Item N1BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: October 21, 2015 Department: Monroe_County Health Department
Bulk Item: Yes x No Staff Contact /Phone #: Mary Vanden Brook 809-5612
AGENDA ITEM WORDING:
Approval of the Contract between Monroe County Board of County Commissioners and the State of
Florida, Department of Health for operation of the Monroe County Health Department -- contract for
2015-2016.
ITEM BACKGROUND:
Review of annual contract and fee schedule for county funding of local health department.
PREVIOUS RELEVANT BOCC ACTION:
This is the annual renewal of an agreement between Monroe County and Florida Department of Health
that has continued for 20+ years.
CONTRACT/AGREEMENT CHANGES:
Fee Schedules and Attachments.
STAFF RECOMMENDATIONS:
Approval.
TOTAL COST: $1,091,804 INDIRECT COST:
DIFFERENTIAL OF LOCAL PREFERENCE:
COST TO COUNTY:
REVENUE PRODUCING: Yes No _
APPROVED BY: County Attorne
�t—
DOCUMENTATION: Included x
DISPOSITION:
Revised 6.15
BUDGETED: Yes x No
SOURCE OF FUNDS:
AMOUNT PER MONTH Year
OMB/PurchasingOMB/Purchasing Risk Management
Not Require
AGENDA ITEM #
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: MC Health Department Contract #
Effective Date: October 1, 2015
Expiration Date: September 30, 2015
Contract Purpose/Description:
Approval of the Contract between Monroe County Board of County Commissioners and
the State of Florida Department of Health - for o eration of the the Monroe Coqn1y Health
Department Contract year 2015-2016.
Contract Manager: Mary Vanden 305-809- MC Health Department
Brook 5612
(Name) (Ext.) (Department/Stop #)
for BOCC meeting on 10/21/2015 Agenda Deadline: 10/06/2015
CONTRACT COSTS
Total Dollar Value of Contract: $ 1,091,804. Current Year Portion: $
Budgeted? Yes® No ❑ Account Codes:
Grant: $ - -
County Match: $ - -
ADDITIONAL COSTS
Estimated Ongoing Costs: $ /yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Changes Date Out
Date In Needed Reviewer
Division Director Yes No
Risk Management Yes No
O.M.B./Purchasing Yes No
County AttorneyQL' Yes No
Comments:
UNlts roam Kevisea 2/2 //u i mt.;N #z
CONTRACT BETWEEN
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF THE
MONROE COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2015-2016
This contract is made and entered into between the State of Florida, Department of Health
("State") and the Monroe County Board of County Commissioners ("County"), through their
undersigned authorities, effective October 1, 2015.
RECITALS
A. Pursuant to Chapter 154, Florida Statutes, the intent of the legislature is to
"promote, protect, maintain, and improve the health and safety of all citizens and visitors of
this state through a system of coordinated county health department services."
B. County Health Departments were created throughout Florida to satisfy this
legislative intent through "promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health care for special populations."
C. Monroe County Health Department ("CHD") is one of the created County Health
Departments.
D. It is necessary for the parties hereto to enter into this contract in order to ensure
coordination between the State and the County in the operation of the CHD.
NOW THEREFORE, in consideration of the mutual promises set forth herein, the
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct
and incorporated herein by reference.
2. TERM. The parties mutually agree that this contract shall be effective from October 1,
2015, through September 30, 2016, or until a written contract replacing this contract is
entered into between the parties, whichever is later, unless this contract is otherwise
terminated pursuant to the termination provisions set forth in paragraph 8. below.
3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD
shall provide those services as set forth on Part III of Attachment li hereof, in order to
maintain the following three levels of service pursuant to section 154.01(2), Florida Statutes,
as defined below:
a. "Environmental health services" are those services which are organized and operated
to protect the health of the general public by monitoring and regulating activities in the
environment which may contribute to the occurrence or transmission of disease.
Environmental health services shall be supported by available federal, state and local funds
and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, and occupational health.
b. "Communicable disease control services" are those services which protect the health
of the general public through the detection, control, and eradication of diseases which are
transmitted primarily by human beings. Communicable disease services shall be supported
by available federal, state, and local funds and shall include those services mandated on a
state or federal level. Such services include, but are not limited to, epidemiology, sexually
transmissible disease detection and control, HIV/AIDS, immunization, tuberculosis control
and maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the collective health of the public, and prevent and control the spread of
disease. Primary health care services are provided at home, in group settings, or in clinics.
These services shall be supported by available federal, state, and local funds and shall
include services mandated on a state or federal level. Examples of primary health care
services include, but are not limited to: first contact acute care services; chronic disease
detection and treatment; maternal and child health services; family planning; nutrition; school
health; supplemental food assistance for women, infants, and children; home health; and
dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources is set forth in Part II of
Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
The State's appropriated responsibility (direct contribution excluding any state
fees, Medicaid contributions or any other funds not listed on the Schedule C) as
provided in Attachment II, Part II is an amount not to exceed $ 4,275,646
(State General Revenue, State Funds, Other State Funds and Federal Funds listed on the
Schedule C)_ The State's obligation to pay under this contract is contingent
upon an annual appropriation by the Legislature.
Y. The County's appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment II, Part II is an
amount not to exceed $ 1,091,804 (amount listed under the "Board of County
Commissioners Annual Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority, whichever is
less, (either current year or from surplus trust funds) in any service category. Unless
requested otherwise, any surplus at the end of the term of this contract in the County Health
Department Trust Fund that is attributed to the CHD shall be carried forward to the next
contract period.
2
c. Either party may establish service fees as allowed by law to fund activities of the CHD.
Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee
schedule. As allowed by law, Monroe County Health Department has established
Communicable disease control and Primary care services rates at 160% of the Medicare Fee
Schedule, rounded up to the next whole dollar. Monroe County Health Department has
established Environmental Health Services Fees in line with local recommendations and
economic factors.
d. Either party may increase or decrease funding of this contract during the term hereof
by notifying the other party in writing of the amount and purpose for the change in funding. If
the State initiates the increase/decrease, the CHD will revise the Attachment II and send a
copy of the revised pages to the County and the Department of Health, Office bf Budget and
Revenue Management. If the County initiates the increase/decrease, the County shall notify
the CHD. The CHD will then revise the Attachment II and send a copy of the revised pages
to the Department of Health, Office of Budget and Revenue Management.
e. The name and address of the official payee to whom payments shall be made is:
County Health Department Trust Fund
Monroe County
PO Box 6193
Key West, FL 33041
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator of
the CHD shall be a State employee or under contract with the State and will be under the
day-to-day direction of the Deputy Secretary for County Health Systems. The
director/administrator shall be selected by the State with the concurrence of the County. The
director/administrator of the CHD shall ensure that non -categorical sources of funding are
used to fulfill public health priorities in the community and the Long Range Program Plan. A
report detailing the status of public health as measured by outcome measures and similar
indicators will be sent by the CHD directorladministrator to the patties no later than October 1
of each year (This is the standard quality assurance "County Health Profile" report located on the Division of
Public Health Statistics and Performance Management Intranet site).
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that
the following standards should apply in the operation of the CHD:
a. The CHD and its personnel shall follow all State policies and procedures, except to the
extent permitted for the use of County purchasing procedures as set forth in subparagraph b.,
below. All CHD employees shall be State or State -contract personnel subject to State
personnel rules and procedures. Employees will report time in the Health Management
System compatible format by program component as specified by the State.
b. The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of County purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
3
services. In such cases, the CHD director/administrator must sign a justification therefore,
and all County purchasing procedures must be followed in their entirety, and such
compliance shall be documented. Such justification and compliance documentation shall be
maintained by the CHD in accordance with the terms of this contract. State procedures must
be followed for all leases on facilities not enumerated in Attachment IV.
c. The CHD shall maintain books, records and documents in accordance with the
Generally Accepted Accounting Principles (GAAP), as promulgated by the Governmental
Accounting Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and Procedures
for Records Management and shall be open for inspection at any time by the parties and the
public, except for those records that are not otherwise subject to disclosure as provided by
law which are subject to the confidentiality provisions of paragraph 6.i., below. Books,
records and documents must be adequate to allow the CHD to comply with the following
reporting requirements:
The revenue and expenditure requirements in the Florida Accounting
Information Resource (FLAIR) System;
ii. The client registration and services reporting requirements of the minimum
data set as specked in the most current version of the Client Information
System/Health Management Component Pamphlet;
N. Financial procedures specified in the Department of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported to
the CHD in a manner consistent with the client registration and service
reporting requirements of the minimum data set as specified in the Client
Information System/Health Management Component Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust Fund
maintained by the state treasurer. These funds shall be accounted for separately from funds
deposited for other CHDs and shall be used only for public health purposes in Monroe
County.
e. That any surplus/deficit funds, including fees or accrued Interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the State or County, as appropriate, based on the funds contributed by
each and the expenditures incurred by each. Expenditures will be charged to the program
accounts by State and County based on the ratio of planned expenditures in this contract and
funding from all sources is credited to the program accounts by State and County. The equity
share of any surplus/deficit funds accruing to the State and County is determined each month
and at contract year-end. Surplus funds may be applied toward the funding requirements of
each participating governmental entity in the following year. However, in each such case, all
surplus funds, including fees and accrued interest, shall remain in the trust fund until
0
accounted for in a manner which clearly illustrates the amount which has been credited to
each participating governmental entity. The planned use of surplus funds shall be reflected in
Attachment II, Part I of this contract, with special capital projects explained in Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy Secretary for
County Health Systems has approved the transfer. The Deputy Secretary for County Health
Systems shall forward written evidence of this approval to the CHD within 30 days after an
emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this contract. Any such subcontract shall include all
aforementioned audit and record keeping requirements.
h. At the request of either party, an audit may be conducted by an independent CPA on
the financial records of the CHD and the results made available to the parties within 180 days
after the close of the CHD fiscal year. This audit will follow requirements contained in OMB
Circular A-133 and may be in conjunction with audits performed by County government. If
audit exceptions are found, then the director/administrator of the CHD will prepare a
corrective action plan and a copy of that plan and monthly status reports will be furnished to
the contract managers for the parties.
L The CHD shall not use or disclose any information concerning a recipient of services
except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent to
this contract for a period of five (5) years after termination of this contract. If an audit has
been initiated and audit findings have not been resolved at the end of five (5) years, the
records shall be retained until resolution of the audit findings.
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law. The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65 and
456.057, Florida Statutes, and all other state and federal laws regarding confidentiality. All
confidentiality procedures implemented by the CHD shall be consistent with the Department
of Health Information Security Policies, Protocols, and Procedures. The CHD shall further
adhere to any amendments to the State's security requirements and shall comply with any
applicable professional standards of practice with respect to client confidentiality.
I. The CHD shall abide by all State policies and procedures, which by this reference are
incorporated herein as standards to be followed by the CHD, except as otherwise permitted
for some purchases using County procedures pursuant to paragraph 6.b.
m. The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial, modification or termination of services. The CHD
will advise applicants of the right to appeal a denial or exclusion from services, of failure to
take account of a client's choice of service, and of his/her right to a fair hearing to the final
governing authority of the agency. Specific references to existing laws, rules or program
manuals are included in Attachment I of this contract.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment Ill.
o. The CHD shall submit quarterly reports to the County that shall include at least the
following:
i. The DE3851-1 Contract Management Variance Report and the DE580L1
Analysis of Fund Equities Report;
ii. A written explanation to the County of service variances reflected in the
DE3851-1 report if the variance exceeds or falls below 25 percent of the
planned expenditure amount. However, if the amount of the service
specific variance between actual and planned expenditures does not
exceed three percent of the total planned expenditures for the level of
service in which the type of service is included, a variance explanation is
not required. A copy of the written explanation shall be sent to the
Department of Health, Office of Budget and Revenue Management.
p. The dates for the submission of quarterly reports to the County shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond the
CHD's control:
i. March 1, 2016 for the report period October 1, 2015 through
December 31, 2015;
ii. June 1, 2016 for the report period October 1, 2015 through
March 31, 2016;
id. September 1, 2016 for the report period October 1, 2015
through June 30, 2016; and
iv. December 1, 2016 for the report period October 1, 2015
through September 30, 2016.
