Item T1May 20 03 09:47a James L Roberts Co Rdmin 305-292-4544
p.2
Monroe County Health Department Disease Management Wellness Project
Scope of Services
Target population
MCHD will perform intense case finding among the adult population in Key West and the
Lower Keys who do not receive medical care in the private sector because of the lack of funds
anWor third party coverage. Patients eligible for this program will have less than 200% of the
FPL.
rvices
To improve the health status of the target population the following primary care services need to
be provided:
1. Intense case finding and wellness screening
2. Regular visits to the physician or ARNP with diagnostic testing and monitoring and with
well -managed medication regimens
3. Education and training opportunities with peer -led workshops in self -management skills
4_ Support by medical providers and health educators for patients working on their self -
management goal setting and action plans
5. Annual physical examinations with comprehensive screenings for prevention and early
detection, reduction of accidental deaths incidence, screening for domestic violence
Service Tyne and Delivery Method
Enabling Services provided by the Monroe County Health Department (MCHD) primary care
include health education, outreach, and interpretation/translation services in both Creole and
Spanish. Central to the primary care program is the Wellness Coordinator and the "Know your
Numbers" outreach campaign. Individuals receive risk assessment and lifestyle counseling and
education and are linked to MCHD for primary care/Disease Management.
Primary Medical Care Services will follow a Disease Management model rather than the
episodic/acute care model. Disease Management addresses the major health problem of our
country; hypertension, diabetes, lipid disorders and respiratory conditions. The core of Disease
Management is self -care: educating and supporting the patient to make lifestyle changes and to
manage his/her own health as a partner with the physician and with the healthcare team.
Primary care services will include: Ambulatory diagnostic and treatment services, laboratory
and X-ray procedures, urgent medical care with open access scheduling, family planning, adult
and childhood immunizations. Patients identified by the wellness coordinator will be referred to
MCHD/primary care for long-term medical management. MCHD also provides screening and
treatment for Sexually Transmitted Disease as well as a Hepatitis Screening Program. Women
in need of specialty obstetrical and gynecological care will be referred to Womankind offering
sliding scale services to the community. Women who are pregnant will be referred to the
Healthy Start Nurse at MCHD for case management and referral to OB/ GYN specialist. The
MCHD TB program provides Directly Observed TB Therapy. Patients needing specialty care
other than that provided by the MCHD physician with a specialty in internal medicine will be
referred to local physicians. Patients in need of dental services will be referred to the Rural
Health Network dental clinic offering sliding scale services in the Lower Keys. Patients in need
of Mental Health/Substance Abuse Services will be referred to the Care Center for Mental
Health offering sliding scale service in the Lower Keys.
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WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Monroe County
State of Florida
Signature Kenneth L. Thurston, CPA
Assistant Deputy Secretary for Medicaid Finance
Agency for Health Care Administration
Name
Title
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LETTER OF AGREEMENT
THIS LETTER OF AGREEMENT made and entered into in duplicate on the day
of , 2003 by and between Monroe County (the County), and the
State of Florida (the State), through its Agency for Health Care Administration (the
1. Per House Bill 27-E, the General Appropriations Act of FY 2002-2003, passed by
the 2002 Florida Legislature, the County and the State, through the Agency agree
that the County will remit to the State $25 000.
a) These payments shall be used by the hospitals in collaboration with the
Department of Health and Monroe County Health Department to provide
primary care services to indigent residents.
b) The increased provision of Medicaid funded health services will be
accomplished through the hospital upper payment limit program for the
expansion of primary care activities. The special Medicaid payments are
contingent upon state matching funds being provided.
During the term of this Agreement, the County agrees to remit to the Agency; bi-annually
payments in the amount of $12,500, beginning May 30, 2003. The Agency shall invoice
the County for the payments and said invoices shall contain sufficient detail for pre -audit
and post -audit thereof.
