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FY2017 09/21/2016AMY REAVILIN, CPA CLERK OF CIRCUIT COURT &COMPTROLLER MONAOE COUNTY, FLORIDA DATE: October 26, 2016 TO: Bob Eadie, Administrator of the Monroe County Health Department FROM. • Cheryl Robertson Executive Aide to the Clerk of Court & Comptroller At the September 21, 2016 Board of County Commissioner's meeting the Board granted approval and authorized execution of Item R1 Approval of the Contract between Monroe County Board of County Commissioners and the State of Florida, Department of Health for operation of the Monroe County Health Department - contract year 2016-2017. The enclosures are not fully executed; they need to be sign by the State of Florida Department of Health and_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 3117 Overseas 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 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 2016-2017 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, 2016. 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, 2016, through September 30, 2017, 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. 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 $ 4,582,455 (State General Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C). The State's obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. ii. The County's appropriated responsibility (direct contribution excluding any fees, othercash orlocal contributions) as provided in Attachment II, Part II is an amount not to exceed $1,165,070 (amount listed under the "Board of County Commissioners Annual Appropriations section of the revenue attachment). b. Overall expenditures will not exceed available funding or budget authority, whichever is less, (either current year or from surplus trust funds) in any service category. Unless requested otherwise, any surplus at the end of the term of this contract in the County Health Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period. c. Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee 2 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 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 3 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; 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 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 Il, Part I of this contract, with special capital projects explained in Attachment V. 4 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) 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 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 III. o. The CHD shall submit quarterly reports to the County that shall include at least the following: i. The DE385L1 Contract Management Variance Report and the DE580L1 Analysis of Fund Equities Report; ii. A written explanation to the County of service variances reflected in the year end DE3851-1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount for the contract year. 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, 2017 for the report period October 1, 2016 through December 31, 2016; ii. June 1, 2017 for the report period October 1, 2016 through March 31, 20171 & September 1, 2017 for the report period October 1, 2016 through June 30, 2017; and iv. December 1, 2017 for the report period October 1, 2016 through September 30, 2017. 