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FY2012 10/19/2011DANNY L. KOLHAGE CLERK OF THE CIRCUIT COURT DATE: October 27, 2011 TO: Robert Eadie, .1 D. C HD Director /Administrator ATTN: Bunny VanBourgondien Contract Administrator FROM: Pamela G. Hanco�wC. At the October 19, 2011, Board of County Commissioner's meeting the Board granted approval and authorized execution of Item M1 Amendment to the Core Contract with the Monroe County Health Department which are required by the State of Florida, Department of Health. Enclosed are six duplicate originals, executed on behalf of Monroe County, for your handling. Please be sure to return two fully executed duplicate originals to our office: one for the Official Record and one for the Finance Department. Should you have any questions, please do not hesitate to contact our office. cc: County Attorney Fina.7e File C/er k. 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 2011 -2012 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, 2011. 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. TER M. The parties mutually agree that this Agreement shall be effective from October 1, 2011, through September 30, 2012, 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 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. " Cormunicable 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 $ 3,294,581 (State General Revenue, State Funds, 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 Il, Part II is an amount not to exceed $ 939,070 (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 CHID employees shall be State or State - contract personnel subject to State personnel rules and procedures. Employees will report time in the Health Management System compatible format by program component as specified by the State. b. The CHD shall comply with all applicable provisions of federal and state laws and regulations relating to its operation with the exception that the use of county purchasing procedures shall be allowed when it will result in a better price or service and no statewide Department of Health purchasing contract has been implemented for those goods or services. In such cases, the CHD director /administrator must sign a justification therefore, and all county- purchasing procedures must be followed in their entirety, and such compliance shall be documented. Such justification and compliance documentation shall be maintaiined 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; 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 determines! 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 confidentiallity. W 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 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, 2012 for the report period October 1, 2011 through December 31, 2011; ii. June 1, 2012 for the report period October 1, 2011 through March 31, 2012; iii. September 1, 2012 for the report period October 1, 2011 through June 30, 2012; and iv. December 1, 2012 for the report period October 1, 2011 through September 30, 2012. 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 through either a self- insurance program or insurance purchased by the County. c. All vehicles will be transferred to the ownership of the County and registered as county vehicles. The county shall assure insurance coverage for these vehicles is available through either a self- insurance program or insurance purchased by the County. All vehicles will be used solely for CHD operations. Vehicles purchased through the County Health Department Trust Fund shall be sold at fair market value when they are no longer needed by the CHD and the proceeds returned to the County Health Department Trust Fund. 8. 