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Item K1BOARD OF COUNTY COMMISSI( AGENDA ITEM SUMMARY Meeting Date: April 18, 2015 Division: Monroe Count' Health Department Bulk Item: Yes x No Staff Contact: Robert Eadie 809-5610 AGENDA ITEM WORDING: Approval of Amendment 1 to the core contract with Monroe County Health Department. ITEM BACKGROUND: Review of amendment to planned expenditures, revenue, and fee schedule for county funding of local health department. PREVIOUS RELEVANT BOCC ACTION: This is the annual renewal of an agreement between Monroe County and Florida Department of Health that has continued for 20+ years. CONTRACT/AGREEMENT CHANGES: As specified in paragraph 4, section d, of the above referenced contract, either party may increase or decrease funds to the contract upon written notification to the other party. Please find the following: • An updated summary of funding revisions • Page 2 of the contract reflecting updated funding adjustments • Revised Attachment lI, Parts H and III, incorporating the changes indicated in the summary and covering the period subsequent to the contract amendment • A revised Attachment H, Part I STAFF RECOMMENDATIONS: Approval. TOTAL COST: $1,165,070.00 INDIRECT COST: BUDGETED: Yes X No COST TO COUNTY: $1,165,070.00 SOURCE OF FUNDS: REVENUE PRODUCING: Yes _ No AMOUNT PER MONTH Year pli APPROVED BY: County Atty � CMI3/Purchasing Risk Management '' x DOCUMENTATION: Included X Not Ilequired DISPOSITION: _ _ AGENDA ITEM # Revised 1/09 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: MC Health Department Contract # Effective Date: October 1, 2014 Expiration Date: September 30, 2015 Contract Purpose/Description: Approval of amendment to the contract between Monroe County Board of Commissioners and The State of Florida, Department of Health - for opSation of the Monroe Countv Health Department Contract vear 2014-2015 Contract Manager. Robert Eadie 809-5610 MC Health Department (Name) (Ext.) (Department/Stop #) for BOCC meetins on 04/18/2015 Agenda Deadline: 03/03/15 CONTRACT COSTS Total Dollar Value of Contract: $ 1,165,070 Current Year Portion: $ Budgeted? Yes® No ❑ Account Codes: - - - Grant: $ 0 - - County Match: $ - - - - ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: (Not included in dollar value aktove ( _, maintenance. uulities. "anitonal, salaries, etc. a 1M t : t It Changes Date Out. Date In Needed Reviewer er Division Director Yes[] No[] A, Risk Management Yes❑ No❑ e_ O.M.B./Purchasing _ Yes[-] No[K]mf County Attorney Yes] Noaf _ r w Comments: L t o- l t C Is) FIRST AMENDMENT TO 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 this day of April 2015. RECITALS WHEREAS, the parties entered into the Agreement intended to serve as a core contract between the parties on October 1, 2014; and WHEREAS, Attachment II, Parts II and III to the Agreement sets forth the fees that may be charged by the State and the County Health Department (CHD) in delivering various services, planned expenditures and revenue; and WHEREAS, Attachment II Parts I to the Agreement sets forth the planned use of funds by the State and the County Health Department (CHD) in delivering various services,; and WHEREAS, the State and the CHD desire to amend the fee schedule, planned expenditures and revenue WHEREAS, the County is in agreement with the request for this amendment; 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. Parts I, II & III of Attachment II to the Agreement is removed and replaced in its entirety with Exhibit A to this First Amendment, which shall henceforth constitute the new Parts I, II & III of Attachment II to the Agreement. 2. 4.a.i. is hereby amended and replaced with: 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 $ 4,519,085 (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. 3. In all other respects the Agreement between the parties remains the same. In WITNESS THEREOF, the parties hereto have caused this —,_ page agreement to be executed by their undersigned officials as duly authorized effective the _,_ day of April 2015. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA MONROE COUNTY, FLORIDA DEPARTMENT OF HEALTH SIGNED BY: NAME: TITLE: DATE: ATTESTED TO: SIGNED BY: NAME: TITLE: DATE: SIGNED BY: NAME: John H. Armstrong, MD TITLE: Surgeon General/Secretary of Health DATE: SIGNED BY: NAME: Robert Eadie, J.D. TITLE: CHD Director/Administrator DATE: 10 Mission: To protect, promote & improve the health of all people In Florida through Integrated state, county & community efforts. February 27, 2015 Rick Scott Governor °' I or R1 2.1 1 John H. Armstrong, MD, FAGS HEALTHI State Surgeon General & Secretary Vision: To be the Healthlest State in the Nation Mr. Roman Gastesi, County Administrator Monroe County Board of County Commissioners 1100 Simonton Street Key West, Fl- 33040 RE: FY 2014-2015 Contract between the Monroe County Board of County Commissioners and the Florida Department of Health for operation of the Monroe County Health Department Dear Mr. Gastesi: As specified in paragraph 4, section d, of the above referenced contract, either party may increase or decrease funds to the contract upon written notification to the other party. Please find the following: • An updated summary of funding revisions • Page 2 of the contract reflecting updated funding adjustments • Revised Attachment II, Parts I, II and III, incorporating the changes indicated in the summary and covering the period subsequent to the contract amendment Please note, there is no change to the level of funding allocated per the Monroe County BOCC budget process, merely an update of information regarding anticipated resources and their use for the contract year. If you have any questions, please feel free to contact Kathy Rodgers at 305-809-5615. Sincerely, *94� Robert Eadie, J.D. Ad min i st rato r/D i rector Monroe County Health Department Enclosures Cc: Beth Benton, Office of Budget and Revenue Management www.FloridaMealth.gov Florida Department of Health TWITTER:HeafthyFLA In XX)0= COUNTY • Program name If desired FACEBOOK:FLDeparlmentofHealth XXXX Address • City, Florida Zip YOUTUBE: fldoh PHONE: XXX/XXX-XXXX - FAX XXX/XXX-XXXX FLICKR: HealthyFla PINTEREST: HealthyFla F- z cw G 2 a H Q a O 0) 0Ni o M co O Lo L T r-• h C � O ❑ U = � U � o f° E In i/1 L 7 LU fA U- a� � 2 � � U � cc M m N t 7 W fn LL r et ti O 00 (O co LIB 't co rn co o Lo N Ln O T N T LO U coL T T O N C N U M U coo m E N E a a LU c o o Q o a C ` T N c T N LL - a � 3T Cc UT p CD (0 U cv 00 cn O T N M co v M N Ln M ® In T L O � N O D M E D a 1 m o N o 00u Worldng Copy ATTACHMENT H . MONROE COUNTY HEALTH DEPARTMENT Part 11. