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FY2016 10/21/2015 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 2015-2016 This contract 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, 2015. 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 created County Health Departments. D. It is necessary for the parties hereto to enter into this contract 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 contract shall be effective from October 1, 2015, through September 30, 2016, or until a written contract replacing this contract is entered into between the parties, whichever is later, unless this contract 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 1 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 is 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 $ 4 275.646 (State General Revenue, State Funds, Other State Funds end 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 $ 1.091.804 (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 contract in the County Health Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period. 2 c. Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. As allowed by law, Monroe County Health Department has established Communicable disease control and Primary care services rates at 160% of the Medicare Fee Schedule, rounded up to the next whole dollar. Monroe County Health Department has established Environmental Health Services Fees in line with local recommendations and economic factors. d. Either party may increase or decrease funding of this contract 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 whom payments shall be made is: County Health Department Trust Fund Monroe County PO Box 6193 Key West, FL 33041 5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator of the CHD shall be a State employee or under contract with the State and will be under the day-to-day direction of the Deputy Secretary for County Health Systems. 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 3 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 contract. 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 the Generally Accepted Accounting Principles (GAAP), as promulgated by the 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 Information Resource (FLAIR) System; ii. The client registration and services reporting requirements of the minimum data set as specified in the most current version of the Client Information System/Health Management Component Pamphlet; iii. Financial procedures specified in the Department of Health's Accounting Procedures Manuals, Accounting memoranda, and Comptroller's memoranda; iv. The CHD is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported to the CHD in a manner consistent with the client registration and service reporting requirements of the minimum data set as specified in the Client Information System/Health Management Component Pamphlet. d. All funds for the CHD shall be deposited in the County Health Department Trust Fund maintained by the state treasurer. These funds shall be accounted for separately from funds deposited for other CHDs and shall be used only for public health purposes in Monroe County. e. That any surplus/deficit funds, including fees or accrued interest, remaining in the County Health Department Trust Fund account at the end of the contract year shall be credited/debited to the State or County, as appropriate, based on the funds contributed by each and the expenditures incurred by each. Expenditures will be charged to the program accounts by State and County based on the ratio of planned expenditures in this 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 4 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 County Health Systems has approved the transfer. The Deputy Secretary for County Health Systems shall forward written evidence of this approval to the CHD within 30 days after an emergency transfer. g. The CHO may execute subcontracts for services necessary to enable the CHD to carry out the programs specified in this contract. 