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Item T11County off Monroe ELj »moo � i G�, � BOARD OF COUNTY COMMISSIONERS /� ri � �� Mayor George Neugent, District 2 The Florida. Ke Sew', y i Mayor Pro Tern David Rice, District 4 ; -== :'„ j y Danny L. Kolhage, District I Heather Carruthers, District 3 Sylvia J. Murphy, District 5 County Commission Meeting November 14, 2017 Agenda Item Number: T.11 Agenda Item Summary #3566 BULK ITEM: No DEPARTMENT: County Attorney's Office TIME APPROXIMATE: STAFF CONTACT: Christine Limbert (305) 292-3470 10:30 A.M. AGENDA ITEM WORDING: Update, discussion and direction on the application by the Florida Keys Area Health Education Center (AHEC) for grant funding as recommended by the Human Services Advisory Board. ITEM BACKGROUND: At the October BOCC meeting, a local physician, his attorney, and some of his patients raised concerns about the County's funding of AHEC through the Human Services Advisory Board process. In addition to arguing that County funding to AHEC is making it difficult for him to keep his practice open, the speakers raised several concerns about AHEC's operations. In response, the BOCC directed the County Attorney to investigate the allegations. Below is a synopsis of the issues raised and answers uncovered to date. As a preliminary matter, Eugene Kyle, the attorney for the physician, alleged during his presentation that AHEC's application contained inaccurate information and statements. Assistant County Attorney Christine Limbert-Barrows requested that Mr. Kyle provide further details regarding his allegations regarding AHEC's application. Mr. Kyle advised that he was going out of town and would provide that information upon his return. As of the 10/30/17 agenda deadline, Mr. Kyle had not provided the requested information. Staff will provide an updated report once Mr. Kyle provides that information. Michael Cunningham, AHEC's Executive Director, advised that he stands by the statements set forth in the application but is willing to verify any specific information Mr. Kyle challenges. In addition, the following information was obtained from staff s review of various sources. • How is AHEC functioning, i.e. providing service and programs? According to AHEC's website and application, it provides in -school health care programs, tobacco -free programs and health services in conjunction with UM health services. The grant funding requested by AHEC is for the school health program and for services rendered in school only. o AHEC's response: Keys AHEC does not provide any Primary Care services outside of the school based setting under this contract or program. All other programs of Keys AHEC have separate funding sources, allocated staff and contracts. • To whom is AHEC providing services? AHEC's school program, which County grant funding is requested for, provides health care services to school aged children, their siblings and Monroe County School District Staff. The contract between AHEC and the Monroe County School District and AHEC's application for grant funding are attached. o AHEC's response: Keys AHEC focuses solely on students, offers continuum of care services to siblings (normally younger) to keep the family unit healthy and to prevent the spread of communicable disease (Pink Eye, Flu, Infections etc). Keys AHEC also does provide a limited amount of care to the Staff (This equates to about 10% of all visits) of the School District as part of its agreement with the District. This service is part of the National Model we have adopted. Keeping the teaching staff well and in the classroom is important to providing a quality education • Does AHEC provide services Parents? No, not unless the parent is also employed by the school district. Per the agreement between AHEC and the School District, AHEC provides school health program services to school district staff, who may also be parents of school aged children and their siblings. However, as a general rule, parents of students are not an included patient group. o AHEC's response: Keys AHEC is not permitted to see parents or other adults on the school campus. This is due to the Jessica Lunsford Act and at request of the District. • What services are conducted outside of school? Per its website and application, AHEC provides tobacco -free programs and health services in conjunction with the University of Miami health services and UM health fairs. AHEC's funding request is for AHEC's school program, not programs administered outside of the school. o AHEC's response: Keys AHEC's other services are clearly outlined in the grant application. Each program has its own unique grant/contract funding with assigned staff. What is the protocol if a child goes to the school nurse? The School District has established policies, in accordance with F.S. 1001.43(7), for when a student goes to the school clinic in the event of sickness or accident (see attached). The policies provide for the child's parent/guardian to be contacted. AHEC advised that they do not administer services unless the parent/guardian has authorized AHEC to provide health care services. The parent/guardian must sign consent forms (AHEC's General Consent for Clinical Treatment Form is attached). o AHEC's response: The Keys AHEC Procedure is as follows: o All students must have a signed written consent form by the parent/caregiver prior to ever being seen. ■ If a student shows up unattended at a school site (no consent on file) they are sent back to the School health Nurse or classroom. A parent will be called to inform them about the visit with service offered if they would like to come in and fill out the consent. This is their choice. ■ No child can be seen without this form on file. o When a student comes to clinic: ■ They are with a parent who has brought them there and has given consent to treat. • A student of record (seen before) may show to clinic. Prior to the visit our Staff will call the caregiver to inquire if they want us to see the child, would like the child held at the school nurses office until they can arrive or if they want to child to be seen by their primary doctor (If they have one). • If a child does receive treatment, the caregiver is called pre and post visit. o Every family/child coming in on their own accord or by referral is given the choice to see our staff or use any other clinic/provider in the county ■ No Provider owns a patient and they have choices. o Should the Keys AHEC staff see a child that has seen a local provider, the NP (Nurse Practitioner) will normally contact them to ensure continuity of care. The Child then will be referred back for follow up care if necessary. o Keys AHEC also refers children back to a Physician or Specialist if the care of the child is beyond that in which they are capable or comfortable providing (Neuro, Ortho, Cardio, Internal etc.) o Patient situation is also taken into consideration at each visit as we look at whether the child is uninsured, coming from a working poor family, needs accessible care right now, does not have the ability to pay, has Medicaid or has a commercial policy, but it has a high deductible and or co pay. Not all commercial policies have affordable options. Is there a vetting process of whether patient has insurance or not? No, AHEC has advised that they provide services to patients regardless of whether they are insured, uninsured or underinsured. o AHEC's response: Keys AHEC does not discriminate or turn patients away based on any socio%conomic/demographic indicators. All students are offered the same care no matter who they are. Patients with standard commercial policies with a primary provider are always encouraged and referred back for follow-up... should they have a physician. o The Keys AHEC patient mix for FY 16117 was 46% uninsured, 28%Medicaid and 26% Commercial. We saw 5, 275 patients for 7,351 visits which shows many patients used us for an acute situation and then mostly likely returned to their primary physician if they were sick again. Finally, Mr. Kyle argued that simply by providing funding to AHEC, the County could face potential liability for any medical malpractice by AHEC. At the October meeting, the County Attorney advised that such a claim would be frivolous under the law but the County may have to expend resources to defend such a claim. Assistant County Attorney Chris Ambrosio has prepared a brief memo on this point, which is attached. Additionally, if the BOCC decides to go forward with funding AHEC's request, the contract will be modified as follows; 1) The indemnification language will include "medical malpractice and medical negligence"; 2) language will be added to reinforce and clarify that AHEC is not an agent or instrumentality of the County. o AHEC's response: Keys AHEC also maintains Medical Malpractice on all of its staff and general liability as an organization. Additional comments from AHEC: Keys AHEC provides no cost primary care medical services for the most medically vulnerable students of Monroe County through school based clinical locations within the County. Patients of these identified families have access to quality health care, timely medical care and be able to establish a medical home for ongoing care. Having primary care services available in the school during school hours will reduce access to care issues and improve the health of identified needy and medically underserved families in the community through direct primary care and early identification/treatment of disease. The Keys AHEC program allows non-insured, Medicaid, and under insured medically needy patients to have access to no cost primary care services that otherwise may not be accessible. Services Include: School Health Physicals & Health Assessments Sick & Well Child Visits Chronic Disease Management (Asthma and Diabetes) Prescriptions Treatment ofMinor Injuries Strep, Urine Dipstick & Glucose Testing Vision/Hearing Tests Pregnancy Testing Referral for Full Labs, Specialty Services, Oral Health & Immunizations Nutrition & Weight Management Counseling Consultation & Collaboration with School Health & Psychology Services. Other: • Keys AHEC is a fully credentialed Medicaid Provider of 6116 (Inclusive of all staff). • Keys AHEC does refer patients for advanced care to Specialists and Primary's that tend to be Board Certified Physicians with Hospital Privileges o Hospital Privileges are needed for admitting patients and having access to hospital resources. o Keys AHEC Staff is credentialed at Fishermen's with Privileges. • Keys AHEC has had 777 visits from the Marathon Schools from 743 patients in FY 16117. This equated to $116, 735 in care provided with only $16, 663 collected-13. S%. • Billing insurance is part of what is required by most Grant Applications and the State's allocation as part of our Sustainability plan. PREVIOUS RELEVANT BOCC ACTION: The Board directed the County Attorney to investigate the concerns raised during its October 18, 2017 meeting. CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: DOCUMENTATION: Keys AHEC Application School District Contract with AHEC The School Board of Monroe County Policy Student Accidents The School Board of Monroe County Policy Emergency Medical Authorization The School Board of Monroe County Policy Health Services Memo to BOCC on liability in AHEC contract Supplemental powers and duties of district school board FS 100143 School health services program FS 381 0056 Contract - A Boiler Plate HSAB Contract FYI (revised) FINANCIAL IMPACT: Effective Date: N/A Expiration Date: Total Dollar Value of Contract: Total Cost to County: Current Year Portion: Budgeted: Source of Funds: CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: Grant: County Match: Insurance Required: Additional Details: N/A If yes, amount: REVIEWED BY: Bob Shillinger Completed 10/31/2017 10:18 AM Christine Limbert Completed 10/31/2017 11:28 AM Budget and Finance Skipped 10/31/2017 11:07 AM Maria Slavik Completed 10/31/2017 12:16 PM Kathy Peters Completed 10/31/2017 12:06 PM Board of County Commissioners Pending 11/14/2017 9:00 AM E]49.a) MONROE COUNTY HUMAN SERVICES ADVISORY BOARD Application for Funding Fiscal Year 2018 Octoberl, 2017 -Septendaer30, 2018 ......................................................................................................................................................................................................... Agency Name Florida Keys Area Health Education Center, Inc -------------------------------------------- ---------------------------------------- ------------- ................................ ---------------------------------------- - --- I Physical Address i 5800 Overseas Hwy, #38 - ------------ - -------- 1-11,111,111,1111, ---------------------------- .......................................... ................................................................................................................................. . ...................................................... . .......... Mailing Address 1 Same ------------------------------- 1-11,111,111,111-1 ------------ ------------------------------- ................. ................. . . City, State, Zip Marathon, FL 33050 .................................. --------------- ------------------------ - - - - - - ------------ - - ----------------------- 1 Phone 1305 743 7111 ----- - - ----------------------------------------------------- - - - - - -- --- - --- - - ----------------------------------------------- ----------------------- ------------------------------- ---------------------- Fax 3057437709 .................................... .... . ............................................................................................. ................ ...................... ................. Email mcunningham@fkahec.org --------------- ------------------------ ------------------------ ----------------------- ..................... ........................... Whom should we contact with questions I Michael Cunningham, CEO about this application? ................ ................... ............. --------------------------- ------------------- ..................... I'll-1111-1---�--�-�--l""I'll""�,� ......................... ............. ...... ----- - ---- - - - ---------- ........... .............. ................................................................................................................................................................................. A ount received for prior fiscal year ending 09/3o/16 $50,000-00 -------------------------------------------- - ---- - - - ------------------------------------------------------------------------------------------------- ............ ---------------------- Amount received for current fiscal year $65,000-00 ending 09130117 --------- - - -------- ---------- ---------- ----------------------- .... ............. ......... . . ..... . ................ . ....... ............... Amount requested for upcoming fiscal year $ 120,000.00 ending og/3o/18 .................................. ...................... ............. ................... ---------------------- - -- ------------ ------------ - - ------------------------ --------------------------- For Fiscal Year 2018 , specifically how will the amount requested be utilized? ------------- Keys AHEC Health Centers will utilize the requested funding to support its no cost School Health Centers program in 8 School sites. This includes a new 3 day per week site at Gerald Adams Elementary and an increase to 3 days per week at Key West High School. Funding will specifically go to directly supporting the ARNP/PA-C medical providers and clinical expenses of the Health Centers for these medically vulnerable children. be directed toward a countywide oral health assessment and dental 111111-1--- . ........... - ......... ..................... — — ------ -------------------------- - ----------------------------------------------- dental sealants program. Those funds may be matched dollar for dollar based on the state funding allocation up to $45p000. Should the HSAB award the full $120,000, Keys AH EC will assign $75K to the Health Centers and $45K to the Oral Health program which will then be matched with up to an additional $45K ($9o,000 total). ........... Lu 0 as Lu E A Packet Pg. 1572 Florida Keys Area Health Education 5159-95M.-Aii :14-14 Please paste a cover letter into the space below providing notification of any change in organizational structure specific to services or method of providing services. The intent is to inform the HSAB of any consolidating, combining, or merging with other agencies to avoid duplication of services. MMIMIM IFINFra lrWr - -mur■ rmTlyn �� j,)itcujaF r ju Office of Management and Budget '1100 Simonton St. A+f Our nro-oge,21 TT77C 10-enn I fir b;IJr',VVI'F L 11111 if it I I-f 11 lu r U11 1 3 r i i I i Icl I I CaTILT7 RM nk you for your interest in the Keys AHEC's program, We envision building a healthier community and decreasing the eical needs of our most vulnerable children. Sincerely, gphax Michael L. Cunningham CEO L) LU 0 (D D Packet Pg. 1573 Florida Keys Area Health Education 1 11, 1 - - - '!!1 !111111111 111 Jill lip iii Jill Pil 11111 illil lillilill IF J! 11 2. List the services your agency provides. Examples of programs include: • Primary Care in 7 School Based Clinics -Expanded in FY 16/17.(8 in FY 17/18) • Direct Medical Exams/Children's Physical Exams • Patient Centered Tobacco Cessation Programs • Health Fairs -University of Miami Medical School •Health Assessments -Cardiovascular Disease, Skin Cancer, Spirometry and Osteoporosis • Komen Supported -Clinical Breast Cancer Exams and Educational Programs School/Child Care Center Based Health and Nutrition Programs -Alliance fora Healthier Generation • Healthy Aging -Diabetes, Chronic Disease and Enhance Fitness • Oral Health Evaluations • Accredited Health Professional Education Program s- Licensure (Live and Online) • Community Health Prevention and Education Programs • Emergency Preparedness Training -Medical Reserve Corp Management (Federal Housing Authority) • Medical, Nursing and Allied Health Student Training Rotations • Health Professional Recruitment VIIII illylillil ''I'ViVIIIII 1111MOOMEM ENAN arm -won 111111:1111ill 1 1011 Zen# UM. a MUM lltb), Flifebul'r 111*11b, I I CdU11C1 I L It I ITUnTr Nil T ARP C Tislurynedring Tests, Pregnancy Testing, Referral for Full Labs, Specialty Services, Nutrition & Weight Management Counseling, Consultation & Collaboration with School Health & Psychology Services. dicaliv vulnerable children in Monroe Counti. Outside of the Ke i s AN EC school based medical clirtic tWere are 17-11i I RM b7Nt*J W72 10 till RN 1114MIM I I W I W71 III I I I r.