FY1998 11/12/1997BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
FAX (305) 289-1745
TO:
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CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
FAX (305) 295-3660
M E M O R A N D U M
Stephanie A. Walters, Administrator
County Health Department
Isabel C. DeSantis, Deputy Clerk .(1 C. &.
November 26, 1997
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 852-7146
At the Board of County Commissioners' meeting of November 12,
1997, the Board granted approval and authorized execution of a
Contract between Monroe County and the Florida Department of
Health, Monroe County Health Department, for Health Department
Services provided to the County.
Attached hereto are three duplicate originals of the document
executed by Monroe County for your follow-through with the
department authority at the State of Florida Department of
Health. Please be sure that one fully executed copy is returned
to this office as quickly as possible.
Should you have any questions, please do not hesitate to contact
this office.
cc: County Attorney
County Administrator, w/o document
,Finance
✓File
STANDARD CONTRACT BETWEEN
MONROE COUNTY
BOARD OF COUNTY COMMISSIONERS
%, AND
STATE OF FLORIDA
DEPARTMENT OF HEALTH
RECEIVED
DEC 081997
Pursuant to Chapter 154, Florida Statutes this contract is
entered into between the Department of Health, hereinafter
referred to as the "department", and Monroe County,
hereinafter referred to as the "county". This contract
stipulates the services that will be provided by the
Monroe County Health Department, hereinafter referred to as the
CHD, the sources and amount of funds that will be committed to
the provision of these services, and the admini-it-aviva.6 and
programmatic requirements which will govern the o p�
funds. This contract also defines the
responsibilities of the department and the county iaregabliri tyke
CHD "to promote, protect, maintain, and improve tke h-lt�} mid
safety of the citizens and visitors through pro4t`oa of e
public health, the control and eradication o% p ve abii.e
diseases, and the provision of primary health ca�l
rec fOX slec
populations." �' �'' Cju
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w v
I. General Provision: w
Both parties agree that the.CHD shall:
A. Provide services according to the conditions specified
in Attachment I and all other attachments to this
contract; and
B. Fund the services specified in Attachment II, Part III,
at the funding level specified for each program service
area in that attachment.
II. Federal and State Laws and Regulations:
Both parties agree that the CHD shall:
A. Comply with the provisions contained in the Civil
Rights Certificate, hereby incorporated into this
contract as Attachment III;
B. Comply with the provisions of 45 CFR, Part 74, and
other applicable regulations if this contract contains
federal funds;
C. Comply with all applicable standards, orders, or
regulations issued pursuant to the Clear Air Act as
amended (42 USC 1857 et seq.), and the Federal Water
Pollution Control Act as amended (33 USC 1368 et seq.),
if this contract contains federal funds and the total
contract amount is over $100,000; and
D. Comply with applicable sections of Chapter 427, Florida
Statutes, (Transportation Services) and Chapter 41-2,
Florida Administrative Code, (Coordinated Community
Transportation Services) regarding the provision of
transportation services for the transportation
disadvantaged if this contract contains any state,
federal or local funds which are used to provide for
direct or indirect (ancillary) transportation services.
III. Records, Reports and Audits:
Both parties agree that the CHD shall:
A. Maintain books, records and documents in accordance
with accounting procedures and practices which
sufficiently and properly reflect all expenditures of
funds provided by the department, the county and other
sources under this contract. Books, records and
documents must be adequate to enable the CHD to comply
with the following reporting requirements:
1. The revenue and expenditure requirements in the
State Automated Management Accounting Subsystem
( SAMAS) ;
2. The client registration and services reporting
requirements of the minimum data set as specified
in the Client Information System/Health Management
Component (CIS/HMC) Manual and any revisions
subsequent to the January 1, 1984 version, or the
equivalent as approved by the State Health Office.
Any reporting system used by or on behalf of the
CHD to produce the above information must provide
data in a machine readable format approved by the
department which can be transferred electronically
to the Client Information System;
3. The CHD is responsible for assuring that all
contracts with service providers include
provisions that all subcontracted services be
reported back 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 Manual and any revisions subsequent to
the January 1, 1984 version;
4. Financial procedures specified in the department's
Accounting Procedures Manuals, Accounting
memoranda's, and Comptrollers memoranda's;
2
5. All appropriate CHD employees shall report time
in the Client Information System/Health Management
Component compatible format by program component
for at least the sample periods specified by the
department; and
6. Any other state and county program specific
reporting requirements detailed in attachments to
this contract.
