HomeMy WebLinkAboutAgreement A-20-210 with CA Dept. of Public Health.pdfAgreement No . 20-210
CALIFORNIA DEPARTMEN T OF PUBLI C HEAL TH
MATERNAL, CHILD AN D ADOLESCENT HEALTH (MCAH ) DI V ISION
FUNDING AGREEMENT PERIOD
FY 2019-2023
AGENCY INFORMATION FORM
Agencies are required to submit an electronic and signed copy (original signatures only} of this form along
with their Ann ual AFA Package.
Agencies are r equired to s ubmit information when updates occ ur during the fiscal year. Updated
submissions do not require certification signatures.
Any program related information being sent from the CDPH MCAH Division will be directed to all
Program Di rectors.
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CHVP II: CHVP 19-10
Update Effective Date: <1u:u,9 ~ro (only required when submitting updates }
\
Federal Employer ID#:
Fl$CAL ID#:
Com plete Official Agen cy Name: County of Fresno
Business Address: 1221 Fulton Street, F resno. CA, 93721
Agency Phone: (559} 600-3330
A gency Fax: (55 9} 455-4705
Agency Website: www.co.fresno.ca.us
Page 1 of 2
AGREEMENT FUNDING APPLICATION
POLICY COMPLIANCE AND CERTIFICATION
Please enter the agreement or contract number for ea c h of the applicable programs
CHVP #: CHVP 19-10
U pdate Effective Date: June 9 , 2020 (only requ ired when su bmitting updates
The undersigned hereby affirms that the statements contained in the Agreement Fun ding Application
(AFA) are true and complete to the best of the applicant's knowledge.
I certify that this Maternal , Child and Adolescent Health (MCAH) program w ill comply with all applicable
provisions of Article 1, Chapter 1, Part 2 , Division 106 of the Health and Safety code (commencing w ith
secti on 12322 5). Chapters 7 and 8 of the Welfare and Institutions Code (commencing w ith Sections
14000 and 142), and a ny applicable rules or regu la tions promulgated by CDPH pu rsuant to t his article
and these Chapters. I further certify t hat all MCAH related prog rams will comply with the most current
MCAH Policies and Procedures Manual, includ ing bu t not limited to, Ad mi nist ration. I further agre e tha t
the MCAH related prog rams may be subj ect to a ll sanctions . or other remed ies applic able, if the MCAH
related program vio lates an y of the above l aws, regulations a nd policies w it h whic h it has ce rtified it will
comply
Original signature of offic i al authorized to commit the Agency to a CHVP Agreement
Signature line:E,
Name (Print)_E rn est Buddy Mendes ______ _
Title_Chairman of the Board of Supervisors of the County of Fresno_ Date .::S\..LJ'\...Q,, 9' @ ai0
I
ature of MCAH D i rector
Name (Print)_Rose Mary Rahn~ ~'C, ~H-0
Title_Division Manag er/MCAH D irector __ Da te .2{te,{-µ,z..o
Page 2 of 2
ATTEST:
BERNICE E . SEIDEL
Clerk of the Board of Supervisors
Co unty of Fresno, State of California
By Cj'. J\D,, f ' ~ Deputy
