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Resolution 706-1989 RESOLUTION NO. 706-1989 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, AUTHORIZING THE MAYOR/CHAIRMAN OF THE BOARD TO EXECUTE AN AGREEMENT BY AND BETWEEN THE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS AND THE STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES REGARDING SERVICES TO BE PROVIDED BY THE COUNTY PUBLIC HEALTH UNIT. BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, that the Mayor/Chairman of the Board is hereby authorized to execute an agreement by and between the Monroe County Board of County Commissioners and the State of Florida Department of Health and Rehabilitative Services regarding services to be provided by the county public health unit, a copy of same being attached hereto. PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular meeting of said Board held on the AII_'- day of Jo"p~ k, A.D. 1989. BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA aif~ By Mayor/Chairman (Seal) Attest: DANNY L. KOLHAGE, Clerk ~~~~.,e i; i ~mo .:lO~NOW J1J ~j ~4 V 0 MfIIIOVED AS TO FORM AND LEGAL SUFFICIENCY. L g. Ol\f ~ 3:11 69. RY LJdU:J.Jd ~U:J U311.:1 ~ ~ ':'. I) ., ., STANDARD CONTRACT BETWEEN !~onroe 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 ~'()nr()p 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 funds, 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 its 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: A. Provide services according to the specified in Attachment I and attachments to this contract: and conditions all other B. Fund the services specified in Attachment II, Part III, at the funding level specified for each program service area in that attachm~nt. II. Federal and State Laws and Regulations: Both parties agree that the CPHU shall: A. Comply with the provisions contained in the Civil Rights Certificate, hereby incorporated in~o this contract as Attachment III: B. Comply with the provisions ot 45 CFR, Part 74, and other applicable regulations it this contrace contains tederal tunds; 1 ~ 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 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 41-1, Florida Administrative Code, (Coordinated Community Transportation Services) regarding the provision of transportation services for the transportation disadvantaged if this contract contains any state or federal 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: ,j '1 :J i j I i .j 3. - 1. The revenue and expenditure requirements in the State Automated Management Accounting System 2.2; 2. 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, or the equivalent as approved by the State Health Office. Any reporting system used by or on behalf ot 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; 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 2 -,:.~ 't~ 'J ...~ A .~ :p 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 department's Accounting and Accounting Memoranda; specified Procedures in the Manuals 6. 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 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"; ., ;...~ :? .J ".,,4 .~.1 -:~ .' .; 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 any 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. '~ '1 ., '. ,j Both parties further agree that: The department shall provide uniform financial statements ot 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: .,' . -; ",I '::~ . i ~ .~ 'c , ~ Both parties necessary, the agree that, as department and/or either determines the county shall . J .. 3 , ~ " \ ,J monitor the budget and services as Attachment II and operated by the subcontractor or assignee. detailed CPHU or in its 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 (HRSM 50-2 security of Data and Information Technology) and federal regulations (45 CFR, part 205.50), except by written consent of the recipient, or 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 incurrence 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 of 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 incurrence 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 ot this contract and to any conditions ot approval that the department and the county shall deem necessary. 