FY2015 10/17/2014 •
AMY HEAVILIN CPA
CLERK OF CIRCUIT COURT & COMPTROLLER
l MONROECOUNRT,FLORIDA
DATE: January 12, 2015
TO: Bob Eadie,
DOH Administrator
ATTN: Jillian Lorenz,
Contract Manager -DOH
FROM: Lindsey Ballard, D.
At the October 17, 2014, Board of County Commissioner's meeting the Board granted
approval and authorized execution of Item MI Contract between Monroe County Board of County
Commissioners and the State of Florida, Department of Health for operation of the Monroe County
Health Department—Contract Year 2014-2015
Enclosed are four (4) duplicate originasl of the above mentioned for your handling. Should you
have any questions,please feel free to contact me.
cc: County Attorney
Finance
File
500 Whitehead Street Suite 101,PO Box 1980,Key West,FL 33040 Phone:305-295-3130 Fax:305-295-3663
3117 Overseas Highway,Marathon,FL 33050 Phone:305-289-6027 Fox:305-289-6025
88820 Overseas Highway,Plantation Key,FL 33070 Phone:852-7145 Fax:305-852-7146
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 2014-2015
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, 2014.
RECITALS
A. Pursuant to Chapter 154, Florida Statutes, 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.
D. It is necessary for the parties hereto to enter into this Agreement in order to
ensure coordination between the State and the County in the operation of the CHD.
NOW THEREFORE, in consideration of the mutual promises set forth herein, the
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the forgoing recitals are true and
correct and incorporated herein by reference.
2. TERM. The parties mutually agree that this Agreement shall be effective from
October 1, 2014, through September 30, 2015, 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. "Communicable disease control services" are those services which protect the
health of the general public through the detection, control, and eradication of diseases
which are transmitted primarily by human beings. Communicable disease services shall
be supported by available federal, state, and local funds and shall include those services
mandated on a state or federal level. Such services include, but are not limited to,
epidemiology, sexually transmissible disease detection and control, HIV/AIDS,
immunization, tuberculosis control and maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the collective health of the public, and prevent and control the spread
of disease. Primary health care services are provided at home, in group settings, or in
clinics. These services shall be supported by available federal, state, and local funds and
shall include services mandated on a state or federal level. Examples of primary health
care services include, but are not limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health services; family planning;
nutrition; school health; supplemental food assistance for women, infants, and children;
home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $ 4,438,817 (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 II, Part II is an amount not
to exceed $1,165,070 (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
2
Health Department Trust Fund that is attributed to the CHD shall be carried forward to the
next contract period.
c. Either party may establish service fees as allowed by law to fund activities of the
CHD. 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, Office
of Budget and Revenue 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, Office of Budget and Revenue
Management.
e. The name and address of the official payee to who payments shall be made is:
County Health Department Trust Fund
Monroe County
PO Box 6193
1100 Simonton Street
Key West, FL 33040
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 Secretary for Statewide Services. The
director/administrator shall be selected by the State with the concurrence of the County.
The director/administrator of the CHD shall ensure 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 Division of Public Health Statistics and Performance Management 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.
3
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 maintained by the CHD in accordance with the terms of this Agreement. State
procedures must be followed for all leases on facilities not enumerated in Attachment IV.
c. The CHD shall maintain books, records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental
Accounting Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public, except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6.i.,
below. Books, records and documents must be adequate to allow the CHD to comply with
the following reporting requirements:
The revenue and expenditure requirements in the Florida Accounting
System Information Resource (FLAIR).
ii. The client registration and services reporting requirements of the
minimum data set as specified in the most current version of the Client
Information System/Health Management Component Pamphlet;
fit. 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
4
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
determined each month and at contract year-end. Surplus funds may be applied toward
the funding requirements of each participating governmental entity in the following year.
However, in each such case, all surplus funds, including fees and accrued interest, shall
remain in the trust fund until accounted for in a manner which clearly illustrates the amount
which has been credited to each participating governmental entity. The planned use of
surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital
projects explained in Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy Secretary
for Statewide Services has approved the transfer. The Deputy Secretary for Statewide
Services 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.
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.
5
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 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
DE385L1 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, Office of Budget and
Revenue Management.
6
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:
L March 1, 2015 for the report period October 1, 2014 through
December 31, 2014;
ii. June 1, 2015 for the report period October 1, 2014 through
March 31, 2015;
iii. September 1, 2015 for the report period October 1, 2014
through June 30, 2015; and
iv. December 1, 2015 for the report period October 1, 2014
through September 30, 2015.
