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Item N2
BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: November 17, 2010 Bulk Item: Yes x No Division: Monroe County Health Department Staff Contact: Robert Eadie 809-5610 AGENDA ITEM WORDING: Approval of the contract between Monroe County Board of County Commissioners and the State of Florida, Department of Health for operation of the Monroe County Health Department — contract year 2010-2011. ITEM BACKGROUND: Review of annual contract and fee schedule for county funding of local health department. PREVIOUS RELEVANT BOCC ACTION: This is the annual renewal of an agreement between Monroe County and Florida Department of Health that has continued for 20+ years. CONTRACT/AGREEMENT CHANGES: Increase of $193,527 from 2009-2010 contract. STAFF RECOMMENDATIONS: Approval. TOTAL COST: $817 247.00 INDIRECT COST: BUDGETED: Yes X No COST TO COUNTY: $817,247.00 SOURCE OF FUNDS: REVENUE PRODUCING: Yes ��NLLo APPROVED BY: County Atty X DOCUMENTATION: Included X DISPOSITION: Revised 1/09 AMOUNT PER MONTH Year W/Purchasing Risk Management Not Required AGENDA ITEM # MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: MC Health Department Contract # Effective Date: October 1, 2010 Expiration Date: September 30, 2011 Contract Purpose/Description: Approval of the contract between Monroe County Board of Commissioners and The State of Florida, Department of Health _ for operation of the Monroe County Health Department Contract year 2010-2011 Contract Manager: Robert Eadie 809-5610 MC Health Department (Name) (Ext.) (Department/Stop #) for BOCC meeting on 11/17/2010 Agenda Deadline: 11/2/2010 CONTRACT COSTS Total Dollar Value of Contract: $ 817,247 Current Year Portion: $ Budgeted? Yes® No ❑ Account Codes: - - - Grant: $ 0 - - - County Match: $ - - - Estimated Ongoing Costs: $_ (Not included in dollar value above ADDITIONAL COSTS /yr For: utilities, janitorial, salaries, etc. CONTRACT REVIEW Changes Date Out Date In Needed Reviewer Division Director Yes[] No❑ Risk Managem nt O.M.B./Purchasing County Attorney qL iU a ICE �� � Yes❑ No❑ 6U d✓�L Yes[:] No Yes❑ No I ''~ jl d L Comments: OMB Form Revised 2/27/01 MCP #2 CONTRACT BETWEEN MONROE COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE MONROE COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2010-2011 This agreement ("Agreement") is made and entered into between the State of Florida, Department of Health ("State") and the Monroe County Board of County Commissioners ("County"), through their undersigned authorities, effective October 1, 2010. RECITALS A. Pursuant to Chapter 154, F.S., the intent of the legislature is to "promote, protect, maintain, and improve the health and safety of all citizens and visitors of this state through a system of coordinated county health department services." B. County Health Departments were created throughout Florida to satisfy this legislative intent through "promotion of the public's health, the control and eradication of preventable diseases, and the provision of primary health care for special populations." C. Monroe County Health Department ("CHD") is one of the County Health Departments created throughout Florida. It is necessary for the parties hereto to enter into this Agreement in order to assure coordination between the State and the County in the operation of the CHID. NOW THEREFORE, in consideration of the mutual promises set forth herein, the sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct and incorporated herein by reference. 2. TERM. The parties mutually agree that this Agreement shall be effective from October 1, 2010, through September 30, 2011, or until a written agreement replacing this Agreement is entered into between the parties, whichever is later, unless this Agreement is otherwise terminated pursuant to the termination provisions set forth in paragraph 8, below. 3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHID shall provide those services as set forth on Part III of Attachment II hereof, in order to maintain the following three levels of service pursuant to Section 154.01(2), Florida Statutes, as defined below: a. "Environmental health services" are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease. Environmental health services shall be supported by available federal, state and local funds and shall include those services mandated on a state or federal level. Examples of environmental health services include, but are not limited to, food hygiene, safe drinking water supply, sewage and solid waste disposal, swimming pools, group care facilities, migrant labor camps, toxic material control, radiological health, and occupational health. b. "Communicable disease control services" are those services which protect the health of the general public through the detection, control, and eradication of diseases which are transmitted primarily by human beings. Communicable disease services shall be supported by available federal, state, and local funds and shall include those services mandated on a state or federal level. Such services include, but are not limited to, epidemiology, sexually transmissible disease detection and control, HIV/AIDS, immunization, tuberculosis control and maintenance of vital statistics. c. "Primary care services" are acute care and preventive services that are made available to well and sick persons who are unable to obtain such services due to lack of income or other barriers beyond their control. These services are provided to benefit individuals, improve the collective health of the public, and prevent and control the spread of disease. Primary health care services are provided at home, in group settings, or in clinics. These services shall be supported by available federal, state, and local funds and shall include services mandated on a state or federal level. Examples of primary health care services include, but are not limited to: first contact acute care services; chronic disease detection and treatment; maternal and child health services; family planning; nutrition; school health; supplemental food assistance for women, infants, and children; home health; and dental services. 4. FUNDING. The parties further agree that funding for the CHD will be handled as follows: a. The funding to be provided by the parties and any other sources are set forth in Part 11 of Attachment 11 hereof. This funding will be used as shown in Part I of Attachment 11. i. The State's appropriated responsibility (direct contribution excluding any state fees, Medicaid contributions or any other funds not listed on the Schedule C) as provided in Attachment II, Part 11 is an amount not to exceed $ 3,930,423 (State General Revenue, Other State Funds and Federal Funds listed on the Schedule C). The State's obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. ii. The County's appropriated responsibility (direct contribution excluding any fees, other cash orlocal contributions) as provided in Attachment 11, Part II is an amount not to exceed $817,247 (amount listed under the 'Board of County Commissioners Annual Appropriations section of the revenue attachment). b. Overall expenditures will not exceed available funding or budget authority, whichever is less, (either current year or from surplus trust funds) in any service category. Unless requested otherwise, any surplus at the end of the term of this Agreement in the County Health Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period. 