HomeMy WebLinkAboutAvenal Community Health Center dba Aria Community Health Center-Health Intervention Activities_A-25-544.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
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www.fresnocountyca.gov
October 21, 2025
Present: 5- Vice Chairman Garry Bredefeld, Supervisor Luis Chavez, Supervisor Nathan Magsig,
Chairman Buddy Mendes, and Supervisor Brian Pacheco
Agenda No. 50. Public Health File ID: 25-1042
Re: Approve and authorize the Chairman to execute Amendment No. 3 to Agreement with Reading and
Beyond to continue providing health intervention activities for Fresno County's Community Health
Worker Network, effective upon execution, extending the three-year base contract term by seven
months from June 1, 2026,through December 31, 2026,with the two optional one-year extensions
bringing the expiration date to December 31, 2028, and increasing the maximum compensation by
$189,000 to a total of$1,449,000;Approve and authorize the Chairman to execute Amendment No. 1
to Agreement with Avenal Community Health Center dba Aria Community Health Center to continue
providing health intervention activities for Fresno County's Community Health Worker Network, effective
upon execution, extending the two-year base contract term by seven months from June 1, 2026,
through December 31, 2026,with the two optional one-year extensions bringing the expiration date to
December 31, 2028, and increasing the maximum compensation by$111,385 to a total of$575,453;
and Approve and authorize the Chairman to execute Amendment No. 3 to Agreement with Fresno
Metropolitan Ministry to continue providing health intervention activities for Fresno County's
Community Health Worker Network, effective upon execution, extending the four-year and five-month
contract term by seven months from June 1, 2026,through December 31,2026,with no change to the
maximum compensation of$12,496,869
APPROVED AS RECOMMENDED
Ayes: 5- Bredefeld, Chavez, Magsig, Mendes, and Pacheco
Agreement No. 25-543,Agreement No. 25-544, Agreement No. 25-545
County of Fresno Page 54
co
Board Agenda Item 50
O 1856 O
FRE`'�
DATE: October 21, 2025
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Interim Director, Department of Public Health
SUBJECT: Multiple Amendments to Agreements with Community Based Organizations to
Implement Department of Public Health's Community Health Worker Network
Intervention Activities
RECOMMENDED ACTION(S):
1. Approve and authorize the Chairman to execute Amendment No. 3 to Agreement with
Reading and Beyond to continue providing health intervention activities for Fresno
County's Community Health Worker Network, effective upon execution, extending the
three-year base contract term by seven months from June 1, 2026, through December 31,
2026, with the two optional one-year extensions bringing the expiration date to December
31, 2028, and increasing the maximum compensation by$189,000 to a total of$1,449,000;
2. Approve and authorize the Chairman to execute Amendment No. 1 to Agreement with Avenal
Community Health Center dba Aria Community Health Center to continue providing health
intervention activities for Fresno County's Community Health Worker Network, effective
upon execution, extending the two-year base contract term by seven months from June 1,
2026, through December 31, 2026, with the two optional one-year extensions bringing the
expiration date to December 31, 2028, and increasing the maximum compensation by
$111,385 to a total of$575,453; and
3. Approve and authorize the Chairman to execute Amendment No. 3 to Agreement with Fresno
Metropolitan Ministry to continue providing health intervention activities for Fresno
County's Community Health Worker Network, effective upon execution, extending the
four-year and five-month contract term by seven months from June 1, 2026,through
December 31, 2026, with no change to the maximum compensation of$12,496,869.
There is no additional Net County Cost associated with the recommended actions. Approval of the
recommended actions will allow Reading and Beyond, Avenal Community Health Center dba Aria
Community Health Center(Aria), and Fresno Metropolitan Ministry(FMM)to continue providing essential
services to residents of Fresno County experiencing health disparities through community health worker
(CHW) interventions by increasing the term of each Agreement by seven months to align with new funding
timelines and increasing Reading and Beyond and Aria's budgets by$189,000 and $111,385, respectively,
to sustain program activities through the extended term. The recommended actions will also amend each
agreement to include additional language prohibiting the duplication of services through other funding
sources. The third recommended action will also amend the scope of work of FMM's agreement to include
additional services identified as applicable by the Department and in alignment with health priorities. This
item is countywide.