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, 2012, 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 For the County: Roman Gastesi Name Administrative Services Director Title! PO Box 6193 Gato Building, 1100 Simonton St. Key West, FL 33041 Address 305- 809 -5612 Telephone County Administrator Title Gato Building, 1100 Simonton St. Key West, FL 33041 Address 305 - 292 -4441 Telephone If different contract managers are designated after execution of this Agreement, the name, address and telephone number of the new representative shall be furnished in writing to the other parties and attached to originals of this Agreement. C. Captions The captions and headings contained in this Agreement are for the convenience of the parties only and do not in any way modify, amplify, or give additional notice of the provisions hereof. In WITNESS THEREOF, the parties hereto have caused this 42 page agreement to be executed by their undersigned officials as duly authorized effective the 1 day of October, 2011. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR Mo e. COUNTY DEPARTMENT OF HEALTH SIGNED BY: SIGNED BY: NAME: 1- ea -i-Ael C I I GA c , -s NAME: H. Frank Farmer, Jr., MD, PhD, FACP TITLE: MW- TITLE: State Surgeon General DATE: �c b . ...!9 Z DATE: L f , ATTESTEI�Rt .A'r° Y` KO r: =K SIGNED :.kti'a< \ SIGNED BY• A� NAME:' �,` `�� ' NAME: Robert Eadie, J. D. TITLE: r.a. TITLE: CHD Director /Administrator DATE: DATE: r . s _,7 9 FLORIDA DEPAENT OF H�!L / Rick Sco tt Governor H. Frank Farmer, Jr., M.D., Ph.D. State Surgeon General MEMORANDUM To: Mike Sentman Assistant Deputy Secretary From: Robert B. Eadie, J.D., Administrator 4F Monroe County Health Department Date: Monday, September 19, 2011 RE: Delegation of Authority I will be out of the office September 21, 2011 — October 6, 2011. Joan Higgs, R.N., Senior Community Health Nursing Director will be delegated in my absence. Joan can be reached at the office at: 305.809.5623 on her blackberry: 305.296.2292 or via email at: joan_higgs @doh.state.fl.us. Thank You, Robert B. Eadie 1 100 Simonton Street P.O. Box 6193 Key West, Florida 3 3041 -6193 (305) 809 -5610 • FAX (305) 809 -5619 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: S ervice Requirement Sexually Transmitted Disease Requirements as specified in FAC 64D -3, F.S. 381 and Program F.S. 384 and the CHD 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/ Improved Pregnancy Outcome 5. Family Planning 7 0 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- 10 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. .p O� 0 v cr =) CD (D N (D O N -' z �, CD 0 Q- U) o CD (D 0 3 : cr - CD co w (D O :3 N - n O c N � Q w O-0 o co cr CD T l J N �. r. O � � T O Q U) (D -0 - CD C 3 cD cr h (D 0 0 0 N O_ p� N 0 a) 1 x 00 cv 0 :E cr Q , CD 0 1 N O_ n 0 Cf)� (D 0 - 0 — CD 3 fD CD N O_ N c cn r-h 7l c Q m (Q CO CD O O W O D c � ci w w cL 3 m c W v CD (0 O O O rn "n z (D °c • / O cn c `< O c m 0 T cn m — n O -N �' .A z c c 0- 3 = - K v° m D n N Co o A 0 _ c m 2 cD v = D -i (D p r m -i z C: _ v v = m z m Z c � ci w w cL 3 - i W v CD (0 O O (0 2 n rn rn (D °c -I :3 cn c `< cn 0 O - i 0 rn rn cn cn 0 0 -N .A w o O w O ATTACHMENT III MONROE COUNTY HEALTH DEPARTMENT CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted during the 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. 