FY2008 09/19/2007
MEMORANDUM
To: Connie Cyr, County Administrator'~ Office
-\,p
From: Isabel DeSantis, Deputy Clerk \;fr"
~'
Date: September 25, 2007
At the BOCC meeting of September 19, 2007 the BOCC granted approval and authorized
execution of the following item:
Annual contract between Monroe County and Florida Department of Health for public
health services provided by the Monroe County Health Department.
Attached hereto are four (4) duplicate originals for your handling. Pleas be sure that the
sets marked Monroe County Clerk's Office Original and Monroe County Finance
Department's Original are returned back to my office. Should you have any questions
concerning this matter, please do not hesitate to contact my office.
CC: County Attorney
Finance, wlo doc.
File c./'
- M__ COllllt1 Qed'. Oftb o.~
CONTRACT BETWEEN
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
THE MONROE COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2007-2008
This agreElment ("Agreement") is made and entered into between the State of Florida,
Department of Health ("State") and the Monroe County Board of County Commissioners
("County"), through their undersigned authorities, effective October 1,2007.
RECITALS
A. Pursuant to Chapter 154, F.S., the intent of the legislature is to "promote,
protect, maintain, and improve the health and safety of all citizens and visitors of this state
through a system of coordinated county health department services."
B. County Health Departments were created throughout Florida to satisfy this
legislative intent through "promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health care for special populations."
C. Monroe County Health Department ("CHD") is one of the County Health
Departments created throughout Florida. It is necessary for the parties hereto to enter into
this Agreement in order to assure coordination between the State and the County in the
operation of the CHD.
NOW THEREFORE, in consideration of the mutual promises set forth herein, the
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the forgoing recitals are true and
correct and incorporated herein by reference.
2. TEHM. The parties mutually agree that this Agreement shall be effective from
October 1, 2007, through September 30, 2008, or until a written agreement replacing this
Agreement is entered into between the parties, whichever is later, unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8,
below.
3. SER:VICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD
shall provide those services as set forth on Part III of Attachment II hereof, in order to
maintain the following three levels of service pursuant to Section 154.01(2), Florida
Statutes, as defined below:
a. "Environmental health services" are those services which are organized and
operated to protect the health of the general public by monitoring and regulating activities
in the environment which may contribute to the occurrence or transmission of disease.
Environmental health services shall be supported by available federal, state and local
funds and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, occupational health.
b. "Communicable disease control services" are those services which protect the
health of the general public through the detection, control, and eradication of diseases
which are transmitted primarily by human beings. Communicable disease services shall
be supponted by available federal, state, and local funds and shall include those services
mandated on a state or federal level. Such services include, but are not limited to,
epidemiology, sexually transmissible disease detection and control, HIV/AIDS,
immunizatlion, tuberculosis control and maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the collective health of the public, and prevent and control the spread
of disease. Primary health care services are provided at home, in group settings, or in
clinics. Thl3se services shall be supported by available federal, state, and local funds and
shall include services mandated on a state or federal level. Examples of primary health
care services include, but are not limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health services; family planning;
nutrition; school health; supplemental food assistance for women, infants, and children;
home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $ 4.203.333 (State General
f/evenue, Other State Funds and Federal Funds listed on the Schedule C). The State's
obligation to pay under this contract is contingent upon an annual appropriation
by the Legislature.
H. The County's appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment II, Part II is an amount not
to exceed $638.400 (amount listed under the "Board of County Commissioners Annual
Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority,
whichever is less, (either current year or from surplus trust funds) in any service category.
Unless requested otherwise, any surplus at the end of the term of this Agreement in the
County Health Department Trust Fund that is attributed to the CHD shall be carried
forward to the next contract period.
2
c. Either party may establish service fees as allowed by law to fund activities of the
CHD. Where applicable, such fees shall be automatically adjusted to at least the
Medicaid fee schedule.
d. Either party may increase or decrease funding of this Agreement during the term
hereof by notifying the other party in writing of the amount and purpose for the change in
funding. IIf the State initiates the increase/decrease, the CHD will revise the Attachment II
and send a copy of the revised pages to the County and the Department of Health,
Bureau of Budget Management. If the County initiates the increase/decrease, the County
shall notify the CHD. The CHD will then revise the Attachment II and send a copy of the
revised pages to the Department of Health, Bureau of Budget Management.
e. The name and address of the official payee to who payments shall be made is:
County Health Department Trust Fund
Monroe County
1100 Simonton Street
Post Office Box 6193
Key West, FL 33040 (33041)
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator
of the CHD shall be a State employee or under contract with the State and will be under
the day-to..day direction of the Deputy State Health Officer. The director/administrator
shall be selected by the State with the concurrence of the County. The
director/administrator of the CHD shall insure that non-categorical sources of funding are
used to fulfill public health priorities in the community and the Long Range Program Plan.
A report detailing the status of public health as measured by outcome measures and
similar indicators will be sent by the CHD director/administrator to the parties no later than
October 1 of each year (This is the standard quality assurance "County Health Profile" report located on
the Office of Planning, Evaluation & Data Analysis Intranet site).
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that
the following standards should apply in the operation of the CHD:
a. The CHD and its personnel shall follow all State policies and procedures, except to
the extent permitted for the use of county purchasing procedures as set forth in
subparagralph b., below. All CHD employees shall be State or State-contract personnel
subject to State personnel rules and procedures. Employees will report time in the Health
Management System compatible format by program component as specified by the State.
b. The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of county purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
services. In such cases, the CHD director/administrator must sign a justification therefore,
and all county-purchasing procedures must be followed in their entirety, and such
compliance shall be documented. Such justification and compliance documentation shall
3
be maintained by the CHD in accordance with the terms of this Agreement. State
procedures must be followed for all leases on facilities not enumerated in Attachment IV.
c. The, CHD shall maintain books, records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental
Accountin!J Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public, except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6.i.,
below. Books, records and documents must be adequate to allow the CHD to comply with
the following reporting requirements:
i. The revenue and expenditure requirements in the Florida Accounting
System Information Resource (FLAIR).
ii. The client registration and services reporting requirements of the
minimum data set as specified in the most current version of the Client
Information System/Health Management Component Pamphlet;
iii. Financial procedures specified in the Department of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported
to the CHD in a manner consistent with the client registration and
service reporting requirements of the minimum data set as specified in
the Client Information System/Health Management Component
Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust
Fund maintained by the state treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Monroe County.
e. That any surplus/deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the state or county, as appropriate, based on the funds contributed by
each and the expenditures incurred by each. Expenditures will be charged to the program
accounts by state and county based on the ratio of planned expenditures in the core
contract and funding from all sources is credited to the program accounts by state and
county. The equity share of any surplus/deficit funds accruing to the state and county is
determined each month and at contract year-end. Surplus funds may be applied toward
the funding requirements of each participating governmental entity in the following year.
