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Item M1BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: April 20, 2011 Division: Monroe County Health Department Bulk Item: Yes x No Staff Contact: Robert Eadie 809 -5610 AGENDA ITEM WORDING: Approval of amendment to the core contract by the Monroe County Health Department which are required by the State of Florida, Department of Health. 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. PREVIOUS RELEVANT BOCC ACTION: 11/17 /10 Board approved the core contract between Monroe County Board of County Commissioners and the State of Florida, Department of Health for public health services provided by Monroe County Health Department. On December 15, 2010 Board approved Resolution No. 464 -2010 for the fee schedule for primary care and public health services provided by Monroe County Health Department. CONTRACT /AGREEMENT CHANGES: Add County contract manager information in Section 9.b.of contract. In -kind contribution amounts are updated for new information/calculations. Attachment 1I, Part IL adjustments updated to revenue sources from Schedule C allocations, plus updates to program revenues based on the most current projections based on 6 months of history. Attachment II, Part III: adjustments made to expenses, FTEs and services by programs to reflect current projections based on 6 months of history. Attachment II has been updated to reflect changes in Trust Fund Balance, based on Part lI and Part III above. STAFF RECOMMENDATIONS: Approval, TOTAL COST: n/a INDIRECT COST: BUDGETED: Yes X No COST TO COUNTY: n/a SOURCE OF FUNDS: REVENUE PRODUCING: Yes _ No AMOUNT PER MONTH_ APPROVED BY: County Atty OMB/Purchasing isk Management g g DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM # Year Revised 1109 AMENDMENT TO CORE CONTRACT THIS AMENDMENT to agreement is made and entered into this day of , 20 , between MONROE COUNTY (COUNTY) and STATE OF FLORIDA DEPARTMENT OF HEALTH, Monroe County Health Department. WHEREAS, a Core Contract (Contract) was entered into November 17, 2010, for the term October 1, 2010 through September 30, 2011, between the parties, providing cooperation and funding of State Health department services in Monroe County; and WHEREAS, it is desired to provide in Section 9 contact information for the County's contract manager and to update several exhibits. NOW THEREFORE, IN CONSIDERATION of the mutual covenants contained herein the parties agree to the amended agreement as follows: 1 . Section 9.b. of the Contract dated November 17, 2010, shall be revised by amending the language regarding County Contract Manager to be, For the County: Roman Gastesi, County Administrator, Gato Building 1 100 Simonton Street, Key West, Florida, 305- 292 -4441; 2. Attachment II, Part II in -kind contribution amounts are updated for new information /calculations; 3. Attachment 11, Part 11: adjustments updated to revenue sources from Schedule C allocations, plus updates to program revenues based on the most current projections based on 6 months of history; 4. Attachment 11, Part III: adjustments made to expenses, FTEs and services by programs to reflect current projections based on 6 months of history; 5. Attachment II has been updated to reflect changes in Trust Fund Balance, based on Part II and Part III above. 6. The Department shall send a copy of this amendment to the State Department of Health, Bureau of Budget Management. 7. The remaining provisions of the Contract effective November 10, 2010, shall remain in full force and effect. 8. The signatories below represent that they have full authority to execute this amendment on behalf of their respective agencies. IN WITNESS WHEREOF, the parties have set their hands and seal on the day and year first above written. Mory Vandgh Brook A inistrative Service FOR COUNTY: (SEAL) or ATTEST: DANNY L. KOLHAGE, CLERK Deputy Clerk BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA Mayor /Chairman 3 .. i1J V ... y// /// Date 2 n n K1 h E- r-_ LO M QD 0) m F O F Z c LLJ C 2 v a a F- z LU Q f,L W r4� Q F- LU 2 z O U w O w z O 2 H a CL Q) M r- L O O j O U U) a �r t0 ❑ U � � � , TZ U � L N N W q m v L f 0 d VJ E U m LiJ o m 9 a N L E >- o U O ' c� o o ° U a L � ON 3 o 'C3 O " U ❑o N n L c� a� U � � ca C N n U o o .c o E � m a) a) .o 0 dQ a N M U r" �U "Q O O Q U w o m co O v c LL a � N �a c � c� rn m c .0 o a) U Q L o a ' � o �a m o m N � r = L U a� � O CC1 O 6 O z 1, GENERAL REVENUE - STATE 015040 ALGICESSPOOL IDI;N'I'IFICA"]'ION AND ELIMINATION 129,414 0 129,414 0 129,414 015040 ALGICONT'R T'O CHDS -AIDS PATILN "F CARE 370,000 0 370,000 0 370,000 015040 ALGlCONTR T'O CHDS -AIDS PATIENT CARE NETWORK 0 0 0 0 0 015040 ALG /CONTR'1'O CHDS -AIDS PREV & SURV & }MELD STAFF 93,724 0 93,724 0 93,724 015040 ALG /CONTR TO CHDS - DEN'I'AL PROGRAM 0 0 0 0 0 015040 ALG /CONTR TO CHDS- MIGRANT LABOR CAMP 0 0 0 0 0 015040 MINORITY OUTREACII- PENALVE:RCLINIC - MIAMI -DADS 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 - FSCAM131A 0 0 0 0 0 015040 STD GENERAL REVENUE 18,617 0 18,617 0 18,617 015040 VARICLLLA IMMUNIZATION R.F:QUIREMLNT 3,387 0 3,387 0 3,387 015040 HEAL'T'HY 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 - 0 0 0 0 0 015040 LA LIGA CON'T'RA El., CANCER 0 0 0 0 0 015040 MANA'T'EE 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 INI'T'IATIVES 0 0 0 0 0 015040 DUVAI. TEEN PREGNANCY PREVENTION 0 0 0 0 0 035040 Fl. CLPPP SCREENING & CASE MANAGEMENT 0 0 0 0 0 015040 FL IIEPAT'ITIS & LIVER FAILURE PREVEN'C10N /CON7'1t01, 144,000 0 144,000 0 144,000 015040 HLAUFAY BEACHES MONITORING 28,965 0 28,965 0 28,965 015040 ALGIIPO I IEALTHY START' /11 0 0 0 0 0 015040 ALGIPRIMARY CARE. 194,161 0 194,161 0 194,161 015040 ALGISCHOOI,IIFALTII /SUPPLEMENTAL 41,981 0 41,981 0 41,981 015040 CHILD ITEAI.A'H MEDICAL SERVICES 0 0 0 0 0 015040 COMMUNITY SMILES - MIAMI -DADI: 0 0 0 0 0 01 5040 COMMUNITY TB PROGRAM 39,592 0 39,592 0 39,592 015040 ALG /CONTR. TO CIIDS- IMMUNIZ /VI']ON OUTREACH 4,722 0 4,722 0 4,722 015040 ALG /CONTR. 