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. 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. 13 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 105 Olivia Street Key West, FL 33040 Ruth Ivins Center Roth Building 3333 Overseas Highway Marathon, FL 33050 50 High Point Road Tavernier, FL 33070 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 Monroe County IL4 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 $ N/A $ N/A $ N/A SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN PROJECT NAME: LOCATION/ ADDRESS: PROJECT TYPE: NEW BUILDING RENOVATION NEW ADDITION ROOFING PLANNING STUDY OTHER SQUARE FOOTAGE: PROJECT SUMMARY: Describe scope of work in reasonable detail. ESTIMATED PROJECT INFORMATION: 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. 1,5, 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 and Ancillary 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 rd 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. Specimens tested in clinic- $10.00 (hemoglobin, urine, blood sugar, mono, wet mount, strep) b. Pregnancy test C. COMMUNITY PUBLIC HEALTH SERVICES (1) Tuberculosis X -ray for suspected, confirmed or Symptomatic contact or case (2) Tuberculosis Skin Test for suspected, confirmed or Symptomatic contact or case (3) Tuberculosis (TB) Sputum Culture for suspected, confirmed, or symptomatic contact of case (4) Tuberculin (TB) Skin Test, with reading, any other than listed above in C. (1). (5) Tuberculin assessment of clients with a past history of positive skin test No charge No Charge No Charge No Charge $35.00 $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. Monroe County Health Department Core Contract Attachment 91912011 1 1 (D 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 2 + $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 Cost x 3.5 D. VITAL STATISTICS: (1) Birth Certificates: $ 16.00 Additional Copies $ 16.00 (2) Protective Covers $ 4.00 (3) Death Certificates — Certified Copy $ 20.00 Additional Copies $ 20.00 (4) Express Fee $ 10.00 E. MEDICAL RECORDS: Copying of Medical Record (per page) $ 1.00 F. PUBLIC RECORDS: 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 H. PUBLIC HEALTH AND MEDICAL PREPAREDNESS New or annual review of Comprehensive Emergency Management Plan for Home Health Agencies, Hospices, Nurse Registries, Home Medical Equipment Providers $ 75.00 Monroe County Health Department Core Contract Attachment 91912011 2 I-1 a c (n (D 0 O C 7 (D v 5 v CD N 3 (D O C� ((] O D d m V m m A W N -` O 'Cl O N p CA 0 O p W N N ?U f D c ( o =. o m o o m m N. m 3 3 m F m= o -1 x -1 � --1 c m N m m= o m c-i ° m m N m° ° a a ,� = 3 = d= d v n _ N n o 'D = m O N N cn w m' m e < m a < m a m (D 3 CD o. c= * o 'a F F m m m m m o 0 0 3 0 3 N 3 Z N (D S = O O O = = N N O O O j (/I = Zr = _ (D y = fD fD S = O C N (D n (D N .. O 2 -= o x X °� (D ?< w v m o m o m c m O N n n O N n 0 N = O m 'p � C (D R p a O CL 'O S CD y 3 = = G m (D a 7 O 2 O O C 0 C C O O O _ m m m N 'O 0 � O' 'O fl. C 2 (0 � O m N � .Z O .� 3 .� 0 N n C. N .m. C 8 a » N p ;; O= O O O N O. 