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 ensure 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 ensure 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,
2015, 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: For the County:
Mary Vanden Brook, J.D. Roman Gastesi
Name Name
Administrative Services Director County Administrator
Title Title
PO Box 6193
1100 Simonton Street 1100 Simonton Street
Key West, FL 33040 Key West, FL 33040
Address Address
305-809-5612 305-292-4441
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.
8
In WITNESS THEREOF, the parties hereto have caused this 3¢ page agreement to be
executed by their undersigned officials as duly authorized effective the 1st day of October, 2014.
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR MONROE C UNTY DEPARTMENT OF HEALTH
SIGNED - SIGNED BY:
NAM Syl is J. urphy NAME: John H. Armstrong, MD
TITLE: Mayor TITLE: Surgeon General/Secretary of Health
DATE: 10 Il X7I4 DATE:
AT • TO:
ISM Itick),
sig. alb '�a'e A ' LtLGCIdy(.- SIGNED BY: �y"" ` " R"u"e
t1�`r i ,!yam NAME: Robert B. Eadie, J.D.
Pt; "Mott, TITLE: CHD Di ctor/Administrator
DA ` + r••loev I"1'r' . alp+- DATE: 0/y
MONROE COUNTY ATTORNEY
A ROV DART; F?/M:
YNTHIA L. ALL
ASSISTANT COUNTY ATTORNEY
Date I I'I L"a01q-
9
ATTACHMENT I
MONROE COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet(DHP 50-20), Environmental Health Coding Pamphlet(DHP 50-21)and FLAIR requirements
because of federal or state law, regulation or rule. If a county health department is funded to provide one of these
services, it must comply with the special reporting requirements for that service. The services and the reporting
requirements are listed below:
Service Requirement
1. Sexually Transmitted Disease Requirements as specified in F.A.C. 64D-3, F.S. 381 and
Program F.S. 384.
2. Dental Health Periodic financial and programmatic reports as specified by
the program office.
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 Requirements as specified in Public Law 91-572,42 U.S.C.
300, et seq.,42 CFR part 59, subpart A, 45 CFR parts 74&
92, 2 CFR 215(OMB Circular A-110)0MB Circular A-102,
F.S. 381.0051, F.A.C. 64F-7, F.A.C. 64F-16, and F.A.C.64F-
19. Requirements and Guidance as specified in the Program
Requirements for Title X Funded Family Planning Projects
(Title X Requirements)(2014)and the Providing Quality
Family Planning Services (QFP): Recommendations of CDC
and the U.S. Office of Population Affairs published on the
Office of Population Affairs website. Programmatic annual
reports as specified by the program office as specified in the
annual programmatic Scope of Work for Family Planning and
Maternal Child Health Services, including the Family Planning
Annual Report(FPAR), and other minimum guidelines as
specified by the Policy Web Technical Assistance Guidelines.
6. Immunization Periodic reports as specified by the department pertaining to
immunization levels in kindergarten and/or seventh grade
pursuant to instructions contained in the Immunization
Guidelines-Florida Schools, Childcare Facilities and Family
Daycare Homes(DH Form 150-615)and Rule 64D-3.046,
F.A.C. In addition, periodic reports as specified by the
department pertaining to the surveillance/investigation of
reportable vaccine-preventable diseases, adverse events,
vaccine accountability, and assessment of immunization
ATTACHMENT I (Continued)
levels as documented in Florida. SHOTS and supported by
CHD Guidebook policies and technical assistance guidance.
7. Environmental Health Requirements as specified in Environmental Health Programs
Manual 150 4*and DHP 50-21•
8. HIV/AIDS Program Requirements as specified in F.S. 384.25 and
F.A.C. 64D-3.030 and 64D-3.031. Case reporting should be
on Adult HIV/AIDS Confidential Case Report CDC Form
DH2139 and Pediatric HIV/AIDS Confidential Case Report
CDC Form DH2140.
Requirements as specified in F.A.C.64D-2 and 64D-3, F.S.
381 and F.S. 384. Socio-demographic and risk data on
persons tested for HIV in CHD clinics should be reported
on Lab Request DH Form 1628 in accordance with the Forms
Instruction Guide. Requirements for the HIV/AIDS
Patient Care programs are found in the Patient Care Contract
Administrative Guidelines.
9. School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines (May 2012). Requirements as
specified in F.S. 381.0056, F.S. 381.0057, F.S. 402.3026 and
F.A.C.64F-6.
10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C.
64D-3 and F.S. 392.
11. 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 F.A.C. 64D-3, F.S. 381, F.S. 384 and the CHD
Epidemiology Guide to Surveillance and Investigations.
12. Refugee Health Program Programmatic and financial requirements as specified by the
program office.
*or the subsequent replacement if adopted during the contract period.
