HomeMy WebLinkAboutAgreement A-22-184.pdf STATE OF CALIFORNIA-DEPARTMENT OF GENERAL SERVICES SCO ID:4265-2010704-A1 Agreement No. 22-184
STANDARD AGREEMENT-AMENDMENT
STD 213A(Rev.4/2020) FAGREEMENT NUMBER AMENDMENT NUMBER Purchasing Authority Number
CHECK HERE IF ADDITIONAL PAGES ARE ATTACHED PAGES 20-10704 1
1.This Agreement is entered into between the Contracting Agency and the Contractor named below:
CONTRACTING AGENCY NAME
California Department of Public Health
CONTRACTOR NAME
County of Fresno
2.The term of this Agreement is:
START DATE
April 22,2021
THROUGH END DATE
June 29,2023
3.The maximum amount of this Agreement after this Amendment is:
$156,397.00 One Hundred Fifty Six Thousand Three Hundred Ninety Seven Dollars and zero cents
4.The parties mutually agree to this amendment as follows.All actions noted below are by this reference made a part of the Agreement and
incorporated herein:
I.Purpose of amendment: Due to updated grant funding requirements,this amendment shifts unspent funds from Year 1 to Year 2,as identified in
Exhibit B,Budget Year 2-A,Attachment II-A,amends the Scope of Work by adding an activity and extending Timeline/Deliverables dates.
II.Certain changes made in this amendment are shown as: Text additions are displayed in bold and underline. Text deletions are displayed as strike
through text(i.e.,Strike).
Ill.Exhibit A,Scope of Work,is hereby replaced in its entirety and shall now read Exhibit A,A1,Scope of Work.
IV.Exhibit B,Budget Detail and Payment Provisions,is hereby replaced in its entirety and shall now read
Exhibit B,Al,Budget Detail and Payment Provisions.
V.Exhibit B,Attachment I,Budget Year 1,is hereby replaced in its entirety and shall now read Exhibit B,All,Attachment I,Budget Year 1.
VI. Exhibit B,Attachment II-A,Budget Year 2-A,is hereby incorporated and made a part of this Agreement and hereby augments Budget Year 2.
All other terms and conditions shall remain the some.
IN WITNESS WHEREOF,THIS AGREEMENT HAS BEEN EXECUTED BYTHE PARTIES HERETO.
CONTRACTOR
CONTRACTOR NAME(if other than an individual,state whether a corporation,partnership,etc.)
County of Fresno
CONTRACTOR BUSINESS ADDRESS CITY STATE JZIP
1221 Fulton Street Fresno CA 93721
PRINTED NAME OF PERSON SIGNING TITLE
Brian Pacheco Chairman of the Board of Supervisors of
the County of Fresno
CONTRACT, SIGNATURE DATE SIGNED
VV S- 3-a v a --4.
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno.State of California
By_ _Deputy
Page 1 of 2
STATE OF CALIFORNIA-DEPARTMENT OF GENERAL SERVICES SCO ID:4265-2010704-A 1
STANDARD AGREEMENT-AMENDMENT
STD 213A(Rev.4/2020) AGREEMENT NUMBER AMENDMENT NUMBER Purchasing Authority Number
CHECK HERE IF ADDITIONAL PAGES ARE ATTACHED PAGES 20-10704 1
STATE OF CALIFORNIA
CONTRACTING AGENCY NAME
California Department of Public Health
CONTRACTING AGENCY ADDRESS CITY STATE ZIP
1616 Capitol Avenue,Suite 74.262,MS 1802,PO Box 997377 Sacramento CA 95899
PRINTED NAME OF PERSON SIGNING TITLE
Joseph Torrez Jeannie Galarpe for Chief,Contracts Management Unit
CONTRACTING AGENCY AUTHORIZED SIGNATURE DATE SIGNED
d" 05/18/2022
CALIFORNIA DEPARTMENT OF GEN APPROVED----
EXEMPTION(If Applicable)
1
JUN 6-2022
EE:th
OFFICE OF LEGAL SERVICES
DEPT. OF GENERAL SERVICES
Page 2 of 2
County of Fresno
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Page 1 of 18
Exhibit A
Scope of Work
1. Service Overview
Pursuant to California Health and Safety Code Sections 131058 and 131085 the County of
Fresno, Department of Public Health (Contractor) will provide prevention and self-management
support to high burden/underserved adult populations diagnosed or at risk for Type 2 Diabetes
(diabetes).
Contractor services will increase chronic disease support services to target population health
status and improve patient intervention management systems through Health Information
Technology (HIT), Health Information Exchange (HIE), and Electronic Health Records (EHR).
Increase and improve referrals for nationally recognized lifestyle change and chronic disease self-
management programs. Service coordination, such as, meetings, consultations and reporting
scope of work activities will be conducted with public health and safety priorities. Service
coordination will be conducted using social distancing measures throughout the duration of the
Coronavirus pandemic, such as, virtual online platforms, telehealth, conference phone calls,
computer assisted coordination and emails.
The Centers for Disease Control and Prevention (CDC), CFDA number 93.426, Grant Number
NU58DP006540, funding awarded to the CDPH for Contractor Local Assistance provides
California Prevention Forward (PF) interventions; including required objectives and strategies as
described in the Scope of Work and in compliance with the CDC Grant.
