FY2011 11/17/2010DANNY L. KOLHA GE
CLERK OF THE CIRCUIT COURT
DATE: January 10, 2011
TO: Robert Eadie, J.D.
CHD Director/Administrator
ATTN: Bunny VanBourgondien
Contract Administrator
FROM: Pamela G. Hanc C.
At the November 17, 2010, Board of County Commissioner's meeting the Board granted
approval and authorized execution of Item N2 Contract between Monroe County Board of
County Commissioners and the State of Florida, Department of Health for operation of the
Monroe County Health Department — contract year 2010 — 2011.
Enclosed are three duplicate originals of the above -mentioned, executed on behalf of
Monroe County, for your handling. Please be sure to return the fully executed "Monroe County
Clerk" and "Monroe County Finance" copies as soon as possible. Should you have any
questions, please do not hesitate to contact our office.
cc: County Attorney
Finance
File✓
Monroe County Clerk
CONTRACT BETWEEN
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
THE MONROE COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2010-2011
This agreement ("Agreement") is made and entered into between the State of Florida,
Department of Health ("State") and the Monroe County Board of County Commissioners
("County"), through their undersigned authorities, effective October 1, 2010.
RECITALS
A. Pursuant to Chapter 154, F.S., the intent of the legislature is to "promote,
protect, maintain, and improve the health and safety of all citizens and visitors of this state
through a system of coordinated county health department services."
B. County Health Departments were created throughout Florida to satisfy this
legislative intent through "promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health care for special populations."
C. Monroe County Health Department ("CHD") is one of the County Health
Departments created throughout Florida. It is necessary for the parties hereto to enter into
this Agreement in order to assure coordination between the State and the County in the
operation of the CHD.
NOW THEREFORE, in consideration of the mutual promises set forth herein, the
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the forgoing recitals are true and
correct and incorporated herein by reference.
2. TERM. The parties mutually agree that this Agreement shall be effective from
October 1, 2010, through September 30, 2011, or until a written agreement replacing this
Agreement is entered into between the parties, whichever is later, unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8,
below.
3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the 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
I
funds and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, and occupational health.
b. "Communicable disease control services" are those services which protect the
health of the general public through the detection, control, and eradication of diseases
which are transmitted primarily by human beings. Communicable disease services shall
be supported by available federal, state, and local funds and shall include those services
mandated on a state or federal level. Such services include, but are not limited to,
epidemiology, sexually transmissible disease detection and control, HIV/AIDS,
immunization, tuberculosis control and maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the collective health of the public, and prevent and control the spread
of disease. Primary health care services are provided at home, in group settings, or in
clinics. These services shall be supported by available federal, state, and local funds and
shall include services mandated on a state or federal level. Examples of primary health
care services include, but are not limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health services; family planning;
nutrition; school health; supplemental food assistance for women, infants, and children;
home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $ 3,930,423
(State General Revenue, Other State Funds and Federal Funds listed on the Schedule C). The
State's obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature.
ii. The County's appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment II, Part II is an amount not
to exceed $817,247 (amount listed under the "Board of County Commissioners Annual
Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority,
whichever is less, (either current year or from surplus trust funds) in any service category.
Unless requested otherwise, any surplus at the end of the term of this Agreement in the
County Health Department Trust Fund that is attributed to the CHD shall be carried
forward to the next contract period.
2
c. Either party may establish service fees as allowed by law to fund activities of the
CHD. Where applicable, such fees shall be automatically adjusted to at least the
Medicaid fee schedule. As allowed by law, Monroe County Health Department has
established Communicable disease control and Primary care services rates at 160% of
the Medicare Fee Schedule, rounded up to the next whole dollar. Monroe County Health
Department has established Environmental Health Services Fees in line with local
recommendations and economic factors.
d. Either party may increase or decrease funding of this Agreement during the term
hereof by notifying the other party in writing of the amount and purpose for the change in
funding. If the State initiates the increase/decrease, the CHD will revise the Attachment II
and send a copy of the revised pages to the County and the Department of Health,
Bureau of Budget Management. If the County initiates the increase/decrease, the County
shall notify the CHD. The CHD will then revise the Attachment II and send a copy of the
revised pages to the Department of Health, Bureau of Budget Management.
e. The name and address of the official payee to who payments shall be made is:
County Health Department Trust Fund
Monroe County
1100 Simonton Street
PO Box 6193
Key West, FL 33041
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator
of the CHD shall be a State employee or under contract with the State and will be under
the day-to-day direction of the Deputy State Health Officer. The director/administrator
shall be selected by the State with the concurrence of the County. The
director/administrator of the CHD shall insure that non -categorical sources of funding are
used to fulfill public health priorities in the community and the Long Range Program Plan.
A report detailing the status of public health as measured by outcome measures and
similar indicators will be sent by the CHD director/administrator to the parties no later than
October 1 of each year (This is the standard quality assurance "County Health Profile" report located on
the Office of Planning, Evaluation & Data Analysis Intranet site).
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that
the following standards should apply in the operation of the CHD:
a. The CHD and its personnel shall follow all State policies and procedures, except to
the extent permitted for the use of county purchasing procedures as set forth in
subparagraph b., below. All CHD employees shall be State or State -contract personnel
subject to State personnel rules and procedures. Employees will report time in the Health
Management System compatible format by program component as specified by the State.
b. The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of county purchasing
3
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
services. In such cases, the CHD director/administrator must sign a justification therefore,
and all county -purchasing procedures must be followed in their entirety, and such
compliance shall be documented. Such justification and compliance documentation shall
be maintained by the CHD in accordance with the terms of this Agreement. State
procedures must be followed for all leases on facilities not enumerated in Attachment IV.
c. The CHD shall maintain books, records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental
Accounting Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public, except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6.i.,
below. Books, records and documents must be adequate to allow the CHD to comply with
the following reporting requirements:
The revenue and expenditure requirements in the Florida Accounting
System Information Resource (FLAIR).
ii. The client registration and services reporting requirements of the
minimum data set as specified in the most current version of the Client
Information System/Health Management Component Pamphlet;
iii. Financial procedures specified in the Department of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported
to the CHD in a manner consistent with the client registration and
service reporting requirements of the minimum data set as specified in
the Client Information System/Health Management Component
Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust
Fund maintained by the state treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Monroe County.
e. That any surplus/deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the state or county, as appropriate, based on the funds contributed by
each and the expenditures incurred by each. Expenditures will be charged to the program
accounts by state and county based on the ratio of planned expenditures in the core
contract and funding from all sources is credited to the program accounts by state and
county. The equity share of any surplus/deficit funds accruing to the state and county is
4
determined each month and at contract year-end. Surplus funds may be applied toward
the funding requirements of each participating governmental entity in the following year.
However, in each such case, all surplus funds, including fees and accrued interest, shall
remain in the trust fund until accounted for in a manner which clearly illustrates the amount
which has been credited to each participating governmental entity. The planned use of
surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital
projects explained in Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy State
Health Officer has approved the transfer. The Deputy State Health Officer shall forward
written evidence of this approval to the CHD within 30 days after an emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this Agreement. Any such subcontract shall include all
aforementioned audit and record keeping requirements.
h. At the request of either party, an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMB Circular A-133 and may be in conjunction with audits performed by
county government. If audit exceptions are found, then the director/administrator of the
CHD will prepare a corrective action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent
to this Agreement for a period of five (5) years after termination of this Agreement. If an
audit has been initiated and audit findings have not been resolved at the end of five (5)
years, the records shall be retained until resolution of the audit findings.
