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HomeMy WebLinkAboutL. Health DepartmentBOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: 9115/10 -MAR Division: Monroe Coun V Health nt Bulk Item: Yes X No Staff Contact: Robert Eadie, 809 -5610 AGENDA ITEM WORDING: Approval of a Resolution authorizing the Monroe County Health Department to establish clinical fees for primary care services offered as set forth in Exhibit A attached to and made a part of the resolution. ITEM BACKGROUND- F.S. 154.01(2) requires Counties to establish and maintain full -time county health departments to provide environmental health, communicable disease control and primary care services through contract with the Florida Department of Health. The Board recently approved such a contract for the Monroe County Health Department on 10 /21 /09. F.S. 154.06(1) authorizes each county to collect fees for primary care services provided that a schedule of such fees is established by resolution of the Board of County Commissioners or by rule of the Department. The MCHD is requesting authorization to establish clinical fees for primary care services offered at the MCHD. PREVIOUS RELEVANT BOCC ACTION: 10/21/2009 Board approved core contract between Monroe County and the Florida Department of Health for public health services provided by the Monroe County Health Department 2/17/2008 Board approved Resolution No. 502 -2008 establishing fees specifically for primary care services, vital statistics, medical records, public records and returned/dishonored checked provided by the Monroe County Health Department CONTRACT /AGREEMENT CHANGES: Fee increase for the copying of medical records from .50¢ per page to $1.00 per page STAFF RECOMMENDATIONS: Approval. TOTAL COST: N/A COST TO COUNTY: N/A BUDGETED: Yes No SOURCE OF FUNDS: N/A REVENUE PRODUCING: Yes x No AMOUNT PER MONTH APPROVED BY: County Atty OMB/Purchasing Risk Management DOCUMENTATION: Included x Not Required DISPOSITION: AGENDA ITEM # Year Revised 2105 RESOLUTION NO. — 2010 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA AUTHORIZING THE MONROE COUNTY HEALTH DEPARTMENT TO ESTABLISH FEES SPECIFICALLY FOR PRIMARY CARE SERVICES, COMMUNITY PUBLIC HEALTH SERVICES, VITAL STATISTICS, MEDICAL RECORDS, PUBLIC RECORDS AND RETURNEDIDISHONORED CHECKS OFFERED AT THE MONROE COUNTY HEALTH DEPARTMENT AS SET FORTH IN EXHIBIT "A" ATTACHED HERETO AND MADE A PART OF THIS RESOLUTION. WHEREAS, F. S. 154.01(2) requires counties to establish and maintain full -time county health departments to provide environmental health, communicable disease control and primary care services; and WHEREAS, F.S. 154.01(3) requires the Department of Health to enter into contracts with counties for this purpose; and WHEREAS, on October 21, 2009, the Board approved the annual core contract between the Monroe County and the Florida Department of Health for public health services; and WHEREAS, F. S. 154.06(1) authorizes each county and each county health department to collect fees for primary care services rendered through the county health departments provided that a schedule of such fees is established by resolution of the Board of County Commissioners or by rule of the department; and WHEREAS, F.S. 154.06(2) requires all fiends collected under this section to be expended solely for the purpose of providing health services and facilities within the county served by the county health department and pursuant to the rules and regulations cited therein and pursuant to all other applicable rules and regulations; and WHEREAS, on December 17, 2008, the Board approved a resolution authorizing the Monroe County Health Department to increase the fees charged for primary care services offered at the Monroe County Health Department (Resolution No. 502 - 2005); and WHEREAS, the Monroe County Health Department has indicated the need to re -define and re- establish fees for public health services offered at the Monroe County Health Department as set forth in Exhibit "A "attached hereto and made a part of this Resolution; and WHEREAS, pursuant to F. S. 154.01(a) and 154.06(1), this fee resolution does not include fees for environmental health services offered at the Monroe County Health Department which are regulated by a uniform statewide fee schedule and are specifically outside of the jurisdiction of the Board of County Commissioners of Monroe County, Florida; and WHEREAS, the Board is satisfied with the justification provided by the Monroe County Health Department; NOW THEREFORE; BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA that; The Monroe County Health Department shall collect fees for primary care services, community public health services, vital statistics, medical records, public records, returned/dishonored checks as specified in Exhibit "A" attached hereto and made a part of this Resolution. 