HomeMy WebLinkAboutHealth Management Associates Inc.-Strategic Planning Consultation Services_A-25-089 A-24-337.pdf COtj County of Fresno Hall of Records, Room 301
2281 Tulare Street
Fresno,California
601 Board of Supervisors 93721-2198
O� 1$56 0 Telephone: (559)600-3529
FRV,t' Minute Order Toll Free: 1-800-742-1011
www.fresnocountyca.gov
March 11, 2025
Present: 5- Vice Chairman Garry Bredefeld, Supervisor Luis Chavez, Supervisor Nathan Magsig,
Chairman Buddy Mendes, and Supervisor Brian Pacheco
Agenda No. 41. Public Health File ID: 25-0126
Re: Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 24-337 with
Health Management Associates, Inc.to provide consultation and assistance to the Department of
Public Health with applying for the California Department of Health Care Services'Voluntary Rate
Range Program, extending the term from June 18, 2026 to December 31, 2026, and increasing the
maximum by$70,000 to a total of$317,843
APPROVED AS RECOMMENDED
Ayes: 5- Bredefeld, Chavez, Magsig, Mendes, and Pacheco
Agreement No. 25-089
County of Fresno Page 43
COZj���C
Board Agenda Item 41
O 1856 O
FRE`'�
DATE: March 11, 2025
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Amendment to Agreement with Health Management Associates, Inc.
RECOMMENDED ACTION(S):
Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 24-337 with
Health Management Associates, Inc. to provide consultation and assistance to the Department of
Public Health with applying for the California Department of Health Care Services' Voluntary Rate
Range Program, extending the term from June 18, 2026 to December 31, 2026, and increasing the
maximum by$70,000 to a total of$317,843.
There is no additional Net County Cost associated with the recommended action. Approval of the
recommended action will extend the term of the agreement with Health Management Associates, Inc. (HMA)
from June 18, 2026 to December 31, 2026 and increase the maximum compensation by$70,000 to a total
of$317,843. HMA would provide the Department of Public Health (Department)with consultation to assist
with completing the complex application for the California Department of Health Care Services' (DHCS)
Voluntary Rate Range Program (VRRP)and participating in the program once approved. This item is
countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended action, the Department will not be able to obtain additional
consultation services from HMA to navigate a complex process for application and participation in the
DHCS's VRRP.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. Upon execution of the
recommended amendment, the maximum compensation for the agreement will increase by$70,000 to a
total of$317,843. The additional consultation services to assist the Department with the VRRP will be
funded by Health Realignment. Sufficient appropriations and estimated revenues are included in the
Department's Org 5620 FY 2024-25 Adopted Budget and will be included in subsequent budget requests.
DISCUSSION:
On June 18, 2024, the Board approved an agreement with HMA for consultation services in developing the
Department's new 10-year strategic plan with a focus on providing essential services in the most
cost-effective manner possible. HMA is currently working with the Department to confirm goals and
initiatives, complete stakeholder engagement, develop a departmental framework, evaluate revenue
sources, and create an official document of the plan. Thus far, HMA has helped the project progress and
continue to meet the estimated timeline.
County of Fresno page 1 File Number.25-0126
File Number:25-0126
Approval of the recommended amendment will increase the maximum compensation upon execution,
extend the term of the agreement through December 31, 2026, and add to the scope of services provided by
HMA. The additional consultation services will involve assistance with navigating a complex DHCS
application for the Department's inclusion to the DHCS's VRRP. Participation in the VRRP will allow the
County to transfer funds to the DHCS to be used as the non-federal share in claiming Federal Financial
Participation dollars for Medicaid covered services. The eligible funds will be used by DHCS to draw down
federal funds, which can then be disbursed to the Managed Care Plans and participating counties as
additional funding.
Approval of the recommended amendment would greatly benefit the County from participation in the VRRP,
as the end result would provide the Department with substantial funding from the DHCS. The Department
plans to use these future funds to support enhanced and increased public health services and additional
related activities to the Fresno County community. HMA is also contracted with and successfully assisted
other California counties with their VRRP process, including Merced County.
REFERENCE MATERIAL:
BAI #74, June 18, 2024
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Amendment No. 1 to Agreement with HMA
CAO ANALYST:
Ron Alexander
County of Fresno page 2 File Number.25-0126
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Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
Agreement No. 25-089
1 AMENDMENT NO. 1 TO SERVICE AGREEMENT
2 This Amendment No. 1 to Service Agreement ("Amendment No. 1") is dated
3 March 11, 2025 and is between Health Management Associates, Inc., a Michigan
4 corporation ("Contractor"), and the County of Fresno, a political subdivision of the State of
5 California ("County").
6 Recitals
7 A. On June 18, 2024, the County and the Contractor entered into Service Agreement,
8 which is County agreement number 24-337 ("Agreement"), for strategic planning consultation
9 services.
