DATE: May 23, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Revenue Agreement with the California Department of Public Health
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute a retroactive revenue Agreement with the California Department of Public Health to implement the Syphilis Outbreak Strategy, effective July 1, 2022 through June 30, 2027, total not to exceed $1,751,673.
REPORT
There is no additional Net County Cost associated with the recommended action. Approval of the recommended action will provide funding from the California Department of Public Health (CDPH) to enhance Department of Public Health (Department) syphilis and congenital syphilis (CS) prevention activities to address the rise of cases within the County, with a focus on disproportionately impacted populations. This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended action, the Department would not be able to enhance strategies and activities aimed at reducing the rise of syphilis cases in the County utilizing dedicated CDPH funding.
RETROACTIVE AGREEMENT:
The recommended retroactive revenue agreement was received from CDPH on November 14, 2022, with a final approved version from CDPH on April 28, 2023. The agreement is retroactive to July 1, 2022; however, the Department has not conducted any activities through this agreement because of contract negotiations with CDPH. It is anticipated the Department will fully utilize the funding through this agreement by the end of the term to meet expected goals.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The recommended revenue agreement will provide a maximum of $1,751,673 to offset costs associated with providing syphilis and CS services from July 1, 2022 through June 30, 2027. The agreement allows full indirect cost recovery, currently at 18.82% of salaries and benefits. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2022-23 Adopted Budget and will be included in subsequent budget requests.
DISCUSSION:
Due to the high rates of early syphilis or CS, Fresno County is one of eight local health jurisdictions within California to be allocated funding by CDPH from the one-time appropriation in the 2022 California Budget Act. Through the recommended agreement, the Department will receive funding from CDPH to support innovative and impactful syphilis and CS prevention and control activities, with a focus on disproportionately impacted populations as determined by the Department’s Epidemiology, STD, and CS Case Management programs. The Department will seek to partner with local clinics, increase the County’s Bicillin program where the local providers are given doses of the antibiotic treatment for syphilis, and create a DoxyPEP program which will provide education on the syphilis preventing medication to increase screening, treatment, and prevention of syphilis and CS.
Since 2016 Fresno County has been struggling with high rates of both syphilis and CS cases, experiencing an average of 1,300 syphilis cases and 40 CS cases per year from 2017 to 2022. After seeing a decline in cases in 2018 from the 2017-high case rates of 1,542 syphilis and 64 CS, the County began to experience an increase in its number of cases by roughly 15% per year since 2020. The current 2022 case numbers are comparable to (or exceed) the 2017 high case rates, creating an urgent need to address this issue for Fresno County.
The recommended agreement also deviates from the County’s standard indemnification language and requires the County (and any County contractor receiving this funding) 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 acceptance of the indemnification language is advantageous to the County, as the grant award will be an essential funding source for syphilis and congenital syphilis prevention and control activities, without which the continued provision of these services would be negatively impacted.
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with the California Department of Public Health
CAO ANALYST:
Ron Alexander