HomeMy WebLinkAboutSaint Agnes Medical Center-Rural Mobile Heath Services_A-25-490 A-23-020.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
September 23, 2025
Present: 5- Vice Chairman Garry Bredefeld, Supervisor Luis Chavez, Supervisor Nathan Magsig,
Chairman Buddy Mendes, and Supervisor Brian Pacheco
Agenda No. 46. Public Health File ID: 25-0899
Re: Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 23-020 with
Saint Agnes Medical Center for Rural Mobile Health program services, effective upon execution,
extending the term by approximately one year from November 13, 2025,through December 31, 2026,
and increasing the maximum compensation by$200,000 to a total of$1,238,211; and approve and
authorize the Chairman to execute Amendment No. 1 to Agreement No.23-021 with The Regents of
the University of California, San Francisco for Rural Mobile Health program services, effective upon
execution, extending the term by approximately one year from November 13, 2025,through December
31, 2026, and increasing the maximum compensation by$800,000 to a total of$4,944,993
PRIOR TO BOARD DISCUSSION,SUPERVISOR MAGSIG RECUSED HIMSELF UNDER THE
LEVINE ACT.A MOTION WAS MADE BY VICE CHAIRMAN BREDEFELD,SECONDED BY
SUPERVISOR CHAVEZ,THAT THIS MATTER BE APPROVED AS RECOMMENDED.THE MOTION
CARRIED BY THE FOLLOWING VOTE:
Ayes: 4- Bredefeld, Chavez, Mendes, and Pacheco
Recuse: 1 - Magsig
Agreement No. 25-490,Agreement No. 25-491
County of Fresno Page 47
co
Board Agenda Item 46
O 1856 O
FRE`'�
DATE: September 23, 2025
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Interim Director, Department of Public Health
SUBJECT: Amendments to Agreements for Rural Mobile Health Program
RECOMMENDED ACTION(S):
1. Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 23-020
with Saint Agnes Medical Center for Rural Mobile Health program services, effective upon
execution, extending the term by approximately one year from November 13, 2025, through
December 31, 2026, and increasing the maximum compensation by$200,000 to a total of
$1,238,211; and
2.Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 23-021
with The Regents of the University of California, San Francisco for Rural Mobile Health
program services, effective upon execution, extending the term by approximately one year
from November 13, 2025,through December 31, 2026, and increasing the maximum
compensation by$800,000 to a total of$4,944,993.
There is no Net County Cost associated with the recommended actions. Approval of the recommended
actions will increase the maximum compensation and extend the terms of the agreements with Saint Agnes
Medical Center(SAMC)and The Regents of the University of California, San Francisco (UCSF) by
approximately one year. Approval of the recommended actions will allow SAMC and UCSF to continue
providing Rural Mobile Health (RMH) program services including health screenings, immunizations, and
linkage for patients to primary care clinics in the County's disadvantaged communities. This item is
countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board elect not to approve the recommended actions,
RMH services will end November 12, 2025. This will leave a gap in health care services to Fresno County's
vulnerable populations who already have limited access to proper health care.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. Upon execution of the
recommended amendments, the maximum compensation for the agreement with SAMC will increase by
$200,000 to a total of$1,238,211, and the maximum compensation for the agreement with UCSF will
increase by$800,000 to a total of$4,944,993. The additional funding will be provided by California
Department of Public Health Care Services Medi-Cal Managed Care Plan funding (MCP). Sufficient
appropriations and estimated revenues are included in the Department's Org 5620 FY 2025-26 Adopted
Budget and will be included in the subsequent budget requests.
DISCUSSION:
County of Fresno Page I File Number.25-0899
File Number:25-0899
On January 3, 2023, the Board approved agreements with SAMC and UCSF to implement the RMH program
in Fresno County. Currently funded by the Department's allocation of the American Rescue Plan Act- State
Local Fiscal Recovery Funds (ARPA-SLRF), the RMH program provides preventive care screenings,
vaccinations, STD testing, eye exams, and more, ensuring that essential health care services reach Fresno
County's underserved populations and patients are connected to community services and primary care
doctors for continued care.
