HomeMy WebLinkAboutMINUTES - 12061994 - 1.8 (2) TO: BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Services Director
#4 - "l` Contra
By: Elizabeth A. Spooner, Contracts Administrator COSta
DATE: November 17, 1994 County
SUBJECT: Approve Agreement #29-395-12 with the State Department of Health Services
for County's AIDS Drug Program
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Health Services Director, or his designee (William
Walker, M.D. ) , to execute on behalf of the County, Agreement #29-395-12 with the
State Department of Health Services, Office of AIDS, for the period from October
1, 1994 through September 30, 1995, in the amount of $193,756, for the County's
AIDS Drug Assistance Program.
II. FINANCIAL IMPACT:
Approval of this agreement will result in an allocation of $193,756 from the State
for County's AIDS Drug Program, for the period from October 1, 1994 through
September 30, 1995.
The allocation will be used to cover the cost of certain drugs for eligible low
income persons with AIDS and/or AIDS related complexes, and may not be used to
cover administrative costs associated with this program or for patient monitoring,
laboratory testing, or other medical services for persons receiving any of the
drugs. The County may make provisions for co-payment by patients, commensurate
with the patient's ability to pay.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
On March 16, 1993, the Board approved Standard Agreement #29-395-8, (as amended
by Amendment Agreements #29-395-9, #29-395-10 and #29-395-11, which provided
funding through September 30, 1994) with the State Office of AIDS, to cover the
cost of certain drugs which have, been included in the AIDS Drug Program by the
State and determined by the U.S. Food and Drug Administration to prolong the life*.
of a person with AIDS, for eligible low income persons who are infected with ..the'
human immunodeficiency virus (HIV) and/or persons with AIDS and related complexes::.:;
who meet certain criteria.
Approval of this agreement provides funding for County's AIDS Drug Program, based
upon actual and projected drug expenditures by the Department, through September
30, 1995.
Four certified and sealed copies of the Board Order should be returned to the
Contracts and Grants Unit for distribution to the State Department of Health
r
Services.
CONTINUED ON ATTACHMENT: YES SIGNATURE: Q
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEN �10OF BOARD COIGITTEE
APPROVE OTHER
SIGNATURE(S) /
ACTION OF BOARD ONBEE { APPROVED AS RECOMMENDED ✓ OTHER
VOTE OF SUPERVISORS
J UNANIMOUS (ABSENT + ) 1 HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN.
Contact: Wendel Brunner, M.D. (313-6712) ®�C `
6 Ono
CC: Health Services Dept. (Contracts) ATTESTED _
Phil Batchelor, Clerk offtth�mn
eBoard of
supwim y
M382/7.83 BY "�J DEPUTY
Standard Agreement for
AIDS Drug Assistance Program
October 1, 1994 - September 30, 1995
Local Health Jurisdiction
CONTRA COSTA COUNTY
The State of California by and through the Department of Health Services (hereinafter called the
Department) and the Local Health Jurisdictio f CONTRA COSTA COUNTY (hereinafter called the
Local Jurisdiction) in consideration of th given , ts, agreements, and stipulations hereinafter expressed
or hereby agree as follows: ,
A,
Article I
1. The funds allocated pursuant to this Agreement are for the cost of providing any drug included in
the AIDS Drug Assistance Program (ADAP) by the Department. This includes drugs currently
provided by ADAP and any drugs to be included in ADAP in the future. All ADAP drugs shall be
approved for use by the Food & Drug Administration (FDA) for persons infected with human
immunodeficiency virus (HIV), or included by the Department because of the medical community
acceptance of a drug as a successful therapy used for the management of HIV disease.
2. For the purposes of this Agreement, drugs currently provided by the ADAP are listed in Exhibit A,
"AIDS Drug Assistance Program Approved Drugs", and incorporated herein, and made part hereof
by this reference.
3. The term of this Agreement is for the period October 1, 1 pugh September 30, 1995.
4. The maximum allocation to the Local Health Jurit o e term of this Agreement shall not
exceed $193,756.
5. The eligibility criteria for individuals who particip, in ADAP is based on the criteria-as follows:
a. A person must provide a valid prescription for the drug which has been signed by a physician
licensed to practice medicine in California;
b. Meet established medical criteria set for the use of each drug;
C. Meet the income criteria established by the Department and provide proof that he/she meets
the income criteria; and
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d. The individual must not be covered for drugs under Medi-Cal or a third party insurance
company. Exceptions are:
(1) ADAP may be used if the enrollee is covered by Medi-Cal but:
(a) is unable to pay the share of cost identified by Medi-Cal or
(b) the number of allowable Medi-Cal prescriptions has been exhausted and a treatment
authorization request (TAR) is denied or delayed.
(2) ADAP funds may also be used to pay for drug costs not covered by an enrollee's
insurance if the enrollee meets all other eligibility criteria.