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law. The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65
and 456.057, Florida Statutes, and all other state and federal laws regarding
confidentiality. All confidentiality procedures implemented by the CHD shall be consistent
with the Department of Health Information Security Policies, Protocols, and Procedures,
dated April 2005, as amended, the terms of which are incorporated herein by reference.
The CHD shall further adhere to any amendments to the State's security requirements and
shall comply with any applicable professional standards of practice with respect to client
confidentiality.
E
I. The CHD shall abide by all State policies and procedures, which by this reference
are incorporated herein as standards to be followed by the CHD, except as otherwise
permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof.
m. The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial, modification or termination of services. The
CHD will advise applicants of the right to appeal a denial or exclusion from services, of
failure to take account of a client's choice of service, and of his/her right to a fair hearing to
the final governing authority of the agency. Specific references to existing laws, rules or
program manuals are included in Attachment I of this Agreement.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the county that shall include at least the
following:
i. The DE3851-1 Contract Management Variance Report and the DE580L1
Analysis of Fund Equities Report;
ii. A written explanation to the county of service variances reflected in the
DE3851-1 report if the variance exceeds or falls below 25 percent of the planned
expenditure amount. However, if the amount of the service specific variance
between actual and planned expenditures does not exceed three percent of the
total planned expenditures for the level of service in which the type of service is
included, a variance explanation is not required. A copy of the written
explanation shall be sent to the Department of Health, Bureau of Budget
Management.
p. The dates for the submission of quarterly reports to the county shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond
the CHD's control:
i. March 1, 2011 for the report period October 1, 2010 through
December 31, 2010;
ii. June 1, 2011 for the report period October 1, 2010 through
March 31, 2011;
iii. September 1, 2011 for the report period October 1, 2010
through June 30, 2011; and
iv. December 1, 2011 for the report period October 1, 2010
through September 30, 2011.
7. FACILITIES AND EQUIPMENT. The parties mutually agree that:
6
a. CHD facilities shall be provided as specified in Attachment IV to this contract and
the county shall own the facilities used by the CHD unless otherwise provided in
Attachment IV.
b. The county shall assure adequate fire and casualty insurance coverage for County -
owned CHD offices and buildings and for all furnishings and equipment in CHD offices
through either a self-insurance program or insurance purchased by the County.
c. All vehicles will be transferred to the ownership of the County and registered as
county vehicles. The county shall assure insurance coverage for these vehicles is
available through either a self-insurance program or insurance purchased by the County.
All vehicles will be used solely for CHD operations. Vehicles purchased through the
County Health Department Trust Fund shall be sold at fair market value when they are no
longer needed by the CHD and the proceeds returned to the County Health Department
Trust Fund.
d. Commencing October 1, 2010, the CHD will reimburse the County, on a monthly
basis, the last day of each month, the sum of $5,500.00 per month, $66,000.00 per
annum, for the facility leased at the request of the CHD located at 3134 Northside Drive,
Building B, Key West, Florida.
e. Pursuant to an inter -local agreement between the City of Key West and the County,
the CHD will continue to operate a Primary Care Clinic and County Health Resource
Center, known as the "Roosevelt Sands Center" located at the Douglass Community
Center, 830 Emma Street, Key West, Florida.
8. TERMINATION.
a. Termination at Will. This Agreement may be terminated by either party without
cause upon no less than one -hundred eighty (180) calendar days notice in writing to the
other party unless a lesser time is mutually agreed upon in writing by both parties. Said
notice shall be delivered by certified mail, return receipt requested, or in person to the
other party's contract manager with proof of delivery.
b. Termination Because of Lack of Funds. In the event funds to finance this
Agreement become unavailable, either party may terminate this Agreement upon no less
than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return
receipt requested, or in person to the other party's contract manager with proof of delivery.
c. Termination for Breach. This Agreement may be terminated by one party, upon no
less than thirty (30) days notice, because of the other party's failure to perform an
obligation hereunder. Said notice shall be delivered by certified mail, return receipt
requested, or in person to the other party's contract manager with proof of delivery.
Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver
of any other breach and shall not be construed to be a modification of the terms of this
Agreement.
9. MISCELLANEOUS. The parties further agree:
a. Availability of Funds. If this Agreement, any renewal hereof, or any term,
performance or payment hereunder, extends beyond the fiscal year beginning July 1,
2011, it is agreed that the performance and payment under this Agreement are contingent
upon an annual appropriation by the Legislature, in accordance with section 287.0582,
Florida Statutes.
b. Contract Managers. The name and address of the contract managers for
the parties under this Agreement are as follows:
For the State:
Mary Vanden Brook
Name
Administrative Services Director
Title
PO Box 6193
Gato Building, 1100 Simonton St.
Key West, FL 33041
Address
305-809-5612
Telephone
For the County:
Name
Title
Address
Telephone
If different contract managers are designated after execution of this Agreement, the name,
address and telephone number of the new representative shall be furnished in writing to
the other parties and attached to originals of this Agreement.
C. Captions. The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify, amplify, or give
additional notice of the provisions hereof.
In WITNESS THEREOF, the parties hereto have caused this �l page agreement to be
executed by their undersigned officials as duly authorized effective the 1�ay of October, 2010.
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR MONROE COUNTY DEPARTMENT OF HEALTH
SIGNED BY:
NAME: Heather Carruthers
TITLE: Mayor
TITLE: Clerk
DATE: November 17, 2010
SIGNED BY:
NAME: Ana M. Viamonte Ros, M.D., M.P.H.
TITLE: State Sur eon General
DATE:
NAME: Robert Eadie, J.D.
TITLE: CHD Director/Administrator
DATE: I & i I
MONROE COUNTY ATTORNEY
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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 160% of the
prevailing Medicare rate. Where there is no Medicare fee, the fee will be the Medicaid
rate. Service levels will be determined utilizing current Medicare guidelines for coding
and billing services provided. Discounting adjustments will be made to client fees
based upon the current contract for services with Medicare and other 3d party payers.
In addition, sliding scale adjustments to fees for primary care services will be based
upon Federal OMB guidelines and in accordance with State of Florida Department of
Health Policy 56-66-08. Medicaid is billed at the current Medicaid Cost -based rate and
reimbursement for these services is considered payment in full.
(2) Pharmacy — Medications issued will be provided at the most recent cost. Medicaid
is accepted as payment in full.
(3) Injection fee for parenteral medications per injection $35.00
(4) Lab fees - All laboratory and pathology fees are subject to sliding scale fee
adjustment based upon OMB Federal Guidelines.
a. Bloods Specimens sent to outside laboratory- cost plus a $35.00 venipuncture
fee per visit.
b. Specimens tested in clinic- $10.00
(hemoglobin, urine, blood sugar, mono, wet mount, strep)
c. Pregnancy test
No charge
d. Non -blood specimens sent to outside laboratory, processing fee $10.00 per visit.
C. COMMUNITY PUBLIC HEALTH SERVICES
(1) Tuberculosis X-ray for suspected, confirmed or
Symptomatic contact or case No Charge
(2) Tuberculosis Skin Test for suspected, confirmed or
Symptomatic contact or case No Charge
(3) Tuberculosis (TB) Sputum Culture for suspected,
confirmed, or symptomatic contact of case No Charge
(4) Tuberculin (TB) Skin Test, with reading, any other than $35.00
listed above in C. (1).
