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FY2016 1st Amendment 07/20/2016
AMY REAVIIIN, CPA CLERK OF CIRCUIT COURT &COMPTROLLER MONROE COUNTY, FLORIDA DATE: October 11, 2016 TO: Roman Gastesi County Administrator ATTN.- Lindsey Ballard Executive Aide FROM. • Cheryl Robertson Executive Aide to the Clerk of Court & Comptroller CCU At the July 20, 2016 Board of County Commissioner's meeting the Board granted approval and authorized execution of Item N1 Approval of First Amendment to the core contract for FY 16 with Florida Department of Health. The enclosures are not fully executed; they need to be signed by the State of Florida Department of Health and then forwarded to the clerk for finalization. 500 Whitehead Street Suite 101, PO Box 1980, Key West, FL 33040 Phone: 305-295-3130 Fax: 305-295-3663 3117Overseas Highway, Marathon, FL 33050 Phone: 305-289-6027 Fax: 305-289-6025 88820 Overseas Highway, Plantation Key, FL 33070 Phone: 852-7145 Fax: 305-852-7146 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 2016-2016 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 407' day of July 2016. RECITALS WHEREAS, the parties entered into the Agreement intended to serve as a core contract between the parties on October 1, 2015; and WHEREAS, Attachment II, Part 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, 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 V to the Agreement sets forth the special projects saving plan by the State and the County Health Department (CHD); and WHEREAS, the State and the CHD desire to amend the planned expenditures and revenue; and 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. Attachment II, Parts I, II & III and Attachment V to the Agreement are removed and replaced entirety with Exhibit A to this First Amendment, which shall henceforth constitute the new Attachment II, Parts I, II & III and Attachment V to the Agreement. 2. 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 00w day of July 2016. BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY SIGNED BY: NAME: Pf t#- y CGi ✓i- U, vrc� l TITLE: W DATE: J ur ut YYIDnw, )OIL, STATE OF FLORIDA DEPARTMENT OF HEALTH SIGNED BY: NAME: Celeste Philip, MD. MPH TITLE: Surgeon General/Secretary of Health DATE: ATM*i SI • SIGNED BY: r NAM lin, Clerk NAME: Robert B. Eadie, J.D. Bv TITLE: Deputy ujerx TITLE: CHD Director/Administrator DATE: l D - / / - Q / a DATE: o�4 0 MONROE COUNTY ATTORNEY AP OVE AS TO E RIMY" C NTHIA L. ALL ASSISTANT CVN Y ATTORNEY Date S "r Mission:z X= Rick Scott To protect, promote & improve the health Governor of all people in Florida through integrated state, county & community efforts. Celeste Philip, MD, MPH HEALTHSurgeon General and Secretary Vision: To be the Healthiest State in the Nation June 28, 2016 Mr. Roman Gastesi, County Administrator Monroe County Board of County Commissioners 1100 Simonton Street Key West, FL 33040 RE: FY 2015-2016 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 3, the CHD shall provide services as set forth on Part III of Attachment II. Please find the following: • Revised Attachment II, Parts II and III, incorporating the changes indicated in the summary and covering the period subsequent to the contract amendment • A revised Attachment II, Part I, and Attachment V updating planned special projects 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 Raymond Sanders at 305-809-5651. Sincerely, Robert Eadie, J.D. Administrator/Director Monroe County Health Department Enclosures Cc: Beth Benton, Office of Budget and Revenue Management Florida Department of Health Division of )00C 4052 Bald Cypress Way, Bin X-XX • Tallahassee, FL 32399 Accredited Health Department PHONE: 850/XXX-XXXX • FAX: 850/XXX-XXXX ' = Public Health Accreditation Board FloridaHealth.gov V) W U Z g a m O Z D LL H m Z ix W F- Q.' W a � 0 d' a 2 W W J 0 � Q = ULU = J W Z = a � } U Z W :) O O ZU LL O O y D 0 W Z Z g IL H Q a c � 00 m U 2 c cu O m m c 0) L =3 W (n LL Z5 LLL r = c -O U f6 a) m io O m E 2 ..cc 0) L =3 W !A LL r O M 0) O U C fD f0 m rn C c W c LL N D L O cq LO O Cl) LO L LO O r- LD N Cl) O Cl) 7T O N O Cl) ca N .0 } E m m t C 0 O U LO 0C) C N O 3 � To 0o M M L r- N LO C O) N 0 O `m 0 U O (6 O C N 0 0 U CO O U O- m 0 'm o 2 0 a m � ao O N U f0 a) a) m o fn U 7 � LL O >, N c O CD N ._ .0 o C E U a m o to (DO Lo N U � c a) m 0 0 O U m O N M Iv N C f6 L_ 16 N L N .