B. Assure these records shall be subject during normal
business hours to inspection, review or audit by state
or county personnel duly authorized by the department
or the county, as well as by federal personnel;
C. Retain all financial records, supporting documents,
statistical records, and any other documents pertinent
to this contract in conformance with the retention
schedules required in HRSM 15-1, "Records Management
Manual", or the subsequent replacement if adopted
during the contract period;
D. Allow persons duly authorized by state or county, and
federal auditors, pursuant to 45 CFR, Part 74.24(a),
(b), and (d) to have full access to, and the right to
examine said records and documents during said
retention period; and
E. Include these aforementioned audit and record -keeping
requirements in all approved subcontracts and
assignments.
IV. Purchasing and Leasing Procedures:
A. The CHD will adhere to the State of Florida purchasing
rules and regulations except when purchasing or leasing
through the county to obtain a better price or service.
When purchases or leases are more cost effective
through the county or by following county procedures a
superior good or service can be acquired, the county
procedures and regulations will be followed in their
entirety. Copies of the State Purchasing Rules and
Regulations shall be maintained at the CHD and if any
purchases or leases are made through the county system,
the county procurement procedures must also be in place
for audit and management purposes. When purchasing or
leasing through the county system, the order and
payment must be documented to note that county
procedures were used because they were more cost
effective.
B. Any lease entered into by a CHD which utilizes county
rather than state procurement procedures must be
U
approved by action of the Board of County
Commissioners. The lease must be voted on as an agenda
item by the Board of County Commissioners prior to
being signed by the delegated county official.
Documentation of this approval, and the fact that all
county procedures were followed must be maintained by
the CHD.
C. Procurements will be authorized by the issuance of a
purchase order or the consummation of a contract prior
to the acquisition of goods or services. Exceptions to
this provision may be made as specified in department
or county procurement directives.
D. Both parties agree that the CHD shall follow general
services operating procedures as specified in the
department's General Services Procedures Manuals,
General Services memoranda's, Department of management
Services' procurement directives, and when operating
under county authority all such county directives.
V. Monitoring:
Both parties agree that, as either determines necessary, the
department and/or the county shall monitor the budget and
services as detailed in Attachment II and operated by the
CHD or its subcontractor or assignee.
VI. Safeguarding Information:
Both parties agree that the CHD shall not use or disclose
any information concerning a recipient of services under
this contract for any purpose not in conformity with the
state law, regulations or manual (HRSM 50-2 Security of Data
and Information Technology, or the subsequent replacement if
adopted during the contract period) and federal regulation
(45 CFR, part 205.50), except by written consent of the
recipient, or his/her responsible parent or guardian when
authorized by law.
VII. Assignments:
Both parties agree that the CHD shall not -assign the
responsibility of this contract to another party without
prior written approval of the department and the county. No
such approval by the department and the county of any
assignment shall be deemed in any event or in any manner to
provide for the occurrence of any obligation of the
department or the county in addition to the dollar amount
agreed upon in this contract. All such assignments shall be
subject to the conditions of this contract and to any
4
conditions of approval that the department and the county
shall deem necessary.
VIII.Subcontracts:
Both parties agree that the CHD shall be permitted to
execute subcontracts with the approval of the delegated
authority in the department for services necessary to enable
the CHD to carry out the programs specified in this
contract, provided that the amount of any such subcontract
shall not be for more than ten (10) percent of the total
value of this contract.
In the event that the CHD.needs to execute a subcontract for
an amount greater than ten (10) percent of the value for
this contract, both parties to this contract must agree in
writing to such a subcontract prior to its execution.
No subcontracts shall be deemed in any manner to provide for
the occurrence of any obligation of the department or the
county in addition to the total dollar amount agreed upon in
this contract. All such subcontracts shall be subject to
the conditions of this contract and to any conditions of
approval that the department and the county shall deem
necessary.
IX. Insurance:
The County agrees to provide adequate fire and casualty
insurance coverage for all furnishings and equipment in CHD
offices and buildings. Buildings used by the CHD that are
owned by the County, and all furnishings and equipment owned
by the County, shall be insured through the County's
insurance program, which shall be either a self-insurance
program or insurance purchased by the County. For any
buildings, furnishings and equipment used by the CHD but not
owned or insured through the County, it is the
responsibility of the CHD to obtain adequate insurance
coverage either through the County, the state, or Department
of Management Services approved private insurance carrier.
