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COUNTY OF FRESNO
Fresno, CA
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AGREEMENT
THIS AGREEMENT is made and entered into this _______ day of ________________, 2017,
by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,
hereinafter referred to as "COUNTY", and READING AND BEYOND, a California Non-Profit
Corporation, whose address is 4670 East Butler Avenue, Fresno, CA 93702, hereinafter referred to as
"CONTRACTOR".
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Public Health (DPH), is in need of staffing
and administrative services required to conduct its Local Dental Pilot Project (LDPP); and
WHEREAS, COUNTY’s DPH received grant funding from the State of California, Department
of Health Care Services (DHCS), to collaborate with local community based organizations for the
Medi-Cal 2020 Waiver, Dental Transformation Initiative; and
WHEREAS, CONTRACTOR, has the capacity, facilities, and personnel skilled in providing
such services; and
WHEREAS, CONTRACTOR, is qualified and is willing to provide such services, pursuant to
the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
hereto agree as follows:
1. SERVICES
A. CONTRACTOR shall perform all services and fulfill all responsibilities
identified in Exhibit A, Scope of Work, and Exhibit D, DHCS approved LDPP proposal, both attached
hereto and by this reference incorporated herein.
B. CONTRACTOR warrants that it possesses all licenses and certificates required
by local, State of California, and / or Federal laws and regulations for the conduct of its business and
shall operate its business in accordance with all applicable laws and regulations. CONTRACTOR
further warrants that all of its personnel performing services under this Agreement shall be licensed
and certified where required, to lawfully perform their duties and shall maintain such licensure and
certifications throughout the term of this Agreement.
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C. CONTRACTOR shall maintain copies of all licenses and certifications noted
above and shall allow COUNTY DPH staff to review the documents upon request.
2. TERM
This Agreement shall become effective on the 1st day of July, 2017 and shall terminate
on the 31st day of December, 2020.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR thirty (30) days advance written notice.
B. Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to COUNTY;
4) Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of any
breach of this Agreement or any default which may then exist on the part of CONTRACTOR. Neither
shall such payment impair or prejudice any remedy available to COUNTY with respect to the breach
or default. COUNTY shall have the right to demand of CONTRACTOR the repayment to COUNTY
of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of COUNTY
were not expended in accordance with the terms of this Agreement. CONTRACTOR shall promptly
refund any such funds upon demand or, at COUNTY’s option, such repayment shall be deducted from
future payments owing to CONTRACTOR under this Agreement.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written notice
of an intention to terminate to CONTRACTOR.
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4. COMPENSATION
For staffing and administrative services identified in Exhibit A, COUNTY agrees to pay
CONTRACTOR and CONTRACTOR agrees to receive compensation based upon the budgeted
amounts in Exhibit B. In no event shall actual services performed under this Agreement be in excess
of Seven Hundred Nineteen Thousand, Eight Hundred Forty and No/100 Dollars ($719,840) during
the period of July 1, 2017 through December 31, 2017; One Million, Three Hundred Ten Thousand,
Two Hundred Forty-Eight and No/100 Dollars ($1,310,248) during the period of January 1, 2018
through December 31, 2018; One Million, Four Hundred Four Thousand, One Hundred Thirty-Four
and No/100 Dollars ($1,404,134) during the period of January 1, 2019 through December 31, 2019;
and One Million, Five Hundred Two Thousand, Six Hundred Forty-Three and No/100 Dollars
($1,502,643) during the period of January 1, 2020 through December 31, 2020. It is understood that all
expenses incidental to CONTRACTOR's performance of actual services under this Agreement shall be
borne by CONTRACTOR.
Payments by COUNTY shall be in arrears, for services provided during the preceding
month, within forty-five (45) days after receipt and verification of CONTRACTOR's invoices by
COUNTY's Department of Public Health. If CONTRACTOR should fail to comply with any
provision of this Agreement, COUNTY shall be relieved of its obligation for further compensation.
5. INVOICING
CONTRACTOR shall invoice COUNTY monthly addressed to the County of Fresno,
Department of Public Health, California Children’s Services, P.O. Box. 11867, Fresno, CA 93775,
Attention: Supervising Account Clerk. Invoices shall detail line items as specified in Exhibit B,
including original budget amount(s), current month’s expenses, year-to-date expenses, and budget
balances. In addition, invoices shall also include all relevant supporting documentation including but
not limited to copies of original statements, program expense receipts, payroll records and mileage
claims.
6. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under
this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
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CONTRACTOR's officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have
no right to control or supervise or direct the manner or method by which CONTRACTOR shall
perform its work and function. However, COUNTY shall retain the right to administer this
Agreement so as to verify that CONTRACTOR is performing its obligations in accordance with the
terms and conditions thereof. CONTRACTOR and COUNTY shall comply with all applicable
provisions of law and the rules and regulations, if any, of governmental authorities having jurisdiction
over matters which are directly or indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR shall have
absolutely no right to employment rights and benefits available to COUNTY employees.
CONTRACTOR shall be solely liable and responsible for providing to, or on behalf of, its employees
all legally-required employee benefits. In addition, CONTRACTOR shall be solely responsible and
save COUNTY harmless from all matters relating to payment of CONTRACTOR's employees,
including compliance with Social Security, withholding, and all other regulations governing such
matters. It is acknowledged that during the term of this Agreement, CONTRACTOR may be
providing services to others unrelated to the COUNTY or to this Agreement.
7. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written
consent of all the parties without, in any way, affecting the remainder. Notwithstanding the above,
changes to line items in the budget, attached hereto as Exhibit B, that do not exceed ten percent (10%)
of the maximum compensation payable to the CONTRACTOR may be made with written approval of
COUNTY’s Department of Public Health Director, or designee, and the designee of DHCS.
8. NON-ASSIGNMENT
Neither party shall assign, transfer or subcontract this Agreement nor their rights or
duties under this Agreement without the prior written consent of the other party.
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9. HOLD-HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
defend the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to
COUNTY in connection with the performance, or failure to perform, by CONTRACTOR, its officers,
agents or employees under this Agreement, and from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to any
person, firm or corporation who may be injured or damaged by the performance, or failure to perform,
of CONTRACTOR, its officers, agents or employees under this Agreement.
10. INSURANCE
Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR
or any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect the
following insurance policies throughout the term of this Agreement:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than One Million
Dollars ($1,000,000) per occurrence and an annual aggregate of Two Million
Dollars ($2,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverage including completed operations,
product liability, contractual liability, Explosion, Collapse, and Underground
(XCU), fire legal liability or any other liability insurance deemed necessary
because of the nature of the Agreement.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits for bodily injury of
not less than Two Hundred Fifty Thousand Dollars ($250,000) per person, Five
Hundred Thousand Dollars ($500,000) per accident and for property damages of
not less than Fifty Thousand Dollars ($50,000), or such coverage with a
combined single limit of Five Hundred Thousand Dollars ($500,000). Coverage
should include owned and non-owned vehicles used in connection with this
Agreement.
C. Professional Liability
If CONTRACTOR employs licensed professional staff (e.g. Ph.D., R.N.,
L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000) per occurrence, Three
Million Dollars ($3,000,000) annual aggregate.
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D. Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
CONTRACTOR shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by the COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under the CONTRACTOR's policies herein.
This insurance shall not be cancelled or changed without a minimum of thirty (30) days advance
written notice given to COUNTY.
Within thirty (30) days from the date CONTRACTOR executes this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Public Health, P.O. Box
11867, Fresno, California, 93775, Attention: Contracts Section – 6th Floor, stating that such insurance
coverage have been obtained and are in full force; that the County of Fresno, its officers, agents and
employees will not be responsible for any premiums on the policies; that such Commercial General
Liability insurance names the County of Fresno, its officers, agents and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned; that such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by the COUNTY, its officers, agents and employees, shall be
excess only and not contributing with insurance provided under the CONTRACTOR’s policies herein;
and that this insurance shall not be cancelled or changed without a minimum of thirty (30) days
advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
herein provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate
this Agreement upon the occurrence of such event.
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All policies shall be with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating
of A FSC VII or better.
11. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
A. The parties to this Agreement shall be in strict conformance with all applicable
Federal and State of California laws and regulations, including but not limited to Sections 5328,
10850, and 14100.2 et seq. of the Welfare and Institutions Code, Sections 2.1 and 431.300 et seq. of
Title 42, Code of Federal Regulations (CFR), Section 56 et seq. of the California Civil Code and the
Health Insurance Portability and Accountability Act (HIPAA), including but not limited to Section
1320 D et seq. of Title 42, United States Code (USC) and its implementing regulations, including, but
not limited to Title 45, CFR, Sections 142, 160, 162, and 164, The Health Information Technology for
Economic and Clinical Health Act (HITECH) regarding the confidentiality and security of patient
information, and the Genetic Information Nondiscrimination Act (GINA) of 2008 regarding the
confidentiality of genetic information.
Except as otherwise provided in this Agreement, CONTRACTOR, as a Business
Associate of COUNTY, may use or disclose Protected Health Information (PHI) to perform functions,
activities or services for or on behalf of COUNTY, as specified in this Agreement, provided that such
use or disclosure shall not violate the Health Insurance Portability and Accountability Act (HIPAA),
USC 1320d et seq. The uses and disclosures of PHI may not be more expansive than those applicable
to COUNTY, as the “Covered Entity” under the HIPAA Privacy Rule (45 CFR 164.500 et seq.),
except as authorized for management, administrative or legal responsibilities of the Business
Associate.
B. CONTRACTOR, including its subcontractors and employees, shall protect, from
unauthorized access, use, or disclosure of names and other identifying information, including genetic
information, concerning persons receiving services pursuant to this Agreement, except where
permitted in order to carry out data aggregation purposes for health care operations [45 CFR Sections
164.504 (e)(2)(i), 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i)] This pertains to any and all persons
receiving services pursuant to a COUNTY funded program. This requirement applies to electronic
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PHI. CONTRACTOR shall not use such identifying information or genetic information for any
purpose other than carrying out CONTRACTOR’s obligations under this Agreement.
C. CONTRACTOR, including its subcontractors and employees, shall not disclose
any such identifying information or genetic information to any person or entity, except as otherwise
specifically permitted by this Agreement, authorized by Subpart E of 45 CFR Part 164 or other law,
required by the Secretary, or authorized by the client/patient in writing. In using or disclosing PHI
that is permitted by this Agreement or authorized by law, CONTRACTOR shall make reasonable
efforts to limit PHI to the minimum necessary to accomplish intended purpose of use, disclosure or
request.
D. For purposes of the above sections, identifying information shall include, but not
be limited to name, identifying number, symbol, or other identifying particular assigned to the
individual, such as finger or voice print, or photograph.
E. For purposes of the above sections, genetic information shall include genetic
tests of family members of an individual or individual, manifestation of disease or disorder of family
members of an individual, or any request for or receipt of, genetic services by individual or family
members. Family member means a dependent or any person who is first, second, third, or fourth
degree relative.
F. CONTRACTOR shall provide access, at the request of COUNTY, and in the
time and manner designated by COUNTY, to PHI in a designated record set (as defined in 45 CFR
Section 164.501), to an individual or to COUNTY in order to meet the requirements of 45 CFR
Section 164.524 regarding access by individuals to their PHI. With respect to individual requests,
access shall be provided within thirty (30) days from request. Access may be extended if
CONTRACTOR cannot provide access and provides individual with the reasons for the delay and the
date when access may be granted. PHI shall be provided in the form and format requested by the
individual or COUNTY.
CONTRACTOR shall make any amendment(s) to PHI in a designated record set
at the request of COUNTY or individual, and in the time and manner designated by COUNTY in
accordance with 45 CFR Section 164.526.
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CONTRACTOR shall provide to COUNTY or to an individual, in a time and
manner designated by COUNTY, information collected in accordance with 45 CFR Section 164.528,
to permit COUNTY to respond to a request by the individual for an accounting of disclosures of PHI
in accordance with 45 CFR Section 164.528.
G. CONTRACTOR shall report to COUNTY, in writing, any knowledge or
reasonable belief that there has been unauthorized access, viewing, use, disclosure, security incident,
or breach of unsecured PHI not permitted by this Agreement of which it becomes aware, immediately
and without reasonable delay and in no case later than two (2) business days of discovery. Immediate
notification shall be made to COUNTY’s Information Security Officer and Privacy Officer and
COUNTY’s DPH HIPAA Representative, within two (2) business days of discovery. The notification
shall include, to the extent possible, the identification of each individual whose unsecured PHI has
been, or is reasonably believed to have been, accessed, acquired, used, disclosed, or breached.
CONTRACTOR shall take prompt corrective action to cure any deficiencies and any action pertaining
to such unauthorized disclosure required by applicable Federal and State Laws and regulations.
CONTRACTOR shall investigate such breach and is responsible for all notifications required by law
and regulation or deemed necessary by COUNTY and shall provide a written report of the
investigation and reporting required to COUNTY’s Information Security Officer and Privacy Officer
and COUNTY’s DPH HIPAA Representative. This written investigation and description of any
reporting necessary shall be postmarked within the thirty (30) working days of the discovery of the
breach to the addresses below:
County of Fresno County of Fresno County of Fresno
Dept. of Public Health Dept. of Public Health Information Technology Services
HIPAA Representative Privacy Officer Information Security Officer
(559) 600-6439 (559) 600-6405 (559) 600-5800
P.O. Box 11867 P.O. Box 11867 2048 N. Fine Street
Fresno, CA 93775 Fresno, CA 93775 Fresno, CA 93727
H. CONTRACTOR shall make its internal practices, books, and records relating to
the use and disclosure of PHI received from COUNTY, or created or received by the CONTRACTOR
on behalf of COUNTY, in compliance with HIPAA’s Privacy Rule, including, but not limited to the
requirements set forth in Title 45, CFR, Sections 160 and 164. CONTRACTOR shall make its
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internal practices, books, and records relating to the use and disclosure of PHI received from
COUNTY, or created or received by the CONTRACTOR on behalf of COUNTY, available to the
United States Department of Health and Human Services (Secretary) upon demand.
CONTRACTOR shall cooperate with the compliance and investigation reviews
conducted by the Secretary. PHI access to the Secretary must be provided during the
CONTRACTOR’s normal business hours, however, upon exigent circumstances access at any time
must be granted. Upon the Secretary’s compliance or investigation review, if PHI is unavailable to
CONTRACTOR and in possession of a Subcontractor, it must certify efforts to obtain the information
to the Secretary.
I. Safeguards
CONTRACTOR shall implement administrative, physical, and technical
safeguards as required by the HIPAA Security Rule, Subpart C of 45 CFR 164, that reasonably and
appropriately protect the confidentiality, integrity, and availability of PHI, including electronic PHI,
that it creates, receives, maintains or transmits on behalf of COUNTY and to prevent unauthorized
access, viewing, use, disclosure, or breach of PHI other than as provided for by this Agreement.
CONTRACTOR shall conduct an accurate and thorough assessment of the potential risks and
vulnerabilities to the confidential, integrity and availability of electronic PHI. CONTRACTOR shall
develop and maintain a written information privacy and security program that includes administrative,
technical and physical safeguards appropriate to the size and complexity of CONTRACTOR’s
operations and the nature and scope of its activities. Upon COUNTY’s request, CONTRACTOR shall
provide COUNTY with information concerning such safeguards.
CONTRACTOR shall implement strong access controls and other security
safeguards and precautions in order to restrict logical and physical access to confidential, personal
(e.g., PHI) or sensitive data to authorized users only. Said safeguards and precautions shall include
the following administrative and technical password controls for all systems used to process or store
confidential, personal, or sensitive data:
1. Passwords must not be:
a. Shared or written down where they are accessible or recognizable
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by anyone else; such as taped to computer screens, stored under keyboards, or visible in a work area;
b. A dictionary word; or
c. Stored in clear text
2. Passwords must be:
a. Eight (8) characters or more in length;
b. Changed every ninety (90) days;
c. Changed immediately if revealed or compromised; and
d. Composed of characters from at least three (3) of the following
four (4) groups from the standard keyboard:
1) Upper case letters (A-Z);
2) Lowercase letters (a-z);
3) Arabic numerals (0 through 9); and
4) Non-alphanumeric characters (punctuation symbols).
CONTRACTOR shall implement the following security controls on each
workstation or portable computing device (e.g., laptop computer) containing confidential,
personal, or sensitive data:
1. Network-based firewall and/or personal firewall;
2. Continuously updated anti-virus software; and
3. Patch management process including installation of all operating
system/software vendor security patches.
CONTRACTOR shall utilize a commercial encryption solution that has received
FIPS 140-2 validation to encrypt all confidential, personal, or sensitive data stored on portable
electronic media (including, but not limited to, compact disks and thumb drives) and on portable
computing devices (including, but not limited to, laptop and notebook computers).
CONTRACTOR shall not transmit confidential, personal, or sensitive data via e-
mail or other internet transport protocol unless the data is encrypted by a solution that has been
validated by the National Institute of Standards and Technology (NIST) as conforming to the
Advanced Encryption Standard (AES) Algorithm. CONTRACTOR must apply appropriate sanctions
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against its employees who fail to comply with these safeguards. CONTRACTOR must adopt
procedures for terminating access to PHI when employment of employee ends.
J. Mitigation of Harmful Effects
CONTRACTOR shall mitigate, to the extent practicable, any harmful effect that
is suspected or known to CONTRACTOR of an unauthorized access, viewing, use, disclosure, or
breach of PHI by CONTRACTOR or its subcontractors in violation of the requirements of these
provisions. CONTRACTOR must document suspected or known harmful effects and the outcome.
K. CONTRACTOR’s Subcontractors
CONTRACTOR shall ensure that any of its contractors, including
subcontractors, if applicable, to whom CONTRACTOR provides PHI received from or created or
received by CONTRACTOR on behalf of COUNTY, agree to the same restrictions, safeguards, and
conditions that apply to CONTRACTOR with respect to such PHI and to incorporate, when
applicable, the relevant provisions of these provisions into each subcontract or sub-award to such
agents or subcontractors..
L. Employee Training and Discipline
CONTRACTOR shall train and use reasonable measures to ensure compliance
with the requirements of these provisions by employees who assist in the performance of functions or
activities on behalf of COUNTY under this Agreement and use or disclose PHI and discipline such
employees who intentionally violate any provisions of these provisions, including termination of
employment.
M. Termination for Cause
Upon COUNTY’s knowledge of a material breach of these provisions by
CONTRACTOR, COUNTY shall either:
1. Provide an opportunity for CONTRACTOR to cure the breach or end the
violation and terminate this Agreement if CONTRACTOR does not cure the breach or end the
violation within the time specified by COUNTY; or
2. Immediately terminate this Agreement if CONTRACTOR has breached a
material term of these provisions and cure is not possible.
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3. If neither cure nor termination is feasible, the COUNTY’s Privacy
Officer shall report the violation to the Secretary of the U.S. Department of Health and Human
Services.
N. Judicial or Administrative Proceedings
COUNTY may terminate this Agreement in accordance with the terms and
conditions of this Agreement as written hereinabove, if: (1) CONTRACTOR is found guilty in a
criminal proceeding for a violation of the HIPAA Privacy or Security Laws or the HITECH Act; or (2)
a finding or stipulation that the CONTRACTOR has violated a privacy or security standard or
requirement of the HITECH Act, HIPAA or other security or privacy laws in an administrative or civil
proceeding in which the CONTRACTOR is a party.
O. Effect of Termination
Upon termination or expiration of this Agreement for any reason,
CONTRACTOR shall return or destroy all PHI received from COUNTY (or created or received by
CONTRACTOR on behalf of COUNTY) that CONTRACTOR still maintains in any form, and shall
retain no copies of such PHI. If return or destruction of PHI is not feasible, it shall continue to extend
the protections of these provisions to such information, and limit further use of such PHI to those
purposes that make the return or destruction of such PHI infeasible. This provision shall apply to PHI
that is in the possession of subcontractors or agents, if applicable, of CONTRACTOR. If
CONTRACTOR destroys the PHI data, a certification of date and time of destruction shall be
provided to the COUNTY by CONTRACTOR.
P. Disclaimer
COUNTY makes no warranty or representation that compliance by
CONTRACTOR with these provisions, the HITECH Act, HIPAA or the HIPAA regulations will be
adequate or satisfactory for CONTRACTOR’s own purposes or that any information in
CONTRACTOR’s possession or control, or transmitted or received by CONTRACTOR, is or will be
secure from unauthorized access, viewing, use, disclosure, or breach. CONTRACTOR is solely
responsible for all decisions made by CONTRACTOR regarding the safeguarding of PHI.
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Q. Amendment
The parties acknowledge that Federal and State laws relating to electronic data
security and privacy are rapidly evolving and that amendment of these provisions may be required to
provide for procedures to ensure compliance with such developments. The parties specifically agree
to take such action as is necessary to amend this agreement in order to implement the standards and
requirements of HIPAA, the HIPAA regulations, the HITECH Act and other applicable laws relating
to the security or privacy of PHI. COUNTY may terminate this Agreement upon thirty (30) days
written notice in the event that CONTRACTOR does not enter into an amendment providing
assurances regarding the safeguarding of PHI that COUNTY in its sole discretion, deems sufficient to
satisfy the standards and requirements of HIPAA, the HIPAA regulations and the HITECH Act.
R. No Third-Party Beneficiaries
Nothing express or implied in the terms and conditions of these provisions is
intended to confer, nor shall anything herein confer, upon any person other than COUNTY or
CONTRACTOR and their respective successors or assignees, any rights, remedies, obligations or
liabilities whatsoever.
S. Interpretation
The terms and conditions in these provisions shall be interpreted as broadly as
necessary to implement and comply with HIPAA, the HIPAA regulations and applicable State laws.
The parties agree that any ambiguity in the terms and conditions of these provisions shall be resolved
in favor of a meaning that complies and is consistent with HlPAA and the HIPAA regulations.
T. Regulatory References
A reference in the terms and conditions of these provisions to a section in the
HIPAA regulations means the section as in effect or as amended.
U. Survival
The respective rights and obligations of CONTRACTOR as stated in this Section
shall survive the termination or expiration of this Agreement.
V. No Waiver of Obligations
No change, waiver or discharge of any liability or obligation hereunder on any
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one or more occasions shall be deemed a waiver of performance of any continuing or other obligation,
or shall prohibit enforcement of any obligation on any other occasion.
12. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of
race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
sexual orientation, or military or veteran status pursuant to all applicable State of California and
Federal statutes and regulations.
13. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a
for-profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR
changes its status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this agreement. A self-dealing transaction shall mean a transaction to which the
CONTRACTOR is a party and in which one or more of its directors has a material financial interest.
Members of the Board of Directors shall disclose any self-dealing transactions that they are a party to
by completing and signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit C
and incorporated herein by reference, and submitting it to the COUNTY prior to commencing with the
self-dealing transaction or immediately thereafter.
14. AUDITS AND INSPECTIONS
CONTRACTOR shall at any time during business hours, and as often as the COUNTY
may deem necessary, make available to the COUNTY for examination all of its records and data with
respect to the matters covered by this Agreement. CONTRACTOR shall, upon request by the
COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to ensure
CONTRACTOR's compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
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CONTRACTOR shall be subject to the examination and audit of the State Auditor for a period of
three (3) years after final payment under contract (Government Code Section 8546.7).