+= lillwatra"M =-Am Dental Sealant project. This portion of our program will be in partnership with the local Rotaries, Oral Health Providers, Schools and other supportive entities both local and statewide. Packet Pg. 1574 Florida Keys Area Health Education Cents 4. Have you previously been funded by HSAB? Would you like the HSAB to consider changing your funding category? Yes 1� 5. Will County HSAB funds be used as match for Grant Award Title: Purpose: Monroe :County Primary Care Initiative Support Of the School Health Centers Granting Agency: Amount: Award Date: Match Requirement: U r­ LU Health Foundation of South Florida $115,500.00 8/2o16 L000-HSAB is a portion of this. ------------ 50_ 0 as Grant Award Title; Purpose: w CL Monroe County School Health Centers Support of the School Health Centers D IN i I Granting Agency: Amount: Award Date: Match Requirement: r --------------------- Florida Blue Foundation =L2_0100�0-0011/2017 No specified anno just local support Grant Award Title: Purpose: School Health Clinics Support of the School Health Centers Granting Agency: Amount: Award Date: Match Requirement: Monroe County School District 18/2016 Support -Blot Suppo-Not Specified .... -------------- I 4 Ez� a. How have the 2017 HSAB funds been spent? Funding received from the HSAB has been utilized in the following categories to support the school based health center program. Major expense categories were for primary care medical staff, our Electronic Health Record and Federal Tax, UC and Fringe. No funding from FY 16117 was utilized for Administrative or Overhead expenses. Expenses include: ($65,000 Award) T. Medical Support Staff-75% 2. Tax/Fringe-13% 3. Electronic Health Record-12% All expenses submitted to the County have been reviewed and reimbursed. b. Were all HSAB funds awarded in FY 2o16 spent? Will all HSAB funds awarded in FY 2017 be spenf-0 M Yes. T00% of all funds awarded this year will be spent and all funds previously awarded were spent. Allocations awarded supported Medical Staff, Medical Supplies and partial assistance to the access of our EHR. Florida Keys Area Health Education C C -OFF —IVIL W � rTIdS D to bring in the Health Foundation's $115,5oo. All revenue of the program was used to support direct medical clinic costs for the treatment of children. Additionally the Blue Foundation ($9oK) and Monroe County School District ($75K) required local match to show community support in their approval of their grant/contract. d. Now much additional funding was received? $280,500 was received through the three entities above. mzm�� All funds received through all of the supporting grant and contract agencies supported Medical Provider Staff, Fringe/Taxes, Medical Director, EHR, Medical Malpractice, Medical Supplies, Travel, Permits, and Professional Fee expenses. A full detailed list of expenses for the entire program is available to the County upon request. The total school health center program expenses for FY 16117 are $450,000. a. Mission Statement. Yes No b. Goals. Yes 0 No c. Expansion or contraction of services, staff or location, Yes 110IMN Keys AHEC since the inception of the School Health Center�ram has exopanded from 2 providers and,4 sites in FY14/15 to 3.5 providers and 7 sites in FY 16/17. We anticipate having 4.5 providers and 8 sites in FY 17/18 plus adding a countywide oral health assessment and dental sealant program which no other organizations are involved in except for the Rotary Club in Key West at two targeted schools. ................................................................................................................................................. d. How prior year funds were spent. Yes C) No LU 0 as F. Packet Pg. 1576 Florida Keys Area Health Education C 8. Did your agency lose any funding, or partial funding in 2017? Yes (�� 9® Do you plan to allocate any part of this HSAB grant, if awarded, as a sub-grant to another organization? Yes 0 No e Please include these on the County NSA B Funding Budget for under "Grants to Other Organizations." offun ding? Yes ONo (F) Please include these on the Agency Expenses form, under "Grants to Other Organizations." 11. Will you or have you applied for other sources of County funding? Yes (�) No Please include these on the Agency Revenue form. Asset Forfeiture Fund $6,774.63 Amount Amount � ISource Source I ISource IAmount r- Packet Pg. 1577 Florida Keys Area Health Education er the past 27 years Keys AH EC has been a leader in delivering healthcare services to at risk and underserved Having primary care services available for out most medically vulnerable children in the school during school hours will reduce access to care issues and improve the health of students, siblings and families in the il I 111,111, on 9 N *14 01911jr.11I IMAM I I 12 W.J. 11 1 1 11.11M it Mill POWWOW care services. 11 ST 111 I'm Mlloil 111M to purchase health insurance -even with the subsidy. Insurances offered through the affordable care act and through the exchange in Monroe County are some of the most costly in the entire country. 1_*w m*t #!�licrei Wy em -exec �It t�&avp� 1"r,-Wing 2,-rd #,f health coverage are the contributing causes for children not receiving medical care until it becomes an -mergency situation. Non emergent illnesses and conditions often go untreated to the point where illnesses W,ecome emergencies. �"or all families living at or near poverty and/or the "working poor," the continued lack of access to health care �gTl iail'a�-M7 *f a "5;*f6 ir6p" aee aMfe" �i h les5 vrosperity. Families continue struggling to provide for their basic needs (affordable housing) and healthcare :nsurance is one that is often sacrificed. Keys AH EC sees this especially in the School aged population where mpproximatelY ■ •........ •. claim an uninsured status. U LU 0 Qd '7 Packet Pg. 1578 Florida Keys Area Health Education 9 he target population of the program in its entirety is the current student population of ii public schools and urrent/exr_i;rm4,in '),rn %^&L nd an additional 15% above that for younger siblings. This places a potential population to draw from at around ,000. The Clinic and its outreach programs anticipate having around 8,ioo unique patient encounters with over o,000 service encounters. ■ Poor Families with children make up a large portion of those living below (11% under l00% • the • or t (29% under 200% of the FPL) poverty levels. The School District reports lo% of their student population misses i or more days of school due to illness, 47% Of all students are on the free/reduced price lunch program. dclitionally Keys AHEC has a population where 3o% have insurance, 29% are on Medicaid and 41% are uninsured. 1 16. How are clients referred to your agencs Children are received by the clinic through the following avenues: -, School Health Nurses, - School Staff, 9 Outside Social Service Providers- Local Medical Providers, o Through AN EC and School Based Outreach, * Walk-ins and Appointments. Keys AN EC also utilizes the MCS D Connect Ed system to reach out to parents multiple times per year. 17. What steps are taken to ensure prospective clients are eligible and the neediest clients are given priority? Keys AHEC has a pre -registration process where clinical registration and consent forms are provided to all students at the start of school. The letter explains the program, how to access it and the services provided. Priority is given to children based on the severity of need given the current medical problem as documented by the medical provider. 18. Describe any networking arrangements that are in ■ with other agencies. Keys AHEC has formal /informal and referral relationships with the three hospitals, Urgent Care Centers, Cardiology, Pediatricians, Laboratories, Imaging Facilities, FQHC's, Dentists, Health Dept, School District Programs, Local Clinics, Social Service and Mental Health providers. 19. List all sites and hours of operation. Please note which of these sites will be using HSAB funding. Keys AH EC Main office is at 5800 Overseas Hwy, #38 Marathon. It additionally has two tobacco sites-Northside Dr., Key West and High Point Rd, Tavernier. HSAB funding will assist in the support of the Health Centers located at Schools in Key Largo, Coral Shores, Marathon MHS, Switlik, Sugarloaf, Gerald Adams, HOB and KWHS. All School sites are open Y2 hour before school to 1/2 hour after school on varying days. Keys AHEC receives a diversified funding allocation stream through different grants and contracts each year. State Tobacco funds, federal grants, private grants and contract funds now make up just about all of AH EC funds. Programs are identified, developed and targeted based on health needs for at risk populations i.e. Primary Care, Breast Cancer, Tobacco Cessation, School Health, Online Training and other programming. Current sources of funding include Tobacco State Funds, Federal Funds and private grants and contracts. Tobacco funds are stable, but have been reduced from $600K to $475K over the past six years. Federalfunds have remained stable over the past four years and private grants and contracts fluctuate year to year based on grant and contract periods and resources available. The most significant change in our funding has been the addition of School Health Center Program. Keys AH EC is currently working in Tallahassee to secure funding as well as grow financial partnerships with Private Foundations, Private Donors and Local entities. it is the goal of the Agency to continue to grow this model of funding with moderate increases annually as need dictates. Lu 0 as Packet Pg. 1579 Florida Keys Area Health Education 21. What organizational challenges do you expect in the next two years, and how do you plan to respond to them? The main organizational change anticipated in the upcoming year continues to be financial, strategic, and operational planning for future program development of agency growth. As staff and program services need t* be sustained, they need stable sources of support. The organization continues to strive to identify funding opportunities to assist in service provision. Service and program lines are now more focused and streamlined based on programmatic requirements, funding source allocations and community need. rX #.rtm K+Y-8-ic KT+trture sustainability versus short term programming. Tobacco, School Health Centers, and Community Health services will be our main focus in future years along with traditional Federal programs for Training. Along with these identified programmatic sources being developed it is the goal of the agency to solidify state allocations and multi -year federal/private grants. 22. How are clients represented in the operation of your agency? The Keys AN EC Board consists of representatives and consumers of services that Keys AN EC provides. All members of the Board come from the healthcare, social service, allied health professional, business community, university or governmental professions. Any interested individual or agency may seek Board Membership based on available positions. The Florida Keys AHEC is directly monitored by the University of Miami School of Medicine's AHEC Program Office quarterly. Additionally Keys AN EC may be monitored by each of its funding sources through quarterly and annual reports it provides to the specified contractual partner including the Dept. of Health. 24• hours of program service were contributed by 1 volunteers in the last year. 75. Will any services funded by the County HSAB award be performed under subcontract by another agency? If so, what services, and who will perform them? No, Keys AN EC will be responsible for the provision and oversight of all programs administered through its staff and community partners. rhe overarching goal of the program is to provide comprehensive integrated direct primary care medical services 'A Medical Home) for students and siblings in the school setting. Having primary care services available in the school during school hours will reduce access to care issues and improve the health of students, siblings and ,.amilies in the community through early identification/treatment of disease. Anticipated results of the program 3re that children will have access to primary care walk in services for non -emergency situations. - Soal 1: Keys AN EC will maintain the 7 School Health Center Sites Soal 2: Keys AH EC will open one new site 3 days per week at Gerald Adams Elementary goal 3: Keys AHEC will provide expansion at KWHS from one to three days per week 5oal 4: Keys AN EC ill hire one new FTE to be assigned at the new and expansion site Soal 5: Keys AN EEC will implement an oral health assessment and dental sealant program for end and 7th traders countywide. Lu m: All C 0 as Packet Pg. 1580 Florida Keys Area Health Education Ce 27. How will you measure these outcomell patient care, health ■ and use of all financial support. Keys AHEC will additional continue to produce detailed clinical reports as required by all other funding partners outlining detailed outcome and process objective detailing clinical progress and program development. *Keys AHEC will be able to track visits and health outcomes through CareTracker and Health Master EHR Systems. *Keys AHEC will initiate a Marketing and Public Relations plan for outreach describing services/programs to students and families for clinical use. *Keys AHEC will initiate additional health assessment and service programs to reach at risk student populations. *Work with the KPHA, Medicaid, Healthy Kids and other commercial insurance providers to secure contracts for reimbursement. 28. Provide information about units of service below. (Response not required if applying for $5,000 or less). I -- Service: . ................ ] Unit (Hour, session, day, etc.) Cost per unit (current year) I Primary Care Encounter Actual Treatment -CPT Codes $21 per billab I e service ---------------- = IService EncountersE All Inclusive Patient Services 6 per service encounter 7MTTnT= neeas of [TWUlCiellij, TAII'lefdDR2 ■ tz;] 1; ■ 10,77nrurrmt if Mdl U I 9�- and suffer from ongoing chronic diseases. This project bridges a significant gap in providing direct primary care services in school settings for at risk and medically underserved children and their families in Monroe County. Medicaid providers in the county have capped enrollments while many parents have not and will not enroll for health insurance through the ACA or Healthy Kids/KidCare programs. Current statistics coming from our clinics show a large proportion of students still without any type of medical coverage even if they qualify. The benefit to the community is that these Additionally the program will also address one of the County's greatest pediatric needs ... Oral Health Care! Lu 0 as 10 Packet Pg. 1581 T.11.a I a 0 LL r CO 0 0 ZZ,, v ON m ry r, N m LA D N 0o D �- en h tR O tCt 0 O o m Q o Q ,*" - N h CL to LA ", 000 �} yp LP1 N AP1 �t1 LNrN 'D N U1 O O O O O O O O O O f+5 K1 8+5 P Kt t/5 t°'Y fd K1 J LL LI LL LL LL LL tt LL �- U- �,�„ Lt_ LI_ ®% v O v O O O J .y "Cw i ll G O C O �J O U 0 n s C E L m C7 C % V Ln a '�. >, Lu = O LJ V O a ^ 0 G E s.. m .� W +n O O O O r O i .0 ofLA v J n v o v C Y u ~ u .a v i ;o p �/ E B o O C" >; �a u7 C w to O cc`- U O w E •� ?+gyp ` c m 'm1 O Li 1 C0 G t0 't GV G 1 Florida Keys Area Health Education Ce KE Include each position in the entire agency. Put an 11 V 11 next to each position directly related to program for which funding is requested. A 4o-hour/week employee would be 1.00 FTE; a 2o-hourlweek employee would be.5 FTE, etc. indicate whether the position is programmatic or administrative, with a "Is" or "A" next tot a position. Proposed -Upcoming Year Ending: Projected - Current Year Ending. Position Title Benefits Director of Education Office/Fiscal Mgr Program Assitant Tobacco Counselors Medical Director Per them Staff Fringe consists of Health Insurance, SEP Plan, Life and Disability. Only one ARNP is taking Health Insurance. No other benefits are offered to non full time or per them positions. Lu m: dc sZ 0 Q) CL T- r_ 0 CL E (a W VI Packet Pg. 1583 V- E r bt -- - - - - - - - - 12 r W ro 2O bo O tv :E -6 7F; ro C2 > az cc ro is rn Vp VY 41 41 V, m 0 0 hD -C ro 41 _0 LA P4 O Ln 4' o O to vi 0 0 r :3 4- 0 W, 0 U 41 tm Ul C W " 0 OJ 0 m ,,- O A tA E ru > 41 0 L 76 ru c to C M r '- Ln 0 0 41 41 4, C tn tn Ein W uj cu jA 41 -0 M tn .(U C c ro ru 41 m 41 %A 0) C 4- 0 - — " m m tdi m W c CL Z L- -0 0 0 0 E -C, -3 Ln ul zt: 00 0 w 0 0 0 41 CLU- 41 W -0 tA 0 M M x x LU LU Florida Keys Area Health Education Ce M 1111111111111 ill III III ON 111!! 11111 1 111! 1 l��iiiiijili Proposed County -Funded Expense Budget for Upcoming Year Ending: 26 J_30J 2oi8 Expenditures Total % Salaries - Program $65,000 0.54 Payroll Taxes - Program $5,000 0.04 Employee Benefits -Program 0.00 Salaries - Administrative 0.00 Payroll Taxes - Administrative 0.00 Employee Benefits -Administrative 0.00 Subtotal Personnel $70,000 o•5E Postage 0.00 Office Supplies $1,000 0.01 Telephone 0.00 Professional Fees Me Rent OX0 Utilities Mo Repair and Maint. Travel 0.00 Me Miscellaneous 0.00 Grants to Other Organizations List others below 0.00 Medical/Oral Health Supplies $42,000 0•35 Medical Malpractice Insurance EHR-Electronic Health Record $4,000 $3,000 M3 0.03 0.00 AM 0.00 0.00 0.00 0.00 0400 My) Total Expenses $120,000 100,00% U Lu 0 as j A Packet Pg. 1585 Florida Keys Area Health Education Cen M Proposed Expense Budget for Upcoming Year Ending: Projected Expenses for Current Year Ending: o6 / 30 2018 06 30 2017 Expenditures Total % Total % Salaries - Program $765,071 0.57 $628,300 0.53 Payroll Taxes - Program $58,530 0.04 $48,065 0.04 Employee Benefits - Program $56,602 0.04 $56,602 0.05 Salaries - Administrative $34,294 0.03 $33,425 0.03 Payroll Taxes - Administrative $2,624 0.00 $2,557 0.00 Employee Benefits -Administrative $5,648 0.00 $5,648 0.00 Subtotal Personnel $922,7 $774,597 o.65 Postage $2,000 0.00 $2,000 0.00 Office Supplies $40,000 0.03 $38,500 0.03 Telephone $107000 0.01 $10,000 0.01 Professional Fees 0o00 0.00 Rent $66,000 0.05 $65,267 o.o6 Utilities $10,500 0.01 $8,500 0.01 Repair and Maint. $2,500 0.00 $ 2?200 0.00 Travel $17,500 0.01 $17,500 0.01 Miscellaneous $1,200 0.00 $1,150 0.00 Grants to Other Organizations 0.00 0.00 List others below Accounting/audit $8,500 0.01 $6,920 0.01 Insurances $18,500 0.01 $17,500 0.01 Student Housing $24,000 0.02 $23,923 0.02 1 Contracts for Service $86,000 o.o6 $85,796 0.07 Computer -Internet $16,000 0.01 $16,1oo 0.01 Equipment Lease $9,000 0.01 $8,338 0.01 Print/Outreach $29,000 0.02 $29,143 0.02 1 Recruitment/Retention/Training $26,500 0.02 $24,500 0.02 Community Health $53,000 0.04 $52,797 0.04 Total Expenses $1,342,969 1.0000( $ 1,184,731 o.9800 Revenue Over/(Under) Expenses $0 $0 1 _J I '4 Packet Pg. 1586 r, Florida Keys Area Health Education Cen w -YITUFUgWA,TrMU"Lr6T%yUrMr4,IlMt, Year Ending: Projected Revenue for Current Year Ending: Revenue Sources - LOCAL GOVERNMENT: Monroe County HSAB City of KW City of Marathon I pit] mmmawas W1 ]AMR Emews 0 m, FEDERAL: FOUNDATION: Health Foundation COMMUNITY FOUND. INS REVENUE FUND RAISING/MISC Total Revenue I I A Packet a z uj 0 Q Z x 6(1) w LL CL m m 4� 4- L cu L- ro cr LL 0 cr w C/) o 0 > o LO (D (D cc (D (D 0 0 0 OJ 0 z 0 z LL 0 z o z O(D0000 0 0 e 0 e & 0 0 G (D 0 0 0 0 0 0 0 e e 0 w 0 0 LU 0 > LLJ CL x Lu .2 0 (U m V) I 0 (U E (U m V) C m LL -0 < 'a m cr D 10 ru aj u 44 c (U u (U 0 E 0 (ON E 0 C� (U 0 CL 0 Q cu 0 CL 0 `^ V) cu E c 0 u CZ5 0 E t ra U- c 0 bO w CC 0 0 0 (L V) cu E c 0 U r_ 0 E t ra a (U 0 -C te 3: c CL E w x ui 0 0 0 CL to U 'a c 0 *zl m c E I a) 0 - 0 j - LA cr 0 CL 0 v g 0 S CLO cr w - 0 01 0 vQ > 0 CL 0 Lu w w CL 3: no 7F, bD C .�= -C 0 - - m m 0 0 CL 0 m -E 0 E C 79 0 >1 m 0 (V ' f 0 -0 0 0 >1 cx 0 v (w v :L- m m 0 4,; CL 0 >1 cx 0 Ij 0 a 0 CL 0 Q 0 0 E 0 2- 0 ': m IV E :te 'a =1 < ca w o & 0 u �n 0 I 0 0 cx o Q .2 ru w u - 0 E 0 t 0 CL cc E E Ln 0 m o k-j E E bO 2 0 8 -0 0 C m , , m o aj m > LA w M co bO m m t a) v m W c D '0 m 0 M CL .2 0 IV x E x w x w co v w U. LL z 0 IL or I D 0 0 q d L) LU A -I Q, eta r E E 0 E .0 0 0 E a; m I Packet 9. 1=588 1 Monroe County School District Superintendent ofSchoolsis Mark T. Porter ..,,..,..... Board Rationale File #: 16-777 TITLE Contract with Florida Keys Area Health Education Center to Provide Primary Care Medical Services BACKGROUND INFORMATION Beginning with the 2014-2015 school year Florida Keys Area Health Education Center has provided primary care medical services at varuios school sites in the Monroe County Schools. For the 2017-2018 school year Florida Keys AHEC is requesting $60,000.00 to provide the following services: -School Health Center -Primary Care Program -School Health Programs -Students (expanded to include additional sites) -Manadated State of Florida staff training - CPR/AED and Safety and First Aid. -Staff Welnness Program - Though School Health Center -Health Occupation Classes BUDGET INFORMATION Item Budgeted? Yes Total Cost: $60,000.00 Contract Originator: Mark Porter, Superintendent Board Meeting Date: June 27, 2017 RECOMMENDATION Approval of Contract with Florida Keys Area Health Education Center to Provide Primary Care Medical Services L) W 0 CL n Monroe County School District Page 1 of 1 Printed on 6/27/2017 THE SCHOOL DISTRICT OF MONROE COUNTY, FLORIDA Contract for Goods & Services This Contract entered into on the date last written below, by and between: Florida Keys Area Health Education Center Inc. (the "Contractor') and The School Board of Monroe County, Florida ("School Board" or "MCSB"), as contracting agent for the School District of Monroe County, Florida ("School District'). In consideration of the mutual covenants and benefits hereinafter set forth, the parties herein covenant and agree as follows: W 1. TERM 0 �a The term of this Contract shall be from: (insert dates — contract may be for a school year) CL n July 1, 2017 to June 30 , 2018. 2. CONTRACTOR'S SERVICES Contractor agrees to provide the following goods/services: Primary Care School Health Clinics, Health Education Services for students and CPR/AED Training for staff. If documentation of the specific goods/services is attached, said documentation is labeled as Exhibit " A "to this Contract and is incorporated herein by reference. In the event of a conflict between the terms of this Contract and any exhibit, the terms of this Contract shall control, unless otherwise agreed in writing as an amendment pursuant to the terms for such as provided herein. 