2. Service Location
The services shall be performed at applicable facilities and/or remotely in the County of Fresno
as prescribed in the Scope of Work.
3. Service Hours
The services shall be provided during normal Contractor workdays, 8 am — 5 pm, Monday
through Friday, except official holidays.
4. Project Representatives
A. The project representatives during the term of this agreement will be:
California Department of Public Health Fresno County Department of Public
Lisa Pulido Health
Telephone: (916) 552-9948 Melanie Ruvalcaba, Program Manager
Fax: (916) 552-9729 Telephone: (559) 600-6449
E-mail: Lisa.Pulido@cdph.ca.gov Fax: (559) 600-7687
E-mail: mruvalcaba(a-),fresnocountyca.gov
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Page 2 of 18
Exhibit A
Scope of Work
B. Direct all inquiries to:
California Department of Public Health Fresno County Department of Public
Chronic Disease Control Branch Health
Attention: Jessica Nunez de Ybarra Office of Health Policy and Wellness
P.O. Box 997377, MS 7208 Attention: Melanie Ruvalcaba, Program
Sacramento, CA 95899-7377 Manager
1221 Fulton Street
Telephone: (916) 522-9877 Fresno, CA 93721
Fax: (916) 552-9729
E-mail: Telephone: (559) 600-6449
Jessica.NunezdeYbarra2(a-),cdph.ca.gov Fax: (559) 600-7687
E-mail: mruvalcaba@fresnocountyca.gov
C. All payments from CDPH to the Contractor shall be sent to the following address:
Remittance Address
Contractor: [County of Fresno
Attention Bruna Chavez, DPH Business Manager
[PO Box 11800
Fresno, CA, 93775
559-600-6438
559-600-7687
�dphboap@fresnocountyca.gov
D. Either party may make changes to the information above by giving written notice to the other
party. Said changes shall not require an amendment to this agreement.
5. Services to be Performed are in the Exhibit A, Attachment I, Scope of Work Below:
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Page 3 of 18
Exhibit A
Scope of Work
Year 1 — 3
March 1, 2021 — June 29, 2023
Category A — Pre-Diabetes and Diabetes Prevention and Control
Goal 1: Increase utilization of a health systems' reporting infrastructure to identify, treat, and manage patients with at least one of the
following six chronic conditions: prediabetes, type 2 diabetes, high blood pressure, undiagnosed high blood pressure, stroke, or high
blood cholesterol.
Subgoal 1.1. Coordinate with a Health System Champion (HSC) to increase Health Information Technology (HIT)/Electronic Health
Record (EHR) systems utilization to improve identification of individuals with prediabetes and type 2 diabetes. The HSC is required to
monitor, track, and complete California Department of Public Health (CDPH) quarterly reports on individuals with the identified chronic
conditions and report those individuals referred to the National Diabetes Prevention Program (National DPP) or Diabetes Self-
Management Education and Support (DSMES) services.
Objective(s) Activities Responsible Timeline Deliverables
Part
1. Partnership with 1.1 Contractor will serve as a liaison to Program March 1, 2021- 1.1 Submit via email to
Community provide resources to CRMC and Manager June 29, 2023 CDPH a list of
Regional Medical two (2) HSC's to assess, plan, and (PM), Health Quarterly materials distributed
Center (CRMC) and implement HIT systems to improve Education to CRMC and new
two (2) HSC's patient referrals to community Specialist HSC who received
implement systems prevention and management (HES) the materials,
to identify programs such as attending quarterly.
individuals with quarterly California Prevention
prediabetes or type Diabetes: Screen, Test, Act,
2 diabetes and refer TodayTM (CA PDSTAT) webinars
them to National and coordinating with Intrepid
DPP or DSMES. Ascent (IA) for HIT support.
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Exhibit A
Scope of Work
1.2 Contractor will complete PM, HES March 1, 2021- 1.2 Submit via email to
Prevention Forward (PF) Local June 39 29, CDPH the LHD
Health Department (LHD) quarterly 2023 survey, quarterly.
surveys to provide information on Quarterly
progress, accomplishments,
challenges, and technical
assistance needs in addressing
objective 1.
PM, HES 1.3 Submit via email to
1.3 Contractor will meet with CRMC March 1, 2021- CDPH CRMC and
and two (2) HSC's to assess, plan, June 29, 2023 HSC's
and implement policies/procedures Annually policies/procedures
to identify individuals within the utilized, annually, to
clinical service area diagnosed with identify individuals
prediabetes or type 2 diabetes. within their clinical
service area
diagnosed with
prediabetes or type
2 diabetes.
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Exhibit A
Scope of Work
Category A — Pre-Diabetes and Diabetes Prevention and Control
Goal 2: Increase patient utilization and adherence to evidenced-based strategies for monitoring referrals to community self-
management programs; such as: lifestyle change, nutrition improvement, and physical activity.
Subgoal 2.1 - Improve access to and participation in American Diabetes Association (ADA)-recognized/Association of Diabetes Care
and Education Specialists (ADCES)-accredited DSMES services in the Contractor's service area. Assist the HSC's to recruit and
expand organization(s) to obtain or renew ADA-recognition/ADCES-accreditation. Share DSMES best practice resources to increase
referral and enrollment.