6. Financial criteria include:
a. Individuals whose annual adjusted gross income is below 400% of the federal poverty level
guidelines will receive the drug at no cost.
b. Individuals whose annual adjusted gross income is between 400%.of the federal poverty level
guidelines and $50,000 will have a payment obligation that is the lesser of the following:
(1) two times their annual state income tax liability, less funds expended by the person for
health insurance premiums, or
(2) the cost of the drugs.
7. Drugs included by the Department in the ADAP shall be provided to eligible individuals according
to the "AIDS Drug Assistance Program Advisory Committee" recommendations and
recommendations made part hereof by this reference ("AIDS Drug Assistance Program Approved
Drugs", Exhibit A). Any exception to these recommendations shall be made upon acceptance of
written justification of medical necessity provided by the eligible individuals' attending physician.
Article II
1. The Local Jurisdiction shall adhere to all State instructions, guidelines or directives pertaining to:
1) the provision of any drug which has been included in ADAP by the Department; and 2) allocation
of funds for the cost of ADAP drugs purchased for distribution to eligible persons; and 3) collection
of co-payments from individuals with annual adjusted gross incomes in excess of 400% of the
Federal poverty level. Guidelines for the implementation of the AIDS Drug Assistance Program are
specified in Department of Health Services, Office of AIDS, AIDS Drug Assistance Program
Guidelines -DRAFT, (October 1, 1994), which are incorporated and made a part hereof by this
reference.
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2. AIDS Drug Assistance Program Guidelines - DRAFT, (October 1, 1994), shall be adhered to in
implementing the AIDS Drug Assistance Program by Local Jurisdictions and are made part hereof
this Agreement. The Local Jurisdiction shall comply with any revisions to these guidelines. Any
changes and/or additions to these guidelines will be made in writing and notification of such changes
shall be made 30 days prior to implementation. Any costs in performing such activities incurred by
Local Jurisdictions shall be addressed in a Standard Agreement amendment which the Local
Jurisdiction shall negotiate with the Department in good faith. Administrative costs associated with
such changes are not reimbursable.
3. The Local Jurisdiction shall verify the enrollee's income on an annual basis. Individuals applying
for eligibility shall provide their most recent California tax return, Form 540, "California Resident
Income Tax Return", or proof of income for determination of their annual adjusted gross income.
If an individual did not file a state tax return and his/her income is more that 400% of the Federal
poverty level, the individual shall fill out a "AIDS Drug Assistance Program Financial Eligibility
and Co-Payment Worksheet" which will be used to determine eligibility and/or obligation for
payment for drug(s). Exhibit B, is incorporated and made a part hereof by this reference.
4. The Local Jurisdiction agrees that the funds will be used for the payment of drugs which have been
included in ADAP by the Department. The Local Jurisdiction may not use these funds to cover
administrative costs associated with this program, nor for patient monitoring, laboratory testing or
other medical services for persons receiving any of the approved drugs.
5. The maximum amount payable under this Agreement as specified in paragraph 4 of Article I shall
be subject to the conditions specified in paragraphs 5 and 6 of Article III set forth herein. The
Department reserves the sole right to amend this contract to make the adjustments specified in
paragraph 11 of Article III.
6. The Local Jurisdiction shall submit cost/expenditure reports containing information on-the cost of
drugs provided and the number of prescriptions. This information shall be submitted in a format
prescribed by the Department as displayed in Exhibit C, "AIDS Drug Assistance Program Invoice
Form", consisting of one page and made a part hereof by this reference. This report shall be
submitted no later than 30 calendar days after the last day of each month.
7. The Local Jurisdiction shall provide all required statistical and demographic data necessary for the
maintenance of this program. This information shall be submitted in the format prescribed by the
Department as displayed in Exhibit D, "AIDS Drug Assistance Program Report", consisting of one
page and made a part hereof by this reference. This report shall be submitted no more than 30
calendar days after the last day of each month. The Department reserves the right to require each
Local Jurisdiction to provide the reports on a computerized disk. The Department also reserves the
right to require each Local Jurisdiction to adopt a statewide computer program for compiling these
reports. These requirements may be made at any time during the length of the Standard Agreement
upon a 30 day notification from the Department.
8. The Local Jurisdiction shall provide, on request, a verification of the actual cost of the drug(s) with
the invoices submitted. A copy of the invoice received from the drug wholesaler or entity from
which the drug was purchased shall be retained by the Local Jurisdiction and surrendered to the
State on request.
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9. All invoices for expenditures and statistical reports, copies verifying actual cost of drugs, and other
official communications shall be mailed to:
Department of Health Services
Office of AIDS
AIDS Drug Assistance Program
P.O. Box 942732
Sacramento, CA 94234-7320
10. The Local Jurisdiction agrees to maintain necessary program records documenting the drugs
provided, identification of persons enrolled in the program, periods of enrollment, and fiscal
expenditures made under this Agreement. Records shall be maintained for at least three (3) years
from the end of the state fiscal year during which this Agreement is terminated, or from the dates
the final expenditure reports to the Federal Government are submitted for costs incurred or until the
termination of all state and federal audits, whichever is later.