3. COMPENSATION School Board shall pay Contractor the sum of $ 60,000.00 to provide said goods/services pursuant to this Contract. No payment shall be due until an invoice for the goods/services has been submitted for payment and the School Board verifies that all services have been fully and satisfactorily completed. The School Board will make diligent efforts to verify and pay invoices within one (1) payment cycle after receipt. If alternate payment TERMS are required they must be outlined below. Rev 2/2017 Page 1 of 10 Contractor will submit quarterly invoices 9/30/17, 12/31/17, 3/31/18 and 6/30/18. 4. INSURANCE Contractor agrees to secure and maintain at all times during the term of this Contract, at Contractor's expense, insurance coverage, as laid out below, covering Contractor for all acts or omissions which may give rise to liability for services under this Contract. All Contractor staff are to be insured in minimum amounts acceptable to the Monroe County School Board and with a reputable and financially viable insurance carrier, naming The School Board of Monroe County, Florida as an additional insured. Such insurance shall not be cancelled except upon thirty (30) days written notice to the MCSB. Contractor shall provide MCSB with a certificate evidencing such insurance coverage within five (5) days after obtaining such coverage. Contractor agrees to notify MCSB immediately of any material change in any insurance policy required to be maintained by Contractor. Contractor is required to obtain the following coverage, with documentation of having obtained CL such coverage being attached hereto as Exhibit " B General Liability Insurance Amount: Professional Liability Insurance Amount: Vehicle Liability Insurance Amount: Workers Compensation Insurance Amount: 5. COMPLIANCE WITH LAWS AND POLICIES Contractor agrees to comply with all current Monroe County School Board Policies and all applicable local, state and federal laws, including laws pertaining to the confidentiality of student records and public records requests. Contractor agrees that MCSB has the right to unilaterally and immediately cancel this Contract upon refusal by Contractor to allow public access to all documents, papers, letters, or other material made or received by the Contractor in conjunction with the contract, unless the records are exempt from s.24(a) of Art. I of the State Constitution and s.119.07(1). Should cancellation be necessary under this clause, MSCB is required only to provide written notice to Contractor, effective upon receipt of notice, which shall be documented. 6. INDEPENDENT CONTRACTOR STATUS Rev 2/2017 Page 2 of 10 The Contractor is, for all purposes arising under this Contract, an independent contractor. The Contractor and its officers, agents or employees shall not, under any circumstances, hold themselves out to anyone as being officers, agents or employees of the School/Department. No officer, agent or employee of the Contractor or School/Department shall be deemed an officer, agent or employee of the other party. Neither the Contractor nor School/Department, nor any officer, agent or employee thereof, shall be entitled to any benefits to which employees of the other party are entitled, including, but not limited to, overtime, retirement benefits, workers compensation benefits, injury leave, or other leave benefits. 7. BACKGROUND CHECKS/FINGERPRINTING In accordance with the legislative mandate set out in sections 1012.32, 1012.465 and 435.04, Florida Statutes as well as with the requirements of HB 1877, The Jessica Lunsford Act, Contractor agrees that all of its employees and sub -contractors, including employees of sub -contractors, who provide or may provide services under this Contract have completed all background screening W requirements through a Monroe County School Board designee pursuant to the above -referenced statutes. It is recognized and agreed that the provisions and exceptions relating to the dictates of The Jessica Lunsford Act, and codified at sections 1012.321, 1012.465, 1012.467 and 1012.468 of the Florida Statutes, shall apply to the requirements of this paragraph where so applicable.cu CL n Contractor agrees to bear any and all costs associated with acquiring the required background L) screenings. Contractor agrees to require all affected employees and sub -contractors to sign a statement, as a condition of employment with Contractor in relation to performance under this Contract, that the employee and/or sub -contractor will abide by the terms and notify Contractor/Employer of any arrest or conviction of any offense enumerated in section 435.04, Florida Statutes within forty-eight (48) hours of their occurrence. Contractor agrees to provide MCSB with a list of all employees and/or sub -contractors who have completed background screenings as required by the above -referenced statutes and that meet the statutory requirements contained therein. Contractor agrees that it has an L) ongoing duty to maintain and update these lists as new employees and/or sub -contractors are hired and in the event that any previously screened employee fails to meet the statutory standards. Contractor further agrees to notify MCSB immediately upon becoming aware that one of its employees or its sub -contractor's employees, who was previously certified as completing the background check, 0 and meeting the statutory standards, is subsequently arrested or convicted of any disqualifying offense. Failure by Contractor to notify MCSB of such arrest or conviction within forty-eight (48) hours of being put on notice by the employee/sub-contractor and within 5 days of its occurrence shall constitute grounds for immediate termination of this contract by MCSB. The parties further agree that failure by E Contractor to perform any of the duties described in their paragraph shall constitute a material breach CU of the contract entitling MCSB to terminate this Contract immediately with no further responsibility to make payment or perform any other duties under this Contract. 8. TERMINATION A. WITHOUT CAUSE This Contract may be terminated for any reason by either party upon thirty (30) days written notice to the other party at the addresses set forth below. If said Contract should be terminated Rev 2/2017 Page 3 of 10 as provided in this paragraph of the Contract, the MCSB will be relieved of all obligations under said contract and the MCSB will only be required to pay that amount of the contract actually performed to the date of termination with no payment due for unperformed work or lost profits. B. TERMINATION FOR BREACH Either parry may terminate this Contract upon breach by the other party of any material provision of this Contract, provided such breach continues for fifteen (15) days after receipt by the breaching parry of written notice of such breach from the non -breaching parry. C. IMMEDIATE TERMINATION BY MCSB School Board may terminate this Contract immediately upon written notice to Contractor (such termination to be effective upon Contractor's/Individual's receipt of such notice) upon occurrence of any of the following events: W i. the denial, suspension, revocation, termination, restricting, relinquishment or lapse of any license or certification required to be held by the Contractor, or of any Company/Individual staffs professional license or certification in the State ofcu Florida;CL conduct by Contractor or any Company/Individual staff which affects the quality of services provided to the School Board or the performance of duties required hereunder and which would, in the School Board's sole judgment, be prejudicial to the best interests and welfare of the School Board and/or its students; iii. breach by Contractor or any Company/Individual staff of the confidentiality provisions of this Contract or the Family Educational Rights and Privacy Act (FERPA); iv. failure by Contractor to maintain the insurance required by the terms of this Contract. 9. ASSIGNMENT Neither Contractor nor the Monroe County School Board may assign or transfer any interest in this Contract without the prior written consent of both parties. Should an assignment occur upon mutual written consent, this Contract shall inure to the benefit of and be binding upon the parties hereto and their respective heirs, representatives, successors and assigns. 10. AMENDMENT This Contract may be amended only with the mutual consent of the parties. All amendments must be in writing and must be approved by the Monroe County School Board. 11. INDEMNIFICATION, GOVERNING LAW & VENUE Rev 2/2017 Page 4 of 10 Contractor shall indemnify and hold harmless the Monroe County School Board from and against any and all claims, liabilities, damages, and expenses, including, without limitation, reasonable attorneys' fees, incurred by the MCSB in defending or compromising actions brought against it arising out of or related to the acts or omissions of Contractor, its agents, employees or officers in the provision of services or performance of duties by Contractor pursuant to this Contract. This Contract shall be construed in accordance with the laws of the State of Florida. Any dispute arising hereunder is subject to the laws of Florida, venue in Monroe County, Florida. The prevailing party shall be entitled to reasonable attorney's fees and costs incurred as a result of any action or proceeding under this Contract. 12. REPRESENTATIONS, WARRANTIES & DEBARMENT Contractor represents and warrants to the School Board, upon execution and throughout the W term of this Contract that: r- A) Contractor is not bound by any Contract or arrangement which would preclude it from entering into, or from fully performing the services required under the CL Contract; B) None of the Contractor's agents, employees or officers has ever had his or her professional license or certification in the State of Florida, or of any other jurisdiction, denied, suspended, revoked, terminated and/or voluntarily relinquished under threat of disciplinary action, or restricted in any way; C) Contractor has not been convicted of a public entity crime as provided in F.S. §287.133, to wit: A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid, proposal, or rely on a contract to provide any goods or services to a public entity, may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list; and D) Contractor and Contractor's agents, employees and officers have, and shall maintain throughout the term of this Contract, all appropriate federal and state licenses and certifications which are required in order for Contractor to perform the functions, assigned to him or her in connection with the provisions of the Contract. E) The Vendor certifies that, neither the firm nor any person associated therewith Rev 2/2017 Page 5 of 10 in the capacity of owner, partner, director, officer, principal, investigator, project director, manager, auditor, and/or position involving the administration of federal funds: (i) Is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions, as defined in 29 CFR Part 93, Section 98.510, by any federal department or agency; (ii) Has not within a three-year period preceding this certification been convicted of or had a civil judgment rendered against it for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state, or local government transaction or public contract; violation of federal or state antitrust statutes; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (iii) Has not within a three-year period preceding this certification had one W or more federal, state, or local government public transactions terminated for cause or default. 13. CONFIDENTIALITY CL n Contractor recognizes and acknowledges that by virtue of entering into this Contract and L) providing services hereunder, Contractor, its agents, employees and officers may have access to certain confidential information, including confidential student information and personal health information. Contractor agrees that neither it nor any Contractor agent, employee or officer will at any time, either during or subsequent to the term of this Contract, disclose to any third party, except where permitted or required by law or where such disclosure is expressly approved by the Monroe County School Board in writing, any confidential student information, personal health information or other confidential/personally identifiable information. Contractor, its agents, employees and officers shall L) comply with all Federal and State laws and regulations and all Monroe County School Board policies regarding the confidentiality of such information. 14. BILLING Bills for fees or compensation under this contract shall be submitted in detail sufficient for a proper pre -audit and post -audit thereof. Further, bills for any travel expenses shall be submitted in accordance with Florida Statute §112.061 where applicable. 15. THIRD -PARTY BILLING AND PAYMENT To the extent applicable with regard to the services provided in this Contract, the Contractor shall cooperate with School Board representatives to determine the eligibility of a referred student for third -party benefits and to bill cooperatively the third -party for services provided to the referred student. Should the third -party decline to pay for billed services, or should the third -party only make partial payment for billed services, Contractor shall provide appropriate documentation to School Board and will assist the School Board in any administrative or appeals process regarding eligibility or payment as may be requested by the School Board. Contractor shall not be entitled to bill nor accept third -party Rev 2/2017 Page 6 of 10 payment without authorization of the School Board and Contractor agrees that School Board shall not be obligated to make any payment that exceeds the rate referred to in the paragraph governing Compensation. The Contractor shall provide service documentation in accordance with professional standards and School Board criteria as requested. 16. CONTRACT RECORDS RETENTION Pursuant to Florida Statute 119.0701, contractor agrees to: (a) Keep and maintain public records that ordinarily and necessarily would be required by the School Board in order to perform the service. (b) Upon request from the School Board's custodian of public records, provide the School Board with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. LU (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the contractor does not transfer the records to the School Board. CL (d) Upon completion of the contract, transfer, at no cost, to the School Board all public records in possession of the contractor or keep and maintain public records required by the School Board to LU perform the service. If the contractor transfers all public records to the School Board upon completion of the contract, the contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the contractor keeps and maintains public records upon completion of the contract, the contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the School Board, upon request from the School Board's custodian of public records, in a format that is compatible with the i0 information technology systems of the School Board. Failure of Contractor to comply with this section and F.S. §119.0701 may include, but not be limited to, the School Board holding the contractor in default, termination of the contract or legal action. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC REOCRDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: (Records(a KeysSchools.com OR MAIL TO: MONROE COUNTY SCHOOL DISTRICT, ATTN: CUSTODIAN OF PUBLIC RECORDS, 241 TRUMBO ROAD, KEY WEST, FL 33040 OR CALL (305)293-1400). 17. ETHICS CLAUSE Contractor warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former Monroe County School District officer or employee. For breach or violation of this provision the Monroe County School District may, in its discretion, terminate this contract without liability and Rev 2/2017 Page 7 of 10 may also, in its discretion, deduct from the contract or purchase price, or otherwise recover the full amount of any fee, commission, percentage, gift or consideration paid to the former Monroe County School District officer or employee. 18. CONFLICT OF INTEREST The following provisions shall apply for conflict of interest. Any violation of these provisions by a School District employee may be grounds for dismissal. No contract for goods or services may be made with any business organization in which the Superintendent or a School Board member has any material financial interest unless it is a single source or clear documentation exists to show that, no other supplier can provide the identical/comparable goods/service, at a lower cost to the School Board. No School Board member or officer, or School District officer or employee, may directly or indirectly purchase or recommend the purchase of goods or services from any business organization which they or their near relative have a material interest as defined by §112.313, Florida Statutes, except as allowed by DOE Interpretative Memorandum No. A-20. No School Board member, School LU District employee or official may receive gifts or any preferential treatment from vendors. Such members, officers, officials or employees shall not be prohibited from participating in any activity or purchasing program that is offered to all School District employees or in School District surplus sales, provided there is no preferential treatment. CL 19. SEVERABILITY >� The parties recognize and agree that should any clause(s) herein be held invalid by a Court of competent jurisdiction, the remaining clauses shall not be affected and shall remain of full force and effect. 20. COUNTERPARTS This Contract may be executed in one or more counterparts, all of which together shall constitute only one Contract. 21. WAIVER A waiver by either party of a breach or failure to perform hereunder shall not constitute a waiver of any subsequent breach or failure to perform. Any waiver of insurance requirements as provided by this Contract and/or the policies of the School Board does not relieve the Contractor of the indemnification provisions contained within this Contract. 22. CAPTIONS The captions contained herein are used solely for convenience and shall not be deemed to define or limit the provisions of this Contract. 23. ENTIRE CONTRACT The parties hereto agree that this is the final Contract between the parties and supercedes any Rev 2/2017 Page 8 of 10 and all prior Contracts and/or assurances, be it oral or in writing. 24. NOTICES All notices required by this Contract, unless otherwise provided herein, by either party to the other shall be in writing, delivered personally, by certified or registered mail, return receipt requested, or by Federal Express or Express Mail, and shall be deemed to have been duly given when delivered personally or when deposited in the United States mail, postage prepaid, addressed as follows: Monroe County School Board: Superintendent Monroe County School District 241 Trumbo Road Key West, FL 33040 With a copy to District Counsel Vernis & Bowling of the Florida Keys, P.A. 81990 Overseas Hwy, 3rd Floor Islamorada, FL 33036 Contractor: Michael Cunningham,CEO Keys AHEC 5800 Overseas Hwy, #38 Marathon, FL 33050 IN WITNESS WHEREOF, the parties have executed this Contract on this 1st day of July , 2017/ GNATURE� OFFCCHA�IR ERERS QF THE BOARD (CONTRACTS OVER $25,000) SI NATURE OF SUPERINTENDENT ez('n SIGNATURE OF CONTRACTOR/REPRESENTATIVE MICHAEL CUNNINGHAM, CEO PRINT NAME AND TITLE June 27, 2017 DATE June 27, 2017 DATE 6/27/17 DATE Rev 2/2017 Page 9 of 10 W 0 CL n V BUSYNESS/PERSONAL RELATIONSHIP DISCLOSURE AFFIDAVIT I, Michael Cunningham , of the City/Township/Parrish of Marathon, State of Florida, and according to law on my oath, and under penalty of perjury, depose and say that; 1) 1 am the authorized representative of the company or entity making a proposal for a project described as follows: Name of company/vendor: Ke s AHEC and Nature of services presently_ being offered to School District: Primary Care School Health Centers, Health Education Services and AED/CPR Training. 2) 1 have _ have not X at any time, and excluding the instant proposal, had a business or personal relationship with any member of the School Board of Monroe County, Florida, and/or with any employee of the School District of Monroe County, Florida. District. b.) Include particular Board member or employee's name(s), position held by su a.) The details of my or my company's present and/or former relationship, excluding the instant proposal, are listed below, including any current or previous work done for Monroe County School ch member or employee and relevant date(s); use reverse for space if needed. James Drake -Board Member of Keys AHEC. 3) The statements contained in this affidavit are true and correct, and made with full knowledge that The School Board of Monroe County, Florida, relies upon the truth of the statements contained in this affidavit in awarding contracts for the subject project. 