FY2000 11/09/1999
1!lannp lL. 1So1bagt
BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
FAX (305) 289-1745
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
FAX (305) 295-3660
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 852-7146
M~MQ.RAHQYM
TO:
stephanie Walters, Administrator
Monroe County Public Health Unit
Isabel C. DeSantis, Deputy Clerk J. eJ):
November 17, 1999
FROM:
DATE:
At the November 9, 1999 meeting, the Board of County
Commissioners granted approval and authorized execution of the
Monroe County Health Department Core Contract for contract year
1999-2000.
Enclosed please find three (3) duplicate originals executed by
Monroe County for your follow-through with Secretary Brooks.
Please be sure that a fUlly-executed original is returned to this
office as quickly as possible.
Should you have any questions concerning the above, please do not
hesitate to contact this office.
cc: Finance
County Administrator, w/o doc.
County Attorney
.;File
..
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(1 /~r*~ or(J/n --a /
CONTRACT BETWEEN
OUNTY BOARD OF COUNTY ~~!$~I9:NERS
AND "J ,-n/:29
'1 \~(fisTATE OF FLORIDA DEPARTMEN';t'iOF,IHEALTH
~t.C \) . FOR OPERATION OF' L. -. iI.~i (,
\ y<~~\~OE COUNTY HEALTH DEPARTMENT
..,~\~;(),:'i ~c,~ \l\~\l"";; CONTRACT YEAR 1999 - 2000
f'\~1(~"" \ c~O\;\
V" ,\ ~~..l
I~'$i0\'J'agreement ("Agreem~nt") is made and entered into
B~tween the State of Florlda, Department of Health ("State")
and the Monroe County Board of County Commi~i~eA8
("County'), through their undersigned authorities, e~e~i~
October 1, 1999. ~p~ ~
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A. Pursuant to Chapter 154, F. S., the intent ~~h~.
legislature is to "promote, protect, maintain, and 1JnP~v~.
the health and safety of all citizens and visitors ~ ~iC)
state through a system of coordinated county health
department services."
. !
RECITALS
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.
reci tals are
reference.
The parties mutually agree that the forgoing
true and correct and incorporated herein by
2. TERM. The parties mutually agree that this Agreement
shall be effective from October 1, 1999, through September
30, 2000, 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.
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3. SERVICES 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 supported by
available federal, state, and local funds and shall include
those services mandated on a state or federal level. Such
services include, but are not limited to, epidemiology,
sexually transmissible disease detection and control,
HIV/AIDS, immunization, tuberculosis control and maintenance
of vital statistics.
c. "Primary care services" are acute care and preventive
services that are made available to well and sick persons
who are unable to obtain such services due to lack of income
or other barriers beyond their control. These services are
provided to benefit individuals, improve the collective
health of the public, and prevent and control the spread of
disease. Primary health care services are provided at home,
in group settings, or in clinics. These services shall be
supported by available federal, state, and local funds and
shall include services mandated on a state or federal level.
Examples of primary health care services include, but are
not limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health
services; family planning; nutrition; school health;
supplemental food assistance for women's, infants, and
children; home health; and dental services.
2
4. FUNDING. The parties further agree that funding for
the County Health Department will be handled as follows:
a. The funding to
other sources are set
hereof. This funding
Attachment II.
be provided by the parties and any
forth in Part II of Attachment II
will be used as shown in Part I of
i. The State's appropriated responsibility as provided in
Attachment II, Part II is an amount not to exceed
$4,464,555. The State I s obligation to pay under this
contract is contingent upon an annual appropriation by
the Legislature.
ii. The County's appropriated
provided in Attachment II, Part II
exceed $590,445.
responsibility
is an amount not
as
to
b. Overall expenditures will not exceed available
funding (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.
c. Either party may establish service fees as allowed by
law to fund activities of the CHD. The amount and purpose
of such fees are listed in Attachments IV and V of this
Agreement. Where applicable, such fees shall be
automatically adjusted to at least the Medicaid fee
schedule.
3
d. Either party may increase or decrease funding of this
Agreement during the term hereof. If the State initiates
the increase/decrease, then the CHD will amend the core
contract and send a copy of the revised contract pages to
the County and the Department of Health, Office of
Management and Budget within 30 days of the executed
amendment to the core contract. If the County initiates the
increase/decrease, then the County shall notify the CHD.
The CHD will then amend the core contract and send a copy of
the revised pages to the Department of Health, Office of
Management and Budget within 30 days of the executed
amendment to the core contract.
e. The name and address of the official payee to who
payments shall be made is:
County Health Department Trust Fund
Monroe County
P.O. Box 6193
Key West, FL 330401-6193
5. CHD DIRECTOR. Both parties agree the director 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 shall be selected
by the State with the concurrence of the County. The
director of the CHD shall insure that noncategorical sources
of funding are used to fulfill public health priorities in
the community and the State Strategic Plan. A report
detailing the status of public health as measured by outcome
measures and similar indicators will be sent by the CHD
director to the parties no later than October 1 of each
year.
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties
hereto agree that the following standards should apply in
the operation of the CHD:
a. The CHD and its personnel shall follow all State
policies and procedures, except to the extent permitted for
the use of county purchasing procedures as set forth in
subparagraph b., below. All CHD employees shall be State or
State-contract personnel subject to State personnel rules
and procedures. Employees will report time in the Client
Information System/Health Management Component 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
4
purchasing procedures shall be allowed when it will result
in a better price or service and no statewide Department of
Heal th purchasing contract has been implemented for those
goods or services. In such cases, the CHD director must
sign a justification therefor, and all county purchasing
procedures must be followed in their entirety, and such
compliance shall be documented. Such justification and
compliance documentation shall be maintained by the CHD in
accordance with the terms of this Agreement. State
procedures must be followed for all leases on facilities not
enumerated in Attachment VI.
c. The CHD shall maintain books, records and documents in
accordance with those promulgated by the Generally
Recognized Governmental Accounting Procedures and
Governmental Accounting Standards Board, and the
requirements of federal or state law. These records shall
be maintained as required by HRSM 15-1 "Records Management
Manual" 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
subparagraph 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).
ll. The client
requirements of the
most current version
Management Component
registration
minimum data
of the Client
Pamphlet;
and services reporting
set as specified in the
Information System/Health
iii. Financial procedures specified in the Department's
Accounting Procedures Manuals, Accounting memoranda, and
Comptrollers 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
5
for public health purposes in Monroe County. The Monroe
County Health Department Trust Fund shall maintain an
average trust fund balance of no less than 8% of its annual
operating budget.