4 ...f.....I:~ · "~' ~~~ ':; . ~~ . 'q 'd "~ -~ t~ VIII. Payment tor Services: ., - ~ ", B. '1 ..; .' " ~ /, j .;~ .~ :{ ~1 1 A. The department agrees: To pay for services identified in Attachment II as tr-.f::: state'~ responsibility in an aIno~nt not to exceed S 2,290,625 In addition, the State share of all state authorized fees in an anticipated ar.ount of $ EC,504 for a c v rr.b i n e 0 tot a 1 0 f $ 2, 44-;- , 129 The s tat e ' s perfo~ance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. These amounts, pI us any other state revenues, incl ude all revenues from whatever sources to be appropriated to the County Public Health Unit Trust Fund for services provided by the county health unit for a grand total of $ 2,5'19,401 The county agrees: To pay for services identified in Attachment II as the county's responsibility in an appropriated amount not to exceed $ 217,842 In addition the county shall provide its share of all county authorized fees in an anticipated amount of $122,955 . These amounts, plus any other local revenues, include all revenues from whatever sources to be appropriated to the County Publ ic Heal th Unit Trust Fund for services provided by the county public health unit for a grand total of $ 368,297 IX. The Department and The County Mutually Agree: '.~ y ,~ A. .~ B. 1 Effective date: 1. This contract shall begin on October 1, 19~ or the date on which the contract has been signed by both parties, whichever is later. 2. This contract shall end on September 30, 19-2..0.. Termination: 1. Termination because of lack o~ 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 5 ;,{ ~~; 1 other party. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of del i very. The department or the county shall be the final authority as to the availability of their respective funds as applicable. In case of cancellation due to the unavailability 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-l, 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 1 imi t 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: 6 f. ! , ;;~ ;? I~f; t~-'~ '1'. D. ModiticationJ Modifications of provisions of this contract shall, unless other.ise specified in Attachment I, be enforceable only ~~en they have been reduced to ....riting :3nj duly si;nad by both parties to this contract. E. Na~e and address of payee: The ~a~e a~d address of ~he official payee to ~hom the pa:z~ent shall be :nade is: Public Health t:nit Trust Fund, "en roe County, Florida F. All te~s and conditions included: This contract and its attachments as referenced, (Attachments I through X ), contain all the terms and conditions agreed upon by the parties. In WITNESS THEREOF, the parties hereto have 42 page contract to be executed by their officials as duly authorized. caused this undersigned BOARD OF COUNTY COMMISSIONERS FOR Monroe COUNTY STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES SIGNED BY: SIGNED BY: (Department Authority) NAME: NAME: John ~arie TITLE: '1ayor, Honroe County TITLE: Ad~inistrator, District 1 r. .~ DATE: DATE: ATTESTED TO: SIGNED BY: SIGNED BY: ~fJ~.::J. CPHU Director/ Administrator NAME: Jose J. Bofill, M.D. TITLE: Director, MCPHU NAME: Danny L. Kolha~e TITLE: Monroe County Clerk DATE: DATE: 7 APPROVED AS TO FORM AND LEGAL S 'fFICIENCY. BY .' 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 Monroe Countv County shall be accounted for separately from funds deposited for other CPHUs, and shall be used only for public health unit services in r-bnroe County. I f 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. o. 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, in such amounts as may be determined by multiplyinq the surplus funds remaining in a program account by the percentage of County Public Health Unit Trust Fund funding provided by each governmental entity for the rendering of the particular health service for which.such account was established. Such surplus funds may be applied toward the funding requirements of each participating governmental enti ty 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 participatinq qovernmental . entity. The planned use ot surplus funds shall be 8 '.1 '.