X. Payment for Services:
A. The department agrees:
To pay for services identified in Schedule "C" of the
operating budget (General Revenue and Federal), and
reflected in Attachment II, Part II, as the State's
appropriated responsibility in an amount not to exceed
$ 3,237,809 ; and the State share of all state
authorized fees in an anticipated amount of $
266,557 In addition, all "OTHER" state
revenues from whatever sources to be appropriated to
the County Health Department Trust Fund for services to
k
be provided by the county health department in an
amount of $ 865,827 , for a grand total State cash
contribution of
$ 4,370,193 The State's obligation to pay
under this contract is contingent upon an annual
appropriation by the Legislature.
B. The County agrees:
To pay for services identified in Attachment II, Part
II, as the county's responsibility in an appropriated
amount not to exceed.$__ 346,000 In addition,
the county shall provide its share of all county
authorized fees in an anticipated amount of $
225,024 These amounts, plus any
"OTHER" local revenues in the amount of $ 37.000
includes all revenues from whatever sources to
be appropriated to the County Health Department Trust
Fund for services to be provided by the county health
department for a grand total county cash contribution
of $ 608,024
XI. The department and the county mutually agree:
A. Effective date:
1. This contract shall begin on October 1, 1997 or
the date on which the contract has been signed by
both parties, whichever is later.
2. This contract shall end on September 30, 1998.
B. Termination:
1. Termination because of lack of funds:
In the event funds to finance this contract become
unavailable, either party may terminate the
contract upon no less then twenty-four hours
notice in writing to the other party. Said notice
shall be delivered by certified mail, return
receipt requested, or in person with proof of
delivery. The department or the county shall be
the final authority as to the availability of
funds. Staffing and services shall be reduced
appropriately.
2. Termination for breach:
Unless breach is waived by either party in
writing, either party may, by written notice to
the other party, terminate this contract upon no
less that twenty-four (24) hours notice. Said
6
notice shall be delivered by certified mail,
return receipt requested, or in person with proof
of delivery. If applicable, either party may
employ the default provisions in Chapter 13A-1,
Florida Administrative Code. Waiver of breach of
any provision 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
the contract. The provisions herein do not limit
either party right to remedies at law or to
damages.
3. Termination at will:
This contract may be terminated by either party
upon no less than thirty (30) days notice, without
cause. Said notice shall be delivered by
certified mail, return receipt requested, or in
person with proof of delivery.
C. Notice and contact:
The department's contract manager for this contract is
Diana Mellon -Lacey The county
representative for this contract is James Roberts
In the event that different
representatives are designated by either party after
execution of this contract, notice of the name and
address of the new representative will be rendered in
writing to the other party and said notification
attached to originals of this contract.
D. Modification:
Modifications of provisions of this contract shall,
unless otherwise specified in Attachment I, be
enforceable only when they have been reduced to writing
and duly signed by both parties to this contract.
E. Name and address of payee:
The name and address of the official payee to whom the
payment shall be made is: County Health Unit Trust
Fund, Monroe County, Key West
F. All terms and conditions included:
This contract and its attachments as referenced,
(Attachment I through IX), contain all the terms and
conditions agreed upon by the parties.
7
In WITNESS THEREOF, the parties hereto have caused this 52 page
contract to be executed by their undersigned officials as duly
authorized.
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR MO OE COUNTY DEPARTME H TH
SIGNSZ SIGNED BY:
(Depar ment Authority)
�aclG London
Keith Be"elas
TITLE°•� -Mayor
DATE: i�i`6 - ; /a , l 9' 9 1
r '
ATTESTED TO ANNY L. �K(�OLKAGE. Clerk
SIGNED='B-�r-.
NAME:
TITLE:
DATE:
AND L L SUFFICAS TO E C
BY N
NN
DATE 0
NAME:Richard G. Hunter, Ph.D
TITLE:Deputv_State Health
Offic r
DATE:
SIGNED BY:
CHD Director/Administrator
NAME: Stephanie A. Walters
TITLE: Administrator
D• /
ATTACHMENT I
SPECIAL PROVISIONS
I. County Health Department Trust Fund:
Both parties agree:
A. That all funds to be expended by the CHD shall be
deposited in the County Health Department Trust Fund
maintained by the state treasurer.
