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FY1997 12/18/199630annp 1C. Iftotjagc BRANCH OFFICE CLERK OF THE CIRCUIT COURT 3117 OVERSEAS HIGHWAY MONROE COUNTY MARATHON, FLORIDA 33050 500 WHITEHEAD STREET TEL (305) 289-6027 KEY WEST, FLORIDA 33040 FAX (305) 289-1745 TEL. (305) 292-3550 FAX (305) 295-3660 MEMORANDUM TO: Stephanie Walters M.C.P.H.UAdministrator FROM: Ruth Ann Jantzen, Deputy Clerk • DATE: January 22, 1997 BRANCH OFFICE 88820 OVERSEAS HIGHWAY PLANTATION KEY, FLORIDA 33070 TEL (305) 852-7145 FAX (305) 852-7146 At the December 18, 1996 County Commission Meeting, the Board granted approval and authorized execution of a Contract between Monroe County and the Florida Department of Health and Rehabilitative Services (Department of Health, effective 1/1/97), for the operation of the Public Health Unit. Enclosed please find two duplicate originals of the above Contract, executed on behalf of Monroe County. Please be sure that one fully executed copy is returned to this office as soon as possible. If you have any questi6us regarding the above, please do not hesitate to contact this office. Enclosure cc: County Attorney Finance County Administrator, w/o document File i. STANDARD CONTRACT BETWEEN MONROE COUNTY BOARD OF COUNTY COMMISSIONERS : we STATE of FLORIDA DEPARTMENT OF HEALTH Pursuant to Chapter 154, Florida Statutes this contract is entered into between the Department of Health and Rehabilitative Services, 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 county public health unit, hereinafter referred to as the CPHU, the sources and amount of funds that will be committed to the provision of these services, the administrative and programmatic` requirements which will govern the use of these funds, and the respective responsibilities of the department and the county in enabling the CPHU "to promote, protect, maintain, and improve the health and safety of the citizens and visitors through promotion of the public health, the control and eradication of preventable diseases, and the provision of primary health care for special populations." "Department", the State of Florida, Department of Health and Rehabilitative Services, or its successor in interest and is specifically intended to include the officers, agents, and employees of the Department. It is expressly understood by the parties that governmental reorganization occurs within the State of Florida and that named entity which is responsible for the operation of the County Public Health Units would change upon the formation of the new Department of Health during the duration of this contract. Upon the formation of the new Department of Health, the name "County Public Health Units" shall be changed to "County Health Departments" as amended in Section 154.02, F.S. The word, "Department", as used herein, is intended to subtend - and include the entity which is reponsible for the County Public Health Units in the State of Florida, regardless of name. I General Provision: Both parties agree that the CPHU 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 State Laws and Regulations: Both parties agree that the CPHU 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 CPHU 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 CPHU to comply with the following reporting requirements: 1. The revenue and expenditure requirements in the State Automated Management Accounting Subsystem; 2. The client registration and services 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, or the equivalent as approved by the State Health Office. Any reporting system used by or on behalf of the CPHU 2 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 CPHU is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported back to the CPHU 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; 5. All appropriate CPHU 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"; 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 Procedures: f � " All county public health units will adhere to the State of Florida purchasing rules and regulations except when purchasing through the county to obtain a better price or service. When purchases are more cost effective through the county, the county procedures and regulations will be followed. Copies of the State Purchasing Rules and Regulations shall be maintained at the CPHU and if any purchases are made through the county system, the County Procurement procedures must also be in place for audit and management purposes. When purchasing through the County system, the order and payment must be documented to note the county procedures were used because they were more cost effective. 