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FY1994 10/20/1993 STANDARD CONTRACT BETWEEN /9 9 3 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES Pursuant to the Laws of Florida, Chapter 83-177 and 154, F.S. as revised, this contract is entered into between the Department of Health and Rehabilitative Services, hereinafter referred to as the "department", and Monroe County, hereinafter referred to as the "county" . This contract stipulates the services that will be provided by the county public health unit, hereinafter referred to as the CPHU, the sources and amount of funds that will be committed to the provision of these services, the administrative and programmatic requirements which will govern the use of these fund, and the respective responsibilities of the department and the county in enabling the CPHU "to promote, protect, maintain, and improve the health and safety of the citizens and visitors through promotion of the public health, the control and eradication of preventable diseases, and the provision of primary health care for special populations. " I. General Provision: Both parties agree that the CPHU shall: conditions A. Provide in Attachment services according a and rdall others attachments specified ithis contract; and B. Fund the services specified in Attachment II, Part III, at the funding level specified for each program service area in that attachment. II. Federal State Laws and Regulations: Both parties agree that the CPHU shall: A. Comply with the provisions contained in the Civil Rights Certificate, hereby incorporated into this contract as Attachment III; B. Comply with the provisions of 45 CFR, Part 74, and other applicable regulations if this contract contains federal funds; C. Comply with all applicable standards, orders, or regulations issued pursuant to the Clean Air Act as amended (42 USC 1857 et seq. ) and the Federal Water 1 Pollution Control Act as amended (33 USC 1368 et seq. ) , if this contract contains federal funds and the total contract amount is over $100, 000; and D. comply with applicable sections of Chapter 427, Florida Statutes, (Transportation Services) and Chapter 41-2, Florida Administrative Code, (Coordinated Community Transportation Services) regarding the provision of transportation services for the transportation disadvantaged if this contract contains any state, federal or local funds which are used to provide for direct or indirect (ancillary) transportation services. III. Records, Reports and Audits: Both parties agree that the CPHU shall: A. Maintain books, records and documents in accordance with accounting procedures and practices which sufficiently and properly reflect all expenditures of funds provided by the department, the county and other sources under this contract. Books, records and documents must be adequate to enable the CPHU to comply with the following reporting requirements: 1. The revenue and expenditure requirements in the State Automated Management Accounting System 2.2; 2. The client registration and services reporting requirements of the minimum data set as specified in the Client Information System/Health Management Component Manual and any revisions subsequent to the January 1, 1984 version, or the equivalent as approved by the State Health Office. Any reporting system used by or on behalf of the CPHU to produce the above information must provide data in a machine readable format approved by the department which can be transferred electronically to the Client Information System; 3. The CPHU is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported back to the CPHU in a manner consistent with the client registration and service reporting requirements of the minimum data set as specified in the Client Information System/Health Management Component Manual and any revisions subsequent to the January 1, 1984 version; 4. Financial procedures specified in the department's Accounting Procedures Manuals 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 periods specified by the department; and 6. Any other state and county program specific reporting requirements detailed in attachments to this contract. B. Assure these records shall be subject during normal business hours to inspection, review or audit by state or county personnel duly authorized by the department or the county, as well as by federal personnel; C. Retain all financial records, supporting documents, statistical records, and any other documents pertinent to this contract in conformance with the retention schedules required in HRSM 15-1, "Records Management Manual"; D. Allow persons duly authorized by state or county, and federal auditors, pursuant to 45 CFR, Part 74.24 (a) , (b) , and (d) to have full access to, and the right to examine and of said records and documents during said retention period; and E. Include these aforementioned audit and record-keeping requirements in all approved subcontracts and assignments. Both parties further agree that: The department shall provide uniform financial statements of program account balances for each level of service on a quarterly basis to the county and to the director or administrator of the CPHU. IV. 