'CO CIIDS - INDOOR AIR ASSIST FROG 0 0 0 0 0 015040 ALG /CONTR. TO CI IDS -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 Cl IDS-PRIM CARE. 15,589 0 15,589 0 15,589 015040 ALG /FAMILY PLANNING 57,494 0 57,494 0 57,494 015050 ALG /CONTR TO CIIDS 1,454,945 0 1,454,945 0 1,454,945 GENERAL REVENUE TOTAL 2,596,591 0 2,596,591 0 2,596,591 2. HON GENERAL REVENUE - STA'T'E 015010 ALG /CONTRTO CHDS- RE• BASING 'T'OBACCOT'F 21,117 0 21,117 0 21,117 015010 ALG /CONT'R. TO CHDS- BIOMEDICAI. WASTE/DEP ADM TF 1,771 0 1,771 0 1,771 015010 ALG /CONT'R. TO CHDS -SAFE DRINKING WATER PRG /DE:P 0 0 0 0 0 015010 BASIC SCI IOOL HEALTH - TOBACCO TF 0 0 0 0 0 015020 CI1D PROGRAM SUPPORT 0 0 0 0 0 015010 ENVIRONMENTAL, IIEALTII PACE PROJECTS 0 0 0 0 0 015010 FOOD AND WATERBORNE DISEASE PROGRAM ADM 0 0 0 0 0 015010 FULL SERVICE SCHOOLS -TOBACCO TF 61,720 0 61,720 0 61,720 015010 IMMUNIZATION SPECIAL. PROJECT 3,720 0 3,720 0 3,720 015010 PUBLIC SWIMMING POOL PROGRAM 0 0 0 0 0 015010 SUPPLEMENTAIXOMPREHENSIVE• SCHOOL HEALTH - 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 10,800 0 10,80Q 0 10,800 015020 TRANSFER FROM ANOTTIER 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 317,378 0 317,378 0 317,378 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 SURVCILLANCF, 0 0 0 0 0 007000 BIOTERRORISM HOSPITAI. PREPAREDNESS 0 0 0 0 0 007000 CHILDHOOD LEAD POISONING PREVENTION 0 0 0 0 0 007000 COASTAL BEACII MONI'T'ORING 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 BREAS FEEDING PEER COUNSELING 42,250 0 42,250 0 42,250 007000 STD FEDERAL GRANT - CSPS 0 0 0 0 0 007000 S I) PROGRAM - PHYSICIAN TRAINING CENTER 0 0 0 0 0 007000 STD PROGRAM - PHYSICIANS TRAINING CENTER 0 0 0 0 0 007000 S'I'D PROGRAM INFERTILITY PREVENTION PROJECT (IPP) 0 0 0 0 0 007000 SYPHILIS ELIMINA'T'ION 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 PROD -ADM1N 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 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 PIMP - CITIES READINESS INITIATIVE 53,867 0 53,867 0 53,867 007000 PUBLIC IIFAL;HI PREPAREDNESS BAST? 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 IMMUNVATION WIC - LINKAGES 0 0 0 0 0 007000 IMMUNIZATION -WIC LINKAGES 0 0 0 0 0 007000 MCH BGT'F- GADSDEN SCHOOL CLINIC 0 0 0 0 0 007000 MCH BGT F' IEAI:TIIY START IPO 0 0 0 0 0 007000 FGTFIFAMILY PLANNING -TITLE X 78,097 0 78,097 0 78,097 007000 FG1171MMUNIZATION 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 2. NON GENERAL REVENUE -STATE 3. FEDERAL FUNDS - State 007000 I {IV IIGUSING FOR PEOPLE LIVING WIT11 AIDS 0 0 0 0 0 007000 HIV INCIDENCE: SURVEILLANCE 0 0 0 0 0 007000 COLORECTAL CANCER SCREENING 2009 -10 0 0 0 0 0 007000 DIABETES PREVENTION & CONTROL PROGRAM 0 0 0 0 0 007000 FAMILY PLANNING - TITLE X 0 0 0 0 0 007000 FGTI: /AIDS MORBIDITY 0 0 0 0 0 007000 TG'I'F / BREAST& Cl- ADMINICASI MAN 0 0 0 0 0 007000 FG l'F /FAMILY PLANNING 'CCl'LE X SPECIAL INITINFIVES 0 0 0 0 0 015009 MEDIPASS WAIVER- IILTIIY STRT CLIENT SERVICES 0 0 0 0 0 015009 MEDIPASS WAIVER -SOBRA 0 0 0 0 0 015075 SCHOOL HEALTH /SUPPLEMENTAL 81,066 0 81,066 0 81,066 007055 ARRA Federal Grant - Schedule C 0 0 0 0 0 015075 Inspections of Summer Feeding Program 421 0 421 0 421 FEDERAL FUNDS TOTAL 1,089,787 0 1,089,787 0 1,089,787 4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE 001020 TANNING FACILITIES 1,410 0 1,410 0 1,410 001020 BODY PIERCING 1,185 0 1,185 0 1,185 001020 MIGRANT HOUSING PERMIT 0 0 0 0 0 001020 MOBILE IiOME AND PARKS 20,350 0 20,350 0 20,350 001020 FOOD EIYGIBNE PERMIT 18,500 0 18,500 0 18,500 001020 BIOIIAZARD WASTE PERMIT 11,270 0 1 1,270 0 11,270 001020 PRIVATE. WATER CONSTIt PERMIT 0 0 0 0 0 001020 PUBLIC WR'I'ER ANNUAL, OPE:R PERM IT 0 0 0 0 0 001020 PUBLIC WATER CONSTR PERMIT 0 0 0 0 0 001020 NON -SDWA SYSTEM PERMIT 0 0 0 0 0 001020 SAFE DRINKING WATER 0 0 0 0 0 001020 SWIMMING POOLS 54,825 0 54,825 0 54,825 001092 OSDS PERMIT FEE 554,653 0 554,653 0 554,653 001092 I& M ZONED OPERATING PERMIT 0 0 0 0 0 001092 AEROBIC OPERATING PERMIT 0 0 0 0 0 001092 SEPTIC TANK SITE EVALUATION 0 0 0 0 0 001092 NON SDWA LAB SAMPLE 0 0 0 0 0 001092 OSDS VARIANCE FEE 0 0 0 0 0 001092 ENVIRONMENTAL I IE ALI'H FEES 0 0 0 0 0 001092 OSDS REPAIR PERMIT 0 0 0 0 0 001170 LAB FEE. CHEMICAL ANALYSIS 0 0 0 0 0 001170 WNFER ANALYSIS - POTABLE 0 0 0 0 0 001170 NONPOTABLE WA"I'ER ANALYSIS 0 0 0 0 0 010304 MQA INSPECTION FEE 450 0 450 0 450 001206 Central Office Surcharge 35,000 0 35,000 0 35,000 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 697,643 0 697,643 0 697,643 5. OTHER CASH CONTRIBU'T'IONS - STATE 010304 STATIONARY POLLUTANT STORAGE TANKS 110,251 0 110,251 0 1 10,251 090001 DRAW DOWN FROM PUBLIC HL-ALTII UNIT 0 0 0 0 0 OTHER CASK[ CONTRIBUTIONS TOTAL 110,251 0 110,251 0 1 10,251 6. MEDICAID - STATEICOUNTY 001056 MEDICAID PHARMACY 0 0 0 0 0 001076 MI DICAID TJ3 0 0 0 0 0 001078 MEDICAID ADMINISTRIV ION OF VACCINE- 15,911 15,911 31,822 0 31,822 001079 MEDICAID CASE MANAGEMENT 0 0 0 0 0 001081 MEDICAID CHILI) HEAL; H 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 Capilation 0 0 0 0 0 001191 MEDICAID MA "FERNIT'Y 0 0 0 0 0 001192 MEDICAID COMPREHENSIVECHILD 369 591 960 0 960 001193 MEDICAID COMPREHE:NSIVI ADULT 107,150 171,450 278,600 0 278,600 001194 MEDICAID LABORATORY 0 0 0 0 0 001208 MEDIPASS $3.00 ADM. FEE 5,335 5,135 10,269 0 10,269 001059 Medicaid Low Income Pool 0 0 0 0 0 001051 lamergency Medicaid 0 0 0 0 0 001058 Medicaid - Behavioral Health 0 0 0 0 0 001071 Medicaid - Oithopedic 0 0 0 0 0 001072 Medicaid - Dermatology 0 0 0 0 0 061075 Medicaid - School Health Certified Match 11,538 18,462 30,000 0 30,000 001069 Medicaid - Refugee Health 23,076 36,924 60,000 0 60,000 001055 Medicaid - Hospital 0 0 0 0 0 001148 Medicaid HMO Non - Capitation 0 0 0 0 0 001674 Medicaid • Newborn Screening 0 0 0 0 0 MEDICAID TOTAL 205,602 334,375 539,977 0 539,977 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 73,991 73,991 LA130RKFORY SERVICES 0 0 0 36,848 36,848 TB SERVICES 0 0 0 0 0 IMMLJNIGA"I'ION SERVICES 0 0 0 497,639 497,639 STD SERVICES 0 0 0 0 0 CONST'RUCT'ION /RENOVATION 0 0 0 0 0 WIC FOOD 0 0 0 937,640 937,640 ADAP 0 0 0 711,562 711,562 DENTA1, SERVICE•S 0 0 0 0 0 O7'HFR (SPECIFY) 0 0 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 2,257,680 2,257,680 i.