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 1. GENERAL REVENUE - STATE 015040 AIDS NETWORK REIMBURSEMENT 259,200 0 259,200 0 259,200 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 ALGlCHD SOVEREIGN IMMUNITY 0 0 0 0 0 015040 ALPHA ONE PROJECT 0 0 0 0 0 015040 CHD - TB COMM UNITY PROGRAM 25,284 0 25,284 0 25,284 015040 COMMUNITY HEALTH INITIATIVES - GENERAL REVENUE 53,766 0 53,766 0 53,766 015040 DENTAL SPECIAL INITIATIVE PROJECTS 0 0 0 0 0 015040 DOH RESPONSE TO TERRORISM 0 0 0 0 0 015040 FAMILY PLANNING GENERAL REVENUE 34,188 0 34,188 0 34,188 015040 HEALTHY START - GR 0 0 0 0 0 015040 HEPATITIS AND LIVER FAILURE PREVENTION & CONTROL 72,000 0 72,000 0 72,000 015040 LA LIGA CONTRA EL CANCER - GR 0 0 0 0 0 015040 LEAD POISONING PREVENTION EDUCATION PROGRAM 0 0 0 0 0 015040 MARY BROGAN BREAST & CERVICAL CANCER (NONREC GR) 0 0 0 0 0 015040 MIGRANT LABOR CAMP SANITATION 0 0 0 0 0 015040 PRIMARY CARE LIP MATCH 0 0 0 0 0 015040 PRIMARY CARE PROGRAM 199,742 0 199,742 0 199,742 015040 RACIAL & ETHNIC DISPARITIES - CHD EXPENSES 0 0 0 0 0 015040 RAPE CRISIS CENTER 0 0 0 0 0 015040 SCHOOL HEALTH SERVICES - GENERAL REVENUE 96,223 0 96,223 0 96,223 015040 SEXUALLY TRANSMITTED DISEASE CONTROL PROGRAM GR 16,755 0 16,755 0 16,755 015040 STD CLINICAL SERVICES - MIAMI DADE CHD 0 0 0 0 0 015040 TEEN PREGNANCY PREVENTION - GENERAL REVENUE 0 0 0 0 0 015030 CHD CLINIC FEES 0 0 0 0 0 015050 CHD GENERAL REVENUE NON -CATEGORICAL 1,178,492 0 1,178,492 0 1,178,492 015050 RACIAL & ETHNIC DISPARI PIES - CHD EXPENSES 0 0 0 0 0 GENERALREVENUETOTAL 2,379,202 0 2,379,202 0 2,379,202 2. NON GENERAL REVENUE -STATE 015010 CHD FEDERAL & LOCAL INDIRECT EARNINGS 0 0 0 0 0 015010 CHD GENERAL REVENUE NON-CATEGORICAI, 0 0 0 0 0 015010 DBPR TRANSFER FOR FEES 0 0 0 0 0 015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 3,859 0 3,859 0 3,859 015010 MEDICAID INCENTIVE FOR ELECTRONIC HLTH RECORD 0 0 0 0 0 015010 PUBLIC SWIMMING POOL PERMIT FEES-10% HQ TRANSFER 0 0 0 0 0 015010 RAPE CRISIS PTF SEXUAL BATTERY VICTIMS ACCESS 0 0 0 0 0 015010 SAFE DRINKING WATER ACT - HEADQUARTERS 0 0 0 0 0 015010 SCHOOL HEALTH SERVICES - TOBACCO FUNDED 0 0 0 0 0 015010 STATE UNDERGROUND PETROLEUM RESPONSE ACT 0 0 0 0 0 015010 TOBACCO NON PILOT EXPENDITURES 0 0 (} 0 0 015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 114,718 0 114,718 0 114,718 015010 TROPICAL STORM ISAAC 2012 22,576 0 22,576 0 22,576 015060 NON -CATEGORICAL TOBACCO REBASING 0 0 0 0 0 NON GENERAL REVENUE TOTAL 141,153 0 141,153 0 141,153 3. FEDERAL FUNDS - State Working Copy ATTACHMENT H . MONROE COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015 State CHD County Total CHID Trust Fund CHD 'rust Fund Other (cash) Trust Fund (cash) Contribution Total 3. FEDERAL FUNDS - State 007000 ABSTINENCE EDUCATION GRANT PROGRAM 0 0 0 0 0 007000 ADULT HEPATITIS B VACCINATION PROJECT 0 0 0 0 0 007000 ADULT VIRAL HEPATITIES PREVENTION & SURVEILLANCE 0 0 0 0 0 007000 ADVANCE REG OF VOLUNTEER HEALTH PROFESSIONALS 0 0 0 0 0 007000 AFRICAN AMERICAN HIV TESTING INITIATIVE/CLINICAL 0 0 0 0 (} 007000 AFRICAN AMERICAN HIV TESTING INITIATIVE/NONCLINC 0 0 0 0 0 007000 AIDS DRUG ASSISTANCE PROGRAM MIN 35,443 0 35,443 0 35,443 007000 AIDS PREVENTION 127,268 0 127,268 0 127,268 007000 AIDS SURVEILLANCE - CORE 0 0 0 0 0 007000 BIOTERRORISM HOSPITAL PREPAREDNESS 0 0 0 0 0 007000 BREAST & CERVICAL CANCER - ADMIN/CASE MANAGEMENT 0 0 0 0 0 007000 CHD GENERAL REVENUE NON -CATEGORICAL 0 0 0 0 0 007000 COASTAL BEACH WATER QUALITY MONITORING 18,962 0 18,962 0 18362 007000 COLORECTAL CANCER SCREENING 0 0 0 0 0 007000 COMPREHENSIVE COMMUNITY CARDIO - PHBG 36,000 0 36„000 0 36,000 007000 DIABETES HEART ENHANCEDD 0 0 0 0 0 007000 FAMILY PLANNING TITLE X - GRANT 60,184 0 60,184 0 60,184 007000 HEALTHY START COALITIONS MCHBG 0 0 0 0 0 007000 HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS 520,798 0 520,788 0 520,788 007000 IMMUNIZATION - AFIX 0 0 0 0 0 007000 IMMUNIZATION ACTION PLAN 8,624 0 8,624 0 8,624 007000 IMMUNIZATION FIELD STAFF 0 0 0 0 0 007000 IMPROVING STD PROGRAMS 0 0 0 0 0 007000 INJURY SURVEILLANCE & PREVENTION GRANT 0 0 0 0 0 007000 MCH SPECIAL PRJC'T UNPLANNED PREGNANCY 22,454 0 22,454 0 22,454 007000 MCH SPECIAL PROJCT DENTAL 0 0 0 0 0 007000 MCH SPECIAL PROJECT PRAMS, 0 0 0 0 0 007000 MCH SPECIAL PROJECTS DENTAL 0 0 0 0 0 007000 MINORITY AIDS FUNDING - PREVENTION - SERVICES 0 0 0 0 0 007000 MINORITY AIDS INITIATIVE TCF.COLLABORATIVE 0 0 0 0 0 007000 MINORITY AIDS INITIATIVES - TREATMENT 0 0 0 0 0 007000 MINORITY INVOLVEMENT IN HIV/AIDS PROGRAM 0 0 0 0 0 007000 MORBIDITY AND RISK BEHAVIOR SURVEILLANCE 0 0 0 0 0 007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC 129,000 0 129,000 0 129,000 007000 PHP-CITIES RESPONSE INITIATIVE 0 t1 0 0 0 007000 PUBLIC HLTH INF STRUCTURE 26,000 0 26,000 0 26,000 007000 PUBLIC HL'rH INFRASTRUCTURE INDIAN RIVER 0 0 0 0 0 007000 RADON INDOOR AIR EPA FUNDNG ASSISTANCE 0 () 0 0 0 007000 RAPE PREVENTION & EDUCATION GRANT 0 0 0 0 0 007000 RYAN WHITE - EMERGING COMMUNITIES 0 0 0 0 0 007000 RYAN WHITE TITLE 11 CARE GRANT 76,595 0 76,595 0 76,595 007000 RYAN WHITE TITLE It GRANT/CHD CONSORTIAM 481,668 0 481,668 0 481,668 007000 STATEWIDE ASTHMA PROGRAM 0 0 0 0 0 007000 STD - COMPREHENSIVE PREVENTION 2014 0 0 0 0 0 007000 TB CONTROL PROJECT 0 0 0 0 0 007000 TEENAGE PREGNANCY PREVENTION REPLICATION 0 0 0 0 0 007000 TOBACCO PREVENTION AND CONTROL PROGRAM 0 0 0 0 0 007000 WIC BREASTFEEDING PEER COUNSELING PROG 40,212 0 40,212 0 40,212 Working Copy ATTACHMENT II . MONROE COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total F _l 007000 WIC PROGRAM ADMINISTRATION 015075 INSPECTIONS OF SUMMER FEEDING PROGRAM - DOE 015075 REFUGEE HEALTH CHD CASE MANAGERS 015075 REFUGEE HEALTH SCREENING EXPENSE REIMBURSEMENT 015075 REFUGEE HEALTH SCREENING REIMBURSEMENT 015075 SUMMERFEEDING 015075 SUPPLEMENTAL SCHOOL HEALTH 015075 VICTIMS OF CRIME ACT GRANTS - FL DAG 015009 MEDIPASS WAIVER-HLTHY STRT CLIENT SERVICES 015009 MEDIPASS WAIVER-SOBRA 007055 ARRA FEDERAL GRANT - SCHEDULE C FEDERALFUNDSTOTAL 4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE 001020 CHD STATEWIDE ENVIRONMENTAL FEES 001020 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 001020 SAFE DRINKING WATER ACT -COUNTY HEALTH DEPARTMENT 001092 CHD STATEWIDE ENVIRONMENTAL FEES 001092 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 001092 REVENUE CONTRACT/OA WINO REPORTING REQUIREMENT 001092 SAFE DRINKING WATER ACT -COUNTY HEALTH DEPARTMENT 001093 CHD STATEWIDE ENVIRONMENTAL FEES 001170 CHD STATEWIDE ENVIRONMENTAL FEES 001170 LABS CONTRACT BILLINGS 001206 DRINKING WATER PROGRAM OPERATIONS 001206 MOBILE HOME & RV PARK FEES 001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 001206 ONSITE SEWAGE TRAINING CENTER 001206 PUBLIC SWIMMING POOL PERMIT FEES-10% HQ TRANSFER 001206 REGULATION OF BODY PIERCING SALONS 001206 SANITATION CERTIFICATES (FOOD INSPECTION) 001206 SEPTIC TANK RESEARCH SURCHARGE 001206 SEPTIC TANK VARIANCE