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. V. Safeguarding Information: Both parties agree that the CPHU shall not use or disclose any information concerning a recipient of services under this contract for any purpose not in conformity with the state law, regulations or manual (HASH 50-2 Security of Data and Information Technology) and federal regulation (45 CFR, part 205.50) , except by written consent of the recipient, or 3 his/her responsible parent or guardian when authorized by law. VI. Assignments: Both parties agree that the CPHU shall not assign the responsibility of this contract to another party without prior written approval of the department and the county. No such approval by the department and the county of any assignment shall be deemed in any event or in any manner to provide for the occurrence of any obligation of the department or the county in addition to the dollar amount agreed upon in this contract. All such assignments shall be subject to the conditions of this contract and to any conditions of approval that the department and the county shall deem necessary. VII. 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 subcontract shall not be for more than ten (10) percent of the total value of this contract. In the event that the CPHU needs to execute a subcontract for an amount greater than ten (10) percent of the value for this contract, both parties to this contract must agree in writing to such a subcontract prior to its execution. No subcontracts shall be deemed in any manner to provide for the occurrence of any obligation of the department or the county in addition to the total dollar amount agreed upon in this contract. All such subcontracts shall be subject to the conditions of this contract and to any conditions of approval that the department and the county shall deem necessary. VIII. Payment for Services: A. The department agrees: To pay for services identified in Schedule "C" of the operating budget (General Revenue and Federal) , and reflected in Attachment II, Part II, as the State's appropriated responsibility in an amount not to exceed $ 2,470,416 ; and the State share of all state authorized fees in an anticipated amount of $ -0- In addition, all "OTHER" state revenues from whatever sources to be appropriated to the HRS County Public Health Unit Trust Fund for services to be provided by the county health unit in an amount of—$ 328,347 , for 4 a grand total State cash contribution of $ 2.798,763 - 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 $ 281 ,716 In addition the county shall provide its share of all county authorized fees in an anticipated amount of $ 250,700 These amounts, plus any "OTHER" local revenues in the amount of $ 416,600 includes all revenues from whatever sources to be appropriated to the HAS County Public Health Unit Trust Fund for services to be provided by the county health 9uni0It 6 for a grand total county cash contribution of $ IX. The department and the county mutually agree: A. Effective date: 1. This contract shall begin on October 1, 1993 or the date on which the contract has been signed by both parties, whichever is later. 2. This contract shall end on September 30, 19yUL. S. 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 than 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 than 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, 5 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. C. Notice and contact: The contract manager for the department for this contract is _Staphan1a a waltan S RN Administrator. The representative of the county for this contract is Thomas Rrnwn Mnnrnc r.,nnty AAmin+ ctrntinn In the event that different representatives are designated by either party after execution of this contract, notice of the name and address of the new representative will be rendered in writing to the other party and said notification attached to originals of this contract. D. Modification: Modifications of provisions of this contract shall, unless otherwise specified in Attachment I, be enforceable only when they have been reduced to writing and duly signed by both parties to this contract. E. Name and address of payee: The name and address of the official payee to whom the payment shall be made is: Public Health Unit Trust Fund, Monroe County, Florida F. All terms and conditions included: This contract and its attachments as referenced, (Attachment I through Attachment II ) , contain all the terms and conditions agreed upon by the parties. 