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HomeMy WebLinkAboutAgreement A-25-174 Revenue Agreement with CalViva.pdf __ Agreement No. 25-174 k IM� Vily tva HEATH_ health net_ LETTER OF AGREEMENT BETWEEN CALVIVA HEALTH/HEALTH NET, LLC AND COUNTY OF FRESNO CalViva Health ("CalViva) and Health Net, LLC ("Health Net), sometimes collectively referred to as"Health Plan" are pleased to inform you that it has approved a Population Health Management (PHM) Program grant in the amount of $7,153,787.64 to County of Fresno, ("Grantee") on the terms and conditions of this Grant Letter and Agreement ("Agreement"). This Agreement is made and entered into effective January 1, 2024 ("Effective Date"), by and between the Health Plan and County of Fresno ("Grantee") for the PHM Program serving the Medi-Cal population within Fresno County. NOW,THEREFORE, for good and valuable consideration, the parties agree as follows: 1. Tax Exemption Status. If Grantee is exempt from state and/or federal taxation, Grantee will provide The Health Plan proof of such exemption upon The Health Plan's written request. If the Grant is a taxable event for Grantee, Grantee agrees to pay all taxes associated with the Grant and Grantee will indemnify the Health Plan against any such taxes. 2. Purpose of Grant. Grantee agrees to use the entire Grant exclusively to support the specific goals, objectives, activities, and outcomes stated in Exhibit A. Grantee may not use any part of the Grant, including any interest earned thereon, for any other purpose without the prior written approval of the Health Plan. In no event shall Grantee use any of the funds from this Grant to (a) support a political campaign, (b) support or attempt to influence any government legislation, except making available the results of non-partisan analysis, study or research, or (c) grant an award to another party or for any purpose other than one specified in Section 170(c)(2)(b) of the Internal Revenue Code of 1986 as amended. 3. Term of Grant.The grant period is from January 15Y, 2024, through December 315t, 2026 (the "Project"). Grantee shall fulfill all outlined grantee activities/deliverables/outcomes on or before the end of the grant period. The term of this Agreement may be extended with no additional compensation for no more than one twelve-month period only upon written approval of both parties before the first day of the extension period. The County of Fresno Director of Public Health or his or her designee(s), is authorized to execute Amendments to this agreement. 4. Return of Grant Funds. The Health Plan reserves the right to discontinue, modify or withhold payments to be made under this Agreement or to require a total or partial return of any funds, including any unexpended funds under the following conditions: (i) if the Health Plan, in its sole discretion, determines that the Grantee has not performed in accordance with this Agreement or has failed to comply with any term or condition of this Agreement; (ii) if Grantee loses its status as an eligible Grantee under Paragraph 1 above; (iii) if Grantee fails to complete and/or Page 1 k C a I Vi va HEALTH_ health net.. achieve the specified grantee activities/deliverables/outcomes outlined in Exhibit A; or (iv) such action is necessary to comply with the requirements of any law or regulation applicable to Grantee or to the Health Plan or to this Grant. 5. Termination without Cause. In circumstances other than those set forth in section 3 and 4, either party may terminate this Agreement by giving at least 30 days advance written notice to the other party. If this Agreement is terminated prior to the term date of December 31, 2026 or later if extended, as listed in Section 3 of the Agreement, Health Plan may withhold all remaining payments or require a return of unexpended funds as set forth in Section 4 of this Agreement. 6. Reports, Records, Audits and Site Visits. Grantee shall submit a final written report to the Health Plan in accordance with the due dates stated on the Grant Summary in Exhibit A. The Health Plan is authorized to conduct audits, including on-site audits, at any time during the term of this Grant and within four years after completion of the Project. Grantee shall allow the Health Plan and its representatives, at its request, to have reasonable access during regular business hours to Grantee's files, records, accounts, personnel and client or other beneficiaries for the purpose of making such audits, verifications or program evaluations as the Health Plan deems necessary or appropriate concerning this Grant. Grantee shall maintain accounting records sufficient to identify the Grant and to whom and for what purpose such funds are expended for at least three (3) years after the Grant has been expended. 