HomeMy WebLinkAboutManiFest MedEx-Health Information Exchange System for Patient Data Transmission_A-24-230 A-22-011.pdf COU Y Count of Fresno Hall of Records,Room 301
2281 Tulare Street
Fresno,California
Board of Supervisors 93721-2198
O 185 0 Telephone:(559)600-3529
FRES Minute Order Toll Free: 1-800-742-1011
www.fresnocountyca.gov
May 21, 2024
Present: 5- Supervisor Steve Brandau,Chairman Nathan Magsig,Vice Chairman Buddy Mendes,
Supervisor Brian Pacheco,and Supervisor Sal Quintero
Agenda No. 44. Public Health File ID:24-0407
Re: Approve and Authorize the Chairman to execute Amendment I to Agreement with Manifest MedEx to
remove Central Valley Health Information Exchange and update agreement scope of work,effective
upon execution with no change in term of January 4,2022 to June 30, 2027,and increasing the
maximum by$415,000 to a total not to exceed$503,130;and approve and authorize the Director of
the Department of Public Health,or designee,as signatory to approve changes and additions of
Statement of Work documents, expenditure forms and reports,and to add new Statement of Work as
needed by program which do not result in any change to the maximum compensation amount
APPROVED AS RECOMMENDED
Ayes: 5- Brandau, Magsig, Mendes, Pacheco,and Quintero
Agreement No.24-230
County of Fresno Page 47
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`9 � Board Agenda Item 44
O 1856 O
DATE: May 21, 2024
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
Susan L. Holt, LMFT, Director of Behavioral Health
SUBJECT: Amendment I to Agreement with Manifest MedEx
RECOMMENDED ACTION(S):
1. Approve and Authorize the Chairman to execute Amendment I to Agreement with Manifest
MedEx to remove Central Valley Health Information Exchange and update agreement scope
of work, effective upon execution with no change in term of January 4, 2022 to June 30, 2027,
and increasing the maximum by$415,000 to a total not to exceed$503,130; and
2. Approve and authorize the Director of the Department of Public Health, or designee, as
signatory to approve changes and additions of Statement of Work documents, expenditure
forms and reports, and to add new Statement of Work as needed by program which do not
result in any change to the maximum compensation amount.
There is no additional Net County Cost associated with the recommended actions, which will remove
Central Valley Health Information Exchange and update agreement scope of work to allow the Department of
Public Health and the Department of Behavioral Health continued access to exchange patient data with
healthcare facilities and providers, and monitor, track, and improve patient care coordination utilizing the
health information technology infrastructure maintained by Manifest MedEx. The increase in the maximum
compensation will be funded with American Rescue Plan Act-State Local Fiscal Recovery Funds
(ARPA-SLFRF), as it relates to the County's Integrated Data System project. This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the Departments will not be able to continue to
utilize Manifest MedEx's (MX)technology infrastructure to access and exchange patient data with healthcare
facilities and providers, requiring staff to continue to utilize existing manual, less efficient, and less
comprehensive methods of obtaining patient data.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The recommended
amendment increases the maximum compensation by$415,000 to a total of$503,130,which will be fully
funded with ARPA-SLFRF. Sufficient appropriations and estimated revenues are included in DPH Org 5620
FY 2023-24 Adopted Budgets and will be included in future budget requests for the duration of the term.
DISCUSSION:
On January 4, 2022, the Board approved Agreement No. 22-011 with Central Valley Health Information
County of Fresno Page 1 File Number.24-0407
File Number:24-0407
Exchange (CVHIE)and MX for the provision of a health information exchange system for patient data
transmission for the Department of Public Health and Behavioral Health.
In August 2023, CVHIE was dissolved, due to completion of the implementation of the Health Information
Exchange (HIE)and in turn every participant had direct agreements with MX.
The proposed recommended actions will support the projects for the County Integrated Data System for
Youth Suicide Prevention and Home Visitation/Care coordination focus. Immediately, the goal for Youth
Suicide Prevention is when a child presents in a hospital emergency room with suicidal ideations there is an
email sent to the child's school nurse or school counselor of the visit. Security and legal protocols will be
followed with the County infrastructure, MX, and the receiving schools.