Objective(s) Activities Responsible Timeline Deliverables
Party
2. Improve access to and 2.1 Recruit the Community Diabetes PM, March 1, 2021- 2.1 Submit via email to
participation in, at Education Program at Community June 29, 2023 CDPH a list of
minimum five (5) DSMES Regional Medical Center as the Quarterly recruited or
programs in underserved HSC's. expansion agencies
areas where the for ADA-
prevalence of chronic PM, HES recognition/ADCES
disease is above the State -accreditation,
average or national quarterly.
average, low income, and
residents who have limited 2.2 Assist HSC's and up to five (5) March 1, 2021- 2.2 Submit via email to
access to healthcare local providers seeking to become June 29, 2023 CDPH a list of
services and trainings in ADA-recognized/ADCES Quarterly DSMES
Fresno County. accredited DSMES programs to stakeholders that
increase referral and enrollment received a DSMES
into DSMES program. application,
quarterly.
PM, HES
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Exhibit A
Scope of Work
2.3 Provide at least two (2) March 1, 2021- 2.3 Submit via email to
educational Continuing Education June 29, 2023 CDPH a list of
Units/Continuing Medical Units Quarterly Training and
opportunities to providers Technical
regarding DSMES program and Assistance (TTA)
opportunities during the contract provided to DSMES
period. organizations to
establish, retain,
and will expand
DSMES; and will
provide a list of
materials
distributed and
organizations who
received the
materials, quarterly.
3. Provide monthly technical 3.1 Collaborate with Fresno Diabetes PM, HES March 1, 2021- 3.1 Submit via email to
assistance to the Fresno Collaborative to update and June 29, 2023 CDPH the LHD
Diabetes Collaborative in maintain web site Quarterly survey to update
efforts to educate and (www.fresnodiabetes.com) the website
inform the community and monthly to include current progress, quarterly.
providers about lifestyle programs, such as DSMES and
change programs in National DPP, and methods of
Fresno County. referrals to diabetes programs
posted on the website.
3.2Update website with learning PM, HES March 1, 2021- 3.2 Submit via email to
opportunities for diabetes June 29, 2023 CDPH the LHD
providers (physicians, nurses, and Quarterly survey to update
Community Health Workers the learning
(CHW): webinars, seminars, opportunities listed
symposiums, and trainings. on the website,
quarterly.
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Exhibit A
Scope of Work
4. Provide per organization 4.1 Assist one (1) HSC, certified as a PM, HES March 1, 2021- 4.1a Submit via email to
support to one (1) DSMES DSMES provider, with adding a June 30, 2021 CDPH a list of
program for Centers for telehealth option, using an online 2022 DSMES
Medicare and Medicaid platform to deliver services. stakeholders that
Services (CMS)/Medi-Cal received telehealth
telehealth billing codes for support by July 30,
providers and patients; 2021 2022.
telehealth capacity
building in patient/provider 4.1 b Submit via email
technology; and/or, patient to CDPH a list of
engagement options to telehealth TTA
improve patient/provider provided to DSMES
and patient/diabetes organizations; and
learning through virtual provide a list of
platforms. materials
distributed and
organizations who
received the
materials by July
30, 2021 2022.
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Exhibit A
Scope of Work
Subgoal 2.2 - Improve access to and participation in CDC-recognized National DPP lifestyle change programs in the Contractor's
service area. Assist the HSC to recruit new and expand organization(s) to obtain or renew CDC recognition. Share National DPP best
practice resources to increase referral and enrollment.
Objective(s) Activities Responsible Timeline Deliverables
Party
5. Improve access to and 5.1 Assist and provide one (1) hour PM, HES March 1, 2021- 5.1 Submit via email to
participation in, at quarterly Technical Assistance June 29, 2023 CDPH, progress in
minimum, one (1) CDC- (TA) to the California Health Quarterly the LHD survey,
recognized National DPP Collaborative (CHC) Partner with quarterly.
program in underserved recruitment efforts to increase
areas where the referrals to and participation in
prevalence of chronic National DPP.
disease is above the March 1, 2021- 5.2a Submit via email to
5.2 Provide TA to at minimum one (1) PM, HES June 29, 2023 CDPH a list of
State average or national additional organization seeking to Quarterly recruited or
average, low income, and achieve recognition for National expansion
residents whom have DPP during the contract period. agencies for
limited access to CDC-recognition
healthcare services and of National DPP.
trainings in Fresno
County. 5.2b Submit via email
to CDPH a list of
National DPP
stakeholders for
CDC application,
quarterly.
5.2c Submit via email to
CDPH a list of TTA
that was provided
to National DPP
organizations to
establish, retain,
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Page 9 of 18
Exhibit A
Scope of Work
and will expand
National DPP; and
provide a list of
materials
distributed and
organizations who
received the
materials,
quarterly.