CONTRACTOR agrees to maintain and preserve, until three (3) years after termination
of this Agreement and final payment from DHCS to the COUNTY, to permit DHCS or any duly
authorized representative, to have access to, examine or audit any pertinent books, documents, papers
and records related to this Agreement and to allow interviews of any employees who might reasonably
have information related to such records.
15. NOTICES
The persons and their addresses having authority to give and receive notices under this
Agreement include the following:
COUNTY CONTRACTOR
Director, County of Fresno Operations Director
Department of Public Health Reading and Beyond
P.O. Box 11867 4670 E Butler Ave
Fresno, CA 93775 Fresno, CA 93702
Any and all notices between the COUNTY and the CONTRACTOR provided for or
permitted under this Agreement or by law shall be in writing and shall be deemed duly served when
personally delivered to one of the parties, or in lieu of such personal service, when deposited in the
United States Mail, postage prepaid, addressed to such party.
16. GOVERNING LAW
The parties agree, that for the purposes of venue, performance under this Agreement is
to be in Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
17. SEVERABILITY
The provisions of this Agreement are severable. The invalidity or unenforceability of
any one provision in the Agreement shall not affect the other provisions.
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18. ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire agreement between the
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understanding of any nature whatsoever unless expressly included in this Agreement.
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12345678910111213141516171819202122232425262728APPROVEDASTOLEGALFORM:DANIELC.CEDERBORG,COUNTYCOUNSELv—2CAPPROVEDASTOACCOUNTINGFORM:OSCARJ.GARCIA,C.P.A.,AUDITOR-CONTROLLER/TREASURER-TAXCOLLECTORByCLLL-?.L*XJy.REVIEWEDANDRECOMMENDEDFORAPPROVAL:ByDavidPomavilleDirectorDepartmentofPublicHealthFund/Subclass:0001/10000Organization:56201602($4,936,865)Account//:729519-COUNTYOl*I'ltESNOI'tvsno,CA
Exhibit A
Page 1 of 5
Scope of Work
ORGANIZATION: Reading and Beyond
ADDRESS: 4670 East Butler Avenue, Fresno, CA 93702
CONTACT: Cesar Lucio, (559) 342-8600
SERVICES: Administrative and Staffing Services
CONTRACT PERIOD July 1, 2017 through December 31, 2017 ($719,840)
AND AMOUNTS: January 1, 2018 through December 31, 2018 ($1,310,248)
January 1, 2019 through December 31, 2019 ($1,404,134)
January 1, 2020 through December 31, 2020 ($1,502,643)
SUMMARY OF SERVICES
Reading and Beyond (RaB) shall provide administrative and staffing services during the term of this
Agreement. The term “administrative and staffing services” shall include, but is not limited to,
providing office space for a maximum of twenty (20) employees as well as associated work related
equipment, supplies, and furniture (i.e., desks, chairs, computers, printers, copiers/fax machines,
paper, etc.). RaB shall also be responsible for the recruitment, monitoring, and evaluation of said
employees that will fall under the classification of Outreach Health Educator (15 Employees),
Provider Relations Coordinator (2 Employees), Project Coordinators (2 Employees), and Program
Director (1 Employee). RaB shall also be responsible for submitting monthly performance reports
and invoices to the Department as well as participating in the Fresno LDPP Dental Health Advisory
Committee (Fresno LDPP-DHAC).
TARGET POPULATION
Fresno County residents between the ages of 0-20 that are recipients of, or are eligible to receive,
Denti-Cal benefits with a focused effort in the Zip Codes of 93701, 93702, and 93722. Dentists in
our community will be targeted and encouraged to participate as a Denti-Cal provider and to
participate in the Dental Transformation Initiative – Domain 3; Continuity of Care Pilot Program.
CONTRACTOR RESPONSIBILITIES
RaB shall provide administrative and staffing services needed to conduct the Department’s Local
Dental Pilot Project (LDPP). The following list is meant to serve as samples of the duties and
responsibilities to be performed by RaB and is neither inclusive nor exclusive, but indicative of
several general types of duties to be performed.
RaB shall provide the following services:
1. Staff Recruitment
• Outreach Health Educators:
Exhibit A
Page 2 of 5
RaB shall perform the duties required to recruit and hire twelve (12) Full Time
Employee (FTE) “Outreach Health Educators” within the first sixty (60) days of
the term of this Agreement with the addition of one (1) “Outreach Health
Educator” within the first sixty (60) days of each consecutive year of the term of
this Agreement for a total of fifteen (15).
• Provider Relations Representative:
RaB shall perform the duties required to recruit and hire two (2) FTE “Provider
Relations Representative” within the first sixty (60) days of the term of this
Agreement.
• Project Coordinators:
RaB shall perform the duties required to recruit and hire two (2) FTE “Project
Coordinators” within the first sixty (60) days of the term of this Agreement.
• Program Director:
RaB shall perform the duties required to recruit and hire one (1) 0.5 FTE
“Program Director” within the first sixty (60) days of the term of this Agreement.
2. Office Space, Equipment, Supplies, and Furniture
RaB shall provide adequate office space for the above mentioned staff and any needed
equipment, supplies, or furniture associated with the work performance of recruited staff
as detailed in the Performance Measurements table listed below. RaB shall also provide
space and host the Virtual Dental Home on-site dental teams.
3. Participation in the Fresno LDPP Dental Health Advisory Committee (Fresno LDPP-DHAC)
RaB shall participate in a monthly Advisory Committee meeting during the first year of the
agreement term. Thereafter, the Advisory Committee meeting will be held bi-monthly for
the remainder of the agreement. The purpose of the Fresno LDPP-DHAC meetings will be
to review project objective activity reports and organizational overview of operational
issues such as staffing levels, training, activity, and financial reports.
STAFF RESPONSIBILITIES
1. Outreach Health Educators (OHE)
The OHE’s shall be responsible for providing the following services to families of the target
population in the languages of English, Spanish, and Hmong in a culturally appropriate
manner. The following list is meant to serve as samples of the duties and responsibilities to
be performed by OHE’s and is neither inclusive nor exclusive, but indicative of several
general types of duties to be performed:
• Education to improve oral health literacy;
o Guidelines on dental periodicity schedule, preventive dental services,
anticipatory guidance/counseling and oral treatment for infants, children and
adolescents;
Exhibit A
Page 3 of 5
• Provide a variety of materials for participants to take home, including informational
pamphlets on several oral health topics (also available in Spanish), stickers,
toothbrushes, toothpaste, dental floss, mouth mirrors, and two-minute timers;
• Contacting the family and ensuring that they have secured a dentist and if they have
not secured a provider then they will assist in the identification of a dentist or dental
care center
• Assist with the initial appointment setting;
• Provide patient support in assisting them in arriving at their scheduled dental
appointments including transportation and will provide referrals to those families
expressing additional social or economic hardships utilizing the following tools;
o The Directory of Community Resources created by The Family Resource
Center, affiliated with the Fresno County Department of Social Services, and
the 2-1-1 Fresno County Information and Referral Helpline will help connect
consumers with agencies and/or organizations that can provide assistance;
• Track client contact and provide patient reports on the number of appointments
scheduled and the efforts made to remind patients of their appointments;
• Coordination of oral health services across multiple providers;
o Dental Hygienist, Mobile Dental Vans, Registered Dental Hygienist in
Alternative Practice and Dentists;
• Request authorization to send the family text reminders of appointments set for
each of the children;
• Contact the family 24 hours after the scheduled visit;
• Contact dentist office to determine if the efforts to educate and support the
patient/family resulted in a kept appointment (level of success);
• Determine why the appointment was not kept and assist in rescheduling;
• Address any rescheduling assistance or follow-up appointments that might be
necessary; and
• On a quarterly basis, families will be sent invitations to attend healthcare fairs where
they will be provided new toothbrushes, toothpaste calendars, etc. and can be
entered into drawings to win oral health products.
2. Provider Relations Representative (PRR)
The PRR’s shall be responsible for providing the following services to dentists that are
serving the communities of the target population. The following list is meant to serve as
samples of the duties and responsibilities to be performed by PRR’s and is neither inclusive
nor exclusive, but indicative of several general types of duties to be performed:
• Educate current Denti-Cal dentists on the Dental Transformation Initiative;
• Encourage Denti-Cal dentists to become eligible for Domain 3;
• Learn the obstacles of current Denti-Cal Dentists who are not accepting new
patients and explain how our Outreach Health Educators might be of assistance (i.e.
reduction in no-show rates and care coordination);
• Outreach to Dentists who are not Denti-Cal providers to encourage them, through
education and support, to enroll in Denti-Cal;
• Conduct Dental Provider Surveys to learn the obstacles in engaging dental
providers in Denti-Cal.
Exhibit A
Page 4 of 5
3.Project Coordinators
The Project Coordinators shall be responsible for coordinating all activities with the Project
Director on program implementation and administration of project plan. Project
Coordinators shall also oversee day to day activities of Outreach Health Educators while
providing information and education to ensure implementation of work plan activities.
Oversees day to day activities of Outreach Health Educators and provide assistance in
problem solving and goal setting to meet high quality standards.
4.Program Director
The Program Director shall oversee and coordinate all activities with collaborative partners
and stakeholders. The Program Director shall also provide direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget
adherence and program outcomes.
PERFORMANCE MEASUREMENTS
RaB shall track and maintain records on the performance of staff. RaB shall provide said records at
the Department’s request for review. Outreach Health Educators (OHE) staff will each be
responsible for an active caseload of approximately 1,000 individuals ages 0-20 (500 families).
Provider Relations Representative (PRR) will be responsible for engaging with Dentists in Fresno
County.
EXPECTED LEVEL OF
PERFORMANCE
JUL 1, 2017-
DEC 31, 2017
JAN 1, 2018 –
DEC 31, 2018
JAN 1, 2019 –
DEC 31, 2019
JAN 1, 2020 –
DEC 31, 2020
Performance Measure 1:
OHE’s will contact and provide
oral dental health materials to
the target population
90% of OHE’s current
caseload will have
knowledge and
awareness of oral
health dental care
90% of OHE’s current
caseload will have
knowledge and
awareness of oral
health dental care
90% of OHE’s current
caseload will have
knowledge and
awareness of oral
health dental care
90% of OHE’s current
caseload will have
knowledge and
awareness of oral
health dental care
Performance Measure 2:
OHE’s will refer targeted
population to Denti-Cal
providers and ensure
scheduling* of their initial
appointments and;
50% of the families in the OHE’s
caseload that have never seen a
dentist will receive dental care
*includes rescheduling of
missed appointments
25% of applicable OHE
targeted population
will be referred to
Denti-Cal providers
and ensure scheduling
of their initial
appointments
25% of applicable OHE
targeted population
will be referred to
Denti-Cal providers and
ensure scheduling of
their initial
appointments
50% of applicable OHE
targeted population
will be referred to
Denti-Cal providers and
ensure scheduling of
their initial
appointments
80% of applicable OHE
targeted population
will be referred to
Denti-Cal providers and
ensure scheduling of
their initial
appointments
Expected Outcome:
80% of the OHE’s
caseload that have
never seen a dentist
will receive dental care
Expected Outcome:
80% of the OHE’s
caseload that have
never seen a dentist
will receive dental care
Expected Outcome:
80% of the OHE’s
caseload that have
never seen a dentist
will receive dental care
Expected Outcome:
80% of the OHE’s
caseload that have
never seen a dentist
will receive dental care
Performance Measure 3:
OHE’s will ensure scheduling* of
their caseloads continuity of
care appointments
and;
Applicable clients in the OHE’s
caseload will receive continuity
of care.*includes rescheduling
of missed appointments
95% of OHE’s current
caseload will have
continuity of care
appointments
95% of OHE’s current
caseload will have
continuity of care
appointments
95% of OHE’s current
caseload will have
continuity of care
appointments
95% of OHE’s current
caseload will have
continuity of care
appointments
70% of all Domain 1
clients in the LDPP will
receive Domain 3
70% of all Domain 1
clients in the LDPP will
receive Domain 3
70% of all Domain 1
clients in the LDPP will
receive Domain 3
70% of all Domain 1
clients in the LDPP will
receive Domain 3
Exhibit A
Page 5 of 5
EXPECTED LEVEL OF
PERFORMANCE
JUL 1, 2017-
DEC 31, 2017
JAN 1, 2018 –
DEC 31, 2018
JAN 1, 2019 –
DEC 31, 2019
JAN 1, 2020 –
DEC 31, 2020
Performance Measure 4:
PRR’s will contact existing Denti-
Cal Providers
90% of assigned Denti-
Cal providers will
receive information on
the Fresno LDPP and
Domain 3: Continuity
of Care
100% of all newly
identified and assigned
Denti-Cal providers will
receive information on
the Fresno LDPP and
Domain 3: Continuity
of Care
100% of all newly
identified and assigned
Denti-Cal providers will
receive information on
the Fresno LDPP and
Domain 3: Continuity
of Care
100% of all newly
identified and assigned
Denti-Cal providers will
receive information on
the Fresno LDPP and
Domain 3: Continuity
of Care
Performance Measure 5:
PRR’s will schedule
appointments with Denti-Cal
providers for an in-service on
DTI Domain 3 Continuity of Care
and the Fresno LDPP
PRR’s will attempt to
schedule appointments
with assigned Denti-
Cal providers for an in-
service on DTI Domain
3 and the Fresno LDPP
PRR’s will attempt to
schedule appointments
with assigned Denti-
Cal providers for an in-
service on DTI Domain
3 and the Fresno LDPP
PRR’s will attempt to
schedule appointments
with assigned Denti-
Cal providers for an in-
service on DTI Domain
3 and the Fresno LDPP
PRR’s will attempt to
schedule appointments
with assigned Denti-
Cal providers for an in-
service on DTI Domain
3 and the Fresno LDPP
Expected Outcome:
70% of assigned Denti-
Cal providers will
receive the in-service
Expected Outcome:
95% of assigned Denti-
Cal providers will
receive the in-service
Expected Outcome:
95% of assigned Denti-
Cal providers will
receive the in-service
Expected Outcome:
95% of assigned Denti-
Cal providers will
receive the in-service
Performance Measure 6:
PRR will successfully engage
with Denti-Cal Providers who
will agree to accept new
patients.
PRR’s will attempt to
successfully engage
with 50% of assigned
Denti-Cal Providers
who will agree to
accept new patients.
PRR’s will attempt to
successfully engage
with 95% of assigned
and remaining Denti-
Cal Providers who will
agree to accept new
patients.
PRR’s will attempt to
successfully engage
with 95% of assigned
and remaining Denti-
Cal Providers who will
agree to accept new
patients.
PRR’s will attempt to
successfully engage
with 95% of assigned
and remaining Denti-
Cal Providers who will
agree to accept new
patients.
Expected Outcome:
70% of the Denti-Cal
Providers will agree to
accept new Denti-Cal
patients
Expected Outcome:
70% of the Denti-Cal
Providers will agree to
accept new Denti-Cal
patients
Expected Outcome:
70% of the Denti-Cal
Providers will agree to
accept new Denti-Cal
patients
Expected Outcome:
70% of the Denti-Cal
Providers will agree to
accept new Denti-Cal
patients
Performance Measure 7:
Licensed dentists not enrolled in
Denti-Cal will be contacted
(through multiple avenues and
attempts) to promote and
encourage their participation in
Denti-Cal
PRR’s will attempt to
engage with 50% of
assigned Dentists.
PRR’s will attempt to
engage with 50% of
assigned and
remaining Dentists.
PRR’s will attempt to
engage with 95% of
assigned and
remaining Dentists.
PRR’s will attempt to
engage with 95% of
assigned and
remaining Dentists.
Performance Measure 8:
Licensed dentists will have
scheduled appointments for
training on Denti-Cal enrollment
requirements and in
participating in Domain 3.
PRR’s will scheduled
appointments for 100%
of dentists interested
in training on Denti-Cal
enrollment
PRR’s will scheduled
appointments for 100%
of dentists interested
in training on Denti-Cal
enrollment
PRR’s will scheduled
appointments for 100%
of dentists interested
in training on Denti-Cal
enrollment
PRR’s will scheduled
appointments for 100%
of dentists interested
in training on Denti-Cal
enrollment
Exhibit B
Page 1 of 9
ORGANIZATION:Reading and Beyond
SERVICES:Administrative and Staffing Services
CONTRACT PERIOD:July 1, 2017 through December 31, 2020
CONTRACT AMOUNT:
BUDGET CATEGORIES 2017 2018 2019 2020
SALARIES & BENEFITS
Salaries 342,500$ 741,600$ 800,980$ 863,255$
Fringe Benefits 116,450$ 252,144$ 272,333$ 293,507$
458,950$ 993,744$ 1,073,313$ 1,156,762$
OPERATING EXPENSES
Facility Rental 34,650$ 71,379$ 73,520$ 75,725$
Office Supplies 10,800$ 10,800$ 10,800$ 10,800$
Communications 29,200$ 24,050$ 24,350$ 24,750$
Printer/Copier 5,200$ -$ -$ -$
Projectors and TV Monitors 2,925$ -$ -$ -$
Program Supplies 18,600$ 18,600$ 18,600$ 18,600$
Office Furniture 33,000$ -$ -$ -$
134,375$ 124,829$ 127,270$ 129,875$
EQUIPMENT
VOIP Telephone System 18,500$ -$ -$ -$
Laptops 16,575$ 975$ 975$ 975$
35,075$ 975$ 975$ 975$
TRAVEL
Milage 19,440$ 38,880$ 38,880$ 38,880$
19,440$ 38,880$ 38,880$ 38,880$
OTHER COSTS
Training 3,500$ 3,500$ 3,500$ 3,500$
3,500$ 3,500$ 3,500$ 3,500$
INDIRECT COSTS
Indirect Costs 68,500$ 148,320$ 160,196$ 172,651$
68,500$ 148,320$ 160,196$ 172,651$
TOTAL 719,840$ 1,310,248$ 1,404,134$ 1,502,643$
BUDGET SUMMARY
CY 2017 - 2020
Page 1 of 1
$4,936,865
Exhibit B
Page 2 of 9
ORGANIZATION:Reading and Beyond
SERVICES:Administrative and Staffing Services
CONTRACT PERIOD:July 1, 2017 through December 31, 2017
CONTRACT AMOUNT:
SALRIES & BENEFITS
Position/Title No. of
Positions FTE Total Cost
Program Director 1 0.5 22,500$
Project Coordinator 2 1 60,000$
Provider Relations Coordinator 2 1 50,000$
Outreach Health Educator 12 1 210,000$
Total Salary 342,500$
Fringe Benefits (34%)116,450$
Total Personnel 458,950$
OPERATING EXPENSES
Facility Rental 34,650$
(Office space rent for for staff)
Office Supplies 10,800$
(Copy paper, Pens, Pencils, Note Pads, Ink, Toner, Folders, Desk Trays,
Binders, Extention Cords, etc)
Communications 29,200$
(Landlines, Cellphones, Internet, Servers, etc.)
Printer/Copier 5,200$
(Purchase and servicing of Printer(s), Scanner(s), Copier(s), and
related materials needed to operate equipment)
Projectors and TV Monitors 2,925$
(Projection and monitor equipment and related materials needed to
operate equipment)
Program Supplies 18,600$
(General and consumable supplies needed for outreach, recruitment
and retention of clients/dentists; meeting/training supplies, etc.)
Office Furniture 33,000$
(Desks, Cabinets, Chairs (Office/Guests), Tables, Shelves, White Boards, etc)
Total Operating Expenses 134,375$
BUDGET DETAIL
JULY 1, 2017 - DECEMBER 31, 2017
Page 1 of 2
$719,840
Exhibit B
Page 3 of 9
ORGANIZATION:Reading and Beyond
SERVICES:Administrative and Staffing Services
CONTRACT PERIOD:July 1, 2017 through December 31, 2017
CONTRACT AMOUNT:
EQUIPMENT Total Cost
VOIP Telephone System 18,500$
(Installation, Equipment, Service Fees, etc.)
Laptops 16,575$
(Installation, Equipment, Service Fees, etc.)
Total Equipment Expense 35,075$
TRAVEL
Mileage 19,440$
(Gas Milage Reimbursement at Standard CalHR Rate Only)
Total Travel Expense 19,440$
OTHER COSTS
Training 3,500$
(Training and conference fees required to implement project)
Total Other Costs 3,500$
INDIRECT COSTS
Indirect Costs 68,500$
(20% of Personnel Cost)
Total Indirect Costs 68,500$
Total Costs for Contract Term July 1, 2017 through December 31, 2017 719,840$
BUDGET DETAIL
JULY 1, 2017 - DECEMBER 31, 2017
Page 2 of 2
$719,840
Exhibit B
Page 4 of 9
ORGANIZATION:Reading and Beyond
SERVICES:Administrative and Staffing Services
CONTRACT PERIOD:January 1, 2018 through December 31, 2018
CONTRACT AMOUNT:
SALRIES & BENEFITS
Position/Title No. of
Positions FTE Total Cost
Program Director 1 0.5 46,350$
Project Coordinator 2 1 123,600$
Provider Relations Coordinator 2 1 103,000$
Outreach Health Educator 13 1 468,650$
Total Salary 741,600$
Fringe Benefits (34%)252,144$
Total Personnel 993,744$
OPERATING EXPENSES
Facility Rental 71,379$
(Office space rent for for staff)
Office Supplies 10,800$
(Copy paper, Pens, Pencils, Note Pads, Ink, Toner, Folders, Desk Trays,
Binders, Extention Cords, etc)
Communications 24,050$
(Landlines, Cellphones, Internet, Servers, etc.)
Program Supplies 18,600$
(General and consumable supplies needed for outreach, recruitment
and retention of clients/dentists; meeting/training supplies, etc.)
Office Furniture -$
(Desks, Cabinets, Chairs (Office/Guests), Tables, Shelves, White Boards, etc)
Total Operating Expenses 124,829$
BUDGET DETAIL
January 1, 2018 - DECEMBER 31, 2018
Page 1 of 2
$1,310,248
Exhibit B
Page 5 of 9
ORGANIZATION:Reading and Beyond
SERVICES:Administrative and Staffing Services
CONTRACT PERIOD:January 1, 2018 through December 31, 2018
CONTRACT AMOUNT:
EQUIPMENT Total Cost
Laptops 975$
(Installation, Equipment, Service Fees, etc.)
Total Equipment Expense 975$
TRAVEL
Mileage 38,880$
(Gas Milage Reimbursement at Standard CalHR Rate Only)
Total Travel Expense 38,880$
OTHER COSTS
Training 3,500$
(Training and conference fees required to implement project)
Total Other Costs 3,500$
INDIRECT COSTS
Indirect Costs 148,320$
(20% of Personnel Cost)
Total Indirect Costs 148,320$
Total Costs for Contract Term January 1, 2018 through December 31, 2018 1,310,248$
BUDGET DETAIL
January 1, 2018 - DECEMBER 31, 2018
Page 2 of 2
$1,310,248
Exhibit B
Page 6 of 9
ORGANIZATION:Reading and Beyond
SERVICES:Administrative and Staffing Services
CONTRACT PERIOD:January 1, 2019 through December 31, 2019
CONTRACT AMOUNT:
SALRIES & BENEFITS
Position/Title No. of
Positions FTE Total Cost
Program Director 1 0.5 47,741$
Project Coordinator 2 1 127,308$
Provider Relations Coordinator 2 1 106,090$
Outreach Health Educator 14 1 519,841$
Total Salary 800,980$
Fringe Benefits (34%)272,333$
Total Personnel 1,073,313$
OPERATING EXPENSES
Facility Rental 73,520$
(Office space rent for for staff)
Office Supplies 10,800$
(Copy paper, Pens, Pencils, Note Pads, Ink, Toner, Folders, Desk Trays,
Binders, Extention Cords, etc)
Communications 24,350$
(Landlines, Cellphones, Internet, Servers, etc.)
