FY1996 01/17/1996GOUNrI,r F
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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
M E M O R A N D U M
To: James Roberts, County Administrator
From: Isabel C. DeSantis, Deputy Clerk
Date: February 12, 1996
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 852-7146
As you know, at the January 17, 1996 meeting, the Board granted
approval and authorized execution of the standard contract with
the State of Florida, Department of Health and Rehabilitative
Services for the operation of the Public Health Unit.
Attached hereto are two duplicate originals of the above document
executed by Monroe County. It is my understanding that your
office will follow-through and obtain the Department's signature.
Please be sure that a fully executed copy is returned to this
office as quickly as possible..
Should you have any questions concerning this matter, please do
not hesitate to contact me.
cc: County Attorney
Finance
,/File j /, .
/996
STANDARD'CONTRACT BETWEEN
C
f � agoww of - COMUIOWSSWAW ...� �
y 4
'tLITATIVB
DEPARTMENT OFis contract is
IiEALTii`ND
Pursuant to Chapter 154, Florida. of Health and Rehabutes ilitative
entered intoDepartment
between the
Services, hereinafter refCrounty, - h as
the
naft a referred to as the
ment"# and
MONROE
"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
ative
committed to the provision of these servicovernhtheduseiofrthese
and programmatic requirements which will g
funds, and the respective responsibilities of the department, and
the county in enabling the CPHU "to promote, protect, maintain,
and improve the health and safetypublic ! the healthitithes and controlltand
through promotion of the pub
eradication of preventable diseases, and the provision of primary
health care for special populations-"
I. General Provision:
Both -parties agree that the CPHU shall:
tions
A. in Atachmente I sand Ball other attachments
to the specified
this
in Attachment
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;
and
B. Complother a apithplicable
thecable regulations if trovisions of 45 his contract contains
other PP
federal funds;
C. Comply with all applicable standards, orders, or
amendedi(42 USC 1857petssegt) andtthe Federalhe Clear Water r Act as
Wat r
amen
368 et
Pollution Control Act
amended
Lederal3 lands land thestotal
if this contract contains
�t isver $100,000; and
coast :�.: • .. fV=-�5 ._ .._ :1.-�.. ^��'.�,�:�-_:�,..��-- - --
1 w p s..secti_ons of Cha tar . 4271 Florida
C. ��P. t on $irvici �' giap 41-2,
anspo
Statu . nistrative Coda, (Coordinated ;Community
Florida;.: ion Ssrvicesj the r9 ision of _
Traa{s t regards_..:.
trans portation services Lor theap°atan
disadvantaged funds contract
are contains
ito provide !or
ledaral or localtransportation services.
direct or indirect (ancillary)
III. Records, Reports and Audits:
Both parties agree that the CPHU shall:
A. Maintain books, records and documents iracti dancwhich
with accounting procedures and p expenditures of
sufficiently and properly reflect all
funds provided by the department, the county and other
sources under this contract. Books, records and
dequate to enable the CPHU to comply
documents must be a
with the following reporting requirements:
1. The revenuetomated ManagementeAccrequirements
uninting
AuSystea 2.2;
State Au
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 equivalentas
ny
approved by the State Health Office.
reporting system used by or on behalf of the CPHU
to produce hine readable informationve provide
formatrmat approved by d
ata
amachine
in a m
department which
Information System;
ired electronically
to the Client
3. The CPHU is responsible for assuringthat
ainclude
contracts with service providers
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 spec
ified
ied
co the component
anal ant nd Information
revisionsSystem/Health
subsequent Management
Component M
the January 11 1984 version;
4. Financial procedures specified in the department's
Accounting Procedures Manuals and Accounting
memoranda;
2
• 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 perl6ds speCitied -by the
_ . deportment _ _ .. _ ; �-. -- t ; y-.•4 �z. c
6. Any other state and county -program spec: 3fii'
reporting requirements det9iW . in attachments,. -to
this contract.
B. Assure these records shall be subject during normal
business hours to personnel duly tiauthorized by the review or department
state
or county p
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
g. Include these aforementioned audit and record -keeping
requirements in all approved subcontracts and
assignments.
Iv. Purchasing Procedures:
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, tand
dented t e
the
county proceduresweesed because theyweremore 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.
3
vi. Safeguarding Information:
Both parties agree that the CPHU shall not use or,disclose
any intorsation concerning; a recipisn ,�,.&. Jcas sr :
act for any purpose not in COMO
this contract �0• - �_..
