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HomeMy WebLinkAboutKaiser Foundation Health Plan Inc.-Northern California Population Health Needs Assessment_A-25-176.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 May 6, 2025 Present: 5- Vice Chairman Garry Bredefeld, Supervisor Luis Chavez, Supervisor Nathan Magsig, Chairman Buddy Mendes, and Supervisor Brian Pacheco Agenda No. 35.1 Public Health File ID: 25-0222 Re: Approve and authorize the Chairman to execute a retroactive revenue agreement with CalViva Health Net, LLC for the Population Health Management Program grant, effective January 1, 2024 through December 31, 2026,total not to exceed$7,153,788; approve and authorize the Chairman to execute a retroactive revenue agreement with Blue Cross of California Partnership Plan, Inc. and its affiliates (Anthem)for the Provider Capacity Incentive Program grant, effective January 1, 2024 through December 31, 2026,total not to exceed$931,290; approve and authorize the Chairman to execute a revenue agreement with Kaiser Foundation Health Plan, Inc.for the California Population Health Needs Assessment Funding grant, effective upon execution through December 31, 2026,which includes one optional one-year extension, total not to exceed $50,000; adopt Budget Resolution increasing the FY 2024-25 appropriations and estimated revenues for Population Health Management Fund 0080, Org 1169 in the amount of$759,525 and$5,836,519 respectively(4/5 vote); and approve and authorize the Department of Public Health Director,or designee,to make non-material changes to the Department's services, staffing, and responsibilities through amendments to the Agreements,which are necessary or advisable in the Director's determination as in the best interest of the County, subject to approval by County Counsel as to legal form and by the Auditor-Controller/Treasurer-Tax Collector as to accounting form,without modifying the maximum compensation APPROVED AS RECOMMENDED Ayes: 5- Bredefeld, Chavez, Magsig, Mendes, and Pacheco Agreement No. 25-174,Agreement No. 25-175,Agreement No. 25-176, Resolution No.25-135 County of Fresno Page 39 COtj��� Board Agenda Item 35.1 O 1856 O FRE`'� DATE: May 6, 2025 TO: Board of Supervisors SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health SUBJECT: Multiple Retroactive Revenue Agreements with Managed Care Plans for Population Health Management Programs RECOMMENDED ACTION(S): 1. Approve and authorize the Chairman to execute a retroactive revenue agreement with CalViva Health Net, LLC for the Population Health Management Program grant, effective January 1, 2024 through December 31, 2026, total not to exceed $7,153,788; 2. Approve and authorize the Chairman to execute a retroactive revenue agreement with Blue Cross of California Partnership Plan, Inc. and its affiliates (Anthem)for the Provider Capacity Incentive Program grant, effective January 1, 2024 through December 31, 2026, total not to exceed $931,290; 3. Approve and authorize the Chairman to execute a revenue agreement with Kaiser Foundation Health Plan, Inc. for the California Population Health Needs Assessment Funding grant, effective upon execution through December 31, 2026, which includes one optional one-year extension, total not to exceed $50,000; 4. Adopt Budget Resolution increasing the FY 2024-25 appropriations and estimated revenues for Population Health Management Fund 0080, Org 1169 in the amount of$759,525 and $5,836,519 respectively(4/5 vote); and, 5. Approve and authorize the Department of Public Health Director, or designee,to make non-material changes to the Department's services, staffing, and responsibilities through amendments to the Agreements,which are necessary or advisable in the Director's determination as in the best interest of the County, subject to approval by County Counsel as to legal form and by the Auditor-Controller/Treasurer-Tax Collector as to accounting form, without modifying the maximum compensation. There is no additional Net County Cost associated with the recommended actions. Approval of the first three recommended actions will allow the Department of Public Health (Department)to implement separate revenue agreements with CalViva Health Net, LLC (CalViva), Blue Cross of California Partnership Plan, Inc. (Anthem), and Kaiser Foundation Health Plan Inc., (Kaiser)to support the Department's effort to address social determinants of health through preventative population health intervention services to Medi-Cal residents of Fresno County. The fourth recommended action will increase the FY 2024-25 appropriations and estimated revenues in the amount of$5,836,519 in the Department's Special Revenue Fund 1169 to align appropriations and revenues with the funding amount received from these agreements this fiscal year. This item is countywide. County of Fresno Page 1 File Number.25-0222 File Number:25-0222 ALTERNATIVE ACTION(S): Should your Board not approve the recommended actions, the Department will forego acceptance of $8,135,077 in grant funding to address population health intervention services for residents experiencing the highest health disparities, causing no new strategies to be implemented and limiting the ability to leverage with existing programs. RETROACTIVE AGREEMENT: The first two recommend actions are retroactive to January 1, 2024, due to the funding agencies' request for program start date, proposal review and deliverable requirements, and coordination between funding agencies. FISCAL IMPACT: There is no increase in Net County Cost associated with the recommended actions. The recommended revenue agreements are fully funded by grant funding. The fourth recommended action is required to increase the FY 2024-25 appropriations and estimated revenues in the amount of$759,525 and $5,836,519 respectively in the Department's Special Revenue Fund 1169. The increase is necessary to align appropriations and revenues with the funding amount received from the revenue agreements this fiscal year. Total funding for each recommended action will occur in lump sum disbursements and are outlined below: CalViva • Term Maximum: (1/1/2024 - 12/31/2026): $7,153,788 Anthem • Term Maximum (1/1/2024 - 12/31/2026): $931,290 Kaiser • Term Maximum (Execution - 12/31/2025): $50,000 Sufficient appropriations and estimated revenues will be included in the Department of Public Health's Org 1169 FY 2025-26 Recommended Budget and in subsequent budget requests. DISCUSSION: The California Department of Health Care Services under its CalAIM program has issued a Population Health Management (PHM) Policy Guide (May 2024)that outlines the requirements for Managed Care Plans to support local health jurisdictions in supporting their local Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP). The PHM main goals are: • Build trust with and meaningfully engage Medi-Cal 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 Medi-Cal members in staying healthy; • Provide care management services for Medi-Cal members at higher risk of poor outcomes; • Provide transitional care services (TCS)for Medi-Cal members transferring from one setting or level of care to another; • Reduce health disparities; and • Identify and mitigate Social Drivers of Health The proposed agreements have areas of focus that will align with the Department's population health priorities and the recent CHA(2023)and CHIP (2024-2028) Community Health Assessment and County of Fresno Page 2 File Number.25-0222 File Number:25-0222 Community Health Improvement Plan - County of Fresno. The proposed agreements will fund staffing to support data analysis and infrastructure, project management, communications, and administrative support. In addition, there is funding to support expansion of Mobile Health services to metropolitan areas, Community Information Exchange, and the Community Health Worker(CHW) Network. On February 25, 2025, your Board adopted a resolution recognizing the Department for receiving a 2024 California State Association of Counties Challenge Award for the Rural Mobile Health program in partnership with the CHW Network as an innovative and effective program that addresses critical community needs. Both of these programs are being supported by the Managed Care Plans in the recommended actions. Each of the proposed agreements are based on member count for each organization, which varies year to year and are evaluated by each organization on an annual basis. Approval of the recommended actions will authorize the Director to make non-material changes to services, staffing, and responsibilities of the Department, as needed, to adjust with these annual fluctuations and mitigate disruptions in services through amendments. Amendments will be approved by the County's County Counsel and the County's Auditor Controller/Treasurer-Tax Collector's Office. The agreements vary from standard County template as they were drafted by each organization and are standard for each organization to provide grant funding to outside agencies. All agreements were approved by County Counsel and HR-Risk. REFERENCE MATERIAL: BAI #4, February 25, 2025 ATTACHMENTS INCLUDED AND/OR ON FILE: On file with Clerk- Revenue Agreement with CalViva On file with Clerk- Revenue Agreement with Anthem On file with Clerk- Revenue Agreement with Kaiser On file with Clerk- Budget Resolution (Org 1169) CAO ANALYST: Ron Alexander County of Fresno Page 3 File Number.25-0222 Agreement No. 25-176 P141 KAISER PERMANENTE, Kaiser Foundation Health Plan,Inc. Northern California Population Needs Assessment Funding Agreement April 18, 2025 Dear County of Fresno: Kaiser Foundation Health Plan, Inc., on behalf of its Northern California region ("KFHP"), is pleased to inform you that it has approved payment disbursement in the amount of $50,000 (the"PNA Funds") to County of Fresno ("Grantee"),pursuant to Title 42 of the Code of Federal Regulations, Section 438.6(b), and the requirements of California Department of Health Care Services ("DHCS"), including but not limited to the CaIAIM: Population Health Management (PHM) Policy Guide, upon the terms and conditions set forth in this Funding Agreement ("Agreement"). KFHP and Grantee may each individually be referred to herein as a "Party" and collectively as the "Parties". 