MX will develop a policy framework to support ongoing data exchange between providers, public health,
county behavioral health, and school districts/schools for patients who are minors, providing
recommendations for both MX and the County of Fresno best practices and potential policies. These
findings, along with independent review and analysis by the County of Fresno legal counsel,will inform the
parameters for data exchange for Youth Suicide Prevention.
MX will work with the County of Fresno and Its stakeholders to further define existing and novel data flows for
Youth Suicide Prevention, including how and where relevant data is captured, triggers for data transmission,
user permissions, and user technology needs, including infrastructure and user interfaces. This
collaborative analysis will also identify any additional or ancillary technology beyond MX's current technology
that is required to enable the Youth Suicide Prevention use case.
MX will implement a notification service ("MX Notify")that alerts the County of Fresno when a Patient of the
County of Fresno is seen in the emergency department or is admitted to or discharged from the hospital.
Notifications will be based on the patient panels submitted by the County of Fresno.
The recommended amendment I to the agreement amends the scope of services to expand as the County
Integrated Data System continues to be built. Funding is available in the proposed amendment to assist
County departments with tailoring the system to address suicide prevention or home visitation/care
coordination requirements. Additionally, the Department may evaluate the capacity with Manifest MedEx to
assess patients receiving rural mobile health services if we experienced a reduction of emergency room
utilization from that patient population.
REFERENCE MATERIAL:
BAI#27-January 4, 2022
BAI #54-January 29, 2019
BAI #33-October 11, 2016
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Amendment to Agreement with Manifest MedEx
CAO ANALYST:
Ron Alexander
County of Fresno page 2 File Number.24-0407
Agreement No. 24-230
Amendment I
To Participation Agreement
THIS AMENDMENT 1 to the Agreement,number 22-011,is made and entered into as of the date
of last signature("Amendment Effective Date"),by and between County of Fresno, a political subdivision
of the State of California,hereinafter referred to as"Participant",and Manifest MedEx("MX")a non-profit
public benefit corporation, whose address is 6001 Shellmound St., Suite 500, Emeryville, CA 94608,
hereinafter referred to as "MX"(collectively the"parties").
A. Participant and MX have entered into that certain Participation Agreement effective
January 41h, 2022 ("Agreement"), which sets forth their respective rights, obligations and duties regarding
the Agreement; and
B. Participant and MX wish to amend the Agreement to permit the issuance of SOWs(defined
below)under the Agreement.
NOW,THEREFORE,for and in consideration of the recitals above and the mutual covenants and
conditions contained herein, Participant and MX agree to the following additional terms:
1. CVHIE. The Parties acknowledge that Central Valley Health Information Exchange ("HIO")
has dissolved its operation and is no longer providing Services to Participant. Pursuant to
Article 11.4 "HIO Termination"of Exhibit 2.a"Terms and Conditions"to the Agreement, the
Agreement remains in full force and effect by and between Participant and MX.
2. Acknowledgement. Participant acknowledges that Amendment 1 is required to assist the
Participant to comply with the objectives adopted by its Board of Supervisors in expenditure
of American Rescue Plan Act State and Local Fiscal Recovery Funds (ARPA-SLFRF) for the
County Integrated Data Sharing System/Community Information Exchange and Rural Mobile
Health.
3. Terms and Conditions.
a. The language set forth in Exhibit 2.a., Terms and Conditions of the Participation
Agreement, Article 12.6 "Federal Reporting Requirements" is amended to add the
following:
To the extent required by law and applicable to the Services being provided, MX
shall provide required documentation in compliance with ARPA Federal Terms
and Conditions (FTC), attached hereto as Exhibit 3.a.1 and incorporated by this
reference. The Parties acknowledge and agree that MX does not participate in
SAM and is not being awarded any funds thereunder.