&r.:ENCV execultVE Dt9.£CTOI 0.~d _ MCAH DfllECfOR Rose Marv !PAnlfCT COOIUJINATOR Je,nnlfer A5CAl OfACD. a,,. .. f15CAl CONTACT AphrBnh Cl.fkK OF THE 80AROor Btmi<,e OlA.IR 80AAOOFSIJPERVISOIIS Emen Of'FlOAl AlJ'TlKlRIZ[O TO En1c,t COMMrl' ACEt4CY RSCALID S: C.oritt:K'!or• l'bunrv rd Ft-no Attttl\tlon~ DPH 8U1.lt1u1 N'b!Nirff Add(CM; PO BOX. 11.SOO Ema ti: dahhn•o.Qfr.,'"nbtt'Jl:ln~Ji .•Dv ~viii• R•h"' Doy c .... , X.~nth 5etde-1 M.-S Mend<, Publl.t. HtUh.h Dl'rllrtM Oivitlon ,-,hn•ttr $t.rpeMJl"IPMN Pubtk: Hnhh BudMu otf1111:e1 Sl>ft' An1lv,t Oerlc: of tht Board of SuJ)41!MsorJ O.~ot, ... 1....a-,~1-DII \N~of"'--CW-.. \h ........ s.ip..~-\Jt•ce.-.av•,, .. -Eitffler p.ar1y m,,y tM~e changu 10 th~ Information a.bow by &h•1t11 wtltteo notice to th other p.rty. ]~;ra, ?{~~ /:.;) .;~TOSfi;:~ ~;,, i \t.1_,1•1~ rJf~~t:J;,-1 ·1 l:i~f-_..,• ~'-1:'\!~ t •• ~•~ ~ ~~, f-:-,; )lft;~_• IIUDGEIS•· ftlWKtS , ' ,.,;_ · lfX,E5.Sll£crB),-N •· ·,I ,, , ••• .., Yu ... No No ... . .. No No NO No No No No No S,,id c,Mnus shll not ~qu\rc an .rnendrnent tothl, ternment. b..-t will re,qulre • n~ ST020il P~ve,a O.ta Record« CDPH9'083 Gow:,nm.tnt A£•ncy T1_q:,,aver t=o<m. ISSSI) 600-3200 ldporn~vilf1(1f<e:Jooe<!!ffl'YS••IO" OIVP {SS,) 600-3330 jrr,hn@frunocounryg.my <><VP (Sst) 600-1130 'fd•yflfr~IAO(..OIJl'll5'YS• S9Y O<VP (SS9) ISOO-J200 tbkhf·,g@frgnoc:ountyq.f"""' n,vp (ss,1600-1330 lu.anvtm@fr~~ocovntvc~ CIM' (S5!1) 600-1601 lt»c•(li;;l@?f{esncx0unr,c1r1.~ ONP (S59) fi00..4O00 1Dl~4@fr~nocounryca,t0w O<VP (S59) 6CXMOOO lc.ntia4@fr~nocountyca ~ Q(',/p
CHVP SGF EXP Scope of Work
Effective Date, 2019
State General Fund California Home Visiting Program
Objectives and Measures for July 1, 2019 – June 30, 2020
Objective Activity Deliverable
1. Develop and provide leadership and
infrastructure for Parents as Teachers
(PAT), Healthy Families America (HFA),
and/or Nurse Family Partnership (NFP)
model implementation of the
California Home Visiting Program
(CHVP) at the Local Implementing
Agency (LIA).
1.1 Develop a CHVP implementation plan that outlines
startup activities that will be completed by 6/30/2020.
1.2 Initiate recruitment, hiring, and training of staff to support
implementation of selected home visiting model.
1.3 Begin securing facilities, needed equipment, and other
programmatic supplies for successful implementation of
selected home visiting model.
1.4 Participate in all CHVP meetings, calls, webinars, and
conferences, as requested.
Submission of implementation plan
within 45 days of receipt of funds.
2. Establish and/or modify data system
infrastructure to support
implementation of CHVP at the LIA.
2.1.a. NFP LIAs will coordinate data system requirements with
the NFP National Service Office.
2.1.b. HFA LIAs will coordinate with the CHVP Data Team to
establish buildout/modification in Efforts to Outcomes (ETO)
data system.
2.1.c. PAT LIAs will coordinate data system requirements with
the PAT National Office for use of the Penelope data system.
2.2 All CHVP State General Fund (SGF) funded home visiting
participants are required to sign the CHVP consent form.
2.3 LIAs will report to CDPH on the total number of women
served.
Submission of implementation plan
within 45 days of receipt of funds.