ALTERNATIVE ACTION(S):
County of Fresno page 1 File Number.25-1042
File Number:25-1042
Should your Board not approve the recommended actions, these Agreements will be terminated early, as
there will be no alternative funding available to support program activities. Critical services that address
health needs of residents in Fresno County will end and unspent grant funds for these services will be
returned to the granting agencies.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum
compensation of the Agreement with Reading and Beyond will increase by$189,000 to $1,449,000 and the
maximum compensation of the Agreement with Aria will increase by$111,385 to $575,453 for the proposed
extended term. The agreements will all be fully funded with braided funding which include Population Health
Management, Health Disparities, and American Rescue Plan Act (ARPA)grant funds through the end of the
proposed agreement term. Sufficient appropriations and estimated revenues are included in the Department
of Public Health's Org 5620 FY 2025-26 Adopted Budget and will be included in subsequent budget
requests.
DISCUSSION:
Agreement with Reading and Beyond Background
On March 28, 2023, the Board approved Agreement A-23-129 which allowed the County to partner with
Reading and Beyond to promote community health support and to provide health intervention activities for
implementation of Fresno County's Health Disparities Program in underserved areas of Fresno County.
Agreement A-23-129 was issued in accordance with a Request for Proposal that was issued on July 13,
2022. On March 19, 2024, the Board approved First Amendment A-24-127 which allowed Reading and
Beyond to carryover unspent fiscal year one funds to fiscal year two and corrected language in Article 7.1 of
the Agreement in accordance with federal funding. On December 17, 2024, the Board approved Second
Amendment A-24-688, which allowed the Agreement term to be extended in alignment with a no cost
extension provided by federal funding that was planned to fully fund the Agreement. Reading and Beyond
has provided outreach to 12,858 individuals, made 1,600 medical and social service referrals to community
members, and enrolled 280 unique clients to receive tailored care-coordination services. The first
recommended action would allow the Agreement with Reading and Beyond to be extended through
December 31, 2026, increase the Agreement's maximum compensation by$189,000, and amend the
Agreement language to add a provision prohibiting the duplication of services through other funding sources.
Agreement with Aria Community Health Center Background
On June 18, 2024 the Board approved Agreement A-24-327 which allowed the County to Partner with Aria to
promote community health support and to provide health intervention activities in a rural clinic setting with a
focus on type-2 diabetes mitigation efforts. Aria has provided outreach to 13,603 individuals, made over
1,100 social service and medical referrals to residents in rural communities of Fresno County, and has
enrolled over 390 unique clients to receive tailored care-coordination services. The second recommended
action would allow the Agreement with Aria to be extended through December 31, 2026, increase the
Agreement's maximum compensation by$111,385, and amend the language of the Agreement to add a
provision prohibiting the duplication of services through other funding sources.
Agreement with Fresno Metropolitan Ministry Background
On December 14, 2021 the Board approved Agreement A-21-539 which allowed the County to partner with
FMM to act as the fiscal sponsor of the Fresno Community Health Improvement Partnership (FCHIP)to
create the FCHIP HOPE Pathways Community Hub (HOPE HUB)and provide service delivery through a
nationally recognized evidence-based CHW model. On January 24, 2023 the Board approved First
Amendment A-23-047 which allowed the Agreement to be extended through July 31, 2024, and increased
County of Fresno Page 2 File Number.25-1042
File Number:25-1042
the total maximum compensation by$2,400,000 to sustain services through this extension period. On July
9, 2024 the Board approved Second Amendment A-24-386 which allowed the Agreement to be extended
through May 31, 2026 and increased the maximum compensation by$2,883,893 to sustain services through
this extension period. The HOPE HUB provides wraparound services to over 1,600 residents, annually,
throughout Fresno County. The third recommended action would allow the Agreement with FMM to be
extended through December 31, 2026, and amend the scope of work of the Agreement to add additional
service deliverables for the Department's Public Health Nursing Division, which align with their service
delivery model.
Population Health Management Grant Funding Background
On May 6, 2025, your Board approved Agreements A-25-174, A-25-175, and A-25-176 which allowed the
County to accept Population Health Management(PHM)grant funding through December 31, 2026.
Acceptance of PHM grant funding allowed the Department to solidify funding to support these Agreements
through December 31, 2026. The service Agreements with Aria, FMM, and Reading and Beyond were
previously funded by federal funds, if approved, the recommended action would allow for services of the
Agreements to continue with the addition of PHM funding. The recommended actions would also allow the
Agreements to be extended through December 31, 2026, in alignment with the PHM grant timeline, and
increase the maximum compensation of the Agreements to support services through this extended period.
The PHM grant ends on December 31, 2026, the Department plans to only exercise the option to extend the
Agreements if the PHM grant is extended or additional grant funding becomes available. The recommended
actions are in alignment with the Department's plan of securing supplemental funding to support these
critical services.
