HomeMy WebLinkAboutMASTER AGREEMENT-Licensed CMC Credentialed Medical Services Provider Groups_A-25-341.pdf COtj County of Fresno Hall of Records, Room 301
2281 Tulare Street
Fresno,California
601 Board of Supervisors 93721-2198
O� 1$56 O Telephone: (559)600-3529
FRV,t' Minute Order Toll Free: 1-800-742-1011
www.fresnocountyca.gov
July 8, 2025
Present: 5- Vice Chairman Garry Bredefeld, Supervisor Luis Chavez, Supervisor Nathan Magsig,
Chairman Buddy Mendes, and Supervisor Brian Pacheco
Agenda No. 45. Public Health File ID: 25-0557
Re: Under Administrative Policy No. 34 for competitive bids or requests for proposals, determine that an
exception to the competitive bidding requirement is satisfied and a suspension of competition is
warranted due to unusual or extraordinary circumstances, and that the best interests of the County
would be served by adding United Health Centers of the San Joaquin Valley to the Master Agreement
given the noncompetitive nature of Master Agreements; and approve and authorize the Chairman to
execute Amendment No. 2 to Master Agreement to add United Health Centers of the San Joaquin
Valley as a contracted provider with no change to the term of September 10, 2019,through September
9, 2029, or maximum compensation of$22,793,197
APPROVED AS RECOMMENDED
Ayes: 5- Bredefeld, Chavez, Magsig, Mendes, and Pacheco
Agreement No. 25-341
County of Fresno Page 48
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Board Agenda Item 45
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DATE: July 8, 2025
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Amendment No. 2 to Master Agreement No. 19-444 for the Provision of Specialty
and Primary Professional Medical Services and Emergency Care
RECOMMENDED ACTION(S):
1. Under Administrative Policy No. 34 for competitive bids or requests for proposals,
determine that an exception to the competitive bidding requirement is satisfied and a
suspension of competition is warranted due to unusual or extraordinary circumstances, and
that the best interests of the County would be served by adding United Health Centers of
the San Joaquin Valley to the Master Agreement given the noncompetitive nature of Master
Agreements; and
2. Approve and authorize the Chairman to execute Amendment No. 2 to Master Agreement to
add United Health Centers of the San Joaquin Valley as a contracted provider with no
change to the term of September 10, 2019, through September 9, 2029, or maximum
compensation of$22,793,197.
There is no additional Net County Cost associated with the recommended actions. Approval of the
recommended actions will allow the Department of Public Health (Department)to utilize an additional
qualified licensed and Community Medical Centers (CMC) credentialed medical service provider group for
mandated specialty and primary professional medical services and emergency care within the hospital and
clinic setting to eligible patients accessing the County's Medically Indigent Services Program (MISP). This
item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the Department will not have full medical service
coverage available to the County's MISP eligible beneficiaries in compliance with Welfare and Institutions
Code, section 17000, et seq. and the County would still be responsible for the medical care and subsequent
costs for eligible MISP patients. Currently, the County's obligation is met through the MISP and services are
provided at CMC and affiliate facilities per Agreements Nos. 19-411 and 19-444.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
It is requested that the County find under Administrative Policy No. 34 (AP 34)that an exception to the
competitive bidding requirement is satisfied, and a suspension of competition is warranted due to unusual or
extraordinary circumstances as the Department seeks to provide access to medical services for MISP
beneficiaries as mandated by Welfare & Institutions Code 17000 et seq. Since MISP services are approved
to be provided at CMC and affiliated facilities under Agreement 19-411 and since CMC has contracted
exclusively with United Health Centers of the San Joaquin Valley (UHC)to be the provider of medical
services at certain CRMC Ambulatory Care clinics, adding UHC to the Master Agreement is the only way to
County of Fresno page I File Number.25-0557
File Number:25-0557
maintain mandated specialty care services to the County's MISP beneficiaries.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The addition of UHC to
the Master Agreement does not change the maximum compensation of$22,793,197 for the ten-year term.
The County only pays for services rendered and, due to the Affordable Care Act, the County has realized
minimal cost under MISP with the last services provided and claims paid under the Agreement being in
2017; however, a mechanism to provide care is still obligated under Welfare and Institutions Code section
17000, et seq. Agreement No. 19-444 is funded with Health Realignment. Sufficient appropriations and
estimated revenues are included in the Department's Org 5240 FY2024-25 Adopted Budget and will be
included in subsequent budget requests for the duration of the term. Actual costs are based on actual
services provided.
DISCUSSION:
The MISP was created to address the County's legal obligation under Welfare and Institutions Code Section
17000 et seq. Prior to December 2014 the County delivered the mandated medical services through a
comprehensive fixed payment master agreement with CIVIC. However, due to the implementation of the
Affordable Care Act, California Affordable Care Act, and State Assembly Bill 85, the County, through its
Department of Public Health, has changed how it delivers medical services to MISP beneficiaries and has
maintained separate agreements with medical and hospital service providers for the MISP.