Program Supplies 18,600$
(General and consumable supplies needed for outreach, recruitment
and retention of clients/dentists; meeting/training supplies, etc.)
Office Furniture -$
(Desks, Cabinets, Chairs (Office/Guests), Tables, Shelves, White Boards, etc)
Total Operating Expenses 127,270$
BUDGET DETAIL
January 1, 2019 - DECEMBER 31, 2019
Page 1 of 2
$1,404,134
Exhibit B
Page 7 of 9
ORGANIZATION:Reading and Beyond
SERVICES:Administrative and Staffing Services
CONTRACT PERIOD:January 1, 2019 through December 31, 2019
CONTRACT AMOUNT:
EQUIPMENT Total Cost
Laptops 975$
(Installation, Equipment, Service Fees, etc.)
Total Equipment Expense 975$
TRAVEL
Mileage 38,880$
(Gas Milage Reimbursement at Standard CalHR Rate Only)
Total Travel Expense 38,880$
OTHER COSTS
Training 3,500$
(Training and conference fees required to implement project)
Total Other Costs 3,500$
INDIRECT COSTS
Indirect Costs 160,196$
(20% of Personnel Cost)
Total Indirect Costs 160,196$
Total Costs for Contract Term January 1, 2019 through December 31, 2019 1,404,134$
BUDGET DETAIL
January 1, 2019 - DECEMBER 31, 2019
Page 2 of 2
$1,404,134
Exhibit B
Page 8 of 9
ORGANIZATION:Reading and Beyond
SERVICES:Administrative and Staffing Services
CONTRACT PERIOD:January 1, 2020 through December 31, 2020
CONTRACT AMOUNT:
SALRIES & BENEFITS
Position/Title No. of
Positions FTE Total Cost
Program Director 1 0.5 49,173$
Project Coordinator 2 1 131,127$
Provider Relations Coordinator 2 1 109,273$
Outreach Health Educator 15 1 573,682$
Total Salary 863,255$
Fringe Benefits (34%)293,507$
Total Personnel 1,156,762$
OPERATING EXPENSES
Facility Rental 75,725$
(Office space rent for for staff)
Office Supplies 10,800$
(Copy paper, Pens, Pencils, Note Pads, Ink, Toner, Folders, Desk Trays,
Binders, Extention Cords, etc)
Communications 24,750$
(Landlines, Cellphones, Internet, Servers, etc.)
Program Supplies 18,600$
(General and consumable supplies needed for outreach, recruitment
and retention of clients/dentists; meeting/training supplies, etc.)
Office Furniture -$
(Desks, Cabinets, Chairs (Office/Guests), Tables, Shelves, White Boards, etc)
Total Operating Expenses 129,875$
$1,502,643
BUDGET DETAIL
January 1, 2020 - DECEMBER 31, 2020
Page 1 of 2
Exhibit B
Page 9 of 9
ORGANIZATION:Reading and Beyond
SERVICES:Administrative and Staffing Services
CONTRACT PERIOD:January 1, 2020 through December 31, 2020
CONTRACT AMOUNT:
EQUIPMENT Total Cost
Laptops 975$
(Installation, Equipment, Service Fees, etc.)
Total Equipment Expense 975$
TRAVEL
Mileage 38,880$
(Gas Milage Reimbursement at Standard CalHR Rate Only)
Total Travel Expense 38,880$
OTHER COSTS
Training 3,500$
(Training and conference fees required to implement project)
Total Other Costs 3,500$
INDIRECT COSTS
Indirect Costs 172,651$
(20% of Personnel Cost)
Total Indirect Costs 172,651$
Total Costs for Contract Term January 1, 2020 through December 31, 2020 1,502,643$
BUDGET DETAIL
January 1, 2019 - DECEMBER 31, 2020
Page 2 of 2
$1,502,643
Exhibit C
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”), members
of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must disclose any
self-dealing transactions that they are a party to while providing goods, performing services, or both
for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest.”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the Corporation has the transaction;
and
b. The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit C
Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date:
Medi-Cal 2020 Waiver,
Dental Transformation Initiative
County of Fresno ,– Department of Public Health
Local Dental Pilot Project
Exhibit D
LDPP County of Fresno Page 2
TABLE OF CONTENTS
Section Page
1.LDPP Lead Entity and Participating Entity Information
1.1 3
1.2 5
1.3 7
1.4 7
2.General Information and Target Population 11
3.Services, Interventions, Care Coordination and Data sharing
3.1 15
3.2 19
3.3 27
3.4 28
4.Progress Reports and Ongoing Monitoring
4.1 29
4.2 36
5.Financing
5.1 37
5.2 38
5.3 38
6.Attestation and Certification 40
7.Exhibit B Budget
APPENDICES
1.Letters of Support / Participation
LDPP County of Fresno Page 3
Section 1: LDPP Lead Entity and Participating Entity Information
EXECUTIVE SUMMARY
1.1
The DHCS California 1115 Waiver, Dental Transformation Initiative
The California Department of Health Care Services (DHCS) has announced the Center for
Medicare and Medicaid Services (CMS) approved 1115 Waiver renewal titled the “California Medi-
Cal 2020 Demonstration.” The demonstration includes $750 million in funding for a Dental
Transformation Initiative (DTI). The DTI is divided into four (4) “domains.” Domain 1, to increase
dental preventive services utilization for children; Domain 2, increase caries risk assessment and
disease management, Domain 3, increase continuity of care among Medi-Cal children. The first
three domains will take place in counties to be designated by DHCS and payments will go directly
to dentists in those counties based on performance measures. DHCS for the fourth domain, called
the “Local Dental Pilot Projects” (LDPPs) will accept applications for innovative approaches to
achieving the overall DTI goals.
The County of Fresno Department of Public Health (DPH) is submitting this innovative Dental
Transformation Initiative (DTI) – Local Dental Project Plan (LDPP-Domain 4) proposal and will
serve as the Lead Entity for the Project. The Fresno LDPP project plan will further two of the DTI
goals of 1. Increased preventive services utilization for children; and 3. Increased continuity of
care.
The DPH is prepared and has the experience to fulfill its role as the Lead Entity in the proposed
and innovative program that has been designed to meet the goals of the DTI. The proposed LDPP
for the Fresno County area, referred to in this proposal as the Fresno-LDPP, will add interventions
to increase oral health education and preventive and treatment participation. The goals, outcomes
and performance metrics included in the Fresno LDPP are consistent with and build upon the
performance metrics of the DTI and all possible efforts have been made to avoid redund ancy on
approaches taken in Domains 1 and3.
The innovative strategy we are proposing is to test a multidisciplinary outreach collaboration
among diverse providers and health teams with the focus on changing behavior addressing access
to care. Addressing pervasive and persistent disparities in Fresno County this strategy requires
multi-pronged preventive approach including coordinating data in oral health programs, oral health
education, patient engagement, self-management and goal setting guidance all employed
consistently over time in settings that will promote ongoing continuity of care. This strategy is
significantly different than the activities that are currently being utilized in the traditional dental
setting in Fresno County in which for children ages 0 -20 yrs 56% of services are restorative while
only 44% of services year to year are preventive. The numbers for 0 -5 are darker yet with nearly
80% of children 0-5 enrolled in Medi-Cal and according to California analysis less than 25% of this
age received preventive services. The specific innovation and strategies that will be tested
include; outreach, oral health education, dental provider relations/recruitment and
teledentistry/University of Pacific Virtual Dental Home. Participating Partner entities are a diverse
set of key local community partners, educational entities, Medi-Cal providers, and stakeholders
who have demonstrated community support and collaboration. The participating partners are
LDPP County of Fresno Page 4
experienced with our target population, and the social determinants of oral disease and improving
access to dental care. The target population will be Medi-Cal children 0-20 years old in Fresno
with a concentrated effort planned in area zip codes of 93701, 93702 and 93722. Domain 1 and 3
outcomes will be tracked and evaluated. The strategy proposed includes the Telehealth model of
Virtual Dental Home in which care is brought to the communities in which peopl e congregate.
Starting with the pre-birth we have the unique advantage with our participating partner Fresno
Economic Opportunities Commission (EOC) to have direct contact and interaction with pregnant
mothers at the teen pregnancy health centers, this con tinuity of care and collaboration of health
continues through birth and childhood at the EOC centers and at the Reading and Beyond Health
Services and Education (RAB-HSE at community and schools sites within our targeted and general
Fresno County population area.
The DPH is requesting $11,127,285 over a three year and six-month period to fund the innovative
Fresno LDPP with added interventions to improve oral health. The two largest components of the
budget are (a) personnel (to support oral health educa tion and provider relations), and (b)
teledentistry/University of Pacific (UOP) Virtual Dental Home (VDH). This budget does not include
Denti-Cal billable services that will be rendered through services of Registered Dental Hygienist
and by providers associated with the virtual dental home.
For the purposes of this proposal, Participating Partners are defined as those partners where a
budget is included in the Fresno LDPP requested budget. Stakeholders are those partners that
are intricately involved in the proposed interventions and strategies and whose services will be
supported by the proposed interventions.
DTI – LDPP Lead Entity
Fresno County Department of Public Health
Type of Entity
☒County ☐ County Entity1 ☐City and County
☐Tribe ☐Indian Health Program
☐UC or CSU Campus
☐Consortium of counties serving a region consisting of more than one
county
Contact
Person Brandon Heberer
Title
Fresno County Department of Public Health
Children’s Medical Services
Staff Analyst
Telephone
(559) 600-6521
Email Address
bheberer@co.fresno.ca.us
Mailing
Address
1221 Fulton Mall
Fresno, CA 93721
LDPP County of Fresno Page 5
1.2 Participating Entities
Noted below is a complete listing of Participating Partne rs/Entities in support of the Fresno County
LDPP
Organization Name
and Address
Description of
Organization
Contact Name, Title,
Telephone and Email Role in LDPP
1) Fresno County
Department of Social
Services
Local Government Delfino Neira
Department of Social Services
Director
(559) 600-2301
dneira@co.fresno.ca.us
Participating Partner
2) Fresno EOC
1920 Mariposa Mall
Fresno, CA 93721
Community
Organization
Brian Angus
Chief Executive Officer
(559) 263-1000
Brian.angus@fresnoeoc.org
Participating Partner;
Will employ LDPP
outreach health
educators and
provider relations
representatives
3) RAB-HSE
4670 E. Butler Ave
Fresno, Ca 93702
Community
Organization
Luis Santana, Executive Director,
(559) 342-8625,
LSantana@readingandbeyond.org
Participating Partner;
Will employ LDPP
outreach health
educators and
provider relations
representatives
4) Paul Glassman
DDS, MA, MBA
Professor of Dental
Practice Director
Pacific Center for
Special Care -
University of the
Pacific
Dr. Glassman
UOP VDH Project Director
(415) 929-6490
pglassman@pacific.edu
Participating Partner
5) Dr. Hilario
SNF Dental Care
4811 E. Olive Avenue
Fresno, CA 93727
Dentist Dr. Hilario
Dental Practice
(559) 225-5228
enhdds@gmail.com
Relevant
Stakeholder; In
support of Fresno
LDPP
6) Fresno Unified
School District
2309 Tulare St.
Fresno, CA 93721
Largest county
school district
Gail Williams; Director of Health
Services for Fresno,
(559) 457-3294,
Gail.Williams@fresnounified.
Relevant
Stakeholder;
facilitates
HealthySmiles mobile
units at school sites
7) Fresno Unified
School District
2309 Tulare St,
Fresno, CA 93721
Largest county
school district
Luis Chavez
School Board President
(559) 457-3727
Relevant
Stakeholder; In
support of Fresno
LDPP
8) Fresno County
Office of Education
1111 Van Ness Avenue
Fresno, CA 93721
County Office of
Education
Alma McKenry
Health Services Director
(559) (559) 265-3026
amckenry@fcoe.org
Relevant
Stakeholder; In
support of Fresno
LDPP
9) Rhoda Howell-
Gonzales 202 W. River
Ridge Avenue Fresno,
CA 93711
Registered Dental
Hygienist Alternative
Practice (RDHAP
Rhoda Gonzales-Howell
Private Practice RHDAP
(559) 960-2232
rhoda@deliveringsmiles.net
Participating Partner;
Denti-Cal provider
LDPP County of Fresno Page 6
Organization Name
and Address
Description of
Organization
Contact Name, Title,
Telephone and Email Role in LDPP
10) Judith Renee
Brown
923 La Jolla Avenue
Clovis, CA 93619
Registered Dental
Hygienist Alternative
Practice (RDHAP)
Judith Renee Brown
RDHAP
(559) 331-4879
z2thfare@yahoo.com
Participating Partner;
Denti-Cal provider
11) Central Valley
Health Policy Institute
1625 E. Shaw Ste#
146, Fresno, CA 93710
California State
University, Fresno
Marlene Bengiamin, PhD,
Research Director,
(559) 228-2167,
marleneb@csufresno.edu
Relevant Stakeholder
12) Healthy Smiles
Mobile Dental
1275 W Shaw Ave Ste
101, Fresno, CA 93711
Mobile Dental
Center
Suzan Kodama
Chief Executive Office
(559) 229‐6437
susan@healthysmiles.us
Participating Partner;
Denti-Cal provider,
Will coordinate with
Fresno LDPP for
case mgt. assistance
13) Fresno City Health
Center
1101 E. University Ave.
Fresno, CA 93741
Community College
Health Center
Lisa Chaney
Health Services Coordinator
(559) 442-8268
lisa.chaney@fresnocitycollege.edu
Relevant Stakeholder
14) Fresno City
College Department of
Dental Hygiene
1101 E. University Ave.
Fresno, CA 93741
Community College
Health Center
Joanne Pacheco
Academic Chair
(559) 244-2622
Joanne.pacheco@fresnocity
colleg.edu
Relevant Stakeholder
15) Assemblyman
Dr. Joaquin Arambula
P.O. Box 4469
Fresno, CA 93744
State Assemblyman,
31st District
Dr. Joaquin Arambula
Assemblyman
(559) 264-3131
Maria.Lemus@asm.ca.gov
Fresno LDPP
Supporter
16) Fresno Madera
Dental Society
371 E. Bullard Ste 120
Fresno, CA 93710
Regional Dental
Society
Merriam Osmondson
Executive Director
fmds@fmds.com
(559) 438-7284
Relevant Stakeholder
17) Representative Jim
Costa - Fresno Office
855 M Street, Suite 940
Fresno, CA 93721
U.S. Representative
16th congressional
district
Jim Costa
U.S. Representative
(559) 495-1620
Fresno LDPP
Supporter
18) Cradle to Career
5260 N Palm Ave, 122
Fresno, CA 93704
Community
Organization
Linda Gleason
Executive Director
(559)696-4095
linda@fresnoc2c.org
Relevant Stakeholder
19) City Council
Sal Quintero VP2600
Fresno St. Fresno CA
93721
Councilmember
District 5
Sal Quintero
Councilmember
(559) 490-5395
Relevant
Stakeholder;
20) Dr. Cheney
620 S. Fairbanks,
Sanger, CA 93657
Dentist Retired DDS
(559) 907-1305
Relevant
Stakeholder; In
support of Fresno
LDPP
LDPP County of Fresno Page 7
1.3 Letters of Participation/Support: See Appendices
Participating Partners/Entities
1) Fresno County Department of Social Services
2) Fresno EOC
3) RAB-HSE
4) University of the Pacific – School of Dentistry
5) Dr. Hilario – Virtual Dental Home participating dentist
6) Dr. Cheney – Virtual Dental Home participating dentist
Stakeholders
7) Fresno Unified School District – Health Services Director
8) Fresno Unified School District – School Board President
9) Fresno County Office of Education (FCOE)
10) Rhoda Howell-Gonzales; RDHAP
11) Renee Brown – RDHAP
12) Valley Health Policy Institute California State University, Fresno
13) Healthy Smiles Mobile Dental
14) Fresno City College – Health Center
15) Fresno City College – Department of Dental Hygiene
16) State Assemblyman Dr. Joaquin Arambula
17) Fresno-Madera Dental Society
18) U.S. Representative Jim Costa
19) Cradle to Career
20) Councilmember Sal Quintero
1.4 Collaboration Plan
The County of Fresno DPH’s core purpose is to promote, preserve and protect the well-being of
the community and to ensure the optimal health of the public. The mission of DPH is the
promotion, preservation and protection of the community’s health. This is accomplished through
identifying community health needs, assuring the availability of quality health services and
providing effective leadership in developing public health policies. DPH is committed to working in
partnership with its communities to eliminate health disparities.
Fresno EOC has the resources, experience, and established network of partnerships necessary to
successfully implement the proposed program. Fresno EOC, a nonprofit 501(c)(3) organization, is
Fresno County’s designated community action agency and is widely recognized as one of the
largest of its kind in the nation. Founded under the Federal Economic Opportunities Commission
Act of 1965, Fresno EOC has grown steadily over the last 51 years to meet the challenges of a
region beset by swelling population pressures and seemingly unabate d need, to become one of
the nation’s finest models for innovative, effective economic and community development. Fresno
EOC remains faithful, effective, and consistent with its mission to humanely focus all available
resources to empower low-income families and individuals working toward the skills, knowledge,
and motivation for self-sufficiency.
LDPP County of Fresno Page 8
Fresno EOC serves approximately 175,000 people each year through its various departments
providing a comprehensive array of services including health services with specialization in primary
care, family planning and reproductive health, pre -natal care, Women’s Infant and Children (WIC);
employment training; a full range of educational services, including two charter schools; a 45 -site
network of Head Start centers and school-age child care; a 150-unit transportation fleet for client
transit needs; the delivery of over 7,500 congregate and home -bound meals prepared in its own
food service center; homeless outreach, emergency and transitional housing; construction
rehabilitation for eligible low-income families; energy conservation and emergency assistance;
refugee services; and micro-enterprise, small business incubation and technical assistance. The
philosophy behind all of Fresno EOC’s programs reflects a commitment to providing quality
essential services to those in need. Fresno EOC has built a strong foundation of services that offer
support to people in all phases of life. Programs designed to meet the needs of youth are a major
focus part of Fresno EOC’s services.
For nearly two decades, the nonprofit organization RAB -HSE’s mission has been to empower
children and families to reach productive, self -reliant lives through cradle-to-career educational
programs for children and parents. Through their programs, they serve hundreds of children (0 -18)
and adults on a daily basis at their sites located at Community Centers, Schools and Churches
located in high need areas throughout Fresno County. RAB -HSE has a strong focus on zip codes
93701 and 93702 because their high l evel of poverty. Because their dual generation approach and
their long term commitment with the population they serve, they have built a close connection with
hundreds of families. They would use their connection with families they already have to expand
and reach out to other families insuring all children in those neighborhoods selected by them also
benefit from the LDPP program. Their existing partnerships with other community based
organizations, such as Boys & Girls Clubs, Catholic Charities, Community Food Bank and United
Way will open doors to access/leverage their connection with families who may qualify for this
program. Lastly, their staff of more than 200 employees has diverse backgrounds and are able to
speak English, Spanish, Hmong, Arabic, Russian, Portuguese as well as other languages and
dialects. They are confident as they team with EOC that they will be able to successfully reach and
engage children and families through the LDPP program.
The Pacific Center for Special Care at the UOP, Arthur A. Dugoni School of Dentistry is
demonstrating a new model of care ,by creating a VDH. The Pacific Center has experience
partnering with a number of funding organizations to implement this demonstration project to bring
much-needed oral health services to underserved populations. These populations range from
children in Head Start Preschools and elementary schools to older or disabled adults in residential
care settings or nursing homes.
DPH as the LDPP Lead Entity will fulfill its role of identifying participating entities to provide high
quality dental prevention services, caries risk assessment, disease management, and continuity of
care by contracting with the proposed partner agencies to evaluate performance outcomes,
facilitate periodic partner meetings, address performance shortcomings or need for staffing
augmentation or changes, and relay activity reports including any known cost avoidance by the
LDPP to the State.
LDPP County of Fresno Page 9
The Lead Entity will facilitate monthly meetings individually with each of the participating partners
in order to review performance metrics and measures, staffing levels, productivity, training
accountability, client and provider satisfaction, and the overall opportunity for improvement and
adherence to state pilot requirements. The L ead Entity will also facilitate the Advisory Board
meetings where these same metrics will be evaluated and discussed. The Advisory Board
meetings will be held initially on a monthly basis, after the first year the frequency would be
reduced to a bi-monthly with special sessions being called as required. In order to reduce possible
service silos the LDPP Lead Entity will ensure that each participating partner will be responsible for
conducting project team meetings with their respective staff concerning al l aspects of the project
including; performance metrics and measures, staffing levels, productivity, training accountability
and the overall opportunity for improvement and adherence to state pilot requirements.
Participating Partners will have autonomy in the operations of their LDPP roles within the
boundaries of the Projects goals and objectives and state pilot requirements and LDPP S pecial
Terms and Conditions (STCs). Should issues arise between or among the parties the Lead Entity
will be the determination member as they are ultimately responsible for the Project ’s success and
are required to enforce the project’s accountability measures.
The Fresno LDPP communication management plan includes the establishment of an Advisory
Board which is comprised of local governmental agencies, professional and community based
advocacy organizations, academic institutions and health agencies.
Communication is critical to the Fresno LDPP as it guides the messages to a project’s affected
stakeholders and ultimately th e consumers we seek to assist in improving their oral health. The
Fresno LDPP communication management plan includes the establishment of an Advisory Board
which is comprised of local governmental agencies, professional and community based advocacy
organizations, academic institutions and health agencies.
The Advisory Board will strategically inform, align, and leverage resources with the goal of
improving oral health in Fresno County. Membership will include; DPH, RAB-HSE, EOC, Fresno
Unified School District, Fresno City College, UOP, VDH Operating Partners (to be named once
subcontracting is completed), Fresno-Madera Dental Society, Cradle to Career (community
organization that works across sectors to strategically inform, align, and leverage resources
throughout Fresno County), Valley Health Policy Institute California State University, Fresno, and
two (2) consumers for a total membership of twelve (12). In addition, the voice of the dental
consumer and dental providers will be heard through surveys to inform project leadership.
Depicted in the table below is the management communication plan with workgroups expected to
be developed as the project moves forward in its implementation. Additionally a Kick-Off meeting is
planned once notification of award has been received. The overall purpose of the committees is to
increase knowledge about the project and why it is important, create a dialogue among
Participating Partners and Stakeholders and to provide opportunity for feedback from stakeholder
groups. Should an issue arise where consensus cannot be reached the Lead Entity will make the
final determination.