b. The language set forth in Exhibit 2.a., Terms and Conditions of the Participation
Agreement, Article 12.12 "Exhibits," of the Agreement is deleted in its entirety and
replaced with the following:
"12.12 Exhibits and Statements of Work. All exhibits and attachments to the Agreement are
incorporated into the Agreement and are a part of the Agreement. The Participants respective
Director of Public Health or designee are hereby granted signature authority and authority to
negotiate prices for services that are not explicitly listed within the Agreement. Details on
specific Services and corresponding pricing(as set forth in the Participant Agreement)may be
specified in separate Statements of Work ("SOWs") to this Agreement, with terms on which
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MX and Participant may agree therein. In such event, the initial SOW shall be designated
Exhibit 3.a. and each new additional SOW shall be consecutively numbered(e.g.;Exhibit 3.b.,
3.c., 3.d., etc.). Upon mutual execution, such new SOW shall be deemed attached to this
Agreement and incorporated herein by reference. In the event of any conflict between the terms
of the Agreement and an SOW, the terms of this Agreement shall govern unless the SOW
expressly references the conflicting provision in this Agreement and provides that the provision
in the SOW shall govern."
4. Statement of Work#1. Exhibit 3.a, Statement of Work#1, attached hereto, shall be added to
the Agreement as Exhibit 3.a.
[Remainder of page intentionally left blank]
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This Amendment is hereby incorporated into the Agreement by reference. All other terns, conditions and
obligations of the Agreement are hereby ratified,reaffirmed and remain in full force and effect. Signatures
submitted electronically including by means such as DocuSign or scanned PDFs shall be deemed original
signatures of the parties and shall be valid and binding upon the parties hereto.
ACKNOWLEDGED,ACCEPTED AND AGREED TO:
Manifest MedEx, a California County of Fresno
nonprofit public benefit
corporation
By: By:
Name: Erica Galvez Name: Nathan Magsig
Chairman of the Board of
Title: Title: Supervisors of the County of
CEO Fresno
Date: 5/6/2024 Date: a/- vZDo?`f
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,state of
California
By Deputy
For Accounting use only:
Org No.: 56208520
Org No.: 56201019
Account No.: 7295
Fund No.:0001
Subclass No.: 10000
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EXHIBIT 3.a
STATEMENT OF WORK#1
MX SOW to Support Fresno County Community Information Exchange
This Statement of Work("SOW"), is made and entered into as of the date of last signature,by and between
Manifest MedEx ("MX") and County of Fresno ("Participant") is issued pursuant to the Participation
Agreement, (as amended, the "Agreement") dated January 4, 2022, between MX and Participant, and
incorporates all of the terms and conditions therein.
Pursuant to the Agreement, MX has agreed to perform certain Services in accordance with written
Statements of Work, such as this one, entered into from time-to-time.
American Rescue Plan Act State and Local Fiscal Recovery Funds (ARPA-SLFRF)" means the
consolidated 2021 bill found in H.R. 1319, Public Law 117-2".
The parties hereby agree as follows:
1. Term. The term of this SOW shall be February 1,2024 through June 30, 2025.
2. Scope&Fees.Under this SOW,MX will endeavor to determine the necessary policy and technical
infrastructure requirements for supporting County Integrated Data System (IDS) and Suicide
Prevention Data Flow for Children("Youth Suicide Prevention"), such efforts to include:
a. Policy:
i. Service Description: MX will develop a policy framework to support ongoing data
exchange between providers, public health, county behavioral health, and school
districts/schools for patients who are minors,providing recommendations for both
MX and Participant best practices and potential policies. These findings, along
with independent review and analysis by Participant legal counsel,will inform the
parameters for data exchange for Youth Suicide Prevention.
ii. Fees: For the Services provided in this Section, Participant shall pay to MX a fee
of$120,000; $60,000 payable upon execution of this SOW, and$60,000 payable
upon delivery of a draft policy framework to Participant by six(6)months.
b. Collaboration:
i. Service Description. MX will work with Participant and Participant stakeholders
to further define existing and novel data flows for Youth Suicide Prevention,
including how and where relevant data is captured,triggers for data transmission,
user permissions, and user technology needs, including infrastructure and user
interfaces. This collaborative analysis will also identify any additional or ancillary
technology beyond MX's current technology that is required to enable the Youth
Suicide Prevention use case. To support alignment between MX's solutioning and
Participant expectations, Participant will include MX in the workgroups listed
below and MX will provide at least one representative for each workgroup that
will attend all regular meetings and provide subject matter expertise. At a
minimum, Participant and MX will confirm mutual understanding of the policy
and technical requirements in writing, including desired data elements and data
output required to fulfill Participant project goals:
1. Youth Suicide Prevention Technical Workgroup
2. Legal Framework/Data Sharing Agreements Workgroup, including legal
compliance assessment.