Both contracted medical providers, SAMC and UCSF, travel to multiple rural locations and agricultural
workplaces in Fresno County several times a week to provide RMH services. Eye exams and on-the-spot
prescription eyeglasses were also provided at RMH events through a separate contract with Tzu Chi Mobile
Clinic. Additionally, Fresno County's Community Health Worker(CHW) Network assists individuals at RMH
events by providing wrap-around care coordination services and health education on topics such as
nutrition, mental health, diabetes, and heart disease.
Since the RMH program's launch, SAMC and UCSF have completed over 545 RMH events and provided
essential health care services to over 13,600 patients at these RMH events. Tzu Chi Mobile Clinic provided
eye exams and prescription eyeglasses at 25 RMH events to 437 patients. The CHW Network reached
more than 90,000 community members through resources and more than 23,900 educational materials
given out during interactions at RMH events.
Approval of the recommended amendments will add MCP funding to both medical provider agreements,
increase the maximum compensation of each upon execution, and extend the term of the agreements
through December 31, 2026. The additional MCP funding will also allow RMH services to expand beyond
rural and agricultural communities into other disadvantaged communities within Fresno County, including
metropolitan areas. Approval of the recommended actions will help ensure the County is committed to
expanding access to essential health care services and supporting the well-being of all residents.
REFERENCE MATERIAL:
BAI #25, January 3, 2023
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Amendment No. 1 to Agreement with SAMC
On file with Clerk-Amendment No. 1 to Agreement with UCSF
CAO ANALYST:
Ron Alexander
County of Fresno page 2 File Number.25-0899
Agreement No. 25-490
1 AMENDMENT NO. 1 TO SUBRECIPIENT AGREEMENT
2 This Amendment No. 1 to Subrecipient Agreement ("Amendment No. 1") is dated
3 September 23, 2025 and is between Saint Agnes Medical Center, a non-profit public benefit
4 corporation ("SUBRECIPIENT"), and the County of Fresno, a political subdivision of the State of
5 California ("COUNTY").
6 Recitals
7 A. On December 13, 2022, COUNTY and SUBRECIPIENT entered into Subrecipient
8 Agreement, which is COUNTY agreement number 23-020 ("Agreement"), for mobile clinical
9 services with the COUNTY's Rural Mobile Health ("RMH") program.
10 B. On July 22, 2024, COUNTY and SUBRECIPIENT extended the Agreement term for one
11 consecutive twelve (12) month period through November 12, 2025, and modified object levels in
12 the budget as Revised Exhibit B, as allowed in the Agreement.
13 C. SUBRECIPIENT has successfully assisted COUNTY's RMH program with providing
14 preventative care screenings, treatment, immunization, and connecting patients to community
15 services and primary care doctors.
16 D. COUNTY and SUBRECIPIENT now desire to further amend the Agreement to extend
17 the term through December 31, 2026, and increase compensation to continue providing medical
18 services for the RMH program.
19 The parties therefore agree as follows:
20 1. All references in the Agreement to "Exhibit A" shall be changed to read "Revised Exhibit
21 A," where appropriate, attached hereto and incorporated herein by reference.
22 2. All references in the Agreement to "Exhibit B" and "Revised Exhibit B" shall be changed
23 to read "Revised Exhibit B1," where appropriate, attached hereto and incorporated herein by
24 reference.
25 3. Section 1 of the Agreement, "GENERAL OBLIGATIONS," Paragraph H, located at Page
26 4, Line 1 is deleted in its entirety and replaced with the following:
27 "H. In addition to billing COUNTY for services, if SUBRECIPIENT has the
28 opportunity to bill patients' private medical insurance and/or other governmental
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1 program for services, including, but not limited to Medicare, Medicaid, Medi-Cal,
2 and/or the Health Resources and Services Administration (HRSA), COUNTY
3 expects that SUBRECIPIENT will explore such opportunities for services not
4 reimbursed by COUNTY."
5 4. Section 11 of the Agreement, "TERM," located at Page 12, Line 5 is deleted in its
6 entirety and replaced with the following:
7 11. TERM
8 The term of this Agreement shall comply with ARPA Guidelines and shall
9 be for a period of two years, commencing on December 13, 2022 through and
10 including November 12, 2024. This Agreement may be extended for one (1)
11 additional consecutive twelve (12) month period upon written approval of both
12 parties no later than the last day of the current term. The Director of the
13 Department of Public Health or his or her designee is authorized to execute such
14 written approval on behalf of COUNTY based on Subrecipient's satisfactory
15 performance.