6. Provide per organization 6.1 Assist the CHC, a National DPP PM, HES March 1, 2021- 6.1a Submit via email to
support to one (1) local provider in Fresno County to offer June 30, 2021 CDPH a list of
National DPP for telehealth service coordination and National DPP 2022 National DPP
CMS/Medi-Cal telehealth access to online virtual platforms Subcontractor stakeholders that
billing codes for providers for lifestyle change programs. received telehealth
and patients; telehealth support by July 30,
capacity building in 2021 2022.
patient/provider
6.1 b Submit via email
technology; and/or, to CDPH a list of
patient engagement telehealth TTA,
options to improve provided to
patient/provider and National DPP
patient/diabetes learning organizations; and,
through virtual platforms. provide a list of
materials
distributed and
organizations who
received the
materials by July
30, 2021 2022
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Exhibit A
Scope of Work
Category A — Pre-Diabetes and Diabetes Prevention and Control
GOAL 3 Increase patient coordination with non-physician care team members to monitor and manage patient condition(s) and
refer individuals to lifestyle change programs.
Subgoal 3.1 - Coordinate recruitment and engagement of a pharmacist(s) within the Contractor's service area to increase the provision
of DSMES patient coordination.
Objective(s) Activities Responsible Timeline Deliverables
Party
7. Engage a minimum of 7.1 Attend and participate in, at PM, HES March 1, 2021- 7.1 Submit via email to
three (3) local pharmacists minimum, two (2) Central Valley June 29, 2023 CDPH the meeting
to promote DSMES and Pharmacy Association meetings Quarterly attendance,
National DPPs. annually to update members on quarterly.
lifestyle change programs.
7.2 Collaborate with, at minimum, HES March 1, 2021- 7.2 Submit via email to
three (3) local pharmacists to June 29, 2023 CDPH a list of
distribute educational and materials
promotional materials and Fresno distributed to
Diabetes Collaborative web site pharmacist(s) and
at least one (1) time per quarter. who received the
materials, quarterly.
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Exhibit A
Scope of Work
Subgoal 3.2 - Identify and report on service area agencies with a CHW program curriculum or training process.
Objective(s) Activities Responsible Timeline Deliverables
Party
8. In partnership with 8.1 Schedule, at minimum, one (1) PM, HES March 1 , 2021- 8.1 Share the progress
"Collaborating for annual meeting with community June 29, 2023 of CHW activities
Wellness" program partners to discuss training and Quarterly within the local
identify and engage with utilization of CHWs in Fresno jurisdiction to CDPH
partner agencies that County. via email, quarterly.
provide resources for
CHWs.
8.2 Schedule, at minimum, two (2) HES March 1, 2021- 8.2 Share the progress
trainings for CHWs in Fresno May 15, 2023 of CHW activities
County for prediabetes and type 2 Quarterly within the local
diabetes during the contract period. jurisdiction to CDPH
via email, quarterly.
8.3 Contractor will attend and invite PM, HES March 1, 2021- 8.3a Submit, via email,
CRMC and HSCs to participate in June 29, 2023 to CDPH the
webinars conducted by Vision y Quarterly meeting
Compromiso (VyC) about CHW attendance.
program curriculum or training
delivery process during the 8.3b Share the
contract period. progress of CHW
activities within the
local jurisdiction to
CDPH, via email,
quarterly.
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Exhibit A
Scope of Work
Subgoal 3.3 - Recruit and engage a pharmacist(s) and provide TTA on DSMES ADA-recognition/ADCES-accreditation.
Objective(s) Activities Responsible Timeline Deliverables
Party
9. Minimum of one (1) local 9.1 Collaborate with the Central Valley HES March 1, 2021- 9.1 Submit, via email, to
pharmacist will receive Pharmacy Association to identify, at March 31, CDPH, a list of
ADA-recognition/ADCES- minimum, one (1) pharmacist June 30, 2022 pharmacist(s) that
accreditation for their committed to offering DSMES Quarterly are interested in
DSMES services that services. Partner with local programs becoming a
connect to a local clinic recognition/accreditation. DSMES program,
patient referral process. quarterly.
9.2 Contractor will share information and HES 9.2a Submit via email,
provide assistance to eligible March 1, 2021- to CDPH, a list of
pharmacists to register as ADA- March 31, materials
recognized/ADCES-accredited June 30, 2022 distributed to
DSMES programs. Quarterly pharmacist(s) and
who received the
materials, quarterly.
9.2b Submit via email,
to CDPH, a list of
pharmacist(s) that
received
recognition for
DSMES, quarterly.
9.2c Submit, via email,
to CDPH, a list of
the pharmacist(s)
that received
recognition for
DSMES-related
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Exhibit A
Scope of Work
TTA; and, submit a
list of materials
distributed and
who received the
materials,
quarterly.
Subgoal 3.4 - Contractor and HSC will recruit a pharmacist or CHW in the service area to increase the patient Comprehensive
Medication Management CMM team-based care process.
Objective(s) Activities Responsible Timeline Deliverables
Party
10. Engage a minimum of 10.1 Disseminate information about the HES March 1, 10.1 Submit, via email,
one (1) local pharmacist patient care process to local 2021-June 29, to CDPH, a list of
to collaborate with an pharmacist(s) at least once 2023 materials
attending physician to annually. Quarterly distributed to
increase the provision of pharmacist(s) and
DSMES patient who received the
coordination. materials,
quarterly.