2. The Monroe County Health Department is solely responsible for ensuring effective notice is provided to the general public and other impacted agencies and organizations of the specific service fee increases. 3. The Monroe County Health Department is solely responsible for ensuring the County's compliance with all financial and transitional rules and regulations, and any other factors that may be impacted by the service fee increases at all levels; local, state and federal. 4. Any prior resolution, ordinance or contract inconsistent herewith is hereby repealed. PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida at a regular meeting held on the 15'' day of September, A.D., 2010. Mayor Sylvia Murphy Mayor Pro Tern Heather Carruthers Commissioner George Neugent Commissioner Kim Wigington Commissioner Mario Di Gennaro (Seal) ATTEST: DANNY L. KOLHAGE, CLERK By: Deputy Clerk BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA BY: Mayor MONROE COUNTY ATTORNEY AP OV D A$ T F R YNTHIA L. HALL 9- - - 20/0 ASSISTA LINTY AT TORNEY FEE RESOLUTIONS A. PURPOSE. To establish public health service fees in order to expand existing public health services to the community at large. B. PRIMARY CARE SERVICES. (1) Primary care services include well and sick adult and child health services and family planning services_ These services will be charged at not more than 150% of the prevailing Medicare rate. Where there is no Medicare fee, the fee will be the Medicaid rate. Service levels will be determined utilizing current Medicare guidelines for coding and billing services provided. Discounting adjustments will be made to client fees based upon the current contract for services with Medicare and other 3` party payers. In addition, sliding scale adjustments to fees for primary care services will be based upon Federal OMB guidelines and in accordance with State of Florida Department of Health Policy 56- 66 -08. Medicaid is billed at the current Medicaid Cost -based rate and reimbursement for these services is considered payment in full. (2) Pharmacy — Medications issued will be provided at the most recent cost. Medicaid is accepted as payment in full. (3) Injection fee for parenteral medications per injection $35.00 (4) Lab fees - All laboratory and pathology fees are subject to sliding scale fee adjustment based upon OMB Federal Guidelines. a. Bloods Specimens sent to outside laboratory -- cost plus a $25.00 venipuncture fee per visit. b. Specimens tested in clinic- $10.00 (hemoglobin, urine, blood sugar, mono, wet mount, strep) c. Pregnancy test No charge d. Non -blood specimens sent to outside laboratory, processing fee $10.00 per visit. C. COMMUNITY PUBLIC HEALTH SERVICES (1) Tuberculosis X -ray for suspected, confirmed or Symptomatic contact or case (2) Tuberculosis Skin Test for suspected, confirmed or Symptomatic contact or case (3) Tuberculosis (TB) Sputum Culture for suspected, confirmed, or symptomatic contact of case (4) Tuberculin (TB) Skin Test, with reading, any other than No Charge No Charge No Charge $35.00 11/12/2009 listed above in C. (1). (5) Sexually Transmitted Diseases — The fee will be derived by considering the client sliding fee group which is calculated at eligibility determination, based on Federal OMB Guidelines. Medicaid identification will be accepted as full payment in lieu of charges. $70.00 (6) Adult Immunizations: Per vaccine- cost + $35.00 injection fee per vaccine. (7) Required Immunizations for children up to age 18 and eligible for the Vaccine for Children program No Charge (8) Class /Seminar attendance registration Per person charge for health care, social work and counseling employees. AIDS 181 $ 5.00 AIDS 500 $10.00 AIDS 501 $50.00 VITAL STATISTICS: (1) Birth Certificates: $ 16.00 Additional Copies $ 16.00 (2) Protective Covers $ 4.00 (3) Death Certificates — Certified Copy $ 13.00 Additional Copies $ 13.00 (4) Express Fee $ 10.00 E. MEDICAL RECORDS: (1) Copying of Medical Record (per page) $ 1.00 F. PUBLIC RECORDS: (1) Copying of Public Record (per page) 25 cents G. RETURNED/DISHONORED CHECKS: (S. 215.34(2), F.S.) A service fee of $15.00 or 5% of the face amount of the check, draft, or money order whichever is greater, not to exceed $150.00 2 11/12/2009 SOLI 110N NO, _ 502 —2008 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA AUTHORIMG THE MONROE COUNTY HEALTH DEPARTMENT TO