� O O cm E LO a c f0 Eli U g .o a m (D c N L 3 `o N m � 0 LO c Cf) U N C y N E N _0. Q N O U 'C _U L 3 N uj c c� m rn � U 'O G �O a N C m O - c 0 W c rn m c a `o Li C 0 2 U O O U U y 3 c j N ti m ;+ N o U N gj o n a a :a aci f�6 Q U a3 f6 Z �U N Q cn m `0 ATTACHMENT II MONROE COUNTY HEALTH DEPARTMENT [I, Sources of Contributions to County Health Departm( October 1, 2015 to September 30, 2016 1. GENERAL REVENUE - STATE COMMUNITY PRIMARY CARE SERVICES - AHCA 015040 AIDS PATIENT CARE 015040 AIDS PREVENTION & SURVEILLANCE - GENERAL REVENUE 015040 AIDS NETWORK REIMBURSEMENT 015040 CHD - TB COMMUNITY PROGRAM Note: Amends 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 015050 CHD GENERAL REVENUE NON -CATEGORICAL GENERAL REVENUE TOTAL 2. NON GF14ERAL 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 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 007000 AIDS SURVEILLANCE - CORE 007000 WIC BREASTFEEDING PEER COUNSELING PROG 007000 COASTAL BEACH WATER QUALITY MONITORING 007000 COMPREHENSIVE COMMUNITY CARDIO - PHBG 007000 CMS-MCH PURCHASED CLIENT SERVICES 2014.2015 007000 FAMILY PLANNING TITLE X - GRANT 007000 HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS 007000 IMMUNIZATION ACTION PLAN 007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 007000 MCH SPECIAL PROJECT PRAMS 007000 HPP AND PHEP COOP AGRMT PHEP EBOLA SUPPLEMENT #2 007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC 007000 AIDS PREVENTION 007000 RYAN WHITE TITLE H CARE GRANT 007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIUM 007000 WIC PROGRAM ADMINISTRATION 015075 INSPECTIONS OF SUMMER FEEDING PROGRAM - DOE 015075 SUPPLEMENTAL SCHOOL HEALTH 015075 REFUGEE HEALTH SCREENING REIMBURSEMENT FEDERAL FUNDS TOTAL State CHD County Trust Fund CHD (cmh) ;yijil;.Trust Fund 24,255 0 24,255 0 24,255 370,000 0 370,000 0 370,000 73,552 0 73,552 0 73,552 259,200 0 259,200 0 259,200 15,784 0 15,784 0 15,784 16,755 0 16,755 0 16,755 53,768 0 53,768 0 53,768 32,678 0 32,678 0 32,678 72,000 0 72,000 0 72,000 199,742 0 199,742 0 199,742 96,224 0 96,224 0 96,224 985,029 0 985,029 0 985,029 2,198,987 0 2,198,987 0 2,198,987 3,719 0 3,719 0 3,719 118,154 0 118,154 0 118,154 121,873 0 121,873 0 121,873 27,888 0 27,888 0 27,888 9,261 0 9,261 0 9,261 5,808 0 5,808 0 5,808 43,799 0 43,799 0 43,799 18,439 0 18,439 0 18,439 35,000 0 35,000 0 35,000 8,000 0 8,000 0 8,000 60,775 0 60,775 0 60,775 414,184 0 414,184 0 414,184 15,649 0 15,649 0 15,649 16,405 0 16,405 0 16,405 4,487 0 4,487 0 4,487 69,692 0 69,692 0 69,692 118,412 0 118,412 0 118,412 126,490 0 126,490 0 126,490 81,550 0 81,550 0 81,550 516,464 0 516,464 0 516,464 292,300 0 292,300 0 292,300 1,587 0 1,587 0 1,587 123,839 0 123,839 0 123,839 175,509 0 175,509 0 175,509 2,165,538 0 2,165,538 0 2,165,538 Attachment_II_PaA_ll - Page 2 of 9 ATTACHMENT II C 4 MONROE COUNTY HEALTH DEPARTMENT Part II, Sources of Contributions to County Health Department October 1, 2015 to September 30, 2016 !' State CHD County Total CHD Trust Fund CHD Trust Fund"_77'' (cash) Trust Fund (cash) Contribution 4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE 001020 CHD STATEWIDE ENVIRONMENTAL FEES 001092 CHD STATEWIDE ENVIRONMENTAL FEES 001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 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: 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT OTHER CASH CONTRIBUTION TOTAL 6. MEDICAID - STATE/COUNTY: 001057 CHD CLINIC FEES 001147 CHD CLINIC FEES 001148 CHD CLINIC FEES MEDICAID TOTAL 7. ALLOCABLE REVENUE • STATE: 018000 CHD CLINIC FEES 018000 CHD LOCAL REVENUE & EXPENDITURES 018000 RYAN WHITE TITLE II CARE GRANT 018000 RYAN WHITE TITLE III • DIRECT TO CHD 037000 RYAN WHITE TITLE III - DIRECT TO CHI) ALLOCABLE REVENUE TOTAL 8.OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND • STATE ADAP PHARMACY DRUG PROGRAM WIC PROGRAM BUREAU OF PUBLIC HEALTH LABORATORIES IMMUNIZATIONS OTHER STATE CONTRIBUTIONS TOTAL 9. DIRECT LOCAL CONTRIBUTIONS • BC0 TAX DISTRICT 008005 CHI) LOCAL REVENUE & EXPENDITURES 008005 IMMUNIZATION CAMPAIGN MONROE COUNTY BOCC DIRECT COUNTY CONTRIBUTIONS TOTAL 89,731 0 89,731 0 89,731 257,775 0 257,775 0 257,775 14,774 0 14,774 0 14,774 1,680 0 1,680 0 1,680 530 0 530 0 530 150 0 150 0 150 5,000 0 5,000 0 5,000 30 0 30 0 30 92 0 92 0 92 626 0 626 0 626 1,710 0 1,710 0 1,710 372,098 0 372,098 0 372,098 0 0 0 0 0 29,021 0 29,021 0 29,021 29,021 0 29,021 0 29,021 0 323 323 0 323 0 3 3 0 3 0 37,141 37,141 0 37,141 0 37,467 37,467 0 37,467 44 0 44 0 44 250 0 250 0 250 21 0 21 0 21 104 0 104 0 104 350 0 350 0 350 769 0 769 0 769 0 0 0 620,603 620,603 0 0 0 69,071 69,071 0 0 0 1,007,122 1,007,122 0 0 0 11,062 11,062 0 0 0 677,463 677,463 0 0 0 2,385,321 2,385,321 0 967,618 967,618 0 967,618 0 146,889 146,889 0 146,889 0 1,114,507 1,114,507 0 1,114,507 Attachment_II_Parl_II - Pepe 3 of 9 ATTACHMENT II MONROE COUNTY HEALTH DEPARTMENT Part II, Sources of Contributions to County Health Departmet October 1, 2015 to September 30, 2016 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001025 CHD CLINIC FEES 001073 CHD CLINIC FEES 001077 CHD CLINIC FEES 001094 CHD LOCAL ENVIRONMENTAL FEES 001110 VITAL STATISTICS CERTIFIED RECORDS FEES AUTHORIZED BY COUNTY TOTAL 11.OTHER CASH AND LOCAL CONTRIBUTIONS • COUNTY 001029 CHD CLINIC FEES 001090 CHD CLINIC FEES 005000 CHD LOCAL REVENUE & EXPENDITURES 007010 RYAN WHITE TITLE III . DIRECT TO CHD 007010 RYAN WHITE TITLE III . DIRECT TO CHD 010300 CHD LOCAL ENVIRONMENTAL FEES 010300 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 010400 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 010500 