The current agreements of the MISP are Agreement No. 19-411 Provision of Comprehensive Inpatient
Hospital Services, Emergency Care, and Outpatient Clinic Services, which allows for hospital and clinic
services to be provided at CIVIC and affiliate facilities and Agreement#19-444 Master Agreement for the
Provision of Specialty and Primary Professional Medical Services and Emergency Care.
The Board approved the Master Agreement No. 19-444 on September 10, 2019, and Amendment No. 1 to
the Agreement on August 20, 2019. Approval of the recommended amendment will add UHC to the
Agreement effective July 8, 2025, to provide specialty and professional medical services at CIVIC and affiliate
facilities to maintain comprehensive medical services to MISP beneficiaries.
REFERENCE MATERIAL:
BAI #45, September 10, 2019
BAI #33, August 20, 2019
BAI #4 and Resolution No. 14-308, August 19, 2014
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition Acquisition Request Form
On file with Clerk-Amendment No. 2 to Master Agreement
CAO ANALYST:
Ronald W. Alexander, Jr.
County of Fresno Page 2 File Number.25-0557
cOc.Y,
Email Me]
Suspension of Competition Acquisition Request Double click!
1. Fully describe the product(s) and/or service(s) being requested.
United Health Centers of the San Joaquin Valley (UHC)will provide specialty and adult primary professional medical
services within the hospital and clinic setting to eligible patients accessing the County's Medically Indigent
Services Program (MISP).
2. Identify the selected vendor and contact person; include the address, phone number and e-mail address for each.
United Health Centers of the San Joaquin Valley -Justin Preas, President &Chief Executive Officer; 3875 W.
Beechwood Ave., Fresno, CA 93711; Corporate@unitedheaIthcenters.org; (559) 646-6618
3. What is the total cost of the acquisition? If an agreement, state the total cost of the initial term and the amounts for
potential renewal terms.
Maximum compensation for the current Master Agreement No.19-444 is $22,793,197. There will be no increase to
the current contract amount with the addition of UHC to Exhibit 1 - List of Contractors.
4. Identify the unique qualities and/or capabilities of the service(s)and/or product(s)that qualify this as a Suspension of
Competition acquisition.
UHC has recently contracted with Community Medical Centers (CMC)to provide specialty and professional medical
services at CMC affiliated facilities as listed on Exhibit 4 of the Agreement#19-444, specifically at the Community
Regional Medical Center(CRMC)Ambulatory Care Center Campus at 290 N. Wayte Lane, Fresno, CA 93701
and CRMC at 2823 Fresno Street, Fresno, CA 93724. UHC will join other contracted specialist groups that are
already providing services at CMC facilities and are already parties to this agreement.
The County and CMC currently also have a companion agreement for the provision of hospital services to MISP
clients (Agreement#19-411, Provision of Comprehensive Inpatient Hospital Services, Emergency Care, and
Outpatient Clinic Services)to be provided at CMC facilities. If UHC is not added to this Agreement No. 19-444,
there will not be enough specialists to provide specialty and adult primary professional medical services at the
CRMC Campus to provide MISP services to eligible MISP beneficiaries.
5. Identify from Administrative Policy#34 what circumstances constitute a Suspension of Competition.
❑ In an emergency when goods or services are immediately necessary for the preservation of the public health,welfare,or safety,or for the
protection of County property.
❑When the contract is with a federal,state,or local governmental agency.
❑When the department head,with the concurrence of the Purchasing Agent,finds that the cost of preparing and administering a competitive
bidding process in a particular case will equal or exceed the estimated contract amount or$5,000 whichever is more.
❑When a contract provides only for payment of per diem and travel expenses and there is to be no payment for services rendered.
❑When obtaining the services of expert witnesses for litigation or special counsel to assist the County.
®When in unusual or extraordinary circumstances,the Board of Supervisors or the Purchasing Agent/Purchasing Manager determines that
the best interests of the County would be served by not securing competitive bids or issuing a request for proposal.
6. Explain why the unique qualities and/or capabilities described above are essential to your department.
The County is mandated to provide necessary medical services to indigent county residents per Welfare & Institutions
Code 17000et seq. The County complies with this mandate by maintaining a Medically Indigent Services Program
(MISP) and by contracting with medical service providers who are able to provide the necessary medical services at
licensed facilities. Per Agreement 19-444, providers of MISP client medical services must be provided by licensed
and certified personnel who are credentialed by CMC, which UHC personnel are and this allows them to provide the
contracted services at CMC facilities. Their agreement with CMC will allow them to provide some specialist clinic
medical services exclusively at the CRMC Ambulatory Care Center on the CRMC Campus.
7. Provide a comprehensive explanation of the research done to verify that the recommended vendor is the only vendor
with the unique qualities and/or capabilities stated above. Include a list of all other vendors contacted, what they were
asked, and their responses.