(5) Tuberculin assessment of clients with a past history of
1 10/20/2010
positive skin test
$35.00
(6) Sexually Transmitted Diseases — The fee below will be adjusted considering the
client sliding fee group which is calculated at eligibility determination, based on
Federal OMB Guidelines. Medicaid identification will be accepted as full payment in
lieu of charges.
Professional Component fees:
Office/Outpatient Visit, New $178.00
Office/Outpatient Visit, Established $117.00
(7) Adult Immunizations
Cost of vaccine +
$35 injection fee
(8) Required Vaccines for children up to age 18 and eligible for
the Vaccine for Children program No Charge
Administration fee charged to third party payer $35.00
(9) Class/Seminar attendance registration
Per person charge for health care, social work
and counseling employees.
AIDS 101 No Charge
AIDS 500 No Charge
AIDS 501 No Charge
(10) Expendable medical/wound care supplies such as: Sponge Gauze,
Bandages/Dressings, Gloves Cost x 3.5
VITAL STATISTICS:
(1) Birth Certificates: $ 16.00
Additional Copies $ 16.00
(2) Protective Covers $ 4.00
(3) Death Certificates — Certified Copy $ 13.00
Additional Copies $ 13.00
(4) Express Fee $ 10.00
E. MEDICAL RECORDS:
(1) Copying of Medical Record (per page) $ 1.00
F. PUBLIC RECORDS:
(1) Copying of Public Record (per page) 25 cents
G. RETURNED/DISHONORED CHECKS: (S. 215.34(2), F.S.)
A service fee of $15.00 or 5% of the face amount of the check, draft, or money order
whichever is greater, not to exceed $150.00
2 10/20/2010
H. Environmental Health:
Environmental Health Services Fees established in line with local recommendations
and economic factors to cover cost of providing services
DESCRIPTION
ONSITE SEWAGE DIPOSAL PROGRAM (OSTDS)
Fee Amt
State
Fee
Application and plan review for construction permit for new systems
200
Application and approval for existing system, if system inspection not required.
45
Application and Exisiting System Evaluation with inspection
100
Application for permitting of an new Performance -based treatment system
200
Site Evaluation
115
Site re-evaluation
90
Permit or permit amendment for new systems
80
Initial system inspection
125
System reinspection(stabilization, non-compliance, or other inspection after initial
inspection.
75
Research fee (State Fee)
0
5
Repair Permit with Inspection
100
Application for system abandonment permit
95
Tank manufacturer's inspection per annum
120
Amendment to an Operating Permit
50
Septage Disposal Service Permit per annum 2X per yr inspection
120
Portable or temporary toilet service permit per annum
120
Additional charge per pump out vechicle
40
Annual operating permit industrial/manufacturing zoning or commercial sewage
waste
150
Biennial Operating permit for aerobic treatment unit or performance -based
treatment system
100
Aerobic treatment unit maintenance entity permit per annum
100
Variance application for a single family residence per each lot or building site
300
Variance application for a multifamily or commercial building site
440
Inspection for construction of an Injection well (FL Keys)
220
OSTDS Operating Permit Late Fee (45 days past due)
50
Per request -Expediting -Fast Track Permitting New & Exisitng (48 hour turn-
around) Charged in addition to state fee
500
Letter of Coordination for development review committees
250
Expedited OSTDS Variance Processing. Received within 6 days of monthly
deadline. Charged in addition to state fee
500
OSTDS PBTS screening test fee
25
PUBLIC SWIMMING POOLS
Annual permit- up to and including 25,000 gallons
240
Annual permit - more than 25,000 gallons
350
Non routine inspection(no charge for first inspection
100
Exempted condominiums/Cooperatives with over 32 units
75
MOBILE HOME & RECREATIONAL VEHICLE PARKS
Annual permit for 5 to 25 spaces
225
Annual permit for 26 to 149spaces $4.00 per space
7.50 per space
Annual permit for 172 and above spaces
1000
10/20/2010
FOOD ESTABLISHMENTS
Annual Permit for Fraternal/Civic
225
Annual Permit School Cafeteria Operating for 9 months or less
275
Annual Permit School Cafeteria Operating for more than 9 months
325
Annual Permit for Movie Theaters
190
Annual Permit for Jails/Prisons
250
Annual Permit for Bars/Lounges
225
Annual Permit for Residential Faciliites
200
Annual Permit for Limited Food Service
225
Child care center
150
Caterer
225
Mobile Food Units
225
Other Food Service
225
Vending machine dispensing potentially hazardous food
85
Plan review per hour public schools, colleges, and vocational teaching facilities
are exempt from this fee
60
Food establishment worker training course per person
10
Alcoholic beverage inspection approval
75
Request for inspection
50
Re -inspection (for each reinspection after the first)
25
Temporary event food service establishment (a)sponser w/o existing
sanitation certificate
200
b) vendor or booth at an establishment or location w/o an existing sanitation
certificate
100
Late renewals
40
BIOMEDICAL
Exempt Facilities
50
Generators
125
Storage Facilities
125
TANNING FACILITIES
Annual Permit
250
Fee per Device
55
Consultation
50
Late Renewal Fee
25
BODY PIERCING ESTABLISHMENTS
License Fee
250
Temporary Establishment
90
Late fee
Consultation
50
HEALTHY HOMES PROGRAM
Healthy home Assessment Voluntary Inspection living unit(radon, CO2,
Mold,Safety)
300
Public Education -Per Attendee
25
10/20/2010
DESCRIPTION
Fee
PUBLIC SWIMMING POOLS
1. Annual permit- up to and including 25,000 gallons
160
2. Annual permit - more than 25,000 gallons
315
3. Exempted Swimming pools (over 32 units)
60
Reinspection fee per inspection
50
MOBILE HOME & RECREATIONAL VEHICLE PARKS
1. Annual permit for 5 to 25 spaces
125
2. Annual permit for 26 to 149 spaces
5.25 per
space
3. Annual permit for 150 and above spaces
725
Reinspection fee per inspection
50
FOOD ESTABLISHMENTS
1. Annual Permit for Fraternal/Civic
200
2. Annual Permit School Cafeteria Operating for 9 months or less
165
3. Annual Permit School Cafeteria Operating for more than 9 months
200
continued sheet 2
4.Annual Permit for Hospital/Nursing Food Service
265
5. Annual Permit for Movie Theaters
200
6. Annual Permit for Jails/Prisons
265
7. Annual Permit for Bars/Lounges
200
8. Annual Permit for Residential
145
9. Annual Permit for Child Care Centers w/o C&F License
105
10.Annual Permit for Limited Food Service
105
FOOD ESTABLISHMENTS CONTINUED
11. Annual Permit Other Food Service
200
12. Plan Review
45/hour
13.Request for Inspection
55
14. Re -inspection (after the first inspection)
45
15. Late Renewal
35
16. Alcoholic Beverage Inspection Approval
45
BIOMEDICAL WASTE GENERATORS
1. Initial Permit
60
2. Renewal of annual permit after October 1
80
3. Renewal of annual by October 1
60
TANNING FACILITIES
1. Annual License fee
160
2. Fee for each additional device
60
3. Late fee
30
10/20/2010
DESCRIPTION
Fee
BODY PIERCING
1.Initial License
160
2.Temporary Establishment
80
4. Annual renewal License Fee
160
3. Late Fee
105
10/20/2010
ATTACHMENT
MONROE COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet (DHP 50-20), Environmental Health Coding Pamphlet (DHP 50-21) and FLAIR requirements because
of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it
must comply with the special reporting requirements for that service. The services and the reporting requirements are
listed below:
Service
Sexually Transmitted Disease
Program
2. Dental Health
3. Special Supplemental Nutrition
Program for Women, Infants
and Children (including the WIC
Breastfeeding Peer Counseling
Program)
4.