C<'. 4wft1': t,,.J>c.·-••·•, ..:,),:_ Pub he Health -~1 ~l i • Maternal, Chid and Adolescen1 Health Divlsion ORIGINAL BUDGET c: BUDGET SUMMARY FISCAL YEAR BUDGET INVOICE TYPE 2019-2020 ORIGINAL QUARTERLY i:.-... ~1,o;..11 PURPOSE: CHVP SGF Expansion FUNDING SOURCE. PCA FUNDING SOURCE, PCA CONTRACTOR: Fresno CHVP -SGF, 51023 AGREEMENT l: 19-10 (2) 131 (4) [S) SUBK: TOTAL FUNDING % s % s FUNDING TOTALS 1,101,920 1,101,920 EXPENSE:. CATEGORY PERSONNEL s1so,o°'e 100.00•1. J180.~8 FRINGE BENEFITS $142,473 100.ocw. $142,•73 OPERATING $•2,190 100.00".4 $42,190 EQUIPMENT $10,100 100,00-/4 510,100 TRAVEL S22,600 100.00% S22.600 SUBCONTRACTS OTHER COSTS $40,000 100.00"/4 S40,000 INDIRECT COST SB0,630 100.00".4 S80,6l0 BUDGET TOTALS S518,041 100 00~1. $518,041 BALANCES =======> $S83,879 Maximum Amount Payable: $518,041 Signature over P ri n t e d Name -1------'------=-----------------Rose Mary Rahn Project Director State Use Only FUNDING SOURCE ?CA CODE PERSONNEL FRINGE BENEFITS OPERAT1NG EQUIP"1ENT TRAVEL SUBCONTRACTS Ol'HER COSTS INDIRECT COST T obis tor PCA Codes 518,041 CHVP SGF EXP 19-10 4 Budget Template FY19-20 03.09.20 xlsx CHVP.SOF 511>2:l 180,048 142,473 42.190 10.100 22,600 ~O.DDO SO,&lO 518,1)41 1 of 3 BUDGET STATUS BALANCE ACTIVE 583,879 FUNDING SOURCE, PCA FUNDtNG SOURCE. PCA 16) 17) t•> (9) % s % $ Printed 311112020 11 :09 AM
Ce ~c.,..i.e Pet>e~,r-,..,, ,:, ..:).,:_ Public Health .,. ~1·11 Mct:rnal. CIWd and Adolc~ccnt Health Olw;ion ORIGINAL BUDGET PURPOSE: CHVP SGF Expansion l=UNOING SOURCE, PCA !=UNOING SOURCE, PCA FUNDING SOURCE, PCA FUNDING SOURCE, PCA CONTRACTOR: Fresno CHVP -SGF, 51023 AGREEMENT f: 19-10 {2) {3) {4) {5) {6) {7) {8) {9) SUBK: TOTAL FUNDING % s % s % s % $ FUNDING TOTALS 1,101,920 1,101,920 EXPENSE CATEGORY PERSONNEL RECC,Nr:11TEI11,N-'-l"l-II iN (Rema,mnQ Funds 100.00% 1ao o,e lOTAL PERSONl)IEL COSTS 180,0,U 180,048 TOTAL WAGES 180,048 I 180,048 ~ ANNUAL < TITLE OR CLASS. HE% TOTAL WAGES E SALARY ~ I JO Supe~lng Public Health Nurse 25°4 4S,:W8 11,337 100.00°;. 11,337 2 LH SupeMSlng Public Health Ni.ne 30'½ 47,764 14,329 100,00"lo 14,329 3 ML P'ublic Health Nurae II 100•1~ 34,393 34,393 100.00% 34,393 • V Pubflc Hnllh Nul'M! II 100.o·A. 34,393 34,393 100.00-1. 34,393 s V Public Hee!Vl Nurs-e II 100% 34,393 34.393 100.oout. 34,393 6 V PubMe Hea,ti N11se I 100.00% 29,308 29,308 100.00"Jlo 29,308 1 MB Office Assslanl I I Data Entry Clerk 100.00% 11,860 11,860 100.00"/2 11,860 8 CV Health EducalJon AssStanl 50.00% 20,070 10,035 100.00'½ 10,035 • )0 FRINGE BENEFITS RECONCILIATION SECTION (Remaining Funds) 100.00"/o 142 473 TOTAL FRINGE BENEFITS 142,473 OPERATING REC<)N1 :11 I.ti.IIuN "'"" ...... (Kemaining ~uncis 100.00% ,., 190 TOTAL OPERATING EXPENSES 42,1,0 42,190 I T,elning 20,000 100.0W. 20,000 2 Communicatio~ 1,500 100.00•/4 ,.soo 3 Office Suppfle$ 1,500 100.00% ,,soo 4 Pos1age 50 100,00% 50 5 Pr\n1ing 1,200 100.00% 1,200 6 M~dical Supp!ie~ 2.9-40 100.00% 2,940 1 Rents & lease$, Fac:Jilie, 15,000 100.00% 15,000 8 ' 10 CHVP SGF EXP 19-10 4 Budget Template FY19·20 03.09.20.xlsx 2 of 3 Prinled: 3111/202011·09 AM