However, in each such case, all surplus funds, including fees and accrued interest, shall
remain in the trust fund until accounted for in a manner which clearly illustrates the amount
which has been credited to each participating governmental entity. The planned use of
4
surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital
projects explained in Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy State
Health Officer has approved the transfer. The Deputy State Health Officer shall forward
written evidence of this approval to the CHD within 30 days after an emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this Agreement. Any such subcontract shall include all
aforementioned audit and record keeping requirements.
h. At the request of either party, an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMS Circular A-133 and may be in conjunction with audits performed by
county government. If audit exceptions are found, then the director/administrator of the
CHD will prepare a corrective action plan and a copy of that plan and monthly status
reports willi be furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent
to this Agreement for a period of five (5) years after termination of this Agreement. If an
audit has been initiated and audit findings have not been resolved at the end of five (5)
years, the records shall be retained until resolution of the audit findings.
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law. The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65
and 456.057, Florida Statutes, and all other state and federal laws regarding
confidentiality. All confidentiality procedures implemented by the CHD shall be consistent
with the D1spartment of Health Information Security Policies, Protocols, and Procedures,
dated April 2005, as amended, the terms of which are incorporated herein by reference.
The CHD shall further adhere to any amendments to the State's security requirements and
shall comply with any applicable professional standards of practice with respect to client
confidentiality.
I. The CHD shall abide by all State policies and procedures, which by this reference
are incorporated herein as standards to be followed by the CHD, except as otherwise
permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof.
m. The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial, modification or termination of services. The
5
CHD will advise applicants of the right to appeal a denial or exclusion from services, of
failure to take account of a client's choice of service, and of his/her right to a fair hearing to
the final governing authority of the agency. Specific references to existing laws, rules or
program manuals are included in Attachment I of this Agreement.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the county that shall include at least the
following:
i. The DE385L 1 Contract Management Variance Report and the DE580L 1
Analysis of Fund Equities Report;
ii. A written explanation to the county of service variances reflected in the
DE385L 1 report if the variance exceeds or falls below 25 percent of the planned
expenditure amount. However, if the amount of the service specific variance
between actual and planned expenditures does not exceed three percent of the
total planned expenditures for the level of service in which the type of service is
included, a variance explanation is not required. A copy of the written
explanation shall be sent to the Department of Health, Bureau of Budget
Management.
6
p. The dates for the submission of quarterly reports to the county shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond
the CHD's control:
i. March 1, 2008 for the report period October 1, 2007 through
December 31,2007;
ii. June 1, 2008 for the report period October 1, 2007 through
March 31,2008;
iii. September 1, 2008 for the report period October 1, 2007
through June 30, 2008; and
iv. December 1, 2008 for the report period October 1, 2007
through September 30, 2008.
7. FACILITIES AND EQUIPMENT. The parties mutually agree that:
a. CHI) facilities shall be provided as specified in Attachment IV to this contract and
the county shall own the facilities used by the CHD unless otherwise provided in
Attachment IV.
b. The county shall assure adequate fire and casualty insurance coverage for County-
owned CHD offices and buildings and for all furnishings and equipment in CHD offices
through either a self-insurance program or insurance purchased by the County.
c. All vehicles will be transferred to the ownership of the County and registered as
county vehicles. The county shall assure insurance coverage for these vehicles is
available through either a self-insurance program or insurance purchased by the County.
All vehicles will be used solely for CHD operations. Vehicles purchased through the
County Health Department Trust Fund shall be sold at fair market value when they are no
longer needed by the CHD and the proceeds returned to the County Health Department
Trust Fund.
8. TER:MINATION.
a. Terrnination at Will. This Agreement may be terminated by either party without
cause upon no less than one-hundred eighty (180) calendar days notice in writing to the
other party unless a lesser time is mutually agreed upon in writing by both parties. Said
notice shall be delivered by certified mail, return receipt requested, or in person to the
other party's contract manager with proof of delivery.
b. Termination Because of Lack of Funds. In the event funds to finance this
Agreement become unavailable, either party may terminate this Agreement upon no less
than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return
receipt requested, or in person to the other party's contract manager with proof of delivery.
c. Termination for Breach. This Agreement may be terminated by one party, upon no
less than thirty (30) days notice, because of the other party's failure to perform an
7
obligation hereunder. Said notice shall be delivered by certified mail, return receipt
requested" or in person to the other party's contract manager with proof of delivery.
Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver
of any other breach and shall not be construed to be a modification of the terms of this
Agreement.
9. MISCELLANEOUS. The parties further agree:
a. Availabilitv of Funds. If this Agreement, any renewal hereof, or any term,
performance or payment hereunder, extends beyond the fiscal year beginning July 1,
2008, it is agreed that the performance and payment under this Agreement are contingent
upon an annual appropriation by the legislature, in accordance with section 287.0582,
Florida Statutes. .
b. Contract Manaaers. The name and address of the contract managers for
the parties under this Agreement are as follows:
For the State:
For the County:
Istrative Services Director
Countv Administrator
Title
Post Office Box 6193
Gato Bldg, 1100 Simonton Street
Key West, Fl 33041-6193
Gato Bldg, 1100 Simonton Street
Key West, Fl 33040
Add ress
Address
305-293-7539
Telephone
305-292-4441
Telephone
If different contract managers are designated after execution of this Agreement, the name,
address and telephone number of the new representative shall be furnished in writing to
the other parties and attached to originals of this Agreement.
c. Captions. The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify, amplify, or give
additional notice of the provisions hereof.