10.2 Coordinate with a minimum of one HES, 10.2 Submit, via
(1) local pharmacist to complete a Pharmacist March 1, email, to CDPH, a
*Collaborative Practice Agreement Subcontractor 2021-June 30 contact list which
(CPA), with an attending physician 29, 2023 will identify
to increase the provision of Quarterly pharmacist(s)
DSMES patient coordination. interested in
completing a CPA,
* Collaborative Practice Agreement(CPA)is a legal quarterly.
document in the United States that establishes a
legal relationship between clinical pharmacists and
collaborating physicians that allows for pharmacists
to participate in collaborative drug therapy
management(CDTM). The CPA is a tool(not a
subcontract)to improve coordination for the benefit
of the patient.
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Exhibit A
Scope of Work
Objective(s) Activities Responsible Timeline Deliverables
Party
10.3 Contractor will support HES, HSC, July 1, 2021 - 10.3a Share the
pharmacy subcontractor to Pharmacist June 30, 2022 progress of CMM
provide CMM and refer 50 Subcontractor activities to CDPH
patients to National DPP or via email,
DSMES programs. Each patient quarterly
receives three encounters with
a pharmacist for CMM, followed 10.3b Submit a
by a referral to National DPP or process map of
DSMES programs with HSC. the referral
process to CDPH
via email,
quarterly.
GOAL 4 - Coordinate with CDPH on a required schedule to increase participation, coordination, management, and delivery to
improve data collection, information exchange, and resource development and distribution.
Objective(s) Activities Responsible Timeline Deliverables
Party
11.1 Attend and actively 11.1 Contractor staff will participate in HE, HES March 1, 2021- 11.1 Provide via email,
participate in PF CDPH webinars, conference calls, June 29, 2023 to CDPH, a list of
quarterly webinars, and meetings to share successes, Quarterly all PF Contractor
conference calls, and challenges, and progress on key Public Health Staff
meetings. Participate by contract deliverables. participation,
sharing successes, quarterly.
challenges, and
progress on key
contracted deliverables.
11.2 Contractors, and a 11.2 Contractor and HSC(s) will attend HE, HES March 1, 2021- 11.2 Provide via email,
minimum of one (1) key CDPH convening in a virtual setting June 29, 2021 to CDPH, a list of
stakeholder, will 2022 the PF
convening(s)
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Exhibit A
Scope of Work
participate in a PF attended via email
sponsored convening. by July 30, 2021
2022.
11.3 Participate in a limited 11.3 Contractor staff will participate in HE, HES March 1, 2021- 11.3 Briefly describe
amount (4-6 hours, PF-sponsored cultural humility or June 29, 2023 efforts in the LHD
annually) of accredited health equity training. Quarterly quarterly survey
online cultural humility or and provide a list
health equity trainings of training(s)
facilitated health equity attended, to
consulting agency to CDPH, via email.
support coordination with
underserved minority
populations facing
multiple social
determinant issues.
11.4 Submit Progress 11.4 Contractor will submit online HE, HES March 1, 2021- 11.4 Submit via Survey
Report(s) (e.g., quarterly progress reports at quarterly fiscal June 29, 2023 Monkey or
LHD compiled file) year FYI intervals to provide health Quarterly hardcopy version,
according to a PF system performance measure data to CDPH, a copy
schedule and format for PF services delivered to local of quarterly
describing key progress populations. progress reports.
and deliverable status
for the reporting period.
The report shall detail
activity achievements
and summarize work
underway. The report
shall list successes and
provide information on
barriers to activity
completion and
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Exhibit A
Scope of Work
recommendations for
future best practices.
11.5 Participate in the PF 11.5 Contractor will update the HE, HES September 30, 11.5 Provide via email,
biennial pharmacist pharmacists/pharmacy locations list 2021 to CDPH, updated
practice survey. in Fresno County, provide the list of
updated list to PF for the biennial pharmacists/phar
pharmacist practice survey and macy locations in
share the biennial pharmacy survey Fresno County
link with all pharmacists/pharmacy and share the PF
locations in Fresno. biennial pharmacy
survey links with
the
pharmacists/phar
macy locations by
September 30,
2021.
11.6 Participate in the PF 11.6 Collaborate with HSC to submit a HE, HES March 1, 2021- 11.6 HSC shall submit
biennial pharmacist list of pharmacy/pharmacist June 29, 2023 via email, to
practice survey. location(s) that have established a Quarterly CDPH, updated
CPA with HSC. list of
pharmacists/phar
macy locations in
collaborative
practice, quarterly.
11.7 Respond to all PF 11.7 Contractor will coordinate with clinic HE, HES March 1, 2021- 11.7 Submit via email,
survey(s) (e.g., quarterly partnerships and local public health June 29, 2023 to CDPH, LHD
LHD surveys and health stakeholders to complete and Quarterly surveys and share
system capacity respond quarterly during the FY to HSC and biennial
surveys) according to a all PF surveys. surveys as
required schedule and needed.
process.
11.8 Partners without a 11.8 Contractor will identify an HSC to HE, HES March 1, 2021- 11.8 Report via email,
connected health participate in PF Activities. Create June 29, 2023 to CDPH, the
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Exhibit A
Scope of Work
system; identify an HSC an engagement method with the Quarterly resource sharing
to engage patients with HSC that will require coordinated method.