5.
0
E:
L
Healthy Start/
Improved Pregnancy Outcome
Family Planning
Requirement
Requirements as specified in FAC 64D-3, F.S. 381 and
F.S. 384 and the CHD Guidebook.
Monthly reporting on DH Form 1008*. Additional reporting
requirements, under development, will be required. The
additional reporting requirements will be communicated upon
finalization.
Service documentation and monthly financial reports as
specified in DHM 150-24* and all federal, state and county
requirements detailed in program manuals and published
procedures.
Requirements as specified in the 2007 Healthy Start
Standards and Guidelines and as specified by the Healthy
Start Coalitions in contract with each county health
department.
Periodic financial and programmatic reports as specified
by the program office and in the CHD Guidebook, Internal
Operating Policy FAMPLAN 14*
Immunization Periodic reports as specified by the department regarding
the surveillance/investigation of reportable vaccine
preventable diseases, vaccine usage accountability as
documented in Florida SHOTS, the assessment of various
immunization levels as documented in Florida SHOTS and
forms reporting adverse events following immunization.
Chronic Disease Program Requirements as specified in the Healthy Communities,
Healthy People Guidebook.
Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4* and DHP 50-21 *
HIV/AIDS Program Requirements as specified in F.S. 384.25 and
64D-3.016 and 3.017 F.A.C. and the CHD Guidebook. Case
reporting should be on Adult HIV/AIDS Confidential Case
Report CDC Form DH2139 and Pediatric HIV/AIDS
Confidential Case Report CDC Form DH2140. Socio-
ATTACHMENT I (Continued)
demographic data on persons tested for HIV in CHD clinics
should be reported on Lab Request DH Form 1628 or Post -
Test Counseling DH Form 1628C. These reports are to be
sent to the Headquarters HIV/AIDS office within 5 days of the
initial post-test counseling appointment or within 90 days of
the missed post-test counseling appointment.
10. School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines (April 2007).
11. Tuberculosis Tuberculosis Program Requirements as specified in FAC
64D-3, F.S. Specific Authority 381.0011(13), 381.003(2),
381.0031(6), 384.33, 392.53(2), 392.66 FS Law Implemented
381.0011(4), 381.003(1), 381.0031(1), (2), (6), 383.06,
384.23, 384.25, 385.202, 392.53 FS.381 and CHD
Guidebook.
12. General Communicable Disease Control Carry out surveillance for reportable communicable and other
acute diseases, detect outbreaks, respond to individual cases
of reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified
in the CHD Guide to Surveillance and Investigations.
*or the subsequent replacement if adopted during the contract period.
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ATTACHMENT H.
MONROE COUNTY HEALTH DEPARTMENT'
Part II. Sources of Contributions to County Health Department
October 1, 2010 to September 30, 2011
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
1. GENERAL REVENUE - STATE
015040
ALG/CESSPOOL IDENTIFICATION AND ELIMINATION
129,414
0
129,414
0
129,414
015040
ALG/CONTR TO CHDS-AIDS PATIENT CARE
370,000
0
370,000
0
370,000
015040
ALG/CONTR TO CHDS-AIDS PATIENT CARE NETWORK
0
0
0
0
0
015040
ALG/CONTR TO CHDS-AIDS PREY & SURV & FIELD STAFF
93,724
0
93,724
0
93,724
015040
ALG/CONTR TO CHDS-DENTAL PROGRAM
0
0
0
0
0
015040
ALG/CONTR TO CHDS-MIGRANT LABOR CAMP SANITATION
0
0
0
0
0
015040
MINORITY OUTREACH-PENALVER CLINIC - MIAMI-DADE
0
0
0
0
0
015040
PRIMARY CARE SPECIAL DENTAL PROJECTS
0
0
0
0
0
015040
SPECIAL NEEDS SHELTER PROGRAM
0
0
0
0
0
015040
STATEWIDE DENTISTRY NETWORK - ESCAMBIA
0
0
0
0
0
015040
STD GENERAL REVENUE
18,617
0
18,617
0
18,617
015040
VARICELLA IMMUNIZATION REQUIREMENT
3,387
0
3,387
0
3,387
015040
HEALTHY START MED WAIVER - SOBRA
0
0
0
0
0
015040
HEALTHY START MED-WAIVER - CLIENT SERVICES
0
0
0
0
0
015040
JESSIE TRICE CANCER CTR/HEALTH CHOICE - MIAMI-DADE
0
0
0
0
0
015040
LA LIGA CONTRA EL CANCER
0
0
0
0
0
015040
MANATEE COUNTY RURAL HEALTH SERVICES
0
0
0
0
0
015040
METRO ORLANDO URBAN LEAGUE TEENAGE PREG PREV
0
0
0
0
0
015040
COUNTY SPECIFIC DENTAL PROJECTS - ESCAMBIA
0
0
0
0
0
015040
DENTAL SPECIAL INITIATIVES
0
0
0
0
0
015040
DUVAL TEEN PREGNANCY PREVENTION
0
0
0
0
0
015040
FL CLPPP SCREENING & CASE MANAGEMENT
0
0
0
0
0
015040
FL HEPATITIS & LIVER FAILURE PREVENTION/CONTROL
144,000
0
144,000
0
144,000
015040
HEALTHY BEACHES MONITORING
28,965
0
28,965
0
28,965
015040
ALG/IPO HEALTHY START/IPO
0
0
0
0
0
015040
ALG/PRIMARY CARE
194,161
0
194,161
0
194,161
015040
ALG/SCHOOL HEALTH/SUPPLEMENTAL
41,981
0
41,981
0
41,981
015040
CHILD HEALTH MEDICAL SERVICES
0
0
0
0
0
015040
COMMUNITY SMILES - MIAMI-DADE
0
0
0
0
0
015040
COMMUNITY TB PROGRAM
39,592
0
39,592
0
39,592
015040
ALG/CONTR. TO CHDS-IMMUNIZATION OUTREACH TEAMS
4,722
0
4,722
0
4,722
015040
ALG/CONTR. TO CHDS-INDOOR AIR ASSIST PROG
0
0
0
0
0
015040
ALG/CONTR. TO CHDS-MCH HEALTH - FIELD STAFF COST
0
0
0
0
0
015040
ALG/CONTR. TO CHDS-SOVEREIGN IMMUNITY
0
0
0
0
0
015040
ALG/CONTRIBUTION TO CHDS-PRIMARY CARE
15,589
0
15,589
0
15,589
015040
ALG/FAMILY PLANNING
57,494
0
57,494
0
57,494
015050
ALG/CONTRTO CHDS
1,435,124
0
1,435,124
0
1,435,124
GENERAL REVENUE TOTAL
2,576,770
0
2,576,770
0
2,576,770
2. NON GENERAL REVENUE - STATE
015010
ALG/CONTRTO CHDS-REBASING TOBACCO TF
21,117
0
21,117
0
21,117
015010
ALG/CONTR. TO CHDS-BIOMEDICAL WASTE/DEP ADM TF
1,771
0
1,771
0
1,771
015010
ALG/CONTR. TO CHDS-SAFE DRINKING WATER PRG/DEP ADM
0
0
0
0
0
015010
BASIC SCHOOL HEALTH - TOBACCO TF
0
0
0
0
0
015010
CHD PROGRAM SUPPORT
0
0
0
0
0
015010
ENVIRONMENTAL HEALTH PACE PROJECTS
0
0
0
0
0
015010
FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS
0
0
0
0
0
015010
FULL SERVICE SCHOOLS - TOBACCO TF
61,720
0
61,720
0
61,720
Version:
4
Page 1 of 7
ATTACHMENT II.