8
In WITNESS THEREOF, the parties hereto have caused this 24 page agreement to be
executed by their undersigned officials as duly authorized effective the 1st day of October, 2007.
BOARD OF COUNTY COMMISSIONERS
FOR -r1'l 01\..(0 e.. COUNTY
STATE OF FLORIDA
DEPARTMENT OF HEALTH
SIGNED BY~I11AU<bj~~
NAME:Ma..f/'O f)iGuu~..a..(O
TITLE: Mo.l/or / Ch<<'A'('ma.. YI
~/
DATE: q- ICf-07
-' SIGNE: .. t:l1Q -Co- --
TITLE: State Suraeon General
DATE: /0- 8 -07
ATTESTED TO:
SIGNED BY: ~;:1 .,.,1.JLQ.
~0V'Il..~- SIGNED By:-1/~
::r::.. ~:;. 0\. b t.l c., () c.. ~Cl"'" ,. i S NAME:
\).0 r->,..k\J C l4.-{ Ie. TITLE:
-r- I
OC{-\q-Or
NAME:
TITLE:
DATE:
Robert Eadie
DATE:
CHD Director/Administrator
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9.
ATTACHMENT I
MONROE COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet (DHP 50-20), Environmental Health Coding Pamphlet (DHP 50-21) and FLAIR requirements because
of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it
must comply with the special reporting requirements for that service. The services and the reporting requirements are
listed below:
~'ervice
Reauirement
1.
Sexually Transmitted Disease
Program
Requirements as specified in FAC 64D-3, F.S. 381 and
F.S. 384 and the CHD Guidebook.
2.
Dental Health
Monthly reporting on DH Form 1008*.
3.
Special Suppiemental Nutrition
Program for Women, Infants
and Children.
Service documentation and monthly financial reports as
specified in DHM 150-24* and all federal, state and county
requirements detailed in program manuals and published
procedures.
4.
Healthy Start!
Improved Pregnancy Outcome
Requirements as specified in the Healthy Start Standards
and Guidelines 1998 and as specified by the Health Start
Coalitions in contract with each county health department.
5.
Family Planning
Periodic financial and programmatic reports as specified
by the program office and in the CHD Guidebook, Internal
Operating Policy FAMPLAN 14*
6.
Immunization
Periodic reports as specified by the department regarding
the surveillance/investigation of reportable vaccine
preventable diseases, vaccine usage accountability, the
assessment of various immunization levels and forms
reporting adverse events following immunization and
Immunization Module quarterly quality audits and duplicate
data reports.
Chronic Disease Program
Requirements as specified in the Community Intervention
Program (CIP) and the CHD Guidebook.
Environmental Health
Requirements as specified in DHP 50-4* and 50-21 *
HIV/AIDS Program
Requirements as specified in Florida Statue 384.25 and
64D-3.016 and 3.017 FAC. and the CHD Guidebook. Case
reporting on CDC Forms 50.42B (Adult! Adolescent) and
50.42A (Pediatric). Socio-demographic data on persons
tested for HIV in CHD clinics should be reported on Lab
Request Form 1628 or Post-Test Counseling Form 1633.
These reports are to be sent to the Headquarters HIV/AIDS
office within 5 days of the initial post-test counseling
appointment or within 90 days of the missed post-test
counseiing appointment.
10
ATTACHMENT I (Continued)
10.
School Health Services
HRSM 150-25", including the requirement for an annual plan
as a condition for funding.
"or the subsequent replacement if adopted during the contract period.
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1. GENERAL REVENUE: - STATE
015040 ALG/CESSPOOL IDENTIFICATION AND ELIMINATION 128,707 0 128,707 0 128,707
015040 ALG/CONTR TO CHDS-AlDS PATIENT CARE 384,663 0 384,663 0 384,663
015040 ALG/CONTR TO CHDS-AlDS PREV & SURV & FIELD STAFF 105,802 0 105,802 0 105,802
015040 ALG/CONTR TO CHDS-DENT AL PROGRAM 0 0 0 0 0
015040 ALG/CONTR TO CHDS-MIGRANT LABOR CAMP SANITATION 0 0 0 0 0
015040 ALG/CONTR. TO CHDS-IMMUNIZA TlON OUTREACH TEAMS 6,592 0 6,592 0 6,592
015040 ALG/CONTR TO CfIDS-INDOOR AIR ASSIST PROG 0 0 0 0 0
015040 ALG/CONTR TO CHDS-MCH HEALTH - FIELD STAFF COST 0 0 0 0 0
015040 ALG/CONTR TO CHDS-SOVEREIGN IMMUNITY 0 0 0 0 0
015040 ALG/CONTRIBUTlON TO CHDS-PRIMARY CARE 17,256 0 17,256 0 17,256
015040 ALGIF AMIL Y PLANNING 62,578 0 62,578 0 62,578
015040 ALGIIPO - OUTREACH SOCIAL WORKERS CAT. 050707 0 0 0 0 0
015040 ALG/IPO HEALTHY STARTIIPO CAT 050707 0 0 0 0 0