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ATTAC1 t
MONROE COUNTY HEALTH DEPARTMENT .
`' .urces of Contributions to County Health De.: x^. /
•ctobe 214.toSe.tembe,30.20W'
State CHD County Total CHD
;j:. Trust Fund CHD Trust Fun. .:.d
,; ,•_,,,,,,,,___•-_,„. rs+,.„,_`,. ,,.,.:.,:aa:,aces`_'r; .u,,t,,,-„a...._.,.L,, (ca8}1),:•::,_Trust Fund ; . .(cash),:"' ' .ntribution"
1.GENERAL REVENUE•STATE
015040 AIDS PATIENT CARE 370,000 0 370,000 0 370,000
015040 AIDS PREVENTION&SURVEILLANCE•GENERAL REVENUE 73,552 0 73,552 0 73,552
015040 AIDS NETWORK REIMBURSEMENT 259,200 0 259,200 0 259,200
015040 CHD-TB COMMUNITY PROGRAM 25,284 0 25,284 0 25,284
015040 SEXUALLY TRANSMITTED DISEASE CONTROL PROGRAM GR 16,755 0 16,755 0 16,755
015040 ALG/CESSPOOL IDENTIFICATION&ELIMINATION PROG 53,766 0 53,766 0 53,766
015040 FAMILY PLANNING GENERAL REVENUE 25,360 0 25,360 0 25,360
015040 HEPATITIS AND LIVER FAILURE PREVENTION&CONTROL 72,000 0 72,000 0 72,000
015040 PRIMARY CARE PROGRAM 199,742 0 199,742 0 199,742
015040 SCHOOL HEALTH SERVICES-GENERAL REVENUE 96,223 0 96,223 0 96,223
015050 CHD GENERAL REVENUE NON-CATEGORICAL 1,178,492 0 1,178,492 0 1,178,492
GENERAL REVENUE TOTAL 2,370,374 0 2,370,374 0 2,370,374
2.NON GENERAL REVENUE•STATE
015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 3,859 0 3,859 0 3,859
015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 114,718 0 114,718 0 114,718
NON GENERAL REVENUE TOTAL 118,577 0 118,577 0 118,577
3.FEDERAL FUNDS•STATE
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN 35,443 0 35,443 0 35,443
007000 WIC BREASTFEEDING PEER COUNSELING PROG 17,337 0 17,337 0 17,337
007000 COASTAL BEACH WATER QUALITY MONITORING 18,962 0 18,962 0 18,962
007000 COMPREHENSIVE COMMUNITY CARDIO•PHBG 13,668 0 13,668 0 13,668
007000 FAMILY PLANNING GENERAL REVENUE 8,828 0 8,828 0 8,828
007000 FAMILY PLANNING TITLE X•GRANT 60,184 0 60,184 0 60,184
007000 HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS 429,306 0 429,306 0 429,306
007000 IMMUNIZATION ACTION PLAN 8,624 0 8,624 0 8,624
007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 17,701 0 17,701 0 17,701
007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC 118,412 0 118,412 0 118,412
007000 AIDS PREVENTION 127,268 0 127,268 0 127,268
007000 RYAN WHITE TITLE II CARE GRANT 76,596 0 76,596 0 76,596
007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIAM 481,668 0 481,668 0 481,668
007000 WIC PROGRAM ADMINISTRATION 300,936 0 300,936 0 300,936
015075 INSPECTIONS OF SUMMER FEEDING PROGRAM-DOE 268 0 268 0 268
015075 SUPPLEMENTAL SCHOOL HEALTH 123,839 0 123,839 0 123,839
015075 REFUGEE HEALTH SCREENING EXPENSE REIMBURSEMENT 25,000 0 25,000 0 25,000
015075 REFUGEE HEALTH SCREENING REIMBURSEMENT 75,000 0 75,000 0 75,000
FEDERAL FUNDS TOTAL 1,939,040 0 1,939,040 0 1,939,040
4.FEES ASSESSED BY STATE OR FEDERAL RULES•STATE
001020 CHD STATEWIDE ENVIRONMENTAL FEES 82,559 0 82,559 0 82,559
001092 CHD STATEWIDE ENVIRONMENTAL FEES 183,145 0 183,145 0 183,145
001093 CHD STATEWIDE ENVIRONMENTAL FEES 36,556 0 36,656 0 36,556
001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 10,000 0 10,000 0 10,000
Page 1 of 3
`' ATTACHMENT III*
2 :
MONROE COUNTY HEALTH DEPARTMENT
Part II,Sources of Contributions to County Health De• , ..eat
,. • .. 0.4 • Se.tembes 0 'I6.