c .. •,,.. .. i..o,-p:i,,....,..,1o1 ~,:_. ORIGINAL BUDGET Public Health •lL L""J · I Maternal ChJldandAdolesc1mt HeahhOivislon PURPOSE: CHVP SGF Expansion FUNDING SOURCE, PCA FUNDING SOURCE, PCA FUNOl~G SOURCE, PCA CONTRACTOR: Fresno CHVP -SGF, 51023 AGREEMENT,,: 19-10 12) SUBK: TOTAL FUNDING % FUNDING TOTALS EXPENSE CATEGORY EQUIPMENT 100.()0% TOTAL EQUIPMENT EXPENSES 10.100 1 Smal Tools & lm.truments 10,100 100.0()('/. 2f-----------------------+-----1----__J 3 1------------------i----+----1 . f-------------------------ll------1------l TRAVEL 100.00% TOTAL TRAVEL EXPENSES 22,600 I Travel 22,600 100.00% 2 1----------------------+----~__J---~ l 1----------------------+----~__J---~ . 1-------------------11----+-----I SUBCONTRACTS TOTAL SUBCONTRACT EXPENSES I 1-------------------11----+------l 2 ,f---------------------+-----+-----1 'f---------------------+-----+-----1 s OTHER COSTS 100,0D'¼ TOTAL OTHER COSTS 40,000 1 Books &. Publir:ations 10,000 100.0CWn 2 Clienl Support MaterM!ls 30,000 100.00% ---3 f-------------------------41-----~1----' f--------------------------1------__Jl----s INDIRECT COST \QO.QOD,4 TOTAL INDIRECT cos1sl 80,630 I 25.00% of 'Total Pergonnel and Benefits I 80,630 100.00%1 CHVP SGF EXP 19-10 4 Budget Template FY19-20 03.09.20.xlsx (3) (4) (S) (6) (7) 'lo % 1,101,920 RECONCILIATION SECTION (Remainin<1 Funds 10 100 10,100 10,1001-----l<t-( JNLII IA, I )UN s-e~ I IUN (Kemamm<1 r unas 77600 22,600 22,600 ,_ ___ ----< RE( .,~ .. IA 1ui-rs ·•-",.. (Kemaming runas ... l\llOll S>-< ;i ,ur, tt<emaining runas 40000 40,000 10,000 30,000 N'P-1.IJN ;1L Ai•nN·c:i=r.1 ir1N (Remalnmg Fun as !0 630 ,0,,,0 I 1 I ,0 .• ,0 I I I 3of3 ~UNDl'NG SOURCE, PCA 1•1 <•) % I I Printed: 3/J 1 /2020 1 1 :09 AM
Original Budget J ustification Section
19-10 Fresno
I ACTIVE I
PERSONNEL
TOTAL S 605.00% 257,530 180,048 142,473
~
ANNUAL TOTAL FRINGE FRINGE Justlfic.:atlon s TITLE OR CLASS. FTE% BENEFIT RATE BENEFIT i SALARY WAGES % AMOUNT
1 JD Supervising Publk: Health Nurse 25.000% 45.348 11,337 80.67% 9,145 Locat ed in Selma Regfon al Center.
2 LH Supervising Public Health Nurse 3D.00•/4 47 ,764 14,329 84. 15'/e 12,058 Localed in Fresno OPH Brix.
3 ML Public Health Nurse U 100.00% 34.393 34,393 76.36% 26,264 Located in Selma Regional Cenler.
4 V Public Health Nurse II 100.0()"/. 34,393 34,393 76 .36'/4 26,264 Located in Fresno OPH Brix.
5 V Public Health Nurse II 100.00•;. 34,393 34,393 76.36'/4 26,26-4 Located in Fresno OPH Brix.
6 V Public Health Nurse I 100.00% 29.308 29,308 75.50'/4 22,128 Located in Selma Regional Cenler.
7 MB Office Assistant 1 / Data Entry Clerk 100.00% 11,860 11,860 89.73% 10,642 Splits time between Selma Regional Center and Fresno DPH Brix.