[tl�. - 31�a ��77�11 :::C +T:3:E�1. ;3173YK�lil►Tl ll' t�7�i77t.1�Y�lT�]7:i�Y�71t711�1 LI)►1�fli]7P►�t�l 001060 CIID SUPPORT POSITION 0 2,400 2,400 0 2,400 001077 RABIES VACCINE 0 0 0 0 0 001077 CIIILD CAR SEAT PROG 0 0 0 0 0 001077 PERSONAL HEALTH FEES 0 259,840 259,840 0 259,840 001077 AIDS CO -PAYS 0 0 0 0 0 001094 ADULT ENTER. PERMIT FEES 0 0 0 0 0 001094 LOCAL ORDINANCE FEES 0 66,600 66,600 0 66,600 001114 NEW BIRTH CERTIFICATES 0 24,000 24,000 0 24,000 001115 Vital Statistics - Death Cer€ificate 0 52,500 52,500 0 52,500 001117 VITAL STATS -ADM. FEE 50 CENTS 0 810 810 0 810 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 0 406,150 406,150 0 406,150 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 001009 RETURNED CHECK I'T'EM 0 0 0 0 0 001029 THIRD PARTY REIMBURSEMENT 0 192,329 192,329 0 192,329 001029 11EALTH MAINTENANCE ORGAN. (IIMO) 0 0 0 0 0 001054 MEDICARE PART I) 0 0 0 0 0 001077 RYAN WHITE TITLE 11 0 0 0 0 0 001090 MEDICARE PART B 0 208,557 208,557 0 208,557 001 190 1lcalih Maintenance Organisation 0 0 0 0 0 005040 INT'ERF.ST F:ARNL'D 0 4,500 4,500 0 4,500 005041 IN'I'ERES'1' EARNED -SLATE 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 I lealth Care Tax not thin 13CC 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 01' GOODS AND SERVICES TO STATE AGENCIES 0 450 450 0 450 010301 EXP WI'T'NESS FEE CONSULTNT CHARGES 0 0 0 0 0 010405 SALE OF PHARMACEUTICALS 0 0 0 0 0 010409 SALT; 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 HEAL :1'11 UNIT 0 0 0 0 0 011000 GRANF DIRECT-NOVA UNIVERSITY CHD TRAINING 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 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 11, OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 011000 GRANT DIRECT - COUNTY REALTR DEPARTMF,NT I)]RECk' 011000 DIRECT-ARROW 011000 GRANT - DIRECT 011000 GRANT- DIRECT 011000 GRANT DIRECT- QUAN'T'UM DENTAL 011000 GRANT DIRECT- ITEALTH CARE DISTRICT PAI IOKEI' 011000 GRANT -DIR 'CI' 011000 GRAND- DIRECT 011000 GRANT-DIRECT 011000 GRANT - DIRECT 011000 GRANT- DIRECT 01 1000 GRANT DIRECT -ARROW 010402 Recycled Material Sales 010303 PDLk: Fingerprinting 007050 ARRA Federal Grant 001010 Recovery of Bad Checks 008065 FCO Contribution 011006 Restricted Cash Donation 028000 Insurance Recoveries 001033 CMS Management Pee - PMPMPC 010400 Sale of Goods Outside State Gownunent 010500 Refugee Health 005045 Interest Carved -Third Party Provider 005043 Interest Earned- Contract/Grant 010306 DOII /DOC Interagency Agreement 008040 BCC Grant/Contract 011002 ARRA Federal Grant - Sub - Recipient OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 12. ALLOCABLE REVENUE - COUNTY 018000 REFUNDS 037000 PRIOR YEAR WARRANT 038000 12 MONTH OLD WARRANT COUNTY ALLOCABLE REVENUE TOTAL. 13. BUILDINGS - COUNTY ANNUAL RENTAL EQUIVALENT VALUE GROUNDS MAINTENANCE OTI IFR (SPECIFY) INSURANCE UTILITIES OTHER (SPC:CIFY) BUILDING MAINTENANCE BUILDINGS TOTAL 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY EQUIPMT?N'I'IVETIICLT? PURCIIASF,S 0 0 0 0 0 0 0 0 0 0 0 0 0 p 0 0 0 0 a o 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 a o 0 0 0 6 0 6 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 a 0 0 0 0 0 0 0 7,980 7,980 0 7,980 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 a o 0 0 0 45,207 45,207 0 45,207 0 a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 1,406,237 1,406237 0 1,406,237 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 501,072 501,672 0 0 p 0 0 0 0 0 0 0 6 0 a 0 0 0 0 0 62,633 62,633 6 0 p 0 0 0 0 a 51,185 51,185 0 0 0 614,890 614,890 0 0 0 0 0 A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION (101) STD (102) A.I.D.S. (103) TB CONTROL SERVICES (104) COMM, DISEASE SURV. (106) HEPATITIS PREVENTION (109) PUBLIC IIEALTH PREP AND RE-SP (1 16) VITAL STATISCICS (I 8o) COMMUNICABLE DISEASE SUBTOTAL B. PRIMARY CARE: CHRONIC DISEASE. SERVICES (210) TOBACCO PREVENTION (212) W.T.C. (221) FAMILY PLANNING (223) IMPROVED PREGNANCY OUTCOME (225) HEALTHY START PRENATAL (227) COMPREHENSIVE CHILD HEALTH (229) IJEAI;THY START INFANT (231) SCHOOL HEALTH (234) COMPREHENSIVE ADULT HEALTH (237) DENTAL I IEAI, ;I (240) PRIMARY CARE SUBTOTAL C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COASTAL BEACH MONITORING (347) LIMITED USE?. PUBLIC WATER SYSTEMS (357) PUBLIC WATER SYSTEM (358) PRIVATE WATER SYSTEM (359) INDIVIDUAL SEWAGE DISP. (361) Group Total Facility Programs FOOD HYGIENE (348) BODY ART (349) GROUP CARL; FACILITY (351) MIGRANT LABOR CAMP (352) 1EOUSING,PUBLIC BLDG SAFETY,SANITATION MOBILE HOME: AND PARKS SERVICES (354) SWIMMING POOLSlBA "1 -1ING (360) BIOMEDICAL WASTE- SERVICES (364) TANNING FACILITY SERVICES (369) Group 'Total 5.88 5,696 20,000 119,577 102,495 119,577 102,495 260,590 183,554 444,144 1.85 296 1,542 40,517 34,729 40,517 34,729 104,103 46,389 150,492 22.05 650 8,700 543,027 465,451 543,027 465,451 869,387 1,147,569 2,016,956 1.45 303 1,549 38,828 33,281 38,828 33,281 142,715 1,503 144,218 0.93 0 2,500 28,767 24,657 28,767 24,657 64,174 42,674 106,848 1.71 718 3,394 53,064 45,483 53,064 45,483 190,944 6,150 197,094 2.48 0 500 51,160 43,851 51,160 43,851 190,022 0 190,022 1.25 2,097 5,800 22,728 19,481 22,728 19,481 0 84,418 84,418 37.60 9,760 43,985 897,668 769,428 897,668 769,428 1,821,935 1,512,257 3,334,192 0.01 0 0 5,704 4,890 5,704 4,890 21,188 0 21,188 2.29 0 446 53,533 