6 27 17 Date STATE OF F`oP-mA COUNTY OF MaN2oE (Signature of Authori Representative) PERSONALLY APPEARED BEFORE ME, the undersigned authority, A116;KAEL CoAMJN41-/M/, who, X being personally known, _ or having produced as identification, and after first being sworn by me, affixed his/her signature in the space provided above on this a—? day of v,► 201. NOTARY PUBLIC Sim M mim NOTARY K1dL.IC STATE OF FLOFdDA Camw Csowzta E*kft 8114=0 Rev 2/2017 My commission expires: Page 10 of 10 L) W 0 �a CL Keys AHEC Health Centers KEYS AHEC Collaborative School Based Programs Proposal 2017-2018 The purpose this proposal is to outline the request of the Florida Keys AHEC (KEYS AHEC) to the Monroe County School District (MCSD). Keys AHEC will outline services, programs and contributions to be made to the MCSD from Keys AHEC as made available. Keys AHEC has been a longstanding partner of the Monroe County School District providing financial support and health services to students, faculty and parents for over 18 years. The proposal & submitted is to request and offer support to continue the collaborative LU efforts of KEYS AHEC and the MCSD for the provision of direct medical and primary care services, health education programming, wellness services, and technical training/assistance for the students and staff of the MCSD. CL This proposal continues the commitment between the two agencies furthering its partnership where both agencies benefit from services and resources provided for the implementation of the below outlined programs. KEYS AHEC proposal offers a mutually beneficial approach collaborating with the MCSD to provide support of in classroom health education programs and direct medical services for our county's most medical vulnerable students. Keys AHEC will provide a return on investment with agency, contract and grant funds at a rate of at least 10 to 1. Total Reauest from Keys AHEC to MCSD-$60,000.00: Financial Support request will be utilized in part for the following outlined programs: Mandated State of Florida Staff Trainina-CPR/AED and Safety and First Aid Funded by Health Readiness Coalition of Monroe County in FY 16117. Keys AHEC will deliver CPR/AED Training for Monroe County School District Staff equaling up to 150 Participants. Keys AHEC will deliver Safety and First Aid for Monroe County District Staff equaling up to 150 Participants. Sessions will be held at School Sites or at predetermined AHEC locations countywide. Sessions held will be based on availability of Keys AHEC Health Centers AHEC instructors following AHA Guidelines of a 6 to1 participant to instructor ratio. AHEC will provide the class, use of all educational material/equipment, provide Certification Cards, and provide single use CPR Masks for each participant. Certifications under this program are good for two years. Staff Wellness Proarams-Thouah School Health Centers • Access to 8 clinical sites -Basic Primary Care program. • Osteoporosis Education and Pdexa Screens -Ultra Sound of Heal -Women only. • Skin Cancer Assessments via a Derma View exam and LU Upper body/extremity evaluation. • Breast Cancer Assessments -May attend at non school based programs if not scheduled at a school. • Full Service Health Fairs at Annual AHEC/UM Dates. CL Health Occupations Classes: KEYS AHEC provides: 1. Support to the Health Occupations Classes that include arranging field trips (UM, FIU, Hospital and Local Providers), Guest Speakers, Materials and Supplies. 2. Summer Camp Opportunities for High School Sophomores and Juniors. 3. Jr MRC-Keys AHEC will support activities. Note: KEYS AHEC provides licensed health professional staff and health professions students for the presentation and implementation of all programs. The KEYS AHEC also provides lesson reinforcement items to all students/staff who participate in programming. All educational programs meet Sunshine State Standards for students as well as adult programs being evidenced based. School Health Centers -Primary Care program -No cost Direct Medical Services for Students, Siblings and Staff. Program funded through a collaborative partnership to provide no cost Primary Care Medical services inclusive of an Oral Health Campaign. Primary Care Medical Services within 8 Monroe County School Sites: Services will include, but not be limited to: School Health Physicals & Health Assessments, Sick & Well Child Visits, Chronic Disease Management (Asthma and Diabetes), Prescriptions, Keys AHEC Health Centers Treatment of Minor Injuries, Strep, Urine Dipstick & Glucose Testing, Vision/Hearing Tests, Pregnancy Testing, Referral for Full Labs, Specialty Services, Oral Health & Immunizations, Nutrition & Weight Management Counseling, Consultation & Collaboration with School Health & Psychology Services. Hours and days of Clinical Operation will be posted and advertised by Keys AHEC for the School Year. Hours and days will include a 6 week summer program following the Summer School Schedule. Clinics will be open on all professional days, but closed on all School Holidays or scheduled days off for students/staff. Keys AHEC will provide all necessary Patient Registration, Medical History, HIPAA and Privacy information forms required. Keys AHEC will maintain licensed Clinical Staff, Malpractice Insurance, an Electronic Health Record and coordinate services with the District's current school health program. a& MCSD will provide no cost space for the clinics and assist in providing clinical and medical information to students as able. Keys AHEC will communicate any changes in Staff or Schedule to the School Principals and District Administration. Request from Monroe County School District: $60,000 Keys AH EC Health Centers Additional in Classrooms to be Offered -Funding Dependent: • School Health Procirams-Students *All programs meet Sunshine State Standards for Vocabulary/Reading, Health and Science. Program Eliminated in FY 16117 due to insufficient financial resources. • Scrubba Bubba-Personal Hygiene Program -Kindergarten and First Grade -The program promotes proper hygiene behaviors that influence individual well-being, identifies ways to keep neat and clean, differentiates between germs, bacteria and viruses, and describes how germs are spread and how to prevent it. • Bone Zone -Second Grade The program promotes the LU importance of proper nutrition, exercise, vitamin D and then focuses on the dangers of tobacco use, alcohol, non- physical activity and caffeine. • Show Down in Tooth Town (Oral Health Care) -Third GradeCL The program focuses on proper oral health care, L) appropriate dental hygiene techniques, healthy nutrition LU and how neglecting them adversely effects our health and leads to the onset of many chronic diseases. • Walk Through Heart -Fourth Grade -The program focuses on how we keep our heart healthy and strong through exercise, nutrition and healthy lifestyles and also identifies i0 contributing factors of heart disease and stroke by talking about cholesterol, tobacco use and alcohol/drug use • Safety and First Aid -Fifth Grade- The program promotes safety and first aid specifically relating to stroke, heart 0 attack, and other danger signs of CVD. Students are taught the proper procedures in case of an emergency and how to recognize and prevent risk factors. CERTIFICATE OF LIABILITY INSURANCE FLORI-1 OP ID: LID DATE (MMfDD1YYYY) 11/10/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polley(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Beth Brattebo Arthur J Gallagher RMS, Inc. PHOI FAx 1665 Terrell Mill Road Arc No Ex, , 770-818-1506 (,JC Noy. 770-850-0988 Marietta, GA 30067 E-MAIL geth_Bratteb T Health Care Insurance Res, Inc ADDRESS: INSURER(S) AFFORDING COVERAGE I NAIC # INSURED Florida Keys Area Health Ed Michael Cunningham 5800 Overseas Hwy, S # 38 Marathon, FL 33050 rnvFRJ%C;FS CFRTIF1r..ATF NI1RARFG- INSURER A: The Medical Protective Company INSURER B : INSURER C INSURER D INSURER E : DC111CIn AI A111RADCo. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR� TYPE OF INSURANCE ILTR INSD ADDL WY POLICY NUMBER MMIODYYYY MM10D1YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE L or -CUR X i ,HN009434 11112/2016 I I EACH OCCURRENCE 11112/2017 �MSES( RENTED PREMISES (Ea occurrenc_el $ 1,000,000 $ 50,000 $ MED EXP (Any one person) $ 1,000,000 PERSONAL & ADV INJURY _ _ $ 3,000,000 - -- $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY E' JECT PRO- LOC GENERAL AGGREGATE PRODUCTS -COMPlOPAGG OTHER: $ AUTOMOBILE LIABILITY GOMBI NED SINGLE LIMIT Ea accident $ ANYAUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY Per aaident { 1 PROPERTY DAMAGE _(Per accidenl $ �" I $ ' UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADEi $ AGGREGATE ! r DIED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYE R$' LIABILITY YIN PRCPRIETORIPARTNER!EXECUTIVE FICERIMEMBER-EXCLUDED? N.IAandatory SPER OTH- r` TATUTE ER $ E.L EACH ACCIDENT DISEASE-EAEMPLOYE $ fY in NH)EL es, describe under E.L. DISEASE -POLICY LIMIT $ RIPTION OF OPERATIONS below A Professional IHN0094.34 11/1212016 11/12/2017 .:Per Event 1,000,000 i 'Aggregate 3,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) L.CR I Ir'II.AI C MULUCI'[ Monroe County School District 241 Trumbo Road Key West, FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHOWZ50 REPRESENTATIVE LIM. cod,-, O td8 CL n ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 111W AKIItlrl The School Board of Monroe County P P P 5 - STUDENT ACCIDENTS The School Board of Monroe County Bylaws & Policies The School Board believes that school personnel have certain responsibilities in case of accidents which occur in school. Said responsibilities extend to the adrr Find It 1 persons trained to do so, summoning of medical assistance, notification of administrative personnel, notification of parents, and the filing of accident reports. Employees should administer first aid within the limits of their knowledge of recommended practices. All employees should make an effort to increase their unde steps to be taken in the event of an accident. F.S. 381.0056, 1001.43 a LU 0 �68 CL M http://www.neola.com/monroe-fl/ 10/24/2017 The School Board of Monroe County The School Board of Monroe County P Bylaws & Policies d P 341 - EMERGENCY MEDICAL AUTHORIZATION The District will distribute annually to parents or guardians of all students the Emergency Medical Authorization Form. In the event emergency medical treatment Find It 1 necessary, the District will adhere to the instructions on the authorization form. The Emergency Medical Authorization Form will be kept in a separate, easily accessible file in each school building during the school year. Any time a student or a group of students is taken out of the District to participate in a school event, the staff in charge of the event must take the Emergency ME E students. This includes, and is not limited to, students involved in music trips, athletic trips, field trips, and academic contests. This does not include student spec LU Whenever it is necessary for staff members to use emergency procedures in order to care properly for a student, they are to follow the procedures described in 1 administrative procedures and are not to abide by any "Do Not Resuscitate" (DNR) agreement that may exist for a student, unless ordered to do so by a court of F.S. 1001.43, 1006.062 0 QJ http://www.neola.com/monroe-fl/ The School Board of Monroe County P P P 531 - HEALTH SERVICES The School Board of Monroe County Bylaws & Policies The Superintendent shall annually develop a written School Health Service Plan and transmit the plan to the School Board. Find It I The District may provide or request parents to provide: A. general physical examinations for athletics, B. dental examinations, C. tests for communicable disease, D. vision and/or audiometric screening, E. scoliosis tests. If the School District chooses to provide nonemergency physical exams or screenings, the Board shall directly notify the parents of students, at least annually at school year, of the specific or approximate dates during the school year when any non -emergency, invasive physical examination or screening is scheduled or e scheduled for students if examination or screening is: (1) required as a condition of attendance, (2) administered by the school and scheduled by the school in a necessary to protect the immediate health and safety of a specific student, or other students. The term "invasive physical examination" means any medical examination that involves the exposure of private body parts, or any act during such examination t insertion, or injection into the body, but does not include a hearing, vision, or scoliosis screening. Unless the physical examination or screening is permitted or required by an applicable State law, parents may refuse to allow the Board to administer a noneme physical examination or screening upon written notification to the Board within five (5) days after receipt of the Board's annual public notice. 20 U.S.C. 1232(h) F.S. 381.0056 LU 0 �68 73 CL n http://www.neola.com/monroe-fl/ MEMORANDUM TO: Mayor George Neugent and Commissioners THRU: Bob Shillinger, County Attorney FROM: Chris Ambrosio, Assistant County Attorney DATE: November 14, 2017 BOCC Meeting Re: Extent of Monroe County's liability for giving partial reimbursement funding for medical health care services provided by independent contractor Florida Keys Area Health Education Center (AHEC) Brief answer: Monroe County does not incur liability for AHEC's services or programs by providing grant funding which partially reimburses AHEC's services and programs. Assignment to County Attorney's Office At the October 18, 2017 BOCC meeting the BOCC directed the County Attorney's Office to research whether the County could face liability for patient claims of medical malpractice or negligence resulting from medical health care services provided by AHEC and its employees in schools. (Item # B.38 FY2018 HSAB Funding). The BOCC did not approve the boilerplate agreement attached to the agenda item as relates to AHEC, and sought revisions. Factual Background Under the reimbursement funding agreement and in all contexts, Monroe County has no ownership, direction, operation, structural control or authority over the AHEC program, services it renders, methods of delivery, hiring, training, supervision, direction or retention of its employees or agents, any of its corporate and business decisions and the acts or omissions of AHEC medical providers and personnel. Monroe County did not create the AHEC organization and has no authority to dissolve it. AHEC is not an instrumentality or agency of Monroe County. In the framework of a contractual relationship to provide reimbursement funding to AHEC, AHEC is an autonomous entity and independent contractor. No Monroe County employee or agent performs any work within the scope of his or her employment with Monroe County under the subject funding agreement or in any service provided by AHEC. Monroe County is solely partially reimbursing funds for the program, along with the School Board. Boilerplate Agreement I suggest these modifications to adjust it particular to the AHEC agreement: 1. ¶1 - AMOUNT OF AGREEMENT. Revise and delete "The Board, in consideration of the PROVIDER substantially and satisfactorily performing providing service for persons ... ". 2. ¶14 - INDEPENDENT CONTRACTOR. Add "... the PROVIDER is an independent contractor and not an employee, agent or instrumentality of the Board...". 3. ¶26 - INDEMNIFICATION AND HOLD HARMLESS. Add "The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims and causes of action for medical malpractice, medical negligence.....". Page 1 of 2 0 �s CU Sovereign Immunity 1. The Sovereign Immunity Statute (§768.28, Fla. Stat.) waives political subdivisions' sovereign immunity from tort claims to the extent specified in the statute. This statute is strictly construed and the scope and extent of the waiver of immunity must be construed always in favor of the sovereign. "Whatever rights of recovery against the state (County) are given to a claimant must affirmatively appear in this section and cannot be read into it." Berek v. Metropolitan Dade County, 396 So.2d 756 (Fla. 3d DCA 1981). The scope and type of services being provided under the AHEC funding agreement are not being provided by or performed by County employees in the course and scope of their office or employment. AHEC's medical health care and education services are not read into the statute. Thus, the waiver of immunity is not extended to the services contemplated in the reimbursement funding agreement. Monroe County is immune from liability for claims based on services provided by AHEC to its patients. 2. The waiver of sovereign immunity imposed by 768.28 is only waived for "liability for torts" caused LU by "the negligent or wrongful act or omission of any employee of the agency or subdivision while acting within the scope of the employee's office or employment." §768.28(1), Fla. Stat. Performance of proprietary acts of AHEC are not activities that fall in the category of governmental functions to CU which there's a waiver of immunity. AHEC's health care and education services are not performed by CL Monroe County employees. County employees could not cause injury caused by negligent care. 3. In its discretionary/judgmental/legislative decision to reimburse funds to AHEC, Monroe County is immune from liability in a tort action. 0 4. Having researched provisions of §766.1115, Fla. Stat. - Health care providers; creation of agency L) relationship with governmental contractors, these don't apply to our scenario. LU Vicarious liability Presumably, under the doctor's theory, an injured patient would sue Monroe County under a theory of vicarious liability for the medical malpractice, negligence or omissions of the individual care provider or AHEC. That claim would not succeed. Monroe County has no direct or indirect relationship with the patient and no duty of care owed to the patient as it relates to the rendering of care provided by AHEC. AHEC could be vicariously liable to its patients for actions of its doctors/staff. Doctrine of respondeat superior Monroe County would not be liable in respondeat superior for tortious conduct, medical malpractice acts or omissions of the health care doctors/nurses because none of them is an employee or agent of Monroe County. AHEC is not an instrumentality or agency of the County. AHEC employees would be furthering the business interests of AHEC. A respondeat superior theory could potentially be used against AHEC. Non -delegable duty doctrine The narrow exception known as the non -delegable duty doctrine would not apply to create liability in Monroe County. A contract defining corporate providers as independent contractors effectively "disavows [the corporation] as a corporation primarily acting as an instrumentality or agency of the state or its subdivisions". Mingo v. ARA Health Servs., Inc., 638 So.2d 85, 86 (Fla. 2d DCA 1994). A nondelegable duty does not arise from the contract. AHEC is not a "corporation primarily acting as instrumentalities or agencies of the ... county" §768.28(2), Fla. Stat. Providing indigent care medical services by AHEC is an important social interest, but that by itself does not translate into a nondelegable duty owed by Monroe County. Page 2 of 2 1001.43. Supplemental powers and duties of district school board, FL ST § 1001.43T.11.g KeyCite Yellow Flag - Negative Treatment Proposed Legislation West's Florida Statutes Annotated Title XLVI11. K-20 Education Code (Chapters 1000-1013) Chapter lool. K-2o Governance (Refs & Annos) Part If. School District Governance A. District School Boards West's F.S.A. § 1001.43 Effective: July 1, 2o16 Currentness The district school board may exercise the following supplemental powers and duties as authorized by this code or State Board of Education rule. (1) Student management. --The district school board may adopt programs and policies to ensure the safety and welfare of individuals, the student body, and school personnel, which programs and policies may: (a) Prohibit the possession of weapons and drugs on campus, student hazing, and other activities that could threaten the operation of the school or the safety and welfare of the student body or school personnel. (b) Require uniforms to be worn by the student body, or impose other dress -related requirements, if the district school board finds that those requirements are necessary for the safety or welfare of the student body or school personnel. However, students may wear sunglasses, hats, or other sun -protective wear while outdoors during school hours, such as when students are at recess. A district school board that implements a districtwide standard student attire policy pursuant to s. 1011,78 is eligible to receive incentive payments. (c) Provide procedures for student dismissal precautions and for granting permission for students to leave school grounds during school hours, including releasing a student from school upon request by a parent or for public appearances of school groups. (d) Provide procedures for managing protests, demonstrations, sit-ins, walk -outs, or other acts of civil disobedience (e) Provide procedures for detaining students and for readmission of students after expulsion. (f) Regulate student automobile use and parking. 