7. FACILITIES AND EQUIPMENT. The parties mutually agree that: a. CHD facilities shall be provided as specified in Attachment IV to this contract and the County shall own the facilities used by the CHD unless otherwise provided in Attachment IV. b. The County shall ensure adequate fire and casualty insurance coverage for County - owned CHD offices and buildings and for all furnishings and equipment in CHD offices through either a self-insurance program or insurance purchased by the County. c. All vehicles will be transferred to the ownership of the County and registered as County vehicles. The County shall ensure insurance coverage for these vehicles is available through either a self-insurance program or insurance purchased by the County. All vehicles will be used solely for CHD operations. Vehicles purchased through the County Health Department used solely for CHID 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 parry'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 contract, any renewal hereof, or any term, performance or payment hereunder, extends beyond the fiscal year beginning July 1, 2017, it is agreed that the performance and payment under this contract 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. Administrative Services Director PO Box 6193 1100 Simonton Street Key West, FL 33041 305-809-5612 Telephone For the County: Roman Gastesi County Administrator 1100 Simonton Street Key West, FL 33040 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. 7 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 19 page contract, with its attachments as referenced, including Attachment I (two pages), Attachment II (6 pages), Attachment III (1 page), Attachment IV (1 page), and Attachment V (1 page), to be executed by their undersigned officials as duly authorized effective the 1st day of October, 2016. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR MONROE COUNTY DEPARTMENT OF HEALTH SIGNED BY: SIGNED BY: NAME: oYdP /Ue 1a 0 f NAME: Celeste Philip, MD, MPH TITLE: Tm TITLE: Surgeon General and Secretary TITLE: el) of y ckr - DATE: -Z O /(p DATE: SIGNED BY: NAME: Robert Eadie, J.D. TITLE: CHD Director/Administrator DATE: —&11146 IJHRIA!Ii1- A SSIS`fA. a 1 r, ?v Y Data 1.1 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: Service 1. Sexually Transmitted Disease Program 2. Dental Health 3. Special Supplemental Nutrition Program for Women, Infants and Children (including the WIC Breastfeeding Peer Counseling Program) Requirement Requirements as specified in F.A.C. 64D-3, F.S. 381 and F.S. 384. Periodic financial and programmatic reports as specified by the program office. Service documentation and monthly financial reports as specified in DHM 150-24* and all federal, state and county requirements detailed in program manuals and published procedures. 4. Healthy Start/ Improved Pregnancy Requirements as specified in the 2007 Healthy Start Standards and Outcome Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. 5. Family Planning Requirements as specified in Public Law 91-572, 42 U.S.C. 300, et seq., 42 CFR part 59, subpart A, 45 CFR parts 74 & 92, 2 CFR 215 (OMB Circular A-110) 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 Matemal Child Health Services, including the Family Planning Annual Report (FPAR), and other minimum guidelines as specified by the Policy Web Technical Assistance Guidelines. 