state law, regulations or *anna►1
and Information Technology) and Lederal_ _• ; 3
hisZOS . SO) , excel by writ_ _ten�sona
her responsible parent or guar Y
law. `
vil. 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 conditions
hethis contract departm department andnd he toany
it
condions off approval
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
contract, provided that the amount of any
such tnract
shall not be for more than ten (10) percent of 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
he conditions
i th t the this
departm nt contract
andand
then county any
shallconditions
deem
approval
4
IX. Insurances
provide adequate property
The County agrees to P ui ment in
insurance coverage for all furnishings
ildings and Bused by the
health unit offices and buildings. the County, and all
health unit that are owned by the County, including
furnishings and equipment owned by
shall be insured through the county's insurance
program, which shall nce
vehicles, be either her a self-insurance program
ay
insurance purchased by the County. The health receipt of Pan
for the annual cost of this insurance up
For any
invoice from the county's Riskwent used b Managent lthe Health Unit
buildings, furnishings and egitupis the responsibility onsibility of the
but not owned by the County, either
health unit to obtainvauate insurance nc coverage
through the state or prite
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
g 2,882,122 and the State share of all state
authorized fees in an anticipated amount of $ 0 •
In addition, all "OTHER" state revenues frost whatever
sources to be appropriated to the HRS County Public
Health Unit Trust Fund for services to be provided 6tby
the county health unit in an amount of S.1, g
or
a grand total State cash contribution of
$ 4,068,798 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 S 281.000 In addition, the
county shall provide its share of all county authorized
fees in an anticipated amount of S-129_. ; --s
These amounts, plus any "OTHER" local revenues in the
amount of $J7.000 , includes all revenues from
whatever sources to be appropriated to the HRS County
Public Health Unit Trust rund for services to be
provided by the county health unit for a grand total
county cash contribution of $ 441,230 •
E
XI. The department and the county mutually agree:
Effective -`data
i. This co tra'shali``nocr�or
the date on -*hich t$.;f7conttac ::ba -been .signed by
both parties=�biohsv
.2. This contract shall end on September 30, 19 %
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
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.
2
C. Notice and contact:
The ` cortrlt � CW#• the--dspartapent.:,..f9r this
his
r
repres .event that
J je ast bY_ either
difleratt�t -'" - �- ce of the
party after sxecutioti. df "this " contxil►
Hams and address of the, nev representative and 1 said
rendered in uniting to the otherp�'tY
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 wh�ththey
parties tobeen
thisreduced
contractvritinq
b
and duly signed y
g. 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 •
F. All terms and conditions included:
This contract and its attachments as containreferenced,
(Attachment I through Tx ),
the
terms and conditions agreed upon by the parties.
7
In WITNESS THEREOF,
page contract to be
duly authorized.
the parties hereto have caused this
56
executed by their undersigned officials as
BOARD OF RUE- COMKISSIONSRS
FOR COUNTY
SIGNED
NAME: SHIRLEY FREEMAN
Mayor
TITLE:
DATE: 0/ /-'9Co
ATTESTED TO: a� �Q�
SIGNED B Q C' �
Deput Clerk
NAME: Dannv L. Kolhage
TITLE: Clerk
DATE:
I 11. � kn-,
STATE OF FLORIDA
DEPARTKENT OF HEALTH AND
REHABILITATIVE SERVICES
SIGNE
( partment Authority)
NAME: i%Nir�9 ! 4 •
TITLE: VCT
DATE : 3. 9. 9�0
SIGNED BY:
CPHU Director/Administrator
NAME:
TITLE:
DATE:
N.
ATTACHMENT I
SPECIAL PROVISIONS
I. County publiq Heal.#.,94t Trust
Both parties agree:.-
F _ nd.
A. That all funds to t
a expendbdiby
.deposited in Y
(CpHUTF) maintained by the state
the CPHU all be
Health Unit Trust Fund
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 moNEnF.
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
fundbalance, 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
contract, with special projects explained in Attachment
MI.
V]
thr
g. There shall be is transfers out a contrac
t ndm the
duly
levels of services withouter
signed by both parties to this contraotKand the .prCPHU
amandmonts .. uni_ a the ,
budget:
director/administrator detirai -the publios>.
exists wherein a time delayptaro lry =o t - apprbV*d.;_
health and the a Deputy
Secretary for 4" - shAl
the transfer. CPHU
forward written ter an emergency trans! idence of this l•to the
within 30 days a!
g . That either party may increase or nodecrease f uin surriting
tifying the other party
this contract by and purpose for the increased/decreased
funding,
of the amandt allowing 3o days for written objection
funds are released
before the athe st t allocation is decreased. o
expenditure or A
ust be
decrease in funds msequestering fed e to a anticipated
shortfall,
appropriations.
G. That the contraa shall include P f Staffing,
Attachment I sectionentitled "Played Expenditures by Type of Service
Clients, Service and
Within Each Level of Service". This section shalo�
include the following
hinieachilevelaofon for service each type
service area
• _ the planned number of full-time equivalents
(FTE's) by level of service;
the planned number of services to be d number of individuals/unitsotodber
the planned _
served; and expenditures.
the planned state and county
Expenditure information acilitatellmon torinq to a contract
in a
quarterly plan
performance.
H. That adjustments in the planned expenditure of funds
for each type of s ut nn amendment to this contract ce within each level of ice
are permitted without
_. 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;
10
3. DE580Ll - "Analysis of Fund Equities"; and
4. A written explanation of the variances
in the DE385L1 report for each QW�
contract year if the CPHU exceeds'o
levels as Spec
fliedio�+ as of-=
quarterly report per.
reflected
ter: ,; of ... the .,
i. tolirance'-
a. The cumulative
percent art��v
by more than 25percenth
articular type of
expenditures for a particular
or fall below planned expenditures
than 25 percent.
planned
service
by more
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
inrwhich the te fance xplanationf is not required.
e is included, a
variance required,
5. The CPHU Contract Management Variance Report
shall:
a. Explain the reason for the viances in area
expenditures in any program
which - exceeds-- the tolerance levels
established above;
b. Specify steps that will
taken
plan� including
comply
with the contract expenditure
a contract amendment, if necessary; and
C. Provide a time table for completing the
ai steps
ure
necessary to comply with the plan.
of the CPHu to accomplish the planned steps
by the dates established in the written
explanation shall constitute non-performance
under the contractwithhold funds tiro r the
the
department may appropriate
contract or bake other appro P
administrative action to achieve compliance.