45,885 53,533 45,885 198,836 0 198,836 7.30 3,394 29,978 141,800 121,543 141,800 121,543 526,686 0 526,686 3.77 1,020 5,095 76,232 65,342 76,232 65,342 198,777 84,371 283,148 0.00 0 0 0 0 0 0 0 0 0 3.79 570 10,500 80,288 68,818 80,288 68,818 0 298,212 298,212 0.43 310 651 9,173 7,862 9,173 7,862 29,996 4,074 34,070 2.77 330 5,500 45,944 39,380 45,944 39,380 102,493 68,155 170,648 4.89 0 115,000 91,799 78,685 91,799 78,685 316,355 24,613 340,968 17.50 3,060 14,010 386,272 331,091 386,272 331,091 444,153 990,573 1,434,726 0.00 0 0 0 0 0 0 0 0 0 42,75 8,684 181,180 890,745 763,496 890,745 763,496 1,838,484 1,469,998 3,308,482 0.73 1,257 1,263 28,197 24,168 28,197 24,168 104,730 0 104,730 0.00 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0 0 a 0 0 0.00 0 0 0 0 0 0 0 0 0 10.55 7,000 12,500 212,277 181,951 212,277 181,951 788,456 0 788,456 11.28 8,257 13,763 240,474 206,119 240,474 206,119 893,186 0 893,186 0.40 36 160 4,000 2,200 4,000 2,200 12,400 0 12,400 0.03 6 12 575 492 574 492 2,133 0 2,133 0.28 35 35 1,000 1,233 2,500 2,500 4,339 2,894 7,233 0.00 0 0 0 0 0 0 0 0 0 0.03 0 6 694 595 694 595 1,548 1,030 2,578 0.56 90 230 9,764 8,370 9,764 8,370 36,268 0 36,268 2.09 539 1,590 37,146 31,839 37,146 31,839 137,970 0 137,970 0.22 117 225 4,289 3,676 4,289 3,676 15,930 0 15,930 0.02 7 15 298 255 298 255 1,106 0 1,106 3.63 830 2,273 57,766 48,660 59,265 49,927 211,694 3,924 215,618 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) 0.10 0 3 0 0 1,000 1,000 1,200 800 2,000 Group Total 1.73 389 777 36,653 31,417 37,653 32,417 137,340 800 138,140 Community Hygiene OCCUPATIONAL I IEALTI1 (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 SOLD WASTE DISPOSAL. (3 63) 0.00 0 0 0 0 50 50 60 40 100 SANITARY NUISANCE (365) 0.19 90 250 3,463 2,968 3,463 2,968 7,726 5,136 12,862 RABIES SURVE[LLANCEICONTROL SERVICES (366) 0.04 3 15 434 820 500 500 1,352 902 2,254 ARBOVIRUS SURVEILLANCE (367) 0.01 0 3 244 209 244 209 545 361 906 RODEN'17ARTHROPOD CONTROL, (368) 0.01 0 3 0 0 100 100 120 80 200 WATER POLLUTION (370) 0.00 0 2 0 0 0 50 30 20 50 AIR POLLUTION (371) 0.05 0 200 200 200 200 200 480 320 800 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 1.14 405 790 20,779 18,286 20,995 18,166 10,977 67,249 78,226 ENVIRONMENTAL HEALTH SUBTOTAL, 17.78 9,881 17,603 355,672 304,482 358,387 306,629 1,253,197 71,973 1,325,170 D. NON - OPERATIONAL COSTS: SPECIAL CONTRACTS (599) 0.00 0 0 0 0 0 0 0 0 0 ENVIRONMENTAL I IE.ALT11 SURCIIA.RGE' (399) 0.00 0 0 10,681 40,438 26,917 25,600 103,636 0 103,636 NON - OPERATIONAL COSTS SUBTOTAL 0.00 0 0 10,681 40,438 26,917 25,600 103,636 0 103,636 TOTAL CONTRACT 98.13 28,325 242,768 2,154,766 1,877,844 2,173,717 1,865,153 5,017,252 3,054,228 8,071,480 RESOLUTION NO. 4 64 -2010 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, AMENDING THE FEE SCHEDULE FOR PRIMARY CARE SERVICES AND PUBLIC HEALTH SERVICES ESTABLISHED VIA RESOLUTION NO. 294 -2010 IN ORDER TO ADD FEES FOR MISCELLANEOUS VACCINATIONS AND INTERNATIONAL CERTIFICATES OF VACCINATIONS AS SET FORTH IN EXHIBIT "A" ATTACHED HERETO AND MADE A PART OF THIS RESOLUTION. 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, Resolution No. 294 -2010, passed by the Board of County Commissioners (BOCC) on September 15, 2010, established a fee schedule for various primary care services, community public health services, vital statistics, medical records, public records, and returned/dishonored checks; and WHEREAS, subsequent to adoption of Resolution No. 294 -2010, the Monroe County Health Department has determined that it needs to add two categories of fees, for "all other immunizations" (item C(8) on Exhibit "A ") and for providing International Certificates of Vaccination (item C(11) on Exhibit "A "); and WHEREAS, the BOCC is satisfied with the justifications provided by the Monroe County Health Department; NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, that: 1. 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 fee increases. 3. The Monroe County Health Department is solely responsible for ensuring the County's compliance with all financial and transition rules and resolutions, and any other factors that may be impacted by the service fee increases at all levels: state, local, 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 meeting of the Board held on the 15` day of December 2010. ° C:) `� ° _ � : —' . ° Mayor Heather Carruthers Yes MO OE COUNTY ATTORNEY e _ Mayor Pro Tem. David Rice yes PR ' ED S M: Commissioner George Neugent Yes CYNTHIA L. HALL - i ___ Commissioner Kim Wigington Yes ASST ANT COUNTY ATTORNEY Commissioner Sylvia Murphy Yes Date_ II M -d-010 w --� — xf BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA S Y L. KOLHAGE, Clerk t` s By: '`' Clerk a or/ airman FEE RESOLUTIONS EXHIBIT A 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 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 $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 11/30/2010 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) 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 (8) All other Immunizations Cost of vaccine x 1.5 + $35 injection fee (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 (11) International Certificates of Vaccination VITAL STATISTICS: (1) Birth Certificates: Additional Copies (2) Protective Covers (3) Death Certificates — Certified Copy Additional Copies (4) Express Fee E. MEDICAL RECORDS: (1) Copying of Medical Record (per page) F. PUBLIC RECORDS: (1) Copying of Public Record (per page) G. RETURNED /DISHONORED CHECKS: (S. 215.34(2), F.S.) 2 Cost x 3.5 $ 16.00 $ 16.00 $ 4.00 $ 13.00 $ 13.00 $ 10.00 $ 1.00 25 cents 11/30/2010 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 3 11/30/2010 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 CHID. 