7. FACILITIES AND EQUIPMENT. The parties mutually agree that -
a. CHD facilities shall be provided as specified in Attachment IV to this contract
and the County shall own the facilities used by the CHD unless otherwise provided in
Attachment IV.
b. The County shall ensure adequate fire and casualty insurance coverage for County -
owned CHD offices and buildings and for all furnishings and equipment in CHD offices
through either a self-insurance program or insurance purchased by the County.
N.
c. All vehicles will be transferred to the ownership of the County and registered as County
vehicles. The County shall ensure insurance coverage for these vehicles is available through
either a self-insurance program or insurance purchased by the County. All vehicles will be
used solely for CHD operations. Vehicles purchased through the County Health Department
Trust Fund shall be sold at fair market value when they are no longer needed by the CHD
and the proceeds returned to the County Health Department Trust Fund.
8. TERMINATION.
a. Termination at Will. This contract may be terminated by either party without cause
upon no less than one -hundred eighty (180) calendar days notice in writing to the other party
unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be
delivered by certified mail, return receipt requested, or in person to the other party's contract
manager with proof of delivery.
b. Termination Because of Lack of Funds. In the event funds to finance this contract
become unavailable, either party may terminate this contract upon no less than twenty-four
(24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or
in person to the other party's contract manager with proof of delivery.
c. Termination for Breach. This contract may be terminated by one party, upon no less
than thirty (30) days notice, because of the other party's failure to perform an obligation
hereunder. Said notice shall be delivered by certified mail, return receipt requested, or in
person to the other party's contract manager with proof of delivery. Waiver of breach of any
provisions of this contract shall not be deemed to be a waiver of any other breach and shall
not be construed to be a modification of the terms of this contract.
9. MISCELLANEOUS. The parties further agree:
a. Availability of Funds. If this Agreement, any renewal hereof, or any term, performance
or payment hereunder, extends beyond the fiscal year beginning July 1, 2016, it is agreed
that the performance and payment under this Agreement are contingent upon an annual
appropriation by the Legislature, in accordance with section 287.0582, Florida Statutes.
b. Contract Managers. The name and address of the contract managers for the parties
under this contract are as follows:
For the State:
Mary Vanden Brook, J.D.
Name
Administrative Services Director
Title
PO Box 6193
1100 Simonton Street
7
For the County:
Roman Gastesi
Name
County Administrator
Title
1100 Simonton Street
Key West, FL 33040
Address
305-809-5612
Telephone
Key West, FL 33040 T
Address
305-292-4441
Telephone
If different contract managers are designated after execution of this contract, the name,
address and telephone number of the new representative shall be furnished in writing to the
other parties and attached to originals of this contract.
c. Captions. The captions and headings contained in this contract are for the convenience
of the parties only and do not in any way modify, amplify, or give additional notice of the
provisions hereof.
In WITNESS THEREOF, the parties hereto have caused this eight page contract, with its
attachments as referenced, including Attachment I (two pages), Attachment II (six pages),
Attachment III (one page), Attachment IV (one page), and Attachment V (one page), to be
executed by their undersigned officials as duly authorized effective the 151 day of October,
2015.
BOARD OF COUNTY COMMISSIONERS
FOR MONROE COUNTY
SIGNED BY:
NAME:
TITLE:
DATE:
TITLE:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
SIGNED Y:
NAME: John H. Armstrono. D
TITLE: Surgeon General/Secretary of Health
DATE:
A 8,,ST d11 3'10 !1Y ,emu„ C RN EY
WnACHMENTI
MONROE COUNTYDEPARTMENT* _ . ; OF
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet (DHP 50-20), Environmental Health Coding Pamphlet (DHP 50-21) and FLAIR requirements
because of Federal or state law, regulation or rule. If a county health department is funded to provide one of these
services, it must comply with the special reporting requirements for that service, The services and the reporting
requirements are listed below:
Service
Requirement
1, Sexually Transmitted Disease
Requirements as specified in F.A.C. 64D-3, F.S. 381 and F.S
Program
384.
2.. Dental Health
Periodic financial and programmatic reports as specified by the
program office.
3, Special Supplemental Nutrition
Service documentation and monthly financial reports as specified
Program for Women, Infants and
in DHM 150-24' and all federal, stale and county requirements
Children (including the WIC
detailed in program manuals and published procedures.
Breastfeeding Peer Counseling
Program)
4. Healthy Start( Improved Pregnancy
Requirements as specified In the 2007 Healthy Start Standards
Outcome
and Guidelines and as specified by the Healthy Start Coalitions in
contract with each county health department.
5. Family Planning
Requirements as specified in Public Law 91-572. 42 U.S.C. 300,
et seq., 42 CFR part 59, subpart A, 45 CFR parts 74 & 92, 2 CFR
215 (OMB Circular A-110) OMB Circular A-102, F.S 381.0051.
F.A.C. 64F-7, F.A.C. 64F-16, and F,A.0 6417-19. Requirements
and Guidance as specified in the Program Requirements for Title
X Funded Family Planning Projects (Title X Requirements)(2014)
and the Providing Quality Family Planning Services (OFP):
Recommendations of CDC and the U, S Office of Population
Affairs published on the Office of Population Affairs website.
Programmatic annual reports as specified by the program office
as specified In the annual programmatic Scope of Work for Family
Planning and Maternal Child Health Services, including the Family
Planning Annual Report (FPAR), and other mnimum guidelines
as specified by the Policy Web Technical Asslstance Guidelines,
6. Immunization
Periodic reports as specified by the department pertaining to
Immunization levels 3"n kindergarten and/or seventh grade
pursuant to instructions contained in the Immunization Guidelines -
Florida Schools, Childcare Facilities and Family Daycare Homes
(DH Form 150-615) and Rule 64D-3.046; F.A.C. In addition,
periodic reports as specified by the department pertaining to the
surveillancefinvestigation of reportable vaccine -preventable
diseases, adverse events, vaccine accountabifty, and
assessment of immunization
ATTACHMENT I (Continued)
Attach t i- Page 1 of 1 i
levels as documented in Florida SHOTS and supported by CHD
Guidebook policies and technical assistance guidance..
Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4" and DHP 50-21"
HIV/AIDS Program Requirements as specified in F.S. 384.25 and F.A.C. 64D-3,030
and 64D-3.031. Case reporting should be on Adult HIV/AIDS
Confidential Case Report CDC Form DH2139 and Pediatric
HIV/AIDS Confidential Case Report CDC Form DH2140.