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 CPHU or its subcontractor or assignee. VI. Safeguarding Information: Both parties agree that the CPHU 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) 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 CPHU 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 conditions of approval that the department and the county shall deem necessary. VIII.Subcontracts: Both parties agree that the CPHU shall be permitted to execute subcontracts with the approval of the delegated authority in the department for services necessary to enable the CPHU to carry out the programs specified in this 4 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 CPHU 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 property insurance coverage for all furnishings and equipment in health unit offices and buildings. Buildings used by the health unit that are owned by the County, and all furnishings and equipment owned by the County, including vehicles, shall be insured through the County's insurance program, which shall be either a self-insurance program or insurance purchased by the County. The health unit shall pay for the annual cost of this insurance, upon receipt of an invoice from the County's Risk Management Director. For any buildings, furnishings and equipment used by the health unit but not owned by the County, it is the responsibility of the health unit to obtain adequate insurance coverage either through the state, or private insurance. 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 $ 2,583,949; and the State share of all state authorized fees in an anticipated amount of $0. In addition, all "OTHER" state revenues from whatever sources to be appropriated to the HRS County Public Health Unit Trust Fund for services to be provided by the county health unit in an amount of $ 1,698,206, for a grand total State cash contribution of $ 4,282,155. The State's obligation to pay under this contract is contingent upon an annual appropriation by the legislature. 5 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 $ 281,000. In addition, the county shall provide its share of all county authorized fees in an anticipated amount of $ 144,600. These amounts, plus any "OTHER" local revenues in the amount of $ 42,000, includes all revenues from whatever sources to be appropriated to the HRS County Public Health Unit Trust Fund for services to be provided by the county health unit for a grand total county cash contribution of $_ 467,600 XI. The department and the county mutually agree: A. Effective date: 1. This contract shall begin on October 1, 1996 or the date on which the contract has been signed by both parties, whichever is later. 2. This contract shall end on September 30, 1997. 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 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 0 C. 10 E. F. 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's 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. Notice and contact: The contract manager for the department for this contract is Stephanie A. Walters. CHD Administrator. The representative of the county for this contract is James Roberts. Monroe County Administrator. 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. 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. Name and address of payee: The name and address of the official payee to whom the payment shall be made is: Public Health Unit Trust Fund, Monroe County, Florida. 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 58 page contract to be executed by their undersigned officials as duly authorized. NAME: "J TITLE: tACIA In% — STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES SIGNED BY: 4 1 (D rtmen{{��t Authority) NAME: �C �tl.�rt�- (9 " N", , TITLE • -7) t c DATE: ( 1,111q4 ATTE$ ED TO: t ATTEST DANNY L KOLHAOE CU3K BY SIGNED BY RK NAME: TITLE: DATE: CPHU Director/Administrator NAME: �S i TITLE: �"tfc' DATE : �y A 7 APPROVED AS TO FORM Amn 08FFICIEN NOiinH dppi O Wb03 01 S`d a3n0 d`d ATTACHMENT I SPECIAL PROVISIONS I. County Public Health Unit Trust Fund: Both parties agree: A. That all funds to be expended by the CPHU shall be deposited in the County Public Health Unit Trust Fund (CPHUTF) maintained by the state treasurer. B. That all funds deposited in the County Public Health Unit Trust Fund shall be expended by the department solely for services rendered by the CPHU 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 Public Health Unit Trust Fund for the CPHU in Monroe County shall be accounted for separately from funds deposited for other CPHUs, and shall be used only for public, health unit 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 HRS county public health unit 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 CPHUTF 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 E contract, with special projects explained in Attachment VIII: 1) Funds designated for Special Projects must go for capital projects and durable goods without significant recurring costs. Examples of projects meeting this criteria include construction and renovation of 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. Special project amounts in 113" above should reflect the total amount of funds anticipated to be expended for special projects during the contract year. This includes funds to complete unfinished projects from previous years as well as for projects initiated during the contract year. More detailed Special Project information, including description and cost by each project, should 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 transfers 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 CPHU 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 CPHU 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/units 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 CPHU shall submit quarterly reports to the county and the department which shall include at least the following sections: 1. A transmittal letter briefly summarizing CPHU activity year-to-date; 2. DE385L1 - "CPHU Contract Management Variance Report; 3. DE58OLl - "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 CPHU 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. 