6. Immunization Periodic reports as specified by the department pertaining to immunization levels in kindergarten and/or seventh grade pursuant to instructions contained in the Immunization Guidelines -Florida Schools, Childcare Facilities and Family Daycare Homes (DH Form 150-615) and Rule 64D-3.046, F.A.C. In addition, periodic reports as specified by the department pertaining to the surveillance/investigation of reportable vaccine -preventable diseases, adverse events, vaccine accountability, and assessment of immunization ATTACHMENT I (Continued) Attachment 1 - Page 1 of 11 7 8. 0 levels as documented in Florida SHOTS and supported by CHD Guidebook policies and technical assistance guidance. Environmental Health Requirements as specified in Environmental Health Programs Manual 150-4* and DHP 50-21* HIV/AIDS Program Requirements as specified in F.S. 384.25 and 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. School Health Services 10. Tuberculosis 11 Requirements as specified in F.A.C. 64D-2 and 64D-3, F.S. 381 and F.S. 384_ Socio-demographic and risk data on persons tested for HIV in CHD clinics should be reported on Lab Request DH Form 1628 in accordance with the Forms Instruction Guide. Requirements for the HIV/AIDS Patient Care programs are found in the Patient Care Contract Administrative Guidelines. 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. 6417-6. Tuberculosis Program Requirements as specified in F.A.C. 64D-3 and F.S. 392_ General Communicable Disease Cary out surveillance for reportable communicable and other acute Control diseases, detect outbreaks, respond to individual cases of reportable diseases, investigate outbreaks, and carry out communication and quality assurance functions, as specified in F.A.C. 64D-3, F.S. 381, F.S. 384 and the CHD Epidemiology Guide to Surveillance and Investigations. 12. Refugee Health Program Programmatic and financial requirements as specified by the program office. *or the subsequent replacement if adopted during the contract period. Attachment —I - Page 2 of 11 e / w LCO LO o \ m 0 f � � t k » 3 k 2 ƒk8 Co S co 8 �0 c //o m 0 coo 2 f 0-0 =I� 9 S @ C%l§ `U2 uj z k0� « 2% 7 �r m 2 L_ � e U � k k z w I\� » E o 02 a.-0_ LU / \ CO w E _ Cc « D (n z UJ O c / 0 : ° ■ -j L 7 @ b \ LU < J / 2 q § § 0 2 ■ L & ui o § 0 2 k % ~ t; 2 ~ /_ a k G ~ @o UG \ £~ vR �~ @C S CO) 7 & 2 $2 S ca k f \f 0§ K 2 E 2ƒ f e ? @m .©m $m ca LU k� �� k\ CD LL LL 3 J� G EC14 7 $w d� 2q �� CL 2 e 2/ a R/ Q Sb ' c 3 o kd o CL m/ cnd -Ca ® w ® U) < ATTAGMIENT II MONROE COUNTY HEALTH DEPARTMENT Part 11, Sources of Contributions to County Health Department October 1, 2016 to September 30, 2017 1. GENERAL REVENUE - STATE 015040 AIDS PATIENT CARE 015040 AIDS PREVENTION & SURVEILLANCE - GENERAL REVENUE 015040 AIDS NETWORK REIMBURSEMENT 015040 CHD - TB COMMUNITY PROGRAM 015040 SEXUALLY TRANSMITTED DISEASE CONTROL PROGRAM GR 015040 ALG/CESSPOOL IDENTIFICATION & ELIMINATION PROG 015040 FAMILY PLANNING GENERAL REVENUE 015040 HEPATITIS AND LIVER FAILURE PREVENTION & CONTROL 015040 PRIMARY CARE PROGRAM 015040 SCHOOL HEALTH SERVICES - GENERAL REVENUE 015050 CHD GENERAL REVENUE NON -CATEGORICAL GENERAL REVENUE TOTAL 2. NON GENERAL REVENUE - STATE 015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS NON GENERAL REVENUE TOTAL 3. FEDERAL FUNDS - STATE 007000 RYAN WHITE TITLE H ADAP DRUG REBATES 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 007000 WIC BREASTFEEDING 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 BASE COMMUNITY PREPAREDNESS CAPABILITY 007000 AIDS PREVENTION 007000 RYAN WHITE TITLE II CARE GRANT 007000 RYAN WHITE TITLE 11 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 SITE SEWAGE DISPOSAL PERMIT FEES 001206 SANITATION CERTIFICATES (FOOD INSPECTION) 001206 