FEES 50% 001206 STATE UNDERGROUND PETROLEUM RESPONSE ACT 001206 TANNING FACILITIES 001206 TAITO PROGRAM ENVIRONMENTAL HEALTH OOI206 VITAL STATISTICS CERTIFIED RECORDS FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 5. OTHER CASH CONTRIBUTIONS - STATE 010306 DOC PHARMACY INTERAGENCY AGREEMENT 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 031 OO5 CHDTF CASH TRANSFER OTHER CASH COT IBUTIONS °TOTAL 6. MEDICAID - STATE/COUNTY 001055 CHD CLINIC FEES 314,269 0 314,269 0 314,269 268 0 268 0 268 0 0 0 0 0 43,782 0 43,782 0 43,782 75,000 0 75,000 0 75,000 0 0 0 0 0 123,839 0 123,839 0 123,939 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,140,356 0 2,140,356 0 2,140,356 100,000 0 100,000 0 [00,000 0 0 0 0 0 0 0 0 0 0 183,145 0 183,145 0 183,145 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,742 0 3,742 0 3,742 10,000 0 10,000 0 10,000 0 0 0 0 0 5,646 0 5,646 0 5,646 60 0 60 0 60 2,350 0 2,350 0 2,350 200 0 200 0 200 200 0 200 () 200 0 0 0 0 0 113 0 113 0 113 370 0 370 0 370 0 0 0 0 0 305,826 0 305,826 0 305,826 0 0 0 0 0 195,258 0 195,258 0 195,258 0 0 0 0 0 195,258 0 195,258 0 195,258 0 0 0 0 0 Working Copy ATTACHMENT H . MONROE COUNTY HEALTH DEPARTMENT Put H. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015 State CHD County Total CHD Trust Fund CHID Trust Fund Other (cash) Trust Fund (cash) Contribution Total .� t M I! 1► 001055 FEDERALLY QUALIFIED HEALTH CENTER FEES 001056 CHD CLINIC FEES 001056 FEDERALLY QUALIFIED HEALTH CENTER FEES 001061 HEALTH START MEDICAID WAIVER DIRECT - AHCA 001069 C14D CLINIC FEES 001075 CHD CLINIC FEES 001076 CHD CLINIC FEES 001076 FEDERALLY QUALIFIED HEALTH CENTER FEES 001059 CHD CLINIC FEES 001059 LOW INCOME POOLAHCA ENHANCENT 001059 LOW INCOME POOL AHCA PRIMARY CARE 001059 LOW INCOME POOL ALLOCATION MNGD BY DOH 001059 LOW INCOME POOL FQHC ALLOCATION 001058 CHD CLINIC FEES 001058 FEDERALLY QUALIFIED HEALTH CENTER FEES 001078 CHD CLIMC FEES 001078 FEDERALLY QUALIFIED HEALTH CENTER FEES 001078 GENERAL CLINIC RABIES SERVICES & DRUG PURCHASES 001087 CHD CLINIC FEES 001087 FEDERALLY QUALIFIED HEALTH CENTER FEES 001079 CHD CLINIC FEES 001079 PROJECT AIDS CARE CASE MANAGEMENT 001082 CHD CLINIC FEES 001082 FEDERALLY QUALIFIED HEALTH CENTER FEES 001099 CHD CLINIC FEES 001089 FEDERALLY QUALIFIED HEALTH CENTER FEES 001089 RW 11 CONSORTIA CLIENT SERVICES 001083 CHD CLINIC FEES 001083 FEDERALLY QUALIFIED HEALTH CENTER FEES 001081 CHD CLINIC FEES 001081 FEDERALLY QUALIFIED HEALTH CENTER FEES 001147 CHD CLINIC FEES 001147 FEDERALLY QUALIFIED HEALTH CENTER FEES 001180 CHD CLINIC FEES 001180 FEDERALLY QUALIFIED HEALTH CENTER FEES 001148 CHD CLINIC FEES 001148 FEDERALLY QUALIFIED HEALTH CENTER FEES 001148 GENERAL CLINIC RABIES SERVICES & DRUG PURCHASES 001148 SCHOOL HEALTH SERVICES - MEDICAID BILLING 001193 CHD CLINIC FEES 001193 FEDERALLY QUALIFIED HEALTH CENTER FEES 001191 CHD CLINIC FEES 001191 FEDERALLY QUALIFIED HEALTH CENTER FEES 001192 CHD CLINIC FEES 001192 FEDERALLY QUALIFIED HEALTH CENTER FEES 00I192 SCHOOL HEALTH SERVICES - MEDICAID BILLING 001194 MEDICAID LABORATORY 001051 EMERGENCY MEDICAID 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,000 9,000 0 9,000 0 0 0 0 0 0 0 0 0 0 0 550 550 0 550 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (} 0 0 0 0 0 0 0 0 0 0 0 14,542 14,542 0 14,542 0 0 0 0 0 0 0 0 0 0 0 8,500 8,500 0 8,500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,000 10,000 0 10,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Working Copy ATTACHMENT 11. ONROE COUNTY HEALTH DEPARTMENT Part 11. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015 State CHD County Total CHD Trust Fund CHD Trust Fund Other (—h) Tlrust Fund (cash) Contribution 6. MEDICAID - STATE/COUNTY 001071 MEDICAID - ORTHOPEDIC 001072 MEDICAID - DERMATOLOGY 001208 CHD CLINIC FEES 001208 FEDERALLY QUALIFIED HEALTH CENTER FEES 001074 MEDICAID - NEWBORN SCREENING 001149 MEDICAID WRAP AROUND MEDICAID TOTAL 7. ALLOCABLE REVENUE -STATE 018000 CRD CLINIC FEES 018000 CUD FEDERAL & LOCAL INDIRECT EARNINGS 018000 CHD GENERAL REVENUE NON -CATEGORICAL 018000 CHD LOCAL REVENUE & EXPENDITURES 018000 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 018000 CHD STATEWIDE ENVIRONMENTAL FEES 018000 CHDTF UNRESTRICTED CASH RESERVE 018000 FEDERALLY QUALIFIED HEALTH CENTER FEES 018000 UNITED WAY CONTRACTS WITH CHDS 037000 PRIOR YEAR WARRANT 038000 CHD CLINIC FEES 038000 CHDTF UNRESTRICTED CASH RESERVE ALLOCABLE REVENUE TOTAL 8, OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE ADAP PHARMACY DRUG PROGRAM STD WIC PROGRAM BUREAU OF PUBLIC HEALTH LABORATORIES IMMUNIZATIONS OTHER STATE CONTRIBUTIONS TOTAL 9. DIRECT LOCAL CONTRIBUTIONS - BCC/TAX DISTRICT 008010 CHD LOCAL REVENUE & EXPENDITURES 008020 CHD LOCAL REVENUE & EXPENDITURES 009030 CHD LOCAL REVENUE & EXPENDITURES 008034 AIDS TAKE CONTROL 008034 CDC ACUTE HEPATITIS GRANT 008034 CHAT PUBLIC HEALTH RESPONSE TEAMS 009034 CHD LOCAL REVENUE & EXPENDITURES 008034 CHLAMYDIA PROJECT STD 008034 HIV/AIDS - LOCAL FUNDING 008034 IMMUNIZATION OUTREACH TEAM COUNTY FUNDED 008034 NORTH MIAMI SOCIAL WORKER 008034 STD HUMAN PAPILLONAVIRUS PUBLIC HEALTH TRUST 008034 TB JAIL SURVEILLANCE PHT 008034 TESTING FOR COMMUNICABLE DISEASES IN PRISON Im 0 0 0 0 0 0 0 0 0 0 0 2 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42,594 42,594 0 42,594 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 479,474 479,474 0 0 0 63,633 63,633 0 0 0 0 0 0 0 0 859,810 859,8I0 0 0 0 18,662 18,662 0 0 0 1,266,400 1,266,400 0 0 0 2,687,979 2,687,979 0 0 0 0 0 i) 0 0 0 0 0 1,165,070 1,165,070 0 1,165,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Working Copy ATTACHMENT II . MONROE COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015 State CHD County Total CHD Trust Fund CHD Trust Fund Other (eash) Trust Fund (cash) Contribution 008034 TUBERCULOS IS LOCAL FUNDING 0 008040 CHD FEDERAL do LOCAL INDIRECT EARNINGS 0 008040 CHD LOCAL REVENUE & EXPENDITURES 0 008040 FAMILY SAFETY ALLIANCE SYSTEMS ADVOCATE 0 008040 HUMAN AND CHILDRENS SERVICES PROGRAM 0 008040 VOLUNTARY INTERIM PLACEMENT PROGRAM 0 DIRECT COUNTY CONTRIBUTION TOTAL 0 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001025 CHD CLINIC FEES 0 001025 FEDERALLY QUALIFIED HEALTH CENTER FEES 0 001025 GENERAL CLINIC RABIES SERVICES &e DRUG PURCHASES 0 001060 CHD CLINIC FEES 0 001060 VITAL STATISTICS CERTIFIED RECO S 0 001077 CHD CLINIC FEES 0 003 077 CHD HEALTHY START COALITION CONTRACT 0 001077 CHD LOCAL REVENUE & EXPENDITURES 0 001077 FEDERALLY QUALIFIED HEALTH CENTER FEES 0 001077 GENERAL CLINIC RABIES SERVICES & DRUG PURCHASES 0 001077 INDIVIDUALIZED SUPERVISED PRACTICE PATHWAYS 0 001077 INFANT CAR SEAT PROGRAM 0 001077 VITAL STATISTICS CERTIFIED RECORDS 0 001114 VITAL STATISTICS CERTIFIED RECORDS 0 001094 CHD CLINIC FEES 0 001094 CHD STATEWIDE ENVIRONMENTAL