10. Tuberculosis
111General Communicable Disea
Control i
12. Refugee Health Program
Requirements as specified in F.A.C. 6413-2 and 64D-3, F.S, 381
and F.S. 384. Socio-demographic and risk data on persons
tested for HIV in CHD clinics should be reported on Lab Request
DH Form 1628 in accordance with the Forms Instruction Guide,
Requirements for the HIV/AIDS Patient Care programs are found
in the Patient Care Contract Administrative Guidelines.
Requirements as specified In the Florida School Health
Administrative Guidelines (May 2012). Requirements as specified
in F.S. 381.0056, F.S. 381.0057, F.S. 402.3026 and F.A.C, 64F-6.
Tuberculosis Program Requirements as specified in F.A.C. 64D-3
and F S. 392.
Carry out surveillance for reportable communicable and other
acute diseases, detect outbreaks, respond to individual cases of
reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified in
F.A.C. 6413-3, F.S. 381, F.S. 384 and the CHD Epidemiology
Guide to Surveillance and Investigations.
Programmatic and financial requirements as specified by the
program office.
'or the subsequent replacement if adopted during the contract period
n
ATTACHMENT II
MONROE COUNTY HEALTH DEPARTMENT
PART I. PLANNED USE OF COUNTY HEALTH DEPARTMENT TRUST FUND BALANCES
Estimated State Estimated County
Share of CHD Trust Share of CHD Trust
Fund Balance Fund Balance Total
1. CHD Trust Fund Ending Balance 09/30/15
2. Drawdown for Contract Year 410.092 1,228,535 1,638,627
October 1, 2015 to September 30, 2016
3. Special Capital Project use for Contract (916.844) (916, 844)
Year
O nhwr 7 9M� lR�eetpmhpl 3[l_ 9QIF! -
4. Balance Reserved for Contingency Fund
October 1, 2015 to September 30, 2015
410.092 311,691 721,783
Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects, and mobile health vans.
Attachment II_Pan_I - Pape 3 of 1 i
L GE111' RAL RMNUE - STATE
016040 AIDS PATIENT CARE
015949 M9S4V,9Vl:Pn'IQN4; SURIULLAINCP - C2N1,,VxUL R'E?Vuw-L
015010 AIDS NETWORK REIMBURSEMENT
016040 C It D TB COMMUNITY PROGRAINA
016040 SEXUALLYTRi�NSMITTED DISEASE CONTROL PROGIUkM. GR
0150,10 ALG/CESSPOOL IDENTIMCATION & rL[MINATION PROG
0150,10 FAMiLY PLANNING GENERAL REVENUE
016040 HEPATITIS AND LIVER FAILURE PREVENTION & CONTROL
018040 PRTMARV CARE PROGRAM
0150,10 SCHOOL HEALTH SERVICES - GENERAL REVENUE
01605b Cl I D G [�NERAJ, REVENUE NON, CATEGORICAL
GENEIAL tEVFNUF TOTAL
Z NON GENERAL REVENUE - STATE
016010 STATE UNDERGROUND PETROLEUM RESPONSE ACT
015010 PNVIRO'4,NIENTALBIGMEDICAI,WAgrEPROGRANI
015010 TOBACCO STATE AND COMMUNM TNTERVFNTIONS
NON GENERAL REVENUE TOTIJ,
R. FEDERAL FUNDS - STATE
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN
007000 AIDS DRUG ASSMANCE PROG 10,M ADMFN HQ
007000 AIDS SURVEILLA.NCE - CORE
007000 VVI C BREASTFEEDING PEER COUNSELING PROG
007000 COASTAL BEACH WATER QUALITY MONITORING
007(M COMPREHENSIVE COMMUNITY CARDIO - PKBG
007000 FAMILY PLANNING TITLE X - GRANT
007000 HOUSING OPPOR!rUNITIES FOR PERSONS WITH AIDS
007000 IMMUNIZATION ACTION PLAIN
007000 NICH SPECIAL PRJCT UNPLANNED PREGNANCY
007000 MCH SPECIAL PROJECTP10LNIS
007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC
W7000 AIDS PREVENTION
007000 RYAN WI I VTE,ro,ro,F If I' ARE GRANT
00-1000 RYAN WHITE TITLE 11 GRANTICHD CONSORTIUM
007000 WIC PROGIb"I ADMINISTRATION
015075 INSPECTIONS OF SUMMER FEED�NG PROGRAM - DOE
015075 SUPPLEMENTAL SCHOOL HEALTH
015075 REFUGEE HEALTH SCREENING RUIMBURSFMFNT
YEDERAL FUNDS TOTZI
001020 CHD STATEWIDE ENVIRONMENTAL FEES
001092 CHD STATEWIDE ENVIRONMENTAL FEES
001206 ON141TESEWAVET)ISPOSALPERMII'FEL-,S
001206 SA-NITATIONCERTIFICATES WOOD INSPE(.'TION)
:170,000
0
370,000
0
370,000
73,652
G
73,552
0
73,582
2.69,200
0
259,200
D
M9,200
16,784
0
15,784
0
16,704
10755
0
16,755
0
16,765
h3,766
0
RH766
a
B3,766
32,G78
0
32,678
0
3Z678
72,000
0
72,000
0
722, DO U
1913,742
0
199,742
0
19R742
96,223
0
96,223
0
96,223
1, 1K212
0
1,184242
0
1, 184„242
2,373941
0
2,373,942
0
2,373,942
11726
a
1336
a
1,736
3,719
0
3,719
0
3,719
118,154
11
118,154
41
118,154
123,609
0
123,609
0
123.609
26,582
0
26,582
0
263 682
6907
0
5,907
0
6,907
1562
0
1.662
0
1,562
55,777
0
55,777
0
55,777
19,439
a
18,439
0
18,139
35,000
0
36,000
0
35,000
57,525
0
57,625
0
57,526
39:3,965
11
393,9&5
0
393,965
8,624
0
8,624
a
0,624
75
0
75
0
75
20,R16
0
20,H16
0
20,816
95,753
0
05,753
0
95,753
L 18,700
0
118,7110
0
118,700
80857
0
80457
0
80,857
482,143
0
482,143
0
482,143
XIT944
0
.337,944
0
337,944
129
0
129
D
129
123,839
0
123A39
0
123,839
144,591
0
144,591
0
144,591
2008,228
0
2,008,228