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 011000 MULTIGENERATIONAL COMMUNITY PARK GRANT . HFSF 011000 SMOKE FREE HOUSING GRANT 011000 CHD LOCAL REVENUE & EXPENDITURES 011001 CHD HEALTHY START COALITION CONTRACT 012020 CHD LOCAL REVENUE & EXPENDITURES 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 12. ALLOCABLE REVENUE - COUNTY 018000 CHD CLINIC FEES 018000 CHD LOCAL REVENUE & EXPENDITURES 018000 RYAN WHITE TITLE II CARE GRANT 018000 RYAN WHITE TITLE III . DIRECT TO CHD 037000 RYAN WHITE TITLE III • DIRECT TO CHD 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 State CHD County Total CHD Trust Fund CHD Trust Fund Othe (cash) Trust Fund (cash) Contributio"Mt. 0 881 881 0 881 0 35,395 35,395 0 35,395 0 91,249 91,249 0 91,249 0 260,307 260,307 0 260,307 0 79,172 79,172 0 79,172 0 467,004 467,004 0 467,004 0 200,043 200,043 0 200,043 0 105,467 105,467 0 105,467 0 9,645 9,645 0 9,645 0 108,000 108,000 0 108,000 0 480,784 480,784 0 480,784 0 179 179 0 179 0 72,375 72,375 0 72,375 0 2,200 2,200 0 2,200 0 47,328 47,328 0 47,328 0 14,625 14,625 0 14,625 0 24,425 24,425 0 24,425 0 5 5 0 5 0 280,237 280,237 0 280,237 0 15 15 0 15 0 498,512 498,512 0 498,512 0 1,843,840 1,843,840 0 1,843,840 0 44 44 0 44 0 250 250 0 250 0 21 21 0 21 0 104 104 0 104 0 350 350 0 350 0 769 769 0 769 0 0 0 597,605 597,605 0 0 0 0 0 0 0 0 83,369 83,369 0 0 0 75,223 75,223 0 0 0 115,566 115,566 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 871,763 871,763 Attachment_II_Part_II - Page 4 of ATTACHMENT II MONROE COUNTY HEALTH DEPARTMENT Part II, Sources of Contributions to County Health Department October 1, 2015 to September 30, 2016 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 CHD PROGRAM State CHD County Total CHD Trust Fund CHD Trust Fund Oth' (cash) Trust Fund (cash) Contribution To 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 4,888,286 3,463,587 8,351,873 3,257,084 11,608,957 Attachment_II_Part_II - Page 5 of 9 ATTACHMENT II MONROE COUNTY HEALTH DEPARTMENT Part III, Planned Staffing. Clients, Services and Expenditures By Program Service Area With October 1, 2015 to September 30, 2016 Quarterly Expenditui FPE's Clients Services/ 1st 2nd 3n (0.00) Unite Visits r (Whole dollars only) A COMMUNICABLE DISEASE CONTROI: IMMUNIZATION (101) SEXUALLY TRANS. DIS. (102) HIV/AIDS PREVENTION (03AD HIV/AIDS SURVEILLANCE (03A2) HIV/AIDS PATIENT CARE (03A3) ADAP (03A4) TUBERCULOSIS (104) COMM. DIS. SURV. (106) HEPATITIS (109) PREPAREDNESS AND RESPONSE U n) REFUGEE HEALTH (118) VITAL RECORDS (180) COMMUNICABLE DISEASE SUBTOTAL B. PRIMARY CARE: CHRONIC DISEASE PREVENTION PRO (210) WIC (21W1) TOBACCO USE INTERVENTION (212) WIC BREASTFEEDING PEER COUNSELING (21W2) FAMILY PLANNING (223) IMPROVED PREGNANCY OUTCOME (225) HEALTHY START PRENATAL (227) COMPREHENSIVE CHILD HEALTH (229) HEALTHY START CHILD (231) SCHOOL HEALTH (234) COMPREHENSIVE ADULT HEALTH (237) COMMUNITY HEALTH DEVELOPMENT (238) DENTAL HEALTH (240) PRIMARY CARE SUBTOTAL C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COSTAL BEACH MONITORING (347) LIMITED USE PUBLIC WATER SYSTEMS (357) PUBLIC WATER SYSTEM (358) PRIVATE WATER SYSTEM (359) ONSITE SEWAGE TREATMENT & DISPOSAL (361) Oro* Total Faa'tity Programs TATTOO FACILITY SERVICES (344) 9.67 1.83 4.22 Amends pmviou* 16.35 1.37 1.07 0.89 1.56 3.38 2.04 1.07 43.49 5,736 285 378 22 483 175 20 0 0 440 1,558 9,333 8,378 204,662 238,713 204,662 481 29,977 34,964 29,977 655 75,668 88,258 75,668 30 1,678 1,957 1,678 4,375 626,727 731,000 626,727 500 20,897 24,374 20,897 110 20.632 24,065 20,632 580 17,960 20,948 17,960 344 29,745 34,694 29,745 6,239 72,765 84,872 72,765 936 59.976 69,954 59,976 4,748 17,076 19,918 17,076 27,376 1,177, 763 1,373, 717 1,177, 763 State County Total 238,714 15,658 871,093 886,751 34,964 16,757 113,125 129,882 88,259 327,646 207 327,853 1,958 7,269 2 7,271 731,001 2,039,106 676,349 2,715,455 24,373 90,474 67 90,541 24,066 15,785 73,610 89,395 20,947 0 77,815 77,815 34,693 128,801 76 128,877 84,872 188,104 127,170 315,274 69.954 259,760 100 259,860 19,918 0 73,998 73,988 1,373,719 3,089,360 2,013,602 5,102,962 0.02 0 0 1,750 2,041 1,750 2,041 4,835 2,747 7,582 5.55 4,691 19,291 93,163 108,663 93,163 108,662 403,651 0 403,651 2.46 0 367 47,228 55,086 47,228 55,087 154,154 50,475 204,629 0.48 0 633 13,140 15,326 13,140 15.327 56,933 0 56,933 3.66 1,065 2,026 95,907 111,864 95,907 111,863 247,772 167,769 415,541 0.00 0 0 0 0 0 0 0 0 0 3.40 825 5,211 50,501 58,903 50,501 58,902 0 218,807 218,807 0.00 0 1 20 23 20 24 0 87 87 2.94 840 4,219 40,702 47,474 40,702 47,475 0 176,353 176,353 6.13 0 175,820 79,136 92,302 79,136 92,302 342,876 0 342,876 3.97 378 1,337 88,865 103,651 88,866 103,651 224,001 161,031 385,032 1.05 0 985 26,398 30,790 26,398 30,790 41,323 73,053 114,376 0.00 0 0 0 0 0 0 0 0 0 29.66 7,799 209,890 536,810 626,123 536,810 626,124 1,475,545 850,322 2,325,867 0.39 394 396 7,603 8,867 7,603 8,867 18,439 14,501 3Z940 0.00 0 0 0 0 0 0 0 0 0 0.00 0 0 50 59 60 59 0 218 218 