J. The nisstrrator'stes quarterly report to the for the cpHU ,co
admi unty and the
department shall be as follows:
1. March 1, 19 96 for the report period October 1,
19_25 through December 31, 1995 ;
2. June 1, 19_1 ._. for the report period October 1,
1995 through March 31, 19 96 .;
11
II.
September 1, 1996 for the report period October
3.
11 19g_ through June 30, 1996f and
4. December 1;- 19�: for the. r�period: pOtober.,: ,
1996 through September 30
Fees: t
A. Environmental regulatory Lees.
The department shall establish by administrative
designated
fees for envirormental regulatory functions
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
the department's rule. The county may,,
howevera
establish fees pursuant to section 381.
0016,, Statutes, toitent
he statutes inconsistent aft r consultation wm pith the
rules and
department.
B. Communicable disease service fees:
The department may establish by administrative rule,
fees for communicable diseaseservices designated in this
environmental regulatory services,
contract and conducted by the .CPHU. The _�unty.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
county
listed in Attachment IV of this contract.
All authorized communicable
bVedisease serviceof this contracts fees shall be
listed in Attachment
C. Primary Care Fees:
.The county may establish fees for primary care services
designated in this contract and conducted by the CPHU
except forthose ederal orees statafor
lawich fee or regulations. schedules
es are
specified
Both parties further agree:
1. That such fees shall be established by resolutioi!
of the Board of County Commissioners,
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 carethe servicesyfor provided byithelCPHUsease
or primary
or r
12
isted
3 . That primary care fees os= �i be tract. in
Attachment V county) L
di prark- * ses shall
D. Communicable sh _and the
automatically-•
'Q rats u ri _ glciatusr;;:of . this
county at the se�l se -- sit or. party
contract I and" C of
unless s sat fo
according to pr
this section.
g, Collection and use of fees:
Both parties agree that:
1. Proceeds from all fees collected by or on behalf
CPHU whether for environmental,
of the or primary care services,
communicable disease,
shall only be used to fund services provided by
the CPHU•
2, All fees collected by or on behalf of the CPHU an
shall be deposited with
the State Treasury
credited to the Countyappropriate Pu ic s at Health account Unit Trust i f
Fund or other
required by Florida Statute or the State
Comptroller. —
III. Service Policies and Standards:
Both parties agree that theublishedshall
byadhere
departmentservice
in
Policies and standards P guidelines provided by the
program manuals and exist, ther a guide for providing each
department, where they
funded service specified in Attachment II, Part III of this
'contract.
Iv. Fair Hearing Guidelines:
The provider shall establish a system through which
resent
applicants for services modification ication rent clients
termination of
grievances over denial, applicants of the
services. The contractor will advise
right to appeal a denial or exclusion from services, of
failure to take account of a client's choice the =service, overning
of his/her right to a fair pecif iari1gc references to existing
authority of the agency.
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).
13
V. personnel:
Both parties agr`40 '`
v� at- licit thi following "employees:
}._
A. The CPHU shalla _.
1. A director. or administrator t,� 'after consultation
Secretary of the department
with the Deputy Secretary for Health and with the
concurrence of the Board of County Commissioners;
Z. A full-time community health nurse;
g. An environmental health specialist; and
4. A clerk.
B. That all department employees department and the subject hato
ll
be -supervised by
Department of Management Services rules.
C. Staffing levels shall be established iand this contract
tracted
in Attachment II, Part III as FTE's, Y co
in accordance with the availability of funds and/or
program needs.
D. The number and classification of employeeslyes rather working than
in
the CPHU that are county
department employees shall be listed in Attachment VI
of this contract.
VI. Facilities:
Both parties agree that:
A. Attachment
facilities shall be provided as specified
dein shall
Attachment VII of this contract. s
attachminclude a description
lofall ca ion offacilities
facilityused
and by
the
CPHU, including
whom the facility is owned;
B. The county shall e own
W rovided he tin ities used Attachment by
e f CPHU
unless otherw P
contract; and
C. Facilities and equipment provided by either party
r y foxes
the CPHU shall be used for public
provided that the county shall have the right to use
such facilities and equipment, owned or leased by the
county,of impose as the a narises, to the extent that such use
unwarranted interference would
nwith the
w
operation of the CPHU.
14
VII. Use of Funds for Lobbying Prohibited:
the provisions of section
which
vIII.Method oi.payssntt
A. The county shall deposit
i its annual Unit Trust Fund iastispecif on to the ed
County Public He
below.
B. The department
lllrelease state contributions to
this contract a
1. Funds appropriated as "Aid to Loterl o er nts„ at
shall be relea ct each our
quaquarterly
t r of ythe contract
the beginning
year;
2. WIC and other state funds appropriated ens, in a cost
and special)
reimbursement category (e•9 P
shall be released on the basis of invoices
documenting expenditures.
Laboratory and Pharmacy Support:
The department agrees to supply laboratory and pharmacy
support services for the cpHU aifleast
a the
level
provided
in the prior state fiscal
Y
X. Emergencies:
Both parties agree, taathnt of their each other insmeetinq public
resources, that they Y assist
health emergencies.