2 c. Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. As allowed by law, Monroe County Health Department has established Communicable disease control and Primary care services rates at 160% of the Medicare Fee Schedule, rounded up to the next whole dollar. Monroe County Health Department has established Environmental Health Services Fees in line with local recommendations and economic factors. d. Either party may increase or decrease funding of this Agreement during the term hereof by notifying the other party in writing of the amount and purpose for the change in funding. If the State initiates the increase/decrease, the CHD will revise the Attachment ll and send a copy of the revised pages to the County and the Department of Health, Bureau of Budget Management. If the County initiates the increase/decrease, the County shall notify the CHD. The CHD will then revise the Attachment II and send a copy of the revised pages to the Department of Health, Bureau of Budget Management. e. The name and address of the official payee to who payments shall be made is: County Health Department Trust Fund Monroe County 1100 Simonton Street PO Box 6193 Key West, FL 33041 5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the directorladmin istrator of the CHD shall be a State employee or under contract with the State and will be under the day-to-day direction of the Deputy State Health Officer. The director/administrator shall be selected by the State with the concurrence of the County. The director/administrator of the CHD shall insure that non -categorical sources of funding are used to fulfill public health priorities in the community and the Long Range Program Plan. A report detailing the status of public health as measured by outcome measures and similar indicators will be sent by the CHD director/administrator to the parties no later than October 1 of each year (This is the standard quality assurance "County Health Profile" report located on the Office of Planning, Evaluation & Data Analysis Intranet site). 6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that the following standards should apply in the operation of the CHD: a. The CHD and its personnel shall follow all State policies and procedures, except to the extent permitted for the use of county purchasing procedures as set forth in subparagraph b., below. All CHD employees shall be State or State -contract personnel subject to State personnel rules and procedures. Employees will report time in the Health Management System compatible format by program component as specified by the State. b. The CHD shall comply with all applicable provisions of federal and state laws and regulations relating to its operation with the exception that the use of county purchasing procedures shall be allowed when it will result in a better price or service and no statewide Department of Health purchasing contract has been implemented for those goods or services. In such cases, the CHD director/administrator must sign a justification therefore, and all county -purchasing procedures must be followed in their entirety, and such compliance shall be documented. Such justification and compliance documentation shall be maintained by the CHD in accordance with the terms of this Agreement. State procedures must be followed for all leases on facilities not enumerated in Attachment IV. c. The CHD shall maintain books, records and documents in accordance with those promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental Accounting Standards Board (GASB), and the requirements of federal or state law. These records shall be maintained as required by the Department of Health Policies and Procedures for Records Management and shall be open for inspection at any time by the parties and the public, except for those records that are not otherwise subject to disclosure as provided by law which are subject to the confidentiality provisions of paragraph G.i., below. Books, records and documents must be adequate to allow the CHD to comply with the following reporting requirements: The revenue and expenditure requirements in the Florida Accounting System Information Resource (FLAIR). ii. The client registration and services reporting requirements of the minimum data set as specified in the most current version of the Client Information System/Health Management Component Pamphlet; iii. Financial procedures specified in the Department of Health's Accounting Procedures Manuals, Accounting memoranda, and Comptroller's memoranda; iv. The CHD is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported to the CHD in a manner consistent with the client registration and service reporting requirements of the minimum data set as specified in the Client Information System/Health Management Component Pamphlet. d. All funds for the CHD shall be deposited in the County Health Department Trust Fund maintained by the state treasurer. These funds shall be accounted for separately from funds deposited for other CHDs and shall be used only for public health purposes in Monroe County. e. That any surplus/deficit funds, including fees or accrued interest, remaining in the County Health Department Trust Fund account at the end of the contract year shall be credited/debited to the state or county, as appropriate, based on the funds contributed by each and the expenditures incurred by each. Expenditures will be charged to the program accounts by state and county based on the ratio of planned expenditures in the core contract and funding from all sources is credited to the program accounts by state and county. The equity share of any surplus/deficit funds accruing to the state and county is 4 determined each month and at contract year-end. Surplus funds may be applied toward the funding requirements of each participating governmental entity in the following year. However, in each such case, all surplus funds, including fees and accrued interest, shall remain in the trust fund until accounted for in a manner which clearly illustrates the amount which has been credited to each participating governmental entity. The planned use of surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital projects explained in Attachment V. f. There shall be no transfer of funds between the three levels of services without a contract amendment unless the CHD director/administrator determines that an emergency exists wherein a time delay would endanger the public's health and the Deputy State Health Officer has approved the transfer. The Deputy State Health Officer shall forward written evidence of this approval to the CHD within 30 days after an emergency transfer. g. The CHD may execute subcontracts for services necessary to enable the CHD to carry out the programs specified in this Agreement. Any such subcontract shall include all aforementioned audit and record keeping requirements. h. At the request of either party, an audit may be conducted by an independent CPA on the financial records of the CHD and the results made available to the parties within 180 days after the close of the CHD fiscal year. This audit will follow requirements contained in OMB Circular A-133 and may be in conjunction with audits performed by county government. If audit exceptions are found, then the director/administrator of the CHD will prepare a corrective action plan and a copy