7. Representations. Grantee acknowledges, represents, and agrees (i) that it acts completely independently of the Health Plan and is solely responsible for any and all activities of Grantee including without limitation those activities that are supported by the Grant, and (ii), to the fullest extent permitted by law, to defend, indemnify, and hold harmless the Health Plan, its affiliates, officers, directors, trustees, employees and agents from and against any and all claims, liabilities, losses, taxes and expenses (including reasonable attorneys' fees) arising from, or in connection with, the Project and any act or omission of Grantee, its employees, or agents, in applying for, accepting, receiving and expending the Grant. 8. Other Obligations. Grantee acknowledges that the Grantee has no obligation to the Company in consideration for the Grant, other than to (i) publicly recognize the Health Plan as a sponsor of the Project in all public hearings, public events and media sessions, (ii) collaborate with the Health Plan to enhance public awareness of the Health Plan's sponsorship of the Project, (iii) placement of the Health Plan's name and logo and a brief description of the Health Plan's sponsorship in all relevant marketing materials, collateral, social media and similar public communications stating that the Project was made possible through the generous support of the Health Plan, (iv) permit the Health Plan to use Grantee's name, trademark, logo and other identifies in communications and publications (including internet, radio, television, etc.) in Page 2 k t''- Cv a I Viva HEALTH_ health net.. furtherance of the Health Plan's efforts to inform others of its connection to the Project, and (v) provide the Health Plan with audio, visual and/or written testimonials that promote the Health Plan's connection to the Project. 9. Independence of the Parties. Neither the Grant nor this Agreement shall be deemed to create any relationship of agency, partnership or joint venture between the parties, and Grantee shall make no such representation to anyone. If any portion of this Agreement is found to be illegal or invalid, it shall not invalidate the remaining portions of the document, provided the essential purposes for which each party has entered into this Agreement can still be achieved. 10. Equal Employment Opportunity. Grantee agrees to comply with and be bound by the nondiscrimination and affirmative action clauses contained in: Executive Order 11246, as amended, relative to equal opportunity for all persons without regard to race, color, religion, sex or national origin; the Vocational Rehabilitation Act of 1973, as amended, relative to the employment of qualified handicapped individuals without discrimination based upon their physical or mental handicaps; the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, relative to the employment of disabled veterans and veterans of the Vietnam Era, and the implementing rules and regulations prescribed by the Secretary of Labor in Title 41, Part 60 of the CFR. 11. Immigration Act Requirements. Grantee shall comply during the term of this Agreement with the provisions of the Immigration Reform and Control Act of 1986 and any regulations promulgated thereunder. Grantee hereby certifies that it has obtained a properly completed Employment Eligibility Certificate (INS Form 1-9) for each worker performing services related to the program described in the Evaluation Plan. 12. Governing Law. The laws of the State of California govern all matters arising from or related to this Agreement. 13. Entire Agreement. This Agreement shall supersede any prior and contemporaneous oral and written understandings or communications between the parties and it constitutes the entire agreement of the parties with respect to the subject matter hereof. This Agreement may not be delegated, assigned, amended, or modified except upon the written consent of both parties hereto. The Director of Public Health his or her designee(s), is authorized to execute Amendments to this agreement on behalf of the Grantee to comply with the fulfillment of the Services, Terms, Termination, and other relevant requirements subject to approval by Grantee's legal counsel as to legal form. Page 3 CalV- "*I;Va health net. HEALTH' Sincerely, Jeffrey Nkansah Dorothy M. Seleski Chief Executive Officer Senior Vice President CalViva Health Health Net Agreed to: County of Fresno Signature: -- Name: Ernest Buddy Mendes Title: Chairman.of the Board of Supervisors of the County of Fresno Date: 5 (v a Oa S ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors County of Fresno,State of California By 7;r Deputy For accounting use only: Org No.: 1169 Account No.: 3530 Fund No.: 0080 Subclass No.: 17369 Page 4 CaIVIVE! health net HEALTH EXHIBIT A POPULATION HEALTH MANAGEMENT (PHM) PROGRAM FUNDING SUMMARY GRANT NUMBER: 12-20-01 DATE AUTHORIZED: 04/09/2025 ORGANIZATION NAME: Fresno County AMOUNT: $7,153,787.64 Department of Public Health GRANT PERIOD:January 1, 2024-December 31, 2026 PROJECT CONTACT, TITLE: Claudia Sandoval, Health Policy & Wellness Division Manager TELEPHONE: 559.600.6546 EMAIL: clsandoval@fresnocountyca.gov COUNTY: Fresno County HEALTH PLAN GRANT CONTACT: Harout Torosian EMAIL: Ha rout.N.Torosian@healthnet.com PHM PROGRAM GRANT PURPOSE: The Population Health Management (PHM) Program is designed to ensure that all members have access to a comprehensive set of services based on their needs and preferences across the continuum of care, which leads to longer, healthier, and happier lives, improved outcomes, and health equity. Specifically, the PHM Program intends to: • Build trust with and meaningfully engage members; • Gather, share, and assess timely and accurate data to identify efficient and effective opportunities for intervention through processes such as data-driven risk stratification, predictive analytics, identification of gaps in care, and standardized assessment processes; • Address upstream drivers of health through integration with public health and social services; • Support all members in staying healthy; • Provide care management services for members at higher risk of poor outcomes; • Provide transitional care services (TCS) for members transferring from one setting or level of care to another; • Reduce health disparities; and • Identify and mitigates Social Drivers of Health (SDOH) DESCRIPTION OF GRANT/INVESTMENT: From January 1, 2024— December 31, 2026 Fresno County DPH, Community Stakeholders, and MCPs will collaborate to identify and implement targeted community and MCP interventions to improve CIS-10 and possible 1-2 lowest performing immunizations to exceed the DHCS benchmark of the 50th%. All efforts will be reported annually, results will compare baseline data to utilization claims data. Dollars are to be used for In-Kind Staffing, SDOH, CBO Contract Reporting, Training Comm., Community Information Exchange, Rural Mobile Health, Community Engagement, and Incentives. Grantee agrees to partner with CalViva Health on Rural Mobile Health activities. Countywide promotion of FCDPH and Manage Care Plan Partners. If agreement is extended in accordance to Section 3, "Term of Grant" of the agreement then Exhibit A deliverables will be extended to reflect extended term. Page 5 Ca Iva health net. HEALTH ALIGNMENT WITH DHCS' BOLD GOALS: The grant objective aligns with the following DHCS' Bold Goals (as described in DHCS' Comprehensive Quality Strategy): ❑Close racial/ethnic disparities in well-child visits and immunizations by 50 percent ❑Ensure CalViva Health exceed the 50t" percentile for all children's preventive care measures GRANT AMOUNT BREAKDOWN & DISBURSEMENT OF FUNDING The following table includes a breakdown of grant funding by PHM Program activity: PHM Program Activity 01/01/2024— 12/31/2024 Funding Amount DHCS Bold Goal Impacted Staffing $800,045.88 CalViva Close racial/ethnic will fund annually disparities in well-child until 2026 visits and immunizations by 50 percent Ensure CalViva Health exceed the 501n percentile for all children's preventive care measures Supplies and Services: Close racial/ethnic CBO Contract Reporting $ 69,840.60 disparities in well-child Training Communication $ 39,590.80 visits and Community Information Exchange $ 1,479,998.64 immunizations by 50 Social Determinant of Health Supports (e.g. food, rent, percent vehicle repair,transportation, utility costs, community based organization subawards, etc.) $ 1,407,431.09 Ensure CalViva Health Rural Mobile Health (subawards) $ 1,756,788.87 exceed the 501n Total $ 4,753,650.00 percentile for all $4,753,650 funding in full per market share for all 3 years. children's preventive care measures Page 6 k t''- Co--a I V i�Va HEALTH" health net_ PHM Program Activity 01/1/2025— 12/31/2025 Funding Amount DHCS Bold Goal Impacted Staffing $800,045.88 CalViva Close racial/ethnic Health will fund disparities in well-child annually until 2026 visits and immunizations by 50 percent Ensure CalViva Health exceed the 50tn percentile for all children's preventive care measures PHM Program Activity 01/1/2026— 12/31/2026 Funding Amount DHCS Bold Goal Impacted Staffing $800,045.88 CalViva Close racial/ethnic Health will fund disparities in well-child annually until 2026 visits and immunizations by 50 percent Ensure CalViva Health exceed the 501n percentile for all children's preventive care measures The Health Plan will disburse the grant award in three (3) installments. To be eligible for funding, Grantee must submit one (1) copy of Grantee's W-9 form and such other documentation reasonably requested by the Health Plan. Health Net will make payment in the amount of$5,553,695.88 within approximately ninety (90) calendar days of the receipt of Grantee's completed Agreement. Health Net will make the second payment in the amount of $800,045.88 within approximately ninety (90) calendar days of the receipt of Grantee's completed progress report due on December 31, 