XI. sponsorship:
tutest
In compliance with at allonotices,5�informationalFlorida a pamphlets,
provider assures that descriptions of the similar
press releases, advertisements, P
sponsorship of the program, research reports•rovidershall
public notices prepared and released by the p
include the statement: OE COUNTY PUBLIC
Sponsored by provider
and the State of Florida, Department of Health and
Rehabilitative Services." If the sponsorship
ofreference
is
in written material, the words,
Department of Health and Rehabilitative Services" shall
15
size letters or type as the name of the
appear in the same
organization.
XII. Indicate in the space below the income eligibility limit for
comprehensive primary care clients.
10, i of OMB Poverty Guidelines.
XIII.Program Specific Reporting Requirements:
Specific information not
available followie gh CIS/HMC or SAMAS
must be -supplied by completing
A, Specify in the space below the minimum number of
clients who will receive comprehensiveprimary
are
services (clients registered in Program
99
who will receive services during this contract period).
5,000 •
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 nds are in the IPOosited in the cPHU line on Attachment rIIt
Fund and included
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 st, the medicaid
shall
automatically be adjusted to, a
reimbursement rate without 154 06 shouldormal sant d reimbursement
in accordance to this contract
with F
rate be increased or decreased. See Page 12, Section D.
16
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In ,
ATTACHMENT III
CIVIL RIGHTS CERTIFICATE
ion
provides this assuran�ederal grantse in at loans
The applicant of obtaining guaranty),
and for the purpose
contracts (except contracts o! insurances or
rt discounts, or other federal crn benefitti q assistance
cial
property,, or activities receivingto
to programs assistance. The provider agrees HRS
federal financial
civil Rights Compliance Questionnaire,
complete by the department.
Forms 946 A and B, if so requested
The applicant assures that it will comply with:
as
1. Title VI of the CivilRights Seq.°fwhich,prohibits
amended, 42 U•S.0 , color or
discrimination on ins basis of
ande, activities
national origin from federal financial
receiving or benefitting
assistance.
1973, as
2. Section 504 of the Rehabs �94tio whichof prohibits
amended, 29 U.S.C.
discrimination on the basis of handicap in
programs and activities receiving or benefitting
for federal financial assistance.
of
97z, as
3. Title IX of the Education Amendmen Wh chlprohibits
amended, 20 U.S.C. 1681 et seq.,ducation
discrimination on the asis of receiving or * in eef fitting
programs and activities
from federal financial assistance.
as amended, 42
4. The Age Discriminagt on 5eq , 19 which prohibits
U.S.C. 6101 a in programs or
discrimination on the basis
benefitting for federal
activities receiving
financial assistance.
omnibus Budget Reconciliation Act of 19811
5. The Omnwhich prohibits discrimination on the
P.L. 9'7-35, sex and religion in programs and
basis of or benefitting from federal
activities receiving
financial assistance.
6. All regulations, guidelines and standards lawfully
adopted under the above statutes.
33
surance
Th
e applicant agrees that ontinued cwith ompliance
receipt
tofs orsbenefit
constitutes a condition of c and that it is binding
from federal financial assistance, transferees, and
the applicant, its successo such assistance is
upon rind during which
assignees for del nt further .assures that all contracts,
provided. The applicant
or others with whom it arranges
subcontractors, subgr articipants or employees
to provide services or benefits programs and activities are
in connection with any inst those participants or employees
not discriminating g regulations, guidelines,
g the
in violation of the above statutes, at its
and standards. In the evnt the grantor of failure t may, at
applicant understands that eek a court order req uiring compliance with the
discretion, sappropriate judicial
terms of this assurance or s to includepp assistance being
or administrative relief, denied.
terminated and further assistance being
34
ATTACHKENT IV
STATE FEE SCHEDULES, BY SERVICE
SERVTCElSERVICE�
I CO DISEASE:
AIDS, HIV, Alternate Site Testing $20 (optional)
11. pR I LARY CAR s
Estimated
Annual Revenue
Accruing To The
CPHU Trust Fund
,Subtotal $ 0
Subtotal $ 0 --
35
III.
(1)
(2)
(3)
(4)
ATTACHMENT IV (CONTINUED)
STATE FEE SCHEDULES, BY SERVICE
ENVIRONMENTAL HEALTH: --- --
A. ONSITE SEWAGE DISPOSAL
(OSDS) PROGRAM Fee
Septic Tank Site Evaluation (Soil Testing/
Site Evaluation ............................$ SO
OSDSPermit...................................$105
OSDSRepair Permit ............................$ 40
Existing System Approval ......................$ 40
Septic Tank ManufacturerInspection
Permitt(Annual)ual)::5 50
50
Septage Disposal
Septic Tank Pumpout Vehicle Inspection ...$ 25
(Per Vehicle) .............................
Portable/Temporary Toilet Service ....$ 50
Permit
(Annual) ...................... ....
Portable Toilet Pumpout Vehicles ..• .$ 25
(Per Vehicle)..........................Reinspection of Non-compliance OSDS ...........
$1$ 25
50
Variance Application OSDS (Single Family) .••••
Variance Application OSDS (Multi -Family &
Commercial Site) ....................... ......$200
Aerobic Treatment Plant (Annual) ........ " •..5150
Industrial/Manufacturing Permit (Annual)••••'•$150
Lime Stabilization Facility (Annual) ..... •••••
Septage Landspreading Site
Evaluation (Annual) ..........................
......•••••.••..$ 40
$140
0
System Abandonment Permit..................