0.00 0 0 0 0 0 0 0 0 0 4.71 1,951 7,465 67,892 79,188 67,892 79,189 184,013 110,148 294,161 5.10 2,345 7,861 75,545 88,114 75,545 88,115 202,452 124,867 327,319 0.13 0 36 1,944 2,268 1,944 2,269 008 3,917 8,425 Attad nerd II Part_III - Pape 6 of 9 ATTACHMENT II MONROE COUNTY HEALTH DEPARTMENT Part III, Planned Staffing. Clients, Services and Expenditures By Program Service Area October 1, 2015 to September 30, 2016 Within Each Level of Service` FTE's Clients Services/ Quarterly 1st Expenditure 2nd Plan 3rd 4th Grand. (0.00) Units visits (Whole dollars only) te` unty Total FOOD HYGIENE (348) 0.57 51 268 8,890 10,369 8,890 10,368 21,560 16,957 38,517 BODY PIERCING FACILITIES SERVICES (349) 0.02 6 7 268 313 268 314 746 417 1,163 GROUP CARE FACILITY (351) 0.08 15 24 1,192 1,391 1,192 1,391 0 5,166 6,166 MIGRANT LABOR CAMP (352) 0.00 0 0 0 0 0 0 0 0 0 HOUSING & PUB. BLDG. (353) 0.00 0 0 0 0 0 0 0 0 0 MOBILE HOME AND PARK (354) 0.55 140 343 7,925 9,244 7,925 9,244 18,673 15,665 34,338 POOLS/BATHING PLACES (360) 2.60 894 2,075 34,812 40,604 34,812 40,605 36,573 114,260 150,833 BIOMEDICAL WASTE SERVICES (364) 0.48 269 292 6,954 8,110 6,954 8,110 13,188 16,940 30,128 TANNING FACILITY SERVICES (369) 0.00 0 0 109 127 109 128 378 95 473 Group Total 4.43 1,375 3,045 62,094 72,426 62,094 72,429 95,626 173,417 269,043 Groundwater Contamination STORAGE TANK COMPLIANCE SERVICES (355) 1.58 221 458 27,422 31,984 27,422 31,985 0 118,813 118,813 SUPER ACT SERVICES (356) 0.00 0 0 0 0 0 0 0 0 0 Group Total 1.58 221 458 27,422 31,984 27,422 31,985 0 118,813 118,813 Community Hygiow COMMUNITY ENVIR. HEALTH (345) 1.41 0 517 24,847 28,981 24,847 28,980 0 107,655 107.655 INJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0 LEAD MONITORING SERVICES (350) 0.00 0 0 0 0 0 0 0 0 0 PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0 SOLID WASTE DISPOSAL SERVICE (363) 0.00 0 0 0 0 0 0 0 0 0 SANITARY NUISANCE (365) 0.16 34 101 2,502 2,919 2,502 2,919 0 10,842 10,842 RABIES SURVEILLANCE (366) 0.04 1 13 654 763 654 764 0 2,835 2,835 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 0 0 0 0 0 0 0 INDOOR AIR (371) 0.00 0 0 87 101 87 102 0 377 377 RADIOLOGICAL HEALTH (372) 0.00 0 0 135 157 135 156 0 583 583 TOXIC SUBSTANCES (373) 0.79 46 46 13,911 16,226 13,911 16,226 0 60,274 60,274 Grow TOW 2.40 81 677 42,136 49,147 42,136 49,147 0 182,566 182,566 ENVIRONMSNPALHEALTH SUBTOTAL 13.51 4,022 12,041 207,197 241,671 207,197 241,676 298,078 599,663 897,741 D. NON-OP&RATIONAL COSTS NON -OPERATIONAL COSTS (699) 0.00 0 0 0 0 0 0 0 0 0 ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 5,840 6,812 5,840 6,811 25,303 0 25,303 MEDICAID BUYBACK (611) 0.00 0 0 0 0 0 0 0 0 0 NONOPERATIONAL COSTS SUBTOTAL 0.00 0 0 5,840 6,812 5,840 6,811 25,303 0 25,303 TOTAL CONTRACT 86.66 21,154 249,307 1,927,610 2,248,323 1,927,610 2,248,330 4,888,286 3,463,587 8,351,873 Attachment11 PartIII - Pape 7 of 9 H w Z �g � a a w W z > C Z Z F=- Q W J = W H U = W O a =O a U J W Q O U w W Z a O 2 O O O O O O O O 00 Cl) Cl) JI H 0 N9 cfl fA f9 E9 a W J a a N � Z c0y 0 t0 N u� N r N N a0 0 N r W N 0 a 0 z Z O 0 o F- o a m 0 a w w w z w z N LU m W ILjcr D < ap LU a- Z z z O H w w H w O O U O w Of a a J Oa O) C a) 26 > V- GN .. C N E E U O N 0. p {gyp 7 a) (1 C O =p 'a)O a) y c a � � 4 v Mr.. m 'c > m n m C a O E' m U > a) Tt O E o O E z, 3 N U i cO y N 0 > aw n o c o c p H a T20 �2c= 00 yC-o LL 3 ty > c c rn m'rnmv L a y m �o m 0-0 O c U m N a) y co r O N ML c�apQ 00 cap c m 'U 1p y U 01 N O 47 hac!Em m m m U d w o d U C C N •C a) � � U Yo03:0 aj� a) m e 0 3 L a) CL LUS 3 0 0 (] C p N C th o .y a) p -0cm y .Q y _U U a) U .. cq 0 a) O LL m a w c 0 LD a c Q d } a a 0 LL uJ a 0 o w LL U w ~ L z a 0 Lu N a U) o) o a 0I CD O LO n wro . O O 0 M v> O d' w a H O U c 0 A 0 e d 0 0 c 0 u 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 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 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. 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 li, Part II is an amount not to exceed $ 41275,646 (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. # 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 i contract period. n the County Health Department Trust Fund that is attributed to the CHD shall be carried forward to the next 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 If 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 -today 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 e, justification therefor 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: i. The revenue and expenditure requirements in the Florida Accounting Information Resource (FLAIR) System; Y. 