LDPP County of Fresno Page 10
PURPOSE FREQUENCY MEETING
SUMMARIES Facilitation
Fresno LDPP
Advisory Board
Review project objective activity
reports, organizational overview of
operational issues such as;
performance metrics and measures,
staffing levels, training, activity and
financial reports
Monthly during
the initial year
and thereafter
bi-monthly;
with special
sessions being
called as
required.
Assignment
will be rotated
among
membership
Fresno
LDPP
Administrator
EOC
Operational issues such as;
performance metrics and measures,
staffing levels, training, activity and
financial reports
Monthly Lead Entity
RAB-HSE
Operational issues such as;
performance metrics and measures,
staffing levels, training, activity and
financial reports
Monthly Lead Entity
VDH
(UOP and VDH
site Operators)
Operational issues such as;
performance metrics and measures,
staffing levels, training, activity and
financial reports
Monthly Lead Entity
In order to provide learnings for potential future local efforts beyond the term of this demonstration
our materials, lessons learned, reports and policy and procedures will be retained and available for
local future efforts through the Lead Entity (DPH) and the Advisory Board. The VDH may be
sustainable following the end of the pilot with the successful education of the Medi -Cal population.
The communication infrastructure anchored by the continuation of the Dental Health Advisory
Board would still possibly serve a role but it is unlikely that the pilot infrastructure would be able to
sustain itself in absence of Federal and State funding.
LDPP County of Fresno Page 11
Section 2: General Information and Target Population
2. Target Population-
General Information: County of Fresno – Project Area Information
Fresno County, located in the heart of California’s Central Valley, is one of the world’s most
productive agricultural areas yet is also among the nation’s most impoverished regions. Fresno
County is the 6th largest county in California (spanning 6,000 square miles) and contains 15
incorporated and 37 unincorporated cities. Referred to as the “Appalachia of the West,” Fresno
and the surrounding counties of the San Joaquin Valley are characterized by chronic
unemployment, high incidence of poverty, and low levels of educational attainment. Twenty -seven
percent of the 946,895 Fresno County residents live in poverty. Only 72.9% of Fresno County
residents have received a high school diploma, and just 18.8% have obtained a bachelor’s degree
or higher (Census, 2012). The county’s average 2015 unemployment rate of 10.18% compares to
a statewide 2015 average unemployment rate of 6.25% (U.S. Bureau of Labor Statistics 2015).
Years of potential life lost before age 75 (YPLL -75) is a measure used to reflect the impact of
premature mortality on a population. In 2007, the age-adjusted YPLL-75 rate per 100,000
population for all California residents was 5,641.7 years, which represented a decrease of 9.4
percent from the 2000 rate of 6,224.1 years. During this same time period the YPLL-75 rate for
Fresno County actually increased by .10% rather than decreased.
As described in the Measure of America’s “A Portrait of California 2014-15,” the state can be
categorized into five different Californias based upon the American Human Development (HD)
Index. Fresno County’s HD not only rates it as part of the “Struggling California” it is also the
county within this profile with the largest population.
Figure 1. California counties exhibiting
high-poverty (greater than 15%), high-
unemployment (greater than 8%), and
high CalFresh enrollment (greater than
90,000 cases).
DPI Siskiyou Modoc
ShastaHumboldtTrinity
Tehama Plumas
ButleMendocino StemGlenn
—•%Colusa *&Lake V.\Placer
El DoradoVolo AlpineSonomaNapa
Solano CafavefSan TuolumneContraJoaquin MonoSanFrancisc
Alameda Mariposa
San Mate o Santa
Clara Merced
BMH Cno
San Fresno
Benito Inyo
mrnmm mgs
San LuisObispo
San BernardinoSantaBarbara
Ventura Los Angoles
Riverside
ImperialSanDiego
KEY
|Greater than 20%poverty^15%to 20%poverty
High CalFresh Enrollment (over 100.000)
LDPP County of Fresno Page 12
FIVE CALIFORNIAS
Inequalities in health, education, and earnings divide California communities in ways that
challenge conventional North-South and inland-coastal divisions in the state. By using the HD
Index score to sort county, town, and neighborhood clusters, “Five Californias” have each been
identified with its own distinct well-being profile.
One Percent California consists of the two neighborhood clusters that score 9 or above out
of 10 on the HD Index; these neighborhoods are home to just under one in every one
hundred Californians.
Elite Enclave California is made up of neighborhood clusters that score between 7 and
8.99 on the Index; 15 percent of Californians are part of this group.
Main Street California comprises of neighborhood clusters that score between 5 and 6.99
and is home to 39 percent of Californians.
Struggling California is home to the largest share of the state’s population, 42 percent,
with these neighborhood clusters scoring between 3 and 4.99 on the Index.
Disenfranchised California comprises of neighborhood clusters that score below 3 on the
HD Index; this California is home to roughly 3 percent of the state’s population.
http://www.measureofamerica.org/california2014-15/
Dental Health Needs
Fresno County Denti-Cal dentists were selected as eligible to participate in the LDPP Domains 1
and 3 incentives. Fresno is listed as the fourth highest county out of 58 in the state of California
with nearly 50% of our total population enrolled in Medi -Cal and greater than 75% of children aged
0-5 in Medi-Cal according to the September 2015 report. Currently data shows that only 44% of 0 -
20 population return year after year for follow up dental preventive care in Fresno County. Our
Medi-Cal children 0-6 years old have been documented as having a high restorative procedure
rate of 46.23% in 2014-15, and a low preventive procedure rate of 53.77% being performed.
Additionally, per the Community Commons’ report of August 13, 2015, Fresno County dentists per
100,000 population is 55.7 vs. the California rate of 77.5 making it even more critical that the
limited number of providers in our area be encouraged to participate in Denti-Cal and through the
proposed support systems the goal is to educate these provid ers of the need in the community and
the potential that the DTI Domains 1 and 3, provides to their practice. There are approximately
813 active dentists licensed in Fresn o County per the Department of Consumer Affairs – Dental
Board of California and only 147 (18%) are Denti-Cal providers with only 87 (59%) of these
providers accepting new patients according to the DHCS report of Fee For Service providers in
Fresno County.
Conducted from February 2005 through April 2005, the Fresno County Smile Survey was part of
the statewide California Smile Survey in which 21,000 Kindergarten and 3rd grade students
received dental screenings at 186 elementary schools throughout California. The Fresno County
Smile Survey report included an additional data subset drawn fro m dental screenings of 1,473
Kindergarten and 3rd grade students from 18 elementary schools to provide a local “snapshot” of
the oral health status of children in Fresno County which is home to an ethnically diverse
LDPP County of Fresno Page 13
population, where Mexican-American children make up 47% of the population under 18 years of
age.
Key Findings:
• Sixty-five percent of Kindergarten and almost 80% of 3rd grade students have experienced
dental disease.
• Four out of ten children have untreated dental disease.
The Survey found that in Fresno County, 729 Kindergarten and 744 3rd grade students received a
dental screening. About half of the children screened were male (47%), 51% were Hispanic, 29%
were White, 11% were Asian, and 5% were African-American. More than 45% of the children
screened were from homes where parents speak a language other than English.
Target Population: The need for health services in Fresno County is extensive and well
documented. Dental caries, the disease that causes cavities, is an infectious, transmi ttable, but
preventable disease. By focusing on prevention, thousands of lost school days and millions of
dollars can be saved. The Fresno LDPP plans to target children 0 -20 years old with a concentrated
effort planned in the zip code areas of 93701, 93702 and 93722. The need for health services in
Fresno County is extensive and well documented. This targeted area for concentrated efforts was
selected to leverage prior community organizational commitments. In the spring of 2009, the City
of Fresno determined to assist the Lowell neighborhood (zip code 93701/02) which is part of the
mission of revitalizing downtown Fresno and the neighborhoods of poverty surrounding the
downtown corridor. The neighborhood area of zip code 93722 was selected, as it is home to the
Central Valley Regional Center who has long advocated for oral health services and who is in
support of the proposed VDH and other LDPP services.
Partners and Stakeholders will be leveraging their community programs and infrastructure to
engage consumers. This includes providing the work space required for staff to deliver oral care
prevention and education and oral hygiene treatment. The participating partner entities are a
diverse set of key local community partners, educational entities, Denti -Cal providers, and
stakeholders who have demonstrated community support and collaboration. The Fresno LDPP
proposal calls for oral health education engagement through quarterly health fairs. Families will be
issued multiple mailings including refrigerator magnets identifying the health fair dates. Our ability
to reach our Medi-Cal population is a result of our collaboration with the Department of Social
Services and their willingness to partner with us by facilitating the direct mailing of educational
items. Attendance will be incentivized through drawings for oral health related items including
dental care health baskets etc. aimed at behavior modification. Families will be served between
our two community-based entities; Fresno EOC, and RAB-HSE. Technology such as a cloud
based Access Database for caseload management and tracking, 1 -800 phone line for
communication (English/Spanish/Hmong), and text messaging will also be components of this
service area but the most important and effective aspect will be our well trained and culturally
competent staff. Activities will be made available during non -traditional hours to accommodate the
needs of our participants.
LDPP County of Fresno Page 14
Fresno County LDPP Goals and Outcomes to Improve DTI Domains 1 and 3
The Fresno LDPP meets the requirements outlined in STCs 106-108 in that there are specific
program performance metrics, oversight, monitoring and reporting incorporating into all three of the
proposed strategies with the goals, outcomes and performance metrics included in the Fresno
LDPP being consistent with, and build upon, the performance metrics of the DTI and all possible
efforts have been made to avoid redundancy on approaches taken in Domains 1 -3. Fresno County
LDPP will address Domains 1 and 3 through alternative programs, using strategies focused on
high poverty areas including local care coordination initiatives and education partnerships. We
have broad-based provider and community support and incentives related to goals and metrics that
contribute to the overall goals listed in the application for LDPP.
Fresno County Dental Transformation Initiative -Goal Summary
Domain 1 Domain 3
Percentage
Increase over
baseline
Additional Clients
Receiving
Services
Total Number of
Clients Receiving
Services
Percentage
Increase
over
baseline
Additional Clients
Receiving Continuity of
Care
Total Number of Eligible
Clients Receiving
Continuity of Care
Baseline 56 ,631 38,361
Year 1 (5 mo)3.27%1,854 58,485 3.17%1,216 39,577
Year 2 8 51%4,821 61,452 8.24%3,162 42,739
Year 3 12.84%7,269 63,900 8.88%3,405 46,143
Year 4 19.65%11,126 67,757 9.51%3,648 49,791
Number of
Health
Educators
Total LDPP
Family Caseload
Size
Individual Clients Domain 1
Domain 1
baseline
Increase for caseload
based on County 2014-
2015 Average
(25%/25%/35%/50%)
Percentage Increase
over the Domain 1
baseline
Year 1 (5 mo)24 12,000 24,000 6.199 1,854 3%
Year 2 26 13,000 26,000 6,716 4,821 9%
Year 3 28 14,000 28,000 7,232 7,269 13%
Year 4 30 15,000 30,000 7,749 11,126 20%
Number of
Health
Educators
Total LDPP
Family Caseload
Size
Individual Clients Domain 3
Domain 3
baseline
70%of all Domain 1
clients in the LDPP will
receive Domain 3
County Percentage
Increase over the
Domain 3 baseline
Year 1 (5 mo)24 12,000 24,000 4,169 1,216 3.17%
Year 2 26 13,000 26,000 4,517 3,162 8.24%
Year 3 28 14,000 28,000 4,864 3,405 8.88%
Year 4 30 15,000 30,000 5,211 3,648 9.51%
Baseline Key!
DOMAIN 1:2014-2015 Fiscal Average*
Q1 Q2 Q3 Q4 Averaqe
Eliqible Clients 206.439 214,193 220,820 226,091 216.886
Clients Seen 26,837 51.192 68,233 80,262 56,631
Percent Utilized 13.00%23.90%30.90%35.50%25.83%
'Average numbers are based on the Four Quarters from The Department of Health Care Services -Beneficiary Utilization Performance Report -Fee-For-Service -
Statewide by County -State Fiscal Year 2014-2015
DOMAIN 3:Based on DHCS -Fresno County Selection Data
County
Population Eliqible Count As a %Continuity of Care Count As a %
219,761 86,758 39.48%38.361 44.22%
LDPP County of Fresno Page 15
Section 3: Services, Interventions, Care Coordination and Data Sharing- 35 points
3.1 Services and Care Coordination:
The goal of the LDPP is to promote community based oral health programs and evidence -based
models of oral disease prevention through care coordination in the Fresno population. Care
coordination will be implemented by Fresno County DPH as the Lead entity in the LDPP. Fresno
County DPH will guide the partners and be responsible for overseeing the commun ity level team
process and will take the lead in multidisciplinary and cross -system/agency collaboration.
Implementing coordination of care with multi-disciplinary agencies will include assessments,
identifying barriers to oral health care, plan development and implementation, collaboration,
identification of child and family needs, communication, monitoring/measuring progress, collecting
data, reporting, and continuously evolving and evaluating from lessons learned. Partnerships with
a broad group of stakeholders who are committed and accountable for implementation improve our
coordination of care. Local relevant stakeholders supporting the LDPP common goal and
coordination of care in this partnership is the Fresno DPH, Fresno County Department of Social
Services, local Legislators, Fresno Unified School District, FCOE, Fresno Madera Dental Society,
Fresno City College, Fresno State, Anthem Blue Cross, Central Valley Health Policy Institute, UOP
VDH, as well as local doctors, dentists, and primary care clin ics. The responsibilities of the
participating entities are to bring a diverse unique set of resources as well as leveraging on the
existing presence of the participating entity in the community.
New infrastructure that will be taking place between the lea d and participating entities is training,
education, data collection, reporting, and collaboration with a VDH community care system. We will
leverage and connect existing community infrastructure by tapping into the resources of Head Start
and WIC using the existing office space and positive encounters to expand upon and include
additional oral prevention education and services .
The County of Fresno LDPP will increase oral health education, preventive and treatment
participation. The specific innovation and strategies that will be tested include; 1) outreach, oral
health education and care coordination services, 2) dental provider relations and recruitment
services and 3) teledentistry/UOP VDH services. The participating partner entities are a diverse set
of key local community partners, educational entities, Denti-Cal providers, and stakeholders who
have demonstrated community support and collaboration. The participating partners and
stakeholders are experienced with our target population , the social determinants of oral disease
and improving access to dental care. Partners and stakeholders will be leveraging their community
programs and infrastructure to engage consumers. This includes providing the workspace required
for staff to deliver oral care prevention education and oral hygiene treatment.
In lieu of incentivizing Continuity of Care, which may be difficult, to sustain the Fresno LDPP
proposal calls for oral health education engagement through quarterly health fairs. Families will be
issued multiple mailings including refrigerator magnets identifying the health fair dates. Attendance
will be incentivized through drawings for oral health related items including dental care health
baskets etc.
Correspondence will be sent through the Fresno County Department of Social Services who will
act as an intermediary for the dissemination of the Fresno LDPP marketing material while still
LDPP County of Fresno Page 16
securing the families’ confidentiality. We are proposing a media campaign that would consist of a
variety of elements including; television, radio and print. We will incorporate the Fresno LDPP in
Website/Social Media such as in the; Fresno County Website, DPH Facebook and Partner
websites and social media pages. Effectiveness of the media campaigns will be evaluated through
the collection of surveys completed by clients during intake. Based on client feedback, media
campaign will be adjusted for optimization.
The LDPP comprehensive plan is a three pronged approach involving Ca re Coordination, Dental
Provider Engagement, and Access to Care with Virtual Dental Home. The Fresno County
population will be served between our two community-based entities; Fresno EOC, and RAB-HSE.
Outreach Oral Health Educators will be performing care coordination consisting of motivational
interviewing (MI), partnering providers with clients and their families, ensuring the families are linked
to the appropriate community resources, communicating to improve the oral health literacy of the
child as well as the entire family. The development of educational materials will be a mixture of
existing and new but education alone will not be sufficient. To change behavior, our proposal also
includes hands on demonstration of oral hygiene and its correlation with healthy eating and overall
healthy lifestyle provided by staff that are culturally competent and experienced with the population.
We are also implementing a curriculum with a pre - and post-annual assessment to test if the
engagement has successfully established habits that will lead to a reduction in early childhood
caries and/or reduction in missing, decayed or filled teeth. Based upon what is learned from pre
and post assessments Public Service Announcement will be utilized to reach the largest number of
families leveraging our community in a multidisciplinary approach with tracking and following up to
link individual cases to an Outreach Oral Health Educator for continuity of care. The Provider
Relations Representatives will work extensively with dental providers while the Outreach Oral
Health Educator will be involved in the individual care coordination. Together, the synergistic
approach coupled with preventive services of fluoride varnish and sealants will enhance the
experience, thus improving the outcomes and reducing cost of care.
Outreach Oral Health Educators will facilitate communication among healthcare teams including
primary care, specialty care, inpatient, emergency department etc.
Current measures to recruit Denti-Cal providers in Fresno County have not been effective and
recruitment has trailed the state and national average. Per the Community Commons ’ report of
August 2016, the rate of dentists per 100,000 population in Fresno County is 55.7 vs. the California
rate of 77.5 making it even more critical that the limited number of providers in our area be
encouraged to participate in Denti-Cal.The goal is to educate providers of the need in the
community and the incentives that the DTI Domains 1 and 3 may provide to their practice. There
are approximately 813 active dentists licensed in Fresno County per the Department of Consumer
Affairs – Dental Board of California and only 147 (18%) are Denti -Cal providers with only 87 (59%)
of these providers accepting new patients according to the DHCS report of Fee For Service
providers in Fresno County. Provider Relations Representatives effectiveness on expanding Denti-
Cal participation will be tracked through our planned Cloud database and monitored through
reports evaluated during and between monthly monitoring meetings with Participating Part ners.
1)Outreach Oral Health Education and Care Coordination
LDPP County of Fresno Page 17
Consumers that opt to engage with us and participate in the project will be served between
our two community-based entities; Fresno EOC, and RAB-HSE. Technology such as a
cloud based Access Database for caseload management and tracking, 1-800 phone line for
communication (English/Spanish/Hmong), and text messaging will also be components of
this service area but the most important and effective aspect will be our well trained and
culturally competent staff. Activities will be made available during non-traditional hours to
accommodate the needs of our participants.
Children encountered that are not insured will be referred to Medi -Cal utilizing our
relationship with federally qualified health cen ters who are contracted by the Department of
Social Services as Medi-Cal Enrollment Assisters. No cost associated with Outreach Oral
Health Educators or treatment of non-Medi-Cal clients will be charged to the Fresno LDPP.
The cost for any services rendered that cannot be claimed to Medi-Cal will be absorbed by
the collaborating partner is involved.
Outreach Oral Health Educator responsibilities:
According to the DHCS “Medi-Cal Eligibles with Threshold Languages report”, 32.35% of
Fresno County Medi-Cal clients speak Spanish and 3.41% speak Hmong. The Outreach
Oral Health Educators will provide the services noted below in the families language and in
a culturally appropriate manner.
Each Outreach Oral Health Educator will have a revolving active caseload of 500
families.
Education to improve oral health literacy
o Guidelines on dental periodicity schedule, preventive dental services, anticipatory
guidance/counseling and oral treatment for infants, children and adolescents
Provide a variety of materials for participants to take home, including informational
pamphlets on several oral health topics (also available in Spanish), stickers,
toothbrushes, toothpaste, dental floss, mouth mirrors, and two -minute timers
Contacting the family and ensuring that they have secured a dentist and if they have not
secured a provider then they will assist in the identification of a dentist or dental care
center
Assist with the initial appointment setting
Provide patient support in assisting them in arriving at their scheduled de ntal
appointments including transportation and will provide referrals to those families
expressing additional social or economic hardships utilizing the following tools;
o The Directory of Community Resources created by The Family Resource Center,
affiliated with the Fresno County Department of Social Services , and the 2-1-1
Fresno County Information and Referral Helpline will help connect consumers with
agencies and/or organizations that can provide assistance. 2 -1-1 Fresno County is a
free and confidential service that is available 24 hours a day, 7 days a week, and 365
days a year in over 170 languages.
Track client contact and provide patient reports on the number of appointments
scheduled and the efforts made to remind patients of their appointments
Coordination of oral health services across multiple providers
LDPP County of Fresno Page 18
o Dental Hygienist, Mobile Dental Vans, Registered Dental Hygienist in Alternative
Practice and Dentists
Request authorization to send the family text reminders of appointments set for each of
the children.
Contact the family 24 hours after the scheduled visit
Contact dentist office to determine if the efforts to educate and support the patient/family
resulted in a kept appointment (level of success)
Determine why the appointment was not kept and assist in rescheduling
Address any rescheduling assistance or follow-up appointments that might be necessary
On a quarterly basis, families will be sent invitations to attend healthcare fairs where they
will be provided new toothbrushes, toothpaste calenda rs, etc. and can be entered into
drawings to win oral health products
2) Provider Relations and Recruitment responsibilities:
Fresno County Denti-Cal dentists were selected to be eligible to participate in the LDPP
Domains 1 and 3 incentives. Fresno is listed as the 4th highest county out of 58 in the state
of California with nearly 50% of our total population enrolled in Medi -Cal and greater than
75% of Children aged 0-5 in Medi-Cal according to the September 2015 report. Currently
data shows that only 44% of our 0-20 population return year after year for follow up dental
preventive care in Fresno County. Our Medi-Cal children 0-6 years old have been
documented to have a high restorative procedure rate of 46.23% in 2014/15, and a low
preventive procedure rate of 53.77% being performed.
Additionally, per the Community Commons report of August 13, 2015, Fresno County
dentists per 100,000 population is 55.7 vs. the California rate of 77.5 making it even more
critical that the limited number of providers in our area be encouraged to participate in Denti-
Cal and, through the proposed support systems, the goal is to educate these providers of
the need in the community and the potential that DTI Domain s 1 and 3 provides to their
practice. There are 813 active dent ists licensed in Fresno County per the Department of
Consumer Affairs – Dental Board of California as of 09/21/16, and only 147 (18%) are Denti-
Cal providers with only 87 (59%) of these providers accepting new patients according to the
DHCS report of Fee For Service providers in Fresno County.
Provider Relations Representative
Educate current Denti-Cal dentists on DTI
Encourage Denti-Cal dentists to become eligible for Domains 1 and 3
Learn the challenges and obstacles of current Denti-Cal Dentists who are not accepting
new patients and explain how our Outreach Oral Health Educators might be of
assistance (i.e. reduction in no-show rates and care coordination)
Outreach to Dentists who are not Denti-Cal providers to encourage them, through
education and support, to enroll in Denti-Cal
LDPP County of Fresno Page 19
Conduct Dental Provider Survey to learn the challenges and obstacles in engaging
dental providers in Denti-Cal
Increase the number of Denti-Cal providers by 2% each calendar year (e.g., 3 providers
per calendar year)
Total number of dentists will be divided equally among the four Provider Relations
Representatives
3.2 Innovations, Interventions, and Strategies:
Strategy Number (1) - Outreach Oral Health Education and Care Coordination Services; the
objective is to provide families with oral health education and an assigned care coordinator to
assist in the identification of available Denti-Cal providers and the scheduling of the initial and
recurring appointments with the goal of increased access to dental care and preventive den tal
appointments as recommended with increased adherence to behaviors that contribute to good oral
health.
