HomeMy WebLinkAboutAgreement A-22-588 with DHCS.pdf Agreement No. 22-588
ALLOCATION AGREEMENT
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
COUNTY Fresno Cow
PROJECT TITLE Medi-Cal Health Enrollment Navi ators Project_
SERVICE TERM Agreement date:October 1,2022 through T End of implementation date:June 30,2025
CLOSE OUT TERM Close out start date:July 1,2025 through I Close out term date:June 30,2026
Under the terms and conditions�of this Agreement, the County agrees to complete Navigators Project efforts as described in
the project description, and the State of California,through its Director of the Department of Health Care Services pursuant to
SB 154(Chapter 43,Statutes of 2022),agrees to fund the County up to the Allocation Amount.
PROJECT DESCRIPTION
The County agrees to provide Medi-Cal Health Navigators services and activities pursuant to SB 154,with a focus on one or
more of the eleven targeted populations: Persons with mental health disorder needs; Persons with substance use disorder
needs;Persons with disabilities;Aged persons; Persons who are homeless;Young people of color; Persons who are in county
jail, in state prison, on state parole, on county probation or under post-release community supervision; Immigrants and
families with mixed immigration status; Persons with limited English Proficiency;Low-wage workers and their families, and
Uninsured children and youth formerly enrolled in Medi-Cal. The County may target other populations as well. The County
shall ensure the needs of the targeted populations are understood and provide information and assistance in a culturally and
linguistically appropriate method at no cost to the individual, including the provision of oral interpretation of non-English
languages and the translation of written documents and alternative formats when necessary or when requested by the
individual to ensure effective communication.
TOTAL ALLOCATION AMOUNT NOT TO ONE MILLION,TWO HUNDRED AND FOUR THOUSAND
EXCEED: $1,204,000 DOLLARS.
The General and Special Provisions attached are made a part of and incorporated into the Agreement.
FRESNO COUNTY DEPARTMENT OF SOCIAL DEPARTMENT OF HEALTH CARE SERVICES STATE
SERVICES OF CALIFORNIA
ATTN: HEALTH ENROLLMENT NAVIGATORS SECTION
P.O.BOX 1912 MEDI-CAL ELIGIBILITY DIVISION
FRESNO,CA 93718-1912 PO BOX 997417,MS 4607
SACRAMENTO,CA 95899-7417
BY( UT)ORIZED SIGNATURE): BY(AUTHORIZED SIGNATURE):
PRINTED NAME AND TITLE OF PERSON SIGNING: PRINTED NAME AND TITLE OF PERSON SIGNING:
Brian Pacheco,Chairman,Board of Supervisors — Sandra Williams,Division Chief
DATE SIGNED: /02_ 3 _a a DATE SIGNED:
_ CERTIFICATION OF FUNDING FOR STATE USE ONLY
AMOUNT OF"ALLOCATION AGREEMENT NUMBER FUND
ADJ.INCREASING ENCUM13ERANCE APPROPRIATION
ADJ.DECREASING ENCUMBERANCE FUNCTION
TOTAL ALLOCATION AMOUNT LINE ITEM ALLOTMENT CHAPTER STATUTE FISCALYEAR
T.B.A NO: BR.NO. INDEX OBJ. PCA PROJECT/WORK PHASE
I hereby eertify upon my personal knowled a that bud eted funds are available for this encumbrance
SIGNATURE OF ACCOUNTING OFFICER DATE
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors Page 1
County of Fresno,State of California
By � Deputy
ALLOCATION AGREEMENT
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
TERMS AND CONDITIONS OF ALLOCATION AMOUNT
The County shall be responsible for the performance of the work as set forth herein below and for the
preparation of deliverables and reports as specified in this Agreement. The County Project
Representative shall promptly notify the State of events or proposed changes that could affect the
Work Plan under this Agreement.
Special Provisions
1. County shall complete all work in accordance with an approved Work Plan, which will be
included in this Agreement as Attachment 2.
2. Rights in Data and Reporting: The County agrees that all data and reports produced in the
performance of this Agreement are subject to the rights of the State as set forth in this section.
The State shall have the right to reproduce, publish, and use all such data and reports, or any
part thereof, in any manner and for any purposes whatsoever and to authorize others to do so in
compliance with applicable laws.
3. Project partner agrees to attend monthly meetings with their assigned analyst or designated
Navigators Project staff.
General Provisions
A. Definitions
A. The term "Allocation" as used herein means the Health Navigators Allocation funding
authorized by SB 154 (Chapter 43, Statutes of 2022).
B. The term "Agreement" as used herein means an allocation agreement between the State
and County specifying the payment of Allocation Amount by the State for the
performance of Work Plan(Attachment 2)within the Service Term by the County.
C. The term "County" as used herein means the party described as the County on page one
(1) of this Agreement.
D. The term "Allocation Amount" as used herein means funds awarded to the County by
the State.