State CHD County _ Total CHD
Trust Fund CHD Trust Fund Other .
•;a,;-,;.,, ,L,Ls.,:�,,,I.r,,: .: Trust_Fund ; ,,; (cas}1). .:-. Contribution Total
001206 SANITATION CERTIFICATES(FOOD INSPECTION) 2,350 0 2,350 0 2,350
001206 SEPTIC TANK RESEARCH SURCHARGE 200 0 200 0 200
001206 SEPTIC TANK VARIANCE FEES 50% 200 0 200 0 200
001206 PUBLIC SWIMMING POOL PERMIT FEES-10%HQ TRANSFER 5,300 0 5,300 0 5,300
001206 REGULATION OF BODY PIERCING SALONS 60 0 60 0 60
001206 TANNING FACILITIES 113 0 113 0 113
001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 370 0 370 0 370
001206 MOBILE HOME&RV PARK FEES 3,742 0 3,742 0 3,742
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 324,595 0 324,595 0 324,595
5.OTHER CASH CONTRIBUTIONS•STATE:
010304 CHD STATEWIDE ENVIRONMENTAL FEES 593 0 593 0 593
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 88,935 0 88,935 0 88,935
OTHER CASH CONTRIBUTION TOTAL 0 0 0 0 0
6.MEDICAID•STATE/COUNTY:
001078 CHD CLINIC FEES 0 3,641 3,641 0 3,641
001083 CHD CLINIC FEES 0 5,000 5,000 0 6,000
001087 CHD CLINIC FEES 0 100 100 0 100
001089 CHD CLINIC FEES 0 14,642 14,542 0 14,542
MEDICAID TOTAL 0 23,283 23,283 0 23,283
7.ALLOCABLE REVENUE•STATE:
1
0 0 0 0 0
MEDICAID TOTAL 0 0 0 0 0
8.OTHER STATE CONTRIBUTIONS NOT IN CID TRUST FUND•STATE
ADAP 0 0 0 479,474 479,474
PHARMACY DRUG PROGRAM 0 0 0 63,633 63,633
STD 0 0 0 0 0
WIC PROGRAM 0 0 0 859,810 859,810
BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 18,662 18,662
IMMUNIZATIONS 0 0 0 1,266,400 1,266,400
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 2,687,979 2,687,979
9.DIRECT LOCAL CONTRIBUTIONS•BCC/TAX DISTRICT
008030 CHD LOCAL REVENUE&EXPENDITURES 0 1,130,050 1,130,050 0 1,130,050
DIRECT COUNTY CONTRIBUTIONS TOTAL 0 1,130,050 1,130,050 0 1,130,050
10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION•COUNTY
001025 CHD CLINIC FEES 0 1,200 1,200 0 1,200
001060 VITAL STATISTICS CERTIFIED RECORDS 0 2,000 2,000 0 2,000
001073 CHD CLINIC FEES 0 35,400 35,400 0 35,400
001077 CHD CLINIC FEES 0 93,204 93,204 0 93,204
001094 CHD STATEWIDE ENVIRONMENTAL FEES 0 119,928 119,928 0 119,928
001114 VITAL STATISTICS CERTIFIED RECORDS 0 17,200 17,200 0 17,200
Page 2of3
a't
•TTACHIVIENT II
MONROE COUNTY HEALTH DEPARTMENT
Part II,Sources of Contributions to County Health De•artment
' '%:' I tober 1 201• to, =•tember,30 2015
_ r State CHD County Total CHD
.'..Trust Fund CHD Trust Fund Other,.