6 In WITNESS THEREOF, the parties hereto have caused this page contract to be executed by their undersigned official as duly authorized. STATE OF FLORIDA DEPARTMENT OF HEALTH AND BOARD OF COUNTY COMMISSIONERS REHABILITATIVE SERVICES FOR COUNTY �IGNED BY: f `4h,l SIGNED BY. (Departmen Authority) NAME: NAME: f'44inita Bock TITLE: Mayor_ Monroe County TITLE:JN Strirt Administrator DATE: October 20 1991 DATE: < Y ` NAME: ° - ATTESTED TO: DANNY L. KOLHAGE, CLERK SubDistrict A 'nistrat r /�//� SIGNED BY: 4 d C• ��a„ d "SIGNED B ' � ^'7 115 CPHU Director/Adminis rator NAME: Isabel C DeSantic NAME: Stephanie A Walters TITLE: Deputy Clerk TITLE: Administrator DATE: 406/006/ 0�0� /993 DATE: /I' 9. fl FOP;A Gy_I ATTACHMENT I SPECIAL PROVISIONS I. Public Health Unit Trust Fund: Both parties agree: A. That all funds to be expended by the CPHU shall be deposited in the County Public Health Unit Trust Fund (CPHUTF) maintained by the state treasurer. B. That all funds deposited in the 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 Public Health Unit Trust Fund for the CPHU in Mnnrne County shall be accounted for separately from funds deposited for other CPHUs, and shall be used only for public health unit services in Monroe County. If actual expenditures should exceed the total planned expenditure amount for either the county or the state as agreed to in this contract, the HRS county public health unit will, by agreement between the department and the county, draw down from the trust fund balance, if any, to cover the excess expenditures, or will cut back services to come within budget. D. That any surplus funds, including fees or accrued interest, remaining in the CPHUTF account at the end of the contract year shall be credited 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 funds accruing to the state and county is determined each month and at contract year end. Such 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 8 Attachment II, Part I of this contract, with special projects explained in Attachment VIII. E. There shall be no transfers of funds between the three levels of services without a contract amendment duly signed by both parties to this contract and the proper budget amendments unless the CPHU director/administrator determines that an emergency exists wherein a time delay would endanger the public's health and the Deputy Secretary for Health has approved the transfer. The Deputy Secretary for Health shall forward written evidence of this approval to the CPHU within 30 days after an emergency transfer. F. That either party may increase or decrease funds to this contract by notifying the other party in writing of the amount and purpose for the increased/decreased funding, and allowing 30 days for written objection before the additional funds are released for expenditure or the state allocation is decreased. A decrease in funds must be related to a reduction, shortfall, or sequestering of anticipated appropriations. G. That the contract shall include as Part III of Attachment II a section entitled "Planned Staffing,• Clients, Service and Expenditures by Type of Service Within Each Level of Service". This section shall include the following information for each type of service area within each level of service: • the planned number of full-time equivalents (FTE's) by level of service; - the planned number of services to be provided; the planned number of individuals/units to be served; and the planned state and county expenditures. Expenditure information shall be displayed in a quarterly plan to facilitate monitoring of contract performance. H. That adjustments in the planned expenditure of funds for each type of service within each level of service are permitted without an amendment to this contract. I. That the CPHU shall submit quarterly reports to the county and the department which shall include at least the following sections: 1. A transmittal letter briefly summarizing CPHU activity year-to-date; 9 2. DE385L1 - "CPHU Contract Management Variance Report"; 3 . DE580L1 - "Analysis of Fund Equities"; and 4 . A written explanation of the variances reflected in the DE385L1 report for each quarter of the contract year if the CPHU exceeds the tolerance levels as specified below as of the end of the quarterly report period: a. The cumulative percent variance cannot exceed by more than 25 percent • the planned expenditures for a particular type of service or fall below planned expenditures by more than 25 percent. b. However, if the cumulative amount of variance between actual and planned expenditures for the report period for a program service area does not exceed one percent of the cumulative planned expenditures for the level of service in which the type of service is included, a variance explanation is not required. 