015040 ALG/IPO-INF ANT MORTALITY PROJECT CAT. 050707 0 0 0 0 0
015040 ALGIMCH-INFANT MORTALITY PROJECT CAT. 050870 0 0 0 0 0
015040 ALG/MCH-OUTREACH SOCIAL WORKERS CAT 050870 0 0 0 0 0
015040 ALG/PRIMAR Y CARE 240,566 0 240,566 0 240,566
015040 ALG/SCHOOL HEALTH/SUPPLEMENTAL 41,665 0 41,665 0 41,665
015040 CA TE - ESCAMBlA 0 0 0 0 0
015040 CLOSING THE GAP PROGRAM 0 0 0 0 0
015040 COMMUNITY 18 PROGRAM 34,710 0 34,710 0 34,710
015040 DENTAL SPECI!\L INITIATIVE PROJECTS 0 0 0 0 0
015040 DUVAL TEEN PREGNANCY PREVENTION 0 0 0 0 0
015040 ENHANCED DENTAL SERVICES 0 0 0 0 0
015040 FL CLPPP SCREENING & CASE MANAGEMENT 0 0 0 0 0
015040 FL HEPATITIS & LIVER FAILURE PREVENTION/CONTROL 0 0 0 0 0
015040 HEALTH PROMOTION & EDUCATION INITIATIVES 58,823 0 58,823 0 58,823
015040 HEALTHY BEACHES MONITORING 28,695 0 28,695 0 28,695
015040 INDIGENT DENTAL CARE - ESCAMBIA 0 0 0 0 0
015040 LA LIGA CONTRA EL CANCER 0 0 0 0 0
015040 MEDIVAN PROJECT - BROWARD 0 0 0 0 0
015040 METRO ORLANDO URBAN LEAGUE TEENAGE PREG PREV 0 0 0 0 0
015040 PENAL VER CLI~IC - MIAMI-DADE 0 0 0 0 0
015040 PRIMARY CAR!; SPECIAL DENTAL PROJECTS 0 0 0 0 0
015040 PRIMARY CARE SPECIAL PROJECTS 0 0 0 0 0
015040 SPECIAL NEEDS SHELTER PROGRAM 0 0 0 0 0
015040 STATEWIDE DENTISTRY NETWORK - ESCAMBIA 0 0 0 0 0
015040 STD GENER!\L REVENUE 21,016 0 21,016 0 21,016
015040 VOLUNTEER SCHOOL HEALTH NURSE GRANT 0 0 0 0 0
015050 ALG/CONTR TO CHDS 1,811,802 0 1,811,802 0 1,811,802
GENERAL REVENUE TOTAL 2,942,875 0 2,942,875 0 2,942,875
2, NON GENERAL REVENUE - STATE
015010 ALG/CONTR TO CHDS-REBASING TOBACCO TF 21,864 0 21,864 0 21,864
015010 BASIC SCHOOL HEALTH - TOBACCO TF 40,839 0 40,839 0 40,839
015010 CHD PROGRAM SUPPORT 0 0 0 0 0
015010 FL HEP A TITlS & LIVER FAILURE PREVENTION/CONTROL 150,000 0 150,000 0 150,000
015010 FULL SERVICE SCHOOLS - TOBACCO TF 61,720 0 61,720 0 61,720
13
2. NON GENERAL REVlcNUE - STATE
015010 ONSITE SEW AGE RESEARCH PROGRAM 43,000 0 43,000 0 43,000
015010 PACE EH 0 0 0 0 0
015010 PUBLIC SWIMMING POOL PROGRAM 0 0 0 0 0
015010 SUPPLEMENTAL/COMPREHENSIVE SCHOOL HEALTH - TOB TF 0 0 0 0 0
015010 TOBACCO PREVENTION & CESSATION PROGRAM 85,265 0 85,265 0 85,265
015010 VARICELLA IMMUNIZATION REQUIREMENT TOBACCO TF 3.528 0 3,528 0 3,528
015018 Summer Food Program 0 0 0 0 0
015020 ALG/CONTR TO CHDS-BIOMEDICAL W ASTEIDEP ADM TF 2,208 0 2,208 0 2,208
015020 ALG/CONTR TO CHDS-SAFE DRINKING WATER PRGIDEP ADM 0 0 0 0 0
015020 FOOD AND WATERBORNE DISEASE PROGRAM ADM TFIDACS 0 0 0 0 0
015010 TlTLEXXIISCHOOL HEALTH/SUPPLEMENTAL 81,066 0 81.066 0 81,066
NON GENERAL REVENlE TOTAL 489,490 0 489,490 0 489,490
3, FEDERAL FUNDS - State
007000 AIDS PREVENTION 189.027 0 189,027 0 189.027
007000 AIDS SEROPREV ALENCE 0 0 0 0 0
007000 AIDS SURVEILLANCE 0 0 0 0 0
007000 BIOTERR SURVEILLANCE & EPIDEMIOLOGY 0 0 0 0 0
007000 BIOTERRORISM PLANNING & READINESS 103,620 0 103.620 0 103,620
007000 CHILDHOOD LEAD POISONING PREVENTION 0 0 0 0 0
007000 COASTAL BEACH MONITORING PROGRAM 25,519 0 25,519 0 25.519
007000 COMPREHENS]VE CARDIOVASCULAR PROGRAM 0 0 0 0 0
007000 DIABETES CONTROL PROGRAM 0 0 0 0 0
007000 FGTF/AIDS MORBIDITY 0 0 0 0 0
007000 FGTF/BREAST & CERVICAL CANCER-ADMIN/CASE MAN 0 0 0 0 0
007000 FGTF/FAMIL Y PLANNING TITLE X SPECIAL INITIATIVES 0 0 0 0 0
007000 FGTF/FAMIL Y PLANNING-TITLE X 74.807 0 74.807 0 74.807
007000 FGTF/IMMUNIZATlON ACTION PLAN 4,791 0 4,791 0 4.79]
007000 FGTFIWIC ADMINISTRATION 261,400 0 261,400 0 261,400
007000 FLORIDA PANDEMIC INFLUENZA 5,200 0 5.200 0 5,200
007000 HEALTH PROGRAM FOR REFUGEES 0 0 0 0 0
007000 ]MMUNIZA TlON FIELD STAFF EXPENSE 0 0 0 0 0
007000 IMMUNIZATION SPECIAL PROJECT 3,720 0 3.720 0 3,720
007000 IMMUNIZATION SUPPLEMENTAL 0 0 0 0 0
007000 IMMUNIZATION WIC-LINKAGES 0 0 0 0 0
007000 IMMUNIZATlON-WIC LINKAGES 0 0 0 0 0
007000 MCH BGTF-GAI)SDEN SCHOOL CLINIC 0 0 0 0 0
007000 MCH BGTF-HEALTHY START IPO 0 0 0 0 0
007000 MCH BGTF-INFANT MORTALITY PROJECT 0 0 0 0 0
007000 MCH BGTF-MCHlCHILD HEALTH 11,347 0 11,347 0 1],347
007000 MCH BGTF-MCH/DENTAL PROJECTS 0 0 0 0 0
007000 MCH BGTF-OUTREACH SOCIAL WORKERS 0 0 0 0 0
007000 PHHSBG/STEP UP FLORIDA' HEAL THY COMMUNITIES 0 0 0 0 0
