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Health and Human Services Agency (HHSA) and the Chief Administrative Office (CAO) recommending the Board:
1) Approve and authorize the transfer of existing Emergency Preparedness and Response program functions related to Public Health Emergency Preparedness (PHEP), which includes the Cities Readiness Initiative (CRI) as a component of the PHEP Program, and Pandemic Influenza Planning (Pan Flu) grants from the CAO to HHSA Public Health Division (PHD), effective July 1, 2024;
2) Adopt and authorize the Chair to sign Resolution 061-2024, amending Resolution 042-2023, related to the delegation of authority to administer grant funds for the PHEP and Pan Flu programs pursuant to the grant agreement; and administer and execute future amendments, if any, and execute required fiscal and programmatic reports related to the PHEP and Pan Flu grant awards, effective July 1, 2024; and
3) Adopt and authorize the Chair to sign Personnel Allocation Resolution 062-2024, authorizing the additions of the following allocations in HHSA:
a) One (1.0) Full Time Equivalent (FTE) Supervising Health Education Coordinator allocation;
b) One (1.0) FTE Health Educator allocation;
c) One (1.0) FTE Fiscal Technician allocation; and
d) One (1.0) FTE Accountant I/II allocation;
4) Approve and adopt the department-specific classification of Emergency Medical Services Manager; and
5) Adopt and authorize the Chair to sign Personnel Allocation Resolution 063-2024, authorizing a change in classifications in the CAO as a result of the transfer of the Emergency Preparedness and Response programs:
a) Approve the Job Class Number, bargaining unit, and salary range for the new Emergency Medical Services Manager classification;
b) Add 1.0 FTE Emergency Medical Services Manager allocation to the CAO and delete a vacant 1.0 FTE Manager of Emergency Medical Services and Preparedness and Response Programs allocation; and
c) Abolish the Manager of Emergency Medical Services and Preparedness and Response Programs classification.
FUNDING: State of California Department of Public Health Grants: PHEP, CRI, and Pan Flu.
Body
DISCUSSION / BACKGROUND:
Board Policy K-3 offers guidance to County departments regarding Emergency Management, focusing on ensuring the continuity of County services and safeguarding the well-being of both employees and the public during emergencies. Specifically, the policy designates the Chief Administrative Officer as the individual responsible for overseeing the implementation of the County's Emergency Management Policy across government departments.
On January 29, 2019, the Board authorized the reorganization of the County’s Emergency Preparedness and Response (EPR) program and the Emergency Medical Services (EMS) program and authorized the transfer of these two programs from HHSA to the CAO, to help ensure coordination between emergency preparedness, emergency medical services, and the many independent districts that provide fire and emergency response services within the County (File ID: 19-0022).
On March 7, 2023, the Board adopted Resolution 042-2023, presented by the CAO EMS and EPR, which delegated the authority to the Chief Administrative Officer, or any Assistant or Deputy Chief Administrative Officer, to accept and authorize the execution of retroactive Grant Agreement 22-10645 with the CDPH, which included the following EPR and EMS grants: (1) Public Health Emergency Preparedness (PHEP) where CRI is a component of PHEP, (2) Hospital Preparedness Program (HPP), and (3) Pandemic Influenza (Pan Flu). These grants and funding in agreement are currently housed and administered by in the CAO EMS Agency for the period of July 1, 2022, through June 30, 2027 (File ID: 23-0237)
In December 2023, CAO and HHSA leadership began having conversations surrounding EPR activities, and mutually determined that the Emergency Preparedness grants (PHEP, CRI and Pan Flu) and related programmatic activities should be transferred from the CAO to HHSA PHD. This transition aligns with several preparedness and response functions currently under the authority of HHSA’s Public Health Division (PHD), including but not limited to: (1) communicable disease and vaccine preventable disease mitigation; and (2) surge response responsibility for established or novel infectious disease outbreaks along with integrated population level health hazard/wellness response/educational services. Further, it was realized that the integration of PHEP program functions to HHSA PHD also presents opportunities for enhanced coordination with both local hospital population focused services, corresponding coordination with County Managed Care Plans, expanded response capability, blended funding and communication efficiencies. These benefits enhance population level interventions that serve and augment protection of County residents from health hazards. It is important to note that the HPP grant, related Hospital Preparedness activities, and programmatic oversight thereof would remain with the CAO.
Subsequently, in January 2024 during the department presentations, the CAO and HHSA Director informed the Board of Supervisors of the benefits in transitioning a portion of the EPR Division including PHEP, CRI and Pan Flu operations to HHSA PHD. Presently, all EPR activities are managed by the CAO through activities focusing on building community resilience and general disaster preparedness through public education and guided response. HHSA PHD and the CAO EMS and EPR Division anticipate a minimal transfer of fixed assets related to this reorganization, which is anticipated to include a trailer to support the PHEP, CRI and Pan Flu program transition.