Although other provider groups exist in Fresno County, the others that provide the necessary services specifically at
CMC and affiliated facilities are already listed as contractors on Exhibit 1 of Agreement 19-444. Conversations
with CMC and UHC staff and the Dept. of Public Health executive staff along with written emails between the
parties confirm that UHC will be the only provider of some necessary specialty services at the Ambulatory Care
Center clinics on the CRMC Campus as of July 1, 2025. Previous conversations with other community partners,
hospitals and FQHCs regarding MISP have made it clear there is an overall lack of interest in providers other
than those already on the Exhibit who are willing to contract with the County since there is very limited payment
that has been made on this agreement due to Medi-Cal's expansion in the past 5 years. The last paid claim made
E-PD-048 (Rev 07/2021)
on this agreement was in 2017; however, the County is still obligated to have a functioning MISP.
iparada 5/22/2025 8:51:18 AM [a Sign] Double click!
Requested By: Title
I approve this request to suspend competition for the service(s) and/or product(s) identified herein.
dluchini 5/22/2025 9:40:56 AM [a Sign] Double click!
Department Head Signature
rblackburn 5/23/2025 3:18:35 PM [a Sign] Double dick!
Purchasing Manager Signature
E-PD-048 (Rev 07/2021)
Agreement No. 25-341
1 AMENDMENT NO. 2 TO MASTER AGREEMENT FOR THE PROVISION OF SPECIALTY AND
2 PRIMARY PROFESSIONAL MEDICAL SERVICES AND EMERGENCY CARE
3 This Amendment No. 2 to Master Agreement for the Provision of Specialty and Primary
4 Professional Medical Services and Emergency Care ("Agreement No. 19-444") is entered into this
5 81" day of July , 2025, by and between the COUNTY OF FRESNO, a political subdivision of the
6 State of California, hereinafter referred to as "COUNTY" and each CONTRACTOR/S listed in
7 Amendment 2 to Exhibit 1 "List of Contractors" (attached hereto and by this reference incorporated
8 herein), and collectively herein referred to as "CONTRACTOR/S". COUNTY and CONTRACTOR/S are
9 referred to herein, collectively, as "Parties" or"Party" individually.
10 Recitals
11 A. COUNTY, under Welfare and Institutions Code section 17000, is responsible for the provision of
12 medically necessary services to avoid suffering or endangerment to life or health to indigent lawful
13 residents, who are not otherwise relieved by their family and friends, by their own means or by state
14 hospitals or other state or private institutions, and thereby has adopted a Medically Indigent Services
15 Program "MISP" for eligible individuals hereinafter referred to as "MISP beneficiaries"; and
16 B. COUNTY desires to make available to MISP beneficiaries certain specialty and adult primary
17 professional medical services, and emergency care "Professional Medical Services" as listed in Exhibit
18 3 of Agreement No. 19-444, which is herein referred to as "Agreement";
19 C. On September 10, 2019, the COUNTY and CONTRACTOR/S entered into the Master
20 Agreement for the Provision of Specialty and Primary Professional Medical Services and Emergency
21 Care, which is County agreement number 19-444; and
22 D. The COUNTY and the CONTRACTOR/S now desire to amend the Agreement to add Contractor
23 United Health Centers of the San Joaquin Valley.
24 The parties therefore agree as follows:
25 1. All references to Exhibit 1 shall be deemed references to Amendment 2 to Exhibit 1, which is
26 attached and incorporated by this reference herein.
27 2. When both Parties have signed this Amendment No 2, the Agreement and this Amendment No.
28 2 together constitute the Agreement.
1 3. The CONTRACTOR/S represents and warrants to the COUNTY that:
2 a. The CONTRACTOR/S is duly authorized and empowered to sign and perform its obligations
3 under this Amendment.
4 b. The individual signing this Amendment on behalf of the CONTRACTOR/S is duly authorized
5 to do so and his or her signature on this Amendment legally binds the CONTRACTOR to the
6 terms of this Amendment.
7 4. The Agreement as amended by this Amendment No. 2 is ratified and continued. All Provisions
8 of the Agreement and not amended by this Amendment No. 2 remain in full force and effect.
9 [SIGNATURE PAGE FOLLOWS]
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1 CONTRACTOR/S COUNTY OF FRESNO
2 See Amendment 2 to Exhibit A"List of
3 Contractors"
4 Subsequent signature page is attached ��`
5 Ernest Buddy Mendes, Chairman of the Board of
6 Supervisors of the County of Fresno
7 Attest:
8 Bernice E. Seidel
Clerk of the Board of Supervisors
g County of Fresno, State of Califomia
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By:
11 Deputy
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13 For accounting use only:
14 Fund: 0001
15 Subclass: 10000
Org No. 5240
16 Account: 7295
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1 United Health Centers of the San Joaquin Valley (UHC)
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3 By:
4 Print Name: Justin Preas
5 Title: President & Chief Executive Officer
6 Date: CP
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17 Mailing Address:
18 3875 W. Beechwood Ave.
Fresno, CA 93711
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20 Contact: Justin Preas, President& Chief Executive Officer
3875 W. Beechwood Ave.
21 Fresno, CA 93711
Phone#: (559) 646-6618
22 Corporate(a)-unitedhealthcenters.org
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