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ii. Fees. For the Services provided in this Section, Participant shall pay to MX a fee
of$80,000; $40,000 payable upon execution of this SOW, and $40,000 payable
upon the conclusion of the Workgroups, which are anticipated to run
approximately until January 31, 2025.
c. Implementation of Pilot:
i. Service Description:
1. Provided that the policy work and collaboration efforts set forth in
Sections 2.a and 2.b above (collectively"Requirements Work") conclude
that the desired data sharing associated with Youth Suicide Prevention is
commercially feasible for the Parties, MX will implement a notification
service("MX Notify")that alerts Participant when a Patient of Participant
is: (i) seen in the emergency department of Participant or an NP
Participant; or (ii) admitted to or discharged from the hospital of
Participant or an NP Participant; subject to any limitations, consents, or
other requirements determined in the Requirements Work. Notifications
will be based on the patient panels submitted by Participant. To the extent
that meeting the policy and/or technical requirements for the Youth
Suicide Prevention use case requires MX to acquire,build, or implement
new technology, including but not limited to methods for consent
management, MX and Participant will agree on implementation and
associated fees prior to MX implementing it.
2. Following implementation,MX will support MX Notify for Youth Suicide
Prevention in production for a period of three (3) months ("Pilot Period")
during which time the project teams will evaluate how well the MX Notify
solution meets the use case requirements and stakeholder needs. This will
allow MX to adjust the solutioning as needed to better support the Youth
Suicide Prevention use case and identify the extent to which the solution
is extensible to other County IDS use cases. Continued use of MX Notify
by Participant for Youth Suicide Prevention and/or other County IDS use
cases following the Pilot Period will require an amendment that will
include ongoing fees.
3. For purposes of clarity,MX shall not be required to implement MX Notify
in the event that the Requirements Work deems the data sharing associated
with Youth Suicide Prevention legally impermissible or commercially
infeasible for MX, as determined in MX's sole reasonable discretion.
ii. Fees: In the event that MX implements MX Notify for Youth Suicide Prevention
without implementing additional or ancillary technology to support the use case,
Participant shall pay to MX a fee of$15,000 under this SOW.
d. Additional Hourly Work at Participant's Request: Participant may request, and MX may
agree to perform, additional Services on a time and material basis, invoiced monthly, at a
rate of$200 per hour, up to a maximum of$200,000 without requiring an amendment to
this SOW. MX shall submit a proposal for review and approval by Participant prior to
conducting Additional Work under this Section 2(d) of the SOW.
3. Total Fees. The total fees paid pursuant to this SOW are not to exceed$415,000
4. Point of Contact. The following individuals shall serve as designated points of contact for the
Services set forth in this SOW:
a. MX: Manifest MedEx
Attn: Leslie Goodyear-Moya, Senior Advisor, Strategic Initiatives
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6001 Shellmound St., Suite 500,Emeryville, CA 94608
E-mail:leslie.g_oodyear-moya a,manifestmedex.org
b. For Participant.
Count of Fresno, a political subdivision of the State of California
Attn: David Luchini, Director
Department of Public Health
1221 Fulton Street
Fresno, CA 93721
E-mail: dluchini@fresnocountyca.gov
c. Attn: Susan Holt, Interim Director
Department of Behavioral Health
1925 E. Dakota Ave.
Fresno, CA 93726
E-mail: sholt@fresnocountyca.gov
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EXHIBIT 3.a.1
U.S. DEPARTMENT OF THE TREASURY CORONAVIRUS LOCAL FISCAL RECOVERY FUND
TERMS AND CONDITIONS
1. Use of Funds.
a) Contractor understands and agrees that the funds disbursed under this award may only be
used in compliance with section 603(c)of the Social Security Act (the Act), Treasury's
regulations implementing that section, and guidance issued by Treasury regarding the
foregoing.
b) Contractor will determine prior to engaging in any project using this assistance that it has
the institutional, managerial, and financial capability to ensure proper planning,
management, and completion of such project.