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 CHID The parties mutually agree that the CHID shall provide those services as set forth on Part III of Attachment II hereof, in order to maintain the following three levels of service pursuant to Section 154.01(2), Florida Statutes, as defined below: a. "Environmental health services" are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease. Environmental health services shall be supported by available federal, state and local funds and shalt 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, HIWAIDS, 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 11 of Attachment II hereof. This funding will be used as shown in Part I of Attachment 11. 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 11, Part 11 is an amount not to exceed $ 3,930, 23 (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 contri'buti'ons) as provided in Attachment 11, Part 11 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 Il 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 6103 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 directorladministrator 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: i. The revenue and expenditure requirements in the Florida Accounting System Information Resource (FLAIR). ii. The client registration and services reporting requirements of the minimum data set as specified in the most current version of the Client Information System /Health Management Component Pamphlet; N. 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 11, 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. 1. 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 CHID 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. L,, 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 S.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 Ill. o. The CHD shall submit quarterly reports to the county that shall include at least the following: i. The DE385L1 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: 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: 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 -focal 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: 7 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 Mana ers. The name and address of the contract managers for the parties under this Agreement are as follows: For the State: Mary Vanden Brook Name For the County: Name Administrative Services Director Title Title PO Box 6193 Gato Building, 1100 Simonton St. Key West, FL, 33041 Address T Address 305 - 809 -5612 Telephone 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 of October, 2010. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR MONROE COUNTY DEPARTMENT OF HEALTH SIGNED BY: SIGNED BY: NAME: Heather Car ers NAME: Ana M. Viamonte Ros M.D. M.P.H. TITLE. - .. TITLE: State Surgeon General ;DATg , ovember 17, 2010 DATE 1 ; i S SIGNED BY: £ l nanny L. Kolhage NAME: Robert Eadie,J.D. TITLE: cl erk TITLE: CHD Director /Administrator DATE: November 17, 2010 DATE: A I tVIONR0E_- COUNTY ATTORNEY ASSISTANT COUNTY ATTORNEY Z!1!� 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 3r 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 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. Professiona 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 ONSITR 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(stabiiization, 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 €ndustriallmanufacturing 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 condom iniumslCooperatives 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 Faciliftes 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 DESC RIPTION 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 MO BILE 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 BarslLoun es 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 ad ditional device 60 3. Late fee 30 10/20/2010 DESCR Pee BODY PIERCING 1.Initial License 160 2.Temporary Establishment 80 4. Annual renewal License Fee 160 3. Late Fee 105 10/20/2010 ATTACHMENT I MONROE COUNTY HEALTH DEPARTMENT PROGRAM SPECIFIC REPORTING REQUIREMENT'S AND PROGRAMS REQUIRING COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS Some health services must compiy 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 Requirement Sexually Transmitted Disease Requirements as specified in FAC 64D -3, F.S. 381 and Program F.S. 384 and the CHID Guidebook. 2. Dental Health Monthly reporting on DH Form 1008 *. Additional reporting requirements, under development, will be required. The additional reporting requirements will be communicated upon finalization. 3. Special Supplemental Nutrition Service documentation and monthly financial reports as Program for Women, Infants specified in DHM 150 -24* and all federal, state and county and Children (including the WIC requirements detailed in program manuals and published Breastfeeding Peer Counseling procedures. Program) 4. Healthy Start/ Requirements as specified in the 2007 Healthy Start Improved Pregnancy Outcome Standards and Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. 5. Family Planning Periodic financial and programmatic reports as specified by the program office and in the CHID Guidebook, Internal Operating Policy FAMPLAN 14* 6. Immunization Periodic reports as specified by the department regarding the surveillance /investigation of reportable vaccine preventable diseases, vaccine usage accountability as documented in Florida SHOTS, the assessment of various immunization levels as documented in Florida SHOTS and forms reporting adverse events following immunization. 7. Chronic Disease Program Requirements as specified in the Healthy Communities, Healthy People Guidebook. 