REFERENCE MATERIAL:
BAI #35.1, May 6, 2025
BAI #62, December 17, 2024
BAI #50, July 9, 2024
BAI #65, June 18, 2024
BAI #45, March 19, 2024
BAI #48, March 28, 2023
BAI #39, January 24, 2023
BAI #68, December 14, 2021
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Amendment No. 3 to Agreement with Reading and Beyond
On file with Clerk-Amendment No. 1 to Agreement with Aria
On file with Clerk-Amendment No. 3 to Agreement with FMM
CAO ANALYST:
Ron Alexander
County of Fresno Page 3 File Number.25-1042
Agreement No. 25-544
1 AMENDMENT NO. 1 TO SERVICE AGREEMENT
2 This Amendment No. 1 to Service Agreement ("Amendment No. 1") is dated
3 October 21, 2025 and is between Avenal Community Health Center dba, Aria Community
4 Health Center, a California 501 C3 Non-Profit corporation ("Contractor"), and the County of
5 Fresno, a political subdivision of the State of California ("County").
6 Recitals
7 A. On June 18, 2024, the County and the Contractor entered into a service agreement,
8 which is County agreement number A-24-327 (Agreement A-24-327 shall be referred to herein
9 as "Agreement"), to provide community health worker interventions to address low health
10 literacy, provide care coordination services and provide health prevention activities for rural
11 residents experiencing health disparities.
12 B. The County and the Contractor now desire to amend the Agreement to (1) increase the
13 maximum compensation of the Agreement; (2) extend the term of the agreement and; (3)
14 Amend Article 7 of the Agreement and; (4) replace Exhibit B with Revised Exhibit B to create a
15 third fiscal budget year, adjust annual budget amounts to reflect actuals, and carryover unspent
16 funds from the current fiscal year two to fiscal year three.
17 The parties therefore agree as follows:
18 1. Section 3.2 titled Maximum Compensation of the Agreement located at page Two (2)
19 beginning at line Thirteen (13) with the number"3.2" and ending at line Twenty-Three (23) with
20 the word "Agreement" is deleted in its entirety and replaced with the following:
21 "3.2 Maximum Compensation. The maximum compensation payable to the
22 Contractor under this Agreement is Five Hundred Seventy-Five Thousand Four
23 Hundred Fifty-Three Dollars and 00/100 ($575,453), commencing as of the
24 effective date, for the entire term of the agreement including any extensions set
25 forth by section 4.2 of this Agreement. The Contractor acknowledges that the
26 County is a local government entity, and does so with notice that the County's
27 powers are limited by the California Constitution and by State law, and with
28 notice that the Contractor may receive compensation under this Agreement only
1
1 for services performed according to the terms of this Agreement and while this
2 Agreement is in effect, and subject to the maximum amount payable under this
3 section. The Contractor further acknowledges that County employees have no
4 authority to pay the Contractor except as expressly provided in this Agreement."
5 2. Section 4.1 titled Term of the Agreement located at page Three (3) beginning at line
6 Fifteen (15)with the number"4.1" and ending at line Seventeen (17) with the word "below" is
7 deleted in its entirety and replaced with the following:
8 "4.1 Term. This Agreement is effective on July 1, 2024 and terminates on
9 December 31, 2026, except as provided in section 4.2, "Extension," or Article 6,
10 "Termination and Suspension," below."
11 3. Article 7 titled Funding Source located at page Six (6) beginning at line Six (6)with the
12 word "Article" and ending at line Eight (8) with the number"93.323" is deleted in its entirety and
13 replaced with the following:
14 7.1 Services Funding Source. Funding for these services is provided by the
15 California Department of Health Care Services Medi-Cal Managed Care Plan
16 funding, the US Department of Health and Human Services CDC—Activities to
17 Support State, Tribal, Local and Territorial (STLT) Health Department Response
18 to Public Health or Healthcare Crises (Catalog of Federal Domestic Assistance
19 Number 93.391).
20 7.2 Prohibition of Duplicative Services. The Contractor certifies that services
21 performed under this Agreement do not duplicate any services previously or
22 currently funded by Federal, State, County, or any other funding source and shall
23 not use any portion of funds under this Agreement for duplicative services."
24 4. That all references in Agreement to "Exhibit B" shall be changed to read "Revised Exhibit
25 B". Revised Exhibit B is attached hereto and incorporated herein by this reference.
26 5. When both parties have signed this Amendment No. 1, the Agreement and this
27 Amendment No. 1 together constitute the Agreement.
28 6. The Contractor represents and warrants to the County that:
2
1 a. The Contractor is duly authorized and empowered to sign and perform its obligations
2 under this Amendment.