FEES 0 001094 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 0 001094 PINELLAS COUNTY LICENSING BOARD 0 001094 SAFE DRINKING WATER ACT -COUNTY HEALTH DEPARTMENT 0 001094 TATTO PROGRAM ENVIRONMENTAL HEALTH 0 001094 X-RAYS MACHINES REGISTRATION AND INSPECTION 0 001117 VITAL STATISTICS CERTIFIED RECORDS 0 001115 CHD CLINIC FEES 0 001115 VITAL. STATISTICS CERTIFIED RECORDS 0 001073 CO -PAY FOR THE AIDS CARE PROGRAM 0 001040 CELL PHONE ADMUNISTRATIVE FEE 0 001041 CREDIT CA CONVENIENCE FEE 0 FEES AUTHORIZED BY COUNTY TOTAL 0 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 001009 CHD CLINIC FEES 0 001009 CHD STATEWIDE ENVIRONMENTAL FEES 0 001009 FEDERALLY QUALIFIED HEALTH CENTER FEES 0 001029 BREAST AND CERVICAL CANCER SCREENING PROGRAM 0 001029 CHD CLINIC FEES 0 001029 FEDERALLY QUALIFIED HEALTH CENTER FEES 0 001029 GENERAL CLINIC RABIES SERVICES & DRUG PURCHASES 0 001029 RYAN WHITE 0 Im 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,165,070 1,165,070 0 1,165,070 905 905 0 905 0 0 0 0 0 0 0 0 0 0 0 0 2,000 2,000 0 2,000 93,204 93,204 0 93,204 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1 0 0 0 0 0 0 17,200 17,200 0 17,200 0 0 0 0 119,928 119,928 0 119,928 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 600 600 0 600 0 0 0 0 42,200 42,200 0 42,200 35,400 35„400 0 35,400 0 0 0 0 0 0 0 0 311,437 311,437 0 311,437 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 185,000 185,000 0 185,000 0 0 0 0 0 0 0 0 0 0 0 0 Working Copy ATTACHMENT H . MONROE COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 001029 WALGREENS 340B PHARMACY PROGRAM 0 a 0 0 0 001090 CHD CLINIC FEES 0 100,000 100,000 0 100.000 001090 FEDERALLY QUALIFIED HEALTH CENTER FEES 0 0 0 0 0 001090 GENERAL CLINIC RABIES SERVICES & DRUG PURCHASES 0 0 0 0 0 001010 CHD CLINIC FEES 0 0 0 0 0 001010 CHD STATEWIDE ENVIRONMENTAL FEES tI 0 0 0 0 001010 VITAL STATISTICS CERTIFIER RECORDS 0 0 0 0 0 001054 CHD CLINIC FEES tl 0 0 0 0 001053 FEDERALLY QUALIFIED HEALTH CENTER FEES 13 0 0 0 0 004010 CHD CLINIC FEES 0 0 0 0 0 005045 CHD CLINIC FEES 0 0 0 0 0 005045 CHD LOCAL REVENUE & EXPENDITURES 0 0 0 0 0 001190 CHD CLINIC FEES 0 0 0 0 0 001190 FEDERALLY QUALIFIED HEALTH CENTER FEES a 0 0 0 0 007099 CHD FEDERAL & LOCAL INDIRECT EARNINGS 0 0 0 0 0 007099 RYAN WHITE TITLE III - DIRECT TO CHD 0 0 0 0 0 008060 STUDENTS WORKING AGAINSTTOBACCO PROGRAM 0 0 0 0 0 010303 CHO CLINIC FEES 0 0 0 0 0 010303 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 0 0 0 0 010400 CHD CLINIC FEES 0 0 0 0 0 010400 CHD LOCAL REVENUE& EXPENDITURES 0 0 0 0 0 010400 CHID SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 4,800 4,800 0 4,800 010400 CHD STATEWIDE ENVIRONMENTAL FEES 0 0 0 0 0 010400 FEDERALLY QUALIFIED HEALTH CENTER FEES 0 0 0 0 0 010300 CHD GENERAL REVENUE NON -CATEGORICAL 0 0 0 0 0 010300 CIIIB SALE OF SERVICES 1N OR OUTSIDE OF STATE GOVT 1.I 0 0 0 0 010300 CHO STATEWIDE ENVIRONMENTAL FEES 1,) 1,516 1.516 0 1,516 010300 INSPECTIONS OF SUMMER FEEDING PROGRAM - DOE 11 0 0 0 0 010300 PETROLEUM STORAGE TANK CONTRACT 6 0 0 0 0 010300 SEXUAL ASSUALT PROGRAM0 0 0 0 0 010300 WIC PROGRAMS AT NON -LEAD COUNTIES 1 0 0 0 0 010302 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 0 0 0 0 005041 CHD CLINIC FEES 1? 0 0 0 0 005041 CHID LOCAL REVENUE & EXPENDITURES 0 7,300 7,300 0 7,300 007010 CAPITAL DEVELOPMENT G NT OSCEOLA CHD tl 0 0 0 0 007010 FEDERAL QUALIFIED HEALTH CENTER INDIRECT EARNING 0 0 0 0 0 007010 FEDERALLY QUALIFIED HEALTH CENTER FEES 1) 0 0 0 0 007010 FQHC OUTREACH AND ENROLLMENT ASSISTANCE 0 0 0 0 0 007010 HEALTH CENTER CLUSTER GRANT - DIRECT TO CHD l 0 0 0 0 007010 HEALTHY START DIRECT TO CHD FEDERAL GRANT 0 0 0 0 0 007010 PREVENTION OF TEEN DATING VIOLENCE Q 0 0 0 0 007010 PRIMARY CARE FEDERALLY QUALIFIED HEALTH CENTER 0 0 0 0 0 007010 RYAN WHITE TITLE III - DIRECT TO C 0 552,509 552,509 0 552,509 007010 RYAN WHITETITLE III - DIRECT TO CHD - 2005-2006 0 0 0 0 0 010304 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT (1 593 593 0 593 010304 CHD STATEWIDE ENVIRONMENTAL FEES 0 0 0 0 0 010304 PETROLEUM STORAGET'ANKCONTRACT 0 0 0 0 0 010304 PETROLEUM STORAGE TANK DEP COMPLIANCE CONT RACi 0 77,000 77,000 0 77,000 Working Copy ATTACHMENT II . MONROE COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 010304 PETROLEUM STORAGE TANK DEP TRAINING 0 0 0 0 0 011000 BAPTIST HEALTH - SCHOOL HEALTH NURSE 0 0 0 0 0 011000 BLUE CROSS BLUE SHIELD NORTH PORT DENTAL 2012-15 0 0 0 0 0 01 loo0 BLUE FOUNDATION COUNTY GRANTS 1) 0 0 0 0 011000 BREAST & CERVICAL CANCER SPECIAL DONATIONS 0 0 0 0 0 011000 BREAST CANCER - RACE FOR THE CURE 0 0 0 0 0 011000 CHD CASH DONATION PNON-SPECIFIC IJ 0 0 0 0 011000 CHD CLINIC FEES 0 0 0 0 0 011000 CHD DENTAL LOCAL FUNDS - LOCAL GRANTS 1) 0 0 0 0 011000 CHD FEDERAL & LOCAL INDIRECT EARNINGS 0 0 0 0 0 011000 CHD GENERAL REVEN UE NON -CATEGORICAL 0 0 0 0 0 011000 CHD HEALTHY START COALITION CONTRACT t) 0 0 0 0 011000 CHD LOCAL REVENUE & EXPENDITURES 0 0 0 0 0 011000 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 0 0 0 0 011000 CHD STATEWIDE ENVIRONMENTAL FEES 0 0 0 0 0 011000 CHILDRENS SERVICES COUN INFANT DROWNING PRVNTN Q 0 0 0 0 011000 COMPREHENSIVE YOUTH SUPPORTS (JWB) 0 0 0 0 0 011000 DENTAL SERVICES - HEAD START Cl 0 0 0 0 011000 DIABETES EDUCATION - CHD LOCAL GRANT 0 0 0 0 0 011000 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA 0 0 0 0 0 011000 FEDERALLY QUALIFIED HEALTH CENTER FEES 1I 0 0 0 0 011000 GULF REGION HLTH CNTR OUTREACH PROGRAM 0 0 0 0 0 o f ldoo GULF REGION HLTH CNTR OUTREACH -PLANNING 0 0 0 0 0 011000 HEALTHIER MI I-DADE WALKING PROGRAM tI 0 0 0 0 011000 HEALTHY FAMILIES FLORIDA tF 0 0 0 0 011000 HEALTHY FAMILIES FLORIDA GRANT II 0 0 0 0 011000 HEALTHY FAMILIES PINELLAS (JWB) GRANT 41 0 0 0 0 011oo0 HUG ME PROGRAM - HEALTHY START COALITION 0 0 0 0 0 011000 INDIGENT CARE PROGRAM 0 0 0 0 0 oll000 LOCAL SCHOOL BOARD YOUTH RISK BEHAVIOR 0 0 0 0 0 011000 LOW INCOME POOL AHCA ENHANCMENT 1 0 0 0 0 011000 MARCH OF DIMES CONTRACTS WITH DEPT OF HEALTH 1) 0 0 0 0 011000 MEMORIAL HOSPITAL ADULT DENTAL PROGRAM 11 0 0 0 0 011000 MOBILE MEDICAL UNIT 1.s 0 0 0 0 011000 NACCHO - MEDICAL RESERVE CORPS 0 0 0 0 0 011000 MH GRANT -HIV PREVENTION/INTERVENTION RESEARCH 1) 0 0 0 0 01100o NURSE FAMILY PARTNERSHIP GRANT it 0 0 0 0 011000 OSTDS ENV HEALTH DEP GRANT Ii 0 0 0 0 011000 PACE CENTER FOR GIRLS Il 0 0 0 0 011oo0 PINELLAS COUNTY LICENSING BOARD {9 0 0 0 0 oll000 PRIMARY CARE LOCAL AGREEMENT PROJECT 0 0 0 0 0 011000 PUBLIC ASSISTANCE ELIGIBILITY [I 0 0 0 0 011000 REVENUE CONT CT/MOA W/NO REPORTING REQUIREMENT 49 0 0 0 0 011000 RW 11 CONSORTIA CLIENT SERVICES r 0 0 0 0 011000 RYAN WHITE 0 0 0 0 0 011000 RYAN WHITE CONTRACTED GRANT PROGRAM t`I 0 0 0 0 011000 RYAN WHITE COST REIMBURSEMENT HILLS-CHD 0 0 0 0 0 011000 RYAN WHITE DENTAL PROGRAM SUB GRANTS 0 0 0 0 0 