(1) (4)
(2)
(3)
(3)
Includes a $5 research fee to be n collected
object codee0012010, 1996,
transferred to headquarters using
Applies where FHA/VA requests system reinspection and where county
ordinance requires inspection for change of building occupancy.
50% of the variance application fee is placed in the applicable CPHU
trust fund, 50% of fee placed in specific HSES variance account usinc
revenue object code 001204.
the CPHUs pursuant to construct:
Includes a $5 surcharge collected by
permit issuance to be transferred
dassistanceoforothis progravide m
monitoring, training, and administrative
using revenue object code 001203.
9.1
ATTACHMENT IV (CONTINUED)
STATE FEE SCHEDULES, BY SERVICE
B. PUBLIC SWIMMING POOLS AND BATHING PLACES Fet
Annual Permits: Up to (and including) 25,000 gallons .......... 25 (1)
More than 25,000 gallons ......................$ 75 (1)
Other Fees:
Plan Review (New Construction) ..••••••••••••••S275 (2
Plan review for modification of $
original construction........
Plan/Application review fee for $150 (2)
bathing place development ............... ....
operating .S125 (2)
_Initial op g permit ................... .
(1) Maximum fee is charged by HRS CPHUs and lo% of that fee is transferred
to headquarters and should be coded to:
Planning and Evaluation Trust Fund
GF 20, SF a 2, FID = 531003, BE = 60500200, IBI = 00, OCA = K3000,
Object Code 001205, State Program = 0402000004, SI = RV
llected by HSEH, the 12 delegated counties and
(2) Fee amount co
District I.
C. MOBILE HOME & RECREATIONAL VEHICLE PARKS,
Annual Permits:
5 Spac&s and Above................S3.50 per space (1)(2)
ten
(1) The minimum statutory fee sieelassessedgpered ufacilityecannotare wbetmoreby
the department. The total
than $600 or less than $50.
(2) 10% of each permit shahisbsurchargershould beto acodedttos erusing revenue
object code 001113. T
GF — 10, SF = 21 FID = 021042, BE - 60500200, IBI = 00, OCA UQ000,
Object Code = 001113, State Program - 0402000004, SI = RV
D. MIGRANT LABOR CAMPS '
Annual Permits: ,,,...$125
Facilities with 5-50 occupants..........
Facilities with 51-100 Occupants..............$225
Facilities with over 100 residents ............ $500
37
E.
F.
(1)
(2)
ATTACHMENT IV (Continued)
STATE FEE SCHEDULES, BY SERVICE
BIOMEDICAL WASTE GENERATORS
Fee
Annual Permits: less
(Except Physician Office Generating
than 25 lbs./30 days) ........................$ 55
Other Fees:
r the first reinspection).•$ 2
Reinspection (afte...........25
Late renewal...........
............
Mobile treatment machine registration ..•••••••$ 2
Fee
DRINKING WATER
Annual Permits: public Water Annual Operation Permit- Limited Use
(Annual Operation Permit First
P ear)..........$ 75 (1)
public Water Annual operation
(Annual Operation Permit Second Year
and Beyond) .................................$ 70 (1)
Other Fees:
public Water Con strucgamnlee ollecti on/Review
.$ 75 (1
Non-SDWA Lab Sample ( p
of Analytical Results/Health Risk
Interpretation): ,,.....$ 50
Delineated Area ............
.$ 40
Bacterial Sample Collection............
Chemical Sample Coln Permit' .. ' • • • ' • ...' $ 60
Private Water Cons $ 40 (2)
(serving 3 or 4 non rental restemnces):::::$ 25
Reinspection of Private Water System
....:.....$ 40
Reinspection of public.Water Sy 50
stem Delineated Area Cleaan.Fee .... ::::::.......$100 (3)
Lab Fee Chemical Analysis
Includes a $5 surcharge that is transferred to
training, monitoring, epidemiological samerevenue object
technical assistance usingirtg
Includes a
training,
technical
$3 surcharge that is transferred to
monitoring, epidemiological support,
assistance using same revenue object
(3) For collection of
for the chemical
statewide health
fees by
analysis
program
headquarters to provi
program evaluations a
code.
headquarters to prov:
program evaluations
code.
the CPHUs on behalf of the state lab. Fe
of watusing revenueshallr sample object ecode ted to the
budget 9
001170
38
(1)
Includes a $10 surcharge that is transferred
to
training, monitoring, epidemiologicalPP
technical assistance using revenue object code
The $10 surcharge should be coded to:
ATTACHMENT IV (CONTINUED)
STATE FEE SCHEDULES, BY SERVICE
Fee
G. FOOD ESTABLISHKENT S
Annual Permits: the
Fraternal/Civic (Serving
Public)..........$160
(1)(2)
School Cafeteria
operating for 9 months
a. Op
or less .......... $130
$160
(1)(2)
(1)(2)
b. Operating for more than
9 months
(1)(2)
Institutional Food Service....................$210
$160
(1) (2)
Movie Theaters ...•••••••••• ...................
....,,,•$210
(1)(2)
Jails/Prisons ...................••••••
Only) $160
(1)(2)
Bars/Lounges (Drink Service
••••••••••::•
.. .$110
.
(1)(2)
Residential Facili ties ..........
.......,.....$ 85
(1)(2)
Child Care Centers ...•••••••••
.....•......$ 85
(1)(2)
Limited Food Service..............