~ !i; 't 'l ~ t reflected in Attachment contract, with special Attachment VIII. II, Part I of this projects explained in E. There shall be no transfers of funds between the three levels of service 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 for~ard 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, Services and Expenditures by Type of Service Wi thin 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 th-is contract. I. That the CPHU shall submit quarterly reports to the county and tha department which shall includa at least the following sections: 9 1. A transmittal letter briefly summarizing CPHU activity year-to-date; 2. OE38SLl - "CPHU Contract Management Variance Report II ; 3. OE580Ll - "Analysis of Fund Equities"; and 4. A written explanation of the variances reflected in the OE385Ll 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 CPHU 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 10 '"c;.: ;;~ I: /., i~ ..;" administrative compliance. J. The required dates tor the CPHU director's/ administrator's quarterly report to the county and the department shall be as follows: action to achieve 1. March 1, 1990 for the report period October 1, 1989 through December 31, 1989; 2. June 1, 1990 for the report period October 1, 1989 through March 31, 1990; 3. September 1, 1990 for the report period October 1, 1989 through June 30, 1990; and 4. December 1, 1990 for the report period October 1, 1989 through September 30, 1990. II. Fees: A. Environmental regulatory fees: The department shall establish by administrative rule fees for environmental regulatory functions designated in Attachment IV of this contract a conducted by the CPHU. Such fees shall supersede any environmental regulatory fees existing prior to the effective date of the department's rule. The county may, however, establish fees pursuant to Florida Statutes, Section 381.311 which are not inconsistent with department rules and other statutes, after consultation with the department. B. Communicable disease services 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 CPHU. The county may establish fees pursuant to Florida Statutes, Section 381.311 which are not inconsistent with department rules and other statutes. All state or federally authorized co~unicable disease services fees 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. 11 ';~ " C. Primary Care fees: Either party 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 fees 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; 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 Attachments IV (state) and V (county) of this contract. D. 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 behal f of the CPHU shall be deposited with the State Treasury and credited to the Publ ic 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 9Ui~e for providing each funded service specified in Attachment II, Part III of this contract. 12 ,- ; ~ , . ,; ~~ IV. Fair Hearing Guidelines: The provider shall establish a system through which applicants tor services and current clients may present grievances over denial, modification or. termination of service~. 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 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 consul tation 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 environmental 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 Administration rules. C. Staffing levels shall be established in this contract in Attachment II, Part III as FTE's, and may be changed as funds become available. D. Th~ 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. 13 . '. r VI. Facilities: Both parties agree that: A. CPHU facilities shall be provided as specified in Attachmen~ 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 would not impose an unwarranted interference with the operation of the CPHU. 14 '.:~1.'.: :'.j' ..~:'.. :'.{~ .'f, .~; ~, . .:~ 1 VII. Method of Payment: (Specify choice by lining through non-applicable A or B.) :~ A. In each quarter of the contract year, the county shall deposit at least one fourth of its total annualcontrib\,;,~ion to the County Public Health Uni t Trust Fund. At least one third of this quarterly contribution shall be deposited no later than the last day of the ...first month in each quarter, ';' ., ., 1 OR 7 -~. ) 5. !