SEPTIC TANK RESEARCH SURCHARGE State CHD County Total CHD Trust Fund CHD Trust Fund Other ir,4 (cash) is+Trust Fund (cash) Contribution 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 20,531 0 20,531 0 20,531 16,755 0 16,755 0 16,755 53,766 0 53,766 0 53,766 31,752 0 31,752 0 31,752 72,000 0 72,000 0 72,000 199,742 0 199,742 0 199,742 96,223 0 96,223 0 96,223 1,183,390 0 1,183,390 0 1,183,390 2,376,911 0 2,376,911 0 2,376,911 061 0 4,561 0 4,561 118,154 0 118,154 0 118,154 122,715 0 122,715 0 122,715 6,523 0 6,523 0 6,523 35,443 0 35,443 0 35,443 42,000 0 42,000 0 42,000 17,460 0 17,460 0 17,460 35,000 0 35,000 0 35,000 55,895 0 55,895 0 55,895 444,049 0 444,049 0 444,049 8,624 0 8,624 0 8,624 18,992 0 18,992 0 18,992 104,557 0 104,557 0 104,557 133,767 0 133,767 0 133,767 76,595 0 76,595 0 76,596 481,668 0 481,668 0 481,668 300,000 0 300,000 0 300,000 1,522 0 1,522 0 1,522 123,839 0 123,839 0 123,839 222,704 0 222,704 0 222,704 2,108,638 0 2,108,638 0 2,108,638 112,109 0 112,109 0 112,109 223,551 0 223,551 0 223,551 18,000 0 18,000 0 18,000 2,000 0 2,000 0 2,000 500 0 500 0 500 Attachment II PartII - Page 4 of 11 .. � r 4 � Az ! t1� ryf '� G • pt. t x pme Ix 4f r 43•,_ a •�j. k� ''�,. y .+lei jig:• IYP 001206 SEPTIC TANK VARIANCE FEES 50% 175 0 175 001206 PUBLIC SWIMMING POOL PERMIT FEES-10% HQ TRANSFER 1,600 0 1,600 001206 REGULATION OF BODY PIERCING SALONS 40 0 40 001206 TANNING FACILITIES 115 0 115 001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 550 0 550 001206 MOBILE HOME & RV PARK FEES 2,100 0 2,100 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 360,740 0 360,740 5. OTHER CASH CONTRIBUTIONS - STATE: 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT OTHER CASH CONTRIBUTION TOTAL 6. MEDICAID - STATE/COUNTY 001057 CHD CLINIC FEES 001148 CHD CLINIC FEES MEDICAID TOTAL 7.ALLOCABLE REVENUE - STATE: 001004 CHD STATEWIDE ENVIRONMENTAL FEES 018000 CHD CLINIC FEES 018000 CHD LOCAL REVENUE & EXPENDITURES 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 - BCC/TAX DISTRICT 008005 CHD LOCAL REVENUE & EXPENDITURES 008005 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 0 0 210,609 0 210,609 0 0 489 0 46,350 0 46,839 0 0 0 0 0 0 0 0 0 210,609 0 210,609 0 489 0 46,350 0 46,839 0 .n 175 1,600 40 115 550 2,100 360,740 0 210,609 210,609 489 46,350 46,839 10 0 10 0 10 50 0 50 0 50 250 0 250 0 250 310 0 310 0 310 0 0 0 672,819 672,819 0 0 0 14,834 14,834 0 0 0 949,409 949,409 0 0 0 10,472 10,472 0 0 0 568,546 568,546 0 0 0 2,216,080 2,216,080 0 767,965 767,965 0 767,965 0 397,105 397,105 0 397,105 0 1,165, 070 1,165, 070 0 1,165, 070 0 850 850 0 850 0 41,400 41,400 0 41,400 0 99,625 99,625 0 99,625 0 218,110 218,110 0 218,110 0 77,000 77,000 0 77,000 0 436,985 436,985 0 436,985 Attachment_II PartII - Page 5 of 11 r�4, Kamm V�%Mt, 7 i .M'x H � 1 c6 tc r y Q r! II, agitl(li CMO> 59`i[, Asv 's 000bcef X 20n to fta �,'. w 001029 CHD CLINIC FEES 0 206,380 206,380 001090 CHD CLINIC FEES 0 105,620 105,620 005000 CHD LOCAL REVENUE & EXPENDITURES 0 9,600 9,600 007010 RYAN WHITE TITLE III DIRECT TO CHD 0 93,074 93,074 007010 RYAN WHITE TITLE III DIRECT TO CHD 0 440,658 440,658 007010 RYAN WHITE TITLE III DIRECT TO CHD 0 110,395 110,395 010300 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 76,819 76,819 010400 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 4,800 4,800 010500 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 52,468 52,468 011000 MULTIGENERATIONAL COMMUNITY PARK GRANT - HFSF 0 35,000 35,000 