of that plan and monthly status reports will be furnished to the contract managers for the parties. i. The CHD shall not use or disclose any information concerning a recipient of services except as allowed by federal or state law or policy. j. The CHD shall retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this Agreement for a period of five (5) years after termination of this Agreement. If an audit has been initiated and audit findings have not been resolved at the end of five (5) years, the records shall be retained until resolution of the audit findings. k. The CHD shall maintain confidentiality of all data, files, and records that are confidential under the law or are otherwise exempted from disclosure as a public record under Florida law. The CHD shall implement procedures to ensure the protection and confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65 and 456.057, Florida Statutes, and all other state and federal laws regarding confidentiality. All confidentiality procedures implemented by the CHD shall be consistent with the Department of Health Information Security Policies, Protocols, and Procedures, dated April 2005, as amended, the terms of which are incorporated herein by reference. The CHD shall further adhere to any amendments to the State's security requirements and shall comply with any applicable professional standards of practice with respect to client confidentiality. 5 I. The CHD shall abide by all State policies and procedures, which by this reference are incorporated herein as standards to be followed by the CHD, except as otherwise permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof. m. The CHD shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The CHD will advise applicants of the right to appeal a denial or exclusion from services, of failure to take account of a client's choice of service, and of his/her right to a fair hearing to the final governing authority of the agency. Specific references to existing laws, rules or program manuals are included in Attachment I of this Agreement. n. The CHD shall comply with the provisions contained in the Civil Rights Certificate, hereby incorporated into this contract as Attachment 111. o. The CHD shall submit quarterly reports to the county that shall include at least the following: i. The DE385L1 Contract Management Variance Report and the DE580L1 Analysis of Fund Equities Report; ii. A written explanation to the county of service variances reflected in the DE385L1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount. However, if the amount of the service specific variance between actual and planned expenditures does not exceed three percent of the total planned expenditures for the level of service in which the type of service is included, a variance explanation is not required. A copy of the written explanation shall be sent to the Department of Health, Bureau of Budget Management. p. The dates for the submission of quarterly reports to the county shall be as follows unless the generation and distribution of reports is delayed due to circumstances beyond the CHD's control: i. March 1, 2011 for the report period October 1, 2010 through December 31, 2010; ii. June 1, 2011 for the report period October 1, 2010 through March 31, 2011; iii. September 1, 2011 for the report period October 1, 2010 through June 30, 2011; and iv. December 1, 2011 for the report period October 1, 2010 through September 30, 2011. 7. FACILITIES AND EQUIPMENT. The parties mutually agree that: M a. CHD facilities shall be provided as specified in Attachment IV to this contract and the county shall own the facilities used by the CHD unless otherwise provided in Attachment IV. b. The county shall assure adequate fire and casualty insurance coverage for County - owned CHD offices and buildings and for all furnishings and equipment in CHD offices through either a self-insurance program or insurance purchased by the County. c. All vehicles will be transferred to the ownership of the County and registered as county vehicles. The county shall assure insurance coverage for these vehicles is available through either a self-insurance program or insurance purchased by the County. All vehicles will be used solely for CHD operations. Vehicles purchased through the County Health Department Trust Fund shall be sold at fair market value when they are no longer needed by the CHD and the proceeds returned to the County Health Department Trust Fund. d. Commencing October 1, 2010, the CHD will reimburse the County, on a monthly basis, the last day of each month, the sum of $5,500,00 per month, $66,000.00 per annum, for the facility leased at the request of the CHD located at 3134 Northside Drive, Building B, Key West, Florida. e. Pursuant to an inter -local agreement between the City of Key West and the County, the CHD will continue to operate a Primary Care Clinic and County Health Resource Center, known as the "Roosevelt Sands Center" located at the Douglass Community Center, 830 Emma Street, Key West, Florida. 8. TERMINATION. a. Termination at Will. This Agreement may be terminated by either party without cause upon no less than one -hundred eighty (180) calendar days notice in writing to the other party unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. b. Termination Because of Lack of Funds. In the event funds to finance this Agreement become unavailable, either party may terminate this Agreement upon no less than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. c. Termination for Breach. This Agreement may be terminated by one party, upon no less than thirty (30) days notice, because of the other party's failure to perform an obligation hereunder. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this Agreement. 9. MISCELLANEOUS. The parties further agree: N a. Availability of Funds. If this Agreement, any renewal hereof, or any term, performance or payment hereunder, extends beyond the fiscal year beginning July 1, 2011, it is agreed that the performance and payment under this Agreement are contingent upon an annual appropriation by the Legislature, in accordance with section 287.0582, Florida Statutes. b. Contract Managers. The name and address of the contract managers for the parties under this Agreement are as follows: For the State: For the County: Mary Vanden Brook Name Name Administrative Services Director Title Title PO Box 6193 Gato Building, 1100 Simonton St. Key West FL 33041 Address 305-809-5612 Telephone Address Telephone If different contract managers are designated after execution of this Agreement, the name, address and telephone number of the new representative shall be furnished in writing to the other parties and attached to originals of this Agreement. C. Captions. The captions and headings contained in this Agreement are for the convenience of the parties only and do not in any way modify, amplify, or give additional notice of the provisions hereof. In WITNESS THEREOF, the parties hereto have caused this ` I page agreement to be executed by their undersigned officials as duly authorized effective the T�'day of October, 2010. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR MONROE COUNTY DEPARTMENT OF HEALTH SIGNED BY: NAME: TITLE: DATE: ATTESTED TO: SIGNED BY: NAME: TITLE: 17:111A fOONROE COUNTY ATTORNEY A P OVE-r- AS �Y���'i3lA A SSIS"IuANT CC)UNTY ATTORNEY SIGNED BY: NAME: Ana M. Vlamonte Ros, M.D., M.P.H. TITLE: State Surgeon General DATE; SIGNED BY: NAME: Robert Eadie J.D. TITLE: CHD Director/Administrator DATE: 19:4;a 7 We] Itil110004K A. PURPOSE, To establish public health service fees in order to expand existing public health services to the community at large. B. PRIMARY CARE SERVICES. (1) Primary care services include well and sick adult and child health services and family planning services. These services will be charged at not more than 160% of the prevailing Medicare rate. Where there is no Medicare fee, the fee will be the Medicaid rate. Service levels will be determined utilizing current Medicare guidelines for coding and billing services provided. Discounting adjustments will be made to client fees based upon the current contract for services with Medicare and other 3rd party payers. In addition, sliding scale adjustments to fees for primary care services will be based upon Federal OMB guidelines and in accordance with State of Florida Department of Health Policy 56-66-08. Medicaid is billed at the current Medicaid Cost -based rate and reimbursement for these services is considered payment in full. (2) Pharmacy — Medications issued will be provided at the most recent cost. Medicaid is accepted as payment in full. (3) Injection fee for parenteral medications per injection $35.00 (4) Lab fees - All laboratory and pathology fees are subject to sliding scale fee adjustment based upon OMB Federal Guidelines. a. Bloods Specimens sent to outside laboratory- cost plus a $35.00 venipuncture fee per visit. b. Specimens tested in clinic- $10.00 (hemoglobin, urine, blood sugar, mono, wet mount, strep) c. Pregnancy test No charge d. Non -blood specimens sent to outside laboratory, processing fee $10.00 per visit. C. COMMUNITY PUBLIC HEALTH SERVICES (1) Tuberculosis X-ray for suspected, confirmed or Symptomatic contact or case No Charge (2) Tuberculosis Skin Test for suspected, confirmed or Symptomatic contact or case No Charge (3) Tuberculosis (TB) Sputum Culture for suspected, confirmed, or symptomatic contact of case No Charge (4) Tuberculin (TB) Skin Test, with reading, any other than $35.00 listed above in C. (1). (5) Tuberculin assessment of clients with a past history of 10/20/2010 positive skin test $35.00 (6) Sexually Transmitted Diseases — The fee below will be adjusted considering the client sliding fee group which is calculated at eligibility determination, based on Federal OMB Guidelines. Medicaid identification will be accepted as full payment in lieu of charges. _Professional Component fees_: Office/Outpatient Visit, New $178.00 Office/Outpatient Visit, Established $117.00 (7) Adult Immunizations Cost of vaccine + $35 injection fee (8) Required Vaccines for children up to age 18 and eligible for the Vaccine for Children program No Charge Administration fee charged to third party payer $35.00 (9) Class/Seminar attendance registration Per person charge for health care, social work and counseling employees. AIDS 101 No Charge AIDS 500 No Charge AIDS 501 No Charge (10) Expendable medical/wound care supplies such as: Sponge Gauze, Bandages/Dressings, Gloves Cost x 3.5 VITAL STATISTICS: (1) Birth Certificates: $ 16.00 Additional Copies $ 16.00 (2) Protective Covers $ 4.00 (3) Death Certificates — Certified Copy $ 13.00 Additional Copies $ 13.00 (4) Express Fee $ 10.00 E. MEDICAL RECORDS: (1) Copying of Medical Record (per page) $ 1.00 F. PUBLIC RECORDS: (1) Copying of Public Record (per page) 25 cents G. RETURNED/DISHONORED CHECKS: (S. 215.34(2), F.S.) A service fee of $15.00 or 5% of the face amount of the check, draft, or money order whichever is greater, not to exceed $150.00 2 10/20/2010 H. Environmental Health: Environmental Health Services Fees established in line with local recommendations and economic factors to cover cost of providing services DESCRIPTION ONSITE SEWAGE DIPOSAL PROGRAM (OS 1-DS) Fee Amt State Fee Application and plan review for construction permit for new systems 200 Application and approval for existing system, if system inspection not required. 45 Application and Exisiting System Evaluation with inspection 100 Application for permitting of an new Performance -based treatment system no Site Evaluation 115 Site re-evaluation 90 Permit or permit amendment for new systems 80 initial system inspection 125 System reinspection(stabilization, non-compliance, or other inspection after initial inspection. 75 Research fee (State Fee) 0 5 Repair Permit with Inspection 100 Application for system abandonment permit 95 Tank manufacturer's inspection per annum 120 Amendment to an Operating Permit 50 Septage Disposal Service Permit per annum 2X per yr inspection 120 Portable or temporary toilet service permit per annum 120 Additional charge per pump out vechicle 40 Annual operating permit Industria llmanufacturing zoning or commercial sewage waste 150 Biennial Operating permit for aerobic treatment unit or performance -based treatment system 100 Aerobic treatment unit maintenance entity permit per annum 100 Variance application for a single family residence per each lot or building site 300 Variance application for a multifamily or commercial building site 440 Inspection for construction of an Injection well (FL Keys) 220 OSTDS Operating Permit Late Fee (45 days past due) 50 Per request-Expediting•Fast Track Permitting New & Exisitng (48 hour turn- around) Charged in addition to state fee 500 Letter of Coordination for development review committees 250 Expedited OSTDS Variance Processing. Received within 6 days of monthly deadline. Charged in addition to state fee 500 OSTDS PETS screening test fee 25 PUBLIC SWIMMING POOLS Annual permit- up to and including 25,000 gallons 240 Annual permit - more than 25,000 gations 350 Non routine inspeoUon(no charge for first inspection 100 Exempted condominiums/Cooperatives with over 32 units 75 MOBILE HOME & RECREATIONAL VEHICLE PARKS Annual permit for 5 to 25 spaces 225 Annual permit for 26 to 143spaces $4.00 per space 7.50 per space Annual permit for 172 and above spaces 1000 10/20/2010 FOOD ESTABLISHMENTS Annual Permit for FraternallCivic 225 Annual Permit School Cafeteria Operating for 9 months or less 275 Annual Permit School Cafeteria Operating for more than 9 months 325 Annual Permit for Movie Theaters 190 Annual Permit for Jails/Prisons 250 Annual Permit for Bars/Lounges 225 Annual Permit for Residential Faciliites 200 Annual Permit for Limited Food Service 225 Child care center 150 Caterer 225 Mobile Food Units 225 Other Food Service 225 Vending machine dispensing potentially hazardous food 85 Plan review per hour public schools, colleges, and vocational teaching facilities are exempt from this fee 60 Food establishment worker training course per person 10 Alcoholic beverage inspection approval 75 Request for inspection 50 Re -inspection (for each reinspection after the first) 25 Temporary event food service establishment (a)sponser w/o existing sanitation certificate 200 b) vendor or booth at an establishment or location w/o an existing sanitation certificate 100 Late renewals 40 BIOMEDICAL Exempt Facilities 50 Generators 125 Storage Facilities 125 TANNING FACILITIES Annual Permit 250 Fee per Device 55 Consultation 50 Late Renewal Fee 25 BODY PIERCING ESTABLISHMENTS License Fee 250 Temporary Establishment 90 Late fee Consultation 50 HEALTHY HOMES PROGRAM Healthy home Assessment Voluntary Inspection living unit(radon, CO2, Mold,Safety) 300 