10 B. The County, through its Department of Public Health ("DPH") is seeking consultation and
11 assistance with navigating a complex State of California ("State") application for DPH's inclusion
12 into the State's Voluntary Rate Range Program ("VRRP").
13 C. The County, through its DPH, seeks participation in the VRRP to be able to receive
14 federal match funding from the State to further support and enhance public health services to
15 Fresno County communities.
16 D. The Contractor has successfully assisted other government entities in implementing and
17 managing VRRP programs.
18 E. The County and the Contractor now desire to amend the Agreement to extend the
19 Agreement term through December 31, 2026 to complete the additional consultation services
20 for the VRRP.
21 The parties therefore agree as follows:
22 1. All references in the Agreement to "Exhibit A" shall be changed to read "Revised Exhibit
23 A,"where appropriate, attached hereto and incorporated herein by reference.
24 2. All references in the Agreement to "Exhibit B" shall be changed to read "Revised Exhibit
25 B," where appropriate, attached hereto and incorporated herein by reference.
26 3. Section 3.2 of the Agreement, "Maximum Compensation," located at Page 2 is deleted in
27 its entirety and replaced with the following:
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Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
1 "3.2 Maximum Compensation. The maximum compensation payable to the
2 Contractor under this Agreement is One Hundred Ninety-Eight Thousand Five
3 Hundred Ninety-Four Dollars ($198,594) for the period June 18, 2024 through
4 June 17, 2025, One Hundred One Thousand One Hundred Eleven Dollars
5 ($101,111) for the period June 18, 2025 through June 17, 2026, and Eighteen
6 Thousand One Hundred Thirty-Eight Dollars ($18,138) for the period June 18,
7 2026 through December 31, 2026. The total maximum compensation payable for
8 the entire term of this Agreement shall not exceed Three Hundred Seventeen
9 Thousand Eight Hundred Forty-Three Dollars ($317,843). The Contractor
10 acknowledges that the County is a local government entity and does so with
11 notice that the County's powers are limited by the California Constitution and by
12 State law, and with notice that the Contractor may receive compensation under
13 this Agreement only for services performed according to the terms of this
14 Agreement and while this Agreement is in effect, and subject to the maximum
15 amount payable under this section. The Contractor further acknowledges that
16 County employees have no authority to pay the Contractor except as expressly
17 provided in this Agreement."
18 4. Section 4.1 of the Agreement, "Maximum Compensation," located at Page 2 is deleted in
19 its entirety and replaced with the following:
20 "4.1 Term. This Agreement is effective June 18, 2024 and terminates on
21 December 31, 2026, except as provided in Article 6, "Termination and
22 Suspension," below."
23 5. When both parties have signed this Amendment No. 1, the Agreement and this
24 Amendment No. 1 together constitute the Agreement.
25 6. The Contractor represents and warrants to the County that:
26 a. The Contractor is duly authorized and empowered to sign and perform its obligations
27 under this Amendment.
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Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
1 b. The individual signing this Amendment on behalf of the Contractor is duly authorized
2 to do so and his or her signature on this Amendment legally binds the Contractor to
3 the terms of this Amendment.
4 7. This Amendment may be signed in counterparts, each of which is an original, and all of
5 which together constitute this Amendment.
6 8. The Agreement as amended by this Amendment No. 1 is ratified and continued. All
7 provisions of the Agreement and not amended by this Amendment No. 1 remain in full force and
8 effect.
9 [SIGNATURE PAGE FOLLOWS]
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Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
1 The parties are signing this Amendment No. 1 on the date stated in the introductory
2 clause.
3
HEALTH MANAGEMENT ASSOCIATES, COUNTY OF FRESNO
4 INC.
5 Signed by: C�
1"7 At' �c, ,s
6 Ernest Buddy Me des, Chairman of the
Jeffrey a ries, Contracts Senior Director Board of Supervisors of the County of Fresno
7
2501 Woodlake Cir, Ste 100 Attest:
8 Okemos, Michigan 48864 Bernice E. Seidel
Clerk of the Board of Supervisors
9 County of Fresno, State of California
10
By:
11 Deputy
12 For accounting use only:
13 Org No.: 56201508; 56201500
Account No.: 7295
14 Fund No.: 0001
Subclass No.: 10000
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Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
Revised Exhibit A
1 Scope of Services
2 Strategic Plan:
3 The Contractor will provide the County with consultation and support in the
4 development of DPH's new 10-year strategic plan. DPH's strategic plan is expected to be
5 developed in approximately twelve (12) months. This estimated time frame will include
6 stakeholder engagement, discussions with the DPH, and final review.