011001 CHD HEALTHY START COALITION CONTRACT 0 290,000 290,000 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 363,826 363,826 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,788,640 1,788,640 12.ALLOCABLE REVENUE -COUNTY 001004 CHD STATEWIDE ENVIRONMENTAL FEES 018000 CHD CLINIC FEES 018000 CHD LOCAL REVENUE & EXPENDITURES COUNTY ALLOCABLE REVENUE TOTAL 13. BUILDINGS - COUNTY ANNUAL RENTAL EQUIVALENT VALUE OTHER (Specify) UTILITIES BUILDING MAINTENANCE GROUNDS MAINTENANCE INSURANCE OTHER (Specify) OTHER (Specify) BUILDINGS TOTAL 14: OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY EQUIPMENT / VEHICLE PURCHASES VEHICLE INSURANCE VEHICLE MAINTENANCE OTHER COUNTY CONTRIBUTION (SPECIFY) OTHER COUNTY CONTRIBUTION (SPECIFY) OTHER COUNTY CONTRIBUTIONS TOTAL GRAND TOTAL CHD PROGRAM 0 0 0 0 0 0 0 0 0 0 0 0 0 206,380 105,620 9,600 93,074 440,658 110,395 76,819 4,800 52,468 35,000 290,000 363,826 1,788,640 0 10 10 0 10 0 50 50 0 50 0 250 250 0 250 0 310 310 0 310 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 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 5,179,923 3,437,844 8,617,767 3,087,843 11,705,610 Attachment_II_Part_II - Page 6 of 1 f eTUtO ns�os C�xrr�r 7�E �GPA Paa»)<!i, Pteamad sraeFoR. ctis�eta, 3e>Aitea aaa Fames Bl►Ri �.iaaAle.a .E,�eA �a..1 aR�aellsiela "re awmqxw 10 A94d ard 4% bi@O Pmae t6: a deffits `it SS' Cyr A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION (101) 9.54 5,082 7,296 223,603 260,806 223,603 260,805 60.153 908,664 968,817 SEXUALLY TRANS. DIS. 00 1.61 260 448 30,302 35,343 30,302 35,343 121,522 9,768 131,290 HIV/AIDS PREVENTION (03AD 4.11 138 366 77,074 89,897 77,074 99.897 260,229 73,713 333,942 HIV/AIDS SURVEILLANCE (03A2) 0.03 4 4 483 563 483 562 2,088 3 2,091 HIV/AIDS PATIENT CARE (03A3) 16.99 446 4,527 639,743 746,182 639,743 746,183 2,023,354 748,497 2,771,851 ADAP (03A4) 1.42 142 404 21,852 25,488 21.852 25,488 94,532 148 94,680 TUBERCULOSIS (104) 0.98 21 120 20,541 23,959 20,541 23,960 20,532 68,469 89.001 COMM. DIS. SURV. (106) 1.12 0 1,045 22,034 25,700 22,034 25,700 0 95,468 95,468 HEPATITIS (109) 1.20 l81 304 22,797 26,590 22,797 26,591 72,001 26,774 98,775 PREPAREDNESS AND RESPONSE (116) 3.46 0 2,936 63,337 73,875 63,337 73,874 104,557 169,866 274,423 REFUGEE HEALTH (118) 2.85 594 1,200 88,M8 103,234 88,508 103,234 383,187 297 383,484 VITAL RECORDS (180) 0.89 1,930 5,830 14,849 17,319 14,849 17,319 0 64,336 64,336 COMMUNICABLE DISEASE SUBTOTAL 44.20 8,798 24,480 1,225,123 1,428,956 1,225,123 1,428,956 3,142,155 2,166,003 5,308,158 B. PRIMARY CARE: CHRONIC DISEASE PREVENTION PRO (210) 0.06 0 0 1,085 1,266 1,085 1,267 4,703 0 4,703 WIC (21W1) 5.23 2,168 15,951 92,287 107,641 92,287 107,641 399,856 0 399,856 TOBACCO USE INTERVENTION (212) 1.84 0 164 34,753 40,535 34,753 40,535 150,576 0 150,576 WIC BREASTFEEDING PEER COUNSELING (21W2) 0.02 0 30 6.787 7,916 6,787 7,916 29,406 0 29,406 FAMILY PLANNING (223) 3.88 1,152 2,210 97,346 113,542 97,346 113,542 235,773 186,003 421,776 IMPROVED PREGNANCY OUTCOME (225) 0.00 0 0 0 0 0 0 0 0 0 HEALTHY START PRENATAL (227) . 