•
_.,_...., __ _ _ . (cash) _Trust Fund... (cash) Contribution,'. • ,
001115 VITAL STATISTICS CERTIFIED RECORDS 0 42,200 42,200 0 42,200
001117 VITAL STATISTICS CERTIFIED RECORDS 0 600 600 0 600
FEES AUTHORIZED BY COUNTY TOTAL 0 311,732 311,732 0 311,732
11.OTHER CASH AND LOCAL CONTRIBUTIONS•COUNTY
001029 CHD CLINIC FEES 0 143,695 143,695 0 143,695
001090 CHD CLINIC FEES 0 87,295 87,295 0 87,295
005041 CHD LOCAL REVENUE&EXPENDITURES 0 7,300 7,300 0 7,300
005043 CHD LOCAL REVENUE&EXPENDITURES 0 10 10 0 10
007010 RYAN WHITE TITLE III•DIRECT TO CHD 0 457,509 457,609 0 457,509
007010 RYAN WHITE TITLE III•DIRECT TO CHD 0 95,000 95,000 0 95,000
010300 CHD STATEWIDE ENVIRONMENTAL FEES 0 683 683 0 683
010400 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 74,800 74,800 0 74,800
010500 IMMUNIZATION CAMPAIGN MONROE COUNTY BOCC 0 226,000 226,000 0 226,000
010500 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 68,425 68,425 0 68,425
011000 SMOKE FREE HOUSING GRANT 0 23,031 23,031 0 23,031
011001 CHD HEALTHY START COALITION CONTRACT 0 290,000 290,000 0 290,000
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 454,387 454,387 0 454,387
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,928,135 1,928,135 0 1,928,135
12.ALLOCABLE REVENUE-COUNTY
0 0 0 0 0
COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0
13.BUILDINGS-COUNTY
ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 580,199 580,199
OTHER(Specify) 0 0 0 0 0
UTILITIES 0 0 0 61,623 61,523
BUILDING MAINTENANCE 0 0 0 71,641 71,641
GROUNDS MAINTENANCE 0 0 0 112,200 112,200
INSURANCE 0 0 0 0 0
OTHER(Specify) 0 0 0 0 0
OTHER(Specify) 0 0 0 0 0
BUILDINGS TOTAL 0 0 0 825,563 825,563
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
GRAND TOTAL CHD PROGRAM 4,842,114 3,393,200 8,235,314 3,513,542 11,748,856
Page 3 of 3
i
ATTACHMENT II
r:._.; ti ,-': ;s MONROE COUNTY HEALTH DEPARTMENT
Part III,Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level of Service
F October 1,2014,to Se.tember 30,2015
s + u Quarterly Expenditure Plan
FTE's ; wClients Services/ let 2nd 3rd 4th Grand;-.
r _ (0.00) Unite Visits (Whole dollars only) State County Total
A. COMMUNICABLE DISEASE CONTROL:
IMMUNIZATION (101) 9.75 5,064 7,333 244,885 209,848 244,885 244,791 8,624 935,785 944,409
SEXUALLY TRANS.DIS. (102) 1.66 230 450 35,031 30,019 35,031 35,018 16,755 118,344 135,099
HIV/AIDS PREVENTION (03A1) 3.94 352 587 80,478 68,963 80,478 80,447 309,954 412 310,366
HIV/AIDS SURVEILANCE (03A2) 0.07 35 38 1,436 1,230 1,436 1,435 5,530 7 5,537
HIV/AIDS PATIENT CARE (03A3) 16.28 421 3,203 674,214 577,749 674,214 673,953 1,963,457 636,673 2,600,130
ADAP (03A4) 1.28 33 37 22,184 19,010 22,184 22,176 85,421 133 85,554
TUBERCULOSIS (104) 0.44 12 29 10,489 8,988 10,489 10,484 40,404 46 40,450
COMM.DIS.SURV. (106) 1.20 0 732 31,451 26,951 31,451 31,440 0 121,293 121,293
HEPATITIS (109) 0.95 250 226 22,415 19,208 22,415 22,405 86,343 100 86,443
PREPAREDNESS AND RESPONSE (116) 2.50 0 600 61,581 52,771 61,581 61,558 237,491 0 237,491
REFUGEE HEALTH (118) 1.33 259 1,979 45,068 38,620 45,068 45,050 173,667 139 173,806
VITAL RECORDS (180) 1.42 1,700 4,664 26,055 22,327 26,055 26,045 38,482 62,000 100,482
COMMUNICABLE DISEASE SUBTOTAL 40.82 8,356 19,878 1,255,287 1,075,684 1,255,287 1,254,802 2,966,128 1,874,932 4,841,060
B. PRIMARY CARE:
CHRONIC DISEASE PREVENTION PRO (210) 1.05 30 60 20,390 17,472 20,390 20,382 13,668 64,966 78,634
WIC (21W1) 5.46 1,940 13,080 105,676 90,556 105,676 105,636 407,544 0 407,544
TOBACCO USE INTERVENTION (212) 2.31 0 47 ,44,609 38,227 44,609 44,592 114,718 57,319 172,037
WIC BREASTFEEDING PEER COUNSELING (21W2) 0.56 0 627 8,102 6,942 8,102 8,098 31,244 0 31,244
FAMILY PLANNING (223) 3.90 1,146 2,085 100,674 86,270 100,674 100,634 112,073 276,179 388,252
IMPROVED PREGNANCY OUTCOME (225) 0.00 0 0 0 0 0 0 0 0 0
HEALTHY START PRENATAL (227) 2.88 632 3,440 58,223 49,892 58,223 58,200 0 224,538 224,538
COMPREHENSIVE CHILD HEALTH (229) 0.22 146 151 4,464 3,825 4,464 4,463 0 17,216 17,216