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 contract for a period of five (5) years after termination of this contract. 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. 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 5 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 contract. 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. p. The dates for the submission of quarterly reports to the County shall be as follows unless the generation and distribution of reports is delayed due to circumstances beyond the CHD's control: i. March 1, 2016 for the report period October 1, 2015 through December 31, 2015; ii. June 1, 2016 for the report period October 1, 2015 through March 31, 2016; iii. September 1, 2016 for the report period October 1, 2015 through June 30, 2016; and iv. December 1, 2016 for the report period October 1, 2015 through September 30, 2016. 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. 6 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 contract 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 contract become unavailable, either party may terminate this contract 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 contract 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 contract shall not be deemed to be a waiver of any other breach and shall not be construed to be a modcation of the terms of this contract. 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, 2016, 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 contract 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 contract, 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 contract. c. Captions. The captions and headings contained in this contract 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 eight page contract, with its attachments as referenced, including Attachment I (two pages), Attachment II (six pages), Attachment III (one page), Attachment IV (one page), and Attachment V cone page), to be executed by their undersigned officials as duly authorized effective the 1' day of October, 2015. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR MONROE COUNTY DEPARTMENT OF HEALTH c SIGNED BY: SIGNED BY: �. NAME: a n L. e. NAME: John H. Armstrong, MD TITLE: / '►t7(yVif/CJAQ,f/Iflq/) TITLE: Surgeon General/Secretary of Health DATE: /0 :l/ - /6 DATE: \Ci\\,,C ATTESTED TO: SIGNED BY: SIGNED BY:SSA ' NAME: NAME: Robert B. Eadie, J.D. TITLE: TITLE: CHD Director/Administrator DATE: DATE: 4S NI‘Ci 1 •r. Apr MONROE COUNTY ATTORNEY kielI - ---- vl ; Nd PFROVEL 7 O FORM. 1A7: J� ICI.: can CYbROVEDApT FORM: AL CHRISTINE M. LIM3E=R 4-B RR6WS 8 ASSISTANT Cf`l, T'I ATTORNEY • 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.361 and F.S. Program 364. 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 specified Program for Women, Infants and in DHM 150-24'and all federal,state and county requirements Children(including the WIC detailed in program manuals and published procedures. Breastteeding Peer Counseling Program) 4. Healthy Start/Improved Pregnancy Requirements as specified in the 2007 Healthy Start Standards Outcome 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 pans 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. 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 (OH 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) Asuhrnenl_1-Page 1011 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* B. 