Strategy Number (2) - Dental Provider Relations and Recruitment Services; Provider Relations
Representatives will contact licensed Denti-Cal dentists including those Denti-Cal providers not
accepting new patients and will recruit those dentists who are not Denti -Cal providers through
onsite education and services on DTI Domains 1 and 3 and the Fresno LDPP in partnership with
the Fresno-Madera Dental Society.
Through the use of a cloud based database, information will be collected such as the pre and post
assessments to evaluate the achievement of the goals set for strategies (1) and (2). Evaluating
reports generated from the database will be used du ring monthly monitoring meetings with
participating partners to assess progress and identify any needs improvement and interventions
that may be required to maximize the effectiveness of the intervention and the process. Specific
anticipated outcome measurements are noted in Section 4.1
Strategy Number (3) – Virtual Dental Home
In section 3.1 we provided an overview of the first two (2) interventions that are proposed by the Fresno
LDPP and while both of the services described are certainly innovative in terms of their incorporation into an
oral health project, the most innovative aspect of our proposal is related to our third intervention a VDH. The
VDH model will be an accessible, continuous , comprehensive, family centered, coordinated, compassionate,
and culturally effective dental home based in the community at the Head Starts and after school program of
Fresno EOC and RAB-HSE and with the capability to mobilize to other locations of need. There is no current
VDH infrastructure in Fresno County.
The Virtual Dental Home (VDH) system of care has been developed and tested in a six-year grant
funded proof-of-concept demonstration. This demonstration established that telehealth -connected
teams can work and that dental hygienists can safely determine what radiographs to take and
place interim therapeutic restorations (ITRs) after being instructed to do so by a dentist.
This strategy includes development of a VDH system in Fresno County that uses Denti -Cal billing
to pay for the dental treatment provided. It will allow testing of the ability of the VDH system to
function and be sustainable.
LDPP County of Fresno Page 20
Although DHCS has adopted regulations that allow providers to bill for services performed using
store-and-forward teledentistry as required by AB1174, this is only a portion of the support needed
for providers to establish and sustain Virtual Dental Home systems. This model for providing
dental care is significantly different than the traditional dental care systems in use. The providers,
community sites and communities will require significant help in system design and customization,
training, and technical assistance over the grant period before these systems are established and
stabilized and they are in a position to be able to continue to provide services using th is model in a
way that is self-sustaining based on program billing revenue. The activities and resources needed
for the required help in system design and customization, initial; equipment purchase, training, and
technical assistance are not claimable under the Denti-Cal system.
For this project, salaries related to patient care, patient care supplies, and equipment (with the
exception of portable equipment purchased in the start-up phase of the project) are part of normal
clinical care operations and will be paid by the providers. UOP has developed and tested an
innovative and customizable oral health delivery system called the VDH system of care. Paul
Glassman DDS, MA, MBA is the Director of the Pacific Center for Special care and will support the
project.
The success of the demonstration of the VDH system resulted in legislation being passed in 2014
that has now created a regulatory environment where this system can be expanded and local
programs can be established that will become self -sustaining using program revenue. However, it
is clear that providers and community organizations will continue to need help with system design,
training and technical support. Pacific is interested in using the DTI funding in the Medicaid 2020
waiver to expand the use of the VDH system, improve oral health of currently underserved groups,
and reduce the financial and human consequences of neglected dental disease.
This VDH will expand the capacity of the oral health care system in Fresno County by engaging the
VDH in various community centers, and after-school programs and will bring prevention and early
intervention oral health services to children that normally do not receive any care until they have
advanced disease. Linking prevention and early intervention care delivered by allied dental
personnel in these locations, with more advanced care in dental offices and clinics, will produce a
full system of care, improve the oral health of the population, and lower the significant personal,
societal, and financial costs that result from neglected dental disease.
VDH Project Goals
The goals of this project will be to demonstrate that incorporating a Virtual Dental Home system
focused on children can allow the system to:
Reach many more Denti-Cal beneficiaries than are currently being reached in the
geographic areas where this demonstration will take place;
Integrate oral health activities into the environment, activities, and processes of community
sites where children already are;
Apply proven prevention and early intervention procedures in community locations such as
schools and pre-school programs;
Establish a “continuous presence” system where the on-site dental team is present in the
community site throughout the school year. This is known to increase awareness and focus
LDPP County of Fresno Page 21
on oral health which is critical to support adoption of health -producing daily mouth care and
“tooth healthy” diets;
Keep the majority of children healthy on site in the community site, and most importantly,
verify through the telehealth system that they are healthy. This is possible because the
dentist is involved through the telehealth system and can determine which children are
healthy, or can be made healthy, through services provided by the dental hygienists on-site;
Refer those children with advanced disease to dental offices/clinics for treatment of those
problems while maintaining on-going diagnostic and prevention services in the community;
and
Improve the oral health of the children served in this demonstration as measured by
incidence of untreated dental caries, signs of pain and infection, and use of the hospital
emergency department and operating room services for dental care.
VDH Participants
The following entities will participate in the Virtual Dental Home portion of this DTI project:
Dental providers:
o To be subcontracted by DPH. Subcontract is only to dictate terms of VDH equipment
use and stipend issuance, not compensation.
Community Sites:
VDH is to be utilized at community sites hosted by RAB and EOC including:
RAB-HSE Community and Head
Start Programs
Fresno EOC Early Head Start and
Head Start Locations
Roosevelt High School
4250 E. Tulare Street
Fresno, CA 93702
Highway City
4721 N. Jennifer, Suite 10
Fresno, CA 93722
Central Unified School District
4605 N. Polk Avenue
Fresno, CA 93722
FRANKLIN
1189 Martin St.
Fresno, CA 93706
Mosqueda Center
4670 E Butler Ave
Fresno, CA 93702
FIREBAUGH
Hazel Bailey Elementary School
1725 Saipan Ave.
Firebaugh, CA 93622
RAB-HSE Facility
190 N Van Ness Ave
Fresno, CA 93701
IVY Mary Ella Brown
Community Center
1350 E. Annadale
Fresno, CA 93706
RAB-HSE Facility
3730 W Shields Ave
Fresno, CA 93722
MADISON
Madison Elementary School
388 S. Brawley
Fresno, CA 93706
LDPP County of Fresno Page 22
MOLLY NEVAREZ
Central Community Church
4710 N. Polk Avenue
Fresno, CA 93722
EAST FRESNO - A
Home Base Satellite Office
4273 W. Richert, Suite # 107 & 108
Fresno, CA 93722
FRANKLIN
Home Base Satellite Office
4273 W. Richert, Suite # 107 & 108
Fresno, CA 93722
VDH targeted population – Each set of VDH clinic equipment is expected to be utilized a minimum
of three (3) days per week with a minimum of 750 clients per year being served. The LDPP
proposal requests two (2) VDH clinic equipment sets bringing the total number of projected clients
being served by VDH to 1,500 per year.
Roles and Responsibilities
The following is a list of roles and responsibilities that will ensure success of the demonstration.
Dental Providers
The dental care providers will:
Hire and pay the salary of the community (on ‐site) dental teams, including dental hygienists
and dental assistant/navigators who will work in the community sites.
Create or modify their IT system to be able to function in a virtual environment (i.e. the
hygienist is collecting records in one location and the dentist is reviewing those records in
another location at another time). Some considerations in evaluating a providers IT/EDR
systems include the following considerations:
The hardware and software available to the community teams must allow the community
team to capture images (radiographic and photographic) in the community site as well as
scanned health histories and consent forms, record dental findings, progress notes and any
other aspect of the EDR.
The information captured in the community must be available and able to be reviewed by a
dentist who is not in the community site. There are several mechanisms that can allow this
to happen: Use of a “cloud” based EDR system where all the information is uploaded and
stored on a cloud‐based server. This is the ideal EDR system as it allows data entry and
access to the data from any location by multiple personnel.
Data can be stored on an office or clinic‐based server and accessed via a VPN or terminal
services connection. If this method is used, it is important that images and other information
collected in the community site can be uploaded to the server and accessed from all sites.
LDPP County of Fresno Page 23
Accept referrals and provide treatment that cannot be provided in the community site for
patients who are deemed to have advanced disease that warrants a visit to a dental office.
Note: This will be far fewer in‐office visits than traditionally needed since the majority of care
will take place in the community.
Provide data on patients seen, services provided and costs incurred and revenue received
as a part of this project. Bill for services provided using store‐and‐forward teledentistry.
Providers in Fresno County may be eligible to receive DTI Domain 1 and 3 incentive
payments for additional children receiving preventive services and continuity of care.
Providers will learn how to operate in a system that is likely to produce improved oral health
outcomes compared to traditional oral health delivery systems. They will be well positioned
as the oral health system moves further into the Era of Accountability and payment methods
become tied to performance measures that include oral health outcomes.
Community Site and Other Participants
The host participating partners community site for this demonstration will be RAB-HSE and EOC
Program administrators will introduce the demonstration and support its adoption and i ntegration.
Participating sites will:
Provide space and host the on-site dental teams;
Help develop and process agreements; and
Help with arrangements for scheduling and integration of the system into school
activities and processes.
Anticipated schedule of participating sites:
Fresno Treatment and Education for Everyone on Teeth and Health
Virtual Dental Home Schedule
Monday Tuesday Wednesday
Franklin/EOC A.Madison A.Van Ness
Mosqueda B.B.
Monday
A.
B.
Tuesday
A.
B.
Wednesday
Franklin/EOC Ivy/EOC Shields
Mosqueda
Monday
A.
B.
Tuesday
A.
B.
Wednesday
Franklin/EOC Madison Van Ness
Mosqueda
Monday Tuesday Wednesday
Franklin/EOC A.Molly/EOC A.Van Ness
Mosqueda B.B.
Thursday
A.
B.
Friday
Central P/F/R
Thursday
A.
B.
Friday
Roosevelt P/F/R
l
Thursday
A.
B.
Friday
Central P/F/R
Highway City
Thursday
A.
B.
Friday
Roosevelt P/F/R
Firebaugh/EOC
Legend
Ivy Mary Ella Brown Community Center -EOC
Van Ness Facility -Reading and Beyond
Shields Facility -Reading and Beyond
Central Unit.School Dist.-Reading and Beyond
Roosevelt High School -Reading and Beyond
Paperwork/Fo 1lowup/Reschedules (P/F/R)
Franklin Head Start -EOC
Mosqueda Family -Reading and Beyond
Madison Elementary -EOC
Molly Nevarez Community Church -EOC
Highway City -EOC
|Firebaugh Hazel Bailey Elementary -EOC
LDPP County of Fresno Page 24
The UOP will:
Creating structure for VDH system
Explanations, community organization, presentations, negotiations
Planning training needs of providers, community organizations
Coordinating Pacific activities with other involved agencies
Assessment and assistance in MOUs and other agreements
Assessing current enrollment program and forms and assisting in developing new
ones for VDH system
Analyzing the current Dental Practice Management software and assisting use and
modification of IT systems
Planning for and developing methods for VDH data collection
Assistance in developing operation protocols and customized documentation for each
practice sites
Facilitate group learning - meetings, webinars, calls
UOP planning, system design, and training topics include:
Formation and use of advisory and steering committees.
Planning for community awareness building about the system as it starts and grows.
Selection of target populations for the system and investigation and understanding of
their characteristics, locations, unique needs, and services systems they are involved
with.
Selection or engagement of the oral health providers that will participate and
investigation and understanding of their current training, capacity, and tra ining needs
for the VDH system.
Assessment of current agreements in place between providers and other participants
and community sites and the need for new agreements. Assistance with modifying
existing agreements or developing new ones for the VDH system.
Assessment of current enrollment and program processes and forms in use by
providers and the need to modify or add new components and processes.
Assistance with modifying existing enrollment and program processes and forms or
developing new ones for the VDH system.
Assessment of provider and community site staffing arrangements and assistance
planning appropriate staffing organization and plans for the VDH system.
Analysis of current provider electronic dental record (EDR) systems and assistance
using, modifying, or incorporating new components needed for the VDH system.
Planning for program evaluation including selection of measures and developing
methods for collecting needed data.
Assistance in developing operating protocols and documentation for use in
community sites.
LDPP County of Fresno Page 25
Provide training including:
The changing health care landscape, implications for the oral health system.
Target populations and partner organizations, including culture, characteristics, and
integrating oral health services.
The use of telehealth in the delivery of oral health services in social, educational and
general health systems including the use of telehealth in the delivery of oral health
services including, use of cloud‐based record system in distributed team
environment, and function and communication of telehealth‐connected teams.
Legal considerations including HIPAA, consent, scope of practice laws and
regulations, telehealth billing regulations, and malpractice coverage.
Operational protocols including arrangements with schools and other community
sites, use and arrangement for space, roles and responsibilities of provider staff and
school staff, scheduling, communications with administrators, staff, parents and other
stakeholders, and infection control in community locations
EDR and Data management issues including using customized components of the
EDR system including risk assessment and basic measures, tracking VDH outcomes
using additional non‐billing procedure codes, and using the EDR for communicating
in telehealth connected team practice.
Scientific basis for VDH procedures including scientific basis for examination and
treatment planning using telehealth technology, risk adjusted prevention protocols,
partial caries removal, and criteria and technique for placing Interim Therapeutic
Restorations.
Facilitating behavior change including factors that influence oral health,
Principles influencing behavior change, and motivational interviewing
Training dental hygienists to place Interim Therapeutic Restorations.
Billing practice and strategies and other financial considerations.
The VDH model providing a dental home with focus on preventive services and care coordination
strategies as outlined in our proposal targets the highest concentration of need in Fresno County,
and throughout the state. Zip code 93701, has the highest amount of poverty per population of
10,000. Of 0-5 year olds in Fresno County 80% are receiving Medi -Cal. WIC programs, Head Start
centers as well as the Central Valley Regional Center provide services within the zip codes of
93701, 93702 and 93722 where we plan to concentrate our efforts. We know that the strategies
proposed will be an asset to our community and that we will do the work required to be successful
in our endeavors. Our plan includes motivational interviewing, health literacy activities, care
coordination, community outreach and education, as well as appointment reminder system.
According to numerous published studies barriers to care can removed with the above mentioned
items included. Our proposal includes the Triple Aim approach of improving access to care,
improving the experience and reducing costs. Based on these studies , we know that the
implemented proposal including the Triple Aim approach will be a success
The infrastructure needed to implement the proposed intervention consists mainly of those related
to the implementation of the VDH. W e currently possess the remainder of the infrastructure
LDPP County of Fresno Page 26
including leadership, collaboration, surveillance capacity, planning and evaluation capacity.
However, to achieve the goal of improved oral health outcomes we must also be able to provide
the VDH evidence-based prevention and promotion programs combined with the co mprehensive
care coordination that targets behaviors in families and communities leading to improved overall
health.
UOP will design and work with providers on a series of measures to find outcomes of these
projects. They will include both process measure s and health outcomes measures. The VDH will
be directed by a contracted dentist who will be responsible for the tactics and technology of the
VDH operation to include; the setup of VDH equipment, making clinical referrals and tracking and
submission of information into the Electronic Dental Records (EDR) system and their time spent as
a mentee with UOP. The VDH contracted Dentist will also function as a Dental Provider billing any
clinical services to Denti-Cal with no duplicative billing. This VDH project will develop, strengthen
and stabilize over a 4 year time frame and will prepare the county to have this system continue on
a self-sustaining basis, supported by program revenue, after the grant period.
Through the shared data that the pilot project will collect, Outreach Oral Health Educators will be
able to coordinate the population’s care more efficiently by being able to understand individual’s
historical and scheduled procedures families will be assured timely, medically necessary care
through an Access Database, VDH dental providers providing preventive care will alert Outreach
Oral Health Educators identifying patients and families that need additional restorative care that
was unable to be provided in the VDH. It will be flagged as routine, or urgent. The Outreach Oral
Health Educators will follow up with families assisting them in making appointments with local
resources. By tracking and alerting in the cloud based Access database patients and families will
be followed and assisted in receiving the medically necessary care in a timely manner. Once the
recommended necessary treatment has been completed this will be updated as well in the
Database showing that the patient has received care.
Required quality improvement/corrective action plans will consistent of required performance
metrics andmeasures, deficient goals/ benchmarks, new/ revised processes, as well as client
and/or provider satisfaction surveys as appropriate. The Lead Entity will continuously monitor and
evaluate progress with the intent to improve processes, prevent problems and maximize the LDPP
success. A database will be implemented to house all of the data collected on the target population
that all participating entities will be able to access via HIPAA compliant cloud stora ge. If there are
technical issues the LDPP Lead Entity will leverage their staff analyst and partner agency staff to
provide assistance. We will also periodically request that Fresno County Department of Social
Services compare our LDPP listing of clients against active Medi-Cal client to identify those
families that have yet to be engaged and to whom further outreach efforts will be made.
As the LDPP Lead Entity, DPH will conduct ongoing monitoring and will make subsequent
adjustments should issues arise including the need to provide role clarification, performance
improvement plans, evaluation and, if necessary, termination of agreements. LDPP will assure
compliance with DHCS that specifies the requirements of the LDPP with STC109 and Attachment
JJ of the Medi-Cal 2020 Waiver Special Terms and Conditions.
LDPP County of Fresno Page 27
3.3 Accountability:
LDPP will monitor performance of the project and its individual partners on a monthly basis .
Information from site visits, monthly activity reports (derived from the Accountability and
Expectations table noted below), financial reports, customer service feedback (both by
professionals and families/children to be served) will be evaluated through surveys which will have
the option to be submitted by mail or by Survey Monkey. Information collected will be used to
identify issues, ensure that families the targeted population receive timely, medically necessary
care, evaluate potential corrective action plans or business process changes, communicate the
changes and then analyze if the changes implemented have produced the intended impact. If
there are technical issues the LDPP Lead Entity will leverage their staff analyst and partner agency
staff to provide assistance. We will also periodically request that Fresno County Department of
Social Services compare our LDPP listing of clients against active Medi-Cal clients to identify those
families that have yet to be engaged and to whom further invitations to participate will be sent.
Users of the Cloud based databases facilitating Outreach Oral Health Education and Provider
Relations and Recruitment will be staff referred by a participating partner and access granted by
the DPH LDPP Staff Analyst or designee.
As the LDPP Lead Entity, DPH will conduct ongoing monitoring and will make subsequent
adjustments should issues arise including the need to provide role clarification, performance
improvement plans, evaluation and, if necessary, termination of agreements with the advisement
and guidance of the Advisory Board. LDPP will assure compliance with DHCS that specifies the
requirements of the LDPP with STC109 and Attachment JJ of the Medi-Cal 2020 Waiver Special
Terms and Conditions. Aggregate data expected to be shared by DHCS via enrolled Medi-Cal
dental providers' submitted claims for reimbursement will further inform the Project of its progress
and provide an opportunity to identify areas to improve.
LDPP County of Fresno Page 28
3.4 Data Sharing:
Data sharing across the Fresno LDPP partners will occur through cloud computing that provides
shared computer processing resources in a securely encrypted manner. An Access database has
been created and will be utilized to store demographic information and information necessary for
care coordination. A secondary Access database will be created to track the work that will be
performed by Provider Relations Representatives and to manage the recruitment effort. The
Fresno LDPP client information will be requested by Outreach Oral Health Educators and retained
only once a Release of Information (ROI) is signed by the family. All LDPP staff will be provided
access to computers/laptops that will be able to access the internet; additionally, Provider
Relations Representatives will be provided have mobile virtual private network access. The
implementation of these databases and the cloud computing can be operational within 60-days of
notification of selection.
Fresno County DTI LDPP Previous Family I Next Family I New Family I Delete Family
Primary Adult
Date of First Contact
First Name
Middle Name
Last Name
DOB
Sex
Medi-Cal Recipient?
Medi-Cal #
SSN/Pseudo
Street Address
APT#
City
State
Zip
eMail Address
Flome Phone
Cell Phone
Text Message ?
Child Information Previous Child
First Name
Middle Name
Last Name
DOB
Age
Sex [Female 0
Comments
0
Secondary Adult
Date of First Contact
First Name
Middle Name
Last Name
DOB
Sex
Medi-Cal Recipient?
Medi-Cal #
SSN/Pseudo
Same as Primary [gj
Street Address
H
APT#
City
State
Zip
eMail Address
Home Phone
Cell Phone
Text Message?
Next Child New Child Delete Child
Appointment Information
Description
Date Time j -
Provider Name
Subject 9/29/2016:-1r-
City |
State
New View ANextn
Back Next New Comment
Phone#|
Street Address
Suite/BLDG #
Fax#
Medi-Cal
Applications
Covered CA Website
Chinesetr.
Other
LDPP County of Fresno Page 29
Section 4: Progress Reports and Ongoing Monitoring- 30 points
4.1 LDPP Monitoring:
Outreach Oral Health Educators and Provider Relations Represe ntatives personnel will input daily
client activity and provider contacts respectively into the cloud based Access database. In turn
there will be reports generated from this data that will help monitor their workload effectiveness and
efficiency. VDH performance will be based upon client satisfaction surveys which will also be
conducted for our Oral Health Educators and Provider Relations Representatives services .
Aggregate data reports derived from the Database s described in Section 3.4 will be created for
review during monthly contractor meetings between DPH, RAB-HSE, EOC, dental providers and
UOP. This information along with contractor financial reports will be reviewed during Fresno LDPP
Advisory Board meetings. The Advisory Board will utilize all information available to assess
performance and agency staff outcome comparisons. DPH will also submit timely quarterly and
annual reports as agreed to DHCS and CMS. Noted in the table below are the expected short-
term process measures whose planning will begin immediately upon notification of selection.
Depicted below is our short-term process measures or implementation plan.
The Fresno County DTI LDPP will use a Cloud based IT infrastructure to manage and share data
with the three participating entities.The Provider Relations Representatives will also be able to
access the system remotely from any location through a HIPAA compliant virtual private network.
DTI LDPP
Database
“(""'too QuOaiQ
0 acflaj
RAB-HSE EOC-HSEDPH
LDPP County of Fresno Page 30
SHORT –TERM PROCESS MEASURES RESPONSIBILITY
Mo.
#1
Mo.
#2
Mo.
#3
Develop evaluation standards for each
staff position and contractors
DPH / Advisory Board
Contract with EOC Health Services and
Educations (EOC)
DPH
Contract with RAB-HSE DPH
Provide initial and ongoing training to
personnel
RAB - HSE
Contract with University of Pacific (UOP) DPH / UOP
Launch Virtual Dental Home site EOC
Establish a VDH Agreement which will
include as participants Dr. Hilario and Dr.