Other Fees: ......$
Plan Review ...... ,,,
.$
Food Worker Training .•••••••••••••... . "
P .......... $
Request For Inspection
Reinspection (after the firstreinspection)...S
Late renewal .......... •••• ..'•........$
Alcoholic Beverage Inspection Approval
headquarters to provic
program evaluations anc
001132.
35/hr
10
40
30
25
30
SF = J, FID = 021042, BE = 60500200, IBI = 00, OCA - 10000,
GF 10, = 001132, State Program = 0402000004, SI : RV
Object Code
t
2) Includes a $5 surcharge that is transferred to headquarters to offs=
( purchasing and providing maintenance on equipment to be
the cost of P used for this program using revenue object code 001119•
The $5 surcharge should be coded to:
021042, BE = 60500200, IBI = 00, OCA = UU000,
State Program = 0402000004, SI = RV
GF = 10, SF = 2, FID =
Object Code = 001119,
W
• ATTACHMENT IV (CONTINUED)
STATE FEE SCHEDULES, BY SERVICE
Feo
H. TANNING FACILITIES
Annual Permits:
lus $55 per device after
Per Facility device) 150 1
the first ......................... .S
ters to
a $10 surcharge that is transferred to program evaluationsoande
(1� Includes a idemiological support,
training, monitoring, p revenue object code 001144.
technical assistance using
l permit transferred to headquarters
The $10 surcharge on each annua
should be coded to: SF OCA = R9000,
021042, BE a 60500200, IBI 00RV
�
GF - 10, = 2, FID State Program 0402000004, gI
Object Code - 001144,
40
ATTACHMENT V
COUNTY FEE SCHEDULES, BY SERVICE
Estimated
Annual Revenue
Accruing To The
FPpLRanae
CP Trust Fund
�res�r �� SERVICE/S
Y. rn�-m rr1TCABLE nTsEAS
Varied
30,000
Immunizations
Medicaid
5,000
STD
Medicaid
2;000
HIV Testing
Varied
500
Tuberculosis
Varied
45,500
Vital Statistics
subtotal $83 , 000
Varied 25,000
Chronic Disease Medicaid 30,000
Family Planning Varied 244,328
Healthy Start Mediciad 50,000
Comprehensive Adult Health Medicaid 60,600
Comprehensive Child Health
Subtotal $ 409,928
. 4:
Varied 2,000
Group Care Facilities Varied 109,906
DEP Storage Tank Program
Subtotal $ 111,906
Total County Fees $ 604,834
41
ATTACHMENT VI
CLASSIFICATION AND NUMBER OF EMPLOYEES WORKING IN THE
_ COUNTY PUBLIC E<NTE�L OF tSERVICS ARE
APPLICABLE PAID BY $
COUNTY,
T, of SMT1 _E / SERVICE
%. col,., CI AAT.F DISEASE:
Tuberculosis
Sexually Transmitted Disease
HIV
' � l. ,
i�iZz�l U__-- -
*Senior Community Health Nurse
*Direct Services Aide
Number
0.5
0.5
II. pRTMARY CARE:
1.0
Basic Care Middle & Upper Keys Advanced Registered Nurse Practitioner 0.5
Nutritionist *Nutritionist
EPSDT *Advanced Registered Nurse Practitioner 0.5
High Risk Adults & Children Senior Community Health Nurse 1.0
Various Environmental Health Specialist 1.0
*Secretary Specialist 0.5
*Indicates partially funded position
42
ATTACHMENT VII
FACILITIES UTILIZED BY THE CPHU
Facility
g.®e 12t m
HRS Monroe County Public Health Unit
HRS Monroe County Public Health Unit
HRS Monroe County Public Health Unit
HRS Health Care Center
HRS Disease Prevention Center
Roosevelt Sands Community Health
Resource Center
5100 W College Road
Key West, Florida
138 Georgia Street
Tavernier, Florida
7999 Overseas Highway
Marathon, Florida
1200 Kennedy Drive
Key West, Florida
517 Whitehead Street
Key West, Florida
Douglas Square
105 Olivia Street
Key West, Florida
Monroe County
Monroe County
C. Chaplin d.b.a.
Prime Properties
The Lower Florida Key
Health Systems, Inc.
Joan R. Lord-Papy
City of Key West
43
ATTACHMENT VIII
DESCRIPTION OF USE OF PUBLIC HEALTH UNIT TRUST FUND BALANCES
FOR SPECIAL PROJECTS, IF APPLICABLE
(From Attachment II, Part I)
The addendum to the FY 1994-95 contract regarding the construction
of the Marathon Public Health Unit, attached hereto and incorporated
herein, is continued through FY 1995-96.
In addition, $400,000 is appropriated for renovation and/or relocation
of the County Public Health Unit facility in Tavernier.