5. The CPHD Contract Management Variance Report shall: a. Explain the reason for the variances in expenditures in any program service area which exceeds the tolerance levels established above; b. Specify steps that will be taken to comply with the contract expenditure plan, including a contract amendment, if necessary; and c. Provide a time table for completing the steps necessary to comply with the plan. Failure of the CPHU to accomplish the planned steps by the dates established in the written explanation shall constitute non-performance under the contract and the county or the department may withhold funds from the contract or take other appropriate administrative action to achieve compliance. J. The required dates for the CPHU director's/administrator's quarterly report to the county and the department shall be as follows: 1. March 1, 19_4_ for the report period October 1, 1993 through December 31, 1993; 10 1 . June 1, 1996 for the report period October 1, 1993 through March 31, 1996 ; 3 . September 1, 199' for the report period October 1, 1994 through June 30, 1921; and 0 . December 1, 192a for the report period October 1, 19 96 through September 30, 192/. II. Fees: A. Environmental regulatory fees: The department shall establish by administrative rule, tees for environmental regulatory functions designated in Attachment IV of this contract and conducted by the Cpgq. Such fees shall supersede any environmental regulatory fees existing prior to the effective date of the department's rule. The county may, however, establish fees pursuant to Florida Statutes, Section 381.0016 which are not inconsistent with department rules and to the statutes, after consultation with the department. B. Communicable disease service fees: The department may establish by administrative rule, fees for communicable disease services, other than environmental regulatory services, designated in this contract and conducted by the CPHO. The county may establish fess pursuant to Florida Statutes, Section 381.0016 which are not inconsistent with department rules and other statutes. All state or federally authorized communicable disease services foes shall be listed in Attachment IV of this contract. All county authorized communicable disease services fees shall be listed in Attachment V of this contract. C. Primary Care Fees: The county may establish fees for primary care services designated in this contract and conducted by the CPHU except for those services for which fee schedules are specified in federal or state law or regulations. Both parties further agree: 1. That such tees shall be established by resolution of the Board of County Commissioners, if promulgated by the county, or by administrative rule, if promulgated by the department; 11 2. That there shall be no duplication of fees by the department and the county for communicable disease or primary care services provided by the CPHU; 3 . That primary care fees shall be listed in Attachment V (county) of this contract. D. Communicable disease and primary care fees shall automatically be established by the department and the county at the medicaid rate upon signature of this contract unless otherwise specified by either party according to procedures set forth in II, B and C of this section. E. Collection and use of fees: Both parties agree that: 1. Proceeds from all fees collected by or on behalf of the CPHU, whether for environmental, communicable disease, or primary care services, shall only be used to fund services provided by the CPHU; 2. All fees collected by or on behalf of the CPHU shall be deposited with the State Treasury and credited to the Public Health Unit Trust Fund or other appropriate state account if required by Florida Statute or the State Comptroller. III. Service Policies and Standards: Both parties agree that the CPHU shall adhere to the service policies and standards published by the department in program manuals and other guidelines provided by the department, where they exist, as a guide for providing each funded service specified in Attachment II, Part III of this contract. IV. Fair Hearing Guidelines: The provider shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The contractor will advise applicants of the right to appeal a denial or exclusion from services, of failure to take account of a client's choice of service, and of his/her right to a fair hearing to the final governing authority of