Public Education -Per Attendee 25 10/20/2010 DESCRIPTION PUBLIC SWIMMING POOLS Fee 1. Annual permit- up to and including 25,000 gallons 160 2. Annual permit - more than 25,000 gallons 315 3. Exempted Swimming pools (over 32 units) 60 Reinspection fee per inspection 50 MOBILE HOME & RECREATIONAL VEHICLE PARKS 1. Annual permit for 5 to 25 spaces 125 2. Annual permit for 26 to 149 spaces 5.25 per Space 3. Annual permit for 150 and above spaces 725 Reinspection fee per inspection 50 FOOD ESTABLISHMENTS 1. Annual Permit for Fraternal/Civic 200 2. Annual Permit School Cafeteria Operating for 9 months or less 165 3. Annual Permit School Cafeteria Operating for more than 9 months 200 continued sheet 2 4.Annual Permit for Hospital/Nursing Food Service 265 5. Annual Permit for Movie Theaters 200 6. Annual Permit for Jails/Prisons 265 7. Annual Permit for Bars/Lounges 200 8. Annual Permit for Residential 145 9. Annual Permit for Child Care Centers w/o C&F License 105 10.Annual Permit for Limited Food Service 105 FOOD ESTABLISHMENTS (CONTINUED) 11. Annual Permit Other Food Service 200 12. Plan Review 45/hour 13.Request for Inspection 55 14. Re -inspection (after the first inspection) 45 15. Late Renewal 35 16. Alcoholic Beverage Inspection Approval 45 BIOMEDICAL WASTE GENERATORS 1. Initial Permit 60 2. Renewal of annual permit after October 1 80 3. Renewal of annual by October 1 60 TANNING FACILITIES 1. Annual License fee 160 2. Fee for each additional device 60 3. Late fee 30 10/20/2010 DESCRIPTION Pee BODY PIERCING I Anitial License 160 2.Temporary Establishment 80 4. Annual renewal License Fee 160 3. Late Fee 105 10/20/2010 ATTACHMENT MONROE COUNTY HEALTH DEPARTMENT PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS Some health services must comply with specific program and reporting requirements in addition to the Personal Health Coding Pamphlet (DHP 50-20), Environmental Health Coding Pamphlet (DHP 50-21) and FLAIR requirements because of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it must comply with the special reporting requirements for that service. The services and the reporting requirements are listed below: Service 1. Sexually Transmitted Disease Program 2. Dental Health 3. Special Supplemental Nutrition Program for Women, Infants and Children (including the WIC Breastfeeding Peer Counseling Program) 4. Healthy Start/ Improved Pregnancy Outcome 5. Family Planning Requirement Requirements as specified in FAC 64D-3, F.S. 381 and F.S. 384 and the CHD Guidebook. Monthly reporting on DH Form 1008*. Additional reporting requirements, under development, will be required. The additional reporting requirements will be communicated upon finalization. Service documentation and monthly financial reports as specified in DHM 150-24* and all federal, state and county requirements detailed in program manuals and published procedures. Requirements as specified in the 2007 Healthy Start Standards and Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. Periodic financial and programmatic reports as specified by the program office and in the CHD Guidebook, Internal Operating Policy FAMPLAN 14* 6. Immunization Periodic reports as specified by the department regarding the surveillance/investigation of reportable vaccine preventable diseases, vaccine usage accountability as documented in Florida SHOTS, the assessment of various immunization levels as documented in Florida SHOTS and forms reporting adverse events following immunization. 7. Chronic Disease Program Requirements as specified in the Healthy Communities, Healthy People Guidebook. 8, Environmental Health Requirements as specified in Environmental Health Programs Manual 150-4* and DHP 50-21* 9. HIV/AIDS Program Requirements as specified in F.S. 384.25 and 64D-3.016 and 3.017 F.A.C. and the CHD Guidebook. Case reporting should be on Adult HIV/AIDS Confidential Case Report CDC Form DH2139 and Pediatric HIV/AIDS Confidential Case Report CDC Form DH2140. Socio- ATTACHMENT I (Continued) demographic data on persons tested for HIV in CHID clinics should be reported on Lab Request DH Form 1628 or Post - Test Counseling DH Form 1628C. These reports are to be sent to the Headquarters HIV/AIDS office within 5 days of the initial post-test counseling appointment or within 90 days of the missed post-test counseling appointment. 10. School Health Services Requirements as specified in the Florida School Health Administrative Guidelines (April 2007). 11. Tuberculosis Tuberculosis Program Requirements as specified in FAC 64D-3, F.S. Specific Authority 381.0011(13), 381.003(2), 381.0031(6), 384.33, 392.53(2), 392.66 FS Law Implemented 381.0011(4), 381.003(1), 381.0031(1), (2), (6), 383.06, 384.23, 384.25, 385.202, 392.53 FS.381 and CHID Guidebook. 12, General Communicable Disease Control Carry out surveillance for reportable communicable and other acute diseases, detect outbreaks, respond to individual cases of reportable diseases, investigate outbreaks, and carry out communication and quality assurance functions, as specified in the CHD Guide to Surveillance and Investigations. *or the subsequent replacement if adopted during the contract period. 6 O F- v L r C) U) � n CD LL O cz o c u ,�„ is w o m a IzT ti 0 N r-� r � T i� N C( C � 1) o O U L O Ll y (ll fn (U U 0) U (U 12 O 1J CO O O O do o N N L a O v v 3 o C L Z o a 0 O cn O - N CY5 00 CD N N T cn T E fa � c zs LL O N �D CT C Oy co U c- ci LO U) 0 -0 O E vo N o 0 N N f0 r O U � m c� o F- U C� Q O O C6 U.. v N :3 O w d' v Y� O ATTACHMENT 1 MONROE COUNTY:IiEAUTH DETARTMENT part 11..Sources `'of Cont> ibutlons to County Health Dei)artnilen.t October 1 2010 to September 30,1011 Ste CHD (:o i sty �'�tal C) I.D IYustIuHd CHD ,Trust ) uliii OtTier � (sns1�3 crust Fund (cas4} Co�3ti ihutlgti . I vial ; 1. GENERAL REVENUE - STATE 015040 Al.GICI;SS11001,1DI NTIFIC'ATION AND I::LIMINATION 129,414 0 129,414 0 129,414 015040 AI„G/CON"1'R "1'0 Cl IDS -AIDS PATIENT CARE 370,000 0 370,000 0 370,000 015040 AL.G/CONTIZ TO CFIDS-AIDS PATIFNT CARE. N1 T WORK 0 d 0 0 0 015040 AI,G/C'ON"I'R "1"0 CFIDS-AIDS PRI:V & SURV & HELD ST"APF 93.724 0 93,724 0 93,724 015040 AI-,G/CONTR TO CFIDS-DENTAL PROGRAM 0 0 0 0 0 015040 ALGICONTR TO Cl IDS-MIGRANTLABOR CAMP SANITATION 0 0 0 0 0 015040 MINORITY 0UTRF`.ACI i-P1 NALVER CLINIC - M1AM1-DADS 0 0 0 0 0 015040 PRIMARY CARD SPECIAL DENTAL PROJF'CrS 0 0 0 0 0 015040 SPECIAL MT=DS SI3F.' rER PROGRAM 0 0 0 0 0 015040 S"I"A"r13WID1: DriNT"1S"1'RY NETWORK -13SCAMBIA d 0 0 0 0 015040 STD GENERAL 18,617 0 18,617 0 18.6]7 015040 VARICELLA IMMUNIZATION RT;QUIRI MENT 3,387 0 3.387 0 3,387 015040 I IFAL rHY START MED WAIVER - SOBRA 0 0 0 0 0 015040 HEALTI IY START MI D-WAIVE R - CLII NT SI RVIC S 0 0 0 0 0 015040 .IF:SSIE'rR10E' CANCEIR CTRIHI:ALT1l CI1010E - M1AM1-DADl: 0 0 0 0 0 015040 LA LIGA CONTRA EL CANCER 0 0 0 0 0 015040 MANATEE. COUNTY RURAL I]EAL,T]I SERVICES 0 0 0 0 0 015046 MI:;TRO ORLANDO URBAN LFAGUETFIENAGE PRI_:G PREV 0 0 0 0 0 015040 COUNTY SPECIFIC. DENTAL, PROJI CTS - FSCAMBIA 0 0 0 0 d 015040 DENTAL. SP13.CIAL INITIATIVES 0 0 0 0 0 015040 DUVALTTiEiN PREGNANCY PREVI_ HON 0 d 0 0 0 015040 FL CLI13111 SCREENING 8 CASF MANAGI:MI NT 0 0 0 0 0 015040 F'L FIEPATITIS & LIVER FAILURE PREVEIN"1-lON/CONT'ROL 144.000 0 144,000 0 144,000 {}15040 I ll."ALTHY BEAC HE'S MONITORING 28,965 0 28,965 0 28.965 015040 ALG/1P0 HEALATlY SrA10/1110 0 0 0 0 0 015040 ALG/PREMARY CARF 194,161 0 194,161 0 194,161 015040 ALG/SCF1001,13L'ALTIUSUPPL.1.:MliNT'AL 41.981 0 41,981 0 41,981 015040 Cl [ILD I II AI 1T1 Ml_:DICAL SERVICES 0 0 0 0 0 015040 COMMUNITY SMILES - MIAMI-DADS 0 0 0 0 0 015040 COMMUNITY 113 PROGRAM 39,592 0 39,592 0 39,592 015040 ALG/CONTR. TO Cl IDS-1MMUN1/.,ATION OUTRI ACI I T EAMS 4,722 0 4,722 0 4,722 015040 ALG/CON"IR. TO CFIDS-INDOOR AIR ASSISTFROG 0 0 0 0 0 015040 ALG/CONT'R. TO C'I3DS-MCI l HEAIJH - F11. LL) S"i'AFP COST 0 0 0 0 0 015040 ALG/CONTR. TO CHDS-SOVERT'70N IMMUNITY 0 0 0 0 0 015040 ALG/CONTRI B UTION TO CADS -PRIMARY CAR El 15,589 0 15,589 0 15,589 015040 AL.G/FAMILY PLANNING 57,494 0 57,494 0 57,494 035050 ALGICONTRTOCIIDS 1,435.124 0 1,435,124 0 1,435,124 GENERAL REVENUE "TOTAL 2,576,770 0 2,576.770 0 2,576,770 2. NON GE ERAL REVENUE. -STATE 015010 AI.,G/CON'1-R'1'0CEIDS-RUBASING'TOBACCOTT 21,117 0 21,117 0 21,117 015010 ALG/CON'TR. 