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2010 to September 30, 2011
State CUD County Total CUD
Trust Fund CUD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
2. NON GENERAL REVENUE - STATE
015010
IMMUNIZATION SPECIAL PROJECT
3,720
0
3,720
0
3,720
015010
PUBLIC SWIMMING POOL PROGRAM
0
0
0
0
0
015010
SUPPLEMENTAL/COMPREHENSIVE SCHOOL HEALTH - TOB TF
41,000
0
41,000
0
41,000
015010
TOBACCO COMMUNITY INTERVENTION
177,250
0
177,250
0
177,250
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015060
Non -Categorical Tobacco Rebasing
0
0
0
0
0
NON GENERAL REVENUE TOTAL
306,578
0
306,578
0
306,578
3. FEDERAL FUNDS - State
007000
AFRICAN AMERICAN TESTING INITIATIVE (AATI)
0
0
0
0
0
007000
AIDS PREVENTION
203,301
0
203,301
0
203,301
007000
AIDS SURVEILLANCE
0
0
0
0
0
007000
BIOTERRORISM HOSPITAL PREPAREDNESS
0
0
0
0
0
007000
CHILDHOOD LEAD POISONING PREVENTION
0
0
0
0
0
007000
COASTAL BEACH MONITORING PROGRAM
25,385
0
25,385
0
25,385
007000
TUBERCULOSIS CONTROL - FEDERAL GRANT
0
0
0
0
0
007000
WIC ADMINISTRATION
362,250
0
362,250
0
362,250
007000
WIC BREASTFEEDING PEER COUNSELING
42,250
0
42,250
0
42,250
007000
STD FEDERAL GRANT - CSPS
0
0
0
0
0
007000
STD PROGRAM - PHYSICIAN TRAINING CENTER
0
0
0
0
0
007000
STD PROGRAM - PHYSICIANS TRAINING CENTER
0
0
0
0
0
007000
STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP)
0
0
0
0
0
007000
SYPHILIS ELIMINATION
0
0
0
0
0
007000
TITLE X MALE PROJECT
0
0
0
0
0
007000
RYAN WHITE
44,309
0
44,309
0
44,309
007000
RYAN WHITE - EMERGING COMMUNITIES
0
0
0
0
0
007000
RYAN WHITE PART B SUPPLEMENTAL
0
0
0
0
0
007000
RYAN WHITE -AIDS DRUG ASSIST PROG-ADMIN
35,443
0
35,443
0
35,443
007000
RYAN WHITE -CONSORTIA
0
0
0
0
0
007000
STATE INDOOR RADON GRANT
0
0
0
0
0
007000
NATIONAL COMPREHENSIVE CANCER CONTROL PROGRAM
0
0
0
0
0
007000
ORAL HEALTH WORKFORCE ACTIVITIES
0
0
0
0
0
007000
ORAL HEALTH WORKFORCE ACTIVITIES 2010-2011
0
0
0
0
0
007000
PHP - CITIES READINESS INITIATIVE
0
0
0
0
0
007000
PUBLIC HEALTH PREPAREDNESS BASE
122,155
0
122,155
0
122,155
007000
RAPE PREVENTION & EDUCATION GRANT
0
0
0
0
0
007000
IMMUNIZATION FIELD STAFF EXPENSE
0
0
0
0
0
007000
IMMUNIZATION SUPPLEMENTAL
0
0
0
0
0
007000
IMMUNIZATION WIC -LINKAGES
0
0
0
0
0
007000
IMMUNIZATION -WIC LINKAGES
0
0
0
0
0
007000
MCH BGTF-GADSDEN SCHOOL CLINIC
0
0
0
0
0
007000
MCH BGTF-HEALTHY START IPO
0
0
0
0
0
007000
FGTF/FAMILY PLANNING -TITLE X
78,097
0
78,097
0
78,097
007000
FGTF/IMMUNIZATION ACTION PLAN
15,702
0
15,702
0
15,702
007000
HEALTH PROGRAM FOR REFUGEES
0
0
0
0
0
007000
HEALTHY PEOPLE HEALTHY COMMUNITIES
25,541
0
25,541
0
25,541
Version:
4
Page 2 of 7
ATTACHMENT II.
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2010 to September 30, 2011
----------
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
3. FEDERAL FUNDS - State
007000
HIV HOUSING FOR PEOPLE LIVING WITH AIDS
007000
HIV INCIDENCE SURVEILLANCE
007000
COLORECTAL CANCER SCREENING 2009-10
007000
DIABETES PREVENTION & CONTROL PROGRAM
007000
FAMILY PLANNING - TITLE X
007000
FGTF/AIDS MORBIDITY
007000
FGTF/BREAST & CERVICAL CANCER-ADMIN/CASE MAN
007000
FGTF/FAMILY PLANNING TITLE X SPECIAL INITIATIVES
015009
MEDIPASS WAIVER-HLTHY STRT CLIENT SERVICES
015009
MEDIPASS WAIVER-SOBRA
015075
SCHOOL HEALTH/SUPPLEMENTAL
007055
ARRA Federal Grant - Schedule C
015075
Inspections of Summer Feeding Program
FEDERAL FUNDS TOTAL
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001020
TANNING FACILITIES
001020
BODY PIERCING
001020
MIGRANT HOUSING PERMIT
001020
MOBILE HOME AND PARKS
001020
FOOD HYGIENE PERMIT
001020
BIOHAZARD WASTE PERMIT
001020
PRIVATE WATER CONSTR PERMIT
001020
PUBLIC WATER ANNUAL OPER PERMIT
001020
PUBLIC WATER CONSTR PERMIT
001020
NON-SDWA SYSTEM PERMIT
001020
SAFE DRINKING WATER
001020
SWIMMING POOLS
001092
OSDS PERMIT FEE
001092
1 & M ZONED OPERATING PERMIT
001092
AEROBIC OPERATING PERMIT
001092
SEPTIC TANK SITE EVALUATION
001092
NON SDWA LAB SAMPLE
001092
OSDS VARIANCE FEE
001092
ENVIRONMENTAL HEALTH FEES
001092
OSDS REPAIR PERMIT
001170
LAB FEE CHEMICAL ANALYSIS
001170
WATER ANALYSIS -POTABLE
001170
NONPOTABLE WATER ANALYSIS
010304
MQA INSPECTION FEE
001206
Central Office Surcharge
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL
5. OTHER CASH CONTRIBUTIONS - STATE
010304
STATIONARY POLLUTANT STORAGE TANKS
090001
DRAW DOWN FROM PUBLIC HEALTH UNIT
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
81,066
0
81,066
0
81,066
0
0
0
0
0
0
0
0
0
0
1,035,499
0
1,035,499
0
1,035,499
1,410
0
1,410
0
1,410
1,185
0
1,185
0
1,185
0
0
0
0
0
20,350
0
20,350
0
20,350
18,500
0
18,500
0
18,500
11,270
0
11,270
0
11,270
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
54,825
0
54,825
0
54,825
570,694
0
570,694
0
570,694
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
450
0
450
0
450
43,500
0
43,500
0
43,500
722,184
0
722,184
0
722,184
110,251
0
110,251
0
110,251
207,040
0
207,040
0
207,040
OTHER CASH CONTRIBUTIONS TOTAL
Version: 4
317,291 0 317,291 0 317,291
Page 3 of 7
ATTACHMENT H.