the agency. Specific references to existing laws, rules or program manuals are included in Attachment IX of this contract. The provider shall post in a readily accessible location and visible to all clients either procedures or a poster 12 • informing clients how they may contact the Human Rights Advocacy Committee (HRAC) . V. Personnel: Both parties agree: A. The CPHU shall have at least the following employees: 1. A director or administrator appointed by the Secretary of the department after consultation with the Deputy Secretary for Health and with the concurrence of the Board of County Commissioners; 2. A full-time community health nurse; 3 . An environ:uental health specialist; and 4. A clerk. B. That all department employees working in the CPHU shall be supervised by the department and subject to Department of Management Services rules. C. Staffing levels shall be established in this contract in Attachment II, Part III as FTE's, and may be changed in accordance with the availability of funds and/or program needs. D. The number and classification of employees working in the CPHU that are county employees rather than department employees shall be listed in Attachment VI of this contract. VI. Facilities: Both parties agree that: A. CPHU facilities shall be provided as specified in Attachment VII of this contract. This attachment shall include a description of all the facilities used by the CPHU, including the location of the facility and by whom the facility is owned; B. The county shall own the facilities used by the CPHU unless otherwise provided in Attachment VII of this contract; and C. Facilities and equipment provided by either party for the CPHU shall be used for public health services provided that the county shall have the right to use such facilities and equipment, owned or leased by the county, as the need arises, to the extent that such use 13 would not impose an unwarranted interference with the operation of the CPHU. VII. Use of Funds for Lobbying Prohibited: To comply with the provisions of section 216. 347, Florida Statutes, which prohibits the expenditure of contract funds for the purpose of lobbying the legislature or a state agency. VIII Method of Payment: A. The county shall deposit its annual contribution to the County Public Health Unit Trust Fund as specified below. Upon receipt of Ad Valorem Tax Revenues, a percentage of Monroe County Real Estate Tax Revenues. B. The department shall release state contributions to this contract as follows: 1. Funds appropriated as "Aid to Local Government" shall be released in four quarterly amounts, at the beginning of each quarter of the contract year; 2. WIC and other state funds appropriated in a cost reimbursement category (e.g. expense and special) shall be released on the basis of invoices documenting expenditures. IX. Laboratory and Pharmacy Support: The department agrees to supply laboratory and pharmacy support services for the CPHU at least at the level provided in the prior state fiscal year if funds are available. X. Emergencies: Both parties agree, to the extent of their respective resources, that they may assist each other in meeting public health emergencies. XI. Sponsorship: In compliance with Section 286.25 Florida Statutes, the provider assures that all notices, informational pamphlets, press releases, advertisements, descriptions of the sponsorship of the program, research reports, and similar public notices prepared and released by the provider shall include the statement: Sponsored by HRS Monroe County Public Health Unit Provider • 14 and the State of Florida, Department of Health and Rehabilitative Services. " If the sponsorship reference is in written material, the words, "State of Florida, Department of Health and Rehabilitative Services" shall appear in the same size letters or type as the name of the organization. XII . indicate in the space below the income eligibility limit for comprehensive primary care clients. 150 % of OMB Poverty Guidelines. XIII Program Specific Reporting Requirements: Specific information not available through CIS/HMC or SAMAS must be supplied by completing the following: A. Specify in the space below the minimum number of clients who will receive comprehensive primary care services (clients registered in Program Component 99 who will receive services during this contract period) . 