B. That all funds deposited in the County Health
Department Trust Fund which are subject to this
contract shall be expended by the department solely for
services rendered by the CHD as specified in this
contract. Nothing shall prohibit the rendering of
additional services not specified in this contract.
C. That funds deposited in the County Health Department
Trust Fund for the CHD in Monroe County shall be
accounted for separately from funds deposited for other
CHDs, and shall be used only for public health
department services in Monroe County. If actual
expenditures should exceed the total planned
expenditure amount for either the county or the state
as agreed to in this contract, the CHD will, by
agreement between the department and the county, draw
down from the trust fund balance, if any, to cover the
excess expenditures, or will cut back services to come
within budget.
D. That any surplus/deficit funds, including fees or
accrued interest, remaining in the County Health
Department Trust Fund account at the end of the
contract year shall be credited/debited to the state or
county, as appropriate, based on the funds contributed
by each and the expenditures incurred by each.
Expenditures will be charged to the program accounts by
state and county based on the ratio of planned
expenditures in the core contract, then 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 and shall be 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 projects explained in Attachment
VIII:
1) Funds designated for Special Projects must be
used for capital projects and durable goods without
significant recurring costs. Examples of projects
meeting this criteria include construction and
renovation of current facilities and associated
infrastructure; purchase of information system
hardware/software and purchase of telecommunications
equipment. Examples of items not meeting this criteria
include grant funds for direct services such as tobacco
prevention and provision of child safety seats; staff
salaries; retirement obligations; rent/leases and funds
held in anticipation of Medicaid paybacks and/or budget
reductions. The total amount of funds anticipated to be
expended for special projects during the contract year
must be shown in Part 1 of Attachment II, of this
Contract. This includes funds to complete unfinished
projects from previous years as well as for projects
initiated during the contract year. Expenditure for
Special Projects must be recorded in SAMAS with the
appropriate Level 5 Organizational Code. More detailed
Special Project information, including description and
cost by each project, must be listed in Attachment
VIII.
2) A cash reserve of 12 percent represents
approximately six weeks of operating funds. Ongoing
cash reserves in excess of 12 percent should be
programmed to services.
E. There shall be no transfer of funds between the three
levels of services without a contract amendment duly
signed by both parties to this contract and the proper
budget amendments 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 Health has approved the transfer. The
Deputy Secretary for Health shall forward written
evidence of this approval to the CHD within 30 days
after an emergency transfer.
F. That either party may increase or decrease funds to
this contract by notifying the other party in writing
of the amount and purpose for the increased/decreased
funding, and allowing 30 days for written objection
before the additional funds are released for
expenditure or the state allocation is decreased. A
decrease in funds must be related to a reduction,
shortfall, or sequestering of anticipated
appropriations.
10
G. That the contract shall include as Part III of
Attachment II a section entitled "Planned Staffing,
Clients, Service and Expenditures by Type of Service
within Each Level of Service". This section shall
include the following information for each type of
service area within each level of service:
- the planned number of full-time equivalents
(FTE's) by level of service;
- the planned number of services to be provided;
- the planned number of individuals/departments to
be served; and
- the planned state and county expenditures.
Expenditure information shall be displayed in a
quarterly plan to facilitate monitoring of contract
performance.
H. That adjustments in the planned expenditure of funds
for each type of service within each level of service
are permitted without an amendment to this contract.
I. That the CHD shall submit quarterly reports to the
county and the department which shall include at least
the following sections:
1. A transmittal letter briefly summarizing CHD
activity year-to-date;
2. DE385L1 - "CHD Contract Management Variance
Report;
3. DE58OL1 - "Analysis of Fund Equities"; and
4. A written explanation of the variances reflected
in the DE385L1 report for each quarter of the
contract year if the CHD exceeds the tolerance
levels as specified below as of the end of the
quarterly report period:
a. The cumulative percent variance cannot exceed
by more than 25 percent the planned
expenditures for a particular type of service
or fall below planned expenditures by more
than 25 percent.
b. However, if the cumulative amount of variance
between actual and planned expenditures for
the report period for a program service area
does not exceed one percent of the cumulative
planned expenditures for the level of service
in which the type of service is included, a
variance explanation is not required.