5. The CPHU Contract Management Variance Report shall: a. Explain the reason for the variances in expenditures in any program service area which exceeds the tolerance levels established above; b. Specify steps that will be taken to comply with the contract expenditure plan, including a contract amendment, if necessary; and C. Provide a time table for completing the steps necessary to comply with the plan. Failure of the CPHU 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 CPHU director's/ administrator's quarterly report to the county and the department shall be as follows: 1. March 1, 1997 for the report period October 1, 19.E through December 31, 199E; 2. June 1, 1997 for the report period October 1, 1996 through March 31, 1997; 3. September 1, 19977 for the report period October 1, 1996 through June 30, 19-97; and 4. December 1, 1997 for the report period October 1, 1996 through September 30, 1997. 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 CPHU. Such fees shall supersede any environmental regulatory fees existing prior to the effective date of 12 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 the statutes, after consultation with the department. 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 CPHU. The county may establish fees pursuant to section 381.0016, Florida Statutes, which are not inconsistent with department rules and other statutes. 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 CPHU 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 CPHU; 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: 13 1. Proceeds from all fees collected by or on behalf of the CPHU, whether for environmental, communicable disease, or primary care services, shall only be used to fund services provided by the CPHU; 2. All fees collected by or on behalf of the CPHU shall be deposited with the State Treasury and credited to the County Public Health Unit 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 CPHU 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 provider shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The contractor 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 provider 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 CPHU shall have at least the following employees: l.. A director or administrator appointed by the Secretary of the department after consultation with the Deputy Secretary for Health and_ with the concurrence of the Board of County Commissioners; 14 2. A full-time community health nurse; 3. An environmental health specialist; and 4. A clerk. B. That all department employees working in the CPHU shall be supervised by the department and subject to Department of Management Services 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 CPHU that are county employees rather than department employees shall be listed in Attachment VI of this contract. VI. Facilities: Both parties agree that: A. CPHU 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 CPHU, including the location of the facility and by whom the facility is owned; B. The county shall own the facilities used by the CPHU unless otherwise provided in Attachment VII of this contract; and C. Facilities and equipment provided by either party for the CPHU 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 CPHU. VII. Use of Funds for Lobbying Prohibited: The CPHU 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. 15 VIII.Method of payment: A. The county shall deposit its annual contribution to the County Public Health Unit Trust Fund as specified below. B. The department shall release state contributions to this contract as follows: 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 CPHU 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, provider 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 provider shall include the statement: Sponsored by Monroe County Health Department Provider 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. 16 XII. Indicate in the space below the income eligibility limit for comprehensive primary care clients. 00 61. . •u: - .- �- 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). 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 CPHU Trust Fund and included in the IPO line on Attachment II, Part III, of this contract. W"I 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 F.S. 154.06 should said reimbursement, rate be increased or decreased. See Page 12, Section D. 17 ro ca O O O '- N O O N O O io 04 N O O O O ' -It Nt F- O OO O O O m O O C,5 ) a.. O LO O LO a0i � LO LL C7 W n } r cO ca cV N O O O F- CA 00 O cli m N N F U Z O rn U 0 m �70 coa O a> > 1? 