6,300 B. Specify in the space below the amount of any county funds earmarked by the Board of County Commissioners for hospitalization in the Improved Pregnancy Outcome program if such funds are deposited in the CPHU Trust Fund and included in the IPO line on Attachment II, Part III, of this contract. g 0 C. Complete the planned Family Planning budget information on the following page for this contract period. XIV. County Fees: Those individual tees established by the county per ordinance or resolution and listed in Attachment V shall automatically be adjusted to, at least, the medicaid reimbursement rate without formal amendment to this contract in accordance with F.S. 154.06 should said reimbursement rate be increased or decreased. See Page 12, Section D. 15 0-1 \ ( `} -1 I. } g ; ! ! N. . , ! ! I ' - I - \ | a 1 / 2 \ ) \ \ \ F. 7 7 \ 7 1 } I. I ° % $ --- - R 1 cc \ | & 2 2 2 § � � $ 8 ` § 1 i § | K « 2 2 ) ! 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V ! ..5 k IDOL k „ ATTACHMENT III CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or guaranty) , property, discounts, or other federal financial assistance to programs or activities receiving or benefitting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, HAS Forms 946 A and B, if so requested by the department. The applicant assures that it will comply with: 1. Title VI of the Civil Rights Act of 1964 , as amended, 42 U.S.C. , 2000 et seq. , which prohibits discrimination on the basis of race, color, or national origin in programs and activities receiving or benefitting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefitting for federal financial ---- --- assistance. 3 . Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq. , which prohibits discrimination on the basis of sex in education programs and activities receiving or benefitting 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 benefitting for federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97- 35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or - - benefitting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. 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 32 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 termsm of thise relief, to include assistance or seek other e rbeingte judicial or term terminated and administrative relief, further assistance being denied. 33 ATTACHMENT IV STATE FEE SCHEDULES, BY SERVICE Estimated Annual Revenue Accruing To The LEVEL OF SERVICE/SRRVTrF: Zee CPHU Trust Fund I. COMMUNICABLE DISEASE: AIDS, HIV, Alternate Site Testing $20 (optional) Subtotal $ 0=- II. PRIMARY CARE: Subtotal $ -o - 34 ATTACHMENT IV STATE FEE SCHEDULES, BY SERVICE III. FNVIRONMRNTAL HEALTH: A. ONSITE SEWAGE DISPOSAL (0$DS) PROGRAM Egg Application Review (new system) $ 25 Soil Testing/Site Evaluation (new system) $ 60 Site Reevaluation $ 40 Permit (Standard Subsurface, Fill or Mound System) $ 45 (1) (2) New System Inspection $ 50 Repair Permit Site Evaluation $ 40 Repair Permit/Inspection $ 40 Existing System Inspection $ 40 Reinspection of Non-Compliance OSDS $ 25 Reinspection Fee per Visit for Site Inspection after System Construction Approval $ 25 Annual Septic Tank Manufacturing Inspection $ 50 Annual Septage Disposal Site Evaluation $100 Annual Septage Disposal Service Permit $ 50 Annual Septage Stabilization Facility $150 Septic Tank Pumpout Vehicle Inspection $ 25 (Per Vehicle) Portable/Temporary Toilet Service $ 50 Permit (annual) Portable Toilet Pumpout Vehicle (Per Vehicle) $ 25 Variance Application OSDS Single Family $150 Variance Application OSDS Multi-Family and Commercial $200 Industrial/Manufacturing Permit (annual) $150 Aerobic Treatment Unit Annual Operating Permit $150 Aerobic Treatment Unit Maintenance Entity Permit $ 25 System Abandonment Permit $ 40 Innovative Systems Evaluation $25,000 maximum Annual Operating Permit for Waterless, Incinerating or Organic Waste Composting Toilets $ 50 Amendments to an Operating Permit per Change $ 25 (1) A $5 research fee is collected until September 30, 1996 (2) A $5 fee collected by the CPHUs pursuant to construction permit issuance shall be transferred to a special State Health Office account to offset headquarters cost of providing technical, monitoring, training and administrative assistance for this program. 35 Contractor Registration: Application for Registration $ 75 Initial Registration $ 75 Renewal of Registration $ 75 Renewal of Inactive Registration $100 Certificate of Authorization (per biennium) $120 Renewal of Inactive Certificate of Authorization $150 B. pUBLIC SWIMMING POOLS AND BATHING PTarP5 Annual Permits: Up to (and including) 25, 000 gallons $ 25 More than 25, 000 gallons $ 75 Other Fees: Plan Review (New Construction) $275 (1) Plan review for modification of original construction $100 (1) Plan/Application review fee for bathing place development $150 (1) Initial operating permit $125 (1) (1) Pee amount charged by HSEH and the 14 counties that have environmental engineering units. C. DRINKING WATER Annual Permits: Limited Use Community or Commercial (Initial) $ 75 (1) Public Water System (Renewal) $ 70 (1) Limited Use Commercial Bottled Water $ 40 Other Fees: Limited Use PWS Construction Permit $ 75 (1) Sample Collection/Review of $ 50 Analytical Results/Health Risk Interpretation for Delineated Areas Private System Construction Permit $ 40 (2) (serving 3 or 4 non-rental residences) Reinspection $ 25/$ 40 Laboratory Analyses $ 10-$100 Delineated Area Clearance Fee $ SO Chemical Sample Collection $ 60 Micro Sample collection $ 40 (1) includes a $5 surcharge that is transferred to headquarters to provide staffing for training, monitoring, epidemiological support, program evaluations and technical assistance. 