11
5. The CHD Contract Management Variance Report
shall:
a. Explain the reason
expenditures in
which exceeds
established above;
for the variances in
any program service area
the tolerance levels
b. Specify steps that will be taken to comply
with the contract expenditure plan, including
a contract amendment, if necessary; and
C. Provide a timetable for completing the steps
necessary to comply with the plan. Failure
of the CHD to accomplish the planned steps by
the dates established in the written
explanation shall constitute non-performance
under the contract and the county or the
department may withhold funds from the
contract or take other appropriate
administrative action to achieve compliance.
J. The required dates for the CHD director's/
administrator's quarterly report to the county and the
department shall be as follows:
1. March 1, 1998 for the report period October 1,
1997 through December 31, 1997;
2. June 1, 1998 for the report period October 1,
1997 through March 31, 1998;
3. September 1, 1998 for the report period October
1, 1997 through June 30, 1998; and
4. December 1, 1998 for the report period October 1,
1997 through September 30, 1998.
II. Fees:
A. Environmental regulatory fees:
The department shall establish by administrative rule,
fees for environmental regulatory functions designated
in Attachment IV of this contract and conducted by the
CHD. Such fees shall supersede any environmental
regulatory fees existing prior to the effective date of
the department's rule. The county may, however,
establish fees pursuant to section 381.0016, Florida
Statutes, which are not inconsistent with department
rules and to state or federal law, after consultation
with the department.
12
B. Communicable disease service fees:
The department may establish by administrative rule,
fees for communicable disease services, other than
environmental regulatory services, designated in this
contract and conducted by the CHD. The county may
establish fees pursuant to section 381.0016, Florida
Statutes, which are not inconsistent with department
rules and other state or federal law. All state or
federally authorized communicable disease services fees
shall be listed in Attachment IV of this contract. All
county authorized communicable disease services fees
shall be listed in Attachment V of this contract.
C. Primary Care Fees:
The county may establish fees for primary care services
designated in this contract and conducted by the CHD
except for those services for which fee schedules are
specified in federal or state law or regulations.
Both parties further agree:
1. That such fees shall be established by resolution
of the Board of County Commissioners, if
promulgated by the county, or by administrative
rule, if promulgated by the department;
2. That there shall be no duplication of fees by the
department and the county for communicable disease
or primary care services provided by the CHD;
3. That primary care fees shall be listed in
Attachment V (county) of this contract.
D. Communicable disease and primary care fees shall
automatically be established by the department and the
county at the Medicaid rate upon signature of this
contract unless otherwise specified by either party
according to procedures set forth in II, B and C of
this section.
E. Collection and use of fees:
Both parties agree that:
1. Proceeds from all fees collected by or on behalf
of the CHD, whether for environmental,
communicable disease, or primary care services,
shall only be used to fund services provided by
the CHD;
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2. All fees collected by or on behalf of the CHD
shall be deposited with the State Treasury and
credited to the County Health Department Trust
Fund or other appropriate state account if
required by Florida Statute or the State
Comptroller.
III. Service Policies and Standards:
Both parties agree that the CHD shall adhere to the service
policies and standards published by the department in
program manuals and other guidelines provided by the
department, where they exist, as a guide for providing each
funded service specified in Attachment II, Part III of this
contract.
IV. Fair Hearing Guidelines:
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 IX of this contract.
The CHD shall post in a readily accessible location and
visible to all clients either procedures or a poster
informing clients how they may contact the Human Rights
Advocacy Committee (HRAC).
V. Personnel:
Both parties agree:
A. The CHD shall have at least the following employees:
1. A director or administrator appointed by the
Secretary of the department after consultation
with the Deputy Secretary for Health or Deputy
State Health Officer and with the concurrence of
the Board of County Commissioners;
2. A full-time community health nurse;
3. An environmental health specialist; and
4. A clerk.
14
B. That all department employees working in the CHD shall
be supervised by the department and subject to
Department of Management Services rules and department
rules.
C. Staffing levels shall be established in this contract
in Attachment II, Part III as FTE's, and may be changed
in accordance with the availability of funds and/or
program needs.
D. The number and classification of employees working in
the CHD that are county employees rather than
department employees shall be listed in Attachment VI
of this contract.