Cheney (Equipment Use & Stipends Only)
DPH
Initiate VDH Training UOP
Pre-testing period of new processes/
procedures
DPH; RAB-HSE; EOC; UOP
Participant recruitment
and enrollment
Recruitment
Enrollment
EOC; RAB – HSE; UOP
Implement LDPP services EOC; RAB – HSE; UOP
Measurement of program outcomes DPH / Advisory Board
OUTREACH ORAL HEALTH EDUCATION AND CARE COORDINATION
GOAL
Fresno LDPP will increase oral health education, preventative and treatment participation OBJECTIVE #1 INTERVENTION DESCRIPTION Outreach Oral Health
Education and Care
Coordination Services
OBJECTIVE STATEMENT: Families identified to receive oral health
education will have received education, information and scheduled
appointments with Denti-Cal Providers
OBJECTIVES:
1. Outreach to all Medi-Cal families with a concentrated effort on
families residing in zip codes 93701, 93702, 93722
2. Provide educational materials including pamphlets on several oral
health topics
MAJOR ACTIVITIES TIMELINE RESPONSIBLE
STAFF
1.1 Outreach to community partners, stakeholders, such as schools, WIC program, Head Start,
Early Head Start, youth services, medical and dental services programs to advertise,
recruit participants and secure access to venues to conduct outreach and provide oral
health materials.
LDPP County of Fresno Page 31
1.2 Identify other sites outside of the community partners where target population frequently
visits; such as supermarkets, swap meats, beauty salons, restaurants, movie theaters, etc.
1.3 Prepare all outreach materials needed for participants to take home including informational
pamphlets on oral health topics (also available in Spanish and Hmong) and other
incentives such as stickers, toothbrushes, toothpaste, dental floss, mouth mirrors, and two -
minute timers.
1.4 Call and meet with patients and provide education on oral hygiene and preventative
services.
1.5 Assist clients with identifying dentist and initial appointment setting
1.6 Provide patient support in assisting them in making and arriving at their scheduled dental
appointments
1.7 Track client contact and provide patient reports on the number of appointments scheduled
and the efforts made to remind patients of their appointments
1.8 Contact dentist office to determine if the efforts to educate and support the patient/family
resulted in a kept appointment (level of success)
1.9 Develop relationships and informal MOUs with Denti-Cal providers, dentists, and other
medical health and encourage them to accept and welcome new clients.
1.10 Make referrals to dentists who have opted-in on Domains 1 and 3 and all other providers
accepting Denti-Cal patient
1.11 Prepare reports summarizing activity outcomes utilizing the LDPP Access database
PERFORMANCE MEASURES AND TRACKING TOOLS
EXPECTED LEVEL OF
PERFORMANCE
JUL 1, 2017-
DEC 31, 2017
JAN 1, 2018 –
DEC 31, 2018
JAN 1, 2019 –
DEC 31, 2019
JAN 1, 2020 –
DEC 31, 2020
Performance
Measure 1:
OHE’s will contact
and provide oral
dental health
materials to the
assigned caseload
of 500/per year.
90% of OHE’s
current caseload
(450 Families) will
have knowledge
and awareness of
oral health dental
care
90% of OHE’s
current caseload
(450 Families)
will have
knowledge and
awareness of oral
health dental care
90% of OHE’s
current caseload
(450 Families)
will have
knowledge and
awareness of
oral health
dental care
90% of OHE’s
current caseload will
(450 Families) have
knowledge and
awareness of oral
health dental care
LDPP County of Fresno Page 32
Performance
Measure 2:
OHE’s will refer
targeted population to
Denti-Cal providers
and ensure
scheduling* of their
initial appointments
and;
50% of the families in
the OHE’s caseload
that have never seen
a dentist will receive
dental care
*includes
rescheduling of
missed appointments
25% of applicable
OHE targeted
population (125
Families) will be
referred to Denti-
Cal providers and
ensure scheduling
of their initial
appointments
25% of applicable
OHE targeted
population (125
Families) will be
referred to Denti-
Cal providers and
ensure
scheduling of
their initial
appointments
50% of
applicable OHE
targeted
population (250
Families) will be
referred to
Denti-Cal
providers and
ensure
scheduling of
their initial
appointments
80% of applicable
OHE targeted
population (400
Families) will be
referred to Denti-Cal
providers and
ensure scheduling of
their initial
appointments
Expected
Outcome:
80% of the OHE’s
caseload that have
never seen a
dentist will receive
dental care
Expected
Outcome:
80% of the OHE’s
caseload that
have never seen
a dentist will
receive dental
care
Expected
Outcome:
80% of the
OHE’s caseload
that have never
seen a dentist
will receive
dental care
Expected Outcome:
80% of the OHE’s
caseload that have
never seen a dentist
will receive dental
care
Performance
Measure 3:
OHE’s will ensure
scheduling* of their
caseloads continuity
of care appointments
and;
Applicable clients in
the OHE’s caseload
will receive continuity
of care.*includes
rescheduling of
missed appointments
95% of OHE’s
current caseload
(475 Families) will
have continuity of
care appointments
95% of OHE’s
current caseload
(475 Families) will
have continuity of
care
appointments
95% of OHE’s
current caseload
(475 Families)
will have
continuity of
care
appointments
95% of OHE’s
current caseload
(475 Families) will
have continuity of
care appointments
70% of all Domain
1 clients in the
LDPP will receive
Domain 3
70% of all
Domain 1 clients
in the LDPP will
receive Domain 3
70% of all
Domain 1 clients
in the LDPP will
receive Domain
3
70% of all Domain 1
clients in the LDPP
will receive Domain
3
Tracking Tools
•Staff training certificates
•List of collaborative partners and stakeholders
•Roster of Head Start and Early Head Start sites
•WIC locations and number of clients they serve
•Presentation handouts and other materials
•Daily attendance roster for each family contact, phone and in person
•Attendance roster from in-services provided at partner locations
•List of agencies from resource guide
•Tracking log of Family contacts thru use of the LDPP Access database
•Pre and post surveys thru mail or Survey Monkey
•Health Fair and events sign in sheets
•Community Services Referral List (community clinics, food banks, advocacy services, etc.)
•Recruitment and Retention Plan
LDPP County of Fresno Page 33
PROVIDER RELATIONS AND RECRUITMENT
Goal:
Fresno LDPP will recruit, educate, and retain dental providers to participate in the Denti-
Cal Program to increase continuity of care for children enrolled in the Medi -Cal Progam
OBJECTIVE #2INTERVENTION DESCRIPTION Provider Relations and Recruitment
Services
OBJECTIVE STATEMENT: By December 30, 2017,the Provider Relations
Representatives will have contacted 100% of licensed Denti-Cal dentists will
have received information on DTI and in particular Domain 3 and 4, and would
have begun recruitment efforts of those Denti-Cal providers who are not
accepting new patients and, recruitment of dentists to become Denti-Cal
providers.
OBJECTIVES:
1. Outreach and provide information to current Denti-Cal providers on Fresno
LDPP and participation in Domain 3: Continuity of Care
2. Learn obstacles of current Denti-Cal providers who are not accepting new
patients and provide technical support to areas that will help with no -show rates
and other challenges.
3. Recruit and train licensed dentists to participate in the Denti-Cal program.
Provide assistance and technical support with the enrollment forms.
MAJOR ACTIVITIES TIMELINE RESPONSIBLE STAFF
2.1 Participate in DHCS provider training to gather more information on the provider
enrollment, documentation requirements, and basic billing information such as diagnosis codes,
treatment plans, reimbursement rates.
2.2 Contact Denti-Cal Providers and schedule appointments for in-services and provide them
with information on Fresno LDPP and Domains 1 and 3: Continuity of Care and how the Fresno
LDPP can be of assistance.
2.3 Outreach to licensed dentists that are not Denti-Cal providers. Schedule appointments for
in services and provide them with information on Denti -Cal and offer assistance to help complete
the enrollment forms and documentation requirements.
2.4 Connect and build relationships with community organizations and provider organizations
throughout assigned locations
2.5 Conduct trainings for Denti-Cal providers and their staff on program updates that are
beneficial to their practice
2.6 Prepare strategic plan to present to Denti-Cal providers to help with their no-show rates,
accepting new patients, and scheduling appointments for continuity of care
2.7 Prepare reports and summarize findings
1.8 Utilize the LDPP Provider Relations and Recruitment database to track service efforts
LDPP County of Fresno Page 34
PERFORMANCE MEASURES AND TRACKING TOOLS
EXPECTED LEVEL
OF PERFORMANCE
JUL 1, 2017-
DEC 31, 2017
JAN 1, 2018 –
DEC 31, 2018
JAN 1, 2019 –
DEC 31, 2019
JAN 1, 2020 –
DEC 31, 2020
Performance
Measure 4:
PRR’s will contact
existing Denti-Cal
Providers
(Currently 147
providers divided
among 4 PPR’s)
90% of assigned
Denti-Cal providers
(132 Providers) will
receive information
on the Fresno
LDPP and
Domains 1 and 3:
Continuity of Care
100% of all newly
identified and
assigned Denti-Cal
providers (Goal of
148) will receive
information on the
Fresno LDPP and
Domains 1 and 3:
Continuity of Care
100% of all newly
identified and
assigned Denti-Cal
providers (Goal of
151) will receive
information on the
Fresno LDPP and
Domains 1 and 3:
Continuity of Care
100% of all newly
identified and
assigned Denti-Cal
providers (Goal of
154) will receive
information on the
Fresno LDPP and
Domains 1 and 3:
Continuity of Care
Performance
Measure 5:
PRR’s will
schedule
appointments with
Denti-Cal providers
for an in-service on
DTI Domain s 1
and 3 Continuity of
Care and the
Fresno LDPP
PRR’s will attempt
to schedule
appointments with
assigned Denti-
Cal providers for
an in-service on
DTI Domains 1 and
3 and the Fresno
LDPP
PRR’s will attempt
to schedule
appointments with
assigned Denti-
Cal providers for
an in-service on
DTI Domains 1 and
3 and the Fresno
LDPP
PRR’s will attempt
to schedule
appointments with
assigned Denti-
Cal providers for
an in-service on
DTI Domain s 1
and 3 and the
Fresno LDPP
PRR’s will attempt
to schedule
appointments with
assigned Denti-
Cal providers for
an in-service on
DTI Domain s 1
and 3 and the
Fresno LDPP
Expected
Outcome:
70% of assigned
Denti-Cal providers
will receive the in-
service
Expected
Outcome:
95% of assigned
Denti-Cal providers
will receive the in-
service
Expected
Outcome:
95% of assigned
Denti-Cal providers
will receive the in-
service
Expected
Outcome:
95% of assigned
Denti-Cal providers
will receive the in-
service
Performance
Measure 6:
PRR will
successfully
engage with Denti-
Cal Providers who
will agree to accept
new patients.
PRR’s will attempt
to successfully
engage with 50%
of assigned Denti-
Cal Providers who
will agree to accept
new patients.
PRR’s will attempt
to successfully
engage with 95%
of assigned and
remaining Denti-
Cal Providers who
will agree to accept
new patients.
PRR’s will attempt
to successfully
engage with 95%
of assigned and
remaining Denti-
Cal Providers who
will agree to accept
new patients.
PRR’s will attempt
to successfully
engage with 95%
of assigned and
remaining Denti-
Cal Providers who
will agree to accept
new patients.
Expected
Outcome:
70% of the Denti-
Cal Providers will
agree to accept
new Denti-Cal
patients
Expected
Outcome:
70% of the Denti-
Cal Providers will
agree to accept
new Denti-Cal
patients
Expected
Outcome:
70% of the Denti-
Cal Providers will
agree to accept
new Denti-Cal
patients
Expected
Outcome:
70% of the Denti-
Cal Providers will
agree to accept
new Denti-Cal
patients
LDPP County of Fresno Page 35
Performance
Measure 7:
Licensed dentists
not enrolled in
Denti-Cal will be
contacted (through
multiple avenues
and attempts) to
promote and
encourage their
participation in
Denti-Cal
PRR’s will attempt
to engage with
50% of assigned
Dentists.
PRR’s will attempt
to engage with
50% of assigned
and remaining
Dentists.
PRR’s will attempt
to engage with
95% of assigned
and remaining
Dentists.
PRR’s will attempt
to engage with
95% of assigned
and remaining
Dentists.
Performance
Measure 8:
Licensed dentists
will have scheduled
appointments for
training on Denti-
Cal enrollment
requirements and
in participating in
Domain s 1 and 3.
PRR’s will
scheduled
appointments for
100% of dentists
interested in
training on Denti-
Cal enrollment
PRR’s will
scheduled
appointments for
100% of dentists
interested in
training on Denti-
Cal enrollment
PRR’s will
scheduled
appointments for
100% of dentists
interested in
training on Denti-
Cal enrollment
PRR’s will
scheduled
appointments for
100% of dentists
interested in
training on Denti-
Cal enrollment
Performance
Measure 9:
Licensed dentists
will enroll as Denti-
Cal providers
PRR’s will
successfully enroll
2% of their provider
caseload in Denti-
Cal
PRR’s will
successfully enroll
2% of their provider
caseload in Denti-
Cal
PRR’s will
successfully enroll
2% of their provider
caseload in Denti-
Cal
PRR’s will
successfully enroll
2% of their provider
caseload in Denti-
Cal
Tracking Tools
•Staff training certificates and training log.
•List of collaborative partners and stakeholders
•List of State licensed providers
•List of Denti-Cal providers
•Denti-Cal presentation and training materials
•Denti-Cal forms completed and submitted
•Daily attendance roster for each dentist contact, phone and in person and their staff
•Attendance roster from in-services provided at partner locations
•Tracking log of dentist contacts
•Pre and post surveys thru mail or Survey Monkey
•Health fair and events sign in sheets
•Recruitment and Retention Planning utilizing the Relations and Recruitment database
VIRTUAL DENTAL HOME
Outcomes
Pacific will design and work with providers on a series of measures to find outcomes of these projects.
They will include both process measures and health outcomes measures.
Quantitative Process Measures
Measures of what was done in the project will include:
Number of children seen
LDPP County of Fresno Page 36
Characteristics of children seen
Procedures performed with an emphasis on preventive procedures
Risk assessments and subsequent interventions
Decisions made by dentists about the need for children to be seen in-person by a dentist
Recall and follow-up visits needed and kept.
Costs and revenue attributable to this system
Qualitative Measures
Opinions of participant providers and site personnel
Satisfaction of children and parents
4.2 Data Analysis and Reporting:
As indicated in section 4.1: Aggregate data reports derived from the Databases described in
Section 3.4, will be created for review, by DPH staff, during monthly contractor meetings between
DPH, RAB-HSE, EOC, dental providers and UOP. This information along contractor financial
reports will be shared during Fresno LDPP Advisory Board meetings. The Advisory Board will
utilize all information available to assess performance, agency staff outcomes comparisons and
DPH will submit timely quarterly and annual reports as agreed to DHCS and CMS.
The Fresno LDPP performance of all partners will be evaluated during monthly advisory meetings
where the financial and activity reports from each agency will be reviewed. If in reviewing these
reports an issue it's determined it will be brought to the partners attention . If in the consecutive
month the issue is not resolved or satisfactory mitigation then a one on one meeting between the
project administrator and the partner will be held and a corrective action plan will be developed. If
at the end of the 90 day review period the issues have not been rectified a formal letter will be
issued by the DPH to the partner alerting them that they are in failur e to perform status and that if
the issue is not corrected within 90 days to DPH’s satisfaction, steps to terminate services will be
initiated. While this is an important program decision item to include its use is extremely unlikely as
the collaborating partners are all well-known and respected professions with a great deal of
experience working with the populations’ unique social economic and cultural backgrounds.
The Lead Entity will facilitate monthly meetings individually with each of the Participatin g Partners
in order to review performance metrics and measures, staffing levels, productivity, training
accountability, client and provider satisfaction, and the overall opportunit ies for improvement and
adherence to state pilot requirements. The Lead Entity will also facilitate the Advisory Board
meetings where these same metrics will be reviewed and discussed. The Advisory Board
meetings will be held initially on a monthly basis, after the first year the frequency would be
reduced to a bi-monthly with special sessions being called as required.
As the LDPP Lead Entity, DPH will conduct ongoing monitoring and will make subsequent
adjustments should issues arise including the need to provide role clarification, performance
improvement plans, evaluation and, if necessary, termination of agreements. DPH will use
analyses for sustainability planning, including how the LDPP may be sustained post DTI funding.
Ultimately, the measure of our progress will be measured by a ggregate data expected to be shared
with DHCS via enrolled Medi-Cal dental providers' submitted claims for reimbursement which will
further inform the DPH of its progress and provide opportunities to identify areas to improve.
LDPP County of Fresno Page 37
Section 5 Financing
5.1 Financing Structure
Activity, performance metrics and measures, financial reports and invoices from participating
partners (RAB-HSE, EOC, dental providers and UOP), will be due monthly by the 10th of the month
following the month of service. These documents will be reviewed by the DPH Analyst who will
alert the LDPP Administrator of any irregularity or if additional questions are generated by the
reports submitted. Once the documents have been approved by the Administrator, the contractors
will be notified that the invoice will be held pending submiss ion of the next quarterly DHCS DTI
LDPP claim period. DPH will submit a total claim amount derived from the participating partners
approved invoices and that of the DPH invoice. Once payment is received from DHCS the
participating partners will receive th eir payments within 15-days. The payment to dental providers
that are subcontracted will be limited to stipends to address training hours provided by UOP. This
process will be detailed in Fresno LDPP contractor agreements that will be instituted once
selection has been received and accepted.
DHCS
Lead Entity
DPH
RAB-HSE
Release
Funds
Review
Invoices
Accept
Funds
Release
Funds
Release
Funds
Review
Invoices
Review
Invoices
Submit
Invoices
EOC-HSE
Accept
Funds
Accept
Funds
Submit
Invoices
Submit
Invoices
UOP - VDH
Submit
Invoices
Accept
Funds
Review
Invoices
Release
Funds
Accept
Funds
Submit
Invoices
Master Agmt
VDH Dental Office
Submit
Invoices
Accept
Funds
i V
y r
LDPP County of Fresno Page 38
5.2 Funding Request
Year 1 Year 2 Year 3 Year 4 Total
DPH $231,299 $176,012 $162,604 $163,113 $733,028
RAB - HSE Subcontract $719,840 $1,310,248 $1,404,134 $1,502,643 $4,936,865
EOC Subcontract $730,079 $1,343,251 $1,474,477 $1,576,203 $5,124,010
UOP Subcontract $96,904 $119,232 $65,787 $50,702 $332,626
TOTAL $1,778,122 $2,948,743 $3,107,003 $3,293,417 $11,127,285
5.3 Budget
Year 1 Year 2 Year 3 Year 4 Total
1) Personnel Costs $26,730 $52,564 $52,312 $53,533 $185,139
2) Fringe Benefits $20,048 $39,423 $39,234 $40,150 $138,855
3) Operating Expenses $67,850 $56,614 $57,546 $58,497 $240,507
4) Equipment Expenses $90,000 $- $- $- $90,000
5) Travel Expenses $- $- $- $- $-
6) Subcontractor Expenses $1,546,823 $2,772,731 $2,944,398 $3,129,548 $10,393,501
7) Other Costs $22,428 $19,068 $5,208 $3,192 $49,896
8) Indirect Costs $4,243 $8,343 $8,304 $8,497 $29,387
TOTAL $1,778,122 $2,948,743 $3,107,003 $3,292,661 $11,127,285
Staffing Plan
Staff Person
(maximum)
Personnel Role and Responsibilities
Fresno LDPP - County of Fresno Department of Public Health
.10 Fresno LDPP
Administrator
The Fresno LDPP Administrator will; Oversee contract negotiations and processing;
Evaluate performance outcomes; Facilitate periodic partner meetings; Take appropriate
actions to address performance issues; Relay LDPP data and fiscal reports to the State and
Oversee LDPP staff training
.20 FTE Staff Analyst
The Staff Analyst will ensure adherence to the Fresno LDPP requirements and regulations.
The Staff Analyst will perform a variety of assignments including research, analysis,
planning, evaluation, and administrative duties including preparation of contracts for Board
of Supervisor approval
.5 FTE Account Clerk Collect monthly activity reports; Log activity data; Process invoices once approved by the
Manager
.5 FTE Office Assistant Responsible for providing ancillary support mainly focusing on invoice processing from
subcontractors and tracking of requested dental provider entity training stipends
RAB-HSE
Program Director (at .50
FTE)
Is responsible for the overall management, planning, evaluation, assessment, continuous
improvement, compliance, budget adherence and program outcomes of the DTI LDPP
Project. Oversees and coordinates all activities and efforts in building relationships with
LDPP County of Fresno Page 39
stakeholders and collaborative partners.
2 FTE Project
Coordinator
Will oversee and coordinate all activities with Program Director on program implementation
and administration of project plan. Manage Outreach Health Educators for carrying out
work plan, data collection instruments, providing technical assistance in administering tools
to collect data and performance measurements.
2 FTE Provider
Relations
Representative
Provider Relations Representative - These individuals will have at least a Bachelor's Degree
in Education / Social Sciences and at least three years of experience…
15 FTE Outreach
Health Educator
Outreach Health Educator - These individuals will have at least a Bachelor's Degree in
Education / Social Sciences and at least three years of experience…
Fresno EOC
Program Director (at .50
FTE)
Is responsible for the overall management, planning, evaluation, assessment, continuous
improvement, compliance, budget adherence and program outcomes of the DTI LDPP
Project. Oversees and coordinates all activities and efforts in building relationships with
stakeholders and collaborative partners.
2 FTE Project
Coordinator
Will oversee and coordinate all activities with Program Director on program implementation
and administration of project plan. Manage Outreach Health Educators for carrying out
work plan, data collection instruments, providing technical assistance in administering tools
to collect data and performance measurements.
2 FTE Provider
Relations
Representative
Provider Relations Representative - These individuals will have at least a Bachelor's Degree
in Education / Social Sciences and at least three years of experience
15 FTE Outreach Oral
Health Educator
Outreach Health Educator - These individuals will have at least a Bachelor's Degree in
Education / Social Sciences and at least three years of experience.
UOP's FTE percentages and budget are based on a formula that takes the amount of dental
providers participating in the LDPP per year and the amount of training, consultation, and technical
assistance (TCTA) that each entity will need into account. The c alculations are based on a
decreasing need for TCTA an entity will need over the course of consecutive years of participation.
UOP anticipates that one dental provider entity will require 267 hours of training during their first
year of participation, 227 in their 2nd year, 62 in their 3rd year, and 29 in their 4th year. The Fresno
LDPP anticipates having two dental provider in Years 1-4 of the LDPP.
University of Pacific Virtual Dental Home - Personnel
Project Director
(FTE .02 Y1, .04 Y2, .02 Y3 & Y4)
Director of the Pacific Center for Special care and will direct the
project.
Director of Operations
(FTE .06 Y1, .11 Y2, .06 Y3, .04 Y4)
Director of Grant Operations and will oversee communications and
implementation with providers and site.
Program Manager
(FTE .16 Y1, .29 Y2, .15 Y3, .11 Y4)
Project Manager will schedule and track deliverables, reporting,
training and monitoring activities.
Program Content Manager
(FTE .07 Y1, .12 Y2, .06 Y3, .04 Y4)
Will schedule and track deliverables, reporting, training and
monitoring activities.
Contracts Manager
(FTE .03 Y1, .06 Y2, .03 Y3, .02 Y4)
Business Manager and will be responsible for contracts, expenses,
reporting systems.
Asst. Project Manager
(FTE .07 Y1, .12 Y2, .06 Y3, .05 Y4)
Responsible for technical training and assistance on data systems
and equipment.