~: C~tll'\~Y eaall eie!ilesi~ lBeRtRl~l eRe ~tJelftR of ~:~ .:~t~: ~nn1:lal ee1'\triButien te the cel:l;;~Y ~i,lie. II~alth Unit Tru3t Fl:lnd. C. The department shall release state contributions to this contract as follows: 1. Funds appropriated as "Aid Government" shall be released in amounts at the beginning of each the contract year; to Local four equal quarter of ~:; . ., >~ :~ ...~ if. ;~ .1 ,~ i i .j . 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. VIII. 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. IX. Emergencies: Both parties agree, to the extent of their respective resources, that they may assist each other in meeting public health emergencies. Sponsorship: 1 ~~ . X. J :j , ) In compliance with Section 286.25 Florida Statutes, the provider assures that all notices, info~ational 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-M:>nroe County Public Health Unit Provider . '. ~ ..~ .~ j ~ j .1.5 and the State of Florida, Department of Health and Rehabilitative Services." If the .ponsorship 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 ot the organization. XI. Program Specific Reporting Requirements: Specific information not available through' CIS/tlMC 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 88 who will receive services during this contract period). 2,000.00 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. $ 00.00 C. Complete the planned Family Planning budget information on the following page for this contract period. , 16 Lt"l 1"1 N I' I' 0 r-- \0 ~ C'\ r-i r-i 0 r-i ~ C'\ r-i CO C'\ C'\ N r-i /G .. .. .. .. .. .. .. ~ \0 ~ \0 ~ N r-i ~ 0 CO N r-i M Lt"l ~ ~ r-i r-i c:: < CzJ >- >. ~ e-. M ~ I' ~ tJ .a /G \C I' M \0 0 N C'\ N qo I' ~ l:l.. M o::r a:: C'\ .. /G U1 .. .. I I .. , Lt"l M e-. 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J ("~ <S> I Lf'l II Z~ CV ~ 0'1 N I cD II ~ ~ (,) ill r-- <S> I l"1 II 0 ~::J rl II M :x::e-.O 0'1 ~ r-- II C,)H~ l"1 \D 0'1 II <0 .-l \D II e-.Z 0'1 ~ II E-<r.J CO 0 ill II <Po. 0'1 I <lI II :>< .-l II I-l U II ~ II V .ri 0 \D 0'1 CO II , II .a > \D l"1 "" II 0 .-l II = I-l l"1 CO 0.') II Z " :;j CV II < I-l " Z UJ r-- ~ l"1 " CV II N I 0'1 " ,.a II ill I II UJ 0 II .-i I II ~~ II ~ f1l I II C,) 0 II 0 :;j l/l I II HO II 'O+J ~ N N I ,..., II > 11 I-l..... -,.., CO \D I c:P " " l:X: II CV > c:: r-- 0:) I ~ n ~ II .a -ri ::J ... I II 00 II ='0 rl l"1 I "" II II ::I c:: , I rl II II ZH I II UJ II I It e-. II l/l ~ \D N I .-l II Z II ~ 0 U1 "" I r-- II ~ I ~~ I II H e-. ~ an N I CO II ...:I !:o.i~ N I \D II C,) I II I I '0 I t!> CV \D I Z ::l <:2' .c:: I H c: :"'1 ~ I r... .ri .-i I r... ~ f1l I < I.:: ((J V I E-< 0 CV :x:: I (fJ \.) 7J I I ..-j' r--t I II Cl > n:l I II t..J l-l ~ I II :z ! :r:: '1.' c: I II :z I E-< (J) .lI I II -< , .....:l E I 1/ ....:l <: --i 0.') c: I II Po. W ,'d <:I' 0 I II :r:: IJ ...., l-l I II .-j ~ I E-< II H ....... "':l > I U II H -< ,~ V c: I 4; 1/ H E-< ::::: c: ~ I ~ II :z CV I e-. d E-c ~ :>. ..... I ::z: . IX: ;:or: u O'l M /. 0 . < Z c: :>. IlJ I C,) . Po. 0 CV :x:: ~ I . ~ 0\ 0 I ....:l n H I-l '0 ~ I 4; II > 'V 0 .a I E-< II Z e 0 ::l I 0 II t..J t..J r... UJ I e-. . I II I~ I II ., .1 II ~ f \ I .1 J\ .;; ; 1 ,,1 , 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 quaranty), property, discounts, or other federa~ financial assistance to programs or activities receiving or benefitting from federal financial qssistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, HRS 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., 2000d 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 U.S.C. 6101 et discrimination on the activities receiving financial assistance. Act of 1975, as amended, 42 seq., which prohibits basis of age in programs or or benefitting for federal 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 a~opted 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 31 t '~ \~ assiqnees for the period during which such assistance is provided. The applicant further assures that all contractors, subcontractors, .ubgrantees or others with whom it arranges to provide .ervice. or benefit. 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, quidelines, and standards. In the event of failure to comply, the applicant understands that the qrantor may, at its discretion, seek a court order requirinq 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. 