PF chronic disease service delivery, performance
service delivery and measure data collection and
establish an agreed- appropriate consideration for local
upon resource sharing participation.
method conducted by
the HSC and upon
specific PF performance
approved by CDPH.
11.9 Partners without a 11.9 Contractor will develop a one (1) HE, HES March 1, 2021- 11.9 Provide via email,
connected health page evidence report that describes June 29, 2023 to CDPH,
system; provide a one- the method of engagement PF evidence of a one-
page evidence of the services provided and amount of page method of
method provided to an compensation with the HSC. agreement
HSC for specific between
performance to support Contractor and
the PF program. HSC.
11.10 Contractor will submit a 11.10 Contractor staff will develop and HE, HES April 1, 2023- 11.10 Provide via email,
final Project Summary submit a final Project Summary June 29, 2023 to CDPH, a copy
Report to CDPH in a Report by March 31, 2023 for of final Project
prescribed form and review and comment. The report Summary Report.
format. will summarize PF services
delivered, local coordination and
The report must include: performance measure completion.
a. Narrative discussion of
key Category A
quantitative and
qualitative process or
outcome measures;
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Exhibit A
Scope of Work
b. Narrative discussion of
program successes or
barriers significant to the
population burden for
Category A
interventions;
c. Brief purpose and
approach statement for
key Category A
interventions;
d. Narrative statement on
the linkages between
Category A interventions
and overall population
health impact;
e. Brief summary of the
intervention process or
outcome, including
lessons learned;
f. Brief summary of
positive improvements to
health processes or
outcomes and impact on
high burden/underserved
populations; and,
g. Sustainability paragraph
identifying options for
continuing or impact of
not continuing the
program.
Exhibit B,Al,Budget Detail and Payment Provisions
County of Fresno
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Exhibit B
Budget Detail and Payment Provisions
1. Invoicing and Payment
A. In no event shall the Contractor request reimbursement from the State for obligations entered
into or for costs incurred prior to the commencement date or after the expiration of this
Agreement.
B. For services satisfactorily rendered, and upon receipt and approval of the invoices, CDPH
agrees to compensate the Contractor for actual expenditures incurred in accordance with the
Budget Line Item amounts specified in Attachment I, II, II-A and III of this Exhibit.
C. Invoices shall include the Agreement Number, CDCB Address, and shall be submitted
electronically, not more frequently than quarterly, in arrears to:
CDCBlnvoices(a)cdph.ca.gov
California Department of Public Health
Chronic Disease Control Branch
P.O. Box 997377, MS 7208
Sacramento, CA 95899-7377
The State, at its discretion, may designate an alternate invoice submission address. A
change in the invoice address shall be accomplished via a written notice to the
Contractor by the State and shall not require an amendment to this agreement.
D. Invoices shall:
1) Be prepared en GentraGtGF letterhead. If ORYGOGes are net en predUGed letterhead
must be signed by an autherized effiGial, empleyee er ageRt Gertifying that the expenditures
plaimefd represent antiyities perfermed and are in annerdanne with Exhibit 4
2TIdentify the billing and/or perfermanc p�d GOyered bythe�Gice.
3) Itemize GOStS fer the billing peried in the same er greater level ef detail as indiGated OR this
agreement. SubjeGt te the terms of this agreement, reimbursement may enly be seug4fe-r
these Gests and/eF GGSt Gategeries expressly identified as allowable On this agreement and
1) Be prepared using the CDPHC/CDCB approved template, which will be provided by
the CDPH/CDCB Contract Manager. Invoices must include contractor letterhead and
be signed by an authorized official, employee or agent certifying that the
expenditures claimed represent activities performed and are in accordance with
Exhibit A.
2) Invoices must be submitted to CDPH electronically only, according to naming
convention (refer to 10 below) Hard copies are not required and will not be accepted.
3) Identify the billing and/or performance period covered by the invoice.
4) Itemize costs for the billing period in the same or greater level of detail as indicated in
this agreement. Subject to the terms of this agreement, reimbursement may only be
sought for those costs and/or cost categories expressly identified as allowable in this
agreement and approved by CDPH.
5) Bear the Contractor's name, as shown on the Agreement.
6) Show an invoice date reflecting when the invoice was prepared.
7) Submitted electronically, no later than five (5) days after the invoice date.
8) Show the Agreement number assigned by CDPH.
9) Show the Contractor's remittance address.
Page 1 of 4
Exhibit B,Al,Budget Detail and Payment Provisions
County of Fresno
20-10704 Al
Exhibit B
Budget Detail and Payment Provisions
10) Electronic invoices must be submitted to read on the subject line as follows: Contract
Number, Vendor Name, State Fiscal Year, Invoice Number.
E. Amounts Payable
The amounts payable under this agreement shall not exceed $156,397.00, as indicated in
Attachment I, II, II-A and III of this Exhibit.
2. Budget Contingency Clause
A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years
covered under this Agreement does not appropriate sufficient funds for the program, this
Agreement shall be of no further force and effect. In this event, the State shall have no liability
to pay any funds whatsoever to Contractor or to furnish any other considerations under this
Agreement and Contractor shall not be obligated to perform any provisions of this Agreement.
