DEPARTMENT: Health
DEPARTMENT HEAD: Jennifer Herriott, MPH
COUNCIL DISTRICTS IMPACTED: Citywide
SUBJECT:
Authorizing the annual State of Texas Grant Funding for FY 2021 including the submission of (18) renewal applications and the acceptance of funds upon award; authorizing the execution of an agreement with the University of Texas Health Science Center at San Antonio (UTHSCSA) for an amount up to $160,000.00 for a term commencing September 1, 2020 and ending August 31, 2021 with options to renew for two, one-year terms; and, authorizing the Director of Metro Health to execute Memoranda of Agreement (MOA) that enhance program services with no exchange of funds associated with these grant-funded projects, including Data Use Agreements and Business Associate Agreements.
SUMMARY:
This ordinance authorizes the annual submission of 18 grant renewal applications and the acceptance of funds upon award in an estimated amount of $14,252,070.00 from the Texas Department of State Health Services (DSHS) for public health functions of the San Antonio Metropolitan Health District (Metro Health) for a period beginning July 1, 2020 through December 31, 2021. Metro Health’s participation in these 18 state grant programs serve a legitimate public purpose in that this funding will promote and provide needed public health functions throughout the community.
For the 18 grant renewals, this action also authorizes the finalization of programmatic budgets, incidental expenditures for grant program participants, and a personnel complement of 153 grant funded positions for the maintenance and delivery of essential public health services within Metro Health as reflected in Attachment I. Temporary support is included in the current budget and will be redirected to personnel if approved by the grantor. In addition, this ordinance authorizes the Director of Metro Health to initiate, negotiate, and execute any and all necessary documents and grant contracts to effectuate the application and acceptance of the referenced grants, and to execute contract amendments pertaining to these contracts, to include: a) carry-over funds, when ascertained and approved by the funding agency through a revised notice of award; b) line item budget revisions authorized by the funding agency; c) modifications to the performance measures authorized by the funding agency and listed in the contracts so long as the terms of the amendment stay within the general parameters of the intent of the grant; d) no cost extensions; e) amendments which will provide supplemental grant funds to a grant by the funding agency in an amount up to 20% of the total amount initially awarded to the grant; f) reimbursement increases of administrative funds for each participant served; g) amendments funding one time equipment purchases or defined program services; and h) changes in state regulations mandated by the funding agency.
Furthermore, this ordinance authorizes the execution of an agreement funded by one of these DSHS grant awards: an agreement with the University of Texas Health Science Center at San Antonio (UTHSCSA) School of Dentistry for an amount up to $160,000.00 for a term commencing September 1, 2020 and ending August 31, 2021 with options to renew for two, one-year terms, for a total amount up to $480,000.00 inclusive of renewals, funded by the Title V Dental - Oral Health grant;
Finally, this ordinance authorizes the Director of Metro Health to execute Memoranda of Agreement (MOA) that enhance program services with no exchange of funds associated with these grant-funded projects, including Data Use Agreements and Business Associate Agreements.
BACKGROUND INFORMATION:
As the public health authority for Bexar County, Metro Health actively addresses the public health functions of policy development, health assessment, and health assurance. To carry out these responsibilities, Metro Health operates evidenced based programs in various settings throughout the County. These 18 DSHS grant awards support 153 grant-funded positions which will account for 35% of the total number of Metro Health staff (429 positions) as adopted through the City’s annual budget for FY 2020. The Department provides services to residents at public health settings and service locations located throughout the City and Bexar County. With State grant support, Metro Health provides preventive health services, community education, limited clinical services to prevent communicable diseases, emergency preparedness, disease control, supplemental nutrition programs, and dental health services.
Metro Health receives approximately 32% of its total budget support through these 18 contract and grant awards from the State of Texas in both direct funding and federal pass-through funding. Since 2007, this support has been authorized by City Council through a block submission of state grant applications and renewals, most recently on February 14, 2019 (Ordinance 2019-02-14-0118) as well as individual actions. Metro Health will request $14,252,070.00 in funding from DSHS through this ordinance.