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. Expendi tures will be charged to the
program accounts by state and county based on the ratio of
planned expenditures in the core contract, then 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 and shall be
accounted for in a manner which clearly illustrates the
amount which has been credited to each participating
governmental entity. The planned use of surplus funds shall
be reflected in Attachment II, Part I of this contract, with
special projects explained in Attachment VII.
f. There shall be no transfer of funds between the three
levels of services without a contract amendment duly signed
by both parties to this contract and the proper budget
amendments unless the CHD director/administrator determines
that an emergency exists wherein a time delay would endanger
the public's health and the Deputy Secretary for Health has
approved the transfer. The Deputy Secretary for Health
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 contract. Any such subcontract shall include all
aforementioned audit and recordkeeping requirements.
h. At the request of either party, an audit may be
conducted by an independent CPA on the financial records of
the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year. This audit
will follow requirements contained in OMB manual A-133 and
may be in conjunction with audits performed by county
government. If audit exceptions are found, then the
director of the CHD will prepare a corrective action plan
6
, .
and a copy of that plan and monthly status reports will be
furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any
concerning a recipient of services except as
Federal or state law or policy.
information
allowed by
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. I f 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 excepted 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 455.667, Florida Statutes, and all other state
and federal laws regarding confidentiality. All
confidentiality procedures implemented by the CHD shall be
consistent with the Department of Health Information
Security Policies, Protocols, and Procedures, dated
September 1997, 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.
1. The CHD shall abide by all
procedures, which by this reference are
as standards to be followed by the CHD,
permitted for some purchases using
pursuant to paragraph 6.b. hereof.
State policies and
incorporated herein
except as otherwise
county procedures
m. The CHD shall establish a system through which
applicants for services and current clients may present
grievances over denial, modification or termination of
services. The CHD will advise applicants of the right to
appeal a denial or exclusion from services, of failure to
take account of a client's choice of service, and of his/her
right to a fair hearing to the final governing authority of
the agency. Specific references to existing laws, rules or
program manuals are included in Attachment I of this
conract.
7
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 DE385Ll Contract Management Variance Report
and the DE580Ll Analysis of Fund Equities Report;
ii. A written explanation to the county and department
of service variances reflected in the DE385Ll report
if the variance exceeds or falls below 25 percent of
the planned expenditure amount. However, if the
cumulative amount of the variance between actual and
planned expenditures does not exceed one percent of
the cumulative expenditures for the level of service
in which the type of service is included, a variance
explanation is not required;
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, 2000 for the report period October 1,1999
through December 31, 1999;
ii. June 1, 2000 for the report period October 1,1999
through March 31, 2000;
iii. September 1, 2000 for the report period October 1,
1999 through June 30, 2000; and
iv. December 1, 2000 for the report period October
1,1999 through September 30, 2000.
7. FACILITIES AND EQUIPMENT.
that:
The parties mutually agree
a. CHD facilities shall be provided as specified in
Attachment VI to this contract and the county shall own the
facili ties used by the CHD unless otherwise provided in
Attachment VI.
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.
8
, '
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 CHD trust fund shall be sold at fair market value when
they are no longer needed by the CHD and the proceeds
returned to the CHD trust fund.
9
8. TERMINATION.
a. Termination at Will. This Agreement may be terminated
by either party without cause upon no less than one-hundred
eighty (180) calendar days notice in writing to the other
party unless a lesser time is mutually agreed upon in
writing by both parties. Said notice shall be delivered by
certified mail, return receipt requested, or in person to
the other party's contract manager with proof of delivery.
b. Termination Because of Lack of Funds. In the event
funds to finance this Agreement become unavailable, the
State may terminate this Agreement upon no less than twenty-
four (24) hours notice. Said notice shall be delivered by
certified mail, return receipt requested, or in person to
the other party's contract manager with proof of delivery.
c. Termination for Breach. This Agreement may be
terminated by one party, upon no less than thirty (30) days
notice, because of the other party's failure to perform an
obligation hereunder. Said notice shall be delivered by
certified mail, return receipt requested, or in person to
the other party's contract manager with proof of delivery.
Waiver of breach of any provisions of this Agreement shall
not be deemed to be a waiver of any other breach and shall
not be construed to be a modification of the terms of this
Agreement.
MISCELLANEOUS. The parties further agree:
a. Availabili ty of Funds. If this Agreement, any
renewal hereof, or any term, performance or payment
hereunder, extends beyond the fiscal year beginning July 1,
1999, 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. Modification. This Agreement and its Attachments
contain all of the terms and conditions agreed upon between
the parties. Modifications of this Agreement shall be
enforceable only when reduced to writing and signed by all
parties.
c. Contract Managers. The name and address of
the contract managers for the parties under this
Agreement are as follows:
10
. '
For the State:
For the County:
Diana M. Mellon-Lacey
Name
James Roberts
Name
Senior Management
Analyst Supervisor
Title
County Administrator
Title
P.O. Box 6193
5100 College Road
Key West, FL 33041-6193
Address
Key West, FL 33040
Address
305-293-7533
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.
d. 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.
11
ENTERED INTO AND AGREED between the parties hereto by
the undersigned authorities, effective the 1st day of
October, 1999.
BOARD OF COUNTY COMMISSIONERS
STATE OF FLORIDA
::::N::~ ~OU:~~~v-F~~. :E::~Ty~~ G:
V Robert G. Brooks, MD
Secretary
NAME: Sft.,'r Ive Fre..e...ma..n
--
TITLE: In Q.. ....'0 r
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li41~
/1- 9- 99
DATE:
DATE:
ATTESTED TO:
SIGNED BY: .::5". W'~tp
CHD Director/Administrator
SIGNED BY:
NAME:
NAME: Stephanie A. Walters
TITLE:
TITLE:County Health Department
Administrator
DATE:
'0Z/99
I
12
ATTACHMENT I
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 CIS/HMC minimum data set and the SAMAS 2.2
requirements because of federal or state law, regulation or rule. If a
county health department is funded to provide one of these services, it
must comply with the special reporting requirements for that service. The
services and the reporting requirements are listed below:
Service
Requirement
1.
Sexually Transmitted Disease
Program
Requirements as specified
in HRSM 150-22*. Requirements
as specified in Policy 87-7-5
regarding State Health Office
STD Program review and approval
of personnel/budget actions.
2.
Dental Health
Monthly reporting on HRSH
Form 1008*.
3.
Special Supplemental Food
Program for Women, Infants
and Children.
Service documentation and
monthly financial reports
as specified in HRSM 150-24*
and all federal, state and county
requirements detailed in the
program manuals and published
procedures.
4.
Improved Pregnancy Outcome
Requirements as specified in
HRSM 150-13A*. Quarterly reports
of services and outcome on HRSH
Form 3096*. Program Quarterly
Progress Report, Quarterly Summary
Report, Presumptive Eligibility/
Medicaid Determination Log by all
providers authorized to determine
presumptive eligibility.
5.
Family Planning
periodic financial and programmatic
reports as specified in HRSM
150.27*.
. .
ATTACHMENT I (Continued)
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.
7. CHD Program
Requirements as specified in HRSM
150-3* and HRSM 50-9*.
8. Chronic Disease Program
Requirements as specified in the
Reference Guide to CHIP and HRS*
forms identified in HRSM 150-8* and
150-12*.
9. Environmental Health
Requirements as specified in HRSM
50-10*.
10. AIDS Program
Requirements in HRSM 150-30* and
case reporting on CDC Form 50.42.