32 ATTACHMENT IV STATE FEE SCHEDULES, BY SERVICE LEV~EL OF SERVICE/SERVICE: Fee Estimated Annual Revenue Accruing To The CPHU Trust Fund I. CO~':NICABLE DISEASE: AIDS, HIV, Alternate Site Testing Vital Statistics $20 (optional) 5,144 220 Subtotal $ 5,364 II. PRIMARY CARE: Family Planning (Statewide Schedule) 11,485 Subtota 1 $ 11,435 II~I. ENVIRONMENTAL HEALTH: A. Swimminq Pools and Bathina Places: -Original construction plan review and approva1/swi~ing pools $275 2,830 -Original construction plan review and approval/bathing places $150 -0- $100 J.,700 $125 2,250 $ 25 1,150 $ 75 3,600 -Modification of original construction -Initial operating permit -Annual operating permit to 25,000 gallons over 25,000 gallons ., ... ._~._..~t.'."":1:;': ......" . ... ..........:-):.'11.._ ",'" .~." __ !'...:-...: -.: ......". ~:'w,~".,,40- .. ~> .Iy--.;. ..,....". .. ~""'..~:..,: ........... '! ..... ".,. ,''''__:. ~~~".''''''' .\t...; 00 ~'!"""': JI*..-... ....._. ... ...._ ~ - ..,... ,. - 33 j -;~ ;'-~ . , ATTACHMENT IV STATE FEE SCHEDULES (Continued) LEVEL OF SERVICE/SERVICE B. On-site Disposal (OSO) Program -Soil testing/site evaluation -Permit (standard subsurface system) -Permit (mound system) -Repair Permit -Existing system approval -Septic tank manufacturing inspection -Septage disposal service permit -Septic tank pumpout vehicle inspection (per vehicle) -Portable/temporary toilet service permit , .1 -Portable toilet purnpout vehicle (per vehicle) -Percolation test , j .~ , I~ "J ~. iI. -Reinspection of non-compliance on site sewage disposal system -:-! \ -Variance application OSO system (single family) (multi-family) -Industrial Site OSDS i I :1 , 1 -Aerobic treatment unit permit (District 11 only) -Aerobic treatment unit maintenance service permit (District 11 only) 34 ~ Estimated Annual Revenue Accruing To The CPHU Trust Fund $ 40 36,480 $ 50 (1) 17,450 $ 50 (1 ) 34,850 $ 40 5,200 $ 40 5,200 $ 50 (annual) 200 $ 50 (annual) 200 $ 10 100 $ 50 (annual) loa $ 10 50 $100 -0- $. 25 11,875 $100 (2) 700 $150 (2) 150 $ 50 (annual) -0- $150 5,250 $ 2S (annual) 150 _ :~l }~ .:.t "'.~ ., .;'f A'M'ACHHENT. IV STATE FEE SCHEDULES (Continued) " .~ LEVEL OF SERVICE/SERVIC~ C. ANNUAL PERMITS: -Mobile home and vehicle parks recreational 6-10 spaces 11-50 spaces 51-200 spaces over 200 -Migrant Labor Camps 5 to 50 residents 51 to 100 over 100 residents -Bottled water plants and dealers -~ater vending machines (per machine) '. Environ~ental S~btotal Total State Fees . ~J ( 1 ) ..; 'I , .u .~ ..; (2) ~ E"st i.a ted Annual Revenue Accruing To The CPHU Trust Fund $ 40 240 $ 80 4,160 $120 3,720 $160 1,920 $ 75 $150 $225 $100 ( 3 ) $ 20 (3) 110 $ J"9,f.55 $ 156,504 A $7 fee to fund the state....ide accelerated soil survey is collected with each permit fee: and a $500 OSDS program research fee is collected with each permit. 50% of the variance application fee is deposi ted in the CPHU Trust Fund and 50% in the Assistant Secretary for Health Administrative Trust Fund Account. ,- ~ . :j J ) (3) The state collects these fees and sends $100 to CPHUs for each water plant and $20 for each vending machine. .. ~ , \ , <~ .~ } ~ Jr.....~:..... ."".*'" ~ $..';;: .....,,..,...,.;.,.......' -''''''~..'_''.'' .~. t.- _.:,..;,~"'t'....1"._,...'. , 1 .1 '" I . ':~ -~"'. .~.:. .,;',.... .,. _ro.. .. - "';.. ,. - 35 . .: ..... ..... ~.....:.., .a~ ~'." ~l ~ ~ .... ..... ..",'" .... ." ...... . ..... ~ .... .;j, ~:1 A I I A\.:HMt:NT v COUNTY F1E SCHEDULE. IY SER V ~ I I ) '~ LEVEL OF SER VICE/SER VICE I. COMMUNICABLE DJSEASt: Inm.mizations STD TB Vital Statistics Fee/Rlnl' Estimated ADDUII RCVCDaI Accfuin. To TI CPHU Trust 1:1 o- J 10 0-10 12 4 6,200 4,600 700 27,37P. Subtotal S 38,878 ~ II. PRIMARY HEALTH CARE: '. roo 2-20 6,900 E?SDT 2-20 2,?7(l CI'..ro:-:.ic Diseases 2- 2 Cl 7,217 Do. :-1 t.a } 5-70 7,(I~2 HCC Patie:-,t FeeE' 0-50 f., PI; . 1'!e11 Baby 0-10 7,520 " !<'lul t Heal t..~ o-} Cl ?,I?~ . ,c: ~ :-z:x::, 1 nEel L~ 0-16 1 ~ , .3? :' '. ;~ .; ~u t'1tC't31 5 5E.~9: J ~ 1 n. E~ \'IR O~\1E ~'T A l HEAL TH: j l F'ocx'l Hygiene 75 2f,OOO* \"Ecto~ Co::t.rol 2r, 1,080 .j ;:.? *P.ei~bursernent froTT'l D. p . R. . :', , i S u t-tot31 S 27,080 t , I ! Total Count\' Fees $ L.2 . 