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 84D-3, F.S.381 and F.S.384. Soclo-demographic and risk data on persons tested for HIV in CHD clinics should be reported on Lab Request DH Form 1828 in accordance with the Forms Instruction Guide. Requirements for the HIV/AIDS Patient Care programs are found in the Patent 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.402.3028 and F.A.C.84F-6. 10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C.84D-3 and F.S.392. 11. General Communicable Disease Carry out surveillance for reportable communicable and other Control 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.AC.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 contact period. 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Guth) tryst P.nb Oostrtauon Toed I.GENERAL REVENUE-STATE 015040 AIDS PATIENT CARE 370,000 0 370,000 0 370,000 016040 AIDS PREVENTION&SURVEILLANCE GENERAL REVENUE 73,552 0 73552 0 73.552 015040 AIDS NETWORK REIMBURSEMENT 259,200 0 259,200 0 2.59.200 015040 CHD•TB COMMI INITY PROGRAM 15781 0 15,784 0 15,784 015040 SEXUALLY TRANSMITTED DISEASE CONTROL PROGRAM OR 16,755 0 16,755 U 16,755 015040 ALA/CESSPOOL IDENT➢/CATION&ELIMINATION PROG 53,766 0 53,766 0 53766 015040 FAMILY PLANNING GENERAL REVENUE .32678 0 32.678 0 32.678 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 96223 0 96,223 0 96,221 015050 CHU GENERAL REVENUE NON CATEGORICAL 1,184,212 0 1,184.242 0 1,184,242 GENERAL REVENUE TOTAL 2,373,942 0 2,373,942 0 2,373,942 2.NON GENERAL REVENUE-STATE 016010 STATE UNDERGROUND PETROLEUM RESPONSE ACT 1,736 0 1,736 0 1,736 015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 3,719 0 3,719 0 3,719 015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 118,154 0 118,154 0 I18,154 NON GENERAL REVENUE TOTAL 123,609 0 123,609 0 123,609 3.FEDERAL FUNDS STATE 007000 AIDS DRUG ASSISTANCE PROGRAM AUMIN 26582 0 26582 0 26,582 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN IIQ 5,907 0 5.907 0 .5,907 007000 AIDS SURVEILLANCE CORE 1,562 0 1,562 0 1,562 007000 WIC BREASTFEEDING PEER COUNSELING FROG 55,777 0 55,777 0 55,777 007000 COASTAL BEACH WATER QUALITY MONITORING 18,429 0 18,439 0 18,439 007000 COMPREHENSIVE COMMUNITY CARDIO-PHEG 35.000 0 35,000 0 35,000 007000 FAMILY PLANNING TITLE X GRANT 57,525 0 57,525 0 57,525 007000 HOI(SING OPPORTUNITIES FOR PERSONS WITH AIDS :393,965 0 393,905 0 39.3,965 007000 IMMUNIZATION ACTION PLAN 8,624 0 8.624 0 8,624 00701M MCH SPECIAL PRJCT UNPLANNED PREGNANCY 75 0 75 0 75 007000 MCH SPECIAL PROJECT PRAMS 20816 0 2n,816 0 20,810 007000 PHP PUBLIC HEALTH PREPAREDNESS BASE AI.LOC 95,753 0 95,753 0 95,763 007000 AIDS PREVENTION II4700 0 118.700 0 I18,700 007000 RYAN WHITE TITLE II CARE GRANT 80857 0 80,857 0 80,857 007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIUM 482.113 0 482,143 0 482.143 007000 WIC PROGRAM ADMINISTRATION 337.911 0 337944 0 337,919 U15075 INSPECTIONS OF SUMMER FEEDING PROGRAM DOE 139 0 129 0 Is9 015075 SUPPLEMENTAL SCHOOL HEALTH 123,839 0 122839 0 123.839 015075 REFUGEE HEALTH SCREENING REIMBURSEMENT 144,591 0 144,591 0 144,591 FEDERAL FUNDS TOTAL 2.008,228 0 2,008,228 0 2,008,228 4.FEES ASSESSED BY STATE OR FEDERAL RULES-STATE 001020 CHD STATEWIDE ENVIRONMENTAL FEES 92,819 0 92,899 0 92,849 001092 CHD STATEWIDE ENVIRONMENTAL FEES 1.50,264 0 150,264 0 150,264 0111206 ON SITE SEWAGE DISPOSAL PERMIT FEES 12.000 0 12,000 0 12,000 001206 SANITATION CERTIFICATES(FOOD INSPECTION/ 2.000 0 2,000 0 2,000 Attachment_II_Par•_II•Page 4 of II . ATTACH 'l'xI mono*point nkmmt*s i fk .' Pae1Wl,fle ardCo,Uth.II nr 4lCnon� !rj$ t Oda*1.2011StoOrpust**Wq,SW frirr rut SO Other (eat) fiwW Contribution Total 001206 SEPTIC TANK RESEARCH SURCHARGE 526 0 525 0 626 001206 SEPTIC TANK VARIANCE PEES 60% 50 0 60 0 50 001206 PUBLIC SWIMMING POOL PERMIT FEES10%HQ TRANSFER 5,000 0 5,000 0 5,000 001206 DRINKING WATER PROGRAM OPERATIONS 12 0 12 0 12 001206 REGULATION OF BODY PIERCING SALONS 60 0 60 0 60 001206 TANNING