007000 PHP-CITIES RESPONSE INITIATIVE 0 0 0 0 0
007000 PHP-CITIES RESPONSE INITIATIVE 2006-2007 0 0 0 0 0
007000 RAPE PREVENTION & EDUCATION GRANT 2007 0 0 0 0 0
007000 RAPE PREVENTION & EDUCATION GRANT 2008 0 0 0 0 0
007000 RISK COMMUN:ICATlONS 0 0 0 0 0
/4
3. FEDERAL FUNDS - State
007000 RYAN WHITE 36.205 0 36,205 0 36,205
007000 RYAN WHITE - EMERGING COMMUNITIES 0 0 0 0 0
007000 RYAN WHITE-AlDS DRUG ASSIST PROG-ADMIN 22,443 0 22,443 0 22,443
007000 RYAN WHITE-CONSORTIA 0 0 0 0 0
007000 SCHOOL HEALTH BASIC - MCH BLOCK GRANT 6,732 0 6,732 0 6,732
007000 STD FEDERAL GRANT - CSPS 0 0 0 0 0
007000 STD PROGRAM - PHYSICIAN TRAINING CENTER 0 0 0 0 0
007000 STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP) 0 0 0 0 0
007000 STD PROGRAM-INFERTILITY PREVENTION PROJECT (IPP) 0 0 0 0 0
007000 STEP UP FLOR]DA! HEAL THY COMMUNITIES 0 0 0 0 0
007000 SYPHILIS ELIMINATION 0 0 0 0 0
007000 TESTING HIV SERONEGATIVE HEADQUARTERS 0 0 0 0 0
007000 TUBERCULOSIS CONTROL - FEDERAL GRANT 0 0 0 0 0
007000 WIC BREASTFEEDING PEER COUNSELING 2007 0 0 0 0 0
007000 WIC BREASTFEEDING PEER COUNSELING PROG FFY 2005 0 0 0 0 0
007000 WIC INFRASTRUCTURE 2006 0 0 0 0 0
015009 MEDIPASS WAIVER-HLTHY STRT CLIENT SERVICES 0 0 0 0 0
015009 MEDIPASS WAIVER-SOBRA 0 0 0 0 0
015009 SCHOOL HEAL TH-S UPPLEMENT - T ANF 11,581 0 11,581 0 11,581
015075 Refugee Screening 0 0 0 0 0
FEDERAL FUNDS TOTAL 756,392 0 756,392 0 756,392
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001020 TANNING FACILITIES 1,000 0 1,000 0 1,000
001020 BODY PIERCING 1.000 0 1,000 0 1,000
001020 MIGRANT HOLSING PERMIT 0 0 0 0 0
001020 MOBILE HOME AND PARKS 17,500 0 17,500 0 17,500
001020 FOOD HYGIENE PERMIT 12,150 0 12,150 0 12,150
001020 BIOHAZARD WASTE PERMIT 5,600 0 5,600 0 5,600
001020 SWIMMING POOLS 46,700 0 46,700 0 46.700
001020 PRIVATE WATERCONSTR PERMIT 0 0 0 0 0
001020 PUBLIC WATER ANNUAL OPER PERMIT 0 0 0 0 0
001020 PUBLIC WATER CONSTR PERMIT 0 0 0 0 0
001020 NON-SDWA SYSTEM PERMIT 0 0 0 0 0
001020 SAFE DRINKING WATER 0 0 0 0 0
001092 ]NDIVIDUAL SEWAGE 297,800 0 297,800 0 297,800
001092 FOOD HYGIENE 1,000 0 1,000 0 1,000
001092 ENVIRONMENTAL HEALTH FEES 0 0 0 0 0
001092 OSDS REPAIR PERMIT 0 0 0 0 0
001092 OSDS PERMIT FEE 0 0 0 0 0
001092 1& M ZONED OPERATING PERMIT 0 0 0 0 0
001092 AEROBIC OPERATING PERMIT 0 0 0 0 0
001092 SEPTIC TANK SITE EVALUATION 0 0 0 0 0
001170 LAB FEE CHEMICAL ANALYSIS 0 0 0 0 0
001170 NONPOTABLE WATER ANALYSIS 0 0 0 0 0
001170 WATER ANALYSIS-POTABLE 0 0 0 0 0
0]0304 MQA INSPECTION FEE 3,800 0 3,800 0 3,800
)5
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 386,550 0 386,550 0 386,550
5, OTHER CASH CONTRIBUTIONS - STATE
010304 STATIONARY POLLUTANT STORAGE TANKS 111,344 0 111,344 0 111,344
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT -108 0 -108 0 -108
OTHER CASH CONTRIBUTIONS TOTAL 111,236 0 111,236 0 111,236
6, MEDICAID-STATE/COUNTY
001056 MEDlCAlD PHARMACY 0 0 0 0 0
001076 MEDlCAlD TB 0 0 0 0 0
001078 MEDlCAlD ADMINISTRATION OF VACCINE 0 0 0 0 0
001079 MEDlCAlD CASE MANAGEMENT 0 0 0 0 0
001080 MEDlCAlD OTHER 32,703 46,597 79,300 0 79,300
001081 MEDlCAlD CHILD HEALTH CHECK UP 0 0 0 0 0
001082 MEDICAID DENTAL 0 0 0 0 0
001083 MEDlCAlD l' AMIL Y PLANNING 1,680 15,120 16,800 0 16,800
001087 MEDlCAlD STD 0 0 0 0 0
001089 MEDlCAlD AlDS 0 0 0 0 0
001147 MEDICAID HMO RATE 0 0 0 0 0
001191 MEDlCAlD MATERNITY 0 0 0 0 0
001192 MEDlCAlD COMPREHENSIVE CHILD 0 0 0 0 0
001193 MEDlCAlD COMPREHENSIVE ADULT 0 0 0 0 0
001194 MEDICAID LABORATORY 0 0 0 0 0
001208 MEDII' ASS $3.00 ADM. FEE 2,075 2,075 4,150 0 4,150
MEDICAID TOTAL 36,458 63,792 100,250 0 100,250
7. ALLOCABLE REVENUE- STATE
018000 REFUNDS 0 0 0 0 0
037000 PRIOR YEAR WARRANT 0 0 0 0 0
038000 12 MONTH OLD WARRANT 0 0 0 0 0
ALLOCABLE REVENUE TOTAL 0 0 0 0 0
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
PHARMACY SERVICES 0 0 0 74,224 74,224
LABORATORY SERVICES 0 0 0 84,563 84,563
TB SERVICES 0 0 0 0 0
IMMUNIZATION SERVICES 0 0 0 306,210 306,210
STD SERVICES 0 0 0 0 0
CONSTRUCT10N/RENOV A TlON 0 0 0 0 0
WIC FOOD 0 0 0 815.959 815,959
ADAP 0 0 0 0 0
DENTAL SERVICES 0 0 0 0 0
OTHER (SPECIFY) 0 0 0 0 0
OTHER (SPECIFY) 0 0 0 0 0