2025. Page 7 Ca Iva health net. HEALTH Health Net will the third payment in the amount of$800,045.88 within approximately ninety(90) calendar days of the receipt of Grantee's completed final report due on December 31, 2026. The Health Plan shall have no obligation to provide any additional funding or grant support to Grantee under this Agreement or for any other purpose. Grantee shall refrain from using any portion of the Grant for costs not approved under this Agreement, including, but not limited to, the following: • Capital campaigns; • Endowments; • Annual drives or fundraisers; • Operating deficit or debt retirement; • Services or costs previously funded by the Health Plan other duplicative funding source; or • Direct services billable to the Health Plan, and/or other miscellaneous lines items. Grantee shall deposit payments into a special revenue interest bearing fund outside of the County general fund. The County general fund shall be reimbursed on a monthly basis for costs incurred under this agreement. This special revenue fund is to be used exclusively for Medi-Cal population health management funding and interest earned. Acceptance of this funding requires that the interest accruing from these payments must be used for Medi-Cal Population Health Management program-related activities and shall be used to defray costs incurred by the program, measurably expand the program, improve the quality of services above the level of services already funded under the Agreement, or support other strategies to improve population health. The interest earned on payments is not included in fiscal year budgets or the grant amount breakdown and disbursement of funding. GRANTEE ACTIVITIES/DELIVERABLES/OUTCOMES & REPORTING: Grantee is agreeing to work in partnership with the Health Plan on achieving/impacting the DHCS Bold Goal(s) identified above. During the PHM Grant Period (January 1, 2024—December 31, 2026), Grantee will provide annual reporting after each fiscal year to the Health Plan that includes the following: PHM Program Activity GRANTEE ACTIVITIES/DELIVERABLES/OUTCOMES Page 8 CaIVIVE! health net HEALTH Staffing 1. Report total positions hired and total dollar amounts. Please see example below: Total LEGEND Total Positions Dollars AS Administrative Support X $$$$$$ CE Community Engagement Comm Communications DI Data Infrastructure IS Implementation Strategies PM Project Management IN-KIND SDOH Support (e.g. food, rent, 1. Annually Reporting of Member Count and Funding vehicle repair,transportation, utility Allocation: Provide an annual report detailing the total cost) number of members served and the corresponding dollar amount allocated to SDOH. The report should include a breakdown of each specific support provided and the members served. If feasible, this report should also be segmented by MCP. 01/2024-12/2026 2. Member Data by Zip code: Provide member data categorized by zip code if feasible. 01/2024-12/2026 3. SDOH Funding for Incentives: Provide a breakdown of allocated dollars to support incentives linked to achieving SMART goal and/or Population Health Management. 01/2024-12/2026 CBO Contract Reporting 1. Report outlining how the dollars were spent. 04/2025- 12/2026 Training Comm. 1. Report outlining how the dollars were spent. 04/2025- 12/2026 Community Information Exchange 1. Purchase, develop, implement, test, and go-live with the Manifest MedEx software system designed to support SMART goal. 04/2025-12/2026 Rural Mobile Health 1. Report outlining how and when funds are allocated and expended. 11/2025-12/2026 Page 9 k t''- Cip a I V i�Va HEALTH" health net_ 2. Report the partners engaged in support of SMART Goal: Rural Mobile Health will partner when appropriate to pilot events and care in partnership with local FQHCs, PPGs, and clinics. 11/2025-12/2026 3. Rural Mobile Health Funding for Incentives: Provide a breakdown of allocated dollars to support incentives and activities linked to achieving SMART goal and/or Population Health Management. 11/2025-12/2026 RECOGNITION: Grantee agrees to place the CalViva logo, name, etc. on all related materials for the Grantee's Project as a sponsor and/or funder for this program. The Health Plan will work with the Grantee to determine which logo shall be used. In addition, CalViva will be acknowledged on the Grantee's website, media related materials and digital tools as a funding partner where appropriate as well as in relation to this program. If applicable, CalViva as specified, will be listed as a Grantee funder at the appropriate level including but not limited to a donor wall, annual reports, newsletters, etc. Grantee agrees to submit to the Health Plan for review on the use of the logo and/or name on all materials in advance. For the avoidance of doubt, in the event the Health Plan changes its name or logo in the future, all displays of such by Grantee shall use the then-current versions. Page 10