HEALTHY START CHILD (231) 2.20 532 2,705 38,769 33,222 38,769 38,756 0 149,516 149,616
SCHOOL HEALTH (234) 4.55 0 139,076 82,590 70,774 82,590 82,559 220,062 98,451 318,513
COMPREHENSIVE ADULT HEALTH (237) 6.08 600 2,811 148,666 127,395 148,666 148,607 309,252 264,082 573,334
COMMUNITY HEALTH DEVELOPMENT (238) 1.91 0 1,131 43,124 36,954 43,124 43,108 166,310 0 166,310
DENTAL HEALTH (240) 0.00 0 0 0 0 0 0 0 0 0
PRIMARY CARE SUBTOTAL 31.12 5,026 165,203 655,287 561,529 655,287 655,035 1,374,871 1,152,267 2,527,138
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COSTAL BEACH MONITORING (347) 0.26 287 291 7,195 6,166 7,195 7,192 19,645 8,103 27,748
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 25 22 25 26 4 94 98
PRIVATE WATER SYSTEM (359) 0.00 0 0 0 0 0 0 0 0 0
ONSITE SEWAGE TREATMENT&DISPOSAL (361) 6.32 3,951 6,402 107,422 92,053 107,422 107,381 259,470 154,808 414,278
Group Total 6.58 4,238 6,693 114,642 98,241 114,642 114,599 279,119 163,005 442,124
Facility Programs
TATTOO FACILITY SERVICES (344) 0.04 0 11 749 642 749 748 2,888 0 2,888
Page 1 0[2
ATTACHMENT II .
MONROE COUNTY HEALTH DEPARTMENT
• Part III,Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level of Service
October 1,2014 to September 30,2015
Quarterly Expenditure Plan
FTE'e Clients Services/ 1st 2nd 3rd 4th Grand
(0.00) Unita Visits (Whole dollars only) State County Total
FOOD HYGIENE (348) 0.51 54 234 8,528 7,307 8,528 8,524 16,473 16,414 32,887
BODY PIERCING FACILITIES SERVICES (349) 0.00 7 0 71 61 71 71 159 115 274
GROUP CARE FACILITY (351) 0.09 30 46 1,621 1,389 1,621 1,619 252 5,998 6,250
MIGRANT LABOR CAMP (352) 0.00 0 0 0 0 0 0 0 0 0
HOUSING&PUB.BLDG. (353) 0.01 1 1 216 185 216 217 22 812 834
MOBILE HOME AND PARK(354) 0.41 119 244 6,397 5,482 6,397 6,395 14,226 10,445 24,671
POOLSBATHING PLACES (360) 1.46 616 1,418 24,324 20,844 24,324 24,316 49,441 44,367 93,808
BIOMEDICAL WASTE SERVICES (364) 0.23 130 132 3,725 3,192 3,725 3,723 10,892 3,473 14,365
TANNING FACILITY SERVICES (369) 0.01 4 9 165 142 165 165 425 212 637
Group Total 2.76 961 2,095 45,796 39,244 45,796 45,778 94,778 81,836 176,614
Groundwater Contamination
STORAGE TANK COMPLIANCE SERVICES (355) 1.73 200 358 34,862 29,874 34,862 34,847 64,445 70,000 134,445
SUPER ACT SERVICES (356) 0.00 0 0 45 38 45 45 173 0 173
Group Total 1.73 200 358 34,907 29,912 34,907 34,892 64,618 70,000 134,618
Community Hygiene
COMMUNITY ENVIR.HEALTH (345) 0.29 0 12 6,933 5,941 6,933 6,932 26,739 0 26,739
INJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0
LEAD MONITORING SERVICES (350) 0.00 0 0 8 6 8 7 1 28 29
PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0
SOLID WASTE DISPOSAL SERVICE (363) 0.00 0 0 0 0 0 0 0 0 0
SANITARY NUISANCE (365) 0.16 40 100 2,808 2,406 2,808 2,807 10,829 0 10,829
RABIES SURVEILLANCE (366) 0.02 2 8 373 320 373 373 1,439 0 1,439
ARBORVIRUS SURVEIL. (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 15 13 15 16 59 0 59
INDOOR AIR (371) 0.00 0 0 0 0 0 0 0 0 0
RADIOLOGICAL HEALTH (372) 0.00 0 0 0 0 0 0 0 0 0
TOXIC SUBSTANCES (373) 0.64 368 369 13,569 11,628 13,569 13,564 1,199 51,131 52,330
Group Total 1.11 410 489 23,706 20,314 23,706 23,699 40,266 51,159 91,425
ENVIRONMENTAL HEALTH SUBTOTAL 12.18 5,809 9,635 219,051 187,711 219,051 218,968 478,781 366,000 844,781
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 5,791 4,963 5,791 5,790 22,335 0 22,335
MEDICAID BUYBACK (611) 0.00 0 0 0 0 0 0 0 0 0
NON-OPERATIONAL COSTS SUBTOTAL 0.00 0 0 5,791 4,963 5,791 5,790 22,335 0 22,335
TOTAL CONTRACT 84.12 19,191 194,716 2,135,416 1,829,887 2,135,416 2,134,595 4,842,115 3,393,199 8,235,314
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. The 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 1100 Simonton Street Monroe County
Administration Key West, FL 33040
Nursing
Juvenile Justice Building 5503 College Road Monroe County
Environmental Health Key West, FL 33040
Murray E. Nelson Government Center 102050 Overseas Highway Monroe County
Environmental Health Key Largo, FL 33037