2. The County will pay the State ir the amount of S25,000 in two (2) equal payments
of $12,500 as follows:
a) The first payment in the amount of 512.500 is due no later than May 30,
2003.
b) The retraining payment shall be in the amount of $12,500 and is due no
later than June 30, 2003.
The County and the State agree that the State will keep adequate records and
supporting documentation of the funds transferred under this agreement. Further,
the County and State agree that the County shall have access to these records, to
the extent permitted by law, upon request to the State.
4, The County and the State agree that any :modifications to this Letter of Agreement
shall be in the same form, namely the exchange of signed copies of a revised
Letter of Agreement.
5. This Letter of Agreement covers the period Tuly 1, 2002 throu h June 30 20Q3•
Monroe County Health Department Disease Management Wellness Project
Scope of Services
Target population
MCHD will perform intense case finding among the adult population in Key West and the
Lower Keys who do not receive medical care in the private sector because of the Iack of funds
and/or third party coverage. Patients eligible for this program will have less than 200% of the
FPL.
Services
To improve the health status of the target population the following primary care services need to
be provided:
l . Intense case finding and wellness screening
2. Regular visits to the physician or ARNP with diagnostic testing and monitoring and with
well -managed medication regimens
3. Education and training opportunities with peer -led workshops in self -management skills
4. Support by medical providers and health educators for patients working on their self -
management goal setting and action plans
5. Annual physical examinations with comprehensive screenings for prevention and early
detection, reduction of accidental deaths incidence, screening for domestic violence
Service Tvne and Delivery Method
Enabling Services provided by the Monroe County Health Department (MCHD) primary care
include health education, outreach, and interpretationitranslation services in both Creole and
Spanish. Central to the primary care program is the Wellness Coordinator and the "Know your
Numbers" outreach campaign. Individuals receive risk assessment and lifestyle counseling and
education and are linked to MCHD for primary care/Disease Management.
Primary Medical Care Services will follow a Disease Management model rather than the
episodic/acute care model. Disease Management addresses the major health problem of our
country; hypertension, diabetes, lipid disorders and respiratory conditions. The core of Disease
Management is self -care: educating and supporting the patient to make lifestyle changes and to
manage his/her oven health as a partner with the physician and with the healthcare team.
Primary care services will include: Ambulatory diagnostic and treatment services, laboratory
and X-ray procedures, urgent medical care with open access scheduling, family planning, adult
and childhood immunizations. Patients identified by the wellness coordinator will be referred to
MCHD/primary care for long-term medical management. MCHD also provides screening and
treatment for Sexually Transmitted Disease as well as a Hepatitis Screening Program. Women
in need of specialty obstetrical and gynecological care will be referred to Womankind offering
sliding scale services to the community. Women who are pregnant grill be referred to the
Healthy Start Nurse at MCHD for case management and referral to OBIOYN specialist. The
MCHD TB program provides Directly Observed TB Therapy. Patients needing specialty care
other than that provided by the MCHD physician with a specialty in internal medicine will be
referred to local physicians. Patients in need of dental services will be referred to the Rural
Health Network dental clinic offering sliding scale services in the Lower Keys. Patients in need
of Mental Health/Substance Abuse Services will be referred to the Care Center for Mental
Health offering sliding scale service in the Lower Keys.
-11
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Monroe County State of Florida
Signature Kenneth L. Thurston, CPA
Assistant Deputy Secretary for Medicaid Finance
Agency for Health Care Administration
Name
Title
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jamea L_ muuerza iv numaii VUJ GJL TJ r. y
Monroe County Health Department
Expanding Access to Primary Care
Budget Detail
Time Period:
7/1/03 through 6/30/04
Budget Item
Requested Grant
Local Cash Local In -kind
Total Project
Funding
Match
Match
Budget
Health Professional Staff
72800
0
0
Support staff
0
0
72800
Medical Supplies
0
20000
20000
Non -Medical Supplies
0
5000
0
5000
Other Expenses
0
5000
0
5000
Equipment
0
50000
0
50000
Contracts with Providers
27200
4000
47800
0
0
4000
Other
0
10000
0
75000
Total
100000
121800
10000
20000
241 00
Total Estimated Cost Per User 148160
Narrative Explanation:
Health Professional Staff include:
Advanced Registered Nurse Practitioner - $56,000 in salary and 30°lo fringe benefits
Contract with Providers - $75,000 agreement with Area Health Education Center to
coordinate health status screening segment of primary care expansion project. This
figure includes $60,000 for salary and $15,000 for administration and expenses_ The
majority of this activity will occur in the Roosevelt Sands Center as a pilot project with
expansion planned throughout Monroe County. The grant will fund $27,200 of this
agreement.