6 LU 0 CL D 1001.43. Supplemental powers and duties of district school board, FL ST § 1001.43T.11.g (2) Fiscal management. --The district school board may adopt policies providing for fiscal management of the school district with respect to school purchasing, facilities, nonstate revenue sources, budgeting, fundraising, and other activities relating to the fiscal management of district resources, including, but not limited to, the policies governing: (a) Sales calls and demonstrations by agents, solicitors, salespersons, and vendors on campus; local preference criteria for vendors; specifications for quantity purchasing; prioritization of awards for bids; declining bid awards; and purchase requisitions, approvals, and routing. KJ LU (b) Sales by booster clubs; marathon fundraisers; and student sales of candy, paper products, or other goods authorized C by the district school board. CL D (c) Inventory and disposal of district property; use of safe-deposit boxes; and selection of real estate appraisers. (d) Payment of contractors and other service providers. (e) Accounting systems; petty cash accounts procedures and reporting; school activities funds procedures and reporting; management and reporting of grants from private sources; and management of funds, including auxiliary enterprise funds. (f) District budgeting system, including setting budget deadlines and schedules, budget planning, and implementation and determination of budget priorities. (g) Use of federal funds to purchase food when federal program guidelines permit such use. (3) Instructional aids. --The district school board may adopt policies providing for innovative teaching techniques, teaching programs and methods, instructional aids and objectives, extracurricular and interscholastic activities, and supplemental programs including, but not limited to, policies providing for: (a) Use of technology, including appropriate use of the Internet as a tool for learning. (b) Instructional priorities and objectives, pilot projects and evaluations, curriculum adoption and design, and lesson planning. (c) Extracurricular and interscholastic activities, including field trips, publishing a student newspaper and other publications, and special programs relating to the arts, music, or other topics of current interest. (d) Participation in physical education programs, including appropriate physical education attire and protective gear; programs for exceptional students; summer school; and the Title I program, including comparability procedures. 1001.43. Supplemental powers and duties of district school board, FL ST § 1001.43T.11.g (4) Facilities management. --The district school board may adopt policies providing for management of the physical campus and its environs, including, but not limited to, energy conservation measures; building and ground maintenance; fencing, landscaping, and other property improvements; site acquisition; new construction and renovation; dedication and rededication or naming and renaming of district buildings and other district facilities; and development of facilities management planning and priorities. (5) School community relations. --The district school board may adopt policies governing public gifts and donations to schools; input from the community concerning instruction resources; advertising in schools; participation in community LU affairs, including coordination with local governments and planning authorities; protocols for interagency agreements; business community partnerships; community use of school facilities; public solicitations in schools, including the 0 distribution and posting of promotional materials and literature; visitors to the school campus; school advisory councils; and parent volunteers and chaperones. CL (6) Legal issues. --The district school board may adopt policies and procedures necessary to implement federal mandates and programs, court orders, and other legal requirements of the state. (7) First', aid and emergencies. --The district school board may adopt programs and policies to ensure appropriate', response', in emergency situations; the provision', of first aid to individuals, the student body,', and school personnel; and the effective', management of student illness, whichprograms and policies may include, but are not limited to: (a) The provision of first aid and emergency' medical care and the provision of school health care facilities and services. (b) The provision of school safety patrol.' (c) Procedures for reporting hazards, including threats of nature, bomb threats, threatening messages, and similar' occurrences, and the provision of warning systems including alarm systems and other technical', devices. (d) Procedures for evacuating the classrooms, playground, or any other district facility; (e) Procedures for reporting accidents, including traffic accidents and traffic violations involving district. -owned', vehicles. (f) Student insurance programs;' (8) Student assessment and affairs. --The district school board may adopt policies and procedures governing attendance monitoring and checks; truancy; graduation requirements and graduation exercises; fees, fines, and charges imposed on students; evaluation of student records and transcripts; transfer of student records; grading and academic evaluation of students; tests and examinations, including early examinations; guidance and counseling; and student participation in competitions, student performances and exhibitions, contests for students, and social events. (9) Administrative support services. --The district school board may adopt policies and procedures governing purchase of property insurance, including comprehensive general liability insurance; transportation of students for extracurricular 1001.43. Supplemental powers and duties of district school board, FL ST § 1001.4 T.11.g activities and special events, including transportation of students in privately owned vehicles; transportation of district personnel, including personal use of district owned vehicles; computer security and computer room access and computer database resources; mail and delivery services, including use of couriers; copyright compliance; and computerized data systems, including computer use, transmission of data, access to the Internet, and other technology -based services. (10) District school board governance and operations. --The district school board may adopt policies and procedures necessary for the daily business operation of the district school board, including, but not limited to, the provision of legal services for the district school board; conducting a district legislative program; district school board member G participation at conferences, conventions, and workshops, including member compensation and reimbursement forLU expenses; district school board policy development, adoption, and repeal; district school board meeting procedures, including participation via telecommunications networks, use of technology at meetings, and presentations by nondistrict 0 personnel; citizen communications with the district school board and with individual district school board members; 4) collaboration with local government and other entities as required by law; and organization of the district school board, CL including special committees and advisory committees. (11) Personnel. --The district school board may adopt policies and procedures necessary for the management of all personnel of the school system. (12) Affordable housing. --A district school board may use portions of school sites purchased within the guidelines of the State Requirements for Educational Facilities, land deemed not usable for educational purposes because of location or other factors, or land declared as surplus by the board to provide sites for affordable housing for teachers and other district personnel and, in areas of critical state concern, for other essential services personnel as defined by local affordable housing eligibility requirements, independently or in conjunction with other agencies as described in subsection (5). (13) Cooperation with Florida College System institutions. --The district school board shall work with the Florida College System institutions in the district to ensure that the Florida College System institution students have access to remedial education. (14) Recognition of academic achievement. -- (a) The Legislature recognizes the importance of promoting student academic achievement, motivating students to attain academic achievement, and providing positive acknowledgment for that achievement. It is the intent of the Legislature that school districts bestow the same level of recognition to the state's academic scholars as to its athletic scholars. (b) The district school board is encouraged to adopt policies and procedures to provide for a student "Academic Scholarship Signing Day" by declaring the third Tuesday in April each year as "Academic Scholarship Signing Day." The "Academic Scholarship Signing Day" shall recognize the outstanding academic achievement of high school seniors who sign a letter of intent to accept an academic scholarship offered to the student by a postsecondary educational institution. District school board policies and procedures may include, but need not be limited to, conducting assemblies or other appropriate public events in which students offered academic scholarships assemble and sign actual or ceremonial documents accepting those scholarships. The district school board may encourage holding such events in an assembly or gathering of the entire student body as a means of making academic success and recognition visible to all students. 1001.43. Supplemental powers and duties of district school board, FL ST § 1001.43T.11.g Credits Added by Laws 2002, c. 2002-387, § 56, off, Jan. 7, 2003. Amended by Laws 2006. c. 2006-69, § 26, off, July 1, 2006; Laws 2006, c. 2006-301, § 13, eff. July 1, 2006; Laws 2009, c. 2009-96, § 33, cil" ;June 1, 2009; Laws 2{}10, c. 2010-203, § 1, ell. July 1, 2{}10; Laws 2011, c. 2011-5, § 16, cfl'. July 6, 2011; Laws 2011, c. 2011-15, § 19, ell" April 27, 2011; Laws 2016, c. 2016-2, § 3, eff. July 1, 2016. Editors' Notes U LU RETROACTIVITY <Laws 2011, c. 2011-15, § 20, provides:> 0 <"This act shall take effect upon becoming a law [April 27, 2011], and those portions of this act CL which were amended, created, or repealed by chapter 2009-96, Laws of Florida, shall operate retroactively to June 1, 2009. If such retroactive application is held by a court of last resort to be unconstitutional, this act shall apply prospectively from the date that this act becomes a law.">CD West's F. S. A. § 1001.43, FL ST § 1001.43 Current through the 2017 First Regular Session and Special "A" Session of the 25th Legislature 81.0056. School health services program, FL ST § 381.0056 T.11.h West's Florida Statutes Annotated Title XX1X. Public Health (Cha tens 381-408) Chapter 381. Public Health: General Provisions (refs & Annos) West's F.S.A. § 381.0056 Effective: July 1, 2015 Currentness (1) This section may be cited as the "School Health Services Act." LU (2) As used in this section, the term: 0 0 a "Emergency health needs" means onsite evaluation management, and aid for illness or injury pending the student's to O g Y g J Yp g return to the classroom or release to a parent, guardian, designated friend, law enforcement officer, or designated health LO CD care provider. (b) "Entity" or "health care entity" means a unit of local government or a political subdivision of the state; a hospital licensed under chapter 395; a health maintenance organization certified under chapter 641; a health insurer authorized under the Florida Insurance Code; a community health center; a migrant health center; a federally qualified health center; an organization that meets the requirements for nonprofit status under s. 501(c)(3) of the Internal Revenue Code; I a private industry or business; or a philanthropic foundation that agrees to participate in a public -private partnership with a county health department, local school district, or school in the delivery of school health services, and agrees to the terms and conditions for the delivery of such services as required by this section and as documented in the local school health services plan. (c) "Invasive screening" means any screening procedure in which the skin or any body orifice is penetrated. (d) "Physical examination" means a thorough evaluation of the health status of an individual. (e) "School health services plan" means the document that describes the services to be provided, the responsibility for provision of the services, the anticipated expenditures to provide the services, and evidence of cooperative planning by local school districts and county health departments. (f) "Screening" means presumptive identification of unknown or unrecognized diseases or defects by the application of tests that can be given with ease and rapidity to apparently healthy persons. (3) The Department of Health shall have the responsibility, in cooperation with the Department of Education, to supervise the administration of the school health services program and perform periodic program reviews. However, the principal of each school shall have immediate supervisory authority over the health personnel working in the school. 81.00 6. School health services program, FL ST § 381.0056 T.11.h (4)(a) Each county health department shall develop, jointly with the district school board and the local school health advisory committee, a school health services plan. The plan must include, at a minimum, provisions for all of the following: 1. Health appraisal; 2. Records review; 3. Nurse assessment; LU 4. Nutrition assessment; 5. A preventive dental program; 6. Vision screening; 7. Hearing screening; 8. Scoliosis screening; 9. Growth and development screening; 10. Health counseling; 11. Referral and followup of suspected or confirmed health problems by the local county health department; 12. Meeting emergency health needs in each school; 13. County health department personnel to assist school personnel in health education curriculum development; 14. Referral of students to appropriate health treatment, in cooperation with the private health community whenever possible; 15. Consultation with a student's parent or guardian regarding the need for health attention by the family physician, dentist, or other specialist when definitive diagnosis or treatment is indicated; 81.0056. School health services program, FL ST § 381.0056 T.11.h 16. Maintenance of records on incidents of health problems, corrective measures taken, and such other information as may be needed to plan and evaluate health programs; except, however, that provisions in the plan for maintenance of health records of individual students must be in accordance with s. 1002.22; 17. Health information which will be provided by the school health nurses, when necessary, regarding the placement of students in exceptional student programs and the reevaluation at periodic intervals of students placed in such programs; 18. Notification to the local nonpublic schools of the school health services program and the opportunity for representatives of the local nonpublic schools to participate in the development of the cooperative health services plan; and L) LU 19. Immediate notification to a student's parent, guardian, or caregiver if the student is removed from school, school transportation, or a school -sponsored activity and taken to a receiving facility for an involuntary examination pursuant 0 0 to s. 394,463, including the requirements established under ss. 1002.20(3) and 1002.33(9), as applicable. CL D (b) Each school health advisory committee must, at a minimum, include members who represent the eight component areas of the Coordinated School Health model as defined by the Centers for Disease Control and Prevention. School health advisory committees are encouraged to address the eight components of the Coordinated School Health model in the school district's school wellness policy pursuant to s. 1003,453. (5) A nonpublic school may request to participate in the school health services program. A nonpublic school voluntarily participating in the school health services program shall: (a) Cooperate with the county health department and district school board in the development of the cooperative health services plan; (b) Make available adequate physical facilities for health services; (c) Provide inservice health training to school personnel; (d) Cooperate with public health personnel in the implementation of the school health services plan; (e) Be subject to health service program reviews by the Department of Health and the Department of Education; (f) At the beginning of each school year, provide parents and guardians with information concerning ways that they can help their children to be physically active and to eat healthful foods; and (g) At the beginning of each school year, inform parents or guardians in writing that their children who are students in the school will receive specified health services as provided for in the district health services plan. A student will be exempt from any of these services if his or her parent or guardian requests such exemption in writing. This paragraph 81.0056. School health services program, FL ST § 381.0056 T.11.h shall not be construed to authorize invasive screening; if there is a need for such procedure, the consent of the student's parent or guardian shall be obtained in writing prior to performing the screening. However, the laws and rules relating to contagious or communicable diseases and sanitary matters shall not be violated. (6) The district school board shall;, (a) Include health services and health', education as part of the comprehensive plan for the school district;', (b) Provide inservice health training for school personnel U LU (c) Make available adequate physical facilities for health services;' 0 (d) At the beginning of each school year, provide parents and guardians with information concerning ways that they can help their children to be physically active and to eat healthful foods; and CL D (e) At the beginning of, each school year, inform parents or guardians in writing that their children who are students in the district schools will receive' specified health services as provided' for in the district health services plan. A student will be exempt from any of these services if his or her parent or guardian requests such exemption in writing. This paragraph' shall not be construed to authorize invasive screening; if there is a'need for such procedure, the consent of the student's parent or guardian shall be obtained', in writing prior to performing the screening. However, the laws and rules relating' to contagious or communicable diseases and sanitary matters shall not be violated. (7) The Department of Health, in cooperation with the Department of Education, may adopt rules necessary to implement this section. The rules may include standards and requirements for developing school health services plans, conducting school health screening, meeting emergency health needs, maintaining school health records, and coordinating with education programs for exceptional students. (8) In the absence of negligence, no person shall be liable for any inj ury caused by an act or omission in the administration of school health services. (9) Any health care entity that provides school health services under contract with the department pursuant to a school health services plan developed under this section, and as part of a school nurse services public -private partnership, is deemed to be a corporation acting primarily as an instrumentality of the state solely for the purpose of limiting liability pursuant to s. 768.28(5). The limitations on tort actions contained in s. 768.28(5) shall apply to any action against the entity with respect to the provision of school health services, if the entity is acting within the scope of and pursuant to guidelines established in the contract or by rule of the department. The contract must require the entity, or the partnership on behalf of the entity, to obtain general liability insurance coverage, with any additional endorsement necessary to insure the entity for liability assumed by its contract with the department. The Legislature intends that insurance be purchased by entities, or by partnerships on behalf of the entity, to cover all liability claims, and under no circumstances shall the state or the department be responsible for payment of any claims or defense costs for claims brought against the entity or its subcontractor for services performed under the contract with the department. This subsection does not preclude consideration by the Legislature for payment by the state of any claims bill involving an entity contracting with the department pursuant to this section. 