Roosevelt Sands Center 105 Olivia Street City of Key West
Clinic Key West, FL 33040 subject to Inter-local
Agreement with Monroe
County for MCHD use
Ruth Ivins Center 3333 Overseas Highway Monroe County
Clinic Marathon, FL 33050
Environmental Health
Roth Building 50 High Point Road Monroe County
Clinic Tavernier, FL 33070
ATTACHMENT V
MONROE COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS
CONTRACT YEAR STATE COUNTY TOTAL
2013-2014' $ $ $
2014-2015" $ $ $
2015-2016' $ $ $
2016-2017"' $ $ $PROJECT TOTAL $ N/A $ N/A $ N/A
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NUMBER:
PROJECT NAME:
LOCATION/ADDRESS:
PROJECT TYPE: NEW BUILDING ROOFING
RENOVATION _ PLANNING STUDY
NEW ADDITION OTHER
SQUARE FOOTAGE:
PROJECT SUMMARY: Describe scope of work in reasonable detail.
START DATE (initial expenditure of funds):
COMPLETION DATE:
DESIGN FEES: $
CONSTRUCTION COSTS: $
FURNITURE/EQUIPMENT $
TOTAL PROJECT COST: $ -
COST PER SQ FOOT: $ N/A
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
'Cash balance as of 9/30/14.
"Cash to be transferred to FCO account.
"'Cash anticipated for future contract years.
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FEE RESOLUTIONS 2014-2015 OYI
HEALTH
PURPOSE: To establish public health service fees in order to expand existing public health services
to the community at large.
A. 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 3rd 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.
i. Specimens tested in clinic-(hemoglobin, urine,
blood sugar, mono, wet mount, strep) $ 10.00
ii. Pregnancy test No charge
B. 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
listed above in C. (1). $ 35.00
(5) Tuberculin assessment of clients with a past history of
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
i. Office/Outpatient Visit, New $ 178.00
Page 1 of 5 Monroe County Health Department Core Contract 2014-2015
ii. 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
(8) Vaccine administration fee (child or adult) $ 23.50
(9) Special vaccination campaigns allow for the acceptance
insurance at contracted amount, no co-pay or deductible to
client. Where manufacturer offers rebate,assistance or
replacement plans, un-insured clients are eligible for no No Charge
cost.
(10) County Sponsored Vaccinations for TdAP, HPV and No Charge for
Seasonal Flu residents earning
400%of Federal
Poverty Level or less
(11)Seasonal Flu vaccinations for those not covered in C.10
above $ 18.00
(12)All other Immunizations Cost of vaccine x 2 + $
23.50 injection fee
(13)Class/Seminar attendance registration per person charge
for health care,social work and counseling employees
i. AIDS 101
ii. AIDS 500 No Charge
iii. AIDS 501 No Charge
(14)Expendable medical/wound care supplies such as:Sponge No Charge
Gauze, Bandages/Dressings, Gloves
(15)International Certificates of Vaccination Cost x 3.5
Cost x 3.5
C. VITAL STATISTICS
(1) Birth Certificates $ 16.00
(2) Additional Birth Certificate Copies $ 16.00
(3) Protective Covers $ 4.00
(4) Death Certificates—Certified Copy $ 13.00
(5) Additional Death Certificate Copies $ 13.00
(6) Express Fee $ 10.00
D. MEDICAL RECORDS
Copying of Medical Record (per page) $ 1.00
E. PUBLIC RECORDS
(1) Copying of Public Record (per page) $ 1.00
A service fee of
F. RETURNED/DISHONORED CHECKS:(S 215.34(2)F.S) $15.00 or 5%of
the face amount of
the check, draft,or
money order
whichever is
greater, not to
Page 2 of 5 Monroe County Health Department Core Contract 2014-2015
exceed $150.00
G. PUBLIC HEALTH AND MEDICAL PREPAREDNESS
Submission and Review of Required Annual Comprehensive
Emergency Management Plan for Home Health Agencies,
Hospices, Nurse Registries, Home Medical Equipment Providers
$ 65.00
Fee Schedule, Environmental Health County Fee List
(In addition to State Fees on alternate Fee Schedule)
I. ONSITE SEWAGE DIPOSAL PROGRAM (OSTDS) County Fee
a. Application and plan review for construction permit for 100
new systems
b. Application and approval for existing system, if system 10
inspection not required.