8 CV H eallh Educa1ion Assistant 50.00% 20,070 10,035 96.75% 9 ,708 Located In Fresno DPH Brix.
9
10
FRINGE BENEFITS
Justific ation
TOTAL FRINGE BENEFITS 142,473
OPERATING
Justification
TOTAL OPERATING 42,190
1 Training 20,000 Registration fees for CHVP required and other professional developmenl
trainings and C EUs as needed when attending required and r elated
conferences. trainings. workshops & meetings for home visiting staff. NFP
requires education for all new Nurse Home Visitors (NHV). Program
Supervisors (PS), and Agency Admants lfators (M) i n D enver, Colorado (fees
per p erson: NHV S4,808 new staff or $2,404 for refresher: PS $868;
M aterials $611 ). All education constSts of in-person & distance education. 3
NHV Education needed once Vacant positions are filled: 3 x($4 ,808 + $611)
= $16,257.1 PS Education n eeded $868. NFP requir es NHVs to take the
Dyadic Assessment of Naturalistic Caregiver--<::hild Experi,ences (DANCE)
training ($135 per N HV and $67 per NHV for annual proficiency
c ertification ). $135 x(J NHV) + $67 x1 NHV = $472. Also includes funding for
local tr a inings for all staff to meet SOW & additional trainf'lgs as may b e
required byCHVP.
2 Communications 1,500 Local & long distance seNice with h ardWare. Rate pro\/Kted by Fresno
Countv ITSD!Communicalions & is based on th e tvoe of device used.
3 Office Supplies 1,500 General office expenses ror starr to carry out day to day activities. Client
ch.:ut binders. shredders. paper. pens. ink, staplers. calendars,
hermometers, batteries, sanitizing wipes, disposable measuring tapes.
exam otoves etc.
4 Postage 50 Regular ma~ postage. Federal Express & overnight mail lor correspondence
i...uth clients. lhe oublic & CDPH.
5 Printing 1,200 Internal Services Department charges for Graphics P rinting or chart forms &
NFP Fac~it.at or Guides used by home visitors every visit, and contact cards.
PHNs have different visrt-to.visil facijitalor tools & nurse instructional guides
every visit. Approximately S0.15 per 2-part carbon-capable p rinted set and
S34 Der Dack o r 250 contact cards.
6 Medical Supplies 2 ,940 Assessment tools such as thermometers (SSOea), infant scales (S200ea ),
adult scal es (S120ea), stethOscopes ($60ea), pressure culls ($60ea) &
protective equipment. PHNs util ize proper clean bag technique and b;uriers
are required for every home visit. Additionally, h and sanitCZer and sanitizing
!wipes are utilized aner each use or equ ipment Approximately $735 for each
PHN.
7 Rents & Leases, Facilities 15,000 Space rental for Selma Regional Center facilfy & community
events/meetings. Program's share of Sel ma Regiona l Center lease and
s ecu,itv and Brix Bu~dino facilities. 1$3 000 oer oerson x 5 stall)
8
9
10
CHVP SGF EXP 19-10 4 Budget Te"l)late FY19-2003.09.20.Jt<a I ol 2 P111ted 3111no20 4.05 PM
Original Budget Justifi cation Section
19-10 Fresno
I ACTIVE I
EQUIPMENT
J ustification
TOTAL EQUIPMENT EXPENSES 10,100
Small Tools & Instruments 10,100 Equipment lor eleclton1c medical record system (lablct or handheld device),
1 estimated at $1,200 each, plus monitors for docking slalion. Color printer.
Office landscaoino, c abinets & chair s.
2
3
4
5
TRAVEL
J ustification
TOTAL TRAVEL EXPENSES 22,600
1 Travel 22,600 Stall travel lo home visd.s , CHVP requued and other professional
d evelopment 1rain1ngs, re lal ed conferences, workshops & meetings for
home visrting staff. Usage, maintenance & gasoline costs for County vehicle
assigned to the program ($4,000 per vehicle annually x 2 vehicles).
Reimbursemenl for privat e aulo mileage ($0.575/mile) when staff travel to
training, home V1Si1s, outreach and p rogram re laled meetings ($1,000/PHN).
County will bill only up to lhe Sta te's per diem rate. Also includes vehicl e
rentals when County or private v ehic les are nol use d ($2.600). Includes
expenses for meals & lodging for out of County travel. NFP required
raiflings include hotel, meals, airfare, shuttles and baggage to Denver, CO
S2 000/Df'rsonl.