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The provider agrees to complete the Civil Rights Compliance Questionnaire, HRS Forms 946 A and B, 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 receivinq or benefittinq 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 benefitting for 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 benefittinq from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 at seq., which prohibits discrimination on the basis Qf age in programs or activities receiving or benefitting for 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 benefitting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. 35 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, transfer*", and assignees for the period durijW. which ''i�uc�;_ assistance is provided. The applicant further assures that all contracts, subcontractors, subgrantees or others with whoa it arranges to provide services or benefits to participants or mWloyoes in connection with any of its programs and activLt1" 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. W ATTACHMENT IV STATE FEE SCHEDULES, BY SERVICE LEVEL OF SERVICE/SERVICE• AIDS, HIV, Alternate Site Testing 37 F-= $20 (optional) Estimated Annual Revenue Accruing To The CPHU Trust Fund Subtotal $ 0 Subtotal $_0 Summary of Environmental Health Surcharges/Transfers July 1, 1996 All surcharges/transfers are deposited to the Statewide Health Programs, Administrative Trust Fund, GF = 10, SF = 2, FID = 021042, BE = 600500200, IBI = 00, OCA = appropriate for fee, Object Code = appropriate for fee, State Program = 0402000004, SI = RV, unless otherwise noted. Title $ Amount OSTDS Permit (Standard subsurface, fill or mound system OSTDS Repair Permit OSTDS Variance Fee (50%) Single .Family Inspection System Previously In Use New System Installation Inspection Research Fee Collected Until 6/30/2002 OSTDS Permit (Standard, subsurface, fill or mound) Septic Tank Manufacturer's Inspection Mobile Home/RV Parks Food Hygiene Permit Tanning Facilities Public Water Construction Permit Private Water Construction Permit Public Water Annual Public Swimming Pools and Bathing Places Lab Fee Chemical Analysis 5.00 5.00 75.00 100.00 5.00 5.00 5.00 10% 1ok 10% 100.00 Headqtrs Revenue Object Code 001203 001203 001204 001204 001203 001203 001201 001203 001113 001132 001144 001164 001165 001166 001205 001170 Headqtrs OCA lE000 lE000 BY000 BY000 lE000 lE000 B9000 lE000 UQ000 10000 R9000 M5000 M5000 M5000 K3000 (1) J5A00 (2) (1) Deposited to Statewide Health Programs, Planning and Evaluation Trust Fund. GF = 20, SF = 2, FID = 531003, BE = 60500200, IBI = 00, OCA = K3000, Object Code = 001205, State Program = 0402000004, SI = RV (2) Deposited to Statewide Health Programs, Planning and Evaluation Trust Fund. GF = 20, SF = 2, FID = 531003, BE = 60500200, IBI = 00, OCA = J5A00, Object Code = 001170, State Program = 0402030001, SI = RV 38 ATTACHMENT IV STATE FEE SCHEDULES, BY SERVICE III. ENVIRONMENTAL HEALTH: Revenue Object A. ONSITE SEWAGE DISPOSAL (OSTDS) PROGRAM Fee Code The following fees are required to accompany application for site evaluations, construction or repair permits, and other services provided by the department. Application for permitting of an onsite sewage treatment and disposal system which includes application and plan review, except repairs ..................................$ Site evaluation for a new system 25 60 .................$ Site evaluation for a system repair ..............$ 40 Site re-evaluation, new or repair ................$ 40 Permit for new systems, including standard subsurface, filled or mounded system ............ $ 55 New system installation inspection ...............$ 55 Research fee to be collected in addition, and concurrent with the permit for a new system installation fee until 6/30/2002................$ 5 Repair permit issuance which includes inspection.$ 50 Inspection of system previously in use ........... $ 50 Reinspection fee per visit for site inspections after system construction approval ...............$ 25 Installation reinspection of non -compliant system per each site visit ......................$ 25 System abandonment permit, includes permit issuance and inspection ........................$ 40 Annual operating permit fee for systems in industrial, manufacturing, and equivalent areas, and for systems receiving commercial sewage waste ....................... ............. $150 Amendments or changes to the operating permit during the permit period per change or amendment ....................................$ 25 Aerobic treatment unit operating permit perannum....................................... $150 Tank manufacturer's inspection per annum......... $100 Septage disposal service permit per annum........ $ 50 Additional charge per pumpout vehicle ............ $ 25 Portable or temporary toilet service permit perannum.......................................$ 50 Additional charge per pumpout vehicle ............ $ 25 Septage stabilization facility inspection fee per annum per facility ......................$150 Septage disposal site evaluation fee per annum... $100 Aerobic treatment unit maintenance entity .permit per annum................................$ 25 39 001092 001138 001138 001138 (1) 001134 (1) 001092 (2) 001201 (1) 001133 (1) 001`�92 001092 001092 001092 001136 001092 001137 (4) 001092 001092 001C92 001092 001092 001092 001092 001092 variance appiication for a single family residence per each lot or building site ......... $150 (3) 001135 variance application for a multi -family or commercial building per each building site ...... $200 (3) 001135 (1) Includes a $5 surcharge collected by the CPHUs pursuant to construction permit issuance to be transferred to HSES to provide technical, monitoring, training and administrative assistance for this program using revenue object code 001203. (2) $5 research fee to be transferred to HSES using revenue object code 001201. (3) 50k of the variance application fee is placed in the applicable CPHU trust fund; 50% of fee placed in a specific HSES variance account using revenue object code 001204. (4) 50t of the septic tank manufacturer inspection fee to be transferred to HSES to provide engineer review of septic tank designs and onsite inspections using revenue object code 001203. The following fees are required to accompany applications for innovative producC approval, registration of individuals or for a certificate of authorization for partnerships and corporations. These fees are deposited by the Onsite Sewage Program Office (HSES). Application for innovative product approval $500 Application for registration including initial examination ..............................$ 75 Initial registration ..............................$ 75 Renewal of registration ...........................$ 75 Renewal of inactive registration ..................$100 Certificate of authorization each two-year period..................................$120 Renewal of inactive certificate of authorization ................................... $150 40 -Reven�ie, B. PUBLIC SWIMMING POOLS AND BATHING PLACES Fee Object Code Annual Permits: Up to (and including) 25,000 gallons .......... $ 75 (1) 001145 More than 25,000 gallons ......................$160 (1) 001145 Exempted Condo Pools (over 32 units) .......... $ 50 (1) 001145 Other Fees: Plan Review (New Construction)................$275 (2) 001092 Plan review for modification of original construction ......................$100 (2) 001092 Plan/Application review fee for bathing place development ..................$150 Initial operating permit (2) 001092 ......................$125 Variance Applications .........................$240 (2) 001092 (3) 001145 (1) Ten percent (10%) of the permit fee is transferred to HSEH to provide training, monitoring, epidemiological support, program evaluations and technical assistance. Permit fees are prorated on a biannual basis. The 10% must be coded to the Planning and Evaluation Trust Fund in the following manner: GF = 20, SF = 2, FID = 531003, BE = 60500200, IBI = 00, OCA = K3000, Object Code = 001205, State Program = 0402000004, SI = RV (2) Fee collected by HSEH, the 12 delegated counties and District I. (3) Fee collected by HSEH and the CPHUs then transferred to HSEH. Revenue Object C. MOBILE HOME & RECREATIONAL VEHICLE PARKS Fee Code Annual Permits: 5 - 14 Spaces..................................$50 (1) 001113 15 - 171 Spaces .......................$3.50/space (1) 001113 172 and above................................$600 (1) 001113 (1) Ten percent (10%) of the permit fee is transferred to HSEH to provide training, monitoring, epidemiological support, program evaluations and technical assistance. Permit fees are prorated on a quarterly basis. The 10% must be coded to the Administrative Trust Fund in the following manner: GF = 10, SF = 2, FID = 021042, BE = 60500200, IBI = 00, OCA = UQ000, Object Code = 001113, State Program = 0402000004, SI = RV 41 D. MIGRANT LABOR CAMPS Fee Revenue Object Code Annual Permits: Facilities with 5-50 occupants................$125 Facilities with 51-100 occupants..............$225 Facilities with over 100 residents ............ $500 No fees are transferred to headquarters and the permits are not prorated. E. BIOMEDICAL WASTE GENERATORS Annual Permits: (Except Physician Office Generating less than 25 lbs./30 days)......... .........:......$ 55 Storage Facilities Permit .....................$ 20 Treatment Facilities Operating Permit ......... $200 Other Fees: 001139 001139 001139 001140 001140 001140 Reinspection (after the first reinspection) ... $ 25 001092 Late renewal ..................................$ 25 001092 Mobile treatment machine registration ......... $ 25 001092 No fees are transferred to headquarters and the permits are not prorated. Revenue Objec: F. DRINKING WATER Fee Code Annual Permits: Public Water Annual Operation Permit- Limited Use (Annual Operation Permit First Year)..........