VI. Facilities:
Both parties agree that:
A. CHD facilities shall be provided as specified in
Attachment VII of this contract. This attachment shall
include a description of all the facilities used by the
CHD, including the location of the facility and by whom
the facility is owned;
B. The county shall own the facilities used by the CHD
unless otherwise provided in Attachment VII of this
contract; and
C. Facilities and equipment provided by either party for
the CHD shall be used for public health services
provided that the county shall have the right to use
such facilities and equipment, owned or leased by the
county, as the need arises, to the extent that such use
would not impose an unwarranted interference with the
operation of the CHD.
VII. Use of Funds for Lobbying Prohibited:
The CHD agrees to comply with the provisions of section
216.347, Florida Statutes, which prohibits the expenditure
of contract funds for the purpose of lobbying the
Legislature or a state agency.
VIII. Method of payment:
A. The county shall deposit its annual contribution to the
County Health Department Trust Fund as specified below.
B. The department shall release state contributions to
this contract as follows:
15
1. Funds appropriated as "Aid to Local Government"
shall be released in four quarterly amounts, at
the beginning of each quarter of the contract
year;
2. WIC and other state funds appropriated in a cost
reimbursement category (e.g. expense and special)
shall be released on the basis of invoices
documenting expenditures.
IX. Laboratory and Pharmacy Support:
The department agrees to supply laboratory and pharmacy
support services for the CHD at least at the level provided
in the prior state fiscal year if funds are available.
X. Emergencies:
Both parties agree, to the extent of their respective
resources, that they may assist each other in meeting public
health emergencies.
XI. Sponsorship:
In compliance with section 286.25, Florida Statutes, the CHD
assures that all notices, informational pamphlets, press
releases, advertisements, descriptions of the sponsorship of
the program, research reports, and similar public notices
prepared and released by the CHD shall include the
statement:
Sponsored by Monroe County Health Department
and the "State of Florida, Department of Health." If the
sponsorship reference is in written material, the words,
"State of Florida, Department of Health" shall appear in the
same size letters or type as the name of the organization.
XII. Indicate in the space below the income eligibility limit for
comprehensive primary care clients.
100 t of OMB Poverty Guidelines.
XIII.Program Specific Reporting Requirements:
Specific information not available through CIS/HMC or SAMAS
must be supplied by completing the following:
A. Specify in the space below the minimum number of
clients who will receive comprehensive primary care
services (clients registered in Program Component 88
who will receive services during this contract period).
16
B. Specify in the space below the amount of any county
funds earmarked by the Board of County Commissioners
for hospitalization in the Improved Pregnancy Outcome
program if such funds are deposited in the County
Health Department Trust Fund and included in the IPO
line on Attachment II, Part III, of this contract.
$ 0
C. Complete the planned Family Planning budget information
on the following page for this contract period.
XIV. County Fees:
Those individual fees established by the county per
ordinance or resolution and listed in Attachment V shall
automatically be adjusted to, at least, the Medicaid
reimbursement rate without formal amendment to this contract
in accordance with section 154.06, Florida Statutes, should
said reimbursement rate be increased or decreased. See Page
13, Section D.
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ATTACHMENT III
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, HRS
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 connection with any
of its programs and activities are not discriminating
against those participants or employees in violation of
the above statutes, regulations, guidelines, and
standards. In the event of failure to comply, the
applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance
with the terms of this assurance or seek other
appropriate judicial or administrative relief, to
include assistance being terminated and further
assistance being denied.