2. Maintenance of and Access to Records.
a) Contractor shall maintain records and financial documents sufficient to evidence
compliance with section 603(c) of the Act, Treasury's regulations implementing that section,
and guidance issued by Treasury regarding the foregoing.
b) The Treasury Office of Inspector General and the Government Accountability Office, or
their authorized representatives, shall have the right of access to records (electronic and
otherwise)of Contractor in order to conduct audits or other investigations.
c) Records shall be maintained by Contractor for a period of five (5)years after all funds have
been expended or returned to Treasury, whichever is later.
3. Compliance with Applicable Law and Regulations.
a) Contractor agrees to comply with the requirements of section 602 of the Act, regulations
adopted by Treasury pursuant to section 602(f) of the Act, and guidance issued by
Treasury regarding the foregoing. Contractor also agrees to comply with all other applicable
federal statutes, regulations, and executive orders, and Contractor shall provide for such
compliance by other parties in any agreements it enters into with other parties relating to
this award.
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b) Federal regulations applicable to this award include, without limitation, the following:
i. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards, 2 C.F.R. Part 200, other than such provisions as Treasury may
determine are inapplicable to this Award and subject to such exceptions as may be
otherwise provided by Treasury. Subpart F-Audit Requirements of the Uniform
Guidance, implementing the Single Audit Act, shall apply to this award.
ii. Universal Identifier and System for Award Management (SAM), 2 C.F.R. Part 25,
pursuant to which the award term set forth in Appendix A to 2 C.F.R. Part 25 is
hereby incorporated by reference.
iii. OMB Guidelines to Agencies on Governmentwide Debarment and Suspension
(Nonprocurement), 2 C.F.R. Part 180, including the requirement to include a term or
condition in all lower tier covered transactions (contracts and subcontracts
described in 2 C.F.R. Part 180, subpart B)that the award is subject to 2 C.F.R. Part
180 and Treasury's implementing regulation at 31 C.F.R. Part 19.
iv. Contractor Integrity and Performance Matters, pursuant to which the award term set
forth in 2 C.F.R. Part 200, Appendix XII to Part 200 is hereby incorporated by
reference.
V. Governmentwide Requirements for Drug-Free Workplace, 31 C.F.R. Part 20.
vi. New Restrictions on Lobbying, 31 C.F.R. Part 21.
vii. Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (42
viii. U.S.C. §§4601-4655) and implementing regulations.
ix. Generally applicable federal environmental laws and regulations.
c) Statutes and regulations prohibiting discrimination applicable to this agreement include,
without limitation, the following:
i. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §§2000d et seq.) and Treasury's
ii. implementing regulations at 31 C.F.R. Part 22, which prohibit discrimination on the
basis of race, color, or national origin under programs or activities receiving federal
financial assistance;
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iii. The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§ 3601 et
seq.), which prohibits discrimination in housing on the basis of race, color,
iv. religion, national origin, sex, familial status, or disability;
V. Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794), which
prohibits discrimination on the basis of disability under any program or activity
receiving federal financial assistance;
vi. The Age Discrimination Act of 1975, as amended (42 U.S.C. §§ 6101 et seq.), and
Treasury's implementing regulations at 31 C.F.R. Part 23, which prohibit
discrimination on the basis of age in programs or activities receiving federal
financial assistance; and
vii. Title II of the Americans with Disabilities Act of 1990, as amended (42 U.S.C. §§
12101 et seq.), which prohibits discrimination on the basis of disability under
programs, activities, and services provided or made available by state and local
governments or instrumentalities or agencies thereto.
4. Hatch Act. Contractor agrees to comply, as applicable, with requirements of the Hatch Act
(5 U.S.C. §§ 1501-1508 and 7324-7328), which limit certain political activities of State or local
government employees whose principal employment is in connection with an activity financed in
whole or in part by this federal assistance.