Working Copy ATTACHMENT It. MONROE COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 011000 RYAN WHITE DIRECT COUNTY GRANTS 0 0 0 0 0 011000 RYAN WHITE MEDICAL PROGRAM SUB GRANTS 0 0 0 0 0 011000 RYAN WHITE TITLE F CARE ACT SERVICES 0 0 0 0 0 011000 RYAN WHITE TITLE I TBr711V COINFECTION GRANT f} 0 0 0 0 011000 RYAN WHITE TITLE 11 CONSORTIA SERVICES 0 0 0 0 0 011000 RYAN WHITE TITLE 111 -DIRECT TO CHD t' 0 0 0 0 011000 SACRED HEART GULF CHD ER DIVERSION PROGRAM () 0 0 0 0 011000 SCHOOL HEALTH CLINICS FUNDED BY SCHOOL BOARD 0 0 0 0 0 011000 SCHOOL HEALTH CLUSTER INITIATIVE - JWB 0 0 0 0 0 011000 SCHOOL HEALTH SERVICES - LOCAL AGENCY FUNDING t 0 0 0 0 011000 SCHOOL HEALTH SERVICES -PRIVATE SCHOOLS -COUNTY 0 0 0 0 0 01 t000 SMOKING CESSATION CLASSES 0 0 0 0 0 011000 SOCIAL SERVICES - KIDCARE 0 0 0 0 0 011000 ST JOHNS RIVER WATER MANAGEMENT DISTRICT 0 0 0 0 0 011000 SUSAN G KOMEN BREAST CANCER FOUNDATION 0 0 0 0 0 011000 TARGETED CASE MANAGEMENT -J MENTL HEALTH SRVC 0 0 0 0 0 011000 TB EPIDEMIOLOGICAL RESEARCH 0 0 0 0 0 011000 TOBACCO GRANT HEALTH FOUNDATION SOUTH FLORIDA 0 29,000 28,000 0 28,000 011000 UNITED WAY CONTRACTS WITH CHDS 0 0 0 0 0 011000 UNIV OF SOUTH FLORIDA AIDS NETWORK 0 0 0 0 0 01 IWO UNIVERSITY OF SOUTH FLORIDA KIDCARE I'i 0 0 0 0 011000 WE CARE REFERRAL & VOLUNTEER PROGRAM 0 0 0 0 0 011000 WEST VOLUSIA HOSPITAL SPECIALITY CARE 0 0 0 0 0 011000 WRAP -AROUND HEALTH SERVICES AGREEMENT (D 0 0 0 0 011001 CHD HEALTHY START COALITION CONTRACT 0 290,000 290,000 0 290,000 011001 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 0 0 0 0 011001 HEALTHY START - TEEN PREGNANCY PREVENTION 0 0 0 0 0 011001 HEALTHY START DATA MANAGEMENT 0 0 0 0 0 011001 HEALTHY START MEDIPASS WAIVER - COALITION TO CHD 0 0 0 0 0 011001 HEALTHY START MOMCARE J 0 0 0 0 011001 HEALTHY START NUTRITION COUNSELING €P 0 0 0 0 OI 1001 HEAUI`HY START RISK SCREENINGS t1 0 0 0 0 0l 100I HEALTHY START -INITIAL CONTACT -CARE COORDINATION 0 0 0 0 0 005040 INTEREST EARNED 0 30 30 0 30 008050 CHD LOCAL REVENUE & EXPENDITURES 0 0 0 0 0 008050 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 (} 0 0 0 008050 SCHOOL HEALTH CLINICS FUNDED BY SCHOOL BOA ID (> 0 0 0 008050 SCHOOL HEALTH SERVICES - LOCAL AGENCY FUNDING 0 0 0 0 0 011006 BREAST & CERVICAL CANCER SPECIAL DONATIONS 0 0 0 0 0 011006 NACCHO - MEDICAL RESERVE CORPS I) 0 0 0 0 010500 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT tt 145,783 t45,783 0 145,783 010500 FEDERALLY QUALIFIED HEALTH CENTER FEES ti 0 0 0 0 010500 VITAL STATISTICS CERTIFIED RECORDS 0 0 0 0 0 011007 CHD CLINIC FEES I 0 0 0 0 011007 CHD HEALTHY START COALITION CONTRACT t➢ 0 0 0 0 011007 CHD LOCAL REVENUE & EXPENDITURES ( 320 320 0 320 010301 EXP WITNESS FEE CONSULTNT CHARGES sa 0 0 0 0 010405 SALE OF PHARMACEUTICALS 0 0 0 0 0 Working Copy ATTACHMENT II . MONROE COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution LM 015020 LOWER ST JOHNS RIVER SEPTIC TANK ENFORCEMNT PROD 0 0 0 0 0 015020 ORHS CONTRACT HUG ME PROGRAM 0 0 0 0 0 015020 PETROLEUM STORAGE TANK CLEANUP CONTRACT 0 0 0 0 0 015020 PETROLEUM STORAGE TANK DEP CLEANUP CONTRACT 0 0 0 0 0 010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 0 0 0 0 012020 CHD GENERAL REVENUE NON -CATEGORICAL 0 0 0 0 0 012020 CHD STATEWIDE ENVIRONMENTAL FEES 0 1,500 1,500 0 1,500 012020 PINELLAS COUNTY LICENSING BOARD 0 0 0 0 0 012020 SAFE DRINKING WATER ACT -COUNTY HEALTH DEPARTMENT 0 0 0 0 0 028020 INSURANCE RECOVERIES -OTHER 0 0 0 0 0 011004 LOW INCOME POOL- SUBRECIPIENT 0 0 0 0 0 011004 LOW INCOME POOL AHCA PRIMARY CARE 0 0 0 0 0 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 395,934 395,934 0 395,934 012021 CHD CLINIC FEES 0 0 0 0 0 012021 CHD GENERAL REVENUE NON -CATEGORICAL 0 0 0 0 0 012021 CHD LOCAL REVENUE & EXPENDITURES 0 0 0 0 0 012021 CHD STATEWIDE ENVIRONMENTAL FEES 0 0 0 0 0 012021 RADIOACTIVE MATERIALS LICENSING 0 0 0 0 0 010402 RECYCLED MATERIAL SALES 0 0 0 0 0 007050 ARKA FEDERAL GRANT 0 0 0 0 0 008065 FCO CONTRIBUTION 0 0 0 0 0 028000 INSURANCE RECOVERIES 0 0 0 0 0 001033 CMS MANAGEMENT FEE - PMPMPC 0 0 0 0 0 005043 INTEREST EARN ED-CONTRACT{GRANT 0 30 30 0 30 011002 ARRA FEDERAL GRANT • SUB -RECIPIENT 0 0 0 0 0 001003 WIRE TRANSFER FEE 0 0 0 0 0 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,790,315 1,790,315 0 1,790,315 12. ALLOCABLE REVENUE - COUNTY 037000 PRIOR YEAR WARRANT 0 39 39 0 39 031000 CHDTF CASH TRANSFER 0 0 0 0 0 018000 COUNTY FOR REFUNDS 0 2,500 2,500 0 2,500 COUNTY ALLOCABLE REVENUE TOTAL 0 2,539 2,539 0 2,539 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 61,523 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 Pt. 825,563 825,563 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY EQUIPMENT/ VEHICLE PURCHASES 0 0 0 0 0 WorkIng. Copy ATTACHMNT 0 - MONROE COIJNTY HEALTH DEPARTME NT Fart 11. Sources of Contributions to County Health Department Web . or-1,1014 tQ Sotem!�wt-10i1Q.t$, County Total CUD Trust Fund CJID Tru5t Fund Other (qaW M-ukFdkd (rash) Contribution 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY VEHICLE INSURANCE 0 0 0 0 VEHICLE MAINTENANCE 0 0 0 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 0 GRAND TOTAL CUD PROGRAM 5,161.795 3,311,955 8,473,750 3,513,542 EMI 0 0 0 0 0 11,987,292 Worldng Copying ATTACHMENT H . MONROE COUNTY HEALTH DEPARTMENT Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service October 1, 2014 to September 30, 2015 Quarterly Expenditure Plan FPE's Clients Services/ 1st 2nd 3rd 4th Grand (0.00) units Visits (Whole dollars only) State County Total A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION (101) 11.16 6,000 7,333 344,466 216,885 216,885 225,000 8,624 994,612 1,003,236 STD (102) 1.90 400 700 46,428 42,000 42,000 42,000 16,755 155,673 172,428 HIV/AIDS PREVENTION(03A1) 3.94 410 750 76,828 76,828 76,828 76,828 307,312 0 307,312 HIV/AIDS SURVEILLANCE (03A2) 0.07 50 95 137 1,000 1,000 t,000 3,137 0 3,137 HIV/AIDS PATIENT CARE (03A3) 15.00 500 4,738 743,880 665,416 665,416 665,416 1,963,457 776,671 2,740,128 ADAP (03A4) 1 20 20 240 23,712 20,570 20,569 20,570 95,421 0 85,421 TB CONTROL SERVICES (104) 1.00 40 29 42,284 12,000 12,000 12,000 40,404 37,880 79,284 COMM. DISEASE SURV. (106) 2.75 0 1,200 27,836 27,000 25,000 27.000 0 106,836 106,836 HEPATITIS PREVENTION (109) 140 385 500 23,072 16,309 16,310 16,309 72,000 0 72,000 PUBLIC HEALTH PREP AND RESP (116) 250 0 7,000 71,909 60,000 60,000 60,000 251,909 0 251,909 REFUGEE HEALTH (119) 1.40 300 800 55,767 42,000 45,068 45,050 187,885 0 187,885 VITAL STATISTICS (180) 1.45 2,000 5,100 29,254 29,254 26,055 26,045 48,608 62,000 110,608 COMMUNICABLE DISEASE SUBTOTAL 43.77 10,105 28,485 1,485,573 1,209,262 1,207,131 1,217,218 2,985,512 2,133,672 5,119,184 B. PRIMARY CARE: CHRONIC DISEASE SERVICES (210) 1.05 0 0 11,896 12,500 11,500 12,000 37,896 10,000 47,896 