ESTABLISH FEES SPECIFICALLY FOR PRIMARY CARE SERVICES, COMMUNITY PUBLIC HEALTH SERVICES, VITAL STATISTICS, MEDICAL RECORDS, PUBLIC RECORDS AND RETURNED/DISHONORED CHECKS OFFERED AT THE MONTROE COUNTY HEALTH DEPARTMENT AS SET FORTH IN EXHIBIT "A" ATTACHED HERETO AND MADE A PART OF THIS RESOLUTION, WHEREAS, F. S. 154.01(2) requires counties to establish and maintain full -tune county health departments to provide environmental health, communicable disease control and primary care services; and WHEREAS, F.S. 154.01(3) requires the Department of Health to enter into contracts with counties for this purpose; and WHEREAS, on January 17, 2007, the Board approved the annual core contract between the Monroe County and the Florida Department of Health for public health services; and WHEREAS, F. S. 154.06(1) authorizes each county and each county health department to collect fees for primary care services rendered through the county health departments provided that a schedule of such fees is established by resolution of the Board of County Commissioners or by rule of the department; and WHEREAS, F.S. 154.06(2) requires all funds collected under this section to be expended solely for the purpose of providing health services and facilities within the county served by the county health department and pursuant to the rules and regulations cited therein and pursuant to all other applicable rules and regulations; and WHEREAS, on September 21, 2005, the Board approved a resolution authorizing the Monroe County Health Department to increase the fees charged for birth and death certificates (R"ofuiron No. 358 - 2005); and WHEREAS, on February 21, 2007, the Board approved a resolution authorizing the Monroe County Health Department to increase the fees charged for primary care services offered at the Monroe County Health Department (Resolrriion No. 093- 2007); and WHEREAS, the Monroe County Health Department has indicated the need to re- define and re- establish fees for public health services offered at the Monroe County Health Department as set forth in Exhibit `A" attached hereto and made a part of this Resolution-, and WHEREAS, pursuant to E S. 154.01(a) and 154.06(1), this fee resolution does riot include fees for environmental health services offered at the Monroe County Health Department which are regulated by a uniform statewide fee schedule and are specifiralty outside of the jurisdiction of the Board of County Commissioners of Monroe County, Florida; and WHEREAS, the Board is satisfied with the justification provided by the Monroe County Health Department; NOW THEREFORE; BE IT RESOLVED BY THE BOARD OF COUNTY CONEMISSIONERS OF MONROE COUNTY, FLORIDA; That the Monroe County Health Department shall collect fees for primary care services, community public health services, vital statistics, medical records, public records, returned/dishonored checks as specified in Exhibit "A" attached hereto and made a part of this Resolution. 2. The Monroe County Health Department is ` solely responsible for ensuring effective notice is provided to the general public and other impacted agencies and organizations of the specific service fee increases. 3. The Monroe County Health Department is solely responsible for ensuring the County's compliance with all financial and transitional rules and regulations, and any other factors that may be impacted by the service fee increases at all levels; local, state and federal. 4. Any prior resolution, ordinance or contract inconsistent herewith is hereby repealed. PASSER AND ADOPTED by the Board of County Commissioners of Monroe County, Florida at a regular meeting held on the 17 ttr day of December, A.D., 2008. A rn Mayor Neugent Yes .' Mayor pro Tern Murphy Yes ��r I CommissiornerDiGennaro Yea �' � ' Co Commissioner Wigington Yes - t Yes * �Ori�In1551oner Carruthers .. { +�ri G Q BOARD OF COUNTY COAUMSSION] OF MONROE COUNTY, FLOPJDA L. KOLAAGE, CLERK BY: Clerk Mayor COUNTY � ��Rr�>*'r AP OVEfl AS ANN A, TTON coUTT.Y ;� � Oats FSE RESOLUTIONS A. PURPOSE. To establish public health service fees In order to expand existing public health services to the community at large. B. PRIMARY CAFE SERVICES. (1) Primary care services include well and sick adult and child health services and family planning services. These services will be charged at not more than 150% of the prevailing Medicare rate. Where there is no Medicare fee, the fee will be the Medicaid rate. Service levels will be determined utilizing current Medicare guidelines for coding and billing services provided. Discounting adjustments will be made to client fees based upon the current