Socio-demographic data on persons
tested for HIV in CHD clinics
should be reported on CDC HIV
Counseling & Testing Report Form.
These reports are to be sent to the
Headquarters AIDS office within 30
days of the initial post-test
appointment regardless of clients'
return.
11. 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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ATTACHMENT II
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
STATE
1. GENERAL REVENUE
015050 ALG/Contributions To CHD (050329) 1,154,035 0 1,154,035
015050 ALG/Contr. To CHDs-.5% Holdback (050329) 0 0 0
015011 ALG/Cont to CHD Primary Care (050329) 17,256 0 17,256
015065 ALG/Cont to CHD AIDS Prev & Surv(050329) 105,802 0 105,802
015050 ALG/Cont to CHD Mig Lbr Camp San(050329) 0 0 0
015050 ALG/Cont to CHD Home Hlth Pilot Proj (050329) 0 0 0
015050 Sovereign Immunity (050329) 0 0 0
015050 ALG/Cont to CHDs Pinellas Indigent Dent! Clinic-UF (050329) 0 0 0
015050 ALG/Cont to CHDs-Dental Praogram (Cat. 050329) 40,000 0 40,000
015050 ALG/Cont to CHD Immun Outreach (050329) 20,848 0 20,848
015050 ALG/Cont to CHD Comm TB Program (050329) 125,805 0 125,805
015050 ALG/Cont to CHD Indoor Air Assist(050329) 0 0 0
015050 ALG/Cont to CHD Fam Trans PRG (050329) 0 0 0
015050 ALG/Pa1m Beach CHD-Health Program Office Staff (050329) 0 0 0
015050 ALG/Cesspool Identification and Elimination (Cat. 050329) 128,707 0 128,707
015048 ALG/Cont to CHD STD Program (050329) 21,016 0 21,016
015050 Improve Overall Health of Fla. Comm. St. Lucie (050329) 0 0 0
015037 ALG/Cont to CHDs Mtrnl & Chid Hlth Field Staff Cost(05 0 0 0
015050 Epidemiology Traning & Clinical Support (CAT. 050329) 0 0 0
015123 ALG/Family Planning (050001) 60,731 0 60,731
015123 ALG/Family Planning Planned Parenthood NE FL (CAT. 050001) 0 0 0
015123 ALG/Family Planning (CAT. 050001) - Alachua Colposcopy 0 0 0
015065 ALG/Cont to CHD AIDS Pat Care (050026) 384,663 0 384,663
015115 ALG/School Health Services (051106) 31,920 0 31,920
015140 ALG/School Health Suppl. (051106) 134,312 0 134,312
015124 ALGIIPO-Healthy StartlIPO (050707) 171,881 0 171,881
015124 ALGIIPO-Infant Mortality Project (CAT. 050707) 0 0 0
015124 ALGIIPO - Outreach Social Workers (CAT. 050707) 0 0 0
015137 ALGIIPO Healthy Start Resource Moms & Dads (050707) 0 0 0
015137 ALGIIPO Healthy Start Incr Maternal Health Care (050707) 0 0 0
015137 ALGIIPO-Healthy Start-Data Collect. Prj Staff (CAT. 050707) 0 0 0
015124 ALG/MCH-Healthy StartlIPO (050870) 11,891 0 11,891
015124 ALGIIPO Outreach Social Workers (CAT 050870) 0 0 0
015124 ALG/MCH-Infant Mortality Project (CAT. 050870) 0 0 0
015123 Planned Parent Hood - Collier and Sarasota (CAT. 050329) 0 0 0
015029 AIDS/Drugs Reimb. One Time Transfer (CAT 180000/FG TF) 0 0 0
015115 G/A Eye Exams NASA -School Health Occular Scrn. (050063) 0 0 0
015012 G/A Epilepsy Services (050082) 0 0 0
015011 ALG/Primary Care (050331) 223,310 0 223,310
GENERAL REVENUE TOTAL 2,632,177 0 2,632,177
2. NON GENERAL REVENUE
015010 ALG/Contr. to CHDs-Rebasing (CAT. 050329) Tobacco TF 21,864 0 21,864
015072 ALG/Cont to CHD Safe Drinking Water-DEP 0 0 0
015026 ALG/Cont to CHD Bio-Medical Waste (DEP) 3,976 0 3,976
015170 Tobacco Coordination (CAT. 105014) Tobacco TF 48,122 0 48,122
015172 Full Service Schools - Tobacco (CAT 102258) Tobacco TF 74,050 0 74,050
015174 Basic School Health - Tobacco (CAT 051 ]06) Tobacco TF 8,919 0 8,919
015016 G/A Epilepsy Prev and Educ (CAT. 050083) /Epilepsy TF 0 0 0
015010 Food Hygiene Program 0 0 0
015010 Health Services in Model City-Dade County 0 0 0
015084 Varicella Immunization Requirement (CAT 050329) Tobacco TF 3,582 0 3,582
015010 SUPER Act Program (CAT. 050329) Adm TF 0 0 0
015020 Food and Waterborne Disease Program (CAT. 050329) Adm TF 0 0 0
015010 Hlth Svcs for E1derly-Medivan Proj-Broward (050329) Tob. TF 0 0 0
ATT ACHMENT II
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
STATE
2. NON GENERAL REVENUE
015010 Pasco CHD Dental Program (CAT 050329) Tobacco TF 0 0 0
015010 Breast & Cerv. Cancer-Prtshp Prj- HiIlsbor.(052250) Tob.TF 0 0 0
015010 Dunbar Center - Lee County - Lee CHD (CAT 052250) Tob. TF 0 0 0
015010 Prim Care Outrch-Pnllas/Suncst.Cm Hsp Res.Pro(052250)Tob TF 0 0 0
015010 Prj SOAR-Hlthy Mthrs/Hlthy Babies-Plm Bch CHD(052250)Tob TF 0 0 0
015010 Leon County Mobile Health Unit (CAT 052250) Tobacco TF 0 0 0
015010 Telemed Pilot-Plm Bch Cty - Palm Bch CHD (052250) Tob TF 0 0 0
015029 Radiation ProtectionTF/X-Ray Inspection (CAT. 180000) 0 0 0
015029 Radiation Prot. TFIRad Lic Fee Transfer (CAT. 180000) 0 0 0
011 055 Other Grants DOE 0 0 0
015113 SPL Program HRS Reimb 0 0 0
010304 Stationary Pollutant Storage-DEP 110,271 0 110,271
015020 Transfers Interagency 0 0 0
015121 Super Act Transfers 0 0 0
NON GENERAL REVENUE TOTAL 270,784 0 270,784
3. FEDERAL FUNDS
007051 FG TF WIC Admin Transfer (050329) 214,311 0 214,311
015075 FG TF Family Trans Program (050329) 47,500 0 47,500
007135 Abstinence Grant Education Program 0 0 0
007065 FG TF AIDS Prevention (050329) 150,566 0 150,566
007064 FG TF AIDS SurvlSerop (050329) 0 0 0
007066 FG TF Ryan White (050329) 410,780 0 410,780
007066 FG TF Ryan White- AIDS Drug Assist Program Admin. (050329) 19,902 0 19,902