E. The term"Service Term" as used herein means the period of time that the partner has to
conduct the approved activities outlined in the work plan (Attachment 2).
F. The term "Project Representative" as used herein means the person authorized by the
County to be responsible for the Allocation Amount and is capable of making daily
management decisions.
Page 2
ALLOCATION AGREEMENT
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California-Department of Health Care Services
G. The term"State" as used herein means the Department of Health Care Services.
H. Project Partner-A qualified County or Community-Based Organization selected to
enter into an agreement with DHCS to provide services and to comply with the terms
and conditions set forth in the Allocation Agreement.
I. The "Closeout Term" as used herein means administrative activities of this Agreement
to closeout or wind down all administrative Health Navigator Project activities engaged
in after the end of the Service Term Period stated on page one.
J. Regular Office Hours - as used herein means the hours between 8:OOAM and 5:OOPM
on all state business days.
B. Allocation Execution
1. County agrees to complete the corresponding activities in accordance with the time of
the Service Term and Closeout Term, and under the terms and conditions of this
Agreement.
2. County shall comply with the provisions of SB 154.
3. County shall begin implementation once this agreement has been signed by the County
and countersigned by DHCS. Any implementation completed prior to the execution date
will not be reimbursed.
4. County agrees to submit in writing any deviation from the Work Plan (Attachment 2) to
the State for approval prior to implementation of changes.
C. Allocation Costs
Subject to the availability of Allocation Amount, the State hereby grants to the County funding
not to exceed the amount stated on page one (1) of this Agreement in consideration of and on
condition that the sum be expended in carrying out the purpose as set forth in the Work Plan
and under the terms and conditions set forth in this Agreement.
The Allocation Amount to be provided to the County, under this Agreement, may be disbursed
as follows:
1. To County: County shall disperse any amount of the Allocation Amount that the County
deems appropriate. County may subcontract with one or more other community-based
organizations to perform the activities identified in the approved Work Plan,
Attachment 2. The State recommends, but does not require, the County to collaborate
with one or more CBOs to develop, conduct, and implement effective tools and
methods to expand Medi-Cal outreach, increase Medi-Cal enrollment and contribute
efforts to retention of the uninsured, targeted populations. The County is not required to
immediately contract with CBOs in light of the timelines the contracting processes may
Page 3
ALLOCATION AGREEMENT
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
necessitate. However, the County will need to demonstrate its contracting progress with
CBOs through required reporting activities.
2. Indirect administrative costs, including planning, plan documentation, and other
administrative costs shall not exceed the amount approved in the Budget Plan,
Attachment 1 of the Allocation Agreement.
D. Payment Documentation
1. All payment requests must be submitted by the County to the State, on a quarterly basis,
using a completed Navigators Project Quarterly Invoice, Attachment 3. The invoice
and the deliverables noted below must accompany the invoice as outlined in the
Quarterly Invoice and Deliverables Deadline Bulletin (2022-005).
a. Budget Plan, Attachment 1
b. Work Plan, Attachment 2
c. Navigators Project Quarterly Invoice, Attachment 3
d. Monthly Data Report, Attachment 4
e. Quarterly Progress Report, Attachment 5
In very limited circumstances, DHCS may approve a different submission schedule for
an individual County outside of what is listed in the Quarterly Invoice and Deliverables
Deadline Bulletin (2022-005). In order for this change to be approved for the
submission of the documents listed in Section D, la, lb, and lc (listed above), this
change must be agreed to, in writing, by both County and DHCS prior to enactment of
this change in schedule.
2. County shall submit all documentation to the State for Allocation completion within the
Closeout Term as shown on page one (1).
3. Payments to the County shall be on a costs incurred basis. Expenses on the quarterly
invoice must include activities performed during the billing period.
4. The County must meet the requirements of this Allocation Agreement, including the
terms of all of its referenced Attachments, in order to receive approved Allocation
payments from the State. If the County fails to meet such requirements or exhibit
deficiencies in the performance of this Agreement, the State may withhold partial or full
Allocation payments. See also section F. Loss of Allocation Amount below for more
information.
5. Payment will be issued by the State upon the accurate, complete, and timely
submission, in accordance with the submission schedule outlined in the Quarterly
Invoice and Deliverables Deadline Bulletin (2022-005), of the following documents:
a. Monthly Data Report Attachment 4
b. A complete Navigators Project Invoice Attachment 3
c. A complete Quarterly Progress Report Attachment 5
Page 4
ALLOCATION AGREEMENT
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
Budget Plan Attachment 1
County is required to use the Budget Plan, Attachment 1 to identify all line items of
expenditure for each fiscal year of the project. DHCS provides approval of this initial
Budget Plan upon DHCS countersignature of the Budget Plan. Upon completion of a fiscal
year, County must submit a new proposed Budget Plan by July 31 that identifies estimated
expenditures for the current and subsequent fiscal years.