1. Purpose of the PNA Funds. Grantee agrees to use the entire PNA Funds during the Funding Period (as defined in Exhibit A) exclusively to support the specific goals, objectives, activities, and outcomes stated in Exhibit A(the "Project"). Grantee may not use any part of the PNA Funds, including any interest earned thereon, for any other purpose without the prior written approval of KFHP. In no event shall Grantee use any of the PNA Funds 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. Grantee understands and agrees that KFHP's disbursement of PNA Funds pursuant to this Agreement does not constitute KFHP's agreement to participate in Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP) activities. 2.Term.This Agreement is effective upon execution and terminates on December 31, 2025 except as provided in the following sentence relating to extension, or paragraph 4, "Return of PNA Funds; Termination,"below.The term of this Agreement may be extended for no more than one,twelve (12) month period only upon written approval of both parties before the first day of the next one-year extension period beginning January 1, 2026 through December 31, 2026.Any changes to the scope of work, funding amount, and reporting deliverables during the extension period will be determined and approved by both parties,in writing,prior to December 1, 2025.The County of Fresno Department of Public Health Director or his or her designee is authorized to sign the written approval on behalf of Grantee. 3. Payment of PNA Funds. Subject to the terms of this Agreement, KFHP agrees pay the PNA Funds to Grantee within sixty(60) calendar days of the Funding Period Start Date set forth in Exhibit A, unless otherwise specified in Exhibit A. Progress toward utilization of funding LEGAL_DOCS:1764014 v2E 9/3/2024 ("Progress Reports") will be reported to KFHP as specified in Exhibit A. Grantee's failure to meet Project milestones can result in a corrective action plan being imposed on Grantee by KFHP. Grantee shall deposit PNA Funds 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,including interest earned,is to be used exclusively for Medi-Cal population health management funding. Acceptance of the PNA Funds requires that the interest accruing from such funding be used for Medi-Cal Population Health Management program-related activities and shall be used to (i) defray costs incurred by the program, (ii) measurably expand the program, (iii) improve the quality of services above the level of services already funded under the Agreement, or(iii) support other strategies to improve population health.The interest earned on PNA Funds deposited into the special revenue fund is not included in fiscal year budgets or the grant amount breakdown and disbursement of funding. 4. Return of PNA Funds: Termination. KFHP reserves the right to discontinue,modify, or withhold payments to be made under this Agreement,to terminate this Agreement,and/or to require a total or partial return of any PNA Funds (expended or unexpended) in the following circumstances: (i) if KFHP, in its sole discretion,determines that the Grantee has failed to comply with any term or condition of this Agreement or(ii) such action is necessary to comply with the requirements of any law or regulation applicable to Grantee, to KFHP, or to the PNA Funds. In circumstances other than those set forth above, either party may terminate this Agreement by giving at least 30 days advance written notice to the other party. Notwithstanding anything herein to the contrary, Grantee shall return all unexpended funds to KFHP at the end of Funding Period set forth in Exhibit A. 5. Reports, Records.Audits and Site Visits. Grantee shall submit written progress report(s) to KFHP in accordance with the due dates and terms set forth in Exhibit A or otherwise communicated to Grantee by KFHP. KFHP, DHCS,the Centers for Medicare and Medicaid Services,the US Health and Human Services Department,the Comptroller General, and the US Department of Justice are authorized to conduct audits, including on-site audits, at any time during the term of this Agreement and within four (4) years after completion of the Project. Grantee shall allow KFHP and its representatives,at their request,to have reasonable access during regular business hours to Grantee's files,records,accounts, personnel and clients or other beneficiaries for the purpose of making such audits, verifications or program evaluations as KFHP deems necessary or appropriate concerning the PNA Funds or the Project. Grantee shall comply with all reasonable requests of KFHP for information and interviews regarding the use of PNA Funds. Grantee shall maintain adequate records sufficient to identify the PNA Funds and to whom and for what purpose such PNA Funds are expended for at least ten (10)years after Grantee spends the PNA Funds. 