5. False Statements. Contractor understands that making false statements or claims in
connection with this agreement is a violation of federal law and may result in criminal, civil, or
administrative sanctions, including fines, imprisonment, civil damages and penalties, debarment
from participating in federal awards or contracts, and/or any other remedy available by law.
6. Publications. Any publications produced with funds from this agreement must display the
following language: "This project [is being] [was] supported, in whole or in part, by federal award
number SLFRP 3678 awarded to County of Fresno by the U.S. Department of the Treasury."
7. Debts Owed the Federal Government.
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a) Any funds paid to Contractor(1) in excess of the amount to which Contractor is finally
determined to be authorized to retain under the terms of this award; (2)that are determined
by the Treasury Office of Inspector General to have been misused; or(3)that are
determined by Treasury to be subject to a repayment obligation pursuant to sections 602(e)
and 603(b)(2)(D) of the Act and have not been repaid by Contractor shall constitute a debt
to the federal government.
b) Any debts determined to be owed the federal government must be paid promptly by
Contractor. A debt is delinquent if it has not been paid by the date specified in Treasury's
initial written demand for payment, unless other satisfactory arrangements have been made
or if the Contractor knowingly or improperly retains funds that are a debt as defined in
paragraph 14(a). Treasury will take any actions available to it to collect such a debt.
8. Disclaimer.
a) The United States expressly disclaims any and all responsibility or liability to Contractor or
third persons for the actions of Contractor or third persons resulting in death, bodily injury,
property damages, or any other losses resulting in any way from the performance of this
award or any contract, or subcontract under this award.
b) The execution of this agreement by Contractor does not in any way establish an agency
relationship between the United States and Contractor.
9. Protections for Whistleblowers.
a) In accordance with 41 U.S.C. §4712, Contractor may not discharge, demote, or otherwise
discriminate against an employee in reprisal for disclosing to any of the list of persons or
entities provided below, information that the employee reasonably believes is evidence of
gross mismanagement of a federal contract or grant, a gross waste of federal funds, an
abuse of authority relating to a federal contract or grant, a substantial and specific danger to
public health or safety, or a violation of law, rule, or regulation related to a federal contract
(including the competition for or negotiation of a contract)or grant.
b) The list of persons and entities referenced in the paragraph above includes the following:
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i. A member of Congress or a representative of a committee of Congress;
ii. An Inspector General;
iii. The Government Accountability Office;
iv. A Treasury employee responsible for contract or grant oversight or management;
V. An authorized official of the Department of Justice or other law enforcement
agency;
vi. A court or grand jury; or
vii. A management official or other employee of Contractor, contractor, or subcontractor
who has the responsibility to investigate, discover, or address misconduct.
c) Contractor shall inform its employees in writing of the rights and remedies provided under
this section, in the predominant native language of the workforce.
10. Increasing Seat Belt Use in the United States. Pursuant to Executive Order 13043, 62 FR
19217 (Apr. 18, 1997), Contractor should adopt and enforce on-the-job seat belt policies and
programs for their employees when operating company-owned, rented or personally owned
vehicles.
11. Reducing Text Messaging While Driving. Pursuant to Executive Order 13513, 74 FR 51225
(Oct. 6, 2009), Contractor should encourage its employees, and subcontractors to adopt and
enforce policies that ban text messaging while driving, and Contractor should establish workplace
safety policies to decrease accidents caused by distracted drivers.
12. Title VI of the Civil Rights Act of 1964. The sub-grantee, contractor, subcontractor,
successor, transferee, and assignee shall comply with Title VI of the Civil Rights Act of 1964, which
prohibits Contractors of federal financial assistance from excluding from a program or activity,
denying benefits of, or otherwise discriminating against a person on the basis of race, color, or
national origin (42 U.S.C. § 2000d et seq.), as implemented by the Department of the Treasury's
Title VI regulations, 31 CFR Part 22, which are herein incorporated by reference and made a part
of this contract (or agreement). Title VI also includes protection to persons with "Limited English
Proficiency" in any program or activity receiving federal financial assistance, 42 U.S.C. § 2000d et
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seq., as implemented by the Department of the Treasury's Title VI regulations, 31 CFR Part 22,
and herein incorporated by reference and made a part of this contract or agreement.
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