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2010 to September 30, 2011
State CHD
County
Total CHD
Trust Fund
CHD
Trust Fund
Other
(cash)
Trust Fund
(cash)
Contribution
Total
6. MEDICAID - STATE/COUNTY
001056 MEDICAID PHARMACY
0
0
0
0
0
001076 MEDICAID TB
0
0
0
0
0
001078 MEDICAID ADMINISTRATION OF VACCINE
15,911
15,911
31,822
0
31,822
001079 MEDICAID CASE MANAGEMENT
0
0
0
0
0
001081 MEDICAID CHILD HEALTH CHECK UP
2,269
3,631
5,900
0
5,900
001082 MEDICAID DENTAL
0
0
0
0
0
001083 MEDICAID FAMILY PLANNING
2,435
21,915
24,350
0
24,350
001087 MEDICAID STD
1,183
1,893
3,076
0
3,076
001089 MEDICAID AIDS
36,537
58,463
95,000
0
95,000
001147 Medicaid HMO Capitation
0
0
0
0
0
001191 MEDICAID MATERNITY
0
0
0
0
0
001192 MEDICAID COMPREHENSIVE CHILD
369
591
960
0
960
001193 MEDICAID COMPREHENSIVE ADULT
107,150
171,450
278,600
0
278,600
001194 MEDICAID LABORATORY
0
0
0
0
0
001208 MEDIPASS $3.00 ADM. FEE
5,135
5,135
10,269
0
10,269
001059 Medicaid Low Income Pool
0
0
0
0
0
001051 Emergency Medicaid
0
0
0
0
0
001058 Medicaid - Behavioral Health
0
0
0
0
0
001071 Medicaid - Orthopedic
0
0
0
0
0
001072 Medicaid - Dermatology
0
0
0
0
0
001075 Medicaid - School Health Certified Match
11,538
18,462
30,000
0
30,000
001069 Medicaid - Refugee Health
0
0
0
0
0
001055 Medicaid - Hospital
0
0
0
0
0
001148 Medicaid HMO Non -Capitation
0
0
0
0
0
001074 Medicaid - Newborn Screening
0
0
0
0
0
MEDICAID TOTAL
182,526
297,451
479,977
0
479,977
7. ALLOCABLE REVENUE -STATE
018000 REFUNDS
0
0
0
0
0
037000 PRIOR YEAR WARRANT
0
0
0
0
0
038000 12 MONTH OLD WARRANT
0
0
0
0
0
ALLOCABLE REVENUE TOTAL
0
0
0
0
0
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
PHARMACY SERVICES
0
0
0
72,991
72,991
LABORATORY SERVICES
0
0
0
36,848
36,848
TB SERVICES
0
0
0
0
0
IMMUNIZATION SERVICES
0
0
0
497,639
497,639
STD SERVICES
0
0
0
0
0
CONSTRUCTION/RENOVATION
0
0
0
0
0
WIC FOOD
0
0
0
937,640
937,640
ADAP
0
0
0
840,000
840,000
DENTAL SERVICES
0
0
0
0
0
OTHER (SPECIFY)
0
0
0
0
0
OTHER (SPECIFY)
0
0
0
0
0
OTHER STATE CONTRIBUTIONS TOTAL
0
0
0
2,385,118
2,385,118
Version: 4 Page 4 of 7
ATTACHMENT IL
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2010 to September 30, 2011
State CUD
County
Total CHD
Trust Fund
CHD
Trust Fund
Other
(cash)
Trust Fund
(cash)
Contribution
Total
9. DIRECT LOCAL CONTRIBUTIONS - COUNTY
008030
Contribution from Health Care Tax
0
817,247
817,247
0
817,247
008034
BCC Contribution from General Fund
0
90,219
90,219
0
90,219
DIRECT COUNTY CONTRIBUTION TOTAL
0
907,466
907,466
0
907,466
10. FEES
AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001060
CHD SUPPORT POSITION
0
2,400
2,400
0
2,400
001077
RABIES VACCINE
0
0
0
0
0
001077
CHILD CAR SEAT PROG
0
0
0
0
0
001077
PERSONAL HEALTH FEES
0
232,971
232,971
0
232,971
001077
AIDS CO -PAYS
0
0
0
0
0
001094
ADULT ENTER. PERMIT FEES
0
0
0
0
0
001094
LOCAL ORDINANCE FEES
0
0
0
0
0
001114
NEW BIRTH CERTIFICATES
0
19,500
19,500
0
19,500
001115
Vital Statistics - Death Certificate
0
52,500
52,500
0
52,500
001117
VITAL STATS-ADM. FEE 50 CENTS
0
600
600
0
600
001073
Co -Pay for the AIDS Care Program
0
0
0
0
0
001025
Client Revenue from GRC
0
0
0
0
0
001040
Cell Phone Administrative Fee
0
0
0
0
0
FEES AUTHORIZED BY COUNTY TOTAL
0
307,971
307,971
0
307,971
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001009
RETURNED CHECK ITEM
0
0
0
0
0
001029
THIRD PARTY REIMBURSEMENT
0
192,329
192,329
0
192,329
001029
HEALTH MAINTENANCE ORGAN. (HMO)
0
0
0
0
0
001054
MEDICARE PART D
0
0
0
0
0
001077
RYAN WHITE TITLE II
0
0
0
0
0
001090
MEDICARE PART B
0
208,557
208,557
0
208,557
001190
Health Maintenance Organization
0
0
0
0
0
005040
INTEREST EARNED
0
4,500
4,500
0
4,500
005041
INTEREST EARNED -STATE INVESTMENT ACCOUNT
0
0
0
0
0
007010
U.S. GRANTS DIRECT
0
587,214
587,214
0
587,214
008010
Contribution from City Government
0
0
0
0
0
008020
Contribution from Health Care Tax not thru BCC
0
0
0
0
0
008050
School Board Contribution
0
0
0
0
0
008060
Special Project Contribution
0
0
0
0
0
010300
SALE OF GOODS AND SERVICES TO STATE AGENCIES
0
450
450
0
450
010301
EXP WITNESS FEE CONSULTNT CHARGES
0
0
0
0
0
010405
SALE OF PHARMACEUTICALS
0
0
0
0
0
010409
SALE OF GOODS OUTSIDE STATE GOVERNMENT
0
0
0
0
0
011001
HEALTHY START COALITION CONTRIBUTIONS
0
360,000
360,000
0
360,000
011007
CASH DONATIONS PRIVATE
0
0
0
0
0
012020
FINES AND FORFEITURES
0
0
0
0
0
012021
RETURN CHECK CHARGE
0
0
0
0
0
028020
INSURANCE RECOVERIES -OTHER
0
0
0
0
0
090002
DRAW DOWN FROM PUBLIC HEALTH UNIT
0
0
0
0
0
011000
GRANT DIRECT -NOVA UNIVERSITY CHD TRAINING
0
0
0
0
0
011000
GRANT -DIRECT
0
0
0
0
0
Version: 4 Page 5 of 7
ATTACHMENT II.