Service delivery and personnel complement needs are anticipated to remain consistent with the adopted DSHS FY 2020 budgets for the following State and Federal pass through grants:
• Local Immunizations
• Federal STD
• HIV Surveillance
• Federal TB
• State TB
• TB Waiver Project
• Surveillance Epidemiology
• State Milk Sample Lab Testing Program
• State Flu Surveillance
• WIC (2 awards)
• Triple O
• Title V Dental
• Exhale (Asthma)
• Public Health Emergency Preparedness (PHEP) Bioterrorism Preparedness
• PHEP Cities Readiness Initiative
• PHEP Lab
This action will authorize a total of 153 grant positions which aligns with the number of positions authorized by DSHS for FY 2021. Temporary support is included in the current budget and will be redirected to personnel if approved by the grantor. A list of the grantors, grant amounts and CFDA numbers is attached as Table 1.
The application amount authorized by this ordinance of $14,252,070.00 represents a $910,500.00 increase over the current State and federal pass-through FY 2020 funding. Final amounts will be determined by State Agencies and may result in higher or lower amounts.
Additionally, the Department requests the authorization of a contract funded with DSHS grant award monies. The contract will be funded by Title V Dental - Oral Health grant in the amount of $160,000.00. Metro Health’s Oral Health Program works to provide preventive dental services such as sealants and fluoride treatments to school-aged children for the prevention of dental caries (tooth decay). Often, children served through Metro Health’s Oral Health program are identified as having significant untreated decay that requires extensive dental treatment beyond the scope of services provided by Metro Health’s Oral Health Program. The agreement with UTHSCSA School of Dentistry will be for the provision of direct patient care and will ensure pediatric patients identified by Metro Health, which are either uninsured or underinsured, have access to critical dental health services.
Frequently Metro Health requests City Council authorize agreements with agencies for the provision of services relating to Metro Health programs and projects. Many times these agreements do not include the exchange of funds between the City and these agencies; however, the execution of these agreements does require City Council action. The Department requests authorization for the Director of Metro Health to execute MOAs, to include Data Use Agreements and Business Associate Agreements, with no exchange of funds that enhance programs or services associated with these grant-funded projects.
ISSUE:
Historically, the State of Texas has provided funding to the City of San Antonio for service delivery in health and disease prevention. Currently, this includes 18 program grants and contracts through the Texas Department of State Health Services.
State and federal funding opportunities are often presented in a time-sensitive manner, requiring the ability to initiate and execute grant submissions, amendments and subsequent awards within prescribed time constraints. Approval of this ordinance allows for a proactive and efficient process for the timely submission and execution of state/federal funding requests. This comprehensive approach maximizes Metro Health, City administration, and City Council resources; expedites the annual support process; coordinates Metro Health’s annual funding processes; and provides City Council with a concise illustration of grant support and Metro Health programs.
Acceptance of funds from the State of Texas continues the long-standing practice of utilizing grant funds to support some of the local public health programs of the City.
ALTERNATIVES:
Approval of this ordinance will facilitate the efficient application for and acceptance of ongoing grants from the State of Texas and leads to seamless continuity of Metro Health services.
Alternatively, each of the grants and the agreements could be submitted separately to City Council. This would require individual Council consideration, action, time and processing causing potential delays in funding, resources and service delivery. Alleviating inefficient processing delays allows personnel and City resources to be utilized proactively, effectively and efficiently to advance the public health efforts of the Department.
FISCAL IMPACT:
This ordinance authorizes the submission of 18 annual grant renewal applications with the State of Texas in an amount of $14,252,070.00 in funding and authorizes acceptance of any prior year carry-forward support, as allowed by the funding agency.
These 18 grant awards will support 153 grant-funded positions. The City will provide an estimated $299,854.00 of contribution services from the General Fund to these grants.
Furthermore, this ordinance authorizes the execution of an agreement with the UTHCSA School of Dentistry funded by the Title V Dental - Oral Health grant in an amount up to $160,000.00 with options to renew for two, one-year terms, for a total amount up to $480,000.00 inclusive of renewals; and, it authorizes the execution of MOAs with no exchange of funds that enhance programs and services associated with these projects, funded by the State of Texas grants.
RECOMMENDATION:
Staff recommends approval of an ordinance 1) authorizing the submission of 18 annual grant renewal applications to the State of Texas totaling $14,252,070.00, acceptance of funds upon award, approval of the proposed budgets and personnel complement, execution of grant contracts and the Director of Metro Health to execute certain grant contract amendments, 2) authorizing the execution of an agreement with the UTHCSA School of Dentistry for an amount up to $160,000.00 with options to renew for two, one-year terms, for a total amount up to $480,000.00 inclusive of renewals, and 3) authorizing the Director of Metro Health to execute MOA’s that enhance programs and services where there is no exchange of funds associated with these grant projects.