DATE: February 26, 2019
TO: Board of Supervisors
SUBMITTED BY: David Pomaville, Director, Department of Public Health
SUBJECT: Retroactive Cooperative Agreement Award with Centers for Disease Control and Prevention and Agreement with California State University, Fresno Foundation
RECOMMENDED ACTION(S):
TITLE
1. Accept the retroactive Cooperative Agreement Award from the Centers for Disease Control and Prevention’s Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes and Heart Disease and Stroke to improve prevention and management of heart disease and stroke through clinic-based strategies and community clinical linkages, effective September 30, 2018 through September 29, 2023 ($3,000,000); and
2. Adopt Budget Resolution increasing FY 2018-19 appropriations and estimated revenues for Public Health Org 5620 in the amount of $255,803 (4/5 vote); and
3. Make a finding that it is in the best interest of the County to waive the competitive bid process consistent with Administrative Policy No. 34 for unusual or extraordinary circumstances for the solicitation of evaluation consultation services for the Department of Public Health; and
4. Approve and authorize the Chairman to execute a sole source Agreement with California State University, Fresno Foundation through its Central Valley Health Policy Institute for comprehensive evaluation services for identification and treatment protocols of high-risk hypertension and high cholesterol of patients of low socioeconomic status for the Collaborating for Wellness: Rx for Health Program, effective upon execution through September 29, 2023, not to exceed four-years seven-months, which includes a two-year seven-month base contract with two optional one-year extensions, total not to exceed $303,333.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first recommended action will accept the Centers for Disease Control and Prevention (CDC) five-year grant funding; $600,000 a year to fund contractual costs, staffing, services, and supplies for the Collaborating for Wellness: Rx for Health Program (Program). The second recommended action will increase the spending authority and revenue for the Program in FY 2018-19. The third and fourth recommended actions will allow the Department of Public Health to implement the Program’s scope of work through California State University (CSU) Fresno Foundation, Central Valley Health Policy Institute (CVHPI), which will address chronic disease in the County and is expected to contribute to the reduction of hypertension rates and increase detection and management of heart disease. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions; the Department will decline the award from the CDC.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
The Department’s request to waive the competitive bidding process is consistent with Administrative Policy No. 34, as CVHPI is the only vendor with specific knowledge of the Department and its grant programs and has the experience and unique capabilities to provide the required evaluation services without training prior to implementing services. Based on this, a letter of interest was not necessary. The Internal Services Department - Purchasing Division concurs with the Department’s request to waive the competitive bidding process.
RETROACTIVE AGREEMENT:
The Notice of Award (NOA) Authorization was received from the CDC on September 29, 2018 and the proposed Cooperative Agreement Award is retroactive to September 30, 2018. Due to the length of time required to prepare and submit requested revisions to the proposal and the length of time for CDC to review and accept the revisions, the item is coming to your Board retroactively.
FISCAL IMPACT:
There is no additional Net County Cost associated with the recommended actions. The total award for the proposed five-year Cooperative Agreement is $3,000,000; $600,000 annually, for contractual costs, staffing, services, and supplies to support chronic disease prevention and management. The recommended Budget Resolution will increase the Department’s Org 5620 FY 2018-19 budget by $255,803 to appropriate unbudgeted costs and revenue in support of the Program’s activities. The award allows for full reimbursement of indirect costs. The maximum compensation for the recommended agreement is $303,333; $43,333 for year one and $65,000 for years two through five for evaluation consultation services. The Department anticipates two subcontracts with local federally qualified health care clinic systems, resulting from a request for proposals, will be brought to your Board for consideration later.
DISCUSSION:
On August 7, 2018, the Board retroactively approved the July 9, 2018 submission of a grant proposal to the CDC for the Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes and Heart Disease and Stroke Project. The Department’s proposal requested Category A and Category B funds to improve prevention and management of diabetes, cardiovascular disease and heart disease and stroke through clinic-based strategies and community clinical linkages. The funding supports the design, testing, and evaluation of novel approaches to address evidence-based strategies aimed at reducing risks, complications, and barriers to the prevention and management of diabetes and cardiovascular disease in high-burden populations. On September 29, 2018, the Department received the NOA stating Category B funding, which focuses on cardiovascular disease, was awarded.
The Program funding will allow the Department to continue work started in 2014 as part of the California Department of Public Health Lifetime of Wellness Communities in Action (LWCA) grant. LWCA enabled the Department to work on strategies that promoted diabetes prevention as well as cardiovascular prevention. LWCA funding began September 30, 2014 and ended September 29, 2018. The Program will build upon the Partners in Community Health (PICH) grant that implemented strategies to reduce obesity and chronic illnesses from September 30, 2014 to September 29, 2017. The chronic disease prevention and management established by the LWCA and PICH grants are the basis for the Program’s scope of work.
Implementation of the Program will enable the County to reach low socioeconomic status populations through partnerships with community organizations and health clinic systems to promote and deliver evidence-based strategies, which is expected to result in an increase in positive health outcomes for County adults. Following a Request for Proposal issued January 2019, the Department anticipates two subcontracts with local federally qualified health care clinic systems will be brought to your Board for consideration to complete the following scope of work activities:
• Identifying patients at risk for hypertension;
• Promoting lifestyle change programs;
• Increasing and refining the referral system using electronic health records (EHR);
• Expanding the Rx for Health community referral program;
• Engaging non-physician team members; and,
• Working with local pharmacists to promote medication therapy management.
The Program includes an evaluator subcontract that will support ongoing process and outcome evaluations for activities and community based bi-directional referrals. The recommended agreement with CSU Fresno Foundation’s CVHPI for evaluation consultation services includes:
• Design of appropriate process and outcome evaluation methodologies, develop performance measures, and create tracking tools to monitor and collect required data;
• Conduct data collection, data entry, and statistical analysis to create written reports and disseminate findings in compliance with and as required by the Department and the CDC; and
• Draft the Evaluation Plan and Data Management Plan as required by CDC.
Evaluation findings produced through CSU Fresno Foundation’s CVHPI will contribute to continuous quality improvements of the Program, support the Program’s strategies, and help establish data for future funding opportunities.
Acceptance of the funding will allow the Department to fulfill the Program requirements. The grant does not have a contract termination provision.
The recommended agreement with CSU Fresno Foundation contains non-standard termination language allowing CSU Fresno Foundation to terminate without cause with 30 days advance written notice, and non-standard hold harmless language limiting CSU Fresno Foundation’s indemnification requirements to the extent of their fault. The nature of CSU Fresno Foundation’s scope of work does not involve protected health information, medical diagnoses, or other sensitive material. County Counsel has advised the risk of harm from this agreement is relatively low; therefore, the Department recommends the agreement with CSU Fresno Foundation.
REFERENCE MATERIAL:
BAI #38, August 21, 2018
BAI #34, May 2, 2017
BAI #51, July 12, 2016
BAI #54, August 11, 2015
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition Acquisition Request
On file with Clerk - Notice of Award/Cooperative Agreement from CDC
On file with Clerk - Resolution (Org 5620)
On file with Clerk - Agreement with CSU Fresno Foundation
CAO ANALYST:
Sonia M. De La Rosa