REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 15, 2022
FROM
JOSHUA DUGAS, Director, Department of Public Health
SUBJECT
Title
Amendments to Contracts for Medical Care and Support Services under the Ending the HIV Epidemic Program
End
RECOMMENDATION(S)
Recommendation
Approve amendments to the following contracts to provide medical care and support services under the Ending the HIV Epidemic Program, revising the scope of work and budgets, decreasing the combined contract amounts by $2,442,554, from $6,901,200 to $4,458,646, and shortening the termination date by two years for a total contract period of October 28, 2020 through February 28, 2023:
1. AIDS Healthcare Foundation, Amendment No. 2 to Contract No. 20-1065, decreasing the contract by $83,599, from $411,939 to $328,340.
2. Borrego Community Health Foundation, Amendment No. 2 to Contract No. 20-1066, decreasing the contract by $1,114,555 from $1,894,593 to $780,038.
3. Desert AIDS Project dba DAP Health, Amendment No. 3 to Contract No. 20-1067, decreasing the contract by $461,262, from $1,917,000 to $1,455,738.
4. Foothill AIDS Project, Amendment No. 3 to Contract No. 20-1068, decreasing the contract by $465,303, from $1,447,297 to $981,994.
5. Young Scholars for Academic Empowerment dba TruEvolution, Inc., Amendment No. 3 to Contract No. 20-1069, decreasing the contract by $317,835, from $1,230,371 to $912,536.
(Presenter: Joshua Dugas, Director, 387-9146)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The amendments reflect an increase of $652,097 for program year 2022-23 based on the allocation and approved carryover funds; however, there is an overall net decrease of $2,442,554 in funding due to the early termination of the contracts. Medical care and support services are funded by the United States Department of Health and Human Services, Health Resources and Services Administration (HRSA) under the Ending the HIV Epidemic (EHE) Program. Adequate appropriation and revenue have been included in Department of Public Health (DPH’s) 2022-23 budget.
BACKGROUND INFORMATION
The EHE Program seeks to achieve the important goal of reducing new HIV infections in the United States to less than 3,000 per year by 2030. Across the United States, the initiative promotes and implements four Pillars to substantially reduce HIV transmissions: Diagnose, Treat, Prevent, and Respond. This funding is for the Transitional Grant Area (TGA), which includes the combined counties of San Bernardino and Riverside, focusing on implementing activities in Pillar Two (Treat) and Pillar Four (Respond). Agencies are required to engage in activities that support Pillars Two and Four to expand access to HIV care and treatment for people with HIV who are newly diagnosed, not engaged in care, and/or not virally suppressed; and addressing unmet needs and improving client-level health outcomes. In addition, agencies are required to address and respond quickly to HIV cluster detection efforts for those needing HIV care and treatment.
HRSA launched the EHE Program initiative in 2019 to reduce HIV infections by scaling up key HIV prevention and treatment strategies. Efforts to reach the goal of reducing HIV infections and delivering additional services has been hindered by the COVID-19 pandemic due to the restrictions regarding seeing clients in-person, immunocompromised HIV+ clients being wary about going out in public to receive services, the barriers to telehealth, and the limitations of outreach. Many local agencies were unable to reach clients and/or spend down funds.
Based on the recommendation from the HRSA EHE project officer, and in consultation with County Counsel, a new procurement for the EHE Program is being conducted and will focus on Pillar Two services. Services under Pillar Two include strategies to reach individuals who are infected with HIV, link them to care and treatment, and re-engage those who have stopped receiving care and/or treatment. HIV treatment not only preserves the health of people with HIV but also reduces HIV transmission. This Pillar aims to treat people with HIV rapidly after diagnosis to help achieve and maintain viral suppression. Since DPH does not have access to data needed to pursue activities under Pillar Four the focus will remain on Pillar Two. It is hoped this effort will increase and expand services via the expansion of service-providing agencies. It is anticipated that additional providers will apply and respond to the formal solicitation to provide the needed services and therefore increase both expenditures and vital service provision to clients. All providers were given prior notice of the changing contracts, and many are anticipated to participate in the new solicitation.
The recommended amendments adjust the expiration date of the contracts to February 28, 2023. This allows the remaining two years of funding to be used for the new procurement for EHE. In addition, the amendments reflect changes based on the final award allocation for Program Year 2022-23 and HRSA-approved carryover funds for Desert AIDS Project and Borrego Community Health Foundation. The scope of work and budgets were adjusted accordingly.
Contractor performance will be measured by review of monthly reporting, review of required data submission, and an annual site visit by County staff to monitor compliance with the administrative, program, and fiscal terms and conditions of the contract, with special attention to the payer of last resort requirement.
PROCUREMENT
On October 27, 2020 (Item No. 65), as a result of a formal procurement, the Board of Supervisors (Board) approved contracts with the agencies listed in the Recommendation, in the combined amount of $1,800,000, to provide medical care and support services under the Ending the HIV Epidemic: A Plan for America Program, for the period of October 28, 2020 through February 28, 2022.
On July 27, 2021 (Item No. 35), the Board approved Amendment No. 1 to the contracts with the agencies listed in the Recommendation, increasing the combined contract amount by $5,101,200 from $1,800,000 to $6,901,200, extending the term an additional three years, for the total contract period of October 28, 2020 through February 28, 2025.
On December 7, 2021 (Item No. 35), the Board approved Amendment No. 2 to Desert AIDS Project, Foothill AIDS Project, and Young Scholars for Academic Empowerment dba TruEvolution, Inc. contracts, revising the scope of work and budget to allow carryover adjustment in the amount of $222,916, for the program year of March 1, 2021 through February 28, 2022, with no change to the total contract amount of $4,594,668 or contract period of October 28, 2020 through February 28, 2025.
REVIEW BY OTHERS
This item has been reviewed by Human Services Contracts (Patty Steven, Contracts Manager, 388-0241) on October 20, 2022; County Counsel (Adam Ebright, Deputy County Counsel, 387-5455) on October 20, 2022; Finance (Paul Garcia, Administrative Analyst, 386-8392) on October 31, 2022; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on October 31, 2022.