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Part III.Planned Staffing,Clients,Services,And Expenditures By Program Service Area Within Each Level Of Service. October 1,2011 to September 30,2012' Quarterly Expenditure Plan FTE's Clients Services/ 1st 2nd 3rd 4th Grand (0.00) Units Visits (Whole dollars only) State County iota A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION(101) 4.56 5,800 7,000 132,479 113,553 132,479 113,553 86,419 405,645 492,064 STD(102) 1.59 300 650 32,620 27,960 32,620 27,960 69,788 51,372 121,160 HIV/AIDS PREVENTION(03A1) 4.52 0 0 87,417 74,929 87,417 74,929 324,692 0 324,692 H1V/AIDS SURVEILANCE(03A2) 0.07 0 0 1,461 1,253 1,461 1,253 3,127 2,301 5,428 HIV/AIDS PATIENT CARE(03A3) 13.75 650 3,200 370,945 317,953 370,945 317,953 462,410 915,386 1,377,796 ADAP(03A4) 1.20 50 0 20,212 17,325 20,212 17,325 75,074 0 75,074 TB CONTROL SERVICES(104) 1.33 175 700 32,876 28,179 32,876 28,179 114,128 7,982 122,110 COMM.DISEASE SURV.(106) 0.20 0 1,500 8,277 7,095 8,277 7,095 17,713 13,031 30,744 HEPATITIS PREVENTION(109) 1.89 663 1,360 41,641 35,692 41,641 35,692 154,666 0 154,666 PUBLIC HEALTH PREP AND RESP(116) 3.13 0 600 56,371 48,318 56,371 48,318 209,378 0 209,378 VITAL STATISTICS(180) 1.25 2,200 5,350 22,356 19,162 22,356 19,162 0 83,036 83,036 COMMUNICABLE DISEASE SUBTOTAL 33.49 9,838 20,360 806,655 691,419 806,655 691,419 1,517,395 1,478,753 2,996,148 B. PRIMARY CARE: CHRONIC DISEASE SERVICES(210) 0.11 0 0 3,092 2,650 3,092 2,650 11,484 0 11,484 TOBACCO PREVENTION(212) 1.30 0 400 36,706 31,462 36,706 31,462 136,336 0 136,336 WIC(21 W 1) 5.53 3,300 28,500 98,642 84,550 98,642 84,550 366,384 0 366,384 WIC BREASTFEEDING PEER COUNSELING(21 W2) 1.87 100 1,000 25,256 21,648 25,256 21,648 93,808 0 93,808 FAMILY PLANNING(223) 5.13 1,298 3,500 115,995 99,424 115,995 99,424 339,570 91,268 430,838 IMPROVED PREGNANCY OUTCOME(225) 0.00 0 0 0 0 0 0 0 0 0 HEALTHY START PRENATAL(227) 4.03 566 4,750 70,794 60,681 70,794 60,681 262,950 0 262,950 COMPREHENSIVE CHILD HEALTH(229) 0.22 150 300 4,369 3,745 4,369 3,745 15,355 873 16,228 HEALTHY START INFANT(231) 2.18 263 2,530 33,561 28,766 33,561 28,766 81,187 43,467 124,654 SCHOOL HEALTH(234) 4.66 0 85,000 80,901 69,343 80,901 69,343 280,584 19,904 300,488 COMPREHENSIVE ADULT HEALTH(237) 16.78 2,800 8,700 370,433 317,514 370,433 317,514 324,157 1,051,737 1,375,894 COMMUNITY HEALTH DEVELOPMENT(238) 0.23 0 0 4,330 3,711 4,330 3,711 9,266 6,816 16,082 DENTAL HEALTH(240) 0.00 0 0 0 0 0 0 0 0 0 PRIMARY CARE SUBTOTAL 42.04 8,477 134,680 844,079 723,494 844,079 723,494 1,921,081 1,214,065 3,135,146 C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COASTAL BEACH MONITORING(347) 0.62 800 800 13,338 11,433 13,338 11,433 49,542 0 49,542 LIMITED USE PUBLIC WATER SYSTEMS(357) 0.00 0 0 0 0 0 0 0 0 0 PUBLIC WATER SYSTEM(358) 0.00 0 0 0 0 0 0 0 0 0 PRIVATE WATER SYSTEM(359) 0.00 0 0 0 0 0 0 0 0 0 INDIVIDUAL SEWAGE DISP.(361) 10.44 3,927 10,579 149,589 128,219 149,589 128,219 318,366 237,250 555,616 Group Total 11.06 4,727 11,379 162,927 139,652 162,927 139,652 367,908 237,250 605,158 Facility Programs FOOD HYGIENE(348) 0.31 38 188 4,532 3,885 4,532 3,885 9,696 7,138 16,834 BODY ART(349) 0.00 6 12 0 0 0 0 0 0 0 GROUP CARE FACILITY(351) 0.09 35 40 1,075 922 1,075 922 2,301 1,693 3,994 MIGRANT LABOR CAMP(352) 0.00 0 0 0 0 0 0 0 0 0 HOUSING,PUBLIC BLDG SAFETY,SANITATION(353)0.09 0 19 1,640 1,405 1,640 1,405 3,509 2,581 6,090 3y Working Copying ATTACHMENT IL MONROE COUNTY HEALTH DEPARTMENT Part III.Planned Staffing,Clients,Services,And Expenditures By Program Service Area Within Each Level Of Service October 1,2011 to September 30,2012 Quarterly Expenditure Plan FTE's Clients Services/ 1st 2nd 3rd 4th Grand (0.00) units Visits (Whole dollars only) State County Total C. ENVIRONMENTAL HEALTH: Facility Programs MOBILE HOME AND PARKS SERVICES(354) 0.33 88 215 3,686 3,160 3,686 3,160 11,173 2,519 13,692 SWIMMING POOLS/BATHING(360) 1.43 415 1,400 19,981 17,126 19,981 17,126 42,747 31,467 74,214 