0
2,008,220
92,849
D
92,840
0
92,849
160,264
41
150.264
0
160,264
12,000
0
12,000
0
12, DOO
2,000
0
2,000
0
2,000
Attadmant-I I- Part- 11 - Page 4 of I I
001206 SEPTIC TANK RESEARCH SURCHARGE
001206 SEPTIC TANK VARIANCE FEES 60%
001206 PUBLIC SWIMMING POOL PERMIT FEES-! 0% HQ TRANSFER
001206 DRINKING WATER PROGRAM OPERATIONS
001206 REGULATION OF BODY PIERCING SALONS
001206 TANNING FACILITIES
001206 ONSITE SEWAGE TRAINING CENTER
001206 TATTO PROGRAM ENVIRONMENTAL HEALTH
001206 MOBILE HOME & RV PARK FEES
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL
S. OTHER CASH CONTRIBUTIONS - STATE:
090001 DRAW DOWN FROM PUBLIC. HEALTH UNIT
OTHER CASH CONTRIBUTION TOTAL
6. MEDICAID - STATWCOUNTY:
001057 CHO CLINIC FEES
001148 CHD CLINIC FEES
MEDICAID TOTAL
7. ALLOCABLE REVENUE - STATE.,
01"0 CHD LOCAL REVENUE & EXPENDITURES
0370DO RYAN WHITE TITLE III - DIRECT TO CHD
ALLOCABLE REVENUE TOTAL
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND STATE
ADAP
PHARMACY DRUG PROGRAM
WIC PROGRAM
BUREAU OF PUBLIC HEALTH LABORATORIES
IMMUNIZATIONS
OTHER STATE CONTRIBUTIONS TOTAL
9. DIRECT LOCAL CONTRIBUTIONS - BCCITAX DISTRICT
008005 CHD LOCAL REVENUE & EXPENDITURES
00M05 IMMUNIZATION CAMPAIGN MONROE COUNTY BOCC
DIRECT COUNTY CONTRIBUTIONS TOTAL
10, FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION COUNTY
001025 CHD CLINIC 17EES
ODI073 CHI} CLINIC FEES
001077 CHD CLINIC FEES
001094 CHD LOCAL ENVIRONMENTAL FEES
001110 VITAL STATISTICS CERTIFIED RECORDS
FEES AUTHORIZED BY COUNTY TOTAL
626
0
625
0
525
50
D
50
0
rlo
5,000
0
6,000
0
5,000
12
0
12
0
12
60
0
60
0
60
117
0
117
0
117
18
0
18
0
18
956
0
955
0
955
2,004
0
2,004
a
2,004
265,554
0
266S54
0
265,854
0
0
0
0
0
0
0
a
0
D
0
0
0
0
a
0
720
720
0
720
0
36,863
36963
0
36,863
0
37,693
.117,58d
0
3ZB&�
Boo
0
600
0
500
aso
0
350
0
360
850
0
850
0
aso
0
0
0
620,603
620,603
0
0
a
69,071
696071
0
0
0
1,007,M-)
1007,122
0
0
0
1 I'm
11,062
0
0
0
677,463
677,463
0
0
0
2,385,321
2385321
0
8OIA90
801,890
801,RgD
0
289,914
289,914
0
289,914
0
1,09-mm
1,091,804
0
1,091,804
0
691
691
0
691
35,000
36,000
0
95,000
0
104,256
104,256
0
104,256
0
137A27
137,69-7
0
137,62.7
0
73,000
73,()00
0
73,OW
0
350,574
350,574
0
350J)74
Aftadm*rrLlLPsrLll - Pop 5 of I I
001029 CHD CLINIC FEES
001090 CHD CLINIC FEES
005000 CHU LOCAL REVENUE & EXPENDITURES
007010 RYAN WHITE TITLE III ® DIRECT TO CHD
007010 RYAN WHITE TITLE III - DI TO CHD
010800 CHU STATEWIDE ENVIRONMENTAL FEES
010300 CHD LOCAL ENVIRONMENTAL FEES
0103GO CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT
010400 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT
010500 CHD SALE OF SERVICES IN OR OUTSIDE OF. ATE GOVT
011000 SMOKE FREE HOUSING GRANT
011001 CHD 14FALTHY SMART COALITION CONTRACT
012020 CHD LOCAL REVENUE & EXPENDITURES
09M02 DRAW DOWN FROM PUBLIC HEALTH UNIT
OTHER CASH AND LOCAL CONTREBUTIONE, TOTAL
12, ALLOCABLE REVENUE - COUNTY
018000 CHD LOCAL REVENUE & EXPENDITURES
037000 RYAN WHITE TITLE III - DIRECT To CHD
COUNTY ALLOCABLE REVENUE TOTAL
13. BUILDINGS - COUNTY
ANNUAL RENTAL EQUIVALENT VALUE
OTHER (Specify)
UTILITIES
BUILDING MAINTENANCE
GROUNDS MAINTENANCE
INSURANCE
OTHER (Specify)
OTHER (Specify)
BUILDINGS TOTAL
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND COUNTY
EQUIPMENT I VEHICLE PURCHASES
VEHICLE INSURANCE
VEHICLE MAINTENANCE
OTHER COUNTY CONTRIBUTION (SPECI M
OTHER COUNTY CONTRIBUTION (SPECIFY)
OTHER COUNTY CONTRIBUTIONS TOTAL
GRAND TOTAL CHD PROG RAM
0
245,830
245,930
0
245,830
0
120,970
120,970
0
120,970
0
11,000
[L000
0
11,000
a
146,0DO
145,00t)
0
145,0m
0
369,483
369,483
0
369,483
0
204
204
0
204
0
1's10
1,510
0
1,610
0
71,602
71,602
0
71,602
0
4,200
4,200
0
4,200
0
70.391
70,391
0
70,391
0
24,425
24,425
0
24,426
0
290,000
290,00D
a
290,000
0
15
15
0
is
0
916,044
916,844
0
916,844
0
2-271,474
2,271474
0
2,271,474
0
600
Soo
0
500
0
351)
350
Q
m
0
85D
850
0
850
0
0
0
597,606
597,606
0
0
0
0
0
0
0
0
83,369
83,369
0
0
0
75,2223
75223
0
0
0
11fi,566
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
a
0
0
671,70
871,763
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4,772j483
3,752,285
8,524,768
3257,084
11,781,062
A. COMMUNICABLE DISEASE CONTROU
IMMUNIZATION TION UDD
9.65
5,724
8,360
210,578
252,612
2IG,678
252,611
8,624
929,755
938,379
SEXUALLY T S. HIS. 1102)
ITS
274
40
50,681
35,765
16)01
35,786
123.568
9,374
132,932
KIWAIDS PREVENTION (03AI)
4.07
Wffi
632
79,
92,498
7%m
92,497
102,252
15LB51
3143,603
HIVtAIDS SUR .IT CE (03A€)
0.04
22
30
122
Sot
722
842
1 562
1,666
3,128
111WAIDSPATt E (0,"IA3)
18.21.