36 (2) Includes a $3 surcharge that is transferred to headquarters to provide staffing for training, monitoring, epidemiological support, program evaluations and technical assistance. D. MOBILE HOME & RECREATIONAL VEHICLE PARRS Annual Permits: 5 Spaces and Above $3. 50 per space (1) (1) This rate applies until rules setting fees are written by the department. The total fee assessed per facility cannot be more than $600 or less than $50. E. MIGRANT LABOR CAMPS Annual Permits: Facilities with 5-50 occupants $125 Facilities with 51-100 occupants $225 Facilities with over 100 residents $500 F. DIOMEDICAL WASTE GENERATORS Aamp., Permits: (Except Physician Office Generating less than $ 55 25 lbs./30 days) Other Fees: Reinspection (after the first rsinspection) $ 25 Late renewal $ 25 Mobile treatment machine registration $ 25 F. fOOD ESTABLISHMENTS Annual Permits: Fraternal/Civic (Serving to Public) $160 (1) (2) School Cafeteria a. Operating for 9 months out of a year $130 (1) (2) b. Operating for more than 9 months $160 (1) (2) Institutional Food Service $210 (1) (2) Movie Theaters $160 (1) (2)Jails/Prisons $210 (1) (2) Bars/Lounges (Drink Service Only) $160 (1) (2) Residential Facilities $110 (1) (2) Child Care Centers $ 85 (1) (2) Limited Food Service $ 85 (1) (2) 37 (1) Includes a $5 surcharge that is transferred to headquarters to provide staffing for training, monitoring, epidemiological support, program evaluations and technical assistance. (2) Includes a $5 surcharge that is transferred to headquarters to offset the cost of purchasing and providing maintenance on equipment to be used for this program. Other Fees: Plan Review $ 35/hr Food Worker Training $ 10 Request For Inspection $ 40 Reinspection (after the first reinspection) $ 30 Late renewal $ 25 G. TANNING FACI71TTIRS Annual Permits: Per Facility (plus $55 per device) $150 (1) (1) Includes a $10 surcharge that is transferred to headquarters to provide staffing for training, monitoring, epidemiological support, program evaluations and technical assistance. 38 ATTACHMENT V COUNTY FEE SCHEDULES, BY SERVICE Estimated Annual Revenue Accruing To The LEVEL OF SERVICE/SERVICE: geelRanae CPHU Trust Fund I. COMMUNICABLE DISEASE: Subtotal $ 44,700 II. EBTMDRY r pr: Subtotal $ 87,000 III. 7NVTRONMF.NTAL Subtotal $ 119,0'0 Total County Fees $ 480,416 39 Monroe County Public Health Unit Fee Schedule Medicaid Or State Price Plus 15% Clinic Services Intestinal Parasites(Specimen Collection) 89100 $27.60 PAP Smear 88155 $6.33 Pregnancy Test 64703 $8.05 Tetanus(post injury) 86280 $9.20 • X-Rays 71010 $24.15 Hepatitis B 90731 $52.69 Today Sponge $3.77 Monistat $19.32 Dlaphram $7.19 Contraceptive Cream $8.38 IUD $93.15 Depo Provera $25.78 RHOgam $17.65 Contraceptive Foam $2.88 Sharps Containers(for Insulin Users) Small $2.29 Large $4.86 Medications and Vitamins Iron Tablets $1.50 Metrorddalzole Pre Packed $0.89 Twenty-eight 250 mg tablets $0.84 Eight 250 mg tablets $0.18 Erythomydan Pre packed $1.39 Eighty 250 mg Tablets $3.88 Nystatin Tablets $2.00 Cream $1.78 Rabies Vacs Rabies Globin 2cc(given by weight) $48.71 Rabies Vaccine(each dose) $118.77 Family Planning InitiaV Annual W9759 $40.25 Supply Visit W9851 $11.50 Counseling W9850 $23.00 Tubal Ligation (postpartum) 58805 $339.25 Tubal Ligation (With C-Section) 58811 $241.50 Vasectomy 55250 $201.25 Page 39-A Improved Pregnancy Outcome Prenatal Vitamins $1.80 Antepartum W1990 $57.50 Prenatal Risk Assessment (first trimester) W9607 $57.50 Prenatal Risk Assessment 99420 $57.50 Prenatal Profile $40.83 CBC 85024 $9.20 Culture, Urine 87070 $9.78 Blood Group&RH 88115 $15.53 Coombs Antibody Screen 86880 $6.33 STD New Patient History&Physical 99201 $57.50 TB Control TB Testing (PPD) 86580 $4.60 Immunizations MMR(Adult Request) 90707 $37.49 Polio(Adult Request) 90713 $47.07 Tetanus 90701 $15.50 Influenza $10.00 RH Antibody Titer 88115 $12.08 Cholera $0.71 Typhoid $1.59 Yelow Fever $38.85 Children Services EPSDT/Well Baby/Well Child W9881 $34.50 Intestinal Parasites(Specimen Collection) 89100 127.60 Lead Screening 84203 $8.33 X- Rays 71010 $24.15 