6. Representations. Grantee acknowledges, represents, and agrees (i) that it acts completely independently of KFHP and is solely responsible for any and all activities of Grantee, including without limitation those activities that are supported by the PNA Funds, Page 2 of 9 and (ii),to the fullest extent permitted by law,to defend, indemnify,and hold harmless KFHP, its affiliates,and each of their respective 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, omission,or breach of this Agreement by Grantee, its employees, or agents,in applying for, accepting,receiving, or expending the PNA Funds. 7.Tax Exemption Status. If Grantee is exempt from state and/or federal taxation, Grantee will provide KFHP proof of such exemption upon KFHP's written request. If the PNA Funds is a taxable event for Grantee, Grantee agrees to pay all taxes associated with the PNA Funds, and Grantee will indemnify KFHP against any such taxes. 8. Conflict of Interest. Grantee warrants that no part of the Grant provided for herein shall be paid directly or indirectly to any officer or employee of the State of California as wages, compensation, or gifts in exchange for acting as an officer, agent,employee,subcontractor, or consultant to Grantee in connection with any services contemplated or performed relative to this Agreement. Grantee certifies that no member of or delegate of Congress,the General Accounting Office,the U.S. Department of Health and Human Services, CMS, or any other federal agency has or will benefit financially or materially from this Agreement. 9. Confidentiality. Grantee shall not disclose or cause to be disclosed any confidential or proprietary information, records, or other documents relating to the practice, services, operations or business of KFHP that Grantee obtains during the term of this Agreement, except as necessary for the Project. Grantee shall use and disclose all personal health information and personally identifiable information only in accordance with all applicable state and federal laws and regulations,including,without limitation,the Health Insurance Portability and Accountability Act of 1996,the Health Information Technology for Economic and Clinical Health Act of 2009, California Civil Code section 56, et seq., and,with respect to each, any amendments and implementing regulations. 10. Independence of the Parties. Neither the PNA Funds 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. 11. 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 Page 3 of 9 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. 12.Amendments. The Parties may amend this Agreement only in writing and signed by both Parties; provided,however,that if any law,rule, or regulation applicable to this Agreement, or any interpretation thereof by any court, is modified or implemented during the term of the Agreement in a way that materially changes the terms of the Agreement, KFHP may,upon written notice to Grantee, amend the Agreement to the minimum degree necessary to comply with such a change in law,rule, or regulation. The Director of Public Health, or his or her designee, is authorized to execute amendments to this Agreement on behalf of the Grantee,subject to approval by Grantee's legal counsel as to legal form. 13.Assignment. Grantee may not assign or delegate any obligations or rights under this Agreement without the prior written consent of KFHP. 14. Governing Law.This Agreement shall be governed by and construed in accordance with the laws of the State of California, as well as all laws and applicable regulations governing the Medi-Cal managed care contract between DHCS and KFHP ("DHCS Contract"). Grantee shall comply with all applicable requirements of the DHCS Contract and the Medi-Cal program, including Medi-Cal or Medicaid statutes, Medi-Cal or Medicaid regulations, and DHCS instructions.This shall include any monitoring requested by KFHP or DHCS. 15. 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. 16. Counterparts. This Agreement may be executed in multiple counterparts, each of which shall be deemed an original and all of which together shall be deemed one and the same instrument. 