If the County needs to adjust line-item expenditures, County can unilaterally shift less than
five percent (5%) of funding between one or more line-item amounts within the Non-
Personnel — Direct Costs section and/or the Personnel Staff section. Any adjustment
resulting in a change that exceeds five percent (5%) of any singular line item from the most
recently approved Budget Plan requires DHCS approval prior to enacting this change. Any
proposed revisions to the Budget Plan by County must be submitted to DHCS in writing.
DHCS has up to thirty (30) calendar days to review and provide response of approval or
denial of the request.
Work Plan Attachment 2
County is required to use the Work Plan, Attachment 2. As outlined in the Quarterly
Invoice, a Work Plan must be submitted to, and approved by, DHCS in order to receive the
quarterly payment. The Work Plan shall include strategies and time-frames for outreach,
enrollment, and retention activities completed by the County and its contracted CBOs. Any
proposed revisions to the Work Plan by County must be submitted to DHCS in writing.
DHCS has up to thirty (30) calendar days to provide a response of approval or denial of the
request.
Navigators Project Invoice Attachment 3
County is required to use the Navigators Project Invoice, Attachment 3. Invoices must be
submitted by the County on a quarterly basis as outlined in the Quarterly Invoice and
Deliverables Deadline Bulletin (2022-005). The invoice must be accurate and complete and
include detailed budget activity and expenditures for the specific quarter. The expenditures
identified in the invoice must be supported by all appropriate documents (such as receipts,
proof of payment, time sheets, etc.) to substantiate that payment was made and is eligible
for reimbursement of allowable expenditures. DHCS will issue an Invoice Dispute
Notification form (STD 209) if the County has submitted an invoice for payment, but has
not submitted any or all of the following items:
• Monthly Data Report (for the corresponding quarter being billed)
• Quarterly Progress Report (for the corresponding quarter being billed)
• Budget Plan due to entering a new fiscal year
• Budget Plan for a shift equal to or greater than five percent (5%)
As outlined in Bulletin 2020-003 Instructions for Submitting Quarterly Invoice and
Progress Report an initial payment is permissible. In order for DHCS to consider approval
of an initial payment request, the County is required to have a DHCS-approved Budget
Plan, submit a prospectus invoice (on the Navigators Project Quarterly Invoice, Attachment
3 form) identifying anticipated expenditures, and provide a narrative explaining why these
Page 5
ALLOCATION AGREEMENT
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
funds are needed and the work expected to be performed. Once submitted, DHCS will
provide notice within two (2)weeks if the request has been approved.
All initial payment requests cannot exceed twenty-five percent (25%) of the current fiscal
year's budget. If a subsequent initial payment is requested, the County must provide proof
of funds expenditure via the quarterly invoice process. All subsequent initial payments
require full utilization before another initial payment will be considered for the requested
amount; otherwise, the subsequent initial payment request will be reduced by the
unexpended amount (the difference between what was paid and what expended in the
approved quarterly invoice.).
If an invoice payment is withheld, the County will need to provide the information and/or
report(s) identified by DHCS to remediate the deficiency before DHCS will authorize
payment.
Monthly Data Report Attachment 4
County is required to use the Monthly Data Report, Attachment 4, or other reporting
method as directed by the State. The County is required to submit accurate and complete
monthly updates on a timely basis, for specific data points, as defined on the Monthly Data
Report Template, regarding the Health Navigators Project, which the State will review and
subsequently publish for public consumption. Each Monthly Data Report must include (at a
minimum) the following pieces of data for every individual submitted as either enrolled or
retained on the "Enrollment and Retention Rpt"tab:
• Full name (first and last)
• Date of birth
• Social Security Number and/or Client Identification Number
• Identify status as either enrolled or retained
• At least one or more of the 11 identified Target Populations
Each Monthly Data Report must also include updates to the following self-reported data
points on the "Aggregate Data Reporting"tab:
• DP 1: Enrolled
• DP 2: Retained
• DP 3: Direct Outreach
• DP 4: Media Outreach
• DP 5: Assisted with Application
• DP 6: Assisted with Accessing&Utilizing Health Care Services
• DP 7: Assisted with Troubleshooting
• DP 8: Assisted with Redetermination
Failure to submit complete and accurate reports on a timely basis, in accordance with the
submission schedule outlined in the Quarterly Invoice and Deliverables Deadline Bulletin
(2022-005), may result in withheld payments and an invoice dispute issued to the County.
Payments will be issued once the complete Monthly Data Report is provided to DHCS.
Page 6
ALLOCATION AGREEMENT
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
Ouarterly Progress Report Attachment 5
County is required to submit a Quarterly Progress Report, Attachment 5 according to the
Quarterly Invoice and Deliverables Deadline Bulletin (2022-005). Quarterly Progress
reports will be required starting with the first quarter reporting period. The County must
provide a progress report to measure and document progress-to-date on the work plan
objectives and performance goals. The State reserves the right to require reports more
frequently than on a quarterly basis if necessary, but no more than once a month. Failure to
submit complete and accurate reports on a timely basis, in accordance with the submission
schedule outlined in the Quarterly Invoice and Deliverables Deadline Bulletin (2022-005),
may result in withheld payments and an invoice dispute issued to the County. Payments
will be issued once the complete Quarterly Progress Report is provided to DHCS.