8. Environmental Health Requirements as specified in Environmental Health Programs Manual 150 -4* and DHP 50 -21 * 9. HIV/AIDS Program Requirements as specified in F.S. 384.25 and 64D -3.016 and 3.017 F.A.C. and the CHID Guidebook. Case reporting should be on Adult HIV/AIDS Confidential Case Report CDC Form DH2139 and Pediatric HIVIAIDS Confidential Case Report CDC Form DH2140. Socio- ATTACHMENT I (Continued) demographic data on persons tested for HIV in CHID 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 11 `m School Health Services Requirements as specified in the Florida School Health Administrative Guidelines (April 2007). 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. 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 CHID Guide to Surveillance and Investigations. *or the subsequent replacement if adopted during the contract period. w 2 LU ■ F- < a. LU — ❑ u � « _ LU Q � « R 0 U m E 2 0 ■ � « � \ @ \ U) 7/ E j/% \ \oƒ ±%m { / (D / \ 5 2 / � c E f � 5 2y@ w w e o w \ % CD _0 ^ \ 7 \ / E % / 0 § \ OL 2 # £ o e \ n ƒ k \ © \ f / 0 0 \ ; k \ c .\ E 0 ƒ { \ / ce) CD 2 \ G co # m o � w § 0 \ 7 § \ 0 q \ § \ U \ 0 / / ® _ 5 > \ E E / % 0 0 \ 0 \ \ // // f \/ CD / / / / 0 E / 0 0 # o \ %\ �ƒ 7\ \ $ E E �k /k \ /2 e 2 0 m m t m 7 3 e \ m ° 3 .\ ¥ \ y 2 3 / o CL 0 = o D § 2/ p CD 2 _ / ƒ � \ E \ \ ' \ / � f 0 2 ƒ 2 0) / / f f 2 $ §2 §3 33 ® 2 kf \ 00 O) o 3 0 & § 2 t ƒ co \ w 6 6 4 cL 015040 ALG /CESSPOOL IDENTIFICATION AND ELIMINATION 129,414 0 129,414 0 129,414 015040 ALG /CON1R TO CIiDS -AIDS PATIENT CARE 370,000 0 370,000 D 370,000 015040 ALG /CONTR TO CADS -AIDS PATIENT CARE NETWORK 0 0 0 0 0 015040 ALGICONTR TO Cl IDS -AIDS PREV & SURV & HELD STAFF 93,724 0 93,724 0 93,724 015040 ALG /CON "I'R 7'0 CIiDS-DENTAL PROGRAM 0 0 0 0 D 015040 ALG /CONTR TO CIiDS- MIGRANT LABOR CAMP SANITATION 0 0 0 0 0 015040 MINORITY OUTREACH- PENALVER CLIW - MIAMI -DADS 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 NE'T'WORK - ESCAMBIA 0 0 0 0 0 015040 STD GENERAL REVENUE 18,617 D 18,617 0 18,617 015040 VARICE:LLA IMMUNIZATION REQUIREMENT 3,387 0 3,387 0 3,387 015040 HEALTHY START MED WAIVER - SOBRA 0 0 0 0 0 015040 HE;AI.THY START MED- WAIVER - CLIENT SERVICES 0 0 0 0 0 015040 JESSIE TRICE CANCER CTR/HL;ALTH CIiOICE - MIAMI -DADS, 0 0 D 0 0 015040 LA LIGA CONTRA EL CANCER 0 0 0 0 0 015040 MANATEE COUNTY RURAL HF.Al. ;FH SERVICES 0 0 0 D 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 HL'AL'TI-IY BE,ACI IE S MONITORING 28,965 0 28,965 0 28,965 015040 ALG /IPO IIF.ALTI IY START /IPO 0 0 0 0 0 015040 ALG /PRIMARY CARE 194,161 0 194,161 0 194,161 015040 ALGISCHOOL HEALTH /SUPPLEMENT'AE, 41,981 0 41,981 0 41,981 015040 CHILD HEAL "I'H MEDICAL SERVICES 0 0 0 0 0 015040 COMMUNITY SMILES - MIAMI -DADS 0 0 0 0 0 015040 COMMUNITY TB PROGRAM 39,592 0 39,592 0 39,592 015040 ALG /CONTRA TO CHDS - IMMUNIZATION OUTREACH TEAMS 4,722 0 4,722 0 4,722 015040 ALGICONTR. TO CHDS - INDOOR AIR ASSIST PROD 0 0 0 0 0 015040 AI,GICON'TR. TO CHDS -MCH HEALTH - FIELD STAFF COST 0 0 0 0 0 015040 ALGICONTR. TO CIIDS- 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 ALGICONTRTO CIA DS 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 ALGICONTR TO CHDS- REBASING TOBACCO TF 21,117 0 21,117 0 21,117 035010 ALGICONTR. TO CIiDS - BIOMEDICAL WAS "I'E /DEP ADM TF 071 0 1,771 0 1,771 015010 ALG /CONTR. TO CHDS -SAFE DRINKING WATER PRG /DFP ADM 0 0 0 0 0 015010 BASIC SCHOOL HEALTH - TOBACCO TF 0 0 0 0 0 015010 Cl ID PROGRAM SUPPORT 0 0 0 0 0 015010 ENVIRONMENTAL HEALITI PACE PROJECTS D 0 0 0 0 015010 FOOD AND WATERBORNE DISEASE PROGRAM ADM TF /DACS 0 0 0 0 0 015010 FULL SERVICE SCI IOOLS -TOBACCO TF 61,720 0 61,720 0 61,720 Version: 4 Page 1 of 7 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 SUPPI.I'ME:ENTALICOMPREH ENS IVE SCHOOL HEALTII - "TOB TF 41,000 0 41,000 0 41,000 0150i0 TOBACCO COMMUNI'T'Y INTERVENTION 177,250 0 177,250 0 177,250 015020 TRANSFER FROM ANOTHER STATE AGENCY 0 0 0 0 d 015020 TRANSFER FROM ANO'T'HER 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 INITIA'T'IVE (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 LFAD POISONING PREVEN - I'ION 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 0 302,250 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 INFERTILI'T'Y 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 WHTTI PART B SUPPLEMENTAL 0 0 0 0 0 007000 RYAN WHITE: -AIDS DRUG ASSIST PROD -ADMIN 35,443 0 35,443 0 35,443 007000 RYAN WI II TL 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 -201 1 0 0 0 0 0 007000 PHP - CITIESREADINESSINITIATIVE 0 0 0 0 0 007000 PUBLIC HEAL'T'H PREPAREDNESS BASE 122,155 0 122,155 0 122,155 007000 RAPE PREVENTION & EDUCATION GRANT 0 0 0 0 0 007000 IMMUNIZATION FIELD S'T'AFF 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 PGI'FIIMMUNIZATION ACTION PLAN 15,702 0 15,702 0 15,702 007000 HEALTH PROGRAM FOR REFUUEES 0 0 0 0 0 007000 HEALTHY PEOPLE HLAL'THY COMMUNITIES 25,541 0 25,541 0 25,541 Version: 4 Page 2 of 7 007000 HIV HOUSING FOR PEOPLE LIVING WITH AIDS 0 0 0 0 0 007000 HIV INCIDENCE SURVEILLANCE: 0 0 0 0 0 007000 COLORECTAL CANCER SCREENING 2009 -10 0 0 0 0 0 007000 DIABETES PREVENTION & CONTROL PROGRAM 0 0 0 0 0 007000 FAMILY PLANNING -TITLE X 0 0 0 0 0 007000 FGTF /AIDS MORBIDITY 0 0 0 0 0 007000 FGTF /BREAST' & CERVICAL CANC,'R-ADMIN /CASE MAN 0 0 0 0 0 007000 FGTF /FAMILY PLANNING TITLE; X SPECIAL, INITIATIVES 0 0 0 0 0 015009 MEDWASS WAIVER- 1-1LT'I-1Y STRT CLIENT SERVICES 0 0 0 0 0 015009 MEDIPASS WAIVER -SOBRA 0 0 0 0 0 015075 SCHOOL HEALTI-4 /80PPLE MENTAL 81,066 0 81,066 0 81,066 007055 ARRA Federal Grant - Schedule C 0 0 0 0 0 015075 Inspections of Summer Feeding Program 0 0 0 0 0 FEDERAL FUNDS TOTAL 1,035,499 0 1,035,499 0 1,035,499 4. FEES ASSESSED BY STATE OR FEDERAL RULES - S'T'ATE 001020 TANNING FACILITIES 1,410 0 1,410 0 1,410 001020 BODY PIERCING 1,185 0 1,185 0 1,185 001020 MIGRANT ROUSING PERMIT 0 0 0 0 0 001020 MOBILE HOME AND PARKS 20,350 0 20,350 0 20,350 001020 FOOD HYGIENE PERMIT 18,500 0 18,500 0 18,500 001020 RI01IAZARD WASTE PERMIT 11,270 0 11,270 0 11,270 001020 PRIVATE WATER CONSTIZ PERMIT 0 0 0 0 0 001020 PUBLIC WATER