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Item S6 .'".;s;;"""1':' ,.. BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: June 18. 2003 Division: County Administrator Bulk Item: Yes No X Department: County Administrator AGENDA ITEM WORDING: Ratification of action taken by the County Administrator between the May and June 2003 County Commission meetings' in reference to supporting the Monroe County Health Department in obtaining funding for a Disease Management Wellness Project. ITEM BACKGROUND: Immediately prior to the May 2003 BOCC meeting the Health Department informed the Mayor and the Administrator of the opportunity for a substantial grant if matching funds could be found outside of the Monroe County Health Department budget. After discussion the Administrator was instructed to cooperate in finding funding and have a check issued for $12,500 for one half the match not later than May 30, 2003 and place the agenda item on the June 2003 agenda. Because of various complications it was not possible to utilize any of the general taxation funds being raised on behalf of the Health Department because most of those had already been paid by the Tax Collector. In seeking not to increase any costs to the County, which was discussed by the BOCC in May, the Administration located $25,000 in funding to a non-profit organization that had declined the funds; therefore, the match could come from those monies without increasing the County's budget for this year. An agreement was prepared and should be approved as part of this item. PREVIOUS RELEVANT BOCC ACTION: As Above CONTRACT I AGREEMENT CHANGES: Nj A STAFF RECOMMENDATIONS: Approval TOTAL COST: $25.000.00 (previously aoprooriated for other use) BUDGETED: Yes-X. No SOURCE OF FUNDS: Ad Valorem COST TO COUNTY: $25.000.00 (previouslv aporopriated for other use) REVENUE PRODUCING: Yes No X AMOUNT PER MONTH YR APPROVED BY: County Atty _ OMB/purChqy, Risk Management_ ~~, James L. Roberts, County Administrator DIVISION DIRECTOR APPROVAL: DOCUMENTATION: Included X To Follow Not Required DISPosmON: AGENDA ITEM # cPt MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: Health Care Admin Contract #_ Effective Date: 5/30/03 Expiration Date: Contract Purpose/Description: Ratification of action taken by the County Administrator between the May and June 2003 County Commission meetings in reference to supporting the Monroe County Health Department in obtaining funding for Disease Management Wellness Project. Contract Manager: Debbie Frederick 4441 CAD #1 (Name) (Ext.) (Department/Stop #) for BOCC meeting on June 18, 2003 Agenda Deadline: June 3,2003 CONTRACT COSTS Total Dollar Value of Contract: $ 25,000.00 Budgeted? YesO No D Account Codes:. Grant: $ County Match: $ Current Year Portion: $ - - - - ----- - - - - ---- - - - - ----- - - - - ----- ADDITIONAL COSTS Estimated Ongoing Costs: $~yr For: (Not included in dollar value above) (eg. maintenance, utilities. janitorial. salaries, etc.) CONTRACT REVIEW Date In Changes Needed -~ R:tir ;) YeSONO~ /'!. "rJ1 ":; L~. YesONoO YesDNoGj ~ YesDNo[];j/' ( 4HrcJud Date Out Division Director Risk Management O.M.B./Purchasing Cvj~/D3 we Cr LP 0"3 County Attorney Comments: OMB Form Revised 2/27/01 MCP #2 LETTER OF AGREEMENT THIS LETTER OF AGREEMENT made and entered into in duplicate on the "30 day of """ A. ':f , 2003 by and between Monroe County (the County), and the State of Florida (the State), through its Agency for Health Care Administration (the Agency). 1. Per House Bil127-E, the General Appropriations Act ofFY 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 in the amount of $25,000 in two (2) equal payments of$12,500 as follows: a) The first payment in the amount of$12,500 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, 2003. . 3. 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 Courity 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 July 1, 2002 through June 30, 2003. F~OH,HONROE COUNTY ATTY OFFICE JUN-05-03 16,43 ... 10,3052923516 PACE 1/1 WlTNl!:SSETH: IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day and year ab~ve first written. Monroe County State of Florida J--~c.O~ Signature Kenneth L. ThW!tOD., CPA Assistant Deputy SecretaIy for Medicaid Finance Agency fOt Health Care Administration ~\......~v L. ~.~~~T.( Name Cac.....n-~ A ~ """ Ia.It..r, ~o ('4..... Title '? R.." C. \ """' \ N ... '^-~ ..A. ~? It ~ v ... L - r.:l~ c:.<.. oD" ",,,,y.I J ~.o'3. r- ,N.4(,. 10 OC~"" tL otJ ~"'d l~ :1.00:1, C. ;LAN,,", ~\l q ':f Av~~v..~ -::7 ~ S'd ....S..-Z6Z-S0f: u~wp~ D~ s~~~qo~ , 5~weL ,I dOZ:CD EO SO unL no: ~u U...;;I- Uoi;JiTUCI ""ClIII'Cf:' L-- I"l5:glD~r va ....u nu,....1 ~-Ug~_. I:;,~. - "Tv'-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 Localln-kind Funding Matct1 Match Health Professional Staff 72800 0 0 Support Staff 0 0 20000 Medical Supplies 0 5000 0 Non-Medical Supplies 0 5000 0 Other Expenses 0 50000 0 Equipment 0 4000 0 Contracts with Providers 27200 47800 0 Other 0 10000 0 Total 100000 121800 20000 Total Project Budget 72800 20000 5000 5000 50000 4000 75000 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 proj eel. This figure includes $60,000 for salary and $15,000 for administration and expenses. The majority ofthis activity wiu 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 SourceslRevenue Expectations: Medicare. $1000 Medicaid - $4000 This revenue ",rill help to defray the excess cash and in-kind match provided. ........ Ma~2tJ 031>'08';....78 .laMes L Rober-~S' Co Ad1'Iti" 305-292'-4'64+ 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 and/or third party coverage. Patients eligible for this program will have less than 200% of the FPL. Senices 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 selt: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, se,reening for domestic violence Service TVDe and DeRve" 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 linkfd 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 countIj,; hypertension, dia.betes, 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 0\\'0 health as a partner with the physician and with the healthcare team. Primary care services will include: Ambulatory diagnostic and treatment services, laboratol)' and X -ray procedures, urgent medical care with open access scheduling, family planning, adult and childhood inununizations. 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.