E. Allocation Termination or Withdrawal
1. County may withdraw from the Health Navigators Allocation Funding by notifying the
State in writing at any time of its request to withdraw from further participation. Once
the withdraw request is received, the State will contact the County to complete close out
tasks.
2. County may unilaterally rescind this Agreement at any time prior to the execution of the
Allocation Amount. After the execution of the Allocation Amount, this Agreement may
be rescinded, modified or amended by mutual agreement in writing.
3. Failure by the County to comply with the terms of this Agreement may be cause for
termination of all obligations of the State under this Allocation Agreement and for any
additional Allocation payments.
Upon termination or withdrawal from participation, the County must return all unspent
allocated funds to the State.
F. Loss of Allocation Amount
The County may be subject to partial or full loss of the approved Allocation Amount if any of
the following occurs, including but not limited to:
1. The County fails, without good cause, to return a signed Agreement to DHCS within
sixty(60) days of receipt of the Agreement.
2. The County fails, without good cause, to produce satisfactory invoices and deliverables
as outlined in the Quarterly Invoice and Deliverables Deadline Bulletin(2022-005).
3. The County fails, without good cause, to meet a satisfactory participation rate as
proposed on their work plan.
4. The County withdraws from the Allocation Agreement.
Page 7
ALLOCATION AGREEMENT
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
5. A County fails to submit a timely and satisfactory Corrective Action Plan (CAP), when
applicable. Such an action shall result in a fifty percent (50%) reduction of the total
Allocation Amount.
G. Hold Harmless
1. County agrees to waive all claims and recourse against the State including the right to
contribution for loss or damage to persons or property arising from, growing out of or in
any way connected with or incident to this Agreement, except claims arising from the
concurrent or sole negligence of the State, its officers, agents, and employees.
2. County agrees to indemnify, hold harmless and defend the State, its officers, agents and
employees against any and all claims, demand costs, expenses or liability costs arising
out of legal actions pursuant to items which the County has certified. County
acknowledges that it is solely responsible for compliance with items to which it has
certified.
H. Financial Records
1. County agrees to maintain satisfactory financial accounts, documents and records for
the expenditures of the Allocation Amount and to make them available to the State for
auditing at reasonable times. County also agrees to retain such financial accounts,
documents and records for three (3) years following the termination or completion of
the Allocation Agreement.
2. County and State agree that during Regular Office Hours each of the parties hereto and
their duly authorized representative shall have the right to inspect and make copies of
any books, records or reports of the other party pertaining to this Agreement or matters
related thereto. County agrees to maintain and make available for inspection by the
State accurate records of all of its costs, disbursements and receipts with respect to its
activities under this Agreement.
3. County agrees to use a generally accepted accounting system.
I. Audits
1. Allocations are subject to audits by the State for three (3) years following the final
payment of the Allocation Amount. The purpose of such audits is to verify that
expenditures of the Allocation Amount were properly documented. County will be
contacted at least thirty(30) days in advance of an audit.
2. Audits will include all books, papers, accounts, documents, or other records of the
County as they relate to the Allocation for which the State authorized the Allocation
Amount. The County shall ensure that the Allocation Amount records, including the
sources, documents and cancelled warrants, are readily available to the State.
Page 8
ALLOCATION AGREEMENT
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
3. County must also provide an employee having knowledge of the Allocation Amount
and the accounting procedure or system to assist the State's auditor. The County shall
provide a copy of any document,paper, record, or the like requested by the State.
4. All Allocation Amount records must be retained for at least one (1) year following an
audit or final disputed audit findings, whichever is later in time.
J. Nondiscrimination
1. County shall not discriminate against any person on the basis of sex, race, color,
religion, ancestry, national origin, ethnic group identification, age, mental disability,
physical disability, medical condition, genetic information, marital status, gender,
gender identity, or sexual orientation when conducting Health Navigators efforts
pursuant to this Agreement and in compliance with the Americans with Disabilities Act.
2. County shall ensure the security,privacy and confidentiality of each enrollee.
K. Health Insurance Portability and Accountability Act of 1996 ("HIPAA") Attachment 6
1. County shall ensure security of privacy and confidentiality of each consumer
application and comply with HIPAA requirements as set forth by law in accordance
with Attachment 6.
L. Federal Terms & Conditions Attachment 7
1. County shall comply with all requirements and special terms and conditions set forth
within the Federal Terms and Conditions that all individuals receiving Title XIX must
adhere to. Such Federal Terms and Conditions are attached hereto as Attachment 7 and
fully incorporated herein by reference.