16 After the last day of the final twelve (12) month extension period, the term
17 of this Agreement shall be extended for a consecutive period starting November
18 13, 2025 through December 31, 2026.
19 The COUNTY's written acceptance of the Final Program Report under
20 Section 3(C) of this Agreement shall include the COUNTY's written notification to
21 the SUBRECIPIENT, on behalf of COUNTY, that the Agreement term has ended.
22 The Director of the Department of Public Health or his or her designee is
23 authorized to execute this written acceptance of the Final Program Report and
24 notification of term end to SUBRECIPIENT."
25 5. Section 13 of the Agreement, "GRANT FUNDING/COMPENSATION," starting on Page
26 13, Line 11 is deleted in its entirety and replaced with the following:
27 \\\
28 \\\
2
1 "13. GRANT FUNDING/COMPENSATION
2 A. The parties understand that funding for this Agreement includes
3 California Department of Public Health Care Services Medi-Cal Managed Care
4 Plan funding and SLFRF provided pursuant to ARPA, codified at Title 31 CFR
5 Part 35, and any amendments thereafter. The total SLFRF grant funding for this
6 Agreement shall not exceed One Million Thirty-Eight Thousand Two Hundred
7 Ten and 80/100 Dollars ($1,038,210.80)for the period of December 13, 2022
8 through November 12, 2025. COUNTY agrees to grant SUBRECIPIENT, and
9 SUBRECIPIENT agrees to receive such grants, up to the total maximum
10 compensation payable to SUBRECIPIENT under this Agreement, not to exceed
11 One Million Two Hundred Thirty-Eight Thousand Two Hundred Ten and 80/100
12 Dollars ($1,238,210.80).
13 SUBRECIPIENT shall submit written drawdown requests monthly for the
14 payment of eligible necessary expenses in support of the Program. Drawdown
15 requests for the COUNTY to make a such payment shall be in accordance with
16 the sample Drawdown Request Form, attached as Exhibit B, and incorporated by
17 this reference. Drawdowns requests shall detail purchase orders, receipts, and
18 reimbursement requests, detailing items purchased, and expenses incurred in
19 support of the Program for items listed in Exhibit B of this Agreement. Requests
20 should include supporting cost documentation such as payroll records,
21 equipment/supply invoices, lease payment, payment records for
22 marketing/education/outreach costs, utility/janitorial payments, mileage records if
23 applicable.
24 SUBRECIPIENT shall submit documentation to the County of Fresno,
25 Department of Public Health, 6t" Floor, 1221 Fresno St, Fresno, CA 93721,
26 Attention: Business Office or electronically, to e-mail address
27 DPHBOAP(a)fresnocountyca.gov. Payment by COUNTY shall be in arrears for
28 services provided during the preceding period of time, within forty-five (45) days
3
1 from date of receipt, verification and approval of SUBRECIPIENT's invoice and
2 supporting documentation by COUNTY. If SUBRECIPIENT fails to comply with
3 any provision of this Agreement, COUNTY shall be relieved of its obligations for
4 further compensation.
5 SUBRECIPIENT certifies that services performed under this Agreement do
6 not duplicate any services previously or currently funded by Federal, State,
7 County, or any other funding source and shall not use any portion of funds under
8 this Agreement for duplicative services."
9 6. When both parties have signed this Amendment No. 1, the Agreement and this
10 Amendment No. 1 together constitute the Agreement.
11 7. SUBRECIPIENT represents and warrants to COUNTY that:
12 a. SUBRECIPIENT is duly authorized and empowered to sign and perform its
13 obligations under this Amendment.
14 b. The individual signing this Amendment on behalf of the SUBRECIPIENT is duly
15 authorized to do so and his or her signature on this Amendment legally binds the
16 SUBRECIPIENT to the terms of this Amendment.
17 8. The parties agree that this Amendment may be executed by electronic signature as
18 provided in this section.
19 a. An "electronic signature" means any symbol or process intended by an individual
20 signing this Amendment to represent their signature, including but not limited to (1) a
21 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
22 electronically scanned and transmitted (for example by PDF document) version of an
23 original handwritten signature.
24 b. Each electronic signature affixed or attached to this Amendment (1) is deemed
25 equivalent to a valid original handwritten signature of the person signing this
26 Amendment for all purposes, including but not limited to evidentiary proof in any
27 administrative or judicial proceeding, and (2) has the same force and effect as the
28 valid original handwritten signature of that person.