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 1,280,956 1,280,956
9. DIRECT COUNTY CONTRIBUTIONS - COUNTY
008030 Bee Contribution from Health Care Tax 0 612,864 612.864 0 612,864
/6
9. DIRECT COUNTY CONTRIBUTIONS - COUNTY
008034 Bee Contribution from General Fund 0 0 0 0 0
DIRECT COUNTY CONTRIBUTION TOTAL 0 612,864 612,864 0 612,864
10, FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001060 VITAL STATISTICS FEES OTHER 0 845 845 0 845
001077 RABIES VACCINE 0 0 0 0 0
001077 CHILD CAR SEAT PROG 0 0 0 0 0
001077 PERSONAL HEALTH FEES 0 117,000 117,000 0 117,000
001077 AIDS CO-PAYS 0 9,200 9,200 0 9,200
001094 LOCAL ORDINANCE FEES 0 0 0 0 0
001094 ADULT ENTER PERMIT FEES 0 0 0 0 0
001114 NEW BIRTH CERTIFICATES 0 13,400 13,400 0 13,400
001115 DEATH CERTIFICATES 0 55,200 55,200 0 55,200
001117 VITAL ST A TS-ADM. FEE 50 CENTS 0 550 550 0 550
FEES AUTHORIZED BY COUNTY TOTAL 0 196,195 196,195 0 196,195
I I. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001009 RETURNED CHECK ITEM 0 0 0 0 0
001029 THIRD PARTY REIMBURSEMENT 0 0 0 0 0
001029 HEALTH MAINTENANCE ORGAN. (HMO) 0 0 0 0 0
001054 MEDICARE PAIn D 0 0 0 0 0
001077 RYAN WHITE TITLE II 0 0 0 0 0
001090 MEDICARE PAIn B 0 27,500 27,500 0 27,500
001190 Health Maintenance Organization 0 0 0 0 0
005040 INTEREST EARNED 0 9,000 9,000 0 9,000
005041 INTEREST EARNED-STATE INVESTMENT ACCOUNT 0 0 0 0 0
007010 U.S. GRANTS DIRECT 0 475,000 475,000 0 475,000
008010 Contribution from City Government 0 0 0 0 0
008020 Contribution from Health Care Tax not thru Bee 0 0 0 0 0
008050 School Board Contribution 0 0 0 0 0
010300 SALE OF GOODS AND SERVICES TO STATE AGENCIES 0 0 0 0 0
010301 EXP WITNESS FEE CONSUL TNT CHARGES 0 0 0 0 0
010405 SALE OF PHARMACEUTICALS 0 0 0 0 0
010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 0 0 0 0
011000 COUNTY - SQWG 0 82,337 82,337 0 82,337
011000 GRANT -DIRECT 0 0 0 0 0
011000 GRANT-DIRECT 0 0 0 0 0
011000 GRANT-DIRECT 0 0 0 0 0
011000 GRANT-DIRECT 0 0 0 0 0
011000 GRANT -DIRECT 0 0 0 0 0
011000 GRANT-DIRECT 0 0 0 0 0
011000 GRANT-DIRECT 0 0 0 0 0
011001 HEALTHY START COALITION CONTRIBUTIONS 0 360,000 360,000 0 360,000
011007 CASH DONATIONS PRIVATE 0 0 0 0 0
012020 FINES AND FORFEITURES 0 0 0 0 0
012021 RETURN CHECK CHARGE 0 0 0 0 0
028020 INSURANCE RECOVERIES-OTHER 0 0 0 0 0
17
il. OTHER CASH AND LOCAL CONTRiBUTIONS - COUNTY
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 43 43 0 43
008060 Special Project Contribution 0 0 0 0 0
OTHER CASH AND LOCAL CONTRiBUTIONS TOT AI. 0 953,880 953,880 0 953,880
12, ALLOCABLE REVENUE - COUNTY
018000 REFUNDS 0 0 0 0 0
037000 PRIOR YEAR WARRANT 0 0 0 0 0
038000 12 MONTH OLD WARRANT 0 0 0 0 0
COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0
i3, BUILDINGS - COUNTY
ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 446,000 446,000
BUILDING MAINTENANCE 0 0 0 45,560 45,560
INSURANCE 0 0 0 0 0
UTILITIES 0 0 0 55,749 55,749
GROUNDS MAINTENANCE 0 0 0 0 0
OTHER (SPECIFY) 0 0 0 0 0
OTHER (SPECIFY) 0 0 0 0 0
BUILDINGS TOTAL 0 0 0 547,309 547,309
i4, OTHER COUNTY CONTRiBUTIONS NOT iN CHD TRUST FUND - COUNTY
EQUIPMENTIVEHICLE PURCHASES 0 0 0 0 0
VEHICLE INSURANCE 0 0 0 0 0
VEHICLE MAIKTENANCE 0 0 0 0 0
OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRiBUTIONS TOTAL 0 0 0 0 0
GRAND TOTAL CHD PROGRAM 4,723,001 1,826,731 6,549,732 1,828,265 8,377,997
18
A, COMMUNICABLE DISEASE CONTROL:
VITAL STATISTICS (180) 1.20 0 0 19,431 22,669 19,431 22,669 60,717 23,483 84,200
IMMUNIZATION (101) 4.00 3,700 11,000 86,887 98,353 86,887 98,353 267,153 103,327 370,480
STD (102) 1.70 200 1,200 30,118 35,138 30,118 35,138 94,113 36,399 130,512
AID.S. (103) 24.25 420 16,000 476,054 555,396 476,054 555,396 1,487,557 575,343 2,062,900
TB CONTROL SERVICES (104) 1.10 200 920 20,403 23,803 20,403 23,803 63,754 24,658 88,412
COMM. DISEASE SURV. (106) 0.50 0 1,100 12,630 14,736 12,630 14,736 39,466 15,266 54,732
HEPATITIS PREVENTION (109) 1.70 480 1,500 29,146 34,004 29,146 34,004 91,075 35,225 126,300
PUBLIC HEALTH PREP AND RESP (116) 2.30 0 0 48,577 56,673 48,577 56,673 151,792 58,708 210,500
COMMUNICABLE DISEASE SUBTOTAL 36.75 5,000 31,720 723,246 840,772 723,246 840,772 2,255,627 872,409 3,128,036