479
4,338
ni,825
740,446
634, ""
740,445
ZIS8,939
611902
2,760,541
ADAP (0 4)
1.32
15
210
21,636
25,235
21,635
25,234
93,616
123
93,739
€IERCULOSIS (104)
1.04
26
162
21;158
24,678
21.168
24,678
15,7&1
76,888
91,072
Comm [)15.SCIRV, (106)
0.87
0
B67
18,966
22,110
18,966
2&110
0
8%132
82,132
HEPATITIS (1 J)
162
245
357
30,926
39,071
30,926
30,071
?Z000
61994
133,VJ4
PREPAREDNESS AND RESPONSE (116)
3.21i
0
6,017
66,477
76,371
65,477
76,372
95,763
18T944
293,697
RR CEEH INI (Il8)
1,97
398
904
50,813
59,267
SAIRS
59,268
219,978
HIS
2,hu,161
VITAL RECORDS (100)
104
1.516
4,816
17, M
20,795
17,ILn
-0,79A
0
77,248
77 248
COMM'UNICABLE DISEASE ST
42.85
9,D&I
29,6.52
1.188,9IX
L386,710
1 198,I
1386,708
2,982,096
2,189,160
5,161,
E, PRIMARY
CHRONIC DISEASE PRE%TMION PRO (210)
9 V2
0
0
1 335
1.ma
1;335
1,558
3&408
2,378
k786
WIC (21WI)
5.35
4,521
IA595
90,
114313
98,007
114,313
42.1,6,10
0
424010
TOBACCO USE INTERVENTION (212)
209
0
112
45554
53,134
45,654
53,114
197,376
0
197,376
WIC HHEASTFEis11ING PECK COUNSELING (21W?J
0.47
0
620
16,179
17„705
15,179
17,70.5
65,768
0
65,768
FAMILY PLANNING (220
3.&1
1030
I'sw
87,652
1OZ270
87682
102,289
327556
52,347
379,903
IMPROVED PREGNANCY OUTCOME (22,1C
0.00
0
0
3,M
4,010
3,9137
4,W2G
17,186
0
I7,im
HMTIPV START PRENATAL (227)
3.38
8 0
5ASO
64,699
63.800
64,MD
63.8w0
236,
236,998
COMIPREHENS[VECUI HEALTH (219)
LLUO
0
0
20
24
20
24
as
0
88
HEALTHY START CHI (23C
Z93
8.'S7
4,204
44,94`2
52,-:
40,12
62,302
10,426
180,M53
194,289
SCHOOL HEALTH (234)
5,03
0
144,270
70,8121e3
83,107
73.82E
93,107
' ,062
125,804
345„866
CCMPREHENS1VE ADULTH .TU (Z17)
391
373
1,317
88,278
102,965
88,278
102,965
199,742
182,744
382-486
COMMUNITY HEALTH DEVELOPMENT (238)
101
0
947
26,097
30,404
26,007
30,404
0
I12,942
1L2,942
DENTAL HEALTH (240)
&00
0
6
0
0
0
0
0
0
0
PRIMAPY CARE SUBTOTAL
2773
8,6111
177,406
645,466
636,209
545,456
M8,2U7
1,409=2
69•076
9-363,329
C. ENVIRONMENTAL HEALTH:
water and Onaits sawav propman
COSTAL BEACH MONITORING (347)
0.36
384
3859,
13 181
9,1BM
11,181
18,439
23,06
41,634
LLMIT D USE PUBLIC WATERSY EhiS (357)
0.00
0
0
0
0
0
0
0
0
0
PUBLIC WATER SYSTEM (36W
000
0
0
168
184
168
183
0
683
683
PfUVATEWATER SYSTEM (369)
0.0D
0
0
0
p
0
0
0
0
0
C3NSITESEWAGE TR 3AIN DISPOSAL (361)
463
1A77
1,605
74,077
86,402
74,077
60, 01
202,7M
118,191
320,957
Group Total
4.91
2,261
3,
83,821
97,767
13.3,821
97,766
221,206
141,969
383,174
Facility Programs
TATM FACILITY SERVICES (344)
0.12
1)
3
2,043
2,393
2,043
2,384
4,500
4,353
8,853
FOOD HYGIENE (34
AW
A,.