81,00 6. School health services program, FL ST § 381.0056 T.11.h Credits Laws 1974, c. 74-356, §§ 1 to 7, 9; Laws 1977, c. 77-174, § 1; Laws 1978, c. 78-245, § 2; Laws 1979, c. 79-288, § 15; Laws 1981, c. 81-18, § 1; Laws 1984, c. 84-317, § 21; Laws 1985, c. 85-81, § 50; Laws 1990, c. 90-344, § 1; Laws 1995, c. 95-148, § 812; Fla.St.1995, § 402,32; Laws 1997, c. 97-101, § 101; Laws 1997, c. 97-237, § 48. Amended by Laws 1999, c. 99-5, § 28, eff. June 291, 1999; Laws 1999, c. 99-2141, § 1, ell" July 1, 1999; Laws 2000, c. 2000-242, § 6, eff. June 7, 2000; Laws 2001, c. 2001-53, § 5, eff. July 1, 2001; Laws 2002, c. 2002-387, § 976, eff. Jan. 7, 2003; Laws 2006, c. 2006-301, § 20, ell" July 1, 2006; Laws 2012, c. 2012-184, § 27, eff. April 27, 2012; Laws 2015, c. 2015-67, § 1, eff. July 1, 2015. Notes of Decisions (4) 6 Footnotes a 0 1 26 U.S.('A. § 501. West's F. S. A. § 381.0056, FL ST § 381.0056 0. Current through the 2017 First Regular Session and Special "A" Session of the 25th Legislature AGREEMENT This Agreement is made and entered into this 18th day of October, 2017, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and Organization, hereinafter referred to as "PROVIDER." WHEREAS, the PROVIDER is a not -for -profit corporation established for the provision of service, and WHEREAS, it is a legitimate public purpose to provide service, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: U W FUNDING 0 1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially and satisfactorily performing and cr'riryiiry out t"e 10 Ll of the L;l U to providingCL services for persons living in Monroe County as _provided for in this Agreement, Florida, shall pay to the PROVIDER the sum of dollaramount NO/100 DOLLARS ($ .00) for fiscal year 2017-2018. 2. TERM. This Agreement shall commence on October 1, 2017, and terminate September 30, 2018, unless earlier terminated pursuant to other provisions herein. 3. PAYMENT. Payment will be made periodically, but no more frequently than monthly, as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The County shall only reimburse, subject to the funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Monroe County Code of Ordinances, State laws and regulations and Attachment A - Expense Reimbursement Requirements. Evidence of payment by the PROVIDER shall be in the form of a letter, summarizing the expenses, with supporting documentation attached. The letter should contain a notarized certification statement. An example of a reimbursement request cover letter is included as Attachment B. The organization's final invoice must be received within thirty days after the termination date of this contract shown in Article 2 above. After the Clerk of the Board examines and approves the request for reimbursement, the Board shall reimburse the PROVIDER. However, the total of said reimbursement expense payments in the aggregate sum shall not exceed the total amount shown in Article 1, above, during the term of this agreement. 4. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued at a level sufficient to allow for continued reimbursement of expenditures for services specified herein, this agreement may be terminated immediately at the option of the Board by written notice of termination delivered to the PROVIDER. The Board shall not be obligated to pay for any services or goods provided by the PROVIDER after the PROVIDER has received written notice of termination, unless otherwise required by law. S. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. RECORDKEEPING 6. RECORDS. PROVIDER shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting Contract -Organization Name-FY18; page 1 principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the Agreement and for four years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to PROVIDER pursuant to this Agreement were spent for purposes not authorized by this Agreement, the PROVIDER shall repay the monies together with interest calculated pursuant to Sec. 55.03, FS, running from the date the monies were paid to PROVIDER. In addition, if PROVIDER is required to provide an audit as set forth in in Section 8(e) below, the audit shall be prepared by an independent certified public accountant (CPA) with a current license, in good standing with the Florida State Board of Accountancy. 7. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable G W access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and PROVIDER in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by PROVIDER. CL 8. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the County the following (items (a)-(j) must be provided prior to the payment of any invoices): (a) IRS Letter of Determination and GUIDESTAR printout indicating current 501(c)(3) status; (b) Proof of registration with the Florida Department of Agriculture, as required by Florida Statute 496.405, and the Florida Department of State, as require by Florida Statute 617.01201, or proof of exemption from registration as per Florida Statute 496.406. (c) List of the Organization's Board of Directors of which there must be at least 5 and for each board member please indicate when elected to serve and the length of term of service; (d) Evidence of annual election of Officers and Directors; (e) Unqualified audited financial statements from the most recent fiscal year for all organizations that expend $150,000 a year or more; if qualified, include a statement of deficiencies with corrective actions recommended/taken; audit shall be prepared by an independent certified public accountant (CPA) with a current license, in good standing with the Florida State Board of Accountancy. If the PROVIDER receives $100,000 or more in grant funding from the County: a. The CPA that prepares the audit must also be a member of the American Institute of Certified Public Accountants (AICPA); b. The CPA must maintain malpractice insurance covering the audit services provided and c. The County shall be considered an "intended recipient" of said audit. (f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules; (g) Organization's Corporate Bylaws, which must include the organization's mission, board and membership composition, and process for election of officers; (h) Organization's Policies and Procedures Manual which must include hiring policies for all staff, drug and alcohol free workplace provisions, and equal employment opportunity provisions; (i) Specific description or list of services to be provided under this contract with this grant (see Attachment C); (j) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end date.) The performance report shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including residency) and numbers served, and outcomes achieved (see Attachment G); (k) Cooperation with County monitoring visits that the County may request during the contract year; and Contract -Organization Name-FY18; page 2 (1) Other reasonable reports and information related to compliance with applicable laws, contract provisions and the scope of services that the County may request during the contract year. RESPONSIBILITIES 9. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and provide the services outlined in Attachment C to residents of Monroe County, Florida. 10. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award against the non -prevailing party, and shall include attorney's fees, courts costs, investigative, and out-of-pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County. 11. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and PROVIDER and their respective legal representatives, successors, and assigns. 12. CODE OF ETHICS. County agrees that officers and employees of the County recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 13. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the PROVIDER agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. 14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the PROVIDER is an independent contractor and not an employee.....agent._or instrumentality of the Board. No statement contained in this agreement shall be construed so as to find the PROVIDER or any of its employees, contractors, servants or agents to be employees of the Board. COMPLIANCE ISSUES 15. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating the provision of such services, including those now in effect and hereinafter adopted. Any violation of said statutes, ordinances, rules and regulations shall constitute a material breach of this agreement and shall entitle the Board to terminate this contract immediately upon delivery of written notice of termination to the PROVIDER. 16. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure that all professionals have current and appropriate professional licenses and professional liability W 0 as CL n Contract -Organization Name-FY18; page 3 insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state and/or federal certification and/or licensure of the PROVIDER'S program and staff. 17. NON-DISCRIMINATION. County and PROVIDER agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. County or PROVIDER agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI of the Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101-6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability; 10) Monroe County Code Chapter 13, Article VI, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; 11) any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. AMENDMENTS, CHANGES, AND DISPUTES 18. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and/or reimbursement of services shall be accomplished by an amendment, which must be approved in writing by the County. 19. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. The PROVIDER and County staff shall try to resolve the claim or dispute with meet and confer sessions to be commenced within 15 days of the dispute or claim. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this agreement or by Florida law. Any claims or dispute that the parties cannot resolve shall be decided by the Circuit Court, 161" Judicial Circuit, Monroe County, Florida. 20. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and PROVIDER agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and PROVIDER specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ASSURANCES 21. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner W 0 a� CL n Contract -Organization Name-FY18; page 4 or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 22. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing and with the prior written approval of the Board, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed upon reimbursement amount for the services of the PROVIDER. 23. NON -WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. CL 24. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug - Free Workplace Statement. 25. AUTHORITY. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. INDEMNITY ISSUES 26. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims and _causes of action for medical malpractice, medical negligence,, fir bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the PROVIDER occasioned by the negligence, errors, or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers. 27. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 28. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non -Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Contract -Organization Name-FY18; page 5 Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. 30. NON -RELIANCE BY NON-PARTIES. No person or entity shall be entitled to rely upon the terms of this Agreement to enforce or attempt to enforce any third -party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. GENERAL 31. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. 32. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand -delivered or mailed, postage pre -paid, by certified mail, return receipt requested, to the other party as follows: For Board: Grants Administrator and 1100 Simonton Street Key West, FL 33040 For PROVIDER Signing Official, Title Organization' Street address City,,ST Zip Code (AreaCode') Phone Number (Area', Code) Fax Number Monroe County Attorney PO Box 1026 Key West, FL 33041 33. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. The County and PROVIDER agree that, in the event of conflicting interpretations of the terms or a term of this Agreement by or between any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding. 34. NON -WAIVER. Any waiver of any breach of covenants herein contained to be kept and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach, either of the same conditions or covenants or otherwise. a W 0 as CL n Contract -Organization Name-FY18; page 6 35. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The County and PROVIDER agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. 36. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between the PROVIDER and the Board. [THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW] W 0 as CL n Contract -Organization Name-FY18; page 7 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. (SEAL) ATTEST: KEVIN MADOK, CLERK By Deputy Clerk Witness Witness BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By Mayor/Chairman OrganizationName (Federal ID No By Chief Executive Officer 6 W 0 as CL n Contract -Organization Name-FY18; page 8 ATTACHMENT A EXPENSE REIMBURSEMENT REQUIREMENTS This document is intended to provide basic guidelines to Human Service and Community -Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: "I certify that the above checks have been submitted to the vendors as noted and that the G W attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source." CL Invoices should be billed to the contracting agency. Third party payments will not be considered for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement. �s �a Only current charges will be considered, no previous balances. > co Reimbursement requests will be monitored in accordance with the level of detail in the contract. This document should not be considered all-inclusive. The Clerk's Finance Department reserves U_ the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to 305-292-3534. 0 Data Processing, PC Time, etc. L) The vendor invoice is required for reimbursement. Inter -company allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. 0 Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. If a Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, date, payee, and support for applicable paid payroll taxes. Postage, Overnight Deliveries, Courier, etc. A log of all postage expenses as they relate to the County contract is required for reimbursement. For overnight or express deliveries, the vendor invoice must be included. Rents, Leases, etc. A copy of the rental or lease agreement is required. Deposits and advance payments are not allowable expenses. Reproductions, Copies, etc. A log of copy expenses as they relate to the County contract is required for reimbursement. The log must define the date, number of copies made, source document, purpose, and recipient. A reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a sample of the finished product are required. Supplies, Services, etc. For supplies or services ordered, a vendor invoice is required. Contract -Organization Name-FY18; page 9 Telefax, Fax, etc. A fax log is required. The log must define the sender, the intended recipient, the date, the number called, and the reason for sending the fax. Telephone Expenses A user log of pertinent information must be remitted including: the party called, the caller, the telephone number, the date, and the purpose of the call. Travel and Meal Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with Monroe County Code of Ordinances and State laws and regulations. Credit card statements are W not acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement requires the vendor invoice. Fuel purchases should be documented with paid receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a CL taxi from one's residence to the airport for a business trip is not reimbursable. Parking is considered a reimbursable travel expense at the destination. Airport parking during a business trip is not. A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room as must be registered and paid for by traveler. The County will only reimburse the actual room and co related bed tax. Room service, movies, and personal telephone calls are not allowable expenses. U_ Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a U residence or office to a point of departure. For example, driving from one's home to the airport for a business trip is not a reimbursable expense. Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state CL that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement. Non -allowable Expenses The following expenses are not allowable for reimbursement: capital outlay expenditures (unless specifically included in the contract), contributions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non -sufficient check charges, c� penalties and fines. E Contract -Organization Name-FY18; page 10 ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, FL 33040 Date The following is a summary of the expenses for (Organization name) for the time period of to Check # Payee Reason Amount 101 Company A Rent $ X,XXX.XX 102 Company B Utilities XXX.XX 104 Employee A P/R ending 05/14/01 XXX.XX 105 Employee B P/R ending 05/28/01 XXX.XX (A) Total (B) Total prior payments X.XXX.XX $ X,XXX.XX (C) Total requested and paid (A + B) $ X,XXX.XX (D) Total contract amount $ X,XXX.XX Balance of contract (D-C) X.XXX.XX I certify that the above checks have been submitted to the vendors as noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. Executive Director Attachments (supporting documentation) Sworn to and subscribed before me this day of 20 by who is personally known to me. Notary Public Notary Stamp a W 0 as CL n Contract -Organization Name-FY18; page 11 ATTACHMENT C Specific description and list of services to be provided under this contract: 6 w 0 as CL D Contract -Organization Name-FY18; page 12 ATTACHMENT D PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." I have read the above and state that neither (Respondent's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signature) Date: STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on (date) by known to me or has produced identification. (name of affiant). He/She is personally (type of identification) as NOTARY PUBLIC My Commission Expires: W 0 a� CL n Contract -Organization Name-FY18; page 13 SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE ATTACHMENT E (Company) W "...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this 0 a� provision the County may, in its discretion, terminate this Agreement without liability and may also, in 1� its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of CL any fee, commission, percentage, gift, or consideration paid to the former County officer or employee." (Signature) Date: STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on (date) by known to me or has produced identification) as identification. (name of affiant). He/She is personally NOTARY PUBLIC My Commission Expires: (type of Contract -Organization Name-FY18; page 14 ATTACHMENT F DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: (Name of Business) 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business' policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. (Signature) Date: STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on or has produced identification. (date) by (name of affiant). He/She is personally known to me (type of identification) as NOTARY PUBLIC My Commission Expires: W 0 a� CL n Contract -Organization Name-FY18; page 15 ATTACHMENT G 6 W 0 as CL D Questions: 1. Please list services and client information below for the program/activities funded by the Monroe County award. Services Target Population # of persons in target population Total # of clients served in FY18 Unduplicated Clients Served 2. What were the measurable outcomes (including numbers) accomplished in FY1 8? Please base these outcomes on the services you identified in Question #1. 