$ 75 (1) 001166 Public Water Annual Operation Permit -Limited Use (Annual Operation Permit Second Year and Beyond) .................................$ 70 (1) 001166 Other Fees: Public Water Construction Permit -Limited Use..$ 75 (1) 001164 Non-SDWA Lab Sample (Sample Collection/Review of Analytical Results/Health Risk Interpretation): Delineated Area .........................$ 50 001142 Bacterial Sample Collection ............. $ 40 001142 Chemical Sample Collection ..............$ 60 001142 ......Combined Chemical/Microbiological ....... $ 65 001142 Private Water Construction Permit (serving 3 or 4 non -rental residences) ..... $ 40 (1) 001165 Reinspection of Private Water System .......... $ 25 001092 Reinspection of Public Water System ........... $ 40 001092 42 Delineated Area Clearance Fee .................$ 50 001092'- Lab Fee Chemical Analysis .....................$100 (2) 001170 Lab Fee Bacterial Analysis ....................$ 10 (2) 001170 For Approved CPHUs: Safe Drinking Water Fee 001211 CPHU retains 80a of the cost and transfers 20a to DEP (DEP will bill the CPHU annually) Fines and Forfeitures 012020 Planning and Evaluation Trust Fund: Potable Water Analysis Fee. ................$10 (3) 00_197 Non -potable Water Analysis Fee................$20 (3) 001197 (1) Ten percent (10%) of the permit fee is transferred to HSEH to provide training, monitoring, epidemiological support, program evaluations and technical assistance. Permit fees are not prorated. The 10% must be coded to the Administrative Trust Fund in the following manner: GF = 10, SF = 2, FID = 0210421 BE = 60500200, IBI = 00, OCA = UQ000, Object Code = 001113, State Program = 0402000004, SI = RV (2) Fees collected by the CPHUs on behalf of the state lab for chemical a-� bacterial analysis of water samples shall be deposited to Statewide Health Programs, Planning and Evaluation Trust Fund: (3) G. GF = 20, SF = 2, FID = 531003, BE = 60500200, IBI = 00, OCA = J5A00, Object Code = 001170, State Program = 0402030001, SI = RV These fees are deposited to the Planning and Evaluation Trust Fund, Statewide Health Programs, using the following SAMAS account codes: GF = 20, SF = 2, FID = 531003, BE = 60500200, IBI = 00, OCA = J5A00, State Program=-0402000004, SI = RV FOOD ESTABLISHMENTS Annual Permits: Fee Fraternal/Civic.......................... .$160 School Cafeteria a. Operating for 9 months or less .......... $130 b. Operating for more than 9 months ........ $160 Hospital/Nursing Food Service.................$210 Movie Theaters ........................... .$160 Jails/Prisons. ... .$210 Bars/Lounges (Drink Service Only).............$160 Residential Facilities. .$110 Child Care Centers ............................$ 85 Limited Food Service ........................ .$ 85 Other Food Service............................$160 43 Revenue Object Code (1) 001132 001132 001132 001132 001132 001132 001132 001132 001132 001132 001132 0 ATTACHMENT V COUNTY FEE SCHEDULES, BY SERVICE Estimated Annual Revenue Accruing To The LEVEL OF SERVICE/SERVICE: Fee/Rance CPHU Trust Fund I. COMMUNICABLE DISEASE: Immunizations Varied $30,000 STD Medicaid $12,000 HIV Testing Medicaid $ 2,000 Tuberculosis Varied $10,000 Vital Statistics Varied $65,000 II. Subtotal $119,000 Chronic Disease Varied $ 35,000 Family Planning Medicaid $ 50,000 Healthy Start Varied $243,956 Comprehensive Adult Health Medicaid $100,000 Comprehensive Child Health Medicaid $ 75,000 Subtotal $503,956 III. ENVIRONMENTAL HEALTH: Group Care Facilities Varied $ 25,000 DEP Storage Tank Program Varied $107,000 Subtotal $132,000 Total County Fees $754,956 44 ATTACHMENT VI CLASSIFICATION AND NUMBER OF EMPLOYEES WORKING IN THE COUNTY PUBLIC HEALTH UNIT WHO ARE PAID BY THE COUNTY, BY LEVEL OF SERVICE, IF APPLICABLE • ulut 1 � ' � Tuberculosis *Senior Community Health Nurse Sexually Transmitted Disease *Direct Services Aide HIV 9 I's 100 X4 w1w.". 0.5 0.5 Basic Care Middle & Upper Keys Advanced Registered Nurse Prac. 1.0 Nutritionist *Nutritionist 0.5 Comprehensive Child Health *Advanced Registered Nurse Prac. 0.5 High Risk Adults & Children Senior Community Health Nurse 1.0 .01Uu i Various Programs Environmental Health Specialist 1.0 *Secretary Specialist 0.5 *Indicates partially funded position 45 ATTACHMENT VII FACILITIES UTILIZED BY THE CPHU Facility Description Location Owned By Monroe County Health Department 5100 W. College Rd Monroe County Key West, Florida Monroe County Health Department 138 Georgia Street Monroe County Tavernier, Florida Monroe County Health Department 7999 Overseas Highway D.Chaplin\dba Marathon, Florida Prime Properties Health Care Center 1200 Kennedy Drive The Lower Key West, Florida Florida Keys Health Systems, Inc. Roosevelt Sands Community Health Douglas Square City of Key Resource Center 105 Olivia Street Key West, Florida 46 ATTACHMENT VIII DESCRIPTION OF USE OF PUBLIC HEALTH UNIT TRUST FUND BALANCES FOR SPECIAL PROJECTS, IF APPLICABLE (From Attachment II, Part I) The addendum of the FY 1994-95 contract regarding the construction of the Marathon Public Health Unit, attached hereto and incorporated herein, is continued through the first six months of the current contract period. $400,000 is appropriated for renovation and/or relocation of the County Public Health Unit in Tavernier. $275,000 is appropriated for additional site renovation activities in Monroe County. $51,619 is appropriated for equipment and communications needs for full conversion to network access, universal workstations, and enhancements to telephone systems. 