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2010 to September 30, 2011
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
011000
GRANT DIRECT -COUNTY HEALTH DEPARTMENT DIRECT SERVICES
0
011000
DIRECT -ARROW
0
011000
GRANT -DIRECT
0
011000
GRANT -DIRECT
0
011000
GRANT DIRECT -QUANTUM DENTAL
0
011000
GRANT DIRECT -HEALTH CARE DISTRICT PAHOKEE
0
011000
GRANT -DIRECT
0
011000
GRANT -DIRECT
0
011000
GRANT -DIRECT
0
011000
GRANT -DIRECT
0
011000
GRANT -DIRECT
0
011000
GRANT DIRECT -ARROW
0
010402
Recycled Material Sales
0
010303
FDLE Fingerprinting
0
007050
ARRA Federal Grant
0
001010
Recovery of Bad Checks
0
008065
FCO Contribution
0
011006
Restricted Cash Donation
0
028000
Insurance Recoveries
0
001033
CMS Management Fee - PMPMPC
0
010400
Sale of Goods Outside State Government
0
010500
Refugee Health
0
005045
Interest Earned -Third Party Provider
0
005043
Interest Earned-Contract/Grant
0
010306
DOH/DOC Interagency Agreement
0
008040
BCC Grant/Contract
0
011002
ARRA Federal Grant - Sub -Recipient
0
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL
0
12. ALLOCABLE REVENUE -COUNTY
018000
REFUNDS
0
037000
PRIOR YEAR WARRANT
0
038000
12 MONTH OLD WARRANT
0
COUNTY
ALLOCABLE REVENUE TOTAL
0
13. BUILDINGS -COUNTY
ANNUAL RENTAL EQUIVALENT VALUE
0
GROUNDS MAINTENANCE
0
OTHER (SPECIFY)
0
INSURANCE
0
UTILITIES
0
OTHER (SPECIFY)
0
BUILDING MAINTENANCE
0
BUILDINGS TOTAL
0
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
EQUIPMENT/VEHICLE PURCHASES
0
Version:
4
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7,980
7,980
0
7,980
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
45,207
45,207
0
45,207
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1,406,237
1,406,237
0
1,406,237
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
501,072
501,072
0
0
0
0
0
0
0
0
0
0
0
0
0
0
62,633
62,633
0
0
0
0
0
0
51,185
51,185
0
0
614,890
614,890
0
0
0
0
Page 6 of 7
ATTACHMENT H.
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2010 to September 30, 2011
State CHD County
Total CHD
Trust Fund CHD
Trust Fund
Other
(cash) Trust Fund
(cash)
Contribution
Total
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
VEHICLE INSURANCE 0 0
0
0
0
VEHICLE MAINTENANCE 0 0
0
0
0
OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0
0
0
0
OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0
0
0
0
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0
0
0
0
GRAND TOTAL CHD PROGRAM 5,140,848 2,919,125
8,059,973
3,000,008
11,059,981
Version: 4 Page 7 of 7
ATTACHMENT IL
MONROE COUNTY
HEALTH DEPARTMENT
Part III. Planned Staffing, Clients,
Services,
And Expenditures By Program Service Area Within Each
Level Of
Service
October 1, 2010 to September 30, 2011
Quarterly Expenditure Plan
FTE's
Clients
1st
2nd
3rd
4th
Grand
(0.00)
Units
Services
(Whole dollars only)
State
County
Total'
A. COMMUNICABLE DISEASE CONTROL:
IMMUNIZATION (101)
5.88
5,696
20,000
119,577
102,495
119,577
102,495
106,399
337,745
444,144
STD(102)
1.85
296
1,542
40,517
34,729
40,517
34,729
104,103
46,389
150,492
A.I.D.S. (103)
22.05
650
8,700
543,027
465,451
543,027
465,451
929,523
1,087,433
2,016,956
TB CONTROL SERVICES (104)
1.45
303
1,549
38,828
33,281
38,828
33,281
142,715
1,503
144,218
COMM. DISEASE SURV. (106)
0.93
0
2,500
28,767
24,657
28,767
24,657
64,174
42,674
106,848
HEPATITIS PREVENTION (109)
1.71
718
3,394
53,064
45,483
53,064
45,483
190,944
6,150
197,094
PUBLIC HEALTH PREP AND RESP (116)
2.48
0
500
51,160
43,851
51,160
43,851
190,022
0
190,022
VITAL STATISTICS (180)
1.25
2,097
5,800
22,728
19,481
22,728
19,481
0
84,418
84,418
COMMUNICABLE DISEASE SUBTOTAL
37.60
9,760
43,985
897,668
769,428
897,668
769,428
1,727,880
1,606,312
3,334,192
B. PRIMARY CARE:
CHRONIC DISEASE SERVICES (210)
0.01
0
0
5,704
4,890
5,704
4,890
21,188
0
21,188
TOBACCO PREVENTION (212)
2.29
0
446
53,533
45,885
53,533
45,885
198,836
0
198,836
W.I.C. (22 1)
7.30
3,394
29,978
141,800
121,543
141,800
121,543
526,686
0
526,686
FAMILY PLANNING (223)
3.77
1,020
5,095
76,232
65,342
76,232
65,342
198,777
84,371
283,148
IMPROVED PREGNANCY OUTCOME (225)
0.00
0
0
0
0
0
0
0
0
0
HEALTHY START PRENATAL (227)
3.79
570
10,500
80,288
68,818
80,288
68,818
0
298,212
298,212
COMPREHENSIVE CHILD HEALTH (229)
0.43
310
651
9,173
7,862
9,173
7,862
29,996
4,074
34,070
HEALTHY START INFANT (231)
2.77
330
5,500
45,944
39,380
45,944
39,380
102,493
68,155
170,648
SCHOOL HEALTH (234)
4.89
0
115,000
91,799
78,685
91,799
78,685
316,355
24,613
340,968
COMPREHENSIVE ADULT HEALTH (237)
17.50
3,060
14,010
386,272
33 L091
386,272
331,091
444,153
990,573
1,434,726
DENTAL HEALTH (240)
0.00
0
0
0
0
0
0
0
0
0
PRIMARY CARE SUBTOTAL
42.75
8,684
181,180
890,745
763,496
890,745
763,496
1,838,484
1,469,998
3,308,482
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COASTAL BEACH MONITORING (347)
0.73
1,257
1,263
28,197
24,168
28,197
24,168
104,730
0
104,730
LIMITED USE PUBLIC WATER SYSTEMS (357)
0.00
0
0
46
39
46
39
102
68
170
PUBLIC WATER SYSTEM (358)
0.00
0
0
18
16
18
16
41
27
68
PRIVATE WATER SYSTEM (359)
0.00
0
0
26
22
26
22
58
38
96
INDIVIDUAL SEWAGE DISP. (361)
10.55
7,000
12,500
212,277
181,951
212,277
181,951
788,456
0
788,456
Group Total
11.28
8,257
13,763
240,564
206,196
240,564
206,196
893,387
133
893,520
Facility Programs
FOOD HYGIENE (348)
0.64
77
365
11,134
9,543
11,134
9,543
41,354
0
41,354
BODY ART (349)
0.03
6
12
575
492
574
492
2,133
0
2,133
GROUP CARE FACILITY (351)
0.28
75
119
4,971
4,261
4,971
4,261
11,091
7,373
18,464
MIGRANT LABOR CAMP (352)
0.00
0
0
0
0
0
0
0
0
0
HOUSING,PUBLIC BLDG SAFETY,SANITATION
(353)0.03
0
6
694
595
694
595
1,548
1,030
2,578
MOBILE HOME AND PARKS SERVICES (354)
0.56
90
230
9,764
8,370
9,764
8,370
36,268
0
36,268
SWIMMING POOLS/BATHING (360)
2.09
539
1,590
37,146
31,839
37,146
31,839
137,970
0
137,970
BIOMEDICAL WASTE SERVICES (364)
0.22
117
225
4,289
3,676
4,289
3,676
15,930
0
15,930
TANNING FACILITY SERVICES (369)
0.02
7
15
298
255
298
255
1,106
0
1,106
Group Total
3.87
911
2,562
68,871
59,031
68,870
59,031
247,400
8,403
255,803
Version: 2 Page 1 of 2
ATTACHMENT H.