Sickle Cell Test 83020 114.95 Hepatitis B 90731 $52.69 PKU 84030 $4.60 Hyperthyroidism 84443 $20.13 Sickle Cell 83053 $4.80 Galectosemia 82760 $25.30 School Physicals New Patient History&Physical 99201 $34.50 Established Patient Evaluation 99211 $13.80 Page 39-B Labs Chlamydia 86317 $17.25 Lithium Level 83725 $10.93 Oral Glucose Tolerance Testing (fasting 1,2,3, hours) 82951 $22.43 Rubella Screen 96006 $27.60 Sickling of RBC, Reduction, Slide Method 85660 $4.60 Blood Group& RH 86115 $15.53 Culture, Urine 87070 $9.78 Glucose, Blood Stick Test 92948 $3.45 Glucose Tolerance Test 3 Specimens 82951 $14.95 CBC With Differential 85023 $9.78 Feto-Protein,Alpha 1, RIAI EIA 88244 $18.98 Bacterial Susceptibility 87070 $14.95 Lithium, Blood Quantitative 83725 $7.48 HIV Antibody Detection; confirmation 86314 $16.88 HIV Without WBA To Confirm 88314 $24.15 HIV Test 86312 $10.35 Syphilis Test(RPR) 86592 $4.60 Toxiplasmosis, Dye Test 86600 $18.10 AMT 19 or More 80019 $13.23 Platelet Count 85580 $6.90 Platelet Count 85580 $4.60 Blood Count, WBC (Cellular Immune Panel, Basic) 85048 $2.30 SED Rate 85851 $4.03 Hemoglobin &Hematocrlt 85014;85018 $10.64 VDRL 86592 $4.60 GC Culture 87082 $28.46 Gram Stain 87028 $16.66 Cellular Immune Panel. Basic $211.80 CARE. Panel 62 $35.65 Hepatkus B Antibody Test 86291 $12.65 Drug Screening Substance Abuse Panel•8 (Alterate,Confirmation) 86319 $16.10 • Page 39-C ATTACHMENT VI CLASSIFICATION AND NUMBER OF EMPLOYEES WORKING IN THE COUNTY PUBLIC HEATLH UNIT WHO ARE PAID BY THE COUNTY, BY LEVEL OF SERVICE, IF APPLICABLE ygVEL OF SERVICE/SERVICE: position Classification Number I. COMMUNTCARLR DTSFASF: T.B. *Senior Community Health Nurse .5 *Direct Service Aid .5 II. PRIMARY CARP: EPSDT *Advanced RN Practitioner .3. -_-_. *Direct Service Aid .5 High Risk Senior Community Health Nurse 1 Adults S Children Basic Care Expanded Advanced RN Practitioner 1 Middle & Upper Keys III. 7J/VIRONXZNTAL HFAT,fj: N/A * Partial payment by County Funds 40 ATTACHMENT VII FACILITIES UTILIZED BY THE CPHU Facility Description Location Owned By HRS - Monroe County 5100 W College Road Public Health Unit Key West. Florida Monroe County HRS - Monroe County 138 Georgia Street Public Health Unit Tavernier, Florida Monroe County HRS - Monroe County 7999 Overseas Highway C. Chaplin d.b.a. Public Health Unit Marathon. Florida Prime Properties • HRS - Monroe County Public Health Unit Under renovations Monroe County HRS - Health Care 1200 Kennedy Drive, Key The Lower Florida Keys Center West. Florida Health System, Inc. HRS - AIDS Prevention 513 Whitehead Street Center Key West, Florida Rent Key West Properties Roosevelt Sands 702 Whitehead Street. Community Health Key West. Florida Comish Memorial AME Resource Center Temporary location Zon Church • Page 41 ATTACHMENT VIII DESCRIPTION OF USE OF PUBLIC HEALTH UNIT TRUST FUND BALANCES FOR SPECIAL PROJECTS, IF APPLICABLE (From Attachment II, Part I) Monroe County Public Health Unit has been authorized by the State of Florida to establish a special projects fund. Money was pulled from the *Contingency Fund to meet the obligations with Monroe County Board of Commissioners. Four Hundred Thousand Dollars has been earmarked for renovation and construction of facilities for the Marathon and Tavernier as a joint project with Monroe County. One Hundred Thousand Dollars is being reserved for fixtures. furnishings, telephone system. computer lines , etc. * Contingency Fund is reflected on page 18 Page 42 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 Reauirement 1. Sexually Transmitted Disease Requirements as specified Program in HRSM 150-22. Requirements as specified in Policy 87-7-5 regarding State Health Office STD Program review and approval of personnel/budget actions. 2. Dental Health - Monthly reporting on HRSH Form 1008. 3. Special Supplemental Food Service documentation and Program for Women, Infants monspecified ly ncial lRrepor0s24 and Children. and all federal, state and county requirements detailed in the program manuals and published procedures. 4. Improved Pregnancy Outcome Requirements as specified in HRSH 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. 5. Family Planning Periodic financial and programmatic reports as specified in HRSM 150-27. • 43 ATTACHMENT IX (continued) 6. Immunization 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. 7 . CPHU Program Requirements as specified in the Reference Guide to CHIP and HAS forms identified in HRSM 150-8 and 150-12 . 9. Environmental Health Requirements as specified in HRSM 50-10. 10. AIDS Program 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. 11. School Health Services HRSM 150-25, including the requirement for an annual plan as a condition for funding. 44