2.83 525 3,728 48,053 56,049 48,053 56,049 0 208,204 208,204 COMPREHENSIVE CHILD HEALTH (229) 0.00 0 0 4 5 4 5 18 0 18 HEALTHY START CHILD (231) 2.60 488 2,892 41,376 48,261 41,376 48,261 179,274 0 179,274 SCHOOL HEALTH (234) 4.58 0 150,610 72,176 84,185 72,176 84,186 312,723 0 312,723 COMPREHENSIVE ADULT HEALTH (237) 3.95 397 1,326 76,978 89,785 76,978 89,785 199,746 133,780 333,526 COMMUNITY HEALTH DEVELOPMENT (238) 2.50 0 733 53,376 62,256 53,376 62,256 96,264 135,000 231.264 DENTAL HEALTH (240) 0.00 0 0 0 0 0 0 0 0 0 PRIMARY CARE SUBTOTAL 27.49 4,730 177,644 524.221 611,441 524,221 611,443 1,608,339 662,987 2,271,326 C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COSTAL BEACH MONITORING (347) 0.29 283 284 7,786 9,081 7,786 9,080 17,460 16,273 33,733 LIMITED USE PUBLIC WATER SYSTEMS (357) 0.00 0 0 0 0 0 0 0 0 0 PUBLIC WATER SYSTEM (358) 0.00 0 0 76 89 76 89 0 330 330 PRIVATE WATER SYSTEM (359) 0.00 0 0 0 0 0 0 0 0 0 ONSITE SEWAGE TREATMENT & DISPOSAL (361) 5.62 1,596 6,885 94,337 110,033 94,337 110,032 265,599 143,140 408,739 Group Total 5.91 1,879 7.169 102,199 119,203 102,M 119,201 283,059 159,743 442,802 Facility Programs TATTOO FACILITY SERVICES (344) 0.13 0 14 2,608 3,041 2,608 3,041 4.500 6,798 11,298 FOOD HYGIENE (348) 0.65 120 406 11,312 13,195 11,312 13,195 20,248 28,766 49,014 Attachment -II -Part -III - Page 7 of 11 ATTAG P II . . MONROA COETRn MAM. V AXrNW Y Pari Ill, Plmmt fig, G mft $e'A" Md AS PtagrSb.- Awft IlSthe &2=k qt$i il1eA p odeber. 1, 2m1a 9vtombow 3 2017 E dam Flan Flms awoft9ecalimee6 1st 2" Mh qm _ad BODY PIERCING FACILITIES SERVICES (349) 0.01 5 5 191 223 191 223 455 GROUP CARE FACILITY (351) 0.07 29 39 1,236 L.441 1,236 1.441 0 MIGRANT LABOR CAMP (352) 0.00 0 0 0 0 0 0 0 HOUSING & PUB. BLDG. (353) 0.00 0 0 0 0 0 0 0 MOBILE HOME AND PARK (354) 0.55 91 280 9,244 10,782 9,244 10,782 19,674 POOLS/BATHING PLACES (360) 2.76 519 1,205 41,091 47,928 41,091 47,929 61,902 BIOMEDICAL WASTE SERVICES (364) 0.31 187 117 4,992 5,822 4.992 5,822 14,051 TANNING FACILITY SERVICES (369) 0.01 5 6 133 156 133 156 458 Group Total 4.49 956 2,072 70,807 82,588 70.807 82,589 121,288 Groundwater Contamination STORAGE TANK COMPLIANCE SERVICES (355) SUPER ACT SERVICES (356) Group Total Community Hygiene COMMUNITY ENVIR. HEALTH (345) INJURY PREVENTION (346) LEAD MONITORING SERVICES (350) PUBLIC SEWAGE (362) SOLID WASTE DISPOSAL SERVICE (363) SANITARY NUISANCE (365) RABIES SURVEILLANCE (366) ARBORVIRUS SURVEIL. (367) RODENT/ARTHROPOD CONTROL (368) WATER POLLUTION (370) INDOOR AIR (371) RADIOLOGICAL HEALTH (372) TOXIC SUBSTANCES (373) Group Total ENVIRONMENTAL HEALTH SUBTOTAL D. NON -OPERATIONAL COSTS: NON -OPERATIONAL COSTS (599) ENVIRONMENTAL HEALTH SURCHARGE (399) MEDICAID BUYBACK (611) NONOPERATIONAL COSTS SUBTOTAL TOTAL CONTRACT 373 828 5.354 5,354 0 0 0 0 20,378 40,052 116,137 178,039 7,577 21,628 120 578 185.503 306,791 1.42 157 274 28,162 32,848 28,162 32,849 1 122,020 122,021 0.00 0 0 0 0 0 0 0 0 0 1.42 157 274 28,162 32,848 28,162 32,849 1 122,020 122,021 1.03 0 37 20,330 23,713 20,330 23,713 1 88,085 88,086 0.00 0 0 0 0 0 0 0 0 0 0.00 0 0 20 23 20 22 0 85 85 0.00 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0 0 0 0 0 0.17 53 156 2,934 3,422 2,934 3,421 0 12,711 12,711 0.01 2 5 293 342 293 341 0 1,269 1,269 0.00 0 0 0 0 0 0 0 0 0 0.00 0 0 101 118 101 119 0 439 439 0.00 0 0 0 0 0 0 0 0 0 0.00 0 0 85 99 85 99 0 368 368 0.00 0 0 40 47 40 48 0 175 175 0.36 25 25 8,876 10,352 8,876 10,352 0 38,456 38,456 1.57 80 223 32,679 38,116 32,679 38,115 1 141,588 141,589 13.39 3,072 9,738 233,847 272,755 233,847 272,754 404,349 608,854 1,013,203 0.00 0 0 0 0 0 0 0 0 0 0.00 0 0 5,788 6,752 5,788 6,752 25,080 0 25,080 0.00 0 0 0 0 0 0 0 0 0 0.00 0 0 5,788 6,752 5,788 6,752 25,080 0 25.080 85.08 16,600 211.862 1,988,979 2,319,904 1,988,979 2,319.905 5,179,923 3,437,844 8,617,767 Attachment II_PartIII - Page 8 of 11 ATTACHMENT III MONROE COUNTY HEALTH DEPARTMENT CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted during the contract period), if so requested by the department. The applicant assures that it will comply with: 1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits discrimination on the basis of race, color or national origin in programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. 