3 b. The individual signing this Amendment on behalf of the Contractor is duly authorized
4 to do so and his or her signature on this Amendment legally binds the Contractor to
5 the terms of this Amendment.
6 7. The parties agree that this Amendment may be executed by electronic signature as
7 provided in this section.
8 a. An "electronic signature" means any symbol or process intended by an individual
9 signing this Amendment to represent their signature, including but not limited to (1) a
10 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
11 electronically scanned and transmitted (for example by PDF document) version of an
12 original handwritten signature.
13 b. Each electronic signature affixed or attached to this Amendment (1) is deemed
14 equivalent to a valid original handwritten signature of the person signing this
15 Amendment for all purposes, including but not limited to evidentiary proof in any
16 administrative or judicial proceeding, and (2) has the same force and effect as the
17 valid original handwritten signature of that person.
18 c. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
19 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part
20 2, Title 2.5, beginning with section 1633.1).
21 d. Each party using a digital signature represents that it has undertaken and satisfied
22 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
23 through (5), and agrees that each other party may rely upon that representation.
24 e. This Amendment is not conditioned upon the parties conducting the transactions
25 under it by electronic means and either party may sign this Amendment with an
26 original handwritten signature.
27 8. This Amendment may be signed in counterparts, each of which is an original, and all of
28 which together constitute this Amendment.
3
1 9. The Agreement as amended by this Amendment No. 1 is ratified and continued. All
2 provisions of the Agreement and not amended by this Amendment No. 1 remain in full force and
3 effect.
4 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Amendment No. 3 on the date stated In the introductory
2 clause.
3
CONTRACTOR COUNTY OFFRESNO
4 AVENAL COMMUNITY HEALTH CENTER
-DBA ARIA COMM ITY- EALTH CENTER
5
6 'e Ernest Buddy Mend , Chairman of the
7 John laine, Chief Executive Officer Board of Supervisors of the County of Fresno
_
16 0 20 2 S _ Attest:
8 Date Bernice E. Seidel
Clerk of the Board of Supervisors
9 Mailing Address: County of Fresno, State of California
10 P.O. Box 580
Lemoore, CA 93245 By:_
11 Deputy
12 For accounting use only:
13 Org No.: 56201558, 56201022, 56201557, 56201621
Account No.: 7295
14 Fund No. : 0001
Subclass No.: 10000
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Revised Exhibit B
Agreement Number: A-24-237
Aareemem Term: July 1,2024.December 31,2026
Organization Name: Aria communityHeath Center
Approved Y1 Budget Amended Y1 Budget Approved Y2 Budget Amended Y2 Budget Approved Y3 Budget Amended Y3 Budget Approved Total New Amended Total
Personnel Salaries 7/1/24-6/30/25 7/1/24-6/30/25 7/1/25-6/30/26 7/1/25-6/30/26 7/1/26-12/31/26 7/1/26-12/31/26 Budget Budget Changes/Justifications
(6 months) (6 months)
Y2 reduced to.751 FTE and moved funding to the marketing line item.To promote outreach events,as well as
CHW have live shows that further education,and the delivery of resources and information to Fresno County
$ 43,680.00 $ 41,777.82 $ 43,680.00 $ 32,824.00 $ $ $ 87,360.00 $ 74,601.82 listeners.
Y3 Community Health Worker(CHW)to complete outreach efforts,data collection and increase health
CHW literacy through health education and provide resources.Performing at 1 FTE.Breakdown is:40 hours per
$ 43,680.00 $ 36,934.28 $ 43,680.00 $ 43,680.00 $ $ 22,880.00 $ 87,360.00 $ 103,494.28 week x 26 weeks(to match the 6 month grant cycle)x22hr=$22,880.00.
Y3 Community Health Worker(CHW)to complete outreach efforts,data collection and increase health
CHW literacy through health education and provide resources.Performing at 1 FTE.Breakdown is:40 hours per
$ 43,680.00 $ 43,289.31 $ 43,680.00 $ 43,680.00 $ $ 22,880.00 $ 87,360.00 $ 109,849.31 week x 26 weeks(to match the 6 month grant cycle)x 22hr=$22,880.00.
Y3 Program Coordinator(PC)to oversee
and implement strategies with program manager on outreach
Program Coordinator efforts,data collection and increase health literacythrough health education and provide resources.
Performing at 1 FTE.Breakdown is:40 hours perweekx 26 weeks(to match the 6 month grant cycle)x 26 hr
$ 50,960.00 $ 50,960.00 $ 50,960.00 $ 50,960.00 $ $ 27,040.00 $ 101,920.00 $ 128,960.00 =$27,040.00.