TOBACCO PREVENTION (212) 2.57 0 450 67,608 40,000 40,000 40,000 114,718 72,890 187,608 WIC (21 W 1) 5,46 1,940 15,500 99,793 99,000 75,000 76,964 350,757 0 350,757 WIC BREASTFEEDING PEER COUNSELING (21W2) 0.35 0 627 9,643 9,600 9,600 9,600 38,443 0 38,443 FAMILY PLANNING (223) 3.90 1,146 2,250 141,512 141,512 120,000 120,000 345,744 177,280 523,024 IMPROVED PREGNANCY OUTCOME (225) 0.00 0 0 0 0 0 0 0 0 0 HEALTHY START PRENATAL(227) 2.83 900 5,000 50,552 50,000 50,500 50,500 0 201,552 201,552 COMPREHENSIVE CHILD HEALTH (229) 0,05 4 4 122 135 125 125 0 507 507 HEALTHY START INFANT (231) 2.20 532 3,000 42,618 15,277 15,276 15,277 0 88,448 88,448 SCHOOL HEALTH (234) 4.55 0 148,125 89,837 89,837 82,000 60,000 220,062 101,612 321,674 COMPREHENSIVE ADULT HEALTH (237) 5.00 600 2,000 126,8 t 1 1[0,000 100,000 100,000 348,953 87,858 436,811 COMMUNITY HEALTH DEVELOPMENT (238) 1.50 0 1,131 53,006 53,006 40,000 30,000 176,012 0 176,012 DENTAL HEALTH (240) 0.00 0 0 0 0 0 0 0 0 0 PRIMARY CARE SUBTOTAL 29.46 5,022 179,097 693,398 620,867 544,001 514,466 1,632,585 740,147 2,372,732 C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COASTAL BEACH MONITORING (347) 0.26 350 350 8,709 8,709 8,700 8,700 19,645 15,173 34,818 LIMITED USE PUBLIC WATER SYSTEMS (357) 0.00 0 0 0 0 0 0 0 0 0 PUBLIC WATER SYSTEM (358) 0.01 0 0 -50 50 0 0 0 0 0 PRIVATE WATER SYSTEM (359) 0.00 0 0 21 0 0 0 0 21 21 TNDIVIDUAL SEWAGE DISP. (361) 4.50 3,951 6,000 88,930 88,930 50,000 89,000 195,833 120,027 315,860 Group Total 4.77 4,301 6,350 97,610 97,689 58,700 96,700 215,478 135,221 350,699 Facility Programs FOOD HYGIENE (348) 0.75 70 350 15,762 15,762 13,000 13,000 30,489 27,036 57,524 BODY PIERCING FACILITIES SERVICES (349) 0.04 7 7 544 100 100 500 709 535 1,244 GROUP CARE FACILITY (3 5 1) 0.09 20 40 1,858 1,000 1,000 1,000 0 4,858 4,858 MIGRANT LABOR CAMP (352) 0,00 0 0 0 0 0 0 0 0 0 Worldng Copying ATTACHMENT H . MONROE COUNTY HEALTH DEPARTMENT Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service October 1, 2014 to September 30, 2015 Quarterly Expenditure Plan IFTE`s Clients Services/ lot god 3rd 4th Grand (0.00) Units Molts (Whole dollars only) State County Total C. ENVIRONMENTAL HEALTH: Facility Programs HOUSING,PUBLIC BLDG SAFETY,SANITATION (353)0.00 0 0 0 0 0 0 0 0 0 MOBILE HOME AND PARKS SERVICES (354) 0.50 80 200 4,755 3,000 2,000 2,000 6,700 5,055 11,755 SWIMMING POOLS/BATHING(360) 1.46 616 1,418 55,946 27,500 27,724 27,716 79,165 59,721 138,886 BIOMEDICAL WASTE SERVICES (364) 0.35 160 132 9,643 1,800 1,725 1,723 9,891 5,000 14,891 TANNING FACILITY SERVICES (369) 0.01 4 9 384 [00 100 75 341 318 659 Group Total 3.20 957 2,156 88,892 49,262 45,649 46,014 127294 102,523 229,817 Groundwater Contaminatlon STORAGE TANK COMPLIANCE (355) 1.40 200 420 64,423 27,000 27,000 27,000 68,423 77,000 145,423 SUPER ACT SERVICE (356) 0,00 0 0 48 0 0 0 48 0 48 Group Total 1.40 200 420 64,471 27,000 27,000 27,000 68,471 77,000 145,471 Community Hygiene TATTOO FACILITIES SERVICES 0.10 0 30 1,952 350 350 350 3,002 0 3,002 COMMUNITY ENVIR HEALTH (345) 1.00 0 1,000 47,329 40,000 40,000 40,000 95,377 71,952 167,329 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 (363) 0.00 0 0 0 0 0 0 0 0 0 SANITARY NUISANCE (365) 0.16 35 100 3,989 2,500 2,508 2,507 11,504 0 11,504 RABIES SURVEILLANCE/CONTROL SERVICES (366) 0,04 4 24 1,249 500 100 88 1,937 0 1,937 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 0 0 0 0 0 0 0 RADIOLOGICAL HEALTH (372) 0.00 0 0 0 0 0 0 0 0 0 TOXIC SUBSTANCES (373) 0.64 200 900 6,378 10,000 17,517 17,517 0 51,412 51,412 Group Total 1.94 239 2,054 60,905 53,356 60,483 60,469 111,821 123,392 235,213 ENVIRONMENTAL HEALTH SUBTOTAL 11.31 5,697 10,980 311,878 227,307 191,832 230,183 523,064 438,136 961,200 D. NON -OPERATIONAL COSTS: NON -OPERATIONAL COSTS (599) 0.00 0 0 0 0 0 0 0 0 0 ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 4,091 4,963 5,790 5,790 20,634 0 20,634 MEDICAID BUYBACK (611) 0.00 0 0 0 0 0 0 0 0 0 NON -OPERATIONAL COSTS SUBTOTAL 0.00 0 0 4,091 4,963 5,790 5,790 20,634 0 20,634 TOTALCONTRACT 84,54 20,824 217,552 2,494,940 2,062,399 1,948,754 1,967,657 5,161,795 3,311,955 8,473,750 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 11. i. The State's appropriated responsibility (direct contribution excluding any state fees, Medicaid contributions or any other funds not listed on the Schedule C) as provided in Attachment 11, Part 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 11, Part 11 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 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. 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; N. Financial procedures specified in the Department of Health's Accounting Procedures Manuals, Accounting memoranda, and Comptroller's memoranda; iv. The CHD is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported to the CHD in a manner consistent with the client registration and service reporting requirements of the minimum data set as specified in the Client Information System/Health Management Component Pamphlet. d. All funds for the CHD shall be deposited in the County Health Department Trust Fund maintained by the state treasurer. These funds shall be accounted for separately from funds deposited for other CHDs and shall be used only for public health purposes in Monroe County. e. That any surplus/deficit funds, including fees or accrued interest, remaining in the County Health Department Trust Fund account at the end of the contract year shall be credited/debited to the state or county, as appropriate, based on the funds contributed by each and the expenditures incurred by each. Expenditures will be charged to the program accounts by state and county based on the ratio of planned expenditures in the core contract and funding from all sources is credited to the program accounts by state and county. The equity share of any surplus/deficit funds accruing to the state and county is 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. I. The CHD shall abide by all State policies and procedures, which by this reference are incorporated herein as standards to be followed by the CHD, except as otherwise permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof. m. The CHD shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The CHD will advise applicants of the right to appeal a denial or exclusion from services, of failure to take account of a client's choice of service, and of his/her right to a fair hearing to the final governing authority of the agency. Specific references to existing laws, rules or program manuals are included in Attachment I of this Agreement. n. The CHD shall comply with the provisions contained in the Civil Rights Certificate, hereby incorporated into this contract as Attachment III. o. The CHD shall submit quarterly reports to the county that shall include at least the following: i. The DE3851-1 Contract Management Variance Report and the DE580L1 Analysis of Fund Equities Report; ii. A written explanation to the county of service variances reflected in the 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. 