47 Addendum to Standard Contract Between Monroe County Board of Cor:nissicners and ztate ofFlorida Department of Health and Rehabilitative Servi:.es for Planning and Construction of Marathon Public Health unit Agreemen : :Wade the _ast day below wr_ -en, by and ce_::een the SCARU OF COUNTY CC�^_'TSS:CNERS OF MONROE COUNT'', and the STATE OF = I.ORT-A DEPARTMENT 0: : �F:.=;: F� 33.,•. , � for _~e Monroe CoLnty _ . biic r:eal:r Unit, whCse ac.ress _s CO w. Co lege Road, Key Vest, FL 33040, WTTNESSETH The Cou: :y and HRS hereby agree to add this addendum to that certain Standard Contract dated -he 1st day of October 1994 as follows: 1. Addendum for Marathon. Public Health Unit Site: The County and RS '.ave agreed hat the County will provide the Monroe County Pjbiic Health Unit (MCPHU) the site listed as "under renovations" in the Standarc Cent 48 A'_t ough not defined in the Standard Contract, tte ac-ua: of ne s:-e re_erre- --s is 3333 Overseas M,arathor., Flor_da. NOW, THEREFORE, for and in consideration of the T::tual prc:-.ises, covenants, anal obi: t:cns contained ere_r. and; contained in tie Standard Con --:act the County and E RS agrees as .1ol lows: 2. P-o,ect Funding: A. : RS (through t-e MCPHU) will provide funding =rcm the Cc•.:-:y Pub:yc 'lea 1t:n. _-it Tr:st Fund In the cf _;�0,000. B. _'ne Ccunzy agrees to contribute 5400,000 =..e f_rs= 54;; :0 _n costs assc.._a=e '-fs prcject w:__ be paid frc-. f-inds t;.at are prov_. ed ty 3. 'he remainder c` t.-e project costs, 1_mi!_=ed :.o S400, COC, will be paid frc7. 'Lu-ds contributed by t`:e County. 4. Funding Uses: A. The 5300,000 In. funding for this project shall be used for costs associated with; planning, are,itectura= services, perm _=ting, site preparation, construction/renovation, purc=.asing, 4mpact fees, 49 assessments, deposits, charges and costs of whatsoever .at'' th3t MT. a % °"e req'.:iYed by any :OCa' , `C::nt%, state, Or fe::e-ral e.^.:it% foot app1 cat -on, review, modi:icat_c-n Of plans or applications. B. A1_ disbursement of HRS funds will be --' nted for r�.:c} s'.:b:�-ssion of project ccst records. al.. �.��: �. ...._.. 5. County Obligations: Construction and Installation of Facilities and improvements TWE COUNTS SHP LL ACT AS CONSTRUCTION MANAGER AND BE R=SpONST_BI�E FOR THE FOLLOWING ACTIVITIES: A. Se_ect_r:,n and contract with an Consultant BP r n A::,�=cve s_�e des-;�, c'.:-.. c�ra.,, CCn-tact d0c_"r.e _s, cons 1--uction, cc:rpe____ve bid process bidder . w- t. fte s ccess___ C. Cc:._rapt G�.:?�nistra=ion, sc: ed'.:_es, cost c^- =ro+ �n� : o-.s =_ :c _ _� : �bserva _:,r: and aprrova' . D. I. -sure that the consultants and the cCn:rac:C_ra__ per..._ts prior to _'r.e s::=== c` construction, filing approvals of plans with governmental bodies and u:-_-:_es having J"r- cticn, that all work is completed in accordance with applicable codes and 50 regulations, local and stare requirements and acquire zC,n_..g; re-=...i..g cr =on—: ng :•aria:.Fes w11ere re ;u:red. S. :::sure that the schedule of completion of Sertembe= ^;9, 1996 be stri:.t_y adhered to. 6. !:ol: Harmless and indemnification Cour:=y and HRS each represents to the other that carr'es suitable public liability and property damage insurance, or is self -insured in amounts adequate to cover any claim within t!:e limitations of Section 768.28 arising �.. c0nnect_�,n lease of the premises under this Agreement and will continue to carry such insurance or remair: d-..r_ng 1'.e entire term. of Lhis Ag_eement. ra:.:. . =r--y shall be respcns__-_e for any acts c: ne_gen.--e c:. _.•e _ _ar: o= _:s a�gen=S and E'C_Cfe25. .a:'? g_ Party sl-a'_l hold t':e other party harmless from all claims neg--ge-ze of its age: :s, employees and in-lepe^dent contractors in connection with this Agreement, and shall defend t^e other party against all claims arising out of such negligence of its agents, employees and �ndepender.t contractors '-nder this lease. 7. County Nights: Use of Facilities In accordance with the Standard Contract, Attachment , Sec=_on V! (c) facilities and equipment provided by ei-::er 51 parry for the CPHU shall be used for public health services pro; _aec�. t%e ::Ci:.'.t}'' S1:a_- :'.aVe t%e r:gr = to use such `acilities and equipment, owned or leased by the county, as the reed arises, to she extent tat such use would not impose an unwarranted interference with the operation of the 8. County obligations: Replacement of Facilities Destruction - In the event of a partial or total destructior. of *he premises during the term of this Agreement from any cause, the County shall forthwith restore t`e same as soot: as reasonably poss-ble and if eccno^ically Feasible. Any partial or total destruction shall neither a-...: - nor vc*d _.._s AgreeTer.:. 