contract for services with Medicare and other V party payers. In addition, sliding scale adjustments to fees for primary care services will be based upon f=ederal OMB guidelines and in accordance with State of Florida Department of Health Policy 56- 66 -08. Medicaid is billed at the current Medicaid Cost -based rate and reimbursement for these services is considered payment in full. (2) Pharmacy -- Medications issued will be provided at the most recent cost. Medicaid is accepted as payment in full. (3) Injection fee for parenteral medications per injection $35.00 (4) Lab fees - All laboratory and pathology fees are subject to sliding scale fee adjustment based upon OMB Federal Guidelines. a. Bloods Specimens sent to outside laboratory- cost plus a $25.00 venipuncture fee per visit. b. Specimens tested in clinic- $10.00 (hemoglobin, urine, blood sugar, mono, wet mount, strep) c, Pregnancy test No charge d. Non -blood specimens sent to outside laboratory, processing fee $10.00 per visit. C. COMMUNITY PUBLIC HEALTH SERVICES (1) Tuberculosis X -ray for suspected, confirmed or Symptomatic contact or case No Charge (2) Tuberculosis Skin Test for suspected, confirmed or Symptomatic contact or case No Charge (3) Tuberculosis (TB) Sputum Culture for suspected, confirmed, or symptomatic contact of case No Charge (4) Tuberculin (TB) Skin Test, with reading, any other than $35.00 EXHIBIT 10130/2008 listed above in C. (1). (b) Sexually Transmitted Diseases —The fee will be derived by considering the client sliding fee group which is calculated at eligibility determination, based on Federal OMB Guidelines. Medicaid identification will be accepted as full payment in lieu of charges. $70.00 (6) Adult Immunizations: Per vaccine- cost + $35.40 injection fee per vaccine. (7) Required Immunizations for children up to age 1 B and eligible for the Vaccine for Children program No Charge (8) Class /Seminar attendance registration Per person charge for health care, social worts and counseling employees. AIDS 101 $ 5.00 AIDS 500 $10.00 AIDS 501 $50.01) VITAL. STATISTICS: (1) Birth Certificates: $ 15.00 Additional Copies $ 16.00 (2) Protective Covers $ 4.00 (3) Death Certificates -- Certified Copy $ 13.00 Additional Copies $ 13,00 (4) Express Fee $ 10.00 E. MEDICAL RECORDS: (1) Copying of Medical Record (per page) 60 cents F. PUBLIC RECORDS (1) Copying of Public Record (per page) 25 cents G. RETURNED/DISHONORED CHECKS: (S. 215.34(2), F.S.) A service fee of $15.00 or 5% of the face amount of the check, draft, or money order whichever is greater, not to exceed $150.00 2 10/30/2008 Statutes & Constitution :View Statutes :- >2009 >Ch0154 >8ection 06: flsenate.gov Page 1 of 1 Select: Year: 2009 Go ` be 2-oog Floiida Statutes Title kl Cha pter 154 View Entire COUNTY ORGANIZATION AND PUBLIC HEALTH Cater INTERGOVERNMENTAL RELATIONS FACILITIES 154.06 Fees and services rendered; authority. -- (1) The Department of Health may establish by rule fee schedules for public health services rendered through the county health departments. Such rules may include provisions for fee assessments, copayments, sliding fee scales, fee waivers, and fee exemptions. In addition, the department shall adopt by rule a uniform statewide fee schedule for all regulatory activities performed through the environmental health program. Each county may establish, and each county health department may collect, fees for primary care services, provided that a schedule of such fees is established by resolution of the board of county commissioners or by rule of the department, respectively. Fees for primary care services and communicable disease control services may not be less than Medicaid reimbursement rates unless otherwise required by federal or state law or regulation. (2) All funds collected under this section shall be expended solely for the purpose of providing health services and facilities within the county served by the county health department. Fees collected by county health departments pursuant to department rules shall be deposited with the Chief Financial Officer and credited to the County Health Department Trust Fund. Fees collected by the county health department for public health services or personal health services shall be allocated to the state and the county based upon the pro rata share of funding for each such service. The board of county commissioners, if It has so contracted, shall provide for the transmittal of funds collected for its pro rata share of personal health services or primary care services rendered under the provisions of this section to the State Treasury for credit to the