B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this
program, the State shall have the option to either cancel this Agreement with no liability
occurring to the State or offer an agreement amendment to Contractor to reflect the reduced
amount.
3. Prompt Payment Clause
Payment will be made in accordance with, and within the time specified in, Government Code
Chapter 4.5, commencing with Section 927.
4. Timely Submission of Final Invoice
A. Final undisputed invoice shall be submitted for payment no more than sixty(00 60
calendar days following the expiration or termination date of this agreement, unless a later or
alternate deadline is agreed to in writing by the program contract manager. Said invoice should
be clearly marked "Final Invoice", indicating that all payment obligations of the State under this
agreement have ceased and that no further payments are due or outstanding. The State may, at
its discretion, choose not to honor any delinquent final invoice if the Contractor fails to obtain
prior written State approval of an alternate final invoice submission deadline.
B. The Contractor is hereby advised of its obligation to submit to the state, with the final invoice, a
completed copy of the "Contractor's Release (Exhibit H)".
5. Expense Allowability/ Fiscal Documentation
A. Invoices, received from the Contractor and accepted for payment by the State, shall not be
deemed evidence of allowable agreement costs.
B. Contractor shall maintain for review and audit and supply to CDPH upon request, adequate
documentation of all expenses claimed pursuant to this agreement to permit a determination of
expense allowability.
C. If the allowability of an expense cannot be determined by the State because invoice detail, fiscal
records, or backup documentation is nonexistent or inadequate according to generally accepted
accounting principles or practices, all questionable costs may be disallowed, and payment may
be withheld by the State. Upon receipt of adequate documentation supporting a disallowed or
Page 2 of 4
Exhibit B,Al,Budget Detail and Payment Provisions County of Fresno
20-10704 Al
Exhibit B
Budget Detail and Payment Provisions
questionable expense, reimbursement may resume for the amount substantiated and deemed
allowable.
6. Recovery of Overpayments
A. Contractor agrees that claims based upon the terms of this agreement or an audit finding and/or
an audit finding that is appealed and upheld, will be recovered by the State by one of the
following options:
1) Contractor's remittance to the State of the full amount of the audit exception within 30 days
following the State's request for repayment;
2) A repayment schedule which is agreeable to both the State and the Contractor.
B. The State reserves the right to select which option as indicated above in paragraph A will be
employed and the Contractor will be notified by the State in writing of the claim procedure to be
utilized.
C. Interest on the unpaid balance of the audit finding or debt will accrue at a rate equal to the
monthly average of the rate received on investments in the Pooled Money Investment Fund
commencing on the date that an audit or examination finding is mailed to the Contractor,
beginning 30 days after Contractor's receipt of the State's demand for repayment.
D. If the Contractor has filed a valid appeal regarding the report of audit findings, recovery of the
overpayments will be deferred until a final administrative decision on the appeal has been
reached. If the Contractor loses the final administrative appeal, Contractor shall repay, to the
State, the over-claimed or disallowed expenses, plus accrued interest. Interest accrues from
the Contractor's first receipt of State's notice requesting reimbursement of questioned audit
costs or disallowed expenses.
7. Advance Payments
No advance payment is allowed under this Contract.
8. Travel and Per Diem Reimbursement
Any reimbursement for necessary travel and per diem shall, unless otherwise specified in this
Agreement, be at the rates currently in effect, as established by the California Department of
Human Resources (Cal HR). If the Cal HR rates change during the term of the Agreement, the new
rates shall apply upon their effective date and no amendment to this Agreement shall be necessary.
No travel outside the state of California shall be reimbursed without prior authorization from the
CDPH. Verbal authorization should be confirmed in writing. Written authorization may be in a form
including fax or email confirmation. Refer to CaIHR website.
Page 3 of 4
Exhibit B,Al,Budget Detail and Payment Provision
County of Fresno
20-10704 Al
Exhibit B
Budget Detail and Payment Provisions
9. Invoice Reporting Requirements and Billing Instructions
A. Quarterly Invoice Schedule - Contractor shall submit electronic quarterly invoice in accordance
with the following schedule:
Quarter Dates Due
1 07/01 thru 09/30 11/1
2 10/01 thru 12/31 2/1
3 01/01 thru 03/31 5/1
4 04/01 thru 6/30 8130
B. Contractor shall have the right to issue a supplemental invoice for expenditures incurred
after quarter four (4) final invoice has been submitted to recover in full all actual costs, as
specified in the executed Exhibit B, Budget Attachment(s) for this agreement.