3. What number and percentage of your clients/participants were at or below the federal poverty level in FY1 8; and/or 200%; and/or another standard used by your organization? 4. Were all the awarded funds used in FY1 8? If not, please explain. 5. What is the number of FTEs working on the program(s) funded by the award in FY18? contract- Organization Name-FY18; page 16 6. Were the awarded funds used as match in FY18? If so, please list matching sources. 7. What area of Monroe County did you serve in FY18? 8. How many total FTEs in your organization? 9. Volunteers: hours of program service were contributed by volunteers in FY18. 10. What was the CEO/Executive Director (or highest paid title) compensation in FY18? (Please a breakdown between salary and benefits.) 0 11. What is your organization's fiscal year? CL n For the following questions, please use the number as reported on your FY18 IRS Form 990. If your FY18 IRS Form 990 is not yet prepared, please provide an estimate for the following questions. 12. What were your organization's total expenses in FY18? 13. What was your organization's total revenue in FY18? 14. What was the organization's total in grants and contracts for FY18? 15. What was the organization's total donations and in -kind (fundraising) in FY18? 16. What percentage of your expenses are program service expenses versus management and general expenses in FY18 as reported on your IRS Form 990? (Program service expenses are defined as expenses needed to run your programs. Management and general expenses encompass expenses such as fundraising, human resources, salaries of those not working directly with programs, legal services, accounting services, insurance expenses, office management, auditing, and other centralized services.) contract -Organization Name-FY18; page 17 N Page 1/29 . LO-tter given To'The Board: of Monroe County Commiss sioners, at meeting 11/14/2017. a . RE -: Keys AHEC State ments- in their Appucation for Monroe County Funding. 1. 'Keys AHEC letter of 4/4/16-with application for funding to Monroe -County states ; "Our p-r-Gpos-al r-equests. 12n 000 +0 fully implement a- direct primary medical se-irvicesprogram w.itb a target audience of school -age chJIdren:and-theJr sJ-6fings." ""The Program addresses primary, secondary, and specialty -needs of children -living. -in low income homes and considered at -risk where -medical -care and coverag-e- is Jacking and unaffordable." s a. "Medical Care -and- Coverage is 'Lacking and unaffordable" is False. In Monroe County there are 'Sic Pe atr'jda- ns, and about 10 Family Practitioners which, -unlike -Keys.. AHE-C,--have .been approved- credentialed, and contracted to provide m-edical-care to these --low-i-n-co-me and r` at risk" children.. b . Keys A.H-Er.. isr,%,otapWoved, not credentialed, and not contracted with to _arovide _Me ical Care or to ._make referrals to M-ed'ica=l Specialists to tl-e lower income and "at risk" children with Medicaid, -Healthy Kids Insurance, KidCare, Children's Medical Services Title 19 specialty -p-lar , -ar -Chi-l-dr--en-'-s-M-edicat Services Title 21 MMA Medicaid. C 1MI Therefore, Keys AHEC cannot provide medical .services to the vast :Majority of Lower. Incom-e ChIldr-e-r. or ChiWein -wit-h Spec' a Nonedc., in Monroe -County. c. -Chiiclren W-th -Merdicaidlzn-d Florid -a - Healthy. -Kids _and. Xid-C-are.-are -all. assigned to approved -local -rrne�dica-1 pr-ovIde rs- including Six Pediatricians and about Ten Fa mily.pra ctiti on ers. m.. M on roe County who have been approved, credentialed, and contracted to provide medical care to these -children, ensure hospitalization when necessary, and make referrals to special fists -when -necessary; -i-n clu-dl ng dental and optometry. Keys AHEC is not .approved..b.y.- any -of the tote_d,ica-i.d._MMA. Programs to do.this. PI '107 0 �iol. d. Keys AHEC cannot refer these Medicaid, IMedica.id.M_I\AX-.Healthy -Kids, iWare, or Ch-i-l-d-rein's Mmdical Sey *wcees ch'4cLr r -L--en- to -a specialist if necessary because % only the Ch-Jid's assigned approved. provider can do "t e. All children with Medicaid are assigned to approved,. credentia led,: contracted local providers. Only the Medicaid approved provide-r -can- -do the. refer --raps to specialists., Keys AHEC cannot. -f. One. Medica.i-d.-Ma.n.age-d--A-ssi.sta-nce program- Staywell/ Welfcare (NiMA) jnf olrr-red -rrie: thr1rart Xeyas- A-H-EC trie- Irul to -become an approved provider* and was de-nied.., 2. Page 41. 'Keys AHEC- states in Description of services , °` o. -Cost" .-Sch.-ool -health D-a-mary -Health- i- f -ham W,omVer -Keys AHEC collects insurance information and dills for services,, Saying No Cost,,. then Hai -lying for service -Is misleading and is not "NO COST." I question legality and ethics of stating -"No Cost"., ---then -Bjltingfor the service? 3. gage .5.Keys AHEC writes-, -No other. IferS -age-n-cy.or -pr o g-,rmJrrrjr -ro n.-Morm. e-C"u-n-ty0f this array of -services to -children in the school based. set-fl ng- or elsewhere.." a 017me In Fact,, -Keys Alif-C-cannot offer "this array of services" ..because. Keys ..AHEC -.is not app.roved. or -co-n.tTac-t.-ed-b-y-ar,ty.-,r,.%,.,f t-h—e-M-ed.;..e.-,a-id---M.a-.-nag,,Od- Assistance Programs to which every child with M ed-ica-id, Healthy Kids_ -K-idCa-re-,.-Child.en's Medic Services CMS title 19 and CMS title 21. are all assigned to a local provider to receive medical services. treys AREC.-is -not. al -lowed by Medicaid to do the referrals to medical spec-lafilsts -when-- necessa,ry-­because- on-ly- the. medical provider that the child is assigned to see -may ..do, so.. 9. 0 AN, 4. There are Six Pediatricians and a , i I jout 10 Fan ni]-yPratfitione-r -Medi'CaI'Doctors ,_and -C)p+ Grr,,cb+ri c+ nentists- -t.-ha-v-,e been tha credentialed , approved, andcontracted by Medicaid..and.the Medicaid.Ma..n.ageed Care Assistance Programs to provide timely access to medical care, do specialty referrais.-'and ensure hospitalization for these children if needed. Again, Keys AHEC has ..not -been Credentialed-, Approved; or Contracted to provide these services to these Chil-dren. -Keys AHEC describes providin.g+s.ervice toVed-icaid-patients -.,,.But ne,al.ecits, to-t,,eff -you- that.-.-M.ed-i-ca-i*.r.4.-ha,s- -contracted most if not all of our Local Doctors to provide care fo+r.all.,of our low income and special needs patients with Medicaid; Keys AHEC cannot. 3 5. Since 2014,,FlLorid:a Medicaid h-as -contr -M-I%,A-,'s.--" M-e.d.icaj-d Managed Assistance programs) -( Exhibit A) such as A_etn_a,,Hj_j_rn_a_n_aA, Unjted.,..Si_rnp+ly,,.. Staywe-11, Prestige, Sunshine, Coventry,. Molina and others. Every child with Medicaid is in -turn assigned -to -a MMA program and assigned to a local medical -doctor-pro Fder.. -Keys L AHEC. is -not approved , credentialed, or contracted to provide the heal-th., care service that.these childrenva,re entitled to -receive. Keys AHEC cannot* -Care i-red-a-ccess- to 4d red provirdelhe 1� -ru., referrals to: specialists, dentists,, ensure hospiaaIizafion and ot-Ke.r requ-irements of the Medicaid Program. 6. Page 5, paragraph 3. .Ke'y.s.AHEC- writes,, In -Fact sch.00tteafth-.services- weqre 1-i-mitted. to -just screeningsand sending children .home that were si k. with no referral fear medical care'. F ais-e'., -Keys AH E-C --ca,not -refer. Low incorr-te children with Medicaid- or other M' MA programs to Medical -Spe.cia-fists. False,"here have -b .een . multi.ple.Med.i.caid Providers -here fort -he past-.30­50--years that took calls from school nurses and took sick patients the saame­day, if .not. i-mm.ediate-ly Page- 10 Keys AHEC medical practitioners are only aval-labIe part time., some days of the week, during short. sch o_ot hour s-,,n-ot -n-,ights .-not. weekends, not after -hours. This is not allowed by -Medicai.d.or theMedica-id Managed Care Assistance Programs. Medical Providers must meet criteria and - have obhgation&'to-be approved,. credentialed, and contracted to provide .. 'Idr - -medical service -to lower income -chi. -en with Medicaid.'. 7. Keys AHEC-describes providing care to -Med.icaid Paflents,,,jow income patients, -and "at risk" patients.; -However., Keys- Ali EC is. Not Approved by the Medicaid Plans to do SO. Keys AHEC neglects to tell you that since 2014, throughout Keys AHEC existences Florida Medicaid has contracted _WI.th multiple Managed Assistance Providers _(M-MA's) -which are i-n tuurn contracted with many Local Medical Provider's to make sure that these --at risk. , low income patients have access to health care, timely access to _health. -care.,. access ,to pedtat.ric ans, access - to spec.i.a I ists., ,.a.c.cess to .H.o.s.pita I i,sts for hosN*ta-I. a d.m.issio-ns../..,avicessAo,:srrecS Ity medical care, as well as access to dental and optometry care from LocalProvide_r_s and out of- county providers when necessary ail able and all contracted to provide Medical Care for our chi-ldren. Keys AHEC has bypassed this Medicaid system . ( Exhibit B) Page 1*2* :1 was told'.by one on, theMe-dicaid. Man,aged Assj*st.a-n--ce program: -representatives A.. from- -Staywell/ Wellcare MMA that Keys AH:EC tried to be credentiaied,...a.pnrove.d,....a.n-d contracted. to -ProVi.de service vice for Med-ica'id Patient's, but was declined and not approved to do so. 8. Paragraph 4. " This project bridges a sign -if ica.n t- ga p. R. se rv;'ce, a-n,d. access-fbr the medically underserved." False, Th.is projeecthas.+prevented sick ,children from seeing-the.ir.own primary care medical doctors that are really credentialed., approved-, and actually.. contracted to see these patients and do thi's work. . • 9. .In Fact,- Parents of Sick'Schoot Children have been asked by school nurses to wait -u-1,-,a,no+he-r dau, to sueooz. Keys AH.rr. Y Ke ". N. 0 - n - urs., e practitioner rather that advised to see their regular local doctor that sa me day, resu.1fing- 'in a Child getting more sick without treatment for days. At least one parent of -a sick child was advised -to wait until another day when the Keys AHEC nurse was there rather than to take a child to the child's regular local doctor. The M.o.+.+h.er regretfully waited. This is NOT as Keys AHEC writes; " bridges a sign i.fi cant. Bap+ in.. service, and access to care for the medically underserved." In fact, it does the opposite. local pediatricians can tell you -of children being misdiagnosed_, ,given the wrong_ medication, delays in getting proper treatment, told to wait until the nurse practitioner is back another day; This has happened. 10. Paragraph 4. Keys AHEC states; ""This program over the past 18 months has successfully implemented and evaluated within Monroe County to address the -unmet health care _needs. & studeents.t-hat.. are uninsured, underinsured, !Medicaid and - at risk populations." This is Pallas; keys AHEC is not. Approved, credentialed, contracted by Medicaid, M-e-dica-ic[MMA's, Heaitfiy+-Kids, -Kidrare or A Children's Medical Services Title 19 or Children's Medical Services Title. 21 to provide medical care to lower income children or children with special needs. False, Keys AHEC working together with -Monroe county School ,district .personme-1 have and continue to keep children from seeing. doctors who are credentialed., approved, contracted to see these -patients, and have prevented children from being referred to specialists that are also approved and contracted to see these children. Parents have also -been advised --by nurses to wait until the next day to see a Keys AHEC nurse. Rather than see their regular local doctor. 11. Keys AHEC Short Hours and Part time office hours only open some weekdays schedule does not provide better access to Medical Care as claimed and as required by Medicaid and Medicaid MMA's. 12. Page 8 ,_ Paragraph 2. "With only 5 pedi-atric alas in the--co-u.nty with.. «capppecl" Medicaid enrollments in -their private pract ces.a slg,nificant- barrier to access [fig basic health care services has developed." This statement is False . None of the doctors or practices have -met. their " capped " enrollment. in fact all of the approved Medicaid providers roust attest that they have not net their "cap " or l.irnit of 3000 active patients. ( Exhibit Q Therefore this Statement made by Keys AHEC is both misleading and False. Six pediatricians would be ""Capped"' at 18000 active patients. There is not that many Children in Monroe County l Do the Math. Not to Mention the 3000 allowed per -Fa i ! j� A , 0. t i;o �-1 . • 13. Page *'8,, pa-rag-rap-h 5,'Xe.ys-AHfC states there are approximately 7900 students /C...ldren . in,Mo-rro-e County Schools with -a potential. population of about -9000. a.There are .5 rpedia Titic-'ans in Key West, 1 in Marathon., 2 in the upper Keys, and about, 10, Family Practitioners that are contracted to -see the MMA/Medicaid patients - Keys AID EC is Not, Medicaid allows each participating doctor to have up to 3,000. active .patients, before. beirt.ff, capped. (Exhibit Q • six'Pediatricians are meowed to have.18,000 active patients. Monroe County is not even rincAt �e�rir�� that .rr��ny. �hildr®n eI'l l., _Vey► close s e is .. .. having y: - 1 1' a 1• �,r 1 e .. r n..- 1 .. 1. l Practitioners, 3000 patients allowed each, are allowed up to 30,000 active .patients. Again.. Do the Math. Keys Ahec is Misleading -telling you that " There are only 5 pediatricians in the county with capped Medicaid enrollments." Also, there are Six Pediatricians. -Now there are about 7900 children in the school and maybe 9000 children in our county. Keys AH EC says doctors are " Gapped". Do the Math ! Keys AHEC stating that the local doctors are "Capped" is absolutely False. b. (Exhibit-D). Statistics from the 2010 census and the American Academy of Pediatrics shove that Mon -roe county has about 1400 children per pediatrician while other counties have up to 6000 or more children per pediatrician. Some rural counties have less. c. For six pediatricians to meet their " caps" .or li m its as Ke y s AH L.ti :tats there �,vouad Dave to ' be 12 000 children in Monroe County... This i's. not the Case. lip i.rt _add.iti n.to all - of this, the Healthy.. Kids/Kid-care program was revised in 2016 which-n now has ips.urance ,e:rer iu:nn.. mirroring private policies." • T IS.-St.ate.nae t Ise +71.e. t:hy X -and idcare insurance cost is sliding scale and -based on..-pa.re-nts.fincome. Lower income. parents are: referred to Med-icaid and given free Medlcajd./MMA Insurance., 15. Keys AHEc hours are short, They are closed some weekda y s, nut_ open -or available every weekday or- eekends, and they a_re not .available after hours, Their hours are limited to school hors, their clinics are not open every school day. This is not allowed by Medicaid. Page 22 16. According to Keys AHEC " oversite" of . the Keys-AHEC ,nu.rse practitioners. -is .done by a Family Practice doctor who is employed by Commu ity health cif .Sou-th _Florida Inc. (CHI). I do not know if CHI supports or is contracted for his "oversite" the school AHEC. nurse practitioners. "Oversite" is a legal requirement. 17. Page B, paragraph 4. " the only" other alternatives are utilizing the ER or Urgent Care C-e-nteTs which -are -even mo-re costly. than private providers." Both of which ave'xtreme,ly Wigh fee structures, require *ash up front, and do not offer no cost or how cast fee structu__ es." This is False. I . Keys AHE C Does not mentio-n. the.SJX_ local pediatricians and approximately 10 family practition-er4 t.hat are "NOT Cp,+Ped' and -really contracted with Medicaid and Medicaid MMAI# s, healthy Kids and Ki.d Care to provide. medical service to these low income children and others. 18. Page 8, Paragraph S. Target Population ; 11 public schools,, approx 7900 students. - some faculty,. poten-ti.al population to draw from at about 9000. Keys AHEC seems to be wanting. to Provide Primary Care to all of the Children in Monroe County, Funded by the Taxpayers and given Salaries, Office Space, Utilities, Phone, personnel, refer -rats of a-lt Monroe- Cotmty St ryt Children to their -Clinics by the Principal on the P�:rs►t-day of School .any refired :w:e�ry time a child sees a school n-urse. 19. P 9 Keys AHEC states, "Medical, Director vr. Morefli p,rov ides `"oversite" to t6 ie.-Keys- AH EC Providers". Dr, Morelli is :really an employee of Come. pity .Hea6tll Care of South Florida Inc. does CHI also _coat-ract .¢01 their employee together with Keys AHEC and Monroe County .1nd The _Mor�_ro.P County School nictrict to provide the legally required "oversite" to the Keys AHEC nurse practioners in our schools? 20. Page 9.,Networking Arrangements, "Private Provider -Medical /Dental Services-. Rece.ive referrals for needed services for the patient." This is False because Keys AHEC is not contracted by any MMA or allowed to provide, make or receive referrals for medical/dental services for Medicaid patients. 21.Medicaid patients do receive dental w;*- t-h.e.i !l,�ed�ic.aid .a M��;A !a�ns.... Keys AHEC cannot and doesnotprovide -dental and cannot. do referrals for these c. lldren to -either dentists ormedical specialistsa .22-. _Page. 9 , Sta f ng,.. _PA/N::P f 3) Prov d.e. alf medical care referrals. This is Ea I.Se. Th-e eys AH EC PA/N P (3), are -n-ot approved or contracted with Medicaid, HP_lthy Kids, n'ia.re n'ld_'en°s Medical Servises to Provide medical care or referrals. 23. P 9 "` KPHA-Keys. Physician Hospital Alliance — Contracting to access health insurance companies -Keys Afi C does not have access to, plus higher -re-i-mbu-rs-erne-n is :" f afsseffiii-ste-a-di n-g even - with KPHA -help in contracting, Keys AHEC 'eont,�sr,nac-,ca.v1" iaJdlelfrom be Medicaid Patient provider. It appears that Keys AHEC is attempting to bypass the Medicaid_, Florida -Healthy Kids; Florida KidCare, and Florida -Child-ren's Medical Services proBrarn. r_ u.les alnd re ui_rem-eats .to provide access to medical care and dental care to love income children and special needs children. .It appears. that -Keys ARE C .d e s.i re_s to.. have its. own "Primary Care -Monroe County. Government partnership" ; Paid for, given Office Space,. Utilities, Personnel, advertising, children referred by the school principals, school personnel and school nurses bypassing the State and Federal Medicaid system. 9 Page 29 Local Self supporting -doctors who have been approve-d. to do th-is work.cannot compete. and should not have to compete with a "Monroe County- Keys.AHEC.Partnership." - This is hurting the LocalDoctorswho are self s.l...,.p-p.or..+.ing,,a-p.p-,ro.v-ed and -contra teal to provide medical care Lto-the- -children of -Monroe County,.jow Income-, special needs, or otherwise. Respectfully, Michael P. Hernandez M.D. .1 April 14.,2016 Laura, deLoach-Martle sr. AdministratorGrants-and Special Projects Offke.otMan nagement and Budget 1100 simontom -St.' Room 2-2 S Key West, Fl- 3NMO Dear MsAeLoach-Hartle: The Ronda Keys Area Health Education- Center (Keys AHEQ, a 5011C) (3) affiliatid with the University Of Miami School ' Of. Medicine is pleased to submit -the enclosed ptoposat for review by the Human ServicesAdvisory Board. We took forwardtocontinuing our partnerAlp with: Monroe.CountY Government for support of our Childrenls' Pd=rV Care Program.' Our proposal requests $120AMOD to fully implement a dl . rec . tprimary medical services program with a target audience of scho Waged children and their siblings. The program -addresses primary, secondary and specialty medical needi-ofchildren living - low income in homes and considered avftmhere]10edica1-care and coverage is NAIng and unanjudable. Program services are delivered ofisite at Six regional school sites eftinatin for familits. g all access barriers Thank yo 'f v or:ycipr interest in the Keys AHIEC's program. We envision building a healthlir TIM CRIUFlity and decreasing the: medical needs of our Most 461nirab le children. Sincerely, 0e, Cunningham CEO Eric. Florida Keys Area -NeOlth Edut0II0.11 Centef. Inc. MW Overspos"Hwy, Suite .38, Marcfton, FL -3M50 PH. 305-743-7111 /Fak 305-743-7709 www.fkahec.org i - •�� £ ' ! iW tdttupe jp peasano y.:. uile lob paD.MP1 Igm gwq ON J® uots°`,DA(! Dd ate uD s�sc xe le3DUD� pue raplAwd,e�Dpa-dd/dNad # iunotue ap him n�oy Lt®z f. auo lgUDjoddns i4p 04.