MONROE COUNTY
HEALTH DEPARTMENT
Part III. Planned Staffing, Clients, Services,
And Expenditures
By Program Service Area Within Each
Level Of
Service
October 1, 2010 to September 30, 2011
Quarterly Expenditure Plan
FFE's
Clients
1st
2nd
3rd
4th
Grand
(0.00)
Units
Services
(Whole dollars
only)
State
County
Total
C. ENVIRONMENTAL HEALTH:
Groundwater Contamination
STORAGE TANK COMPLIANCE (355)
1.63
389
774
36,653
31,417
36,653
31,417
136,140
0
136,140
SUPER ACT SERVICE (356)
0.15
0
6
2,876
2,465
2,876
2,465
6,416
4,266
10,682
Group Total
1.78
389
780
39,529
33,882
39,529
33,882
142,556
4,266
146,822
Community Hygiene
OCCUPATIONAL HEALTH (344)
0.01
0
4
127
109
127
109
0
472
472
CONSUMER PRODUCT SAFETY (345)
0.00
0
0
0
0
0
0
0
0
0
INJURY PREVENTION (346)
0.00
0
0
0
0
0
0
0
0
0
LEAD MONITORING SERVICES (350)
0.00
0
0
0
0
0
0
0
0
0
PUBLIC SEWAGE (362)
0.00
0
0
0
0
0
0
0
0
0
SOLID WASTE DISPOSAL (363)
0.01
0
0
98
84
98
84
218
146
364
SANITARY NUISANCE (365)
0.19
90
250
3,463
2,968
3,463
2,968
7,726
5,136
12,862
RABIES SURVEILLANCE/CONTROL SERVICES (366)0.02
2
11
434
372
434
372
968
644
1,612
ARBOVIRUS SURVEILLANCE (367)
0.01
0
3
244
209
244
209
545
361
906
RODENT/ARTHROPOD CONTROL (368)
0.01
0
6
184
157
184
157
409
273
682
WATER POLLUTION (370)
0.00
0
2
42
36
42
36
94
62
156
AIR POLLUTION (371)
0.00
0
0
5
4
5
4
10
8
18
RADIOLOGICAL HEALTH (372)
0.02
0
0
298
255
298
255
664
442
1,106
TOXIC SUBSTANCES (373)
0.81
312
313
16,013
13,725
16,013
13,725
0
59,476
59,476
Group Total
1.08
404
589
20,908
17,919
20,908
17,919
10,634
67,020
77,654
ENVIRONMENTAL HEALTH SUBTOTAL
18.01
9,961
17,694
369,872
317,028
369,871
317,028
1,293,977
79,822
1,373,799
D. NON -OPERATIONAL COSTS:
SPECIAL CONTRACTS (599)
0.00
0
0
0
0
0
0
0
0
0
ENVIRONMENTAL HEALTH SURCHARGE (399)
0.00
0
0
10,875
10,875
10,875
10,875
43,500
0
43,500
NON -OPERATIONAL COSTS SUBTOTAL
0.00
0
0
10,875
10,875
10,875
10,875
43,500
0
43,500
TOTAL CONTRACT
98.36
28,405
242,859
2,169,160
1,860,827 2,169,159
1,860,827 4,903,841
3,156,132
8,059,973
Version: 2 Page 2 of 2
ATTACHMENT III
MONROE COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period), if so requested by the department.
The applicant assures that it will comply with:
Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
benefiting from federal financial assistance.
Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance.
3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance.
4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees
for the period during which such assistance is provided. The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in violation of the above statutes, regulations, guidelines, and
standards. In the event of failure to comply, the applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, to include assistance being terminated and further assistance
being denied.
ATTACHMENT IV
MONROE COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Gato Building
Administration
Nursing
Environmental Health
Health Care Center
Location
1100 Simonton Street
Key West, FL 33040
3134 Northside Drive
Building B
Key West, FL 33040
Murray E. Nelson Government Center 102050 Overseas Highway
Environmental Health Key Largo, FL 33037
Roosevelt Sands Center
Ruth Ivins Center
105 Olivia Street
Key West, FL 33040
3333 Overseas Highway
Marathon, FL 33050
Owned By
Monroe County
MW &JC, LLC and
Leased to
Monroe County
For MCHD use
Monroe County
City of Key West
subject to Inter -local
Agreement with Monroe
County for MCHD use
Monroe County
Roth Building 50 High Point Road Monroe County
Tavernier, FL 33070
ATTACHMENT V
MONROE COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT.
CONTRACT YEAR
STATE COUNTY
TOTAL
2007-2008
$ $
$ _
2008-2009
$ $
$ _
2009-2010
$ $
$ _
2010-2011
$ $
$ _
2011-2012
$ $
$ _
PROJECT TOTAL
$ - $ _
$ _
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NAME:
LOCATION/ ADDRESS:
PROJECT TYPE:
NEW BUILDING
ROOFING
RENOVATION
PLANNING STUDY
NEW ADDITION
OTHER
SQUARE FOOTAGE:
PROJECT SUMMARY: Describe scope of work in reasonable detail
ESTIMATED PROJECT INFORMATION:
START DATE (initial expenditure of funds)
COMPLETION DATE:
DESIGN FEES:
$
CONSTRUCTION COSTS:
$
FURNITURE/EQUIPMENT
$
TOTAL PROJECT COST:
$ -
COST PER SQ FOOT: $
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
ATTACHMENT VI
MONROE COUNTY HEALTH DEPARTMENT
PRIMARY CARE
"Primary Care" as conceptualized for the county health departments and for the use of categorical
Primary Care funds (revenue object code 015040) is defined as:
"Health care services for the prevention or treatment of acute or chronic medical conditions or minor
injuries of individuals which is provided in a clinic setting and may include family planning and
maternity care."
Indicate below the county health department programs that will be supported at least in part with
categorical Primary Care funds this contract year:
X Comprehensive Child Health (229/29)
X Comprehensive Adult Health (237/37)
Family Planning (223/23)
Maternal Health/IPO (225/25)
Laboratory (242/42)
Pharmacy (241/93)
Other Medical Treatment Program (please identify)
Describe the target population to be served with categorical Primary Care funds.
The primary population served is under and non-insured.
Does the health department intend to contract with other providers for the delivery of primary health
care services using categorical (015040) Primary Care funds? If so, please identify the provider(s),
describe the services to be delivered, and list the anticipated contractual amount by provider. In
addition, contract providers are required to provide data on patients served and the services provided
so that the patients may be registered and the service data entered into HMS.
No