2
3
4
5
SUBCONTRACTS
J ustification
TOTAL SUBCONTRACT EXPENSES
1
2
3
4
5
OTHER COSTS
Justification
TOT AL OTHER COSTS 40,000
1 Books & Publ1 cal10ns 10,000 Books in English and Spanish that support CHVP SOW, provided to clients
to increase kno'N\edge and skills for parenting and safety. provide cognitive
stimulation and support early hteracy (S4-8 each). Some educallonal
m aterials incorporale extensive graphics lo engage large! population and
h ave co,responding v.eb apps Understanding Pregnancy, Birth. Your
Newborn, Mother & New Baby Care , W hat To Do When My Child is Sick.
Approximately $100/fam~y x 25 fam~ies/PHN x 4 PHNs.
2 Cl ient S upport Material s 30.000 Clie nl support malerials include items to assist with achieving program goals
during the course of the program. Supplemental m aterials incl ude loys,
infant rattles, infant mirrors, toothbrushes. sorting rings a nd blocks.
Approximately $300/fam~y x 25 families/PHN x 4 PHNs. The items comply
......t h CHVP Policv 400-30.
3
4
5
INDIRECT COST
Justification
TOTAL INDIRECT COSTSI 80,630
2s.0•1o101 Total Personnel and Beneflls I 80,630 Per COPH apJ)fOVed ICR.
CHVP SGf EXP 19-10 4 BuogetT~le FY19-2003.09.20~Sll 2ol2 Priited: 3111/2020 4·05 PM
Agreement Funding Application Between the County of Fresno and the
California Department of Public Health
Agreement Name: CDPH California Home Visiting Program Grant Agreement No.
CHVP 19-10
Fund/Subclass: 0001/10000
Organization #: 56201750
Revenue Account #: 3530
SONIA Y. ANGELL, MD, MPH
State Public Health Officer & Director
State of California-Health and Human Services Agency
California Department of Public Health
March 10, 2020
Rose Mary Rahn
MCAH Director
County of Fresno
1221 Fulton Street
Fresno, CA 93721
Dear Ms. Rahn
GAVIN NEWSOM
Governor
APPROVAL OF AGREEMENT FUNDING APPLICATION (AFA) FOR AGREEMENT
CHVP SGF EXP 19-10-FISCAL YEAR 2019-20
The California Department of Public Health, Maternal, Child and Adolescent Health
(CDPH/MCAH) Division approves your Agency's AFA for administration of MCAH
related programs.
To carry out the program(s) outlined in your approved SOW(s) and Budget(s), during
the period of July 1, 2019 through June 30, 2020 the CDPH/MCAH Division will
reimburse expenditures up to the following amounts:
California Home Visiting Program ................ $1, 101,920
The availability of State General Funds are based upon funds appropriated in the FY
2019-20 Budget Act. Reimbursement of invoices is subject to comp lian ce with all
federal and state requirements pertaining to the CDPH/MCAH related programs and
adherence to all appl icable regulations, policies and procedures. Your Agency agrees
to invoice actual and documented expenditures and to follow all the conditions of
compliance stated in the current CDPH/MCAH Program and Fiscal Policies and
Procedures manuals, including the ability to substantiate all funds claimed.
Please ensure that all necessary individuals within your Agency are notified of this
approval and that the approved AFA documents are carefully reviewed. This approval
letter constitutes a binding agreement. If any of the information contained in your
approved Budget is incorrect or different from that negotiated, please contact your
contract manager, Michael Neff or by e-mail at michael.neff@cdph.ca.gov within 14
calendar days from the date of this letter. Non-response constitutes acceptance of your
approved AFA documents.
CDPH Maternal, Child and Adolescent Health Division/Center for Family Health
MS 8305, P.O. Box 997420, Sacramento, CA 95899-7420
(916) 650-0300 • {916) 650-0305 FAX
Internet Address: www.cdph.ca.gov
Sincerely,
~hz::s
RomeoAmian
Assistant Division Chief
Maternal, Child and Adolescent Health Division
Enclosure( s)
cc: Rose Mary Rahn
MCAH Director
Michael Neff
Contract Manager
Sosha Marasigan-Quintero
CHVP Program Consultant
Central File