9. ERS Obligation Coordination of ERS gh 'cn_oe Count; Public Health U (MCPHU) of'; orals shall ccnsui-- with and coordinate with t::e County Cor:s_ructior Manager for the planning, const=uc_ien, s:al:at_on and use of t::e Facilities. Tne design, construction, location and installation of the Facilities to be placed on the Marathon site shall be approved in writing by the HRS representatives, it being the intentions of the County and HRS that HRS shall have absolute control over the location and placement of the Facilities upon the Marathon MCPHU premises. No other structures, improvements, or 52 fivlures shai_ be placedupon the Marathon MCPHU premises A_=ncut pr_cr ::_:�:e�: per-_ss_c:. cf HRS. Any approval required by HRS hereunder shall not be unreasonably w; _..-e1d. 10. HRS Obligation: Control Over Premises The Coun:, agrees that, in the event of the sale, lease cr other disp�:sitien Of the premises currently owned by the Co::.^.ty upon which the Facilities are located, the County s::a:l insure `at su:.h lease, sale or other disposition is s,:'4ect to t-.is Agreement and will not interfere with HRS's .ts _.:de_ :'is A _reemen`, so long as this Agree7nent shall remain in force and effect. =R: R= Use of 7 a;:_' i` es =RS s*-a__ '. e _-e r`g'":t tc use e Fac__-t_es w_--.--;_ _.. :erference _o pro^ete, protect, maintain and improve -e ..ems__h and s_rz=e v of tie citizens and visitors through prcnotion of P;:b1ic health, the control and eradicatior. of _-e entable t seases, and the provision of primary health care for special populations. 12. HRS Ob=ioations: Supervision of Activities ERS shall be responsible for the supervision of all ac=ivities involving the use of the Facilities which HRS er Y,CPHU officials ; ave sponsored, schec.:led or over which HRS would normally exercise control. 53 13. County Cbliga, ions • Pro-Rata Reimbursement to -RS3 hRS may cancel t`_s- Agreement and e'_ec= to terminate -s respons_b for operation and maintenance of =}.e Facilities because of a material breach of the Agreement t/ -.e� by this Agreement, a material bre;-- tie County. As ::ef.. shall be one :ha-_ substantially departs from the letter sc' ri t of the ter::s of this Agree-ent . In the event of cancellation the County shall, within six (6) months of cancellation, re::-,burse E RS for the adjusted value of the ra;._lities PL, _r. by LRS. 13. Nc:--Ass_Cn e^t This Agreement may not be assigned, and the County c_ ERR may r.c: tent cr s::b_ease any Dart of t`:e Fac:____ec, A_� —out the e:'Cre:S �� wry :en consent of the 14. Notice of ?reach; Cure in the even: of a breach of any term of this Agreeme:._ �y one party, _: shall. be the obi`gation or the other par=y to provide written notice of such breach or violation, ar.:: a reasonable period of time shall be allowed for the curing of such breach or violation, the reasonableness of the time period being determined by the circumstances and na:..re c= the breach. 15. Notice of Unsafe Condition 54 In the event that either party becomes aware of an it shall correct :..e saute or, if s;:z:: is the responsibility 'of the other pa==y, notify the other party of the hazard and the need for corrective action. In all Other respects, the prcrisior.s of the Standard -or.;ract between the Monroe County Board o: Couni-y Commissioners and the State of Florida Department of Health and Rehabilitative Services, dated, October 1, 1995, shall _emiain in e`fect and be unchanged by this addendum. 55 IN WITNESS WHEREOF, the Board of County Con-lissior.ers Of "or.ree Cc�^ty, :lor_da, 'F�rs�ant to a T.ct_c� seconded and passed in regular and open session and by and through its Mayor and Clerk; and HRS, by and t••=O';7 its District 11 Administrator and Monroe County P;:blic Health .:'.it Adr.^i^_StratOr, have affixed their respec�:ve anC representative hands and seals on the dates indicated. BOARD 01 COUNTY C01�^MISSIONERS Attest • i�ANNY L. g0I$AGF, OF MONROE COUNTY, FLORIDA My & Le AA X., VV (SEAL) OF Attest: SERvICES By n/. Date: /V .3 -9�- 56 TAT: DE 1� ny 5a tflaHU A:DMP11STi*T0fZ 3.2-7•9S 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 public health unit 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 RRecru r m n 1. 2. 3. 4. 5 Sexually Transmitted Disease Program Dental Health Special Supplemental Food Program for Women, Infants and Children. ;-Improved Pregnancy Outcome Family Planning 57 Requirements as specified 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. Monthly reporting on HRSH Form 1008. 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 15a.27. ATTACHMENT IX (Continued) 6. Immunization 7. CPHU Program 8. Chronic Disease Program 9. Environmental Health 10. AIDS Program 11. School Health Services 58 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 CPHU 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. HRSM 150-25, including the requirement for an annual plan as a condition for funding.