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 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 CHD 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) year; 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 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. Spec 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 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; #. A written explanation to the County of service variances reflected in the DE3851-1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount. However, if the amount of the service specific variance between actual and planned expenditures does not exceed three percent of the total planned expenditures for the level of service in which the type of service is included, a variance explanation is not required. A copy of the written explanation shall be sent to the Department of Health, 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, 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; N. 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. FACIUTIES 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 modification 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: Mary Vanden Brook J.D. Name Administrative Services Director Title PO Box 6193 1100 Simonton Sheet For the County: Roman Gastesi Name County Administrator Title 1100 Simonton Street Key West, FL 33040 Address 305-809-5612 Telephone Key West, FL 33040 Address 305-292-4441 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 (one page), to be executed by their undersigned officials as duly authorized effective the 1" day of October, 2015. BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY SIGNED BY: .AP STATE OF FLORIDA DEPARTMENT OF HEALTH NAME: John H. Armstrong. MD I III Lt: i v / /r/Y�Qh _ TITLE: Sur eon General/Secretary of Heap DATE: /0 ' a% S� DATE: a q 1Sr 16 ATTESTED TO: SIGNED BY: NAME: TITLE: DATE: SIGNED BY: A;��' NAME: Robert B. Eadie, J.D. TITLE: CHD D c r/Administrator DATE:aeJ`^ API iU� tU&—V-& ;I! , !,; 1 r,FOAObs ATTACHMENT MONROE COUNTY HEALTH DEPARTMENT PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS Some health services must comply with specific program and reporting requirements in addition to the Personal Health Coding Pamphlet (DHP 50-20), Environmental Health Coding Pamphlet (DHP 50-21) and FLAIR requirements because of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it must comply with the special reporting requirements for that service. The services and the reporting requirements are listed below: "rice Reoutiement 1. Sexually Transmitted Disease Program Requirements as specified in F.A.C. 6413-3, F.S. 381 and F.S. 384. 2, Dental Health Periodic financial and programmatic reports as specified by the program office. 3, Special Supplemental Nutrition Program for Women, Infants and Service documentation and monthly financial reports as specified in DHM 150-24• and all federal, state and county requirements Children (including the WIC detailed in program manuals and published procedures. Breastfeedmg Peer Counseling Program) 4 Healthy Startf 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, at 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. 6417-16, and F.A.C. 64F-19. Requirements and Guidance as specified In the Program Requirements for Title X Funded Family Planning Projects (Title X Requkementsx2014) 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 Fanaly 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. 3. 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.AC. In addition, periodic reports as specified by the department pertaining to the survediancelnvestigation of reportable vaccine -preventable diseases, adverse events, vaccine acoountabilfty, and assessment of immunization ATTACHMENT I (Continued) AttwAment_I - Page 1 of 11 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.AC. 64D-3.o30 and 64D-3.031. Case reporting should be on Adult HIV/AIDS Confidential Case Report CDC Form DH2139 and Pediatric HMAIDS Confidential Case Report CDC Form DH2140. Requirements as specified in F.A.C. 6413-2 and 64D-3, F.S. 381 and F.S. 384. Soso -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 FAC. 6413-3 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. 640-3, 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 Attachment1- Papa 2 of 11 w � N m �f V � Z C U. c F U= � � Ua tom = W W 1i W O � O d W v =C J x 2 �v w 0 A U. W W W LL C W 2 a 92 m s � a N C CS 42 }E c ti m ° 0 a Li 42,04 W � 2 H � v U 0 to 1 •- CV 07 li W I- ti C m O E s M � .Q a W C N 81c 2 v 0 LD r E �o 0 c LD 0 C a W 9 E U co ATTACHMENT II MONROE COUNTY HSALTS D*PABno* Part H. &mr o of Cfttla'b&Ums to Cosa* b�aeaea>t oar 1, loia to 8aptsltiot ao sbu T:oat lwlgd 4AD (mob) Trlutirrad fComm 1. GENERAL REVENUE - STATE 016040 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 016040 A1,G/CFSSPOOI. IDENTIFICATION & ELIMINATION PROG 015040 FAMILY PLANNING GENERAL REVENUE 015040 HEPATITIS AND LIVER FAILURE PREVENTION & CONTROL 015040 PRIMARY CARP PROGRAM 01.5040 SCHOOL HEALTH SERVICES - GENERAL, REVENUE 015050 CHD GENERAL REVENUE NON -CATEGORICAL GENERAL REVENUE TOTAL 2. NON GENERAL REVENUE - STATE 016010 STATE UNDERGROUND PETROLEUM RESPONSE ACT 01.5010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 015010 TOBACCO STATE AND COMMUNITY INTFRVFNTION.S NON GENERAL REVENUE TOTAL 3. FEDERAL FUNDS - STATE 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 007000 AIDS SURVEILLANCE - CORE 007000 WIC BRF,ASTFEEDING PEER COUNSELING PROG 007000 COASTAL BEACH WATER QUALITY MONITORING 007000 COMPREHENSIVE COMMUNITY CARDIO - PHBG 007000 FAMILY PLANNING TITLE X - GRANT 007000 HOUSING, OPPORTUNITIES FOR PERSONS WITH AIDS 007000 IMMUNIZATION ACTION PLAN 007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 007000 MCH SPECIAL PROJECT PRAMS 007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC 007000 AIDS PREVENTION 007000 RYAN WHiTF, TITLE. 