c. Application and Existing System Evaluation with inspection 50
d. Application for permitting of an new Performance-based 75
treatment system
e. Site Evaluation 0
f. Site re-evaluation 40
g. Permit or permit amendment for new systems 25
h. Initial system inspection 50
i. System re-inspection(stabilization, non-compliance, or 25
other inspection after initial inspection.
j. Research fee (State Fee) 0
k. Repair Permit with Inspection 50
I. Application for system abandonment permit 45
m. Tank manufacturer's inspection per annum 20
n. Amendment to an Operating Permit 0
o. Septage Disposal Service Permit per annum 2X per yr 45
inspection
p. Portable or temporary toilet service permit per annum 45
q. Additional charge per pump out vehicle 5
r. Annual operating permit industrial/manufacturing zoning 0
or commercial sewage waste
s. Biennial Operating permit for aerobic treatment unit or 0
performance-based treatment system
t. Aerobic treatment unit maintenance entity permit per 0
annum
u. Variance application for a single family residence per each 100
lot or building site
v. Variance application for a multifamily or commercial 140
building site
w. Inspection for construction of an Injection well (FL Keys) 95
x. OSTDS Operating Permit Late Fee (45 days past due) 50
Page 3 of 5 Monroe County Health Department Core Contract 2014-2015
y. Per request-Expediting-Fast Track Permitting New& 500
Existing (48 hour turn-around) Charged in addition to state
fee
z. Letter of Coordination for development review 250
committees
aa. Expedited OSTDS Variance Processing. Received within 6 500
days of monthly deadline. Charged in addition to state fee
bb.OSTDS PBTS screening test fee 25
II. PUBLIC SWIMMING POOLS
a. Annual permit- up to and including 25,000 gallons 115
b. Annual permit- more than 25,000 gallons 100
c. Non routine inspection(no charge for first inspection 100
d. Exempted condominiums/Cooperatives with over 32 units 25
III- MOBILE HOME& RECREATIONAL VEHICLE PARKS
a. Annual permit for 5 to 25 spaces 125
b. Annual permit for 26 to 149spaces$3.50 per space
c. Annual permit for 150 and above spaces 400
IV. FOOD ESTABLISHMENTS
a. Annual Permit for Fraternal/Civic 35
b. Annual Permit School Cafeteria Operating for 9 months or 105
less
c. Annual Permit School Cafeteria Operating for more than 9 125
months
d. Annual Permit for Movie Theaters 0
e. Annual Permit for Jails/Prisons 0
f. Annual Permit for Bars/Lounges 35
g. Annual Permit for Residential Facilities 65
h. Annual Permit for Limited Food Service 115
i. Child care center 40
j. Caterer 45
k. Mobile Food Units 45
I. Other Food Service 35
m. Vending machine dispensing potentially hazardous food 0
n. Plan review per hour public schools,colleges, and 20
vocational teaching facilities are exempt from this fee
o. Food establishment worker training course per person 0
p. Alcoholic beverage inspection approval 15
q. Request for inspection 10
r. Re-inspection (for each re-inspection after the first) 0
s. Temporary event food service establishment 100
(a)sponsor w/o existing sanitation certificate
t. b)vendor or booth at an establishment or location w/o an 50
existing sanitation certificate
Page 4 of 5 Monroe County Health Department Core Contract 2014-2015
u. Late renewals 15
V. BIOMEDICAL
a. Generators 40
b. Storage Facilities 40
c. Late Fee 20
VI. TANNING FACILITIES
a. Annual Permit 100
b. Fee per Device 0
c. Consultation 50
d. Late Renewal Fee 0
VII. BODY PIERCING ESTABLISHMENTS
a. License Fee 100
b. Temporary Establishment 15
c. Late fee 0
d. Consultation 50
VIII. HEALTHY HOMES PROGRAM
a. Healthy home Assessment Voluntary Inspection living 300
unit(radon, CO2, Mold Safety)
b. Public Education-Per Attendee 25
Page 5 of 5 Monroe County Health Department Core Contract 2014-2015