AGENDA STAFF REPORT

Agenda Item AGENDA STAFF REPORT ASR Control 20-001007
MEETING DATE:	01/26/21
legal entity taking action:	Board of Supervisors
board of supervisors district(s):	All Districts
SUBMITTING Agency/Department:	Health Care Agency (Approved)
Department contact person(s):	Marc Meulman (714) 834-2980
	Margaret Bredehoft (714) 834-3882

Subject: Amendment to Contract for Rental Assistance Program Services

ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Agreement to Form

Discussion

3 Votes Board Majority

Budgeted: Yes

Current Year Cost: $37,500

Annual Cost: FY 2021-22 $112,500,
FY 2022-23 $112,500,
FY 2023-24 $112,500,
FY 2024-25 $75,000

Staffing Impact:

# of Positions:

Sole Source: Yes

Current Fiscal Year Revenue: N/A

Funding Source: FED: 100% (Health Resources and Services Administration)	County Audit in last 3 years: No

Prior Board Action: N/A

RECOMMENDED ACTION(S):

Approve Amendment No. 1 to renew the Contract with City of Anaheim for provision of Rental Assistance Program Services for the term of March 1, 2021, through February 28, 2025, for an amount not to exceed $450,000 for a revised cumulative contract total amount of $500,000.

Authorize the County Procurement Officer or authorized Deputy to execute Amendment No. 1 to the Contract with City of Anaheim, as referenced in the Recommended Actions above.

SUMMARY:

Approval of Amendment No. 1 to the Contract with the City of Anaheim for Rental Assistance Program Services will allow expanded housing availability for people living with HIV to achieve optimal health outcomes and reduce further transmission of HIV in Orange County.

BACKGROUND INFORMATION:

As of December 31, 2019, there were 6,449 individuals diagnosed and living with HIV in Orange County. In addition, an estimated 904 individuals are unaware that they are living with HIV according to Centers for Disease Control and Prevention methodology, bringing the total estimated number of people living with HIV (PLWH) in Orange County to 7,353, as of December 31, 2019. Orange County receives approximately 300 newly reported cases of HIV each year.

On February 21, 2020, the Health Care Agency (HCA) was awarded $850,000 annually in grant funding for a five-year project period (March 1, 2020 - February 28, 2025) from the Health Resources and Services Administration (HRSA) for the project titled, "Ending the HIV Epidemic: A Plan for America-Ryan White HIV/AIDS Program Parts A and B”. Your Honorable Board of Supervisors (Board) approved HCA to accept this grant award on March 24, 2020. The goal of the Ending the HIV Epidemic (EHE) Initiative is to reduce new HIV infections in the U.S. to less than 3,000 per year by 2030. HRSA EHE Initiative funding is intended to support efforts to link and retain PLWH into care and support services and achieve viral load suppression.

The City of Anaheim is the sole recipient of Housing Opportunities for Persons with AIDS (HOPWA) funding from the U.S. Department of Housing and Urban Development (HUD) in Orange County. HOPWA funding is allocated to the most populous city in the County or jurisdiction. The HOPWA Program provides funding for housing and related support services for low–income PLWH throughout Orange County. The Rental Assistance Program (RAP) provides financial payments on behalf of eligible PLWH to ensure permanent housing is maintained. The monthly RAP payments on behalf of eligible PLWH are provided in accordance with HUD requirements and service qualifications for the RAP:

a. Have an income under 50 percent of area median income

b. Be HIV positive

Due to the COVID-19 pandemic and to allow needed services to be provided as soon as possible to populations disproportionately impacted by HIV and COVID-19, HCA entered into a five-month pro-rated Contract in the amount of $50,000 with the City of Anaheim through a Sole Source process on October 1, 2020, to provide RAP Services utilizing EHE grant funding. This Contract will end February 28, 2021.

HCA has completed a second Sole Source to allow for the continuation of RAP Services through the City of Anaheim. This allows HCA to build upon its existing partnership with the City of Anaheim and leverage EHE Initiative funding with HOPWA funding to support the housing needs of PLWH in Orange County through the RAP. Funding will provide financial assistance for housing to eligible PLWH (households). The second Sole Source was executed on November 25, 2020, and allows for an additional four-year contract for the term of March 1, 2021, through February 28, 2025, for a contract amount of $450,000.

Performance Standards

RAP Services target individuals disproportionately impacted by HIV who are very low income as defined by HUD (50 percent of area median income) and who are ineligible for other housing programs to help prevent homelessness. Without stable housing, these individuals are less likely to link to care, stay in care, take their medications and ultimately achieve or maintain viral suppression. In addition, PLWH who are homeless and contract COVID-19 may have worse health outcomes and could more easily transmit COVID-19. Ensuring long-term housing for this population is essential to reducing transmission of both HIV and COVID-19.

Performance outcome measures for HIV Housing Services such as the RAP include the percentage of virally suppressed clients receiving services to assess the impact of services in helping clients maintain or improve their health as well as stay engaged in care. Viral load is an indication of the amount of active HIV in the blood; a suppressed viral load is an indication of improved health for the client and reduces the risk of HIV transmission. The viral load outcome measure is collected through laboratory reports.

Outcome Measure

FY 2018-19

Outcomes

FY 2019-20 Outcomes

FY 2020-21

Goals

Percentage of virally suppressed clients receiving Housing services

78 percent

82 percent

This Contract does not currently include subcontractors. See Attachment B for Contract Summary Form.

HCA requests that the Board approve Amendment No. 1 to the Contract for the provision of RAP Services as referenced in the Recommended Actions.

FINANCIAL IMPACT:

Appropriations for the Contract are included in Budget Control 042 FY 20-21 Budget and will be included in the budgeting process for future years.

Should services need to be reduced or terminated due to lack of funding, the Contract contains language that allows HCA to give 30 days' notice to either terminate or renegotiate the level of services to be provided. The notice will allow HCA adequate time to transition or terminate services to clients, if necessary.

STAFFING IMPACT:

N/A

ATTACHMENT(S):

Attachment A - Amendment No. 1 to Contract MA-042-21010428
Attachment B - Contract Summary Form
Attachment C - Redline Version for Attachment A
Attachment D - Sole Source Justification