11 CARE GRANT 007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIUM 007000 WIC PROGRAM ADMINISTRATION 015075 INSPECTIONS OF SUMMER FEEDING PROGRAM - DOE 015075 SUPPLEMENTAL SCHOOL HEALTH 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 001206 ON SITF SF,WACF, DISPOSAL PERMIT FEES 001206 SA-�IiTATION CERTIFICATES (FOOD INSPECTION) Qtbar Cont 6ation Total 370,000 0 370,000 0 370,000 73,552 0 73,552 0 73,552 259,200 0 259,200 0 259,200 15,784 0 15,784 0 15,784 16.756 0 16,755 0 16,765 53,766 0 63,766 0 53,7W3 32,678 0 32.678 0 32,678 72,000 0 72,000 0 72,0(MI 199,742 0 199,742 0 199,742 96.223 0 96,223 0 96,223 1,184,242 0 1,184,242 0 1,184,242 2,373,942 0 2,373,942 0 2,373,942 1,736 0 1,736 0 1,736 3,719 0 3,719 0 3,719 118,194 0 118, t54 0 118,154 123,609 0 123,609 0 123.609 26,582 0 26,582 0 26,582 5,907 0 5,907 0 5.907 1,562 0 1,562 0 1,562 56,777 0 55.777 0 65,777 18,439 0 18,439 0 18,439 36.000 0 35,000 0 35.000 57,525 0 57,525 0 57,525 393,966 0 393,965 0 393,966 8,624 0 8,624 0 8,624 75 0 75 0 75 20.816 0 20.816 0 20,816 95,753 0 95,753 0 95,753 118,700 0 118,700 0 118,700 80,857 0 90.867 0 80,857 482,143 0 482,143 0 482.143 337,944 0 337,944 0 337,944 129 0 129 0 129 123,839 0 123.839 0 123,839 144,591 0 144,691 0 144,591 2.008,228 0 2,008,228 0 2,008,228 92.849 0 92,849 0 92.849 150,264 0 150.264 0 160,264 12,000 0 12,000 0 12.000 2,000 0 2,000 0 2,000 Alta&menl_II_PaA_II - Page 4 of 11 ATTACMONT U MONROE COUN71r RRAW Pare U. eoa> oe, at OoaSr#buMOW 1* � �!�►_ ►•at Oclaba I. Ulli to .his 8lab:GSD �o�u�3e'y ToW OSD Tsiut ih d -.Cjip Ti l*d Other (out " 'Frost; I+ti�d fe1u1J ConMbution 001206 SEPTIC TANK RESEARCH SURCHARGE 625 0 525 0 001206 SEPTIC TANK VARIANCE FEES 60% 50 0 50 0 001206 PUBLIC SWIMMING POOL PERMIT FEES•10% HQ TRANSFER 5,000 0 5,000 0 001206 DRINKING WATER PROGRAM OPERATIONS 12 0 12 0 001206 REGULATION OF BODY PIERCING SALONS 60 0 60 0 001206 TANNING FACILITIES 117 0 117 0 001206 ONSITE SEWAGE TRAINING CENTER 18 0 18 0 001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 955 0 965 0 001206 MOBILE HOME & RV PARK FEES 2,004 0 2,004 0 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 265,854 0 265,854 0 5. OTHER CASH OONTRIBUTIONS - STATE: 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT OTHER CASH CONTRIBUTION TOTAL S. MEDICAID - STATE/COUNTY: 001067 CHD CLINIC FEES 001148 CHD CLINIC FEES MEDICAID TOTAL 7. ALLOCABLE REVENUE - STATE: 018000 CHD LOCAL REVENUE & EXPENDITURES 037000 RYAN WHITE TITLE III - DIRECT TO CHD ALLOCABLE REVENUE TOTAL & OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE ADAP PHARMACY DRUG PROGRAM WIC PROGRAM BUREAU OF PUBLIC HEALTH LABORATORIES IMMUNIZATIONS OTHER STATE CONTRIBUTIONS TOTAL 9. DIRECT LOCAL CONTRIBUTIONS - BCC/TAX DISTRICT 008005 CHD LOCAL REVENUE & EXPENDITURES 008W5 IMMUNIZATION CAMPAIGN MONROE COUNTY BOCC DIRECT COUNTY CONTRIBUTIONS TOTAL 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001025 CHD CLINIC FEES 001073 CHD CLINIC FEES 001077 CHD CLINIC FEES 001094 CHD LOCAL ENVIRONMENTAL FEES 001110 VITAL STATISTICS CERTIFIED RECORDS FEES AUTHORIZED BY COUNTY TOTAL 11. OTHER CASH AND LOCAL CONTRIBUTIONS . COUNTY Total 526 60 5.000 12 60 117 18 955 2,004 265,854 0 0 0 0 0 0 0 0 0 0 0 0 0 0 d 0 720 720 0 720 0 36,863 36,863 0 36,863 0 37,583 37.583 0 37,583 500 0 500 0 5W 350 0 350 0 350 850 0 850 0 850 0 0 0 620,603 620,603 0 0 0 69,071 69,071 0 0 0 1,007,122 1,007,122 0 0 0 11,062 11,062 0 0 0 677.463 677,463 0 0 0 2,395,321 2,386.321 0 801.890 801,890 0 80I,890 0 289,914 289,914 0 289,914 0 1.091,804 1,091,804 0 1,091,804 0 691 691 0 691 0 36,000 35,000 0 35,000 0 104,256 104,266 0 104.266 0 137,627 137,627 0 137,627 0 73,000 73,000 0 73,000 0 360,674 350,574 0 360,574 AflacW-e 9_Psdo - Fags 5 of 11 ATTACIIIV[ENT II moxRoz cwtirNW Hai"_ p vot D. scams of 0004a 1dow 10 Flolt*H�iit� �Dat�O�at Ootoblr I. Ii016 tbp64N0.7lO16 ". plim CIiD' -ORow Told CHD h i- Tn t Iboa %ASt A=d Ot6gr 16, eM Teaat lnsd (oish) Con"'at{on Tots1 001029 CHD CLINIC FEES 0 246,030 245,830 0 245,830 001090 CHD CLINIC FEES 0 120,970 120,970 0 120,970 006000 CHD LOCAL REVENUE & EXPENDITURES 0 11,000 11,000 0 ll,000 007010 RYAN WHITE TITLE III • DIRECT TO CHD 0 145,000 145,000 0 146,000 007010 RYAN WHITE TITLE Ill - DIRECT TO CHD 0 369,483 369,483 0 369,483 010300 CHD STATEWIDE ENVIRONMENTAL FEES 0 204 204 0 204 010300 CHD LOCAL ENVIRONMENTAL. FFFS 0 1,610 1,610 0 1,610 