007062 FG TFI AIDS Epid research Study (050329) 0 0 0
007049 Cont to CHDs - STD Chlamydia Study (CAT 050329) 0 0 0
007049 FG TF/ALG Contr to CHDs-STD Program (050329) 0 0 0
007067 FG TF/ALG/Contr to CHDs-Community TB (050329) 0 0 0
007084 Immunization Special Project 1,941 0 1,941
007084 FG TF/ALG/Contr to CHDs-Immunization Action Plan (050329) 9,461 0 9,461
007085 FG TFI Breast and Cervical Cancer Grant 0 0 0
007084 FG TFI ALG/Contr to CHDs-Project Field Staff (050329) 0 0 0
007084 ALG/Contr. to CHDs-Immun. Action Plan - WIC-Imm Linkages 0 0 0
007000 Brain Injury Prevention Program (CAT. 000700) 0 0 0
007133 Family Planning Title X (050001) 49,344 0 49,344
007133 Fam Planning Title X Spec Proj (050001) 0 0 0
007133 Family Planning Title X Sterilzations (50001) 2,289 0 2,289
015075 ALG/Family Planning - Pregnancy Prev - TANF (CAT 050001) 13,927 0 13,927
007127 MCH BLK Grt. Child Health (050870) 11 ,446 0 11 ,446
007127 MCH BLK Grt. Child H1th (Ages 0-1 YR),(050870) 2,753 0 2,753
007134 ALG/MCH-MCHBG Hlthy StartJIPO (050870) 29,400 0 29,400
007134 ALG/MCH-MCHBG Outr. Soc Workers (050870) 0 0 0
007134 MCH BLK Grt.-IPO Infant Mort. Proj. (050870) 0 0 0
007132 MCH BLK Grt. Dental Projects (050870) 0 0 0
007134 ALG/IPO/MCH-Infant Mortality Project (CAT. 050707) 0 0 0
007134 ALG/IPO/MCH Outr Social Workers (050707) 0 0 0
007134 ALG/IPO-MCH Blk. Grt.-IPO (CAT. 050707)-Gadsden Sch Clinic 0 0 0
007134 ALG/IPO-MCHBG Hlthy StartJIPO (050707) 37,189 0 37,189
007058 FG TF/Diabetes Control 0 0 0
007071 FG TF EPI Res Stud. of AIDS/HIV (180000) 0 0 0
007063 PHBG HERR Chronic Dis Init (101505) 0 0 0
007133 Planned Parenthood 0 0 0
007030 PREY HLTH BLK GRT-Migrant Labor (180000) 0 0 0
007000 Phiesteria Related Illness Surv & Prev (180000) 0 0 0
007056 FG TF Health Program for Refug. (180000) 0 0 0
ATTACHMENT II
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
STATE
3. FEDERAL FUNDS
007044 PREV HLTH BLK GRT-Rape Awareness(180000) 0 0 0
015075 Transfer-FED Grants other Agencies 0 0 0
015060 Entrant Reimb. Transfer 2,000 0 2,000
FEDERAL FUNDS TOTAL 1,002,809 0 1,002,809
4. FEES ASSESSED BY STATE OR FEDERAL RULES
001091 Communicable Disease Fees 2,000 0 2,000
001092 Environmental Health Fees 190,000 0 190,000
001113 Mobile Home and Parks 16,000 0 16,000
001132 Food Hygiene Permit 10,000 0 10,000
001133 OSDS Repair Permit 0 0 0
001134 OSDS Permit Fee 0 0 0
001211 Safe Drinking Water 0 0 0
001136 I & M Zoned Operating Permit 0 0 0
001137 Aerobic Operating Permit 0 0 0
001138 Septic Tank Site Evaluation 0 0 0
001139 Migrant Housing Permit 0 0 0
001140 Biohazard Waste Permit 3,100 0 3,100
001141 Non-SDW A System Permit 0 0 0
001142 Non SDW A Lab Sample 100 0 100
001144 Tanning Facilities 1,100 0 1,100
001145 Swimming Pools 32,000 0 32,000
001164 Public Water Constr Permit 0 0 0
001165 Private Water Constr Permit 0 0 0
001166 Public Water Annual Oper Permit 0 0 0
001170 Lab Fee Chemical Analysis 0 0 0
001026 Returned Check Ser Fees 0 0 0
010403 Fees-Copy of Public Doc 0 0 0
015055 Registar Fees (Ch. 382.34) 0 0 0
001135 OSDS Variance Fee 200 0 200
015052 Transfers-Mobile Home/RV Park 0 0 0
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 254,500 0 254,500
5. OTHER CASH CONTRIBUTIONS
090001 Draw down from Public Health Unit -257,575 0 -257,575
OTHER CASH CONTRIBUTIONS TOTAL -257,575 0 -257,575
6. MEDICAID
001056 CHD Incm:Medicaid-Pharmacy 0 0 0
001080 CHD Incm:Medicaid-Other 0 0 0
001081 CHD Incm:Medicaid-EPSDT 500 0 500
001082 CHD Incm:Medicaid-Dental 0 0 0
001083 CHD Incm:Medicaid-FP 500 0 500
001084 CHD Incm:Medicaid-Physician 2,000 0 2,000
001085 CHD Incm:Medicaid-Nursing 0 0 0
001086 CHD Incm:Co-Insurance 0 0 0
001087 CHD Incm:Medicaid-STD 0 0 0
001088 CHD Incm:Med Reimb AZT Disp Fee 0 0 0
001089 Medicaid AIDS 30,000 0 30,000
001147 Medicaid HMO Rate 0 0 0
001148 Medicaid-HMO Admin 0 0 0
001181 CHD Incm:Medicaid Transportation 0 0 0
001190 Health Maintenance Organ. (HMO) 0 0 0
001191 CHD Incm:Medicaid Maternity 0 0 0
ATTACHMENT II
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
STATE
6. MEDICAID
001192 CHD Incm:Medicaid Compo Child 0 0 0
001193 CHD Incm:Medicaid Compo Adult 0 0 0
001194 CHD Incm:Medicaid Sonagram 0 0 0
001208 Medipass $3.00 Adm. Fee 2,900 0 2,900
MEDICAID TOTAL 35,900 0 35,900
7. ALLOCABLE REVENUE
011007 Cash Donations Private 0 0 0
001029 Third Party Reimbursement 0 0 0
010301 Exp Witness Fee Consultnt Charges 0 0 0
005040 Interest Erned State Investment 90,000 0 90,000
005041 Interest Erned Local Investment 0 0 0
007010 U.S. Grants Direct to CHD 428,000 0 428,000
008094 Grnts/Contracts other Agencies Direct 0 0 0
011098 Donation School Based Clinic 0 0 0
011099 Other Grants/Donations Direct 3,000 0 3,000
012020 Fines and Forfeitures 0 0 0
018001 Refunds, Salary 10 0 10
018003 Refunds, other Personal Services 0 0 0
018004 Refunds, Expenses 500 0 500
018006 Refunds, Operating Capital Outlay 0 0 0
018010 Refunds, Special Category 0 0 0
018011 Refunds, Other 0 0 0
018099 Refunds, Certified Forward 0 0 0
037000 Prior Year Warrant 75 0 75
038000 12 Month Old Warrant 1,500 0 1,500
010300 Sale of Goods and Services 2,000 0 2,000
010402 Recycle Paper Sales 0 0 0