submitted to on the s ihiont lino as follows:
G ntront Number, Vender Alamo State Gic I Year, IRVe4Ge Number
Page 4 of 4
Exhibit B,Al,Attachment I Budget Year 1 Exhibit B,Attachment I County of Fresno
Budget Year 1 20-10704 Al
(3 J^�ci 04/22/2021 -6/30/2021)
Category A Category A Total Total
Diabetes Diabetes
A. PERSONNEL
Total Monthly % of
Position Title FTE Annual Months Salary Fund Subtotal Subtotal Total Cost Total Cost
Salary
Program Manager 33% $98,580.00 4 $2,731.90 100% $4- $8,124.18 $4 $8,124.18
Health Education Specialist 1 39% 1 $49,384.001 4 1 $1,596.48 100% 1 $6�o 385.93 $4,422.28 $10,808.21 $4,422.28
Total Salaries $17 314 57 $12,546.461 $29 85U 98 $12 546.46
FRINGE BENEFITS 67% 1 $-
,6g�06j $8,406.13 $20- g $8,406.13
Total Personnel Costsi 1 $ 58 20,952.59 $4�� $20,952.59
Category A Category A Total Total
Diabetes Diabetes
B. OPERATING EXPENSES DETAIL % of Subtotal Subtotal Total Cost Total Cost
Fund
General Expense (office supplies): 98% $244-97 $0.00 $'�7 $0.00
Communication/Software (input methodology): 100% $2,064-80 $0.00 $0.00
Space/Rent ($625 Rate x 4 Months-$2,500): 1 100% $2-;50000 $32.56 $2��509-00 $32.56
Total Operating $32.56 $q�gq � $32.56
Category A Category A
Total Total
Diabetes Diabetes
C. SUBCONTRACTORS % of Subtotal Subtotal Total Cost Total Cost
Fund !/�� /�//�� !� /�
National f1DD Provider subcontractor: Obj 6.1 100% $_1_500-0 3 $0.00 �_1�5gt7�8t3 $0.00
Phaarm�_rnaacr'st suhren+radon .(lh' 1n 2 100% $14 0(�(� 00 $0.00 $4-0 000 00 $0.00
Total Other Costs $ 0�08�� $0.00 $44 500-0g w $0.00
Category A Category A
Total Total
Diabetes Diabetes
D. OTHER COSTS % of Subtotal Subtotal Total Cost Total Cost
Fund
Meeting Rnnmc ago% QC00 00 $0.00 500 GO 0.00
Education and training materials and Participation fees: 'n� w128 w��� ��
22,2.3, 1 n.1, `5.Z` , 7`, 8��9- , 9 2
�99°� Q�,1��,28�00 $0.00 Q�,1 0.00
DR—MER—INDDD GertifiGatien food and materials fer Health System
Champ,on(s). -Obj2, 2.1, &4.1; Obj10.1 & 10.2; Goal 4, Obj. 11.2, a 000% $20,000.00 $0.00 $20,000.00 $0.00
11 1Q & 11 A
Total Other Costs 2 28 00 $0.00 2 28 w 0.00
Category A Category A
Total Total
E. INDIRECT Diabetes Diabetes
% of Subtotal Subtotal Total Cost Total Cost
Fund
Total Personnel Cost 25.00% 100% $7,'�,z28.39 $4,750.79 $12 $7,228.39
Total Indirect Cost $T 2 3a $4,750.79 Q� u $7,228.39
Category A Category A
Total Total
Diabetes I Diabetes
TOTAL EXPENSES $75,081:Og 25,735.94 $_T5�0g1_40 $25,735.94
*Rounding may occur
Exhibit B,Attachment II-A,Budget Year 2-A Exhibit B,Attachment II-A County of Fresno
Budget Year 2-A 20-10704 Al
(7/1/2021 -6/30/2022)
Category A
Total
Diabetes
A.OPERATING EXPENSES DETAIL % of Subtotal Total Cost
Fund
General Expense (office supplies): 100% $ 500.06 $ 500.06
Communication/Software (input methodology): 100% $ 3,500.00 $ 3,500.00
Space/Rent ($625 Rate x 4 Months-$2,500): 100% $ 5,500.00 $ 5,500.00
Total Operating $ 9,500.06 $ 9,500.06
Category A
Total
Diabetes
B. SUBCONTRACTORS % of Subtotal Total Cost
Fund
National DPP Provider subcontractor: Obj. 6.1 100% $ 1,500.00 $ 1,500.00
Pharmacist subcontractor: -Obj. 10.2 100% $ 28,345.00 $ 28,345.00
Total Other Costsi $ 29,845.00 1 $ 29,845.00
Category A Total
Diabetes
C. OTHER COSTS % of Subtotal Total Cost
Fund
Education and training materials and Participation fees: -Obj. 2.1, 2.2, 2.3, 100%
3.1, 3.2, 4.1, 5.2, 7.2, 8.1, 8.2, 9.1, 9.2 $ 5,000.00 $ 5,000.00
DSMES/NDPP certification fees and materials for Health System
Champion(s). -Obj. 2, 2.1, &4.1; Obj. 10.1 & 10.2; Goal 4, Obj. 11.2, 11.10 100% $ 5,000.00 $ 5,000.00
& 11.8
Total Other Costsi $ 10,000.00 $ 10,000.00
Category A Total
Diabetes
TOTAL EXPENSES $ 49,345.06 $ 49,345.06
*Rounding may occur
Amendment I to Agreement Between the County of Fresno and the
California Department of Public Health
Amendment Name: CDPH Prevention Forward for Type 2 Diabetes (State Agreement
No. 20-10704-1)
Fund/Subclass: 0001/10000
Organization #: 56201556
Revenue Account #: 4380