'1
10,A70
12,679
10,am
12,
17.E#3
29,166
47,099
BODY PIERCING FACILITIES SERVICES (349)
0.p-
8;
1
316
369
316
3619
9I5
455
1,570
Aft 1l 8C Pago7ofll
OM
17
27
1,556
1,818
1,558
18i8
0
6,752
6,752
0.00
0
0
4
0
0
0
a
0
a
0.00
0
a
a
0
0
0
0
0
0
0.56
143
349
8,759
10216
9,759
10,217
16,798
19,153
37.961
2.62
nos
2,091
39,119
45,627
39119
45,627
4ZOGO
126,692
169,492
0,62
292
316
&291
9,670
8,29E
91670
11,810
24,112
35,922
O.OI
2
3
143
167
141
Ica
454
167
921
4.68
1418
3,127
71,099
82,929
71,0999
92,933
97.22E
210M0
SW,060
1,62
M
III
27,9?9
32088
27,939
3209
0
ULM
121,055
0.8D0
0
0
0
0
0
a
0
0
q}
1.82
213
411
27,939
32,588
27,039
32,089
a
121,055
121055
1,310
0
495
25,754
X039
25,754
30,040
0
111M7
111.587
Roo
0
O
0
0
0
0
0
0
0
OAD
0
0
0
a
a
0
0
0
0
0.1%D
a
0
0
0
a
11
0
0
0
0,00
0
0
0
0
a
0
0
it
0
0.18
39
113
3I°°V
3,647
V27
.i,648
0
13,647
13,547
0.05
1
16
745
870
715
870
a
3,230
3,2.30
000
a
0
a
0
0
O
O
0
0
O-on
a
0
0
0
0
0
0
0
0
o.d1
a
0
0
0
a
0
0
0
0
UO
a
0
89
L04
89
104
0
O,OD
0
a
139
12
139
162
4
00'2
0,82
47
47
16,IN
17,722
15.194
17,723
a
MAIM
1 ,8xi
2.40
97
671
45,048
62,544
45,W8
02,545
0
195,165
195,185
13.41
3,019
8,2129
227.Wl
4-66,528
227907
265,832
318,425
669,049
987,474
000
0
0
0
0
0
0
a
0
0
000
O
0
li'241
Is,122
5,249
0,121
22,741
0
22341
000
0
a
0
0
0
a
0
a
0
0.00
0
0
5,241)
6,122
6,249
6,121
22,741
0
22,741
W.99
20,623
212,2A7
1,967,516
2,294.B69
1967,516
2UNAM
4,772,484
11,752,71IS
8,624,769
AN9d JLPasd 69i - Page a o1 I
ATTACHMENT III
MONROE COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period); if so requested by the department,
The applicant assures that it will comply with:
I Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C_„ 2000 Et seq., which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U,S.C. 794, which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance.
1 Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance.
4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5- The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees
for the period during which such assistance is provided. The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in violation of the above statutes, regulations, guidelines, and
standards. In the event of failure to comply, the applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, to include assistance being terminated and further assistance
being denied.
Allachment__ I if - Page 9 of 11
ATTACHMENT IV
MONROE COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Gato BUilding: Administration, Clinic,
Healthy Start, Vital Statistics
Roosevelt Sands Center Clinic, WIC
Location Owned By
1100 Simonton Street, Key West, FL Monroe County
33040
105 Olivia Street, Key West, FL 33040 City of Key West subject to interlocal
agreement with Monroe County for FLOOH-�
Monroe use
Juvenile Justice Building; Environmental 5503 College Road, Key West, FL 33040
Health
Murray E, Nelson government Center; 102050 Overseas Highway, Key Largo; FL
Environmental Health 33037
Ruth Ivins Center Clinic, Environmental 3333 Overseas Highway, Marathon, FL
Health 33050
Roth Building: Clinic 50 High Point Road, Tavernier, FL 33070
Monroe County
Monroe County
A t1V - Page Iaoftt
QQNTRACT YEAR
2014-2015•
2015-2016"
2016-2017••'
2017-2016•••
PROJECT TOTAL
ATTACHMENT V
MONROE COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
n/a 0
nia 0
S_ nla $
S nta 0
S n1a 0
SPECIAL PROJECTS CONSTRUCTIOWRENOVAnON
NEW BUILDING
ROOFING
RENOVATION
PLANNING STUDY
NEW ADDITION
OTHER
0
scribe scope of work in reasonable detail
START DATE flnim expeamom orfunds)
Special Capital Projects are now construction or renovation projects and now furniture or equipment associated with these projects and
mobile health vane.
Cash balance as of 9W115
Cash to be transferred to FCO account
—Cash anticipated for future contract years.
r�!i�'tnYTiir'ij�T�l* ++
FEE RESOLUTIONS 2015-2016
Im
PURPOSE: To establish public health service fees in order to expand existing public health services
to the community at large.
A. PRIMARY CART~ SERVICES.
(1) Primary care and ancillary services include well and sick adult and child health
services and family planning services. These services will be charged at not more
than 160% of the prevailing Medicare rate. Where there is no Medicare fee, the fee
will be the Medicaid rate. Service levels will be determined utilizing current Medicare
guidelines for coding and billing services provided. Discounting adjustments will be
made to client fees based upon the current contract for services with Medicare and
other 3'd party payers. In addition, sliding scale adjustments to fees for primary care
services will be based upon Federal OMB guidelines and in accordance with State of
Florida Department of Health Policy 56-66-13. Medicaid is billed at the current
Medicaid Cost -based rate and reimbursement for these services is considered
payment in full.
(2) Pharmacy — Medications issued will be provided at the most recent cost. Medicaid
reimbursement is accepted as payment in full.
(3) Injection fee for parenteral medications per Injection $ 35
(4) Lab fees - All laboratory and pathology fees are subject to
sliding scale fee adjustment based upon OMB Federal
Guidelines.
I. Specimens tested in clinic -(hemoglobin, urine,
blood sugar, mono, wet mount, strep) $ 10
ii. Pregnancy test No charge
B. COMMUNITY PUBLIC HEALTH SERVICES
(1)
Tuberculosis X-ray for suspected, confirmed or
Symptomatic contact or case
No charge
(2)
Tuberculosis Skin or blood Test for suspected, confirmed or
Symptomatic contact or case
No charge
(3)
Tuberculosis (TB) Sputum Culture for suspected, confirmed,
or symptomatic contact of case
No charge
(4)
Tuberculin (TB) Skin or blood Test, with reading, any other
than listed above in C. (1).