FACILITIES 117 0 117 0 117 001206 ONSITE SEWAGE TRAINING CENTER 18 0 18 0 18 001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 955 0 955 0 955 001206 MOBILE HOME&RV PARK FEES 2,004 0 2,009 0 2,004 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 265854 0 265,854 0 265,854 5.OTHER CASH CONTRIBUTIONS-STATE: 0 0 0 0 0 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 0 0 0 0 OTHER CASH CONTRIBUTION TOTAL 0 0 0 0 0 6.MEDICAID-STATE/COUNTY: 001057 CHD CLINIC FEES 0 720 720 0 720 001148 CHD CLINIC FEES 0 36,863 36,863 0 36,863 MEDICAID TTOTAL 0 31,683 37,583 0 117583 7.ALLOCABLE REVENUE-STATE. 018000 CHD LOCAL REVENUE&EXPENDITURES 500 0 500 0 MN) 037000 RYAN WHITE T TITLE III-DIRECT TO CHD 350 0 350 0 350 ALLOCABLE REVENUE TOTAL 850 0 850 0 850 8.OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND-STATE ADAP 0 0 0 620,603 620,603 PHARMACY DRUG PROGRAM 0 0 0 69.071 69,071 WIC PROGRAM 0 0 0 1,007,122 1,007,122 BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 11,062 11,062 IMMUNIZATIONS 0 0 0 677,963 677463 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 2,385,321 2386,321 9.DIRECT LOCAL CONTRIBUTIONS-BCC/TAX DISTRICT wewO CHD LOCAL REVENUE&EXPENDITURES 0 801.890 801890 0 801,890 0019105 IMMUNIZATION CAMPAIGN MONROE COUNTYBOCC 0 289,914 289.914 0 289914 DIRECT COUNTY CONTRIBUTIONS TOTAL 0 1,091,MN 1,091,804 0 I.091,809 10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION-COUNTY 001025 CHD CLINIC FEES 0 691 691 0 691 001073 CHD CLINIC FEES 0 35,000 85,000 0 35,000 001077 CHD CLINIC PEES 0 104,256 104,256 0 104.256 001094 CHD LOCAL ENVIRONMENTAL.FEES 0 137.627 137,627 0 137.627 001110 VITAL STATISTICS CERTIFIED RECORDS 0 73,000 73,000 0 73.0110 FEES AUTHORIZED BY COUNTY TOTAL 0 350,674 350,674 0 350,574 II.OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY Attachment 11 Pun_il-Page 5 of II ATTACHMENT It uotooIpoveiTYstark pgema ir1' paran,enteadponymaelonm0.020wll0 .m' DamesIew>dwep ggua,im '. taw*MO -Hp Tins TEatPR.a lituto Tent then^ Tat.) 001029 CHD CLINIC FEES 0 245830 245,830 0 246830 001090 CHD CLINIC FEES 0 120,970 120,970 0 120,970 006000 CHU LOCAL REVENUE&EXPENDITURES 0 11,000 11,0161 0 11,000 007010 RYAN WHITE TITLE III DIRECT TO CHD 0 145,000 145,000 0 145,COO 007010 RYAN WHITE TITLE III-DIRECT TO CHD 0 369,483 369483 0 369,483 010300 CHD STATEWIDE ENVIRONMENTAL FEES 0 204 204 0 204 010300 CND LOCAL ENVIRONMENTAL FEES 0 1,510 1,510 0 1,510 010300 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 71,602 71602 0 71,602 01041)0 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 4,200 4,200 0 4,200 010500 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 70,391 70,391 0 10391 011000 SMOKE FREE HOUSING GRANT 0 24,425 24,426 0 24.425 011001 CHD HEALTHY START COALITION CONTRACT 0 290000 290,000 0 290,000 012020 CHD LOCAL REVENUE&EXPENDITURES 0 16 15 0 15 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 916.844 916,844 0 916,844 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 2,271474 2.271,474 0 2,271,474 12.ALLOCABLE REVENUE-COUNTY 018000 CHD LOCAL REVENUE&EXPENDITURES 0 600 600 0 500 037000 RYAN WHITE TITLE III-DIRECT TO CHD 0 350 350 0 360 COUNTY ALLOCABLE REVENUE TOTAL 0 850 860 0 850 13.BUILDINGS-COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 597606 597,605 OTHER(Specify) 0 0 0 0 0 UTILITIES 0 0 0 83,369 83,369 BUILDING MAINTENANCE 0 0 0 75.223 75,223 GROUNDS MAINTENANCE 0 0 0 115,566 115,566 INSURANCE 0 0 0 0 0 OTHER(Specify) 0 0 0 0 0 OTHER(Specify) 0 0 0 0 0 BUILDINGS TOTAL 0 0 0 871,76.3 871,763 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 4.772,483 3,752,2E5 8,524,768 9,257.084 11,781.852 Attachment JI Pal II-Page 6 of 11 A4 aautRMax4,§mµyr**1tstioae . cant,ttw..dis,aims.fleni o4 b40A$aMmese t4$a►1.wate.m,w sties OS,kin*ra (too) u t. ins ' ,aw ,( dal /ow ei 9. coma/ Mow A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION (1011 Safi:. 