the system.
For estimated Phase I implementation ($5 million), SLFRF will fund the development of the necessary Master Agreement(s) (including confidentiality, financial, and governance provisions), consultant costs for project management, RFP development, and legal support, and will support a significant financial portion of the IT backbone to achieve a minimal viable product. In this phase the IT framework will be developed, and some County database would be exchanging information amongst County departments and possibly a partner outside of the County IT infrastructure. Estimated completion by January 2025.
Estimated Phase II implementation ($5 million source to be identified) will fund building from the IT backbone, exchanging information with County databases, and creating interoperability within limited systems.
Estimated Phase III implementation ($5 million source to be identified) will add to Phase II progress by connecting more IT systems and will evaluate exchanging data with the local Health Information Exchange and/or other larger exchanges to improve coordination of care.
Currently, the Department anticipates that FCSS will assist in the original design of the County IDSS and provide some funding for the initial IT backbone costs and future maintenance costs. FCSS will share the IT backbone to create an interface from the community perspective of integrating school data and contracted CBO’s. This type of design is consistent with a current community school model that is being implemented throughout Fresno County, which is experiencing significant funding opportunities from the State level.
With your Board’s approval of the recommended actions, $5,000,000 will be allocated to the Department to be used to initially implement the IDSS project. The project is tentatively scheduled to begin, pending your Board’s approval of the funds. Detailed scopes of work, project timelines, including project start and completion dates, and key performance indicators for this project will be provided to the CAO on a quarterly and annual basis.
REFERENCE MATERIAL:
BAI #3, February 1, 2022
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Resolution (Org 5620)
CAO ANALYST:
George Uc