For County Use:
Fund: 0001
Subclass: 10000
Org: 56107012
Account: 3480- State Welfare/4361 -Federal Welfare
Page 9
DHCS Health Enrollment Navigators Project Attachment 1
Budget Plan Reporting Instructions
# Field Name Definitions
Tab Budget Plan Template Read the definitions for each section below. Based on the definitions, complete
2 Tab 2: The Budget Plan Template and Tab 3: Descriptions
Tab 2: Allocate funds appropriately for each line item and each fiscal year(FY) period based on your
N community-based organization (CBO)and county needs to successfully implement the Health Navigators
Project. If you need to add a line item different from the proposed line items on the template, add a row and
C bold the added line item for DHCS review.
v
i Once awarded, any line item increases or decreases that meet or exceed 5%from the approved budget plan
N will require a revised budget plan for DHCS review and approval. Changes below 5%will not require any
approval.
Tab 3: The descriptions tab allows partners to provide a detailed breakdown of each line item. For example,
identify the individuals working on this project, the intended expenses for each line items, and intended sub-
contractors, etc. Provide as much information in the descriptions tab to ensure items intended to purchase are
permissible.
1 SFY 1 Allocated funds throughout the State Fiscal Year(SFY)of July 1, 2022 to June 30, 2023.
2 SFY 2 Allocated funds throughout the SFY of July 1, 2023 to June 30, 2024.
3 SFY 3 Allocated funds throughout the SFY of July 1, 2024 to June 30, 2025.
4a 4 Administrative Close- Out This column is optional upon partner needs to close out their agreement. If the county or organization does not
require funds for wrap up activities, the column should be left blank.
M 5 Total Column This is the overall total by each line item. Throughout the duration of the project, funds can be redistributed to
J other line items based on partner needs. If the line item amount exceeds by 5%, the partner is required to
submit a revised budget plan to DHCS for review and approval of the change. If the line item amount does not
aexceed by 5%, no review or approval from DHCS is needed.
+� 6 Grant Total for Each FY Column and Admin This the overall total of each FY and Admin Close out period. Any unspent funds from the previous FY can be
Column rolled over into the following FY and redistributed among line items as necessary. This change will require an
annual revised budget plan submitted to DHCS for review and approval before implementing. Partners cannot
proceed with the change without DHCS approval.
m
7 Grand Total -Overall This is the overall total requested to fully execute the Health Navigators Project. This amount is what DHCS
awarded to your county or organization. This total should match the total displayed on your Health Navigators
Project-Allocation Agreement. If awarded, you cannot exceed this total amount at any time during the Health
Navigators Project. If you need to increase or decrease this amount for any reason, notify your assigned
analyst to receive instructions on the amendment process.
Page 1 of 6
DHCS Health Enrollment Navigators Project Attachment 1
Budget Plan Reporting Instructions
# Field Name Definitions
8 Personnel Staff Identify all staff working directly on the Health Navigators Project. Provide the name and job title/positions. If
you have multiple people of the same job title working on this, please group together in one line item on tab 2
N and break it down in tab 3. For example, in Tab 2 state"5 Eligibility Workers."and in Tab 3 identify all 5
V Eligibility Workers
a�
9 Time Base FTEs The time each staff spends directly working on the Navigators Project.
c
= For example; Full Time is (1), Part Time is (.50), and Quarter time (.25). If multiple people of the same job title
O
L are spending different amount of time on the project, leave the full time equivalent(FTE)column blank and
a) identify that on Tab 3.
a
10 Benefits Benefits of your personnel staff working on the Health Navigators Project.
11 Office Expenses Items that are commonly purchased on a frequent basis. For example, pens, pencils, paper, ink, folders,
N binders, note pad, highlighters, staplers, etc.
N O 12 Equipment Tangible items that are functionally necessary for its intended purpose, nonexpendable, and needed for the
(„) performance of the agreement. For example: laptop, cell phone, iPad, monitor, keyboard, mouse, scanner,
etc.
Please contact your liaison to receive guidance prior to proposing or procuring any equipment. Items with a
i useful lifespan that exceeds the length of your agreement would require preapproval from DHCS prior to
4) ni irnhnm
Q 13 Travel Any travel used for outreach efforts only. Anything outside of outreaching within your intended communities
O cannot be billed
V
i 14 Training Training specific to Medi-Cal; how to complete an application, enroll individuals, complete renewal packets,
etc.
0
Cannot bill for training that is outside the scope of the Navigators Project
15 Outreach Material Items that are printable with any Medi-Cal information displayed.
O
i For example; flyers, brochures, handouts, cards, signs, etc.
O 16 Media Outreach Media ads used to provide Medi-Cal information.
a
= For example: social media ads on various platforms, TV ads, radio ads, movie ads, etc.
O
Z 17 Total Budget for All CBOs Subcontractors expenses who are working on the Health Navigators Project
Page 2 of 6
DHCS Health Enrollment Navigators Project Attachment 1
Budget Plan Reporting Instructions
# Field Name Definitions
18 Other Cost: Any other items not identified above.
Incentives
0 For example: Rent, utilities, etc.
L N
a-' This line item can also be used for any incentive(s) purchased.