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, 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: Mary Vanden Brook, J.D. Name Administrative Services Director Title PO Box 6193 1100 Simonton Street Key West, FL 33040 Address 305-809-5612 Telephone For the County: Roman Gastesi Name County Administrator Title 1100 Simonton Street Key West, FL 33040 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 - 3: page agreement to be executed by their undersigned officials as duly authorized effective the 1st day of October, 2014. BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY TITLE: Mayor DATE: 0Gt D&e` I r"', aU 1 q- ONROE COUNTY ATTORNEY A P116A OVE' A � TT YNTNIA L, HALL ASSISTANT COUNTY ATTORNEY STATE OF FLORIDA DEPARTMENT OF HEALTH SIGNED BY: ' NAME: John H. Armstrona, MD TITLE: Suraeon General/Secretary of Health DATE: P& NAME: Robert B. Eadier J.D. TITLE: CHPAM-=- W 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 Sexually Transmitted Disease Program 2. Dental Health 3. Special Supplemental Nutrition Program for Women, Infants and Children (including the WIC Breastfeeding Peer Counseling Program) 4. Healthy Start/ Improved Pregnancy Outcome 5. A Requirement Requirements as specified in F.A.C. 64D-3, F.S. 381 and F.S. 384. Periodic financial and programmatic reports as specified by the program office. Service documentation and monthly financial reports as specified in DHM 150-24" and all federal, state and county requirements detailed in program manuals and published procedures. Requirements as specified in the 2007 Healthy Start Standards and Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. Family Planning Requirements as specified in Public Law 91-572, 42 U.S.C. 300, of seq., 42 CFR part 59, subpart A, 45 CFR parts 74 & 92, 2 CFR 215 (OMB Circular A-110) OMB 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. 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. W N CD n F5 n v U. CD N D) CD _ CD _ N C _0 _ 0 1 1 _ 0 D) rl� O' 1 Q C' (7 _ a _ c 0 CD 3 CD v cn 0 0 v c� a CD CD O CD 0 N _ tl 3 0 0• u 3 CD D) S N _ to 0 0 cr CD Cl 7 N CA O j O � CD O go 3 _ CJ CD O W CD O = K N .r O W. N O N 00 c 070 o(D ov o°' C C CD o f N ,D. 0 � N '* 0 o O 7 n N n CCD 0 0 CD 0' CD cr N CAD O (�D Lti O 0 O N � N CA .�+ C)) CD D) I C -ncnm = v CL N � o � m0 Q- 0 3: cn CD v n -n cn m � v Q� 3 0 n 0_ :10 2 0 m vg N —I 0 E O z X O m n O C z a r 2 v m M a M -I ic m z 1. GENERAL REVENUE • STATE 015040 AIDS PATIENT CARE 015040 AIDS PREVENTION & SURVEILLANCE - GENERAL REVENUE 015040 AIDS NETWORK REIMBURSEMENT 015040 CHD - TB COMMUNITY PROGRAM 015040 SEXUALLY TRANSMITTED DISEASE CONTROL PROGRAM GR 015040 ALG/CESSPOOL IDENTIFICATION & ELIMINATION PROG 015040 FAMILY PLANNING GENERAL REVENUE 015040 HEPATITIS AND LIVER FAILURE PREVENTION & CONTROL 015040 PRIMARY CARE PROGRAM 015040 SCHOOL HEALTH SERVICES - GENERAL REVENUE 015050 CHD GENERAL REVENUE NON -CATEGORICAL GENERAL REVENUE TOTAL 2. NON GENERAL REVENUE • STATE 015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS NON GENERAL REVENUE TOTAL S. FEDERAL FUNDS • STATE 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN 007000 WIC BREASTFEEDING PEER COUNSELING PROG 007000 COASTAL BEACH WATER QUALITY MONITORING 007000 COMPREHENSIVE COMMUNITY CARDIO - PHBG 007000 FAMILY PLANNING GENERAL REVENUE 007000 FAMILY PLANNING TITLE X - GRANT 007000 HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS 007000 IMMUNIZATION ACTION PLAN 007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC 007000 AIDS PREVENTION 007000 RYAN WHITE TITLE II CARE GRANT 007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIAM 007000 WIC PROGRAM ADMINISTRATION 015075 INSPECTIONS OF SUMMER FEEDING PROGRAM - DOE 015075 SUPPLEMENTAL SCHOOL HEALTH 015075 REFUGEE HEALTH SCREENING EXPENSE REIMBURSEMENT 015075 REFUGEE HEALTH SCREENING REIMBURSEMENT FEDERAL FUNDS TOTAL 4. FEES ASSESSED BY STATE OR FEDERAL RULES • STATE 001020 CHD STATEWIDE ENVIRONMENTAL FEES 001092 CHD STATEWIDE ENVIRONMENTAL FEES 001093 CHD STATEWIDE ENVIRONMENTAL FEES 001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 370,000 0 370,000 0 370,000 73,552 0 73,552 0 73,552 259,200 0 259,200 0 259,200 25,284 0 25,284 0 25,284 16,755 0 16,755 0 16,755 53,766 0 53,766 0 53,766 25,360 0 25,360 0 25,360 72,000 0 72,000 0 72,000 199,742 0 199,742 0 199,742 96,223 0 96,223 0 96,223 1,178,492 0 1,178,492 0 1,178,492 2,370,374 0 2,370,374 0 2,370,374 3,859 0 3,859 0 3,859 114,718 0 114,718 0 114,718 118,577 0 118,577 0 118,577 35,443 0 35,443 0 35,443 17,337 0 17,337 0 17,337 18,962 0 18,962 0 18,962 13,668 0 13,668 0 13,668 8,828 0 8,828 0 8,828 60,184 0 60,184 0 60,184 429,306 0 429,306 0 429,306 8,624 0 8,624 0 8,624 17,701 0 17,701 0 17,701 118,412 0 118,412 0 118,412 127,268 0 127,268 0 127,268 76,596 0 76,596 0 76,596 481,668 0 481,668 0 481,668 300,936 0 300,936 0 300,936 268 0 268 0 268 123,839 0 123,839 0 123,839 25,000 0 25,000 0 25,000 75,000 0 75,000 0 75.000 1.939,040 0 1,939,040 0 1,939,040 82,559 0 82,559 0 82,559 183,145 0 183,145 0 183,145 36,556 0 36,556 0 36,556 10,000 0 10,000 0 10,000 Page 1 of 3 001206 SANITATION CERTIFICATES (FOOD INSPECTION) 001206 SEPTIC TANK RESEARCH SURCHARGE 001206 SEPTIC TANK VARIANCE FEES 50% 001206 PUBLIC SWIMMING POOL PERMIT FEES-10% HQ TRANSFER 001206 REGULATION OF BODY PIERCING SALONS 001206 TANNING FACILITIES 001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 001206 MOBILE HOME & RV PARK FEES FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 5. OTHER CASH CONTRIBUTIONS - STATE: 010304 CHD STATEWIDE ENVIRONMENTAL FEES 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT OTHER CASH CONTRIBUTION TOTAL 6. MEDICAID - STATEMOUNTY: 001078 CHD CLINIC FEES 001083 CHD CLINIC FEES 001087 CHD CLINIC FEES 001089 CHD CLINIC FEES MEDICAID TOTAL 7. ALLOCABLE REVENUE - STATE: MEDICAID TOTAL 8. OTHER STATE CONTRIBUTIONS NOT IN CIJD TRUST FUND - STATE ADAP PHARMACY DRUG PROGRAM STD WIC PROGRAM BUREAU OF PUBLIC HEALTH LABORATORIES IMMUNIZATIONS OTHER STATE CONTRIBUTIONS TOTAL 9. DIRECT LOCAL CONTRIBUTIONS - BCC/TAX DISTRICT 008030 CHD LOCAL REVENUE & EXPENDITURES DIRECT COUNTY CONTRIBUTIONS TOTAL 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001025 CHD CLINIC FEES 001060 VITAL STATISTICS CERTIFIED RECORDS 001073 CHD CLINIC FEES 001077 CHD CLINIC FEES 001094 CHD STATEWIDE ENVIRONMENTAL FEES 001114 VITAL STATISTICS CERTIFIED RECORDS 2,350 0 2.350 0 2,350 200 0 200 0 200 200 0 200 0 200 5,300 0 5,300 0 5,300 60 0 60 0 60 113 0 113 0 113 