Agenda Item   

AGENDA STAFF REPORT

 

                                                                                                                        ASR Control  12-001721

 

MEETING DATE:

01/29/13

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):

Donna Fleming  (714) 834-2980 

 

 

 

 

 

Subject:  Agreements for HIV 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: 3/1/13 - 6/30/13: $765,687

Annual Cost: 7/1/13 - 6/30/14: $2,216,534
7/1/14 - 2/28/15: $1,370,320

 

 

 

    Staffing Impact: No

# of Positions:

Sole Source: N/A

    Current Fiscal Year Revenue: N/A

    Funding Source: FED: 100% (Ryan White)

 

    Prior Board Action: 1/24/2012 #26 & 11/20/2012 #8

 

RECOMMENDED ACTION(S):

 

 

1.

Approve the Agreement with AIDS Services Foundation Orange County for provision of HIV Services with a maximum obligation of $1,717,109 for the period March 1, 2013 through February 28, 2014 and a maximum obligation of $1,717,109 for the period March 1, 2014 through February 28, 2015.

 

2.

Approve the Agreement with Delhi Center for provision of HIV Services with a maximum obligation of $142,958 for the period March 1, 2013 through February 28, 2014 and a maximum obligation of $142,958 for the period March 1, 2014 through February 28, 2015.

 

3.

Approve the Agreement with Laguna Beach Community Clinic, Inc. for provision of HIV Services with a maximum obligation of $241,581 for the period March 1, 2013 through February 28, 2014.

 

4.

Approve the Agreement with Shanti Orange County for provision of HIV Services with a maximum obligation of $195,413 for the period March 1, 2013 through February 28, 2014 and a maximum obligation of $195,413 for the period March 1, 2014 through February 28, 2015.

 

5.

Without further Board action, authorize the Health Care Agency Director or designee to exercise a contingency Agreement cost increase of the maximum obligation of the Agreements referenced in Recommended Actions 1 through 4 above not to exceed a total of ten percent of the maximum obligation for the period March 1, 2013 through February 28, 2014 for the entire term of the contract and within the scope of work set forth in the contract.

 

6.

Authorize the Health Care Agency Director, or designee, on behalf of the Board of Supervisors, to execute the individual Agreements as referenced in Recommended Actions #1 through 4 above.

 

 

 

 

 

SUMMARY:

 

The Health Care Agency requests approval of Agreements with AIDS Services Foundation Orange County, Delhi Center, Laguna Beach Community Clinic, Inc., and Shanti Orange County for provision of HIV Services.

 

 

 

BACKGROUND INFORMATION:

 

As of December 31, 2011, there are an estimated 6,674 Orange County residents living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS).  Based on current reporting trends, there are approximately 300-350 newly reported HIV/AIDS cases in Orange County each year. Under the Ryan White Treatment Extension Act of 2009 (Ryan White Act), the County of Orange receives funds to provide medical and support services to persons living with HIV disease. The Orange County HIV Planning Council (Council) has mandated authority to establish service priorities and allocate Ryan White Act funding to service categories based on service utilization information, expenditure data, and epidemiological data. As the fiscal agent for the funding, the Health Care Agency (HCA) procures those services. 

 

The HCA solicited proposals for HIV services in 2010 for Agreements starting in FY 2010/2011. On January 24, 2012, your Honorable Board approved original Agreements with AIDS Services Foundation (ASF), Delhi Center (Delhi), Laguna Beach Community Clinic, Inc. (LBCC), and Shanti Orange County (Shanti) for the period of March 1, 2012 through February 28, 2013. Your Board also approved a subsequent amendment to the agreement with LBCC on November 20, 2012. The proposed Agreements continue HIV services with the same organizations at the same funding and service levels as the original agreements except where noted below.

 

Because Agreements must be executed prior to Federal award notification, mid-year reallocations and agreement amendments are often necessary to properly expend funding during the allowable 12 month fiscal period. Penalties are implemented if more than 5% of formula funding is unobligated at the end of the fiscal year. Therefore, the HCA also requests that your Board authorize the Purchasing Agent, or designee, to amend, as needed, each Agreement’s maximum obligation by an amount not to exceed 10 percent of the maximum obligation without further Board action.