$ 35
(5)
Tuberculin assessment of clients with a past history of
positive skin test
$ 35
(6)
Sexually Transmitted Diseases —The fee below will be
adjusted considering the client sliding fee group which is
calculated at eligibility determination, based on Federal
OMB Guidelines. Medicaid identification will be accepted as
full payment in lieu of charges
i. Office/Outpatient Visit, New
$ 178
Pagel of 5
Monroe County Health Department Core Contract 2015-2016
ii. Office/Outpatient Visit, Established $ 117
(7) Required Vaccines for children up to age 18 and eligible for No Charge
the Vaccine for Children program
(8) Vaccine administration fee (child or adult) other than item $ 23.50
11 below
(9) County sponsored vaccinations for TdAP, HPV, Seasonal Flu, No Charge for
and population -specific needs for Pneumonia for uninsured residents earning
or underinsured residents 400% of Federal
Poverty Level or less
(10)County sponsored immunizations for uninsured Take Stock No Charge
in Children's Experiment in International Living Scholarship
recipients
(11)Seasonal Flu vaccinations for those not covered in items 7 $ 22 product + $10
or 9 above Admin fee = $ 32 total
charge
(12) All other Immunizations not covered in items 8, 9, 10 above
Cost of vaccine x 2 +
$23.50 injection fee
(13) Class/Seminar attendance registration per person charge
for health care, social work and counseling employees
I. AIDS 101
No Charge
il. AIDS 500
No Charge
iii. AIDS 501
No Charge
(14) International Certificates of Vaccination
Cost x 3.5
C. VITAL STATISTICS
(1) Birth Certificates
$ 16
(2) Additional Birth Certificate Copies
$ 16
(3) Protective Covers
$ 4
(4) Death Certificates — Certified Copy
$ 13
(5) Additional Death Certificate Copies
$ 13
(6) Express Fee
$ 10
D. MEDICAL RECORDS
Copying of Medical Record (per page)
$1
E. PUBLIC RECORDS
Copying of Public Record (per page)
$ 1
A service fee of
F. RETURNED/DISHONORED CHECKS: (S 215.34(2) F.S)
$15 or 5%of the
face amount of the
check, draft, or
money order
Page 2 of 5 Monroe County Health Department Core Contract 2025-2016
whichever is
greater, not to
exceed $150
G. PUBLIC HEALTH AND MEDICAL PREPAREDNESS
Submission and Review of Required Annual Comprehensive
Emergency Management Plan for Home Health Agencies,
Fee Schedule, Environmental Health County Fee List
(In addition to State Fees on alternate Fee Schedule)
I. ONSITE SEWAGE DIPOSAL PROGRAM (OSTDS) County Fee
a.
Application and plan review for construction permit for
$ 100
new systems
b.
Application and approval for existing system, if system
$ 10
inspection not required.
c.
Application and Existing System Evaluation with inspection
$ 50
d.
Application for permitting of an new Performance -based
$ 75
treatment system
e.
Site Evaluation
No charge
f.
Site re-evaluation
$ 40
g.
Permit or permit amendment for new systems
$ 25
h.
Initial system inspection
$ 50
i.
System re-i nspectio n (stab il iz ation, non-compliance, or
$ 25
other inspection after initial inspection.
j.
Research fee (State Fee)
No charge
k.
Repair Permit with Inspection
$ 50
I.
Application for system abandonment permit
$ 45
m.
Tank manufacturer's inspection per annum
$ 20
n.
Amendment to an Operating Permit
No charge
o.
Septage Disposal Service Permit per annum 2X per yr
$ 45
inspection
p.
Portable or temporary toilet service permit per annum
$ 45
q.
Additional charge per pump out vehicle
$ 5
r.
Annual operating permit industrial/manufacturing zoning
No charge
or commercial sewage waste
s.
Biennial Operating permit for aerobic treatment unit or
No charge
performance -based treatment system
t.
Aerobic treatment unit maintenance entity permit per
No charge
annum
u.
Variance application for a single family residence per each
$100
lot or building site
v.
Variance application for a multifamily or commercial
$ 140
building site
w.
Inspection for construction of an Injection well (FL Keys)
$ g5
Page 3 of 5 Monroe County Health Department Core Contract 2015-2016
x. OSTDS Operating Permit Late Fee (45 days past due) $ 50
y. Per request -Expediting -Fast Track Permitting New & $ 500
Existing (48 hour turn -around) Charged in addition to state
fee
z. Letter of Coordination for development review $ 250
committees
aa. Expedited OSTDS Variance Processing. Received within 6 $ 500
days of monthly deadline. Charged in addition to state fee
bb. OSTDS PETS screening test fee $ 25
II. PUBLIC SWIMMING POOLS
a. Annual permit- up to and including 25,000 gallons $ 115
b. Annual permit - more than 25,000 gallons $ 100
c. Non routine Inspection (no charge for first inspection $ 100
d. Exempted condominiums/Cooperatives with over 32 units $ 25
Ill. MOBILE HOME & RECREATIONAL VEHICLE PARKS
a. Annual permit for 5 to 25 spaces $ 125
b. Annual permit for 26 to 149spaces $3.50 per space
c. Annual permit for 150 and above spaces $ 400
IV. FOOD ESTABLISHMENTS
a.
Annual Permit for Fraternal/Civic
$ 35
b.
Annual Permit School Cafeteria Operating for 9 months or
$ 105
less
c.
Annual Permit School Cafeteria Operating for more than 9
$ 125
months
d.
Annual Permit for Movie Theaters
No charge
e.
Annual Permit for Jails/Prisons
No charge
f.
Annual Permit for Bars/Lounges
$ 35
g.
Annual Permit for Residential Facilities
$ 65
h.
Annual Permit for Limited Food Service
$ 115
I.
Child care center
$ 40
j.
Caterer
$ 45
k.
Mobile Food Units
$ 45
1.
Other Food Service
$ 35
m.
Vending machine dispensing potentially hazardous food
No charge
n.
Plan review per hour public schools, colleges, and
$ 20
vocational teaching facilities are exempt from this fee
o.
Food establishment worker training course per person
No charge
p.
Alcoholic beverage inspection approval
$ 15
q.
Request for inspection
$ 10
r.
Re -inspection (for each re -inspection after the first)
No charge
s.
Temporary event food service establishment
$ 100
(a)sponsor w/o existing sanitation certificate
t.
b) vendor or booth at an establishment or location w/o an
$ 50
Page 4 of 5
Monroe County Health Department Core Contract 2015-2016
existing sanitation certificate
u. Late renewals
$ 15
V. BIOMEDICAL
a. Generators
$ 40
b. Storage Facilities
$ 40
c. Late Fee
$ 20
VI. TANNING FACILITIES
a. Annual Permit
$ 100
b. Fee per Device
No charge
c. Consultation
$ 50
d. Late Renewal Fee
No charge
VII. BODY PIERCING ESTABLISHMENTS
a. License Fee
$ 100
b. Temporary Establishment
$15
c. Late fee
No charge
d. Consultation
$ 50
Vlll. HEALTHY HOMES PROGRAM
a. Healthy home Assessment Voluntary Inspection living
$ 300
unit(radon, CO2, Mold Safety)
b. Public Education -Per Attendee
$ 25
Page 5 of 5 Monroe County Health Department Core Contract 2015-2016