B, PRIMARY CARE:
CHRONIC DISEASE SERVICES (210) 0.00 0 0 583 681 583 681 1,821 707 2,528
TOBACCO PREVENTION (212) 1.20 0 0 24,289 28,337 24,289 28,337 75,896 29,356 105,252
HOME HEALTH (215) 0.00 0 0 0 0 0 0 0 0 0
W.re. (221) 5.40 1,750 1,400 89,382 104,278 89,382 104,278 279,296 108,024 387,320
FAMILY PLANNING (223) 3.80 960 4,000 102,983 120,147 102,983 120,147 321,798 124,462 446,260
IMPROVED PREGNANCY OUTCOME (225) 0.00 0 0 146 170 146 170 455 177 632
HEALTHY START PRENATAL (227) 3.90 440 11,000 76,363 89,091 76,363 89,091 238,618 92,290 330,908
COMPREHENSIVE CHILD HEALTH (229) 0.30 75 200 11,367 13,261 11,367 13,261 35,519 13,737 49,256
HEALTHY START INFANT (231) 270 300 7,500 48,966 57,126 48,966 57,126 153,006 59,178 212,184
SCHOOL HEALTH (234) 5.00 0 64,000 58,292 68,008 58,292 68,008 182,150 70,450 252,600
COMPREHENSIVE ADULT HEALTH (237) 2.30 1,000 3,600 64,607 75,375 64,607 75,375 201,883 78,081 279,964
DENTAL HEALTH (240) 0.00 0 0 292 340 292 340 911 353 1,264
Healthy Start lnterconception Woman (232) 0.00 0 0 0 0 0 0 0 0 0
PRIMARY CARE SUBTOTAL 24.60 4,525 91,700 477,270 556,814 477,270 556,814 1,491,353 576,815 2,068,168
C, ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COASTAL BEACH MONITORING (347) 0.50 800 860 19,431 22,669 19,431 22,669 60,717 23,483 84,200
LIMITED USE PUBLIC WATER SYSTEMS (357) 0.00 0 0 0 0 0 0 0 0 0
PUBLIC WATER SYSTEM (358) 0.00 0 0 0 0 0 0 0 0 0
PRIVATE WATER SYSTEM (359) 0.00 0 0 0 0 0 0 0 0 0
INDIVIDUAL SEWAGE DlSP. (361) 12.20 4,000 11,600 194,308 226,692 194,308 226,692 607,166 234,834 842,000
Group Total 12.70 4,800 12,460 213,739 249,361 213,739 249,361 667,883 258,317 926,200
Facility Programs
FOOD HYGIENE (348) 0.50 60 240 7,772 9,068 7,772 9,068 24,287 9,393 33,680
BODY ART (349) 0.00 6 8 292 340 292 340 911 353 1,264
GROUP CARE FACILITY (351) 0.25 140 200 2,915 3,401 2,915 3,401 9,107 3,525 12,632
MIGRANT LABOR CAMP (352) 0.00 0 0 0 0 0 0 0 0 0
HOUSING,PUBLlC BLDG SAFETY,SANITATI0N (358)00 0 0 0 0 0 0 0 0 0
MOBILE HOME AND PARKS SERVICES (354) 0.00 100 280 7,772 9,068 7,772 9,068 24,287 9,393 33,680
SWIMMING POOLS/BA THING (360) 1.50 750 1,600 19,916 23,236 19,916 23,236 62,235 24,069 86,304
BIOMEDICAL WASTE SERVICES (364) 010 30 32 8,744 10,202 8,744 10,202 27,322 10,570 37,892
/9
C. ENVIRONMENTAL HEALTH:
Facility Programs
TANNING FACILITY SERVICES (369) 0.00 0 0 0 0 0 0 0 0 0
Group Total 2.35 1.086 2,360 47,411 55,315 47,411 55,315 148,149 57,303 205,452
Groundwater Contamination
STORAGE TANK COMPLIANCE (355) 2.60 480 800 45,663 53,273 45,663 53.273 142.684 55,188 197,872
SUPER ACT SERVICE (356) 0.00 0 35 389 453 389 453 1,214 470 1,684
Group Total 2.60 480 835 46,052 53,726 46,052 53.726 143,898 55,658 199,556
Community Hygiene
RADIOLOGICAL HEALTH (372) 0.00 0 0 0 0 0 0 0 0 0
TOXIC SUBSTANCES (373) 0.10 110 105 2,429 2.833 2,429 2,833 7,590 2,934 10,524
OCCUPATIONAL HEALTH (344) 0.10 0 0 680 794 680 794 2,125 823 2,948
CONSUMER PRODUCT SAFETY (345) 0.00 0 0 49 57 49 57 152 60 212
INJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0
LEAD MONITORING SERVICES (350) 0.00 0 0 0 0 0 0 0 0 0
PUBLIC SEWAGE (362) 0.00 0 0 292 340 292 340 911 353 1,264
SOLID WASTE DISPOSAL (363) 0.00 0 0 0 0 0 0 0 0 0
SANITARY NUISANCE (365) 0.10 36 125 1,361 1,587 1,361 1.587 4,250 1,646 5,896
RABIES SURVEILLANCE/CONTROL SERVICES (36<11)00 I 12 195 227 195 227 607 237 844
ARBOVIRUS SURVEILLANCE (367) 0.00 0 0 0 0 0 0 0 0 0
RODENT/ARTHROPOD CONTROL (368) 0.00 0 0 49 57 49 57 152 60 212
WATER POLLUTION (370) 0.00 0 0 0 0 0 0 0 0 0
AIR POLLUTION (371) 0.00 0 1 97 113 97 113 304 116 420
Group Total 0.30 147 243 5,152 6,008 5,152 6,008 16,091 6,229 22,320
ENVIRONMENTAL HEALTH SUBTOTAL 17.95 6.513 15,898 312,354 364,410 312,354 364,410 976,021 377,507 1,353,528
D. SPECIAL CONTRACTS:
SPECIAL CONTRACTS (599;' 0.00 0 0 0 0 0 0 0 0 0
SPECIAL CONTRACTS SUBTOTAL 0.00 0 0 0 0 0 0 0 0 0
TOTAL CONTRACT 79.30 16,038 139,318 1,512,870 1,761,996 1,512,870 1,761,9964,723,001 1,826,731 6,549,732
~o
ATTACHMENT III
MONROE COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contraGt period), if so requested by the department.