N
.. O
G� C� Incentives are small nominal items used in order to reach individuals or a specific group. Items preferable
under$5. Mainly used in outreach events and campaigns to grab an individual or groups attention.
0 .
i For example: pens, pencils, highlighters, erasers, small notepads, candy, bottle water, small hand sanitizers,
dface masks, stickers, keychains, etc.
Q
= Q Before purchasing, this may require DHCS approval of the requested item. Contact your Navigators Analyst
O prior to purchasing any items if you are unsure if they will be eligible for reimbursement. Also, refer to the
Z Permissible & Excluded Activities bulletins (2020-001 and 2020-002)on the Navigators website for more
information.
19 Indirect costs Cost that are overhead expenses of your personnel.
_ For example, general and administrative expenses, department costs, legal expenses, additional benefits,
G> etc.
C
r— NO 20 Health Benefits Additional benefits of your personnel.
N V
O 0 21 Indirect Percent the cost billed to your indirect is a percentage of your personnel costs. If you identify on the budget your
IZ i indirect cost rate is 15%, your indirect costs allocated in your budget plan should be 15% of your personnel
costs.
O
Z Your indirect cost rate should be no more than 15%. If your organization uses a rate higher than 15%, it may
not be approved. Contact your Health Navigators Analyst for guidance on proposed rates higher than this
amount.
Page 3 of 6
Department of Health Care Services COUNTY OF FRESNO Attachment 1
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
BUDGET PLAN
Upon a fully signed and executed Allocation Agreement(Agreement), the county or organization is authorized to use funds for its approved purposes. Any proposed
changes to this approved funding agreement requires written approval by DHCS prior to implementing the changes.
Cumulative transfers among annual budget line items are allowed as long as the amount does not exceed five percent (5%) of the current total approved budget.
Time Base SFY 1 SFY 2 SFY 3 Administrative
Medi-Cal Navigators Project (AB 74) (FTEs) Close-Out
7/01/22 —6/30/23 7/1/23—6/30/24 7/1/24—6/30/25 7/1/25—6/30/26 Amount
Personnel Staff
Benefits $ -
Total Personnel Expenses - $ - $ - $ - $ - $ -
Non-Personnel — Direct Costs
Office Expenses $ -
Equipment $ 1,000.00 $ 1,000.00 $ 1,000.00 $ 3,000.00
Travel $ -
Training $ -
Outreach Material $ 1,200.00 $ 1,200.00 $ 1,200.00 $ 3,600.00
Media Outreach $ 250.00 $ 250.00 $ 250.00 $ 750.00
Total Budget for All CBOs $ 398,883.00 $ 398,883.00 $ 398,884.00 $ 1,196,650.00
Other Costs [itemize expenses in an attachment] $ -
-Incentives $ -
Total Direct Costs $ 401,333.00 $ 401,333.00 $ 401,334.00 $ - $ 1,204,000.00
Non-Personnel — Indirect Costs
-Health Insurance $ - $ - $ - $ -
-Other Costs [itemize expenses in an attachment] $ - $ - $ - $ -
Total Indirect Costs $ - $ - $ - $ - $ -
Total Personnel Expenses $ - $ - $ - $ - $ -
Total Direct Costs $ 401,333.00 $ 401,333.00 $ 401,334.00 $ - $ 1,204,000.00
Total Indirect Costs @ 15.0% $ - $ - $ - $ - $ -
Grand Total $ 401,333.00 $ 401,333.00 $ 401,334.00 $ - $ 1,204,000.00
PAGE 4OF6
DHCS Health Enrollment Navigators Project Attachment 1
Budget Plan Reporting Instructions
Field Name Description
Tab 3 Budget Plan Line Items For the Personnel section of your budget plan; state the staff, the time spent on the
project,job title, and the role the individual will serve during the Health Navigators
N Project.
C
O For the Direct operating costs, state what your county or organization intends to bill
0 toward each line item.
L
N Once awarded, If you plan to bill something different then what was previously stated,
C please notify DHCS for approval before purchasing. If you do not seek approval prior to
purchasing and the item(s) is not permissible, DHCS will not reimburse the item(s)
purchased.
FTE Name/Job Title or Position Role Description for the Health Navigators Project
M
4W
U)
C
C
O
N
L
a
Equipment Canopy frames. Collapsable utility wagons, poster display A-Frams, tables, chairs, table
cloths and any other item requested by CBO and approved by DSS Admin for use at
outreach events.
i Travel
N
0 N
.. O
QV Training
Ir
O
L
Q
a
_ o Outreach Material Flyers (in English and Spanish): "How to Apply for Benefits", "Medical Notice"; "Are you
O Covered?", and PHE Unwind. Brochure: Minor Consent(Eng. &Spanish) A-Frame
Z Posters: For various Outreach Events and PHE Unwind. Canva Pro: 1-year subscription
renewal to create flyers and social media posts (County Facebook and Instagram
accounts).