955 i 36 . .. :~ I A T.T ACHMENT VI CLASSIFICATION AND NUMBER OF EMPLOYEES WORKING IN THE COUNTY PUBLIC HEALTH UNIT WHO ARE PAID BY THE COUNTY. BY LEVEL OF SERVICE, IF APPLICABLE .EVEL OF SERVICE/SERVICE: I. COMMUNICABLE DISEASE: N/A Position Classifica tion Number N/A l'l/A II. PRIMARY HEALTH CARE: N/A K/.I\ ,!'-'/A III. E~VIRO~\1E:-':TAL HEALTH: }:;/ J>. ~:/J._ !::/.n, 37 ~ j~ A ,1 :acility '" )cscriotion ':~ ~ , Key ~-vest Clinic "1iddle Keys Clinic Luper Keys Clinic AIDS Education Project f " .) 1 , I..... ,;4 1 j i :1 'i~ ,~. 1 1 A TT ACHMENT VII - " ". I FACILITIES UTILIZED BY THE CPHU Location Owned Bv Key Nest r~athon Tavernier Key h1est ~lonroe County r-bnroe County Monroe ('.ounty Kniaht Realty 38 A TT ACHMENT VIII , \._ 'f' i 1 DESCRIPTION OF USE OF PUBLIC HEALTH UNIT TR UST FUND BALANCES FOR SPECIAL PROJECTS. IF APPLICABLE (From Attachment II, Part I) N/A N/A N/A 39 .~ .~ :~ .:~;~ ,~ ..!, .' J 9. j ~ 1 J , ~; ~ 1 ,~ ~ q i i ~ . , .1 .\ ,I J ~ 1 ., " J 'J i J 10. II. I' . 6. Immunization 7. CPHU Program s. Chronic Disease Program Environmental Health AIDS Program School Health Services A TT ACHMENT IX (continued) Periodic reports as specified by the department regarding the surveiJla ncc/investiga tion of reporta bIe vaccine preven ta ble diseases. vaccine usage accountability. the assessment of various immunization levels and forms reporting adverse events following immuniz3 tion. Requirements as specified in HRSM 150-3 and HRSM 50-9. Periodic reports as specified by rhe program and use of HRS forms identified in HRSM 150-8 and 150-12_ Requirements 2S specified in HRSM 50-10. Requirements in HRSM 150-30 and case reporting on CDC Form 50.~2. Socio-demographic data on persons tested for HIV in CPHU clinics should be reponed on CDC HIV Counseling &. Testing Report Form. These reports are to be senr to the Headquarters AIDS office within 30 days of the initial post-test appointment regardless of clients' return. HRSM J 50.25, including the requirement for an annual pian as a condition for funding. 40 • • ATTACH)fENT IX (continued) 6. Immunization Periodic reports as specified b;J the department regardinm the surveillance/investiga tion 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 HRSM 150-3 and HRSM 50-9. f.: C:.• ..i: DJI . _. I rc•p a Y'c ic is rc C. .2 17. . .riCC � 't.. . :CF'Z:'. l5: C : HT:( S. ire is orJJ;,cr,'- i Hcal;}. Recuircmer.ts 25 specified C2SC C:. CD_ C212 c ;:'::.._ fc : �. . .tt .. . C .. L _ _ _ ... . 4 J ��... I.�r•. . C :... r:; ,.":< ETC. tc• C: :cr.; IC-. C. .. FI_�.. C. .._! .. — sl / 1 - . • . ... .... _... ... . C L... C ......2. ..... • • 41. "ll- "i- e. ;. :i:' ~j rJ i. \, ,) .f, ATTACHMENT X ELIGIBILITY AND FEE ASSESSMENT FOR PRIMARY CARE SERVICES . Beginning October 1, 1989, list below any eligibility limits for. primary care services -ror persons . at or above 100' poverty. Primary care services include, but are not limited to, first contact acute care; chronic disease prevention, detection and treatment; maternal and child health; family planning; nutrition; school health; AIDS patient care; home health; and dental services. (5. 154.01 (2) (b) (c), F.S.) ~ ter?ns who a~e eliaible &or the local VA Clinic are first referred there. Similarly, those enrollee in Key Care are referred there. There are no eligibility restrictions for ~ersons at or above lOO% of poverty. ., ':~ "1 . I .'j 1 ,.'J ~. " ~ 'j _l , i 1 I f I , 1 42 -1 i' j .~ .~ \ d ,. .'" ATTACHMENT X ELIGIBILITY AND FEE ASSESSMENT FOR PRIMARY CARE SERVICES . Beginning October 1, 1989, list below any eligibility limits for primary care services for persons at or above 100' poverty. Primary care services include, but are not limited to, first contact acute care; chronic disease prevention, detection and treatment; maternal and child health; family planning; nutrition; school health; AIDS patient care; home health; and dental services. (5. 154.01 (2) (b) (c), F.S.) ~eter?ns who a~e eliaible &or the local VA Clinic are first referred there. Similarly, those enrolled in Key Care are referred there. There are no eligibility restrictions for cersons at or above 100% of poverty. 1 j :, J , j ~ t 42