County Health Department Trust Fund, but in any event the proceeds from such fees may only be used to fund county health department services. (3) The foregoing provisions notwithstanding, any county which charges fees for any services delivered through county health departments prior to July 1, 1983, and which has pledged or committed the fees yet to be collected toward the retirement of outstanding obligations relating to county health department facilities may be exempted from the provisions of subsection (1) until such commitment or obligation has been satisfied or discharged. History. - -ss. 1, 2, ch. 69 -80; ss. 19, 35, ch. 69 -106; s. 3, ch. 72 -323; s. 34, ch. 77 -147; s. 9, ch. 83- 177; s. 3, ch. 89 -311; s. 22, ch. 97 -101; s. 11, ch. 97 -237; s. 2, ch. 2000 -242; s. 153, ch. 2003 -261. Disclaimer. The information on this system is unverified. The journals or printed bills of the respective chambers should be consulted for official purposes. Copyright m 2000 -2006 5tate of Florida. htlp: lA vww. flsenate. goviStatuteslindex. cfrn . ?p= 2 &App_mode=Disptay_Statute &Search Suing = =BLUR... 11/2/2009 PROGRAMS D SERVICES Promoting and protecting the health and safety of all Monroe County residents HealthC areC enter 3134 Northside Drive, Building B Key West, FL 33010 (305) 292 -6885 (main) (305) 293 -1561 (fax) Complex located on the corner of Northside Drive and Glynn Archer Junior Drive, behind Wachovia • Primary care • Full service internal medicine • Tropical medicine • Ryan White Part C- funded HIV primary specialty care Medipass and most insurances accepted. Sliding scale fee is available based upon eligibility determination. Roosevelt Sands Center 105 Olivia Street Key West, FL 33040 (305) 809 -5680 (main) (305) 293 -1747 (fax) Located behind Douglass Gym • Childhood and adult immunizations • Refugee health • Title X family planning, STD diagnosis and treatment, HIV testing and counseling, primary care Medipass, Medicaid, Medicare and most insurances accepted. Sliding scale fee is available based upon eligibility determination. Ruth Ivins Center 3333 Overseas Highway Marathon, FL 33050 (305) 289 -2708 (main) (305) 289 -2479 (fax) Located oceanside, next to Fishermen's Hospital • Childhood immunizations • Title X family planning, STD diagnosis and treatment, HIV testing and counseling. • Ryan White Part C- funded HIV primary specialty care Medicaid, Medicare and most insurances accepted. Sliding scale fee is available based upon eligibility determination. Roth Building 50 High Point Road Tavernier, FL 33070 (305) 853 -3240 (main) (305) 853 -3242 (fax) Located in the Roth complex, next to the Monroe County Sheriffs Office • Childhood and adult immunizations • Refugee health • Title X family planning, STD diagnosis and treatment, limited primary care • Ryan White Part C- funded HIV primary specialty care Medicare, Medicaid and most insurances accepted. Sliding scale fee is available based upon eligibility determination ilia I W&MI ItRNII li I M SEXUALLY TRANSMITTED DISEASE PREVENTION Sexually Transmitted Disease Program staff work as the front line of defense for intervening in the spread of STDs. Disease intervention specialists are responsible for verifying the diagnosis and treatment of all reportable STDs from public and private health care providers. Following verification of diagnosis and treatment using methods approved by the Centers for Disease Control and Prevention, the DIS offers counseling and partner referral services to those individuals involved in the case. Reportable STDs include: chlamydia, gonorrhea, syphilis and HIV. TUBERCULOSIS PREVENTION The Tuberculosis Program's primary goal is to treat and cure everyone diagnosed with active TB disease. The program supervisor identifies and tests anyone at risk for becoming infected with TB bacilli, as well as provides treatment to anyone infected with TB bacilli to prevent TB disease. The supervisor also provides TB resources, support and education. IMMUNIZATIONS An immunizations program is one of the pillars upon which a community builds good public health, saves lives, prevents illness and enriches the health of the community. Infants and toddlers receive routine immunizations providing protection from 14 different diseases, including diphtheria, tetanus, pertussis (whooping cough), hepatitis A and B, measles, mumps, rubella, varicella (chicken pox), polio, rotavirus, seasonal influenza and pneumococcal conjugate. Teens receive immunizations providing protection from HPV, seasonal influenza, hepatitis B, meningococcal conjugate and TDAP booster. Last year, the Monroe County