BIOMEDICAL WASTE SERVICES(364) 0.12 100 200 1,863 1,597 1,863 1,597 3,986 2,934 6,920 TANNING FACILITY SERVICES(369) 0.00 7 15 0 0 0 0 0 0 0 Group Total 2.37 689 2,089 32,777 28,095 32,777 28,095 73,412 48,332 121,744 Groundwater Contamination STORAGE TANK COMPLIANCE(355) 2.47 414 823 25,793 22,107 25,793 22,108 95,801 0 95,801 SUPER ACT SERVICE(356) 0.02 0 5 284 244 284 244 1,056 0 1,056 Group Total 2.49 414 828 26,077 22,351 26,077 22,352 96,857 0 96,857 Community Hygiene OCCUPATIONAL HEALTH(344) 0.00 0 2 0 0 0 0 0 0 0 COMMUNITY ENVIR.HEALTH(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) 0.00 0 0 0 0 0 0 0 0 0 SANITARY NUISANCE(365) 0.19 85 236 2,215 1,899 2,215 1,899 4,741 3,487 8,228 RABIES SURVEILLANCE/CONTROL SERVICES(366)0.02 2 8 117 100 117 100 251 183 434 ARBOVIRUS SURVEILLANCE(367) 0.00 0 0 0 0 0 0 0 0 0 RODENT/ARTHROPOD CONTROL(368) 0.00 0 0 0 0 0 0 0 0 0 WATER POLLUTION(370) 0.00 0 0 0 0 0 0 0 0 0 INDOOR AIR(371) 0.00 0 0 458 392 458 392 980 720 1,700 RADIOLOGICAL HEALTH(372) 0.02 0 I 208 178 208 178 445 327 772 TOXIC SUBSTANCES(373) 1.00 312 312 26,190 22,310 26,190 22,310 0 97,000 97,000 Group Total 1.23 399 559 29,188 24,879 29,188 24,879 6,417 101,717 108,134 ENVIRONMENTAL HEALTH SUBTOTAL 17.15 6,229 14,855 250,969 214,977 250,969 214,978 544,594 387,299 931,893 D. NON-OPERATIONAL COSTS: Non-Operational Costs(599) 0.00 0 0 81 69 81 69 300 0 300 ENVIRONMENTAL HEALTH SURCHARGE(399) 0.00 0 0 9,057 9,058 9,057 9,058 36,230 0 36,230 NON-OPERATIONAL COSTS SUBTOTAL 0.00 0 0 9,138 9,127 9,138 9,127 36,530 0 36,530 TOTAL CONTRACT 92.68 24,544 169,895 1,910,841 1,639,017 1,910,841 1,639,018 4,019,600 3,080,117 7,099,717 35- Working Copy ATTACHMENT II. MONROE COUNTY HEALTH DEPARTMENT Part 11. Sources of Contributions to County Health Department October 1,2011 to September 30,2012 State CIID County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total isijuik.k. „+ Ia 1. GENERAL REVENUE-STATE 015040 AIDS PREVENTION 73,552 0 73,552 0 73,552 015040 AIDS SURVEILLANCE 0 0 0 0 0 015040 ALG/CESSPOOL IDENTIFICATION AND ELIMINATION 64,707 0 64,707 0 64,707 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-SOVEREIGN IMMUNITY 0 0 0 0 0 015040 ALG/IPO HEALTHY START/IPO 0 0 0 0 0 015040 ALG/PRIMARY CARE 199,742 0 199,742 0 199,742 015040 ALPHA ONE PROGRAM-MIAMI-DADE 0 0 0 0 0 015040 CHILD HEALTH MEDICAL SERVICES 0 0 0 0 0 015040 CLOSING THE GAP PROGRAM 0 0 0 0 0 015040 COMMUNITY SMILES-MIAMI-DADE 0 0 0 0 0 015040 COMMUNITY TB PROGRAM 28,019 0 28,019 0 28,019 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 FAMILY PLANNING GENERAL REVENUE 47,373 0 47,373 0 47,373 015040 FL CLPPP SCREENING&CASE MANAGEMENT 0 0 0 0 0 015040 FL HEPATITIS&LIVER FAILURE PREVENTION/CONTROL 72,000 0 72,000 0 72,000 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-LEAGUE AGAINST CANCER-MIAMI-DADE 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 MIGRANT LABOR CAMP SANITATION 0 0 0 0 0 015040 MINORITY OUTREACH-PENALVER CLINIC-MIAMI-DADE 0 0 0 0 0 015040 SCHOOL HEALTH GENERAL REVENUE 56,596 0 56,596 0 56,596 015040 SPECIAL NEEDS SHELTER PROGRAM 0 0 0 0 0 015040 STATEWIDE DENTISTRY NETWORK-ESCAMBIA 0 0 0 0 0 015040 STD GENERAL REVENUE 16,755 0 16,755 0 16,755 015050 NON-CATEGORICAL GENERAL REVENUE 1,138,406 0 1,138,406 0 1,138,406 GENERAL REVENUE TOTAL 2,067,150 0 2,067,150 0 2,067,150 2. NON GENERAL REVENUE-STATE 015010 ALG/CONTR.TO CHDS-BIOMEDICAL WASTE 2,679 0 2,679 0 2,679 015010 ALG/CONTR.TO CHDS-SAFE DRINKING WATER PRG 0 0 0 0 0 015010 ALG/PRIMARY CARE 0 0 0 0 0 015010 CHD PROGRAM