ANNUAL OPEN PERMIT 0 0 0 0 0 001020 PUBLIC WATER CONSTR P1RM1T 0 0 0 0 0 001020 NON -SDWA SYSTEM PERMIT 0 0 0 0 0 001020 SAFE DRINKING WATER 0 0 0 0 0 001020 SWIMMING POOLS 54,825 0 54,825 0 54,825 001092 OSDS PERMIT FEE 570,694 0 570,694 0 570,694 001092 I& M ZONED OPERATING PERMIT 0 0 0 0 0 001092 AEROBIC OPERATING PERMIT 0 0 0 0 0 001092 SEP "ITC TANK SITE EVALUATION 0 0 0 0 0 001092 NON SDWA LAB SAMPLE 0 0 0 0 0 001092 OSDS VARIANCE FEE 0 0 0 0 0 001092 ENVlRONMI -NT'AL I IE:ALTI I FETES 0 0 0 0 0 001092 OSDS REPAIR PERMIT 0 0 0 0 0 001170 LAB FEE Cl-IEMICAL ANALYSIS 0 0 0 0 0 001 170 WATER ANALYSIS - POTABLE 0 0 0 0 0 001 170 NONPOTAl3E.E WATER ANALYSIS 0 0 0 0 0 010304 MQA INSPECTION FEE 450 0 450 0 450 001206 Cmitra1 Office Surcharge 43,500 0 43,500 0 43,500 FEES ASSESSED BY STATE. OR FEDERAL RULES TOTAL 722,184 0 722,184 0 722,184 5. OTHER CASK[ CONTRIBUTIONS - STATE 010304 STATIONARY POLL.U'I'AN'I' STORAGE: TANKS 110,251 0 110,251 0 110,251 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT.' 207,040 0 207,040 0 207,040 OTHER CASH CON`T'RIBUTIONS TO'T'AL 317,291 0 317,291 0 317,29E Version: 4 Page 3 of 7 001056 MEDICAID PHARMACY 0 0 0 0 0 001076 MEDICAID TB 0 0 0 0 0 001078 MEDICAID ADMINISTRATION OP VACCINE 15,911 15,911 31 ,822 0 31,822 001079 MEDICAID CASE MANAGEMEN'F 0 0 0 0 0 001081 MEDICAID CHILD HEALTH CHECK UP 2,269 3,631 5,900 0 5,900 001082 MFD[CA[D 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 MAfERNH'Y 0 0 0 0 0 001 192 MEDICAID COMPREHENSIVE. CHILD 369 591 960 0 960 001193 MEDICAID COMPRMIENSIVE ADULT 107,150 171,450 278,600 0 278,600 001194 MEDICAID LABORATORY 0 0 0 0 0 001208 MEDIPASS $3.00 ADM. FETE 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 - Bebavioral 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 - I lospital 0 0 0 0 0 001 148 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 WARRAN"1' 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 CON'T'RIBU'T'IONS NOT IN CHD TRUST FUND - STA'T'E PHARMACY SERVICES 0 0 0 72,991 72,991 LABORA'1ORY SERVICES 0 0 0 36,848 36,848 TB SERVICES 0 0 0 0 0 IMMUNIZATION SERVICES 0 0 0 497,639 497,639 S'T'D SERVICES 0 0 0 0 0 CONSTRUCTIONIRENOVATION 0 0 0 0 0 WIC FOOD 0 0 0 937,640 937,640 ADAP 0 0 0 840,000 840,000 DENT'AI,SERVICE=S 0 0 0 0 0 O "fl-EER (SPECIFY) 0 0 0 0 0 OT] -IL-'R (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 008030 Contribution from Health Care Tax 0 817,247 817,247 0 817,247 008034 13CC 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 COUN'T'Y 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 CE11LD CAR SEAT PROG 0 0 0 0 0 001077 PERSONAL. I IEAE.TII FEES 0 232,971 232,971 0 232,971 001077 AIDS CO -PAYS 0 0 0 0 0 001094 ADD C ENCI:R. PERMIT FEES 0 0 0 0 0 001094 LOCAL ORDINANCE FEES 0 0 0 0 0 001 1 14 NEW BIRTH CERTIFICATES 0 19,500 19,500 0 19,500 001115 Vita€ Statistics - Death Certificate 0 52,500 52,500 0 52,500 001117 VITAL SCATS -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 U 001040 Cell Phone Administrative Fee 0 0 0 0 0 FEES AUTHORIZED BY COUNTY TOTAL 0 307,971 307 0 307,971 11, O'C'HER CASH AND LOCAL CON'T'RIBU'T'IONS - COUNTY 001009 RE FURNI D CHECK ITEM 0 0 0 0 0 001029 TI URD PARTY REIMBURSEMENT 0 192,329 192,329 0 192,329 001029 HEALTH MAINTI' NANCE ORGAN. (HMO) 0 0 0 0 0 001054 MEDICARE: PART I) 0 0 0 0 0 001077 RYAN WHITE, TITLE It 0 0 0 0 0 001090 MLDICARE PART 13 0 208,557 208,557 0 208,557 001190 Ilealth Maintenance Organization 0 0 0 0 0 005040 INTEREST EARNED 0 4,500 4,500 0 4,500 005041 INTERI S'I' 1.?Al2NED- 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 13CC 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 CONS UL'I'NT CHARGES 0 0 0 0 0 010405 SALE OF PHARMACEUTICALS 0 0 0 0 0 010409 SALE OP GOODS OUTSIDE SCATS GOVL:RNMENC 0 0 0 0 0 011001 11l AUI'HY START COALITION CONTRIBUTIONS 0 360,000 360,000 0 360,000 01 1007 CASH DONATIONS PRIVATE 0 0 0 0 0 012020 PINES AND FORITITURES 0 0 0 0 0 012021 RETURN CHECK CI-IARGL 0 0 0 0 0 028020 INSURANCE RLCOVERIES -OTHER 0 0 0 0 0 090002 DRAW DOWN FROM PUBLIC HL;AE; rif UNIT 0 0 0 0 0 011000 GRANT DIRECT-NOVA UNIVERSITY CI 117 TRAINING 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 Version: 4 Wage 5 of 7 011000 GRANT" DIREECT- COUNTY I IEALTH DEPARTMENT DIRECT SERVICES 0 0 0 0 0 011000 DIRECT -ARROW 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT DIRECT- QUANTUM DEN'I'AL 0 0 0 0 0 011000 GRANT DIKECT-I IEALTI -I CARE DISTRICT PAHOKEF 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT- DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 W 1000 GRANT' DIRECT -ARROW 0 0 0 0 0 010402 Recycled Material Sales 0 0 0 0 0 010303 I DLF. Fingerprinting 0 0 0 0 0 007050 ARRA federal Grant 0 7,980 7,980 0 7,980 001010 Recovery of Clad Checks 0 0 0 0 0 008065 FCO Contribution 0 0 0 0 0 01 1006 Restricted Cash Donation 0 0 D fl 0 028000 Insurance Recoveries 0 0 0 0 0 001033 CMS Management Pee - PMPMPC 0 0 0 0 0 010400 Sale of Goods Outside State Government 0 0 0 0 0 010500 Refugee Health 0 45,207 45,207 0 45,207 005045 Interest Earned- Third Party Provider 0 0 0 0 0 005043 Interest Earned- Coutract/Grant 0 0 0 0 0 010306 DOIi /DOC Interagency Agreement 0 0 0 0 0 008040 BCC Gram/Contract 0 0 0 0 0 011002 ARRA federal Grant - Sub- Recipient 0 0 0 0 0 OTHER CASH AND LOCAL, CONTRIBUTIONS TOTAL 0 1,406,237 1,406,237 0 1,406,237 12. ALLOCABLE REVENUE - COUNTY ol8000 REFUNDS 0 0 0 0 0 037000 PRIOR YEAR WARRANT 0 0 0 0 0 038000 €2 MONTH OLD WARRANT 0 0 0 0 0 COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0 13. BUILDINGS - COUNTY ANNUAL RENTAL EQUIVALfN "T'VALUE 0 0 0 501,072 501,072 GROUNDS MAINTENANCE 0 0 0 0 0 0'1 "TIER (SPECIFY) 0 0 0 0 0 INSURANCE-' 0 0 0 0 0 UTILITIES 0 0 p 62,633 62,633 O'1'11ER (SPECIFY) 0 0 p 0 0 BUILDING MAINTENANCE 0 0 0 51,185 51,185 BUILDINGS TOTAL 0 0 0 614,890 614,890 14. OTHER COUN'T'Y CONTRIBUTIONS NOT IN CHD TRUST FUND - COUN'T'Y EQUIPMENT /VEI IICLE PURCHASES 0 0 0 0 D Version: 4 Page 6 of 7 Vii IICLE INSUIZANCE VeI iICLE MAINTENANCr, GRIER COUNTY CONTIMBUTION (SPECIFY) OTI lr-,R COUNTY CONTRIBUTION (SPECIFY) OTHER COUNTY CONTRIBUTIONS TOTAL GRAND TOTAL CI PROGRAM 0 0 0 a 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 a 0 0 5,140,848 2,919,125 8,059,973 3,000,008 ]1,059,981 Version: 4 Page 7 of 7 A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION (10i) STD (102) A. I. D.S. (103) TB CONTROL SERVICES (104) COMM. DISEASE SURV. (106) HLPATITIS PREVENTION (109) PUBLIC HEALTH PREP AND RESP (1 16) VITAL STATISTICS (180) COMMUNICABLE DISEASE SUBTOTAL B. PRIMARY CARE: CHRONIC DISEASL SERVICES (2 10) TOBACCO PREVENTION (212) W.I.C. (22 1) LAMELY PLANNING (223) IMPROVED PREGNANCY OUrCOML (225) 1ILAI.; fI TY START PRENATAL (227) COMPREHENSIVE CHILD HEALTH (229) 1IEAUI`HY START INFANT (23 1) SCHOOL HLALTH (234) COMPREI4E:NS1VE ADULT EEEAL'I'H (237) DENTAL HEAL'I'1I (240) 5.88 5,696 20,000 119,577 102,495 119,577 102,495 106,399 337,745 444,144 1.85 296 1,542 40,517 34,729 40,517 34,729 104,103 46,389 150,492 22.05 650 8,700 543,027 465,451 543,027 465,451 929,523 1,087,433 2,016,956 1.45 303 1,549 38,828 33,281 38,828 33,281 142,715 1,503 144,218 0.93 0 2,500 28,767 24,657 28,767 24,657 64,174 42,674 106,848 1.71 718 3,394 53,064 45,483 53,064 45,483 190,944 6,150 197,094 2.48 0 500 S 1,160 43,851 51,160 43,851 190,022 0 190,022 1.25 2,097 5,800 22,728 19,481 22,728 19,481 0 84,418 84,418 37,60 9,760 43,985 897,668 769,428 897,668 769,428 1,727,880 1,606,312 3,334,192 O.OI 2,29 7.30 3.77 0.00 3.79 0.43 2.77 4.89 17.50 0.00 42 75 PRIMARY CARE SUBTOTAL 0 C. ENVIRONMENTAL HEALTH: 4,890 Water and Onsite Sewage Programs 4,890 COASTAL BEACH MONITORING (347) 0.73 LIMITED USE PUBLIC WATER SYSTEMS (357) 0.00 PUBLIC WATER SYSTEM (358) 0.00 PRIVATE WATER SYSTEM (359) 0.00 INDIVIDUAL S1WAGE DISP. (361) 10.55 Group Total 11.28 Facility Programs 29,978 FOOD HYGIENE (348) 0.64 BODY ART (349) 0.03 GROUP CARL: FACILITY (35 1) 0.28 MIGRANT LABOR CAMP (352) 0.00 HOIISING,PUBLIC BLDG SMETY,SAMTATION (353)0.03 76,232 MOBILE HOME AND PARKS SERVICES (354) 0.56 SWIMMING POOLSIBAI HING (360) 2.09 BIOMEDICAL WASTE SERVICES (364) 0.22 'T'ANNING f'ACILITY SERVICES (369) 0.02 Group Total 3.87 0 0 5,704 4,890 5,704 4,890 21,188 0 21,188 0 446 53,533 45,885 53,533 45,885 198,836 0 198,836 3,394 29,978 141,800 121,543 141,800 121,543 526,686 0 526,686 1,020 5,095 76,232 65,342 76,232 65,342 198,777 84,371 283,148 0 0 0 0 0 0 0 0 0 570 10,500 80,288 68,818 80,288 68,818 0 298,212 298.212 310 651 9,173 7,862 9,173 7,862 29,996 4,074 34,070 330 5,500 45,944 39,380 45,944 39,380 102,493 68,155 170,648 0 115,000 91,799 78,685 91,799 78,685 316,355 24,613 340,968 3,060 14,030 386,272 331,091 386,272 331,091 444,153 990,573 1,434,726 0 0 0 0 0 0 O 0 0 8,684 181,180 890,745 763,496 890,745 763,496 1,838,484 1,469,998 3,308,482 1,257 1,263 28,197 24,168 28,197 24,168 104,730 0 104,730 0 0 46 39 46 39 102 68 170 0 0 18 16 18 16 41 27 68 0 0 26 22 26 22 58 38 96 7,000 12,500 212,277 181,951 212,277 181,951 788,456 0 788,456 8,257 13,763 240,564 206,196 240,564 206,196 893,387 133 893,520 77 365 11,134 9,543 11,134 9,543 41,354 0 41,354 6 12 575 492 574 492 2,133 0 2,433 75 119 4,971 4,261 4,971 4,261 11,091 7,373 18,464 0 0 0 0 0 0 0 0 0 0 6 694 595 694 595 1,548 1,030 2,578 90 230 9,764 8,370 9,764 8,370 36,268 0 36,268 539 1,590 37,146 31,839 37,146 31,839 137,970 0 137,970 117 225 4,289 3,676 4,289 3,676 15,930 0 15,930 7 15 298 255 298 255 1,106 0 1,106 911 2,562 68,871 59,031 68,870 59,031 247,400 8,403 255,803 Version: 2 Page 1 of 2 Group Total 1.78 389 780 39,529 33,882 39,529 33,882 142,556 4,266 146,822 Community Hygiene OCCUPATIONAL HEAL TI I (344) 0.01 0 4 127 109 127 109 0 472 472 CONSUMER PRODUC "I' SAFE °rY (345) 0.00 0 0 0 0 0 0 0 0 0 INJURY PREVLN'L10N (346) 0.00 0 0 0 0 0 0 0 0 0 LOAD 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 /CON'FROL 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 /AR'I'L IROPOD CONTROL (3 68) 0.01 0 6 184 157 184 157 409 273 682 WATGR 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 8 UBS'I'ANCES (3 73) 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 HEALTF[ SUBTOTAL 18.01 9,961 37,694 369,872 317,028 369,871 317,028 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: 1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits discrimination on the basis of race, color or national origin in programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. 3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97 -35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the applicant understands that the grantor may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief, to include assistance being terminated and further assistance being denied. ATTACHMENT IV MONROE COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Location Owned By Gato Building Administration Nursing Environmental Health Health Care Center 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 105 Olivia Street Key West, FL 33040 Ruth Ivins Center 3333 Overseas Highway Marathon, FL 33050 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 2007 -2008 $ 2008 -2009 $ 2009 -2010 $ 2010 -2011 $ 2011 -2012 $ PROJECT TOTAL $ TOTAL $ $ SPECIAL PROJECT CONSTRUCTIONIRENOVATION PLAN PROJECT NAME: LOCATION/ ADDRESS: PROJECT TYPE: NEW BUILDING RENOVATION NEW ADDITION ROOFING PLANNING STUDY OTHER SQUARE FOOTAGE: PROJECT SUMMARY: Describe scope of work in reasonable detail. ESTIMATED PROJECT INFORMATION: 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 (229129) X Comprehensive Adult Health (237137) Family Planning (223123) Maternal Health /lPO (225125) Laboratory (242142) Pharmacy (241193) 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 (0 15040) 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