010403 Fees-Copies of Documents 800 0 800
010405 Sale of pharmaceuticals 0 0 0
011055 Other Grant DOE 0 0 0
012021 Return Check Charge 75 0 75
018005 Refunds Grants to Local Gov't 0 0 0
029010 Sale of Fixed Assets 0 0 0
ALLOCABLE REVENUE TOTAL 525,960 0 525,960
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND
State Pharmacy Services 0 59,898 59,898
State Laboratory Services 0 88,098 88,098
State TB Services 0 0 0
State Immunization Services 0 51,307 51,307
State STD Services 0 0 0
State Construction/Renovation 0 0 0
WIC Food 0 707,041 707,041
AIDS Drug Assistance Program (ADAP) 0 350,000 350,000
Other (specify) 0 0 0
Other (specify) 0 0 0
Other (specify) 0 0 0
OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND TOTAL 0 1,256,344 1,256,344
TOTAL STATE CONTRIBUTIONS 4,464,555 1,256,344 5,720,899
A TT ACHMENT II
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
COUNTY
1. BOARD OF COUNTY COMMISSIONERS ANNUAL APPROPRIATIONS:
008030 Grants-County Tax Direct 276,000 0 276,000
008034 Grants Cnty Commsn Other 66,585 0 66,585
BOARD OF COUNTY COMMISSIONERS ANNUAL APPROPRIATIONS TOTAL: 342,585 0 342,585
2. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION:
001077 Primary Care Fees 18,000 0 18,000
001093 Communicable Disease Fees 38,000 0 38,000
001094 Environmental Health Fees 100,000 0 100,000
001114 New Birth Certificates 6,720 0 6,720
001115 Death Certificates 40,000 0 40,000
001116 Computer Access Fee 0 0 0
001060 Vital Statistics Fees Other 800 0 800
001004 Child Car Seat Prog 0 0 0
001074 Adult Enter. Permit Fees 0 0 0
001195 Primary Care Transfer Fees 0 0 0
001117 Vital Stats-Adm. Fee 50 cents 340 0 340
001196 Water Analysis-Potable 0 0 0
FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION TOTAL 203,860 0 203,860
3. OTHER CASH AND LOCAL CONTRIBUTIONS
090002 Draw down from Public Health Unit 0 0 0
001090 Medicare 5,000 0 5,000
008050 Grants-Cnty Sch Board Direct 35,000 0 35,000
008010 Grants Contracts Frm Cities Direct 0 0 0
008033 County Contributions For Facilities 0 0 0
008090 Grants other Local Govn't Direct 0 0 0
008095 Grants Cnty Sect 403.102 Air Pol 0 0 0
008099 ReimbIRebate Local Govn't 0 0 0
008031 County AIDS Education 0 0 0
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 40,000 0 40,000
4. ALLOCABLE REVENUE
011007 Cash Donations Private 0 0 0
001029 Third Party Reimbursement 4,000 0 4,000
010301 Exp Witness Fee Consultnt Charges 0 0 0
005040 Interest Erned State Investment 0 0 0
005041 Interest Erned Local Investment 0 0 0
007010 U.S. Grants Direct to CHD 0 0 0
008094 Grnts/Contracts other Agencies Direct 0 0 0
011098 Donation School Based Clinic 0 0 0
011099 Other GrantslDonations Direct 0 0 0
012020 Fines and Forfeitures 0 0 0
018001 Refunds, Salary 0 0 0
018003 Refunds, other Personal Services 0 0 0
018004 Refunds, Expenses 0 0 0
018006 Refunds, Operating Capital Outlay 0 0 0
018010 Refunds, Special Category 0 0 0
018011 Refunds, Other 0 0 0
018099 Refunds, Certified Forward 0 0 0
037000 Prior Year Warrant 0 0 0
038000 12 Month Old Warrant 0 0 0
010300 Sale of Goods and Services 0 0 0
010402 Recycle Paper Sales 0 0 0
010403 Fees-Copies of Documents 0 0 0
ATTACHMENT II
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
COUNTY
4. ALLOCABLE REVENUE
010405 Sale of pharmaceuticals 0 0 0
011055 Other Grant DOE 0 0 0
012021 Return Check Charge 0 0 0
018005 Refunds Grants to Local Gov't 0 0 0
029010 Sale of Fixed Assets 0 0 0
COUNTY ALLOCABLE REVENUE TOTAL 4,000 0 4,000
5. BUILDINGS:
Annual Rental Equivalent Value 0 225,000 225,000
Maintenance 0 20,000 20,000
Other (specifY) 0 50,000 50,000
Other (specifY) 0 0 0
Other (specifY) 0 0 0
Other (specifY) 0 0 0
Other (specifY) 0 0 0
BUILDINGS TOTAL 0 295,000 295,000
6. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND
Other County Contribution (specifY) 0 0 0
Other County Contribution (specifY) 0 0 0
Other County Contribution (specifY) 0 0 0
Other County Contribution (specifY) 0 0 0
Other County Contribution (specifY) 0 0 0
OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND TOTAL 0 0 0
TOTAL COUNTY CONTRIBUTIONS 590,445 295,000 885,445
GRAND TOTAL CHD PROGRAM 5,055,000 1,551,344 6,606,344
ATTACHMENT II
MONROE COUNTY HEALTH DEPARTMENT
Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service
October 1,1999 to September 30, 2000
A. COMMUNICABLE DISEASE CONTROL:
Immunization (101) 4.00 0 12,000 47,500 47,500 47,500 47,500 55,000 135,000 190,000
STD (102) 2.50 150 2,000 30,000 30,000 30,000 30,000 12,000 108,000 120,000
A.I.D.S. (103) 14.00 700 9,000 425,000 425,000 425,000 425,000 0 1,700,000 1,700,000
TB Control Services (104) 2.25 1,500 2,750 31,500 31,500 31,500 31,500 10,000 116,000 126,000
Comm. Disease Surv. (106) 0.75 0 900 10,500 10,500 10,500 10,500 38,000 4,000 42,000
Vital Statistics (180) 2.50 0 0 25,000 25,000 25,000 25,000 47,860 52,140 100,000
COMMUNICABLE DISEASE SUBTOTAL 26.00 2,350 26,650 569,500 569,500 569,500 569,500 162,860 2,115,140 2,278,000
B. PRIMARY CARE:
Chronic Disease Services (210) 1.50 100 1,000 20,000 20,000 20,000 20,000 20,000 60,000 80,000
Home Health (215) 0.00 0 0 0 0 0 0 0 0 0
W.I.C. (221) 6.00 2,300 12,000 70,000 70,000 70,000 70,000 20,000 260,000 280,000