LDPP County of Fresno Page 40
Section 6: Attestations and Certification
6.1 Attestation I certify that, as the representative of the LDPP Lead Entity, the Lead Entity agrees
to the following conditions:
The LDPP Lead Entity will assure appropriate participation in regular Learning Collaboratives
to share best practices among participating entities, in accordance with STC 109.
The LDPP Lead Entity will enter into an agreement with DHCS that specifies the requirements
of the LDPP with STC109 and Attachment JJ of the Medi-Cal 2020 Waiver Special Terms and
Conditions. The agreement with DHCS will include a data sharing agreement. See Exhibit A
“HIPAA Business Associate Addendum (BAA)” of this Application. The provisions in the DHCS
boilerplate BAA apply only to BAA -covered information that is shared by DHCS with the LDPP
specifically for the purpose of LDPP operations and evaluation. DHCS does not anticipate that
BAA-covered information will be shared for the purpose of LDPP operations or evaluation.
DHCS anticipates limited, or no, BAA-covered information sharing from the LDPP to DHCS.
However, DHCS will include a BAA in the event that data needs to be shared. The BAA will
apply to the transfer of BAA-covered information should the need arise.
The LDPP Lead Entity shall submit quarterly and annual reports in a manner specified by
DHCS and CMS. Continuation of the LDPP may be contingent on timely submission of the
quarterly and annual reports.
The LDPP Lead Entity will report and submit timely and complete data to DHCS in a format
specified by the State and as defined in the LDPP’s individual agreement with the State.
Incomplete and/or untimely data submissions may lead to a financial penalty after multiple
occurrences and technical assistance is provided by the State.
The LDPP Lead Entity will assure participation in program evaluation activities and will agree to
provide data to measure the success of key activities of the work plan throughout the duration
of the project.
I hereby certify that all information provided in this application is true and accurate to the best of my
knowledge, and that this application has been completed b ased on a thorough understanding of
program participation requirements as specified in the Medi-Cal 2020 Waiver Special Terms and
Conditions and Attachment JJ of said waiver.
Signature of LDPP Lead Entity Representative Date
LDPP County of Fresno
APPENDICES
1. Letters of Support / Participation
Year 1 Year 2 Year 3 Year 4 Total
1) Personnel Costs 26,730$ 52,564$ 52,312$ 53,533$ 185,139$
2) Fringe Benefits 20,048$ 39,423$ 39,234$ 40,150$ 138,855$
3) Operating Expenses 67,850$ 56,614$ 57,546$ 58,497$ 240,507$
4) Equipment Expenses 90,000$ -$ -$ -$ 90,000$
5) Travel Expenses -$ -$ -$ -$ -$
6) Subcontractor Expense 1,546,823$ 2,772,731$ 2,944,398$ 3,129,548$ 10,393,501$
7) Other Costs 22,428$ 19,068$ 5,208$ 3,192$ 49,896$
8) Indirect Costs 4,243$ 8,343$ 8,304$ 8,497$ 29,387$
Total 1,778,122$ 2,948,743$ 3,107,003$ 3,293,417$ 11,127,285$
Year 1 Year 2 Year 3 Year 4 Total
DPH 231,299$ 176,012$ 162,604$ 163,869$ 733,784$
RAB Subcontrcact 719,840$ 1,310,248$ 1,404,134$ 1,502,643$ 4,936,865$
EOC Subcontract 730,079$ 1,343,251$ 1,474,477$ 1,576,203$ 5,124,010$
UOP Subcontract 96,904$ 119,232$ 65,787$ 50,702$ 332,626$
Total 1,778,122$ 2,948,743$ 3,107,003$ 3,293,417$ 11,127,285$
LDPP
Page 1 of 8
Personnel
# of Staff FTE %
1 0.1
1 0.2
1 0.5
1 0.1
1 0.5
Operating Expenses
Information Technology Infrastructure
Communications
Total Operating Expenses
Equipment
Portable Equipment Sets X 2
Nomad Pro 2 X-Ray w/ Carrying Case X 2
Digital X-Ray Sensor - Size 0 X 2
plus Care Plan - 5 YR ADV Plan X 2
Total Equipment Expenses
Subcontracts
Reading and Beyond - HSE
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$458,950 $19,440 $35,075 $3,500
Fresno Economic Opportunities Commision
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$471,566 $20,300 $41,800 $3,400
University of the Pacific
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$73,153 $8,400 $0 $0
Total Subcontracts
Other Costs
Dental Provider Entity Stipends
Total Other Costs
Indirect Costs Indirect Costs
Annual Budget Total
6,500$
1,546,823$
$96,904
$730,079
22,428$
22,428$
Systems & Procedures Analyst $5,500 - $6,000 3,505$
Account Clerk $2,000 - $2,500 7,125$
Office Assistant $2,100 - $2,600
Exhibit A Attachment I
Budget
Year I
07/01/2017 through 12/31/2017
Position Title Monthly Salary Range Annual Cost
Division Manager $7,500 - $8,000 4,750$
Staff Analyst $3,750 - $4,750 4,850$
Total Salary 26,730$
Fringe Benefits (75%)*20,048$
$134,375
45,000.00$
22,850.00$
57,000$
16,000$
13,800$
3,200$
90,000.00$
Total Personnel 46,778$
67,850$
$4,200 $11,151
Total Costs
$719,840
Total Costs
$68,500
$124,513 $68,500
Total Costs
4,243$
1,778,122$
* Fresno County Public Health employees’ benefit rate includes Unemployment Insurance, Benefit Administration, OASDI, Health Insurance, and
Retirement. Retirement and Health Insurance are the primary contributors to a high benefit percentage. When the minimal amount for Benefit
Administration and Unemployment Insurance, and 7% for OASDI are included, the average benefit rate for these positions is just over 75%.
LDPP
Page 2 of 8
Division Manager:
Staff Analyst:
Systems & Proced-
ures Analyst:
Account Clerk:
Information Techno-
logy Infrastructure:
Communications:
Equipment:
Other Costs:
Office Assistant:Responsible for providing ancillary support mainly focusing on invoice processing from subcontractors
and tracking of dental provider training stipends as well as day-to-day activities of other staff.
Fresno County Department of Public Health's Federally approved Indirect Cost rate of 15.873% of
salary.
Responsible for report generation, subcontract development, performance monitoring, IT
implementation and development.
Responsible for reviewing invoices submitted by subcontractors, maintaining adherence to budget, and
preparing invoices for submittal to DHCS.
Media campaign to include DTI public service announcements via TV, Radio, Print, and Digital.
Development and production of educational materials.
Year I
07/01/2017 through 12/31/2017
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct
and indirect supervision of project design, implementation, contract compliance, quality assurance,
budget adherence and program outcomes.
Responsible for the development, implementation, and maintenance of the LDPP's Information
Technology Infrastructure.
License and maintenance fees for IT system and data management. Initial design of front-end user
interface and back-end reporting. Staff training.
Portable dental equipment needed to run VDH includes Digital X-Ray Sensor size 1 and 2, Intra-Oral
Camera, Laptop, Portable Light, Portable Chair, Extra-Oral Camera, Curing Light, Amalgamator -
Touchpad, Clinical Instruments, Lead Apron (1 Adult, 1 Child), MiFi Hotspot, Aseptico Delivery Unit,
Aseptico Fiber Optics, Cavitron, Hand Pieces, and Instruments.
Stipends are to be provided at an hourly rate of $42 per UOP training attendee. Fresno LDPP
anticipates two provider entities partaking in year one. This equates to 534 potential training hours at
$42 per hour ($22,428).
Indirect Costs:
Exhibit A Attachment I
Budget Narrative
LDPP
Page 3 of 8
Personnel
# of Staff FTE %
1 0.1
1 0.2
1 0.5
1 0.07
1 0.5
Operating Expenses
Information Technology Infrastructure
Communications
Total Operating Expenses
Subcontracts
Reading and Beyond - HSE
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$993,744 $38,880 $0 $3,500
Fresno Economic Opportunities Commision
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$1,011,631 $42,400 $2,800 $3,400
University of the Pacific
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$90,098 $11,200 $0 $0
Total Subcontracts
Other Costs
Dental Provider Entity Stipends
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
Office Assistant $2,100 - $2,600 13,390$
19,068$
19,068$
Systems & Procedures Analyst $5,500 - $6,000 5,055$
56,614$
Total Costs
Account Clerk $2,000 - $2,500 14,535$
Total Salary 52,564$
10,000.00$
Exhibit A Attachment I
Budget
Year II
01/01/2018 through 12/31/2018
Position Title Monthly Salary Range Annual Cost
Division Manager $7,500 - $8,000 9,690$
Staff Analyst $3,750 - $4,750 9,894$
46,614.00$
Fringe Benefits (75%)*39,423$
Total Personnel 91,987$
$125,804 $148,320 $1,310,248
Total Costs
2,772,731$
$134,700 $148,320 $1,343,251
Total Costs
$4,200 $13,734 $119,232
* Fresno County Public Health employees’ benefit rate includes Unemployment Insurance, Benefit Administration, OASDI, Health Insurance, and
Retirement. Retirement and Health Insurance are the primary contributors to a high benefit percentage. When the minimal amount for Benefit
Administration and Unemployment Insurance, and 7% for OASDI are included, the average benefit rate for these positions is just over 75%.
8,343$
2,948,743$
8,343$
LDPP
Page 4 of 8
Division Manager:
Staff Analyst:
Office Assistant:
Systems & Proced-
ures Analyst:
Information Techno-
logy Infrastructure:
Account Clerk:
Communications:
Other Costs:
Responsible for providing ancillary support mainly focusing on invoice processing from subcontractors
and tracking of dental provider training stipends as well as day-to-day activities of other staff.
Indirect Costs:Fresno County Department of Public Health's Federally approved Indirect Cost rate of 15.873% of
salary.
Stipends are to be provided at an hourly rate of $42 per UOP training attendee. Fresno LDPP
anticipates two provider entities partaking in year two. This equates to 454 potential training hours at
$42 per hour ($19,068).
Media campaign to include TV, Radio, Print, and Digital. Development and production of educational
materials.
Exhibit A Attachment I
Budget Narrative
Year II
01/01/2018 through 12/31/2018
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct
and indirect supervision of project design, implementation, contract compliance, quality assurance,
budget adherence and program outcomes.
Responsible for report generation, subcontract development, performance monitoring, IT
implementation and development.
Responsible for the development, implementation, and maintenance of the LDPP's Information
Technology Infrastructure.
License and maintenance fees for IT system and data management.
Responsible for reviewing invoices submitted by subcontractors, maintaining adherence to budget, and
preparing invoices for submittal to DHCS.
LDPP
Page 5 of 8
Personnel
# of Staff FTE %
1 0.1
1 0.2
1 0.5
1 0.05
1 0.5
Operating Expenses
Information Technology Infrastructure
Communications
Total Operating Expenses
Subcontracts
Reading and Beyond - HSE
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$1,073,313 $38,880 $0 $3,500
Fresno Economic Opportunities Commision
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$1,124,381 $44,200 $2,800 $3,400
University of the Pacific
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$46,152 $8,400 $0 $0
Total Subcontracts
Other Costs
Dental Provider Entity Stipends
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
Office Assistant $2,100 - $2,600 13,792$
5,208$
5,208$
Systems & Procedures Analyst $5,500 - $6,000 3,719$
57,546$
Total Costs
Account Clerk $2,000 - $2,500 14,826$
Total Salary 52,312$
10,000.00$
Exhibit A Attachment I
Budget
Year III
01/01/2019 through 12/31/2019
Position Title Monthly Salary Range Annual Cost
Division Manager $7,500 - $8,000 9,884$
Staff Analyst $3,750 - $4,750 10,092$
47,546.00$
Fringe Benefits (75%)*39,234$
Total Personnel 91,546$
$128,245 $160,196 $1,404,134
Total Costs
2,944,398$
$139,500 $160,196 $1,474,477
Total Costs
$4,200 $7,035 $65,787
* Fresno County Public Health employees’ benefit rate includes Unemployment Insurance, Benefit Administration, OASDI, Health Insurance, and
Retirement. Retirement and Health Insurance are the primary contributors to a high benefit percentage. When the minimal amount for Benefit
Administration and Unemployment Insurance, and 7% for OASDI are included, the average benefit rate for these positions is just over 75%.
8,304$
3,107,003$
8,304$
LDPP
Page 6 of 8
Division Manager:
Office Assistant:
Staff Analyst:
Systems & Proced-
ures Analyst:
Information Techno-
logy Infrastructure:
Account Clerk:
Communications:
Other Costs:
Responsible for providing ancillary support mainly focusing on invoice processing from subcontractors
and tracking of dental provider training stipends as well as day-to-day activities of other staff.
Stipends are to be provided at an hourly rate of $42 per UOP training attendee. Fresno LDPP
anticipates two provider entities partaking in year two. This equates to 124 potential training hours at
$42 per hour ($5,208).
Indirect Costs:Fresno County Department of Public Health's Federally approved Indirect Cost rate of 15.873% of
salary.
Media campaign to include TV, Radio, Print, and Digital. Development and production of educational
materials.
Exhibit A Attachment I
Budget Narrative
Year III
01/01/2019 through 12/31/2019
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct
and indirect supervision of project design, implementation, contract compliance, quality assurance,
budget adherence and program outcomes.
Responsible for report generation, subcontract development, performance monitoring, IT
implementation and development.
Responsible for the development, implementation, and maintenance of the LDPP's Information
Technology Infrastructure.
License and maintenance fees for IT system and data management.
Responsible for reviewing invoices submitted by subcontractors, maintaining adherence to budget, and
preparing invoices for submittal to DHCS.
LDPP
Page 7 of 8
Personnel
# of Staff FTE %
1 0.1
1 0.2
1 0.5
1 0.05
1 0.5
Operating Expenses
Information Technology Infrastructure
Communications
Total Operating Expenses
Subcontracts
Reading and Beyond - HSE
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$1,156,762 $38,880 $0 $3,500
Fresno Economic Opportunities Commision
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$1,207,052 $46,000 $2,800 $3,400
University of the Pacific
Personnel Operating Expenses Travel Equipment Indirect Costs Other Costs
$33,062 $8,400 $0 $0
Total Subcontracts
Other Costs
Dental Provider Entity Stipends
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
* Fresno County Public Health employees’ benefit rate includes Unemployment Insurance, Benefit Administration, OASDI, Health Insurance, and
Retirement. Retirement and Health Insurance are the primary contributors to a high benefit percentage. When the minimal amount for Benefit
Administration and Unemployment Insurance, and 7% for OASDI are included, the average benefit rate for these positions is just over 75%.
Office Assistant $2,100 - $2,600 14,205$
Systems & Procedures Analyst $5,500 - $6,000 3,830$
$50,702
58,497$
Total Costs
Account Clerk $2,000 - $2,500 15,122$
Total Salary 53,533$
10,000.00$
Exhibit A Attachment I
Budget
Year IV
01/01/2020 through 12/31/2020
Position Title Monthly Salary Range Annual Cost
Division Manager $7,500 - $8,000 10,081$
Staff Analyst $3,750 - $4,750 10,294$
48,497.00$
Fringe Benefits (75%)*40,150$
Total Personnel 93,683$
3,192$
3,192$
$130,850 $172,651 $1,502,643
Total Costs
3,129,548$
$144,300 $172,651 $1,576,203
Total Costs
$4,200 $5,040
8,497$
3,293,417$
8,497$
LDPP
Page 8 of 8
Division Manager:
Staff Analyst:
Office Assistant:
Systems & Proced-
ures Analyst:
Information Techno-
logy Infrastructure:
Account Clerk:
Communications:
Other Costs:
Responsible for providing ancillary support mainly focusing on invoice processing from subcontractors
and tracking of dental provider training stipends as well as day-to-day activities of other staff.
Stipends are to be provided at an hourly rate of $42 per UOP training attendee. Fresno LDPP
anticipates two provider entities partaking in year two. This equates to 76 potential training hours at
$42 per hour ($3,192).
Indirect Costs:Fresno County Department of Public Health's Federally approved Indirect Cost rate of 15.873% of
salary.
Media campaign to include TV, Radio, Print, and Digital. Development and production of educational
materials.
Exhibit A Attachment I
Budget Narrative
Year IV
01/01/2020 through 12/31/2020
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct
and indirect supervision of project design, implementation, contract compliance, quality assurance,
budget adherence and program outcomes.
Responsible for report generation, subcontract development, performance monitoring, IT
implementation and development.
Responsible for the development, implementation, and maintenance of the LDPP's Information
Technology Infrastructure.
License and maintenance fees for IT system and data management.
Responsible for reviewing invoices submitted by subcontractors, maintaining adherence to budget, and
preparing invoices for submittal to DHCS.
Reading and Beyond - HSE
Page 1 of 8
Personnel
# of Staff FTE %
1 0.5
2 1
2 1
12 1
Operating Expenses
Facility Rental
Office Furniture
Office Supplies
Communications
Printer/Copier
Projectors/Projector Screens
Program Supplies
Total Operating Expenses
Equipment
VOIP Telephone System/Server
Laptops
Total Equipment Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Other Costs
Training
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
60,000$
50,000$
210,000$
134,375$
Total Salary
Fringe Benefits (34%)
342,500$
116,450$
458,950$ Total Personnel
34,650$
33,000$
10,800$
29,200$
5,200$
Exhibit B Attachment I
Budget
Year I
07/01/2017 through 12/31/2017
Program Director
Annual CostPosition Title Monthly Salary Range
$7,000 - $8,000 22,500$
3,500$
Provider Relations Representative
Outreach Oral Health Educator
Project Coordinator $4,500 - $5,500
$4,000 - $4,500
$2,500 - $3,500
2,925$
18,600$
18,500$
35,075$
19,440$
16,575$
Operating Expenses
-$
3,500$
68,500$
719,840$
68,500$
Reading and Beyond - HSE
Page 2 of 8
Program Director:
Project Coordinator:
Outreach Oral Health
Educators:
Facility Rental:
Office Furnature:
Office Supplies:
Communications:
Program Supplies:
VOIP Telephone
System/Server:
Laptops:
Printer Copier:
Projector/Screen:
Travel:
Training:
Indirect Expense:
General and consumable supplies needed for outreach, recruitment and retention of clients and dentists to participate in the
program. Meeting and training supplies.
Provider Relations
Representative:
Recruit, train, enroll, retain, and build strong relationships with Dental Providers to participate in the Denti-Cal Program.
Providing in-services and continuing education to the dental and medical community.
Coordinates all activities with Project Director on program implementation and administration of project plan. Oversees day
to day activities of Outreach Health Educators. Will provide information and education to ensure implementation of work
plan activities. Oversees day to day activities of Outreach Health Educators and provide assistance in problem solving and
goal setting to meet high quality standards.
Year 1 begin with 12 Educators, Year 2 increase to 13 Educations, Year 3 increase to 14 Educators, and Year 4 increase to 15
Educators. Recruit, train, enroll, retain and build strong relationships with families and clients. Referral and facilitating
appointments to the dental providers and establish dental homes.
Office space rent for for staff.
Desks with overhead cabinets, office chairs, guest chairs, training tables, training chairs, filing cabinets, book shelves for staff,
white boards.
Landline connections, Internet and WiFi connections, servers, cell phones.
Office and consumable supplies such as papers, pens, notepads, toners, folders, desk trays, folders, binders, electrocal cords,
extension cords.
Year I
07/01/2017 through 12/31/2017
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
Calculated at 20% of wages - to contribute towards Reading and Beyond's documented administrative and overhead costs.
VOIP Telephone System and Server for the office needed to communicate with staff, clients and all day to day activities of the
program.
17 laptops/Surface Pro for all staff. These equipment need to be portable and be carried to the actual sites of clients/provider
locations to gather data and help with enrollment with Denti-Cal and scheduling appointments with providers.
For scanning, faxing and printing.
2 portable projectors and 2 TVs for training and presentations inside the facility and outside training for inservices,
recruitment.
Mileage to and from meetings, recruitment of clients and providers, implementation of project.
Training and conference fees required to implement project.
Exhibit B Attachment I
Budget Narrative
Reading and Beyond - HSE
Page 3 of 8
Personnel
# of Staff FTE %
1 0.5
2 1
2 1
13 1
Operating Expenses
Facility Rental
Office Supplies
Communications
Laptops
Program Supplies
Total Operating Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Other Costs
Training
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
Exhibit B Attachment I
Budget
Year II
01/01/2018 through 12/31/2018
Position Title Monthly Salary Range Annual Cost
Program Director $7,000 - $8,000 46,350$
Project Coordinator $4,500 - $5,500 123,600$
Provider Relations Representative $4,000 - $4,500 103,000$
Outreach Oral Health Educator $2,500 - $3,500 468,650$
Total Salary 741,600$
Fringe Benefits (34%)252,144$
Total Personnel 993,744$
71,379$
10,800$
24,050$
125,804$
975$
18,600$
38,880$
Operating Expenses
-$
3,500$
148,320$
1,310,248$
148,320$
3,500$
Reading and Beyond - HSE
Page 4 of 8
Program Director:
Project Coordinator:
Outreach Oral Health
Educators:
Facility Rental:
Office Supplies:
Communications:
Program Supplies:
Laptops:
Travel:
Training:
Indirect Costs:
Budget Narrative
Exhibit B Attachment I
Year II
01/01/2018 through 12/31/2018
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
Coordinates all activities with Project Director on program implementation and administration of project plan. Oversees day
to day activities of Outreach Health Educators. Will provide information and education to ensure implementation of work
plan activities. Oversees day to day activities of Outreach Health Educators and provide assistance in problem solving and
goal setting to meet high quality standards.
Provider Relations
Representative:
Recruit, train, enroll, retain, and build strong relationships with Dental Providers to participate in the Denti-Cal Program.
Providing in-services and continuing education to the dental and medical community.
Mileage to and from meetings, recruitment of clients and providers, implementation of project.
Training and conference fees required to implement project.
Calculated at 20% of wages - to contribute towards Reading and Beyond's documented administrative and overhead costs.
1 laptop and license for additional staff.
Year 1 begin with 12 Educators, Year 2 increase to 13 Educations, Year 3 increase to 14 Educators, and Year 4 increase to 15
Educators. Recruit, train, enroll, retain and build strong relationships with families and clients. Referral and facilitating
appointments to the dental providers and establish dental homes.
Office space rent for for staff
Office and consumable supplies such as papers, pens, notepads, toners, folders, desk trays, folders, binders, electrocal cords,
extension cords,
Landline connections, Internet and WiFi connections, servers, cell phones
General and consumable supplies needed for outreach, recruitment and retention of clients and dentists to participate in the
program. Meeting and training supplies.