Health Department mounted a ' countywide campaign in response to the emergence of the H IN 1 influenza virus. More than 17 percent of Monroe County residents were vaccinated. Staff immunized 100 percent of those in high -risk categories, including children in public and private schools, pregnant women and persons with compromised immune systems. Currently, we are preparing to offer seasonal flu vaccine throughout the county at no cost to clients. We will hold three mass vaccination clinics: October 2 at the Murray Nelson Building, October 9 at the Marathon Fire Station and October 16 at the Gato Building in Key West. EPIDEMIOLOGY The Monroe County Health Department monitors infectious diseases in the community. Most recently, staff have been working with the Key West medical community, the Florida Department of Health, the Centers for Disease Control and Prevention and the Florida Keys Mosquito Control District to monitor and track cases of dengue acquired in Key West. REFUGEE HEALTH Most refugee resettlement program participants received an overseas medical examination prior to coming to America. Once here, refugees are offered a domestic health screening within 90 days of their arrival at no charge to them, including vaccinations needed for adjustment of immigration status. These health services in Monroe County are administered by the Refugee Health Program and provided through the Monroe County Health Department. Refugees with identified health conditions are referred to primary care physicians and specialists for follow -up health care. SCHOOL HEALTH Basic school health services are mandated by the School Health Services Act and are provided to all Florida public school students, primarily through county health departments. Basic services include health record reviews, follow -up for mandated school entry physical examinations and appropriate grade level immunizations against preventable communicable diseases, screenings for health conditions that can directly affect student learning ability (vision, hearing, growth and development and scoliosis), first aid, medication assistance and emergency health services. FAMILY PLANNING Comprehensive family planning services are available through the Monroe County Health Department. FDA: approved methods of contraception are available. Priority is placed on serving low - income individuals who are at risk of unwanted pregnancy. Services include initial and annual family planning visits, counseling and laboratory services. The Medical Preparedness Division coordinates resources, plans and responses that are related to manmade and naturally occurring disasters, especially those that can impact public health. The division's mission is to ensure that Monroe County is prepared for and can respond to and recover from weather - related events, bioterrorism incidents, outbreaks of infectious disease and other public health emergencies. All Monroe County Health Department staff members have been trained in emergency management procedures and assigned roles in the Incident E Command structure in the event of any natural or manmade emergency or disaster impacting the Florida Keys. As a hurricane approaches the Florida Keys, staff evacuate to Miami to set up and operate a shelter for Monroe County residents who are enrolled in the Special Needs Registry program run through Monroe County Social Services. Individuals are eligible for the program and evacuation to the special needs shelter if they are 60 years of age or older, frail, elderly, medically needy and /or disabled and are not served in or by a residential facility program. BIOMEDICAL WASTE DISPOSAL Environmental Health Division personnel inspect and permit facilities that generate, transport, store or treat biomedical waste through processes other than incineration. The objective of the biomedical waste program is to protect health care workers, environmental service staff, waste haulers and the general public from risks associated with potentially infectious biomedical waste. BODY ART & PIERCING Body piercing, a form of body art, is the act of penetrating the skin to make a hole, mark or scar. It does not include the use of mechanized, presterilized ear piercing systems that penetrate the outer perimeter or lobe of the ear or both. State law prescribes minimum sanitary and safety requirements related to the design and operation of body piercing salons and temporary establishments, all of which are monitored through county health departments. FOOD HYGIENE The goal of the Food Hygiene Program is to reduce the occurrences of foodborne illness (often referred