Consequently, to align with this transition, HHSA is recommending that the Board sign a new Resolution, amending Resolution 042-2023, related to the delegation of authority to administer grant funds for the PHEP and Pan Flu programs pursuant to the grant agreement, and administer and execute future amendments, if any, and execute required fiscal and programmatic reports related to the PHEP and Pan Flu grant awards, effective July 1, 2024.
In collaboration with Human Resources, HHSA is recommending the Board to approve the Personnel Allocations for the addition of 1.0 FTE Supervising Health Education Coordinator, 1.0 FTE Health Educator, 1.0 FTE Fiscal Technician, and 1.0 FTE Accountant I/II to support the transition of PHEP, CRI and Pan Flu programs to HHSA. The request of a Fiscal Technician and Accountant I/II allocation is to assist HHSA not only with the administration of the Preparedness grants, but is in response to the overall increase in HHSA managed grants and restricted funding. The HHSA Administration and Fiscal Division hasn’t had an increase in fiscal staff allocations in many years, but the workload has increased significantly. The number of grants and funding sources have increased, which triggers an increase in vendor contracts, payables, grant management, fiscal reporting, audits, program staff payroll, purchase requests, travel and training, etc. Additional processes have also increased such as taking on purchase contracts and increasing accounts payable processes. The increase in workloads have contributed to an increase in staff turnover. The two fiscal positions will be funded through HHSA’s Indirect Cost Rate Plan. The addition of the two fiscal-focused allocations will increase the ability of HHSA to effectively administer grant funding, including the Preparedness Grants.
The CAO EMS and EPR Division currently has a Manager of Emergency Medical Services and Preparedness and Response Programs allocation. Due the movement of the Preparedness Programs to HHSA, this classification is no longer appropriate. The CAO has worked with the Human Resources Department to develop the new classification of Emergency Medical Services Manager. The CAO is recommending Board adopt the new classification specification and approve a Resolution to delete and abolish the vacant Manager of Emergency Medical Services and Preparedness and Response Programs allocation and add an Emergency Medical Services Manager allocation to the Chief Administrative Office.
ALTERNATIVES:
Should the Board choose to decline the transfer of PHEP, CRI and Pan Flu operation and associated funding to HHSA PHD, anticipated enhancement and efficiencies would be forfeited. The existing operations structure would remain within the CAO.
Additionally, the Board could choose not to approve the Personnel Allocation changes proposed in the two Resolutions.
PRIOR BOARD ACTION:
1) 01/29/19, 19-0022, CAO EMS Preparedness Transfer
2) 10/20/20, 20-1294, CAO EMS/EP Transfer to General Fund
3) 12/08/20, 20-1536, CAO EMS/EP - BT Correction (Tfr to GF)
4) 08/24/21, 21-1325, HR EMS Specialist Class Spec Update
5) 01/03/23, 22-2113, CAO EMS/EP - Transfer of Grant Signature Authority
6) 03/07/23, 23-0237, CAO EMS, PHEP, HPP & Pan Flu 5-Year CDPH Grant Agreement
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel has reviewed the Resolutions that were developed in concert with Human Resources.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
Base funding for PHEP, CRI and Pan Flu activities is estimated to be $205,243. Grant receivership would default to HHSA Public Health Division. A Public Health Division 2024-25 supplemental budget has been developed itemized as follows; PHEP CDPH funding $205,243; CRI CDPH funding $50,904; Pan Flu CDPH funding $66,319; Realignment $130,000.
The addition of 1.0 FTE Supervising Health Education Coordinator has an estimated annual cost increase to the Public Health budget of $110,000, 1.0 FTE Health Educator has an estimated annual cost increase to the Public Health budget of $119,000, 1.0 FTE Fiscal Technician has an estimated annual cost increase to the HHSA Admin and Finance budget of $99,260, and 1.0 FTE Accountant I/II allocation has an estimated annual cost increase to the HHSA Admin and Finance budget of $116,600. There are sufficient appropriations in the Fiscal Year 2024-25 Budget to cover the addition of these positions and will be included in future budgets.
The deletion of the vacant Manager of Emergency Medical Services and Preparedness and Response Programs allocation and addition of an Emergency Medical Services Manager allocation to the CAO could increase Salaries and Benefits costs by $2,000. This position is primarily funded through County Service Area 3 and 7 EMS funding.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
1) Obtain signature of Chair on Resolutions, if approved;
2) If signed, provide one (1) certified Signature Authority Resolution to HHSA-Contracts at 3057 Briw Rd; and
3) If signed, provide one (1) certified Personnel Allocation Resolution to HHSA-Contracts at 3057 Briw Rd and one (1) certified Personnel Allocation Resolution to Heather Andersen in Human Resources at 330 Fair Lane.
STRATEGIC PLAN COMPONENT:
This agenda item contributes to the workforce excellence and safe and healthy communities goals.
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency
Sue Hennike, Assistant Chief Administrative Officer