6729 8300 216,578 252,612 210,578 252,611 8,024 029,755 938,979 SEXUALLY TRANS.IIIS (1021 L78 279 462 30,081 35,786 30.681 35,786 123.558 9,374 132,932 HIV/AIMS PREVENTION(03A1) 4.0/ 365 632 79,304 92.498 79,304 92,497 192,252 151,351 34.A603 HIV/AIDS SI5RVE11JANCE (03A2) 004 22 30 722 842 722 892 1,562 1,fl 3.128 HIV/AIDS PATIENT CARE (0M3) 1621 479 4,338 639,825 740446 634,025 790,945 2,138,939 611,602 2,750,541 ADAP (0.3A4) 1,32 15 218 21,035 25,235 21636 95,234 93,816 123 93,739 TUBERCULOSIS (104) LW 28 152 21,158 24,678 21,158 24,678 16789 76,888 91,672 COMM.BLS.8URV.(100) 087 0 567 18056 22,110 18956 22,110 0 82,132 82,132 HEPATITIS (109/ 1,62 245 357 30,926 36.071 30,9% 90,071 72,000 61,099 13,994 PREPAREDNESS AND RESPONSE (116) 320 0 B017 66,477 76,37/ 65,477 78872 95,753 187.949 263,697 REFUGEE HEALTH (118) 197 398 904 50,015 59.267 50,813 59,260 219.978 183 220,161 VITAL RECORDS (ISO) 1.04 1,515 4,615 17,829 20,795 17,829 20,706 0 77.248 77,248 COMMUNICABLE DISEASE SUBTOTAL 4285 9083 26,662 1.138909 1,386,710 1.188,904 1,386,708 2982.066 2,189 160 5.151,226 B. PRIMARY CARE: CHRONIC DISEASE PREVENTION PRO(210) 002 0 0 1 335 1,558 1.335 1,558 3,408 2,378 5,716 WIC (21W11 535 1.521 18,506 98 UO7 114,319 S8,007 114,311 424,640 0 424,640 TOBACCO USE INTERVENTION 1212) 209 0 312 45,554 53.134 45,654 63,134 197,376 0 197,376 WIC BREASTPEEDINO P71 R COUNSELING (21W2) ll.47 0 320 15,179 17,705 15,179 17,705 66,768 0 65718 FAMILY PLANNING (223) 3,59 1,030 1960 87,682 102270 87,682 102.269 327,556 52.347 379903 IMPROVED PREGNANCY OUTCOME (225) OW 0 0 995'/ 4,626 3,067 4,626 17.186 0 17,186 HEALTHY START PRENATAL(227) 338 820 5.ISO 6.699 63,800 54,W9 63,800 0 236,998 236,998 COMPREHENSIVE CHILD HEALTH (2 ) 0D3 0 0 20 24 211 29 88 0 88 HEAL THY START CHUM (281) 293 337 4,204 44,842 52.300 44,842 62,302 13,426 180.863 194289 SCHOOL HEALTH (234) .509 0 144.270 79,826 93.107 79,826 93,107 220,062 125,804 345,860 COMPREHENSIVE ADULT HEALTH (231) 391 373 1,317 88,278 102,965 88,278 102,965 199,792 182.744 382,486 COMMUNITY HEALTH DEVELOPMENT (238) 101 0 947 26,067 30,404 26,007 30,409 0 112,942 112,942 DENTAL HEALTH 1240) 003 0 0 0 0 0 0 U 0 0 PRIMARY CARE SUBTOTAL 2773 7,581 177,906 545,466 638.209 599,456 636,207 1.469.252 894,076 2383,328 C. ENVIRONMENTAL HEALTH: Water and Ooun Snaggy Pro nm. COSTAL BEACH MONITORING (347) 038 884 335 U,580 II101 9,586 11.181 IB,439 23095 91614 LIMITED USE PUBLIC WATER SYSTEMS (357) 0.00 0 0 0 0 0 0 0 0 0 PUBLIC WATER SYSTEM (358) 0.00 II 0 158 184 158 183 0 683 683 PRIVATE WATER SYSTEM (359) 0U0 0 0 0 0 0 0 0 0 U ONSITE SEWAGE TREATMENT&DISPOSAL(M1) 453 1,877 3,605 74,077 86402 79,077 9440I 202766 118191 320.957 Crony Total 491 2,261 3090 83,821 97167 83.821 97,765 221,206 141.969 363,174 Facility Propane,' TATTOO FACILITY SERVICES (349) 0 12 0 33 2043 2,383 2,1143 2304 4,500 4353 &863 FOOD HYGIENE (398) U.84 67 301 10,870 12,679 10,870 12,Mt) 17,943 29,161) 97,099 BODY PIERCING FACILITIES SERVICES(340) 002 6 7 316 3689 316 369 915 466 1,370 A8aanont_II Part_III Page7M11 , ATreaORxxv M0NE4 Co telei*Vann ntAxneett Pot M.P1 ,4J.8t.moi.Oa 7Mk� M�j� �+.00 Pc*.As*WkW t S 3th ..A of&** o.11(Mp i.1004004411440 BD,Me Quetettaipseilfan rig% oak*timbtl 1* *Rd Ord .th amati moo) Eta* Vida (we*eaten- 84M Cow* 1.41 OR0UF CARE FACILITY(3511 OAQ 17 21 1550 1,81E 1,558 1,818 0 6,752 8,]52 MIGRANT LABOR CAMP(352) C,ql 0 0 0 0 0 0 0 0 0 HOUSING et PCB BLDG, ONO 000 0 0 0 0 0 0 0 0 0 MOBILE HOME AND PARK 1354) 0.56 143 349 8,759 10,216 8759 10.217 18,798 1915E 37951 POO19/RATHINO PIACES(300) 262 1)l 2,091 39.119 45,627 39,119 45,627 42800 129,692 169,492 BIOMEDICAL WASTE SERVICES (361) 052 292 316 B291 9,670 8.291 9,670 I1,810 24112 55,92E TANNING