7 The Contractor will work with DPH to confirm goals and initiatives, develop a
8 departmental framework, review the strategic plan, and create an official document of the
9 plan. This will include:
10 • Development or revision of the DPH Core Purpose, Vision, Mission, and Values
11 statements.
12 • Facilitation of discussions with DPH management, employees, and other County
13 departments to identify how DPH can be more impactful.
14 • Review of current DPH programs to categorize which direct services are managed
15 by DPH or subcontracted, including annual contract amounts.
16 • Facilitation of discussions with DPH management, employees, and other County
17 departments to identify how DPH can be more aligned with equity, diversity and
18 inclusion priorities.
19 • Facilitation of stakeholder engagement activities to evaluate the community's
20 perception on DPH's current service delivery, focus and future expectations.
21 Stakeholders should represent rural, metropolitan, and diverse communities within
22 Fresno County.
23 • Review of required public health mandates, mandate levels, and revenue sources.
24 • Identification of public health priority outcomes and actions after research and
25 analysis is completed.
26 • Documentation of this information for current and future planning and budgetary
27 purposes.
28 • Final review and creation of an official document of the Strategic Plan.
A-1
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Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
Revised Exhibit A
1 The Contractor will provide a service plan that includes preliminary timelines for key
2 activities, implementation and deliverables. The Contractor will review the most recent
3 information regarding the Fresno County Community Health Improvement Plan Healthy
4 Fresno County (healthyfresnocountvdata.orc and Community Health Needs Assessment
5 2020chna.pdf(fresnostate.edu) to reference in developing DPH's strategic plan. The
6 Contractor will also consider DPH's plans to achieve its goal of accreditation through the
7 National Public Health Accreditation Board within the next few years.
8 Upon completion of DPH's strategic plan, the Contractor will assist each of the seven
9 DPH divisions with developing their strategic plan that aligns with the department's strategic
10 plan. The Contractor will work with each division to confirm goals and initiatives, develop a
11 division framework, review each strategic plan, and create an official document of each plan.
12
13 Voluntary Rate Range Program (VRRP):
14 The Contractor will provide DPH with consultation and assistance with the VRRP. The
15 Contractor will provide the following services and any other tasks, as required.
16 . Research and investigate to determine the opportunity for the County's
17 participation in the VRRP.
18 • Provide assistance and support to DPH with participation in the VRRP with
19 CalViva, Anthem, and Kaiser. This work will include the following:
20 o Provide initial information and education to DPH regarding participation in
21 the VRRP process; this may take the form of conference calls and the
22 provision of written materials. As necessary, HMA will work with executive
23 managers, elected officials, attorneys, and others throughout the VRRP
24 process.
25 o Assist DPH to identify and submit its costs for the provision of plan services
26 to plan member patients during the reporting year to which the VRRP
27 pertains. This involves understanding the California Department of Health
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A-2
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Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
Revised Exhibit A
1 Care Services (DHCS) requirements for calculating unreimbursed costs,
2 etc.
3 o Provide financial calculations to DPH regarding the dollar amounts involved
4 in their VRRP at each step of the process.
5 o Communicate with DHCS and/or Partnership Health Plan of California
6 regarding any issue related to the VRRP including but not limited to the
7 VRRP timelines, document language, etc.
8 o Provide DPH with drafts for their approval of any VRRP documents required
g by DHCS, including the Health Plan-Provider Agreement and the
10 Intergovernmental Agreement with DHCS. These drafts will be based on the
11 latest document templates provided by DHCS, modified to include
12 information specific to the County Partnership Health Plan of California.
13 o Provide instruction and support to DPH regarding the timely execution and
14 transmittal of the final signed documents to DHCS.
15 o Assist DPH with any issues regarding the wiring of funds to DHCS and the
16 payment of the VRRP-funded proceeds by the plan.
17 Perform other activities as required to support the efficient and prompt implementation
18 of the VRRP.