The applicant assures that it will comply with:
1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance.
3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance.
4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees
for the period during which such assistance is provided. The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in violation of the above statutes, regulations, guidelines, and
standards. In the event of failure to comply, the applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, to include assistance being terminated and further assistance
being denied.
21
ATTACHMENT IV
FACILITIES UTILIZED BY THE MONROE COUNTY HEALTH DEPARTMENT
Facility
Description
Location
Owned Bv
Gato Building
Administration
Nursing
Environmental Health
1100 Simonton Street
Key West, FL 33040
County
Health Care Center
1200 Kennedy Drive
Key West, FL 33040
Lower Keys Medical
Roosevelt Sands Center
105 Olivia Street
Key West, FL 33040
City of Key West
Ruth Ivins Center
For Public Health
3333 Overseas Hwy.
Marathon, FL 33050
County
Environmental H€ialth
13367 Overseas Hwy.
Marathon, FL 33050
Alan Schmitt
Roth Building
Public Health Unill
Environmental H€ialth
50 High Point Road
Tavernier, FL 33070
County
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ATTACHMENT V
MONROE COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT.
CONTRACT YEAF~ STATE COUNTY TOTAL
2004-2005 $ $ $
2005-2006 $ $ $
2006-2007 $ $ $
2007-2008 $ $ $
2008-2009 $ $ $
PROJECT TOTAL $ $ $
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NAME:
LOCATION/ ADDRESS:
PROJECT TYPE:
NEW BUILDING
RENOVATION
NEW ADDITION
ROOFING
PLANNING STUDY
OTHER
SQUARE FOOTAGE:
PROJECT SUMMARY: Describe scope of work in reasonable detail.
ESTIMATED PROJECT INFORMATION:
ST ART DATE (initial expenditure of funds) :
COMPLETION DATE:
DESIGN FEES: $
CONSTRUCTION COSTS: $
FURNITURE/EQUIPMENT $
TOTAL PROJECT COST: $
COST PER SQ FOOT: $
Special Capital Projllcts are new contruction or renovation projects and new furniture or equipment
associated with the!~e projects and mobile health vans.
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ATTACHMENT VI
MONROE COUNTY HEALTH DEPARTMENT
PRIMARY CARE
"Primary Care" as conceptualized for the county health departments and for the use of categorical
Primary Care funds (revenue object code 015040) is defined as:
"Health care selvices for the prevention or treatment of acute or chronic medical conditions or minor
injuries of individuals which is provided in a clinic setting and may include family planning and
maternity care."
Indicate below the county health department programs that will be supported at least in part with
categorical Primary Care funds this contract year:
_x_
_X_
Comprehensive Child Health (229/29)
Comprehensive Adult Health (237/37)
Family Planning (223/23)
MatHrnal Health/IPO (225/25)
Laboratory (242/42)
Pharmacy (241/93)
OthHr Medical Treatment Program (please identify)
Describe the target population to be served with categorical Primary Care funds.
The primary p,opulation served is under and non-insured.
Does the health department intend to contract with other providers for the delivery of primary health
care services using categorical (015040) Primary Care funds? If so, please identify the provider(s),
describe the se,rvices to be delivered, and list the anticipated contractual amount by provider. In
addition, contract providers are required to provide data on patients served and the services provided
so that the patients may be registered and the service data entered into HCMS.
The Monroe County Health Department contracts with WomanKind Inc. to provide Family
Planning Services to women whose income level is up to 179% of federal poverty guidelines
and who are not recipients of Medicaid insurance or other health insurance and to persons
under the age of nineteen (19) or still enrolled in high school at no out of pocket or sliding fee
payment. Contract amount is $82,000.
Medical records shall comply with Chapter 154, Florida Statutes and the provider shall
maintain a rec:ord of eligibility determination.
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