FACILITY SERVICES(369) 001 2 3 143 167 143 108 454 169 321 Group Total 4.68 1418 3,121 71 099 82,929 71,099 82.983 9I220 210,840 308,060 Groundwater cot.mm(noo STORAGE TANK COMPIJANCE SERVICES 1355) I.62 213 441 27,939 32,588 27,939 32,589 0 121055 12105.5 SUP ACT SERVICES (3560 000 0 0 0 0 0 0 0 0 11 Group Total 152 213 441 27 939 32.588 27,939 32.589 0 121055 121,055 Community Hygiene COMMUNITY ENVIR HEALTH (345) 1.35 0 495 25.754 30039 25,754 30,090 0 111587 111,587 INJURY PREVENTION (348O I/W 0 0 0 0 0 0 0 0 0 LEAD MONITORING SERVICES(350) OCO 0 0 0 0 0 0 0 0 0 PUBLIC SEWAGE 1362) 000 a 0 a 0 0 0 0 0 0 SOLID WASTE DISPOSAL SERVICE 1363) 0.03 0 0 0 0 0 0 0 0 0 SANITARY NUISANCE (365) 018 J9 113 3,127 3647 3,127 3,696 0 13547 13547 RABIES SURVEILLANCE (3042) O06 1 16 745 870 715 870 0 3,230 3,230 ARBORVIRUS SURVEIL. 1367) O00 0 0 0 0 0 0 0 0 0 RODENT/ARTHROPOD CONTROL 1368) 0 CO 0 0 0 0 0 0 0 0 0 WATER POLLUITION (370) 0.00 a 0 0 0 0 0 0 0 0 INDOOR AIR(371) 0.W 0 0 89 104 89 104 0 3PA 389 RADIOLOGICAL IIEALTH (372) C.W 0 0 139 162 139 162 0 602 602 TOXIC SUBSTANCES(373) 082 47 47 IS,194 17,722 15.194 17,723 0 65.833 €5.833 Group Total/ 240 87 671 95,048 52,544 45,048 52,545 0 195,185 19.5.185 ENVIRONMENTAL HEALTH SUBTOTAL 13.41 3,979 8,229 227.907 245,828 227907 265.83E 318.425 669,049 987474 D. NON-OPERATIONAL COSTS': NO&OPERATIONAL COSTS (599) 000 0 0 0 0 0 0 0 0 0 ENVIRONMENTAL HEALTH SURCHARGE (399) 000 0 0 5,249 5,122 5,249 6,121 22,741 0 22.741 MEDIQMD BUYBACK(610 000 0 0 0 0 0 0 0 0 0 NON OPERATIONAL COSTS SUBTOTAL 003 0 0 9249 6,122 6249 6,121 22,741 0 T2,741 TOTAL CONTRACT 8199 20828 212.287 1,967,516 2294.869 1,967,518 2,2948223 4,772,984 3,752,285 8524,769 Amenneer4 II Pnl_IIl.Pape e o111 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,OH 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. AttachmentIII-Page 9 of 11 ATTACHMENT IV MONROE COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Descnotion Location Owned By Gato Building:Administration,Clinic, 1100 Simonton Street,Key West,FL Monroe County Healthy Start,Vital Statistics 33040 Roosevelt Sands Center:Clinic,WIC 105 Olivia Street,Key West,FL 33040 City of Key West subject to interlocal agreement with Monroe County for FLDOH- Monroe use Juvenile Justice Building:Environmental 5503 College Road,Key West, FL 33090 Monroe County Health Murray E.Nelson government Center: 102050 Overseas Highway,Key Largo,FL Monroe County Environmental Health 33037 Ruth Ivins Center:Clinic,Environmental 3333 Overseas Highway,Marathon,FL Monroe County Health 33050 Roth Building:Clinic 50 High Point Road,Tavernier, FL 33070 Monroe County Attathmait v-Page 10 of 11 ATTACHMENT MONROE COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS CONTRACT YEAR STATE COUNTY TOTAL 2014-2015' $ Na $ 0 $ 0 2015-2016" $ n/a $ 0 $ 0 2016-2017'' $ n/a $ 0 $ 0 2017-2018"' $ n/a $ 0 $ 0 PROJECT TOTAL $ nla $ 0 $ 0 SPECIAL PROJECTS CONSTRUCTION/RENOVATION PLAN PROJECT NUMBER PROJECT NAME: LOCATION/ADDRESS: PROJECT TYPE: NEW BUILDING ROOFING RENOVATION _PLANNING STUDY NEW ADDITION _OTHER SQUARE FOOTAGE. 0 PROJECT SUMMARY: Describe scope of work fe reasonable detail START DATE (mien eapentNn of funds) COMPLETION DATE: DESIGN FEES: $ 0 CONSTRUCTION COSTS- $ 0 FURNITURE/EQUIPMENT: $ 0 TOTAL PROJECT COST: $ 0 COST PER SO FOOT. $ 0 Special CapItal Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mows health rang. •cash balance as of 9/30/15 • Cash to be transferred to FCO account. "•Cash anticipated for future contract years. Attachmenlv-Page II of 11 FEE RESOLUTIONS 2015-2016 fl Tidd 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 56-66-13. 