Family Planning (223) 4.50 1,000 4,000 62,500 62,500 62,500 62,500 25,000 225,000 250,000
Improved Pregnancy Outcome (225) 0.50 50 500 3,750 3,750 3,750 3,750 0 15,000 15,000
Healthy Start Prenatal (227) 4.75 400 20,000 62,500 62,500 62,500 62,500 0 250,000 250,000
Comprehensive Child Health (229) 2.00 100 900 20,000 20,000 20,000 20,000 20,000 60,000 80,000
Healthy Start Infant (231) 2.50 200 12,000 30,000 30,000 30,000 30,000 20,000 100,000 120,000
School Health (234) 7.50 0 70,000 75,000 75,000 75,000 75,000 35,000 265,000 300,000
Comprehensive Adult Health (237) 5.00 600 6,000 68,750 68,750 68,750 68,750 25,000 250,000 275,000
Dental Health (240) 0.50 200 350 10,000 10,000 10,000 10,000 0 40,000 40,000
PRIMARY CARE SUBTOTAL 34.75 4,950 126,750 422,500 422,500 422,500 422,500 165,000 1,525,000 1,690,000
C. ENVIRONMENTAL HEALTH:
Private Water System (357) 0.02 10 10 750 750 750 750 1,000 2,000 3,000
Public Water System (358) 0.10 1 100 1,000 1,000 1,000 1,000 1,000 3,000 4,000
Individual Sewage Disp. (361) 14.00 1,000 5,000 150,000 150,000 150,000 150,000 100,000 500,000 600,000
Food Hygiene (348) 0.60 50 300 7,500 7,500 7,500 7,500 3,200 26,800 30,000
Group Care Facility (351) 0.40 100 300 5,000 5,000 5,000 5,000 0 20,000 20,000
Migrant Labor Camp (352) 0.00 0 0 0 0 0 0 0 0 0
Housing,Public Bldg Safety,Sanitation (353) 0.01 2 5 250 250 250 250 1,000 0 1,000
Mobile Home and Parks Services (354) 0.50 48 150 5,000 5,000 5,000 5,000 4,000 16,000 20,000
Swimming Pools/Bathing (360) 2.00 200 200 18,750 18,750 18,750 18,750 43,000 32,000 75,000
Biomedical Waste Services (364) 0.40 50 100 3,750 3,750 3,750 3,750 11,900 3,100 15,000
Tanning Facility Services (369) 0.02 5 10 300 300 300 200 0 1,100 1,100
Rabies Surveillance/Control Services (366) 0.06 5 30 750 750 750 750 1,000 2,000 3,000
Arbovirus Surveillance (367) 0.00 0 0 0 0 0 0 0 0 0
Rodent/Arthropod Control (368) 0.00 0 0 0 0 0 0 0 0 0
Storage Tank Compliance (355) 3.00 700 1,200 37,500 37,500 37,500 37,500 0 150,000 150,000
Super Act Service (356) 0.00 0 0 0 0 0 0 0 0 0
Occupational Health (344) 0.00 0 0 0 0 0 0 0 0 0
Consumer Product Safety (345) 0.00 0 0 0 0 0 0 0 0 0
Emergency Medical (346) 0.00 0 0 0 0 0 0 0 0 0
Lead Monitoring Services (350) 0.01 2 2 100 100 100 100 400 0 400
. '
A TT ACHMENT II
MONROE COUNTY HEALTH DEPARTMENT
Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service
October 1, 1999 to September 30, 2000
C. ENVIRONMENTAL HEALTH:
Public Sewage (362) 0.01 1 4 125 125 125 125 500 0 500
Solid Waste Disposal (363) 0.00 0 0 0 0 0 0 0 0 0
Sanitary Nuisance (365) 0.04 5 15 250 250 250 250 1,000 0 1,000
Water Pollution (370) 0.50 0 2,000 12,500 12,500 12,500 12,500 25,000 25,000 50,000
Air Pollution (371) 0.00 0 0 0 0 0 0 0 0 0
Radiological Health (372) 0.04 0 5 750 750 750 750 3,000 0 3,000
Toxic Substances (373) 2.00 140 180 27,500 27,500 27,500 27,500 66,585 43,415 110,000
ENVIRONMENTAL HEALTH SUBTOTAL 23.71 2,319 9,611 271,775 271,775 271,775 271,675 262,585 824,415 1,087,000
TOTAL CONTRACT 84.46 9,619 163,011 1,263,775 1,263,775 1,263,775 1,263,675 590,445 4,464,555 5,055,000
ATTACHMENT III
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, HRS
Forms 946 A and B (or the subsequent replacement if adopted
during the contract period), if so requested by the
department.
The applicant assures that it will comply with:
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 acti vi ties receiving or
benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as
amended, 29 D.S.C. 794, which prohibits discrimination
on the basis of handicap in programs and acti vi ties
receiving or benefiting from federal financial
assistance.
3. Ti tIe 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 acti vi ties 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.
ATTACHMENT III
(continued)
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 connection with any
of its programs and activities are not discriminating
against those participants or employees in violation of
the above statutes, regulations, guidelines, and
standards. In the event of failure to comply, the
applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance
with the terms of this assurance or seek other
appropriate judicial or administrative relief, to
include assistance being terminated and further
assistance being denied.
ATTACHMENT IV
STATE FEE SCHEDULES, BY SERVICE
T ,F.VF.T I OF SF.RVI CE / SF.RVT CF. .
Ee.e.
Estimated
Annual Revenue
Accruing To The
CHD Trust Fund
I. COMMUNICABLE DTSF.ASF.:
AIDS, HIV, Alternate Site Testing
$20 (optional)
Subtotal $ -0-
II. PRIMARY CARE:
Subtotal $
35.900.
ATTACHMENT V
COUNTY FEE SCHEDULES, BY SERVICE
LEVEL OF RRRVTCR/RERVICE:
F~~/Range
I. COMMUNICABT.R DTRRASR.
Immunizations
STD
Tuberculosis
Vital Statistics
Varied
Medicaid
Varied
Varied
II. PRIMARY CARE:
Chronic Disease
Family Planning
Comprehensive Adult
Comprehensive Child
Varied
Medicaid
Medicaid
Medicaid
III. ENVTRONMRN'l'AT. HRAT.'l'H:
OSTDS FEES
$160.00
Estimated
Annual Revenue
Accruing To The
CHD 'l'rw:; t. Fund
$38,000.
2,000.
2,000.
47,860.
Rllbt.otC'll $89.8hO
$ 2,000.
3,000.
7,000.
1,000.
Rllbtotal $11.000
$100,000.