Reading and Beyond - HSE
Page 5 of 8
Personnel
# of Staff FTE %
1 0.5
2 1
2 1
14 1
Operating Expenses
Facility Rental
Office Supplies
Communications
Laptops
Program Supplies
Total Operating Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Other Costs
Training
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
975$
18,600$
73,520$
10,800$
24,350$
Exhibit B Attachment I
Budget
Year III
01/01/2019 through 12/31/2019
Position Title Monthly Salary Range Annual Cost
Program Director $7,000 - $8,000 47,741$
Project Coordinator $4,500 - $5,500 127,308$
Provider Relations Representative $4,000 - $4,500 106,090$
Outreach Oral Health Educator $2,500 - $3,500 519,841$
Total Salary 800,980$
Fringe Benefits (34%)272,333$
Total Personnel 1,073,313$
38,880$
128,245$
Operating Expenses
-$
3,500$
160,196$
1,404,134$
160,196$
3,500$
Reading and Beyond - HSE
Page 6 of 8
Program Director:
Project Coordinator:
Outreach Oral Health
Educators:
Facility Rental:
Office Supplies:
Communications:
Program Supplies:
Laptops:
Travel:
Training:
Indirect Costs:
01/01/2019 through 12/31/2019
Exhibit B Attachment I
Budget Narrative
Year III
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
Coordinates all activities with Project Director on program implementation and administration of project plan. Oversees day
to day activities of Outreach Health Educators. Will provide information and education to ensure implementation of work
plan activities. Oversees day to day activities of Outreach Health Educators and provide assistance in problem solving and
goal setting to meet high quality standards.
Provider Relations
Representative:
Recruit, train, enroll, retain, and build strong relationships with Dental Providers to participate in the Denti-Cal Program.
Providing in-services and continuing education to the dental and medical community.
Year 1 begin with 12 Educators, Year 2 increase to 13 Educations, Year 3 increase to 14 Educators, and Year 4 increase to 15
Educators. Recruit, train, enroll, retain and build strong relationships with families and clients. Referral and facilitating
appointments to the dental providers and establish dental homes.
Mileage to and from meetings, recruitment of clients and providers, implementation of project.
Training and conference fees required to implement project.
Calculated at 20% of wages - to contribute towards Reading and Beyond's documented administrative and overhead costs.
Office space rent for for staff.
Office and consumable supplies such as papers, pens, notepads, toners, folders, desk trays, folders, binders, electrocal cords,
extension cords.
Landline connections, Internet and WiFi connections, servers, cell phones.
General and consumable supplies needed for outreach, recruitment and retention of clients and dentists to participate in the
program. Meeting and training supplies.
1 laptop and license for additional staff.
Reading and Beyond - HSE
Page 7 of 8
Personnel
# of Staff FTE %
1 0.5
2 1
2 1
15 1
Operating Expenses
Facility Rental
Office Supplies
Communications
Laptops
Program Supplies
Total Operating Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Other Costs
Training
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
975$
18,600$
75,725$
10,800$
24,750$
Exhibit B Attachment I
Budget
Year IV
01/01/2020 through 12/31/2020
Position Title Monthly Salary Range Annual Cost
Program Director $7,000 - $8,000 49,173$
Project Coordinator $4,500 - $5,500 131,127$
Provider Relations Representative $4,000 - $4,500 109,273$
Outreach Oral Health Educator $2,500 - $3,500 573,682$
Total Salary 863,255$
Fringe Benefits (34%)293,507$
Total Personnel 1,156,762$
38,880$
130,850$
Operating Expenses
-$
3,500$
172,651$
1,502,643$
172,651$
3,500$
Reading and Beyond - HSE
Page 8 of 8
Program Director:
Project Coordinator:
Outreach Oral Health
Educators:
Facility Rental:
Office Supplies:
Communications:
Program Supplies:
Laptops:
Travel:
Training:
Indirect Costs:
01/01/2020 through 12/31/2020
Exhibit B Attachment I
Budget Narrative
Year IV
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
Coordinates all activities with Project Director on program implementation and administration of project plan. Oversees day
to day activities of Outreach Health Educators. Will provide information and education to ensure implementation of work
plan activities. Oversees day to day activities of Outreach Health Educators and provide assistance in problem solving and
goal setting to meet high quality standards.
Provider Relations
Representative:
Recruit, train, enroll, retain, and build strong relationships with Dental Providers to participate in the Denti-Cal Program.
Providing in-services and continuing education to the dental and medical community.
Year 1 begin with 12 Educators, Year 2 increase to 13 Educations, Year 3 increase to 14 Educators, and Year 4 increase to 15
Educators. Recruit, train, enroll, retain and build strong relationships with families and clients. Referral and facilitating
appointments to the dental providers and establish dental homes.
Mileage to and from meetings, recruitment of clients and providers, implementation of project.
Training and conference fees required to implement project.
Calculated at 20% of wages - to contribute towards Reading and Beyond's documented administrative and overhead costs.
Office space rent for for staff.
Office and consumable supplies such as papers, pens, notepads, toners, folders, desk trays, folders, binders, electrocal cords,
extension cords.
Landline connections, Internet and WiFi connections, servers, cell phones.
General and consumable supplies needed for outreach, recruitment and retention of clients and dentists to participate in the
program. Meeting and training supplies.
1 laptop and license for additional staff.
Fresno Economic Opportunities Commission - HSE
Page 1 of 8
Personnel
# of Staff FTE %
1 0.5
2 1
2 1
12 1
Operating Expenses
Facility Rental
Office Supplies
Communications
Printer/Copier
Projectors and TV Monitors
Program Supplies
Office Furniture
Total Operating Expenses
Equipment
VOIP Telephone System/Server
Laptops
Total Equipment Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Other Costs
Training
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
* Fringe Benefits calculated at a variable rate fo 36-40% to take into account different classification's benefit package.
Program Director $7,000 - $8,000 22,500$
Project Coordinators $4,500 - $5,500 60,000$
Provider Relations Representative $4,000 - $4,500 50,000$
Outreach Oral Health Educator $2,500 - $3,500 210,000$
Exhibit B Attachment II
Budget
Year I
07/01/2017 through 12/31/2017
Position Title Monthly Salary Range Annual Cost
Total Salary 342,500$
Fringe Benefits (38%)*129,066$
34,000$
3,000$
3,000$
39,600$
6,000$
29,313$
9,600$
20,300$
Operating Expenses
-$
Total Personnel 471,566$
124,513$
41,800$
68,500.00$
3,400$
18,000$
23,800$
3,400$
68,500$
730,079$
Fresno Economic Opportunities Commission - HSE
Page 2 of 8
Program Director:
Project Coordinator:
Outreach Oral Health
Educators:
Facility Rental:
Office Supplies:
Communications:
Program Supplies:
Office Furniture
VOIP Telephone
System/Server:
Projectors and TV
Monitors:
Laptops:
Printer/Copier:
Travel:
Training:
Indirect Costs:
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
Recruit, train, enroll, retain, and build strong relationships with Dental Providers to participate in the Denti-Cal Program.
Providing in-services and continuing education to the dental and medical community.
Desks with overhead cabinets, office chairs, guest chairs, training tables, training chairs, filing cabinets, book shelves for staff,
white boards.
Exhibit B Attachment II
Budget Narrative
Year I
07/01/2017 through 12/31/2017
VOIP Telephone System and Server for the office needed to communicate with staff, clients and all day to day activities of the
program.
Coordinates all activities with Project Director on program implementation and administration of project plan. Oversees day
to day activities of Outreach Health Educators. Will provide information and education to ensure implementation of work
plan activities. Oversees day to day activities of Outreach Health Educators and provide assistance in problem solving and
goal setting to meet high quality standards.
Provider Relations
Representative:
Year 1 begin with 12 Educators, Year 2 increase to 13 Educations, Year 3 increase to 14 Educators, and Year 4 increase to 15
Educators. Recruit, train, enroll, retain and build strong relationships with families and clients. Referral and facilitating
appointments to the dental providers and establish dental homes.
20% of Personnel excluding Fringe Benefits.
2 portable projectors and 2 TVs for training and presentations inside the facility and outside training for inservices,
recruitment.
17 laptops/Surface Pro for all staff. These equipment need to be portable and be carried to the actual sites of clients/provider
locations to gather data and help with enrollment with Denti-Cal and scheduling appointments with providers.
For scanning, faxing and printing.
Mileage to and from meetings, recruitment of clients and providers, implementation of project.
Training and conference fees required to implement project.
Office space rent for for staff.
Office and consumable supplies such as papers, pens, notepads, toners, folders, desk trays, folders, binders, electrocal cords,
extension cords.
Landline connections, Internet and WiFi connections, servers, cell phones.
General and consumable supplies needed for outreach, recruitment and retention of clients and dentists to participate in the
program. Meeting and training supplies.
Fresno Economic Opportunities Commission - HSE
Page 3 of 8
Personnel
# of Staff FTE %
1 0.5
2 1
2 1
13 1
Operating Expenses
Facility Rental
Office Supplies
Communications
Program Supplies
Office Furniture
Total Operating Expenses
Equipment
Laptops
Total Equipment Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Other Costs
Training
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
* Fringe Benefits calculated at a variable rate fo 36-40% to take into account different classification's benefit package.
84,000$
12,000$
25,200$
12,000$
1,500$
Exhibit B Attachment II
Budget
Year II
01/01/2018 through 12/31/2018
Position Title Monthly Salary Range Annual Cost
Program Director $7,000 - $8,000 46,350$
Project Coordinators $4,500 - $5,500 123,600$
Provider Relations Representative $4,000 - $4,500 103,000$
Outreach Oral Health Educator $2,500 - $3,500 468,650$
Total Salary 741,600$
Fringe Benefits (36%)270,031$
Total Personnel 1,011,631$
134,700$
2,800$
42,400$
Operating Expenses
-$
3,400$
148,320$
1,343,251$
148,320$
3,400$
2,800$
Fresno Economic Opportunities Commission - HSE
Page 4 of 8
Program Director:
Project Coordinator:
Outreach Oral Health
Educators:
Facility Rental:
Office Supplies:
Communications:
Program Supplies:
Office Furniture
Laptops:
Travel:
Training:
Indirect Costs:
Budget Narrative
Exhibit B Attachment II
General and consumable supplies needed for outreach, recruitment and retention of clients and dentists to participate in the
program. Meeting and training supplies
Year II
01/01/2018 through 12/31/2018
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
Coordinates all activities with Project Director on program implementation and administration of project plan. Oversees day
to day activities of Outreach Health Educators. Will provide information and education to ensure implementation of work
plan activities. Oversees day to day activities of Outreach Health Educators and provide assistance in problem solving and
goal setting to meet high quality standards.
Provider Relations
Representative:
Recruit, train, enroll, retain, and build strong relationships with Dental Providers to participate in the Denti-Cal Program.
Providing in-services and continuing education to the dental and medical community.
Year 1 begin with 12 Educators, Year 2 increase to 13 Educations, Year 3 increase to 14 Educators, and Year 4 increase to 15
Educators. Recruit, train, enroll, retain and build strong relationships with families and clients. Referral and facilitating
appointments to the dental providers and establish dental homes.
Office space rent for for staff
Office and consumable supplies such as papers, pens, notepads, toners, folders, desk trays, folders, binders, electrocal cords,
extension cords,
Landline connections, Internet and WiFi connections, servers, cell phones
20% of Personnel excluding Fringe Benefits.
Training and conference fees required to implement project
Desks with overhead cabinets and office chair for additional staff
1 laptop and license for additional staff
Mileage to and from meetings, recruitment of clients and providers, implementation of project.
Fresno Economic Opportunities Commission - HSE
Page 5 of 8
Personnel
# of Staff FTE %
1 0.5
2 1
2 1
14 1
Operating Expenses
Facility Rental
Office Supplies
Communications
Program Supplies
Office Furniture
Total Operating Expenses
Equipment
Laptops
Total Equipment Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Other Costs
Training
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
* Fringe Benefits calculated at a variable rate fo 36-40% to take into account different classification's benefit package.
Exhibit B Attachment II
Budget
Year III
01/01/2019 through 12/31/2019
Position Title Monthly Salary Range Annual Cost
Program Director $7,000 - $8,000 47,741$
Project Coordinators $4,500 - $5,500 127,308$
Provider Relations Representative $4,000 - $4,500 106,090$
Outreach Oral Health Educator $2,500 - $3,500 519,841$
Operating Expenses
-$
Total Salary 800,980$
Fringe Benefits (40%)323,401$
Total Personnel 1,124,381$
2,800$
160,196$
139,500$
2,800$
44,200$
3,400$
1,474,477$
3,400$
160,196$
88,800$
12,000$
25,200$
12,000$
1,500$
Fresno Economic Opportunities Commission - HSE
Page 6 of 8
Program Director:
Project Coordinator:
Outreach Oral Health
Educators:
Facility Rental:
Office Supplies:
Communications:
Office Furniture
Laptops:
Travel:
Training:
Indirect Costs:
Office and consumable supplies such as papers, pens, notepads, toners, folders, desk trays, folders, binders, electrocal cords,
extension cords,
Exhibit B Attachment II
Budget Narrative
Year III
01/01/2019 through 12/31/2019
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
Coordinates all activities with Project Director on program implementation and administration of project plan. Oversees day
to day activities of Outreach Health Educators. Will provide information and education to ensure implementation of work
plan activities. Oversees day to day activities of Outreach Health Educators and provide assistance in problem solving and
goal setting to meet high quality standards.
Provider Relations
Representative:
Recruit, train, enroll, retain, and build strong relationships with Dental Providers to participate in the Denti-Cal Program.
Providing in-services and continuing education to the dental and medical community.
Year 1 begin with 12 Educators, Year 2 increase to 13 Educations, Year 3 increase to 14 Educators, and Year 4 increase to 15
Educators. Recruit, train, enroll, retain and build strong relationships with families and clients. Referral and facilitating
appointments to the dental providers and establish dental homes.
Office space rent for for staff
Training and conference fees required to implement project
20% of Personnel excluding Fringe Benefits.
Landline connections, Internet and WiFi connections, servers, cell phones
Desks with overhead cabinets and office chair for additional staff
1 laptop and license for additional staff
Mileage to and from meetings, recruitment of clients and providers, implementation of project.
Fresno Economic Opportunities Commission - HSE
Page 7 of 8
Personnel
# of Staff FTE %
1 0.5
2 1
2 1
15 1
Operating Expenses
Facility Rental
Office Supplies
Communications
Program Supplies
Office Furniture
Total Operating Expenses
Equipment
Laptops
Total Equipment Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Other Costs
Training
Total Other Costs
Indirect Costs
Indirect Costs
Annual Budget Total
* Fringe Benefits calculated at a variable rate fo 36-40% to take into account different classification's benefit package.
93,600$
12,000$
25,200$
12,000$
1,500$
Exhibit B Attachment II
Budget
Year IV
01/01/2020 through 12/31/2020
Position Title Monthly Salary Range Annual Cost
Program Director $7,000 - $8,000 49,173$
Project Coordinators $4,500 - $5,500 131,127$
Provider Relations Representative $4,000 - $4,500 109,273$
Outreach Oral Health Educator $2,500 - $3,500 573,682$
Total Salary 863,255$
Fringe Benefits (40%)343,797$
Total Personnel 1,207,052$
Operating Expenses
-$
172,651$
144,300$
2,800$
46,000$
3,400$
172,651$
3,400$
2,800$
1,576,203$
Fresno Economic Opportunities Commission - HSE
Page 8 of 8
Program Director:
Project Coordinator:
Outreach Oral Health
Educators:
Facility Rental:
Office Supplies:
Communications:
Program Supplies:
Office Furniture
Laptops:
Travel:
Training:
Indirect Costs:
Office and consumable supplies such as papers, pens, notepads, toners, folders, desk trays, folders, binders, electrocal cords,
extension cords,
Exhibit B Attachment II
Budget Narrative
Year IV
01/01/2020 through 12/31/2020
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
Coordinates all activities with Project Director on program implementation and administration of project plan. Oversees day
to day activities of Outreach Health Educators. Will provide information and education to ensure implementation of work
plan activities. Oversees day to day activities of Outreach Health Educators and provide assistance in problem solving and
goal setting to meet high quality standards.
Provider Relations
Representative:
Recruit, train, enroll, retain, and build strong relationships with Dental Providers to participate in the Denti-Cal Program.
Providing in-services and continuing education to the dental and medical community.
Year 1 begin with 12 Educators, Year 2 increase to 13 Educations, Year 3 increase to 14 Educators, and Year 4 increase to 15
Educators. Recruit, train, enroll, retain and build strong relationships with families and clients. Referral and facilitating
appointments to the dental providers and establish dental homes.
Office space rent for for staff
Training and conference fees required to implement project
20% of Personnel excluding Fringe Benefits.
Landline connections, Internet and WiFi connections, servers, cell phones
General and consumable supplies needed for outreach, recruitment and retention of clients and dentists to participate in the
program. Meeting and training supplies
Desks with overhead cabinets and office chair for additional staff
1 laptop and license for additional staff
Mileage to and from meetings, recruitment of clients and providers, implementation of project.
University of the Pacific
Page 1 of 8
Personnel
# of Staff FTE %
1 0.02
1 0.06
2 0.16
Program Content Expert 1 0.07
1 0.03
1 0.07
Operating Expenses
Training/Meeting Expenses
Total Operating Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Indirect Costs
Indirect Costs
Annual Budget Total *
* See Page 39, Section 5.3 of LDPP Proposal for explanation of UOP's budget formulary.
Total Salary 55,757$
Exhibit B Attachment III
Budget
Year I
07/01/2017 through 12/31/2017
Position Title Monthly Salary Range Annual Cost
Project Director $20,000 - $22,250 5,576$
Director of Operations $7,250 - $7,500 5,576$
Program Manager $7,250 - $7,501 27,878$
Contracts Manager
$5,250 - $5,750
2,788$ $6,500 - $7,000
Assistant Project Manager 5,576$
$10,000 - $11,000 8,363$
Operating Expenses
-$
11,151$
96,904$
Fringe Benefits (31.2%)
Total Personnel
17,396$
73,153$
4,200$
4,200$
11,151$
8,400$
University of the Pacific
Page 2 of 8
Project Director:
Director of
Operations:
Program Manager:
Prgram Content
Expert:
Contracts Manager:
Assistant
Projects Manager:
Will oversee communications and implementation with providers and sites.
Will schedule and track deliverables, reporting, training and monitoring activities.
Will be responsible for contracts, expenses, reporting systems.
Will be responsible for technical training and assistance on data systems and equipment.
Exhibit B Attachment III
Budget Narrative
Year I
07/01/2017 through 12/31/2017
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
Provide expert consultation on scientific, dental practice, and operational workflow integration.
University of the Pacific
Page 3 of 8
Personnel
# of Staff FTE %
1 0.04
1 0.11
2 0.29
Program Content Expert 1 0.12
1 0.06
1 0.12
Operating Expenses
Training/Meeting Expenses
Total Operating Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Indirect Costs
Indirect Costs
Annual Budget Total *
* See Page 39, Section 5.3 of LDPP Proposal for explanation of UOP's budget formulary.
Exhibit B Attachment III
Budget
Year II
01/01/2018 through 12/31/2018
Position Title Monthly Salary Range Annual Cost
Project Director $20,000 - $22,250 6,867$
Director of Operations $7,250 - $7,500 6,867$
Assistant Project Manager $5,250 - $5,750 6,867$
Total Salary 68,672$
Program Manager $7,250 - $7,501 34,336$
Contracts Manager $6,500 - $7,000 3,434$
$10,000 - $11,000 10,301$
Total Personnel 90,098$
4,200$
4,200$
Fringe Benefits (31.2%)21,426$
119,232$
11,200$
Operating Expenses
-$
13,734$
13,734$
University of the Pacific
Page 4 of 8
Project Director:
Director of
Operations:
Program Manager:
Prgram Content
Expert:
Contracts Manager:
Assistant
Projects Manager:
Will be responsible for technical training and assistance on data systems and equipment.
Will oversee communications and implementation with providers and sites.
Will schedule and track deliverables, reporting, training and monitoring activities.
Provide expert consultation on scientific, dental practice, and operational workflow integration.
Will be responsible for contracts, expenses, reporting systems.
Exhibit B Attachment III
Budget Narrative
Year II
01/01/2018 through 12/31/2018
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
University of the Pacific
Page 5 of 8
Personnel
# of Staff FTE %
1 0.02
1 0.06
2 0.15
Program Content Expert 1 0.06
1 0.03
1 0.06
Operating Expenses
Training/Meeting Expenses
Total Operating Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Indirect Costs
Indirect Costs
Annual Budget Total *
* See Page 39, Section 5.3 of LDPP Proposal for explanation of UOP's budget formulary.
Exhibit B Attachment III
Budget
Year III
01/01/2019 through 12/31/2019
Position Title Monthly Salary Range Annual Cost
Project Director $20,000 - $22,250 3,518$
Director of Operations $7,250 - $7,500 3,518$
Program Manager $7,250 - $7,501 17,588$
Contracts Manager $6,500 - $7,000 1,759$
$10,000 - $11,000 5,276$
8,400$
Assistant Project Manager $5,250 - $5,750 3,518$
Total Salary 35,177$
Fringe Benefits (31.2%)10,975$
Total Personnel 46,152$
4,200$
4,200$
Operating Expenses
-$
7,035$
65,787$
7,035$
University of the Pacific
Page 6 of 8
Project Director:
Director of
Operations:
Program Manager:
Prgram Content
Expert:
Contracts Manager:
Assistant
Projects Manager:
Will be responsible for technical training and assistance on data systems and equipment.
Will oversee communications and implementation with providers and sites.
Will schedule and track deliverables, reporting, training and monitoring activities.
Provide expert consultation on scientific, dental practice, and operational workflow integration.
Will be responsible for contracts, expenses, reporting systems.
Exhibit B Attachment III
Budget Narrative
Year III
01/01/2019 through 12/31/2019
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
University of the Pacific
Page 7 of 8
Personnel
# of Staff FTE %
1 0.02
1 0.04
2 0.11
Program Content Expert 1 0.04
1 0.02
1 0.05
Operating Expenses
Training/Meeting Expenses
Total Operating Expenses
Travel (At CalHR Reimbursement Rates)Total Travel
Subcontracts
Name
Personnel Travel Subcontracts Indirect Costs Total Costs
Total Subcontracts
Indirect Costs
Indirect Costs
Annual Budget Total *
Exhibit B Attachment III
Budget
Year IV
01/01/2020 through 12/31/2020
Position Title Monthly Salary Range Annual Cost
Program Manager $7,250 - $7,501 12,600$
Project Director $20,000 - $22,250 2,520$
Director of Operations $7,250 - $7,500 2,520$
8,400$
Assistant Project Manager $5,250 - $5,750 2,520$
Total Salary 25,200$
Fringe Benefits (31.2%)7,862$
Total Personnel 33,062$
4,200$
4,200$
1,260$ $6,500 - $7,000Contracts Manager
$10,000 - $11,000 3,780$
Operating Expenses
-$
5,040$
50,702$
5,040$
* See Page 39, Section 5.3 of LDPP Proposal for explanation of UOP's budget formulary.
University of the Pacific
Page 8 of 8
Project Director:
Director of
Operations:
Program Manager:
Prgram Content
Expert:
Contracts Manager:
Assistant
Projects Manager:
Will be responsible for technical training and assistance on data systems and equipment.
Will be responsible for contracts, expenses, reporting systems.
Exhibit B Attachment III
Budget Narrative
Year IV
01/01/2020 through 12/31/2020
Oversees and coordinates all activities with collaborative partners and stakeholders. Provides direct and indirect supervision
of project design, implementation, contract compliance, quality assurance, budget adherence and program outcomes.
Will oversee communications and implementation with providers and sites.
Will schedule and track deliverables, reporting, training and monitoring activities.
Provide expert consultation on scientific, dental practice, and operational workflow integration.