ATTACHMENT IV
STATE FEE SCHEDULES, BY SERVICE
LEVEL OF SERVICE/SERVICE:
I. COMMUNICABLE DISEASE:
AIDS, HIV, Alternate Site Testing
PRIMARY CARE:
Fee
$20 (optional)
Estimated
Annual Revenue
Accruing To The
CHD Trust Fund
Subtotal $ 1000.00
Subtotal $ 2500.00
p-
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ATTACHMENT V
COUNTY FEE SCHEDULES, BY SERVICE
LEVEL OF SERVICE/SERVICE: Fee/Range
I. COMMUNICABLE DISEASE:
Immunizations Varied
STD Medicaid
HIV Testing 0
Tuberculosis Varied
Vital Statistics Varied
II. PRIMARY CARE:
Chronic Disease Varied
Family Planning Medicaid
Comprehensive Adult Health Medicaid
Comprehensive Child Medicaid
III. ENVIRONMENTAL HEALTH:
Estimated
Annual Revenue
Accruing To The
CHD Trust Fund
15,000
2,000
0
2,000
700
Subtotal $ 19.700
10,000
5,000
20,000
50,000
Subtotal S 85_,000
Group Care Facilities Varied
DEP Storage Tank Program Varied
Small Quantities Hazardous Waste Varied _
OSTDS Operating Permit Revenue 160.00
12,000
102,077
65,000
25,000
Subtotal $204,077
Total County Fees $308.777
�'1RlICn nN? !'I
CLASSIFICATI011 AUD Y=zR OT EI�LOYl�WOMEM IN "a
COUNTY MMLIC RULTR UNIT VRO MM PUD W MM
COMM,, HY LZV= OF SERVICE, It UWaCAM
�,ei ;: p z4:
Tuberculosis
Sexually Transmitted Disease
HIV
PRIMARY CARE
Basic Care Middle & Upper Keys
Nutritionist
EPSDT
High Risk Adults & Children
Various
*Senior Community Health Nurse
*Direct Services Aide
0.5
0.5
Advanced Registered Nurse Practitioner 1.0
*Nutritionist 0.5
*Advanced Registered Nurse Practitioner 0.5
Senior Community Health Nurse 1.0
Environmental Health Specialist
*'Secretary Specialist
*Indicates partially funded position
1.0
0.5
ATTACHMENT VII
FACILITIES USED BY THE CHD
Facility DescriQn T'cc-ation
Monroe County Health Department 5100 College Road
Key West, Florida
Monroe County Health Department
Monroe County Health Department
Health Care Center
148 Georgia Avenue
Tavernier, Florida
3333 Overseas Highway
Marathon, Florida
1200 Kennedy Drive
Key West, Florida
Monroe County
Monroe County
Monroe County
The Lower
Florida Keys
Health Systems,
Inc.
Roosevelt Sands Community Health Douglas Square City of Key
Resource Center 105 Olivia Street West
Key West, Florida
ATTACHMENT VIII
DESCRIPTION OF USE OF CHD TRUST FUND BALANCES
FOR SPECIAL PROJECTS, IF APPLICABLE
(From Attachment II, Part I)
None
ATTACHMENT IX
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 CIS/HMC minimum data set and the SAMAS 2.2
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 Reauirement
1. Sexually Transmitted Disease Requirements as specified
Program in HRSM 150-22*. Requirements
as specified in Policy 87-7-5
regarding State Health Office
STD Program review and approval
of personnel/budget actions.
2. Dental Health Monthly reporting on HRSH
Form 1008*.
Special Supplemental Food
Program for Women, Infants
and Children.
4. Improved Pregnancy Outcome
5. Family Planning
Service documentation and
monthly financial reports
as specified in HRSM 150-24*
and all federal, state and county
requirements detailed in the
program manuals and published
procedures.
Requirements as specified in
HRSM 150-13A*. Quarterly reports
of services and outcome on HRSH
Form 3096*. Program Quarterly
Progress Report, Quarterly Summary
Report, Presumptive Eligibility/
Medicaid Determination Log by all
providers authorized to determine
presumptive eligibility.
Periodic financial and programmatic
reports as specified in HRSM
150.27*.
t 1.
NO
7.
M
a
ATTACHMENT IX (Continued)
Immunization
CHD Program
Chronic Disease Program
Environmental Health
10. AIDS Program
Periodic reports as specified by
the department regarding the
surveillance/investigation of
reportable vaccine preventable
diseases, vaccine usage
accountability, the assessment of
various immunization levels and
forms reporting adverse events
following immunization.
Requirements as specified in HRSM
150-3* and HRSM 50-9*.
Requirements as specified in the
Reference Guide to CHIP and HRS*
forms identified in HRSM 150-8* and
150-12*.
Requirements as specified in HRSM
50-10*.
Requirements in HRSM 150-30* and
case reporting on CDC Form 50.42.
Socio-demographic data on persons
tested for HIV in CHD clinics
should be reported on CDC HIV
Counseling & Testing Report Form.
These reports are to be sent to the
Headquarters AIDS office within 30
days of the initial post-test
appointment regardless of clients'
return.
11. School Health Services HRSM 150-25*, including the
requirement for an annual plan
as a condition for funding.
*or the subsequent replacement if adopted during the contract period.