Tot.al Count.y F~~s $?0?.8hO
Subt.otC'll $100.000
ATTACHMENT VI
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Monroe County Health Department
Monroe County Health Department
Monroe County Health Department
Monroe County Health Department
Health Care Center
Roosevelt Sands Community Health
Resource Center
Location
5100 College Road
Key West, Florida
148 Georgia Avenue
Tavernier, Florida
3333 Overseas Highway
Marathon, Florida
85960 Overseas Highway
Islamorada, Florida
1200 Kennedy Drive
Key West, Florida
Douglas Square
105 Olivia Street
Key West, Florida
Own~d By
Monroe County
Monroe County
Monroe County
Gerald E. and
Merle V. Strahl
The Lower
Florida Keys
Health Systems,
Inc.
City of Key
West
ATTACHMENT VII
DESCRIPTION OF USE OF CHD TRUST FUND BALANCES
FOR SPECIAL PROJECTS, IF APPLICABLE
(From Attachment II, Part I)
$48,000. Vehicle Purchase, 3 Station wagons
$600,000. Construction/Renovation/Furnishings/Equipment
DESCRIPTION OF SPECIAL CONTRACTS
(Please list separately)
Special contracts are contracts for services for which there are
no comparable services in the county health department core
programs; no service codes in Departmental coding manuals;
projects that are locally designed and have no standard statewide
set of services and therefore cannot be accounted for within
existing county health department programs. These contracts are
coded to SAMAS Level 599 and include some contracts formerly
handled at the district offices such as Epilepsy, colposcopy,
Project WARM, community planning and special family planning and
teen mother projects.
ENVIP~WMENTAL HEALTH FEE SCHF~ULE
FY 1999-2000
(Revised 06/28/1999)
DESCRIPTION FEE DEPOSIT
AMOUNT AMOUNT
PUBLIC SWIMMING POOLS AND BATHING PLACES
1. Annual Permit - Up to (and including) 25,000 gallons 75.00 67.50 8978
1 a. Transfer to headquarters 7.50
2. More than 25,000 gallons 160.00 144.00 22176
2a. Transfer to headquarters 16.00
3. Exempted Condo Pools (over 32 units) 50.00 45.00 900
3a. Transfer to headquarters 5.00
OTHER FEES
Collected by the 12 delegated counties
Broward, Dade, Duval, Hillsborough, Lee, Manatee,
Collier, Palm Beach, Pinellas, Polk, Sarasota, Vol usia, Escambia.
Variances for Okalossa, Santa Rosa, Walton counties
are processed by Escambia County as follows:
1. Plan review (new construction) 275.00 275.00
2. Plan review for modification of original construction 100.00 100.00
3. Plan/application review for bathing place development 275.00 275.00
4. Initial operating permit 125.00 125.00
5. Variance applications 240.00 216.00
5.a. Transfer to Headquarters 24.00
All other counties are to send the fee to Bureau of Facility
Programs in Tallahassee or the Environmental Engineering
section in Orlando as follows:
1. Plan review (new construction) 275.00 275.00
2. Plan review for modification of original construction 100.00 100.00
3. Plan/application review for bathing place development 275.00 275.00
4. Initial operating permit 125.00 125.00
5. Variance applications 240.00 240.00
MOBILE HOME & RECREATIONAL VEHICLE PARKS
(FEES ARE PRORATED ON A QUARTERLY BASIS)
1. Annual permit for 5 to 14 spaces 50.00 45.00 2790
1 a. Transfer to headquarters 5.00
3.50 per
2. Annual permit for 15 to 171 spaces space 10510
2a. Transfer to headquarters 10%
3. Annual permit for 172 and above spaces 600.00 540.00 2700
3a. Transfer to headquarters 60.00
MIGRANT LABOR CAMPS
1. Annual permit for facilities with 5-50 occupants 125.00 125.00
2. Annual permit for facilities with 51-100 occupants 225.00 225.00
3. Annual permit for facilities with over 100 occupants 500.00 500.00
BIOMEDICAL WASTE GENERA TORS
1. Initial permit 55.00 55.00
Page 1
10/28/99
ENVIRnNMENTAL HEALTH FEE SCHF~ULE
FY 1999-2000
(Revised 06/28/1999)
DESCRIPTION FEE DEPOSIT
AMOUNT AMOUNT
2. Renewal of annual permit(except physician office generating
less than 251bs/30 days) postmarked by October 1 55.00 55.00 3080
2. Renewal of annual permit(except physician office generating
less than 251bs/30 days) postmarked after October 1 75.00 75.00
3. Storage facilities permit postmarked by October 1 55.00 55.00
3. Storage facilities permit postmarked after October 1 75.00 75.00
4. Treatment facilities operating permit by October 55.00 55.00
4. Treatment facilities operating permit after October 1 75.00 75.00
FEES COLLECTED AT HEADQUARTERS
5. Transporter registration (one vehicle) postmarked by 10/1 55.00 For headquarters use only
5. Transporter registration (one vehicle) after 10/1 75.00 For headquarters use only
6. Transporter registration additional vehicle 10.00 For headquarters use only
TANNING FACILITIES
1. Annual license fee 150.00 135.00 675
1a. Transfer to headquarters 15.00
2. Fee for each additional device 55.00 49.50 445
2.a. Transfer to headquarters 5.50
3. Late fee 25.00 25.00
FOOD ESTABLISHMENTS
1. Annual Permit for Fraternal/Civic 160.00 144.00 1296
1 a. Transfer to headquarters 16.00
2. Annual Permit School Cafeteria Operating for
9 months or less 130.00 117.00 1170
2a. Transfer to headquarters 13.00
3. Annual Permit School Cafeteria Operating for more
than 9 months 160.00 144.00
3a. Transfer to headquarters 16.00
4. Annual Permit for Hospital/Nursing Food Service 210.00 189.00 1512
4a. Transfer to headquarters 21.00
5. Annual Permit for Movie Theaters 160.00 144.00 288
5a. Transfer to headquarters 16.00
6. Annual Permit for Jails/Prisons 210.00 189.00 378
6a. Transfer to headquarters 21.00
7. Annual Permit for Bars/Lounges (Drink Service Only) 160.00 144.00 5040
7a. Transfer to headquarters 16.00
8. Annual Permit for Residential Facilities 110.00 99.00
8a. Transfer to headquarters 11.00
9. Annual Permit for Child Care Centers without C&F license 85.00 76.50
9a. Transfer to headquarters 8.50
10. Annual Permit for Limited Food Service 85.00 76.50
10a. Transfer to headquarters 8.50
11. Annual Permit Other Food Service 160.00 144.00
Page 2
10/28/99
ENVIBnNMENTAL HEALTH FEE SCHF~ULE
FY 1999-2000
(Revised 06/28/1999)
DESCRIPTION FEE DEPOSIT
AMOUNT AMOUNT
11a. Transfer to headquarters 16.00
12. Plan Review $35/hour $35/hour
13. Food Worker Training 10.00 10.00
14. Request for Inspection 40.00 40.00
15. Reinspection (after the first reinspection) 30.00 30.00
16. Late Renewal 25.00 25.00
17. Alcoholic Beverage Inspection Approval 30.00 30.00 300
ONSITE SEWAGE DISPOSAL PROGRAM (OSTDS)
1. Application for permitting of an onsite sewage 25.00 23.00 16100
treatment and disposal system which includes
application and plan review for new and repair permits
1 a. Transfer to headquarters 2.00
2. Site evaluation for a new system 60.00 55.20 16560
2a. Transfer to headquarters 4.80
3. Site evaluation for a system repair 40.00 36.80
3a. Transfer to headquarters 3.20
4. Site re-evaluation, new or repair 40.00 36.80
4a. Transfer to headquarters 3.20
5. Permit for new systems, including standard subsurface, 55.00 50.60
filled or mounded systems
5a. Transfer to headquarters 4.40
6. New system installation inspection 55.00 50.60
6a. Transfer to headquarters 4.40
7. Research fee to be collected in addition, and concurrent with 5.00 5.00
the permit for a new system installation fee until 6/30/2002.