SUPPORT 0 0 0 0 0 015010 FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS 0 0 0 0 0 015010 PUBLIC SWIMMING POOL PROGRAM 0 0 0 0 0 015010 SCHOOL HEALTH TOBACCO TF 41,000 0 41,000 0 41,000 015010 TOBACCO ADMINISTRATION&MANAGEMENT 0 0 0 0 0 015010 TOBACCO ADMINISTRATIVE SUPPORT 30,000 0 30,000 0 30,000 015010 TOBACCO COMMUNITY INTERVENTION 108,000 0 108,000 0 108,000 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 3( Working Copy ATTACHMENT II. MONROE COUNTY HEALTH DEPARTMENT Part IL Sources of Contributions to County Health Department October 1,2011 to September 30,2012 State CHD County Total CHD Trust Fund CIID Trust Fund Other (cash) Trust Fund (cash) Contribution Total 2. NON GENERAL REVENUE-STATE 015060 NON-CATEGORICAL TOBACCO REBASING 21,117 0 21,117 0 21,117 NON GENERAL REVENUE TOTAL 202,796 0 202,796 0 202,796 3. FEDERAL FUNDS-State 007000 AIDS PREVENTION 124,224 0 124,224 0 124,224 007000 AIDS SURVEILLANCE 0 0 0 0 0 007000 BIOTERRORISM HOSPITAL PREPAREDNESS 0 0 0 0 0 007000 COASTAL BEACH MONITORING PROGRAM 23,418 0 23,418 0 23,418 007000 COLORECTAL CANCER SCREENING 2009-10 0 0 0 0 0 007000 ENHANCE COMPREHENSIVE PREVENTION PLANNING AND IMPL 15,976 0 15,976 0 15,976 007000 EXPANDED TESTING INITIATIVE(ETI) 0 0 0 0 0 007000 FGTF/AIDS MORBIDITY 0 0 0 0 0 007000 FGTF/BREAST&CERVICAL CANCER-ADMIN/CASE MAN 0 0 0 0 0 007000 FGTF/FAMILY PLANNING TITLE X SPECIAL INITIATIVES 76,366 0 76,366 0 76,366 007000 FGTF/FAMILY PLANNING-TITLE X 84,671 0 84,671 0 84,671 007000 HEALTH PROGRAM FOR REFUGEES 0 0 0 0 0 007000 HEALTHY PEOPLE HEALTHY COMMUNITIES 13,917 0 13,917 0 13,917 007000 HIV HOUSING FOR PEOPLE LIVING WITH AIDS 0 0 0 0 0 007000 HIV INCIDENCE SURVEILLANCE 0 0 0 0 0 007000 IMMUNIZATION FEDERAL GRANT ACTIVITY SUPPORT 9,582 0 9,582 0 9,582 007000 IMMUNIZATION FIELD STAFF EXPENSE 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 COALITIONS 0 0 0 0 0 007000 ORAL HEALTH WORKFORCE ACTIVITIES 0 0 0 0 0 007000 PHP-CITIES READINESS INITIATIVE 0 0 0 0 0 007000 PUBLIC HEALTH PREPAREDNESS BASE 115,379 0 115,379 0 115,379 007000 RAPE PREVENTION&EDUCATION GRANT 0 0 0 0 0 007000 RYAN WHITE 81,591 0 81,591 0 81,591 007000 RYAN WHITE-EMERGING COMMUNITIES 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 STD FEDERAL GRANT-CSPS 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 TEENAGE PREGNANCY PREVENTION REPLICATION 2010-11 0 0 0 0 0 007000 TEENAGE PREGNANCY PREVENTION REPLICATION 2011-12 0 0 0 0 0 007000 TITLE X HIV/AIDS PROJECT 0 0 0 0 0 007000 TITLE X MALE PROJECT 0 0 0 0 0 007000 TOBACCO FAITH BASED PROJECT 0 0 0 0 0 007000 TUBERCULOSIS CONTROL-FEDERAL GRANT 0 0 0 0 0 007000 WIC ADMINISTRATION 284,156 0 284,156 0 284,156 007000 WIC BREASTFEEDING PEER COUNSELING 60,875 0 60,875 0 60,875 015009 MEDIPASS WAIVER-HLTHY STRT CLIENT SERVICES 0 0 0 0 0 015009 MEDIPASS WAIVER-SOBRA 0 0 0 0 0 007055 ARRA Federal Grant-Schedule C 10,321 0 10,321 0 10,321 3-7 Working Copy ATTACHMENT II. MONROE COUNTY HEALTH DEPARTMENT Part II. Sources of Contributions to County Health Department October 1,2011 to September 30,2012 State CUD County Total CIID Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 3. FEDERAL FUNDS-State 015075 ON SITE SEWAGE TREATMENT&DISPOSAL SYSTEM 4,500 0 4,500 0 4,500 015075 SCFIOOL HEALTH TITLE XXI 125,758 0 125,758 0 125,758 015075 Inspections of Summer Feeding Programs 0 0 0 0 0 015075 TRANSFER OF FEDERAL GRANT FROM OTHER AGENCY 0 0 0 0 0 FEDERAL FUNDS TOTAL 1,066,177 0 1,066,177 0 1,066,177 4. FEES ASSESSED BY STATE OR FEDERAL RULES-STATE 001020 TANNING FACILITIES 