11. The Local Jurisdiction agrees to provide access during normal working hours to authorized
representatives of the Department and of other state and federal agencies to all records, files, and
documentation related to this Agreement, subject to applicable state and federal laws concerning
confidentiality.
12. The Local Jurisdiction shall be liable for all federal and state funds allocated under this Agreement,
including but not limited to, any audit exceptions that may arise. The Local Jurisdiction shall submit
repayment of any funds not spent for the cost of providing any approved drug, or for persons who
did not meet the income eligibility guidelines, or for overcharges of the drug(s), or any amount that
the Department assesses the Local Jurisdiction will not expend from their allocation within 30 days
of written notification from the State.
13. If it appears the Local Jurisdiction will not expend the entire amount of its allocation under this
Agreement, the State may redistribute any projected unexpended funds of the Local Jurisdiction's
allocation to other Local Jurisdictions. The Department shall notify the Local Jurisdiction in writing
30 days prior to any changes in the Local Jurisdiction's allocation.
14. The Local Jurisdiction agrees to maintain the confidentiality of patients who apply for eligibility
under this program.
15. The Local Jurisdiction agrees to the provisions as stated in the attached Exhibit E, entitled
"Nondiscrimination Clause". The Local Jurisdiction and its subcontractors shall not unlawfully
discriminate against any employee or applicant for employment because of race, religion, color,
national origin, ancestry, physical handicap, medical condition, marital status, age (over 40), sex,
or sexual orientation. Exhibit E, consisting of one page is incorporated and made a part hereof by
this reference.
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Article III
1. The Department shall authorize the payments in arrears up to the maximum allocation of this
Agreement upon the execution of this Agreement if all previous allocations pursuant to the AIDS
Drug Assistance Program have been fully expended.
2. The Department will reimburse the Local Jurisdiction upon receipt of invoice forms, any amount
expended by the Local Jurisdiction for the provision of approved drugs, but not exceeding the
maximum amount reimbursable under this Agreement. Reimbursements to the Local Jurisdictions
will be contingent upon receipt of the AIDS Drug Assistance Program Invoice Form.
3. The Department of Health Services will reimburse the Contractor for approved drugs provided at
rates specified by the Department ("AIDS Drug Assistance Program Maximum Reimbursement
Amounts", Exhibit F) and incorporated herein and made a part hereof by this reference. Any new
drugs approved and added to the AIDS Drug Assistance Program shall be reimbursed at rates
specified by the Department in writing which will be made part hereof by Standard Agreement
amendment.
4. The Department shall recover any funds which are not expended in accordance with this Agreement.
Recovery of funds may be accomplished by withholding payments to the Local Jurisdiction,or upon
written notification from the State. The Local Jurisdiction shall submit repayment within 30 days
of receipt of that notification.
5. It is mutually understood between the parties that this Agreement may have been written before
ascertaining the availability of Federal or State funds for the mutual benefits of both parties in order
to avoid program delays which would occur if the contract were executed after that determination.
This Agreement is valid and enforceable only to the extent that sufficient funds are made available
to the State by the United States Government and or by the State, for the purposes of this program.
If sufficient federal and/or state funds are not made available pursuant to the Agreement, this
Agreement shall be invalid and of no further force and effect. In this event, the State shall have no
liability to pay any state funds whatsoever to the Local Jurisdiction, or furnish any other
considerations under this Agreement and the Local Jurisdiction shall not thereafter be obligated to
perform any duties of this Agreement.
6. The Department may expand or decrease the maximum income level for the income eligibility
criteria at any time during the project time period if it is determined the income criteria are too
stringent, too expansive, and cost reports and projections indicate possible non-expenditure or over
expenditure of the State's total allocation. The Department shall send written notification 30 days
prior to any changes in eligibility guidelines.
7. This Agreement is subject to any additional restrictions, limitations or conditions enacted by the
Congress or the State Legislature which may affect the provisions, terms or funding of this
Agreement in any manner.
8. The terms of this Agreement may be modified in writing upon mutual consent of both parties.
9. This Agreement may be terminated at any time without cause by either party by giving 30 days prior
written notice to the other. Notification shall state the effective date of the termination.
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10. Notice of the termination by the Local Jurisdiction shall be followed within 30 days by a final report
and a final claim for reimbursement, or repayment of funds disbursed but not expended and,
therefore, subject to recovery by the State.
11. An adjustment may be made on the allocation to increase the amount of the payments over the Local
Jurisdiction's maximum allocation if more funds become available. Adjustments may also be made
to decrease the payments if it is determined that the Local Jurisdiction will not expend its full
maximum allocation.
IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto.
State of California Local Health Jurisdiction
Signature Signature
Title Title
Date Date
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