19 The Contractor's Associate Principal will serve as the project manager and will ensure
20 timely completion of deliverables, coordinate team activities, and provide consistent
21 communication with the County. The Contractor's Managing Principal will also be assigned to
22 this project. Additional HMA staff will provide services for the project as appropriate.
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Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
Revised Exhibit A-Scope of Work:Strategic Plan
Proposed Service Plan and Timeline-The Contractor will work with the County to finalize.
Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25
1.1:Establish a Core Team and Steering Committee X X
1.2:Host a Kickoff Meeting and Confirm the Scope and Timeline X X
1.3:Launch the Steering Committee and Set Norms for Interaction X X
1.4:Develop DPH's Purpose,Vision,Mission,and Value Statements X
2.1:Review and Summarize DPH Services,Public Health Mandates,and X X
Revenue Sources
2.2:Conduct a Needs Assessment and DPH Discussions(includes in-person X X X
visits to Fresno County)
2.3:Summarize Findings and Present Them to DPH X X
3.1:Develop a Communication and Engagement Plan X
3.2:Engage Community Stakeholders(includes in-person visits to Fresno County) X X X X
3.3:Summarize Findings and Present Them to DPH X X
4.1:Facilitate Five Work Groups to Draft the Plan X X X
4.2:Create the DPH Strategic Plan X X
•
Jul-25 Aug-25 Sep-25 70.t-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26 Apr-26 May-26 Jun-26
5.1: Develop Aligned Division-Specific Strategic Plans(includes in-person visits to X X X X X X X X
Fresno County)
A-4
Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
Revised Exhibit A-Scope of Work:Voluntary Rate Range Program(VRRP)
Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26 Apr-26 May-26 Jun-26 Jul-26-
Dec-26
6.1 Research and investigate to determine the opportunity for the County's X X
participation in the VRRP.
6.2 Provide assistance and support to DPH with participation in the VRRP with X X X X X X X X X X X X X X X X X
CalViva,Anthem,and Kaiser.
6.2.1:Provide initial information and education to DPH regarding
participation in the VRRP process;this may take the form of conference
calls and the provision of written materials.As necessary,HMA will work X X X X X X X X X X X X X X X X X
with executive managers,elected officials,attorneys,and others throughout
the VRRP process.
6.2.2 Assist DPH to identify and submit its costs for the provision of plan
services to plan member patients during the reporting year to which the
VRRP pertains.This involves understanding the California Department of X X X X X X X X X X X X X X X X X
Health Care Services(DHCS)requirements for calculating unreimbursed
costs,etc.
6.2.3:Provide financial calculations to DPH regarding the dollar amounts X X X X X X X X X X X X X X X X X
involved in their VRRP at each step of the process.
6.2.4:Communicate with DHCS and/or Partnership Health Plan of California
regarding any issue related to the VRRP including but not limited to the X X X X X X X X X X X X X X X X X
VRRP timelines,document language,etc.
6.2.5:Provide DPH with drafts for their approval of any VRRP documents
required by DHCS,including the Health Plan-Provider Agreement and the
Intergovernmental Agreement with DHCS.These drafts will be based on the X X X X X X X X X X X X X X X X X
latest document templates provided by DHCS,modified to include
information specific to the County Partnership Health Plan of California.
6.2.6:Provide instruction and support to DPH regarding the timely X X X X X X X X X X X X X X X X X
execution and transmittal of the final signed documents to DHCS.
6.2.7:Assist DPH with any issues regarding the wiring of funds to DHCS X X X X X X X X X X X X X X X X X
and the payment of the VRRP-funded proceeds by the plan.
A-5
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Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
Revised Exhibit B
1 Compensation
2 The Contractor will be compensated for performance of its services under this
3 Agreement as provided in this Revised Exhibit B. The Contractor is not entitled to any
4 compensation except as expressly provided in this Revised Exhibit B. The total maximum
5 compensation payable for the entire term of this Agreement shall not exceed Three Hundred