Third Party Revenue Sources/Revenue Expectations:
Medicare - $1000
Medicaid - $4000
This revenue grill help to defray the excess cash and in -kind match provided.
May 20 03 09:50a James L Roberts Co Rdmin 305-292-4544 p.1
LETTER OF AGREEMENT
THIS LETTER OF AGREEMENT made and entered into in duplicate on the day
of , 2003 by and between Monroe County (the County), and t
State of Florida (the State), through its Agency for Health Care Administration (the
Agency).
1. Per House FloridagAppropriations27-Ethe General
islature, the Count yand the State, through he Agency agree
the 2002 Leg
that the County will remit to the State S25,000.
itals in
he
a) These artment o Health and e used by the
Monroe County Health Dcollaboration partment to provide
Department
primary care services to indigent residents.
b) The increased provision of Medicaid funded health services '71t be
accomplished through the hospital upper payment limit program for the
expansion of primary care activities. The special Medicaid payments are
contingent upon state matching funds being provided.
During the term of this Agreement, the County agrees to remit to the Agency; hi-annuall
payments in the amount of $12.500, beginning May 30, 2003. The Agency shall invoice
the County for the payments and said invoices shall contain sufficient detail for pre -audit
and post -audit thereof.
2. The County will pay the State in the amount of S25,000 in two (2) equal payments
of S12,500 as follows:
a) The first payment in the amount of S12,500 is due no later than May 30,
2003.
b) The remaining payment shall be in the amount of $12,500 and is due no
later than June 30, 20031
3. The County and the State agree that the State will keep adequate records and
supporting documentation of the fmids transferred under this agreement. Further,
the County and State agree that the County shall have access to these records, to
the extent permitted by law, upon request to the State.
4. The County and the State agree that any modifications to this Letter of Agreement
shall be in the same form, namely the exchange of signed copies of a revised
Letter of Agreement.
5. This Letter of Agreement covers the period Duty 1, 2002 through June 30, 2003.
Mad 20 03 09:46a
James L Roberts Co Rdmin 3C5-292-4544 p-t
Monroe County Health Department
Expanding Access to Primary Care
Budget Detail
Time Period:
7/1/03 through 6/30/04
Budget Item
Requested Grant
Local Cash Local In -kind
Total Project
Funding
Match
Match
Budget
Health Professional Staff
72800
0
Support staff
0
0
72800
Medical Supplies
0
0
20000
20000
Non -Medical Supplies
0
5000
0
5000
Other Expenses
0
5000
0
5000
Equipment
0
50000
0
50000
Contracts with Providers
27200
4000
47800
0
4000
Other
0
0
75000
Total
100000
10000
121800
0
20000
10000
241800
Total Estimated Cost Per User $483 60
Narrative Explanation:
Health Professional Staff include:
Advanced Registered Nurse Practitioner - $56,000 in salary and 30% fringe benefits,
Contract with Providers - $75,000 agreement with Area Health Education Center to
coordinate health status screening segment of primary care expansion project. This
figure includes $60,000 for salary and $15,000 for administration and expenses_ The
majority of this activity will occur in the Roosevelt Sands Center as a pilot project with
expansion planned throughout Monroe County. The grant will fund $27,200 of this
agreement.
Third Party Revenue Sources/Revenue Expectations:
Medicare - $1000
Medicaid - $4000
This revenue A211 help to defray the excess cash and in -kind match provided,