17. Recitals and Exhibits.The recitals set forth in,and the exhibits attached to,this Agreement are incorporated made a part of the Agreement by this reference. Yours in good health, Page 4 of 9 Vidyalyengar VP, Medicaid Operations/Care Delivery-CA/Hl 4/22/2025 1 9:21 AM PDT Erica Mahgerefteh Lead,Medi-Cal Population Needs Assessment and PHM Strategy, CA �._„�p,�.4/22/2025 1 8:33 AM PDT us,wan `�' : Count gree 'fie: y of Fresno Signature: Name: Ernest Buddy Mencies Title: Chairman of the Board of Supervisors of the County of Fresno Date: 5—60 —a0a5 ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors County of Fresno state of California By_ Deputy For accounting use only: Org No.: 1169 Account No.: 3530 Fund No.: 0080 Subclass No.: 17369 Page 5 of 9 Exhibit A:Population Needs Assessment Funding Agreement Summary Grantee Name: [County of Fresno] Amount:$50,000 Project Contact:Claudia Sandoval Telephone: 559-600-6546 Email: clsandoval@fresnocountyca.gov KFHP Contact: Lindsey Ball KFHP Contact's Email: Lindsev.xl.ball@kp.org Purpose and Funding Objectives: The PNA Funds disbursed pursuant to the Agreement are intended to support Grantee,a Local Health Jurisdiction,in completion of its Community Health Assessment(CHA) and Community Health Improvement Plan (CHIP) in the following ways • Administrative support and project management • Governance (convening support, etc.) • Community engagement(e.g., incentives/food for community participation,funds for childcare,and gas cards) • Communications (e.g.,funding for media/messaging about CHA,sharing success stories,and consultants) • Contracts with community-based organizations • Implementation strategies (specific to CHIP) Funding Period&Project Milestones Start date:January 1, 2025 End Date:December 31, 2025 GRANTEE ACTIVITIES/DELIVERABLES/OUTCOMES&MILESTONE REPORTING: For the Funding Period specified above, Grantee will provide to KFHP annual reporting after each fiscal year that includes the following: Page 6 of 9 PNA Program Activity GRANTEE ACTIVITIES/DELIVERABLES/OUTCOMES Staffing 1. Report total positions hired and total dollar amounts. Please see example below: Total Total LEGEND 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 Allocation: vehicle repair,transportation, Provide an annual report detailing the total number of members utility cost) 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. Execution-12/31/2025 2. Member Data by Zip code: Provide member data categorized by zip code. Execution-12/31/2025 3. SDOH Funding for Incentives: Provide a breakdown of allocated dollars to support incentives linked to achieving SMART goal and/or Population Health Management. Execution-12/31/2025 CBO Contract Reporting 1. Report outlining how the dollars were spent. Execution- 12/31/2025 Training Comm. 1. Report outlining how the dollars were spent. Execution- 12/31/2025 Community Information Exchange 1. Purchase, develop, implement,test,and go-live with the software Manifest MedEx system designed to support SMART goal. Execution-12/31/2025 Rural Mobile Health 1. Report outlining how and when funds are allocated and expended. Execution-12/31/2025 Page 7 of 9 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. Execution- 12/31/2025 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. Execution-12/31/2025 Disbursement of PNA Funds Subject to the terms of the Agreement,to support the Project, KFHP will disburse the PNA Funds to Grantee in a single installment,within sixty(60) calendar days of the Funding Period Start Date set forth above,as required by DHCS.To be eligible for funding,Grantee must submit to KFHP one (1) copy of the Grantee's W-9 form and any additional documentation reasonably requested by KFHP. KFHP shall have no obligation to provide any additional funding to Grantee under this Agreement or for any other purpose. Grantee shall not use any portion of the PNA Funds for costs not approved under this Agreement,including,but not limited to,the following: • Indirect costs,including accounting and legal expenses,administrative salaries,office expenses,rent, security expenses,telephone expenses,and utilities,unless otherwise approved under this Agreement. • Capital campaigns; • Endowments; • Annual drives or fundraisers; • Operating deficit or debt retirement; • Services or costs previously funded by other duplicative funding source; • Direct services billable to KFHP,and/or • Other miscellaneous lines items. Reporting Requirements: Grantee shall prepare and deliver Progress Reports to KFHP by the dates identified below. Submission of Progress Reports will be completed via an online portal or as otherwise indicated by KFHP. KFHP may request additional Progress Report(s) during the Term and up to one (1)year after the expiration or termination of this Agreement. Grantee shall submit each Progress Report no later than five (5)business days after the reporting date listed below: Progress Report Reporting Date Mid-Term Progress Report N/A Final Progress Report December 31,2025 Page 8 of 9 KFHP may change the reporting due date(s)of the Progress Reports based on changes to DHCS's submission timeframe or upon written agreement between KFHP and Grantee. Each Progress Report shall (1) document progress toward the funding activity(ies)listed in"Purpose and Funding Objectives"above in the format required by KFHP and (2) meet other requirements imposed by DHCS. Failure to timely complete and submit Progress Reports,or submission of incomplete Progress Reports,may impact receipt of PNA Funds under this Agreement and may disqualify Grantee from receiving any future Population Needs Assessment funding. Grantee's reporting obligations shall survive any expiration or termination of the Agreement. Page 9 of 9