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 reimbursement is accepted as payment in full. (3) Injection fee for parenteral medications per injection $ 35 (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 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 or blood 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 or blood Test,with reading,any other than listed above in C. (1). $35 (5) Tuberculin assessment of clients with a past history of positive skin test $ 35 (6) Sexually Transmitted Diseases—The fee below will he 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 Page 1 of 5 Monroe County Health Department Core Contract 2015-2016 ii. Office/Outpatient Visit, Established $ 117 (7) Required Vaccines for children up to age 18 and eligible for No Charge the Vaccine for Children program (8) Vaccine administration fee (child or adult)other than item $ 23.50 11 below (9) County sponsored vaccinations for TdAP, HPV,Seasonal Flu, No Charge for and population-specific needs for Pneumonia for uninsured residents earning or underinsured residents 400%of Federal Poverty Level or less (10)County sponsored immunizations for uninsured Take Stock No Charge in Children's Experiment in International Living Scholarship recipients (11)Seasonal Flu vaccinations for those not covered in items 7 $ 22 product+$10 or9 above Admin fee= $32 total charge (12)All other Immunizations not covered in items 8,9, 10 above 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 No Charge ii. AIDS 500 No Charge iii. AIDS 501 No Charge (14)International Certificates of Vaccination Cost x 3.5 C. VITAL STATISTICS (1) Birth Certificates $ 16 (2) Additional Birth Certificate Copies • $ 16 (3) Protective Covers $ 4 (4) Death Certificates—Certified Copy $ 13 (5) Additional Death Certificate Copies $ 13 (6) Express Fee $ 10 D. MEDICAL RECORDS Copying of Medical Record (per page) $ 1 E. PUBLIC RECORDS Copying of Public Record (per page) $ 1 A service fee of F. RETURNED/DISHONORED CHECKS:45 215.3442)F.S) $15 or 5%of the face amount of the check,draft, or money order Page 2 of 5 Monroe County Health Department Core Contract 2015-2016 whichever is greater, not to exceed $150 G. PUBUC HEALTH AND MEDICAL PREPAREDNESS Submission and Review of Required Annual Comprehensive Emergency Management Plan for Home Health Agencies, Nos.ices, Nurse Re:istries,Home Medical E.ui.ment Providers $ 65 Fee Schedule, Environmental Health County Fee List (In addition to State Fees on alternate Fee Schedule) 1. 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 No charge 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) No charge 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 No charge 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 No charge or commercial sewage waste s. Biennial Operating permit for aerobic treatment unit or No charge -- performance-based treatment system t. Aerobic treatment unit maintenance entity permit per No charge 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 Page 3 of 5 Monroe County Health Department Core Contract 2015.2016 - x. OSTDS Operating Permit Late Fee (45 days past due) $50 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 No charge e. Annual Permit for Jails/Prisons No charge 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 No charge 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 No charge p. Alcoholic beverage inspection approval $ 15 q. Request for inspection $ 10 r. Re-inspection(for each re-inspection after the first) No charge 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 Page 4 of 5 Monroe County Health Department Core Contract 2015-2016 existing sanitation certificate 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 No charge c. Consultation $50 d. Late Renewal Fee No charge VII. BODY PIERCING ESTABLISHMENTS a. License Fee $ 100 b. Temporary Establishment $ 15 c. Late fee No charge 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 2015-2016