44
Addendum to S=andard Contract Between
Morroo, Coo .ty Board of Co:r.►lssidr.ers
- :.-. and
Mate of _crida
Department of Health and Rehabilitative Services
for Plar.n4 n- and construction of
Marathon Public Health Unit
Ag reeme^. = made
the last day be -Low wr===erg by and
ce = �reea the BOARD OF COCti = Y CO'C :T SS =ON-RS OF MONROE CO`.:K
_OR.DA ("County , NCO i�' itehead Street, Hey West, FL
33040, and the STATE OF FLORIDA, DEPARTMENT OF HEALTH PND
for the Monroe County ::;blic Health Unit, whose address `_s
3:C0 W. College Road, Key West, FL 33040,
WITNESSETH
The County and aRS hereby ag_ee to add this
addendum to that certain Standard Contract dated
1st day of October 1-994 as follows:
1. Addendum for Marathon Public Health Unit Site:
The County and HRS have agreed =ha: the County will
provide the Monroe County Public Health Unit (MCPHU) the
site 'listed as "under rerovations" i. the Standard Cc::tr =•
45
M •a
Al�o„gI not defined :n the Standard Contract, the ac-_,,:al
t-
• - _oa of :h sj :e referred is 3333 Overseas r+g•'•�ay,
e
Marathon, Floridav
NOW, THEREFOREr for and in consideration of the.mutual
- _cns contained. :ere:r. an-d
F=c�•ises covenants, and cb�:g__
contained in the Standard Contact the County and HRS agrees
as follows:
2. Project .-ju di^
A. =RS (through t e MCPHU) will provide fu.^:d ^.g
P •c Realt:^. ^.it T=::st Fund In ne amo•_..:
o--400,000.
agrees to contribute $400,000
c '^in ccszs assCZ4 a--e4
ti:is project w:2: be paid frc;- funds that are provided by
;RS through the Y. r.J.
B. The remainder cf the project costs, limited
to S400,000, wil: be laid frc-. Alunds contributed by the
County.
4. Funding Uses:
A. The 5300,000 in funding for this project
shall be used for costs associated with; planning,
ar:.:^.itectura: services, pern_:tir.q, site preparation,
construction./renovation., purc-asing, impact fees,
46
assessments, depos::s, charges and costs of whatsoever
nature that Ma/ be required by any 10ca1, county# state, or
federal entity for application, review, modi:icat-40n of
plans or applications.
B. All disbursement of H RS funds will be
pr �,St =e` Cr�S.
ac�
c;;nted :�^- rc::c_} s,.:---ssion o_f ojec..
5. Cou Ob'_iaations: Construction. and installation
*morove ^ents
of Faciliries and
THE COUNTS Sp-p-rL ACT AS CONSTRUCTION MANAGER AND BE
R=SPONSIBLE FOR zE FOLLOWING ACTIVITIES:
Se -eve--.. and co;.-ra-t wl,} an
-eering Consultant
g, Approve site desigr., building program,
cc -.==act dcc::re :s, ccns'-uctie.n, coroetitive bid process
enter a _
r,:cr=en cc-t=ac= wit}: t*:e sLccess:.:l
bidal er.
C. roc;. ac:ninist=a=ion, sc: edu:es, cost
_cr
C^.. == , nA -ns- � ..1. _ -�:. �bSErVB: f on and approval .
D. Insure that the consultants and the
c
^ cc ract"a:±• a" requi red pe:--its prior to the start Of
cCC,_ ,.:
construction, filing approvals of plans with governmental
bodies and es 'raving j ur isd=ction, that all work is
�.:t_i_�-
completed in accordance with -applicable codes and
47
local ar.d
state requirements and acquire
=a:io^s
Or
var_ •-es where regzired.
that
the schedule of c6�letion•,a_�:- -
c, Insure
So-•errbe:
U9, 1996 be
s:_ictlly adhered to.
6. =^'A uavmlless and Indemnification
Co;:r:.y a.*:..d .;RS each represents to the other tat _ _
carries suitable p,„blic liability and property damage
:_--nsured in amounts adequate to cover
_ems-ra ce, or is se
r claim within the limitations of Section 768.28 arising
- e ~e^_ses under
se o^is
_ �ne p 1
ryreeriert and will continue to carry such insurance or
the err re term of this
f s. a.
be respcnsib_e for any ac:s
n�
-ents Grad e.:.oioyees. =ach
�:eyger.:.e _.
o e part o: i�s agents
--
-arty sha:'_ hold the other party harmless from all claims
-e o` its agents, e�•oloyees and
arts_::g f=on hey--y_ ...
independent contra-t-rs in connection with this Agreement,
and shall defend the other party against all claims arisir:5
out of such negligence of its agents, employees and
incependent contractors '.:nde-- this lease.
7. Count Ri '.:ts: Use of Facilities
In accordance with the Standard Contract, Attachment
sec=ion v� (c)
:i`_es and equipment provided by e_:*-e__
48
I
parry for the CPHU shall to used for public health servi;.es
: rt to u-se su:.h;
.;s;:a:1 have the �r 9 • -
pr�•: _ded :ha: t`.e ccL . -y•
facilities and equipment, owned oir leaaed�:6y�the county; as
reed arises, to the exaent that such 'us0 would. -not -
the
impose an unwarranted interference with the operation of the
8. County Obli atio^s: Re lacement of Facilities
Destruction - in the event of a partial or total
cestruction of the pre^ises during the term of this
Agreement from any cause, the County shall forthwith restore
same as soot: as reasonac'_y pess:ble and :f eccncn:_cally
feasible. Any partial or total destruction shall neither
nor vole this AgrBeTen=•
- 9. Coordina~ ion of r:,nst rue _ ion
y�cS Ob..i �t_cn:
HRS through Monroe County Public Health Unit (MCPHU)
_ais
of_; stall consul-- with and coordinate with the County
_
Construction Manager for the planning, construction,
_ns=allation and ',:se of the Facilities. The 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
Co,:rty and ::RS that HRS s::a:l have absolute control over the
location and placement of the Facilities upon the Marathon
M�-HU pre.r►ises. No other structures, it:.preverer,ts, or
49
f i-.%-_ores shall be paced -,Pon tte Marathon MCPHU premises
w-:ss:cn of HRS• pr.y approval
N _ : ' l7li t p r � = = is ' � :: e � �:� ... .� .: R:..:;.. - . ,;. _ . ,,.aA.t•�,,;:-a...a„G...•,r+f i-t;`� . ,
,required by HRS hereunder shall not be unreasonably
wi:t eld.