'FO CHDS-1310MI:T)ICAL. WASTE/DP:P ADM TT 1,771 0 1.771 0 1,771 015010 ALG/CONT I TO CFIDS-SAFE.. DRINKING WATER PRG/DEP ADM 0 0 0 0 0 015010 BASIC SCHOOL, I IEAtAl l- TOBACCO TT 0 0 0 0 0 015010 CHD PROGRAM SUPPORT 0 0 0 0 0 015010 ENVIRONMENTAL. I IEAL:3'H PACEPROJECTS CrS 0 0 0 0 0 015010 FOOD AND WATERBORNE DISI AS1_; PROGRAM ADM TF/DACS 0 0 0 0 0 015010 I-U1.,L sj-,Rvicj7 SCI IOOI..S - "r013ACCO TT 61,720 0 61,720 0 61.720 Version: 4 Page 1 of 7 015010 IMMUNIZATION SPECIAL. PR0,113CT 3,720 0 3,720 0 3,720 0 I50 10 PU13LIC SWIMMING POOL PROGRAM 0 0 0 0 0 015010 SUPPLEMENT'AL/GOMPIZL'lil?NSIVI;i SCI1001_ 1il ALIT I - TOR TF 41,000 0 41,000 0 41,000 015010 'TOBACCO COMMUNITY INTERVENTION 177.250 0 177.250 0 177,250 015020 TRANSFER FROM ANOTHER SLATE AGENCY 0 0 0 0 0 015020 TRANSFER FROM ANOTI1ER S'rA'If: AGENCY 0 0 0 0 D 015020 TRANSFER FROM ANOTITEIZ STA F AGENCY 0 0 0 0 0 015060 Non-Catc.-orical Tobacco Rebasjn- 0 0 0 0 0 NON GENERAL RF,VF,NUK TOTAL 306,578 0 306,578 0 306,578 3. FEDERAL FUNDS - State 007000 AFRICAN AMERICAN TESTING INITIATIVE (AA-1-1) 0 0 0 0 0 007000 AIDS PRP�VE NTION 203,301 0 203-30J 0 203,301 007000 AIDS SURVEILLANCE: 0 0 0 0 0 007000 T310TERRORISM HOSPITAL PRT PARI.-DNESS 0 0 0 0 0 007000 CITILDIi00D LEAD POISOMNO PREVENTION 0 0 0 0 0 007000 COASTAL BEACH MONITORING PROGRAM 25,385 0 25"385 0 25.385 007000 TUBERCULOSIS CONTROL - PI?DERAI., GRAM' 0 0 0 0 0 007000 WIC ADMINISTRATION 362,250 0 362,250 U 362,250 007000 WIC BUASIFEEIDING PEER COUNSH-INU 42,250 U 42,250 0 42,250 007000 STD FEiDEiRAI., GRANTT - CSPS 0 0 0 0 0 007000 STIR PROGRAM - PI IYSICIAN TRAINING Cl"NITER 0 U 0 0 0 007000 S E) PROGRAM - PHYSICIANS TRAINING CFNITE:IZ 0 D 0 0 0 007000 SII) PROGRAM INFERTILITY PR1'.VFN1T0N PROJECT (IPP) 0 D 0 0 0 007000 SYPHILIS ELIMiNAT[ON 0 0 D 0 0 007000 TI'ILF X MALT; PRO.II C:T 0 0 0 0 0 007000 RYAN W1II'TI_: 44,309 0 44,309 0 44,309 007000 RYAN W111TE - EMERGING COMMUNITIES 0 0 0 0 0 007000 RYAN W HIT PART l3 SUPPLEMENTAL D 0 0 0 0 007000 RYAN WHITE -AIDS DRUG ASSIST PROD-ADMIN 35,443 0 35,443 0 35,443 007000 RYAN WHITE -CONSORTIA 0 0 0 0 0 007000 STATE INDOOR RADON GRANT 0 0 0 0 0 007000 NATIONAL. COMP)ZFill NSIVI CANCI-:IZ CONTROL PROGRAM 0 0 0 0 0 007000 ORAL IIFALTH WORKFORCE ACTIVITIES 0 0 0 0 0 007000 ORAL, HE AIJI I WORKFORCE ACTIVITIES 2010-2011 0 0 0 0 0 007000 PIIP- CITIES READINESS SS INH1AT] V[' 0 0 0 0 0 007000 PUBLIC H AL;1-II PREPAREDNESS BASE 122,155 0 122,155 0 122,155 007000 RAPE PREVENTION & EDUCATION GRANT 0 0 0 0 D 007000 IMMUNIZATION FIELD STAFF 1�.XPENSE 0 0 0 0 0 007000 IMMUNIZATION SUPPLI MENTAL 0 0 0 0 0 007000 IMMUNIZATION WIC -LINKAGES 0 0 0 D 0 007000 IMMUNIZATION -WIC LINKAGES 0 0 0 0 0 007000 MCI I 13G'IT-GADSDI7N SCI100L. CLINIC. 0 0 0 0 0 007000 MCH WiTF-I lI3AL;I11Y START IP0 0 0 0 0 0 007000 FGTT/FAMILY PLANNING -TITLE X 78,097 0 78,097 0 79,097 007000 FGTF/IMMUNIZATION ACTION PLAN 15,702 0 15,702 0 15,702 007000 11FALTIi PROGRAM FOR R13PUGEE'"S 0 0 0 0 0 007000 111--W.' TY PI OPLL: 1-11 A ATlY COMMUNITIES 25,541 0 25,541 0 25,541 Version: 4 Wage 2 of 7 007000 1IIV I IOUSING FOR PEiOP1.1 I,IV1NG WITI I AIDS 0 0 0 Q 0 007000 HIV INCIDEiNC:Ci SUIZVt:[1.LANCE 0 0 0 0 0 007000 COLORI C'I'AI.CANC'I:R SCRI"I"N1NG 2009-10 0 0 0 0 0 007000 DIA131 I I:,S PRI:VI:.N110N & CONTROL PROGRAM 0 0 Q U 0 007000 FAMILY PLANNING-"I'I"I t.:l, x 0 U Q 0 0 007000 1-G'rl'IAIDS MORBIDTI'Y 0 0 0 0 0 007000 1=GTI=/131ZL:AS7' & CERVICAL. CANCER-ADMINIC'ASE MAN 0 0 0 0 0 007000 FG'II-/FAMt1.Y P1,ANNINt;'rt'I't r X SPI=CIAI.. INITIA"TIVL'S 0 0 0 0 0 015009 MI:DIPASS WAIVER-1-11.31-IY S'TRT CUENT SERVICI::S 0 0 0 0 0 015009 MEDIPASS WAIVER-SOI31ZA 0 0 0 0 0 015075 SCHOOL IILAL.TII/SUi>PLrMENTAI. 81,066 0 81,066 0 91.066 007051 AIZRA Federal Grant - SCltednlC C 0 0 0 0 0 015075 lnst=6011s Of Sumntei' Feeding Proarazll 0 0 0 0 0 FEDERAL, FUNDS TOTAL 1,035,499 0 1,035,499 0 1,035,499 4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE 001020 'I'ANNING I ACII.,I'r11S 1,410 0 1,410 0 1,410 001020 BODY PII IZCING 1.195 0 1-185 0 1,185 001020 MIGRANT WUSINO 1117WN' 0 0 0 0 0 001020 M01311,1_: HOME AND PAIZKS 20,350 0 20,350 0 20.350 001020 FOOD HYGEL:NE PIiRMIT 18,500 0 18,500 0 18,500 001020 13101EA%ARDWAS"T1 PFiIZMI'1' 11.270 0 11,270 0 11,270 001020 PRIVAIT WA'1'1:R C'ONSI'R PI-RMI'I' 0 0 0 0 0 001020 IlUI3LIC WATPR ANNUAL OPL'•R PI:RMI'I' 0 0 0 U 0 001020 PU1:3I.IC WAIT?R CONSTR PEIZMI'I' 0 0 0 0 0 001020 NON -SD WA SYSTEM PERMIT 0 0 0 0 0 001020 SAII': DRINKING WA'1'1=:IZ 0 0 0 0 0 001020 SWIMMING POOLS 54,825 0 54,825 0 54,825 001092 OSDS HAWIT FEES 570.694 U 570-694 0 570,694 001092 1& M ONI D OPERA'1.1NG PERMIT 0 0 0 0 0 001092 AGR013IC OPERATING PERMIT 0 0 0 0 0 001092 St P'TIC TANK SITE: i VAL-UA'1'ION 0 0 Q 0 0 001092 NON SDWA LAI3 SAMP1,1_ 0 0 U 0 0 001092 OSDS VAIZIANCF Il l 0 0 0 0 0 001092 13NVIRONMEN'TAL 1117AU Ri l) IDS U 0 0 0 0 001092 OSDS REPAIR P1RM]"1' 0 0 0 0 0 001170 1,AI3 I I:I: CIWMICAI. ANALYSIS 0 0 0 0 0 001 170 WATER ANALYSIS-POTA131-.Ii 0 0 Q 0 0 001170 NONPO'TABI-El WA'TGR ANAI„YSIS 0 0 0 0 0 010304 MQA INSPEC DON PEE 450 0 450 Q 450 001206 Central Office Sin -charge 43:500 0 43,500 0 41500 FEES ASSESSED BY STATE OR FEDERAL, RULES TOTAL 722,184 0 722,184 0 722,184 5. OTHER CASK CONTRIBUTIONS - STATE 010304 S"I'ATIONARY 1101,I.,U'rAN7' S'I'ORAGE'1'ANKS 110,251 0 110,251 0 110,251 090001 DRAW DOWN FIZOM PUBLIC HIiAL:I l I UNI'I' 207,040 0 207,040 0 207,040 OTHER CASH CONTRIBUTIONS TOTAL 317,291 0 317,291 0 317,291 Version: 4 Page 3 of 7 001056 MEDICAID PHARMACY 0 0 p 0 0 001076 MI DICAID T13 0 0 p 0 0 001078 MEDICAID ADMINISTRATION OF VACCINE. 15,911 1.),91 1 31.822 0 31,822 001079 MEDICAID CASE`. MANA(3t3Mt-:NT (> 0 p 0 0 001081 MIi;DICAID CHH,I) 1.11_ AL.T11 C'H1-'CK UP 2,269 3,631 5_,900 0 5,9pp 001082 MLDIC'A1D DI NTAL. 0 0 p 0 0 001083 MI DICAID FAMILY PLANNING 27435 21 915 24,350 0 24,350 001087 M1-'.DIC'A1DSTD 1,183 1.893 3,076 0 3,076 001099 MLDICAID AIDS 36.537 58,463 95,000 0 95,000 001 147 Medicaid I IMO Capifatiorl 0 0 p 0 0 001191 MEDICAID A4AI1-1'1ZNiLY 0 0 0 0 0 001192 MEDICAID COMPRL;I-1t NS1VI.- CI11LD 369 591 960 0 960 001193 MLDICAID COMPRLi11ENS1Vl ADULT 107,150 171,450 278,600 0 278.600 001194 MLDICAID LABORA'I'ORY 0 0 0 0 0 001208 M131)IPASS S3.00 ADM. FF.Li 5,135 5,135 10,269 0 10,269 001059 Medicaid Low ]name Pool 0 0 U 0 0 001051 Flim-gcncy Medicaid 0 0 0 0 0 001058 Medicaid - Behavioral Health 0 0 0 0 0 001071 Medicaid - Orthopedic 0 0 0 0 0 001072 Medicaid - Dermatology 0 0 p 0 0 001075 Medicaid - School I Icalth Certified Match 11,538 18,462 30.000 0 30,000 001069 Medicaid - IZefogec Health 0 0 0 0 0 0010.5.5 Medicaid - Hospital 0 0 0 0 0 001 148 Medicaid HMO Non -Capitation 0 0 0 0 0 001074 Medicaid - Newborn Screening 0 0 0 0 0 MEDICAID TOTAL t82,526 297,451 479,977 0 479,977 7. ALLOCABLE REVENUE -STATE 018000 RIT'UNDS 0 0 0 0 0 037000 PRIOR YLAR WAIZRAN'1' 0 0 0 U 0 038000 12 MON'lli OLD WARRANT 0 0 0 0 0 ALLOCABLE REVENUE TOTAL 0 0 p 0 0 S. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE PHARMACY SLRV10"S 0 0 0 72,991 72,991 LA1301W'ORY SI>RVICTiS 0 0 0 36,848 36,848 1'13 SEiIZVIC[ S 0 0 p 0 fl IMMUNILA [ON SI3RVICI-S 0 0 p 497,639 497,639 STD SL:RVICES 0 0 p 0 0 CON S'IRUCi'iONIREsNOVA1I0N 0 0 p 0 0 WIC FOOD 0 0 0 937:640 917,640 ADAP 0 0 U 840,000 840,000 DLN1'AL SERVICES 0 0 p 0 0 O"1']ILR(SPl3CIFY) 0 0 0 0 0 OTII]-"R (SI'EiCIFY) 0 0 p 0 0 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 2,385,1 18 2,385,1 IS Version: 4 Page 4 of 7 008030 Contribution from Health Care Tax 0 817,247 817.247 0 817,247 008034 13CC Contribution from Cienoral Fund 0 90.219 90,219 0 90,219 DIRECT COUNTY CONTRIBUTION TOTAL 0 907,460 907.466 0 907,466 10, FEES AUTIIORIZCD BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001060 CHD SUPPORT POSITION a 2,400 2.400 0 2,400 001077 RA1311S VACCINE 0 0 Q 0 0 001077 CHILD CAR S1,iA7' FROG 0 0 0 0 a 001077 PERSONAL I II AL:TII F L'S 0 232,971 232,97f 0 2327971 001077 AIDS CO -PAYS 0 0 0 p 0 001094 ADUL:1' I:N'1'l-R. PERMIT FFl7S 0 0 0 p 0 001094 LOCAL ORDINAN10, fEI:S 0 0 0 0 0 001 114 NI:iW BIRTH CFRTIFICAT)-S 0 19,500 19,500 0 19.500 001115 Vital Statistics - Death Certificate 0 52,500 52,500 0 52,500 001 1 17 VITAL STA"TS-ADM, H.-IT-1 50 Cl."N'1:S 0 600 600 0 600 001073 Co -Pay for (fie AIDS Care Program 0 Q 0 0 0 001025 Client Revenue from GRC 0 0 0 0 0 001040 Cell Phone Administrative Fee 0 0 0 0 0 FEES AUTHORIZED BY COUNTY TOTAL 0 307.971 307.971 0 307,971 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 001009 Rl"FURNE) Cl II:;CK IT1 M 0 0 0 0 0 001029 THIRD PARTY RI IMB1)RS1 MI:N'I' 0 192,329 192.329 0 192.329 001029 HF.ALTH MAINTENANCE ORGAN. (I ]MO) 0 0 0 0 0 001054 MEDICARE PARTI) 0 0 p 0 0 001077 RYAN WI11'Tfil'I'1'L.L: It a 0 0 0 0 001090 MEDICARE: PART 13 0 208,557 208.557 0 208,557 001 190 1 ieallh Maintenance Organization 0 0 0 0 0 005040 INTI'R]. S'I' EARNED 0 47500 4,500 0 4.500 005041 IN"ITiRI"iS"f 1_ARNL:D-S`I'A"1'I:i INVIiS"rMI NT ACCOUNT 0 0 0 0 0 007010 U.S. GRANTS DIRt.CT U 587,214 597.214 0 587,214 008010 Contribution front City Government U 0 0 0 0 008020 Contribution from I leallh Carc Tax not thru 13C:C U 0 0 0 U 008050 School Board Contribution 0 U 0 0 0 008060 Special Project Contribution 0 0 0 0 0 010300 SAI,.E 01" GOODS AND Sl.iRVICr:S TO STATI:i AGI-'NCII S a 450 450 0 450 010301 [XI' WI'fNIiSS FF'I CONSULrNT CI IARGI:S 0 0 Q 0 0 010405 SAI,I:01' PIIARMACF.LJ' ICALS 0 0 0 0 U W0409 SAI.I-. OF GOODS OUTSIDE STATI. GOVERNMI N'I' 0 0 0 0 0 U11001 IfI':ALTIlYS'I'ARTCOALITIONCONTRIBUTION'S 0 360,000 360.000 0 360,000 011007 CASI I DONATION'S PR1VA'IT 0 0 0 0 0 012020 FINES AND EORI=EfrURES 0 Q 0 Q 0 012021 RETURN CHFCK CHARGL 0 0 0 0 0 028020 INSUIZANCl: R[;COVLItIL5-07'ITT R 0 a 0 0 U 090002 DRAW DOWN FROM PUBLIC HI::ALTI I UNIT a 0 0 0 0 011000 GRANT D1RI:C'f-NOVA UNIVERSITY CHI) TRAINING 0 0 0 0 0 011000 GRAN'f-DIRI CI' 0 0 0 0 0 Version: 4 Page 5 of 7 011000 GRANT I)IRL-'Cr-COUNTY HEALTH llI nAR-I'Ml-'N'T' i)ll [ C'r SLRVICI-S 0 0 0 0 0 011000 DIRECT -ARROW 0 0 0 0 0 011000 (;RANT -DIRECT 0 0 p 0 0 011000 GRANT-DIRI_C']' 0 0 0 0 0 a1 1000 GRANT DIRLC'-QUANTUM 1)I.;NTAI, 0 0 0 0 0 011000 GItAN'f D1[tLCr I II:AI 1 [i CARI DISTRICT I'AIIOKCI 0 0 0 0 0 011000 GRANT -DIRECT 0 0 p 0 0 011000 GRANT-D]RI Cr a 0 p 0 a 011000 GRANT -DIRECT 0 0 p 0 fl 011000 GRANT-DlRI.�CI- 0 0 p 0 0 011000 GRANT-DIRLCT 0 0 p 0 0 011000 GRANT DIRLCr-ARROW 0 0 p 0 0 010402 Recycled Material Sales 0 0 p 0 0 010303 I-DI,E Fingcrprinting 0 0 p 0 0 0070.50 ARRA Federal Grant 0 7,980 7.980 0 7,980 001010 Recovery ol'Bad Chccks 0 0 p 0 0 008065 FCO Contribution 0 0 (S 0 0 011006 Restricted Cash Donation 0 0 p 0 0 029000 Insurance Recoveries o 0 p 0 0 001033 CMS Management Fee - PMPMPC 0 0 0 0 0 010400 Sale ol'Goods Oulside State Government 0 0 0 0 0 010500 Rerugec I[Cal th 0 45,207 45.207 0 45,207 00504S Interest I arned=Third Party Provider 0 0 p 0 0 005043 Interest Earned -con tracl/Grant 0 0 0 0 0 010306 D01 I/170C hitcragcttcy Agreement 0 0 0 0 0 008040 BCC Grant/Contract 0 0 p 0 0 011002 ARRA federal Grant - Sub-Rccipicnt 0 0 p 0 0 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL, 0 1,406,237 1,406,237 0 17406,237 12. ALLOCABLE REVENUE - COUNTY 018000 R1";F1JNI)S 0 0 p 0 0 037000 PRIOR YI_`AR WARRANT 0 0 0 0 0 038000 12 MONTII 01,D WARRANT 0 0 p 0 0 COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0 13. BUILDINGS - COUNTY ANNUAL. RLNTAI, I QUIVAI_,T?NT VAI.UI 0 0 0 5011072 501:072 GROUNDS MAINTENANCE. 0 0 0 0 0 OTH17R (SPI_`C]FY) 0 0 0 0 0 INSURANCL 0 0 0 0 0 UTILITU.S 0 0 0 62,633 02,633 07'1-31::R(SPECIFY) 0 0 0 0 0 13iJ1L DING MAINTENANCE a 0 0 51 J85 51,185 BUILDINGS TOTAL. 0 0 14, OTHER COUNTY CONTRIBUTIONS NOT IN CIID TRUST FUND - COUNTY 3,:Q1JIPMINT/VL-HIC'LI PURCIIASFS Version: 4 0 0 0 614,890 614,890 0 0 0 Page 6 of 7 ATTACHMENTIL.:. MUNKOT COUNTY H.EAI TH I)I I'A.RTMENT Tart It. Soul.ces of COili t ibutitms to Co>utty Health Departmel> t October 1201© to September 30 2011 State C11D 1a(AID Trust Fund C11D Trust Fund d Otitei' ' (cash) Trust Fmid (cash.) Coufrlbutimt ': Ibtal 14. OTRER COUNTY CONTRIBUTIONS NOT IN CfID TRUST FUND - COUNTY VL-:1,I1CLF ENSURANCC 0 0 0 0 0 VE'Hi Cf.l: MAINTI:NANCI, 0 0 0 0 0 OTIIE;R COUNTY CONTM13UTION (SPHUI Y) 0 0 p 0 0 OTHER COUNTY CONTR18UTION (SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTIONS TOTAL, 0 0 0 0 0 GRANT) TOTAL CIID PROGRAM 5,140,848 2,919,125 8,0597973 3,000,008 11,059,981 Version: 4 Page 7 of 7 A. COMMUNICABLE DISEASE CONTROL: IMMUNI'LA'I'ION (101) S'I'D (102) A,1.1).S. (103) T13 CONTROL S1:RVICI S (104) COMM, DISEASE SURV. (106) 1113YATI(7S PREVEN"['ION (109) I10131.,IC I-II.:AL,'1'li PREP AND R1SP (116) VITAL. S'IWIT1 'HCS (180) COMMUNICABLE DISEASE SUBTOTAL B. PRIMARY CARE: CHRONIC DISEASE SI RVICI S (210) TOBACCO PRi-VF N'170N (212) W.I.C. (22 1) I-AMIf„Y PLANNING (223) IMPROV),"D PREGNANCY O(J"ICOM1: (225) 1 IEA1.;1'11Y START PRf NATAL. (227) COMPRE'llI:NSIVE7 CIHLD I-II:AI1II1 (229) 1�EA1: I'HY S'1'AR'1' 1NPAN'f (231) SCI 1001,1 iFAI XI 1 (234) COMPREIiENSIVE ADUL:I I IJ_-AI_;IH (237) D1 NTAl-111-AUI-I i (240) PRIMARY CARE SUBTOTAL C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COAS"I'AL BEACH MONITORING (347) I."IMI'I'L D USE: P(R3L:IC WATFA SYS'I.'MS (357) PUBLIC WATER SYS'I'1M (358) PR1VATF. WATER SYSTEM (359) INDIVIDiJAI.SFWAGIa DISP. (361) 5.88 5,696 20.000 119,577 102,495 119,577 102,495 106,399 337,745 444,144 1.85 296 1,542 40,517 34,729 40,517 34,729 104,103 46,389 150,492 22,05 650 8,700 543,027 465,451 543.027 465451 929,523 1,087,433 2,016,956 1.45 303 11549 38,828 33.281 38,828 33,281 142,715 1,503 144,218 0.93 0 2.500 28,767 24,657 28,767 24,657 64,174 42,674 106,848 1.71 718 3,394 53.064 45,483 53,064 45,483 190.944 6,150 197,094 2.48 0 500 51,160 43,851 S I.160 43.851 190,022 0 190,022 1.25 2,097 5,800 22,728 19,481 22,728 19,481 0 84,418 84,418 37,60 9,760 43,985 897,668 769_,428 897,668 769,428 1,727,880 1,606,312 3,334,192 0.01 0 0 5,704 4,890 5,704 4,990 21,188 0 21,188 2.29 0 446 53,533 45,885 53,533 45,885 