4
1 c. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
2 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part
3 2, Title 2.5, beginning with section 1633.1).
4 d. Each party using a digital signature represents that it has undertaken and satisfied
5 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
6 through (5), and agrees that each other party may rely upon that representation.
7 9. This Amendment is not conditioned upon the parties conducting the transactions under it
8 by electronic means and either party may sign this Amendment with an original handwritten
9 signature.
10 10. This Amendment may be signed in counterparts, each of which is an original, and all of
11 which together constitute this Amendment.
12 11. The Agreement as amended by this Amendment No. 1 is ratified and continued. All
13 provisions of the Agreement and not amended by this Amendment No. 1 remain in full force and
14 effect.
15 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Amendment No. 1 on the date stated in the introductory
2 clause.
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SUBRECIPIENT COUNTY OF FRESNO
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5 c�r.�artrr,� T a��e�eautrLai
6 Ivonne Der Torosian, Vice President Ernest Buddy Mendes, hairman of the
Community Health and Wellbeing Board of Supervisors of the County of Fresno
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Mailing Address: Attest:
9 Saint Agnes Medical Center Bernice E. Seidel
1303 E Herndon Ave, MS 77 Clerk of the Board of Supervisors
10 Fresno, CA 93720 County of Fresno, State of California
11
By:
12 Deputy
13 For accounting use only:
14 Org No.: 56201022, 56201557
Account No.: 7295
15 Fund No.: 0001
Subclass No.: 10000
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Revised Exhibit A
SCOPE OF WORK
The County of Fresno (County) Department of Public Health (DPH) is in need of vendors to identify
gaps in health care among residents living in Fresno County, especially rural areas, connecting patients
to community services and a primary care doctor. Licensed and unlicensed medical staff(Registered
Nurses, Licensed Vocational Nurses and Medical Assistants or Certified Nursing Assistants with valid
licensure and/or certification in the State of California) and clerical staff will need to organize and
conduct clinics that will provide communicable disease and chronic disease screenings, immunizations,
preventative care, treatment, and linkage for patients to a primary care clinic. Clinics will be held
through employers or through community medical clinic/vaccination events that may be open to the
general public.
The vendor will assist County with identifying mobile clinic locations, dates, times, and sizes of the
clinic request. Lead time to clinic scheduling will be 5 days—4 weeks.
For the period of December 13, 2022 through November 12, 2025, the County anticipates 10 to 12
clinics per month in Fresno County disadvantaged communities, focused in rural and/or agricultural
communities. Mobile clinics are intended to operate a minimum of 2 days per week, any day of the
week, including weekends and evenings.
For the period of November 13, 2025 through December 31, 2026, the County anticipates 2 to 4 clinics
per month in Fresno County disadvantaged communities. Vendor is expected to provide mobile clinics
through December 2026.
Clinic times will vary as follows:
• Clinic hours will vary from 3 —8 hours depending on event needs.
• Approximately 100 patients reached per day(may be over multiple locations).
• Events may be held inside, outside or as a drive thru.
• Events may be located anywhere within Fresno County rural areas and disadvantaged
communities.
• Vendor will assist County with promoting mobile clinic events via social media and with
community partners.
• Vendor will be required to work with the venue host to determine if the vendor will need to
provide tables, chairs,popup tents, etc.
• Optional: Vendor may make direct payment to venue for any rental costs.
The Counly will provide the following_
• Venue and direct payment to venue for any rental costs.
• Clinic date, time, location and venue contact information.
• Promote mobile clinic events by sharing event information on DPH's social media platforms and
with community partners.
Page 1 of 2
Revised Exhibit A
• County will work with the vendor to develop an aggregate monthly report that demonstrates the
type of services provided,patient demographics, location, and number of unique patients per
event.
• County will work with the vendor to identify the appropriate reporting mechanism and access to
data to assess emergency room utilization and primary care access for rural mobile health
patients.
The Vendor will be responsible for the following_
• Vendor will provide screening for communicable diseases including but not limited to Influenza,
COVID-19, and certain sexually transmitted diseases identified by County.
o Providers are expected to follow the standard of care for follow-up/treatment of abnormal
test results.
• Vendor shall follow all applicable State and Federal pharmaceutical regulations.