370 0 370 0 370 3,742 0 3,742 0 3,742 324,595 0 324,595 0 324,596 593 0 593 0 593 88,935 0 88,935 0 88,936 0 0 0 0 0 0 3,641 3,641 0 3,641 0 5.000 5,000 0 5,000 0 100 100 0 100 0 14,542 14,542 0 14,542 0 23,283 23,283 0 23,283 0 0 0 0 0 0 0 0 0 0 0 0 0 479,474 479,474 0 0 0 63,633 63,633 0 0 0 0 0 0 0 0 859,810 859,810 0 0 0 18,662 18,662 0 0 0 1,266,400 1,266,400 0 0 0 2,687,979 2.687,979 0 1,130,050 1,130,050 0 1,130,050 0 1,130,050 1,130,050 0 1,130,050 0 1,200 1,200 0 1,200 0 2,000 2,000 0 2,000 0 35,400 35,400 0 35,400 0 93,204 93,204 0 93,204 0 119,928 119,928 0 119,928 0 17,200 17,200 0 17,200 Page 2 of 3 001115 VITAL STATISTICS CERTIFIED RECORDS 001117 VITAL STATISTICS CERTIFIED RECORDS FEES AUTHORIZED BY COUNTY TOTAL 11. OTHER CASH AND LOCAL CONTRIBUTIONS • COUNTY 001029 CHD CLINIC FEES 001090 CHD CLINIC FEES 005041 CHD LOCAL REVENUE & EXPENDITURES 005043 CHD LOCAL REVENUE & EXPENDITURES 007010 RYAN WHITE TITLE III DIRECT TO CHD 007010 RYAN WHITE TITLE III DIRECT TO CHD 010300 CHD STATEWIDE ENVIRONMENTAL FEES 010400 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 010500 IMMUNIZATION CAMPAIGN MONROE COUNTY BOCC 010500 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 011000 SMOKE FREE HOUSING GRANT 011001 CHD HEALTHY START COALITION CONTRACT 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 12. ALLOCABLE REVENUE • COUNTY COUNTY ALLOCABLE REVENUE TOTAL 13. BUILDINGS • COUNTY ANNUAL RENTAL EQUIVALENT VALUE OTHER (Specify) UTILITIES BUILDING MAINTENANCE GROUNDS MAINTENANCE INSURANCE OTHER (Specify) OTHER (Specify) BUILDINGS TOTAL 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND • COUNTY EQUIPMENT / VEHICLE PURCHASES VEHICLE INSURANCE VEHICLE MAINTENANCE OTHER COUNTY CONTRIBUTION (SPECIFY) OTHER COUNTY CONTRIBUTION (SPECIFY) OTHER COUNTY CONTRIBUTIONS TOTAL GRAND TOTAL CBD PROGRAM 0 42,200 42,200 0 42,200 0 600 600 0 600 0 311,732 311,732 0 311,732 0 143,695 143,695 0 143,695 0 87,295 87,295 0 87,295 0 7,300 7,300 0 7,300 0 10 10 0 10 0 457,509 457,509 0 457,509 0 95,000 95,000 0 95,000 0 683 683 0 683 0 74,800 74,800 0 74,800 0 226,000 226,000 0 226,000 0 68,425 68,425 0 68,425 0 23,031 23,031 0 23,031 0 290,000 290,000 0 290,000 0 454,387 454,387 0 454,387 0 1,928,135 1,928,135 0 1,928,136 0 0 0 0 0 0 0 0 0 0 0 0 0 580,199 580,199 0 0 0 0 0 0 0 0 61,623 61,523 0 0 0 71,641 71,641 0 0 0 112,200 112,200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 825,563 825,563 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,842,114 3,393,200 8,235,314 3,513,542 11,748,856 Page 3 of 3 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 5,630 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 50 20,390 17,472 20,390 20,382 13,668 64,966 78,634 WIC (21W1) 5.46 1,940 13,080 105,676 90.556 105,676 105,636 407,644 0 407,544 TOBACCO USE INTERVENTION (212) 2.31 0 47 M.609 38,227 44,609 44,592 114,718 67,319 172,037 WICBREASTFEEDING 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 0 149,516 149,516 SCHOOL HEALTH (234) 4.55 0 139,076 82.590 70,774 82,590 82,559 220.062 98.451 318,613 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 1,162,267 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 of 2 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 POOLS/BATHINGPLACES (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 91,426 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 6,791 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. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits discrimination on the basis of race, color or national origin in programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. 3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the applicant understands that the grantor may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief, to include assistance being terminated and further assistance being denied. Facility Description Gato Building Administration Nursing ATTACHMENT IV MONROE COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Location 1100 Simonton Street Key West, FL 33040 Juvenile Justice Building 5503 College Road Environmental Health Key West, FL 33040 Murray E. Nelson Government Center 102050 Overseas Highway Environmental Health Key Largo, FL 33037 Roosevelt Sands Center 105 Olivia Street Clinic Key West, FL 33040 Ruth Ivins Center Clinic Environmental Health 3333 Overseas Highway Marathon, FL 33050 Owned By Monroe County Monroe County Monroe County City of Key West subject to Inter -local Agreement with Monroe County for MCHD use Monroe County Roth Building 50 High Point Road Monroe County Clinic Tavernier, FL 33070 CONTRACT YEAR 2013-2014* 2014-2015** 2015-2016*** 2016-2017*** PROJECT TOTAL ATTACHMENT V MONROE COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS STATE COUNTY $ 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 TOTAL 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. -0 (G (D a o a o a a a a d "' `' m 7-.•' X 7 _ m 7 N m 0 m .�y N n = -I 9l -i d -1 a _, 7 m f1 m d = N N Nw m C G1 G C.) 'A N m v m 0 , m a p? p a N N m m N m N e a �' w 3 a< m fD m � 0 c 3 0 m 3 n 3 O z m '.m0. m' N - f o ID y N �. m r m m m o fA >� 7' ' 3 Z 3 O .m. m T m ` N O m O0 N C N N m G 0 D] O o' N T m m w n a N CL B e m "O m g N ° o -' c 3 0 e 3 c m 0 c m c m a m C.m G pp C' 0y W `� -'I m m p = m N Q m m m A N 2 m a O m O N J m n is N 3 a m 7 0 T y O O. 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A N A N A N A N A N A N A N A N A N A N A N A N A N A N A N A N A N A N A N P N A N A A N N A N z c 0 o a 0 0 0 0 0 a o 0 0 0 0 0 0 0 0 0 0 0 10, 0 0 0 1 G) Im 0 -1 0 -1 0 v 0 -1 0 -7 0 !a' -I 0 -I 0 -1 a 'V o V 0 -I 0 M 0 V '',. o -I o -1 0 al 0 -i 0 'J 0 -I 0 N 0 v 0 0 V V 0 `J m 0 O a 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 o a o 0 0 0 1 W W w W W W W W w w W W W w W w W w W w w W W w 0 0 '.. 0 0 0 0 0 o m o 0 0 0 0 0 0 0 0 0 0 CA 0 Ol 0 0 O) T 0 O O 0 0 0 0 a a m o 0 0 0 o O o Of 0 0 0 T 0 0 o W O W o W 0 01 0 m a 0 0 O 0 T 0 0 0 0 o a O 0 o a o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o 0 a O z A 0 0 0 0 o o a a 0 0 0 0 a 0 o 0 a 0 o 0 0 a 0 o 0 0 0 0 0 0 0 0 0 0 0 0 '0 0 0 0 0 '0 0 o a o 0 0 0 0 a o 0 0 0 0 O 0 0 0 0 0 0 0 o a a ' 3 0 0 0 0 0 0 o a o 0 0 0 010 0 0 0 0 o a o 0 0 0 FEE RESOLUTIONS 2014-2015 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 3'd 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. L 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)AII 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 DIPOSALPROGRAM `(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 w 0)j p u. late renewals 1.5 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 V11. BODY PIERCING ESTABLISHMENTS a. License Fee 100 b. Temporary Establishment 15 c. Late fee 0 d. Consultation 50 Vill. 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