3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the applicant understands that the grantor may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief, to include assistance being terminated and further assistance being denied. Attachment_III - Page 9 of 11 C m E t LL 2 m C a u 3 O m Q. O w C m CO O CV E U c°� w U M M 00 C) U') 00 co — �. CY tr LO m w w N UO C) N cn O N L QQQQ[] O N O N O N O N 9 C 3 - C -2 C C -2 C m E L M O R O m uw' N to LL N E O o O m Ul N o O m N N o O m y N O m y N CLZ 3 �ETm'Ea m �E 0E �E aE O 3EmCo o o Y. Q 3 0 of 0 0 of 0 0 of 0 0 3E 0 0 O 0 0 U UU UU UU UU U J O m o C « 0 0 0 m T 0 m Z+ o C m T o m T o C 0 U `c 0 0 0 0 0 gU m � a 0 gU 0 gU 0 gU 0 gU C C 2 m L m CD= p C U C U am= C C O E 0 C 01 C p U U m m E ae E �+ m cc C) C) U U� V U U m a Q m 0 0 cm 0 Q m 0 0 C7 U U N m caU U _ C L m m m C) cc 0 rn 0 0 rn rn J` 7 0 v 0 v 0 v 0 v 0 aZ C O N c — w E w cu U w O — Q s a 0 c m= o� V= U Ul ccc � (n � U m C7 (1) � Q U InC 0 r (D .O C> w w > L Co Q 2 Q m V O � 0 C L L C O LL o �w � w �� isU w o O � �U LL_ Y `N C N Y C0 a)> > m T co3.O LO ` CD �;a m 0) 0 N C, �. 0) Y L I� O0.—O)oMH L f0 p U J (nM Y p0=M2M� O m OJ NO OccM �M �J MLL ra OM C� NM 0)� 0 CAM 0)L CJ Q. m m > CnM Oi NL. — 0 � E 0 fs O LL a. U v 0> ' O U O JM tin 0)t M CA M 0 O N m M = `o _o d rn m 0_ —I a N co Q 3 a ca O rm cts h O Gl CO r03 73 3 a a co U � a 0' cts U 00 C ns t3 � � a a� a Z a O O ,cOi 0 Q a C c 3 Co CO 4 O 03 h h !r O O a rn Co � O j � Q a U O o � � cs h q)_ ttz � y h o � 0 4 = U o c =0 � a 0 c co C O •C co Qj 03 = O U O 3 m � O o 'ra U `o a� 2 col C)'� cts 0) a °o w Z y h � 0) ca •V ,C � � o co RCn C 00 � m � CONTRACT YEAR 2015-2016* 2016-2017** 2017-2018*** 2018-2019*** PROJECT TOTAL PROJECT NUMBER: PROJECT NAME: LOCATION/ADDRESS: PROJECT TYPE: ATTACHMENT V MONROE COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS STATE COUNTY $ 0 $ 0 $ 0 $ 200000 $ 0 $ 100000 $ 0 $ 0 $ 0 $ 300000 SPECIAL PROJECTS CONSTRUCTION/RENOVATION PLAN TOTAL a $ 200000 $ 100000 $ 0 $ 300000 TBD CLINIC ENHANCEMENTS 2016-2017 Key West FL 33040 NEW BUILDING ROOFING RENOVATION X PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: 0 PROJECT SUMMARY: Describe scope of work in reasonable detail. FDOH Monroe would like to add a dental area in Key West. The project will involve renovation, equipment, plumbing and electrical. The project is anticipated to begin in September of 2016, and to be completed by December 2017. Dental care in Key West specifically is in demand, with only one provider currently accepting Medicaid clients. Adding dental space will increase capacity and give FDOH Monroe the ability to hire a part time dentist to provide services to low income clients. START DATE (Initial expenditure of funds) COMPLETION DATE: DESIGN FEES: CONSTRUCTION COSTS: FURNITURE/EQUIPMENT: TOTAL PROJECT COST: COST PER SQ FOOT: 01 /01 /17 12/31/17 $ 50000 $ 100000 $ 150000 $ 300000 $ 0 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans. * Cash balance as of 9/30/16 '* Cash to be transferred to FCO account. *** Cash anticipated for future contract years. Attachment_V - Page 11 of 11