198,836 0 198,836 7.30 3.394 29,978 141.800 121,543 141,800 121,543 526,696 0 526,686 3.77 1,020 5,095 76,232 65,342 76.232 65.342 198,777 84,371 283,148 0.00 0 0 0 0 0 0 0 0 0 3.79 570 10,500 80,288 68,818 80,288 68,818 0 298,212 298.212 0.43 310 651 9,173 7,862 9,173 7,862 29,996 4.074 34,070 2.77 330 5,500 45,944 39,380 45,944 39,380 102,493 68,155 170,648 4.89 0 115,000 91-799 78,685 91,799 78,685 316,355 24,613 340,968 17.50 3,060 14.010 386,272 331,091 386.272 331,091 444,153 990,573 1,434,726 0.00 0 0 0 0 0 0 0 0 0 42.75 8,684 191,180 890,745 763,496 890,745 763,496 1,83SA84 1,4697998 3,308A82 0.73 0.00 0,00 0.00 10.55 Group "Total 11.28 Facility Programs POOL) IIYG1GNI" (348) 0.64 BODY ART (349) 0.03 GROUP CART: PACLIfY (351) 0.28 MIGRANT LABOR CAMP (352) 0.00 I IOIJSING,PU131.1C 131,DG SAI-T'I'Y,SANITATION (353)0.03 MOBILE 1fOME AND PARKS SERVICES (354) 0.56 SWIMMING POOLSII3ATHING (360) 2.09 BIOMEDICAL WASTE SERVICES (364) 0.22 TANNING FACII.,I"IY SERVICES (369) 0.02 Group Total 3.97 1,257 1,263 29,197 24,168 28,197 24,168 104,730 0 104,730 0 0 46 39 46 39 102 68 170 0 0 18 16 18 16 41 27 68 0 0 26 22 26 22 58 38 96 7.000 12,500 212,277 181J51 212,277 181,951 788A56 0 788,456 8,257 13,763 240,564 206,196 240,564 206,196 893,387 133 893,520 77 365 11.134 9.543 11,134 9,543 41.354 0 41,354 6 12 575 492 574 492 2,133 0 2,133 75 119 4,971 4,261 4,971 4,261 11,091 7:373 18,464 0 0 0 0 0 0 0 0 0 0 6 694 595 694 595 1,548 1,030 2,578 90 230 9:764 8,370 9,764 8,370 36,268 0 36,268 539 1,590 37,146 31.839 37,146 31,839 137,970 0 137,970 117 225 4189 3,676 4,289 3,676 15,930 0 15,930 7 15 298 255 298 255 1,106 0 1,106 911 2,562 68,871 59,031 68,870 59,031 247,400 8,403 255,803 Version: 2 Page 1 of 2 ATTACHMENT H. MONROE. COUNTY. HEALTH`DEPARTMLN.T Part JI Planueci Staifng;'.Clients, Services; Ancl Expenditures By:Progi. i Service r#1 ea Witlttn aclt Level Of Set vice . , October 1, 2010 to September 30, 20.11 ..Qi1A1 FCrl y�7ijlCn4ltlUfC flan 1 fl's [Rents Isf 2nd 3td 4tR Grand.:. {0 00) Units Se t vices (Whole dollars only) state Coun1} Total C. LNVIRONMENTAL HEALTI1: Groundwater Contamination S'i'ORAGE TANK COVIPL]ANC I:. (355) 1.63 389 774 36,653 31,417 36,653 31,417 136,140 0 136,140 SUPER ACL' SERVICE: (356) 0.15 0 6 2,876 2,465 2,876 2,465 6,416 4,266 10,682 Group Total 1.78 389 780 39.529 33,882 39,529 33,892 142,556 4,266 146,822 Community Hygiene OCCUPATIONAL, I IE:ALTI I (344) 0.01 0 4 127 109 127 109 0 472 472 CONSUMER PRODUM' SAFF"I'Y (345) 0.00 0 0 0 0 0 0 0 0 0 INJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0 L,I;AD MONITORING SERVICES (350) 0.00 0 0 0 0 0 0 0 0 0 PUBLIC Sl'iWACiI (362) 0.00 0 0 0 0 0 0 0 0 0 SOLID WASIT DISPOSAL. (363) 0,01 0 0 98 84 98 84 218 146 364 SANN'ARY NUISANCE (365) 0.19 90 250 3,463 2.968 3,463 1968 7,726 5,136 12,862 RABIES SURVI-',] LLANCE/CONTROL SERVICE'S (366)0.02 2 11 434 372 434 372 968 644 1,612 AR13{)V1RUS SCIRV!_:11.1..ANCI (367) 0.01 0 3 244 209 244 209 545 361 906 RODE'N'PARTHROPOD CONTROL (368) 0.0] 0 6 184 157 184 157 409 273 682 WATER POI,JAJ-DON (370) 0.00 0 2 42 36 42 36 94 62 150 AIR POLLUEIC3N (371) 0.00 0 0 5 4 5 4 10 8 18 RADIOLO(WAL. I1EA1,11I (372) 0.02 0 0 298 255 298 255 664 442 1,106 'T0XIC: SU13STANCES (373) 0.81 312 313 16,013 13,725 16,013 13,725 0 59,476 59,476 Group Total 1.08 404 589 20,908 17 )19 20,908 17,919 10,634 67,020 77.654 ENVIRONMENTAL HEALTH SUBTOTAL 19.01 9,961 17,694 369,872 317,028 369,871 317,028 1,293,977 7%822 1,373.799 D. NON -OPERATIONAL. COSTS; SPECIAL CONTRACTS (599) 0.00 0 0 0 0 0 0 0 0 0 E'NVIRONMFN'EAl, HGAI 1'I I SURCIIARGI (399) 0.00 0 0 10,875 10,875 ]0,875 10,875 43.500 0 43,500 NON -OPERATIONAL COSTS SUBTOTAL 0.00 0 0 10,875 10,875 10,875 10,875 43,500 0 43,500 TOTAL. CONTRACT 98.36 28,405 242,859 2,169,160 1,860,827 2,169,159 1,860,827 4,903,841 3,156,132 8,059,973 Version: 2 Page 2 of 2 ATTACHMENT III MONROE COUNTY HEALTH DEPARTMENT CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted during the contract period), if so requested by the department. The applicant assures that it will comply with: Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits discrimination on the basis of race, color or national origin in programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. 3. Title IX of the Education Amendments of 1972, as amended, 20 U,S.C. 1681 et seq., which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the applicant understands that the grantor may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief, to include assistance being terminated and further assistance being denied. ATTACHMENT IV MONROE COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Location Owned By Gato Building 1100 Simonton Street Monroe County Administration Key West, FL 33040 Nursing Environmental Health Health Care Center 3134 Northside Drive MW &JC, LLC and Building B Leased to Key West, FL 33040 Monroe County For MCHD use Murray E. Nelson Government Center 102050 Overseas Highway Monroe County Environmental Health Key Largo, FL 33037 Roosevelt Sands Center 105 Olivia Street City of Key West Key West, FL 33040 subject to Inter -local Agreement with Monroe County for MCHD use Ruth Ivins Center 3333 Overseas Highway Monroe County Marathon, FL 33050 Roth Building 50 High Point Road Monroe County Tavernier, FL 33070 ATTACHMENT V MONROE COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT. CONTRACT YEAR STATE 2007-2008 $ $ 2008-2009 $ $ 2009-2010 $ $ 2010-2011 $ $ 2011-2012 $ $ PROJECT TOTAL $ - $ COUNTY SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN PROJECT NAME: LOCATION/ ADDRESS: PROJECT TYPE: NEW BUILDING ROOFING RENOVATION PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: PROJECT SUMMARY: Describe scope of work in reasonable detail. ESTIMATED PROJECT INFORMATION: START DATE (initial expenditure of funds) COMPLETION DATE: DESIGN FEES: $ CONSTRUCTION COSTS: $ FURNITURE/EQUIPMENT $ TOTAL PROJECT COST: $ COST PER SQ FOOT: $ TOTAL Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans. ATTACHMENT VI MONROE COUNTY HEALTH DEPARTMENT PRIMARY CARE "Primary Care" as conceptualized for the county health departments and for the use of categorical Primary Care funds (revenue object code 015040) is defined as: "Health care services for the prevention or treatment of acute or chronic medical conditions or minor injuries of individuals which is provided in a clinic setting and may include family planning and maternity care." Indicate below the county health department programs that will be supported at least in part with categorical Primary Care funds this contract year: X Comprehensive Child Health (229/29) X Comprehensive Adult Health (237/37) Family Planning (223/23) Maternal Health/iPO (225/25) Laboratory (242/42) Pharmacy (241/93) Other Medical Treatment Program (please identify) Describe the target population to be served with categorical Primary Care funds. The primary population served is under and non-insured. Does the health department intend to contract with other providers for the delivery of primary health care services using categorical (015040) Primary Care funds? If so, please identify the provider(s), describe the services to be delivered, and list the anticipated contractual amount by provider. In addition, contract providers are required to provide data on patients served and the services provided so that the patients may be registered and the service data entered into HMS. No