Page 5 of 6
DHCS Health Enrollment Navigators Project Attachment 1
Budget Plan Reporting Instructions
# Field Name Description
Media Outreach Medi-Cal outreach and PHE unwind messaging, with tools such as the Canva
0) application, to be shared with the general public via news and social media outlets
_ (Local TV stations, Podcasts, Department Youtube account, Instagram, Twitter).
i
d
CL
0
a-' Total Budget for All CBOs Master Agreement/Contract with CBOs, NRCs, and FQHCs for the provision of PHE
dunwind direct messaging, client education, outreach, application assistance- renewals
and enrollments.
0 N
� U
_
_
0
i Other Cost:
G� -Incentives
a
z°
Page 6 of 6
COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN
Program Planning and Startup Plan
anticipatedSection 1: Identify specific Navigators Project's planning and start-up activities and the
PROGRAM PLANNING AND START-UP ACTIVITIES ANTICIPATED ACTUAL
COMPLETION COMPLETION
What strategies/activities will be used to achieve? DATE DATE
Create social media posts for County Facebook, Instagram, and Twitter accounts to inform public of pending
PHE end and steps current Medi-Cal clients should take to assist in maintaining active Medi-Cal. 2/28/2023
Create fliers to inform public of pending PHE end and steps current Medi-Cal clients should take to assist in 2/28/2023
maintaining active Medi-Cal.
Create aids for social media posts and fliers to provide tips for maintaining an active Medi-Cal case and to 4/30/2023
assist in choosing a Managed Care Plan for those that do not qualify for Medi-Cal.
Concentrate specific outreach efforts to community centers and senior centers throughout Fresno County in
order to expand messaging of program changes (Medi-Cal Expansion) and pending PHE termination. 2/28/2023
Provide targeted training to contracted Neighborhood Resource Centers to educate support staff regarding 2/28/2023
upcoming Medi-Cal program changes.
Generate scope of work, amend current NRC contracts, initiate process to contract with interested CBOs and
secure Board of Supervisor approved contracts, conduct initial training sessions with partners for the 4/30/2023
provisions related to PHE messaging and retention as outlined in contracts, and any other related tasks to
intiate CBO activities start-up.
2-Planning&Start-Up Page 1 of 7
COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN
NormalOperations
troubleshooting,Section 2: Identify specific outreach, application assistance,enrollment,access&utilization to health care, activities that meets the
core objectives of AB 74 you will conduct to implement this approach. Identify specific target ... responsible
list an activity(ies)for each task. For reference, a short list of examples of activities under each task is on Tab 6.
STRATEGIES AND ACTIVITIES TARGET RESPONSIBLE
POPULATIONS ENTITY
What strategies/activities will be used to achieve the AB74 goals? Refer to Tab 6 Name of county or CBO,or
Task subcontracted entity
Conduct outreach events (pop-ups or one-off community events)to distribute fliers, resource materials, and incentives.
Outreach Provide general information and/or one-on-one assistance to attendees/clients. 5, 6, 7, 8, 9, 10, 11 CBOs
Application Assist applicants in person with completing Medi-Cal applications and/or collecting necessary verifications. Submit 5, 6, 7, 8, 9, 10, 11 CBOs
Assistance client applications to DSS for processing/enrollment.
Provide assistance to clients when completing redetermination packets and/or submitting required substantiating 5, 6, 7, 8, 9, 10, 11 CBOs
Retention documentation.
Troubleshooti Assist clients with accessing/contacting DSS eligibility staff to discuss issues; provide guidance, literacy assistance for 5, 6, 7, 8, 9, 10, 11 CBOs
ng client during interactions.
Access& Provide information about how to use Medi-Cal, provide information regarding the various managed care plans in the
Utilization area and how to access; assist with accessing services. 5, 6, 7, 8, 9, 10, 11 CBOs
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
3-Normal Operations Page 2 of 7
COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN
Public Health Emergency (PHE) Plan
Section 3: On phases of PHE. 1)Identify activities relating
importantto outreach focus during PHE to encourage beneficiaries to provide their local county social services agency with any updated contact information such as: name,address,
phone number,and email so the county can contact beneficiaries with population(s)and the
responsibleo outreach and retention during the .i days prior to PHE termination. Identify specific target
... responsible
...ulation(s)and the responsible entity who will implement
TARGET RESPONSIBLE
Task STRATEGIES AND ACTIVITIES POPULATIONS ENTITY
What strategies/activities will be used to achieve this phase? Refer to Tab 6 Name of county or CBO,or
subcontracted entity
During PHE
Share resources at outreach events informing public of impending changes with PHE and the need for udpated client
contact information. Conduct case look-ups onsite, inform clients of information/verification necessary to maintain an 5, 6, 7, 8, 9, 10, 11 DSS
Outreach active case.