8. Repair permit issuance which includes inspection 50.00 41.40 4140
8a. Transfer to headquarters 3.60
8b. Transfer to headquarters for training center 5.00
9. Inspection of system previously in use 50.00 46.00 41400
9a. Transfer to headquarters 4.00
10. Reinspection fee per visit for site inspections after system 25.00 23.00 2300
construction approval
10a. Transfer to headquarters 2.00
11. Installation reinspection of non-compliant system per 25.00 23.00
each site visit
11 a. Transfer to headquarters 2.00
12. System abandonment permit, includes permit 40.00 36.80
issuance and inspection
12a. Transfer to headquarters 3.20
13. Annual operating permit fee for systems in 1M and 150.00 138.00 690
equivalent areas, and for systems receiving commercial waste
13a. Transfer to headquarters 12.00
Page 3
10/28/99
ENVIP^~NTAL HEALTH FEE SCHF~ULE
FY 1999-2000
(Revised 06/28/1999)
DESCRIPTION FEE DEPOSIT
AMOUNT AMOUNT
14. Amendments or changes to the operating permit during 25.00 23.00
the permit period per change or amendment
14a. Transfer to headquarters 2.00
15. Aerobic treatment unit operating permit per annum 150.00 138.00 103605
15a. Transfer to headquarters 12.00
16. Tank manufacturer's inspection per annum 100.00 50.00 250
16a. Transfer to headquarters 50.00
17. Septage disposal service permit per annum 50.00 46.00 460
17a. Transfer to headquarters 4.00
18. Additional charge per pumpout vehicle 25.00 23.00 460
18a. Transfer to headquarters 2.00
19. Portable or temporary toilet service permit per annum 50.00 46.00 230
19a. Transfer to headquarters 4.00
20. Additional charge per pumpout vehicle 25.00 23.00 115
20a. Transfer to headquarters 2.00
21. Septage stabilization facility inspection fee per annum 150.00 138.00
21 a. Transfer to headquarters 12.00
22. Septage disposal site evaluation fee per annum 100.00 92.00
22a. Transfer to headquarters 8.00
23. Aerobic treatment unit maintenance entity permit per annum 25.00 23.00 690
23a. Transfer to headquarters 2.00
24. Variance application for a single family residence per 150.00 75.00
each lot or building site
24a. Transfer to headquarters 75.00
25. Variance application for a multi-family or commercial 200.00 100.00 500
building per each building site
25a. Transfer to headquarters 100.00
26. Inspection for construction of an injection well (FL Keys) 125.00 125.00 2500
Performance-based Treatment Systems
1. Application for permitting of a new performance-based 125.00 115.00
treatment system, which includes application and plan review
1 a. Transfer to headquarters 10.00
2. Permit for new performance-based treatment system 125.00 115.00
2a. Transfer to headquarters 10.00
3. Installation inspection for new performance-based systems 75.00 69.00
3a. Transfer to headquarters 6.00
6. Research fee to be collected in addition, and concurrent with 5.00 5.00
the permit for a new performance-based system installation fee
4. Repair permit issuance which includes inspection 125.00 115.00
4a. Transfer to headquarters 10.00
5. Inspection of system previously in use 25.00 23.00
Page 4
10/28/99
ENVIP^~NTAL HEALTH FEE SCHF-ULE
FY 1999-2000
(Revised 06/28/1999)
DESCRIPTION FEE DEPOSIT
AMOUNT AMOUNT
Sa. Transfer to headquarters 2.00
6. Reinspection fee per visit for site inspections after system 25.00 23.00
construction approval
6a. Transfer to headquarters 2.00
7. Installation reinspection of non-compliant system per 50.00 46.00
each site visit
7a. Transfer to headquarters 4.00
8. System abandonment permit, includes permit 75.00 69.00
issuance and inspection
8a. Transfer to headquarters 6.00
9. Annual operating permit fee for performance-based 200.00 184.00
treatment system. Fee charged second year of operation
9a. Transfer to headquarters 16.00
10. Review of application due to proposed amendments or 75.00 69.00
changes after initial operating permit issuance.
10a. Transfer to headquarters 6.00
11. Variance application for a single family residence per 150.00 75.00
each lot or building site
11 a. Transfer to headquarters 75.00
FEE COLLECTED AT HEADQUARTERS - Onsite Sewage
1. Application for innovative product approval 500.00 For headquarters use only
2. Application for registration including initial examination 75.00 For headquarters use only
3. Initial registration 100.00 For headquarters use only
4. Renewal of registration 100.00 For headquarters use only
5. Renewal of inactive certificate of authorization 250.00 For headquarters use only
DRINKING WATER
1. First Year Public Water Annual Operation Permit -Limited Use 75.00 67.50
1 a. Transfer to headquarters 7.50
2. Second Year Public Water Annual Operation Permit -
Limited Use 70.00 63.00
2a. Transfer to headquarters 7.00
3. Public Water Construction Permit - Limited Use 75.00 67.50
3a. Transfer to headquarters 7.50
4. Private Water Construction Permit - serving 3 or 4 40.00 36.00
non-rental residences
4a. Transfer to headquarters 4.00
5. Initial Operating Permit Fee After March 31 of Any Year 35.00 31.50
Sa. Transfer to headquarters 3.50
6. Non-SDWA Lab Sample (Sample Collection/Review
of Analytical Results/Health Risk Interpretation): 100
Delineated Area 50.00 50.00
Bacterial Sample Collection 40.00 40.00
Page 5
10/28/99
. .
ENVIP~~NTAL HEALTH FEE SCHF-ULE
FY 1999-2000
(Revised 06/28/1999)
DESCRIPTION
FEE
AMOUNT
50.00
55.00
25.00
40.00
50.00
15.00
25.00
DEPOSIT
AMOUNT
Chemical Sample Collection
Combined Chemical microbiological
7. Reinspection of Private Water System
8. Reinspection of Public Water System
9. Delineated Area Clearance Fee
10. Limited Use Commercial Registered System
11. Limted Use Commercial Public Water System
Operating Permit Family Day Care Establishment
Page 6
50.00
55.00
25.00
40.00
50.00
15.00
25.00
10/28/99