6 Seventeen Thousand Eight Hundred Forty-Three Dollars ($317,843).
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Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
Revised Exhibit B-Strategic Plan Budget Summary
Vim- •
■ Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 qW
Development or revision of the DPH Core Purpose,Vision,Mission,and Values X X X $10.460.00
statements
Facilitation of discussions with DPH management,employees,and other County X X X X $6,100.00
departments to identify how DPH can be more impactful
Review of current DPH programs to categorize which direct services are X X X $8,260.00
managed by DPH or subcontracted,including annual contract amounts
Facilitation of discussions with DPH management,employees,and other County
departments to identify how DPH can be more aligned with equity,diversity and X X X X $6,100.00
inclusion priorities
Facilitation of stakeholder engagement activities to evaluate the community's
perception on DPH's current service delivery,focus and future expectations. X X X X $34,800.00
Stakeholders should represent rural,metropolitan,and diverse communities
within Fresno County
Review of required public health mandates,mandate levels,and revenue X X X $7,220.00
sources
Identification of public health priority outcomes and actions after research and X X X X $3,840.00
analysis is completed
Documentation of this information for current and future planning and budgetary X X X X $8,250.00
purposes
Final review and creation of an official document of the Strategic Plan X X X X X X X $55,730.00
Activities for the Development of each DPH division's strategic plan(year one):
1.Facilitation of five(5)work groups to draft strategic plan(year 1) X X X X X X X X X X X X $27,925.00
2.HMA Core Team Meetings(biweekly.5 hours x 18 weeks)(year 1)
3.HMA/DPH PM Team Meetings(biweekly.5 hours x 18 weeks)(year 1)
4.HMA All Team Meeting(bi-monthly.5 hour x 6 months)(year 1)
Travel labor and expenses X X X X X X X X X X X X $11,117.00
Focus Group Incentives X X X X $3,200.00
TOTAL YEAR 1 BUDGET $183,002.00
B-2
Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
Revised Exhibit B-Strategic Plan Budget Summary
Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26 Apr-26 May-26
Activities for the Development of each DPH division's strategic plan(year two):
1.HMA Core Team Meetings(Monthly.5 hours x 8 weeks)(year 2) X X X X X X X X X X $13,765.00
2.HMA/DPH PM Team Meetings(Monthly.5 hours x 18 weeks)(year 2)
Development of each DPH division's strategic plan X X X X X X X X X X $39,960.00
Travel labor and expenses X X X X X X X X X X $11,116.00
TOTAL YEAR 2 BUDGET $64,841.00
IMMW
Position Hourly Rate Description
Principal $425.00-$465.00 Charles Robbins,Principal,will serve as the project director for this work.
Associate Principal $385.00-$425.00 Betsy Uhrman,Associate Principal,will serve as the strategy and facilitation
lead.
Michael Butler and Nayely Chavez,Senior Consultants,are proposed project
Senior Consultant $340.00-$375.00 team members.Michael will serve as the project manager,and Nayely will
serve as Focus Group Facilitator(fluent in Spanish).
Emma Clark,Carlos Mena,and Jared Staheli,Consultants,are proposed
Consultant $240.00-$265.00 project team members.Emma Clark will serve as a Data Analyst.Carlos
Mena will serve as a Project Coordinator and interpreter(fluent in Spanish).
Jared Staheli will serve as Stakeholder Engagement Support.
Travel costs are for four two-night trips from Los Angeles to Fresno.
B-3
Docusign Envelope ID:89EC055D-7E8B-4C7C-8276-21967B15D9F3
Revised Exhibit B-VRRP Budget Summary
Time Frame to
- •- - - Complete Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26 Apr-26 May-26 Jun-26 Dec-2-
ee-26
6.1 Research and investigate to determine the opportunity for the County's X X $3,500.00
participation in the VRRP.
6.2 Provide assistance and support to DPH with participation in the VRRP with X X X X X X X X X X X X X X X X X
CalViva,Anthem,and Kaiser.
6.2.1:Provide information and education to DPH regarding participation in X X X X X X X X X X X X X X X X X
the VRRP process.
6.2.3:Assist DPH to identify and submit its costs for the provision of plan X X X X X X X X X X X X X X X X X
services.
6.2.4 Provide financial calculations to DPH regarding the dollar amounts X X X X X X X X X X X X X X X X X
involved in their VRRP at each step of the process.
6.2.5 Communicate with DHCS and/or Partnership Health Plan of California $66,500.00
regarding any issue related to the VRRP including but not limited to the X X X X X X X X X X X X X X X X X
VRRP timelines,document language,etc.
6.2.6 Provide DPH Wth drafts for their approval of any VRRP documents X X X X X X X X X X X X X X X X X
required by DHCS.
6.2.7 Provide instruction and support to DPH regarding the timely execution X X X X X X X X X X X X X X X X X
and transmittal of the final signed documents to DHCS.
6.2.8 Assist DPH with any issues regarding the wiring of funds to DHCS and X X X X X X X X X X X X X X X X X
the payment of the VRRP-funded proceeds by the plan.
TOTAL VRRP BUDGET $70,000.00
B-4