®� I te5Dqpads !l.�' 9tgrpui ,fie 30 }4i�]:Dad a �DEa ,�e�sD� .103 �! y� �y �.g ■� ® j. . 1*ni auo .'4uno J 8o juoW' jno4jn D, . JJ�6dp p G Oo � i � � f{F7 t + uej2o d area kmLL ud s uai PllLp �oddns o; 2u jpur4 papanbaai v, 4 *4pztqnMmuwjlOJdOJB. keW LpwaH LoOLPS"Il3HV► to , oJd aje, AiewPd ` 000'RD $ : L1Jo£i e► uD.p W_%�� Sugpua no 6�s4 Laura jol paela3w � s s�s3o r E ._ �j�,o �u D ua �ea� Des - - .p 1 y joud .Do; pa�a� 4unowV J -- - --- - - �3 Wuh lali"w x a ",Inoge suopseanb tplm pep w t t=ed.(�u,DDDut13lDJ 6bLL:El50� - A [ 5 _ E. �l `aa4ua:) uogmnp3 y;le8H easy sAa E �-= - 33HV sAaX) -x� auMN Ira .i Ltoz 46C jagwoldsS - gao.zh jaqopo Lt= aea D A 1 !j uIp=Jo} Up eallddv tip V08 AVOSIAGV S3)lA 13S WWnH CIO:30VNOW-= 'M'11Fi1rA lRON lathe best of our knowledge and bdWf, the -ink cWI HAIUIed in this applkatlon and at#achments is true Dui Corti ct< Monro�County is hereby au onzed>to verify all information contained herein, and we understand that . inaccurac s, grniss ins, os any a ther:ir�fortnati found to tie false`may Alt to nejec on .of tfiis appikanan. Thls certifies drat diis1request for-fiMingis consistent with our oWnizatidWs Ardcies of Ineoroo n e� Byta�rs and f been approved b'p a.malcrity of ft. Board cf Directors. We affi m that the Agency vigil use Monroe County funds for the aurgases as submitted in this AAP� for Funding. e will require written approval from the Monroe County Arty gang req .. Board,of County Commissioners; We droddrstandthat the agency rr _ UA sL ibstantially meet tRse Pi(Obilityc6teria to be consideredf6rMonroe CowAy fund g and that arty applicable attadwments not included disqualify thdi agency's application: We understand that, all funding recenred through this opporE aft must be spent forthe benefit of Monroe C ri� ty, .We furdw undemtuW that meeting the Ogiblit►- funding-by-the-HumanServices AdvisoryBoard. Mw .commwfty, avahlIII,*of. funds, etc. HSrAB fundireg of CountyCommissia . Typed`Mame of Y _ � Win WRFNM•� - -. Cunningham Typed raise of.Board Presidestt/tdv&man:. Holly Raschein in no way ensures that he agency wMbe reco f y 7 in C;inip! data is collected :real tame at each patient vW and updated with follow eap appo'n�ttneiets Thriough the gi ft we can pull mmntirly:reports to t®ok for trends:and medical treatment efficacy. Program data is again collected at the time of program delivery; entered -into the Keys AMEC data coliecM system and anatyzedquarterly-for repor irtg-purposes, _ Data Report* are provided to our partners on Clinical services quarterly%semi-anualty w th updates on pro�sarn deliverables tie s AHEC.will proms copies.af than. data and' nepocts to the, County fo�wi is mpoij ednle as % our baseline and currant trending data. Any anomalles;.barders, concerns and/or successes will be no and addressedas reporteug indicates_ the need for.. Data outcomes are currently ana'.Wed specific.to the stated-Work:Matnx relatini bacto mgtams obis, outcomes, 'processes .and goat :t(eys Af EC CEO has t[ a menu responsibility foie outcomes a a�ee'tie and staff as necessary taA assist with breakdown of areas of concern and anomalies. Each component_ of the data collected is stratified and analyzed through a previousWtesteddata systern that provided_us our baseline information: This data And report dritres our,prograM madel.to be proactW in adapting its focus, devetop ent,ptan, use of resaurcds and.atteasttma to future -trends: This in addition has assisted us in imptemeru4ing improvement reiommenrlatians.to the local school health policies. V. ftvide Wormation about -units -of service below. (tf appVng: for. $3,00o or less; a response Is not required.) Cost per service in FY 14/25 was approzimate$3fa per un ly.klue patient encounter or S6.80 per service i ate T$ same rate will be reduced about 4q+96 par unft in`Fy 15/16 as we have seen an increase to the nurn6er of patients and service encounters: AHEC Clinical: Fee fist is attached as lttachmertt l: 3his is used. for insurance Wilting only and does not represent casts noted below. Cost noted flow is based on number of services divided by tota .1.0r6krammost. 28. In 300 words "less, address any topics not covered above (optf o pal). Required Requ r +eat attachments were distributed -to ` you as: a s }� eparate.docaamen ffe sure to include the4e vath jrcrtdr application. Please note:. the required. attachments A tt9roaagh F ere onl�r available in,lVltcroso f t Excel f � We that you: ease this formef, lance it wilt rautoarsattically expand.rows, generate totals and percentagesy and. align ftgures foe' easier reading. Please label each attachment with your orgcanizatidrt caeca canct attadment teller: . 13 n AITACHMENT 8-AGEAlCY COMPEN ATIQN-DETAIL FY20s7 Include eada posit,kn n the enure Q ncy Pelt on "X""next:-to each position directly related keys Ee. to progrg. fior w+ fi►nding is requested Please round ail dollar amoupts to the nmrat do Iar, do not round FrEIS: . 40. .x ujAv--eek: oye6,w acid be t ot-Fie a 2oo-h isr/wweek eawbyee would_he y Fib eic orldicdtte whether the position is progrgmmaiit orQdrnfrdstra$ve, withcs "P" or "�1" Rext.to tbeatitaon, taY.'a tt ��hy����i Jw�i�-�i�,'.� •�'�.'>;.S�Sf"e �i 1: �n4}i}^d �f!"�.x�.:, �.`:k'd! •'�A {� Y �..V'ry 'fig". (•%H.":w"(o ��� t4 M �5„ni y"�`' 'A.1 y14'3 YS �ty,� K.',;`�•, �y�xr4., �, ` �n'�' ��t% 'YY',v �'L ^,�v� .4�r�y�1£��''C,�mlrW 'L R - }.��T,X Y-fj.•.ff �'�i' �fi� Y� "x`4 �fY vxF�.Y a . �i}'dtPT S y� u, N<'"'{4 r }��, fY3%y€M ,h "Y n'y$� 3'� r1�;t: � { L�'Y i'juxJ` d! �" 1 i,::r .�a+L-d, x'YL. X�'�1»�d �S J"�"{.S yj6"�.'� -_ �i RR 1-op Ill,0oa, 15,370a oo is 000 15,756 _ � PI. �► 1.00 48aQo0 ... rr o2 a,00 :..46,500 ' 0,455 1;60 K000. '. as ens :. : f oca 63,�� se,645. ;9 P�' A s- 4 5oa ` : 7,� .1.00 ` �42s5 16,E 0 :,�5 75 a oo a4a 000 8,40o 2.6o _z o,dao : 8,400 P 0,20 9,375 o P : a oa 46,50 _ 8,zoo : 1.00 46®350 505 o,6o .. §6 o 0.60. : a 895 75Q i' oaa a 5�00 • o o ao 15,000 � o P .: 0.70: 33.600 o tool, ` 48,Qot o g CEO.-_ P� . Director of Pw,, Ed. office/Fiscat AA Physlaan Assistae is 2 with no H ins Pro' Assistant* " !c . West CrrS v r s Med peal Dif2Ctor* Per Dim StfE* 74 .� " ...,�.m ... .i.,.. LM �µr®�Y• �'��..^TTS �±�..J...z, a'.�*'.4 .J°},.,r,..,:: , N',✓.. r.s.. E *piety list waEits; i uded: Health: Insurance lifeens $50K Tem D SEP Plan- of Salary after a Year *0o not.receiue benefits New Staff does not qualify for SEP. Additonally tl. Ins premiums have cha�ati due to staff rnember's Vie. AA �1Ai ®� _ _>I� ■ �r � THr1NATrL RICK SCOTT ELIZABETH DUDEK GOVERNOR SECRETARY A —At In -`n4 A - IMPORTANT INFORMATION FOR ALL MEDIPASS PRIMARY CARE PROVIDERS Dear MediPass Provider The Statewide Medicaid Managed Care, Managed Medical Assistance (MMA) program will be implemented in a_ phased rollout starting May 1., 2014.. Under this program; nearly, all. Medicaid recipients will enroll in a managed care plan to receive .their Medicaid services. ' The MediPass Program will sunset as the rollout occurs (see Florida Statute 409.9122).,. This means that the MediPass program will end. Recipients in your region will be enrolled in MMA plans effective July 1.2014. The enclosed MMA Snapshot provides, additional information. What this means for you: • You will no longer receive the $2 per member per month to act as the primary care provider for any former MediPass patients. This is effective July 1 in Regions 10 and 11. • If you wish to continue treating former MedlPass patients who have transitioned to MMA, yeas Illuut lxiilUMA IMUZ all :a-w% plat! In youl n:qtu : iu LM R-az i ul au pluviucl lluivvUlik. • There will no longer be any MediPass patients assigned to you effective IJuly 1,- 2014, • Some Medicaid recipients are voluntary or excluded from enrollment in the .MMA v .... 11a1 UC. LV L16V 1U%_j ; a.. r✓iw�iotit. t vu litgy a,vtaultuc av ucoa utVQc IYt>rVltiglu.t'GLI'JIGIIaJ vvrly uv itva uaatmuvtl w 1\A&a;A %I— 1.•11 Aar.1•..,..':11... l.._ i.._aL:....,.. a:....r• /...... iM:... 1VIIVIA. 1 Vu to V111 IVICutt-cou 10C-1V1-ael-Vlcc IVI'"uiose � atue,iW. k Icas 5CG 1110 01RAVOCU MMA Snapshot for additional information on voldntary and excluded 0013ulationsl: To ensure the movement to the new program is: a smooth one, the Agency has several program requirements that will allow for seamless continuity of care during the transition period. Detailed r_--a:__ L_. aaa____ 1---- 1 r-_.._.._ __r______ 1111 VI 11t1CIUV11 4UVUUt U IGSG P1 V V 1.'91Vi 1S lb w11WUbUU lul yUU1 I GICI Cl m u. The .Agency for Health. Care Administration would like to #hank you for your service and dedication to the MediPass Program. We encourage you to continue to serve Medicaid recipients of Florida through participation in the. MMA program. For more information on these programs and how to contact health plans participating in the MMA program, please'visit ., FIR13.11di1(;dl.11)V11U FlUt1.W11110MIM... . Sincerely, J �} Tracy Jeier MediPass Program Administrator zV11Vri" i it rdPs? lUt, %.Oul rirr zuuy Ul %s a1 u rw4ulr:rmul rim 111 u = :l ul tautsU 1V1t:UV.;a1 ^=klz5UU rS:C Program_ •:2: rutana1. unve a mau Jiop 4%I Tallahassee; FL- 32308 wklh . dam s:rz :Ir:ti:t ar:::r:s az ��,.� AHCA. MyFlorida. com 2. i 4i trZ3 ii_4l is Uk. • °Choosing art MMA-1Plan Steps to Help di Select Ur MMA Plan Specia6tu Plan Informia jv!, • Services Offered by All MMA Plans • Reference Information Choosing an MMA Plea In Florida, most Medicaid recipients must enroll in an MMA plan for their health care rpI Each plan offers all of the basic Florida Medicaid benefits. For more information see the Services Ofi Md by AIMMA MA Plan - section on the following page. 1. look at the MMA plans in your packet or on the web at wu!rw.flmedicaidmanagedcare ce, to seethe basic services offered by all plans and the extra benefits:that each pl= offers. 2. Think about the services you or your family members use and the doctor(s) you see. • What services do i think i need? tDoctor's visits, +p w. f sp f 34.► t� b Js vP L! a . ispo tor, to covered services. • What kind of doctors do'I need — a pediatrician, a family eloctor, or a specialist to treat an ongoing condition? • What plan(s) do my doctors take? • What extra benefits meet my needs? Choose a plan that best fits your needs. ftlt1E13+sfi WellCare. Health Plans, Inc. The TNWChn? Group of Congwdes Attestation of Total Patient !L oad — 2616 i MICHAEL PAMCK HE% TANDFZ, MD 9499 0W..RSEAS HEW MARATHON; FL 33050 Dear Docto i _t n. ell W The Agency for Health Care Administration regulations require that each Primary Care Physician shall not exceed a patient {[tt� !cad „f 4 11/1!1 ayµ;.y .� t;o.,to �.r�m rlT e�l�na y.� gRe v.e�ac inri�zr�ino rrt_mmamial imprnnrre y 4ctivepatients are defined as patients who have been seen by the Primary Care Physician at least three umes per yerar. In order to meet contractual obligations, we ask that you provide the information requested below. Please check !he box, _.,� ���...... 4fl0 1`Ma Z­ F.v `y tU- !`�u`ivn_tiolinn llryn�rtm t a4 1 _R��_:1�5_F3'r' Should you have any questions, please contact the Credentiaiing Department from 9:00 am — 5:00 pm weekdays, at 1-800- 960-:5=0 ert 6995. Sincerely, -:-_ n �.._,► MICHAEL P. HERNANDEZ, MD. [.uu : v:•.cu ST. Crel '-+i-1;Y n.ls'1:� 9499 OVERSEAS HWY Credentialing'Department MARATHON, FL 330,FA p 1aR""WZ. Mr F de not have more than 3,000 octhv patients. ��A� HW� i WFATHON, FL 3M 41 4 A 41//� MICH.4EL PATRICK &-r1 j Z J HERNANDET NID C.09 Physician Printed Name • r - - 131010 .A PC? R"itf', 3000 active patients would see in excess of4 "active- patients every hour for 8 hours a day 5 days a week, -42 weeks ofthe '.fir V I tncite :. voxr — QIM tncitc a vA.1� 9000 _ 52 =173 visits per week- 1 -73 5 = "55 visits per day 35 _ 3 = 4 visits per hour v+r n — n . — nnna n/n nr' ^ rune . T_. /O/C\ iCC CA^S9 tSVX J 1` kr'tt "IT'rl- ✓0UJ 1-J-0JV - L11V11G 4UVVj 7V'Y.�✓✓V GAL V97✓ • 1 dx tt5l!Uj �✓✓-vR +✓ c The AAP Child Health Mapping Project A 1O0zbwiitvs edvacepi and res,--nd"i pru�ad of bIsAAF &et iiie Daibitou,3', hstituiefol PcAq precam C4kzKPJ welcome to The AAP ChNd Health Mapping Projects The American Academy of Pediatrics has partnered vvith the Dartmouth Institute for Health Policy & :fit P. 'ct! ce L- aer—a a wat- basw geou.-aPhM -MP- Mscntatic; --. --f Chilli 1; 1 Z11,31 ! ' "ti'= States, T, he CNIMI Health Mapping, Project uses a data -driven approach to supper the delivery of high quality Pediatric health care in the United States. 1 his project provides naiionai and State-speddc data on peoiatnc neaten care Celivery at the Primaiy Care seMce- Area (PCSA) level. A range of maps is available, inciuding the number of chiidren under the age of 18 per pediatrician; number of children in linquisticaky isolated households, median housshold income- number of pediatric residents and fAsoves; and estirnam vaccine coverage rates. For an interactive mapping tool available to AAP members only, please click here. We invite you to e)plore both nabonal and state data: AdverbJ�zh@ Diadar"Ic- Thy -9Wde.- tO-' 6M q 0 . ity ca re Pre gnant w0in en, their feluluses, and thax-Ir newborns. I https:llwww&VorWen-uslprofessiorW-resourcesIReseucblresearch-imourceslpagesimay... 11/6/2017 ass$ itsa all �w,aimtig11. 11451Isla s 1 91 Nla 4 8 i�oaraeaas� �r��'+E e►Qwe w�movan �son" L o�oe000000cooog eoe.--Nr0000H a T FA O *IV O O H n - O - O O Mi p O A- O M O 1! 0 !v rO � i I 11R=IA2113i Ii IRIRJR st1all 11 E ►s G' el re if C e, dl re re a G+ 6L LL LL ea!LL rz! e,e l i i 1 1 i s- i- w ii t A9 tet Eli iI il� 9 1 M oIa11I9m110 2 9114,'4,M ISM ,aim 9 N atwq I ngig niegig fwp .-oi-0000l000 0 o-.-ow.uof. i e6ldG!feeL8 G°G!9 �g I i m z e Wil reill 982 SO 4XI -.a N O - O Primary Care Service Areas (PCSAs) for Florida and surrolundinti areas Tabic 1 PCSA Nanw. Chften ps Chan n prr Chirf Children per CW10r4l Pedlatrio Median Total Children (0• Household Percord IJnpusttle IsolaJon of Children AY SNda P1&L_w r1ccJsn _ Health EINtdclan Fnndb Phystelan ,Peritatrlelan Subeeer,lallats pauef P sluisne gyM Income 647 /ra J FL 1,$75 bib 395 4 0 5 _ 1.975 343,801i _ 014 MILTON FL 3,927 1,8t'S 905 3 0 13 '11,780 84i3.z Ogg SANTA Itc*A Fl. 6®e _ GF1 598 8 0 12 7,171 S&),5'M 0% C3ULF13RE6 ZEBREE&E FL 1,037 715 576 5 0 0 _ _ 5,185 $51. li 0% NAVARRE FL 4,434 2,30 1,26T 2 2 7 8 $60734 0% SANTA RO&A FL 522 369 313 3 0 5 1,566 aT.),3811 0% SARASOTA FL 412 313 412 15 6 15 6,179 i1p,26i 3% 8.4RASOTA 84RASOTA FL 3.012 _ 1 SCt3 731 7 2 27 21,083 W3.58589 2% FL 1,602 1,OC2 751 9 0 12 8,014� 36389I py, 84RASOTA Ft. 1,118 617 3" 4 2 13 4,470 $53,741) 0% E'VGLEVJOt 1p FL 4.266 1 X4 385 1 1 12 4,255 34i,292 2% V=NICE FL 2,164 641 228 4 1 38 816" 34).28(3 016 N3RTH POET SANFORD Fi. 1A88 _ 850 4r7 2 �'--- a 7 3,338 S -6-w1 01( FL 1,079 1,210 792 6 0 -^ � 15 '11,876 $33,610 1 X LAKE MARY FL 2,201 11651 1,831 9 3 12 '19.812 371,301 15 OJIED0 FL 1.910 1,135 639 15 1 41 28,654 $71.743 016 LONGWOOD FL 933 541 322 10 1 29 9.327 SS'r1316 1% OASSELSEI.RY ^-� FL --- 760 _ 557 510 2 1 3 1.531 64 IM) 1% AIJAPAONTH SPRINGS FL 2,W5 1.081 559 B 2 30 _ 16,750 3STM-, 1 g CASS,ELBEf.RY FL 2,278 102 759 2 0 6 4,656 354,56r1 0% %INTER PA1K FL No doctor 1,531 334 0 0 11 4,229 39216511 0% CENTER HILL FL No doctor 7,413 118,55 0 0 4 7,416 33: em 1% THEVILIASES FL 797 _ 351 159 2 - 0 10 1,594 $51.391 3'A LWE OAK FL No doctor 4,101 1,0;2S ` 0 0 _-� 6 _ 6,152 $39,313 116 BIRANFORD FL No doctor 51911 1,4r8 0 0 1 1,478 $33.1811 4% TAYLOR FL 0,230 2,761 11246 1 0 5 6,230 $33.231) 1% UcKE BUTLER FL No doctor 2,403 602 0 0 5 31010 $41,737 31A DAYTONA REACH _ FL 1�834 _ Sol 270 17 5 122 32,886 s43.000 1 PORT ORAKOE FL 2,345 76J 278 2 0 17 4,690 3S3,7a1 -- 116 NI:W SMYRPIA BEACH FL 1,693 I'm 665 9 1 15 9,975 W552 0'A DISLAND FL 2,441 1151) 1,011,5 7 0 17 1708 343,18:! 24 Ol4ANt3E CF'Y FL 11021 1,447 3.2,11 13 0 5 '16,205 341010 1% WEARY Fl. 44" 11961 ase �Y-3 3 1 10 '13,767 $0,137 0% CIRAWFORWILLE FL No doctor 6,824 1,731 0 4 6=5 555,56:i 0T DBFUIJIAK4iPRINOS FL 91690 2.020 792 1 0 9 6.590 333,14:1 2% CHIPLEY FL No doctor 1,5v. 3111 y 0 a 3,044 33 %O 0% 81 ATE FL 1,404 971 740 2,733 600 5,400 3.809,750 R-W ' Z§6 NATIONAL U8 1,642 1,031 'ra 48.102 11,258 9;,259 74,101,467 451,0111 216 NoUs: Di.ta 8oraoev: 2010 Physician supply d its, 2010 US Consns dab tend 2006401C! American CommunBy Survey (Medlin Household In:0M3 and I lnpulstio Isclatloo Sell desmnab;d primary phyelcbrs Variable deftr Sons: Eitats The state of the ZIP Coda that has the h Met rlanry core acttviv a,; meertured by Medico n Balms _ C*9d per Padistrolan I Children <11➢ yeryears of i go; posWME conical pen)ral pedletrta4n3 General Pec.tstrbtans Number of Irost.3ME c9nbcl general FedlatrIctant F'adbtdo Sv'oapectabrte Number of posN3ME cblcnl subspeclAst pedWalans F'amu , Pritzeonars Numhsr of post�WE c9tdce1kn* prncounere C;hrd Hasltls Phvstabns Nranbsr of ro, st-rME Ntln(aclseneral pmdlstrlcisnz, + 0.25 femlty t ractitloron. ___ __,�!__ a. Pala b ar 77 a a r N 0000 rr Nr�J l9 r!1 r N�7 N rr r O rl 00 O.O r N r MAUI! ! of I'll sli g� 0� ;all 91-.15111�p pOVI&Ig19I11:111 adallI � ��c9 m o t0 !J ff tPl N a� � v"• ,•r, 1tl r c -• 1� r I I I I i 01 'ova® cs Prs a 3'A2vim eMir: vN.N� ���$nACrn'oMn�o f:v�000,��a�ean A OJ r 0 g O O O O P3 Il r O O O r n O O O f O 0 0 0 0 o i a n N r r p W m O O O O n .N r♦ � f 0W O •J ® OJ®e p -Sec: O A Q A 0 0' O r. N O n rN O rype O r r N Ali ! 1 I 5rt ' o il as NA�..rr�rr_NAlrrrerjrrgr 1:-r� .0,I.: �._ I:�:. A-- ��� I I I nr G! G! it i! is! if it ILI dle G! if a! fdia! r to re eYam! d e I-L elfi r.! re IL ILIi a a! G! leis! ti G! Pi' if L if aG' ie if G! if i! di s' I.JL li' I I I I I! I I I I I I i 1 I I I I I I l i r w w umw s�3 ww=� �w��a�o8o®noo i'a=yya+x fig e. Ej $RIQ�i�Sl�iis§Iacov RICK SCOTT GOVERNOR ELIZABETH DUDEK SECRETARY 0260973482 PRV-9008-R/=0260973482/1 Illll 1111111111 I II11� I ��I II �I FLORIDA KEYS AREA HEALTH EDUCATION CENTER, INC 5800 OVERSEAS HWY STE 38 MARATHON FL 33050-2744 June 22, 2016 Dear Provider: Welcome to the Florida Medicaid program. Your application to provide services to Florida's Medicaid recipients has been approved. We are pleased that you have chosen to join us in our efforts to serve the needs of Florida's Medicaid recipients. As an approved provider, you may submit. claims for reimbursement under the Medicaid programs within the scope -of coverage of your provider type for Medicaid eligible individuals. Please refer to the Florida Medicaid provider handbooks as a. valuable resource for information that explains how the Medicaid program operates. The Coverage and Limitations Handbook describes policy specific to your provider type. The Reimbursement; Handbook describes how to bill for services rendered on the appropriate.claim form. These handbooks are available for download from the.Medicaid website at http://mymedicaid-florida.com. If you do not have access to the internet, you may request handbooks by calling the fiscal agent at 1-800-289-7799. Please specify whether you want to receive a CD containing PDF files of the handbooks or, if you prefer, pre-printed hard copies. The handbooks also contain the contact information for HP, the Florida Medicaid fiscal agent, as well as for the Agency for Health Care Administration staff in your local area. The AHCA area office staff is available to answer policy questions that you cannot find an answer for in the Coverage and Limitations Handbook. HP has staff available Monday through Friday, 7:00 a.m. - 6:00 p.m., to answer your enrollment, billing and eligibility questions. HP also offers several automated options for getting the same information quickly and efficiently. The success of the Florida Medicaid program is dependent on providers like you who furnish services directly to Medicaid recipients. Thank you for your participation and your efforts to maintain and improve the health of Florida's Medicaid recipients. Sincerely, cc: Provider File Enclosure Gay L. Munyon, Chief Medicaid Fiscal Agent Operations 2727 Mahan Drive • Mail Stop # 22 Facebook.com/AHCAFlorida Tallahassee, FL 32308 _ ' Youtube.com/AHCAFlorida jn AHCA.MyFlorida.com '' ;. Twifter.com/AHCA—FL SlideShare.net/AHCAF[odda cc s a 2/65 RICK SCOTT GOVERNOR ELIZABETH DUDEK SECRETARY Provider NPI: 1104225663 Medicaid Provider ID: 015578900= - Address: 5800 OVERSEAS HWY STE 38 MARATHON, FL 33050-2744 Provider Type: 25 - PHYSICIAN (M.D.) Provider Specialty: 011 - GENERAL PRACTICE (DEFAULT SPEC FOR PHYS) The effective date of your Medicaid ID for billing purposes is: 08/27/2015 Provider Contracts: Child Health Chck-Up Family Planning Srvc Physician Services 2727 Mahan Drive • Mail Stop # 22 Tallahassee, FL 32308 AHCA.MyFlorida.com Facebook.com/AHCAFlorida Youtube.com/AHCAFlorida Twitter.com/AHCA FL SlideShare.net/AHCAFIorida