 

AIDS Services Foundation

The FY 2012-13 maximum obligation was amended twice during the term of the Agreement, to meet service need, by exercising the Board approved contingency cost increase from $1,618,245 to $1,772,594.  Therefore, the maximum obligation of the proposed Agreement is being decreased from the current Agreement by $55,485 from $1,772,594 to $1,717,109. Funding levels and units are consistent with the current FY 2012-13 Agreement except where noted below:

-

Medical Case Management ($661,885): Provision of case management services to 451 clients to maintain medical care;

-

Non-Medical Case Management ($102,785): Assist 250 clients in referrals to eligible services;

-

Benefits Counseling ($187,000 decrease from $187,485): Assist 750 clients in obtaining and maintaining public and private benefits;

-

Minority AIDS Initiative (MAI) Medical Case Management ($144,226):  Provision of case management services to 128 clients who meet MAI criteria to maintain medical care;

-

Nutritional Supplements ($57,584): Provision of nutritional supplements to 214 clients to help them gain and/or maintain appropriate weight;

-

Food Bank ($99,000 decrease from $114,000): Provision of food orders to 321 clients to help them gain and/or maintain appropriate weight;

-

Mental Health ($155,399):  Provision of individual and group counseling to 134 individuals;

-

Emergency Financial Assistance for Medications and Health Insurance ($39,363): Provision for payments of insurance premiums, co-payments, or medications for 52 clients;

-

Home Health Care ($135,000): Provision of in-home health care services such as nursing attendant care and skilled nursing visits to 86 clients; and

-

Medical Transportation Services ($134,867 decrease from $174,867): Provision of transportation services to 130 clients for health care appointments.

 

Delhi Center

Maintain annual funding from the prior period of $142,958 for the following:

-

Minority AIDS Initiative (MAI)-Medical Case Management: Provision of case management services to 140 clients to maintain medical care.

 

Laguna Beach Community Clinic, Inc. (LBCC)

Increase maximum obligation from the prior period by $5,000 from $236,581 to $241,581 for ambulatory medical care. Combined Ryan White funding and HCA's Low Income Health Program revenue maintains level funding for services at $241,581.  Language included in the Agreement allows HCA to reduce the maximum obligation by any LBCC generated revenues for the following:

-

Outpatient/Ambulatory Medical Care: Provision of HIV medical care to 151 clients in the southern region of the County.

 

Shanti Orange County

The FY 2012-13 maximum obligation was amended to meet service need, by exercising the Board approved contingency cost increase from $178,413 to $195,413. Under the proposed Agreement, funding levels and units are consistent with the amended FY 2012-13 Agreement for the following:

-

Medical Case Management ($51,222): Provision of case management services to 71 clients to maintain medical care;

-

Client Advocacy ($28,191): Provision of assessment and referral services to 70 clients to maintain medical and supportive services;

-

Home Delivered Meals ($50,000): Provision of nutritional meals delivered to 30 home-bound clients; and

-

Mental Health ($66,000): Provision of individual and group counseling to 49 individuals.

 

Outcome measures for these programs are consistent with outcome measures established by the federal Health Resources and Services Administration and can be summarized as follows: improvement in health status and increased access to available services. The quality management report of FY 2011-12 indicates that services received have helped clients to maintain or improve their health as well as access and stay engaged in care.  For example, 92% of clients had an undetectable viral load.

 

Administrative and programmatic evaluations of the proposed providers indicate that all are meeting or exceeding expectations in providing the services.

 

The Agreements with Delhi and LBCC do not have subcontracts.  ASF subcontracts with an individual provider for facilitation of a Spanish language mental health support group for the annual budgeted amount of $3,675 and with Action Home Health Care and Visiting Nurses Association for home health care services for the annual budgeted amount of $109,250.  Shanti subcontracts with an individual provider who serves as director of its mental health program for the annual budgeted amount of $55,000.

 

The Health Care Agency requests that your Board approve the Agreements for HIV Services with AIDS Services Foundation Orange County, Delhi Center, Laguna Beach Community Clinic, Inc., and Shanti Orange County; authorize the Health Care Agency Director, or designee, to exercise a contingency contract cost increase; and authorize the Health Care Agency Directors, or designee, to execute the individual Agreements as referenced in Recommended Actions 1 through 4.

 

 

 

FINANCIAL IMPACT:

 

The Agreements are included in the Health Care Agency's FY 2012/13 Current Budget and will be included in the budgeting processes for FY 2013/14 and FY 2014/15.

 

It is estimated that funding for these services represent an estimated 32% of AIDS Services Foundation Orange County budget, 11% of Delhi Center budget, 10% of Laguna Beach Community Clinic budget and 41% of Shanti Orange County budget.  Should services need to be reduced or terminated due to lack of funding, these Agreements contain language that allows Health Care Agency 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.  HCA staff has reviewed each contractors' financial documentation, including their most recent financial statements.  At this time, there appear to be no issues that would impact the contractors' ability to perform services.

 

 

 

STAFFING IMPACT:

 

N/A

 

 

ATTACHMENT(S):

 

A.  Agreement for Provision of HIV Services between County of Orange and AIDS Services Foundation of Orange County
B.  Agreement for Provision of HIV MAI Medical Case Management Services between County of Orange and Delhi Center
C.  Agreement for Provision of HIV Services between County of Orange and Laguna Beach Community Clinic, Inc.
D.  Agreement for Provision of HIV Services between County of Orange and Shanti Orange county.
E.  Redline Version to Attachment A
F.  Redline Version to Attachment B
G.  Redline Version to Attachment C
H.  Redline Version to Attachment D