1,280 0 1,280 0 1,280 001020 BODY PIERCING 970 0 970 0 970 001020 MIGRANT HOUSING PERMIT 0 0 0 0 0 001020 MOBILE HOME AND PARKS 19,500 0 19,500 0 19,500 001020 FOOD HYGIENE PERMIT 16,000 0 16,000 0 16,000 001020 BIOHAZARD WASTE PERMIT 10,155 0 10,155 0 10,155 001020 PRIVATE WATER CONSTR PERMIT 0 0 0 0 0 001020 PUBLIC WATER ANNUAL OPER PERMIT 0 0 0 0 0 001020 PUBLIC WATER CONSTR PERMIT 0 0 0 0 0 001020 NON-SDWA SYSTEM PERMIT 0 0 0 0 0 001020 SAFE DRINKING WATER 0 0 0 0 0 001020 SWIMMING POOLS 76,287 0 76,287 0 76,287 001092 OSDS PERMIT FEE 283,000 0 283,000 0 283,000 001092 1&M ZONED OPERATING PERMIT 0 0 0 0 0 001092 AEROBIC OPERATING PERMIT 0 0 0 0 0 001092 SEPTIC TANK SITE EVALUATION 0 0 0 0 0 001092 NON SDWA LAB SAMPLE 0 0 0 0 0 001092 OSDS VARIANCE FEE 0 0 0 0 0 001092 ENVIRONMENTAL HEALTH FEES 100 0 100 0 100 001092 OSDS REPAIR PERMIT 0 0 0 0 0 001170 LAB FEE CHEMICAL ANALYSIS 0 0 0 0 0 001170 WATER ANALYSIS-POTABLE 0 0 0 0 0 001170 NONPOTABLE WATER ANALYSIS 0 0 0 0 0 010304 MQA INSPECTION FEE 2,891 0 2,891 0 2,891 001206 Central Office Surcharge 36,102 0 36,102 0 36,102 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 446,285 0 446,285 0 446,285 5. OTHER CASH CONTRIBUTIONS-STATE 010304 STATIONARY POLLUTANT STORAGE TANKS 78,675 0 78,675 0 78,675 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 0 0 0 0 OTHER CASH CONTRIBUTIONS TOTAL 78,675 0 78,675 0 78,675 6. MEDICAID-STATE/COUNTY 001056 MEDICAID PHARMACY 0 0 0 0 0 001076 MEDICAID TB 167 211 378 0 378 001078 MEDICAID ADMINISTRATION OF VACCINE 12,228 12,228 24,456 0 24,456 001079 MEDICAID CASE MANAGEMENT 0 0 0 0 0 001081 MEDICAID CHILD HEALTH CHECK UP 1,483 1,883 3,366 0 3,366 001082 MEDICAID DENTAL 0 0 0 0 0 001083 MEDICAID FAMILY PLANNING 2,278 20,501 22,779 0 22,779 Working Copy ATTACHMENT II. MONROE COUNTY HEALTH DEPARTMENT Part IL Sources of Contributions to County Health Department October 1,2011 to September 30,2012 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 6. MEDICAID-STATE/COUNTY 001087 MEDICAID STD 216 274 490 0 490 001089 MEDICAID AIDS 39,257 49,843 89,100 0 89,100 001147 Medicaid HMO Capitation 0 0 0 0 0 001191 MEDICAID MATERNITY 0 0 0 0 0 001192 MEDICAID COMPREHENSIVE CHILD 0 0 0 0 0 001193 MEDICAID COMPREHENSIVE ADULT 86,337 109,616 195,953 0 195,953 001194 MEDICAID LABORATORY 0 0 0 0 0 001208 MEDIPASS$3.00 ADM.FEE 3,333 3,333 6,666 0 6,666 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 13,218 16,782 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 158,517 214,671 373,188 0 373,188 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 68,740 68,740 LABORATORY SERVICES 0 0 0 27,849 27,849 TB SERVICES 0 0 0 0 0 IMMUNIZATION SERVICES 0 0 0 508,171 508,171 STD SERVICES 0 0 0 0 0 CONSTRUCTION/RENOVATION 0 0 0 0 0 WIC FOOD 0 0 0 876,356 876,356 ADAP 0 0 0 0 0 DENTAL SERVICES 0 0 0 0 0 OTHER 0 0 0 0 0 OTHER(SPECIFY) 0 0 0 0 0 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 1,481,116 1,481,116 9. DIRECT LOCAL CONTRIBUTIONS-COUNTY 008030 Contribution from Health Care Tax 0 902,575 902,575 0 902,575 008034 BCC Contribution from General Fund 0 0 0 0 0 DIRECT COUNTY CONTRIBUTION TOTAL 0 902,575 902,575 0 902,575 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION-COUNTY 39 Working Copy ATTACHMENT II. MONROE COUNTY HEALTH DEPARTMENT Part II.Sources of Contributions to County Health Department October 1,2011 to September 30,2012 State CHD County Total CUD Trust Fund CHI) Trust Fund Other (cash) Trust Fund (cash) Contribution Total 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION-COUNTY 