10. HRS Obli ation: Control over Premises
The Cou-_y agrees that, in the event of the sale, lease
- ^•her d; s^^s4 4 o. the premises currently owned by the
c_ -
Co,;n--y upon which the Facilities are located, the County
s':a--
'l insure at such lease, sale or other disposition is
-
s;:_-;ect to tis Agreement and will not interfere with HRS's
--;..:s
u::der :.._s A:reerent, so long as this Agree:neau- t s:a_
re-:ain in ful: force and effect.
of Facilities
spa__ .:a•e _: e r_5`t tc use t^e es
nS -
interference :0 promote, protect, maintain and improve t:Ae
'.aa;th and sa_o:y of t-e citizens and visitors through
promotion of cublic health, the control and eradication, of
:e•;e^.table .::seases, and the provision of primary health
care for special populations.
12. HRS Obligations: Supervision of Activities
FRS shall_ be responsible for the supervision of all
activities *,.vo'ving the use of the Facilities which HRS or
xf_'?':U officials have sponsored, scheduled or over which ::nS
would normally exercise control.
50
13. Co,.:nty Cbl ations• Fro -Rats Reimbursement to ==•�
1-;RS may cancel Agreement and elect to terminate
itQ respons:bi'_::y .or operation: and mairte^ante of the
Facilities because of a material breach of the Agreement t/
t*-e County. As defied by this Agree:ent, a material brea::
shall be one that subs:antially departs from the letter ant
��n eve;- of
f } ~er�:s o` :his Agree: - the .ent. � -
s;rit o the
cancellation the County shall, within six (6) months of
c=ncellation, re`Tbu=se FRS for the adjusted value of the
Fa;,-lities put In by FRS.
13.
This Agreement maf not be assigned, and the County c=
rct r r s-:^he Faci--_}e5,
RS May e.. _ ..^ _.,-ease any part of t
t} press o::or written consent of the ct=er
�_t-out a e:.
14. Notice of Breach; Cure
In the evert of a breach of any term of this Agreeme-:
�y one party, 4t shail be the obligation of the other parw
to provide written notice of such breach or violation, and a
reasonable period of time shall be allowed for the curing of
such breach or violation, the reasonableness of the time
period being dete^::ne� by the circumstances and .nature cf
the breach.
15. Notice of unsafe Condition
51
In the even that either par:/ Becomes aware of an
_:.s-:.-e sit -= n it stall correct :*..a sane or, i= sac^ :a
aa_.o,
the responsibility of the other pa==_l, notify the otter
party of the hazard and the need for corrective action.
In all other respects, the prcvisior.s of the Standard
contract between the Monroe County Board Of County
Corr_nissioners and the State of Florida Department of wealth
and Rehabilitative Services, dated, October 1, 1994, shall _
regain in e`fect and be unchanged b;r this addendum.
52
1N WITNESS WHEREOF, the Board of County Com'nissicr-ers c:
Xo::roe Cc.:^ty, :lor:da, •F;:rsuant to a a.ot'or. c�:;r :-.ade,
seconded and passed in regular and open session and by and
through its Mayor and Clerk; and HRS, by and t'=ought its
District 11 Administrator and Monroe County P::blic Health
Adri^-straLor, have affixed their respec:_•:e and
representative hands and seals on the dates ind:cated.
BOARD 0. COUNTY CC�'�'.ISSIC`:=RS
(Sr..AI') ego OF MONROE COUNTY, FLORIDA
Attest �AI�NY � K�I�iAGE, ,
7
ny
JY J �/
- V
Date:
`
(SEAL)
OF Attest:
SERVICES
STATE 0.7 DEPARTMENT
A\=
By BY
• mc?'Hu s ra fZ
Date:
53
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
I. Sexually Transmitted Disease
Program
2. Dental Health
3. Special Supplemental Food
Program for Women, Infants
and Children.
A. Improved Pregnancy Outcome
5. Family Planning
Requirement
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
150.27.
54
ATTACHMENT IX
6. Immunization
7. CPHU Program
S. Chronic Disease Program
9. Environmental Health
10. AIDS Program
11. School Health Services
(Continued)
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.
55
Addendum to Standard Contract Between
Monroe County Board of Commissioners
and
State of Florida
Department of Health and Rehabilitative Services
County and HRS each represents to the other that is carries
suitable public liability and property damage insurance, or
is self -insured in amounts adequate to cover any claim
within the limitations of Section 768.28 arising in
connection with the lease of the premises under this
Agreement and will continue to carry such insurance or
remain self -insured during the entire term of this
Agreement. Each party shall be responsible for any acts of
negligence on the part of its agents or employees. Each
party shall hold the other party harmless from all claims
arising from negligence of its agents, employees and
independent contractors in connections with this Agreement,
and shall defend the other party against all claims arising
out of such negligence of its agents, employees and
independent contractors under this lease.
56