Subtotal $ 182,000.00 $ 172,961.41 $ 182,000.00 $ 171,144.00 $ $ 72,800.00 $ 364,000.00 $ 416,905.41
Benefits
CHW Fringe Benefits include the following:health,dental,life,and vision insurance,FICA,disability insurance,at
$ 5,241.60 $ 5,241.60 $ 5,241.60 $ 3,938.88 $ $ $ 10,483.20 $ 9,180.48 12%of total Personal Cost.
CHW Fringe Benefits include the following:health,dental,life,and vision insurance,FICA,disability insurance,at
$ 5,241.60 $ 5,207.59 $ 5,241.60 $ 5,241.60 $ $ 2,745.60 $ 10,483.20 $ 13,194.79 12%of total Personal Cost.
CHW Fringe Benefits include the following:health,dental,life,and vision insurance,FICA,disability insurance,at
$ 5,241.60 $ 5,241.60 $ 5,241.60 $ 5,241.60 $ $ 2,745.60 $ 10,483.20 $ 13,228.80 12%of total Personal Cost.
Program Coordinator Fringe Benefits include the following:health,dental,life,and vision insurance,FICA,disability insurance,at
$ 6,115.20 $ 6,115.20 $ 6,115.20 $ 6,115.20 $ $ 3,244.80 $ 12,230.40 $ 15,475.20 12%of total Personal Cost.
Subtotal $ 21,840.00 $ 21,805.99 $ 21,840.00 $ 20,537.28 $ $ 8,736.00 $ 43,680.00 $ 51,079.27
Total Personnel $ 203,840.00 $ 194,767.40 $ 203,840.00 $ 191,681.28 $ $ 81,536.00 $ 407,680.00 $ 467,984.68
Operational
Y3 Assist with carrying out grant objectives such as contacting patients and community residents for health
Communication education workshops,communicating with patients on follow ups,following up on resources,reaching out to
$ 3,600.00 $ 3,385.55 $ 3,600.00 $ 2,100.00 $ $ 1,050.00 $ 7,200.00 $ 6,535,55 local CBOs for additional resources,etc
Total Operational $ 3,600.00 $ 3,385.55 $ 3,6W.00 $ 2,100.00 $ $ 1,050.00 $ 7,200.00 $ 6,535.55
Travel
Y2 Staff averaging 750 miles per month YTD.Increase local travel to 9,000 miles over 12 months,6 months at
Mileage the current IRS rate of$0.70 per mile and an estimated rate increase of$0.73 for the last 6 months.Y3 Local
travel to perform continued project activities such as health education classes,local meetings and training
$ 2,500.00 $ 2,500.00 $ 2,500.00 $ 6,435.00 $ $ 3,285.00 $ 5,000.00 $ 12,220.00 events calculated at 750 miles per month x$0.73=$547.5 x 6 months=$3,285.00.
Total Travel $ 2,500.00 $ 2,500.00 $ 2,500.00 $ 6p35.00 $ $ 3,285.00 $ 5,000.00 $ 12,220.00
Other
Meeting&Education Supplies Y2 and Y3 Costs to cover meeting supplies during educational events.
$ 1,000.00 $ 1,000.00 $ 1,000.00 $ 1,900.00 $ $ 998.86 $ 2,OOO.O0
$ 3,898.86
Y2 and Y3 Partnership with La Ley 94.5 FM to promote outreach events,as well as have on air live shows to
further education,and the delivery of resources and information to Fresno County listeners.Including 7
Marketing Fresno County Cuadrilla outreach events catured to agricultural workers at their work location,dates are TBD.
This partnership will commence in December 2025 and will last until December 2026,at a cast of$2,500.00
$ $ $ $ 17,500.00 $ $ 15,000.00 $ $ 32,500.00 per month.
Total Other $ 1,000.00 $ 1,000.00 $ 500.00 $ 19,400.00 $ $ 15,998.86 $ 2,000.00 $ 36,398.86
Total Direct Costs $ 210,940.00 $ 201,652.95 $ 210,940.00 $ 219,616.28 $ $ 101,869.86 $ 421,880.00 $ 523,139.09
Indirect Cogs L.1 10% $ 21,094.00 $ 20,165.30 $ 21,094.00 $ 21,961.63 $ $ 10,136.99 $ 42,198.00 $ 52,313.91 10%of overall grant total(including accounting,adminstrative,and indirect operational and support costs)
Grand Total $ 232,034.00 $ 221,818.25 $ 232,034.00 $ 241,577.91 $ S 112,os6.as $ a64,o6s.00 $ s7sps3.00