001060 CHD SUPPORT POSITION 0 2,600 2,600 0 2,600 001077 RABIES VACCINE 0 6,000 6,000 0 6,000 001077 CHILD CAR SEAT PROG 0 0 0 0 0 001077 PERSONAL HEALTH FEES 0 253,323 253,323 0 253,323 001077 AIDS CO-PAYS 0 5,744 5,744 0 5,744 001094 ADULT ENTER.PERMIT FEES 0 0 0 0 0 001094 LOCAL ORDINANCE FEES 0 74,515 74,515 0 74,515 001114 NEW BIRTH CERTIFICATES 0 22,500 22,500 0 22,500 001115 Vital Statistics-Death Certificate 0 53,000 53,000 0 53,000 001117 VITAL STATS-ADM.FEE 50 CENTS 0 850 850 0 850 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 0 418,532 418,532 0 418,532 11. OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY 001009 RETURNED CHECK ITEM 0 0 0 0 0 001029 THIRD PARTY REIMBURSEMENT 0 204,020 204,020 0 204,020 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 0 180,540 180,540 0 180,540 001190 Health Maintenance Organization 0 0 0 0 0 005040 INTEREST EARNED 0 0 0 0 0 005041 INTEREST EARNED-STATE INVESTMENT ACCOUNT 0 7,500 7,500 0 7,500 007010 U.S.GRANTS DIRECT 0 551,481 551,481 0 551,481 008010 Contribution from City Govemment 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 0 0 0 0 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 0 350,000 350,000 0 350,000 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 011000 GRANT DIRECT-COUNTY HEALTH DEPARTMENT DIRECT SERVICES 0 100,000 100,000 0 100,000 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 DENTAL 0 0 0 0 0 011000 GRANT DIRECT-HEALTH CARE DISTRICT PAHOKEE 0 0 0 0 0 `10 Working Copy ATTACHMENT H. MONROE COUNTY HEALTH DEPARTMENT Part II. Sources of Contributions to County Health Department October 1,2011 to September 30,2012 State CHD County Total CUD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 11. OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT DIRECT-ARROW 0 0 0 0 0 010402 Recycled Material Sales 0 0 0 0 0 010303 FDLE Fingerprinting 0 0 0 0 0 007050 ARRA Federal Grant 0 0 0 0 0 001010 Recovery of Bad Checks 0 0 0 0 0 008065 FCO Contribution 0 0 0 0 0 011006 Restricted Cash Donation 0 0 0 0 0 028000 Insurance Recoveries 0 0 0 0 0 001033 CMS Management Fee-PMPMPC 0 0 0 0 0 010400 Sale of Goods Outside State Government 0 90,751 90,751 0 90,751 010500 Refugee Health 0 60,047 60,047 0 60,047 005045 Interest Earned-Third Party Provider 0 0 0 0 0 005043 Interest Earned-Contract/Grant 0 0 0 0 0 010306 DOH/DOC Interagency Agreement 0 0 0 0 0 008040 BCC Grant/Contract 0 0 0 0 0 011002 ARRA Federal Grant-Sub-Recipient 0 0 0 0 0 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,544,339 1,544,339 0 1,544,339 12. ALLOCABLE REVENUE-COUNTY 018000 REFUNDS 0 0 0 0 0 037000 PRIOR YEAR WARRANT 0 0 0 0 0 038000 12 MONTH OLD WARRANT 0 0 0 0 0 COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0 13. BUILDINGS-COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 511,595 511,595 GROUNDS MAINTENANCE 0 0 0 0 0 OTHER(SPECIFY) 0 0 0 0 0 INSURANCE 0 0 0 0 0 UTILITIES 0 0 0 63,948 63,948 OTHER(SPECIFY) 0 0 0 0 0 BUILDING MAINTENANCE 0 0 0 60,260 60,260 BUILDINGS TOTAL 0 0 0 635,803 635,803 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND-COUNTY EQUIPMENT/VEHICLE PURCHASES 0 0 0 0 0 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 4/ Working Copy ATTACHMENT II. ". • MONROE COUNTY HEALTH DEPARTMEN Part IL Sources of Contributions to County Health Desartmenr October 1,2011 to September 30,2012 .` State CUD County Total CHDD.. . Trust Fund CHD Trust Fund Other` (cash) Trust Fund (cash) Contribution GRAND TOTAL CHD PROGRAM 1019,6o0 3,0S0,117 7.099.717 2 116.919 9,216,636