Create Medi-Cal outreach and PHE unwind messaging, with tools such as the Canva application, to be shared with the
Media general public via news and social media outlets (Local TV stations, Podcasts, Department Youtube account, 5, 6, 7, 8, 9, 10, 11 DSS
Outreach Instagram, Twitter).
Outreach Provide PHE unwind messaging through direct client contact 1-10 CBOs
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
60 Days Prior to PHE Termination
Share resources at outreach events informing public of impending changes with PHE and the need for updated client 5, 6, 7, 8, 9, 10, 11 CBOs
Outreach contact information.
Provide client education through direct contact regarding actions/documentation necessary to maintain active case 1-10 CBOs
Outreach following end of PHE.
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
12 Month PHE Unwinding Period
Provide assistance to clients in the field and in office when completing their redetermination packets and/or submitting 5, 6, 7, 8, 9, 10, 11 CBOs
Outreach required substantiating documentation.
4-PHE Operations Page 3 of 7
COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN
At outreach events, provide direct information to clients regarding how to maintain their ongoing case, update contact 5, 6, 7, 8, 9, 10, 11 CBOs
Outreach information, and provide information on necessary verifications.
Retention lContinue client education and PHE messaging. Assist clients with on-site retention/reenrollment applicatons. 1-10 CBOs
(Select One)
(Select One)
(Select One)
(Select One)
(Select One)
4-PHE Operations Page 4 of 7
Normal Operations
FY 1 12024-25
Media Outreach (1,000) (1,000) (1,000) Will be conducted by Department
Direct Outreach 10,000 10,000 10,000
Application Assistance 1,550 1,550 1,550
Enrollment 1,200 1,200 1,200 CBOs to provide assistance. Proce
Retention 900 900 900 CBOs to provide assistance. Proce
Navigation 750 750 750
Troubleshooting 300 300 300
Focused Activities For
Direct Outreach 8,000
Application Assistance 840
Media Outreach (1,000) Will be conducted by Department staff; NOT funded by proj
Enrollment 24 CBOs to provide assistance. Processing/determinations do I
Retention 900 CBOs to provide assistance. Processing/determinations do I
Navigation 750
Troubleshooting 300
Page 5 of 7
COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN
Target Populations
1. Persons with Mental Health Disorders
2. Persons with Substance Use Disorders
3. Persons with Other Disabilities
4. Aged Persons
5. Homeless Persons
6. Young People of Color
7. Immigrants&Families of Mixed Immigration Status
8. Persons with Limited English Proficiency
9. Low-Wage Workers and their Families and Dependents
10. Uninsured Children or Youth Formerly Enrolled in Medi-Cal
11. Persons Who are in County Jail or State Prison,on State Parole,on County Probation,or Under Post Release Community Supervision
Task Definition Example
Activities for this task are for individuals encountered was enrolled into/approved for Medi- Example activities include processing/approving the Medi-Cal
Enrollment Cal as a result of submitting their application package. application or when Medi-Cal enrollment is a direct result of
being educated by or receiving assistance from the Navigators
Project.
Activities for this task are for individuals encountered that result in their continuation of Example activities include processing redeterminations, change
Retention their Medi-Cal benefits, or re-establishing eligibility within the 90 day cure period. in circumstance reports, assisting individuals complete the
redetermination packets and and/or submit required
substantiating documentation.
Example activities include community events, handing out
Activities for this task are if the individual was directly encountered as part of the outreach flyers, and direct calls.
Direct Outreach activities. For purposes of this Project, "outreach" is defined as "Individuals being informed
or educated about Medi-Cal Program including how to apply for and keep Medi-Cal benefits.
Activities for this task are used if the individual was encountered through various media Example activities include radio ads, bill board ads, and an
platforms as part of the outreach activities. For purposes of this Project, "outreach" is Instagram post.
Media Outreach defined as"Individuals being informed or educated about Medi-Cal Program including how
to apply for and keep Medi-Cal benefits.
Application Activities for this task are when an individual encountered was assisted in completing any or Example activities include filling out an application, and/or
Assistance all parts of the Medi-Cal application package. submit required substantiating documentation.
Access& Activities for this task include assisting with access&utilization to health care. Example activities include providing information about how to
utilization to use Medi-Cal, explaining the difference between managed care
health care and eligibility.
6-Information (TPs,Task Ex) Page 6 of 7
COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN
Activities are assisting with resolving any problems or issues associated with their Medi-Cal Example activities include researching limitations or denials of
Troubleshooting benefits and access to care. care, requesting new Medi-Cal Benefits Identification Cards,
and providing points of contact to resolve issues.
Activities for this task are when an individual encountered was assisted in completing any or Example activities include researching limitations or denials of
Assistance with all parts of the Medi-Cal annual redetermination package prior to their redetermination care, requesting new Medi-Cal Benefits Identification Cards,
Redetermination date, or those same efforts during the 90 day cure period to retain. and providing points of contact to resolve issues.
6-Information (TPs,Task Ex) Page 7 of 7