010300 CHD SALE OF SERVICES IN OR OUTSIDE. OF STATE GOVT 0 71,602 71,602 0 71,602 010400 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 GOUT 0 70,391 70,391 0 70,391 011000 SMOKE FREE HOUSING GRANT 0 24,425 24,425 0 24,425 011001 CHD HEALTHY START COALITION CONTRACT 0 290,000 290,000 0 290,000 012020 CHD LOCAL. RF.VF.NUF. & EXPENDITURES 0 15 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 2,271,474 2,271,474 0 2,271,474 12. ALLOCABLE REVENUE • COUNTY 018000 CHD LOCAL REVENUE & EXPENDITURES 0 500 500 0 500 037000 RYAN WHITE TITLE III - DIRECT TO CHD 0 350 350 0 350 COUNTY ALLOCABLE REVENUE TOTAL 0 850 950 0 950 13. BUILDINGS - COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 597,606 697,605 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 0 116,566 115,566 INSURANCE 0 0 0 0 0 OTHER (Specify) 0 0 0 0 0 OTHER (Specify) 0 0 0 0 0 BUILDINGS TOTAL 0 0 0 871,763 871,763 14.OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND • COUNTY EQUIPMENT I 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 3,752.295 8.624,768 3.257.084 11.781,852 Attachment II Part II - Page 6 of 11 u moamoa ©oumio r } Ffr� ]I!, PLnwA Blr ne, flN4+etr. $oetibtN p iHM A i i' Withln S4tei [.rv�l pf 9a rtaa Ootebge 1, rB4 ` Rb�eYlep , 7=119 OHM" v 1}t 9id $ltd (0.00 Unk. salts A COMMUNICABLE DISEASE CONTROL: IMMUNIZATION (lo) SEXUALLYTRANS. DIS. (102) HIV/AIDS PREVENTION (03AU HiVIAIDSSURVEILIANCE (03A2) HIVIAIDS PATIENT CARE (03A3) ADAP (03A4) TUBERCULOSIS (104) COMM, DIS. SURV. (106) HEPATITIS (109) PREPAREDNESS AND RESPONSE (11Fa REFUGEE HEALTH (118) VITAL RECORDS (180) COMMUNICABLE DISEASE SUBTOTAL 11. PRIMARY CARE: CHRONIC DISEASE PREVENTION PRO (210) WIC (21WI) TOBACCO USE INTERVENTION (212) WIC BREASTFEEDING PEER COUNSELING (21W2) FAMILY PLANNING (223) IMPROVED PREGNANCY OUTCOME (225) HEALTHY START PRENATAL (227) WMPREHENSIVE CHILD HEALTH C229) HEALTHY START CHILD (231) SCHOOL HEALTH (234) COMPREHENSIVE ADULT HEALTH (237) WMMUNITY HEALTH DEVELOPMENT (238) DENTAL HEALTH (240) PRIMARY CARE SUBTOTAL C. ENVIRONMENTAL HEALTH: Water and Omits Sewage Programe COSTAL BEACH MONITORING (347) LIMITED USE PUBLIC WATER SYSTEMS (357) PUBLIC WATER SYSTEM (358) PRIVATE WATER SYSTEM (369) ONSITE SEWAGE TREATMENT & DISPOSAL (361) Group Total FaCH4 Prop - TATTOO FACILITY SERVICES (344) FOOD HYGIENE (348) BODY PIERCING FACILITIES SERVICES (349) COUMF toe. 9AS 5.724 8,360 216,678 252,612 216,578 252,611 8,624 929.755 938,379 1.76 274 492 30,681 35,786 30,681 36,785 123.558 9.374 132,932 4.07 366 632 79,304 92,498 79,304 92,497 192,262 151,351 343,603 R04 22 30 722 842 722 842 1,562 1.666 3,128 16.21 479 4,338 634,825 740,446 634,826 740,445 2,138,939 811,602 2,750.541 1.32 16 218 21,636 25,235 21.635 25.234 93.616 123 93,739 1.04 26 162 21,158 24,678 21,168 24,678 15,784 75,880 91,672 0.87 0 567 18,956 22,110 18,966 22.110 0 82,I32 82,132 1.62 245 357 30,926 36,071 30,926 K071 72,000 61,994 133,994 3.26 0 6,017 66,477 76,371 65.477 76,372 96,753 187.944 283,697 1.97 398 961 50,813 59,267 50,813 69.268 219.978 183 220,161 1.04 1,616 4,616 17.829 20,79E 17.829 20,705 0 77.248 77,248 42.8E 9.093 26,652 1.188,904 1,386,710 1,188,904 1.386.708 2,96%OM 2,189,160 5,/51,226 0.02 0 0 1,335 1,558 1,335 1,558 3,408 2,378 5,786 5.35 4.521 18,696 98,007 114.313 98,007 114,313 424.640 0 424,840 2.09 0 312 45,554 53,134 46,664 63.134 197.376 0 197,376 0.47 0 620 15,179 17.706 15,179 17,705 66.768 0 65,768 3,54 1,030 1,961) 87,682 102,270 87,682 102,269 327,656 5$347 379,903 0.00 0 0 3.967 4,626 3,967 4,626 17,186 0 17,186 &38 820 6.180 54.699 63.800 54,699 63.800 0 236,998 236,M8 0.(X) 0 0 2U 24 20 24 88 0 88 2.93 837 4.204 44.842 52.303 44,842 52.302 13,426 180,W3 194,289 503 0 1",270 79,826 93,107 79,826 93.107 220,062 125" 346,86E 391 373 1.317 88.278 102.965 88,278 102,965 199,742 182,744 3BZ486 1.01 0 947 26.067 30,404 26,067 30,404 0 lIZ942 lIZ942 0.00 0 0 0 0 0 0 0 0 0 27.73 7,581 177,406 545.46E 636,209 545,456 SM,207 1,469,252 894,076 2,363,328 0.38 384 385 9,586 11,181 9,58E 11,181 18.439 23,096 41.534 0.00 0 0 0 0 0 0 0 0 p 0.00 0 0 158 184 168 183 0 683 689 0.00 0 0 0 0 0 0 0 0 0 4,63 1,877 3,606 74,077 86,402 74,077 86.401 207766 118,191 320,957 4.91 2,261 3,990 83,821 97,767 83,821 97,766 221,206 141,969 363,174 0.12 0 33 2,043 2,383 2,043 2,394 4,500 4,353 9,853 0.64 67 301 10,870 12,679 10,870 12,680 17,943 29,166 47,099 0.02 6 7 316 369 316 369 915 455 1.370 Attachment II_Pwt_NI - Pape 7 of 11 AtTAIDWIMNT 11 NONRON OOUNft PPJfr 010PA"bUlft Plat III. Pl�msd Btu. EU4roe�, i1sle•Io..lead 14 ue� $y Pam ¢elniw Ana WkLia;ao4 Lewt of 8vvv 00100 L 11016 00 001vlla6,l0, �3A �n PLn rra's cats a nl.