• Vendor shall follow all applicable Clinical Laboratory Improvement Amendments (CLIA).
• Vendor will provide screening for chronic conditions including but not limited to diabetes and
high blood pressure.
• Vendor may provide refills of certain medications to prevent emergency room utilization.
• Vendor will provide immunizations and follow all applicable storage, handling and reporting
requirements.
• Vendor will provide treatment of minor injuries.
• Vendor shall offer referral services in connecting patients to a primary care clinic.
• In addition to billing County for services, if vendor has the opportunity to bill patients' private
medical insurance and/or other governmental programs for services, including,but not limited to
Medicare, Medicaid, Medi-Cal, and/or the Health Resources and Services Administration
(HRSA), County expects that vendor will explore such opportunities.
• Vendor shall provide monthly aggregate data as required by County.
• Vendor will collaborate with County to collect data of its rural mobile health patients to assess
emergency room utilization and primary care access throughout duration of the agreement.
Vendor shall submit invoices to:
County of Fresno Department of Public Health
1221 Fresno Street, 6th fl. (Business Office)
Fresno, CA 93721
DPHBOAPgfresnocoun . ca.gov
KEY RESOURCES
• CDC's Storage and Handling Toolkit
Page 2 of 2
Revised Exhibit B1
Saint Agnes Medical Center
Subrecipient Expenditure Plan (ARPA)
Budget Period: December 13, 2022 through November 12, 2025
Budget Category Revised Budget
Personnel
Lead Community Health Worker (Mobile Health Coord) $ 112,500.00
Physician $ 329,777.00
Community Health Worker $ 72,348.00
Translator $ 1,748.00
Social Worker $ 11,228.00
Medical Assistant .10 FTE $ 947.00
Medical Van Driver $ 54,900.00
Security $ -
Personnel Subtotal $ 583,448.00
Fringe (27.64%) $ 161,289.00
Total Personnel $ 744,737.00
Operating Costs
Equipment/Technology $ 68,942.00
Medical Vehicle Maintenance $ 6,035.00
Therapeautics $ 124,114.00
Total Operating $ 199,091.00
Direct Costs $ 943,828.00
Indirect Costs (10%) $ 94,382.80
Total Direct and Indirect $ 1,038,210.80
Other Costs
Total Other $ -
GRAND TOTAL $ 1,038,210.80
Page 1 of 3
Revised Exhibit B1
Saint Agnes Medical Center
Subrecipient Expenditure Plan (MCP)
Budget Period: November 13, 2025 through December 31, 2026
Budget Category Budget
Personnel
Mobile Health Coordinator 1 FTE $ 55,101.00
Community Health Worker .80 FTE $ 30,548.00
Mobile Health Van Driver .60 FTE $ 16,381.00
Medical Assistant .20 FTE $ 9,173.00
Physician .60 FTE $ 41,184.00
Personnel Subtotal $ 152,387.00
Fringe (18% non-physician staff only) $ 27,231.00
Total Personnel $ 179,618.00
Operating Costs
Mobile Health Vehicle Operations $ 2,200.00
Total Operating $ 2,200.00
Direct Costs $ 181,818.00
Indirect Costs (10%) $ 18,182.00
Total Direct and Indirect $ 200,000.00
Other Costs
$ -
Total Other $ -
GRAND TOTAL $ 200,000.00
Revised Exhibit 131 (continued)
Drawdown Request Form
Date:
County of Fresno
Department of Public Health, 6th Floor
1221 Fresno St
Fresno, CA 93721
Subject: Drawdown Request for Payment
Subrecipient Program: Subrecipient Name:
Agreement#:
In accordance with the executed Agreement for the above-referenced Program,
[SUBRECIPIENT NAME] is requesting drawdown payment of$ [AMOUNT] in support of the
Program for services provided during the period of [DATE] through [DATE].
[SUBRECIPIENT NAME] certifies that this request for payment is consistent with the amount of
work that has been completed to date, detailing items purchased, and expenses incurred in
support of the Program in accordance with the Subrecipient Expenditure Plan (Exhibit B)
documented in the executed Agreement, and as evidenced by the enclosed invoices and
supporting documents.
Payee Invoice # Amount $
Sincerely,
[Subrecipient Officer]
[Subrecipient Name]
Enclosure(s)