to as food poisoning). The Monroe County Health Department regulates only certain types food service operations, including those located in institutional settings such as schools and jails, civic and fraternal organizations, theaters, bars and lounges that don't prepare food and churches that serve the public. Each operator of a food service facility regulated by the department must maintain an annual operating permit. Staff conduct regular inspections of each facility. MOBILE HOME PARKS The objective of the Mobile Home Parks Program is to minimize the risk of environmental -based injury and illness in mobile home parks, lodging and recreational vehicle parks and recreational camps in Monroe County. Staff inspect these parks and camps twice per year, focusing on proper sewage disposal, safe drinking water, safe solid waste collection and disposal and effective insect and rodent control. Annual licenses are required for each park operating in the county. SANITARY NUISANCES A sanitary nuisance is a condition by which people's health or lives may be threatened or impaired or through which a disease may be caused or transmitted, either directly or indirectly. Some examples of sanitary nuisances include: improperly treated human or animal waste, defective septic tanks, unsanitary garbage storage oir other conditions that harbor flies, mosquitoes or other insects capable of disease transmission. Investigations of sanitary nuisances are usually triggered by a complaint. Upon receipt of a complaint, staff investigates its validity; if valid, staff serves notice that it must be removed or abated. ONSITE SEWAGE DISPOSAL Many homes across the Keys are not connected to central sewer systems; instead, they are served by onsite sewage treatment and disposal systems (OSTDS) regulated through the Monroe County Health Department. The department issues permits for the construction, installation, modification, abandonment or repair of OSTDS; conducts annual inspections; and requires annual operating permits for certain types of OSTDS. As of July 1, 2010, Florida statute protects the unique and fragile ecosystem of the Florida Keys by requiring that all new systems achieve high standards for treating wastewater using performance -based systems that are designed by a professional engineer licensed in the State of Florida. POOLS & SPAS Environmental Health Division staff wants to minimize the number of injuries and any diseases that can be associated with public pools and bathing places. What exactly is a public pool? Florida statute defines a public pool as operated by or serving camps; churches; cities; counties; day care centers; group home facilities for eight or more clients; health spas; institutions; parks; state agencies; schools; subdivisions; or the cooperative living -type projects of five or more living units including apartments, boarding houses, hotels, mobile home parks, motels, RV parks and townhouses. Staff issues operating permits and conducts inspections of all public pools. Public pools are inspected twice a year, including tests for water quality and a thorough examination of the pool operations. Inspectors look for the presence of required safety equipment, documentation of daily pool water quality tests and the proper operation of other equipment such as filters, pumps and disinfection feeders. RABIES SURVEILLANCE Environmental Health investigates animal bites to prevent the spread of rabies. Rabies is very rare in Monroe County. This disease is usually transmitted to humans when the virus is introduced into an open wound or abrasion of the skin or mucous membranes following exposure to the saliva of a rabid animal. If your physician has diagnosed you with a significant exposure to rabies, then s/he will write you a prescription for the vaccine. Post - diagnosis and prescription, you will contact the Monroe County Health Department to complete paperwork, set up payment arrangements and order the vaccine from the distributor. Your vaccine will arrive within a week, at which time you will pick it up and have your physician administer it. The Monroe County Health Department locally administers an annual budget of $8.5 million. The Budget and Fiscal Office oversees purchasing, leases, agreements and billing for services in keeping with Florida Department of Health policy. The department has 110 full- and part-time employees and maintains offices and clinics in six facilities in Key Largo, Tavernier, Marathon and Key West. The department actively pursues grant opportunities to support its mission and to maintain service levels throughout the community.