«r ift s>. d sa 40 a>~1la (0.00) Umita 9 wtm (Wwh dolim mdy) auto 04m* Total GROUP CARE FACILITY (351) 0,09 17 27 1,658 1,818 1.558 1,818 0 6.752 6,762 MIGRANT LABOR CAMP (352) 0.00 0 0 0 0 0 0 0 0 0 HOUSING & PUB BLDG. (363) 0.00 0 0 0 0 0 0 0 0 U MOBILF, HOME AND PARK (354) 0.56 143 349 8,759 10,216 8,759 10.217 18,798 19,163 37,961 POOISMATHINGP)ACFS (360) 2.62 901 2,091 39,119 45.627 39,119 45,627 42,900 126,692 169,492 BIOMEDICAL WASTE SERVICES (3&0 0.62 292 316 8,291 9.670 8,291 9.670 11,810 24,11E 35,922 TANNING FACILITY SERVICES (369) 0.01 2 3 143 167 143 168 454 167 621 Group Total 4.58 1.08 3,127 71.099 82,929 71,099 82933 97,220 210.840 308,060 Groundwater Cootemiaatioo STORAGE TANK COMPLIANCE SERVICES (355) 1.52 213 441 27,939 32,588 27,939 32,589 0 121,065 121,055 SUPER ACT SERVICES (350 O.OD 0 0 0 0 0 0 0 0 0 Group Total 1.52 213 441 27,939 32,5N 27,939 32.689 0 121.056 121,055 Community Hygiene COMMUNITY ENVIR HEALTH (345) 1.35 0 495 25,754 30,039 25,754 30,040 0 111,587 111,587 INJURY PREVENTION (346) O.W 0 U 0 0 U 0 0 0 0 LEAD MONITORING SERVICES (360) 0.00 0 0 0 0 0 0 0 0 0 PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0 SOLID WASTE DISPOSAL SERVICE (363) 0.00 0 0 0 0 0 0 0 0 0 SANITARY NUISANCE (355) 0.18 39 113 3,127 t&47 3,127 3,646 0 13.547 13,547 RABIES SURVEILLANCE (366) 0.05 1 16 746 870 745 870 0 3.230 3,230 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 0 0 0 0 0 0 0 INDOORAIR (371) 0.00 0 0 &9 104 89 104 0 886 386 RADIOLOGICAL HEALTH (372) 0.00 0 0 139 162 139 162 0 602 002 TOXICSUBSTANCES (373) 0.82 47 47 15,194 17,722 15,194 17,723 0 65,833 65,833 (1roupTotal 2,40 87 671 45.048 6$544 45,048 52,545 0 195,185 195,186 ENVIRONMENTAL HEALTH SUBTOTAL 13.41 3.979 8,229 227.907 265,828 227.907 265,832 $18,425 669,049 987,474 D. NON -OPERATIONAL COSTS! NONOPERATIONAL COSTS (699) 0.00 0 0 0 0 0 0 0 0 0 ENVIRONMENTAL HEALTH SURCHARGE (399) 000 0 0 6,249 6,122 6.249 6,121 22,741 0 2$741 MEDICAID BUYBACK (611) 0,00 0 0 0 0 0 0 0 0 0 NON-OPBRATIONAL COSTS SUBTOTAL 0.00 0 0 5,249 6,122 5.249 6,121 22.741 0 22.741 TOTAL CONTRACT 83.99 20,623 212,287 1,967,516 2.294,869 1,967.616 2,294,868 4.772.484 3,752,285 8,524369 Alleclpnenl_II PaA_MI - Pape 8 of 11 ATTACHMENT 10 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 (e)cept 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 Ad 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 Ad 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 Ad of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the applicant understands that the grantor may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief, to include assistance being terminated and further assistance being denied. Attachment-1 11 - Page 9 of 77 ATTACHMENT IV MONROE COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Gato Building: Administration, Clinic, Healthy Start, Vital Statistics Roosevelt Sands Center: Clinic, WIC Location Owned 8v 1100 Simonton Street, Key West, FL Monroe County 33040 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 33040 Health Murray E. Nelson government Center: 102050 Overseas Highway, Key Largo, FL Environmental Health 33037 Ruth Ivins Center. Clinic, Environmental 3333 Overseas Highway, Marathon, FL Health 33050 Roth Building: Clinic 50 High Point Road, Tavernier, FL 33070 Monroe County Monroe County Monroe County Monroe County A4achment_N - Page i a d 11 CONTRACT YEAR 2014-2015' 2015-2016" 2016-2017"' 2017-2018— PROJECT TOTAL PROJECT NUMBER: PROJECT NAME: LOCATIONADDRESS: PROJECT TYPE: SQUARE FOOTAGE: PROJECT SUMMARY: ATTACHMENT V MONROE COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN CASH RESERVED OR ANTICIPATED TO 8E RESERVED FOR PROJECTS STATE COUNTY $ Na $ 0 $ n/a $ 0 $ Na $ 0 $ Na $ 0 $ Iva $ 0 SPECIAL PROJECTS CONSTRUCTIOWRENOVATION PLAN NEW BUILDING RENOVATION NEW ADDITION 0 Descrfe scope of work a reasonable deW START DATE (k"axpwxWum of &,W COMPLETION DATE: DESIGN FEES: CONSTRUCTION COSTS: FURNITUREIEQUIPMENT: TOTAL PROJECT COST: COST PER SO FOOT: ROOFING PLANNING STUDY OTHER $ 0 $ 0 $ 0 $ 0 $ 0 Special Capital Projects are now construction or renovation projects and new furniture or equipment associated with those projects and mobile health vans. Cash balance as of 9130115 •' Cash to be hansfelred to FCO account. — Cash anticipated tof future contract years. MK.hffmd v - Pape 1 f of 11 FEE RESOLUTIONS 2015-2016 pride 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 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 56-66-13. 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 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 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 or 9 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 Ill. 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: (S 215.34(2) 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 2025-2016 whichever is greater, not to exceed $150 G. PUBLIC HEALTH AND MEDICAL PREPAREDNESS Submission and Review of Required Annual Comprehensive Emergency Management Plan for Home Health Agencies, 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 L 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 If. 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 L 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 S Monroe County Health Department Core Contract 2015-2016