Agenda Item   



                                                                                                                        ASR Control  10-000574




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):

Robert Gates (714) 834-2021 



Melissa Tober (714) 834-5891



Subject:  Community Clinic Tobacco Settlement Revenue Agreements


      ceo Concur

County Counsel Review

Clerk of the Board


Approved Agreement to Form




3 Votes Board Majority




    Budgeted: Yes

Current Year Cost: N/A

Annual Cost:
FY 2010-11: $5,189,618




    Staffing Impact: No

# of Positions:

Sole Source: N/A

    Current Fiscal Year Revenue: N/A

    Funding Source: TSR: 100%


    Prior Board Action: N/A






Approve the Agreement for Support of Community Clinic Services for the period July 1, 2010 through June 30, 2011 with the Coalition of Orange County Community Clinics, in the amount of $298,240.



Approve the Master Agreement for the Provision of Community Clinic Services for the period July 1, 2010 through June 30, 2011, in the amount of $4,891,378.



Authorize the Health Care Agency Director, or designee, on behalf of the Board of Supervisors, to execute the individual Agreements set forth in item number 2 with participating community clinics.







The Health Care Agency requests approval of the Community Clinic Services Agreement with the Coalition of Orange County Community Clinics and the Master Agreement for the Provision of Community Clinic Services with the individual Community Clinics.






In accordance with Measure H and the policy guidelines approved by your Honorable Board on April 28, 2009, the Health Care Agency (HCA) is proposing to distribute the community clinic allocation of Tobacco Settlement Revenue (TSR) for direct medical, dental, and mental health services to community clinics through a Master Agreement with the various licensed community clinics in Orange County.  These funds were previously distributed through an agreement with the Coalition of Orange County Community Clinics (Coalition).  For FY 2010-11, the Coalition has proposed redirecting its efforts from providing administrative oversight and program support services for the community clinics to developing and implementing an access and quality program.


Agreement with Coalition - $298,240


By redirecting its efforts, the Coalition is proposing to work collaboratively with community clinics to increase access to direct medical, dental, and mental health services for the uninsured, underinsured, and indigent populations of Orange County, and to enhance the quality performance of the clinics.  Under the terms of the proposed Agreement, the Coalition will work with the community clinics to improve patient flow and access at all facilities, design and implement a Healthcare Effectiveness Data and Information Set (HEDIS) program, expand patient satisfaction survey tools, and promote and facilitate adoption and meaningful use of electronic health records.  The proposed Agreement will include subcontracts with consultants who will provide professional medical and dental consulting services that assist the Coalition in carrying out the specific service obligations of the Agreement.


Master Agreement with Community Clinics - $4,891,378


Beginning in FY 2010-11, HCA will assume direct responsibility for administering the agreements for Community Clinic Services with the participating Community Clinics through the proposed Master Agreement. 


A total of $4,891,378 is available for participating community clinics for FY 2010-11.  Of this amount, $75,000 is set aside for funding of new community clinics that have not previously participated in the TSR program.  For FY 2010-11, North Orange County Regional Health Foundation is the only new clinic expressing interest in providing TSR funded community clinic services.


The balance of the funding is allocated to each of the community clinics that are continuing to provide TSR funded services based on the following formula:  50% divided equally among all the clinics, and the remaining 50% allocated to each clinic based on its Uncompensated Care and Client Encounters, as reported to Office of Statewide Health and Planning Department for the four quarters ending December 31, 2008, the latest full year of data available for all participating community clinics.


The following licensed community care clinics in Orange County submitted proposals detailing how they would use the TSR funds available to them.  HCA reviewed each proposal to ensure that the proposed services and financial considerations comply with your Board's approved policies relating to these funds.  Specifically, the reviews confirmed that funds would 1) be used for direct medical, dental or mental health services; 2) not be used to offset the cost of services funded by other payors; and 3) not support the provision of abortions or abortion related activities.


The resulting contracts and proposed services are as follows:



Community Clinic










$   269,311

Medical, Dental

Huntington Beach

Birth Choice


$   162,926


Irvine, Placentia, Santa Ana

Camino Health Center


$   258,006


San Juan Capistrano

Central City


$   210,440



Children's Hospital

of Orange County


$   265,966



Friends of Children


$   224,803

Medical, Dental

La Habra

Gary Center


$   395,492

Mental Health, Dental

La Habra

Healthy Smiles for Kids


$   206,766


Garden Grove

Hurtt Family Health Clinic (OCRM)


$   248,461



Laguna Beach

Community Clinic


$   229,709


Laguna Beach

Lestonnac Free Clinic


$   288,007

Medical, Dental


Nhan Hoa

Comprehensive Health Clinic


$   284,874


Garden Grove

North Orange County Regional Health Foundation

$   75,000







Share Our Selves Free Medical Clinic


$   393,988

Medical, Dental

Costa Mesa

Sierra Health Center


$   191,187



St. Joseph - La Amistad


$     96,014



St. Joseph - Puente a la Salud


$   213,707



St. Jude Community Clinics


$   253,261



UCI Family Health Clinics

$   426,624

Medical, Dental


Santa Ana

VNCOC Asian Health Center

$   196,836

Medical, Dental

Santa Ana











These Agreements contain mutual indemnification provisions which vary from the County standard of sole indemnification.  CEO/Risk Management has approved the indemnification and insurance provisions and determined the risk to be acceptable for these services.


Should services need to be reduced or terminated, these Agreements and all Coalition subcontracts contain language that allows HCA to give 30 days notice to either terminate or renegotiate the level of specific services to be provided. The notice will allow HCA adequate time to transition or terminate services to clients, if necessary.


The Health Care Agency requests that your Board approve the Agreement with the Coalition of Orange County Community Clinics and the Master Agreement for Community Clinic Services as referenced in the Recommended Actions.






These Agreements are included in the Health Care Agency's FY 2010-11 Requested Budget.


Information provided by the Coalition of Orange County Community Clinics indicates that this Agreement represents less than ten percent of the contractor's total annual operating budget.


Master Clinic Agreement:  There are currently twenty community clinics that share an aggregate maximum funding amount under the proposed Master Agreement.  Funding for each clinic varies depending upon actual utilization of services.  For the past fiscal year, the most utilized clinic received approximately nine percent of total funding available.












A.  Agreement for Support of Community Clinic Services with the Coalition of Orange County Community Clinics
B.  Master Agreement for the Provision of Community Clinic Services
C.  Redline Version to Attachment A
D.  Redline Version to Attachment B